The Big Doozie Flashcards
How do you differentiate between schizoaffective disorder and bipolar disorder with psychotic features?
In schizoaffective, psychoses happen in abscense of mood sx. In bipolar w/ psychotic, psychotic sx only happen during mood periods.
Pt has hx of rheumatic fever. What heart abnormality, and how does it present?
Mitral valve prolapse, LA enlargement, can compress esophagus (since LA is on posterior of heart against esophagus)
Attributes of right colon cancer, left colon cancer, and rectosigmoid cancer?
RCC=Weight loss, progressive fatigue, occult bleeding, B12 deficiency
LCC=Constipation/Diarrhea (obstructs the pathway more)
Rectosigmoid=hematochezia
For following structures, give embryologic origin: Kidneys Gi tract Liver Pancreas Spleen Adrenal Cortex Adrenal Medulla
Kidneys: Mesoderm GI tract: Endoderm Liver: Endoderm Pancreas: Endoderm Spleen: Mesoderm Adrenal Cortex: Mesoderm Adrenal Medulla: Neural crest (ectoderm)
Which l.n. drain the glans penis, the scrotum, and testes?
Penis: Deep inguinal
Scrotum: Superficial inguinal
Testes: Para-aortic
How is malignant hyperthermia treated and what is the MOA?
Treated w/ dantrolene.
It blocks intracellular calcium release, prevents further contraction
5 receptors involved in vomiting?
M1 muscarinic, D2 dopaminergic, H1 histaminic, 5HT3 serotinergic, Neurokinin 1 (NK1) receptors.
Fibrates MOA? Main use? What do they predidpose to?
MOA=upregulate lipoprotein lipase (LPL), increase triglyceride clearance (also causes decreased VLDL production). Main use=lower triglycerides.
Predispose: cholesterol gallstones (b/c decreased bile acid)
Does this by INHIBITING CHOLESTEROL 7-ALPHA HYDROXYLASE
Pt has large amplitude unvoluntary swinging movement of contralateral limb. Where has damage occurred? Potential cause?
This is hemiballismus. Location=subthalamic nucleus
Cause=Lacunar stroke.
Not Huntington’s those are low-amplitude movements (chorea). Caused by atrophy of caudate nucleus.
2 types of scleroderma and associated antibodies for each?
Diffuse: widespread, rapid. Scl-70 Ab (anti-DNA topoisomerase 1)
Limited: CREST syndrome. Anti-centromere Ab.
In someone who is starving, at one point does fuel source change from glycogenolysis to gluconeogenesis?
After 12-18 hours (so if past one day, it’s gluconeogenesis. Involves Oxaloacetate to phosphoenolpyruvate.
What happens once the ribosome interacts with the stop codon?
A release factor binds to the ribosome and the finished script is released from the ribosome.
How does mycoplasma pneumonia relate to erythrocytes?
Its cell membrane is similar to that of erythrocytes, so infection with this organism can lead to hemolytic anemia (which is complement-mediated and intravascular)
What is the positioning of the ureter in relation to:
Gonadal vessels
Internal iliac artery
Uterine artery
Posterior to gonadal vessels and uterine artery (water under the bridge).
Anterior to internal iliac artery.
Which subthalamic nucleus controls circadian rhythm and pineal gland function?
Suprachiasmatic
What is considered a normal A-a gradient?
5-15. If w/in those limits, it means that the problem is caused by alveolar hypoventilation, not the other 3 causes.
An ACTH suppression test doesn’t cause ACTH to decrease even at high doses. What is the likely cause?
Exogenous ACTH (such as from metastatic small cell lung cancer or something like that). It's not caused by a pituitary adenoma.
How is pulmonary arterial hypertension treated?
Definitively with transplant.
For the interim, with Bosentan (a competitive antagonist of endothelin receptors)
What 3 structures run along the anterior elbow?
Median nerve, Radial nerve, brachial artery.
Radial n. most likely injured w/ lateral displacement of fracture, Median n. injured w/ medial displacement
Where does the trachea lie in relation to the esophagus and vertebral bodies?
Between them. On CT, the esophagus doesn’t have a lumen (it’s usually compressed)
T or F?
Adenocarcinoma in situ of the lung involves invasion?
False.
No invasion of vascular or stromal tissue
Woman with Sjogrens (or RA) w/ pruritus and fatigue. Probable dx? Histologically looks like what other process?
Dx: Primary biliary cirrhosis (PBC)
Looks like Graft v. host disease
Both involve lymphocytic inflammation
Tetanus inhibits which neurotransmitters?
GABA and glycine.
Why do ppl w/ Crohn’s dx get gallstones?
Terminal ileum inflammation–>decreased bile reabsorption–>hyperconcentrated bile w/ cholesterol–> gall stones
A pt being treated w/ levodopa for Parkinson’s starts to have times when they freeze. Should you stop tx?
No. It’s hard to predict the response, but this is a side effect of tx and shouldn’t be stopped.
What causes glaucoma, and what is usually used to treat it?
Increased intraocular pressure due to increased aqueous humor production or decreased outflow. Aqueous humor is produced by the EPITHELIUM of the ciliary body. So tx targets that.
What functions as a glucose sensor within the cell?
Glucokinase. It detects glucose and signals for insulin release
Post MI, what is the most common cause of death?
Rupture of the ventricular wall which then leads to hypotension and cardiac tamponade.
What type of drug is neuroleptic malignancy syndrome caused by? What are some sx? Treatment?
Antipsychotic meds.
Fever, elevated Creatine kinase, muscle rigidity, autonomic dysregulation.
Treat w/ dantrolene (to antagonize ryanodine receptors)
What type of drugs (think receptor) are involved with orthostatic hypotension?
The alpha-1 adrenergic antagonists (-azosins)
What is the MOA of digoxin in treating atrial fibrillation?
It decreased AV node conduction by INCREASING PARASYMPATHETIC TONE.
It’s also a positive inotrope by inhibiting the sodium potassium ATPase pump
A previously healthy infant has an intracranial bleed. What is he likely low on, and what process is impaired?
Low on Vitamin K.
Impaired gamma carboxylation.
What’s the triad of Plummer-Vinson syndrome?
Iron deficiency anemia, esophageal webs, atrophic glossitis (DYSPHAGIA)
Also associated with shiny red tongue and spoon shaped nails (koilonychia).
Treat with iron supplementation
A child has a head MRI that shows intracranial calcifications. You were thinking a pituitary adenoma before that. Dx? Origin?
Dx: Craniopharyngioma.
Derived from remnants of Rathke pouch, which becomes the ANTERIOR PITUITARY
Most common childhood supratentorial tumor.
They commonly cause bitemporal hemianopia (blindness in the lateral half of both eyes) b/c they compress optic chiasm
Review sarcoidosis vs amyloidosis
Sarcoidosis: Lungs, African Americans, bilateral hilar adenopathy, constitutional sx, NON-caseating granulomas (vs TB which has caseating granulomas). HYPERCALCEMIA caused by activated neutrophils which cause increased intestinal absorption (PTH independent)–>the granulomas produce ACE 1,25 dihidroxy-cholecalciferol (active form of Vit D)
Amyloidosis: Kidneys
What properties of drugs make them more likely to be metabolized AND cleared by the liver?
Highly lipophilic with a high volume of distribution.
What structure do ACE inhibitors work on?
They work on the efferent arteriole (prevent them from constricting, thus decreasing the GFR)
What are the side effects of thiazolinediones (TDZs), used to treat diabetes by increasing insulin sensitivity?
Names of drugs and MOA?
Weight gain and edema (fluid retention)
Not the best for people with congestive heart failure.
Pioglitazone.
Reduce insulin resistance, bind peroxisome proliferator-activated-receptor-gamma, transcriptional regulation.
Take several days to weeks to kick in due to altered gene expression.
Where is a central line typically placed?
In the Superior Vena Cava
Mechanism of action of nitrates?
Common side effects of nitrates to take into account?
Activate guanylate cyclase and increase amounts of intracellular cGMP. These increased levels lead to dephosphorlyation of myosin light-chain, resulting in vascular smooth muscle relaxation.
Throbbing headache/flushing
What is Hartnup disease? How are neutral AAs involved?
AR disease, deficiency of neutral AA (tryptophan) leads to decreased absorption from gut, decreased niacin, pellagra-like symptoms.
Treat with niacin supplementation
How are CML and leukemoid reaction similar? How do they differ?
Both have increased myeloid precursor cells on blood smear. CML has low leukocyte alk phos level. Leukemoid reaction has normal or high leukocyte alk phos level.
CML-Philadelphia translocation (9:22), BCR-ABL.
If pt has carcinoid syndrome, where has metastasis had to have occurred?
What marker is diagnostic?
How is it treated?
To the liver (ie originate in intestine, but serotonin is metabolized there. If it metastasizes, then pt has symptoms).
Marker: 5-hydroxy… acid (5-HIAA)
Treated w Octreotide and surgery
Common cause of fecal incontinence post labor?
This nerve also senses pain involved w/ external hemmrhoids.
Pudendal nerve injury
Just think POOdendal
What part of brain determines personality?
Lesions to which side cause apathy/depression, and disinhibited behavior?
Frontal lobe=executive fnxn and personality.
Left sided=Apathy/depression
Right sided=Disinhibition
Benign disorder of sugar metabolism.
Which ones aren’t benign?
Benign=Fructokinase deficiency
Not benign=Aldolase B deficiency (hereditary fructose intolerance), Galactose-1-phosphate uridyl transferase deficiency (classic galactosemia)
Differentiate btwn 2 types of Chiari Malformations
Type 1: More mild. Low-lying cerebellar tonsils thru foramen magnum, headaches + cerebellar dysfnxn
Type 2: More severe. Downward displacement of cerebellum + medulla thru foramen magnum.
Kaposi Sarcoma shows what on biopsy?
Spindle cells, neovascularization, extravasation.
Causes diarrhea, esp in HIV pts.
What 3 changes pertaining to stool are seen in lactose intolerance?
Decreased pH (fermenting AAs), Increased breath hydrogen content, increased stool osmolality
What does silicosis impair?
It impairs the macrophages. Macrophages are necessary for fighting off TB.
A pt has breast cancer risk and osteoporosis. Best tx, tamoxifen or raloxifene?
Raloxifene–>opposes estrogen in breast, agonist at bone.
Tamoxifen–>also opposes estrogen in breast, some agonist at bone, but also creates risk for uterine cancer.
Where is contracture most likely to occur?
