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STEP > USMLE-Rx Question Log > Flashcards

USMLE-Rx Question Log Flashcards

1
Q

What are the AEs for nortriptyline?

A

Remember the 3 Cs:
Coma
Convulsions
Cardiotoxicity (arrhythmia/prolonged QT)

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2
Q

What is dipalmitoyl phosphatidylcholine?

A

surfactant
Made most abundantly at week 35
At 28 weeks, not high enough
Measured by lecithin: sphingomyelin ratio ( >2 is good)

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3
Q

What are toxicities of amiodarone?

A 
Get PFTs, LFTs, and TFTs
pulmonary fibrosis
hepatotoxicity
hypo OR hyperthyroid
also photodermatitis & constipation
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4
Q

Which class of antiarrhythmics has greater effect on cardiac tissue that depolarizes frequently?

A

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

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5
Q

How can you correct and untreatable ACD?

A

Erythropoietin

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6
Q

In a patient with bone metastases, what will your levels of Calcium and alk phosph be?

A

Calcium decreased
Alk phosph increased
Ca low b/c it’s being used to build new bone in area of mets

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7
Q

What is the molecule that is causing hypertension in 11B-hydroxylase deficiency?

A

11-deoxycorticosterone(mineralocorticoid precursor)

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8
Q

What is the formula for sensitivity?

A

TP/ (TP + FN)

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9
Q

What are the most common sites for PAD?

A

Affects arteries
Abd aorta, iliac, femoral, politeal, tibial, and peroneal
Treat w/ antiplatelets or surgical revascularization

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10
Q

Where does mumps cause inflammation? What is the epithelium in this area?

A

epididymis

pseudostratified columnar epithelium w/ stereocilia

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11
Q

What are the symptoms of tracheoesophageal fistula? What does it mean if air is seen in the stomach?

A

choking, coughing, salivation, cyanosis during feeding

If air in stomach, this means the lower esophagus/stomach is communicating with the trachea in some way

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12
Q

How does dangerous hyperkalemia manifest on an EKG?

A

peaked T waves

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13
Q

Meds that cause torsades de pointes?

A 
"Some Risky Meds Can Prolong QT"
Sotalol
Risperidone (antipsychotics)
Macrolides
Chloroquine
Protease inhibitors (-nivir)
Quinidine (Class Ia & III)
Thiazides
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14
Q

Tanner Stage 3

A

Peak growth height
1 year after initial breast development
enlargement of breast/areola w/ single contourgrowth of darker, coarse, curled pubic hair

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15
Q

Milestones for a 7-11 month old

A 
Sitting alone
standing w/ aid
crawling
wave bye bye
say mama/dada
Stranger anxiety
Babinski relfex (disappears at 1 year)
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16
Q

Where are proteins tagged with mannose-6-phosphate?

A

Golgi

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17
Q

How does measles typically present?

A

Blanching red rash
Starts on face, moves to trunk and limbs, resolves in same order

SSPE is a rare complication in 7-9 yos

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18
Q

Which RNA polymerase produces each type of RNA?What toxin is produced by Amanita phalloides and which polymerase does it inhibit?

A

rRNA- RNA pol I
mRNA- RNA pol II
tRNA- RNA pol III

alpha-amantin-> inhib RNA pol II (mRNA). Leads to severe hepatoxicity

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19
Q

What types of defects does Valproic acid cause?

A

Neural tube

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20
Q

Deficiency of what neuropeptide causes narcolepsy? Where is it produced

A

Orexins A & B

Lateral hypothalamus

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21
Q

AEs of steroid treatment

A

Cushing-like symptoms, cataracts, HTN, increased appetite, hyperglycemia, insomnia, profound mood changes (steroid psychosis)

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22
Q

What toxin does aspergillus flavus produce? What are its effects?

A

aflatoxin
Causes hepatocellular carcinoma

Think Asia/Africa

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23
Q

Which COX inhibitor irreversibly binds COX?

A

Aspirin (via acetylation)

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24
Q

When should you give rabies immunoglobulin? How many rabies vaccines should you give?

A

If not immunized, give immunoglobulin

Give everyone vaccine (4 if never received; 2 if previously received)

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25
Q

In an HIV patient with CD4 count < 200, what types of organisms are most difficult to control?

A

Those controlled by cell-mediated arm of immune system

Intracellular organisms such as L. monocytogenes

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26
Q

What type of deficiency can be caused by phenytoin?

