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STEP COPY > last min facts > Flashcards

last min facts Flashcards

1
Q

calculate ejection fraction

A

Ef=(EDV-ESV)/EDV

Ef= SV/EDV

Normal >55%

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2
Q

Immunohistochemistry test and 5 examples

A

using an antibody to detect a intermediate filament protein

Vimentin –> sarcomas

Desmin –> rhabdomyosarcoma

Cytokeratin –> epithelial tumors (squamous cell carcinoma)

GFAP –> astrocytoma, glioblastoma

Neurofilaments –> neuroblastoma

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3
Q

IL-5 (3 things) and who secretes it?

A
  1. promotes growth and differentiation of B cells.
  2. Enhances class switching to IgA
  3. Stimulates growth and differentiation of eosinophils

(secreted by Th2 cells)

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4
Q

where do ubiquitin tagged proteins get degraded?

A

proteasome

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5
Q

what type of cancer comes from calcitonin “C cells”

A

Medullary Carcinoma –> sheets of granular cells embedded in hyaline stroma

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6
Q

neural plate is present, but neural tube not yet complete…what day am I?

A

Roughly day 12

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7
Q

what day does neural tube close

A

day 28

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8
Q

MS lesions with vision think what?

A

MLF…always

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9
Q

E. Coli infection, pt in sepsis, what is virulence factor?

A

LPS endotoxin (lipopolysaccharide)

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10
Q

melanoma in-situ

A

lentigo maligna…consists of malignant cells but does NOT show malignant growth

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11
Q

seborrheic keratosis

A

waxy brown wart

noncancerous

originated is outer layer of keratinocytes

“stuck on”

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12
Q

Leser-Trélat sign

A

sudden appearance of multiple seborrheic keratoses, indicating an underlying malignancy (eg, GI, lymphoid)

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13
Q

left shoulder referred pain in context of internal bleeding

A

Kehr Sign: it is irritation of the diaphragm signaled by the phrenic nerve because the supraclavicular nerves have the same cervical nerve origin as the phrenic nerve –> this is commonly seen in a splenic rupture, ruptured ectopic pregnancy, or any other internal bleeding

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14
Q

ipsilateral CN III palsy mydriasis (“blown pupil”); may also see ptosis, “down and out” eye….caused by what?

A

Posterior communicating artery aneurysm rupture

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15
Q

down and out gaze

A

think occulomotor nerve…then need to decide if being compressed by PCA aneurysm, uncal herniation…

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16
Q

what does fick equation tell us?

A

CO=O2 consumption / (Art O2- Ven O2)

O2 consumption is proportional to body size/Hb

Art O2 is finger probe O2

Ven O2 is from Swan Ganz in pulm artery

SWAN GANZ GIVES US CO, and SVR

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17
Q

PCWP is equal to

A

LA pressure

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18
Q

all 3 types of shock share what characteristics?

A

low BP

high HR

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19
Q

Causes and hallmark of Cardiogenic shock

A

Causes: Acute MI, CHF, valvular dysfunction, arrhythmia

Hallmark: low CO caused by weak heart muscle..so all intracardiac pressure measurments are high (RA, RV, PCWP)

SVR is also high because body is clamping down trying to maintain BP

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20
Q

Hypovolemic shock, causes and hallmark

A

Causes: hemorrhage, dehydration, burns

Hallmark: low CO with ALL the internal heart measurments low (RA, RV, PCWP)

SVR is high to try to maintain BP

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21
Q

septic shock hallmark

A

hallmark –> LOW SVR

pressures are variable depending on early or late

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22
Q

take a bunch of acetaminophen, what do you do to liver?

A

deplete glutathione, replace with N-Acetylcysteine

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23
Q

organophosphate poisoning…FIRST STEP…then second step

A

GIVE ATROPINE FIRST!! (think that the organophosphate irreversibly inhibits the ACh-E, so have a shit ton of ACh. Need to give Atropine, a muscarinic antagonist to block these effects.

Then you can give Pralidoxime that regenerates ACh-E

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24
Q

acute intermitent porphyria enzyme

A

porphobilinogen deaminase

Remember 5 P’s

painful abd

port wine urine

polyneuropathy

psych

precipitated by drugs

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25
Q

what is the role of IkB in NF-kB signal transduction pathway

A

release NF-kB after undergoing phosphorylation

IkB INACTIVATES NF-kB

It is acted on by glucocorticoids

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26
Q

incidence calculation

A

new cases/# people at risk (during a specific time period)

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27
Q

platelet 804,000

leukocyte 146,000

anemia

A

this pt has CML

tx. imatinib

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28
Q

hydroxyurea mechanism and uses

A

mechanism: inhibits ribonucleotide reductase (disrupts purine and pyrimadine synthesis)
uses: sickle cell anemia (increase HbF), CML, Melanoma, polycythemia vera

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29
Q

foot drop

A

damage to deep peroneal nerve

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30
Q

what does dorsiflexion of the foot?

