Uworld journal part 2 Flashcards
1
Q
how does diptheria get its toxin
A
phage conversion
most AB toxins are aquired this way
2
Q
amphotericin B toxicity
A
Severs hypokalemia and hypomagnezemia can result due to severe renal damage
moniter serum K+ and Mg2+
used after an infection for mucormicosis
3
Q
PPAR Gamma
A
intracellular nuclear receptor that TZDs agonize the most important target is adiponectin
4
Q
C. Teteni toxin directly effects the release of what neuro transmitter
A
GABA or glycine
NOT Ach thats botchulism
5
Q
progressive spastic paresis and choreoathoid movements
lab: high arginine levels
A
Arginase deficency
makes urea and ornithine from arginine
low protein diet that is devoid of arginine
can look like cerebral palsy
6
Q
part of long bone that osteomylites effects
A
the metaphasis because of the slow flowing sinusoidal vasculature
7
Q
manifestation of parvo virus in adults
A
acute arthropathy that resolves on its own
8
Q
what is close to the inferior thyroid artery
A
the recurrent laryengial nerve
9
Q
derivitive for the R cardinal vein
A
SVC
sandwhiched between the acending aorta and R pulmonary artery
10
Q
what is formed when a patient gets the diptheria vacciene
A
IgG circulating antibodys
protects people from when the toxin is released into their body
11
Q
artery most likely to be affected by a midshaft humerous fracture
A
deep brachial artery
12
Q
what does cortisol act on to induce the production of epinephrine from NE
A
phenylethanolamine-N-methyltransferase (PNMT)
13
Q
what do people with homocystineurea need to be supplemented with
A
vitamin B6
because they have a deficency in cystethione beta-synthase
present with marfanoid habitis, clotting issues, and mental retardation
14
Q
myoclonic seziures
A
no loss of consiousness, Brief jerking movments
treat with valproid acid
15
Q
what pharmacotherapy for PTSD
A
SSRI or another anti depressant
16
Q
what will you find with autonaumic neuropathy resulting in urinary incontanance
A
increase post void residual volume
this is also called overflow incontance
17
Q
phenoxybenzamine
A
alpha 1 antagonist
used to pretreat before removal of a pheochromocytoma
18
Q
how does HBV cause cancer
A
integration of viral DNA into the host genome
19
Q
side effect of mannatol and other osmotic diuretics
A
flash pulmonary edema
20
Q
thickened renal arterials that stain pink with hematoxylin eosin
A
think non-malignany hypertension or diabetes mettitus
21
Q
what is a plausable way to decrease the ereythrocyte precurser apoptosis seen with folate deficency
A
supplement with thymidine (neucleiec acid) so that there would be some dTMP
22
Q
aromatase deficency
A
results in maternal virulization during pregnancy and ambiguus genitalia for the XX neonate
the neonate will have an increased androgen level
23
Q
proof reading
A
3’==> 5’
24
Q
fidaxomicin
A
macrocyclic antibiotic (related to macrolides)
use for recurrent c-diff infections
25
are concentrations of angiotensin 2 higher in the pulmonary veins of the pulmonary arteries
veins
26
during a check up what should be tested in patients taking SGA (olanazpine)
a lipid panel and a fasting gluconse
27
side effect of methylphenidate
used for ADHD
| Decreased appitite and weight loss
28
c-myc
implicated in cell proliferation
29
proteosome inhibitors cause what
apoptosis
used in multiple myloma
30
why dot you want to give TCAs or venlafaxine to someone with bipolar 1
because you may precipitate a manic episode
31
enterocept
TNF alpha inhibitor used in rheumatoid arthritis
acts as a soluble receptor decoy protein
32
protective facotors against ovarian cancer
- oral contraceptives
- multiparity, breastfeeding
- tubal ligation, salpingo-oophorectomy
33
what should thrombophelibitis raise suspicion for
viceral cancer
most frequantly of the pancreaus
34
what should be given to a patient with sever asthma that is refractory to corticosteroids
andi IgE antibodies
omalizumab is an example
35
Fatigue, weight gain, myoedema (lumping with percussion), and elevated CK
think hypothyroid myopathy
36
what does shigella like toxin do
inactivates the 60s ribosomal subunit
37
how is the glycerol backbone of triglycerides salvaged for gluconeogenisis
glycerol kinase
38
enoxaparin binds to what?
