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STEP 1 > STEP 1 Week 1 > Flashcards

STEP 1 Week 1 Flashcards

1
Q

Four impairments in glycogenolysis

A
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2
Q

Characteristics of Pompe disease and cause

A

Cause: deficiency of acid alpha glucosidase

Normal glucose levels

Extreme cardiomegaly

Glycogen accumulation in lysosomes

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3
Q

Muscle pierced for chest tube at 5th intercostal space, mid-axillary line

A

Serratus anterior

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4
Q

Pierre Robin Sequence

A
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5
Q

Progression of cells after MI

A
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6
Q

Regulatory T-Cell function

A
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7
Q

What is the IPEX disorder

A

Mutation in FOXP3 expression, leads to unrelgulated T and B cell activity

IPEX - Immune dysregulation, polyendocrinopathy, enteropathy, X-linked

See: autoimmune neteritis (villous atrophy,etc), excematous dermatitis, type 1 diabetes in infant

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8
Q

Trigylceride metabolism to glucose

A
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9
Q

Best long-term therapy for specific phobia

A

exposure-based CBT

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10
Q

Ovarian venous drainage

A

Left ovarian vein into left renal vein

Right ovarian vein into IVC

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11
Q

Distribution of data on a bell curve (percentiles)

A
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12
Q

When is B-HCG detectable in serum and urine

A

β-hCG is produced by the syncytiotrophoblast after implantation, which generally occurs 6-7 days after fertilization at the earliest. β-hCG typically is detectable in the maternal serum approximately 8 days after fertilization, whereas it is detectable in the urine 14 days after fertilization. Therefore, a serum pregnancy test will be positive before a urine pregnancy test.

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13
Q

What is hyperacute transplant rejection

A

Occurs minutes to hours

Preformed recipient antibodies against graft antigens

See: mottling and cyanosis, fibrinoid necrosis and capillary thrombotic occlusion

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14
Q

What is acute transplant rejection

A

Usually <6 months

Donor antigens induces activation of naive immune cells - Cell mediated, sensitization of recipient T cells

See: lymphocytic infiltrate, cd4 deposition, neutrophils, necrotizing vasculitis

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15
Q

What is chronic transplant rejection

A

Months to years later

Chronic low-grade immune response refractory to immune repression, mixed-cell and humoral

See: vascular wall thickening, interstitial fibrosis, parenchymal atrophy

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16
Q

Process of tRNA amino acid binding

A

The 3’ CCA tail of tRNA serves as the amino acid binding site.Aminoacyl tRNA synthetase is the enzyme responsible for “loading” the appropriate amino acid to the 3’ terminal hydroxyl group of the CCA tail.

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17
Q

How can buprenoprhine precipitate withdrawals

A

It is a partial opiod receptor agonist that binds with high affinity but low activity. It can displace other opioids leading to withdrawal

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18
Q

Effects of unilateral renal artery stenosis

A
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19
Q

Location and effect of adrenergic receptors

A
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20
Q

What does staph secrete that allows Haemophillus to grow on blood agar

A

V Factor (NAD+)

Also helps release factor X (hemetin), both are necessary for haemophilus

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21
Q

Pathophys of an acute hemolytic transfusion reaction

A

Type II hypersensitivty

IgG and IgM autoantibodies with complement activation (cell lysis)

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22
Q

What are clavulinic acid, subactam, and tazobactam

A

beta-lactamase inhibitors

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23
Q

Most common cause of nosocomial blood stream infections

A

Intravascular catheters (allows staph to enter bloodstream)

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24
Q

What type of cells allow growth of HPV

A

Stratified squamous epithelium

Cervix, anus, true vocal cords

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25
Q

Manifestations of hypovolemia

A
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26
Q

Pathophys of rheumatoid arthritis

A

Activation of CD4+ T (Th1, Th17) cells and macrophasges secrete IL-1 and TNF-alpha, leading to articular destruction

IL-1 : induces matrix metalloproteinases and T cell response

TNF-alpha: inflammatory cells

Both activate osteoclasts

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27
Q

Causes of nonvalvular heart failure and changes in wall thickness and function

A
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28
Q

Effects on heart of volume overload vs pressure overload

A

Volume overload : eccentric hypertrophy (decompensated heart failure)

Pressure overload: Concentric hypertrophy (hypertensive heart disease)

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29
Q

What nerve is impacted in Bell’s palsy

A

facial nerve (CN VII)

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30
Q

Functions of facial nerve (CN VII)

A

Motor output to the muscles controlling movement of the face (including eye closure)

Somatic sensation afferents from portions of the pinna and external auditory canal

Special sensation afferents for taste from the anterior two-thirds of the tongue

Parasympathetic innervation of the submandibular and lacrimal glands

Motor innervation of the stapedius muscle, which causes sound dampening

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31
Q

Changes to the lungs with age (lung capacity, FVC, RV)

A

Lung capacity is unchanged - chest compliance goes down (stiff ribs) and lung compliance goes up (loss of recoil)

FVC goes down (RV bigger portion of TLC)

RV goes up

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32
Q

Sources of nitrogens in purines

A
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33
Q

Sources of carbon in purines

A
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34
Q

Ribavirin MOA

A

Inhibits IMP dehydrogenase, blocks conevrsion of IMP to GMP

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35
Q

Mycophenolate MOA

A

Immunosuppresant

Blocks IMP dehydrogenase

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36
Q

6-mercaptopurine MOA

A
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37
Q

What is Lesch-Nyhan syndrome

A

X-linked absence of HGPRT (cant do purine salvage)

See excess uric acid production (juvenile gout), excess de novo purine synthesis (high PRPP, IMP)

SX: hypotonia, chorea, self-mutilation

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38
Q

Carbon and nitrogen sources for pyrimidines

A
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39
Q

What is orotic aciduria

A

Autosomal recessive defect in UMP synthase

SX: orotic acid in urine, megaloblastic anemia, hypersegmented neutrophils

TX: Uridine

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40
Q

Signs of orithine transcarbamylase deficiency

A

Causes a breakdown in urea cycle

See: increased carbamoyl phosphate and orotic acid in urine, but also see increase in ammonia

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41
Q

MOA of 5-FluroUracil

A

5-FU is a chemotherapy agent

Mimics uracil. Blocks thymidilate synthase and formation of dTMP

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42
Q

MOA of methotrexate

A

Blocks dihydropholate reductase so cant form THF, leads to blocked formation of dTMP

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43
Q

B12 vs Folate deficiency

A
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44
Q

Features of bulemia nervosa

A
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45
Q

What are the universal stop codons

A

UAA, UAG, UGA

Lead to releasing factor

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46
Q

Complete vs partial mole

A
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47
Q

Afferent vs efferent nerves for visual light reflex

A

Afferent: CN II

Efferent: CN III (edinger westphal for other eye, PNS)

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48
Q

Clinical features of selective IgA deficiency

A
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49
Q
A
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50
Q

MOA of carbon monoxide poisoning

A

CO binds to heme iron with a much higher affinity than oxygen, creates carboxyhemoglobin.

Impedes oxygen delivery and decreases cardiac output

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51
Q

What is type II error

A

Probability of concluding no difference exists when one actually does exist

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52
Q

What is Power

A

1 - Type II error

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53
Q

Clinical features of PCOS

A
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54
Q

Pathophys of PCOS

A

Increased activity of activity of 17α-hydroxylase; 17,20 lyase; and 3β-hydroxysteroid dehydrogenase. The overexpression of these enzymes results in elevated androgen levels (eg, testosterone, androstenedione, DHEA) and the clinical consequences of hirsutism and acne.

Incresed risk for endometrial carcinoma

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55
Q

Pharyngeal and aortic arches derivatives (1-6)

A
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56
Q

Changes to glomerular filtration during pregnancy

A

Because blood volume and cardiac output goes up, GFR increases

Placental proteins also increae permeability of glomerular basement membrane, so see proteinuria

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57
Q

Source of single brain abscess vs multiple

A

Single - direct invasion from contiguous source

Multiple - hematogenous spread from distant infection

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58
Q

Exudative vs transudative pleural effusions

A
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59
Q

Regulation of glycogenolysis in liver vs muscle

A

In liver, regulated by glucagon and Epi through cAMP.

