Board Qs Flashcards
1
Q
Wernicke-Korsakoff
A
Wernicke: oculomotor dysfunction, ataxia, encephalopathy; mamillary bodies; alcoholics; thiamine (B1) def
Korsakoff: chronic deficiency = amnesia, confabulation, apathy
2
Q
Fragile X
A
Fragile X syndrome is caused by an increased number of CGG trinucleotide repeats on the fragile X mental retardation 1 (FMR1) gene on the long arm of the X chromosome. This leads to hypermethylation and inactivation of FMR1; macroorchidism, large jaw, intellectual disability
3
Q
Huntington disease
A
CAG repeat on chromosome 4 caused by looping and repair during replication, unequal crossing over during meiosis
4
Q
Friedreich’s ataxia
A
FXN gene encoding for frataxin (GAA)
stumbling, childhood kyphoscoliosis, hammertoes, pes cavus, dysarthria, nystagmus
5
Q
direct bilirubin disorders
A
Rotor (NML liver histology, elevated total urine coproporphyrin) and Dubin Johnson (black liver, NML total coproporphyrin)
6
Q
SCID
A
recurrent infections, FTT, diarrhea
ADA deficiency
7
Q
William Syndrome
A
elfin face, hypercalcemia, developmental delay, well-developed skills, cardiac issues
8
Q
encephalopathy secondary to liver cirrhosis pathophys
A
ammonia is metabolized in liver > when it’s not, it causes swelling in the brain > somnolence, asterixis (hand-flapping tremor), coma
9
Q
Kartagener
A
AKA primary ciliary dyskinesia
AR
defect in dynein
chronic resp infections, recurrent OM, infertility, situs inversus (point of maximal impulse may be on right), bronchiectasis
10
Q
presentations of SCD
A
vaso-occlusive crisis (dactylitis most often)
stroke (pediatric)
acute chest syndrome (fever, chest pain, hypoxemia, resp distress)
splenic sequestration (SM, decreased Hb, thrombocytopenia)
11
Q
Lesch Nyhan
A
XL
deficiency of HGPRT
developmental delay, self-mutilation, gout, choreiform movements
12
Q
Lassa fever
A
arenaviridae (grains of sand appearance on EM) > 2 segmented ambisense ssRNA genome; hemorrhagic fever (pharyngitis, cough, N/V/D, myalgia, retrosternal chest pain, back pain, abd pain; face swelling, pulm edema, mucosal bleeding ,hypotension, deafness if severe
13
Q
adenovirus
A
swimming pool conjunctivitis (fever, sore throat, coryza, red eyes, pharyngitis)
14
Q
Hartnup
A
def in tryptophan > precursor to niacin (B3) > pellagra (4 Ds = dermatitis, diarrhea, dementia, death)
15
Q
how do you decrease type II error?
A
increase power by increasing sample size or decreasing variability
16
Q
carcinoid syndrome
A
secretes high levels of serotonin; hydroxyindoleacetic acid (5-HIAA) is metabolite of serotonin found in urine of these pt
Presentation: wheezing, diarrhea, flushing, right-sided valvular lesions (esp tricuspid regurg)
17
Q
DIC
A
low platelets, low plasminogen, high PT (activation of both coagulation and fibrinolytic system > excessive consumption of clotting factors and platelets)
18
Q
ITP
A
low platelets, elevated bleeding time, NML PT, PTT; idiopathic meaning there’s not really anything besides low platelets and high bleeding time consequently to tell you anything
19
Q
VWD
A
NML platelets, high bleeding time and PTT (VIII stabilized by vwf)
20
Q
vitelline duct abnormalities
A
persistent vitelline duct (fistula) = meconium discharge from umbilicus
Meckel diverticulum = most common
vitelline sinus
vitelline duct cyst
21
Q
West Nile
A
fever, headache, rash, neuroinvasive sx (Parkinsonian, asymmetric flaccid paralysis)
22
Q
where are lipophilic drugs (like anesthesia) absorbed quickly?
A
Well-vascularized tissue > brain, kidney, liver, lungs, heart
delayed distribution in skeletal m, bone, fat
23
Q
chronic bronchitis most commonly caused by…
A
smoking
24
Q
type I pneumocytes
A
form alveolar capillary barrier with endothelial cells
25
Reye pathophys
aspirin use during viral infxn > mitochondrial toxicity > impaired FA metabolism > microvesicular fat deposits in liver > hepatic dysfunction > hyperammonemia > diffuse astrocyte swelling (cerebral edema)
26
sirolimus MOA
binds FKBP that inhibits mTOR to stop IL-2 signaling
27
cyclosporine and tacrolimus MOA
binds cyclophilin or FKBP (respectively) which then inhibits calcineurin and stops IL-2 gene transcription
28
what can't use ketones in the body?
RBCs
29
+ membrane potentials
Na or Ca
30
- membrane potentials
K or Cl
31
1 SD, 2 SD, 3 SD
68%, 95%, 99.7%
32
normal AG causes
```
simply d/t loss of bicarb > HARDASS
Hyperchloremia
Addison
RTA
Diarrhea
Acetazolamide
Spironolactone
Saline infusion
```
33
elevated AG causes
```
d/t accumulation of unmeasured acidic compounds > MUDPILES (CAT)
Methanol
Uremia
DKA
Paraldehyde
Iron, Isoniazid
Lactic acidosis
Ethanol, ethylene glycol
Salicylate/ASA/Aspirin
```
Carbon Monoxide
Aminoglycosides
Theophylline
34
NML AG
10-14
35
montelukast and zafirlukast MOA
inhibit leukotrienes ("lukast" = LEUKOtriene)
36
CV abnormalities in Turner
Aortic coarctation, bicuspid aortic valve
37
pathogenesis of preeclampsia
ABNML placental development that results in high resistance, low perfusion vessels leading to ischemia > triggers widespread maternal endothelial dysfunction (vasospasm), increased vascular permeability, and decreased end-organ perfusion > classic presentation is HA and visual changes
38
what psych medication is CI in binge eating?
BUPROPION REMEMBER IT DAMMIT
39
schizotypal personality disorder
magical beliefs, social anxiety, eccentric behavior, odd perceptual experiences
40
type IIa dyslipidemia (hypercholesterolemia)
high total cholesterol, high LDL, everything else NML
41
type I dyslipidemia (hyperchylomicronemia)
NML to high cholesterol, super high TGs, CM elevated
42
type IIb dyslipidemia (hypercholesterolemia)
LDL and VLDL high, high cholesterol, high TGs
43
type III dyslipidemia (dysbetalipoproteinemia)
IDL high, high cholesterol, high TGs
44
type IV dyslipidemia (hypertriglyceridemia)
VLDL high, NML to high cholesterol, high TGs
45
type V dyslipidemia
VLDL and CM high, high to moderately high cholesterol, super high TGs
46
subacute granulomatous thyroiditis
AKA de Quervain thyroiditis; often after viral URI, only form that results in painful thyroid gland
47
Courvoisier's sign
painless palpation of distended, obstructed gallbladder in pancreatic CA
48
signs of pancreatic cancer
Courvoisier's, Trosseau (migratory and recurrent thrombophlebitis), Virchow's node (L supraclavicular)
49
digoxin toxicity and MOA
bradycardic, visual disturbances (yellow halo), N/V
MOA: inhibit myocardial Na/K ATPase
50
why are local anesthetics less effective at sites of infection and thus require a higher dose for infected sites?
Local anesthetics are alkaline and infection results in an acidic environment
51
tuberous sclerosis
seizures, intellectual disability, subependymal astrocytoma, ash leaf spots, ungual fibromas, angiomyolipomas
52
identification
adopts and models behaviors of another person
53
idealization
only focuses on + traits of self or others and overlooks flaws
54
ToF
PROVe: pulmonary stenosis (left USB harsh systolic murmur), RVH (boot-shaped heart), overriding aorta, VSD
Cyanotic spells (often caused by crying, fever, exercise d/t exacerbation of RV outflow obstruction) > squatting increases SVR > decreases R-L shunt > improves cyanosis; a/w 22q11 syndromes
55
hemochromatosis
DM, liver failure, skin hyperpigmentation, cardiac sx (dilated CM, restrictive CM, arrhythmias), arthritis
56
thiazide diuretics MOA (hydrochlorothiazide, metolazone, chlorthalidone, indapamide)
inhibit NaCl reabsorption from luminal side of epithelial cells in DCT by blocking Na/Cl transporter
57
berry aneurysm b/w anterior communicating and anterior cerebral can cause what visual field defect?
bitemporal hemianopia
58
what nerve is most likely injured in fibular fracture
common peroneal n > inability to dorsiflex foot (foot drop) > tibialis anterior, extensor digitorum longus and hallucis
59
where does prolactin come from?
