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UW wrong Q mix - A1 > Step 1 UW mix -A-1 > Flashcards

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

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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

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3
Q

ARP in exp ?

A

ARP exposed= 100 * (risk in exp - risk in unexp) / risk in exp)

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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

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5
Q

Panic disorder, Rx?

A

SSRI/ SNRI

acute : BZD ( risk for abuse pt)

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6
Q

paget dx, initial phase?

A

1st: inc Osteoclast
2nd: mix
3rd: osteoblast (lab: inc ALP)

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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

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8
Q

CDK 4/6 reg G1-> S phase ( cyclin D), SE?

A

palbociclib:

inhibit hematologic cells in BM -> neutropenia, anemia, thrombocytopenia

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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)

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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)

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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

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12
Q

shiga-like toxin, moa?

A

inactivating 60S ribosomal subunit in human cell -> bloody diarrhea mucosal cell death

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13
Q

alterd FAS pn, moa?

A

alternative splicing - single gene code for unique pn by selective inc / excluding diff DNA exon

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14
Q

ubiquitination, moa?

A

small regulatory pn, making them pn degradation

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15
Q

WPW syn, moa?

A

accessory conduction pathway- accessory bypass AV node tract / bundle of kent - preexcitation of ventricles

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16
Q

nephrotic syn, frothy app urine moa?

A

dec plasma oncotic pressure, dec serum albumin

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17
Q

+ KIT ( CD 117) , excessive histamine , flushing, diarrhea, dx?

A

systemic mastocytosis- clonal mast cell proliferation + kit receptor TK mutation

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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
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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

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20
Q

lateral epicondylitis - injuried causes?

A

wrist extension ( tennis elbow) injury - pt of attachement for extensor carpi radialis brevis & extensor digitorum

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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

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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

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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

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24
Q

salmonella typhi, sym?

A

bloody diarrhea, abd pain, high fever, salmon- colored macules
lymphoplasmacytic inf infiltrate asso w/ hemorrhage

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25
Q

shigella flexneri, syn?

A

sudden onset severe abd cramping, bloody diarrhea, vomiting, high fever

cryptitis, ulceration, crypt abscesses

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26
Q

RNA no proofreading?

A

No 3’ -> 5’ exonuclease activity

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27
Q

5’ -> 3’ exonuclease activity ?

A

DNA polymerase I to engage in nick translation, DNA repair + removal of RNA primers during replication

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28
Q

sick sinus syn- age degeneration loc?

A

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

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29
Q

AV block, loc?

A

inf portion of INTERATRIAL SEPTUM contain the His bundle

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30
Q

Thiazolidinediones?

A

Pioglitazone

mao/ + PPAR-gamma , dec insulin resistance

se/ fluid retention/ HF,
WG

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31
Q

inc CO, inc VR , dx?

A

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

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32
Q

acute GI bleeding, physio change?

A

sharp dec circulation BV, shift VR to left

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33
Q

phenylephrine infusion, physio change?

A

inc SNS+ -> vasoconstriction, inc TPR

dec CO due to inc afterload along with dec VR

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34
Q

MI, physio change?

A

isolated dec CO, no change in BV/ VR

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35
Q

anaphylaxis, physio change?

A

widespread venous + arterial dilation with inc capillary permeability into 3rd space of fluid –> significant drop in VR

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36
Q

cavenous hemangioma ?

A

MC benign liver tumor, typically in 30-40 yo

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37
Q

piriformis syn?

A

pass thru greater sciatic foramen inv external hip rotation- sciatic nerve entrapment

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38
Q

Denosumab, moa?

A

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

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39
Q

aplastic anemia, hx?

A

hx/ profondly hypocellular BM infiltrated with adipose

sym/ pancytopenia

etio/ injury from drugs, radiation, viruses, multipotent hematologic stem cells

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40
Q

primary myelofibrosis, hx?

A

hx/ BM fibrosis with colonal expansion of megakaryocytes. dacrocytes

BM dry with fbrosis + atypical megakaryocytes

sym/ HSM, cytopenia,

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41
Q

girl with 46 XY, lack 2ndry sexual char’ + blind vagina, dx?

A

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

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42
Q

5a- reductase def, causes?

A

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

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43
Q

rivaroxaban, apixaban, mao?

A

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

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44
Q

eptifibatide, moa?

A

inhibits pt aggregation + thrombosis : blocking Gp2b/3a receptor, binding site for fibrinogen

rx/ ACS + PCI

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45
Q

Dabigatran, moa?

A

oral direct thrombin inhibitor that inactivates both circulating + clot asso thrombin

Rx/ thromboembolic dx + stroke prophylaxis

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46
Q

terbinafine, moa?

A

inhibiting enz squalene epoxidase : inhibits synthesis of ergosterol of fungal membrane

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47
Q

nystatin, amp B, moa?

A

binding to ergosterol

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48
Q

flucytosine, moa?

A

inhibits fungal protein synthesis by replacing uracil with 5-FU in fungal mRNA

rx/ systemic fungal infection

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49
Q

griseofluvin, moa?

A

binds to polymerized microtubules and disrupts fungal mitotic spindle, preventing fungal cell mitosis

rx/ dermatophytosis

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50
Q

fungemia: candida systemic infection, moa?

A

low neutrophil count, hematogenous spread via indwelling CV catheter

** DOES NOT spread to resp

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51
Q

superificial Candida inf ( oral/ esophageal/ cutaneous/ vulvovaginitis), moa?

A

T lymphocytes - Th cells

eg. HIV low T cell count inc risk

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52
Q

riboflavin def, effect on TCA cycle ?

A

succinate dehydrogenase ( complex II) affected : FMN + FAD

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53
Q

atypical pn - mycoplasma pn/ chylamdia pn, moa?

A

completely lacks a cell wall

rx with/ bacterial pn synthesis inhibitor
eg: macrolide/ tetracycline

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54
Q

TB, rx isoniazid, moa?

A

isoniazid: mycolic acid synthesis inhibitor - cell wall of mycobacterium

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55
Q

pul arterial HTN hereditary, moa?

A

dysfunctional endothelial + SM cell proliferation
–> vasoconstriction, anti-proliferative meditators ( NO, Prostacyclin)

Heart sound: sound S2 , RVH, elevate JVP, hepatic congestion, peripheral edema

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56
Q

Rifaximin, moa?

