Q Banks: Week of 02/06/17 Flashcards

1
Q

Explain the term polycistronic.

A

Polycistronic is when multiple genes exist on the same mRNA transcript. The classic example is the E. coli lac operon, which has three enzymes needed for lactose metabolism on one mRNA.

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2
Q

What’s the only significant effect mediated by kappa opioid receptors?

A

Kappa receptors mediate miosis.

“They Kick your pupils.”

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3
Q

What fascia is often cut to relieve carpal tunnel syndrome?

A

The transverse carpal ligament, also called the flexor retinaculum

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4
Q

Describe the overall pathology of Paget’s disease.

A

Initially, osteoclasts –which are MULTInucleated cells dependent on RANK-L for activation –increase the resorption of bone. Later, osteoblasts get even more activated in response and end up increasing the deposition of bone too much.

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5
Q

What does defective DHEA sulfatase produce?

A

Nothing (that is, people are asymptomatic)

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6
Q

Which organ has foregut blood supply but is derived from the mesoderm?

A

The spleen!

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7
Q

How does pseudogout appear under polarized light?

A

Because the calcium pyrophosphate crystals in pseudogout are positively birefringent, they appear yellow when light is perpendicular and blue when the light is parallel. Also, the crystals are rhomboid.

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8
Q

How does the antidote to cyanide poisoning work?

A

Sodium thiosulfate donates sulfur with captures cyanide.

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9
Q

The three most common types of pica are _________________.

A

(1) earth/soil, (2) ice, and (3) starches (like flour or cornstarch)

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10
Q

Those with ataxia-telangiectasia are most at risk for what kind of DNA damage?

A

Double-strand breaks from ionizing radiation

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11
Q

True or false: HIPAA allows for verbal permission to release information.

A

True. In general, written consent is preferred, but verbal consent can be given.

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12
Q

Describe the types of pain that occur with appendicitis.

A

Appendicitis usually starts with dull, visceral pain because the internal organs do not localize well. The dull pain is often midline. As appendicitis progresses, it inflames the peritoneum which is somatically innervated and localizes well.

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13
Q

Other than pericardial disease, ____________ can also cause pulsus paradoxus.

A

severe asthma and COPD

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14
Q

In an elderly woman with primary osteoporosis, the PTH level is likely to be _____________.

A

normal (as would the calcium)

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15
Q

What molecule inhibits the degradation of levodopa?

A

Carbidopa

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16
Q

_________________ has been shown to be a mutant protein that decreases the efficacy of chemotherapy.

A

Multi-drug resistance (a P-glycoprotein that uses ATP to pump hydrophobic drugs out of tumor cells)

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17
Q

What is the only reaction in the TCA cycle that produces a triphosphate?

A

Succinyl-CoA to succinate

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18
Q

Which reactions in the TCA cycle produce electron carriers?

A

All of the ones that are not rearrangements or losing CoA (that is, citrate to isocitrate and fumarate to malate do not produce anything, and succinyl-CoA to succinate produces GTP)

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19
Q

What two spots usually act as transcription initiators?

A

CAAT and TATA

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20
Q

Those with aplastic anemia will almost always not have ______________.

A

splenomegaly

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21
Q

A great way to diagnose rupture or aneurysms is _________________.

A

CT without contrast showing white accumulations in the sulci

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22
Q

Immature T lymphocytes arrive in the __________ area of the thymus and lack ___________. They then proceed to the cortex where __________ occurs.

A

subcapsular area; both CD4 and CD8 (meaning they are “double negative” when they arrive in the thymus); positive selection

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23
Q

What phospholipid ratio indicates lung maturity in a preterm fetus?

A

Lecithin : sphingomyelin greater than 2

Remember: you wants Lots of Lecithin.

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24
Q

Amniocentesis levels of ____________ can help diagnose erythroblastosis fetalis.

A

bilirubin

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25
Q

What vitamin D reaction takes place in the skin?

A

7-dehydrocholesterol to cholecaliceferol

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26
Q

True or false: the kidneys can deactivate vitamin D.

