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USMLE > USMLE QBank Review > Flashcards

USMLE QBank Review Flashcards

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USMLE® Step 1 flashcards
1
Q

Scaphoid Fractures

A
  • most common of carpal bone fractures
  • from fall on outstretched hand
  • pain and tenderness in the anatomical snuffbox (scaphoid and trapezium for the floor)
  • scaphoid branch of radial artery supplies scaphoid
  • fractures = avascular necrosis and nonunion
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2
Q

Dupuytren’s Contracture

A
  • slowly progressive fibroproliferative disease of the palmar fascia
  • nodules form on the fascia, eventually resulting in contractures that draw the fingers into flexion
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3
Q

Opiod analgesics Sideefects

A
  • I.e. Morphine
  • can cause contraction of smooth muscle cells in sphincter of oddi leading to spasm and an increase in common bile duct pressures
  • cause histamine release leading to vasodilation of blood vessels and itching = can cause hypotension
  • constipation
  • no direct toxic effect to liver but is metabolized by liver
  • increase somatostatin secretion from pancreas
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4
Q

Sarcomere

A
  • A band = thick filaments in sarcomere and includes portions overlapped by thin filaments. H band is apart of the A band
  • I band = contains the Z line and actin filaments that do not overlap with thick filaments
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5
Q

Oral vs Anal drug bioavailability

A
  • when taking an oral drug there is first pass metabolism by the liver which diminshes drug concentration in the systemic circulation
  • sublingual drug administration can help bypass first pass metabolism
  • rectal drug administration partially bypasses the first pass metabolism because 2/3 of venous drainage goes straight to IVC while the other goes into the portal veinous system
  • IV, sublingual, and rectal administration bypasses some or all first pass and allows more drug to reach systemic circulation
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6
Q

Anti-Smith Antibodies

A
  • associated with SLS
  • smith protein normally complexes with small nuclear RNA in cytoplasm that forms SnRNPs
  • autoantibodies directed against SnRNP’s = anti-smith antibodies ==> defect in removal of introns from mRNA
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7
Q

RNA types

A

RNA polymerase 2 = mRNA and snRNA

- other types of RNA are rRNA and tRNA

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8
Q

Lesch Nyhan Syndrome

A

If purine salvage is impaired then the activity of PRPP amidotransferase will increase to supply de novo purine synthesis
- X linked recessive disorder

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9
Q

Southwestern Blot

A

Helps to identify DNA binding proteins
Uses double stranded DNA as a probe (compared to Southern and Northern blot that use single stranded DNA as probes)
-c-Jun and c-Fos are nuclear transcription factors that directly bind DNA via a leucine zipper motif
- Southwestern Blots are used to detect DNA binding proteins like transcription factors, nucleases, and histones

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10
Q

Lesch Nyhan Syndrome

A

If purine salvage is impaired then the activity of PRPP amidotransferase will increase to supply de novo purine synthesis
- X linked recessive disorder

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11
Q

Cystic Fibrosis

A
  • mutation in CFTR gene due to phenylalanine deletion
  • chronic pulmonary infections, bronchiectasis, pancreatic insufficiency, digital clubbing
  • infertility due to absence of vas deferens bilaterally (azoospermia)
  • meconium ileus in new born
  • CFTR gene mutations are the most common cause of bilateral absence of the vas deferens
  • can diagnose with elevated sweat chloride levels and measurement of nasal transpeithelial potential difference
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12
Q

Primary Ciliary Dyskinesia

A
  • dynein arm defect - abnormal ciliary motion and impaired mucociliary clearance
  • chronic pulmonary infections
  • situs in versus
  • infertility due to immotile spermatozoa
    Diagnosis
  • low nasal nitric oxide levels
  • genetic testing
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13
Q

Kleinfelter Syndrome

A
  • most common meiosis nondisjunction
  • the higher numbers of X chromosomes = more severe manifestations
    Clinical features
  • primary testicular failure due to hyalinization and fibrosis of the seminiferous tubules ==> infertility and cryptorchidism
  • testosterone deficiency causes eunuchoid body habits = tall stature and gynecomastia
  • facial and body hair are sparse or absent
  • mild intellectual disability
  • gynecomastia
  • long legs
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14
Q

Marfan Syndrome

A
  • arachnodactyly, scoliosis, aortic root dilatation

- due to an inherited defect of the ECM protein fibrillin

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15
Q

Fragile X Mental Retardation

A
  • Macroorchidism = enlarged testes
  • large jaw and long face
  • large Everett ears
  • mitral valve prolapse, flat feet, and hypotonia
  • intellectual disability

CGG repeat
X -linked = affects the methylation and expression of the FMR1 gene

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16
Q

Turner Syndrome

A

45 XO

  • short stature
  • broad chest
  • primary amenorrhea
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17
Q

Bloom Syndrome

A

Premature aging due to shortened telomeres

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18
Q

Telomerase

A
  • reverse transcriptase (RNA-dependent DNA polymerase)

- lengthens telomeres by adding TTAGGG repeats to the 3’ end of chromosomes

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19
Q

Insulin Biochemical Pathway

A

Anabolic hormone that acts via tyrosine kinase signaling to increase the synthesis of glycogen, proteins, fatty acids and nucleic acids
-Tyrosine kinase/phosphatidylinositol-3-kinase stimulation promotes glycogen synthesis by activating protein phosphatase, an enzyme that de phosphorylates (activates glycogen synthase)

Once pro insulin is made in the RER there is cleavage of pro insulin in the islet cell secretory granules that yields insulin and C-peptide which are stored in the granule until they are secreted in equimolar amounts

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20
Q

What is tetrahydrobiopterin a cofactor for?

A

Tetrahydrobiopterin (BH4) is a cofactor in the synthesis of serotonin, tyrosine, and DOPA

Phenylalanine –> Tyrosine –> DOPA –>Melanin or Catecholamines

Tryptophan –> 5 hydroxytryptophan –>Serotonin

  • serotonin is formed via hydroxylation and decarboxylation of tryptophan
  • Phenylketonuria can result from BH4 deficiency due to Dihydropyridine reductase deficiency ===> serotonin deficiency and hyperphenylalanemia. Treatment = low phenylalanine diet and BH4 supplementation
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21
Q

Ventricular Septal Defect

A

Low pitched holosystolic murmur heard best at the left sternal border with increase in hand grip

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22
Q

Atrial Septal Defect

A
  • mid-systolic pulmonary ejection murmur that results from increased flow across the pulmonic valve
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23
Q

Aortic Regurgitation

A

Early diastolic murmur

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24
Q

Genital Ulcer Disease

A

Check Pictures

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25
Q

Mechanism of Action of Bacterial Toxins

A

Check Pictures

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26
Q

Water Soluble Vitamins

A

See Pictures

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27
Q

Coronary Steal Syndrome

A
  • collateral micro vessels form adjacent pathways for blood flow to areas distal to an occluded vessel
  • Adenosine and dipyridamole are selective vasodilators of coronary vessels that can cause coronary steal = blood flow in ischemic areas is reduced due to arteriolar vasodilation in non ischemic areas because ischemic areas are already maximally vasodilated due to local vasodilators.
    Coronary steal can lead to hypoperfusion and worsening of existing ischemia
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28
Q

Ehlers Danlos syndrome

A
  • group of hereditary disorders characterized by defective collagen synthesis
  • caused by procollagen peptidase deficiency which causes impaired cleavage of terminal propeptides in the extra cellular space

Clinical manifestation

  • joint laxity
  • hyper extensible skin
  • tissue fragility due to the formation of soluble collagen that does not properly cross link
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29
Q

Uncomplicated umbilical Hernia

A
  • defect at the linea covered by skin
  • caused incomplete closure of the umbilical ring which allows for protrusion of bowel through the abdominal musculature
  • most are reducible, asymptomatic, and resolve spontaneously in first few years of life
  • reducible bulge at the umbilicus notably with increased abdominal pressure
    Associated with Down syndrome, hypothyroidism, beck with-Wiedermann syndrome
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30
Q

Oomphalocele vs. Gastrochisis

A

O = midline herniation of abdominal contents contained within a membranous sac

G = full thickness abdominal wall defect that presents as intestines outside sac

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31
Q

Pharyngeal Arches

A 
First = trigeminal nerve and maxillary artery 
Second = facial nerve, muscles of facial expression, and stapedial artery 
Third = glossopharyngeal nerve, parts of the hyoid bone and stylopharyngeous muscle, common and proximal internal carotid arteries
Fourth = superior laryngeal nerve of the vagus, muscles of the pharynx and soft palate, and some laryngeal muscles. Aortic arch and subclavian arteries 
Fifth = obliterated during fetal development 
Sixth = recurrent laryngeal nerves of the vagus, muscles of larynx, pulmonary arteries and ductus arteriosus

LOOK AT PICTURE

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32
Q

Prolactin facts

A
  • manufactured due to stimulation by TRH and is inhibited by progesterone

Although prolactin secretion increases as pregnancy progresses, high progesterone levels inhibit lactation through negative feedback on prolactin on the anterior pituitary

Lactation during pregnancy is suppressed due to high progesterone levels inhibiting the anterior pituitary

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33
Q

Craniopharyngiomas

A
  • supra stellar tumors found in children and composed of calcified cysts containing cholesterol crystals. They come from remnants of Rathke’s punch an embryonic precursor of anterior pituitary
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34
Q

Osteoporosis Facts

A
  • African American women have higher bone density through out their lives than women of other ethnicities

Non Modifiable risk factors

  • advanced age
  • female sex
  • white Hispanics or Asian ethnicity
  • personal or family history of fractures

Modifiable Risk factors

  • decreased physical activity
  • Low BMI
  • poor calcium and vitamin D intake
  • excessive alcohol or tobacco use
  • premature menopause
  • glucocorticoid use
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35
Q

Rheumatoid Arthritis Complication

A

Long standing rheumatoid arthritis can affect the cervical spine and cause vertebral malalignment that can affect the atlantoaxial joint
- extension of the neck during endotracheal intubation can worsen the subluxation leading to acute compression of the spinal cord and vertebral arteries causing sudden areflexia of all extremities

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36
Q

Intra ventricular Hemorrhage

A
  • blood in the ventricles of the brain
    Common due to prematurity
  • Can be silent or present with altered level of consciousness, hypotonia, and decreased spontaneous movements
  • Symptoms: bulging anterior Fontanelle, hypotension, decrebrate posturing, tonic-clinic seizures, irregular respirations, and coma

Usually originates from the germinal matrix

Increased frequency with decreasing age and birth weight

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37
Q

Clear Cell Carcinoma

A

Most common subtype of Renal Cell carcinoma

  • appears as cuboidal or polygonal cells with clear abundant cytoplasm and eccentric nuclei
  • golden yellow on microscope due to high glycogen and lipid content
  • originates from proximal renal tubules

Risk factors include smoking and obesity

Renal oncocytomas = collecting duct cells (with numerous mitochondria)

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38
Q

Viral Myocarditis

A

Progressive onset of heart failure in the setting of a recent viral infection = dilated cardiomyopathy

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39
Q

Filtration Fraction

A

FF = GFR/RPF

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40
Q

Prokaryotic DNA polymerases

A

All 3 can remove mismatched nucleotides via their 3’-5’ exonuclease activity

Only DNA polymerase 1 has 5’ to 3’ exonuclease activity which is used to remove the RNA primer synthesized by RNA primase

