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Step Random Tidbits > Step Random Tidbits > Flashcards

Step Random Tidbits Flashcards

1
Q

What residues are hydroxylated in the RER during collagen synthesis?

A

Proline, lysine

Vitamin C is cofactor

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2
Q

Function of teres minor

A

SITS muscle

Adduction, external rotation

Axillary nerve innervation

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3
Q

Where do the right and left ovarian vein flow to?

A

Right ovarian vein feeds into the IVC

Left ovarian vein feeds into the left renal vein

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4
Q

Culture negative endocarditis

Organism also causes bacilliary angiomatosis in immunocomprimised

A

Bartonella Henselae

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5
Q

Mutations in transthyretin result in

A

hereditary cardiac amyloidosis –> infiltrative cardiomyopathy

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6
Q

HLA Subtype associates with what disease?

DR4

A

Rheumatoid arthritis

DM type I (also DR3)

Addison disease (also B8, DR3)

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7
Q

DPCC is a major component of:

A

pulmonary surfactant

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8
Q

What do these have in common?

S. pneumoniae

Haemophilus influenzae

Neisseria meningitidis

Salmonella typhi

Group B strep

A

Encapsulated

risk of infection in SCD post autosplenectomy

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9
Q

When does acute rejection occur?

A

1-4 weeks dense infiltrate of mostly T cells (against foreign MHC)

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10
Q

Basket weave pattern of media of large arteries

A

cystic medial degeneration –> aneurysm Marfan syndrome

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11
Q

Embryonic vitelline veins become:

A

the portal system

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12
Q

Damage to optic nerve

Effect on pupillary light reflex

A

Light in affected eye –> no response in either eye

Light in unaffected eye –> both eyes constrict (motor pathways are intact)

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13
Q

HLA Subtype associates with what disease?

DR5

A

Pernicious anemia

Hashimoto thyroiditis (also DR3)

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14
Q

Larger VSDs present with:

A

Softer murmurs bc the pressure gradient is not there

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15
Q

Prior to fertilization, secondary oocytes are arrested in what cell cycle phase?

A

Metaphase of meiosis II

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16
Q

Where is the SA node?

A

Junction of the SVC and RA

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17
Q

What is the difference between binge eating disorder and bulemia?

A

Binge eating disorder has no compensatory behaviors ie vomiting or fasting or excessive exercise

Bulemia - binges and compensations have to happen at least once a week for 3 months

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18
Q

CV complications w/ Down syndrome

A

Endocardial cushion defects (ie ostium primum ASDs, regurgitant AV valves)

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19
Q

Armadillos are a reservoir for:

A

Mycobacterium leprae

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20
Q

Two main anomalies presenting with cyanosis at birth:

A

Tetralogy of Fallot

Transposition of the great arteries

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21
Q

Peaked T waves on EKG indicate

A

Localized hyperkalemia

First sign of MI

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22
Q

How to treat acute dystonia?

A

Meds w/ M1 receptor antagonism,

ie benztropine, diphenhydramine

restore dopaminergic-cholinergic balance

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23
Q

What antibiotic that works by inhibiting protein synthesis can also be used to improve GI motility?

A

Erythromycin activates motilin receptors

Macrolide binds to 23S of 50S

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24
Q

Crescent shaped hematoma on CT

A

Subdural hematoma

Bridging cortical veins

Between dura and arachnoid

Gradual onset HA and confusion

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25
Q

Most common cardiac complications of Marfan syndrome

A

MVP

Cystic medial degeneration of the aorta

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26
Q

ST elevation in V1-V4 suggests MI where:

A

LAD

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27
Q

De novo mutations in MECP2 gene associated with

A

Rett Syndrome

MECP2 on X chromosome

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28
Q

“Pipestem” fibrosis of portal vein

A

Hepatic schistosomiasis

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29
Q

A single episode of severe vertigo but no hearing loss that can last for days is:

A

Vestibular neuritis aka labyrinthitis

viral or post viral inflammation of the vestibular nerve

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30
Q

Pathophys behind Crohn’s and gallstones

A

terminal ileum inflamed –> bile acids not reabsorbed –> cholesterol:bile ratio up –> stones

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31
Q

Probe used in Western blot

A

Antibody

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32
Q

Associated cranial nerve and derivative with pharyngeal and aortic arch 2

A

Facial nerve;

Stapedial artery (regresses)

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33
Q

Function of IL-4

A

Secreted by Th2

Induces more differentiation to Th2 Class switching

promotion to IgE and IgG

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34
Q

Steps in nucleotide excision repair:

A

Endonuclease nicks both sides of the damage (on 1 strand)

DNA polymerase makes new DNA in the place of the damaged DNA

DNA ligase seals

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35
Q

beta-1 receptor stimulation has what effect?

A

increase cAMP –> increase contractility Norepi adrenergic Gs

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36
Q

Gene involved in medullary thyroid cancer

A

RET

proto-onco gene codes for tyrosine kinase receptor in both MEN type 2 syndromes and sporadic medullary thyroid cancer

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37
Q

Culture Neisseria gonorrhoeae on:

A

Thayer-Martin VCN medium

selective

Vancomycin Colistin Nystatin Trimethoprim

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38
Q

Hypocapnia leads to what cerebral effect?

A

Cerebral vasoconstriction

pCO2 - potent cerebral vasodilator

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39
Q

HLA Subtype associates with what disease?

DR2

A

MS

Hay fever

SLE

Goodpasture syndrome

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40
Q

MOA terbinafine

A

inhibits the synthesis of ergosterol by inhibiting squalene epoxidase

tx for dermatophytosis (tinea corporis aka ringworm)

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41
Q

Common carotid bifurcates at

A

C4

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42
Q

Aldolase B deficiency

A

Cant catalyze Fructose-1-P –>DHAP/Glyceraldehyde

failure to thrive, liver and renal failure

hypoglycemia and vomiting after fructose ingestion

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43
Q

How does the Candida skin test work?

A

Like PPD

Failure to respond - anergy -

SCID Macrophages present candida to CD4T’s CD4T’s recruit CD8Ts via cytokines Induration, erythema CD4 and CD8 release interferon gamma

Interferon gamma tells macrophages to eat the Candida

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44
Q

Merozoite

A

Released by liver

Infect RBC’s

Lysis –> fevers

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45
Q

MacConkey’s agar and EMB agar are examples of what kind of medium?

A

Differential

identify organism based on metabolic and biochemical properties

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46
Q

Give two examples of the effects of hypocalcemia in DiGeorge

A

Chvostek sign (facial tapping –> twitchin of nose and lips)

Trousseau sign (wrist tapping –> carpal spasm)

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47
Q

Precursor for serotonin, melatonin and nicotinic acid:

A

Tryptophan (essential)

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48
Q

Parasite that causes vitamin B12 deficiency and megaloblastic anemia

A

Diphyllobothrium latum tapeworm from freshwater fish

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49
Q

pH > 7.45 HCO3 > 28

A

Metabolic alkalosis

Response: Hypoventilation to retain CO2

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50
Q

Central, cystic dilation in cervical spinal cord

A

Syrinx (C8-T1)

damage to vental white commisure and anterior horns

syringomelia

scoliosis common w/ dx

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51
Q

Complete absence of tyrosinase results in

A

complete albinism

production of pigment is defective

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52
Q

Recurrent infections with Neisseria suggest

A

C5b-C9 deficiency

cannot form MAC

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53
Q

What drug should female epileptic patients switch to of they are considering pregnancy?

A

Levetiracetam

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54
Q

CD31+

A

CD31 is platelet endothelial cell adhesion molecule

indicates vascular endothelial cells

liver angiosarcoma (PVC piping/arsenic/thorotrast exposure) expresses CD31

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55
Q

Biconvex hematoma on CT

A

Epidural hematoma

Lucid interval

Between skull and dura

Rupture of middle meningeal artery

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56
Q

Pathogenesis of PH from LHF

A

Passive increase in pulmonary capillary and arterial pressue secondary to pulmonary venous congestion

decreased NO

increased endothelin (vasoconstrictor)

increased vascular tone

remodeling/smooth muscle cell proliferation

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57
Q

Lower extremity edema

Hepatomelagy

What kind of HF?

A

RHF

The most common cause of RHF is LHF

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58
Q

What antivirals depent only on host cell kinase to work?

A

Cidofovir, Tenofovir

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59
Q

Robertsonian translocations typically involve chromosomes

A

13, 14, 15, 21, 22

acrocentric chromosomes (centromere at the end)

they fuse and lose the short arms

balanced translocations go unnoticed

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60
Q

Use what medication for gancyclovir-resistant CMV?

A

Foscarnet

AE: hypocalcemia

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61
Q

CDKN2A makes

A

p16 (blocks G1–>S)

TSG

melanoma and pancreatic cancer

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62
Q

Exaggerated drop in systolic BP during inspiration

A

Pulsus paradoxus

Seen in cardiac tamponade, COPD, asthma, constrictive pericarditis

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63
Q

WT-1 - what kind of gene and where?

A

TSG

11

Wilms tumor

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64
Q

Function of serum amyloid A

A

an acute phase reactant

upregulated

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65
Q

RB - what kind of gene and where?

A

TSG

13

Retinoblastoma and osteosarcoma

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66
Q

Function of IL-6

A

secreted by macrophages

fever and acute phase proteins

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67
Q

Normal A-a gradient

A

5-15

A-s gradient is normal in alveolar hypoventilation with hypoxemia - how to distinguish from other forms of hypoxemia

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68
Q

Immune response involved in Schisto

A

Th2-mediated

granulomatous Th2 cells, eosinophils, M2 macrophages –> marked fibrosis of bowel or bladder/ureters

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69
Q

Elevated ICP in absence of ventricular enlargement

A

Pseudotumor cerebri

young, obese women with HA, papilledema and optic neuropathy

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70
Q

First-line tx for Wilson disease

A

Cu chelators

  • d-penicillamine
  • trientine
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71
Q

Primary systemic amyloidosis involves deposition of

A

Immune globulin light chains

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72
Q

Function of thyroid peroxidase

A

oxidation of iodide to iodine, the iodination of thyroglobulin, and iodotyrosine coupling antibodies to thyroid peroxidase in Hashimoto’s

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73
Q

Steps in collagen synthesis

A
  1. pre-pro-alpha chain
  2. signal removed –> pro-alpha chain
  3. hydroxylation of proline and lysine (vit C)
  4. glycosylation of hydroxylysine
  5. assembly to procollagen
  6. to Golgi –> ECM
  7. terminal propeptides cleaved by N and C procollagen peptidases –> tropocollagen (EDS defect)
  8. spontaneous assembly to fibrils
  9. cross links by lysyl oxidase
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74
Q

Name the 4 beta-lactam classes

A
  1. Penicillins
  2. Cephalosporins
  3. Carbapenems
  4. Monobactams - Aztreonam
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75
Q

Labwork with isolated thrombocytopenia suggests what diagnosis?

A

ITP

autoimmune platelet destruction - ecchymoses, petechiae, mucosal bleeding, no other obvious causes of thrombocytopenia

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76
Q

What kind of gene is TSC1?

A

TSG

Tuberous sclerosis

makes hamartin

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77
Q

Acyclovir, Valacyclovir, Famciclovir, Ganciclovir all depend on what to work:

A

viral kinase class - viral-dependent nucleosides

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78
Q

Function of human placental lactoge (hPL) (aka chorionic somatomammotropin)

A

Decreases maternal fatty acid stores and increases maternal serum glucose in order to provide adequate glucose to the growing fetus (induces insulin resistance in 2nd and 3rd trimesters)

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79
Q

Can use Aztreonam in penicillin-allergic patient?

