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Uworld Added 1 Flashcards

1
Q

Histology of GBM

A

Necrosis, Hemorrhage, Pallisading pattern

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2
Q

Histology of Meningioma

A

Psammoma bodies (also papillary thyroid carcinoma, serous papillary ovarian adenocarcinoma)

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3
Q

Histology of Oligodendroglioma

A

Fried egg appearance

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4
Q

PCNSL Histology

A

Uniform atypical lymphocytes

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5
Q

Lingual Thyroid

A

Thyroid tissue fails to migrate –> Removal cause hypothyroid

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6
Q

dx of asthma after Methacholine challenge

A

Decr in FEV1 of >20%

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7
Q

Cutaneous Neurofibromas –>

A

NF1 –> Autosomal Dominant (Chr 17)

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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

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9
Q

EKG Triad for WPW

A

Shortened PR, Delta wave, Wide QRS

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10
Q

Linear deposits of Ig along glomerular basement membrane

A

Anti-GBM disease (Goodpasture) = Type 1 RPGN = Crescents on LM

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11
Q

Basement membrane splitting in kidney bx

A

Alport and MPGN Type 1

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12
Q

Uniform, diffuse wall thickening in kidney bx

A

Membranous Glomerulopathy

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13
Q

B6 is an essential cofactor for

A

Transamination and Decarboxylation of Aas, Gluconeogenesis

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14
Q

OAA + Glutamate –>

A

Aspartate and a-KG

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15
Q

Transamination reactions

A

AA and a-keto acid –> Amine transferred to a-keto acid, which becomes AA

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16
Q

Most common form of Galactosemia

A

Galactose-1-P uridyl transferase deficiency

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17
Q

What to check before initiating metformin therapy?

A

Serum Creatinine –> Lactic Acid accumulation (also contraindicated in hepatic dysfunction, CHF, alcoholism, sepsis)

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18
Q

Bloom syndrome is characterized by

A

General chromosomal instability

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19
Q

Ataxia Telangiectasia is characterized by

A

DNA hypersensitivity to ionizing radiation

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20
Q

Cardiac Output equation

A
  1. SV x HR; 2. (O2 consumption) / (AV O2 difference)
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21
Q

TCA cause what heart manifestation

A

Quinidine-like effect: QRS and QT prolongation by inhibiting fast Na channels

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22
Q

Treatment for cardiac TCA overdose

A

Hypertonic NaHCO3: Corrects QRS prolongation, Reverses hypotension, Treats ventricular dysrhythmias

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23
Q

What accounts for awakening from barbiturate anesthesia

A

Redistribution (not elmination)

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24
Q

MOA of Oxybutynin

A

M3 antagonist –> Decr IP3 –> Decr Ca (urge incontinence)

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25
Q

Common causes of myopathy with elevated CK

A

Hypothyroid, Muscular Dystrophy, Inflammatory Muscle Disease, HMG-CoA Reductase inhibitor

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26
Q

Fatiguability, Weight gain, and Myoedema –>

A

Hypothyroid

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27
Q

CK levels in Steroid-induced myopathy

A

Normal

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28
Q

Ciprofloxacin is NOT effective for

A

Anaerobic infections

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29
Q

Ceftriaxone has poor activity against

A

Anaerobes

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30
Q

Azithromycin is used for

A

Chlamydia, Mycoplasma, H flu, Moraxella

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31
Q

Permissive effects of cortisol

A

Incr vascular and bronchial smooth muscle reactivity to catecholamines

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32
Q

Valproate causes what birth defect

A

Neural Tube defects

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33
Q

PYR positive

A

GAS

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34
Q

What molecule is upregulated to mediate Transmigration

A

PECAM-1

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35
Q

Caspofungin is most active against

A

Candida and Aspergillus (not against Mucor or Rhizopus)

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36
Q

Selective Proteinuria

A

Albumin loss with minimal loss of more bulky proteins (IgG, Macroglobulin)

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37
Q

Most selective derminant for size in glomerulus

A

GBM and slit diaphragm (4nm)

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38
Q

Barrier to albumin loss in urine

A

charge selectivity

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39
Q

Tubular proteinuria

A

Presence of low molecular weight proteins in urine that should have been reabsorbed

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40
Q

Overload pronteinuria

A

Normally reabsorbed, smaller proteins exceed reabsorption capacity

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41
Q

Functional proteinuira

A

change in blood flow through glomerulus

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42
Q

Histologic features of Acute Viral Hepatitis

A

Ballooning degeneration, Mononuclear infiltrates, Councilman bodies

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43
Q

Anorexia, nausea, and low grade fever followed by bilirubinuria and R upper quadrant tenderness

A

Acute Hepatitis - most commonly caused by HAV in young adults

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44
Q

Pulmonary Vascular Resistance is lowest when

A

At Functional Residual Capacity (after casual exhalation)

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45
Q

Require cholesterol for growth in acellular media

A

Mycoplasma

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46
Q

MacConkey agar contains ___ to inhibit growth of contaminant

A

Bile

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47
Q

Virulence factor of E coli in neonatal meningitis

A

K1 capsular antigen

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48
Q

Virulence factor of E coli in non-bloody gastroenteritis

A

Heat stable/labile

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49
Q

Virulence factor of E coli in UTI’s

A

P (pyelonephritis) Fimbriae

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50
Q

Na channel binding strength among Class I Anti-arrhythmics

A

1C > 1A > 1B (correlates to use dependence)

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51
Q

MOA of BNP

A

Incr cGMP via GC

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52
Q

Slow acetylation affects which drugs

A

INH, Dapsone, Hydralazine, Procainamide

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53
Q

MOA of Rifampin

A

DNA-dependent RNA synthesis inhibition

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54
Q

Rifampin vs Isoniazid

A

Rifampin is not specific for mycobacteria

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55
Q

99mmTc-pertechnetate scan detects

A

presence of gastric mucosa

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56
Q

Digestive effects after sub-total pancreatectomy

A

Deficient in all digestive enzymes normally secreted by pancrease into duodenum

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57
Q

D-xylose absorption

A

Monosaccharide that can be absorbed direct w/out pancreatic enzymes

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58
Q

oral administration of fixed dose D-xylose

A

Differentiate b/t malabsorption of pancreatic vs GI mucosal etiology

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59
Q

Langhans Cells

A

Multinucleated giant cell with role in Granulomatous inflammation

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60
Q

Raquet-shaped intracytoplasmic granule

A

Birbeck granule in Langerhans cells

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61
Q

Merkel Cells

A

Basal layer neuroendocrine cells with role in touch

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62
Q

Portal triad runs in

A

Hepatoduodenal ligament

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63
Q

Which part of heart injured in stab wound to left 4th intercostal space

A

Right Ventricle

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64
Q

Two important steps in workup of metabolic alkalosis

A

Volume Status, Urine Chloride

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65
Q

Treatment of Vomiting/NG suction Metabolic Alkalosis

A

Isotonic saline for volume and Cl repletion

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66
Q

What leads to metabolic alkalosis that is saline unresponsive

A

Hyperaldosteronism or Hypercortisolism

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67
Q

Low blood-gas partition coefficient means

A

Poor solubility –> Blood saturates quickly –> Fast rise in partial pressure –> Faster brain saturation –> Faster onset time