A

This is the deep peroneal nerve

  • tibialis anterior
  • extensor hallicus longus
  • extensor digitorum longus
  • peroneus tertius
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31
Q

treacher collins syndrome

A

neural crest dysfunction –> mandibular hypoplasia, facial abnormalities

This is a problem with the FIRST pharyngeal arch

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32
Q

micrognathia

glossoptosis

A

small lower jaw

downward displacement of the tongue

BOTH of these findings are seen in Pierre Robinson sequence…derivative of the 1st arch

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33
Q

phosphocreatine in the context of early exercise

A

phosphocreatine = creatine phosphate

can anaerobically donate a phosphate group to ADP to form ATP during the first 2-7 seconds following an intense muscular or neuronal effort

**This makes it so ATP does not fall appreciably in these first few seconds because remember that not much ATP is stored in a cell**

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34
Q

4yo boy with a karytotype of 47,XY+21 develops pancytopenia, lethargy, numerous bruises, pallor, and fever. Subsequent examination of bone marrow will show?

A

excess lymphoblasts

*need to remember that a kid with Down Syndrome has a higher risk of having ALL, which has MUCH increased Lymphoblasts

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35
Q

bladder anatomy

specifically, what is at the top of the trigone

A

These are the ureteric orifices

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36
Q

loss of peripheral vision in BOTH eyes to the LEFT. Metastatic tumor where?

A

Tumor in occipital lobe

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37
Q

SLE systemic sx

RASH OR PAIN

A
  • *RASH OR PAIN:**
  • *R**ash (malar A or discoid)
  • *A**rthritis (nonerosive)
  • *S**erositis
  • *H**ematologic disorders (eg, thrombocytopenia) Oral/nasopharyngeal ulcers
  • *R**enal disease
  • *P**hotosensitivity
  • *A**ntinuclear antibodies
  • *I**mmunologic disorder (anti-dsDNA, anti-Sm, antiphospholipid)
  • *N**eurologic disorders (eg, seizures, psychosis)
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38
Q

ruptured AAA, what see on physical exam

A

decreased femoral pulses

severe abd pain

tachycardia, low BP

pulsatile periumbilical mass

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39
Q

ampicillin/amox mechanism of resistance

A

penicillinase in bacteria (a type of B-lactamase)

NOT ALTERATION IN PCN BINDING PROTEIN…that is mechanism for cephalosporins

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40
Q

RANK and RANK-L

A

Osteoclast precursors express a cell-surface receptor known as RANK(RANK stands for Receptor Activator of Nuclear factor-Kappa B). Osteoblasts express RANKL (RANK Ligand) on the extracellular surface of their plasma membrane.

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41
Q

18mo boy with severe combined immunodeficiency syndrome requires a blood transfusion for severe anemia. Which blood product is most appropriate

A

irradiated RBC

*this kid has no immune system and nothing to fight any infection with. give him some clean shit

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42
Q

Hereditary hemorrhagic telangiectasia

A

=Osler-Weber-Rendu syndrome.

AD

Inherited disorder of blood vessels. Findings: branching skin lesions (telangiectasias), recurrent epistaxis, skin discolorations, arteriovenous malformations (AVMs), GI bleeding, hematuria

Displays incomplete penetrance

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43
Q

pouches vs arches

A

pouches –> endoderm. ears, tonsils, bottom, to, top

arches –> Mesoderm + neural crest. MOST of the stuff (cartilage, muscle, nerve)

remember CAP (ecto, meso + nc, endo)

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44
Q

ursodial

A

nontoxic bile acid

increases bile acid secretion, decrease cholesterol secretion and reabsorption

used for gallstone prevention in someone who does not want surgery

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45
Q

most dangerous type of Ehlers Danlos

A

Vascular type (deficient Collagen III- reticulin, blood vessels)

Berry Aneurysms

Hollow organ rupture

LIFE THREATENING…80% have vascular event by age 40

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46
Q

Menke’s vs Wilsons

A

Think of them as opposite

Menke’s: ATP7A gene, impaired copper absorption leads to decrease activity lysyl oxidase (requires copper as a cofactor so unable to cross-link collagen) –> brittle, kinky hair

