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Step1 > Things I struggle with > Flashcards

Things I struggle with Flashcards

1
Q

case control study

A

copmapre a group of people with the disease to a group without the disease to look for risk factor. Odds ratio

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2
Q

cohort study

A

takes a group of people with a risk or exposure to a group without an exposure to see if it increases frequency of disease. Use relative risk

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3
Q

Phase 1 clinical trial

A

is it safe

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4
Q

phase 2 clinical trial

A

does it work

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5
Q

phase 3 clinical trial

A

is it better

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6
Q

phase 4 clinical trial

A

long term issues

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7
Q

sensitivity

A

a/a+c proportion of people with disease that test positive for disease. In other words, if the disease is present, the test will be positive. It is good for ruling out disease and indicates low false native. It is good for screening low prevalence disease

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8
Q

specificity

A

d/D+B- proportion of all people without disease who test negative. Disease is not present if the test is negative. It is good for confirming a positive screening test. It is used to rule in a disease

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9
Q

PPV

A

probation of positive test results that are true positive. If person tests +then they have disease. Prevalence increases the value

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10
Q

NPV

A

If person tests negative then they don’t have the disease. High prevalence means the NPV decreases.

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11
Q

incidence

A

number of new cases/ people at risk

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12
Q

prevalence

A

number of cases/people in population

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13
Q

chronic disease- changes in incidence and prevalence

A

prevalence is greater than incidence because there is a larger number of existing cases

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14
Q

when does the odds ratio equal the risk ratio

A

if the prevalence is low

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15
Q

precision

A

consistence and reproducibility of the test

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16
Q

accuracy

A

trueness of the test measurements

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17
Q

reliability

A

precision

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18
Q

validity

A

accuracy

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19
Q

Beckson Bias

A

hospital patients are used instead of normal healthy control

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20
Q

recall bias

A

can remember more exposures if there is a disease present

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21
Q

Pygmalian effect

A

observer believes the treatment works so records a biased view

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22
Q

Procedure bias

A

groups are not treated the same

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23
Q

confounding bias

A

other multiple factors are playing in

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24
Q

Hawthorne effect

A

people change behavior when being watched

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25
Q

lead time bias

A

early detection does not mean increased survival time

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26
Q

1 std

A

68%

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27
Q

2 std

A

95%

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28
Q

3std

A

99.7%

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29
Q

for 95% CI what is z

A

1.96

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30
Q

for 99% CI what is z

A

2.58

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31
Q

type 1 error

A

false positive

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32
Q

type 2 error

A

false negative- can be influenced by number of participants

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33
Q

beneficience

A

act in best interest of the patient

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34
Q

non-maleficence

A

do not harm

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35
Q

exceptions for informed consent

A

emergency, legally incompetent, witholding psychiatric records, waiver

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36
Q

minor can concept for

A

sex, drugs, and rock n roll

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37
Q

order of surrogates

A

spouse>adult children>parents>adult siblings>other relatives

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38
Q

does a proxy come first or spouse in decisions

A

proxy

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39
Q

transference

A

patient projects feelings about formative or other important figures onto the physician. Psychiatrist is seen as a parent to the patient

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40
Q

countertransference

A

doctor projects feelings about people onto the patient.

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41
Q

fixation

A

partially remaining at a childsih level of development- like focussing on video games

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42
Q

idealization

A

expressing extremely positive thoughts of self and others while ignoring negative thoughts

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43
Q

identification

A

modeling behavior after another person who is more powerful- abused child becomes abuser

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44
Q

intellectualization

A

using factors of logic to emotionally distance oneself

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45
Q

isolation of affect

A

separating feelings from ideas and events

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46
Q

projection

A

attributing an unacceptable internal impulse to an expernal source- husband thinks wife is cheating because he is cheating

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47
Q

displacement

A

transferring avoided ideas and feelings to a neutral person- mother yells at child because husband yelled at her

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48
Q

reaction formation

A

replacing a warded off idea or feeling by an emphasis on the opposite

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49
Q

repression

A

involuntarily withholding an idea or feeling from conscious awareness

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50
Q

sublimation

A

replacing unacceptable wish with a course of action that does not conflict with values

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51
Q

suppression-

A

intentionally holding off worry

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52
Q

Tourettes

A

before 18 with sudden rapid recurrent stereotypes motor and vocal tics for over 1 year. associated with OCD and ADHD. Can treat with antipsychotics or tetrabenazeine, guanfacine, and clonidine

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53
Q

positive symptoms of schizo

A

delusions, hallucinations, disorganized speech, disorganized or catatonic behavior,

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54
Q

negative symptoms of schizo

A

affective flattening, avolition, anhedonia, asociality, alogia

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55
Q

tuboinfundibular pathway

A

increased prolactin secretion from schizo treatment

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56
Q

nigrostriatal pathway

A

EPS effects

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57
Q

mesocortical pathway

A

negative symptoms

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58
Q

mesolimibic pathway

A

positive symptoms

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59
Q

brief psychotic disorder vs. schizophreniform

A

brief is 1 month, and schizophreniform is 1-6 months

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60
Q

schizoaffective

A

two weeks of hallucinations or delusions without a major mood episode plus periods of concurrent major mood episode and schizophrenia

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61
Q

pathologic grief

A

persistent and causes functional impairment. meets criteria for major depression

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62
Q

adjustment disorder

A

emotional symptoms or anxiety or depression causing impairment following an identifiable psychosocial stressor and lasting under six months or over 6 months in the proscenia of a chronic stressor

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63
Q

PTSD

A

exposure to prior trauma, intrusive re-experiencing of the event, avoid stimuli, changes in cognition and mood and persistently increased arousal- lasts over 1 month with significant distress or dysfunction

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64
Q

somatic symptom disorder

A

variety of body complaints lasting for months to years associated with excessive persistent thoughts and anxiety about symptoms. May co-occur with medical illness

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65
Q

conversion disorder

A

loss of sensory or motor function often from an acute stressor. Patient is aware of but indifferent toward symptoms.

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66
Q

illness anxiety disorder

A

excessive preoccupation with acquiring or having a serious illness despite medical evaluation and reassurance; minimal somatic symptoms

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67
Q

what is decreased in narcolepsy

A

hypocretin/orexin production

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68
Q

precontemplation

A

not acknowledging there is a problem

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69
Q

contemplation

A

acknowledging that there is a problem but not be willing yet to make a change

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70
Q

alcohol withdrawal

A

tremor, autonomic hyperactivity, seizures

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71
Q

opioid withdrawal

A

sweating, dilated pupils, piloerection, fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea

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72
Q

barbituate withdrawal

A

delirum and life threatening cardiac collapse

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73
Q

bezo withdrawal

A

sleep disturbance, depression, rebound anxiety, seizure

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74
Q

stimulant withdrawal

A

post use crash, depression, lethargy, increased appetite, sleep disturbance and vivid nightmares

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75
Q

what can you treat cocaine overdose with and what will kill them if you give them

A

treat with alpha blockers and benzos. If you give a beta blocker, you get increased hypertension because there is uncontrolled alpha stimulation

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76
Q

violence, impulsive, psychomotor agitation, nystagmus, tachycardia, hypertension, analgesia, psychodis, delirium, seizures

A

PCP- treat with antipsychotic or benzo

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77
Q

perceptual distortion, depersonalization, anxiety, flashbacks, paranoia,

A

LSD

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78
Q

euophoria, delusions, anxiety, paned, perception of time is slowed, social withdrawal, hallucinations, red eyes,

A

weed

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79
Q

irritable, anxiety, depression, insomnia, restlessness, and decreased appetite

A

pot withdrawal

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80
Q

delerium tremens

A

autonomic hyperactivity, tremors, anxiety, seizures, seen after surgery because cannot be drinking. hallucinations 12-48 hours after last drink

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81
Q

neuroleptic malignant syndrome

A

rigidity, myoglobinuria, autonimic instability, hypyrexia- treat with dantrolene, or bromocriptine to get the D2 flowing again

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82
Q

what is in the follicle of a LN

A

B cells maturation and germinal centers

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83
Q

what is in the medulla of a LN

A

plasma cells

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84
Q

what is in the paracortex of the LN

A

T cell

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85
Q

what makes the paracortex of the LN hypoplastic

A

Digeorge

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86
Q

what makes the paracrotex of the LN hyperplastic

A

viral infections

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87
Q

what happens after a splencectomy and why

A

decreased IgM, decreased complement activation, decreased C3b opsonization, and increased susceptibility to encapsulated organisms

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88
Q

what cells are seen after a splenectomy

A

Howell Jolly bodies, target cells, thrombocyotsis from loss of sequestration, lymphocytosis

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89
Q

what is the thymus derived from

A

third pouch

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90
Q

when the thymus hypoplastic

A

Digeorge and SCID

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91
Q

when is the thymus hyperplastic

A

Myasthenia Gravis

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92
Q

adaptive immunity

A

T and B cells, highly specific and used immunoglobulin. memory cells cause quicker response the second time

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93
Q

innate immunity

A

neurophils, macrophages, monocytes, complement- rapid and CRP and TLR bind PAMP

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94
Q

MHC I

A

binds TCR and Cd8, and is on all nucleated cells. It presents cytosolic proteins or antigens to the CD8 cells

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95
Q

MHC II

A

binds TCR and CD4 cells. These are only on APC cells. It presents exogenous proteins like bacterial proteins to the T helper cells to activate them

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96
Q

what enhances the activity of NK cells

A

IL2, IL12, IFNalpha, IFN beta

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97
Q

positive selection of T cells

A

has TCR that can bind the self-MHC- this occurs in the cortex

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98
Q

negative selection of T cells

A

eliminate TCRs that bind the self antigen on the dendritic cells or thymic medullary cells. This is the elimination of autoimmune cells- occurs in the medulla

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99
Q

Th1 cells activation

A

It is induce by IFN gamma and IL12 to secrete IFN gamma which activates the macrophages and the cytotoxic T cells. It is inhibited by IL4 and IL10

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100
Q

Th2 cells activation

A

induced to differentiate by IL4 and they secrete IL4, IL5, IL10, IL13 which recruit eosinophila for parasite defense and promote IgE production by B cells. It is inhibited by IFN gamma

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101
Q

what does hepcidin do

A

it decreases iron absorption by degrading ferroportin and decreases iron release from macrophages and leads to anemia of chronic disease

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102
Q

what does CRP do

A

it is an opsonin which fixes complement and facilitates phagocytosis. Measured clinically as a sign of ongoing inflammation

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103
Q

what mediates the classic complement pathway

A

IgG and IgM

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104
Q

what are the opsonins

A

C3b and IgG are the two first degree ones which enhance phagocytosis. They coat cells so the Fc ro C3B receptors can grab onto them

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105
Q

what is the function of C1 esterase inhibitors

A

it prevents complement activation on self cells

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106
Q

C1esterase inhibitor deficiency

A

causes hereditary angioedmea due to unregulated activation of chalkier and increased bradykinin. ACE inhibitors make it worse. There is facial swelling, laryngeal swelling and GI issues

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107
Q

C3 deficiency

A

increases risk of severe recurrent pyogenic sinus and respiratory tract infections and increased susceptibility to HN3

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108
Q

C5-C9 deficiency

A

leads to Neisseria infections repeatedly

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109
Q

DAF deficiency

A

complement mediated lysis of RBCs and paraoxysmal nocturnal hemoglobinuria

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110
Q

what cytokine causes fever and acute inflammation- activates endothelium to express adhesion molecules and induces chemokine secretion to recruit WBC

A

IL-1

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111
Q

what cytokine causes fever and stimulates production of acute phase proteins

A

IL-6

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112
Q

what cytokine is the major chemotactic factor for neutrophils

A

IL-8

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113
Q

what cytokine induces differentiation of T cells into Th1 cells. Activates NK cells

A

IL12

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114
Q

what cytokine mediates septic shock, activates endothelium and causes WBC recruitment and vascular leak

A

TNF alpha

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115
Q

what cytokine stimulates growth of T helper, cytotoxic, and regulatory T cells and NK cells

A

IL2

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116
Q

what cytokine supports growth and differenctiaon of bone marrow stem cells

A

IL3

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117
Q

what cytokine is secreted by NK cells and T cells in response to IL12 from macrophages and stimulates macrophages to kill phagocytes pathogens. Inhibits differentiation of TH2 cells

A

interferon gamma

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118
Q

what cytokine induces differentiation of T cells into TH2 cells. Promotes growth of B cells and enhances class switching to IgE and IgG

A

IL4

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119
Q

what cytokine promotes growth and differentiation of B cells and enhances IgA and stimulates growth of eosinophiles

A

IL5

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120
Q

What cytokine attenuates inflammatory response. Decreases expression of MHCII and Th1 cytokines. Inhibits activates macrophages and dendritic cells. Also secreted by regulatory T cells

A

IL10

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121
Q

what cytokines are secreted by macrophages

A

IL1, 6, 8, 12, and TNF alpha

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122
Q

what cytokines are secreted by all T cells

A

IL2 and IL3

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123
Q

what cytokines are secreted from Th1 cells

A

interferon gamma

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124
Q

what cytokines are secreted from Th2 cells

A

Il-4, 5, 10

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125
Q

why is sputum blue green

A

myeloperoxidase

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126
Q

what are the first two steps in the respiratory burst

A

NAPH oxidase and superoxide dismutase

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127
Q

what does NADPH do

A

generates the ROS

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128
Q

what does superoxide dismutase do

A

produces H2O2

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129
Q

what is the deficiency in with chronic granulomatous disease and what are the risks

A

increased granuloma formation because there are increased infections from catalase positive species which are able to break down the H2O2 from superoxide dismutase. The ROS are not generated because of the lack of NADPH disputes. Increased s aureus and aspergillus

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130
Q

what are interferons

A

they are glycoproteins secreted by virally infected cells that prime the uninfected cells which help them degrade factors the virus needs for replication

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131
Q

CD3, CD28, B7, CXCR4, CCR5

A

T cells

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132
Q

CD4 and CD40L

A

Helper T cells

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133
Q

CD8, CXCR4, CCR5

A

Cytotoxic T cells

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134
Q

CD19, CD20, CD21, CD40, MHCII B7

A

B cells

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135
Q

what receptor binds EBV

A

CD21

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136
Q

CD14, CCR5, MHCII, B7, Fc, C3b

A

macrophages

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137
Q

CD16 CD56

A

NK cells

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138
Q

CD34

A

hematopoetic stem cells

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139
Q

what are the antigen presenting cells

A

macrophages, B cells, dendritic cells

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140
Q

what kind of immune response do you get from a live attenuated vaccine and which vaccines are live

A

indue cellular and humoral responses. nasal flu, measles, mumps, polio (sabin), rubella, varicella, yellow fever

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141
Q

what live vaccines can you give to AIDS patients

A

yellow, MMR, varicella

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142
Q

what kind of response does killed vaccines give and which are killed

A

induce only a humoral response which may require a booster. Rabies, flue, polio salk, hepatitis A

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143
Q

anaphylactic atopic, IgE crosslinks on mast cells triggering immediate release of vasoactive amines, that react with post capillary venues. Reaction develops rapidly after antigen exposure because of preformed antibody. Delayed reopens follows due to production of arachidonic acid and metabolites

A

Type 1 HSN

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144
Q

rhinitis, hay fever, eczema, hives, asthma

A

HSN1

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145
Q

anaphylaxis

A

HSN1

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146
Q

IgM and IgG mediated that bind to a fixed antigen on a cell and does cellular destruction by opsonization, phagocytosis, complement and Fc medicated inflammation, antibody mediated cellular dysfunction

A

HSN2

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147
Q

Direct Coombs

A

detects antibodies that have adhered to patients RBC

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148
Q

indirect coombs

A

deterects antibodies in the serum that adhere to other RBC

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149
Q

widespread thrombosis of graft vessel with ischemia and necroses- graft must be removed- why did it happen and what kind of rejection is it

A

pre-existing antibodies react to donor antigen, and activate complement- hyperacute

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150
Q

Proliferation of vascular smooth muscle, parenchymal atrophy, interstitial fbrosis- atheroscleosis

A

CD4 T cells respond to recipient APC presneintg donor peptides including allogenic MHC. Type I and IV sensitivity- chronic

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151
Q

bronchiolitis obliterans- dyspnea, dry cough, wheezes

A

chronic

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152
Q

vasculitis of graft vessels with dense interstitial infiltrate. CD8 cells activated against donor MHC HSN4.