antithrobin III
39
base excision repair sequance
1. Glycosylase cleaves the altered base leaving an AP site
2. endonuclease cleaves the 5'end and lyase cleaves the 3' end
3. DNA polymerase fills the single nucleotide gap and ligase seals the nick
40
golgi tendon organ
causes epontanious mucle relaxion when lifting too much weight
interacts with inhibitory interneurons that then interact with the out going alpha motor neurons
41
stimulation of what nerve can help OSA
hypoglossal
42
treatment for bulimia nervosa
SSRI like fluoxitine
43
treatment of bipolar disorder
lithium, valproate, or quietapine
44
Labs show hyponatremia, decreased TSH and free T4, decreased cortisol and the woman hasn't started lactating
pan-hypopit
Sheehans syndrom caused by ischemia
45
where do hydroceles collect
tunica vaginalis
46
comedonal and inflammatory nodular eruptions on face chest and back in an 20 something athletic male
think steroids like methyltestosterone
47
first line therapy for chronic asthma
Fluticasone
immunosupression so it inhibits leukocytic infiltrate
48
causes of eisenmenger syndrome
uncorrected left to right shunt
VSD, ASD, PDA
49
what will you see in the spleen of a sicle cell patient
fibrosis and atrophy due to recurrent infections
50
cause of macrocytic anemia in a sickle cell patient
folic acid deficency
caused by increased cell turnover
will have a relatively low reticulocyte sndex
51
method of reporting with exposure and non exposure
exposure odds ratio
52
most important factors in blood flow auto regulation
nitric oxide and adenosine
flow mediated vasodilation
53
what does aspirgillus cause as it forms and what kind of cancer does it cause
aflavitoxins
strongly linked with hepatocellular carcinoma
G==>T substitution
think aspirgillus when you think of toxic moldy grains
54
Rasburicase
can be used to prevent build up of/excretion of uric acid seen in tumor lysis syndrome
it is a urate oxidase inhibitor and you can use it n conjunction with or as a substitute for allopurinol which inhibits xanthine oxidase
with tumor lysis syndrome you can have electrolyte abnormalities and arrythmias
55
what lines the walls of a pancreatic pseudocyst
fibrous and granulation tissue
56
patient on dialysis that is bleeding from a catheter site
uremic platelet dysfunction
| The only thing that is wrong is a prolonged bleed time
57
wiscott aldrich syndrome
Recurrent infections, thromocytopenia, eczema
X linked disorder
mixed B cell and T cell dysfunction
58
how is PKU inherated
AR
59
pain that radiates to the neck with a R lower lobe PNA
the pain sensation of carried by the phrenic nerce which innervates the medistinal pleura and the diaphragmatic pleura
60
dopamine agonists
ergot: bromocriptine
Nonergot: pramipexole, ropinirole
61
extrapyramidal side effects
- acute dystonic reaction: sustained muscle contractuiions
- akathsisa: subjective restlessness with inability to sit still
- Drug induced parkensonism
62
rifaximin
non-absorbable antibiotic that alters GI flora to decrease intestional synthasis and absorption of ammonia
63
lactulose
increases the conversion of ammonia to ammonia by acidifying the stool
64
acute stress disorder
presents with night mares similar to PTSD
65
what should you look for when a child has an imperferate anus
urinary tract defects
66
equation for alveolar gradient
PAO2= 150- (PaCO2/0.8)
Normal is 10-15
67
origen of schwann cells
neural crest
68
function on snRNPs
removal on introns from RNA transcripts
69
transferrance
applying a feeling towards someone in the past towards someone in the present
Ex. someone saying a doctor doesn't car for them when their mother didn't care for them in the past
70
you see atrophy of what in alzheimers disease?
Lentiform nucleus
71
region where frontal, parital, temporal, and sphenoid bones meet in the skull
Pterion
Fracture here likely severs the middle meniengial artery which is a branch of the maxillary artery
72
surface glycoproteins that confers resistance to cancer drugs
efflux pump
ATP dependant transporter
73
what increases right afer B12 replacment
reticulocyte count
74
Severe combined immune deficiency
low CD3+ T cells
- recurrent viral and bacterial infections
- can have thymic aplasia
75
juvinile cateracts but otherwise asymptomatic
Deficency in galactokinase
aldose reductase causes production of galactitol which causes cateracts
76
which part of the kidney responds to ADH
the medullary collecting duct
77
ventromedial neculeus of the hypothalamus
mediates saity
without it patients experiance hyperphagia
78
lateral nucleus of the mypothalamus
Mediates hunger
destruction leads to annorexia
79
posterior nucleus of the hypothalamus
mediates heat conservation
80
arcuate nuclease
secretes dopamine, GHRH, and RnRH
81
renin in secondary hyperaldosteroneism
low
K low
Bicarb high
sodium normal
82
Methylmalonic acidemia
-increased methylmalonic acid in urine
-increased propionic acid
decreased glucose
-increased urine ketones
-increased serum ammonia
deficency in methylmalonal co mulase which catalyses the reaction methylmalonyl CoA ==> succinyl CoA
83
what dephosforolates glycogen synthase
protein phosphatase 1 which is activated by insulin
84
what is really effective at inactivating thrombin
unfractionated heprin
85
myotonic dystrophy
- AD
- Frontal baldness, cataracts, gonadal atrophy
- difficulty releasinf grip
- repeat expansion of CTG in the gene that codes for myotonia protein kinase
- type 1 muscle fibers are affected
86
what is seen on a liver biopsy in a petint with Reye syndrome
Microvascular steatosis
they slip into a coma because of hyperammoiema
87
side effects of CCB
peripheral edema
88
equations for cardiac output
CO=HRxSV
CO= (O2 consumption/ arteriovenous difference)
89
does left ventricular end diastolic pressure decrease with nitro
Yes
90
what is rho- gam
anti-RH D antibodies so that they can interact with fetal RBC
91
Tuberoinfundibular pathway
connects the hypothalamus and the pituitary gland
responsiable for dopamine dependent inhibition of prolactin
92
pallor of the substantia nigra, locus ceruleus, and vagal nucleus dorsalis
PKU
defeciency in phenylalanine hydroxylase
93
HIV patient with fever, hepatospleno megaly, , retroperitenoal lymphadenopathy
acid fast bacteria that grow optimally at 41 degrees
mycobacterium avium complex
prephalyxis: azithromycin
94
characteristics of burgers disease
vPVD sensitive to tobacco extract
-segmental vasculitis extending into contiguoud veins and nerves
95
decreased activity of which enzyme can cause the formation of gall stones
7-alpha-hydroxylase
96
emperic treatment for patient with endocardidis caused by Coag negative staph
VANCO because a lot of them are resistant
97
what do aurer rods stain + for
peroxidase
always look for auer rods when they give you a blood smear
98
uroporphobiligin decarboxylase
uroporphyrinogen III ==> coprophyrinogen III
most common deficency in porpheryn synthesis
abd pain, photosensativity (because it is involved in the late stages of porpheryn synthasis)
99
what explains the symptoms in mysthenia gravis
reduced motor end plate potential
100
probability of being free from a disease if you test - for it
NPV
101
Most likely diagnosis if PT does not corrcet with vit-K supplementation
factor VII deficency
Factor VII has the shortest half life
102
if someone is paranoid about just one thing like a group of people trying to poisen them
delusional disorder
103
pigment stones
usually secondary to infection whihc leads to the release of beta-glucuronidase by injured hepatocyted or bacteria
this enzyme contibutes to the hydrolysis of bilirubin glucuronides and increases the amount of unconjugated bili in the bile
opisthorchis sinensis is a fluke that is associated the the formation of these stones
104
what do gliomas stain posative for
glial fibrillary scidic protein (GFAP)
105
HLA class I
present on all nucleated cells (HLA B27)
106
HLA class II
DR, DP, DQ
expressed by antigen presenting cells
associated with rheumatoid arthritis, DM type 1,, and ciliac
107
issues with finger extention
radial nerve
passes through the supinator canal and that is normally where the injury is
108
dysplastic tissue is differentiated from neoplastic tissue how?
