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STEP 1 > STEP 1 Week 3 > Flashcards

STEP 1 Week 3 Flashcards

1
Q

Where in the ovaries are androgens converted to estrogens

A

Granulosa cells

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2
Q

Converstion enzymes from O2 to hydrochlorous acid

A

NADPH oxidase converts O2 to O- free radical. Superoxide dismutase converts that to H2O2, which is more stable. Myeloperoxidase converts H2O2 to hydrochlorous acid

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3
Q

Most common site of nosebleeds

A

Usually in the anterior nares at the nasal spetum, where there is watershed of three vessels

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4
Q

Muscles that help you sit up

A

Rectus abdominus, external abdominal obliques, and hip flexors (iliopsoas, rectus femorus, tensor fascia lata)

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5
Q

What is a dandy-walker malformation

A

Absence of the cerebellar vermis, leads to cystic dialtion of the fourth ventricle

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6
Q

Strength of binding of class I antiarrhthymics

A

1C > 1A > 1B

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7
Q

What kind of anemia does celiac cause

A

Microcytic - caused by iron deficiency (most iron is absorbed in the duodenum)

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8
Q

Characteristics of WPW ECG

A
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9
Q

What happens to right atrial and LVED pressures in left heart failure

A

Both go up

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10
Q

Treatment for organophosphate poisoning

A

Atropine - competitive inhibitor of acetylcholine receptors

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11
Q

Breakdown of heme into billirubin

A
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12
Q

Pathophys of normal pressure hydrocephalus symptoms

A

Increased CSF leads to pressure on the decscending cortical fibers in the periventricular tracts and also pressure on the basal ganglia

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13
Q

What is congenital torticollis

A

Caused by birth trauma or malposition of the head in utero

Causes sternocleidomastoid m. injury and fibrosis - head tilted to affected side and chin pointing away

Casn also have other muskuloskeletal problems

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14
Q

Most common oncogene present in glioblastoma

A

Overexpression of epidermal growth factor receptors (EGFR)

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15
Q

Liver changes with age

A

Decreased hepatic blood flow leads to smaller liver size

Decreased P450 enzyme activity

Reduced rate of hepatic regeneration

Aminotransferases should be the same

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16
Q

Features of a glucagonoma

A

Necrolytic migratory erythema

Diabetes mellitus

GI issues

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17
Q

What is PD-1 on T cells

A

Programmed death receptor. Binds to PD-L1 on neoplastic cells and inhibits their ability to cause apoptosis

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18
Q

Vector for babesia

A

Ixodes tick - can have coinfection with Lyme

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19
Q

When does uric acid form stones

A

Only at low pH - lwoest in the distal tubules and collecting ducts

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20
Q

What is bethenacol

A

Muscarinic agonst - can help with urinary retention

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21
Q

SX of fetal parvovirus

A

Interuption of erythropoesis, so get anemia

Also see ascites and oericardial effusion

Hydrops fatal

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22
Q

What amino acid is used to increase ammonia int he urine

A

Glutamine

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23
Q

What is a developmental field defect

A

When an initial embryologic disturbance leads to multiple malformations by disturbing tissues in the region

EX: holoprosencephaly

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24
Q

MOA of OCPS on hirsutism

A

Decrease the release of LH so reduces ovarian androgen production

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25
Q

Effects of a lactase deficiency

A

When lactos cant be broken down into galactose and glucose, a large amount of medium chain fatty acids are synthesized. This causes an acidification of the stool

Hydrogen gas is also produces so breatghe hydrogen increases and there is elevated stool osmolality which causes diarrhea

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26
Q

Significance of lepromin skin test

A
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27
Q

Cause of amenorrhea in anorexia

A

Low leptin levels (low fat stores) decrease pulsative releae of GnRH, so get a drop in LH and FSH, and then a drop in producton of estradiol

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28
Q

Systemic vs local progestin OCPs

A
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29
Q

Treatment for calcium stones and MOA

A

Thiazide diuretics - inhibition of Na/Cl induces absorption of calcium

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30
Q

Risk factors for abdominal aortic aneurysm

A
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31
Q

Where is the highest concentration of B cells in the lymph nodes

A

In the germinal centers

Some in the outer cortex but there are also T cells

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32
Q

Pathophys of mallory-weiss tear

A

Occur due to a rapid increase in intraabdominal and intraluminal gastric pressure during repeated retching

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33
Q

What is a metyrapone sensitivity test

A

Looks to see if the CRH/ACTH/cortisol axis is functioning

Blocks formation of cortisol so should see an increase in ACTH and then 17-hydroxycorticosteroid

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34
Q

How to find CO using O2

A

CO = rate of O2 consumption / arteriovenous O2 difference

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35
Q

Cause of a unilateral cleft lip

A

Failure of the fusion of the maxillary prominence with and intermaxillary segment

