Step1_qbank_random2 Flashcards
1
Q
How is Galactosemia inherited? Which enzyme is defective?
A
AR; galactose-1-phosphate uridyltransferase
2
Q
What effect does the hypothalamus have on prolactin secretion?
A
Inhibitory via dopamine production
3
Q
Effect modification
A
when the effect of an exposure on an outcome is modified by another variable
4
Q
What is the triad for babies that experienced in-utero Toxo
A
(1) hydrocephalus (2) choreoretinitis (3) intracranial calcifications
5
Q
Anti inflammatory cytokines
A
TGF-B and IL-10
6
Q
Treatment for severe allergic asthma
A
Omalizumab; [anti-IgE antibodies]
7
Q
What is Omalizumab? How does it work?
A
recombinant humanized IgG1 monoclonal antibody; binds with IgE to inhibit the action of IgE –> decrease allergic response
8
Q
Which organism grows well at 41C
A
Mycobacterium avium complex
9
Q
What is the ppx for mycobacterium avium complex?
A
Azithromycin
10
Q
What metabolizes pro-carcinogens? Where is it located?
A
cytochrome P-450 monooxygenase; in hepatic microsomes and ER
11
Q
What is the function of cytochrome P-450 monooxygenase?
A
metabolize steroids, alcohol, toxins, and other foreign substances
12
Q
What is the draw back to cytochrome P-450 monooxygenase?
A
Also converts pro-carcinogens into carcinogens –> mutations in human DNA
13
Q
How long after fertilization during ovulation does it take for Beta-HCG to be positive?
A
8-11days
14
Q
How is Isoniazid metabolized?
A
Acetylation
15
Q
What dictates the speed one acetylates?
A
Whether they are fast or slow acetylates
16
Q
Most common comorbidity for imperforate anus?
A
Urogenital tract anomalies
17
Q
What is Etanercept function
A
Soluble decoy protein
18
Q
[suffix of biological agents] (mab)
A
monoclonal AB
19
Q
[suffix of biological agents] (cept)
A
receptor molecule
20
Q
[suffix of biological agents] (nib)
A
kinase inhibitor
21
Q
Which region of the kidney is impermeable to water
A
Thick and thin ascending limbs of Henle’s loop
22
Q
What is the most potent cerebral vasodilator?
A
pCO2
23
Q
What is the effect of decreased cerebral vascular resistance on cerebral perfusion and ICP?
A
Increase; Increase
24
Q
[MoA] C. diptheriae - Diphteria toxin
A
Inactivates EF-2 via ribosylation, thus inhibiting host cell protein synthesis
25
[MoA] P. aeruginosa - Exotoxin A
Inactivates EF-2 via ribosylation, thus inhibiting host cell protein synthesis
26
[MoA] S. aureus - Enterotoxin
Superantigen that acts locally in the GI tract causing vomiting
27
[MoA] S. aureus - TSS toxin
Superantigen that stimulates T-cells leading to widespread cytokine release and shock
28
[MoA] - C. difficile - Cytotoxin B
Induces actin depolymerization leading to mucosal cell death, necrosis of colonic mucosal surfaces, and pseudomembrane formation
29
[MoA] - C. botulinum - Botulinum toxin
Blocks the presynaptic release of acetylcholine at the neuromuscular junction resulting in flaccid paralysis
30
[MoA] - B. pertussis - Pertussis toxin
Disinhibits adenylate cyclase via Gi ADP ribosylation, increasing cAMP production in the host cell; causes increased histamine sensitivity and phagocyte dysfunction
31
[MoA] - V. cholera - Cholera toxin
Activates adenylate cyclase via Gs ADP ribosylation, increasing cAMP production in the host cell; causes secretory diarrhea, dehydration, and electrolyte imbalances
32
Which med class would you use to dilate the pupil? Why?
alpha-adrenergic agonist; dilator muscle of the pupil has alpha 1 receptors
33
Which med class would you use to relax the uterus?
beta 2 agonists
34
How is lithium excreted?
Kidneys
35
Signs of lithium toxicity (6)
Neuromuscular excitability, irregular course tremors, fascicular twitching, agitation, ataxia, delirium
36
Drugs that increase lithium levels? (3)
Thiazide diuretic;, ACE inhibitors; NSAIDs
37
Effect of Pramipexole [Parkinsons]?
