Step 1 UW mix -A-1 Flashcards
1
Q
HIV pt with pnuria, glucosuria: intacytoplasmic esoinophilic inclusion@ PCT, Dx?
A
Tenofovir- induced nephotoxicity: AKI + PT dysfunction
NRTIs
el via PCT interfere mito DNA synthesis + cellular damage
2
Q
Exercise, increase expected at peak of exertion?
A
increase Venous blood mean CO2 content
inc oxidative metabolism of Glc + FA in skeletal muscle
Vasodilation skeletal muscle-> dec SVR, Ph
inc HR, SV, CO
Arterial O2 + CO2 remains constant
3
Q
ARP in exp ?
A
ARP exposed= 100 * (risk in exp - risk in unexp) / risk in exp)
4
Q
TOF, squatting position relieves child sym via?
A
inc SRV -> forces higher proportion of RV output to enter the pul circulation & oxygenate in pul capillary by inc arterial O2 concentration, relieve tet spell
5
Q
Panic disorder, Rx?
A
SSRI/ SNRI
acute : BZD ( risk for abuse pt)
6
Q
paget dx, initial phase?
A
1st: inc Osteoclast
2nd: mix
3rd: osteoblast (lab: inc ALP)
7
Q
pt with DM2, upregulation which will improve fibroblast proliferation + reepithelization in nonhealing wound?
A
inc IL-10 + GF: inhibits inflammation allow healing process
8
Q
CDK 4/6 reg G1-> S phase ( cyclin D), SE?
A
palbociclib:
inhibit hematologic cells in BM -> neutropenia, anemia, thrombocytopenia
9
Q
Test: Compare the diff btwn the MEANS of 2 or more gps?
A
ANOVA
t-test : use for 2 tests compare btwn the means of 2 gps
Meta-analysis: pooling data from several studies to perform analysis with greater statistical power than ind studies alone
Chi-square test: evaluate asso btwn 2 categorical variable ( quantitative)
10
Q
Esophageal varies - chronic shunting blood thru vein?
A
Esophageal varices: left gastric vein ( portal) - esophageal vein ( systemic)
caput medusa: paraumbilical vein (portal) - sup + inf epigastric vein ( systemic)
11
Q
traveler’s diarrhea , moa?
A
ETEC: self limited
plasmid-encoded heat labile - resembles cholera toxin (Gs- inc intracellular cAMP in gut mucosal cell)
/ heat stable enterotoxin
12
Q
shiga-like toxin, moa?
A
inactivating 60S ribosomal subunit in human cell -> bloody diarrhea mucosal cell death
13
Q
alterd FAS pn, moa?
A
alternative splicing - single gene code for unique pn by selective inc / excluding diff DNA exon
14
Q
ubiquitination, moa?
A
small regulatory pn, making them pn degradation
15
Q
WPW syn, moa?
A
accessory conduction pathway- accessory bypass AV node tract / bundle of kent - preexcitation of ventricles
16
Q
nephrotic syn, frothy app urine moa?
A
dec plasma oncotic pressure, dec serum albumin
17
Q
+ KIT ( CD 117) , excessive histamine , flushing, diarrhea, dx?
A
systemic mastocytosis- clonal mast cell proliferation + kit receptor TK mutation
18
Q
needle along upper border 10th ribs @ rt omidaxillary line, injury what st?
A
Rt hepatic injury
- intercostal vein, artery, nerve lie in subcostal groove along the LOWER border of the rib- thoracentesis should perform just ABOVE the upper border of the rib
19
Q
tolerance to med due to?
A
receptor internalization, tachyphylaxis -
alpha & beta adrenergic receptors undergo confirmation change on ligand binding, allow activate heterotrimeric G pn inv signal transduction.
confirmation change result binding arrestin, prevent further G pn activation
20
Q
lateral epicondylitis - injuried causes?
A
wrist extension ( tennis elbow) injury - pt of attachement for extensor carpi radialis brevis & extensor digitorum
21
Q
mannitol, moa ?
A
inc plasma / tubular fluid osmolarity -> causes water to move from interstitial space to vascular space/ tubular lumen
Eg. water redistribution from tix -> plasma -> reduce cerebral edema & dec ICP
se/ further water + K move out of cell & brain -> worsening pul vasculature - pul edema
22
Q
Rx for pn + septic shock ?
A
isotonic crystalloid 0.9% saline / lactated ringer soln
vs/ 0.45% half normal saline hypotonic ;
5% dextrose in 0.45% saline -> hypertonic initially becomes hypotonic
—> use in low infusion rate for hypernatremia / maintenance hydration, not effective for rapid voln resusciaton cuz low Osm causing fluid voln shift into intracellular space
23
Q
pseudomembranes consist neutrophil- predominant inf infiltrate, fibrin, bacterial, necrotic epi, organism?
A
clostridium difficile
moa/ toxin A ( enterotoxin) ; toxin B ( cytotoxin) - toxin disrupt cellular cytoskeleton + intercellular tight junctions
se/ dev non-ob colonic dilation - toxic megacolon -> colonic perforation
24
Q
salmonella typhi, sym?
A
bloody diarrhea, abd pain, high fever, salmon- colored macules
lymphoplasmacytic inf infiltrate asso w/ hemorrhage
25
shigella flexneri, syn?
sudden onset severe abd cramping, bloody diarrhea, vomiting, high fever
cryptitis, ulceration, crypt abscesses
26
RNA no proofreading?
No 3' -> 5' exonuclease activity
27
5' -> 3' exonuclease activity ?
DNA polymerase I to engage in nick translation, DNA repair + removal of RNA primers during replication
28
sick sinus syn- age degeneration loc?
older pt > 65 yo
exp progressive fatigue, syncope
SA node - RIGHT ATRIAL WALL initating normal cardiac conduction
moa/ bradycardia w/ delayed P waves, sinus arrest (prolong P wave -> P wave dropped), junctional escape beats ( narrow QRS complex preceded by long pause + no P wave)
sym/ dec CO, dyspnea, fatigue, LH, syncope
29
AV block, loc?
inf portion of INTERATRIAL SEPTUM contain the His bundle
30
Thiazolidinediones?
Pioglitazone
mao/ + PPAR-gamma , dec insulin resistance
se/ fluid retention/ HF,
WG
31
inc CO, inc VR , dx?
chronic AV fistula-
acutely: dec TPR -> inc CO & inc VR & inc Mean sys pressure
overtime SNS & kidney compensate for chronic fistula by inc cardia contractility, vascular tone, circulating BV
32
acute GI bleeding, physio change?
sharp dec circulation BV, shift VR to left
33
phenylephrine infusion, physio change?
inc SNS+ -> vasoconstriction, inc TPR
| dec CO due to inc afterload along with dec VR
34
MI, physio change?
isolated dec CO, no change in BV/ VR
35
anaphylaxis, physio change?
widespread venous + arterial dilation with inc capillary permeability into 3rd space of fluid --> significant drop in VR
36
cavenous hemangioma ?
MC benign liver tumor, typically in 30-40 yo
37
piriformis syn?
pass thru greater sciatic foramen inv external hip rotation- sciatic nerve entrapment
38
Denosumab, moa?
works like OPG -> binds RANK-L (osteoblast) and prevents interaction with nuclear factor kappa B RANK receptor ( on osteoclast) -> dec osteoclast diff + activity -> dec bone resorption
39
aplastic anemia, hx?
hx/ profondly hypocellular BM infiltrated with adipose
sym/ pancytopenia
etio/ injury from drugs, radiation, viruses, multipotent hematologic stem cells
40
primary myelofibrosis, hx?
hx/ BM fibrosis with colonal expansion of megakaryocytes. dacrocytes
BM dry with fbrosis + atypical megakaryocytes
sym/ HSM, cytopenia,
41
girl with 46 XY, lack 2ndry sexual char' + blind vagina, dx?
17a- hydroxylase def
CAH - unable to converts pregenolone -> 17- hydroxypregenolone + progesterone
impairs synthesis androgen, estrogen, cortisol
does NOT inhibit mineralocorticoid production -> inc aldosterone
high ACTH cuz low cortisol
42
5a- reductase def, causes?
hormones def conversion of testosterone -> dihydrotestosterone
resp fusion of labial folds in male fetal dev
phy/ male infant: ambiguous genitalia at birth, normal sexondary sexual char at puberty
43
rivaroxaban, apixaban, mao?
direct oral anticoagulant-direct Factor Xa inhibitors
- less variability in therapeutic effect compare to warfarin
* lab monitoring is NOT required vs. warfarin need monitoring w/ INR
rx/ DVT
prophylaxis/ AF, stroke
44
eptifibatide, moa?
inhibits pt aggregation + thrombosis : blocking Gp2b/3a receptor, binding site for fibrinogen
rx/ ACS + PCI
45
Dabigatran, moa?
oral direct thrombin inhibitor that inactivates both circulating + clot asso thrombin
Rx/ thromboembolic dx + stroke prophylaxis
46
terbinafine, moa?
inhibiting enz squalene epoxidase : inhibits synthesis of ergosterol of fungal membrane
47
nystatin, amp B, moa?
binding to ergosterol
48
flucytosine, moa?
inhibits fungal protein synthesis by replacing uracil with 5-FU in fungal mRNA
rx/ systemic fungal infection
49
griseofluvin, moa?
binds to polymerized microtubules and disrupts fungal mitotic spindle, preventing fungal cell mitosis
rx/ dermatophytosis
50
fungemia: candida systemic infection, moa?
low neutrophil count, hematogenous spread via indwelling CV catheter
** DOES NOT spread to resp
51
superificial Candida inf ( oral/ esophageal/ cutaneous/ vulvovaginitis), moa?
