Uworld Added 1 Flashcards
1
Q
Histology of GBM
A
Necrosis, Hemorrhage, Pallisading pattern
2
Q
Histology of Meningioma
A
Psammoma bodies (also papillary thyroid carcinoma, serous papillary ovarian adenocarcinoma)
3
Q
Histology of Oligodendroglioma
A
Fried egg appearance
4
Q
PCNSL Histology
A
Uniform atypical lymphocytes
5
Q
Lingual Thyroid
A
Thyroid tissue fails to migrate –> Removal cause hypothyroid
6
Q
dx of asthma after Methacholine challenge
A
Decr in FEV1 of >20%
7
Q
Cutaneous Neurofibromas –>
A
NF1 –> Autosomal Dominant (Chr 17)
8
Q
Widened QRS converts to narrow during tachyarrhythmia in WPW b/c
A
accessory pathway no longer pre-excites but instead forms re-entrant circuit
9
Q
EKG Triad for WPW
A
Shortened PR, Delta wave, Wide QRS
10
Q
Linear deposits of Ig along glomerular basement membrane
A
Anti-GBM disease (Goodpasture) = Type 1 RPGN = Crescents on LM
11
Q
Basement membrane splitting in kidney bx
A
Alport and MPGN Type 1
12
Q
Uniform, diffuse wall thickening in kidney bx
A
Membranous Glomerulopathy
13
Q
B6 is an essential cofactor for
A
Transamination and Decarboxylation of Aas, Gluconeogenesis
14
Q
OAA + Glutamate –>
A
Aspartate and a-KG
15
Q
Transamination reactions
A
AA and a-keto acid –> Amine transferred to a-keto acid, which becomes AA
16
Q
Most common form of Galactosemia
A
Galactose-1-P uridyl transferase deficiency
17
Q
What to check before initiating metformin therapy?
A
Serum Creatinine –> Lactic Acid accumulation (also contraindicated in hepatic dysfunction, CHF, alcoholism, sepsis)
18
Q
Bloom syndrome is characterized by
A
General chromosomal instability
19
Q
Ataxia Telangiectasia is characterized by
A
DNA hypersensitivity to ionizing radiation
20
Q
Cardiac Output equation
A
- SV x HR; 2. (O2 consumption) / (AV O2 difference)
21
Q
TCA cause what heart manifestation
A
Quinidine-like effect: QRS and QT prolongation by inhibiting fast Na channels
22
Q
Treatment for cardiac TCA overdose
A
Hypertonic NaHCO3: Corrects QRS prolongation, Reverses hypotension, Treats ventricular dysrhythmias
23
Q
What accounts for awakening from barbiturate anesthesia
A
Redistribution (not elmination)
24
Q
MOA of Oxybutynin
A
M3 antagonist –> Decr IP3 –> Decr Ca (urge incontinence)
25
Common causes of myopathy with elevated CK
Hypothyroid, Muscular Dystrophy, Inflammatory Muscle Disease, HMG-CoA Reductase inhibitor
26
Fatiguability, Weight gain, and Myoedema -->
Hypothyroid
27
CK levels in Steroid-induced myopathy
Normal
28
Ciprofloxacin is NOT effective for
Anaerobic infections
29
Ceftriaxone has poor activity against
Anaerobes
30
Azithromycin is used for
Chlamydia, Mycoplasma, H flu, Moraxella
31
Permissive effects of cortisol
Incr vascular and bronchial smooth muscle reactivity to catecholamines
32
Valproate causes what birth defect
Neural Tube defects
33
PYR positive
GAS
34
What molecule is upregulated to mediate Transmigration
PECAM-1
35
Caspofungin is most active against
Candida and Aspergillus (not against Mucor or Rhizopus)
36
Selective Proteinuria
Albumin loss with minimal loss of more bulky proteins (IgG, Macroglobulin)
37
Most selective derminant for size in glomerulus
GBM and slit diaphragm (4nm)
38
Barrier to albumin loss in urine
charge selectivity
39
Tubular proteinuria
Presence of low molecular weight proteins in urine that should have been reabsorbed
40
Overload pronteinuria
Normally reabsorbed, smaller proteins exceed reabsorption capacity
41
Functional proteinuira
change in blood flow through glomerulus
42
Histologic features of Acute Viral Hepatitis
Ballooning degeneration, Mononuclear infiltrates, Councilman bodies
43
Anorexia, nausea, and low grade fever followed by bilirubinuria and R upper quadrant tenderness
Acute Hepatitis - most commonly caused by HAV in young adults
44
Pulmonary Vascular Resistance is lowest when
At Functional Residual Capacity (after casual exhalation)
45
Require cholesterol for growth in acellular media
Mycoplasma
46
MacConkey agar contains ___ to inhibit growth of contaminant
Bile
47
Virulence factor of E coli in neonatal meningitis
K1 capsular antigen
48
Virulence factor of E coli in non-bloody gastroenteritis
Heat stable/labile
49
Virulence factor of E coli in UTI's
P (pyelonephritis) Fimbriae
50
Na channel binding strength among Class I Anti-arrhythmics
1C > 1A > 1B (correlates to use dependence)
51
MOA of BNP
Incr cGMP via GC
52
Slow acetylation affects which drugs
INH, Dapsone, Hydralazine, Procainamide
53
MOA of Rifampin
DNA-dependent RNA synthesis inhibition
54
Rifampin vs Isoniazid
Rifampin is not specific for mycobacteria
55
99mmTc-pertechnetate scan detects
presence of gastric mucosa
56
Digestive effects after sub-total pancreatectomy
Deficient in all digestive enzymes normally secreted by pancrease into duodenum
57
D-xylose absorption
Monosaccharide that can be absorbed direct w/out pancreatic enzymes
58
oral administration of fixed dose D-xylose
Differentiate b/t malabsorption of pancreatic vs GI mucosal etiology
59
Langhans Cells
Multinucleated giant cell with role in Granulomatous inflammation
60
Raquet-shaped intracytoplasmic granule
Birbeck granule in Langerhans cells
61
Merkel Cells
Basal layer neuroendocrine cells with role in touch
62
Portal triad runs in
Hepatoduodenal ligament
63
Which part of heart injured in stab wound to left 4th intercostal space
Right Ventricle
64
Two important steps in workup of metabolic alkalosis
Volume Status, Urine Chloride
65
Treatment of Vomiting/NG suction Metabolic Alkalosis
Isotonic saline for volume and Cl repletion
66
What leads to metabolic alkalosis that is saline unresponsive
Hyperaldosteronism or Hypercortisolism
67
Low blood-gas partition coefficient means
Poor solubility --> Blood saturates quickly --> Fast rise in partial pressure --> Faster brain saturation --> Faster onset time
68
High blood-gas partition coefficient means
High solubility --> Blood saturates slowly --> Delayed rise in partial pressure --> Slow brain saturation --> Slow onset time
69
Function of BRCA1/2
Double strand DNA break repair
70
Heritability of BRCA mutations
Autosomal dominant
71
Dysfunction in Alkaptonuria
Homogentisate Oxidase - Tyrosine to Fumarate
72
What in urine in Alkaptonuria imparts black color if oxidized
Homogentisic Acid
73
Ochronosis
Blue-black pigmentation in Alkaptonuria
74
Tx for combined absence and tonic clonic
Valproate
75
Tx for Absence Seizures
Valproate, Ethosuximide
76
Ethosuximide is not effective for
Tonic Clonic
