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Flashcards in Last Push Deck (203):
1

Treating Alzheimer's with a cholinesterase inhibitor (donepezil, galantamine, rivastigmine) improves memory because of its ability to target synaptic connections between what structures?

Basal forebrain (basal nucleus of Meynert) and neurons in the cerebral cortex

2

What nerve is most likely to be damaged by a tumor invading the right side of the pericardium?

Right phrenic nerve

3

What is polyglutamic acid?

Protein capsule of B. anthracis

4

Do blood vessels have both sympathetic and parasympathetic components?

NO - only sympathetic innervation (either vasoconstriction or lack of vasoconstriction)

5

How does a carotid massage work?

Increased pressure on carotid baroreceptor leads to increased firing leads to increased AV node refractory period leads to decreased heartrate (bradyarrhythmia)

6

Why do people pass out from carotid massage?

Bradyarrhythmia NOT blood pressure change

7

Why do mitochondria encode their own tRNA?

Use a non-standard genetic code

8

Does CHF lead to transudate or exudate?

Transudate - increased hydrostatic pressure

9

Which hepatic enzyme is initially activated by exercise to start glycogenolysis?

Phosphorylase kinase

10

When do we use chi-square vs. ANOVA?

Chi-square means categorical (chi-tegorical) outcomes vs. ANOVA for comparing means of different groups

11

Surgical neck of the humerus fracture - what nerve is damaged?

Axillary

12

What is the sensory deficit with damage to the axillary nerve?

Lateral arm

13

Midshaft fracture of the humerus - what nerve is damaged?

Radial

14

What is the sensory deficit with damage to the musculocutaneous nerve?

Lateral forearm

15

What do we use to classify different serogroups of neisseria meningitidis?

Antibodies to capsular polysaccharide

16

Pancreatic cancer - what is the most common cause of jaundice?

Common bile duct obstruction - leads to both jaundice and pale stool (bile gets into the blood but not the GI tract)

17

What drug can you use to treat both hypertension and Raynaud's?

Nifedipine - use calcium channel blockers (dihydropyridine) to treat vasospasm

18

Oxygen hemoglobin dissociation curve shifts to the right most directly results in?

Release of oxygen in tissue capillaries (decreased affinity for oxygen)

19

What stimulates VEGF?

Hypoxia

20

What heart medication has toxicities that are mostly cholinergic mediated?

Digoxin - nausea, vomiting, diarrhea, blurry yellow vision

21

What are the spirochetes?

Borrelia, leptospirosis, treponema

22

What causes lyme disease?

Borrelia

23

What happens to calcium and phosphate levels in chronic renal disease/failure?

Calcium levels go down (from decrease in 1 alpha hydroxylase activity) while phosphate levels go up (from inability to excrete phosphate)

24

Swelling of cells in the case of ischemic damage is most directly related to?

Decrease in ATP from sarcoplasma reticulum means that Na-K pump can't work so that Na accumulates in the cell and water moves in and cell swells

25

Spleen - retroperitoneal?

No so if it's damaged, blood will be in the abdominal cavity

26

Tail of the pancreas - retroperitoneal?

No

27

Retroperitoneal structures?

SAD PUCKER: SVC, aorta, duodenum (2nd - 4th parts), pancrease (except for the tail), ureters, colon (ascending and descending), kidneys, esophagus (lower 2/3), rectum

28

Plasmids are transferred through what process?

Conjugation

29

What is ropinirole?

Non-ergot dopamine agonist (selective for D2 receptors)

30

GI drug that promotes gastric emptying and relieves nausea and vomiting?

Metoclopramide (D2 receptor antagonist)

31

How does glucagon affect adipocytes in a fasting state?

Activates hormone-sensitive lipase

32

Catheter to get to the uterus starting at the femoral artery - path?

Femoral artery - external iliac - internal iliac - uterine artery

33

What happens to lower esophageal sphincter tone in CREST?

Decreases because of atrophy of the muscle - this is why CREST patients are at increased risk for GERD and adenocarcinoma

34

Methanol poisoning - what enzyme do you want to inhibit?

Alcohol dehydrogenase (with fomepizole)

35

What is the mechanism by which multiple myeloma patients get hypercalcemia?

Local IL-1 and TNF effects - IL-1 is also called osteoclast activating factor

36

Baby overreacts to stimuli around him and has marked startle response - mother was using what drug?