Palms, soles, anterior thorax, serious burns. Excess matrix metalloproteinase activity and myofibroblast accumulation.
Which portion of the spine does RA tend to affect?
The cervical spine.
If someone has hives, what would biopsy show?
Dermal edema
DS baby has an umbilical hernia. Normal? Tx?
Umbilical ring didn’t close properly. Usually self resolve.
What drugs should be avoided in ppl w/ decreased C1 esterase inhibitor levels?
ACE inhibitors.
Signs of C1 esterase inhibitor deficiency=angioedema
Differentiate btwn pathologic causes of U/L and B/L hearing loss.
U/L=Acoustic Schwannoma between Cerebellum and Lateral Pons.
B/L=Neurofibromatosis Type 2
What artery is occluded when a patient has either Broca or Wernicke aphasia?
Middle cerebral artery
What would cause longitudinal tears at the gastro-esophageal jxn?
Rapid changes in intra-abdominal pressure (ie lots of vomiting).
This is Mallory-Weiss tears. Seen in bulimics or alcoholics since they throw up a lot.
What role does cytochrome C play in apoptosis?
It’s a mitochondrial enzyme that activates caspases and indirectly brings about cell death via intrinsic apoptosis.
Do the campylobacter sketchy.
Do it!
What’s at the 3’ end of the tRNA?
CCA sequence
What is involved if there is skin necrosis after starting warfarin therapy?
A deficiency of Protein C (or Protein S). Due to a hypercoagulable state, and occlusion of the microvasculature
Differentiate btwn Niemann Pick and Tay-Sachs. What will accumulate in each?
Niemann-Pick: hepatosplenomegaly, cherry red spot. Sphingomyelin accumulates.
Tay-Sachs: NO hepatosplenomegaly, cherry red spot. GM2 ganglioside accumulates.
What is the mechanism of myasthenia gravis?
Autoantibodies against postsynaptic ach receptor. Reduced motor end plate potential
How do you treat people with overstimulation of muscarinic receptors in gut? (excessive cholinergic)
Scopalamine
Someone has excessive orotic acid. What is deficient?
Ornithine transcarbamylase. Most common Urea cycle disorder. X linked recessive. Interferes with ability to eliminate ammonia.
Will see increased orotic acid, decreased BUN, decreased citrulline, increased glutamine, NO MEGALOBLASTIC ANEMIA (vs orotic aciduria)
What is theophylline used for and what are the toxicities?
Not widely used, for asthma.
Toxicities: Seizures and arrhythmias (heart and brain)
In what situations can pulsus paradoxus be observed?
Cardiac tamponade, Asthma, Obstructive Sleep Apnea, Pericarditis, Croup
How are acute obstructive pulmonary exacerbations treated?
With beta-2-adrenergic receptor agonists.
Gs protein–>increased intracellular cAMP
How do methimazole and propylthiouracil both treat hyperthyroidism?
They both block the coupling. PTU also decreases peripheral conversion of T4 to T3.
Using gancicolvir and TMP-SMX increases odds of developing what?
Neutropenia.
Zidovudine does the same thing
What’s the pathogenesis of bacterial colonization on heart valves in strep viridans?
Fibrin deposition.
Sudden appearance of flat, dark cutaneous lesions on trunk and head. Dx? At risk of?
Dx: Seborrheic keratosis (common in old ppl)
Indicative of underlying malignancy
Hallmark of diastolic heart failure? Associations?
Elevated LV filling pressure. Associated w/ htn, obesity, infiltrative disorders (transthyretin-amyloidosis, sarcoidosis).
What muscle is innervated by the thoracodorsal nerve?
Latissimus Dorsi
What are hallmarks of anaplastic tumors?
They don’t have any resemblance to the tissue they originate from. Also contain numerous abnormal mitoses and giant tumor cells.
What’s the net effect of ribavirin? What is it used to treat?
Treats Hepatitis C.
It interferes with the duplication of viral genomic material.
How do dysplasia and carcinoma differ?
Dysplasia is reversible until it includes the basement membrane.
What structures are associated with the 1st, 2nd, and 3rd parts of the duodenum?
1st=1st lumbar verebra (only part that isn’t retroperitoneal)
2nd=head of pancreas, common bile duct
3rd=superior mesenteric vessels, uncinate process of pancreas
For what organism is dark-field microscopy used?
Treponema pallidum (which causes syphilis). Look for helical motile spirochetes.
What is etoposide used to treat? What is the difference between topoisomerase I and II?
Etoposide treats testicular and small cell lung cancer. It targets topoisomerase II.
Top I makes only nicks in a single strand of DNA.
Top II cuts both (to relieve tension). Etoposide prevents Top II from resealing the break, so the cells get killed b/c their DNA is chopped up. (Podophyllin does the same thing, but to treat genital warts)
What effect do nitrites have on hemoglobin?
In what situation would you give someone nitrites?
They cause it to switch to the methemoglobin form (which can’t carry O2, binds to cyanide). The partial pressure of O2 in blood remains same.
Give them nitrites in cyanide poisoning to get cyanide off of the cytochrome in mitochondria
What type of mutation causes HbS and HbC?
Missense mutations.
HbS=Glu->Val (even more positive)
HbC=Glu->Lys (even more positive)
Remember: Missense is when only one is substituted. Nonsense can’t make sense b/c it stops early. Missense is just a mistake.
All exclusively breastfed newborns should be supplemented with what vitamins? (hint, one is a one-time thing, one is continual for first 6 months)
Vitamin D supplementation
Vitamin K injection (one time)
What does leuprolide used for, and how does it work?
It’s a GnRH analog. It can either be pro-androgen (pulsatile therapy) or anti-androgen (continuous therapy ie for prostate cancer or precocious puberty).
Most common NNRTIs?
Nevirapine, Efavirenz
What eye finding would you expect to see with uncal herniation secondary to increased intracranial pressure?
CN III palsy. Fixed dilated pupil (damage to parasympathetic fibers)
Recurring calcium oxalate kidney stones. Tx?
Thiazide diuretics (increased calcium reabsorption). Don’t use if hypercalcemic.
Which cytokine is involved in cachexia? (Muscle wasting) What do the following do? Interferon alpha IL-3 TGF-beta
TNF-alpha.
Interferon alpha: synth by leukocytes. Antiviral and antitumor
IL-3: activated by CD4 cells. Myeloid cell growth (bone marrow stimulation)
TGF-beta: inhibits inflammatory response (T cells, cytokines)
Differentiate btwn:
Simple/Complex partial seizures
Partial/Generalized seizures
Simple: maintain consciousness
Complex: impaired consciousness
Partial: Only single area of brain (usually medial temporal lobe)
Generalized: Diffuse
What test is used to test for fat in stool?
Stool microscopy w/ Sudan III stain
Give quick summary of nephrotic syndrome.
Increased glomerular permeability–>major loss of protein–>drop in colloid osmotic pressure–>fluid moves into interstitium (edema)–>increased aldosterone (replenish fluid in vasculature)–>increased protein production in liver
Which drug should be used to treat atropine toxicity?
Physostigmine (Physostigmine “Phyxes” atropine overdose)–>penetrates CNS as well as periphery.
Neostigmine=NO CNS.
Bot are anticholinesterases
What is the cancer marker CA-125 strongly associated with?
Epithelial ovarian neoplasms (serous and mucinous cystadenocarcinomas).
MOA of anastrozole, used to treat breast cancer w/ ER mutation.
It’s an aromatase inhibitor–>decreases amount of estrogen, pretty effective.
Meds that diminish the degradation of Ach are beneficial in Alzheimer’s. Why?
Ach is decreased in basal nucleus of Meynert and hippocampus in Alz due to decreased act. of choline acetyltransferase.
What’s a scotoma?
It’s a visual defect that occurs due to pathological process.
Pt has swollen erythematous joint w/ fever and reduced ROM. Dx? Next steps?
Synovitis. Tap the joint and test it.
Don’t leave untreated–>fever and severe pain tip you off to serious process, NSAIDs won’t cut it.
Parakeratotic stratum corneum, esp. on elbows.
Psoriasis
What’s the mechanism of ionizing radiation?
It causes double-strand breaks in the DNA and formation of oxygen free radicals.
Differentiate btwn IL-4 and IL-5
IL-4: produced by Th2 helper cells. Facilitates growth of B cells and T helper lymphocytes. Stimulates antibody switching (esp IgE)
IL-5: B cell differentiation, stimulates IgA production and eosinophil activity. Important in parasitic infections
What is Corynebacterium diphtheriae grown on?
Cysteine-tellurite agar (grows black). Remember exudate is grayish color.
Carbidopa is added to levodopa. What side fx will get worse?
What is Entacapone used for?
Anxiety & agitation. Carbidopa increases availability in CNS, decreases in periphery. Improves most side fx. However, these get worse bc they are central
*entacapone is often added later on, it also decreases the peripheral conversion
White spots w/ erythematous center in buccal mucosa (Koplik spots).
Measles. Cough, Coryza, Conjunctivitis. Then spots. Then you get maculopapular rash that starts at head and moves down.
2 classes of dopamine agonists?
1) Ergot (bromocriptine)
2) Non-ergot (pramiprexole, ropinirole)
Why might a pregnant women have bad hypotension when supine?
Uterus compresses IVC, less venous return. Should lay on their left side.
What type of channel is blocked in CF?
ATP channel
Choosing between glipizide, glimepiride, and glyburide, which has lowest chance of causing hypoglycemia?
Glipizide (it’s short acting). Just gotta memorize that.
In EPI (exocrine pancreatic insufficiency), which process will still be normal?
The absorption of MONOSACCHARIDES (don’t require pancreatic enzymes to digest them).
Lipase, Amylase, trypsinogen, and stool fat content will all be irregular.
Between succinylcholine and the “curare” type drugs, which one is depolarizing and which is nondepolarizing?
Succinylcholine is depolarizing in phase I, then repolarized in phase II.
Curare drugs are nondepolarizing.
I don’t really understand this stuff.
When should you expect to hear a VSD, and what maneuver makes it more pronounced?
Hear a holosystolic murmur made worse by hand grip maneuver (increased systemic resistance, more left to right movement of blood)
Allopurinol is a chronic gout drug. It’s a xanthine oxidase inhibitor. What drugs does it increase concentration of?
Azathioprine and 6-Mercaptopurine (both metabolized by XO)
Why are beta-2 adrenergic agonists used in obstetrics?
Relaxes uterine muscle(tocolysis, inhibits contractions)–>can hold off labor for a little bit.