77
Chronic effects of Obstructive Sleep Apnea
Reflexive systemic and pulmonary vasoconstriction and sympathetic cardiac stimulation --> Pulmonary HTN and Right Heart Failure
78
Hepatic Angiosarcoma is associated with
Arsenic, Thorotrast, Polyvinyl Chloride
79
CD31
PECAM1 --> Leukocyte migration thru endothium
80
IF microscopy in PSGN
Granular deposits of IgG, IgM, C3 = Starry Sky
81
EM in PSGN
Subepithelial humps = Antigen-antibody complexes
82
Longer menstrual cycles and irregular bleeding in adolescent
Anovulatory cycles due to immature HP-Ovarian axis
83
Transports ammonia from peripheral tissues to kidneys
Glutamine --> Glutamate + Free Ammonia Ion
84
Function of N-acetylglutatmate
Active Carbamoyl Phosphate Synthetase I in urea cycle
85
Nitrogen atoms in urea cycle are derived from
NH3 and Aspartate
86
Rate limiting enzyme in urea cycle
Carbamoyl Phosphate Synthetase I (activated by N-acetylglutamate)
87
Causes of HIV esophagitis
Candida, HSV1, CMV - Clinically indistinguishable, need endoscope
88
Endoscopic findings in Candidal Esophagitis
Patches of adherent gray-white pseudomembranes
89
Endoscopic findings in HSV-1 Esophagitis
Small vesicles that evolve into typical "punched out" ulcers
90
Endoscopic findings in CMV Esophagitis
Linear ulceration
91
Isospora belli
Profuse, watery diarrhea in HIV patients
92
Fever, Generalized LAD, Facial Edema, and Diffuse Morbilliform skin rash 2-8 weeks after drug exposure
DRESS!!!
93
Common drugs associated with DRESS
Anticonvulsants, Allopurinol, Sulfonamides
94
Drug-induced Anti-neutrophil cytoplasmic antibodies
Hyperthyroidism meds, Hydralazine
95
Mixed cryoglobulinemia is typically associated with
Chronic inflammatory states (SLE, HepC)
96
Purpose of squatting in Tetralogy of Fallot
Incr SVR/PVR ratio to prevent bypass of lungs
97
Synthesize dextrans from sucrose? Purpose?
Strep viridans --> Adherence to fibrin
98
Why does Strep viridans only bind to damaged endothelium
Adheres to fibrin, which is only deposited at sites of damage
99
Colistin kills
Gram negatives other than Neisseria
100
Reducing media
Used to culture organisms that reduce iron or sulfur
101
Result of incr in Hb saturation at lower oxygen mmHg
Erythrocytosis
102
Activated macrophages are necessary for
Delayed hypersensitivity reactions, Cytotoxicity against intracellular organisms
103
IL-12 receptor deficiency
Severe mycobacterial infections with inability to mount strong cell-mediated granulomatous immune response --> Tx with IFN-g
104
Infused citrate in packed RBCs can cause
Hypocalcemia (occurs with 5-6 liters of blood given over 24 hours)
105
6-MP and 6-TG are converted to active metabolites by
HGPRT
106
Degradation of activated 6-MP and 6-TG is done by
Xanthine Oxidase, Thiopurine Methyltransferase
107
Why give Allopurinol with 6-MP
Prevents inactivation by Xanthine Oxidase and greatly reduces needed dose
108
First line treatment for gestational diabetes
Diet then Insulin
109
Korsakoff syndrome is associated with damage to
Anterior and Dorsomedial Thalamic Nuclei --> Memory loss and Confabulation
110
Role of microglia in post-infarct repair
Move into area 3-5 days after onset of ischemia and phagocytize fragments of neurons, myelin, and necrotic debris
111
How does leptin regulate appetite, metabolism
Decr NPY in arcuate nucleus; Stimulates POMC/a-MSH in arcuate nucleus
112
EML4-ALK is seen in ___? Targeted therapy?
Non-Small Cell Lung Carcinoma (often nonsmokers with adenocarcinoma) --> Crizotinib
113
Sensorineural hearing loss, Tinnitus, Paralysis of facial muscles, Loss of corneal reflex -->
Vestibular Schwannoma affectiing V, VII, VIII --> Cerebellopontine angle
114
Specific symptoms of iron-deficiency anemia
Dysphagia, Koilonychia
115
Most common cause of Hydatid Cysts in humans
Echinococcus granulosus
116
beta adrenergic activity in coronaries
vasodilation
117
Oxygen content in Pulmonary Artery vs Coronary Sinus
Lower in coronary sinus because much more O2 used in myocardium than systemically
118
Prior strep infections are evidenced by
Anti-Streptolysin, Anti-DNaseB, Anti-Hyaluronidase
119
PYR Positive vs negative
GAS, Enterococci are PYR+; GBS, Bovis are PYR-
120
Etiologic agent of scrofula
Mycobacterium scrofulaceum
121
MOA of Nacetylcysteine
Glutathione substitute, Provides sulfhydryl groups to enhance non-toxic sulfation elimination of acetaminophen
122
Effect of glucocorticoids on liver protein synthesis
Incr Gluconeogenic and Glycolytic enzyme synthesis
123
Used to stimulate peristalsis in post-op ileus
Bethanechol, also to treat non-obstructive urinary retention
124
Effect of cholinergic agonist on glaucoma
Miosis causes iris to move further from cornea --> Widens anterior chamber and allows for better outflow of acqueous humor
125
Kidney histology in chronic transplant rejection
Vascular wall thickening, Luminal narrowing, Interstitial fibrosis, Parenchymal atrophy
126
What causes activation of RAS
GTP binding
127
NADPH is required as cofactor for
FA, Cholesterol, Steroid synthesis
128
MOA of Anastrozole
Aromatase inhibitor (+ Letrozole, Exemestane)
129
Bones associated with First Pharyngeal Arch
Maxilla, Zygoma, Mandible, Vomer, Palatine, Incus, Malleus
130
Bones associated with Second Pharyngeal Arch
Styloid, Lesser Horn of Hyoid, Stapes
131
Muscles associated with Second Pharyngeal Arch
Facial Expression, Stylohyoid, Stapedius, Posterior Digastric
132
Neonatal manifestations of Erythroblastosis Fetalis
Anemia, Jaundice, Edema, Nucleated RBCs, Extramedullary Hematopoiesis
133
Who gets oral thrush
Dentures, DM, Immunosuppressed, HIV
134
What causes problem with Fragile X expansion
Hypermethylation (not breakage)
135
What is unique to the duodenum
Brunner's Glands - Located in SUBMUCOSA and secreted bicarb
136
3rd Aortic Arch Derivatives
Common Carotid, Prox internal carotid
137
4th Aortic Arch Derivatives
True Aortic Arch, Subclavian Arteries
138
6th Aortic Arch Derivatives
Pulmonary arteries, Ductus arteriosus
139
Effect of DKA on K
Incr excretion, Decr total stores, But increased extracellular
140
Homeless man with increased fatiguability and exertional dypnea, LE edema, decr sensation in periphery + cardiac dilation and incr CO
B1 deficiency (Beriberi)
141
Laryngeal edema and difficulty breathing after ACEi is due to
Kinin accumulation
142
Long acting benzodiazepines
Chlordiazepoxide, Chlorazepate, Diazepam, Flurazepam (Carefully Choose Due to Falls)
143
What are the dimorphic fungi?
