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First Aid Qbank > Step 1 Qank > Flashcards

Step 1 Qank Flashcards

1
Q

Which chemotherapuetic drugs act on the M-phase of the cell cycle?

A 
Vinca alkaloids (vincristine, vinblastine)
Paclitaxel
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2
Q

MOA of vinca alkaloids (vincristine, vinblastine)?

A

Inhibits microtubule function and spindle formation

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3
Q

MOA of paclitaxel

A

Reversibly binds to tubulin and hyperstabilizes microtubules that have already polymerized, preventing spindle breakdown

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4
Q

Which drugs are associated with prolongation of QT interval?

A

Class 1a and III antiarrhythmics

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5
Q

Fibrinous pericarditis is a complication that usually occurs _______ days post-MI.

A

1-3 days

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6
Q

Presentation of fibrinous pericarditis

A

Chest pain that is relieved when the patient leans forward; often a pericardial friction rub can be auscultated on cardiac examination

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7
Q

Free wall rupture is a complication that occurs ____ days after MI and can result in ______.

A

3-14; cardiac tamponade

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8
Q

Presentation of cardiac tamponade

A

Hypotension, distant heart sounds and elevated jugular venous pressure

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9
Q

B-blockers ________ end diastolic volume by decreasing ____ and _____, permitting greater filling time

A

increase; HR and contractility

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10
Q

Fibrates increase _______ by increasing PPAR-a activity

A

HDL levels

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11
Q

Effect of NE on B1 receptor: Positive dromotropic effect, which is an increase in conduction velocity through the AV node, is caused by increase in ___________

A

inward Ca2+ current

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12
Q

Effect of NE on B1 receptor: Positive inotropic effect, which is an increase in contractility in cardiac myocytes, is caused by an increase in ______

A

inward Ca2+ current

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13
Q

Effect of NE on B1 receptor: Positive chronotropic effect, which is an increase in HR via SA node, is caused by increase in _________

A

inward Ca2+ and Na+ current

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14
Q

Aortic stenosis requires increased pressure to open the aortic valve, prolonging the _______ ________ phase

A

isovolumetric contraction

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15
Q

A potent vasodilator that is first line tx for HTN in pregnancy

A

Hydralazine

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16
Q

What should hydralazine be taken with to prevent serious side effects?

A

Taken with B-blocker to prevent reflex tachycardia

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17
Q

Polymyalgia rheumatica is associated with what vascular disease?

A

Temporal arteritis

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18
Q

Polyarteritis nodosa is associated with what infection?

A

Hepatitis B infection

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19
Q

What disease is a necrotizing vasculitis which affects small vessels, all of which are typically at the same stage of inflammation, and is associated with MPO-ANCA (p-ANCA)? It commonly affects the lung and kidney and granulomas are absent

A

Microscopic polyangiitis

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20
Q

Which drug is given to treat Wegener’s granulomatosis and polyarteritis nodosa?

A

Cyclophosphamide

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21
Q

Diuresis with ____________ is effective in mitigating acute exacerbation of congestive heart failure marked by SOB secondary to pulmonary edema

A

loop diuretics such as furosemide

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22
Q

What type of virus causes mumps?

A

Single stranded, negative sense, enveloped RNA virus of the Paramyxoviridae family

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23
Q

Presentation of mumps

A

Inflammation/swelling of one or both parotid glands and also the testes (orchitis)

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24
Q

Lhermitte phenomenon

A

A transient shock-like sensation most often triggered by flexion of the neck, seen in MS

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25
Q

Tremor at rest is a symptom of what disease?

A

parkinsons disease

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26
Q

Intention tremor is a symptom of what disease?

A

MS

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27
Q

Treatment of CMV

A

Ganciclovir

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28
Q

Adverse effects of ganciclovir

A

Leukopenia, neutropenia, thrombocytopenia, renal toxicity

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29
Q

MOA of ganciclovir

A

Activated to its monophosphate form by viral thymidine kinase and then converted to the triphosphate form.
Ganciclovir triphosphate is used as a substrate for viral DNA polymerase, leading to formation of “faulty” DNA

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30
Q

Side effects of metoprolol

A

Mild sedation, depression, impotence and exercise intolerance

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31
Q

Treatment of absence seizures

A

Ethosuximide (first line), or valproic acid

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32
Q

MOA of ethosuximide

A

Blocks T-type Ca channels

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33
Q

MOA of valproate

A

Increase Na channel inactivation, increase GABA concentration by inhibiting GABA transaminase

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34
Q

Gabapentin, an analogue of _______, has been approved for the treatment of all seizure types except ________. Gabapentin functions to inhibit high voltage Ca channels

A

g-aminobutyric acid; absence seizures

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35
Q

Cholinesterase inhibitor toxicity is treated with what?

A

Atropine, a muscarinic antagonist

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36
Q

_________ is a chelator used to treat lead, arsenic gold, or acute mercury poisoning

A

Dimercaprol

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37
Q

________ is a direct cholinergic agonist used to treat ileus and urinary retention because it stimulated GI motility and bladder contraction

A

bethanechol

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38
Q

_________ is a granulocyte colony-stimulating factor [G-CSF] that is used to augment the recovery of bone marrow, preventing infections and decreasing the duration of neutropenia associated with receiving myelosuppresive cancer chemo

A

Filgastrim

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39
Q

_______ are characteristic of LMN lesions. They are thought to be caused by release of ____________ from degenerating nerve terminal at the neuromuscular junction

A

Fasciculations; acetylcholinesterase

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40
Q

__________ is a progressive, stepwise cognitive decline. History of HTN, cerebrovascular accident, and neurologic symptoms makes this diagnosis more like likely

A

Multi-infarct vascular dementia

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41
Q

What is a watershed zone?

A

The zone supplied by the most distal sections of 2 different arteries

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42
Q

The right internal carotid artery supplies blood to both the right ___________ and _____________.

A

anterior cerebral artery and middle cerebral artery

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43
Q

In a sarcomere, the _________, which is the length of myosin, does not change upon contraction

A

A-band

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44
Q

Acoustic neuromas are thought to arise from loss of a tumor-suppressor gene on chromosome ___ and may be a manifestation of ___

A

Chromosome 22, NF2

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45
Q

___________ are eosinophillic inclusions bodies seen in the cytoplasm of neurons from patients infected with rabies.

A

Negri bodies

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46
Q

IFN-gamma activates macrophages and TH1 cells. A failure to produce this leads to ___________ (________) characterized by coarse facies, staphyloccal skin/respiratory infections and bone abnormalities

A

Hyper-IgE syndrome (Job syndrome)

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47
Q

Erbs palsy presents with “_________” arm position and is due to damage of the ___ and ____ nerve roots of brachial plexus

A

Waiters tip; C5 and C6

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48
Q

____________ is characterized by contralateral muscle weakness, ipsilateral tongue deviation, and contralateral loss of sensation from the body, sparing the face

A

Medial medullary syndrome

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49
Q

Medial medullary syndrome is caused by infarct of the ______________

A

Anterior spinal artery

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50
Q

What is the most common ligament affected in ankle sprains?

A

Anterior talofibular ligament

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51
Q

This disease is characterized by extensive remodeling of bone that results in drastically increased bone mass; often seen in older patients; this heavy bone is more prone to fracture

A

Pagets Disease

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52
Q

Describe the pertinent lab values seen in patients with Paget’s Disease

A

Normal calcium (sometimes elevated), normal phosphate, and elevated alkaline phosphatase

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53
Q

__________ is marked by proliferation of fibrous tissue, with occasional small foci of calcification, that causes a loss of elasticity of pericardial tissues; mimics sings if right heart failure

A

constrictive pericarditis

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54
Q

What are common causes of constrictive pericariditis?

A

Infections such as SLE, rheumatic fever; post-radiation changes, and viral and bacterial infections

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55
Q

____ is a key cytokine produced by TH1 cells and is a potent stimulator of macrophages. It also has antitumor and antiviral activity.

A

IFN-g

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56
Q

What interleukin does macrophages secrete?

A

TNF-a

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57
Q

_______ is diagnosed when an individual presents with several physical complaints in multiple organ systems. Such patients have often undergone several tests, none of which indicate an organic cause. The symptoms must have begun before age 30 and cannot be intentionally produced.

A

Somatic symptom disorder

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58
Q

Patients with ____________ often engage in self destructive behaviors such as cutting or burning themselves with cigarettes. They have extremely labile moods (mood swings), impulsivity, and unstable relationships. Often exhibit splitting

A

Borderline personality disorder

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59
Q

Hepatocyte congestion suggest ___________ and _______

A

right sided heart failure and nutmeg liver

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60
Q

_________ is classically associated with fatalities and fulmitant hepatitis in pregnant women, commonly seen in sub-saharan Africa, spread by fecal-oral route

A

Hepatitis E infection

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61
Q

Histologic finding of hepatitis infections?

A

Patchy necrosis of liver cells from focal hepatocyte damage

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62
Q

________ is associated with chronic liver disease and is a result of disorders such as Alcoholism, Wilson Disease, and hemochromomatosis

A

Micronodular cirrhosis

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63
Q

What disease is characterized by a tyrosine kinase signaling defect that arrests B lymphocytes at the pre-B-lymphocyte stage so they cannot yet produce immunoglobulins. Characterized by low serum IgG, IgM, and IgA levels after the first few months of life

A

Bruton x-linked agammaglobinemia

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64
Q

Classic physical exam finding of patients with Bruton x-linked agammaglobinemia?

A

Absence or near absence of tonsils and adenoids, which are B-lymphocyte rich tissues

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65
Q

MOA of clozapine

A

Blockade of serotonin and dopamine receptors

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66
Q

MOA of chloramphenicol

A

Inhibits protein synthesis by binding to and inhibiting the 50S ribosomal subunit

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67
Q

MOA of sulfonamide

A

Inhibits dihyropteroate synthetase, an enzyme involved in folate synthesis

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68
Q

___________ competes with K at the Na/K ATP pump. Thus in hypokalemia, this drug binds more readily to its target, leading to possible toxicity

A

Digoxin

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69
Q

Adverse effects of chloramphenicol

A

Aplastic anemia: suppression of all blood lines: erythroid, myeloid and thrombocytes
Results in anemia, neutropenia and thrombocytopenia which present as fatigue, predisposition to infection and excessive bleeding

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70
Q

Hypotonia

A

also known as floppy baby syndrome, a state of low muscle tone

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71
Q

Which drug do you use for diuresis in patients that are allergic to sulfa drugs

A

Loop diuretic ethacrynic acid

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72
Q

Angiosarcomas are composed of malignant cells forming vascular channels and are predominantly found in the ___________

A

right atrium

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73
Q

T or F: Procarbazine is an antineoplastic agent that is also a MAOI

A

True

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74
Q

The muscles of facial expression are derived from what?

A

Second branchial arch

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75
Q

The muscles of mastication are derived from what?

A

First branchial arch

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76
Q

Duchennes muscular dystrophy, which produces weakness starting before age 5, is usually due to what mutation

A

Frame shift mutation

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77
Q

Beckers muscular dystrophy, which is a less severe form of DMD, results from what mutation

A

Point mutation of dystrophin gene

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78
Q

Congenital CMV manifests as what? What would you see in CT of the head?

A

petechial rash, hepatosplenomegaly and microcephaly;

Intracranial calcification

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79
Q

Patients with autism spectrum disorder have an association with which conditions?

A

Tuberous sclerosis and seizures

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80
Q

MOA of aminoglycosides (gentamicin, neomycin, amikacin, tobramycin, streptomycin)

A

Bactericidal; irreversible inhibition of initiation complex through binding of the 30S subunit; causes misreading of mRNA

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81
Q

Clinical use of aminoglycosides

A

Severe gram negative rod infections, synergistic with B-lactam antibiotics

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82
Q

Adverse effects of aminoglycosides

A

nephrotoxicity, neuromuscular blockade, ototoxicity, teratogen

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83
Q

_________, produced by platelets, stimulates platelet aggregation and vasoconstriction, and will be elevated at the site of a clot.

