UWORLD Q Flashcards
Which type of HLA is associated with Ankylosing sondylitis?
HLA-B27
HLA Class I Serotype
What neurotransmitter is important in the development of tolerance to morphine?
Glutamate
Fluid accumilation around the testical in a 5 month old infant is indicative of this kind of hernia
Indirect Hernia–> collection of fluid within the tunica vagnialis and hydrocoele
In which part of the nephron would PAH be lowest? Why?
In Bowman’s space.
PAH is filtered and secreted. The secretion takes place in the proximal tubule. Therefore the lowest concentration of PAH woul dbe up stream of that (Bowman’s space)
Young child of European descent with fair skin, light eyes, and musty or mousy ordor. (Also may see mental status changes)
What AA becomes essential? What enzyme is implicated?
Phenylketonuria (PKU)
Lack of phenylalanine hydroxylase causes a build up of phynylalanine with a lack of conversion to tyrosine.
Tyrosine becomes essential. Leads to a lck of pigment production and catecholamine production.
Two common side effects of statin therapy, elevation of what kinase is commonly seen?
Hepatic toxicity
Myopathy–> Creatine Kinase elevation
47XXY
What does this person look like?
What is the name of the Syndrome?
Kleinfelter Syndrome
Tall, Gynecomastia, Infertile
What is the major important step in gluconeogenisis?
Oxaloacetate –> Phophoenolpyruvate
Malate–>oxaloacetate–> Phophoenolpyruvate (by phosphoenolpyruvate carboxikinase [PEPCK])
15 y/o pt. with a low fever, cough and sore throat. What is the name of the cell seen on peripheral blood smear? What kind of cell is it?
Downey cell–> infection with EBV (infectous mononucleosis)
Proliferation of atypical CD8+ T-lymphocytes
Equation for net excretion of Substance A=
Net Excretion of Substance A= (inulin clearance)(Plasma concentration of substance A) - (tubular reabsorption of substance A)
Calculation of filtration of substance A?
Filtration of A= (inulin clearence)(Plasma concentration of A)
What interleukin is release from what cell in excess in chronic asmatic bronchiolitis?
IL-5 from Th2 helper cells–> activates eosinophils
–> leads to the excess release of eosinophilic granules–> **Charcot-leyden chrystals **
Infant’s urine is brought in and had turned dark or black on the way to the office. What is the disorder? What enzyme deficiency?
Alkaptonuria
Inadequate conversion of Tyrosine to fumerate by homogentisate 1,2-deoxygenase
Leads to a build up of homogentisic acid and onchronosis (dark pigment deposistion at mucos membranes)
This image is indicative of what disease? Why?
What other signs may this patient have?
What is the mode of inheritance of this disease?
Neurofibromatosis Type 1
Multiple cafe-au-lait spots and neurofibromas. This patient may also experience arthralgias, vision changes and headaches
-Autosomal dominant single gene inheritance of NF1 gene on chromosome 17
Medication used to help diagnose asthma in a patient
Methacholine Challenge (muscarinic agonist)
Decrease of FEV1 of more than 20%
Young child with tonsilar exudates that stain with aniline dye (methylene blue)?
What is the mechanism of pathogenisis of this organsim?
Cornybacterium diptheriae
(G+ polymorphic chinese letters on microscopy)
AB toxin- B gains access and A subunit inhibits protein synthesis by binding to EF-2 of ribosomes.
Which virus type (enveloped or non-enveloped) is sensitive to the action of ether and other organic solvents? Why?
Enveloped
The envelope is derived from the host’s lipid bilayer membrane and is disrupted by the ether–> loss of infectivity
Which Gp is important for the binding of platelets to vWF and the underlying collagen?
Which Gp is involved in platelet aggregation? Which moniclonal antibody blocks this function? How?
- GpIb is responsible for initial binding of platelets to the underlying collagen. This binding activates the release of ADP(clopidigrel) and thromboxane A2 (aspirin) to activate other platelets.
- GpIIb/IIIa is responsible for platelet aggregation. Multiple IIb/IIIa receptors are cross linked by fibrinogen and this function is blocked by drugs like abciximab.
What race female has a higher bone desity at similar ages?
Black female
A defect in debranching enzyme presents how?
What is the name for this disorder?
What is the normal function of the enzyme defect?
Cori disease (debranching enzyme defect) presents with:
–> hepatomegaly, hypoglycemia, hypertiglyceridemia, and ketoacidosis.
Debranching enzyme–> normally cleaves the last 3 or 4 glycogen at their alpha 1-4 linkages and moves them to the main chain. Then the alpha-1,6-glucosidase cleaves the last glycogen to liberate glucose.
McArdel’s Disease
Deficiency of Glycogen Phosphorylase in muscle (McArdel’s=Muscle)
–> increased glycogen in the muscles with no breakdown leading to painful muscle cramps and myoglobinuria with exercise
Pompe’s Disease
Deficiency of lysosomal alpha-1,4-glocosidase (normally cleaves glycogen A-1,4-glycocidic bonds)
–> Leads to a buildup of glycogen in all tissues but notably the heart leading to cadiomegaly.