Blasto, Histo, Paracoccidiodies, Coccidiodes, Sporothrix - Body Heat Purportedly Changes Shape
144
Removal of apical ectodermal ridge from newly formed limb bud
Shortened length, Abnormal ventral dorsal
145
Which aortic arch becomes Ductus Arteriosus
Sixth
146
Refsum's disease
Myelin synthesis due to FA oxidation/synthesis disorder
147
Findings in Sarcoidosis
GRAIN - Globulinemia, RA, elevated ACE, Interstitial fibrosis, Noncaseating granulomas
148
pregnant woman hypotensive when supine
IVC compression --> lay on left side at night
149
Especially effective CT agent for Hodgkin
Vincristine
150
Location of the CTZ
Area postrema of the medulla
151
CV manifestations of Turner's
Bicuspid Aortic Valve, Preductal Coarction of Aorta
152
Where is stratified squamous epithelium found in respiratory tract?
Oropharynx, Laryngopharynx, Anterior epiglottis, Upper half of posterior epiglottis, True vocal cords
153
MOA of Alpha-Glucosidase inhibitors
Prevent disaccharide breakdown in intestine, thus absorption
154
Role of adiponectin in T2DM
Low, increased by TZDs
155
Annular pancrease is caused by
Abnormal migration (not apoptosis) of ventral pancreatic bud
156
Bilateral lens subluxation, Massive stroke, Old renal infarcts
Homocysteinuria
157
Most patients with Homocysteinuria respond dramatically to
B6 supplementation
158
Fluoxetine overdose
Tachycardia, Drowsiness, Tremor, Vomitting, Nausea
159
Physical exam finding in AV fistula
Pulsative mass with thrill on palpation, Auscultation reveals bruit over site
160
SST decreases
Secretin, CCK, Glucagon, Insulin, Gastrin
161
AA's that are metabolized to Propionyl CoA
Isoleucine, Valine, Threonine, Methionine
162
L-asparaginase
Antineoplastic by lowering circulating asparagine levels (leukemic cells collect asparagine from serum)
163
Symptoms, Signs of congenital hypothyroidism
Poor feeding, Prolongued jaundice, Constipation, Hypotonia, Hoarse Cry, Macroglossia, Myxedema, Umblical hernia
164
Which diuretic is used to decrease urine calcium
Thiazides
165
Most common cause of SVC syndrome
Bronchogenic Carcinomas
166
Most important HLA association with RA
HLA-DR4
167
HLA associated with SLE
HLA-DR2/3
168
HLA-A3 associated with
Primary Hemochromatosis
169
Lambert Eaton vs MG
LE doesn not improve with AChEi's, Strength improves with repeated testing, Enhanced neurotransmission with repetitive stimulation
170
Limited vs Systemic Sclerosis Ab's
Limited associated with Anti-centromere; Systemic with Anti-Topo 1
171
Kernicterus is most likely to affect which parts of CNS
Basal ganglia, Thalamus, Cerebellum, Cerebral gray matter, Spinal cord
172
Which hepatitis type is associated with PAN
Hep B (Hep C associated with Mixed Cryoglobulinemia)
173
Symptoms of Acute Intermittent Porphyria
Abdominal pain, N/V, Peripheral neuropathy, Paralysis, Psychiatric
174
Anti-mitochondrial Ab is a marker for
Primary Biliary Cirrhosis
175
Treatment of Lithium-induced DI
Amiloride - Blocks channel that lithium uses to enter principal cell
176
SLE on prednisone long term - what vitamin to supplement?
VITAMIN D
177
Toxicity of Nitrosureas
Carmustine --> pulmonary fibrosis
178
Accumulated intermediate in Acute Intermittent Porphyria vs Prophyria Cutanea Tarda
AIP = Porphobilinogen, PCT = Uroporphyrinogen
179
MOA of Bacitracin
Inhibits transfer of mucopeptides to growing cell wall
180
When do Red Neurons appear after cerebral ischemia?
12-24 hours
181
When does liquefactive necrosis appear after cerebral ischemia?
1-2 weeks
182
What can minors consent to when pregnant?