A

Thromboxane A2

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84
Q

__________ is synthesized by vascular endothelium and smooth muscle. It decreases platelet aggregation and causes vasodilation

A

Prostaglandin I2

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85
Q

What are some anticholinergic adverse effects

A

urinary retention, dry mouth, tachycardia, constipation, and blurry vision

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86
Q

what are cowdry a inclusion bodies?

A

Intranuclear eosinophilic inclusions surrounded by a clear halo, seen in cells infected with VZV, CMV, HSV

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87
Q

What is locked in syndrome?

A

Locked in syndrome consists of almost complete motor paralysis (sparing vertical eye movements) with total preservation of sensation, consciousness and reason.

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88
Q

How do patients get locked in syndrome?

A

It results from occlusion of the basilar artery, disrupting blood supply to the ventral pons

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89
Q

What type of drug is busulfan?

A

DNA alkylation agent; chemotherapeutic

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90
Q

What type of drug is cisplatin?

A

Platinum based chemotherapeutic drug that is a DNA crosslinking agent

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91
Q

MOA of doxorubicin

A

Doxorubicin generates free radicals and results in DNA double stranded breaks

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92
Q

MOA of chemotherapeutic drug etoposide

A

Inhibits type 2 topoisomerase

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93
Q

Treatment of extrapyrimidal side effects of atypical antipsychotics

A

Anticholinergic agents like benztropine

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94
Q

_______, which acts by inhibiting mycolic acid synthesis, is the treatment of choice for TB prophylaxis

A

Isonaizid

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95
Q

____________ is used to help break up mucus plugs in patients with cystic fibrosis

A

N-acetylcysteine

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96
Q

Patients with CF are at risk for developing ____-______ vitamin deficiencies

A

Fat soluble vitamin deficiencies (vitamins A, D, E, K)

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97
Q

MOA of carbamazepine

A

Antiepileptic drug that inactivates Na channels and inhibits N-methyl-D-aspartate receptors

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98
Q

Adverse effects of antiepileptic carbamazepine

A

Blood dyscrasias (agranulocytosis or aplastic anemia), liver toxicity, diplopia, ataxia and teratogenesis

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99
Q

As the prevalence of disease increases, the PPV ________ and the NPV ________

A

increases, decreases

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100
Q

Guillan-Barre syndrome is an autoimmune disease characterized by an ascending paralysis caused by ________ and _______ of the PNS

A

inflammation and demyelination

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101
Q

Intracytoplasmic eosinophilic inclusions, also known as _____________, are seen in ________________

A

Mallory bodies; alcohol-induced hepatitis

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102
Q

Patients with sickle cell anemia are at risk for osteomyelitis due to ________ or ________

A

salmonella or staphyloccus

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103
Q

__________ is a major risk factor for osteomyelitis caused by Pseudomonas

A

IV drug abuse

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104
Q

In multiple myeloma, a common finding seen on peripheral blood smear is a ____________________

A

Rouleaux formation - single file stacking of RBCs

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105
Q

_________ causes pneumonia in older patients with a history of alcoholism, tobacco use, diabetes, chronic illness or immunosuppression and can be cultured on buffered charcoal yeast extract containing cysteine and iron

A

Legionella pneumophilla

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106
Q

Mycoplasma pneumonia requires media containing ________

A

sterols

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107
Q

What lysosomal storage disorder is characterized by a defect in N-acetylglucosaminyl-1-phosphotransferase?

A

I-cell disease

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108
Q

What happens in I-cell disease

A

Failure of golgi apparatus to phosphorylate mannose residues on glycoproteins -> proteins are secreted extracellularly rather than delivered to lysosomes

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109
Q

Presentation of I-cell disease

A

Coarse facial features, clouded corneas, restricted joint movement, and high plasma lysosomal enzymes; often fatal in childhood

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110
Q

__________ is a genetic disease in which fatty substances (sphingolipids) accumulate in cells and certain organs; caused by hereditary deficiency of enzyme glucocerebrosidase (aka glucosylceramidase)

A

Gaucher Disease

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111
Q

C. diptheriae produces diphtheria toxin. Diphtheria toxin inhibits ______, inhibiting ______ and protein synthesis

A

EF-2a; translocation

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112
Q

Intracytoplasmic eosinophilic inclusion bodies describe what?

A

Lewy bodies

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113
Q

Patients with ________ personality disorder are submissive and clinging; they have low self-esteem and have an excessive need to be taken care of

A

dependent

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114
Q

Patients with ________ personality disorder display excessive emotionality, somatisization, attention-seeking and sexually provacative behavior

A

Histrionic

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115
Q

Patients with _______ personality disorder are sensitive to rejection and are socially inhibited and timid.

A

avoidant

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116
Q

Within the carotid sheath, the common carotid artery is _______, the internal jugular vein is _________ and the vagus nerve lies ________

A

medial, lateral, posterior

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117
Q

_____________ is rapidly fatal and is characterized by hemorrhagic mediastinitis, mediastial widening and bloody pleural effusions

A

inhalational anthrax; B. anthracis, a gram positive rod in chains with protein capsule

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118
Q

What neurological deficits are seen in syringomyelia (an enlargement of the central canal of the spinal cord, commonly occurring at C8-T1

A

The crossing fibers of the spinothalamic tract are damaged (bilateral loss of pain and temperature sensation), but dorsal column function remains intact (position and vibration sense)

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119
Q

What is the most common cause of pyridoxine deficiency (Vitamin B6)?

A

Isoniazid

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120
Q

MEN-1 (Wermer syndrome) is inherited as an autosomal dominant mutation of chromosome 11, as causes a tumor in the “3Ps”: ____________ __________ __________

A

Pituitary, Parathyroid and pancreas

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121
Q

Arsenic exerts its toxic effects via inhibition of _________, a required cofactor for the pyruvate dehydrogenase complex

A

lipoic acid

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122
Q

How do you differentiate between child with osteogenesis imperfecta (defect in type 1 collagen synthesis) and victim of abuse?

A

Look for blue sclera or miscolored and damaged teeth (both seen in osteogenesis imperfecta)

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123
Q

_________ is a gram negative rod that is usually associated with cat scratches. Chronic lymphadenitis would most commonly be seen in young children

A

Bartonella henselae

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124
Q

_________ is a gram negative coccoid rod that is normally found in dogs, can cause fever, malaise and HSM in humans. Veterinarians are at increased risk

A

Brucella canis

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125
Q

A-amanitin, toxin found in Amanita phalloides (death cap mushrooms) inhibits _________________, which is responsible for the production of mRNA.

A

RNA polymersase II

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126
Q

RNA polymerase I is responsible for what?

A

synthesis of rRNA

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127
Q

RNA polymerase III is responsible for what?

A

synthesis of tRNA

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128
Q

Acyclovir is an acyclic guanosine derivative that inhibits DNA synthesis in viruses after activation by viral ____________

A

thymidine kinase

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129
Q

The subscapularis acts to ____________________ the arm

A

medially rotate and adduct

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130
Q

In addition to causing glossitis, macrocytic megaloblastic anemia, and dementia, vitamin B12 deficiency causes neurological symptoms due to degeneration of what?

A

Degeneration of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts

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131
Q

Patients who develop polio experience injury to the nerve roots that supply the ___________

A

superior gluteal nerve

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132
Q

Areteriovascular malformation and HTN are associated more with which type of brain injury?

A

Intraparenchymal hemorrhage, more so than subarachnoid hemorrhage which is often due to rupture of aneurysm

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133
Q

What does Km (michealis menton constant) reflect?

A

the Km inversely reflects the affinity of the enzyme for its substrate
- the higher the Km, the lower the affinity and vice versa

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134
Q

Competitive inhibitors have what effect on Km? How can competitive inhibition be overcome?

A

Increase Km = decrease the affinity

Competitive inhibition can be overcome by adding more substrate

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135
Q

MTX is administered with what to adverse effects?

A

Leucovorin (folinic acid)

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136
Q

What enzyme is needed to convert testosterone to DHT

A

5a-reductase

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137
Q

What enzyme is needed to convert testosterone to estrogen

A

Aromatase

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138
Q

Where does the lymphatic drainage of the testes go?

A

para-aortic lymph nodes

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139
Q

What drugs are first line therapy for severe hypertriglyceridemia?

A

Fibrate and niacin

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140
Q

MOA of fibrates

A

Increase LPL activity -> increase TG clearance; activates PPARa to induce HDL synthesis

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141
Q

MOA of niacin

A

Inhibits lipolysis (hormone sensitive lipase) in adipose tissue; reduces hepatic VLDL synthesis

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142
Q

_____________ (degeneration of the dorsal columns of the spinal cord and the dorsal roots) is on the possible manifestations of tertiary syphilis. Symptoms include impaired proprioception and ataxia

A

Tabes dorsalis

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143
Q

HLA B27 predisposes individuals to what conditions?

A

Psoriasis, ankylosing spondylitis, inflammatory bowel disease and Reiters syndrome (reactive arthritis)

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144
Q

____________ is an amide anesthetic capable of causing cardiac arrythmias and hypotension

A

Bupivacaine

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145
Q

________ are macrophages of the central nervous system that, like other tissue macrophages, arise from monocytes in the bone marrow

A

microglia

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146
Q

HIV encephalitis is caused by infection of the __________ and ________ in the brain

A

macrophages and microglia

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147
Q

_______________ can be identified on a bone marrow smear by looking for macrophages engulfing RBCs

A

Hemophagocytic lymphohistiocytosis

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148
Q

Achilles tendon reflex tests which nerve roots?

A

S1-2 (S1,2 buckle my shoe)

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149
Q

________ reduces alveolar surface tension by disrupting the hydrogen bonds between molecules of water

A

surfactant

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150
Q

___________ are intermediate cells that immediately precede the terminally differentiated neutrophil and are present during a systemic inflammatory response

A

band cells

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151
Q

Adverse effects of lithium (which is used to treat bipolar disorder)

A

Tremor, hypothyroidism, birth defects, polyuria and nephrogenic diabetes insipidus due to ADH antagonism

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152
Q

Amphotericin B toxicity include?

A

Fever and chills, hypotension, nephrotoxicity, and arrhytmias

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153
Q

SCC is associated with excessive _______, leading to hypercalcemia, and is suggested by a large hilar mass with cavitation in a smoker

A

PTHrP (parathyroid hormone related peptide)

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154
Q

Polyarteritis nodosa is a systemic necrotizing vasculitis of small or medium sized arteries characterized histologically by _____________. PAN, which is generally antineutrophil cytoplasmic antibody (ANCA) negative, has a strong association with HBV

A

fibrinoid necrosis

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155
Q

A-hemolytic form what color colonies on blood agar?

A

green colonies

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156
Q

What is the cofactor required in the hydroxylation of proline and lysine residues in collagen synthesis

A

Vitamin C, deficiency leads to scurvy

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157
Q

Scarlet fever is caused by?

A

Strep pyogenes (GAS)

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158
Q

Scalded skin syndrome is caused by?

A

Staph aureus

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159
Q

Diagnosis of Bipolar II requires?

A

History of BOTH a major depressive disorder and a hypomanic episode

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160
Q

Diagnosis of Bipolar I requires?

A

Presence of an elevated, expansive or irritable mood for more than 1 week that causes marked impairment in functioning socially at work, or at home

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161
Q

Vascular type of Ehlers Danlos syndrome is caused by deficiency of what?

A

Type 3 collagen

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162
Q

What are the trinucleotide repeat diseases?

A

Huntingtons Disease, Myotonic dystrophy, Friedrich ataxia, Fragile X syndrome

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163
Q

SLE is associated with what renal disease?

A

Diffuse Proliferative Glomerulonephritis

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164
Q

Which IL is responsible for fever?

A

IL-1, IL-6, TNFa

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165
Q

IL-3 function

A

Responsible for stimulating the growth and differentiation of bone marrow.

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166
Q

IL-4 function

A

Responsible for growth of B cell and enhancing class switching

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167
Q

IL-5 function

A

Promotes the differentiation of B cells and enhancing class switching to IgA. Also produced and activation of eosinophils, which play a role in defending in parasitic infections

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168
Q

The deltaF508 mutation in cystic fibrosis results in what defect?