A

Yes

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80
Q

Gamma hemolytic means

A

No hemolysis on blood agar

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81
Q

The difference in risk attributable to the intervention

A

Absolute risk reduction (ARR)

c/(c+d) - a/(a+b)

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82
Q

How to confirm a dx of narcolepsy

A

low CSF levels of hypocretin-1 (orexin-A);

shortened REM latency on polysomnography

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83
Q

What is the function of C1 esterase inhibitor?

A

Suppresses activation of the C1 complement component (and therefore the rest of the complement pathway)

Also inactivates kallikrein which catalyzes the conversion of kininogen to bradykinin

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84
Q

Things that attract neutrophils

A

LTB4

C5a

IL-8

bacterial products

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85
Q

Function of pyruvate dehydrogenase

A

Enzyme in pyruvate –> Acetyl CoA

if nonfunctional, as when inhibited by NADH accumulation, pyruvate becomes lactic acid (anaerobic path)

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86
Q

Inhibition of DNA-dependent RNA polymerase MOA of what RIPE therapy component?

A

Rifampin

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87
Q

Innervation of Infraspinatus

A

SITS muscle

Suprascapular nerve

C5-C6

External and lateral rotation

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88
Q

Histamine upregulates what selectin in rolling?

A

P selectin (from Weibel-Palade bodies)

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89
Q

Absent bilateral vas deferens bilaterally suggests

A

Cystic fibrosis

Normal levels of LH, FSH, testosterone

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90
Q

What do trimethoprim, methotrexate and pyrimethamine have in common?

A

They inhibit the same step in THF synthesis

All inhibit dihydrofolate reductase

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91
Q

Difference in risk between exposed and unexposed groups; aka the proportion of risk attributable to an exposure

A

Attributable risk

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92
Q

beta-2 receptor stimulation has what effect?

A

increase cAMP –> bronchodilation, vasodilation

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93
Q

Apocrine glands secrete their product how?

A

membrane bound vesicles

ie mammary glands

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94
Q

AR

hypersensitivity to UV damage and chemotherapy agents

impaired DNA repair facial anomaly growth retardation

A

Bloom syndrome

BLM gene defect makes faulty helicase generalized chromosomal instability –> risk of neoplasms

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95
Q

Teratogenic effects of Aminoglycosides

A

ototoxicity

vestibulotixicity

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96
Q

How to increase fetal survival in a preterm fetus with lecthicin:sphingomyelein ratio

A

Corticosteroids accelerate maturation of type II pneumocytes

give to moms at risk of preterm labor

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97
Q

RPR positive in what infections?

A

Syphilis

Yaws

Pinta

Bejel

(all subspecies of Treponema pallidum)

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98
Q

Embryonic cardinal veins become:

A

the systemic circulation

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99
Q

The third aortic arch becomes

A

the common carotid artery

the proximal internal carotid artery

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100
Q

Fever that recurs every 48 hours

What malarial organism?

A

“Tertian”

P. vivax

P. ovale

P. falciparum (more irregular)

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101
Q

HLA-B*57:01 is associated with

A

Hypersensitivity to Abacavir

NRTI

Type IV hypersensitivity reaction

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102
Q

Immune response involved in tuberculoid leprosy

A

Th1 Cell mediated immunity

(+) lepromin skin test

less severe

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103
Q

Classical complement pathway means:

A

C1 binds IgG or IgM bound to antigen (GM makes classic cars) –> C3 convertase produced

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104
Q

At what age? Runs, kicks ball Builds tower of 2-4 cubes Removes clothing 10-25 word vocabulary, identifies 1 or more body parts understands “mine” begins pretend play

A

18 months

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105
Q

A Turner syndrom patient with a bicuspid aortic valve would have what kind of heart murmur?

A

Early systolic, high frequency click over the 2nd right intercostal space

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106
Q

CYP-450 Inhibitors

Give 3 examples

A

Erythromycin

grapefruit juice

Ketoconazole

Ciprofloxacin

Quinidine

Cimetidine

Omeprazole

Ritonavir

Chloramphenicol

Acute alcohol intoxication

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107
Q

Translocation in follicular lymphoma

A

t(14;18)

cleaved and noncleaved follicle center cells

B cell

bcl2 overexpression

most common indolent Non-Hodgkin lymphoma

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108
Q

What is the function of Rb?

A

inhibits E2F which blocks G1–>S

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109
Q

Protein involved in AD hereditary hypothalamic DI

A

Neurophysin II point mutation –> abnormal folding –> removal of ADH and neurophysin from the ER

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110
Q

Most important AEs of Amphotericin B

A

Nephrotoxicity

Hypokalemia

Hypomagnesemia

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111
Q

MAO function

A

Degrades excess monoamine NTs in the presynaptic nerve terminal;

Detoxifies tyramine in the GI tract

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112
Q

PTSD requires symptoms for how long?

A

at least 1 month insomnia, nightmares, avoidance, dissociative symptoms, emotional detachment, flashbacks, intrusive thoughts, sleep disturbance

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113
Q

Purpose of the dexamethasone suppression test

A

Will suppress ACTH and cortisol levels with Cushing syndrome if caused by a pituitary adenoma but not when it is caused by ectopic ACTH secretion (ie small cell carcinoma)

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114
Q

The probability of being free of disease if the test result is negative

A

NPV

varies with pre-test probability

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115
Q

Secreted proteins of innate immunity

A

Lysozyme

Complement

C-reactive protein

Defensins

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116
Q

MOA Finesteride

A

5-alpha reductase inhibitor

decreases testosterone –> DHT

can use for androgenic alopecia early in the course

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117
Q

Neuroendocrine cells in the basal layer of the epidermis that are felt to play a role in the perception of touch

A

Merkel cells

often found in association with nerve projections

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118
Q

Immune response involved in lepromatous leprosy

A

Th2

Humoral immunity

(-) lepromin skin test

bacterial load higher

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119
Q

Progressive splenic enlargement and weight loss over months

Organism?

A

Kala-azar aka leishmeniasis (leishmania is a parasite transmitted by sandflies)

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120
Q

Most common AE from:

Atazanavir, Darunavir, Indinavir, Ritonavir

A

Hyperglycemia

Protease inhibitors

Also cause lipodystrophy and drug-drug interactions

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121
Q

Otitis externa by a gram negative motile aerobic rod, organism?

A

Pseudomonas

MOE - malignant otitis externa - elderly/diabetic

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122
Q

Cavernous lymphangioma

Network of endothelium-lined lymph spaces beneath the epidermis

Children

Neck, Axilla

Turner syndrome

dx?

A

Cystic hygroma

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123
Q

Contact with infected freshwater

Larvae mature in liver

Adults got to bladder or intestine

Larvae start by living in freshwater snails

dx?

A

Schistosoma Haemobactium –> bladder Japonicum and Mansoni –> intestine –> feces

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124
Q

Most cases of cerebellar hemorrhage are caused by

A

hypertensive vasculopathy

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125
Q

HLA Subtype associates with what disease?

A3

A

Hemochromatosis

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126
Q

Failure of involution of the mammary ridge causes

A

accessory nipple aka polythelia, supernumerary nipple;

hyperpigmentation

epidermal thickening

can become tender with hormonal changes

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127
Q

What is heteroplasmy?

A

Different mitochondrial genomes in a singe cell

Determines how severe a mitochondrial-encoded disorder can end up being

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128
Q

Chronic reduction in CSF absorption at the arachnoid villi –> massive enlargement of ventricles

A

Normal pressure hydrocephalus

Wet, wacky, wobbly

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129
Q

G6PD inheritance

A

X-linked recessive

Males affected, females carriers

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130
Q

Teratrogenic effects of TMP-SMX

A

Neural tube defects

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131
Q

An artificial increase in survival time among tested patient who actually have an unchanged prognosis

A

Lead time bias

For example, “new screening test” for poor prognosis diseases ie pancreatic cancer

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132
Q

Pathophysiology behind normal pressure hydrocephalus

A

Progressive decline in absorptive capacity of arachnoid villi

Pressure remains normal because gradual distention of ventricules accomodates CSF accumulation

periventricular system –> dementia and emotional blunting;

traction of sacral motor fibers –> urinary incontinence and ataxia;

cortical afferent/efferent fibers in corona radiata

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133
Q

Mutation involved in anaplastic thyroid cancer

A

inactivating mutation of p53

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134
Q

How do azoles inhibit ergosterol synthesis?

A

They inhibit the methylation of lanosterol –> ergosterol

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135
Q

Weakness of foot dorsiflexion due to involvement of common peroneal nerve

A

Charcot-Marie-Tooth disease

mutation in myelin protein

“neural form” of muscular atrophy

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136
Q

The pulmonary trunk is derived from:

A

the truncus arteriosus

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137
Q

Osteogenesis Imperfecta - mutation in what collagen type?

A

Type I

Spontaneous fractures

Bone and tooth malformation

Blue sclerae due to exposure of choroidal veins

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138
Q

IL-4 IL-5 IL-10 IL-13 all secreted by

A

Th2 cells

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139
Q

ST elevation in leads II, III, aVF suggests MI where:

A

RCA

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140
Q

Involuntary movements after chronic use of antipsychotics, ie lip smacking, choreoathetoid movements

A

Tardive dyskinesia

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141
Q

Cushing syndrome with increased ACTH levels - causes?

A

Pituitary adenoma;

ectopic ACTH secretion

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142
Q

Ertapenem is unique among the carbapenems because

A

It does not cover pseudomonas or Acinetobacter

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143
Q

Failure of the distal part of the urachus to close results in

A

Urachal sinus

recurrent infection

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144
Q

Continued inflammation is mediated by what interleukin?

A

IL-8, attracts more neutrophils after macrophages come in to clean up the damage

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145
Q

Mental status changes

Muscle weakness

Constipation

Polyuria/polydipsia

Dehydration

Too much of?

A

Hypercalcemia seen in granulomatous diseases such as sarcoidosis from production of excess 1,25-dihydroxyvitamin D –> increased intestinal absorption of Ca and phosphate

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146
Q

Pulmonary hypolasia

Flat facies

Limb deformities ie club feet

dx?

A

Potter sequence

renal anomaly is bilateral renal agenesis –> decreased urine output = oligohydramnios

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147
Q

Where is IgA made?

A

Peyer patches

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148
Q

AR

hypersensitivity to DNA cross-linking agents

impaired DNA repair

A

Fanconi anemia - bone marrow failure (aplastic anemia), short stature, increased incidence of tumors/leukemia, cafe-au-lait spots, thumb/radial defects

hypersensitivity of DNA to cross-linking agents

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149
Q

Coarse features

Corneal clouding

Cognitive deficits

Failure to thrive

Presentation during first year of life

dx?

A

Inclusion cell disease

typically fatal in childhood

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150
Q

In the bronchioles, what cell secretes mucus?

A

Club cells

(Goblet cells in bronchi)

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151
Q

MOA Aminoglycosides

A

Bacteriocidal

Bind 30S

Ineffective against anaerobes

Buy AT 30, CCEL at 50

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152
Q

Suspensory ligament of the ovary is aka

A

Infundibulopelvic ligament

blood supply to ovary

twists in ovarian torsion (cyst or neoplasm are main risk factors)

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153
Q

Probe used in Southwestern blot

A

DS DNA S

outhwestern blotting is used to detect DNA-binding proteins such as TFs, nucleases and histones

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154
Q

Isoniazid must be processed by:

A

Mycobacterial catalase peroxidase (to activate drug)

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155
Q

Klinefelter syndrome is most commonly caused by:

A

Meiotic nondisjunction

Variants - 46,XY/47,XXY mosaic, 48,XXXY (more severe)

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156
Q

Delayed puberty

Anosmia

Dx?