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68
Q

High blood-gas partition coefficient means

A

High solubility –> Blood saturates slowly –> Delayed rise in partial pressure –> Slow brain saturation –> Slow onset time

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69
Q

Function of BRCA1/2

A

Double strand DNA break repair

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70
Q

Heritability of BRCA mutations

A

Autosomal dominant

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71
Q

Dysfunction in Alkaptonuria

A

Homogentisate Oxidase - Tyrosine to Fumarate

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72
Q

What in urine in Alkaptonuria imparts black color if oxidized

A

Homogentisic Acid

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73
Q

Ochronosis

A

Blue-black pigmentation in Alkaptonuria

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74
Q

Tx for combined absence and tonic clonic

A

Valproate

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75
Q

Tx for Absence Seizures

A

Valproate, Ethosuximide

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76
Q

Ethosuximide is not effective for

A

Tonic Clonic

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77
Q

Chronic effects of Obstructive Sleep Apnea

A

Reflexive systemic and pulmonary vasoconstriction and sympathetic cardiac stimulation –> Pulmonary HTN and Right Heart Failure

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78
Q

Hepatic Angiosarcoma is associated with

A

Arsenic, Thorotrast, Polyvinyl Chloride

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79
Q

CD31

A

PECAM1 –> Leukocyte migration thru endothium

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80
Q

IF microscopy in PSGN

A

Granular deposits of IgG, IgM, C3 = Starry Sky

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81
Q

EM in PSGN

A

Subepithelial humps = Antigen-antibody complexes

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82
Q

Longer menstrual cycles and irregular bleeding in adolescent

A

Anovulatory cycles due to immature HP-Ovarian axis

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83
Q

Transports ammonia from peripheral tissues to kidneys

A

Glutamine –> Glutamate + Free Ammonia Ion

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84
Q

Function of N-acetylglutatmate

A

Active Carbamoyl Phosphate Synthetase I in urea cycle

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85
Q

Nitrogen atoms in urea cycle are derived from

A

NH3 and Aspartate

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86
Q

Rate limiting enzyme in urea cycle

A

Carbamoyl Phosphate Synthetase I (activated by N-acetylglutamate)

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87
Q

Causes of HIV esophagitis

A

Candida, HSV1, CMV - Clinically indistinguishable, need endoscope

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88
Q

Endoscopic findings in Candidal Esophagitis

A

Patches of adherent gray-white pseudomembranes

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89
Q

Endoscopic findings in HSV-1 Esophagitis

A

Small vesicles that evolve into typical “punched out” ulcers

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90
Q

Endoscopic findings in CMV Esophagitis

A

Linear ulceration

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91
Q

Isospora belli

A

Profuse, watery diarrhea in HIV patients

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92
Q

Fever, Generalized LAD, Facial Edema, and Diffuse Morbilliform skin rash 2-8 weeks after drug exposure

A

DRESS!!!

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93
Q

Common drugs associated with DRESS

A

Anticonvulsants, Allopurinol, Sulfonamides

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94
Q

Drug-induced Anti-neutrophil cytoplasmic antibodies

A

Hyperthyroidism meds, Hydralazine

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95
Q

Mixed cryoglobulinemia is typically associated with

A

Chronic inflammatory states (SLE, HepC)

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96
Q

Purpose of squatting in Tetralogy of Fallot

A

Incr SVR/PVR ratio to prevent bypass of lungs

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97
Q

Synthesize dextrans from sucrose? Purpose?

A

Strep viridans –> Adherence to fibrin

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98
Q

Why does Strep viridans only bind to damaged endothelium

A

Adheres to fibrin, which is only deposited at sites of damage

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99
Q

Colistin kills

A

Gram negatives other than Neisseria

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100
Q

Reducing media

A

Used to culture organisms that reduce iron or sulfur

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101
Q

Result of incr in Hb saturation at lower oxygen mmHg

A

Erythrocytosis

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102
Q

Activated macrophages are necessary for

A

Delayed hypersensitivity reactions, Cytotoxicity against intracellular organisms

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103
Q

IL-12 receptor deficiency

A

Severe mycobacterial infections with inability to mount strong cell-mediated granulomatous immune response –> Tx with IFN-g

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104
Q

Infused citrate in packed RBCs can cause

A

Hypocalcemia (occurs with 5-6 liters of blood given over 24 hours)

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105
Q

6-MP and 6-TG are converted to active metabolites by

A

HGPRT

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106
Q

Degradation of activated 6-MP and 6-TG is done by

A

Xanthine Oxidase, Thiopurine Methyltransferase

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107
Q

Why give Allopurinol with 6-MP

A

Prevents inactivation by Xanthine Oxidase and greatly reduces needed dose

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108
Q

First line treatment for gestational diabetes

A

Diet then Insulin

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109
Q

Korsakoff syndrome is associated with damage to

A

Anterior and Dorsomedial Thalamic Nuclei –> Memory loss and Confabulation

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110
Q

Role of microglia in post-infarct repair

A

Move into area 3-5 days after onset of ischemia and phagocytize fragments of neurons, myelin, and necrotic debris

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111
Q

How does leptin regulate appetite, metabolism

A

Decr NPY in arcuate nucleus; Stimulates POMC/a-MSH in arcuate nucleus

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112
Q

EML4-ALK is seen in ___? Targeted therapy?

A

Non-Small Cell Lung Carcinoma (often nonsmokers with adenocarcinoma) –> Crizotinib

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113
Q

Sensorineural hearing loss, Tinnitus, Paralysis of facial muscles, Loss of corneal reflex –>

A

Vestibular Schwannoma affectiing V, VII, VIII –> Cerebellopontine angle

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114
Q

Specific symptoms of iron-deficiency anemia

A

Dysphagia, Koilonychia

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115
Q

Most common cause of Hydatid Cysts in humans

A

Echinococcus granulosus

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116
Q

beta adrenergic activity in coronaries

A

vasodilation

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117
Q

Oxygen content in Pulmonary Artery vs Coronary Sinus

A

Lower in coronary sinus because much more O2 used in myocardium than systemically

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118
Q

Prior strep infections are evidenced by

A

Anti-Streptolysin, Anti-DNaseB, Anti-Hyaluronidase

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119
Q

PYR Positive vs negative

A

GAS, Enterococci are PYR+; GBS, Bovis are PYR-

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120
Q

Etiologic agent of scrofula

A

Mycobacterium scrofulaceum

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121
Q

MOA of Nacetylcysteine

A

Glutathione substitute, Provides sulfhydryl groups to enhance non-toxic sulfation elimination of acetaminophen

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122
Q

Effect of glucocorticoids on liver protein synthesis

A

Incr Gluconeogenic and Glycolytic enzyme synthesis

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123
Q

Used to stimulate peristalsis in post-op ileus

A

Bethanechol, also to treat non-obstructive urinary retention

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124
Q

Effect of cholinergic agonist on glaucoma

A

Miosis causes iris to move further from cornea –> Widens anterior chamber and allows for better outflow of acqueous humor

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125
Q

Kidney histology in chronic transplant rejection

A

Vascular wall thickening, Luminal narrowing, Interstitial fibrosis, Parenchymal atrophy

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126
Q

What causes activation of RAS

A

GTP binding

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127
Q

NADPH is required as cofactor for

A

FA, Cholesterol, Steroid synthesis

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128
Q

MOA of Anastrozole

A

Aromatase inhibitor (+ Letrozole, Exemestane)

