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Caleb's Step 1 > March 16 > Flashcards

March 16 Flashcards

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1
Q

Thiamine B1

A

Function
carbohydrate metabolism
decarboxylation of alpha-keto acids
pyruvate dehydrogenase cofactor

Deficiency:
Dry beriberi - polyneuritis and symmetrical muscle wasting
Wet beriberi - dilated cardiomyopathy, edema
Wernicke-Korsakoff Syndrome - confusion, ophthalmoplegia, ataxia, memory loss (permanent)
damage to mammillary bodies and medial dorsal nucleus of thalamus

tx: glucose AND thiamine

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2
Q

Riboflavin B2

A

Function
FAD

Deficiency
angular cheilosis, stomatitis, glossitis, corneal vascularization
normocytic anemia

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3
Q

Niacin B3

A

Function
NAD/NADP
tx: dyslipidemia (decrease VLDL, increase HDL)
side fx: flushing

Deficiency = Pellagra
dermatitis, dementia, diarrhea, peripheral neuropathy

Tryptophan can be used to synthesize Niacin B3 if not available in diet

Hartnup Disease - autosomal recessive, inability to absorb/resorb neutral amino acids –> tryptophan deficiency and Pellagra

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4
Q

Pyridoxine B6

A

Function
synthesis of heme, niacin, histamine, 5-HT, Epi, NE, DA, GABA

Deficiency
cheilosis, stomatitis, glossitis
convulsions, peripheral neuropathy
sideroblastic anemia due to impaired heme synth

must supplement with INH therapy

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5
Q

Folate B9

A

Function
DNA and RNA synthesis

Deficiency
macrocytic megaloblastic anemia
increased homocysteine
normal methylmalonic acid

acquired due to phenytoin, sulfonamides, methotrexate

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6
Q

Cobalamin B12

A

Function
cofactor for methionine synthase

Deficiency
macrocytic megaloblastic
degeneration of dorsal cloumn, lateral corticospinal, and spinocerebellar tract

increased homocysteine and increased methylmalonic acid

absorbed in the terminal ileum

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7
Q

Ascorbic Acid Vitamin C

A

Function
hydryoxylation of proline and lysine for proper collagen synthesis

Deficiency = Scurvy
petechial hemorrhage, gingival swelling, impaired wound healing, weak immune system

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8
Q

Aschoff Body

A

aka Interstitial Myocardial Granuloma

lymphocytes, macrophages, multinucleated giant cells

Acute Rheumatic Fever related myocarditis post untreated Group A Strep infection

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9
Q

Embryonic Defect: Agenesis

A

Complete absence of an organ

ex. renal agenesis

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10
Q

Embryonic Defect: Association

A

Multiple anomalies with an unknown unifying cause

ex. VACTERL

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11
Q

Embryonic Defect: Deformation

A

Structural abnormality due to extrinsic mechanical force

ex. adhesions causing finger malformations

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12
Q

Embryonic Defect: Dysplasia

A

Abnormal organization/cellular architecture in a tissue

ex. Osteogenesis Imperfecta

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13
Q

Embryonic Defect: Field Defect

A

Initial disturbance causes multiple malformations

ex. holoprosencephaly

can be genetic like DiGeorge or environmental like Accutane - isoretinoic acid

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14
Q

Alpha-1 antitrypsin deficiency

A

Autosomal Dominant

Z-allele - decreased secretion of alpha-1 antitrypsin due to abnormal protein folding

Affects LIVER and LUNGS

Lungs - panacinar emphysema due to unopposed destruction of alveolar walls

Liver - intrahepatocyte accumulation of polymerized misfolded AAT - stain red/pink with acid-Schiff

Pt with wheezing and poor air movement with increase AST and ALT

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15
Q

Midshaft Humerus Fracture

A

Damage:
Deep Brachial Artery
Radial Nerve –> wrist drop = inability to extend forearm (triceps) + cutaneous sensory of dorsal hand, forearm, upper arm

