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Combank Q facts > Combank 4 > Flashcards

Combank 4 Flashcards

1
Q

Dipeptidyl peptidase-4 (DPP-4) inhibitors prevent what from being broken down?

A

incretins

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2
Q

Incretins serve what function?

A

They are responsible for increasing glucose dependent insulin secretion from pancreatic beta cells and decreasing gastric emptying time

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3
Q

Name two examples of DPP-4 inhibitors

A

Sitagliptin and saxagliptin; end in “GLIPTIN”

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4
Q

What is exenatide?

A

an incretin mimetic

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5
Q

What does acarbose do?

A

it inhibits intestinal brush border alpha glucosidases thereby decreasing starch and disaccharide absorption in the gut;

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6
Q

Acarbose and Miglitol are in what class of diabetic drugs?

A

alpha glucosidase inhibitors

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7
Q

What is the mechanism of action of sulfonylureas?

A

close K+ channel in beta cell membrane, so cell depolarizes –> triggering insulin release via increased Ca2+ influx

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8
Q

Name two first generation sulfonylureas

A

Tolbutamide; Chlorpropamide; end in “AMIDE”

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9
Q

What is pramlintide and what does it do?

A

amylin analogue; secreted by the pancreas along with insulin and helps regulate glucose absorption by slowing down gastric emptying; decreases glucagon secretion

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10
Q

What class of diabetes drugs is metformin in? what is the MOA?

A

biguanides; exact MOA is unknown; decreases gluconeogenesis, increase glycolysis, increase peripheral glucose uptake (insulin sensitivity)

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11
Q

Choroid plexus papillomas are most commonly seen in what population and what does it result in?

A

most common in children <2 y.o.; result in increased CSF production and obstruction of CSF outflow leading to hydrocephalus

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12
Q

What is the hypothalamus responsible for controlling?

A

hunger and thirst, anterior and posterior pituitary regulation, autonomic regulation; temperature regulation, sexual urges, mediation of osmolarity and sensation of nausea from the area postrema

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13
Q

Function of anterior hypothalamic nucleus?

A

acts as a heat-loss center (esp. the pre-optic area); controls body temperature through vasodilation and sweating; destruction of this center results in hyperthermia

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14
Q

Function of the posterior hypothalamus?

A

produces body heat and controls body temperature through vasoconstriction and shivering; does not have direct input from the central thermoreceptors but it is inhibited by the anterior hypothalamus when body temperature rises

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15
Q

Lesions to the posterior hypothalamus result in?

A

poikilothermia; inability to regulate body temperature

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16
Q

Function of the ventromedial nucleus of the hypothalamus?

A

satiety; destruction results in hyperphagia and weight gain

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17
Q

Function of the lateral nucleus of the hypothalamus?

A

hunger; destruction results in anorexia, failure to thrive (infants)

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18
Q

A lesion of the amygdala results in what syndrome?

A

Kluver-Bucy syndrome; manifests as hyperorality, hypersexuality, and disinhibited behavior

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19
Q

Kluver-Bucy Syndrome is associated with what type of infection?

A

Herpes simplex virus type I

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20
Q

The amygdala is primary responsible for what function?

A

processing memory and emotion reactions

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21
Q

What is the basal ganglia composed of and what is it responsible for?

A

caudate nucleus, putamen, globus pallidus, substantia nigra, subthalamic nucleus; responsible for voluntary movements and postural adjustments

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22
Q

The cerebellum located above the 4th ventricle is responsible for?

A

regulating balance and fine motor movements

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23
Q

A lesion of the cerebellum results in what type of deficits?

A

ipsilateral deficit b/c the cerebellar fibers decussate at two different points; falls toward side of lesion, intention tremor and limb ataxia

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24
Q

A lesion to the hippocampus can result in?

A

anterograde amnesia - the inability to make new memories

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25
Q

Function of the hippocampus?

A

plays a major role as part of the limbic system which is responsible for the 5 F’s - feeding, fleeing, fighting, feeling, sexual drive

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26
Q

Crohn’s disease can affect which part of the GI system?

