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1
Q

Most reliable ausculatory finding indicating mitral stenosis severity

A

A2-OS interval. As the pressure increases it becomes more difficult to push blood out of the LA, so the OS occurs sooner to provide more time to generate the pressure.

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2
Q

Chemoprophylaxis for meningococcal disease, Mechanism

A

1) Rifampin -penetrates well into all tissues. Inhibits DNA dependent RNA polymerase
2) Ciprofloxacin -risk of CT pathology
3) IM ceftriaxone -pnful route
4) sulfamethoxazole- Resistance

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3
Q

Bounding femoral and carotid pulses w/ head bobbing

Early blowing, diastolic decrescendo murmur best at left 3 or 4 ICS

A

Aortic Regurgitation
Wide pulse pressure (water-hammer)
Stroke volume increases due to increased preload, when the LV relaxes during diastole blood flows backwards and out of the arteries (collapsing arteries)

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4
Q

Lithium interaction with a hypertensive med leading to nonspecific T wave abnormalities

A

Hydrochlorothiazide

Volume depletion leads to increased reabsorption of Lithium in the PCT.

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5
Q

Chronic Lithium toxicity DDI

A

(volume depletion) Thiazides, ACEI, and NSAIDS

confusion, ataxia, neuromuscular excitability

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6
Q

Hyperosmotic volume contraction

A

osmol increase, ECF decreased, ICF decreased

Diabetes insipidus or decreased fluid intake, increased sweating

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7
Q

Central DI

A

Decreased ADH released -> water is not reabsorbed and the urine is very dilute

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8
Q

Isosmotic volume contraction

osmol same, ECF decreased, ICF same

A

osmol same, ECF decreased, ICF same

Acute GI hemorrhage or diarrhea -fluid is only lost from the ECF (blood vessels)

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9
Q

Hyposmotic volume contraction

A

osmol decreased, ECF decreased, ICF increased
Adrenal insufficency - lack of aldosterone
NaCl not reabsorbed-> ECF decreased.
ECF is low on solutes, so water shifts into cells (ICF)

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10
Q

Hypertonic volume expansion

A

osmol increased, ECF increased, ICF decreased
Hypertonic saline infusion- ECF volume and osmolarity increase
Water leaves the ICF to dilute the ECF

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11
Q

Hyposmotic volume expansion

A

osmol decrease, ICF increase, ECF same
Primary polydipsia and SIADH
Increased water intake or reabsorption shifts into ICF to dilute with the ECF staying the same. The increased water leads to overall decreased osmolarity

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12
Q

Onion-like concentric thickening of arteriolar walls

A

Hyperplastic arteriolosclerosis

Malignant HTN pathology

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13
Q

Homogenous acellular thickening of arteriolar walls

A

Hyaline arteriosclerosis

Lower HTN

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14
Q

Granulomatous inflammation of the media

A

Giant cell arteritis

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15
Q

Transmural inflammation of the arterial wall w/ fibrinoid necrosis

A

Polyarteritis nodosa

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16
Q

Smooth transition for impatient to outpatient

A

Discharge checklist

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17
Q

Down Syndrome Fetal Markers

A

AFP low
B-Hcg high
Inhibin A high

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18
Q

Chediak Higashi: What is it? Signs

A

Microtubule Disorder of neutrophil phagolysosome fusion

Partial albinism, peripheral neuropathy, recurrent pyogenic infxns

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19
Q

Proximal muscle weakness and Gottron’s papules (ertythematous plaques over hand joints)

A

Dermatomyositis

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20
Q

Dermatomyositis association

A

Often paraneoplastic to lung, colorectal, and ovarian CA

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21
Q

Blistering cutaneous photosensitivity

Uroporphorinogen decarboxylase deficency

A

Porphyria cutaenous tardia

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22
Q

Paraventricular tumor

Perivascular rosettes

A

Ependymoma

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23
Q

Cerebral hemisphere tumor

Hypercellular areas of atypical astrocytes bordering regions of necrosis (pseudopalisading)

A

Glioblastoma

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24
Q

Cerebellar tumor in kids
Small blue cells surrounding a neurophil
Homer-Wright Rosettes

A

Medulloblastoma

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25
Q

White matter of cerebral hemispheres

Round nuclei w/ halo of clear cytoplasm (Fried egg cells)

A

Oligodendroglioma

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26
Q

Cerebellar tumor in kids

eosinophilic granular bodies and elongated hairlike fibers (Rosenthal fibers)

A

Pilocytic astroocytoma

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27
Q

Spindle cells w/ palisading nuclei arranged around Verocay bodies composed of eosinophilic cores (antoni A)
Cerebelloponite angle

A

Schwannoma

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28
Q

Benign suprasellar tumor in kids

cords/nests of palisading squamous epithelium w/ internal areas of lamellar “wet keratin”

A

Adamantinomatous craniopharyngioma

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29
Q

Moldy grains in China w/ substance causing G to T mutation in p53 increase risk of what cancer?

A

Aflatoxins from aspergillus -> increased risk of HCC

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30
Q

Lac P

A

Promoter region where RNA polymerase binds

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31
Q

Lac I

A

gene for repressor -binds operator to prevent RNA polymerase binding. Constitutively on

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32
Q

Lac O

A

Operator- where the repressor binds, downstream of promoter region

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33
Q

Lactose (inducer)

A

Binds to the repressor to prevent it from binding to the operator and preventing RNA polymerase

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34
Q

Lac operon regulation

A

1) negative - repressor binds to operator preventing RNA polymerase from binding the promoter
2) cAMP-CAP binding upstream from the promoter. High glucose-> decreased cAMP.
Low glucose-> high cAMP-> binding to CAP-> cAMP-CAP binding to promoter

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35
Q

Patient is using herbal supplements that have not caused them SE

A

Advise on safety, quality, and efficacy

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36
Q

Conduct Disorder vs. Antisocial personality disorder

A

Conduct before 18, antisocial after 18

Persistent pattern of violating societal norms and other’s rights

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37
Q

Ligated IMA, which artery provides collateral circulation to the descending colon (not rectum)

A

SMA via marginal artery of Drummond

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38
Q

AIDS pt w/ working memory problem, executive dysfxn, and slow information processing

A

HIV associated dementia

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39
Q

HIV associated dementia histology

A

Microglial nodules, groups of activating macrophages and microglial cells around small areas of necrosis. They may fuse to form multinucleated giant cells

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40
Q

Mycobacterial Drug resistance due to non-expression of catalase-peroxidase enzyme

A

Resistance to INH. INH must be processed by mycobacterial catalase-peroxidase to be activated

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41
Q

Post-streptococcal glomerulonephritis complication risk increases for which pts?

A

Adults have poor prognosis due to higher risk of chronic HTN and renal insufficiency

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42
Q

Enzyme deficiencies of early steps in porphyrin synthesis

A

Neuropsych w/o photosensitivity due to metabolite accumulation

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43
Q

Uroporphyrinogen decarboxylase deficiency

A

Vesicles and blisters on sun exposed areas, edema, pruritus, pain, and erythema

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44
Q

Inflammatory arthritis, ulcer of the hard palate, butterfly rash

A

SLE-

ANA, anti-smith (spliceosome snRNP), anti-dsDNA

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45
Q

ALS microscopic

A

Loss of anterior horn - LMN lesions - muscle weakness and atrophy
Demyelnation of lateral corticospinal tracts - UMN lesion -spasticity and hyperreflexia
Can affect CN 5,9,10,12

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46
Q

ALS mutation

A

SOD1 -gene that codes for copper-zinc superoxide dismutase

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47
Q

Synovial WBC >100,000 and no crystals

A

Septic arthritis Tx w/ abx to prevent joint destruction, osteomyelitis, and sepsis

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48
Q

Acutr tx of gout when pt has peptic ulcer dz

A

Colchicine

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49
Q

Colchicine mechanism

A

Binds to intracellular tubulin and inhibits MT polymerizaton. Disrupts chemotaxis and phagocytosis

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50
Q

Colchicine SE

A

diarrhea, nausea, abd pn

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51
Q

Primary biliary cirrhosis classic pt

A

Pruritus and fatigue in middle aged woman
Cholestasis - jaundice, pale stool, dark urine
hypercholesterolemia - xanthelesmas

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52
Q

What does spironolactone due with K and H

A

Spironolactone blocks Na reabsorption and increases K and H reabsorption.
Fewer hydrogen ions are secreted from the collecting tubules

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53
Q

PCT osmolarity

A

300 isotonic w/ plasma regardless of final urine concentration

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54
Q

Descending loop of Henle osmolarity

A

Water leaves the tubule and the filtrate becomes concentrated, >300. ADH is high it will =1200

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55
Q

Ascending loop of henle osmolarity

A

Water comes back in to dilute the filtrate. <300

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56
Q

Distal convoluted tubule osmolarity

A

Most dilute section, impermeable to water, 100 osmol

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57
Q

Collecting duct osmolarity

A

Water leaves the tubule to dilute the hypertonic interstitium. So the somolarity is around 1200

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58
Q

Thyroid cytology - clusters of overlapping cells w/ large nuclei containing sparse, finely dispersed chromatin
Intranuclear inclusion bodies and grooves

A

Thyroid papillary carcinoma
Ground glass -Orphan Annie eyes
Psammoma bodies

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59
Q

Thyroid cytology - markedly pleomorphic cells, including irregular giant cells and biphasic spindle cells

A

Anaplastic cancer

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60
Q

Thyroid cytology - colloid nodule

A

Benign hyperplasia

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61
Q

Thyroid histology- Polygonal to spindle shaped cells w/ slightly granular cytoplasm.
Stains for calcitonin.
Adjacent amyloid deposits

A

Medullary thyroid cancer - from parafollicular C cells

MEN 2A and 2B

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62
Q

Homeless male w/ abd pn,
Develops acute confusion, nystagmus and b/l abducens palsy
b/l lesions in the mamillary body and Periaqueductal gray matter in the hospital

A

Wernicke’s encephalopathy triad - ataxia, ophthalmoplegia, confusion

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63
Q

Thiamine deficient pt given glucose

A

Develop Wernicke encephalopathy -added glucose worsens thiamine deficiency. Thiamine is cofactor for glucose metabolism (decarboxylase rxns)

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64
Q

Car accident pt develops excessive thirst and frequent urination that continues weeks later

A

Central DI - hypothalmic nuclei injury. Posterior pituitary injury would be transient

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65
Q

How is INH metabolized?

A

Acetylation to N-acetyl-INH

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66
Q

Bimodal distribution of metabolism

A

Fast and slow acetylators

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67
Q

Large mass surrounding the intestines

Uniform, round, medium-sized tumor cells w/ basophilic cytoplasm and proliferation fraction (Ki-67 fraction) of >99%

A

EBV - Burkitt Lymphoma (starry sky)

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68
Q

Chronic non-atrophic gastritis affecting the antrum: cause

A

H. Pylori infxn

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69
Q

Atrophic chronic gastritis of the body

A

Pernicious anemia

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70
Q

Most common benign liver tumor

A

Cavernous hemangioma - cavernous blood filled vascular spaces lined by a single epithelial layer

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71
Q

Which liver tumor can regress w/ d/c OC

A

hepatic adenoma

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72
Q

NOD2 mutation -> NF -KB decrease. What will be impaired

A

Cytokine production will be impaired -> impaired innate barrier fxn
Bugs get in and cause exagerated immune response

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73
Q

Fever, neuro sx (progressive lethargy), renal failure, anemia, and thrombocytopenia in setting of GI illness

A

Classic pentad of thrombocytopenic thrombotic purpura

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74
Q

Plt activation in arterioles and capillaries
Diffuse microvascular thrombosis
Microangiopathic hemolytic anemia w/ schistocytes
Thrombocytopenia

A

Clinical and pathologic features of thromobocytopenic thrombotic purpura

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75
Q

S-shaped bacteria causes decreased somatostatin-producing antral cells, what will this lead to

A

Duodenal ulcer as decreased somatostatin will lead to decreased inhibition of gastrin. The loss of somatostatin does not lead to gastric lymphoma, even though MALTs are possible with prolonged infxn

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76
Q

s/p coronary artery stent, livedo reticularis, hx of hyperlipidemia and CAD. What does biopsy of the kidney look like?

A

Cholesterol clefts in the arterial lumen. Cholesterol debris gets lodged leaving needle shaped clefts in intralobular renal arteries

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77
Q

Polycystic kidney dz w/ bone pn and weakness - Levels of Phosphate, PTH, and Calcitriol

A

-Phosphate is increased due to decreased GFR (less phosphorus filtered)
-Calcitriol is decreased, Hyperphosphatemia stims osteoclasts to secrete FGF, which is meant to decrease Phosphate reabsorption, but also decreases calcitriol synthesis
PTH is increase due to low Ca and high phosphate

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78
Q

Pulmonary histology - columnar mucin secreting cells that line the alveolar spaces w/o invading the stroma. How would you classify?

A

Malignant neoplasm, adenocarcinoma in situ (formerly bronchioalveolar carcinoma)

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79
Q

Why does a rt mainstem bronchus obstruction present as a u/l completely opacified lung

A

All of the alveoli collapse (atelectasis) - there is no air in the lung. It condenses into what looks like a solid organ.