A

True. The 24-hydroxylase reaction deactivates vitamin D.

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27
Q

What two things are at the periphery of the nucleus?

A

Barr bodies (inactivated X chromosomes) and heterochromatin (chromosomes with lots of methylated DNA and deacetylated histones)

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28
Q

What is Berkson’s bias?

A

Choosing hospitalized patients as a control group leads to a skewed comparison

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29
Q

What is the Pygmalion effect?

A

The Pygmalion effect describes how a researcher’s belief can affect the outcome of the trial. For instance, when teachers were told that students had exceptionally high IQs when the students were actually average, the students performed better –likely because the teachers acted differently toward them.

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30
Q

What must first happen to create an anaphylactic reaction?

A

A person must be exposed to an antigen (e.g., bee venom) that then leads to an overly robust production of IgE. The next time they are exposed to that antigen, the IgE will cross-link mast cells and release histamine.

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31
Q

Remember that fatty streaks can present as early as _______________, even in healthy, asymptomatic people without histories of heart disease.

A

the second decade of life

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32
Q

What symptoms can be found in NF-1?

A
  • Neurofibromas
  • Café-au-lait spots
  • Pheochromocytomas
  • Scoliosis
  • Meningiomas
  • Lisch nodules
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33
Q

What kind of play is characteristic of two-year-olds?

A

Parallel play

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34
Q

Describe the pre-contemplative stage of behavior change?

A

When a person doesn’t want to change

For instance, a smoker might not feel the need to stop smoking.

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35
Q

What disease can damage the putamen?

A

Wilson’s disease

Think of a copper volleyball –a là Castaway –PUT on A MaN.

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36
Q

What is leptin?

A

Leptin is a hormone secreted by fat cells that acts on the hypothalamus to decrease appetite.

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37
Q

How do thiazolidinediones work?

A

They stimulate the PPAR-gamma receptor which upregulates adiponectin and increases GLUT4 receptors. The upregulated adiponectin stimulates the oxidation of fatty acids which decreases serum triglycerides.

(In the Sketchy scene, the thiazolidinedione boy is wearing a turtleNECk sweater to represent the upregulation of adiponectin. Also, there is an insulin mailbox on the table behind the girl reading the glitter-covered card. Lastly, the act of the boy eating the donut represents decreased triglycerides.)

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38
Q

In essential fructosuria, ____________ can do some of the work that would normally have been done by fructokinase.

A

hexokinase

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39
Q

The two functions served by type II pneumocytes are ________________.

A

secretion of surfactant and regeneration of type I pneumocytes

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40
Q

Fructose-2,6-bisphosphate inhibits _____________.

A

fructose-1,6-bisphophatase

Fructose-2,6-bisphosphate stimulates glycolysis. Thus, it needs to inhibit gluconeogenesis, which is mediated by fructose-1,6-bisphosphatase.

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41
Q

The esophagus passes between which cardiac structures?

A

The left atrium and the descending aorta

AED = atrium esophagus descending

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42
Q

What is nursemaid’s elbow?

A

Occurring pulling on the forearm of a young child, nursemaid’s elbow is a subluxation of the radius from the annular ligament. The child will present with a pronated and extended elbow.

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43
Q

True or false: hepatic encephalopathy results from accumulated BUN.

A

False! Hepatic encephalopathy results from accumulated ammonia due to a liver unable to convert ammonia to urea. Common precipitating factors include increase ammonia intake, such as from eating excess protein or GI bleeds. (GI bleeds lead to increased nitrogen intake from the load of hemoglobin.)

44
Q

Which cell type dysfunction causes the first step in atherosclerosis?

A

Endothelial cells

It’s thought that repeat damage to endothelial cells leads to increased LDL deposition and subsequent macrophage attraction.

45
Q

What causes Ménière’s disease?

A

Defective resorption of endolymph

46
Q

What’s the difference between Ménière’s disease and vestibular neuritis?

A

Vestibular neuritis does not cause hearing loss.

47
Q

What’s the best predictor of future suicide attempt?