Prenatal care, Dx and Tx of STD's, Drug and Alcohol Rehab; NOT abortions (or elective non-emergency procedures)
183
Acute transplant rejection is mediated by
T cell response against HLA/MHC antigens
184
Symptoms of Systemic Mastocytosis are induced by
Histamine releas
185
What is pulsus paradoxis
Decr systemic blood pressure during inspiration (incr venous return deviates IV septum toward left and blocks outflow)
186
When does Pulsus Paradoxis occur
Acute cardiac tamponade, Constrictive pericarditis, Severe obstructive lung dz, Restrictive CM
187
Most significant factor in Shigellosis
Mucosal invasion, not toxin
188
Confusion, Fever, Nausea, Elevated LFT's four days after anesthesia
Massive hepatic necrosis from Halothane
189
Hepatic Granulomatosis is associated with
Methyldopa, Hydralazine, Quinidine
190
MOA and use of Primidone
First line for benign essential tremor; MOA unknown but metabolizes to phenobarbital
191
Activation of Intrinsic vs Extrinsic pathway
Intrinsic by damaged vessel (XII), Extrinsice by tissue damage (TF, VII)
192
Defect and major manifestations of Type 1 Dyslipidemia
LPL, ApoC --> Chylomicrons --> Acute pancreatitis, Xanthomas, HSM
193
Defect and major manifestations of Type 2a Dyslipidemia
LDL, ApoB-100 --> LDL --> CAD, Corneal Arcus, Tendon Xanthomas
194
Defect and major manifestations of Type 3 Dyslipidemia
ApoE --> Chylomicron, VLDL remnants --> CAD, PVD, Xanthomas
195
Defect and major manifestations of Type 4 Dyslipidemia
ApoA-V --> VLDL --> Pancreatitis, Obesity, Insulin resistance
196
Purine Antimetabolites
6-MP, 6-GP, Fludarabine, Cladribine
197
Use of Cladribine
Hairy Cell Leukemia - Resistant to Adenosine Deaminase
198
Bupropion is contraindicated with
Anything that can lower seizure threshold (eg electrolyte disorders from bulemia)
199
Good samaritan law
Standard of care must be met (meant to protect people, including off duty medical professionals, who help in accidents/emergencies)
200
Laplace's Law
P=2T/r
201
Uptake of unconjugated bililrubin occurs via
Organic Anion Transporting Polypeptide (OATP) - passive
202
Conjugated bilirubin is secreted from hepatocytes via __? This is blocked in __?
MRP2 (active organic anion transporter) - Criggler-Najjar, Rotor
203
Concentration of Bicarb along Proximal Tubule
Actively reabsorbed due to Carbonic Anhydrase --> Acetazolamide causes excretion
204
How to differentiate MAC from MTB in HIV patient
MAC has anemia, HSM, incr ALP/LAD due to widespread involvement of RES; Also grows well at 41degC
205
Prophylaxis and treatment of MAC
Proph with Azithromycin; Tx with Azith + Ethambutol or Rifampin
206
Absence of ganglion cells in colonic wall causes
affected segment to narrow (can't relax)
207
Which parts of GI tract are always involved in Hirschprung
Since NCC's migrate caudally, rectum always involved
208
How does metabolism of drug relate to drug-induced lupus?
Slow acetylators more likely (hydralazine, procainamide)
209
Most liver hydrolysis involve what enzymes
Amidase, Esterase
210
When is Exenatide used?
(GLP-1) Suboptimal glucose control in patients already on Metformin and Sulfonylureas
211
Ventricular response to AF is dependent on
Transmission through AV node
212
What types of viral genomic material can be individually infective?
Positive Linear ssRNA
213
Interstitial pneumonia in transplant patient
CMV
214
Treatment of C. diphtheria
Antitoxin --> Penicillin or Erythromycin --> DPT vaccine
215
Most common cause of death from C diph
Cardiomyopathy
216
Features of Cutaneous Neurofibromas
Rubbery, Buttonholing
217
Features of Wiskott-Aldrich
Thrombocytopenic Purpura, Eczema, Recurrent infections
218
Acute Narrow Angle Glaucoma is often precipitated by
Anticholinergics --> Anterior chamber narrows, obstructing trabecular meshwork
219
Confirmatory test for calculus cholecystitis
HIDA scan (not ultrasound)
220
Stool osmotic gap? What increase?
Colonic fermentation products --> Increased when poorly absorbable substances present (lactose)
221
Nonpolar Aliphatic Hydrophobic AA
VIP GAL - Valine, Isoleucine, Proline, Glycine, Alanine, Leucine
222
Aromatic Hydrophobic AA
Try Trippin w/ Phenytoin - Tyrosine, Tryptophan, Phenilalanine
223
Basic/Positive AA's
Shallow HAL is positive - Hystidine, Arginine, Lysine
224
Acidic/Negative AA's
Glutamate, Aspartate
225
Hydrophilic uncharged AA's
Come, Take My GAS! - Cysteine, Threonine, Methionine, Glutamine, Asparaine, Serine
226
When is Arginine essential?
During + nitrogen balance
227
Non-lactose fermenting, Oxidase negative organism in Sickle Cell Osteomyelitis
Salmonella
228
Oxidase Positive bugs
Vibrio, Pseudomonas, Campylobacter, Helicobacter, Neisseria, Moraxella, Legionella
229
Main virulence factor of S aureus in osteomyelitis
Adhesion to collagen
230
Apo E4 predisposes to
Late-onset familial Alzheimer's
231
Hypertrophic CM trait
AD - Beta myosin heavy chain
232
MOA and use of Dezrazoxane
Iron chelating agent to prevent cardiotoxicity from Anthracyclines
233
Location of 5-HT3 receptors implicated in chemo n/v
Peripherally in presynaptic nerve terminals of vagus in GI, Centrally in CTZ and Solitary nucleus/tract
234
Loop diuretics stimulate release of
Prostaglandins --> incr renal BF
235
Most common benign tumor of breast
Fibroadenoma (<35, often bilateral, cyclinc)
236
Fibroadenoma histology
Cellular, often myxoid stroma that encircles and sometimes compresses epithelium-lined glandular and cystic spaces
237
Function of vWF
Platelet adhesion by crosslining GpIb with exposed collagen underneath damaged endothelium
238
Secondary role of vWF
Carrier protein for factor VIII
239
Proteins C and S act to inactivate
V and VIII
240
Thrombin is produced from Prothrombin by
Activated Factor X
241
Growth Hormone binds to a __ receptor
JAK-STAT
242
Lecithin-Sphingomyeline Ratio is a marker for
Lung maturity (>1.9 = mature)
243
Mechanism of methicillin resistance
Alterations in PBP2a (also affects cephalosporins)
244
Immunity to reinfection by influenza is mediated by
Circulating antibodies against Hemagluttinin
245
Tumor originating from collecting duct cells
Renal Oncocytoma
246
Transitional cell tumors of pelvis are often what morphology
Papillary
247
Niacin-induced flushing is mediated by
Prostaglandins
248
___ reduces pain by decreasing level of substance p in PNS
Capsaicin
249
Clinical uses of Valproate
Anticonvulsant (absence, myoclonic, grand mal) AND mood stabilizer (acute mania, bipolar)
250
Anticonvulsants used as mood stabilizers in bipolar
Valproate, Carbamazepine, Lamotrigene
251
Carbamazepine indications
Trigeminal Neuralgia, Manic episodes, Partial and generalized seizures
252
MOA and use of Olanzapine
second gen antipsychotic
253
QT interval reflects
Myocyte AP duration
254
Two congenital syndromes that cause QT prolongation
1. Jervell Lange-Nielson (AR, neurosensory deafness); 2. Romano-Ward (AD, no deafness)
255
Mutations affecting cardiac cell cytoskeletal proteins or mitochondrial enzymes of ox phos are though to cause
Genetic Dilated CM's
256
Mutations of calcium-binding SR protein might underly
Arrhythmogenic RV Cardiomyopathy --> Progressive fibrofatty replacement of RV
257
Extramedullary hematopoesis is most frequently associated with
Chronic Hemolytic Anemias (eg beta thal)
258
Pentazocine
Opioid narcotic designed to produce analgesia with little to no abuse potential (weak antagonist at mu)
259
Short-acting benzos
ATOM - Alprazolam, Triazolam, Oxazepam, Midazolam
260
Long-acting benzos
Choose Carefully Due to Falls - Chlordiazepoxide, Chlorazepate, Diazepam, Flurazpam
261
Malabsorption, Diarrhea, PAS-positive granules in intestinal macrophages
WHIPPLES DISEASE - Tropheryma whippelii
262
Recurrent infections with Strep pneumo, H flu, and Moraxella indicate
Humoral immunodeficiency
263
Pneumocystis and chronic mucocutaneous candidiasis indicate
T cell deficiency
264
Immotile cilia syndrome presents in newborn period with
Respiratory distress --> Recurrent Otitis Media, Bronchitis, Sinusitis (opprotunistic infections like PCP unusual)
265
Agammaglobulinemia means susceptible to
Extracellular, encapsulated bacteria
266
Exchange of viral dna in coinfection by non-segmented viruses
Recombination
267
Viral phenotypic mixing
Coinfection leads to one virus with nucleocapsid protein from another
268
AE's of TZD's
Weight gain, edema, CHF
269
Damage to the Caudate is associated with
Transient hemiparesis and frontal lobe symptoms such as inattentiveness, abulia, forgetfulness
270
Compression fracture in elderly woman --> Calcium and PTH?