In muscle, regulated by muscle contraction (Ca2+) mostly and some cAMP

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60
Q

Characteristics of drugs that are mainly excreted by the liver

A

High lipophilicity

High volume of distribution

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61
Q

What is the drawback of using creatinine to measure GFR

A

Creatinine is secreted by the proximal tubules so the calculated GFR is 10-20% higher than actual GFR

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62
Q

Contents of superior occular vs inferior occular fissures vs optic canal

A
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63
Q

Features of TCA overdose

A

Most deaths come from cardiac arrhythmias and refractory hypotension

TX: Sodium Bicarbonate

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64
Q

Pathophys of rheumatic fever

A

Autoimmune reaction following GAS infection. Antibodies against strep M protein and N-acteyl-beta-D-glucosamine cross react

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65
Q

Infection in children marked by URI sx, stridor, brassy cough, barking cough, hoarsness, resp distress

A

Laryngotracheitis (croup)

caused by parainfluenza virus - paramyxovirus

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66
Q

Difference between GLUT 1, 2, and 4 transporters

A
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67
Q

Features of pyruvate kinase deficiency

A

Converts phosphoenylpyruvate to pyruvate

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68
Q

Sources of fuel over course of 24 hour fast

A
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69
Q

What is Von Gierke’s Disease (Glycogen storage disease type 1)

A

Glucose-6-phosphatase deficiency

Sever hypoglycemia between meals, lethargy, seizures, lactic acidosis (Cori cycle)

Enlarged liver (cant get glycogen out)

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70
Q

What is Pompe’s disease (glycogen storage disease II)

A

Acid alpha-glucosidase deficiency

Accumulation of ghlycogen inside lysosomes

Presents in childhood, severe

See enlarged muscles (cardiomegaly, macroglosia), hypotonia, no metabolic problems but have heart failure

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71
Q

What is Cori’s disease (glycogen storage disease type III)

A

Debranching enzyme deficiency

Similar to Von Girkes but mild hypoglycemia and have muscle involvement

See enlarged liver and also hypotonia

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72
Q

What is McArdle’s Disease (Glycogen storage disease V)

A

Glycogen phosphorylase deficiency

Adolescence or early adulthood

No liver problems, but have exercise problems - weakness and cramps

Myoglobinuria and urine turns dark after exercise

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73
Q

Uses of NADPH

A
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74
Q

What is respiratory burst

A

Killing of bacteria by phagocytes with oxygen

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75
Q

What is chronic granulomatous disease and features

A
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76
Q

How is fructose brought into glycolysis

A
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77
Q

What is essential fructosuria

A

Deficiency of fructokinase

Benign, fructose not taken up into liver, spills into urine

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78
Q

What is hereditary fructose intolerance

A

Deficiency in aldolase B

Get buildup up of fructose 1- phosphate and get depletion of ATP

See hypoglycemia, vomiting, hepatomegaly, FTT after weaning off breastmilk

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79
Q

How is galactose converted to glucose

A
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80
Q

What is classic galactosemia

A

Deficiency in galactose 1-phosphate uridyltransferase (GALT)

Galactose 1-phosphate builds up in liver and galactose is also converted to galactitol (accumulates in eye like sorbitol)

See hepatomegaly, jaundice, childhood cataracts

Have to avoid milk

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81
Q

Required cofactors for pyruvate dehydrogenase

A

NAD+

FAD+

CoEnzyme A

Thiamine

Lipoic Acid

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82
Q

What is the malate shuttle

A

Oxaloacete and NADH cannot cross membrane, but malate can. Malate is used to bring electrons in for NADH and then can be converted into oxaloacete inside mitochondria

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83
Q

How many ATP made per NADH/FADH2

A

3 per NADH

2 per FADH2

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84
Q

Inhibitors of electron transport chain

A
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85
Q

What tissues cannot use fatty acids for energy

A

RBCs (glycolysis only, no mitochondria)

Brain (glucose and ketones only)

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86
Q

What is the carnitine shuttle

A

Helps fatty acids undergo B-oxidation by moving fatty acyl coA into the mitochondria

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87
Q

Features of carnitine deficiency

A

Cant bring long chain fatty acids into mitochondria to break down fatty acids

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88
Q

What is a MCAD deficiency

A

Deficiency in medium chain Acyl-CoA dehydrogenase

AcetylCoA is low so gluconeogenesis is shut down

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89
Q

Pathophys of lactic acidosis in alcoholism

A
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90
Q

Genetic risk factors for Alzheimers

A
  • Amyloid precursor protein on chromosome 21
  • Presinilin 1 on chromosome. 14
  • Presinilin 2 on chromosome 1
  • ApoE4
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91
Q

Features of cystic fibrosis

A
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92
Q

Syphillis diagnostic serology

A
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93
Q

MOA of penicillins

A

Structurally simialr to D-alanine-D-alanine, bind to transpeptidase that inhibits formation of bacterial peptidoglycan cell way

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94
Q

Mechanisms of septic organ dysfunction (3)

A

Poor oxygen use

  1. Bacterial products trigger free radicals that lead to mitochondrial damage = decreased oxydative phosphorylation and lactic acidosis
  2. Vasodilation shunts blood quickly through organs
  3. Increased capillary permeability causes edema that increases distance O2 must travel to mitochondria
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95
Q

Deposition seen in poststrep glomerulonephritis

A

Starry sky (granular) deposition of IgG, IgM, and C3 immune complexes

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96
Q

Stages of alcohol withdrawal

A
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97
Q

What is integrin

A

Helps bind cells to one another by binding to fibronectin, collagen, and laminin

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98
Q

What is X-linked agammaglobulinemia

A

X-linked agammaglobulinemia is characterized by low or absent circulating mature B cells (ie, CD19+, CD20+, CD21+ cells) and pan-hypogammaglobulinemia (low IgG, IgM, IgA). Affected patients have increased susceptibility to pyogenic bacteria, enteroviruses, and Giardia lamblia due to the absence of opsonizing and neutralizing antibodies.

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99
Q

Sources of ATP during exercise (3 phases)

A
  1. Phosphocreatine shuttle
  2. Glycolysis
  3. Oxidative phosphorylation
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100
Q

Steps of insulin release (start with glucose receptor)

A
  1. Glucose enters cell through GLUT-2, broken down by TCA cycle into ATP
  2. ATP binds K+ channel and closes it, leading to depolarization
  3. Calcium channel opens
  4. Insulin release
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101
Q

Permeability of nephron regions to water

A
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102
Q

What is purulent pericarditis and most common causes

A
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103
Q

Structures derived from neural crest cells

A

SOME SALT

Schwann cells, odontoblasts, melanocytes, enterochromaffin cells, spinal membranes [pia and arachnoid], adrenal medulla/ganglia, laryngeal cartilage, tracheal cartilage

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104
Q

Visual pathway

A
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105
Q

Important HIV genes

A

Pol gene - encodes protease, reverse transcriptase, integrase

Env gene - surface glycoprotein, enables host immune escape

Nef gene - downregulates MHC 1 on infected cells

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106
Q

Major virulence factor of staph epidermis

A

Ability to produce biofilm - extracellular polysaccharide matrix

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107
Q

Hormonal control of pancreatic secretions

A
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108
Q

Prolonged exposure to loud noises causes hearing loss due to damage to the_____ of the ______.

A

Prolonged exposure to loud noises causes hearing loss due to damage to the stereociliated hair cells of the organ of Corti.

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109
Q

Higher frequency sounds are heard at the ____ of the cochlea

A

Earlier portion

Low frequency - farther in (cochlear cupula)

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110
Q

Risks and protective factors for epithelial ovarian cancer

A

The pathogenesis of epithelial ovarian cancer is linked to the frequency of trauma and repair at the ovarian surface. Oral contraceptives, multiparity, and breastfeeding are protective by decreasing the frequency of ovulation. Risk factors include BRCA mutation, nulliparity, and infertility.