A

Folate

look out for macrocytic anemia

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27
Q

What drug can be used for both parkinsons and as influenza prophylaxis?

A

Amantidine

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28
Q

What are the AEs of amantidine?

A

ataxia
dizziness
slurred speech

Be careful in seizure patients

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29
Q

Which hepatitis viruses are spread fecal-oral route?

A

Hepatitis A & E

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30
Q

Homocystinuria Deficiency? Presentation?

A

Def in cystathionine synthase
Similar to Marfan’s (subluxation of lens and tall stature)
Life threatening thromboembolic events

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31
Q

What is an anti-IgG antibody?

A

Rheumatoid Factor

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32
Q

Where do you see squamous cell carcinoma in the lung? What protein can it produce and what symptoms will this cause?

A 
Central bronchogenic carcinoma
Can produce PTHrP
Increase calcium
Decrease phosphate
constipation & polyuria
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33
Q

What toxicity can nitroprusside cause? Symptoms? What should you give prophylactically to prevent this complication?

A 
Cyanide toxicity (inhib cyt oxidase--> blocks ETC)
decreased O2 utilization, lactic acidosis, possible death
Admin sodium thiosulfate (cyanide--> thiocyanate by rhodanese)
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34
Q

Which lymphoma has high expression of bcl-2 gene?

A

Follicular lymphoma

t(14;18)

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35
Q

Which amino acids are lost in cystinuria? What is the complication and how is it treated?

A

Lose lysine, arginine, cystine, and ornithine
Causes stone formation
Treat with hydration and alkalization of urine with acetazolamide

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36
Q

Most common cause of septic arthritis in adults and children?

A

s. aureus

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37
Q

What is echinococcus granulosus? How does it present? How is it treated?

A

Dog tapeworm
Hydatid cysts in the liver contain larvae
Can cause anaphylaxis when it ruptures
Treatment is surgical excision

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38
Q

What do you need to measure after putting someone on heparin?

A

Platelets every 2-3 days to prevent HIT

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39
Q

What is naphthalene? What can it cause?

A 
Aniline dye (textiles)
transitional cell carcinoma of bladder
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40
Q

What is a deficiency of uridine diphosphate glucuronyl transferase called and what does it cause?

A 
Crigler-Najjar syndrome type 1
Causes inability to conjugate bilirubin
Increased unconjugated bilirubin leads to:
-jaundice
-kernicterus
-bilirubin deposition in brain
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41
Q

What is commonly the first presentation of vWD?

A 
Mucocutaneous bleeding (after a dental extraction)
Prolonged PTT, decreased factor VIII, reduced ristocetin-induced platelet aggregation

auto dominant

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42
Q

What cells are capable of transforming into activated ameboid cells with CNS tissue damage? What is their embryonal origin?

A

Microglia (resident phagocytes of CNS)

Mesoderm (circulating blood monocytes)

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43
Q

What types of vacuoles are tennis racket-shaped? What cell type are they found in? What is activated by this cell type?

A

Birbeck granules founds in Langerhans cells

Langerhans cells activate Helper T cells

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44
Q

Treatment and drug MOA for Wilson’s disease?

A

N-penicillamine

copper chelating agent

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45
Q

How should you measure a B12 deficiency?

A

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

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46
Q

What is milk alkali syndrome?

A

Hypercalcemia, metabolic alkalosis, renal insufficiency
Caused by calcium carbonate (OTC antacid)
Can cause severe renal toxicity if not discontinued

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47
Q

Characteristics of organism causing cat scratch fever

A

Bartonella heneslae
gram negative coccobacillus
oxidase positive
catalase positive

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48
Q

What urinary symptoms occur in sickle cell trait?

A

Episodic hematuria and impaired ability to concentrate urine

Result of microscopic thromboembolic events within renal medulla

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49
Q

Where is the most common CF defect located?

A

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

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50
Q

Hypertension + hyperkalemia with a genetic basis.Diagnosis? Treatment?

A

Liddle’s syndrome-> constitutively activated ENaC in CT of kidney
Treat with traimterene or amiloride

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51
Q

What do rotavirus and coltivirus have in common?

A

double stranded segmented RNA virus

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52
Q

Which neoplasm is associated with Down syndrome (20x increased incidence)

A

ALL(may also see AML; less common)

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53
Q

Kid comes in with weight gain/edema and proteinuria. What is the next step?

