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Step 3 Flashcards

1
Q

Azithromycin MOA

A

Macrolide not aminoglycoside

binds 50s subunit of the ribosome

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2
Q

Txmnt of pseudomonas

A

Double coverage w/ 2 of 3
Anti-pseudomonal beta lactam (pipi/tazo, cefepime, ceftazadime, aztreonam)
Resp FQ (levofloxacin)
Aminoglycoside (gentamycin or tobramycin)

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3
Q

Cardiac fxn curve increases along the same line and venous return fxn curve shifts right, cause?

A

The CO has increased due to increased venous return, but the cardiac fxn has not changed. The increased cardiac output is due to Frank-Starling not increased contractility

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4
Q

Cardiac fxn curve shifts up to a new line and venous return curve shifts right, cause?

A

Exercise/sympathetic stimulation
Increased contractility-> cardiac fxn shift
Venoconstriction-> increased preload, right shift

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5
Q

Cardiac fxn curve moves up or down along the same line, what does it mean?

A

Up along the same line = arteriolar dilation (decrease preload-Increase CO)
Down along same line= arteriolar constriction (increase preload-decrease CO)

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6
Q

Cardiac fxn curve moves up to a new line

A

Increased cardiac contractility

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7
Q

Venous fxn curve moves left or right along the same line

A

Left - decreased vascular volume, venodilation. CO goes down

Right- volume up, venoconstriction. CO goes up

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8
Q

9 yo w/ sensorineural hearing loss, bowing of anterior tibias, frontal bossing, and flattened nose

A

Congenital syphilis
Deafness
Saber shins
Saddle nose

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9
Q

Hutchinson’s triad

A

Congenital syphilis
Deafness
Interstitial keratitis
Notched incisors

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10
Q

Which cells release secretin?

A

D cells

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11
Q

What hormone is increased secondary to Zollinger Ellison syndrome?

A

Gastrinoma increases gastrin acidifying the lumen. Secretin from the D cells is increased to increase the pH

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12
Q

Signs of VIPoma

A

watery diarrhea and hypokalemia

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13
Q

What do G cells secrete?

A

Gastrin

Found in antrum of stomach and duodenum

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14
Q

What do D cells secrete?

A

Somatostatin

Found in pancreatic islets and GI mucosa

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15
Q

What do I cells secrete?

A

CCK found in duodenum and jejunum

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16
Q

What do S cells secrete?

A

Secretin (duodenum)

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17
Q

What do K cells secrete?

A

Glucose-dependent insulinotropic peptide-gastric inhibitory peptide (GIP) (duodenum and jejunum)

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18
Q

Increased End diastolic volume, same end diastolic pressure, decreased diastolic pressure, increased systolic pressure, same end systolic pressure, and same contractility

A

Increased preload w/o increased LA pressure
Increased pulse pressure
Same contractility
Aortic regurg w/ dilated LV

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19
Q

What happens to the conjugated bilirubin in cholestasis?

A

Conjugated bilirubin has increased urinary excretion (tea pee)
Decreased secretion of conjugated bilirubin in the gut, so it is not metabolized by bx into urobilinogen - decreased urinary urobilinogen

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20
Q

What acid base disturbance do diuretics (furosemide) and antacid abuse have?

A

Metabolic alkalosis

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21
Q

What kind of pt has hypoxemia that can not be corrected by 100% O2?

A

Right-left shunt
No matter how oxygenated the blood gets, some of the deoxygenated blood is continually sent into the systemic circulation

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22
Q

Ziehl-Nielsen stain

A

Acid fast carbol fuchsin stain

Nocardia, TB, cryptosporidium

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23
Q

Scaly red plaque w/ ulceration and/or bleeding on the face, neck, or hands

A

Squamous cell CA

Precursor-actinic keratosis (sun damage)

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24
Q

Molluscum contagiosum Description and virus

A

Flesh colored papule w/ central depression

Pox virus

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25
Q

Verruca vulgaris, description and virus

A

Common wart-HPV

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26
Q

Dysplastic nevi may be a precursor to what CA

A

Melanoma

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27
Q

If the femoral n was injured, what would be affected?

A

Quadricep weakness

paresthesis/anesthesia of anterior medial thigh, medial shin, and arch of the foot

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28
Q

Difference btwn PCP and cocaine on PE?