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111
Q

What causes diastolic heart failure

A

Hypertension, obesity, infiltrative disorders (transythyretin-amyloid, sarcoidosis)

Caused by decreased LV compliance, see normal LVEF. and LV end-disatolic volume, but high LV filling pressures

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112
Q

Portions of hypothalamic nuclei that mediate food intake

A

Venteromedial. - mediate satiety, destruction = hyperohagia

Lateral - mediates hunger, destruction = anorexia

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113
Q

Portions of. hypothalamic nuclei that mediate heat

A

Anterior. - heat dissipation, destruction = hyperthermia

Posterior - heat conservation, destruction = hypothermia

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114
Q

Gram stain of common infectious urethritis organisms

A

N. Gonorrhea - Gram negative, see intracellulat diplococci

Chlamydia trachomatous and mycolplasma - do not graim stain because not enough peptidoglycan

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115
Q

Radial nerve function and sensory distribution

A
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116
Q

Function of Natural Killer cells

A

Recognize and kill cells with reduced MHC 1 expression (virus, tumor). Contain perforins and granzymes that lead to apoptosis

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117
Q

What is the alanine cycle

A

During starvation, alanine in muscles is transported to the liver. In the liver alanine is converted into pyruvate which can. be used to generate glucose

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118
Q

What is the Cori cycle

A

Muscle and RBC convert glucose to lactate which then goes to the liver. Lactate can then be converted to glucose to. be sent back to the muscle

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119
Q

Kwashiorkor vs Marasmus

A

Kwashiorkor is inadequate protein intake, see edema (low albumin)

Marasmus is insufficient calories, no edema

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120
Q

Hypoglycemia causes when after feeding vs fasting

A

After feeding: Galactosemia, hereditary fructose intolerance

Fasting: Glycogen storage disease

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121
Q

Sypmtoms of proprionic aciduria and methylmalonic aciduria

A

Poor feeding, hypotonia, vomiting, lethargy

Metabolic acidosis (anion gap)

Hypoglycemia and ketosis

Hyperammonemia, elevated organic acids in serum/urine

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122
Q

What is maple syrup urine disease

A

Branched chain amino acid disorder - deficiency of alpha ketoacid dehydrogenase

Get buildup of branched change AA and alpha ketoacids

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123
Q

Branched chain amino acids

A

Leucine, isoleucine, valine

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124
Q

Two causes of hypoketotic hypoglycemia and features

A

Carnitine deficiency - low carnitine levels, low acyl-carnitine levels

MCAD deficiency - High acylcarnitine. level and highicarboxylic acids

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125
Q

Features of ornithine transcarbamylase deficiency

A

High ammonia

High orotic acid

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126
Q

Hallmark of mitochodnrial disorder

A

High alanine

Pyruvate cannot be converted to. acetyl coA. (usually by. pyruvate dehydrogenase in mitochondria) so converted to alanine

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127
Q

Cell type and function

A
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128
Q

Cause and effect of midgut malrotation

A

Rotation of 180 instead of 270 degrees counterclockwise

Results in cecum in RUQ - intestinal obstruction due to bands connecting to mesentary over duodenum.

Can also get twisting around superior mesenteric artery

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129
Q

Lymph drainage of rectum

A

Above dentate line - internal illiac and inferior mesenteric, some superior mesenteric

Below dentate line - inguinal nodes

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130
Q

The live attenuated oral (sabin) polio vaccine creates a stronger ____ response than the inactivated (salk)

A

IgA - made in duodenal lumen

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131
Q

Contact dermititis, granulomatous inflamation, and reactive skin testing are all forms of ____

A

Type IV hypersensitivity - T cell mediated

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132
Q

Causes of eccentric vs concentric LV hypertrophy

A

Concentric - pressure overload

Eccentric - volume overload

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133
Q

How can cancer cells. mutate to resist anti-cancer drugs

A

The human multidrug resistance (MDR1) gene codes for P-glycoprotein, a transmembrane ATP-dependent efflux pump protein that has a broad specificity for hydrophobic compounds. This protein can both reduce the influx of drugs into the cytosol and can increase efflux from the cytosol, thereby preventing the action of chemotherapeutic agents.

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134
Q

EKG leads

A
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135
Q

Mechanical dysfunctions associated with MI timeframe and SX

A
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136
Q

Anion gap equation

A

Na+ - (Cl- + bicarb)

Normal: 10-14

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137
Q

Cause of an non-anion gap met acidosis

A

Loss of bicarb

Diarrhea, renal tubular acidosis, saline infusion

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138
Q

What muscles are targeted in pelvic floor strengthening

A

Levator ani

pubococcygeus, puborectablis, illeococcygeos

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139
Q
A
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140
Q

Difference between DNA replication in eukaryotes and prokaryotes

A
  1. Prokaryotes have 5 DNA polymerases, eukaryotes have 3
  2. Eukaryotic is much larger genome
  3. Prokaryotic is circular and has one cite of replication. Eukaryotic is linear with multiple cites (faster)
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141
Q

Portosystemic anastamoses

A
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142
Q

Low dose aspirin mechanism and side effects

A

COX-1 inhibition, risk of gastric bleeding

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143
Q

Pathophys of myasthenia gravis

A

Autoimmune disease that leads to dicrease in number of acetylcholine receptors, reduces the amplitude of the motor end plate potential

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144
Q

Hemodynamic changes seen in aortic regurgitation

A

Will result in eccentric hypertrophy so larger LV

Causes an overall increase in systolic bp due to increase cardiac output and contractility

Aortic diastolic will be low and LV diastolic will be high

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145
Q

MOA of acetominophen toxicity

A

Formation of NAPQI that disrupts hepatocyte mitochondrial function and causes hepatic oxidative damage

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146
Q

Abortive and preventative therapy for migraines

A
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147
Q

Pathogenesis of primary aldosteronism

A
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148
Q

Techniques for motivational interviewing

A

OARS

Open ended questions, affirmations, reflect, summarize

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149
Q

Portion of hypothalamic nuclei involved in circadian rhythyms

A

suprachiasmatic

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150
Q

Symptoms of parvovirus B19

A

Symptomatic anemia, decreased erythropoesis, transient aplastic crisis. Worse in patients with hemoglobin disorders

See giant pronormoblasts and intranuclear inclusions

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151
Q

Features of the Phenylalanine hydroxylase reaction

A

Hydroxylation of phenylalanine is irreversible so phenylalanine cannot be derived from tyrosine.

Phenylalanine hydroxylase uses the co-enzyme tetrahydrobiopterin (BH4) to supply reducing equivalents for the hydroxylation reaction.

Over the course of the phenylalanine hydroxylase reaction tetrahydrobiopterin is oxidized to dihydrobiopterin.

Tetrahydrobiopterin is regenerated from dihydrobiopterin by dihydrobiopterin reductase in a reaction involving the oxidation of NADPH.

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152
Q

What is hartnup disease

A

Autosomal recessive Absence of an AA transporter in the proximal tubule

Leads to loss of tryptophan in the urine, can cause niacin deficiency that lead to sx (pellagra)

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153
Q

What is the alanine cycle

A

Use of alanine to transfer ammonia to the liver

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154
Q

Drugs that can cause a folate deficiency

A

Phenytoin

Methotrexate

Trimethoprim

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155
Q

What is the hallmark of a B12 deficiency

A

Hugh methymalonic acid

Neuropathy (legs>arms)

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156
Q

What is pernicious anemai

A

Autoimmune destruction of gastric parietal cells (type 2 hsr) that leads to deficiency of intrinsic factor so low B12

Associated with. HLA-DR and gastric adenocarcinoma

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157
Q

What vitamin allows for conversion. of Fe3+ to Fe2+

A

Vitamin C

Improtant for Heme synthesis and collagen synthesis

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158
Q

Vitamin high in sarcoidosis

A

Vitamin D

Conversion to 1,25 hydroxyvitamin D independent of the kidney, so get high calcium

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159
Q

What is acrodermatitis enteropathica

A

Low Zinc

Dermatitis, decreased hair, diarrhea, poor growth

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160
Q

What is Lecithin-cholesterol acyl transferase (LCAT)

A

Catakyzes rdterification of cholesterol - packages it tightly in core of HDL

Activated by A-1 on HDL

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161
Q

What is the most common cause of community-acquired pneumonia and describe vaccine

A

Strep pneumoniae (Gram negative)

Two vaccines:

  • Pneumococcal polysaccaride vaccine, 23 valent, moderate B cell response
  • Pneumococcal conjugate vaccine, polysaccride conjugated to protein so get robust T cell response
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162
Q

Mechanism of cataracts

A

Nuclear sclerosis (layers), photooxidative damage to crystalline, osmotic damage

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163
Q

Gene and associations

A
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164
Q

Features of carcinoid syndrome

A
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165
Q

What types of cells are involved in superantigen. response

A

T- cells (IL-2)

Macrophages (IL-1)

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166
Q

MOA of opioid side effects

A

Direct activation. of mast cells - release of histamines

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167
Q

Conduct disorder vs Oppositional defiant disorder

A

Conduct disorder is more severe, includes aggressive behavior, stealing, destruction

Oppositional defiant disorder is less severe, more irritable mood and defiance

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168
Q
A
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169
Q

What type of collagen is found in scars?