A

Assume MCD b/c most common cause and begin empirical treatment with steroids
Should only biopsy if they don’t respond to steroids

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54
Q

Decreased urine output with hepatic failure and no proteinuria/hematuria. What will imaging reveal and why?

A 
Normal pathology
reduced GFR due to declining hepatic function. 
Splanchnic vasodilation (3rd compartment type syndrome)
prerenal type azotemia
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55
Q

How do fibrates activate LPL?

A

activate PPAR-alpha protein

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56
Q

AEs of thiazide diuretics

A

hypokalemic metabolic alkalosis
hyponatremia
hyperGLUC–> glycemia, lipidemia, uricemia, calcemia

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57
Q

How is status epliepticus defined? Drug of choice?

A

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

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58
Q

Role of phospholamban in cardiac myocytes?

A

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

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59
Q

What is the Schilling test?

A 
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

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60
Q

What are the intrinsic laryngeal muscles (except the cricothyroid m) a derivative of?

A

sixth branchial (pharyngeal) arch

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61
Q

What is Hunter’s? What are the symptoms? How can you distinguish it from Hurler’s?

A

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

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62
Q

What is Hurler’s? What are the symptoms? How can you distinguish it from Hunter’s?

A

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

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63
Q

Symptoms of sarcoidosis? Treatment and AE?

A

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.

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64
Q

What role does calcium-calmodulin complex play in constriction of smooth muscle?

A

activates myosin light-chain kinase, which then phosphorylates myosin light chains.

Phosphorylated myosin light chains then facilitate cross-bridge formation

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65
Q

How does Angiotensin II act on vascular smooth muscle cells? What type of receptor does it bind?

A

Angiotensin II binds Gq

This causes contraction of renal arterioles

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66
Q

What is the treatment for Hepatitis B? MOA? AE?

A

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
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67
Q

Symptoms of cyanide poisoning

Treatment

A

Almond breath odor
Confusion
headache

Creates a metabolic lactic acidosis (high anion gap)

Treatment:
Sodium thiosulfate
amyl nitrite

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68
Q

What is the primary reducing agent in cells that produce steroids?

A

NADPH

Derived from B3 (niacin)

G-6-P Dehydrogenase is the enzyme that generates NADPH

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69
Q

What types of tumors are associated with NF2?

A

Bilateral vestibular schwannomas

Other CNS tumors, including ependymomas, meningiomas, gliomas, neurofibromas

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70
Q

What type of test might be a false positive for a patient with SLE?

A

VDRL (syphilis)

Remember that this test is not very specific

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71
Q

What is the pentad of thrombotic thombocytopenic purpura (TTP)?

A
  1. fever
  2. thrombocytopenia
  3. Microangiopathic hemolysis
  4. Neurologic symptoms
  5. Renal insufficiency
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72
Q

What is the most effective medication for raising HDL levels? AEs?

A

Cholesterol

AEs:
flushing
pruritus
paresthesias
nausea
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73
Q

What is the visible manifestation of glucagonoma?

A

necrolytic migratory erythema

painful, pruritic erythematous papules that blister/erode/crust over

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74
Q

What types of disease are Aschoff bodies seen in? What types of cells do they contain?

A

Rheumatic heart disease

Contain multinucleated giant cells and large Anitschkow cells

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75
Q

What type of molecule is ras?

A

GTP-binding protein

Loss of GTPase activity results in constitutively active G protein b/c it can’t be inactivated

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76
Q

What markers do smudge cells (CLL/SLL) express? From what cells do they originate?

A 
They come from B lymphocytes and express B cell markers:
CD5
CD19
CD20
CD23
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77
Q

What muscle opens the jaw? What innervates this muscle?

A

Lateral pterygoid

V3

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78
Q

What protein does imatinib inhibit?

A

Bcr-Abl tyrosine kinase

Philadelphia chromosome t(9;22) seen in CML

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79
Q

How can you tell the difference b/w folate and B12 deficiency?

A

B12: high homocysteine & MMA

Folate: High homocysteine (but NORMAL MMA)

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80
Q

Which diuretic causes gynecomastia, testicular atrophy, and decreased libido? Why does this occur?

A

Spironolactone

Weak androgen receptor antagonist

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81
Q

As secretory flow rate increases, how does composition of saliva change?

