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Uworld Added 2 Flashcards

1
Q

Saddle anesthesia and Loss of anocutaneous reflex =

A

S2-S4 lesion (cauda equina syndrome)

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2
Q

Danazol MOA

A

Synthetic androgen for endometriosis and hereditary angioedema

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3
Q

Mifepristone MOA

A

Synthetic steroid with anti-progestin and anti-glucocorticoid effects

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4
Q

Mitotane MOA

A

Adrenocorticolytic used primarily for adrenocortical carcinoma

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5
Q

Maintenance Dose =

A

Cpss x CL / [Bioavailability fraction]

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6
Q

Half life =

A

(Vd x 0.7) / CL

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7
Q

Loading Dose =

A

(Vd x Cpss) / [Bioavailability Fraction]

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8
Q

Methoxamine MOA

A

Selective a1 agonist

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9
Q

a2 activation effects

A

Decr insulin, Decr lipolysis, Decr aqueous humor production, Incr Platelet Aggregation

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10
Q

b1 activaiton effects

A

HR/Contractility, Incr Renin and Lipolysis

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11
Q

b2 activation effects

A

Vasodilation/Bronchodilation; Incr Lipolysis and Insulin; Decr uterine tone; Ciliary muscle relaxation and acqueous humor production

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12
Q

Recurrent kidney stones in young patient indicates

A

Inborn error of metabolism

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13
Q

Sodium Cyanide-Nitroprusside test

A

Detects presence of (sulfhydryl groups) urine cystine (converts cystine to cysteine and nitroprusside binds to make purple)

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14
Q

Treatment of Cystinuria

A

Hydration and Alkalinization of urine

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15
Q

Microscopic finding of irreversible cardiac ischemic injury

A

Vacuoles and Phospholipid-containing amorphous densities w/in mitochondria

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16
Q

Glandular epithelial changes from Proliferative to Secretory stages in endometrium

A

Pseudostratified, elongated, mitotically active epithelial cells –> Acquire large cytoplasmic vacuoles

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17
Q

Features that differentiate LEMS from MG

A

Hypo/areflexia, Autonomic symptoms, Classic incremental response to repetitive stimuli

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18
Q

Pyruvate Carboxylase activity is increased by

A

Acetyl-CoA

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19
Q

Citrate is a regulator of

A

Positive regulator of AcCoA Carboxylase, F-1,6-BP; Negative of PFK1 and 2 (inhibiting glycolysis)

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20
Q

Narcolepsy with Cataplexy is most often caused by

A

Lack of Hypocretin 1/2 (Orexin A/B) from Lateral Hypothalamus

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21
Q

Elevatd 14-3- protein in CSF

A

CJD

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22
Q

Low CSF 5-hydroxyindole-acetic acid

A

Impulsive, destructive behaviors

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23
Q

How to differentiate syphillis from other spirochetes on darkfield

A

Motility

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24
Q

H ducreyi requires what in culture

A

Factor X (like H flu)

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25
Q

Fever and sore throat in pt with hyperthyroidism being treated

A

AGRANULOCYTOSIS

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26
Q

Arthralgias with PTU

A

50% develop ANCA, some develop arthralgias and glomerulonephritis

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27
Q

Abdominal pain, distension, fever, diarrhea, shock in Ulcerative Colitis

A

Possibility of Toxic Megacolon

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28
Q

Alveolar proteases (eg. elastase) are produced by

A

Macrophages and PMNs

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29
Q

Acute Hypotension, Tachycardia, Elevated CVP (JVD) with Pulsus paradoxus

A

Cardiac Tamponade

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30
Q

Reid Index

A

Chronic Bronchitis –> Ratio of Gland thickness to total thickness of wall between epithelium and cartilage

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31
Q

When not to use Probenicid for Hyperuricemia

A

Poor renal function, Risk for uric acid stones or uric acid nephropathy

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32
Q

MOA of Rasburicase

A

Urate Oxidase: Uric Acid –> Allantoin

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33
Q

CHOP therapy is for

A

Non-hodgkin lymphoma

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34
Q

Herpesvirus drug that doesn’t require viral kinase

A

Cidofovir, Foscarnet

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35
Q

Peritrichious Flagella

A

Characteristic of highly motile organisms such as Proteus mirabilis

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36
Q

“serpentine” or “medusa head” chains on microscopy

A

B anthracis

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37
Q

How does tetanus toxin causes paralysis

A

Wound –> Motor Neuron Axons –> Spinal Cord –> Inhibits inhibitory motor neuron

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38
Q

Features of Edwards Syndrome

A

Rocker bottom, Micrognathia, Low set ears, Clenched hands, Prominent Occiput, ASD/VSD, Omphalocele, Horeshoe kidney

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39
Q

Features of Patau Syndrome

A

Microcephaly, Holoprosencephaly, Microphtalmia, Polydactyly, Cleft lip/palate, Rocker bottom feet, Cystic kidneys, VSD

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40
Q

Methods of Isoniazid resistance

A

(1) Decr expression of catalase-peroxidase enzyme necessary for activation; (2) Modification of protein binding site

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41
Q

Rheumatic aortic disease usually produces

A

Combined AS and Aortic Regurgitation

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42
Q

Acanthocytes indicate

A

Abetalipoproteinemia

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43
Q

Which genes play major role in Type 1 DM

A

HLA-DQ and DR

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44
Q

Pancreatic islet amyloid deposition is seen in

A

Type 2 DM (universal)

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45
Q

Dose effects of dopamine

A

Low = D1 + B1; High = D1 + B1 + A1

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46
Q

Sensory innervation of Deep Fibular Nerve

A

Between first and second toes

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47
Q

Trauma or sustained pressure (cast) to the neck of the fibular

A

Injury to the common peroneal nerve

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48
Q

Basophil granules contain

A

Heparin, Histamine, SRS-A

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49
Q

What activates ALA synthase

A

CYP inducers, Barbiturates, Anti-epileptics, EtOH, Smoking

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50
Q

What inhibits ALA synthase

A

Heme, Glucose

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51
Q

Conversion of 1,3-BPG to 2,3-BPG is increased in

A

Hypoxia, Chronic Anemia

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52
Q

Babesiosis

A

Malaria-like illness w/ prediliction for asplenic patients

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53
Q

Toxoplasmosis in immunocompetent causes

A

flu-like illness

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54
Q

Brucellosis causes

A

Fever, malaise, LAD, HSM

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55
Q

Childreen 1-3 with gingivostomatitis characterized with intranuclear inclusions

A

HSV-1

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56
Q

MOA of Mesna

A

Binds Acrolein (toxic metabolite of cyclophosphamide)

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57
Q

Atypical Depression

A

Improvement in mood in response to something positive

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58
Q

MAOi’s are used for

A

Atypical Depression, Anxiety, Refractory

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59
Q

Jejunal, Ileal, and Colonic Atresia are caused by

A

Vascular accidents in utero, NOT abnormal fetal development

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60
Q

Presentation of Follicular Lymphoma

A

Indolent course, Painless lymph node enlargement or abdominal discomfort from abdominal mass

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61
Q

Presentation of Diffuse Large Cell Lymphoma

A

Aggressive –> Large LN or extranodal mass (oropharyngeal lymphoid tissue and GI tract commonly involved)

