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USLME Kiss my ass and pray > USLME - Grab Bag > Flashcards

USLME - Grab Bag Flashcards

1
Q

Hypertrophy - types of cells that only do this (3)

A

Growth of cell through organelle production

  • cardiac, skeletal, nerve
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2
Q

Hyperplasia

A

new cells from a stem cell

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3
Q

Dysplasia

A

disordered cell growth

also reversible

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4
Q

atrophy

A

decrease in stress -> decrease in organ size
Both:
apoptosis - lower cell #
smaller size - ubiquitin proteosome degradation and autophagy

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5
Q

Metaplasia

A

change in stress -> change in cell type
Reversible
chronic-> dysplasia

apocrine metaplasia of breast only one not increased risk for cancer

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6
Q

Aplasia

A

failure of cell production - embryogenisis

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7
Q

Hypoplasia

A

decreased cell production - embryogenesis

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8
Q

Ischemia

A

decreased blood flow

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9
Q

hypoxemia

A

low partial pressure of O2 in the blood

PaO2 <60mmHg

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10
Q

Coagulative necrosis - What is it and seen in?

A

necrotic tissue remains firm, cell structure is preserved

```
ischemic infarction (wedge shaped) - pale
except brain
~~~

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11
Q

liquefactive necrosis - What is it and seen in(3)?

A

necrotic tissue becomes liquified, enzymatic lysis

Brain infarct
abcess
pancreatitis

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12
Q

Gangrenous necrosis - what? and seen in (2)?

A

Resembles mummified tissue -

Ischemia of lower limp and GI

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13
Q

Caseous necrosis - what? and seen in (2)?

A

soft friable - cottage cheese
combination of coagulative and liquefactive

Seen in TB and fungal infections

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14
Q

Fat necrosis - what? and seen in(2)?

A

necrotic adipose w/ chalky white appearance w/ Ca deposit

Trauma to fat and pancreatitis mediated damage

Ca deposits on dead tissue - dystrophic calcification and normal serum [Ca] vs. metastatic which has high serum [Ca]

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15
Q

Fibrinoid necrosis - What? and seen in(2)?

A

necrotic damage to blood vessel - leaking proteins into vessel wall (pink)

Malignant HTN and vasculitis

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16
Q

PAS staining - periodic acid schiff

A

used to detect polysaccharides such as glycogen, and mucosubstances such as glycoproteins, glycolipids and mucins in tissues

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17
Q

Psommona Body tumors (4)

A

Papillary carcinoma of thyroid
Meningioma
papillary serous endometrial carcinoma
mesothelioma

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18
Q

Priaprism

A

Painful errection > 4 hrs

  • tazadone, hydralazine, prazolin, chlorpromazine, PDE inhibitors, alprostadil SE
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19
Q

Neural crest cell derivatives

A 
PNS
Melanocytes
chromaffin
parafollicular cells
schwann
 cells
pia/arachnoid
nines of skull
odontoblasts
aortiocpulmonary
corner
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20
Q

Mutation in HOXD13 lead to

Caused by?

A

synpolydacyly

retinoic acid

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21
Q

desmoplasia

A

excessive formation of fibrous tissue, seen around some tumors

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22
Q

Type 1 collagen

A

Strong
-bONE, skin, tendons, scar tissue

defective in ostogenesis imperfecta

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23
Q

Type 2 Collagen

A

Slippery

-cartilage, CarTWOlage, vitreous body, nucleus puposis

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24
Q

Type 3 Collagen

A

Bloody

-Reticulin, skin, blood, vessels, granulation tissue(beefy red)

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25
Q

Type 4 collagen

A

Basement membrane

defective in alport syndrome

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26
Q

Vitamin C is necessary for what in collagen

A

hydroxylation of lysine and proline

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27
Q

AA necessary for collagen formation(3)

A

Glysine, lysine and proline

-latter 2 are hydroxylated

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28
Q

AA for elastin production(2)

A

Glysine and proline

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29
Q

Ehlers Danslos syndrome is characterized by and due to?

A

Classic -hyper extensible skin and hyper mobile joints
-AD mutation in alpha chain of collagen and cross linking

Vascular - Easy bruising and bleeding disorders
-Auto recessive mutation

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30
Q

Hereditary nephritis, cataracts and sensoorineural hearing loss

A

Alport syndrome

  • due to Type IV collagen defect
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31
Q

hyperflexible, arachnodactyly, aortic dissection, lens dislocation

A

Marfans

  • defect in fibrillin scaffolding
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32
Q

Connection between elastin and emphysemia

A

alpha 1 antitripsin deficiency does not protect from elastase breakdown of elastin

-defective alpha 1 antitrypsin also builds up in the liver -> hepatitis

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33
Q

Mutliple fractures at different stages seen on x ray think (2)

A

Osteogenisis imperfecta - look for blue sclera and hearing loss and dental imperfections (defect in Type 1)

Child abuse

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34
Q

HAVe 1 M&M

A

Gq receptors w/ increased Ca as a result

phospholipase C-> PIP2 split into DAG and IP3

DAG-> protein kinase C

IP3 -> increased Ca intracellularly and smooth muscle contraction

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35
Q

Renal cell carcinoma paraneoplastic

A

PTHrP -> hypercalcemia w/ excess PTH

Erythropoietin -> polycythemia

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36
Q

Aspiration of peanut goes where?

upright and supine

A

lower portion of R inferior lobe- upright

superior portion of R inferior lobe -supine
-exits superior off the bronchi

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37
Q

Metformin is contraindicated when?

A

Renal failure - due to lactic acidosis adverse effect

Glipizide instead (not if hepatic dysfunction)

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38
Q

Hemolytic anemia in a neonate w/ + coombs suggestive of?

A

ABO or Rh incompatibility

See jaundice

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39
Q

Coombs reagent is?