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80
Q

Why is pancreatitis a risk factor for ARDS?

A

Pancreatitis leads to release of inflammatory cytokines and pancreatic enzymes that lead to neutrophils attacking the pulmonary interstitium and alveoli

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81
Q

ARDS Pathology

A

interstitial and alveolar edema, inflammation, and fibrin deposition cause the alveoli to become lined with waxy hyaline membranes

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82
Q

ARDS impact on the lungs: capillary permeability, lung compliance, WOB, V/Q match, PCWP

A

Decreased capillary permeability-> edema and decrease lung compliance, increased WOB, and atelectasis->V/Q mismatch, not ventilated, but perfused (shunt)
PCWP is NL

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83
Q

Why is Pulmonary capillary wedge pressure NL in ARDS

A

Noncardiogenic pulmonary edema

The problem is in the lungs not the heart, so the LA pressure is NL

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84
Q

Bright red hematemesis, splenomegaly, no liver biopsy abnormalities

A

Hepatic vein thrombosis - The obstruction is before the liver, so it is not affected. Blood spills back into anastamoses w/ systemic circulation

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85
Q

Budd-Chiari liver biopsy

A

Occlusion of hepatic vein leaving the liver. Centrilobular congestion and fibrosis

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86
Q

Porcelain gallbladder pathology

A

Chronic cholecystitis. Dystrophic intramural deposition of Ca salts.

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87
Q

Porcelain gallbladder increases risk of what?

A

Galbladder adenocarcinoma

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88
Q

Anti- tissue transglutaminase, where do you biopsy to confirm dx?

A

Celiac dz, biopsy the duodenum.

Duodenum and jejunum see highest level of gliadin

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89
Q

Crohn dz, where do you biopsy?

A

terminal ileum

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90
Q

Ischemia induced ventricular arrhythmias, tx w/?

A

Class IB antiarrhythmics,
mexiletine
lidocaine

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91
Q

Weakest Na channel blocker, dissociates the fastest, small effect on QRS, prefer inactivated channels

A

Class IB antiarrhythmics
mexiletine
lidocaine

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92
Q

Hypotension baroreceptor response

A

Low BP -> decreased stretch -> decreased baroreceptor signal -> increased SNS stimulation -> increased HR, increased contractility, increased bp

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93
Q

HTN baroreceptor response Carotid massage

A

High BP -> increased stretch -> increased baroreceptor signal -> increased PNS stim -> decreased HR, decreased contractility, decreased bp

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94
Q

Arteriolar vasodilators

A

minoxidil and hydralazine

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95
Q

SE of hydralazine and minoxidil

A

Na and fluid retention
Arteriolar vasodilators cause hypotension -> decreased stretch -> increase SNS -> increase RAAS -> increased Na and water reabsorption

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96
Q

Maintenance dose formula

A

MD = (Cpss X Cl)/bioavailability fraction

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97
Q

Half life formula

A

t1/2= (0.7 X Vd) / Cl

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98
Q

Loading dose formula

A

LD = (Cpss X Vd)/ bioavailability fraction

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99
Q

Overweight woman OD on antiseizure meds w/ PMH of abortion of fetus w/ spina bifida. She is confused. What lab abnormaltiy would you expect?

A

Increased liver transaminases. Rare, but fatal hepatotoxicity (measure LFTs)

Would cause respiratory depression -> respiratory acidosis

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100
Q

Valproic acid SE

A 
Teratogenic -NTD
Hepatotoxicity
Pancreatitis
tremors
wt gain
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101
Q

Mechanism of nitrates

A

NO activates guanylate cyclase -> increased cGMP-> activates myosin light chain phosphatase (MLCP) -> vascular smooth muscle relaxation
Also increased cGMP decreases intracellular Ca

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102
Q

NL Smoothe muscle contraction

A

Ca flows in and binds to myosin light chain kinase (MLCK) -> smooth muscle contraction

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103
Q

Phentolamine mechanism

A

Blocks alpha 1 -> vasodilation

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104
Q

Class 1 Na channel binding strength

A

1C>1A>1B
1B has the weakest Na binding. Dissociates quickly. Prefers ischemic tissue due to delayed switch from inactivated to resting state

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105
Q

Class 1C properties

A

Most use dependence
Has the greatest binding to Na channels
Slow dissociation allows the effects to accumulate -> arrhythmias

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106
Q

Opioid MOA - pre-synapse

A

Opiods bind to Mu receptors on presynaptic - block Ca channels -> decreased Ca-> decreased NT release

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107
Q

Opioid MOA post synapse

A

Bind to Mu receptors

Stimulate K efflux out of the cell -> hyperpolarization ( less likely to depolarize

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108
Q

Increased release of DA and NE from presynaptic nerve terminals. SE due to increased NE. Which sympathetic output will be affected: adrenal, eccrine sweat glands, bladder?

A

Sympathetic output to the bladder will be most affected.
Eccrine sweat glands and the adrenals get Ach released presynaptically to stimulate them. Other visceral organs get NE released presynaptically to stimulate them

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109
Q

Acute MI tx leads to wheezing. Which part of NT release is affected?

A

Epi is prevented from binding to B2-R to stimulate bronchodilation
B blockers block B2 -> bronchoconstriction -> asthma exacerbation

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110
Q

Nitroglycerin primarily affects which vessels

A

Large veins

Primary venodilator -> decreased preload

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111
Q

Constipation, bradycardia, AV block, and worsening heart failure after Afib txmnt

A 
nondihydropyridine CCB (diltiazem and verapamil) SE
AV block (chronotropic effect)
worse Hf- negative inotropic effect
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112
Q

Dilitiazem and verapamil MOA

A

Block L-type Ca channels-> decrease phase 0. Slow Av conduction -> AV block

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113
Q

Canagliflozin MOA

A

blocks SGLT, which normally would reabsorb glucose

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114
Q

What should be checked before starting canagliflozin?

A

Check serum CR, should be avoided in pts w/ moderate or severe renal impairment

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115
Q

SE of SGLT inhibitors

A

UTI, increased sugar in the urine for bugs

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116
Q

Pt undergoes general anesthesia and has fever, jaundice, tender HM, centrilobular necrosis, and elevated LFT, and bili. What med caused this?

A

Desflurane, halothane, enflurane

Metabolized by CYP450 in the liver that creates active metabolites or immune-mediated hepatocellular damage

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117
Q

anti-u1RNP

A

MCTD -mixed connective tissue dz

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118
Q

Mixed connective tissue disease

A

Sx of SLE, systemic sclerosis, RA and polymyositis

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119
Q

Anti-La

A

anti SSB

Sjogren’s

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120
Q

anti ro

A

anti-SSA

Sjogrens

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121
Q

Pulsus alterans: What is it? What causes it?

A

Beat to beat variation in pulse amplitude

Commonly severe LV dysfxn

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122
Q

Dicrotic pulse: What is it? What causes it?

A

Pulse w/ 2 peaks, 1 for systole and 1 for diastole

Severe systolic dysfxn and high systemic arterial resistance

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123
Q

Hyperkinetic pulse: What is it? What causes it?

A

Rapidly rising pulse w/ high amplitude. Large SV against decreased afterload
Aortic regurg, AVM

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124
Q

Pulsus parvus et tardus What is it? What causes it?

A 
Diminished SV (parvus) and prolonged  LV ejection time (tardus)
LVOT obstruction - Aortic stenosis
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125
Q

What causes angioedema in a woman who just started taking lisinopril?

A

ACEI leads to increased bradykinin, which increases vascular permeability

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126
Q

What should you suspect in a kid w/ angioedema?

A

C1 esterase inhibitor deficiency. Complement is hyperactive-> unregulated activation of kallikrein-> increased bradykinin

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127
Q

Kawasaki dz complication

A

coronary artery aneurysms

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128
Q

Rt arm and rt side of face swelling

A

Brachiocephalic vein obstruction

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129
Q

Face and arms swelling b/l

A

SVC syndrome

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130
Q

What defects can lead to a paradoxical embolus?

A

PFO, ASD, VSD

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131
Q

Why does a reperfusion injury lead to increased creatinine kinase

A

The cell membrane is damaged by reactive oxygen species and creatinin kinase is able to leak out of the cell

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132
Q

Murmur at the apex radiates to the axilla

A

Mitral regurg. The blood flows back to the pulmonary vessels

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133
Q

Murmur at the RSB radiates to the neck

A

Aorti stenosis- Increased flow of blood out to the carotids

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134
Q

Aorti regurg sound

A

Diastolic high pitched=twangy

“blowing” murmur. The blowing is subtle

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135
Q

What is transthyretin’s normal role?

A

Transport thyroxine and retinol

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136
Q

What can a mutation of TTR lead to?

A

Transthyretin can then misfold and become an amyloid that causes restrictive dz in the heart

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137
Q

3 day onset of progressive cough, orthopnea, dyspnea, and LE edema

A

Acute decompensated heart failure

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138
Q

CXR: Cephalization of pulmonary vessels, perihilar alveolar edema (batwing), costophrenic angle blunting, Kerley B lines

A

Acute decompensated heart failure w/ secondary pulmonary edema

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139
Q

Causes of ADHF

A

MI, severe HTN, valvular abnl, arrhtymias, cocaine

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140
Q

AV Fistula - Preload and afterload

A

Preload is increased - more blood coming back to the heart

Afterload is decreased - the fistula allows for some of the arterial pressure to be transferred to veins

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141
Q

What medication can increase peripheral vascular resistance, increase systolic bp, decrease pulse pressure, and decrease HR?

A

Phenylephrine (Alpha 1 agonist)
Vasoconstricts to increase peripheral resistance and systolic bp.
The HTN is sensed by baroreceptors, which activate PNS to decrease HR and SV -> decreased pulse pressure (smaller difference btwn systolic and diastolic)

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142
Q

What is decreased in the post-synaptic cells of pts w/ Myasthenia gravis?

A

The have Ab against Ach-R, so fewer ACh-R exist (removed due to complement) -> decreased motor end plat potential. A synapse still has the same potential, but the potential of the whole end-plate is reduced.

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143
Q

What would you use to improve diarrhea, nausea and abd cramping in a MG patient given pyridostigmine?

A

Scopolamine (anti-cholinergic)

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144
Q

Pilocarpine MOA

A

Muscarinic agonist

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145
Q

Hyoscamine MOA

A

Muscarinic antagonist like scopolamine

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146
Q

Carbonic monoxide findings: Carboxy Hgb, PaO2, methemoglobin

A

Carboxy Hgb increased
PaO2 NL
Methemoglobin NL

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147
Q

What can cause methemoglobinemia?

A

Dapsone (Dihydropteroate synthesis inhibitor-similar to sulfonamides. Use in leprosy), nitrites

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148
Q

RPF equation

A

RPF = RBF X (1-hematocrit)

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149
Q

Length constant of an AP?

A

Distance at which the originating potential decreases to 37% of its original amplitude

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150
Q

What does myelination do to the length constant?

A

Myelination lengthens the length constant so that a potential can get farther before it dissipates

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151
Q

Why would you hypoventilate a pt w/ cerebral edema?

A

Hypoventilation would decrease PaCO2, which is a potent vasodilatoer. Decreasing PaCO2 -> vasoconstriction and increased cerebral vascular resistance, Preventing further edema

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152
Q

Major causes of hypoxemia:

alveolar hypoventilation

A

NL A-a gradient, there is not enough O2 inspired in the air

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153
Q

Cause of hypoxemia:

V/Q mismatch

A

Increased A-a gradient. Obstruction in airway leads to decreased ventilation w/ NL perfusion

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154
Q

Cause of hypoxemia: Diffusion impairment

A

ie. alveolar hyaline membrane dz. Diffusion is prevented by a thickened alveolar capillary membrane

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155
Q

Cause of hypoxemia: right to left shunt

A

Deoxygenated blood from the right heart flows into systemic circulation -> decreased PaO2

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156
Q

In what cases is PaO2 decreased?

A

It is decreased in high altitude. There is less oxygen in the blood. Anemia, CO, and CN poisoning have nl PaO2

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157
Q

In what cases is SaO2 decreased?

A

CO poisoning and high altitude
CO competes with the O2 binding
High altitude there is just very little O2 to bind
Nl in anemia, CN poisoning, and polycythemia

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158
Q

In what cases is oxygen content (Hgb content and oxygen saturation) decreased?

A

High altitude - low O2 able to bind available Hgb
CO poisoning - Hgb is bound to CO, so very little O2 is bound to Hgb
Anemia - There is a low amount of Hgb, so even though O2 may be available there isn’t Hgb to bind to

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159
Q

Conductive hearing loss in right ear (describe PE)

A

BC>AC -abnl Rinne. The ear drum does not vibrate when the fork is put in the air, but does vibrate when put on the mastoid bone.

Localize to the right - Weber
The rt ear does not get ambient noise conduction and so it is better able to hear the resonation through bone

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160
Q

Sensorineural hearing loss on the right ear

A

AC> BC - NL Rinne Test. The nerve hears the sound just as poorly from the ear drum as direct contact

Localizes to the left -Weber
The rt ear has a damaged nerve, so it does not transmit the nerve impulse from bone conduction as well as the Nl ear

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161
Q

K percentages in Bowman’s, PCT, ascending loop, and collecting duct in NL person

A

Bowman’s -100%
PCT- 35%
Ascending- 10%
Collecting duct - 110%

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162
Q

What kind of receptors are Ca sensing receptors? What is a disorder of these receptors?

