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1
Q

What’s the difference between reticulate and elementary bodies in chlamydia?

A

Elementary bodies are extracellular infxs form

Reticulate bodies are intracellular, active metabolic form

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2
Q

Ketoacidosis: Which PFK will be down, What happens to HSL, and what happens to GLUT expression in skeletal muscle?

A

PFK-1 activity will be down ( less glycolysis)
HSL will be up to use FA for energy
GLUT-4 expression will decrease in skeletal muscle

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3
Q

Difference btwn GLUT-2 and GLUT-4

A

GLUT-2 is bidirectional, insulin independent. In liver, kidney and small intestine
GLUT-4 is insulin dependent in the skeletal muscle and adipose tissue

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4
Q

What happens w/ recurrent branch of the median n. injury?

A

Weakness of thenar muscles
Opponens policis (most likely)
Abductor pollicis brevis (APL unaffected - deep radial n.) and
Flexor pollicis brevis (FPL-anterior interosseous n.)

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5
Q

Fractional excretion of water equation

A 
FEwater= urine flow rate / GFR
GFR= Inulin estimates GFR
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6
Q

What do PAH and inulin estimate?

A

PAH-estimates RPF

Inulin -estimates GFR

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7
Q

HFR to F- cell, What is oriT and how can you tell which genes will be transferred and their frequency

A

oriT is the origin and tra is the end both will not be present after crossing conjugal bridge. The genes closest to the origin will be transferred most frequently

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8
Q

Sulfasalazine SE

A

Anorexia, reversible oligospermia, erythema multiformes, SJS, exfoliative dermatitis, Toxic epidermal necrolysis

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9
Q

G6PD aggravators

A

-quine, nitrofurantoin, sulfonamides, fava beans, and naphthalene

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10
Q

Drug induced bronchoconstriction can be caused by what commonly used class of drugs?

A

NSAIDS

COX block can shift pathway to more production of leukotrienes precipitating (aspirin sensitive asthma)

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11
Q

Buccal smear of newborn has 3 barr bodies, What is karyotype

A

All except one X become barr body so she must have 4 Xs

48 XXXX

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12
Q

Which NT is outside of NL range in schizophrenia?

A

Excess DA, block w/ antipsychotics that block D2-R

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13
Q

Decreased NE and 5HT, are characteristic of what condition?

A

Depression

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14
Q

Elevated NE is associated w/ what neuro condition?

A

Anxiety

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15
Q

Baclofen MOA

A

GABA B agonist- tx spasticity common in ALS

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16
Q

What is the most important tx for anaphylaxis?

A

IM Epi to reverse bronchial and upper airway constriction

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17
Q

Mixed respiratory alkalosis w/ metabolic acidosis after increased med use. What med?

A

Aspirin (salicylate)

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18
Q

What can cause delayed emergence phenomenon from general anesthesia?

A

Increased Vd due to ascites or CHF

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19
Q

Kid eats aunt’s pills (just had a baby) gets brown/black emesis, n, abd pn, then metabolic acidosis. Tx

A

Kid took Fe pills, tx w/ deferoxime

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20
Q

Mouse has exaggerated response to B agonists, what is deficient?

A

B-arrestin

bind to GPCR after activation and endocytose GPCR to modulate response

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21
Q

Where is a drug that has Vd of 15,000

A

Bound to fat depots and intracellular constituents

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22
Q

Best cholinergic agent for xerostomia

A

Pilocarpine -salivation, sweating, lacrimation, and contract pupil sphincter to open trabecular meshwork in Schlemm’s canal

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23
Q

What are the pharmacokinetics of aspirin?

A

Zero order - constant amount eliminated

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24
Q

RLS of catecholamine synthesis

A

Tyrosine hydroxylase - tyrosin to DOPA

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25
Q

Child ingest med and has bradycardia, hypotension, lethargy, and weak pulses. What did she ingest and how to tx?

A

B-blocker

Tx w/ glucagon, saline, or atropine

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26
Q

What pathway does insulin activate intracellularly?

A

RAS, Raf MAPK via intrinsic tyrosine kinase

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27
Q

Neurogenic bladder tx w/?

A

Bethanechol or carbachol

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28
Q

What enzyme performs final metabolism of opioids before elimination in the kidney?

