Uworld Added 3 Flashcards
1
Q
Mechanism of Edema and Lethal factors (anthrax)
A
Edema = cAMP; Lethal = Protease that inhibits MAPK
2
Q
Bordatella pertussis toxins
A
Pertussis = Gi ribosylation –> cAMP; AC toxin = AC –> cAMP
3
Q
Location and symptoms of Germinomas
A
Pineal –> (1) Precocious puberty, (2) Obstructive hydrocephalus, (3) Parinaud
4
Q
Functions of Thyroid Peroxidase
A
(1) Oxidation of iodide to iodine; (2) Iodination of thyroglobulin tyrosine residues; (3) Iodotyrosine coupling to form T3 and T4
5
Q
Anti-TPO
A
Hashimoto’s
6
Q
Chronic lymphedema is a risk for developin what skin tumor
A
Angiosarcoma
7
Q
Spongiosa filling medullary canal with no mature trabeculae
A
Osteopetrosis
8
Q
Squatting vs Passive leg raise
A
Squatting increases both Preload and Afterload, while Passive leg raise just Preload
9
Q
How to decrease MVP murmur
A
Decr LV volume, bringing valve leaflets into a more normal anatomic arrangement
10
Q
In severe MVP, the murmur becomes more
A
Holosystolic
11
Q
Histology of MVP
A
Attenuation of fibrosa (collagen) layer; Thickening of spongiosa layer thru deposition of mucoid (myxomatous) material; Thinning of collagenous core of chordae tendineae
12
Q
Chromium deficiency
A
Glucose intolerance (GLUT cofactor), Peripheral neuropathy
13
Q
Selenium deficiency
A
Muscle pain and weakness, Dilated CM
14
Q
Copper deficiency
A
Microcytic anemia (ferrochetolase), Aortic dissection (elastic tissue), Poor wound healing (lysyl oxidase)
15
Q
Only bile acid that is not reabsorbed in the terminal ileum
A
Lithocholic acid
16
Q
Magnesium def
A
Hypocalcemia with Tetany, Tachycardia
17
Q
Magnesium excess
A
Neuromuscular depression, Bradycardia
18
Q
Congenital defect in Cytochrome b5 reductase
A
This reduces ferrous hb to ferric in methemoglobinemia
19
Q
Free radicals from drugs and alcohol-related fatty change affect which zone of liver
A
III
20
Q
Ubiquinated cytokeratin intermediate filament in hepatocytes in alcoholic liver disease
A
Mallory bodies
21
Q
Nephrocalcinosis
A
Metastatic calcification of renal tubules –> Diabetes insipidus
22
Q
Chemo regimen for Hodgkin
A
Adriamycin, Bleomycin, Vinblastine, Dacarbazine
23
Q
AE of Dacarbazine
A
Azospermia
24
Q
Ecthyma gangrenosum is strongly associated with
A
P aeruginosa
25
Virulence factors of Pseudomonas in Ecthyma gangrenosum
Exotoxin A (protein synthesis), Elastase, PLC, Pyocyanin (ROS)
26
Exposure to bats or bird droppins in Ohio or Mississippi area
Histo (resembles tuberculosis)
27
Chlorthalidone
Thiazide diuretic
28
Holocrine glands
Associated with sebaceous - entire cells secreted
29
Apocrine vs Eccrine
Apocrine secretes into hair follicles, Eccrine directly onto skin
30
Rapid y descent that becomes deeper and steeper during inspiration
Constrictive pericarditis
31
Timeline of T cell response to MTB
2-4 weeks after infection
32
Most dangerous complication of UC
Toxic Megacolon
33
Sacral micturation center
S2-S4 - parasympathetic fibers travel with pelvic nerves
34
Pontine Micturation Center
Pontine Reticular Formation
35
Medium chain acyl-CoA DH deficiency causes
Hypoglycemia, Hypoketonemia
36
Each round of FA beta oxidation produces
1 NADH, 1 FADH2, 1 AcetylCoA
37
During rapid beta oxidation, the TCA cycle is overwhelmed -->
Shunting acetyl-CoA toward production of ketone bodies
38
Acetyl-CoA Carboxylase
RLS - first step in FA synthesis
39
Anti-cholesterol meds that should be used with caution in patients with pre-existing GB disease
Bile acid resins, Fibrates
40
Parvovirus binds what antigen
Erythrocyte P antigen
41
EBV envelope glycoprotein gp350 binds what
C3d complement component (CR2 or CD21)
42
Hydrocephalus, Intracranial calcifications, Chorioretinitis
Congenital Toxo
43
What type of enzyme is telomerase
RNA-dependent DNA polymerase (RT)
44
Rifampin monotherapy
Exposure to H flu or N meningitidis
45
Tx of MAC
Macrloide + Rifampin + Ethambutol
46
Hurthle Cells
Hashimoto's
47
Beta-Galactosidase
Lactose --> Glucose + Galactose
48
Lac operon
Lack of glucose increases cAMP, Presence of Lactose binds repressor
49
FFA's and insulin resistance
Increase resistance, also decrease insulin secretion
50
Pyogenic granuloma
Polypoid form of capillary hemangioma - Resemble hypertrophic granulation tissue
51
Cystic hygroma
Endothelium-lined lymph spaces beneath epidermis - Differ from cavernous hemangiomas by absence of luminal vessels
52
Liver hemangiosarcomas are associated with
Arsenic (pesticides), Thorotrast (contrast), Polyvinyl chloride
53
Diet recommended for PDH deficiency
Ketogenic (Leucine, Lysine)
54
Glucogenic AA's
Methionine, Valine, Histidine (met sugary valiant hunk)
55
Glucogenic/Ketogenic AA's
Phenylalanine, Isoleucine, Threonine, Tryptophan
56
Ketogenic AA's
Leucine, Lysine
57
Mutation of Myelin protein gene
Charcot-Marie-Tooth (weakness of foot dorsiflexion)
58
Additional manifestations of Polycythemia Vera
Peptic ulceration, Pruritis, Gouty arthritis