Heroin

37

What structure attaches to the cervical region and extends posteriorly and can be incised in female pelvic surgery?

Uterosacral ligament

38

What function in mRNA synthesis and processing is likely encoded by the 3' sequence AATAAA?

Cleavage and polyadenylation

39

How does gemfibrozil affect simvastatin?

Fibrates inhibit cytochrome p450

40

What diet is recommended for patients with DM2?

Low-calorie

41

What does a congenital pharyngo-cutaneous fistula (2nd arch) connect?

Fistula between tonsillar area and lateral neck

42

What binds GpIIbIIIa?

Fibrinogen

43

Loud, harsh, high pitched holosystolic murmur that radiates over the precordium and a palpable thrill at the left sternal border?

VSD

44

Atypical cells in EBV infection?

T lymphocytes (Downey cells)

45

Increased urine concentrations of dermatan sulfate and heparan sulfate, no corneal deposits - what enzyme is deficient?

Iduronate sulfatase

46

What do protease inhibitors do in HIV treatment?

Prevent maturation of new viruses (prevent HIV1 protease which cleaves the polypeptide products of HIV mRNA into their functional parts)

47

What neurotransmitter is released in excess following ischemia and can initiate a receptor-mediated Ca2+ influx that leads to neuronal death?

Glutamate

48

When a movement is planned but not executed, which brain region shows an increase in activity in functional MRI?

Premotor cortex

49

What kind of vaccine do we have for Hepatitis B?

Recombinant protein

50

What cytokines do all T cells secrete?

IL-2 and IL-3

51

Shoulder injury typically leads to damage of which nerve?

Axillary

52

What is the normal response of the vestibular apparatus when you instill warm water into the ear?

Nystagmus with a quick phase to the ipsilateral side

53

Numbness over thenar eminence?

Median nerve

54

Atrophy of the interosseous muscles?

Ulnar nerve

55

Decreased strength during extension of the thumb?

Radial nerve

56

Decreased strength of opposition of the thumb?

Medial nerve

57

Loss of sensation to the skin covering the dorsum of the hand?

Radial or ulnar nerve

58

Loss of sensation to the skin of the little finger?

Ulnar nerve

59

Enlarged lateral ventricles - most likely cause?

Cerebral aqueduct stenosis

60

Where do we find Lewy bodies in Parkinson's?

Substantia nigra

61

HIV patient with 1 cm, irregularly shaped, raised, indurated lesion on the forehead - infection?

HHV-8

62

Increasing sample size does what to the confidence interval?

Decreases (makes it narrower)

63

Neutrophils stimulated with opsonized bacteria show decreased production of O2, H2O2, HOCl, OH. What's the enzyme deficiency?

NADPH oxidase

64

Which molecules must interact to induce immune cell activation by the superantigen toxic shock syndrome toxin-1?

Class II MHC and T cell receptor

65

How do the steroid hormones signal?

Transmembrane diffusion and binding of signaling molecule to transcription factor

66

Diarrhea leads to metabolic acidosis or alkalosis?

Acidosis (you lose bicarb in diarrhea)

67

What vitamins are required from the diet and function to protect tissues from deleterious effects of free radicals?

Vitamins A, C, and E are antioxidants

68

Gently tapping over the facial nerve in front of the ear results in reflex contraction of the facial muscles - electrolyte abnormality?

HYPOcalcemia (think muscle spasms - Chvostek's sign, diarrhea, tetany)

69

What is the mechanism of action of the azoles?

Inhibits synthesis of ergosterol (part of fungal cell membrane) by inhibiting C14 lanosterol demethylase

70

What agent inhibits both the production of IL-2 in resting T lymphocytes and the production of gamma-interferon in activated T lymphocytes?

Cyclosporine

71

What is the most appropriate next step in management after identifying a spontaneous pneumothorax?

Needle aspiration

72

Which aortic arch develops into the common carotid arteries?

3rd

73

What do you give to reverse the effects of tubocurarine?

Neostigmine (need ACh to overcome the nicotinic blockade)

74

ACE inhibitors produce systemic vasodilation by what mechanism?

Decreased degradation of bradykinin which is a vasodilator

75

What triad of signs and symptoms is most often present in a patient shortly after taking an overdose of heroin?

Coma, miosis, cyanosis

76

Why do symptoms from Meckel's diverticulum improve with H2 receptor antagonist therapy?

