U world Flashcards
(470 cards)
0
Q
What causes gray vaginal discharge?
A
-garnerella vaginalis
1
Q
Big black spots on the skin in a neutropenic pt?
A
-ecthyma gangrenosum caused by pseudo aeruginosa
2
Q
What is “clasp knife spasticity?” What is it a sign of? Where can the lesion be (6)?
A
- resistance and then a sudden release when maximum extension of a limb is achieved
- it is the result of an upper motor neuron injury
- lesions can occur:
1. Corticospinal tract
2. medulla
3. pons
4. midbrain
5. internal capsule
6. precentral gyrus (primary motor cortex)
3
Q
What are 4 main differences of colon cancer arising from inflammatory bowel disease v sporadic colorectal cancer?
A
- More likely to arrise from non-polypoid dysplastic lesions
- Be multifocal in nature
- Develop early p53 and late APC mutations (sporadic = “AK53”)
- Be of higher histological grade
4
Q
What drug is used as prophylaxis for mycobacterium avium in HIV ots?
A
-azithromycin
5
Q
What do auer rods stain for?
A
-peroxidase
6
Q
Sequence of hepatitis B replication?
A
-ds DNA –> template +RNA –> progeny ds DNA
7
Q
Biliary colic: what is it? Pathogenesis? Ssx?
A
- opioid analgesics can cause contraction of the smooth m in the sphincter of oddi –> causes increased pressures in the bile duct and gall bladder
- ssx: severe pain and cramping in the right upper abdomen, jaundice can occur in more severe cases
8
Q
Name 3 beta-lactamase inhibitros, what is their function?
A
- Clavulanic acid
- Sulbactam
- Tazobactam
- they inhibit beta-lactamase & are given with penicillins to extend their spectrum
9
Q
What does aldose reductase normally do?
A
- converts glucose to sorbitol
- sorbitol is then metabolized to fructose by sorbitol dehydrogenase
10
Q
What is lipofuscin? When is it commonly seen?
A
- the product of lipid peroxidation
- accumulates in aging cells normally
11
Q
When is extramedulary hematopoiesis usually seen?
A
- with severe chronic hemolytic anemias
- ex. Beta thal
12
Q
What disease are antibodies to citrullinated peptides seen in?
A
-RA
13
Q
What are the biochemical abnormalities seen in alzheimers?
A
-decreased acetylcholine levels in the hippocampus and nucleus basalis of meynert
14
Q
What embryologic layer is the posterior pituitary formed from?
A
-neural tube
15
Q
Which of the anti TB drugs requires an acidic envi? What does that mean?
A
- pyrazinamide
- that means that it works well at targeting the intracellular mycobacteria, but has little effect on the extracellular bacteria
16
Q
Where should a biopsy for hirschsprung disease be taken from?
A
-the submucosa of the narrowed area bc this is the most superficial are where the absence of ganglion cells can be seen
17
Q
What test is diagnositc for meckle’s diververticulum?
A
- 99mmTc-pertecnetate scan = detects presence of gastric mucosa
- accumulation of gastric mucosa in the right lower abdominal quadrant = diagnostic of meckel’s!!
18
Q
What is the pathogenesis for megaloblastic anemia seen in chronic alcoholics?
A
-due to nutritional deficiency of folate –> impairs synthesis of purine and pyrimidine bases
19
Q
What is affected more in diffusion-limited states, O2 or CO2? Why?
A
-O2 is affected more, bc the diffusion capacity of CO2 across the respiratory membrane is 20x greater than that of oxygen, so when there is a diffusion problem O2 suffers more!
20
Q
Which quadrant if an injection is given in it can injury the sciatic n?
A
-inferiormedial quadrant
21
Q
What can be seen in a liver biopsy of the majority of sarcoidosis ots?
A
-scattered granulomas
22
Q
What are clue cells? When are they usually seen?
A
- squamous epithelia cells covered in bacterial organisms
- seen in gardnerella vaginalis
23
Q
What can cause a release of ANP by the ventricles?
A
- hypertrophy of the heart
- normally ANP is released by the atria
24
What exposures are linked to bladder cancer?
1. Tobacco smoke
| 2. Occupational exposures = rubber, aromatic amine-containing dyes, textiles, leather, etc
25
In what disease do you see antibodies against the alpha-3-chain of type IV collagen?
- goodpastures syndrome
| - remember BM is made up of type IV collagen
26
Which embryonic layer is the anterior pituitary (rathske's pouch) formed from?
-surface ectoderm
27
What embryological structure(s) are maldeveloped in DiGerorge syndrome?
-third and fourth brachial (pharyngeal) pouches
28
How can an S3 heart sound be accentuated in a patient? Why?
- have the pt lie on their left and fully exhale
| - exhaling decreases the volume of the lungs and brings the heart closer to the chest wall
29
What are the three most common cancers in women? What are the three cancers that cause the most death in women? Rank them!
```
Most common occurrence:
1. Breast
2. Lung
3. Colon
Most common deaths:
1. Lung
2. Breast
3. Colon
```
30
What muscles does the superior laryngeal nerve supply? When it is at risk for injury and why?
- cricothyroid m
| - at risk for injury during thryroidectomies bc close to superior thyroid a and v
31
What do arteriovenous concentration gradients tell you about an inhaled anesthetic? What does a high gradient mean?
- reflects the solubility of the anesthetic in the tissue
| - high gradient = high solubility = slow onset of action
32
What is the cause of a direct inguinal hernia?
-weakness of the transversalis fascia
33
What does "highly" or "poorly" selective proteinuria mean? What type is minimal change disease?
- refers to the ratio of low-to-high molecular weight proteins in the urine
- minimal change disease is highly selective since mostly only low-molecular weight proteins, such as albumin, are found in the urine
34
Which 3 foods are associated with staph aureus?
1. Custard
2. Mayo
3. Processed or salted meats
35
Recurrent abdominal pain, hepatomegaly, and pancreatic calcifications suggests what?
-ethanol abuse
36
What makes up HbF?
-2 alphas and 2 gammas
37
What 3 gene mutaions are associated with early onset Alzheimer's (<60 yrs)?
1. Amyloid precursor protein (APP) on chromosome 21
2. Presenilin 1 gene on chromosome 14
3. Presenilin 2 on chromosome 1
38
What food is associated with HUS?
- undercooked contaminated ground beef
| - EHEC 0157:H7
39
Name 4 dopamine agonists
1. Bromocriptine
2. Pergolide
3. Pramipexole
4. Ropinerole
40
Which quadrant of the dupa should be avoided when giving an injection and why?
-the superiormedial quadrant bc the superior gluteal n
41
What is the most common type of renal cancer and where does it usually metastasize to?
- clear cell carcinoma
| - most common mets to lungs, then bone
42
What muscles does the recurrent laryngeal supply?
-all laryngeal mm but the cricothyroid m
43
What causes the clinical manifestations in fragile X syndrome?
-hypermethylation of the FMR1 gene due to the CGG trinucleotide repeats
44
What are two manifestations of c. Perfringens?
1. Late-onset food poisoning w/ transient watery diarrhea
| 2. Clostridial myonecrosis (gas gangrene)
45
What is a ghon complex and when is it seen?
-consists of a lower lung lesion (= ghon focus) + an ipsilateral hilar adenopathy
46
What gene mutation is associated with late-onset Alzheimer's dz?
-apolipoprotien E4
47
Which drug combo can increase the risk of gallstone formation?
-gemfibrozil + cholestyramine
48
Golgi tendon organs
- located at the junction of the muscle and tendon
- relatively insensitive to changes in muscle length due to passive stretching, but very sensitive to muscle tension
- when a muscle exerts too much force the GTO will inhibit contraction of e muscle and cause a sudden muscle relaxation --> prevents damage to the musculoskeletal system
49
Which quadrant of the dupa is the safest to give an injection?
-the superiorlateral
50
What is the replication sequence for retroviruses?
- ex. HIV
| - single stranded +RNA --> template ds DNA --> progeny ss +RNA
51
What is the Hb and MCV in megaloblastic anemia?
-low Hb and high MCV
52
What accumulates in patients who receive repeated blood transfusions?
-hemosiderin
53
What drugs can be given to help with urge incontinence?
-antimuscurinics = block M3 receptors
54
What is claudication a sign of?
- atherosclerosis of larger, named arteries
| - caused by lipid-filled intimal plaques that bulge into the arterial lumen
55
What will K be if delta G is negative? Positive? Zero?
- negative delta G --> K > 1
- positive delta G --> K < 1
- delta G = 0 --> K = 1
56
Antidote to arsenic poisoning? MOA?
- dimercaprol
| - displaces arsenic ions from sulfhydryl groups of enzymes and increases their excretion
57
An infection with what is strongly associated with gullian-barre?
-campylobacter jejuni
58
What markers are found in small cell carcinoma of the lungs?
- neuroendocrine markers --> they are neuroendocrine in origin (secrete hormone-like substances)
- contain neurosecretory granules in their cytoplasm
59
If the hypothalamus was knocked out, what hormone would increase and why?
-prolactin, bc dopamine produced by the hypothalamus normally inhibits prolactin
60
What is the best treatment for TCA-associated cardiac abnormalities?
-sodium bicarbonate, it can correct QRS prolongation, reverse hypotension, and treat ventricular dyrhythmias
61
What is the empty can test done for?
-testing for injuries in the supraspinatus m.
62
What is the "on-off" phenomenon?
- characteristic in advanced Parkinson's dz
- its unpredictable and dose-independent
- it is a sudden loss of the anti-Parkinsonian effects of levodopa --> hypokinesia and rigidity
- "on" period usually occurs when the pt takes meds and the pt feels fine
- "off" period is usually a while after the drug was taken &the levels of the drug have dropped --> causes sx that are worse than if the pt never took any meds
- this effect is minimized if the dose of the meds are kelt constant
63
Which lipid lowering drug can exacerbate gout?
-niacin
64
What is the best drug that can be used as an alternative to aspirin as an antiplatelet drug? What's its MOA?
- clopidogrel can be used
- MOA: irreversibly blocks platelet surface ADP receptors that are necessary for platelet activation, aggregation, and fibrin binding
* *synergistic when used with aspirin!
65
Graft-versus-host transplant rejection: pathogenesis
- the donor WBCs get transplanted with the tissue and attack the recipient
- T cells proliferate & reject the host
- causes severe organ dysfunction
- most commonly seen with bone marrow or liver transplants
* *potentially beneficial in bone marrow transplants!!
66
Cryptococcus neoformans: lab features?
- stains with india ink
- has very thick capsule
- non dimporphic yeast
67
Bug that most commonly causes endocarditis in IV drug users?
-staph aureus
68
Sumatriptan: MOA
- 5-HT agonist --> stimulates serotonin receptors
- inhibits trigeminal nerve activation --> prevents vasoactive peptide release --> so, causes vasoconstriction!