A

PCP - miosis constricted pupils

Cocaine - Mydriasis dilated pupils

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29
Q

Amaurosis fugax

A

Transient monocular blindness - Carotid stenosis

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30
Q

Evans Syndrome

A

Thrombocytopenia and autoimmune hemolytic anemia

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31
Q

Lateral aspect of thigh, dorsal foot, decreased sensation in the 1st and 2nd toe web space

A

L5

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32
Q

Patellar reflex is what nerves?

A

L3, L4

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33
Q

Egg yolk agar for what organism

A

Clostridium perfringens

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34
Q

Chocolate agar for what organisms

A

N. menigitidis

w/ factors X (heme) and V (NAD) - H. influenzae

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35
Q

Cystine-tellurite agar for what organism

A

Corynebacterium diphtheriae

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36
Q

What chromosome has a mutation in Alpot dz?

A

X chromosome -Males get Alport

Females w/ one copy just get hematuria

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37
Q

Renal dz w/ mutation on chromosome 6

A

AR PCKD

Kids

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38
Q

Renal dz w/ mutation on chromosome 16

A

ADPKD adults

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39
Q

AKI w/ fever, eosinophilia, and urticarial rash. What is the likely cause, what is injured, and what type of hypersensitivity?

A

Drug induced acute interstitial necrosis - abx, NSAIDS, thiazides, PPI
Type IV sensitivity even though there are eosinophils

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40
Q

Is ristocetin cofactor assay normal or abnl in Von Willebrand dz?

A

Abnl, using ristocetin (activates Gp1b) doesn’t cause Plt agglutination, b/c the VWF is too low

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41
Q

Hydroxyurea MOA

A

Increases Fetal Hgb, which inhibits the polymerization of HgbS

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42
Q

What should be measured regularly in a pt taking hydroxyurea?

A

CBC for myelosuppression and LFT for hepatotoxicity

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43
Q

Compliance, radial traction, FEV1, and DlCO in obstructive dzs

A

Compliance is increased -damaged alveoli (floppy)
Radial traction is decreased due to alveoli damage, radial traction pulls airways open, FEV1 is decreased -less ability to push air out
DlCO - Low due to alveolar wall damage

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44
Q

Where in the lung is centriacinar emphysema?

A

Smoking emphysema upper lobes

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45
Q

Where in the lung is panacinar emphysema?

A

Alpha 1 antitrypsin deficiency

Lower lobes

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46
Q

What cause rouleaux formation?

A

Excessive IgG causes RBCs to stick together

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47
Q

What effect does a PPI have on the blood?

A

Higher Cl in the blood
Inhibits H/K ATPase so less bicarb and H is generated, less bicarb means less Cl entering the cell via bicarb/Cl antiporter, more in venous blood

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48
Q

Stage 2 pubic hair vs Stage 3

A

2-scanty long hair at base of penis

3- small amount of dark, curly, coarse hair

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49
Q

Testes size

Stage 1-5

A 
1 -1.5 cc
2 -4 cc
3 -10 cc
4 -16 cc
5 -20 cc
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50
Q 
Allotype
Idiotype
Isotype
Subisotype
of Ig
A

Allotype-part of constant region dictated by inheritance
Idiotype -antigen recognizing sections
Isotype- IgG or IgA
Subisotype - IgG4

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51
Q

Which factor is most important in mediating septic shock?

A

TNF-alpha
Activated by LPS
Leads to vasodilation and activation of cytokines

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52
Q

What NSAID should be avoided in person w/ sulfa drug injury?

A

Celecoxib

Sulfonamide side chain

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53
Q

Sulfa drugs w/o sulfa in the name:

A 
Celecoxib
Diuretics
Anticonvulsants: topiramate, zonisamide
Bosentan
Arrhythmic drugs - Dofetilide, sotalol, dronedarone
Sumatriptan
Tamsulosin
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54
Q

Tramadol MOA

A

Very weak opioid
Block reuptake of NE and 5HT
Risk of 5HT syndrome

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55
Q

Hyperammonemia w/ decreased citrulline, low BUN

A

Ornithine transcarbamylase deficiency

Ornithine and carbamoyl phosphate to citrulline

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56
Q

Protein losing gastroenteropathy in elderly w/ enlarged rugal folds

A

Menetrier dz
Hyperplasia of mucus secreting foveolar cells
Parietal cell atrophy->decreased acid