A

Anti human IgG
indirect -> testing serum, normal RBC-> see if all 3 react

direct-> testing for Ab on RBCs in serum and see agglutination

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40
Q

Winged scapula injury?

A

long thoracic nerve

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41
Q

Acetazolamide causes what metabolic dysfunction?

A

Acidosis w/ inhibition of carbonic anhydrase you have local diuretic loss of bicarb w/out replacement

  • counter indicated in any acidosis
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42
Q

nerve exits from the spinal cord location?

A

C1-C7 above its vertebrae

C8, T1-12, L1-5 below its corresponding vertebra

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43
Q

Structure responsible for bone growth post fracture

A

periosteum containing osteoblasts

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44
Q

alpha fetoprotein tumor secretors(3)

A

heptaocellular carcinoma
yolk sac
nonseminomatous germ cell tumors

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45
Q

efficacy

Km and Vmax

A

maximal effect a drug can produce

-directly related to Vmax, NO effect on Km

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46
Q

potency

Km and Vmax

A

amount of drug to achieve a given effect

- high potence= high receptor affinity, inversely related to Km

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47
Q

kernicterus

A

neo natal high bilirubin levels -> brain dysfunction

ex- sulfonamides in pregnancy

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48
Q

Abx to avoid in pregnancy (8)

A 
sulfonamides - kernicterus
aminoglycosides - ototoxicity
fluoroquinolones - cartilage damage
Clarithromycin - embryotoxix
tetracyclines - teeth
ribavirin - teratogenic
griseofulvin - teratogenic
chloramphenical - grey baby
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49
Q

women’s oocytes are arrested in what stage for most of her life

A

prophase 1

Metaphase 2 right before conception

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50
Q

Poor prognosis cancers

A

Pancreatic adenocarcinoma

esophageal adenocarcinoma

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51
Q

MEN Type I tumors (3)

A

Pituitary - prolactin or GH
Parathyroid
Pancreatic endocrine - Zollinger Ellison, insulinomas, VIPoma,

Angiofibromas and lipomas common
“the diamond”

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52
Q

delerium Tremons

A

Seen in severe alcohol withdrawal w/ autonomic hyperactivity

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53
Q

presentation of failure to thrive, steatorrhea, acanthocytosis (Spiculated RBCs), ataxia and night blindness is?

Due to?

A

abetalipoproteinemia

Due to defect in microsomal tryglyceride transfer protein gene

inability to add B48 and B100 on VLD and chylomicrons to export out

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54
Q

Best way to test for chronic alcohol in the system

A

Serum gamma gutamyl transpeptidase (GGTCP)

Tox screen - acute alcohol levels

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55
Q

deficiency in arysulfitase A

A

metachromic leukodytrophy

accum of cererbroside sulfates

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56
Q

deficiency in beta-glucocerebrosidase

A

Gaucher disease

-> springolipidosis

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57
Q

Deficiency in beta-galactocerebrosidase

A

Krabbe disease

-> springolipidosis

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58
Q

Deficiency in sphingomyelinase

A

Niemann Pick disease

cherry red spots w/ Tay Sachs

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59
Q

Deficient in hexosaminididase A

A

Tay Sachs

Cherry red w/ Niemann Pick

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60
Q

t(11:22)

A

Ewing Sarcoma

Onion skin appearance on bone - w/ annaplastic small blue cell malignant tumors

Boys less than 15 yrs

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61
Q

yellow testicular tumor in young males?

Follow what marker

A

yolk sac tumor

follow AFP

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62
Q

Glycogen storage disease w/ cardiomegaly and other systemic findings (weakness w/ skeletal muscle)

implicated enzyme

A

Pompe

lysosomal alpha 1-4 glucosidase

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63
Q

Start a patient on anticoag (maybe post PE or acute coronary) and see a thrombocytopenia

Stop what drug and replace w/

A

Heparin due to HIT

lepirudin or bivalirudin
- does not use platelet factor 4 and have IgG activate against the complex

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64
Q

ixoide tick carried

A

borrelia burgidorferi

babesia microti

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65
Q

dermacentar tick carries

A

franciella tularnsis

rickettsia rickettsii

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66
Q

See a PE think of as a cause

A

DVT

like from the femoral vein

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67
Q

Bacteria associated w/ transformation

A

SHiN

Strep pneumo
H. influenza
Neisseria

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68
Q

Don’t forget if a kid presents w/ weight loss

A

may be diabetic and not bulimic

look at glucose levels

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69
Q

Presentation of seizures, renal, fever, thrombocytopenia, microangiopathic hemolytic anemia, w/ schistocytes and purport

A

Def in ADAM 13 cleavage

Thrombotic thrombocytopenic purpura
seen in younger women

lack of Fibrin split products and normal PT and PTT r/o DIC

very similar to HUS but here minus the mental ∆

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70
Q

Adenoyosis looks like endometriosis in presentation except

A

the uterus is enlarges,

endometrium w/in the myometrium

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71
Q

Muscle responsible for protrusion of the tounge

A

genioglossus

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72
Q

3 oncogenes associated w/ tyrosine kinase

A

HER2-neu
abl
ret

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73
Q

glalactose 1 phosphate uridyltransferase deficiency - presentation

similar to what other disease in theory

A

Auto recessive Galactosemia - STOP milk

FTT, jaundice, hepatomegaly, cataracts, retardation, Vomitting, diarrhea

Similar to aldose B deficiency and fructose - losing phosphates on sugars that can’t be utilized

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74
Q

2 virus families w/ reverse transcriptase capabilities

A

hepadnavirus - Hep B

Retrovirus - HIV

uses a RNA dependent DNA Polymerase

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75
Q

hemochromatosis presentation?

A

Bronze diabetes

  • skin pigmentation
  • DM
  • Cirrhosis

prussian blue stains for Fe

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76
Q

infected RBCs are cleared by?

A

NK cells due to lack of MHC I

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77
Q

HSV encephalitis affects which lobe

A

temporal

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78
Q

soap bubble lesions in the brain?
cause and type?

