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STEP 1 MIXED > UWSA 1 > Flashcards

UWSA 1 Flashcards

1
Q

Where is AV node anatomically located?

A

Intratrial septum near tricuspid valve

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2
Q

Where is SA node anatomically located?

A

RA near SVC

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3
Q

What is order of length of conduction from fastest to slowest?

A 
PAVA
Purkinje fibers (bundle of HIS) 2.2m/sec
Atrial muscle 1.1 m/s
Ventricular muscle 0.3 m/sec
AV node (slowest at 0.05 m/s)
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4
Q

What bone condition is associated with Paget’s disease?

A

Osteosarcoma. Lysis and sclerosis of bone, focal periosteal elevation, Codman’s triangle, subburst pattern of soft tissue adjacent to bone

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5
Q

Which vitamin is teratogenic in 1st trimester?

A

Vit A- spontaneous abortion and fetal defects, cardiac anomalies, microcephaly, early epiphyseal closure, growth retardation

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6
Q

MOA oseltamivir?

A

Inhibits neuraminidases that inhibit cleaving of sialic acid and release of viral particles

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7
Q

What is DNA laddering?

A

Appearance of DNA fragments on gel electrophoresis. Malignant cells overexpress BCL2 antiapoptotic protein and so their endonucleases don’t work- the fragments will remain uncleaved

***DNA laddering –> BCL2 –>Evasion of apoptosis

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8
Q

What does Ach do to smooth muscle in lungs? Which receptors are activated?

A

Causes contraction via stimulation of M3 receptors

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9
Q

MOA physiostigmine?

A

AchE inhibitor - will increase levels of Ach and cause bronchoconstriction

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10
Q

Which drug blocks the action of M3 receptors in lung?

A

Atropine - competitive muscurinic receptor antagonist

Will act as anticholinergic agent and decrease the effects of Ach (decreased smooth muscle constriction)

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11
Q

What are SE of benzos? Who gets them

A

Elderly people who have slower CYP hepatic oxidative reduction

Confusion, anterograde amnesia, falls, ataxia

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12
Q

What are signs of anticholingergic toxicity?

A

Mad as a hatter, hot as a hare, blind as a bat, red as a beet, dry as a bone, full as a flask, fast as a fiddle

Mydriasis, urinary retention, dry, flushed skin, confusion/hallucinations, tachycardia, hyperthermia, decreased sweat and salivation

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13
Q

Which drugs cause anticholingeric toxicity?

A

Jimson weed (seeds)

Atropine (M3 antagonist), scopolamine, hyoscyamine

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14
Q

If genetic mutation is present in offspring, but not in parents, what occurred?

A

Germline mosaicism

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15
Q

What will you see on smear for AML?

A

Auer rods

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16
Q

What is translocation in AML?

A

15;17

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17
Q

What is Tx for AML?

A

All trans-retonoic acid

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18
Q

What are initial symptoms of AML?

A

Pancytopenia- weakness, fatigue, bleeding gingiva, easy bruising

DIC

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19
Q

Which cells secrete IL-2? What is function?

A

T-cells that have been activated by antigens

IL-2 stimulates growth of other white cells- NK cells, B cells, T cells, macrophages

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20
Q

What transmembrane proteins are used for epithelial cells to adhere to one another?

A

Cadehrins- form desmosomes and adherens junctions. They are calcium-dependent & will not adhere without extracellular Ca2+

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21
Q

What will you see on histology for molluscum contagiosum (pox virus)?

A

Cytoplasmic inclusion bodies- eosinophilic cytoplasmic inclusion bodies made of viral particles

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22
Q

What stimulates bile and bicarbonate release?

A

Low duodenal pH

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23
Q

What muscles are near the popliteal artery?

A

Adductor magnus and soleus

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24
Q

Sublimation? (psych)

A

Channelling impulses into socially acceptable behaviors ( never drinking because your dad drank)

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25
Q

What does ligand binding to tyrosine kinase receptor do?

A

Causes **dimerization* of two identical receptor subunits that then undergo conformational change to expose tyorsine kinase active sites

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26
Q

MOA phosphodiestrase-5 inhibitors?

