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Step 1 Journal RC > UWorld part 2 > Flashcards

UWorld part 2 Flashcards

1
Q

what does the middle meningeal artery branch off of

A

Maxillary artery

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2
Q

What does the maxillary artery branch off of

A

External carotid artery.

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3
Q

What is tachyphylaxis

A

Rapidly declining effect after a few days of use

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4
Q

alpha adrenergic agonists have tachyphlaxis, resulting in..

A

rebound rhinorrhea (which is nasal congestion w/o cough, sneezing, or post nasal drip. Rhinorrhea may or may not be present)

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5
Q

Nitroglycerine and tachyphylaxis

A

Dimished release of NO from target cells. ergo why you need drug free intervals of 8-10 hours.

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6
Q

How is fibromyalgia dx?

A

Dx made in pt with chronic pain and fatigue for >3 months in absence of physical or laboratory findings suggestive of an inflammatory etiology

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7
Q

tx of fibromyalgia

A

gradual incremental aerobic exercise
TCA
SNRI

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8
Q

Ankylosing spondylitis

A

Chronic inflammatory disease of the axial skeleton characterized by progressive pain and stiffness of the spine, sacroiliitis, and positive HLA-B27 serology

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9
Q

Dermatomyositis

A

autoimmune condition causing bilateral proximal muscle weakness assoc with violaceous eruption on the eyelids and knuckles and elevated creatine kinase levels

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10
Q

Polymalgia rheumatica is what

frequently assoc with what

A

Inflammatory disorder that affects patients >=50 yo and causes bilateral pain and morning stiffness in the shoulders and hips, weight loss, fever, malaise, and an elevated ESR

Freq assoc with giant cell (temporal) arteritis

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11
Q

Lichen planus

What might be on the plaque surface

A 
5 Ps
-Polygonal
-Planar
-Pruritic
-Purplish
-Plaques
on the wrists, hands, trunk, and legs

Finely reticulated scale termed Wickham’s striae may be present on the plaque surface.

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12
Q

Dermatitis herpetiformis presents how?

Strong association?

A

erythematous pruritic papules, vesicles, and bullae ahtat appear bilaterally and symetrically on the extensor surfaces.

Strongly assoc with celiac disease

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13
Q

why is dietary fructose rapidly metabolized compared to other sugars (glucose/galactose/mannose)

A

Dietary fructose is phosphorylated in the liver to F1P and is rapidly metabolized b/c it bypasses PFK-1, the major RLS of glycolysis.

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14
Q

Bone specific alk phos reflects ___ activity

A

osteoblastic activity.

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15
Q

what markers for osteoclastic activity and which is most reliable?

A

Urinary deoxypyridinoline (most reliable)
tartrate resistant acid phosphatase
Urinary hydroxyproline

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16
Q

How is bone specific ALK phos differentiated from liver alk phos

A

Bone specific is easily denatured by heat (bone=boil)

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17
Q

how to treat post operative urinary retention w/ incomplete bladder emptying?

A

Muscarinic agonist (bethanechol)
or
Alpha1 blocking drug

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18
Q

Enfuvirtide mechanism

A

binds to heptad repeat 1 (HR1) of gp41, preventing from undergoing conformational changes necessary for the viral membrane to fuse w/ the target cellular membrane. as a result HIV genome denied entry into uninfected CD4+ t cells

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19
Q

why does left ventricular ruptured free wall cause death

A

profound hypotension from cardiact tamponade, restriction of ventricular filling during diastole.

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20
Q

cardiac tamponade triad

A
  • elevated jugular venous pressure
  • profound hypotension
  • muffled heart sounds
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21
Q

First step in dx malabsorption

A

Sudan III stain of stool identifying fecal fat >7 g/day

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22
Q

schistocytes are dx of

A

traumatic mechanism, either Microangiopathic hemolytic anemia
or
Mechanical damage

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23
Q

HUS vs. DIC

A

in HUS, Coag system is not activated so coag tests are normal (pt and ptt)

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24
Q

causes of microangiopathic hemolytic anemia

A
  • HUS
  • TTP
  • DIC
  • Malignant hypertension
  • Metastatic carcinoma
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25
Q

pathophys of HUS

A

endothelial cell injury, isolated activation of platelets and formation of microthrombi.

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26
Q

TTP vs. HUS

A

TTP in adults w/ predominant neurological symptoms

HUS in children with predominant renal involvement

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27
Q

What characteristics common to both TTP and HUS

A

Fever
Thrombocytopenia
Microangiopathic hemolytic anemia

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28
Q

Tx for TTP or HUS

A

Emergent plasmapheresis

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29
Q

Dx for dubin johnsons yndrome

A

conjugated hyperbilirubinemia w/ direct bilirubin fraciton of at least 50% and an otherwise normal liver function profile must be present

Confirm w/ elevated urinary coproporphyrin I

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30
Q

histo feature of dubin johnson

A

normal but a dense pigment composed of epinephrine metabolites w/in the lysosomes can be seen

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31
Q

how does streptokinase work

A

forms complex with plasminogen, cleaving it to form plasmin. Plasmin cleaves fibrin, thereby dissolving thrombi

Streptokinase-plasminogen complex also destroys fibrinogen and clotting factors V and VII

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32
Q

SE to streptokinase

A

hemorrhage

hypersenstivity (b/c protein synth by beta hemolytic streptococci)

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33
Q

organism most commonly assoc with cryoglobulinemia is

A

hepatitis C virus

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34
Q

what organisms assoc with hemadsorption (hemagglutinins or glycoproteins w high affinity for RBCs expressed on the host cell)

A

Influenza

Parainfluenza

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35
Q

flucytosine use

mechanism

A

used in combo with amphotericin B for cryptococcal meningitis in AIDS patients

Nucleotide analog that competitively inhibits RNA synthesis in fungal cells

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36
Q

caspofungin mechanism

use

A

Blocks synth of glucan component of the fungal cell wall

active against candida and aspergillus.