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36
Q

TX for cyanide toxicity

A
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37
Q

What are C-Jun and C-Fos

A

Nuclear transcription factors that bind directly to DNA using leucine zipper motif

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38
Q

Abnormality on CT of someone with myasthenia gravis

A

Thymoma - a large thymus

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39
Q

Brain changes seen in wernicke kirsakov

A

Hemmorhage in the mammilary bodies and periaqueductal gray

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40
Q

What do the embyronic cardinal veins form

A

The systemic venous circulation, inlcuidng vena cava

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41
Q

How are immune complexes removed

A

Activation of the mononuclear phagocyte system

IgG binds and can use C3b to induce phagocytosis or phagocytes can directly bind IgG

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42
Q

Inhibitors of acetylcholine transmission

A
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43
Q

What screening should be done before starting antidepressent

A

History of mania - depression could indicate bipolar

All antidepressents carry a risk of inducing mania

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44
Q

Changes to LV during mitral valve stenosis

A

There are no changes until late in the disease

Can eventualy lead to a reduction in diastolic pressure and afterlod with an increase in contractility (SNS triggered)

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45
Q

TX for scabies

A

Permethrin or ivermectin

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46
Q

Where is a lesion that can cause “pie in the sky”

A

Temporal lobe

Would block lower tracts of meyers loop (upper visual field)

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47
Q

What is metalozone

A

Thiazide diuretic

Can be combined with a loop to stop the reabsorption of Na that accumulates in DCT

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48
Q

Pathyphys of ankylosing spondylithis

A

Increased IL-17 activity in the gut that activates inflammatory markers like TNF-alpha and prostoglandins that lead to bony erosions

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49
Q

What causes skalded skin syndrome

A
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50
Q

Phases of ARDS

A
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51
Q
A
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52
Q

What is chronic mesenteric ischemia

A

Occurs when there is atherosclerosis in the mesenteric arteries

When more blood is needed for digestion, it cannot flow well. Causes post-prandial epigastric pain

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53
Q

What are the S3 and S4 sounds

A

S3 - right after S2, passive filling

S4 - before S1, atrial contraction with stiff ventricle

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54
Q

When are heart gallops heard best

A

With bell of stethoscope at apex of heart, end expiration

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55
Q

Where are B1 receptors

A

Cardiac smooth muscle AND renal juxtaglomerular cells

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56
Q

Causes of epispadias vs hypospadias

A

Epispadias - faulty positioning of the genital tubercle

Hypospadias - Non-fusion of the urethral folds

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57
Q

Signs of hypocalcemia

A

Neuromuscular excitabilty - twitching of face when tapped and carpal tunnel spasms

QTC prolongation, seizures

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58
Q

How does hyperphosphatmia lead to hypocalcemia

A

It can bind free calcium and precipitate in soft tissues

Phosphate also activates FGF 23 which inhibits formation of 1,25 hydroxylase leading to less absorption of calcium from the intestine

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59
Q

What is a risk factor for testicular torsion

A

Inadequate fixation of the lower pole of tesits to the tunica vaginalis - allows for increased mobility of the testis

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60
Q

When do red dead neurons appear

A

12-24 hours after ischemia

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61
Q

Most common causes of pneumonia after an influezna infection

A

Strep pneumo, Staph aureus, and H. flu

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62
Q

T3 and hypothyroidism

A

Because T3 is made peripherally and fluctuates widely - it is often normal in hypothyroidism

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63
Q

What is neurocysticercosis

A

Ingestion of pork tapework eggs in stool contaminated food water, leads to invasion of brain

See large cyst/scloex in brain

Endemic to central/south america

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64
Q

What nerves pass through the esophageal hiatus

A

Trunks of the vagus nerve

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65
Q

Contents of the cubital fossa

A

Brachial artery and median nerve

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66
Q

What nerve can cause blindness during recurrent VZV outbreak

A

Trigeminal - V1 innervates corneal reflux

Good predictor is if side of nose becomes infected - nasociliary branch affects both eye and nose

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67
Q

How to calculate filtration fraction

A

FF = GFR/RPF

RPF = RBF x (1-HCT)

Not all blood through kidney is filtered, so have to find perfusion from blood flow

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68
Q

Characteristics of stages of sleep

A

Stage 1 - theta waves

Stage 2 - sleep spindles and K complexes

Stage 3 - delta waves, slow waves

REM - eye movement, vivid dreaming, muscle paralysis

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69
Q

Manifestations of entamoeba histolytica

A

Colitis (flask shaped ulcers, iarrhea, bloody stool)

Liver abscess (single, right lobe)

Brain, lung, pleural abscess

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70
Q
A

REED STERNBERG
HODGKINS LYMPHOMA

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71
Q

MOA of ketamine

A

NMDA antagonist, also a sympathetic mimetic - bronchodilation and increased heart rate and cerebral blood flow (releases chatecolamines)

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72
Q

What type of bone loss is seen with aging

A

First: loss of trabelcular lone with loss of bridging

Second:Loss of cortical bone

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73
Q

Cause of wet macular degeneration

A

Extracellular accumulation of drusen depositis causes hypoxia and neovascularization due to VEGF - get leaky vessels.