Test w?

A

Monomorphic yeast
cryptococcous neoformans

lattex agglutination 1st

india ink not as sensitive (heavily encapsulated)

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79
Q

most common cause of death before reaching the hospital w/ Acute MI

A

arrhythmia

V fibrillation w/in 24-48 hrs

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80
Q

prosopagnosia

A

inability to recognize faces

bilateral lesion of visual cortex

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81
Q

Na stibogluconate

A

Rx for Leishmania donovani

Carried by the sandfly

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82
Q

Triad of mono?

histo feature

A

Fever
Pharyngitis
LAD

CMV or LAD

Downey or atypical cells (C8 in origination though look like B cells)

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83
Q

Products seen in fasting?(2)

A

actetoacetic acid

3 betahydroxybutric acid

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84
Q

FAP is associated w/ mutation on chromosome?

A

5q21

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85
Q

CEA levels are elevated in ?

A

Colorectal cancer - not a good screener, great for monitoring

Seen in pancreatitis also

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86
Q

Hemophilia A due to

A

Hemophelia “Aight”
VIII deficiency

B is 9

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87
Q

Initiating factors of the coat pathway

Intrinsic ->

Extrinisic

A

Sub endothelial collagen
- Factor 12, 11, 9, 8

Tissue factor release by endothelial
Factor 7

All meet at 10

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88
Q

Goal of Coag pathway ?

A

make thrombin

which catalyzes the transformation of Fibrinogen to fibrin

Plasin (from plasminogen) breaks it up

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89
Q

Low K effects which coag factors

A

2, 7, 9, 10

7 being key for extrinsic -> PT and INR in warfarin monitoring

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90
Q

D dimer vs fibrin degeneration products?

A

D dimer is specific to clots made w/ thrombin
- activity of both thrombin and plasmin must be present

FDPs come from fibrin (mainly and circulating fibrinogen precursor)

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91
Q

Importance of conjugate vaccines?

A

provides a a protein antigen to facilitate the conversion of IgM to IgG w/ T cells stimulation

polysaccharide only gets IgM

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92
Q

hyper pigmented mouth, lips, palms, soles and skin w/ harmatomas, crampy abdominal pain at increased risk for?

A

AD Peutz jeghers

Colorectal cancer and other visceral malignancies (pancreatic etc.)

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93
Q

weird barbiturate name?

A

thiopental

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94
Q

Wide QRS may indicate (3)

A

signal not from purkinje:

  • premature ventricular contraction (PVC)
  • ventricular tachy
  • bundle branch block

narrow QRS indicates though the conduction system no matter what path or normal pays may be causing it

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95
Q

normal little box on ECG is

A

0.04sec

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96
Q

5 little boxes or 1 big box is?

Associated path if larger?

A

0.2 sec

If PR interval is bigger may have primary heart block

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97
Q

Normal PR interval

A

less than 200 msec (1 big box)

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98
Q

normal QRS interval

A

less than 120 msec (3 little boxes)

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99
Q

Common causes of L axis deviation (5)

A 
inferior wall MI
L anterior fasicular block
L ventricular hypertrophy
high diaphragm
LBBB
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100
Q

Common causes of R axis deviation (5)

A 
R ventricular hypertrophy
Acute R heart strain (PE?)
left posterior fasicular block
RBBB
dextrocarida
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101
Q

Positive deflection in ECG means?

Normally travels?

A

that the QRS is more above the line vs below (+) in the lead given

Normally travels down and to the left

Example positive in L I and LII normally

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102
Q

Lead where it is never normal to have positive deflection?

A

aVR

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103
Q

Target cells seen in?(4)

A

Thalassemia
hemoglobin C
Liver disease
asplenia - (sickle cell eventually)

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104
Q

Mutation of dystropin is found where

A

on the X gene-

need both for a girl(higher incidence in turner syndrome), one for a guy (recessive)

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105
Q

hernia travels through the inguinal canal through both deep and superficial rings and is lateral inferior epigastrics

A

Indirect hernia

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106
Q

hernia that only goes through the superficial ring by tearing a hill in the weak part of the abdominal wall in inguinal triangle medial to inferior epigastrics

A

direct hernia

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107
Q

stones, bones and groans presentation?

A

osteritis fibrosa cystica due to primary hyperparathyroidism

stones - renal stones

bones - increased alk phis and cystic spaces in the bones

groans- constipation/ weakness

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108
Q

Adductor pollicis inervated by?

A

Ulnar nerve

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109
Q

Lumbricals innervated by?

A

Lateral 2 median

Medial 2 ulnar

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110
Q

Interosseous muscle innervated by?

A

Ulnar nerve

- digital abduction and adduction

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111
Q

flexor pollicis brevis inervated by?

A

median nerve

Carpol tunnel and have them make an O w/ pinky and thumb
- thumb opposition

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112
Q

3 Paraneoplastic seen in small cell carcinoma

A

ACTH -> cushing
ADH -> SIADH
Abx against presynaptic Ca Channels -> lambert eaten syndrome

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113
Q

FeNa less than 1%

A

prerenal cause (hypovolumeia)

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114
Q

FeNa >2%

A

Intra renal cause like acute tubular necrosis

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115
Q

Normal BUN:creatine ratio

A

~15:1 usually

pathological >20:1 thinking prerenal causes

less than 15:1 interregnal issues like acute tubular necrosis

could also be causes w/ out flow like BPH leading to increased reabsorbtion of BUN into the blood

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116
Q

Increased aldosterone like in Conn syndrome leads to what metabolic disorder and why

A

metabolic alkalosis

increased aldosterone -> increase in K secreting channels in the cortical ducts in addition to eNaC Channels sequestering Na from the lumen

The K is lost but some of the K in the lumen also stimulates the loss of H as eel (alpha intercalated cells a little later on) -> H and K loss and alkalosis

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117
Q

Chronic renal failure can lead to this hormone imbalance?

