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Test 30 Flashcards

1
Q

first line therapy for pts w/ hypercholesterolemia

A

statins

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2
Q

MOA of statins

A

competitively inhibit HMG CoA reductase> DECREASED cholesterol synthesis>
upregulation of LDL receptors>
increased uptake of LDL from circulation>
lowers LDL

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3
Q

affect of cholestyramine on hepatic cholesterol production

A

INCREASES hepatic cholesterol production

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4
Q

how do bile acid binding resins like cholestyramine work?

A

bile acid binding resins bind BA in GI tract>
BA can’t be recycled>
hepatic synthesis of new bile acids>
consumes liver cholesterol>
hepatic uptake of LDL from circualtion is increased> activates HMG Co A reductase>
increased cholesterol synthesis

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5
Q

why do we give combination of simvastatin w/ cholestyramine

A

together they increase hepatic uptake of cholesterol>

lower LDL

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6
Q

origin of chromaffin cells of adrenal medulla and parafollicular cells

A

NCC

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7
Q

what causes tumors in BOTH the adrenal medulla and the thyroid?

A

germ-line mutation in NCC seen in MEN syndromes 2A and 2B

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8
Q

Increased urinary VMA excretion and adrenal mass

A

pheochromocytoma

assoc w/ MEN 2A and 2B

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9
Q

tumor:
pituitary
parathyroid
pancreas

A

MEN 1

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10
Q

tumor:
medullary thyroid cancer
parathyroid
pheo

A

Men 2A

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11
Q

medullary thyroid cancer
neuromas
pheo

A

Men 2B

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12
Q

genetic defect assocaited w/ MEN 2A and 2B

A

RET proto-oncogene> afffects multiple endocrine organs b/c they all have the same origin (NCC)!!

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13
Q

arises from the 4th pharyngeal pouch and fuse iwth thyroid follicular cells to form the thyroid gland

A

parafollicular cells

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14
Q

parafollicular cells

A

C cells
assocaited w/ thyroid
secrete calcitonin> TONES DOWN Ca

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15
Q

autoimmune destruction of parietal cells (chronic atrophic gastritis)

A

pernicious anemia

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16
Q

secrete HCL and IF and are found in the SUPERFICIAL region of gastric glands

A

parietal cells

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17
Q

progressive fatigue
lower extremity paresthesias
megaloblastic RBC

atrophy of gastric body and body (where parietal cells are) and normal antrum

A

pernicious anemia

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18
Q

loss of parietal cells w/ lymphocytic and plasma cell infiltraiton

A

chronic atrophic gastritis (autoimmune gastritis)

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19
Q

oxyntic cells found in the UPPER GLANDULAR layer that secrete acid and IF

A

parietal cells

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20
Q

TP

A

Sensitivity * number of pts w/ disease

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21
Q

FN

A

(1-sensitivity) * (number of pts w/ disease)

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22
Q

leads to acute renal failure and precipitation of Ca oxalate crystals in renal tubules> ca oxalate crystals in urine

AG metabolic acidosis
increased osmolar gap

A

ethylene glycol ingestion

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23
Q

each tRNA can bind a few different codons for the same AA

A

wobble

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24
Q

catalase negative

A

streptococci

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25
Q

catalase positive

A

staphylococci

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26
Q

beta hemolytic
bacitracin susceptible
pyrrolidonyl arylamidase positive

A

GAS

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27
Q

bile soluble

optochin susceptible

A

strep pneumoniae

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28
Q

dark urine
facial puffiness
pustular skin lesions that broke down and formed thick scabs on lower extemities
urine w/ RBC cell casts

A

Impetigo- caused by S. pyogenes

*staph is MC cause

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29
Q

PYR (pyrrolidonyl arylamidase) test

A

specific for s. pyogenes (bacitracin test is nto very specific)

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30
Q

associated w/ prior strep pharyngeal or skin infection

A

glomerulonephritis

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31
Q

pain and numbness of the dorsum of the right foot

can’t dorsiflex right ankle

A

peroneal nerve

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32
Q

MC nerve injured in the leg

A

common peroneal nerve

superficial location around the lateral neck of hte fibula

**lateral blows, tight plaster casts

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33
Q

sciatic nerve braches

A

common peroneal nerve

tibial nerve

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34
Q

superficial branch of peroneal nerve

A

innervates muscles of the lateral compartment of hte leg

gives off braches that provide sensory innervation to majority of foot

EVERTS foot

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35
Q

innervates anterior compartment of hte leg, muscles dorsiflex foot and toes

A

deep peroneeal nerve

36
Q

regulates circadian rhythm

A

suprachiasmatic nucleus

SLEEP to be charasmatic

(processes light info from the retina and relays it to ohter hypothalamic nuclei and pineal gland to modulate body temp and production of hormones like cortisol and melatonin

37
Q

tx for insomnia associated w/ jet lag

38
Q

stimulated by leptin

mediates satiety

A

ventromedial

if you zap your ventromedial nucleus you’ll grow ventarlly and medially

39
Q

inhibited by leptin

triggered when you’re HUNGRY

A

lateral nucleus (lesion you shrink LATERALLY)

40
Q

cooling via PNS

destruction leads to hyperthermia

A

Anterior

AC needed for anterior cooling

41
Q

mediates heat conservation via sns

destruction leads to hypothermia

A

posterior nucleus

zap your POSTERIOR nuceuls you become a poikilotherm (snake)

42
Q

secretes DA
GHRH
GnRH

43
Q

ADH
CRH
oxytocin
TRH

A

paraventricular

44
Q

supraoptic

A

ADH

oxytocin

45
Q

what causes increased afterload, excess fluid retention and cardiac remodeling in a pt w/ CHF?