anterior pituitary
60
what hormones come from posterior pituitary?
vasopressin and oxytocin
61
epiglottitis
fever, sore throat, dysphagia, drooling, muffled voice, respiratory distress (tripod position opens airway), thumbprint sign on XR
3Ds: dysphagia, drooling, distress are hallmark
62
albuterol MOA
beta 2 agonist > activates AC > increases cAMP > increased PKA > smooth muscle relaxation > bronchodilation
63
hypertrophic CM
syncope in athletic setting; AD condition caused by missense mutation in genes for beta-myosin heavy chain
64
NK cells induce apoptosis by...
perforin and granzyme production; Fas/FasL binding on cell surface
65
Lambert-Eaton
presynaptic disorder of NM transmission in which there is reduced ACh release d/t Ab against voltage-gated Ca channels; paraneoplastic; leg weakness, general weakness, pain, stiffness, arm weakness, ptosis, dry mouth, constipation, impotence
66
Hashimoto
signs of hypothyroidism, hx of autoimmune disorders, germinal centers w/ lymph infiltrate and follicular destruction; anti-TPO
67
schizoid personality disorder
no desire for close relationships, flat affect, prefers solitary activities, little or no interest in sexual experiences, enjoys few or no activities, indifferent to criticism, praise, or other people's opinions of them, no close friends
68
Wallenberg syndrome
lateral medullary syndrome; PICA; ipsilateral loss of pain and temp in face, contralateral loss of pain and temp in body, dysarthria, dysphagia, ataxia
69
lateral pontine syndrome
AICA; ipsi face analgesia, contra body analgesia, ipsi face hemiparesis, ipsi deafness
70
MCA stroke
contra hemianesthesia, contra hemiplegia, contra homonymous hemianopia, ipsi horizontal gaze preference
71
mid-shaft humerus fractures most commonly injure what nerve
radial > brachioradialis, extensors of the wrist and fingers, supinator, triceps (BEST)
72
borderline personality disorder
instability of relationships, self-image, and affect, marked impulsivity, avoid abandonment; initial tx is CBT/DBT, psychodynamic therapy
73
hereditary fructose intolerance
hypoglycemia, tiredness, vomiting, diaphoresis since introducing fruit; deficiency in aldolase B > buildup of F1P
74
Marcus Gunn pupil
alternating constriction and dilation of both pupils with swinging flashlight test; when directed into NML eye, pupils constrict like NML, but when directed into affected eye they appear to dilate; damage to either optic n or retina
75
what happens to increase blood flow to muscles during exercise?
local metabolites (Co2, H+, K+, adenosine) and decreased O2 > dilate arterioles and recruit capillaries
76
ankylosing spondylitis
low back pain that gets better with exercise, worse @ night, SI joint, enthesitis, restrictive lung disease, aortic insufficiency, uveitis, systemic sx
77
cocaine MOA
inhibits reuptake of DA, 5-HT, NE into presynaptic neurons > increased risk of preterm delivery
78
heparin MOA
potentiates action of antithrombin III
79
what layer of bowel is most susceptible to ischemia?
Innermost > mucosa
80
MHC II function
Present antigens to the CD4 helper T cells
81
atrial myxoma
constitutional sx; often in left atrium > impaired blood flow through mitral valve and reduce preload > low CO > syncope > early diastolic murmur that changes in frequency with changes in pt body position > can develop embolic stroke, mesenteric ischemia, arterial insufficiency, AKI
82
COPD path from smoking
increases oxidants in lungs
83
Ebstein anomaly
tricuspid regurg, downward displacement of TV leaflets into RV, RHF can occur > JVD, peripheral edema, and/or HM; hypoxemia, cyanosis
84
cecum supplied by branches of ...
SMA (lower duodenum, jejunum, ileum, cecum, ascending colon, transverse colon to splenic flexure)
85
tx of phthirus pubis and scabies
topical permethrin
86
cleft lip results when...
maxillary prominence fails to fuse with intermaxillary segment
87
MCC of renal infarction
Systemic thromboembolism from LA or LV; common complication of afib
88
age-related changes to resp system
decreased chest wall compliance/expansion, decreased alveolar elastic recoil (increases compliance and increased air trapping), increased a-A gradient (increased deadspace)
89
GVHD
graft immunocompetent T cells migrate into host tissues, where they recognize host MHC antigens as foreign and become sensitized > destroy host cells
will get diffuse response w/ rash, jaundice, diarrhea, HSM
90
P-glycoprotein
efflux pump found in brain that prevents many substances from entering
91
PTH function
increase bone resorption > Ca and P release > increase Ca in blood
kidneys increase Ca reabsorption and decrease P reabsorption > increase Ca in blood, increase P in urine
92
Pott disease
progressive back pain, intermittent fever, vertebral bone destruction w/ abscess > M tuberculosis spondylitis (infection spreads behind ALL to vertebrae and IVD space > abscess)
D/t hematogenous seeding of vertebrae from primary pulmonary infxn; months to years later
93
REM sleep behavior disorder
parasomnia characterized by dream-enactment behaviors d/t loss of atonia; a/w alpha-synuclein neurodegeneration like Parkinson, Lewy body dementia
94
Catheter pressures
RA = <10
RV = <10-25
PA = 10-25
PA wedge = ~10
95
what portion of the nephron absorbs the most water?
PCT
96
severe mitral regurgitation can result in...
L-sided volume overload with S3 gallop d/t large volume of regurgitant flow reentering ventricle mid-diastole
97
digoxin toxicity
GI distress, arrhythmias, fatigue, confusion, weakness, color vision alterations, high K (from inhibition of Na/K pumps)
Tx for HF
98
lesion in internal carotid artery of TIA
contralateral leg weakness, ipsilateral vision loss (amaurosis fugax); internal carotid supplies EXTERNAL brain (hemispheres)
99
alcohol withdrawal effects on receptors
decreased GABA activity, increased glutamate activity d/t increased # of NMDA receptors
100
Berger/IgA nephropathy
MCC of glomerulonephritis; painless hematuria accompanied by URI
101
lung abscess antibiotic tx should cover...
facultative and strict anaerobes (often present)
102
what part of the posterior urethra is more prone to injury following pelvic fx in male?
membranous
103
tibial n injury
inability to plantarflex, invert, and flex toes; sensory loss over sole
104
oculomotor n injury
down and out eye, diplopia, dilation of pupil and loss of accommodation, ptosis; SR, MR, IR, IO, LPS
105
what amino acid is a/w folate?
Thymidine
106
mitochondrial diseases
"red ragged muscle fibers"; maternal inheritance
107
femoral nerve block site
below inguinal lig
108
saphenous nerve block site
adductor canal or medial tibial condyle
109
pudendal nerve block site
ischial spine tip
110
obturator nerve block site
obturator canal
111
apolipoprotein E risk
late-onset alzheimer's
112
NNH
1 / ARI
| ARI = rate AE (drug) - rate AE (placebo)
113
best approach to somatic symptom disorder
regular visits with the same provider
114
what determines need to abx tx in a person with GAS?
swab for GAS antigens; gram stain isn't effective because the mouth contains other g+ cocci
115
cerebellar injury
motor planning and coordination of ipsilateral extremities
116
Crohn
prolonged diarrhea, abd pain, constitutional sx, malabsorption, weight loss, a/w ankylosing spondylitis, arthritis
terminal ileum commonly involved where bile acids are normally reabsorbed and recycled (vit K is a fat-soluble vitamin so can have coagulation issues)
117
inadequate thyroid hormone levels in infants being treated for congenital hypothyroidism..
rapid growth > increasing need for thyroid hormone
decreased absorption of levothyroxine
coadministration with certain foods or drugs can lead to poor intestinal absorption
118
EF=
SV / EDV
119
WPW
caused by accessory conduction pathway (bundle of Kent)
| Triad: short PR, wide QRS, delta wave (slurred upstroke into QRS)
120
atopic dermatitis
pruritic, lichenified plaque; often flares w/ low humidity; genetically-mediated epidermal barrier dysfunction and immune dysfunction part of pathogenesis; Th2 response > IL-4 and IL-13 trigger IgE production
121
propionic acidemia
congenital def in propionyl-CaA carboxylase (converts propionyl to methylmalonyl) > met acid, hypoglycemia, ketosis
uses valine, isoleucine, methionine, threonine for energy
122
MEN1
primary hyperparathyroidism
pituitary tumors
pancreatic tumors (esp. gastrinomas)
123
MEN2A
medullary thyroid cancer (calcitonin)
pheochromocytoma
primary hyperparathyroidism
124
MEN2B
medullary thyroid cancer (calcitonin)
pheochromocytoma
mucosal neuromas/marfanoid habitus
125
HPV affects _____ vocal cords
true
126
dantrolene MOA
blocks RYR1 to prevent Ca release from SR into cytoplasm of skeletal muscles
127
prolonged muscle weakness after receiving succinylcholine
plasma pseudocholinesterase def > genetic polymorphism in BCHE gene > lot of drug reaches NMJ
128
STEMI tx w/o percutaneous coronary intervention
thrombolytics (alteplase) > reperfusion related arrhythmia
129
pt with low HDL levels...
should focus on lowering LDL with HMG-CoA reductase inhibitors (statins); niacin is most effective for raising HDL but doesn't reduce risk of CV events and is a/w AE (flushing, hyperglycemia)
130
elderly w/ myopia...
can actually have improved vision with age d/t age-related presbyopia
131
carcinoid syndrome develops when a carcinoid tumor has
metastasized
132
abd pain/distension, bloody diarrhea, fever, shock in setting of untreated UC
Toxic megacolon > XR
133
Common hepatic artery gives off...
