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1

Anastrozole

Aromatase inhibitor that decreases estrogen

2

What hormone regulates fetal lung maturity?

Cortisol

3

Diagnosis of DM?

Fasting >126
random >200
Elevated HbA1c

4

Ezetimibe

prevents cholesterol absorption at small intestines brush border
(decreases LDL)

5

How to treat pyruvate dehydrogenase def.

increase intake of ketogenic nutrients
Lysine and leucine (purely ketogenic aa)
High fat diet

6

Signs and symptoms of a Glucagonoma

4 D's:
Dermatitis (necrolytic migratory erythema)
Diabetes
DVT
Depression
(normochromatic normocytic anemia)

7

How distinguish DI central from nephrogenic

Central responds to ADH (desmopressin test)

8

What enzyme is used to compensate for fructokinase def.?

Hexokinase

9

Colchicine

Acute gout tx
inhibits microtubule polymerization decreasing PMN chemotaxis (decreases LTB4)

10

Treatment for enterobiasis

Abendazole

11

Treatment for TCAD OD

NaHCO3 for widened QRS and ventricular arrhythmias

12

Drugs that cause lupus erythematous

HIP
Hydralazine
Isoniazid
Procainamide

13

Pathophys of drug induced lupus

metabolism by phase II acetylation and some people are slow acetylators

14

Captopril

ACE inhibitor
SE: angioedema so DO NOT USE with C1 esterase inhibitor deficiency

15

What is the crescent made of in rapidly progressive glomerulonephritis

Fibrin, monocytes, parietal cells, macs

16

Tx for urea acid cycle malfunction

protein restriction

17

What controls ventricular contraction rate during a fib?

AV node refractory period

18

What innervates the Trapezius?

CN XI

19

SCID defect

IL-2R gamma chain (x-linked)
Adenosine deaminase def (AR)

20

Antiphospholipid Ab Syndrome

Associated with SLE
increased aPTT, miscarriages, thrombosis, and +RPR

21

Hardy-weinberg analysis

Allele frequency: p (normal) +q(mutant)=1
Phenotypic frequency:
p^2 (freq in normal individuals) +2pq (carrier freq) + q^2 (freq of dz individuals) =1
calculating mutant allele frequency from disease prevalence: sq root (q^2)=q

22

Anal squamous cell carcinoma + HIV =

HPV 16 and 18

23

MOA of hydroxyurea

Increased HbF
sickle cell pain crisis

inhibits ribonucleotide reductase--> decreases DNA synthesis (S phase specific)
Melanoma, CML

24

Grades channel blockers MOA

Tx for sickle cell
inhibits efflux of K and h2o from cell--> prevents dehydration and reduces polymerization of HbS

25

Where is serotonin released from?

5HT comes from Raphe nuclei

26

where is NE released from?

Locus ceruleus

27

One month old with jaundice, muscle rigidity and lethargy

Crigler Najjar--absent UDP-glucuronosyl transferase

Build up of unconjugated (indirect) bilirubin

causes Kernicterus

28

JAK2-STAT mutation

Myeloproliferative disorders
Constitutive tyrosine phosphorylation activity

29

Teardrop RBC, hepatosplenomegaly, pancytopenia, STAT +

Primary Myelofibrosis
JAK2 mutation, obliteration of bone marrow

30

Base excision repair

Glycosylases-->Endonucleases-->Lyase-->Polymerase-->ligase

31

Growth factor receptor pathway

PI3K/Akt/mTOR
responsible for cell proliferation

32

Inhaled anesthetic effect on liver

Halothane causes acute hepatitis: prolonged PT

33

Maintenance dose

MD=Cpss x CL/(Bioavailability fraction)

34

Thiamine is a cofactor for...

