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STEP 1 > STEP 1 Week 2 > Flashcards

STEP 1 Week 2 Flashcards

1
Q

Most hypotonic region of the renal tubule in setting of ADH and non-ADH

A

ADH - distal convoluted tubule (remains mostly impermeable to water)

Low ADH - collecting duct, no porins inserted so becomes less concentrated

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2
Q

What causes vasoconstriction and increased proliferation in the lunc

A

Thromboxane and endothelin

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3
Q

Treatment for Myasthenia gravis

A

Pyrostigmine - and AchE inhibitor

If too low - will respond to edrophonium test (aother AchE)

If too high - Desensitized muscles, wont respond to edrophonium (stop pyrostigmine temporarily)

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4
Q

How to measure severity of mitral stenosis

A

A2 to opening snap time interval

Shorter in more severe cases (the snap is when the mitral valve reaches its maximal diameter)

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5
Q

Symptoms and histo of hypersensitivity pneumonitis

A
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6
Q

Most common ligament injured in the ankle

A

Anterior talofibular ligament (lateral)

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7
Q

Function of fibroblast growth factor 23

A

Secreted by osteocytes in response to high phosphate levels

Inhibits synthesis of 1,25 hydroxyvitamin d in the kidney, so leads to a drop in calcium and phosphate absorbption in the kidney and intestine

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8
Q

Function of each of the rotator cuff muscles

A

Supraspinatus - abduction (first 15)

Infraspinatus - external rotation

Teres minor - external rotation and adduction

Subscapularis - internal rotation and adduction

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9
Q

What is stress hyperglycemia

A

In times of metabolic stress, the body releases chatecolamines, cortisol, and other inflammatory cytokines that increases hepatic gluconeogensis and glycogenolysis

High blood sugar with no diabetes

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10
Q

Function of type II pnuemocytes

A

Secerte surfactant

Regeneration of alveolar lining after damage

Can differentiate into type I pneumocytes

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11
Q

Histo of Lewy body dementia vs alzheimers vs frontotemporal dementia vs parkinsons

A

Lew body dementia - alpha synuclein

Alzheimers - Beta emyloid, presinilin, tau (tangles)

Frontotemporal - Tau protein inclusions, TDP-43

Parkinsons - Lewy bodies (alpha synuclein)

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12
Q

What is a cholesteotoma

A

A pearly mass of squamous cell debris in the middle ear behind the tympanic membrane, caused by chronic negative preasure

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13
Q

What causes dissemenated mycobacterium infections in childhood

A

Deficiency in the INF-gamme pathway (JAK-STAT)

Macrophages cant be activated appropriately - wont secrete IL-12 to induce phagolysosome killing and wont form granulomas

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14
Q

Methotrexate fetal effects

A

Cardiac, urinary, neural tube defects

Blocks dihydrofolate reductase

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15
Q

Treatement for acute gouty arthritis

A

NSAIDS (COX inhibitors)

Colchicine

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16
Q

Lymph drainage of the testes

A

Testes - para-aortic lymph nodes

Scrotum - superficial inguinal nodes

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17
Q

HIV/HSV drug that does not require phosphorylation

A

Foscarnet

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18
Q

Lesions of the macula cause:

A

Central scotoma

Like in macular degeneraion

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19
Q

Side effects of dopamine receptor blockers (metochlopramide)

A

Can cause dopamine blockade that can lead to cholinergic activity = extrapyramidal symptoms

Give with something with anticholinergic activity like diphenhydramine

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20
Q

What induces P and E selectins

A

P-selectins = weibel-palade bodies

E-selectins = Il-1 and TNF

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21
Q

Label the regions

A

Ach stimulates the medulla chromaffin cells

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22
Q

Side effects of amiodarone

A
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23
Q

Types of analysis to do based on type of independent and dependent variables (qualitative or quantitative)

A
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24
Q

Physical manifestations of cystic fibrosis

A

Nasal polyps, bronchiectasis, recurrent infections, digital clubbing

Pancreatic insufficiency, absence of vas deferens (inferitility), failure to thrive

CFTR gene helps developement of wolffian structures

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25
Q

Course of the great saphenous vein

A

Begins on the medial fit, courses up medial to medial melleolus then uo medial aspect of leg and thigh. Joins femoral vein in the femoral triangle (bounded by inguinal ligament, sartorius, adductor longus), inferior to pubic tubercle

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26
Q

Cancer and PD-1

A

Cancer cells often have mutations that make them express less PD-1, which would usually bind PD-L1 (programmed death ligand 1) on cytotixic T cells and cause lead to destruction

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27
Q

What cell surface signal is lacking in leukocyte adhesion deficiency

A

CD18 - see leukocytosis because neutrophils and macrophages cant enter tissues

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28
Q

Innervation of inner ear muscles

A

Tensor tympani - CN V3

Stapedius - CN VII

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29
Q

What will a mutated PRPP enzyme cause (phosohoribosyl pyrophosphate)

A

Gout due to increased purine synthesis

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30
Q

Causes of gongenital hypothyroidism (4) and hormone levels

A

Primary hypothyroidism

Thyroid hormone resistance

Central hypothyroidism

Transient due to maternal exposure

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31
Q

Normal pancreas development

A

Dorsal - tail, body, most of head, accessory duct

Ventral - Main duct, uncinate provess, part of head

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32
Q

Is pregnancy prothrombotic or antithrombotic? why?