A

acute-

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153
Q

accelerated atheroscelorisis after transplant

A

chronic

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154
Q

Increased HTN and CA, with fibrosis and internal thickening, mononuclear infiltrate with tubular atrophy and interstitial firbrosis- after transplant

A

chronic

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155
Q

vanishing bile ducts- transplant

A

chronic

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156
Q

maculopapular rash, jaundice, diarrhea, heaptosplenomegaly

A

gradted immunocomputent T cells proliferate in the immunocomprimised host and reject host cells with foreign proteins- type IV HSN- graft vs host- only happens in liver and bone marrow

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157
Q

intrinsic apoptosis

A

Bcl2 is anti-apoptotic and BAX or BAK is pro-apoptotic. If BCL2 is overexposed then the cells won’t die

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158
Q

extrinsic apoptosis

A

Fas ligand or TNF alpha. Immune cells with perforin and granzyme

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159
Q

coagulative necrosis

A

heart- ischmia or infarct in most tissue but the brain

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160
Q

liquefactive necrosis

A

bacterial abscesses, brain infarcts due to increased fat content. Neurtrophils release lysosomal enzymes that digest the tissue. Microglia test to be first. Early is cellular debris and macrophages and then its cavitation and cavitation

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161
Q

caseous necrosis

A

TB, systemic fungi- macrophages wall off the infecting microorganism- granular debris- fragmented cells and debris surround. This leads to cottage cheese appearance

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162
Q

Fat necrosis

A

enzymatic- acute pancreatitis saponification of peripancreatice fat or breast trauma- outilines of dead fat cells without nuceli- appears dark blue of H and E stain

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163
Q

fibrinoid necrosis

A

immune reaction in the vessels- immune complexes combine with fibrin and vessel wall damage- vessel walls are thick and pink

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164
Q

gangrenous necrosis

A

distal extremity after chronic ischemia- dry is ischemia and wet has a superfinection

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165
Q

reversible signs of cell injury

A

cellular and mitochondrial swelling, nuclear chromatin clumping, membrane blebbing,

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166
Q

irreversible cell injury

A

mitochondrial permeability and vacuolization, nuclear pyknosis- condensation, karyolysis which is fading and plasma membrane damage and lysosomal rupture

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167
Q

areas first hit by ischemia in brain

A

ACA/MCA/PCA

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168
Q

areas first hit by ischemia in heart

A

sunendocardium

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169
Q

areas first hit by ischemia in kidney

A

PCT

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170
Q

areas first hit by ischemia in liver

A

area around central vein

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171
Q

areas first hit by ischemia in colon

A

splenic flexure and rectum

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172
Q

red infarct

A

occur in venous occlusion and in tissues with multiple blood supplies like liver, lung, intestine, testes, reperfusion

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173
Q

what causes re-perfusion injury

A

the free radical damage

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174
Q

pale infarct

A

occur in solid organs with a single blood supply like the heart, kidney, and spleen

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175
Q

chromatolysis

A

neuronal axonal cell injury- there is increased protein synthesis in effort to repair famed axon- round cellular swelling, displacement of nucleus, dispersion of Nissle substance and Wallerian degeneration

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176
Q

dystrophic calcification

A

ca desposit in abnormal tisseus due to necrosis or injury- tends to be localized. No abnormal calcium level

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177
Q

metastatic calcification

A

widespread diffuse deposition of CA. Can be high calcium levels. Tend to be in interstitial issues.

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178
Q

chemotaxtic agents for neutrophils

A

C5a, IL8, LTB4, kalikreinin, platelet activating factor

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179
Q

what provides the strength to a scar

A

collagen

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180
Q

keloid- why does it happen

A

PDGF and TGF beta are controlling fibroblast growth and proliferation. TGF beta stimulates CT synthesis and remodelling in the extracellular matrix. TGF beta tends to decrease in maturation place to limit collagenase. Increased TGF beta from this

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181
Q

PDGF

A

secreted by platelets and macrophages. Induces vascular remodeling and smooth muscle cell migration stimulates fibroblast growth factor for collagen synthesis

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182
Q

proliferative phase of wound- up to 3 weeks

A

deposition of granulation tissue and type II collagen. Angiogenesis, epithelial cell proliferation, dissolution of clot and wound contraction

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183
Q

remodeling phase of wound healing- 1 week- 6 months

A

type III collagen replaced by type collagen I and increased tensile strength

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184
Q

what leads to granuloma formation

A

IFN gamma and activation of TNF alpha from macrophages induces and maintains granuloma formation

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185
Q

exudate

A

cellular- cloudy, increased protein, increased LDH, and its from lymphatic obstruction, inflammation/infection, malignancy

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186
Q

transudate

A

hypocellular, decreased protein, decreased LDH, low specific gravity, increased hydrostatic pressure, decreased oncotic pressure

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187
Q

ESR- increased

A

products of inflammation coat RBCs and cause aggregation. The denser RBC aggregates fall at a faster rate within a pipette tube. Increased with anemia, infections, inflammation, cancer, renal disease, pregancny

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188
Q

decreased ESR

A

sickle cell, polycythemia, HF, mucrocytosis, hypofibrinogeninemia

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189
Q

amyloidosis

A

abnormal aggregation of proteins into beta pelted sheets damage and apoptosis. Apple green bipfringence

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190
Q

primary amyloidosis

A

deposition of proteins from Ig light chains. Can occur as plasma cell disorder or associated with multiple myeloma. It is restrictive cardiomyopathy, renal disease, hematologic, easy bruising, splenomegaly, hepatomegaly, neuropathy

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191
Q

lipofuscin

A

wear and tear pigment associated with normal aging. Formed by oxidation and polymerization of autophagocytosed organellar membranes. Autopsy of elderly person will reveal deposits in the heart, colon, liver, kidney, eye, and other organs

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192
Q

hypertrophy vs. Hyperplasia

A

hypertrophy is increased in size of cells. hyperplasia is the increase innumber of cells. Risk of future malignancy

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193
Q

metaplasia

A

replacement of one cell type by another. Usually due to exposure to an irritant such as gastric acid or cigaretter smoke. Can undergo malignant transformation if its not removed

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194
Q

neoplasia

A

uncontrolled clonal proliferation of cells can be benign or malignant

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195
Q

dysplasia

A

disorded non enoplastic ell growth used only with epithelial cells. Mild dysplasia is usually reversible, severe dysplasia can move onto carcinoma

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196
Q

anaplasia

A

loss of cell polarity, complete disruption of normal architecture, pleomorphic cells, large nucleus to cytoplasm rain, increased mitotic figures, giant multinucleated giant cells

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197
Q

cancer grade

A

degree of cellular differentiation and mitotic activity-

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198
Q

cancer stage

A

degree of localization spread based on site and size of spread to lymph nodes

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199
Q

alkylating agents

A

leukema and lymphoma

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200
Q

aromatic amines

A

transitional bladder cancer

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201
Q

aresnic

A

liver, lung, skin

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202
Q

carbon tetrachloride

A

liver

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203
Q

nitrosamines

A

stomach cancer

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204
Q

radon

A

lung cancer

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205
Q

vinyl chloride

A

liver cancer

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206
Q

Psammoma bodies in what cancers

A

papillary thyoid cancer, serous papillary cystadenocarcinomal of ovary, meningioma, malignant mesotheliuoma- dystrophic calcification

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207
Q

breast cancer screening

A

mammogram once every 2 years from 50-75 years

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208
Q

cervical cancer screening

A

21-65 and once every 3 years

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209
Q

lung cancer screening

A

CT annually if 30 year pack history

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210
Q

what amino acids are histones rich in and why

A

lysine and arginine- they are positively charged

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211
Q

what does histone acetylation do to the DNA

A

it makes it relaxed making the DNA active

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212
Q

difference between nucleoside and nucelotide

A

nuceloside is a base plus a sugar and a tide is a base plus ribose plus phosphate

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213
Q

what are the amino acids needed for purine synthesis

A

glycine, aspartate, and glutamine

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214
Q

what are the pureines

A

a and g

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215
Q

pyrimidines

A

C, U, T

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216
Q

what is the rate limiting step of pyrimidine synthesis

A

CPSII

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217
Q

what is the rate limiting step of purine synthesis

A

PRPP synthetase

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218
Q

what is the nitrogen source for pyrimidine synthesis

A

glutamine

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219
Q

increased orotic acid, no increase in ammonia, megaloblastic anemia- what is the deficient enzyme- what pathway is this a part of

A

UMP synthase and pyrimidine synthesis

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220
Q

what med blocks PRPP synthase

A

azothioprine/6 mercaptopurine

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221
Q

what enzyme degrades 6-MP and what can cause toxicity from this med

A

it is metabolized by xanthine oxidase and if also take allopurinol it can lead to toxic accumulation of 6mp

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222
Q

what enzyme takes IMP to GMP and what pathway is this in

A

It is in the purine denovo synthesis pathway and it is IMP dehydrogenase

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223
Q

what medication blocks the conversion of IMP to GMP aka what enzyme does it block and what is the medication used for

A

It blocks IMP dehydrogenase- mycophenolate and ribavirin prevents the synthesis of purines in B and T cells

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224
Q

what enzyme takes UDP to dUDP and what blocks it and what pathway is it a part of

A

It is ribonucelotide reductase and it is blocked by hydroxyurea which is used in Sickle cell to increase the production of fetal hemoglobin. It is part of the pyrimidine pathway

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225
Q

what enzyme takes dUMP to dTMP and what blocks it and what pathway is it a part of

A

it blocks thymidilate synthase. It is 5 flurouracil. It has increased action with leucovorin as compared to methotrexate. It needs folic acid to continue to blockade the production of pyrimidines

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226
Q

what enzyme recycles dihydrofolate to to tetrahydrofolate and what 2 things block this. What pathway is it a part of and what is the drug to rescue this pathway

A

tetrahydrofolate reductase is blocked by methotrexate and trimethoprim, and pyrimethamine- these are for humans, bacteria, and protozoa respectively. Leucovorin can rescue this pathway by providing an excess of folic acid

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227
Q

what is the point of the purine salvage pathway and what does it produce

A

it is a way to recycle purines once they are used. It produces uric acid

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228
Q

what enzyme converts hypoxanthine to xanthine and xanthine to uric acid. What medication blocks this transformation

A

It is xanthine oxidase which is targeted by allopurinol. Allopurinol and febuxostat decrease the production of uric acid which contributes to gout. Also allopurinol can decrease the metabolism of 6mp and azothioprine

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229
Q

what enzyme converts guanine to GMP and hypoxanthine to IMP

A

HGPRT

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230
Q

Child is aggressive, has increased uric acid, gout, is aggressive, dystonic, and has self-mutilation like lip biting and finger biting- what is the enzyme that is deficient and what pathway is it a part of- what is the treatment

A

HGPRT deficiency also called Lesch Nyhan syndrome- It cannot recycle purines, so there is an overproduction of uric acid and continuous denovo purine synthesis- It is treated with allopurinol to help decrease the uric acid production, but it can only really treat the gout

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231
Q

what enzyme takes adenosine to inosine

A

adenosine deaminase

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232
Q

child has failure to thrive, chronic diarrhea, thrush, and constant recurrent infections with opportunistic and any other infections. No thymic shadow, and no germinal centers on the LN and no migration of T cells in the candida skin test- what enzyme is deficient and what pathway is it a part of

A

adenosine deaminase deficiency causing SCID it is part of the purine salvage pathway

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233
Q

megaloblastic anemia that does not improve with folate or B12

A

orotic aciduria

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234
Q

unwinds DNA template at replication fork

A

helicase

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235
Q

prevents strands from re-anealing

A

single stranded binding proteins

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236
Q

create double or single stranded breaks in DNA helix to add or remove supercoils

A

DNA topoisomerase

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237
Q

what is another name for DNA topoisomerase II

A

gyrase

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238
Q

what blocks prokaryotic DNA topoisomerase II and IV and what is it used for

A

FQ used for antibiotic

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239
Q

what blocks eukaryotic topoisomerase II and what is it used for

A

etoposide and teniposide- these are used for leukemia and lymphoma

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240
Q

this is prokaryotic only and elongates the leading strand by adding deoxynucleotides to the 3’ end. Elongates the lagging strand until it reaches the end. what kind of proofreading does it have

A

it is DNA polymerase III and has 3’-5’ proofreading

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241
Q

This is a prokaryotic enzyme only and it degrades RNA primer and replaces it with DNA and what proofreading does it have

A

it is DNA polymerase I and it has 5’-3’ proofreading

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242
Q

eukaryotic and has primer and starts the synthesis

A

polymerase alpha

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243
Q

eukaryotic and has the job of repairing the DNA during replication

A

polymerase beta

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244
Q

eukaryotic and has the job of doing the lagging strand replication

A

polymerase delta

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245
Q

eukaryotic and has the job of replacing the leading strand

A

polymerase epsiolon

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246
Q

eukaryotic and has the job of replicating the mitochondrial DNA

A

polymerase gamma

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247
Q

catalyzes the formation between the Okasaki fragments

A

DNA ligase

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248
Q

a RNA dependent DNA polymerase that adds DNA to the 3’ end of chromosomes to avoid loss of genetic material with every duplication- only in eukaryotes