T lymphocytes - Th cells
eg. HIV low T cell count inc risk
52
riboflavin def, effect on TCA cycle ?
succinate dehydrogenase ( complex II) affected : FMN + FAD
53
atypical pn - mycoplasma pn/ chylamdia pn, moa?
completely lacks a cell wall
rx with/ bacterial pn synthesis inhibitor
eg: macrolide/ tetracycline
54
TB, rx isoniazid, moa?
isoniazid: mycolic acid synthesis inhibitor - cell wall of mycobacterium
55
pul arterial HTN hereditary, moa?
dysfunctional endothelial + SM cell proliferation
--> vasoconstriction, anti-proliferative meditators ( NO, Prostacyclin)
Heart sound: sound S2 , RVH, elevate JVP, hepatic congestion, peripheral edema
56
Rifaximin, moa?
dec inraluminal ammonia production
rx/ hepatic encephalopathy, cirrhosis, asterixis, astrocyte dysfunction, neuroinflammation, edema
combine + lactulose -> cat' by intestinal bact flora to short chain FA -> lowering colonic Ph + inc conversion of ammonia -> ammonium
57
azathioprine, moa? check lab?
inhibits purine synthesis pathway
azathioprine -> 6-mercaptopurine converted to 6-thioguanine met
lab/ pancytopenia monitor complete blood count
58
montelukast, zadirlukast, moa?
leukotriene receptor antagonists:
| inhibit the CysLT1 receptor ( LTC4, LTD4, LTE4) at target cell
59
PECAM-1 gene delection, causes?
absent of Transmigration
60
P-selectin / E-selectin def?
Margination- increase vascular leakage in the microvasculature / Rolling on endothelium viz Sialyl-Lewis X
61
ICAM-1 (CD34) def?
tight adhesion
62
neck mass w/ Sq cell CA, primary site?
nasopharynx - anterior cervical LN
unilateral middle ear effusion - eustachian tube obstruction
vs/ vocal cords , bast tongue, piriform sinus - not ob eustachian tube
63
orthomyxoviruses, transmitted to human thru animals via?
Genetic reassortment: segmented genome, HA, NA
64
antigenic drift?
point mut HA, NA genes slightly alter product pns
65
frameshift mutation?
number of bases that are NOT multiple of 3 are added / deleted from coding region of a gene- premature termination of translation + truncated pn containing wrong AA
66
phenotypic mixing?
2 viruses infect the same cell and progeny viruses exhibit coat / env
pn NOT coded for by genetic material
67
QT prolongation causes?
Med-
Antiarrhythmic: Class IA (quinidine), III (dofetilide)
aB: macrolides, fluoroquinolones
anti-psyChotic: haloperidol
Anti-Depressant: TCAs
anti-Emetics: ondansetron
electrolytes abnormalities
68
isopropanol 70% disinfect skin, moa?
disruption of cell membrane, denaturation of pn- no sporicidal
69
Iodine, moa?
halogenation of pn & nucleic acids, sporicidal
70
H2O2, moa?
produces destruction free radicals that oxidize cellular components, sporicidal
71
formaldehyde, glutaraldehyde , moa?
alkylating + cross linking DNA + pn
72
Mullerian aplasia ( mayer -Rokitansky-Kuster-Hauser) syn, moa?
variable uterine dev, no upper vagina ( short), primary amenorrhea, normal ovaries, regular secondary sexual char', 50% coexist unilateral renal agenesis
*normal dev fallopian tubes, uterus, upper vagina
46XX female
73
CAH- 21 hydroxylase def?
female : virilization, salt wasting ( dec BP)
male: precocious puberty , salt wasting
74
androgen insensitivity syn ( AIS) ?
46 XY male, appear phenotypically female due to androgen receptor defect
sym/ minimal axillary / pubic hair, cryptochid testes, no uterus/ ovaries
75
integrase inhibitor, moa?
disrupts the ability of ds HIV DNA to integrate into host cells chrm
inhibits viral mRNA production- viral genome cannot be transcribed by host cellular machinery
76
IgE independent mast cell + due to?
more common:
| opioids, radiocontrast agents, VNC- induce mast cell degranulation by activation of pn kinase A + PI3 kinase
77
IgE -dependent mediated degranulation due to?
food, vespid stings, beta-lactam + sulfonamide ab
78
Donepezil, moa?
acetylcholinesterase inhibitors - reduction in Ach breakdown
ENHANCE ACH + PNS TONE
se/ slowing cardiac conduction: bradycardia, AV block , dec CO -> syncope, LH
79
diphenhydramine, moa?
first gen histamine -1 blocker - alpha 1 receptor blocking : orthostatic syncope via inhibit vasoconstriction
80
succinylcholine, moa?
competitve agonist nicotinic Ach receptor of motor endplate- persistent depolarization-> desensitization + skeletal muscle paralysis
rapidly hydrolyzed by plasma pseudocholinesterase
** pt with pseudocholinesterase def will unable to met' succinylcholine -> paralysis for hrs
81
DRE, prostate biopsy ?
85% peripheral zone - prostate adenocarcinoma
transrectal route US, multiple random biopsies of prostate
** central zone: surrounds vas deferens, stroma elements
** transition zone: surrounds urethra - primary site for BPH
** FNA - not recommended- tix architecture lost in sampling
82
prostate adenocarcinoma MTS, hx?
osteoblastic mts, related to advancing age.
sym/ late stage of hematuria + urinary ob (dysuria)
hx/ IRREGULAR glands with enlarge nuclei + prominent nuclei, cellular atypia
-osteoblast differentiation factor ( endothelin 1, ILGF, PDGF, bone morphogenic
83
osteolytic bone lesion, dx?
moth eating appearance: pleomorphic cells - melanoma ( brown melanin pigment)
- MM ( effacement marrow with plasmablasts + plasma cell
- RCC ( abundant clear cytoplasm)
- thryoid papillary ca ( complex papillary pattern, psammoma bodies)
84
prostate ca, gleason grade, stage?
Gleason grade- degree of cancer cell atypia
highest is 5 - poorly differentiated: sheets of invasion cells with no glandular elements
stage: degree of spread from site of cancer origin
higher stage- mts to LN / organs
85
beta -adrenergic activity ?
inc Na/K/ATPase pump -> endogenous catecholamines + b2 agonist -> transiet hypokalemia -> inc transport K+ intracellulary
86
andexanet alfa , moa?
rx/ life threatening bleeding while on factor Xa inhibitor (rivaroxaban, apixaban) but no proteolytic effect
moa/ function to decoy that binds to factor Xa inhibitors -> restores IV coagulation by inc available endogenous FXa -> converts prothrombin -> thrombin generates fibrin clots
87
ticagrelor , moa?
blocks P2Y12 adenosine diphosphate receptor on surface of pt, prevents pt aggregation
88
Dabigatran, moa?
direct oral anticoagulant inhibits circulating + clot bound thrombin.
reverse by idarucizumab ( monoclonal ab fragment that binds & inhibits dabigatran)
89
supersaturation of gallstone, moa?
1. inc cholesterol synthesis - hypercholesterolemia: OBESITY ( inc HMG-CoA reductase activity), med, DM, diet, genetics
2. gallbladder hypomotility - pregnancy, med, prolong fasting
3. inc ca+/ mucin concentration- rapid WL inc ca+/ mucin conc in bile, trap cholesterol crystal + promote stone formation
4. dec bile acid synthesis/ recirculation- fibrates inhibit BA syn, inc chol conc in bile, dec bile resorption at ileum
90
buserelin/ goserelin/ leuprolide, moa?
GnRH analogue: stimulates pituitary gland in continous fashion lead to down regulation of GnRH receptor -> subsequently drops LH secretion, lowers androgen production by testes.
91
bicalutamide, moa?
androgen -receptor inhibitors - to prevent the surge in androgen during the first few weeks to block the activity of androgen on tumor cells
92
heparin, lab? thrombin time/ PTT/ FXa ?
moa/ anticoagulant effect indirectly by binding to antithrombin III (AT), serine protease inhibitor that irreversibly neutralizes clotting factor.
lab/
- thrombin time prolong
- PTT prolong
- activity factor Xa dec
93
abiraterone, moa?
irreversibly inhibits 17-a hydroxylase
prostate adenoCa - androgen sensitive tumor, mainly produced from tested + some from adrenal glands via exp 17-a hydroxylase , c-p450 enz that converts pregnenolone/progesterone into DHEA/ androstenedione
94
true GFR, compared to Cr?
GFR 20% lower that Cr
GFR - ideal filtration marker that is freely filtered acaross glomerulus not metabolized, secreted/ reabsorbed
Cr- waste product generated from breakdown of creatine kinase in SKELETAL MUSCLE MASS- actively secreted by PCT; overestimates the GFR
95
defect in TTN gene exon result truncated titin pn, dx?
dilated CMP - dec in contractile function of one/ both ventricles with consequent increase in ventricular cavity size
idiopathic DCM/ familial DCM- AD
causes SCD from vent arrhythmia (vent tachy , V fib)
** titin: elastic pn that anchors the beta- myosin heavy chain to Z discs and contributes to passive myocardial tension, absence of complete titin pn leads to myocardial dysfunction
96
HOCM, moa?
AD, mut genes encoding beta- myosin heavy chain / myosin binding pn C
97
restrictive CMP, moa?
infilitrative dx, inc mut in genes encoding 1/ several sacromere/ cytoskeletal on
98
property of elastin?
interchain cross - links inv lysine
emphysema:
a-1 antitrypsin def conseq dev excessive alveolar elastin degration
** after tropoelastin formed, secreted into ECS interact with microfibrils ( fibrillin) function as scaffold.
lysyl oxidase , Cu-dep enz, oxidatively deaminated some lysine residues of tropoelastin, facilitating formation of desmosine cross-links to hold elastin molecules tog
99
ECG: ST elevation in lead I + avL, which arteries occlusion?
left circumflex artery- lateral limb leads : also in v5-v6
ecg/ st elevation/ q waves
100
LAD arteries, leads?
supply left vent + IVS septal branches: v1-V4 ( promixal occlusion)
distal occlusion spares V1-2
101
left main coronary artery, leads?
give rise to LAD + LCX : v1-4, v-6, I, avL
102
RCA , leads?
lead II, III, avF
103
chancroid , haemophilus ducreyi, hx?
sym/ multiple + deep ulcers, base have gray to yellow exudate, PAINFUL lesion
hx/ RAGGED BORDERS asso with grey exudate + inguinal LAD
104
granuloma inguinale ( donovanosis), hx?
klebsiella granulomatis
hx/ extensive & progessive ulcerative lesion W/O LAD, base have granulation-like tix, deep staining gram - intracytoplasmic cysts (Donovan bodies)
NOT painful
105
Lymohagranuloma venerum, chlamydia trachomatis, his?
hx/ small, shallow ulcers, large, painful, coalesced ingiunal LN ( buboes), intracytoplasmic chlamydial inclusion bodies in epi cell & leukocytes
NOT painful
106
Zidovudine, moa?
enz grows DNA by adding nucleotides to terminal 3'- hydroxyl gp using 3'-5' phosphodiester bond.