A

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

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57
Q

azathioprine, moa? check lab?

A

inhibits purine synthesis pathway
azathioprine -> 6-mercaptopurine converted to 6-thioguanine met

lab/ pancytopenia monitor complete blood count

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58
Q

montelukast, zadirlukast, moa?

A

leukotriene receptor antagonists:

inhibit the CysLT1 receptor ( LTC4, LTD4, LTE4) at target cell

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59
Q

PECAM-1 gene delection, causes?

A

absent of Transmigration

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60
Q

P-selectin / E-selectin def?

A

Margination- increase vascular leakage in the microvasculature / Rolling on endothelium viz Sialyl-Lewis X

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61
Q

ICAM-1 (CD34) def?

A

tight adhesion

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62
Q

neck mass w/ Sq cell CA, primary site?

A

nasopharynx - anterior cervical LN
unilateral middle ear effusion - eustachian tube obstruction

vs/ vocal cords , bast tongue, piriform sinus - not ob eustachian tube

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63
Q

orthomyxoviruses, transmitted to human thru animals via?

A

Genetic reassortment: segmented genome, HA, NA

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64
Q

antigenic drift?

A

point mut HA, NA genes slightly alter product pns

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65
Q

frameshift mutation?

A

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

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66
Q

phenotypic mixing?

A

2 viruses infect the same cell and progeny viruses exhibit coat / env

pn NOT coded for by genetic material

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67
Q

QT prolongation causes?

A

Med-
Antiarrhythmic: Class IA (quinidine), III (dofetilide)

aB: macrolides, fluoroquinolones

anti-psyChotic: haloperidol

Anti-Depressant: TCAs

anti-Emetics: ondansetron

electrolytes abnormalities

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68
Q

isopropanol 70% disinfect skin, moa?

A

disruption of cell membrane, denaturation of pn- no sporicidal

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69
Q

Iodine, moa?

A

halogenation of pn & nucleic acids, sporicidal

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70
Q

H2O2, moa?

A

produces destruction free radicals that oxidize cellular components, sporicidal

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71
Q

formaldehyde, glutaraldehyde , moa?

A

alkylating + cross linking DNA + pn

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72
Q

Mullerian aplasia ( mayer -Rokitansky-Kuster-Hauser) syn, moa?

A

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

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73
Q

CAH- 21 hydroxylase def?

A

female : virilization, salt wasting ( dec BP)

male: precocious puberty , salt wasting

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74
Q

androgen insensitivity syn ( AIS) ?

A

46 XY male, appear phenotypically female due to androgen receptor defect

sym/ minimal axillary / pubic hair, cryptochid testes, no uterus/ ovaries

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75
Q

integrase inhibitor, moa?

A

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

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76
Q

IgE independent mast cell + due to?

A

more common:

opioids, radiocontrast agents, VNC- induce mast cell degranulation by activation of pn kinase A + PI3 kinase

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77
Q

IgE -dependent mediated degranulation due to?

A

food, vespid stings, beta-lactam + sulfonamide ab

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78
Q

Donepezil, moa?

A

acetylcholinesterase inhibitors - reduction in Ach breakdown
ENHANCE ACH + PNS TONE

se/ slowing cardiac conduction: bradycardia, AV block , dec CO -> syncope, LH

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79
Q

diphenhydramine, moa?

A

first gen histamine -1 blocker - alpha 1 receptor blocking : orthostatic syncope via inhibit vasoconstriction

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80
Q

succinylcholine, moa?

A

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

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81
Q

DRE, prostate biopsy ?

A

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

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82
Q

prostate adenocarcinoma MTS, hx?

A

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

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83
Q

osteolytic bone lesion, dx?

A

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)
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84
Q

prostate ca, gleason grade, stage?

A

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

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85
Q

beta -adrenergic activity ?

A

inc Na/K/ATPase pump -> endogenous catecholamines + b2 agonist -> transiet hypokalemia -> inc transport K+ intracellulary

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86
Q

andexanet alfa , moa?

A

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

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87
Q

ticagrelor , moa?

A

blocks P2Y12 adenosine diphosphate receptor on surface of pt, prevents pt aggregation

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88
Q

Dabigatran, moa?

A

direct oral anticoagulant inhibits circulating + clot bound thrombin.
reverse by idarucizumab ( monoclonal ab fragment that binds & inhibits dabigatran)

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89
Q

supersaturation of gallstone, moa?

A
  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
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90
Q

buserelin/ goserelin/ leuprolide, moa?

A

GnRH analogue: stimulates pituitary gland in continous fashion lead to down regulation of GnRH receptor -> subsequently drops LH secretion, lowers androgen production by testes.

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91
Q

bicalutamide, moa?

A

androgen -receptor inhibitors - to prevent the surge in androgen during the first few weeks to block the activity of androgen on tumor cells

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92
Q

heparin, lab? thrombin time/ PTT/ FXa ?

A

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
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93
Q

abiraterone, moa?

A

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

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94
Q

true GFR, compared to Cr?

A

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

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95
Q

defect in TTN gene exon result truncated titin pn, dx?

A

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

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96
Q

HOCM, moa?

A

AD, mut genes encoding beta- myosin heavy chain / myosin binding pn C

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97
Q

restrictive CMP, moa?

A

infilitrative dx, inc mut in genes encoding 1/ several sacromere/ cytoskeletal on

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98
Q

property of elastin?

A

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

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99
Q

ECG: ST elevation in lead I + avL, which arteries occlusion?

A

left circumflex artery- lateral limb leads : also in v5-v6

ecg/ st elevation/ q waves

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100
Q

LAD arteries, leads?

A

supply left vent + IVS septal branches: v1-V4 ( promixal occlusion)

distal occlusion spares V1-2

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101
Q

left main coronary artery, leads?

A

give rise to LAD + LCX : v1-4, v-6, I, avL

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102
Q

RCA , leads?

A

lead II, III, avF

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103
Q

chancroid , haemophilus ducreyi, hx?

A

sym/ multiple + deep ulcers, base have gray to yellow exudate, PAINFUL lesion

hx/ RAGGED BORDERS asso with grey exudate + inguinal LAD

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104
Q

granuloma inguinale ( donovanosis), hx?