A

can affect any part of the GI system from mouth to anus; usually terminal ileum and colon; skip lesions, rectal sparing

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27
Q

Manifestations of Crohn’s disease

A

mostly causes abdominal pain, diarrhea (with blood if there is marked inflammation), vomiting and weight loss; ALSO causes migratory polyarthritis, erythema nodosum, ankylosing spondylitis, uveitis and kidney stones

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28
Q

What life style habit can exacerbate Crohn’s disease?

A

smoking

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29
Q

Crohn’s disease patients have serum antibodies that are positive for?

A

Saccharomyces cerevisiae (ASCA)

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30
Q

Biopsy of Crohn’s disease would show?

A

TRANSMURAL inflammation and non-caseating granumlomas

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31
Q

Bloody diarrhea is most common in which inflammatory bowel disease?

A

Ulcerative colitis

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32
Q

What is a special characteristic of the inflammation seen in Crohn’s disease?

A

non-continuous pattern known as SKIP LESIONS

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33
Q

Inflammation seen in Ulcerative colitis is restricted to what areas?

A

inflammation is limited to the mucosa and superfiicial submucosal layer of the intestinal wall

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34
Q

Iron is absorbed in what part of the small intestine?

A

duodenum

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35
Q

Folate is absorbed in what part of the small intestine?

A

jejunum

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36
Q

Vitamin B12 is absorbed in what part of the small intestine?

A

ileum

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37
Q

What is ferritin and when would it be low?

A

Ferritin is the cellular storage protein for iron; it will be low if there is no iron to store or if iron stores have been depleted

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38
Q

What is transferrin and when is it increased?

A

Transferrin is the major transporter for iron trafficking through the plasma; hepatic synthesis of transferrin is INCREASED in an iron deficient state

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39
Q

What are the lab findings in iron deficiency anemia?

A

Elevated transferrin; elevated total iron binding capacity (TIBC) with a depressed transferrin saturation; low serum iron concentration; low ferritin

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40
Q

Sickle cell disease is in what category of anemias?

A

normocytic, normochromic hemolytic anemia

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41
Q

Haptoglobin is responsible for binding what in blood?

A

free hemoglobin

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42
Q

What is the laboratory presentation of sickle cell disease?

A

anemia, reticulocytosis, unconjugated hyperbilirubinemia, elevated serum LDH, low serum haptoglobulin

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43
Q

What is the laboratory presentation of anemia of chronic disease?

A

chronic inflammatory states causes body to store iron (macrophages trap and store iron); produces decreased serum iron, normal to increased serum ferritin; anemia

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44
Q

Beta thalassemia is most common in people from what descent?

A

Mediterranean

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45
Q

What category of anemia is beta thalassemia in?

A

microcytic, hypochromic anema

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46
Q

What is prevalence?

A

of people who have the disease at a particular point in time or time period / # of people at risk

47
Q

What is incidence?

A

of new cases in a specified time period divided by the total number of people at risk

48
Q

How does screenings affect incidence and prevalence for most diseases?

A

incidence and prevalence decreases

49
Q

How does emphysema affect gas exchange in the lungs?

A

poor pulmonary gas exchange and air trapping; destruction of the alveolar-capillary interface leading to decreased diffusion of oxygen into the blood; air trapping occurs due to loss of elasticity of the lung parenchyma

50
Q

Pyloric stenosis is most commonly seen in what population of patients?

A

it is a congenital anomaly most common in male infants at 2-3 weeks of life

51
Q

How does pyloric stenosis present?

A

presents as persistent NON-BILIOUS projectile vomiting; physical exam reveals an olive shaped mass in the region of the distal stomach

52
Q

How does persistent vomiting affect physiologic pH?

A

gastric juices contain large quantities of hydrogen and sulfide making it acidic; multiple episodes of vomiting gastric contents leads to an increase in physiologic pH via loss of hydrogen and chloride ions while retaining bicarb

53
Q

What are normal physiologic pH values?

A

7.35 to 7.45

54
Q

Salicylate toxicity results in what type of pH imbalance?

A

metabolic acidosis

55
Q

What is deficient in Lesch-Nyhan syndrome?