(Pompe= buildup in the Pump)
Von-Gierke’s disease
Lack of Glucose-6-phosphatase dosen’t allow of liberation of glucose after the final step of glycogenolysis or gluconeogenisis.
Results in: severe fasting hypoglycemia, Marked increase in liver glycogen, increased blood lactate and hepatomegaly.
What antibody is present in high amounts and is very specific for RA?
Anti-cyclic citrullinated peptide antibodies (Anti-CCP)
What enzyme is present in herpes and varicella virus and is not in CMV and EBV and contributes to the effectiveness of drugs like acyclovir (guanisine analogue)?
Thymidine Kinase
–> present in HSV and VZV–> phosphorylates and activates acyclovir
CMV and EBV do not have this enzyme and therefore can not effectively activate acyclovir
Most effective treatment to raise HDL?
Naicin
Persistent vitelline duct is associated with what other developmental abnormality?
Meckel Diverticulum
What B blocker also has K+ channel activity and can prolong the QT interval?
Sotalol
Patient drinks a lot of alcohol then has palpitations. What is the abnormality and what is seen on EKG?
Atrial Fibrillation
Absent P waves
Clozapine should be followed with what test? Why?
CBC
Induces granulocytopenia
From what AA does NO come from?
Arginine
What are the two locations of ribosomes? Where do their respective products act?
Free ribosomes: synthesize cytosolic proteins
RER or Membrane bound ribosomes: Synthesize secretory, membrane bound, and lysosomal proteins.
Rh antibodies are what kind of Ig?
IgG
K+ sparring diuretics act in what part of the nephron?
Collecting duct
Patient with sarcoidosis, what cell is elevated in bronchiolar levage fluid?
CD4+ Lymphocytes
Glycerol is acted upon by what enzyme that is only present in the liver in the process of triglyceride breakdown?
Glycerol is acted upon by glycerol kinase–>glycerol-3-phosphate–>DHAP which then enters glycolysis
Cystic fibrosis is a defect in what kind of transporter?
CFTR–> ATP-binding casset Cl- transporter
Fenoldepam is used in what situation? What is its MOA?
It is a benzopine that is used in the Tx of hypertenisive crisis.
D1 receptor agonist that preferentially increases cAMP in renal, mesenteric and coronary beds–> vasodilation
A lesion in the right temporal lobe would result in what visual deficit?
“Pie in the sky” Left hononomys superior quadrantanopia
Due to compression of the upper portion of the optic radiation.
What is a serious complication of treatment of a trauma patient with mannitol?
The volume expansion from fluid being pulled from the ECF lead to an increase in vascular hydrostatic pressure and can lead to serious pulmonary edema.
Terbinafine acts as an antifungal by….
How do the -azoles act?
Inhibitbing squalene epoxidase
UAA, UAG and UGA all will cause the binding of….
Release factors
They are all stop codons
(U Are Away, U Are Gone, U Go Away)
Scare tissue after MI is composed promarily of what type of collagen and therefore will resemble what structures?
Type I collagen
-bone, skin, tendon
Paitent who presents with poilio most likely got the infection by what route?
Fecal oral
-Enterovirus: RNA vireus so nammed due to its fecal-oral transmission (aslso includes coxsackie virus and echovirus)
Esophageal varicies in cirrhosis are caused by portal-caval anastomosis between what two vein?
How about hemorrhoids and caput medusa?
- Esophageal varicies: Left gastric and Esophageal V.
- Hemorrhoids: superior rectal v. and middle and inferior rectal
Caput medusa: para-umbilical V. and Superior/Inferior epigastric
What is the function of Kinesin?
To carry vessicles away from the nucleus
e.g. Anterograde transport of NT in a neuron
Which antibiotic used to treat MRSA causes elevation of CPK and myopathy?
What is it’s MOA?
Daptomycin
MOA: Depolarization of pathogen membrane
What is the MOA of Vancomycin?
What is the most severe adverse side effect?
Inhibits polymerazation of murine monomers by binding to D-Ala-D-Ala and inhibiting glycoprotein syntheisis
–>nephrotoxicity
What types of drug are the choice in treating alcohold withdrawl symptoms?
Benzodiazepines
What drug will decrease the uptake of radioactive iodine? How?
Perchlorates
–>they compete for the N+/I- symporter
Characteristics of anaplastic cells:
- Loss of polarity
- Variation in size and shape
- Dysproportionately large nuclei
- Multinucleated giant cells
Most sensitive hormone test in menopause? Why?
FSH
–> FSH increases early in pregnancy due to the loss of estrogen negative feedback
What is the effect of estrogen on thyroid values and function?
Estrogen prevents the breakdown of thyroid binding globulin (TBG) and therefore causes an increase in bound and total T4 levels.
–>Free T4 and T3 levels remain normal and so the patient remains euthyroid and has a noral TSH.
Which interleukin allows for Ig class switching after presentation of an antigen? How?
IL-4
–> IL-4 activates TH2 cells and stimulates B-cells to class switch into plasma cells and produce IgG, IgM, and IgE to the offending antigen.
Deficiency of dihydropterin reductase causes a disease known as ______ ______.
What is the result of this deficiency?