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62
Q

Presentation of Hairy Cell Leukemia

A

Splenomegaly, Pancytopenia in older men

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63
Q

DNA Polymerase I vs III

A

I has 5’ to 3’ exonuclease activity (removes RNA primer, performs repair of damage), 5’ to 3’ polymerase activity, and 3’ to 5’ exonuclease activity; III performs bulk of replication

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64
Q

Signs of Acute Tubular Necrossi

A

Oliguria, Muddy Brown Casts, Anion Gap Metabolic Acidosis

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65
Q

Signs of Aromatase Deficiency

A

Maternal virilization, High androgens, Low estrogen, Tall, Osteoporosis –> Girls have ambiguous genitalia, boys just tall and osteoporosis

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66
Q

Function of Red Nucleus

A

Motor control of Upper extremities

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67
Q

Skin biopsy in Dermatitis Herpetiformis shows

A

PMNs and fibrin at tips of dermal papilla = microabcesses; IgA deposits

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68
Q

Infant with malabsorption, failure to thrive, progressive ataxia, acanthocytes

A

Abetalipoproteinemia

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69
Q

Epinephrine stimulates B2 receptors in skeletal muscle to

A

Incr BF, Glycogenolysis, Lipolysis

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70
Q

Endocrine comorbidities with Down Syndrome

A

Hypothyroid, T1DM, Obesity

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71
Q

Rheumatology and Hematology comorbidities with Down Syndrome

A

Acute Leukemia, Atlantoaxial instability

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72
Q

are only found in Alzheimer’s dementia

A

Neurofibrillary Tangles

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73
Q

Lewy bodies

A

Round, eosinophilic, intracytoplasmic inclusions that contain neurofilaments of a-synuclein

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74
Q

Negri Bodies

A

Round eosinophilic inclusions seen in the cytoplasm of pyramidal hippocampal neurons and cerebellar purkinje cells

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75
Q

When does the metonephros begin to produce urine

A

8-10 wks

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76
Q

Most common cause of fetal hydronephrosis

A

Inadequate recanalization of the ureteropelvic junctions

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77
Q

Tumor that causes necrolytic migratory erythema

A

Glucagonoma

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78
Q

Manifestations of Somatostatinoma

A

DM, Steatorrhea, Cholelithiasis, Hypochlohydria

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79
Q

Order of sound /pressure waves in inner ear

A

Round window –> Scala Vestibuli –> Scala Tympani –> Basilar Membrane dilation

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80
Q

Brown pigment stones typically arise secondary to

A

Infection of the biliary tract –> Releases B-Glucoronidase –> Hydrolysis of bilirubin glucoronides –> incr amount of unconjugated bilirubin in bile

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81
Q

7a-Hydroxylase function

A

Convert cholesterol to bile acids (sufficient activity reduces likelihood of cholesterol stone formation)

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82
Q

Important to metabolism/levels of digoxin

A

Renal clearance mostly, Plasma protein binding and body mass somewhat; Not liver enzymes

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83
Q

Most common known viral cause of acute hemorrhagic cystitis in children (and males in particular)

A

Adenovirus (serotypes 11 and 21 of B subgroup)

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84
Q

Pathogenesis of Centriacinar Emphysema

A

Smoke –> Macrophages –> PMNs –> Proteases active, Antiproteases inactivated

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85
Q

Club/Clara cell function

A

Nonciliated, secretory cells in terminal respiratory epithelium –> Secrete protein, surfactant and help detoxify

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86
Q

Is S3 or S4 always pathologic in young patients

A

S4 always in younger, Not always in older

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87
Q

V/Q and Acid/Base consequences of PE

A

Redistribution of blood to unaffected –> V/Q mismatch –> Hypoxemia stimulates hyperventilation –> Respiratory Alkalosis

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88
Q

3 NNRTI’s

A

Nevirapine, Efavirenz, Delavirdine

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89
Q

MOA of Enfuvirtide

A

Prevent fusion by binding gp41

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90
Q

Most concerning AE of NNRTI’s

A

Hepatic Failure with Encephalopathy

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91
Q

Holoprosencephaly is associated with

A

Trisomy 13 and 18, Fetal Alcohol Syndrome

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92
Q

Deformation vs Malformation

A

Deformation occurs due to extrinsic mechanical force; Malformation is a primary defect in cells or tissues that form an organ

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93
Q

“Disruption”

A

Secondary breakdown of a previously normal tissue or structure

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94
Q

Aldolase function

A

A/B/C metabolize F-1,6-BP to G3P and DHAP; Aldose B also metabolizes F-1-P to Glyceraldehyde and DHAP

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95
Q

Tx Aldolase B deficiency by

A

Eliminating dietary fructose (sucrose)

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96
Q

Sucrose

A

Fructose + Glucose

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97
Q

Lactose

A

Galactose + Glucose

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98
Q

Maltose

A

Glucose + Glucose

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99
Q

For patients with stiff lungs, work of breathing is minimized when

A

RR is high, TV is low

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100
Q

For patients with high airflow resistance, work of breathing is minimized when

A

RR is low, TV is high

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101
Q

LPS/LOS cause sepsis by induction of systemic inflammatory response characterized by

A

TNFa, IL-1b, IL-6, IL-8 (much of which is formed after interaction with TLR-4)

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102
Q

Osteoporosis is defined as

A

Bone density >2.5 SD below mean for peak young adult bone density

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103
Q

Risk factors for Osteoporotic Fractures

A

White/Hispanic/Asian, Hx, Decr activity, Low body weight, Excessive alcohol or tobacco, Premature menopause

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104
Q

How do GC’s incr bone loss

A

(1) Decr GI absorption of Ca, (2) Inhibit collagen synthesis, (3) Decr GnRH, (4) Incr urinary Ca loss

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105
Q

Side effects of Statins

A

Myotoxicity, Hepatotoxicity (discontinue if LFT’s >3x normal)

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106
Q

CYP Inducers

A

Chronic Alcohol, St Johns wort, Phenytoin, Phenobarbital, Nevirapine, Rifampin, Griseofulvin, Carbamazepine

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107
Q

CYP substrates

A

Anti-epileptics, Theophylline, Warfarin, OCPs

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108
Q

CYP inhibitors

A

Acute Alcohol, Ritonavir, Amiodarone, Cimetidine, Ketoconazole, Sulfonamides, Isoniazid, Grapefruit, Quinidine, Macrolides (ex azithromycin)

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109
Q

Acanthosis

A

Incr thickness of stratum spinosum (psoriasis commonly associated with acanthosis)

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110
Q

Spongiosis

A

Intercellular epidermal edema –> incr space b/t cells (eg eczematous dermatitis)

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111
Q

Dyskeratosis

A

Premature keratinization of individual keratinocytes (eg SCC)

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112
Q

First line for isolated systolic HTN in non diabetics

A

Thiazides and DHP CCBs

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113
Q

HTN drug that can lead to flushing and peripheral edema

A

Amlodipine

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114
Q

First line for essential HTN in general public

A

HCTZ

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115
Q

Most frequent AE’s w/ Verapamil

A

Constipation, Gingival hyperplasia

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116
Q

Drugs that cause Gingival Hyperplasia

A

Phenytoin, CCBs, Cyclosporine

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117
Q

MOA of Clomiphene

A

SERM that prevents negative feedback inhibition on hypothalamus (used in PCOS)

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118
Q

Diseases that cause myocardial fibrosis

A

Dermatomyositis, Muscular Dystrophy, Sarcoidosis, Scleroderma

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119
Q

Why doesnt Anti-HepC IgG confer immunity?