A

klebsiella granulomatis

hx/ extensive & progessive ulcerative lesion W/O LAD, base have granulation-like tix, deep staining gram - intracytoplasmic cysts (Donovan bodies)
NOT painful

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105
Q

Lymohagranuloma venerum, chlamydia trachomatis, his?

A

hx/ small, shallow ulcers, large, painful, coalesced ingiunal LN ( buboes), intracytoplasmic chlamydial inclusion bodies in epi cell & leukocytes
NOT painful

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106
Q

Zidovudine, moa?

A

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
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107
Q

GFAP + stain for, Dx?

A

neoplasms of glial origin : astrocytomas, ependymomas, oligodendrogliomas

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108
Q

synaptophysin, stain for dx?

A

transmembrane glycopn found in presynaptic vesicles of neurons, neuroendocrine, neuroectodermal cells

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109
Q

anastrozole, moa?

A

dec androgen aromatization: dec syn of estrogen from androgen, suppressing estrogen level in PM woman

rx/ slowing progression ER + tumor

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110
Q

basophilic cytoplasm + proliferation fraction Ki-67 fraction , dx?

A

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

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111
Q

HHV-8, hx?

A

primary effusion lymphoma, large cells, big nuclei, prominent nucleoli

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112
Q

case fatality rate?

A

fatal / fatal + nonfatal cases

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113
Q

cilostazol, moa?

A

reduce pt activation by inhibiting pt phosphodiesterase, enz resp for breakdown of cAMP

direct arterial vasodilator, dec claudication sym PAD

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114
Q

destroy ectopic focus rx arrhythmia, nerve close proximity site?

A

phrenic nerve- PSVT radiofreq ablation

crista terminalis loc @ RA
injury cause elevation of rt hemidiaphram CXR

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115
Q

Sym trunk injury?

A

parallels spina column on both sides provide sym innervation throughput body.

sym/ horner syn ( miosis, ptosis, anhydrosis)

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116
Q

CHF , moa?

A

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

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117
Q

delay ASA toxicity, lab?

A

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)
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118
Q

hepatic steatosis, moa?

A

dec free FA oxidation : secondary to excess NADH production by alcohol dehydrogenase & aldehyde dehydrogenase

**impaired lipoprotien assembly ass with alcohol -induced hepatic steatosis

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119
Q

bisacodyl/ senna, moa?

A

stimulant laxatives - activates enteric nerve in myenteric plexus to stimulate peristalsis

se/ abdominal disturbances

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120
Q

dousate ( surfactant), moa?

A

dec stool surface tension, enabling water to enter stool

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121
Q

methynaltrexone, moa?

A

mu -opioid receptor antagonist , rx opioid induced constipation

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122
Q

mg hydroxide, polyethylene glycol, lactulose, moa?

A

osmotically active agents that are poorly absorbed by the intestines.
draw water into intestinal lumen, softening stool + make stool easier to pass

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123
Q

Lupiprostone, moa?

A

agonist of CIC-2 chloride channel loc at apical membrane of intestine, inc Cl secretion into intestinal lumen

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124
Q

diabetic neuropathy, moa?

A

endoneurial arteriole hyalinization –> narrowing arteriole lumen + ischemia nerve damage, glycosylation end products are directly toxic to nerve tix

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125
Q

GB syn, moa?

A

endoneurial inflammatory infiltration of peripheral nerve, rapid ascending paralysis , segmental demyelination

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126
Q

CTS, moa?

A

entrapment of nerve w/in anatomic compartment leads to compression neuropathy

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127
Q

beam radiation ( gamma, x-ray), moa?

A

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

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128
Q

UV light radiation, non-ionizing radiation, moa?

A

EG. XP

pyrimidine-pyrimidine dimers ( thymine dimers)
ionizing radiation has higher energy to remove electron leaving more cell damage

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129
Q

cephalosporins resistance , moa?

A

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

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130
Q

methicillin resistance in S. aureus, moa?

A

PBP alternation- reduced AFFINITY for b-lactam anti-microbrial agents: resistant to all b-lactam agents

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131
Q

fluoroquinolone resistance, moa?

A

mut DNA gyrase, not impact beta-lactam ab activity

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132
Q

VNC resistance , moa?

A

D-ala-D-ala cell wall precursor – D-ala-D-lac

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133
Q

personality, behavior change, brain injury which loc?

A

orbitofrontal cortex

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134
Q

lateral prefrontal cortex injury?

A

injury result unable to executive function, motivation , organizing, planning purposeful action

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135
Q

irreversible myocardial cell injury, moa?

A

mitochondrial vacuolization - permanent inability to generate further ATP via oxidative phosphorylation

** mito swelling -> reversible cellular injury

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136
Q

dissociation of rRNA from mRNA reversible ischemic/ hypoxic injury, moa?

A

disaggregation of polysomes denotes the dissociation –> into monosomes–> impairs pn synthesis

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137
Q

single brain abscess @ lateral temporal lobe, loc entry?

A

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)

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138
Q

ependymoma, ob where in brain ?

A

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

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139
Q

statin + cholestryamine, : hepatic cholesterol synthesis ?

A

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

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140
Q

diabetic ketoacidosis , TG metabolism?

A

glycerol kinase : glycerol + FA ( via beta -oxidation –> Ketone acids) –> glycerol 3- phosphate –> DHAP –> energy + glucose

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141
Q

pleiotrophy, moa?

A

single genetic defect causing different organ system affected

eg. homocystinuria

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142
Q

Polyploidy, moa?

A

more than 2 complete sets of hormones w/in an organism / cell

eg. 69 XXX. XXY, XYY - partial hydatidiform mole

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143
Q

rituximab, moa?

A

express CD20 surface Ig monoclonal ab
rx/ lymphoma immunotherapy

** transtuzumab - also monoclonal ab rx breast cancer

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144
Q

imatinib, moa?

A

CML - phil t (9, 22) - BRC-ABL fusion gene pn TK

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145
Q

chylothorax , injury to ?

A

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

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146
Q

phrenic nerve injury?

A

elevation of hemidiaphragm

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147
Q

isoniazid toxicity, cause?

A

hepatotoxic, hepatitis

lab/ inc ALT/ASL

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148
Q

serum sickness drug HS causes?

