Deck 6 Flashcards
1
Q
Where are androgens and progesterones synthesized in female?
A
Theca interna cells
2
Q
Where is estradiol syntehsized?
A
Granulosa cells (contain aromatase)
3
Q
What neuronal structure is used to transport HSV to and from epithelial cells
A
Toward epithelium = kinesin
Retrograde axonal = dynein
4
Q
WHere does PCL attach?
A
From posterior tibia to medial condyle femer
5
Q
Where does ACL attach?
A
From anterior tibia to lateral condyle of femur
6
Q
Equation for number needed to harm?
A
NNH = 1/ absolute risk increase
7
Q
Equation for absolute risk increase?
A
(# dead/ total receiving Tx A) - (# dead/ total receiving Tx B)
8
Q
What is the Kozak censensus sequence? What happens if there is a mutation in it?
A
gccgccRccAUGG (r = A or G)
Initiation of translation
If mutation occurs, initiation of translation stops, like in B thalessemia
9
Q
What is MHC I made of?
A
MHC I class Heavy chain + B-2 microglobulin
10
Q
Why can’t you use NSAIDs with loops?
A
Loops increase prostaglandins and increase GFR, NSAIDs will inhibit prostaglandins and block effects of loops
11
Q
What are the main electrolytes influencing the electrochemical gradient in a cell?
A
K+ and Na+ (K+ most)
12
Q
What does azathioprine get converted to?
A
6MP – will cause purine synthesis inhibition
13
Q
What are hypocretin-1 levels in narcolepsy? What is wrong with sleep cycle?
A
Low hypocretin-1 in CSF
Less than 15 mins REM latency
14
Q
WHat does IL-5 stimulate? Which cells secrete IL-5?
A
Secreted by Th2 for Eosinophilic activation. Also activates IL-4 which stim IgE
15
Q
What is Lynnch syndrome? What gene mutation causes it?
A
Hereditary nonpolyposis colorectal cancer (adenocarcinoma) (HNPCC)
MSH1 gene - DNA mismatch repair
16
Q
Who gets Lynnch syndrome/
A
Young people <50
17
Q
What does HAART therapy do to body habitus?
A
Lipoatrophy (NRTI) loss of fat in face and extremities
Central fat deposition
Metabolic syndrome - insulin resistance, hypertriglycerides, reduced HDL levels
18
Q
What is neuroblastoma? Symptoms?
A
opsoclonus-myoclonus, raised catecholamines, abdo mass (renal medulla), periorbital ecchymosis, may have spinal cord compression
19
Q
How do NSAIDS cause gastric erosion?
A
COX 1 inhibition –> Decreased prostaglandin synthesis causes gastric hyperacidity and impaired defense
20
Q
What causes flat contour of R cardiac silouhette?
A
Compresion of RA by R middle lobe
21
Q
MOA macrolides in diabetic gastropareisis
A
Increases gastric motility (erythromycin). Agonist on motilin receptors** in muscularis externa
Use when metclopramide doesn’t work
22
Q
Equation for NNT?
A
NNT= 1/ARR
23
Q
How do you calculate ARR?
A
Control event rate - treatment event rate (same as absolute risk increase?)
24
Q
What structures are at risk if you do a horizontal transection of the rectus abdominus muscles?
A
Inferior epigastric arteries
Must ligate them during C section to prevent bleeding
25
SE of digoxin?
color blindness, n/v, arrhythmias, anorexia
26
How does biliary atresia present?
Obstruction of extrahepatic bile ducts, increased direct bili, dark urine, pale stools
27
Woman with watery diarrhea, hypokalemia, achlorydia. WHat is it?
VIPoma. VIP stimulating pancreatic bicarbonate and chloride secretion
28
Tx VIPoma?
Somatostatin (octreotide) inhibits VIP and many other gastric secretions
29
Focal neurological deficit after SAH. What caused it?
Cerebral vasospasm
30
What conditions within gallbladder cause stone formation?
High cholesterol, low bile salts and PPDC
Bile salts and PPDC increase cholesterol solubility
31
What are RF and symptoms of lead poisoning?