reversability of changes
109
Ddx if the shilling test reveals low B12 in both phases
Ilial disease, pancratic insufficency, intestinal bacterial overgrowth
110
Ipratroprium
blocks muscarinic receptors preventing vasoconstriction
acetocholene released by the vegas nerve is what stimulates these receptor
111
what amino acid precurser makes nitric oxide
Arginine
Arginine + O2=(eNOS)=>NO + Citruline
112
Dofetilide
potassium channel blocker
113
part of GI tract that celiac effects
small bowel
114
echinococcus granulosus
form hydated cysts in the liver causing anaphylaxis if antigens released
- use ethanol or hypertonic saliene to kill daughter cysts before romoval
- use Albendozole to treat
- contracted from dogs
115
first line treatment in narcalepsy
modafinil
non-amphetamine stimulant to help people stay awake
116
Widened QRS or ventricular arrythmia
indication for sodium bicarb
Use in arrythmias caused by TCAs
- it increases the serum PH making the TCA favor the non ionized form makinging less accessable to bind to sodium channels
- it also increases extracellular sodium which helps overcome the competitive rapid sodium channel blockade by the TCAs
117
chlordiazepoxide
benzodiazapine
-the only one that doesn't end in "pam"
118
muscle responsable forr lifting arm over head and stabilize and rotate the scapula upward
serratus anterior
- innervated by the long thoracic nerve which arises from the C5-7 nerve roots of the brachial plexus
- can be injured by axillary lymphnode removal
119
enerocutanious fistula
chrone's disease
120
what is consistant with lymphoma on histology
Monoclonal T-cell receptor gene rearrangments indicating that there is a possible malignancy of that one cell type
-if a dsingle allele for the V region of the TCR predominates in a lymphocytic population monoclonal proliferation in suspected
121
strongyloides stercoralis
- will see rhabditiform larvae in the stool
- migrate to the lungs and then move to the intestine where they lay their eggs to be hatched
chronic cough and recurrent respoiratory infections
122
drug that prolongs PT and PTT but has no effect on thrombin time
Xa inhibitors
-Rivaroxaban, apixaban
123
mallory-weiss tears
occur due to rapid increases in intraabdominal pressure
124
what does silicosis do in terms of immunity
impairs macrophage killing predisposing these patients to having TB
125
normal liver biopsy in the setting of ruptured esophegial varicies
thinkportal vein thrombosis
these patients will have splenomegaly in the setting of hematemisis
126
what happens to the C-peptide of insulin
it is packed into secratory granules and released from the cells
127
low FEV1 with eosinaphils
Patient likely has asthma
Avoid animal dander
128
acute confusion
think delirium
129
patient that had recent surgery and presents with symptoms of cholestais, and fever
think drug induced hepato toxicity caused by inhailed anesthetics like halothane
will see a sshrunken liner with hepatocellular pattern of injury
Labs: elevated LFT and prolonged PT (failure of synthetic function and factor VII) , leukocytosis, eosinophilia
130
Friedreich ataxia
- autosomal resessive trinucliotide repreat (GAA) on chromosome 9
- gene code for frataxin which is an iron binding protein
- present with kyphoscoliosis, ataxia, nystagmus, muscle weakness, pes cavus (high arched foot) , hammer toes, diabetes, and hypertrophic cardiomyopathy
131
blastomycosis
- endemic in the southern states
- caused pulmonary symptoms on IMMUNOCOMPITANT hosts
- dimorphic, can for yeast buds in humans (look like owls eyes) and a bud with a broad base
- can cause pulmonary infiltrates that can disseminate to the skin or bone
- treat with azoles
132
first line of defemce whien trying to reverse heperin
protamine, give it beofre anything else
133
what do esophageal veins branch off of
the left gastric vein which comes directly off of the portal vein
134
what vessels are most suseptible to atherosclerosis
coronary arteries and lower abdominal aorta
135
JAK/STAT pathway
think JAK2 which is a tyrosine kinase which is constitutively active in chronic myeloproliferative disorders
-Treat with the JAK2 inhibitor rucolitinib
136
young patient with recurrent episodes of chest pain, sweating, and palpitations. What do you give him
benzos, he is having a panic attack
137
Ribavirin
inhibits synthasis of guanine nucliotides by competitively inhibiting inosine monophosphate dehydroginase
interferes with duplication of viral genetic material
Uses: chronic HCV, RSV
Toxicity: Hemolytic anemia, severe tetrogen
138
vision loss with temporal lobe mass
-it effects myers loop witch barries libers from the upper quanrent of the contrallateral eye field resulting in left homonymous quadreantanopia
139
what is scaulded skin syndrome caused by
exotoxin mediated skin damage
-you get endotoxin mediated response with gram - organisms
140
what land mark is useful in identifying the appendix
Tenia coli
141
what area of the aorta is involved in blunt aortic injury
aortic isthmus (decending portion of the arch of the aorta)
142
isolated systolic hypertension
caused by age related stiffening of the aorta
-if it were dur to renal artery stenosis then both SBP and DBP would be elevated
**Look at both numbers
143
Alkaptonuria
- Autosomal Recessive
- Deficency in homogentisate oxidase in the degradative pathway of tyrosine to funerate
- black urine, dark connective tissue, may have debilitating arthralsias
144
IgE independent mast cell degranulation occurs in the setting of what
Adverse drug reaction to opioids, radiocontrase agents, and vanco
- The induce degraulation by activation of PKA and PI3 kinase
145
equation for renal flow
Flow= r^4
-if the flow is decreased by a certain amount then devide by that amount
146
biliary sludge
precurser to developing a stone
