Step 1 Qank Flashcards
Which chemotherapuetic drugs act on the M-phase of the cell cycle?
Vinca alkaloids (vincristine, vinblastine) Paclitaxel
MOA of vinca alkaloids (vincristine, vinblastine)?
Inhibits microtubule function and spindle formation
MOA of paclitaxel
Reversibly binds to tubulin and hyperstabilizes microtubules that have already polymerized, preventing spindle breakdown
Which drugs are associated with prolongation of QT interval?
Class 1a and III antiarrhythmics
Fibrinous pericarditis is a complication that usually occurs _______ days post-MI.
1-3 days
Presentation of fibrinous pericarditis
Chest pain that is relieved when the patient leans forward; often a pericardial friction rub can be auscultated on cardiac examination
Free wall rupture is a complication that occurs ____ days after MI and can result in ______.
3-14; cardiac tamponade
Presentation of cardiac tamponade
Hypotension, distant heart sounds and elevated jugular venous pressure
B-blockers ________ end diastolic volume by decreasing ____ and _____, permitting greater filling time
increase; HR and contractility
Fibrates increase _______ by increasing PPAR-a activity
HDL levels
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 ___________
inward Ca2+ current
Effect of NE on B1 receptor: Positive inotropic effect, which is an increase in contractility in cardiac myocytes, is caused by an increase in ______
inward Ca2+ current
Effect of NE on B1 receptor: Positive chronotropic effect, which is an increase in HR via SA node, is caused by increase in _________
inward Ca2+ and Na+ current
Aortic stenosis requires increased pressure to open the aortic valve, prolonging the _______ ________ phase
isovolumetric contraction
A potent vasodilator that is first line tx for HTN in pregnancy
Hydralazine
What should hydralazine be taken with to prevent serious side effects?
Taken with B-blocker to prevent reflex tachycardia
Polymyalgia rheumatica is associated with what vascular disease?
Temporal arteritis
Polyarteritis nodosa is associated with what infection?
Hepatitis B infection
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
Microscopic polyangiitis
Which drug is given to treat Wegener’s granulomatosis and polyarteritis nodosa?
Cyclophosphamide
Diuresis with ____________ is effective in mitigating acute exacerbation of congestive heart failure marked by SOB secondary to pulmonary edema
loop diuretics such as furosemide
What type of virus causes mumps?
Single stranded, negative sense, enveloped RNA virus of the Paramyxoviridae family
Presentation of mumps
Inflammation/swelling of one or both parotid glands and also the testes (orchitis)
Lhermitte phenomenon
A transient shock-like sensation most often triggered by flexion of the neck, seen in MS
Tremor at rest is a symptom of what disease?
parkinsons disease
Intention tremor is a symptom of what disease?
MS
Treatment of CMV
Ganciclovir
Adverse effects of ganciclovir
Leukopenia, neutropenia, thrombocytopenia, renal toxicity
MOA of ganciclovir
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
Side effects of metoprolol
Mild sedation, depression, impotence and exercise intolerance
Treatment of absence seizures
Ethosuximide (first line), or valproic acid
MOA of ethosuximide
Blocks T-type Ca channels
MOA of valproate
Increase Na channel inactivation, increase GABA concentration by inhibiting GABA transaminase
Gabapentin, an analogue of _______, has been approved for the treatment of all seizure types except ________. Gabapentin functions to inhibit high voltage Ca channels
g-aminobutyric acid; absence seizures
Cholinesterase inhibitor toxicity is treated with what?
Atropine, a muscarinic antagonist
_________ is a chelator used to treat lead, arsenic gold, or acute mercury poisoning
Dimercaprol
________ is a direct cholinergic agonist used to treat ileus and urinary retention because it stimulated GI motility and bladder contraction
bethanechol
_________ 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
Filgastrim
_______ are characteristic of LMN lesions. They are thought to be caused by release of ____________ from degenerating nerve terminal at the neuromuscular junction
Fasciculations; acetylcholinesterase
__________ is a progressive, stepwise cognitive decline. History of HTN, cerebrovascular accident, and neurologic symptoms makes this diagnosis more like likely
Multi-infarct vascular dementia
What is a watershed zone?
The zone supplied by the most distal sections of 2 different arteries
The right internal carotid artery supplies blood to both the right ___________ and _____________.
anterior cerebral artery and middle cerebral artery
In a sarcomere, the _________, which is the length of myosin, does not change upon contraction
A-band
Acoustic neuromas are thought to arise from loss of a tumor-suppressor gene on chromosome ___ and may be a manifestation of ___
Chromosome 22, NF2
___________ are eosinophillic inclusions bodies seen in the cytoplasm of neurons from patients infected with rabies.
Negri bodies
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
Hyper-IgE syndrome (Job syndrome)
Erbs palsy presents with “_________” arm position and is due to damage of the ___ and ____ nerve roots of brachial plexus
Waiters tip; C5 and C6
____________ is characterized by contralateral muscle weakness, ipsilateral tongue deviation, and contralateral loss of sensation from the body, sparing the face
Medial medullary syndrome
Medial medullary syndrome is caused by infarct of the ______________
Anterior spinal artery
What is the most common ligament affected in ankle sprains?
Anterior talofibular ligament
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
Pagets Disease
Describe the pertinent lab values seen in patients with Paget’s Disease
Normal calcium (sometimes elevated), normal phosphate, and elevated alkaline phosphatase
__________ 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
constrictive pericarditis
What are common causes of constrictive pericariditis?
Infections such as SLE, rheumatic fever; post-radiation changes, and viral and bacterial infections
____ is a key cytokine produced by TH1 cells and is a potent stimulator of macrophages. It also has antitumor and antiviral activity.
IFN-g
What interleukin does macrophages secrete?
TNF-a
_______ 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.
Somatic symptom disorder
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
Borderline personality disorder
Hepatocyte congestion suggest ___________ and _______
right sided heart failure and nutmeg liver
_________ is classically associated with fatalities and fulmitant hepatitis in pregnant women, commonly seen in sub-saharan Africa, spread by fecal-oral route
Hepatitis E infection
Histologic finding of hepatitis infections?
Patchy necrosis of liver cells from focal hepatocyte damage
________ is associated with chronic liver disease and is a result of disorders such as Alcoholism, Wilson Disease, and hemochromomatosis
Micronodular cirrhosis
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
Bruton x-linked agammaglobinemia
Classic physical exam finding of patients with Bruton x-linked agammaglobinemia?
Absence or near absence of tonsils and adenoids, which are B-lymphocyte rich tissues
MOA of clozapine
Blockade of serotonin and dopamine receptors
MOA of chloramphenicol
Inhibits protein synthesis by binding to and inhibiting the 50S ribosomal subunit
MOA of sulfonamide
Inhibits dihyropteroate synthetase, an enzyme involved in folate synthesis
___________ competes with K at the Na/K ATP pump. Thus in hypokalemia, this drug binds more readily to its target, leading to possible toxicity
Digoxin
Adverse effects of chloramphenicol
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
Hypotonia
also known as floppy baby syndrome, a state of low muscle tone
Which drug do you use for diuresis in patients that are allergic to sulfa drugs
Loop diuretic ethacrynic acid
Angiosarcomas are composed of malignant cells forming vascular channels and are predominantly found in the ___________
right atrium
T or F: Procarbazine is an antineoplastic agent that is also a MAOI
True
The muscles of facial expression are derived from what?
Second branchial arch
The muscles of mastication are derived from what?
First branchial arch
Duchennes muscular dystrophy, which produces weakness starting before age 5, is usually due to what mutation
Frame shift mutation
Beckers muscular dystrophy, which is a less severe form of DMD, results from what mutation
Point mutation of dystrophin gene
Congenital CMV manifests as what? What would you see in CT of the head?
petechial rash, hepatosplenomegaly and microcephaly;
Intracranial calcification
Patients with autism spectrum disorder have an association with which conditions?
Tuberous sclerosis and seizures
MOA of aminoglycosides (gentamicin, neomycin, amikacin, tobramycin, streptomycin)
Bactericidal; irreversible inhibition of initiation complex through binding of the 30S subunit; causes misreading of mRNA
Clinical use of aminoglycosides
Severe gram negative rod infections, synergistic with B-lactam antibiotics
Adverse effects of aminoglycosides
nephrotoxicity, neuromuscular blockade, ototoxicity, teratogen
_________, produced by platelets, stimulates platelet aggregation and vasoconstriction, and will be elevated at the site of a clot.
Thromboxane A2
__________ is synthesized by vascular endothelium and smooth muscle. It decreases platelet aggregation and causes vasodilation
Prostaglandin I2
What are some anticholinergic adverse effects
urinary retention, dry mouth, tachycardia, constipation, and blurry vision
what are cowdry a inclusion bodies?
Intranuclear eosinophilic inclusions surrounded by a clear halo, seen in cells infected with VZV, CMV, HSV
What is locked in syndrome?
Locked in syndrome consists of almost complete motor paralysis (sparing vertical eye movements) with total preservation of sensation, consciousness and reason.
How do patients get locked in syndrome?
It results from occlusion of the basilar artery, disrupting blood supply to the ventral pons
What type of drug is busulfan?