Which muscle(s) of rotator cuff cause ER?
Infraspinatus (and some teres minor).
Supraspinatus-abduction
teres minor-adduction/ER
Subscapularis-IR, adduction
Bell’s Palsy
Facial n paralysis. Unilateral paralysis.
Can’t smile, eyebrow sagging, can’t close eye. Decreased tear formation, decreased taste of ant 2/3 of tongue
For patients who don’t benefit more from meds in Parkinson’s, where should DBS be targeted?
To the subthalamic nucleus or globus pallidus INTERNUS
Pt with amenorrhea. Skinny, works out a lot. Why?
Decreased leptin, dysfunctional GnRH stimulation. Decreased LH, FSH, estradiol (Functional Hypothalamic Amenorrhea)
Which breast cancer marker is indicative of poor prognosis?
HER2
In which patients are corticoid tx first line for gout?
People w/ contraindications to cyclooxygenase inhibitors (NSAIDS) and colcichine (those are the usual first line treatments).
Differentiate b/w PDA and tetralogy of Fallot
PDA–>cyanosis in lower extremities.
Tetralogy–>the r-l shunt of VSD causes whole body cyanosis (problem is in the heart)
Patient has an elevated alk phos. What should you follow it up w/ to determine if liver is source?
gamma-glutamyl transpeptidase (this is specific to the liver)
Screen for this if looking for renal failure in diabetics
Albumin. Do serum dipstick looking for albumin.
Orotic acid, retardation, megaloblastic anemia. Dx, tx?
Dx: Orotic aciduria
Tx: Uridine supplementation
Most important opsonins
IgG and C3b
Thiazide diuretics lead to increased excretion of this. Causes…
Potassium. Causes hypokalemia and metabolic alkalosis (b/c hydrogen also excreted)
Puffer fish toxins block..
Depolarization (voltage gated sodium, blocks sodium influx)
RIght sided murmurs increase on…
lEft sided murmurs increase on…
rIght=Inspiration (tricuspid regurg)
lEft=Expiration (mitral regurg, VSD)
AST:ALT ratio in alcoholic pancreatitis? What else is indicative?
AST:ALT>2. Macrocytosis of RBCs is also indicative of alcoholic (vs acute pancreatitis)
Pt w/ RA, post intubation has flaccis paralysis. Cause?
Cerebral vertebrae subluxation
Hormone body produces that acts like diuretic.
ANP, released from atria
Where should thoracocentesis be performed?
Mid clavicular: between 6th and 8th rib
Mid axillary: between 8th and 10th
Paravertebral: btwn 10th and 12th
Glucocorticoid effect on liver?
Increased gluconeogensis and glycogenesis.
Biggest warning with lamotrigine (anti-epileptic)?
Steven Johnson syndrome-monitor for rash, more likely in kids.
What is blocked by a monoclonal antibody in HER2 mutations?
What is the name of the monoclonal antibody?
A tyrosine kinase receptor
Trastuzumab. It inhibits proliferation and promotes apoptosis
Nonsurgical management of gallstones?
Bile acid supplement–>more bile acid=less cholesterol concentration
TB drug that requires bacterial catalase peroxidase?
Isoniazid
Pt has urine that darkens upon it standing overnight, painful abd, polyneuropathy. Dx? Cause? When treated (w/ heme preparation), what is downregulated?
Acute intermittent porphyria, AD condition.
Porphobilinogen deficiency.
Give glucose or heme.
Heme downregulates aminolevulinate synthase (ALA synthase)
Pt has low EF. But then when bypass is performed, the function increases. What is likely cause?
Hibernating myocardium–>the dysfxn is resolved with revascularization
Cytokine crucial for wound healing
TGF-beta. It attracts fibroblasts.
Ristocetin shows decreased aggregation of platelets.
Von Willebrand factor deficiency
Urea cycle defect, increased ornithine. What should be limited in pt?
Protein
DS associated w/ what hematologic malignancy?
> 5 yrs old=ALL
<5 yrs old=Acute megakaryoblastic leukemia
What hormones are neurophysins involved with, and where are those hormones released from?
Involved with ADH (vasopressin) and oxytocin. Released from posterior pituitary.
Where do ACL and PCL originate and attach?
ACL: Orig @ ant lateral femoral condyle. Attach @ medial tibial plateau ANTERIOR to PCL. Prevents anterior movement of tibia related to femur.
PCL: Orig @ ant medial femoral condyle. Attach @ lateral tibial plateau POSTERIOR to ACL. Prevents posterior movement of tibia related to femur.
4 drugs for partial seizures, 4 for general seizures, 1 for absence.
Partial: CGPP (Carbamazepine, gabapentin, phenobarbital, pheytoin)
General: LLTV (Lamotrigine (stevn Johnson!), Levetiracetam, Topiramate, Valproate
Absence: Ethosuximide
Peripheral artery disease tx that blocks platelets and vasodilates.
Cilostazol.
Should also give aspirin or clopidogrel as antiplatelets to avoid coronary heart disease and stroke,
Hormone that keeps you thin, if you lose it you get obese?
Leptin–>the satiety hormone. LepTIN keeps you THIN
Ghrelin is the hunger hormone
Most common brain tumor in adults. Histology?
Glioblastoma multiforme (from asrocytes) Histo: Pseudopalisading pleomorphic tumor cells surround area of necrosis and hemorrhage
Acute bacterial arthritis in sexually active female. Cause?
N. Gonorrhea
If efferent arteriole constricts in kidney, what happens to GFR and FF?
GFR increases. FF increases.
Pt lost pain and temp sensation to UE. Dx? What is damaged?
Syringomyelia.
Central cystic dilation leads to damaged ventral white commissure and anterior horns. Associated w/ Chiari malformations.
Upper motor neuron signs w/ scoliosis would also indicate syringomyelia.
Antibiotic associated w/ reversible cytopenias and irreversible aplastic anemia.
Chloramphenicol. Binds bacterial 50s.
What are the following markers found on? CD4 CD8 CD15 CD16 CD19 and CD20
CD4: t helper cells
CD8: cytotoxic T cells
CD15: Granulocytes and Reed-Sternberg cells (Hodgkin Lymphoma)
CD16: Fc receptor on NK cells, neutrophils, macrophages.
CD 19 and 20: pre-B cells (19, 20 and 21 on mature B cells)
Wolf Parkinson White quick hits:
Delta wave, shortened PR interval, widened QRS.
Accessory pathway bypasses AV node, directly connects atria and ventricles.
Which drug classes prolong the QT interval? Of these, which is least likely to cause Torsades de Point?
Class IA sodim (Disopyramide, Procainamide, Quinidine) and Class III potassium (amiodarone, dronedarone) antiarrhythmics.
Amiodarone is least likely to cause Torsades de Point.
Clinical presentations of tertiary syphilis?
Cardiovascular symptoms, gummas.
Remember VDRL is indicative of syphilis
Neurotransmitter abnormalities in Huntington’s
Decreased Ach and GABA, Increased dopamine
remember atrophy of caudate nucleus
What type of drug metabolism would have bimodality?
Acetylation (there are slow and fast acetylators)
For the coronary arteries, give where you would see St elevations for MI:
LAD
Left Circumflex
Right Coronary
LAD: V1-V4, anteroseptal transmural ischemia
Left Circumflex: V5, V6 (possible I and aVL), transmural ischemia of lateral wall of LV
Right Coronary: II, III, aVF, posteroinferior wall of LV
Waxing and waning lymphadenopathy, most common indolent non-hodgkin lymphoma.
Follicular Lymphoma. B-cell origin.
t(14;18)
Overexpression of bcl-2 oncogene
Pt presents w/ jaundice and shortness of breath. Labs show both liver and lung abnormalities. Dx?
Alpha 1 antitrypsin deficiency. Cirrhosis and hepatocellular carcinoma are potential complications
What are bisphosphonates (-nates) similar in structure to? What is their MOA?
Similar to pyrophosphate
Disrupts osteoclast fxn by attaching to hydroxyapatite binding sites on bones (makes osteoclasts apoptose)
What are the targets of the following viruses?
CMV-->Cellular integrins EBV-->CR2 (CD21) HIV-->CD4/CXCR4/CCR5 Rabies-->Nicotinic Acetylcholine Receptor Rhinovirus-->ICAM1
Elevated propionic acid. Involved AA’s?
Valine, Isoleucine, Methionine, Threonine
Base excision repair sequence:
Glycosylase cleaves–>Endonuclease cleaves 5’ end–>Lyase cleaves 3’ end–>DNA Pol III–>Ligase
Sertoli cell fxn?
Produce inhibin–>suppress FSH
Also facilitate spermatogenesis. Loss of fxn would mean infertility
Difference between transference and displacement (psych)
Transference: Emotions for someone from the past moved to someone in present
Displacement: Emotions for someone in present moved to someone else in present
Alternate treatment for hypertriglyceridemia (besides fibrates)?
Niacin. It increases HDL, lowers LDL and triglycerides.
Side fx=increased prostaglandins (treated w/ aspirin)
Etanercept is a secondary treatment for rheumatoid arthritis. What is its MOA?
It is a soluble receptor decoy protein. It is a “deceptor”. Get it? Etanercept–>decept–>decoy?
What is a direct indicator of alveolar ventilation status?
PaCO2. If it is low, it means there is alveolar hyPER ventilation. If it’s high, it means there is alveolar hypoventilation.
What is the autonomic function of dopamine?
At low doses, dopamine binds to D1 receptors in renal vasculature and cause increases in GFR, RBF, and sodium excretion.
At higher doses, dopamine increases cardiac contracility by binding to beta-1 adrenergic receptors.
What do the vinca alkaloids (used as chemo) act on, and what phase of cell cycle do they lock cells in?
They act/inhibit microtubule formation. Thus, they arrest cells in M phase since the DNA can’t be pulled apart. Causes peripheral neuropathy.
MOA of benzodiazepines?
Open CNS GABAa receptor-chloride channels. (Keep open longer so choloride can move more).
Anticonvulsant, muscle relaxant, anxiolytic, hypnotic.
No bone marrow aspirated. Pancytopenia. Massive splenomegaly (red pulp). Dx? Histo findings?
Hairy cell leukemia.
Diagnosed by finding TRAP on flow cytometry.
Lymphocytes w/ cytoplasmic contractions on histo (like hair)
IV drug user dies. They have signs of endocarditis. What valve involed, and what would you expect to see on lungs?
Valve=Tricuspid valve
Lungs: Wedge shaped hemorrhagic lesions on periphery, secondary to septic pulmonary embolus.