Meckel diverticulum may contain ectopic acid-secreting gastric mucosa

77

What enzyme is required for acyclovir to work?

Thymidine kinase

78

Compared with heparin, what is the advantage of enoxaparin?

Less monitoring required

79

What age-related anatomic changes contribute to well-maintained cardiac output (compensating for lowered HR) in elderly men?

Cardiac hypertrophy

80

5 day old newborn cyanotic since birth with soft systolic murmur and a decrease in pulmonary blood flow?

Tetralogy of Fallot

81

An increase in the serum concentration of which hormone is the most conclusive sign that ovulation has occurred?

Progesterone

82

During the differentiation of mammary gland alveolar cells in late pregnancy, the hormone that acts synergistically with estrogen is which of the following?

Human placental lactogen

83

Zinc finger motif on steroid hormone receptor binds specifically to what?

DNA

84

Why do we get thrombi in the heart in dilated cardiomyopathy?

Larger space --> turbulent flow

85

What is the cause of pain in MI?

Accumulation of metabolic products in heart tissue

86

How does arterial PO2 change with exercise?

It doesn't - expired minute ventilation and cardiac output are unchanged

87

How does removing the carotid bodies change the ventilatory response to decreasing levels of inspired oxygen?

Gets rid of that response

88

What hormone will be notably elevated when you transect the pituitary stalk?

Prolactin because there is no more inhibition by dopamine

89

What is the most likely complication of BPH?

Bacterial cystitis

90

If we do not treat gonococcal urethritis, what is the most likely complication?

Epididymitis

91

How do bisphosphonates work?

Inhibits osteoclasts via ingestion of it as a pyrophosphate analog

92

What are the nitrite negative UTI microbes?

Enterococci or staph saprophyticus

93

Why is there no vaccine for gonococcus?

High/rapid antigenic variation of pili

94

All paramyxoviruses contain what two proteins?

Hemagglutinin (allows RBC's to agglutinate) and F fusion protein (allows for formation of syncytia)

95

What do RNA viruses show on RPLF gels?

3 fragments

96

How does H. pylori lead to ulceration?

Elaboration of proteases and ureases with local tissue destruction

97

What antibody binds F fusion protein?

Pavilizumab

98

How can we kill C. diff spores?

Autoclave (steam at 121 C for 15 minutes)

99

When do we get rupture of the papillary muscle post MI?

3-7 days

100

When do we get rupture of the free wall post MI?

3-14 days

101

What causes the reaction in the skin after an injection?

Arthus reaction = type III HSR = immune complexes

102

Where do lower extremity lymphatics drain?

Lateral - popliteal, medial - inguinal

103

Where does the esophagus blood supply come from?

Upper - inferior thyroid artery, middle - aorta, lower - left gastric

104

Hereditary porphyrias have what inheritance pattern?

Autosomal dominant

105

How does vitamin A work as a pharm treatment (mechanism)?

Activation of nuclear gene transcription

106

What weight loss drug can cause steatorrhea and good changes in lipid studies?

Orlistat

107

Are case-control studies prospective, retrospective, or both?

Only retrospective

108

Collapse of the superior half of the right femoral head with preservation of the articular cartilage?

Aseptic necrosis

109

Hip adductor muscles insert onto the femur from where?

Ischium

110

What is the mechanism of cisplatin?

Causes crosslinking of DNA

111

Old man with fever and abdominal symptoms and contrast collects in the colon?

Diverticulitis

112

Patients with deficiency of myeloperoxidase are unable to produce?

Hydroxy-halide radicals (MPO produces HOCl from H2O2)

113

What is the function of ribosome peptidyl transferase?

Forms peptide (covalent) bonds between adjacent amino acids during translation of proteins

114

The amount of calcium sequestration in the sarcoplasmic reticulum is highest when there is a lot or a little stimulation of skeletal muscle?

Little

115

What is neuropathic pain described as?

Burning

116

What causes an increased A-a gradient?

May occur in hypoxemia - shunting, V/Q mismatch, fibrosis (usually something is messed up with the diffusion barrier)

117

Why can deoxygenated blood carry more carbon dioxide than oxygenated blood?

Deoxyhemoglobin is a better buffer of hydrogen ions than oxyhemoglobin

118

What does the first aortic arch give rise to?

Maxillary artery (branch of external carotid)

119

What does the second aortic arch give rise to?

Stapedial artery and hyoid artery

120

What does the third aortic arch give rise to?