A

Hypoxanthine-guanine phosphoribosyl transferase (HGPRT)

56
Q

What is the most common site for bowel obstruction?

A

small bowel

57
Q

What is the most common cause of bowel obstruction?

A

adhesions

58
Q

What are some typical symptoms of bowel obstruction?

A

severe colicky abdominal pain, abdominal distension, nausea and vomiting and fever and tachycardia

59
Q

How should pyelonephritis be treated in pregnancy?

A

it must be treated immediately and aggressively; it can lead to pre-mature labor b/c bacterial toxins can cause early contractions; patient should be hospitalized and given IV antibiotics

60
Q

Preferred treatment of pyelonephritis in pregnancy studies

A

ceftriaxone OR cefepime OR aztreonam OR ampicillin and gentamicin

61
Q

What class of antimicrobials does gentamicin belong to and what is the MOA?

A

Aminoglycoside; binds to bacterial 30S ribosomal subunit to inhibit formation of initiation complex for protein synthesis

62
Q

Name the organism: lactose negative on MacConkey agar; produces hydrogen sulfide (a black precipitate); transmitted through contaminated food; symptoms include fever, diarrhea that can contain RBCs and abdominal cramps 7-12 hours after infection

A

Salmonella typhimurium

63
Q

Name the organism: lactose positive on MacConkey agar; do not produce hydrogen sulfide; different strains can cause different types of diarrhea

A

E. coli

64
Q

Lactose and hydrogen sulfide status for Proteus mirabilis

A

Lactose negative; produces hydrogen sulfide

65
Q

Shigella is more commonly found in what populations?

A

children who attend daycare and patients in mental institutions

66
Q

How does salmonella typhimurium cause its symptoms?

A

It does not have an enterotoxin; rather, it elicits an immune response that leads to increased intracellular cAMP levels – this accounts for the watery diarrhea

67
Q

How does the Shiga toxin of shigella species and the Shiga-like toxin of EHEC work?

A

Irreversibly nicks the 60s ribosome, resulting in inhibition of protein synthesis – leads to cellular death and blood diarrhea

68
Q

What is leptospira?

A

a gram negative question marked shaped spirochete found in animal urine

69
Q

What symptoms does leptospira cause?

A

flu-like symptoms, HA, fever, abdominal pain; unique symptoms are jaundice and photophobia

70
Q

Celiac disease is an AI disease with Abs against ?

A

gluten (gliadin)

71
Q

What other AI disease commonly occurs with celiac disease?

A

Hashimoto thyroiditis

72
Q

How does aspirin work?

A

irreversibly binding to the enzyme cyclooxygenase which prevents the production of prostaglandins and thromboxane synthesis

73
Q

How does heparin and its low molecular weight derivatives (enoxaparin, dalteparin) work?

A

binds to the enzyme inhibitor antithrombin III causing a conformational change that results in accelerated activity; activated antithrombin III then inactivates thrombin and other proteases involved in blood clotting, especially factor Xa

74
Q

What class of drug is clopidogrel in and what is the MOA?

A

ADP receptor inhibitors; works by specifically and irreversibly binding to ADP receptor located on platelet cell membranes; blockade of the ADP receptor inhibits platelet aggregation by inhibiting the glycoprotein IIb/IIIa pathway, which functions as a fibrinogen receptor

75
Q

What class of drug is Tissue plasminogen activator in? What is the mechanism of action?

A

Thrombolytics; catalyze conversion of plasminogen to plasmin, which is the major enzyme responsible for clot breakdown

76
Q

What is Boerhaave’s syndrome?

A

Presents with retching and vomiting followed by severe retrosternal chest pain and abdominal pain; involves tearing of the esophagus with stomach contents forced into the mediastinum

77
Q

What is the triad of symptoms seen in patients with fat emboli syndrome?

A

hypoxemia, neurologic abnormalitiies, petechial rash

78
Q

What is the MOA of cisplatin and what is it used for?

A

antineoplastic that alkylates and cross-links DNA; used in the treatment of testicular, bladder, ovary and lung carcinomas

79
Q

What are the side effects of cisplatin?