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37
Q

griseofulvin mech

use

A

interacts w/ fungal cell microtubules, inhibiting mitosis

accumulates in keratin containing tissues and treats dermatophyte infections (microsporum, epidermophyton, trichophyton)

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38
Q

cyclosporine mech

and use

A

immunosuppressant in transplant patients to prevent rejection by decreasing IL2 production (thus inhibit T cell prolif)

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39
Q

Polyenes examples

mech

A

Amphotericin B and nystatin

Binds ergosterol molecules in fungal cell membranes and creates pores causing cell lysis. (especially leakage of K+)

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40
Q

most common locations for colon cancer

A

rectosigmoid is most common

ascending colon is 2nd most common

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41
Q

left sided vs. right sided colon tumors presentation

A

left sided tend to be smaller and cause obstruction

right sided cause bleeding, so iron deficiency anemia

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42
Q

what differentiates the different presentations of m leprae

A

lepromin skin test (m leprae antigens injected intradermally) differentiate between tuberculoid and lepromatous

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43
Q

deficiencies of C3 predispose to

A

encapsulated organism recurrent infections

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44
Q

deficiencies of C5-9 predisposes to

A

recurrentinfxn of neisseria meningitidis or n gonorrhoeae

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45
Q

leukocyte adheison deficiency is caused by what?

presents as

A

defect in D18, common component in many integrins, responsible for leukocyte adherence and transmigration through endothelial walls

presents with

  • Delayed separation fo the umbilical cord
  • Recurrent cutaneous infection w/o pus formation
  • poor wound healing
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46
Q

inherited defect involving interferon gamma results in

A

disseminated mycobacterial disease in infancey or early childhood. need lifelong treatment w antimycobacterial agents.

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47
Q

xla predisposes to

A

recurrent lower respiratory tract and giardia lamblia infection

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48
Q

use dependence of class I antiarrhythmics

A

1C>1A>1B

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49
Q

platelet derived growth factor receptor mutations play a role in

A

chronic myelomonocytic leukemia

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50
Q

tartrate resistant acid phosphatase stains positively in.

this condition presents with

A

hairy cell leukemia. the neoplasti cells are B lymphocyte precursors and are CD20+.

presentation

  • splenomegaly
  • fatigue
  • pancytopenia
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51
Q

Terminal deoxynucleotidyl tranfserase (TdT) is responsible for what?

is positive in what?

A

Adding nucleotides to the VDJ regions of the antibody gene for antibody diversity.

marker of immature lymphocytes both B and T.

Neoplastic cells in acute lymphoblastic leukemia (ALL) are TdT positive.

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52
Q

auer rods found in myeloblasts in AML stain positive for what

A

peroxidase.

auer rods indicate myeloid differentiation

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53
Q

prognosis of colorectal adenocarcinoma is directly related to what and not to what

A

related to stage of the tumor

NOT TO THE GRADE

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54
Q

what are the 3 clinical phenotypes of 21-hydroxylase deficiency

A

classic salt wasting

classic non salt wasting

non classic, delayed

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55
Q

treatment of congenital adrenal hyperplasia

A

administer low dose exogenous corticosteroids to suppress ACTH secretion. thus decrease androgen production.

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56
Q

medullary carcinoma of the thyroid gland is characterized by

A

extracelluar deposits of amyloid formed by calcitonin secreted from neoplastic parafollicular C cells

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57
Q

P450 Inhibitors

A

SICKFACES.COM

Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol binge/acute
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole

Grapefruit juice

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58
Q

P450 inducers

A

CRAP GPS induce me to madness

Carbamazepines
Rifampin
Alcohol chronic
Phenytoin
Griseofulvin
Phenobarbital
Sulfonylureas
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59
Q

what artery runs w/ the radial nerve

A

deep brachial artery

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60
Q

dermatomyositis presentation

A
  • proximal muscle weakness
  • violaceous discoloration of the upper eyelids (heliotrope rash)
  • Raised violaceous scaling eruption on the knuckles (Gottron’s sign)
  • CPK levels elevated
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61
Q

How does PTH act on osteoclasts to cause bone resorption?

A

binds to osteoblasts, stimulating them to release RANK-ligand and monocyte colony stimulating factor (M-CSF).

These two factors stimulate osteoclastic precursors to differentiate into bone-resorbing, mature osteoclasts

Also decreases release of Osteoprotegerin (OPG) a decoy receptor for RANK-ligand. this allows more interaction between RANK-ligand and the osteoclasts.

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62
Q

Where in the body is oxygen extraction the highest

A

myocardium. resting is 75%-80%, up to 90%.

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63
Q

in heart ischemia, how quickly do you lose contractility

how long before irreversible dmg

A

w/in 60 seconds. Although total ATP may still be normal, it is rapidly depleted from areas of the cell w/ high metabolic demand (cytosol surrounding the contraction fibers and electrolyte transport pumps)

reversible if less than 30 minutes. Keep in mind it won’t come back right away is it is stunned

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64
Q

heterophile antibody negative mononucleosis like syndrome dx is

A

cytomegalovirus infection

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65
Q

aseptic meningitis and herpangina (fever, posterior pharyngeal gray vesicles/ulcers) in children

A

Coxsackie A

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66
Q

PML from JC virus presentation

A

hemiparesis

visual field defects

cognitive impairment

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67
Q

What are the two major risk factors for developing ARDS, adult respiratory distress syndrome

what does it cause?

A

Sepsis and Shock are the two major risk factors for ARDS.