ATP
Alpha-ketoglutarate dehydrogenase
Transketolase
Pyruvate dehydrogenase

35

Maxillary body necrosis

Wernicke

36

Southwestern

Detects DNA-bound proteins
Transcription factors, nucleases, histones

37

c-Jun and c-Fos

Transcription factors (DNA binding proteins)

38

Ras

porto-oncogene codes for membrane bound G-protein

bound to GTP=active
bound to GDP=inactive

39

CYP 450 inducers ++

Chronic alcohol use
St john wort
phenytoin
phenobarbital
Nevi rapine
Rifampin
Griseofulvin
Carbamazepine

Chronic alcoholics steal Phen-phen and Never refuse greasy carbs

40

Abacavir

HLA-B*57:01
Type IV hypersensitivity
delayed rash

41

Effects of beta blocker on heart conduction

Slows AV node conduction-->increases AV nodal refractory period--> PR interval prolongation

42

Why treat for Group A strep

Prevent acute rheumatic fever and mitral valve damage

43

Amanita phalloides

Amatoxin in mushrooms
bind RNA pol Type II and inhibit mRNA synthesis

44

Garlic breath, vomiting, watery diarrhea QT prolongation,

Arsenic poisoning
exposure to insecticides or contaminated water

inhibits cellular respiration by messing with pyruvate dehyg.

45

Treatment for arsenic poisoning

Dimercaprol

46

Tx for Lead poisoning

CaNa2 EDTA

47

Treatment for Hepatic encephalopathy

Rifaximin
Lactulose (increased conversion of ammonia to ammonium ions)

48

MOA Rifaxmin

antibiotic that alters GI flora and decreases intestinal production of ammonia

49

Effect of ureter constriction on kidney function

increased hydrostatic pressure in capsule-->Decrease GFR
efferent constriction--> decreased FF

50

tx for cyanide tox

Na thiosulfate, hydroxocobalamin, sodium nitrate

51

Where adenocarcinoma in esophagus

lower 1/3
barrets esophagus common cause (obesity and GERD too)

52

where squamous cell carcinoma in esophagus?

upper 2/3

53

Rickets effect on bone

excess of unmineralized osteoid matrix

54

cryptococcus morphology

Budding yeast

55

Effect of IgA protease

allows bacteria to adhere to mucosa

56

P bodies

quality control and storage for mRNA in cytoplasm

57

Liver damage due to Hep B from

viral expression of HBsAg and HBcAg with MHC 1 which activates CD8 t cells which damage hepatocytes

58

PDA sound

continuous machine like murmur loudest at S2
left intraclavicular region

59

EBV on blood smear

See CD8+ T cells because they proliferate more and destroy the infected B cells

60

High Hct with normal RBC mass

Relative polycythemia
causes: dehydration and excessive diuresis

61

High Hct, increased RBC mass, low epo levels

Polycythemia vera
all three cell lines increase

62

High Hct, Increased RBC mass, high epo, saO2

secondary erythrocytosis from hypoxia

63

Hyperphenylalanemia and elevated prolactin

Dihydropteridine reductase deficiency

Get downstream deficiencies that lead to neurologic impairment

64

coordination of glycogenolysis and skeletal muscle contraction

Ca release from SR--> stimulates phosphorylase kinase--> phosphorylase glycogen phosphorylase (activate)

65

Defective ApoE

Familial dysbetalipoproteinemia (type III hyperlipoproteinemia)
elevated Chylomicron and VLDL remnants

Palmar xanthomas
premature atherosclerosis

66

defective LPL or ApoC2

hyperchylomicronemia (type I)
Acute pancreatitis and eruptive xanthomas
increased everything

67

Defective LDL receptor

familial hypercholesterolemia (type II)
premature atherosclerosis and tendon xanthomas

68

Increased VLDL

Familial hypertriglyceridemia (type IV)
pancreatitis

69

Cofactors for Pyruvate dehydrogenase

Tender Loving Care For Nancy
Thiamine
Lipoate
Coenzyme A
FAD
NAD

(also required for branched chain alpha ketoacid dehyd. and alpha ketoglutarate dehyd)

70

Sorbitol is converted to...

Fructose via sorbitol dehydrogenase

71

Reyes syndrome

Child with viral illness given aspirin
Encephalopathy, n/v, and fatty liver
Impaired beta oxidation-->impaired fatty acid metabolism in hepatic mitochondria

72

Role of ascorbate

Vit C
facilitates Iron absorption by keeping Fe2+ in reduced state
cofactor for DA-->NE
Hydroxylation of Proline to lysine

73

Beta glucuronidase

hydrolyzes bilirubin glucuronides and increases unconjugated bilirubin.

increase leads to pigmented gallstones

74

Cause of pigment stones in gallbladder

Bacterial (e. coli) or helminthic (ascaris lumbricoides, clonorchis sinensis)

infect biliary tract--> release of beta-glucuronidase

also from hemolytic anemia

75

What is a case-control study asking?