A

RNA polymerase errors –> Varied antigenic structure

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120
Q

AE’s of Amphotericin B

A

Infusion reaction, Thrombophlebitis, Nephrotoxicity, HypoMg/HypoK, Anemia (suppressed EPO)

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121
Q

BH4 is a cofactor for synthesis of

A

Tyrosine, DOPA, Serotonin, Prolactin, NO

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122
Q

Cardiac morphology changes with aging

A

(1) Decr LV chamber size; (2) Sigmoid IV septum; (3) Incr interstitial CT; (4) Lipofuscin accumulation

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123
Q

Murmur of VSD

A

Loud holosystolic murmur over left sternal border 3-4 intercostal space (smaller = louder)

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124
Q

Phenylethanolamine N-methyltransferase

A

NE to Epi

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125
Q

Systemic sclerosis is thought to be due to activation of what cell type

A

CD4

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126
Q

A strict vegetarian diet can cause a deficiency of

A

B12

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127
Q

Free wall rupture occurs how long after MI

A

3-7 days

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128
Q

Triad of muffled heart sounds, elevated JVP, profound hypotension indicate

A

Pericardial Tamponade

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129
Q

How does GI bleed precipitate Hepatic Encephalopathy

A

Incr nitrogen delivery to gut in form of hemoglobin –> converted to ammonia and enters bloods stream

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130
Q

Molecules that act thru nuclear receptors

A

TH, Retinoids, PPAR, Fatty Acids

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131
Q

Spirochetes are universally sensitive to

A

Penicillin (gram nevative peptidoglycan cell wall)

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132
Q

Xeroderma Pigmentosa is defect in

A

DNA excision repair

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133
Q

DNA mismatch repair defect

A

Lynch syndrome

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134
Q

Why doesn’t Ceftriaxone work on Chlamydia

A

Cell wall lacks peptidoglycan (Ureaplasma lacks cell wall alltogether)

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135
Q

Phentolamine MOA

A

Alpha 1 and 2 blocker (no BB effects)

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136
Q

Dose-dependent effects of Epinephrine

A

Increases systolic, Increases HR, and either increases or decreases diastolic dependending on dose (a1 at high, or B2 at low)

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137
Q

Kappa opioid receptors mediate

A

Miosis

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138
Q

Hexamethonium MOA

A

Potent nicotinic receptor antagonist

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139
Q

Defect in keratins 5 and 14

A

Epidermolysis Bullosa Simplex

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140
Q

Characteristic Triad of Ataxia Telangiectasia

A

Those + Incr risk of sinopulmonary infections (IgA deficiency)

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141
Q

ATM gene is responsible for

A

DNA break repair (hypersensitive to x ray radiation)

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142
Q

Why does lead cause hypochromic anemia

A

Inhibits mitochondrial iron transport

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143
Q

Bare Lymphocyte Syndrome

A

Absent MHC II –> T and B cell deficiency

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144
Q

Features of Lesch-Nyhan

A

Hyperuricemia, Gout, Pissed off, Retardation, dysTonia

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145
Q

AICA block

A

Facial droop means AICA’s pooped

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146
Q

Process of Base Excision Repair

A

Abnormal Base –> Glycosylase removes –> Endonuclease and Lyase cleave 5 and 3’ –> DNA polymerase and ligase

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147
Q

Pyrophosphate analog that doesn’t require phosphorylation

A

Foscarnet

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148
Q

Properties of Type 1 muscle fibers

A

Slow = Aerobic, High myoglobin and mitochondria

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149
Q

Side chain cleavage enzyme in adrenals

A

Cholesterol –> Pregnenalone

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150
Q

Pulmonary Stretch Receptors

A

C fibers in lungs and airways that regulate degree of distension (Hering-Breuer reflex)

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151
Q

Infant with Air in bowel wall, Abdominal distension, and Bloody stools

A

Necrotizing Enterocolitis

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152
Q

N-acetylmuramic acid and N-acetylglucosamine

A

Saccharides that combine with AA chain to form peptidoglycan cell wall

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153
Q

Tay Sachs findings

A

Cherry Red Macula, Neurodegeneration, Developmental delay, Onion Skin Lysosomes, No HSM (vs Niemann-Pick)

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154
Q

Niemann-Pick findings

A

Cherry Red Macula, Neurodegeneration, Foam Cells, HSM

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155
Q

Important genes altered by PPARg

A

Adiponectin, FA transport, Insulin receptor, Glut-4

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156
Q

DOC for Complex Partial Seizures

A

Carbamazepine

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157
Q

PTH effects on bone cells

A

Incr RANKL and M-CSF production by osteoblasts; Decr OPG

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158
Q

MOA of Pergolide

A

D2 agonist

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159
Q

Isoniazid vitamin deficiency

A

B6 –> Peripheral neuropathy (GABA def)

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160
Q

4 phases of lobar pneumonia

A

Congestions (first 24hr) –> Red Hepatization (2-3d) –> Gray Hepatization (4-6d) –> Resolution

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161
Q

Microscopic appearance in Congestion –> Red –> Gray Hepatization

A

Vascular Dilatation, Mostly bacteria –> RBCs, PMNs, Fibrin –> Disintegrated RBCs, PMNs and Fibrin

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162
Q

MTB virulence factor allowing for intracellular proliferation

A

Sulfatide

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163
Q

Soft Exudate

A

Grayish-white, cotton wool - due to microinfarct

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164
Q

Hard Exudate

A

Clear margins - due to leakage of protein

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165
Q

Absolute vs Relative Erythrocytosis

A

Red Cell Mass increased in Absoluate

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166
Q

Ureters lie antermedial to what structures in true pelvis

A

Internal Iliac

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167
Q

Death due to TCA toxicity

A

Cardiac Fast Na channel block –> Arrhythmia, Cardiogenic Shock

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168
Q

TCA’s also block

A

mAChR, alpha1, Cardiac Fast Na, H1; NE and 5-HT reuptake

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169
Q

Common precursor of Beta-Endorphin and ACTH

A

POMC (also yields MSH)

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170
Q

Gastroeneteritis with intestinal invasion

A

Salmonella, Shigella, EIEC, Campylobacter, Entamoeba histolytica

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171
Q

Stacked-brick intestinal adhesion

A

EAEC

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172
Q

Characteristic histologic findings in GERD

A

Basal zone hyperplasia, Elongation of lamina propria, Inflammatory cells (eo’s, Pmn’s, lymph’s)

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173
Q

First gen anti-histamines

A

Dim First Gen History Professors Dip Cope - Dimenhydrinate, Hydroxyzine, Promethazine, Diphenhydramine, Chlorpheniramine

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174
Q

Second gen anti-histamines

A

Second Gen History Certainly want tadine - Cetirizine, -adine

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175
Q

Bisphosphonates should be used carefully in patients with

A

Renal failure - Excreted unchanged

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176
Q

Common robertsonian translocations

A

14;21 and 21;22

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177
Q

Most susceptible parts of kidney to hypoxia

A

PCT, Thick Ascending Limb

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178
Q

Prophylaxis of cerebral vascular spasm following SAH

A

Nimodipine

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179
Q

Two types of pneumococcus vaccine

A

(23) Polysaccharide = B cell response = Less effective; (17) Polysaccharide conjugated to diph toxin = T cell response = better

