USMLE-Rx Question Log Flashcards
What are the AEs for nortriptyline?
Remember the 3 Cs:
Coma
Convulsions
Cardiotoxicity (arrhythmia/prolonged QT)
What is dipalmitoyl phosphatidylcholine?
surfactant
Made most abundantly at week 35
At 28 weeks, not high enough
Measured by lecithin: sphingomyelin ratio ( >2 is good)
What are toxicities of amiodarone?
Get PFTs, LFTs, and TFTs pulmonary fibrosis hepatotoxicity hypo OR hyperthyroid also photodermatitis & constipation
Which class of antiarrhythmics has greater effect on cardiac tissue that depolarizes frequently?
Class I
Block Na+ channels in the open state (“use dependence”)
Selectively depress tissue that is frequently depolarized (fast tachy) or relatively polarized at rest (hypoxia)
Arrhythmic tissues more often depolarized; drugs can selectively target these tissues
How can you correct and untreatable ACD?
Erythropoietin
In a patient with bone metastases, what will your levels of Calcium and alk phosph be?
Calcium decreased
Alk phosph increased
Ca low b/c it’s being used to build new bone in area of mets
What is the molecule that is causing hypertension in 11B-hydroxylase deficiency?
11-deoxycorticosterone(mineralocorticoid precursor)
What is the formula for sensitivity?
TP/ (TP + FN)
What are the most common sites for PAD?
Affects arteries
Abd aorta, iliac, femoral, politeal, tibial, and peroneal
Treat w/ antiplatelets or surgical revascularization
Where does mumps cause inflammation? What is the epithelium in this area?
epididymis
pseudostratified columnar epithelium w/ stereocilia
What are the symptoms of tracheoesophageal fistula? What does it mean if air is seen in the stomach?
choking, coughing, salivation, cyanosis during feeding
If air in stomach, this means the lower esophagus/stomach is communicating with the trachea in some way
How does dangerous hyperkalemia manifest on an EKG?
peaked T waves
Meds that cause torsades de pointes?
"Some Risky Meds Can Prolong QT" Sotalol Risperidone (antipsychotics) Macrolides Chloroquine Protease inhibitors (-nivir) Quinidine (Class Ia & III) Thiazides
Tanner Stage 3
Peak growth height
1 year after initial breast development
enlargement of breast/areola w/ single contourgrowth of darker, coarse, curled pubic hair
Milestones for a 7-11 month old
Sitting alone standing w/ aid crawling wave bye bye say mama/dada Stranger anxiety Babinski relfex (disappears at 1 year)
Where are proteins tagged with mannose-6-phosphate?
Golgi
How does measles typically present?
Blanching red rash
Starts on face, moves to trunk and limbs, resolves in same order
SSPE is a rare complication in 7-9 yos
Which RNA polymerase produces each type of RNA?What toxin is produced by Amanita phalloides and which polymerase does it inhibit?
rRNA- RNA pol I
mRNA- RNA pol II
tRNA- RNA pol III
alpha-amantin-> inhib RNA pol II (mRNA). Leads to severe hepatoxicity
What types of defects does Valproic acid cause?
Neural tube
Deficiency of what neuropeptide causes narcolepsy? Where is it produced
Orexins A & B
Lateral hypothalamus
AEs of steroid treatment
Cushing-like symptoms, cataracts, HTN, increased appetite, hyperglycemia, insomnia, profound mood changes (steroid psychosis)
What toxin does aspergillus flavus produce? What are its effects?
aflatoxin
Causes hepatocellular carcinoma
Think Asia/Africa
Which COX inhibitor irreversibly binds COX?
Aspirin (via acetylation)
When should you give rabies immunoglobulin? How many rabies vaccines should you give?
If not immunized, give immunoglobulin
Give everyone vaccine (4 if never received; 2 if previously received)
In an HIV patient with CD4 count < 200, what types of organisms are most difficult to control?
Those controlled by cell-mediated arm of immune system
Intracellular organisms such as L. monocytogenes
What type of deficiency can be caused by phenytoin?
Folate
look out for macrocytic anemia
What drug can be used for both parkinsons and as influenza prophylaxis?
Amantidine
What are the AEs of amantidine?
ataxia
dizziness
slurred speech
Be careful in seizure patients
Which hepatitis viruses are spread fecal-oral route?
Hepatitis A & E
Homocystinuria Deficiency? Presentation?