Rx?

A

secondary hyperparathyroidism
due to impaired phosphate excretion and ultimately hypocalcemia

Calcimimetrics -> Cinacalate: increases sensitivity of PTH Ca sensing receptors decreasing PTH levels

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118
Q

Cinacalate?

A

increases sensitivity of PTH Ca sensing receptors of chief cells of parathyroid decreasing PTH levels

for secondary hyperparathyroidism

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119
Q

increasing the radius of a vessel drops resistance?

A

1/ (r^4)

120
Q

Pure mucinous gland in the mouth?

A

Sublingual
- sub mandibular mix
parotid - serous

121
Q

Supracondylar fracture damages what nerve?

seen w/ what deviation of the wrist?

A

median nerve

innervates flexor carpi radialis

flexor carpi ulnaris is unopposed (Ulnar nerve) leading to ulnar deviation

122
Q

endocarditis in SLE

A

aseptic vegitations

libman-sacks endocarditis

123
Q

LPL enzyme is found where?

A

endothelial cells

124
Q

In addition to bleeding what other toxicity is associated w/ Warfarin (2)

A

skin/tissue necrosis w/ protein C deficiency(hypercoaguable and microvascular thrombosis)
-> sharp, demarcated erythematous, purpuritic

Drug- drug

125
Q

lymph node biopsy shows large binucleated cells w/ prominent nucleoli and eosinophilic cytoplasm

A

Hodgkins

126
Q

Key feature of PTSD

A

disturbance lasting > 1 month
-Regardless of symptoms

Acute stress disorder 2 days - 1 month

127
Q

DVT predisposed by (3)

A

Stasis
hypercoagulability - defects in cascade (factor 5 - pregnant)
endothelial damage - exposed collagen

128
Q

Vitamin K’s function?

Synthesized where?

A

gamma carboxylation of glutamic acid

synthesized by intestinal flora, risk w/ broad spectrum Abx long term

129
Q

Lactulose given for?

MOA?

A

hepatic encephalopathy -> increased NH3 w/ urea cycle failure

reduces NH3 absorption from GI due to bacteria breaking it down and making it an acidic environment trapping NH3 and NH4+

130
Q

Cardiac amyloidosis w/out other organs involved?

A

transthyretin (TTR) of primary amyloidosis

131
Q

Fibrinoid necrosis can be seen in

- Fuck you pathoma (4)

A

Malignant hyper tension
preeclampsia
Vasculitis
Rheumatoid arthritis (w/ palisading epitheliod cells)

132
Q

Hypertension and BPH think of using a?

A

Alpha 1 antgonist

Prazosin/Terazosin

133
Q

metabolic alkalosis is a common problem w/ these drugs? (2)

A

Loop dieuretics - hyponatremia -> aldosterone and loss of K/H directly by alpha intercalated

thiazide diuretics - volume depletion -> aldosterone

134
Q

axillary nerve runs w/ what artery?

A

Posterior Circumflex

135
Q

See homovanillic acid, vanillylmandelic acid and metanephrine in the urine think of

A

Pheochromocytoma

COMT, MAOI -degradation products of
Dopamine
NE
Epi

136
Q

CD14 found on

also has

A

Macrophages

CD40

137
Q

CD 56 found on

also has?

A

NK cells

CD16

138
Q

CD 28 found on

A

T cells

139
Q

Most common cause of neonatal meningitis?

A

Streptococcus agalactia

  • E coli 2nd
    -listeria - 3rd
    -
140
Q

associated maladsorption complication w/ CF due to

A

deficiency in fat soluble vitamins ADEK w/ lack of lipase from the pancreatic duct

141
Q

tender thyroid

cause?

A

Dequervians, sub acute throiditis,

  • post viral

presents symptomatically like Hashimoto’s otherwise

142
Q

+ combs test and hemolytic anemia >37 degrees C

which antibody?

A

means warm agglutinin - will see hyperbilirubinemia, unconjugated

Found in SLE, drugs and other auto immune

IgG

143
Q

IgM against RBCs characteristic of

A

Cold agglutins w/ + combs at cold temps

Mycoplasma pneumonia or lymphoma cause

144
Q

Immediate hypersensitivity

A

Type 1

145
Q

Cytotoxic disease/hypersensitivity

A

Type 2

146
Q

Delayed hypersensitivity

A

Type 4

147
Q

Arthus Reaction

A

Type 3

148
Q

eruptive xanthomas

A

yellow papules due to elevated tryglycerides

149
Q

Rx for pregnant HTN (2)

how does it work?

A

Worry when diastolic > 100mmHg

Clonidine
-> direct alpha 2 agonist

alpha methydopa
-> converted to alpha methynorepiniphrine -> alpha 2 agonist

150
Q

Known ethambutol complication

A

neurotoxin -> optic neuropathy

TB drug

151
Q

non infectious cause of hand-foot erythema and desquamatizing rash

Concerned w?

A 
Kawasaki on kids < 5
Also see
-Cervical LAD
-Fever*
-conjunctival injection /bilateral
-strawberry tongue/ pharyngeal erythema

concern of coronary aneurisms

152
Q

hyperventilation leads to what changes in

pH?
vascular diameter

A

increases pH blowing off CO2 - respiratory alkalosis

Less CO2 -> less vasodilatation -> constriction
- lungs are an exception

153
Q

Only DNA virus family that contains its own DNA dependent RNA polymerase(iron associated transcriptase)

A

Poxvirus

brick shaped complexes

154
Q

Serum Marker for oxygen saturation

A

Lactic acid level

155
Q

topical retinoid acid use and HA due to

A

pseudotumor cerebri

Vitamin A toxicity, tetracycline, corticosteriods have been implicated

156
Q

Direct vs indirect Combs test

A

Direct Combs test is testing the blood for anti RBC antibodies attached - for example, the babies blood if they are undergoing hemolytic anemia