-pain after eating a fatty meal
147
target of treatment in 21-hydroxilase deficency
- supress ACTH
- If you supress ACTH then you will decrease the amout of sex hormone being made
- do this by giving physiologic doses of glucocorticoid
148
increased slope of both cardiac function curve and the venous return curve
Decreased total peripheral resistance caused by a continious arteriovenus fistula
149
delta-aminolevilinate synthase
- B6 is a cofactor
| - deficiency can case sideroblastic anermia in the setting of ISN use
150
histology of hoshimoto thyroiditis
- mononeuculear parenchymal infiltration with well developed germinal centers
- often surrounded by hurthle cells which are large oxyphilic cells filled with granular cytoplasm which represent follicular epithelium that have undergone metaplastic change in response to inflammation
151
how is androgenic alopecia inherited
polygenic inheritance
152
underlying mechanism of zenker diverticulum
Cricopharyngeal motor dysfunction
153
what is used for energy in cholesterol synthasis
NADPH made in the ribose 5-phosphate pathway
154
protein abnormality seen in patients with CF
abnormal post translational modifications because of the deletion of a phenylalanine
155
type of hypersensitivity with monoclonal antibodies
type 3
- it causes serum
- can present with joint pain and puritic skin rash
156
symptoms of a gastrin secreting tumor
- dirrehea
| - postbulbar duadenoal ulcers
157
where is the common peroneal nerve mot often injured
fibular head
158
what is increased in tuberculoid leprocy
IL-2 and IFN-gamma in the skin leasions
-TH1 cells are more active in tuberculoid leprocy and the bacterial load is low
159
pure red cell aplasia
Associated with thymmomas and lymphocytic leukemia
- can also be caused by parvo virus B19
- anemic with abcence of erythroid precursers
160
squamous metaplasia in the pancreatic ducts
vit-A deficency
remember that they have a deficency in ADEK
161
bilateral wedge shaped infarcts on autopsy
- watershed regions affected by ischemia
| - hypoxic-ischemic encephalopathy caused by profound hypOtension
162
part of urethra that is most likely injured with a pelvic fracture
posterior spongy urethra
163
paranoid patient that has be up for days studying for exams that was totally norml previously. Hypertensive, tachycardiac, diaphoretic
think substance induced psychotic disorder
-ampheramined or methylphenidate could be responsiable
164
common place for clear cell renal carcinoma to metastisize to
lungs
-characteristic cells with abundant clear cytoplasm
165
most frequant predisposing factor for infectious endocarditis
- mitral valve prolapse
| - rheumatic heart disease is not where close to being the most common predisposing factor any more!
166
the higher the arterovenous concentration gradient for a inhailed anesthetic
the slower the onset of action
-decreased av gradient means increased speed of equilibrium with the brain
167
when UCU and bing to AGA and AGG
wobble
-usually the 3rd nucleotide position
168
effect on constriction of the effarent arterial of FF and GFR
increases them both
169
globus sensation
trouble swallowing associated with stress with no functional abnormalities
170
DNA lattering in the absence of a growth factor
sign of apoptosis
171
trouble seeing clearly, thirsty, bugs crawling on skin, after chewing plant seeds
think anticholonergic side effects
172
when a genetic defect is identified in multiple offspring but not the parent
genetic mosaicism
173
what should diabetics do daily
a foot inspection
174
what is seen on byopsy of mollescum contagiosum
cytoplasmic inclusion bodies
175
what structure is compromised when the femur is displaced posteriorly
popliteal artery
176
main cause of endometriitis
bacteriodies species
177
sublimation
channeling feelings into socially acceptible behaviors
178
what part of the penis does viagra effect
the corporus cavernosa by increasing cyclic GMP
179
transudate in CHF
- low protein
| - low LDH
180
put a bunch of NaCl with soem blood cells and test heolysis
Herediatry spherocytosis
-preforming a splenectomy decreases the likelyhood of bilirubin gall stones
181
what cancer is associated with mysthemia gravis
thymoma
182
alteration to a protein before adding a carboxyl tail
palmitoylation
-fatty acids anchored to cytosine residues
183
the pressure in which vanculature increases with cirrohis
splenic vein
-portal vein
184
mutation in fibroblast growth factor receptor 3 on chromosome 4
achondroplasia
- point mutation
- autosomal dominant
185
what receptor does glucagon act through
Gs
186
what does red safranin stain
cartalage, , mast cell granules, mucin
187
acid base disturbance with a PE
respiratory alkalosis
188
weak lower extremity pulses and ischemic colitis
think extensive atherosclerosis
189
most common genetic defect in b-oxidation
acyl-CoA dehydroginase deficency
190
autonomic postganglionic nerves
unmylinated
191
prader willi
LOSS of Pathernially inherated gene
192
acanthosis nigracans that appear rapidly
think malignancy
193
what causes the cardiac abnormalities in digeorge
persistant truncus arterious
194
broom like appearance of a fungus
aspirgillus
195
after load of a skeletal muscle
force against which they must contract
196
common complication after sub arachnoid hemmorhage
arterial vaso spasm
-use nimopine to prevent vaso spasm
197
SGLT2 inihibitor
2nd or 3rd line in diabetes managment
- inhibits SGLT2 in renal tubules to lower the threshold for glucose to be lost in the urine
- don't use in patients with renal disfunction
198
what can be used in the treatment of psorasis
- Vitamin D analogs
- calcipotriene, calcitriol, tacalcitol
- activates vit D receptor and inhibits the differentiation of keritinocytes
199
crecent formation with no anti-bodies of immune deposits