Def in cystathionine synthase
Similar to Marfan’s (subluxation of lens and tall stature)
Life threatening thromboembolic events
What is an anti-IgG antibody?
Rheumatoid Factor
Where do you see squamous cell carcinoma in the lung? What protein can it produce and what symptoms will this cause?
Central bronchogenic carcinoma Can produce PTHrP Increase calcium Decrease phosphate constipation & polyuria
What toxicity can nitroprusside cause? Symptoms? What should you give prophylactically to prevent this complication?
Cyanide toxicity (inhib cyt oxidase--> blocks ETC) decreased O2 utilization, lactic acidosis, possible death Admin sodium thiosulfate (cyanide--> thiocyanate by rhodanese)
Which lymphoma has high expression of bcl-2 gene?
Follicular lymphoma
t(14;18)
Which amino acids are lost in cystinuria? What is the complication and how is it treated?
Lose lysine, arginine, cystine, and ornithine
Causes stone formation
Treat with hydration and alkalization of urine with acetazolamide
Most common cause of septic arthritis in adults and children?
s. aureus
What is echinococcus granulosus? How does it present? How is it treated?
Dog tapeworm
Hydatid cysts in the liver contain larvae
Can cause anaphylaxis when it ruptures
Treatment is surgical excision
What do you need to measure after putting someone on heparin?
Platelets every 2-3 days to prevent HIT
What is naphthalene? What can it cause?
Aniline dye (textiles) transitional cell carcinoma of bladder
What is a deficiency of uridine diphosphate glucuronyl transferase called and what does it cause?
Crigler-Najjar syndrome type 1 Causes inability to conjugate bilirubin Increased unconjugated bilirubin leads to: -jaundice -kernicterus -bilirubin deposition in brain
What is commonly the first presentation of vWD?
Mucocutaneous bleeding (after a dental extraction) Prolonged PTT, decreased factor VIII, reduced ristocetin-induced platelet aggregation
auto dominant
What cells are capable of transforming into activated ameboid cells with CNS tissue damage? What is their embryonal origin?
Microglia (resident phagocytes of CNS)
Mesoderm (circulating blood monocytes)
What types of vacuoles are tennis racket-shaped? What cell type are they found in? What is activated by this cell type?
Birbeck granules founds in Langerhans cells
Langerhans cells activate Helper T cells
Treatment and drug MOA for Wilson’s disease?
N-penicillamine
copper chelating agent
How should you measure a B12 deficiency?
High MMA (product of methymalonyl CoA)
Methymalonyl CoA usually converted to succinyl CoA w/ cofactor B12. W/o B12, it becomes MMA.
MMA high with low B12.
Don’t use B12 b/c it is mostly protein bound
What is milk alkali syndrome?
Hypercalcemia, metabolic alkalosis, renal insufficiency
Caused by calcium carbonate (OTC antacid)
Can cause severe renal toxicity if not discontinued
Characteristics of organism causing cat scratch fever
Bartonella heneslae
gram negative coccobacillus
oxidase positive
catalase positive
What urinary symptoms occur in sickle cell trait?
Episodic hematuria and impaired ability to concentrate urine
Result of microscopic thromboembolic events within renal medulla
Where is the most common CF defect located?
defective processing from ER to the golgi of the CFTR protein
end result is altered conductance
Second most common is defective protein synthesis causing complete lack of CFTR protein
Hypertension + hyperkalemia with a genetic basis.Diagnosis? Treatment?
Liddle’s syndrome-> constitutively activated ENaC in CT of kidney
Treat with traimterene or amiloride
What do rotavirus and coltivirus have in common?
double stranded segmented RNA virus
Which neoplasm is associated with Down syndrome (20x increased incidence)
ALL(may also see AML; less common)
Kid comes in with weight gain/edema and proteinuria. What is the next step?
Assume MCD b/c most common cause and begin empirical treatment with steroids
Should only biopsy if they don’t respond to steroids
Decreased urine output with hepatic failure and no proteinuria/hematuria. What will imaging reveal and why?
Normal pathology reduced GFR due to declining hepatic function. Splanchnic vasodilation (3rd compartment type syndrome) prerenal type azotemia
How do fibrates activate LPL?
activate PPAR-alpha protein
AEs of thiazide diuretics
hypokalemic metabolic alkalosis
hyponatremia
hyperGLUC–> glycemia, lipidemia, uricemia, calcemia
How is status epliepticus defined? Drug of choice?