Wilson’s: ATP7B gene, TOO MUCH COPPER

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47
Q

holoprosencephaly

A

trisomy 13

fetal alcohol syndrome

–> failure of midline cleavage of embryonic forebrain

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48
Q

drug that inhibits axonal transport along microtbules

A

colchicene

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49
Q

wallerian degeneration

A

anterograde degeneration

disappearance of axons and myelin sheats and secondary prolif of Schwann Cells

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50
Q

ependymal cells

A

produce CSF…they line the choroid plexus

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51
Q

neuromelanin

A

blackish intracytoplasmic pigment found in substantia nigra and locus ceruleus

(disappears w/ Parkinson)

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52
Q

neurofibrillary tangles

A

intracytoplasmic degenerated neurofilaments seen in Alzheimers

53
Q

Cowdry Type A inclusion bodies

A

intranuclear inclusions that are found in neurons and glia in HSV encephalitis

54
Q

most common site of cerebral aneurysm

A

anterior communicating artery

55
Q

posterior communicating artery aneurysm

A

third nerve palsy (down and out)

56
Q

blood supply of broca and wernicke

A

middle cerebral

57
Q

posterior cerebral artery occlusion

A

contralateral hemianopia with macular sparing

*provides major blood supply to midbrain*

58
Q

lacteration of bridging veins

A

subdural hematoma

  • not cross midline
  • crescent shaped
  • ALWAYS cause brain damage
59
Q

lacteration of middle meningial artery

A

epidural hemorrage

“lucid interval”

-branch of the maxillary artery, enters cranium through foramen spinosum

60
Q

noncommunicating hydrocephalus caused by

A

blockage of cerebral aqueduct

(often congenital)

61
Q

normal-pressure hydrocephalus

A

CSF not absorbed by arachoid villi

wet, wobbly, wacky

62
Q

pseudotumor cerebri

A

benign intracranial hypertension

increased resistance to CSFoutflow at arachnoid villi

OBESE women

papilledema w/o mass, elevated CSF, deteriorating vision

63
Q

bloody csf

A

subarachnoid hemorrhage

64
Q

etoposide

A

topoisomerase II

65
Q

deviation of infundibular septum

A

Tet of fallot

66
Q

HCTZ effect on calcium in serum

A

increase

(remember it blocks the Na/Cl and it subsequently increases Ca reaborption

67
Q

neuro sx incompatable with any known neurologic disease.

A

conversion disorder

(often acute and assoicated with stress event)

68
Q

excessive anxiety and preocupation with >1 unexplained sx

A

somatic symptom disorder

69
Q

enhancers

A

can be upstream, downstream, or within introns or wherever the fuck they want to be

70
Q

primary cause lacunar infarcts

A

lipohyalinosis

71
Q

parkinson surgery target where

A

deep brain stimulation of subthalamic nuclei

high frequency stim inhibits firing of these nuclei

72
Q

wide fixed splitting of S2 (not vary with resp)

A

ASD

Eventually results in pulm artery hypertrophy, when gets super strong, this increases resistance and end up getting reversal…eisenmenger syndrome

73
Q

raltegravir

A

integrase inhibitor

disrupts the ability of the DS HIV DNA to integrate into the host cell’s chromosomes

In the absence of integration, the viral genome CANNOT be transcribed by host cell machinery

74
Q

precursor for NO

A

arginine + O2 –> NO

via endothelial nitric oxide synthase

75
Q

ribavirin mechanism

A

interfere with duplication of viral genetic material

inhibits inosine monophosphate dehydrogenase

use in Hep C and RSV

(nucleoside antimetabolite drug)

76
Q

PE pt

what is pH, CO2, O2, Bicarb

A

hypoperfusion causes V/Q mismatch will cause hypoxemia which causes hyperventilation

pH increase

CO2 decrease

O2 decrease

Bicarb normal (acute phase, loss in 48 hrs)

77
Q

CREST syndrome manifestation in lungs

A

desposition of collagen results in intimal thickening of pulm arterioles –> pulm HTN –> cor pulmonale

78
Q

egg whites

A

biotin (B7)

Important in

  1. pyruvate carboxylate
  2. Acetyl-CoA carboxylase
  3. Propionyl CoA carboxylase

(ate whe WHOLE BOX of EGGS)

79
Q

abortion, few days later sick…what called and what bug?

A

septic abortion (retained products of conception)

S. Aureus (can be E. Coli and GBS)

tx: broad spectrum abx, surgical evacuation (careful not take all layers and end up with Ashermann syndrome)

80
Q

what gives bruise its green color?

