USMLErX Flashcards
Jaundice + positive coombs test + INC retic count. What is this and tx?
Warm agglutination. IgG chronic anemia - from SLE, CLL, DRUGS (methydopa) Tx w/ STEROIDS
Where are majority of dopamine RECEPTORS located?
Dopamine neurons in substantia niagraRECEPTORS in Striatum! (putamen, caudate)
Which larger parasites invades mucosa?
CryptospordiumEntamoebaNOT giardia
WHAT HAPPENS IN ELISA? What is best confirmatory test for HIV?
Binding of protein (for example HIV protein) and ab (patients ab - tests to see if pt has ab) . Differs from Western blot in that the ab is linked to an enzyme. The activity of the enzyme changes color - intensity depends on amount of ab. Western blot is the least likely to have false positives and false negatives so it is the major CONFIRMATORY STEP.
Which 2 chemo drug types work on the G2 phase?
Topoisomerase (Etoposide) - (G2 and S)And Bleomycin - strand breaks. (G2)
Bevacizumab used in?
VEGF ab - colon CA, breast, nonsmall cell Lung CA.
Tx for alcohol related cardiomyopath?
ACE, Digoxin, diuretics
Longtime bikers can get handlebar palsy. What is this? What else innervated by this nerve?
Compression of ulnar nerve - cause difficulty spreading fingers and making a fist. Hook of hamate compresses ulnar nerve. Ulnar nerve dmg can cause ulnar claw hand, as well as lumbricals 3,4 (claw hand) and ADDUCTOR pollicis
Two treatments of serotonin syndrome?
Diphenhydramine and cyproheptadine
Tx for PCP in sulfa allergy pt?
Not TMP-SMXSecond would be AEOROZOLIZED PENTAMIDINE
Most common side effect of Odansetron? Mech of action?
5-HT3 receptor blocker.Headache, constipation, urinary retention, dizziness (blocks GU tract)
What are 3 ways to define AIDS?
Serologic evidence of HIV infection CD4 count less than 200CD4% less than 14%Presence of one or more opportunitistic infections
micronodules in liver?Macronodules in liver?
Micro - chronic liver disease - alcoholism, Wilsons, hemochromatosisMacro - postinfectious, drug induced hepatitis.
Antibiotics tha tcan cause ototox?
AG
Pagets lab findings?
Lytic findings on radiographcElevation of alk phosNORMAL partyhyroid, Ca, P
What is pre-ecmalpsia first line?
Delivery of baby.IV Magnesium to PREVENT SEIZURES - can see DEc deep tendon reflexes.Phenytoin and diazepam are second kline (phenytoin second line due to neural tube problems etc)
Red casts?WBC casts?Granular castS?Fatty casts?Waxy casts?Hyaline casts?
RBC - inflam - GN. ishemia, malignant HTNWBC - ifnection/pyleo, tx rejection.Fatty - nephroticGranular/muddy - Acute Tubular NecrosisWaxy - advanced/chronic renal failureHyaline - nonspecific. Can be seen in concentrated urine samples
As the prevalance INC, what happens to the PPV and the NPV?
PPV INCNPV DEC
SchizoaffectiveSchizophreniformShizophreniaSchizoid personalitySchizotypal personalityGeneral anxiety disorder must last how long?
shizoaffective - 2weeks +. Shizo plus mood/depressionSchizophreniform 1-6 monthsSchizophreniaShizoid - voluntary withdrawalShizotypal - magical thinkingGAD - 6 months+
What muscles are supplied by the radial nerve?
Brachioradialis, Extensors of wrist/fingers, Supinator, Triceps. (bEST)
Where do most pancreatic CA occur?
Ventral pacnreatic bud = obstructive jaundice, weight loss, ab pain radiating to back
What is more likely to cause MI?Plaque rupture or thromboembolic event?
Plaque rupture leading to possible thrombus.
What test can be used to dx Acromegaly?