A

Past attempt

48
Q

What’s the best way to distinguish between arthritis from osteomyelitis and neoplastic arthritis?

A

Neoplastic arthritis arises quickly and does not alleviate with rest.

49
Q

Histologically, how can you distinguish between hepatic adenoma and hemangioma?

A

Hepatic adenoma presents with expanded hepatocytes with preserved architecture while hemangioma presents with fibrous tissue with blood-filled spaces.

50
Q

What is the usual treatment for anaphylaxis?

A

First administer epinephrine to stabilize blood pressure and then administer diphenhydramine.

51
Q

Poor diet or excessive consumption of raw eggs can cause a deficiency of _____________.

A

biotin (B7); this is needed for gluconeogenesis, fatty acid synthesis, and fatty acid oxidation

Symptoms include anorexia, dermatitis, and mental status changes.

52
Q

CSF levels of _____________ will be low in those with narcoplepsy.

A

orexein (aka hypocretin)

53
Q

What side effects are common in ADHD medications like methylphenidate and amphetamines?

A

Appetite suppression (with weight loss) and insomnia

54
Q

True or false: the intensity of the murmur in regurgitation murmurs correlates with how severe the defect is.

A

False. Larger orifices (with more regurgitation) are usually quieter.

55
Q

What is the most significant complication of mitral regurgitation?

A

Dilated cardiomyopathy from fluid overload

56
Q

If you encounter a patient who seems to be trying to get on disability, how should you approach their care generally?

A

Try to understand where they’re coming from and empathize with them.

57
Q

What causes dilation of the coronary sinus?

A

Increased right-sided heart pressure, such as from pulmonary hypertension.

58
Q

How does temperature affect the oxygen-hemoglobin binding curve?

A

Increased temperature causes a right shift. This is important because exercising muscles will be warm and they need extra oxygen.

59
Q

True or false: anemia can cause a left shift in the oxygen-hemoglobin curve?

A

False. Severe anemia is likely to precipitate an acidotic state from lactate metabolism, which will right-shift the hemoglobin curve.

60
Q

How is the hirsutism of PCOS treated?

A

Hirsutism in PCOS results from increased LH, so oral contraceptives are given to decrease the androgen production.

61
Q

Removal of thymic neoplasms can cure what hematologic disorder?

A

Pure red cell aplasia (PRCA)

This is a rare marrow disorder that is characterized by isolated failure or RBC production. It can also be caused by parvovirus infection.

62
Q

Which cancers can produce erythropoietin?

A

VHL cancers: RCC and cerebellar hemangioblastoma

63
Q

Stimulation of which receptor class will lead to the intracellular production of NO?

A

M3 muscarinic receptors (recall the exhaust pipe in the Sketchy scene!)

64
Q

Which cell type helps form granulomas?

A

Th1

65
Q

What’s the difference between gyrase and helicase?

A

Gyrase prevents the formation of supercoils by unwinding the double helix and helicase unzips the double strand.

66
Q

Where do the superior and inferior divisions of the middle cerebral artery go?

A

They course alongside the outside of the brain, supplying the gray matter on the outer cortex.

67
Q

What do hemorrhages of the lenticulostriate vessels cause?

A

Contralateral hemiparesis and hemianesthesia (because the contents of the internal capsule are interrupted)

68
Q

Aneurysms at the __________________ can disrupt the oculomotor nerve.

A

area where the posterior communicating artery joins the middle cerebral artery

69
Q

The accumulated serotonin and norepinephrine caused by TCA overdose cause _____________.

A

seizures and tremors

70
Q

Where are PDA murmurs heard the loudest?

A

Inferior to the left clavicle

71
Q

Why might a patient with facial pain present with pancytopenia?

A

Because carbamazepine is a first-line therapy for trigeminal neuralgia!!!

72
Q

Persistently impaired lymph drainage can increase the risk of developing _______________.

A

lymphangiosarcoma (a classic sequela of radical mastectomy)

73
Q

Osteocytes are connected via _______________.

A

the gap junctions seen in lacunae

74
Q

Differentiate cauda equina syndrome and conus medullaris syndrome.