A

Prothrombotic

  1. Increased clotting factors - like fibrinogen
  2. Decreased anti-clotting factors - like protein S
  3. Less fibrinolysis
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33
Q

Levels of the sciatic nerve

A

L4-S3

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34
Q

What muscles does the median nerve course between

A

Humoral and ulnar heads of the pronator teres

flexor digitorum superficialis and flexor digitorum profundus

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35
Q

Inhibitory checks on trypsin activity

A

Trypsin inhibitors (encoded by SPINK 1 gene) are released in the pancreas

Tryspin also can cleave another molecule of trypsin at a second site different from activation that inactivates it - stops excessive cascade

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36
Q

Main cause of epiglottitis vs steeple sign

A

Haemophilus influenza type B = epiglottitis

Croup = steeple sign

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37
Q

Nondisjunction in meiosis I vs meisosis II

A
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38
Q

What blood changes would be seen after several days at high altitude

A

Slightly high pH, low O2, low CO2, low bicarb

Low O2 in air increases respiration (chemoreceptors) that leads to loss of CO2 and resp alkalosis. This leads to loss of bicarb in kidneys

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39
Q

Effects of fetal hyperglycemia (from uncontroled maternal diabetes)

A

Lots of glucose crosses to placenta so big baby (macrosomia)

Leads to increase in fetal insulin and beta cell hyperplasia - after birth see hypoglycemia so have to give glucose

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40
Q

APC vs KRAS vs TP53

A

APC - progression from normal mucosa to polyp (B catenin accumulation)

KRAS - Increase size of adenoma

TP53 - malignant transformation

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41
Q

Most likely cause of fatigue, fever, and new heart murmur

A

Infective endocarditis

proliferative glomerulonephritis can be secondary (nephritic syndrome)

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42
Q

Cause of fetal midgut atresia

A

Vascular injury

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43
Q

Hematologic cancers associated with downs syndrome

A

Acute lymphoblastic leukemia

Acute megakaryoblastic anemia

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44
Q

Effects of raloxifene in different areas of the body

A

Estrogen agonist in bone (good for osteoporosis)

Estrogen antagonist in the breast and uterus

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45
Q

What increases urea reabsorption and where

A

Vasopressin (ADH) in collecting tubule

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46
Q

Function of calcium in neuronal transmission

A

Triggers fusion and release of neurotransmitter vesicles

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47
Q

Nerve most at risk during ablations involving the right atrium

A

The right phrenic nerve

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48
Q

Why are ischemic occlusions rare in the lung

A

Dual blood suply bc anastamoses between bronchial and pulmonary arteries. Broncial arteries can continue to supply nutrients

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49
Q

How is blastomyces described histologically

A

Branching hyphae

large round yeast with doubly retractile walls and a single broad based bud

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50
Q

Is cystic fibrosis obstructive or restrictive

A

Obstructive - progressive bronchiectasis, mucus plugging

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51
Q

Effect of acetazolamide on Na and K in urine

A

In the proximal tubule, it blocks reabsorption of Na.

But later in the collecting duct, Na is reabsorbed in exchange for K leading to an overall increase in K in the urine

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52
Q

Pathophys of high altitude pulmonary edema

A

Drop in O2 leads to vasoconstriction. If this is uneven, can lead to increase in pulmonary arterial pressure and perfusion in a certain area that can cause capillary membrane disruption and lead to edema

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53
Q

Pathophys of a staghorn calculus

A

Urease producing organisms (proteus, klebsiella) cause an increase in urea that is converted to ammonia in the urine. This alkalinizes the urine and causes precipitation of struvite crystals

Continuous urea production makes stones grow very rapidly, can lead to renal atrophy

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54
Q

Pathophys of cachexia

A

TNF-alpha is produced by macrophages and some neoplastic cells

Decreases appetite due to affect on hypothalamus and increases basic metabolic rate = musle wasting

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55
Q

Histology of mesothilioma

A

Flattened cells or spindle cells

Immunohistochemistry: cytokeratins, abundant tonofilaments

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56
Q

Effect of ATP on muscle contraction

A

ATP binds to myosin light chain and causes a releases from actin = relaxation

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57
Q
A

A - caudate

B - internal capsule

D- putamen

E - globus pallidus

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58
Q

Muscle that takes up most of the sciatic foramen and can compress the sciatic nerve

A

Piriformis - external rotation

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59
Q

Changes in the endometrial tissue throughout menstruation

A
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60
Q

Where is most water absorbed in the tubule

A

THE PROXIMAL TUBULE

>60% regardless of hydration status

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61
Q

Potency of neuromuscular blocking agents in myasthenia gravis

A

Nondepolarizing (rocuronium, vecuronium) - more potent because fewer receptors that they compete for

Polarizing (succinylcholine) - less potent, fewer receptors so cant produce same effect

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62
Q

Fungal infection most associated with central venous catheter

A

Candida - pseudohyphae and blastoconidia

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63
Q

Main regulator of depth and rate of respiration

A

Respiration center in medulla based on peripheral and central chemoreceptors

Carotid and aortic bodies are main site that monitor PaO2 during hypoxemia

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64
Q

Most common causes of COPD exacerbations

A

Viral or bacterial illnesses - usually rhonovirus, influenza, H. flu, moraxella catarrhalis, strep pneumo

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65
Q

MOA of hydroxyurea

A

Inhibits ribonucleotide reductase = myelosuppression

Also shifts beta globin expression to gamma globvin, increasing fetal hemoglobin

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66
Q

Vincristine MOA and toxicity

A

Inhibits formation of microtubules - effective in stopping M phase

Neurotoxicity (peripheral neuropathy)

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67
Q

Side effects of statins

A

Muscle toxicity

Hepatotoxicity - check transaminases before starting

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68
Q

Treatment for simple cystitis

A

Nitrofurantoin or trimethoprim-sulfamethoxazole

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69
Q

Skin manifestations in syphillis stages

A

primary - chancre

secondary - diffuse macular rash, condyloma lata

tertiary - gumma (panless, indurated, granulomatous lesion)