-malignant or atypical phenylketonuria
–> BH2 can not be reduced back to BH4–> this results in decreased production of dopamine and therefore elevated levels of serum prolactin.
Factor contributing most to increased bone mass in a female?
Genetic factors
Most common cause of osteomyelitis in chidhood?
Sickel cell?
Pott disease?
Children- S. aureus
Sickel cell- Salmonella
Pott disease- TB
What is the most common laboratory abnormality seen in Legionella pneumophilia pneuomonia?
What are some other common Sx?
How about the etiology?
Etiology: Person who was on a cruise or trip to watery place (hotel)
Hyponatremia is a characteritic finding in L. pneumophilia
-High fever (>39c), watery diarrhea, pulmonary consolidation
Potter sequence/syndrome cause and Sx:
Oligohydramnios/Anhydramnios due to renal aplasia or agenisis
–> Club feet, nasal occular ear and jaw deformities and pulmonary hypoplasia.
What supplement can reduce the rate of stomatitis in methotrexate therapy?
Folic acid
What baseline test should be acquired before beginning statin therapy? When should this value be obtained again?
LFT
–>Should be tested again if the pt is experiencing anorexia, fever or malaise.
The metanephric bastema gives rise to what part of the kidney?
Bowman’s space, PCT, DCT, and collecting ducts.
Tetanus vaccine allows the body to produce antibodies that do what?
Bind to inactivate the tetanus toxin
What virus commonly causes aseptic meningitis in children?
Echovirus
Filtration fraction (FF)=
FF=(GFR/RPF)
Renal Plasma Flow (RPF)=
RPF= (1-HCT)(RBF)
What are the effects of the toxins associated with C. difficile?
A toxin: Chemoattractant for neutrophils resulting in mucosal swelling and diarrhea
B toxin: causes actin depolymerazation–> leading to loss of cytoskeleton integrity, and cell death and necrosis of mucosa
What is the most common cause of retinitis in AIDS pts?
What is it treated with?
What CD4+ Tcell count is associated with this infection?
CMV retinitis
Gancyclovir
CD4 count <50
Mnenomic to remember the Class I antiarrythmics:
Double Quater Pounder. Lettuce Tomato Mayo. More Fries Please.
Where are thyroid hormone receptors located?
Within the nucleus
How is the attributeable risk calculated? What is it?
ATR= (Relitive risk (RR)- 1) / (RR)
It is the risk attributable to a certain exposure
What MHC class is only presented by antigen presenting cells?
MHC Class II
What is a side effect of antipschotic use that can be relieved by M1 agonists? How does this reaction come about?
Acute dystonia and EPS
–> caused by D2 receptor blockade in the nigrostriatal pathway that leads to muscle spasm (torticollis) and parkinson like muscle tremors.
Occurs most frequently with stonger antipsychotics like haloperidol and fluphenezine
Wide, fixed splitting of S2 is indicative of what disorder? This can cause irreversible injury to what structure?
ASD
Pulmonary vessels
ARBs bind to this receptor:
AT-1 receptor
Leads to: increase renin, increased AT1 increased AT2 and decreased aldosterone
Patients with polycystic kidney disease are at risk for what kind of aneurysm?
Berry aneurysm
Tx with what class of drug has been shown to decrease mortality after a subarachnoid hemorrhage (SAH) d/t aneurysm rupture?
Calcium channel blockers
–> Neurologic deficits in a patient soon after SAH and PCKD
Aggregates of packed follicles in a patient with painless lymphadenopathy.
What disease, What mutation and gene product?
Follicular lymphoma
t(14;18)
BCL-2 overexpression
Which of the following viruses are acid stable? Explain.
- Coxsackie A
- Poliovirus
- Echovirus
- Rhinovirus
- Hepatitis A
- Rhinovirus
–> Polio, echo and coxsackie are all enterovirusis, all names so because they are stable in the GI tract
–> This is why rhino virus is respiratory
What two markers may appear in the amniotic fluid of a fetus with an NTD?
- alpha-fetoprotein
- acetylcholinesterase
–>both due to incomplete fusion of the neural tube
What drug can be givin IM during accute hypoglycemia?
Glucagon
Why does anemia of a patient with M. pneumonia resolve spontaneously after Tx?
Cold Agglutinins (Ab against RBCs) are what cause the anemia.
Once the infection is treated, the anemia will resolve.
Patient with joint pain and hard nodules at the pip joints?
Osteoarthritis
Bouchards and Haberdens nodes
B before H
RNA primer is removed by which enzyme?
DNA polymerase I
Trisomy 21 is at long term risk for what hematologic disorder?
ALL
(acute lymphoblastic leukemia)
Does cushing syndrome result in hyperplasia or hypertrophy of the zona faciculata and reticularis?
Hyperplasia
What structure lies just anterior to the esophagus and can be visualized on ultrasoundography?
Left atrium
What is the most common cause of torticollis?
Intrauterine malpositioning
What section of the nephron is impermeable to H20?
The ascending loop and the early distal convoluted tubule
What is the most common site of MRSA in a colonized individual?
Anterior Nare
Methicillin resistance arises from…..?