NRTI: dec risk of perinatal transmission by inhibiting Phosphodiester bond formation
* * NRTI: must be phosphorylated within host cell to form the functional triphosphate moiety.
* ** NNRTI: bind directly to + inactivate RT without being phosphorylated
107
GFAP + stain for, Dx?
neoplasms of glial origin : astrocytomas, ependymomas, oligodendrogliomas
108
synaptophysin, stain for dx?
transmembrane glycopn found in presynaptic vesicles of neurons, neuroendocrine, neuroectodermal cells
109
anastrozole, moa?
dec androgen aromatization: dec syn of estrogen from androgen, suppressing estrogen level in PM woman
rx/ slowing progression ER + tumor
110
basophilic cytoplasm + proliferation fraction Ki-67 fraction , dx?
EBV - asso with Burkitt lymphoma ( induce B cell proliferation)
hx/ starry sky appearance , benign macrophages
t( 8,14) translocation, overexp c-MYC, transcriptional regulator controls cell proliferation, high mitotic index
111
HHV-8, hx?
primary effusion lymphoma, large cells, big nuclei, prominent nucleoli
112
case fatality rate?
fatal / fatal + nonfatal cases
113
cilostazol, moa?
reduce pt activation by inhibiting pt phosphodiesterase, enz resp for breakdown of cAMP
direct arterial vasodilator, dec claudication sym PAD
114
destroy ectopic focus rx arrhythmia, nerve close proximity site?
phrenic nerve- PSVT radiofreq ablation
crista terminalis loc @ RA
injury cause elevation of rt hemidiaphram CXR
115
Sym trunk injury?
parallels spina column on both sides provide sym innervation throughput body.
sym/ horner syn ( miosis, ptosis, anhydrosis)
116
CHF , moa?
dec CO in HF, dec renal perfusion, dec baroreceptor --> + neuroendocrine compensatory mech to maintain organ perfusion
--> inc afterload, inc preload
compensatory mech --> inc SNS + inc arteriolar resistance & inc vasoconsriction + voln retention --> RAAS --> inc ANP/BNP -> vasodilation, salt water excretion
117
delay ASA toxicity, lab?
primary resp alkalosis - stimulate medullary resp center -> inc ventilation + loss CO2 in expired air
primary AG met acidosis - toxic salicylate inc lipolysis , uncouple oxidative phosphorylation, inhibits citric acid cycle. Acc organic acids in blood ( ketoacids, lactate) inc AG
```
lab/ Ph normal
Paco2 dec ( inc RR)
plasma Hco3 dec ( met acidosis)
```
118
hepatic steatosis, moa?
dec free FA oxidation : secondary to excess NADH production by alcohol dehydrogenase & aldehyde dehydrogenase
**impaired lipoprotien assembly ass with alcohol -induced hepatic steatosis
119
bisacodyl/ senna, moa?
stimulant laxatives - activates enteric nerve in myenteric plexus to stimulate peristalsis
se/ abdominal disturbances
120
dousate ( surfactant), moa?
dec stool surface tension, enabling water to enter stool
121
methynaltrexone, moa?
mu -opioid receptor antagonist , rx opioid induced constipation
122
mg hydroxide, polyethylene glycol, lactulose, moa?
osmotically active agents that are poorly absorbed by the intestines.
draw water into intestinal lumen, softening stool + make stool easier to pass
123
Lupiprostone, moa?
agonist of CIC-2 chloride channel loc at apical membrane of intestine, inc Cl secretion into intestinal lumen
124
diabetic neuropathy, moa?
endoneurial arteriole hyalinization --> narrowing arteriole lumen + ischemia nerve damage, glycosylation end products are directly toxic to nerve tix
125
GB syn, moa?
endoneurial inflammatory infiltration of peripheral nerve, rapid ascending paralysis , segmental demyelination
126
CTS, moa?
entrapment of nerve w/in anatomic compartment leads to compression neuropathy
127
beam radiation ( gamma, x-ray), moa?
Double strand DNA breaks - breakage of both strands is generally req
free radical formation: ROS formed by ionization of water, oxygen free radicals are then able to caouse cellular and DNA damage
128
UV light radiation, non-ionizing radiation, moa?
EG. XP
pyrimidine-pyrimidine dimers ( thymine dimers)
ionizing radiation has higher energy to remove electron leaving more cell damage
129
cephalosporins resistance , moa?
extended spectrum beta lactamase ( ESBL) - producing e. coli
genes encoding these enzymes often located on plasmids + transferred btwn organism + diff species thru conjugation
Rx/ carbapenems - ESBL producing orgamism
130
methicillin resistance in S. aureus, moa?
PBP alternation- reduced AFFINITY for b-lactam anti-microbrial agents: resistant to all b-lactam agents
131
fluoroquinolone resistance, moa?
mut DNA gyrase, not impact beta-lactam ab activity
132
VNC resistance , moa?
D-ala-D-ala cell wall precursor -- D-ala-D-lac
133
personality, behavior change, brain injury which loc?
orbitofrontal cortex
134
lateral prefrontal cortex injury?
injury result unable to executive function, motivation , organizing, planning purposeful action
135
irreversible myocardial cell injury, moa?
mitochondrial vacuolization - permanent inability to generate further ATP via oxidative phosphorylation
** mito swelling -> reversible cellular injury
136
dissociation of rRNA from mRNA reversible ischemic/ hypoxic injury, moa?
disaggregation of polysomes denotes the dissociation --> into monosomes--> impairs pn synthesis
137
single brain abscess @ lateral temporal lobe, loc entry?
ring enhancing lesions with HA, fever, seizure
single abscess - spread to mastoid air cells --> invade temporal lobe leading to temporal lobe abscess
** frontal lobe abscess --> direct spread of ethmoid / frontal sinusitis
** multiple brain abscess - hematogenous dissemination from a distant infection ( endocarditis/ empyema)
138
ependymoma, ob where in brain ?
arise from ependymal cells of ventricular system + central canal of SC produce CSF --> ob non-communicating hydrocephalus --> inc ICP, dilated ventricles
hx/ ependymal cells palisading around BV ( perivascular pseudorosette)
choroid plexus tumor also found in lateral ventricles
139
statin + cholestryamine, : hepatic cholesterol synthesis ?
statin: inhibit HMG Co reductase --> DECREASE hepatic chol synthesis --> inc hepatic clearance LDL --> inc LDL receptor recycling
se/ statin induce MYOPATHY
cholestyramine: binding bile acids in GI tract --> inc BA excretion --> INCREASE hepatic syn of new BA --> INCREASE TG level
140
diabetic ketoacidosis , TG metabolism?
glycerol kinase : glycerol + FA ( via beta -oxidation --> Ketone acids) --> glycerol 3- phosphate --> DHAP --> energy + glucose
141
pleiotrophy, moa?
single genetic defect causing different organ system affected
eg. homocystinuria
142
Polyploidy, moa?
more than 2 complete sets of hormones w/in an organism / cell
eg. 69 XXX. XXY, XYY - partial hydatidiform mole
143
rituximab, moa?
express CD20 surface Ig monoclonal ab
rx/ lymphoma immunotherapy
** transtuzumab - also monoclonal ab rx breast cancer
144
imatinib, moa?
CML - phil t (9, 22) - BRC-ABL fusion gene pn TK
145
chylothorax , injury to ?
throacic duct, due to cervial LN removal - milky white, inc TG
orginates at level T12 in abdomen - superiorly thru mediastinum ( posterior to esophagus) and drains into the junction btwn left subclavian + JV in lower neck
**Thoracic duct collect lymph from most of the body, all left tix and inf rt tix)
** right lymphatic duct : drain right side head, arm, thorax
146
phrenic nerve injury?
elevation of hemidiaphragm
147
isoniazid toxicity, cause?
hepatotoxic, hepatitis
lab/ inc ALT/ASL
148
serum sickness drug HS causes?
Type 3 HSR
5-10 days after exposure the drug, fever, proteinuria, LAD, urticaria, arthralgias,
149
autoimmune hepatitis, hx?
high anti-smooth muscle ab titers + hypergammaglobulinemia
hx/ hepatocellular pattern of liver injury, lymphoplasmacytic infiltrate in portal and periportal region
150
primary sclerosing cholangitis, hx?
MC male
periductal FIRBOSIS + luminal obliteration of biliary ducts --> cholestasis
high ALP level , near normal aminotransferase
151
chronic HBV, hx?
ground glass heptocytes, acc hepatitis B surface Ag w/in cytoplasm, central balloon degeneration, hepatocyte apoptosis
viral HBsAg + HBcAg express conjunction with MHC I : activate cytotoxic CD8+ T lymphocytes respond by destroying the infected hepatocytes
152
acetaminophen overdose, ,hx?
hepatic inflammation + necrosis w/ neutrophilic infiltration
153
prolactinoma, lab - GnRH, LH, testo?