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70
Q

Medications for weight loss and MOA

A
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71
Q

Why is peripheral edema initially avoided in chronic heart failure

A

Increased lymph flow

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72
Q

MOA of 5-FU

A

Creates a complex between tetrahydropholate and thymidilate synthetase, causing an inability to get back to DHF

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73
Q

Drug used to “rescue” cells during methotrexate use

A

Leucovorin (folinic acid) - a tetrahydrofolate derivative that can yield DNA synthesis without DHF reducatse that is inhibited by methrotrexate

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74
Q

What is seen grossly in TB meningitis

A
  • Thick, gelatinous exudate on basal portion of brain
  • Tubular vasculitis causing multiple bilaterla brain infarctions
  • Hydrocephalus causing ventriculomegaly
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75
Q

Desmosomes vs hemidesmosomes

A

Both are spot-like junctions made of keratin intermediate fillaments but desomosomes are between adjacent cells and hemi-desmosomes are with the basement membrane

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76
Q

Type of cell junction of the BBB

A

Tight junctions - only transport by diffusion across membranes or. transporters

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77
Q

Usual location of third degree heart block

A

Av or bundle of his - bundle of his usually able to take over but not under control of SA

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78
Q

What does the HIV env gene do

A

Codes for polyprotein gp160 that is extensively glycosylated. Cleaved in the golgi into gp 120 and gp41 which allow for virion attachment to target cells

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79
Q

Histologic features of legionella

A

Poorly gram stains and does not grow on conventional agar

Will silver stain

Grow on buffered charcoal yeast extract agar with l-cysteine and iron

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80
Q

What is length-time bias

A

Screening test is less likely to pick up those with very quickly progressing disease than those with a slowly progressing disease that already have a better prognosis

Falsely elevated survival time

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81
Q

What enzymes are inhibited in lead poisoning

A

ALA dehydratase and ferrochetalase

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82
Q

What drugs can trigger G6PD

A

Bactrim (TMP/SMX), dapsone, antimalarials, nitrifurantoin

Fava beans

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83
Q

What is countertransferance

A

A therapists concious or uncocnious response to a patient based on past personal relationships

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84
Q

Fucntion of methimazole and propylthiouracil

A

Decrease production of thyroid hormones

Block thyroid peroxidase which adds iodine to tyrosine in colloid

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85
Q

SX of vitamin E deficiency

A

Hemolysis

Neurologic symptoms - ataxia, loss of proprioception, loss of sensation, loss of deep tendon reflexes (looks like freidrichs ataxia)

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86
Q

What is thyroglobulin

A

large glycoprotein made in the thyroid that is used to contribute tyrosine residues. Released when thyroid productio is occuring

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87
Q

Innervation of teeth and lower lip

A

Branches of CN V3

Teeth - inferior alveolar nerve

Lower lip - mental nerve

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88
Q

MOA and side effects of sulfonylureas

A

Close K+ channels in pancreatic beta cells cause depolarization - insulin release due to calcium influx

Side effects: hypoglycemia, weight. gain

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89
Q

Symptoms of digoxin toxicity

A

Arrhythmias, vague sx, vision changes, hyperkalemia

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90
Q

What causes swelling of hands and feet in SC infants

A

Vasoocclusion - infarctions. in the. bone of the extremities causes swelling and pain. More commoninnfants because. still hematopoetic tissue

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91
Q

Pathophys of fragile X syndrome

A

Many CGG repeats on X chromosome leads to increased methylation of FMR1 gene - leads to impaired neural development

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92
Q

What is a delayed hemolytic transfusion reaction

A

Occurs when someone. has previosly been exposed to a foreign minor red blood cell antigen (non-ABO) like pregnancy or transfusion

After reexposure, B cells produce a large numebr of antibodies resulting in hemolysis - amnestic response

SX: often asymptomatic, hemolysis, positive coombs test

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93
Q

How is the lac operon regulated in E. Coli

A
  1. negatively. by the binding of repressor protein the lac operator locus
  2. positively by cAMP-CAP binding upstream from lac operon – inhigh levels of cAMP, CAP will bind upstream and turns on lac cAMP. low in the presend of glucose
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94
Q

Coagulation and nephrotic syndrome

A

Nephotic. syndromes cause a hypercoagulable state due to a loss of anticoagulant factors in the urine - especially antithrombin III

Can cause a renal vein thrombosis - would see flank pain, hematuria, elevated lactate dehydrogenase, possible left sided varicocele

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95
Q

Pathophys of postpartum thyroiditis

A

Autoimmune destruction of the thyroid gland - get release of thyroid hormine

Lymphocytic infiltrate with possible germinal centers

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96
Q

Medications associated with gout exacerbations

A

Reduced uric acid secretion - diurectics, cyclosporine, ACE inhibitors, salicylates

Increased production - cytotoxic chemotherapy (bc cell lysis)

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97
Q

Nerve most ofte injured during repair of inguinal hernias

A

Illioinguinal nerve - pain in anterior scrotum (labia majora), base of penis (mons pubis), medial thigh

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98
Q

Loading of MHC I vs MHC II

A

MHC I - proteasomes break down product and bring into ER via TAP proteins. MHC is assembled and sent to membrane

MHCII - MHC II is sent out from ER and fuses with lysosomes that contain bacterial products, MHC II forms within vesicle and then goes to membrane

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99
Q

What genes are affected by HPV

A

Decreased activity of p53 and Rb = unregulated cell proliferation

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100
Q

What is chronic granulomatous disease and common infections

A

Deficiency in NADPH oxidase, so cant turn O2 into radical to do oxidative burst in neutrophils