DNA alkylation agent; chemotherapeutic
What type of drug is cisplatin?
Platinum based chemotherapeutic drug that is a DNA crosslinking agent
MOA of doxorubicin
Doxorubicin generates free radicals and results in DNA double stranded breaks
MOA of chemotherapeutic drug etoposide
Inhibits type 2 topoisomerase
Treatment of extrapyrimidal side effects of atypical antipsychotics
Anticholinergic agents like benztropine
_______, which acts by inhibiting mycolic acid synthesis, is the treatment of choice for TB prophylaxis
Isonaizid
____________ is used to help break up mucus plugs in patients with cystic fibrosis
N-acetylcysteine
Patients with CF are at risk for developing ____-______ vitamin deficiencies
Fat soluble vitamin deficiencies (vitamins A, D, E, K)
MOA of carbamazepine
Antiepileptic drug that inactivates Na channels and inhibits N-methyl-D-aspartate receptors
Adverse effects of antiepileptic carbamazepine
Blood dyscrasias (agranulocytosis or aplastic anemia), liver toxicity, diplopia, ataxia and teratogenesis
As the prevalence of disease increases, the PPV ________ and the NPV ________
increases, decreases
Guillan-Barre syndrome is an autoimmune disease characterized by an ascending paralysis caused by ________ and _______ of the PNS
inflammation and demyelination
Intracytoplasmic eosinophilic inclusions, also known as _____________, are seen in ________________
Mallory bodies; alcohol-induced hepatitis
Patients with sickle cell anemia are at risk for osteomyelitis due to ________ or ________
salmonella or staphyloccus
__________ is a major risk factor for osteomyelitis caused by Pseudomonas
IV drug abuse
In multiple myeloma, a common finding seen on peripheral blood smear is a ____________________
Rouleaux formation - single file stacking of RBCs
_________ 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
Legionella pneumophilla
Mycoplasma pneumonia requires media containing ________
sterols
What lysosomal storage disorder is characterized by a defect in N-acetylglucosaminyl-1-phosphotransferase?
I-cell disease
What happens in I-cell disease
Failure of golgi apparatus to phosphorylate mannose residues on glycoproteins -> proteins are secreted extracellularly rather than delivered to lysosomes
Presentation of I-cell disease
Coarse facial features, clouded corneas, restricted joint movement, and high plasma lysosomal enzymes; often fatal in childhood
__________ is a genetic disease in which fatty substances (sphingolipids) accumulate in cells and certain organs; caused by hereditary deficiency of enzyme glucocerebrosidase (aka glucosylceramidase)
Gaucher Disease
C. diptheriae produces diphtheria toxin. Diphtheria toxin inhibits ______, inhibiting ______ and protein synthesis
EF-2a; translocation
Intracytoplasmic eosinophilic inclusion bodies describe what?
Lewy bodies
Patients with ________ personality disorder are submissive and clinging; they have low self-esteem and have an excessive need to be taken care of
dependent
Patients with ________ personality disorder display excessive emotionality, somatisization, attention-seeking and sexually provacative behavior
Histrionic
Patients with _______ personality disorder are sensitive to rejection and are socially inhibited and timid.
avoidant
Within the carotid sheath, the common carotid artery is _______, the internal jugular vein is _________ and the vagus nerve lies ________
medial, lateral, posterior
_____________ is rapidly fatal and is characterized by hemorrhagic mediastinitis, mediastial widening and bloody pleural effusions
inhalational anthrax; B. anthracis, a gram positive rod in chains with protein capsule
What neurological deficits are seen in syringomyelia (an enlargement of the central canal of the spinal cord, commonly occurring at C8-T1
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)
What is the most common cause of pyridoxine deficiency (Vitamin B6)?
Isoniazid
MEN-1 (Wermer syndrome) is inherited as an autosomal dominant mutation of chromosome 11, as causes a tumor in the “3Ps”: ____________ __________ __________
Pituitary, Parathyroid and pancreas
Arsenic exerts its toxic effects via inhibition of _________, a required cofactor for the pyruvate dehydrogenase complex
lipoic acid
How do you differentiate between child with osteogenesis imperfecta (defect in type 1 collagen synthesis) and victim of abuse?
Look for blue sclera or miscolored and damaged teeth (both seen in osteogenesis imperfecta)
_________ is a gram negative rod that is usually associated with cat scratches. Chronic lymphadenitis would most commonly be seen in young children
Bartonella henselae
_________ 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
Brucella canis
A-amanitin, toxin found in Amanita phalloides (death cap mushrooms) inhibits _________________, which is responsible for the production of mRNA.
RNA polymersase II
RNA polymerase I is responsible for what?
synthesis of rRNA
RNA polymerase III is responsible for what?
synthesis of tRNA
Acyclovir is an acyclic guanosine derivative that inhibits DNA synthesis in viruses after activation by viral ____________
thymidine kinase
The subscapularis acts to ____________________ the arm
medially rotate and adduct
In addition to causing glossitis, macrocytic megaloblastic anemia, and dementia, vitamin B12 deficiency causes neurological symptoms due to degeneration of what?
Degeneration of dorsal columns, lateral corticospinal tracts, and spinocerebellar tracts
Patients who develop polio experience injury to the nerve roots that supply the ___________
superior gluteal nerve
Areteriovascular malformation and HTN are associated more with which type of brain injury?
Intraparenchymal hemorrhage, more so than subarachnoid hemorrhage which is often due to rupture of aneurysm
What does Km (michealis menton constant) reflect?
the Km inversely reflects the affinity of the enzyme for its substrate
- the higher the Km, the lower the affinity and vice versa
Competitive inhibitors have what effect on Km? How can competitive inhibition be overcome?
Increase Km = decrease the affinity
Competitive inhibition can be overcome by adding more substrate
MTX is administered with what to adverse effects?
Leucovorin (folinic acid)
What enzyme is needed to convert testosterone to DHT
5a-reductase
What enzyme is needed to convert testosterone to estrogen
Aromatase
Where does the lymphatic drainage of the testes go?
para-aortic lymph nodes
What drugs are first line therapy for severe hypertriglyceridemia?
Fibrate and niacin
MOA of fibrates
Increase LPL activity -> increase TG clearance; activates PPARa to induce HDL synthesis
MOA of niacin
Inhibits lipolysis (hormone sensitive lipase) in adipose tissue; reduces hepatic VLDL synthesis
_____________ (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
Tabes dorsalis
HLA B27 predisposes individuals to what conditions?
Psoriasis, ankylosing spondylitis, inflammatory bowel disease and Reiters syndrome (reactive arthritis)
____________ is an amide anesthetic capable of causing cardiac arrythmias and hypotension
Bupivacaine
________ are macrophages of the central nervous system that, like other tissue macrophages, arise from monocytes in the bone marrow
microglia
HIV encephalitis is caused by infection of the __________ and ________ in the brain
macrophages and microglia
_______________ can be identified on a bone marrow smear by looking for macrophages engulfing RBCs
Hemophagocytic lymphohistiocytosis
Achilles tendon reflex tests which nerve roots?
S1-2 (S1,2 buckle my shoe)
________ reduces alveolar surface tension by disrupting the hydrogen bonds between molecules of water
surfactant
___________ are intermediate cells that immediately precede the terminally differentiated neutrophil and are present during a systemic inflammatory response
band cells
Adverse effects of lithium (which is used to treat bipolar disorder)
Tremor, hypothyroidism, birth defects, polyuria and nephrogenic diabetes insipidus due to ADH antagonism
Amphotericin B toxicity include?
Fever and chills, hypotension, nephrotoxicity, and arrhytmias
SCC is associated with excessive _______, leading to hypercalcemia, and is suggested by a large hilar mass with cavitation in a smoker
PTHrP (parathyroid hormone related peptide)
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
fibrinoid necrosis
A-hemolytic form what color colonies on blood agar?
green colonies
What is the cofactor required in the hydroxylation of proline and lysine residues in collagen synthesis
Vitamin C, deficiency leads to scurvy
Scarlet fever is caused by?
Strep pyogenes (GAS)
Scalded skin syndrome is caused by?
Staph aureus
Diagnosis of Bipolar II requires?
History of BOTH a major depressive disorder and a hypomanic episode
Diagnosis of Bipolar I requires?
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
Vascular type of Ehlers Danlos syndrome is caused by deficiency of what?
Type 3 collagen
What are the trinucleotide repeat diseases?
Huntingtons Disease, Myotonic dystrophy, Friedrich ataxia, Fragile X syndrome
SLE is associated with what renal disease?
Diffuse Proliferative Glomerulonephritis
Which IL is responsible for fever?
IL-1, IL-6, TNFa
IL-3 function
Responsible for stimulating the growth and differentiation of bone marrow.
IL-4 function
Responsible for growth of B cell and enhancing class switching
IL-5 function
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
The deltaF508 mutation in cystic fibrosis results in what defect?
Defective processing from the ER to the golgi apparatus
E. coli ferments what?
Lactose
What is first line treatment for pneumococcus infection?
Penicillin or amoxicillin
The reduced GFR in chronic renal disease leads to accumulation of phosphate which does what?
Directly stimulated PTH, suppress renal production of vitamin D3
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
Liddle syndrome
Why is mannitol, an osmotic diuretic, contraindicated in patients with CHF?