A

UDP glucuronosyltransferase

Polar molecules are eliminated by the kidney (Phase II)

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29
Q

Phase II metabolism does what transformations

A

Glucuronidation, acetylation, and sulfation

Make the drug inactive and more polar

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30
Q

Therapeutic index equation

A

TI= Toxic dose/ efficacious dose

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31
Q

Eccentric contraction

A

Muscle lengthens while contracting

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32
Q

Concentric contraction

A

Muscle shortens while contracting

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33
Q

Isometric contraction

A

Muscle length is constant while contracting

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34
Q

What muscle can cause sciatica and is sometimes pierced by the sciatic n?

A

Piriformis syndrome - external rotator of the hip. Commonly running and cycling

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35
Q

Painful popliteal cyst (Baker cyst) txmnt

A

Glucocorticoid injection to decrease inflammation and pressure

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36
Q

Sjogren’s syndrome has increased risk of what?

A

Marginal zone lymphoma

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37
Q

Vitamin D deficiency(osteomalacia) findings on spinal x-ray

A

Blurry vertebral bodies

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38
Q

Sprained ankle tx

A

NSAIDS and compression wrap

X-ray if malleolar tenderness

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39
Q

How does exercise improve insulin sensitivity?

A

Increase GLUT4 expression on skeletal muscle

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40
Q

Bevacizumab MOA

A

VEGF mab
Renal cell carcinoma
Colorectal CA

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41
Q

Eculizimab

A

Complement C5 mab
PNH tx
Prevents C5 from cleaving to C5a (chemotaxis) and C5b (MAC)

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42
Q

Natalizumab

A

Alpha-4-integrin mab

blocks Alpha-4-integrin, which is required for WBC to cross blood into organs

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43
Q

Tx of GCA and mechanism

A

Corticosteroids block PLA2, which normally releases arachidonic acid from the cell membrane

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44
Q

Causes of myopathy w/ elevated CK

A

Hypothyroidism
Muscular dystrophy
Inflammatory (dermato or polymyositis)
Statin inhibitors

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45
Q

Proximal muscle weakness w/ myoedema (mound of muscle after percussion)

A

Hypothyroidism

Slow reabsorption of Ca by the SR

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46
Q

4 yo boy w/ increased growth, pubes, and increased testosterone and 17-hydroxyprogesterone.

A

21-hydroxylase deficiency
Non-salt wasting
excess 17-hydroxyprogesteron is specific to 21 hydroxylase deficiency

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47
Q

Txmnt of CAH

A

Low dose corticosteroids to suppress excess ACTH secretion

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48
Q

Thiazolidinedione MOA

A

Binds PPAR-gamma and RX to bind DNA
Increased GLUT-4 (skeletal and fat)
Increased adiponectin (increase insulin responsive fat cells and FA oxidation)
Decrease TNF alpha and leptin

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49
Q

Increased urinary orotic acid causes

A

Ornithine transcarbamylase deficiency

Heriditary orotic aciduria

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50
Q

Failure to thrive, hyperammonemic encephalopathy
Decreased BUN
Increased urinary orotic acid

A

Ornithine transcarbamylase deficiency

Excess carbamoyl phosphate goes down pyrimidine pathway and makes excess orotic acid

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51
Q

Failure to thrive, developmental delay, megaloblastic anemia, mental retardation, and excess orotic acid

A

Hereditary orotic aciduria
Defect in UMP synthass
orotic acid can’t be converted to UMP
supplement w/ uridine (converted to UMP via nucleoside kinases)

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52
Q

Fat loss from the face and trunk fat increased, what med

A

NRTI like zidovudine and stavudine

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53
Q

What is the most common cause of primary hyperaldosteronism?

A

b/l adrenal hyperplasia

u/l adrenal adenoma

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54
Q

Initial presentation of pt w/ adrenocortical tumor secreting excess aldosterone

A

Paresthesias and muscle weakness due to hypokalemic alkalosis
No significant extracellular volume expansion due to aldosterone escape

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55
Q

How do catecholamines, TNF-alpha, glucocorticoids and glucagon cause insulin resistance?