High GH -> high Insulin like growth factor - confirmed via glucose tolerance test - Normally - growth hormone is suppressed after glucose load.Lack of suppression indicates GH excess that is not responsive to negative feedback loop. Acromegalic pt usu display hyperglycemia!SUMAMRY: ACROMEGALY ALWAYS HAVE ILGF floating around. THEREFORE desensitive to insulin. THEREFORE HYPERGLYCEMIC.
BartonellaFrancisellaPasteurella
Bartonella - regional LAN,. low gaade feverFrancisella - LAN + ULCER. wild rabbits and ticksPasteurella - cat/dog - RAPID inflam (w.in hours) and purulent discharge.
Standard tx for C diff diarrhea?
Metronidazole or Vanc
Malignant hyperthermia due to mutation where?
Ryanodine receptor!!! RYR1!!!DHP is normal and triggers Ryanodine.
Potters disease is due to failure of what to form?
URETERIC bud - (outgrowth that arises from mesonephric duct) Fialure of ureteric buds to form -> potters.
Treatment for E Coli O157H7>
Most Ecoli including O157H7 - supportive - hydration - AVOID antibiotic therapy.
phosphodiesterase inhbiitors such as sildenafil INC what levles?
cGMP levels - relaxes smooth muscles and INC penile blood flow.
N-acetyl cysteine is?
A reducing agent - the sulfhydryl group reduces glutathionine, so that glutathionine can reduce again.
where is the ilioinguinal nerve located?
ilioinguinal nerve located in inguinal canal - pass es through the inguinal ligament on top of the spermatic cord.Supplies cutaneous scrotum/labia and medial aspect of thigh. NOT part of spermatic cord - must be islated separately from cord during hernial surgeries so there is no loss of sensation.
Tx of salmonella?
Usu dont try to treat w/ antibiotics - PROLONGS fecal excretion.Also dont treat E coli HUS. Unless UTI (TMp-SMX, penicillin) or meningitisShigella you can treat.
What maneuver DEC preload.What maneuver INC afterload?
DEC preload w/ valsalva (INC intrathyoracid pressure DEC venous return) - Mitral valve prolapse murmur INC w/ valsalva maneuver. Hand grip INC afterload
Pros and cons of hormone replacement therapy?
Pros: Helps w/ menopaus symtpoms,. DEC colorectaCA and osteoporotic fractureCons - INC MI risk, Stroke risk, Venous thromboembolism risk, Breast CA risk.
Where woudl you want to ablate in parkinsons disease?
Not enough dopamine from substantia nigra.Ablate globus paladus (GPi/e)
polyhydramnios and congenital diaphragmatic hernia due to?
failure of pleuroperitoneal folds to derive. Often have flat stomach (w/ contents visible) and heart dispalced to right.
Prerenal Intrarenal has what ratio?Postrenal has what ratio?
Pre - ratio greater than 20:1. Intra - ratio below 15:1Post - ratio greater than 15:1.
Normal pressure hydrocephalus usu due to?
Communicating hydrocephalus - some type of problem w/ resorption in villi
Mutation in burkitts?
c-mycEBcstary sky8:14
Ceramic working. THink?
Lead posioning. Thus ALAD blocked.(second enzyme in pathway)
Replacement of heparin after HIT?
Direct thrombin inhibitor. Argatroban, bivalirudin, lepirudinShort half life do not cross react.
Best treatment for bulimia?
Fluoxetine.perhaps mirtazapine and trazadonie
What should you do before giving DOC for ankylosing spondylosis?
Tx is infliximab - anti-TNFa monoclonal ab - must check PPD (purified protein derivative skin test)
What does mom chlamydia -> birth -> kid usu yield?
Inclusion conjunctivitis - D-K.See inclusions w/ special stain.Also pneumonia between 4 to 11 weeks of life.
Severe diarrhea leads to what plasma changes?
Loss of bicarb (acidosis)INC in Cl reabs (to get NaCl from dehydration) -> non-anion gap metabolic acidosis. Often can see hyperventilation to blow CO2 off.
Tx for cryptosporidium?
There is no tx - supportive care. (esp for immunocompromised. Can give nitazoxanide to immunocompetentn AKA DONT TREAT ECOLI HUS, SALMONELLA, CRYPTO
Chediak Higashi mech?
disorder of microtubule polymerization.