- half life is < 2 hrs (so taken symptomstically)
69
How is the carrier status of sickle cell anemia determined?
- through a hemoglobin electrophoresis
| - HbS moves more slowly on the gel bc of the loss negatively charged glutamate
70
What is a good marker to measure in cirrhotic patients that are at risk for hepatocellular carcinoma? What do the levels tell you?
- alpha-fetoprotein
- this marker does not correlate well with size, stage, or prognosis of HCC
- an AFP > 500 mcg/L can be diagnostic for HCC
71
Acute transplant rejection: features
-vasculitis of graft vessels w/ dense interstitial lymphocytic infiltrate
72
What is the rule of 10s for pheochromocytomas? (4)
1. 10% are bilateral
2. 10% are extra-adrenal
3. 10% are benign
4. 10% are part of hereditary syndromes (ex. MEN 2A, MEN 2B, and von Hippel Lindau dz)
73
Rituximab: MOA
-monoclonal antibody against CD20 = found on most B-cell neoplasms
74
Thiopental: MOA & clinical uses
- barbiturate
- general anesthetic given IV, used for induction of anesthesia
- increases GABAs action by ^^ the duration of the Cl- channel being open --> vv neuron firing
- after thiopental equilibrates in the brain it rapidly redistributes to the skeletal m and adipose tissue = rapid recovery from the anesthesia!
75
Isonizid: clinical uses
- M. TB
| - the ONLY TB drug that is used as a solo agent for prophylaxis against TB
76
What 3 types of cancer is EBV associated with an increased risk for?
1. Hodgkin's lymphoma
2. Non-hodgkin's lymphoma
3. Nasopharyngeal carcinoma
77
What happens after iodine enters the follicular cells of the thyroid?
-iodine is oxidized to organic iodide via thyroid peroxidase
78
Ergosterol
- unique to to fungi
- like cholesterol in their membranes
- what amphotericine B binds to
79
Rituximab: Clinical uses
1. non-hodgkins lymphoma
| 2. RA w/ methotrexate
80
3 D's of botulism ssx:
1. Diplopia
2. Dysphagia
3. Dysphonia = trouble speaking
81
Warfarin MOA:
- inhibits vitamin K dependent carboxylation of glutamic acid residues of clotting factors II, VII, IX, X
- causes dysfunctional coagulation proteins to be made
- takes a few days to work bc some of the K dependent clotting factors have longer half lives
- use PT or INR to monitor therapeutic effects
- usually used for long term anti-coag tx
82
What type of bonds hold the primary structure of proteins together? Secondary structure?
- primary = peptide bonds
| - secondary = hydrogen bonds (both alpha-helix and beta-sheets)
83
Reassortment
VIRAL
- when 2 viruses with segmented genomes exchange segments
- high frequency recombination
- can cause worldwide influenza pandemics
84
Central retinal artery occlusion: ssx
- sudden painless, and permanent monocular blindness
| - see pale retina and a "cherry-red" macula on fundoscopic exam
85
Normal pressure hydrocephalus: sx triad
1. Wacky = dementia
2. Wobbly = ataxia
3. Wet = urinary incontinence
86
ACEi's and acute renal failure
- ARF with ACEis can occur in pts that rely on the vasoconstriction of their efferent arterioles to maintain renal perfusion
- this can be seen in pts w/: renal artery stenosis decompensated heart failure, chronic kidney disease, and volume depletion
- vasoconstriction of the efferent (leaving) arterioles is usually stimulated by ang II
- causes decrease in GFR and FF and an increase in creatinine
87
What 3 things are seen in a liver biopsy of ALL cases of acute viral hepatitis?
1. Diffuse ballooning degeneration = hepatocyte swelling
2. Mononuclear cell infiltrates
3. Councilman bodies = eosinophilic apoptotic hepatocytes
88
Hormones that use cGMP
- "think vasodilation!"
- ANP
- NO (EDRF)
89
Hemarthrosis
- bleeding into joint spaces
| - usually due to coagulopathy (ex. Hemophilia A)
90
What is thoracic outlet syndrome?
-disappearance of radial pulse when you move your head to the ipsilateral side of an inferior brachial trunk injury
91
What kind of metabolic acidosis does lactic acidosis cause? Pathogenesis? One cause of this?
- causes anion-gap metabolic acidosis
- due to overproduction and/or impaired clearance of lactic acid
- septic shock can cause lactic acidosis --> tissue hypoxia decreases oxidative phosphorylation --> causes shunting of pyruvate to lactate after glycolysis = increase in lactic acid formation + the hypoxia = hepatic hypoperfusion, and since the liver is the main side of lactate clearance = build up of lactic acidosis!!
92
What is the pathology of prion disease?
- the prion protein is normally found in neurons and has an alpha-helical structure --> susceptible to proteases
- dz causes conversion of the alpha-helixes to beta-pleated sheets --> RESISTANT to proteases = build up in gray matter --> spongiform change
- see vacuoles and w/in the cyto of neurons and neutrophils that grow lgr and become cysts
93
What drugs can cause urinary retention?
1. Anticholinergic medications --> ex. Atropine
| 2. Drugs with anticholinergic effects --> ex. Tricyclic anti-depressants and antihistamines
94
What conditions promote gallstone formation?
1. High cholesterol
2. Low phosphatidylcholine
3. Low levels of bile acids
* *high levels of bile salts and phosphatidylcholine increase cholesterol solubility and decrease the risk of gallstones
95
What does a prolonged bleeding time signify?
- a defect in platelet function
| - can be caused by a qualitative or quantitative defect in platelets
96
Glucokinase
- found in liver and beta cells of pancreas
- has low affinity for glucose
- has high Km
- INDUCED by insulin (insulin DEPENDENT!)
- has high Vmax -->" GLUcokinase is a GLUtton, it has a high Vmax bc it cannot be satisfied"
- will store excess glucose at HIGH concentrations of glucose!
97
Meso-limbic mesocortical pathway: function? Diseases associated?
- regulates behavior
| - associated with schizophrenia
98
What 2 drugs can be used for absence seizures?
1. Ethosuximide
| 2. Valproate --> preferred in pts with combined absence + tonic-clonic seizures
99
What does it mean when the radial pulse disappears when a pt turns their head to one side?
- thoracic outlet syndrom!
| - means that there was an injury to the inferior trunk of the brachial plexus in the IPSILATERAL side!!!!
100
Malignant otitis media: what is it? Who is it commonly seen in? Ssx?
- severe infection seen most commonly in elderly pts
- usually caused by pseudo areuginosa
- ssx: extreme ear pain and drainage + can see granulation tissue in the ear canal
101
Which basic interviewing technique has the physician express concern independent of understanding?
-support
102
What is the most common cause of pharyngitis with generalized lymphadenopathy?
- infectious mononucleosis
| - caused by EBV
103
Bosentan: MOA & clinical use
- MOA: competitive agonist of endothelin receptors --> decreases pulmonary vascular resistance
- used to treat primary (idiopathic) pulmonary arterial HTN
104
What is congo red stain used for?
- staining amyloid deposits
| - they will have apple green birefringence
105
Opsoclonus-myoclonus: what is it? Who is it seen in?
- non-rhythmic conjugate eye mvmnts associated with myoclonus
- seen in young children in association with neuroblastomas
106
Which sensory pathway relays in the lateral geniculate body?
-visual pthwy
107
Acute transplant rejection: when does it happen?
-weeks later
108
Amenorrhea in athletes
- intense exercise regiments can cause a decrease in gonadotropin secretion --> amenorrhea
- this can happen in very thin female athletes that are NOT anorexic!
- ex. Seen in long distance runners
109
CSF in bacterial meningitis
1. elevated opening pressure
2. increased neutrophils
3. elevated protein
4. decreased glucose
110
Use dependence with class I antiarrhythmics
- the channels that are the most active and undergoing depolarization most often are more susceptible to blockage by the drug
- ranking of the the use dependence in sodium channel blockers 1C > 1A > 1B
111
What is a normal variation seen in the hearts of 20-30% of adults?
-patent foramen ovale
112
Which organ is least vulnerable to infarction?
- liver!
| - it has a dual blood supply!
113
Hepatic encephalopathy: what is it? Px?
- reversible decline in neurologic fctn following hepatic damage
- px: liver is not metabolizing the waste products properly so the ammonia builds up in the circulation
114
Which pneumoconioses produces noncaseating granulomas?
-beryllium
115
What do lymphocytes look like in infectious mononucleosis? What makes them different from malignant lymphocytes?
- atypical lymphocytes
- lots of pale blue cytoplasm w/ basophilic rim that is often indented by the surrounding RBCs
* *lots of cyto + lack of bizzare nuclear changes = differentiates these from immature blasts found in hem malignancies
116
What cancer is associated arsenic and polyvinyl chloride exposure?
-liver angiosarcoma
117
Acute tubular necrosis: what is it and what can cause it?
- most common cause of intrinsic renal failure in the US
- causes:
1. Renal ischemia --> due to shock or sepsis = decreased blood flow to kidneys (most common)
2. Crush injury --> due to myoglobinuria
3. Drugs
4. Toxins (ex. Mushrooms, phenol, pesticides, contrast dyes, ethylene glycol, heavy metal, etc.)
118
Mechanism of peripheral neuropathy and cataracts in DM?
- excess glucose is converted to sorbitol via aldose reductase
- sorbitol accumulates within the cells & attracts water into the cells --> osmotic cellular injury
119
What is the MOA of non-selective beta-blockers for tx of glaucoma?
-they decrease the secretion of aqueous humor by the ciliary epithelium
120
Effects of chronic lung transplant rejection?
-immune rxn affects small airways --> causes bronchiolitis obliterans syndrome
121
What are black pigment gallstones associated with?
- chronic extravascular hemolysis --> bc of increased levels of unconjugated bilirubin
- stones are usually small and crumbly
- usually radioopaque
122
Does drug induced lupus cause kidney dz?
-usually no!
123
What class of drugs are contraindicated in porphyria?
-barbituates!!
124
How does degranulation of mast cells occur?
-by the cross-linking of multiple membrane-bound IgE antibodies by a specific antigen --> results in aggregation of IgE-Fc receptors on the mast cell surface --> causes mast cell degranulation
125
What is cryptococcus's morphology?
- only has a yeast form
| - round or oval encapsulated (thick capsule!) cells with narrow-based buds
126
What does a mutation in the FAS protein predispose a pt to?