A

it is telomerase

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249
Q

what does transition mutation mean

A

purine to purine or pyrimidine to pyrimidine

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250
Q

what does transgression mutation mean

A

purine to pyrimidine or the other way around

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251
Q

what kind of mutation is a substitution of base but still codes for the same aa

A

silent mutation

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252
Q

what kind of mutation is a nucelotide substitution resulting in changed amino acid

A

missense mutation- sickle cell disease

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253
Q

what kind of mutation is a nucleotide substitution leading to an early stop codon

A

nonsense mutation

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254
Q

what kind of mutation is a deletion or inception of a number of nucleotides not divisible by three, resulting in misreading of all of the nucleotides downstream from the error. Protein may be shorter or longer rand can be disrupted or altered function

A

frameshift mutation

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255
Q

what kind of mutation is a retained intron in the mRNA leading to a protein with impaired function or altered function

A

it is a splice site mutation which can lead to cancer, dementia, epilepsy, and some types of beta thalassemia

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256
Q

what changes occur with low glucose on the lac operon site

A

increased adenylate cyclase activity which increases the cAMP generation from ATP and activates the catabolite activator protein and increased transcription

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257
Q

what changes occur with high lactose on the lac operon site

A

unbinds the repressor protein and increases the transcription

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258
Q

specific endonuclease release oligonucleotides containing damaged bases. DNA poly and ligase fill and reseal this gap. It repatriate bully and distorted lesions-

A

nucleotide excision repair

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259
Q

what is defective in xeroderma pigmentosum and what causes damage

A

defective endonuclease repair- removal of dimer and it is in nucleotide excision repair and it mutates in exposure to sunlight

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260
Q

base specificc glycosylase rmovesthe altered base and creates a base site without a purine or pyrimidine. And then it is filled in with beta polymerase

A

Base excision repair

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261
Q

new synthesized strand is recognized, mismatched nucleotides are removed and the gap is filled and resealed- occurs in G2 phase

A

Mismatch repair

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262
Q

what is deceptive in Lynch syndome

A

mismatch repair

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263
Q

brings two ends of DNA fragments together to repair double stranded breaks- not homologous- what is it called when this is defective

A

non homologous end joining- it is mutated in ataxia telangactase and Faconi anemia

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264
Q

what are the start codons

A

AUG which his methionine

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265
Q

what are the stop codons

A

UGA, UAA, UAG

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266
Q

what are the DNA binding motifs

A

zinc finger, helix loop helix, helix turn helixm and leucine zipper

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267
Q

how do you terminate prokaryotic RNA transcription

A

Rho factor knocks off RNA polymerase or a GC rich region self binds creating a hairpin loop which knocks off the polymerase

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268
Q

site where RNA polymerase II and multiple other TFs bid to DNA upstream from the gene- AT rich segment with TATA or CAAT and what would a mutation here do

A

promoter region and it would decrease the level of gene transcription

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269
Q

stretch of DNA that alters the gene expression by binding TFs

A

enhancer

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270
Q

site where negative regulators bind

A

silencer

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271
Q

what makes rRNA in eukaryotes

A

RNA poly I

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272
Q

what makes tRNA in eukaryotes

A

RNA poly III

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273
Q

what makes mRNA in eukaryotes

A

RNA poly II

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274
Q

what inhibits RNA polymerase II

A

amanita phalloides- death cap mushroom which causes severe hepatotoxicity

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275
Q

what drug inhibits RNA polymerase in prokaryotes and eukaryotes

A

rifampin

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276
Q

what processes occur in the nucleus after transcription

A

capping of the 5 prime end, polyadenylation of the trial, spline of the introns and this is the mRNA

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277
Q

what do p bodies do

A

they are processing bodies which are quality control of the mRNA in the cytoplasm

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278
Q

what do spliceosomes do

A

they move introns with GU at the 5’ end and AG at the 3’ stie mutations lead to inappropriate splicing and impaired function of the protein

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279
Q

what can cancer cells do with altered splicing to avoid apoptosis

A

they can alternatively splice to that Fas loses its transmembrane domain this means that it cannot be in the membrane, so that it cannot be bound.

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280
Q

what is at the end of the 3’ end of tRNA

A

it is the CCA end which carries the amino acid

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281
Q

what charges the tRNA

A

aminoacyl tRNA syntheses scrutinizes the amino acid before it binds to tRHA and it hydrolyzes and it in charge of the accuracy of the tRNA

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282
Q

what order are the RNA sites

A

APE: A is incoming and P is growing peptide and E is the exit site

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283
Q

what are the numbers of the eukaryotic and prokaryotic RNA

A

Euk- 40, 60, 80 and Pro are 30,50,70

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284
Q

what happens when Rb is hypophosphorylated

A

it is active then so it binds E2F to prevent the progression of G1 to S phase

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285
Q

what role does P53 play in the cell cycle

A

it checks at G1 to S and G2 to M to make sure there is not too much damage. if there is it cannot be used and causes cell to degrade

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286
Q

dyenin goes which way

A

retrograde

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287
Q

chines goes which way

A

anterograde

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288
Q

what drugs act on microtubules

A

mebensazole, griseofulvin, colchicine, vincristen and blastine which stop growth, and paclitaxel whch stabalizes

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289
Q

infertilty, increased ectopic pregnancy, bronchiectasis, recurrent sinusitis, and situs inverses or dextrocardia on the CXR- what is the disorder and why

A

Kartagener syndrome and it is from defect in dynein arm, so cilia do not move

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290
Q

collagen found in cartilage, vitreous body, and nucleus pulposis

A

collagen II

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291
Q

collagen in bone, skin, tension, dentin, fascia, and cornea with late wound repair

A

type I

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292
Q

collagen found in the basement membrane, basal lamina, and lens

A

Type IV

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293
Q

collagen found in skin, blood vessels, uterus, fetal tissue and granulation tissue

A

Type III

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294
Q

OI is associated with which collagen

A

type I collagen

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295
Q

vascular Ehlers Danlos is associated with which type of collagen

A

Type III

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296
Q

Alport and Goodpasture involve which collage

A

Type IV

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297
Q

many fractures wit little trauma, blue sclerae, hearing loss and tooth acbomalities- types of it

A

abnormal collagen I. It is fatal in type II

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298
Q

hyper extensible skin and hyperbole joints. what type of collage in the this kind. what kind of collagen is the vascular kind and what is the defieincy

A

type V is the normal kind. vessel is III collagen. It can be a deficiency in the lys oxidase which forms the bonds between tropocollagen. or a deficiency in pro collagen with peptidase enzymes

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299
Q

what aa are the elastin rich in

A

proline, glycine and lysine

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300
Q

Marfan is a defect in what

A

fibrillin which is the glycoprotein that forms the sheath around the elastin

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301
Q

what are wrinkles from

A

decreased collagen and elastin production

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302
Q

what causes panacinar emphysema

A

overactive elastase because there is not enough alpha 1 antitrypsin blocking it

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303
Q

test used to amplify a DNA fragment

A

PCR

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304
Q

Blot that looks for mutated DNA

A

southern blot

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305
Q

blot that looks at RNA for the levels of mRNA which is reflective of gene expression

A

Northern blot

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306
Q

sample protein is separated by get electrophoresis and transferred to a membrane and label is used to bind a relevant protein. Shows that transcription is increased

A

western blot

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307
Q

identifies DNA binding proteins aka transcriptin factors using labelled probes

A

southwestern blot

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308
Q

known antibody to test for presence of antigen

A

direct ELISA

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309
Q

known antigen to test for antibody

A

indirect ELISA

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310
Q

ohenotype varies among individuals with the same genotype

A

variable expressivity

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311
Q

one gene contributes to multiple phenotypic effects

A

pleiotropy

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312
Q

increased severity with earlier onset of disease in succeeding generations

A

anticipation

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313
Q

mutations in different loci can produce a similar phenotype

A

locus heterogeneity

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314
Q

different mutations in the same loci produce the same phenotype

A

allelic heterogeneity

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315
Q

both normal and mutated tDNA resulting in variable expression in mitochronidrally inherited disease

A

heteroplasmy

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316
Q

only one allele is alive and the other is inactive with one allele inactivated deletion of the active allele disease. Methylation picks one parent to express the gene

A

imprinting

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317
Q

maternal imprinting and gene from mom is normally silent but paternal gene is deleted or mutated or there is maternal disomy- hyperphaia, obesity, intellectual disability, hypogonadism, and hypotonia

A

Prader Wili

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318
Q

dads gene is usually silent but maternal is deleted or mutated. Or parental disomy- it has laughter, seizures, ataxia, and severe intelletual disability

A

Angelman syndrome

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319
Q

bilateral massive enlargement of kidney dues to large cucsts. mutation in PKD1 with berry aneurysms

A

autosomal dominant PKD

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320
Q

colon covered in ademotous polyps after puberty

A

familial adenomatous polyposis

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321
Q

inhertited disorder of blood vessels with branching skin lesions, epistaxis, skin sidocoloration, AV malformations, GI bleeding, hematuria

A

hereditary hemorrhagic telangactasia

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322
Q

spheroid RBC and defect in spectrin and ankyrin. increased MCHC and increased RDW and treated with splenectomy

A

hereditary spherocytosis

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323
Q

dpression, and progressive dementia, choreiform movements, caudate atrophy- increased dopamine, decreased GABA, increased ACH in the brain- what chromosome and defect

A

Huntington and chromosome 4

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324
Q

abnormaility which leads to multiple malignancies at a young age- have sarcoma, breast, leukemia, and adrenal gland cancer, osteosarcoma, and brad adenocarcinoma what is mutated

A

Li Fraumeni- p53

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325
Q

what is the defect in the gene causing talk, long extremities, precuts excavate, hyperbole joints, and long fingers and toes, and cystic medial necrosis of the aorta, and floppy mitral valve with aibluxation of the lens upward

A

marfan defect in FBN1 and chromosome 15 fibrillin defect

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326
Q

osteomas, lipomas, sebaceous cysts, and colon polyps and cancer

A

Gardner syndrome

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327
Q

what genetic condition have the increased risk of rhabdomyosarcoma of the heart

A

Tuberous scleorsis

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328
Q

what disorder is characterized by RCC pro, angiogenic growth factors, and hemangioblastomas- what chromosome and what defect

A

VHL and its chromosome 3 tumor suppressor

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329
Q

what does dystrophin do and what is the mutation that covers duchenne

A

link actin to transmembrane proteins- frameshift

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330
Q

what is the mutation for becker that causes it

A

non-frameshift- truncated but somewhat functional gene

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331
Q

muscle wasting, catarats, testicular atriphy and frontal balding, arrhythmia- what causes it

A

CTG repeasts in the DMPK gene that causes abnormal expression of myotonin protein kinase-

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332
Q

large testicles, mental retard, long face, large jaw, everted ears, autism, mitral valve prolapse- what gene and inheritance pattern

A

Fragil X mutation in the FMR1 gene with trinucleotide expansion

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333
Q

what is the translocation that can cause Downs syndrome

A

14;21

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334
Q

severe intellecutal disability, rocker bottom feet, microagnathia, low set ears, clenched hands, overlapping fingers, congenital heart disease- whats on the quad screen and disease

A

trisomy 18 and decreased everything

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335
Q

severe intellectual disability, rocker bottom feet, microphthalamia, microcephaly, cleft lip and palate, holoprosenscepahly, polydactyl and congentiac heart disease and cutis aplasia- quad screen and disorder

A

trisomy 13 and decreased hcg

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336
Q

woman has multiple miscarriages but when she has the a child, it has dismorphic features and lots of organ abnormalities

A

unbalanced robertsonian translocation

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337
Q

microcephaly, moderate intellecutal disability, high pitched cry, epicentral folds, and cardiac abnormalities- what is it called and why does it happen

A

cri du chat syndrome- microdeletion on chromosome 5

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338
Q

elf face, disability, hypercalcemia, and well developed verbal skills, friendly and cardiac problems- what is the disorder and genetics

A

Willimas and micro deletion on chromosome 7

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339
Q

hypocalcemia, T cell deficiencyy, and cardiac defects like tet of fallot and truncus- what is the defect and gene

A

22q11 and Digeorge syndrome- no 3 and 4th branchial pouches

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340
Q

what are the fat soluble vitamins

A

A, D, E, K

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341
Q

what vitamins can be produced by enteric bacteria

A

folate and vitamin K

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342
Q

what is the vitamin profile after gastric bypass

A

increased K and folate from bacterial overgrowth and decreased B12, A, D, E, iron

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343
Q

deficiency of this causes night blindness, dry scaly skin, corneal degeneration, some immunosuppression

A

vitamin A

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344
Q

excess from acute toxicity leads to nausea vomitting vertigo, and blurred vision

A

vitamin A

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345
Q

chronic toxicity leads to apologia, dry skin, arthralgia, and pseudo tumor cerebri

A

vitamin A

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346
Q

what can vitamin A be used to treat

A

AML M3 subtype and measles

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347
Q

deficiency of this: ATP depletion, worked by glucose infusion, highly aerobic tissues are hit first.Start to see with alcohol chronically. Confusion, opthmalplegia, personality change, ataxia, confabulation, personality change, an memory loss. damage to medial dorsal nun the thalamus and maxillary bodies. dry beriberi- polyneuritis and symmetrical muscle wasting. wet is high output cardaic failure and edema

A

thiamine defiency loss of pyruvate dehydrogenase,e alpha ketoglutartate, transkelotase, and branched cain amino acids

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348
Q

what is the first enzyme in alcohol metabolism

A

alcohol dehydrogenase

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349
Q

what drug blocks the first step of alcohol metabolism and what is the use for it

A

fomepizole- it is used an the antidote for methanol and ethylene glycol toxicity

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350
Q

what is the second enzyme in the alcohol metabolism pathway

A

acetaldehyde dehydrogenase

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351
Q

what blocks the second step of alcohol metabolism

A

disulfiram

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352
Q

why does alcohol causes steatosis

A

it increases the NAD/NADH ratio so that it is metabolized instead of close and it used the malate shunt instead so that it prevents gluconeogenesis as well

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353
Q

In what organelle has fatty acid oxidation, acetyl coA production, TCA, oxidative phosphorylation, ketogenesis

A

mitochondria

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354
Q

where in the cell has glycolysis, HMP shunt, and synthesis of steroids, proteins, and carry acids, nucelotides