A

Type 3 HSR

5-10 days after exposure the drug, fever, proteinuria, LAD, urticaria, arthralgias,

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149
Q

autoimmune hepatitis, hx?

A

high anti-smooth muscle ab titers + hypergammaglobulinemia

hx/ hepatocellular pattern of liver injury, lymphoplasmacytic infiltrate in portal and periportal region

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150
Q

primary sclerosing cholangitis, hx?

A

MC male

periductal FIRBOSIS + luminal obliteration of biliary ducts –> cholestasis
high ALP level , near normal aminotransferase

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151
Q

chronic HBV, hx?

A

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

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152
Q

acetaminophen overdose, ,hx?

A

hepatic inflammation + necrosis w/ neutrophilic infiltration

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153
Q

prolactinoma, lab - GnRH, LH, testo?

A

GnRH - dec
LH- dec
testo- dec

all dec due to high prolactin level supporess GnRH secretion

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154
Q

muscle contraction, ATP attach to sarcomere causes?

A

myosin head detachment from actin filament

** calcium binding to Troponin-C shifts tropomyosin away from myosin binding site on actin, NOT directly on ATP

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155
Q

prolong use, beta blocker withdrawal?

A

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

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156
Q

ascites in cirrhosis , moa?

A

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
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157
Q

nephrotic syn, lab change?

A

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

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158
Q

histoplasma capsulatum, hx?

A

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

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159
Q

coccidioides immitis, hx?

A

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
Q

HIT type 2 , moa?

A

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
Q

HIT type 1 , moa?

A

non- immune mediated condition caused by pt clumping

does NOT cause thrombosis

162
Q

vasospastic angina , moa?

A

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
Q

unstable angina, moa?

A

ulceration of thin fibrous cap overlying ATS plaque

sym/ intermittent chest pain , not relieved by NG

164
Q

uric acid stone formation?

A

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

  1. inc urine conc: hot, arid climate, DEHYDRATION
  2. low urine ph: chronic diarrhea ( Gi HCO3 loss) , met syn/ DM

clinical/ radiolucent stones ( not visible on XR)

165
Q

Ca &oxalate stone, moa?

A

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
Q

strep pyogenes bacterial pharyngitis infection , dx?

A

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
Q

strep pyogenes, virulence factor?

A

coates the surface GAS with Ab against M pn

168
Q

strep pyogenes, complication dx?

A

elevate Ab titer against streptolysin O - indicate recent GAS inf + dx GAS complication
eg. RF, glomerulonephritis

169
Q

MHC-II molecule genes encode- HLA-DP, DQ, DR , moa?

A

APC eg. B cells, macrophages, after excellular Ag loaded onto MHC class II molecule acidified LYSOSOME ( CD 4+)

170
Q

MHC-I molecule genes encoded HLA-A, B, C moa?

A

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
Q

fragile X syn - moa?

A

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
Q

Lynch syn, moa?

A

defect DNA mismatch repair genes- inc risk of Hereditary non-polyposis colorectal cancer + endometrial cancer

173
Q

cocaine w/drawal sym?

A

“crash” - irritable, w/drawn, hypersomnolent, hyperphagic, fatigue, vivid dreams, acute depression

174
Q

BZD w/drawal sym?

A

rebound anxiety , insomnia, perceptual disturbances, tachycardia, seizures, psychosis

175
Q

familial hypocalciuric hypercalcemia - moa?

A

being autosomal defective CaSR in PTH + kidney

Ca sensing receptor: transmembrane Gq pn coupled

176
Q

ITP, moa?

A

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
Q

left temporal hemiretina, loc injury?

A

left lateral geniculate body in thalamus - –> travels via ipsilateral optic radiation to ipsilateral primary visual cortex

178
Q

confounding ?

A

FALSE / NO association of expose with a dx -

occurs when exposure-dx relationship muddled the extaneous factor asso with both exp + dx

179
Q

effect modification?

A

ASSOCIATION:

external variable positively / negatively impacts the observed effect of risk factor on dx status

180
Q

Nocardia mao?

A

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
Q

actinomyces moa?

A

ANAEROBIC organism, cervofacial infection

abscess with sulfur granules

182
Q

exudative moa?

A

inc vascular membrane permeability ( infection, malignancy, rheumatic dx)

high fluid: serum ratio of total pn > 0.5 / lactate dehydrogenase >0.6

183
Q

transudative moa?

A
  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
Q

familial chylomicronemia syn type I, moa?

A

pn defect: lipoprotein lipase , APO-C II

elevate chylomicrons

sym/ acute pancreatitis, HSM, lipemia retinalis, eruptive skin xanthomas

185
Q

familial hypercholesterolemia type IIA, moa?

A

pn def: LDL receptor , Apo-B -100

elevate: LDL

sym/ premature CAD, corneal arcus, tendon xanthomas, xanthelasmas

186
Q

familial dysbetapnemia type 3 moa?

A

pn def: Apo-E

elevate chylomicron + VLDL remants : cholesteral + TG

sym/ premature CAD, tuboeruptive + palmar xanthomas

187
Q

familial hyperTG type 4, moa?

A

pn def: Apo-A-V

elevate VLDL

sym/ inc pancreatitis risk, obesity + insulin resistance

188
Q

CLL , mature B cell accumulate in BM + peripheral blood due to oncogenic mutation inhibits apoptosis?

A

clonal pop with CD 19, 20, 23

se/ anemia , thrombocytopenia , infection due to neutropenia

hx/ smudge cells

189
Q

CML, myeloproliferative of granulocytes ?

A

BCR-ABL fusion gene ( phil chrm)

190
Q

glyburide, moa?

A

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
Q

GLP-1 ( glucagon like polypeptide-1 ) , moa?

A

secrete by intestinal L cells acts thru cell surface receptors that are COUPLED with G-Pn AC

192
Q

melanoma recurrence, hx?

A

brown pigment (melanin granules) in cytoplasm- large, hyperchromatic nuclei, irregular nuclear shape ( binucleated cells)

lab/ + melanin/ melonoma marker S-100 , HMB-45

193
Q

Chronic systolic HF , hx?

A

brown , hemosiderin laden macrophages

194
Q

mitochondrial DNA (mtDNA) exists as?

A

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
Q

streptococcus pyogenes, lab?

A 
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
Q

closterium perfringens, lab?