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129
Q

Bones associated with First Pharyngeal Arch

A

Maxilla, Zygoma, Mandible, Vomer, Palatine, Incus, Malleus

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130
Q

Bones associated with Second Pharyngeal Arch

A

Styloid, Lesser Horn of Hyoid, Stapes

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131
Q

Muscles associated with Second Pharyngeal Arch

A

Facial Expression, Stylohyoid, Stapedius, Posterior Digastric

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132
Q

Neonatal manifestations of Erythroblastosis Fetalis

A

Anemia, Jaundice, Edema, Nucleated RBCs, Extramedullary Hematopoiesis

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133
Q

Who gets oral thrush

A

Dentures, DM, Immunosuppressed, HIV

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134
Q

What causes problem with Fragile X expansion

A

Hypermethylation (not breakage)

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135
Q

What is unique to the duodenum

A

Brunner’s Glands - Located in SUBMUCOSA and secreted bicarb

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136
Q

3rd Aortic Arch Derivatives

A

Common Carotid, Prox internal carotid

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137
Q

4th Aortic Arch Derivatives

A

True Aortic Arch, Subclavian Arteries

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138
Q

6th Aortic Arch Derivatives

A

Pulmonary arteries, Ductus arteriosus

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139
Q

Effect of DKA on K

A

Incr excretion, Decr total stores, But increased extracellular

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140
Q

Homeless man with increased fatiguability and exertional dypnea, LE edema, decr sensation in periphery + cardiac dilation and incr CO

A

B1 deficiency (Beriberi)

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141
Q

Laryngeal edema and difficulty breathing after ACEi is due to

A

Kinin accumulation

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142
Q

Long acting benzodiazepines

A

Chlordiazepoxide, Chlorazepate, Diazepam, Flurazepam (Carefully Choose Due to Falls)

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143
Q

What are the dimorphic fungi?

A

Blasto, Histo, Paracoccidiodies, Coccidiodes, Sporothrix - Body Heat Purportedly Changes Shape

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144
Q

Removal of apical ectodermal ridge from newly formed limb bud

A

Shortened length, Abnormal ventral dorsal

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145
Q

Which aortic arch becomes Ductus Arteriosus

A

Sixth

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146
Q

Refsum’s disease

A

Myelin synthesis due to FA oxidation/synthesis disorder

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147
Q

Findings in Sarcoidosis

A

GRAIN - Globulinemia, RA, elevated ACE, Interstitial fibrosis, Noncaseating granulomas

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148
Q

pregnant woman hypotensive when supine

A

IVC compression –> lay on left side at night

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149
Q

Especially effective CT agent for Hodgkin

A

Vincristine

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150
Q

Location of the CTZ

A

Area postrema of the medulla

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151
Q

CV manifestations of Turner’s

A

Bicuspid Aortic Valve, Preductal Coarction of Aorta

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152
Q

Where is stratified squamous epithelium found in respiratory tract?

A

Oropharynx, Laryngopharynx, Anterior epiglottis, Upper half of posterior epiglottis, True vocal cords

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153
Q

MOA of Alpha-Glucosidase inhibitors

A

Prevent disaccharide breakdown in intestine, thus absorption

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154
Q

Role of adiponectin in T2DM

A

Low, increased by TZDs

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155
Q

Annular pancrease is caused by

A

Abnormal migration (not apoptosis) of ventral pancreatic bud

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156
Q

Bilateral lens subluxation, Massive stroke, Old renal infarcts

A

Homocysteinuria

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157
Q

Most patients with Homocysteinuria respond dramatically to

A

B6 supplementation

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158
Q

Fluoxetine overdose

A

Tachycardia, Drowsiness, Tremor, Vomitting, Nausea

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159
Q

Physical exam finding in AV fistula

A

Pulsative mass with thrill on palpation, Auscultation reveals bruit over site

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160
Q

SST decreases

A

Secretin, CCK, Glucagon, Insulin, Gastrin

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161
Q

AA’s that are metabolized to Propionyl CoA

A

Isoleucine, Valine, Threonine, Methionine

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162
Q

L-asparaginase

A

Antineoplastic by lowering circulating asparagine levels (leukemic cells collect asparagine from serum)

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163
Q

Symptoms, Signs of congenital hypothyroidism

A

Poor feeding, Prolongued jaundice, Constipation, Hypotonia, Hoarse Cry, Macroglossia, Myxedema, Umblical hernia

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164
Q

Which diuretic is used to decrease urine calcium

A

Thiazides

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165
Q

Most common cause of SVC syndrome

A

Bronchogenic Carcinomas

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166
Q

Most important HLA association with RA

A

HLA-DR4

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167
Q

HLA associated with SLE

A

HLA-DR2/3

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168
Q

HLA-A3 associated with

A

Primary Hemochromatosis

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169
Q

Lambert Eaton vs MG

A

LE doesn not improve with AChEi’s, Strength improves with repeated testing, Enhanced neurotransmission with repetitive stimulation

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170
Q

Limited vs Systemic Sclerosis Ab’s

A

Limited associated with Anti-centromere; Systemic with Anti-Topo 1

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171
Q

Kernicterus is most likely to affect which parts of CNS

A

Basal ganglia, Thalamus, Cerebellum, Cerebral gray matter, Spinal cord

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172
Q

Which hepatitis type is associated with PAN

A

Hep B (Hep C associated with Mixed Cryoglobulinemia)

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173
Q

Symptoms of Acute Intermittent Porphyria

A

Abdominal pain, N/V, Peripheral neuropathy, Paralysis, Psychiatric

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174
Q

Anti-mitochondrial Ab is a marker for

A

Primary Biliary Cirrhosis

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175
Q

Treatment of Lithium-induced DI

A

Amiloride - Blocks channel that lithium uses to enter principal cell

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176
Q

SLE on prednisone long term - what vitamin to supplement?

A

VITAMIN D

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177
Q

Toxicity of Nitrosureas

A

Carmustine –> pulmonary fibrosis

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178
Q

Accumulated intermediate in Acute Intermittent Porphyria vs Prophyria Cutanea Tarda

A

AIP = Porphobilinogen, PCT = Uroporphyrinogen

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179
Q

MOA of Bacitracin

A

Inhibits transfer of mucopeptides to growing cell wall

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180
Q

When do Red Neurons appear after cerebral ischemia?

A

12-24 hours

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181
Q

When does liquefactive necrosis appear after cerebral ischemia?

A

1-2 weeks

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182
Q

What can minors consent to when pregnant?