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180
Q

Killed Vaccines

A

RIP Always = Rabies, Influenza, Polio, Hep A

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181
Q

3 adverse effects of all Protease Inhibitors

A

(1) Lipodystrophy; (2) Hyperglycemia; (3) P450 inhibition

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182
Q

What to use instead of rifampin for patients with mycobacterial infection in patients on protease inhibitors

A

Rifabutin

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183
Q

3 important mitochondrial syndromes

A

(1) Leber Hereditary Optic Neuropathy; (2) Myoclonic Epilepsy w/ Ragged-Red Fibers; (3) MELAS

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184
Q

Aortic Arch Derivatives

A

3 = Common/Internal Carotid; 4 = Aortic Arch, R Subclavian; 6 = Pulmonary Arters, Ductus Arteriosis

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185
Q

5 Dehydrogenase Cofactors

A

B1, B2 (FAD), B3 (NAD), B5 (CoA), Lipoid Acid

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186
Q

Prevention of neonatal tetanus

A

Vaccinate mom –> Placental transfer of IgG

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187
Q

Conversion of Pyruvate to PEP requires what 2 enzymes

A

Pyruvate Carboxylase, PEPCK

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188
Q

How can mitochondrial OAA be transported to cytosol

A

(1) Conversion to PEP; (2) Transamination to Aspartate; (3) Reduction to Malate

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189
Q

What step of CAC is GTP produced in?

A

Succinyl CoA to Succinate

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190
Q

Anti-arrhythmic specific for ischemic myocardium

A

Ischemic = Depolarized –> Lidocaine

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191
Q

What has currently replaced lidocaine for ventricular tachycardia

A

Amiodarone

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192
Q

Procainamide is more specific for arrhythmias arising from

A

Centers of normal automaticity

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193
Q

Prolonged administration of Verapamil pts with V Tach can

A

Lead to V fib and death –> Distinguish between Supraventricular and Ventricular Tach

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194
Q

Adenosine is used for

A

Acute treatment of Paroxysmal Supraventricular Tachycardia

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195
Q

Gene in PAH

A

BMPR2

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196
Q

Hypophosphorylated Rb prevents

A

G1 –> S (Hypophosphorylated = Active)

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197
Q

Colloid Cyst

A

Benign formation in third ventricle –> Lethal obstruction

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198
Q

Reticulin deposits and chronic inflammatory infiltrates in brain tumor

A

Xanthoastrocytoma

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199
Q

Activated Protein C inhibits

A

Factors Va and VIIIa

200
Q

Aside from gas gangrene, C perf can cause

A

Late-onset food poisoining –> Transient watery diarrhea

201
Q

X linked recessive disorders

A

Bruton, Wiskott, Fabry, G6PD, Ocular Albinism, Lesch-Nyhan, DMD, Hunter Syndrome, Hemphophilia, OTC Def

202
Q

Autosomal Dominant disorders

A

HHT, Fam Hyperchol, FAP, MEN, NF1/2, Marfans, Her Spher, Achondroplasia, Huntingtons, Li-Fraumeni, BRCA1/2, Polycystic, Tuberous Sclerosis, vHL

203
Q

HIV gene that is glycosylated and cleaved

A

ENV –> Gp140 –> Gp120 and Gp41

204
Q

How does blood from Bronchial Arteries return

A

Majority to left heart in deoxy form via pulmonary veins (admixture); Some to right heart via azygous, acessory hemiazygous, or intercostal veins

205
Q

Afferent fibers from Carotid and Aortic baroreceptors terminate in

A

Solitary nucleus of medulla

206
Q

Histology of Psoriasis

A

Hyperparakeratosis, Acanthosis, Elongation of Rete Ridges, Mitotic activity above epidermal basal layer, Reduced or absent stratum granulosum

207
Q

Munro microabscesses

A

PMNs form spongiotic clusters in superficial dermis and parakeratotic stratum corneum in Psoriasis

208
Q

Advantage of proline in collagen

A

Kink the polypeptide chain and enhance rigidity b/c of their ring configuration

209
Q

What happens to procollage once secreted

A

Cleaved C and N terminals –> Solubility decreases –> Collage fibrils –> Lysil Oxidase crosslinking

210
Q

Alkaptonuria is a defect in what pathway

A

Tyrosine to Fumarate

211
Q

What causes nipple inversion with breast cancer

A

Invades central region

212
Q

What causes skin retraction in breast cancer

A

Infiltration of Cooper ligaments

213
Q

Alternative to SSRI when sexual side effects occur

214
Q

Xanthoma vs Xanthelasma

A

Xanthoma is surrounded by inflammatory cells and fibrotic stroma, Xanthelasma not

215
Q

Ergonavine MOA

A

Constricts SM by stimulating both alpha adrenergic and 5-HT receptors

216
Q

Phentolamine MOA

A

a1 and a2 blocker

217
Q

In what part of bone is hematogenous osteomyelitis most likely

218
Q

Hyper IgM syndrome results from

A

Absence of CD40L on t cells or Genetic deficiency in isotype switching enzyme

219
Q

Hyper IgM manifestations

A

Recurrent sinopulmonary infections; Lymphoic hyperplasia

220
Q

IgA class switching is induced by

221
Q

Specific marker of mast cell activation

A

Tryptase (released in degranulation)

222
Q

Antimicrobials that block ENaChannels

A

Trimethoprim, Pentamadine

223
Q

Why is serum Na normal in Mineralocorticoid Excess

A

Aldosterone Escape via ANP –> Prevents edema and Na increase

224
Q

Contraction alkalosis

A

Reabsorption of HCO3-

225
Q

Where does uric acid precipitate in tubules

A

Low pH of Distal Tubules and Collecting Ducts

226
Q

Penicillinase-stable penicillins

A

Nafcillin, Oxacillin, Methicillin

227
Q

Prognosis of Capillary Hemangioma

A

Initially progress, eventually regress

228
Q

Histology in De Quervain’s Thyroiditis

A

Mixed, cellular infiltrate with multinucleated giant cells

229
Q

Opsoclonus-Myoclonus syndrome

A

Neuroblastoma

230
Q

Why not use TCA with BPH?

A

Anti-Cholinergic –> retention

231
Q

Why not use TCA with Orthostatic Hypotension?