Mutations resulting in poor binding of drugs to penicillin binding proteins (PBP)
What is a buzzword sign of arsenic insectiside poisoning? How is it treated?
Garlic smell on breath
–>Tx with dimercaperol
Methimazole major MOA?
Inhibition of iodine peroxidase therefore organification and coupling of iodine.
What is a major side effect of amiordarone therapy? Blood studies for this shoul dbe conducted before starting amiodarone.
Thyroid dysfunction
Amiodarone is 40% iodine by weight!!!!
Ballooning and vacuolar degeneration with oxylate chrystals in the kidneys.
Ethylene glycol poisoning
To what part of the tRNA does the amino acid bind?
to the 3’/5’ acceptor end (the free end)
In fertility therapy, hCG is given to induce production of what other hormone?
LH surge
Trisomy 18 is associated with what musculoskeletal abnormalities?
How about GI?
Clenched hands
Over-riding pointer and pinky finger
Rocker-bottom feet
–> Meckel diverticulum
PSGN results is brought about by what mechanism? How does it appear on microscopy?
Immune complex deposition (antigens produced against the pathogen cross react with host glomerular basement membranes)
–> Lumpy-bumpy appearence
Para-aminobenzoic acid (PABA) protect against what form of radiation?
UVB only!
Clotting factors affected by warfarin…GO!
II, VII, IX and X
Protein C and S
What kind of antidepressants have a greater risk of inducing mania?
TCAs and venlafaxine
If immunoglobulins can not class switch, what class is default?
What are the signs and symtoms?
Hyper IgM syndrome–> IgM is the first in the translated region
–>recurrent mucosal infections due to lack of IgA
t(14;18) results in overexpression of this gene product
Bcl2
What are two short acting benzodiazepines?
Tirazolam and alprazolam
Increased MCV, anemia, poikoilocyes, and hypchromia in a mediterannian male?
B-thalassemia
Dysfunctional mRNA processing
Young male with fatigue, polydipsia, and polyuria. Unablt to gain weight.
Type I diabetes mellitus
Which myeloproliferative disorders are associated with a JAK-STAT mutation?
Primary myelofibrosis
Polycythemia vera
Essential thrombocytosis
Drug of choice for trigeminal neuralgia
Carbamazepine
What is the first drug given in the case of gouty flair up?
NSAIDs
Allopurinol and xanthine oxidase inhibitors are only given for prophylaxis
How does TNF-alpha affect the function of insulin receptors causing insulin resistance?
TNF-a activates serine kinases which phosphorylate the insuline receptor serine residues and renter the IR inactive (becuase it cannot phosphorylate its own tyrosine residues).
What is the typical presentation of fragile X syndrome in a male?
Mental retardation
Long face, prominent jaw, large ears and cleft palate
Large testicles
mitral valve prolapse
Short hight, joint laxity, pes cavus, double joited thumbs, and a single palmar crease
Homeobox containing genes typically code for what kind of protein?
Trascription regulators
Whcih antiarrythmic prolongs the QT interval but is not associated with tosades de points?
Amiodarone
Which CD marker is associated with monocyte/macrophage lineage and is implicated in the formation of granulomas in secondary TB?
CD14
From which aortic arch does the ductus arteriosus develop?
The sixth aortic arch
45’ or accute branching hyphae
Aspergillus fumigates
Cryptococcus neoformans causes what disease in immunocompromised individuals? What is the morphology of cryptococcus neoformans?
Cryptococcal meningitis
Budding yeast
Paget disease of the bone is characterized by what order of cellular activity?
Osteoclastic followed by osteoblastic activity in which collagen is laid down haphazardly.
Resulting in–> mosaic pattern of lamellar bone and irregular sections linked by cement lines
Inhibition of what component of the coagulation cascade will cause a prolongation of both the PT, and aPTT without affecting thrombin time?
Factor Xa inhibitors
What affect doe anesthtic solubility have on the blood/gas partition coefficient?
High solubility results in a high blood/gas partition coefficient–> this is because the anesthetic is diffusing into the blood faster than it can diffuse across the BBB.
The opposite is true for Low solubility gasses
Infant who is feeding poorly, lethargic, has prolonged jaundice, constipation, hypotonia and a hoarse cry might have what congenital abnormality?
What kind of hernia is common in these individuals?
Congenital hypothyroidism
Umbilical hernia
Patient with cough, lowgrade fever and hepatosplenomegaly. Pt. has HIV. Bone marrow aspirate shows the cell below:
Histoplasma capsulatum
–>Small ovoid bodies within a macrophage
What hormone regulates iron stores in the body? From what organ does it originate?
Hepcidin
From the liver
What cofactor is essential for this reaction?
Vitamin B6 (Pyridoxine)
What is the most common cause of community acquired pneumonia in an immunocompetant individual?
S. pneumonia
(capsulated, alpha hemolytic, optichin sensitive)
What kind of immune cell activates macrophages and allows them to form Langhans Giant cells in tuberculosis?
CD4+ T Lymphocytes
A patient on an antiplatelet drug developes mouth ulcers and neutropenia. What drug is this patient on?
Ticlopidine
What enzyme stimulated by cortisol is responsible for the conversion of NE to EPI?