A

cytoplasm

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355
Q

autosomal recessive defect in an enzyme leads to increased methylmalonic acid so metabolic acidosis, hypoglycemia from increased basal metabolic rate leads to increased ketones which leads to AGMA. This inhibits the urea cycle which leads to hyperammonia- hypotonic, lethargic, vomitting, respiratory distress- increased urine propionic acid and methylamalonic acid- what enzyme is deficient

A

methylmalonic acid mutatse

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356
Q

what is the GLUT for hepatocytes and Beta cells of the pancreas

A

2

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357
Q

what is the GLUT for neurons and placenta

A

3

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358
Q

what is the GLUT for fructose in the GI tract

A

5

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359
Q

what is the GLUT for RBC, BBB, and is generally independent

A

1

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360
Q

what is the GLUT for skeletal muscle and adipose which is insulin dependent

A

4

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361
Q

what is the first enzyme in the glycolytic pathway

A

hexokinase and glucokinase

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362
Q

what is the rate limiting enzyme of glycolysis and what regulates it

A

PFK 1- increased AMP and fructose 2,6

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363
Q

what down regulates the rate limiting step of glycolysis

A

increased ATP and citrate from the TCA cyle

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364
Q

what enzyme takes phosphoenolpyruvate to pyruvate

A

pyruvate kinase

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365
Q

what is pryruvate kinase stimulated by

A

fructose 1,6 bisphosphate

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366
Q

what down regulated pyruvate kinase

A

ATP and alanine

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367
Q

what is the deficiency if there is hemolytic anemia due to inability to maintain Na-K ATPase

A

pyruvate kinase deficiency because the RBC can only go through glycolysis to produce ATP

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368
Q

in the well fed state, which enzyme is stimulated in the fructose 6-P pathway

A

PFK2 is stimulated so that fructose 2,6 bisphos is increased which turns off glycolysis and k creased glycolysis

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369
Q

in the fasting state, which enzyme is stimulated in the fructose 6p pathway

A

FBPase is stimulated so fructose 2-6 goes to frucuctose 6p and gluconeogenesis

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370
Q

what are the fates of pyruvate

A

odd chain FA propyl coA, TCA as oxaloactetate, and AA as oxaloacetate

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371
Q

what is the rate limiting step of gluconeogenesis

A

fructose 1,6 bisphosphatase

372
Q

what increases and decreases the rate limiting enzyme of gluconeogenesis

A

ATP increases it and AMP decreases it

373
Q

neurologic defects, lactic acidosis, increased alanine and can be from B1 deficiency or arsenic exposure-

A

pyruvate dehydrogenase complex deficiency- a buildup of pyruvate gets shunted to lactase and alanine- treatment is a ketogenic diet like lysine and leucine

374
Q

pyruvate to alanine aminotransferase requires what cofactor

A

b6

375
Q

pyruvate to oxaloacetate for the TCA cycle of gluconeogenesis requires what cofactor

A

biotin- pyruvate decarboxylase

376
Q

pyruvate to glycolysis to TCA by pyruvate dehydrogenase requires what cofactors

A

B1, B2m B3, B5

377
Q

pyruvate to the lactic acid cycle is major pathway in what tissues and requires what

A

RBC, WBC, kidney medulla, lens, testes, and cornea- B3

378
Q

What is the first enzyme in the TCA cycle

A

citrate synthase take acetyl cos and oxaloacetate to citrate

379
Q

what is the rate limiting enzyme of the TCA cycle

A

isocitrate dehydrogenase

380
Q

what is the most heavily regulated step of the TCA cycle and what regulates it

A

alpha ketoglutarate dehydrogenase- requires B1, lipoic acid, B5 ,B2, B3- yields 1 GTP, 3 NADH, and FADH2

381
Q

what inhibits complex 1 of the OxPhos

A

amytal and rotenone and BMDP

382
Q

what inhibits complex 3 of OxPhos

A

antimycin

383
Q

what are rotenone and antimycin

A

fish poisons

384
Q

what inhibits complex IV

A

cyanide, sodium azide, CO, and hydrogen sulfide

385
Q

what inhibits ATPase of ox phos

A

oligomycin A- macrolide

386
Q

what are the uncoupling agents of oxphos

A

high dose aspirin and 2,4 DNP

387
Q

what does the HMP shunt do

A

its provides NADPH from glucose 6P which is required for reduction reactions and it veils ribose for nucleotide synthesis and glycolytic intermediates

388
Q

what is the rate limiting step in oxidative HMP shunt

A

glucose 6p dehydrogenase

389
Q

what is the rate limiting step in the non oxidative HMP shunt and what does it require

A

B1 and it is phosphopentose isomerase or transkelotases

390
Q

Patient has hemolytic anemia following sulfonamide treatment- what does the patient have, what else can set it off, and why does it happen

A

It is G6PD deficiency. NADPH is necessary to keep glutathione reduces which detoxifies free radicals and peroxides. The decrease in NADPH production in RBC leads to hemolytic anemia due to poor RBC defense against oxidizing agents. Infection can precipitate hemolysis and inflammatory response produces free radicals that diffuse into the RBC causing the damage. Drugs: fav beans, sulfonamides, primaquine, anti-TB drugs- confers malaria resistance

391
Q

what cells are seen with G6PD deficiency

A

heinz bodies- denature hemoglobin precipitates in the RBC due to oxidative stress, and bite cells which are the result of phagocytic removal of the Heinz bodies by splenic macrophages

392
Q

what enzyme in the HMP shunt pathway neutralizes the H2o2

A

glutathione peroxidase

393
Q

patient presents with fructose in the blood and urine- what is the deficient enzyme, condition, and inheritance

A

essential fructosuria, def in fructokinase, AR

394
Q

patient has hypoglycemia, jaundice, cirrhosis, and vomiting after consumption of fruit, juice, and honey in a smoothie- what is the deficient enzyme, what is the condition, what is the treatment

A

fructose intolerance, deficiency in aldolase B, AR, fructose 1P accumulates, whcich decreases the available phosphate which causes the symptoms because it blocks glycogenolysis and gluconeogenesis. Urine dipstick will be negatie. Decrease the consumption of fructose and sucrose

395
Q

patient has galactose in the blood and urine following feeding and has infantile catcalls and cannot track objects and does not have a social smile. what is the deficient enzyme, what is the condition, what is the treatment

A

Galactokinase deficiency- galactokinase- galactitole accumlates and it is AR. It appears when they start feeding- tends to be mild treat with reduced galactose in the diet

396
Q

patient has failure to thrive, jaundice, hepatomegaly, infantile cataracts, intellectual disability and has had neonatal ecoli sepsis- what is the deficient enzyme, what is the condition, what is the treatment

A

classic galactosemia- absence of galactose 1 P uridyltransferase AR- damage is accumulation of galactitol in the lends and other ares of the body need to exclude galactose and lactose in the diet of the newborn

397
Q

what enzyme converts glucose to sorbitol and sorbitol to fructose

A

aldose reductase and sorbitol dehydrogenase

398
Q

what cells/tissues can do the full conversion of glucose to fructose

A

liver, ovaires, and seminal vesicel

399
Q

what cells/tissues only have alludes reductase

A

schwann cells, retina, kidneys

400
Q

what happens to sorbitol conversion in a hyperglycenic state

A

aldose reductase converts glucose to sorbitol faster than it can be metabolized and this lets increased sorbitol accumulate and increased water can diffuse into the cells. The NADPH is depleted which increases oxidative stress which accelerates the development of cataracts and diabetic microvascular complications

401
Q

patient has bloating, cramps, flatulence, and osmotic diarrhea what is the deficient enzyme, what is the condition, what is the treatment

A

lactase deficiency- stool has decreased pH and increased hydrogen content and there is normal mucosa there is osmotic diarrhea due to the extra stuff in the lumen of the gut

402
Q

what are the essential amino acids

A

methionine, valine, histidine, isoleucine, phenylalanine, threonine, tryptophan, leucine, lysine

403
Q

what are the acidic amino acids

A

aspartic acid and glutamic acid which are negatively charged at body pH

404
Q

what are the basic amino acids

A

arginine and lysine and histidine

405
Q

what enzyme takes CO2 and Nh3 to carbamoyl phosphate

A

CPS1

406
Q

what enzyme takes ornithine to citruline with carbamoyl phosphate

A

ornithine transcarbamylase

407
Q

explain alanine role in transport of ammonia

A

alanine is release by muscle during protein catabolism as part of the glucose alanine cycles that removes excess nitrogen. Alanine goes to the over as a vehicle of nitrogen disposal and it is then used as a carbon source for gluconeogenesis. Alanine is transaminated to form pyruvate and alpha ketoglutarate which accepts the amino group. Glutamate then receives the amino group and releases ammonia to regenerate the alpha ketoglutarate

408
Q

patient has tremor, slurring of speech, somnolence, vomiting, cerebral edema, and blurring of vision from accumulation of this why does it happen

A

excess amminoia depletes the alpha ketoglutarate and this leads to an inhibition of the TCA cycle

409
Q

treatments for hyperammonia

A

lactulose which acidifies the GI tract and traps the ammonium, rifaximin to decrease colonic amminogenic bacteria, benzoate, phenyl acetate, and phenylbutarate bind to NH4 and lead to increased excretion of it

410
Q

neonate with poorly regulated respiration and body temperature, poor feeding, developmental delay and intellectual disability-what is the deficient enzyme, what is the condition, what is the treatment

A

absence of N acetyl glutamate which is a required cofactor for CPS1

411
Q

patient has increased orotic acid in the blood and urine and decreased BUM, hyperammonenmia, and no megaloblastic anemia- vomitting confusion, coma, tachypnea-what is the deficient enzyme, what is the condition, what is the treatment

A

Ornithine transcarbamoylase deficiency which is X linked recessive- it interfers with ability to eliminate ammonia.

412
Q

child has vomiting, poor feeding, and urine smells like burnt sugar, CNS defects, and intellectual disability- what is the deficient enzyme, what is the condition, what is the treatment

A

MSUD- blocked degradation of branched chain amino acids like isoleucine, leucine, and valine due to decreased branched chain alpha ketoacid dehydrogenase cases increased lupine. Need to restrict the ILV and supplement with thiamine

413
Q

blue-black connective tissue and sclerae, urine turns black with prolonged exposure to air and has arthritis-what is the deficient enzyme, what is the condition, what is the treatment

A

homogentisate oxidase in the tyrosine degradation pathway of tyrosine to fumarate. It is benign but the homogentisic acid is toxic to cartilage

414
Q

patient has increased homocysteine in the urine, intellectual disability, marinades, osteoporosis, lens subluxation down and in and thrombosis and atherosclerosis-what is the deficient enzyme, what is the condition, what is the treatment

A

can be from cystathione synthase deficiency which can be treated with increased cysteine and B12 and folate. or from decreased affinity of cystathione synthase for pyridoxal phosphate- treat with increased B6 and cysteine. Methionine syntheses def- decrease methionine in the diet and try B6

415
Q

patient has recurrent hexagonal stones in the urethra-what is the deficient enzyme, what is the condition, what is the treatment

A

defect of renal PCT and intestinal amino acid transporter that prevents reabsorption of cysteine, ornithine, lysine, and arginine- the excess cysteine forms these stones. Treat with urinary alkalization or good hydration

416
Q

what is the type of bond are the branches of glycogen

A

alpha 1-6

417
Q

what is the type of bond that holds together the glycogen linkages

A

alpha 1-4

418
Q

what are the tone bodies

A

acetone, acetoacetate, and beta hydropxybutyrate

419
Q

refeeding syndrome

A

negligible nutrient intake for five days to intracellular stores depleted. Body takes all of the new nutrients into the cells which decreased the blood levels which can depletes ATP from trapping nutrients in the cells

420
Q

starvation at 1-3 days- what maintains everything

A

hepatic gluconeogenesis, adipose release of FFA, muscle and liver shift to FFA, hepatic glucose from lactase and alanine and from adipose tissue odd chain fatty acids

421
Q

when are glycogen stores depleted

A

1 day

422
Q

starvation what maintains everything

A

adipose stores which are being used by the brain as ketones. after this is depleted, protein degradation accelerates leading to organ failure. Amount of excess stores determines survivial

423
Q

apoE

A

mediates remnant uptake

424
Q

apoA1

A

activates LCAT

425
Q

apoC2

A

lipoprotein lipase cofactor

426
Q

apoB48

A

mediates chylomicron secretion

427
Q

apoB100

A

binds LDL receptor

428
Q

LDL transports cholesterol to

A

the tissue from the liver

429
Q

HDL transports cholesterol to

A

the liver from the tissue

430
Q

chylomicro

A

delivers diet TG to tissue and delivers cholesterol to the liver in the form of remnants

431
Q

VLDL

A

delivers hepatic TG frto perioheral tissue

432
Q

IDK

A

formed in the degradation of VLDL and delivers TGS and cholesterol to the liver

433
Q

LDL

A

delivers heaptic cholestorl to the peripheral tissues

434
Q

HDL

A

mediates reverse cholesterol transport and are increased in alcohol synthesis

435
Q

capsule

A

prevents phagocytosis

436
Q

glcocalyx

A

mediates adherence to surfaces and can form the biofilm

437
Q

periplasm

A

the space between the cytoplasmic membrane and outer membrane of gram negative bacteria with the peptidoglycan wall in the middle

438
Q

outer membrane

A

contains the LPS which is the endotoxin for TNF alpha and IL1

439
Q

lipotechoic acid

A

extend from the membrane to the outside and this acts as the inducer of TNF and IL1 in gram positive infections

440
Q

where are the beta lactamases located

A

in the periplasmic spaces

441
Q

which bacteria are filamentous and what are their oxygen requirements

A

nocardia(aerobe) and actinomyces(anaerobe)

442
Q

which bacteria have no cell wall

A

mycoplasma, ureaplasma

443
Q

which bacteria are spirochetes

A

borrelia, leptospira, and treponema

444
Q

bacteria that does not gram stain well

A

treponema, leptospira, mycobacteria, mycoplasma, ureaplasma, legionella, rickettsia, chlamydia, bartonella, ehrlichia, anaplasma

445
Q

what does PAS stain diagnose?