59
Measure of fetal lung maturity
Incr ratio of phosphatidylcholine (lecithin) to sphingomyelin ratio
60
Primary abnormality in Paget's
Excessive osteoclastic bone resorption
61
Phenazopyridine
Urinary analgesic - provides symptomatic relief of dysuria, urinary frequency, urgency
62
Ascorbic acid accelerates what reactions
Hydroxylation, Amidation
63
Workup of all patients with gastrinoma should include
Serum calcium, PTH, and Pituitary hormones - MEN-1
64
Anti-MTB drug that requires acidic intracellular environment
Pyrazinamide
65
INH MOA
Synthesis of mycolic acid
66
Ethambutol MOA
Blocking Arabinosyl Transferase
67
Segmented viruses
Reovirus (rota, colti), Orthomyxo, Arena, Bunya
68
Excessive rise in left atrial systolic pressure (v wave) is characteristic for
Mitral Regurgitation
69
Differentiate bone-specific ALP
Easily denatured by heat (bone = boil)
70
Urinary hydroxyproline and deoxypyridinolin excretion
Osteoclast activity (most common measures), also TRAP
71
Antipsychotic most notorious for causing prolonged QT
Ziprasidone
72
Cardiac medication that can cause hypothyroidism
Amiodarone
73
Clozapine acts on what receptors
D4
74
Prevent intracelllular dehydration in sickle cell
Gardos channel blockers (ca-dep K channel)
75
Specificity of tPA
Can only bind plasminogen strongly in presence of fibrin = clot-specific
76
Most common elbow injury in children
Radial Head Subluxation = Tear of annular ligament
77
Blanching of vein into which NE is being infused + induration and pallor
NE extravasation --> a1 vasoconstriction --> Phentolamine
78
Respiratory muscarinic antagonists
Ipratropium, Tiotropium, Glycopyrrolate
79
Eye muscarinic antagonists
Atropine, Homatropine, Tropicamide
80
GI muscarinic antagonists
Hyoscyamine, Dicylomine
81
GU muscarinic antagonists
Oxybutynin, Solifenacine, Tolterodine
82
Flunisolide
Inhaled GC for prophylactic treatment of asthma (bronchial)
83
Calcific Tendonitis
Deposits of calcium hydroxyaptite crystals in periarticular soft tissues (esp tendons, rotator cuff)
84
Anti-EGFR Ab
Cetuximab
85
Muromonab
Anti-CD3 (acute rejection treatment for liver, kidney, heart)
86
Most common bugs causing sepsis in sickle cell
Pneumococcus, H flu
87
How does radiation kill cells
DNA ds break, ROS
88
Secretin stimulates pancreas to release
Bicarb rich, Cl poor fluid (Cl to produce NaCl)
89
High levels of what increase ESR
Fibrinogen stimulted by Acute Phase Reactants
90
Pure Red Cell Aplasia is associated with
Parvo B19, Thymoma, Lymphocytic Leukemias
91
Invasive Mole vs Choriocarcinoma
Hydropic villi and proliferated trophoblast vs Atypical cytotrophoblastic and syncytiotrophoblastic cells w/ foci of hemorrhage and necrosis
92
Pulsus alternans
LV dysfunction - Beat to beat variation in magnitude of pulse pressure in presence of regular rhythm
93
Dicrotic pulse
Two distinct peaks - Severe dystolic function
94
Pulsus parvus et tardus occurs in
Aortic stenosis
95
Hyperkinetic pulse
Rapid ejection of large stroke volume against decr afterload
96
Paget disease of nipple
DCIS spreads to nipple skin without having crossed basement membrane
97
Ductal dilation, Inspissated breast secretions, Chronic granulomatous inflammation in the periductal and interstitial areas
Mammary Duct Ectasia
98
Most common benign tumor of esophagus
Esophageal Leiomyoma
99
Adenosine MOA
AV node - slows conduction and decreases automaticity by hyperpolarizing cells
100
Usefulness of Methacholine challenge
High sensitivity, Low specificity
101
UG Sinus vs Wolffian Ducts in males
UG sinus = Bladder, urethra, prostate, bulbo's; Wolffian = Epididymis, Ductus, Seminal vesicles
102
In a healthy individual, airway resistance is smallest when
lungs are inflated - radial traction of pulmonary tissue on conducting airways
103
Repetitive ischemia of cardiomyocytes or persistent hypoperfusion -->
Hibernation - Chronic but reversible loss of function
104
Myocardial stunning
Less severe form of ischemia-induced reversible loss of contractile function than hibernation (from brief ischemic episodes)
105
Long term lithium requires monitoring of
Thyroid and Renal function
106
PCWP =
LA EDP, which should equal LVEDP
107
Regulatory step for Pyrimidine synthesis
ATP, CO2, Glutamine --> Carbamoyl Phosphate
108
Treatment of Orotic Aciduria
Can't for UMP, so supplement with uridine (--> UMP)
109
Presentation of Orotic Aciduria
Hypochromic megaloblastic anemia, Neuro, Growth
110
Hydroxyurea inhibits
Ribonucleotide Reductase
111
Leflunomide blocks formation of
Orotic Acid
112
Peptide YY
Ileum and Colon --> ECL --> Inhibit gastrin-stimulated histamine release from ECL's
113
Bladder lymph drainage
Superior to External Iliac, Inferior to Internal
114
Traction diverticula
Due to inflammatino and scarring --> True (eg mediastinal lymphadenitis, periesophageal scarring)
115
Pathophys of aortic dissection from hypertension