Phenylethanolamine-N-methyltransferase (PNMT)
Yellow-brown pigment in the heart cells of an older person? What causes this?
Lipofuscin
–>product of free radical injury and lipid peroxidation
Blotchy red muscle fibers on Gomori trichrome stain is indicative of what kind of abnormality?
Mytochondrial myopathy
What is the drug most commonly associated with neuroleptic malignant syndrome?
Haloperidol
Conversion of what to what is affected in idividuals with 21-a-hysroxylase deficiency?
Progesterone–> 11-Doc
Pentazocine will cause withdrawl symtoms in a individual who was previously on opioids. Why?
Pentazocine is a partial agonist with weak antagonist activity at Mu receptors.
It was orriginally designed to reduce abuse potential
can T3 be converted to rT3?
NO.
Only T4 can be converted to T3 and rT3
What artery is at highest risk for injury in a femoral neck fracture?
Medial femoral circumflex
When a young male (5-15) with pes cavus, kyphscoliosis, and a wide based gait with ataxia presents to you, what is the diagnosis and what is the most litkely furture cause of death in this patient?
Friedrich Ataxia
–>Dilated cardiomyopathy is the most common cause of death
A female with a prolactinoma is also at risk for bone fractures, why? What other effect may this endocrine abnormality have on her personal life?
Prolactin in high levels supresses the GnRH axis, this leads to drecreased estrogen.
Decreased estrogen places the patient at increased risk for bone fracture and sexual dysfunction like amenorrhea and vaginal dryness.
Patient on Penelazine just ate at a pizza restaurant. What severe side effect is he at most risk for? Why?
Tyramine toxicity
Tyramine is a sympathomimetic and will cause hypertenisve crisis!!
What virulence factor is the cause of symtoms of septic shock from gram negative bacteria?
Lipid A from LPS
Activates granulocytes and Macrophages
Excessive PRPP in Lesch-nyhann syndrome leads to excessive activation of what enzyme?
PRPP amidotransferase
What is the only clinically significant virus that is ssDNA and non-enveloped?
Parvoviridae
Parvovirus B19–> Erythema infectiosum
Aplastic crisis in sickle cell and
How does resistance to rifampin develop?
Rifampin inhibits DNA-dependant-RNA-polymerase.
Mutations in the DNA-dependant-RNA-polymerase will cause resistance to rifampin.
Which histone is not part of the nucleosome core proteins?
Histone H1
H2, 3 and 4 are all part of the nucleosome core
Tumor in 20 year old that is causing vision changes and is filled with cystic spaces and brownish fluid. Also calcified.
Craniopharyngeoma
What antisiezure medication can cause generalized lymphdenopathy and gingival hyperplasia?
Phenytoin
Dysphagia and spooning of the nails is specific for what kind of anemia?
Iron deficiency
Absorption of what solute is increased by action of vasopressin?
Where does this take place specifically?
Urea absorption increases to help drive absorbtion of free water.
Medullary segement of the collecting duct
Absorbtion of what two solutes is imparied in the sweat glands of pts with cystic fribrosis?
Explain.
Na and Cl
CFTR is a transporter that is responsible for the transport of both Cl and Na. Cl is normally resorbed in sweat glands and Na follows to produce a hypotonic sweat. This is imparied in CF pts.
What is the purpose of entacapone in combination with levodopa in pts with parkinson disease?
entacapone inhibits COMT (catechol-O-methyl transferase)–> inhibits peripheral methylation and deactivation of levodopa
Tolcapone inhibits both peripheral and central methylation by COMT
What is the toxin in C. perfringins that causes cell lysis and death?
Alpha toxin- Phospholipase A2
Hydrolyzes phopholipids
What are the three short acting insulins?
Lispro
Aspart
Glulisine
“Short acting insulin doesn’t LAG”
What is the difference between the mechanisms of HBV and HCV that cause hepatocellular CA?
HBV–> caused by integration of the DNA into the host genome and prduction of Hbx which is a P53 inhibitor
HCV–> Cirrhosis causes genetic instability
What measurement is indicative of insulin resistance, metabolic syndrome and T2DM?
Waist-to-hip ratio
DOC for mucormycosis?
Who gets mucormycosis?
Amphotericin B
Diabetics
Is the relationship between GFR and serum creatinine linear or non-linear?
Non-linear
Why are people with silicosis at increaed risk for TB infection?
Reduced macrphage killing and therefore cell mediated immunity
Patients who develop lupus like syndrome are most likely what kind of acetylators?
Slow acetylators
DOC for lyme disease?
Ceftriaxone
How does filtration fraction relate to GFR?
FF=GFR/RPF
So they are directly proportional
In postmenopausal osteoporosis what are the typical values of PTH and calcium? (High, Low, or Normal)
Both NORMAL
What is the most common cause of meningitis in all ages of adults?
Strep. pneumo
What class of antiarrythmics show a use dependant prolongation of the QT interval? That is, as the heart rate speeds up, their prolongation increases due to less and less time for the drug to unbind form the receptor?
Class IC antiarrythmics
Na+ Ch inhibitor like Flecainide
Tx for DVT in pregnant patient?