A

Bicarb secreted at higher rates
Sodium increased
Potassium decreased

82
Q

What type of vaccine can be given to pregnant women? What is an example?

A

Killed virus vaccine

Inactivated polio

83
Q

What flavivirus presents histologically with eosinophilic globules (apoptosis of individual hepatocytes)?

A

Yellow fever
jaundice, aches, high fever
vector= mosquito

Councilman bodies on liver bx

84
Q

PCP intoxication signs? Treatment?

A 
Assaultive behavior, belligerence, & psychosis
fever
tachycardia
vertical & horizontal nystagmus
HTN
ataxia, seizures, delirium

Treatment: benzodiazepines or haloperidol (if severe)

85
Q

What is erythromelalgia? What diseases is it associated with?

A

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

86
Q

What things shift the oxygen-hemoglobin dissocation curve?

A 
CO2
Acid
DPG
Exercise
Temperature
87
Q

5 criteria of dermatomyositis/polymyositis

A
  1. symmetric prox muscle weakness
  2. heliotrope rash
  3. elevated serum muscle enzymes
  4. myopathic changes on electromyography
  5. muscle bx abnormalities
88
Q

What can cause drug-induced hyperthermia? How is it treated?

A

Inhaled anesthetics (-flurane)

Treat with dantrolene & cooling

Occurs more often in patients with mutation in ryanodine receptor–> allows for uncontrolled calcium release from SR

89
Q

Where do T cells exist within the spleen?

A

Perarterial lymphoid sheath

90
Q

Deficiency in hemophilia A & B

A

Hemophilia A-> Factor VIII

Hemophilia B-> Factor IX

91
Q

Disease-modifying treatment in MS

A

Beta-IFN (class 1)

Acute attacks treated with glucocorticoids

92
Q

HLA-DR2 associations

A

MS
hay fever
SLE
Goodpasture’s Syndrome

93
Q

What do you see with dermatitis herpetiformis?

A

Anti-gliadin antibodies cause:

  1. celiac sprue
  2. erythematous/vesicular rash (anti-gliadin abs + hyperreactive T lymphocytes)

May results in malignancy (T-cell lymphoma)

94
Q

What is the danger in giving Celecoxib to dehydrated patients?

A

COX-2 inhibitor causes constriction of afferent arteriole of kidney

Risk of renal failure

95
Q

HIV patient, CD4 count < 100, new onset seizures

A

Toxoplasmosis

May also see chorioretinitis

96
Q

Which virus affecting the liver causes a higher elevation of AST compared to ALT?

A

Yellow fever (flavivirus)

97
Q

Pegylated IFN. Treatment? AEs?

A

Hep B & C
AEs:
flu-like reaction (episodic fever/chills)
profound depression

98
Q

Deficiency in hyperchlyomicronemia

A

LPL

High triglycerides (>1000)
Increased risk of pancreatitis
Cardiac risk unchanged (HDL/LDL normal)
99
Q

Myotonic dystrophy. Type of genetic disorder? Mutation?

A

Auto dominant
CTG nucleotide repeat

Muscle wasting, cataracts, heart conduction defects, & myotonia

100
Q

Late finding in CMV retinitis? Treatment?

A

retinal detachment

treat with ganciclovir & foscarnet

101
Q

Where can HHV-8 appear beside the skin? How can it manifest?

A

50% of patients have GI involvement:

  • hematochezia
  • hematemesis
  • melena
102
Q

What is the most common cause of squamous cell carcinoma of the bladder?

A

Helminth-> schistosoma haematobium

103
Q

Holosystolic murmur at 4ICS

A

In kid-> VSD

In IVDU-> Tricuspid regurge

104
Q

How to fat soluble vitamins first enter circulation?

A

Vitamins A,D,E, & K all enter circulation through the thoracic duct through lacteals and then larger lymphatics

105
Q

Thalassemia major lab values

A

Hypochromic, microcytic anemia

Reticulocyte count elevated

106
Q

What is the most common directly fatal complication of aortic dissection?

A

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
107
Q

Protamine sulfate: chemical nature?

A

Cationic

binds negatively charged heparin

108
Q

Signs of aspiring overdose

A 
tinnitus
n/v
lethargy
fever
tachypnea
metabolic acidosis w/compensatory metabolic alkalosis

-treat with sodium bicarb to alkalize urine

109
Q

How does cocaine affect sympathetic nerves? How does hydroxyamphetamine affect sympathetic nerves?