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74
Q

What does niacin help form

A

NAD and NADP

Important for TCA cycle

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75
Q

What causes ataxia telangectasia

A

Mutation in ATM gene that helps to fix DNA strand breaks after X-ray/UV damage

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76
Q

Who are at increased risk for drug-induces lupus

A

Slow acetylaters

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77
Q

At what concentration does glucose start to spill into the urine

A

200 mg/dL

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78
Q

Pathophys of rheumatoid arthritis

A

Synovial hyperplasia and inflammatory inflitrates lead to a local increase in metabolic demand, causing local hypoxia. This leads to the formation of new blood vessels

The joint space is replaced by a rheumatoid panus(synovial cells, inflammatory cells, granulation tissue) that can destroy the articular cartilage and subchondral bone

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79
Q

What cytokine helps to regulate remodeling of the cartilage scar post MI

A

TGF-beta

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80
Q

What do the first an second pharyngeal arches form

A

First - maxilla, zygoma, mandible, incus, malleus

Second - styloid process, stapes, lesser horn of hyoid

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81
Q

Most likely sites of osteomyelitis in adults vs children

A

Adults - vertebral bodies

Children - metaphysis of long bones (highly vascular)

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82
Q

What muscle attaches to the greater trochanter

A

Gluteus medius - hip abduction

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83
Q

What is pulsus paridoxus

A

An exagerated drop in systolic BP during inspiraition

Caused by pericarditis - right heart usually can shift out but cant so shifts left, lowering SV

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84
Q

Effect of estrogen on thyroif function

A

Estrogen increases TBG, which transiently reduces free T4. Triggers release of TSH which increases T4, leading to an increases in total T4

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85
Q

What is mesna

A

Used to protect chemotherapy patients from cystitis

Toxic mustard derivate chemotherapy agenst are broken down into acrolein which is toxic to the bladder. Mesna binds to and inactivates toxic compounds in the urine

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86
Q

Pathogenesis of cholesterol gall stones

A
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87
Q

Phases of acute tubular necrosis

A
  1. Initiation - original toxic insult, lasts 24-36 hours
  2. Maintenance - fall in urine output, tubular necrosis, 1-2 weeks
  3. Recovery - Re-epithelization of tubules
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88
Q

Effects of coronary autoregulation

A

WHen an artery is occluded, the initial drop in blood flow will cause vasodilation and a decrease in pressure to maintain blood flow

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89
Q

Osteoarthritis vs rheumatoid arthritis

A
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90
Q

Drugs that treat bipolar d and epilepsy

A

Valproate, lamotrigine, carbamazepine

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91
Q

Part of the GI that is always affecte dby Hirshprung

A

The rectum - neural crest cells travel caudally

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92
Q

What is leuprolide

A

A GnRH analog use to continuously activate pituitary until LH and FSH are desensitized

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93
Q

Function of brown fat

A

Prevents hyothermia - large number of mitochondria

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94
Q

Most common cause of COPD exacerbations

A

Upper respiratory infections

Rhonovirus, H. flu, strep pneumo, moraxella cattarhalis

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95
Q

How does prostate cancer reach the spine

A

Prostatic venous plexus

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96
Q

What kidney stones are most common in Crohns

A

Oxalate

In crohns, there is impaired fat absorption in the illeum, so calcium binds to the fat. Calcium usually binds to oxalate and they are excreted

Free oxalate is reabsorbed and extreted in the urine and can form stones

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97
Q

Cancers associated with MEN1

A

Pancreatic, pituitary, parathyroid

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98
Q

What. disease is associated with anti-mitochondrial antibodies

A

Primary billiary cholangitis

Also would have elevated alk phos

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99
Q

MOA of rivaroxaban

A

Direct fatcor Xa inhibior - stops conversion of prothrombin to thrombin

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100
Q

What is akithisia

A

Subjective restlestness and inability to sit still

Extrapyramidal symptom

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101
Q

What is chostocondritis

A

MSK problem involving the chest wall- repetitive motions irritate the intercostals and chostocondral junctions