Presents with:

Non-cardiogenic pulmonary interstitial

intra-alveolar edema,

inflammation,

alveolar hyaline membranes

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68
Q

first line antiplatelet drugs

A

aspirin or clopidogrel

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69
Q

ticlodipine SE

A

neutropenia presenting as fever and mouth ulcers

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70
Q

where is low frequency sound heard best

A

at the apex of the cochlea near the helicotrema

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71
Q

where is high frequency heard best

A

at the base of the cochlea near the oval and round windows

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72
Q

acanthosis is what

and is assoc with what

A

increase in thickness of the stratum spinosum (b/w the granular cell layer and the basal layer of the epidermis)

Associated with psoriasis

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73
Q

Spongiosum is what

assoc with what

A

intercellular epidermal edema that histologically appears as an increase in the width of spaces b/w cells.

associated with spongiotic dermatitis,

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74
Q

acantholysis is what

assoc with what

A

loss of cohesion b’/w keratinocytes in the epidermidis or in adnexal structures.

assoc with spongiotic dermatitis.

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75
Q

Dyskeratosis is what

assoc with what

A

abnormal premature keratinization of individual keratinocytes. may be strongly eosinophilic and have small basophilic nuclear remnants.

found in diseases like scc

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76
Q

urticaria/hives is characterized by

A

superficial dermal edema and lymphatic channel dilation.

no epidermal changes are present

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77
Q

what has a high specificity for rheumatoid arthritis

A

antibodies to citrullinated peptides/proteins

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78
Q

what is citrullination

A

tissue inflammation causes arginine residues in proteins like vimentin to be enzym converted into citrulline. this changes protein shape and can serve as antigen.. Exaggerated response to this is seen specifically in Rheumatoid Arthritis.

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79
Q

what CD is found on all NK cells and binds to the constant region of IgG

A

CD16

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80
Q

what CD inhibits complement C9 binding

A

CD55 and CD59

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81
Q

What CD is endotoxin receptor found on macrophages

A

CD14

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82
Q

carcinoid syndrom

A 
BFDR
Bronchospasm and wheezing
Flushing
Diarrhea
Right sided heart lesion (valvular lesion and HEart murmurs)
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83
Q

if patient is on cyp450 3a4 inhibitor, what statin can u give them

A

pravastatin

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84
Q

ataxia telangiectasia is caused by what (mech)

presentation

A

defect in ATM gene leading to DNA double strand breaks and cell cycle arrest

(the As!!)
cerebellar defects (Ataxia),

spider Angiomas (telangiectasia),

IgA deficiency (repeated sinopulmonary infections)

increase in AFP

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85
Q

catalase positive organisms that become problematic in CGD

A

Staph aureus

Burkholderia cepacia

Serratia maracescens

Nocardia

Aspergillus

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86
Q

AFP marker

A

useful marker in cirrhotic pt at increased risk for hepatocellular carcinoma. regularly monitoring in this pt population is recommended.

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87
Q

CEA marker assoc with what

used for what

A

assoc with colorectal cancer

used for staging/planning. NOT screening

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88
Q

CA125 marker assoc w/

used for

A

assoc w/ ovarian cancer. also other malignancies and other benign.

not effective screening. monitoring temporal changes may be of benefit

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89
Q

PSA use

A

establish extent of prostate cancer and evaluate response to cancer treatment. controversial to screen.

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90
Q

Acid phosphatase marker assoc with

A

undergoing active osteoclast initiated bone resorption

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91
Q

LAD coronary supplies

A

anterior 2/3 of the interventricular septum

the anterior wall of the left ventricle

part of the anterior papillary muscle

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92
Q

left circumflex coronary artery supplies

A

lateral and posterior superior walls of the left ventricle via obtuse marginal branches

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93
Q

acute marginal branches arise from the right coronary areteyr to supply

A

wall of the rigth ventricle

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94
Q

what is carbamazepine used for

mech?

A

generalized tonic clonic seizures

simple and complex partial seizures

mood stabilizer in bipolar

trigeminal neuralgia

Mech: blocks voltage gated Na channels in cortical neurons, stabilizing in an inactivated state.

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95
Q

SE of carbamazepine

A

Bone marrow suppression

Hepatotoxic

ADH secretion (so SIADH)

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96
Q

ethosuximide mechanism

A

blocks T-type Ca2+ channels and decreases calcium current in thalamic neurons

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97
Q

detection of elevated amounts of ____ helps dx creutzfeldt jakob disease

A

14-3-3 protein

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98
Q

how to treat neonatal opioid withdrawal

A

tincture of opium

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99
Q

most common cause of meconium ileus

A

CF

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100
Q

Most common cause of death for CF patients

A

Pneumoniae

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101
Q

what is identified in about 50% of systemic b cell lymphomas and almost all primary CNS lymphomas occuring int he setting of HIV infection?

A

Epstein Barr Virus

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102
Q

in patients with Hypertrophic cardiomyopathy, how does dynamic left ventircular outflow tract obstruction occur

A

due to abnormal systolic anterior motion of the anterior leaflet of the mitral valve toward a hypertrophied interventricular septum

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103
Q

what drugs can increase serum uric acid levels

A

Niacin
Hydrochlorothiazide
Cyclosporine
Pyrazinamide

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104
Q

SE of niacin

A

increased uric acid
facial flushing/warmth (prevent w/ aspirin)
Hepatotoxicity at high dose
Worsening hyperglycemia in diabetic patients.

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105
Q

SE of statins

A

hepatitis
myopathy
myalgias

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106
Q

SE of fibrates

A

hepatotoxicity
myopathy (increased when in combo with statins)
Increase risk of cholesterol gall stones

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107
Q

SE of bile acid binding resins

A

GI upset
Impaired nutrient absorption and drugs
Hypertriglyceridemia

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108
Q

SE of ezetimibe

mechanism of ezetimibe

A

Elevations in liver enzymes
Myopathy

Mech: selectively inhibits intestinal absorption of cholesterol

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109
Q

Isoniazid MOA

A

inhibits mycolic acid synthesis

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110
Q

Rifampin MOA

A

inhibits bacterial DNA dependent RNA polymerase

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111
Q

Ethambutol MOA

A

Inhibits mycobacterial cell wall synthesis but with no effect on creation of mycolic acid. Unclear mechanism how.