Seizure activity continued more than 5-10 minutes w/o regaining consciousness b/w episodes
Diazepam is DOC b/c of short duration of action
Role of phospholamban in cardiac myocytes?
Dephosphorylation of phospholamban causes it to bind SERCA2 and decrease its affinity for calcium, reducing the influx of calcium into the sarcoplasmic reticulum/terminal cisternae
SERCA2 is the SR calcium ATPase that pumps calcium back into the SR following an AP
What is the Schilling test?
Radioactive oral B12 & Stage 1: Unlabled IM B12 Stage 2: Oral Intrinsic Factor Stage 3: Oral antibiotics Stage 4: Pancreatic Enzymes
Measure B12 in urine Diagnosis if high Stage 1-> dietary deficiency Stage 2 & 3-> pernicious anemia Stage 4-> Pancreatic insufficiency
If still low in stage 4, look for other causes such as ileal resection
What are the intrinsic laryngeal muscles (except the cricothyroid m) a derivative of?
sixth branchial (pharyngeal) arch
What is Hunter’s? What are the symptoms? How can you distinguish it from Hurler’s?
X-linked deficiency of iduronate sulfatase
Symptoms include coarse facies, aggressive behavior, and pearly skin lesions on the scapulae
Hunter’s does NOT have corneal clouding
What is Hurler’s? What are the symptoms? How can you distinguish it from Hunter’s?
Deficiency in alpha-L-iduronidase
Musculoskeletal abnormalities, hepatosplenomegaly, severe mental retardation
Hurler’s WILL have corneal clouding
It is more severe and is diagnosed within the first year of life
Symptoms of sarcoidosis? Treatment and AE?
AA woman with lung symptoms w/ bilateral hilar lympadenopathy & interstitial infiltrates, negative PPD, and HIGH ACE.
Treatment is corticosteroid taper. OD can lead to iatrogenic Cushing’s syndrome.
What role does calcium-calmodulin complex play in constriction of smooth muscle?
activates myosin light-chain kinase, which then phosphorylates myosin light chains.
Phosphorylated myosin light chains then facilitate cross-bridge formation
How does Angiotensin II act on vascular smooth muscle cells? What type of receptor does it bind?
Angiotensin II binds Gq
This causes contraction of renal arterioles
What is the treatment for Hepatitis B? MOA? AE?
alpha-IFN
degrades viral mRNA and inhibits protein synthesis
Stimulate NK and CD8 T cells
AEs: Dose-limiting neutropenia pancytopenia in general psych disturbances flu-like symptoms
Symptoms of cyanide poisoning
Treatment
Almond breath odor
Confusion
headache
Creates a metabolic lactic acidosis (high anion gap)
Treatment:
Sodium thiosulfate
amyl nitrite
What is the primary reducing agent in cells that produce steroids?
NADPH
Derived from B3 (niacin)
G-6-P Dehydrogenase is the enzyme that generates NADPH
What types of tumors are associated with NF2?
Bilateral vestibular schwannomas
Other CNS tumors, including ependymomas, meningiomas, gliomas, neurofibromas
What type of test might be a false positive for a patient with SLE?
VDRL (syphilis)
Remember that this test is not very specific
What is the pentad of thrombotic thombocytopenic purpura (TTP)?
- fever
- thrombocytopenia
- Microangiopathic hemolysis
- Neurologic symptoms
- Renal insufficiency
What is the most effective medication for raising HDL levels? AEs?
Cholesterol
AEs: flushing pruritus paresthesias nausea
What is the visible manifestation of glucagonoma?
necrolytic migratory erythema
painful, pruritic erythematous papules that blister/erode/crust over
What types of disease are Aschoff bodies seen in? What types of cells do they contain?
Rheumatic heart disease
Contain multinucleated giant cells and large Anitschkow cells
What type of molecule is ras?
GTP-binding protein
Loss of GTPase activity results in constitutively active G protein b/c it can’t be inactivated
What markers do smudge cells (CLL/SLL) express? From what cells do they originate?
They come from B lymphocytes and express B cell markers: CD5 CD19 CD20 CD23
What muscle opens the jaw? What innervates this muscle?
Lateral pterygoid
V3
What protein does imatinib inhibit?
Bcr-Abl tyrosine kinase
Philadelphia chromosome t(9;22) seen in CML
How can you tell the difference b/w folate and B12 deficiency?