Test for cANCA because it is likely to be wegners
-type 3 pauci immune glomerular nephritis
200
transection of the rectus abdominous laterally puts which structures at risk
inferior epigastric arteries
201
paraneoplastic syndroms associated with SCLC
- Lambert-eaton myasthenic syndrome
- Subacute cerebellar degeneration
- SIADH
- Cushing syndrome
202
attributable risk percent= 100 x [(risk in exposed - risk in unexposed)/risk in exposed]
see card
203
Hereditary angioedema
- AD
- low serum levels of C1 esterase inhibitor
- ACEI are inhibited because of their side effect of angioedema
204
what is seen with an MI involving the RCA
RV dysfunction
- PCWP will decrease
- CO will decrease
- JVP/central venous pressure will increase
205
zero order kenitics
no matter how much you put in the same amount (not percentage) is metabolized
206
what is commonly seen on blood smear in someone that has sepsis and a leukemoid reaction
Dohle bodies
-basophilic oval inclusions in mature neutrophils
207
complications of varicose veins
painful thrombosis, stasis dermatitis, skin ulcerations, poor wound healing, superficial infections
208
part of the nephron that is impermiable to water
Thick and thin acending loops of henley
209
if a bacteria down regulates MHC I what kind of cell will they likely be killed by
NK cells
- + for CD16 or CD56
- Activated by IFN-gamma and IL12
210
Atrilization of the R ventricle
ebstine anamoly
| - associated with lithium use
211
pearly mass behind the tempanic membrane in the middle ear
cholesteatomas
- squamous cell debris
- can cause painless otorhea
212
Rett syndrome
- commonly seen in girls
- deceleration in head growth
- due to a de novo mutation in the X-linken MECP-2
- sterotyped hand ringing
213
mucor mycosis
can be caused by rhizopus species, mucor, or absidia
- right angles
214
Kawaski disease
-asain children
215
hairy cell leukemia
older men
- TRAP +
- Marrow fibrosis with dru tap
- massive splenomegaly
216
nerve involved in ear problems that accompany temporalmandibular disorder.
Mandibular branch of the trigeminal nerve
- Tensor tympany is innervated by this nerve
217
if someone has muscurenic agonist poisening and is given atropine, what are they still at risk for?
muscle paralysis because the atropine takes care of the muscurinic symptoms but no tthose caused by the activation of nicotinic receptors
-must give pralidoxime as well
218
specific antibodies for rheumatoid arthritis
- anti-CCP (most specific)
| - Rheumatoid factor
219
normal A-a gradient
10-15
-Alveolar O2 - arterial O2
220
average total body water
41L- lipophilic drugs
-14L extracellular fluid:
3L plasma volume
interstitial makes up the rest
large drugs will be cound to plasma proteins and then will remain mostly in the 14L of extra cellular fluid
221
vascular leasions containing IgA and C3 in a child
Henoch- schonlein purpura
- rash
- abd pain
- polyarthralsia
222
progressive liver failure with HCC is most likely caused by
HBV because it integrates into the host genome and the liver damage is continious
223
histology of the liver in primary biliary cirrohis resembles
- graft vs host disease
- inflammatory and leukocytic infiltrate
- associtaed with anti-mitochonrial antibodies
224
what is given when a DVT is present
- Xa inhibitor
| - riviroxiban
225
where does the trigeminal nerve exit the brain stem
- at the level of the middle cerebellar peduncle
| - lateral aspect of the mid pons
226
oxylate crystals on renal biopsy
ethyline glycol posiening
227
what biochemical pathway does alcohol inhibit
Gluconeogenesis
-increaseses the NADH/NAD+ ratio and htuse inhibits anything that needs NAD+ as a substrate
228
how is glucose brought into adipocytes
GLUT 4 transporter
-facilitated diffusions via carrier proteins
229
osgood-schlotter
avolsion of the tibia from the secondary ossification center of the tibia
-injury to the petellar tendont which inserts on the tibial tuberosity
230
nucleolus is the primary site of
rRNA transcripition
-RNA pol I functions here
231
dermatomyositis
can persent as a paraneoplastic syndrome of the lung, ovary, or colon
232
chronic mesentaric ischemia
- angina of the gut
- pain about an hour after eating
- pt has a history of atherosclerosis
233
the lateral epicondyle is the attachment point for what
-extensor carpi radialis breavis and extensor digitorum which are involved in wrist extension
234
telangiectasias, recurrent epistaxis, skin discoloration, AVM, GI bleeding, hematuria
Osler-weber-rendu syndrome
235
what does the CFTR gene encode
- an ATP dependent chloride channel
- secretes Cl- in lungs and GI tract
- resorbs Cl- in the sweat glands
236
what is responsible for synchronization between glycogen breakdown and muscle contraction
Ca2+
-it is a more potent activator of PK in the muscle as opposed to cAMP in the liver
237
medical treatment for gall stones
Bile acid supplimentation
- they will solubilize the cholesterol that is implicated in making stones and thus prevent stone formation
- prevents gallstone dissolution by improving cholesterol solubility
238
what is present in lung hamartomas
- hyaline cartilage, fat, smooth muscle, and clefts liked by respirtory epithelium
- often presents as an incidental coin leasion
239
with luperlide what initially increases
testosterone and DHT
240
topoisomerase II
makes double stranded breaks in DNA to relieve coiling
241
which carbohydrate is metabolized the quickest
Fuctose-1-phosphate
-bypasses PFK-1
242
how to distinguish a direct vs indirect hernia
MD's don't LIe
- medial to the inferior epigastric artery= direct
- lateral to the inferior epigastric artery = indirect
243
what part of the stomach does pernicious anemia affect
- the body
| - h. pylori affects the antrum
244
acute eczematous dermatitis is characterized histologicall by...