A

Kallman syndrome

mutation in KAL-1 gene of the FGFR-1 gene

failure of GnRH secreting neurons to migrate from their origin in the olfactory placode to the hypothalamus

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157
Q

The middle meningeal artery is a branch of:

A

Maxillary artery (one of the terminal branches of the external carotid artery)

Enters skull in foramen spinosum and supplies dura mater and periosteum

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158
Q

Dizogotic twins uterus situation:

A

always dichorionic diamniotic (bc 2 zygotes)

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159
Q

What are the cardiovascular complications associated with Turner syndrome?

A

Aortic coarctation

Bicuspid aortic valve

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160
Q

ST elevation in leads I and aVL suggests MI where:

A

Left circumflex (V5, V6 also possible)

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161
Q

Teratogenic effect of tetracylcines

A

staining of teeth, enamel hypoplasia, potential disruption of skeletal development

do not use in kids

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162
Q

RNA Pol III makes

A

tRNA

5s rRNA (part of 60S)

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163
Q

What’s happening in GVHD?

A

Remaining immunocompetent DONOR T cells become sensitized to HOST MHC.

GI issues, rash, diarrhea, liver function abnormalities

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164
Q

Codeine

Dextromethorphan

Fluoxetine

Haloperidol

Loratadine

Metoprolol

Paroxetine

Risperidone

Thioridazine

Venlafaxine

all metabolized by

A

CYP 2D6

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165
Q

Defect in neutrophil phagosome lysosome function

Nystagmus

Peripheral and cranial neuropathies

Partial albinism

A

Chediak-Higashi syndrome

abnormal giant lysosomal inclusons that are visible on light microscopy of a peripheral blood smear

recurrent pyogenic infections (Staph and Strep)

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166
Q

Hemolytic anemia in SCD causes what kind of jaundice?

A

Unconjugated hyperbilirubinemia

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167
Q

80% of cardiac myxomas arise in

A

LA

Myxomas produce large amounts of interleukin 6 –> constitutional symptoms ie fever, weight loss

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168
Q

Tyramine - how it works

A

indirect sympathomimetic usually metabolized by MAO in the gut MAOi

  • ie phenelzine, tranylcypromine ingest draft beer/aged cheeses/cured meats –> hypertensive emergency
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169
Q

Release of what substance is responsible for red man syndrome?

A

Histamine

AE from vancomycin

Prevent by slowing infusion rate

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170
Q

The efferent limb of the light reflex pathway is the

A

PS fibers of the oculomotor nerve

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171
Q

Pathologic fractures in children suggest

A

Extramedullary hematopoiesis

Also seen: chipmunk facies from maxillary overgrowth

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172
Q

Medullary thyroid cancer is a neuroendocrine tumor that arises from:

A

parafollicular calcitonin-secreting C cells

amyloid from the calcitonin - stain with congo red

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173
Q

Hereditary spherocytosis inheritance pattern

A

AD

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174
Q

What is the PPV?

A

The proportion of people who test + and actually have the disease

influenced by prevalence

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175
Q

What kinds of medications cause drug-induced Parkinsonism?

A

Antipsychotics (first gen > second gen);

Antiemetics/gastric motility agents ie prochlorperazine, metoclopramide

Both are D2 receptor blockers

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176
Q

Function of Ferritin

A

an acute phase reactant;

upregulated;

binds and sequesters iron to inhibit microbial scavenging

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177
Q

Incomplete division of the forebrain (prosencephalon) into 2 hemisphere is:

A

Holoprosencephaly

“malformation”

genetic (trisomy 13, SHH gene mutations), alcohol

range: midline cleft palate to cyclops

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178
Q

Teratogenic effect of chloramphenicol

A

gray baby syndrome - gray skin, lethargy, vomiting, cardiopulmonary collapse -

can be in infants or in infants whose mothers received med near delivery

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179
Q

Histological appearance of Glioblastoma Multiforme

A

pseudopalisading necrosis - foci of necrosis surrounded by tumor cells, new vessel formation

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180
Q

At what age? walks up/down stairs on both feet, jumps builds 6-cube tower copies a line, turns pages 50+ word vocab, 2 word phrases follows 2 step command, parallel play, begins toilet training

A

2 years

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181
Q

MOA Macrolides (ie Erythromycin)

A

Bind 50S Bacteriostatic

Same MOA as Clindamycin and Linezolid

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182
Q

Hereditary angioedema involves low serum levels of:

A

C1 esterase inhibitor

AD

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183
Q

What kind of gene is TSC2?

A

TSG

Tuberous sclerosis

makes tuberin

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184
Q

Enfuvirtide prevents

A

Viral adsorption

Fusion inhibitor

Binds gp41

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185
Q

Segmental thrombosing vasculitis that often extends into contiguous veins and nerves, encasing them in fibrous tissue

A

Buerger’s disease aka thromboangiitis obliterans;

can be toxocity or hypersensitivity to tobacco

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186
Q

Function of Hepcidin

A

an acute phase reactant

upregulated

destroys ferroportin to decrease iron absorption and release (anemia of chronic disease)

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187
Q

Ehlers-Danlos - mutation in what collagen type?

A

Type V

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188
Q

Pyrogens like LPS cause macrophages to do what?

A

IL-1 and TNF, which both upregulate E-selectin on endothelial cells (neutrophil rolling) –>

TNF ups cyclooxygenase activity in the hypothalamus –>

PGE2 also helps, set point for temp raises (fever)

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189
Q

Small and shallow, not painful ulcers

Large, painful, coalesced inguinal lymph nodes (buboes)

Intracytoplasmic inclusion bodies in epithelial cells and leukocytes

A

Lymphogranuloma venereum

Chlamydia trachomatis

serotype L1-L3

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190
Q

What is the effect of Mullerian Inhibitory factor?

A

Involution of paramesonephric ducts - to inhibit female reproductive organs

Produced by Sertoli cells

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191
Q

Inhibition of mycolic acid synthesis MOA of what RIPE therapy component?

A

Isoniazid

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192
Q

Mechanism of resistance acquired by Enterococcus against Aminoglycosides

A

Enterococcus has developed class-specific modes of resistance

Acquired via plasmids or transposons

Aminoglycoside-modifying enzymes that transfer chemical groups (ie acetyl groups) to the aminoglycoside molecule and impair their attachement to ribosomal units

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193
Q

Never give ACEis to patients with:

A

hereditary angioedema, bc the increase in bradykinin levels can trigger disease episodes

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194
Q

Teratogenic effects of Isotretinoin

A

Microcephaly

Thymic hypoplasia

Small ears

Hydrocephalus

for acne with scarring refractory to other therapy

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195
Q

Most common cause of meningitis in babies > 28 days

A

S. pneumoniae

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196
Q

When receptors aggregate in an allergic response, they attach to what part of IgE?

A

Fc portion;

cross-linking of multiple membrane bound IgE antibodies by a multivalent antigen results in aggregation of the FceRI receptors causing degranulation

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197
Q

What is a beta error?

A

Saying there is no difference between 2 groups when there actually is one (example of a random error)

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198
Q

Spasmodic torticollis is what kind of reaction?

A

Acute dystonic reaction - a type of EPS

  • likely due to antipsychotic medication between 4 hours and 4 days post new meds

Other examples: oculogyric crisis (eyes up) opsthonotonus (arching of back and head thrown back); laryngospasm

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199
Q

What is the function of VHL?

A

TSG;

Inhibits hypoxia inducible factor 1a

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200
Q

bright red venous blood

altered mental status

lactic acidosis

seizures

cardiovascular collapse

A

cyanide poisoning

can be from nitroprusside tx (metabolized to release NO and CN)

tx with sulfur donor

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201
Q

What pharyngeal and aortic arch completely obliterates in development?

A

Fifth

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202
Q

TPO antibody dx?

A

Hashimoto

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203
Q

Most common cause of Down syndrome.

A

Maternal meiotic nondisjunction

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204
Q

When performing cardiac catheterization, arterial puncture above the inguinal ligament increases the risk of:

A

Retroperitoneal hemorrhage;

Cannot be controlled with manual compression;

Most common cause of unexpected mortality after cardiac cath

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205
Q

Clozapine

A

Second generation antipsychotic

Third-line for patients refractory to traditional therapy

Highest incidence of sialorrhea (drooling)

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206
Q

Glial scars are made up of

A

Astrocytes;

>2 weeks post ischemic stroke

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207
Q

Treatment for Wet AMD

Wet AMD - acute vision loss (days to weeks), retinal neovascularization metamorphopsia (distortion of straight lines);

Subretinal discoloration with adjacent fluid/hemorrhage

A

VEGF inhibitors ie ranibizumab, bevacizumab and smoking cessation

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208
Q

Where in the heart is the most common site for thrombus formation?

A

Left atrial appendage

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209
Q

Most common cardiovascular manifestation associated with SLE

A

Pericarditis

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210
Q

Transamination reactions occur between:

A

An amino acid and an alpha-keto-acid ;

Amino group given to alpha-keto acid to make another aa;

Pyridoxal phosphate (vitamin B6) is essential for transaminase action

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211
Q

What does MOTEL PASS stand for?

A

Structures arising from neural crest cells:

Melanocytes

Odontoblasts

Tracheal cartilage

Enterochromaffin cells

Laryngeal cartilage

Parafollicular cells of thyroid

Adrenal Medulla and all ganglia

Schwann cells

Spiral membrane

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212
Q

Intellectual disability

Gait/posture abnormality

Eczema Musty

body odor

dx?

A

PKU

AR

mutation in gene for phenylananine hydroxylase

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213
Q

Another word for nucleoside monophosphate

A

Nucleotide

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214
Q

Xeroderma pigmentosum - defect in:

A

nucleotide excision repair (endonuclease)

UV rays –> thymine dimers but no UV-specific endonuclease to fix

AR

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215
Q

alpha-1 receptors increase

A

IP3 –> peripheral vasoconstriction –> increase BP, decrease renal and hepatic BF

Norepi - adrenergic

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216
Q

An arrangement in which a payor pays a fixed (predetermined) fee to cover medical services is called:

A

Capitation

HMOs are structured like this

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217
Q

Random presentations of pellagra:

A

Prolonged isoniazed therapy;

Hartnup disease - intestinal and renal absorption of tryptophan is defective;

Carcinoid syndrome

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218
Q

Proportion of risk reduction attributable to the intervention as compared to a control

A

Relative Risk Reduction

1-RR

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219
Q

Most common site for nosebleeds

A

Anterior septum

Kiesselbach plexus

anterior ethmoidal, sphenopalatine and superior labial arteries anatasmose here

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220
Q

Teratogenic effects of Valproate

A

Neural tube defects ie meningomyelocele (decreases levels of folic acid)

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221
Q

Teratogenic effect of Warfarin

A

nasal hypoplasia

stippled epiphysis

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222
Q

Vitamin K is an essential cofactor for:

A

gamma-glutamyl carboxlase

carboxylates factors II, VII, IX, X

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223
Q

Inheritance of Wiskott-Aldrich syndrome

A

X-linked

combined B and T cell disorder

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224
Q

Function of Supraspinatus

A

SITS muscle

C5-C6

Suprascapular nerve

ABducts arm

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225
Q

Most common manifestation of CMV in HIV patients

A

Retinitis

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226
Q

MOA Etoposide

A

Inhibits eukaryotic topoisomerase II (anticancer)

Teniposide same MOA

Solid tumors (testicular and SCLC), leukemia, lymphoma

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227
Q

Cofactor for glutathione peroxidase

A

Selenium

Used in respiratory burst

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228
Q

Amantadine prevents

A

viral uncoating

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229
Q

In hypoglycemia, elevated insulin with undetectable C-peptide suggests:

A

injection of exogenous insulin (which does not contain C-peptide)

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230
Q

What is tachyphylaxis?

