Wk 8 block Flashcards
1
Q
All ribosomal RNA except rRNA is transcribed in the?
A
nucleolus
2
Q
Pts with antiphospholipid syndrome will have prolonged PT/PTT?
A
PTT (cardiolipin interferes with PTT test)
3
Q
A wet mount test is the same thing as a?
A
Saline microscopy
4
Q
The most likely bacteria to cause infection in a septic abortion is?
A
Staph aureus
Others: E.coli
5
Q
Long term complication of septic abortion?
A
Adhesions -> secondary amenorrhea and infertility (Asherman Syndrome)
6
Q
Tumors in the hypophaynx, larynx or base of tongue can cause?
A
Referred otalgia (ear pain) due to sensory contributions from CN 9 & 10
7
Q
When PD-L1 (programmed death ligand) binds to cytotoxic T cell, what do they do?
A
Inhibits their ability to induce apoptosis
** so many cancer cells upregualte PDL-1 receptors to avoid apoptosis.
8
Q
A fracture at the pteryion will risk damage to this blood vessel?
A
Middle meningeal artery leads to epidural hematoma
**branch of maxillary artery
9
Q
This maneuver can be used to abolish paroxysmal supraventricular tachycardia?
A
Valsava maneuver
Others; carotid massage (vagal stimulation)
10
Q
A patient presenting with sinopulmonary infections, Giardia Lambia gastro, failure to thrive and low immunoglobulins is suggestive of?
A
X-linked agammaglobunemia
11
Q
A patient presenting with sinopulmonary infections, Giadia Lamblia gastro, failure to thrive and low immunoglobulins is suggestive of?
A
X-linked agammaglobunemia
(failure of pre-B cells to mature)
Increased risk of infection with pyogenic bacteria
12
Q
N-acetlytransferase results in diminished ability to metabolize drugs such as?
A
Isonaizid & sulfonamides
13
Q
Erythromycin, in addition to being an antibiotic can also act to?
A
Increase gastrointestinal motility (acts as agonist on motilin receptors in the muscularis externa)
**can be used to tx pts with diabetic gastroparesis
14
Q
Intracellular receptors that directly act as transcription factors contain zinc finger binding domains and bind the following materials?
A
Steroids, Thyroid hormone and fat soluble vitamins (all pass through the lipid membrane into cytoplasm)
15
Q
Ligation of these arteries should stop post partum hemorrhage?
A
Internal illiac arteries (stops uterine blood flow)
16
Q
Treatment for narcolepsy include?
A
Pyschostimulants (modafinil)
2nd line: amphetamines
17
Q
Holoprosencephaly is an example of a ___ defect?
A
Field defect
**an initial embryonic disturbance (incomplete division of the forebrain) leads to multiple malformations by disrupting the development of adjacent tissues and structures.
18
Q
Down syndrome is associated with low levels of __ and ___?
&
high levels of__ & ___
A
AFP and estriol
B-hCG & inhibin A
**These 4 are known as the quadriple screen test.
19
Q
Omphalocele and gastroschisis and Neural tube defect and multiple gestation lead to high levels of?
A
AFP
20
Q
Infection by this organism can cause serpiginous tracks due to subq migration and pruritic rash?
A
Hookworm (contact from waking outside barefooted)
21
Q
What molecule stimulates neutrophil migration to sites of inflammation?
A
Leukotriene B4
22
Q
Thoracic outlet syndrome most often occurs due to compression of brachial plexus within?
A
Scalene triangle (made up to ant. and middle scalene and first rib)
*UE weakness, numbness, tingling with repetitive overhead arm movements.
23
Q
Ultraviolet rays damage DNA by cross-linking _____?
A
Pyrimidines
24
Q
Epidural hematoma?
A
Between bone and dura matter Often from MVA Affect middle meningeal artery Transient loss of consciousness Ipsilateral dilated pupil due to uncal herniation and CN III compression.
25
Which lung disease does diffuse cutaneous scleroderma present with?
Limited Cutaneous?
Interstitial lung disease
PAH (pulmonary HTN)
26
Low dose dopamine action?
Increasing doses?
High end of dose
Vasodilation via D1 (Incr. Blood flow) in renal and mesenteric vasculature
Stimulate B1 & A1 receptors (incr. CO)
Decr. CO (due to increased afterload)
27
What medication is first line for tx of aortic dissection?
Esmolol (given IV) helps to decrease contraction velocity and HR.
**can give vasodilators after not before (to avoid reflex tachy)
28
Are monoclonal Antibodies eliminated by hepatic or renal clearance?