Pain is reproduced with palpation and movement

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102
Q

What landmark can be used to identify the appendix

A

Tinea coli - converge at the base of the appendix

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103
Q

What cell damage is caused by ionizing radiation used in chemotherapy

A

Double strand DNA breaks

104
Q

How can thiazides cause hypokalemia

A

A. loss of Na leads to activation of renin-angiotensin system

Aldosterone leads to a loss of potassium in the urine

105
Q

What is increased in keloids

A

TGF - beta

106
Q

What landmark is used surgically to differentiate between direct and idirect hernia

A

Inferior epigastric vessles

Direct - originates medially

Indirect - originates laterally

107
Q

What is Hartnup disease

A

AR metabolic order that causes inactivation of the neutral amino acid transporter

Tryptophan cant be absorbed and converted to niacin so get a pellagra-like reaction. Test is neutral amino acids in the urine. TX: high protein diet and niacin

108
Q

What can be damaged by fracture of 12th rib

A

Kidney

109
Q

Where is NADPH used metabolically

A

Reductive biosynthesis - formation of fatty acids, cholsterol, steroids

P450 metabolism

Formed by G6PD in the PPP

110
Q

What is human placenta lactogen

A

A hormone produced by the syncitiotrophoblast that causes insulin resistance – allow more glucose for baby. Also triggers ketone and fatty acid metabolism (lipolysis) in the mother so glucose goes to baby

hCl also increaes production of insulin so diabetes doesnt occur

111
Q

How does anti-Rh Ig work

A

It is Anti-D IgG

Given to mother, will bind any Rh+ RBCs that cross into the mother and sequester them in the spleen so no immune reaction occurs

112
Q

Cause of spastic bladder

A

Loss of descending inhibitory control from upper motor neurons

113
Q

Major risk factors for CAD

A
114
Q

How do ANP and BNP work

A

Bind to ANP receptors that are bound to guanylyl cyclase that triggeres an increase in cGMP. This leads to vasodilation

115
Q

What two things does tetanus block the release of

A

GABA and GLYCINE

116
Q

What is enthesitis

A

Pain at sites of mechanical stress and insertion of tendons

Can be associated with ankylosing spondylitis

117
Q

Actions of NF-kB

A

Activation of TLRs on surface lead to the degradation of IkB, which regulates NFkB

NFkB then goes to the nucleus and triggeres production of inflammatory signals

118
Q

Maternal tests that indicate trisomy 21

A
119
Q

Alpha 1 antitrypsin deficiency in liver

A

Misfolded A1a proteins can accumulate in the liver and can lead to hepatomegaly and cirrhosis

120
Q

Drugs that can cause SIADH

A

Carbamazapine

SSRIs, TCAs, cyclophosphamide, chlorpropamide, ecstasy,

121
Q

What seperates the lungs from the abdominal organs

A

The pleural peroteneal folds

If they dont close, can cause diaphragmatic herniation and no lung development

122
Q

Function of RNA polymerase I

A

Helps to syntehsize rRNA so only in the nucleolus

123
Q

What causes skin dimpling in breast cancer

A

Spread to the suspensory ligaments (cooper ligaments)

124
Q

pH change that occurs in hypovolemic shock

A

A drop in blood volume leads to less perfuysion of muscles which causes lactic acidosis as muscles stop oxidative phosphorylation

Causes metabolic acidosis with hyperventilation

125
Q

Function of DNA polymerase

A

A bacterial enzyme that removes RNA primers and inserts DNA

126
Q

What kind of reaction is henoch schonlein purpura

A

Type III hypersensitivity mediated by IgA

127
Q

What cancers are associated with EBV

A

Nasopharyngeal carcinoma

Burkitt lymphoma

Hodgkins lymphoma

128
Q

What does a lesion in the left cerebellum cause

A

Left Dysdiadochokinesia (problem with rapid alternating movements), distance imperception (overshooting), intention tremor

129
Q

What causes an S3 sound

A

Volume overload - forceful passive filling during diastole that exceeds the relaxation capacity of the ventricle

130
Q

What does the murmur sound like in an atrial septal defect

A

Wide and fixed splitting of S2 that doesnt change with breathing

131
Q

What to give for patients with absecne and tonic-clonic seizures

A

Valproate

132
Q

Function of HER2

A

Increases proliferation and resistance to apoptosis

It spans the cell membrane and has a tyrosine kinase activity in the intercellular domain

133
Q

Antibodies against ___ are the main source of protection against reinfection from the same influenza strain

A

Hemaglutinin

134
Q

What are the walls of a Meckels diverticulum composed of

A

It is a true diverticulum so the same as the intestine - mucose, submucosa, and muscularis layer

135
Q

Impact of testosterone on blood

A

Stimualtes red blood cell proliferation, so increases hematocrit

136
Q

What would the lungs look like in ACUTE MI

A

Transudate and pulmonary edema - engorged capillaries and alveoli filled with pink material