A

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

110
Q

Signs of ischemic bowel? Most common location?

A

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)

111
Q

What does bacitracin help distinguish between?

A

s. pyogenes (sensitive)

s. agalactiae (resistant)

112
Q

Development of what systems are affected with cretinism?

A

bone growth and CNS maturation

113
Q

Initial treatment for SLE-induced DPGN?

A

cyclophosphamide (usually given in combination with glucocorticoids)

114
Q

What is Lhermitte’s phenomenon?

A

A transient shock-like sensation most often triggered by flexion of the neck
associated with MS

115
Q

What is Malonyl-CoA a building block for? What is the cofactor used in its formation?

A

Building block for FA synthesis

Formation fo malonyl-coa: acteyl-CoA carboxylation using biotin as a cofactor

116
Q

What is usually the precipitating even for Berger’s disease? What is seen on immunoflourescence

A
  • respiratory infection
  • GI infection
  • pharyngitis

IgA deposits in the mesangium

Would see hematuria with infection as a repetitive event in the patient’s life

117
Q

What causes diffuse cortical necrosis? Triad? What are the indications for acute dialysis?

A

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

118
Q

What are the main functions of vWF?

A
  1. adhesion of platelets to collagen via glycoproteins

2. carrier molecule of factor VIII

119
Q

Defect in person getting recurrent candida infections?

A

Rare defect in T lymphocytes’ ability to effectively fight candidiasis

120
Q

Diverticulitis symptoms

A 
lower abdominal pain
anorexia
systemic symptoms
-inflammation, fever, leukocytosis
(Bleeding uncommon in acute diverticulitis)
121
Q

Why might you give allopurinol with cyclosporine?

A

tumor lysis syndrome can cause urate nephropathy-> acute gouty arthritis from increased urate occurs secondary to nephrotoxicity

122
Q

EKG pattern for aortic dissection complications?

A

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

123
Q

EKG pattern for pulmonary embolism

A

S1Q3T3 pattern (specific but poorly sensitive)

Lead 1- S wave
Lead 3- Q wave and inverted T wave

124
Q

Curling’s ulcers: cause? risk factor? treatment?

A

overproduction of acid
burn patients
omeprazole

125
Q

AAT histology?

A

intracellular periodic acid-Schiff (PAS)-positive globules

126
Q

What would you expect with almost immediate cyanosis?

A

transposition of the great vessels

127
Q

What type of sensitivity is PSGN?

A

Type III (antigen-Ab complexes)

128
Q

How do you treat invasive aspergillus? AE?

A

voriconazole

Prolonged QT interval

129
Q

Histologic fiding in papillary carcinoma?

A

Orphan annie (ground glass) nuclei w/ psammoma bodies

130
Q

What anticoagulant is given for atrial fib? What types of drugs should be used with caution in conjunction with this drug?

A

Warfarin

Beware with CYP inhibitors

131
Q

What disorder has elevated direct bilirubin and normal indirect bilirubin?

A

Dubin-Johnson Syndrome

impairment of transport system for removing cojugated anions into bile

Melanin-like pigment seen in hepatocytes

Jews or Iranians

Relatively benign

132
Q

Bloody mucoid diarrhea
recent travel
hepatic abscess

Diagnosis? Treatment?

A

Entamoeba histolytica

Metronidazole

133
Q

Formula for specificity?

A

TN/(FP + TN)

134
Q

Idiopathic pulmonary fibrosis: characteristic appearance on chest CT

A

honeycombing

135
Q

What lab will be abnormal with idiopathic pulmonary fibrosis?

A

hematocrit

upreg of EPO by kidneys in response to chronic decreased blood oxygen tension

136
Q

HbA levels in Beta-thalassemia major? Beta-thalassemia minor?

A

Major- no HbA1

Minor- decreased HbA1

137
Q 
AEs for:
enflurane
halothane
desflurane
methoxyflurane
A

Enflurane: pro-convulsant
Halothane: hepatotoxicity, hyperthermia
Desflurane: airway irritation
Methoxyflurane: nephrotoxicity

138
Q

Lesch-Nyhan histology?

A

Hypersegmented neutrophils

occurs due to inability to utilize B12 leading to macrocytic anemia

139
Q

What type of coarctation occurs with Turner syndrome?