A

GPCR
Familial hypocalciuric hypercalcemia
Ca binds to CaSR and inhibits PTH Normally

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163
Q

Intrinsic Tyrosine kinase Receptors

A

Insulin

IGF- Insulin like growth factor

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164
Q

JAK STAT receptors

A

EPO
GH
cytokines
PRL

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165
Q

Marker of osteoblast activity

A

Bone specific alkaline phosphatase- synthesizing bone matrix leads to release of alkaline phosphatase

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166
Q

Markers of osteoclast activity

A

Tartrate resistant acid phosphatase
Urinary hydroxyproline
Urinary deoxypyridinoline

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167
Q

What does increased lung volume due to alveolar resistance?

A

Increased lung volume lengthens and narrows the alveoli - > increased alveolar vessel resistance

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168
Q

What does decreased lung volume due to extra-alveolar resistance?

A

Decreased lung volume

Extraalveolar lung vessels narrow due to chest cavity compression -> increased extra-alveolar resistance

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169
Q

Pulmonary vascular resistance equation

A

PVR= alveolar + extra-alveolar resistance

increased or decreased lung volumes increase PVR, lowest at FRC

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170
Q

RBF equation

A

RPF/ (1-hematocrit)

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171
Q

Deficient IL-12 would lead to a decrease in which cells and what cytokine could make up for it?

A

IL-12 activates Th1 cells. You could give IFN-gamma, which helps stimulate differentiation to Th1 and also is secreted by Th1

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172
Q

Nitroprusside’s effects on preload and afterload

A

Nitroprusside decreases preload and afterload through equal arteriole and vein dilation

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173
Q

Oval or round yeasts inside macrophages, Many small yeasts

A

Histoplasmosis is smallest btwn blasto and coccidiodes

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174
Q

Milrinone MOA

A

PDE-3 Inhibitor
Cardiac - Increased cAMP leads to increased cardiac muscle contraction
Vasculature - Increased cAMP leads to vasodilation

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175
Q

Which med would cause a greater increase in QRS complex at a higher HR?

A

Class 1C has the greatest use dependence. Will block Na channels more rapidly at higher HR and lengthen the QRS more at higher HR

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176
Q

22 yo ruptured cerebral anuerysm w/ extensive intracranial hemorrhage? Most likely congenital cardiac anomaly/

A

Adult type Aortic coarctation

increased risk of berry aneursyms and aortic HTN

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177
Q

Hyperlipidemia drug causes flushing, what mediates the SE?

A 
Niacin causes flushing via PGD2 and PGE2.
Give aspirin (Cox inhibitor) before niacin to decrease flushing
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178
Q

How to prevent Group B strep in an infant?

A

There is no vaccine for GBS. You give the mom ampicillin to clear the infxn during pregnancy

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179
Q

Bosentan MOA

A

Endothelin receptor antagonist. Blocks vasoconstricting effects of endothelin

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180
Q

Bosentan used for?

A

Idiopathic Pulmonary artery HTN

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181
Q

What pt dz would cause anaphylaxis when giving O negative RBCs?

A

IgA deficiency

Develop IgE against IgA (anti-IgA). The RBCS may have a small amount of IgG that triggers anaphylaxis

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182
Q

Chronic rejection of a lung allograft damages where?

A

Small airways, Bronchiolitis obliterans. Solid organs-vascular obliteration

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183
Q

Which segment in the lungs has the greatest airway resistance?

A

The medium sized bronchioles - due to highly turbulent flow

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184
Q

Which segment has the lowest airway resistance?

A

Terminal bronchioles - increased cross-sectional area

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185
Q

Cough reflex afferent and efferent

A

Afferent is internal laryngeal n. (sensory-branch of CN 10) in piriform recess
Efferent is CN 10

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186
Q

Hyperoxia in COPD pt leads to what effect on V/Q?

A

Hyperoxia leads to vasodilation, which creates alveoli that are now ventilated with poor perfusion. Increased physiologic dead space

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187
Q

Hypoxia affect in COPD on vasculature

A

Hypoxia causes vasoconstriction of vessels supplying alveoli w/ low O2 content, perfusion is saved for the alveoli that are well ventillated

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188
Q

Whats causes a brown pigment stone?

A

Biliary tract infxn
Injured hepatocytes and bacteria release beta-glucuronidase, which breaks down bilirubin glucuronide ->increased Unconjugated bili

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189
Q

What causes black pigment stones?

A 
Chronic hemolysis (SCA or spherocytosis)
Ileal dz - increased enterohepatic cycling of bili
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190
Q

Inhibition of 7 alpha hydroxylase, what drug and MOA?

A

Fibrates inhibit 7-alpha-hydroxylase

Reduce conversion of cholesterol to bile acids -> lower solubility of cholesterol stones

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191
Q

What kind of liver dz has decreased serum albumin?

A

Chronic end stage liver dz

The remaining hepatocytes have reduced fxn, albumin has long half life (20 days)

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192
Q

What kind of liver dz causes distended abdominal veins, ascites, and palmar erythema?

A

End stage liver dz (cirrhosis), due to portal HTN and increased estrogen

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193
Q

What kind of liver dz causes splenomegaly?

A

Portal HTN causes blood to flow to Splenic vein since portal vein is blocked

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194
Q

What kind of liver dz causes a prolonged PT time, elevated aminotransferases, leukocytosis, and eosinophilia, and NL albumin?

A

Acute fulminant hepatitis

Halothane hepatotoxicity is indistinguishable from acute fulminant viral hepatitis on histology

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195
Q

Pt has any kind of surgery somewhere besides USA and develops and dies from liver issues. What pattern of injury?

A

Hepatocellular pattern

Rapid liver atrophy (shrunken)

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196
Q

Hepatocellular pattern of injury on histo

A

Widespread centrilobular necrosis

Inflammation of the portal tracts and parenchyma

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197
Q

Mechanism of halogenated anesthetic heptotoxicity

A

Hypersensitivity to the drug causes immune mediated attack against hepatocytes

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198
Q

Nerves innervating EAC

A

Posterior is auricular branch of vagus, and the rest is auriculotemporal of mandibular (V3)

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199
Q

Medical Tx of biliary colic

A

Ursodeoxycholic acid (hydrophilic bile acids) increase bile solubility and reduce cholesterol secretion

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200
Q

Cholestyramine and risk of gallstones

A

No net risk
Decrease enterohepatic recirculation of bile acids (less soluble cholesterol increased risk)
Stim conversion of cholesterol to bile acid and increase gallbladder motility (decreased risk)

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201
Q

Fibrate MOA

A

Upregulate LPL -> clear LDL
Activate PPAR-gamma to increase HDL synthesis
Inhibit 7-alpha-hydroxylase -> decreased conversion of cholesterol to bile acid (increased cholesterol stone risk)

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202
Q

Diphenoxylate MOA

A

Mu opioid -decrease GI motility

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203
Q

What drugs is diphenoxylate combine with? Why?

A

It is combined w/ atropine to cause dry mouth, blurry vision, and nausea (anticholinergic) at high doses to discourage excessive use

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204
Q

Meperidine MOA

A

Mu opioid- decrease GI motility

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205
Q

Loperamide MOA

A

Low dose Mu opioid agonist

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206
Q

Hepatic abscess via hematogenous seeding, what bug

A

Staph Aureus

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207
Q

Total gastrectomy requires lifelong administration of?

A 
Vitamin B12 (water soluble)
Lack of IF to bind B12 and facilitate absorption
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208
Q

Kid gets recurring giardiasis what enzyme will be deficient due to inflammation and infxn?

A

Secondary lactase deficiency

Also possible w/ celiac dz

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209
Q

Theophylline MOA and toxicity

A

PDEI - similar to cortical stimulant effects of caffeine, used for bronchodilation
Can cause sz and tachyarrhythmia due to caffeine like effects

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210
Q

Months of fatigue, rash (worse after hot showers), flushing, abd cramps, dizziness, syncope, and mast cells positive for KIT

A

Systemic mastoytosis

Increased mast cells w/ KIT (tyrosine kinase) mutation. Excessive tryptase and histamine

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211
Q

What does excess histamine cause in systemic mastocytosis?

A

Syncope, flushing, hypotension, pruritus, urticaria, and increased gastric acid secretion

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212
Q

What is the mechanism behind Zenker’s diverticulum?

A

Cricopharyngeal motor dysfxn

Cricopharyngeus doesn’t relax leading to increased oropharyngeal intraluminal pressure-> herniation-> false diverticulum

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213
Q

Anti-mitochondrial Ab

A

Primary biliary cholangitis

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214
Q

Lymphocytic infiltration and destruction of small intrahepatic bile ducts (2 possible causes)

A

Primary biliary cirrhosis

Graft versus host dz

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215
Q

Acetaminophen OD histo

A

Centrilobular necrosis that can extend to include the entire lobe

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216
Q

Acetaminophen OD tx

A

N-acetyl-cysteine, regenerates the decreased glutathione

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217
Q

Acetaminophen common drug name and where it acts

A

Tylenol, mostly in the CNS Cox3, less GI SE

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218
Q

Acetaminophen OD pathology

A

Acetaminophen metabolite (NAPQI) depletes glutathione and forms toxic byproducts in the liver

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219
Q

Hepatocellular swelling and necrosis, Mallory bodies, neutrophilic infiltration, and fibrosis. What caused this?

A

Alcoholoic hepatitis

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220
Q

What is a mallory body?

A

Cytoplasmic inclusion in heptocytes made up of damaged intermediate filament

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221
Q

Hepatomegaly w/ tense capsule and reddish-purple parenchyma, severe centrilobular congestion and necrosis

A

Budd-Chiari Syndrome

Hepatic vein obstruction

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222
Q

Non-inflammatory hepatocyte necrosis w/ fibrosis

A

Hemochromatosis

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223
Q

Liver histo - Panlobular microvesicular steatosis

A

Reye Syndrome

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224
Q

What is reye syndrome?

A

Give aspirin to a kid w/ a viral infxn

encephalopathy and liver dz

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225
Q

Reye syndrome mechanism

A

Aspirin metabolites decrease beta oxidation by reversible inhibition of mitochondrial enzymes

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226
Q

Reye Syndrome findings

A

Mitochondrial abnormalities, microvesicular fatty liver, hypoglycemia, vomiting, hepatomegaly, coma

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227
Q

What viruses is Reye syndrome associated with?

A

VZV and Influenza B

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228
Q

Pernicious anemia effect on gastrin, gastric pH, and parietal cell mass

A

Parietal cell mass low -> decreased gastric acid (high gastric pH) and decreased IF (B12 deficiency)
Leads to increased gastrin secretion from gastric G cells

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229
Q

What part of HDV life cycle is supported by previous HBV?

A

HBV provides the coating of HDV particles allowing it to penetrate a hepatocyte

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230
Q

Name products of TCA cycle

A

Pyruvate -> acetyl CoA-> citrate->isocitrate->alpha-ketoglutarate->succinyl Coa->succinate-> fumarate->malate-> oxaloacetate

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231
Q

Pyruvate kinase

A

PEP to pyruvate

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232
Q

Pyruvate dehydrogenase and what cofactors are required

A

Pyruvate to acetyl CoA
requires thiamine (decarboxylase)
B2-riboflavin, B3- niacin, B5-pantothenic acid, lipoic acid

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233
Q

Citrate Synthase

A

Oxaloacetate + acetyl CoA to citrate

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234
Q

Aconitase

A

Citrate to isocitrate

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235
Q

Isocitrate dehydrogenase

What Cofactor

A

Isocitrate to alpha-ketoglutarate

requires niacin as NAD+ -> NADH

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236
Q

Alpha-ketoglutarate dehydrogenase. What cofactors?

A

Alpha-ketoglutarate to succinyl CoA
Requires Thiamine(B1)
B2-riboflavin, B3-niacin (NAD+-> NADH), B5-patothenic acid, and lipoic aicd

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237
Q

Succinate thiokinase

Cofactor

A

AKA Succinyl-CoA synthetase
Succinyl-CoA to succinate
Requires GDP-> GTP

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238
Q

Succinate dehydrogenase

What Cofactor

A

Succinate to fumarate
Requires B2-riboflavin
FAD+->FADH

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239
Q

Fumarase

A

Fumarate to malate

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240
Q

Malate dehydrogenase

Cofactor?

A 
Malate to oxaloacetate
Requires niacin (NAD+-> NADH)
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241
Q

Pyruvate carboxylase

Cofactor?

A 
Pyruvate to oxaloacetate for gluconeogenesis
Requires Biotin (carboxylase)
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242
Q

What are the defense mechanisms against giardiasis?