A

Antagonizes alpha 1 peripherally

232
Q

Causes of Hypercalciuria

A

Mainly Idiopathic; Also Hyperoxaluria, Hyperuricosuira, Low urinary volume, Hypocitratruria

233
Q

Causes of Hyperoxalouria

A

Diet (chocolate, nuts, spinach; Low calcium diet (more oxalate absorbed)

234
Q

Main radiographic finding in Mesothelioma

A

Nodular or smooth pleural thickening

235
Q

Gold standard for Mesothelioma diagnosis

A

EM = Numerous long, slender microvilli with abundant tonofilaments (adenocarcinoma has short, plump microvilli)

236
Q

Bronchioalveolar carcinoma has a characteristic

A

Distribution along alveolar septa w/out vascular or lymphatic spread

237
Q

Gemcitabine vs Cytarabine

A

Both pyrimidine analogs, but Gemcitabine is not S phase specific, likely due to additional cytotoxic functions (eg inhibition of ribonucleotide reductase)

238
Q

Methotrexate vs 5-FU

A

Both inhibit thymidalate formation, but only MTX overcome by Folinic Acid supplementation

239
Q

Gottron papules and heliotrope rash

A

Dermatomyositis

240
Q

Antidote for Cyanide (nitroprusside) toxicity

A

Sulfur (Sodium Thiosulfate) = Donates sulfur to liver rhodanase to enhance conversion of cyanide to thiocyanate

241
Q

Microangiopathic hemolytic anemia

A

Small vessels = DIC, TTP, HUS

242
Q

Triggers of G6PD

A

Bactrim, Dapsone, Antimalarials, Nitrofurantoin, Fava Beans

243
Q

What is low in G6PD deficiency

244
Q

Cause of Lipofuscin

A

Free radical injury and lipid peroxidation

245
Q

Most common location of supine aspiration

A

Right Lower Lobe

246
Q

What underlies most cases of Hereditary Hypothalamic Diabetes Insipidus

A

Neurophysin II mutations

247
Q

SPINK1

A

Trypsin inhibitor secreated by pancreatic acinar cells

248
Q

Germ tubes when incubated at 37 degrees

A

Candida –> True Hyphae

249
Q

Hep B replication

A

dsDNA –> Template +RNA –> dsDNA

250
Q

Fate of tRNA that is mischarged

A

Will incorporate wrong AA into polypeptide chain (not corrected when charged by AA-tRNA synthetase proofreading)

251
Q

MOA of mushroom toxins

A

Inhibit DNA-dependent RNA polymerase Type II = mRNA

252
Q

RNA polymerase I vs II vs III

A

I = rRNA; II = mRNA; III = tRNA

253
Q

MOA of Ricin

A

Cleaves rRNA component of 60S subunit

254
Q

Resistance to Ethambutol

A

Increase production of Arabinosyl Transferase

255
Q

Resistance to Streptomycin

A

Modification of 30S protein structure

256
Q

Resistance to Pyrazinamide

A

Modify Pyrazinamidase, which must activate Pyrazinamide

257
Q

MOA of Bosentan

A

Endothelin-receptor antagonist

258
Q

Neutrophil Alk Phos

A

Elevated in Leukemoid reaction, Decr in CML

259
Q

Acute Leukemia blast percentage

A

Greater than 20%

260
Q

Eyelid manifestation of Primary Biliary Cirrhosis

A

Xanthelasma

261
Q

Primary acceptor of amino groups during breakdown of other Amino Acids

262
Q

Glycine + Methylene Group

263
Q

What type of colonic adenoma can secrete mucus

264
Q

Perfusion defect anatomically matched by ventilation defect

A

Collapsed lung

265
Q

First test for PE

A

CT angiography

266
Q

First line treatment for open angle glaucoma

A

Prostaglandins

267
Q

Muscle responsible for accomodation? control?

A

Ciliary muscle - solely under cholinergic (m3) control

268
Q

Treatment of Restless Leg Syndrome

A

(1) Limit alcohol, nicotine, caffeine; (2) Dopamine Agonists (eg pramipexole)

269
Q

Restless Leg is common in those with

A

Iron Deficiency, CKD, Diabetes

270
Q

Treatment of Cataplexy

A

Muscarinic Antagonists (narcolepsy)

271
Q

When does the neural tube form

A

Third week of fetal life

272
Q

When do the neuropores close

A

Week Four = Anterior on day 25, Posterior on day 27

273
Q

Tensilon Test

A

Tx of MG pt with Edrophonium (short acting AChEsterase inhibitor); Lack of improvement = cholinergic crisis

274
Q

What mediates rapid decrease in myocardial calcium before relaxation

A

Na/Ca pump sarcolemmal pump; and Ca-ATPase

275
Q

Major immune mechanism against Giardia

A

CD4 and IgA

276
Q

RUQ pain after opiate

A

Biliary colic from contraction of SM cells in sphincter of oddi

277
Q

Mu opioid effects on Histamine, Parietal Cells

A

Increase histamine (don’t use in hypotension); Decr parietal gastric acid secretion

278
Q

Non-caseating granulomas - Crohn’s or Ulcerative colitis

279
Q

Unidirectional enzymes in glycolysis

A

Gluco/Hexokinase, PFK-1, Pyruvate Kinase

280
Q

F-2,6-BP activates what?

A

PFK1 = Glycolysis

281
Q

Insulin vs Glucagon effects on PFK1

A

Insulin –> PFK2 –> F-2,6-BP –> PFK-1 = Glycolysis; Glucagon inactivates PFK-2 via phosphorylation

282
Q

What causes myocardial swelling with ischemia?

A

No ATP to pump Na (Na/K) or Ca (Ca-ATPase) out

283
Q

Mechanism of nitrites in cyanide poisoning

A

Oxidized iron to Fe3+, which binds and sequesters cyanide, preventing it from binding cytochrome a-a3

284
Q

What is used beside nitrites in cyanide poisoining

A

Thiosulfate –> Sulfate binds cyanide

285
Q

Most common cause of aPTT prolongation

A

Lupus anticoagulants

286
Q

Common findings in PCA stroke

A

(1) Contralateral hemianopia; (2) Contralateral parasthesias and numbness [thalamus]

287
Q

Cranial Nerves supplied by PCA

A

III and IV

288
Q

Why gallstones in Crohn’s

A

Can’t resorb bile acids in terminal ileum

289
Q

Rate limiting step in catecholamine synthesis? What blocks this?

A

Tyrosine Hydroxylase - Metyrosine

290
Q

What maintains cardiac output in acute/subacute aortic regurgitation

A

HR temporarily, but mainly increased LV preload

291
Q

Carbamazepine adverse effects

A

(1) BM suppression; (2) Hepatotoxic; (3) SIADH

292
Q

Drugs that cause SIADH

A

Carbamazepine, Cyclophosphamide, SSRI’s

293
Q

Allergic contact dermatitis is due to

A

Antigen presentation by Langerhans cell –> CD4 response

294
Q

Acanthosis

A

Incr in spinosum (think psoriasis)

295
Q

Hypergranulosis

A

Excessive granulation of s granulosum (think lichen planus)

296
Q

Max and min pressures in RV, Pulmonary Artery

A

4-25 in RV; 9-25 in PA

297
Q

Treatment of PSGN

A

Loop diuretics and Vasodilators to relieve edema and hypertension

298
Q

Most important prognostic indicator in PSGN

299
Q

Osteoporosis tends to affect what bone

A

Trabecular - Vertebral bodies, Neck of femure

300
Q

what is characteristic of hyperparathyroidism

A

Subperiosteal resorption with cystic degeneration

301
Q

Vit D bone loss is characterized by

A

Excessive unmineralized osteoid

302
Q

Osteopetrosis is characterized by

A

Persistance of primary, unmineralized spongiosa in medullary canals

303
Q

Drugs that cause seizures

A

I BItE my tongue - INH, Buproprion, Imipenem, Enflurane

304
Q

Most common sites of intracranial hemorrhage

A

Deep brain = Basal ganglia, Cerebellar nuclei, Thalamus, Pons

305
Q

Cerebral amyloid angiopathy tends to occur in what areas

A

Lobar/cortical parenchyma

306
Q

Findings with Pulmonary Silicosis

A

Nodular densities and eggshell calcifications

307
Q

Pulmonar berylliosis findings

A

Resembles sarcoidosis (nodular infiltrates, enlarged lymph nodes, non-caseating granulomas), but is not strongly associated with pleural plaques or effusions

308
Q

Findings in coal worker’s pneumoconiosis

A

Multiple discrete nodules most prominent in upper lung zones

309
Q

X ray of hypersensitivity pneumonitis due to inhalation of organic dust

A

Diffuse nodular interstitial infiltrates

310
Q

Granulomatous destruction of liver bile ducts

A

Primary biliary cirrhosis

311
Q

Intrahepatic hydatid cysts

A

Echinococcus

312
Q

Mechanism of gingival hyperplasia with phenytoin

313
Q

Phenytoin toxicity mainly effects

A

Cerebellum and vestibular system –> Ataxia, Nystagmus

314
Q

Systolic ejection murmur that increases with standing? Decreases with standing?