Can use H2O2 formed by catalase (-) bacteria, but catalase (+) bacteria remove H202

Staph aureus, burkholderia (pseudomonas) cepacia, serratia marcecens, nocardia, aspergillus

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101
Q

What is MGMT

A

Gene that helps to repair DNA damage, especially alkylating DNA damage

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102
Q

What happens to bicarb if chloride increases

A

Goes down - this is a NAGMA

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103
Q

Signs of cyanide poisoning and treatment

A

Reddish skin coloration, tachypnea, headache, tachycardia, nausea/vomiting, weakness

TX: Amyl nitrite

Converts iron (fe2+) to ferrous iron (fe3+) to make methemaglobin which binds to cyanide and sequesters it

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104
Q

How to treat heart valve infections

A

Vancomycin

Coagulase negative staphylococci are assumed to be methicillin resistent, otherwise would use nafcillin or oxacillin

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105
Q

Obstructions at the level of the larynx (epiglottitis) have _____ stridor

A

Inspiratory

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106
Q

What is mastocytosis

A

Abnormal proliferation of mast cells with increased histamine release

SX: hypersecretion of gastric acid by parietal cells, hypotension, flushing, urticaria, pruritis.

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107
Q

What is transpeptidase

A

A type of penicillin binding protein that penicillin or cephalosporins would bind to

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108
Q

First line therapy for atopic dermatitis

A

Topical glucorticoids - PLA2 inhibitor

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109
Q

Function of CN IX (hypoglossal)

A

Somatic motor: stylopharyngeus m (elevate palate during swallowing)

Parasympathetic: parotid gland (runs with V3)

General sensory: inner surface of tempanic membrane, eustachian tube, posterior 1/3 of tongue, tonsilar region, upper pharynx, carotid body and sinus

Special sensory: taste on posterior 1/3 of togue

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110
Q

Most common place for ulnar nerve damage

A

Fracture of the hook of the hamate as it passes through Guyon canal

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111
Q

MOA of PCP

A

N-methyl-D-aspartate receptor antagonism

Leads to dopamine dysregulation

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112
Q

Derivatives of ectoderm

A
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113
Q

Derivatives of mesoderm

A
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114
Q

Derivatives of endoderm

A
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115
Q

What is dilated cardiomyopathy

A

Direct insult to the myocardium leads to leads to ventricular dysfucntion and increased ventricular cavity size

Cause: viral, drugs, disease, idiopathic (familial - TTN gene)

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116
Q

What is titin

A

An elastic fiber that binds myosin heavy chain to the Z disk, contributes to passive myocardial tension

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117
Q

Examples of exocrine pancreatic enzymes

A

Lipase, elastase, amylase, trypsin, chymotrypsin

Low levels would indicate oancreatic insuffficiency

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118
Q

What is severe combined immune deficiency

A

Defect in T cell production - get loss of cellular and humoral immunity. B cells cant be activated

See: recurrent fungal, viral, bacterial, opportunistic infections. DIarrhea and failure to thrive

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119
Q

Cells involved in type IV hypersensitivty

A

Macrophages, CD4, CD8

NO B CELLS

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120
Q

DNA-binding proteins examples

A

Transcription factors, steroid hormone receptors, thyroid hormone receptor, fat-soluble vitamin receptors, DNA transcirption/replication proteins

121
Q

Nerve most likely to be injured during thyroid surgery and muscle it innervates

A

External laryngeal nerve

Cricothyroid m.

Runs with superior thyroid artery and vein

122
Q

Best rehydration for viral diarrhea

A

Hypotonic sodium-glucose solution

Sodium will pull water in

123
Q

Treatment for nephrogenic diabetes insipidus

A

Water replacement and thiazide diuretic

Thiazide causes a mild volume depletion that leads to sodium and water reabsorption in the proximal tubule

124
Q

What can lead to inactivation of fluoroquinolones

A

Chelating agents that contain calcium, iron, aluminum, magnesium

Antacids would be a common cause

125
Q

MOA of heparin

A

Binds and induces antithrombin III, an anti-clotting facor

See prolonged thrombin time and PTT, decreased activity of factor Xa

126
Q

What penicilins and cephalosprins are effective agaionst P. aurugenosa

A

Tcarcillin and pipercillin

cefepime and ceftazadime

127
Q

SX of dissemenated histoplasmosis

A

Growi inside macrophages so can travel through reticuloendothelial system

hepatosplenomegaly, lyphmadenopathy, pancytopenia, tongue ulcerations

128
Q

Contents of femoral triangle from lateral to medial

A

Femoral nerve, femoral artery, femoral vein, deep inguinal nodes

129
Q

Pathophys of acanthosis nigricans

A

Caused by an increase in free fatty acids

Insulin insensitivity leads to lipolysis

130
Q

Condition associated with HLA-B27 and what to monitor

A

Ankylosing spondylitis

Can limit chest wall mobility so monitor chest expansion

Can also cause dilation of the aortic ring and anterior uveitis

131
Q

Cardiac problem associated with SLE

A

Fibrinous pericarditis - pleuritic chest pain that may radiate to shoulder, diffusely elevated ST segments

Would see fibrin-containing exudate

132
Q

Nerves injured during prostatectomy that causes erectile dysfunction

A

Prostatic plexus in fascia of prostate - cavernousn nerves carry post-ganglionic parasympathetics to penis