A

IgA prevents adherence

and CD4 Th Cells

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243
Q

2 Major causes of polyhydramnios

A

Impaired fetal swallowing or increased fetal urination

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244
Q

2 main Causes of decreased fetal swallowing leading to polyhydramnios

A

GI obstruction - esophageal, duodenal, or intestinal atresia

Anencephaly - No brain to coordinate swallowing

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245
Q

Pregnant pt w/ epilepsy what is the baby at risk for

A

Valproate, carbamazepine, phenytoin -> increase risk of NTD

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246
Q

Pulmonary hyoplasia is cause or result of what?

A

It is a result of oligohydramnios, possibly due to renal agenesis. Low volume of urine made leads to low amount of amniotic fluid-> poor lung development

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247
Q

Ipratropium MOA

A

Anti-muscarinic - bronchodilation

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248
Q

Magnesium sulfate in asthma MOA

A

Inhibits Ca influx -> bronchodilation
Stabilizes T cells
Inhibits mast cell degranulation

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249
Q

What does pulmonary edema due to compliance and surface tension, and FRC?

A

Fluid in the alveoli increases air resistance -> decreased compliance
Surface tension increases w/ fluid in the alveoli->decreased compliance-> alveoli more likely to collapse -atelectasis
The decreased compliance means the lungs can’t fill as well-> decreased FRC and decreased TLC

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250
Q

Atrialization of the right ventricle (Epstein’s anomaly) is associated with what med?

A

Lithium used for bipolar

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251
Q

General classes used to treat bipolar disorder, schizophrenia, and epilepsy

A

Bipolar - lithium and mood stabilizers like valproic acid, carbamazepine, and atypical antipsychotics
Schizophrenia - antipsychotics (haloperidol, fluphenazine) atypicals (aripiprizole, clozapine)
Epilepsy (valproate, phenytoin, carbamazepine)

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252
Q

Bipolar tx

A

Lithium
Carbamazepine
Valproate
Atypical antipsychotics(aripiprazole and zapines)

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253
Q

Schizophrenia Tx

A

Haloperidol, fluphenazine

atypical - apiprazole, clozapine

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254
Q

Epilepsy Tx

A

Valproate, carbamazepine, phenytoin

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255
Q

Child has vascular lesions w/ IgA and C3 deposition

A

Henloch Schonlein Purpura -
Purpuric rash (butt)
colicky abd pn, polyarthralgia

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256
Q

Vasculitis: Saddle nose and olguria

A

Granulamatosis with polyangitis

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257
Q

Vasculitis: Weak upper extremity pulses

A

Takayasu arteritis - aorta and its branches

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258
Q

Vasculitis: HA and blurred vision

A

GCA

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259
Q

What cells release histamine and tryptase?

A

Histamine- basophils and mast cells

Tryptase - Mast cells only

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260
Q

Multiple cystic edematous hydropic villi, P57 negative

A

Complete mole,p57 negative=absence of maternal genome, all dad

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261
Q

Carcinoembryonic antigen

A

colorectal maliignancy

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262
Q

CA-125

A

Ovarian CA

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263
Q

Sarcoma botryoides in a young girl

A

Bunch of grapes out of vagina

rhabdomyosarcoma arising from the bladdeer or vaginal mucosa

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264
Q

CA 19-9

A

Pancreatic CA

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265
Q

C3b fxn

A

Opsonin and activates MAC

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266
Q

5-HETE (5-hydroxyicosatetraenoic acid) fxn

A

LT and lipoxin precursor
Neutrophil and Macrophage chemotaxis
Neutrophil degranulation

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267
Q

C5A fxn

A

Chemotaxis and increased phagocytosis directly

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268
Q

LTB4

A

Chemotaxis

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269
Q

Opsonins

A

IgG, C3B, CRP, and mannose binding lectin

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270
Q

Which hormones have the same alpha subunit?

A

Hcg, TSH, FSH, LH

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271
Q

Which hormones have beta subunits with significant homology?

A

Hcg and TSH

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272
Q

Painless scrotal mass, increased sweating and heat intolerance, increased T4 and T3, hypoechoic mass w/in the testicle

A

Testicular germ cell tumor secreting Hcg which can bind TSH -R if excessive enough

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273
Q

How do cancers met to the skeletal system?

A

Hematogeneous spread not lymphatic

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274
Q

Prostatic venous plexus receives blood from where?

A

Prostate, penis, bladder

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275
Q

Preventable adverse event

A

Harm to pt due to failure to follow EBM

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276
Q

Near miss

A

No harm to pt, prevented before harm could take place

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277
Q

Atypical endometrial cells, disorganized glands, and multiple mitoses

A

Endometrial adenocarcinoma commonly in post-menopausal women

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278
Q

Dilated, coiled endometrial glands and edematous stroma

A

Common during the luteal phase
Pathologic- ectopic pregnancy will stimulate this luteal phase due to the corpus luteum, but no implantation in the uterus

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279
Q

Enlarged chorionic villi and avascular edematous stroma

A

Molar pregnancy

280
Q

Inflammatory infiltration of endometrial glands

A

Endometritis -infxn of the decidua

281
Q

Straight, short endometrial glands, and compact stroma

A

Proliferative phase of the menstrual cycle

282
Q

Anaphylactic schock tx

A

1-epinephrine - Alpha 1 vasoconstricts to increase bp
B1- Increases cardiac contractility, HR, and AV conduction
B2-bronchodilates -improving breathing
2-Diphenhydramine

283
Q

Why not use NE to tx anaphylaxis?

A

Mostly an alpha 1 agonist - high vasoconstriction can limit CO stimulate carotid sinus to decrease bp and HR

284
Q

Aspirin intoxication (acute salicylate toxicity) ABG

A

1) Respiratory alkalosis - stim medullary respiratory center to increase ventilation leading to decreased PaCO2
2) After 12 hrs - metabolic acidosis- salicylates uncouple oxidative phosphorylation leading to increased organic acids-> decreased bicarb

285
Q

Aspirin intoxication ABG

A

1) 1st 12 hours respiratory alkalosis, pH up, PaCO2 down, HCO3 NL
2) after 12 hours mixed respiratory alkalosis and metabolic acidosis
pH close to NL, PaCO2 down (not compensated), HCO3 down

286
Q

Layers in cricothyrotomy

A

Skin
superficial cervical fascia (SQ fat and platysma)
Deep cervical fascia (investing and pretracheal layers)
Cricothyroid membrane

287
Q

What is RT-PCR used to detect?

A

mRNA, you take the RNA and RT back to DNA (cDNA) and make copies of mRNA containing exons w/o introns

288
Q

CML RT-PCR

A

would show mRNA with both BCR and ABL exons

289
Q

What do Southwestern blots detect?

A

Proteins that bind DNA

290
Q

What does RAS code for?

A

Codes for GPCR, activates MAP kinase pathway -> affects transcription

291
Q

What are c-Jun and c-Phos?

A

Nuclear transcription factors that bind DNA via a leucine zipper motif
Proto-oncogenes

292
Q

S-100 marks waht cells?

A

Neural crest cells

Melanocytes, Schwann cells, Langerhans (DC)

293
Q

Why eat carb rich food before workout?

A

Increased Ca release from SR->activate phosphorylase kinase to stim glycogen phosphorylase to break down glycogen
Synchronizes muscle contraction w/ glycogen breakdown, less anaerobic metabolism

294
Q

3 fluid compartments and volumes

A

Total body water = 41 L
ECF= 14L
Plasma 3L

295
Q

Low molecular weight molecule, which compartment

A

ECF 14L

296
Q

Lipophilic molecule, which compartment

A

Total body water 41L

297
Q

Not bound to albumin

A

Not in Plasma, ECF or TBW

298
Q

Most abundant AA in collagen

A

glycine (Gly-X-Y)

also proline and lysine

299
Q

DNA Pol I

A

Old school, It synthesizes the lagging strand and has 5’-3’ and 3’ to 5’ exonuclease proofreading

300
Q

DNA pol III

A

New kid, Synthesizes leading strand and has 3’-5’ exonuclease proofreading

301
Q

To avoid wrong site surgery

A

2 separate people identify the site individually

302
Q

On effect/drug concentation grafts what do x and y axis mean?

A

X axis -lower the value the greater the affinity and potency

y axis- higher the value the greater the efficacy

303
Q

Potency and affinity go together, what does not necessarily mean increased affinity?

A

lower Km does not necessarily mean that affinity is greater

304
Q

CMV in a pregnant women can lead to a child w/

A

chorioretinitis

305
Q

Ataxia, telangectasia, and sinopulmonary infxns are classic triad

A

Ataxia telangectasia
ATM gene mutation -> DNA break repair
IgA deficiency

306
Q

Fragile X syndrome

What is the mutation and what does it do to DNA?

A

FMR mutation leads to FMR1 hypermethylation

307
Q

How would you determine methylation and number of repeats?

A

Use Southern blot to determine number of CGG

308
Q

MOA of botulinum toxin

A

Cleaves SNAREs preventing NT release from vesicles (pre-synaptic)

309
Q

Antipsychotic OD - diffuse muscle rigidity, high fever, tachycardia, HTN, and altered sensorium
Name syndrome and tx

A

Neuroleptic malignant syndrome

Tx w/ dantrolene to block Ryanodine receptors

310
Q

What NT is produced in the posterior rostral pons at the lateral floor of the fourth ventricle?

A

Locus ceruleus produces NE

311
Q

What NT at ventral tegmental area and substantia nigra pars compacta

A

DA

312
Q

3 DA pathways

A

Mesolimbic and mesocortical - cognition and behavior
Nigrostriatal - coordination of voluntary movements
Tuberoinfundibular - inhibit PRL

313
Q

NT produced from Periaqueductal gray, rostral ventral medulla, and dorsal horn of the spinal cord

A

Dynorphin (opioid)

314
Q

NT from posterior hypothalamus

A

Histamine and orexin - arousal and wakefulness

315
Q

Transamination rxns require which vitamin?

A

Vit B6

316
Q

What is the major AA responsible for transferring nitrogen to the liver?

A

alanine

317
Q

What happens to alanine once it reaches the liver?

A

Alanine transfers the amino group to alpha ketoglutarate to form glutamate

318
Q

What happens to glutamate in the liver?

A

Glutamate is transformed to regenerate alpha ketoglutarate and free ammonia by glutamate dehydrogenase

319
Q

Morbilliform rash on trunk and arms, fever, encephalitis, and flaccid paralysis in the summer

A

WNV - Positive sense ssRNA flavivirus transmitted by Culex female mosquitos

320
Q

Main features of a glucagonoma

A

Diabetes
GI- diarrhea, anorexia, abd pn
Necrolytic migratory erythema

321
Q

Describe necrolytic migratory erythema

A

Erythematous plaques/papules on face. perineum, and extremities
Lesions coalesce leaving bronze colored, central indurated area w/ peripheral blistering and scaling

322
Q

What is arginine a substrate for?

A

Arginase producing urea

323
Q

Spastic diplegia, abnl movements, and growth delay

A

Arginase deficiency- arginine is not changed to ornithine and urea

324
Q

Arginase deficiency- hyperammonemia?

A

Mild or no hyperammonemia

325
Q

Thyroid histo: Nests of polygonal cells with Congo red positive deposits

A

Medullary thyroid CA

326
Q

Why does medullary thyroid CA have Congo red positive deposits?

A

Tumor from calcitionin secreting C cells. The amyloid depositis are calcitonin secreted from the c cells

327
Q

Thyroid histo: branching structures with interspersed calcified bodies

A

Papillary thyroid CA

calcified bodies are psammoma bodies

328
Q

Follicular hyperplasia with tall cells forming intrafollicular projections

A

Papillary thyroid CA - intrafollicular projections = papilla. Don’t forget Orphn annie eyes- pale nuclei with thin rim of peripheral chromatin

329
Q

Pleomorphic giant cell nests w/ occasional multinucleated cells

A

Anaplastic thyroid carcinoma

330
Q

Sheets of uniform cells forming small follicles

A

Benign follicular adenom

331
Q

Neonatal intraventricular hemorrhage in premature baby will have bleeding from where?

A

Germinal matrix - highly cellular and vascularized layer in the subventricular zone. neuron an glial cells migrate out of during development

332
Q

What adrenergic receptor affects uterine contractions?

A

B2 agonists -decreases uterine contractions, tocolytic

333
Q

What adrenergic receptor causes mydriasis?

A

Alpha 1 agonists-> mydriasis

334
Q

In DKA which enzyme provides substrate for gluconeogenesis?

A

Glycerol kinase

335
Q

TG breakdown in DKA

A

FA undergo beta oxidation to provide energy and ketone bodies, but not glucose
The glycerol backbone goes to DHAP to provide energy and glucose

336
Q

Manifestations of pineal tumor (germinoma)

A

Obstructive hydrocephalus and dorsal midbrain syndrome (Parinaud)

337
Q

What is Parinaud syndrome?

A

Limited upward gaze, downward gaze preference, b/l eyelid retraction and accomodation w/o pupil rxn

338
Q

What is required for glycolysis? Glyceraldehyde-3-phosphate to 1,3-bisphosphoglycerate

A

NAD+

339
Q

In anaerobic conditions what does pyruvate to lactate accomplish?