A

preductal

might see small left arm due to compromised blood flow w/ involvement of left subclavian artery

140
Q

MEN Type 1: areas involved

A

pancreas
pituitary
parathyroid

141
Q

MEN Type 2: areas involved

A

thyroid
pheochromocytoma
parathyroid

ret oncogene

142
Q

Person comes in with encephalopathy, confusion, gait ataxia, and nystagmus. Late stages: selective deficits in antero-/retrograde memory.

Diagnosis?
Deficiency?

A

Wernicke-Korsakoff syndrome

Deficient in B1 (thiamine)

143
Q

In what setting does primary sclerosing cholangitis occur? What enzyme might be elevated with this condition?

A

Might occur in the setting of ulcerative colitis
Fatigue, pruritis, and scleral icterus.

You would see elevated alk phosph

144
Q

Anti-mitochondrial Abs

A

primary biliary cirrhosis

145
Q

Which biliary condition affects:
ONLY intrahepatic ducts
intra & extrahepatic ducts

A

ONLY intra: primary biliary cirrhosis

Intra & extra: primary sclerosing cholangitis

146
Q

Polymyxin:
MOA?
AE?

A

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

147
Q

Cytarabine: MOA

A

pyrimidine analog
prodrug activated to AraCTP.
intereferes with DNA synthesis

used for leukemia

148
Q

Hematopoiesis during development

A

1st- yolk sac (week 3)
2nd- liver (week 6-birth)
3rd- spleen (week 10-28)
4th- bone marrow (week 18)

149
Q

Plummer-Vinson diagnostic triad

A
  1. Iron deficiency anemia
  2. Upper esophageal web
  3. Glossitis

(1 & 2 can lead to dysphagia of solids)

Increased risk of squamous cell carcinoma of oral cavity, hypopharynx, or esophagus

150
Q

Gerstmann’s syndrome tetrad

A
  1. inability to distinguish right from left
  2. inability to identify fingers
  3. writing disability (agraphia/dysgraphia)
  4. can’t do math (acalculia/dyscalculia)

Affected area= visual association cortex (angular gyrus)

can still read
might have visual field defects (contralateral)

151
Q

Hartnup disease: MOA?

Deficiency & treatment?

A

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

152
Q

Which skin lesions are painful: yersinia pestis or bacillus anthracis?

A

yersinia pestis

153
Q

What is a complication of yersinia pestis?

A

DIC

154
Q

Treatment of acute PE? What do you need to monitor when giving this drug?

A

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

155
Q

Thiazolidinone. Indication? MOA?

A

Sensitization of muscle and liver to insulin

binds PPAR nuclear regulator–> increase insulin receptor

156
Q

How do glucose, galactose, and fructose traverse the:

  • apical membrane
  • basolateral membrane
A

Apical:
glu/galac-> SGLT-1 (Na dependent)
fructose-> GLUT-5

Basolateral:
GLUT-2

157
Q

Diagnosis if jaundice, anemia, increased reticulocytes, and positive warm-agglutinin test

A

Warm reactive autoimmune hemolytic anemia

158
Q

Treatment of warm-reactive autoimmune hemolytic anemia (AIHA)?

A

corticosteroids

splenectomy if chronic or refractory, but this is NOT first line

159
Q

Guillan barre: treatment?

A

plasmapharesis followed by immunoglobulins and supportive care

160
Q

Wiskott-Aldrich symptoms

A 
WATER:
Wiskott-Aldrich
Thrombocytopenic purpura
Eczema
Recurrent infections
161
Q

Wiskott-Aldrich: deficiency

A

X=linked recessive
WASP gene

T cells unable to reorganize actin skeleton

162
Q

What is another name for the Ziehl-Neelsen stain?

A

acid fast

163
Q

What does e. coli ferment?

A

lactose

pink colonies on MacConkey

164
Q

APL: which translocation? What are the two products involved? Treatment?

A

t(15;17)
15- PML
17- retinoic acid receptor

Treatment: Retinoic Acid

165
Q

Displaced lens, chromosome 15… think?

A

Marfan’s

166
Q

Problems with swallowing post-surgery: nerve and structure it is derived from?

A

superior laryngeal n. of vagus

4th branchial arch

167
Q

How does lead poisoning inhibit heme synthesis?

A

Blocks delta-aminolevulinic acid dehydratase

decreases iron incorporation into heme

168
Q

What is the treatment for n. gonorrheae that persists despite treatment with a fluoroquinolone?