The only place in GI tract where ulcers don’t have increased risk of carcinoma in same location.
Duodenum.
Type 1 error vs Type 2 error? How does power fit it?
Type 1 error (alpha): Probability of seeing a difference when there isn’t one in reality.
Type 2 error (beta): Probability of seeing no difference when one truly exists.
Power (1-beta): ability of a study to detect a difference when one really exists
Cardiac tissue conduction velocities, fastest to slowest.
Purkinje system–>atrial muscle–>ventricular muscle–>AV node.
“Park AT VENture AVenue”
Slowest in AV node so ventricle can fill during diastole.
Why are conjugate vaccines used?
To elicit a T cell response leading to long term immunity through memory B cells.
What are the source of amatoxins, and what do these toxins do?
Poisonous mushrooms. They inhibit RNA Pol II, thus preventing production of mRNA.
MOA and use of colcichine?
Acute gout and prophylactic gout drug.
It inhibits tubulin polymerization, messes up microtubules/cytoskeleton.
GI side effects
Brain mass causing early morning emesis and papilledema/headaches. Dx? Location?
Pineal gland tumor. Most likely a germinoma causing obstructive hydrocephalus. Suprasellar.
Potential problems w/ massive amounts of blood transfusion?
Citrate can chelate calcium, cause hypocalcemia.
Difference between heteroplasmy and penetrance?
Penetrance: Either you have the disease or you don’t.
Heteroplasmy: People have varying severities of the disease, seen in mitochondrial diseases b/c ppl inherit different amounts of maternal mitochondria
musculocutaneous n. muscles & sensory
forearm flexors (biceps, brachialis, coracobrachialis) sensory: lateral forearm
artery in head of femur, damage leads to avascular necrosis
medial circumflex a. (of profunda femoral)
What do LMW heparin and unfractionated heparin bind to?
LMW heparin (enoxaparin): antithrombin III, Factor Xa Unfractionated heparin: antithrombin III, Factor Xa, Thrombin (more effective)
Characteristics of ARPKD and ADPKD
ARPKD: Infantile. Congenital hepatic fibrosis. Can lead to Potter sequence. Systemic htn, progressive renal insufficiency, portal htn.
ADPKD: usually mutation in PKD1. Adult onset. Numerous huge cysts, flank pain, hematuria, htn. Extrarenal manifestation=Liver cysts (3rd to 4th decade)
Why is hydroxyurea used in sickle cell disease?
What about gardos channel blockers?
It leads to production of Hemoglobin F, less Hb S. Mechanism not understood. Used for pts with pain crises.
Gardos channel blockers block exit of water and potassium from cell, prevents dehydration and polymerization of RBCs.
Signs of Graves disease
exophthalmos (treated by high-dose GLUCOCORTICOIDS!), pretibial myxedema, periorbital edema, eye movement limitation.
In Graves, antibodies attack the TSH receptor in body.
Preferred treatment for open angle glaucoma
Topical prostaglandins–>they increase acqueous humor outflow
What blocks ascension of kidneys in horseshoe kidney? What is clinical sign of it?
The inferior mesenteric artery blocks it.
Frequent UTIs are a sign of it, associated w/ ureteropelvic obstruction, hydronephrosis, renal stones, infection, aneuploidy syndromes.
60 yo smoker hematuria, flank pain, polycythemia, palpable mass. Dx?
Renal cell carcinoma–>also one of the “silent” cancers, don’t catch it til it metastasizes.
Between polyclonal and monoclonal lymphocytic proliferation, which is most likely malignant?
Monoclonal–cells of one type are malignant.
Vitamin deficiency associated with eating too many egg whites.
Biotin (Vit B7). Avidin in egg whites binds biotin.
It’s a co-factor for carboxylation enzymes.
Used in conversion of pyruvate to oxaloacetate, results in lactic acidosis.
“Flame shaped retinal hemorrhage”
Caused by hypertension, causes unilateral vision problems.
Child, massive splenomegaly, pancytopenia, osteoporosis, macrophages w/ “wrinkled tissue paper.” Diagnosis? Deficiency?
Gaucher’s (high in Ashkenazi jews).
Beta-glucocerebrosidase deficiency.
AR lysosomal storage disorder.
Supplement with glucocerebrosidase.
Malignancy associated with myasthenia gravis
Thymoma
Vessels at risk after transverse cut in in rectus abdominis during C-section?
Inferior epigastric arteries (they are susceptible to hematoma)
Calcification of hilar l.n., birefringent particles visible, cmmon in certain industries.
Silicosis
What effect do beta blockers have on juxtaglomerular apparatus?
They block beta 1 receptors there. Normally those receptors release renin, but blockers block that and thus also lower Renin, Angiotensin II, Angiotensin I, and Aldosterone. They don’t have an effect on the ACE system, so don’t affect angiotensinogen or bradykinin..
Friederich Ataxia and Vitamin E deficiency look alike. What are the symptoms? (what kills ppl w/ friederich ataxia?)
Ataxia, Loss of position and vibration sense, loss of deep tendon reflexes.
Friederich Ataxia ppl die of heart issues (hypertrophic cardiomyopathy). It is caused by degeneration of spinocerebellar tracts.
What is it that makes methadone such an effective treatment for opioid addiction?
It’s a full mu-opioid agonist with a really long half life (less likely to have withdrawal symptoms)
Give 2 equations to calculate Renal Blood Flow
(Urine PAH*Urine flow rate)/Plasma PAH
or
(PAH clearance)/(1-hematocrit)
What is extramedullary hematopoiesis indicative of?
Some sort of hemolytic process (ie severe chronic hemolytic anemia, Beta-thalassemia)
Drug that slows heart rate with no effect on contractility or relaxation. Name of drug? MOA?
Ivabradine.
It selectively inhibits the funny channel (Na channel, Phase 4)
What causes greatest risk of death in Acute Rheumatic Fever?
Pancarditis–>myocarditis, cardiac dilation, heart failure, death.
What is RT-PCR used to detect?
Levels of mRNA in a sample.
Pathogenesis of black pigment gall stones?
Brown stones?
Increased amounts of unconjugated bilirubin in bile (ie secondary to chronic hemolysis, ileal disease).
Brown=biliary tract infections.
Mnemonic to differentiate between high and low potency antipsychotics?
TRy to Fly High (Trifluoperazine, Fluphenazine, Haloperiodol)–>neurologic side fx
Cheating THieves are low (Chlorpromazine, Thioridazine)–>non-neurologic side fx.
Crigler-Najjar vs Gilbert vs Dubin-Johnson
Crigler-Najjar: Unconjugated hyperbilirubinemia. Absent UDP (which converts unconj to conj bili). Jaundice w/ neuro symptoms (kernicterus=bilrubin deposits in brain)
Gilbert: Unconjugated hyperbilirubinemia, mild anemia, decreased levels of UDP.
Dubin-Johnson: Conjugated hyperbilirubinemia, defective liver excretion. Black liver. Benign. (Rotor’s=similar, milder, no black liver)
Mechanism of development of insulin resistance?
serine kinases in the beta subinit of insulin receptor get phosphorylated (induced by catecholamines, glucocorticoids, glucagon, TNF-alpha), which then prevents the downstream signaling that insulin binding to alpha receptors usually causes.
Head bobbing in cardiovascular problems
Widened pulse pressure, likely secondary to aortic regurgitation
Strawberry vs cherry hemangiomas
Strawberry=common in kids, they regress by age 5-7.
Cherry=most common in adults. Do not regress. Appear in adulthood.
Subarachnoid hemorrhage in pt w/ adult polycystic kidney disease. Give what to prevent cerebral vasospasm?
Berry aneurysm.
Give calcium channel blocker, specifically beine.
Berry aneurysm associated with ADPKD, Eherls Danlos Syndrome
Antifungal that changes composition of cell membrane, and involved CYP450
-Azole drugs.
Suppress synthesis of ergosterol. Also inhibit CYP450 oxidase system in humans.
Drug class used to lower LDL that causes hypertriglyceridemia?
Bile-acid binding resins. It’s b/c they inhibit the enterohepatic circulation of bile acids which increases production of triglycerides and causes hypertriglyceridemia
Cholestyramine, Colestipol, Colesevelam.
Signs of abusive head trauma (“shaking baby syndrome”)
Full anterior fontanelle, tearing of bridging veins and SAH, retinal hemorrhages, posterior rib fractures.
*note that if no Vit K supplementation occured, then that’s the leading differential
Which nerve (and subsequently muscle lesion) is at risk from thyroidectomy?
External branch of superior laryngeal nerve.
The cricothyroid muscle is at risk.
Relation of blood/gas coefficient to blood saturation and onset of action in inhaled anesthetics?
Lower blood/gas coef: High blood saturation, fast onset, lower potency
Higher blood/gas coef: Low blood sat, slow onset, high potency.
Why have monoclonal antibodies been devleoped to PD-1 and CTLA-4?
PD-1 and CTLA-4 are found on T cells and carry out cell death unless the cells they bind to have PD-L1 and B7 ligands that bind to those surface receptors. Cancerous cells overexpress PD-L1 and B7 to avoid immune system. By developing monoclonal antibodies to PD-1 and CTLA-4, it prevents tumor cells from being able to avoid the immune system.
Which arteries provide the lesser and greater curvatures of the stomach?
Lesser: Left and right gastric
Greater: Left and right gastroepiploic and short gastric
Differentiate between indirect and direct hernias.
Indirect: LATERAL to epigastric vessels. Protrude at deep inguinal ring.Continue into scrotum. Felt with tip of finger (thru external inguinal ring)
Direct: MEDIAL to vessels. Hesselbach triangle. Felt w/ pulp of finger.
MD’s don’t LIe.
Leukemia associated w/ 15:17 translocation and treatment.
APML (M3 version of AML).
Responds to all-trans retinoic acid.
Promyelocytes and intracytoplasmic Auer Rods, bleeding in setting of DIC, decreased fibrinogen
Also associated with promyelocyte leukemia gene (15:17)
Dry vs. wet age-related macular degeneration
Dry: gradual decrease in vision. Yellowish spots on pigment epithelum (“drusen spots”)
Wet: rapid loss of vision, neovascularization. Grayish green subretinal discoloration.
HLA Class I and II associated spondyloarthropathies:
Class I (HLA B27): Seronegative spondyloarthropathies-->Psoriatic arthritis, Ankylosing Spondylitis, IBD, Reactive Arthritis (PAIR) Class II: Rheumatoid Arthritis, T1DM, Celiac.