GnRH - dec
LH- dec
testo- dec
all dec due to high prolactin level supporess GnRH secretion
154
muscle contraction, ATP attach to sarcomere causes?
myosin head detachment from actin filament
** calcium binding to Troponin-C shifts tropomyosin away from myosin binding site on actin, NOT directly on ATP
155
prolong use, beta blocker withdrawal?
up-regulation of beta adrenergic receptor -> inc sensitivity
inc HR, tachycardia, palpitation, inc BP due to inc CO, inc oxygen demand cause ischemia (angina pain)
** circulating catecholamines is unchanged from baseline
156
ascites in cirrhosis , moa?
portal HTN ->
1. NO release , stimulated by bacterial products ( endotoxin) --> easier translocate from GI tract to reduce host defense
2. splanchnic vasodilation --> dec splanchnic resistance & lowers effective arterial BV
3. low perfusion pressure --> + RAAS --> retention of na + water
4. low plasma oncotic pressure , reduce fluid resorption from interstitium
5. portal capillary permeability UNCHANGED --> hypervolemia and 3rd spacing, promoting formation ascites + peripheral edema
6. Portal capillary hydrostatic pressure : increase
157
nephrotic syn, lab change?
inc permeability of glomerular capillary wall -> loss of albumin
dec capillary oncotic pressure -> defect in Na excretion , and retention inc Effective arterial BV
splanchnic vascular resistance unaffected
158
histoplasma capsulatum, hx?
Hx/ oval / rounf yeast w/in MACROPHAGES
Via/ bird + bat droppings
dimorphic fungus - impaired immunity ( advance AIDS) risk of dissemination thru reticuloendothelial sys
sym/ HSM, LAD, pancytopenia
159
coccidioides immitis, hx?
thick-walled SPERULES CONTAINING ENDOSPORES
transmitted/ spores formed by inhalation - fragmentation hypae
sym/ lung dx eg. pn (mc), chronic progressive pn, pul nodules + cavities, MNG
loc @ arozina/ california
160
HIT type 2 , moa?
IgG ab form against neoAg ( heparin - pt factor 4) result in Ab aggregation on pt surface
sym/ dev 5-10 days after heparin initiation.
lab/ thrombocytopenia - clearance of Ab coated pt by splenic macrophages. Ab aggregation on pt surface also cause wide spread pt aggregation, inc venous + arterial thrombosis
Rx/ non-heparin anticoagulant ( argatroban) help prevent/ treat thrombosis
161
HIT type 1 , moa?
non- immune mediated condition caused by pt clumping
does NOT cause thrombosis
162
vasospastic angina , moa?
sym/ pain at rest/ during sleep
spontaneous resolution < 15 mins
ecg/ ST elevation
rx/ sublingual NG (active) + CCB ( preventative)
moa/ hyper-reactivity of coronary SM due to endothelial dysfunction + autonomic imbalance
163
unstable angina, moa?
ulceration of thin fibrous cap overlying ATS plaque
sym/ intermittent chest pain , not relieved by NG
164
uric acid stone formation?
concentrated acidic urine ( insoluble) , lowers urine Ph < 5.5 ( acidic urine) , supersaturation of urine with UA precipitated crystal formation
moa/
1. inc uric acid excretion: gout, myeloproliferative dx
2. inc urine conc: hot, arid climate, DEHYDRATION
3. low urine ph: chronic diarrhea ( Gi HCO3 loss) , met syn/ DM
clinical/ radiolucent stones ( not visible on XR)
165
Ca &oxalate stone, moa?
disruption of normal enterohepatic circulation BA causes malabsorption of lipids, forms soap complexes with Ca+ --> inc absorption of free oxalate excess by kidney ( radio-opaque )
166
strep pyogenes bacterial pharyngitis infection , dx?
abrupt onset fever, sore throat- exudative tosillopharyngitis enlarge tonsils
dx/ microbiologic testing prior to initation of AB :
1. rapid Ag det testing - swab immunoassay evaluates for GAS Ag
2. throat culture- beta hemolysis w/in 48 hrs - broad zone of complete hemolysis
167
strep pyogenes, virulence factor?
coates the surface GAS with Ab against M pn
168
strep pyogenes, complication dx?
elevate Ab titer against streptolysin O - indicate recent GAS inf + dx GAS complication
eg. RF, glomerulonephritis
169
MHC-II molecule genes encode- HLA-DP, DQ, DR , moa?
APC eg. B cells, macrophages, after excellular Ag loaded onto MHC class II molecule acidified LYSOSOME ( CD 4+)
170
MHC-I molecule genes encoded HLA-A, B, C moa?
nucleated cells after PROTEASOME --> peptide fragements--> b2 -microglobulin + TAP pn --> cytosolic Ag has been transported into ER and loaded onto MHC-I molecule ( CD 8+)
171
fragile X syn - moa?
CGG trinucleotides repeats > 200 causes FMR1 hypermethylation
DNA methylation inactivates FMR1 , preventing transcription + production of fragile X mental RP, impair neural dev
dx/ southern blot analysis
172
Lynch syn, moa?
defect DNA mismatch repair genes- inc risk of Hereditary non-polyposis colorectal cancer + endometrial cancer
173
cocaine w/drawal sym?
"crash" - irritable, w/drawn, hypersomnolent, hyperphagic, fatigue, vivid dreams, acute depression
174
BZD w/drawal sym?
rebound anxiety , insomnia, perceptual disturbances, tachycardia, seizures, psychosis
175
familial hypocalciuric hypercalcemia - moa?
being autosomal defective CaSR in PTH + kidney
Ca sensing receptor: transmembrane Gq pn coupled
176
ITP, moa?
autoimmune destruction of pt by anti-pt Ab, IgG autoAB against pt membrane glycopn GP2b/3a
immune thrombocytopenic purpura (ITP)- thrombocytopenia asso with ecchymosis
177
left temporal hemiretina, loc injury?
left lateral geniculate body in thalamus - --> travels via ipsilateral optic radiation to ipsilateral primary visual cortex
178
confounding ?
FALSE / NO association of expose with a dx -
| occurs when exposure-dx relationship muddled the extaneous factor asso with both exp + dx
179
effect modification?
ASSOCIATION:
| external variable positively / negatively impacts the observed effect of risk factor on dx status
180
Nocardia mao?
impaired cell mediated immunity, branching filaments, partial acid fast (mycolic acids in cell wall )
aerobic like TB
rx/ TMP-SMX , surgical drainage of abscess
181
actinomyces moa?
ANAEROBIC organism, cervofacial infection
abscess with sulfur granules
182
exudative moa?
inc vascular membrane permeability ( infection, malignancy, rheumatic dx)
high fluid: serum ratio of total pn > 0.5 / lactate dehydrogenase >0.6
183
transudative moa?
1. dec oncotic pressure-> hypoalbuminemia (cirrhosis, nephrotic syn)
2. inc intraabdominal hydrostatic pressure - abdominal ascites inc portal HTN ( cirrhosis)
3. inc hydrostatic pressure in pul venous sys: HF
184
familial chylomicronemia syn type I, moa?
pn defect: lipoprotein lipase , APO-C II
elevate chylomicrons
sym/ acute pancreatitis, HSM, lipemia retinalis, eruptive skin xanthomas
185
familial hypercholesterolemia type IIA, moa?
pn def: LDL receptor , Apo-B -100
elevate: LDL
sym/ premature CAD, corneal arcus, tendon xanthomas, xanthelasmas
186
familial dysbetapnemia type 3 moa?
pn def: Apo-E
elevate chylomicron + VLDL remants : cholesteral + TG
sym/ premature CAD, tuboeruptive + palmar xanthomas
187
familial hyperTG type 4, moa?
pn def: Apo-A-V
elevate VLDL
sym/ inc pancreatitis risk, obesity + insulin resistance
188
CLL , mature B cell accumulate in BM + peripheral blood due to oncogenic mutation inhibits apoptosis?
clonal pop with CD 19, 20, 23
se/ anemia , thrombocytopenia , infection due to neutropenia
hx/ smudge cells
189
CML, myeloproliferative of granulocytes ?
BCR-ABL fusion gene ( phil chrm)
190
glyburide, moa?
targeting MEMBRANCE ION CHANNELS-
inc insulin secretion by inhibiting beta- cell K ATP channel, inducing depolarization + L-type Ca channel opening -> inc ca+ influx stimulates beta cell insulin release independent of blood glu conc
se/ hypoglycemia, WG
191
GLP-1 ( glucagon like polypeptide-1 ) , moa?
secrete by intestinal L cells acts thru cell surface receptors that are COUPLED with G-Pn AC
192
melanoma recurrence, hx?
brown pigment (melanin granules) in cytoplasm- large, hyperchromatic nuclei, irregular nuclear shape ( binucleated cells)
lab/ + melanin/ melonoma marker S-100 , HMB-45
193
Chronic systolic HF , hx?
brown , hemosiderin laden macrophages
194
mitochondrial DNA (mtDNA) exists as?
small circular chrm with slight diff genetic code that nuclear DNA
-rRNA + tRNA needed for mitochondrial pn synthesis
- endosymbiotic theory that mitochondria orginate as prokaryotic cells
- maternally derived mtDNA
- double membrane + wavy cristae
195
streptococcus pyogenes, lab?
```
G+ cocci, coagulase -
catalase -
PYR +
small colonies with wide zone of beta hemolysis +
bacitracin +
```
virulence factor/ M pn allows bacteria to envade phagocytosis by preventing activation of alternate complement pathway
- EC toxin inc hemolysis O + S
- pyrogenic exotoxin ( superantigen result in tix injury + septic shock)
rx/ surgical debridement + AB
196
closterium perfringens, lab?