B12: high homocysteine & MMA
Folate: High homocysteine (but NORMAL MMA)
Which diuretic causes gynecomastia, testicular atrophy, and decreased libido? Why does this occur?
Spironolactone
Weak androgen receptor antagonist
As secretory flow rate increases, how does composition of saliva change?
Bicarb secreted at higher rates
Sodium increased
Potassium decreased
What type of vaccine can be given to pregnant women? What is an example?
Killed virus vaccine
Inactivated polio
What flavivirus presents histologically with eosinophilic globules (apoptosis of individual hepatocytes)?
Yellow fever
jaundice, aches, high fever
vector= mosquito
Councilman bodies on liver bx
PCP intoxication signs? Treatment?
Assaultive behavior, belligerence, & psychosis fever tachycardia vertical & horizontal nystagmus HTN ataxia, seizures, delirium
Treatment: benzodiazepines or haloperidol (if severe)
What is erythromelalgia? What diseases is it associated with?
burning/redness of hands and feet due to platelet obstruction of blood flow in capillaries/arterioles
May do TIAs
Any type of thrombocytosis
Essential thrombocytosis can be treated with hydroxyurea
What things shift the oxygen-hemoglobin dissocation curve?
CO2 Acid DPG Exercise Temperature
5 criteria of dermatomyositis/polymyositis
- symmetric prox muscle weakness
- heliotrope rash
- elevated serum muscle enzymes
- myopathic changes on electromyography
- muscle bx abnormalities
What can cause drug-induced hyperthermia? How is it treated?
Inhaled anesthetics (-flurane)
Treat with dantrolene & cooling
Occurs more often in patients with mutation in ryanodine receptor–> allows for uncontrolled calcium release from SR
Where do T cells exist within the spleen?
Perarterial lymphoid sheath
Deficiency in hemophilia A & B
Hemophilia A-> Factor VIII
Hemophilia B-> Factor IX
Disease-modifying treatment in MS
Beta-IFN (class 1)
Acute attacks treated with glucocorticoids
HLA-DR2 associations
MS
hay fever
SLE
Goodpasture’s Syndrome
What do you see with dermatitis herpetiformis?
Anti-gliadin antibodies cause:
- celiac sprue
- erythematous/vesicular rash (anti-gliadin abs + hyperreactive T lymphocytes)
May results in malignancy (T-cell lymphoma)
What is the danger in giving Celecoxib to dehydrated patients?
COX-2 inhibitor causes constriction of afferent arteriole of kidney
Risk of renal failure
HIV patient, CD4 count < 100, new onset seizures
Toxoplasmosis
May also see chorioretinitis
Which virus affecting the liver causes a higher elevation of AST compared to ALT?
Yellow fever (flavivirus)
Pegylated IFN. Treatment? AEs?
Hep B & C
AEs:
flu-like reaction (episodic fever/chills)
profound depression
Deficiency in hyperchlyomicronemia
LPL
High triglycerides (>1000) Increased risk of pancreatitis Cardiac risk unchanged (HDL/LDL normal)
Myotonic dystrophy. Type of genetic disorder? Mutation?
Auto dominant
CTG nucleotide repeat
Muscle wasting, cataracts, heart conduction defects, & myotonia
Late finding in CMV retinitis? Treatment?
retinal detachment
treat with ganciclovir & foscarnet
Where can HHV-8 appear beside the skin? How can it manifest?
50% of patients have GI involvement:
- hematochezia
- hematemesis
- melena
What is the most common cause of squamous cell carcinoma of the bladder?
Helminth-> schistosoma haematobium
Holosystolic murmur at 4ICS
In kid-> VSD
In IVDU-> Tricuspid regurge
How to fat soluble vitamins first enter circulation?
Vitamins A,D,E, & K all enter circulation through the thoracic duct through lacteals and then larger lymphatics
Thalassemia major lab values
Hypochromic, microcytic anemia
Reticulocyte count elevated
What is the most common directly fatal complication of aortic dissection?
Pericardial tamponade
Aortic insufficiency results from aortic annulus disruption following retrograde dissection into the aortic root.
- Can lead to chronic myocardial remodeling
- Can be repaired surgically
Protamine sulfate: chemical nature?
Cationic
binds negatively charged heparin
Signs of aspiring overdose
tinnitus n/v lethargy fever tachypnea metabolic acidosis w/compensatory metabolic alkalosis
-treat with sodium bicarb to alkalize urine
How does cocaine affect sympathetic nerves? How does hydroxyamphetamine affect sympathetic nerves?