spongyosis
-an accumulation of edema fluid in the intercellular spaces of the epidermis
245
best test to confirm the diagnosis of trichamonas
saline microscopy
246
episodic jaundice and increased DIRECT bilirubin
- defective hepatocellular excretion of bilirubin glucuronides
- dubin johnson syndrome
247
what part of the nephron absorbs the most water
the proximal tubules (60%)
248
red blue tumor under the finger nail
tumer of the thermoregulatory glomus body
249
stain for cryptococcal menengitis
india ink
wide clearing because of polysacceride capsule
-high protein, high opening pressure, low glucose
250
complete collapse of one lung
mainstem bronchous obstruction
-trachea will deviate to that side
251
holoproencephaly
an example of malformation
-defect in cells or tissues that form the organs
252
treatment for anexity attacks
SSRI
253
Pantothenic acid
- Vit B5
| - Bioten
254
anal wink reflex
S3 S4 winks galore
255
how does anastrozole work for breast cancer metastissis
inhibits aromaitazation of androgens by aromatase because aromotase is a CYP 450 enzyme and the azoles are cyp 450 inhibitors
256
CML diagnosis
basophelia and eosinaphilia
- corrilation with EBV infection
- myleocytes
257
what remains normal in the setting of nitrate poisening
- partial pressure of oxygen in the blood
| - oxidized iron to the Fe3+ state
258
How is PAH secreted into the tubules of the nephron
Carrier proetin transport
259
what drains internal hemmroids
Superior rectal veins and inferior mesentaric veins
260
order of arteries involved in atherosclerosis
Abdominal aorta>coronary arteries>popliteal arteries >internal carotids>circle of willis
261
what is give to a patient with suspected graves disease with severe proptosis
-glucogorticoids to supress inflammatory infiltratioon, decrease fibroblast activity, and decrease the periferal conversion of T4 to T3
262
features of a glucagonoma
- necrolytic migratory erythema (leasions that enlarge and coelese), indurated area around the perineum
- normocytic anemia
- DM
- tumer arising from alpha cells
263
Vit E deficency
- posterior column and spinocerebellar tract atrophy
- loss of DTR
- can present like b12 deficency but the megaloblastic anemia is absent
- leasions similar to those in fredrichs ataxia
264
episodic headache
think pheochromocytoma especiallu when suspecting MEN
265
cystine uria
- it is a type of aminoaciduria
| - hexagonoal crystals in the urine
266
why do you want to decraese the CO2 in someone with cerebral edema
to increase cerebral vascular resistance (aka. decrease vasodialation)
267
what are areas caused by liquifactive necrosis lined by in the brain
Glial cells like astrocytes
268
side effects of Thiazide diuretics
- Hyponatremia
- Hypokalemia
- Hypercalcemia
- Hyperglycemia
- Hypercholesterolemia
- hyperurcemia
269
HTN, increased renin, hypoK
JG cell tumor that is secreting renin
270
symptoms of a puneal gland mass
- obstructive hydrocephalis
- dorsal midbrain syndrome (paralysis of upward gaze, ptosism pupillary abnormalities due to direct compression of the pretectal region of the midbrain
271
what is IFN-gamma secreted by
T-cells and NK cells
272
spasmatic torticolis is a type of what?
- Dystonia
- Sustained muscle contractions
- writers cramp is another example
273
injury to what artery would cause osteonecrosis of the femur head
-medial femoral artery
274
3 phases of acid secretion
cephalic==> cholenergic vagal stimulous
gastric==> gastrin
intestinal==> decraeses the amount of gastric acid
275
phentolamine
alpha-1 blocker that is used during epi extravisation
276
pt with possible toxic megacolin (hx of UC)
get a plane film x-ray
277
KRAS
protooncogene
-most mutations are activating mutations
278
ketamine and PCP
NMDA receptor antagonists
279
what causes the outflow obstrcution in HOCOM
The thickened interventricular septum and the mitral valve leaflet
280
how can you prevent gynocomstia
Tamoxafen or selective estrogen receptor modulators
281
what is JAK
it is a cytoplasmic tyrosine kinase
282
where do the ganglionic cells of the rectum reside?
in the submucosa
-meissners plexus
283
touretts disorder
symptoms greater than 1 year (multiple motor and one or more vocal tic)
284
what is seen histologically in takayasu arteritis
giant cells in the aortic arch
-usually females
285
what is seen in the stool of cholera patients
mucus and some sloughed off epithelial cells
-remember this is a non-inflammatory diarrhea so you will not see fecal leukocytes
286
what needs to be tested before amioderone therapy is initiated
TSH because it carries iodine and can cause thyroid dysfunction
287
how do you calculate drug concentration
dose/volume of distribution
288
why is it important for an ASD to be corrected
to prevent irreversiable changes to the pulmonary artery that could result in a r==>L shunt because of increased pulm pressure
289
overactivity of what causes keloids?