How do liver and skeletal muscle differ in terms of how glycogenolysis is initiated?
Liver: Epinephrine and glucagon bind Gs, increased cAMP phosphorylates PK which then activates glycogenolysis.
Skeletal Muscle: Contraction causes release of calcium which phosphorylates PK to activate glycogenolysis.
Rule of thumb for kidney function:
Creatinine doubles as GFR halves. (ie GFR 60—>30, Cr 1–>2).
Difference between paranoid and delusional personality disorder?
Paranoid: Distrusting, no specific delusions (ie don’t trust neighbors but don’t think they’re doing anything)
Delusional: Delusions for over a month, but otherwise functional. (ie don’t trust neighbors and think they are poisionig them)
Signs of mesothelioma:
Pleural effusion, pleural thickening, asbestos connection, psammoma bodies w/ numerous long slender microvilli and abundant tonofilaments.
Where does bleeding typically occur in intraventricular hemorrhage in premies?
The germinal matrix.
Hormone that is stored in liver that mobilizes fatty acids for metabolism in times of stress.
Hormone-sensitive lipase
Finger/thumb extension is weak, everything else ok. Nerve affected? Where does this nerve pass through?
Radial nerve. Passes through supinator canal.
Best drug for acute MI to slow down heart, decrease oxygen demand?
Cardioselective beta blocker (Beta-1 adrenergic blocker).
How to differentiate between all the types of beta blockers?
What is their general MOA?
Beta 1 selective antagonists: go from A to M (atenolol, betaxolol, esmolol, metoprolol.
Nonselective antagonists: go from N to Z (nadolol, pindolol, propranolol, timolol
Nonselective alpha and beta: Modifixed suffixes (-lol instead of -olol)
MOA: They inhibit the interaction between neurotransmitters and their receptors in adrenergic synapses.
Give vessels responsible for and characteristics of these issues: Epidural hematoma: Subdural hematoma: Subarachnoid hemorrhage: Intraparenchymal hemorrhage:
Epidural hematoma: middle meningeal artery. “Lucid interval”
Subdural hematoma: Bridging veins. Crescent-shaped hemorrhage. Midline shift.
Subarachnoid hemorrhage: Rupture of aneurysm (Berry aneurysm). “Worst headache of my life”. Treat with nimodipine (ca channel blocker)
Intraparenchymal hemorrhage: Systemic htn, amyloid angiopathy, recurrent lobar hemorrhagic stroke in elderly.
MOA of aspirin, NSAIDS, celecoxib, acetaminophen.
Aspirin: Irreversible COX1 and COX2 inhibition via acetylation.
NSAIDS: reversibly inhibit COX1 and COX2
Celecoxib: Reversibly inhibits COX2. Doesn’t cause GI side effects
Acetaminophen: reversibly inhibits COX, mainly in CNS (thus no anti-inflammatory effects)
Diuretic used for increased intracranial pressure. Toxicity?
Mannitol (acts on proximal straight tubule, an osmotic diuretic)
Toxicity: Pulmonary edema.
MOA of SSRIs?
Blockade of the serotonin transporter.
2nd generation antipsychotics are D2 and serotonin receptor antagonists.
Most common predisopsing factor for infective endocarditis?
Mitral valve prolapse (in developed countries) Rheumatic fever (in developing countries)
What motions do the cerebellar hemispheres control?
Ipsilateral motion. Lesions to a hemisphere would cause ipsilateral dysdiadokinesia
What are the cumulative effects of sickle cell disease on the spleen? Major sx of SCD?
Major atrophy and fibrosis due to repeated splenic infarctions (during times of crises).
Pain crises, dactylitis (swelling of hands and feet due to infarctions in bones of extremeties), intra and extravascular hemolysis.
How to keep where the branches of trigeminal nerve exit?
“Standing Room Only”
Superior orbital fissure (V1, CNIII, IV, VI)
Foramen Rotundum (CN V2)
Foramen Ovale (CN V3)
How to reverse atropine toxicity (excessive muscarinic activation)
Physostigmine (b/c it does both periphery and central)
Neostigmine has NO central.
What tissue are heart valves made of?
Connective tissue
Net effect of ACE inhibitors?
Increased Angiotensinogen, Angiotensin 1, Bradykinin (b/c ACE normally breaks down bradykinin)
Decreased Angiotensin II and Aldosterone.
Chronic lymphedema predisposes to…
Angiosarcoma (especially after mastectomy). Presents as firm violaceous nodules.
Distinguish between Th1 and Th2 helper cells.
Th1 cells: release IFN-gamma. Activate macrophages and cytotoxic T cells. Activated by IFN-gamma and IL-12 (from macrophages).
Involved in Crohn disease
Th2 cells: release IL-4, IL-5, IL-10, IL-13. Recruit eosinophils for parasite defense and promote IgE (from B cells). Activated by IL-4, inhibited by IFN-gamma.
Involved in Ulcerative Colitis
General mechanism of Regulatory T cells
They suppress CD4 and CD8 T-cell effector functions. Express CD3, CD4, CD25, and FOXP3.
When activated they produce anti-inflammatory cytokines (IL-10, TGF-beta)
Triad of McCune Albright Syndrome?
1) Endocrine disorders
2) Cafe au lait spots
3) Fibrous dysplasia of bone
International adoption (no newborn screening), blurry vision. Deficient enzyme?
Galactokinase deficiency–>accumulation of buildup of galactose and thus galactitol, which causes cataracts.
*remember that galactose-1-phosphate deficiency is the very serious galactosemia and present early 2o to consuming milk. Due to accumulation of galactose-1-phosphate.
In which part of bilirubin cycle is it green in color?
When it’s biliverdin.
RBCs–>Heme–>Biliverdin–>Unconjugated bilirubin–>Unconjugated bilirubin albumin complex–>Conjugated bilirubin–>Urobilinogen–>either urobilin (pee) or stercobilin (poop).
Heme oxidase changes from heme to biliverdin.
UGT changes from uncon. complex to conjugated bilirubin.
Which muscle type is used more for sustained things (ie posture)
Type 1 (like the paraspinal movements). Usually have lots of mitochondria, not much glycolysis occurs here
Net effects of parathyroid hormone?
Increased bone resorption of Ca and phosphate.
Increased kidney reabsorption of CALCIUM in DCT
Decreased reabsorption of PHOSPHATE in PCT.
Increased 1,25 OH D3 (calcitriol) production by kidney
Increased serum calcium, urinary phosphate
Decreased serum phosphate
By occluding the hepatoduodenal ligament (Pringle maneuever), which vessels are blocked?
If those vessels are occluded and bleeding still happens, what vessels are implicated?
Portal triad in hepatoduodenal ligament: Hepatic artery, portal vein, common bile duct.
If still bleeding, either the IVC or hepatic veins are injured.
What drug class does dobutamine fit into?
Beta 1 adrenergic agonist. Stimulates Gs, increased cAMP. Positive inotrope, chronotrope, vasodilator
Which structure makes up most of the anterior surface of the heart (ie susceptible to stab wounds from front)
Right ventricle
What is one of the key factors that contributes to insulin resistance?
Elevated fatty acid levels–>increased glucose uptake and gluconeogenesis.
Elevated insulin levels also contribute to insulin resistance.
What’s a cholesteatoma? Where would you expect to find it?
It’s a pearly mass in the inner ear (beyond the tympanic membrane) caused by squamous cell debris.
What is the drug class and MOA for both abortive and prophylactic migraine treatment?
Abortive: Triptans. They are 5-HT1B/1D agonists. They inhibit trigeminal nerve activation and prevent release of vasoactive substances.
Prophylactic: Tricyclic Antidepressants, inhibit presynaptic serotonin and norepinephrine (amitryptiline, venlafaxine).
Beta blockers, and anticonvulsants also used prophylactically.
Where do the following diuretics act?
1) Carbonic anhydrase inhibitor (Acetazolamide)
2) Osmotic diuretics (mannitol)
3) Loop diuretics (-ides)
4) Thiazide diuretics (hyrdochlorothiazide)
5) Potassium sparing diuretics (spironolactone, Triamterene, Amiloride)
1) Acetazolamide: Proximal tubule. Alkalinizes urine. Metabolic acidosis
2) Mannitol: Descending loop of Henle, proximal tubule. Hypernatremia, pulmonary edema
3) Loop diuretics: Thick ascending loop of Henle. Hypokalemia, hyponatremia, hypocalcemia, hypomagnesemia, ototoxicity
4) Thiazides: Distal convoluted tubule, Hyper GLUC, hypokalemia.
5) Spironolactone: Collecting duct. Hyperkalemia.
2 treatment options for CMV infections. One is activated intracellularly, one binds DNA pol and reverse transcriptase and does not require intracellular activation. What are they?
Main treatment: Ganciclovir, requires intracellular activation.
Second treatment: Foscarnet, used in gancicolovir resistant infections.
Remember that CMV can cause colitis, especially in HIV patients
Anemia, bite cells, Heinz bodies are associated with G6PD deficiency. What conditions predispose to G6PD deficiency?
1) Infections
2) Drugs (dapsone, antimalarials, TMP-SMX)
3) DKA
4) Eating fava beans
What would you expect to see on peripheral smear of someone with gram negative sepsis and signs of anemia?
Schistocytes. A sign of DIC
How to differentiate between pilocytic astrocytomas, medulloblastomas, and ependymomas?
1) Astrocytomas=most common. Low grade. Commonly in cerebellum. Solid AND cystic components on imaging.
2) Medulloblastomas: second most common. Malignant. ONLY cerebellum. Solids ONLY (NO cystic). Poor prognosis, severe headaches and cerebella dysfxn. Derived from primitive cells.
3) Ependymomas: Third most common. Hydrocephalus. gland like structures called “rosettes”
Decreased CMAP that then increases following rapid repetetive stimulation is indicative of what?
Botulism.
Also look for both nicotinic (diplopia, dysphagia) and cholinergic (dry mouth) blockade
Match each syndrome with its gene association: Lynch Syndrome Familial adenomatous polyposus Von-Hippel Lindau Li-Fraumeni Multiple endocrine neoplasia 1 Multiple endocrine neoplasia 2
Lynch: MSH2, MLH1, MSH6, PMS2 (colorecrtal, endometrial, ovarian)
FAP: APC (colorectal, brain)
VHL: VHL (pheo, hemangioblastomas, clear cell renal)
Li-Fraumeni: TP53 (sarcomas, breast, brain)
MEN1: MEN1 (parathyroid, pancreas, pituitary, “3 P’s”)
MEN2: RET (thyroid, pheochromocytoma, parathyroid hyperplasia)
MEN2B–>marfinoid habitus, mucosal neuromas
What parts of spinal cord does Vit B12 deficiency affect?