NONE
**removed by target mediated drug clearance (endocytosis) and non specific clearance by immunoglobulins
29
Duodenal atresia is caused by?
| Jejunum/ileum atresia are caused by?
Failure of recanalization (double bubble sign) * asx with Down syndrome
Vascular injury. Apple peel or Christmas tree deformity. Asx with gastrcoschisis
30
This dz will px with a pruritic rash on flexor surfaces of wrist, finger, and webs?
Scabies
Dx: skin scraping.
31
What is wrong is Alkaptouria?
Disorder or tyrosine metabolism. Tyrosine -> Dopa (melanin & catecholamines) or Homogenistic acid (fumarate). In Alkaptouria Tyrosine is unable to be transformed to fumarate. Excess Homogenistic acid -> black pigments around the body.
32
Simple cuboidal cells are found in the female repro organ?
Ovary
| helps with repair of ovulatory surface defects from ovulation
33
Treatment of scabies?
Topical permethrin and/or ivermectin.
34
A retroperitoneal hematoma can also injure this nerve?
Femoral n
35
As patients get older, what happens to their bone marrow?
It gets replaced with fat (decreased mass)
36
Injury to the prostatic plexus or prostatectomy can cause?
Erectile dysfunction
** the prostatic plexus is found within the prostatic fascia (can be injured during surgery)
37
Hemorrhagic cystitis after chemotherapy (esp cyclophosphamide) can be prevented by?
Mesna. In addition: aggressive hydration, bladder Irrigation.
38
Flutamide MOA?
Non steroid anti-androgen that acts as competitive inhibitor of testosterone receptors.
**used in tx of prostate cancer
39
Tumor suppressor genes are involved in the following processes? (4)
DNA repair
Cellular differentiation
Checkpoints control of cell cycle
Transcription factor regulation
40
Patients with tx//castration resistant prostate cancer should be treated with?
17 alpha hydroxylase inhibitors (abiraterone). Block generation of androgen -> limit prostate cancer growth.
41
Bisphophonates is taken to tx this condition.
An adverse effect of this medication is?
Osteoporosis
Osteonecrosis of the jaw & medication induced esophagitis
42
Patients with Giant cell (temporal) arteritis will have elevated?
CRP and ESR
43
The most common causes of DIC in pregnancy is?
The release of tissue factor (thromboplastin) from an injured placenta.
44
Mitochondrial inheritance shows ______ ( genetic inheritance feature)?
Heteroplasmy (different mitochondrial genomes within a single cell) the severity of dz is dependent on the proportion of abnormal to normal mitochondria within a patients cell.
45
SLE can have antibodies against snRNPS (anti-Smith). What are snRNPS?
Small nuclear DNA (snRNA) complexed with Specifc proteins to form snRNPs (an essential part of spliceosomes).
46
Horizontal transection of the rectus abdominis at the level of the arcuate line (cesarean section)could damage this structure?
Inferior epigastric artery
47
Painful enlargement of the thyroid gland is suggestive of?
Subacute granulomatous thyroiditis (de Quervain)
**histology will show mixed inflammatory infiltrate with macrophages with multi-nucleated giant cells
48
Subacute granulomatous thyroiditis usually occurs after?
Acute viral illness.
**Incr in acute phase markers (ESR & CRP)
49
BCL-2 is an antiapototic protein that prevents cancer death in CLL by this MOA?
Overexpression of BCL-2 - prevents trigger of the intrinsic apoptotic cascade via release of cytochrome C from the mitochondria and subsequent activation of caspases.
50
Osgood-schlatter disease is characterized by anterior knee pain and swelling due to chronic avulusion of the?
Tibial tubercle.
**quadriceps attach here
51
Delayed stage (skin induration) of T1 HS rxn is due to?
Local tissue damage caused by major basic protein released from eosinophils
**occurs hours after exposure
52
3 ways that Down syndrom can be inherited?
Meiotic nondidjucntion
Unbalanced Robertsonian translocation
3. Mosaicism: some cells have an extra copy of chromosome 21
53
Why would a pt with Klinefelter syndrome px with gynecomastia?
In Klinefelter syndrome -> damaged sertoli cells (lack of inhibin feedback) & damaged leydig cells (low testosterone) -> excess gonadotrophins -> Increase estrogen levels.
**Azoospermia & infertility
54
Dissection of axillary lymph nodes during a mastectomy can damage this nerve?
Long throacic n -> weakness in serratus anterior -> winging of scapula
55
Most immediate physical symptoms of marijuana use?
Tachycardia & conjuctivial injection (red eyes)
Others: increased appetite and dry mouth
56
Difference between polymyalgia rheumatica & fibromyalgia.