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57
Q

Keratizing or non-keratizing squamous cell carcinoma in the nasopharynx of an Asian man

A

Nasopharyngeal carcinoma associated w/ EBV

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58
Q

Pill OD: impaired cognition, slurred speech, ataxia, nystagmus, and muscle weakness

A

BZD toxicity

Tx w/ flumazenil

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59
Q

Pill OD: Diarrhea, increased urination, miosis, bronchospasm, bradycardia, Lacrimation, sweating, salivation

A

Atropine OD

Tx w/ physostigmine - Phyxes atropine OD

60
Q

Pill OD: nausea, vomiting, and abd pn

A

Acetylcystine (tylenol)

Tx w/ N-acetylcysteine

61
Q

Pill OD: hyperventilation, tinnitus

A

Asprin OD Tx w/ bicarb to alkalinze the urine and remove acid

62
Q

3 Cs of TCA OD

A

Convulsions, Coma, Cardiotoxicity

63
Q

Cinacalcet MOA

A

Calcimimetic that increase the sensitivity of the PTH CaSR to Ca

64
Q

What med should be used for pts w/ ESRD who have secondary hyperPTH?

A

Cinacalcet increases PTH’s sensitivity to Ca -> decreased PTH

65
Q

Is the most important pathogenic attribute of Pseudomonas the capsule or pigment formation?

A

Capsule protects from phagocytosis

66
Q

What do pyocyanin and pyochelin do for Pseudomonas?

A

Pyocyanin - impairs cilia, injures respiratory epithelium, and increases inflammation
Pyochelin - Siderophore that sequesters Fe to enhance growth in low Fe states

67
Q

Hour glass shaped stomach

A

Sliding hiatal hernia

68
Q

Near complete absence of smooth muscle peristalsis and LES tone

A

Systemic scleroderma

69
Q

Difficulty swallowing (motility unaffected), anemia, and atrophic glossitis

A

Plummer -Vinson

Esophageal webs

70
Q

Inherited Hemolytic anemia affecting both men and women

A

Pyruvate kinase deficiency
Autosomal recessive
RBC can’t produce enough pyruvate to undergo oxidative phosphorylation. Low ATP -> hemolysis

71
Q

Acute intermittent Porphyria: 5 Ps

A 
Peripheral neuropathy
Painful abd
Pink urine
Psych - depression, hallucination
Paralysis
72
Q

What can exacerbate AIP?

A

Drugs that induce CYP450 (barbs, smoking , drinking) and sulfonamides

73
Q

Nerves affected by C5-C6 n injury

A

Suprascapular n.
Musculocutaneous n.
Axillary n.

74
Q

Long thoracic n. affects what muscle, what on PE?

A

Serratus anterior
winging of the scapula
Weakness of the ability to protract the scapula

75
Q

Nerve roots of FPL and FPB

A

FPL: C7 C8
FPB: C8, T1

76
Q

Angiogenesis is primarily driven by which two factors?

A

VEGF and FGF

77
Q

Cleaved and noncleaved follicular cells, waxing and waning LAD

A

Follicular lymphoma t(14,18)

Bcl-2

78
Q

Classic triad of paroxysmal nocturnal hemoglobinuria

A

Hemolytic anemia (heomglobinuria)
Pancytopenia
Thrombosis at abnl sites
Can cause hemosiderosis in the kidney

79
Q

Erythematous maculopapular lesions on the chest and trunk w/ bloody diarrhea? Shigella or Salmonella

A

Salmonella - Salmon colored spots

80
Q

Phenytoin CNS SE

A

Ataxia and nystagmus

81
Q

Phenytoin long term use SE

A

Gingival hyperplasia, coarsening of facial features, hirsutism

82
Q

Phenytoin hematologic SE

A

Megaloblastic anemia-Interferes w/ folic acid

83
Q

Phenytoin SE in pregnancy

A

Fetal hydantoin syndrome (teratogen)

84
Q

Why do asians have higher incidence of gastric CA?