A

Activate serine kinases that phosphorylate B-subunit of IRS. This inhibits the tyrosine phosphorylase of IRS done by the intrinsic tyrosin kinase and shuts down RAS/MAPK pathway

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56
Q

ApoE, purpose and dz when defective

A 
Mediates remnant uptake
Familial dysbetalipoproteinemia (palmar xanthomas, premature atherosclerosis)
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57
Q

ApoB-100 and apoB-48, purpose and dz when defective

A

B-100 binds the LDL-R, Familial hypercholesterolemia -tendon xanthomas, premature atherosclerosis
B-48 mediates chylomicron secretion

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58
Q

ApoC2, Purpose and dz when defective

A

LPL cofactor, Familial chylomicronemia-pancreatitis, lipemia retinalis

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59
Q

ApoA1 purpose

A

Activate LCAT-helps esterify cholesterol

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60
Q

What is the major regulator of the zona glomerulosa?

A

Angiotensin II, not ACTH

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61
Q

What is the major regulator of the zona fasciculata and reticularis?

A

ACTH

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62
Q

Prolonged excess ACTH stimulation causes what change in the adrenal gland?

A

Hyperplasia of the zona fasciculata and reticularis

Zona glomerulosa is primarily regulated by angiotensin II

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63
Q

What is a ketogenic AA? Name two

A

Lysine and leucine

Generate ketone body precursor acetyl CoA

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64
Q 
What is a glucogenic AA?
Name 3 (MVH)
A

Produce pyruvate or TCA intermediates that can be used for gluconeogenesis
Methionine, valine, histidine

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65
Q

Where is GTP synthesized in the TCA cycle?

A 
Succinate thiokinase (succinyl CoA synthase)
Succinyl CoA to succinate
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66
Q

Where is FADH2 synthesized in the TCA cycle?

A

Succinate dehydrogenase

Succinate to fumarate

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67
Q

Where is NADH synthesized in the TCA cycle?

A

Isocitrate dehydrogenase (isocitrate to alpha-ketoglutarate)
Alpha ketoglutarate dehydrogenase (alpha to succinyl CoA)
Malate dehydrogenase
Malate to oxaloacetate

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68
Q

Prolonged glucocorticoid use w/ Cushing syndrome, What will the adrenals look like?

A

b/l adrenal atrophy

The adrenals have quit since exogenous steroids were doing the work

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69
Q

Statin SE

A

Myopathy

Hepatotoxicity

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70
Q

Cholestyramine and bile acid sequestrant SE

A

Increase TG, GI upset, decrease other drug absorption, and decrease Vit A,D,E,K absorption

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71
Q

Ezetimibe MOA and SE, what lipid lab is affected

A

Prevent cholesterol absorption, Only LDL down

Diarrhea, rare increase LFTs

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72
Q

Fibrate SE

A

Myopathy, increase risk of gallstones

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73
Q

Niacin SE

A

Red flushing, Hyperglycemia, hyperuricemia (gout)

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74
Q

Pt taking lipid lowering drug gets muscle pain and elevated LFTs. What drug?

A

Statin

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75
Q

Pt taking lipid lowering drug develops gout, hyperglycemia, and flushed face

A

Niacin, Pretx w/ NSAID to reduce flushing

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76
Q

Pt taking lipid lowering med develops gallstone and muscle pain

A

Fibrates

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77
Q

Pt taking lipid lowering med has increased TG, decreased absorption of Vit A,D,E,K

A

Cholestyramine

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78
Q

What effect does DM2 have on adipocytes and how does that contribute to insulin resistance?

A

Blocks antilipolytic effects of insulin, Increased lipolysis and FA ->impair insulin dependent glucose uptake and increase hepatic gluconeogenesis

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79
Q

Where does HMG-CoA exist in the cell?

A

Mitochondrial enzyme

80
Q

Where in the cell does the pentose phosphate pathway take place?

A

Cytosol

81
Q

Primary hyperaldosteronism w/ HTN, what would the values of Na, K, and HCO3 be?

A

Na would be NL, as more Na gets reabsorbed via aldosterone the increased volume causes pressure natriuresis limiting Na retention
K would be decreased due to high aldosterone
HCO3 is increased by alpha intercalated cells due to increased loss of H+ (metabolic alkalosis)

82
Q

What does aldose reductase do?

A

Converts glucose to sorbitol

83
Q

What enzyme works to metabolize fructose in fructokinase deficiency?