A

G+ rod
catalase -
coagulase -
double zone of beta - hemolysis

etio/ good poisoning, clostridial myonecrosis ( gas gangrene) , bacteremia

197
Q

stable angina, moa?

A

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
Q

ACUTE mitral regurgitation - spontaneous chordae tendineae rupture, moa afterload, preload, EF?

A

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
Q

CHRONIC MR , lab?

A

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
Q

XO inhibitor - allopurinol, febuxostat , moa?

A

prevent acute attack in pt with recurrent + progressive gouty arthritis + macroscopic tophi

NOT be initiated during acute gout attack

201
Q

non- seminomatous germ cell tumor, lab?

A

lab/ + hcg/ aFP / LDH

eg. embryonal ca, yolk sac chorioCA, teratoma, mixed

202
Q

MS , diastolic pressure, afterload, contractility?

A

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
Q

dilated CMP, ischemia HD , lab?

A

LV systolic contractility dec

LVDP + afterload near normal

204
Q

STRESS urinary incontinence , moa?

A

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
Q

overflow UI, moa?

A

sym/ incomplete emptying + persistent involuntary dribbling

mao/ impair detrusor contractility , bladder outlet ob

206
Q

URGE UI, moa?

A

moa/ detrusor hyperactivity

sym/ sudden, overwhelming urge to urinate

rx/ M3 antagonist : oxybutynin : relaxes the ureter muscle

207
Q

thyroglossal duct cyst, moa?

A

incomplete obliteration of duct at midline mass , moves superiorly with protrusion of tongue / swallowing

208
Q

ectopic thymic cysts, moa?

A

lesion dev along descent of thymus ( angle of jaw to mediastinum) , UNILATERAL

209
Q

brachial cleft cyst, moa?

A

remnant branchial arch st -> LATERAL neck mass

sinus tract / fistula may present

210
Q

pudendal nerve injury, moa?

A
  • 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
Q

methemoglobinemia moa?

A

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
Q

most definitie MALIGNANT hx?

A

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
Q

benign cancer hx?

A

admixture of several lymphoid cell types in LN

214
Q

left shift O2 dissociation curve causes?

A

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
Q

vagal maneuvers, moa?

A

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
Q

anisocoria, pupillary asymmetry, moa?

A

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
Q

randomized control trail ?

A

exp studies - research RANDOMLY assigns intervention to potential participants to assess the effect of the controlled intervention

218
Q

prospective cohort studies / retrospective cohort studies ?

A

pt are already ASSIGNED to exposure gps

219
Q

field cancerization, moa?

A

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
Q

tricuspid valve regurgitation, moa?

A

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
Q

AV regurgitation , moa?

A

RF dx, aortic root dilation

sym/ Lt side HF ,PUL edema with CRACKLES

222
Q

metolazone , moa?

A

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
Q

Vancomycin , se?

A

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
Q

type 2 DM , moa?

A

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
Q

type 1 DM, moa?

A

HLA-DQ / DR - DR3/ DR4

  • pancreatic islet infiltration with leukocytes, circulating anti- islet Ab , DKA
226
Q

subarachnoid hemorrhage, moa?

A

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
Q

epidural hematoma, moa?

A

middle meningeal artery

-LENS shape convexity
contained btwn suture lines

228
Q

subdural hematoma, moa?

A

bridging veins

-CRESCENT shape
cross suture lines
-older pt, shaken babies syn

229
Q

intracerebral hemorrhage, moa?

A

blood w/in brain parenchyma - small arteries eg. basal ganglia, thalamus, pons
- extend into ventricles

230
Q

cerebral cytotoxic ionic edema , moa?

A

failure ATP dep ion pumps , comb with release of excitatory AA glutamate leads to acc of intracellular Na + water in neural + glial cells

231
Q

vasogenic cerebral edema, moa?

A

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
Q

clopidogrel moa?

A

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
Q

ASA moa?

A

enhancing cAMP- mediated inhibition of pt TXA2 synthesis

234
Q

sickle cell anemia ( hb S) , promoted by condition ?

A

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
Q

left shifts O2-Hb dissociation curve, due to?

A

inc 2,3 BPG, inc temp, inc H+, inc co2

236
Q

severe aortic stenosis, causes?

A

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
Q

HIV asso dementia, hx?

A

microglial cells
resident macrophages of CNS + blood derived perivascular macrophages

microglial nodules -fuse tog form multinucleated giant cells

238
Q

rabies, hx?

A

eosinophilic inclusion bodies in cytoplasm of neuronal cells , negri bodies

239
Q

superficial burn, moa?

A

erythema that blanches w/o blistering- damage + inflammatory mediators release from epidermal + immune cells-

release HISTAMINE + vasoactive mediators from mast cells in mins

240
Q

Deeper , partial thickness burns, moa?

A

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
Q

crigler -najjar syn type 1 , moa?

A

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
Q

rotor syn, moa?

A

AR, asymptoatic conjugated hyperbilirubinemia –> defect in hepatic uptake + excretion of bilirubin pigments.

243
Q

dubin johnson syn moa?

A

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
Q

strongest latex beads?

A

mature mRNA , processed ready for nuclear export + translation into pn.
- post transcriptional modification

245
Q

ichthyosis vugaris , moa?

A

inherited dx caused by mutation of FILAGGRIN GENE, epidermal hyperplasia + defective keratinocyte desquamation –> dry, scaly skin w/ loss of normal barrier function

246
Q

cauda equina moa?

A

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
Q

fluoroquinolones, drug drug interaction, moa?

A

insoluble chelate complexes with polyvalent cations ( calcium, iron, aluminum, mg) - leads to impaired absorption + significant dec DRUG bioavailability

248
Q

diltiazem, cytochrom p450 inhibitor, moa?

A

inc systemic level of numerous drugs , drug toxicity

249
Q

biliary atresia , moa?

A

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
Q

galactosemia, moa?

A

galactose -1-phosphate urydyl transferase ( GALT) def, defective galactose to breakdown to lactose –> glc

sym/ vomiting, diarrhea, inability to digest breast milk/ formula

251
Q

hemolytic dx of NW , moa?

A

Rh incompatibility

sym/ dev jaundice on 1st day of life -> indirect hyperbilirubinemia
+ coombs antiglobulin test confirms presence of AB-mediated hemolysis

252
Q

insulin, surface receptor moa?