TGF-beta
| transforming growth factor beta
290
absence of GPI and defeciency in CD55 and CD59
paryoxismal nocturnal hemoglobinuria
==> compliment is activate and distroys red blood cells
triad of hemolytic anemia, pancytopenia, and hemoglobinuria
291
treatment for extraparymidal side effects
benztropine
292
side effects of theophylline
- tachyarrhythmias
- seziures
- cyp450 DDI
293
kind of inflammation with gillan birrae
endoneural inflammatory infiltration
294
what innervates the quadracepts muscle
the femoral nerve (L 2, 3, 4)
295
fredrech ataxia
degeneration of the spinocerebellar tracts
296
bluish color of reticulocytes
From residual ribosomal RNA
instrument
297
BRAF
Malanocytes
- mutated in menanoma
- protein kinase
298
cilostazol
reduces platelet activation by inhibiting phosphodiesterase
-also a direct vaso dilator
299
ulcers in the distal duodnum
ZE syndrome caused by a neoplasm
300
how does alcohol cause hepatic statosis
decreased fatty acid oxidation because of an excess of NADH
- remember that it inhibits gluconeogenesis as well
301
what increases in heart failure
arteriolar resistance because the RAAS system is activated
302
incontinants win normal pressure hydrocephalus is caused by what?
Stretching of decending cortical fibers that normally inhibit the spinal micturation centers
303
sarcoidosis can cause an elevation in what enzyme
ACE
304
what differentiates a gastric errosin from a gastric ulcer
weather it errodes completely thought the muscularic mucosa
305
what do vascular endothelial cells synhtasize to inhibit platelet aggrigation
- prostacyclin
306
loss of DTR's in patient that has rheumatoid arthritis that is intubated
Vertebral sublaxation involving the atlantoaxial joint
307
what does excess bradykinin cause
angioedema
308
hemolytic anemia, thrombosis, and pancytopenia
paroxysmal nocturnal hemoglobinuria
-absence of CD55 on the surface of RBCs
309
renal involvment in patient with SA endocardidis
-circulated immune comples-mediated injury
310
how does nitro improve the symptoms of angina
decreaseing preload of the LV via venodialation
311
test for fructokinase defeciency
copper reduction test
312
pulsion
increased intraluminal pressure
-responsiable for false diverticulum
313
antibody in scleraderma
anti-centrimere
314
what part of the stomach does h. pylori colonize
the antrium or prepyloric area
315
if you don't see nuclei what should you suspect
necrosis
316
what pathologys can xanthomas (lipid layden macrophages on histolody) be associated with
primary biliary sclerosis and anything else that causes and increase in the release of cholesterol
317
what can Beta-thalacemia do to hemaglibin A1c
it can increase it because of increased cell turnover despite approprite glycemic control
318
cells involved in delayed hypersensativity reaction
macrophages, CD4+ cells, CD8+ cells, NK cells
319
Leading cause of esophageal SCC
Tobacco and alcohol consumption
320
what kind of kidney injury do NSAIDS cause
chronic interstitial nephritis
321
lab pattern in vWF deficency
prolonged bleeding time and PTT
-bleeding time is a marker of platelet function and there is a prolonged PTT as well because of the factpr VIII deficency that comes along with it
322
what does the PAS stain detect
it highlights polysaccharides of the fungal cell wall, mucosubstances secreted by the epithelia, and basement membranes
-can be used to detect wipple disease by reaction with the glucoprotein present in the cell walls on the gram + actinomycete
323
in order to diagnose someone with ARDS what must be normal
PCWP so that you rule out cardiogennic pulmonary edema
324
how can you diagnose wilsons disease
slit lamp examination of tissues
325
what are the water shed areas of the colon
- Splenic flexture
- Rectosigmoid junction
NOT THE HEPATIC FLECTURE
326
serum testing for SLE
decreased C3 and C4
327
pneumonic for SLE symptoms
S-serositic
O-oral ulcers
A-arthritis
P-photosensitivity, pulmonary fibrosis
B-blood cells
R-renal, raynauds
A-ANA
I-Immunologic markers (anti AM, anti ds DNA)
N-neuropsych
M- malar rash
D-discoid rash
328
odds ratio
with 2x2 table
ad/bc
329
what drugs end in -navir and what are their side effects
viral protease inhibitors used for treatment of HIV
They cause metabolic sideeffects like lipodystrophy, insulin resistance, and dislipidemia
they also inhibit cyp450 so they have many DDI's especially with rifampin
330
name the NNRTI's
Nevirapine
Efavirenz
Defviridine
all of them have "vir" in the middle
Side effects include:
- rash (SJS)
- Hepatotoxicity
- Neuropsychiatric effects like vivid dreams
331
side effects of NRTI's
- lactic acidosis
- Lipodystrophy
- pancreatitis
- bone marrow supression that is reversed with G-CSF
332
Integrase inhibitors names and side effects
- Dolutegravir
- Raltegravir
SE: myopathy
333
what part of the nephron collects the most water
proximal tubule
334
what birth defects cause an elevated AFP
- open neural tube defects
- Ventral wall defects (omphalocele, gastroschisis)
- multiple gestation
335
what causes a low AFP during pregnancy
Aneuploidies (trisomy, monosomy)
336
Connexins
gap junctions
337
claudins, occludin
tight junction
338
adherens junction
cadherens
339
hemidesmisomes
integrins
340
where is the bladder in respect to the prostate
bladder is anterior to the prostate
341
what is elevated in the amniotic fluid in fetuses with neural tube defects
- AFP
| - Acetocholenesterase
342
most common risk factor for developing calcium stones
hypercalciuria
343
what does ammonia cause depletion of
GlutaMATE and alphaketogluterate (which causes halting of the krebs cycle)
-it causes accumulation of glutamine
344
pressures in the heart
- RV==> diastolic is very low and systolic is about 25
| - moving to the left heart the diastolic increases but the systolic stays the same
345
erythemia multiform in herpies
is a reaction to a local infection, not a systemic one
346
MVP
caused by a degeneration of connective tissue
347
subthalamic nucleus