A

Prenatal care, Dx and Tx of STD’s, Drug and Alcohol Rehab; NOT abortions (or elective non-emergency procedures)

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183
Q

Acute transplant rejection is mediated by

A

T cell response against HLA/MHC antigens

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184
Q

Symptoms of Systemic Mastocytosis are induced by

A

Histamine releas

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185
Q

What is pulsus paradoxis

A

Decr systemic blood pressure during inspiration (incr venous return deviates IV septum toward left and blocks outflow)

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186
Q

When does Pulsus Paradoxis occur

A

Acute cardiac tamponade, Constrictive pericarditis, Severe obstructive lung dz, Restrictive CM

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187
Q

Most significant factor in Shigellosis

A

Mucosal invasion, not toxin

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188
Q

Confusion, Fever, Nausea, Elevated LFT’s four days after anesthesia

A

Massive hepatic necrosis from Halothane

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189
Q

Hepatic Granulomatosis is associated with

A

Methyldopa, Hydralazine, Quinidine

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190
Q

MOA and use of Primidone

A

First line for benign essential tremor; MOA unknown but metabolizes to phenobarbital

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191
Q

Activation of Intrinsic vs Extrinsic pathway

A

Intrinsic by damaged vessel (XII), Extrinsice by tissue damage (TF, VII)

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192
Q

Defect and major manifestations of Type 1 Dyslipidemia

A

LPL, ApoC –> Chylomicrons –> Acute pancreatitis, Xanthomas, HSM

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193
Q

Defect and major manifestations of Type 2a Dyslipidemia

A

LDL, ApoB-100 –> LDL –> CAD, Corneal Arcus, Tendon Xanthomas

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194
Q

Defect and major manifestations of Type 3 Dyslipidemia

A

ApoE –> Chylomicron, VLDL remnants –> CAD, PVD, Xanthomas

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195
Q

Defect and major manifestations of Type 4 Dyslipidemia

A

ApoA-V –> VLDL –> Pancreatitis, Obesity, Insulin resistance

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196
Q

Purine Antimetabolites

A

6-MP, 6-GP, Fludarabine, Cladribine

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197
Q

Use of Cladribine

A

Hairy Cell Leukemia - Resistant to Adenosine Deaminase

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198
Q

Bupropion is contraindicated with

A

Anything that can lower seizure threshold (eg electrolyte disorders from bulemia)

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199
Q

Good samaritan law

A

Standard of care must be met (meant to protect people, including off duty medical professionals, who help in accidents/emergencies)

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200
Q

Laplace’s Law

201
Q

Uptake of unconjugated bililrubin occurs via

A

Organic Anion Transporting Polypeptide (OATP) - passive

202
Q

Conjugated bilirubin is secreted from hepatocytes via __? This is blocked in __?

A

MRP2 (active organic anion transporter) - Criggler-Najjar, Rotor

203
Q

Concentration of Bicarb along Proximal Tubule

A

Actively reabsorbed due to Carbonic Anhydrase –> Acetazolamide causes excretion

204
Q

How to differentiate MAC from MTB in HIV patient

A

MAC has anemia, HSM, incr ALP/LAD due to widespread involvement of RES; Also grows well at 41degC

205
Q

Prophylaxis and treatment of MAC

A

Proph with Azithromycin; Tx with Azith + Ethambutol or Rifampin

206
Q

Absence of ganglion cells in colonic wall causes

A

affected segment to narrow (can’t relax)

207
Q

Which parts of GI tract are always involved in Hirschprung

A

Since NCC’s migrate caudally, rectum always involved

208
Q

How does metabolism of drug relate to drug-induced lupus?

A

Slow acetylators more likely (hydralazine, procainamide)

209
Q

Most liver hydrolysis involve what enzymes

A

Amidase, Esterase

210
Q

When is Exenatide used?

A

(GLP-1) Suboptimal glucose control in patients already on Metformin and Sulfonylureas

211
Q

Ventricular response to AF is dependent on

A

Transmission through AV node

212
Q

What types of viral genomic material can be individually infective?

A

Positive Linear ssRNA

213
Q

Interstitial pneumonia in transplant patient

214
Q

Treatment of C. diphtheria

A

Antitoxin –> Penicillin or Erythromycin –> DPT vaccine

215
Q

Most common cause of death from C diph

A

Cardiomyopathy

216
Q

Features of Cutaneous Neurofibromas

A

Rubbery, Buttonholing

217
Q

Features of Wiskott-Aldrich

A

Thrombocytopenic Purpura, Eczema, Recurrent infections

218
Q

Acute Narrow Angle Glaucoma is often precipitated by

A

Anticholinergics –> Anterior chamber narrows, obstructing trabecular meshwork

219
Q

Confirmatory test for calculus cholecystitis

A

HIDA scan (not ultrasound)

220
Q

Stool osmotic gap? What increase?

A

Colonic fermentation products –> Increased when poorly absorbable substances present (lactose)

221
Q

Nonpolar Aliphatic Hydrophobic AA

A

VIP GAL - Valine, Isoleucine, Proline, Glycine, Alanine, Leucine

222
Q

Aromatic Hydrophobic AA

A

Try Trippin w/ Phenytoin - Tyrosine, Tryptophan, Phenilalanine

223
Q

Basic/Positive AA’s

A

Shallow HAL is positive - Hystidine, Arginine, Lysine

224
Q

Acidic/Negative AA’s

A

Glutamate, Aspartate

225
Q

Hydrophilic uncharged AA’s

A

Come, Take My GAS! - Cysteine, Threonine, Methionine, Glutamine, Asparaine, Serine

226
Q

When is Arginine essential?

A

During + nitrogen balance

227
Q

Non-lactose fermenting, Oxidase negative organism in Sickle Cell Osteomyelitis

A

Salmonella

228
Q

Oxidase Positive bugs

A

Vibrio, Pseudomonas, Campylobacter, Helicobacter, Neisseria, Moraxella, Legionella

229
Q

Main virulence factor of S aureus in osteomyelitis

A

Adhesion to collagen

230
Q

Apo E4 predisposes to

A

Late-onset familial Alzheimer’s

231
Q

Hypertrophic CM trait

A

AD - Beta myosin heavy chain

232
Q

MOA and use of Dezrazoxane

A

Iron chelating agent to prevent cardiotoxicity from Anthracyclines

233
Q

Location of 5-HT3 receptors implicated in chemo n/v

A

Peripherally in presynaptic nerve terminals of vagus in GI, Centrally in CTZ and Solitary nucleus/tract

234
Q

Loop diuretics stimulate release of

A

Prostaglandins –> incr renal BF

235
Q

Most common benign tumor of breast

A

Fibroadenoma (<35, often bilateral, cyclinc)

236
Q

Fibroadenoma histology

A

Cellular, often myxoid stroma that encircles and sometimes compresses epithelium-lined glandular and cystic spaces

237
Q

Function of vWF

A

Platelet adhesion by crosslining GpIb with exposed collagen underneath damaged endothelium

238
Q

Secondary role of vWF

A

Carrier protein for factor VIII

239
Q

Proteins C and S act to inactivate

A

V and VIII

240
Q

Thrombin is produced from Prothrombin by

A

Activated Factor X

241
Q

Growth Hormone binds to a __ receptor

242
Q

Lecithin-Sphingomyeline Ratio is a marker for

A

Lung maturity (>1.9 = mature)

243
Q

Mechanism of methicillin resistance

A

Alterations in PBP2a (also affects cephalosporins)

244
Q

Immunity to reinfection by influenza is mediated by

A

Circulating antibodies against Hemagluttinin

245
Q

Tumor originating from collecting duct cells

A

Renal Oncocytoma

246
Q

Transitional cell tumors of pelvis are often what morphology

247
Q

Niacin-induced flushing is mediated by

A

Prostaglandins

248
Q

___ reduces pain by decreasing level of substance p in PNS

249
Q

Clinical uses of Valproate

A

Anticonvulsant (absence, myoclonic, grand mal) AND mood stabilizer (acute mania, bipolar)