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41
Q

Transketolase

A

Converts Fructose 6 phosphate to a ribose sugar in the non-oxidative part of the HMP Shunt

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42
Q

Phenylketonuria

A

Autosomal recessive defect of phenylalanine hydroxylase or BH4 (tetrahydrobiopterin)
- Children present with intellectual disability, seizures, eczema, light haiir/skin, and a musty Odor

Screening occurs 2-3 days after birth because the mother makes enzyme for fetus

Maternal PKU = lack of proper dietary therapy during pregnancy = microcephaly, intellectual disability , growth retardation, congenital heart defects in child

Treatment = restriction of phenylalanine intake and supplementation of tyrosine , must avoid artificial sweetener aspartame

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43
Q

Anaplastic Tumor Characteristics

A

Cells that demonstrate a complete lack of differentiation

  • loss of cell polarity with complete disruption of normal tissue architecture, cells coalesce into sheets or islands in a disorganized fashion
  • significant variation in the shape and size = cellular and nuclear pleomorphism
  • Hyperchromatic nuclei with high N/C ratios
  • Giant multinucleated tumor cells
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44
Q

Clinical Phenotypes of 21 Hydroxylase deficiency

A

CHECK PICTURES

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45
Q

Common Causes of Myopathy

A

Check Pictures

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46
Q

Cardiac Tissue Conduction Velocity

A

CHECK PICTURES

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47
Q

Acute Inferior Wall MI

A

Right Ventricular Myocardial Infarction

  • presents with hypotension, elevated jugular pressure and clear lungs
  • leads 2,3, and AVF
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48
Q

Amatoxins and Ricin

A
  • from mushroom poisoning = Amanita phylloides or death cap
  • potent inhibitors of RNA polymerase 2 (halting mRNA synthesis)

Ricin

  • from the castor oil plant Ricinus communis
  • potent toxin that inhibits protein synthesis by cleaving the rRNA component of the eukaryotic 60S subunit
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49
Q

Lymphatic Drainage of the Leg

A
  • superficial lymphatic system is divided into medial and lateral tracks

Medial Track

  • runs up to the superficial inguinal lymph nodes bypassing the popliteal nodes
  • runs along the long sap heinous vein up the superficial inguinal lymph nodes and bypasses the popliteal nodes
  • lesion on medial = inguinal lymphadenopathy

Lateral Track

  • drain the lateral part of the leg and communicates with the popliteal and inguinal nodes
  • lesions here = both popliteal and inguinal lymphadenopathy
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50
Q

Cytomegalovirus

A
  • causes mononucleosis-like syndrome
  • mono spot negative
  • in immunocompromised = primary or reactivated CMV infection can result in severe retinitis, pneumonia, esophagitis, colitis, or hepatitis
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51
Q

Diabetes

A

Type 2

  • excess visceral fat and limited subcutaneous fat
  • waist circumference & waist to hip ratio is very profound

Type 1
- high ketone levels = DKA = no presence of insulin at all

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52
Q

Differential Diagnosis of Vaginosis

A

Check Pictures

Trichomonas = can be seen on wet mount Saline microscopy of vaginal discharge. Presents with yellow-green discharge and vaginal burning and is sexually transmitted

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53
Q

Systemic Mastocytosis

A
  • colonal mast cell proliferation occurs in the bone marrow, skin, and other organs
  • mast cell is associated with C-KIT receptor tyrosine kinase mutation
  • these cells have a large expression of tryptase
  • there is excessive histamine release from de granulation of the mast cells which causes syncope, flushing, hypotension, pruritus, and urticaria
  • histamine also induces gastric acid secretion which can lead to gastric ulcers
  • the excess acid inactivates pancreatic and intestinal enzyme causing diarrhea
  • other GI symptoms include nausea, vomiting, and abdominal cramps

Overall causes Gastric hypersecretion

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54
Q

Hepatitis E Virus

A

Unenveloped single stranded RNA virus that spreads through fecal oral route
- cause high mortality in infected pregnant women

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55
Q

Osteoporosis

A
  • Trabecular thinning with fewer interconnections
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56
Q

Osteitis Fibrosa Cystica

A

Skeletal Manifestation of Primary hyperparathyroidism

  • presents with bone pain
  • superiosteal erosions affecting the phalanges of the hand = affects mostly cortical (compact bone)
  • salt and pepper skull
  • brown tumor bone cysts
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57
Q

Osteoporosis

A

Persistence of primary spongiosa said in the medullary cavity with no mature trabeculae

  • accumulation of woven bone and diffuse skeletal thickening
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58
Q

Common Causes of Nonvalvular Heart Failure

A

Look at picture

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59
Q

Diabetes

A

Type 2

  • excess visceral fat and limited subcutaneous fat
  • waist circumference & waist to hip ratio is very profound

Type 1
- high ketone levels = DKA = no presence of insulin at all

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60
Q

Differential Diagnosis of Vaginosis

A

Check Pictures

Trichomonas = can be seen on wet mount Saline microscopy of vaginal discharge. Presents with yellow-green discharge and vaginal burning and is sexually transmitted

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61
Q

SIADH

A
  • low plasma sodium and osmolality
  • concentrated urine
  • normal body fluid volume due to ANP
  • can be due to Small Cell lung cancer
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62
Q

The -omas

A

VIPoma

  • diarrhea
  • hypokalemia
  • achlorhydria

Glucagonoma
Check Pictures

Somatostatinoma

  • abdominal pain, gallbladder stones, constipation, hyperglycemia, and Steatorhea
  • inhibition of GI motility
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63
Q

Superior Gluteal Nerve Lesion

A
  • causes positive trandelenburg sign = hip drop observed contra lateral to lesion as the ipsilateral foot is lifted off the ground = superior gluteal nerve lesion or gluteus medius muscle
  • weakened gluteus medius can’t contract
  • caused by injection at superiomedial quadrant of the left buttock (proper placement should be in superiolateral quadrant of left buttockor even better the anterograde real gluteal region)

Injections to the superiomedial, inferomedial, and inferolateral regions of buttock risk injury to sciatic nerve

Superior gluteal nerve gives innervation to gluteus medius and minimus = hip abductors

inferior gluteal nerve = gluteus maximus = hip extender

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64
Q

Supine Hypotensive Syndrome

A

CHECK PICTURES

- occurs a lot to pregnant women supine

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65
Q

Types of Collagen

A

Type 1 = for mature scars

LOOK AT PICTURE

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66
Q

Hypertrophic Cardiomyopathy Pulse

A

A bifid carotid pulse with brisk upstroke (spike and dome)

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67
Q

Central Vein Access via Femoral Vein

A
  • the optimal site for obtaining vascular access in the lower extremity during cardiac catheterization is the common femoral artery below the inguinal ligament
  • if going above the inguinal ligament this can significantly increase the risk of retroperitoneal hemorrhage
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68
Q

SHOCK

A

When it comes to hypovolemic shock
- IV fluids that are normal saline are given to increase the intravascular and left ventricular end diastolic volumes. The increase in preload stretches the myocardium and increases end diastolic sarcomere length leading to an increase in stroke volume and cardiac output.

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69
Q

Jervell and Lange-Nielsen Syndrome

A

Congenital Long QT syndrome

  • autosomal recessive
  • accompanied by congenital neuro sensory deafness
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70
Q

How do you decrease mitral regurgitation?

A

By decreasing left ventricular afterload = will increase the forward to regurgitation volume ratio

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71
Q

Sings of Reversible and Irreversible Injury

A

Reversible

  • myofibril relaxation = cardiac myocytes occurs with severe ischemia
  • dis aggregation of poly soles = ischemic injury
  • dis aggregation of nuclear granules
  • TAG accumulation
  • Glycogen loss

Irreversible
- Mitochondrial vacuoles action = involved mitochondria is permanently damaged and can’t produce ATP

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72
Q

IL-10

A

Important anti-inflammatory cytokine that inhibits TH1 cells and reduce expression of MHC2 and suppresses the activation of macrophages and dendritic cells

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73
Q

Buerger’s Disease (Thromboangiitis Obliteran’s)

A

A vasculitis of medium and small sized arteries in the tibial and radial arteries

  • there is acute and chronic inflammation of the arterial walls often with thrombosis of the lumen which can undergo organization and recanalization
  • this segmental thrombosing vasculitis often extends into contiguous nerves and veins
  • this condition can result from direct endothelial cell toxicity from tobacco products or from hypersensitivity to it
  • usually seen among heavy cigarette smokers with onset before age 35 and is associated with hypersensitivity to intra dermal injections of tobacco extracts
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74
Q

Drug Treatments for TB

A

See Pictures

Mycolic acids in the cell wall cause mycobacteria to be acid fast as they retain the carbolfuschin dye and resist decoloration by acid-alcohol de colorizing agent

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75
Q

Important GI Hormones & Impairments in Glycogenolysis

A

See Pictures

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76
Q

Biotin Cofactors

A

See Pictures on

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77
Q

Neurophysins

A
  • carrier proteins for oxytocin and vasopressin (ADH)
    Act as chaperone molecules as they transport the hormones toward the nerve terminals in the posterior pituitary from their site of production in paraventricular and supraoptic nuclei

Point mutations in neurophysin 2 = hypothalamic diabetes insipidus

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78
Q

Phase 4 of SA node action potential

A

Acetylcholine and adenosine reduce the rate of depolarization by prolonging phase 4

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79
Q

Valsalva Maneuver

A
  • can induce vagal stimulation to decrease tachycardia
  • the rectus abdominus muscle is recruited in this process to achieve increased intra abdominal and intrathoracic pressure
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80
Q

Gonorrhea

A
  • can cause urethritis (dyslexia and purulent urethral discharge)
  • the nucleic acid amplification test is the diagnostic test of choice
  • intra cellular diplococci
  • dual therapy with ceftriaxone and azithromycin due to concerns about resistance and chlamydia co-infection
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81
Q

Common Clinical Disinfectants

A

SEE PICTURE

  • formaldehyde and glutaraldehyde function by alkylation get and cross-linking DNA and proteins = most commonly used for sterilization of hospital instruments that cannot withstand autoclave temp
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82
Q

Binding Globulins

A

An increase in estrogen activity increases levels of TBG this leads to an increase in total thyroid hormone levels, but feedback control maintains normal levels of free thyroid hormone

  • an increase in TBG leads to an increase in total T4 (bound T4 plus free T4) as well as total T3
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83
Q

Gestational Trophoblastic Disease

A

See Picture

Complete mole = snowstorm appearance

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84
Q

Primary Biliary Cholangitis

A
  • chronic autoimmune liver disease characterized by lymphocytic infiltrates and destruction of small and mid-sized intrahepatic bile ducts
  • common in middle aged women and is associated with other autoimmune disorders
  • serum alkaline phosphate is elevated and AMA titers are positive
  • granulomas and bile staining of hepatocytes are common
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85
Q

Erythema multiforme

A
  • cell mediated inflammatory disorder of the skin
  • erythematous papules that evolve into target lesions
  • most commonly associated with HSV
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86
Q

DNA probes

A
  • protein that must be able to bind DNA
  • transcription factors, steroids, thyroid proteins, vitamin D receptors, retinoic acid receptors, DNA transcription and replication proteins
  • N-myc and C-myc can bind DNA = transcription factors
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87
Q

Toxic Megacolon

A
  • well recognized complication of ulcerative colitis
  • patients typically present with abdominal pain/dissension, bloody diarrhea, fever, and signs of shock
  • use abdominal X-Ray
  • barium enema and colonoscopy are contraindicated due to risk of perforation
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88
Q

Differential diagnosis and features of chest pain

A

See pictures

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89
Q

Hypertensive disorders of pregnancy

A

See pictures

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90
Q

Hemicholinium

A

Inhibits the sodium co-transporter bringing choline and sodium into the neuron. Inhibits production of acetylcholine.