It can cause pulmonary edema
Small cell carcinomas of the lung is associated with what paraneoplastic syndrome?
Cushing syndome via increased ACTH
Squamous cell carcinoma of the lung is associated with paraneoplastic syndrome?
Produces PTHrP -> HYPERCALCEMIA
A palpable thrill of the abdomen just to the left of the midline could indicate what?
Renal artery stenosis
MOA of cyclosporine
Binds to cyclophilin, thus inhibiting calcineurin, blocking production of IL-2 and blocking activation of T-lymphocytes
What immunosuppresant inhibits T-lymphocyte proliferation by inhibiting nucleotide production and DNA synthesis?
Azathioprine
What are some common causes of dilated cardiomyopathy?
Alcohol abuse, wet BeriBeri, Coxsackie B virus, cocaine, Chagas disease, Doxorubicin, hemochromatosis, sarcoidosis, peripartum cardiomyopathy
What is used to treat heparin OD?
Protamine
Pertussis toxin does what?
Inhibition of Gi
Lethal factor, which is released by Bacillus anthracis, is a zinc metalloprotrease that inactivated protein kinase and that stimulated macrophages to release _____
TNFa
A postive quellung test (positive reaction with capsular swelling) indicates what?
S. pneumo pneumonia
MOA of macrolides
Inhibit protein synthesis by blocking translocation of the 23S ribosomal RNA of the 50S ribosomal subunit
MOA of aminoglycosides
Inhibits formation of the initiation complex, causes misreading of mRNA (binds to 30S)
Which antiretroviral drug is associated with crystal induced nephropathy?
Indinavir - protease inhibitor
Obstructive lung diseases is characterized by decreased vital capacity and an increased _________, ________, _________
Increased residual volume, total lung capacity, and functional residual capacity
Restrictive lung disease is characterized by decreased vital capacity, _________, _________, _________
decreased residual volume, total lung capacity and functional residual capacity
Why do both obstructive and restrictive lung disease result in decrease vital capacity?
Because of reduced ability to expire air in obstructive lung disease and reduced ability to inspire in restrictive lung disease
SCID can result from what deficiency?
Adenosine deaminase deficiency
Osmotic demyelination, AKA central pontine myelinosis, can result from overaggressive treatment of ___________
hyponatremia
Unfractionated heparin tends to have dramatic affect on ________________
activated partial thromboplastin time (aPTT)
MOA of amantidine in treatment and prophylaxis of influenza?
Binds to M2 protein on virus to prevent viral uncoating
Aschoff bodies (granulomas with giant cells) are seen in what disease?
rheumatic fever
Negative reaction to the nitroblue tetrazolium test is diagnostic for what disease?
Chronic Granulomatous Disease
What is the substrate for the NADPH oxidase enzyme complex? Phagocytes use NADPH oxidase to convert this to reactive oxygen species.
O2
The fibers of the ___________ that cross at the anterior white commissure can be damaged by the enlargement of the central canal seen in syringomyelia.
Spinothalamic tract
______________ is clinically characterized by progressive bone marrow failure and multiple congenital abnormalities, including radial hypoplasia and thumb deformity
Fanconi anema
What is the dominant component of surfactant
phosphatidylcholine (lecitin)
All the sensory modalities of the face, except for olfactory sensation, pass through the _________________ of the thalamus on their way to the cortex
ventral posteromedial nucleus
__________ 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
Ataxia-telangiectasia
____________ is a autosomal recessive disorder characterized by destruction of the anterior horn cells; it presents with diffuse muscle atrophy, hypotonia, fasciculations, and decreased DTR
Werdnig-Hoffman Disease
Imatinib inhibits BCR-ABL _____________ created by t(9:22), which is the defining cytogenic lesion in CML
tyrosine kinase
A noncompetitive inhibitor will have what affect on Vmax and Km?
Decrease Vmax, no chance in Km
Adverse effects of aspirin?
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
MOA of sumatriptan
Serotonin receptor agonist
Ras proteins belong in which families of molecules?
GTP binding proteins
First line treatment for otitis externa is what?
Flouroquinolone
Glucose intolerace, coarsening of facial features, thickened fingers, fatigue and sweating are signs of excessive ____________
GH synthesis
__________ are the only output cells of the cerebellum, and they are all what type of neurons?
Purkinje cells; GABAergic
What is oligohyramnios?
Toot little amniotic fluid
Unlike folate deficiency, vitamin B12 deficiency causes ___________
Neurological deficits
The first branchial arch develops what?
The muscles of mastication
The first branchial cleft gives rise to what?
the external auditory meatus
The 2nd branchial arch develops what?
Muscles of facial expression
The permanent metanephric kidneys found in humans originate from what?
the ureteric bud
Paroxysmal nocturnal hemoglobinuria, caused by ____________, leads to intravascular hemolysis and hemosideren in urine
PIG-A GPI anchor mutation
PE of a patient results in almond breath odor, confusion and headache. What is the patient suffering from?
Cyanide poisoning
What is characterized by degeneration of the anterior horn cells, not tertiary syphillis?
Polio
What is characterized by degeneration of posterior column?
Tertiary syphilis (Tabes dorsalis)
Degeneration of the anterior white commissure results from what?
Syringomyelia
Deficiency of adenosine deaminase can cause what?
SCID
Mutation in ATM kinase, which in involved in dsDNA break repair leads to what?
Ataxia-telangiectasia
MOA of amphetamines?
Promotes extravesicular release of catecholamines into the synaptic cleft
Acute transplant rejection is mediated by what?
CD8 cytotoxic T lymphocytes
Massive blood transfusions carry the risk of _________ caused by the concomittant administration of a large dose of anticoagulant citrate with the blood
hypocalcemia
_________ is a condition that results from injury to the subthalamic nucleus, which is a basal ganglia nucleus
Hemiballismus
MEN 1 neoplasms
Parathyroid tumors, Pituitary tumors, Pancreatic endocrine tumors;
associated with mutation in MEN1 gene (menin, a tumor suppressor)
MEN 2a neoplasms
Parathyroid hyperplasia, Pheochromocytoma, Medullary thyroid carcinoma;
associated with mutation in RET gene
MEN 2b neoplasms
Pheochromocytoma, medullary thyroid carcinoma, mucosal neoplasms;
associated with mutation in RET gene
Injury of what nerve should be suspected in a patient with midshaft humerus break?
radial nerve
What artery runs along the radial groove of the humerus with the radial nerve?
Radial collateral artery
What common thyroid cancer has histo characteristics of “orphan annie eye nuclei” (empty looking ground glass nuclei) and psammoma bodies?
Papillary carcinoma
MOA of phenytoin
Increases Na channel activation, thereby decreasing the flux of Na ions across the neuronal membrane
Toxicity of phenytoin
Gingival hyperplasia, megaloblastic anemia, induction of cytochrome p-450 system
Treatment of choice for tonic clonic seizures?
phenytoin
___________ is characterized by ipsi loss motor function, vibration, and proprioception and the contralateral loss of pain and temp sensation
Brown-Sequard Syndrome, or hemisection of spinal cord
What is the rate limiting step in glycolysis?
Conversion of F-6-phosphate to F-1,6-bisphosphate by phosphofructokinase
(This step is inhibited by citrate and increased ATP)
___________________ promotes the proliferation, differentiation and recruitment of lymphoid cells. It is used to treat RCC and is thought to promote immune mediated antitumor effects
Recombinant IL-2 (aldesleukin)
Tay sachs disease is due to a deficiency of ________________, causing an accumulation of GM2 ganglioside
hexosaminidase A
Oocytes remain in ___________ from birth to ovulation
prophase 1
After ovulation, the oocyte progresses through meiosis 1 and is arrested in ___________ until after fertilization occurs
metaphase II
Which amino acid residue is needed to create thyroid hormone?
Tyrosine
Congenital diaphragmatic hernia is due to failure of what?
Failure of the pleuroperitoneal canal to close completely; leads to protrusion of the abdominal viscera into the chest, usually the left side
What megaloblastic anemia results in BOTH increased MMA and homocysteine?
Vitamin B12 deficiency`
Leukocyte adhesion deficiency is caused by deficiency in what?
Deficiency of B2-integrin and subsequent defects in several proteins including LFA-1
MOA of tetracyclines
Binds at 30S subunite and prevents attachment of the aminoacyl-tRNA
What is Meigs syndrome?
Triad of benign ovarian tumor, ascites and hydrothorax (pleural effusion)
_________ is characterized by proximal muscle weakness and delayed muscle relaxation and may manifest in childhood or adulthood. Caused by nucleotide expansion of CCTG
Myotonic dystrophy
On peripheral blood smear, dacrocytes are a sign of what?
Extramedullary hematopoiesis
What type of pneumocyte proliferates during lung damage?
Type 2 pneumocytes
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?
Hairy Cell leukemia
Absence of a-ketodehydrogenase leads to what?
Maple syrup urine disease - inability to degrade branched amino acids
A deficiency of metionine synthase would lead to development of what?
Homocysinuria, a disorder characterized by mental retardation, osteoporosis, tall stature, kyphosis and lens subluxation
Function of LH?