- prevents the apoptosis of auto-reactive lymphocytes
| - predisposes to developing an autoimmune dz, (ex. Lupus)
127
Pancreatic endocrine tumors
- usually secrete gastrin --> causes recurrent ("untreatable") ulcers = Zollinger-Ellison syndrome
- can also have tumors that secrete insulin (insulinomas), VIP (VIPoma), glucagon (glucagonoma-rare)
128
3 stages of acute tubular necrosis, risks, findings, & prognosis
1. Inciting event
2. Maintenance phase --> OLIGURIA, lasts 1-3 weeks
- risk of HYPERkalemia
- increased BUN and creatinine
- volume overload
- death most often occurs in this phase
3. Recovery phase --> POLYURIC
- BUN and creatinine fall
- risk of HYPOkalemia
* *if pt survives all 3 phases, prognosis is good!
129
What is the most likely outcome in a hepatitis C infection?
-chronic hepatitis (seen in 55-85%) of pts
130
How granulomas form in M. TB
- TH1 activated macs phago the TB, which is indigestible --> mac looses ability to move --> accumulate at the site of injury --> transform into epithelioid cells
- eventually a bunch of these epitheliod cells fuse together = langerhans giant cell! (Nuclei are arranged in an arch around the periphery)
131
Pulmonary anthrax: microscopy
- forms long chains that have a "serpentine" or "medusa head" appearance
- produces an antiphagocytic capsule that has D-glutamate, rather than polysaccharides
132
Which cholesterol medication can cause an increased incidence of cholesterol gallstones? MOA?
- fibrates
- suppress 7 alpha-hydroxylase activity --> reduces the conversion of cholesterol to bile acids --> causes an increase in cholesterol secretion in bile
133
Which sensory pathway goes to the cortex without relaying in the thalami?
Smell
134
Diverticula acquired in adulthood: are they true or false? What is their px?
- they are typically false
- usually caused by increased pressure that causes herniation of the mucosa and submucosa through weak spots in the muscularis layer
- ex. Zenker diverticulum in esophagus & colonic diverticulum
135
Which organisms have peptidoglycans cell walls and which dont?
-DO: gram + and gram -
| DONT: mycoplasma
136
Hormones that use RECEPTOR-associated tyrosine kinase pthwys
PIG:
- Prolactin
- Immunomodulators (ex. Cytokines, IL-2, IL-6, IL-8, IFN)
- GH
137
Chronic transplant rejection: pathogenesis?
-CD 8 T lymphocytes think that the Class I-MHC (nonself)s are actually I-MHC (self)s presenting a nonself antigen --> attack!
138
Congenital toxoplasmosis: classic triad of sx
1. Chorioretinitis = yellow/white fluffy/cotton patches on retinal exam
2. Hydrocephalus
3. Intracellular calcifications
139
Hematocolpos
- accumulation of blood in the vaginal canal
- can be caused by imperforated hymen
- can cause distention of the vagina that can lead to back pain, problems defecation, or problems uriniating
- presentation = vaginal bulge and/or mass palpated anteriorly on rectal exam
140
Where is myeloperoxidase predominately found?
-in neutrophils
141
What portion of the heart is the diaphragmatic surface of the heart? What artery is it supplied by?
- the inferior wall of the left ventricle = diaphragmatic surface of heart
- posterior descending artery supplies this area --> derived from the RIGHT coronary a in most ppl! (But can also be left or co-dominant!)
142
Calcipotriene: MOA? Other drugs like it? Clinical use?
-topical vitamin D analog --> binds to vitamin D receptor --> inhibits keratinocyte proliferation + stimulate keratinocyte differentiation
143
Hexokinase
- ubiquitous
- has high affinity for for glucose --> takes up glucose when the concentrations are low
- has low Km
- low Vmax = easily satisfied
- insulin INDEPENDENT!!
- inhibited by g-6-p via negative feedback
144
Vein used for cardiac bipass when multiple coronary aa, or a cornoary other than the LAD is occluded?
Saphenous v
145
Pancreatic pseudocyst
- complication of pancreatitis
- form when the proteolytic enzymes cause pancreatic secretions to leak into the peripancreatic space --> the fluid causes an inflammatory rxn in the surrounding walls --> granulation tissue forms & encapsulates the fluid
- not a true cyst bc not lined by epithelium
146
Where are the mammillary bodies located in the brain?
-anteriorly (think boobs are on the anterior surface of your body) & inferior to the hypothalmus
147
What heritable disease can cause BOTH and prolonged PTT and prolonged bleeding time?
-von Willebrand dz
148
What are the derivatives of the 3rd aortic arch?
- Common Carotid a and proximal part of the internal Carotid a
* * C is the 3rd letter of the alphabet!
149
What are muscle fasiculations a sign of? UMN or LMN lesions?
-LMN
150
Chronic transplant rejection: features
- irreversible
- T-cell and antibody mediated vascular damage seen = obliterative vascular fibrosis
- see fibrosis of graft tissue and blood vessels
151
What is the length constant?
- AKA space constant
- measure of how far along an axon an electrical impulse can propagate
- increased by myelin
152
What happens during the fasted state in regards to the regulation by F2,6BP?
-^^glucagon --> ^^ cAMP --> ^^ protein kinase A --> ^^ FBPase-2 + vv PFK-2 = LESS glycolysis & more gluconeogenesis
153
Complementation
VIRAL
-when 1 cell has a non functional protein and another cell infects it, which causes the nonfunctional protein to now be functional
154
What is D-xylose used to test for?
- an oral dose is given to differentiate btwn malabsorption caused by pancreatic etiology or mucosal etiology
- d-xylose = monosaccharide --> so doenst need oancreatuc enzymes for absorption
155
What are these sx typical for: "prolonged bleeding after dental extractions and surgeries & spontaneous hemarthroses"? What can be given to cause blood clotting?
- hemophilia!!
- hemophilia A = vv factor VIII
- hemophilia B = vv factor IX
- administering thrombin would result in clotting in both!!
156
Loss of neurons in which region(s) is seen in Huntington's dz?
1. Caudate nucleus --> most
| 2. Putamen --> moderate
157
Estrone
-peripheral estrogen made from aromatization of androstendione
158
C. Diptheria: what is it cultured on? What do the colonies look like? What does the bacteria oroduce and hiw can it be detected on microscopy?
- cultured on cysteine-tellurite agar
- colonies are black
- produces intracellular polyphosphate granules = metachromatic granules --> can be visualized via microscope with methylene blue staining
159
Dactylitis
- painful swelling of hands and feet
- common in YOUNG children with SS (hands and finger bones are still hematopoetic in young)
- ssx: swelling, tenderness, warmth
160
Most common cause of bacterial meningitis in adults of all ages? What does it look like on CSF gram stain? Whos at even higher risk?
- STREP PNEUMO!
- lancet-shaped
- gram positive cocci in pairs
- alcoholics, asplenics, & SC pts are often at even higher risk
161
What receptors does NE effect? Rank them!
Alpha 1 = alpha 2 > beta 1 & No beta 2 or D1!
162
What is the tx for drug-induced parkinsonism?
-anticholinergics --> such as benztropine and trihexyphenidyl
163
What are 2 more specific sx of Graves dz?
1. Infiltrative dermopathy --> ex pretibial myxedema
| 2. Exopthalmos
164
Barbituates: MOA
- increase GABA's action by ^^ duration of the Cl- channel opening --> vv neuron firing
- "barbiDURATes increase the DURATion"
165
What 4 dz is carpal tunnel syndrome commonly associated with?
1. Hypothyroidism
2. DM
3. RA
4. Dialysis associated amyloidosis
166
Pulmonary anthrax: transmission? Sx?
- inhalation of spores from contaminated wool = "woolsorter's dz"
- ssx: flu-like sx that rapidly progress to fever, pulmonary hemorrhage, mediastinitis, & shock
* *mediastinitis = widened mediastinum on x-ray --> KEY FEATURE
167
What is the best test for diagnosing Prinzmetal's angina? MOA?
- ergonovine test
- ergonovine = alkaloid that constricts vascular smooth m by stimulating both alpha-adernergic and serotonin receptors
- low doses induce chest pain in ots with prinzmetal's
168
What 2 ways can toxoplasmosis get transmitted?
1. Cysts in meat or cat feces
| 2. Crosses placenta --> pregnant women should avoid cats!!!
169
Hyperacute transplant rejection: pathogenesis?
- antibody mediated type II HSR
| - due to presence of PREFORMED anti-donor antibodies in the recipient
170
Amphotericin B: sfx (6)
"Amphoterrible"
1. Fever and chills --> common "shake and bake"
2. Hypotension --> reduced with hydration
3. Nephrotox --> check labs often
4. Arrhythmias --> usually due to hypoK and hypoMg, so supplement!!
5. Anemia
6. IV phlebitis = inflammation of IV site
171
Bruton's agammaglobulinemia: defect
- defect in BTK = tyrosine kinase gene
- have no B cell maturation!
- X-linked recessive
- BOYS that are BRUTes are NOT MATURE!"
172
Hereditary angioedema: px? What drugs are contraindicated in these pts?
- C1 esterase deficiency
| - ACEi are contraindicated --> bc increases production of bradykinin, which causes angioedema!
173
Hormones that use cAMP signaling pathways
FLAT ChAMP:
- FSH
- LH
- ACTH
- TSH
- CRH
- hCG
- ADH
- MSH
- PTH
- calcitonin
174
What happens after iodine is oxidized?
-the iodide binds to tyrosine residues that are found within the thyroglobulin --> form mono-or diiodotyrosines (MIT & DIT)
175
Serum levels of what is diagnostic for B12 deficiency? Why?
- methylmalonic acid
- B12 is a cofactor for the enzyme methylmalonyl CoA mutase, which catalyzes the conversion of methylmalonyl CoA into succinyl CoA --> so without the enzyme, you get a build up of methylmalonic acid
176
Hormones that use IP3 signaling pthwys
GOAT
- GH
- Oxytocin
- ADH
- TRH
177
Hemophilia B: whats deficient? What are the ssx?
- AKA christmas disease
- deficient in factor IX
- indistinguishable clinically wit hemophilia B
- have prolonged PTT
- ssx:
1. Intramuscular hemorrhage
2. Hemarthrosis
3. Prolonged bleeding following surgical procedures (ex. Tooth extraction)
- X linked inheritance
178
What is the motor deficit seen with an obturator n injury?
-thigh adduction
179
Which pneumoconioses causes eggshell calcifications of the hilar lymph nodes and bifringement particles surrounded by fibrous tissue on histologic exam?
-silicosis
180
Which pneumoconitis causes accumulations of coal dust-laden macs?
-coal miner's lung!
181
Pilocytic astrocytoma: Tumor marker present? What does it look like grossly? Microscopically?
- GFAP positive
- gross: cystic and solid
- microscopic: rosenthal fibers = eosinophilic, corkscrew fibers
182
What changes in bone structure can be seen in rickets?
-see osteoid matrix accumulation around trabeculae
183
What are the 3 high potency neuroleptics? What do they treat? Sfx?
1. TRifluoperazine
2. FLuphenazine
3. Haloperidol
"TRy to FLy High"
-use: POSITIVE sx of schizophrenia
-sfx: extrapyramidal sx
184
Where is the majority of free water absorbed in the kidney? How is this effected by the pts hydration status?