133
Q

Function of HIV gp120 and gp41

A

Gp 120 allows for attachment to T cell

Gp41 allows for fusion and insertion of viral core

134
Q

What causes a mid-systolic crescendo decrescendo murmur

A

Aortic or pulmonary valve stenosis

135
Q

Estrogen effects on epiphyseal growth plate

A

Initially triggers increased growth, but then causes epihphyseal growth plate closure

136
Q

What is somatomedin C

A

Insulin like growth factor 1

137
Q

Lung manifestation of RA

A

Pulmonary fibrosis - restrictive lung disease

138
Q

Risks for diverticulitis

A

Dietary - high in red meat, fat, low in fiber

Obesity

Physical inactivity

Smoking

139
Q

Most common cause of pericarditis

A

Viral illness

140
Q

What usually causes serum sickness

A

Exposure to nonhuman proteins in antitoxins, antivenom, MABs, vaccines

Causes type III hypersensitivity with deposition in tissue - fever, urticarial rash, arthralgia

141
Q

Segmented viruses

A

Bunya

Orthomixo

Arena

Reo

142
Q

What ligament is often injury in radial head subluxation (nurse maids elbow)

A

Annular ligament

143
Q

What do menotropin and hCG due for ovulation

A

Menotropin serves as FSH, allowing for the maturation of a dominant follice

hCG serves as the LH surge, inducing ovulation

144
Q

Vitamin deficiency associated with measles

A

Vitamin A - can give occular complications so give. A

145
Q

Histo of emphysema

A

Interalveolar septal destruction with bronchial wall inflammation

146
Q

Function of leptin

A

Leptin is made by adipocytes and reduces appetite

Reduces production of neuropeptide Y (appetitie stimulant) and increases POMC (inhibits food intake), both in the arcuate nucleus of hypothalamus

147
Q

Histo of poxvirus molluscum contagiosum

A

intracytoplasmic eiosinophilic inclusion bodies

148
Q

Sensory innervation of the parietal pleura

A

Phrenic nerve: diaphragmatic and mediastinal pleura - get pain in neck and shoulder bc C3-C5

Intercostal nerves: Costal and cervical

149
Q

Pathophys of febrile seizure

A

hyperthermia-induced diffuse neuronal injury

150
Q

Toxicities of common chemotherapy agents

A
151
Q

What is patiromer

A

Drug to treat hyperkalemia - binds to colonic potassium in exchange for calcium

152
Q

When is alk phos elevated

A

In disorders of the bile ducts (stasis)

Disorders with high bone turnover (paget)

153
Q

Most common cause of aminoglycoside resistance

A

Antibiotic modifying enzymes - add alkyl groups, phosphates, etc to stop binding with ribosome subunit

154
Q

Embryonic origin of pituitary

A

Anterior - surface ectoderm

Posterior - neuroectoderm from diencephalon

155
Q

AA precursor of serotonin

A

Tryptophan

156
Q

Histo for hep B

A

Ground glass appearance - homogenous, pale, opaquepink cytoplasm

Councilman bodies - eosinophilic glovules of shrunken hepatocytes

157
Q

TX for diabetic neuropathy

A

Glycemic control and foot care

If painful: SNRI, TCA, gabapentinoid

158
Q

What causes neonatal hydrocele

A

Patent processes vaginalis - fluid accumulates in the tunica vaginalis

Tunica albugenia is what directly covers testicle and corproa cavernosa

159
Q

What is the accumulation effect

A

A certain time period or level of exposure is needed to see benefits or detriments of a risk reducer or increaser

160
Q

Benefit of hypothermia therapy

A

Decreases the formation of ROS (temp dependent), lowers cerebral blood flow, lowers O2 and glucose consumption

161
Q

Pathophys of Ehlers-Danlos

A

Deficiency in the cleavage of the C and N terminals of procollagen

162
Q

What crescendo is best heard leaning forward

A

Aortic regurgitation

Hear a decrescendo, best heard at C

163
Q

MOA of nitrates

A

Vasodilation, mostly venodilation in the periphery, so preload is reduced (LV end diastolic volume) and afterload because easier to pump

Mild coronary artery dilation, overall less cardiac oxygen demand

164
Q

Describe mechanism of nichotinic cholinergic receptor

A

Ionotropic recpetor - uses ion channels that open

Binding of two acetylcholine molecules opens channel that allows for influx of calciuma nd sodium and efflux of potassium, generating end plate potential

165
Q

Cause of lateral medullary syndrome

A

Damage to PICA - branches off of vertebral artery

166
Q

Conditions associated with atopic dermatitis

A

Things mediated by IgE

Allergic rhinitis, asthma, food allergies

167
Q

Changes in ghrelin, leptin, and insulin during fast

A

Ghrelin goes up and stimulates appetit

Weight loss leads to less fat so lower leptin, and increase in insulin sensitivity to lower insulin

168
Q

Relationship between nitrates and PDE inhibitors

A

Nitrates is converted to NO which leads to an accumulation of cGMP in cells

phosphodiesterase usually degrades cGMP but PDE inhibitor will lead to further accumulation of the cGMP = profound hypotension

169
Q

How to reverse effects of warfarin

A

Fresh frozen plasma

170
Q

Morphological changes seen in superficial burns

A

Mast cells release histamine and other facts that cause blanching erythema

Deeper burns will damage the endothelium that causes extravasation of fluid between gaps in cells (blisters)

171
Q

Mutation seen in CF

A

delta F508

CFTR Chlroide channel is messed up - chloride and sodium remain in sweat = hyponatremia

172
Q

How does shiga toxin work

A

Inactivates 60s robosome subunit - cell cant produce proteins and dies

173
Q

Most common organisms seen in aspiration pneumonia

A

Facultative and strict anaerobic oral organisms

Bacteroides, prevotella, peptostreptococcus, fusobacterium

174
Q

Prolactin effect on GnRH

A

Inhibits - so low GnRH, LH, and testosterone

175
Q

SX of pituitary apoplexy

A
176
Q

Associations with each part of the duodenum (1-4)