Behavior changes, constipation, abdo pain, decreased vit D, encephalopathy, anemia, interstitial nephritis
RF include living in homes built before 1978
32
How to diagnose lead poisoning?
Blood lead level. Interrupts heme synthesis
33
How does glucagon work in hypoglycemia Tx?
Increases hepatic glycogenolysis (glycogen breakdown) and gluconeogenesis
Stimulates insulin secretion from pancreas
Little/no effect on other organs/tissues
34
Where does portal HTN due to cirrhosis affect other organs?
Connected to portosystemic collateral veins (L gastric, esophagus, rectum, abdomen. Caput medusae, anorectal varices, esophageal varices
35
What layer of vessel is affected in Marfan Syndrome?
Tunica media shows myxomatous changes (weakening) due to decreased extracellular glycoprotein fibrillin-1.
36
What type of collagen is used in scar tissue after MI?
Type I collagen
37
Where else is Type I collagen found?
Dermis, bone tendons, ligaments, dentin, cornea BV, scar tissue
38
Where is type II collagen found?
Cartilage, vitreous umor, nucleus pulposus
39
Where is type III collagen found?
Skin, lungs, intestines, BV, bone marrow, lymphatics, granulation tissue
40
Where is type IV collagen found?
Basement membranes
41
What type of collagen is defective in Alport syndrome?
Type IV collagen (BM)
42
What collagen type is defective in Ehlers Danlos type 3 and 4?
Type III collagen (skin)
43
What type of collagen is defective in osteogenesis imperfecta?
Type I collagen--> bone
44
What are symptoms of Mullerian duct agenesis? Karyotype?
46 XX
Variable uterine growth --->primary amenorrhea
Short/absent upper vagina
Normal ovaries --> 2ndary sexual characteristics present
45
How does androgen insensitivity syndrome present? Karyotype?
46 XY
Phenotypically female
Cryptorchid testes, no uterus or ovaries
Due to complete androgen receptor insensitivity
46
What is Kallman syndrome? Presentation?
Decreased GnRH secretion from hypothalamus
- Primary amenorrhea
- Lack secondary sexual characteristics
- Olfactory sensory defect
47
What is Klinefelter syndrome? Presentation?
```
47, XXY
Males with tall stature
Poor secondary sexual characteristics
Atrophic testes
Infertility
```
48
New test for disease A that is 95% specific. If 8 people with disease A are tested, what is the probability that ALL tests will come back negative?
0.95^8 = 35%
49
Which antiviral causes nephrotoxicity?
Acyclovir - use aggressive IV hydration
50
WHat is the effect of estrogen on thyroid hormone levels?
Increases TBG levels, which bind T4 and cause more stimulation of TRH from anterior pituitary --> greater overall T4 levels
51
What antigen is needed for formation of integrins?
CD18
| Absence causes leukocyte adhesion deficiency
52
What are symptoms of leukocyte adhesion deficiency?
Recurrent skin and mucosal infections with *No pus** (no neutrophils at site)
Poor wound healing
Delayed umbilical cord separation (>21 days)
Marked peripheral leukocytosis and neutrophilia
53
What disease causes progressive neurological degeneration of the putamen
Wilson's disease
54
Where is the caudate nucleus?
C shape in the lateral ventricles
55
What heart murmur is seen with pulmonary artery HTN?
Tricuspid regurg from enlarged R ventricle
56
What agents are used to treat primary pulmonary artery HTN?
Endothelin receptor antagonists. They inhibit vasoconstriction and SM proliferation in pulmonary arteries. (Bosentan, ambrisentan)
57
What substances cause vasodilation?
Substance P, Ach, serotonin, bradykinin, sheer force
58
What is pathway for activating vasodilation?
Substance (Ach etc) --> synthesis of endothelial nitric oxide synthase --> NO ---> Vasodilation
59
What is nitric oxide synthesized from?
Argenine, O2, NADPH
60
What type of reaction is occurring when transplant patient has decreased UO, fever, and renal failure within first few weeks?