A

Hypertrophic CM - increases; Valvular aortic stenosis - decreases

315
Q

Wide splitting of S1 accentuated by inspiration

A

Delayed closure of tricuspid = Complete right bundle branch block or tricuspid stenosis

316
Q

Carboxylation of glutamate residues

317
Q

Erythropoeisis and peripheral blood smeal in Acute Intermittent Porphyria

A

Erythropoeisis and peripheral blood smear normal

318
Q

Opiates used for diarrhea

A

Loperamide, Diphenoxylate

319
Q

Pathogens most responsible for post-flu pneumonia

A

Pneumococcus, S aureus, H flu

320
Q

Mycobacterium kanasaii symptoms

A

Pulmonary tuberculosis-like symptoms

321
Q

High intracellular NADH in setting of hypoglycemia

A

Fuel other than glucose is being metabolized

322
Q

High NADH/NAD+ ratio

A

Pyruvate to lactate and OAA to malate => Inhibits gluconeogenesis

323
Q

What antibody is rarely seen in drug-induced Lupus

A

Anti-dsDNA (look for anti-histone)

324
Q

Range for microalbuminuria

A

30-300 ug/mg creatinine

325
Q

MOA of Adenosine in Supraventricular Tachy

A

Slows conduction thru AV node by hyperpolarizing the nodal pacemaker and conducting cells

326
Q

All inhalational anesthetics, except what, are respiratory depressants

327
Q

Inhalational anesthetics preferred in pts with asthma

A

Halothane, Sevofluorane - Bronchodilation properties

328
Q

Inhalational anesthetic effects on hepatic, renal, and cerebral BF

A

Decr hepatic; Incr cerebral; Decr GFR and RPF

329
Q

Main side effects of bile acid binding resins

A

HyperTG (incr VLDL and TG synthesis), GI upset, Malabsorption, Gallstones

330
Q

First line treatment of hypertriglyceridemia

A

Fibrates - decr hepatic synthesis

331
Q

Clinical manifestations of schistosomiasis result from

A

Th2-mediated granulomatous response directed against eggs (with eos and mac’s)

332
Q

Periportal Pipestem Fibrosis

A

Hepatic schistosomiasis

333
Q

Echinococcus reservoir

334
Q

Diphyllobothrium latum comes from

A

Freshwater fish

335
Q

2,3-BPG only binds to

A

Deoxyhemoglobin

336
Q

Why doesn’t HbF bind 2,3-BPG as well

A

Serine residues instead of histidine

337
Q

HbC

A

Glutamic acid –> Lysine = Mild, chronic hemolytic anemia

338
Q

Directly responsible for intimal thickening in athersclerosis

A

Smooth muscle cells (NOT FIBROBLASTS)

339
Q

Treatment with Menotropin and hCG

A

Menotropin is human menopausal gonadotropin and acts like FSH; hCG acts like LH surge

340
Q

Hepatolenticular degeneration

A

(GP and Putamen) Wilson’s disease –> Wing-beating tremor, Psychosis

341
Q

Burning or stabbing sensation in one half of body

A

Thalamic syndrome

342
Q

Mechanism of Dermatitis Herpetiformis

A

Cross reaction of anti-Gliadin ab’s with Reticulin in epidermal basement membrane

343
Q

Cerebral amyloid angiopathy vs hypertensive hemorrhage

A

Lower mortality rate, More benign clinical course than hypertensive hemorrhage

344
Q

Hematuria and proteinuria in subacute BE

A

Immune complex deposition

345
Q

Bacteriostatic antibiotic that inhibits binding of aminoacyl-tRNA to 30S subunit

A

Tetracyclines

346
Q

What is upregulated after statins lower total serum cholesterol

A

LDL receptor

347
Q

LCAT vs CETP

A

LCAT catalyzes esterification of cholesterol (nascent HDL to mature HDL); CETP transfers cholesterol to other lipoprotein particles

348
Q

Endocrine hormones that increase cAMP

A

FLAT ChAMP CGC - FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2), MSH, PTH, Calcitonin, GHRH, Glucagon

349
Q

Hormones that increase cGMP

A

ANP, BNP, NO (EDRF)

350
Q

Endocrine Hormones that increase IP3

A

GOAT HAG - GnRH, Oxytocin, ADH (V1), TRH, H1, AgII, Gastrin

351
Q

Intrinstic tyrosine kinase receptors

A

Insulin, IGF-1, FGF, PDGF, EGF

352
Q

Receptor-associated tyrosin kinase

A

PIGGLET - Prolactin, Immunomodulators (Cytokines, IFN), GH, G-CSF, EPO, Thrombopoetin - Acidophils and Cytokins

353
Q

Resistant to Ampicillin but sensitive to Ceftriaxone

A

Beta-Lactamase production

354
Q

Meniere’s disease

A

Triad of vertigo, sensorineural hearing loss, tinnitus –> Incr production and/or decr excretion of endolymph

355
Q

Blastomycosis on chest x ray

A

Mimics TB –> Granulomatous nodules

356
Q

Systolic ejectin in aortic stenosis

A

Decr, because it takes longer for valve to open

357
Q

Most common cause of pyridoxine deficiency

358
Q

First line for malignant otitis externa

A

Fluoroquinolone

359
Q

Renal and lungs masses –> Improvement after removing renal mass

A

RCC –> Tx with IL_2

360
Q

Central Venous Pressure and what tend to correlated

A

Pulmonary capillary wedge (at least in septic shock?)