A

negative feedback (decreased production of endogenous NE from the nerve terminals) from overuse of topical nasal decongestants resulting in vasodilation and rebound rhinorrhea

examples: phenylephrine, xylometazoline, oxymetazoline = alpha adrenergic agonists

NO use can also result in tachyphylaxis

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231
Q

Nissl substance

A

RER of neurons

Red neurons = 12-24 hours post acute injury, loss of Nissl substance, pyknosis, eosinophilic, irreversible

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232
Q

Head and neck muscle weakness

Dysphagia

Dysarthria

Nuclei of corresponding cranial nerves remain intact

A

Pseudobulbar palsy

Seen in Central pontine myelinolysis = osmotic demyelination of axons in center of pons

Bulbar would be a pathologic process in the nerve nuclei

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233
Q

Why are dendritic cells, such as Langherhans cells of the skin and mucous membranes, the most effective APCs?

A

Because they constitutively express MHC II and B7

costimulatory signal Myeloid cell line

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234
Q

SCID inheritance

A

AR or X-linked recessive

recurrent severe viral, fungal, opportunistic (ie PJP) infections, chronic diarrhea, failure to thrive

tx stem cell transplant

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235
Q

Where is fibrocystin found?

A

epithelial cells of renal tubule and bile ducts

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236
Q

Gene involved in follicular thryoid cancer

A

RAS

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237
Q

Most common cause of unilateral fetal hydronephrosis

A

Obstruction - inadequate canalization of the ureteropelvic junction

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238
Q

Function of NF1

A

TSG;

RAS GTPase activating protein aka neurofibromin

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239
Q

Acyclovir MOA

A

Nucleoside analog

Activated by viral thymidine kinase

Gets incorporated –> viral DNA synthesis terminated

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240
Q

Function of Pyocynanin

A

Made by Pseudomonas aeruginosa

Makes ROS to kill competing microbes

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241
Q

vivid dreams, hypersomnia, hyperphagia, acute depression

what dx/toxidrome?

A

cocaine withdrawl

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242
Q

Combined UMN/LMN lesions suggest

A

ALS

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243
Q

Associated cranial nerve and derivative with pharyngeal and aortic arch 6

A

Recurrent laryngeal branch of vagus;

Pulmonary arteries, ductus arteriosus

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244
Q

Lab finding in Hartnup disease

A

aminoaciduria (neutrals - alanine, serine, threonine, valine, leucine, isoleucine, phenylalanine, tyrosine, tryptophan, histidine)

Treat with high protein diet and niacin

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245
Q

Function of Diphtheria toxin

A

AB exotoxin -

inhibits protein synthesis ADP-ribosylation of EF-2

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246
Q

How is methicillin (ie nafcillin) resistance conferred?

A

Alterations in PBPs involved in cell wall synthesis

For example, PBP2a has greatly reduced affinity for beta-lactams (except Ceftaroline, 5th gen)

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247
Q

Cleavage of the brain structures prosencephalon to telencephalon and diencephalon happens when:

A

5 weeks

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248
Q

Advanced hemochromatosis complication

A

Diabetes mellitus

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249
Q

Neurofibromin ia a key suppressor of what gene?

A

Ras

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250
Q

CV complications with DiGeorge

A

Tetralogy of Fallot

Interrupted aortic arch

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251
Q

Relative risk is used in what kind of study?

A

Cohort study

Comparing with exposure to without exposure

a/a+b OVER c/c+d

252
Q

Functions of DNA Pol III

A

5’-3’ polymerase

3’-5’ exonuclease (most proofreading is in this direction)

253
Q

Why is DNA Polymerase I unique?

A

Only prokaryotic polymerase that also has 5’-3’ exonuclease activity –>

removes RNS primer (made by RNA primase) and repairs damaged DNA sequences

Other jobs: 5’-3’ polymerase 3’-5’ exonuclease

254
Q

Most common viral gastroenteritis in US

A

Norovirus

(Rotavirus has a vaccine)

255
Q

Region where the frontal, temporal, occipital and sphenoid bones all meet

A

Pterion damage here - can lacterate middle meningeal artery –> epidural hematoma

256
Q

Rathkes pouch is invaginated oral ectoderm that becomes:

A

the anterior pituitary

257
Q

What is the biggest indicator of vertical transmission of Hepatitis B?

258
Q

Patients with hemolytic anemia are predisposed to folic acid deficiency (macrocytic anemia) due to

A

increased rbc turnover

259
Q

Solution of cardiolipin, cholesterol, lecithin What test?

A

Rapid plasma reagin (RPR) test Mix patient serum Aggregation = “flocculation” –> presence of cardiolipin antibodies in serum detects antibodies to human cellular lipids released into the bloodstream after cell destruction by T. palladum.

260
Q

T lymphocytes prevent what kind of fungal infections?

A

Superficial (oral/esophageal candidiasis)

261
Q

Ataxia telangectasia predisposes to what kind of cancers?

A

hematologic maligancies

ATM gene defect - DNA break repair

hypersensitivity to X-ray radiation

262
Q

What is the only embryologic pharyngeal groove that is not obliterated during development?

A

1st pharyngeal groove Becomes the epithelium of the external ear canal

263
Q

Acute dystonic reactions are thought to result from the antipsychotic property of D2 antagonism in what pathway?

A

Nigrostriatal pathway

Akathisia, Parkinsonism - all D2 blockade

causes: haloperidol, fluphenazine

264
Q

What is incised in an episiotomy?

A

Posterior vaginal opening to Perineal body

265
Q

Testosterone mediated the development of what structures in the male fetus?

A

Internal genitalia

DHT mediates development of external genitalia

266
Q

Azoospermia Eunuchoid habitus Mild intellectual disability Long legs Gynecomastia

A

Klinefelter syndrome

267
Q

What is the normal function of calcineurin?

A

Protein phosphatase - activated on stimulation of the appropriate cell receptor in T-cells - dephos NFAT –> NFAT goes to nucleus to bind IL-2 promoter –> IL-2 stimulates growth and differentiation of T-cells

268
Q

Nikolsky sign

A

Sloughing of skin with gentle pressure ie Staph Scalded Skin Syndrome exfoliatin exotoxin

269
Q

Th1 cells secrete

A

Interferon-gamma **critical for immunity to viral and intracellular bacteria** increases MHC expression activates macrophages promotes Th1 differentation Inhibits Th2 differentiation

270
Q

Pathology in SCID

A

Defective T cell development and B cell dysfunction –> loss of both cellular and humoral immunity ADA accounts for 15% of SCID cases

271
Q

Fibrates inhibit the rate-limiting step in bile acid synthesis. What enzyme?

A

cholesterol 7-alpha-hydroxylase

272
Q

NF-1 - what kind of gene and where?

273
Q

At what age?

balances and hops on 1 foot

copies a square

identifies colors

speech 100% intelligible

cooperative play

274
Q

Why are sulfonamides contraindicated in neonates?

A

Displace bilirubin from albumin –> kernicterus

275
Q

Associated cranial nerve and derivative with pharyngeal and aortic arch 4

A

Superior laryngeal branch of vagus; True aortic arch, subclavian arteries

276
Q

Which is the active form of Rb?

A

Hypophosphorylated Rb is active form –> prevents G1–> S

277
Q

Most common cause of coronary sinus dilation

A

Pulmonary HTN –> Elevated Right sided heart pressure

278
Q

SCD spleen looks like

A

Fibrosis, atrophy

vasooclusive events –> infarction

279
Q

What ARE interferons?

A

Part of innate immunity

Made by virally-infected cells and act locally

Glycoproteins

280
Q

Third generation cephalosporins have broad spectrum except against

A

Listeria

Listeria has altered PBPs - use ampicillin

Facultative intracellular –> must clear by CMI –> infants and elderly have bad CMI

281
Q

Parvo is associated with aplastic anemia and what other blood disorder?

A

Pure Red Cell Aplasia (PRCA) - rare

can be viral or autoimmune

282
Q

Sperm use what energy source?

283
Q

Hexokinase catalyzes

A

Fructose –> F6P

284
Q

Other names for niacin

A

nicotinic acid vitamin B3 from diet or made endogenously from tryptophan

285
Q

translocation in APL

A

t(15;17)

formation of PML/RARalpha fusion protein

results in transcription repression and abnormal receptor that cannot signal for differentiation

286
Q

Function of BRCA1/BRCA2

A

TSG DNA repair gene Breast and ovarian cancer

287
Q

Fungus have BOTH a cell membrane and a cell wall. What antifungals inhibit cell wall synthesis?

A

The Echinocandin class

Caspofungin and other “fungins”

Inhibit beta-glucan synthesis

288
Q

HLA-A, HLA-B, HLA-C code for:

289
Q

In hypoglycemia, elevation of both insulin and C-peptide suggests:

A

excess endogenous insulin due to a sulfonylurea medication or insulinoma

290
Q

Penicillins covalently bind and inhibit

A

transpeptidase (enzyme for cross-linking)

291
Q

Lab findings in androgenic steroid abuse

A

Increased Hct

292
Q

APL is associated with what vascular complication?

293
Q

LMN lesion refers to

A

damage to the motor neurons of the anterior horn

flaccid paralysis, hypotonia, hyporeflexia, atrophy, fasiculations

ie poliomyelitis, infantile spinal muscular atrophy

294
Q

Gestational diabetes occurs when

A

Maternal insulin is inadequate

295
Q

MHC I present what kind of antigens?

A

Endogenous (viral/cytosolic proteins)

296
Q

Function of IL-12

A

secreted by macrophages induces differentiation of T cells –> Th1 cells Activates NK cells

297
Q

Displacement of a malformed tricuspid valve into the RV

A

Ebstein’s anomaly

cyanosis and HF from severe tricuspid regurgitation

298
Q

What makes up the MAC?

A

C5b plus C6-C9

299
Q

HLA Subtype associates with what disease? B27

A

Ankylosing spondylitis Psoriatic arthritis IBD-associated arthritis Reactive arthritis “seronegative arthropathies”

300
Q

Symptoms of an internal capsule stroke

A

Pure motor weakness of contralateral lower face, arm, leg

301
Q

C3 convertase function

A

C3 makes C3a and C3b –> C3b is an opsonin for phagocytosis C3a mediates mast cell degranulation

302
Q

Necrotic, migratory erythema, anemia and diabetes mellitus suggest what dx?

A

Glucagonoma markedly elevated glucagon levels

303
Q

What two chemicals are involved in O2-independent killing (not the oxidative burst)?

A

Lyzozyme Major basic protein

304
Q

Maternal virilization High androgens, low estrogen AR Clitoromegaly/ambiguous genitalia

A

Aromatase deficiency Female girls have normal internal genitalia Later in life - tall, primary amenorrhea, osteoporosis *low estrogen delays fusion of the epiphyses*

305
Q

Fever, tinnitus, tachypnea suggest what dx?