SEE PICTURE

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91
Q

The Pharyngeal Pouch Derivatives

A

SEE PICTURES

The floor of the foregut gives rise to the thyroid not the pharyngeal arches.

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92
Q

Enterobius vermicularis (enterobiasis) PINWORM

A

Occurs more frequently in school age children
- diagnosed by Scott tape test

First line treatment = Albendazole and second line is pharyngeal pamoate

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93
Q

What activates gaunylyl Cyclase?

A

ANP, BNPm NO

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94
Q

Chronic AV shunt

A
  • increases cardiac output because of SNS
  • decreases total peripheral resistance and increases venous return
  • causes the venous return curve to shift right because ECV is increased through renal retention of fluids and because venous pooling is reduced by the increases SNS tone
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95
Q

Bones of Wrist and Hand

A

See Pictures

Some Lovers Try Positions That They Can’t Handle

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96
Q

Nerve Distribution of the Leg

A

See Pictures

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97
Q

Base Excision Repair and CaSr

A

See Picture

CaSr = G-protein coupled receptors that regulate the secretion of parathyroid hormone in response to changes in circulating calcium levels.

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98
Q

Central Retinal Artery Occlusion

A

Pale retina (due to ischemia and edema) and a cherry red macula

  • sudden, painless, and permanent, monocular blindness
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99
Q

Trypsin Inactivation

A

See Pictures

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100
Q

HLA proteins

A

Class 1 = HLA B27
- expressed by all nucleated cells

Class 2 = HLA DR, DP, DQ

  • expressed by antigen presenting cells and present predominantly foreign antigens to CD4 helper T-cells
  • conditions associated with HLA class 2 include rheumatoid arthritis, diabetes type and celiac disease

See Picture

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101
Q

Primary Aldosteronism

A

See Pictures

Disease prevalence = q^2

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102
Q

For rare autosomal recessive disorders

A

2pq

P = 1

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103
Q

Side Effects of Corticosteroids

A

See Picture

  • causes an increase in neutrophil count = demargination of neutrophils from their attachment on the vessel wall
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104
Q

Type 2 Diabetes

A

Pancreatic Islet amyloid deposition is characteristic

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105
Q

Ectopic Pregnancy

A

In an ectopic pregnancy the uterine specimen would reveal decidualized endometrium only
- consisting with dilated coiled endometrial glands and vascularized edematous stroma

These changes occur in the luteal phase of the menstrual cycle under the influence of progesterone as the endometrium prepares for implantation. Embryonic and trophoblastic tissue will be absent from the uterus

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106
Q

Type 4 hypersensitivity reactions

A

Key cells involved are the macrophages, CD4 helper T cells and CD8 helper T cells

  • macrophages present the antigen to CD4 helper T cells
  • then the CD4 helper T cells secrete cytokines that recruit CD8 T cells to the area and produce the characteristic signs of induration and erythema
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107
Q

Angioedema

A

Can be hereditary or acquired (ACE drugs)
- in hereditary = low C1 esterase inhibitor activity leads to increases in bradykinin levels

See Picture

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108
Q

Hormone regulation

A

Permissiveness = when one hormone allows another to exerts its maximal effect
- cortisol increases alpha 1 receptors on VSM to increase the effects of catecholamines

Synergistic = when the combined effect of both drugs exceeds the sum of the individual drug effects

Additive = when the combined effect of 2 drugs is equal to the sum of their individual effects

Tachypylaxis = decreased drug responsiveness in a short period following one or more doses (rapidly developing tolerance)

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109
Q

Drugs

A

Drug continuous infusion of a drug metabolized by first order kinetics, the steady state concentration is reached in 4-5 half lives.

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110
Q

HIV

A
  • in the HIV replication cycle
  • only the env gene polyprotein product is glycosylated to gp160 and is proteolytically cleaved within the endoplasmic reticulum and Golgi apparatus to form the envelope glycoproteins gp120 and gp41
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111
Q

Types of Exocrine Glands

A

See Pictures

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112
Q

Bloom Syndrome

A
  • autosomal recessive
  • mutations in the BLM gene encoding helicase
  • Patients present with growth retardation, facial anomalies, photosensitive skin rash, and immunodeficiency due to chromosomal instability and breakage
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113
Q

Patella Fractures

A
  • due to a direct blow to the anterior aspect of the knee
  • the patella can also be fractured indirectly due to excessive force transmitted through the quadriceps tendon
  • patients develop acute swelling, tenderness, inability to extend the knee against gravity, and a palpable gap in the extensor mechanism
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114
Q

Mood Stabilizers in Bipolar Disorder & Antifungal Targets

A

Check Pictures

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115
Q

Biventricular Pacemakers

A

Has 3 leads

  • first 2 are placed in the right atrium and right ventricle
  • the third lead is used to pace the left ventricle and courses through the coronary sinus and resides in the anterioventricular groove in the posterior aspect of the heart
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116
Q

Elastin Production

A
  • synthesized as a large polypeptide precursor composed of about 700 mostly no polar amino acids
  • elastin contains proline and lysine residues but a few of these amino acids are hydroxylated
  • after trophoblastic is formed it is secreted in the Extracellular space where it interacts with fibrillin that functions a scafold
  • Then Lysil oxidase (requires copper) oxidatively delaminates some of the lysine residues of tropoelastin helping with the formation of desmosomes cross-links between neighboring polypeptides
  • these cross links allow for the rubber like properties of elastin

The rubber like properties of elastin are due extensively cross-linking between elastin monomers, which is facilitated by Lysyl oxidase

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117
Q

Lead Time bias

A
  • an artificial increase in survival time among tested patients who actually have an unchanged prognosis
  • patients screened with more sensitive tests appear to live longer only because the disease was detected earlier than it would have been if diagnosed clinically
  • the overall length of tie from disease onset to death actually remains the same in both groups
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118
Q

Beta blockers

A
  • decrease AV nodal conduction

- leading to an increased AV nodal refractory period = PR interval prolongation

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119
Q

Cromolyn

A

And Nedocromil

- inhibit mast cell degranulation and prevent release of preformed chemical mediators

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120
Q

C. Diphtheria

A

The bacterium produces intra cellular poly phosphate granules that are called metachromic granules that can be detected on microscopy after methylene blue staining

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121
Q

Giardia Lambilia

A
  • cause injury to the duodenal and jejunal mucosa by adhering to the intestinal brush border and releasing molecules that induce a mucosal inflammatory response
  • Secretory IgA which impairs adherence is the major component of adaptive immunity against G. Lamblia

FYI
Eosinophils are used against worm infections only!

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122
Q

HIV

A
  • the high mutability for the evasion of host humoral and cellular immune responses and the development of resistance to anti-retrovirus drugs
  • Pol gene mutations are responsible for acquired resistance to HIV reverse transcriptase inhibitors and HIV protease inhibitors
  • Env gene mutations enable escape from host neutralizing antibodies
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123
Q

Chest X Ray for Emphysema

A

Flattened Diaphragm!!!!

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124
Q

Cystic Fibrosis

A

Look at Pictures

  • autosomal recessive disease that results from a mutation in the CFTR gene on chromosome 7
  • The CFTR protein is a transmembrane ATP-gated channel
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128
Q

Acute Respiratory Distress Syndrome

A

Pg 613

Remember white out of lungs and thick hyaline membranes
- due to damage of type 1 pneumocytes

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129
Q

Restrictive Lung Diseases

A

Pg 611-612

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130
Q

Nephrogenic DI

A

Treated with Thiazides or indomethacin (to decrease synthesis of prostaglandins which inhibit ADH)

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131
Q

Interstitial Lung Disease

A
  • associated with decreased lung volumes and increased lung elastic recoil caused by fibrotic interstitial tissue.
  • the increased elastic recoil results in increased radial traction (outward pulling) on the airways leading to increased expiration flow rates when corrected for the low lung volume (opposite for emphysema)
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132
Q

Intestinal atresia

A

See picture

- in the jejunum/ileum are due to vascular injury

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133
Q

Bordatella Pertussis

A
  • causes whooping cough
  • clinical presentation is a paroxysmal cough lasting >2 weeks that is associated with post-tussive eyes is or inspiratory whoop after a severe coughing episode

SEE PICTURE

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134
Q

Mitochondrial DNA

A
  • exists as a small circular chromosome
  • codes for the rRNA and tRNA needed for mitochondrial protein synthesis
  • each mitochondria contains 1-10 copies of maternally derived mtDNA
  • mitochondria have a double membrane and wavy cristae
  • it resembles prokaryotic DNA and is maternally derived
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135
Q

Left Renal Vein

A
  • can be compressed by superior mesenteric artery
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136
Q

Pathogens responsible for secondary bacterial pneumonia after a viral infection

A
  • S. Pneumonia
  • S. Aureus
  • H. Influenza
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137
Q

Psoriasis

A
  • Can cause deforming joint disease

- common complications include arthritis, nail pitting, and uveitis

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138
Q

AV shunts

A
  • increase cardiac preload by increasing the rate and volume of blood flow back to the heart
  • because they bypass the arterioles, the TPR is reduced which decreases the after load as well
  • AV fistula is an abnormal communication between an artery and a vein that bypasses the arterioles the major source of resistance in the vascular system = can reveal a pulsatile mass with a thrill on palpating over the site or a constant bruit
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139
Q

Rabies

A
  • bats are main source of rabies
  • agitation and spasms progressing to coma with weeks of exposure is strongly supportive of rabies encephalitis
  • prophylactc vaccination is given for high risk people = inactivated vaccine
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140
Q

Recurrences of genital herpes

A
  • can be reduced through daily treatment with oral valacyclovir, acyclovir, or farcical over
  • condom use can help prevent a primary genital HSV infection but dose not prevent deactivation of latent infection
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141
Q

Polycythemia

A
  • defined as a hematocrit level >52% in men and >48% in women
  • it may be the result of a true increase in the red blood cell mass (absolute erythrocytosis) or decrease in the plasma volume (relative erythrocytosis)
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142
Q

Carotid Sinus

A
  • dilation of the internal carotid artery located just above the bifurcation of the common carotid artery
  • the carotid sinus reflex has an afferent limb that arises from the baroreceptors in the carotid sinus and travels to the vagal nucleus and medullary centers via the glossopharyngeal nerve
  • the efferent limb carries parasympathetic impulses via the vagus nerve
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143
Q

To protect the thyroid from a nuclear accident

A

KI is given prophylactically to protect the thyroid from excessive accumulation of radioactive Iodide

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144
Q

Iron absorption

A

Occurs primarily in the duodenum and proximal jejunum

  • bypass of the small bowel segment by gastrojejunostomy results in iron deficiency anemia
  • malabsorption of vitamin B12, folate, and ADEK

Vitamin C = distal small bowel active process
- B6 = jejunum and ileum passive process
Biotin and pantothenic acid = small and large intestine via sodium dependent transporter