Acute graft rejection
61
What is acute graft rejection usually caused by?
Host T-cell sensitization against graft MHC antigens, lymphocytic infiltrate(cellular)
Or humoral reaction (C4 deposition, nec vasculitis, neutrophilic infiltrate)
62
What are symptoms of temporal arteritis (giant cell arteritis)
jaw claudication
headaches
visual disturbance (ischemic optic neuropathy)
May be associated with polymyalgia rheumatica
63
What does oculomotor CN III palsy look like?
No reaction to light or accomodation
Ptosis
"down and out" appearance of eye due to unopposed action of Lateral rectus and Superior oblique (CN VI and CN IV)
64
Where is aneurysm if it causes CN III palsy?
Posterior communicating artery
65
What are clinical symptoms of splenic laceration?
Shoulder pain and hiccups (C3-C5) phrenic nerve irritation
66
Where do you do femoral catherization?
Medial to femoral artery and below inguinal ligament
67
What do pheochromocytoma cells contain?
Synaptophysin, chromogranin, neuron-specific enolase, catecholamines
68
What type of CAH does infant have if they have ambiguous genatalia, hypokalemia, and HTN?
11-B-OH deficiency
11-Deoxycorticosterone is weak mineralcorticoid so they'll have hypokalemia and HTN
**HTN distinguishes it from 21-OH deficiency
69
What happens to venous return and CO after MI?
Decreased CO, normal venous return
70
What is function of RNA polymerase i?
Transcribes 45S pre-rRNA gene that codes for ribosomal subunits
**Found only in nucleus**
71
What is p53? Which stage of cell cycle does it act?
Tumor suppressor gene
| G1, prevents it from moving on to mitosis
72
What is a cholesteatoma made of? Effect?
Squamous cell debris, appears like a pearly white mass behind tympanic membrane
Causes conductive hearing loss, may cause vertigo or affect facial nerve if large enough
73
What high potency antipsychotics cause tardive diskenesia?
Haloperidol
| Fluphenazine
74
What do blotchy red muscle fibers of Gomori stain indicate?
Midochondreal myopathies
"red ragged fiber"
Can only be passed down maternally
75
Which receptors do atenolol work on?
Selective B1 adrenergic receptors found in cardiac tissue and JG cells
Decreased Gs pathway, decreases cAMP
76
When do you use chi square test?
2x2 table
| 2 categorial variables compared
77
when is t-test used?
to compare the means in 2 groups
78
when does vasospastic angina occur?
at night
79
What medication precipitates vasospastic angina
Dihydroergotamine (for headaches), provokes vasoconstriction. Triptans, smoking, and cocaine can also provoke variant angina
80
MOA enfurvitide?
Binds gp41 and inhibits it from making conformational changes that allow viral fusion and entry
81
Ash leaf-spots, brain hamartomas, and renal angiolipomas. What is it?
Tuberous sclerosis, autosomal dominant disease
82
What is cystinuria?
Condition where amino acid transporter is defective, resulting in impaired renal and intestinal absorption/reabsorption
**recurrent Cysteine kidney stones form - flat yellow hexagonal crystals
83
What is premature ejaculation?
Ejaculation in less than 1 min of penetration for at least 6 months
84
Clubbing and cyanosis in lower extremities but not upper, increased fatigability on exertion, recurrent respiratory infections. Which heart abnormality is it?
PDA
85
MOA fatty liver/ hepatic steatosis?
Triglyceride accumuliation, decreased free fatty acid oxidation due to excess NADH production via alcohol dehydrogenase and aldehyde dehydrogenase
86
Wha are sofosbuvir and ledipasvir for?
TTx of HCV
87
How do sofosbuvir and ledipasvir work?
RNA dependent RNA polymerase inhibitors, protease inhibitors, NS5A inihbitors
Inhibits viral repllication and assembly
88
What fails to fuse in patent foramen ovale?
Septum premum and septum secundum
89
What does patent foramen ovale put you at risk for?
Paradoxical brain embolism
90
What is heteroplasmy?