A

Hexokinase converts fructose to fructose-6-P

84
Q

Lysosome storage dz w/ increased cerebroside sulfate? Peripheral neuropathy and ataxia

A

Metachromatic leukodystrophy
Arylsulfatase A deficiency
Central and peripheral demyelination

85
Q

How does niacin precipitate gout?

A

Niacin decreases renal excretion of uric acid

86
Q

What is the most important cofactor in branched chain alpha ketoacid dehydrogenase?

A

Thiamine

87
Q

What cofactor is needed to go from propionyl CoA to methylmalonyl CoA?

A

B6

88
Q

What cofactor is needed to go from methylmalonyl CoA to succinyl CoA?

A

B12

89
Q

What 5 factors are needed for the enzyme complexes: Pyruvate, alpha-ketogluturate and branched chain alpha-ketoacid dehydrogenase? (Tender Loving Care For Nancy)

A 
Thiamine
Lipoate
CoA
FAD
NAD
90
Q

Newborn w/ restricted joint movement, sever mental retardation, skeletal abnormalities, abnl vacuolization and inclusions in the cytoplasm of mesenchyme cells

A

I cell dz
Defect in golgi phosphotransferase
Phosphate is not added to mannose so the enzymes are sent out of the cell rather than remaining in the cell

91
Q

What happens to specificity, sensitivity, PPV, and NPV if you raise the cutoff?

A

Fewer false positives
Increase specificity
Increase PPV

More false negatives
Decrease sensitivity
Decrease NPV

92
Q

Sensitivity relationship to PPV and NPV

A

Sens up NPV up (proportional)

Sens up PPV down (inverse)

93
Q

Borderline personality

A

Borderline -Unstable realtionships, splitting, suicidal gestures, fear abandonment

94
Q

Histrionic personality

A

Attention seeking, stuck on appearance, dramatic presentation, unstable relationships, rash decisions

95
Q

Cushing syndrome w/ mass in adrenal gland: Levels of urine 17-hydroxycorticosteroid, Urine cortisol, and serum ACTH

A

Urine 17-hydroxycorticosteroid and cortisol will be high due to overproduction of cortisol
ACTH will be low due to negative feedback

96
Q

Which diuretic acts synergistically w/ furosemide?

A

Hydrochlorothiazide

97
Q

Demeclocycline MOA and use

A

ADH

Tx DI

98
Q

Neonatal septicemi and menigitis. What bug?

A

Listeria

Granulomatosis infantisepticum

99
Q

Thenar vs hypothenar, innervation

A

Thenar - Opponens pollicis, abductor pollicis brevis and flexor pollicis brevis - Recurrent branch of radial n
Hypothenar - opponens digiti minimi, abductor digiti minimi, and flexor digiti minimi brevis-ulnar n.

100
Q

Vascular malformations of the skin (port-wine stain), leptomeninges, and cerebral cortex (seizures)

A

Sturge-Weber Syndrome

101
Q

MRI color of blood in the brain

A

White

102
Q

Blood across most of right hemisphere, sparing brainstem and cerebellum, What vessel is damaged?

A

Internal carotid artery supplying ACA, MCA, PCA

103
Q

Nonresponder to HBV vaccine gets HBV, what serum marker would you see 2 weeks later?

A

HbsAg -first serum marker

Doesn’t have HbsAb (nonresponder)

104
Q

Cholelithiasis: levels of direct and indirect bili

A

Regardless of cause, usually
Direct bili is high ( blockage)
Indirect bili is normal

105
Q

Ovoid peach colored smooth area of skin w/ few hairs tapered near proximal end

A

Alopecia areata (exclamation point hairs)- Antithyroglobulin and anti-microsomal Ab

106
Q

In specialized transduction which genes are most likely to be transferred?

A

The genes closest to the insertion site

107
Q

What are the transferrin levels in hemochromatosis?

A

Trasnferrin, serum Fe, and ferritin are all elevated

108
Q

Metronidazole SE

A 
Gi distress
convulsions
insomnia
peripheral neuropathy
thrombophlebitis
109
Q

Red man Syndrome

A

Vancomycin

110
Q

Alpha cells of pancreas secrete what?

A

Glucagon

111
Q

Beta cells of pancreas secrete what?

A

Insulin

112
Q

Delta cells of pancreas secrete what?