R gastric (inferior lesser curvature) and gastroduodenal (supplies pylorus, prox duodenum, and head of pancreas)
134
Eisenmenger
cyanosis, pulmonary HTN, reversal of blood through a defect (VSD, ASD, or PDA), 2nd or 3rd decade w/ s/s of RHF, diffuse cyanosis, and clubbing
VSD alone doesn't produce cyanosis
135
Dandy Walker malformation
congenital brain anomaly involving posterior fossa and cerebellum; begins w/ cystic enlargement and posterior extension of 4th ventricle; causes hypoplasia and cephalad rotation of cerebellar vermis
136
tx for acute pulm edema in setting of decompensated HF
loop diuretic
137
SCC of the lung
centrally located; hypercalcemia of malignancy; keratin pearls w/ intracellular bridging; strong a/w smoking
138
AIHA
spherocytes, elevated reticu, reduced haptoglobin, and +direct Coombs
139
where do the nerve roots exit the spinal cord?
above the corresponding vertebrae; so a herniated C6/7 disc corresponds to C7
140
middle meningeal artery
enters through foramen spinosum and is terminal branch of maxillary a (arises from external carotid)
141
language aphasia affected based on location
arcuate fasciculus: conduction, intact fluency, impaired repitition, intact comprehension
primary motor cortex: no aphasia (dysarthria), intact rest
Broca: impaired fluency and repetition, intact comprehension
Wernicke: intact fluency, impaired repetition and comprehension
142
Systolic HF (HFrEF) loop
decreased SV and increased ESV and EDV
143
Whipple disease
arthralgias, weight loss, steatorrhea, abd pain
144
CYP450 inducers
carbamazepine, rifampin, griseofulvin, phenobarbital, phenytoin, St John's wort, chronic alcohol
145
Inhibitors of CYP450
Diltiazem, itraconazole, ketoconazole, erythromycin, clarithromycin, grapefruit juice, protease inhibitors, nefazodone, acute alcohol
146
common cause of bleeding in ped patient w/ no hemorrhoids or anal fissures...
Meckel diverticulum
147
duodenal ulcers should suspect...
ZES > overproduction of gastrin in G cells of pyloric antrum and duodenum
148
Parinaud syndrome (dorsal midbrain syndrome)
impaired vertical gaze, NML to lg pupils, light-near dissociation, convergence-retraction nystagmus, and eyelid retraction (Collier sign); caused by pineal gland tumor, hydrocephalus, MS, brainstem infarction
149
diabetic neuropathy findings
mesangial expansion, GBM thickening, podocyte injury, glomerulosclerosis (Kimmelstiel-Wilson nodules)
150
primary hyperaldosteronism (Conn)
HTN, unexplained hypokalemia, metabolic alkalosis, low renin; d/t adrenal hyperplasia or adrenal adenoma
151
blastomycosis
inflammatory lung disease, verrucous skin lesions, lytic bone lesions
152
t-PA MOA
degradation of fibrin through conversion of plasminogen to plasmin
153
bone spurs
osteophytes seen in osteoporosis
154
spinal cord hemisection (Brown Sequard)
ipsi spastic paralysis, ipsi loss of touch and sensation , contra loss of pain and temp about 2 levels below lesion
155
biggest complaint after being on an estrogen agonist years later...
postmenopausal bleeding > endometrial hyperplasia and cancer
156
tx of acute chest pain in angina pectoris
nitroglycerin > stimulate GC > increase cGMP > activate myosin light chain phosphatase > vasodilation
157
anterior spinal cord syndrome
paraplegia below, loss of temp and pain bilaterally, intact pinpoint and vibration
158
tx of HTN in pregnant pt
methyldopa (alpha-2 agonist), hydralazine (reduce afterload by increased cGMP), labetalol, nifedipine
159
medullary CA of thyroid
high calcitonin d/t prolif of parafollicular C-cells
160
oligodendroglioma
MC primary CNS tumor in 4th-6th decades; HA, seizure, confusion, cognitive dysfunction, focal weakness, sensory abnormalities, aphasia; fried egg appearance, chicken wire appearance; frontal lobes MC
161
tx of organophsphate poisoning
atropine and pralidoxine
162
Horner =
damage to sympathetics; ptosis, miosis, and anhidrosis
163
NSAIDs MOA
conversion of AA to PGDs by COX
164
"-zosins"
alpha-1 receptor blockers > treat HTN and BPH
165
trazodone
atypical antidepressant weak inhibitor of 5-HT2A receptor; se = priapism
166
temporal arteritis
tenderness @ temporal region, jaw claudication, HA, visual impairment; granulomas w/ giant cells; a/w polymyalgia rheumatica (both a/w HLA-DR4)
167
menopause
decline in sensitivity of ovaries to stimulation by gonadotropins > high FSH, LH
168
ADPKD association
berry aneurysms > rupture = subarachnoid hemorrhage
169
increased prevalence of disease...
increases PPV, reduces NPV
170
decreasing the cutoff value for a test...
increases NPV, reduces PPV
171
type II pneumocytes
make up the largest # of alveolar cells (although type I make up the largest SA) and act as progenitor cells for type I, which cannot regenerate on their own; produce surfactant
172
gonadal arteries arise from...
abdominal aorta
173
H pylori infection = increased risk of...
gastric ulcers, gastric adenocarcinoma, and MALT lymphoma
174
mild galactosemia..
def in galactokinase > cataracts d/t buildup of galactitol
175
postpartum blues (i.e. normal postpartum rxn)
resolves w/i 2 weeks; mild depression, tearfulness, irritability
176
postpartum depression
onset w/i 4-6 weeks; >2w of moderate to severe depression, sleep, or appetite disturbance, low energy, guild, difficulty concentrating, suicidal ideation
177
overflow incontinence
impaired detrusor contractility or bladder outlet obstruction; involuntary and continuous leakage when bladder is full w/ incomplete emptying
178
AIN
drugs > rash, fever, AKI, pyuria, hematuria, WBC casts, urinary eosinophils
179
anemia
PaO2 and % sat would be NML but O2 content would be low d/t lower Hb
180
HAPE
high-altitude pulmonary edema; reduced PiO2 > hypoxic pulm vasoconstriction > increased pulm arterial pressure > unbalanced hypoxic vasoconstriction > alveolar-capillary membrane disruption
181
DNA polymerase I in prokaryotes
5' to 3' exonuclease activity
182
DNA polymerase III
3' to 5' exonuclease activity, 5' to 3' polymerase activity
183
tRNA
contains modified bases; CCA sequence at 3' end > serves as AA binding site
184
Rickettsia ricketsii
RMSF > nonspecific sx followed by macular-petechial rash that moves distal to central > tx w/ doxy
185
major RFs for AAA
age >65, smoking, male
186
metabolites of morphine
glucoronide > renal elimination > w/ renal dysfunction, metabolites accumulate and opioid toxicity results
187
pharyngeal arch 1
trigeminal; maxillary a
188
pharyngeal arch 2
facial n
189
pharyngeal arch 3
glossopharyngeal n; common carotid, proximal ICA
190
pharyngeal arch 4
superior laryngeal branch of vagus; true aortic arch, subclavian aa
191
pharyngeal arch 6
recurrent laryngeal branch of X; pulmonary aa, ductus arteriosis
192
ghrelin
produced in response to fasting; stimulates appetite and promotes weight gain
193
leptin
produced in response to short-term food intake > acts on hypothalamus to decrease appetite (obesity blunts this)
194
what viruses are capable of reassortment?
segmented - orthomyxo (flu), reo (rota), bunya, arena
195
how is copper excreted?