Normal
271
Driver of respiratory function in COPD vs normal
pO2 in COPD vs pCO2 normally --> Supplementary O2 in COPD will lead to respiratory suppression and coma
272
Main toxin of C perf
Lecithinase (phopholipase C, alpha toxin)
273
Insular cortex is associated with
Integrating body states w/ emotions (limbic); ANS control; Conscious experience of visceral sensations
274
Damage to internal vs external Globus Pallidus
Internal --> Excessive movement; External --> Decreased
275
Role of D arm of tRNA
Dihydrouracil residues --> Helps facilitate correct tRNA recognition by proper Aminoacyl tRNA synthetase
276
Role of T arm of tRNA
Binding tRNA to ribosomes
277
Only RNA that contains thymidine
T RNA
278
NE to Epinephrine requires
SAM - PNMT enzyme
279
BH4 is required for synthesis of
Tyrosine, DOPA, Serotonin, Prolactin
280
Winter's Formula
PaCO2 = (1.5*HCO3) + 8 +/- 2
281
Media for growing V cholerae
Alkaline - extremely acid sensitive organism
282
Mechanism of hepatocyte damage in Hep B
CD8 response to viral antigens on cell surface
283
Regulatory HIV genes required for replication
Tat, Rev
284
Structural HIV genes
Gag, Pol, Env
285
Products of Gag, Pol, Env genes in HIV
Gag - p24, p7; Pol - RT, Integrase, Protease; Env - gp120, gp41
286
Function of HIV nef gene? Rev? Tat?
Nef - Downregulate CD4 and MHC 1; Rev - Transport of unspliced viral transcripts out of nucleus; Tat - Protein that transcriptionally activates other viral genes
287
Features of Colitis-associated CRC vs sporadic
(1) younger; (2) Flat or non-polypoid dysplastic precursor; (3) Mucinous and/or signet ring morphology; (4) early p53 and late APC - opposite of sporadic; (5) proximal colon; (6) Multifocal
288
MOA of Varenicline
Partial agonist at nicotinic ACh receptor
289
Pentamidine is used for
Prophylaxis and tx of PCP
290
Nifurtimox is used for
Chagas treatment
291
Normal alveolar pO2
104 mmHg (if higher, poor perfusion)
292
When is O2 equilibration diffusion-limited
Emphysema, Fibrosis, Very high blood flow (ie exercise)
293
A, I, and H bands
A is thick myofilament, I is Actin only, H is Myosin only
294
Pharmacodynamic Drug Antagonism
Drug can antagonize or prevent effect of another drug or endogenous substance
295
Pharmacokinetic drug interaction
eg CYP inducers
296
Treatment of recurrent C diff colitis
Fidaxomicin
297
MOA of Fidaxomicin
Inhibits sigma subunit of RNA polymerase; Less effect on normal flora; Poor oral
298
Most common cystic fibrosis mutation and result
dF508 --> Impaired post-translational processing and results in proteasome degradation
299
AA's with three titratable protons
Acidics, Basics, CT = Glutamate, Aspartate, Histidine, Arginine, Lysine, Cysteine, Tyrosine
300
Salicylate acid base disorder
(1) Rapid respiratory depression causing alkalosis; (2) A few hours later metabolic acidosis
301
Effect of ANP on kidney, Adrenals, BVs
Dilates afferent arterioles, Inhbitis Na reabsorption, Restrict aldosterone secretion, cGMP-mediated veno- and arteriodilation
302
Type of MI usually associated with Bradycardia
Inferior - SA/AV nodal branch block
303
ANS drug that can cause Glaucoma
Atropine --> Midriasis --> Narrowing of anterior chamber
304
Anti-mitochondrial Ab's
Primary biliary cirrhosis
305
Anti-Smith Ab's
Anti-snRNP = Specific for SLE
306
Rapid atrophy and shrinkage of liver on autopsy
Halone-induced liver failure
307
Shortest half life pro-coagulant factor
Factor VII (PT)
308
What enzyme produces urea in Urea cycle
Arginase (Arginine --> Urea + Ornithine)
309
Excessive amounts of Orotic acid are usually found in
OTC deficiency, Citrullinemia, Arginosuccinate aciduria
310
Low levels of C1 esterase inhibitor
Hereditary Angioedema
311
Mechanisms of C1 esterase inhibitor
Inhibit C1 --> Activated C1; Inactivates Kallikrein (which converts Kininogen to Bradykinin)
312
16S rRNA function
Component of 30S subunit --> Expresses sequence complementary to Shine-Dalgarno in all prokaryotic mRNA
313
23S rRNA function
Peptidyltransferase - Peptide bond formation
314
Pontiac Fever
Legionella --> Acute, flu-like, self-limited disease
315
Features of Legionnaire's Disease
Recent expsoure to contaminated water, Pneumonia, High Fever; Sometimes GI, Relative bradycardia, neurologic
316
Most common lab finding in Legionnaire's
Hyponatremia
317
Bilateral ACA occlusion
LE motor, Behavioral (abulia), Urinary incontinence
318
Spread of H flu vs N meningitidis to meninges
H flu uses lymphatics, N men is hematogenous, Both from Pharynx
319
MOA of Organophosphates
AChE inhibitors
320
Bromoacetylcholine MOA
Inhibits Choline Acetyltransferase
321
Nicotininc receptor antagonists
Pancuronium, Tubocurarine
322
Hemicholinium MOA
Choline import into presynaptic terminal
323
Train of Four seen in Non-depolarizing blockade
eg Tubocurarine - Slanted within group, Group increases each 4
324
Train of Four seen in Depolarizing blockade
Equal within group, Group increases each four (phase 1) --> Resembles slanting of non-depolarizing in phase 2
325
Neostigimine in Phase 1 vs 2 of Succinylcholine NMB
Augments blockade in Phase 1, Reverses it in Phase 2
326
Duration of Succinylcholine action depends on
Diffusion out of NMJ and metabolism by plasma cholinesterase
327
Nitrate with best bioavailability