A

whipple disease- trophema whippeli

446
Q

which bugs are intracellular

A

legionella, rickettsia, chylamydia, bartonella, ehrlichia, anaplasma

447
Q

Ziehl Neelsen stain- carbol fuchin

A

acid fast bacteria

448
Q

india ink stain

A

cryptococcus neoformans

449
Q

silver stain

A

fungi and legionella, helicobacter pylori

450
Q

what is the difference between selective and differential media

A

selective- factors particular organism and indicator has a color change with certain bacteria but does not inhibit growth of others

451
Q

Thayer Martin media

A

selective for Neisseria by inhibiting the growth of other organisms with the antibiotics

452
Q

tellurite agar

A

diptheria- growths with black iridescent colonies

453
Q

pink colonies on MacConkey

A

lactose fermenters

454
Q

anaerobic bacteria

A

clostridium, bacteriodes, fusobacterium, actinomyces

455
Q

obligate intracellular bactera

A

rickettsia, chlamydia, coxiella- rely on host ATP

456
Q

facultative intracellular bacteria

A

salmonella, neusseria, brucella, mycobacteria, listeria, francisella, legionella, yersinia pestis

457
Q

encapsulated bacteria

A

pseudomonas, strep pneumo, haemophilus, flu b, neisseria meningitis, ecoli, slamonella, klebsiella, group B strep

458
Q

what patient population has an increased risk of infection from encapsulated bacteria

A

asplenic patients

459
Q

which are capsular vaccines

A

s pneumo, h flu, and meningitis

460
Q

organisms that cause stag horn calculi and why

A

creases positive- proteus, ureaplasma, staph saptophyticus

461
Q

catalase positive and what disorder has increased risk of these infections

A

nocardia, pseudomonas, listeria, aspergillus, candida, ecoli, staphylococci, serratia, b.cepacia, h pylori

462
Q

yellow sulfur granules

A

actinomyces

463
Q

blue green pigment

A

pseudomonas

464
Q

yellow pigment

A

staph arueas

465
Q

red pigment

A

serratia

466
Q

biofilm on catheter and prosthetic valves

A

staph epi

467
Q

biofilm on dental plaques and infective endocarditis

A

viridans strep

468
Q

biofilm in CF patients in lung and contact lens ketatosis

A

pseudomonas

469
Q

protein A

A

binds the Fc region of the IgG to prevent opsonization and phagocytosis- s aureus

470
Q

enzyme that cleaves IgA

A

s pneumo, hib, neisseria and use to it adhere to the mucosa

471
Q

helps prevent phagocytosis

A

group A strep and causes the long term issues with strep

472
Q

ability to take up naked DNA from the environment and what bacteria can do this

A

its called transformation and it is done my strep pneuma and hi and neusseria- if deoxyribonuclease is added the environment then it can not longer transform it

473
Q

transfer of plasmid from one bacteria to another

A

conjugation

474
Q

segment of DNA that can jump from one location to another and can transfer genes from plasmid to chromosome and vice versa. When excision occurs it can include some flanking chromosomal DNA which can be incorporated into a plasmid and transferred to another bacteria

A

transposition

475
Q

lytic phage infects bacteria leading to cleavage of bacterial DNA. Parts of bacterial chromosomal DNA may be in the phage capsid. Phage infects another bacteria which transfers these genes

A

transduction

476
Q

lysogenic phage infectes bacteria and viral DNA is incorporated into the DNA and its in the phage capsid for another bacteria- what bacteria toxins are in lysogenic phages

A

specialized transduction- botulinum, group a strep, cholera, diphtheria, shiga toxin

477
Q

what kills spores and how long

A

autoclave with steam at 121 for 15 minutes

478
Q

what produces spores

A

bacillus, clostridium, and coxiella

479
Q

what is an endotoxin

A

Lipid A from LPS and it has shock, fever, hypotension, DIC, from induction of TNF, IL1, and 6

480
Q

what is an exotoxin

A

it is a polypeptide and it is a low infective dose

481
Q

alpha hemolytic bacteria

A

strep penumo and viridans strep

482
Q

beta hemolytic bacteria

A

s bureaus from secretion of hemolysin and strep progenies and strep agalactiae

483
Q

gram positive beta hemolytic catalase + coag+ clusters

A

staph aureus.

484
Q

short incubation of food poisoning- vomitting

A

s aureus food poisoning

485
Q

fever rash, vomiting, desqamation and shock with end organ failure associated with tamposn

A

s aureus TCC it binds the MHC II and TCR to induces this damage

486
Q

normal flora that is gram + catalase + and coagulase - urease - in clusters that are novobiocin sensitive- it an cause infection of prostethic devices and IV catheters

A

staph epi

487
Q

gram + coag- cata + cocci urease +novobiocin resistant- normal flora of perineum

A

staph saprophyticus

488
Q

gram positive lancet shaped diplococci, encapsulated that is optician sensitive causes meningitis, otitis media, pneumonia sinusitis, rusty sputum- can undergo natural transformation

A

strep pneumo

489
Q

what patients are at an increased risk of sepsis from strep pneumo

A

sickle cell and asplenic

490
Q

gram positive alpha hemolytic cocci that are normal in the oropharynx and can cause dental caries- this can cause subacute bacterial endocarditis- optician resistant

A

strep viridans- they are not afraid of the chin (optochin) because they live in the mouth

491
Q

gram positive cooci pyogenic infection causing pharnygitis, cellulitis, impetigo, and erysipalas

A

strep pygenes

492
Q

gram positive cocci- scarlet fever tS, necrotizing facitis

A

strep pyogenes

493
Q

criteria or acute rheumatic fever

A

polyarthritis, carditits, nodules, eryhtema marginatum(central clearing), chorea

494
Q

blanching, sandpaper body rash, strawberry tongue, and circumpolar pallor after strep A pharyngitis

A

scarlet fever

495
Q

gram positive, colonized vagina and causes meningitis, spots, and pneumonia in babies- produces a factor that increases hemolysis

A

strep B

496
Q

when do you screen moms for strep B

A

35-37 weeks

497
Q

gram positive cocci causing subacute endocarditis- what cancer and what bug

A

strep bovis- colon cancer

498
Q

gram positive cocci- normal colonic flora that are resistant to pcn and can cause UTI biliary tract infections, and subacute endocarditis following GI or GU procedures

A

enterococci

499
Q

what is enterococcus often resistant to

A

vancomycin

500
Q

only bacteria with polypeptide capsule- that contains d-glutamate

A

bacillus anthracis

501
Q

painless papule surrrounded with vesicle with a painless necrotic eschar that can progress to bacteremia

A

b.anthracis

502
Q

inhales spores leads to flue symptoms and rapidly progressing fever, pul hemorrhage, and medisatinitis and shock after exposure to wool

A

b. anthracis

503
Q

reheated rice food poisoning with vominting after 1-5 hours with preformed txon

A

b. cererus

504
Q

produces after a penetrating would with contractors from the blockade of inhibitory NT spastic paralysis- how to treat and what causes

A

c. tetani- antitoxin and vaccine booster and diazepam and debride- can be from umbilicus in newborns

505
Q

heat labile toxin inhibtis ACH release at the NMJ- ccuases flaccid paralysis- what is different with babies who have get this- what is the exposure

A

it is c botulinum and babies get it from ingesting the spores in honey which leads to the disease and these germinate in the GI tract. Adults ingest it from home-canned food and its a preformed toxin

506
Q

produces alpha toxin causing myonecorsis and hemolysis- it has gangrene with are lesions

A

c perfringens- anaerobe

507
Q

spores can survive in undercooked food and are a heat labile enterotoxin- from the same thing that causes gas gangrene

A

c perfringens

508
Q

pseudomembranous colitis with a toxin A that binds the brush border of the gut and a toxin B that causes cytoskeletal disruption via actin depolymerization and diarrhea- usually with antibiotic like cloned or ampicillin use

A

c diff

509
Q

gram positive rods, beta prophage withe the toxin and it inhibits EF2. it causes pseudomembranous pharyngitis with lymphadenopathy, myocarditis, and arrhythmias-

A

cornybacterium dipteheria

510
Q

gram positive facultative intracellular rod- from dairy products, cold cut meats, and transplacental or from birth canal- have rocket ails that allow intraceullar movement and tumbling motion in the broth- can cause amnionits sepsis and spontaneous abortin in pregnancy, neonatal meningtitis, gastroenteritis in adults

A

listeria

511
Q

acid fast aerobic, filamentous with pulmonary infections in the compromised and cutaneous infections in immunocompotent

A

nocardia

512
Q

non acid fast, anaerobe with norm oral, GI, and reproductive flora- causes oral and facial abscess with draining sinus tract and self granules and can be from PID with IUD

A

actinomyces

513
Q

lower lobe with ipsilateral calcified ln with TH1 mediated caveating necrosis with a ghon complex with the hilar nodes

A

primary TB

514
Q

fibrocaseous cavitary lesion in the apex with liquefactive necrosis and erased the pulmonary vessels occasionally leading to hemoptosys and persistent cavitation can lead to aspergillus

A

reactivation of TB

515
Q

milliary TB

A

spread to meinges, vertebrae, lungs, LN, spleen, bone,s adrenals

516
Q

vertebral TB disease

A

Potts disease

517
Q

AIDs Tb with resistance to multiple drugs

A

MAC- use prophylactic azithromycin

518
Q

mycobacterium marnium

A

infection on aquarium handlers

519
Q

night sweeats, fever, weight loss, cough, hemoptysis

A

tb

520
Q

what is cord factor in TB

A

it is a serene cord appearance that inhibits macrophage maturation and induces the release of TNF alpha- which then increases the virulence

521
Q

diffuse skin involvement with lion face and is high TH2 response with communicable- tends to be in compromised patients

A

lepromatous

522
Q

hairless plaques, and these lesions have no feeling in them- cell mediated immunity is mainly a TH1 response

A

tuberculoid leprosy

523
Q

what bacteria ferment lactose

A

klebsiella, ecoli, enterobacter, and serratia

524
Q

reinfection with an STD because of

A

antigenic variation of the pilus on neusseria gonocci

525
Q

septic arthritis, neonatal conjunctivitis, PID and fitzhugh curtis syndrome with gram negative diplococci that are often intracellular- there is sexual transmission and can cause blindness in newborns

A

n gonnorhea

526
Q

gram negative diplococci that causes meningitis and has a capsule the B type capsule is most common- can have petechial hemorrhages, gangrene of the toes, and waterhouse freidericheson wit hDIC

A

causes my n meningitis

527
Q

neisseria infections are increased in which deficiency

A

people who don’t form membrane attack complexes

528
Q

small gram neg coccobaccilus with aerosol transmission- nontypable cause miucosal infections like otitis media, conjunctivitis and bornchitis

A

non-encapsulated homophiles influenzae

529
Q

the encapsulated strain causes epiglottis which has stridor and drooling, meningtitis, pneumonia and otitis medai

A

capsulated HIB

530
Q

what is the prophylaxis for close contacts to HIB

A

rifampin

531
Q

gram negative aerobic coccobacillus that and cause tracheal cytotizin and a paradoxical cough and it has a long cough term

A

bordatella pertusis

532
Q

gram negative rod that can be seen with silver stain, grows on charcoal with iron an cysteine with aerosol transmission from environmental water source causes severe knomonia that is unilateral and lobar-

A

legionella

533
Q

mild flu like illness from gram negative rod that can be seen with silver stain, grows on charcoal with iron an cysteine with aerosol transmission from environmental water source causes severe

A

pontiac fever with legionaires

534
Q

aerobic motile gram negative rod that can ferment oxidase and produces pyocyanin and endotoxin, exotoxin that inactivates EF2 and phospholipase C- pneumonia, sepsis, erythema gangrenosum (necrotic skin ulcers), indwelling catheter associated UTi, and otitis extern, nosocomial infections, hot tub folliculitis

A

pseudomonas

535
Q

colonizes lung of CF patients and has mucoid capsule

A

pseudomonas

536
Q

treatments for pseudomonas

A

carbapenems, aminoglycosides, monobactams, polymyxins, FQs, 3-4 generation cephalosporins, piperacillin, ticaricillin.

537
Q

microbe invades the intestinal mucosa causing necrosis and inflammation- which ecoli

A

EIEC like shigella

538
Q

produces heat labile and stable enterotoxin but no inflammation or invasion- diarrhea from mexico

A

travelers diarrhea- ETEC

539
Q

no toxin produced adheres to the apical surface and flattens villi and prevents absorption- diarrhea in children

A

EPEC-

540
Q

undercooked beef or raw veggies- anemia, thrombocytopenia, and acute renal failure due to micro thrombi forming on damaged endothelium and causes mechanical hemolysis with schistocytes on the peripheral blood smear-platelets are consumed and decreased renal blood flow occurs

A

EHEC- shiga toxin

541
Q

gram negative rose that causes lobar pneumonia from aspiration with mucoid colonies from polysaccharide capsules and has currant jelly sputum- can also cause liver and lung abscesses tends to occur in alcoholics or diabetics

A

klebsiella

542
Q

gram negative comma or s shaped bacteria with polar flaglaa that is oxidase positive- it is bloody diarrhea in child with fecal oral transmission that can come from infected animals like puppy with diarrhea

A

campylobacter jejuni

543
Q

what can campylobacter jejune cause

A

GB or reactive arthtisis

544
Q

bacteria with swarm mobility and is urease positive that form stag horn calculi

A

proteus

545
Q

need a high dose to get inoculated because gastric acid can neutralize it, antibiotics prolong the excretion- can cause rose spots on the abdomen, constipation, and absomial pain with ever- has capsule that can prevent opsonization- can hide in the gall bladder for carrier state colonization

A

salmonella typhi

546
Q

anibiotics prolong duration and have bloody diarrhea from poultry, eggs, pets, and turles- gastroenteritis

A

all other salmonella

547
Q

what can cause osteomyelitis in sickle cell patients

A

salmonella

548
Q

bloody diarrhea with invasion of the organism during invasion

A

shigella

549
Q

gram negative flagellated comma shaped oxidase positive profuse watery stool with increase cMP and Gs from the enterotoxin requires a large inculum unless there is a decrease in gastric acid

A

vibrio cholerae

550
Q

gram negative rod that is transmitter by pet feces like puppies or milk or pork can cause acute diarrhea or pseudoappendicitis

A

yersinia enteroclitica

551
Q

curved rod with terminal flagella gram negative- catalase, oxidase and urease positive. colonizes the antrum of the stomach, gastritis and peptic ulcers and increased risk of peptic ulcer disease, gastric adenocarcinoma and MALT lymphoma

A

hpylori

552
Q

treatment for hpylori

A

amoxicillin, clarithromycin, PPI

553
Q

spirochete found in water with animal urineflu with myalgia of the calves, jaundice, and photophobia typically seen in surfers in the tripics

A

leptospira interrogans

554
Q

sever jaundice and azotemia from liver and kidney dysfunction with fever, hemorrhage and anemia

A

Weil disease- leptospira interrogate

555
Q

what is lyme disease transmitted by

A

ioxedes tick

556
Q

what is stage 1 of lyme

A

erythema migrants and flu

557
Q

second stage of lyme

A

secondary lesion, pancarditis, AV block, facial nerve palsy, migratory myalgias and transient arthritis

558
Q

third stage of lime

A

encephalopathies and chronic arthritis

559
Q

primary syphilis

A

painless chancre and can see organism on darkfield

560
Q

secondary syphilis

A

maculopapular rash on palms and sles, condyloma lata, lymphadenopathy, patyhc hair loss

561
Q

tertiary syphilis

A

gumbos with parotitis with vasa vasorum destruction and neurosyphilis from loss of doral columns, argyll robertson pupil- accomidae but won’t react.