A

Food preservatives
Nitrosamine
Polycylic hydrocarbons found in smoked fish, red meats, and preserved food

85
Q

Classic tests for identifying PNH

A

Sucrose and Ham test

Serum is acidified to activate complement and then PNH cells are added to lyse

86
Q

Fluphenazine MOA

A

High potency typical antipsychotic

D2-R blocker like haloperidol

87
Q

Trazodone class and MOA

A

Atypical antidepressant
used mainly for insomnia
Block 5HT, Alpha 1, and H1

88
Q

Menopause: GnRH, FSH, and LH

A

All are increased due to no Estrogen being produced

89
Q

What is the name for fragmented and helmet shaped cells? Why?

A

Schistocytes due to mechanical damage including massive trauma

90
Q

Difference btwn acetazolamide and latanoprost and when to use them

A

Acetazolamide - Carbonic anhydrase that decreases aqueous humor production. Turns down faucet. Acute close angle glaucoma
Latanoprost - Opens drain. open angle glaucoma. Topical agent

91
Q

Most common cause of 1st trimester pregnancy loss

A

Chromosome abnormalities

92
Q

Most common cause of 2nd and 3rd trimester pregnancy loss

A

Chorioamnionitis-ascending infxns

93
Q

Common cause of 3rd trimester pregnancy loss

A

Abruptio placentae and Placenta previa

94
Q

Why would you see prolonged PT and mildly prolonged PTT in pancreatitis?

A

Poor fat soluble vitamin absorption

Vit K is low

95
Q

Fibrosis of the intrahepatic and extrahepatic bile ducts

A

Primary sclerosing cholangitis often associated w/ UC

96
Q

3 potential complications of MI from days 5-10

A

Free wall rupture
Papillary muscle rupture
Ventricular septal perforation

97
Q

What does papillary muscle rupture lead to following MI?

A

Acute mitral valve prolapse

98
Q

True ventricular aneurysms, when are they likely to occur after MI and what makes them true?

A

Occur several weeks later

Outpouching of damaged tissue lined by fibrosis

99
Q

Adverse effects of glucocorticoids

A 
Hypocalcemia
Fluid retention
Hypokalemia
Hyperglycemia
HTN
chronic use - osteoporosis and vascular necrosis
100
Q

1st line disease modifying antirheumatic drug. What do you bridge with?

A

Methotrexate

Bridge w/ glucocorticoids

101
Q

How to remember Glucocorticoid adverse effects?

A 
Mineralocorticoid SE, insulin resistance, and osteoporosis
HTN
Hypokalemia
Hyperglycemia
Hypocalcemia - > osteoporosis
102
Q

Effects of cocaine, prazosin, and phenoxybenzamine on NE

A

Cocaine potentiates NE
NE reuptake blocker
Prazosin is a competitive inhibitor
Phenoxybenzamine is a noncompetitive inhibitor

103
Q

7 week kid w/ pneumonia and conjunctivitis

A

Chlamydia trachomatis

Chlamydia pneumonia

104
Q

Large, round densely eosinophilic viral inclusions in epithelial cells

A

Molluscum contagiosum

Pox virus

105
Q

AA amyloid

A

Acute phase reactant amyloid (rheumatoid arthritis

106
Q

AL amyloid

A

Light chain
Multiple myeloma
B cell lymphomas

107
Q

AF amyloid

A

Familial and old fogies

Transthyretin

108
Q

A Cal amyloid

A

Calcitonin

Medullary carcinoma of the thyroid and pancreatic islet cell adenomas

109
Q

Punched out ulcers in the esophagus of a HIV pt

A

HSV

110
Q

Glassy, basophilic intranuclear eosinophilic inclusions in cells of esophageal ulcer

A

HSV

111
Q

Where does urobilinogen come from?

A

Bilirubin passing through the GI tract gets changed to urobilinogen and can be excreted through urine or feces. Low in cholestasis

112
Q

What do you look for in urine to confirm cholestasis?

A

Urinary bilirubin not urobilinogen

113
Q

How do you tx acute RA?

A

NSAIDS -Celecoxib

114
Q

DMARD drugs

A

Methotrexate and sulfasalazine

115
Q

What is one thing aspirin can do that acetaminophen can not?