A

Defective processing from the ER to the golgi apparatus

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169
Q

E. coli ferments what?

A

Lactose

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170
Q

What is first line treatment for pneumococcus infection?

A

Penicillin or amoxicillin

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171
Q

The reduced GFR in chronic renal disease leads to accumulation of phosphate which does what?

A

Directly stimulated PTH, suppress renal production of vitamin D3

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172
Q

What genetic disorder is characterized by a constitutive activation of the epithelial sodium channel (ENaC) in the collecting tubules of the kidney. This disease leads to early HTN characterized by low levels of renin and angiotensin leading to hypokalemia and metabolic alkalosis

A

Liddle syndrome

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173
Q

Why is mannitol, an osmotic diuretic, contraindicated in patients with CHF?

A

It can cause pulmonary edema

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174
Q

Small cell carcinomas of the lung is associated with what paraneoplastic syndrome?

A

Cushing syndome via increased ACTH

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175
Q

Squamous cell carcinoma of the lung is associated with paraneoplastic syndrome?

A

Produces PTHrP -> HYPERCALCEMIA

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176
Q

A palpable thrill of the abdomen just to the left of the midline could indicate what?

A

Renal artery stenosis

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177
Q

MOA of cyclosporine

A

Binds to cyclophilin, thus inhibiting calcineurin, blocking production of IL-2 and blocking activation of T-lymphocytes

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178
Q

What immunosuppresant inhibits T-lymphocyte proliferation by inhibiting nucleotide production and DNA synthesis?

A

Azathioprine

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179
Q

What are some common causes of dilated cardiomyopathy?

A

Alcohol abuse, wet BeriBeri, Coxsackie B virus, cocaine, Chagas disease, Doxorubicin, hemochromatosis, sarcoidosis, peripartum cardiomyopathy

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180
Q

What is used to treat heparin OD?

A

Protamine

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181
Q

Pertussis toxin does what?

A

Inhibition of Gi

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182
Q

Lethal factor, which is released by Bacillus anthracis, is a zinc metalloprotrease that inactivated protein kinase and that stimulated macrophages to release _____

A

TNFa

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183
Q

A postive quellung test (positive reaction with capsular swelling) indicates what?

A

S. pneumo pneumonia

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184
Q

MOA of macrolides

A

Inhibit protein synthesis by blocking translocation of the 23S ribosomal RNA of the 50S ribosomal subunit

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185
Q

MOA of aminoglycosides

A

Inhibits formation of the initiation complex, causes misreading of mRNA (binds to 30S)

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186
Q

Which antiretroviral drug is associated with crystal induced nephropathy?

A

Indinavir - protease inhibitor

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187
Q

Obstructive lung diseases is characterized by decreased vital capacity and an increased _________, ________, _________

A

Increased residual volume, total lung capacity, and functional residual capacity

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188
Q

Restrictive lung disease is characterized by decreased vital capacity, _________, _________, _________

A

decreased residual volume, total lung capacity and functional residual capacity

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189
Q

Why do both obstructive and restrictive lung disease result in decrease vital capacity?

A

Because of reduced ability to expire air in obstructive lung disease and reduced ability to inspire in restrictive lung disease

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190
Q

SCID can result from what deficiency?

A

Adenosine deaminase deficiency

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191
Q

Osmotic demyelination, AKA central pontine myelinosis, can result from overaggressive treatment of ___________

A

hyponatremia

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192
Q

Unfractionated heparin tends to have dramatic affect on ________________

A

activated partial thromboplastin time (aPTT)

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193
Q

MOA of amantidine in treatment and prophylaxis of influenza?

A

Binds to M2 protein on virus to prevent viral uncoating

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194
Q

Aschoff bodies (granulomas with giant cells) are seen in what disease?

A

rheumatic fever

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195
Q

Negative reaction to the nitroblue tetrazolium test is diagnostic for what disease?

A

Chronic Granulomatous Disease

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196
Q

What is the substrate for the NADPH oxidase enzyme complex? Phagocytes use NADPH oxidase to convert this to reactive oxygen species.

A

O2

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197
Q

The fibers of the ___________ that cross at the anterior white commissure can be damaged by the enlargement of the central canal seen in syringomyelia.

A

Spinothalamic tract

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198
Q

______________ is clinically characterized by progressive bone marrow failure and multiple congenital abnormalities, including radial hypoplasia and thumb deformity

A

Fanconi anema

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199
Q

What is the dominant component of surfactant

A

phosphatidylcholine (lecitin)

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200
Q

All the sensory modalities of the face, except for olfactory sensation, pass through the _________________ of the thalamus on their way to the cortex

A

ventral posteromedial nucleus

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201
Q

__________ is a multisystem disorder caused by defect in DNA repair enzymes. It usually presents with cerebellar problems (ataxia), IgA deficiency and spider angiomas (telangiectasia) of the eye and skin

A

Ataxia-telangiectasia

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202
Q

____________ is a autosomal recessive disorder characterized by destruction of the anterior horn cells; it presents with diffuse muscle atrophy, hypotonia, fasciculations, and decreased DTR

A

Werdnig-Hoffman Disease

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203
Q

Imatinib inhibits BCR-ABL _____________ created by t(9:22), which is the defining cytogenic lesion in CML

A

tyrosine kinase

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204
Q

A noncompetitive inhibitor will have what affect on Vmax and Km?

A

Decrease Vmax, no chance in Km

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205
Q

Adverse effects of aspirin?

A

Gastic ulcers, tinitis, reyes syndrome in kids, acute renal failure
OD initially causes hyperventilation -> respiratory alkalosis and later transitions to mixed metabolic acidosis-respiratory alkalosis

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206
Q

MOA of sumatriptan

A

Serotonin receptor agonist

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207
Q

Ras proteins belong in which families of molecules?

A

GTP binding proteins

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208
Q

First line treatment for otitis externa is what?

A

Flouroquinolone

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209
Q

Glucose intolerace, coarsening of facial features, thickened fingers, fatigue and sweating are signs of excessive ____________

A

GH synthesis

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210
Q

__________ are the only output cells of the cerebellum, and they are all what type of neurons?

A

Purkinje cells; GABAergic

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211
Q

What is oligohyramnios?

A

Toot little amniotic fluid

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212
Q

Unlike folate deficiency, vitamin B12 deficiency causes ___________

A

Neurological deficits

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213
Q

The first branchial arch develops what?

A

The muscles of mastication

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214
Q

The first branchial cleft gives rise to what?

A

the external auditory meatus

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215
Q

The 2nd branchial arch develops what?

A

Muscles of facial expression

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216
Q

The permanent metanephric kidneys found in humans originate from what?

A

the ureteric bud

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217
Q

Paroxysmal nocturnal hemoglobinuria, caused by ____________, leads to intravascular hemolysis and hemosideren in urine

A

PIG-A GPI anchor mutation

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218
Q

PE of a patient results in almond breath odor, confusion and headache. What is the patient suffering from?

A

Cyanide poisoning

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219
Q

What is characterized by degeneration of the anterior horn cells, not tertiary syphillis?

A

Polio

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220
Q

What is characterized by degeneration of posterior column?

A

Tertiary syphilis (Tabes dorsalis)

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221
Q

Degeneration of the anterior white commissure results from what?

A

Syringomyelia

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222
Q

Deficiency of adenosine deaminase can cause what?

A

SCID

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223
Q

Mutation in ATM kinase, which in involved in dsDNA break repair leads to what?

A

Ataxia-telangiectasia

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224
Q

MOA of amphetamines?

A

Promotes extravesicular release of catecholamines into the synaptic cleft

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225
Q

Acute transplant rejection is mediated by what?

A

CD8 cytotoxic T lymphocytes

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226
Q

Massive blood transfusions carry the risk of _________ caused by the concomittant administration of a large dose of anticoagulant citrate with the blood

A

hypocalcemia

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227
Q

_________ is a condition that results from injury to the subthalamic nucleus, which is a basal ganglia nucleus

A

Hemiballismus

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228
Q

MEN 1 neoplasms

A

Parathyroid tumors, Pituitary tumors, Pancreatic endocrine tumors;
associated with mutation in MEN1 gene (menin, a tumor suppressor)

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229
Q

MEN 2a neoplasms

A

Parathyroid hyperplasia, Pheochromocytoma, Medullary thyroid carcinoma;
associated with mutation in RET gene

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230
Q

MEN 2b neoplasms

A

Pheochromocytoma, medullary thyroid carcinoma, mucosal neoplasms;
associated with mutation in RET gene

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231
Q

Injury of what nerve should be suspected in a patient with midshaft humerus break?

A

radial nerve

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232
Q

What artery runs along the radial groove of the humerus with the radial nerve?

A

Radial collateral artery

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233
Q

What common thyroid cancer has histo characteristics of “orphan annie eye nuclei” (empty looking ground glass nuclei) and psammoma bodies?

A

Papillary carcinoma

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234
Q

MOA of phenytoin

A

Increases Na channel activation, thereby decreasing the flux of Na ions across the neuronal membrane

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235
Q

Toxicity of phenytoin

A

Gingival hyperplasia, megaloblastic anemia, induction of cytochrome p-450 system

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236
Q

Treatment of choice for tonic clonic seizures?

A

phenytoin

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237
Q

___________ is characterized by ipsi loss motor function, vibration, and proprioception and the contralateral loss of pain and temp sensation

A

Brown-Sequard Syndrome, or hemisection of spinal cord

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238
Q

What is the rate limiting step in glycolysis?

A

Conversion of F-6-phosphate to F-1,6-bisphosphate by phosphofructokinase
(This step is inhibited by citrate and increased ATP)

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239
Q

___________________ promotes the proliferation, differentiation and recruitment of lymphoid cells. It is used to treat RCC and is thought to promote immune mediated antitumor effects

A

Recombinant IL-2 (aldesleukin)

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240
Q

Tay sachs disease is due to a deficiency of ________________, causing an accumulation of GM2 ganglioside

A

hexosaminidase A

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241
Q

Oocytes remain in ___________ from birth to ovulation

A

prophase 1

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242
Q

After ovulation, the oocyte progresses through meiosis 1 and is arrested in ___________ until after fertilization occurs

A

metaphase II

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243
Q

Which amino acid residue is needed to create thyroid hormone?

A

Tyrosine

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244
Q

Congenital diaphragmatic hernia is due to failure of what?

A

Failure of the pleuroperitoneal canal to close completely; leads to protrusion of the abdominal viscera into the chest, usually the left side

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245
Q

What megaloblastic anemia results in BOTH increased MMA and homocysteine?

A

Vitamin B12 deficiency`

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246
Q

Leukocyte adhesion deficiency is caused by deficiency in what?

A

Deficiency of B2-integrin and subsequent defects in several proteins including LFA-1

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247
Q

MOA of tetracyclines

A

Binds at 30S subunite and prevents attachment of the aminoacyl-tRNA

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248
Q

What is Meigs syndrome?

A

Triad of benign ovarian tumor, ascites and hydrothorax (pleural effusion)

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249
Q

_________ is characterized by proximal muscle weakness and delayed muscle relaxation and may manifest in childhood or adulthood. Caused by nucleotide expansion of CCTG

A

Myotonic dystrophy

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250
Q

On peripheral blood smear, dacrocytes are a sign of what?

A

Extramedullary hematopoiesis

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251
Q

What type of pneumocyte proliferates during lung damage?

A

Type 2 pneumocytes

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252
Q

The presence of abnormal lymphocytes with cytoplasmic projections on peripheral blood smear in addition to signs and symptoms of fatigue, weight loss, splenomegaly and pancytopenia should raise suspicion of what?

A

Hairy Cell leukemia

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253
Q

Absence of a-ketodehydrogenase leads to what?

A

Maple syrup urine disease - inability to degrade branched amino acids

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254
Q

A deficiency of metionine synthase would lead to development of what?

A

Homocysinuria, a disorder characterized by mental retardation, osteoporosis, tall stature, kyphosis and lens subluxation

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255
Q

Function of LH?

A

Stimulate the production of androgens by theca cells

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256
Q

Familial adenomatous polyposis, which is characterized by rectal bleeding in a 20-40 year old with a family history of colon polyps and/or colorectal cancer, is caused by mutation in what gene?