Medial hypertrophy of aortic vasa vasorum --> Reduced BF for aortic media --> Medial degeneration
116
PABA esters block
UVB (290-320)
117
UV what is major cause of sunburn, photo-aging, and carcinogenesis
UVB
118
Avobenzone
UVAI and UVAII
119
Zinc Oxide sunscreen
UVB, UVAI, UVAII
120
Stomatitis in treatment of RA
MTX (supplement folic acid)
121
Serious potential AE of Hydroxychloroquine
Permanent retinal damage
122
Lack of GC's means response to what will be limited
Vasopressors
123
Strong predisposing factor to Mallory Weiss
Hiatal hernia
124
Which MEN has marfanoid habitus
MEN2b
125
Which lung cancer is not surgically approached
Small cell
126
Primary mechanism of combination OCP's
Suppression of FSH, LH (no midcycle LH spike for ovulation); Secondary mechanism is blocking sperm and preventing implantation
127
Neuro-endocrine markers
Neuron-specific enolase, Chromagranin, Synaptophysin
128
Vimentin is used to dx
Sarcoma (mesenchymal origin)
129
Thrombin Time
Fibrinogen to Fibrin
130
Chronic HTN causes what microvascular changes in brain
Lipohyalinosis, Microatheroma
131
Lacunar infarct in Base of Pons
Ataxia-Hemiplegia; Dysarthria-Clumsy Hand syndrome
132
Lacunar infarct in Genu of Internal Capsule
Dysarthria-Clumsy Hand Syndrome
133
Initial presentation of Charcot Bouchard vs Lacunar Infarct
Charcot Bouchard would show hemorrhage on initial CT
134
First sign of puberty
Testicular and breast enlargement
135
What causes LV outflow obstruction in HCM
Abnormal systolic anterior motion of anterior leaflet of mitral valve toward hypertrophied IV septum
136
Garlic odor after poisoning
Arsenic --> Dimercaprol (which itself causes nephrotoxicity and HTN)
137
EDTA is used for
Lead and Mercury poisoning
138
Well-developed smooth ER
Steroid-producing cells (eg adrenals, gonads, liver); Detoxification
139
Most specific marker for dx of acute HepB
Anti-HBc IgM
140
All females with Mullerian defects should undergo
Renal ultrasound (coexisting urologic abnormality)
141
Relative speed of conduction in cardiac components
Purkinje > Atrial Muscle > Ventricular Muscle > AV node (Park At Ventura Avenue)
142
Why do cryptorchid testes not secrete Inhibit
Temperature degenerates seminiferous tubules selectively
143
Chronic gastritis with antral sparing vs antral-predominant
Autoimmune spares antrum; H pylori mostly affects antrum
144
Most common bening vascular tumors in adults
Cherry Hemangiomas (do not regress)
145
Superficial Hemangioma
Infantile, Capillary, Strawberry - Grow rapidly and regress
146
B1 is a cofactor for
Pyruvate DH, a-KG DH, Transketolase
147
QRS complex in exercise
Normally decr; If prolonged --> 1c anti-arrhythmic (use-dependent)
148
Use dependence of Class III anti-arrhythmics
Reverse use-dependence = Slower heart rate means more QT prolongation
149
Digoxin and K
Toxicity causes HyperK, but can be exacerbated by HypoK
150
Citrullination
Tissue inflammation --> Arginine enzymatically converted to citrulline
151
GABAa vs GABAb
A = Cl influx; B = GPCR (K efflux, decr Ca influx, inhibit AC)
152
Clinical manifestations of Chronic Interstitial Nephritis
(1) Modest elevation in creatinine; (2) Evidence of tubular dysfunction - polyuria, nocturia; (3) Fanconia syndrome - Aminoaciduria, Glycosuria, Hypophosphatemia, Hypouricemia
153
NSAID-associated chronic renal injury is morphologically characterized by
Papillary Necrosis; Chronic Interstitial Nephritis
154
Myelofibrosis
Atypical Megakaryocytic Hyperplasia --> Activate fibroblast prolifation
155
Myelodysplastic syndromes - BM bx
BM bx shows disordered differentiation affecting all non-lymphoid lineages, Ringed siderblasts, Megaloblastoid maturation
156
Myelophthisic anemia
Space-occupying lesion sof bone marrow - All lines affected (pancytopenia)
157
Most common causes of Myelophthisic anemia
Infiltration by met carcinomas w/ associated fibrosis; Also granulomas
158
Ergot Dopamine agonists
Bromocriptine, Pergolide
159
Non-ergo Dopamine agonists
Pramipexole, Ropinirole
160
CEA is a marker for
Colon, Pancreatic
161
CA-125
Maligant ovarian carcinoma
162
Congenital Long QT and Sensorineural deafness
Jervell and Lange-Nielsen (AR)
163
Congenital Long QT, pure cardiac
Romano-Ward
164
Virus with lipid solubule envelope are susceptible to
Diethyl Ether, Chloroform, 50% trichlorofluoroethane
165
Most common benign lung tumor
Hamartoma (Pulmonary chondroma) - Coin lesion
166
Lung lesion with alveolar growth pattern along alveolar septae without fascular or stromal invasion
Bronchioalveolar Carcinoma
167
Sporicidal compounds
Hydrogen Peroxide, Iodine (not alcohols or chlorhexidine, which disrupt membrane)
168
Chlorhexidine works by
Destabilizing cell membranes and coagulating intracellular constituents
169
Formaldehyde and Glutaraldehyde work by
Alkylating and cross-linking DNA and proteins
170
Matching is used to control
Confounding
171
Viruses that cleave one polyprotein via protease
#NAME?