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145
Q

Thioamides

A

Methimazole and propylthiouracil

  • decrease the formation of thyroid hormones by inhibition of thyroid per oxidase that is responsible for both iodine organification and coupling of iodotyrosines
  • PTU also decreases the peripheral conversion of T4-T3
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146
Q

Treating Thromboembolisms in Pregnant women

A
  • use low molecular weight heparin = enoxaprin (doesn’t cross the placenta like warfarin)
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147
Q

Veranicline

A
  • partial agonist at the alpha4beta2 nicotinic acetylcholine receptor that reinforces the effects of nicotine in the CNS system
  • this drug competes with nicotine and prevents its binding
  • because it’s a partial agonist it helps reduce the symptoms of nicotine withdrawal by mildly stimulating the receptor

This drug assists patients with cessation of tobacco use by reducing withdrawal cravings and attenuating the rewards effects of nicotine

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148
Q

Piriform Recess

A
  • where food can get caught
  • a branch of the superior laryngeal vagus nerve is there which carries motor fibers to the muscles involved in vocal cord function
  • the nerve mediates the afferent limb of the cough reflex by carrying sensation from the mucosa superior to the vocal cords
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149
Q

Henoch Schonlein purpura

A
  • due to IgA immune complex

Post-Glomerular Strep GN

  • granular deposition of IgG, IgM, and C3 in the mesangium and basement membrane
  • starry sky appeared
  • EM = sure epithelial humps
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150
Q

Bethancol

A

Used for postoperative urinary retention

- muscarinic agonist that will allow for urination

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151
Q

LaPlace’s law

A

See Picture

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152
Q

AV nodal Artery

A
  • usually arises from the dominant coronary artery
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153
Q

Erythropoeisis Stimulating Agents

A
  • are used to treat anemia of chronic kidney disease
  • ESA’s can improve anemia without need for blood transfusions
    There is a high risk thromboembolic events
  • due to increased blood viscosity as a result of the elevation in red cell mass
  • increased risk for hypertension due to activation of erythropoietin receptors on vascular endothelial and smooth muscle cells
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154
Q

Green Color of pus and sputum from bacterial infections

A
  • blue green heme based pigmented molecule contained within the azurophilic granules of neutrophils and catalyzes the production of hypochlorous acid (BLEACH) from chloride and H2O2 during the phagocytic respiratory burst ==> this is due to MYELOPEROXIDASE
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155
Q

Influenza Vaccine

A
  • inactivated killed vaccine = injection
    Function by inducing neutralizing antibodies against the hemagluttinin antigen in selected viral strains
  • Live attenuated vaccine = nasal spray
    Generate a strong cell mediated immune response in addition to providing humoral immunity
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156
Q

Catalase Positive Organisms

A
  • S. aureus
  • Burkholderia Cetacea
  • Serratia marcescens
  • Nocardia
  • Aspergillus
157
Q

Crohn’s Disease

A
  • due to a mutation in the NOD2 gene (expressed on epithelial cells and macrophages)
  • the gene activates the NF-kB pathway = this is a pro inflammatory transcription factor that increases cytokine production
  • In Crohn’s disease mutations in NOD2 result in decreased activity of NF-kB pathway which impairs the innate immune response of the intestinal mucosa and allows intestinal microbes to induce an exaggerated response by the adaptive immune system, resulting in chronic GI inflammation
158
Q

Hepatic Abscesses

A

S. Aureus can cause this by hematogenous seeding of the liver

Enteric bacteria (E. Coli, Klebsiella, and enterococcus) can cause hepatic abscesses by ascending the biliary tract (ascending cholangitis), portal vein premix, or direct invasion from an adjacent area

159
Q

FRC

A
  • airway pressure equals zero

- but the intra pleural pressure is negative with a value of -5cm H20

160
Q

Structures derived from neural crest cells

A 
Melanocytes
Odontoblasts
Tracheal cartilage
Enterochromaffin cells 
Laryngeal cartilage
Parafollicular cells of the thyroid 
Adrenal medulla 
Schwann cells
Spiral membrane

MOTEL PASS

161
Q

Steroid Producing Cells

A
  • cells in the adrenals, gonads, and liver
162
Q

Pyelonephritis

A
  • suppression of endogenous flora, colonization of the distal urethra by pathogenic gram negative rods and attachment of these pathogens to the bladder mucosa are the stages of pathogenesis in the lower urinary tract infections
  • anatomical or functional vesicoureteral reflux is almost always necessary for the development of acute pyelonephritis
163
Q

Klinfelter Syndrone

A
  • primary hypogonadism
  • elevated FSH and LH and low testosterone
  • long lower extremities, small, firm testes, and azoospermia
164
Q

Acute Tubular Necrosis

A
  • due to decreased renal perfusion
  • straight proximal tubules and the thick ascending limb of Henle are the most commonly affected portions
  • muddy brown casts are seen
165
Q

Heparin and Warfarin

A 
Heparin = PTT watch
Warfarin = PT watch and also check INR
166
Q

Rebound Rhinorrhea

A

Topical preparations of alpha adrenergic agonists cause vasoconstriction of the nasal mucosa vessels and are used as decongestants
- Overuse of these drugs cause negative feedback resulting in decreased norepinephrine synthesis and release from nerve endings which diminishes their effects

167
Q

Hemangioma

A
  • never biopsy a hemangioma because it can lead to a fatal hemorrhage and has low diagnostic yield
168
Q

What is the earliest sign of diabetic nephropathy?

A
  • moderately increased albuminuria is the earliest sign of diabetic nephropathy and the leading cause of ESRD
  • screening for early stage diabetic nephropathy is best achieved through the use of albumin urine dipsticks
169
Q

Sirloimus

A
  • binds to the immunophilin FK-506 binding protein in the cytoplasm, this forms a complex that binds and inhibits mTOR
  • inhibition of mTOR signaling blocks IL2 signal transduction and prevents cell cycle progression and lymphocyte proliferation
170
Q

Artery the true pelvis

A

The ureter lies medial to the ovarian vessels and anterior to the internal iliac artery

Increased intake of citrate and fluid help to prevent calculus formation

9,10,11 rib over lie the spleen

12th rib overlies the kidney

171
Q

Grape fruit Juice

A
  • slows the breakdown of drugs by inhibiting the CYP450 ==> CYP3A enzymes
172
Q

Where does the most water reabsorption in occur in the nephron when there is 24 hours of water deprivation?

A
  • The proximal tubules reabsorb >60% of the water filtered by the glomeruli, regardless of the patients hydration statu s
173
Q

Ethical obligations for impaired colleagues

A
  • non emergency situation a person should contact the designated hospital committee, commonly called a physician health program
  • if this is not possible or such a body doesn’t exist then the state licensing board should be contacted
174
Q

Linkage Disequilibrium

A
  • a pair of alleles are inherited together in the same gamete more or less often than would be expected given random chance
  • this can occur even if the genes are on different chromosomes
175
Q

Pancreas

A
  • the dorsal pancreatic bud = pancreatic tail, body, most of the head, and small accessory pancreatic duct
  • the ventral bud = uncinate process, pancreatic head and proximal portion of the main pancreatic duct
176
Q

Physicians and Gifts

A
  • it is ethically problematic for physicians to accept expensive gifts as they may influence or appear to influence physician behavior
  • these gifts should be declined after expression of appreciation
177
Q

Osmotic Laxatives

A

Polyethylene glycol
Magnesium Hydroxide
Magnesium Citrate

178
Q

Chronic Lung Transplant Rejection

A
  • affects the small bronchioli producing the obstructive lung disease known as bronchiolitis obliterans
  • characterized by lymphocytic inflammation, fibrosis, and ultimately destruction of the bronchioles
179
Q

What increases risk of statin myopathy?

A
  • use with gemfibrozil = impairs the hepatic clearance of statins if given together
180
Q

Why does the myocardial cell swell during transient ischemia?

A
  • ion pump failure due to ATP deficiency during cardiac ischemia causes intra cellular accumulation of Na+ and Ca2+
  • this draws water into the cell causing the cellular and mitochondrial swelling
181
Q

Hypertrophic Cardiomyopathy

A
  • produces a systolic murmur
182
Q

Contraindications for OCP use

A
  • prior history of thromboembolic event or stroke
  • history of an estrogen-dependent tumor
  • women over age 35 years who smoke heavily
  • hypertriglyceridemia
  • decompensated or active liver disease
  • pregnancy
183
Q

Vasopressin and Desmopressin

A
  • cause V2R mediated increase in water permeability in the cortical and medullary collecting ducts
  • vasopressin activates urea transporters in the medullary collecting duct, increasing urea reabsorption and decreasing renal urea clearance e
  • this increases the medullary osmotic gradient and allows for the production of maximally concentrated urine and
184
Q

Acute Cholecystitis

A
  • caused by gallstones obstructing the cystic duct
  • the gallbladder will not be visualized due to the obstruction by a radio tracer
  • ultrasound findings = gallbladder wall thickening, pericholecystic fluid, and a + Murphy sign
185
Q

Cord Factor by Mycobacteria

A
  • establishes virulence through neutrophil inhibition,
  • mitochondrial destruction
  • induced release of TNF
186
Q

Diffuse Esophageal Spasm

A
  • several segments of the esophagus contract inappropriately at the same time which appears as disorganized non-peristaltic contractions on esophageal manometers and corkscrew esophagus on barium
  • pathogenesis = impaired inhibitory neurotransmission within the esophageal my enteric plexus
187
Q

Lymph Node drainage

A

Above the dentate line = inferior mesenteric and internal iliac lymph nodes

Below the dentate line = inguinal nodes

188
Q

Mesothelioma

A
  • dyspnea and chest pain
  • hemorrhagic pleural effusions are usually present
  • Nodular or smooth pleural thickening with the lung parenchyma intact
  • histopathology = tumor cells with numerous long slender micro villi and abundant toon filaments
  • use pancytokeratin as immunohistochemical marker
189
Q

Indicator of Obestity induced Restrictive Lung Disease

A
  • reduction in expiratory reserve volume due to increased respiratory rates with reduced tidal volumes
  • obesity has minimal effect on residual volume but FRC is the sum of RV + ERV
  • so FRC is markedly decreased
190
Q

Ecthyma gangrenosum

A
  • cutaneous necrotic disease with a strong association with Pseudomonas
  • occurs from peri vascular invasion and release of tissue-destructive exotoxins causing vascular destruction and insufficient blood flow to patches of skin that become edematous and necrosis
  • pseudomonas infections are common in patient that are neutropenia, hospitalized, have burns or indwelling catheters
191
Q

Acute Cholecystitis

A
  • caused by gallstones obstructing the cystic duct
  • the gallbladder will not be visualized due to the obstruction by a radio tracer
  • ultrasound findings = gallbladder wall thickening, pericholecystic fluid, and a + Murphy sign
192
Q

Cord Factor by Mycobacteria

A
  • establishes virulence through neutrophil inhibition,
  • mitochondrial destruction
  • induced release of TNF
193
Q

Diffuse Esophageal Spasm

A
  • several segments of the esophagus contract inappropriately at the same time which appears as disorganized non-peristaltic contractions on esophageal manometers and corkscrew esophagus on barium
  • pathogenesis = impaired inhibitory neurotransmission within the esophageal my enteric plexus
194
Q

Lymph Node drainage

A

Above the dentate line = inferior mesenteric and internal iliac lymph nodes

Below the dentate line = inguinal nodes

195
Q

Mesothelioma

A
  • dyspnea and chest pain
  • hemorrhagic pleural effusions are usually present
  • Nodular or smooth pleural thickening with the lung parenchyma intact
  • histopathology = tumor cells with numerous long slender micro villi and abundant toon filaments
  • use pancytokeratin as immunohistochemical marker
196
Q