250
Q

Anticonvulsants used as mood stabilizers in bipolar

A

Valproate, Carbamazepine, Lamotrigene

251
Q

Carbamazepine indications

A

Trigeminal Neuralgia, Manic episodes, Partial and generalized seizures

252
Q

MOA and use of Olanzapine

A

second gen antipsychotic

253
Q

QT interval reflects

A

Myocyte AP duration

254
Q

Two congenital syndromes that cause QT prolongation

A
  1. Jervell Lange-Nielson (AR, neurosensory deafness); 2. Romano-Ward (AD, no deafness)
255
Q

Mutations affecting cardiac cell cytoskeletal proteins or mitochondrial enzymes of ox phos are though to cause

A

Genetic Dilated CM’s

256
Q

Mutations of calcium-binding SR protein might underly

A

Arrhythmogenic RV Cardiomyopathy –> Progressive fibrofatty replacement of RV

257
Q

Extramedullary hematopoesis is most frequently associated with

A

Chronic Hemolytic Anemias (eg beta thal)

258
Q

Pentazocine

A

Opioid narcotic designed to produce analgesia with little to no abuse potential (weak antagonist at mu)

259
Q

Short-acting benzos

A

ATOM - Alprazolam, Triazolam, Oxazepam, Midazolam

260
Q

Long-acting benzos

A

Choose Carefully Due to Falls - Chlordiazepoxide, Chlorazepate, Diazepam, Flurazpam

261
Q

Malabsorption, Diarrhea, PAS-positive granules in intestinal macrophages

A

WHIPPLES DISEASE - Tropheryma whippelii

262
Q

Recurrent infections with Strep pneumo, H flu, and Moraxella indicate

A

Humoral immunodeficiency

263
Q

Pneumocystis and chronic mucocutaneous candidiasis indicate

A

T cell deficiency

264
Q

Immotile cilia syndrome presents in newborn period with

A

Respiratory distress –> Recurrent Otitis Media, Bronchitis, Sinusitis (opprotunistic infections like PCP unusual)

265
Q

Agammaglobulinemia means susceptible to

A

Extracellular, encapsulated bacteria

266
Q

Exchange of viral dna in coinfection by non-segmented viruses

A

Recombination

267
Q

Viral phenotypic mixing

A

Coinfection leads to one virus with nucleocapsid protein from another

268
Q

AE’s of TZD’s

A

Weight gain, edema, CHF

269
Q

Damage to the Caudate is associated with

A

Transient hemiparesis and frontal lobe symptoms such as inattentiveness, abulia, forgetfulness

270
Q

Compression fracture in elderly woman –> Calcium and PTH?

271
Q

Driver of respiratory function in COPD vs normal

A

pO2 in COPD vs pCO2 normally –> Supplementary O2 in COPD will lead to respiratory suppression and coma

272
Q

Main toxin of C perf

A

Lecithinase (phopholipase C, alpha toxin)

273
Q

Insular cortex is associated with

A

Integrating body states w/ emotions (limbic); ANS control; Conscious experience of visceral sensations

274
Q

Damage to internal vs external Globus Pallidus

A

Internal –> Excessive movement; External –> Decreased

275
Q

Role of D arm of tRNA

A

Dihydrouracil residues –> Helps facilitate correct tRNA recognition by proper Aminoacyl tRNA synthetase

276
Q

Role of T arm of tRNA

A

Binding tRNA to ribosomes

277
Q

Only RNA that contains thymidine

278
Q

NE to Epinephrine requires

A

SAM - PNMT enzyme

279
Q

BH4 is required for synthesis of

A

Tyrosine, DOPA, Serotonin, Prolactin

280
Q

Winter’s Formula

A

PaCO2 = (1.5*HCO3) + 8 +/- 2

281
Q

Media for growing V cholerae

A

Alkaline - extremely acid sensitive organism

282
Q

Mechanism of hepatocyte damage in Hep B

A

CD8 response to viral antigens on cell surface

283
Q

Regulatory HIV genes required for replication

284
Q

Structural HIV genes

A

Gag, Pol, Env

285
Q

Products of Gag, Pol, Env genes in HIV

A

Gag - p24, p7; Pol - RT, Integrase, Protease; Env - gp120, gp41

286
Q

Function of HIV nef gene? Rev? Tat?

A

Nef - Downregulate CD4 and MHC 1; Rev - Transport of unspliced viral transcripts out of nucleus; Tat - Protein that transcriptionally activates other viral genes

287
Q

Features of Colitis-associated CRC vs sporadic

A

(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
Q

MOA of Varenicline

A

Partial agonist at nicotinic ACh receptor

289
Q

Pentamidine is used for

A

Prophylaxis and tx of PCP

290
Q

Nifurtimox is used for

A

Chagas treatment

291
Q

Normal alveolar pO2

A

104 mmHg (if higher, poor perfusion)

292
Q

When is O2 equilibration diffusion-limited

A

Emphysema, Fibrosis, Very high blood flow (ie exercise)

293
Q

A, I, and H bands

A

A is thick myofilament, I is Actin only, H is Myosin only

294
Q

Pharmacodynamic Drug Antagonism

A

Drug can antagonize or prevent effect of another drug or endogenous substance

295
Q

Pharmacokinetic drug interaction

A

eg CYP inducers

296
Q

Treatment of recurrent C diff colitis

A

Fidaxomicin

297
Q

MOA of Fidaxomicin

A

Inhibits sigma subunit of RNA polymerase; Less effect on normal flora; Poor oral

298
Q

Most common cystic fibrosis mutation and result

A

dF508 –> Impaired post-translational processing and results in proteasome degradation

299
Q

AA’s with three titratable protons

A

Acidics, Basics, CT = Glutamate, Aspartate, Histidine, Arginine, Lysine, Cysteine, Tyrosine

300
Q

Salicylate acid base disorder

A

(1) Rapid respiratory depression causing alkalosis; (2) A few hours later metabolic acidosis

301
Q

Effect of ANP on kidney, Adrenals, BVs

A

Dilates afferent arterioles, Inhbitis Na reabsorption, Restrict aldosterone secretion, cGMP-mediated veno- and arteriodilation

302
Q

Type of MI usually associated with Bradycardia

A

Inferior - SA/AV nodal branch block

303
Q

ANS drug that can cause Glaucoma

A

Atropine –> Midriasis –> Narrowing of anterior chamber

304
Q

Anti-mitochondrial Ab’s

A

Primary biliary cirrhosis

305
Q

Anti-Smith Ab’s

A

Anti-snRNP = Specific for SLE

306
Q

Rapid atrophy and shrinkage of liver on autopsy

A

Halone-induced liver failure

307
Q

Shortest half life pro-coagulant factor

A

Factor VII (PT)

308
Q

What enzyme produces urea in Urea cycle

A

Arginase (Arginine –> Urea + Ornithine)

309
Q

Excessive amounts of Orotic acid are usually found in

A

OTC deficiency, Citrullinemia, Arginosuccinate aciduria

310
Q

Low levels of C1 esterase inhibitor

A

Hereditary Angioedema

311
Q

Mechanisms of C1 esterase inhibitor

A

Inhibit C1 –> Activated C1; Inactivates Kallikrein (which converts Kininogen to Bradykinin)

312
Q

16S rRNA function

A

Component of 30S subunit –> Expresses sequence complementary to Shine-Dalgarno in all prokaryotic mRNA