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16
Q

Chronic Granulomatous Disease

A

NADPH oxidase mutation

Dihydrorhodamine flow cytometry test - decreased fluorescence

Nitroblue tetrazolium test - does NOT turn blue

recurrent infection with catalase positive organisms

Candida
Aspergillus
T (no)
Aureus (Staph)
Listeria 
Aeruginosa (Pseudomonas)
Serratia
E. coli
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17
Q

Myeloperoxidase

A

blue-green heme-containing pigment that gives sputum its color

generates HCLO’ from H2O2 +Cl-

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18
Q

3’ end of tRNA

A

CCA

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19
Q

HbF

A

Fetal Hemoglobin

2 alpha
2 gamma

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20
Q

Canagliflozin

Dapagliflozin

A

SGLT2 inhibitors (Sodium GLucose coTransporter 2)

block Glucose/Na resorption from the lumen of the proximal tubule - increase glucose loss in urine

Contraindicated in patients with moderate-to-severe renal impairment

Check BUN and Cr first!

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21
Q

Short Acting Benzodiazepines

A

Half life <6hr

Triazolam, oxazepam, midazolam

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22
Q

Intermediate Benzos

A

Half life 6-24hr

Alprazolam, lorazepam, temazepam

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23
Q

Long Acting Benzos

A

Half life >24hr

Diazepam, Flurazepam, chlordiazepoxide

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24
Q

Urine Electrolytes in DKA pt

A

Urinary Acid Secretion accomplished by
free H+
(NH3 + H+) = NH4+
(PO4– +2H+) = H2PO4