Dorsal columns (loss of position, vibration, Romberg sign) Lateral corticospinal tracts (spastic paresis)
Before starting someone on etanercept for RA, Psoriasis, or ankylosing spondylitis, what test should you perform?
A skin tuberculin test. Etanercept is a TNF-alpha inhibitor, and TNF-alpha is key for keeping latent TB at bay.
Remember that etanercept is a TNF decoy receptor (deCEPTor)
What are the 3 stop codons?
UAA, UGA, UAG
A metabolism issue that looks a lot like Marfan syndrome
Homocystinuria.
AR mutation causing cystathionine synthase deficiency.
Treat w Vit B6 (PYRIDOXINE) and decreased methionine intake w cysteine supplementation
Definition of pleiotropy
When one genetic defect causes multiple seemingly unrelated symptoms/phenotypic manifestations
Order of symptoms/signs of alcohol withdrawal
1) Tremors/Anxiety (6-24 hours)
2) Generalized tonic-clonic seizures (12-24 hours)
3) Hallucinations (12-48 hours)
4) Delirium tremens
How to differentiate between strep viridans and strep pneumo (both alpha hemolytic) in regards to optochin and bile.
S. Pneumo: Optochin sensitive, bile soluble (MOPS)
S. Viridans: Optochin resistant, bile insoluble (post dental caries)
In what condition are Auer rods present? How do they look on histology? What do they stain positive for?
Present in AML M3.
Present in myeloblasts (large cells that have abundant basophilic cytoplasm (blue outlines filled with pink).
Auer rods stain positive for peroxidase.
Intracellular and extracellular levels of potassium, sodium, and cloride.
Intracellular: High potassium, low sodium and chloride.
Extracellular: Low potassium, high sodium and chloride.
When ion channels open, chloride flows out of the cell.
Mom has rubella. Complications for mom and kid?
Mom: Polyarthralgias
Kid: sensorineural defects, cataracts, cardiac malformations.
Children and non-pregnant women of child bearing age should be vaccinated with LIVE vaccine
A patient has an occluded subclavian vein proximal to the left subclavian artery. How does the body compensate?
Subclavian steal syndrome. Blood will flow retrograde through the left vertebral artery to meet back with rest of circulation.
Symptoms include arm ischemia and dizzyness upon exercise.
Treatment of pregnant mothers with which drug will cause Ebstein anomaly in the baby?
Lithium (for bipolar disorder).
Ebstein anomaly is when there is apical displacement of the tricuspid leaflets, decreased volume of RV, and atrialization of RV.
First line treatment for general anxiety disorder?
SSRIs/SNRIs (ie citaprolam)
Benzodiazepines shouldn’t be used for long term treatment!
MOA of opioid analgesics?
Bind opioid receptor (mu, delta, kappa). They open potassium channels and close calcium channels, also block release of neurotransmitters from the presynaptic terminal.
All of it to make you feel no mo pain.
Naloxone/Naltrexone are used to reverse effects, opiod receptor antagonists.
Where are the pupillary light reflexes mediated and directed?
In the neural structures (optic nerve, oculomotor nerve, Edinger-Westphal nucleus) of the UPPER MIDBRAIN
What is responsible for the green color of sputum during common bacterial infections?
Myeloperoxidase released from neutrophil azurophilic granules that then form HCl.
Pt blood smear shows >30% plasma cells. What do they have, and what are they at risk of developing?
Have multiple myeloma.
At risk of develoing AL amyloidosis.
Amyloid is derived from monoclonal immunoglobulin light chains, deposits in kidneys, heart, tongue, and nervous system (unlike sarcoid which deposits in lungs)
Woman has itchy erythematous skin rash on breast. Diagnosis? Cause?
Inflammatory breast cancer.
Peau d’orange rash.
Caused by lymphatic obstruction (cancerous cells clog lymphatics)
MOA of SGLT-2 inhibitors (-liflozin) in management of diabetes?
Block reabsorption of glucose at PCT.
Check renal function before starting (Cuz glucosuria can be rough on kidneys)
Which ln drain medial and lateral aspects of foot?
Medial–>Superficial inguinal nodes (along with scrotum, buttocks, anterior abdominal wall, and skin of penis)
Lateral–>Popliteal–>deep inguinal nodes (along with glans of penis)
Tx for kid w/ both absence and tonic-clonic seizures?
What about tx for someone with epilepsy and bipolar?
Valproate (Ethosuximide ONLY treats absence)
Epilepsy and bipolar–>also valproate
First line treatment for RA? Side effects?
Methotrexate.
Side fx=Stomatitis (mouth sores), liver dysfxn, bone marrow suppression.
*takes a few weeks to kick in. So you should give corticosteroids or NSAIDS for acute management until methotrexate kicks in
Premie is given supplemental oxygen. Potential side effect?
Retinal hemorrhage, major cause of blindness in developed countries
Why is diarrhea a major sx of chronic pancreatitis?
Exocrine insufficiency (due to calcifications of ductal plugs, epigastric). Will have malabsorption. Associated w/ excessive alcohol.
In CNIII Palsy, why is there down and out gaze?
Because the superior oblique and lateral rectus muscles are unopposed. (The CNIII muscles are all messed up).
Remember, SO4 LR6 R3
Why does kidney failure lead to osteodystrophy?
When kidneys fail they produce less 1,25 di… and filter less phosphate, so there is decreased calcium and increased phopshate. Body responds by increasing PTH, more bone resorption and more PTH resistance. A vicious cycle that unleashes itself on the bone.
Autosomal dominant condition causing lots of telangiectasias and nosebleeds.
Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasias)
What is linkage disequilibrium?
It’s when alleles at 2 linked loci occur at a rate higher or lower than what would be expected. Ie if one gene has a freq of 0.2, another has 0.4, but together they appear 0.2 (should be 0.4*0.2)
What is usually deficient in chronic granulomatous disease? How is it diagnosed?
NADPH oxidase. Released from neutrophils. Recurrent infection with CATALASE POSITIVE bacteria/fungus.
Dx: Absence of green fluorescence on nitroblue tetrazolium test, or DHR flow cytometry.
Infectious causes and manifestations of esophagitis?
Candida: white pseudomembrane, pain with swallowing
HSV-1: Punched-out ulcers
CMV: Linear ulcers (look for enlarged cells with intranuclear inclusions)
What process is G6PD involved in? If there is a deficiency, what becomes deficient, and what processes are affected?
Involved in first step of pentose phosphate pathway (PPP). This produces NADPH, a key reducing agent (of glutathione).
If deficient, the biosynthesis of cholesterol, fatty acids, and steroids will all be affected.
What leads to lactic acidosis in hypoxic conditions?
Intracellular NADH inhibits pyruvate dehydrogenase (which normally converts pyruvate to acetyl coenzyme A for ox. phopsphorylation as part of glycolysis). As a result, pyruvate is instead converted to lactate by lactate dehydrogenase.
Why does glucosuria occur in situations of DKA?
Glucose is reabsorbed at PCT by carrier protein, thus it is saturable. If it becomes saturated, then theexcess glucose can’t be reabsorbed and is released in the urine.
Which substance is typically used to calculate GFR?
Inulin
Match each w/ site of release, net effect: Gastrin Somatostatin Cholecystokinin Secretin GIP VIP Motilin
Gastrin: G cells (stomach duodenum), increased gastric acid, mucosa, motility
Somatostatin: D cells (pancreatic islets, GI mucosa), decreased gastric acid, pepsinogen (octreotide is an analog)
Cholecystokinin: I cells (duo, jej), increased panc, gallbladder, decreased gastric empt
Secretin: S cells (duo), increased bicarb, decreased gastric acid
GIP: K cells (duo, jej), decreased gastric, increased insulin
VIP: parasymp sphincters, gallbladder, small intestin, increased intestinal water and relaxation
Motilin: Small intestine, Increased MMCs
Net effect of ezetimibe?
Inhibits cholesterol absorption at brush border of intestine, then liver increases LDL receptor expression, so serum cholesterol decreases
How to differentiate between different Class I sodium channel antiarrhythmics in terms of drug names, inhibition of phase 0 depol, and length of AP?
IA: “Queen PROClaims Diso’s pyramid” (Quinidine, Procainamide, Disopyramide). Intermediate phase 0 depol, lengthens AP.
IB: “I’d Buy Liddy’s Mexian Tacos” (Lidocaine, MexileTine). Weak phase 0 depol, SHORTENS AP.
IC: “Can I have Fries, Please” (Flecainide, Propafenone”. STRONG PHASE 0 DEPOL, no effect on AP.
Important cytokine involved in Giant Cell arteritis to which there is a monclonal antibody drug (tocilizumab)?
How to diagnose Giant Cell arteritis?
IL-6
Dx: Elevated ESR, CRP. Intimal thickening+giant cells on artery biopsy
2 major etiologies of angioedema?
1) Mast cell activation: Itching and hives involved. Type 1 hypersensitivity reactions, direct activation (opioids)
2) Excess bradykinin: No itching/hives. ACE inhibitors, C1 inhibitor deficiency
Sudden upward stretching of the arm causes damage to which part of brachial plexus? Signs?
The lower trunk. Paralysis of intrinsic hand muscles (Klumpke palsy), total claw hand deformity
Symptoms of congenital hydrocephalus?
Macrocephaly, full fontanelle, Muscle hypertonicity/hyperreflexia (from upper motor neuron injury)
How does aplastic anemia appear on histology?
Hypocellularity and an abundance of fat cells (with pancytopenia)
MOA and side fx of statins?
HMG-CoA reductase inhibitors. Toxicities: muscle and liver. Check hepatic transaminases prior to initiating therapy
Etiology of stress, urge, and overflow incontinence.
Stress: loss of urethral support, dysfnxnal urethral sphincter (pelvic floor laxity, urethral sphincter dysfxn)
Urge: Detrusor overactivity (uninhibited bladder contraction)
Overflow: Impaired detrusor contractility, bladder outlet obstruction (Detrusor muscle weakness)
What would be the physical findings if a ureter was accidentally injured during a pelvic surgery?
Flank pain radiating to the groin with ballotable mass that develops within a week. Likely due to an obstructive process that causes hydronephrosis
How do prolactinomas typically present in men/women?