A

Mutation on chromosome 5 of APC gene

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257
Q

MOA of bleomycin

A

Inhibits DNA synthesis by binding to DNA and causing single strand and double strand breaks

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258
Q

The cremaster muscle is formed from what abdominal muscle?

A

The internal oblique muscle

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259
Q

What is heteroplasmy?

A

The presence of both normal and mutated mitochondrial DNA. The condition results in variable expression of mitochondrial inherited diseases

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260
Q

What is Trousseau syndrome?

A

A unique migratory thrombophlebitis that occurs as a results of the liberation of clotting factors, such as tissue factor, by some pancreatic tumors

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261
Q

What antiviral is used to treat Hep C infection? This antiviral is associated with hemolytic anemia

A

Ribavirin

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262
Q

What is conversion disorder?

A

Loss of sensory or motor function, often following an acute stressor

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263
Q

Patient presents with painful vaginal bleeding in the third trimester. She smokes, has HTN and uses cocaine. What does she have?

A

Placental abruption (abruptio placentae)

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264
Q

The cardinal ligaments located at the base of the broad ligements of uterus contain what?

A

Uterine arteries and veins

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265
Q

How do you calculate attributable risk?

A

The risk difference: calculated by subtracting the incidence of disease in nonexposed from incidence of disease in exposed persons

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266
Q

___________________ is an autosomal dominant disorder that affects a number of systems secondary to accumulation of porphobilinogen and d-aminolevulinate?

A

Acute intermittent porphyria

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267
Q

What disease is associated with vertigo, sensorineural hearing loss and tinnitus?

A

Meniere Disease

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268
Q

B-hCG is structurely similar to what hormones?

A

FSH, LH, TSH

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269
Q

What autoimmune disease is associated with HLA-DR4?

A

Rheumatoid arthritis

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270
Q

Adverse effect of milk of magnesia?

A

Diarrhea

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271
Q

Triple therapy for H. pylori infection?

A

Clarithromycin, amoxicillin (metronidazole if pt has penicillin allergy), proton pump inhibitor

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272
Q

Where in the spleen are the T cells located?

A

The periarterial lymphoid sheath

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273
Q

What marker is elevated in hepatocellular carcinoma?

A

A-fetoprotein

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274
Q

In the vast majority of cases, Down syndrome is due to nondisjunction during what phase?

A

Anaphase of meiosis 1

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275
Q

What is treatment of E coli O15:H7?

A

Hydration and avoidance of antibiotics

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276
Q

Antidote for heparin OD?

A

Protamine sulfate (positively charges molecule that binds negatively charges heparin)

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277
Q

Diagnosis of cryptosporidium infection can be confirmed by what?

A

Oocytes on an acid fast stain of stool smear

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278
Q

____________ is characterized by the absence or a decreased amount of the normal vWF metalloprotease ADAMTS13

A

Thrombotic thrombocytopenic purpura

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279
Q

MS can be treated with what cytokine?

A

B-interferon

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280
Q

What is IL-11 (also known as oprelvekin) used for?

A

Stimulate megakaryocyte and platelet growth to treat thrombocytopenia

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281
Q

What are the neoplastic cells in multiple myeloma?

A

plasma cells

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282
Q

What hormone is required for the formation of normal male external genitalia in utero?

A

DHT

283
Q

Role of mullerian inhibiting factor?

A

Secreted by the testes of male during embryogenesis; it prevents the formation of female internal genital organs from the Mullerian ducts.

284
Q

Meckel’s diverticula often contain what 2 types of tissue?

A

gastric and pancreatic tissue

285
Q

______________ is a congenital failure in the migration of neural crest cells to the distal colon and is associated with Down syndrome

A

Hirschsprung disease

286
Q

Which type of molar pregnancy is associated with fetal parts?

A

Partial mole

287
Q

Aniline dyes such as naphthalene increases risk for what?

A

transition cell carcinoma of bladder

288
Q

What is sulfasalazine used for?

A

ulcerative colitis

289
Q

MOA of sumatriptan

A

Serotonin agonist used in treatment of headache

290
Q

MOA of ondansetron

A

Serotonin receptor antagonist, used in treatment of nausea and vomiting associated with chemo

291
Q

Osteoporosis is associated with ______ calcium, ______ phosphorus, ________ alk phos levels

A

normal, normal, normal

292
Q

___________________ is a deletion on chromosome 3 associated with hemangioblastomas and bilateral renal cell carcinoma

A

Von hippel lindau

293
Q

Alkaptonuria is due to defect in homogentisate dioxygenase in the degradation pathway of this amino acid?

A

tyrosine

294
Q

What disease is associated with cafe au lait spots, pigmented spots around iris (Lisch nodules), neurofibromas and bone abnormalities?

A

NF1

295
Q

Which tumor markers are elevated in the setting of pancreatic adenocarcinoma?

A

CA19-9, CEA (carcinoembryonic antigen)

296
Q

Complete neurological deficits below the level of T8 arise from occlusion of what artery?

A

Adamkiewicz

297
Q

Which disease is caused by a mutation in the ATP7B gene and its characterized by basal ganglia degeneration, corneal deposits, micronodular cirrhosis of liver and neuropsychiatric symptoms?

A

Wilson disease

298
Q

________________ are more likely associated with the development of colorectal cancer.

A

Villous adenoma; the larger the polyp and the greater its surface area, the higher likelihood of cancer

299
Q

Tx for prostatic carcinoma?

A

Leuprolide and flutamide

300
Q

The most common breast masses in young women are _______________, which appear histologically as fibrosing interlobular stroma around normal duct and gland architecture.

A

fibroadenoma

301
Q

PSC is associated with what?

A

ulcerative colitis

302
Q

Which tumor is characterized by chickenwire and fried egg appearance?

A

Oligodendroglioma

303
Q

Crohns disease is characterized by what?

A

Transmural inflammation and noncaseating granulomas

304
Q

Use of bismuth

A

Used in peptic ulcers; bismuth binds to the ulcer base, providing physical protection from acid

305
Q

Adverse effects of -azoles

A

Impair liver function (inhibits cytochrome P-450), hepatotoxicity

306
Q

Which leukotrienes are bronchoconstrictors?

A

LTC4, LTD4, LTE4

307
Q

Function of leukotriene B4?

A

LTB4 is a neutrophil chemotactic agent

308
Q

_____________ is the use of positive and negative consequences (reinforcement or punishment) to modify a certain behavior

A

Operant conditioning

309
Q

What is mitochondrial myopathy?

A

Rare disorder; often presents with myopathy, lactic acidosis and CNS disease secondary to failure of oxidative phosphorylation.
Muscle biopsy often shows “ragged red fibers”

310
Q

What is desmopressin?

A

ADH analogue used to treat central DI by limiting diuresis, making it effective to treat enuresis

311
Q

MOA of shiga toxin

A

Cleaves host cell rRNA

312
Q

MOA of edema factor of bacillus anthracis

A

Acts as an adenylate cyclase leads to characteristic edematous borders of black eschar in cutaneous anthrax

313
Q

Tx for crohns disease

A

Infliximab - monoclonal antibody to TNFa

314
Q

What is external validity?

A

Extent to which the study results are applicable to a population other than the study population

315
Q

What is internal validity?

A

Measure of accuracy of the study

316
Q

____________ are stress ulcers thought to be caused by overproduction of acid. Associated with burn victims

A

Curling ulcers; use proton pump inhibitors to treat

317
Q

MOA of propylthiocuracil

A

Inhibits both the conversion of iodide to elemental iodine and the organification of iodine with tyrosine, therefore blocking the production of mono- and diiodotyrosine withing thyroid follicular cells.
PTU also inhibits the peripheral conversion of T4-T3

318
Q

Which antithyroid can be used in pregnancy

A

PTU

319
Q

What are the mediators of anaphylaxis?

A

IgE, C3a and C5a

320
Q

What is griseofulvin?

A

Orally administered antifungal drug; interferes with microtubule function, thus inhibiting mitosis

321
Q

Clinical use of lactulose?

A

Used to treat hepatic encephalopathy; decrease ammonia absorption from the gut by converting it to NH4+ thus trapping it

322
Q

Pathogenesis of HPV induced cervical cancer

A

HPV produces viral proteins E6 and E7, which leads to loss of function of p53 and Rb genes, which act as regulators of transcription and of the cell cycle

323
Q

Adverse effects of interferons used to treat hepatitis?

A

Flu-like symptoms and depression

324
Q

What is the drug of choice for preventing seizures in preeclamptic women during labor?

A

Magnesium sulfate

325
Q

Where is iron adsorbed?

A

duodenum

326
Q

T or F: Gastric ulcers get better with food?

A

False, gastric ulcers are worsened by food

327
Q

T or F: duodenal ulcers get better with food?

A

true

328
Q

During the first half of the luteal phase (days 14-21), estrogen and progesterone levels are _____, and they exert a ________ feedback on FSH and LH

A

high; negative

329
Q

What protein is accumulated in the cells of patients with Parkinsons disease

A

A-synuclein

330
Q

Nephrogenic DI is due to what?

A

Dysfunction at the level of the kidney (V2 receptor), does not respond to ADH

331
Q

What is the characteristic finding of AML?

A

myeloblasts with auer rods

332
Q

The glomerular basement membrane provides selective filtration on the basis of size and charge via what?

A

Filtration slits and a anionic (negative) charge barrier

333
Q

What is transformation

A

Transformation is the gene transfer resulting from the uptake of DNA from the environment

334
Q

What is transduction

A

Transduction is gene transfer from a donor to a recipient by way of a bacteriophage

335
Q

Adverse effect of metronidazole?

A

Disulfiram like reaction

336
Q

_________ activates trypsinogen to trypsin, which in turn activates the pancreatic enzymes

A

enterokinase

337
Q

What is treatment for Hep B

A

Lamivudine and INFa

338
Q

At high flow rates, saliva is __________ compared to plasma

A

isotonic

339
Q

At low flow rates, saliva is _________ compared to plamsa

A

hypotonic

340
Q

Lab findings in hepatocellular carcinoma?

A

Elevated aFP, INR and low total protein

341
Q

What alleles is Type 1 DM associated with?

A

HLA-DR3 and HLA-DR4

342
Q

Philadelphia chromosome (9,22) is associated with what?

A

CMl

343
Q

Where does most of resorption in the kidney occur?

A

Proximal tubule

344
Q

What is the presentation of ascending cholangitis?

A

Infection of gallbladder and biliary tree: presents as right upper quadrant pain, fever, and jaundice

345
Q

___________ tumors of the testes typically manifest in infants or young children with a testicular mass and an elevated AFP level. Have Schiller-Duval bodies, which resemble glomeruli

A

Yolk sac tumors

346
Q

What do you use to treat nocardia?

A

Sulfonamide

347
Q

What do you use to treat actinomyces?

A

penicillin

348
Q

Children with down syndrome are at increased risk for what cancer?

A

Acute Lymphocytic Leukemia

349
Q

What syndrome is characterized by a microdeletion of the short arm of chromosome 5. Presents as microcephaly, intellectual disability, high-pitched crying/mewing, epicanthal folds and cardiac abnormalities (VSD)

A

Cri-du-chat syndrome

350
Q

What infection is associated with Polyarteritis Nodosum, which is characterized by immune complex mediated inflammation of medium sized arteries

A

Hep B

351
Q

Smudge cells are seen in what?

A

CLL

352
Q

What is the immediate treatment for suspected increased ICP?

A

Intubation and mechanical ventilation (hyperventilate), elevating the head of the bed to 30 degrees, and use osmotic diuretics such as mannitol

353
Q

What is Dressler Syndrome?

A

Autoimmune pericarditis

354
Q

What is essential thrombocythemia?

A

A myeloproliferative disorder characterized by increaed platelets in the peripheral blood and increased megakaryocytes in the bone marrow

355
Q

S4 heart sound, commonly called the “atrial kick” suggests what?

A

S4 suggests a decrease in ventricular compliance such occurs as in ventricular hypertrophy resulting from chronic HTN

356
Q

What cancers are associated with Rb mutation?

A

Retinoblastoma and osteosarcoma

357
Q

How do you calculate sensitivity?