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112
Q

Streptomycin MOA

A

Aminoglycoside antibiotic, inhibits bacterial 30S ribosomal subunit, halting protein synthesis.

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113
Q

Uses for streptomycin

A

Mycobacterium tuberculae

Plague (Yersina pestis)

Tularemia (Francisella tularensis)

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114
Q

prophylaxis for MAC (mycobacterium avium complex)

A

Azithromycin

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115
Q

what happens to amniotic fluid total protein and albumin concentrations from early gestation to term

A

Decrease by 50%

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116
Q

What happens to sphingomyelin over the course of pregnancy

A

unchanged. (it is phosphotidylcholine aka lecithin that increases in the mid 3rd trimester)

117
Q

acute drug intoxication of

depressed mental status/miosis/respiratory depression

A

heroin

118
Q

acute drug intoxication of

choreiform movements/tooth decay/tachycardia/violent behavior and psychosis

A

methamphetamine

119
Q

acute drug intoxication of

chest pain/seizures/mydriasis

A

cocaine

120
Q

acute drug intoxication of

violent behavior/hallucinations/nystagmus (horizontal or vertical)

A

PCP/phencyclidine

121
Q

MOA of PCP

A

NMDA receptor antagonist –>excess release of excitatory NT

122
Q

differences b/w PCP and methamphetamine

A

Meth is longer, lasting up to 20 hours

Nystagmus (vert or horiz) only seen in PCP

123
Q

cytoplasmic inclusions in oligodendrocytes

A

Describes

Progressive multifocal leukoencephalopathy

124
Q

Microglial nodules and multinucleated giant cells are characteristic of

A

Viral infections of CNS, (Found in HIV assoc encephalopathy for example)

125
Q

how does prion disease appear?

A

Affected gray matter undergoes spongiform change: vacuoles form within cytoplasm of neurons and neutrophils. Later grow bigger and form cysts, involving larger areas of the brain tissue.

No inflammatory changes.

126
Q

major adaptive immune mechanism that prevents reinfection w/ the influenza virus is

A

anti-hemagglutinin antibodies

127
Q

what hereditary syndromes are assoc with pheochromocytoma

A

MEN2A and MEN2B and Von Hippel Lindau disease

128
Q

Rule of 10s for what condition and what are the rules

A 
Pheochromocytoma
10% part of hereditary syndromes
10% bilateral
10% extradrenal
10% malignant
129
Q

femoral neck fractures associated with what vessel injury

A

medial circumflex (which supplies the majority of the blood suppply to the femoral head and neck)

130
Q

ergonovine test

A

most sensitive provocative diagnostic test for coronary vasospasm

131
Q

moa of ergonovine

A

ergot alkaloid that constricts vascular smooth muscle by stimulating both alpha adrenergic and serotonergic receptors. low doses induce coronary spasm, chest pain, and ST segment elevation

132
Q

phentolamine moa

A

alpha1 alpha2 adrenergic antagonist, therefore vasodilating drug

133
Q

tx for prinzmetal’s angina (variant angina)

A

nitrates

calcium channel blockers

134
Q

stabilizing force for secondary structure of proteins

A

hydrogen bonds

135
Q

Stabilizing force for tertiary structure of proteins

A

Ionic bonds
Hydrophobic interactions
Hydrogen bonds
Disulfide bonds

136
Q

why is there increased incidence of cholelithiasis in women who are pregnant or using oral contraceptives

A

Estrogen induced increased cholesterol synthesis by upregulating hepatic HMG-CoA reductase activity

Progesterone reduces bile acid secretion and slows gallbladder emptying

137
Q

meniere’s disease presentation

A

triad of

  1. tinnitus
  2. vertigo
  3. hearing loss
138
Q

Mechanism of meniere’s disease

A

increased vol of endolymph from defective resorption. This causes damage to both the vestibular and cochlear components of the inner ear.

139
Q

what is meniere’s similar to?

how is it different?

A

tinnitus/vertigo/hearing loss similar to mass lesions at the cerebellopontine angle (acoustic neuromas, schwannomas of CN VIII)

but the acoustic schwannoma would be progressive and constant not episodic w/ exacerbations and remissions as seen with meniere’s disease

140
Q

treatment of lung abcesses

A

Need to cover both anaerobic and aerobic bacteria. so give Clindamycin, the drug of choice for lung abcesses.

141
Q

what is most common in ALL, B cell or T cell derived. how can you differentiate?

A

B cell responsible for 70-80%

T cell has symptoms of mediastinal compression (esophageal or superior vena caval syndrome or respiratory symptoms)

B cell has fever, malaise, bleeding, bone pain, hepatosplenomegaly

142
Q

where does the coronary sinus empty?

A

right atrium

143
Q

what can cause coronary sinus dilation

A

pulmonary hypertension or any factor causing dilatation of the right atrium

144
Q

pulmonary pressure of

RA
RV
PA
LA
LV
Aorta
A 
RA:0/8
RV:4/25
PA:9/25
LA:2/12
LV:9/130
Aorta:70/130
145
Q

RPF is what

A

RPF=RBF(1-hematocrit)

146
Q

dx of schizophrenia

A

2 of 5

  1. delusions
  2. hallucinations
  3. disorganized speech
  4. grossly disorganized behavior
  5. negative symptoms

greater than 6 months, including PRODROMAL AND RESIDUAL PERIODS with at least 1 month of active symptoms

147
Q

canagliflozin mechanism

A

SGLT2 inhibitors, leading to significant glucose urinary loss (normally 90% of filtered glucose reabsorbed in proximal tubule)

148
Q

canagliflozin contraindication

A

moderate to severe renal impairment

149
Q

what drugs do u need to test thyroid function before taking

A

amiodarone

lithium

150
Q

what drugs do you need to test liver function and heart failure before taking

A

thiazolidinediones

151
Q

screening tests for treponema pallidum

confirmatory tests

A

screening with RPR or VDRL

Confirmatory with FTA-ABS

152
Q

isospora belli causes what

A

chronic watery profuse diarrhea in immunocompromised patients, especially AIDS

153
Q

how does trypanosoma cruzi cause achalasia/megacolon/megaureter/megaesophagus

A

releases neurotoxin that destroys the myenteric plexus and causes intramural parasympathetic denervation of smooth muscle.