A

Cauda equina:
•Caused by a lower lesion/disruption of select nerve roots
•Asymmetric distribution of sensory loss and muscle weakness
•Severe pain

Conus medullaris:
• Caused by a higher disruption that occludes the distal tip of the spinal cord as well as some roots
• Symmetric distribution of sensory loss and muscle weakness
• Milder pain
•Sexual dysfunction and urinary/bowel problems common
• Loss of bulbocavernosus reflex

75
Q

The perianal region is innervated by the ________________ nerve roots.

A

S3 - S5

76
Q

What is myoglobin, molecularly?

A

Myoglobin is a monomeric protein that is almost identical to hemoglobin’s beta subunit. Because it only has one protein, it cannot have the complex interactions that hemoglobin does.

77
Q

Describe the effects of anesthesia on blood flow throughout the body.

A

Overall, general anesthesia decreases blood flow to the body: renal flow decreases, hepatic flow decreases, flow to muscle decreases, and the blood pressure drops. In the brain, however, there is a decrease in resistance that promotes an increase in flow; this is an undesirable effect because it can lead to increased ICP.

78
Q

If a patient with nephrotic syndrome presents with frank hematuria, what likely occurred?

A

In nephrotic syndrome, antithrombin III is lost and a hypercoagulable state ensues. Renal vein thrombosis can occur which will lead to renal infarction, hematuria, and varicocele (if on the left kidney).

79
Q

Clinically, how can you differentiate between bullous pemphigoid and pemphigus vulgaris?

A

Pemphigus vulgaris (caused by antibodies to desmoglein) is a more superficial lesion. As such, it is more likely to cause erosions and more likely to spread with pressure than bullous pemphigoid. Also, pemphigus vulgaris is more likely to affect the oral mucosa.

80
Q

What will you notice on histologic/immunofluorescent examination of the glomeruli of someone with PSGN?

A
  • Histologic: lymphocytic infiltrate, mesangial proliferation, and endothelial proliferation
  • Immunofluorescent: deposition of IgG and IgM (from the immune reaction to S. pyogenes) as well as the subsequent C3b that results
81
Q

Typically, creatinine levels will not rise until _______________.

A

GFR drops below 60 mL/min

82
Q

What is the utility of hemoglobin electrophoresis?

A

Point mutations cause hemoglobin to move more slowly through gels, so it can be used to diagnose sickle cell trait as well as hemoglobin C disease.

83
Q

Metabolism of which amino acid is used to excrete acid in the kidneys?

A

Glutamine

Recall that glutamine is metabolized to glutamate and then alpha-ketoglutarate which generates two molecules of ammonia. That ammonia captures acid in the renal tubule.

84
Q

What kind of immunoglobulin is RhoGAM?

A

It is IgG directed at Rh(d). This might seem counterintuitive because that is the same antibody that causes fetal hemolysis. The key, though, is that it is a much smaller amount of IgG than that generated in an immune reaction. It coats fetal RBCs as they enter the maternal bloodstream and prevent the mother’s immune system from seeing Rh(D).

85
Q

What’s the difference between complete and partial nephrogenic DI?

A

Partial nephrogenic DI will have a mild (but insufficient) response to ADH.

86
Q

True or false: protamine does not reverse LMWH toxicity.

A

True and false… protamine can help dampen the anticoagulation seen in heparin toxicity, but it does not completely reverse the effects.

87
Q

What is the best way to prevent wrong-site surgeries?

A

Have two healthcare providers independently verify the patient, procedure, and site; performing it together has been shown to lead to repeat error.

88
Q

How can you differentiate vascular dementia from Alzheimer’s with amyloidosis of the cerebral vessels?

A

First remember that vascular dementia results from repeated small stroke, so the classic history is step-wise worsening of symptoms. Next know that Alzheimer’s can present with amyloidosis of the extracellular space as well as of the cerebral arteries.

89
Q

Why does leuprolide cause gynecomastia in men?

A

It primarily depresses the production of androgens, whereas estrogen production is less affected. As such, the androgen:estrogen ratio is decreased and gynecomastia results.