Stimulates dopamine receptors
38
Sputum shows many neutrophils no organisms
Legionella
39
[features of immunodeficiency disorders] Ataxia -telangiectasia
Ataxia; telangiectasia; sinopulmonary infections
40
[features of immundeficiency disorders] Chediak-Higashi Syndrome
Oculocutaneous albinism; pyogenic infection; progressive neurologic dysfunction
41
[features of immundeficiency disorders] Chronic Granulomatous disease
Severe bacterial and fungal infections; granuloma formation
42
[features of immundeficiency disorders] DiGeorge Syndrome
Congenital heart disease; dysmorphic facies; hypocalcemia
43
[features of immundeficiency disorders] Severe Combined Immundeficiency
Severe bacterial and viral infections in infancy; Chronic diarrhea; Mucocutaneous CANDIDIASIS
44
[features of immundeficiency disorders] C5-C9 deficiency
recurrent NEISSERIA infection
45
[features of immundeficiency disorders] Wiskott-Aldrich
Recurrent infections that worsen with age; easy bleeding; eczema
46
Sputum findings: esosinophils and Charcot-leyden crystals
Extrinsic allergic asthma
47
Clinical findings extrinsic allergic asthma?
Paroxymal breathlessness, wheezing
48
[Epi] Latent Period
Time elapsed from initial exposure;
49
[Epi] Lead time bias
Time between the initial detection of disease and a specific outcome (ie detecting diseases at earlier stages)
50
Dyspnea, cough, swelling of the face, neck, and upper extremities, dilated collateral veins in upper trunk
Superior vena cava syndrome
51
mutation in TATA box affects which cell function?
Transcription initiation
52
What is a TATA box? What does it bind (2)?
Promoter region; binds transcription factors and RNA polymerase II
53
Where is the TATA box located?
25 bases upstream from the beginning of the coding region
54
Which centers regulate Micturition reflex (urination)? (3)
Sacral micturition center (S2-S4) - bladder contraction; Pontine micturition center (pontine reticular formation); Cerebral cortex - inhibits sacral micturition center
55
Describe the function of the Sacral micturition center. Location/ Fibers involved
S2-S4; Parasympathetic fibers travel from S2-S4 ventral white matter within pelvic nerves and stimulate cholinergic receptors in the bladder wall ---> BLADDER CONTRACTION
56
Describe the function of the Pontine micturition center.
Coordinates relaxation of external urethral sphincter w/ bladder contraction during voiding
57
Generally which fibers regulate bladder control
Descending cortical fibers
58
Which histones help pack DNA into nucleosome
H1 histone
59
Impaired balance, difficulty speaking, elevated serum transaminases; What do you suspect; What is the next test?
Wilson's disease; slit lamp
60
Polycythemia vera (PV) define.
Clonal myeloproliferative disease of pluripotent hematopoietic stem cells
61
Polycythemia vera (PV) characteristics.
Increased RBC mass, increased plasma volume, and low EPO levels
62
Mutation associated with Polycythemia vera? Effect
JAK2 V617F; hematopoietic stem cells become more sensitive to growth factors
63
What drug class is effective in preventing Chemo-induced vomiting?
5-HT3 receptor antagonists
64
Name some 5-HT3 receptor antagonists.
Onansetron; granisetron; dolasetron
65
Which neuropeptidesare deficient in the CSF of a Narcoleptic patient? Where are they produced
Hypocretin-1 (orexin-A) and Hypocretin-2 (orexin-B); lateral hypothalamus
66
1st arrhythmia associated with myocardial ischemia.
V Fib
67
Pyrrolidonyl arylamidase (PYR)-positive, beta-hemolytic, gram-positive coccie in chains
S. Pyogenes
68
S. agalactia is also known as___. Is Coag____. And catalase____. Gram ____ ____ in ____.
GBS; Negative; Negative; Gram positive cocci in chain
69
S. aureus is a gram _____ _____ that grows in ____. Catalase____. Coag____. PYR___.
gram positive coccus that grows in chains. Catalase positive. Coag positive. PYR negative.
70
C perferingen characteristics?
large spore forming; anarobic; gram positive ROD; catalase-neg; coag-neg
71
Whar does C perferingen produce on blood agar?
Double zone of beta hemolysis
72
A. Hydrophila characteristics? Likely exposure
oxidase-positive, non-fermenting, gram-negative ROD;; contaminated water
73
Genus of organism that lack cell wall? Which Abx are not effective with them?
Mycoplasma genus; Penicillins
74
Treatment for mycoplasma infections
tetracyclins; erythromycin
75
Common cause of UTI (not E. Coli)? Whast is it resistant to?
Staph Saprophyticus; Novobiocin
76
What is responsible for the toxic effects observed in meningitis and meningococcemia?
Lipooligosaccharide (LOS) -Outer membrane
77
How does Lipooligosaccaride (LOS) differ from Lipopolysaccharide (LPS) of enteric gram neg rods?