A

NADH transfers e- to pyruvate to make lactate and regenerates NAD+ to continue glycolysis

340
Q

What substrate activates pyruvate carboxylase and inhibits pyruvate dehydrogenase? Promotes gluconeogenesis over TCA cycle

A

Acetyl CoA
When Acetyl CoA is low pyruvate dehydrogenase is disinhibited to make more
When Acetyl-CoA is high it prevents more by activating pyruvate carboxylase

341
Q

Trazodone MOA

A

5HT modulator

5HT post-synaptic blocker and inhibits 5HT reuptake

342
Q

Besides 5HT what does trazodone act on?

A

Alpha 1 block - orthostatic hyypotension
H1 block- sedation
5HT - insomnia associated w depression

343
Q

Trazodone SE

A

TrazoBONE- priapism

orthostatic hypotension

344
Q

Gastric erosions, what layer

A

Up to but not throught muscularis mucosa

345
Q

Gastric ulcers, what layer?

A

Extend into submucosa or deeper

346
Q

Duration of trazolam, oxazepam, and midazolam

A

Short acting < 6 hrs half-life

347
Q

Duration of alprazolam, lorazepam, and temazepam

A

Intermediate 6-24 hrs half-life

348
Q

Duration of chlordiazepoxide, diazepam, and flurazepam

A

Long > 24 hr half-life

349
Q

To avoid undesirable daytime effects take short or intermediate acting benzos

A

short- oxazepam, midazolam, trazolam

intermediate - alprazolam, lorazepam, and temazepam

350
Q

Narcolepsy tx

A

Psychostimulant like modafinil

351
Q

Modafinil MOA

A

Non-amphetamine psychostimulant thought to enhance DA signaling

352
Q

Tx of tx-resistant schizophrenia

A

Clozapine - 2nd gen antipsychotic

353
Q

Clozapine SE

A

Agranulocytosis, metabolic syndrome, seizures, myocarditis

354
Q

Aripiprazole and ziprasidone, risperidone

A

2nd gen antipsychotics

355
Q

Tx of drug-induced Parkinsonism

A

D/c drug and centrally acting anti-muscarinic - benztropine

Don’t use carbidopa/levodopa - could precipitate psychosis

356
Q

Most common cause of death in TCA OD

A

arrhythmia from inhibtion of fast acting Na channels in cardiac myocytes

357
Q

TCA effects what receptors

A

Presynaptic NE and 5HT prevent reuptake - antidepressant
Muscarinic Ach-R block- tachycardia, hyperthermia
H1 -sedation
Alpha 1 block- vasodilation
Cardiac Na channels

358
Q

Panic disorder tx emergent and long term

A

Emergent- benzo

Long term SSRI/SNRI

359
Q

TCA blocks what receptors

A 
NE and 5HT reuptake
H1
Alpha 1
Muscarinic
Cardiac fast acting Na channels
360
Q

Venlafaxine, duloxetine, ddesvenlafaxine, levomilnacipran, milnacipram MOA

A

SNRI

361
Q

High potency 1st gen antipsychotics

A

Haloperidol and fluphenazine - more likely EPSE

362
Q

Low potency 1st gen antipsychotics

A

Chlorpormazine and thioradizine -more likely sedation (H1), orthostatic hypotension (Alpha 1), anticholinergic (muscarinic)SE

363
Q

11-beta hydroxylase deficiency (hypokalemic metabolic acidosis) : cortisol, renin, and aldosterone

A

Cortisol is low as 11-deoxycortisol can’t become cortisol -> Increased ACTH -> increased 11-deoxycorticosterone (MC) -> increased Na reabsorption -> HTN
Renin and aldosterone would be low as the pt is HTN

364
Q

What family of virus does RSV fall in?

A

Paramyxovirus - Negative sense ssRNA helical w/o envelope

365
Q

dsDNA, enveloped, icosahedral

A

Hepadnavirus-HBV

Herpes virus - HSV

366
Q

dsDNA, naked, icosahedral

A

Adenovirus - conjunctivitis, pharyngitis
Papillomavirus- warts
Polyomavirus- JC-progressive multifocal leukoencephalopathy (PML) in AIDS
BK-transplant pt, targets kidneys

367
Q

ssDNA, naked, icosahedral

A

Parvovirus- B19 targets RBC- hydrops fetalis or aplastic crisis in SCA

368
Q

Negative sense ssRNA, bullet shaped, enveloped virus

A

Rhabdovirus - Rabies

369
Q

Negative sense ssRNA, helical enveloped virus in kid w/ wheezes

A

Paramyxovirus - measles, mumps, parainfluenza-croup, and RSV

370
Q

Positive sense ssRNA, icosahedral, enveloped virus

A

Togavirus - Rubella, equine encephalitis
Flavivirus- Hep C, WNV, Dengue
Coronavirus - common cold, SERS
Retrovirus - HIV, HTLV

371
Q

Positive sense ssRNA, icosahedral, naked

A

Calicivirus - Norovirus

Picornavirus (PERCH) - Polio, echo, rhino, cocksackie, and HAV

372
Q

Picornaviruses (PERCH)

A 
Polio
Echo
Rhino
Cocksackie
HAV
373
Q

D-ALA dehydratase and ferrochetalase are affected

A

Lead poisoning - microcytic anemia, Basophilic stippling, GI and kidney dz

374
Q

Uroporphorinogen decarboxylase is affected

A

Porphyria cutanea tarda - blistering cutaneous photosensitivity

375
Q

Porphobilinogen deaminase is affected

A

Acute intermittent porphyria - Pnful abd, psycho disturbance, port wine stain, polyneuropathy

376
Q

D-ALA synthase is affected

A

Sideroblastic anemia (X-linked) or B6 (pyridoxine) deficiency

377
Q

What substrates accumulate in lead poisoning?

A

Protoporphyrin, D-ALA in the blood

378
Q

What substrates accumulate in acute intermittent porphyria?

A

Porphobilinogen, D-ALA, coporphobilinogen (urine)

379
Q

What substrates accumulate in porphyria cutanea tarda?

A

Uroporphyrin (tea colored pee)

380
Q

What is believed to be the cause of endometrial carcinoma in post-menopausal women? tX

A

Unopposed estrogen

Tx w/ estrogen combined with progesterone to dampen the effects of estrogen

381
Q

Diphenhydramine MOA and receptors affected

A

H1 blocker
anti-muscarinic
anti-alpha

382
Q

Why would diphenydramine cause vision issues?

A

anti-muscarinic properties cause mydriasis aggravating acute angle-closure glaucoma. Alpha block would cause miosis not mydriasis

383
Q

Things that can cause digoxin toxicity

A

Quinidine, amiodarone, verapamil - displace digoxin and decrease clearance
Hypokalemia

384
Q

Yellow vision, premature ventricular contractions, curved ST segment

A

Digoxin toxicity

385
Q

Kidney: Filter load equation

A

FL=GFR (L/day) X plasma concentration (mEq/L)

386
Q

Kidney: Fractional excretion equation

A

FE = Excretion rate (mEq/day)/ filtered load

mEq/day

387
Q

To get the fraction excreted

A

how much is secreted over how much is filtered - how much is in the plasma times the GFR

388
Q

Fluphenazine vs phenelzine

A

Fluphenazine - 2nd gen antipsychotic

phenelzine - MAOI

389
Q

Meperidine MOA

A

Opioid that also blocks 5HT reuptake. Can cause Serotonin syndrome when combined w/ MAOI

390
Q

What does partial emancipation at age 15 allow for?

A

STI screening and tx -including HIV
substance abuse tx
Prenatal care and birth control

391
Q

Agents that can cause lupus

A

Hydralazine - arteriole dilation
Procainamide - Class 1A anti-arrhythmic
INH - Prevents mycolic acid synthesis
Methyldopa - alpha 2 agonist (pregos)
Chlorpromazine - 1st gen low potency antipsychotic
Quinidine - Class 1A anti-arrhythmic
Minocycline - tetracycline
Terbinafine - Inhibits fungal squalene epoxide
Phenytoin - Anti-sz, blocks Na channels, also Class 1B antiarrhythmic
Sulfasalzine-Combo of sulfapyridine (anti-bx) and 5-aminosalicylic acid (anti-inflamm)

392
Q

Treating HTN and pt gets SLE, what drug. What if the pt is pregnant?

A

Hydralazine -arteriole vasodilator

Methyldopa- alpha 2 agonist -decrease adrenergic

393
Q

Treating an atrial arrythmia and the pt gets SLE, what if you were treating a ventricular arrhythmia post-MI

A

Class 1A anti-arrythmics
Quinidine or procainamide
Post-MI likely Class 1B - phenytoin

394
Q

Treating a tonic-clonic sz and pt gets SLE

A

Phenytoin

395
Q

Treating tuberculosis and pt gets SLE

A

Isoniazid

396
Q

Tx pt for schizophrenia and pt gets SLE

A

Chlorpromazine

397
Q

Tx for borrelia burgdorferi and pt gets SLE

A

minocycline

398
Q

Tx for onchomycosis (nail fungus) and pt gets SLE

A

Terbinafine

399
Q

Tx UC or Crohn dz and pt gets SLE

A

Sulfalazine

400
Q

The most common solid tumor in childhood

A

Wilms tumor not neuroblastoma appear the same on CT -heterogeneous

401
Q

3 Syndromes associated w/ Wilms tumor

A

Denys-Drash - gonadal dysgenesis, early-onset nephropathy
Beckwith-Wiedmann-organomegaly, macroglossia, hemihypertrophy, omphalocele
WAGR- WT, aniridia, GU malformation, retardation

402
Q

Acid fast organisms

A

Mycobacteria (TB, leprosy)
Nocardia
Cryptosporidium

403
Q

What characteristic is most important to the spread of cryptosporidium?

A

Resistance to Cl

404
Q

How do you tx Cryptosporidium parvum?

A

Nitozoxanide - healthy

Azithromycin - immunocompromised

405
Q

Posterior dislocation of the femur at the hip, what nerve is injured and what muscles would be weak?

A

Inferior gluteal n.

Loss of hip extension and lateral rotation of the thigh -gluteus maximus

406
Q

Superior gluteal n injury. What movement is affected and which muscles

A

gluteus medius, gluteus minimus, and tensor fascia latae

Abduction of the hip

407
Q

What characteristics of a protein make it more likely to be filtered?

A

small 7,000 Da

neutral - negative proteins get repelled by heparan

408
Q

Alpha-synuclein is found in what?

A

Lewy bodies

409
Q

Anemia compared to NL: CO, arterial PO2, Mixed venous PO2, 2,3-DPG

A

Right shift
CO increased to make up for low O2 delivery due to low Hgb
Arterial PO2 and arterial oxygen concentration -NL (independent of Hgb)
Mixed venous PO2 - increased O2 extraction by the tissues due to right shift
2,3-DPG increased to increased O2 extraction

410
Q

What is chylothorax?

A

Accumulation of lymph in pleural space

411
Q

Acute pleural masses w/ effusion w/ hx of installing fire-resistant tiles

A

Mesothelioma due to asbestos

Silicosis doesn’t have acute pleural masses or effusions

412
Q

What is a carbuncle?

A

Cluster of boils draining pus to the skin, S. Aureus. Neck, face, and chest, doesn’t persist for years

413
Q

What is a furuncle?

A

Painful boil due to hair follicle inflammation. Neck, face, and chest, doesn’t persist for years

414
Q

What is an erythrasma?

A

Scaling, fissuring, and maceration. Brown scaly superficial infxn

415
Q

What is hidradenitis suppuritiva

A

Local inflamm of apocrine sweat glands-> obstruction and rupture of ducts. Persists for decades. No abx

416
Q

What kind of hypersensitivity is contact dermatitis and what things are important to that kind of rxn?

A

Secretion of Th1 cytokines like IFN gamma and TNF-alpha

417
Q

Anti-microsomal Ab

A

Hashimoto’s thyroditis also anti-thyroglobulin

418
Q

What type of hypersensitivity is Hashimoto’s thyroiditis?

A

Type 4- T cells get sensitized to antigens

419
Q

Poultry processing worker w/ flu sx and elevated LFT, What dz and what tx

A

Chlamydophila psittaci

tx w/ tetracycline

420
Q

Hypothyroid w/ breast d/c. Is TRH or TSH low?

A

If there is breast d/c then PRL is being stimulated by TRH, so the hypothyroidism must be at the level of the pituitary, TSH is low, but TRH is high

421
Q

O father, B daughter, and A mother. What’s up?

A

Dad is not the father, could not have given B. Keep it simple

422
Q

Chemotaxis agents

A

C5A, LTB4, IL-8

423
Q

Cleft lip/palate, omphalocele, polydactyly, and cutis aplasia

A

Patau Syndrome Trisomy 13

424
Q

VACTERL is an association what does it stand for?

A 
Vertebral defects
Anal atresia
Cardiac defects
Tracheo-esophageal fistula
Renal anomalies
Limb anomalies
425
Q

Nontender GB, obstructive jaundice, and wt loss

A

Pancreatic adenocarcinoma at the head

426
Q

Greatest risk factor for pancreatitis

A

Smoking

427
Q

What happens to copper in the body?

A

In the liver it is incorporated into alpha2 globulin to form ceruloplasmin, which is then resecreted in the plasma

428
Q

How is copper eliminated?