A

heme oxygenase making biliverdin

81
Q

S cells

A

S cells –> secretin –> increase pancreatic bicarb secretion (from brunner glands), decrease gastric H secretion

82
Q

HIV replication cycle starting at polyprotein (env)

A

polyprotein –> glycosolated to become gp160 –> protealytically cleaved to gp120 and gp41

gp120 mediates viral attachment by binding to the CD4 receptor (what miriviroc binds)

gp41 is transmembrane and anchors gp120

83
Q

gray hepatization in pneumonia

A

day 4-6

RBC disintegrate

alveolar exudate contains neutrophils and fibrin

GRAY-BROWN firm lobe

(congestion –> red –> grey –> resolution)

84
Q

enterobius vermicularis

A

pinworm

butt

scotch tape

tx: bendazoles

85
Q

electrolyte abnormality from massive transfusion

A

hypocalcemia

86
Q

why does H. pylori cause an ulcer

A

chronic antral gastritis –> decrease in # somatostatin producing cells (delta cells) –> these cells normally inhibit gastrin release –> now have no brake on that, so get increased H+ secretion by parietal cells –> duodenal ulceration (not adequately neutralized by bicarb)

87
Q

most common cause of spontaneous lobar hemorrhages in the brain

A

amyloid angiopathy

hemorrhage tends to be recurrent and involves occipital (homonomous hemianopia) and parietal lobes

88
Q

doxorubicin side effect

A

dilated cardiomyopathy

89
Q

day 12 post MI

A

granulation tissue with neovascularization

90
Q

what is the point of IgA protease

A

bacterial adherance to mucosa

91
Q

infant infected with Hep B, what show up on lab resort

A

This means mom was a HBeAg + carrier (thus high infectivity)

Infants have HIGH viral loads and HIGH HBeAg levels***

92
Q

name 2 effects of milrinone

A

+ inotropy (cardiac muscle)

vasodilation (smooth muscle) (decrease afterload on heart)

–> workse by PDE3 inhibition, used in CHF

93
Q

pt with gastrectomy needs to take HIGH

A

Vit B12 (water soluble)

-not getting any intrinsic factor that is normally secreted in stomach from parietal cells and necessary for B12 absorption in terminal ilium

*pts with gastrectomy need to be on lifelong B12 supplementation

94
Q

urge incontinence

A

detrusor overactivity

(sudden urge to empty bladder)

95
Q

MS lesion involving micturition

A

lead to detrusor hyperreflexia and urge incontinence

96
Q

pt in DKA uses what process to create glucose

A

triglyceride metabolism (lipase) –> glycerol + fatty acids –> glycerol 3 phosphate (glycerol kinase) –> DHAP

–> glucose (gluconeogenesis)

–> energy (glycolysis)

97
Q

medullary carcinoma thyroid

A

parafollicular calcitonin secreting cells (neuroendocrine tumor seen in MEN2A/B)

see nests or sheets of polygonal or spindle shaped cells with extracellular amyloid depositon –> CONGO RED (derived from calcitonin)

98
Q

what part of bone does osteomyolitis affect

A

metaphysis

99
Q

DI that is given desmopressin and responds….central DI…now what renal clearance value will decrease?

A

urea

vasopressin activates urea transporters in the medullary collecting duct increasing urea reabsorption and decreasing urea clearance

100
Q

drug that controls uterine hemorrhage post birth

A

oxytocin

101
Q

skin cancers

upper lip

lower lip

A

upper –> basal cell carcinoma

lower –> Squamous cell carcinoma

REMEMBER BS!

102
Q

actinic keratosis

A

precursor lesion of SQUAMOUS CELL CARCINOMA

**think keratin=squamous cells**

103
Q

variants of melanoma

A

1. superficial spreading –> most common. dominant early radial growth (side to side). good prognosis

2. Lentigo maligna melanoma –> radial growth. good prognosis

3. Nodular –> early vertical growth. POOR prognosis

4. Acral lentiginous –> palms and soles, dark skinned individuals. NOT related to UV exposure

104
Q

levels of skin affected by Staph scalded skin syndrome and toxic epidermal necrolytis

A

SSSS –> stratum granulosum (exofoliative A and B toxins) destroys the keratinocyte attachments. (+ Nikolski skin)

TEN –> destroys dermal/epidermal junction

105
Q

Lichen planus (think P)

A

pruritic, planar, polygonal, purple papules often with reticular white lines on thier surface.