Indicator of Obestity induced Restrictive Lung Disease

A
  • reduction in expiratory reserve volume due to increased respiratory rates with reduced tidal volumes
  • obesity has minimal effect on residual volume but FRC is the sum of RV + ERV
  • so FRC is markedly decreased
197
Q

Ecthyma gangrenosum

A
  • cutaneous necrotic disease with a strong association with Pseudomonas
  • occurs from peri vascular invasion and release of tissue-destructive exotoxins causing vascular destruction and insufficient blood flow to patches of skin that become edematous and necrosis
  • pseudomonas infections are common in patient that are neutropenia, hospitalized, have burns or indwelling catheters
198
Q

Acute Cholecystitis

A
  • caused by gallstones obstructing the cystic duct
  • the gallbladder will not be visualized due to the obstruction by a radio tracer
  • ultrasound findings = gallbladder wall thickening, pericholecystic fluid, and a + Murphy sign
199
Q

Cord Factor by Mycobacteria

A
  • establishes virulence through neutrophil inhibition,
  • mitochondrial destruction
  • induced release of TNF
200
Q

Diffuse Esophageal Spasm

A
  • several segments of the esophagus contract inappropriately at the same time which appears as disorganized non-peristaltic contractions on esophageal manometers and corkscrew esophagus on barium
  • pathogenesis = impaired inhibitory neurotransmission within the esophageal my enteric plexus
201
Q

Lymph Node drainage

A

Above the dentate line = inferior mesenteric and internal iliac lymph nodes

Below the dentate line = inguinal nodes

202
Q

Mesothelioma

A
  • dyspnea and chest pain
  • hemorrhagic pleural effusions are usually present
  • Nodular or smooth pleural thickening with the lung parenchyma intact
  • histopathology = tumor cells with numerous long slender micro villi and abundant toon filaments
  • use pancytokeratin as immunohistochemical marker
203
Q

Indicator of Obestity induced Restrictive Lung Disease

A
  • reduction in expiratory reserve volume due to increased respiratory rates with reduced tidal volumes
  • obesity has minimal effect on residual volume but FRC is the sum of RV + ERV
  • so FRC is markedly decreased
204
Q

Ecthyma gangrenosum

A
  • cutaneous necrotic disease with a strong association with Pseudomonas
  • occurs from peri vascular invasion and release of tissue-destructive exotoxins causing vascular destruction and insufficient blood flow to patches of skin that become edematous and necrosis
  • pseudomonas infections are common in patient that are neutropenia, hospitalized, have burns or indwelling catheters
205
Q

IL-2 Activity

A
  • produced by Helper T cells and is the major growth factor for T lymphocytes
  • stimulates the growth, differentiation, and survival of antigen-specific CD4 T cells and CD8 T-cells
  • also promotes the growth of B cells and activates natural killer cells and monocytes
  • Increased activity of T cells and NK cells are thought to be responsible for IL-2’s anti-tumor effects
  • IL-2 is currently used as immunotherapy for metastatic melanoma and renal cell carcinoma
206
Q

GERD histology finding

A
  • basal Zone hyperplasia

- elongation of the lamina propria papillae and scattered eosinophils and neutrophils

207
Q

Inferior Wall of the Heart

A
  • supplied by the right coronary artery

- lead 2,3, AVF

208
Q

Ecological Studies

A
  • unit of analysis is populations and not individuals
  • the frequency of a given characteristic and a given outcome are studied using population data
  • useful for generating hypotheses but should not be used to make conclusions regarding individuals within these populations
209
Q

Other EBM things to know

A
  • Nested case control designs = start with cohort studies in which participants are followed over time and those participants who develop an outcome of interest become cases for a case-control study
  • Qualitative Studies = use focused discussion groups, interviews, and other anthropological techniques to obtain narrative information that can be crucial in explaining quantitative results
210
Q

Bisphosphonate

A
  • have a similar structure to pyrophosphate and attach to hydroxyapatite binding sites on bony surfaces preferentially binding in areas of increased bone turnover
  • induce osteoclast apoptosis
211
Q

CCB

A
  • The SA and AV node undergo diastolic depolarization during phase 4 due to a slow, inward sodium current
  • verapamil slows the diastolic depolarization that occurs in phase 0 and the latter part of phase 4 = SA and AV node
  • in cardiac muscle cells it decreases the excitation and contraction coupling
  • pay attention to the CELL specified
212
Q

Bradykinin

A
  • hormone produced by the kidney

- acts locally to constrict veins and dilate arterioles to increase renal perfusion

213
Q

Foscarnet

A
  • pyrophosphate analog that is sometimes used for ganciclovir-resistant CMV infections
  • can chelate calcium
  • can cause renal hypomagnesemia and a reduction in the release of PTH which contributes to hypocalcemia
  • the hypocalcemia and hypomagnesemia promotes seizures
214
Q

Skull exits for the cranial nerves

A

Pg 475

Remember CN 5 mandibular exits through the foramen ovale
CN 5 maxillary exits through foramen rotund up

215
Q

Ataxia Telangiectasias

A
  • increased risk of sinopulmonary infections that constitute a characteristic triad of ataxia telangiectasia = cerebellar ataxia, Telangiectasias, and increased risk of sinopulmonary infections
  • talengiectasia - superficial blanching nests of distended capillaries on sun exposed areas of the skin
  • autosomal recessive inheritance
  • defect in gene that codes for ATM gene that plays a role in DNA break repair
  • the immune deficiency manifests as an IgA deficiency that predisposes to infections of the upper and lower airways
216
Q

Patients with HIV

A
  • headaches, seizures, and multiple ring enhancing CNS lesions on MRI = toxoplasmosis encephalitis
217
Q

Horners Syndrome + Muscle weakness in ipsilateral arm

A

Think Pancoast tumors

218
Q

Spinal accessory nerve

A
  • made of fibers from cranial and cervical spinal nerve roots
  • passes through the posterior triangle of the neck and provides innervation to the SCM and trapezius
  • lesion = impaired abduction of the arm above horizontal and drooping of the shoulder
219
Q

Polio vaccines

A
  • The live attenuated Sabin vaccine produces a stronger mucosal secretory IgA immune response than the inactivated poliovirus vaccine
220
Q

Glossopharyngeal Nerve

A
  • causes loss of sensation in the upper pharynx, posterior tongue, tonsils, and middle ear cavity, and loss of taste sensation of the posterior third of tongue
221
Q

Ethics

A
  • Physicians are not required to provide medical services against their personal beliefs
  • once a patient physician relationship is made the physician can refer the patient to another provider who can perform the requested medical service
  • physicians should respond to disclosure of past sexual abuse with empathy and concern. Clearly acknowledging the trauma and communicating willingness to discuss it when the patient is ready
222
Q

Possible Triggers for Prinzmetal angina

A
  • cigarette smoking
  • cocaine/amphetamines
  • dihydroergotamine/Triptans = constricts vascular smooth muscle via stimulation of both alpha-adrenergic and serotonergic receptors
223
Q

Heart Failure contributions

A
  • RAAS activation and SNS activation results in increased after load, excessive fluid retention and deleterious cardiac remodeling
224
Q

Places most susceptible to atherosclerosis

A
  • lower abdominal aorta and coronary arteries
225
Q

Candida

A
  • Germ tubes at 37 degrees Celsius
226
Q

Calcium efflux from cardiac cells prior to relaxation

A
  • mediated by the Na/Ca exchange pump and Sarcoplasmic reticulum Ca-ATPase pump
227
Q

Rifaximin

A
  • nonabsorbable antibiotic that alters GI flora to decrease intestinal production and absorption of ammonia = decreases intra luminal ammonia production
  • lactulose = increases conversion of ammonia to ammonium
228
Q

Eosinophilic Damage

A
  • major basic protein released by eosniophils normally functions to kill helminths
  • it is also though to contribute to the bronchial epithelial damage sustained by patients with atopic (extrinsic allergic asthma)
229
Q

Campylobacter

A
  • can get from exposure to domestic animals (cattle, chickens, dogs) or contaminated food

Vibrio parahemolyticus = transmitted by contaminated shellfish

230
Q

Exacerbation of myasthenia Travis

A

In a patient treated with long acting acetylcholinesterase inhibitors occurs due to myasthenic or cholinergic crisis

  • The edrophonium (tension) test helps to differentiate
  • Clinical improvement after the test indicates that the patient is under treated
231
Q

Prokaryotic DNA polymerase

A

DNA Poly 1 = has both 5’–>3 ‘ and 3–>5’ exonuclease activity = which means it can remove the RNA primer created by RNA primate and repair damaged DNA sequences
DNA Poly 3 = only has 3’–>5’ activity

232
Q

Multi factorial Inheritance

A
  • the complex interaction of numerous genetic and environmental factors to determine phenotypic expression
  • although the exact inheritance risk cannot be determined, the closer a relative is to the affected person, the more likely the relative is to develop the trait
233
Q

Group B S. Agalacticae treatment

A
  • Universal prenatal screening for group B strep colonization by vaginal-rectal culture at 35-37 weeks gestation is recommended to identify colonized women who require intrapartum antibiotics, most frequently with penicillin or ampicillin to prevent neonatal GBS sepsis pneumonia and meningitis

Don’t give penicillin earlier than 35 weeks because it will clear from the females system and can still come back again before delivery

234
Q

Spread of different Bacteria

A

N. Meningitidis –> Pharynx -> blood -> choroid plexus -> meninges

H. influenza –> Pharynx -> lymphatics -> meninges

M. Tuberculosis –> primary lung focus –> blood –> meninges

235
Q

Statins

A
  • when it comes to Statins = hepatotoxicty is more of a fear than muscle
  • so check LFT’s first before checking serum creatinine (for renal failure)
236
Q

COPD and Fibrosis

A

The work of breathing is minimized in patients with increased elastic resistance when their respiratory rate is high and tidal volume is low
- patients with diseases that increase airflow resistance breathe at a lower rate/higher tidal volume in order to minimize the work of breathing

237
Q

What drug helps with hair growth?