What happened?
Use odds ratio

76

What is a cohort study asking?

who developed the dz? or who will develop the Dz?
use relative risk

77

Buspirone

slow onset of action (2 wks) so no good for panic disorder
partial agonist of 5HT1A receptor

78

Treatment for lung abscess

Clindamycin

good for anaerobes and aerobic G+ bugs

79

Ivabradine

Cardiac rate control w/ no effect on contractility or relaxation

blocks funny channel in phase 4

80

Osteocytes

connected via gap junctions

maintain structure of mineralized matrix and control release of Ca2+
regulate bony remodeling via signaling osteoblasts

81

common cardinal veins become...

SVC and systemic circulation

82

Exercise physiology: effects on blood flow

stimulation of muscle chemo and mechanoreceptors increase symp outflow thus increasing HR and contractility and vasoconstricing unused muscles

HOWEVER local metabolite production leads to arteriolar dilation w/in muscles--> decreasing systemic vascular resistance

83

what influences peak bone density?

80% genetic
race (AA have stronger bones)
environmental

84

Osgood-Schlatter dz

over use of secondary ossification center (apophysis) of tibial tubercle
limited leg extension

85

CCA

3'end of tRNA used for recognizing protein
made up of chemically modified bases

86

Umbilical hernia cause

incomplete closure of umbilical ring (defective lines alba)
reducible bulge

87

Effects of renal hypoprofusion

increased renin release from JG cells--> hypertrophy of JG cells

88

Pituitary tumor, parathyroid issues, pancreas tumor

MEN1

89

asymptomatic hypercalcemia or renal stones with bitemporal visual field defects

MEN1

90

Cuboidal or polygonal cells w/ abundant cytoplasm in a kidney tumor

clear cell carcinoma
originate from proximal tubules

91

stimulus control treatment for insomnia

using bed only for sleep
go to bed only when tired
fixed wake up time
leave bed when unable to sleep

92

location of anal fissure

Posterior midline (poor perfusion)

93

Ras-MAP kinase pathway

Growth factor--> Autophos tyrosine residues--> interaction with SOS--> Active Ras (bound to GTP)--> MAP kinase--> transcription

Inactive Ras bound to GDP

94

N-myc and C-myc

Transcription factors

95

Cholesterol 7 alpha hydroxylase

Catalyze rate-limiting step in synthesis of bile acids

inhibited by Fibrates

96

Ehlers-Danlos dysfunction

Deficiency in pro collagen peptidase
impaired N-terminal propeptide removal
can't cross link collagen

97

Lynch syndrome (hereditary nonpolyposis colon cancer) cause

Defective DNA mismatch repair

AD dz

98

N-acetylcysteine

Treatment for CF and for acetaminophen overdose

99

What causes Giant Cell arteritis?

cell mediated immunity
inflammatory infiltrate due to IL-6
tx with steroids and tocilizumab (ab against IL-6)

100

Femoral n. location and injury

in psoas muscle then between psoas and illiacus

injury--> weakness of quads (difficulty with stairs and knee buckling)
sensory loss over anterior and medial thigh and leg
loss of patellar reflexes

101

Kidney compensation for metabolic acidosis

increase HCO3 IN
Increase H+ and H2PO4 OUT

102

Lactase deficiency signs

osmotic diarrhea
decreased pH in stool (bacterial fermentation of lactose)

103

Parietal cell regulation

+ Gastrin, Histamine, ACh
- Prostaglandins, misoprostol, somatostatin

104

parietal cell hyperplasia and enlargement of gastric folds

Zollinger-Ellison

105

Positive empty can test

Supraspinatus
initial arm abduction before deltoid

106

Latanoprost

topical prostaglandin
Galcoma tx
increases outflow

107

What makes a drug have higher hepatic clearance?

increased lipophilicity and increased volume of distribution
lipophilicity makes it easier to enter hepatocytes and allows for a wider distribution (CNS)

108

Tx for alcohol withdrawal

Benzodiazepines (diazepam or chlordiazepoxide)