Women: Menstrual irregularities/galactorrhea in premenopausal women, present later.
Men: present later, Headache, bitemporal field defects (clumsiness)
In which states do Rb proteins keep cells stuck in the G1 to S checkpoint?
When they’re hypOphosphorylated.
If hyperphosphorylated, they’re inactivated and let cells continue to replicate (can lead to tumor)
Which vitamin seres to maintain normal differentiation of epithelial cells?
Vitamin A
Most common cause of otitis externa. Characteristics of this bug?
Pseudomonas. It’s motile and oxidase positive.
Treat w/ aminoglycosides, piperacillin, quinolones.
Exotoxin inactivates EF2 by ribosylation (same as diptheriae)
Histo of Hashimoto’s?
Other features? Compare to subacute granulomatous thyroditis
Hashimoto’s: Dense lymphocytes (mononuclear), well developed Germinal centers. Autoimmune, PAINLESS, associated w HLA-DR5 and non-Hodgkin lymphoma. TPO antibody.
Granulomatous: Painful, post viral, transient hyperthyroid, increased ESR, giant cells.
Collagen synthesis:
Intracellular: Signal sequence–>hydroxylation (Vit. C/scurvy)–>Glycosylation (procollagen triple helix/Osteogenesis Imperfecta)
Extracelllar: Cleavage of disulfide-rich terminal regions–>Cross-linking (Ehler-Danlos syndrome, Menkes disease)
Difference in valve pahtology bwn rheumatic fever and infective endocarditis
Rheumatic Fever: Fibrosis, commissural fusion at edges
Infective Endocarditis: Large friable vegetations, destruction of valve leaflets
An IV anesthetic (propofol) has fast onset as well as wears off fast. Why?
Goes to brain fast initially, then redistributes to low blood flow tissues
What makes H flu virulent, and to what is vaccine developed?
Type B capsule. H flu is gram neg diplococci
Panic disorder treatment?
SSRI or benzo.
SSRI preferred b/c don’t have abuse potential
Tx for:
Oral candidiasis
Systemic candidiasis
Dermatophytoses
Oral candidiasis: Nystatin (similar mech to Amph B)
Systemic Candidiasis: Amph B
Dermatophytoses: Terbinafine (allylamine antifungal), Griseofulvin (inhibits fungal mitoses at metaphase)
Tx for bulimia nervosa?
SSRI–>specifically fluoxetine, also CBT and nutritional rehabilitation
Differentiate btwn common peroneal and tibial n injuries
Common peroneal: “Foot drop”, “steppage gait”, loss of eversion, dorsiflexion, dorsum of foot sensation lost.
Tibial: Loss of inversion, plantar flexion, sole of foot sensation, inability to curl toes. Passes through popliteal fossa
Hallmarks of obstructive and restrictive lung dseases on PFTs?
Obstructive: Decreased FEV1/FVC, maybe increased LVs
Restrictive: Increased FEV1/FVC, decreased lung volumes
Rat poison treatment (think warfarin overdose).
Tx for warfarin vs heparin overdose?
Warfarin: Vitamin K (takes days), Fresh Frozen Plasma (immediate)
Heparin: Protamine sulfate
Processes that occur to mRNA in cytoplasm?
Associate with ribosomes (translation), or P bodies (regulate mRNA translation and mRNA degradation)
Differentiate between 2 most common causes of CAH, including what the deficient enzymes do.
1) 21-hydroxylase deficiency. Salt wasting, decreased BP, XX virilization. Normally converts progesterone to 11-deoxycorticosterone and 17-OH progesterone to 11-deoxycortisol.
2) 11 beta-hydroxylase deficiency. INCREASED BP, virilization of XX. Normally converts 11-deoxycorticosterone to Corticosterone (precursor to aldosterone) and 11-deoxycortisol to cortisol.
What is the cause of gram negative sepsis (ie from e coli?)
Lipid A, the toxic component of LPS. Causes widespread release of IL-1, TNF alpha
Sudden cardiopulmonary arrest in a mom post-delivery (or during pregnancy). Likely cause and findings?
Amniotic fluid enters mom’s circulation, anapylaxis, hypoxia and hypotensive shock, possible death, DIC.
Will see fetal squamous cells on biopsy of pulmonary vasculature.
How is venous thromboembolism treated in pregnancy?
With low-molecular-weight heparins (enoxaparin, selteparin).
4 Glycogen Storage diseases: Von Gierke disease (Type 1) Pompe disease (Type II) Cori disease (Type III) McArdle disease (Type V)
Von Gierke: Fasting hypogly. Increased glycogen in liver, blood lactate, and triglycerides. G-6-Phosphatase def.
Pompe: Severe cardiomegaly, hypotonia, early death, glycogen in lysosomal vesicles. Acid alpha-glucosidase deficiency
Cori: Milder version of Type 1, w/ normal blood lactate. Deficient alpha-1,6-glucosidase
McArdle: Muscle issues (pain, myoglobinuria). Myophosphorylase deficiency–>failure of glycogenolysis
Tall young male unilateral chest pain, diminished tactile fremitus, hyperresonance, and diminished breath sounds on that side. Dx? Cause?
Dx: Primary spontaneous pneumothorax
Caused by rupture of apical blebs or cysts.
Compare how H flu and N mening both cause meningitis
H flu: Pharynx–>Lymphatics–>Meninges
N mening: Nasopharynx–>Blood–>choroid plexus–>Meninges
How to differentiate between phenoxybenzamine and phentolamine (nonselective alpha blockers)
Phenoxybenzamine: IRReversible, longer drug=longer. Treats pheochromocytoma to prevent hypertensive crisis.
Phentolamine: Reversible. Use for pts on MAO inhibitors eating tyramine foods
What type of incontinence is associated with T1DM?
Overflow incontinence (due to diabetic autonomic neuropathy), which also causes inability to sense a full bladder and incomplete bladder empyting.
Adverse effects of these drugs: Lithium Valproate Carbamazepine Lamotrigine
Lithium: Diabetes insipidus, hypothyroidism, Ebstein anomaly
Valproate: Hepatotoxicity, Neural tube defects
Carbamazepine: Agranulocytosis, hypnatremia, NTDs
Lamotrigine: Steven-Johnson syndrome, benign rash
Differentiate between upper and lower motor neuron injuries
Upper: Spastic paralysis, clasp-knife rigidity, Hyperreflexia, Babinski sign
Lower: Flaccid paralysis, Hypotonia, HypOreflexia, muscle atropy & fasciculations
What does vascular endothelium release to inhibit platelet aggregation?
Prostacyclin (PGI2). It opposes action of Thromboxane A2., and causes vasodilation and increased permeability.
Synthetic prostacyclin used in pulmonary htn, peripheral vascular disease, Raynaud syndrome.
Middle aged white male w/ diarrhea, weight loss, joint pain, neuro sx, and PAS (+) organism
Whipple disease (from gram (+) Tropheryma whipplei. Treat w/ antibiotics
Signs of marijuana use
Tachycardia, conjunctival injection (red eyes), inappropriate laughter, increased appetite, cognitive impairment, dry mouth
Relative sodium channel binding strength of IA, IB, and IC sodium channel blockers
IC>IA>IB
Drug type recommended for patients w/ systolic HF and past MI?
ACE inhibitors, providing a mortality benefit
Microscopic changes seen post ischemic stroke in brain?
12-24 hours: Eosinophils “red nuclei”
24-72 hrs: Neutrophilic infiltration
3-7 days: macrophage/microglia infiltration
1-2 weeks: reactive gliosis, vascular proliferation
>2 weeks: glial scar formation (astrocytes)
Differentiate btwn S3 and S4 sounds:
S3: Ventricular gallop. turbulent flow to ventricles due to increased volume. Normal in children, YOUNG ADULTS, and pregnancy. *if head in older adults, it’s a sign of LVF
S4: Atrial gallop. Heard after atrial contraction as blood is forced into stiff ventricle (reduced ventricular compliance). Normal in OLDER ADULTS
General features of Paroxysmal Hemoglobinuria
Uncontrolled complement mediated RBC lysis, impaired GPI anchor (due to mutated PIGA gene), CD55/CD59 deficiency. Aplastic Anemia.
Can lead to Budd-Chiari syndrome
Manifestations: fatigue, jaundice, hemoglobinuria, thrombosis at atypical sites, pancytopenia.
ALSO LEADS TO HEMOSIDEROSIS!
Virus associated with measles virus
Vitamin A. Supplementation recommended.
It prevents ocular complications, reduces recovery time and length of hospital stay.
Which l.n. drain the colon proximal to and distal to the dentate line?
Proximal: Inferior mesenteric and internal iliac
Distal: Inguinal
Patient’s hat size changes. What do you expect? On biopsy, bone shows cells with over 100 nuclei. What is the marker for that cell type?
Paget’s disease of bone (disorder of bone remodeling).
Nuclie>100=osteoclasts
Marker=RANK-L, M-CSF.
Look for mosaic pattern of lamelar bone (cement lines) on biopsy
Risk associated w/ cavernous hemangioma?
Intracerebral hemorrhage and seizure
Ghon complex associated w/ which stage of T B infection?
Primary TB infection
In lead poisoning, what is seen on RBCs on peripheral blood smear?
What enzyme is inhibited?
Basophilic stippling, microcytic anemia. Normal blood studies.
Ferrochelatase and delta-aminolevulinic acid dehydratase are inhibited.
Hallmark findings of MS?
Demyelination of CNS, IgG in CSF, Oligoclonal bands are diagnostic, Oligodendrocyte loss and reactive gliosis, destruction of axons. MRI is gold standard.
HIV patient gets a skin rash and associated virus?
Kaposi Sarcoma. Associated with HHV-8
Blue-violet or brown skin plaques, derived from primitive mesenchymal cells
Match each with its defective/important process:
Nucleotide Excision Repair–>Endonucleases
Base Excision Repair
Mismatch Repair
Nonhomologous end joining
Nucleotide Excision Repair: Xeroderma Pigmentosum
Base Excision Repair: Spntaneous/toxic deamination
Mismatch Repair: HNPCC (Hereditary nonpolyposis colorectal cancer–>MLH1 and MLH2 mutations
Nonhomologous end joining: Ataxia telangiectasia, Fanconi anemia
How does growth hormone mediate growth in the body?
It stimulates release of IGF-1 from liver (through JAK-STAT signaling pathway)
How is cholecystitis diagnosed?