PR - older age >50. Inflammatory condition. Inc in acute phase protein - ESR & CRP
Fibro: w/t neuro symptoms and tenderpoints and fatigue
57
What tests can support the diagnosis of chronic pancreatitis (3)?
Low fecal elastase (not degraded) + sudan staining and elevated Hgb A1C
58
What is the function of a p-glycoprotein?
Also known as permeability-protein. Efflux pump found on brain capillary endothelial cells (Part of BBB) -> inhibit a wide range of substrates from entering the brain.
59
PAS stain helps in staining this products?
Glycoporoteins of cell wall.
60
Why is Bicalutamide is usually administered with GnRH analogs?
Prevent initial surge
61
Patients with IL-12 efficiency are susceptible to?
Severe mycobacterial infections (inability to mount strong cell mediated granulomatous immune response) due to lack of IFN-alpha
62
What is Methynaltrexone?
Peripherally acting mu opoid antagonist (can be used to treat constipation w/o inducing withdrawal symptoms)
63
What type of immunity do TNF-alpha inhibitors impair?
Cell mediated immunity (increased susceptibility to TB)
**evaluate for TB first before starting theraphy
64
Valproatic acid leads to neural tube defects by decreasing levels of?
Folic acid
65
Peripheral smear in leukomoid reaction will show this in neutrophils?
Dohle bodies (basophilic oval granules/inclusions)
66
Irritation of what nerve causes hiccups?
Phrenic nerve
**any abdominal process (ruptured spleen, peritonitis, hemoperitoneum) can irritate this n.
67
Peritonitis can cause referred pain to the?
Shoulder (kehr sign)
68
Rapid onset of numerous seborrhagic keratosis is typically indicative of?
Internal malignancy (leser-trelet sign)
69
Wrinkled tissue paper appearance of macrophage in bone marrow aspirate is associated with?
Guacher dz (Lipid laden Macrophages)
70
Guacher dz presents with?
Incr levels of B-glucocerebrosidase deficiency. Pancytopenia and hepatomegaly.
71
Cytotoxic (early) edema that begins hours after an ischemic brain injury is due to?
Decreased ATP (due to failure of ATP dependent pumps) -> Na accumulate in cells-> water follows -> swelling.
72
When does vasogenic edema occur after an ischemic stroke?
24-48 hours later after inflammatory mediators disrupts tight junctions of BBB
73
How does human placental lactogen affect maternal glucose?
Causes insulin resistance -> incr glucose -> help provide nutrient for growing fetus.
74
Postural muscles (e.g paraspinal) are type I or 2 fibers?
Type 1 slow twitch with high number of mitochondria.
75
Non disjunction occurs due to failure of homologous chromosome to separate in?
Meiosis
** or failure of sister chromatids to separate during meiosis II or mitosis
76
Pts with homocytsinuria respond dramatically to?
B6 - pyridoxine supplementation
77
Object lodged in the piriform recess may cause damage to this nerve impairing the cough reflex
Internal laryngeal n. (branch of CN 10)
78
Which nerve travels through the guyon canal?
The ulnar n (enters between the hook of hamate and pisiform bone)
79
PECAM-1 is responsible for this neutrophil action during inflammation ?
Transmigration
80
ICAM is helps neutrophils acheivethis action?
Tight adhesion and crawling
81
E -selectin/P selectin on endothelial cells help neutrophils perform this action?
Rolling
82
Abnormal bleeding in uremia affects only this value?
Prolonged bleeding time (toxins impair platelet aggregation)
83
Adrenalectomy of the zona glomerulosa will lead to these sx?
Electrolyte abnormality -> parasthesia and muscle weakness.
84
What is a competitive inhibitor of alcohol dehydrogenase and acts as a treatment for ethylene glycol or methanol poisoning?
Fomepizole
**ethylene glycol - kidney injury
Methanol injury - blindness
85
To prevent congenital rubella effects utilize a ____ vaciine?
Live attenuated virus vaccine
86
Anal fissure often happen at this location?
Posterior mid-line (due to decreased blood flow to this area)
87
Pelvic fracture of ten damage this part if the male GU?
Posterior urethra
**px with full bladder sensation, boggy prostate and blood at meatus
**Anterior ureter - saddle injury
88
Genetic abnormality in DiGeorge is due to?
Microdeletion
89
Gold test for Di George syndrome?
FISH
90
Pathology for Bloom syndrom?
Mutation in BLM gene which codes for helicase -> chromosomal instability to breakage -> growth retardation, facial anomalies -> photosensitive rash -> immunodeficiency
91
In which type of carcinoma do you see signet ring cells?