Cocaine: inhibits reuptake of norepinephrine
-malfunction indicates lack of neurotransmitter in synapse
Hydroxyamphetamine: causes release of NE from postganglionic neuron
-malfunction indicates problem with POSTganglionic neuron
Signs of ischemic bowel? Most common location?
hx of hypotension
Acidosis & tense/tender abdomen
Seen at splenic flexure of large bowel b/c it is junction b/w SMA and IMA (watershed phenomenon)
What does bacitracin help distinguish between?
s. pyogenes (sensitive)
s. agalactiae (resistant)
Development of what systems are affected with cretinism?
bone growth and CNS maturation
Initial treatment for SLE-induced DPGN?
cyclophosphamide (usually given in combination with glucocorticoids)
What is Lhermitte’s phenomenon?
A transient shock-like sensation most often triggered by flexion of the neck
associated with MS
What is Malonyl-CoA a building block for? What is the cofactor used in its formation?
Building block for FA synthesis
Formation fo malonyl-coa: acteyl-CoA carboxylation using biotin as a cofactor
What is usually the precipitating even for Berger’s disease? What is seen on immunoflourescence
- respiratory infection
- GI infection
- pharyngitis
IgA deposits in the mesangium
Would see hematuria with infection as a repetitive event in the patient’s life
What causes diffuse cortical necrosis? Triad? What are the indications for acute dialysis?
Caused from DIC due to precipitating event (like complications from pregnancy)
Triad: abrupt onset of
- anuria
- gross hematuria
- flank pain
Indications for acute dialysis: AEIOU
Acidosis
Electrolyte abnormalities (esp high potassium)
Intoxication with drugs
Overload (volume)
Uremic symptoms (cardiac friction rub & altered mental status)
Of course, try to treat acidosis (bicarb), electrolytes, and volume (diuretics) before dialysis
What are the main functions of vWF?
- adhesion of platelets to collagen via glycoproteins
2. carrier molecule of factor VIII
Defect in person getting recurrent candida infections?
Rare defect in T lymphocytes’ ability to effectively fight candidiasis
Diverticulitis symptoms
lower abdominal pain anorexia systemic symptoms -inflammation, fever, leukocytosis (Bleeding uncommon in acute diverticulitis)
Why might you give allopurinol with cyclosporine?
tumor lysis syndrome can cause urate nephropathy-> acute gouty arthritis from increased urate occurs secondary to nephrotoxicity
EKG pattern for aortic dissection complications?
Diffuse low-voltage QRS complexes and electrical alternans
Cardiac tamponade leads to decreased vent filling and CO
Beck’s triad: hypotension, increased JVP, distant heart sounds
EKG pattern for pulmonary embolism
S1Q3T3 pattern (specific but poorly sensitive)
Lead 1- S wave
Lead 3- Q wave and inverted T wave
Curling’s ulcers: cause? risk factor? treatment?
overproduction of acid
burn patients
omeprazole
AAT histology?
intracellular periodic acid-Schiff (PAS)-positive globules
What would you expect with almost immediate cyanosis?
transposition of the great vessels
What type of sensitivity is PSGN?
Type III (antigen-Ab complexes)
How do you treat invasive aspergillus? AE?
voriconazole
Prolonged QT interval
Histologic fiding in papillary carcinoma?
Orphan annie (ground glass) nuclei w/ psammoma bodies
What anticoagulant is given for atrial fib? What types of drugs should be used with caution in conjunction with this drug?
Warfarin
Beware with CYP inhibitors
What disorder has elevated direct bilirubin and normal indirect bilirubin?
Dubin-Johnson Syndrome
impairment of transport system for removing cojugated anions into bile
Melanin-like pigment seen in hepatocytes
Jews or Iranians
Relatively benign
Bloody mucoid diarrhea
recent travel
hepatic abscess
Diagnosis? Treatment?
Entamoeba histolytica
Metronidazole
Formula for specificity?
TN/(FP + TN)
Idiopathic pulmonary fibrosis: characteristic appearance on chest CT
honeycombing
What lab will be abnormal with idiopathic pulmonary fibrosis?
hematocrit
upreg of EPO by kidneys in response to chronic decreased blood oxygen tension
HbA levels in Beta-thalassemia major? Beta-thalassemia minor?