Common carotid and proximal part of the internal carotid (C is the 3rd letter of the alphabet)

121

What does the fourth aortic arch give rise to?

On the left - aortic arch, on the right - proximal part of the right subclavian artery (4th arch = 4 limbs = systemic circulation)

122

What does the sixth aortic arch give rise to?

Proximal part of pulmonary arteries and (on the left only) ductus arteriosus

123

What general tissue do the clefts, arches, pouches give rise to?

CAP = ectoderm, mesoderm, endoderm

124

Which cleft develops into the external auditory meatus?

1st

125

What is the mnemonic for thinking about what the branchial arches give rise to?

When at the restaurant of the golden arches, children tend to first chew (1 - muscles of mastication, CN V2 and V3), then smile (2 - muscles of facial expression, CN VII), then swallow stylishly (3 - stylopharyngeus, CN IX), or simply swallow (4 - cricothyroid, CN X) and then speak (6 - recurrent laryngeal branch, CN X)

126

What is the mnemonic for what the branchial pouches give rise to?

Ear, tonsils, bottom-to-top
Ear (1 - endoderm lined structures of the ear), tonsils (2 - epithelial lining of palantine tonsil), bottom (dorsal 3 - inferior parathyroids), to (ventral 3 - thymus), top (superior parathyroids)

127

What is the mode of inheritance for cleft lip/palate?

Multifactorial

128

What is the drug of choice for postpartum hemorrhage?

Oxytocin

129

What is the difference in mepp vs. epp (end plate potential) and how are they affected in botulinum poisoning?

mepp is the excitation of each unit (i.e. vesicle) of ACh whereas epp is the summation of all the vesicles - so in botulinum poisoning, your mepp should be the same but your epp will be decreased

130

How does zanamivir work?

Inhibits the release of progeny influenza virus

131

How does IkB work?

Releases NFkB after undergoing phosphorylation

132

What are the abnormal lab values for osteoporosis?

NONE! - serum calcium, phosphate, ALP, PTH are all normal

133

Describe osteoblast vs. osteoclast activity with decreased DEXA bone scan.

Osteoclast increase, osteoblast decrease

134

Pain reproduced with resisted abduction of the shoulder when the shoulder is abducted 90 degrees and the arm is giving the thumbs down sign?

Supraspinatus (NOT deltoid)

135

Hypotension leads to increased or decreased carotid sinus baroreceptor activity?

Decreased (think about it as the opposite of the carotid massage)

136

Do cholinomimetics affect both muscarinic and nicotinic receptors?

No - only muscarinics

137

What happens to ATP during the first 10-20 seconds of muscle contraction?

Does not fall appreciably because ATP is quickly regenerated from creatine phosphate

138

What is the immediate treatment for cholinergic poisoning?

Atropine (NOT pralidoxime)

139

What can technetium 99m pertechnetate identify besides gastric tissue?

Thyroid, testes, RBCs (helps identify ectopic spleen tissue)

140

If someone stares off into space and does not respond to any questions, is that a simple or complex seizure?

Complex - loss of consciousness

141

What part of the superior temporal gyrus is Wernicke's area located on?

Posterior

142

Coarse facial features, clouded corneas, restricted joint movement, high plasma levels of lysosomal enzymes?

I cell disease - abnormal targeting of enzymes to lysosomes

143

What happens if you treat salmonella enterica with antibiotics?

Prolonged fecal excretion of the organism

144

What artery general supplies the posterior surface of the heart?

PDA from the right coronary (assuming individual has right dominant circulation)

145

What is lentigo maligna?

Melanoma in situ

146

What causes infertility in PCOS?

Increased estrogen (from adipose tissue) that inhibits FSH

147

What is additive for malignant hyperthermia when combined with inhaled anesthetics?

Succinylcholine

148

What is type I error?

You say there is a difference when there isn't one (alpha = you sAw a difference that did not exist)

149

What is type II error?

You didn't see a difference when there was one (beta = Blind to a difference that does exist)

150

What is power?

1 - beta

151

Lymphatic drainage - head and neck?

Cervical

152

Lymphatic drainage - lungs?

Hilar

153

Lymphatic drainage - trachea and esophagus?

Mediastinal

154

Lymphatic drainage - upper limb, breast, skin above umbilicus?

Axillary

155

Lymphatic drainage - liver, stomach, spleen, pancreas, upper duodenum?