G+ rod
catalase -
coagulase -
double zone of beta - hemolysis
etio/ good poisoning, clostridial myonecrosis ( gas gangrene) , bacteremia
197
stable angina, moa?
fixed coronary artery stenosis - CAD > 80% coronary artery lumen
** RELIEVE by NG/ rest
mao/ mismatch of oxygen supply and demand - anginal sym ( CP, SOB)
pharm stress testing/ dobutamine - -1 agonist -> inc HR + contractility to mimic the inc myocardial oxygen demand with exercise - increase demand --> transient dec in contractility wall motion defect --> dec ejection fraction
198
ACUTE mitral regurgitation - spontaneous chordae tendineae rupture, moa afterload, preload, EF?
afterload: dec
preload: inc
EF: inc
LA is normal size + compliance + sudden exposed to large voln of regurgitant blood from LV --> high LA pressure and pul edema
inc LVEDV ( preload) due to regurgitant blood --> led LV afterload dec --> inc LV ejection fraction ( inc SV) --> overall dec forward SV + dec CO ( hypotension + cardiogenic shock)
199
CHRONIC MR , lab?
compensatory LA enlarge --> regurgitant voln at lower filling pressure , prevent pul edema dev
LV ECCENTRIC hypertrophy--> early help maintain forward SV--> inc wall stress with contractile dysfunction --> dec forward SV--> dec CO + inc left side filling pressure ( pul edema)
200
XO inhibitor - allopurinol, febuxostat , moa?
prevent acute attack in pt with recurrent + progressive gouty arthritis + macroscopic tophi
NOT be initiated during acute gout attack
201
non- seminomatous germ cell tumor, lab?
lab/ + hcg/ aFP / LDH
eg. embryonal ca, yolk sac chorioCA, teratoma, mixed
202
MS , diastolic pressure, afterload, contractility?
diastolic pressure : normal
afterload: normal
contractility: normal
mid to late diastolic murmur - exertional dyspnea, elevated LA pressure -> orthopnea, PND , absence of voln overload , sound S1,
203
dilated CMP, ischemia HD , lab?
LV systolic contractility dec
LVDP + afterload near normal
204
STRESS urinary incontinence , moa?
sym/ leakage with cough , lifting , sneezing
mao/ dec external urethral sphincter tone, urethral hypermobility
PM woman have estrogen def, laxity + wkness pelvic floor support
rx/ stimulation a- adrenoreceptor : help by contracting IUS , inc intestinal + bladder sphincter muscle contraction
205
overflow UI, moa?
sym/ incomplete emptying + persistent involuntary dribbling
mao/ impair detrusor contractility , bladder outlet ob
206
URGE UI, moa?
moa/ detrusor hyperactivity
sym/ sudden, overwhelming urge to urinate
rx/ M3 antagonist : oxybutynin : relaxes the ureter muscle
207
thyroglossal duct cyst, moa?
incomplete obliteration of duct at midline mass , moves superiorly with protrusion of tongue / swallowing
208
ectopic thymic cysts, moa?
lesion dev along descent of thymus ( angle of jaw to mediastinum) , UNILATERAL
209
brachial cleft cyst, moa?
remnant branchial arch st -> LATERAL neck mass
| sinus tract / fistula may present
210
pudendal nerve injury, moa?
- stress on pelvic floor : denervation + wkness of voluntary perineal musculature, fecal incontinence
S2-4 ventral rami, passes btwn piriformis + coccygenus muscle exits the pelvis thru greater sciatic foramen.
motor branch - external urethral + anal sphincters
moa/ reenters the pelvis near ischial spine thru lesser sciatic foramen prior dividing into terminal branches.
211
methemoglobinemia moa?
nitrites posisoning conversion of heme (Fe2+)--> oxidized ferric (fe3+) state, methemoglobin unable to bind O2, binds tightly to cyanide
lab/ leftward shift of O2-dissociation curve --> partial pressure O2 in blood ( amt of O2 dissolved in plasma UNCHANGED)
% sat of Hb dec (CO completes with O2)
total O2 content ( both dissolved + o2 attached to Hb ) dec
sym/ dusky discoloration of skin
212
most definitie MALIGNANT hx?
reactive hyperplasia:
monoclonal TCR gene rearrangement
malignant transformation: normal LN architecture is distorted / effaced by proliferation of malignant lymphoid cells
sym/ WL, night sweat, fever, anorexia
213
benign cancer hx?
admixture of several lymphoid cell types in LN
214
left shift O2 dissociation curve causes?
high affinity of Hb for O2 inc -->
reduce the ability of Hb to release O2 w/in peripheral tix -->
low O2 level stimulate the kidney to increase EPO synthesis -->
compensatory erythrocytosis that help maintain normal O2 delivery
215
vagal maneuvers, moa?
carotid sinus massage, valsalva, cold water immersion - terminate PSVT: reentrant impulse traveling circularly btwn slowly + rapidly conducting segments of AV node
carotid sinus massage leads to inc afferent firing from carotid sinus --> inc vagal PSN tone --> slow conduction thru AV node + prolongs AV refractory period help terminate reentrant tachycardia
216
anisocoria, pupillary asymmetry, moa?
unilateral defect in input from either the ocular SYN (pupil dilation) / PNS (pupil constriction) pathway
dim light - input from oculosympathetic pathway initiates pupillary DILATION, allowing more light to reach retina
** asymetry increases in dim light : affects the smaller pupil unable to DILATE
Bright lights- PNS input from ipsilateral N3 initiates pupillary constriction, limiting the amt of light received by retina
** asymmetry inc in bright lights- larger pupil unable to CONSTRICT, loss of PNS input
217
randomized control trail ?
exp studies - research RANDOMLY assigns intervention to potential participants to assess the effect of the controlled intervention
218
prospective cohort studies / retrospective cohort studies ?
pt are already ASSIGNED to exposure gps
219
field cancerization, moa?
eg.
- head & neck SCC
- BCC skin exp to UV light
- Colorectal ca exp to dietary ca
large area of cells w/in a field that are primed to dev cancer cuz of widespread exposure to mutagens
mut affect many similar cells can increase the likeihood of developing mutlipule primary malignancies
220
tricuspid valve regurgitation, moa?
permanent pacemaker @ RV lead pass thru SVC --> RA --> TV orifice to terminate on endocardium on RV
damage to TV leaflet / inadequate leaflet co-adaption lead to severe TR ( rt side HF)
sym/ distended JV, pulsatile tender HM + abd distention with ascites + LE edema
Holosystolic murmur @ LL sternal border, intensifies with maneuvers inc w/ RV preload
221
AV regurgitation , moa?
RF dx, aortic root dilation
sym/ Lt side HF ,PUL edema with CRACKLES
222
metolazone , moa?
Thiazide - potentiate loop diuretics:
excrete more Na+ and K+
inhibition of NA/CL cotransporter with metolazone prevents reabsorption of inc Na delivered to the distal tubules , inc total Na+ excretion
223
Vancomycin , se?
Red man syndrome - non allergic drug reaction (non IgE mediated)- infused too rapidly - direct activation of mast cell , release of vasoactive mediators ( histamine)
sym/ flushing, erythema, pruritis
224
type 2 DM , moa?
inc insulin resistance + defective insulin secretion
compensatory insulin response by beta cells ultimately fails, poor glc tolerance - number of generic + aq factors are implicated in beta cell dysregulation
Islet amyloid polypeptide (AMYLIN) responsible for beta cell dysfunction
- Amylin causative role in beta cell apoptosis + defective insulin secretion
225
type 1 DM, moa?
HLA-DQ / DR - DR3/ DR4
- pancreatic islet infiltration with leukocytes, circulating anti- islet Ab , DKA
226
subarachnoid hemorrhage, moa?
spontaneous rupture saccular berry aneurysm - branch pt ant, middle, post cerebral arteries -- blood empties into subarachnoid space and pools in cerebral sulci and basal cisterns
ehio/ ADPKD, EDS
se/ vasospasm , days after initial bleeding --> stroke
227
epidural hematoma, moa?
middle meningeal artery
-LENS shape convexity
contained btwn suture lines
228
subdural hematoma, moa?
bridging veins
-CRESCENT shape
cross suture lines
-older pt, shaken babies syn
229
intracerebral hemorrhage, moa?
blood w/in brain parenchyma - small arteries eg. basal ganglia, thalamus, pons
- extend into ventricles
230
cerebral cytotoxic ionic edema , moa?
failure ATP dep ion pumps , comb with release of excitatory AA glutamate leads to acc of intracellular Na + water in neural + glial cells
231
vasogenic cerebral edema, moa?
24-48 hrs later, release inflammatory mediators disrupts the tight junction of BBB , allow albumin + water enter the interstitial space - persistent cerebral edema for wks
232
clopidogrel moa?
preventing ADP stimulated pt activation
**ADP receptor responsible for Gp2b/3a receptor on surface of pt. w/o Gp2b/3a, pt cannot aggregate tog
233
ASA moa?
enhancing cAMP- mediated inhibition of pt TXA2 synthesis
234
sickle cell anemia ( hb S) , promoted by condition ?
low O2 level ( o2 unloading), inc acidity, low BV ( dehydration) : high oxygen demand
** hydrophobic interaction causes polymerization of HbS molecules + subseq erythrocyte sickling --> membrane damage + permanent distortion of RBC
sickled cells not flexible enough to pass thru micro-vasculature, impede blood flow and cause microinfracts in tix and painful vasoocclusive crisis
235
left shifts O2-Hb dissociation curve, due to?
inc 2,3 BPG, inc temp, inc H+, inc co2
236
severe aortic stenosis, causes?
Syncope
Angina
Dyspnea - HF
outflow ob --> high chamber pressures + inc wall stress during systole + diastole
-->RISE systolic WALL STRESS inc myocardial oxygen demand
inc diastolic wall stress reduce the coronary perfusion pressure gradient --> dec myocardial perfusion
inc LV mass --> concentric hypertrophy -> inc myocardial oxygen demand -> anginal sym
237
HIV asso dementia, hx?
microglial cells
resident macrophages of CNS + blood derived perivascular macrophages
microglial nodules -fuse tog form multinucleated giant cells
238
rabies, hx?
eosinophilic inclusion bodies in cytoplasm of neuronal cells , negri bodies
239
superficial burn, moa?
erythema that blanches w/o blistering- damage + inflammatory mediators release from epidermal + immune cells-
release HISTAMINE + vasoactive mediators from mast cells in mins
240
Deeper , partial thickness burns, moa?
affect dermal st + nerve ending + venules in additional to epidermis -> nerve damage lead to loss of sensation + fluid extravasation thru gaps btwn injured venule endothelial cells
241
crigler -najjar syn type 1 , moa?