A

Finestaride

238
Q

Dopamine Hydroxylase Deficiency

A
  • causes dysautonomia which is ptosis, orthostatic hypotension, hypoglycemia, and hypothermia
239
Q

Bacillus Anthracis

A
  • found in soil and able to survive past the boiling point of water
    At 100
  • spore forming bacteria are able to survive high temperatures, desiccation, and chemical agents by forming spores
  • Spore forming bacteria can be killed by autoclave
240
Q

Atropine

A
  • reverses the muscarinic symptoms of organophosphate poisoning but has no nicotinic effects
  • so patients treated with atropine are still at risk of muscle paralysis
241
Q

Alpha-1 antitrypsin

A
  • associated with reddish-pink, periodic acid-Schiff positive granules of un-secreted polymerized AAT in the peri portal hepatocyte
242
Q

Frontal Lobe lesions

A
  • Left sided lesions = are associated with apathy and depression
  • Rightsided lesions - disinhibition of behavior
243
Q

Ureter blood supply

A
  • proximal ureter to the kidney = renal artery
  • distal ureter close to the bladder = superior vesical artery
  • circulation to the middle portions are highly variable

Fat emboli in the pulmonary vasculature stain black with osmium tetroxide

244
Q

TCA

A

-have anti muscarinic side effects = confusion, constipation, and urinary retention

Amityrptiline

245
Q

Long Half life’s of Benzodiazepene

A
  • chlordiazepoxide
  • diazepam
  • flurazepam

Intermediate half life = Alprazolam and Clonazepam

Short half life = Triazolam

Benzos that are preferred in patients with impaired hepatic metabolism that undergo glucoronidation directly and are not dependent on hepatic enzymes = Lorazepam, oxazepam, temazepam

246
Q

Parkinson’s Disease On-Off phenomenon

A
  • thought to be a consequence of progressive nigrostriatal neurodegeneration leading to a decreased therapeutic window for levodopa
  • unpredictable
  • this phenomenon does not resolve
247
Q

Bilateral Anterior Cerebral Artery Occlusion

A
  • behavioral symptoms (Abulia)

- urinary incontinence = micturition center = medial frontal lobe/cingulate gurus

248
Q

Atropine

A
  • can cause acute closed angle glaucoma by narrowing of the anterior chamber angle and diminished outflow of aqueous humor
249
Q

First line treatment for essential tremor

A
  • nonspecific Beta adrenergic antagonist
250
Q

Myotonic Dystrophy

A
  • autosomal dominant disorder
  • increased number of trinucleotide repeats on myotonia proteins kinase gene
  • sustained muscle contraction, along with weakness and atrophy
  • cataracts are seen in almost all patients
  • frontal balding and gonadal atrophy are other common features
251
Q

Increasing Diffusion Rate

A
  • increased with temperature due to increased molecular movement speed and increased macromolecule solubility
  • larger membrane surface areas
  • increased solubility of the diffusing substance
252
Q

Neprilysin

A
  • a metalloprotease that cleaves and I activates endogenous peptides including natriuretic peptides glucagon, oxytocin, and bradykinin
253
Q

Herpesvirus Family

A
  • the herpesvirus family bud through and acquire the lipid bilateral envelope from the host cell nuclear membrane
  • But overall most enveloped nucleocapsid viruses acquire their lipid bilateral envelope by budding through the plasma membrane of the host cell
254
Q

Nitrates

A
  • patients taking daily maintenance nitrates need to have a nitrate free period every day to avoid tolerance to the drug
255
Q

Delirium

A
  • may manifest as acute changes in cognition and behavior
  • low dose antipsychotics (haloperidol) are the medications of choice to treat the behavioral and psychotic manifestations of delirium
  • do not give benzo’s because it can worsen the state unless it is in the case of alcohol withdrawal
256
Q

Anti-Arrhythmics

A

Use dependence describes the phenomenon in which higher rates of depolarization leads to increased sodium channel blockade due to the channels spending less time in the rating state

  • For Class 1 = sodium channel binding strength is 1C>1A>1B
  • class 1C demonstrates the most use dependence and class 1B has the least
257
Q

Bilateral Renal Artery Stenosis

A
  • GFR is dependent on Angiotensin 2 mediated efferent arteriolar vasoconstriction in RAS
  • ACE inhibitors or A2 receptor inhibitors will cause efferent arteriolar vasodilation that causes the GFR to fall and may lead to the development of acute renal failure
258
Q

Features that Aid in Localizing a Transverse Spinal Cord

A
  • moving roster ally spinal levels have increasing amounts of white matter, decreasing amount of gray matter and are more oval shaped
  • lower cervical and limbo sacral regions have larger ventral horns because they innervated the limbs
  • Thoracic and early lumbar sections contain lateral gray matter horns
  • Gracile and cuneate fasiculiare present above the T7 spinal level, whereas only the gracile Fasciculus is present below this level.
259
Q

Meningitis

A
  • their outer membrane LOS is the same as LPS and it accounts for the morbidity and mortality in infected people
260
Q

Rat Poison

A
  • Same thing as warfarin
  • to treat an overdose very quickly you must give fresh frozen plasma and also vitamin K
  • FYI heparin overdose is treated with protamine sulfate
261
Q

H. Influenza

A
  • blood loving organism that gets its NAD+ from co-culture with S. Aureus and demonstrates the satellite phenomenon
262
Q

K+ sparing diuretics

A
  • work on the collecting duct = Late distal tubule and cortical collecting duct
263
Q

Spontaneous intracranial hemorrhage

A
  • most common cause in young adults are AV malformations, ruptured cerebral aneurysms, or sympathomimetic drugs like cocaine
  • this can also occur due to coarctation of the aorta causing high pressures in the brain
264
Q

Insulin Types

A
  • Short acting insulin = best for post-meal hyperglycemia
  • Regular insulin = best for DKA
  • NPH = is given twice a day
  • long acting insulin analogs = are best for basal levels
265
Q

Renal Facts

A
  • Drug induced tubular necrosis = aminoglycosides, radio contrast media, cisplatin, amphotericin B, and foscarnet
  • Drug induced tubular obstruction may be due to intra tubular precipitation of tissue degradation products drugs, or drug metabolites ==> sulfonamides, methotrexate, IV acyclovir, and triamterene = can precipitate in renal tubules and cause renal failure
  • Acute allergic interstitial nephritis = methicillin, cephalosporins, Acetozolamide, allopurinol, sulfonamides, and NSAIDs
  • Chronic allergic interstitial nephritis = lithium and cyclosporine

ACE inhibitors can be bad by precipitating acute renal failure in those that have atherosclerotic disease and are dependent on efferent arterioles constriction to maintain renal perfusion (renal artery stenosis)

266
Q

Subarachnoid Hemorrhage

A
  • patients that survive the initial subarachnoid hemorrhage can have a number of complications
  • some may develop secondary arterial vasospasm = this vasospasm occurs in the vessels surrounding the ruptured aneurysm
  • the secondary vasospasm causes cerebral ischemia which presents as new-onset confusion and focal neurological deficit
  • severe vasospasm 4-12 days after the initial insult is the major cause of morbidity and mortality in patients recovering from SAH

Rebleeding can also occur

  • symptoms include the sudden development of a severe headache, severe nausea and vomiting, a change in the level of consciousness and the appearance of new neurological deficits
  • if rebleeding occurs the CT scan can identify the newly extravasated blood
267
Q

Toxic Shock Syndrome

A
  • S. Aureus creates superantigen that activates large numbers of helper T cells
  • super antigens interact with major histocompatibility complex molecules on antigen presenting cells and T cell raptors to cause a widespread activation of T lymphocytes
  • activation of T cells is responsible for the release of IL2 from the T cells and IL-1 and TNF from macrophages
  • these IL’s cause capillary leakage, circulatory collapse, hypotension, shock, fever, skin findings, and multi organ failure
268
Q

Antipsychotic Side Effects

A

Extra pyramidal
- Acute dystonic reaction = sudden onset of sustained muscle contractions

  • Akithisia = subjective restlessness with inability to sit still or stand in one position
  • Drug induced Parkinsonism = tremor, rigidity, bradykinesia, masked facies

Tardive Dyskinesia

  • involuntary movements after chronic use (ex: lip smacking, choreoathetoid movements)
  • this is the only side effect that can worsen or persist following medication discontinuation

Neuroleptic malignant syndrome
- Fever, rigidity, mental status changes, autonomic instability

269
Q

Lung Transplantation

A

Acute rejection = pulmonary and bronchial vessels are targets

Chronic rejection = small airways are affected causing bronchiolitis obliterans (inflammation and fibrosis of the bronchiolitis walls lead to narrowing and obstruction of the affected bronchioli)

270
Q

Important

A

Cancers of the pelvis including the prostate spread to the lumbosacral spine via the vertebral venous plexus
= this is why the brain is the first metastasis site when it comes to prostate cancer

271
Q

Respiratory acidosis

A

Acute = heroin overdose that causes Hypoventilation

Chronic = COPD allows enough time for renal compensation

272
Q

Trigeminal Neuralgia

A
  • Carbamezapine is the drug of choice

- Baclofen and Valproic acid are second line

273
Q

The main cause of overdose death

A

Opioids = #1
Heroin = #2
Prescription Analgesics = #3

274
Q

Pericarditis

A

Acute due to viral infection = friction rub

Constrictive pericarditis = kussmaul breathing and pericardial knock
- requires months or years to develop

275
Q

LPS

A

In gram negative species is a very long heat stable molecule arranges into three regions

O antigen = cell wall outer membrane polysaccharide antigen used to classify gram negative bacteria

Core polysaccharide

Lipid A = responsible for the toxic properties of LPS that lead to gram negative sepsis and endotoxins septic shock. Causes widespread activation of macrophages leading to the widespread release of IL-1 and TNF-alpha

LPS is not actively secreted by bacteria

276
Q

Tamoxifen

A

A selective estrogen receptor modulator used in the treatment of estrogen receptor positive breast cancer

  • it is a prodrug metabolized by CYP2D to its active metabolite endoxifen
  • patients with genetic polymorphism a resulting in poor CYP2D activity are exposed to decreased levels of the active metabolite and have a higher risk of disease relapse
277
Q

Treatment for Transient Ischemic Attack

A
  • blood pressure control
  • statin
  • low dose aspirin which selectively inhibits COX1 and can increase risk of GI bleeding
278
Q

Nitric Oxide

A

Is found in the cortex, hippocampus, hypothalamus, cerebellum and olfactory system and is thought to participate in the formation of new memories
- it is a unique neurotransmitter because it freely diffuses across cell membranes and does not need to interact with other neurons via a synapse

279
Q

Heart Failure cells

A

Hemosidierin macrophages

  • macrophages containing golden cytoplasmic granules that turn dark blue with Prussian blue staining
  • this means left ventricular dysfunction
  • macrophages eat the red blood cells that come into the blood
280
Q

Choleliathisis in Pregnancy

A
  • Pregnancy and the usage of OCP’s predispose to gallstone formation
  • Estrogen increases cholesterol synthesis by up regulating HMG-CoA reductase which causes the bile to become supersaturated with cholesterol
  • Progesterone reduces bile acid secretion and slows gallbladder emptying

Gallstones are increased in women that are fat, fertile, female, and forty

281
Q

Bacterioides Fragilis

A
  • apart of the normal colonic flora

- can form abscesses within the GI tract

282
Q

Pudendal nerve Block

A
  • performed by injecting an anesthetic intravaginally
  • medial to the ischial spine and through the sacrospinous ligament
  • this provides anesthesia to most of the perineum
283
Q

Lyme disease in pregnant women

A
  • Ammoxicillin should be given instead of Doxycycline due to teratogenic effects
284
Q

Important

A
  • Never give a patient both an SSRI and a MAO inhibitor
  • this is due to the risk of serotonin syndrome
    This is why Patients must wait at least 2 weeks after MAO inhibitor discontinuation before initiating SSRI therapy allowing enough to time for regeneration of MAO
285
Q

Cleft Lip and Cleft Palate

A

Cleft Lip = maxillary prominence fails to fuse with the intermaxillary segment during the 5th-6th week of development

Cleft Palate = palatine shelves fail to fuse with one another or with the primary palate.