137
Q

Two types of galactose metabolism disorders

A

Galactokinase deficiency - usually just cataracts from conversion to galacticol

GALT deficiency - more serious, liver and kidney disfunction. Early failure to thrive from builduo of galactose-1-phosphate

138
Q

What is fenoldopam

A

A periferal dopamine receptor agonist

Increases cAMP so leads to vasodilation - increased renal profusion and natriuresis

Good for hypertensive emergencies

139
Q

Most commonly injured bone in fall on outstretched hand and complication

A

Scaphoid

Avascular necrosis

140
Q

Complication from break of the anatomical neck of the humerus

A

Avascular necrosis of the head

141
Q

Signs of congenital hypothyroidism

A

Lethargy, bulginf fontanelle, puffy face (accumulation of matrix substances), protruding tongue, umbilical hernia, risk of nonreversible intellectual disability

142
Q

Most important cause of aortic disection

A

Hypertension

143
Q

What vitamin is necessary for conversion of homocysteine to cysteine

A

B6

144
Q

Effect of dopamine

A

Low dose: actiovates D1, vasodilation

Medium dose: activates B1, increased HR and CO

High dose: actovates a1, vasoconstriction

145
Q

Glucorticoids impact on liver and bone

A

Liver: increase liver enzymes to favor gluconeogenesis and increasing glycogen reserves

Bone: decrease bone mass by decreasing calcium absorption from intenstine, and inhbiting osteoblast function

146
Q

MOA of hydroxyurea

A

Inhibits ribonucleoside reductase so slows DNA/RNA synthesis

Favors production of HgF

147
Q

TX for trigeminal neuralgia

A

Carbamazepine

Inhibits sodium channels so slows high frequency firing

148
Q

How to make a patent foramen ovale open

A

Look at the release phase of the valsalva maneuver - a decrease in SVR will lead to higher pressure in the Right side

149
Q

What is characteristic of islet cells in T2DM

A

Amyloid deposition

150
Q

Phases of lobar pneumonia

A
  1. Congestion - increase in permeability as. eutrophils secrete chemokines, see abundant proteinaceuous fluid
  2. Red hepatic - appears red with fibrin, erythrocytes, neutrophils
  3. Grey hepatic - macrophages invade
  4. Resolution - macrophaes liquefy fibrous necrosis
151
Q

What does CNS reponse to injury look like

A

Gliosis - astrocytes proliferate and form a glial scar

152
Q

What forms from the third pharygeal pouch

A

Thymus and inferior parathyroid gland

153
Q

Cause of epidiodymitis

A

Young men - chlamydia or gonorrhea

Older men - bladder outlet syndrome

154
Q

How does actin chain change to cause contraction in skeletal muscle

A

In the relaxed state, tropomyosin covers the binding sites of actin

Calcium influx leads to calcium binding to troponin C which shifts tropomyosin and leads to exposure of myosin binding sites

155
Q

What stops glycolysis during anaerobic respiration in patients with lactate dehydrogenase deficiency

A

There is not enough NAD+ regenerated

156
Q

Effect of insulin

A

Leads to decrease in hepatic glucose proudction and uptake of glucose from insulin-responsive tissues

AND inhibits the release of glucagon

157
Q

Most common nerve injured in axillary lymph node removal

A

Interchostobrachial nerve - causes decreased sensation over upper arm

158
Q

What type of leukemia shows auer rods (needle shape crystals)

A

Acute myeloid leukemia

159
Q

SX of cocaine withdrawal

A

Hyperphagia, vivid dreams, lethargy, fatigue, hypersomnia, depression

160
Q

How to calculate if effusion is exudate

A

pleural protein/serum protein > 0.5

Pleural LDH/Serum LDH > 0.6

Pleural LDH > upper 2/3 limit of normal LDH

161
Q

In a healthy person with kidney stones, what are the calcium levels

A

Normocalcemia, hypercalciuria

162
Q

What does ubiquitination do to transcription factors

A

Leads to their degradation by proteasomes - so get less DNA expression

163
Q

What causes an isolated supine hypotension in pregnancy

A

The baby compresses the SVC!