Heparin
Location and cause of charcot-buchard aneurysms?
Basal ganglia.
HTN causes hyaline arteriolosclerosis which leads to small aneurysms and then hematomas with focal deficits.
What is the result of blockage of the gp41 protein on HIV?
What drug uses this mechanism?
Blocks fusion and entry of HIV into the host t cell.
Enfuviritide is a fusion inhibitor
gp120 blockage would inhibit attachment
What molecule would be rapidly depleted in anerobic muscle with inhibited action of lactate dehydrogenase?
NAD+
Needed to produce 1,3-BPG
What are the drugs of choice for heparin induced thrombocytopenia?
Direct thrombin inhibitors:
Argatraban, lepirudin, hirudin
Cannot grow in the presence of bile. Bile soluble.
Strep. peneumo
Lipophillic or lipophobic drugs are better eliminated by the liver?
Lipophillic and high Vd
India ink stain?
Tx in the case of meningitiis?
Cryptococcus neomformans
Amphoterocin B and flucytosine
Stem cell of alveoli?
Type II pneumocyte
Location of steroid receptor?
Cytosol–> then transported to the nucleus
Which interleukin is directly involved in chemotaxis and activation of neutrophils in infection?
IL-8
Of the anti-tuberculosis drugs, which is most known for causing visual disturbances?
What is the MOA of this drug?
Ethambutol
Inhibits arabosinyl transferase and thereby inhibits mycolic cell wall synthesis
Why do patients with cardiac myxomas also present with fever, weight loss, and other constitutional symptoms?
Myxomas produce IL-6
What cells is most directly responsible for the fibrinogenisis in atherosclerotic disease?
White blood cells
SMC are responsible for the intimal hyperplasia
Xeroderma pigmentosum defect?
DNA Excision repair
Anticoagulant that inhibits bothe factor Xa and thrmbin equally?
Which one inhibits Xa more strongly?
Unfractionated heparin
LMWH
Familial dysbetalipoproteinemia (lack of ApoE3 and E4) results in a buildup of what?
Chylomicron remanants because the liver can not take up chylomicrons or VLDL without ApoE
Pharyngealconjunctival fever is caused by what virus?
What are the symtoms?
Who gets it?
Adenovirus
Fever, conjuctivits, pharyngitis, cough, nasal congestion and enlarged cervical lymph nodes
People living in close quarters and small groups
High serum levels of what will cause insulin resistance?
Free Fatty Acids (FFA)
Malignant hyperthermia can be induced by what anesthetics?
What receptor mutation is it assciated with?
What is the Tx?
Succinylcholine and halothane
Associated with a mutated ryanodine receptor which reacts by releasing too much Ca++ from the sarcoplasmic reticulum. This leads to muscle rigidity as well as increased activity of the Ca++-ATPase on the sarcoplasmic reticulum. This all causes an increase in ATP demand and an increase in heat poduction.
Tx: Dantrolene
What to give to reduce uptake of toxic substances into the thyroid?
Iodine
BCR-ABL mutation and disease?
Chronic Myeloid Leukemia
Philadelphia Chromosome–> t(9;22)
What does ricketts look like histologically?
Accumilation of osteoid around the trabeculae
What is commonly seen on microscopy of islet cells in T2DM?
Amyloid deposition
What two drugs should a patient with suspected vaginal infection always be treated with?
Ceftiaxone and Doxycyline or azithromycin
Hemolytic anemia of blood transfusion presents how?
What kind of hypersensitivity reaction is it?
Fever, chills and body aches
Complement mediated destruction–> Type II Hypersensitivity
Which saccarhides do not need pancreatic enzymes to be absorbed?
D-xylose like glucose and galactose
Modified smooth muscle cells of the afferent arteriole are also known as?
Juxtaglomerular aparatus
CNIII passes between what two vessels as it leave the brain stem?
Posterior cerebral artery and the superior cerebellar.
Aneurysm in either can compress CNIII
Why should O2 be used with caution in people with long standing hypercapnea like COPD?
Becuase the primary driver of respiration (PCO2) is now desensitized.
The primary drive is hypoxia sensed by the carotid bodies and as O2 rises this suppresses breathing substantially
Type of cellular connection in osteocytes?
Gap Junctions
In essential fructoseurea, fructokinase is dysfunctional. Fructose can still be used in limited amounts due to the action of what enzyme?
Hexokinase
Drug that both decreases platelet aggregation and dilates blood vessels? MOA?
Cilostazol
Inhibits platelet phosphodiesterase increasing cAMP
This also dilates vessels
How have enterococci developed resistance to aminoglycosides like gentamycin?
By transfer of acetyl groups to the binding site
Most common location of a schwannoma?
Cerbellarpontine angle
The clear polygonal cells of renal cell carcinoma (Clear cell is most common type) are derived from…
Proximal tubular epithelial cells
MOA of carbemazepine?
block voltage gated Na channels in the CNS
What kind of drugs increase risk of lithium toxicity?
What are the symtoms of litium toxicity?
- Thiazides, ACE inhibitors, NSAIDs
- Tremors and ataxia
What gene is mutated in ataxia telangiectasia?