Stimulate the production of androgens by theca cells
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?
Mutation on chromosome 5 of APC gene
MOA of bleomycin
Inhibits DNA synthesis by binding to DNA and causing single strand and double strand breaks
The cremaster muscle is formed from what abdominal muscle?
The internal oblique muscle
What is heteroplasmy?
The presence of both normal and mutated mitochondrial DNA. The condition results in variable expression of mitochondrial inherited diseases
What is Trousseau syndrome?
A unique migratory thrombophlebitis that occurs as a results of the liberation of clotting factors, such as tissue factor, by some pancreatic tumors
What antiviral is used to treat Hep C infection? This antiviral is associated with hemolytic anemia
Ribavirin
What is conversion disorder?
Loss of sensory or motor function, often following an acute stressor
Patient presents with painful vaginal bleeding in the third trimester. She smokes, has HTN and uses cocaine. What does she have?
Placental abruption (abruptio placentae)
The cardinal ligaments located at the base of the broad ligements of uterus contain what?
Uterine arteries and veins
How do you calculate attributable risk?
The risk difference: calculated by subtracting the incidence of disease in nonexposed from incidence of disease in exposed persons
___________________ is an autosomal dominant disorder that affects a number of systems secondary to accumulation of porphobilinogen and d-aminolevulinate?
Acute intermittent porphyria
What disease is associated with vertigo, sensorineural hearing loss and tinnitus?
Meniere Disease
B-hCG is structurely similar to what hormones?
FSH, LH, TSH
What autoimmune disease is associated with HLA-DR4?
Rheumatoid arthritis
Adverse effect of milk of magnesia?
Diarrhea
Triple therapy for H. pylori infection?
Clarithromycin, amoxicillin (metronidazole if pt has penicillin allergy), proton pump inhibitor
Where in the spleen are the T cells located?
The periarterial lymphoid sheath
What marker is elevated in hepatocellular carcinoma?
A-fetoprotein
In the vast majority of cases, Down syndrome is due to nondisjunction during what phase?
Anaphase of meiosis 1
What is treatment of E coli O15:H7?
Hydration and avoidance of antibiotics
Antidote for heparin OD?
Protamine sulfate (positively charges molecule that binds negatively charges heparin)
Diagnosis of cryptosporidium infection can be confirmed by what?
Oocytes on an acid fast stain of stool smear
____________ is characterized by the absence or a decreased amount of the normal vWF metalloprotease ADAMTS13
Thrombotic thrombocytopenic purpura
MS can be treated with what cytokine?
B-interferon
What is IL-11 (also known as oprelvekin) used for?
Stimulate megakaryocyte and platelet growth to treat thrombocytopenia
What are the neoplastic cells in multiple myeloma?
plasma cells
What hormone is required for the formation of normal male external genitalia in utero?
DHT
Role of mullerian inhibiting factor?
Secreted by the testes of male during embryogenesis; it prevents the formation of female internal genital organs from the Mullerian ducts.
Meckel’s diverticula often contain what 2 types of tissue?
gastric and pancreatic tissue
______________ is a congenital failure in the migration of neural crest cells to the distal colon and is associated with Down syndrome
Hirschsprung disease
Which type of molar pregnancy is associated with fetal parts?
Partial mole
Aniline dyes such as naphthalene increases risk for what?
transition cell carcinoma of bladder
What is sulfasalazine used for?
ulcerative colitis
MOA of sumatriptan
Serotonin agonist used in treatment of headache
MOA of ondansetron
Serotonin receptor antagonist, used in treatment of nausea and vomiting associated with chemo
Osteoporosis is associated with ______ calcium, ______ phosphorus, ________ alk phos levels
normal, normal, normal
___________________ is a deletion on chromosome 3 associated with hemangioblastomas and bilateral renal cell carcinoma
Von hippel lindau
Alkaptonuria is due to defect in homogentisate dioxygenase in the degradation pathway of this amino acid?
tyrosine
What disease is associated with cafe au lait spots, pigmented spots around iris (Lisch nodules), neurofibromas and bone abnormalities?
NF1
Which tumor markers are elevated in the setting of pancreatic adenocarcinoma?
CA19-9, CEA (carcinoembryonic antigen)
Complete neurological deficits below the level of T8 arise from occlusion of what artery?
Adamkiewicz
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?
Wilson disease
________________ are more likely associated with the development of colorectal cancer.
Villous adenoma; the larger the polyp and the greater its surface area, the higher likelihood of cancer
Tx for prostatic carcinoma?
Leuprolide and flutamide
The most common breast masses in young women are _______________, which appear histologically as fibrosing interlobular stroma around normal duct and gland architecture.
fibroadenoma
PSC is associated with what?
ulcerative colitis
Which tumor is characterized by chickenwire and fried egg appearance?
Oligodendroglioma
Crohns disease is characterized by what?
Transmural inflammation and noncaseating granulomas
Use of bismuth
Used in peptic ulcers; bismuth binds to the ulcer base, providing physical protection from acid
Adverse effects of -azoles
Impair liver function (inhibits cytochrome P-450), hepatotoxicity
Which leukotrienes are bronchoconstrictors?
LTC4, LTD4, LTE4
Function of leukotriene B4?
LTB4 is a neutrophil chemotactic agent
_____________ is the use of positive and negative consequences (reinforcement or punishment) to modify a certain behavior
Operant conditioning
What is mitochondrial myopathy?
Rare disorder; often presents with myopathy, lactic acidosis and CNS disease secondary to failure of oxidative phosphorylation.
Muscle biopsy often shows “ragged red fibers”
What is desmopressin?
ADH analogue used to treat central DI by limiting diuresis, making it effective to treat enuresis
MOA of shiga toxin
Cleaves host cell rRNA
MOA of edema factor of bacillus anthracis
Acts as an adenylate cyclase leads to characteristic edematous borders of black eschar in cutaneous anthrax
Tx for crohns disease
Infliximab - monoclonal antibody to TNFa
What is external validity?
Extent to which the study results are applicable to a population other than the study population
What is internal validity?
Measure of accuracy of the study
____________ are stress ulcers thought to be caused by overproduction of acid. Associated with burn victims
Curling ulcers; use proton pump inhibitors to treat
MOA of propylthiocuracil
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
Which antithyroid can be used in pregnancy
PTU
What are the mediators of anaphylaxis?
IgE, C3a and C5a
What is griseofulvin?
Orally administered antifungal drug; interferes with microtubule function, thus inhibiting mitosis
Clinical use of lactulose?
Used to treat hepatic encephalopathy; decrease ammonia absorption from the gut by converting it to NH4+ thus trapping it
Pathogenesis of HPV induced cervical cancer
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
Adverse effects of interferons used to treat hepatitis?
Flu-like symptoms and depression
What is the drug of choice for preventing seizures in preeclamptic women during labor?
Magnesium sulfate
Where is iron adsorbed?
duodenum
T or F: Gastric ulcers get better with food?
False, gastric ulcers are worsened by food
T or F: duodenal ulcers get better with food?
true
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
high; negative
What protein is accumulated in the cells of patients with Parkinsons disease
A-synuclein
Nephrogenic DI is due to what?
Dysfunction at the level of the kidney (V2 receptor), does not respond to ADH
What is the characteristic finding of AML?
myeloblasts with auer rods
The glomerular basement membrane provides selective filtration on the basis of size and charge via what?
Filtration slits and a anionic (negative) charge barrier
What is transformation
Transformation is the gene transfer resulting from the uptake of DNA from the environment
What is transduction
Transduction is gene transfer from a donor to a recipient by way of a bacteriophage
Adverse effect of metronidazole?
Disulfiram like reaction
_________ activates trypsinogen to trypsin, which in turn activates the pancreatic enzymes
enterokinase
What is treatment for Hep B
Lamivudine and INFa
At high flow rates, saliva is __________ compared to plasma
isotonic
At low flow rates, saliva is _________ compared to plamsa
hypotonic
Lab findings in hepatocellular carcinoma?
Elevated aFP, INR and low total protein
What alleles is Type 1 DM associated with?
HLA-DR3 and HLA-DR4
Philadelphia chromosome (9,22) is associated with what?
CMl
Where does most of resorption in the kidney occur?
Proximal tubule
What is the presentation of ascending cholangitis?
Infection of gallbladder and biliary tree: presents as right upper quadrant pain, fever, and jaundice
___________ 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
Yolk sac tumors
What do you use to treat nocardia?
Sulfonamide
What do you use to treat actinomyces?
penicillin
Children with down syndrome are at increased risk for what cancer?
Acute Lymphocytic Leukemia
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)
Cri-du-chat syndrome
What infection is associated with Polyarteritis Nodosum, which is characterized by immune complex mediated inflammation of medium sized arteries
Hep B
Smudge cells are seen in what?
CLL
What is the immediate treatment for suspected increased ICP?
Intubation and mechanical ventilation (hyperventilate), elevating the head of the bed to 30 degrees, and use osmotic diuretics such as mannitol
What is Dressler Syndrome?
Autoimmune pericarditis
What is essential thrombocythemia?
A myeloproliferative disorder characterized by increaed platelets in the peripheral blood and increased megakaryocytes in the bone marrow
S4 heart sound, commonly called the “atrial kick” suggests what?