through bile
196
amniotic fluid embolism
pregnancy complication that results from amniotic fluid entering maternal circulation; hypotensive shock > fetal squamous cells seen in pulmonary vasculature
197
sympathomimetic weight loss drugs
phentermine, diethylpropion, benzphetamine > short-term tx of obesity; stimulate release and inhibit reuptake of NE
198
prevention of neonatal tetanus
vaccination of mother and those of childbearing age; hygienic delivery and cord care
199
permissiveness in pharmacology
hormone has no direct effect on a physiologic process but allows another hormone to exert its maximal effect on that process
200
meds ineffective in MRSA
oxacillin, methicillin, cephalosorins, and other beta-lactams
201
type I HS
IgE degranulates mast cells > following repeat exposure IgE can release preformed histamine and LTs (wheal and flare) > late phase stimulate Th2 cells to activate eosinophils > proteins (MBP, peroxidase) cause tissue damage > indurated lesion 2-10 hours following
202
glioblastoma multiforme
MC primary brain tumor in adults; increased vascularity, pseudopalisading tumor cells around necrotic areas
203
radial n action
extends the wrist > "Radial n Reaches back"
204
idiopathic pulmonary fibrosis
patchy lymphoplasmacytic infiltrates, focal fibroblastic proliferation, fibrosis, honeycombing, hyperplasia of T2 pneumocytes > inhibit TGF-beta and other GFs
205
glucocorticoid MOA
bind cytosolic receptor, translocate to nucleus, alteration in transcription (in immune cells inhibit NF-kB)
206
P falciparum
predominant in Africa; chloroquine-resistant > atovaqoune-proguanil, artemisinins) > no primaquine required d/t no dormant liver form
207
kinesin
anterograde transport (toward +, distant from nucleus)
208
Asherman syndrome
intrauterine adhesions mostly d/t D&C; secondary amenorrhea w/ no other signs
209
hydatidiform mole
proliferation of chorionic epithelium and cystic swelling of villi
210
DPP-4 inhibitors
"-gliptins" increase levels of endogenously secreted GLP-1 (increased insulin release and satiety, decreased glucagon release and gastric emptying)
211
psoriasis
hyperkeratosis, parakeratosis, acanthosis, elongated rete pegs, hypervascular dermal papillae
212
sarcoidosis
immune-mediated disease characterized by widespread noncaseating granulomas, restrictive lung disease, bilateral hilar LAD, Bell's palsy, rash, erythema nodosum, blurry vision; causes rise in ACE, hypercalcemia, hypervitaminosis D
213
Kallmann
lack of puberty development, lack of secondary sex characteristics, decreased sense of smell
214
Klinefelter
Hypogonadism, gynecomastia, psychosocial problems, and infertility, 47 XXY karyotype
215
prophylactic tx for seizures in HELLP
mag sulf > evaluate DTRs for hypermagnesemia
216
macrolides severe side effect
prolonged QT
217
type I HS in sensitized individual
binding of antigen to IgE antibodies on surface of mast cells and basophils
218
cytokine that activates CD4 and 8 cells
IL-2
219
DIC
simultaneous thrombolysis and clot formation > D-dimer high d/t thrombolytic effect, but fibrinogen is low d/t formation of clots > "consumption of clotting factors and platelets"
220
anterior talofibular
always tears first; inversion ankle sprain; lateral malleolus to neck of talus
221
conivaptan
vasopressin receptor antagonist; prevents ADH action in CD
222
Whipple
similar presentation to IBD, but steatorrhea not common in IBD
223
dermatomyositis associations
increased risk of adenocarcinoma, particularly ovarian cancer
224
hyperthyroidism
overactive body > IgG antibodies against TSH in Graves
225
papillary carcinoma appearance
papillary growth with optically clear nuclei (ground-glass chromatin/orphan-annie eyes)
226
scabies
irritated rash common in the webbing of fingers and toes; low hygiene and overcrowding (homeless shelters) facilitate spread
227
ACEI is DOC for hypertensive pt w/...
diabetic nephropathy
228
Thiazide diuretics are DOC in hypertensive pt w/....
no other comorbidities
229
BB are DOC in hypertensive pt w/...
angina or hx of MI
230
alpha-blockers are DOC in hypertensive pt w/...
BPH
231
Friedreich ataxia is a/w what cardiac abnormality?
HOCM
232
"worst headache of my life"
subarachnoid hemorrhage
233
Ehler Danlos is a/w what vascular pathology
berry aneurysm
234
Holstein-Lewis fractures commonly injure what nerve
Radial n
235
tibial n innervates...
posterior leg mm
236
chylothorax
milky fluid composed of TGs within pleural space a/w trauma or lymphoma
237
Turner
45, XO; short stature, broad chest, primary amenorrhea
238
Swan-Ganz catheters measure pulmonary artery occlusion pressure which closely reflects...
left atrial and left ventricular ED pressures
239
TAP proteins
Load cytoplasmic proteins onto MHCI > activate CD8 cells
240
lactase def can be caused by...
inflammatory or infectious processes that damage microvilli
241
matching variables in a case-control study controls...
confounding bias
242
VSD murmur
harsh, holosystolic murmur at left lower sternal border > L>R shunting
243
taking exogenous thyroid hormone will show...
diffuse atrophy of thyroid follicles w/ decreased colloid d/t suppressed TSH
244
pericardial effusion
h/o URI > pericarditis; chest tightness, DOE, tachy, low voltage QRS and diminished heart sounds, enlarged globar cardiac silhouette on CXR
245
cofactors for branched chain alpha-ketoacid dehydrogenase
Tender Loving Care For Nancy = Thiamine, Lipoate, CoA, FAD, NAD
246
most common mechanisms of aminoglycoside resistance
antibiotic-modifying enzymes that add chemical groups (acetyl, adenyl, phosphate) to target drug
247
causes of supratherapeutic INR in warfarin
disruption to intestinal flora > destruction of vitamin K-producing bacteria in the gut > reduce vitamin K production > what little vitamin K is available is being inhibited by warfarin > increased INR
248
calcium oxalate stones
octahedron (square w/ X in center) (oxalate = octahedron)
249
calcium phosphate stones
wedge-shaped, form rosettes
250
mag ammonium phosphate (struvite) stones
coffin lids
251
uric acid stones
diamond or rhombus (4 letters in uric, 4 sides)
252
cystine stones
flat, yellow, hexagonal (six-tine)
253
acyclovir MOA
nucleoside analog > converted to monophosphate via thymidine kinase > convert to triphosphate which competes w/ deoxyguanosine triphosphate for viral DNA polymerase > when acyclovir becomes incorporated into replicating viral DNA, viral DNA synthesis is terminated
254
when does vitamin B12 deficiency start showing neurological signs
4-5 years after complete absence of intake; a lot of B12 can be stored
255
NRTI MOA
block PDE bond formation
256
succinylcholine blockade
phase I blockade prevents repolarization of motor endplate and shows equal reduction of all 4 twitches during TOF stimulation; phase II blockade Ach receptors become desensitized
257
TTP
decreased ADAMTS-13 > uncleaved vWF > platelet trapping and activation; hemolytic anemia (MAHA), thrombocytopenia, sometimes w/ renal failure, neurologic manifestations, fever
FATRN: fever, anemia (MAHA), thrombocytopenia, renal failure, neurologic manifestations
258
liquefactive necrosis
severe bacterial infxn, CNS infarcts
259
fibrinoid necrosis
HTN, vasculitis
260
fat necrosis
acute pancreatitis, trauma
261
caseous necrosis
mycobacterial infxn, fungal infxn
262
coagulative necrosis
irreversible ischemic injury outside CNS
263
what should be used in pt with stable angina w/ aspirin allergy to prevent CV events
clopidogrel
264
method for resistance in ESBL E Coli
plasmid w/ drug resistance gene
265
serum sickness is a type ____ HS reaction
III; deposition of immune complexes in tissue
266
kids with communicating hydrocele are at risk of what?
indirect inguinal hernia
267
lymph drainage in male anatomy
superficial inguinal nodes from scrotum > deep inguinal nodes from glans penis and superficial nodes > para-aortic nodes from testis
268
rickets =
excess unmineralized matrix d/t less calcium and phosphorus for the bone
269
medicare covers...