A

Secreted into the bile and out through the stool

429
Q

RAS MAPK pathway

A

GF ligand binds receptor tyrosine kinase->autophosphorylation-> GTP binding->MAPK influencing gene expression in the nucleus

430
Q

How is RAS regulated?

A

RAS has its own GTPase to remove GTP so that too much RAS doesn’t build up. RAS mutations -> decreased GTPase activity -> more activated RAS

431
Q

Lost in desert for 3 days:

ADH, plasma osmolarity, and water excretion

A

ADH up
Plasma osmolarity up
water excretion down
Water continues to get lost even w/ low water excretion, so the plasma osmolarity increases w/ low volume and ADH increases to compensate

432
Q

Buprenorphine characteristics

A

Partial Mu agonist

433
Q

Why would using morphine not be effective after buprenorphine had been administered?

A

Buprenorphine is less efficacious as a partial agonist so it takes up receptors preventing morphine from having full effects

434
Q

HA, vision problems, frontal bossing, sausage fingers, diaphoresis, hypoglycemia, sx improve w/ octreotide

A

Acromegaly- excess GH

GH antgonizes insulin

435
Q

Professor has trouble speaking in front of people, NL in other situations

A

Social phobia-specific situations are stressful

436
Q

Complications of multiple myeloma

A

Frequent sever infxns (monoclonal plasma cells), renal failure, anemia, and neuro dz

437
Q

Pacemaker lead becomes dislodged into adjacent artery, which artery runs alongside the coronary sinus?

A

LCA - circumflex runs with coronary sinus

438
Q

What kind of lung dz is asbestosis?

A

Restrictive, FEV1/FVC is close to nl. Make sure to look at FEV1 and FVC in graphs

439
Q

Colicky RUQ pn, xanthomas, scleral icterus, hypercholesterolemia, prolonged PT, elevated conjugated bili, decreased Vit D

A

Extrahepatic cholestasis
Bile is not making it to the small intestine to help absorb fat soluble vitamins, Vit K, so you get prolonged PT, Low Vit D absorption
Too much bile so synthesis is turned off, cholesterol builds up in the liver, and LDL-R decrease

440
Q

Constant severe RUQ pn, fever, nausea, vomiting, elevated WBC, and slightly elevated LFTs

A

Acute cholecystitis -

stone lodged in the cystic duct

441
Q

Postprandial Colicky RUQ pn radiating to the rt shoulder, jaundice, and elevated alk phos, slightly elevated LFT

A

Choledochlithiasis -stone in CBD

442
Q

Choledocholithiasis vs cholecystitis

A

In the CBD the pn occurs after eating when CCK is secreted. In the cystic duct it hurts continually

443
Q

Leading cause of death in a AA male police officer age 25-34

A

Unintended accident, doesn’t matter that he’s a cop

444
Q

Leading cause of death in AA male age 15-24

A

Homicide

445
Q

Goal of Tx in Wolf-Parkinson White

A

Stop conduction of accessory pathway, not AV conduction-this will push more signal through accessory pathway

446
Q

Goal of txing Isolated supraventricular arrythmias

A

Block AV node so atrial arrythmia is not transferred to the ventricle

447
Q

Shortened PR interval, wide QRS, and delta wave

A

WPW- Myocyte loop in the bundle of Kent
Shortened PR interval as atria fire more quickly, ventricles start to fire sooner (delta wave) and the QRS gets lengthened due to the presence of multiple pathways

448
Q

What medications should be used to prevent v-fib in WPW?

A 
Class 1A - relatively nonselective (diffuse mycoytes) and dissociate slowly.
 Something that does not affect the AV node (rhythm control)
No class 2 or 4, digoxin, or adenosine
449
Q

Adenosine MOA

A

Increased K+ out of pacemaker cells leads to hyperpolarization. Slows AV conduction through pacemaker cells

450
Q

Digoxin CI in which heart pts

A

V-fib and WPW

451
Q

Digoxin MOA

A

Inhibits Na/K pump so Na and then Ca build up in the cell-> increased contractility
Stims vagus n to decrease HR at the AV node

452
Q

1st degree heart block

A

PR interval is lengthened, it takes longer for atrial depolarization has delay to ventricle

453
Q

Mobitz Type 1 Heart block (2nd degree)

A

The PR lengthens progressively until a beat is dropped and a QRS is not transmitted.

454
Q

Mobitz Type 2 Heart Block (2nd degree)

A

PR interval is constant and then there is a sudden dropped beat (no QRS)

455
Q

3rd degree heart block (complete)

A

Atria and ventricle beat independently. Possible w/ myomectomy

456
Q

Drugs that can exacerbate MG

A

aminoglycosides-decreased presynaptic release and decreased post-synaptic sensitivity

457
Q

Pregnant teen, what do you tell her

A

You can do prenatal care w/o informing pts, encourage to talk to parents, but don’t insist

458
Q

Alcoholism, anterograde amnesia, and confabulations

A

Korsakoff syndrome-neuropsych manifestation o Wernicke Encephalopathy
Lesion of the mamillary bodies

459
Q

Where is the lesion in Wernicke aphasia?

A

Superior temporal gyrus of the temporal lobe

460
Q

AL amyloidosis (primary or secondary) what disease is an example

A

AL amyloidosis is primary like multiple myeloma

Made up of Ig Light chains

461
Q

AA amyloidosis (primary or secondary) what dz is an example

A

Secondary amyloidosis

Chronic inflammatory dzs like RA, IBD. Fibrils made of Amyloid A

462
Q

Kappa, Lambda, and M proteins

A

Products of whole Ig released by plasma cells

Seen in primary amyloidosis and MM

463
Q

Multiple discrete lesions in the brain

A

Likely metastasis. Often located at gray-white jxn

464
Q

Limited oxygen uptake (peak oxygen uptake of 15 mL/kg/min) and increased bp during stress test indicate what?

A

The pt has stable HF/deconditioning. Fatigue is a direct result of deconditioning

465
Q

Tx for ischemic cardiomyopathy/stable HF/deconditioning

A

Closely monitored exercise regimen

466
Q

Posterior stab in the 8th ICS , hydropneumothorax w/ high TG

A

Thoracic duct injury- leaks TG

467
Q

Adrenal medulla vs. adrenal cortex

A

Medulla has glomerulosa, fasciculata, and reticularis

Cortex has NE and Epi

468
Q

Elderly person w/ pneumonia. Hypofxn of what endo organ prevents improvement?

A

Thyroid-hypothyroidism

Adrenal cortex-cortisol deficiency

469
Q

Kid w/ posterior fossa tumor and Rosenthal (corkscrew fibers)

A

Pilocytic astrocytoma also has pink blobs

470
Q

Kid w/ posterior fossa tumor, small blue cells and Homer-Wright rosettes

A

Medulloblastoma

471
Q

Radiodense bony spike covered with a radiolucent cap

A

Osteochondroma

472
Q

Arterial O2 saturation, what does it mean

A

The % of Hgb that is saturated. NL in anemia, as the Hgb available has Nl binding

473
Q

Arterial PO2, what does it mean

A

The partial pressure of O2 in the blood. Unaffected by Hgb. This is dissolved O2

474
Q

Arterial O2 content, what does it mean

A

It includes Hgb O2 saturation (saO2) and PaO2. Decreased in anemia

475
Q

Anemia: SaO2, PaO2, Arterial O2 content, venous O2

A

SaO2 - Nl, the available Hgb bin NLy
PaO2-NL independent of Hgb
Arterial O2 content - decreased as it depends on Hgb
Venous O2- decreased as more O2 will be extracted due to low Hgb

476
Q

What is similar and different btwn Squamous cell CA and keratoacanthoma?

A

Both: abnl epithelial maturation, acanthosis, loss of basal cell layer
Different: Keratoacanthomas have central crater (volcano)

477
Q

Low IFG binding protein, what will happen to IGF?

A

IGF will also be decreased. Low GH -> Low IGF and IGFBP

478
Q

Lethargy, constipation, depression, shortened QT, ocular band keratopathy, HTN, duodenal ulcer, and pancreatitis. What could be a cause?

A

Primary hyperPTH

All signs of hypercalcemia from PTH excess

479
Q

What condition is often associated with Meneire’s dz?

A

Permanent low frequency hearing loss

480
Q

Dry, yellowish skin, low pulse, and slow shallow respirations, low sodium, low glucose, high cholesterol. What hormone is deficient?

A

T4
Decreased cardiac stim
Decreased LDL-R
Decreased GFR

481
Q

What keeps RBF and GFR constant from 80 to 180 mmHG?

A

Changes in glomerular vascular resistance (constricting or dilating glomerular arterioles)

482
Q

Metoclopramide MOA

A

Increase tone, contractility, and motility
Facilitates cholinergic effect
D2-R block

483
Q

With what kind of vomiting would you use ondansetron?

A

Cancer chemotherapy and hyperemesis w/ pregnancy

5HT block

484
Q

Tx diabetic gastroparesis with?

A

Metoclopramide- D2-R blocker w/ cholinergic effect- facilitates motility

485
Q

MAP equation

A

MAP = SVR X CO

486
Q

Lymphocytes that are most increased in the blood in EBV are?

A

T cells attacking EBV

They are the atypical lymphocytes

487
Q

CYP450 Inhibitors -> increased drug level in blood

A 
Acute alcohol abuse
Ritonavir
Amiodarone
Cimetidine/ciprofloxacin
Ketoconazole
Sulfonamides
Isoniazid
Grapefruit
Quinidine
Macrolides (erythro and clarithromycin)
488
Q

CYP450 Inducers

A 
Chronic alcoholics
St Johns wort
Phenytoin
Phenobarbital
Nevirapine
Rifampin
Griseofulvin
Carbamazepine
489
Q

Nizatadine MOA

A

H2 blocker used for GERD. No CYP450 interaction like cimetidine

490
Q

Sucralfate MOA

A

Form polymer that protects stomach from acid. Not compatible w/ acid lowering meds. It needs the acidic environment

491
Q

What type of selection? T cells w/ thymic cortical epithelial cells.

A

Positive selection in the cortex, must have affinity for self-MHC

492
Q

What type of selection? T cells w/ thymic medullary epithelial and DC.

A

Negative selection in the medulla, not too strong an affinity for self-MHC

493
Q

How does INH lead to microcytic, sideroblastic anemia?

A

INH decreases B6, which is a cofactor for D-ALA synthase. Low D-ALA synthase means low production of heme and the iron builds inside the RBC

494
Q

Poor Plt aggregation in the presence of ristocetin

A

VWF deficiency. Ristocetin activates Gp1 for NL VWF to bind. low VWF leads to low aggregation

495
Q

What does GpIIb/IIIa bind to?

A

Binds to fibrinogen, which can bind to another Plt via gpIIb/IIIa

496
Q

Lithium SE

A

Hypothyroidism
Nephrogenic DI
Tremor
Ebstein anomaly- atrialization of RV

497
Q

Valproate SE

A

NTD

hepatotoxicity

498
Q

Carbamazepine SE

A

Agranulocytosis
SIADH
NTD

499
Q

Lamotrigine SE

A

Steven-Johnson syndrome

benign rash

500
Q

Fxn of the proteasome

A

Recycle proteins, breakdown apoptotic proteins

501
Q

Bortezomib MOA

A

Boronic acid dipeptide that inhbits the proteasome -> increased pro-apoptotic proteins and toxic proteins-> apoptosis

502
Q

Severe hypoplasia of erythroid precursors w. NL granulopoeisis and thrombopoiesis

A

Pure red cell aplasia
Caused by thymomas
lymphocytic leukemia, and parvovirus B19

503
Q

What occurs in the nucleolus?

A

Ribosomal subunit maturation and assembly

504
Q

Which RNA Polymerase fxns exclusively in the nucleolus

A

RNA Pol I - transcibre 45S pre-rRNA gene that codes for most of the RNA components

505
Q

RNA Pol II synthesizes what?

A

mRNA
snRNA
miRNA
most highly regulated of the RNA polymerases

506
Q

RNA polymerase III synthesizes what>

A

tRNA and 5s rRNA (genes of this part of rRNA are made outside the nucleus)

507
Q

Cause of megaloblastic anemia in chronic alcoholic?

A

Diminished thymidine synthesis due to folic acid and B12 deficiency ( also deficient due to pancreatitis)

508
Q

Citalopram MOA

A

SSRI

509
Q

Bupropion MOA

A

NDRI- smoking cessation and MDD. Not used for GAD

510
Q

Buspirone tx what

A

Tx GAD. 5HT activator

511
Q

SE of olanzapine and clozapine

A

Metabolic - wt gain, dyslipidemia, hyperglycemia, increased risk of diabetes

512
Q

Cloazpine 1% SE

A

Agranulocytosis, not seen w/ olanzapine

513
Q

Mycoplasma pneumonia and cold agglutinins whats the link?

A

Mycoplasma has antigen in cell membrane that is similar to I antigen in RBC membranes, cross-rxn occurs w/ IgM (cold agglutinins)

514
Q

Tx of alcoholism

A

Disulfiram- inhibits aldehyde dehydrogenase leading to build up of aldehydes, which makes you feel sick
Acamprosate - Modulates glutamate at NMDA-R (once abstinent)
Naltrexone- block mu opioid-R inhibiting rewarding effects

515
Q

PR interval 0.09

widened QRS

A

WPW, short PR and wide QRS

Nl PR interval is <200 ms

516
Q

QRS complexes followed by inverted P waves?