A

Anti-inflammatory

Both have anti-pyretic and analgesic effects

116
Q

Meperidine MOA

A

Opioid

117
Q

Hyaline membranes within alveolar walls, alveolar septal thickening, neutrophilic infiltrate, no hemosiderin deposit

A

ARDS

diffuse alveolar damage

118
Q

Desquamative interstitial pneumonitis

A

Tobacco smoke
Hyperplasia of pneumocytes
Accumulation of histiocytes that fill alveolar cavities

119
Q

What does hemodynamic pulmonary edema mean?

A

Increased hydrostatic pressure

120
Q

Which areas of the renal tubule are impermeable to water?

A

Early DCT and cortical thick ascending loop of henle

121
Q

What is MAP?

A

Mean arterial pressure

Pressure as it leaves the heart - pressure that returns to the heart

122
Q

Wrinkling of the intimal surface of the aorta?

A

Syphilis

Obliterative endarteritis of the vasa vasorum of the aorta

123
Q

3 Cs of measles

A 
Cough
Coryza (rhinorrhea)
Conjunctivitis
Blanching erythematous macules
Photphobia
124
Q

Do glucocorticoids affect Vitamin D or PTH?

A

NO

125
Q

How do glucocorticoids cause osteoporosis?

A

Decrease intestinal Ca reabsorption and increase urinary Ca elimination

126
Q

What hormone will be increased during exercise and what factor will be increased an hour after exercise?

A

During -GH

1 hr later - VEGF. Non-endothelial cells secrete VEGF in hypoxic conditions to increase endothelial proliferation

127
Q

Mucinous cystadenoma “Jelly belly”. Where is the primary disease process?

A

Appendix or Ovary

Pseudomyxoma peritonei

128
Q

Cyclophosphamide: DNA alkylator or intercalator?

A

Guanine alkylator facilitating DNA crosslinking

129
Q

Chemo drug that inhibits purine synthesis?

A

G,A

6-mercaptopurine

130
Q

Chemo drug that inhibits pyrimidine synthesis?

A

C,T,U

5-Fluorouracil

131
Q

DNA intercalators

A

Doxorubicin

Bleomycin

132
Q

3 alkylating agents

A

Cyclophosphamide
Cisplatin
Procarbazine

133
Q

What are neurofibrillary tangles made of? (Intracellular)

A

Hyperphosphorylated Tau

134
Q

What are extracellular senile plaques?

A

A-beta amyloid

135
Q

Rod-shaped, crystal-like eosiniphilic intracellular aggregates of actin

A

Hirano bodies

Alzheimer’s dz

136
Q

Flame shaped intracytoplasmic inclusions in the neocortex and hippocampus. Consist of paired helical filaments

A

Neurofibrillary tangle made up of hyperphosphorylated Tau

137
Q

Kid w/ posterior fossa tumor filling the 4th ventricle. What PE finding?

A

Papilledema

Blocking 4th ventricle would lead to hydrocephalus, increased ICP and papilledema

138
Q

What causes preeclampsia?

A

Placental ischemia - > Maternal HTN

139
Q

Ovoid (nodular) hyaline masses in the periphery of the glomerulus

A 
Nodular glumerolosclerosis (Kimmelstiel-Wilson nodules)
DM nephropathy
140
Q

PAS +, electron dense depositis distributed along the epithelial side of the capillary basement membrane

A

Membranous glomerulonephritis

SLE, HBV, NSAIDS

141
Q

Fibrosis of the endocardium, focal myocardial necrosis and prominent inflammatory cell infiltrate

A

Loeffler endocarditis

Endomyocardial fibrosis w/ (idiopathic) hypereosinophilia

142
Q

Oka strain live attenuated vaccine

A

Prophylaxis for VZV in children

143
Q

Causes of increased pulse pressure

A

Arteriosclerosis, aortic regurgitation. Big difference btwn systolic and diastolic

144
Q

Causes of decreased pulse pressure

A

Aortic stenosis, mitral stenosis

The systolic and diastolic pressures are close

145
Q

Cause of increased diastolic pressure

A

Mitral stenosis

146
Q

Causes of decreased diastolic pressure

A

Aortic regurgitation, Patent ductus arteriosus

147
Q

Fentanyl, propofol , and midazalom are administered, what should be used to revers respiratory depression

A

Naloxone for fentanyl
and flumazenil for midazolam
Both opioids and BZD cause respiratory depression

Step (5 decks)

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