109

Ecological study

Looking at population data not individuals

110

Homogenous deposition of eosinophilic hyaline material

Hyaline arteriolosclerosis

111

cause of hyaline arteriolosclerosis

poorly controlled HTN and DM

112

onion like concentric thickening

hyperplastic arteriolosclerosis

113

hyperplastic arteriolosclerosis cause

due to malignant HTN

114

proximal muscle weakness (trouble with stairs and standing from sitting), dry mouth and impotence

Lambert-Eaton myasthenic syndromes
better with muscle use
inhibition of presynaptic Ca channels
associated with small cell lung cancer

115

Hydralazine

arteriolar vasodilator
leads to decreased SVR but stimulates baroreceptors--> symp stimulation--> RAAS--> sodium and fluid retention

also Minoxidil

116

Chronic post mastectomy lymphedema with violaceous nodules

Angiosarcoma

117

Signet ring cells

Gastric adenocarcinoma
infiltrate growth into stomach wall--leather bottle stomach
Loss of e-cadherin

involvement of supraclavicular LN and periumbilical nodes (sister mary joseph)

118

Fixed cecum in URQ and bilious vomiting in first day of life

failure of midgut rotation around SMA

intestinal obstruction and midgut volvulus

119

source of gonadal artery

abdominal aorta

120

effect of bile and phosphatidylcholine on gallstones

more bile salt and phosphatidylcholine makes cholesterol more soluble--> decreases risk of gallstones

121

Beta endorphin source

POMC--> just like ACTH and MSH

122

Cross sectional study is what?

Snapshot--> measuring exposures and outcomes at the same time

123

effect of nitroprusside on LV

decrease afterload and preload

124

IgE-independent mast cell activation

Due to drugs (opioids, radio contrast, vanco)

degranulation due to PKA and PI3 K

diffuse itching and pain, bronchospasm and localized swelling (urticaria)

125

causes of acute pancreatitis

Gallstones
alcoholism-- also find anemia if malnourished

126

Effects of insulin and hydration

increased serum bicarb. Intracellular shift of K+--> decreased serum K+

decreased serum osm

127

Chronic interstitial nephritis and papillary necrosis

NSAID-associated chronic renal injury

months after taking NSAID

128

Cause of Mallory-Weiss tears

increased intraabdominal pressure from vomiting or retching

can also find hiatal hernias

129

white/yellow pseudomembranes on sigmoidoscopy + abdominal pain and diarrhea

C. Diff from antibiotics

cytotoxin A--diarrhea
Cytotoxin B--colonic epithelial cell necrosis and fibrin deposition

130

Oliguria after a few days of hospitalization for internal bleeding

ATN

131

Recovery phase of ATN

tubular re-epithelization and recovery

risk of hypokalemia

132

Cirrhosis and estrogen

decreased P450 leads to decreased free tosterone/estrogen ratio

produces more sex hormone binding protein

Get gynecomastia, testicular atrophy, spider angiomata (dilation from estrogen), decreased body hair

133

Liver biopsy with lymphocyte infiltration and granulomatous destruction of interlobular bile duct

Primary biliary cirrhosis

autoimmune dz w/ Anti-mitochondrial Ab

134

middle aged woman with pruritus and fatigue w/ pale stools and dark urine

Primary biliary cirrhosis

cholestasis-->jaundice, pale stool, dark urine

can also get xanthelasma

135

what do you see with reactive lymphoid hyperplasia that makes you suspect malignancy?

Monoclonal T-cell receptor gene rearrangements

136

lung mass, progressive dizziness, limb and truncal ataxia, dysarthria and visual disturbances

Paraneoplastic cerebellar degeneration

cerebellar symptoms and small cell lung cancer

Autoimmune w/ antibodies against purkinje neurons (Anti-Yo, anti-P/Q, anti-Hu)

137

Location of atherosclerosis

Abdominal aorta>coronary >popliteal>carotid artery

138

Major cause of mortality in lung transplants

bronchiolitis obliterans

Chronic rejection--destruction of small airways

dyspnea and wheezing

139

PAS stain

Whipple dz
stains glycogen and mucopolysaccharides

140

older man with weight loss, diarrhea, arthritis, fever and adenopathy

Whipple dz

foamy macs with PAS+

141

why are reticulocytes blue with wright-giemsa stain?