A

Increase cGMP and cause SM vasodilation in corpora cavernosa

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27
Q

What muscle is paralyzed in winged scaupla? Innervation?

A

Serratus anterior, rotates scapula upward

Long thoracic nerve. Lymph node dissection or chest tube placement can sometimes damage nerve

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28
Q

What does pancreas secrete in response to secretin?

A

Bicarbonate

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29
Q

As flow rate increases, what electroyltes are secreted from pancreas?

A

Bicarbonate and Na+

Bicarb and Cl have inverse flow relationship due to Cl-/HCO3- exchanger

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30
Q

Duration of acute stress disorder vs PTSD?

A

ASD = 3 days to 1 month

PTSD > 1 month

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31
Q

What are categories in punnet square for determining TP, TN, FP, FN?

A

Diseased and non-diseased

vs + test and - test

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32
Q

Equation for false positive rate?

A

(1-specificity)

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33
Q

How do you calculate RR?

A

RR = (diseased/total in group A)/(diseased/total in group B)

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34
Q

Equation NNT?

A

1/ARR

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35
Q

Calculation for ARR?

A

Control Event rate - experimental event rate

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36
Q

Patient with port wine colored urine, abdominal pain, n/v, peripheral neuropathy. What is it?

A

Porphobilinogen deaminase deficiency
Acute intermittent porphorya (defective heme synthesis
No skin photosensitivity*
Usually occurs after oxidative stress (medications)

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37
Q

How is retinoblastoma caused by hereditary disease?

A

2 hit hypothesis
RB1 gene already mutated
A second mutation causes the disease from spontaneous somatic mutation

Bilateral mutlifocal retinoblastoma + osteosarcoma

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38
Q

Most common cuase of septic arthritis?

A

Staph aureus & N gonorrhea

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39
Q

What are WCC like for people with digeorge? Which infections will they get

A

Dysplastic thymus –> Abnormally low T cells (CD3+) but normal B cells

Fungal infections - Candida and P Jirovecii

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40
Q

What is chiari malfomation I?

A

Displacement of cerebellum through foramen magnum

Occipital headaches, ataxia, worse with physical activity

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41
Q

46XY with female karyotype. Vagina ends in blind pouch. What is it?

A

Complete androgen insensitivity syndrome

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42
Q

What are labs in 5-alpha reductase deficiency? Presentation?

A

Ambiguous genetalia

Testosterone/DHT ratio elevated

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43
Q

What receptors are found in adrenal medulla?

A

Alpha1 and Beta 1 (responsible for catecholamine release and HTN)

44
Q

MOA Phenoxybenzamine? When do you use it?

A

Irreversible Alpha-1 inhibitor. Before pheochromocytoma surgery to avoid hypertensive crisis
Don’t give beta-blockers because they increase the action of Alpha-1 receptors in periphery

45
Q

What structure in the brain is responsible for neonatal IV hemorrhage?

A

Germinal matrix (dense cellular and vascular layers where neurogenesis occurs). Bleeds into ventricles

46
Q

What does amiodarone do to lung?

A

Interstitial pneumonitis

47
Q

What is misoprostol used for? MOA?

A

Prostaglandin E1 analogue, decreases gastric acid secretion. Can treat peptic ulcers
Cervical ripening in pregnancy

48
Q

How do NSAIDs lead to asthma and respiratory disease?

A

Inhibit COX pathway and cause increased production of leukotrienes

49
Q

Where do squamous cell carcinomas due to smoking occur in head/neck?

A

Ventral tongue, floor of mouth, lower lip, soft palate, gingiva. Mets to submandibular area

50
Q

Effect of nitrates on HR and end diastolic volume?

A

Decreased EDV, increased HR (due to reflex tachycardia)

51
Q

What is electrolyte composition in sweat and mucous for CF patients?

A

High Cl in sweat

Low Cl and Na in mucous

52
Q

What are the stages of mRNA processing?

A

5’ capping - stabilizes 5’ mRNA in cytosol
PolyA trail addition- stabilizes 3- in cytosol
Splicing out of introns (causing DNA loops) by snRNPs***

53
Q

What is allelic heterogeneity?