A

Type I

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170
Q

Type I vs Type II muscle fibers

A
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171
Q

Symptoms of cauda equina syndrome

A

Sciatic nerve - back. pain, lower limb weakness

Pudendal nerve - saddle parasthesia

Pelvic splanchnic (PNS) - constipation and urinary retention

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172
Q

Risk factors and sx of anal squamous cell carcinoma

A
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173
Q

What are the retroperitoneal organs

A

SAD PUCKER

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174
Q

Impact of hyperthyroidism on SVR

A

Increased metabolic demand and direct effect of thyroid hormone on vascular smooth muscle leads to vasodilation and decreased SVR

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175
Q

What is a septic abortion and common organisms

A

Infected retained products of conception

Staph. aureus

E. coli and group B strep

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176
Q

Steps of insulin synthesis and secretion

A
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177
Q

Most common side effects if Amphotericin B

A

Renal toxicity - can get hypokalemia and hypomagensemia

Normocytic anemia

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178
Q

What is heparin induced thrombocytopenia (HIT)

A

IgG antibodies against heparin and platelet factor IV, induces platelet aggregation

TX: Direct thrombin inhibitor (hirudin, lepirudin, argatroban)

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179
Q

Fetal vs adult hemoglobin

A

Fetal hemoglobin is made up of 2 alpha and two delta subunits, and has a hgher affinity for oxygen (allowd for better delivery of oxgen to baby)

Adult hemoglobin is two alpha and two beta. Replaces fetal by 6 months

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180
Q

Clinical manifestations of hemochromatosis

A
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181
Q

What glucose transporter is responsive to insulin and where is it located

A

GLUT 4

Adipocytes and skeletal muscle

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182
Q

Common DNA damage cuased by UV radiation

A

Pyrimidine dimers

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183
Q

What is the cause of microsatellite instability

A

Deficiency of mismatch repair (DNA slippage that is not repaired)

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184
Q

Cause and SX of ataxia telangectasia

A

Deficiency in non-homologous end joining repair

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185
Q

How are herpes virus antivirals activated

A

Drugs for HSV and VZV are phorpylated twice, first by viral thymidine kinase

Drugs for EBV and CMV are only phosphorylated by human TK because those viruses wont phosphorylaye

186
Q

What is adenosine deaminase

A

Enzyme in purine metabolism that converts adenosine to inosine. Without it, toxic metabolites are made that inhibit DNA and lead to apoptosis.

ADA deficiency is bad for highly dividing cells like lymphocytes (severe combined immunodeficiency)

187
Q

Action potentials of pacemaker vs non-pacemaker cells

A
188
Q

TCAs side effects

A

Coma

Cardio stuff

Confusion

Anticholinergics

189
Q

Causes of cleft lip amnd cleft palate

A

Cleft lip- maxillary prominence fails to fuse with intermaxillary. segment

Cleft palata - Palantine shelves fail to fuse with each other or with the primary palate

Caused by polygenetics and environment

190
Q

Causes of polyhydramnios

A
191
Q

What causes hemosiderin laden macrophages in the lungs

A

Chronic passive lung congestion as a result of chronic heart failure - fluid backs up in the lungs and RBC are pushed into lung parenchyma

192
Q

Pathogenesis of ascites in cirrhosis

A
193
Q

What travel through the jugular foramen

A

CN IX, X, XI, jugular vein

194
Q

What. is. porphyrea cutanea tarda

A

Deficiency in uroporphrynogen decarboxylase, distrupts heme synthesis

causes photosensitivity. - vesicles

195
Q

How is drug delivery to the brain improved

A

Helping cross the BBB by distrupting tight junctions

Stopping cellular eflux transporters like inhibiting p-glycoprotein

196
Q

How to tell if anisacoria (pupil size difference) is due to PNS or SNS dysfunction

A

If worse in dim light - SNS disturbance, affected pupil cant dilate

If worse in bright light - PNS, affected pupil cant constrict

197
Q

Recombination vs reassortment

A

Recombination is crossing-over and swapping of genetic material between nonsegmented viruses

Reassortment is with segmented viruses

198
Q

Impact of aging on bone marrow

A

Increased bone marrow fat and decreased BM mass

199
Q

Breath sounds, fremitus, resonance

A
200
Q

Impact of kidney disease on vitamin d, phosphate, and PTH

A
201
Q

How is the G1 to S phase regulated

A

Regulated by cyclin dependent kinases (CDK4/6). Cyclin D binds CDK and activates it to phosphylate Rb tumor suppresor gene. This. phophorylation inhibits Rb. and allows the cell cycle to go forward

202
Q

Lithium side effects

A

LMNOP

Lithium

Movement problems

Nephrogenic diabetes insipidus

hypOthyroidism

Pregnancy (ebstein)

203
Q

How to diagnose mucormycosis vs asperigilosus

A

Mucosal biopsy.

Mucor is non-septate with. right. angles along vessels

Apergillus is septate with acute angles

204
Q

Where is norepinephrine produced

A

Mainly produced in the locus ceruleus - pigmented cells in posterior rostral pons near floor of fourth ventricle

205
Q

What are snRNAs/U-RNAs

A

Form of RNA with lots of uracil that helps to splice out exons (forms splicesome)

206
Q

What enzyme adds amino acids to tRNA

A

Aminoacyl-tRNA synthetase

207
Q

What triggers maturation into Th1 cells

A

Macrophages with MHC II present to Th0 cells with IL-12 that then differentiate into Th1 cells

208
Q

Path of embolis that causes retinal artery occlusion

A

Internal carotid –> opthalmic artery –> retianl artery

209
Q

What is a rectocele

A

Herniation of rectum into posterior vaginal wall due to weakened pelvic floor (levator ani)

210
Q

Relative risk equation

A

Use for a cohort study

RR = (risk of disease in exposed)/(risk in unexposed)

211
Q

Short and intermediate acting benzos

A
212
Q

Long acting benzos

A
213
Q

What happens to BP and SVR during exercise

A

There is only a mild elevation in BP becuase of large drop in SVR - local metabolites cause vasodilation

214
Q

Manifestations of chikungunya

A
215
Q

What is hemolytic uremic syndrome (HUS)

A

Shiga toxin samages epithelium. (glomerular damage) that causes microthrombi that consume platelets and damage RBC - shistocytes

216
Q

How is calcium pumped out of cardiac cells after contraction

A

Pumped back into SR using SERCA (Ca2+ and ATP)

Pumped out in exhange for Na+ using NCX (1 ca = 3 na)

217
Q

Where is potassium during DKA

A

Potassium is driven out of the cells into the plasma, so low intracellular and high/normal extracellular

Insulin will drive potassium back into cells so also have to monitor potassium and give as needed during therapy

218
Q

TX for serotonin syndrome

A

Cyproheptadine

219
Q

TX for benzo overdose

A

Flumazenil

220
Q

Duration of pharmacological insulin

A
221
Q

Histology as you moved down the airway

A

Bronchi have a ciliated pseudostratified columnar epithelium with mucin-secreting goblet cells and submucosal mucoserous glands.

The airway epithelium gradually changes to ciliated simple cuboidal by the level of the terminal bronchioles.

Bronchioles lack glands and cartilage, and the number of goblet cells decreases distally, ending before the terminal bronchioles.

Ciliated epithelium persists up to the respiratory bronchioles.

222
Q

Progression of p53 to Rb

A

Double stranded break activates p53, which induces p21. p21 inhibits CDK-cyclin complex. This leads to hypophosphorylation of Rb and cell cycle arrest

Occurs at G1-S

223
Q

What is Li-Fraumeni syndrome

A

Mutation in TP53 that encodes for p53 leads to inhibition of cell cycle arrest due to damage = accumulation of damage and malignancy

224
Q

In the golgi:

_____ added to asparagine

_______ added to serine and threonine

_______ added to lysosomal proteins

A

N-oligosaccharides added to asparagine

O-oligosaccharides added to serine and threonine

Mannose-6-phosphate added to lysosomal proteins

225
Q

What is I-cell disease

A

Defect in Golgi (trans) of the enzyme that adds phosphate to mannose-6-phosphate. This causes a defect in adding proteins to lysosomes and proteins are secreted extracellularly.