A

AV reentry tachycardia due to WPW. signal travels down AV node and back up Bundle of Kent to the atrium, where the atria are stimulated after the ventricles in retrograde fashion-Inverted P

517
Q

Bx reducing nitrate to nitrite means what?

A

Oxidase negative bacteria

enterobacteria. Don’t use oxidative phosphorylation

518
Q

Pseudomonas makes what?

A

glycocalyx and blue-green pigment pyocyanin

Encapsulated organism

519
Q

Why would opioid administration cause RUQ pn?

A

Contracts smooth muscle of sphincter of Oddi (spasm) increasing CBD and GB pressure. Opioids inhibit release of Ach

520
Q

b/l lens opacities in a kid w/o other sx

A

Galactokinase deficiency-> increased galactitol, which accumulates in the lens

521
Q

Rhabditiform larvae in the stool and eggs and adult parasites on an intestinal biopsy. Tx?

A

Strongyloides stercoralis

Tx w/ ivermectin

522
Q

Parasite eggs in the stool?

A

Schistosoma mansoni or japonicum

523
Q

Perianal egg deposition?

A

Enterobius vermicularis (scotch tape) Pinworms

524
Q

Proglottids in the stool

A 
Intestinal tapeworms (flatworms) made of multiple segments (proglottids)
Taenia solium, T saginata, and diphyllobothrium lata
525
Q

Trophozoites and cysts in the stool

A

Giardia lamblia and entamoeba histolytica

526
Q

Oxidase +, Gram -, comma shaped rods that can survive on alkaline media

A

Vibrio cholera

527
Q

S-shaped, motile, gram -, oxidase + rod, grows at 42 degrees

A

C. jejuni

microaerophilic and thermophilic

528
Q

Most likely hepatitis from sexual transmission

A

HBV more commonly than HCV (usually asx and not very efficient sexual transmission)-more commonly IVDU

529
Q

Serum sickness-like syndrome: joint pain lymphadenopathy, pruritic urticarial rash, RUQ pn, hepatomegaly, elevated LFTs

A

HBV

HCV is usually asx and transmitted by IVDU, less commonly sex

530
Q

Asterixis

A

flapping tremor commonly seen in cirrhosis

531
Q

Elevated LFTs mean what?

A

Hepatocyte injury

532
Q

Elevated alk phos and GGT (gamma glutamyl peptidase) mean what?

A

Biliary injury or cholestasis

533
Q

Elevated bilirubin means what?

A

Impaired transport and metabolic capacity

534
Q

Elevated PT time and hypoalbuminemia mean what?

A

Impaired biosynthetic capacity

535
Q

What labs predict prognosis in cirrhosis?

A

Indicators of liver fxn
Low albumin
Prolonged PT
Elevated bilirubin

536
Q

Glutamine-glutamatae cycle w/ hyperammonemia

A

Nl: astrocyte takes up glutamate from the synapse (preventing excess excitation) and ammonia from the blood to make glutamine via glutamine synthase
Too much ammonia causes accumulation of glutamine and swelling of the astrocyte so it no longer takes up glutamate -> excess excitation (asterixis)

537
Q

What do amatoxins in poisonous mushrooms do?

A

Inhibit RNA polymerase II (mRNA)

538
Q

Colonoscopy- multiple polypoidal, hemorrhagic lesions.

Biopsy-spindle cells w/ surrounding blood vessel proliferation

A

Kaposi’s sarcoma

539
Q

Colonoscopy: non-ulcerative inflammation
Biopsy: basophilic cluster seen on the surface of intestinal mucosal cells

A

Cyptosporidium

540
Q

Ribavirin MOA

A
  1. Hypermutation during RNA dependent RNA replication
  2. Direct inhibition of HCV RNA polymerase by ribavirin triphosphate
  3. Inhibit IMP dehydrogenase
  4. Defective 5’ cap formation
  5. Enhance Th1>Th2 for more effective immune response
541
Q

Why does signet ring gastric adenocarcinoma have diffuse infiltration?

A

Loss of E-cadherin

linitis plastica

542
Q

HypoPTH - where is phos reabsorption increased and the absorption of Ca decreased

A

Phos has increased reabsorption in the PCT, so phos increases
Ca is not reabsorbed in the Distal convoluted tubule so Ca decreases

543
Q

Why would uric acid stones form in a pt who has an ileostomy and is dehydrated and has chronic diarrhea?

A

Dehydration and chronic diarrhea lead to decreased HCO3 reabsorption from the gut, kidney excretes more H+ and reabsorbs more HCO3. So the tubule becomes acidic allowing for the formation of uric acid crystals

544
Q

What type of cell does renal cell carcinoma originate from?

A

Epithelial cells of the proximal convoluted tubule

545
Q

4 y/o girl, colicky abd pn, vomiting, and loose bloody stools. Red urine, anemic, thrombocytopenia

A

Hemolytic uremic syndrome like due to O157:H7

546
Q

What is the mechanism of AKI in HUS?

A

Shig toxin injures endothelium of preglomerular arterioles -> Plt activation and microthrombi

547
Q

HUS triad

A

Microangipathic hemolytic anemia
thrombocytopenia
Acute kidney injury (microthrobi in the renal vasculature)

548
Q

Henloch Schonlein Purpura presentation

A

Abd pn, palpable purpura, arthralgias, acute glomerulonephritis, Nl Plt and coagulation studies

549
Q

Non-lactose fermenting gram - rod causing pyelonephritis in a man w/ urinary catheter

A

Psuedomonas aeruginosa - Oxidase +

550
Q

Enterobacter cloacae, What is it?

A

Gram - rod, lactose fermenter, extensive abx resistance

551
Q

What does increased selective filtration of proteins mean in the kidney?

A

Increased filtration of proteins, ignore selective. It means more protein is filtered due to foot process effacement

552
Q

Sodium cyanide-nitroprusside test on the urine, what dx?

A

Cystinuria

Detects cystine in the urine

553
Q

How is digoxin eliminated?

A

Renally, decreased clearance in elderly

554
Q

What do anti-phospholipid Ab due to coagulation studies?

A

Prolong PTT on lab test, but the pt is actually hypercoagulable

555
Q

What causes muscle weakness and cramps in pt taking chlorthalidone?

A

Hypokalemia from thiazide diuretic. Also, causes metabolic alkalosis. Does not effect phosphate

556
Q

Where are the JG cells?

A

The JG cells are modified smooth muscle cells around the afferent arteriole that secrete renin when stimulated by macula densa cells that surround the DCT

557
Q

Which arteriole is affected by the RAAS system?

A

The efferent arteriole. Don’t get confused that JG cells are around the afferent arteriole and secrete renin

558
Q

Multiple injuries in MVA gets txed w/ a diuretic and develops pulmonary edema, what was the med?

A

Mannitol. helps decrease cerebral edema by drawing fluid into the vasculature. If too aggressive the fluid will start to leak in the lungs and cause pulmonary edema

559
Q

Bumetanide MOA

A

Loop diuretic

560
Q

Clinical manifestations of schistomosiasis result from what immune response

A

Th2 granulomatous response to the eggs-> marked fibrosis, ulceration and scarring of the bladder or bowel

561
Q

Where else can shistosoma deposit in the body besides the bladder?

A

Presinusoidal radicals of the portal vein -> periportal “pipestem” fibrosis

562
Q

DM1, Inability to sense a full bladder, difficult starting and maintaining urine, nocturnal enuresis? What kind of incontinence and what other finding?

A

Overflow incontinence

Increased post-void residual volume

563
Q

What causes overflow incontinence in a DM1?

A

DM autonomic neuropathy
impaired detrusor contractility
Loss of autonomic afferents telling the brain the bladder is full

564
Q

What does increased post-void residual volume tell you?

A

Weak detrusor contraction

565
Q

What kind of depression should you definitely use MAOI for?

A

Treatment resistant Atypical depression - increased appetite and sleep, leaden paralysis, mood reactivity, and rejection sensitivity.

566
Q

Increased urinary frequency and not controlling urge to urinate w/ MS and other UMN signs

A

Urge incontinence - overactive or spastic bladder

567
Q

Urodynamic studies of urge incontinence in MS

A

Little or no urine after void. Nl contraction, but poor distensability -

568
Q

Why does the bladder have poor ability to distend in MS?

A

Loss of descending inhibitory control from UMN. Once it starts to fill it is hyperreactive and contracts the detrusor.

569
Q

Earliest manifestation of diabetic nephropathy

A

Microalbuminuria, glycosuria comes later

570
Q

What happens to the kidneys w/ acyclovir tx?

A

Acyclovir gets concentrated in the collecting duct and forms crystals causing renal tubular damage

571
Q

How do you prevent nephrotoxicity from acyclovir?

A

Aggressive IV hydration

572
Q

What does acidosis cause in the kidney?

A

Stimulates renal ammoniagenesis
Renal tubular epithelial cells take glutamine and make ammonium and bicarb (CO2 comes from alpha ketoglutarate as it gets broken down, which acts against the acidosis)

573
Q

Skin biopsy- scattered areas of fibrinoid necrosis and neutrophil infiltration involving small blood vessels

A

Serum sickness - Type III hypersensitivity

Also hypocomplement, low C3 and C4

574
Q

Signs of serum sickness

A

Fever, pruritic skin rash,and arthralgias 7-14 after antigen exposure

575
Q

Causes of serum sickness

A

chimeric mabs -rituximab and inflixamab
nonhuman Ig - venom antitoxins
Non protein drugs - TMP/SMX, penicillin

576
Q

Ankylosing spondylitis complications of: respiratory, cardio, eye

A

Respiratory: costovertebral and costernal jxn enthesopathies can limit chest wall expansion
Cardio: ascending aortitis
Eye: Anterior uveitis

577
Q

What should be monitored to track disease progression in ankylosing spondylitis?

A

Chest wall expansion

578
Q

Drug induced lupus is more common in what kind of pt?

A

Slow acetylators

579
Q

What drugs commonly cause drug induce SLE in slow acetylators?

A

INH
procainamide
Hydralazine

580
Q

Acute right knee pain with swelling and redness that has happened before, polycythemia vera. What would you see in the synovial fluid?

A

Monosodium urate crystals -Gout- polycythemia vera (myeloproliferative disorder will increase urate production predisposing to gout)

581
Q

Synovium shows numerous RBCs, nontraumatic

A

Hemophilia or pts taking warfarin

582
Q

mab to Il-6

A

Tocilizumab

583
Q

Ab to myeloperoxidase and proteinase-3

A

ANCA associated vasculitides

584
Q

B cell activating factor belongs to what family

A

TNF family

585
Q

Muscle biopsy: transmural inflammation of mid-sized arteries w/ areas of amorphous, eosin-staining arterial wall necrosis (fibrinoid necrosis), and internal elastica lamina disruption

A

Polyartertitis nodosa

586
Q

What is the most likely predisposing factor for PAN?

A

HBV infxn

587
Q

Nervous system clinical features of PAN

A

Mononeuritis multiplex

588
Q

2 mo baby, progressives floppiness and poor feeding, sleepy, constipated, large anterior fontanelle, large tongue, reducible umbilical hernia

A

Congenital hypothyroidism

589
Q

What dz process in mom is associated w/ caudal regression syndrome?

A

Uncontrolled DM

agenesis of sacrum and lumbar spine, LE paralysis

590
Q

Action of supraspinatus and innervation

A

Abduction (initiates)

suprascapular n.

591
Q

Action of infraspinatus and innervation

A

External rotation

suprascapular n.

592
Q

Action of teres minor

A

Adduction and external rotation

Axillary n.

593
Q

Action of subscapularis and innervation

A

Adduction and internal rotation

upper and lower subscapular n.

594
Q

Anteromedial displacement of supracondylar humeral fracture. What n. is injured?

A

median n. crosses over anteromedial aspect of humerus

595
Q

Anterolateral displacement of supracondylar humeral fracture. What n. is injured?

A

Radial n. crosses anterolateral aspect of humerus

596
Q

Medication given in gout that selectively binds to an Il-1 inducible enzyme highly expressed by inflammatory cells exclusively

A

Cox-2 inhibitor - celecoxib
Also induced by TNF-alpha
Preferred if pt has PUD

597
Q

Which Cox is secreted by all cells and which one is only secreted by inflammatory cells?

A

Cox-1 -all cells used for housekeeping fxns

Cox-2 secreted by inflammatory cells after being induced by Il-1 and TNF -alpha

598
Q

What will parvovirus in a kid look like?

A

Slapped cheek-bright red rash on the cheeks w/ circumoral pallor and fever
Generalized reticular rash on trunk, arms, and legs
Erythema infectiosum

599
Q

Parvovirus in an adult

A

Acute arthropathy
Symmetric polyarthritis
RA-like

600
Q 
Sarcomere: 
H band
A band 
M line
I band
Z line
A

H- myosin only (heavy chain)-shrinks
A- all myosin including overlap w/ actin (heavy chain)-constant length
M- Where the myosin anchors to structural filaments
I- Actin only (light chain)- shrinks
Z- Where actin binds structural elements (Z-Z shrinks)

601
Q

Difficulty combing hair, endomysial mononuclear infiltrate, patchy muscle fiber fibrosis, what dz and what Ab

A

Polymyositis
ANA
Anti-Jo-1 = anti-histidyl tRNA synthase

602
Q

What enzymes are increased in polymyositis?