313
Q

23S rRNA function

A

Peptidyltransferase - Peptide bond formation

314
Q

Pontiac Fever

A

Legionella –> Acute, flu-like, self-limited disease

315
Q

Features of Legionnaire’s Disease

A

Recent expsoure to contaminated water, Pneumonia, High Fever; Sometimes GI, Relative bradycardia, neurologic

316
Q

Most common lab finding in Legionnaire’s

A

Hyponatremia

317
Q

Bilateral ACA occlusion

A

LE motor, Behavioral (abulia), Urinary incontinence

318
Q

Spread of H flu vs N meningitidis to meninges

A

H flu uses lymphatics, N men is hematogenous, Both from Pharynx

319
Q

MOA of Organophosphates

A

AChE inhibitors

320
Q

Bromoacetylcholine MOA

A

Inhibits Choline Acetyltransferase

321
Q

Nicotininc receptor antagonists

A

Pancuronium, Tubocurarine

322
Q

Hemicholinium MOA

A

Choline import into presynaptic terminal

323
Q

Train of Four seen in Non-depolarizing blockade

A

eg Tubocurarine - Slanted within group, Group increases each 4

324
Q

Train of Four seen in Depolarizing blockade

A

Equal within group, Group increases each four (phase 1) –> Resembles slanting of non-depolarizing in phase 2

325
Q

Neostigimine in Phase 1 vs 2 of Succinylcholine NMB

A

Augments blockade in Phase 1, Reverses it in Phase 2

326
Q

Duration of Succinylcholine action depends on

A

Diffusion out of NMJ and metabolism by plasma cholinesterase

327
Q

Nitrate with best bioavailability

A

Isosobide Mononitrate

328
Q

Hep B Window Period

A

Time lag betwee HBsAg disappearing and Anti-HBs appearing

329
Q

Most specific marker for diagnosis fo acute Hep B

A

Anti-HBc IgM –> Present in window period

330
Q

Vitamin E deficiency manifestations

A

Neuromuscular disease (myopathy, ataxia, pigmented retinopathy, dorsal column) and Hemolytic anemia

331
Q

Vitamin E primarily serves to

A

Protect fatty acids from oxidation –> Neurons and erythrocytes most susceptible

332
Q

Vitamin C excess

A

Nausea, Abdominal pain, Diarrhea, Stones

333
Q

Physostigmine vs Neostigmine and Edrophonium

A

Neostigimine and Edrophonium are Quaternary Amines and can’t cross BBB

334
Q

Tarry stool and fatigue are seen with what CT agents

A

Alkylating agents (upper GI bleed)

335
Q

Abdominal pain and jaundice may be seen with what CT agent

A

Mercaptopurine (cholestasis and hepatitis)

336
Q

Flagellate skin discoloration is seen with what CT agent

A

Bleomycin (along with pulmonary fibrosis)

337
Q

Nitroblue Tetrazolium testing

A

Properly functioning PMNs produce ROS that reduce yellow NBT to dark blue formazan that precipitates within the cells

338
Q

DHR flow testing

A

NADPH oxidase shows decr fluorescence

339
Q

NBT and DHR testing in MPO deficiency

340
Q

Pyruvate kinase deficiency is a common cause of

A

Chronic Hemolytic Anemia

341
Q

Ortner Syndrome

A

Mitral Stenosis –> LA enlargement –> Impingement on Recurrent Laryngeal N

342
Q

Location of Glut-2

A

Regulation of Insulin Release –> Hepatocytes, Beta cells, Renal tubular cells, Small intestine

343
Q

Location of Glut-3

A

Placenta, Neurons

344
Q

What is commonly found regarding uterus on vaginal vaginal examination in Endometriosis

A

Nodularity of uterosacral ligaments, Fixed retroversion of uterus

345
Q

Ectopic endometrial tissue secretes

A

PG’s –> Interfere with ovulation and tubal function –> Infertility

346
Q

Adenomyosis

A

Presence of endometrial glands w/in uterin myometrium (presents with bleeding, painful menses, and enlarged uterus unlike endometriosis)

347
Q

When to give Ribavirin with RSV?

A

Confirmed, severe RSV at risk for dz progression (immunodeficiency, prematurity, cardiopulmonary disease)

348
Q

Mechanism of Shiga-like toxin

A

AB - A subunit prevents binding of tRNA to 60S ribosomal subunit

349
Q

Bactrim is drug of choice for

A

Pneumocystis jiro, Toxoplasma, Nocardia

350
Q

Hyoscyamine

A

Anti-muscarinic to counteract AChEi in Myasthenia Gravis

351
Q

Side effects of Thiazide Diuretics

A

Hyper Glycemia Lipidemia Uricemia Calcemia

352
Q

Medication-induced fat redistribution

A

Corticosteroids, HAART (Protease inhibitors)

353
Q

Chronic Eosinophilic Bronchitis in asthmatics involves

A

Bronchial wall infiltration by numerous activated eosinophils in response to IL-5 by allergen-activated TH2 cells

354
Q

Class 3 Anti-arrhythmics

A

Amiodarone, Ibutilide, Dofetilide, Sotalol

355
Q

Which vitamin supplement should be given to child with Measles

A

Vitamin A - Reduces time to recovery from pneumonia and diarrhea, as well as risk of death

356
Q

Which HIV drug to give to pregnant women

A

Zidovudine

357
Q

Protein secondary structure is due to

A

Hydrogen bonds (Tertiary due to ionic bonds, hydrophobic interactions, hydrogen bonds, and disulfide bonds)

358
Q

E coli aquired ability to form pili via

A

Conjugation

359
Q

Strep pneumo aquired capsule via

A

Transformation

360
Q

Function of Thyroid Peroxidase

A

Oxidize inorganic iodide to organic iodine; Formation of monoiodotyrosine and diiodotyrosin; Coupling of these to iodotyrosines

361
Q

Lab studies in HUS

A

Only bleeding time elevated

362
Q

Bacitracin MOA

A

Prevents mucopeptide transfer into growing cell wall

363
Q

Trimpethroprin, Methotrexate, and __ inhibit DHFR

A

Pyrimethamine

364
Q

Important Bactrim AE’s

A

Hyperkalemia, Megaloblastic Anemia

365
Q

Serotonin Syndrome effects

A

HARM - Hyperthermia, ANS instability, Rigidity, Myoclonus

366
Q

Drugs that precipitate Serotonin Syndrome

A

TTYL - Tramadol, Triptans, trYcyclics, Linezolid

367
Q

Features of Myotonic Dystrophy

A

Frontal balding, Gonadal atrophy, Arrhythmia (My toupe, my testicles, my ticker); sustained grip, type 1 fiber loss

368
Q

Most important signalers in Coronary autoregulation

A

Adenosine, NO

369
Q

What causes NO release in coronaries

A

Pulsatile stretch, Flow shear stress

370
Q

What subtype not stimulated by NE

371
Q

Skeletal Muscle Depolarization –>

A

L-type channel-RyR mechanical coupling (no significant flux of Ca across L-type Ca channel) –> RyR1 opening –> Binds Troponin C

372
Q

Cardiac Muscle Depolarization –>

A

L-type Ca influx on PM –> RyR2 opening

373
Q

Smooth Muscle Depolarization –>

A

v-gated L type Ca influx –> Calmodulin (no troponin) –> Myosin light chain kinase –> P-lation of myosin