Isosobide Mononitrate
328
Hep B Window Period
Time lag betwee HBsAg disappearing and Anti-HBs appearing
329
Most specific marker for diagnosis fo acute Hep B
Anti-HBc IgM --> Present in window period
330
Vitamin E deficiency manifestations
Neuromuscular disease (myopathy, ataxia, pigmented retinopathy, dorsal column) and Hemolytic anemia
331
Vitamin E primarily serves to
Protect fatty acids from oxidation --> Neurons and erythrocytes most susceptible
332
Vitamin C excess
Nausea, Abdominal pain, Diarrhea, Stones
333
Physostigmine vs Neostigmine and Edrophonium
Neostigimine and Edrophonium are Quaternary Amines and can't cross BBB
334
Tarry stool and fatigue are seen with what CT agents
Alkylating agents (upper GI bleed)
335
Abdominal pain and jaundice may be seen with what CT agent
Mercaptopurine (cholestasis and hepatitis)
336
Flagellate skin discoloration is seen with what CT agent
Bleomycin (along with pulmonary fibrosis)
337
Nitroblue Tetrazolium testing
Properly functioning PMNs produce ROS that reduce yellow NBT to dark blue formazan that precipitates within the cells
338
DHR flow testing
NADPH oxidase shows decr fluorescence
339
NBT and DHR testing in MPO deficiency
Normal
340
Pyruvate kinase deficiency is a common cause of
Chronic Hemolytic Anemia
341
Ortner Syndrome
Mitral Stenosis --> LA enlargement --> Impingement on Recurrent Laryngeal N
342
Location of Glut-2
Regulation of Insulin Release --> Hepatocytes, Beta cells, Renal tubular cells, Small intestine
343
Location of Glut-3
Placenta, Neurons
344
What is commonly found regarding uterus on vaginal vaginal examination in Endometriosis
Nodularity of uterosacral ligaments, Fixed retroversion of uterus
345
Ectopic endometrial tissue secretes
PG's --> Interfere with ovulation and tubal function --> Infertility
346
Adenomyosis
Presence of endometrial glands w/in uterin myometrium (presents with bleeding, painful menses, and enlarged uterus unlike endometriosis)
347
When to give Ribavirin with RSV?
Confirmed, severe RSV at risk for dz progression (immunodeficiency, prematurity, cardiopulmonary disease)
348
Mechanism of Shiga-like toxin
AB - A subunit prevents binding of tRNA to 60S ribosomal subunit
349
Bactrim is drug of choice for
Pneumocystis jiro, Toxoplasma, Nocardia
350
Hyoscyamine
Anti-muscarinic to counteract AChEi in Myasthenia Gravis
351
Side effects of Thiazide Diuretics
Hyper Glycemia Lipidemia Uricemia Calcemia
352
Medication-induced fat redistribution
Corticosteroids, HAART (Protease inhibitors)
353
Chronic Eosinophilic Bronchitis in asthmatics involves
Bronchial wall infiltration by numerous activated eosinophils in response to IL-5 by allergen-activated TH2 cells
354
Class 3 Anti-arrhythmics
Amiodarone, Ibutilide, Dofetilide, Sotalol
355
Which vitamin supplement should be given to child with Measles
Vitamin A - Reduces time to recovery from pneumonia and diarrhea, as well as risk of death
356
Which HIV drug to give to pregnant women
Zidovudine
357
Protein secondary structure is due to
Hydrogen bonds (Tertiary due to ionic bonds, hydrophobic interactions, hydrogen bonds, and disulfide bonds)
358
E coli aquired ability to form pili via
Conjugation
359
Strep pneumo aquired capsule via
Transformation
360
Function of Thyroid Peroxidase
Oxidize inorganic iodide to organic iodine; Formation of monoiodotyrosine and diiodotyrosin; Coupling of these to iodotyrosines
361
Lab studies in HUS
Only bleeding time elevated
362
Bacitracin MOA
Prevents mucopeptide transfer into growing cell wall
363
Trimpethroprin, Methotrexate, and __ inhibit DHFR
Pyrimethamine
364
Important Bactrim AE's
Hyperkalemia, Megaloblastic Anemia
365
Serotonin Syndrome effects
HARM - Hyperthermia, ANS instability, Rigidity, Myoclonus
366
Drugs that precipitate Serotonin Syndrome
TTYL - Tramadol, Triptans, trYcyclics, Linezolid
367
Features of Myotonic Dystrophy
Frontal balding, Gonadal atrophy, Arrhythmia (My toupe, my testicles, my ticker); sustained grip, type 1 fiber loss
368
Most important signalers in Coronary autoregulation
Adenosine, NO
369
What causes NO release in coronaries
Pulsatile stretch, Flow shear stress
370
What subtype not stimulated by NE
Beta 2
371
Skeletal Muscle Depolarization -->
L-type channel-RyR mechanical coupling (no significant flux of Ca across L-type Ca channel) --> RyR1 opening --> Binds Troponin C
372
Cardiac Muscle Depolarization -->
L-type Ca influx on PM --> RyR2 opening
373
Smooth Muscle Depolarization -->
v-gated L type Ca influx --> Calmodulin (no troponin) --> Myosin light chain kinase --> P-lation of myosin
374
Nonselective beta blocker with a1 blocking activity
Labetolol
375
Systemic sequelae with Diphtheria
Myocarditis, Heart Failure, Neurotoxicity
376
EKG leads for LAD
V1-V3
377
Type 3 collagen is found in
Granulation tissue, Skin, Lungs, Blood vessels
378
Bell vs Diaphragm
Bell = Low freq; Diaphragm = High
379
S3 on end expiration
More audible, Heart closer to chest wall
380
Localized amyloidosis confined to cardiac atria
ANP-derived (elderly)
381
Prolyl Hydroxylase -->
Proline on Procollagen --> Stable triple helix
382
Lysyl Hydroxylase -->
Stronger
383
Bepridil
CCB - Second line anti-anginal drug
384
Loud P2 =
Pulmonary hypertension
385
Kussmaul =