Coarse features, gingival hyperplasia, clouded cornea, restricted joints, high plasma levels of lysosomal enzymes

226
Q

Coating of vesicles and where they go (clathrin, CopI/II)

A

Clathrin - bw plasma membrane and golgi

COPI - Golgi to RER

COPII - RER to golgi

227
Q

Function of three types of filaments

A

Microfilaments - muscle contraction (actin), cytokinesis

Intermediate - maintain cell structure (messed up in many cancers)

Microtubules - movement, cell division

228
Q

What is kartagener’s syndrome

A

Triad of symptoms seen in Primary Ciliary Dyskinesia 0 dyniene messed up, cilia cant beat

  1. Chronic sinusitus
  2. Brinchiectasis
  3. Situs inversus

Also see infertility

229
Q

Mneumonic for collagen types

A

Be So Totally Cool, Read Books

1 - Bone, Skin, Tendons

2 - Cartilage

3 - Reticulin (blood vessels)

4 - Basement membrane

230
Q

Main components of collagen

A

Glycine, proline, lysine

Gly-X-Y

231
Q

Steps in collagen synthesis

A
  1. hydroxylation of pro alpha chains (vitamin C)
  2. Glycosylation and forming triple helix (OI)
  3. exocytosis and cleavage of terminal ends
  4. Cross links (Menkes)
232
Q

Osteogenesis imperfecta mutations

A

COL1A1 and COL1A2

Type 1 collagen

233
Q

Elastin components

A

Non-hydroxylated and non-glycosylated proline, glycine, lysine

234
Q

What causes Marfans

A

FBN1 mutation on chromosone Fifteen causes defect in Fibrillin

See constellation of Sx:

Mitral valve prolapse, aortic dissection and aneurysm, lens subluxation (up and out)

235
Q

What is McCune-Albright syndrome

A

Example of mosaicism (cells have to be mixed to survive)

Gs-protein activating mutation, see precocious puberty, fibrous growth in bones, cafe au laet spots

236
Q

Steps pf meiosis

A
237
Q

Where are oocytes arrested in oogenesis

A

Primary oocyte arrested in Prophase of meiosis I

At puberty, a few secondary oocytes arrest in metaphase of meiosis II

Completion of meiosis II at fertilization

238
Q

What is a robertsonian translocation

A

Frequent cause of trisomy 21, often 14 and 21 (parent is a carrier)

239
Q

Hardy-Weinberg equation

A

P2 + 2pq + q2 = 1

p2 and q2 are homozygotes

2pq is heterozygote

If x-linked, male risk = q, female = q2

240
Q

What is used to screen for neural tube defects

A

AFP AND Acetylcholineesterase

241
Q

What is Von-Hippel Lindau

A

Mutation in VHL gene - overexpression of angiogenic growth factor (like VEGF)

Hemangioblastoma, renal clear cell carcinoma, pheocromocytoma

242
Q

What is the greatest risk factor for completed suicide

A

Previous attempted suicide

243
Q

What are the significance of the colors in melanoma

A

Red - vessel ectasia (dilation) and inflammation

Black/brown - advancing melanocytes

White - T lymphocytes target and melanocytes regress

244
Q

What is X-linked aggamaglobulinemia

A

Mutation in BTK gene that prevents maturation and exit of BM by pre-B cells. Have low B cell and immunoglobulin levels

Susceptible to enteroviruses and encapsulated bacteria

245
Q

Features of chronic bronchitis

A

Thickened bronchial walls, lymphocytic infiltrate, mucous gland elargment, patchy squamous metaplasia

Tobacco is strongest predisposing factor

246
Q

Postpartum mood disorders

A
247
Q

Number needed to treat

A

1/ARR

248
Q

What is deficient in vegan dieta

A

Calcium, vitamin d, B12

249
Q

What is seen in injury to common peroneal (fibular) nerve

A

Often break of neck of fibula

Loss of dorsal foot sensation, inability to evert foot, inability to dorsiflex

250
Q

What nerves are present in the cavernous sinus

A

III, IV, VI, V (opthalmic and maxillary)

251
Q

Steps in base excision repair

A
252
Q

How does Chagas disease lead to megaesophagus and megacolon

A

Destriction of myenteric and submucosal plexi

253
Q

Three associated esophagitises associated with HIV

A
254
Q

How is blood flow to kidney autoregulated in chronic hypertension

A
  1. afferent arteriole reflexesively constrict at higher BP
  2. High BP leads to hyperfiltration that leads to higher Na and Cl in urine, leading to release of adenosine which further constricts afferent a.

If BP is corrected too rapidly, blood flow to kidney drops and can cause acute tubular necrosis

255
Q

Effect of BNP and ANP

A

BNP released by ventricle stretch, ANP by atrial stretch

Cause vasodilation and diuresis

256
Q

Pathogenesis of anemia of chronic disease

A

Disease causes release of inflammatory citokines, including hepcidin

Hepcidin binds to iron transporters on enterocytes and macrophages leading to less iron recycling and utilization

less overall circulating iron and total iron binding capacity

257
Q

What is apnea of prematurity

A

Central stimulatory neurons of respiratory center are not fully developed, leads to periods of apnea and bradychardia

258
Q

How does iodide block production of thyroid hormone

A

Competitively binds to iodine receptor for uptake into thyroid and prevents iodine organification which reduces thyroid hormone release (Wolf-Chaickoff)

259
Q

Levodopa side effects

A

Peripheral : nausea, vomiting, tachyarrhythmias, postural hypotension, hot flashes

Central: anxiey, irritation

260
Q

Difference in PO2 and PCO2 in difdusion-limited perfusion

A

Due to changes in diffusion like fibrosis, emphysema

High gradient between alveolar O2 and capillary O2 because catn diffuse

Less of a gradient in CO2 because CO2 diffuses much more readily than O2

261
Q

Normal alveolar gas exchange numbers

A
262
Q

TX for beta blocker overdose and MOA

A

Glucagon

stimulates adrenergic receptors to increae cAMP

263
Q

Why is reflux common in pregnancy

A

Elevated estrogen and progesterone decrease LES tone. Later, fetus can compress stomach

264
Q

What mutation is associated with sebborheic keratosis

A

Fibroblast growth factor receptor 3

265
Q

Acromegaly impact on heart

A

Can lead to ventricular hypertrophy leading to systolic dysfunction and heart failure

266
Q

What is Prader-Willi syndrome

A

Paternal allel is deleted or mutation on chormosome 15 - PWS, 25% due to maternal uniparental disomy

Hyperphagia, obesity, hypogonadism, intellectual disability

267
Q

What is Angelman syndrome

A

Maternal allele is deleted or mutated on ch 15 - UBE3A

SAIL - seizures, ataxia, intellectual disability, laughter

5% from uniparental oarental disomy

268
Q

Features of trisomy 21

A

5 As:

Advanced maternal age, Atresia (duodenal), ASD, Alzhiemers, AML/ALL

269
Q

Pregnancy screens associated with down sydnrome

A

Poorly formed nasal bones, nuchal translucency

Increased B-hCG

Decreased PAPP-A and AFP

270
Q

What is Edwards Syndrome

A

Trisomy 18

PRINCE : Prominent occiput, rocker bottom feet, intellectual disability, nondisjunction, ears are low set

Also see clenched fist, congenital heart defect

Death usually by 1 yr

271
Q

Maternal screens seen with trisomy 18

A

Low PAPP-A and B-HCG

Basically low everything

272
Q

What is Patau sundrome

A

Trisomy 13

Cleft palate, holoProsencephaly, polydactyly, cutis apalasia, polycystic kidney disease, heart defect

Also die by 1 yr, low everything

273
Q

What is Ducehenne muscular dystrophy

A

X-linked recessive mutation in DMD gene that encodes for dystrophin (frameshift - truncated protein)

274
Q

What is dystrophin

A

Binds actin to transmembrane proteins (dystroglycan)

275
Q

Features od Duchenne Muscular Dystrophy

A

Myonecrosis - elevated CK and aldolase

Waddling gait, using hands to push. up from chair, weakness

Cardiomyopathy is common cause of death - fibrosis

276
Q

What is Becker muscular dystrophy

A

Milder form of Duchenne’s caused by non-frameshift mutation so get abnormal protein instead of truncated

277
Q

What is Fragile X syndrome

A

X-linked dominant tinucleotide repeat (CGG) in FMR1 gene. Causes hypermethylation and less expression

Intellectual disabilities, long face, everted ears, mitral valve prolapse, hypermobile joints

278
Q

What is Freidrich’s Ataxia

A

GAA repeat in frataxin gene, Autosomal recessive

Ataxic gait, hypertrophic cardiomyopathy

279
Q

What is myotonic dystrophy

A

CTG repeats in DMPK gene, autosomal dominant, progressive muscle. wasting with prolonged contractions

Cataracts, balding, hypogonadism, arrhythmias

280
Q

What is cri-du-chat syndrome

A

deletion of part of hsort arm of chromosome 5

Intellectual disability, infant has high pitched cry (like cat), microcephaly, cardiac (VSD)

281
Q

What is Williams syndrome

A

Deletion on part of chromosome 7, partially for gene for elastin

Elfin features, intellectual disability, extreme friendliness with strangers, supravalvular aortic stenosis, hypercalcemia

282
Q

Kleinfelter’s

A

Usually 47 XXY - nondisjunction during meiosis. of either parent

Hypogonadism (low testosterone but high FSH, LH)

Gynecomastia, delayed puberty, low body hair and sperm count

283
Q

Turner Syndrome

A

Females 45 XO, can be mosaic 45X/46XX if mitotic nondysjunction in zygote

Short stature, broad chest, webbed neck, lymph obstruction, hypogonadism (streak ovaries), low inhibin b and estrogen (high LH and FSH)

Primary ammenorhea, bicuspid aortic valve, coarctation of aorta, high bp, horseshoe kidney, osteoporosis

284
Q

What is supplied by the inferior mesenteric artery

A

Hindgut derivatives - distal 1/3 transverse, descending, sigmoid colon, and rectum

285
Q

What dictates the severity of mitochondrial disorders

A

Heteroplasmy - some cells may recieve many damaged mitochondria and others very few

286
Q

Dobutamine MOA

A

Beta adrenergic agonist, especially in the heart.