361
Q

Normal CVP and PCWP

A

CVP 2-8; PCWP 2-15

362
Q

Effects of Ia, b, and c on AP conduction conduction velocity

A

Ia slows, Ib no effect, Ic slows

363
Q

Effects of Ia, b, and c on AP duration

A

Ia prolongs, Ib shortens, Ic minimal effect

364
Q

Predominant actions of Class II antiarrhythmics

A

Slow sinus node discharge rate, Slow AV node conduction and prolong refractoriness

365
Q

Predominant effects of Class III antiarrhythmics

A

Prolong AP duration; No effect on conduction velocity

366
Q

Predominant effects of Class IV antiarrhythmics

A

Slow sinus node discharge rate; Slow AV node conduction and prolong refractoriness

367
Q

MOA of Adenosine

A

A1 receptors –> Activates K channels –> incr K conductance –> transient conduction delay thru AV node

368
Q

Digoxin effects on AP duration and QT interval

A

Decr APD, Shorten QT interval

369
Q

C3a stimulates

A

Histamine release –> Permeability, Dilation

370
Q

Platelet Activating Factor causes

A

Platelet agg, Vasoconstriction, Bronchoconstriction, Incr leukocyte adhesion to endothelium

371
Q

Hyperplastic polyps are composed of

A

Well-differentiated mucosal cells that form glands and crypts

372
Q

Hamartomatous polyps are composed of

A

Mucosal glands, Smooth muscle, CT

373
Q

Inflammatory polyps are seen in

A

UC, Crohn’s –> Regenerating intsetinal mucosa

374
Q

Lymphoid polyps are found in

375
Q

4 Non-neoplastic polys

A

Hyperplastic, Hamartomatous, Inflammatory, Lymphoid

376
Q

Symptoms of Diffuse Esophageal Spasm

A

Dysphagia and Chest pain

377
Q

Phosphoglucomutase

A

Glucose 1 6 phosphate

378
Q

Carnitine deficiency

A

Impairs FA transport into mitochondria, restricting ketone body formation

379
Q

Skeletal Muscle Carnitine def symptoms

A

Myoglobinemia, Weakness after exercise, Elevated muscle TG’s, Hypoketonemia

380
Q

Medium Chain Acyl-CoA DH deficiency

A

Hypglycemia, Hypoketonemia

381
Q

Tryptophan is a precursor for

A

Nicotinic Acid, Serotonin, Melatonin

382
Q

Clinical manifestations of Hartnup disease are primarily due to

A

Tryptophan malabsorption –> Niacin deficiency

383
Q

Symptoms of Hartnup

A

Most children asymptomatic –> Can have pellagra-like rashes, photosensitivity, ataxia

384
Q

Urinary excretion of what AA’s is normal in Hartnup

A

Proline, Hydroxyproline, Arginine

385
Q

Thiamine use by the body is maximal in states of

A

Accelerated carb metabolism

386
Q

Pyridoxine def results in

A

Anemia, Peripheral neuropathy, Dermatitis

387
Q

Tocopherol deficiency

A

Vitamin E = Myelopathy and neuro

388
Q

How do Listeria and Shigella survive intracellularly

A

Escape from phagosome into cytosol

389
Q

How does MTB survive intracellularly

A

Blocks fusion of phagosome with lysosome, Inhibits phagolysosome acidification

390
Q

Immune response to Listeria

A

IFNg, TNFb, IL-12 –> Cell mediated response –> macrophage killing

391
Q

Gram negative rod that grows at 4 degrees

392
Q

Uricosuric drugs

A

Probenecid, Sulfinpyrazone

393
Q

Xanthine oxidase inhibitor safer than allopurinol

A

Febuxostat

394
Q

Most common manifestation of CMV in HIV

395
Q

Epispadias results from

A

Faulty positioning of genital tubercle in fifth week of gestation

396
Q

Virus that aquires lipid envelope form nucleus

A

Herpes family

397
Q

Blockade of what receptor inhibits gluconeogenesis, glycogenolysis, and lipolysis

398
Q

Main effect of nitrates in treating angina

A

Reduce preload –> reduce LV volume

399
Q

Herniation causing CN III neuropathy

400
Q

Most common cause of Abetalipoproteinemia

A

LOF mutation in Microsomal TG Transfer Protein (MTP) –> Normally folds apoB and transfers lipids into chylomicros or VLDL

401
Q

Polyol pathway impairment occurs in tissues that

A

Do not rely on insulin for glucose transport (lens, peripheral nerves, kidney, blood vessels)

402
Q

Elevated galactitol

A

Galactosemia –> Cataracts

403
Q

Cross linking of proteins by glycosylation products in vessels facilitates

A

Inflammatory cell invasion, Deposition of LDL –> Atheroscerlosis

404
Q

Skeletal findings in hyperparathyroidism

A

Cortical (compact) bone in appedicular skeletal –> Subperiosteal erosions, Salt-and-pepper skull, Osteolytic cysts (osteitis fibrosa cystica)

405
Q

Disorganized lamellar bone structure in mosaic pattern

406
Q

Osteoid matrix accumulation around trabeculae

A

Vit D deficiency - Excessive unmineralized osteoid with widened osteoid seams

407
Q

Persistence of primary spongiosa in medullary cavity with no mature trabeculae

A

Osteopetrosis –> Accumulation of woven bone, diffuse skeletal thickening

408
Q

Trabecular thinning with fewer interconnections

A

Osteoporosis

409
Q

How do erythrocytes utilize NADPH

A

Maintain Glutathione in reduced state by glutathione reductase

410
Q

What is a Heinz body

A

Denatured Hb from oxidative stress

411
Q

As opposed to serotonin syndrome, NMS is characterized by

A

Absence of myoclonus and presence of rigidity

412
Q

Keratoderma blennorhagicum commonly associated with

A

Reactive Arthritis

413
Q

Mechanism of Pertussis toxin

A

Disinhibits AC via Gi ADP ribosylation –> incr cAMP –> Incr histamine sensitivity and phagocyte dysfunction

414
Q

Direct tissue effects of GH

A

(1) Insulin resistance; (2) Fat utilization; (3) Protein synthesis

415
Q

Indirect tissue effects of GH

A

IGF-1 by liver –> Growth of bone, cartilage, soft tissue

416
Q

GH vs IGF-1 receptor

A

GH is JAK-STAT; IGF-1 is specific receptor TK

417
Q

Main sites of digestion and absorption of dietary lipids

A

Duodenum –> Jejunum

418
Q

How does diet affect calcium stones

A

Low calcium diet actually increases risk; High protein and Na diet increases risk

419
Q

What is recommended for patients with calcium stones who have hyperoxaluria

A

Pyridoxine –> Decreases endogenous oxalate production

420
Q

Vitelline vs Cardinal veins

A

Vitelline form portal; Cardinal form caval

421
Q

PG’s that mediate protection of gastric mucosa

A

PGI2 and PGE2

422
Q

Salicylism

A

Vertigo, Tinnitus, Hearing loss

423
Q

Classic Legionnaires presentation

A

Very high fever in smoker + diarrhea, confusion, cough

424
Q

Coccidiomycosis in immunocompetent

A

Usually asymptomatic

425
Q

Conversion of NE to Epi occurs where? Stimulated by?