Cleft lit and palate can occur together or in isolation

286
Q

Protein Structue

A

Primary = covalent peptide bonds
Secondary = alpha helix or beta sheet with hydrogen bonding
Tertiary structure = overall shape a single polypeptide chain makes after compaction from secondary structure (ionic bonds, hydrophobic interactions, hydrogen bonds, and disulfide bonds

287
Q

Liver Can’t use Ketone bodies

A
  • Lacks the succinyl CoA transferase enzyme (thiophorase) to convert the ketone body to acetoacetyl CoA
288
Q

S. Pyogenes

A
  • Pyrrolidonyl arylamidase positive
289
Q

Neutropenic Patients

A
  • are at high risk for viral and fungal infections
  • the most common fungal causes are Aspergillus and candida species
  • invasive pulmonary aspergillosis presents with some combo of fever, chest pain, cough, dyspnea, and hemoptysis
290
Q

Important

A

Changes in host range are most commonly caused by a mutation in the viral encoded surface glycoproteins that mediates virion attachment to targets host cell plasmalemma receptors

291
Q

Nicotinic Receptors

A
  • a type of inotropic receptor that doesn’t depend on 2nd messenger
  • these receptors are ion channels that are comprised of 5 subunits with 2 ACh binding sites.
  • if and only if both binding sites are filed, the ion channel will open
292
Q

If a person is infected with Hep B

A
  • and they have acute hepatitis with mild or sub clinical symptoms
  • they will eventually completely resolve

3 types of Hep B infections

  • acute hepatitis with complete resolution (>95 of cases)
  • fulminant hepatitis with massive liver necrosis
  • chronic hepatitis with or without cirrhosis
293
Q

Normal Aging in the Heart

A
  • include a decrease in left ventricular chamber apex to base dimension
  • development of a sigmoid shaped ventricular septum
  • myocardial atrophy with increased collagen deposition
  • accumulation of cytoplasmic lipofuscin pigment within cardiomyocytes
294
Q

Candida Infection

A
  • Local defense = superficial infection is by T lymphocytes

- hematogenous defense for disseminated candidiasis = neutrophils

295
Q

Kozak Sequence

A
  • occurs on eukaryotic mRNA and is defined by gccRccAUGG in which R is either adenine or guanine. This sequence helps initiate translation at the methionine start codon.
296
Q

Bleeding in Pateints kidney disease (Uremia)

A

Renal failure

  • the accumulation of uremic toxins in the circulation impair platelet aggregation and adhesion resulting in a qualitative platelet disorder that only prolongs bleeding time
  • Uremic bleeding can be improved with dialysis because it removes the toxins and partially reverses the bleeding abnormality
297
Q

Acute Chest Syndrome

A

Occurs in sickle cell patients
- due to vaso-occlusive crisis localized to the pulmonary vasculature
-

298
Q

Inflammatory Leukocyte Accumulation Steps

A
  1. Margination = increased vascular leakage in the micro vasculature leads to hemoconcentration and decreased wall shear stress, improving the contact of neutrophils with the endothelial lining
  2. Rolling = Neutrophils roll on the endothelium via the loose binding of sialylated carbohydrate groups to L-selectin on neutrophils or E-selecting/P-selection on endothelial cells. Cytokine stimulation increases expression of endothelial selectins
  3. Activation: slow rolling allows the leukocyte to sample the chemokines secreted by the inflamed tissue. This activates the integrins by inducing a signaling cascade that results in a conformational change in the integrins necessary for binding
  4. Tight adhesion and crawling: neutrophils become firmly attached to the endothelium via the binding of CD18 beta 2 integrins (Mac-1 and LFA1) to intercellular adhesion molecule 1 (ICAM-1) on endothelial cells
  5. Transmigration: after crawling to the endothelial cell periphery, neutrophils eventually migrate out of the vasculature by squeezing in between the cells via integrin attachments and adherence to platelet endothelial cell adhesion molecule 1 (PECAM-1). This protein is found primarily at the peripheral intercellular junctions of endothelial cells.
299
Q

Dermatomyositis

A
  • proximal muscle weakness
  • heliotrope rash in the perioorbital area and cheeks along with got rods papules on the hands
  • has a strong association with malignancy (lung, colorectal, and ovarian cancer)
300
Q

Theophylline Intoxication

A
  • Seizures are the major cause of morbidity and mortality
  • Tachyarrhythmias are the major concern but do not usually cause QT prolongation

Treatment of theophylline intoxication includes administration of activated charcoal to reduce GI absorption.

Beta blockers are the drug of choice for theophylline induced Tachyarrhythmias
Seizures can be treat with benzo and barbituates

301
Q

SAH

A

Sub arachnoid hemorrhage has a risk of vasospasm due to blood breakdown (4-10 days after hemorrhage)
= giving a patient a CCB can help in preventing these symptoms

302
Q

Penicillins

A

Inhibit transpeptidases by binding covalently to their active site

303
Q

Acute Compartment Syndrome

A

Most common in the anterior compartment of the leg
= includes the foot extensor muscles, anterior tibial artery, and the deep peroneal (fibular) nerve

  • Injury to the deep peroneal nerve causes decreased sensation between the first and second toes, decreased dorsiflexion of the foot, foot drop, and claw foot
304
Q

Health Risk Assessment

A

A questionnaire that uses demographic, medical, lifestyle, and family history information to calculate a patients risk age.

  • A patient whose risk age is greater than chronological age has a higher risk of death than the average individual of that chronological age
305
Q

Antioxidants

A

Superoxide dismutase in as an antioxidant that neutralizes reactive oxygen species, preventing cell injury

306
Q

Placement of a Tracheal Tube

A

Between the superficial cervical fascia and cricothyroid membrane

It goes through the following structures

  1. Skin
  2. Superficial Cervical Fascia (including subcutaneous fat and platysma muscle)
  3. Investing and pre tracheal layers of the deep cervical fascia
  4. Cricothyroid membrane
307
Q

Capitation

A

An arrangement in which a payor (individual, employer, or government entity) pays a fixed determined fee to cover all medical services required by a patient

  • payment structure in HMO’s
  • the payor can directly negotiate a capitated contract with an insurance company that then pays the providers, or a large medical group may negotiate directly with the payor
308
Q

Lithium Toxicity

A

Can occur from thiazides, NSAIDs, or ACE inhbitors

309
Q

Differentiating Between DIC and TTP

A
  • both have schistocytes
  • in DIC everything will be increased including PT, PTT, and BT
  • in TTP only Bleeding Time will be increased
310
Q

Transference

A
  • unconscious shifting of emotions or desires associated with a person from the past to another person in the present
311
Q

Cystathione Deficiency

A

Can present as marfinoid habits due to homocystinuria
= supplement B6 in diet

Affected people have marfinoid habitus, ectopia lentis, and development delay. High risk of thromboembolism

312
Q

Opening Snap of Mitral Stenosis

A
  • will get worse when A2 and OS gets closer together

- this tells you that the pressures in the left atria are very high

313
Q

Emetic Center of the Brain

A

Area Postrema

- lies in the dorsal medulla near the fourth ventricle

314
Q

Recombination vs. Reassortment

A

Recombination = exchange of genes between 2 chromosomes via crossing over within homologous regions. The resulting proveny will have recombined genomes with traits not present simultaneously in either parent virus = nonsegmented virus = 2 dsDNA strands

Reassortment = genetic composition that occurs when host cells are coinfected with 2 segmented viruses that exchange whole genome segments. (I.e. Influenza)

315
Q

Propofol and other highly lipophilic drugs

A
  • readily diffuse across membranes quickly accumulating in tissues receiving high blood flow, this accounts for their rapid onset of action.
  • these compounds are then distributed to organs receiving less blood flow, which explains their short duration of action
316
Q

Ganciclovir Therapy

A
  • neutropenia is a significant adverse effect and is increased with co-administration of zidovudine or TMP-SMX
317
Q

Graves Disease Exopthalmos

A

High dose glucocorticoids like prednisone are used to control severe Grave’s opthalmopathy
- they are helpful in decreasing the severity of inflammation and decreasing extra ocular volume

= Conventional anti thyroid drugs do not improve this

318
Q

Acyclovir

A
  • can cause crystalline nephropathy if adequate hydration is not provided
319
Q

How to avoid wrong site surgery?

A
  • Mark the operative site
  • independent verification of the patient, procedure, and site by 2 health care workers (nurse and physician) should be performed
  • the dual identifiers must perform the verification independently because 2 clinicians verifying identifiers together can result in replicating an error
  • surgical timeout before the procedure in order to conduct a final verification of the patient, procedure and site
320
Q

Important

A

When atherosclerotic occlusion develop slowly over time there can be compensation by the development of arterial collateral around the point of occlusion
- the collateral circulation can provide flow to the hypoperfused areas distal to the point of occlusion

Thin fibrous cap and increased lipid core and active inflammation = more likely to rupture

321
Q

Lipofuscin

A

Yellow brown finely granular perinuclear pigment = produce of free radical injury and lipid peroxidation
= aging

322
Q

Tuberculosis

A

Active TB is never treated with drug mono therapy due to the fast emergence of mycobacterial antibiotic resistance from rapid, selective gene mutations

  • Isoniazid mono therapy may be used for patients who have a positive PPD and a negative chest X Ray
323
Q

Medical Conditions that present as Anxiety

A
  • hyperthyroidism
  • hypoglycemia
  • Pheochromocytoma
  • hypercortisolism
  • cardiac arrhythmia
324
Q

Integrins

A

Bind to specific proteins = collagen, fibronectin, and laminins, cadherins, selectins, and Ig superfamily members

325
Q

Aspergilloma

A

Colonize and develop in old lung cavities from TB, emphysema, and sarcoidosis

  • forms fungus ball without lung tissue invasion
  • radiopaque structure that shifts when the patient changes position
  • might cause cough and hemoptysis
326
Q

Q fever

A
  • myalgia, fatigue, Fever >10 days
  • retroorbital headache with a normal leukocyte count
  • thrombocytopenia and increased liver enzymes
327
Q

Tetralogy of Fallot

A

The degree of right ventricular outflow tract obstruction is the major determinant of the degree of right to left intra cardiac shunting and resultant cyanosis

328
Q

G protein receptors and integral membrane proteins

A

Contain transmembrane domains composed of alpha helicase with hydrophobic amino acid residues (alanine, valine, isoleucine, phenylalanine, tryptophan, methionine, proline, glycine)

= these transmembrane domains help anchor the protein to the phospholipid bilayer of the cell membrane

329
Q

Heparin

A

Both unfractionated heparin and LWMH (enoxaparin) can bind to antithrombin to increase its activity against Factor 10a

= but only unfractionated heparin is able to bind to both antithrombin and thrombin to allow antithrombin to inactivate thrombin

330
Q

Obstructive Lesion in a Mainstem bronchus

A

Can prevent ventilation of an entire lung leading to obstructive atelectasis and complete lung collapse

Chest X Ray will show unilateral pulmonary opacification and deviation of the mediastinum toward the pacified lung

331
Q

Demyelination Principles

A

Length constant = space constant

  • measure of how far along an axon an electrical impulse can propagate
  • demyelination will decrease the length constant and result in impaired stimulus transmission
332
Q

HbS

A

Valine substitution promotes hydrophoic interaction among Hb molecules and results in HbS polymerization and erythrocytes sickling

333
Q

Hydralazine Side Effect

A
  • Reflex Sympathetic Activity
  • causing fluid retention
    Don’t give to angina/CAD patients
  • lupus like syndrome
334
Q

LAD reconstruction

A
  • if just one = use left internal mammary (thoracic) artery
  • if multiple arteries need reconstruction = breath sap heinous vein

Great saphenous vein it’s located inferolateral to the pubic tubercle
- coarses anterior to the medial malleolus

Femoral triangle

  • inguinal ligament superiority
  • sartorious muscle laterally
  • adductor long us muscle medially
335
Q

Cystic Fibrosis AGAIN

A

In Respiratory and Gastric Glands
- impaired functioning of the CFTR protein reduces luminal chloride secretion and increases sodium and net water absorption, resulting in dehydrated mucus and a more negative transepithelial potential difference

In sweat glands
- abnormal CFTR function causes reduced salt absorption, leading to the production of hypertonic sweat with high chloride content.