Major- no HbA1
Minor- decreased HbA1
AEs for: enflurane halothane desflurane methoxyflurane
Enflurane: pro-convulsant
Halothane: hepatotoxicity, hyperthermia
Desflurane: airway irritation
Methoxyflurane: nephrotoxicity
Lesch-Nyhan histology?
Hypersegmented neutrophils
occurs due to inability to utilize B12 leading to macrocytic anemia
What type of coarctation occurs with Turner syndrome?
preductal
might see small left arm due to compromised blood flow w/ involvement of left subclavian artery
MEN Type 1: areas involved
pancreas
pituitary
parathyroid
MEN Type 2: areas involved
thyroid
pheochromocytoma
parathyroid
ret oncogene
Person comes in with encephalopathy, confusion, gait ataxia, and nystagmus. Late stages: selective deficits in antero-/retrograde memory.
Diagnosis?
Deficiency?
Wernicke-Korsakoff syndrome
Deficient in B1 (thiamine)
In what setting does primary sclerosing cholangitis occur? What enzyme might be elevated with this condition?
Might occur in the setting of ulcerative colitis
Fatigue, pruritis, and scleral icterus.
You would see elevated alk phosph
Anti-mitochondrial Abs
primary biliary cirrhosis
Which biliary condition affects:
ONLY intrahepatic ducts
intra & extrahepatic ducts
ONLY intra: primary biliary cirrhosis
Intra & extra: primary sclerosing cholangitis
Polymyxin:
MOA?
AE?
binds to gram negative cell bacterial membrane phospholipids and destroys membranes by acting like a detergent
AE: numbness of extremities, CNS effects, nystagmus/blurry vision
Used for severe gram (-) infections
Cytarabine: MOA
pyrimidine analog
prodrug activated to AraCTP.
intereferes with DNA synthesis
used for leukemia
Hematopoiesis during development
1st- yolk sac (week 3)
2nd- liver (week 6-birth)
3rd- spleen (week 10-28)
4th- bone marrow (week 18)
Plummer-Vinson diagnostic triad
- Iron deficiency anemia
- Upper esophageal web
- Glossitis
(1 & 2 can lead to dysphagia of solids)
Increased risk of squamous cell carcinoma of oral cavity, hypopharynx, or esophagus
Gerstmann’s syndrome tetrad
- inability to distinguish right from left
- inability to identify fingers
- writing disability (agraphia/dysgraphia)
- can’t do math (acalculia/dyscalculia)
Affected area= visual association cortex (angular gyrus)
can still read
might have visual field defects (contralateral)
Hartnup disease: MOA?
Deficiency & treatment?
Defect in neutral amino acid transporters in both renal and GI tracts
affects all neutral amino acids but proline
deficiency in tryptophan: leads to decreased niacin and pellagra
Which skin lesions are painful: yersinia pestis or bacillus anthracis?
yersinia pestis
What is a complication of yersinia pestis?
DIC
Treatment of acute PE? What do you need to monitor when giving this drug?
Low molecular weight heparin (LMWH)
You don’t have to monitor anything!
Give unfractionated heparin in patients with severe hypotension, morbid obesity, or renal failure. In this case, monitor PTT
Thiazolidinone. Indication? MOA?
Sensitization of muscle and liver to insulin
binds PPAR nuclear regulator–> increase insulin receptor
How do glucose, galactose, and fructose traverse the:
- apical membrane
- basolateral membrane
Apical:
glu/galac-> SGLT-1 (Na dependent)
fructose-> GLUT-5
Basolateral:
GLUT-2
Diagnosis if jaundice, anemia, increased reticulocytes, and positive warm-agglutinin test
Warm reactive autoimmune hemolytic anemia
Treatment of warm-reactive autoimmune hemolytic anemia (AIHA)?
corticosteroids
splenectomy if chronic or refractory, but this is NOT first line
Guillan barre: treatment?
plasmapharesis followed by immunoglobulins and supportive care
Wiskott-Aldrich symptoms
WATER: Wiskott-Aldrich Thrombocytopenic purpura Eczema Recurrent infections
Wiskott-Aldrich: deficiency
X=linked recessive
WASP gene
T cells unable to reorganize actin skeleton
What is another name for the Ziehl-Neelsen stain?
acid fast
What does e. coli ferment?
lactose
pink colonies on MacConkey
APL: which translocation? What are the two products involved? Treatment?
t(15;17)
15- PML
17- retinoic acid receptor
Treatment: Retinoic Acid
Displaced lens, chromosome 15… think?