Diffuse carcinoma (linitis plastica)
**due to loss of ecadherins
92
2 signs associated with gastric adenocarcinomas incleuse?
Sister mary joseph nodule (periumbilical nodes)
Virchows node (supraclavicular node)
93
Paget dz of bone often present with increased amounts of this molecule?
Alk phosphatase (increase formation of new bone)
94
Pts with androgen receptor dysfunction (AIS - androgen insensitivity syndrome) in will px with these symtoms?
Decreased facial, axillary and pubic hair. Also oligospermia, gynecomastia, undervirilization
95
Necrotizing entercolitis is associated with these 2 thins?
Premature & eteral feeding
96
Characteristic neuroimaging findings in Huntington include?
Enlargement of the frontal horns of the lateral ventricles.
**Atrophy if caudate nucleus and putamen
97
Serum sickens is a Type ____ HS rxn and is characterized by?
Type 3 HS rxn
Characterized by vasculitis that arise from deposition of immune complexes.
**can occur following administration of monoclonal antibodies
98
Red man syndrome is a (mast cell activation) reaction to this _____ antibiotic that is NOT _____ mediated?
Vancomysin
Not IgE mediated]
**infuse slower and symptoms will stop
99
This is an essential protein in the activation of Interleukin 2 that promotes the growth and differentiation of T cells?
Calcineurin
**tacrolimus and cyclosproine (used in transplant patients) inhibit its activation
100
The recognition sequence in tRNA is?
CCA (at 3' end) - serves as AA binding site
tRNA will have chemically modified bases (pseudouridins, dihydrouridine etc)
101
Epistaxis is commonly caused by the irritation of highly vascular muscosal of ?
Nasal septum (has kiesselbach plexus - anastamoses)
102
Which type of Cushing Syndrome (ACTH dependent or ACTH independent causes hyperpigmentation?
ACTH dependent
| melanin is a product of POMC - ACTH precursor
103
Which neuro effect is associated with Chediak-Higashi syndrome?
Nystagmus and progressive peripheral neuropathies.
104
What is the most powerful stimulator of Phosphorylase Kinase (activate glycogen phosphorylase to start breakdown of glycogen) in muscle cells?
Calcium release
105
C1 inhibitor deficiency will px as?
Angioedema
* C1 inhibitor also inhibits kininogen -> bradykinin (a potent vasodilator) so in its absence -> excess bradykinin -> angioedema
106
Releasing factors recognize ___ codons?
stop codons
**UAA, UAG,UGA
107
In contact dermatitis which T cells are primary effector cells?
CD8 cells
108
The only histone protein not a part of the histone -DNA (nucleosome) core complex is?
Histone H1 (helps package nucleosome in t more compact structures by linking adjacent DNA
**made up of 8 (2 each of 2A, 2B, 3, 4)
109
Antibody-drug conjugates help improve drug efficacy in chemotherapy?
allowing conventional agents to selectively target and kill cancer cells (while sparing healthy cells) Targeted delivery
(eg EGFR + csispalstin)
110
ALS can affect this organ that is important for breathing?
Diaphragm
**can result in dyspnea and respiratory failure
111
Rate limiting step in heme synthesis is?
An important cofactor for this step is?
ALA synthase
B6 (pyrodixine)
112
Which structure contains the ovarian artery, vein, lymphatic and nerves?
Suspensory ligament
113
Head lice is known as?
Pediculus humanus capitis
114
How are C- peptide removed from the cell
Stored in granules until secretion from the cell via exocytosis
115
Prolonged exposure to loud noises causes hearing loss due to damage to?
stereociliated hair cells of the organ of corti
High frequency hearing gloss is lost first regardless of frequency of sound causing damage
116
Flattening of deltoid m with acromial prominence after shoulder injury is indicative of?
Anterior humerus dislocation (blow to abducted and externally rotated arm)
*loss of axillary n -> deltoid paralysis and loss of sensation over lateral shoulder
117
What is the most common GI complication of Downs Syndrom?
Duodenal atresia
Others: imperforate anus, Hirsprung, tracheoesophageal fistula and celiac dz
118
The superficial and deep inguinal rings are physiologic opening s of ?
The external abdominal oblique muscles and transversus abdomins muscle
119
Reducing sugar tests used in the testing of essential fructosuria contain this material?
Cooper (is a copper reduction test)
120
A painless solid mass should be considered to be ____ until proven otherwise?
Testicular cancer
121
Hypothyroid myopathy presents with these sx?
Myalgia, proximal m. weakness, elevated CK levels, DELAYED RELAXATION of deep tendon reflexes.
122
What cells release IFN- gamma?
T lymphocytes
123
What type of cells do NK cells recognise?