DERMAL-EPIDERMAL junction with “saw tooth” appearance

Associated with Hep C virus

106
Q

modafinil use

A

narcolepsy

107
Q

where is the lowest osmolality in the tubule of the kidney

A

distal convoluted tubule

108
Q

probability of being free from a disease is the test result is negative

A

negative predictive value

109
Q

posterior urethral valves

A

only occur in males

results in bilateral hydronephrosis

due to malformation of wolffian duct

110
Q

simple cuboidal lining where in female repro tract

A

ovary

(fallopian, uterus is simple columnar)

111
Q

beri beri seen what vitamin def

A

Ber1 Ber1 (B1)

dry –> polyneuritis + muscle wasting

wet –> high output cardiac failure, edema

112
Q

hartnup disease

A

cannot reabsorb tryptophan from PCT –> pellagra-like sx

(remember tryptophan –> niacin (via B6)

113
Q

calculate coefficient of determination

A

squaring the correlation coefficient

so lets say correlation of coefficient is (0.-8)

take this number .8x.8-.64=64% is explained by whatever factor you are analyzing

114
Q

lack of time frame in study

A

cross-sectional study

**snapshot of time

Can determine PREVALENCE

115
Q

Glycogen stuck in:

liver only

lysosomes

muscles + liver

muscles only

A

liver only –> Von Gierke (glucose 6 phosphatase)

lysosomes –> Pompe (alpha-1,4-glucosidase)

muscles + liver –> Cori (debranching, alpha-1,6)

muscles only –> McArdle (myophosphorylase)

116
Q

cytotoxic T cells

Helper T cells

Regulatory T cells

A

cytotoxic –> CD8. Kill virus infected cells, neoplastic cells, donor graft cells by inducing apoptosis (perforin, granzyme B)

Helper –> CD4 These are the Th1 (Cell mediated immunity, INF-y) and Th2 cells (Humoral Immunity, IL4, IL5, IL10, IL13 activate B cells to produce Ab)

Regulatory T cells –> Suppress CD4 and CD8 T cells. Express CD3, CD4, CD25, FOXP3. These secrete IL-10 and TGF-Beta

117
Q

cytokine cause cachexia

A

TNF-alpha (mediates septic shock, activates endothelium, cause WBC recruitment, vascular leak)

118
Q

IL-3

A

supports growth and differentiation of bone marrow stem cells

-Functions like GM-CSF

119
Q

Organ Transplant Rejection

hyperacute

acute

chronic

A

hyperacute –> preformed AB (Type II)

acute –> CD8 T cells, see lymphocytes (Type IV)

chronic –> CD4 cells, see fibrosis (Type II and IV)

120
Q

serum calcium levels in:

dystrophic calcification

metastatic calcification

A

dystrophic calcification –> Ca in ABNORMAL tissues (seen in TB, liquifactive necrosis, fat necrosis, infarcts, thrombi, schistosomiasis, mockingberg arteriolosclerosis, congenitam CMV, psammona bodies. Pts usually NORMOCALCEMIC

metastatic calcification –> Ca in NORMAL tissue secondary to hypercalcemia (primary hyperparathyroidism, sarcoidosis, hypervitaminosis D) Pts usually are NOT NORMOCALCEMIC

121
Q

neonatal lupus

A

Mom Ab –> fetus

Caused by any autoimmune dz, but most commonly by SJORGEN

Need anti-SSA/SSB (can be found in SLE, but more common in sjorgen)

Rash

Conenital complete HEART BLOCK

122
Q

lymphocytic sialadentis

A

specific for Sjorgen Syndrome

also remember that 40-65% of pts with PBC also have Sjorgens

123
Q

pilocarpine uses

A

stimulator of sweat, tears, and saliva

  • Open-angle and closed-angle glaucoma,
  • Sjögren syndrome

*Remember it is a muscarinic agoinst

124
Q

PCP mechanism

A

NMDA ANTAGONIST

125
Q

why is essential fructosuria benign

A

because hexokinase can rescue it and convert

fructose –> fructose 6 phosphate, which is back in glycolysis

126
Q

hyperventilate head injury pt, why?

A

low co2 causes vasoconstriction. This results in a reduction in cerebral blood volume leading to decreased ICP

Remember that CO2 is a potent VASODILATOR of cerebral vasculature

(increased cerebral vascular resistance)

127
Q

treatment of adrenal crisis

A

dexamethasone and aggressive fluids

128
Q

treat neonatal opiate withdrawl

A

methadone (long t1/2)

morphine

sx are tachypnea, irritability, diarrhea

129
Q

increased acetylcholinesterase in amniocentesis

A

neural tube defect

STEP COPY (36 decks)

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