S4 suggests a decrease in ventricular compliance such occurs as in ventricular hypertrophy resulting from chronic HTN
What cancers are associated with Rb mutation?
Retinoblastoma and osteosarcoma
How do you calculate sensitivity?
TP/(TP+FN)
How do you calculate specificity?
TN/(TN+FP)
A homozygous mutation to what genes provides immunity to HIV?
Homozygous mutation in CCR5 gene
What is McArdle Disease
A glycogen storage disorder in which glycogen phosphorylase is deficient in muscle
What is tenesmus?
Tenesmus is the sensation of the need to empty the bowel accompanied by pain and cramping
What is trismus?
Lockjaw
What is red man syndrome?
Red man syndrome is a nonallergic release of histamine after vancomycin administration; it can be prevented by slow infusion and pretreatment with antihistamines
Which antihypertensives are protective against diabetic nephropathy?
ARBs and ACEi; protect against hyperfiltration injury to the glomerulus over time
MOA and use of flumazenil?
Flumenazil works by competitively inhibits the GABA-A receptor; used as antidote for benzo OD
What is the cause of anemia in patients taking phenytoin?
Folate deficiency
What disorder is characterized by the following lab values: AFP: Down, B-hCG: Up, Estriol: Down, Inhibin A: Up
Down syndrome (trisomy 21)
What disorder is characterized by the following lab values: AFP: Down, B-hCG: down, Estriol: Down, Inhibin A: normal
Edwards syndrome (trisomy 18)
What disorder is characterized by the following lab values: AFP: normal, B-hCG: down, Estriol: normal, Inhibin A: normal
Patau syndrome (trisomy 13)
Main difference between Folate deficiency anemia and Vitamin B12 deficiency anemia?
- 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
What condition are anti-Jo1 antibodies found in?
Dermatomyositis
MOA of trazadone
Trazadone is an antidepressant that works by inhibiting serotonin reuptake, and acting as a partial agonist at serotonin receptors
Clinical use of IFNa
Treatment for Chronic Hep B and C, Kaposi sarcoma, malignant melanoma
What is Lambert-eaton disease?
an autoimmune disease with antibody against presynaptic voltage gated ca channels
Cause of NF1
Mutation on chromosome 17 in a tumor suppressor gene that normally regulates Ras; in NF1 Ras is unregulated
What is a chemical antagonist?
A chemical antagonist works by binding directly to an agonist, thus preventing the agonist from binding its target
what is a hapten?
A molecule that cannot elicit an immune response on its own, but can do so when protein is bound to it
What endogenous substance decreases acid levels from stomach by increasing pancreatic and biliary bicarb secretion?
Secretin
Patient presents with anxiety, insomnia, diaphoresis, dilated pupils, rhinorrhea, lacrimation and piloerection, what is going on?
Opiod withdrawal
Cause of maple syrup urine disease?
Maple syrup urine disease is caused by an autosomal recessive defect in a-ketoacid dehydrogenase
What is Plummer Vinson Syndrome?
Triad of iron deficiency anemia, esophageal webs, and atrophic gastritis
what is treatment for B-lymphocyte deficiency?
Immunoglobulin injections
Tx of choice for lyme disease?
Doxycyline (adverse effects is teeth discoloration)
MOA of tetracyline
Binds to 30s ribosomal subunit; inhibits attachment of aminoacyl-transfer RNA in bacteria
What is cyclothymia?
Mood syndrome characterized by alternating periods of hypomanic and depressive symptoms
What is Diamond Blackfan anemia?
A congenital pure RBC aplasia caused by primary failure of erythroid progenitor cells in the bone marrow
What cells produce mullerian inhibiting factor?
sertoli cells
Which tumors are characterized by shiller duval bodies?
yolk sac tumors
Which tumors are characterized by reinke crystals?
Leydig cell tumors
_________ results from impaired cartilage maturation caused by impaired cartilage maturation caused by autosomal dominant mutation in the FGFR gene
Achondroplasia
The chemoreceptor zone of the area postrema is located where?
In the medulla, on the floor of the 4th ventricle
Treatment for OCD
SSRIs, clomipramine is the only approved TCA for OCD treatment
What is a physiologic antagonist?
A drug that counteracts the effects of the agonist by binding to a different receptors and producing opposing effects
What type of lung cancers is more often seen in nonsmokers and females?
Adenocarcinoma, which tend to be located in the periphery of the lung
The medial umbilical ligaments are remnants of what?
Fetal umbilical arteries
What is the remnant of the allantois?
Median umbilical ligament; problem here would lead to urachal cyst or sinus
What thyroid tumor is characterized histologically as “ground glass”
Papillary thyroid carcinoma
What is the vitelline duct?
the vitelline duct connects the embryo to the yolk sac and is normally obliterated by birth. Meckels Diverticulum is a persistence of the duct
MOA of TSST-1 of S. aureas?
TSST-1 can activate a large proportion of t lymphocytes nonspecifically, resulting in an exaggerated immune response
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
increased; decreased
Origin of Long Thoracic nerve?
C5, C6, C7
Polio virus damages what?
Polio infection causes destruction of the cells in the ANTERIOR HORN of spinal cord (LMN death)
Brushfield spots, which are dark spots on the iris are associated with what disease?
Down syndrome
The t(9:22) producess a Bcr-Abl fusion protein which does what?
Bcr-Abl functions as a constitutively active tyrosine kinase receptor that promotes malignant cell proliferation in CML
What is the most common cause of dialysis associated peritonitis?
Staph epidermidis
What type to receptor does angiotensin II bind too?
Gq receptors -> activates phospholipase C
IFN-B is indicated in treatment of what?
MS
Presentation and associated mutation of Folicular lymphoma
Patients present with PAINLESS, waxing and waning lyphadenopathy; associated with t(14:18) activating Bcl2 mutation
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
Mittelschmerz
__________ is an autosomal dominant disease characterized by “ash leaf” spots, shagreen patch, cardiac rhabdomyomas, renal angiomyolipomas and epilepsy
Tuberous sclerosis
_______ is a key intermediate in the TCA cycle that inhibits phosphofructokinase and activates acetyl coA carboxylase.
Citrate; citrate synthase is inhibited by ATP
ANP and BNP are released in response to what?
ANP is release due to atrial stretch, BNP is release due to ventricular stretch due to increase volume
What is mechanism of resistance to an aminoglycoside?
Covalent modification via acetylation, adenylation or phosphorylation
What are small cell tumors made of?
Neuroendocrine kulchitsky cells
What paraneoplastic syndromes are associated with small cell carcinoma
Increased ACTH, SIADH, and Lambert Eaton syndome
Function of CCK
Increase pancreatic secretion, increase gallbladder contraction, decrease gastric emptying, increase sphincter of Oddi relaxation
What physiologic conditions cause left shits in the O2 curve?
Increased pH (reduced H concentration), decreased 2,3 DPG levels, and decreased arterial CO2 pressure
_________ 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
Gene loss
____________ may present with cyanosis and chocolate colored blood. What is the treatment?
Methemoglobinemia; tx is methylene blue
What serves as the permeability barriers in the nervous system?
Perineum
In Guillan barre syndrome, what serves as the site of inflammatory infiltrate?
the endoneurium, which surrounds each nerve fiber
What is the ONLY glossus muscle of the tongue that does NOT recieve innervation from CN12?
The palatoglossus which gets innervation from CN10
CN10 innervates the levator veli palatini and the palatopharyngeus (all the oral muscles with root “palat” EXCEPT?)
Tensor veli palatini which is innervated by V3
MOA of macrolide
Macrolide inhibits protein synthesis by blocking the 23S ribosomal subunit (part of the 50S) during translation
How does HCC metastasize?
HCC disseminates hematogenously; Choriocarcinoma also spreads hematogenously
In a ________________, exposure and outcome are measured simultaneously at a particular point in time
cross-sectional study
Ca efflux from cardiac cells prior to relaxation is primarily mediated by __________ and _________
Na/Ca exchange pump and sarcoplasmic reticulum Ca ATPase pump
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
Fc portion of IgG
During skeletal muscle contraction, Ca is released from the SR and binds to __________________, thereby allowing the binding of actin and myosin
Troponin C
T-cell ALL often presents as what?
a mediastinal mass that can cause respiratory symptoms, dysphagia or superior vena cavMOa syndrome
MOA of rasburicase
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
MOA of antifungal echinocandins (ex. caspofungin)
Inhibits the synthesis of polysaccharide glucan, an essential component of the fungal cell wall
First line in tx for bipolar disorder
valproate and lithium
Anaphylaxis is the result of widespread mast cell and basophil degranulation and the relaease of preformed inflammatory mediators including _______ and _______
histamine and tryptase
Destruction of the posterior hypothalamic nuclei leads to what?
Hypothermia
As a class, second gen antipsychotics are associated with what adverse effects?
Metabolic side effects (weight gain, hyperglycemia, dyslipidemia)
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-ketoglutarate; glutamate
Prenatal _________ use for bipolar disorder or epilepsy is associated with increased risk of neural tube defects due to impaired folate metabolism
valproate
What is the presentation of someone with Fragile X syndrome?