A

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
Q

sevelamer, moa?

A

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
Q

thyroid peroxidase (TPO) enz , moa?

A

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
Q

severe AS -> induce sudden onset HF , moa?

A

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
Q

neonatal tetanus, prophylaxis?

A

clostridium tetani spores to infants –> spasms + hypertonicity –> VACCINATE WOMAN who are pregnant with inactivated tetanus toxin ( TETANUS TOXOID)

transplacental IgG to fetus

257
Q

familial adenomatous polyposis ( FAP), moa?

A

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
Q

TP53 , moa?

A

inhibit cellular growth

asso with Li Fraumeni syn : BBSLA -

259
Q

lynch syndrome , moa?

A

HNPCC: hereditary non-polyposis colorectal ca - germline mut to DNA MISMATCH REPAIR GENE: MSH2/6 , MLH1

** colon ca dysplasia in flat colonic mucosa :

260
Q

Ob sleep apnea, moa?

A

recurrent of upper airway result functional airway collapse –> apnea airflow despite continued breathing effort

261
Q

acute MI, hx?

A

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
Q

AS, are related calcific AV Dx , moa?

A

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
Q

MV prolapse, moa?

A

myxomatous value thickening + elastin fragmentation -

264
Q

Rheumatic fever dx, moa?

A

subendocardial granulomatous lesion with fibrinoid necrosis + subsequent fibrosis –> MV inv –> MS / MR

265
Q

vaccine failure, moa?

A

dec production of naive B + T lymphocytes -> impair the adaptive immune response to novel Ag

266
Q

aspiration on, moa?

A

oral flora aspiration, aspration of gastric contents

hx/ neutrophil rich, inflammatory exudates w/in bronchioles + alveolar spaces

267
Q

Pul infarction, hx?

A

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
Q

paroxysmal A Fib ablation?

A

irregular irregular rhythm, no p waves

atrial remodeling @pul veins near ostia into LA

269
Q

A flutter, ablation ?

A

cavotricuspid isthmus area of RA tix btwn crista terminalis + tricuspid annulus

270
Q

corticosteroids , moa on uncontrolled asthma?

A

inhibit production of (inflammatory mediators: cytokines, PGE, Leukotrienes), dec leukocyte extravasation into resp epithelium + induce apoptosis inflammatory cells

271
Q

JC virus, hx?

A

advance AIDS , risk for viral reactivation spread to brain.

white matter demyelination w/ no mass effect / enhancement - oligodendrocytes, progressive multifocal leukoencephalopathy (PML)

272
Q

measles, moa?

A

subacute , sclerosing panencephalitis - fatal progressive dx

slowly worsening neurologic sym + multifocal , enhancing, white matter lesion

273
Q

MI caused ST elevation myocardial infarction (STEMI), moa?

A

acute rupture of ATS plaque with fully ob thrombus

DOES NOT relieve by NG /rest

274
Q

warfarin, moa?

A

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
Q

fibrates, moa?

A

inhibit PPARa , dec VLDL

inhibits hepatic production of TG

276
Q

niacin, moa?

A

dec TG
inc HDL
dec VLDL –> LDL : dec LDL concentration

277
Q

supracondylar humeral fracture, ANTEROLATERAL displacement?

A

radial nerve

278
Q

medical epicondyle injury?

A

brachial artery + median nerve

279
Q

african malaria, choroquine resistant, rx?

A

Atovaquone-proguanil / artemisinins

280
Q

neoplastic cord compression, extend into?

A

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
Q

intramedullary MTS , dx?

A

assoc with lung ca, Brown Sequard syn

282
Q

intervertebral disc herniation , causes?

A

nerve root compression ( sciatica)

283
Q

acute simple cystits , rx?

A

E.coli –> rx/ TMP-SMX/ nitrofurantoin

284
Q

Chlamydia trachmatous infection , rx?

A

Azithromycin / doxycycline

285
Q

trichomonas vaginalis, rx?

A

metronidazole

286
Q

increase ratio foward flow voln to regurgitant flow voln?

A

dec SYS vascular resistance

apical holosystolic murmur radiating to axilla –> MR

Eg. Nitroprusside

287
Q

pancreatic ca, etio?

A

SMOKING - MCC environmental risk factor

288
Q

recombination, moa?

A

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
Q

Phenotypic mixing, moa?

A

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
Q

Reassortment, moa?

A

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
Q

epidermolysis bullosa, moa?

A

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
Q

bacterial toxin -induced cleavage of desmoglein 1, dx?

A

bullous impetigo ( erythema , vesicles with yellow crusts) –> Staphylococcal scaled skin syn ( generalized erythema with flaccid bullae in flexural areas)

293
Q

atopic dermatitis, moa?

A

Loss of function in FILAGGRIN + other epidermal barrier pn

294
Q

fastest rate of metabolism glycolytic pathway?

A

Fructose -1 -phosphate
bypass phosphofructokinase

F-1-P –> Aldoase B–> DHAP + glyceraldehyde

** DHAP converted to triose phosphate isomerase–> glyceraldehyde -3 p

295
Q

focal nodular hyperplasia, hx?

A

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
Q

hepatic adenoma, hx?

A

benign liver lesion, strongly asso with ORAL CONTRACEPTIVE PILLS –> undergo malignant transformation / rupture

297
Q

ureters, anterior which vessels in true pelvis ?

A

Anterior to internal Iliac Artery

298
Q

Ureter relationship to uterine artery?

A

Ureter course POSTERIOR to Uterine artery before entering the bladder

299
Q

acute serum sickness, moa?

A

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
Q

schizoaffective disorder, moa?

A

delusion / hallunication for > 2 wks in the absence of MDD / Manic episode

301
Q

Pul Arterial HTN, effect on:

prostacyclin, TXA2, NO?

A

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
Q

RCC , obstructing IVC , invading what vein?

A

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
Q

RCC, elevate Hbg suggest?

A

erythrocytosis

hypercalcemia -> over production of PTH-rP / lytic bone MTS

304
Q

P. aeruginosa, resistance due to AB-modifying enz?

A

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
Q

CLL with trisomy chrm 12 , Dx?

A

FISH - highly sensitive cytogenetic test identify presence of chrm duplication + large deletion + translocation

306
Q

ELISA - dx?