Different mitochondreal genomes within a single cell Some cells will have normal mitochondrea and others won't
Inheritence pattern will still go through mother but only some of the offspring will be effected
91
Why do parkinson's disease drugs sometimes cause good mobility and other times cause bradykinesia/rigidity?
"on-off" patterns, drug is upredictable in response, there is a small therapeutic window and as the nigrostriatum degenerates this window gets smaller
92
Tx for juvenile myoclonic epilepsy?
Valproic acid (broad spectrum)
93
Diastolic decrescendo murmur best year L sternal border?
AR - valvular type best heart at L 3rd intercostal space
| Marfan's AR due to root dilation best heard at R upper sternal border
94
What does osteoporosis from hyperparathyroidism look like?
Subperiosteal respotion with cortical thinning
95
Equation for RR?
RR = (a/(a+b))/(c/(c+d))
96
What are symptoms of CMV colitis and who gets it?
Diarrhea, abdominal pain, fever, fatigue.
| Renal transplant pts on immunosuppressive therapy
97
What is Tx for CMV colitis? What do you see on colonoscopy? On histology?
Gancyclovir
Colonic ulcerations
Intracytoplasmic basophilic inclusions
98
SE of gancyclovir?
Neutropenia
Anemia
Thrombocytopenia
99
DMS criteria for MDD?
>5 symptoms for >2 weeks, one must be depressed mood or anhedonia
100
Main risk tamoxifen
Endometrial hyperplasia, and cancer
Also hot flashes and VTE
101
What is age cutoff for understanding death
under 7 won't understand
102
What are hindgut derivatives?
Distal 1/3 of transverse colon, descending colon, sigmoid colon, and rectum
103
What supplies the hindgut derivatives?
Inferior mesenteric artery
104
How does silicosis increase risk of TB?
Impairs macrophage function
105
What does tetrodotoxin from pufferfish do?
Bind voltage-gated sodium channels in nerve and cardiac tissue
106
Papilledema, headache, vomiting from obstructive hydrocephalus. Limited upward gaze. What is it?
Pineal gland mass causing Parinaud syndrome
107
What is pineal gland mass usually caused by?
Germinomas. They may present in young boys in gonads or mediastinu. Can cause hypothalamic/pituitary dysfunction
108
Man dies from lung condition- what is condition if spindle cells positive for cytokeratin and calretininmean?
Mesothelioma
| Asbestos exposure
109
What is hyperacute renal rejection caused by?
Antibody-mediated reaction- preformed IgG against donor antigens (ABO and anti-HLA)
Type II hypersensitivity
Will see rapid necrosis and oligria
110
What is graves ophthalmopathy caused by? What is treatment?
T-cell acivation and inflammatory infiltration, stimulation of orbital fibroblasts
Glucocorticoids
111
MOA phenytoin?
blocks Na+ channels, inhibits depolarization
112
Tx status epilepticus?
IV lorazepam and phenytoin concurrently
113
What is Tx for hypertrigliceridiemia causing acute pancreatitis?
Fibrates (fenofibrate, gemfibrozil)
114
Time length to diangose dysthymia?
>2 years + presence of 2 depressive symptoms
115
What changes will kidney undergo if they have hydronephrosis?
pressure induced parenchymal atrophy, scarring
116
What does portal hypertension for alcoholic liver disease do to spleen?
Splenomegaly, **expansion of red pulp from venous congestion
117
How does septic shock cause lactic acidosis?
Tissue hypoxia impairs oxidattive phosphrylation. Pyruvate gets shunted to lactate after glycolysis (due to NADH buildup).
118
History o dementia/stroke will put someone at risk for aspiration pneumonia. Where will aspirate go?
Superior regions of lower lobes. Superior and posterior regions. Superior of lower lobes, posterior of upper lobes
119
Which vessel does RCC usually obstruct?
IVC AFTERinvading the renal vein
120
Why do RCC patients have erythrocytosis?
Excessive EPO production by RCC. May have hypercalcemia from overpoduction of PTHrP