562
Q

congenital syphilis

A

facial abnormality and snuggles, saddle node, hotchinsom teath, saber shints, mulberry molars, and VIII deafness

563
Q

false postives on the VDRL lab

A

viral infection, drugs, rheumatic fever, lupus, leprosy

564
Q

what can happen after treating syphillis

A

can feel like the flue from the destruction of the spirochetes

565
Q

what transmits anaplasmossi

A

ixodes

566
Q

what transmits bartonella

A

cat scratch

567
Q

what transmits barely burgorderi

A

ixodes tick

568
Q

what transmits borrelia recurrentis

A

louse

569
Q

what transmits brucella

A

unpasteurized dairy

570
Q

what transmits campulocbater

A

pets and people

571
Q

what transmits chlamyydphila psittaci

A

parrot

572
Q

what transmits coxiella burnetii

A

aersol of cattle and sheep

573
Q

what transmits ehrlichia

A

ambyloma

574
Q

what transmits francilla

A

rabbit

575
Q

what transmits leptospirsa

A

animal urine

576
Q

what transmits pasturella

A

animal bite

577
Q

what transmits rickettsia prowazekii

A

human to human or louse

578
Q

what transmits rickettsia ricketsii

A

dog tick

579
Q

what transmits rickettsia typhi

A

fleas

580
Q

what transmits salmonella

A

reptiles and poultry

581
Q

what transmits yersinia pestis

A

flea and prarie dogs

582
Q

pleomorphic gray vaginal discharge with fishy smell clue cells with stippled appearance

A

gardnerella

583
Q

disease occurs in south atlantic states like north carolina with rash that starts at wrists and ankles and moves to the trunk and palms and soles- headache, fever, rash

A

rickettsi rickettsii

584
Q

fleas causing rash that starts centrally and spreads out can also be from the louse

A

rickettsii type and prowazeki

585
Q

monocytes with mulberry inclusions tick vector

A

ehrlichiosis

586
Q

tick vector with granulocytes and morula

A

anaplasma

587
Q

spores inhaled by aerosol and causes pneumonia and culture negative enodcarditis- typically intracellular and from cow placenta

A

coxiella burnetti

588
Q

choinc infection causing blindness from follicular conjunctivitis in africa

A

chlamydia A,BC

589
Q

urethritis and PID, ectopic preg, neonatal pneumonia with staccato cough, and eosinophilia, neonatal conjunctivitis

A

DK clap

590
Q

small painless ulcers on the genitalia with swollen inguinal lymph nodes that ulcerate into buboes

A

L1,L2,L3 clap

591
Q

intracellualr infection with elementary bodies that enter the cell via endocytosis and go to the reticulocytes body which replicates then reorganizes to travel

A

chlamydia

592
Q

can case follicular conjunctivitis, nongonococcal urethrtitis and PID, prostatitis

A

chlamydia

593
Q

what fungus type grows at cold temperature

A

mold

594
Q

what fungus type grows at hot temperatures

A

yeast

595
Q

dimoprhic fungus from bat and bird droppings from macrophages filled with RBC and ovoid cells within the macrophages

A

histoplasmosis

596
Q

dimorophic fungus from the US and central america- inflammatory lung disease and can disseminate to skin and bones, and forms granulomatous nodules. It is broad based budding yeast- thick wall round yeast with broad based buds

A

blastomycosis

597
Q

SW Us and California, and causes pneumonia and meningitis and can disseminate to the skin and bone can increase rate after earthquakes. Can get some arthritis and skin findings. Spherule filled with endospores

A

cocciodomycosis

598
Q

budding yeast with captains wheel formation much larger than RBC- severe pneumonia with granulomas

A

paracoccidiomycosis

599
Q

what are the types of tinea

A

microsporidium, trichophytan, and epidermophyten

600
Q

what is fungal on the head called

A

tinea capitus

601
Q

what is dermatophye on the body called and looks like ring worm

A

tine coporis

602
Q

what is dermatophyte on the feet called

A

tinea pedis

603
Q

what is dermatophyte on the nail called

A

tinea unguium

604
Q

spagetti and meat balls appearance on the slide and hypo pigmented lesions with degradation of lipids that produces acids that damage the melanocytes in those areas

A

tina versicolor or pitaryasis or malassezia furfur

605
Q

dimorphic fungus with psudeohyphae and budding yeasts and germ tubes. These can cause a superficial infection (neutrophils are used for it) and systemic is mediated by T cells not working. Esophageal thrush is in immune compromised and vulvocaginitis, diaper rash, endocarditis of drug users, and can be chronic in SCIDs

A

candida albicans

606
Q

what is the treatment for Candida

A

topical azole, nystatin, or ampho B if systemic

607
Q

septate hyphae at 45 degree angles- produce conidia and can cause lung infection on preexisting evacuations from TB.

A

aspergillus

608
Q

aspergillus can have reaction in what other condition

A

asthma

609
Q

what kind of cancer comes from afalatoxin

A

hepatocellular carcinoma

610
Q

narrow budding heavily encapsulated yeast found in pigeon droppings, and inhalation with hematogenous dissemination to meninges. Latex agglutination detects capsular antigen. Can start as symptomatic lung infection then meningoencepahlitis and then it is budding year with a thick capsule

A

cyptococcus

611
Q

what do the brain lesions look like in cyptococcus meningoencephalitis

A

soap bubble lesions

612
Q

what type of patients are more susceptible to moocher and rhizopus

A

DKA and neutropenic patients (leukemia)

613
Q

irregular broad non spectate hyphae at wide angles and they proliferate through blood vessel walls causing them to penetrate the cribriform plate and enter the brain. Rhino cerebral frontal lobe abscess and cavernous sinus thrombosis- headache, facial pain, black necrotic eschar on face with cranial nerve involvement

A

Mucor and Rhizopus

614
Q

diffuse intersitial pneumonia with yeast like fungus that is inhaled. Most are asymptomatic unless they are compromised with AIDS. Bilateral ground glad opacities on CXR.

A

PJP

615
Q

what is the prophylaxis for PJP and when to start

A

TMP-SMX and its when CD4 drops below 200

616
Q

dimorpic cigar shaped yeast that grows in branching hypes with rosettes of conidia. Lives on vegetation it is usually from thorn and it cause local pustule or ulcer with nodules along draining lymphatics

A

sporothrix schenckii

617
Q

what is the treatment for sporothrix

A

potassium iodine and itraconazole

618
Q

bloating flatulence, foul smelling diarrhea and seen in campers- transmission, protozoa, and treatment

A

giardia, from cysts in the water, pear shaped ova, have four flagella, and can do metronidazole

619
Q

bloody diarrhea, liver abscess with anchovy paste, RUQ and flask shaped ulcer- transmission, protozoa, and treatment

A

cysts in the water fecal oral, entamoeba histolytic, and metronidazole and iodoquinol

620
Q

severs diarrhea in AIDs patiens mild disease in noncompromised- transmission, protozoa, and treatment

A

oocysts in water, fecal oral or person to person, and acid fast pink oocytes on the stain- cryptosporidium- can be treated by filtering the water supply or nitazoxanide

621
Q

congenital infection with choreoretinitis , hydrocephalus, and intracranial calcifications- transmission, protozoa, and treatment

A

toxoplasmosis, cysts in meat or cat feces, and sulfadiazine and pyrametahmine

622
Q

AIDS has a brain abscess that is seen as a ring enhancing lesion- transmission, protozoa, and treatment

A

cysts in meat or cat feces, toxoplasmosis, and sulfasizine and pyrimethamine

623
Q

enlarge LN, recurring fever, somnolence and coma- transmission, protozoa, and treatment

A

tsetse fly, and trypanosome brucei, and trypomastigote in blood smear that looks like a ribbon- suramin

624
Q

what do the fevers with trypanosome go up and down

A

antigenic variation

625
Q

what plasmodium has a 48hour cycle

A

vivax and ovale

626
Q

what plasmodium has a 72 hour cycle

A

malariae

627
Q

what is the transmitter of malaria

A

anopheles mosquito

628
Q

which malaria is the more virulent strain

A

falciparum

629
Q

what kinds do you use primaquine for

A

vivax and ovale

630
Q

what do you see on blood smear

A

trophozoite ring in the RBC

631
Q

fever, hemolytic anemia, northeastern US and increased risk in asplenic- transmission, protozoa, and treatment

A

ixodes tick can have lyme disease too, maltese cross and rinks in the TBC, and treat with atovaquine and azithromycin

632
Q

dilated cardiomyopathy with apical atrophy, megacolon, megaesophagus, from south america, and unilateral swelling of the orbiatal characteristic of the acute stage. transmission, protozoa, and treatment

A

reduviid bughas feces deposited into the bite- trypomatigote in the blood smear- bennidazole and nifurtimox- chagas disease in trypanosoma cruzi

633
Q

spiking fevers, hepatosplenomegaly, pancytopenia, and can be big skin ulcers if only cutaneous- transmission, protozoa, and treatment

A

sandfly- leishmania donovani- macrophages contrain amistigotes- ampho B

634
Q

foul smelling green discharge itching burning- sexual contact see trophozoites and a strawberry cervix- transmission, protozoa, and treatment

A

trichomonas vaginalis- treat with metronidazole

635
Q

which nematodes are ingested

A

enterobius, ascaris, toxocara, trichinella

636
Q

what nematodes are cutaneous

A

strongyloides, ancylostoma, necator

637
Q

what nematodes are from bites

A

loa loa and onchocerca volvulus, and wuchereria bancrofti

638
Q

what is the immune response to helminths

A

eosinophils are acted on by type I and II HSN reactions and these are in response to helminths. Type I neutralization of histamine and leukotrienes. Type II is eosinophils attach to surface of helminths via IgE and release cytokines contain in the granules. Eosinophils are secreted by Th2 secreting IL5 for the binding of IgE to the Fc portion it then degranulates leading to MBP being released and antibody dependent cell mediated cytotoxic killing

639
Q

intestinal infection causing anal pruritis- transmission, helminth, and treatment

A

scotch tape test, decal oral- enterobeus vermicularis, bendazoles

640
Q

intestinal infection with possible obstruction of the ileocecal valve- transmission, helminth, and treatment

A

ascaris lumbricoides- fecal oral visible feces under microscope, bendazoles

641
Q

intestinal infection cauing anemia by sucking blood from intestinal wall can have puritic serpiginous rash from walking on the beach barefoot-only one that comes through the lung- transmission, helminth, and treatment

A

larvae penetrate the skin, ancyclodotma duodenal and nectar americans, bedazzles or pyrantel pamoate

642
Q

intestinal infection larvae enter the blood and encyst in striated muscle cells and inflammation of the muscle. fever vomiting nausea periorbital edema, myalgia- transmission, helminth, and treatment

A

fecal oral and undercooked pork, trichinella spiralis- bendazoles

643
Q

neamotes migrate to the blood through intestinal wall causing inflammation and damage the heart and liver and CNS like seizures and coma- transmission, helminth, and treatment

A

fecal oral, toxacara canis- bensazoles

644
Q

skin changes, loss of elastic fibers, and river blindness, allergic reaction to microilaria- transmission, helminth, and treatment

A

nchocera volvulus- female blackly- ivermectin

645
Q

swelling in the skin, worm in the conjunctiva,- transmission, helminth, and treatment

A

deer fly, horse fly, mango fly-Loa loa- diethycarbamazine

646
Q

elepheantitis worms invade lymph nodes and cuase inflammation which can block lymphatic vessels take 9mo-1 year after bite to become symptomatic- transmission, helminth, and treatment

A

gemale mosquito, wuchereria bancrofti- diethylcarbamazine

647
Q

intestinal tape worm can cause neuocysticoccis- transmission, helminth, and treatment

A

taneinia solium- praziquantal- ingesting of larvae encysted in undercooked pork or eggs with human feces

648
Q

vitamin B12 deficiency causes megaloblatic anemia- transmission, helminth, and treatment

A

diphyllobothrium datum- parziquantal

649
Q

hyatid cysts in the liver causing anaphylaxis if the antigens are related. The cyst needs to be injected with ethanol first the kill cysts before removal- transmission, helminth, and treatment

A

ingestion of eggs from dog or sheep- echinococcus granulosis- albendazole

650
Q

liver and spleen enlargement fibrosis and inflammation- can lead to squamous cell cancer of the bladder- transmission, helminth, and treatment

A

schistosoma- snails are host and can penetrate the skin- praziquantal

651
Q

biliary tract inflammation, pigmented gallstones, cholangiosarcoma- transmission, helminth, and treatment

A

undercooked fish-clonrchis sinesis-praziquantal

652
Q

biliary tract disease cholangiosarcoma- what parasite does it

A

clonorchis sinesis

653
Q

brain cysts and seizures- what parasite does it

A

taenia solium

654
Q

hematuria, squamous cell bladder cancer- what parasite does it

A

schistosoma haematobium

655
Q

liver hyatid cysts- what parasite does it

A

echinococcus granulosis- SW US with dog or sheep with egg shell calcifications can give anaphylaxis

656
Q

microcytic anemia- what parasite does it

A

ancylostoma and necator

657
Q

myalgias, perorbital edema- what parasite does it

A

trichinella spiralis

658
Q

perianal puritis- what parasite does it

A

enterobius

659
Q

portal hypertension- what parasite does it

A

schistosoma mansoni, schistosoma japonicum

660
Q

vitamin B12 deficiecny- what parasite does it

A

diphyllobothrium latum

661
Q

mites burrow into the stratum corner and cause puritis cause serpangious burrows in webspace of hands and feet- who and transmission, treatment, what

A

children and populations, transmission through fomites and skin to skin contact, treat with permethrin cream, washing, drying gall clothing and bedding, scabies

662
Q

blood sucking insects that prefer to live on clothing. Intense parities pink merciless and papillose commonly in intertriginous regions

A

lice- pyrethroids, malathion or ivermectin lotion, children get it

663
Q

exchange of genes between 2 chromosomes by crossing over with regions of base sequence homology

A

viral recombination

664
Q

when 1 of 2 viruses that infect the cel has a mutation that results in a nonfunctional protein, the non mutated virus complements the mutated on by making a functional protein that serves both viruses. hepatitis D requires the presence of replicating hep B virus to supply HBsAg, the envelope preteen for HDV.