154
Q

what bacteria produce IgA proteases

A

N gonorrhea
N meningitidis
Strep pneumoniae
Haemophilus influenzae

155
Q

peptidoglycan precursor molecules consist of

A

disaccharide of
N-acetylmuramic acid (MurNAc)
N-acetylglucosamine (GlcNAc)

156
Q

what do sulfonamide antibiotics compete with for incorporation into folic acid?

A

PABA (paraaminobenzoic acid)

157
Q

b12 vs. b6 deficiency, how are they different and why?. what does this result in?

A

b12 is respon for conversion of methylmalonyl CoA to succinyl CoA. thus elevation of methylmalonyl CoA seen only in b12 def

also the incorportaion of nonphys fatty acids into neuronal lipids results in the neurologic dysfunction.

158
Q

where do most nonsecretory adenomas arise from?

A

gonadotrophs. presents with mass effects and hypogonadism.

do not produce intact FSH or LH, instead overproduce alpha subunits.

grow slowly

159
Q

most common cell type in normal pituitay

A

somatotrophs (secreting Growth Hormone) 50%

160
Q

Most common pituitary denoma

A

prolactinoma

161
Q

hemophilia vs. platelet disorders

A

platelet disorders have petechial lesions, hemophilia DOES NOT.

162
Q

mild hemophilia is about what of normal

A

5% of pro-coagulant normal

163
Q

hemophilia vs. von willebrand disease

A

hemophilia has spontaneous hemarthroses but von willebrand disease does not

164
Q

platelet disorders cause

A

prolongation of bleeding time

petechiae

165
Q

von willebrand disease causes

A 
prolongation of bleeding time
increased PTT (b/c protects circulating factor VIII from degradation)
166
Q

desmopressin treats what

A

mild to moderate hemophilia A

167
Q

where does hydroxylation of proline and lysine residues in collagen occur

A

rough ER

168
Q

most common complication if SAH is survived. how does it present?

how is it seen?

how is it prevented?

A

secondary arterial vasospasm

new onset confusion and or focal neurological deficit 4-12 days after initial insult.

may not show on CT, but transcranial color doppler may see it.

prevent w/ nimodipine, a selective CCB

169
Q

most deadly complication of SAH

how does it present

how is it seen

A

rebleeding, not the most common overall (that is secondary arterial vasospasm). it is the most deadly though.

presents as sudden development of new severe headache, nasuea, vomiting, change in level of consciousness

Seen by CT

170
Q

what is contained in the superior colliculi

A

conjugate vertical gaze center

171
Q

horner syndrome is assoc with what

A

spinal cord lesion above T1
which occurs with…

Pancoast tumor
Brown sequard syndrome
Late stage syringomyelia

172
Q

what are the nuclei of vagus nerve and what do they do

A

I. Nucleus solitarius: conveys visceral sensory information (taste/baroreceptors/gut distension)

II. Nucleus Ambiguous: Conveys visceral motor innervation (Pharynx/Larynx/Upper esophagus)

III. Dorsal motor nucleus: Autonomic fibers (Heart/Lungs/Upper GI)

173
Q

thalamic syndrome characterized by

A

characterized by

total sensory loss on the contralateral side of the body.

no motor deficits

proprioceptoin profoundly affected

174
Q

lesion of internal capsule would cause

A

motor deficit

175
Q

ischemic events in pons frequently assoc w/

A
  • coma
  • bilateral paralysis
  • decerebrate rigidity
  • pinpoint pupils
  • death
176
Q

dmg to caudate nucelus assoc w/

A

transient hemiparesis

frontal lobe symptoms (inattentiveness, abulia, forgetfulness)

agitation/psychosis/choreoathetosis/dyskinesia

177
Q

lacunar infarctions are the result of what

what are the risk factors?

A

result of small vessel lipohyalinosis and atherosclerosis involving the penetrating vessels supplying the deep brain structures.

uncontrolled hypertension and diabetes mellitus are risk factors for this condition

178
Q

causes of congenital hydrocephalus

A

impaired csf outflow due to congen abnormalities like

  • Type II arnold-Chiari malformations
  • Hereditary aqueductal stenosis
  • prenatal infections (toxoplasmosis)
179
Q

presentation of congenital hydrocephalus

A

irritability
poor feeding
muscle hypertonicity and hyperreflexia (dmg from stretching of periventricular pyramidal tracts)

180
Q

presentation of acute hepatitis B infection

A

I. Prodrome
-serum sickness like: malaise, fever, rash, pruritis, lymphadenopathy, joint pain

II. Anorexia, nausea, jaundice, RUQ pain. elevated ALT AST, bilirubin and alkphos increase

181
Q

best way to prevent tetanus

A

maternal immunization w/ tetanus toxoid, this transfers protective IgG across placenta to the neonate.

182
Q

what change in blood pressure is seen in old people?

what is it caused by?

A

isolated systolic hypertension (ISH)

age related decrease in compliance/increased stiffness of the aorta and its proximal major branches

183
Q

erythrocytes and leukocytes in stool indicate

A

Enteroinvasive E coli
Campylobacter jejuni
Salmonella
Shigella

184
Q

Erythrocytes w/o leukocytes in stool indicates

A

Enterohemorrhagic E coli O157:H7 (toxin mediated enterocyte death and intestinal hemorrhage w/o mucosal invasion)

185
Q

leukocytes w/ monocytic predominance is typical for

A

typhoid fever caused by salmonella typhi

186
Q

leukocytes w/ neutrophilic predominance is typical of

A

invading bacterial that cause dysentery or inflammatory diarrhea

  • Shigella
  • Salmonella
  • Campylobacter jejuni
  • EIEC
187
Q

Watery diarrhea w/ no erythrocytes or leukocytes indicate

A

Vibrio cholerae

Enterotoxigenic E coli

188
Q

thiamine is a necessary cofactor for

A

pyruvate dehydrogenase
alpha-ketoglutarate dehydrogenase
transketolase

189
Q

growth pattern of strawberry type capillary hemangiomas

A

initially grow in proportion with patient, eventually regressing and completely by 7 yrs of age

190
Q

what happens in cystic fibrosis mechanistically most common?