Cells with decreased MHC class i antigen expression ( e.g virus infected cells ad tumor cells)
124
Icthyosis is characterized by dermal dryness and scaling and drying that primarily affect the trunk and extensor surface of extremities is caused by?
Mutation in filaggri gene -> epidermal hyperplasia -> defect desquamation -> loss if normal barrier function
125
Why does the hepatititis C virus have many sub-types and is genetically unstable?
lacks proofreading 3'-5' exonuclease activity in its RNA polymerase.
126
Which enzyme is unregulated during inflammation by IL-1 and TNF-alpha?
COX-2
127
Most aggressive form of breast cancer?
HER2
| **responds to anti-HER mab - trastuzumab. Is tyrosine kinase active -> increase cell proliferation
128
Which DNA polymerase has both 5'-3' exonuclease activity in addition to 5'-3' polymerase and 3-5' exonuclease actitivities?
DNA polymerase 1
129
Spliceosomes remove introns containing ___ at the 5' site and __ at the 3' site?
GU
AG
130
In Lower extremities, the medial track runs up to the ____ LN by passing the ___LN.
superficial inguinal LN
popliteal
**the lateral tracks go through both the popliteal and inguinal areas
131
Loperamide an opoid agoinist doesnt cross the BBBand inhibits ___ release?
aceytocholine
132
Give this medication for severe agitation and psychotic manifestations of delirium?
Haldol
133
Difference between chain composition of MHC I & MHC II?
MHC 1: 1 heavy chain and a B2 microglobulin
MHC II - 1 alpha and 1 beta chain
134
Severe diabetic acidosis ca leas to eventual?
Respiartory failure (inability to compensate)
135
Incretins work in the gut by stimulating insulin release through production of 2 secretions in the absence of glucose?
GLP - Glucaon like peptide and GIP
136
Difference between MHC I and MHC II?
MHC 1- on all cells, activates CD8 -> apoptosis
MHC II - on APC cells, activates CD4 -> activates cell and humoral immunity
137
Osteoporosis affects this part of the bone first?
Trabecular (thinning and perforation with loss of interconnecting bridges)
138
Duchenne Muscular dystrophy is caused by ___ mutation?
Frameshift -> truncated dystrophine gene
** Or nonsense mutation
139
A fall on outstretched hand can lead to dislocation of the ___ bone that can compress the median n?
Lunate
140
What are the acute phase proteins?
CRP & Fibrinogen
Acute phase protein increase ESR (non specific marker for inflammation)
141
Effects of growth hormone are mediated by?
Insulin like growth factor
**growth and development of bone, cartilage and soft tissue
142
Entanercept MOA?
Acts as decoy receptor of TNF-alpha -> reduces biological activity
143
Androgenic alopecia MOA?
Greater DHT effect (increased local coversion of Testosterone -> DHT) -> progressive hair loss.
144
Tt of androgenic hair loss?
%alpha reductase inhibitor -> decrease conversion of testosterone -> DHT
145
These antioxidant convert ROS to oxygen and water, neutralizing their capacity fro cellular damage?
Superoxide dismutase, gluthathione peroxidase and catalase.
146
In chronic granulomatous disease, what chemical is deficient?
NADPH oxidase (those affected are unable to destroy catalase positive organisms)
147
Use of these meds (2) in pregnancy termination?
MOA?
Mifepristone - progesterone antagonist -> causes necrosis of decidua
Misoprostol - prostaglandin E1 analog -> cervical softening and uterine contractions
148
Serotonin releasing neurons in the CNS are found here?
Raphe nuclei
149
Pts with narcolepsy with cataplexy have undetectable amounts of this in their CSF?
Hypocretin -1 2 (orexin A&B)
150
IFN Alpha & Beta are produced by human cells in response to?
Viral infections (helps suppress viral replication by halting g protein synthesis and promoting apoptosis)
151
mRNA interact with these in the cytoplasm?
P-bodies - they help store mRNA to be later released and utilized for protein translation.
152
Injection in this part of the buttock has a high risk of injuring this nerve?
Superior gluteal n -> trendelenburg gait.
153
Excessive matrix metalloprotease activity and myofibroblast accumulation in the wound margin can result in ?
contracture
154
Rheumatoid arthritis often affects this part of the spine?
Cervical spine involvement (subluxation and cord compression)
155
Decongestants work by affecting ___ smooth muscles?
Thee act like Alpha-adrenergic agonists
156
Overuse of decongestants can lead to this?
Tachyphylaxis: overuse -> -ve feedback -> decr NE -> relative vasodilation and subsequent edema and congestion -> exacerbation of nasal congestion symptoms.