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
Tx for bacterial vaginosis
Clindamycin, metronidazole
MOA of B-blockers in treatment of thyrotoxicosis
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
Pneumonia with high fevers and HYPONATREMIA
Legionaires Disease
__________ is the presence of endometrial glands within the uterine myometrium. Abnormal uterine bleeding and painful menses are common, and the uterus is generally enlarged
Adenomyosis
MOA of bradykinin
Acts locally to constrict veins and dilate arterioles to increase renal perfusion
Distinguishing features of people with marfans vs homocystinuria
Individuals with homocystinuria have similar Marfanoid body habitus but also have intellectual disability and increased risk of thrombotic events
Function of anterior hypothalamic nuclei
mediates heat dissipation; lesion leads to hyperthermia
Function of posterior hypothalamic nuclei
mediates heat conservation; lesion leads to hypothermia
Function of arcuate nucleus of hypothalamus
Secretion of dopamine (inhbits prolactin), GHRH, GNRH
Function of paraventricular hypothalamic nuclei
Secretes ADH, CRH, oxytocin, and TRH
Function of supraoptic nuclei of hypothalamus
Secretes ADH and oxytocin
MOA of adenosine
Adenosine interacts with A1 receptors on cardiac cells and activates K channels, increasing K conductance -> decreasing inward Ca levels (hyperpolarizes the cell)
MOA of capsaicin
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
Adverse effects of nitro
Headahces, cutaneous flushing, lightheadedness and hypotension (avoid with PDE5 inhibitors)
What is the virulence factor for S. pyogenes
Protein M
MOA of morphine
Binds to mu receptors -> G protein coupled activation of K conductance -> K efflux increases causes postsynaptic neurons effectively blocking pain transmission
Clinical use of cilostazole
Peripheral arterial disease
MOA of cilostazole
Cilostazole is a phosphodiesterase inhibitor that inhibits platelet aggregation and acts as a direct arterial vasodilator
MOA and use of argatroban
Argatroban is a direct thrombin inhibitor primarily used in the treatment of heparin induced thrombocytopenia
How does the carotid sinus massage work
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
Use and MOA of varenicline
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
Stimulation of a1 receptors in the eye
stimulation of a1 receptors of the eye causes contraction of the ocular pupillary dilator muscle, resulting in mydriasis (pupillary dilation)
Hypovolemia stimulates resorption of what in the proximal tubules?
Uric acid -> hyperuricemia and potentially precipitate a gout attack
MOA of buprenophine
Buprenorphine is a partial opiod agonist that has low intrinsic activity for opiod mu receptors therefore it acts an a antagonist
What inherited disorder causes BOTH prolonged PTT and bleeding time
von Willebrand disease
A bifid carotid pulse with brisk upstroke (“spike and dome”) is characteristic of ____________________
hypertrophic obstructive cardiomyopathy
Which inhaled anesthetic is associated with liver failure?
Halothane
Increased ______ activity is responsible for the hypertrophic/keloid scarring and fibrosis of the lung, liver and kidney that occur with chronic inflammation
TGF-B
What is the clinical manifestation of cystinuria
Recurrent nephrolithiasis
_________ is a microtubule associated ATP powered motor protein that facilitates the anterograde transport of neurotransmitter-containing secretory vesicles down axons to synaptic terminals
Kinesin
Amniocentesis shows increases AFP and acetylcholinesterases: what does this indicates?
Neural tube defect
Narcolepsy with cataplexy is most often caused by the lack of which 2 peptides?
Low Hypocretin-1 (orexin A), Low hypocretin-2 (orexin B)
Postural skeletal muscles such as the soleus and paraspinal muscles contain predominantly _________ fibers
Type 1 slow twitch, which contain red muscle fibers that derive ATP primarily from oxidative (aerobic) metabolism
MOA of aprepitant
NK1 receptor antagonist which can be used for chemo induced vomitting
Left sided frontal lesions are associated with?
Apathy
Right sided frontal lesions are associated with?
Disinhibition
MOA and use of Dantrolene
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
What adverse effects are associated with the use of erythopoiesis stimulating agents (ESAs)
ESA are associated with increased risk for HTN and thromboembolic events
What is the most common cause of mitral stenosis?
Prior rheumatic heart disease
The inferior colliculus is involved in what pathway?
The auditory pathway
What is lead time bias
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
What is statistical power (1-b)
Statistical power represents a study’s ability to detect a difference when one exists
What nerve often gets injured during a thyroidectomy?
The recurrent laryngeal nerve, due to its close proximity to the inferior thyroid artery
From what artery does the AV nodal branch come off of?
The posterior descending artery
________ can be used to assist in the prevention of cerebral vascular spasm following SAH
Ca Channel Blockers
Major adaptive immune mechanisms that prevent reinfection with the influenza virus include antibodies to what?
Antibodies against hemagglutinin
ADH acts on the medullary segment of the collecting duct to increase resorption of what?
Water and Urea
What does the notochord become in adults?
The nucleus pulposis
What Budd Chiari syndrome?
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
What type of collagen is in mature scars?
Type 1
Adverse effect of ethambutol
Optic neuritis
What is Asherman Syndrome?
Secondary amenorrhea due to loss of basalis and scarring
________ increases the conversion of NE to epi in the adrenal medulla by increasing the expression of PNMT
Cortisol
“Red ragged” muscle fibers are seen in _______________
mitochondrial diseases
What is the function of surfactant?
To decrease surface tension
A baby presents with recurrent infection that worsen with age, easy bleedinng and eczema, what does the baby have?
Wiskott Aldrich Syndrome
Low dose ___________ are the medications of choice to treat the behavioral and psychotic manifestations of deliruim
antipsychotics (ex. haloperidol)
What thyroid cancer is characterized by nests or sheets of polygonal or spindle-shaped cells with extracellular amyloid deposits?
Medullary Thyroid cancer - cancer of parafollicular c cells
How does DDAVP help those with von Willebrand disease?
DDAVP can alleviate bleeding throught endothelial release of vWF
_______ and _______ are microtubule associated motor proteins that function in the rapid transport of materials and organelles within cells.
Kinesin and dynein
Effect of atropine on muscarinic and nicotinic receptors in organophosphate poisoning
Atropine reverses muscarinic symptoms of organophosphate poisoning but does not have any effect on nicotinic receptors
What medication reverses BOTH muscarinic and nicotinic effects of organophosphates?
Pralidoxime
Positive selection of T cells (T cells capable of binding to MHC) take place where
Cortex of thymus
Negative selection of T cells (removing T cells that bind too strongly to self MHC) take place where
Medulla of thymus
Cause of maturity onset diabetes of the young?
Mutations in the glucokinase gene
Which drugs inhibit dihydrofolate reductase?
MTX, trimethoprim, pyrimethamine
__________ 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?
Hibernating myocardium
What the the role of the glomus body?
Thermoregulation
____________ is the feeling of a “lump in the throat” without accompanying physical, endoscopic, or radiologic findings of esophageal obstruction
Globus sensation
___________ is a process in which fatty acids are covalently anchored to plasma membrane cysteine residues, thereby increasing the hydrophobicity of a protein
Palmitoylation
___________ are adhesion molecules that bind epithelial cells together within tissues; are Ca dependent
Cadherins (cells “adhere” together”)
_________ are used by hemidesmosomes to bind to basement membrane
Integrins (“integrate with basement)
_________ is a mature defense mechanism in which a person channels unacceptable thoughts or impulses into socially acceptable behavior
Sublimation
How to calculate false positive rate?
1 - specificity
____________ is a disorder caused by mutations in the SMN1 gene, resulting in impaired assembly of snRNPs in lower motor neurons
Spinal muscular atrophy
What sequence helps initiate translation in prokaryotes?
Shine delgarno sequence
What sequence helps initiate translation in eukaryotes?
Kozak sequence
ASD is associated with what heart sound?
Widely split and fixed S2
MOA of clipopidegrel
Clopidegrel inhibits platelet aggregation by blocking P2Y12 on platelet ADP receptors
MOA of abcimixib
Abciximab is a blocker of glycoprotein (GP) IIb/IIIa receptor which normally promotes platelet binding to fibrinogen.
What is Glanzmann thrombasthenia?
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
On biopsy macrophages with accumulated PAS postive granules are consistent with ____________
Whipple disease
______ is the key regulatory gene for eye and brain development
PAX6
What is von gierke disease?
Glucose 6 phosphatase deficiency which is characterized by hypoglycemia, lactic acidosis, hepatomegaly and hypertriglyceridemia
Tissue damage and resultant abscess formation if primarily caused by _________ release from neutrophils and macrophages
lysosomal enzyme
Exposure to what causes calcification of the rim of hilar nodes (eggshell calcification) and birefringent silica particles surrounded by fibrous tissue?
Exposure to silica
MOA of gabapentin?
Gabapentin is an anticonvulsant that works by inhibiting presynaptic voltage gated Ca channels
MOA of perchlorate and pertechnetate
Perchlorate and pertechnetate are competitive inhibitors of the Na/I symporter
Which hypercholesterol medication increases TGs
Cholestyramine
Adverse effects of acyclovir
Crystal nephropathy (can be avoided with adequate hydration)
MOA and use of entacapone and toltacapone
COMT inhibitors use to reduce peripheral metabolism of levodopa, resulting in increased levodopa bioavailability to the brain
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)
Vascular accidents in utero
__________ is a defense mechanism in which an individual transforms unacceptable feelings or impulses into their extreme opposites
Reaction formation
How do you calculate power?