A

3 bp deletion removing phenylalanine at amino acid 508. causes impaired posttranslational processing (improper folding and glycosylation) detected by ER. as result it is targeted for proteasomal degradation, preventing it from ever reaching the cell surface

191
Q

se of lithium involving kidney

A

antagonize vasopressin on principal cells w/in the collecting duct system.

192
Q

dysplastic vs. carcinoma is what

A

reversibility of changes. once the dysplastic cells have breached the basement membrane as seen in invasive carcinoma, the process is no longer considered reversible.

High grade dysplasia=carcinoma in situ

193
Q

microsopic findings in reye syndrome

electron microscopic findings

A

micro: microvesicular steatosis (presence of small fat vacuoles in the cytoplasm of hepatocytes). No necrosis or inflammation in the liver.

EM: Swelling, deceased number of mitochondria, glycogen depletion

194
Q

although u avoid giving aspirin to children under 16, what is an exception

A

aspirin is a mainstay of kawasaki

195
Q

characteristic light microscopy findings for viral hepatitis

A

apoptosis of hepatocytes

acinar necrosis

periportal mononuclear inflammatory inflammation

196
Q

characteristic finding in right sided heart failure patients

A

centrilobular congestion

197
Q

primary biliary cirrhosis displays what

A

bile duct destruction

periductal granulomatous inflammation,

bile duct proliferation.

198
Q

presentation of reye’ syndrome

A

hepatic dysfunction

encephalopathy (hepatic dysfunction and toxic effect of hyperammonemia on the CNS leading to cerebral edema)

199
Q

how does schilling test work

A

oral radiolabeled cobalamin and intramuscular unlabeled cobalamin. if URINE EXCRETION higher than 5% then normal. if lower, then repeat with intrinsic factor. If still low then pernicious anemia is ruled out and suggests malabsorption syndrome: pancreatic insufficiency/bacterial overgrowth/short gut syndrome

200
Q

three phases of dopamine action depending on dose

A

low: Dopamine D1 receptors (vasodilation and increased blood flow to mesenteric and renal)

Medium: beta1 (increased cardiac contractility)

High: alpha1 (vasoconstriction)

201
Q

what is normal in ARDS

A

pulmonary capillary wedge pressure is normal (elevated would suggest cardiogenic hemodynamic cause of pulmonary edema)

202
Q

most common brain tumor and presentation

A

metastasis (lung, breast, kidney, skin/melanoma). multiple well circumscribed masses at the junction of gray and white matter.

203
Q

most common adult primary brain tumor, and second, and third

A

glioblastoma multiforme

meningioma

acoustic neuroma

204
Q

neurovasc pairing:

axilla/lateral thorax

surgical neck of humerus
midshaft of humerus

distal humerus/cubital fossa

popliteal fossa

Posterior to medial malleolus

A

long thoracic/lateral thoracic

Axillary/Posterior circumflex

Radial/Deep Brachial

Median/Brachial

Tibial/Popliteal

Tibial/Posterior tibial

205
Q

McCune-Albright syndrome

A

precocious puberty

cafe au lait spots

fibrous dysplasia of bone

206
Q

Albright heredtiary osteodystrophy (aka type 1A psseudohypoparathyroidism)

A

pth resist at renal tubules leading to

decreased serum calcium, increased phosphate

Increase PTH release

207
Q

C3a does what

A

stimulates mast cell histamine release, causing increased vascular permeability and vasodilation

208
Q

what is critical for formation and maintenance of granulomas

A

Interferon-gamma
IL-12
TNF-alpha

209
Q

prader willi cause and presentation

A

maternal imprinting (normal and silent) but Paternal gene is deleted/mutated

hyperphagia, obesity, intellectual disability, hypogonadism, hypotonia.

210
Q

Angelman cause and presentation

A

Gene from dad is silent and normal. MAternal gene is deleted/mutated

inappropriate laughter, seizures, ataxia, severe intellectual disability.

211
Q

for prader willi and angelman syndromes, how else can it present other than normal silent and then deleted/mutated allele?

A

25% of prader willi and 5% of angelman have uniparental disomy.

212
Q

most common cause of lung abcess

A

peptostreptococcus
prevotella
bacteroides
fusobacterium

213
Q

risk factors for lung abcess

A 
alcoholism
drug abuse
seizure disorders
stroke
dementia

(conditions increasing aspiration risk)

214
Q

surface ectoderm gives rise to

A

skin and appendages
nasal and oral epithelium
anal epithelium to the dentate line
lens and cornea

215
Q

neuroectoderm gives rise to

A 
all neurons of the CNS
neurohypophysis
retina
pineal gland
preganglionic autonomic fibers
astrocytes
ependymal cells
choroid plexus
216
Q

mesoderm gives rise to

A 
muscles
bones
blood
genital tissues
dermis
most organ systems
NO EPITHELIAL SURFACES
217
Q

endoderm gives rise to

A

thyroid tissues

epithelial linings of the

  • GI tract
  • Lung
  • Urethra
  • Bladder
  • Outer and middle ear

Liver
Pancreas
Lungs

218
Q

notochord gives rise to

A

nucleus pulposus

219
Q

how does methyl capping work

A

5’ end of all mRNA capped with a 7-methylguanosine residue by a unique 5’ to 5’ linkage which occurs in 2 stages.