172
BH4 is cofactor for synthesis of
Tyrosine, DOPA, Serotonin, NO
173
Xanthomas are most characteristic of
Hypercholesterol or Hypertriglyceride
174
Familial hypercholesterolemia etiology
LDL Receptor
175
Peutz-Jeghers mutation
Serine/Threonine kinase 11 (STK11) on 19
176
Peutz-Jeghers manifestations
Skin lesions within first few years, intestinal polyposis follows
177
Buccal mucosa pigmented lesions
Pathognomonic for Peutz-Jeghers
178
Histology of Rhabdomyoma
Fascicles of polygonal cells with vacuolated cytoplasm and peripherally placed nuclei
179
Where do Rhabodmyomas occur
Head and neck of younger males
180
Dermoepidermal junction autoantibodies to type VII collagen
Epidermolysis Bullosa Acquisita
181
Clomiphene is best used to
Achieve fertility in women with ovulatory failure who are normogonadotrophic, normoprolactinemic, euthyroid
182
hCG therapy can be used to trigger
ovulatory cascade in an oocyte donor when her follicles are deemed mature
183
HOCM murmur is louder/softer with
Louder with decreases in Preload or Afterload; Softer with increases
184
IgA deficiency can lead to incr incidence of
Atopic, Autoimmune disease
185
Excise RNA primers and replace with DNA
DNA Polymerase I
186
AFP is associated with what repro malignancy
Yolk Sac tumors
187
Classic AE's with Prednisone
Avascular necrosis of femoral head, Insomina, Psych
188
Glyburide
Sulfonylurea
189
Cytoplasmic what accumulation is a hallmark of ischemic injury
Ca2+
190
Tamm-Horsfall
Exclusively secreted by renal tubular epithelial cells in ascending LOH (Prerenal azotemia and low urine flow rate --> Accumulation to form hyaline casts)
191
Findings in homocysteinuria
Marfanoid, Lens down and in, Thrombosis, Athersclerosis, Osteoporosis
192
Warfarin embryopathy
Midfacial hypoplasia, Chondrodysplasia punctata, Hemorrhage, Organ hypoplasia, CNS
193
Changing of pili in neisseria
Phase variation (on-off) and Antigenic variation
194
Complementation
Production of distinct phenotypic trait resulting from homozygous mutations in more than on egene
195
Important finding NOT found in McArdle's
Hypoglycemia (liver glycogen phosphorylase intact)
196
Glycogen synthase deficiency
Infancy = Hypoglycemia, Ketosis, Metabolic acidosis, Growth delays
197
Effects of beta blocker on K
Hyperkalemia
198
EKG signs of hyperkalemia
Peaked T, Loss of p, Prolonged PR, Widen QRS, Slow HR
199
EKG signs of hypokalemia
QT prolongation, U waves, ST depression --> Torsades
200
EKG signs of Hypo vs Hypercalcemia
Hypo causes QT prolongation; Hyper causes QT shortening
201
In general, a medullary lesion would result in
Contralateral spastic paresis, Ipsilateral CN XII defect
202
Phenylephrine
Selective alpha 1 agonist
203
Dobutamine
Mostly Beta 1 agonist - little effects on PVR
204
Isoproterenol
Non-selective beta agonist; Incr HR/CO/PP, Decr PVR
205
Epinephrine effects on HR and PVR
Incr HR, Decr PVR
206
CAAT box
Promoter - binding site for RNA polymerase II
207
Promoters/Binding sites for RNA polymerase II
CAAT, TATA
208
Enhancers are unique in that
they can be located very far away
209
Sublimation
Converting unacceptable feelings or drives into socially acceptable ones
210
Hepatic sinusoidal endothelial cells are unique in that
Fenestrated, Lack BM
211
Stellate cells
Vit A storage; Diff into myofibroblast upon injury --> Fibrosis
212
Block 23S rRNA of 50S
Macrolides, Clindamycin
213
Inhibition of 50S peptidyltransferase
Chloramphenicol
214
Decreasing [Kin]
Increases likelihood of neuronal depolarization w/out altering AP amplitude
215
Increasing [Kin]
Hyperpolarize neuron without altering AP amplitude
216
Mechanism for age-related lactase deficiency
Decr gene expression
217
Cyclosporine MOA
Binds cyclophilin --> inhibits calcineurin --> Inhibit calcium-dependent promotion of IL2 transcription
218
Basiliximab, Daclizumab MOA
mAb that blocks IL-2R
219
Tacrolimus MOA
Binds FKBP --> inhibits calcineurin --> inhibit calcium-dependent promotion of IL-2 transcription
220
Sirolimus (Rapamycin) MOA
Binds FKBP --> Blocks mTOR --> Prevents IL-2 response
221
Tardive Dyskinesia mechanism
Upregulate D receptors; Concomitant decr in cholinergic activity in Striatum
222
The plateau phase of cardiomyocyte AP corresponds to
ST segment (isoelectric)
223
Virus that carries its own DNA-dep RNA polymerase
Pox
224
What can decrease glomerular capillary filtration coefficient
Chronic HTN, DM --> Drop in GFR
225
Calcipitriol
Vit D analog for treatment of Psoriasis (topically)
226
Antibiotic efflux pumps are found in what type of bugs
Typically gram negative
227
Orlistat MOA
Lipase inhibitor
228
McArdle's disease severity
Typically begin in young adulthood --> Muscle cramps, Fatigue, Transient myoglobuinuria --> normal lifespan
229