A

Somatostatins

113
Q

Acinar cells of pancreas secrete what?

A

Lipases and proteinases

114
Q

What technique to identify translocations, inversions, aneuploidy, and interstitial deletions?

A

FISH

115
Q

What technique for trinucleotide repeats?

A

Southwestern blot to detect methylation and number of repeats

116
Q

Cholangitis and cholangiocarcinoma in eosinophilic pt from SE Asia

A

clonorchis sinesis-undercooked fish

117
Q

Villous structures containing nucleated erythrocytes in a vaginal clot specimen

A

Aborted fetus
Chorionic villi -loosely fibrous core covered w/ trophoblastic cells. More mature villi may have nucleated erythrocytes from the fetus

118
Q

What ACheI do you give in myasthenia gravis?

A

Pyridostigmine and neostigmine-carbamoylation of AChE

119
Q

When is physostigmine used?

A

Glaucoma, AcheI

120
Q

Where does cyanide bind?

A

Complex IV Cytochome C oxidase

121
Q

Burn victim w/ edema and NL pulmonary artery and pulmonary wedge pressure: Lymph flow, microvascular permeability, interstitial oncotic pressure, and microvascular hydrostatic pressure

A

Increased microvascular permeability is main cause of edema
Lymph flow increases
Proteins flow out into interstitium increasing interstitial oncotic pressure (edema)
Microvascular hydrostatic pressure is NL ( pulmonary pressure are NL)

122
Q

Prego w/ cushings during pregnancy, ectopic receptors on adrenal glands, improves w/ OC use. What hormone receptor is ectopic on adrenal glands?

A

LH
The Hcg is high during pregnancy, which would bind LH and cause her sx.
It can not be estrogen or progesterone b/c OC would cause those hormones to bind their receptors (she would get increased sx w/ OC use)

123
Q

Gastrointestinal stromal tumors, what kind of cells and what markers?

A

GI pacemaker cells, Interstitial cells of Cajal
Express CD-34 and c-kit
actin, desmin, and s-100 are less common

124
Q

What does c-kit do and what medication inhibits it?

A

Tyrosine kinase that acts as stem cell factor. Imatinib inhibits

125
Q

What condition can Imatinib be used for and what are the markers?

A

CML- Bcr-Abl tyrosine kinase

GIST - C-kit tyrosine kinase

126
Q

What enzyme will be increased and what will be decreased in Lesch Nyhan?

A

HGPRT is deficient so purines (AG) can’t be recycled

Must increase purine production - PRPP amidotransferase is 1st commited step of de novo purine synthesis

127
Q

Eccentric eater: papilledema, dry skin, and hepatomegaly. What vitamin abnormality?

A

Vit A overuse

128
Q

Which E. coli virulence factor is responsible for bacteremia and sepsis?

A

LPS- Macrophage activation -IL-1, IL-6, TNF alpha

129
Q

What e. coli virulence factor is responsible for neonatal meningitis?

A

K1 capsular polysaccharide-prevent phagocytosis and complement mediated lysis

130
Q

What E. coli virulence factor is responsible for bloody gastroenteritis?

A

Shiga toxin

Inactivate 60S ribosome-> cell death

131
Q

What E. coli virulence factor causes watery diarrhea?

A 
Heat labile (cAMP)
Heat stable (cGMP)
132
Q

What E. coli virulence factor causes urinary tract infections?

A

P fimbriae

133
Q

How do you dx Cryptococcus Neoformans?

A

Mucicarmine stain
India ink of CSF
Agglutination of CSF
Methanamine (GMS)

134
Q

Narrow Budding yeast in the CSF

A

Cryptococcus neoformans

135
Q

Facultative, intracellular gram + rod, narrow zone of beta hemolysis, tumbling motility at 22 degrees

A

Listeria Monocytogenes

136
Q

What is the most important immune defense against listeria?

A

Cell-mediated since they are obligate intracellular

137
Q

Dizziness, dysarthria, b/l limb ataxia. lung mass and cerebellar Purkinje cell degeneration

A

Subacute cerebellar degeneration
Paraneoplastic
Immune response to tumor cells that cross react with Purkinje neuron antigens

138
Q

Anti-Yo, Anti-P/Q, Anti-Hu

A

Subacute cerebellar degeneration

139
Q

Where are very long chain fatty acids and phytanic acid oxidized?