-the majority of free water (60%) is absorbed in the proximal tubules, NO MATTER WHAT THE HYDRATION STATUS IS!!!
185
What 2 things are classic findings in Alzheimer's dz?
1. Neurofibrillary tangles
| 2. Amyloid plaques
186
What ligament contains the ovarian vessels?
-suspensory ligament
187
Primary pulmonary HTN: px? Ssx?
- px: due to a mutation that inactivates the BMPR2 gene, which normally functions to inhibit vascular smooth m proliferation --> see increased thickening of smooth m of arterioles and fibrosis of the intima
- ssx: typically seen in young women (20-40) with dyspnea and exercise intollerance
- tx: lung transplant and bosentan in the mean time
188
What can the disulfram-like effects of metronidazole cause? What are the clinical uses for metronidiazole?
-when combined with alcohol it can cause a disulfram-like rxn
-used to treat:
1. Giardia
2. Entamoeba
3. Trichomonas
4. Gardnerella vaginalis
5. Anaerobes (bacteriodes, c. Diff)
6. h. Pylori (w/ ppi for triple tx)
"Mind the GAP when you GET on the METRO"
"No drinking on the metro!"
189
What tumor is the most common extracranial childhood cancer?
-neuroblastoma
190
Alpha toxin: what is it? What is it made by? What does it cause?
- exotoxin made by clostridium perfringens
- MOA: phospholipase that degrades the tissue and cell membranes
- causes myonecrosis ("gas gangrene") and hemolysis
191
Which drugs are effective against mycoplasma?
- anti-ribosomal drugs
| - ex. Macrolides & tetracyclines
192
Hyperpyrexia: what is it? Tx?
- very high fever > 42*C
- tx: must be treated immediately to prevent brain damage!
1. Immediate cooling by increasing heat loss via cold blankets, fans, application of cold saline bags to groin/axilla, etc.
2. NSAIDs or acetaminophen (kids) = inhibit PGE2 production --> lower hypothalmic temperature set point
193
NO: MOA
-in smooth m stimulates guanylate cyclase to convert GTP into cGMP --> causes decrease in intracellular Ca --> decreases activity of myosin light-chain kinase --> so myosin light chain is dephosphorylated --> smooth m. Relaxation
194
What 4 classes of antibiotics act on peptidoglycan cell walls? What genus of bacteria are they ineffective on?
1. Penicillin
2. Cephlosporins
3. Carbepenems
4. Vancomycin
- WONT work on mycoplasma!
195
What can occur post group A strep infection regardless of whether or not the strep infection was treated rheumatic fever or acute-streptococcal glomerulonephritis?
-acute post-streptococcal glomerulonephritis!!
196
What can cause an obturator n. injury?
-anterior hip dislocation
197
What 2 ssx are suggestive of shaken baby syndrome?
- subdural hematoma
| - bilateral retinal hemorrhages
198
Which sensory pathway relays in the VPL
-touch: both the spinothalamic and the medial lemniscus
199
When can a pericardial knock be heard?
-in early diastole (before s3 would be heard) in a pt with constrictive CHRONIC pericarditis!
200
What AA is NO made from?
-arginine, via nitric oxide synthase
201
Where are high frequency sounds best detected?
-at the base of the cochlea near the oval and round windows
202
Other than dry skin and night blindness, what can occur with a vitamin A deficiency (ie seen in CF pts with fat malabsorption)
- vitamin A maintains an orderly differentiation of specialized epithelia, including epithelia of mucus-secreting columnar epithelia of the ocular conjunctiva, resp, urinary, pancreatic, and other exocrine ducts
- vit A deficiency can vause squamous metaplasia of the epithelia --> keratinizes the epithelium
203
What does verapamil do in slow-response tissue?
- slow-response tissue = SA and AV nodes
| - slows the depolarization of these tissues by decreasing the Ca ion influx that occurs during phase 0 and phase 4
204
What 3 things does myelin do for axons?
1. Increase space constant = length constant
2. Increases conduction velocity
3. Insulates axon
205
What ligament injury can result from sudden traction on the outstretched and pronated arm of a child? Ssx?
- "nursemaid's elbow"
- annular ligament is torn and displaced
- child holds arm close to body w/ elbow extended & forearm pronated
- not really in pain unless arm is moved, have some tenderness at radial head
206
What acid/base disturbance is caused by salicylate intoxication?
Two:
1. First get acute resp alkalosis--> salicylates directly stimulate the medullary resp center --> hyperventilation
2. Metabolic acidosis bc of organic acid accumulation (ex. Ketoacids, lactate, & pyruvate) --> this effect increases with time
207
Cl and metabolic alk
Askiudfgasodhfbas
208
Flat facial features, excessive skin at the nape of the neck, VSD, and duodenal atresia are features of?
-Down syndrome
209
What mutation can cause a mild hyperglycemia that can be exacerbated by pregnancy?
-an inactivating mutation in glucokinase
210
"Satellite phenomenon" btwn H. Influenza and Staph aureus
- h. Influenza requires factors X (hematin) and V (NAD+) for growth --> its blood loving
- if grown near staph aureus the staph will provide the X and V that H. Flu wants
211
What embryological failure causes a cleft lip?
-cleft lip results when the maxillary prominences fail to properly fuse with the intermaxillary segment during early embryonic development
212
Perchlorate
-Blocks iodine absorption by thyroid gland via competitive inhibition
213
Isoniazid: sfx
1. Neurotox --> bc cause B6 deficiency (^^urinary excretion) , so give pyridoxine to prevent damage!
2. Hepatotox
Think: INH "Injures Neurons and Hepatocytes"
214
What does monoclonal proliferation of lymphocytes in a lymph node signify?
-strong evidence for malignancy!
215
What should be restricted in the diet of pts with urea cycle disorders? What builds up in the blood of pts with these disorders?
- need to balance protein intake and output
| - ammonia from protein digestion accumulates in the blood
216
A prolonged PTT indicates a defect in which factors?
1. VII
2. IX
3. XI
4. XII
217
What is "iodine trapping" how is it done?
- when the thyroid gland takes up iodine
- occurs via the sodium/iodine symporter
- energy dependent process
218
What is the most common cause of aseptic meningitis? How is it transmitted?
- enterovirus = RNA virus
| - transmitted: fecal-oral
219
What drug is used for opioid intoxication? What receptors does it bind to? What are the effects of the receptor it binds to with the most affinity?
- naloxone
- antagonist that binds to mu (highest affinity!), kappa, and deltoid receptors
- when opioids bind to mu receptors it causes:
1. Respiratory depression
2. Reduced GI motility
3. Sedation
4. Euphoria
5. Physical dependence
220
Toxoplasmosis: tx
1. Sulfadiazine + pyrimethamine
221
How are small (< 2 micro m) , medium, and large particles cleared from the airways?
- small = phagocytosis (ex. Dust in pneumocoses)
- medium = mucocilliary transport
- large = coughing, sneezing, & upper airway trapping
222
Pneumobillia
- air in the biliary tract
| - suggestive of gallstone ileus
223
Transtentorial herniation: ssx?
1. Ipsilateral fixed and dilated pupil --> usually first sign
2. Paralysis of occulomotor m
2. Comtralateral or ipsilateral hemiparesis
3. Contralateral homonymous hemianopsia w/ macular sparing
224
7 risk factors for osteoporosis:
1. Smoking
2. Menopause
3. Corticosteriod tx
4. Physical inactivity
5. Caucasian race
6. Low total body weight
7. Alcohol use
225
Endothelium-derived relaxation factor
- released by the binding of cholimenergic agents to muscarinic receptors on endothelial surface of blood vessels
- aka NO
- activates guanylate cyclase --> increase intracellular cGMP --> activates Ca pump --> efflux of Ca from cells --> this decrease in Ca = vascular smooth m relaxation
226
What is the most important determinant of insulin resistance?
-waist-to-hip ratio
227
2 renal injuries seen with chronic NSAID use?
1. Papillary necrosis
| 2. Chronic interstitial nephritis
228
Age of occurrence of neuroblastomas?
-average age of onset = 2 yrs old
229
What receptors does dopamine effect? Rank them!
1. Dopamine @ low dose
2. Beta 1 > beta 2 @ medium dose
3. Alpha 1 = alpha 2 @ high dose
230
What is primary polydipsia?
- excessive (pathologic) water drinking
- "psychogenic polypisia"
- can also be a side effect of certain meds that cause dry mouth
231
What 4 conditions can cause avascular necrosis to the femoral head? Pathogenesis?
1. Sickle cell disease --> bc of thrombotic occlusion of arteries
2. Lupus --> bc of vasculitis, which causes injury to the vessel wall & impaired blood supply
3. High doses of steroids --> mechanism unknown
4. Alcoholism --> mechanism unknown
232
What does thyroid peroxidase do?
1. Catalyses iodine oxidation
2. Catalyses the formation of mono- and diiodotyrosine
3. Catalyses the coupling that forms T4 and T3
233
Specialized transduction
- an "excision event"
- a lysogenic phage infects bacterium --> viral DNA incorporates into bacterial chromosome
- when the phage is excised flanking bacteria, genes might be excised too
- the DNA is packaged into phage viral capsid and can infect other bacteria
234
Conjugation: 2 types
BACTERIAL
1. F+ x F-
- F+ plasmid contains genes required for sex pilus and conjugation
- cells without the plasmid = F-
- and F+ cell transfers its plasmid to an F- cell --> recipient now F+
- NO transfer of chromosomal DNA!!
2. Hfr x F-
- F+ plasmid can get integrated into bacterial chromosomal DNA
- that cell = high frequency recombination cell
- the replication of incorporated plasmid DNA might include some flanking chromosomal DNA
235
What does sulfonylurea abuse cause?
- increased insulin, increased c-peptide, and increased pro-insulin levels!
- urine will be positive for hypoglycemic agents
236
Where do the 3 branches of CN V exit the skull?
- V1 = Superior orbital fissure
- V2 = foramen Rotundum
- V3 = foramen Ovale
* *think Standing Room Only
237
X-ray of pneumonia that "looks worse that the pt appears clinically": what is it caused by?
- "walking pneumonia"
- atypical pneumonia
- most commonly caused by mycoplasma pneumoniae
238
Scarlet fever: bacteria that causes it? 5 ssx? Complications?
- caused by strep pyogenes
- ssx:
1. fever
2. pharyngitis (can have grey-white exudates)
3. sandpaper-like rash
4. circumoral pallor (pale around mouth)
5. strawberry tongue
- complications: acute rheumatic fever & glomerulonephritis
239
Cardiac malformations common in down syndrome?