A

2- ampulla of vater where secretions from pancreas + bile come in

3- superior mesenteric artery

177
Q

GI bugs that can cause disease with very low numbers

A

Shigella, campylobacter, entamoeba, giardia

178
Q
A
179
Q

What cells make up the alveolar capillary membrane

A

Type I pneumocytes

180
Q

Complications of obstructive sleep apnea

A

Pulmonary hypertension (pulm vasoconstriction during hypoxia)

Systemic hyeprtension, right heart failure, Afib, arrhythmias, sudden cardiac death

181
Q

Growth factors elevated in idiopathic pulmonary fibrosis

A

TGF-B, PDGF, VEGF, FGF

Perfinidone is against TGF-B

Nintedanib is against FGF, VEGF, PDGF

182
Q

Mood stabilizers for bipolar disorder

A
183
Q

Location of the greater and lesser omentum

A
184
Q

Causes of insulin-induced weight gain

A
185
Q

effects of beta thalesemia major and minor on HBa1c and HA2

A

To. compensate for a loss of beta chains, the HA2 will rise, while hemoglbin A will fall, so HBA1c will fall

In minor - slight elevation of A2 and decrease in HBA

In major - no HBA and large increase in A2

186
Q

How does a HBa1c work

A

Hemoglobin A1c us produced by nonreversible glycosylation of N-termus of hemoglobin - lasts as long as RBC lives

187
Q

Effect of 2,3-BPG

A

Decreases the affinity of hemoglobin for O2 - leads to offloading into tissue

188
Q

What is mullerian agenesis

A

Hypoplasia/aplasia of the mullerian structures - fallopian tubes, uterus, cervix, upper vagina

Will have normal secondary sex chaarcteristics and are 46, XX

189
Q

What AAs can lead to a buildup of proprionyl coA

A

VOMIT

Valine, odd chain fatty acids, methionine, isoleucine, threonine

190
Q

SX of kawasaki disease

A

Conjunctivitis glossitis, fissured lips, rash, erhythema and edema of distal extremities, cervical lymphadenopathy

Risk for coronary aortic aneurysm

191
Q

Somatic vs germline mosaicism

A

In somatic mosaicism, the individual posses phenotypic evidence of the mutation

In germline, they do not, but can pass the mutation on to offspring

EX: Turner mosaicism 45X/46XX

192
Q

When is hospice an option

A

When less than 6 months prognosis and aggressive treatment is no longer beneficial or desired

193
Q

Part of brain that if damaged would cause disinhibition, personality change, irritability

A

orbitofrontal cortex

194
Q

Targets of the four antifungal classes

A
195
Q

What happens to methotrexate and DHF/folic acid inside the cell

A

Polyglutamation - keeps them inside the cell

196
Q

Most common site for vestibular schwanoma

A

Cerebellopontine angle - would affect CN VIII, VII, V

197
Q

Blood supply of the liver

A

Right and left hepatic arteries which are branches of the celiac trunk

198
Q

Blood supply to the SA/AV and bundle of His

A

Right coronary artery

199
Q

Impact on preload, afterload, and CO during pregnancy

A

There is an overall drop in SVR during pregnancy, which causes a drop in afterload, and increase in preload

There is an increase in blood volume which causes increased CO and preload

200
Q

Those at risk for serious infection with vibrio vulnificus

A

Liver disease, iron overload

201
Q

What are neurophysins

A

They are chaperone proteins that carry vasopressin and oxytocin from the hypothalamus to the posterior pituitary

202
Q

What type of drug to use for urge incontinence

A

Antagonist for muscarinic cholinergic receptors - M3 in the detrusor muscle

203
Q

MOA of thiazide diuretics

A

Block the NaCl transport in DCT so less reabsorption

Also cause less excretion of calcium = good for osteoporosis

204
Q

Autosomal dominant vs recessive polycystic kidney disease

A

Dominant presents later in life - cysts are very smalla t birth and then grow

recessive - presents as kidney masses at birth

205
Q

Manifestations of Leischmania

A

Cutaneous - enlarging pinkish papule, nodule or plaque that ulcerates

Histo - Grows within macrophages as intracellular, round-oval amastigoytes with rod-shaped kinetoplasts

206
Q

Bone cancer with small, round blue cells

A

Ewing sarcoma

207
Q

What kind of channel is CFTR

A

ATP-gated

208
Q

What activates platelets

A

thromboxane, ADP, decreased cAMP

209
Q

What kind of hernia would travel through a patent tunica vaginalis

A

Indirect - passes through the inguinal canal

210
Q

What is a stratum ovarii tumor

A

An ovarian germ line tumor that is comprised of 50% thyroid cells - produces thyroid hormone

Appears as an oily cystic mass

211
Q

The middle meingeal artery is a branch off of ___

A

Maxillary artery, which comes off of external carotid

212
Q

How is CO2 carried in the blood

A

Preodimately in the form of HCO3-

Carbonic anhydride in the RBC converts it, and then exchanges it for chloride – the chloride shift

213
Q

What is retinitis pigmentosa

A
214
Q

Gram negative rod that is lactose positive and indole positive

A

E. Coli – can convert tryptophan to indole

E. cloacae is indole negative

215
Q

Venous drainage of the fundus of the stomach

A

Splenic vein - with thrombosis can get varices just in the fundus

216
Q

Pathophys of a hypersensitive carotid baroreceptor

A

When slight pressure is applied, baroreceptor thinks there is a very high blood pressure - reduces sympathetics and increases pns to the heart