90
Q

Which drug is commonly used to prevent gynecomastia in men on androgen-suppression therapy?

A

Tamoxifen, because it inhibits the effects of estrogen on breast tissue

91
Q

True or false: ramelteon should be avoided in the elderly.

A

False. Ramelteon is safe in the elderly.

(You might get confused by Sketchy, because they put the ramelteon scene – in which the old man is safely sleeping –in the same room as the zolpidem/zaleplon/eszopiclone picture –in which the old man is getting swatted by the antihistamine fly swatter.)

92
Q

What structure is often used to identify the appendix?

A

The tenia coli

The TC converge at the base of the vermiform appendix, thus following them back will usually lead to the appendix.

93
Q

What are the side effects of the SGLT2 inhibitors?

A
  • Hypotension (because of osmotic fluid loss)

* UTIs from mycotic organisms (because the urine will be sugary)

94
Q

Canagliflozin should be avoided in patients with _____________.

A

renal failure (both because of increased risk of adverse effects and decreased efficacy)

(Remember the Sketchy scene in which the substitute teacher is carrying UTI cups on the cracked kidney!!!)

95
Q

Describe the pathogenesis of cholesteatomas.

A

Chronic negative pressure in the middle ear (from infection, trauma, allergies, or congenital causes) leads to a dimpling in of the tympanic membrane. Excess squamous cells then move in and form a pearly mass. This can even present with a hole in the tympanic membrane and subsequent otorrhea. Lastly, erosion can cause the release of lytic enzymes that degrade the ossicles and produce conductive hearing loss.

96
Q

________________ can cause small intestinal bacterial overgrowth.

A

Roux-en-Y bypass

Bacteria can colonize the blind-end gastroduodenal segment.

97
Q

Describe the pathogenesis of HBV.

A

First, HBV does infects hepatocytes but does not cause hepatocyte damage. Hepatocytes die by CD8 cells killing them. HBV can integrate into DNA and raise future risk of HCC.

98
Q

What nerve mediates the cough reflex?

A

The internal laryngeal nerve (from the vagus)

It lies in the piriform recess between the aryepiglottic fold and the thyroid cartilage. It sense if food is caught near the opening of the trachea.

Note: the recurrent laryngeal and external laryngeal mediate the vocal cord control.

99
Q

What cranial nerve controls salivation?

A

The glossopharyngeal (“it makes your tongue GLOSSy”)

100
Q

Which two nerves mediate the gag reflex?

A

The glossopharyngeal (sensory) and vagus (motor)

101
Q

Acanthosis nigricans often presents with _______________.

A

acrochordons

102
Q

Calcium-channel blockers (the dihydropyridines) can cause _______________.

A

peripheral edema

103
Q

Go through the aortic arch derivatives.

A
  • 1st: maxillary artery (“1st is max!”)
  • 2nd: stapedial artery
  • 3rd: common carotids (c is the 3rd letter)
  • 4th: aortic arch (for your four limbs)
  • 6th: ductus arteriosus
104
Q

What’s the best way to reverse hypoglycemia?

A

It depends on the setting:
•Hospital: IV glucose
•With first-aid kit: intramuscular glucagon
•With nothing else: oral glucose

105
Q

Lung hamartomas most commonly contain ______________.

A

hyaliine cartilage

106
Q

Acetyl-CoA inhibits pyruvate ____________ and activates pyruvate ______________.

A

dehydrogenase; carboxylase

107
Q

Trace the normal pO2 levels from the trachea to the venous blood.

A

Recall that one atmosphere is roughly 760 mm Hg. Because oxygen accounts for 20% of atmospheric air, the partial pressure of inspired oxygen is about 160 mm Hg; it decreases to 150 mm Hg in the trachea because of the presence of water vapor. The normal venous pCO2 is 45 mm Hg, so this ultimately displaces 40 mm Hg of the pO2 from the alveoli, so the alveolar pO2 is about 110 mm Hg. The A-a gradient in a healthy person is roughly 5, so PaO2 should be about 100 mm Hg.