Paradoxical rise in JVP during inspiration
386
Don't use DPH-CCB with
Acute Coronary Syndrome (reflex tachycardia)
387
Digoxin toxicity
Hyperkalemia, Vision, N/V/D
388
Afib with RVR: tx -->
CCBs, BBs, then Digoxin second line
389
Lidocaine is for what arrhythmias
Ventricular, not Atrial
390
Mechanism of Fibrates
Peroxismal Proliferator-Activated Receptor Alpha --> LPL activity increase --> Decr TB, Raise HDL
391
How do assess severity of Mitral Regurg
Presence of S3 gallop
392
Defect in Chediak-Higashi
Phagosome-Lysosome fusion --> Recurrent pyogenic infections with Staph and Strep
393
Features of Chediak-Higashi
Immunodef, Albinism, Neurologic (nystagmus, cranial neuropathies)
394
Phosphorylation of NRTI's vs NNRTI's
NRTI's must be phosphorylated
395
Most important mechanism of lead poisoning
Affinity for sulfhydryl groups --> Inhibition of d-ALA dehydratase and ferrochetolase
396
Formation of d-ALA
Succinyl-CoA and Glycine via Pyridoxal Phosphate cofactor
397
Cause and manifestation of acute serum sickness
Type 3 (IC deposition) --> Fever, Pruritic skin rash, Arthralgias, Fibrinoid necrosis, Hypocomplementemia
398
Serum sickness can be caused by
Chimeric monoclonal Ab's, Nonhuman Ig's, Nonprotein drugs (eg penicillin, cefaclor, bactrim)
399
Osteolytic phase of Paget's is due to excess
RANK signaling, NFKB activation
400
Pattern of bone in Osteoblast phase of Paget's
Dense, hypovascular, mosaic pattern of lamellar bone with irregular, haphazardly oriented sections separated by prominent cement lines
401
What stimulates Inhibin B secretion
FSH stimulation of Sertoli cells
402
MOA of trihexyphenidyl
centrally-acting anti-muscarinic
403
Anti-cholinergics such as benztropine and trihexyphenidyl should be avoided in elderly patients, esp with
BPH, Angle-Closure Glaucoma
404
S-100 protein function
Homodimeric calcium-binding proteins, important for protein p-lation, cell growth, and differentiation
405
S-100 marks what cells
Neural Crest (melanocytes, Schwann), Langerhans and other dendritic
406
DLCO depends on
Thickness and total SA of alveolar capillary membrane, Hematocrit, Total volume of pulmonary capillary blood
407
DLCO in emphysema vs chronic bronchitis
Reduced in Emphysema, Normal in CB
408
Mechanism of Bohr effect
CO2 --> H+ and HCO3+ --> H+ binds histidine side chains of Hb --> Stabilize deoxygenated form of Hb
409
What happens to H+ and HCO3 in RBC from CO2
H+ binds Hb; HCO3 exchanged for Cl (Cl enters)
410
Which step of Glycolysis utilizes NAD+
G3P --> 1,3-BPG
411
When is FADH2 produced
During conversion of succinate to fumarate
412
Synthesis of Carnitine
Lysine + Methionine via Vit C cofactor
413
Citrate is formed from
Condensation of Acetyl CoA w/ OAA
414
Heart Failure definition
(1) Cannot pump enough blood to meet demand; or (2) Can onliy do so from elevated ventricular filling pressure
415
Diarrhea in pellagra results from
Columnar epithelium atrophy
416
NAD functions as a coenzyme for
Dehydrogenases involved in metabolism of fats, carbs, and amino acids
417
Niacin can be synthesized endogenously from
Tryptophan
418
Populations that primarily subsist on __ are prone to developing pellagra
Corn (niacin in corn is bound and unabsorbable)
419
Pellagra is less commonly seen in what patient populations
Carcinoid, Prolonged INH, Hartnup (more commonly in alcoholics and chronic disease)
420
Arginine is a precursor of
NO, Urea, Ornithine, Agmatine, Creatine
421
Orotic acid is a precursor of
Pyrimidine
422
Ab-dependent cellular cytotoxicity is defense against
Virus, Parasite
423
Function of MPO
Hypochlorite from H2O2 and Chlorine
424
Testicular feminization syndrome =
Complete Androgen Insensitivity = Absent Wolffian and Mullerian structures
425
Pulmonary hypertension is usually found in patients with
Scleroderma
426
H1 receptors are found in
Vascular endothelium, Bronchial smooth muscle
427
5 important classes of meds with Anti-muscarinic effects
Atropine, TCA's, H1 blockers, Neuroleptics, Anti-Parkinson - NATHA
428
MOA of Ribavirin
Nucleoside antimetabolite - (1) Lethal hypermutation, (2) Inhibit RNA polymerase and IMP DH (depleting GTP), (3) Defective 5'-cap formation on viral mRNA, (4) Modulating a more effective immune response
429
Bone turnover is regulated by ratio of
RANKL to OPG - incr when RANK-L high and OPG low
430
How does PTH activated Osteoclasts
Stimulates Osteoblasts to upregulate RANKL and secrete M-CSF --> Osteoclast maturation
431
Function of Osteoprotegrin
Decoy RANK-L receptor
432
Arachnodactyly, Scoliosis, and Aortic Root Dilatation are signs of
Marfan
433
Macroorchidism, Large Jaw, and Intellectual disability are signs of
Fragile X
434
Top 3 causes of meningitis in neonates
GBS, E coli, Listeria
435
Courses between Biceps brachii and Coracobrachialis
Musculocutaneous
436
Courses between Flexor Carpi Ulnaris and Flexor Digitorum Profundus in forearm
Ulnar
437
Courses between Flexor Digitorum Profundus and Flexor Digitorum Superficialis
Media N
438
Substrate for PRPP synthetase
Ribose-5-Phosphate
439
Gout occurs with increased frequency in patients with activating mutations of
PRPP Synthetase
440
First line for Acute Gouty Arthritis
NSAIDs (Colchicine second)
441
How does pregnancy affect gallstones?