336
Q

Allergic Bronchopulmonary Asperfillosis

A
  • occurs in 5-10% of corticosteroid dependent asthmatics
  • patient have high serum IgE levels, eosinophilia, and IgE plus IgG antibodies to Aspergillus
  • there is intense airway inflammation and mucus plugging with exacerbations and remissions
  • repeated exacerbations may produce transient pulmonary infiltrates and proximal bronchiectasis
337
Q

Polysaccharide capsular vaccines

A
  • S. Pneumonia
  • H. Influenza
  • N. Meningitidis
338
Q

Hepatocellular Carcinoma

A
  • World wide, the countries that have high rates of hepatitis B virus (HBV) infection have more than 85% of all Hepatocellular carcinoma cases.
  • The people that develop HCC in these countries usually have chronic HBV infection acquired through vertical transmission at childbirth, which increases their risk of developing HCC by early to middle adulthood 200-fold
  • In these countries with high rates of HBV infection, HCC commonly presents in adults 20-40 years old
  • So universal vaccination of children against HBV would be the one measure most likely to cause a steep decline in the incidence of Hepatocellular carcinoma worldwide
339
Q

Primary Aldosteronism

A
  • Hypernatremia never occurs due to aldosterone escape
340
Q

ARea postrema

A
  • the central emetic center is in the dorsal surface of the medulla at the caudal end of the 4th ventricle
341
Q

IV drugs

A

Highly lipophilic drugs

  • it is rapidly cleared from the plasma and preferentially distributed to organs receiving high blood flow (Brain, heart, liver, and kidneys)
  • this initial distribution accounts for the rapid onset of sedation seen with administration
  • over time propofol is redistributed to. Organs receiving less blood flow (skeletal muscle and skin)
  • then lastly bone, adipose and connective tissue

IV anesthetics are eliminated through the liver

Inhaled anesthetics are eliminated through the lungs

The neuromuscular blocking agents spontaneously degrade in plasma and organ tissue, a type of metabolism known as Hoffman elimination

342
Q

TMP-SMX

A

Is associated with bone marrow suppression

343
Q

The treatment of Choice for Diabetic Ketoacidosis

A
  • IV normal saline and insulin

- these therapies increase serum bicarbonate and sodium and decrease serum glucose, osmolarity and potassium

344
Q

PCR

A

Used to amplify small fragments of DNA

  • you first need a source DNA template that includes the target region to be amplified as well as flanking sequences adjacent to the target region
  • the oligonucleotide sequence of these flanking regions must be known in order to make the primers necessary to start PCR
345
Q

Left or Right nasal hemianopia

A

Will occur with aneurysm from internal carotid artery
- will cause ipsilateral nasal hemianopia by damaging uncrossed optic nerve fibers from the temporal portion of the retina

346
Q

Calcium Channel Blocker Side effects

A

Include headache, flushing, dizziness, and peripheral edema
- development of peripheral edema occurs due to preferential dilation of pre capillary vessels (arteriolar dilation) this leads to increased capillary hydrostatic pressure and fluid extravasation into interstitium

347
Q

Abdominal Aortic Aneurysms

A

Characterized by Transmural inflammation of the aortic wall

  • chronic inflammation leads to degradation of elastin and collagen by proteases, resulting in loss of elastin and smooth muscle cells and abnormal collagen remodeling and cross-linking
  • These changes lead to weakening and progressive expansion of the aortic wall resulting in aneurysm formation
348
Q

Middle episiotomy

A

The perineal body is a fibrous ulnar tissue between the urogenital and anal triangle

  • a midline episiotomy is a vertical incision from the posterior vaginal opening to the perineal body
  • it transacts the vaginal submucosal tissue but not the external anal sphincter or the rectal mucosa
349
Q

Nafcillin, Oxacillin, Methicillin, and Dicloxacillin

A
  • Have bulky R groups that prevents Beta Lactamases
  • the only way resistance can be conferred is if there is altered penicillin binding proteins which are resistant to the drug
  • the penicillin binding protein is where it binds
350
Q

Low Vd (3-5L)

A
  • characteristics of a drug such as high molecular weight, high plasma protein binding, high charge, and hydrophilicity tend to trap the drug in the plasma compartment
351
Q

Heparin Overdose

A

You can’t give fresh frozen plasma because it contains antithrombin 3 which enhances heparin effect

Give protamine = effective

352
Q

Pre tibial Myxedema

A

Will cause lower leg skin thickening and induration

- seen in hyperthyroidism due to grave’s disease

353
Q

Carpal Tunnel Syndrome

A

Associated with conditions that reduce carpal tunnel space, including pregnancy (fluid accumulation), hypothyroidism (GAG buildup), diabetes (connective tissue thickening), and rheumatoid arthritis (tendon inflammation)
- patients with a long history of hemodialysis can also develop median nerve compression through deposition of Beta 2 microglobulin in the carpal tunnel

354
Q

Rickettsia and Chlamydia

A

Are intra cellular organisms because they can’t make their own ATP

355
Q

Obligate Anaeorobes

A

Lack catalase and Superoxide dismutase

356
Q

Mycobacterium Kasasii

A

Pulmonary TB-like symptoms in COPD patients

357
Q

Mycobacterium scrofulaceum

A

Causes cervical lymphadenitis in children

358
Q

Mycobacterium Marinum

A

Hand infection in aquarium

359
Q

Hepatitis D

A

Considered replication defective because it must be coated by external coat hepatitis B surface antigen of HBV to penetrate the hepatocyte

-

360
Q

CCL4 poisoning

A

CYP450 will produce free radicals that start a vicious cycle of hepatic injury = lipid peroxidation

CCL4 injury develops rapidly and leads to swelling of the ER, destruction of mitochondria, and increased permeability of cell membranes. This causes hepatocyte necrosis

361
Q

Aspirin Toxicity

A

Would caused a mixed respiratory alkalosis and non anion gap metabolic acidosis so the pH would normal

362
Q

Occulomotor Nerve

A
  • Has parasympathetic fibers inside it

Uncal herniation will cause a dilated pupil

363
Q

Gastric Bypass Surgery

A

Can cause small intestinal bacterial overgrowth (SIBO) due to excessive bacterial proliferation in the blind-ended GI segment.

SIBO results in deficiency of most vitamins (B12, A, D, and E) and iron, but increased production of folic acid and vitamin K

364
Q

Varicose Veins

A

Can cause lower extremity edema due to venous stasis

  • common complications resulting from poor blood flow include painful thromboses, stasis dermatitis, skin ulceration, poor wound healing, and superficial infections
  • venous stasis ulcers often occur over the medial malleolus
  • varicose vein thromboses are restricted to the superficial venous system
365
Q

EBM

A 
Reproducibility = reliability 
Validity = Accuracy
366
Q

Common Peroneal Nerve Injury

A

Foot drop and stoppage gait

367
Q

Recurrent C. Diff Infection Treatment

A

Fidaxomicin is used primarily in recurrent CDI and is bacteriocidal with minimal systemic absorption

  • a macrocyclic antibiotic (related to macrolides) that inhibits the sigma subunit of RNA polymerase, leading to protein synthesis impairment and cell death
  • it is an oral drug with bacteriocidal activity, minimal systemic absorption and a narrow spectrum it has less effect on normal colonic flora than either metronidazole or vancomycin
368
Q

Lactase Deficiency

A
  • elevated stool osmotic gap
  • decrease in stool pH because the bacteria Ferment lactose to produce short chain fatty acids
  • increase in hydrogen gas which causes flatulence
369
Q

Nucleolus

A

All rRNA is made in the Nucleolus

370
Q

Abetalipoproteinemia

A
  • will see clear or foamy cytoplasm in the intestinal epithelium
371
Q

Peripheral Neuropathy

A

Toxin penetration through the blood-nerve barrier leading to peripheral neuropathy occurs with diphtheria

Hyalinization of nerve arterioles is seen in diabetes mellitus (diabetic microangiopathy) = leads to the narrowing of the arterial lumen and ischemic nerve injury = one mechanism of diabetic neuropathy

Guillain barre = acute demyelination peripheral neuropathy. Segmental demyelination and an endometrial inflammatory infiltrate seen on light microscope

372
Q

Digoxin

A

Used for ventricular rate control in atrial fibrillation as it decreases AV conduction by increasing PSNS vagal tone
- Digoxin slows the ventricular rate during atrial fibrillation by enhancing vagal tone which leads to the inhibition of AV nodal conduction

373
Q

Succinylcholine

A
  • can cause significant potassium release and life threatening arrhythmias in patients at high risk for hyperkalemia, including those with burns, myopathies, crush injuries, and denervation injuries or disease
374
Q

Thiazide Diuretics

A

Can cause hypokalemia and lead to significant muscle weakness, cramps, and rhabdomyolysis

375
Q

Cox 2

A

Is an inducible enzyme that is undetectable in most tissues except in cases of inflammatory cell activation

FYI COX1 creates constitutive prostaglandins
COX2 creates inducible prostaglandins

376
Q

Her2

A

Oncogene
Tyrosine Kinase Receptor
185-kD transmembrane glycoprotein that has intra cellular tyrosine kinase activity
It is one of the epidermal growth factor receptors that play a role in the activation and control of epithelial growth and differentiation = increased rates of breast and ovarian cancer

377
Q

Growth Factors that increase angiogenesis in neoplastic tissue

A

VEGF AND FGF

Also pro inflammatory cytokines IL-1 and IFN-gamma can indirectly promote angiogenesis through increased expression of VEGF

378
Q

Roseola HHV6

A

Fever for 4-5 days then maculopapular rash.

Some may get seizures

379
Q

Heterophile antibody negative mononucleosis like syndrome

A

Most likely it is cytomegalovirus

  • CMV can be acquired via transfusions by leukocyte laden blood products because the virus infects leukocytes of granulocyte macrophage lineage
  • other causes are HHV6, HIV, and toxoplasmosis
380
Q

Tetanus Diagnosis

A

Pure Clinical via History and Exam

  • no other way to diagnose
381
Q

Pelvic Floor Muscles

A

Kegal exercises help strengthen the pelvic floor muscles

  • levator ani = iliococcygeus, pubococcygeus, puborectalis
  • these muscles hold the bladder and the urethra in the proper Anatomic position
  • injury to these muscles can result in urethral hypermobility which can lead to stress incontinence
382
Q

Non-small cell lung cancer

A

Some patients may have a chromosomal rearrangement that creates a fusion protein EML4 and ALK
THIS RESULTS IN CONSTANT TYROSINE KINASE THAT CAUSES MALIGNANCY

383
Q

Supracondylar Fracture

A

Lateral displacement = radial nerve

Medial displacement = medial nerve and brachial artery

384
Q

Telomerase

A

RNA DEPENDENT DNA POLYMERASE that consists of 2 components

  1. Telomerase reverse transcriptase
  2. Telomerase RNA

USMLE (14 decks)

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