AR , dx of bilirubin metabolism caused by genetic lack of UGT liver enzyme needed to catalyze bile glucuronidation
--> when bilirubin not correctly enz processed by liver --> unconjugated hyperbilirubinemia dev --> unable to excreted in urine --> deposit cause kernicterus ( bilirubin encephalopathy) , severe jaundice , neurologic impairment
242
rotor syn, moa?
AR, asymptoatic conjugated hyperbilirubinemia --> defect in hepatic uptake + excretion of bilirubin pigments.
243
dubin johnson syn moa?
AR, absence of biliary transport pn , MRP2 (multi-drug resistance pn 2) -->
```
result direct ( conjugated hyperbilirubinemia)
, used in heptocellular excretion of bilirubin glucuronides into bile canaliculi
```
sym/ liver darkly pigmented
244
strongest latex beads?
mature mRNA , processed ready for nuclear export + translation into pn.
- post transcriptional modification
245
ichthyosis vugaris , moa?
inherited dx caused by mutation of FILAGGRIN GENE, epidermal hyperplasia + defective keratinocyte desquamation --> dry, scaly skin w/ loss of normal barrier function
246
cauda equina moa?
lumbosacral nerve roots compressed by epidural mts -
pelvic splanchnic nerves ( s2-4) provided PNS
- innervation to hindgut, bladder + urinary sphincters promotes peristalsis + bladder emptying , pelvic floor relation during defecation
247
fluoroquinolones, drug drug interaction, moa?
insoluble chelate complexes with polyvalent cations ( calcium, iron, aluminum, mg) - leads to impaired absorption + significant dec DRUG bioavailability
248
diltiazem, cytochrom p450 inhibitor, moa?
inc systemic level of numerous drugs , drug toxicity
249
biliary atresia , moa?
partial / complete ob of extrahepatic bile ducts
etio/ immune related / viral ind
infants may appear healthy at birth , present with jaundice within first 2 mths
sym/ dark urine, acholic stools, firm hepatomegaly
lab/ elevate direct bilirubin + GGT
250
galactosemia, moa?
galactose -1-phosphate urydyl transferase ( GALT) def, defective galactose to breakdown to lactose --> glc
sym/ vomiting, diarrhea, inability to digest breast milk/ formula
251
hemolytic dx of NW , moa?
Rh incompatibility
sym/ dev jaundice on 1st day of life -> indirect hyperbilirubinemia
+ coombs antiglobulin test confirms presence of AB-mediated hemolysis
252
insulin, surface receptor moa?
transmembrane pn with intrinsic TK activity in cytoplasmic domain.
+ TK --> phosphorylation of insulin receptor substrate 1
--> activates IC pathway induce:
1. PI3K pathway + metabolic function of translocation GLUT-4 to cell membrane , glycogen synthesis + fat synthesis --> promote glycogen synthesis by activate PN PHOSPHATASE , enz dephosphorylates glycogen synthesis
2. RAS/MAP kinase pathway --> cell growth , DNA synthesis
253
sevelamer, moa?
moa/ nonabsorbable anion-exchange resin that DEC INTESTINAL ABSORPTION of PHOSPHORUS
CKD - causes hyperphosphatemia due to impair PO4 excrete -> elevate Blood phosphate trigger release fibroblast GF 23 from bone, lower calcitriol production + intestinal ca absorption
254
thyroid peroxidase (TPO) enz , moa?
thyroglobilin iodination
** AB against TPO > 90% of pt with chronic lymphocytic Hashimoto thyroiditis
- catalyzes the oxidation of iodide , iodination of thyroglobulin, coupling rxn btwn 2 iodized tyrosine residues
255
severe AS -> induce sudden onset HF , moa?
precipitate by acute Atrial Fib:
loss normal atrial contraction --> sudden dec in left ventricular preload --> severe hypotension --> blood back up in LA + pul vein --> acute pul edema
** concentric LV hypertrophy
** acute hypotension --> dec afterload
256
neonatal tetanus, prophylaxis?
clostridium tetani spores to infants --> spasms + hypertonicity --> VACCINATE WOMAN who are pregnant with inactivated tetanus toxin ( TETANUS TOXOID)
transplacental IgG to fetus
257
familial adenomatous polyposis ( FAP), moa?
AD, innumerable colonic polyps - invasive colon ca near 100%
moa/ AK53 -
APC : TSG - encodes for pn that degrades beta catenin , loss of APC pn increases cellular concentration of beta catenin, activates transcriptional pn --> intestinal crypt proliferation + dev polyps
258
TP53 , moa?
inhibit cellular growth
asso with Li Fraumeni syn : BBSLA -
259
lynch syndrome , moa?
HNPCC: hereditary non-polyposis colorectal ca - germline mut to DNA MISMATCH REPAIR GENE: MSH2/6 , MLH1
** colon ca dysplasia in flat colonic mucosa :
260
Ob sleep apnea, moa?
recurrent of upper airway result functional airway collapse --> apnea airflow despite continued breathing effort
261
acute MI, hx?
acute MI induce acute LVF --> rapid onset pul venous htn + acute pul edema
fluid accumulates is transudate --> engorged alveolar capillaries + INTRACELLULAR, ACELLULAR, PINK MATERIAL
262
AS, are related calcific AV Dx , moa?
early pathogenesis : CAVD --> arterial atherosclerosis --> endothelium lining aortic side of AV cusps exposed to high pressure + tubulent BF
atheroma dev in vascular endothelium --> aortic valve cusp endothelium trigger endothelial dysfunction
inc production of pn inv tix calcification ( osteopontin) --> fibroblast diff into OSTEOBLAST LIKE CELLS--> aberrant bone matrix deposition with progressive valvular ca + stenosis
263
MV prolapse, moa?
myxomatous value thickening + elastin fragmentation -
264
Rheumatic fever dx, moa?
subendocardial granulomatous lesion with fibrinoid necrosis + subsequent fibrosis --> MV inv --> MS / MR
265
vaccine failure, moa?
dec production of naive B + T lymphocytes -> impair the adaptive immune response to novel Ag
266
aspiration on, moa?
oral flora aspiration, aspration of gastric contents
hx/ neutrophil rich, inflammatory exudates w/in bronchioles + alveolar spaces
267
Pul infarction, hx?
hemorrhagic, ischemic necrosis of lung parenchyma
hx/ well demarcated area of alveolar + vascular wall necrosis with cells that lack nuclei + alveolar spaces may contain RBC
268
paroxysmal A Fib ablation?
irregular irregular rhythm, no p waves
atrial remodeling @pul veins near ostia into LA
269
A flutter, ablation ?
cavotricuspid isthmus area of RA tix btwn crista terminalis + tricuspid annulus
270
corticosteroids , moa on uncontrolled asthma?
inhibit production of (inflammatory mediators: cytokines, PGE, Leukotrienes), dec leukocyte extravasation into resp epithelium + induce apoptosis inflammatory cells
271
JC virus, hx?
advance AIDS , risk for viral reactivation spread to brain.
white matter demyelination w/ no mass effect / enhancement - oligodendrocytes, progressive multifocal leukoencephalopathy (PML)
272
measles, moa?
subacute , sclerosing panencephalitis - fatal progressive dx
slowly worsening neurologic sym + multifocal , enhancing, white matter lesion
273
MI caused ST elevation myocardial infarction (STEMI), moa?
acute rupture of ATS plaque with fully ob thrombus
DOES NOT relieve by NG /rest
274
warfarin, moa?
blocks epoxide reductase, lowers the reduced form of Vit K in the liver: prevents gamma -carboxylation of vit K-dependent clotting factors ( 2, 7, 9 10)
cuz only blocks the new generation of new clotting factors, therapeutic effect is delayed 3-5 days until preexisting clotting factors are consumed
- showest t1/2 factor F7
275
fibrates, moa?
inhibit PPARa , dec VLDL
inhibits hepatic production of TG
276
niacin, moa?
dec TG
inc HDL
dec VLDL --> LDL : dec LDL concentration
277
supracondylar humeral fracture, ANTEROLATERAL displacement?
radial nerve
278
medical epicondyle injury?
brachial artery + median nerve
279
african malaria, choroquine resistant, rx?
Atovaquone-proguanil / artemisinins
280
neoplastic cord compression, extend into?
epidural space - local extension of vertebral MTS
sym/ severe back pain worse at night, progress to motor wkness + sensory deficits
urinary + fecal retention / incontinence late stage
281
intramedullary MTS , dx?
assoc with lung ca, Brown Sequard syn
282
intervertebral disc herniation , causes?
nerve root compression ( sciatica)
283
acute simple cystits , rx?
E.coli --> rx/ TMP-SMX/ nitrofurantoin
284
Chlamydia trachmatous infection , rx?
Azithromycin / doxycycline
285
trichomonas vaginalis, rx?
metronidazole
286
increase ratio foward flow voln to regurgitant flow voln?
dec SYS vascular resistance
apical holosystolic murmur radiating to axilla --> MR
Eg. Nitroprusside
287
pancreatic ca, etio?
SMOKING - MCC environmental risk factor
288
recombination, moa?
exchange genetic info btwn 2 virus strains -
NON-SEGMENT , double stranded DNA genomes.
exchange 2 chrms via CROSS-OVERING within homologous regions
** Progeny can have recombined genomes with traits from both parent virus
289
Phenotypic mixing, moa?
host cell coinfected with 2 viral strains + progeny virions contain parental genome from one strain + nucleocapsid pn from the other strain
**genome is unchanged, subsequent progeny would NOT retain these traits
290
Reassortment, moa?
changes in genomic composition that occur when host cells co-infected with 2 SEGMENTED viruses that exchange whole genome segments
** viral progeny has WHOLE genome segment- NOT engage reassortment
291
epidermolysis bullosa, moa?
mutation inv intraepidermal + dermoepidermal adhesion complexes in BM zone
moa/ Mutation in KERATIN GENES that impair the assembly of keratin into filaments
sym/ friction -induced blisters at palms + sole, ORAL BLISTERS
292
bacterial toxin -induced cleavage of desmoglein 1, dx?
bullous impetigo ( erythema , vesicles with yellow crusts) --> Staphylococcal scaled skin syn ( generalized erythema with flaccid bullae in flexural areas)
293
atopic dermatitis, moa?