decreased pH
decreased HCO3- (increased bicarb resorption) 
increased H
increased H2PO4
increased NH4+
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25
Metastasis of Prostate Cancer
via prostatic venous plexus --> vertebral venous plexus
26
Most common benign tumor of the breast
Fibroadenoma well demarcated
27
Most important steps for preventing central venous catheter infections
hand hygiene full barrier precautions chlorhexidine skin disinfection removal of catheter when it is no longer needed femoral vein has higher rate of infection
28
Hepatitis D
dependent on HBV because it needs its viral particles
29
Colonic Adenoma --> Carcinoma
COCKED AK 53 APC COX-2 KRAS p53
30
Effect of Nitrates
Venodilators Decreased: Left ventricular end-diastolic pressure Decreased: systemic vascular resistance Increased: Peripheral venous capacitance
31
Portal Triad Contents
Common Bile Duct Hepatic Artery Hepatic Portal Vein
32
Tetanus route
Wound --> Motor neuron axon --> spinal cord
33
Phenylephrine
alpha1-agonist increases peripheral vascular resistance and systolic blood pressure this causes reflex bradycardia and decreased pulse pressure
34
Homocystinuria
Autosomal Recessive deficiency of Cystathionine beta-synthase (required pyridoxine B6 cofactor) dislocated lens (3-10years old) intellectual disability marfanoid habitus thromboemoblic occlusion restrict methionine
35
Warfarin-induced skin necrosis
Occurs in individuals with underlying Protein C Deficiency Protein S Deficiency shortly after starting warfarin tx: fresh frozen plasma
36
Angiotensin II Receptor Blocker
-sartans ``` increased renin increased AngI increased AngII decreased Aldo no change in bradykinin ```
37
Less addicting sleep aid?
Zolpidem
38
alpha-1 adrenergic
Organ - Effect Peripheral vasculature - vasoconstriction - increase BP (systolic) Bladder - contraction internal urinary sphincter Eye - mydriasis (constriction of pupillary dilator) Drugs: phenylephrine, epinephrine, norepinephrine
39
beta-1 adrenergic
Increase heart rate, contractility, conductance Drugs: epinephrine, Dobutamine, Dopamine, Isoproterenol
40
beta-2 adrenergic
peripheral vasculature - vasodilation - decrease BP (diastolic) bronchodilation isoproterenol, terbutaline
41
Isoproterenol
beta-1 = increase cardiac contractility beta-2 = decrease vascular resistance
42
Clonidine
alpha-2 = decreased sympathetic outflow @ CNS = decrease is peripheral vascular resistance, decrease heart rate, decrease blood pressure
43
Hepatic Processing of Bilirubin
1) carrier mediated uptake at hepatic sinusoids 2) conjugation with glucuronic acid by UGT (uridine diphosphate-glucuronyltransferase) 3) biliary excretion of water-soluble, nontoxic bilirubin glucuronides
44
Conjugated Bilirubin
"Direct Bili" water soluble loosely bound to albumin excreted in the urine
45
Unconjugated Bilirubin
"Indirect Bili" highly unsoluble in water tightly bound to albumin toxic deposits in tissues (brain!)
46
Crigler-Najjar
Autosome Recessive lack of UGT enzyme - responsible for conjugating bilirubin increased levels of circulating toxic unconjugated bilirubin deposition in the brain causses kernicterus - potentially fatal kernicterus - muscle rigidity, lethargy, seizures
47
t(14:18)
Follicular Lymphoma (b-cells) 18 = overexpression of Bcl-2 which is anti-apoptotic 14 = heavy-chain Ig painless waxing/waning LAD in adults
48
t(8:14)
Burkitt lymphoma 8=c-myc 14= heavy chain Ig associated with EBV Jaw lesion in endemic form in Africa pelvic or abdominal mass in sporadic form 'starry sky' appearace = sheets of lymphocytes
49
p53
tumor suppressor gene - decreased activity in cancers and tumors
50
Immunity to tetanus toxin
circulating antibodies that neutralize it :) immunization with toxoid
51
Gaucher Disease
Autosomal Recessive lysosomal storage disorder common in Jews beta-glucocerebrosidase deficiency bone pain, easy bruising and bleeding, pallor and fatigue, hepatosplenomegaly anemia/thrombocytopenia/leukopenia/pancytopenia lipid laden macs = crumpled tissue paper
52
Lympatic Drainage of Lower Limb
Lateral track --> popliteal and deep inguinal/superolateral LN medial track --> superficial/superomedial inguinal
53
Lymphatic Drainage: Prostate
internal iliac LN
54
Lymphatic Drainage: Scrotum
superficial inguinal LN
55
Lymphatic Drainage: Testes
para-aortic LN
56
Promoter Region
bind RNA Pol II and Transcription Factors directyl TATA @-25bp CAAT @ -70-80bp
57
Enhancer Region
Bind activator proteins, facilitates interaction with promoter region --> increased rate of transcription can be up or down stream of gene within intron or on separate chromosome
58
Familial erythrocytosis
reduced binding of 2,3-BPG at beta-globin increased hemoglobin oxygen affinity - left shift gamma-globin of fetal hemoglobin also has decreased binding of 2,3-BPG --> increased O2 affinity
59
Sarcoidosis