plays a role in basal ganglia output
-a stroke here can cause hemibalisimus
348
What causes septic shock with N. menengiditis
-Outer membrane lipopolysaccharide
349
LGN
vision
350
most common cause of spontaneous lobar hemorrhage
Cerebral amyloid angiopathy
351
how is lithium nephrotoxic
reduces the ability of the kidneys to concentrate urine by antagonizing the action of vasopressin in the collecting tubules and ducts
352
campylobacter
gram - oxidase + rod that can be transmitted from animals (like dogs) to humans
353
branches of what nerve are responsiable for the pain associated with external hemmroids
branches of the pudendal nerve
354
cAMP
FLAT CHAMP Gunner
- FSH
- LH
- ACTH
- TSH
- CRH
- hCG
- ADH
- MSH
- PTH
- GHRH
- Glucagon
355
cGMP
Anything that vasodialates causes an increase in cGMP
ANP, BNP, NO
356
IP3 (Gq)
GnRH, oxytcin, ADH, TRH, Histamine, Angiotensin II, gastrin
GOAT HAG
**If the end result is vasoconstriction think this pathway
357
Intracellular receptor
Vit D, estrogen, testosterone, T3/T4, Cortisol, aldosterone, progesterone
**don't forget that aldosterone and progesterone are steroid hormones
358
Intensic tyrosine kinase
Insulin, IGF-1, FGF, PDGF, EGF
**map kinase pathway, think growth factors
359
receptor associated tyrosine kinase
Prolactin, Immunomodulators (cytokines, IL-2, IL-6, IFN, TNF), GH, G-CSF, erythropoetin, thrombopoeiten
they can work thorough serene kinases
JAK STAT pathway
think acidophils and cytokines
360
effects of glucocorticoids on the liver
increases protein synthasis because of increased gluconeogenesis and glycogenolysis
-upregulate the synthasis of key gluconeogenic enzymes (PEP carboxylase)
**also increase hepatic glycogen reserves by increasing the expression of glycogen synthasis
361
Bile acid binding resins cause an increase in what
triglycerides
362
what do you absolutely need to make a diagnosis of thrombotic thrombocytopenic purpura
decrease in ADAMTS13 leading to microvascular thrombi and hemolitic anemia
- the other symptoms like renal failure, neurologic manifectations and fever only happen in a subset of patients
- the treatment is plasma exchange
363
equation for T1/2
t1/2=(0.7xVd)/CL
then to figure out the dosing you figure out how much should be excreted by a certen time (like 75%)
364
serrated polyp
iron deficency anemia, cauliflower like leasion
- jagged appearance
365
transformation
Direct uptake of naked DNA
366
transduction
bacteriophage conversion
367
history of pancreatitis and only dilated veins around the gastrc fundus
Splenic vein thrombosis
-causes increased pressure in the short gastric veins causing hematemisis and melania
368
when the IMA is out of the game, which artery supplies the decending colon
SMA
369
where does aspiration pneumonia happen
If the patient is supine: posterior segment of the right upper lobe and upper segment of the middle lobe
If the patient is upright and aspirates basilar segments of the right and left lung
more likely to go down the right main stem bronchus
370
for which enzyme does acetyl CoA act as an allosteric activator
first step of gluconeogenesis from pyruvate to oxcyloacetate
371
Major depression with psycotic features
- they only hear voices with their depressed mood.
| - compair with schizoaffective disorder where they have some episodes of hearing voices without mood swings
372
5' to 3' exonuclease activity
DNA pol 1
373
rectal administration of a drug
partially bipass firstpass metabolism
374
citalopram
Citalopram is an SSRI
use SSRIs to treat generalized anexity disorder
375
hypomania
- better functioning
- does not require hospitalizations
- no psycotic features
- characteristic of bipolar 2
376
Glyburide vs Glipazide
they are both second generation sulfonureas but glyburide has a greater risk of causing hypoglycemia
-glyburide and glimepiride are long acting and have a higher risk of hypoglycemia (think glip as in you only get a tiney glip of medicine)
377
esmolol
bets blocker
- prolongs PR
- no effect of potassium channels like sotalol
378
which nerve resides in the piraform recess and what is it responsiable for
- Superior lyrengeal nerve of CN X
| - responsible for cough reflex
379
best test to see if the gene is being transcribed
Northern blot to look for mRNA
**be careful to pay attention to the words transcribed and translated
380
how to thiozide diuretics prevent kidney stones
decreases rge amount of Ca2+ excretion in the urine
- it inhibits the Na+/Cl- transporter which activates the Na+/Ca2+ pump on the serum side pumping Ca2+ back into the blood
381
how do benzodiazapines act on GABA
they bind allosterically and increase the frequancy of opening
382
most important protection against influenza A
antibodies against hemagluttanin
-neutralize the virus and block binding to host cells
383
what forms the diaphragmatic surface of the heart
inferior portion of the left ventricle supplied by the posterior decending artery which comes off of the RCA
384
CA-125
epithelial ovarian cancer like serous cystadenocarcinoma and mucinous cystadenocarcinoma
385
Hawthorne effect
the behavior changes when the people getting monitered know it
386
sensation of the inner ear an passing out when it is stimulated is mediated by which nerve
Auricular branch of the Vagus
387
synaptophysin
neuronal origen
388
how is intracellular calcium is removed in cardiac myocytes by which mechanism
Na+/Ca2+ exchange pump (NCX) and sarcoplasmic reticulim Ca2+ ATPase pump (SERCA)
389
with ARBS is there an increase or decrease in aldosterone
there is a decrease because the ACE2 receptor is needed for aldosterone release
390
esiengmyer syndrome only in the lower extremities
think PDA which can lead to heart failure if large enough and left uncorrected
391
arterial vasodilation causes what
water and salt retention
392
milranone
PDE inhibitor that can cause vasodilation
393
what is the cause of aortic dissection
HYPERTENSION
394
KIT receptor +
systemic mastocytosis
| excess histamine causes gastric hypersecretion