Loss of function in FILAGGRIN + other epidermal barrier pn
294
fastest rate of metabolism glycolytic pathway?
Fructose -1 -phosphate
bypass phosphofructokinase
F-1-P --> Aldoase B--> DHAP + glyceraldehyde
** DHAP converted to triose phosphate isomerase--> glyceraldehyde -3 p
295
focal nodular hyperplasia, hx?
nonmalignant lesion, MC in YOUNG WOMAN
hx/ small, solitary, pale nodules composed of cords of normal appearing hepatocytes + central stellate scar with fibrous septae surround abnomrally large hepatic arterial branches
296
hepatic adenoma, hx?
benign liver lesion, strongly asso with ORAL CONTRACEPTIVE PILLS --> undergo malignant transformation / rupture
297
ureters, anterior which vessels in true pelvis ?
Anterior to internal Iliac Artery
298
Ureter relationship to uterine artery?
Ureter course POSTERIOR to Uterine artery before entering the bladder
299
acute serum sickness, moa?
type 3 HSR - tix deposit of circulating immune complex
sym/ begins 7-14 days after exposure to Ag.
LAD + pnuria
hx/ small vessel vasculitis with fibrin necrosis + intense neutrophil infiltration
deposit IgG + IgM complement fixing Ab result localized complement consumption + hypocomplementemia ( dec serum C3 level)
300
schizoaffective disorder, moa?
delusion / hallunication for > 2 wks in the absence of MDD / Manic episode
301
Pul Arterial HTN, effect on:
| prostacyclin, TXA2, NO?
Prostacyclin dec
TXA2 dec
NO dec
endothelial dysfunction leads to INC vasoconstriction, proproliferative mediators in SM : ( ENDOTHELIN, TXA2)
** Bosentan : endothelin receptor antagonist --> reduce vasoconstriciton
DEC in vasodilative antiproliferative mediators ( NO, PROSTACYLIN)
* * Epoprostenol : prostacyclin analogues
* * NO enhancing : Sildenafil
302
RCC , obstructing IVC , invading what vein?
invades RENAL VEIN
sym/ hematuria, flank pain, palpable mass
chronic cases : collateral venous circulation dev on side of ob-- upper segment of IVC ob
303
RCC, elevate Hbg suggest?
erythrocytosis
| hypercalcemia -> over production of PTH-rP / lytic bone MTS
304
P. aeruginosa, resistance due to AB-modifying enz?
Aminoglycoside ( gentamicin) : enz add chemical groups to Ab which diminishes its ability to bind to 16S ribosomal RNA w/in the 30S ribosomal subunit
305
CLL with trisomy chrm 12 , Dx?
FISH - highly sensitive cytogenetic test identify presence of chrm duplication + large deletion + translocation
306
ELISA - dx?
AB / AG in a fluid
307
Flow cytometry, dx?
```
leukemia
surface markers ( CD5)
```
308
reticulocytes contain bluish cytoplasm + reticular precipitates , residual of?
rRNA - basophilic , reticular network of residual
microcytic anemia , hypochromic - IDA
inc Hbg result from enhances erythropoiesis + accelerated release of both mature RBC + reticulocytes into BS
309
Edwards syn, trisomy 18, sym?
meiotic nondisjunction -
sym/ rocker bottom feet, clenched hands with OVERLAPPING FINGERS
VSD, PDA, horseshoe kidney, GI sym ( Meckel's diverticulum, malrotation)
310
trisomy 13, patau syn sym?
midline facial defects ( holoprosencphaly, cleft lip/ palate) , polydactyly, GI ( omphalocele, umbilical hernia)
**NO overlapping fingers
311
isoproterenol, moa?
nonselective B adrenergic agonist :
inc B1 + myocardial contraction
B2 + vasodilation by relation of vascular SM --> dec vascular resistance + MBP
312
adenosine , moa?
A1 receptor on cardiac cells + potassium channels , inc K+ conductance
transient conduction delay thru AV node--> peripheral vasodilation , but reduces the myocardial contractility
313
Straphylococcus epidermidis , differentiate by lab?
+ catalase : diff Stap vs Strep
- coagulase test : diff S. aureus vs others
gram + cocci grape like clusters
+ novobiocin sensitive
Gamma hemolytic
314
thick peptidoglycan layer + teichoic acid , moa?
M pn (alpha helical coiled coil pn share epitopes st homology) :
TROPOMYOSIN + MYOSIN virulence factor : inhibits phagocytosis + prevents complement binding , aids in epithelial attachment
315
Gram + bacterial cell wall S pyogenes, moa?
mechanical support + protect from osmotic lysis
| - composed peptidoglycan , mesh like cross lined polymer peptides + sugars
316
metformin , moa?
moa/ inhibits hepatic gluconeogenesis via inhibition of mito isoform of glycerophosphate dehydrogenase in liver
se/ GI upset + diarrhea + LACTIC ACIDOSIS
contra/ RF
317
SIADH, rx with vasopressin V2 receptor antagonist:
lab for plasma Osm, Urine output, Urinary Na excretion?
plasma Osm + inc serum Na level: Inc
Urine output: inc
Urinary Na+ excretion: no change
** Tolvaptan : rx hyponatremia : inc free water excretion by blocking ADH action , no direct effect on Na/K excretion
ADH ( vasopressin) : stimulates renal CT to reabsorb water back into sys circulation --> lowers serum Osm + suppress further ADH secretion
318
Adjustment disorder?
within 3 months of identifiable stressor < 6 months once stressor ceases
sym/ distressing + impairing
319
acute stress disorder ?
re-exp , avoidance, neg moods, dissociation, hyperarousal last 3 days - 1 months following life threatening traumatic event
320
Alzheimer dx, LATE onset familial asso with ?
E4 allele of Apolipoprotein E
* * EARLY onset AD:
1. APP gene on chrm 21
2. Presenilin 1 gene crm 14
3. presenilin 2 gene chrm 1
321
foscarnet, moa?
chelate calcium
rx/ CMV resistant infection
se/ HYPOMAGNESEMIA, --> dec release of PTH --> HYPOCALCEMIA state
promote seizure
322
cidofovir, se?
CMV retinitis, asso with NEPHROTOXICITY, pnuria, elevate CR
323
Mt sickness lab?
Ph inc : met alkalosis
HCO3 dec slightly --> due to kidney compensated by inc HCO3 excretion to dec serum HCO3 + help normalize Ph
PaO2 : dec (Hypoxemia)
PaCO2: dec --> inc RR (resp alkalosis)
324
psoriasis, vit D analogs ( Calcipotriene, calcitriol) moa?
inhibition of T cell + keratinocyte proliferation + stimulation of keratinocyte differentiation
325
hydroquinone, moa?
tyrosinase inhibitor dec syn of melanin
rx/ melasma - hyperpigmentation dx
326
neurocysticercosis, etio?
ingestion of Taenia solium (pork tapeworm) excreted in feces of human carrier
lab/ eosinophilia , inc ESR
rx/ albendazole
327
bordetella pertussis, hx?
tracheal cyotoxin: loss of ciliated resp epithelial cells
pertussin toxin: AB toxin enters cells + activates AC --> inibit phagocyte activity cause lymphocytosis
sym/paroxysmal cough with inspiratory whooping + vomiting
328
strep pneumoniae, hx?
migration of neutrophils from BS into alveoli
329
hyperaldosteronism , lab Na, K, HCO3?
Na: normal
K: low
HOC3: high
inc aldosterone -->
inc Na reab --> HTN, inc BV --> ALDO escape : limits edema -> inc RBF, inc GFR, inc ANP --> inc Na excretion --> Na NORMAL
dec K reab --> hypokalemia
dec H+ reab--> met alkalosis ( inc HCO3)
330
gynecomastia, rx?
inc estrogen: androgen ratio
rx/ tamoxifen, SER modulator - acts as estrogen antagonist in the breast, dec risk of gyncomastia
331
primary prevention?
health promotion :
| diet habit , exercise...
332
S3 heart sound, causes?
forceful rapid passive filling -> expansion ventricle capacity with high vent filling pressure/ voln --> INC LVESV
333
Enterobiasis, rx?
perianal itching
hx/ scotch tape test
rx/ albendazole / pyrantel pamoate
334
Loa Loa + Wuchereria Bancrofti, rx?
DEA
335
Strongyloides stercoralis + Onchocerca volvulus , rx?
Ivermectin
336
Trypansomes cruzi, rx?
Nifurtimox
337
Schistosoma, Clonorchis sinensis, Paragonimus westermani, rx?
Praziquantel
338
tuberinfundibular pathway, defect causes?
cxn hypothalamus to pituitary gland --> responsible for tonic inhibition of of prolactin secretion
339
nigrostriatal pathway, defect causes?
Substantia nigra --> caudate nucleus + putamen : coordinates
of voluntary movements
D2 receptor blockade causes extrapyramidal effect : dystonia, akathisia, tardive dyskinesia
340
bordetella pertussis, moa?
pertussis toxin : disinhibits AC thru Gi ADP-ribosylation , inc cAMP --> edema + phagocyte dysfunction
AC toxin --> inc cAMP
341
bacillus anthracis , toxin?
1. polypeptide capsule, compose poly-r-glutamic acid inhibits phagocytosis
2. trimeric exotoxin - EF: calmodulin-dep-AC inc cAMP conc --> acc fluid within btwn cells + supression of neutrophil + macrophage function
2. LF
342
Hormone sensitive lipase enz, moa?
enz found in adipose tix --> catalyzes the mobilization of stored TG into FFA --> ketone bodies + GLYCEROL --> Glycerol -3-P --> DHAP--> glucose
inhibit by release of insulin
343
Lipoprotein lipase enz, moa?
found in endothelial cells function to degrade TG found in VLDL + chylomicrons --> FFA transport into adipocytes storage / used by tix for energy
344
invasive pulmonary aspergillosis , hx?
septate narrow hyphae with 45 degrees angle
comming in ICP, AIDS
345
ALS , sym?