A

Same disease, but different genes causing it

54
Q

Man with hyperpigmentation, derranged LFTs, arthralgia, Diabetes, cardiomyopathy. what is it?

A

Hemochromatosis- autosomal recessive disease of excess iron stores. Excessive GI absorption of iron

55
Q

How does cirrhosis cause splenomegaly?

A

Portal venous system congestion, increased backpressure into splenic vein (valveless system)

56
Q

Burn victim with yellow crusting on wound. What is organism?

A

Staph or strep- impetigo- yellow crust

57
Q

What is cell mechanism for multidrug resistance?

A

Bacterial antibiotic efflux pumps using ATP, proton electrochemical gradients, and sodium gradients**

58
Q

Which gene is affected in achondroplasia?

A

FGFR3 - restricted chondrocyte proliferation

59
Q

What are White cells like in X-linked burton agammalobinemia?

A

No B cells, present T cells

Intracellular messaging abnormality

60
Q

Where do insulin N-terminal peptide sequence proteins accumulate in someone with diabetes?

A

Proteins accumulate in cytosol.
Normally translated –>ER cleaves preproinsulin into proinsulin–>Golgi–>cleavage of proinsulin–> exocytosis of insulin and C peptide

61
Q

What accumulates in maple syrup urine disease?

A

Branched chain amino acids

62
Q

What enzyme and vitamin is deficient in MSU disease?

A 
Alpha ketoacid dehydrogenase
Requires B1 (thiamine) as a cofactor
63
Q

What type of cells secrete andorgen binding protein in males? Why is this important?

A

Sertoli cells secrete them in order to maintain high concentrations of testosterone in epydidymis and seminiferous tubules so that spermatogenesis can occur

64
Q

Signaling path for glucagon?

A

Stimulates Gs –>adenylate cyclase–>cAMP–>

glygocenolysis & gluconeogenesis

65
Q

What is signaling path for insulin?

A

Tyrosine kinase receptor —> phosphoinositide 3-pathway –> increases glucose uptake in tissues, increasess glcogen synthesis, decreases gluconeogenesis

66
Q

What type of collagen is affected in OA?

A

Type II collagen - haline cartilage

67
Q

What is pathogenesis of OA?

A

Increased biomechanical stress and metalloprotease activity

68
Q

What are clinical signs of pulmonary artery hypertension?

A

Pitting edema, RV hypertrophy, R ventricular heave

Due to pulmonary endothelial dysfunction** hyperplasia of intimal layer

69
Q

What enzyme is deficient in neonatal hypoketotic hypoglycemia?

A

Medium chain Acyl-CoA dehydrogenase deficiency. No formation of Acetyl-CoA to form ketone bodies. Fatty acids usually oxidized to form ketone bodies

70
Q

What genes are associated with 2-hit hypothesis (tumor supressor genes?)

A

VHL, BRCA1/2, APC, TP53, RB, WT1

71
Q

What genes are associated with gain of function (proto-oncogenes?)

A

RAS, MYC, ERBB1/2, HER2, ABL, BRAF

72
Q

What are internal ribosome entry sites?

A

Part of programmed cell death when a specific nucleotide sequence (internal ribosome entry) will attract eukaryotic mRNA and allow it to be translated in middle of sequence

73
Q

MOA piolitazone?

A

Thiazolidinediones (PPAR-y activators)

-Decrease insulin resistance by upregulating genes for GLUT4 and adiponectin (fatty acid oxidation)

74
Q

SE of pioglitazone?

A

Fluid retention, weight gain

No hypoglycemia

75
Q

MOA dapaglifozin?

A

SGLT-2 inhibitor- inhibits glucose reabsorption

76
Q

MOA sulfonylureas (glyburide) and meglitinides (repaglinide)?

A

Block K+ ATPase in pancreatic beta cells, causing depolarization of L-type calcium cannels, releasing insulin

77
Q

What is main treatment for hepatic encephalopathy?