A

Peroxisomes

140
Q

Disorders of Very long chain fatty acid oxidation commonly create neuro issues do to what?

A

Unable to form myelin in the CNS

141
Q

Primary cause of morbidity in acute rheumatic fever

A

Heart failure from severe pancarditis

142
Q

What CN exits at the lateral aspect of the mid pons ath the level of the middle cerebellar peduncle

A

CN V

Trigeminal

143
Q

Phenytoin pt has diffuse confluent erythema, palpable generalized LAD, symmetrical face swelling

A

Drug rxn w/ eosinophilia and systemic sx (DRESS)

144
Q

3 yo w/ high fevers and malaise won’t walk on his leg, where will scintigraphy have increased focal radiotracer uptake?

A

Metaphysis-slow flowing sinusoidal vasculature

Hematogenous Osteomyelitis

145
Q

Most common site of hematogenous osteomyelitis in adults

A

Vertebral body

146
Q

2 causes of MG exacerbation when being txd w/ pyridostigmine

A

1) myasthenic crisis -undertxd, Edrophonium (tensilon test) improves sx
2) Cholinergic crisis- dose of ACheI too high. Excess ACh desensitizes NMJ. Tensilon test shows no improvement

147
Q

Pramipexole MOA

A

DA agonist

148
Q

DA agonist used in PD, Ergot and non ergot

A

Ergot: bromcriptine

Non-ergot: pramipexole and ropinirole

149
Q

Selegiline MOA

A

MAOI B

150
Q

Amantadine MOA in PD

A

Enhances effects of endogenous DA, anticholinergic stops tremors

151
Q

Entcapone and tolcapone MOA

A

Block COMT from breaking down DA

152
Q

Anticholinergics used to tx PD

A

Benztropine and trihexyphenidyl

153
Q

Txmnt of Psoriasis that inhibits keratinocyte proliferation and keratinocyte differentiation

A

Topical Vit D analogs

Calcipotriene, calcitriol, tacalcitol

154
Q

Ustekinumab (stelara) MOA

A

Targets Il-12 and IL-23

Inhibits differentiation and activation of Th1 and Th17

155
Q

Regulation of ALA synthase

A

Upregulated by CYP450 inducers (smoking and alcohol)

Downregulated by heme and glucose

156
Q

Acute intermittent porphyria defect

A

PBG deaminase deficiency

Red pee

157
Q

PD-1 and PDL-1 due what to the immune system

A

When PD-1 on T cell and PDL-1 on tumor cell bind they inhibit CTL allowing the tumor cell to live

158
Q

What receptors are targeted to prevent chemotherapy induced emesis?

A

DA-metoclopramide, prochlorperazine
NK - Aprepitant, fosaprepitant
5HT - Odansetron, granisetron

159
Q

What receptors are targeted in motion sickness and hyperemesis gravidarum?

A

Antimuscarinic -Scopolamine

Histamine - diphenhydramine, meclizine, promethazine

160
Q

What takes place in the germinal centers in a LN?

A

Isotype switching
B-cell CD40
T cell CD40L

161
Q

Why do sickle cells sickle?

A

HbS allows hydrophobic interaction btwn Hgb molecules allowing it to clump

162
Q

Which part of the spleen is involved in removal of defective RBCs?

A

Red pulp reticuloendothelial cells

163
Q

What converts pro-carcinogens to active metabolites?

A

CYP450 microsomal monoxygenase

164
Q

What enzyme converts heme to biliveridin (green color in old bruise?

A

Heme oxygenase in macrophages

165
Q

Cytokines, EPO, and GH have what in common?

A

Same kind of JAK-STAT cytoplasmic kinase

166
Q

Cervical CA risk factors

A 
HPV 16 and 18
STI
Early sexual activity
Immunosuppression 
OC use
Tobacco use
167
Q

Felbamate, memantine, and ketamine MOA

A

NMDA blockers
Ketamine - anesthetic
Memantine-Alzheimer dz
Felbamate-anticonvulsant

168
Q

Donepezil MOA

A

ACheI used in Alzheimer’s

169
Q

Main SE of carbamazepine

A

Bone marrow suppression

SIADH

170
Q

Anesthetic had very high Arteriovenous gradient. What properties does it have?