A

Aspirin intoxication Usually present with a mixed respiratory alklalosis and anion gap metabolic acidosis pH normal bc of competing processes

306
Q

Function of Protein M (strep pyogenes)

A

Inhibits phagocytosis and complement activation and mediates adherence

307
Q

Where is the optimal site for cardiac cath in the lower extremity?

A

Below the inguinal ligament Common femoral artery

308
Q

Carrier proteins for oxytocin and vasopressin

A

Neurophysins - chaperones Oxytocin and vasopressin are made in the paraventricular and supraoptic nuclei, respeictively

309
Q

What organisms does Clarithromycin cover that Erythromycin does not?

A

Mycobacterium avium (MAC) M. leprae Toxoplasma gondii

310
Q

Caspofungin has the most activity against:

A

Aspergillus

Candida

311
Q

Cortical atrophy in AIDS dementia can result in

A

Hydrocephalus ex-vacuo

*neuronal volume loss*

ventricles expand but CSF pressure stays normal

312
Q

First viral marker detected in the serum after inoculation with hepatitis B?

A

HbsAg

peaks when patient is most ill drops to undetectable amounts by 3-6 months (if recovery occurs)

313
Q

Most common primary brain tumor in adults

A

GBM

Crosses midline (butterfly appearance)

314
Q

Reactive arthritis often includes what axial involvement?

A

Sacroilitis

315
Q

Function of TNF-alpha

A

secreted by macrophages

cachexia in malignancy

mediates septic shock

activates endothelium

causes WBC recruitment, vascular leak

316
Q

Cells that express CD3, CD4, CD25 and FOXP3

A

Regulatory T cells When activated, produce anti-inflammatory cytokines: IL-10, TGF-beta

317
Q

Common mutations associated with hypertrophic cardiomyopathy (AD)

A

single point missense mutations in genes for: beta-myosin heavy chain myosin-binding protein C

318
Q

Isolated atrial amyloidosis is due to deposition of

A

abnormally folded atrial natriuretic peptide

319
Q

What is coronary dominance?

A

The coronary artery that supplies the posterior descending artery (PDA) - PDA supplies the AV node RCA in 70% of people - “right dominant” Left circumflex in 10% of people - “left dominant” Both in 20% of people - “codominant”

320
Q

Function of sulfonylureas

A

Bind to K-ATP channels and close them (independent of ATP) –> insulin release This channel is malfunctioning in neonatal diabetes

321
Q

Genetic defect in von Hippel Lindau syndrome

A

Deletion or mutation of VHL (tumor suppressor gene) on chrom 3p (both sporadic and hereditary RCCC) AD

322
Q

Preformed proteins in cytotoxic T cells

A

Perforin Granzyme B

323
Q

Sulfonamide antibiotics (ie Sulfamethoxazole) antagonize what compound?

A

Para aminobenzoic acid (PABA) inhibit dihyropteroic acid synthase Bacteriostatic

324
Q

Source of NADPH

A

HMP Shunt Used in respiratory burst Reducing equivalent in cytosol

325
Q

MOA Arsenic

A

inhibition of pyruvate dehydrogenase

binds sulfhydryl groups

impairs cellular respiration

326
Q

tuncal and gait ataxia, lesion where?

A

Cerebellar vermis (center line)

impaired modulation of the medial-descending motor systems

327
Q

CV complications w/ Marfan syndrome

A

Cystic medial necrosis (ie aortic dissection, aneurysm); MVP

328
Q

Complete mole genotype

A

46,XX Paternal DNA only no fetal parts Empty ovum fertilized –> sperm duplicated to make 46,XX

329
Q

Mutation in Frederich’s Ataxia

A

Frataxin gene - GAA repeat codes for mitochondrial protein important in respiratory function and iron homeostasis

330
Q

What protein does TP53 activate?

A

P21 which blocks G1–>S

Li Fraumeni syndrome

331
Q

Therapeutic Index

A

TD50/ED50 or LD50/ED50

332
Q

Criteria for Tourettes

A

both vocal and motor tics >1 year onset before 18 tics are irresistible urges followed by feelings of relief

333
Q

The superior vena cava is embryologically derived from:

A

the common cardinal veins

the common cardinal veins drain into the sinus venosus

334
Q

Interferon-gamma release assay

A

tests latent TB infection better than PPD bc does not cross react with vaccine

335
Q

Every time the GFR halves…

A

the serum creatinine doubles

Relatively large decreases in GFR –> small increases in serum creatinine (when GFR is normal)

Then, small decreases in GFR –> large changes in creatinine when GFR is low

336
Q

Give what with Imipenem to prevent degradation by renal dihydropeptidases?

337
Q

Squamous cell debris that forms a peraly mass behind the tympanic membrane in the middle ear Dx?

A

Cholesteatoma cause conductive hearing loss - erosion into auditory ossicles congenital or follow infection/trauma/surgery

338
Q

AR mutation of ATP7B

A

Wilson disease

339
Q

At what age? Walks up and down stairs alternating feet, rides tricycle copies a circle, uses utensils 3 word sentences, speech 75% intelligible knows age and gender, imaginative play

340
Q

Abdominal aorta bifurcates at

341
Q

Metanephros forms

A

the true kidney

342
Q

Short stature Hypotonia Intellectual disability Obesity

A

Prader-Willi syndrome paternal microdeletion - 15q11-13

343
Q

Main function of IgE

A

Fixes complement IgG also fixes complement

344
Q

The afferent limb of the light reflex pathway is the

A

optic nerve

345
Q

Situs inversus Immotile spermatozoa Bronchiectasis, Chronic sinopulmonary infections

A

Primary ciliary dyskinesia aka Kartagener syndrome Dynein arm defect –> abnormal ciliary motion

346
Q

Which macrolide is safe for use in pregnancy?

A

Azithromycin

347
Q

Borders of the femoral triangle

A

Superior - Inguinal ligament

Medial - Adductor longus muscle

Lateral - Sartorius muscle

348
Q

What kind of gene id NF2?

A

TSG Makes merlin (aka schwannomin)

349
Q

Congenital absence of gyri

A

Lissencephaly

severe mental retardation and seizures

350
Q

CV complications with Kartagener syndrome

A

Situs inversus

351
Q

Cutoffs for ADHD dx

A

before age 12 at least 6 inattentive and/or hyperactive/impulsive symptoms at least 2 settings

352
Q

Naive B cells express what before differentiation?

A

IgM and IgD

353
Q

Bcl2- is associated with what translocation?

A

t(14;18) follicular cell lymphomas Bcl-2 is an apoptosis inhibitor

354
Q

Cause of Menieres disease

A

Increased pressure and volume of endolymph ear fullness/pain, recurrent vertigo, unilateral *sensorineural* hearing loss and tinnitus

355
Q

Vertical transmission of HPV results in:

A

Respiratory papillomatosis

356
Q

Trachea bifurcates at

357
Q

How do UV rays damage DNA?

A

Formation of covalent bonds between adjacent thymine/cytosine residues (pyrimidine dimers) Pyrimidine dimers are removed by nucleotide excision repair.

358
Q

Fructokinase catalyzes

A

Fructose –> F1P

deficient in essential fructosuria

benign

359
Q

Function of IL-5

A

Secreted by Th2 Enhances class switching to IgA Stimulates growth and differentiation of eosinophils

360
Q

Failure of the anterior neuropore to close leads to:

A

neural tube defects ie anencephaly

361
Q

Color blindness AE of what antibiotic?

A

Ethambutol RIPE tx Inhibition of RNA synthesis

362
Q

Daptomycin AE

A

Rhabdomyolysis - elevated creatinine phosphokinase

**Daptomycin is inactivated by pulmonary surfactant

363
Q

The mesonephric ducts become:

A

Epididymus

Ductus deferens

Seminal vesicles

364
Q

vertigo/nystagmus, lesion where in the cerebellum?

A

flocculonodular lobe - balance and eye movements

dysregulation of the vestibular nucear complex

365
Q

T/F: Deletions are not associated with maternal age

366
Q

Zero order drugs:

A

Aspirin at high concentrations

Ethanol

Phenytoin

367
Q

Unexplained medical symptoms Excessive health care use dx?

A

Somatic symptom disorder Tx: Regular visits with same provider, reduce stress, reduce unnecessary workups, assure patient serious stuff is ruled out - goal is functional improvement

368
Q

Demecloycline use

A

Tetracycline used for SIADH

369
Q

Teratogenic effects of Lithium

A

Ebstein anomaly

Nephrogenic diabetes insipidus

Hypothyroidism

370
Q

What is PCV13?

A

13-valent pneumococcal conjugate vaccine nontoxic diphtheria protein conj to polysacchardies T-cell recruitment –> memory B cells –> higher and longer lasting immunity Use PPSV23 for >65 or diabetic, COPD, CVD (polysaccharide only)

371
Q

Beta-2-glycoprotein-I antibody suggests what diagnosis?

A

SLE

Antiphospholipid antibodies –> paradoxical hypercoagulable state with prolonged aPTT

372
Q

Lateral hemisphere of the cerebellum controls

A

Motor planning

373
Q

Persistent lymphedema following a radical mastectomy predisposes to

A

lymphangiosarcoma

374
Q

Causes of reactive arthritis:

A

Chlamydia Salmonella Shigella Yersinia Campylobacter C. diff

375
Q

HLA Subtype associates with what disease? B8

A

Addison disease Myasthenia Gravis

376
Q

Function of IL-1

A

secreted by macrophages aka osteoclast activating factor causes fever and acute inflammation activates endothelium to express adhesion molecules induces chemokine secretion to recruit WBCs

377
Q

The acute onset of mental status change is most suggestive of:

A

delirium acute, reversible, fluctuating LOC

378
Q

C-reactive protein function

A

Opsonin;

fixes complement;

facilitates phagocytosis ;

an acute phase reactant,

upregulated - measured clinically as an ongoing sign of inflammation

379
Q

Teratogenic effect of Methotrexate

A

Limb and cranial abnormalities Neural tube defects Abortion

380
Q

What happens when a partial agonist is added in the presence of a full agonist?

A

The response of the full agonist is reduced The partial agonist acts as an antagonist

381
Q

MEN1 makes

A

Menin

TSG

3P’s for MEN1 (pancreatic, primary hyperparathyroidism, pituitary)

382
Q

Hagemen Factor (Factor XII) is activated by

383
Q

Helper T cells differentiate into

A

IL-12 make Th1 IL-4 make Th2 TGF-beta and IL-6 make Th17 all in the lymph node

384
Q

Why do patients with TB or sarcoidosis have hypercalcemia?

A

PTH-independent conversion expression of 1-alpha-hydroxylase in activated macrophages 1-alpha hydroxylase turns 25-D to 1,25 D (normally in the kidney) can also see the same thing in Hodgkin disease and some non-Hodgkin lymphoma

385
Q

How is pre-mRNA processed?

A

Processed in the nucleus,

Add 5’ cap (methylguanosine)

Add poly A tail

Splice (GU at 5’ and AG at 3’) by spliceosomes

386
Q

Function of C5 convertase

A

C5 –> C5a and C5b

C5b to MAC

C5a is chemotactic for neutrophils

387
Q

Uterine arteries are branches of

A

internal iliac artery

388
Q

Serum screening results in Down Syndrome

A

Low AFP Low unconjugated estriol High inhibin A High b-hCG

389
Q

Holocrine glands secrete their product how?