A

AB / AG in a fluid

307
Q

Flow cytometry, dx?

A 
leukemia
surface markers ( CD5)
308
Q

reticulocytes contain bluish cytoplasm + reticular precipitates , residual of?

A

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
Q

Edwards syn, trisomy 18, sym?

A

meiotic nondisjunction -

sym/ rocker bottom feet, clenched hands with OVERLAPPING FINGERS
VSD, PDA, horseshoe kidney, GI sym ( Meckel’s diverticulum, malrotation)

310
Q

trisomy 13, patau syn sym?

A

midline facial defects ( holoprosencphaly, cleft lip/ palate) , polydactyly, GI ( omphalocele, umbilical hernia)

**NO overlapping fingers

311
Q

isoproterenol, moa?

A

nonselective B adrenergic agonist :

inc B1 + myocardial contraction

B2 + vasodilation by relation of vascular SM –> dec vascular resistance + MBP

312
Q

adenosine , moa?

A

A1 receptor on cardiac cells + potassium channels , inc K+ conductance
transient conduction delay thru AV node–> peripheral vasodilation , but reduces the myocardial contractility

313
Q

Straphylococcus epidermidis , differentiate by lab?

A

+ catalase : diff Stap vs Strep

  • coagulase test : diff S. aureus vs others

gram + cocci grape like clusters
+ novobiocin sensitive

Gamma hemolytic

314
Q

thick peptidoglycan layer + teichoic acid , moa?

A

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
Q

Gram + bacterial cell wall S pyogenes, moa?

A

mechanical support + protect from osmotic lysis

- composed peptidoglycan , mesh like cross lined polymer peptides + sugars

316
Q

metformin , moa?

A

moa/ inhibits hepatic gluconeogenesis via inhibition of mito isoform of glycerophosphate dehydrogenase in liver

se/ GI upset + diarrhea + LACTIC ACIDOSIS

contra/ RF

317
Q

SIADH, rx with vasopressin V2 receptor antagonist:

lab for plasma Osm, Urine output, Urinary Na excretion?

A

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
Q

Adjustment disorder?

A

within 3 months of identifiable stressor < 6 months once stressor ceases

sym/ distressing + impairing

319
Q

acute stress disorder ?

A

re-exp , avoidance, neg moods, dissociation, hyperarousal last 3 days - 1 months following life threatening traumatic event

320
Q

Alzheimer dx, LATE onset familial asso with ?

A

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
Q

foscarnet, moa?

A

chelate calcium

rx/ CMV resistant infection

se/ HYPOMAGNESEMIA, –> dec release of PTH –> HYPOCALCEMIA state
promote seizure

322
Q

cidofovir, se?

A

CMV retinitis, asso with NEPHROTOXICITY, pnuria, elevate CR

323
Q

Mt sickness lab?

A

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
Q

psoriasis, vit D analogs ( Calcipotriene, calcitriol) moa?

A

inhibition of T cell + keratinocyte proliferation + stimulation of keratinocyte differentiation

325
Q

hydroquinone, moa?

A

tyrosinase inhibitor dec syn of melanin

rx/ melasma - hyperpigmentation dx

326
Q

neurocysticercosis, etio?

A

ingestion of Taenia solium (pork tapeworm) excreted in feces of human carrier

lab/ eosinophilia , inc ESR

rx/ albendazole

327
Q

bordetella pertussis, hx?

A

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
Q

strep pneumoniae, hx?

A

migration of neutrophils from BS into alveoli

329
Q

hyperaldosteronism , lab Na, K, HCO3?

A

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
Q

gynecomastia, rx?

A

inc estrogen: androgen ratio

rx/ tamoxifen, SER modulator - acts as estrogen antagonist in the breast, dec risk of gyncomastia

331
Q

primary prevention?

A

health promotion :

diet habit , exercise…

332
Q

S3 heart sound, causes?

A

forceful rapid passive filling -> expansion ventricle capacity with high vent filling pressure/ voln –> INC LVESV

333
Q

Enterobiasis, rx?

A

perianal itching

hx/ scotch tape test

rx/ albendazole / pyrantel pamoate

334
Q

Loa Loa + Wuchereria Bancrofti, rx?

335
Q

Strongyloides stercoralis + Onchocerca volvulus , rx?

A

Ivermectin

336
Q

Trypansomes cruzi, rx?

A

Nifurtimox

337
Q

Schistosoma, Clonorchis sinensis, Paragonimus westermani, rx?

A

Praziquantel

338
Q

tuberinfundibular pathway, defect causes?

A

cxn hypothalamus to pituitary gland –> responsible for tonic inhibition of of prolactin secretion

339
Q

nigrostriatal pathway, defect causes?

A

Substantia nigra –> caudate nucleus + putamen : coordinates
of voluntary movements

D2 receptor blockade causes extrapyramidal effect : dystonia, akathisia, tardive dyskinesia

340
Q

bordetella pertussis, moa?

A

pertussis toxin : disinhibits AC thru Gi ADP-ribosylation , inc cAMP –> edema + phagocyte dysfunction

AC toxin –> inc cAMP

341
Q

bacillus anthracis , toxin?

A
  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
  3. LF
342
Q

Hormone sensitive lipase enz, moa?

A

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
Q

Lipoprotein lipase enz, moa?

A

found in endothelial cells function to degrade TG found in VLDL + chylomicrons –> FFA transport into adipocytes storage / used by tix for energy

344
Q

invasive pulmonary aspergillosis , hx?

A

septate narrow hyphae with 45 degrees angle

comming in ICP, AIDS

345
Q

ALS , sym?

A

UMN: corticospinal tract —> spasticity , hyperreflexia

LMN: motor neurons in anterior horn –> wkness, atrophy, fasciculation

346
Q

poliomyelitis, sym?

A

pure MOTOR neurons ( LMN) only

347
Q

hemophillia, moa?

A

F8 + 9- intrinsic coagulation pathway + activate F10 –> F10a –> F2 prothrombin into thrombin

rx. THROMBIN –> blood clotting

348
Q

fibrinogen, moa?

A

pn synthesized by liver

** thrombin mediates cleavage fibrinogen to form fibrin

349
Q

Cortisol has enhances the vasoconstrictive effect of catecholmines + ATII ?