A

TP/(TP+FN)

358
Q

How do you calculate specificity?

A

TN/(TN+FP)

359
Q

A homozygous mutation to what genes provides immunity to HIV?

A

Homozygous mutation in CCR5 gene

360
Q

What is McArdle Disease

A

A glycogen storage disorder in which glycogen phosphorylase is deficient in muscle

361
Q

What is tenesmus?

A

Tenesmus is the sensation of the need to empty the bowel accompanied by pain and cramping

362
Q

What is trismus?

A

Lockjaw

363
Q

What is red man syndrome?

A

Red man syndrome is a nonallergic release of histamine after vancomycin administration; it can be prevented by slow infusion and pretreatment with antihistamines

364
Q

Which antihypertensives are protective against diabetic nephropathy?

A

ARBs and ACEi; protect against hyperfiltration injury to the glomerulus over time

365
Q

MOA and use of flumazenil?

A

Flumenazil works by competitively inhibits the GABA-A receptor; used as antidote for benzo OD

366
Q

What is the cause of anemia in patients taking phenytoin?

A

Folate deficiency

367
Q

What disorder is characterized by the following lab values: AFP: Down, B-hCG: Up, Estriol: Down, Inhibin A: Up

A

Down syndrome (trisomy 21)

368
Q

What disorder is characterized by the following lab values: AFP: Down, B-hCG: down, Estriol: Down, Inhibin A: normal

A

Edwards syndrome (trisomy 18)

369
Q

What disorder is characterized by the following lab values: AFP: normal, B-hCG: down, Estriol: normal, Inhibin A: normal

A

Patau syndrome (trisomy 13)

370
Q

Main difference between Folate deficiency anemia and Vitamin B12 deficiency anemia?

A
  • In folate deficiency anemia, there are NO neurological symptoms; elevated homocystine and normal MMA
  • In Vit B12 deficiency anemia, there are nuerological symptoms; elevated homocystine and MMA
371
Q

What condition are anti-Jo1 antibodies found in?

A

Dermatomyositis

372
Q

MOA of trazadone

A

Trazadone is an antidepressant that works by inhibiting serotonin reuptake, and acting as a partial agonist at serotonin receptors

373
Q

Clinical use of IFNa

A

Treatment for Chronic Hep B and C, Kaposi sarcoma, malignant melanoma

374
Q

What is Lambert-eaton disease?

A

an autoimmune disease with antibody against presynaptic voltage gated ca channels

375
Q

Cause of NF1

A

Mutation on chromosome 17 in a tumor suppressor gene that normally regulates Ras; in NF1 Ras is unregulated

376
Q

What is a chemical antagonist?

A

A chemical antagonist works by binding directly to an agonist, thus preventing the agonist from binding its target

377
Q

what is a hapten?

A

A molecule that cannot elicit an immune response on its own, but can do so when protein is bound to it

378
Q

What endogenous substance decreases acid levels from stomach by increasing pancreatic and biliary bicarb secretion?

A

Secretin

379
Q

Patient presents with anxiety, insomnia, diaphoresis, dilated pupils, rhinorrhea, lacrimation and piloerection, what is going on?

A

Opiod withdrawal

380
Q

Cause of maple syrup urine disease?

A

Maple syrup urine disease is caused by an autosomal recessive defect in a-ketoacid dehydrogenase

381
Q

What is Plummer Vinson Syndrome?

A

Triad of iron deficiency anemia, esophageal webs, and atrophic gastritis

382
Q

what is treatment for B-lymphocyte deficiency?

A

Immunoglobulin injections

383
Q

Tx of choice for lyme disease?

A

Doxycyline (adverse effects is teeth discoloration)

384
Q

MOA of tetracyline

A

Binds to 30s ribosomal subunit; inhibits attachment of aminoacyl-transfer RNA in bacteria

385
Q

What is cyclothymia?

A

Mood syndrome characterized by alternating periods of hypomanic and depressive symptoms

386
Q

What is Diamond Blackfan anemia?

A

A congenital pure RBC aplasia caused by primary failure of erythroid progenitor cells in the bone marrow

387
Q

What cells produce mullerian inhibiting factor?

A

sertoli cells

388
Q

Which tumors are characterized by shiller duval bodies?

A

yolk sac tumors

389
Q

Which tumors are characterized by reinke crystals?

A

Leydig cell tumors

390
Q

_________ results from impaired cartilage maturation caused by impaired cartilage maturation caused by autosomal dominant mutation in the FGFR gene

A

Achondroplasia

391
Q

The chemoreceptor zone of the area postrema is located where?

A

In the medulla, on the floor of the 4th ventricle

392
Q

Treatment for OCD

A

SSRIs, clomipramine is the only approved TCA for OCD treatment

393
Q

What is a physiologic antagonist?

A

A drug that counteracts the effects of the agonist by binding to a different receptors and producing opposing effects

394
Q

What type of lung cancers is more often seen in nonsmokers and females?

A

Adenocarcinoma, which tend to be located in the periphery of the lung

395
Q

The medial umbilical ligaments are remnants of what?

A

Fetal umbilical arteries

396
Q

What is the remnant of the allantois?

A

Median umbilical ligament; problem here would lead to urachal cyst or sinus

397
Q

What thyroid tumor is characterized histologically as “ground glass”

A

Papillary thyroid carcinoma

398
Q

What is the vitelline duct?

A

the vitelline duct connects the embryo to the yolk sac and is normally obliterated by birth. Meckels Diverticulum is a persistence of the duct

399
Q

MOA of TSST-1 of S. aureas?

A

TSST-1 can activate a large proportion of t lymphocytes nonspecifically, resulting in an exaggerated immune response

400
Q

As the rate of salivary flow increases, the electrolyte consumption becomes more similar to plasma; thus Na will be ______ and K will _________ relative to normal salivary electrolyte levels

A

increased; decreased

401
Q

Origin of Long Thoracic nerve?

A

C5, C6, C7

402
Q

Polio virus damages what?

A

Polio infection causes destruction of the cells in the ANTERIOR HORN of spinal cord (LMN death)

403
Q

Brushfield spots, which are dark spots on the iris are associated with what disease?

A

Down syndrome

404
Q

The t(9:22) producess a Bcr-Abl fusion protein which does what?

A

Bcr-Abl functions as a constitutively active tyrosine kinase receptor that promotes malignant cell proliferation in CML

405
Q

What is the most common cause of dialysis associated peritonitis?

A

Staph epidermidis

406
Q

What type to receptor does angiotensin II bind too?

A

Gq receptors -> activates phospholipase C

407
Q

IFN-B is indicated in treatment of what?

A

MS

408
Q

Presentation and associated mutation of Folicular lymphoma

A

Patients present with PAINLESS, waxing and waning lyphadenopathy; associated with t(14:18) activating Bcl2 mutation

409
Q

Suspect _________ in a woman with sudden onset of abdominal pain in the middle of her menstrual cycle, but a clinical history and lab results inconsistent with pregnancy

A

Mittelschmerz

410
Q

__________ is an autosomal dominant disease characterized by “ash leaf” spots, shagreen patch, cardiac rhabdomyomas, renal angiomyolipomas and epilepsy

A

Tuberous sclerosis

411
Q

_______ is a key intermediate in the TCA cycle that inhibits phosphofructokinase and activates acetyl coA carboxylase.

A

Citrate; citrate synthase is inhibited by ATP

412
Q

ANP and BNP are released in response to what?

A

ANP is release due to atrial stretch, BNP is release due to ventricular stretch due to increase volume

413
Q

What is mechanism of resistance to an aminoglycoside?

A

Covalent modification via acetylation, adenylation or phosphorylation

414
Q

What are small cell tumors made of?

A

Neuroendocrine kulchitsky cells

415
Q

What paraneoplastic syndromes are associated with small cell carcinoma

A

Increased ACTH, SIADH, and Lambert Eaton syndome

416
Q

Function of CCK

A

Increase pancreatic secretion, increase gallbladder contraction, decrease gastric emptying, increase sphincter of Oddi relaxation

417
Q

What physiologic conditions cause left shits in the O2 curve?

A

Increased pH (reduced H concentration), decreased 2,3 DPG levels, and decreased arterial CO2 pressure

418
Q

_________ is a phenomenon in which gene expression is turned off secondary to loss of genetic material. It is the mechanism by which reticulocytes regulate gene expression

A

Gene loss

419
Q

____________ may present with cyanosis and chocolate colored blood. What is the treatment?

A

Methemoglobinemia; tx is methylene blue

420
Q

What serves as the permeability barriers in the nervous system?

A

Perineum

421
Q

In Guillan barre syndrome, what serves as the site of inflammatory infiltrate?

A

the endoneurium, which surrounds each nerve fiber

422
Q

What is the ONLY glossus muscle of the tongue that does NOT recieve innervation from CN12?

A

The palatoglossus which gets innervation from CN10

423
Q

CN10 innervates the levator veli palatini and the palatopharyngeus (all the oral muscles with root “palat” EXCEPT?)

A

Tensor veli palatini which is innervated by V3

424
Q

MOA of macrolide

A

Macrolide inhibits protein synthesis by blocking the 23S ribosomal subunit (part of the 50S) during translation

425
Q

How does HCC metastasize?

A

HCC disseminates hematogenously; Choriocarcinoma also spreads hematogenously

426
Q

In a ________________, exposure and outcome are measured simultaneously at a particular point in time

A

cross-sectional study

427
Q

Ca efflux from cardiac cells prior to relaxation is primarily mediated by __________ and _________

A

Na/Ca exchange pump and sarcoplasmic reticulum Ca ATPase pump

428
Q

Protein A is a virulence factor found in the peptidoglycan cell wall of S. aureus that binds to _______________, leading to impaired complement activation, opsonization and phagocytosis

A

Fc portion of IgG

429
Q

During skeletal muscle contraction, Ca is released from the SR and binds to __________________, thereby allowing the binding of actin and myosin

A

Troponin C

430
Q

T-cell ALL often presents as what?

A

a mediastinal mass that can cause respiratory symptoms, dysphagia or superior vena cavMOa syndrome

431
Q

MOA of rasburicase

A

a recombinant version of urate oxidase; it catalyzes the conversion of urate to allantion, which is more soluble
- used in prevention of Tumor Lysis Syndrome

432
Q

MOA of antifungal echinocandins (ex. caspofungin)

A

Inhibits the synthesis of polysaccharide glucan, an essential component of the fungal cell wall

433
Q

First line in tx for bipolar disorder

A

valproate and lithium

434
Q

Anaphylaxis is the result of widespread mast cell and basophil degranulation and the relaease of preformed inflammatory mediators including _______ and _______

A

histamine and tryptase

435
Q

Destruction of the posterior hypothalamic nuclei leads to what?

A

Hypothermia

436
Q

As a class, second gen antipsychotics are associated with what adverse effects?

A

Metabolic side effects (weight gain, hyperglycemia, dyslipidemia)

437
Q

Hyperammonemia in hepatic encephalopathy results in depletion of ___________, causing inhibition of the Krebs cycle. Excess ammonia also depletes _______, an excitatory neurotransmitter, and causes accumulation of glutamine, resulting in astrocyte swelling and dysfunction

A

a-ketoglutarate; glutamate

438
Q

Prenatal _________ use for bipolar disorder or epilepsy is associated with increased risk of neural tube defects due to impaired folate metabolism

A

valproate

439
Q

What is the presentation of someone with Fragile X syndrome?