A

Cell lysis sebaceous glands meibomian (eyelid) glands

390
Q

The nucleus basalis of Meynert houses the cell bodies of:

A

cholinergic neurons In Alzheimer’s, these neurons secrete decreased amounts of acetylcholine.

391
Q

Endonuclease that degrades all RNA in the cell Activated by dsRNA

A

RNaseL (Ribonuclease L) an interferon

392
Q

Give the equation for NNT

A

1/ARR = 1 OVER c/[(c+d) - a(a+b)] switch the terms for NNH

393
Q

Function of Myeloperoxidase

A

Found in neutrophils Converts H2O2 –> HClO (hypochlorous acid)

394
Q

On ECG, prominent Q waves suggest

395
Q

Enzyme involved in collagen cross-linking

A

Lysyl oxidase (Menke’s disease - Cu deficiency - corkscrew hair)

396
Q

A vaccine with a polysaccharide capsule induces what immune response?

A

B cell only Need a protein conjugate for B and T cell response and longer immunity (through production of memory B cells)

397
Q

Why does ventilation INCREASE from apex to base during inspiration?

A

Because alveoli expand more at the lung base (during inspiration)

At end-expiration, apex alveoli are more stretched

398
Q

Paroxysmal nocturnal dyspnea

Orthopnea

Dyspnea on exertion

What kind of HF?

399
Q

The ductus arteriosus is an embryonic derivative of:

A

the sixth aortic arch

400
Q

What kind of cancer does PTEN cause?

A

TSG

breast/prostate/endometrial

401
Q

Phrenic nerve innervated what pleura

A

mediastinal and diaphargmatic pleura (C3-C5) –> sharp pain at base of neck

402
Q

CV complications with Friederich ataxia

A

Hypertrophic cardiomyopathy

403
Q

0.7Vd/Cl

404
Q

Abnormally upslanting left atrial “v wave” during cardiac catheterization

A

Mitral regurgitation

405
Q

Chemically modified bases such as pseudouridine, dihydrouridine, ribothymidine, are found where?

A

tRNA

small, noncoding RNA

CCA sequence at 3’ end used as recognition sequence by proteins - the aa binding site is the 3’ terminal OH

406
Q

Clavulanate

Sulbactam

Tazobactam are?

A

beta-lactamase inhibitors

use with penicillins

407
Q

Bilaterally enlarged, cystic fetal kidneys on US; Oligohydramnios dx?

A

AR Polycystic kidney disease (ARPKD) Defect in PKHD1 - makes fibrocystin

408
Q

The ureteric bud gives rise to:

A

the collecting system of the kidney = pelvis, collecting ducts, calyces and ureter

409
Q

What paraneoplastic condition is associated with squamous cell lung carcinoma?

A

PTPrP and hypercalcemia

410
Q

HNPCC occurs due to a defect in:

A

DNA mismatch repair enzymes

411
Q

Chi-square tests

A

The relationship between two categorical variables (ie therapy vs no therapy)

412
Q

RNA Pol I functions exclusively to transcribe

A

45S pre-rRNA

that eventually becomes 18S, 5.8S, 28S rRNA

413
Q

HLA Subtype associates with what disease? DQ2/DQ8

A

Celiac disease “I 8 2 much gluten at Dairy Queen”

414
Q

Drugs that inhibit calcineurin activation

A

Cyclosporine Tacrolimus Immunosuppressants

415
Q

Associated cranial nerve and derivative with pharyngeal and aortic arch 3.

A

Glossopharyngeal (IX); Common carotid, Proximal ICA

416
Q

In the CNS, serotonergic neurons are located:

A

in the raphe nuclei of the brainstem (midbrain, paons, medulla) axons project widely into cerebral cortex – thalamus, hypothalamus, cerebellum, hippocampus, spinal cord

417
Q

Teratogenic effect of ACE inhibitors

A

Renal dysgenesis Oligohydramnios

418
Q

Prokaryotic topoisomerase II (DNA gyrase) is inhibited by:

A

Fluroquinolones (ie Ciprofloxacin)

419
Q

Ethanol Isoniazid Acetominophen (at high doeses) all metabolized by

420
Q

CYP-450 Inducers Give 3 examples

A

Phenobarbital Nicotine St. John’s Wort Rifampin Phenytoin Carbamazepine Chronic alcohol consumption

421
Q

Genetic defect in Prader Willi syndrome

A

15q deletion

422
Q

RNA Pol II makes

A

mRNA snRNA micro RNA

423
Q

Prolactin-secreting adenomas cause:

A

Galactorrhea and hypogonadism in men Amenorrhea in women

424
Q

Pain and temperature is transmitted by the

A

spinothalamic tract

425
Q

Alprazolam Carbamazepine Cyclosporine Diltiazem Erythromycin Azoles Lidocaine Lovastatin Midazolam Nifedipine Quinidine Simvastatin Tacrolimus Verapimil all metabolized by

A

CYP 3A4 50-60% of all drugs metabolized by 3A4

426
Q

Blowing holosystolic murmur at cardiac apex, radiation to axilla

A

Mitral regurgitation

Rheumatic fever

(Mitral stenosis is a snap as opposed to a murmur)

427
Q

Narcolepsy with cataplexy is most often caused by the lack to 2 related neuropeptides, hypocretin-1 (orexin-A) and hypocretin-2 (orexin-B), located:

A

in the lateral hypothalamus

428
Q

At age 2, a child should have a vocabulary of:

A

50-200 words,

2 word phrases

language is the most commonly delayed milestone

always get a hearing examination

429
Q

HPV has predilection for what kind of epithelium?

A

Stratified squamous

(ie true vocal cords, cervix, anus)

430
Q

The metanephric mesoderm (blastema) gives rise to:

A

Renal cortex stuff:

glomeruli

Bowman’s space

PCT

DCT

loop of Henle

431
Q

MHC II present what kind of antigens?

A

Exogenous (ie bacterial)

432
Q

Hb-NH-CO2

A

Carbamate

How Hb carries CO2 back to lungs

15% of CO2 travels this way, the rest as bicarb

433
Q

Glucagon is released by what pancreatic cells?

A

Alpha cells of the islets of Langerhans

434
Q

Handgrip maneuver

Effect on heart

A

Increases afterload

Can detect VSD bc blood Left–> right

Can hear holosystolic murmur

435
Q

Enzyme involved in CO2 + H2O –> H2CO3

A

Carbonic anhydrase

H2CO3 –> H + HCO3-

HCO3- diffuses out and Cl- diffuses in (maintains electronic gradient) = “chloride shift”

436
Q

Failure of the central portion of the urachus results in

A

urachal cyst

437
Q

Multiple deep ulcers with gray/yellow exudate at base

Organisms clump in long parallel strands to create a “school of fish” appearance

Ulcers are painful

A

Chancroid

Haemophilus ducreyi

438
Q

pH > 7.45

PaCO2 low

A

Respiratory alkalosis

Response: delayed, to lower HCO3

439
Q

Most common mutation in CF results in

A

deletion of the three nucleotides that code for phenylalanine at aa 508 delta-F508, 70% of cases CFTR is an integral membrane protein

440
Q

Penicillins are synergistic with what other drug class in tx of enterococcus/pseudomonas?

A

Aminoglycosides (Gentamicin) Aminoglycosides are polar - cannot cross cell wall Penicillinc weaken cell wall –> penetration of Aminoglycosides

441
Q

Charcot-Bouchard aneurysms can rupture and cause:

A

intracerebral hemorrhage (NOT SAH)

CB aneurysms - small - longstanding HTN

found in arterioles that supply the basal ganglia, internal capsule, deep white matter

442
Q

What acute phase reactants are downregulated in inflammation?

A

albumin - reduction conserves aa’s for positive reactants

Transferrin

443
Q

Most common cause of bilateral fetal hydronephrosis in boys

A

Posterior urethral valves

444
Q

Neuromuscular lesions Ragged skeletal muscle fibers lactic acidosis what dx?

A

Mitochondrial encephalomyopathy

445
Q

At what age? Stands Walks first steps independently Throws ball 2 finger pincer grasp Says first words besides mama and dada Separation anxiety Follows 1-step commands

446
Q

Toddler with painless GI bleeding due to ectopic gastric mucosa

A

Meckel diverticulum Failure of obliteration of the vitelline (or omphalomesenteric) duct

447
Q

Finding in Mayer-Rokitansky-Kuster-Hauster syndrome

A

aka Mullerian aplasia no upper vagina variable uterine development –> primary amenorrhea Ovaries OK –> secondary sex characteristics OK

448
Q

What is the preferred treatment for Enterobius Vermicularis in pregnant patients?

A

Pyrantel Pamoate

(Albendazole for everyone else)

449
Q

What posttranslational modification signals proteins for lysosomes?

A

Phosphorylation of mannose residues by phosphotransferase enzyme defective in Inclusion cell (I-cell) disease

450
Q

Nissl substance becomes fine, granular and dispersed throughout the cytoplasm of a neuron;

Within 24-48 hours of injury

A

Axon has been severed –> Nissl is trying to regenerate proteins

“Axonal reaction” - cell will be enlarged and rounded

451
Q

Posterior surface of the heart is formed mainly by:

A

Left atrium

452
Q

The Haemophilus influenzae serotype b vaccine is made of:

A

Capsular polysaccharide conjugated to a carrier protein (TTP from tetanus or OMP from Neisseria)

453
Q

HLA Subtype associates with what disease? DR3

A

DM type I SLE (also DR2) Graves disease Hashimoto thyroiditis (also DR5) Addison disease (also B8, DR4)

454
Q

In Roseola (HHV6), when does the rash appear?

A

When the fever subsides

455
Q

Binds ergosterol on cell membranes

Some activity against cholesterol –> AEs like nephrotoxicity

A

MOA of Amphotericin B

456
Q

UMN lesion refers to

A

any damage above the anterior horn

is stroke, brain tumor

spastic paralysis, clasp-knife rigidity, hyperreflexia, Babinski sign

*Lesions to the corticospinal tract do not cause sensory deficits

457
Q

IL-10 decreases expression of:

A

MHC II and Th1

458
Q

Case control studies use what statistical comparison?

A

Odds ratio With disease vs without disease ad/bc

459
Q

Merocrine glands secrete their product how?

A

Exocytosis ie salivary, eccrine sweat glands, apocrine sweat glands

460
Q

RNA Pol I makes

461
Q

Diazepam

Omeprazole

all metabolized by

462
Q

Bitemporal hemianopsia from mass effect suggests what kind of tumor?

A

Pituitary adenoma - prolactinomas are the most common

463
Q

DPC4/SMAD4 gene products are deleted in

A

pancreatic cancer TSG

464
Q

Associated cranial nerve and derivative with Pharyngeal and aortic arch 1

A

Trigeminal; Maxillary artery portion

465
Q

Tryptase is an enzyme specific for:

A

mast cells anaphylaxis

466
Q

Innervation of Subscapularis muscle

A

Upper and Lower subscapularis nerve Interna/medial rotation, Adduction C5-C6 SITS

467
Q

Glucose enters beta cells through what transporter?