A

Lactulose (intestinal acidification to create lactic acid and acetic acid)

78
Q

Which antibiotic interacts w warfarin?

A

SMP-TMX, it inhibits CYP 450 which then increases effect of warfarin (must lower dose of warfarin if giving SMP-TMX)

79
Q

What are second messengers for Alpha 1/2, Beta 1/2 receptors?

A

Alpha 1 - increases IP3
Alpha 2- decreases CAMP
Beta 1 increases CAMP
Beta 2 increases CAMP

80
Q

What part of bone is affected in osteomalacia?

A

Decreased mineralization of OSTEOID** in Haversian canal

81
Q

Early onset malignancies- sacoma, breast, brain, adrenal, leukemia. What happened to their genes?

A

p53 two hit hypothesis - inactivating mutation on an alelle

82
Q

What does recurrent laryngeal nerve supply?

A

all intrinsic muscles except for cricothyroid (superior laryngeal nerve)

83
Q

What type of thyroid condition causes huge germinal centers to appear?

A

Hashimoto thyroiditis

84
Q

What type of inheritence is duchenne muscular dysrtrophy?

A

X linked recessive

85
Q

What causes achalasia?

A

Absence of esophageal peristalsis in distal esophagus. Degeneration of inhibitory ganglion cells in myenteric plexus

86
Q

Who gets G6PD?

A

Africans, asians, mediterranians

87
Q

What type of neurons are unmyelinated?

A

Slow pain, heat, and olfaction. Post-ganglionic autonomic nerves

88
Q

Describe antigen processing in APC cell process?

A

MHC II made of alpha and beta subunits
These are brought together by invariant chain and they go through RER and Golgi body to form a new complex that can be presented to T cells

89
Q

What are symptoms of iron deficiency anemia?

A

Glossal pain, dry mouth, tongue papillae atrophy, alopecia

90
Q

What happens cellularly when cardiac hypertrophy occurs?

A

Increased rate of myosin mRNA suynthesis

91
Q

What layer of skin thickens when you get a callous?

A

Stratum corneum

92
Q

MOA doxycycline?

A

Tetracycline, inhibits 30S ribosomal unit

93
Q

MOA eurythromycin?

A

Binds 50s subunit

94
Q

what determines cellular differentiation and de-differentiation?

A

Transcription factors

95
Q

What does cholingergic stimulation do to eye?

A

Muscurinic agonists. Pupillary constriction (pilocarpine is a cholinomimetic)

96
Q

What is pernicious anemia? Result?

A

Autoimmune descruction of gastric mucosa. Hypochloridia, decreased gastric acid, increased gastrin levels, decreased intrinsic factor and B12

97
Q

Does varicocele transilluminate?

A

No. Only bulges when standing up not lying down

98
Q

What are heart abnormaliies in Digeorge syndrome?

A

ToF, TA, interrupted aortic arch

99
Q

What is result of CD40L deficiency? What is inheritance pattern?

A

X linked recessive
Inability to class switch, hyperIgM syndrome
Low IgA, IgG, IgE
Normal B and T cell count

100
Q

Alpha 1 receptors peripherally have what type of messenger system?

A

Phosphatidylinositol 2nd messenger system
Gq–>phospholipase C –> inositol triphosphate (IP3)*** release, DAG, IP3 liberates calcium in ER and leads to smooth muscle contraction

101
Q

What substances use cGMP as a second messenger?

A

BNP, ANP, NO

102
Q

What do etanercept and infliximab target?

A

Anti-TNF-alpha agents. Used in autoimmune conditions

103
Q

What organism does methenamine silver stain look for?

A

Aspergillus. Broomlike appearance. fungus balls in lng cavities

104
Q

What do HOX13 genes do?

A

Determine where hand-foot-genitals go. Deformity results in malformations

105
Q

How does afterload affect contraction velocity?

A

Decrease in afterload increases contraction velocity

106
Q

Where do the maxillary sinuses drain?

A

Middle nasal meatus

107
Q

What part of the sarcomere lengthens and shortens during muscle contraction and relaxation?

A

I- band containing thin actin filaments (and Z line)

STEP 1 MIXED (13 decks)

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