What else do you see in Kawasakis besides necrotizing vasculitis, fever, cervical LAD, hand rash, racing heart, aneurysm in future?
INJECTED CONJUNCTIVAE, strawberry tongue.hand foot rash PLSU EDEMA ON DORSAL ASPECT OF HANDS.
What does PCP look like on gross xray?PCP tx in sulfa allergy?
microscopic cysts. Pentamidine, dapsone, atovaquone. Atovaquone - INHIBITS MITO ELECTRON TRANSPORT.
DIC blood smear?
Schistocytes
Tx of GAS in penicillin allergic pt?
erythromycin - has activity agasinst GP (pneumo, strep, staph, corynebactera, enterococci and gram negative.
Male - hernia protrudes w/ effort and reduces in rest. What is this?
direct! Medial!Indirect do not disappear - are always in your sac ish.
mitral stenosis sound?
Opening snap followed by late diastolic rumble
Common tx for achalasia?
Chalcium channel blocker, nigroglycerin, botulinum.First 2 can help DEC cAMP. Achalisa often due to failure to relax. So help the muscle to relax.
First like tx for strep pneumo?
penicillin/amoxicillinhigh incidience of resistance -> vanc 2nd line
IgA def puts you at risk for?
URI and GI infections (giardiasis)both are needed in the mucus spaces.
Hb taut vs relaxed O2 affinities?
Hb taut - has low O2 affinity. Meaning a right shift (Cl, H, co2, 23,BPG) - drops off O2 easily.Hb relax - high O2 affinity - left shift.So Taut in Tissue.Relaxed in respiratory!
Pain w/ leg hyperextention?
Appendicitis! Iliopsoas pushes agaisnt appendix - sig pain and iritation. Innervated by lumbar plexus and formal nerve.
What type of HSR is SLE? What else is in that same category?
Type 3 - polyarteritis nodosa, PSGN, Serum sicknes, Arthrus reaction (swelling following tetanus rx)T4 - MS, Guillain barre, graft vs host, PPD, Candida skin test, contact dermatitis
Other than prematurely, what else INC risk of hyaline membrane disease?
Hyaline membrane disease = neonatal respiratory DS. Prematurity, diabetes (large for gestational age), C-section. YOU KNEW THIS! Diabetes = too much sugar, cortisol impaired.
Tx for DNA viral meningitis?Tx for RNA viral meningitis?
DNA viral - herpes - acycloviRNA - supportive care for most RNA.
Bipolar 1BIpolar 2Cyclothymic?
BP1 - 1 or more MANIC episodes, with or without hypomania/depressionBP2 - Requires MDD episode AND! hypomanic. NOT Manic.Manic automatically makes it BP1.Cyclothymic - hypomania and dysthmia. Milder. Lasts at least 2 YEARS.
When is C section indicated?
If either one or both are distressed (baby or mother). If netiher are, it is usually not indicated. Perhaps elective tho.
Sumatriptan mech of action?
Serotonin agonists - can cause serotonin syndrome and CORNOARY VASOCONSTRICTION. so THINK CONSTRICTION of migraine. Be cautious of use in CAD pt.
PT w/ INC ICP. What to do?
Intubate and hyperventilate - DEC in CO2 causes vasoconstriction. Buys you time - ios shortlived.Mannitol also works. Would want to ELEVATE head to allow for venous outflow.
Young kid. No Auer rods. ALL or AML?
ALL - usu under 15. Esp if lack auer rods. AML - median onset 65. Presence of auer rods.
RoseolaRubellaRubeola
Roseala - HV6Rubella - Rubeola - Measles
How does Iron tox affect blood levels?
It is the I in mudpile s- anion gap metabolic acdiosis
First of line for cardiogenic shock?
Dobutamine. NOT epinephrine. Because epi can cause arrhythmias.
Where do you see Howell Jolly bodies?