  1. addition of guanine triphopshate to teh 5’ end of the mRNA catalyzed by guanlyltransferase
  2. Methylation of the guanosine cap catalyzed by guanine-7-methyltransferase.
220
Q

noninflammatory diarrhea causes

A

ETEC
EAEC
V cholerae
C perfringens

221
Q

inflammatory diarrhea causes

A 
Shigella
EHEC
EIEC
C. difficile
C. jejuni
222
Q

presentation of elevated somatostatin

mechanism?

A 
abd pain
gallbladder stones
constipation
hyperglycemia
steatorrhea

(b/c inhibition of…

  • insulin
  • glucagon
  • gastrin
  • secretin
  • cck
  • gastrointestinal motility)
223
Q

presentation of VIPoma

A

intractable diarrhea
hypokalemia
achlorhydria
(hypotensive due to dehydration and vasodilatory)

224
Q

zinc deficiency presentation

A

erythematous skin lesions around body orifices that are predominantly vesicular and pustular w/o a central clearing

  • hypogonadism
  • azoospermia
  • hair loss
  • impaired taste
  • night blindness
  • impaired wound healing.
225
Q

presentation of glucagonoma

A

diabetes mellitus

necrolytic migratory erythema (elevated painful and pruritic rash affecting face, groin, extremities. over time coalesce to form large lesions w/ central clearing of bronze colored induration)

normocytic normochromic anemia resembling anemia of chronic disease

226
Q

who wouldnt you give an ACEI to?

A

patients dependent on efferent arteriole constriction to maintain renal perfusion (eg: renal artery stenosis). this can lead to acute renal failure

227
Q

heroin and pamidronate can cause

A

focal segmental glomerulosclerosis

228
Q

gold therapy can cause

A

membranous nephropathy

229
Q

aminoglycosides, radiocontrast media, cisplatin, amphotericin B , and foscarnet can cause

A

drug induced tubular necrosis (direct toxic or ischemic effects)

230
Q

Sulfonamides, methotrexate, intravenous acyclovir, triamterene can cause

A

drug induced tubular obstruction (intratubular precipitation of tissue degradation products, drugs, or drug metabolites)

231
Q

Methicillin (most common), cephalopsorin, acetazolamide, allopurinol, sulfonamides, NSAIDs, can cause

A

acute allergic interstitial nephritis

232
Q

lithium and cyclosporine can cause

A

chronic interstitial nephritis

233
Q

most common and second most common causes of cystitis and acute pyelonephritis

A

E. coli is most common 80%

Staph saprophyticus is 2nd

234
Q

major clinical manifestations of factor V leiden

A

DVT
Cerebral vein thrombosis
Recurrent pregnancy loss

235
Q

cord factor does what

A

mycobacterium can cause disease by

  • inactivate neutrophils
  • damage mitochondria
  • induce release of TNF
236
Q

dx of dubin johnson is made how

A

conjugated chronic hyperbilirubinemia with a direct bilirubin fraction of at least 50% and an otherwise normal liver function profile.

237
Q

treatment of digitalis toxicity

A

oral activated charcoal

manage serum potassium by insulin/kayexalate/hemodialysis (not calcium gluconate)

Digoxin specific antibody fragments

238
Q

how does PTH work?

A

acts on osteoblasts to stimulate secretion of monocyte colon stimulation factor and RANKligand. thus stimulating osteoclastic precursor to become mature osteoclasts.

239
Q

immune complex vasculitis assoc with IgA and C3 deposition

A

Henoch Schonlein purpura

240
Q

Henoch schonlein purpura presentation

A

purpuric rash
colicky abd pain
poly arthralgia

241
Q

wegeners/granulomatosis w/ polyangiitis presentation

A

nasal mucosal ulcerations (saddal nose if severe)
glomerulonephritis (oliguria)
serum cytoplasmic stainining antineutrophil cytoplasmic antibodies (C-ANCA)

242
Q

Takayasu arteritis presentation

A

weak upper extremity pulses, large vessel vasculitis involving aorta and proximal branches.

lesions are similar to giant cell arteritis

243
Q

Giant cell arteritis presentation

A

headache and blurred vision

244
Q

N-MYC overexpression seen in

A

Neuroblastoma

Small cell carcinoma of the lung

245
Q

most common primary CNS tumors in adults

A

Glial origin
Meningiomas
Pituitary adenomas

246
Q

GFAP found in

A

Astrocytomas (glioblastoma multiforme)
Oligodendrogliomas
Ependymomas
Peripheral neural sheath tumors

247
Q

how are meningiomas Dx?

also where are they from

A

from cells of arachnoid villi. Benign.

Dx by imaging, do NOT stain for GFAP or synaptophysin

248
Q

where is synaptophysin found

A

presynaptic vesicles of:

  • Neurons
  • Neuroectodermal
  • Neuroendocrine
249
Q

although liver is resistant to infarcts due to dual blood supply, when can it?

A

Transplanted liver undergoing hepatic artery thrombosis.

can develop biliary tree infarction and organ failure b/c the collateral blood supply is severed during transplantation.

250
Q

how quickly does irrev dmg in neurons occur during complete ischemia

A

5 minutes

251
Q

withdrawal of opiods

A 
dilated pupil
piloerection
hyperactive bowel sounds
lacrimation*
yawning*
252
Q

withdrawal of alcohol and benzodiazepines

A

seizures* (main diff from opioids withdrawal)
tachycardia
palpitations

253
Q

mechanism of griseofulvin

use for griseofulvin

A

binding of microtubular proteins

dermatophytes only

254
Q

SE of amphotericin B

A

Nephrotoxicity
Hypokalemia
Hypomagnesemia

255
Q

treat paroxysmal supraventricular tachycardia

A

Increase vagal tone by

  • Carotid sinus massage
  • Valsava maneuvar

if this fails then IV adenosine

256
Q

how does intestinal phase decrease gastric acid secretion

A

ileum and colon release peptide YY, binds to receptors on the endocrine, histamine-containing cells described as enterochromaffin like. This counteracts the cephalic and gastrin phases of acid secretion

257
Q

untreated sleep apnea leads to

A

pulmonary HTN

Right sided heart failure

258
Q

how does homocysteine get to cysteine?