Increases contractility and heart rate, increasing Oxygen demand. Small decrease in BP (vasodilation)

287
Q

Where are actin and myosin

A
288
Q

What DNA viruses are enveloped

A

Hepadnavirus

Herpesvirus

Poxvirus

289
Q

Describe the complement system

A
290
Q

Pathophys of tetrology of fallot

A

Abnormal neural crest cell migration that leads to deviation of the infundibular septurm.

  1. overriding aorta
  2. VSD
  3. Right pulmonary obstruction
  4. Right Ventricle hypertrophy
291
Q

V/Q ratio as you move down the lung

A

Ventilation/Perfusion(Q) is lowest at the base and highest at the apex

Ventilation is slightly higher in the base and slightly lower in the apex (gravity changes complaince). Perfusion is very high in the base and very low in the apex

292
Q

Common sites of globe fractures

A

Medial into ethmoid air cells

Inferior into maxillary sinus

293
Q

What does the mandibular nerve (CN V3) innervate

A

TMJ, floor of mouth, anterior tongue, lower part of face, tensor tympani (muffles sound), muscles of mastication

294
Q

How does the lac operon in E. Coli work

A
295
Q

What is the diptheria toxin

A

An AB toxin

Inhibits cell protein synthesis by catalyzing ATP-ribosylation on EF-2

296
Q

Heparin MOA

A

Binds to antithrombin III

Then binds Xa and thrombin

297
Q

What are RANK-L and OPG (osteoprotegrin)

A

RANK-L binds RANK on osteoclasts and increases formation and activity

OPG binds to RANK-L and stops it from inducing osteoclasts = less osteoclast function

298
Q

Histo features of an aortic aneurysm

A

Cystic medial degeneration - smooth muscle replaced by basophillic extracellular matrix znd elastic fragments w cysts

299
Q

What is achondroplasia

A

Limb shortening with a normal torso due to overexpression of FGFR3 gene that inhibits chondrocyte formation

300
Q

What leads to formation of testosterone and inhibin

A

GnRH –> LH. –> Testosterone

GnRH —> FSH –> inhibin

301
Q

What is the odds ratio

A

The odds of disease of exposed individuals vs non-exposed individuals

302
Q

How does digoxin slow HR

A

Increased parasympathetic (vagal) tone

303
Q

What does CD14 bind

A

Macrophages

304
Q

Markers for natural killer cells

A

CD16 and CD56

305
Q

Function of glucagon-like peptide 1

A

Secreted by gastric L cells, stimulates release of insulin and decreases glucagon

306
Q

MOA of DPP-4 ihibitors

A

Stop the breakdown of GLP-1 (done by DPP-4) so increase the glucose-dependent release of insulin

GLIPTINS

307
Q

Process of male genital development

A

Presence of SRY gene on Y chromosome leads to expression of testes-determining factor

Leydig cells = testosterone –> DHT = external and internal (Wollfian) male development

Sertoli cells = anti-mullerian hormone = involution of paramesonephric ducts

308
Q

How to calculate specificity and sensitivity

A
309
Q

Features of anti-glomerular basement mebrane antibodies

A

Target type IV collagen so see linear deposits of IgG and C3 with RPGN and crescent formation

310
Q

Functions of the frontal lobe

A

Executive functioning (abstraction, impulse inhibition), personality, motor function, language

311
Q

Features of cerebellar tremor

A

Action tremor (increases as hand gets closer)

ataxia, gait disorder

Seen most commonly in multiple sclerosis

312
Q

Vitamin supplements for infants

A

Vitamin D (low in breast milk, usually low sun)

Vitamin K (given as shot at birth)

Iron (greater than 4 months, low weight)

313
Q

MOA of fibrates

A

Activate PPAR alpha leading to decreased VLDL production and increased LPL function

314
Q

Function of Th1 T cells vs Th2

A

Both are CD4 T cells

Th1 - “cell mediated” immunity, activate macrophages and CD 8 cells. Also B cells

Th2 - “humoral” immunity, activate B cells to produce IgE and IgE

315
Q

Anti-inflammatory cytokine

A

IL-10

316
Q

Infections that need TH1 response

A

Intracellular - TB, listeria

317
Q

Relatiosnhip bw macrophages and Th1

A

Th1 produce IFN- gamma that activates macriphages

Macrophages produce IL-12 that activate Th1

Deficiency: mycobacterium infections

318
Q

Function of granzymes

A

Activate caspases that lead to cell apoptosis

Present in CD8 T cells

319
Q

Function of Th17 cells

A

Important for GI bacteria regulation

Induce neutrophullic inflammation

320
Q

What is the AIRE gene and deficiency

A

Autoimmune regulator in thymus

Without AIRE get CHAR

chornic candidiasis, hypoparathyroidism, adrenal insufficiency, recurrent candida infections

321
Q

B cell surface proteins

A
322
Q

Self cell markers that block complement

A

Decay Accelerating Factor (DAF/CD55)

CD59 inhibits MAC

323
Q

Risks associated with early complement defifiency

A

Low C1 - C4

Pyogenic sinus and respiratory tract infections

324
Q

Risks associated with late complement defifiency

A

Low C5-C9

Susceptible to Neisseria

325
Q

What is C1 esterase inhibitor deficiency

A

Causes activation of C1 leading to low C4. Causes high bradykinin that leads to angioedema

326
Q

Formation of leukotrienes, prostoglandins, and thromboxanes

A
327
Q

What is erythropoeitin

A

Released by renal cortex and medula during hypoxia that stimulates BM to produce more RBC, increasing. capacity for oxygen

328
Q

Which non-glucose monosacchride is metabolised fastest

A

Fructose, bypasses PFK-1 in glycolysis

329
Q

Most common cause of pathologic nipple discharge

A

Intraductal papilloma

See epithelial and myoepithelial cells lining a vascular core

330
Q

Function of interferon alpha and beta

A

Produced by virally infected epithelial cells, bind to neighboring cells that are induced to make antiviral RNA enzymes - target double stranded RNA for destruction

331
Q

Location of purely sensory strokes

A

ventral posterior thalamus

332
Q

Neonatal tetanus prevention

A

Vaccinating women with inactivated tetanus toxin, will pass IgG on to baby

333
Q

MOA of the four TB drugs

A
334
Q

Treatment for PID

A

Have to treat for both gonorrhea and chlamydia

Third gen cephalosporin for gonoccocal

Azithromycin or doxy for chlamydia (not suscpetible to beta lactams)

335
Q

Features of hypertrophic cardiomyopathy

A

Hypertrophic interventricular septum that can block outflow

See increased LV mass, decreased LV volume, preserved ejection fraction, impaired LV relaxation

336
Q

Causes of premature cataracts

A

Glucorticoids (predisone)

DM II

trauma

radiation

337
Q

Function of kinesin

A

Move vesicles along microtubules from - to + which means away from the nucleus (like towards nerve terminals)

338
Q

Most common cause of fetal hydronephrosis

A

Narrowing of ureter at the uretropelvic junction

339
Q

Stroke mechanisms in context of cocaine

A
  1. Cerebral vasospasm
  2. BP increased and sympathetic tone increased, can lead to dissection and rupture of small vessels
  3. Increased activation of platelets
340
Q

Changes seen in distributive shock

A

Seen in widespread vasodilation (anaphylaxis)

Decreased SVR, decreased PCWP (lower volume), decreased venous return (CVP)

341
Q

MOA of shiga toxin

A

AB toxin

A portion stops protein synthesis leading to death of mucosal cells. Stops binding of tRNA to 60s subunit

342
Q

Promoter regions on DNA

A

TATA is 25 nucleotides from transcription

CAAT is 75

343
Q

How to calculate alveolar ventilation

A

(tidal volume - dead space) x RR

344
Q

What is superior mesenteric artery syndrome

A

When the transverse protion of the dudoenum is traooed between SMA and aorta

Can be due to diminished fat, burns, lordosis

345
Q

Effects of Vasoactive intestinal peptide

A

Stimulates pancreatic bicarb and chloride secretion, increased cAMP in intestinal cells that causes release of sodium, chloride, water secretion into bowel