1) Ultrasound that visualizes wall thickening or pericholecystic fluid (stones aren’t diagnostic)
2) Cholescintigraphy (failure to see gall bladder on radionuclide biliary scan
Why is butt chugging better than oral absorption?
It is more likely to bypass first pass metabolism in the liver and go straight to circulation
If something binds 2,3-bispohosphoglycerate, how does that affect hemoglobin binding affinity?
Has a greater hemoglobin binding affinity, more like fetal homeglobin.
Does the glossopharyngeal or hypoglossal nerve injury cause deviation of the tongue?
Hypoglossal nerve
Glossopharyngeal injury would cause loss of gag reflex, loss of sensation of upper pharynx, middle ear, and and tonsils, and loss of taste of posterior third of tongue
Young girl has a rash all over body that started as a “slap cheek” rash on face. Siblings had it.
Dx? Cause? Where does this replicate?
What effect does it have in adults?
Dx: Erythema Infectiosum, or Fifth Disease (from Parvovirus B19)
Replicates in the bone marrow (precursor of erythrocytes)
Causes arthritis in adults.
Neoplasm, most common cause of SIADH, neuroendocrine origin
Small cell lung cancer.
Euvolemic, hyponatremia, hyperosmolality of urine compared to serum (>100 mOsm, body can’t remove water)
Release of Ach from presynaptic terminal at NMJ is dependent upon what?
The influx of calcium into the presynaptic terminal.
Sensory and gustatory innervation of the tongue:
Sensory: Ant 2/3=mandibular branch of trigeminal (V3)
Post 1/3=glossopharyngeal nerve
Post area of tongue root=Vagus
Gustatory: Ant 2/3=maxillary branch of facial
Post 1/3=glossopharyngeal
Post area of tongue root: Vagus
Acute tubular necrosis quick hits
Granular “muddy brown” casts.
Increased FeNa.
3 phases: 1)Inciting Event 2) Maintenance phase(hyperkalemia) 3) Recovery phase (hypokalemia)
Can be caused by ischemia or neophrotoxic substances
Most commonly affects the PCT or thick ascending loop of Henle
Most common outcome is resolution w/ tubular re-epithelization.
Differentiate between Stanford Type A and B aortic dissection
Type A: Ascending aorta, just distal to aortic valve
Type B: Descending aorta, just distal to left subclavian artery
Differentiate between SER and RER. Which cells would have predominately SER?
RER: Site of synthesis of secretory, lysosomal, integral membrane proteins
SER: Steroid and phospholipid biosynthesis. (think adrenals, gonads, liver). Ex: ACTH which promote glucocorticoid production
What is edrophonium used for?
Increases Ach, diagnoses myasthenia gravis as well as checks levels of medication. If pt has symptoms that resolve w/ edophonium, their dose of Achesterase inhibitors (pyridostigmine) is too low. If not, their dose is too high
Which type of drug exacerbates hypoglycemia in diabetics?
Non-selective beta adrenergic blockers (-lols from N-Z, mask adrenergic sx). Should only prescribe B-1 blockers for diabetics.
Alzheimer drugs w/ MOA and toxicity?
Memantine: NMDA receptor antagonist, prevents excitotoxicity, Tox: confusion, dizziness
Donepezil, Galantamine, Rivastigmine, Tacrine: AchE inhibitors. Tox: Nausea, dizziness, insomnia
Also Vitamin E (antioxidant)
Remember, w/ Alz you’ll see cortical atrophy
Why can’t RBCs use ketones as energy?
They don’t have mitochondria
How do perfusion, ventilation, and V/Q change from apex to base in lung?
Perfusion is MUCH higher in base compared to apex
Ventilation is higher in base compared to apex, but not as much of a difference
V/Q is higher in apex than lung b/c of this (since perfusion is so much less there)
First step in the adenoma to carcinoma sequence?
APC inactivation.
p53 inactivation and K-ras activation happen much later in the process
K-RAS mutation increases size of adenoma (uninhibited proliferation).
TP53 is key in malignant transformation from adenoma into carcinoma.
This process is found most in sporadic colon cancer and pts with FAP
What test will be abnormal in Hemophilia?
PTT (everything else will be normal)
X-linked, prolonged bleeding after operations
Decreased Factor VIII (hemophilia A) or IX(Hemophilia B)
Net effect on cholesterol of statins and fibrates?
Statins: decrease hepatic cholesterol synthesis
Fibrates: increase hepatic cholesterol synthesis.
When used synergistically, they reduce cholesterol even more than statin monotherapy
Which medications cause IgE-INDEPENDENT mast cell degranulation, causing itching and swelling, pain, bronchspasm?
Opioids, radiocontrast agents, and some antibiotics (vancomycin)
Appendiceal carcinoids can cause appendicitis. What type of cells are they derived from?
Neuroendocrine cells
Match the following casts with their cause
RBC casts:
WBC casts:
Fatty casts ("oval fat bodies"):
Granular ("muddy brown") casts:
Waxy casts:
Hyaline casts:RBC casts: glomerulonephritis, malignant htn
WBC casts: Tubulointerstitial inflammation, acute pyelonephritis, transplant rejection
Fatty casts (“oval fat bodies”): Nephrotic syndrome
Granular (“muddy brown”) casts: ATN
Waxy casts: End-stage renal disease
Hyaline casts: Nonspecific, concentrated urine
Pathogenesis of minimal change disease?
Most common nephrotic in kiddos.
T cell dysfxn–>glomerular permeability factor (cytokine)–>podocyte foot process fusion (effacement)–>decreased anionic properties of glomerular basement membrane–>selective albuminuria
Responds excellently to corticosteroids
Where would PAH concentration be lowest?
In the Bowman Capsule (because it is secreted into nephron by PCT, and none of it is reabsorbed)
Which antibiotics bind 30S subunit and 50S subunit?
“Buy AT 30, CCEL (sell) at 50
30:
Aminoglycosides (-cin, but not clindamycin). Bactericidal, initiation complex.
Tetracyclines (-cycline). Static. Prevent tRNA attachment
50:
Chloramphenicol. Static. Blocks peptidyltransferase. Mengitis & Rocky Mountain Fever
Clindamycin. Static. Blocks peptide transfer. Anaerobes above diaphragm (vs metronidazole)
Macrolides (erythromycin). Static. 23rRNA of 50S subunit. Atypical pneumonias, pertussis.
Oxazolidinones (Linezolid). Initiation complex. Gram pos species including MRSA
How to diagnose mucormycosis? How does it differ from aspergillis on histo?
Get a mucosal biopsy and then look at it. It will have nonseptate hyphae with right angle branching.
Aspergillis has septate hypae with acute angle branching
MOA of antidepressant w/ no sexual side effects? Other use?
Bupropion. It’s a norepinephrine and dopamine reuptake inhibitor with no effect on serotonin.
Also used for smoking cessation
Causes of acne in adults?
Anabolic steroids (androgens) which boost sebum production, stimulate follicular epidermal hyperproliferation. In steroid use, also look for testicular atrophy, erythrocytosis, and virilization in females
Signs of riboflavin deficiency, and which process is messed up?
Inflammation of ips, scaling and fissures at corners of mouth, corneal vascularization.
FAD and FMN are derived from riboFlavin.
Redox reactions impaired–>particularly SUCCINATE DEHYDROGENASE rxn in TCA cycle (which converts succinate into fumarate)
What promotes sickling in sickle cell patients? Which organs are more likely to promote sickling?
How would 2,3 bis… fit in? pH?
Sickling associated with low oxygen levels (oxygen unloading). Organs that take lots of oxygen (brain, muscle, placenta) promote sickling.
2,3 bis causes lower O2 affinity. So decreased 2,3 bis would be better in sickle cell patients.
Decreased pH promotes sickling, so less acidic is better for sickle cell patients
Levels of TSH, T4, and T3 in hypothyroidism?
Elevated TSH, Decreased Free T4, and normal T3 until later on in the course of the disease (when it decreases).
T3 stays normal b/c it has a short-life and is converted in periphery
How to differentiate between central and nephrogenic Diabetes Insipidus?
Central: Lack of ADH being released from posterior pituitary. On water deprivation test, body responds to ADH analog.
Nephrogenic: Normal ADH levels, dilute urine, concentrated serum. No response to ADH analog
MOA and toxicity of these 3 MRSA drugs?
Vancomycin
Daptomycin
Linezolid
Vancomycin: blocks glycopeptide polymerization by binding to D-alanyl-D-alanine. Tox=Red man syndrome, nephrotoxicity
Daptomycin: Depolarizes cellular membrane (inserts channels). Tox=Myopathy & CPK elevation. Surfactant inhibits it
Linezolid: Binds 50S subunit. Tox=Thrombocytopenia, optic neuritis, serotonin syndrome
Diabetic mononeuropathy of CN III is caused by? Clinical findings?
Caused by central ischemia that affects somatic but not parasympathetic. As a result, you’ll see ptosis and down and out gaze, but normal light and accommodation reflexes.
Neuro complication of parotid gland tumor?
Facial nerve paralysis (the facial n. emerges within this gland and splits into its 5 branches here)
Pt has surgery in different country, then dies. Shrunken liver on autopsy. What tests would be expected?
This is due to inhaled anesthetic (halothane) induced lethal fulminant hepatitis. If tested before death they would show severely elevated AST/ALT and prolonged Prothrombin Time (PT)
Why does alcohol cause hypoglycemia after glycogen stores are depleted?
Ethanol inhibits gluconeogenesis, so once glycogen is depleted, there is no more.
This is b/c alcohol promotoes NAD–>NADH, so processes needing NAD+ are found lacking (lactate can’t be made into pyruvate)
Why do statins+fibrates make myopathy so much worse?
B/c fibrates inhibit the hepatic clearance of statins so their effects are more prolonged/pronounced.
What does Neer’s impingement test test?
Impingement of the supraspinatus tendon by acromion process
Rapidly progressive dementia, myoclonic jerks, vacuoles in gray matter.
Creutzfeld-Jakob disease–>prion disease
Differences between antipsychotics and atypical antipsychotics?
Antipsychotics: D2 receptor! Dystonia/extrapyramidal side effects! (involves nigrostriatial pathway)
Also cause increased prolactin b/c dopamine normally inhibits prolactin (will see amenorrhea, galactorrhea as side effect)
Atypical: 5H2A receptor. No dystonia/extrapyramidal
Local vs systemic defense against candida?
Local: T cells. Localized candida infxns in HIV pts
Systemic: Neutrophils. Systemic candidiasis in neutropenic pts