UMN: corticospinal tract ---> spasticity , hyperreflexia
LMN: motor neurons in anterior horn --> wkness, atrophy, fasciculation
346
poliomyelitis, sym?
pure MOTOR neurons ( LMN) only
347
hemophillia, moa?
F8 + 9- intrinsic coagulation pathway + activate F10 --> F10a --> F2 prothrombin into thrombin
rx. THROMBIN --> blood clotting
348
fibrinogen, moa?
pn synthesized by liver
** thrombin mediates cleavage fibrinogen to form fibrin
349
Cortisol has enhances the vasoconstrictive effect of catecholmines + ATII ?
Permissiveness effect --> no direct effect on physio process but allows another hormones to exert to maximal effect
350
synergistic / additive moa?
additive : 1+ 1 = 2
combine effect of 2 drugs is equal to sum
synergistic : 1 + 0 > 1
351
lunate dislocation , unable to perform ?
CTS:
recurrent branch of median nerve to thenar muscle:
OAF-
abductor pollicis brevis
(thumb abduction)
flexor pollicis brevis ( thumb flexion)
opponens pollicis ( thumb opposition)
352
deep motor branch of ulnar nerve , responsible?
finger abduction - dorsal + volar interossei + thumb adduction to innervate the adductor pollicis
353
Primary TB infection, loc?
lower lobe of lung - virulence factors ( cord factor) prevent bact destruction by alveolar macrophages
ipsilateral hilar LN --> Ghon complex
354
reactive TB, loc?
apical cavitary lesion
355
influenza vaccination , moa?
inactivated inf vaccine stimulate the formation of neutralizing AB against the hemagglutinin antigen --> preventing hemagglutinin from attaching to sialic acid receptor --> PREVENTING VIRAL ENTRY
356
Neuraminidase, moa?
cleaves the terminal sialic acid residues on glycoconjugate receptors --> competitively inhibits influenza neuraminidase, PREVENT RELEASE VIRAL PROGENY
357
TMP-SMX , se?
hyperkalemia, blockade of Na channels in CT , prevents Na/K exchange and reduces renal excretion of K
358
hypoglycemia, due to which enz inc?
inc endogenous hormone -- insulin excess --> inc glycolysis by activating PFK-2 ( phosphofructokinase-2) that produces F 2,6 BP
359
prochlorperazine ( dopamine receptor blocker) + diphenhydramine , moa?
anticholinergic activity - due to blockade of D2 receptor --> inc Ach activity causes EPS ( acute dystonic rxn)
360
HPV 6, 11 , hx?
At risk with : HIV infection
hx/ large, atypical lesion
papilloma formation with thickening of stratum corneum ( hyperkeratosis) + epidermal hyperplasia ( acanthosis), nuclear irregularity + perinuclear vacuolization
361
2ndry syphilis , condyloma lata , hx?
verruciform lesion - dense lymphoplasmacytic infiltrate
362
acute cholangitis, moa?
biliary ob, enables bacteria proliferate within biliary tree- CALCULOUS OB of CBD
sym/ RUQ pain, fever, jaundice - CHARCOT TRIAD
hypotension, altered mental status ( REYNOLD PENTAD)
lab/ leucocytosis, direct hyperbilirubinemia, inc ALP
363
acute pancreatitis, hx?,
hx/ acinar cell dysfunction + necrosis
sym/ fever , hypotension, epigastric pain radiating to back, N/V, elevate lipase
364
autoimmune hepatitis, hx?
immune mediated hepatocyte destruction
sym/ fever , tachycardia, hypotension
365
acetaminophen overdose, sym?
RUQ pain, jaundice, vomiting, confusion, after 72 hr ingestion
366
budesonide, moa?
glucocorticoids, lipid derived hormones bind to cytosolic receptor than cell surface receptor --> translocate into nucleus --> bind to DNA region
inhibition of proinflammatory transcription factors ( NF-KB) --> reduce expression of cytokines and inflammatory mediators ( TNF-a) dec immune cell survival + propagation
367
sigmoid shape response curve, moa for?
ionizing radiation - no effect until reach max threshold conc
368
patiromer, moa?
non-absorbable cation exchange resin that BIND COLONIC K in exchange for Ca
rx/ Chronic hyperK
369
Na-Zirconium cyclosilicate, moa/
non-absorbable cation exchange resin that binds intestinal K in exchange for NA + H
370
methemoglobinemia, moa?
oxidation of heme iron from Fe2 --> Fe3 unable to bind O2
increase oxygen affinity of other hemes inc --> left shift -- >dec tix O2 delivery
sym/ cyanosis not imp with supplement of O2
choc brown blood
pulse oximetry inaccurate
rx/ METHYLENE BLUE
371
retinis pigmentosa , moa?
genetic dx, progressive dystrophy of retinal pigmented epi + photoreceptors ( rods, cones)
early RODS: highly met active + prevalent in peripherally --> affect first --> progressive night blindness + loss peripheral vision
hx/ retinal vessel attenuation , narrow vessels , waxy, pale optic disc nerve atrophy + gliosis
late CONES: central retina causes dec central acuity dec-> BONE SPICULE PATTERN
372
vit A def, hx?
abnormal keratinization of ocular + lacrimal epi --> dry eyes + Bitot spots ( conjunctival keratinization)
373
azathioprine, moa on:
| B lym, T lym, IG, IL-2 ?
B lym, T lym, IG, IL-2: All DECREASE
generates thioguanine met --> inhibits de nova purine synthesis + disrupt DNA + RNA replication
--> dec proliferation of B + T lym --> reduce IL-2 activity --> dec # of activated B lym --> dec IG level
se/ pancytopenia , susceptible to infection
374
muomobab, moa?
rx/ prevent organ transplant rejection
moa/ monoclonal AB--> binds to CD3 receptors onT cells to trigger apoptosis --> dec T lym + IL-2
NO direct effect on B lym + IG
375
rituximab, moa?
monoclonal Ab
rx/ non-HK lymphoma,
autoimmune dx + hema Ca
moa/ binds to CD20 receptors on B lym result apoptosis --> dec IG
NO effect on T lym
376
arginase def, affect?
arginase in urea cycle enz --> produce urea + ornithine from arginine
Arginase def causes-->
sym/ spastic diplegia, abnormal movement, growth delay
rx/ decrease PN in diet
lab/ mild/ no hyperammonemia
377
mechanical vent weaning , moa: RR, TV?
INC RR to maintain min ventilation
DEC TV
physio total dead space inc : anatomic dead space ( permanent voln of dead space w/in conducting airway) + alveolar dead space (voln of air in resp zone that does NOT participate in gas exchange)
Lower tidal voln--> inc proportion of each breath composed of dead space
378
hepatic metabolism desired?
high lipophilicity
( lipid solubility )
allows the drugs to cross cellular barriers more easier and enter hepatocytes -- > excreted in bile and elimination
** high VD into CNS
379
drug not well absorbed , moa?
low rate of redistribution
low lipid solubility - hydrophilicity
remain in Intravascular compartment
poor CNS penetration--> low VD --> highly plasma Pn bound +
380
vestibular neuritis ( labyrinthitis) moa?
inflammation of vestibular nerve ( viral / postviral) - single episode last days
severe vertigo but NO hearing loss
381
BPPV, moa?
otholiths in semiciruclar canals
sym/ brief episodes by head movements
NO auditory sym
382
meniere dx, moa?
inc pressure + voln in endolymph
sym/ recurrent vertigo, ear fullness/ pain,
UNILATERAL hearing loss + tinnitus
383
HSV, hx?
erythema multiforme , acute inflammatory dx --> erythematous papules evoles into target lesion
lab/ cytotoxic CD8 lymphocytes
384
neuroleptic malignant syndrome , sym?
diffuse rigidity lead pipe
HYPOreflexia
altered mental status
385
serotonin syn, sym?
clonus
| hyperreflexia
386
olanzapine , lab check?
fasting glucose + lipid panel
387
straphylococcus epidermidis, moa for virulence ?
```
BIOFILMS- producing organism:
function as barrier to ab penetration and interferes with host defenses , opsonization , neutrophil migration , T lymphocyte activation
```
388
ACUTE adrenal insufficiency ( adrenal crisis) , lab CRH, ACTH, CORTISOL?
All Decrease -
atrophy of hypothalamic CHR releasing neurons, pituitary, adrenal zone reticularis all inhibit
Etio/ neisseria meningitidis ( bacterial sepsis)
389
chronic adrenal insufficiency, etio?
```
autoimmune adrenalitis ( 90%)
--> Atrophy of Bilateral adrenal glands
```
sym/ skin HYPERPIGMENTATION
--> inc ACTH + MSH
390
rapid infusion of blood and normal saline, moa?
increase in preload stretches the myocardium and INC End-diastolic sacromere length --> inc SV + CO
391
HF cells + pul edema , hx?
hemosiderin -laden macrophages
| breaks in endothelium and extravastion of RBC into alveoli +lung parenchyma
392
HSV encephalitis,, infected area in brain?
via olfactory tract --> temporal + inferior lobe
sym/ aphasia + personality changes
393
throboangiitis obliterans ( buerger disease) , hx?
SEGMENTAL small, medium size vasculitis
etio/ SMOKING
394
polyarteritis nodosa , hx?
middle aged man, Hep B virus
hx/ TRANSMURAL inflammatory arterial wall with fibrinoid necrosis
395
Primary biliary cholangitis, hx + asso with?
ASSO with GVHD
immune mediated destruction of intrahepatic bile ducts
lab/ ANTIMITCHONDRIAL AB titer +
lymphocytic inflammation --> granulmatous destruction of intrahepatic bile ducts with necrosis + micronodular regeneration of periportal tix
396
cryptorchidism , enters which opening?
EXTERNAL OBLIQUE muscle aponeurosis above the pubic tubercle
SUPERIFICIAL inguinal ring