Indirect combs is testing the serum w/ test blood for the presence of anti RBC antibodies, if they cause clumping, example the mother who is Rho - and is concerned of IgG presence

157
Q

painful sharply demarcated erythematous rah 3-10 days after atria fibrillation and Rx is started be concerned of

A

Warfarin skin necrosis and microthromboemboli with initial hypercoaguability and KO of protein C and S at first

may present as painful red rashes

158
Q

associated immune compromised state w/ albinoism

A

Chediak Higashi Syndrome

Impaired microtubule function leading to NK cell disruption and other phagocytic cells

159
Q

Hemagglutin

A

what our body makes antibodies to in the flu, necessary for viral attachment

the h in h1n1

n is neuaminidase

160
Q

CD18

A

Implicated in leukocye adhesion deficiency

Lack of integrin -> increased infection and delayed wound healing

delayed separation of umbilical stump

161
Q

stapedius is innervated by?

A

CN7

dampens sound w/ loud noises,
damage leads to hyperacusis

162
Q

Cells that are CD30 and CD15 positive are

A

Reed Sternberg cells

seen in hodgkins lymphoma, usually no CD20

163
Q

Tartate resistant acid phosphatase

A

TRAP

Used to stain for hairy cell leukemia

164
Q

ADPCKD is associated with what major complication and treated w/ what

A

increased renin -> HTN

Rx w/ ACE or and ARB

165
Q

Gastric hypertrophy w/ protein losing enteropathy is?

What is seen on histology?

A

Menetrier’s disease

Increased mucous cell(excess mucous production) and and decrease in parietal cells

Rugae of stomach hypertrophied

166
Q

Renal Protective HTN medication in diabetes

A

Ace Inhibitors

  • just don’t use in bilateral renal stenosis
167
Q

Retinoblastoma caused by a mutation on what gene on what chromosome

A

Rb1

13

gene implicated in osterosarcoma as well

168
Q

Perfusion limited gas example and look of the graph

A

CO2 and N20

The graph reaches alveolar pressure early along the length of the capillary. limited by the amount of blood flowing through

169
Q

Diffusion limited gas example and look of the graph

A

CO and O2 in a diseased state (emphysema/fibrosis)

The graph of the partial pressure in the capillary does not reach alveolar pressure and is dependent. There is a difference

170
Q

3 damn Pyruvate enzymes what are they- what are their products

Pyruvate kinase
Pyruvate dehydrogenase
Pyuvate Carboxylase

A

PEP -> Pyruvate

Pyruvate -> acetyl Co A
-needs thiamine

Pyruvate -> oxaloacetate (gluconeogenesis) -> PEP and eventally glucose via PEP carboxykinase (weird little circle)

Biotin needed

171
Q

Medication for GAD w/ no sedation, addition or tolerance effects

Acts on what receptor

A

Buspirone
(not buproprion/welbutrin)
- takes 2 weeks to work

5HT1a agonist

172
Q

Diuretic that retains Ca

Dieretic that loses Ca

A

Loops lose Ca

Thiazides retain (hypercalcemia w/ PTH hyperexpression)

173
Q

Pyruvate kinase deficiency presents as?

A

hemolytic anemia due to increased rigidity of RBCs

May be seen in a newborn

Auto recessive

174
Q

young patient comes in with mousy odor, mental retardation and eczema

A

PKU

Auto recessive

175
Q

Polyhydraminos is due to?(2)

A

lack of fetal swallowing

  • anencephaly
  • intestinal blockage(atresias…)
  • diaphragmatic herniation

increased urination

176
Q

Most common dislocation of the humorous?

A

anterior

177
Q

vitilago vs albinism

A

decreased # of melanocytes in vitilago vs decreased melanin production w/ albinosim (less tyrosinase activity)

178
Q

secondary hyperparathyroidism is seen when?

Due to?

A

Seen in chronic renal failure due to:

Decreased renal 1 alpha hydroxylase making active D3

Decreased excretion of phosphate -> high PTH w/ low Ca levels

179
Q

Vitamin A is used to treat (3)

A

Measles
acne
AML - M3

180
Q

Ground glass appearance of HBV

A

fine cytoplasmic protein granules

181
Q

most common lasting sequel of herpes zoster

A

post herpatic neuralgia

- can be upwards of a month

182
Q

thiopental rapidly redistributes to?

A

adipose tissue and skeletal muscle

its a barbiturate used for induction of anesthesia

183
Q

Pellagara deficiency presents as?

Can be prevented with?

A

Diarrhea, dermatitis and dementia

due to B3 (niacin deficiency). B3 is a constituent of NAD and NADP (derived from tryptophan if made endogenously, also can come from diet)

184
Q

Which organ suffers the least risk of infarct due to a thrombi?

A

Liver - dual blood supply

185
Q

infection that sickle cell patients are especially susceptible too

A

Salmonella and osteomyolitis(occlusion -> necrosis -> colonization)

  • special capsule that prevents obsinization and vaccination

functional autosplenectomy in sickle cell

186
Q

Vitamin overdose that leads to these symptoms-> loss of appetite, stupor and hypercalcemia

Similar to what pathology otherwise ?

A

Vitamin D

similar to Granulomatous diseases - sarcoidosis and TB w/ hypercalcemia secondary to high levels of calcitriol (active Vit D)

187
Q

excitatory neurotransmitter involved in pain

A

substance P

188
Q

lysosomal storage disease associated w/ renal failure

A

Fabrys disease

  • X linked w/ peripheral neuropathy, angiokeratomas and CV disease as well

alpha glactodidase A is deficient

189
Q

lysosomal storage disease associated w/ bone crisis and macrophages that look like tissue paper

A

Gaucher’s disease

Glucocerebrosase deficiency

Auto recessive

190
Q

suprachondylar fracture going to effect what nerve?