1. Endocardial cushion defects
- ASD
- regurgitant MV or TV
240
MEN 2B: endocrine neoplasias and genetic defect
- 1 P + 2 M's:
1. Pheocromocytoma
2. Medullary carcinoma = calcitonin
3. Mucosal neuromas --> associated with Mafanoid habitus
- ret gene mutation
241
Which dz do pts present with tubular/tendon xanthomas and xanthelasmas?
-hypercholesterolemia (high LDL)
242
Which 2 types of cholesterol meds can cause hepatotoxicity and myopathy?
1. HMG-CoA reductase inhibitors
| 2. Fibrates (increases the risk for myopathy when used with statins!)
243
Infections in SS:
- more susceptible to encapsulated bacteria bc older kids and adults have autoinfarcted their spleen
- encapsulated bacteria: SHiNE SKiS=
1. Strep pneumo
2. HiB
3. Neiserria meningitidis
4. E. coli
5. Salmonella
6. Klebsiella pneumoniae
7. group b Strep
244
Which 4 types of drugs should be avoided when a pt is on benzodiazepines? Why?
1. Alcohol
2. Barbiturates
3. Neuroleptics
4. 1st generation antihistamines = chlorpheniramine
- benzos cause sedation so other CNS depressant drugs should be avoided when on them so there is not more sedation!
245
What receptors does isoproterenol affect? Rank them!
ONLY Beta 1 = beta 2
246
What type of insulin is preferred for the acute tx of DKA and what is its duration of action?
- regular insulin
- when given intravenously: insulin has an effect rapidly and has a half-life of 5 min --> when treating DKA, this is the delivery method of choice!!
- when given sub Q: starts working in 30 min, peaks at 2-4 hrs, lasts 5-8 hrs
247
What are 4 sfx of ganciclovir? Is it more or less toxic than acyclovir?
1. Leukopenia
2. Neutropenia
3. Thrombocytopenia
4. Renal toxicity
* *MORE toxic than acyclovir!
248
What are 5 sfx of nucleoside reverse transcriptase inhibitors?
1. Bone marrow suppression --> can be reversed with G-CSF, but can be increased if pt is also on ganciclovir!
2. Peripheral neuropathy
3. Lactic acidosis
4. Rash
5. Anemia
249
Tocolysis
- decrease in uterine contractions
| - can be caused by B2 agonist
250
Caudal regression syndrome: what is it? Ssx? What can cause it?
- agenesis of sacrum and lumbar spine
- ssx: flaccid paralysis of legs, dorsiflexed contractures of feet, and urinary incontinence
- usually caused by uncontrolled maternal DM
- rare
251
Transference
- the unconscious shifting of emotions or desires associated with one person (ex sibling, spouse, parent) to another person (ex therapist, physician, etc)
- it can be positive or negative
252
Oseltamivir: MOA & clinical use
- inhibits influenza neuraminidase --> blocks the virus from being able to release progeny
- tx and prevention of influenza A and B
253
Sensorineural hearing loss: Rinne test results? Weber?
- Rinne: normal in BOTH ears = air > bone
| - Weber: localizes to unaffected ear
254
Phentolamine: MOA? Uses?
- reversible non-selective alpha blocker
| - given to pts on MAO inhibitors that eat tyramine-containing foods
255
MEN 1: endocrine neoplaisias + gene defect
- 3 P's:
1. Parathyroid tumor = hypercalcemia
2. Pancreatic tumor = gastrin --> NOT present in any other MEN
3. Pituitary adenoma = prolactin and ACTH
- sometimes not all will be present
- defect in MENIN on chrom 11
256
Angiosarcoma: what is it? What can predispose to it? Prognosis?
- blood vessel malignancy
- acillary lymph node dissection esp with radical mastectomy = risk factor & classic predisposing procedure!!
- prognosis is poor, bc usually detected late
* *pretty much the same thing as lymphangiosarcoma, bc they think lymphangiosarcoma also comes from blood vessels rather than lymph nodes!
257
What is the first step in glycolysis? What is the purpose? What is it catalyzed by?
- the first step is phosphorylation of glucose --> glucose-6-phosphate
- this traps the glucose in the cell
- this is catalyzed by:
1. Glucokinase - in liver and beta cells of pancreas
2. Hexokinase - in all other cells
258
What causes the green color of pus or sputum that occurs during bacterial infections?
-myeloperoxidase from neutrophil azurophilic granules
259
What is the typical response to injury in the brain?
-liquefactive necrosis caused by lysosomal degradation of the tissue
260
Where do watershed infarctions usually occur? What do they look like?
- usually occur btwn the zones of perfusion of the anterior, middle, and posterior cerebral arteries
- see bilateral wedge-shaped bands of necrosis over the cerebral convexity just lateral to the interhemispheric fissure
261
Fibronectin: what is it? What does it do?
- large glycoprotein that is produced by fibroblasts and some epithelial cells
- binds to integrins, matrix collagen, and glycosaminoglycans = mediator of normal cell adhesion and migration
262
Pertechnate
-blocks iodine absorption of the thyroid gland via competitive inhibition
263
Clostridium perfringens: exotoxin, what does it do, how does it manifest
- exotoxin = alpha toxin
- MOA = phospholipase that degrades cell and tissue membranes
- manifestation = degradation of phospholipid C --> myonecrosis ("gas gangrene") and hemolysis
264
What 2 things doe von Willebrand factor do? What makes it? What does a deficiency cause?
- Function:
1. Carries factor VIII
2. Enables platelet adhesion to the endothelium
- made by endothelial cells
- deficiency causes both a factor VII and platelet adhesion deficiency
265
Zanamivir: MOA & clinical use
- inhibits influenza neuraminidase --> blocks the virus from being able to release progeny
- tx and prevention of influenza A and B
266
Conductive hearing loss: rhinne test results? Weber test?
- Rhine: bone > air in abnormal ear
| - Weber: localizes to affected ear
267
Which basic interviewing technique has the physician express understanding and vicarious experiencing of a patient's situation?
-empathy
268
Essential tremor: what is it? Genetics? Tx?
- action tremor that is exacerbated by holding a posture/limb position
- genetic predisposition
- pts tend to self medicate with alcohol, which decreases the tremor
- tx: Bbs or primidone
269
What are pancreatic enzymes secreted in an inactive form? What activates them and where? What insures that these enzymes will not be prematurely activated? What can happen if the inactivation doesnt occur?
- to protect the pancreas from autodigestion
- trypsin activated them in the duodenal lumen
- pancreatic secretory trypsin inhibitor (PSTI) is secreted by pancreatic acinar cells and inhibits any trypsin that might be abnormally activated within the pancreas
- if this process is not functioning properly the pt can get pancreatitis!!
270
Follicular lymphoma: tumor of what cell type?
-mature B cells
271
Which drugs can help reduce chemo-induced vomiting?
- 5-HT3 receptor antagonists: ondansetron, granisetron, & dolasetron
- "-setron"
272
Enterococci: what is it? Where is it found?
- group D streptococci
- gram positive cocci that is catalase negative
- found in normal colonic flora
273
What is the pathogenesis of PCOS? What lab values are seen for LH, FSH, and androgen levels?
- have hypothalamic-pituitary-ovarian abnormilites
- have progesterone deficiency, acyclic estrogen production, and elevated LH
- labs: high LH and high androgens (testosterone and androstenedione) and normal FSH
274
What are "red neurons"? What do they signify? When are they seen?
- very eosinophilic neurons
- sign of irreversible neuronal injury
- usually seen 12-48 hrs after brain ischemia
275
Superior mesenteric syndrome: what is it? Cause?
- occurs when the transverse portion of the duodenum is entrapped btwn the SMA and the aorta --> causes partial intestinal obstruction
- can occur with any condition that causes diminished mesenteric fat --> ex. Low body weight, recent weight loss, severe burns, etc. can also occur in severe lordosis or after surgical correction of scoliosis
276
Hyperacute transplant rejection: features
- occlsion of grafting vessels --> causes ischemia and necrosis of graft organ
- organ needs to be re-transplanted or it will fail!
277
What does an accentuated pulmonary component of the second heart sound suggest?
-increased pulmonary artery P and pulmonary HTN
278
Pseudo aeruginosa's lab features
1. Non-lactose fermenting
2. Oxidative-positive
3. motile
4. Gram-neg rod
279
Which sensory pathway relays in the medial geniculate body?
-auditory
280
Most serious complication of kawasaki disease?
-coronary artery aneurysm
281
What is N-acetylcysteine an antidote for?
-acetaminophen toxicity
282
What is the embryological cause of tetralogy of fallot?
-abnormal migration of neural crest cells
283
What is a latent EBV infection in the presence of a focal brain lesion in an HIV-positive pt suggestive of?
-primary CNS-lymphoma of B-cell origin
284
Transtentorial herniation: possible causes?
- AKA uncal herniation
- can be caused by:
1. Ipsilateral hemorrhage
2. Ipsilateral brain tumor
285
What drug is used to control the sx of a carcinoid tumor?
-octreotide
286
What is the neurotransmitter that is deficient in Huntington's disease?
-GABA
287
What is seen in the peripheral smear of a patient with DIC?
-schistocytes!
288
What 2 types of cancers is HPV associated with and who are they most commonly seen in?
1. Cervical squamous carcinoma --> most commonly seen in HIV + females
2. Anal squamous carcinoma --> most commonly seen in HIV + homosexual males
289
Two most common causes of focal brain lesions in HIV-positive pts?
1. Toxoplasmosis
| 2. Primary central nervous system lymphoma --> usually of B-cell origin, often see latent EBV infection
290
Why do some men with testicular tumors have hyperthyroidism too?
- hCG can increase to very high concentrations in some testicular tumors
- hCG is structurally similar to TSH, but has a lower affinity --> at high concentrations it can stimulate the thyroid to make T3 and T4!
291
What is seen in the tubules of a pt survives all three stages of acute tubular necrosis?
-tubular re-epithelization
292
Acute transplant rejection: pathogenesis?
- cell mediated
- due to CD 8 T lymphocytes reacting against foreign MHCs
- reversible w/ immunosuppressants
293
Chronic transplant rejection: when does it occur?
-months to years later
294
Haptaglobin: what is it? How long is its half life?
- plasma protein that binds free Hb to prevent it from being excreted in kidneys
- levels will be decreased in a pts with hemolytic anemias
- complex of haptaglobin/hemoglobin is cleared by liver & only has a half life of 90 min
- half life of free haptoglobin is 5 days
295
Crytococcus neoformans: how is it spread?
- typically found in soil and PIGEON droppings
| - inhaled
296
What does a positive reaction to a candida extract injection test signify?
-that the ot has an intact T-cell response
297
Sumatriptain: sfx & who is it contraindicated in?
1. coronary vasospasm
- contraindicated in pts w/ CAD or primzmetal's angina
2. Mild tingling
298
What is the cause of differential cyanosis?
- PDA w/ late-onset reversal of shunt flow
| - causes cyanosis in lower extremities, but upper extremities are normal!