those 65+ and younger individuals w/ disabilities
270
HSP
think IgA nephropathy + petechiae
271
gigantism
hypersecretion of GH during childhood > excessive liver production of IGF-1
272
transudative effusions
HF, cirrhosis, nephrotic syndrome > changes in hydrostatic or oncotic pressure
273
exudative effusions
infxn, malignancy, rheumatologic disease > increased vascular membrane permeability from inflammation
274
atheroembolic disease
common after vascular procedure; cholesterol clefts; kidneys, skin, GI, CNS
275
isoniazid w/o pyridoxine
pyridoxine is cofactor for ALA synthase (catalyzes rate limiting step in heme synthesis) > typically prescribe both to prevent microcytic anemia
276
tx of priapism
alpha-adrenergic agonists > induce contraction of cavernosus smooth m
277
prerenal injury
BUN:Cr >20
Fractional excretion of Na <1%
Urine osmolality >500
microscopy hyaline casts
278
ALS
loss of neurons in anterior horn, atrophy of LCSTs, denervation atrophy, LMN and UMN sx, diaphragmatic atrophy
279
CN III PNS nucleus
Edinger-Westphal > miosis, accomodation
280
CN VII PNS nucleus
Superior Salivary > salivation in submandibular gland
281
CN IX PNS nucleus
Inferior Salivary > salivation in parotid
282
CN X PNS nucleus
Dorsal Vagal > secretions in GI tract/lungs
283
causes of metastatic bone cancer
Prostate > Breast > Kidney > Thyroid > Lung
| Painful Bones Kill The Lungs
284
Kawasaki
```
CRASH and burn on a Kawasaki
Conjunctival injection, CV risks
Rash
Adenopathy
Strawberry tongue
Hand-foot changes (edema, erythema)
fever
```
285
microglial cells
macrophages for the CNS; derived from monocytes (mesoderm)
286
hydroxychloroquine
DMARD that causes retinal deposits
287
acute diverticulitis
inflamed colonic outpouching commonly seen w/ stranding; mimics left-sided appendicitis; most commonly in sigmoid region
288
hcg is produced by...
syncytiotrophoblast of placenta (maintains CL during early pregnancy)
289
ZES
multiple peptic ulcers, rugal thickening, diarrhea
290
REM is initiated by... and reduced by...
ACh, NE
291
trisomy 18
PRINCE Edward
Prominent occiput, Rocker bottom feet, Intellectual disability, Nondisjunction, Clenched fists w/ overlapping fingers, low-set Ears
292
mercury toxicity
tremor, behavioral, gingivo-stomatitis, neuropathy, etc.
| Tx w/ chelation: dimercaprol, penicillamine, unithiol, succimer
293
alprostadil
PGE1 analog used to keep ductus arteriosus patent until surgical repair for TGA
294
Sheehan
pituitary ischemia following postpartum bleed > global decrease in ALL hormones produced from anterior pituitary
295
common manifestation of blastomycosis infection
verrucal skin lesions
296
migraine headaches with aura predisposes someone to...
CVAs
297
MG
muscle fatigue, difficulty swallowing, eyelid drooping, worsening of sx throughout day > tx w/ pyridostigmine
298
site of NE synthesis and linked to clinical depression
locus ceruleus
299
Ewing sarcoma
onion-skin layering, t(11;22) translocation; MC in boys
300
FOOSH injury often presents with _______ radial head
posterior
301
Job (hyperimmunoglobulinemia E)
eczema, eosinophilia, recurrent skin and pulm infections
302
Trendelenburg gait
weak hip abductors
303
for an RNA molecule purified from a virus to be infectious on its own, it must act as mRNA capable of using host's cell machinery for translation, meaning...
+ssRNA
304
crossover study
subjects randomly allocated to a sequence of 2+ tx given consecutively (often spaced by a washout period where no tx is given to limit confounding effects of prior tx)
305
hemiballism can involve what nucleus
subthalamic nucleus (modulates basal ganglia output)
306
mechanism of Zenker diverticulum formation
cricopharyngeal motor dysfunction
307
NK1 receptor antagonists used in chemo-induced N/V
aprepitant, fosaprepitant
308
skin condition a/w GI malignancy
seborrheic keratosis
309
metronidazole MOA
produces highly reactive radical anions
310
metformin MOA
decrease hepatic gluconeogenesis via inhibition of mitochondrial gylcerphosphate dehydrogenase (mGPD), increase glycolysis, increase insulin sensitivity
311
Brown-Sequard
Everything ipsilateral, except spinothalamic (pain, temp)
312
zileuton MOA
5-lipoxygenase inhibitor
313
serum sickness can be d/t
antitoxin tx (response to horse antibody), biologics
314
serum sickness is a type ____ HS
III
315
what type of shock should be assumed in a pt who has had an MVA and is hypotensive?
Hypovolemic/hemorrhagic
316
Schistosomiasis presents as...
swimmer's itch
317
phenytoin use in pregnancy presents as what in the baby
fetal hydantoin > skull, face abnormalities, hypoplasia of fingernails and toenails
318
Tx of Guillian Barre
plasmapheresis
319
which drugs have been shown to improve long-term survival in pt w/ systolic HF
ACEI, BB, ARB, aldosterone antagonists
320
heparin reversal agent
protamine sulfate
321
brachial plexus runs b/w
anterior and middle scalene mm
322
when do you administer RhoGam?
28w, immediately following invasive procedures like amniocentesis, elective abortion or spontaneous miscarriage, ectopic pregnancy, w/i 74h after delivery of Rh+ fetus, as soon as any kind of vaginal bleeding is present
323
what artery supplies Brocas and Wernickes area?
MCA most often in left hemisphere (dominant)
324
Moro reflex
startle reflex
325
histology of AIDS dementia
multinucleated giant cells
326
onchocerca volvulus
river blindness; transmitted by black fly; ivermectin
327
trypanosoma
African sleeping sickness; tsetse fly
328
pericardial tamponade
Beck's triad: hypotension, JVD, distant or muffled heart sounds
329
Job syndrome
hyper IgE; mutation in STAT3 on ch 17
330
osteoporotic fractures
compression fractures most common > show anterior wedging of vertebrae
331
patients with severe, symptomatic aortic stenosis should be treated w/...
valve replacement
332
nitrates MOA
activate guanylate cyclase > increase cGMP > relax smooth muscle > decrease preload, decrease venous return > reduced cardiac work and O2 demand
333
VHL
hematuria, polycythemia, palpable flank masses, hemangioblastomas, angiomatosis, bilateral RCCs, pheochromocytomas; AD mutation from deletion of VHL gene on chromosome 3
334
MS
young female, neurological sx separated by time and space; increased oligoclonal bands in CSF
335
RTA type 1
defect in distal tubule resulting in acidosis (hypercalciuria, autoimmune disease, hereditary defects in kids), increased risk of calcium phosphate stones
336
RTA type 2
defect in PCT resulting in impaired bicarb reabsorption (acetazolamide, Fanconi, and MM causes it, non-AG met acid, hypophosphatemia)
337
RTA type 4
problem w/ aldosterone (hyperkalemic)
338
ARDS
severe hypoxemia and bilateral pulmonary infiltrates in absence of evidence of cardiogenic pulmonary edema; acute inflammatory damage at alveolar-capillary interface; progresses to interstitial fibrosis
339
SIRS criteria (2 of the 4)
temp >100.4 or <96.8
HR >90
RR >20 or PaCO2 <32
WBC >12,000 or <4000 or band forms
340
exudative phase of lung injury
macrophages release cytokines > attract neutrophils to cause capillary damage > leakage of exudate > hyaline membranes
341
proliferative phase of lung injury
type II pneumocytes and fibroblasts proliferate
342
fibrotic phase of lung injury
collagen produced and deposited
343
tophi
chalky uric acid crystal deposits under the skin
344
joint aspiration for gout/pseudogout
gout = negative birefringence; pseudo = positive ("p's")
345
RNA polymerase function is limited to...
the nucleolus
346
pathogenesis of decompensated HF
increased SNS, RAAS activation, ADH secretion all to maintain BP
347
mechanisms of antianginal therapy
increase coronary vasodilation (CCBs, nitrates)
decrease HR (BB, nondihydropyridines)
venodilation (reduce preload > nitrates)
arterial dilation (reduce afterload > dihydropyridines)
348
leads I, avL
lateral limb leads > left circumflex MI
349
leads II, III, avF
inferior limb leads > right coronary MI
350
leads V1-4
anterior chest leads > LAD (proximal = V1,2)
351
morphine MOA
potassium efflux at postsynaptic membrane, reduced calcium influx at presynaptic membrane
352
a monoclonal antibody binds to...
a single epitope on an antigen
353
infective endocarditis
mitral regurg, petechiae, splinter hemorrhages, Roth spots, janeway lesions (embolization of valvular vegetations on palms/soles), Osler nodes (immune complex deposition in pulp of fingers/toes)
354
best agents for chemo-induced emesis
```
DA antagonists (prochlorperazine, metoclopramide)
5-HT3 antagonists (ondansetron, granisetron)
NK1 antagonists (aprepitant, fosaprepitant)
```
355
acetazolamide MOA
block reabsorption of NaHCO3 in PCT > excrete HCO3 > alkalinizes urine
increased K excretion d/t distal Na reabsorption
356
vasospastic/prinzmetal angina patho
hyperreactivity of coronary smooth muscle d/t endothelial dysfunction and autonomic imbalance
357
vitamin E def
NM disease and hemolytic anemia
358
primary infection with HSV...
herpetic gingivostomatitis
359
when can serum beta-hCG first be detected?