Residual rRNA

142

Urinary 5-hydroxyindoleacetic acid

Carcinoid syndrome

143

histology of a lung hamartoma

islands of mature cartilage, fat, smooth muscle and clefts lined by respiratory epithelium

144

fluctuating painless lymphadenopathy

Follicular lymphoma
indolent non-hodgkin lymphoma

from B cells

145

Splenomegaly and pancytopenia in older man

Hairy cell leukemia
Tartrate-resistant acid phosphatase (TRAP)

146

Effects of obesity on the lungs

Restrictive lung disease
decreased compliance
Decreased ERV and FVC (as well as TLC)

147

third brachial pouch

inferior parathyroid and thymus

148

elevated aldo and renin

Secondary hyperaldosteroninsm
causes:
renal artery stenosis, diuretics, malignant HTN, Renin secreting tumor (JG cell tumor)

149

Antiviral tx for VZV with resistance

Cidofovir and Foscarnet

do not need virus to phosphorylate them

150

Etanercept

TNF-alpha inhibitor
tx for moderate to severe RA (along with methotrexate)
Acts as decoy receptor

-cept--> receptor molecule

151

Raloxifine

SERM that inhibit osteoclast differentiation

152

HTN, Hypokalemia, metabolic alk, decreased renin

Primary hypoaldo

153

Aldo antagonist

Spironolactone, epleronone

SE: gynecomastia

154

Tx for delirium

Low dose haloperidol for acute agitation and psychosis

155

most common benign tumor of liver

Cavernous hemangioma--> dilated blood vessels in 30-50yo

156

Inheritance of polycystic kidney dz

AD!!

Adults are DOMINANT Babies are NOT

157

-dronate

Bisphosphonates
inhibit osteoclast activity

158

Denosumab

bind RANKL

159

Virus that leads to aplastic crisis in sickle cell pts

Parvovirus B19
Non enveloped single stranded DNA

160

Proteasome inhibitors

tx for multiple myeloma
Bortezomib
inhibition leads to cell apoptosis

161

Triptan MOA

postsynaptic serotonin agonist

162

Why give sublingual or rectally?

Avoid high first pass in the liver

163

Pancytopenia, venous thrombosis, hemolytic anemia

Paroxysmal nocturnal hemoglobinuria
Coombs -
CD 55/59 -
Cause: increased complement mediated RBC lysis
Tx: Eculizumab

164

Hemosiderosis

iron buildup in kidney due to chronic hemolysis

165

Actinic Keratoses increase risk of...

Invasive squamous cell carcinoma

166

Colitis associated carcinoma features

multifocal
Develop p53 mut EARLY, LATE APC mut
progresses from flat and non-polypoid dysplasia

167

Theophylline intoxication

Seizures, tachyarrhythmias, n/v. diarrhea

tx: Beta blockers

168

Hepatocyte swelling and cytoplasmic emptying (ballooning)

Acute viral hepatitis
Hepatocyte necrosis and apoptosis

169

Councilman bodies

apoptosis of hepatocytes with cellular shrinkage and nuclear fragmentation with eosinophilia

seen in acute viral hepatitis

170

SE Niacin

decreased renal excretion of uric acid-->acute gout

flushing, hyperglycemia, hepatotox

171

Dyspnea, chest pain, hemorrhagic pleural effusion, pleural thickening

Mesothelioma

long slender microvilli and tonofilaments

172

Pityriasis versicolor

Malassezia sp.

stratum corneum, spaghetti and meatballs

173

Autoimmune destruction of melanocytes

Vitiligo

174

Matrix metalloproteinases

wound healing
encourage myofibroblast accumulation at wound edges and tissue remodeling

175

Hospitalized patient with ballooning cells and vacuolar degeneration of proximal tubule cells

ATN

Ischemic
or nephrotoxic (ethylene glycol)

176

Oxalate crystals in tubular lumen

ethylene glycol poisoning

high anion gap met. acidosis

177

Trastuzumab

tx for Her2+ breast cancer
blocks activation of tyrosine kinase

178

SE of bile acid-binding resins

GI upset, impaired absorption, hyperTGs

179

beta blockers plus NDHP CCB

additive negative chronotropic effect--> bradycardia and hypotension

180

Pink mesangial matrix overgrowth and glomerular BM thickening

Kimmelstiel-Wilson nodules
DM glomeruli nephropathy