Rapid vasodilation with a sinus pause

217
Q

What are the codes of intron splice sites

A

GU at the 5’

AG at the 3’

218
Q

What is hypertrophic osteoarthropathy

A
219
Q

Most common placenta for monozygotic and dizygotic twins

A

Dizygotic - Diamniotic/dichorionic

Monozygotic - diamniotic/monochorionic (division around day 4-8)

220
Q

Where do carcinomas usually spread first

A

Regional lymph nodes

Head and neck - jugular nodes

221
Q

Significance of viridans streptococci

A

Often found in dental carries, heart valve infections

Can adhere to tooth enamel and platelets on damaged heart valves because they produce insoluble extracellular polysaccharides (dextrans) from sucrose

222
Q

What do nitrates predominately work

A

Large veins - decrease preload and myocardial oxygen demand

223
Q

Most prominent surface marker for monocyte-macrophages

A

CD-14

224
Q

Most important process in formation of shiggelosis

A

Mucosal invasion - Invades M cells and uses actin polymerization as it kills cells

225
Q

What first activates trypsin

A

Enteropeptidase on brush border

226
Q

How to measure the osmolar gap

A

Elevated in toxic alcohol metabolism

227
Q

Signs and risks of placental abruption

A
228
Q

Location of pacemaker and what can it cause

A

Can cause tricuspid regurgitation

229
Q

Function and innervation of latissimus dorsi

A

Extension, adduction, internal rotation of the humerus

Innervation is thoracodorsal (C6-C8)

230
Q

Three steps of normalk swallow

A
  1. Displacement of the larynx superiorly and anteriorly under base of tongue to direct food to posterior esophagus
  2. Tilting of eppiglotis to cover airway
  3. Adducting of vocal coards to cover glottis
231
Q

What is DRESS syndrome

A

Drug reaction with eosinophilia and systemic systems

Reaction 2-8 weeks after starting a drug (anticonvulsants, allopurinol, abx) that shows widespread eosinophilia - lymphadenopathy, facial edema, rash

232
Q

What tests are used to diagnose GAS

A
  1. Rapid antigen test for Group A antigen
  2. Culture and look for beta hemolysis if antigen test is negative
233
Q

How to avoid ACE inhibitor first does hypotension

A

Stop all diuretics and start at low doses

Occurs more if angiotension II and aldosterone are high (like in volume depletion from diuretic)

234
Q

What is Henoch Schonlein purpura

A
235
Q

What is seen in loop diuretic overruse

A

Hypokalemic, hypochloric metabolic alkalosis

236
Q

Fasciculus cuneatus vs fasciculius grascilus

A

Both in DCML

Gracile - medial, from below T6

Cuneate - lateral, above T6

237
Q

What drugs can lead to higher levels of statins

A

CYP3A4 inhibitors

Macrolide abx, ketoconazole, non-dihydro Ca blockers, amiodarone, protease inhibitors

238
Q

What is the late phase of a type 1 hypersensitivity

A

TH2 cells release IL-5 to activate eosinophils

Eos release major basic protein and other chemicals that cause tissue damage - indurated lesion 2-10 hours later

239
Q

What is an infantile hemangioma

A

Endothelial cells

240
Q

Methimazole vs propylthiouracil

A

Methimazole is preferred for hyperthyroidism in most patients over PTU because of hepatotoxicity

Methimazole is a teratogen so PTU is used in the first trimester of pregnancy, and then patient can be switched back to methimazole

241
Q

MOA of amiloride and triamterene

A

Potassium sparing diuretics that block the sodium uptake channel in collecting duct

242
Q

Function of homeobox (HOX) genes

A

Code for transcription factors that regulate gene expression of different segments of the embryo

243
Q

Types of cells increased in COPD

A

CD 8 T cells, macrophages, neutrophils

244
Q

What is deferoxamine

A

Iron chelation drug

245
Q

What is Gerstmann syndrome

A

Stroke to the angular gyrus of the dominant parietal lobe

Finger agnosia, acalcula, agrpahia, L-R disorientation

246
Q

Pressures on the right side of the heart

A
247
Q

Budesonide MOA

A

A glucocorticoid

Binds to a cytosolic receptor that then travels to the nucleus and causes a tissue specific change in transcription - includes inhibition of proinflammatory transcription factors like NF-kB

248
Q

What is seen in photoaging

A

Loss of production of collagen fibrils, caused by UVA

See more collagen cross-linking which causes wrinkles

249
Q

What drug affects prostate volume

A

Finasteride - takes 6-12 months

Alpha 1 antagonists affect relaxation

250
Q

What would cause air in the billiary tree

A

A large gall stone can herniate through a fistula into the intestine, intestinal gas then flows back into the billiary system

251
Q

Phases of wound healing

A
252
Q

Embryologic origins of the kidney

A

Metanephros - glomeruli, bpwmans space, proximal tubules, loop of henle, DCT

Ureteric bud - collecting tubules and ducts, major and minor calyxes, renal pelvis, ureters

253
Q

Effects of muscarinic receptors on cardiovascular system

A

In vessels , M3 leads to vasodilation because increased NO

In cardiac muscle, M2 leads to decrease in heart rate (chronotropy) and decreased contractility (inotropy)

254
Q

Obturator nerve function

A

Innervates thigh adductors and sensory over medial thigh

Exits through the obturator canal

255
Q

Common causes of candida vaginosus

A

Reduction in the lactobacillus population that allows fop overgrowth

Can also be immunosuppression, diabetes, high estrogen

256
Q

What causes exercise-associated collapse

A

A sudden drop in preload to the heart

During exercise, contracting muscles push blood back to the heart. But after stop, muscles relax and BV suddenly drops to the heart and there is not enough to meet cardiac demands – syncope, hypotension, collapse