A

GLUT-2 glucose –> TCA –> increase in ATP –> ATP binds an closes K-ATP channel –> ATP rises in cell –> Ca channels open –> that and increase in cAMP from GLP-1 transporter effects together lead to insulin exocytosis

468
Q

Caffeine Ciprofloxacin Theophylline R-warfarin all metabolized by

469
Q

Most common mutation in Polycythemia Vera

A

617 valine –> phenylalanine

V617F mutation in JAK2 gene

hematopoietic cells more sensitive to growth factors ie EPO and thrombopoietin

470
Q

CV complications w/ Tuberous Sclerosis

A

Cardiac rhabdomyomas –> valvular obstruction

471
Q

A patent urachus connects

A

The umbilicus to the bladder (Persistance of allantois remnant) Allantois becomes urachus Pee through belly button

472
Q

Function of IL-8

A

secreted by macrophages major chemotactic factor for neutrophils

473
Q

The 3rd pharyngeal pouch becomes

A

The inferior PTH glands Thymus

474
Q

Treatment for Tourettes

A

Antipsychotics Alpha-adrenergic receptor agonists Behavioral therapy

475
Q

Garlic breath

vomiting

QT prolongation

watery diarrhea

A

Arsenic poisoning

Tx dimercaprol (British anti-Lewisite) or DMSA (succimer)

476
Q

Why are fluoriquinolones contraindicated in children?

A

Cartilage development impaired –> tendonitis and rupture

477
Q

Superoxide dismutase Glutathione peroxidase Catalase all have what in common?

A

Antioxidant enzymes ROS –> Oxygen and water

478
Q

Bloon in basal cisterns on CT

A

Subarachnoid hematoma

Worst HA of my life, fever, nuchal rigidity

Between arachnoid and pia mater

Aneurysm or AV malformation of anterior and posterior communicating arteries

479
Q

Genetic defect in cri-du-chat syndrome

A

5p deletion

480
Q

Ibuprofen

Naproxen

Phenytoin

S-warfarin

all metabolized by

481
Q

Vibration and proprioception is transmitted by:

A

Dorsal column pathway

482
Q

Cerebella hemangioblastomas, clear cell renal carincomas, pheochromocytomas - what condition?

A

von Hippel Lindau

483
Q

Immune response to killed vaccine

A

Humoral only

Live attenuated is cellular and humoral

484
Q

Valacyclovir is a prodrug for

485
Q

Teratogenic effect of Phenytoin

A

Neural tube defects Orofacial clefts Microcephaly Nail or digit hypoplasia

486
Q

MOA Fluoroquinolones

A

Inhibit two DNA gyrases (bacterial DNA top II and IV) ie Cipro, all “floxacins”

487
Q

Germline mutations in the RET proto-oncogene include:

A

Pheochromocytoma; Medullary thyroid cancer (parafollicular C cell malignancy); Parathyroif hyperplasia (MEN2A) of mucosal neuromas and marfanoid habitus (MEN2B) Multiple endocrine neoplasia type 2

488
Q

Benztropine and Trihexyphenidyl are

A

Anticholinergics use in treatment of drug-induced Parkinsonism

489
Q

High altitude results in hypoxemia with respiratory:

A

alkalosis

CO2 low (hyperventilation) –> bicarb lowers within 48 hours via renal excretion of bicarb

490
Q

The most abundant aa in collagen

A

Glycine Gly-X-Y (every 3rd aa) Collagen is 3 alpha chains held together by hydrogen bonds

491
Q

The most important mediator for sepsis

A

TNF-alpha acute phase cytokine produced by activated macrophages.

492
Q

Increased 2,3 DPG

Effect on Hb curve

A

Right shift (also increased temp, decreased pH)

493
Q

D-ala-D-lactate

A

vancomycin resistant bacteria

494
Q

MOA Zidovudine

A

aka AZT

NRTI

competitively binds to reverse transcriptase, incorporated into viral genome as a thymidine analog

**No 3’OH group –> 3’-5’ phosphodiester bond formation

495
Q

c-MYC located on chrom:

A

8 - Burkitt lymphoma and diffuse large B cell lymphoma

496
Q

Subjective restlessness with inability to sit still - EPS

497
Q

Craniopharyngiomas arise from

A

remnants of Rathke’s pouch

498
Q

Probe used in Southern or Northern blot

A

ssDNA or RNA (hybridization probe)

499
Q

How to diagnose trich

A

wet mount aka saline microscopy

500
Q

alpha-2 receptors have what effect?

A

decrease cAMP –> decrease release of norepi and insulin Norepi Adrenergic

501
Q

Subacute bacterial endocarditis with strep gallolyticus (bovis) suggests

A

colon cancer

502
Q

Melanocytes arise from what germ layer?

A

Neural crest cells Malignancy of melanocytes = melanoma

503
Q

MOA trimethoprim

A

inhibits dihydrofolate reductase

504
Q

MHC-II is encoded by

A

HLA-DP HLA-DQ HLA-DR

505
Q

Extensive and progressive ulcerative lesions w/o lymphadenopathy

Base may have granulation tissue

Deeply staining gram-negative intracytoplasmic cysts called Donovan bodies

Ulcers not painful

A

Granuloma inguinale

Klebsiella granulomatis

506
Q

AE Linezolid

A

High risk for serotonin syndrome

Thrombocytopenia

Optic neuritis

507
Q

Zidovudine - analog of:

A

thymidine

competiviely binds to RT

incorporated into viral genome

azido group in place of 3’OH –> chain termination

508
Q

Protease inhibitor SE

A

hyperglycemia

lipodystrophy

dislipidemia

insulin resistance

cyp 450 inhibition

509
Q

InteGRAse inhibitors

A

Dolutegravir

Raltegravir

510
Q

Griseofulvin interacts with

A

fungal cell MTs

tx for dermatophytes

511
Q

NK cells express either

A

CD16 or CD56

*present in athymic patients bc they do not require the thymus to mature

512
Q

NK cells are activated by

A

interferon-gamma and IL-12

513
Q

AR

deficiency of apolipoprotein B48 and B100

Malabsorption

A

Abetalipoproteinemia

514
Q

sulfa drug that is also a carbonic anhydrase inhibitor

A

Acetozolamide

SE metabolic acidosis, hypokalemia

can reduce ICP in idiopathic intracranial HTN

515
Q

Tx for Acetominophen OD, replenishes glutathione

A

Acetylcysteine

516
Q

Stewart-Treves syndrome, risk factor

A

Lymphedema, ie as precipitated by radical mastectomy

Angiosarcoma

517
Q

Bullous pemphigoid IgG distribution

A

Linear at BM

Pemphigus vulgaris is netlike IgG distribution

518
Q

Most common malignancy associated with acanthosis nigracans

A

Gastric adenocarcinoma

519
Q

d-aminolevulenic acid in the urine

child with constipation, anemia, cognitive problems

A

lead poisoning

520
Q

bilious vomiting

abdominal distention

inability to pass meconium

A

Hirschsprung disease

seen in newborn

failure of internal sphincter relaxation

megacolon

521
Q

linear xanthoma - linear lesion on skin fold

strongly associate with

A

primary biliary cirrhosis

522
Q

When strawberry (capillary) hemangiomas are found viscerally what organ is commonly involved?

523
Q

Complications of psoriasis

A

Conjunctivitis, blepharitis, uveitis;

yellow-brown discoloration of nails with pitting or crumbling;

arthritis

524
Q

BRAF mutation V600E (meaning valine –> glutamine at protein 600)

what cancer?

A

Melanoma

mutation seen in 40-60% of patients

525
Q

Vemurafenib

A

potent BRAF inhibitor

BRAF is a protein kinase

Vemurafenib is menaloma tx

526
Q

Acantholysis

A

loss of intracellular connections

ie VZV, PV

527
Q

Subepidermal blister with neutrophils in dermal papilla

A

dermatitis herpeteformis

528
Q

most common benign vascular tumor in adults

A

cherry hemangiomas aka senile hemangiomas

*always superficial (vs strawberry hemangiomas in babies)

529
Q

Sulfonamides

Phenytoin

Allopurinol

All known for what AE?

A

SJS - fever, hypotension and skin slouging

530
Q

Erythema multiforme - target lesions - commonly associated with

A

recent infection ie herpes simplex, mycoplasma

can also be seen with sulfonamide use, malignancy etc.

531
Q

Elevated what seen in porphyria cutanea tarda?

A

urinary porphyrin levels - uroporphyrin, heptacarboxyl porphyrin

skin fragility and blistering lesions in sun exposed areas

532
Q

Benign proliferations of melanocytes that involve both the dermis and the epidermis

A

Compound nevus

533
Q

accumulation of edema fluid in the intercellular spaces of the epidermis

A

spongiosis

seen in acute allergic contact dermatitis - a kind of eczema

type IV hypersensitivity reaction

534
Q

Ipratropium, class and effect

A

Anticholinergic

blocks ACh at muscarinic receptors

prevents bronchoconstriction and reduced PS stimulation to tracheobronchial submucosal glands in the lungs

535
Q

Clindamycin, activity against

A

Gram pos and anaerobes

good for aspiration pneumonia and abscess

binds to 50S

536
Q

Zolpidem

A

non-benzodiazepine hypnotic used for insomnia

537
Q

COMT inhibitors are used for

A

Entacapone, Tolcapone

Catechol-O-methyl transferase (COMT) - brain and liver - degrades catecholamines

COMT inhibitors prolong the effects of levodopa in Parkinson disease tx

538
Q

Cocaine

A

Indirect sympathomimetic

Blocks reuptake of dopamine, norepi and serotonin in presynaptic cleft

539
Q

Isoniazid is matabolized by

A

Acetylation

Fast and slow acetylators

Other drugs metabolized like this: dapsone, hydralizine, procainamide

540
Q

Major Clozapine AE

A

Agranylocytosis, must monitor absolute neutrophil count

For refractory schizophrenia w/ suicidality

Low EPS risk

541
Q

Chlordiazepoxide

A

Long acting benzo

Tx of EtOH withdrawl

542
Q

Benzodiazepines without active metabolites are preferred for use in patients with liver disease. These include:

A

Lorazepam

Oxazepam

Temazepam

543
Q

MOA Benzodiazepines

A

Bind allostericall to GABA channel

Increases Cl- through channel

544
Q

High potency antipsychotics SE

A

EPS

ie Fluphenazine, Haloperidol

545
Q

Low potency antipsychotics SE

A

Anticholinergic effects, sedating, orthostatic hypotension

ie Chlorpromazine

546
Q

Venlafaxine

547
Q

Imipramine

548
Q

Inactivating mutations involving the pro-apoptotic BMPR2 gene

A

Primary pulmonary HTN

Women 20-40

Endothelial and smooth cell proliferation –> vascular remodeling, elevated pulmonary vascular resistance, progressive pulmonary HTN

Lung transplant is only tx, but Bosentan can promote vasodilation and relieve symptoms

549
Q

Bosentan MOA

A

Endothelin-receptor antagonist (competitive)

Vasodilator (bc endothelin is a vasoconstrictor)

Decreases pulmonary arterial pressure and lessens progression of vascular and right ventricular hypertrophy

550
Q

Risperidone primary MOA

A

D1 and D2 receptor antagonist

Antipsychotic

Hyperprolactinemia and amenorrhea (inhibition of GnRH release) possible SE

551
Q

Buproprion is contraindicated in:

A

Anorexia, Bulemia, Seizure disorders bc the drug lowers the seizure threshold

552
Q

1 - ß

A

Power of a study = the probability of seeing a difference when there is one

ß is a type II error

553
Q

Positive selection happens in the

A

cortex

double positives (CD4 CD8) are tested to see if they recognize self-antigen

554
Q

Negative selection happens in the

A

medulla

do cells recognize self too much?

