5/14

Question 1

What cellular reactions utilize NADPH?

Answer 1

Cholesterol and FA synthesiss

Question 2

What molecules represent kidney GFR and RPF?

How do you calculate clearance of a molecule from the kidney?

How do you calculate the filtration fraction in a pt?

Answer 2

GFR ~ Creatinine Clearance
RPF ~ PAH Clearance

Clearance = ([Molecule in Urine] * (urine flow rate)) / [Molecule in Plasma]

Filtration Fraction = GFR/RPF

Question 3

What is the best way to prevent neonatal tetanus?

Answer 3

Make sure the mom has been vaccinated during pregnancy, the IgG will transfer to the fetus via placenta

Question 4

What bone condition is a pt with cholestasis at risk for?

Answer 4

Vit D deficiency which can lead to osteomalacia

Question 5

What protein is upregulated in Burkitts Lymphoma? What does this cause?

Answer 5

c-myc

c-myc is an oncogene and a TF –> will upregulate transcription activation

Question 6

What is the most common lab finding with legionella infection?

Answer 6

hyponatremia and many neutrophils

Question 7

What is the main cause of cyanosis in pts with tetralogy of Fallot?

Answer 7

The pulmonic stenosis is the major determining factor

Question 8

What is the most sensitive test when checking to see if menopause has occured?

Answer 8

There should be an increased FSH due to lack of (-) feedback of estrogen. LH will also be raised, but happens later and is thus unreliable

Question 9

Where are JG cells located? What do they look like? What is their reaction to renal artery stenosis?

Answer 9

JG cells are modified SM cells located in the affarent arteriole.

In response to RAS, they will hypertrophy in an effort to increase renin release - the kidney is stupid and thinks it isnt getting perfused due to lack of volume and wants to add more to it via angiotensin and aldosterone activation

Question 10

What section of the myocardial AP curve do the classes of antiarrythmics work on? What class is dofetilide?

Answer 10

Phase 0 = Class 1 Na blockers
Phase 1 - none
Phase 2 - Class 2 Ca blockers
Phase 3 - Class 3 K channel - slow efflux (Dofetilide)

Question 11

What kind of studies are case controls and cohorts? What can you calculate from these?

Answer 11

Case Control = Retrospective, Observational; can measure an Odds Ratio (AD / BC)

Cohort Study = Retro or Prospective, Observational; can measure a Relative Risk (A/A+B) / (C/C+D)

Question 12

What are the phases of a clinical trial, and who are the pts they utilize?

Answer 12

Phase 1: healthy volunteers; tests safety, toxicity, pharmicokinetics
Phase 2: small group of dz; tests dosing, efficacy, and sdx
Phase 3: large groups of dz; compares it to gold standard
Phase 4: post-market analysis; tests long term sdx + efficacy

Question 13

What does a meta analysis increase?

Answer 13

It can potentially increase the power of the study, but also opens the door for alot of bias

Question 14

How does the prevalence of a disease in a population (or pretest probability) affect the Sensitivity, Specificity, PPV, and NPV of a test?

Answer 14

It will not change the Sens and Spec.

A high prevalence (pretest prob) will increase the PPV and decrease the NPV

Question 15

What is the NPV of a test with 99% sensitivity?

Answer 15

Very high. Sensitive tests should have very few false negatives, thus if this test comes back negative, you can be sure you dont have the dz.

Conversely, highly specific tests have a very high PPV

Question 16

What happens to the OR and the RR when disease prevalence is low?

Answer 16

RR ~ OR

decreased A and C, thus B and D are the only values that matter

Question 17

What is equation for NNT and NNH?

Answer 17

NNT = 1/ARR (absolute risk reduction)

NNH = 1/AR (attributable risk)

Question 18

What type of bias is Berkson’s bias?

What is the problem occurring with sampling bias?