A

Fragile X syndrome is an x-linked disorder that presents with a long, narrow face, a prominent chin and forehead and large testes. Patients often have developmental delay and neuropsychiatric findings that overlap with anxiety disorders, autism and ADHD

440
Q

Tx for bacterial vaginosis

A

Clindamycin, metronidazole

441
Q

MOA of B-blockers in treatment of thyrotoxicosis

A

B-blockers help the symptoms of thyrotoxicosis by decreasing the effect of sympathetic adrenergic impulses on target organs. They also decrease the rate of peripheral conversion of T4 -> T3

442
Q

Pneumonia with high fevers and HYPONATREMIA

A

Legionaires Disease

443
Q

__________ is the presence of endometrial glands within the uterine myometrium. Abnormal uterine bleeding and painful menses are common, and the uterus is generally enlarged

A

Adenomyosis

444
Q

MOA of bradykinin

A

Acts locally to constrict veins and dilate arterioles to increase renal perfusion

445
Q

Distinguishing features of people with marfans vs homocystinuria

A

Individuals with homocystinuria have similar Marfanoid body habitus but also have intellectual disability and increased risk of thrombotic events

446
Q

Function of anterior hypothalamic nuclei

A

mediates heat dissipation; lesion leads to hyperthermia

447
Q

Function of posterior hypothalamic nuclei

A

mediates heat conservation; lesion leads to hypothermia

448
Q

Function of arcuate nucleus of hypothalamus

A

Secretion of dopamine (inhbits prolactin), GHRH, GNRH

449
Q

Function of paraventricular hypothalamic nuclei

A

Secretes ADH, CRH, oxytocin, and TRH

450
Q

Function of supraoptic nuclei of hypothalamus

A

Secretes ADH and oxytocin

451
Q

MOA of adenosine

A

Adenosine interacts with A1 receptors on cardiac cells and activates K channels, increasing K conductance -> decreasing inward Ca levels (hyperpolarizes the cell)

452
Q

MOA of capsaicin

A

capsaicin causes excessive activation of TRPV1, causing a buildup of intracellular Ca that results in long lasting dysfunction of nociceptive nerve fibers (defuctionalization). In addition it depletes substance P, a polypeptide neurotransmitter involved in transmission of pain signals

453
Q

Adverse effects of nitro

A

Headahces, cutaneous flushing, lightheadedness and hypotension (avoid with PDE5 inhibitors)

454
Q

What is the virulence factor for S. pyogenes

A

Protein M

455
Q

MOA of morphine

A

Binds to mu receptors -> G protein coupled activation of K conductance -> K efflux increases causes postsynaptic neurons effectively blocking pain transmission

456
Q

Clinical use of cilostazole

A

Peripheral arterial disease

457
Q

MOA of cilostazole

A

Cilostazole is a phosphodiesterase inhibitor that inhibits platelet aggregation and acts as a direct arterial vasodilator

458
Q

MOA and use of argatroban

A

Argatroban is a direct thrombin inhibitor primarily used in the treatment of heparin induced thrombocytopenia

459
Q

How does the carotid sinus massage work

A

Carotid sinus massage causes reflect parasympathetic stimulation of the SA node, atrial myocytes and the AV node, resulting in a transient decrease in HR and CO

460
Q

Use and MOA of varenicline

A

Varenicline is a partial agonist of nicotinic Ach receptors. It can assist patients with cessation of tobacco use by reducing withdrawal cravings and attenuating the rewarding effects of nicotine

461
Q

Stimulation of a1 receptors in the eye

A

stimulation of a1 receptors of the eye causes contraction of the ocular pupillary dilator muscle, resulting in mydriasis (pupillary dilation)

462
Q

Hypovolemia stimulates resorption of what in the proximal tubules?

A

Uric acid -> hyperuricemia and potentially precipitate a gout attack

463
Q

MOA of buprenophine

A

Buprenorphine is a partial opiod agonist that has low intrinsic activity for opiod mu receptors therefore it acts an a antagonist

464
Q

What inherited disorder causes BOTH prolonged PTT and bleeding time

A

von Willebrand disease

465
Q

A bifid carotid pulse with brisk upstroke (“spike and dome”) is characteristic of ____________________

A

hypertrophic obstructive cardiomyopathy

466
Q

Which inhaled anesthetic is associated with liver failure?

A

Halothane

467
Q

Increased ______ activity is responsible for the hypertrophic/keloid scarring and fibrosis of the lung, liver and kidney that occur with chronic inflammation

A

TGF-B

468
Q

What is the clinical manifestation of cystinuria

A

Recurrent nephrolithiasis

469
Q

_________ is a microtubule associated ATP powered motor protein that facilitates the anterograde transport of neurotransmitter-containing secretory vesicles down axons to synaptic terminals

A

Kinesin

470
Q

Amniocentesis shows increases AFP and acetylcholinesterases: what does this indicates?

A

Neural tube defect

471
Q

Narcolepsy with cataplexy is most often caused by the lack of which 2 peptides?

A

Low Hypocretin-1 (orexin A), Low hypocretin-2 (orexin B)

472
Q

Postural skeletal muscles such as the soleus and paraspinal muscles contain predominantly _________ fibers

A

Type 1 slow twitch, which contain red muscle fibers that derive ATP primarily from oxidative (aerobic) metabolism

473
Q

MOA of aprepitant

A

NK1 receptor antagonist which can be used for chemo induced vomitting

474
Q

Left sided frontal lesions are associated with?

A

Apathy

475
Q

Right sided frontal lesions are associated with?

A

Disinhibition

476
Q

MOA and use of Dantrolene

A

Dantrolene is a muscle relaxant effective in malignant hyperthermia. It acts on ryanodine receptors on the SR and prevents release of Ca into the cytoplasm of muscle fibers

477
Q

What adverse effects are associated with the use of erythopoiesis stimulating agents (ESAs)

A

ESA are associated with increased risk for HTN and thromboembolic events

478
Q

What is the most common cause of mitral stenosis?

A

Prior rheumatic heart disease

479
Q

The inferior colliculus is involved in what pathway?

A

The auditory pathway

480
Q

What is lead time bias

A

Lead time is the time between the initial detection of a disease and a specific outcome or measured outcome. It can occur when a test diagnoses or detects the disease at an earlier stage than another test does without impacting the natural history of the disease. The study may erroneously conclude that using the earlier-detection tests prolongs survival, when in actuality, the increased survival time is due solely to earlier detection of the disease

481
Q

What is statistical power (1-b)

A

Statistical power represents a study’s ability to detect a difference when one exists

482
Q

What nerve often gets injured during a thyroidectomy?

A

The recurrent laryngeal nerve, due to its close proximity to the inferior thyroid artery

483
Q

From what artery does the AV nodal branch come off of?

A

The posterior descending artery

484
Q

________ can be used to assist in the prevention of cerebral vascular spasm following SAH

A

Ca Channel Blockers

485
Q

Major adaptive immune mechanisms that prevent reinfection with the influenza virus include antibodies to what?

A

Antibodies against hemagglutinin

486
Q

ADH acts on the medullary segment of the collecting duct to increase resorption of what?

A

Water and Urea

487
Q

What does the notochord become in adults?

A

The nucleus pulposis

488
Q

What Budd Chiari syndrome?

A

Occlusion of the hepatic vein, which drains blood from the liver and portal circulation into the systemic circulation. Liver biopsy will show centrilobular congestion and fibrosis

489
Q

What type of collagen is in mature scars?

A

Type 1

490
Q

Adverse effect of ethambutol

A

Optic neuritis

491
Q

What is Asherman Syndrome?

A

Secondary amenorrhea due to loss of basalis and scarring

492
Q

________ increases the conversion of NE to epi in the adrenal medulla by increasing the expression of PNMT

A

Cortisol

493
Q

“Red ragged” muscle fibers are seen in _______________

A

mitochondrial diseases

494
Q

What is the function of surfactant?

A

To decrease surface tension

495
Q

A baby presents with recurrent infection that worsen with age, easy bleedinng and eczema, what does the baby have?

A

Wiskott Aldrich Syndrome

496
Q

Low dose ___________ are the medications of choice to treat the behavioral and psychotic manifestations of deliruim

A

antipsychotics (ex. haloperidol)

497
Q

What thyroid cancer is characterized by nests or sheets of polygonal or spindle-shaped cells with extracellular amyloid deposits?

A

Medullary Thyroid cancer - cancer of parafollicular c cells

498
Q

How does DDAVP help those with von Willebrand disease?

A

DDAVP can alleviate bleeding throught endothelial release of vWF

499
Q

_______ and _______ are microtubule associated motor proteins that function in the rapid transport of materials and organelles within cells.

A

Kinesin and dynein

500
Q

Effect of atropine on muscarinic and nicotinic receptors in organophosphate poisoning

A

Atropine reverses muscarinic symptoms of organophosphate poisoning but does not have any effect on nicotinic receptors

501
Q

What medication reverses BOTH muscarinic and nicotinic effects of organophosphates?

A

Pralidoxime

502
Q

Positive selection of T cells (T cells capable of binding to MHC) take place where

A

Cortex of thymus

503
Q

Negative selection of T cells (removing T cells that bind too strongly to self MHC) take place where

A

Medulla of thymus

504
Q

Cause of maturity onset diabetes of the young?

A

Mutations in the glucokinase gene

505
Q

Which drugs inhibit dihydrofolate reductase?

A

MTX, trimethoprim, pyrimethamine

506
Q

__________ refers to the presence of left ventricular systolic dysfunction due to reduced coronary blood flow at rest that is partially or completely reversible by coronary revascularization?

A

Hibernating myocardium

507
Q

What the the role of the glomus body?

A

Thermoregulation

508
Q

____________ is the feeling of a “lump in the throat” without accompanying physical, endoscopic, or radiologic findings of esophageal obstruction

A

Globus sensation

509
Q

___________ is a process in which fatty acids are covalently anchored to plasma membrane cysteine residues, thereby increasing the hydrophobicity of a protein

A

Palmitoylation

510
Q

___________ are adhesion molecules that bind epithelial cells together within tissues; are Ca dependent

A

Cadherins (cells “adhere” together”)

511
Q

_________ are used by hemidesmosomes to bind to basement membrane

A

Integrins (“integrate with basement)

512
Q

_________ is a mature defense mechanism in which a person channels unacceptable thoughts or impulses into socially acceptable behavior

A

Sublimation

513
Q

How to calculate false positive rate?

A

1 - specificity

514
Q

____________ is a disorder caused by mutations in the SMN1 gene, resulting in impaired assembly of snRNPs in lower motor neurons

A

Spinal muscular atrophy

515
Q

What sequence helps initiate translation in prokaryotes?

A

Shine delgarno sequence

516
Q

What sequence helps initiate translation in eukaryotes?

A

Kozak sequence

517
Q

ASD is associated with what heart sound?

A

Widely split and fixed S2

518
Q

MOA of clipopidegrel

A

Clopidegrel inhibits platelet aggregation by blocking P2Y12 on platelet ADP receptors

519
Q

MOA of abcimixib

A

Abciximab is a blocker of glycoprotein (GP) IIb/IIIa receptor which normally promotes platelet binding to fibrinogen.

520
Q

What is Glanzmann thrombasthenia?

A

Glanzman thrombasthenia is an autosomal recessive disorder that is caused by a deficient or defective glycoprotein 2b/3a on platelet surfaces and that typically present in childhood with mucocutanous bleeding

521
Q

On biopsy macrophages with accumulated PAS postive granules are consistent with ____________

A

Whipple disease

522
Q

______ is the key regulatory gene for eye and brain development

A

PAX6

523
Q

What is von gierke disease?

A

Glucose 6 phosphatase deficiency which is characterized by hypoglycemia, lactic acidosis, hepatomegaly and hypertriglyceridemia

524
Q

Tissue damage and resultant abscess formation if primarily caused by _________ release from neutrophils and macrophages

A

lysosomal enzyme

525
Q

Exposure to what causes calcification of the rim of hilar nodes (eggshell calcification) and birefringent silica particles surrounded by fibrous tissue?

A

Exposure to silica

526
Q

MOA of gabapentin?

A

Gabapentin is an anticonvulsant that works by inhibiting presynaptic voltage gated Ca channels

527
Q

MOA of perchlorate and pertechnetate

A

Perchlorate and pertechnetate are competitive inhibitors of the Na/I symporter

528
Q

Which hypercholesterol medication increases TGs

A

Cholestyramine

529
Q

Adverse effects of acyclovir

A

Crystal nephropathy (can be avoided with adequate hydration)

530
Q

MOA and use of entacapone and toltacapone

A

COMT inhibitors use to reduce peripheral metabolism of levodopa, resulting in increased levodopa bioavailability to the brain

531
Q

Intestinal atresia distal to the duodenum occurs due to ______________. (blind ending proximal jejunum, a length of absent bowel and mesentery and a terminal ilieum spiraled around an ileocolic vessel)

A

Vascular accidents in utero

532
Q

__________ is a defense mechanism in which an individual transforms unacceptable feelings or impulses into their extreme opposites

A

Reaction formation

533
Q

How do you calculate power?