Lipofuscin is produced when
ROS --> Membrane Lipids
230
Cholesterol Ester Storage disorder
Partial defect in lysosomal acid lipase --> Accumulation of cholesterol ester, TG's --> Hepatic fibrosis, Premature atherosclerosis
231
Clinical manifestations of Cryptosporidium
Mild enterocolitis with water, non-bloody diarrhea
232
Toxoplasmosis in immunocompetent
Nonspecific --> Fever, headaches, myalgia, lymphadenitis
233
Nephrotic Syndrome in adults
Membranous Glomerulonephritis
234
Methenamine silver stain showing thickening of glomelar BM
Membranous Glomerulonephritis
235
CCB's in pregnancy
Limb loss - decreased placental perfusion
236
BB's in pregnancy
Generally safe
237
Incr in endothelium-bound LPL activity
Insulin resistance
238
Increased cholesteryl ester storage in hepatocytes and endothelial cells
Cholesteryl Ester Storage disease - Lysosomal acid lipase defect
239
Insulin effect on Adipocyte vs Endothelial LDLR's
Upregulate on hepatocytes, Downregulate on endothelial cells
240
Complicated non-gonoccocal urethritis
Epididymitis --> 2 wks of doxy or 1 wk azithromycin
241
Probenicid and Penicillin
inhibits renal tubular secretion of penicillins, most cephalosporins,
242
Cilastatin and Imipenem
Prevent proximal tubular brush border hydrolysis of imipenem by dehydropeptidase
243
Stimultion of auricular branch of vagus nerve
Reflex coughing or vomitting
244
Bloom syndrome
Photosensitivity, Short stature, Erythema, Telangiectasias - Defect in DNA helicase gene -- Predisposed to lymphoproliferative and gastrointestinal malignancies
245
ATM gene is important for
DNA repair following ionizing radiation - Telangiectasias in eyes and ears, Lymphoproliferative malignancies
246
Tumors in Li Fraumenia
Breast cancer, Soft tissue sarcoma
247
Location of Lynch syndrome polyps
proximal
248
Histology of Follicular Lymphoma
Effacement; Small cleaved cells (centrocytes), Larger non-cleaved cells w/ multiple nucleoli (centroblasts)
249
Presentation of Sporadic Burkitt's
Ascites and abdominal mass from ileum, cecum, or mesentery
250
Manifestations of hyperestrogenism in cirrhosis
Spider angiomas, Palmar erythema, Dupuytren's, Decr body hair
251
Niacin MOA
(1) Impair VLDL production; (2) Inhibit Hormone Sensitive Lipase --> Decr TG; (3) Incr HDL by limiting cholesterol transfer form HDL to VLDL, slowing HDL clearance
252
intestinal Kaposi
Hemorrhagic nodules by endoscopy
253
Most common cause of Restriction Fragment Length Polymorphism
SNPs
254
RNA virus that replicates in nucleus
Influenza
255
High blood ammonia and Increased urinary orotic acid
OTC deficiency (Increased Carbamoyl Phosphate shunted to Orotic Acid)
256
Uncal herniation findings
CNIII, Contralateral muscle paresis (cerebral peduncle)
257
Somatic Symptom Disorder vs Illness Anxiety Disorder
Minimal or no actual physical symptoms in Illness Anxiety
258
Pseudodementia
Cognitive dysfunction that occurs in patients with severe psych illness
259
Why hypoglycemia in MCAD
Acetyl-CoA is consumed by medium chain fatty acids that accumulate --> Low concentrations of AcetylCoA inhibit conversion of pyruvate to OAA (inhibiting gluconeogenesis
260
Anti-SRP antibodies
Autoimmune Myositis
261
MHC II pathway is particularly important for generating helper T response against
Extracellular and Intracellular membrane-bound pathogens
262
T lymphocyte antigen recognition is determied by
Specificity of TCR for both MHC variant allele and peptide fragment bound to it
263
Positive T lymphocyte selection
Thymic cortex - Responsible for generating T cells compatible with person's HLA haplotype
264
Individuals with HLA haplotypes that cannot bind certain polypeptide fragments
will not be able to mount T cell dependent immune response against these antigens
265
Most common opportunistic viral infection affecting GI tract of HIV patients
CMV - Ulcers, Mucosal erosions, Large cells with basophilic intranuclear & intracytoplasmic inclusions
266
Biopsy in HIV Cryptosporidium diarrhea
Organism confined to microvilli - basophilic parasites attached to mucosal brush border
267
Microsporidium diarrhea in HIV
Distortion of villous architecture w/out inflammation; Small spores with diagonal or equatorial belt-like structure
268
MAC diarrhea in HIV
Necrotizing and Non-necrotizing granulomas; Acid fact staining bacilli
269
HIV protease cleaves
gag and pol products
270
Carboxyhemoglobin
HbCO --> Loss of cooperativity, Unable to unload O2
271
Sclerosing Adenosis
Incidental finding (rarely palpable mass) --> Slight incr risk, Must biopsy
272
Mammary duct ectasia
Skin retraction, Thick creamy or bloody discharge, Palpable periareolar mass
273
Fibroblasts in a cartwheel or storiform pattern
Dermatofibrosarcoma protuberans
274
Dysplastic Nevus syndrome
CDKN2A on 9p21