A

nephrotoxicity, acoustic nerve damage, peripheral neuropathy that can lead to foot or wrist drops

80
Q

How does Bleomycin work?

A

antineoplastic agent that inhibits DNA synthesis through free radical formation that induces single strand breaks in DNA; bleomycin inhibits DNA, RNA and protein synthesis in the G2 and M phases of the cell cycle

81
Q

What is bleomycin used for?

A

Hodgkin lymphoma and testicular cancer

82
Q

What are the side effects of bleomycin?

A

pulmonary fibrosis – can lead to restrictive lung disease

83
Q

How does busulfan work?

A

antineoplastic that works by alkylating and cross-linking strands of DNA and is cell cycle nonspecific

84
Q

What is busulfan used for?

A

treatment of chronic myelogenous leukemia or to ablate a patient’s bone marrow before bone marrow transplantation

85
Q

What are side effects of busulfan?

A

pulmonary fibrosis and hyperpigmentation

86
Q

How does etoposide work?

A

a topoisomerase II inhibitor that leads to the inhibition of DNA synthesis; primarily acts in the S and G2 phases of the cell cycle

87
Q

What is etoposide used for?

A

small cell carcinoma and testicular carcinoma

88
Q

What are the SEs of etoposide?

A

myelosuppression, GI irritation and alopecia

89
Q

Steeple sign on x-ray (an inverted V shape in the trachea) is usually associated with?

A

croup

90
Q

The thumbprint sign is commonly associated with?

A

epiglottitis

91
Q

What is the most common inherited bleeding disorder?

A

von Willebrand’s disease (vWD)

92
Q

What is von Willebrand’s disease?

A

AD disease; deficiency in vWF, a carrier protein for factor VIII; results in prolonged bleeding time

93
Q

What type of inheritance does PKU have?

A

autosomal recessive

94
Q

What causes PKU?

A

defect in the metabolism of phenylalanine, which is normally converted to tyrosine by phenylalanine hydroxylase

95
Q

Common conditions that cause transudative effusions are?

A

CHF, cirrhosis, nephrotic syndrome

96
Q

Common conditions that cause exudative effusions

A

lung infections, malignancy, pulmonary embolism, collagen vascular disease

97
Q

Personality changes, lack of social judgment and difficulty concentrating may indicate a lesion to what part of the brain?

A

Frontal lobe; this lobe is responsible for planning, concentration, orientation, language, motor regulation, abstraction and judgment

98
Q

Mammilary bodies, a part of the limbic system are responsible for? damage to this area can lead to what?

A

processing memoring; damage can result in Wernicke-Korsakoff syndrome – confusion, ataxia, ophthalmoplegia, memory loss, personality changes

99
Q

What type of inheritance does Huntington’s disease have?

A

autosomal dominant

100
Q

On what chromosome is the mutation for Huntington Disease?

A

Chromosome 4 – CAG repeats

101
Q

What physiologic parameters are expected in cardiogenic shock?

A

high preload, low CO, adequate intravascular volume

102
Q

What physiologic parameters are expected in hypovolemic shock?

A

low preload, low CO, decreased intravascular volume

103
Q

What physiologic parameters are expected in distributive shock?

A

normal/low preload, high CO, decreased vascular resistance

104
Q

What physiologic parameters are expected in obstructive shock?

A

Low preload, low CO, increased vascular resistance

105
Q

In a normal distribution ____% of all observations lie within one SD

A

68

106
Q

In a normal distribution ____% of all observations lie within two SD

A

95

107
Q

In a normal distribution ____% of all observations lie within three SD

A

99.7

108
Q

What nerve passes posterior to the medial epicondyle?

A

ulnar nerve

109
Q

What nerve supplies cutaneous innervations to the 5th digit and half of the 4th digit

A

ulnar nerve

110
Q

What nerve travels beneath the biceps tendon on the forearm?

A

median nerve

111
Q

Which nerve supplies cutaneous innervations to the first three and a half digits?

A

median nerve

112
Q

What Ab is specific for systemic sclerosis (scleroderma)?

A

Anti-Scl-70 antibody

113
Q

CREST syndrome is a type of?

A

scleroderma

Combank Q facts (11 decks)

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