374
Q

Nonselective beta blocker with a1 blocking activity

375
Q

Systemic sequelae with Diphtheria

A

Myocarditis, Heart Failure, Neurotoxicity

376
Q

EKG leads for LAD

377
Q

Type 3 collagen is found in

A

Granulation tissue, Skin, Lungs, Blood vessels

378
Q

Bell vs Diaphragm

A

Bell = Low freq; Diaphragm = High

379
Q

S3 on end expiration

A

More audible, Heart closer to chest wall

380
Q

Localized amyloidosis confined to cardiac atria

A

ANP-derived (elderly)

381
Q

Prolyl Hydroxylase –>

A

Proline on Procollagen –> Stable triple helix

382
Q

Lysyl Hydroxylase –>

383
Q

Bepridil

A

CCB - Second line anti-anginal drug

384
Q

Loud P2 =

A

Pulmonary hypertension

385
Q

Kussmaul =

A

Paradoxical rise in JVP during inspiration

386
Q

Don’t use DPH-CCB with

A

Acute Coronary Syndrome (reflex tachycardia)

387
Q

Digoxin toxicity

A

Hyperkalemia, Vision, N/V/D

388
Q

Afib with RVR: tx –>

A

CCBs, BBs, then Digoxin second line

389
Q

Lidocaine is for what arrhythmias

A

Ventricular, not Atrial

390
Q

Mechanism of Fibrates

A

Peroxismal Proliferator-Activated Receptor Alpha –> LPL activity increase –> Decr TB, Raise HDL

391
Q

How do assess severity of Mitral Regurg

A

Presence of S3 gallop

392
Q

Defect in Chediak-Higashi

A

Phagosome-Lysosome fusion –> Recurrent pyogenic infections with Staph and Strep

393
Q

Features of Chediak-Higashi

A

Immunodef, Albinism, Neurologic (nystagmus, cranial neuropathies)

394
Q

Phosphorylation of NRTI’s vs NNRTI’s

A

NRTI’s must be phosphorylated

395
Q

Most important mechanism of lead poisoning

A

Affinity for sulfhydryl groups –> Inhibition of d-ALA dehydratase and ferrochetolase

396
Q

Formation of d-ALA

A

Succinyl-CoA and Glycine via Pyridoxal Phosphate cofactor

397
Q

Cause and manifestation of acute serum sickness

A

Type 3 (IC deposition) –> Fever, Pruritic skin rash, Arthralgias, Fibrinoid necrosis, Hypocomplementemia

398
Q

Serum sickness can be caused by

A

Chimeric monoclonal Ab’s, Nonhuman Ig’s, Nonprotein drugs (eg penicillin, cefaclor, bactrim)

399
Q

Osteolytic phase of Paget’s is due to excess

A

RANK signaling, NFKB activation

400
Q

Pattern of bone in Osteoblast phase of Paget’s

A

Dense, hypovascular, mosaic pattern of lamellar bone with irregular, haphazardly oriented sections separated by prominent cement lines

401
Q

What stimulates Inhibin B secretion

A

FSH stimulation of Sertoli cells

402
Q

MOA of trihexyphenidyl

A

centrally-acting anti-muscarinic

403
Q

Anti-cholinergics such as benztropine and trihexyphenidyl should be avoided in elderly patients, esp with

A

BPH, Angle-Closure Glaucoma

404
Q

S-100 protein function

A

Homodimeric calcium-binding proteins, important for protein p-lation, cell growth, and differentiation

405
Q

S-100 marks what cells

A

Neural Crest (melanocytes, Schwann), Langerhans and other dendritic

406
Q

DLCO depends on

A

Thickness and total SA of alveolar capillary membrane, Hematocrit, Total volume of pulmonary capillary blood

407
Q

DLCO in emphysema vs chronic bronchitis

A

Reduced in Emphysema, Normal in CB

408
Q

Mechanism of Bohr effect

A

CO2 –> H+ and HCO3+ –> H+ binds histidine side chains of Hb –> Stabilize deoxygenated form of Hb

409
Q

What happens to H+ and HCO3 in RBC from CO2

A

H+ binds Hb; HCO3 exchanged for Cl (Cl enters)

410
Q

Which step of Glycolysis utilizes NAD+

A

G3P –> 1,3-BPG

411
Q

When is FADH2 produced

A

During conversion of succinate to fumarate

412
Q

Synthesis of Carnitine

A

Lysine + Methionine via Vit C cofactor

413
Q

Citrate is formed from

A

Condensation of Acetyl CoA w/ OAA

414
Q

Heart Failure definition

A

(1) Cannot pump enough blood to meet demand; or (2) Can onliy do so from elevated ventricular filling pressure

415
Q

Diarrhea in pellagra results from

A

Columnar epithelium atrophy

416
Q

NAD functions as a coenzyme for

A

Dehydrogenases involved in metabolism of fats, carbs, and amino acids

417
Q

Niacin can be synthesized endogenously from

A

Tryptophan

418
Q

Populations that primarily subsist on __ are prone to developing pellagra

A

Corn (niacin in corn is bound and unabsorbable)

419
Q

Pellagra is less commonly seen in what patient populations

A

Carcinoid, Prolonged INH, Hartnup (more commonly in alcoholics and chronic disease)

420
Q

Arginine is a precursor of

A

NO, Urea, Ornithine, Agmatine, Creatine

421
Q

Orotic acid is a precursor of

A

Pyrimidine

422
Q

Ab-dependent cellular cytotoxicity is defense against

A

Virus, Parasite

423
Q

Function of MPO

A

Hypochlorite from H2O2 and Chlorine

424
Q

Testicular feminization syndrome =

A

Complete Androgen Insensitivity = Absent Wolffian and Mullerian structures

425
Q

Pulmonary hypertension is usually found in patients with

A

Scleroderma

426
Q

H1 receptors are found in

A

Vascular endothelium, Bronchial smooth muscle

427
Q

5 important classes of meds with Anti-muscarinic effects

A

Atropine, TCA’s, H1 blockers, Neuroleptics, Anti-Parkinson - NATHA

428
Q

MOA of Ribavirin

A

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
Q

Bone turnover is regulated by ratio of

A

RANKL to OPG - incr when RANK-L high and OPG low

430
Q

How does PTH activated Osteoclasts

A

Stimulates Osteoblasts to upregulate RANKL and secrete M-CSF –> Osteoclast maturation

431
Q

Function of Osteoprotegrin

A

Decoy RANK-L receptor

432
Q

Arachnodactyly, Scoliosis, and Aortic Root Dilatation are signs of

433
Q

Macroorchidism, Large Jaw, and Intellectual disability are signs of

434
Q

Top 3 causes of meningitis in neonates

A

GBS, E coli, Listeria

435
Q

Courses between Biceps brachii and Coracobrachialis

A

Musculocutaneous

436
Q

Courses between Flexor Carpi Ulnaris and Flexor Digitorum Profundus in forearm

437
Q

Courses between Flexor Digitorum Profundus and Flexor Digitorum Superficialis

438
Q

Substrate for PRPP synthetase

A

Ribose-5-Phosphate

439
Q

Gout occurs with increased frequency in patients with activating mutations of

A

PRPP Synthetase

440
Q

First line for Acute Gouty Arthritis

A

NSAIDs (Colchicine second)

441
Q

How does pregnancy affect gallstones?