8 days after fertilization; 14 days for urine pregnancy tests
360
what important energy carrying coenzyme contains riboflavin?
FAD
361
Buerger disease
small and medium vasculitis
SMOKING
middle-aged men
362
what vitamin synthesizes NAD? what amino acid provides an alternate path?
niacin; tryptophan
363
thyroid antibody diseases
```
thyrotropin receptor antibody > Graves
thyroid peroxidase (TPO) antibody (anti-mirosomal) > Hashimoto, other thyroiditis
```
364
where does the pupillary reflex occur?
midbrain
365
NMS
fever, altered mental status, muscle rigidity, autonomic instability
366
PDA
from pulm artery to aorta
367
fenoldapam is useful in...
hypertensive emergency
368
pneumatosis intestinalis
air in bowel well > curvilinear areas of lucency on XR; w/ abd distension and bloody stools > necrotizing enterocolitis
369
pulmonary edema histology
engorged capillaries and alveoli filled with acellular pink material
370
congenital long QT syndrome
syncope, family hx, decreased outward K flow with prolonged AP > at risk of vtach and sudden death
371
CK-MB levels after MI
rise 6-12 h after and peak at 20h > useful in dx reinfarction (return to NML in 48h whereas troponins will remain elevated for 7d)
372
antidote for acetaminophen
N-acetylcysteine
373
antidote for iron
deferoxamine
374
antidote for digoxin
digifab and electrolyte management
375
antidote for theophylline
BB
376
antidote for methanol and ethylene glycol
ethanol or fomepizole
377
antidote for benzos and Z drugs
flumazenil
378
antidote for opioids
naloxone
379
antidote for organophosphates, neostigmine, physostigmine
pralidoxime and atropine
380
antidote for anti-muscarinics
physostigmine
381
antidote for warfarin and rat poison
vit K, FFP
382
ethylene glycol toxicity
N/V, AG met acid, coma, seizures, CV depression
383
AAT deficiency
panacinar emphysema, younger pt with sx of COPD w/o hx of smoking and signs of liver cirrhosis
384
theca lutein cell hormone production
cholesterol > pregnenolone > progesterone via 3-beta-HSD OR > androstenedione via 17-alpha-OH
385
granulosa lutein cell hormone production
androstenedione from theca cells > estradiol via aromatase
386
tx of prolactinoma
D2 agonists (cabergoline and bromocriptine)
387
cluster HA tx
oxygen, sumatriptan, removal of offending agent (alcohol common trigger)
388
De Quervain tenosynovitis
All Peanut Lovers Eat Peanut Butter > Abductor Pollicis Longus, Extensor Pollicis Brevis; Finkelstein maneuver dx (pain w/ ulnar deviation of wrist with thumb inside fist)
389
subfalcine herniation
medial frontal lobe (cingulate gyrus) herniates across midline > mental status changes and reappearance of primitive reflexes
390
threatened abortion
bleeding and closed cervix in setting of viable pregnancy
391
inevitable abortion
bleeding and pain w/ dilated cervix
392
incomplete abortion
bleeding and pain w/ closed or dilated cervix and partial expulsion of pregnancy tissue
393
missed abortion
nonviable fetus, intact on US, closed cervix and no hx of passage of tissue
394
complete abortion
contents completely expelled and cervix closed
395
MS MRI
multiple ovoid, periventricular white matter lesions
396
anthrax tx
cipro (or doxy in kids/allergies to fluoroquinolones) + vaccine
397
ITP
recent viral infection, IgG antibodies against GpIIb/IIIa platelet membrane glycoprotein, signaling platelet destruction by spleen > increased platelet production in bone marrow (increased megakaryocytes)
398
somatostatinoma
DM, cholelithiasis, steatorrhea
399
LAD1
def in CD18; delayed umbilical cord separation, recurrent infxn w/o pus
400
infraspinatus action
external rotation
401
subscapularis action
internal rotation
402
H2 blockers
table for 2: take H2 blockers before you DINE > "-dine"
403
BB overdose
bradycardia, hypotension, hypoglycemia, fatigue
404
CCB overdose
bradycardia, hypotension, tachycardia w/ dihydro, hyperglycemia, dizziness
405
pathognomonic sign of familial dysbetalipoproteinemia
xanthomas (accumulations of cholesterol-laden macrophages)
406
21-hydroxylase deficiency
inability to produce glucocorticoids and mineralocorticoids > hypotension d/t salt-wasting > activation of RAAS
407
finasteride
5-alpha reductase inhibitor (prevents formation of DHT from T > DHT causes hyperplasia of prostate)
408
seronegative spondylarthropathies
AS, Reiter's, psoriatic arthritis
409
clomiphene
selective estrogen receptor modulator that inhibits feedback on gonadotropins to treat anovulation in PCOS
410
what drugs improve survival in CAD?
SABA > Statin, ACEI, BB, ASA
411
dextromethorphan
cough suppressant w/o significant opioid receptor agonism; risk of serotonin syndrome, NMDA receptor inhibition
412
anaphylaxis results in _____ and ____ release
histamine and tryptase
413
acute cervicitis
purulent cervical discharge and friable cervix that bleeds easily w/ contact > risk for PID, ectopic pregnancy, infertility
414
CF
thick, viscous clogging secretions in MANY organs > pancreatic insufficiency, chronic sinusitis, nasal polyps, chronic bronchitis, steatorrhea, meconium ileus at birth, a/w DM
415
DiGeorge is failure of neural crest to migrate into
3rd and 4th pharyngeal pouches
416
thyroid peroxidase
iodine organification and coupling of iodotyrosines > methimazole and PTU inhibit
417
sterile platelet-rich thrombi on mitral valve leaflets
nonbacterial thrombotic endocarditis most commonly a/w advanced malignancy and SLE (Libman-Sacks)
418
TOF O2 sats
Acyanotic: LA 98, LV 98, RV 85, RA 75
| Cyanotic Tet episode: LA 98, LV 80, RV 75, RA 75
419
duodenal atresia
failure of recanalization > double bubble sign > Down
420
jejunal/ileal atresia
vascular injury > bilious emesis w/ abd distension > gastroschisis
421
colonic atresia
constipation and abd distension > Hirschsprung
422
peripheral chemoreceptors ______ and _______ ________ are sites for sensing PaO2 (stimulated by hypoxemia)
carotid and aortic bodies
423
transient global amnesia
sudden-onset confusion, memory loss, and anterograde amnesia resolving w/i 24 hours > hippocampus
424
purpose of carotid sinus massage in paroxysmal supraventricular tachy
stretches baroreceptors and mimics increased pressure > increases afferent activity in carotid sinus nerves > increased PNS, decreased SNS > decreased conduction in AV node
425
zero-order elimination kinetics
rate of elimination is constant regardless of plasma concentration of a drug; phenytoin, ethanol, salicylates, fluoxetine, omeprazole, cisplatin
426
myelofibrosis histo will commonly show _________ cells
tear drop
427
Tx of nephrogenic DI w/ lithium use
Amiloride > blocks epithelial Na channels (ENaC)
428
in skeletal muscle, Ca binds to....
troponin > conformational change in troponin
429
spina bifida
failure of caudal neuropore to close
430
maternal hyperglycemia induces _______ in the fetus
hyperinsulinemia
431
SCD mutation
point mutation replacing glutamic acid w/ valine
432
Kluver-Bucy
bilateral amygdala damage > visual agnosia (inability to recognize familiar people or objects), hyperorality/hyperphagia, hypersexuality, docility > HSV encephalitis (temporal lobe damage)
433
functional residual capacity
amount of air in lungs at end of NML exhalation
434
residual volume
amount of air in lungs at end of forced exhalation
435
DOC for UTI during pregnancy
amoxicillin
436
adjuvant therapy in Alzheimer's
memantine > NMDA receptor antagonist
437
speed of conduction down an axon depends on 2 constants
length and time; myelination increases length and decreases time
438
labetalol
nonselective vasodilatory BB > B1 > A1 > B2
| get decreased SVR and decreased HR w/o affecting SV
439
BPH can cause..... in the kidney
parenchymal atrophy and scarring d/t bladder obstruction > hydronephrosis
440
during catherization of L atria, what structure is passed through?