A

I - B; B is type 2 error; the probablity of concluding there is no difference when there actually is one

534
Q

In biostats, what is a?

A

A is type 1 error, or the probability that the association is due to chance; p-value

535
Q

In diseases with increased elastic resistance (pulmonary fibrosis, pulmonary edema, ARDS), __________________________ are favored to minimize work of breathing

A

Rapid and shallow breathes

536
Q

In diseases with increased airflow resistance (COPD, asthma) __________ are favored to minimize work breathing

A

slow deep breaths

537
Q

Tachypnea causes hypocapnea and ___________, thereby decreasing cerebral blood flow and ICP

A

vasoconstriction

538
Q

MOA of mifepristone

A

Progesterone antagonist use for pregnancy termination

539
Q

Patient presents with uniformly enlarged uterus and heavy menstrual bleeding and dysmenorrhea, what does she have?

A

Adenomyosis, the presence of endometrial glandular tissue within the myometrium

540
Q

Mutations in NOD2 gene is associated with what disease?

A

Crohns Disease

541
Q

Anticardiolipin antibodies are typically seen in ____________ which is characterized by recurrent venous thrombosis and/or pregnancy loss

A

antiphospholipid syndrome

542
Q

The key growth factors that promote angiogenesis in neoplastic and granulation tissue are ______ and _______

A

VEGF and FGF

543
Q

How to approach someone with somatic symptom disorder?

A

Schedule regular visits with same provider

544
Q

_____________________ shoes be strongly suspected in a patient with severe long bone and/or pelvic fractures who develops acute onset neurologic abnormalities, hypoxemia and petechial rash

A

Fat embolism syndrome

545
Q

Which prokaryotic DNA polymerase has 5’-3’ exonuclease actvity, which is used to remove the RNA primer synthesized by RNA primase?

A

DNA polymerase I

546
Q

Where does CN V3 exit the skull

A

Foramen ovale

547
Q

Where does CN V2 exit the skull

A

Foramen rotundum

548
Q

The phrenic nerve originates from what nerve roots?

A

C3-C5

549
Q

_______ and _______ are exclusively ketogenic and would not increase the blood lactate levels in patients suffering from pyruvate deh deficiency

A

Lysine and leucine

550
Q

In TB, _________ establishes virulence through neutrophil inhibition, mitochondrial destruction and the induced release of TNF

A

cord factor

551
Q

A major side effect of linezolid

A

Peripheral/optic neuropathy, thrombocytopenia, serotonin syndrome

552
Q

The ________________________ regulates the number of atrial impulses that reach the ventricle and determines the ventricular contraction rate in conditions where the atria undergo rapid depolarization (atrial fibrillation)

A

atrioventricular node refractory rate

553
Q

What disease is characterized by multiple telangiectasias; vascular telangiectasias are found in skin and mucous membranes of the lips, oropharynx and respiratory and urinary tracts. Their rupture may cause epistaxis, GI bleeding or hematuria

A

Osler weber Rendu disease (AKA Hereditary Hemorrhagic Telangiectasias) - autosomal dominant

554
Q

What autosomal recessive disorder presents with long QT syndromes accompanied by congenital neurosensory deafness?

A

Jervell and Lange Nielsen Syndrome

555
Q

_______ is an immature defense mechanism involving the misattribution of one’s unacceptable feelings or thoughts to another person who does not actually have them

A

Projection

556
Q

What amino acid is the percursor to serotonin?

A

Tryptophan

557
Q

What can be used to pharmacologically treat serotonin syndrome?

A

Cyproheptadine

558
Q

__________ have a chemical structure similar to pyrophosphate and disrupt osteoclast function by attaching to hydroxyapatite binding sites on bony surfaces

A

Bisphosphanates

559
Q

_____________ is the hallmark of microangiopathic hemolytic anemia

A

Schistocytes

560
Q

What is the cause of classic galactosemia?

A

Classic galactosemia is caused by impaired galactose 1 phosphate metabolism due to deficiency of galactose 1 phosphate uridyl transferase

561
Q

What amino acid becomes essential in homocysteinuria?

A

Cysteine

562
Q

__________ recognize stop codons and terminate protein synthesis. They facilitate release of the polypeptide chain from the ribosome and dissolution of the ribosome-mRNA complex

A

Releasing factor

563
Q

_____ mediates paraneoplastic cachexia in humans by suppressing appetite and increasing basic metabolic rate

A

TNFa

564
Q

_______ calcification occurs in damaged or necrotic tissue in the setting of normal Ca levels

A

Dystrophic

565
Q

_______ calcification occurs in normal tissue in the setting of hypercalcemia

A

metastatic

566
Q

___________ decreases maternal fatty acid store and increases maternal serum glucose in order to provide adequate glucose to the growing fetus

A

Human placental lactogen (hPL)

567
Q

Inferior MI is often due to blockage of what artery?

A

Right coronary artery; which is why inferior MI often associated with bradycardia because the RCA is responsible for perfusing the SA and AV nodes

568
Q

Where does the majority of water resorption occur in the kidney?

A

The proximal tubule, regardless of patients hydration status

569
Q

Where are the serotonin releasing neuron in the CNS located?

A

Raphe nucleus

570
Q

Where are norepinephrine secreting neurons in the CNS located?

A

Locus ceruleus

571
Q

Digoxin is used for ventricular rate control in A. fib as it decreases AV nodal conduction by what mechanism?

A

Increasing parasympathetic vagal tone

572
Q

________, ___________, ___________ inhibits neuronal high frequency firing by reducing the ability of Na channels to recover from inactivation

A

Phenytoin, carbamazepine, valproate

573
Q

Mitral stenosis is almost always caused by _________________

A

rheumatic fever

574
Q

What is aniscoria?

A

Different sized pupils

575
Q

Chronic alcoholism can cause atrophy of the ________ and __________ resulting in gait ataxia, truncal instability, intention tremor and a rhythmic, postural “Parkinsonian” tremor of the fingers and hands

A

anterior lobes and cerebelar vermis

576
Q

What type of cancers are patients with Lynch Syndrome predisposed to?

A

ovarian, endometrial, colon cancers

577
Q

Patients with what disease should avoid metoclopromide?

A

Parkinsons

578
Q

What disease is caused by acid a-glucosidase deficiency; presents with normal glucose levels, cardiomegaly and glycogen accumulation in lysosomes

A

Pompe Disease

579
Q

What disease is caused by defect in debranching enzyme; presents as hepatomegaly, ketotic hypoglycemia, hypotonia and weakness, and has abnormal glycogen with very short outer chains

A

COri Disease

580
Q

Hypocalcemia and hypokalemia can lead to what EKG change?

A

QT prolongation -> increased risk for torsades

581
Q

What are the findings of Parinaud syndrome, which is caused by pineal tumor?

A

Upward gaze palsy, absent pupillary light refltx, and impaired convergence

582
Q

GI stem cells are located where?

A

Crypts of leiberkuhn

583
Q

Cystic hygromas, which manifest as soft, compressible masses that tranilluminate, usually found on head and neck, are most commonly associated what?

A

Chromosomal aneuploidy (trisomies, Turner Syndrome)

584
Q

Lactase intolerance results from a _________________ of lactase production by small intestinal enterocytes

A

normal downregulation

585
Q

MOA of rituximab

A

Monoclonal antibody against CD20

586
Q

Cause of tardive dyskinesia

A

Medication induced movement disorder caused by the prolonged exposure to dopamine blocking agents causing the upregulation and supersensitivity of dopamine receptors

587
Q

What is phenotypic heterogeniety?

A

Phenotypicy heterogeniety describes the process through which mutations in the same gene result in different phenotypes

588
Q

______ are gastrointestinal hormones produced by the gut mucosa that stimulate pancreatic insulin secretion in response to sugar containing meals

A

Incretins

589
Q

___________ results from a defect in the DNA helicase gene RecQL3 and is characterized by photosensitivity, short stature, erythema and telangiectasias

A

Bloom Syndrome

590
Q

Which lymphoma is characterized by overexpression of Bcl2 protein?

A

Follicular lymphoma t(14:18)

591
Q

Insulin increases the cellular uptake of glucose in adipocytes and skeletal muscle by increasing the ____________________, a passive glucose transporter, from intracellular vesicles to the cell membrane

A

translocation of GLUT4

592
Q

Physical exam finding of someone with uncal herniation (cerebellar herniation through the tentorium cerebelli)

A

fixed and dilated pupil on ipsi side due to CN3 palsy

593
Q

Hyperammonemia, increased urinary orotic acid secretion

A

Ornithine transcarbamylase deficiency

594
Q

Megaloblastic anemia, NO HYPERAMMONEMIA, increased orotic acid in urine

A

orotic aciduria

595
Q

The cerebellum is a derivative of what primitive structure?

A

Rhombencephalon

596
Q

Purine and pyrimidine synthesis occurs in what part of the cell?

A

Nucleus

597
Q

MOA of -gliptans

A

Used in T2DM, inhibits DPP4 which degraded GLP1 and other incretins, improved glycemic control

598
Q

What is the Haldane effect?

A

In lungs, the binding of O2 to hemoglobin drives the release of H and CO2 from Hb

599
Q

What is Bohr Effect?

A

In peripheral tissues, high concentrations of CO2 and H+ facilitate O2 unloading from Hb

600
Q

In patients with liver disease, which benzos can be used to treat alcohol withdrawal?

A

Benzos that do not undergo oxidative metabolism in the liver and have no active metabolites; LOT - lorazapam, oxazepam, temazepam

601
Q

B-hCG is typically detectable in the maternal SERUM approximately ________ after fertilization, whereas it is detectable in URINE _______ after fertilization

A

8 days; 14 days

602
Q

What medication can be used to treat serotonin syndrome?

A

Cyproheptadine

603
Q

Which receptors does naloxone have the greatest affinity for?

A

Greatest affinity for Mu opoid receptors; tho it does bind to all opiod receptors

604
Q

MOA for ketamine

A

NMDA receptor antagonist

605
Q

MOA of sirolimus

A

Sirolimus binds to FK506 binding protein (FKBP) in the cytoplasm, forming a complex that binds and inhibits mTOR. Inhibition of mTOR signalling blocks IL2 signal transduction and prevents cells cycle progression and lymphocyte proliferation

606
Q

MOA of rivaroXAban and apiXAban?

A

Direct factor Xa inhibitors which bind to the active site of factor Xa and prevent thrombin formation

607
Q

Stimulation of a2 adrenergic receptors and insulin release?

A

Inhibits insulin release

608
Q

Stimulation of b2 adrenergic receptors and insulin release?

A

Stimulates insulin release

609
Q

MOA of Ricin

A

Ricin is a potent toxin that inhbits protein synthesis by cleaving the rRNA component of the eukaryotic 60S subunit

610
Q

MOA of amatoxins

A

Amatoxins are found in poisonous mushrooms and are potent inhibitors of RNA polymerase II (halt mRNA synthesis)

611
Q

What id TdT a marker for?

A

TdT is a marker for immature lymphocytes, both T and B cells

612
Q

What is the first line treatment for essential tremor?

A

Propanalol

613
Q

What 2 mechanisms do B-blockers use to reduce BP?

A
  1. Reduce HR and myocaridal contractility

2. Decreased renin release by kidney

614
Q

MOA of carbidopa in Parkinson treatment

A

Adding carbidopa inhbits the peripheral conversion of levodopa, making more of it available to the brain; reduces the peripheral side effects of levodopa

615
Q

Side effects of low potency typical antipsychotics (chlorpromazine, thioridazine)

A

Sedation, anticholinergic SE, orthostatic hypotension

616
Q

Side effects of high potency typical antipsychotics (haloperidol, fluphenazine)

A

Extrapyrimidial symptoms (acute dystonia, akathesia, parkinsonism)

617
Q

What population is genetically predisposed to developing drug induced lupus

A

Slow acetylators

618
Q

Isolated systolic HTN is due to age related ___________________________

A

Stiffness and decrease in compliancee of the aorta and major peripheral arteries

619
Q

What is the major virulence factor H. influenzae type b?