275
LV End systolic volume, End diastolic volume and pressure in exercise
End systolic volume decreased, End diastolic volume up, End diastolic pressure same
276
Metencephalon -->
Pons and Medulla
277
Three vs Five embryonic vesicles
Pros, Mes, Rhomb --> Tel, Di, Mes, Met, My
278
Short a-helix with leucine resides at every seventh position
Leucine zipper dimerization domain --> TF's known as Basic Zipper Proteins
279
DNA-binding motifs
(1) Zinc finger; (2) Helix-loop-helix; (3) Leucine zipper dimerization domain
280
First reaction of Pyrimidine synthesis
Glutamine, CO2, 2 ATP --> Carbamoyl Phosphate in Cytosol
281
Peroxisome function
Lipid metabolism (beta oxidation), Oxidative reactions, Purine catabolism
282
Cellular location of G-6-Phosphatase
Smooth ER
283
CYP inhibition/induction effects on Warfarin
Inhibits incr Warfarin effect (decr inactivation)
284
2 most common sites for hypertension-related intracerebral hemorrhage
Thalamus, Putamen
285
Hyptertensive hemorrhage in pons
(1) Pinpoint pupils; (2) Loss of horizontal gaze; (3) Decerebrate posturing; (4) Coma
286
mechanisms of incr ICP in brain tumors
(1) Obstruction; (2) Disrupt BBB = vasogenic edema
287
Cutaneous findings in Reiter's
Keratoderma blenorrhagica, Balanitis circinata
288
Causes of nephrogenic diabetes insipidus
(1) Hypercalcemia; (2) Hypokalemia; (3) Post-obstructive diuresis; (4) Lithium, Amph B, Gentamicin, Cisplatin
289
Eptifibatide
Gp Iib/IIIa inhibitor that inhibits platelet aggregation by binding fibrinogen site
290
Effect of CYP inhibitors/inducers of Clopidogrel
Must be activated, so inhibitors decr drug levels
291
Nomal post-void residual volume
50cc
292
Oxybutynin
Anti-muscarinic for urge incontinence
293
Histology of Hep B vs C
B = Ballooning, Necrosis, Portal inflammation, GROUND GLASS; C = Lymphoid aggregates w/in portal tracts, Focal areas of macrovesicular steatosis
294
Most common meds that cause ED other than SSRIs
Clonidine, Methyldopa, BB's
295
COMT inhibitors vs Carbidopa
Both peripheral work peripherally; Carbidopa on DOPA decarboxylase
296
Entacapone vs Tolcapone
Entacapone is peripheral only (can't Enter the CNS); Tolcapone associated with haptotoxicity
297
MOA of Ropinerole
DA agonist
298
Carrier vs Channel proteins
Carrier proteins undergo conformational changes as substrate is transported
299
Uptake of cholesterol occurs via
Receptor-mediated endocytosis
300
Transport of Glucose by Glut4 is
Carrier-mediated transport (co-transport in GI tract, renal tubule)
301
Blank requirements are lower in adrenal insufficiency
Insulin
302
Chloride in primary adrenal insufficiency
Increased to maintain electroneutrality of extracellular fluid
303
Secondary/Tertiary adrenal insufficency vs primary
Can still release aldosterone in response to AgII --> No electrolyte
304
Isolated hyperkalemia can be caused by
Insulin deficiency; Diet; Cell lysis; B1 antagonists
305
Side effects of Flutamide
Hot flashes, Gynecomastia, Impotence (androgen depletion)
306
GnRH agonists
Leuprolide, Goserelin, Nafarelin, Histrelin
307
Cyproterone MOA
Androgen receptor blocker (like Flutamide)
308
IL-2 is approved for treatment of
RCC, Melanoma
309
Translocation is catalyzed by blank and requires blank
EF2, GTP hydrolysis
310
Type of anemia in beta thal minor
Hypochromic, microcytic
311
Most common cell type in pituitary
Somatotroph
312
How to prevent HSV2 recurrences
Daily treatment with Acyclovir, Valacyclovir, Famciclovir
313
Close contact prophylaxis for Hep A
Ig, Vaccine for high risk
314
Vaginal Adenosis
Glandular metaplasia due to DES --> Clear cell adenocarcinoma
315
Blutn Aortic Injury ocurs most often at
Isthmus (attched to Ligamentum Arteriosum)
316
Fall on outstretched, dorsiflexed hand
Lunate discloation
317
Onset of Otosclerosis
middle age
318
AE's of Ganciclovir
Pancytopenias, Renal
319
Major AE of Zidovudine
BM suppression
320
Foscarnet AE
Electrolytes, Renal
321
AE's common to all NNRTI's
Rash/SJS, Hepatotoxicity
322
MOA of Nitroglycerin
Dilate large veins --> Decr preload
323
Primary site of hormonal regulation of systemic BP
Small arteries and arterioles
324
Control of precapillary sphincters
NE, Epi, Local regulators
325
Rhabditiform Larvae in stool
Strongyloides --> Ivermectin
326
Parasite eggs in stool
Schistosoma mansoni or japonicum --> Praziquantel
327
Proglottids in stool
Tapeworms = Taenia, Diphyllobothrium
328
Trophozoites and Cysts in stool
Protozoa = Giardia lamblia, Entamoeba histolytica
329
Strongyloides infection
Skin penetration --> Alveoli --> Pharynx --> Intestine --> Autoinfection
330
a-Glucosidase inhibitors
Acarbose, Miglitol
331
Th in Cronhn's vs UC
Th1 in Crohn's, Th2 in UC
332
First 5 years of diabetic nephropathy
Glomerular hypertrophy, Increase GFR!