Reduced venous return and Cardiac output

164
Q

How are MABs metabolized

A

They are not metabolised in the liver or kidney - usually just broken down in macrophages

165
Q

Naloxone half life

A

Short - 6 hours

redosing may be necessary

166
Q

Most susceptible areas to ischemic colitis

A

Splenic flexure and rectosigmoid junction - watershed zones

167
Q

At what age should fetal corticosteroids be given

A

Any premature birth before 32 weeks

168
Q

Why does glycolysis in erythrocytes yield no ATP

A

The step that yields ATP is swapped for the production of 2,3 BPG

169
Q

Features of amniotic fluid embolism

A
170
Q

Locus heterogeneity vs allelic heterogeneity

A

Locus heterogeneity is when two different mutations on two different loci result in a similar mutation

Allelic heterogeneity is when two mutations at the same loci result in a similar mutation

171
Q

Effect of erythromycin on GI

A

It is a motilin receptor agonsit so causes gastric motility

172
Q

Metoclopramide MOA

A

It is a GI prokinetic that is a D2 receptor antagonist

Can cause extrapyramidal sx

173
Q

Why is the S2 split in an ASD

A

Usually, S2 is only split during inspiration when venous return is greatest

In ASD, right sided pressure is continuously. higher, leading to a constant forceful ejection into the pulmonary vessels (systolic murmur) and splitting of S2 from higher poressure and volume

174
Q

What is Fanconi syndrome

A

A defect in absorption of basically everything in the proximal tubule - leads to hypercalciuria and glucosuria - UTIs and stones

175
Q

Impact of fibrates on cholesterol

A

Lead to increased lipoprotein lipase so increae in oxidized fatty acids. Block the conversion of cholesterol into bile salts so increased risk of cholesterol stones

176
Q

What determines L or R heart dominance

A

Whether the Posterior descending artery comes off the right coronary or left circumflex

AV node artery comes off dominant artery

177
Q

Origin of innervation for pelvic floor muscles and urinary retention muscles

A

S2-S4

178
Q

Function of neprolysin

A

Cleaves ANP and BNP - inhibiting would lead to increase in urine and antagonizing RAAS

Also inactivates Angiotension II so if you inhibit it you would want to give an ARB to block angiotension II

179
Q

Why is the RV less damaged during ischemia

A

It has a lower oxygen demand (lower mass and afterload) and relatively low systolic rpessure means it recieved coronary blood flow in diastole and sistole

180
Q

Where can ketones not be utilized

A

In erythrocytes (no mitochondria) and the liver (cant form acetoacetyl coA)

181
Q

What causes a murmur in athletes

A

Athletes may have an increase in Stroke volume due to eccentric heart expansion. Leads to a pulmonic murmur

182
Q

What is a cerebral arteriovenous malformation

A

Occurs when blood flows directly from arteries to veins, without flowing through any capillaries

Causes tangles of large vessels at risk for rupture

183
Q

What causes ataxia in Friedrichs ataxia

A

Expansion of GAA repeat in frataxin gene causes decreased mitochondrial fxn and increased oxidative stress that causes degeneration of the spinocerebllar tracts and dorsal columns

184
Q

How do beta blockers lower BP

A
  1. Reduce myocardial contractility and HR
  2. Decrease renin release in JG cells
185
Q

How does actinomyces appear on biopsy

A

FIllamentous branching and can see sulfur granules

On staining, granules appear purple or red

186
Q

What is epidermolysis bullosa

A

Genetic mutations in epidermal adhesion complexes, most commonly in keratin fillaments

187
Q

MOA of capsaisin

A

Used for neuropathic pain

Causes an influx of calcium that leads to disfunction of nocireceptors

Decreases substance P, a pain related neurotransmitter

188
Q

What cytokine activates eosinophils

A

IL-5

189
Q

Pathophys of pericarditis after MI

A

Peri-infarction pericarditis occurs 2-4 after MI due to inflammation of the pericardium around the area of necrosis of the myocardium

190
Q

What happens to SBP, DBP, and PP during exercise

A

SBP increases, DBP is unchanged, PP increases

SVR goes down but there is a shunting of blood to arterioles so DBP is unchanged. SV goes up so SBP and PP increase

191
Q

Characteristics of tissue in PBC

A

Dense lymphocytic infiltration of portal tracs and granulomatous destruction of interlobular bile ducts

AST and ALT should be normal becuase hepatocytes arent targeted

192
Q

Most common cardiac neoplasm and location

A

Myxoma in left atrium

Looks like cattered cells with mucopolysaccharide stroma and hemorrhage (high VEGF)

193
Q

Common association with oropharyngeal cancer

A

HPV 16 and 18 - esepcially at base of tongue and tonsil

194
Q

Associations with tuberous sclerosis

A

Renal angiomyolipoma, subependymal hamartomas in brain, ash-leaf patches, facial angiofibromas

195
Q

Pathophys of hypertrophic cardiopmyopathy

A

Cardiomyocyte hypertrophy with disordered arrangement - due to defective structural sarcomere proteins - myosin chains and binding proteins

196
Q

Main branches of the external illiac artery

A

Inferior epigastric artery

circumflex illiac artery

197
Q

What reactions does riboflavin participate in

A

Important for the electron transport chain, especially succinate dehydrogenase which also is in the TCA cycle