A

viral complementation

665
Q

When virus with segmented genomes, changed genetic material Like the H1N1 flu A pandemic emerged via complex ira reassortment of genes from human, swine, and avian viruses and has potential to cause antigenic shift

A

viral reassortment

666
Q

Occurs with simultaneous infection of a cell with 2 viruses. Denim of virus A can be partially or completely coated with surface proteins of virus B and this determines the tropism of the hybrid virus. The progeny from this infection have a type A coat that is only encoded by viral A DNA

A

phenotypic mixing

667
Q

what can mediate the species jump between hosts

A

if the surface glycoprotein changes it mediates the attachment to the host cell, so it can change the type of species it can infect

668
Q

what kind of response does live attenuated vaccines do

A

induce humoral and cell mediated response but can sometimes revert back to virulent strain

669
Q

what vaccines are live

A

smallpox, yellow fever, rotavirus, chickenpox, Sabin polio, MMR and nasal flu

670
Q

what kind of immunity does Sabin give compared to Salk

A

sabin give mucosal immunity through IgA and it is a live attnuated

671
Q

what are the vaccines with egg allergy

A

yellow fever and flu

672
Q

what are the killed vaccines

A

induce only humoral immunity so might need a booster

673
Q

which are the killed vaccines

A

rabies, muscular flu, Salk polio, and HAV

674
Q

which vaccines are subunit vaccines

A

HBV and HPV

675
Q

what DNA viruses are circular

A

papiloma virus, polyoma, and hepadnavirus

676
Q

which DNA viruses are single stranded

A

parvo

677
Q

which RNA virus is double stranded

A

Reo

678
Q

what are the positive RNA viruses

A

toga, retro, flavi, corona, hepe, and calci and picorna

679
Q

which types of viruses are infective on their own

A

positive RNA and double stranded DNA these are able to replicate without host

680
Q

which DNA virus does not replicate in the nucleus

A

poxvirus

681
Q

which RNA virus does not replicate in the cytoplasm

A

flu and retro

682
Q

which viruses are naked

A

papilloma, adeno, parvo, polyoma, calci, picorna, reo hepe

683
Q

the virus that causes highly ccontagious flesh colored papillose with central umbilication which can be seen on the genitals

A

poxvirus- molluscum contangiousum

684
Q

virus family that causes acute and chronic hepatitis that has a reverse transcriptase

A

HBV hepadena virus which is dsDNA

685
Q

what cells kill HBV infected hepatocytes and why

A

CD8 cells kill hepatocytes from MHCI from HBsAg and HbcAg

686
Q

causes a febrile pharyngitis and acute hemorrhagic cystitis and pneumonia and conjunctivities at daycares, summer caps, and military baracks

A

adenovirus

687
Q

causes warts, CIN, cervical cancer and anal cancer- what is the virus and the serotypes that cause each

A

HPV warts 1,2,6,11; cancer is 16 and 18

688
Q

progressive multifocal leukoencephalopathy in HIV or MS drugs- would see mental detrioration and ataxia coma

A

polyomavirus

689
Q

seen in transplant patients and targets the kidney

A

BK virus- typically seen in kidney damage and causes complete dysfunction of the kidneys

690
Q

aplastic crisis in sickle cell patients

A

parvo B19

691
Q

slapped cheek rash with high fever

A

parvovirus

692
Q

what is the presentation of mother and fetus with congenital parvoB19 infection

A

adults have symmetric arthralgia and the child has RBC destruction and hydrous fetalis- can have red cell aplasia- questions often mention a school teacher

693
Q

vesicles on the lips and hard palate with a fever and lymphadenopathy, can be seen on the fingers- what is the virus, family, and transmission and where is it latent

A

HSV1- respiratory secretion and saliva- sits latent in CNV- intranuclear inclusions

694
Q

altered mental status, seizures, aphasia and RBC in the spinal tap- what is the virus, family, and transmission

A

HSV1 temporal lobe encephalitis- personality change plus meningitis

695
Q

seen as multiple painful ulcerated vesicles on the genitalia- what is the virus, family, and transmission and latent

A

sexual contact HSV2- stays in the sacral ganglia. Viral meningitis is more common with 2 than 1

696
Q

causes childhood vesicular illness or in older people it has vesicles in one dermatome only that are paiful- what is the virus, family, and transmission and latency

A

respiratory secretions VZV- can see inclusions in the keratinocytes and giant cells- sits in dorsal root or trigemninal nerve can use capsaicin to decrease the pain and it decreases substance P

697
Q

fever, hepatosplenomegaly, pharyngitits, lymphadenopathy, and posterior cervical nodes, increased risk of splenic rupture- what is the virus, family, and transmission and what are the cancers associated with it, and what cells does it effect and how

A

respiratory secretions or saliva- EBV- can see lymphomas like endemic Burkitt or nasopharyngeal carcinoma in Asians, It infects B cells through the CD21 expansion by CD8 cells and atypical cells appear which are the abnormal T cells called Downey cells. The test is a positive heterophile antibodies

698
Q

Mono with a negative test and see with pneumonia in transplant patient to aids reitintis which is seen as full thickness retinal necrosis and exam with scar tissue and vascular shutting and absorbed hemorrhage– what is the virus, family, and transmission, characteristic cells and CD4 count for retinitis

A

CMV- CD4<50, that with gancylcovir have owl eye nuclear inclusions

699
Q

roseola have high fevers for days then when fever breaks there is a diffuse rash- can have febrile seizures

A

HHV6 and 7

700
Q

dark violaceous plaques and nodules that are vascular proliferations can be in lungs and GI- what is the virus, family, and transmission, what patients get it, and what are the lesions look like

A

HHV8 Kaposi sarcoma- vascualr neoplasm with spindle cells with atypia and blood vessel proliferation and RBC with hemosiderin deposits and bloody diarrhea

701
Q

what is the Tzanck test for

A

HSV it is from an opened skin vesicle to look for multinucelated giant cells

702
Q

what receptors does EBV use

A

Cd21

703
Q

what receptors does HIV use

A

CD4, CXCR4, CCR5

704
Q

what receptors does rabies use

A

nicotinic AchR

705
Q

what receptors do rhino virus use

A

ICAM-1

706
Q

cause of fatal diarrhea in children- family and name

A

rotavirus and reovirus

707
Q

causes enteritis and anterior horn paralysis

A

poliovirus-picorna

708
Q

aseptic meningitis

A

echo, picorna

709
Q

causes the common cold

A

rhino picorna

710
Q

aseptic meningitis, ulcers on the soft palate and hangs, myocarditis, pericarditis

A

coxsackievirus, picorna

711
Q

acute viral hepatitis

A

picorna HAV- RNA virus

712
Q

causes hepatitis in pregnant indian women

A

HEV- hepevirus

713
Q

viral gastroenteritis with vomitting and diarrhea on a cruise ship

A

norovirus calcivirus

714
Q

causes chronic hepatitis from sex and IV drugs- and why is it highly variable

A

it has no 3’-5’ exonuclease activity- flat- HCV

715
Q

what mosquito give the virus that has black vomit

A

aedes and it is yellow fever-flavi

716
Q

what mosquito carries fever rtetroorbital pain, joint and bone pain, and can have worse symptoms with reinfection because of increased immune response

A

aegypti- Dengue- flavi

717
Q

birds are the resovoir for this with humans as the dead end host, and can have a high fever and flu like illness that becomes neurological in 10% of cases with paralysis

A

WNV- flavi

718
Q

what are the retroviruses

A

HTLV and HIV

719
Q

what are the corona viruses

A

common cold and SARs and MERS

720
Q

what is the orthomyxovirus and its special property

A

flu segments

721
Q

croup, bronchiolitis in babies, and measles, and mumps- virus, family and specific names of the first two

A

paramyxo- parainfluenza and RSV

722
Q

what are the viruses under filovirus

A

marburg and ebola

723
Q

what are the arena viruses

A

LCMV and Lass

724
Q

what are the bunyaviruses

A

california encephalitits, crimean congo, hantavirus

725
Q

how is the hanta virus spread and what does it cause

A

hemorrhagic gever wit hpulmonary edema from rat urine

726
Q

what is the only virus in the delta family and what does it need to replicate

A

HDV and HBV

727
Q

what must negative RNA viruses bring

A

RNA dependent RNA polymerase

728
Q

which are the segmented viruses

A

bunya, orthomyxo, arena, reo

729
Q

what cells can be seen in a yellow fever infection

A

councilman bodies which are eosinophilic apoptotic globules on the liver biopsy

730
Q

winter daycare diarrhea with blunted villi and lose NA and K

A

rotavirus

731
Q

what are the two special proteins for the flu and what do they promote

A

hemagglutinin- promotes viral entry, and neuraminidase promotes progeny vision release

732
Q

what is the greatest mortality risk with the flu

A

superinfection of the lungs with s.aureus, s pneuma, and hflu

733
Q

what is genetic or antigenic shift

A

reassortment of the viral genome segments so that it can cause a pandemic

734
Q

genetic drift/antigenic drift

A

causes epidemics from mutation in hemagglutinin or neuraminidase

735
Q

H5N1

A

bird flu- only bird to human currently- gives URI with some GI features

736
Q

H1N1

A

swine flue which is 2 swine, 1 bird and 1 human flu plus Gi

737
Q

fever, postauricular, and lymphadenopathy with fine confluent rash that starts on the face and spreasds out with arthralgia- wha is the disease and what can congenital infection cause- name and family name

A

togavirus rubella- maternal infection si a lowgrade fever wit hrash and women get arthralgia but the child gets sensorineural deafness, cataracts, and a PDA with a blueberry muffin rash from dermal extra medullary hematopoesis

738
Q

seal bark cough and steeple on CXR

A

parainfluenza virus

739
Q

what do the paramyxoviruses contain

A

they form syncitia from a surface fusion protein which causes respiratory epithelial cells to fuse and form multinucleate cells

740
Q

palivizumab

A

monoclonal antibody against F protein which his used to prevent pneumonia in at risk premature infacts

741
Q

what are the common summer viruses

A

enterovirus and WNV

742
Q

what are the common winter viruses

A

RSV, rotavirus, flu

743
Q

Cough, Coryza, and conjunctivitis, Koplik spots are seen which are red spots on blue which center on the gums followed by a rash that starts at head and goes downward. There is giant cells whcich are fused lymphocytes. The rash coalesces- what vitamin should you give, long term outcome, what is the virus and family

A

measles- rubeola- paramyxovirus- subacute scelrosing pancencephalitis, giant cell pneumonia, give vitamin A

744
Q

parotitis, orchitis, aseptic meningitis, and pancreatitis- virus and family

A

mumps and paramyxo

745
Q

bullet shaped virus, negri bodies, pukinje cells of the hippocampus and cerebellum, variable incubation based on retrograde axonal transport through nicotinic receptors- fever, malaise, agitation, photophobia, hydrophobia, increased salivation, and paralysis, coma death- what animals is it from and what is it

A

rabies, from skunk, bat, raccoon

746
Q

targets endothelial cells, phagocytes, hepatocytes, and has an incubation period of 21 days, abrupt flu, diarrhea, vomiting, diarrhea, high fever, DIC hemorrhage shock- transmission, and virus and family

A

ebola virus, from fomites, secretions, bats, monkeys, filovirus

747
Q

what does HBV cause that allows it to progress to hepatocellular carcinoma

A

p53 mutation

748
Q

what is the highest risk of being a carrier for HBV

A

vertical transmission

749
Q

how can you get HAV

A

shellfish, fecal oral, tavelers, day care

750
Q

what is the worse prognosis for HDV

A

superinfection which is a quick seccession infection

751
Q

what does HBV have an increased risk for besides cancer

A

polyarteritis nodosa

752
Q

what are the HBV markers for acute HBV

A

+HBsAg, and HBeAg with IgM

753
Q

what are the HBV markers for windo

A

only anti-Hbe

754
Q

what are the HBV markers for chronic HBV high infectivity

A

HbsAg, and HbeAg with IgG

755
Q

what are the HBV markers for chronic hBV low infectivity

A

HBsAg, AntiHbe IgG

756
Q

what are the HBV markers for recovery

A

Anti-Hbs and AntiHbe

757
Q

what are the HBV markers for immunized

A

Anti-Hbs

758
Q

what is the env for in HIV

A

gp120 which is for attachment to T cells and p41 which is for fusion and entry

759
Q

what are the gag proteins in HIV

A

p24 and p17 which are capsid and matrix proteins

760
Q

what are the pol proteins in HIV

A

reverse transcriptase and integrate which can become resistant in long term HAART therapy- these are used to integrate into the host genome

761
Q

if you are hetero for a CCR5 mutation or homo for CCR5

A

hetero is slower course and homo is immunity-

762
Q

what is the standard HIV test

A

ELISA which is sensitive but wester blot which is specific after but this does not quickly detect infection

763
Q

quicker HIV test

A
  • test for antigen before antibody is being produced
764
Q

what does the acute phase of HIV feel like

A

flu

765
Q

what does latent HIV feel like

A

nothing

766
Q

when do you start getting hIV symptoms

A

CD4<400

767
Q

what are the common HIV diseases with CD4<500

A

candida oral, EBV oral hairy leuko, cherry red angiomatosis (bartonell henselae), kaposi, cryptosporidium diarrhea, or HPV

768
Q

CD4<200 illnesses HIV

A

HIV dementia (see microgliosis), JC reactivation (nonenhancing lesion), PJP ground glass

769
Q

what is the prophylaxis for PJP

A

TMP-SMX

770
Q

CD4<100 illnesses HIV

A

aspergillus (cavitary lesions), cryptococcus, candida esophagitis, CMV retinitis (cheese pizza used gancylcovir), B cell lymphoma (solitary ring enhancing lesion), histoplasma (oval yeast in macrophages, fever, weight loss, fatigue, cough, dyspnea, nausea, vomitting), MAC, too (multiple ring enhancing lesions)

771
Q

prophylaxis at CD$<200

A

PJP- TMP-SMX

772
Q

prophylaxis at CD4<100

A

toxo- TMP-SMX

773
Q

prophylaxis at CD4<50

A

MAC so azithro once a week

774
Q

rapidly progressive dementia what are all the causes

A

CJD- from prions which are abnormal aggregates of beta pleated sheets, mad cow which is mainly England, kuru, dura mater transplant