Lacks the repeating O-antigen of LPS
78
Hypopigmented or hyperpigmentedt skin patches or papules are characteristic of ___.
Pityriasis versicolor (aka tinea versicolor)
79
Name the fungus that causes Pityriasis versicolor (aka tinea versicolor).
Malassezia furfur
80
Where does the infection of Pityriasis versicolor (aka tinea versicolor) localize to? [which skin layer]
Stratum corneum
81
Superficial inguinal lymph nodes drain cutaneous lymph from where?
umbilicus to feet [exclude posterior calf]
82
Palpable firm superficial inguinal lymph nodes assoc with cancer where
external genitalia and anus
83
Toxic side effect of Loop Diuretics and Aminoglycosides/salicylates/cisplatin
Ototoxicity
84
Name some ototoxic agents
Aminoglycosides/salicylates/cisplatin
85
Genome imprinting is produced by what?
DNA methylation (ie methyl group from S-adenocyl-methionine to a cyosine residue in a DNA molecule)
86
Renal tubular ischemia affects which cells preferentially?
proximal tubules AND thick ascending limb of Henle's loop
87
What is Cytochrome c? [What does it activate? What does it bring about? Through which pathway?]
mitochondrial enzyme that activates caspsaes and indirectly brings cell death through intrinsic pathway apoptosis
88
What are the regions of LPS; which is responsible for toxic shock?
O antigen, core polysaccaride, Lipid A; Lipid A responsible for toxic shock
89
What are the Golgi tendon organs (GTOs)?
sensory receptors located at the junction of the muscle and tendon -- innervated by group Ib sensory axons --contract when muscle extends against too much force
90
What are A-delta fibers?
thin, myelinated nerve fibers; free nerve endings detect TEMP and PAIN
91
Which sensory axons innervate muscle spindles (intrafusal fibers)?
Group Ia and group II
92
What are muscle spindles (intrafusal fibers) sensitive to? What do they mediate?
changes in muscle length; stretch reflex
93
Drug class that reduces prostate volume; Examples
5-Alpha reductase inhibitors; finasteride/dutasteride
94
[stages of lobar pneumonia] Congestion - time/ presentation
(first 24hr) affected lobe is read heavy and boggy; vasc dilation/alveolar exudate (bacteria)
95
[stages of lobar pneumonia] Red hepatiation - time/ presentation
(days 2-3) Red, firm lobe "liver like"; Alverolar exudate (erythrocytes, neutrophils, fibrin)
96
[stages of lobar pneumonia] Gray hepatiation - time/ presentation
(days 4-6) Gray-brown firm lobe; RBCs disintergrate/ Averolar exudate (neutrophils and fibrin)
97
[stages of lobar pneumonia] Resolution - time/ presentation
restoration of normal architecture; Enzymatic digestion of the exudate
98
Gram positive organism causing cervicofacial manifestations after oral trauma
Actinomyces israelii
99
Sulfur granules
Actinomyces israelii
100
High fever, cough confusion, diarrhea - Causative organism? Lab findings?
HYPOnatremia; sputum gram stain showing many neutrophils but few/no organisms
101
Amyloid precursor protein (APP) is involved in what process? Name an abnormal fragment.
Synaptic formation and repair; A-Beta-amyloid
102
On which chromosome is Amyloid precursor protein (APP) located? Associated with which disease?
Chr 21; Down Syndrome
103
Which bug likes alkaline selective media (thiosulfate-citrate-bile sats sucrose)
V. Cholera
104
Which drug simulates an ideal environment in the body for V. Cholera?
Omeprazole
105
Tinnitus, Vertigo, Hearing loss (sensorineural)
Meniere's disease
106
Disorder of inner ear characterised by increased volume of endolymph
Meniere's disease
107
How to estimate the risk of metastasis in Melanoma?
Vertical growth (depth) [Breslow thickness)
108
What mediates paraneoplastic cachexia?
TNF-alpha
109
Consider _____ deficiency with sudden death after blood transfusion.
Select immunoglobulin (IgA) deficiency
110
Islets in Type 1 DM?
Leukocytic infiltration
111
Islets in Type 2 DM?
Amyloid deposition
112
Renal biopsy: ballooning and vacuolar degeneration of prox. Tubules AND multiple oxalate crystals
Toxic renal injury
113
How does ethylene glycol lead to acute renal failure
Precipitation of calcium oxalate crystals in renal tubules
114
Metabolic acidosis, increased osmolar gap, calcium oxalate crystals in urine, suggest WHICH INGESTION?