A

median nerve

191
Q

immune deficiency problem of endoderm development

A

Digeorge syndrome

192
Q

Immune deficiency due to tyrosine kinase defect

A

Agammaglobulinemia

BTK gene (tyrosine kinase gene)

193
Q

conversion disorder

A

neurologic affliction of voluntary motor or sensory (pain, optic, paralysis etc) in the presence of stressor and no medical findings can confirm it. it cannot be limited to pain or sexual dysfunction

There is no secondary gain with the loss of function as well.

Somatization form - multiple physical complaints

194
Q

somatization disorder

A

numerous complaints starting prior to the age of 30

4 pain
2 GI
1 sexual
1 pseudoneurologic symptom

No medical findings

195
Q

rose spots on the abdomen and abdominal distress w/ hepatosplenomegaly, hemhorragic enteritis

A

salmonella typhi

196
Q

chamber of the heart laying next to the esophagus

A

Left atrium

197
Q

Where is the descending aorta in relationship to the esophagus?

A

behind

198
Q

herpes viruses are the exception to the rule in where they get their envelope for their membrane. Where is it from

A

nuclear membrane

199
Q

CD surface marker that inhibits complement from binding

A

CD 55 and CD 59

200
Q

CD surface markers found on Reed Sterberg Cells

A

CD15 and CD30

201
Q

deficiency in vWF will lead to what ∆s in lab values?

A

increased bleeding time mainly b/c it facilitates platelet aggregation/adhesion to GP Ib–1X

wWf also carries factor VIII increasing its half life so ultimately prolonged PTT if deficient

202
Q

Defect in delta aminolevulinic acid dehydratase (ALA dehydrastase) may be due to?

Accumulate?

What other enzyme is affected leading to basophilic stppiling

A

lead poisoning

protoporphyrin and delta ALA in the blood

Lead also blocks ferrochelatase -> blocking heme production

203
Q

Acute intermittent porphyria enzyme defect and presentation (5)

A

defect in porphobilinogen (3rd step in heme synth)

painful ab
port wine -colored urine
polyneuropathy
psychological disturbances
precipitated by drugs
204
Q

2 enzymes inactivated by lead

A

ferrochelatase -> final step in heme

delta-aminolevulinic acid dehydrates
- 3rd step in heme synthesis
(excess delta ALA in the serum)

ultimately microcytic anemia

205
Q

Myoglobin construction and oxygen response

A

Made of only one monomer of glob in vs hemoglobin made of 2 usually (2 alpha and 2 beta)

the presence of only one glob in -> lack of positive cooper ability (either all on or all off) NOT sigmoidal hemoglobin sat oxygenation curve (relative left shift)

206
Q

Patient w/ managed hyperthyroidism comes into a clinic with fever and throat pain. What extra step should be done and why?

A

WBC and differential due to agranulocytosis caused by propylthiouracil and methimazole

207
Q

seronergic neurons are found where in the brain stem

A

ralphe nucleus

208
Q

Patent foramen ovale occurs in what % of adults

A

20-30%
considered a variant of normal
-Functionally closed w/ high L atrial pressure vs R

-> paradoxical embolism w/ strokes and DVTs

209
Q

History of RA w/ no alcohol Hx presents w. fatigue, R abdominal pain; labs show high ANA and ASMA, elevated IgG and no viral markers

A

autoimmune hepatitis

ASMA = antismooth muscle Ab- Type 1

210
Q

Liver biopsy shows elevated LKM-1 antibodies, no alcohol Hx, no viral seromarkers. See infiltration of the portal and periprotal area w/ lymphocytes

A

autoimmune hepatitis

LKM-1 = liver/kidney microsomal Ab - Type II

211
Q

Substance needed for relaxation of the LES

A

Nitric Oxide

212
Q

Adenovirus causes (4)

A

DS linear virus w/o envelope

Pharygitis
Conjunctivitis
Pneumonia
hemorrhagic cystitis - most common viral cause in kids

213
Q

Oseltamivir MOA

A

Acts to block neuroaminidase activity and viral release

214
Q

2nd most common cause of osteomyolitis in kids

A
  1. Staph aureous

2nd Strep pyrogenies

215
Q

Patient has a fever, abdominal pain and diarrhea w/ a little blood. A couple days later he has hematuria and oliguria. Dx?

A

Hemolytic Uremia Syndrome

Due to Shigella like toxin EHEC or from Shigella reentry

thrombocytopenia

No DIC

216
Q

how does digoxin slow the HR

A

in addition to blocking Na/K ATPase -> increase in intracellular Ca

it also activates the vagus nerve

217
Q

Drugs used as anti nausea and sea sickness

A

meclizine M1 and H1 blocker
Dihendrimate M1 and H1

Scopolamine - H1

218
Q

acute pancreatitis is due to inappropriate activation of what enzyme most likely

A

trypsinogen -> trypsin which activates all pancreatic zymogens

lipase is secreted in active form and does not need further activation

219
Q

Thiamine deficiency is bad in alcoholics b/c

A

it is a cofactor in enzymes like pyruvate dehydrogenase (links glycolysis to TCA) and thus impaired glucose breakdown. -> wernicke in the acute setting (mammary bodies) Korsakoff in chronic

give glucose w/out thiamine exacerbates

220
Q

hemachromatosis is a defect in?

A

Iron absorption

Mutation on HLA - H on chromosome 6

221
Q

essential cofactor for transamination reactions

A

B6 pyridoxine

ALT and AST
-alpha leto group -> amino acid
Decarboxylation reaction
glycogen phosphorylase

222
Q

the onset of action of a inhaled anesthetic is dependent on what?