Important source of FAD

198
Q

Muscles that attach to the greater trochanter and used inhip abduction and internal rotation

A

Gluteus medius and gluteus minimus

199
Q

Three ways that trisomy 21 can occur

A
  1. Parental nondisjunction in meiosis
  2. Unbalanced translocation
  3. Mosaicism- nondisjunction during mitosis so two distinct cell lines
200
Q

Where are long chain fatty acids and branch chain fatty acids metabolized

A

Peroxisomes

Zellweger syndrome - AR defect of peroxisomes

201
Q

Main virulence factor of Staph a. that causes tissue necrosis

A

PVL - panton-valentince leukocidin

202
Q

What is a Gleason score

A

How grade of prostate cancer is determined

1-similar to prostate, 5-poorly differentiated (sheets of abnormal cells with no glands)

Score is found by adding together two most common grades

203
Q

Bleomycin MOA and adverse effects

A

Induces free radical formation that causes DNA strand breaks

Causes pulmonary fibrosis

204
Q

What directions do the clavicle pieces go in a fracture

A

Distal - down due to deltoid

Proximal - Up due to trapezius and sternocleidomastoid

205
Q

What viruses are associated with CNS lymphoma

A

HIV and EBV

206
Q

Side effects of erythropoeisis stimulating agents

A

Thromboembolic events and htn (may stimulate vascular smooth muscle)

207
Q

P450 inducers

A

Barb’s funny mom refuses greasy carb shakes

Phenobarbital, phenytoin, modafinil, rifampin, greseofulvin, carbamazapine, st johns wart

208
Q

P450 inhibitors

A

Inhibitors stop cyber-kids from eating grapefruit

Isoniazid, sulfonamides, cimetidine, ketoconazole, eryhtromycin, grapefruit juice

209
Q

What is a permissive effect of two drugs

A

When one drug has no effect on a certain process on its own but when combine with another will amplify. the effect of the second drug

210
Q

Effect of preeclampsia on kidneys

A

Third spacing and vasoconstriction leads to less urine output - lower volume and higher specific gravity

Damage to the glomerulus will lead to proteinuria but no RBC

211
Q

Cause of hypogonadism in hemochromatosis

A

Iron deposits in the pituitary and leads to a drop in gonadotropins

212
Q

Function of the rectus femoris

A

Hip flexion and knee extension

213
Q

What would cause a systolic murmur during an MI

A

Ischemia of the papillary muscle causing mitral regurgitation

214
Q

Most common mutation in CF

A

F508 mutation in the CFR gene that causes a 3 base pair deletion that alters the protein structure

This impairs post-translational processing which causes the protein to be targeted for degradation by proteasomes so it never reaches the cell surface

215
Q

Path of the jaw jerk reflex

A

afferent: CN V3 from masseter (mandibular division)
nuclei: trigeminal mesencephalic and trigeminal motor
efferent: Also V3

216
Q

Describe HIV docking to cell

A

gp 120 first binds the CD4 receptor and then CCR5 chemokine receptor as a coreceptor. Binding of both receptors leads to a confirmation change that allows gp41 to fuse with the membrane and allow for fusion

217
Q

What are the factor Xa inhibitors

A

Apixaban and rivaroxaban

both have Xa in them

218
Q

What is andexanat alfa

A

It is a factor Xa decoy that will serve to inibit Xa inhibitors if bleeding occurs

219
Q

What kind of Ig are anti-A, B and O

A

Anti - A and B = IgM

Anti-O = IgG and IgM so can cross placenta

220
Q

Three causes of neonatal hyperbilirubinemia

A
  1. Increases production - more breakdown of RBC
  2. Less conjugation - UDP glucuronosyltransferase is immature
  3. Higher enterohepatic circulation - less bacteria in gut to convert to urobillinogen so it is coinverted back to billirubin by enteric B-glucuronidase and reabsorbed
221
Q

What does HIV look like in the brain

A

Infection of microglial cells causes microglial nodules and multinucleated giant cells

222
Q

What mutation is seen in Acute promyeloid leukemia

A

a 15;17 translocation involving the PML gene and retinoic acid gene on 17 (inhibits myeloid cells)

223
Q

Sx of fibromyalgia

A

Widespread MSK pain with fatigue and neuropsychiatric distubrances

224
Q

What is reverse T3

A

An inactive form of T3 that is generated from T4

Drop in T4 would cause a drop in rT3

225
Q

Puncture of the femoral artery above the inguinal ligament would lead to accumulation of blood in

A

the retroperotoneal space

226
Q

Blood supply of the ureter

A

Proximal - renal artery

Distal - superior vesical artery

227
Q

Function of T tubules in muscle

A

Allow for rapid propogation of impulse evenly throughout the muscle so you get a coordinated contraction