775
Q

normal flora of the skin

A

s epidermidis

776
Q

normla flora and colonized of the nose

A

staph epi and s aureus

777
Q

normal flora of the oropharynx

A

viridans strep

778
Q

normal flora of the dental plaque

A

s mutans

779
Q

normal flora of the colon

A

bacteriodes fragilis and ecoli

780
Q

normal flora of the vagina

A

lactobacillus, ecoli, and bstrep

781
Q

food poisoning- rice

A

b. cerus

782
Q

food poisoning- canned foods or honey

A

botulism

783
Q

food poisoning- reheated meat

A

perfringens- transiet watery diarrhea, delayed onset from spores germination

784
Q

food poisoning- undercooked meat

A

ecoli O157H7

785
Q

food poisoning-poultry, meat, and eggs

A

salmonella

786
Q

food poisoning- meats, mayo, custard

A

s.aureus- preformed toxin

787
Q

food poisoning- contaminated seafood

A

HAV if some hepatitis, or vibe parahemoylticus and vulnificans

788
Q

bloody diarrhea- s shaped or comma shaped

A

campylobacter

789
Q

bloody diarrhea- liver abscess with anchovy paste

A

entomeabea histolytica

790
Q

bloody diarrhea- with hemolytic uremic syndrome

A

ecoli 157H7

791
Q

bloody diarrhea- invades colonic mucosa and from fecal contamination

A

ETEC

792
Q

bloody diarrhea- lactose negative, flagella, poultry and eggs

A

sallmonella

793
Q

bloody diarrhea- lactose neg, very low dose needed, can cause hemolytic uremic syndrome

A

shigella

794
Q

bloody diarrhea- pseudoapendicitis, puppy or pet wit hdiarrhea

A

yersinia enteroclitica

795
Q

watery diarrhea- pseudomembranous colitis, clindamycin or ampicillin can be some blood

A

c diff

796
Q

watery diarrhea- from contaminated water while traveling

A

has heat stabile an heat labile toxin- icily travelers

797
Q

watery diarrhea- from 2 protozoa

A

giardia and cryptosporidium

798
Q

watery diarrhea- comma shaped with watery stool can be from seafood

A

cholera

799
Q

watery diarrhea- viral causes (3)

A

rotavirus, norovirus, adenovirus

800
Q

what are the common causes of pneumonia-neonate

A

group B strep, ecoli

801
Q

what are the common causes of pneumonia- children

A

RSV, mycoplasma, c, trachomatis, c oenumo, s pneumo,

802
Q

what are the common causes of pneumonia- adults 18-40

A

mycoplasma, c penumo, s pneumo, flu

803
Q

what are the common causes of penumo- adults 40-65

A

s pneumo, h flu, anearobes

804
Q

what are the common causes of pneumonia- elderly

A

s pneumo, flu, anearobes, flu, gram neg rods

805
Q

what are the common causes of pneumonia- alcoholic

A

klebsiella or anaerobes

806
Q

what are the common causes of pneumonia- IV drugs

A

s penumo or s aureus

807
Q

what are the common causes of pneumonia-aspiration

A

anearobes

808
Q

what are the common causes of pneumonia- atypical

A

mycoplasma, legionella, chlamydia

809
Q

what are the common causes of pneumonia-CF

A

pseudomonas, s aureus, s penumo, burkholdera

810
Q

what are the common causes of pneumonia-immunocompromised

A

s aureus, enteric gram neg rods, gundi, viruses, PJP

811
Q

what are the common causes of pneumonia- nosocomial

A

s aureus, pseudomonas

812
Q

what are the common causes of pneumonia-postviral

A

s pneumo, s aureus, h flu

813
Q

what are the common causes of meningitis in- newborn

A

group B strep, ecoli, listeria

814
Q

what are the common causes of meningitis in- children 6mo-6yr

A

s pneumo, n meningitis, hflu, enterovirus

815
Q

what are the common causes of meningitis in- children 6-60 year

A

s penumo, n meingitits, enterovirus, HSV

816
Q

what are the common causes of meningitis in- over 60 years

A

s pneumo, gram neg rods, listeria

817
Q

why does ceftriaxone not cover listeria

A

altered PBP binding protein

818
Q

meningitis- gram positive diplococci

A

strep pneumo

819
Q

meningitis- gram negative dilpo cocci

A

neisseria meningitis

820
Q

meningitis- gram negative coccobacilli

A

h flu

821
Q

what is the flow of infection in neisseria meningitidis

A

pharynx, blood, choroid plexus, then meninges

822
Q

what are the most common infection leading to brain abscess

A

strep viridans, s aureus, and usually from a dental infection like abscess,

823
Q

what is the cause of osteomyelitis in- normal people

A

staph aureus

824
Q

what is the cause of osteomyelitis in- sexually active

A

neusseria gonorhea but septic is still more common

825
Q

what is the cause of osteomyelitis in- sickle cell disease

A

salmonella

826
Q

what is the cause of osteomyelitis in- prostethis joint replacement

A

staph aureus or epidermidis

827
Q

what is the cause of osteomyelitis in- vertebral involement

A

staph aureus, TB

828
Q

what is the cause of osteomyelitis in-cat and dog bites

A

pasturella

829
Q

what is the cause of osteomyelitis in-IV drug abuse

A

pseudomonas, candida, staph aureus

830
Q

childhood rashes-oval shaped vesicles on palms and soles and oral mucosa

A

coxsackie A- hand foot and mouth

831
Q

childhood rashes- asymptomatic rose colored merciless on the body with high fever, febrile seizures and infants

A

HHV6- roseola

832
Q

childhood rashes-begins at his and moves down, rash is proceed by cough, coryza, conjunctivitis and Koplik spots

A

roseola

833
Q

childhood rashes-erythematous, sandpaper rash, fever and sore throat

A

scarlet fever, and strep pyogenes

834
Q

childhood rashes- vesicular rash begins on trunk, spreads to face and extremities with lesions of different stages

A

varicella zoster

835
Q

nosocomial infection: antibiotic use

A

c diff- disrupt cell membrane- need gloves and gown

836
Q

nosocomial infection: aspiration secondary to altered mental status or old age

A

polymicrobial gram negative bactera-

837
Q

what lobe is affected with aspiration pneumonia if laying down

A

right middle lobe

838
Q

what lobe is affected with aspiration pneumonia if sitting up

A

right upper lobe

839
Q

nosocomial infection: decubitus ulcers, surgical wounds and drains

A

staph aureus and anearobes-erythema tenderness, induration and drainage from surgical site

840
Q

nosocomial infection: intravascular catheters

A

staph aureus, staph epi, enterobacter or pseudo

841
Q

nosocomial infection:mechanical ventilation, endotracehal tube

A

pseudomonas, kleb, acinetobacter, s aureus- sputum with sweet odor

842
Q

nosocomial infection: renal dialysis unti needlestick

A

HBV

843
Q

nosocomial infection:urinary catheterization

A

ecoli, kleb, proteus- dusuria, leukocytosis, flank pain, costovertebral angle tenderness

844
Q

nosocomial infection: water aerosols

A

legionella, signs of pneumonia, GI nausea vomiting, neurologic abnormalities

845
Q

what meningitis microbe colonizes the nasopharynx

A

h flu

846
Q

asplenic patient with infection

A

s pneumo, h flu, n meninges

847
Q

branching rods in oral infection with sulfur granules

A

actinomyces

848
Q

chronic granulomatous disease- infection

A

catalase postive organism like s aureus

849
Q

currant jelly sputum

A

klebsiella

850
Q

dog or cat bite

A

pasturella

851
Q

facial nerve palsy

A

lyme disease

852
Q

fungal infection of diabetic or immunocompromised

A

muco or rhizopus

853
Q

heath care provider needlestick

A

HBV

854
Q

neutropenic patent with fungal infection

A

candida or aspergillus

855
Q

organ transplant recpient infection

A

CMV

856
Q

PAS positive

A

tropheryma whipplei

857
Q

pediatric infection of epiglotitis

A

h flu

858
Q

pneumonia in cystic fibrosis or burn patient

A

pseudomonas

859
Q

pus, empyema, and abscess

A

staph aureus

860
Q

rash on hands and feet

A

coxsackie A, treponema pallidum, rickettsia rickettsii

861
Q

sepsis/meingitis in newborn

A

group B strep

862
Q

surgical wound infection

A

staph aureus

863
Q

traumatic open wound

A

clostridium perfringens

864
Q

what is TB prophylaxis

A

isoniazid

865
Q

what is TB treatment

A

rifampin, isoniazid, pyrazinamide, ethambutol

866
Q

whats prophylaxis for MAC

A

azirhtomycin

867
Q

what is the treatment for leprosy

A

dapsone, rifampin, and sometimes clofazimine

868
Q

zero order elimination

A

rate of elimination is constant regardless of Cp.

869
Q

what are the examples of zero order elimination

A

phenytoin, ethanol and aspirin

870
Q

what is first order elimination

A

rate of elimination is directly proportional to the drug concentration. Constant fraction of drug eliminated per unit time. It applies to most drugs

871
Q

weak acids are trapped in the urine with what? and what are drug examples of this

A

trapped with bicarb. It is phenobarbitol, methotrexate, and aspirin

872
Q

weak bases are trapped in the urine with what and what are the drug examples

A

it is trapped with ammonium chloride and it is amphetamines, TCAs

873
Q

What are the reactions of Phase 1 metabolism

A

reduction, oxidation, hydrolysis with P450

874
Q

what kind of metabolites does phase 1 reactions produce

A

still somewhat active metabolites

875
Q

what kind of metabolites does phase 2 reactions produce

A

methylation, glucordination, acetylation, sulfonation

876
Q

what kind of metabolites does Phase 2 reactions produce

A

inactive metabolites

877
Q

what patients have increased drug side effects

A

decreased metabolism because of slow acetylation

878
Q

what is efficacy

A

maximal effect a drug can produce. Unrelated to potency. It is basically the Vmax

879
Q

what is the change in efficacy for a full agonist and partial agonist

A

The partial agonist has decreased efficacy

880
Q

what is potency

A

amount of drug needed for a given effect. It is represented by EC50 which is the Km.

881
Q

As the EC50 decreases, the potency does what

A

increases because you don’t have yo give as much drug

882
Q

what is the therapeutic index

A

it is the median toxic dose over the median effective dose

883
Q

what drugs have a low therapeutic index

A

seizure drugs, digoxin, warfarin, lithium, theophylline

884
Q

What are nicotinic Ach receptors- what is the type of receptor and where are they found

A

it is a ligand gated Na/K channels. They are on autonomic ganglia and NMJ and skeletal muscle.

885
Q

What are the muscarinic Ach receptors- what type of receptor are they and where are they found

A

G protein coupled receptors and usually act through second messengers. They are found in heart, smooth muscle, brain, exocrine glands, and on sweat glands

886
Q

Left axis deviation of the heart

A

inferior wall MI, left anterior fasicular block, left ventricular hypertrophy, LBBB

887
Q

right axis deviation of the heart

A

right ventricular hypertrophy, acute right heart strain like a PE, left posterior fasicular block, RBBB

888
Q

if T wave is peaked

A

hyperkalemia

889
Q

flat T wave

A

decreased K

890
Q

U wave

A

depolarization of papillary muscle- increased Ca or decreased K

891
Q

what induces torsades

A

class Ia and III antiarrythmics, macrocodes, haloperidol, TCAs, ondansetron, decreased K and MG

892
Q

how to treat torsades

A

magnesium sulfate

893
Q

Romano Ward syndrom

A

AD- cardiac defect in ion channels leadsing to spontaenous torsades and surdden cardiac death

894
Q

Jervell and LAnge Neilsen syndrome

A

dfeective K channel leads to tornadoes risk and long QT with deafness

895
Q

Brugada

A

Asian makes AD with pseudo RBBB and ST elevations with increased risk of tach and SCD.

896
Q

WPW

A

abnormal accessory pathway in the atria to ventricle to the bundle of Kent and it bypasses the AV node leading to ventricles begin to partially deploy earlier and shortened PR interval- SVT

897
Q

carotid sinus what nerves does it use

A

afferent is glossopharyngeal and efferent is vagus

898
Q

arotic receptors what nerves does it use

A

both are vagu

899
Q

ANP does waht

A

increase in response to increased blood volume and causes diuresis through decreased NA absorption at CT and constrict efferent and dilated afferent to increase GFR.

900
Q

what increases the effect of ANP

A

neprilysin stops its degradation

901
Q

BNP does what

A

it is in response to tension and it is the test for heart failure

902
Q

what is the reaction of the carotid to decreased BP

A

firing decreases and decreased PNS and increased SNS so increased a1 and B1 to increased BP and HR

903
Q

what is the reaction to increased BP

A

increased firing so increased PNS tone through the vague and glossopharyngeal

904
Q

what are the drivers of the central chemoreceptors

A

PCO2 and pH

905
Q

what are the drivers of peripheral chemoreceptors

A

PCO2, PO2, and Ph

906
Q

what happens to chemoreception in COPD

A

there is blunted response to Pco2 and so O2 decreasing becomes the driver of breathing response so it becomes the responsibility of the peripheral chemoreceptors

907
Q

ASD murmur

A

wide fixed split S2 and flow over RH

908
Q

congential rubella heart issue

A

PDA or pulmonary stenosis

909
Q

down heart defect

A

endocardial cushion defect

910
Q

marfan heart issue

A

myoxmatous degeneration of the media of vessels. MVP, thoracic aortic aneurysm, dissection, aortic regurg

911
Q

turner heart issues

A

bicuspid aortic valve, coarctation of the aorta

912
Q

Williams heart issues

A

supravalvular aortic stenosis

913
Q

Digeorge syndrome heart issue

A

truncus or get of Fallot

914
Q

which vessels are hit first with atheroscelrosis

A

abdominal aorta, coronary vessels, popliteal and carotid

915
Q

medial calcific scelrosis

A

calcified internal elastic lamina and media of arteries still but not obstructed looks like a pipestem

916
Q

what areas are more effects by atherosscelorsis and why

A

low flow areas near branch points because there is more accumulation

917
Q

pathogenesis of atheroscelorsis

A

endotherlila dysfunction, macrophage and LDL accumulation, foam cells, fatty streak, smooth muscle migration proliferation and em deposition, fibrous plaque, complex atheroma

918
Q

traumatic aortic rupture

A

deceleration injury near the aortic isthmus in proximal descending aorta distal to the left subclavian because of insertion of a tendon there

919
Q

standford A aortic dissection

A

ascending aorta, near sinotubular junction, aortic regard and tamp anode with valvular issues- surgery

920
Q

stanford B aortic dissection

A

descending aorta and arctic arch by left subclavian treat with beta blockers

921
Q

what things can cause prinzmetal angina

A

can be secondary to spasm- smoke, coke, triptans

922
Q

coronary steal syndrome

A

distal to cornoary stenossis, vessels are dilated and if give dilators then the already dilated vessels in well perused areas get blood furthering the ischemia of the necrotic tissue

923
Q

chronic ischemia of the heart can lead to

A

HF

924
Q

STEMI is what

A

full wall thickness- st elevation

925
Q

NSTEMI

A

only subendocardial ischemia with ST depression

Step1 (9 decks)

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