Ethylene glycol
115
Organism that causes transient pulmonary infiltrates in asthmatic or CF
Aspergillus Fumigatus
116
[Week 1 of illness] raising fever Bacteremia, relative bradycardia; [Week 2] abdominal pain; [Week 3] Hepatosplenomegaly, intestinal bleeding and perforation
Salmonella Typhi
117
Delayed umbilical cord falling off - diagnosis
Leukocyte adhesion deficiency
118
Cause of Leukocyte adhesion deficiency
Absence of CD18 antigen, which is needed to form INTERGRINS
119
Long term complication of Hydrocephalus? Why?
Hypertonicity/Hyperreflexia; UMN damage
120
What do lesions to the glossopharyngeal nerve result in?
Loss of the gag reflex (afferent limb); loss of sensation in the upper pharynx, posterior tongue, tonsils, and middle ear cavity, loss of sensation in the posterior 1/3 of the tongue
121
Fever and HA; CSF: bean-shaped gram negative cocci in pairs
N. Meningitides
122
Route of N. Meningitides infection? (4)
Pharynx --> blood --> choroid plexus --> meninges
123
Which deficiency(s) predispose patients to warfarin induced skin necrosis? Treatment?
Protein C or S; FFP
124
What causes acute appendicitis?
Obstruction of the appendicular lumen
125
Notable biochemical abnormality in Alzheimer disease?
decreased acetylcholine level (2/2 decreased choline acetyltransferase activity in nucleus basalis)
126
Where is the biochemical abnormality of Alzheimer disease seen (2)? What is that area responsible for?
[decrease acetylcholine level] basal nucleus of meynert and hippocampus; memory and cognition and formation of new memories
127
What do ergot alkaloids (ergonovine) do?
constrict vascular smooth muscle by stimulating both alpha-Adrenergic and Serotonergic receptors
128
Ergots alkaloids + Hypercontractile coronary artery segments (Prinzmetal's angina) leads to what?
Coronary artery spasm, chest pain, and ST-segment elevation
129
Biopsy of a non-tender cervical lymphnode that fluctuates in size is likely to show what?
Follicular small cleaved cell lymphoma
130
Cell line Follicular small cleaved cell lymphoma is derived from? Cytogenetic change?
B cells (non-Hodgkin lymphoma); t(14;18) -- over expression of bcl-2
131
Flushing, watery diarrhea, bronchospasm - associated with what?
Carcinoid syndrome (malignant carcinoid tumor)
132
What is elevated in urinary excretion in a person with carcinoid syndrome?
5-HIAA
133
Treatment for carcinoid syndrome?
Octreotide and surgery for mets
134
Insidious-onset exertional dyspnea, restrictive PFTs, paraseptal and subpleural cystic airspace enlarge (honeycomb lung)
Idiopathic pulmonary fibrosis
135
Gradual worsening of dyspnea and productive cough, bilateral patchy pulmonary opacification (2/2 intraalveolar accumulation of amorphous protein and phospholipid material--surfactant)
Pulmonary alveolar proteinosis (PAP)
136
Crohn's disease associated with increase activity of which cells? And also produce and activate what (3)?
TH-1 helper cells; IL-2 and interferon-y and activate macorphages --> synthesize TNF
137
Cochlear part of CN VIII mediates what? Compression leads to what?
Hearing; Sensorineural hearing loss and tinnitus
138
Vestibular part of CN VIII mediates what? Compression leads to what?
Balance; vertigo, dysequilibrium, and nystagmus
139
Loss of taste in the anterior 2/3 of the tongue suggest problem with which CN?
CN VII
140
Compression of CN V results in what? (3)
Loss of sensation around the mouth and nose, loss of corneal reflex, and paralysis of the muscles of mastication
141
Low hemoglobin, thrombocytopenia, absent hematopoietic cells in the bone marrow
Aplastic anemia
142
Aplastic anemia is associated with a compensatory increase in what?
EPO
143
Demylenation of axons results in what?
Impaired saltatory conduction down the axon
144
#1 test to demonstrate cystic duct obstruction. What would you see if obstructed?
HIDA scan; failed gallbladder visualization on radionucleotide biliary scan
145
Findings of DIC. (5)
(1) prolonged PT and PTT; (2) thrombocytopenia and microangiopathic hemolytic anemia; (3) low fibrinogen; (4) elevated fibrin spil products (D-dimer); (5) Low factor V and VIII levels
146
Abdominal discomfort, greasy stools, weight-loss; Biopsy: PAS-positive granules in lamina propria
Tropheryma whippelii
147
Hamartoma on histology
"popcorn calcification" - disorganized cartilage, fibrous and adipose
148
Gold standard diagnosis for Malignant mesothelioma
Electron microcopy
149
tumor cells with numerous long, slender microvilli and abundant tonofilaments
Malignant mesothelioma