A

I. Serine/B6/Cystahtionine synthetase

II.B6/Cystathionase

259
Q

how does homocysteine get to methionine

A

N-5-methyl-tetrahydrofolate and B6

260
Q

how can Down syndrome occur?

A
  1. Trisomy 21 (95%) by meiotic nondisjunction
  2. Unbalanced Robertsonian translocation (2-3%) 46 chr but extra arm of chr21 attached to another chromosome
  3. Mosaicism.
261
Q

findings for obstructive lesion in a mainstem bronchus preventing ventilation of an entire lung leading to lung collapse

A

Unilateral pulmonary opacification

Deviation of the mediastinum toward the opacified lung

262
Q

muddy brown cast

A

acute tubular necrosis

263
Q

where does hypoxia affect most in renal

why?

A

Proximal Tubules
Ascending limb of Henle’s loop

b/c located in outer medulla of the kidney, area w/ low blood supply.
AND
active (ATP consuming) transport of ions

264
Q

symptoms of temporal arteritis

A
  1. headache
  2. craniofacial pain syndromes
  3. polymalgia rheumatica
  4. Sudden vision loss
265
Q

polymalgia rheumatica is assoc with what?

presents how?

A

assoc w/ temporal arteritis/giant cell vasculitis

neck, torso, shoulder, pelvic girdle pain and morning stiffness

fatigue fever wt loss also.

266
Q

cAMP signaling

A

FLAT ChAMP

FSH
LH
ACTH
TSH
CRH
hCG
ADH (V2)
MSH
PTH
Calcitonin
GHRH
Glucagon
267
Q

cGMP signaling

A

ANP

NO (EDRF)

268
Q

IP3 signaling

A

GOAT HAG

GnRH
Oxytocin
ADH (V1)
TRH
Histamine (H1)
Angiotensin-II
Gastrin
269
Q

Steroid receptor

A

VETTT CAP

Vitamin D
Estrogen
Testosterone
T3/T4
Cortisol
Aldosterone
Progesterone
270
Q

Intrinsic tyrosine kinase

A 
Insulin
IGF-1
FGF
PDGF
EGF

MAP kinase pathway
Think growth factors

271
Q

Receptor assoc tyrosine kinase

A

Prolactin
Immunomodulators (cytokines IL-2, IL-6, IL-8, IFN)
GH

JAK/STAT pathway
think Acidophiles and Cytokines
PIG

272
Q

encapsulated bacteria

which are the most common

A

SHiNE SKiS

Streptococcus pneumoniae
Haemophilus influenzae
Neisseria meningitidis
E. coli
Salmonella
Klebssiella
Group B Strep

most common are
Strep pneumoniae
Haemophilus influenzae

273
Q

osteomyelitis in child w/ sickle cell disease, most common cause, then the next

A

Salmonella is the most common cause

Staph aureus
E. coli

274
Q

what can potency of inhaled anesthetic depend on?

what doesnt it?

A

can depend on

  • body temperature
  • decreases w/ increasing pt age

does not depend on:
type of surgery/duration of anesthesia/sex/height/wt

275
Q

C3b function

A

opsonization

276
Q

C3a, C4a, C5a function

A

anaphylaxis

277
Q

C5a function

A

recruits and activates

neutrophil
monocytes
eosinophils
basophils

278
Q

when do u give acute gout patients glucocorticoids

A

elderly w/renal dysfunction, because they can’t take colchicine or NSAIDs

279
Q

Klinefelter

cause

A

47 xxy
primary hypogonadism (elevated FSH and LH, low testosterone) long lower extremities
small firm testes
azoospermia

due to progressive destruction and hyalinization of the seminiferous tubules

280
Q

kallman

cause

A

low LH, FSH, low testosterone, decreased sperm

due to failed migration of GnRH cells and fomration of olfactor bulb

anosmia is also seen

281
Q

Drug induced lupus vs. SLE differentiate

A

DILE rarely has anti dsDNA seen in SLE.

282
Q

drugs that induce DILE

which are highest risk?

A 
Sulfonamides
Hydralazine
Isoniazid
Procainamide
Phenytoin
Minocycline
Quinine

highest risk seen in
procainamide
hydralazine

283
Q

portocaval anastomoses

esophageal varices
hemorrhoids
caput medusae

A

[portal circulation/systemic circulation]

Left gastric vein/Esophageal vein
Superior rectal vein/Middle and inferior rectal veins
Paraumbilical veins/Superficial and inferior epigastric veins

284
Q

main complications from varicose veins

Most common?

A 
painful thromboses
stasis dermatitis
skin ulcerations
poor wound healing
superficial infections

Venous stasis ulcers over the medial malleolus are the most common

285
Q

pilocytic astrocytoma vs. medulloblastoma

A

pilocytic astrocytoma has a cystic and solid component

medulloblastomas are always solid

286
Q

what is milrinone

A

phosphodiesterase inhibitor that increases cardiac contractility and decreases both preload and afterload

287
Q

what is the metyrapone stimulation test

A

blocks cortisol synthesis by inhibiting 11betahydroxylase (which converts 11 deoxycortisol to cortisol)

this should increase ACTH, serum 11-deoxycortisol, urinary 17-hydroxycorticosteroids (11-deoxycortisol is metabolized in liver to 17-hydroxycorticosteroids). failure to rise indicates HPA failure

288
Q

most common lung cancer in general population. Also in women. also in nonsmokers.

A

Adenocarcinoma.

289
Q

specific symptoms to graves disease

A

infiltrative dermopathy (pretibial myxedema) and exophthalmos

caused by autoimmune response against thyrotropin receptor that results in the accumulation of glycosaminoglycans w/in the affected tissues.

Step 1 Journal RC (9 decks)

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