Estrogen-induced cholesterol hypersecretion (HMG CoA Reductase); Progesterone reduces bile acid secretion and slows gallbladder emptying
442
Fluid-filled cavitiy in liver + Fever, Chills, RUAbdominal Pain
Most likely bacterial abscess in developed nation
443
Pyogenic bacteria most commonly gain access to liver via
Biliary tract, Portal vein pyema, Hepatic artery
444
How does RBC carry CO2
15% as carbamate on Hb, Remained as bicarb ion w/in RBC
445
Diuretic often used in management of Cerebral edema and Incr ICP
Mannitol
446
Overaggressive treatment with osmotic diuretic therapy
Excessive volume depletion and eventual hypernatremia
447
Osmotic diuretics should be used cautiously in what patients
CHF, Pre-existing pulmonary edema
448
Spironolactone side effects
Hyperkalemia, Gynceomastia, Decr libido, Erectile dysfunction
449
The risk of statin myopathy is increased when
Fibrates and/or Niacin also used
450
Drugs that can cause myopathy
SGFC PHIN - Statins, GC's, Fibrates, Colchicine, Penicillamine, Hydroxychloroquine, IFNa, Niacin
451
MOA of Fenodolpam
Benazepine derivative of DA --> Selective DA-1 agonist with no effect on alpha or beta receptors
452
Stimulation of DA receptors in kidneys
Improves RBF and Na and Water excretion
453
Fenoldopam is indicated for
Short term management of severe HTN
454
Use and risk of Nitroprusside
Most effective agent for most cases of HTN emergency --> Cyanide toxicity
455
Vimentin is a marker for
Mesenchyme
456
Chromogranin A
Neuroendocrine tumors
457
Imperforate anus is most commonly associated with
GU malformation - VACTERL (vertebral, anal atresia, cardiac anomalies, TE fistula, esophageal atresia, renal anomalies, limb anomalies)
458
Fibrinous pericarditis is most commonly caused by
MI, RF, Uremia; Also viral
459
Pericardial knock
Brief, high frequency, precordial sound heard shortly after S2 in constrictive (chronic) pericarditis
460
Heme in the liver is synthesized for
CYP450 system
461
Acute Intermittent Porphyria can be precipitated by
Phenobarbital, Griseofulvin, Phenytoin, Low calorie diet, Alcohol --> All decr hepatic heme --> Incr ALA synthase activity
462
Heme synthesis enzymes inhibited by lead
ALA dehydratase, Ferrochetolase
463
Influenza vaccine induces
Neutralizing antibodies against Hemagglutinin
464
Why don't killed vaccines stimulate CD8 response
They don't enter host cell for MHC Class 1 presentation
465
Sensory nerve to parietal pleura
Phrenic to Diaphragmatic and Mediastinal; Intercostal to remainder
466
Superficial Inguinal Nodes drain
Nearly all cutaneous lymph from umbilicus to feet, including external genitalia and anus
467
Lymph from Glans penis and cutaneous portion of posterior calf drain into
Deep inguinal lymph directly (bypassing superficial)
468
Effect of cyanide poisoining
Inhibits cytochrome C oxidase - SaO2 of venous blood increases due to failure of oxygen unloading
469
Crescents of RPGN are composed of
Proliferated glomerular parietal cells, Monocytes, Macrophages, Fibrin
470
Inactivated HFE increases iron by
(1) Incr DMT1 on enterocytes; (2) Decr hepcidin --> Incr ferroportin expression
471
Atypical antipsychotics most and least likely to cause EPS
Clozapine least likely, Risperidone most likely
472
Top 3 risk factors for Coronary Heart Disease
Noncoronary Athersclerotic Disease, Diabetes Mellitus, CKD
473
Pineal Tumors most commonly cause
Parinauds, Precocious puberty, Obstructive hydrocephalus
474
Short acting insulins
Lispro, Aspart, Glulisine
475
When to use regular insulin
DKA
476
What accounts for delayed onset of regular insulin
Dimer and hexamer formation (short acting are monomers)
477
NPH insulin works by
Crystalline suspension with protamine and zinc --> Delays absorption
478
Detemir insulin works by
FA bound to lysine --> Binds albumin and slowly dissociates
479
MAOi's
MAO Takes Pride In Shanghai = Tranylcypromine, Phenelzine, Isocarboxazid, Selegline (B selective)
480
SSRI's
Flashbacks Paralyze Senior Citizens = Fluoxetine, Paroxetine, Sertraline, Citalopram
481
SNRI's
Venlafaxine, Duloxetine
482
How quickly after ischemia does loss of contractility occur in cardiomyocytes?
60 seconds
483
At what timepoint is myocardial ischemia irreversible
30 minutes
484
Ligands for Receptor Tyrosine Kinase vs JAK/STAT
Growth Factors bind RTKs; JAK/STAT bound by Cytokines, Growth Hormone, Prolactin, IL-2, EPO
485
Microscopy of Membranous Glomerulopathy
LM - Mesangial proliferation; IF - Ig and C3; EM - Spike and Dome
486
T-ALL is most likely to present
Anterior Mediastinal mass that compresses great vessels and esophagus
487
EKG progression of Acute Transmural Infarct
Peaked T waves --> STE --> Q waves
488
Imaging in Gallstone Ileus shows
Intestinal gas (obstruction), Air in biliary tree
489
Boerhaave Syndrome
Transmural tear (vs Mallory Weiss which is mucosal)
490
Cricopharyngeal motor dysfunction occurs due to
Diminished relaxatin of pharyngeal muscles during swallowing
491
Renal consequences of Ethylene Glycol ingestion
Oxalate crystals, Tubular epithelial damage (ballooning and vacuolar degeneration mostly in PCT)
492
FA vs Glucose oxidation in ATP generation and O2 use
FA oxidation produces more ATP, but uses more O2 per ATP
493
Receptor mediating Mydriasis
Alpha 1
494
Receptor mediating uterine relaxation
Beta 2 (tocolysis = Terbutaline, Ritodrine)
495
Mom and infant sequelae of rubella
Mom = Polyarthritis/Polyarthralgia; Infant = Sensorineural deafness, Cataracts, Cardiac malformations (PDA)
496
Intracellular pyrophophate granules in a bug
C diph (methylene blue staining)
497
Conus Medullaris Syndrome
L2 lesion = Flaccid paralysis of bladder and rectum, impotence, saddle anesthesia
498
Cauda Equina Syndrome
Radiating back pain, Saddle anesthesia, Loss of anocutaneous reflex, Bowel and bladder dysfunction, Loss of ankle-jerk reflex w/ plantar flexion weakness