Example of a rapid onset drug

A

the lower the blood solubility the faster the onset. Spills into the brain that much faster
-can be expressed as blood/gas partition coefficient; lower the coefficient the faster the effect

NO2 is an example

223
Q

Statisical power is

A

the capability of rejecting the null hypothesis when it is truly false

1 - beta

224
Q

rare complication of a helical enveloped RNA virus that initially causes fever, cough, coryzea and conjunctivitis

A

subacute sclerosing panencephalitis
- due to virus missing an M antigen leading to no antibodies to this and failure of clearance

presents years later w/ataxia, myoclonus and visual disturbances

225
Q

Live attenuated viruses(6)

A 
Smallpox
yellow fever
chickenpox
Sabins polio
MMR
Influenza - intranasal
226
Q

Killed viruses(4)

A

RIP Always

Rabies
Influenza - injectes
Polio (sabins)
HAV

227
Q

Responsible for the breakdown of very long FA

A

peroxisome

also oxidase and catalase to metabolize toxic substances

228
Q

holosystolic blowing murmur

A

mitral regurgitation

229
Q

esophageal varices is due to anastomose between

A

L gastric vein and esophageal veins

230
Q

hemorrhoids is due to anastomose between

A

superior rectal veins and middle/inferior rectal veins

231
Q

Superior laryngeal nerve innervates

A

external branch =motor - the cricothyroid

internal branch = sensory above the vocal cords

Rest of the larynx innervated by recurrent laryngeal nerve - > muscle and sensory (below vocal cords)

All Vagus

232
Q

the part of the nephron w/ the highest osmolarity in absence of ADH

A

right after the descending loop of hence, only part really permeable to H2O if no ADH is available

233
Q

enzyme in bacteria w/ 5-3’ exonucleus activity

A

DNA polymerase I, removes the RNA primers and replaces w/ gap with 5’-3’

Polymerase III does general replication

234
Q

What drugs cause increased concern for Lithium toxicity if given together

A

Thiazide diuretics due to Li being treated like Na due to exclusive renal excretion. The loss of Na causes the proximal tubules to reabsorb more +1 cations (Na and Li)

also worry about NSAIDs and ACE inhib

235
Q

beta blockers in hyperthyroid state help in 2 ways

A

mitigate sympathetic stimulation

block peripheral conversion of T3->T4 through some unknown way

236
Q

18 month with fever, rhinitis and pharyngitis -> brassy cough and respiratory distress

A

Croup by parainfluenza

237
Q

test for primary hypothyroidism

A

TSH

238
Q

Drug induced SLE is often due to what sort of metabolism problem

A

slow acetylators in Phase II liver metabolism

vonjugation reactions -> very polar, inactive real excreted metabolites

239
Q

HIV Viral proteins encoded

gag
env
pol

A

gag- p24; capsid
env - gp120 and gp 41; membrane
pol - reverse transcriptase

240
Q

Drug of choice in ischemic ventricular tachycardia post MI?

A

lidocaine - Class 1B; Amiodarone also

tocainide
mexliletine

241
Q

more specific RA marker

A

anti cyclic citrullinated peptide

anti CCP

242
Q

red ragged muscle fibers on gomori Trichrome stain indicates

A

mitochondrial mutation

243
Q

Lambert Eaton presentation (4)

A

auto Abs to presynaptic Ca channels

Have issues w/ proximal muscle weakness that IMPROVES w/ muscle use (vs myasthenia gravis)

also antimuscarinic and CN (like III) involvement common

50% associated w/ small cell lung CA

244
Q

cafe au late spots associated w/ (2)

A

neurofibromatomas type 1

mckune albrite syndrome

245
Q

Examples of JAK kinase activators(4)

A

Growth hormone, prolactin, IL2, receptors for cytokines

tyrsosine kinase associated

246
Q

Examples of tyrosine kinase activators(3)

A

Growth factor receptors; EGF, PDGF, FGF

intrinsic kinase activity that phosphorylates RAS

247
Q

polyribisylribitol phosphate Ab indicates protection from

A

Haemophilus influenza

  • type b capsular polysaccharide conjugated to diphtheria toxoid
248
Q

allosteric activator of gluconeogenesis is?

Leads to increased pyruvate carboxylase

A

acetyl CoA

Increased acetyl CoA( from beta oxidation of FA)
-> increased pyruvate carboxylase reaction which sets the stage to get pyruvate out of the mitochondria (trapped w/ pyruvate kinase action) by converting pyruvate into oxelacetate (w/ biotin and pyruvate carboxylase)

-> malate which leaves-> oxelacetate again which can be converted back to glucose (1st step PEP carboxykinase)

249
Q

Rx for Conn’s Syndrome

Presentation?

A

Sprinolactone and epleronone

hypokalemic alkalosis, decreased renin activity, hypertension and fatigue, periodic HA

250
Q

Primary abducter of the humerous

A

supraspinatus

  • most commonly injured rotator cuff muscle, inserts superiorly on the head of the humorous and subject to impingement injury w/ acromion
251
Q

air in the gull bladder w/ long standing Hx of choleithiathias

A

gallstone in the ileum

252
Q

K1 antigen

A

E coli neonatal meningitis

253
Q

what needs to be substituted when using amphotericin B

A

K and Mg

Renal toxicity is a big side effect, cause renal vasoconstriction and decreased GFR; increased distal tubule permeability w/ necrosis

254
Q

parvo virus in adults vs kids

A

kids - 5ths disease

Adults is hydrous fettles if pregnant, bilateral arthritis ~ RA that is self resolving

255
Q

Leptin is?

Acts where

A

a protein made my adipocytes that act on the arcuate nucleus of the hypothalamus blocking the production of neuropeptide Y -

says I’m full - produces alpha MSH instead

256
Q

AA that feeds N directly into the urea cycle

A

Aspartate

257
Q

2 causes of fat redistribution due to medications

A
  1. Glucocorticoids -> cushings syndrome

2. HAART -> lipodystrophy; protease inhibitors

258
Q

Major contraindication for metformin

A

Renal failure

  • Lactate acidosis is common side effect
259
Q

Thyroid levels are monitored w/ what 2 drugs?