346
Q

What is seen in a VIPoma

A

WDHA syndrome - watery diarrhea, hypokalemia, achlorhydria

347
Q

What causes a narrowed mediastinum on neonatal XRay

A

Transposition of great arteries

348
Q

Examples of drugs that directly stimulate dopamine receptors

A

Ergot alkaloids: bromocriptine

Nonergots: pramipexole, ropinirole

349
Q

MOA of senna and bisacodyl

A

Stimulant laxatives

Activate enteric nerves in myenteric plexus to induce peristalsis

350
Q

What is calcineurin

A

Dephosphorylates nuclear factor of activated T cells (NFAT) that moves to the nucleus to induce production of IL-2 (activate more T cells)

351
Q

Probablity of exact HLA match between siblings

A

25 %

2 genes - 1 each from each parent

352
Q

What is graft vs host disease

A

Grafted T cells proliferate in host and see host cells as foreign - type IV hypersensitivity

Rash, jaundice, diarrhea, hepatosplenomegaly

353
Q

What is DiGeorge Syndrome

A

Failure to develop 3rd and 4th pharyngeal puches due to 22q11 deletion

Lack of thymus - T cell deficiency

Lack of parathyroid - hypocalcemia

354
Q

What is Severed combines immunodeficiencies

A

Cytoline receptor defectors

Adenosine deaminase deficiency (nucleotide salvage pathways)

MHC II deficiency

RAG mutation - VDJ recombinant deficient

355
Q

X-linked agammaglobinemia

A

Defect in BTK tyrosine kinase gene

No B cell maturation so no Ig

356
Q

Pathophys of hyper IgM syndrome

A

There is a defect on the CD40 receptor so B cells cant activate helper T cells - only produce IgM

T cells dont produce IL-4 and IL-5 that induce class swithcing so low IgE, IgA, IgG

Reccurent pyogenic infections and mucosal infections

357
Q

What is wiskott aldrich syndrome

A

WATER

Thrombocytopenia, eczema, recurrent infections

Mutatoin in WAS gene (defective cytoskleton and antigen presentation)

X-linked

358
Q

What do the paramesonephric ducts. form

A

They fuse laterally to form the fallopian tubes, uterus, cervix, and upper vagina

359
Q

Where is robosomal rna found

A

Nucleolus

360
Q

What are P bodies

A

Structures found in cytoplasm that play a role in mRNA regulation and turnover - can cause translation termination and storage of mRNA

361
Q

How does cortisol attenuate hypoglycemia

A

During a prolonged fast, cortisol is released and diffused across cell membranes. In the cytoplasm it binds to receptors bound to heat shock proteins. The receptor is release from the HSP and dimerize. They move into the nucleus and induce gluconeogenic. enzyme production

362
Q

Treatment for turners syndrome and MOA

A

Growth hormone

Binds to JAK receptor in the liver and activates STAT which goes to the nucleus to induce production of IGF-1

363
Q

Gonadotropin regulation in males

A
364
Q

Features of aortic regurgitation

A

Diastolic decrescendo murmur

Bounding femoral and carotic pulses - widened pulse pressure

Bobbing head - stronger LV

365
Q

What is trendelenburg sign

A

Hip drop with foot raise on contralateral side fue to weakness of gluteus medius/superior gluteal nerve

Due to giving shots superomedial - should give superolateral

366
Q

How is bioavailability calculated

A

Area under the curve of the route / area under IV curve

367
Q

TX for toxo encephalitis

A

pyramethamine and sulfadiazine (or clinda)

368
Q

What is primary central nervous system lymphoma

A

Second most common cause of ring enhancing lesions in HIV - usually solitary

Caused by B cells - usually with EBV

369
Q

What vitamins do gut bacteria produce

A

Vitamin K and folate

Can be overproduced in Rou-en-Y procedure that produces blind ended gastric pouch

370
Q

Brain features od Alzheimers

A

Neurodegeneration, B-amyloid plaques, neurofibrillary tangles

371
Q

Mneumonic for reflexes

A

S1 S2 buckle my shoe

L3 L4 kick the door

C5 C6 Pick up sticks

C7 C8 lay them straight

372
Q

Process of platelet plug formation

A

VWF bind platelets on exposed epithelium

Platelet is activated and releases TXA2 to cause vasoconstriction, more substances released to form clot

Prostacyclin (PGI2) and NO oppose formation

373
Q

How to measure for primary hypothyroidism

A

Use TSH levels because small changes in thyroxin cause large changes in TSH - can drop before thyroxin drop is noticeable

374
Q

What two factors stop fungal infections

A

T cells stop sueprficial fungal infections (skin)

Neutrophils stop hematogenous fungal infections

375
Q

Common pathogens seen in cystic fibrosis

A

Staph aureus, H. Flu, Pseudomonas aeurigonas, Burkholderia capacia

376
Q

MOA of loop diuretics

A

Block NaK2Cl transporters

Can cause metabolic alkalosis because losing more Cl- –> body becomes less negative so holds onto HCO3-

Can give carbonic anhydrase inhibitor (acetazolamid) to lose bicarb

377
Q

MOA of verinicline

A

Partial agonist of nicotine receptor – lowers cravings for tobacco and attenuates response to it

378
Q

What is Fas ligand

A

Produced by T cells that keep reacting to self antigen. Binds to CD95 and causes apoptosis

379
Q

Phenotype of regulatory T CELLS

A

CD4CD25FOXP3

380
Q

What lupus tests are specific and which are sensitive

A

Specific : anti-dsDNA and Anti-Sm

Sensitive: Anti-ANA

381
Q

Why can people with lupus have a false positive lupus test

A

People with LES can have anticardiolioin antibodies (type of antiphospholipid) that is used to test for syphillis (released by damaged cells)

382
Q

Common causes of drug induced SLE

A

Hydralazine, isoniazid, procainamide

383
Q

Pathophys of sjogrens

A

Lyphocytes - Type IV hypersensitivity

Destruction of salivary and lacrimal glands

384
Q

Common comorbidity with sjogrens

A

Rheumatoid arthritis

Will have rheumatoid factor in blood

385
Q

What causes neonatal lupus

A

The Anti-SSA ribonucleoprotein, crosses the placenta and can cause heart block

386
Q

What is systemic sclerosis (scleroderma)

A

Autoimmune damage of vessels

Endothelial damage leads to inflammation and inflammation - increased endothelin, TGF -beta, PDGF

Leads to fibrosis

387
Q

What amino acids cant be absporbed in cystinuria

A

cysteine, lysine, ornithine, arginine

COLA

Get cystine stones (hexagon)

388
Q

What is Rett syndrome

A

X-linked condition marked by normal development until 6-18 months then regression of speech, repetivive hand movements, gait abnormaities

MECP2 gene causes arrested brain development

389
Q

What can cause malaria despite prophylaxis

A

P. Falciparum is resistant to chloroquine, have to give mefloquine

The larvae live in schizonts inside the liver for up to 30 days, mefloquine only works in the blood. If stop before 30 days, can develop malaria

390
Q

Course of the ureters

A

From kidneys, pass posetrior to gonadal vessels, then anterior to the internal ileac, then posterior to uterine artery

391
Q

Describe the Ras pathway

A

Growth factors bind to a tyrosine kinase which converts GDP bound to inactive Ras to GTP, making active Ras. Ras then activates MAP kinase that goes to the nucleus

392
Q

Impact of hypothyroidism on lipids

A

Hypothyroidism causes a decrease in the number of LDL receptors leading to higher LDL

Also have decreased activity of lipoprotein lipase so high triglycerides

393
Q

Role of CTLA4

A

Blocks CD80 on APC which stops interaction with CD28 on T cells, causing anergy

394
Q

What determines the maintenance dose

A

Steady state cocentration x clearance x interval

395
Q

What is leukocyte adhesion deficiency

A

Deficiency in CD18, WBCs cant roll and migrate

see late separation of the umbilical cord, low pus, dysfunctional neutrophils

396
Q

Glucorticoids MOA

A

Inactivation of NF-KB, a key inflammatpry transcription factor

397
Q

Cancer associated with Sjogrens

A

B cell lymphoma - will see unilateral parotid gland enlargment

398
Q

What is scleroderma and manifestations

A

Systemic sclerosis - vasculopathy, collagen deposition, fibrosis

Diffuse - skin, early visceral, kidney (use ACE)

Limited - CREST (calcinosis, anti-centromere antibody, raynauds, esophageal dysmotility, sclerodatyly, telangesctasia)

399
Q

What is Potters sequence

A

Oligohydramnios causes Flat face, limb deformities, pulm hypoplasia

400
Q

Odds ratio calculation

A

(a/b)/(c/d)