A

ceftriaxone + azithromycin

169
Q

Which lung tumor is found to be found in the periphery of a nonsmoker’s lung?

A

Adenocarcinomas

170
Q

Ischemic stroke treatment

A

clopidogrel & ticlopidine

inhibit platelet aggregation by blocking adenosine phosphate receptors

171
Q

anti-phospholipid antibodies: characteristics

A

hypercoagulability
recurrent fetal losses
prolong PTT not corrected with 1:1 FFP

172
Q

Metformin: AE (esp in context of renal disease)

A

lactic acidosis (anion gap metabolic acidosis)

173
Q

Risk factors for suicide completion

A 
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

174
Q

baby malformations seen with maternal warfarin use

A

facial/limb malformations
neurological defects

you should give LMW heparin

175
Q

methachromatic leukodystrophy: auto recessive. Deficiency & symptoms?

A

lysosomal storage disease: arylsulfatase A deficiency-> converts sulfatide to galactocerebroside

tissue accumulation of cerebroside sulfatide

loss of myelination
metachromatic granules on histologic examination

176
Q

What is a hapten?

A

a molecule that can’t elicit an immune response on its own but can do so with a protein bound to it

177
Q

immune thrombocytopenic purpura: blood smear appearance?

A

enlarged platelets & greater abundance of megakaryocytes

178
Q

What types of cells use SGLT glucose transporters?

A

enterocytes and nephrons

179
Q

Waldenstrom’s macroglobulinemia: presentation?

A 
high IgM
plasma cells dominate BM
mild anemia
high/normal BUN
increased total protein
180
Q

molecules involved in thyroxine synthesis

A

iodine

tyrosine

181
Q

treatment for m. pneumoniae

A

tetracycline

182
Q

nerve block for woman in labor: nerve and nerve roots?

A

pudendal nerve

S2-S4

183
Q

MS treatment

A

beta-IFN

184
Q

What can cross the BBB?

A

CO2
O2
amino acids
glucose

185
Q

Gaucher’s disease: deficiency? most commonly seen in?

A

beta glucocerebrosidase

Ashkenazi Jews

186
Q

LTs that cause asthma symptoms?

A

C4, D4, & E4

prescribe zileuton & zafirlukast

187
Q

stop codons

A

UGA
UAA
UAG

188
Q

HSV1 encephalitis: CT

A

focal, unilateral temporal lobe pathology

189
Q

extra-intestinal manifestations of Crohn’s Disease

A

uveitis
migratory polyarthritis
erythema nodosum
renal calculi

190
Q

IBD & kidney stones: mechanism

A

increased intraluminal fat in intestine binds calcium
More oxalate is absorbed than calcium
oxalate + dehydration from diarrhea = precipitation of calcium oxalate stones

191
Q

Paneth’s granular cells: location & purpose

A

small intestine

release alpha-defensins & lysoszymes

192
Q

Agar to distinguish between shigella & salmonella

A

Hektoen enteric agar

black= H2S (salmonella)

193
Q

NSAID prescribed to patients with history of GI distress

A

Celecoxib (COX-2 specific)

caution in patients with CV stuff

194
Q

lymph node pain with alcohol consumption

A

Hodgkin’s lymphoma

195
Q

Essential amino acids

A 
Leucine
Isoleucine
Lysine
Phenylalanine
Tryptophan
Methionine
Threonine
Valine

(histidine during periods of growth)

196
Q

Gaucher’s disease (AR-> beta glucocerebrosidase, ashkenazi jews): common symptoms

A

hepatosplenomegaly
aseptic necrosis of femur
bone crises
gaucher’s cells (crinkle cells)

197
Q

What 4 embryologic structures make up the diaphragm?

A
  1. Pleuroperitoneal folds
  2. Septum transversum
  3. Dorsal mesentery of esophagus
  4. Muscular outgrowth of lateral body wall
198
Q

HIV:
Initial screening test?
confirmation?

A

Initial- ELISA

Confirmation- Western blot

199
Q

p. jiroveci: treatment in patient allergic to TMP-SMX?

A

Pentamidine

200
Q

Malignant otitis externa: bug? first line treatment? treatment if resistant?

A

p.aeruginosa

treat with a fluorquinolone (cipro)

if resistant, hit it with a piperacillin/tazobactam combo

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