Celiac

156

Lymphatic drainage - lower duodenum, jejunum, ileum, colon to splenic flexure?

Superior mesenteric

157

Lymphatic drainage - colon from splenic flexure to upper rectum?

Inferior mesenteric

158

Lymphatic drainage - lower rectum to anal canal (above pectinate line), bladder, vagina (middle third), prostate?

Internal iliac

159

Lymphatic drainage - testes, ovaries, kidneys, uterus?

Para-aortic

160

Lymphatic drainage - anal canal (below pectinate line), skin below umbilicus (except popliteal territory)?

Superficial inguinal

161

Lymphatic drainage - dorsolateral foot, posterior calf?

Popliteal

162

HLA types for MHC I?

A, B, C

163

HLA types for MHC II?

DR, DP, DQ

164

HLA type associated with hemochromatosis?

A3

165

HLA type associated with psoriatic arthritis, ankylosing spondylitis, inflammatory bowel disease, reactive arthritis?

B27

166

HLA type associated with celiac disease?

DQ2/DQ8

167

HLA type associated with multiple sclerosis, hay fever, SLE, Goodpasture syndrome?

DR2

168

HLA type associated with DM1, SLE, Graves?

DR3

169

HLA type associated with rheumatoid arthritis, DM1?

DR4

170

HLA type associated with pernicious anemia, hashimoto thyroiditis?

DR5

171

Th1 cells secrete what cytokine?

IFN-gamma

172

Th2 cells secrete what cytokines?

IL-4, IL-5, IL-6, IL-13

173

What inhibits the Th1 response?

IL-4 and IL-10 (from the Th2 cell)

174

What inhibits the Th2 response?

IFN-gamma (from the Th1 cell)

175

What cytokines do T-regs produce?

IL-10 and TGF-beta to downregulate the immune response

176

What receptor-ligand interaction is necessary for class switching?

CD40-CD40L (this is defective in Hyper IgM)

177

What are the cytokines for acute inflammation?

IL-6, IL-1, TNF-alpha, IFN-gamma

178

What are the anaphylotoxins?

C3a, C4a, C5a

179

What are the cytokines that are secreted by the macrophages?

Acute inflammation: IL-1, IL-6, TNF-alpha
Chemotactic for neutrophils: IL-8
Th1 response: IL-12

180

What cells have CD16 and CD56?

NK cells

181

What cells have CD28?

T cells (binds to B7 on APC)

182

When do we give passive immunity (preformed antibodies)?

To Be Healed Rapidly: Tetanus toxin, Botulinum toxin, HBV, Rabies

183

What are the killed virus vaccines?

RIP Always: Rabies, Influenza (injected), Polio (Salk), HAV

184

What are the live attenuated virus vaccines?

Smallpox, yellow fever, chickenpox, MMR, Sabin polio, influenza (intranasal)

185

What are the recombinant viral vaccines?

HBV (HBsAg), HPV (types 6, 11, 16, 18)

186

Anti-cardiolipin, lupus anticoagulant?

SLE, antiphospholipid syndrome

187

Anticentromere ab?

CREST (limited scleroderma)

188

Antidesmoglein ab?

Pemphigus vulgaris

189

What are the definitive ab for SLE?

Anti-dsDNA and anti-Smith

190

Anti-glutamate decarboxylase ab?

DM1

191

Anti-hemidesmosome ab?

Bullous pemphigoid

192

Antihistone ab?

Drug-induced lupus

193

Anti-Jo1, SRP, Mi-2 ab?

Polymyositis, dermatomyositis

194

Antimicrosomal, antithyroglobulin ab?

Hashimoto thyroiditis

195

Antimitochondrial ab?

Primary biliary cirrhosis

196

Anti-Scl-70 (anti-DNA topoisomerase I) ab?

Scleroderma (diffuse)

197

Anti-smooth muscle ab?

Autoimmune hepatitis

198

Anti-SSA, SSB (Ro, La) ab?

Sjogren

199

Anti-TSH ab?

Graves

200

IgA antiendomysial, IgA anti-tissue transglutaminase ab?

Celiac

201

c-ANCA (PR3-ANCA)?

Wegener's (granulomatosis with polyangiitis)

202

p-ANCA (MPO-ANCA)?

Microscopic polyangiitis, Churg-Strauss syndrome

203

Anti-CCP ab (cyclic citrullinated peptide)?

Rheumatoid arthritis