228
Q

RA impact on the spine

A

RA can affect the cervical spine and cause subluxation (misalignment) that could lead to acute spinal injury

229
Q

Best drugs for chemotherapy induced emesis

A

Dopamine antagonists, serotonin antagonists, NK1 receptor anatgonists

230
Q

What is TDP-43

A

Transactive response DNA binding protein 43

Abnormal ubiquitination is seen in frontotemporal dementia and ALS

231
Q

Histology of syphillis

A

Proliferative endarteritis (around arteries) with plasma cell-rhc infiltrate

232
Q

What test is used to monitor warfarin

A

PT - impacts factor VII most

233
Q

What allows many different proteins to be formed from a single mRNA

A

Alternative splicing

234
Q

What causes ARDS

A

Can come from sepsis, pancreatitis, trauma

Increased cytokines leads to capillary permeability and edema - neutrophil accumulation and hyaline membranes

235
Q

Isoniazid impact on the liver

A

DIRECTLY hepatotoxic - can cause hepatitis with jaundice, nausea, anorexia

236
Q

What would differentiate CML from leukomoid reaction

A

Alk phos is decreased in CML but normal/high in a leukomoid reaction

237
Q

How is the insulin transporter inhibited

A

Serine phosphorylation, glucagon, and Epi

238
Q

Where is procollagen hydroxylated

A

In the RER

239
Q

What cellular signal allows neutrophils to squeeze through epithilium into a site of inflammation

A

Platelet endothelial cell adhesion molecule (PECAM-1)

240
Q

MOA of diphenoxylate

A

Opioid anti-diarrheal

Binds to Mu receptors to slow motility

241
Q

How can heat stroke cause DIC

A

Rapid shunting of blood to the skin can cause hypoperfusion of organs leading to ischemia and necrosis. Tissue factor is released that causes coagulation

242
Q

Adrenergic effects of epinephrine

A

Agonist

Low dose: B1=B2>a1

High dose: B1=a1>B2

243
Q

Description of a VSD murmur

A

Harsh holosystolic murmur in the left lower border of sternum

244
Q

Pathophys of euthyroid sick syndrome

A

Low circulating T3 that occurs in the context of severe disease

Happens because high levels of cortisol, ffa, and inflammatory cytokines suppress the deiodination of T4

245
Q

What part of the prostate does finasteride target

A

Epithelial tissue - those with stromal type (smooth muscle or collagen predominance) dont respond as well

246
Q

What is the blood supply to the ovary and where is it located

A

Ovarian artery, branches off the abdominal aorta

Located in the suspensory ligament, attaches laterally

247
Q

Impact of acetaminophen toxicity in chronic vs acute alcohol ingestion

A

Acute: Alcohol can be a competitive inhibitor becuase it is also somewhat broken down by P450 – good

Chronic: P450 is upregulated so there is more conversion to NAPQI – bad

248
Q

What is carcinoid heart disease

A

When a carcinoid tumor spread past the liver, serotonin can enter the heart

Causes fibrinous thickening of the endometrium, especially of the right heart with thickening of the tricuspid and pulmonic valves

Serotonin is broken down by MOA in the lung so left not affected

249
Q

Clozapine side effects

A

Second gen antipsychotic for tx resistent schizophrenia

Neutropenia with life threatening agrunolocytosis

250
Q

Gastritis caused by H. Pylori vs autoimmune

A
251
Q

Most likely predisposing factor for pyelonephritis

A

Vesicoureteral urine reflux

Although colonization of the urethra can cause a lower UTI, pyelonephritis usually doesnt occur unless the vesicouteral junction has been weakened (functional abnormality, recurrent UTIs)

252
Q

Steps in digestive phases

A

Cephalic phase (cholinergic and vasal)

Gastric phase (gastrin)

Intestinal phase (proteins entering intestine)

253
Q

Phentolamine MOA

A

A1 adrenergic antagonist

Can be given to counteract epinephrine that causes venous blanching and necrosis (too much constriction)

254
Q

SX of lateral medullary syndrome

A

Caused by occlussion of PICA

Vertigo and nystagmus (vestibular nucleus)

Ataxia (inferior cerebellar peduncle)

Loss of pain in temp in ipsalateral face and contralateral body

Bulbar weakness (dysphagia, dysarthria)

Horners syndrome

255
Q

What is deficienct in alkaptonuria

A

Homogentisic acid dioxygenase

256
Q

Comparison of muscle twitches between non-depolarizing and depolarizing muscle blockers

A

Non-d = gradual decrease (competitive inhibition, eventually more are occupied)

D =. first all are lower (mobilized Ach), then phase II is same as non-d

257
Q
A

STEP 1 (8 decks)

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