I - B; B is type 2 error; the probablity of concluding there is no difference when there actually is one
In biostats, what is a?
A is type 1 error, or the probability that the association is due to chance; p-value
In diseases with increased elastic resistance (pulmonary fibrosis, pulmonary edema, ARDS), __________________________ are favored to minimize work of breathing
Rapid and shallow breathes
In diseases with increased airflow resistance (COPD, asthma) __________ are favored to minimize work breathing
slow deep breaths
Tachypnea causes hypocapnea and ___________, thereby decreasing cerebral blood flow and ICP
vasoconstriction
MOA of mifepristone
Progesterone antagonist use for pregnancy termination
Patient presents with uniformly enlarged uterus and heavy menstrual bleeding and dysmenorrhea, what does she have?
Adenomyosis, the presence of endometrial glandular tissue within the myometrium
Mutations in NOD2 gene is associated with what disease?
Crohns Disease
Anticardiolipin antibodies are typically seen in ____________ which is characterized by recurrent venous thrombosis and/or pregnancy loss
antiphospholipid syndrome
The key growth factors that promote angiogenesis in neoplastic and granulation tissue are ______ and _______
VEGF and FGF
How to approach someone with somatic symptom disorder?
Schedule regular visits with same provider
_____________________ 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
Fat embolism syndrome
Which prokaryotic DNA polymerase has 5’-3’ exonuclease actvity, which is used to remove the RNA primer synthesized by RNA primase?
DNA polymerase I
Where does CN V3 exit the skull
Foramen ovale
Where does CN V2 exit the skull
Foramen rotundum
The phrenic nerve originates from what nerve roots?
C3-C5
_______ and _______ are exclusively ketogenic and would not increase the blood lactate levels in patients suffering from pyruvate deh deficiency
Lysine and leucine
In TB, _________ establishes virulence through neutrophil inhibition, mitochondrial destruction and the induced release of TNF
cord factor
A major side effect of linezolid
Peripheral/optic neuropathy, thrombocytopenia, serotonin syndrome
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)
atrioventricular node refractory rate
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
Osler weber Rendu disease (AKA Hereditary Hemorrhagic Telangiectasias) - autosomal dominant
What autosomal recessive disorder presents with long QT syndromes accompanied by congenital neurosensory deafness?
Jervell and Lange Nielsen Syndrome
_______ is an immature defense mechanism involving the misattribution of one’s unacceptable feelings or thoughts to another person who does not actually have them
Projection
What amino acid is the percursor to serotonin?
Tryptophan
What can be used to pharmacologically treat serotonin syndrome?
Cyproheptadine
__________ have a chemical structure similar to pyrophosphate and disrupt osteoclast function by attaching to hydroxyapatite binding sites on bony surfaces
Bisphosphanates
_____________ is the hallmark of microangiopathic hemolytic anemia
Schistocytes
What is the cause of classic galactosemia?
Classic galactosemia is caused by impaired galactose 1 phosphate metabolism due to deficiency of galactose 1 phosphate uridyl transferase
What amino acid becomes essential in homocysteinuria?
Cysteine
__________ recognize stop codons and terminate protein synthesis. They facilitate release of the polypeptide chain from the ribosome and dissolution of the ribosome-mRNA complex
Releasing factor
_____ mediates paraneoplastic cachexia in humans by suppressing appetite and increasing basic metabolic rate
TNFa
_______ calcification occurs in damaged or necrotic tissue in the setting of normal Ca levels
Dystrophic
_______ calcification occurs in normal tissue in the setting of hypercalcemia
metastatic
___________ decreases maternal fatty acid store and increases maternal serum glucose in order to provide adequate glucose to the growing fetus
Human placental lactogen (hPL)
Inferior MI is often due to blockage of what artery?
Right coronary artery; which is why inferior MI often associated with bradycardia because the RCA is responsible for perfusing the SA and AV nodes
Where does the majority of water resorption occur in the kidney?
The proximal tubule, regardless of patients hydration status
Where are the serotonin releasing neuron in the CNS located?
Raphe nucleus
Where are norepinephrine secreting neurons in the CNS located?
Locus ceruleus
Digoxin is used for ventricular rate control in A. fib as it decreases AV nodal conduction by what mechanism?
Increasing parasympathetic vagal tone
________, ___________, ___________ inhibits neuronal high frequency firing by reducing the ability of Na channels to recover from inactivation
Phenytoin, carbamazepine, valproate
Mitral stenosis is almost always caused by _________________
rheumatic fever
What is aniscoria?
Different sized pupils
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
anterior lobes and cerebelar vermis
What type of cancers are patients with Lynch Syndrome predisposed to?
ovarian, endometrial, colon cancers
Patients with what disease should avoid metoclopromide?
Parkinsons
What disease is caused by acid a-glucosidase deficiency; presents with normal glucose levels, cardiomegaly and glycogen accumulation in lysosomes
Pompe Disease
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
COri Disease
Hypocalcemia and hypokalemia can lead to what EKG change?
QT prolongation -> increased risk for torsades
What are the findings of Parinaud syndrome, which is caused by pineal tumor?
Upward gaze palsy, absent pupillary light refltx, and impaired convergence
GI stem cells are located where?
Crypts of leiberkuhn
Cystic hygromas, which manifest as soft, compressible masses that tranilluminate, usually found on head and neck, are most commonly associated what?
Chromosomal aneuploidy (trisomies, Turner Syndrome)
Lactase intolerance results from a _________________ of lactase production by small intestinal enterocytes
normal downregulation
MOA of rituximab
Monoclonal antibody against CD20
Cause of tardive dyskinesia
Medication induced movement disorder caused by the prolonged exposure to dopamine blocking agents causing the upregulation and supersensitivity of dopamine receptors
What is phenotypic heterogeniety?
Phenotypicy heterogeniety describes the process through which mutations in the same gene result in different phenotypes
______ are gastrointestinal hormones produced by the gut mucosa that stimulate pancreatic insulin secretion in response to sugar containing meals
Incretins
___________ results from a defect in the DNA helicase gene RecQL3 and is characterized by photosensitivity, short stature, erythema and telangiectasias
Bloom Syndrome
Which lymphoma is characterized by overexpression of Bcl2 protein?
Follicular lymphoma t(14:18)
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
translocation of GLUT4
Physical exam finding of someone with uncal herniation (cerebellar herniation through the tentorium cerebelli)
fixed and dilated pupil on ipsi side due to CN3 palsy
Hyperammonemia, increased urinary orotic acid secretion
Ornithine transcarbamylase deficiency
Megaloblastic anemia, NO HYPERAMMONEMIA, increased orotic acid in urine
orotic aciduria
The cerebellum is a derivative of what primitive structure?
Rhombencephalon
Purine and pyrimidine synthesis occurs in what part of the cell?
Nucleus
MOA of -gliptans
Used in T2DM, inhibits DPP4 which degraded GLP1 and other incretins, improved glycemic control
What is the Haldane effect?
In lungs, the binding of O2 to hemoglobin drives the release of H and CO2 from Hb
What is Bohr Effect?
In peripheral tissues, high concentrations of CO2 and H+ facilitate O2 unloading from Hb
In patients with liver disease, which benzos can be used to treat alcohol withdrawal?
Benzos that do not undergo oxidative metabolism in the liver and have no active metabolites; LOT - lorazapam, oxazepam, temazepam
B-hCG is typically detectable in the maternal SERUM approximately ________ after fertilization, whereas it is detectable in URINE _______ after fertilization
8 days; 14 days
What medication can be used to treat serotonin syndrome?
Cyproheptadine
Which receptors does naloxone have the greatest affinity for?
Greatest affinity for Mu opoid receptors; tho it does bind to all opiod receptors
MOA for ketamine
NMDA receptor antagonist
MOA of sirolimus
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
MOA of rivaroXAban and apiXAban?
Direct factor Xa inhibitors which bind to the active site of factor Xa and prevent thrombin formation
Stimulation of a2 adrenergic receptors and insulin release?
Inhibits insulin release
Stimulation of b2 adrenergic receptors and insulin release?
Stimulates insulin release
MOA of Ricin
Ricin is a potent toxin that inhbits protein synthesis by cleaving the rRNA component of the eukaryotic 60S subunit
MOA of amatoxins
Amatoxins are found in poisonous mushrooms and are potent inhibitors of RNA polymerase II (halt mRNA synthesis)
What id TdT a marker for?
TdT is a marker for immature lymphocytes, both T and B cells
What is the first line treatment for essential tremor?
Propanalol
What 2 mechanisms do B-blockers use to reduce BP?