interatrial septum > fossa ovalis covered by thin membrane that is easily pierced to allow entry of catheter from RA directly to LA
441
anterior humerus dislocation
flattening of deltoid prominence, protrusion of acromion, anterior axillary fullness; axillary n most commonly injured by anterior shoulder dislocations
442
medulloblastoma
sheets of primitive cells and many mitotic figures; kids
443
selective cox-2 inhibitor
celecoxib
444
acute management of Tet spell
oxygen, fluids, phenylephrine, propranolol, sodium bicarb, emergency shunt
445
small bowel obstruction
air-fluid levels on XR; smooth muscle contraction against resistance; high pitched bowel sounds
446
thiazides for kidney stones
decrease Ca excretion by inhibiting NaCl in DCT
447
disulfiram-like reactions
cefoperazone, cefamandole, metronidazole, procarbazine, first generation sulfonylureas
448
DOC for SVT
adenosine
449
tx of latent TB (+ TB test, +IGRA, - CXR)
isoniazid
450
complex regional pain syndrome type 1
1. pain out of proportion to event
2. at least 1 sx present from 3+ of the categories
Sensory: hyperesthesia and/or allodynia
Vasomotor: temp asymmetry, skin color asymmetry, and/or skin changes
Sudomotor/edema: edema, sweating changes and/or sweating asymmetry
Motor/trophic: decreased ROM, motor dysfunction and/or trophic changes (hair, nail, skin)
3. dx of exclusion, no evidence of nerve damage (type 2 = evidence)
451
Beckwith-Wiedemann
Wilms tumor in a/w organomegaly, macroglossia, neonatal hypoglycemia
452
conus medullaris syndrome
think cauda equina but with UMN signs
453
anterior hypothalamic nucleus
stimulation: panting, sweating
lesion: difficulty lowering body temp
454
dorsomedial hypothalamic nucleus
stimulation: sham rage
lesion: decreased aggression and feeding
455
lateral hypothalamic nucleus
stimulation: increased feeding
456
supraoptic hypothalamic nucleus
stimulation: increased blood volume, BP, metabolism
lesion: DI
457
ventromedial hypothalamic nucleus
stimulation: decreased feeding
458
DOC for onychomycosis
terbinafine
459
DOC for RLS
dopamine agonists (pramipexole, ropinirole)
460
DOC for carcinoid syndrome
octreotide (mimics SST and inhibits release of vasoactive substances from tumor cells)
461
Tx of hookworm infxn
albendazole
462
PGD analogs side effects in glaucoma
darkening of iris, lengthen and darken eyelashes, ocular irritation
463
hereditary spherocytosis
normocytic anemia, increased LDH, increased bilirubin (hemolytic anemia), splenomegaly, spherocytes, mutations in ankyrin and spectrin (cytoskeleton abnormalities)
464
what med can precipitate opioid withdrawal?
buprenorphine
465
tx of acute adrenal insufficiency
hydrocortisone or dexamethasone
466
meconium ileus association
CF
467
anterior pituitary (Rathke pouch) derivative of
surface ectoderm
468
mechanisms of inheritance of Down
mostly meiotic nondisjunction
| can have unbalanced translocation (Robertsonian) and mosaicism
469
dsDNA replication of HepB
dsDNA > +RNA > partially dsDNA progeny
470
rare but life-threatening complication of some drugs (phenytoin, carbamazepine, allopurinol, sulfonamides, vanco, minocycline)
DRESS > drug-induced herpesvirus reactivation > clonal expansion of T cells that cross-react w/ the drug
fever, LAD, facial edema, diffuse skin rash, etc. > eosinophilia, elevated ALTs
471
Ehler-Danlos is a defect in...
collagen synthesis
472
clear cell RCC
originates from epi of PCT; lipid-filled mass w/ areas of necrosis and hemorrhage
473
pityariasis rosea
Herald patch (oval, raised plaque or patch with peripheral scales) then Christmas tree pattern eruption
474
tx of hypoglossal n in poor suckling infant
condylar decompression
475
intraperitoneal structures
stomach, jejunum, ileum, cecum, appendix, transverse and sigmoid colon, liver, spleen, gallbladder
476
chronic kidney disease findings
```
edema
hyperkalemia
met acid
hyperphosphatemia
hypocalcemia
renal osteodystrophy
HTN
pulm edema
CHF
uremia
peripheral neuropathy
pruritus
```
477
tx for progression of MS
beta-interferon
478
statins can cause....
rhabdomyolysis
479
vitamin B12 def
spasticity w/ gastrectomy > loss of parietal cells that secrete IF
480
tx of primary hyperaldosteronism (Conn)
spironolactone > inhibits androgen receptor > gynecomastia and decreased libido in males; menstrual irregularities in females
481
hemiballism
unilateral flailing of a limb > disruption to contralateral subthalamic nucleus MC d/t lacunar infarct
482
smooth ER makes
lipids, phospholipids, chol derivatives (steroid hormones = sex steroids, cortisol, aldosterone)
483
type B dissection
originates near left subclavian a. (involves descending aorta)
484
prostate gland is located...
anterior to anal canal and posterior to bladder
485
bacteria can produce...
vit K and folate
486
cricothyrotomy goes through...
superficial cervical fascia and cricothyroid membrane
487
XP is a def in
endonuclease (involved in excision repair)
488
status epilepticus tx
IV benzo
489
tx for ascites
spironolactone (aldosterone antagonist)
490
empyema
purulent fluid > bac translocation from alveoli into pleural space
491
field defect
initial embryonic disturbance > multiple malformations by disrupting adjacent tissues (holoprosencephaly leads to multiple midline defects)
492
struma ovarii
ovarian germ cell tumor in setting of thyrotoxicosis
493
Thiamine cofactor for...
PDH, alpha-ketoglutarate dehydrogenase, BCAA, transketolase
494
21 OH converts...
progesterone to 11-deoxycorticosterone
495
TB is associated with CD_ T cells
4
496
TCA overdose
inhibits NE and serotonin, inhibits GABA, inhibits H1, inhibits alpha-1, inhibits muscarinic receptors, blocks Na channels > coma, seizures, cardiac conduction abnormalities (wide QRS, prolonged PR or QT intervals, bundle branch blocks), anticholinergic toxicity
497
TCA overdose tx of cardiac abnormalities
sodium bicarb
498
bubonic plague
fever, cough, dyspnea, hemoptysis, LAD (buboes), DIC, necrosis of fingertips and tip of nose; Yersinia pestis
499
Behcet
recurrent oral aphthous ulcers, genital ulcers, uveitis, joint involvement, panniculitis (erythema nodosum); Middle Eastern; HLAB51; autoimmune vasculitis
500
Colles fracture
distal radius; dinner fork appearance
501
Huntington affects...
caudate nucleus
502
Meissner corpuscles
transient tactile stimuli
503
Ruffini corpuscles
skin stretch (changes in finger position, movement allowing alterations in grip, deformations w/i joint capsule)
504
perivascular pseudorosettes
ependymoma
505
meds that lower tone of LES
anticholinergics, alpha-blockers, B-agonists, CCBs
506
17-alpha-hydroxylase deficiency
low sex hormones and cortisol production; increased ACTH; HTN, hypokalemia > volume expansion > inhibits renin and synthesis of aldosterone; estrogens low, FSH, LH high secondary to deficient sex production
507
metformin SE
lactic acidosis, decreased folate and B12 absorption > megaloblastic anemia, neurological sx
508
Dupuytren contracture
inability to extend 4th and 5th digits
509
dorsal interossei fxn
abducting fingers
510
bosentan MOA
competitively antagonizes endothelin-1 receptors
511
seborrheic dermatitis
greasy-looking, yellow scales on a red base; cradle cap
512
Whipple disease is caused by...
a bacteria
513
tetanus
intracellular Ca accumulates > extends cross-bridge cycling and disables muscle relaxation
514
attachments of dura for craniosacral motion
axis, C3, foramen magnum, S2
515
5-alpha reductase def
males born with ambiguous genitalia but when puberty happens T increases greatly which can compensate for lack of DHT
516
osteoarthritis findings
osteophytes (heberden and bouchard nodes in fingers), subchondral sclerosis, joint space narrowing
517
Menetrier disease
diarrhea, weight loss, edema, rugae increased in size (cerebral), corkscrew shaped glands w/ mucous cells and less parietal and chief cells
518
schistosomiasis causes...