Marfan’s
Problems with swallowing post-surgery: nerve and structure it is derived from?
superior laryngeal n. of vagus
4th branchial arch
How does lead poisoning inhibit heme synthesis?
Blocks delta-aminolevulinic acid dehydratase
decreases iron incorporation into heme
What is the treatment for n. gonorrheae that persists despite treatment with a fluoroquinolone?
ceftriaxone + azithromycin
Which lung tumor is found to be found in the periphery of a nonsmoker’s lung?
Adenocarcinomas
Ischemic stroke treatment
clopidogrel & ticlopidine
inhibit platelet aggregation by blocking adenosine phosphate receptors
anti-phospholipid antibodies: characteristics
hypercoagulability
recurrent fetal losses
prolong PTT not corrected with 1:1 FFP
Metformin: AE (esp in context of renal disease)
lactic acidosis (anion gap metabolic acidosis)
Risk factors for suicide completion
SAD PERSONS Sex (male) Age (teen or elderly) Depression Previous attempt Ethanol/drug use loss of Rational thinking Sickness Organized plan No spouse Social support lacking
Women try more often; men succeed more often
baby malformations seen with maternal warfarin use
facial/limb malformations
neurological defects
you should give LMW heparin
methachromatic leukodystrophy: auto recessive. Deficiency & symptoms?
lysosomal storage disease: arylsulfatase A deficiency-> converts sulfatide to galactocerebroside
tissue accumulation of cerebroside sulfatide
loss of myelination
metachromatic granules on histologic examination
What is a hapten?
a molecule that can’t elicit an immune response on its own but can do so with a protein bound to it
immune thrombocytopenic purpura: blood smear appearance?
enlarged platelets & greater abundance of megakaryocytes
What types of cells use SGLT glucose transporters?
enterocytes and nephrons
Waldenstrom’s macroglobulinemia: presentation?
high IgM plasma cells dominate BM mild anemia high/normal BUN increased total protein
molecules involved in thyroxine synthesis
iodine
tyrosine
treatment for m. pneumoniae
tetracycline
nerve block for woman in labor: nerve and nerve roots?
pudendal nerve
S2-S4
MS treatment
beta-IFN
What can cross the BBB?
CO2
O2
amino acids
glucose
Gaucher’s disease: deficiency? most commonly seen in?
beta glucocerebrosidase
Ashkenazi Jews
LTs that cause asthma symptoms?
C4, D4, & E4
prescribe zileuton & zafirlukast
stop codons
UGA
UAA
UAG
HSV1 encephalitis: CT
focal, unilateral temporal lobe pathology
extra-intestinal manifestations of Crohn’s Disease
uveitis
migratory polyarthritis
erythema nodosum
renal calculi
IBD & kidney stones: mechanism
increased intraluminal fat in intestine binds calcium
More oxalate is absorbed than calcium
oxalate + dehydration from diarrhea = precipitation of calcium oxalate stones
Paneth’s granular cells: location & purpose
small intestine
release alpha-defensins & lysoszymes
Agar to distinguish between shigella & salmonella
Hektoen enteric agar
black= H2S (salmonella)
NSAID prescribed to patients with history of GI distress
Celecoxib (COX-2 specific)
caution in patients with CV stuff
lymph node pain with alcohol consumption
Hodgkin’s lymphoma
Essential amino acids
Leucine Isoleucine Lysine Phenylalanine Tryptophan Methionine Threonine Valine
(histidine during periods of growth)
Gaucher’s disease (AR-> beta glucocerebrosidase, ashkenazi jews): common symptoms
hepatosplenomegaly
aseptic necrosis of femur
bone crises
gaucher’s cells (crinkle cells)
What 4 embryologic structures make up the diaphragm?
- Pleuroperitoneal folds
- Septum transversum
- Dorsal mesentery of esophagus
- Muscular outgrowth of lateral body wall
HIV:
Initial screening test?
confirmation?
Initial- ELISA
Confirmation- Western blot
p. jiroveci: treatment in patient allergic to TMP-SMX?
Pentamidine
Malignant otitis externa: bug? first line treatment? treatment if resistant?
p.aeruginosa
treat with a fluorquinolone (cipro)
if resistant, hit it with a piperacillin/tazobactam combo