257
Q

First order vs zero order kinetics

A

First order - a constant proportion of drug is metabolized

Zero - a constant amount of drug is metabolized

258
Q

Pregnancy affect on blood

A

Increased plasma volume, increased RBC (more erythropoetin), dilution causes lower hemoglobin

259
Q

Nerve most likely compressed in an aneurysm of the internal carotid in the cavernous sinus

A

CN VI - abducens

260
Q

Histo of chronic

A

Obliterative vascular wall thickening with tubular atrophy (kidney) and interstitial fibrosis

Mixed cell response - cell mediated and antibody mediated

261
Q

What is the Reid index

A

Index of the size of submucosal glands

C/(B+C+D)

262
Q

What accounts for the rubber-like properties of elastin

A

Desmosine cross links and the high content of. nonpolar residues like lysine

263
Q

How does variation in gonococcal pilli occur

A

Antigenic variation through recombination

Not plasmid - that is abx resistance

264
Q

What happens to blood volumes in the heart during inspiration

A

Suring inspiration, intrathoracic pressures drop allowing more blood to flow into the right heart

Drop in pressure also allows for more blood in the pulmonary circuit so blood volume to left heart falls

Right heart murmurs increase with inspiration

265
Q

Function of the golgi tendon organ

A

Feedback mechanism that monitors and regulates muscle force - sensitive to change in. force but not stretch

Would cause sudden relaxation if something is too heavy

266
Q

Most common site of aortic rurptures

A

Type A - sinotubular junction

Type B - close to origin of left subclavian artery

267
Q

MOA of abciximab

A

GPIIb/llla inhibitor on platelets

268
Q

Location of focal seizures that have a sensory prodrome

A

Medial temporal lobe - hipocampus, amygdala, parahippocampal gyrus

269
Q

What are the common Na channel toxins

A

Pufferfish, red tide, moray eel

270
Q

MOA of alteplase

A

Binds fibrin on clot and converts plasminogen to plasmin = clot lysis

Adverse event is hemorrhage

271
Q

What is effect modification

A

When the effect of an exposure is modified by another variable

Different strata of the popualtion will have different measures of association

272
Q

Neutropenia makes you suscpetible to what kind of organism

A

Gram negative

273
Q

Medications associated with risk for osteoporosis

A
274
Q

Best antiemetic for GI irritation

A

5HT3 receptor antagonists

GI irritation leads to release of more serotonin which activates the vomiting center

275
Q

What is field cancerization

A

An area of cells are primed to form cancers because of widespread expsure to a carcinogen

Would be like all the cells in the mouth being primed due to chewing tobacco

276
Q

Right vs Left colon cancers

A

Right - large, tend to bleed (iron deficiency, occult blood)

Left - smaller, invade the wall and decrease lumen size so cause obstruction (bowel changes, nausea)

277
Q

Symptoms of Scleroderma (sysetmic sclerosis)

A

CREST

calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangectasia

278
Q

What infusion to use for volume resuscitation

A

Isotonic crystalloid - 0.9% saline or lactated ringers

279
Q

What does the musculocutaneous nerve innervate

A

Arm flexors (biceps) and lateral forearm sensory

280
Q

Nerve control of peristalsis

A

Vagus before splenic flexture, S2-S4 after splenic flexture

281
Q

Treatment for orotic aciduria if from PYRIMIDINE synthesis

A

Can supplement with uridine

282
Q

Classical vs operant conditioning

A
283
Q

Respiratory muscle innervation

A
284
Q

What foods are common for Hep A

A

Shellfish, berries - tainted food or water

285
Q

Nitrates dosing and reasing

A

Usually dont do an evening fose, or have a epriod of no admin

Bc vessels can become desensitized - develop tolerance

286
Q

How soon does the heart stop beating in hypoxia

A

Within 60 seconds

30 minutes of ischemia = irreversible damage

287
Q

What happens to blood flow in tension pneumothorax

A

The increasingly growing pleural space can collapse the vena cava and cause a decrease in venous return = hypotension

288
Q

Conditions that promote RBC sickling

A

Low oxygen content (oxygen unloading), low pH, low blood volume

289
Q

Drugs to give for malaria from chloroquine resistant areas

A

Atovaquone and proguanil

Give primaquin if P vivax or P ovale (liver)

290
Q

Areas most susceptible to atherosclerosis

A

Lower abdominal aorta and coronary arteries - areas with bends and branch points that encourage turbulent flow

291
Q

What is the arteriovenous concentration gradient for anesthetics

A

Difference between arteries and veins concentration - dictated by absorption into tissue.

If high, there is a large concetration in the tissues, so would take longer to have any effect on the brain

292
Q

What causes permenet central DI

A

Damage to the hypothalamus

Damage to posterior pituitary causes transient DI

293
Q

What is multiple myeloma

A
294
Q

Why does bioavailability change with rectal drugs

A

Becuase less first pass metabolsim - only supply above dentate line goes to portal, below is to systemic

295
Q

Most common cause of nephritic syndrome

A

Immune complex deposition

296
Q

Who is most at risk for lactic acidosis on metformin

A

Low renal clearnace - should check creatinine before starting

297
Q

How is fetal lung development measured

A

Amniocentesis looking at phospholipids

The lecithin the sphingomyelin ratio is calculated - greater than 2 is mature

298
Q

Azathioprine metabolism to active form and inactive by what enzymes

A
299
Q
A

STEP 1 (8 decks)

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