elevated serum calcium elevated serum ACE noncaseating granulomas bilateral hilar adenopathy in pulmonary - increased CD4+
60
Most likely side effect of SSRIs
sexual dysfunction - decreased libido, decreased arousal, anorgasmia depression, anxiety disorder, bulemia, panic disorder, PTSD, OCD,
61
Minimal Change Disease
increased selective filtration of proteins podocyte foot process fusion --> loss of negative charge --> loss of albumin in the urine aka selective albuminuria symp: facial puffiness/edema most common NEPHROTIC dz in children
62
Hemolytic Uremic Syndrome
post bloody diarrhea from EHEC (releases shiga-like toxin) or Shigella infection acute renal failure anemia, thrombocytopenia smear: schistocytes normal coag studies
63
Shiga Toxin Shiga-Like Toxin
Shiga from Shigella Shiga-like from EHC inactivate 60S ribosome precedes hemolytic uremic syndrome
64
Ovarian Torsion
sudden-onset unilateral pelvic pain +/- nausea, vomiting, fever most commonly due to ovarian mass (cyst/neoplasm) which causes ovary to twist infundibulopelvic ligament aka suspensory ligament of the ovary carries ovarian N. A. V. - becomes occluded in torsion
65
Complication of Left Atrial Enlargement + Atrial Fibrillation
thromboembolism, clot develops in Left Atrial Appendage (little cul-de-sac) cause stroke.
66
Trochlear Nerve (CN IV) Palsy
vertical diplopia - most noticable when looking down towards nose ex. up close reading and walking down stairs (but not a problem when looking up) superior oblique muscle - causes eye to internally rotate and depress patients may compensate by tucking in chin and tilting head away from affected eye
67
Actinomyces israelii
Gram + anaerobic branching filamentous not acid fast bacteria forms yellow 'sulfur granules' oral/facial abscesses tx: Penicillin
68
Mallory-Weiss Tear
Esophageal tear caused by high intra-gastric pressure (vomiting) may be seen with Metabolic Alkalosis due to loss of H+ during emesis
69
Cells with Neural Crest Origins
``` Melanocytes Odontoblasts Tracheal cartilage Enterochromaffin cells Laryngeal cartilage ``` Parafollicular C cells Adrenal Medulla (Chromaffin cells) Schwann Cells Spiral Membrane
70
Marker of Osteoblast Activity?
bone-specific alkaline phosphatase
71
Haemophilus influenzae type b (Hib) infections
meningitis* #1 pneumonia epiglottitis sepsis virulence factor: PRP capsule - acilitates invasion PRP = polyribosyl ribitol phosphate
72
Hib Vaccine
cell wall polysacchride conjugated with protein toxoid from diphtheria or tetanus given at 2 months decreases meningitis (also pneumonia, bacteremia, epiglottitis)
73
Thionamides
Methimazole and Propylthiouracil inhibit thyroid peroxidase - impairs iodine organification Methimazole - teratogenic PTU - decreased peripheral conversion of T4 --> T3 can cause agranulocytosis - pts taking these meds with signs of infection need WBC count with differential!
74
Congenital Hydrocephalus Symptoms
macrocephaly bulging fontanelle poor feeding UMN lesion: muscle hypertonicity. spasticity, hypereflexia developmental delay seizures
75
Wolff-Parkinson-White Syndrome
accessory AV conduction pathway recurrent supraventricular tachycardia in an otherwise healthy individual ``` shortened PR delta wave at the start of QRS widened QRS (not using His Purkinje system) ```
76
Acetazolamide
Proximal Convoluted Tubule Diuretic inhibits carbonic anhydrase --> blocks NaHCO3 (and water) resorption --> decrease in total body HCO3- and alkaline urine decrease aqueous humor synthesis via inhibition of carbonic anhydrase tx: glaucoma, altitude sickness, metabolic alkalosis (more HCO3- in the pee) ACIDazolamide causes ACIDosis
77
Antiretroviral Protease Inhibitors
-NAVIR (darunavir, ritonavir, lopinavir) ARDs: hyperglycemia, CYP450 inhibition, buffalo hump fat deposition
78
Anesthetic with high peripheral tissue uptake
large arteriovenous gradient (lungs --> arterial circulation --> uptake by tissues --> venous circulation) this means that it has high tissue solubility and will have a SLOWER onset of action low peripheral tissue uptake = low tissue solubility = fast onset
79
Minimal Alveolar Concentration (MAC)
Defines POTENCY of an anesthetic high potency = low MAC Mac = alveolar concentration required to sedate 50% of general population
80
Migratory thrombophlebitis
aka Trousseau Syndrome indicative of visceral cancers - esp adenocarcinoma of pancreas, colon, and lung hypercoagulability due to visceral cancer
81
Orthopnea
LEFT-sided heart failure
82
Acyclovir
guanosine analog that is activated by virally-encoded thymidine kinase treats: HSV-1, HSV-2, VZV Ineffective: EBV, CMV
83
Physiologic Changes associated with Exercise
Increased HR Increased SV Increased CO vasodilation in active skeletal muscles Decreased systemic vascular resistance (^)

Caleb's Step 1 (16 decks)

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