Answer 18

Berksons = selection bias; this occurs from selecting hospitalized pts as study group members

Sampling bias = the results you get are from one pop (China) and are not generalizable for the broad population

Question 19

What are Mean, Median, and Mode values for a positive and negative skew?

Answer 19

Positive Skew = tail to the right and Mean>Median>Mode

Negative Skew = tail to the left and Mean<Mode

Question 20

What is the original assumption in hypotheses testing?

What does a small P value indicate?

Answer 20

that the null hypothesis is true

small P (<0.05, you reject your null hypothesis, and accept your alternative hypothesis. You can claim that your results are statistically significant.

Question 21

What is the Standard Error of Mean?

What happens when the 95% CI includes 1?

Answer 21

SEM = SD/sqrt*n

If CI includes 1, the H0 is not rejected

Question 22

What is the difference between a t-test, ANOVA, and chi square?

Answer 22

t-test and ANOVA are used to compare means of a changing variable (ANOVA can be used for more than 2 groups)

Chi Square is used to compare %. This data is categorical and fixed

Question 23

What thyroid cancers involve an upregulation of tyrosine kinase?

Answer 23

Papillary and Medullary

Question 24

What is the main use for amitriptyline? What is its other use? What are some side effects it can cause?

Answer 24

Main use: TCA, antidepressent

Other use: treat diabetic neuropathies

sdx: tremor, insomnia, arrythmias, hypotension, anti-muscarinic actions, anti-histamine (sedation), anti-a1 (orthostatic hypotension)

Question 25

What is the most common behavior and cause of death of PCP use?

Answer 25

behavior - violence

COD = trauma

Question 26

Know how the heart sits in a chest xray

Answer 26

Right ventricle to the left and close to sternum

Right atrium to the right ant close to the sternum

Question 27

What cranial nerve is involved in vertical diplopia?

Answer 27

Trochlear (Sup oblique is cut thus you cant look at your nose)

Question 28

What is the MOA of nitroglycerin?

Answer 28

Venodilates causing a decreased preload on the heart (decrease in LV volume)

Question 29

Define the terms additive, synergistic, and permissive

Answer 29

Additive = when you add two drugs together, their new effect is equal to the sums of them individually

Synergistic = when you add two drugs together, their new effect is greater than their individual sums

Permissive = When one drug does nothing unless its added to another drug, then the effects are big

Question 30

What are the bugs that kids with CGD are most likely to get?

Answer 30

Cat+ bugs:

S. Aureus, Burk cepacia, serratia marcescens, nocardia, aspergillis

Question 31

What is caudal regression syndrome and what causes it?

Answer 31

When the baby is born with flaccid LE and poorly developed lumbar spine/sacrum

This is caused by maternal diabetes

Question 32

What are the histological findings of a ruptured ectopic pregnancy?

Answer 32

Abdominal pain, vaginal bleeding, hemmorhagic shock w/ a history of amenorrhea.

Biopsy will show decidual changes in endometrium but NO chorionic villie

Question 33

What is pantothenic acid, and where is it used?

Answer 33

vit B5 –> becomes CoA

It is used in the oxaloacetate to citrate reaction (first step of the TCA cycle)

Question 34

What is ethambutol and what are its side effects?

Answer 34

One of the main TB drugs used

sdx: optic neuritis, color blindness, central scotoma, and decreased vision
curable if you stop using the drug

Question 35

MOA of class 1 anti-arrhythmics

Answer 35

block Na channels in the heart.

They dissociate from the channel when the channel goes into resting (occurring after the channel repolarizes and is done being inactive)

These drugs exhibit “use dependence” which means they work better on channels that undergo more frequent depolarization and thus spend more time in the activated and inactivated stages and LESS time in the resting stage

Binding strength = 1C>1A>1B (1C binding can last multiple cycles)
(1B dissociate quickly from receptors)

1B’s are more selective for ischemic myocardium b/c these cells have a lower resting membrane potential, thus making the inactive phase (when the drug can bind) longer