What is the resulting defect?
ATM gene
Defect in DNA repair
Live vaccines differ from killed vaccines in their ability to increase antibody production where?
Increased IgA on mucosal surfaces
Alcoholic in the hospital. Ater one day, has changes in vision, confusion and ataxia. What lead to this development?
Wernike Encephalopathy
–> Chronic alcoholics with thiamine deficiency given glucose without thiamine
A VIPoma is also know as what condition? What can be used to treat it?
Pancreatic cholera–> VIP increases pancreatic secretions and leads to a secretory diarrhea.
Can be treated with octreotide which inhibits VIP
What organisms most commonly cause secondary bacterial pneumonia?
Strep pneumonia
Staph aureus
Hemophilis influensza
Fragile X syndrome morphology and cause?
Long face, big nuts
CCG repeats and a mutation in DNA methylation
MOA of ethosuxamide?
Blocks T-type Ca channels in the thalamus
Which is the last section of the fetal ureter to canalize?
The uretopelvic junction (junction between the ureter and the kidney)
Chronic alcoholic is admitted to the hospital. What is the most likely symtom seen after several days of hospitalization?
Tremors from alcohol withdrawl
Which portion of the nephron is the concentrating segment? At which point is the osmolarity the highest?
The descending loop of henle is impermeable to electrolytes and is considered the concentrating segment.
Highest osmolarity is at the bottom of the loop
Pt was in a traumatic accident and the family informs you of a change in behaivor. (pt has become less inhibited and more vulgar as well as less organized). Where is the damage?
Frontal lobe
What and where is the purpose of carnitine?
Carnitine is joined to fattyacyl-CoA to facilitate transport into the inner mitochondrial membrane
–> a deficiency of carnitine will impair B-oxidation and therefore lead to lower levels of the associated ketones (Acetoacetate, and B-hydroxybuterate)
Which of the antifungals inhibit cyp-450 enzymes? What reaction is this?
What other drugs should be avoided with antifungals for this reason?
-azoles
Inhibit lanosterol-a-demethylase (cyp450 enzyme) and therefore inhibites the conversion of lanosterol to ergosterol
-avoid with: warfarin, phenytoin, isoniazide, rifampin, OCPs, cyclosporin etc.
Why is it so difficult to develop a vaccine against Hep C?
It’s RNA polymerase lacks 3’-5’ endonuclease proofreading.
This means that there is massive antgenic variation even within one individual.
Tetrodotoxin MOA and origination?
Pufferfish
–> Inhibits activation of Na+ channels
Causes parasthesias, loss of reflexes, nausea, vomiting, and weakeness
In transamination reactions alanine passes it’s nitrogen to what molecule? Then where does this go?
Alanine passes it to a-ketogluterate to form glutamate.
Glutatmate passes it to oxaloacetate to form aspartate wheich then enters the urea cycle and combines with citrulline to form arginosuccinate
What enzyme, present in epidermal basal cells, is responsible for TAAGAA repeats?
Telomerase
Present in stem cells and contributes to the indefinite life
What type of hypersensitivity reaction is contact dermatitis? (Poison ivy, oak, sumac, nickel)
Type IV delayed T cell
What enzyme has a defect in Xeroderma pigmentosum?
Endonucleases
Nucleotide excision repair
Rods in the cytoplasm of B cells?
Auer Rods
t(15;17)
Acute mylogenous leukemia
Specifically the M3 variant
Most dangerous toxicity of amphoterocin B?
Nephrotoxicity leading to cardiac dysfunction
A fib with RVR put on medication that causes an AV block. What medication?
Verapamil
Osteoclasts form from what cell lineage?
mononuclear phagocyte lineage
Formed when many precursors for together into multinucleated giant cells
Genetic imprinting involves what reaction with the DNA?
Methylation
What genetic immunodeficiency has a risk of developing anaphylaxis to blood transfusion? Why?
Slelective IgA deficiency
They have IgG against IgA and the donors blood may contain some degree of IgA which the patient will react to.
Conduction velocities of the following systems in order from fastest to slowest:
Atrial
Pukinje
AV node
Ventricular
Purkinje
Atrial
Ventricular
AV node
What are the stages of lobar pneumona?
Congestion
Red hepatization (2-3d)
Grey Heptization (4-6d)
Resolution
HUS is associated with what GI infections?
O157:H7
and
Shigella
(anything that contains the shiga or shiga-like toxin)
Smoker with a central lung mass composed of chromogrannin (+) cells
Small cell carcinoma
Is the pulmonary-capillary wedge pressure high, low, or normal in ARDS
Normal
Class I antiarrythmics (A, B, C) in order of Na channel binding strength?
1C>1B>1A
Triad of symptoms in vitamin C deficiency?
Where is collagen synthesized?
Bleeding Gums
Ecchymosis and Petechiae
Imparied wound healing
Rough Endoplasmic Reticulum
When giving leuprolide to a pt with prostate cancer, what are the typical levels of DHT and testosterone?
Leuprolide–> GnRH analogue
Initially causes an increase (start up flare) followed by a decrease of testosterone and DHT
What can Viridans strep produce that allows them to adhere to valves and tooth enamel?