SCC of the bladder
519
tricuspid regurgitation
increases during inspiration > more blood into heart
520
Marburg
think Ebola with evidence of spread from bats
521
Bruton's aggamaglobulinemia
defect in BTK gene responsible for development of B cells and antibody function; increased bacterial infxn w/o increase in fungal or viral
522
constrictive pericarditis
can present w/ TB infxn; fibrotic calcifications around thickened pericardium
523
mandibular branch of V passes through
foramen ovale
524
eversion ankle injuries injure the _____ ligament
deltoid
525
ketorolac
NSAID
526
CGD has a ______ NBT test
negative; detects ROS produced by NADPH oxidase > defect in NADPH oxidase = no ROS = negative test
527
urge incontinence
involuntary and uninhibited detrusor contractions
528
brown pigmented gallstones caused by release of...
beta-glucoronidases
529
myxoma
constitutional sx (d/t IL-6 prod), diastolic murmur that changes in frequency as pt shifts positions, syncope, at risk for embolic stroke
530
median n can become compressed b/w
pronator teres
531
polyarteritis nodosa a/w
hep B
532
hematopoiesis in fetus
yolk sac until about 3m, then liver and spleen midway, bone marrow is present at the highest levels starting around month 7
533
what case ruled that the physician is mandated to inform someone who is in danger
Tarasoff v. Regents of University of California
534
infective endocarditis
petechiae, subungual hemorrhages, osler nodes (SC nodules on distal pads of digits), Janeway lesions (nontender maculae on palms and soles), Roth spots (retinal hemorrhages w/ small, clear centers)
535
double effect
action that has both negative and positive consequences can be ethically justified if the intention is to achieve the positive effect (i.e. providing morphine to a terminally ill patient even though it can kill them because you're providing symptom control)
536
Meniere disease
vertigo, sensorineural hearing loss, tinnitus; excess endolymph in inner ear
537
BRCA genes have impaired DNA repair mechanism in...
homologous recombination
538
lateral geniculate of thalamus
visual
539
medial geniculate of thalamus
auditory
540
ventral lateral of thalamus
basal nuclei and cerebellum related to control and coordination of movement
541
VPL of thalamus
somatosensory for body
542
VPM of thalamus
somatosensory for face
543
MM
anemia, elevated protein (diff b/w protein and albumin is >4.5 = large amount of Igs), ltyic lesions, hypercalcemia, renal impairments, constitutional sx
544
PCOS will have a LH:FSH ratio of...
>2
545
Gardner
GI polyps, desmoid tumors, osteomas, epidermoid cysts, lipomas, dental abnormalities, congenital hypertrophy of retinal pigment epi
546
syphilitic aneurysm
obliterative endarteritis of vasa vasorum of media; aortic dilation and aortic valve insufficiency
547
danazol
synthetic androgenic steroid that acts by inhibiting pituitary gonadotropin secretion and blocking ovarian enzymes that produce estrogen (suppresses FSH and LH release)
548
when do you see dyskinesia in a Parkinson's pt?
when they're "on" and able to move d/t medication rather than when they're "off" and bradykinetic
549
3 Ps of MEN1
pituitary adenoma, parathyroid adenoma, pancreatic endocrine tumor (gastrinoma, VIPoma etc)
550
2 Ps, 1 M of MEN2A
Pheochromocytoma
parathyroid adenoma
Medullary thyroid cancer
551
1 P, 3Ms of MEN2B
pheochromocytoma
medullary thyroid cancer
mucosal neuromas
marfanoid habitus
552
mannitol
osmotic diuretic - acts to draw water out where water is permeable (PCT, thin descending limb, CD)
553
first sign of magnesium toxicity
decreased DTRs
554
what case determined pt have the right to refuse life-sustaining tx?
cruzan v. director
555
when treating post-op ileus and similar conditions, what order should tx be done in?
sympathetics, parasympathetics, visceral (i.e. paraspinal inhibition > sacral rocking > mesenteric lift)
556
waxy casts seen in...
advanced renal failure
557
hyaline casts are seen in...
NML states or dehydration
558
C. jejuni infxn causing ascending paralysis would cause CSF to have...
elevated protein w/ NML WBCs
559
triple therapy for H pylori
PPI, clarithromycin, amoxicillin or metronidazole
560
bismuth quadruple therapy for H pylori
bismuth, H2 blocker, metronidazole, tetracycline
561
MC adverse effect of ECT
HA
562
first line for stable angina
nitrate and BB (second line CCB)
563
MC location of endometriosis
ovaries > chocolate cysts
564
somatostatinoma
SST from delta cells in pancreas; inhibits insulin, glucagon, gastrin, GH > DM, cholelithiasis, steatorrhea, hypochlorhydria
565
Hawthorne effect
results altered by the fact that the subjects are aware they're being studied
566
Pygmalion effect
the fact that when research participants know the expected outcome, they tend to modify their behaviors to favor the outcome
567
MCC of bacterial parotitis
staph aureus (don't get confused with presentation thinking strep mutans)
568
iron intoxication
hematemesis, N/V, met acid; tx w/ deferoxamine
569
arsenic poisoning
acute: GI, garlic breath, rice water stools
chronic: skin changes in a raindrop pattern, pallor, loss of hair
Think of a vampire = garlic, skin changes, pallor, etc.
Tx: a vampire sucks (succimer) blood out of a damsel (dimercaprol) with a pencil (penicillamine)
570
lead poisoning
acute: GI, tremor
chronic: anemia, wrist drop, nephropathy, hepatitis
Tx: dimercaprol, succimer
571
mercury poisoning
acute: hemorrhagic gastroenteritis, shock
chronic: ataxia, hearing and vision loss, paresthesias
Tx: dimercaprol, succimer
572
Menkes syndrome
disorder of copper uptake in GI tract > copper def
fine, silver hair, depigmentation, muscle weakness, neurological abnormalities, HSM
573
selenium def
CM, MSK abnormalities, immune function impairment, mood disorders, male infertility
574
zinc def
acrodermatitis enteropathica (perioral dermatitis, alopecia, diarrhea), mood changes, recurrent infxn
575
pyridoxine def
angular cheilitis, seborrheic dermatitis, glossitis and stomatitis, confusion, depression
576
biotin def
perioral dermatitis, conjunctivitis, mental status changes
577
tx of gastroparesis
metoclopramide
578
MOA of spironolactone and eplerenone
inhibits aldosterone in CD
579
MOA of triamterene and amiloride
inhibits ENaC in distal tubule to CD
580
Angelman
methylation of paternal chromosome 15 and gene deletion on maternal chromosome 15
581
tx of Huntingtons
tetrabenazine first line for chorea; second gen antipsychotic for schizophrenic sx and chorea
582
angiotensin II acts at...
efferent arteriole > Angiotensin II Constricts Efferent (ACE) > ACE inhibitors work to decrease GFR, increase RPF and decrease FF
583
FAs a/w CPT def
LCFA (13-21)
584
substrates of CYP450
theophylline, OCPs, anti-epileptic, warfarin (the OCPs are anti-war)
585
CYP450 inducers
CRAP GPS induces my rage (Carbamazepine, Rifampin, Alcohol, Phenytoin, Griseofulvin, Phenobarbital, St. John's Wort)
586
CYP450 inhibitors
azoles, valproate, INH, chloramphenicol, macrolides, sulfonamides, cipro, omeprazole, metro, amiodarone, ritonavir, grapefruit juice, cimetidine
587
gestational DM increases risk of...
NRDS, shoulder dystocia (macrosomia > others related to this = postpartum hemorrhage, laceration, increased risk of C-section, birth trauma, polycythemia, meconium aspiration, etc.)
588
what contraception has the highest rate of efficacy?
copper IUD
589
what can be used for emergency contraception?
levonorgestrel (plan B), combined OCPs w/i 72h
| copper IUD and ulipristal (antiprogestin) pill w/i 120h
590
ASA toxicity
tinnitus, severe abd pain, mixed acid-base of AG met acid and resp alkalosis (NML pH), hyperthermia
591
initial diagnostic test for postmenopausal bleeding woman
endometrial biopsy
592
Kallmann syndrome
hypogonadotropic hypogonadism > defective migration of neurons and failure of olfactory bulbs to develop > decreased synthesis of GnRH, anosmia, infertility; MRI done to r/o other pituitary etiologies
593
Klinefelter
male, 47 XXY
testes atrophy, tall stature, gynecomastia, female hair distribution, developmental delay
dysgenesis of semi tubules > low inhibin B > elevated FSH
ABNML Leydig cell fxn > low T > elevated LH > elevated estrogen (increased risk of breast cancer)
inactivated X chromosome (Barr body)
594
Turner
female 45, XO;
short, ovarian dysgenesis, shield chest, bicuspid aortic valve, coarctation, lymphatic defects, horseshoe kidney
MCC primary amenorrhea
no Barr body like in Klinefelter
595
RFs for preeclampsia
nulliparity, age > 40y, chronic preexisting HTN or renal disease, pregestational or gestational DM, obesity, antiphospholipid syndrome, twins
596
branches from the ____ supply the subthalamic nucleus leading to hemiballismus
PCA
597
heart disease is the leading cause of death in those
>65
598
leading cause of death in those 45-64
malignancy
599
RFs for RCC
smoking, asbestos, acetaminophen, chronic hep C, PCKD, VHL
600
paradoxical splitting is heard in...
LBBB, AS where AV closure is delayed and instead pulmonic valve closes first
601
lowering the cutoff value for a test...
increased FP and decreased FN
increased sensitivity and NPV
decreased specificity and PPV
602
raising the cutoff value for a test
increased FN and decreased FP
increased specificity and PPV
decreased sensitivity and NPV