A

Estrogen-induced cholesterol hypersecretion (HMG CoA Reductase); Progesterone reduces bile acid secretion and slows gallbladder emptying

442
Q

Fluid-filled cavitiy in liver + Fever, Chills, RUAbdominal Pain

A

Most likely bacterial abscess in developed nation

443
Q

Pyogenic bacteria most commonly gain access to liver via

A

Biliary tract, Portal vein pyema, Hepatic artery

444
Q

How does RBC carry CO2

A

15% as carbamate on Hb, Remained as bicarb ion w/in RBC

445
Q

Diuretic often used in management of Cerebral edema and Incr ICP

446
Q

Overaggressive treatment with osmotic diuretic therapy

A

Excessive volume depletion and eventual hypernatremia

447
Q

Osmotic diuretics should be used cautiously in what patients

A

CHF, Pre-existing pulmonary edema

448
Q

Spironolactone side effects

A

Hyperkalemia, Gynceomastia, Decr libido, Erectile dysfunction

449
Q

The risk of statin myopathy is increased when

A

Fibrates and/or Niacin also used

450
Q

Drugs that can cause myopathy

A

SGFC PHIN - Statins, GC’s, Fibrates, Colchicine, Penicillamine, Hydroxychloroquine, IFNa, Niacin

451
Q

MOA of Fenodolpam

A

Benazepine derivative of DA –> Selective DA-1 agonist with no effect on alpha or beta receptors

452
Q

Stimulation of DA receptors in kidneys

A

Improves RBF and Na and Water excretion

453
Q

Fenoldopam is indicated for

A

Short term management of severe HTN

454
Q

Use and risk of Nitroprusside

A

Most effective agent for most cases of HTN emergency –> Cyanide toxicity

455
Q

Vimentin is a marker for

A

Mesenchyme

456
Q

Chromogranin A

A

Neuroendocrine tumors

457
Q

Imperforate anus is most commonly associated with

A

GU malformation - VACTERL (vertebral, anal atresia, cardiac anomalies, TE fistula, esophageal atresia, renal anomalies, limb anomalies)

458
Q

Fibrinous pericarditis is most commonly caused by

A

MI, RF, Uremia; Also viral

459
Q

Pericardial knock

A

Brief, high frequency, precordial sound heard shortly after S2 in constrictive (chronic) pericarditis

460
Q

Heme in the liver is synthesized for

A

CYP450 system

461
Q

Acute Intermittent Porphyria can be precipitated by

A

Phenobarbital, Griseofulvin, Phenytoin, Low calorie diet, Alcohol –> All decr hepatic heme –> Incr ALA synthase activity

462
Q

Heme synthesis enzymes inhibited by lead

A

ALA dehydratase, Ferrochetolase

463
Q

Influenza vaccine induces

A

Neutralizing antibodies against Hemagglutinin

464
Q

Why don’t killed vaccines stimulate CD8 response

A

They don’t enter host cell for MHC Class 1 presentation

465
Q

Sensory nerve to parietal pleura

A

Phrenic to Diaphragmatic and Mediastinal; Intercostal to remainder

466
Q

Superficial Inguinal Nodes drain

A

Nearly all cutaneous lymph from umbilicus to feet, including external genitalia and anus

467
Q

Lymph from Glans penis and cutaneous portion of posterior calf drain into

A

Deep inguinal lymph directly (bypassing superficial)

468
Q

Effect of cyanide poisoining

A

Inhibits cytochrome C oxidase - SaO2 of venous blood increases due to failure of oxygen unloading

469
Q

Crescents of RPGN are composed of

A

Proliferated glomerular parietal cells, Monocytes, Macrophages, Fibrin

470
Q

Inactivated HFE increases iron by

A

(1) Incr DMT1 on enterocytes; (2) Decr hepcidin –> Incr ferroportin expression

471
Q

Atypical antipsychotics most and least likely to cause EPS

A

Clozapine least likely, Risperidone most likely

472
Q

Top 3 risk factors for Coronary Heart Disease

A

Noncoronary Athersclerotic Disease, Diabetes Mellitus, CKD

473
Q

Pineal Tumors most commonly cause

A

Parinauds, Precocious puberty, Obstructive hydrocephalus

474
Q

Short acting insulins

A

Lispro, Aspart, Glulisine

475
Q

When to use regular insulin

476
Q

What accounts for delayed onset of regular insulin

A

Dimer and hexamer formation (short acting are monomers)

477
Q

NPH insulin works by

A

Crystalline suspension with protamine and zinc –> Delays absorption

478
Q

Detemir insulin works by

A

FA bound to lysine –> Binds albumin and slowly dissociates

479
Q

MAOi’s

A

MAO Takes Pride In Shanghai = Tranylcypromine, Phenelzine, Isocarboxazid, Selegline (B selective)

480
Q

SSRI’s

A

Flashbacks Paralyze Senior Citizens = Fluoxetine, Paroxetine, Sertraline, Citalopram

481
Q

SNRI’s

A

Venlafaxine, Duloxetine

482
Q

How quickly after ischemia does loss of contractility occur in cardiomyocytes?

A

60 seconds

483
Q

At what timepoint is myocardial ischemia irreversible

A

30 minutes

484
Q

Ligands for Receptor Tyrosine Kinase vs JAK/STAT

A

Growth Factors bind RTKs; JAK/STAT bound by Cytokines, Growth Hormone, Prolactin, IL-2, EPO

485
Q

Microscopy of Membranous Glomerulopathy

A

LM - Mesangial proliferation; IF - Ig and C3; EM - Spike and Dome

486
Q

T-ALL is most likely to present

A

Anterior Mediastinal mass that compresses great vessels and esophagus

487
Q

EKG progression of Acute Transmural Infarct

A

Peaked T waves –> STE –> Q waves

488
Q

Imaging in Gallstone Ileus shows

A

Intestinal gas (obstruction), Air in biliary tree

489
Q

Boerhaave Syndrome

A

Transmural tear (vs Mallory Weiss which is mucosal)

490
Q

Cricopharyngeal motor dysfunction occurs due to

A

Diminished relaxatin of pharyngeal muscles during swallowing

491
Q

Renal consequences of Ethylene Glycol ingestion

A

Oxalate crystals, Tubular epithelial damage (ballooning and vacuolar degeneration mostly in PCT)

492
Q

FA vs Glucose oxidation in ATP generation and O2 use

A

FA oxidation produces more ATP, but uses more O2 per ATP

493
Q

Receptor mediating Mydriasis

494
Q

Receptor mediating uterine relaxation

A

Beta 2 (tocolysis = Terbutaline, Ritodrine)

495
Q

Mom and infant sequelae of rubella

A

Mom = Polyarthritis/Polyarthralgia; Infant = Sensorineural deafness, Cataracts, Cardiac malformations (PDA)

496
Q

Intracellular pyrophophate granules in a bug

A

C diph (methylene blue staining)

497
Q

Conus Medullaris Syndrome

A

L2 lesion = Flaccid paralysis of bladder and rectum, impotence, saddle anesthesia

498
Q

Cauda Equina Syndrome

A

Radiating back pain, Saddle anesthesia, Loss of anocutaneous reflex, Bowel and bladder dysfunction, Loss of ankle-jerk reflex w/ plantar flexion weakness

Uworld (16 decks)

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