Splenectomy.ALSO AUTOSPNEECOMTY IN SICKLE CELL PT.
wHAT DOES PULSUS PARADOXUS make yous suspicious with? Where else is it seen?What confrims suspicion?
Cardiac Tamponade.Also seen in PERICARDITIS asthma, obstructive sleep apnea, croupBecks triad - muffled heart sounds, hypotension, distened neck veins CONFRIMS cardiac tomponade w/ pulsus paradoxus.
What does corticobulbar control
muslces of face, head neckCorticospinal does rest of body.
What is a transplant from an identical twin?AutogeneicAllogeneicSynergeneic
Autgeneic - self onlyAllogeneic -s oemone elseSynergeneic - twin.
DOC for gout?
Acute - NSAIDS. Then glucocoirtoicds, colchicine.Chronic/preventive - Xanthin oxidase inhibitors. (febuxostat, allopurinol)
Periods in 8 year old. what tumor?
Granulosa theca - produce estrogen.Although in a young kid usually jump to yolk sac/endodermal sinus tumor.
How to measure anestheticPOTENCYSpeed to Induction?
Potency - inverse of MAC.Speed to induction - lower the blood solubility, the faster it has an affect.
Irqa - HSM, fever, peripheral eosinophilia
Katayama fever. Middle easy, Africa, south america. Esp if exposed to fresh water.From Shistosoma mansoni Similarly Shistosoma haematobium can cause SCCA of bladder, and liver/spleen granulomas, fibrosis/inflam
First step in curing digoxin tox? Then what?
Slowly normalize K levels. Then you can do whatever 0 lidocaine, anti-dig Fab, Mg etc.
How does indirect hernia originateHow does direct originate?
Indirect- patent processus vaginalisDirect - weakness of ab wall
First line for OCD?
SSRi.
Ultrasound of pyloric stenosis?Duodenoal stenosis?
Pyloric stenosis -s ee thickened pylorusDUodenoal stenosis - see double bubble.
Congo red stain in pt w/ lytic back bone lesions?What is the stain of?
MM. Ig light chain. PRIMARY AMYLOIDOSIS.
What are the major sources of estrogen post-menopaus?
Adrenals - androsteinodioneAndrosteinodione taken in peripheral adiopcytes and aromatize it into Estrone.
What is the cell type of the epididymis?
Pseudostratified columnar epi w/ stereocilia
What is desquamative intestitial pneumonia?
DIp is a restrictive lung type - resmelbes idiopathic pul firosis in early stage - can see “honeycomb appearance”
Calcium algate swab, w/ plating on potato agar/regn lowe medium for?
Brodetella pertussis. Bugs dont transfer well on cotton swab.
What does folate do in the body?
One carbon transcers
Difference between gel electrophoresis and Soutehrn blot?
GEel electrophoresis ends w/ gel being stainied and visualized udner UV lightSOtuerh blot - you give it a radiolabled probe.
short palpebral fissures, cleft lip, MR?
Fetal alcholol syndrome
Meissner vs Pacinian, Merkel?
Meissner - fine touchPacinian - pressure/vibrationmMerkel - deel pressure
Primary intervention for NMS?
Dantrolene.L-dopa etc are later.
When should you have concern for HIT?
Pt who have had Hep before, then have Hep again.Can have immune ab build up. Have plt counted every 2-3 days
What fibers carry visceral pain?
Sympathetic fibers?
How does osteoarthritis affect heme?
It does not cause anemia of chronic diasesa
Excessive melatonin production presentation?
Pineoblastoma - drowsiness or VIVID DREAMS
Who is at risk to have tendon rupture w/ fluoroquinolones?
over 50, renal disease hx, hemodialsis, renal transplant, long term steroid use.
How does protamine sulfate work?
Heparin is neg charged.Protamine sulfate is highly cationic and binds it.
Only solo treatment for TB prophylaxis?
Isoniazid?Although in the actually dsease isoniazid is never given alone.
preeclampsia before 20 weeks suggests?
ectopic preg.
Who can produce exotoxins? Endotoxins?
Exotoxins - both GN and GPEndotoxin - only GN
What is ribavarin used to treat? What can it result in?