- Reduce HR and myocaridal contractility
2. Decreased renin release by kidney
MOA of carbidopa in Parkinson treatment
Adding carbidopa inhbits the peripheral conversion of levodopa, making more of it available to the brain; reduces the peripheral side effects of levodopa
Side effects of low potency typical antipsychotics (chlorpromazine, thioridazine)
Sedation, anticholinergic SE, orthostatic hypotension
Side effects of high potency typical antipsychotics (haloperidol, fluphenazine)
Extrapyrimidial symptoms (acute dystonia, akathesia, parkinsonism)
What population is genetically predisposed to developing drug induced lupus
Slow acetylators
Isolated systolic HTN is due to age related ___________________________
Stiffness and decrease in compliancee of the aorta and major peripheral arteries
What is the major virulence factor H. influenzae type b?
Capsule consisting of polyribosylribitol phosphate (PRP)
Maculopapular rash that starts on face and spreads to the trunk and extremeties with postauricular lymphadenopathy
Togavirus rubella
In muscles, what causes the activation of phosphorylase kinase, which stimulates glycogen phosphorylase to increase glycogenolysis?
Increase in intracellular Ca2+ and epinephrine acitivates phosphorylase kinase in muscles
In liver, what causes the activation of phosphorylase kinase, which stimulates glycogen phosphorylase to increase glycogenolysis?
Epinephrine and glucagon
What is uterine atony?
Failure of the uterus to contact adequately after delivery; the most common cause of postpartum hemorrhage
A dense interstitial mononuclear infiltrate is characteristic of _______________ rejection
acute cellular rejection
Vascular fibrinoid necrosis and neutrophil infiltration of arterioles, glomeruli and peritubular capillaries are characteristic of ______________ rejection
hyperacute rejection
Obliterative intimal thickening, tubular atrophy, and interstitial fibrosis is characteristic of ________ rejection
chronic rejection
________ is a physiologic decoy receptor that decreases binding of RANKL to RANK
osteroprotegerin
Rugae thickening with acid hypersecretion is characteristic of what?
Zollinger ellison syndrome
Rugae thicking WITHOUT acid hypersecretion is characteristic of what?
Menetrier disease
A positive lepromin skin test in someone with leprosy indicates what?
Tuberculoid leprosy as they exhibit a strong CD4 TH1 cell mediated immune response to M. leprae
A negative lepromin skin test in someone with leprosy indicates what?
Lepromatous leprosy; due to their weak TH1 cell mediated immune response
Most anal fissures occur where?
Most anal fissures occur at the posterior midline of the anal verge
Long term acid suppression with proton pump inhibitors may be associated with an increased risk of osteoporotic hip fractures due to what?
Due to decreased Ca absorption
MOA of baclofen
Baclofen is an agonist at the GABA-B receptor; used for treatment of spasticity
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
germinal matrix
________ the rate limiting enzyme that catalyzes the first step in fatty acid synthesis
Acetyl CoA carboxylase
Insulin increases glycogen synthesis by activation of which molecule?
Insulin promotes glycogen synthesis by activating protein phosphatase, an enzyme that activates glycogen synthase by dephosphorylating it
Naltrexone as pharmacotherapy for alcohol abstinence
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
________ acts as a partial neuronal nicotinic receptor agonist and prevents nicotine stimulation of the mesolimbic dopamine system associated with nicotine addiction
Varenicline
____________ 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
The anterior cerebral artery
________ is a polypeptide synthesized by the liver that acts as the central regulator of iron homeostasis
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
What is parinaud syndrome?
Parinaud syndrome is a vertical gaze palsy caused by a tumor of the pineal gland which compresses the vertical gaze center at the MLF
Antidote for TCA toxicity?
Sodium bicarb
What is the toxic components of LPS?
Lipid A
What is schizoaffective disorder?
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
Where in the nephron is most of K resorbed?
Proximal tubule then thick ascending limb
Damage of what nuclei cause PURE contralateral SENSORY loss?
Ventral posterior thalamus: VPL (sensory from body), VPM (sensory from face)
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
M cells
_________ is an allosteric activator of gluconeogenesis that acts by increasing the activity of pyruvate carboxylase when it is abundant
Acetyl coa
________ is an inducible enzyme that is upregulated to increased the synthesis of pro-inflammatory arachidonic acid metabolites
COX2
Treatments of akathesia due to antipsychotics
Benzo or B-blocker
What vitamin deficiency can occur due to ingestion of raw white eggs?
Vitamin B7 (biotin); raw white eggs have avidin
_________ 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
Thoracic outlet syndrome
The _________________ is a measure of the potency of an inhaled anesthetic
Minimal alveolar concentration (MAC); potency is inversely proportional to the MAC: the lower the MAC, the more potent the anesthetic
________ released by eosinophils normally functions to kill helminths
Major basic protein
Giving thrombin to someone with hemophilia leads to what?
Clotting
________ is associated with exposure to carcinogens such as arsenic, thorotrast and TVC. Tumor cells express CD31, an endothelial cell marker
Hepatic angiosarcoma
_________ colon adenocarcinoma are more likely to bleed and cause iron deficiency anemia
right sided
_________ colon adenocarcinoma are more likely to present with obstructing symptoms
left sided
CNS tumors of neuronal origin frequently stain positively for _________ on immunohisto
synaptophysin
Renal oncocytomas arise from __________
collectng duct cells
RCC arises from epithelial cells of _____________
proximal renal tubules
What culture medium is used to culture B. pertussus
Bordet-Gengou
C diphtheraie is cutlured on ________
cysteine tellurite agar
Triad of cardiac tamponade
JVD, hypotension, muffled heart sounds
What is the first area damaged during global cerebral ischemia?
The hippocampus
Lesions to the macula cause what?
central scotoma
Which laryngeal muscle is innervated by external branch of the superior laryngeal nerve?
Cricothyroid muscle; the external branch of the superior laryngeal nerve is
HBV assists with which life cycle aspect of HDV?
Coating of viral particles - necessary for penetration of hepatocyte
Chronic lithium toxicity (confusion, ataxia, tremor) can be precipitated by volume depletion and which drugs?
Thiazide diuretics, ACE inhibitors and NSAIDs
During times of starvation, what enzyme provides substrates for hepatic gluconeogenesis and ketone body formation?
Hormone sensitive lipase
Loss of cardiomyocyte contractility occurs within _______ after onset of total ischemia
60s
After about ______ of total ischemia, ischemic injury to heart becomes irreversible
30min
The portal triad which consists of the hepatic artery, portal vein, and common bile duct run through what?
Hepatoduodenal ligament
MOA of fenoldopam
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
Which form of Rb is active?
Hypophosphorylated Rb is active
The rubber like properties of elastin are due to what?
Interchain cross links involving lysine which is facilitated y lysyl oxidase
Acute ureteral constriction or obstruction _______ the GFR and filtration fraction
decreases
_____ pigment stones are associated with biliary tract infections (microbes produce B-gluconidases)
Brown
______ pigments stones occur in the setting of chronic hemolysis and increased enterohepatic cycling of bilirubin
black
What is the SVC derived from?
The common cardinal veins
MOA of desmopressin in von willebrand disease and Hemophilia A
DDAVP significantly increases circulating factor 8 levels and also stimulated vWF secretion from endothelial
Which hypercholesterolemia medication increase TG levels? (via increased VLDL)
Cholestyramine
MOA and use of evolucamab
Evolucamab binds PCKS9 and prevents degradation of LDL receptors, increasing uptake of circulating LDL
In T2DM, what contributes to insulin resistance?
Chronically elevated free fatty acid levels
What is cholinergic crisis in MG?
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
_______ 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
Rett syndrome
Tetrahydrobiopterin is a cofactor in the synthesis of what molecules?
Serotonin, tyrosine, DOPA
Exogenous secretin _______ gastrin release from gastrinomas (ZES)
stimulate; in normal patients, secreting inhibits gastrin from normal gastric G cells
In left ventricular failure, fluid accumulation in the lung interstitium results in __________ compliance
decreased
GLUT4 receptors are on what types of cells?
Skeletal muscles and adipocytes
In patients with tetrology of fallot, what is the major determinant to the degree of right to left shunting and resulting cyanosis?
The degree of right ventricular outflow tract obstruction
MOA and use cilostazol
Cilostazol is a PDE inhibitor that is occasionally used in patients with symptomatic peripheral vascular disease
H pylori can cause duodenal ulcers and is typically found in greatest concentration in the _________________
prepyloric area of the gastric antrum
Injury to what artery due to a displaced femoral neck fracture can cause osteonecrosis of the femoral head
Medial femoral circumflex artery
Adverse effects of methimazole and PTU
Both can cause agranulocytosis;
methimazole is a teratogen, and can cause cholestatis
PTU can lead to hepatic failure (can use PTU in pregnancy)
MOA of aprepitant
NK1 receptors antagonist used in chemotherapy induced emesis
MOA of metoclopromide
Dopamine receptor antagonist used in diabetic gastroparesis and chemo induced emesis
Damage below the red nucleus results in what?
Decerebrate (extensor) posturing; loss of descending excitation to the upper limb flexors and extensor predominance
Damage above the red nucleus results in what?
Decorticate (flexor) posturing; loss of descending inhibition of the red nucleus and subsequent hyperactivity of upper extremity flexor muscles
What hemoglobin is predominant in the first few months of life?
HgF (A2G2)
BMI formula
BMI = (Weight in kg)/(Height in m^2)
Which Vitamin gets depleted in measles?
Vitamin A