A

High tissue binding, so little makes it to the veins. This will give it a slow onset of action. Negatively affects brain saturation. The potency will not be affected

171
Q

Qualities of anesthetic w/ low solubility in the blood

A

Rapid induction and rapid recovery times, as it quickly leaves the blood and goes to the brain

172
Q

Qualities of anesthetic w/ increased solubility in lipids

A

Slow induction but high potency (1/MAC)

173
Q

What is MAC in anesthetics?

A

Minimum alveolar concentration to prevent 50% from moving

174
Q

What can you say about the potency of a anesthetic w/ slow onset due to increased lipid solubility?

A

High potency (1/MAC)

175
Q

Toxic effects of neisseria menigitis are mediated by? Correlates w/ morbidity and mortality

A

Lipooligosaccharide (LOS)
Outermembrane lipooligosaccharide
The inner and outer membran proteins are involved in homeostasis

176
Q

How do type I interferons act in viral illness?

A

IFN-A and B bind to infected and neighboring cells and lead to transcription of RNAse L (endonuclease breaks down RNA) and protein kinase R (inactivates eIF2). Protein synthesis gets inhbited but only in the presence of dsRNA

177
Q

Motile gram - rods w/ green metallic sheen on eosin methylene blue agar and hemolysis on blood agar? Facultative anaerobe

A

E. Coli has green metallic sheen on EMB

178
Q

Most important virulence factor for UTI w/ E. Coli

A

Fimbriae

179
Q

Earliest manifestation of diabetic nephropathy

A

Microalbuminemia, Prevent worsening w/ ACEI

180
Q

Kid w/ facial rash and lacy, reticular body rash

A

Parvovirus B19

Erythema infectiosum

181
Q

Pt grew up in rural Guatemala, has sz, no immunocompromise and has minimally enhancing cyst

A 
Neurocysticercosis
Taenia Solium (pork tapeworm eggs) secreted in feces
182
Q

Labs of neurocysticercosis

A

Taenia solium
Increased ESR
Eosinophilia

183
Q

What does parenteral mean?

A

Not by mouth, IV or IM

184
Q

Pt returns from Mexico. High grade fever, myalgias, HA, and joint pn. Diffuse maculopapular rash, multiple purpuric lesions, HM, thrombocytopenia, leukopenia, elevated LFTs. Had less severe sx last time he went to Mexico

A

Dengue fever
1st infxn asx
2nd infxn
Ab dependent enhancement of infxn, increased T cell response

185
Q

Buzz words of dengue virus

A

Break bone fever
Rash (white island in sea of red)
+ tourniquet test (petechiae after bp cuff)

186
Q

Do fibrates inhibit LDL-R degradation or reduce hepatic VLDL production?

A

Reduce hepatic VLDL production

187
Q

2 mechanisms of fibrates via PPAR-alpha

A

1) Increase LPL to breakdown TG (chylomicrons) and VLDL (free FA)
2) Decrease hepatic VLDL production

188
Q

What do PCSK9 Inhibitors do?

A

Proprotein convertase subtilisin kexin 9 inhbitor

mab that reduces LDL-R degradation in the liver

189
Q

Niacin MOA in hyperlipidemia

A

Decrease HSL in adipocytes (decreases lipolysis)

Reduces hepatic VLDL synthesis

190
Q

Difference btwn aspergillus and pneumocystis on CXR

A

Aspergillus - dense infiltrate

Pneumocystis - Diffuse b/l interstitial infiltrates

191
Q

Daptomycin MOA

A

Create transmembrane channels in gram + bx

192
Q

In what conditions is daptomycin ineffective?

A

Gram - bx, can’t pentrate

Pneumonia -inactivated by surfactant

193
Q

Daptomycin SE

A

myopathy, elevated CPK

194
Q

Linezolid MOA and SE

A

Binds ribosome 50S subunit
Thrombocytopenia
Optic neuritis
High risk for 5HT syndrome

195
Q

Milrinone MOA

A

PDEI - Increase cAMP

Vasodilates vasculature and increased inotropy in the heart

196
Q

Where do analgesics harm the kidney compared to b-lactam abx?

A

Analgesics - Papillary necrosis

B-lactams - Acute interstitial nephritis

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