RSV -and chronic Hep C - IMP blocker - competitive inhibitionHemolytic anemia. TERATOGENIC.
What is a sidefx of Macroline?
cholestatic hepatitis, Arrhitmia, rash, eosinophilia
Pregnant women - vaginal bleedign after 20 months. Suggets? Risk factors?
Placenta previaRisk factors - prior C section, INC number of prior preg, twin gestation, hx of prior curretage for elcetive abortions.
Trousseaus syndrome. What is it? When is it seen? What is it caused by?
Unique migratory thrombophelebitis - occurs as a result of RELEASE OF CLOTTING FACTORS (suchj as TISSUE FACTOR) by PANCREATIC /gliomas/lung TUMORS.
Contraindication of TPA therapy.
BP over 190, hx of stroke/ehad trauma w/in 3 months, INR over 1.7, platelet count less than 100,000
TX of SLE?
First NSAIDS for rash/arthralgias - usualyl need to add steroids on top for an effec.tFor SEVERE SLE, serositis and visceral involvement, such as Diffuse proliferative GN - IMMUNOSUPPRESNANTS (such as cyclophoshamide)
Tx for Rheumatoid Arhtritis?
NSAIDS, Corticoids, Disease modifying (METHOTREXATE etc)
Probenecid used for?
Gout tx - exp cronic gout - prevents reabs of uric acid in PCT - promotes secretion -
Drug cocktail to treat hodgkins?
ABVD - adiramycin (doxorubicin), Bleomycin, Vinblastin, Dacarbazine
C diff from Enterococcus treatment. What was used?
Ampicillin.Clindaymcin cannot treat entercocci -s oampicililn would have been giving gto cause it.
Congenital diaphragmatic hernias most commonly from failure of?
Pleuroperitoneal folds to form and fuse. Can get heart to be shfited over and lung hypoplasia and bowel sounds in lung.
In horners what type of sympathetic neuron is usually dmaged?
Second order preganglionic sympathetic
Post splenectomy - what is seen in peripheral blood slide?
Howell Jolly and Target cells.
Where are JG cells located?
Modified msooth muscles of AFFERENT ARTERIOLE - sense DCT delviery.
Dorsal penis from? In girls?Ventral penis from? In girls?
Dorsal penis (epispadia)-genital tubercle - clitoris Ventral penis (hyposadia) - urogenital folds - labia minora
What cells in body have SGLUT?
Neprhons and enterocytes
First line in to treat COPD/asthmatic that is LEAST LIKELY to cause cardiac arrhythmias?
Ipratropium
Elisa used to detect?
proteins - such as Ab.
What age kids have testicular tumor w/ INC AFP?
Yolk Sac tumor - average age is 3 y.o. INC AFP.Embryonal CA would be around 30 y.o
Where in the body do you get pale infarcts?
Single blood supply - heart, kidney, spleen. Red infarct - loose tissue w/ multiple supplies - liver, lung, intestine.
Boerdrline personality?
Cluster B - emotional, impulseive, labile mood, unstable relationships - SPLITTING (all good or all bad)may engage in self destructive behaviors in attemps to gain attention
Statins are what kind of biochemical class of drugs for HMGcoA reductase?
competitive inhibitors. DEC Km,. Same Vmax.
What are risk factors for endometrial CA
Anything that INC Estrogen.Obesity(peripheral androgens)Late menopausNulliparity Smoking is not a risk
Serum sickness - what kind of HSR is this? presentation?
T3 - rash, Glomerulephritis, arthritis, fever.
durable power of autorny vs livving will? who wins?
Durable power of autorney.
Neural tube defects are a failure of what to close?
Neural folds. Not notochord.
Guillame barre affets what cells?
peripheral schwann demyelinationNOT SPINAL CORD.
pOSSIBLE MECH OF THE PROBLEM W/ FETAL ALCOHOL SYNDROME?
inhibits CELL MIGRATION during 3-8 weeks.Impaired differnetiation, apoptosis, cell metabolism. MICROCEPHALY, HEART DEFECTS, LIMB DISLOCATION