A

Adrenal medulla by PNMT - Stimulated by Cortisol (incr PMNT gene expression)

426
Q

COMT converts epi and NE to

A

Metanephrine and Normetanephrine

427
Q

SGLT2 inhibitors

A

Canagliflozin, Dapaglifozin

428
Q

AE’s of SGLT2 inhibitors

A

Urinary tract and Genital mycotic infections; Symptomatic hypotension

429
Q

What should be assessed before starting SGLT2 inhibitors

A

Renal function

430
Q

Which anti-diabetic requires LFT’s

A

Thiaxolidinediones

431
Q

Soft, breathy voice =

A

Vocal cord dysfunction

432
Q

Acid-base abnormality in ATN

A

Retention of H and anions –> high anion gap metabolic acidosis

433
Q

Recovery phase of ATN

A

Profuse diuresis, HypoK/Mg/PO4/Ca

434
Q

Triptan MOA

A

5-HT 1b/d agonists –> Inhibit vasoactive peptides, promote vasoconstriction, block pain pathways

435
Q

Bupropion MOA

A

DA, NE reuptake inhibitor

436
Q

Migraine prophylaxis

A

TCAs, SNRI’s, BB’s, Valproate, Topiramate

437
Q

What cholesterol meds increase bile acid synthesis

A

Binding resins; Fibrates

438
Q

First and second line treatment of AF with RVR

A

CCBs/BB’s, then Digoxin

439
Q

Delayed afterdepolarizations

A

Occur in states of hyperexcitability (eg high intracellular Ca or high catecholamine states) - How digoxin can lead to Vtach

440
Q

Signs of Uncal (transtentorial) herniation

A

CNIII, Contralateral or ipsilateral hemiparesis (crus cerebri), Contralateral homonymous hemianopsia with macular sparing (PCA)

441
Q

Subfalcine herniation sign

A

ACA compression

442
Q

Duret hemorrhage

A

Caudal displacement of brainstem –> Rupture of paramedian basilar artery branches –> Duret

443
Q

Ingestion of what can cause myxomatous degeneration

A

Sweet peas –> Angiolathyrism

444
Q

Incr murmur in HOCM

A

Decrease preload or afterload –> Decr LVEDV and increase outflow obstruction

445
Q

Bile salt deconjugation

A

Colonic bacteria in small intestine –> Steatorrhea due to failure of miscelle formation

446
Q

Final product of FA oxidation that enters CAC

A

Succinyl CoA (from methlymalonyl CoA)

447
Q

Lab findings in SLE

A

Hemolytic anemia, Thrombocytopenia, Leukopenia, Hypocomplementemia

448
Q

Cause of anemia and thrombocytopenia in SLE

A

Type II hypersensitivity

449
Q

Fibrous intimal thickening with endocardial plaques limited to right heart

A

Carcinoid heart disease –> Pulmonic stenosis, Restrictive cardiomyopathy

450
Q

How to grow H flu in sheeps blood agar

A

S aureus –> X factor released by hemolysis, V factor secreted by s aureus

451
Q

Fat embolism syndrome is characterized by

A

pulmonary insufficiency, diffuse neuro impairment, thrombocytopenia, anemia

452
Q

46 XY with normal Leydig cells but total absence of Sertoli

A

Male external genitalia (DHT); Both Female and Male internal genitalia (need Sertoli to produce MIF)

453
Q

Treatment of pinworm (Enterobius)

A

Albendazole

454
Q

Diethylcarbamazine is used to treat

A

Loa Loa, Wuchereria bancrofti

455
Q

Ivermectin is used to treat

A

Strongyloides, Onchocerciasis

456
Q

Nifurtimox is used to treat

A

Trypanosomes, including Chagas

457
Q

Praziquantel is used to treat

A

Schistosoma, Clonorchis, Tenia, Diphyllobothrium - Praise the SC TD

458
Q

Don’t use colchicine in

A

Pregnancy, Renal dysfunction

459
Q

Glucocorticoids inhibit what step of PG synthesis

460
Q

Preferred treatment of acute gouty arthritis in elderly or renal failure

A

Glucocorticoids

461
Q

Specific inhibitor of 5-lipoxygenase

A

Zileuton –> Inhibits LTB4, C4, D4, E4

462
Q

Monteleukast MOA

A

LTD4 receptors

463
Q

Stimulation of B1 receptors in heart causes what 3 effects:

A

(1) + Inotropy; (2) Weak + chronotropy; (3) Incr conduction velocity

464
Q

FGF contributions

A

Angiogenesis, Embryonic development, Hematopoeisis, Wound repair

465
Q

Incr LV diastolic pressure in paitent with suspect Mitral Stenosis

A

Aortic valve also dysfunctional

466
Q

Mechanism of Ciguatoxin and Batrachotoxin

A

Binds Na channel, keeping it open –> persistent depolarization

467
Q

Toxin that acts similarly to Tetrodotoxin

468
Q

What increases solubility of cysteine

A

High pH - So risk of cystine stone with low pH

469
Q

Cystine shares transporter with

A

Ornithine, Arginine, Lysine

470
Q

OTC deficiency symptoms

A

Hyperammonemia, Mental retardation

471
Q

Daptomycin is not effective in treating

A

Gram negatives; Pneumonia (surfactant)

472
Q

Terbinafine MOA

A

Squalene Epoxidase

473
Q

Effectiveness of Unfractionated Heparin vs LMWH

A

Unfractionated has equal activity against Factor Xa and Thrombin; LMWH has greater activity against Factor Xa than thrombin

474
Q

How to separate Gamma hemolytic Strep’s

A

Enterococci is PYR+, Grows in bile and NaCl; Bovis is PYR-, grows in bile but not NaCl

475
Q

How to separate Alpha hemolytic Strep

A

Viridans is Optochin resistant and Bile insoluble

476
Q

Effect of TNFa on Insulin receptor

A

Phosphorylates serine residues of Insulin Receptor Substrate 1 –> Decr activity

477
Q

Phosphorylation of serine residues of Insulin Receptor Substrate 1

A

TNFa, Catecholamins, Glucocorticoids, Glucagon –> Insulin resistance

478
Q

Papillary Thyroid cancer histology

A

Large cells w/ overlapping nuclei, Finely dispersed chromatin, Ground glass appearance = Orphan Annie

479
Q

Benign follicular thyroid adenoma vs carcinoma

A

Invasion of vessels or capsule

480
Q

Corneal reflex pathway

A

Nasociliary V1 –> Temporal branch of VII

481
Q

Contents of Superior Orbital Fissue

A

CN III, V1 branches, CNIV, CNVI, Superior Ophthalmic veins

482
Q

Bleeding in CKD patient

A

Uremic toxins –> Impair platelet aggregation

483
Q

HIV Bloody diarrhea - Hemorrhagic polypoidal lesions, Spindle cells with surrounding blood vessel proliferation

A

Kaposi sarcoma

484
Q

Chronic rejection of lung transplant

A

Small airways –> Bronchiolitis obliterans

485
Q

Most common cause of elevated AFP

A

Dating error - Confirm with fetal US

486
Q

Decreased Estriol on Triple Test

A

Placental insufficiency

487
Q

Retrolental fibroplasia

A

Retinopathy of prematurity - Neovascularization from hypoxia and oxygen therapy

488
Q

Serum added to mixture of cardiolipin, lecithin, cholesterol

A

Rapid Plasma Reagin test

489
Q

7a hydroxylase

A

Cholesterol –> Bile Salts

490
Q

Tholase

A

Condenses two equivalents of Acetyl-CoA to form Acetoacetyl-CoA –> Substrate for HMG CoA Reductase

491
Q

Extremely high hCG may cause

A

Hyperemesis gravidarum, Pre-eclampsia, Hyperthyroidism, Theca-lutein cysts

492
Q

Drugs that increase Lithium levels

A

Thiazides (not loops), ACEi’s, NSAIDs

493
Q

Lithium reabsorption in kidney is linked to

A

Na reabsorption

494
Q

Major AA responsible for transferring nitrogen to liver for disposal

495
Q

Hepatic tumor that can regress after OCT discontinuation

A

Hepatic Adenoma

496
Q

Most common benign liver tumor

A

Cavernous Hemangioma

Uworld (16 decks)

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