A

compensatory activation of RAS and SNS leads to an increase in HR, vasoconstriction and ECV

46
Q

What causes CHF?

A

heart is unable to pump a sufficient amt of blood to meet body’s metabolic demands>
decreased CO

47
Q

decreased CO seen w/ CHF leads too…

A

compensatory neurohumoral stimulation to maintain BP

48
Q

pulsus paradoxus

A

decrease in systolic BP greater than 10 mmHG w/ inspiration

49
Q

cuases of pulsus paradoxus

A

acute cardiac tamponade**
constrictive pericarditis
severe obstructive lung disease
restrictive cardiomyopathy

50
Q

what causes pulsus paradoxus

A

increased right ventricular volume that occurs with inspiration pushes hte interventriculiar septum LEFT

so left heart volume/stroke volume are reduced leading to decreased system blood pressure during inspiration

*normally, inspiration causes an increase in systemic venous return, causing the RV to expand into hte pericardial space w/ litle impact on left side of the heart. Can’t do that when heart is RESTRICTED

51
Q

pulsus paradoxus can occur insettings of severe obstructive pulmonary disease like asthma. who do you tx this?

A

beta adrenergic agonists

control actue asthma exacerbatoins by causing bronchial SMOOTH MUSCLE RELAxation by increasing cAMP

52
Q

MC pathogen causing cystitisa nd acute pyelonephritis

53
Q

second MC uUTI in sexually active owmen

A

staph saprophyticus

54
Q

when should screening for group B strep occur in pregnant women?

A

vaginal rectal culture at 35-37 weeks to identify women who require INTRAPARTUM antibiotics

55
Q

What intrapartum antibiotics are used to prevent neonatal GBS sepsis, pneumonia and meningitis

A

peniciliin

ampcillin

56
Q

first line therapy for tx of acute gouty arthritis

A

NSAIDS> COX inhibitor

colchicine is second line d/t nausea and diarrhea

Glucocorticoids in pts w/ renal failure

57
Q

Recurrent respiratory infection by Pseudomonas, chronic diarrhea, FTT

+ early sibling death from pulmonary infection

58
Q

cause of steatorrhea and FTT in pt w/ CF

A

pancreatic insuficiency

59
Q

tx for CF pt w/ pancreatic insufficiency

A

pancreatic lipase

60
Q

decreass gut motility, blood flow, and endocrine/exocrine pancreatic function (decreass secretion of pancreatic enzymes into intestine)

A

octreotide

61
Q

causes depolarization of bacterial cellular membrane and inhibition of DNA/RNA and protein synthesis

A

Daptomycin

62
Q

SE of Daptomycin

A 
increased CPK (creatine phosphokinase)
myopathy
63
Q

TU daptomycin

A

gram + orgs (MRSA)

64
Q

drugs commonly used for invasive MRSA

A

vanco
dapto
linezolid

65
Q

blocks glycopeptide polymerization by binding tightly to D alanyl D alanine

A

vancomycin

66
Q

depolarizes cell membrane

A

daptomycin

67
Q

inhibits bacterial protein synthesis by binding 50S

68
Q

red man syndrome

69
Q

thrombocytopenia
optic neuritis
high risk for 5HT syndrome

70
Q

prevention of red man syndrome

A

pre treatment w/ antihistamines and slow infusion rate

71
Q

irreversible effects on COX

72
Q

selective COX2 inhibitor

73
Q

reversibly inhibit cox 1 and 2

A 
aspirin
ibuprofen
naproxen
indomethacin
ketrolac
diclofenac
74
Q

Malignancy is going to be removed from the htird part of hte duodenum. What sturcutre is at greatest risk for directe penetration by the tumor?

75
Q

thickened bronchial walls
neutrophil infiltrate
mucous gland enlargement
patchy squamous metaplasia of bronchial mucosa

A

chronic bronchitis

76
Q

leading cause of chronic bronchitis

77
Q

lethal tissue ischemia in myocardium (and most tissues) causes

A

coagulative necrosis

78
Q

ischemic cell death in CNS

A

liquefactive necrosis

79
Q

fat necrosis

A

acute pancreatitis

80
Q

caseous necrosis

A

most TB infections and some fungal infections (histoplasmosa, cryptococcus, coccidioides)

81
Q

how do you make hte dx for tetanus

A

CLINICAL

hx of penetrating wound in pt who hasn’t been VACCINATED

82
Q

trismus
sardonic smile
muscle spasma

A

high clincial suscpision for tetanus

83
Q

what is used to excise RNA primers in prokaryotes

A

bacterial DNA pol I (has 5’ to 3” exonuclaease activity)

*used to excise RNA primers

gaps are then replaced by DNA pol I in 5’ to 3’ direction

*has same fxn as DNA pol III but also can excise primer

84
Q

T cell maturation process htat occurs in the thymic medulla

A

negative selection

85
Q

t cell maturation process that ocurs in the thymic cortex

A

positive selection

86
Q

negative selection

A

eliminates T cells that bind SELF MHC/Ags wtih HIGH affinity

*if these selves were permitted to survive they would induce immune/inflammatory rxns against SELF rxns and lead to autoimmune disease

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