A

Permissiveness effect –> no direct effect on physio process but allows another hormones to exert to maximal effect

350
Q

synergistic / additive moa?

A

additive : 1+ 1 = 2
combine effect of 2 drugs is equal to sum

synergistic : 1 + 0 > 1

351
Q

lunate dislocation , unable to perform ?

A

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
Q

deep motor branch of ulnar nerve , responsible?

A

finger abduction - dorsal + volar interossei + thumb adduction to innervate the adductor pollicis

353
Q

Primary TB infection, loc?

A

lower lobe of lung - virulence factors ( cord factor) prevent bact destruction by alveolar macrophages
ipsilateral hilar LN –> Ghon complex

354
Q

reactive TB, loc?

A

apical cavitary lesion

355
Q

influenza vaccination , moa?

A

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
Q

Neuraminidase, moa?

A

cleaves the terminal sialic acid residues on glycoconjugate receptors –> competitively inhibits influenza neuraminidase, PREVENT RELEASE VIRAL PROGENY

357
Q

TMP-SMX , se?

A

hyperkalemia, blockade of Na channels in CT , prevents Na/K exchange and reduces renal excretion of K

358
Q

hypoglycemia, due to which enz inc?

A

inc endogenous hormone – insulin excess –> inc glycolysis by activating PFK-2 ( phosphofructokinase-2) that produces F 2,6 BP

359
Q

prochlorperazine ( dopamine receptor blocker) + diphenhydramine , moa?

A

anticholinergic activity - due to blockade of D2 receptor –> inc Ach activity causes EPS ( acute dystonic rxn)

360
Q

HPV 6, 11 , hx?

A

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
Q

2ndry syphilis , condyloma lata , hx?

A

verruciform lesion - dense lymphoplasmacytic infiltrate

362
Q

acute cholangitis, moa?

A

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
Q

acute pancreatitis, hx?,

A

hx/ acinar cell dysfunction + necrosis

sym/ fever , hypotension, epigastric pain radiating to back, N/V, elevate lipase

364
Q

autoimmune hepatitis, hx?

A

immune mediated hepatocyte destruction

sym/ fever , tachycardia, hypotension

365
Q

acetaminophen overdose, sym?

A

RUQ pain, jaundice, vomiting, confusion, after 72 hr ingestion

366
Q

budesonide, moa?

A

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
Q

sigmoid shape response curve, moa for?

A

ionizing radiation - no effect until reach max threshold conc

368
Q

patiromer, moa?

A

non-absorbable cation exchange resin that BIND COLONIC K in exchange for Ca

rx/ Chronic hyperK

369
Q

Na-Zirconium cyclosilicate, moa/

A

non-absorbable cation exchange resin that binds intestinal K in exchange for NA + H

370
Q

methemoglobinemia, moa?

A

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
Q

retinis pigmentosa , moa?

A

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
Q

vit A def, hx?

A

abnormal keratinization of ocular + lacrimal epi –> dry eyes + Bitot spots ( conjunctival keratinization)

373
Q

azathioprine, moa on:

B lym, T lym, IG, IL-2 ?

A

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
Q

muomobab, moa?

A

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
Q

rituximab, moa?

A

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
Q

arginase def, affect?

A

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
Q

mechanical vent weaning , moa: RR, TV?

A

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
Q

hepatic metabolism desired?

A

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
Q

drug not well absorbed , moa?

A

low rate of redistribution

low lipid solubility - hydrophilicity

remain in Intravascular compartment

poor CNS penetration–> low VD –> highly plasma Pn bound +

380
Q

vestibular neuritis ( labyrinthitis) moa?

A

inflammation of vestibular nerve ( viral / postviral) - single episode last days

severe vertigo but NO hearing loss

381
Q

BPPV, moa?

A

otholiths in semiciruclar canals

sym/ brief episodes by head movements
NO auditory sym

382
Q

meniere dx, moa?

A

inc pressure + voln in endolymph

sym/ recurrent vertigo, ear fullness/ pain,
UNILATERAL hearing loss + tinnitus

383
Q

HSV, hx?

A

erythema multiforme , acute inflammatory dx –> erythematous papules evoles into target lesion

lab/ cytotoxic CD8 lymphocytes

384
Q

neuroleptic malignant syndrome , sym?

A

diffuse rigidity lead pipe
HYPOreflexia
altered mental status

385
Q

serotonin syn, sym?

A

clonus

hyperreflexia

386
Q

olanzapine , lab check?

A

fasting glucose + lipid panel

387
Q

straphylococcus epidermidis, moa for virulence ?

A 
BIOFILMS- producing organism: 
function as barrier to ab penetration and interferes with host defenses , opsonization , neutrophil migration , T lymphocyte activation
388
Q

ACUTE adrenal insufficiency ( adrenal crisis) , lab CRH, ACTH, CORTISOL?

A

All Decrease -
atrophy of hypothalamic CHR releasing neurons, pituitary, adrenal zone reticularis all inhibit

Etio/ neisseria meningitidis ( bacterial sepsis)

389
Q

chronic adrenal insufficiency, etio?

A 
autoimmune adrenalitis ( 90%) 
--> Atrophy of Bilateral adrenal glands

sym/ skin HYPERPIGMENTATION
–> inc ACTH + MSH

390
Q

rapid infusion of blood and normal saline, moa?

A

increase in preload stretches the myocardium and INC End-diastolic sacromere length –> inc SV + CO

391
Q

HF cells + pul edema , hx?

A

hemosiderin -laden macrophages

breaks in endothelium and extravastion of RBC into alveoli +lung parenchyma

392
Q

HSV encephalitis,, infected area in brain?

A

via olfactory tract –> temporal + inferior lobe

sym/ aphasia + personality changes

393
Q

throboangiitis obliterans ( buerger disease) , hx?

A

SEGMENTAL small, medium size vasculitis

etio/ SMOKING

394
Q

polyarteritis nodosa , hx?

A

middle aged man, Hep B virus

hx/ TRANSMURAL inflammatory arterial wall with fibrinoid necrosis

395
Q

Primary biliary cholangitis, hx + asso with?

A

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
Q

cryptorchidism , enters which opening?

A

EXTERNAL OBLIQUE muscle aponeurosis above the pubic tubercle

SUPERIFICIAL inguinal ring

UW wrong Q mix - A1 (1 decks)

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