299
What happens to the digestive enzymes secreted by the pancreas following a subtotal pancreatomy?
-the pt will deficient in all of them
300
What statistical test can be used to compare the difference in means btwn more than 2 groups?
-analysis of variance (ANOVA)
301
Chorioretinitis
- yellow/white fluffy/cotton patches on retinal exam
| - seen in congenital toxoplasmosis
302
What does verapamil do in fast-response tissue?
- fast-response tissue = contractile cardiac muscle cells
| - verapamil decreases the amnt of Ca intracellularly = decreases their contractility
303
Transposition
BACTERIAL
- a segment of DNA can "jump" from one location to another --> via excision and reinsertion
- can transfer genes from plasmid to chromosome and vice versa
- can include some flanking DNA when excision occurs --> this can then be incorporated into a plasmid and transfered to another bacteria
304
Alpha or beta receptors stimulate insulin secretion?
- alpha receptors inhibit insulin secretion
| - beta receptors stimulate insulin secretion
305
What receptors does albuterol, salmeterol, and terbutaline effect? Rank them!
Beta 2 >> beta 1
306
What percentage of the cross section of a vessel needs to be blocked before sx of angina occur?
-75%!
307
What are the 4 ssx of pick's disease?
1. Progressive dementia
2. Behavioral disinhibition
3. Speech difficulties --> ex dysarthria, aphasia, & echolalia
4. Atrophy of the frontal lobe
308
Echinococcus granulosus: transmission & where is it endemic to?
- tapeworm ingesting eggs from dog feces
- most commonly seen in people from endemic regions (mediterranean countries, middle east, southern south africa, iceland, australia, new zeland) or people in southwest region of US with sheep and dog exposure
309
What is involuntary head bobbing a sign of?
- widened pulse pressure
| - can be seen with aortic regurgitation
310
Portal vein thrombosis: what 3 ssx does it cause and what 2 things are typically not seen
- causes:
1. Portal HN
2. splenomegaly
3. varicosities at portocaval anastomoses
- does NOT cause changes to the hepatic parenchyma
- usually dont see acscites either
311
Ssx of hydrocephaly in early infancy?
1. Macrocephaly
2. Irritability
3. Poor feeding
4. Muscle hypertonicity*
5. Muscle hyperreflexia*
* caused by UMN damage that results from the stretching of the perventricular pyramidal tracts
312
Pulsus paradoxus
- a decrease in the arterial pulse >10mm during inspiration --> measured with bp cuff
- can feel with that pulse disappears on inspiration
- note: a decrease in pulse <10 mm during inspiration is normal!!
- sign of cardiac tamponade!
313
Isoniazid: MOA
- decrease synthesis of mycolic acids (part of cell wall of mycobacteria)
- chemically similar to pyridoxine (vit B6) --> causes its depletion!
- isonizid uses the bacteria's catalase peroxidase to convert itself to its active metabolite
314
What 2 things are PCOS pts at risk for developing?
1. Endometrial adenocarcinoma --> due to unopposed estrogen
| 2. Type 2 DM
315
What is ESR a marker for? What causes it to increase?
- ESR = nonspecific marker of inflammation
| - increased by high levels of circulating fibrinogen
316
Kaposi's sarcoma: what is it? Dx? Sx? What is it associated with?
- endothelial malignancy, usually of skin and GI tract
- see dark red/purple skin/mouth lesions that rage from flat maculopapular to nodular
- associated with HHV-8 and HIV
- bx: shows spindle cells, and neovascularization
* *often confused with bacillary angiomatosis
317
Increased secretion of which 5 things can cause maternal insulin resistance during pregancy?
1. Human placental lactogen
2. Placental growth hormone
3. Estrogen
4. Progesterone
5. Glucocorticoids
318
What are the 2 low potency neuroleptics? Use? Sfx?
1. CHlorpromazine
2. THIoridazine
"CHeating THIeves are low"
-use: POSITIVE sx of schizophrenia
-sfx: anticholinergic, antihistamine, Corneal deposits (Chloropromaxine) & reTinal deposits (Thioridazine)
319
Lambert-eaton syndrome: what is it? Px? Sx?
-paraneoplastic syndrome
-px: due to antibodies against presynaptic Ca++ channels at NMJ --> vv Ach release
-seen w/ small cell lung cancer
Ssx: proximal muscular weakness that improves with use
320
Phenotypic mixing
VIRAL
- simultaneous infection of a cell with 2 viruses
- the genome of virus A can be partially or completely coated with the surface protiens of virus B
- type B protein coat determines the tropism (infectivity) of the hybrid virus
- the progeny are back to the original, ie virus A coated by virus A
321
Which body fluids can transmit hepatitis B?
-ALL of them! (Blood, sweat, tears, semen, breast milk, saliva, etc.)
322
Hormones that use INTRINSIC tyrosine receptors
- "think growth factors"
- insulin
- IGf-1
- FGF
- PDGF
- EGF
323
Bruton's agammaglobulinemia: ssx
- recurrent bacterial infections after 6 mnths if age (loose mom's IgG) bc have opsonization defect
- decreased amnt of immunoglobulins of ALL classes
- will have a normal candida skin test rxn --> bc T cells are NORMAL
324
Two types of cerebellar tumors in kids? How do you tell the difference?
1. Policytic astrocytoma = cystic AND solid (most common)
| 2. Medulloblastima = always solid
325
What is the antidote to acetominophen overdose? What is the MOA?
- N-acetyl cysteine (NAC)
- acts as a glutathione substitute --> binds to the toxic metabolite
- provides the sulfhydrryl groups to enhance the non-toxic sulfation elimination of acetominophen
326
Thrombocytopenia sx:
- petechia
- purpura
- hematemesis
- epistaxis
327
What happens in the fasting state in regards to regulation by F2,6BP?
-^^ insulin --> vv cAMP --> vv protein kinase A --> vv FBPase-2 & ^^ PFK-2 = MORE glycolysis & less gluconeogenesis
328
Cell maker associated with caseating granulomas?
-CD14
329
What is the most common inherited bleeding disorder? How is it inherited?
- von Willebrands dz
| - autosomal dominant w/ VARIABLE penetrance
330
HUS: triad of sx? What can it be caused by? Labs?
- triad of ssx:
1. Acute renal failure
2. Thrombocytopenia --> bc toxin induces vascular damage --> causes capillary thrombus formation = platelets are used up & RBCs are damaged (= anemia)
3. Microangiopathic hemolytic anemia = palor wkness, & tachy
- usually affects young children, caused by EHEC O157:H7 serotype
- labs: vv Hb, hematocrit, RBC count, & platelet count (= ^^ bleeding time!), + ^^ LDH & reticulocyte count
* *NO clotting factor deficiencies or HUS, so all other clotting factor tests will be normal!
331
What does denudation of axons mean?
- demyelinating
| - "removal of covering"
332
Anti-phospholipid antibody (ALPA) syndrome
- can be caused by the lupus anticoagulant, which is found in 10-30% of SLE pts
- syndrome has: 1. Anti phos antibodies plus one or more of-
1. Hypercoag w/ venous thromboembolism
2. Hypercoagulability arterial thromboembolisms
3. Repeated 2nd or 3rd trimester miscarriages
333
Mitochondrial encephalomyopathy: ssx? Inheritance?
Ssx:
- lactic acidosis
- stroke-like episodes
- muscle weakness
- genetics: mitochondrial inheritance
334
What is the significance of "moldy" grains and what disease does it cause of increased risk of?
- aspergillus flavus and aspergillus parasiticus can grow on on foods such as corn, soybeans, and peanuts when it is hot and humid
- they produce aflatoxins as a byproduct w/ B1 being the most common
- aflatoxin B1 can cause mutations in p53 that can cause hepatocellular carcinoma
335
What is the most common cause of death in hospital after an acute MI?
- terminal ventricular failure
| - usually occurs w/in 2-10 days
336
Tuberounfundibular pathway: function? Disease associated?
- controls prolactin secretion
| - associated with hyperprolactinemia
337
A measurement of what enzyme can be used as a marker for mast cell activation? Why?
- tryptase is released by mast cell degranulation
| - it is relatively specific to mast cells
338
Graft-versus-host transplant rejection: when does it usually occur?
-varies
339
Phenoxybenzamine: MOA? Clinical use?
- irreversible non-selective alpha blocker
- used for pheos --> use before removal of tumor, high levels of catecholamines will not be able to overcome the blockage!
340
What causes the cellular and mitochondrial swelling seen during cardiac ischemia?
-ion pump failure due to ATP decrease --> intracellular accumulation of Na & Ca --> free water drawn in cell
341
bcl-2
- anti-apoptosis gene
| - over expressed in follicular lymphoma bc of the (t14;18) translocation!
342
What germ-line mutation can be a part of MEN 2A and 2B? What tumors does it cause?
- mutations in crest cells
- cause tumors in both the adrenal medulla (pheos) and tumors in the parafollicular C-cells of the thyroid bc they are both formed from neural crest cells
343
Polyclonal proliferation of lymphocytes in a lymph node signifies?
-benign lymph node enlargement in response to antigenic stimulation
344
What are the insulin, c-peptide, and pro-peptide levels in an insulinoma?
-ALL increased
345
Pulmonary M. TB: mechanism or spreading and proliferation
- spreads from person to person via resp droplets --> large ones are swept out by cilia, and small ones get down into the alveoli of the lower lung fields --> phagocytosed by the alv macs --> intracellular proliferation occurs
- macs die and then are lysed and the process continues
346
Langhans giant cell
- made of multiple epitheliod mac cells
- multinucleated giant cells
- the nuclei are arranged in an arch a round the periohery
- seen in granulomatous conditions, including M. TB
347
Which antiarrhythmic drugs are the best post MI (for ischemic tissues)? Why?
- class IB antiarrhythmics --> bc have fast dissociation speed
- lidocaine, mexiletine, tocainide
348
Nigrostriatal pathway: function? Diseases associated?
- coordination of voluntary movements
| - associated with parkinsonism
349
What does Hb bind and release in the lungs?
- binds oxygen
- releases CO2
- releases H+
350
What is the sensory deficit seen with obuturator n injury?
-medial thigh
351
4 drugs for M. TB tx:
"I saw a Red Pyre (fire) burning the liver"
1. I- isoniazid
2. Red- rifampin
3. Pyre- pyrazinamide
4. Burning- ethambutol
* *all cause liver damage so check LFTs!!
352
What is the tx of choice for hairy cell leukemia? What is its MoA?
- cladribine
| - adenosine analog --> resistant to adenosine deaminase, so it has high intracellular concentrations
353
Recimbination
VIRAL
| -exchange of genes btwn 2 chromosomes by crossing over w/in regions of significant base sequence homology
354
Which 3 benzodiazepines are short-acting? What is their addictive potential? What is their risk of daytime drowsiness?