401
Q

MOA of rituximab

A

MAB to CD20 on B cells, leads to reduction in B cells

402
Q

What WBCs increase in steroid use

A

Neutrophils - steroids induce them to “demergination” off of vascular wells so get more circulating

403
Q

What to moitor on testosterone therapy

A

PSA (can enlarge prostate)

Hematocrit (can make blood more coagulable)

404
Q

Four components of informed consent

A

disclosure, understanding, voluntariness, authorization (documents)

405
Q

What structures are injured with an anteromedial displacement of humerus

A

Brachial artery and medial nerve

406
Q

Organ with the highest oxygen demand

A

Myocardial tissue

407
Q

SX of pineal gland tumor

A

Hydrocephalus (blocks aqueductal obstruction) and Parnaud syndrome (cant gaze upward)

Usually a germinoma

408
Q

Blood supply of the rectus abdominus

A

Inferior epigastric arteries

Enters at the arcuate line (above line, m has anterior and posterior sheath. Below, only anterior)

409
Q

Side effects of succinylcholine

A

Malignant hyperthermia

Hyperkalemia - K leaks out of cell when polarized

Bradychardia or tachycardia

410
Q

SX of cholangitis

A

Fever, RUQ pain, jaundice (charcot triad)

Can have hypotension and altered mental status

Often caused by obstruction of common bile duct

411
Q

HBV life cycle

A

HBV has a partially double stranded DNA sequence

Goes into cell and dumps DNA material into nucleus where it is “fixed” by host DNA polymerase and then transcribed by host machinery into + RNA that goes into cytoplasm

RNA is reverse transcribed. by viral reverse transcriptase into the partially double stranded DNA. Host ribosomes make protein capsule

412
Q

What is alternative splicing

A

Process by which one gene can code for various proteins - exclusion or inclusion of certain. introns can create a different protein

413
Q

Pathophys of neonatal respiratory distress syndrome

A

With inadequate surfactant production by type II pneumocytes, the lungs have a higher surface tension and are less compliant. This cuases atelectasis - can see ground glass opacities

414
Q

Changes seen in obesity induced restrictive lung disease

A

Low FEV1, Low FVC, low ERV, can be low TLC

Normal RV

415
Q

What is beri-beri

A

Thiamine deficiency

Dry - peripheral neuropathy

Wet - neuropathy and cardiac involvment

416
Q

Which diuretic to use with heart failure

A

Spironolactone

Aldosterone blocking can stop heart remodeling

417
Q

SX of hyperaldosteronsim

A

Hypertension

Hypokalemia

Metabolic alkalosis

Sodium is retained in exchange for dumping of K and H

See muscle weakness and paresthesias

418
Q

What organs cant undergo hyperplasia

A

Pemanent cells - myocytes, skeletal muscle, nerves

419
Q

Hallmark of reversible cellular injury

A

Cellular swelliong - loss of microvilli, membrane blebbing, swelling of RER

NA/K pump is inhibited and Na builds up, pulling water in

420
Q

Hallmark of irreversible cellular injury

A

Membrane damage - plasma membrane, mitochondrial (cyt c leaks out = apoptosis), lysosomal

421
Q

Dosing of hydrophilic vs hydroophobic drugs in obese patients

A

Hydrophilic - lower dose than body weight becuase drug will stay extracellulary - wont go into larger adipose store

Hydrophobic - higher dose, drug has to saturate fat before it can take effect

422
Q

Origin of melanocytes

A

Neural crest – Melanoma

423
Q

Function of TNF-alpha

A

macrophage activation, phagolysosomes, granulomas

424
Q

Muscles that control defecation

A

Internal and external sphincter

Puborectalis muscle

425
Q

Neuro finding on REM sleep behavior disorder

A

alpha-synuclein

426
Q

What impacts creatinine levels

A

Muscle mass and meat intake

427
Q

Order of veins off of the SVC

A

external jugular drains into subclavian then drains into brachiocephalic then into SVC

428
Q

What CN innervate sensory of ear

A

V, VII, IX, X

429
Q

Normal flow of pleural fluid

A

Into pleaural space from intercostal microvessels, out via parietal pleural lymphatics

430
Q

Pathophys of TMJ

A

Dysfucntion of joint, hypersensitivity of mandibular nerve (V3) and muscle spasm (masseter, pterygoid)

431
Q

SX of typhoid fever

A
432
Q

Conditions that make TB more likely

A

Chronic kidney disease, DM, HIV, immunosuppression

433
Q

Bone changes in osteoporosis in aging vs hyperparathyroidism

A

Aging - lamellar bone is reduced

PTH - Cortical thinning (subperiostial)

434
Q

Pathogenesis of migraines

A

Cortical spreading depression is allowed by increased cerbreal excitability. The cortical spreading (aura) leads to release of CGRP (calcitonin gene related peptides) that transmit pain and cause vasodilation

Triptans block CGRP

435
Q

explain transient warfarin hypercoagulability

A

Protein C and VII have short half lives and are depleted first by warfarin. Protein C is an anticoagulant so allows Vitamin K to go unchecked until depleted

436
Q

TX for delirium

A

Treat underlying disease (abx)

Antipsychotics (usually firsy gen - haloperidol)

437
Q

What is acute intermittent porphyria

A

Deficiency in PBG deaminase (in porphyrin synthesis)

5 Ps - painful abdomen, Port wine pee, polyneuropathy, psychological disturbances, precipitated by drugs (P-450 inducers)

438
Q

What is lymphogranuloma venereum

A

Caused by chlamydia L1-L3

Starts as painless ulcer, then several large painful ulcers along inguinal nodes (boobos)

TX: Doxy

439
Q

MOA of calcium channel blockers (dihydropyridines vs non)

A
440
Q

Effects of ANP and BNP

A

Kidney: increases GFR, diuresis, renin inhibition

Adrenal: reduce aldrosterone

Vessels: vasodilate and increase permeability

441
Q

Metabolic effects of glucagon

A

Primarily increases glycogenolysis

Then decreases glycolysis and increases gluconeogenesis

442
Q

Process of loss of nucleus

A

Pyknosis - shrinking

Karyorrhexis - fragmentation

Karyolysis - dissolution

443
Q

What is coagulative necrosis

A

Necrotic tissue that remains firm, retains its shape

Proteins coagulate, no nuclei

INFARACTION - wedge shaped

444
Q

What is caseous necrosis

A

Friable, cottage cheease like necrosis

Liquefactive necrosis with TB or fungal infection

445
Q

What is saponification

A

Calcium deposit on fat necrotic tissue due to binding of calcium to fatty acids

446
Q

What is metastitc calcification

A

When there are high serum calcium levels that forces clacium into tissues

447
Q

What is Bcl2

A

Stabilized the mitochondrial membrane. Without it Cyt-C leaks out and activates caspases = apoptosis

448
Q

What are the three free radicals and what degrades each

A

Superoxide (O2-) – superoxide dismutaes

Peroxide H202 – catalse

OH free radical – glutathione peroxidase

449
Q

Process of carbon tetrachloride injury

A

Becomes ccl3 a free radical

Damages hepatic cells = swelling = ribosomes pop off RER so less protein formation

Less apolipoprotein formation = fatty liver

450
Q

Primary vs secondary amyloidosis

A

primary - deposition of AL amyloid from Ig light chain

secondary - AA amyloid (from acute phase reactant SAA)

See nephrotic cyndrome, cardiomyopathy, tongue enlargment, hepatosplenomegaly

451
Q

Features of gardnerella

A

Thin off-white discharge, positive whiff test

No inflammation

Anaerobic gram-variable, see clue cells

452
Q

Effect of heart on a-1 agonism

A

Becuase of vasoconstriction, baroreceptors will cause increased vagal stimulation leading to an inhibition of pacemaker rate

453
Q

Common features of turner syndrome

A
454
Q

How to measure lung maturity of fetus

A

The phosphotidylcholine/sphingomyelin ratio

Phosphotidylcholine is a component of surfactant so should increase

Sphingeomyelin is a phospholipid and shouldnt increase as much

455
Q

Location of pneumonia if aspiration lying down vs standing

A

Always in the right

456
Q

MOA of sofosbuvir

A

RNA-dependent RNA polymerase inhibitor

Stops formation of proteins

HCV

457
Q

Hormonal changes in pregnancy

A
458
Q

Most common site of ectopic impulse in A fib

A

Pulmonary veins

459
Q

Sounds heard with mitral regurgitation

A

Holosystolic murmur at apex of heart radiating to axila\

Can produce an S3 - sign of volume opverload in LV

460
Q

Where are gastric parietal cells located

A

Upper glandular layer

461
Q

Serotype associated with reactive arthritis and SX

A

HLA-B27

STEP 1 (8 decks)

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