333
Gouty nephropathy
Chronic tubulointerstitial nephritis
334
First line for Wilson's
Penicillamine, Trientene
335
Vitamin store longevity for A, D, Folate, B12
A for 6 months, D for 3 months, Folate for 3 monts, B12 for 3-4 years
336
Storage of water soluble vitamins
All flushed easily except folate and B12
337
Anti-psychotics more likely to cause anti-cholinergic effects
Traditional low-potency (eg chlorpromazine, thiordazine)
338
Alleviation of negative symptoms of schizophrenia is thought to be due to
Inhibition of 5-HT2a (atypical anti-psychotics)
339
Common symptoms for sickle cell traint
Hematuria, Inability to concentrate urine
340
Lab indications of sickle cell trait
sickling test positive, all else negative
341
Dubin-Johson = absence of
MRP2
342
Deconjugation of bile acids
Anaerobes, S aureus --> Less soluble --> Less able to form miscelles --> Lipid malabsorption
343
Lower border of parietal pleura
7th --> 10th --> 12th
344
Where should thoracentesis be performed
5-7 (midclavicular) --> 7-9 (midaxillary) --> 9-11 (paravertebral)
345
Unlike ACh, Succinylcholine is not
degraded by AChEsterases
346
Succinylcholine Phase 1 vs 2
1 is depolarized, 2 is non-depolarized
347
Relaxant for intubation --> Hyperkalemia
Succinylcholine
348
AE's of Succinylcholine
(1) Malignant hyperthermia; (2) Severe hyperkalemia; (3) Bradycardia
349
Who gets hyperkalemia with Succinylcholine
Burns, Myopathies, Crush injuries, Denervation
350
Atracurium releases
Histamine --> Fall in BP, Bronchoconstriction
351
Sensory from inner tympanic membrane, eustachian tube
CN IX
352
Noninfective envelope glycoprotein that forms spheres and tubules 22 nm in diameter
HBsAg
353
Milrinone
PDE 3 inhbitor --> Incr cAMP --> Ca conductance --> + Inotropy
354
Dipyridamole, Cilostazol
Decr platelet PDE --> Incr cAMP --> Decr platelet aggregation; Cilastazol also directly vasodilates
355
Ticlopidine, Clopidogrel MOA
Block ADP receptor --> Decr Gp Iib/IIIc receptor
356
Ingestion of undercooked shellfish
V cholera, Norwalk virus, Hep A
357
VPM receives input from
Superior Olivary Nucleus, Inferior Colliculus of Pons
358
Subacute Cerebellar Degeneration
Small cell, Female repo cancers --> Anti-Yo, -P/Q, -Hu --> Cross-react with cerebellar purkinje neurons
359
Post-viral Cerebellar Ataxia
Within 3 weeks of Varicella, Measles, EBV in children --> Self-resolving
360
Clinical associations with Adenocarcinoma
Clubbing, Hypertrophic osteoarthropathy
361
Location and clinical associations with Large cell carcinoma of lung
Peripheral; Gynecomastia, Galactorrhea
362
Carcinoid syndrome is associated with decreased
Niacin
363
Liver histology Reye's syndrome
Microvesicular steatosis w/out inflammation
364
Most adults in US with Anti-HAV IgG
Have never experience icteric illness
365
Icterus in HAV infection depends on
Age (children typically anicteric)
366
Petechiae, Purpura, Ecchymoses
Pupurua 5mm to 1cm
367
Stones in IBD
Calcium binds to lipids instead of oxalate --> more Oxalate absorbed --> Stones
368
Volume depletion after activity in CF
Can't reabsorb Cl or Na in sweat
369
Direct and Indirect Factor Xa inhibitors
Direct = Rivaroxaban, Apixaban; Indirect = Fondaparinux
370
Direct Thrombin Inhibitors
Argatroban, Bivalirudin, Dabigatran
371
HBx -->
Activates synthesis of IGF-2, and IGF-1 receptors --> Cell proliferation
372
Acetyl CoA Carboxylase catalyzes
FA synthesis (--> Malonyl CoA) in cytosol
373
ATP citrate lyase
Converts Citrate --> OAA and Acetyl CoA in cytosol
374
Liver-specific enzyme serving as bridge b/t TG breakdown and Gluoneogenesis
Glycerol Kinase (Glycerol --> Glycerol-3-P)
375
Prevent Prolactin-mediated lactation in pregnancy
Estrogen, Progesterone
376
hCG in second half of pregnancy
Very low
377
Binds 30S subunit and inhibits binding of Aminoacyl-tRNAs
Tetracyclines
378
MacConkey agar
Bile and salt containing; Inhibits gram positives; Grows enterics
379
Blood agar with saline and bile grows
Enterococci (Strep bovis grows in bile but not hypertonic saline)
380
Fever is caused by
PGE2 increasing set point in anterior hypothalamus
381
CNS cells especially sensitive to heat damage
Purkinje cells in cerebellum
382
First line for Legionella
Erythromycin
383
Arcuate nucleus of Hypothalamus
DA (inhibits prolactin), GHRH, Gonadotropin
384
Bacterial DNA Polymerase with 5->3 exonuclease activity
DNA Polymerase I
385
Fornix
Projection from Hippocampus to Mamillary Body
386
Dorsal vs Anterior Thalamus
Dorsal relays from spinal cord to cortex; Anterior part of Papez circuit
387
Lesions of Splenium of Corpus Callosum
Alexia without Agraphia
388
How can dietary fructose be used for glycolysis in Fructokinase deficiency?