1. Triazolam
2. Oxazepam
3. Midazolam
- higher addictive potential
- tend to cause less day time drowsiness
355
Transformation
BACTERIAL
- the ability of a bacteria to take up naked DNA (ex. From cell lysis) from the envi
- a feature of S. pneumo, H. Influenza B, and Neisseria
* *adding deoxyribonuclease to the envi degrades the naked DNA in the medium --> no transformation!
* *NO genomic change in the progeny!!!
356
Lung abscess: ssx
1. Fever
2. Malaise
3. Weight loss
4. Clubbing
5. Leukocytosis
6. Cough w/ lots of foul-smelling sputum
357
What is the most common type of necrosis?
-coagulative
358
MEN 2A: endocrine neoplasias and genetic defect
- 2 P's + 1 M:
1. Pheochromocytoma
2. Parathyroid hyperplasia/tumor = hypercalcemia
3. Medullary Carcinoma = calcitonin
- ret gene mutation
359
Octreotide: MOA
- synthetic analog of somatostatin
- has a longer half life than somatostatin
- inhibits secretion of many hormones (somatostatin mainly is an inhibitory hormone)
360
What 4 structures does the ureteric bud give rise to?
1. Ureter
2. Pelvises
3. Calyces
4. Collecting ducts
361
Epiglottitis: ssx? What that causes it?
- ssx:
1. Sore throat
2. DYSPHAGIA
3. DROOLING
4. Respiratory distress
- cause: Haemophilus influenzae
362
Where do the nitrogen atoms in the urea molecule derive from in the urea cycle?
1. NH3
| 2. Aspartate
363
What happens after MIT and DIT are made?
- they combine to either for T3 or T4
| - which are then taken back up into the follicular cell so that they can be secreted into the blood
364
Cardiac malformations commonly seen in Tuberous sclerosis?
1. Valvular obstruction due to cardiac rhabdomyomas
365
What kind of an injury can cause hand clumsiness/paralysis?
- sudden upward jerking of arm at shoulder can cause injury to the lower trunk of the brachial plexus
- lower trunk = ulnar and median nn --> innervate all of the intrinsic m of the hand
366
After how many hours of fasting does gluconeogenesis become the primary source of blood glucose?
-12-18 hrs
367
What is the triad of ssx for pre-eclampsia?
1. HTN
2. Proteinuria
3. Edema
* *during pregnancy
368
IV phlebitis: what is it and what is one drug that can cause it?
- inflammation of the IV site
| - can be cause by amphoterricin B
369
What causes wrinkles with aging?
-net loss of dermal collagen and elastin
370
N-acetylcysteine: MOA & clinical uses
- mucolytic agent that loosens up plugs in CF pts by decreasing the intermolecular disulfide bridges
- ALSO used as an antidote for acetaminophen overdose!
371
What response is seen during a water deprivation test when ADH is given?
- the urine osmolality has been steadily increasing all along
- do not see a significant increase in urine osmolality when ADH is given
372
What would a lack of T-tubules cause?
-uncoordinated contraction of myofibrils
373
Hepatic encephalopathy: tx
- goal is to decrease the ammonia level
| - give lactulose = osmotic laxative --> promotes nitrogen excretion as NH4+
374
Which 5 cell products contribute to granuloma formation? And what do each of them do?
1. TH1 --> product of CD4 helper T cells
2. IL-2 --> stimulates TH1 cell proliferation
3. IFN-gamma --> stimulates macrophage activation
375
Vein used for cardiac bipass when just LAD is occluded
Left internal mammary a.
376
Hemolytic Uremic Syndrome: triad of sx? pathophys? who is it common in? PT and PTT?
- HUS
- triad of:
1. Anemia
2. Thrombocytopenia
3. Acute renal failure
- can be caused by shiga-like toxin and shiga toxin
- this is a form of microangiopathic hemolytic anemia
- due to endothelial injury that causes an isolated activation of platelets --> forms microthrombi
- typically seen in kids
- PT & PTT will be NORMAL bc the coag system is not activated!!
377
When can AFP be increased (4)?
1. Pregnancy
2. Tumors of gonadal origin
3. Chronic liver dz (ex viral hepatitis)
4. HCC
378
What receptors does epinephrine effect? Rank them!
Beta 1 = beta 2 > alpha 1 = alpha 2 & Not D1
379
What is the most common presentation of a patient with hyperchylomicronemia?
- abdominal pain due to acute pancreatitis
- can have skin xanthomas, but NOT tubular/tendon xanthomas and xanthelasmas
- usually not at increased risk for premature coronary artery dz
380
Wide fixed splitting that does not vary with respiration
-ASD
381
What 5 structures does the metanephric mesoderm give rise to?
1. Glomeruli
2. Bowman's space
3. Proximal tubules
4. Loop of henle
5. Distal convoluted tubules
382
What is the most common cause of acute renal failure in kids?
-HUS
383
Syringomyelia
- damage of anterior white commisure of spinothalamic tract by a syrinx (= csf filled cavity)
- ssx: BILATERAL loss of P&T limited to the effected level (usually arms and hands -C8-T1) --> fine touch is preserved
- syrinx can expand to effect other tracts too
- seen with Chiari I malformation
384
Ssx of the nasopharyngitis? 3 common causes?
"Common cold"
- ssx:
1. Nasal congestion & discharge
2. Sneezing
3. Cough
4. Sore throat
- bugs:
1. Rhinovirus
2. Influenza virus
3. Coronavirus
385
What must be monitored in ankylosing spondylitis?
-chest expansion
386
Amphotericin B: MOA
- binds ergosterol (unique to fungi) --> forms pores --> causes leakage of electrolytes
- "amphoTERicin TEaRs holes in the fungal membrane by forming pores"
- can also bind sometimes to cholesterol in human cells, thats why you there are so many sfx with this drug
387
5 drugs that can cause drug induced lupus (DILE) ? Who is at the highest risk?
1. Hydralazine --> HIGH risk!!
2. Procainamide --> HIGH risk!!
3. Isoniazid
4. Minocycline
5. Quinidine
* * slow acetylators are at the highest risk of DILE
388
Allergic bronchopulmonary aspergillosis (ABPA):
- due to aspergillus fumigatus
- can complicate asthma
- can cause transient recurrent pulmonary infiltrates and eventually causes proximal bronchiectasis
389
Laryngotracheitis: ssx? What causes it?
"Croup"
- ssx: URI followed by-
1. Hoarseness
2. BARKING cough
3. STRIDOR
4. Respiratory distress
- caused by: parainfluenza virus (part of the paramyxovirus family)
390
What are the levels of creatine kinase like in hypothyroidism and why?
- increased
- bc hypothyroidism can cause atrophy of type II muscle fibers
* * can sometimes be the first sx of hypoTH
391
Crytococcus neoformans: what dies it typically cause?
- unusually only infects immunocomps
- inhaled and causes lung infection at first and then spreads hematogenously to the meningies and causes meningitis
- see "soap bubble" lesions on brain
392
Who does factitious hypoglycemia usually occur in?
- commonly seen in both diabetic and non-diabetic pts in a health-related occupation
- often associated with depression and personality disorders too
393
Hemophilia A: whats deficient? what are the ssx?
- deficient in factor VIII
- indistinguishable clinically wit hemophilia B
- have prolonged PTT
- ssx:
1. Intramuscular hemorrhage
2. Hemarthrosis
3. Prolonged bleeding following surgical procedures (ex. Tooth extraction)
394
Stopped at # 26!
Yeah!
395
Chi-square test
-used to test the associations between 2 categorical variables
396
How can human placental lactogen cause maternal insulin resistance (4)?
1. increase in insulin resistance
2. stimulates proteolysis
3. stimulates lipolysis
4. inhibits gluconeogenesis
397
What does the lepromin skin test show in patients with each type of leprosy and why?
1. Lepromatous = non-active bc the dz is characterized by low cell-mediated immunity with a humoral Th2 response
2. Tuberculoid = positive bc the dz is characterized by strong CD4+ Th1 humoral response (high cell-mediated immunity)
398
Cardiac malformations commonly seen with friedreich's ataxia?
1. Hypertrophic cardiomyopathy
399
Neuroblastoma: location? Genetics? What is elevated in the urine?
- tumor of the adrenal medulla, usually located in the abdomen, can be found anywhere along the sympathetic chain
- over-expression of c-myc --> associated with rapid progression and poor prognosis
- homovanillic acid (HVA) is elevated in the urine = breakdown product of dopamine
400
Reactivation of varicella-zoster virus
- primary infection is usually in childhood (chickenpox)
- reactivation of vzv that was latent in the dorsal root ganglia
- usually occurs in the elderly and immunocompromised
- will have varicella IgG antibodies --> these are protective against chicken pox, but not shingles
401
Amphotericin B: clinical uses
- first line for most systemic mycoses:
1. Crytococcus
2. Blastomyces
3. Coccidiodes
4. Histoplasmosis
5. Candida
6. Mucor
- given intrathecally for fungal meningitis
402
What skin changes can be seen with varicose veins on the legs?
- stasis dermatitis = erythema, scaling, dermal fibrosis, and hyper-pigmentation on the legs
- cause by chronic venous insufficiency
403
Which nucleoside analogue antiviral drug doesnt need both herpes viral and cellular kinases for conversion to their active form?
-cidofovir --> only needs cellular kinases for acivation!
404
What structure can be used to tell indirect and direct inguinal hernias appart?
- inferior epigastric artery
- Medial to inferior epigastric a = Direct inguinal hernia
- Lateral to inferior epigastric a = Indirect inguinal hernial
- "MDs dont LIe"
405
Amitriptyline: sfx?
1. Sedation
2. Alpha1-blocking effects --> inc postural hypotension
3. Atropine-like side effects --> anti-Ach effects = tachy, urinary retention, dry mouth, etc.
* *so especially use with caution in pts with BPH bc of the urinary retention sfx!
406
Factor V Leiden dz
- mutant factor V that is resistant to degradation by activated protein C
- MOST COMMON cause of inherited hypercoagulability in whites!
- causes DVTs and PEs
407
What receptors does phenylephrine effect? Rank them!
Alpha 1 > alpha 2
408
Metabolic alkalosis: labs? most common causes (4)?
-most common causes:
1. Vomiting
2. NG suction
3. Diuretic use
4. Hypoaldo
Labs: high arterial blood pH, HCO3, and pCO2
-check chloride levels to help determine the cause of the metabolic alk!
409
Where is low frequency sound best detected in the ear?
-at the apex of the cochlea near the helicotrema
410
What usually happens with strawberry-angiomas?
-they first increase in size and then regress spontaneously
411
Sumatriptan: clinical use
1. Migraine attacks
| 2. Cluster headache attacks
412
What tumor marker is structurally similar to TSH?