A

Capsule consisting of polyribosylribitol phosphate (PRP)

620
Q

Maculopapular rash that starts on face and spreads to the trunk and extremeties with postauricular lymphadenopathy

A

Togavirus rubella

621
Q

In muscles, what causes the activation of phosphorylase kinase, which stimulates glycogen phosphorylase to increase glycogenolysis?

A

Increase in intracellular Ca2+ and epinephrine acitivates phosphorylase kinase in muscles

622
Q

In liver, what causes the activation of phosphorylase kinase, which stimulates glycogen phosphorylase to increase glycogenolysis?

A

Epinephrine and glucagon

623
Q

What is uterine atony?

A

Failure of the uterus to contact adequately after delivery; the most common cause of postpartum hemorrhage

624
Q

A dense interstitial mononuclear infiltrate is characteristic of _______________ rejection

A

acute cellular rejection

625
Q

Vascular fibrinoid necrosis and neutrophil infiltration of arterioles, glomeruli and peritubular capillaries are characteristic of ______________ rejection

A

hyperacute rejection

626
Q

Obliterative intimal thickening, tubular atrophy, and interstitial fibrosis is characteristic of ________ rejection

A

chronic rejection

627
Q

________ is a physiologic decoy receptor that decreases binding of RANKL to RANK

A

osteroprotegerin

628
Q

Rugae thickening with acid hypersecretion is characteristic of what?

A

Zollinger ellison syndrome

629
Q

Rugae thicking WITHOUT acid hypersecretion is characteristic of what?

A

Menetrier disease

630
Q

A positive lepromin skin test in someone with leprosy indicates what?

A

Tuberculoid leprosy as they exhibit a strong CD4 TH1 cell mediated immune response to M. leprae

631
Q

A negative lepromin skin test in someone with leprosy indicates what?

A

Lepromatous leprosy; due to their weak TH1 cell mediated immune response

632
Q

Most anal fissures occur where?

A

Most anal fissures occur at the posterior midline of the anal verge

633
Q

Long term acid suppression with proton pump inhibitors may be associated with an increased risk of osteoporotic hip fractures due to what?

A

Due to decreased Ca absorption

634
Q

MOA of baclofen

A

Baclofen is an agonist at the GABA-B receptor; used for treatment of spasticity

635
Q

IVH in preterm infants usually originate from the _________, a highly cellular and vascularized layer in the subventricular zone from which neurons and glial cells migrate out during brain development

A

germinal matrix

636
Q

________ the rate limiting enzyme that catalyzes the first step in fatty acid synthesis

A

Acetyl CoA carboxylase

637
Q

Insulin increases glycogen synthesis by activation of which molecule?

A

Insulin promotes glycogen synthesis by activating protein phosphatase, an enzyme that activates glycogen synthase by dephosphorylating it

638
Q

Naltrexone as pharmacotherapy for alcohol abstinence

A

Naltrexone blocks the mu opioid receptor and can be initiated while the individual is still drinking. Naltrexone blocks the rewarding and reinforcing effects of EtOH and has been shown to reduce craving for it

639
Q

________ acts as a partial neuronal nicotinic receptor agonist and prevents nicotine stimulation of the mesolimbic dopamine system associated with nicotine addiction

A

Varenicline

640
Q

____________ supply the medial portions of the 2 hemispheres (frontal and parietal lobes). Occlusion can cause contra motor and sensory deficits of the lower extremities, behavioral changes and urinary incontinence

A

The anterior cerebral artery

641
Q

________ is a polypeptide synthesized by the liver that acts as the central regulator of iron homeostasis

A

Hepcidin; high iron and inflammation increase hepcidin, hypoxia and increased erythropoiesis lower hepcidin

Low hepcidin levels increase intestinal iron absorption and stimulates iron release by macrophages

642
Q

What is parinaud syndrome?

A

Parinaud syndrome is a vertical gaze palsy caused by a tumor of the pineal gland which compresses the vertical gaze center at the MLF

643
Q

Antidote for TCA toxicity?

A

Sodium bicarb

644
Q

What is the toxic components of LPS?

A

Lipid A

645
Q

What is schizoaffective disorder?

A

Psychotic symptoms with episodic superimposed major depression or mania. Psychosis is present with and w/o mood disorder, but mood disorder is present only with psychosis

646
Q

Where in the nephron is most of K resorbed?

A

Proximal tubule then thick ascending limb

647
Q

Damage of what nuclei cause PURE contralateral SENSORY loss?

A

Ventral posterior thalamus: VPL (sensory from body), VPM (sensory from face)

648
Q

Shigella invates the GI mucosa by gaining access to ________ in ileal Peyer patches through endocytosis. Shigella subsequently lyses the endosome and spreads laterally into other epithelial cells, causing death and ulceration with hemorrhage and diarrhea

A

M cells

649
Q

_________ is an allosteric activator of gluconeogenesis that acts by increasing the activity of pyruvate carboxylase when it is abundant

A

Acetyl coa

650
Q

________ is an inducible enzyme that is upregulated to increased the synthesis of pro-inflammatory arachidonic acid metabolites

A

COX2

651
Q

Treatments of akathesia due to antipsychotics

A

Benzo or B-blocker

652
Q

What vitamin deficiency can occur due to ingestion of raw white eggs?

A

Vitamin B7 (biotin); raw white eggs have avidin

653
Q

_________ is due to compression of the lower trunk of the brachial plexus in the scalene triangle, the space bordered by the anterior and middle scalene and the first rib

A

Thoracic outlet syndrome

654
Q

The _________________ is a measure of the potency of an inhaled anesthetic

A

Minimal alveolar concentration (MAC); potency is inversely proportional to the MAC: the lower the MAC, the more potent the anesthetic

655
Q

________ released by eosinophils normally functions to kill helminths

A

Major basic protein

656
Q

Giving thrombin to someone with hemophilia leads to what?

A

Clotting

657
Q

________ is associated with exposure to carcinogens such as arsenic, thorotrast and TVC. Tumor cells express CD31, an endothelial cell marker

A

Hepatic angiosarcoma

658
Q

_________ colon adenocarcinoma are more likely to bleed and cause iron deficiency anemia

A

right sided

659
Q

_________ colon adenocarcinoma are more likely to present with obstructing symptoms

A

left sided

660
Q

CNS tumors of neuronal origin frequently stain positively for _________ on immunohisto

A

synaptophysin

661
Q

Renal oncocytomas arise from __________

A

collectng duct cells

662
Q

RCC arises from epithelial cells of _____________

A

proximal renal tubules

663
Q

What culture medium is used to culture B. pertussus

A

Bordet-Gengou

664
Q

C diphtheraie is cutlured on ________

A

cysteine tellurite agar

665
Q

Triad of cardiac tamponade

A

JVD, hypotension, muffled heart sounds

666
Q

What is the first area damaged during global cerebral ischemia?

A

The hippocampus

667
Q

Lesions to the macula cause what?

A

central scotoma

668
Q

Which laryngeal muscle is innervated by external branch of the superior laryngeal nerve?

A

Cricothyroid muscle; the external branch of the superior laryngeal nerve is

669
Q

HBV assists with which life cycle aspect of HDV?

A

Coating of viral particles - necessary for penetration of hepatocyte

670
Q

Chronic lithium toxicity (confusion, ataxia, tremor) can be precipitated by volume depletion and which drugs?

A

Thiazide diuretics, ACE inhibitors and NSAIDs

671
Q

During times of starvation, what enzyme provides substrates for hepatic gluconeogenesis and ketone body formation?

A

Hormone sensitive lipase

672
Q

Loss of cardiomyocyte contractility occurs within _______ after onset of total ischemia

A

60s

673
Q

After about ______ of total ischemia, ischemic injury to heart becomes irreversible

A

30min

674
Q

The portal triad which consists of the hepatic artery, portal vein, and common bile duct run through what?

A

Hepatoduodenal ligament

675
Q

MOA of fenoldopam

A

Fenoldopam is a selective peripheral D1 receptor agonist; usually given IV to lower BP in hypertensive emergency, especially in patients with renal insufficiency; it causes arteriolar dilation, increase renal perfusion and promotes diuresis and natriuresis

676
Q

Which form of Rb is active?

A

Hypophosphorylated Rb is active

677
Q

The rubber like properties of elastin are due to what?

A

Interchain cross links involving lysine which is facilitated y lysyl oxidase

678
Q

Acute ureteral constriction or obstruction _______ the GFR and filtration fraction

A

decreases

679
Q

_____ pigment stones are associated with biliary tract infections (microbes produce B-gluconidases)

A

Brown

680
Q

______ pigments stones occur in the setting of chronic hemolysis and increased enterohepatic cycling of bilirubin

A

black

681
Q

What is the SVC derived from?

A

The common cardinal veins

682
Q

MOA of desmopressin in von willebrand disease and Hemophilia A

A

DDAVP significantly increases circulating factor 8 levels and also stimulated vWF secretion from endothelial

683
Q

Which hypercholesterolemia medication increase TG levels? (via increased VLDL)

A

Cholestyramine

684
Q

MOA and use of evolucamab

A

Evolucamab binds PCKS9 and prevents degradation of LDL receptors, increasing uptake of circulating LDL

685
Q

In T2DM, what contributes to insulin resistance?

A

Chronically elevated free fatty acid levels

686
Q

What is cholinergic crisis in MG?

A

Cholinergic crisis is where a patient receives inappropriately high doses of AChE inhibitor and has excessive ACh in the synaptic cleft. This results in excessive stimulation of skeletal muscles and results in refractory to future impulses.
Treatments is to temporarily stop AChE inhibitor

687
Q

_______ is characterized by loss of speech and motor skills, deceleration of head growth, and stereotypical hand movements after a period of normal development. It affects mainly girls and is associated with mutations in the MECP2 gene

A

Rett syndrome

688
Q

Tetrahydrobiopterin is a cofactor in the synthesis of what molecules?

A

Serotonin, tyrosine, DOPA

689
Q

Exogenous secretin _______ gastrin release from gastrinomas (ZES)

A

stimulate; in normal patients, secreting inhibits gastrin from normal gastric G cells

690
Q

In left ventricular failure, fluid accumulation in the lung interstitium results in __________ compliance

A

decreased

691
Q

GLUT4 receptors are on what types of cells?

A

Skeletal muscles and adipocytes

692
Q

In patients with tetrology of fallot, what is the major determinant to the degree of right to left shunting and resulting cyanosis?

A

The degree of right ventricular outflow tract obstruction

693
Q

MOA and use cilostazol

A

Cilostazol is a PDE inhibitor that is occasionally used in patients with symptomatic peripheral vascular disease

694
Q

H pylori can cause duodenal ulcers and is typically found in greatest concentration in the _________________

A

prepyloric area of the gastric antrum

695
Q

Injury to what artery due to a displaced femoral neck fracture can cause osteonecrosis of the femoral head

A

Medial femoral circumflex artery

696
Q

Adverse effects of methimazole and PTU

A

Both can cause agranulocytosis;
methimazole is a teratogen, and can cause cholestatis
PTU can lead to hepatic failure (can use PTU in pregnancy)

697
Q

MOA of aprepitant

A

NK1 receptors antagonist used in chemotherapy induced emesis

698
Q

MOA of metoclopromide

A

Dopamine receptor antagonist used in diabetic gastroparesis and chemo induced emesis

699
Q

Damage below the red nucleus results in what?

A

Decerebrate (extensor) posturing; loss of descending excitation to the upper limb flexors and extensor predominance

700
Q

Damage above the red nucleus results in what?

A

Decorticate (flexor) posturing; loss of descending inhibition of the red nucleus and subsequent hyperactivity of upper extremity flexor muscles

701
Q

What hemoglobin is predominant in the first few months of life?

A

HgF (A2G2)

702
Q

BMI formula

A

BMI = (Weight in kg)/(Height in m^2)

703
Q

Which Vitamin gets depleted in measles?

A

Vitamin A

First Aid Qbank (1 decks)

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