A

Creatinine kinase

Aldolase

603
Q

Anti-mitochondrial Ab

A

Primary biliary cirrhosis-pruritus, jaundice, diarrhea

604
Q

Anti-smooth muscle Ab

A

Autoimmune hepatitis - middle aged women w/ chronic progressive hepatitis

605
Q

Anti-CCP (most specific) and Anti-IgG Ab

A

Rheumatoid arthritis

Inflammation causes arginine to be converted to citrulline. The citrullinated proteins trigger immune response

606
Q

Anti-centromere Ab

A 
CREST syndrome
C-calcinosis
Raynaud phenomenon
Esophageal dysmotility
Sclerodactyl
Telangiectasia
607
Q

Anti-dsDNA

A

SLE (specific)

608
Q

3 drugs that decrease bone formation

A

Glucocorticoids
unfractionated heparin
Thiazolidinediones

609
Q

Drug that decreases calcium absorption

A

Long term PPI

610
Q

Drugs that increase Vit D catabolism via CYP450 induction

A

Phenobarbital
phenytoin
carbamazepine

611
Q

New back pain, fever, recent endocarditis or bacteremia. What is it and what is the initial evaluation?

A

Vertebral osteomyelitis

Blood cultures and spinal MRI to visualize the bacteria

612
Q

3 phases of Lyme dz

A

Early: Erythrema chronicum migrans (bulls eye)
Early disseminated: facial palsy and AV nodal block
Late (mo or yrs) asymmetric arthritis or subacute encephalopathy

613
Q

Tx of lyme dz

A

Doxycylcine or ceftriaxone

614
Q

Osteoid matrix accumulation around trabeculae

A

Vit D deficiency

Increased osteoid w/o mineralization

615
Q

Trabecular thinning w/ fewer interconnections

A

Osteoporosis-decrease in osteoblasts and increase in osteoclasts

616
Q

Subperiosteal resorption w/ cystic degeneration

A

HyperPTH- subperiosteal thinning is classic

617
Q

Lamellar bone structure resembling a mosaic

A

Paget’s dz

Irregular sections of bone linked by cement lines

618
Q

Spongiosa filling the medullary canal w/ no mature trabeculae

A

Osteopetrosis-defective osteoclasts, CA mutation

Too much osteoblast activity

619
Q

What does digital clubbing signify?

A 
Chronic hypoxemia
Large cell lung CA
TB
CF 
Empyema
Bronchiectasis
Chronic lung abscess
620
Q

Adverse effects of succinylcholine

A

Malignant hyperthermia
Severe hyperkalemia - burns, crush injuries, and denervation- upregulated AchR during stage II block -> increased K efflux
Bradycardia or tachycardia

621
Q

Which class I antiarrhythmics prefer activated or inactivated cells?

A 
All 3 types of class I prefer activated or inactivated.
Class Ib prefers ischemic, because it is slower to go to resting and it has the fastes dissociation
622
Q

What cell jxn uses connexins?

A

Gap junctions-connects

623
Q

What cell jxn uses claudins and occludins?

A

Tight junctions-occludes

624
Q

What cell junctions use cadherins?

A

Adherens junctions and desmosmomes

Adhere cells together

625
Q

What cells jxn uses integrins?

A

Hemidesmosomes-integrates cell into BM

626
Q

Atypical cells infiltrating the nipple skin

A

Paget dz of the nipple-ductal spread of malignant cells

627
Q

Cysts lined by metaplastic aprocrine cells

A

Fibrocystic change of the breast

628
Q

Liquefactive necrosis of the adipocytes w/ hemorrhage

A

Fat necrosis due to trauma

629
Q

Stroml proliferation compressing the ducts to slits

A

Fibroadenoma

630
Q

Papillary cells w/ fibrovascular core

A

Intraductal papilloma

blood d/c due to twisting of vascular stalk of the papilloma in the duct

631
Q

Benign myometrial smooth muscle cell proliferation

A

leiomyoma-uterus irregularly enlarged. irregular bleeding

632
Q

Blastocyst implantation in the fallopian tube

A

Ectopic pregnancy
+ pregnancy test
Amenorrhea w/ or w/o abd pn

633
Q

Endometrial tissue in the myometrium, uniformly enlarged uterus, secretory endometrium

A

Adenomyosis-middle aged parous females w/ heavy menstrual bleeding
Secretory endometrium is a NL finding

634
Q

Hyperplastic growth of tissue from endometrial surface

A

Endometrial polyps

635
Q

Greater increase in endometrial gland proliferation compared to the stroma

A

Endometrial hyperplasia-irregular but not painful menstrual bleed

636
Q

Fever, abd pn, uterine tenderness, foul-smelling d/c after pregnancy termination

A

Septic abortion

Instrumentation S. Aureus and E. coli

637
Q

Edema: capillary hydrostatic pressure, plasma oncotic pressure, sodium and water and lymphatics

A 
More fluid in the capillaries, increases volue and dilutes osmolarity
Increased capillary hydrostatic pressure
Decreased plasma oncotic pressure
Na and H20 retention
Lymphatic obstruction
638
Q

If there is increased CVP what prevents peripheral edema?

A

Lymphatic drainage works against edema until it becomes overrun

639
Q

Clomiphene MOA

A

Blocks estrogen-R in the hypothalamus so pituitary continues to produce FSH and LH -> promotes fertility in PCOS

640
Q

PCOS tx for pt wanting pregnancy and not wanting pregnancy

A

Pregnancy- clomiphene to stim FSH and LH

Non-pregnancy - Estrogen and progestin OC-reduced androgens and endometrial proliferation

641
Q

Where will blood pool if you puncture the common femoral artery above the inguinal ligament?

A

It will pool in the retroperitoneum.The vessel sits just under the peritoneum

642
Q

Sebaceous glands in acne are what kind of glands?

A

Holocrine glands

643
Q

Salivary and eccrine glands are what kind of glands?

A

Merocrine

644
Q

DCIS ductal carcinoma in situ looks like

A

Swollen mushroom hat

645
Q

Breast: orderly row of cells due to decrease E-cadherin

A

Invasive Lobular carcinoma

646
Q

15 yo female w/ amenorrhea, fully developed secondary sexual characteristics (pubic hair), shortened vaginal canal w/ rudimentary uterus

A

Mullerian aplasia
Mayer-Rokitansky-Kuster-Hauser
No upper vagina (short vagina)
Variable uterus and NL ovaries

647
Q

Does androgen insensitivity have a uterus?

A

No uterus, XY, Mullerian duct is degraded

648
Q

Vagina has what kind of cells

A

Squamous epithelial cells

649
Q

Cervix has what kind of cells

A

Ectocervix-squamoues

Endocervix-columnar

650
Q

Fallopian tube has what kind of cells?

A

Columnar w/ cilia

651
Q

Ovaries have what kind of cells?

A

Cuboidal (germinal) rapidly proliferate

652
Q

Hemosiderin deposits and endometrial glands or stroma outside the uterus

A

Endometriosis

653
Q

Most important risk factor for intimal tears like aortic dissection

A

HTN

654
Q

Copious green vaginal discharge burning on urination w/o CMT

A

Trichomonas vaginalis

655
Q

How to confirm trichomonas vaginalis?

A

Saline microscopy- wet mount to identify trichomonads

656
Q

What do you use cervial cytology to identify?

A

HPV

657
Q

KOH test reveal what?

A

Amine-whiff test confirms gardnerella vaginosis

658
Q

How do combined OC prevent pregnancy?

A

Reduce gonadotropin levels

prevent LH spike

659
Q

How do locally acting progestins prevent pregnancy?

A

Thickens cervical mucus and impair sperm penetration

660
Q

Common dermal finding of ulcerative colitis

A

Erythema nodosum

Pyoderma gangrenosum

661
Q

Derm findings of DM

A

skin tags, acanthosis nigricans, and necrobiosis lipoidica diabeticorum

662
Q

How does INH lead to sensory ataxia and decreased pain sensation in the distal extremities

A

INH decreasese B6, which is a part of the synthesis of NT

663
Q

Deficiency of methylmalonyl-CoA mutase

A

Lethargy, vomiting, tachypnea of the newborn,

Hyperammonemia, ketotic hypoeglycemia, and metabolic acidosis

664
Q

Elevated urine methylmalonic acid and propionic acid

A

Methylmalonic acidemia

665
Q

Pathway for Threonine, methionine, valine, and isoleucine to enter TCA

A

All converted to propionyl CoA-> methylmalonyl CoA via propionyl CoA carboxylase w/ biotin (CO2)
Methylmaonyl CoA goes to succinyl CoA via methylmalonyl CoA mutase w/ Vit B12. Succinyl Coa cna enter TCA

666
Q

Where is atrophy most pronounced in Alzheimer’s dz?

A

Temporoparietal lobes and hippocampus

667
Q

Clasp-knife spasticity, what is it?

A

Initial resistance to passive extension followed by a sudden release of resistance

668
Q

What does clasp-knife spasticity mean?

A

UMN lesion

669
Q

Internal capsule stroke would have what signs?

A

Pure motor weakness affecting the c/l arm, leg, and lower face, c/l clasp-knife spasticity and hyperreflexia

670
Q

Putamen lesion signs

A

C/l tremor, bradykinesia, and rigidity

671
Q

Globus pallidus external segment lesion

A

Decreased movement, external segment inhibits STN which stims Gpi to inhibit the thalamus
Gpe Lesion: STN is not inhibited so it stims Gpi to inhibit the thalamus. no motion

672
Q

Globus palidus internal segment lesion

A

Excessive movement

Internal segment inhibits thalamus, so lesion would disinhibit thalamus

673
Q

Direct pathway does what to Gpi?

A

Inhibits Gpi-> disinhibits thalamus to move

674
Q

Indirect pathway does what to Gpi?

A

Decreases stim of Gpi-> disinhibits thalamus to move

675
Q

Direct pathway of basal ganglia

A

Substantia nigra -> increase (+) putamen -> increase (-) Gpi -> decrease (-) thalamus -> motion

676
Q

Indirect pathway of basal ganglia

A

Substantia nigra -> increase (-) putamen -> decrease (-) Gpe -> increase (-) STN -> decrease (+) Gpi -> decrease (-) Thalamus

677
Q

Spastic diplegia, growth delay, frequent choreoathetoid movements

A

Arginase deficiency - Increase urea and ornithine from arginine

678
Q

What is the adrenergic receptor on the uterus?

A

B2 agonists relax uterine muscle

679
Q

What nerves innervates the external genitalia, the perineum, and the anus ?

A

Pudendal n.

680
Q

What nerve innervates the pelvic floor muscles, external anal and urethral sphincters

A

Pudendal n.

681
Q

Fecal and urinary incontinence following prolonged delivery due to what?

A

Pudendal n. stretch

682
Q

Horner’s syndrome w/ u/l arm pn

A

Pancoast tumor

683
Q

Which RNA polymerase is responsible for many mistakes in HCV?

A

RNA Pol III

Decreased 3’-5’ exonuclease proofreading

684
Q

Prevent cerebral vasospasm following SAH w/ what med?

A

Nimodipine (CCB)

685
Q

AchE in the amniotic fluid means what?

A

NTD, AchE and AFP are leaking out of the CSF

686
Q

Tetrodotoxin MOA

A

Binds NA channels in nerve and cardiac cells. Flaccid paralysis

687
Q

Tx of tetrodotoxin

A

Gut lavage and charcoal

688
Q

What immune cells protect from local candidiasis?

A

T cells

689
Q

What immune cells protect from systemic candidiasis?

A

Neutrophils

690
Q

Result of Liddle Syndrome

A 
Gain of fxn of ENaC in collecting duct
HTN
Hypokalemia
Metabolic alkalosis
Low aldosterone
691
Q

ENac in collecting duct is constitutively turned on, what will be the level of aldosterone and the tx

A

Aldosterone will be low as Liddle syndrome acts like hyperaldosteronism, so RAAS is turned down
Tx w/ amiloride, which blocks ENac

692
Q

What is in the capsule of pseudomonas?

A

P. aeruginosa has exopolysaccharide capsule (alginate)

693
Q

What does alginate form pseudomonas do?

A

Inhibits ciliary clearance, allows for bacteria to adhere to one another and prevents phagocytosis. Ab to alginate do not clear it

694
Q

X, Y, and Z in the kidney, the plasma conc is increased, The clearance changes with constant GFR: X up, Y constant, Z down. What are the substances

A

X- As glucose plasma conc increases the glucose transporter becomes saturated (limited reabsorption) and more glucose gets filtered
Y- Inulin, not secreted or reabsorbed, independent of plasma concentration, only depends on GFR
Z- PAH, secreted into the lumen, when plasma conc increases the secretion transporter gets saturated and clearance decreases

695
Q

What part of the esophagus is affected in dermatomyositis?

A

Upper 1/3 of the esophagus. Preference for striated muscle under voluntary control

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