- hCG
413
Generalized transduction
BACTERIAL
- a "packing" event
- lytic phage infects bacterium --> cleavage of bacterial DNA
- parts of bacterial DNA can get packaged into a viral capsid
- the phage then infects another bacteria and transfers these genes!
414
Shiga-like toxin
- AKA: vero cytotoxin (VT)
- produced by enterohemorrhagic E. coli (EHEC)
- can inhibit protein synth in human cells --> enhances cytokine release --> causes intestinal mucosa cell death + direct toxicity to renal endothelial cells --> causes HUS
- closely related to shiga toxin produced by shigella, but does not invade host cells!
415
Where does lymph from the scrotum drain?
-to the superficial inguinal lymph nodes
416
Aicid/base status in DKA?
- causes a high anion gap metabolic acidosis that is usually accompanied with a compensatory resp alk
- see: low pH, low serum bicarb, and low PaCO2
417
What is the most common cause of sudden cardiac death with an acute MI?
-ventricular fibrillation
418
What 3 cytokines mediate a systemic inflammatory response and can cause an increased ESR?
1. IL-1
2. IL-6
3. TNF-alpha
419
Intrathecally
-giving a med dirrectly into the CsF
420
Nitroprusside: MOA? Clinical use? Toxicity? Antidote?
- increases cGMP via causing a direct release of NO
- used in emergencies when blood pressure needs to be decreased quickly
- sfx: causes cyanide toxicity, esp at high doses
- antidote to cyanide tox: sulfur (sodium thiosulfate)
421
Alkaptonuria: what is it? Sx? Px? Genetics?
- autosomal recessive
- accumulation of homogentistic acid (AKA alkapton) in the body that causes pigmentation of connective tissue (ears, eyes, etc) and causes arthritis in adults
- urine turns black when exposed to air
- px: deficient in homogentistic acid oxidase
422
Labs in hemophilia A
- PTT prolongation
| - other hem function tests are usually normal (PT, TT, and bleeding time)
423
Dobutamine
- B-adernergic agonist
- predominately effects B1 receptor, with some B2 activity, and some a1 activity
- used for acute heart failure that is assoc with decreases myocardial contractility
- stimulates an increase in cAMP production, which causes:
1. Increased inotrophy
2. Slightly increases chronotrophy --> increases O2 consumption, so negative effect
3. Increases cardiac conduction velocity, also a negative effect --> can cause arrhythmias
424
Heteroplasy
- mixture of two types of genetic material
| - responsible for the clinical variability of mitochondrial diseases
425
Reticulocyte: what is it? What are its microscopic features?
- immature RBC
- slightly larger than RBC
- lacks nucleus
- bluish bc still contains rRNA
426
Hepatic encephalopathy: what can precipitate it?
- GI bleed (ex. Hematemesis)
- any stressor that alters the ammonia balance of the body (ex. Hypovolemia, hypokalemia, metabolic alkalosis, hypoxia, sedative use, hypoglycemia, infection)
427
4 common causes of elevated creatine kinase?
1. Hypothyroidism
2. Statins
3 autoimmune dz
4. Muscular dystrophies
428
What is the drug of choice for oral candidiasis? MOA?
- Nystatin
- topical --> "swish and swallow"
- same MOA as amphotericin B = binds ergosterol and tears holes in the membrane
429
In what vasculitis do you see IgA and C3 deposition? What 3 sx are commonly seen? What is a possible complication?
1. Puritic rash
2. Colicky abdominal pain
3. Polyarthralgia
* *usually self limiting dz
- complication: acute glmoerularnephritis
430
Enterococci: what 3 diseases can it cause?
1. UTI
2. Biliary tract infections
3. Subacute endocarditis (esp. After GU procedures)
431
Which sensory pathways (2) relays in the VPM?
- taste: gustatory pathways
| - touch from face: trigeminal pthwys
432
Shat is the rate-limiting enzyme in the urea cycle? What activates it?
- carbamoyl phosphate synthetase I (CPSI)
| - activated by N-acetylglutamate (NAG)
433
Estradiol
- peripheral estrogen made from aromatization of testosterone
- can also be made from estrone
434
Follicular lymphoma: genetics
-t(14;18) translocation of heavy chain Ig (14) and bcl-2 (18-normally inhibits apoptosis)
435
Bronchiolitis? Ssx? What causes it?
- ssx: URI followed by-
1. WHEEZING
2. Cough
3. Resp distress
- caused by: respiratory syncytial virus
436
What is common pulmonary complication of CREST syndrome? What can it lead to?
- pulmonary HTN
| - can lead to hypertrophy of RV and eventually right-sided heart failure
437
How do you tell the difference btwn an insulinoma and oral hypoglycemics abuse?
-screen the urine for hypoglycemic agents, the urine will be positive only in the pts abusing hypoglycemic agents
438
Great saphenous v.
- longest vein in the body
- located superficially in the leg
- commonly used for cardiac bipass surgery, taken either from:
1. Medial leg
2. Point of origin in the upper thigh near femoral triangle = just inferior to public tubercle
439
Budd-chiari syndrome
- occlusion of the hepatic v (drains blood from the liver and portal circ into the systemic circ)
- will see centrilobular congestion and fibrosis
440
3 general ssx of hepatitis
1. Fever
2. Anorexia
3. Nausea
441
What causes painless genital ulcer that is followed weeks later by swollen, painful inguinal nodes that coalesce, ulcerate, and rupture?
-chlamydia trachomatis
442
What 4 sx are commonly seen in syringomyelia?
1. Segmental loss of upper extremity pain and temp
2. LMN damage signs in the upper extremity
3. UMN damage signs in the lower extremity
4. Scoliosis
443
How is excess copper usually excreted in a normal pt?
- copper is combined with alpha-globulin --> forms cerruloplasm --> goes into plasma to make up most of the circulating copper
- old cerruloplasm and excess unabsorbed copper is secreted into the bile (via liver) and excreted in the stool
444
Osteogeneic imperfecta: px? Ssx? Inheritance?
- defective synthesis of type I collagen --> causes an impairment of bone matrix formation
- ssx: multiple fractures after only minimal trauma, blue sclera, small/malformed teeth
445
What are 2 common side effects of ALL nitrates? What causes them?
1. Headache
2. Facial flushing
- bc vasodilation in the meninges and skin
446
What receptors does dobutamine effect? Rank them!
Beta 1 >> beta 2 = alpha 1 = alpha 2
447
What are the three main sources for energy for myocardial cellular fctns? Which makes the most ATP? Which uses the most oxygen to make ATP? What is actually the main source used?
1. Glycolysis (30%)
2. Glucose oxidation (30%)
3. Fatty acid ox --> makes the most ATP! Uses the most oxygen! Main source (60%!!)
448
Echinococcus granulosus: what dz does it cause? Tx? what can be a complication? What can be done to avoid the complication?
- causes cysts in the liver
- tx: bendazole + surgical removal
- if antigens are released during surgical removal it can cause anaphylaxis --> preinjected with ethanol before removal to kill cyst
449
Amitriptyline: MOA & clinical uses
- tricyclic antidepressant
- blocks the reuptake of NE and serotonin
- clinical uses:
1. Major depression
2. Fibromyalgia
3. Painful diabetic neuropathy
450
Wiskott-Aldrich syndrome: triad of sx, inheritance, when do you first see it, tx
Triad:
1. Eczema
2. Recurrent infections, esp with encapsulated bugs and opportunistic infections, due to a combined B and T lymphocyte disorder
3. Thrombocytopenia
- X-linked disease
- first seen @ 6mnth, bc thats when baby loses mom's Igs
- tx bone marrow transplant
451
Gallstone ileus
- rare
- mechanical bowel obstruction that is caused by a large gallstone that erodes into the intestinal ileum
- ssx: crampy abdominal pain, vomiting, and abdominal distention
- pneumobilia is often seen
452
Graft-versus-host transplant rejection: ssx?
1. Maculopapular rash
2. Jaundice
3. Hepatosplenomegaly
4. Diarrhea
453
Non-pathogenic strains of corynebacterium diptheria acquire ability to cause pseudomembranous pharyngitis via?
-bia acquiring the Tox gene by a bacteriophage
454
Pilocytic astrocytoma: what is it? who is it seen in? Prognosis?
- low-grade, benign brain tumor that arises from astrocytes
- most common brain tumor in children
- usually found in the posterior fossa, esp. Cerebellum
- good prognosis
455
What is the c-peptide, proinsulin, and serum insulin levels in a pt taking exogenous insulin?
- decreased c-peptide
- decreased pro-insulin
- increased serum insulin
456
What is N-acetylglutamate produced from?
-produced from glutamate and acetyl CoA in a reaction that is activated by arginine
457
Cardial malformations commonly seen in DeGeorges?
1. Tetrology of fallot
| 2. Aortic arch anomalies
458
What developmental failure causes the formation of a cleft palate?
-cleft palate results when the palatine shelves fail to fuse with one another
459
What is iodotyrosine deiodination? What hormone is it controlled by?
- allows the thyroid gland to recycle
- non-functional mono- and diiodotyrosine are de-iodinated so the iodine can be reused
- TSH up-regulates this process
460
Two common site for metastases?
1. Lymph nodes
| 2. Liver
461
Treatment of 21-hydroxylase deficiency
-low dose exogneous corticosteroids --> will cause negative feedback to suppress the ACTH secretion
462
What are the 4 second generation neuroleptics? What do they treat?
1. Clozapine
2. Risperidone
3. Olanzapine
4. Quetiapine
- they treat BOTH the positive and negative sx of schizophrenia!
463
Why can risperidone cause amenorrhea?
- risperidone can cause hyperprolactinemia --> causes hypogonadism via inhibiting release of gonadotrophin releasing hormone from hypothalamus
- this occurs bc of its antidopaminergic action
464
What are 3 monosaccharides? How are they absorbed?
1. Glucose
2. Galactose
3. D-xylose
* *they are absorbed directly WITHOUT the action of pancreatic enzymes --> SO, they are not affected by pancreatic insufficiency!!
465
FSH, LH, estradiol, and estrone levels in anorexia + reason for these changes
- FSH = v
- LH = v
- estradiol = v
- estrone = v
- drop in body fat below normal levels --> v LH surge --> amenorrhea
- hypogonadotrophic amenorrhea
466
Toxoplasmosis: what 2 diseases can it cause?
1. brain abscess in HIV (ring-enhancing brain lesion)
| 2. Congenital toxoplasmosis
467
What does cyanotic toes and renal failure in an elderly pt after an invasive vascular procedure characteristic of? Pathogenesis?
- atheroembolic disease
| - cholesterol containing debris gets pushed from larger arteries to smaller during the procedure
468
What dz is granular casts been seen in a key finding for?
- acute tubular necrosis
| - "muddy brown casts"
469
Hyperacute transplant rejection: when does it occur?
-within minutes