A

Lithium

Amiodarone

260
Q

albumino cytologic dissociation

A

CSF finding in Guillain barre syndrome where the protein is increased w/ no change in cell count

261
Q

Arteries w/ nerves to relook at

anterior interosseous
posterior interosseous
posterior circumflex
suprascapular artery
deep brachial artery
dorsal scapular artey
lateral thoracic artery
Ulnar artery
brachial artery
A

anterior interosseous - anterior interossous nerve (median)
posterior interosseous - deep radial
posterior circumflex - axillary
suprascapular artery - suprascapular nerve
deep brachial artery - radial
dorsal scapular artery - dorsal scapular nerve
lateral thoracic artery - long thoracic nerve
Ulnar artery - ulnar nerve
brachial artery - median nerve

262
Q

general empiric treatment with a baby’s infection

A

ampicillin and gentimycin

263
Q

SIDS

When does it occur

Prevention

A

2-4 months

sleep on back avoid co sleeping smoke exposure,
Preventative- breastfeeding, pacifier, fan

264
Q

Risk factors for SIDS

Maternal

baby

A

smoker, low SES, <20

Low birth weight, male, premature, prone sleeping,

265
Q

Low birth weight bevy defines as?

Risk of (5)

A

<2500 g

infections/sepsis
neonatal RDS
necrotizine entercolitis (feeding too fast)
circulatory problems (insufficiency)
SIDs
266
Q

Neplasms in kids(12)

A 
ALL
Astrocytoma
Neuroblastoma - adrenals
hemangioma
Wilms tumor
Hepatoblastoma
retinoblastoma
rhabdomyosarcoma
ewing sarcoma
osteogenic sarcoma
lymphoma 
teratoma
267
Q

Tanner stages in

Boys genitalia

A

1 -prepubital

  1. enlargement - scotum /testes
  2. enlargement - penis length
  3. Penis grows in breadth/testes enlarge
  4. Adult
268
Q

Tanner stage in girls

A
  1. prepubital
  2. bud elevation, aereola enlarges
  3. Further enlargement
  4. Areola and papilla form secondary mound
  5. mature
269
Q

Female development timeline

Breasts/Growth/menarche

A

breasts around 11
Growth 12
menarche 13

270
Q

Male development timeframe

A

tanner stage 2 - 12

growth 14-15

271
Q

APGAR

means? - amount

A 
A- appearance 
- 0 cyanotic, 1 hands/feet, 2 pink
Pulse
-0 none, 1: 100
Grimace
-0 no response   2, pulls away from neg stimulus
Activity
-0 -limp 2- resisits extension
R - respirations
0- none; 1- gasping; 2 crying vigorus
272
Q

birth - 3 months highlights

A

rolls over at 3 months
social smile
orients and respons to voice

273
Q

7-9 month highlights

A

Sits alone, crawls, transfers toys from hand to hand

Stanger anxiety - when someone approaches

babbles and plays peek a boo, name recognition

274
Q

12-15 months highlights

A

walks, babinski disappears

separation anxiety - mom leaves and baby freaks

few words 1-3

275
Q

12-24 month highlights

A

climbs stairs, stacks blocks (6 blocks at 2)

use of fork or spoon, 6 words at 15 months

2 word phrases

276
Q

core gender identity at

A

2-3 yrs

277
Q

when to begin potty training?

A

2-3

278
Q

Parallel play vs cooperative play time line

A

2-3 yrs vs 4 yrs

279
Q

Jumping kid and feeds w/ fork/spoon

A

2-3 yrs

280
Q

copies lines and circle, stairs and complete sentences

A

3 yr old

281
Q

grooms self, hops on one foot and has an imaginary friend

A

4 yr old

282
Q

translocation w/ AML M3

characteristic smear/

A

(t 15:17)

Auer rods (many)
-Some may be in M2 (t 8:21)
283
Q

TdT - deoxynucleotidetransferase is positive when?

A

ALL

Precursor b
- CD 19 or CD10

Precursor T cells
- CD 1, CD2 or CD5

284
Q

most common clinical manifestations of Vit E deficiency (2)

A

neuromuscular disease
-skeletal myopathy
-spinocerebellar ataxia
pigmented retinopathy

Hemolytic anemia

protects FA from beta oxidation

285
Q

hydlrazine and minoxidil have what side effects?

A

reflex tachycardia and renin activation -> Na and water retention

286
Q

Patients w/ essential fructosuria can still metabolize fructose partially through

A

hexokinase

fructose -> fructose 6 phosphate

low affinity

287
Q

cricopharyngeal dysfunction leads to

A

zenker diverticulum

288
Q

ecthyma gangreosum

A

necrotic black skin lesion associated w/ septic pseudomonas infections in immune compromised

289
Q

true vocal cords are covered by?

other areas w/ same covering?

A

stratified squamous cells

includes upper half of posterior epiglottis, anterior epiglottis, oropharynx, laryngopharynx,

rest is pesudostratified ciliated columnar cells

290
Q

short acting benzo - <6hrs

A

triazolam or alprazolam

loazepam is intermediate

the rest are long - >24hrs

  • diazepam
  • flurezapam
291
Q

RPF vs RBF

A

Renal plasma flow vs renal blood flow

get renal blood flow from RPF/(1-Hct)

RPF = [U(urine PAH) x V]/ P(plasma PAH)

292
Q

postcervical lymph nodes(3)

A

EBV - mono
cat scratch fever - bartonella henslae
acute otitis media

293
Q

pigmented harmatoma in the iris

A

Lisch nodules in neurofibromatosis

294
Q

50 yr old man w/ new unexplained skin yellowing and no other symptoms need to r/o

A

pancreatic CA - Head

painless jaundice

295
Q

alpha keto acid dehydranse

A

deficiency implicated in maple syrup syndrome

  • blocks degradation of leucine, isoleucine and valine

USLME Kiss my ass and pray (33 decks)

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