555
Q

Nitroprusside

A

Balanced arterio and venous dilator –> SV maintained bc changes are balances

tx of hypertensive emergencies

reduces preload and afterload

556
Q

Phenotypic mixing

A

Genome is unchanged, new virions acquire new capsid proteins from other virus;

Subsequent progeny will revert bc new capsid proteins not encoded for

557
Q

Growth factor involved in tissue regeneration and repair

558
Q

Expressing unacceptible feelings through actions

A

Acting out

immature defense mechanism

559
Q

Behaving as if an aspect of reality does not exist

A

Denial

immature

560
Q

Transferring feelings to a more acceptable object

A

Displacement

immature

561
Q

Using intellect to avoid uncomfortable feelings

A

Intellectualization

immature

562
Q

Avoiding conflict by expressing hostility covertly

A

Passive aggression

immature

563
Q

Attributing one’s own feelings to others

A

Projection

immature

564
Q

Justifying behavior to avoid difficult truths

A

Rationalization

immature

565
Q

Responding in a manner opposite to one’s actual feelings

A

Reaction formation

immature

566
Q

Reverting to an earlier developmental stage

A

Regression

immature

567
Q

Channeling impulses into socially acceptable behaviors

A

Sublimation

mature

568
Q

Putting unwanted feelings aside to cope with reality

A

Suppression

mature

569
Q

What drug to use in patients with recurrent C. Diff infection?

A

Fidaxomicin

Bacteriocidal, minimal systemic absorption

inhibits sigma subunit of RNA polymerase

570
Q

Genetically predisposed individuals who are slow acetylators are at greater risk of developing

A

drug induced lupus

571
Q

Lymph from the testes drains to the

A

para-aortic lymph nodes

lymph from the scrotum drains to the superficial inguinal lymph nodes

572
Q

What antipsychotics carry the highest risk for developing hyperglycemia/dsylipidemia?

A

Clozapine

Olanzapine

Both second generation antipsychotics

573
Q

The H band contains

A

only thick filaments

574
Q

The I band contains

A

thin filaments

575
Q

MOA Thiazide diuretics, ie Clorthalidone

A

inhibit the Na/Cl cotransporter in the DCT –> increased excretion of Na and H2O, as well as H and K

Increases distal tubular Ca reabsorption

576
Q

Fever and sore throat in a patient with hyperthyroidism, being treated, should raise concern for

A

thionamide-induced agranulocytosis

thionamides = methimazole, propylthiouracil

MOA - inhibit thyroid peroxidase which impairs iodine organification

577
Q

Uses for propylthiouracil

A

useful in 1st trimester of pregnancy, and in thyroid storm, as it decreases peripheral T4 to T3;

can cause agranulocytosis (neutrophils

578
Q

The recurrent laryngeal nerves innervate all of the intrinsic muscles of the larynx except

A

the cricothyroid muscle.

Paresis of vocal cords innervated by the left recurrent laryngeal nerve can cause hoarseness

Left atrial enlargement can sometimes cause left recurrent laryngeal nerve impingement

579
Q

Mitral stenosis can cause left atrial dilitation sufficient to impinge on the left recurrent laryngeal nerve. Dx?

A

Ortner syndrome

580
Q

MOA Pyridostigmine

A

long-acting AChE inhibitor

symptomatic treatment of MG

581
Q

Tensilon test

A

infusion of a short-acting AChE inhibitor ie edrophonium

if symptom improvement –> myasthenic crisis

if no symptom improvement –> cholinergic crisis - muscle is refractory to impulse bc AChE dose was too high

582
Q

Hepatosplenomegaly, neurologic regression, cherry res spot on macula in infancy

A

Niemann-Pick disease

sphingomyelinase deficiency

accumulation of sphingomyelin

583
Q

Mutations involving the trypsinogen of SPINK1 genes

A

hereditary pancreatitis

trypsinogen activates prematurely before reaching the duodenum, or cannot be inactivated –> autodigestion

584
Q

In a patient with mitral regurgitation, the most reliable auscultatory finding indicating high regurgitrant volume (severe MR) is

A

left sided S3 gallop

585
Q

Prostaglandin E1 antagonist

Pregnancy termination

What medication?

A

Misoprostol

586
Q

Progesterone antagonist, glucocorticoid antagonist

Pregnancy termination

What drug?

A

Mifepristone

587
Q

transient hypercoagulable state that can occur during the first few days of warfarin therapy

A

warfarin-induced skin necrosis

warfarin inhibits proteins C and S (natural anticoagulants present in the blood)

588
Q

Which cranial nerves have their nuclei located in the medulla?

A

CN IX

CN X

CN XII

589
Q

Which cranial nerves have their nuclei located in the pons?

A

CN V, VI, VII, VIII

590
Q

Which cranial nerves have their nuclei located in the midbrain?

A

CN III, IV

591
Q

Infection of the cavernous sinus affects what nerves?

A

cavernous sinus infection

CN III, IV, VI –> varying degrees of opthalmoplegia

V1 and V2 of CN V - hypo or hyperasthesia

592
Q

What are the muscles of mastication?

A

Close jaw - masseter, temporalis, medial pterygoid

Open jaw - lateral pterygoid

593
Q

Leptin decreases the production of:

A

Neuropeptide Y (a potent appetite stimulant) in the arcuate nucleus of the hypothalamus –> decreased appetite

594
Q

Leptin stimulates the production of:

A

POMC - propiomelanocortin - in the arcuate nucleus

POMC gets cleaved to make alpha-melanocyte-stimulating hormone, which inhibits food intake (increases satiety)

595
Q

HIgh extracellular K levels directly stimulate what cells in the kidney?

A

Principal cells (basolateral Na/K pump) –> secretion of K into tubular fluid;

Elevated K levels also increase aldosterone secretion

596
Q

Effect of alkalosis on K

A

H/K exchange, K lost ino order to get H – alpha-intercalated cells

597
Q

How is K reabsorbed along the nephron?

A

100% filtered

65% reabsorbed at PCT always

25-30% reabsorbed via Na/K/2Cl exchanger in the ascending loop of Henle always

Possible K secretion by principal cells in DCT/collecting duct

End result - 10-110% of initial K

598
Q

Buspirone is effective for, not effective for…

A

Effective for treating GAD but not panic disorder;

Slow onset of action (2 weeks to take effect)

599
Q

The presence of hemosiderin-laden macrophages (golden cytoplasmic granules) in pulmonary alveloi indicates:

A

Chronic elevation of pulmonary capillary hydrostatic pressures, most commonly as a result of left-sided HF

600
Q

Best ways to diagnose herpes simplex

A
  1. PCR
  2. viral culture (low sensitivity)
  3. Tzanck smear (not the same as a gram stain)
  4. direct fluorescence antibody
601
Q

What do absence seizures look like on EEG?

A

3 Hz generalized spike and slow wave EEG pattern

<10 seconds

occur mainly in children

1st line ethosuximide, 2nd line sodium valproate

602
Q

Name two selective vasodilators of coronary vessels

A

Adenosine

Dipyridamole

Can cause coronary steal due to vasodilation of nonischemic areas, overall reduction in blood flow to ischemic areas –> hypoperfusion and worsening of existing ischemia;

Can use these drugs to TEST amount of coronary vasodilation

603
Q

The short gastric veins drain:

A

The fundus of the stomach to the splenic vein;

Splenic vein joins with inferior mesenteric vein and joins the portal vein (to liver);

Splenic vein thrombosis –> back up into gastric veins –> gastric varices in fundus

604
Q

The azygous vein drains

A

esophageal veins into the SVC

605
Q

Common causes of splenic vein thrombosis (seen as gastric varices due to back up of blood flow)

A

Pancreatitis, pancreatic cancer

606
Q

Inheritance pattern for CAHs:

21-hydroxylase deficiency;

11 beta-hydroxylase deficiency;

17 alpha-hydroxylase deficiency

607
Q

Primary adrenal insufficiency (low Na, high K, high chloride, low bicarb = non-anion gap metabolic acidosis) involves autoantibodies to:

A

All three zones of the adrenal cortex

aka Addison’s disease;

exogenous ACTH does not stimulate cortisol production

608
Q

Major rate-limiting enzyme in glycolysis

A

PFK-1

Fructose 6P –> Fructose-1,6-bisP

609
Q

How does galactose enter glycolysis?

A

Galactose –> Galactose-1-P –> Glucose-1-P –>

Glucose-6-P

610
Q

How does mannose enter glycolysis?

A

Mannose –> Mannose-6-P –> Fructose-6-P

611
Q

Fetal hemoglobin is made of:

A

alpha2 gamma2

612
Q

Heparin-induced thrombocytopenia is caused by antibodies to:

A

heparin and platelet factor IV

613
Q

MOA of Hirudin Lepirudun, Argatroban

A

Direct thrombin inhibitors;

do not require antithrombin III

use to treat HIT (along with stopping heparin)

614
Q

ADP receptor inhibitor

A

Clopidogrel, Ticlopidine

inhibit ADP-mediated platelet aggregation

Useful following percutaneous coronary intervention, treatment of unstable angina, non Q-wave MI

615
Q

GpIIb/IIIa inhibitor

A

Abciximab

Eptifibatide

Tirofiban

Use post PCI in ACS

616
Q

MOA Dipyridamole and Cilostazol

A

inhibit platelet aggregation

PDE inhibitors –> increase cAMP

617
Q

Use: Clonidine

A

Clonidine is an alpha-2-receptor agonist;

Use in children with ADHD who failed methylphenidate

618
Q

Name the broad-spectrum anticonvulsants

A

Valproic acid

Levetiracetam

Topiramate

Lamotrigine

619
Q

Avoid narrow-spectrum anticonvulsants ie carbamazepine, gabapentin, phenobarbital, phenytoin in treated generalized seizures because

A

they may aggregate the symptoms;

use only with focal-onset seizures

620
Q

Chemotherapy-induced emesis can be ameliorated by 3 drug classes. Give an example of each:

Dopamine receptor antagonists;

5HTs receptos antagonists;

Neurokinin 1 (NK1) receptor antagonists

A

Dopamine receptor antagonists - Prochlorperazine, Metoclopramide

5HT3 receptor antagonists - Ondansetron, Granisetron

NK1 receptor antagonists - Aprepitant, Fosaprepitant

621
Q

Treat hyperemesis of pregnancy with what antihistamine?

A

Promethazine

622
Q

How to assess statistical significance?

A

Confidence interval does not contain the null (0) value;

Values can be positive or negative, but do not include 0 in order to be statistically significant

623
Q

What does a confidence interval of 95% mean?

A

That is the study was repeated 100 times, 95 times out of 100, the results would lie within the range given.

624
Q

Triglyceride metabolism

TG –(lipase)–> Glycerol + FA

What happens to the glycerol and FA?

A

Glycerol –(glycerol kinase)–> Glycerol-3-P –> DHAP

DHAP has 2 fates –> glycolosis OR gluconeogenesis

FAs undergo ketogenesis/betaoxidation

625
Q

Reactive arthritis most commonly follows infections with:

A

Shigella

Salmonella

Campylobacter

Yersinia

Chlamydia

Bartonella

*immune complexes*

626
Q

Symptoms related to the *autoimmune* response of Gravves disease

A

exopthalmous

pretibial myxedema

627
Q

The most common ankle sprain involves what ligament?

A

Anterior talofibular ligament - pain and ecchymosis of anterolateral aspect of the ankle;

Due to inversion of the plantar-flexed foot

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