Hexokinase (Fructose --> Fructose-6-P)
389
Aldose Reductase
Glucose --> Sorbitol
390
Where does intron splicing occur
Nucleus
391
P bodies
Foci involved in mRNA regulation and turnover
392
Porcelain gallbladder
Risk of GB cancer
393
LM changes in first 24 hours after MI
4-12 = Coag necrosis, Edema, Hemorrhage, Wavy; 12-24 = Coag necrosis, Contraction band
394
Neutrophil and Macrophage infiltration after MI
PMNs 1-5 days; Macrophages 5-10 days
395
When does granulation tissue form after MI
10-14 days w/ neovascularization
396
Fluid/Osmolarity changes after acute GI hemorrhage
Isotonic loss from ECF is only change
397
Fluid/Osmolarity changes after Adrenal Insufficiency
Hypertonic fluid loss = Decr osm, Decr volume, Water shifts intracellularly
398
Fluid/Osmolarity changes after Hypertonic Saline
Inc osmolarity, Fluid shifts from intracellular to extracellular
399
Fluid/Osmolarity changes after Primary Polydipsia
Fluid shifts intracellularly = Incr in intra and extracellular volume with decr in osmolarity
400
Cholesterol in bile is solubilized by
Bile salts, Phosphatidylcholine
401
Fracture of 12th rib injures
Left Kidney
402
Spleen borders what ribs
9, 10, 11
403
Ribs overlying Liver
8, 9, 10, 11
404
Most common manifestation of Botulism
Diplopia, Dysphagia, Dysphonia 12-46 hours after consumption
405
Superior infectivity due to unique binding site on intestinal M cells
Shigella
406
DMD histology
Widespread necrosis, Angulated fibers
407
Charcot-Marie-Tooth
Myelin synthesis defect --> Decr nerve conduction --> Presents with foot drop
408
Microabscesses at tips of dermal papillae
Dermatitis Herpetiformis
409
Positive straight leg raise test
Sciatic nerve root irritation (eg intervertebral disc herniation)
410
Cryoprecipitate vs FFP
FFP contains all factors, Cryoprecipitate contains only cold-soluble (VIII, Fibrinogen, vWF, Vitronectin)
411
Nedocromil MOA
Inhibit mast cell degranulation (like cromolyn)
412
Zileuton
Lipoxygenase inhibitor
413
Claudication is almost always result of
athersclerosis of larger, named arteries
414
Calories per gram of Ethanol, Carbs, Fat
7 for Ethanol, 4 for carbs, 9 for fat
415
Mechanism of reversing opioid tolerance
NMDA antagonism (activation of NMDA is though to enhance tolerance)
416
Blank is required for activation of NMDA
Glycine and Glutamate
417
Anticonvulsants and Osteoporosis
Induce CYP --> Incr Vit D metabolism --> Decr Ca
418
PPI's and Osteoporosis
Decr Ca absorption (need acid to absorb)
419
Heparin, Thiazolidinediones and Osteoporosis
Decr bone formation
420
Pseudobulbar Palsy
Central Pontine Myelinolysis - CN IX, X, XI
421
Rapid correction of hypernatremia
Cerebral edema
422
Labetalol
Antagonist of a1, B1, B2 with minor B2 agonist activity
423
Diabetic retinopathy fundoscopy
Cotton wool, Aneurysms, Dot anb blot hemorrhages
424
Amourosis Fugax
Painless, transient, monocular vision loss caused by small embolus (few seconds)
425
45yo female with long history of pruritis and fatigue who developed pale stool and xanthelasma
Primary Biliary Cirrhosis - Destruction by granulomatous inflmmation, Heavy portal tract infiltration
426
Bile tract disease associated with UC
Primary Sclerosing Cholangitis
427
Vit E deficiency may closely mimic
Friedreich's Ataxia - Ataxia, Dysarthria, Loss of position and vibration sense
428
Fever w/ relative bradycardia
Salmonella Typhi
429
Gastric Erosion
Limited to mucosa
430
Gastric Ulcers
Extend into submucosal layers
431
Limitation of chest expansion in Ankylosing Spondylitis is due to
Enthesopathy of Costovertebral and Costosternal junctions --> Hypoventilation