Extracellular capsule composed of dextrans from SUCROSE
Ehlers danlos syndrome resuts in a defect in
extracellular protein cleavage
Function of 3-5 exonuclease on DNA-polymerase III?
Nick out and fic mismatched DNA
Signs of Lead poisoning?
Upper abdominal coliky pain (lead Colic)
Blue line on oral mucosa (lead line)
Peripheral neuropathy
Anemia
DOC for giardia?
Metronidazole
Side effect of amytryptiline? What is it typically used for?
Urinary retention from anticholinergic side effects
Diabetic neuropathy (TCA)
Most common cause of death with TCA intoxication?
Na channel inhibition resulting in arrythmia
Where in the gut are lipids absorbed?
Jejunum
Where in the gut are bile acids resorbed?
In the ilium
If someone has diplopia when they look down, what nerve and muscle are most likely affected?
Superior oblique
Trohlear Nerve
Excuisitly painful mass under the nail.
Name of the neoplasm? Function of the cells?
Glomus tumor
Thermoregulation
How does conn’s syndrome produce parasthesia and weakness?
Hyperaldosteronism leads to hypokalemia and HTN.
The contraction alkalosis further causes a Ca+ deficiency and the two combined produce parasthesias and weakenss
medication causing prolonged QT?
sotalol
Where does CMV get it’s envelope?
From the host membrane through budding
What fungus does mucicarmine stain for?
Cryptococcus neoformans
Pt with glycogen deposition in the heart and liver.
What dz? What Enzyme is deficient?
Pompe’s
Lysosomal-a-glucosidase
Which diuretic increases Ca+ reabsorbtion from the distal convoluted tubules?
Hydrochlorothyozide
–>Furosemide trashses it furiously (Loops lose Calcium)
(HCTZ has the letter C in it!!!)
Drug well known for causing aplastic anemia
Chloamphenicol
What is it called when a single gene defect results in multiple phenotypic manifestations?
Pleiotropy
Taking a multivitamin while on a carbadopa/levodopa medication.
Good or bad?
BAD
Multivitamins contain vitamin B6 wich increases peripheral conversion of levodopa to dopamine, no longer giving it access to the CNS.
What form of leukemia has an association with retinoic acid receptors?
Acute promyelocytic leukemia (M3 variant of AML)
t(15;17)–> codes for a abbarant retinoic acid receptor that does not allow for differentiation of myeloid precursors
Tx: All trans-retinoic acid
In what treatment regimine is fat redistributed from the arms and legs to the trunk?
HAART therapy
HIV
What drug is given as a test for prinzmetal angina?
Ergonovine
Mutation in polycythemia vera?
Jak-2 kinase
non-receptor tyrosine kinase
What kind of malignancies are associated with EBV?
Hodgkin’s lymphoma
Non-hodgkin’s lymphoma
Nasopharyngeal carcinoma
polyribosyl-ribitol-phosphate capsule
H. influensza
Stab wound in the fourth intercostal space on the left sternal border would puncture what vital structure?
The right ventricle
–> remember the right ventricle comprises most of the anterior surface of the heart
Serum ferritin and transferrin in an iron deficint patient?
Feritin low
Transferrin high
What MHC class presents antigens to CD8 Cells?
How about CD4 Cells?
MHC class I presents to CD8
MHC Class II presents to CD4 helpers cells
First line treatment for essential tremor?
Propanolol
A Beta2 agonist would have what affect on the uterus?
relaxation
An alpha2 agonist would have what effect on the pupil?
Mydriasis
During what phase of meiosis does trisomy 21 usually arise?
Nondisjunction of homologus chromosomes in maternal meiosis I
Mneumonic for cofactors needed in MSUD
Tender Loving Care For Nancy
Thiamine pyrophosphate, Lipoate, Coenzyme A, FAD, NAD
What three enzymes require Thiamine (B1)?
In what pathologic state is there disruption of these reactions?
Pruvate dehydrogenase
alpha ketogluterate dehydrogenase
Transketolase
What is wrong with the CFTR protein in CF patients?
A 3 base pair deletion results in the final protein missing an phenylalanine.
B/c a base pair is missing post translational modification and folding to the CFTR is disrupted. Results in eventual degredation by lysosomes.
Which steps of collagen synthesis occur in the fibroblast?
Which steps occur outside of the fibroblast?
- Inside fibroblasts:
- Translation of preprocollagen
- Hydroxylation of proline and lysine (ER) requires Vit C
- Glycosylation of pro-alpha-chain hydroxylysines and formation of procollagen and tripple helix formation
- Outside fibroblasts:
- Cleavage of disulfide rich terminals–>tropocollagen
- Reinforcement by lysine-hydroxylysine cross-linkages (with a Cu conatining enzyme) (Ehlers Danlos)
A patient defecient in what intracellular organelle would have difficulties with beta-oxidation of FA? Sx?
Peroxisomes
–>Zelwegger syndrome–> seizures and hypotonia D/T lack of proper myelination
What does an overdose on TCA look like? What is the Tx?
Tachycardia, flushed face, dry skin, dilerium
Sodium Bicarb
