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1

Laplace's Law

P=2T/r

2

Uptake of unconjugated bililrubin occurs via

Organic Anion Transporting Polypeptide (OATP) - passive

3

Conjugated bilirubin is secreted from hepatocytes via __? This is blocked in __?

MRP2 (active organic anion transporter) - Criggler-Najjar, Rotor

4

Concentration of Bicarb along Proximal Tubule

Actively reabsorbed due to Carbonic Anhydrase --> Acetazolamide causes excretion

5

How to differentiate MAC from MTB in HIV patient

MAC has anemia, HSM, incr ALP/LAD due to widespread involvement of RES; Also grows well at 41degC

6

Prophylaxis and treatment of MAC

Proph with Azithromycin; Tx with Azith + Ethambutol or Rifampin

7

Absence of ganglion cells in colonic wall causes

affected segment to narrow (can't relax)

8

Which parts of GI tract are always involved in Hirschprung

Since NCC's migrate caudally, rectum always involved

9

How does metabolism of drug relate to drug-induced lupus?

Slow acetylators more likely (hydralazine, procainamide)

10

Most liver hydrolysis involve what enzymes

Amidase, Esterase

11

When is Exenatide used?

(GLP-1) Suboptimal glucose control in patients already on Metformin and Sulfonylureas

12

Ventricular response to AF is dependent on

Transmission through AV node

13

What types of viral genomic material can be individually infective?

Positive Linear ssRNA

14

Interstitial pneumonia in transplant patient

CMV

15

Treatment of C. diphtheria

Antitoxin --> Penicillin or Erythromycin --> DPT vaccine

16

Most common cause of death from C diph

Cardiomyopathy

17

Features of Cutaneous Neurofibromas

Rubbery, Buttonholing

18

Features of Wiskott-Aldrich

Thrombocytopenic Purpura, Eczema, Recurrent infections

19

Acute Narrow Angle Glaucoma is often precipitated by

Anticholinergics --> Anterior chamber narrows, obstructing trabecular meshwork

20

Confirmatory test for calculus cholecystitis

HIDA scan (not ultrasound)

21

Stool osmotic gap? What increase?

Colonic fermentation products --> Increased when poorly absorbable substances present (lactose)

22

Nonpolar Aliphatic Hydrophobic AA

VIP GAL - Valine, Isoleucine, Proline, Glycine, Alanine, Leucine

23

Aromatic Hydrophobic AA

Try Trippin w/ Phenytoin - Tyrosine, Tryptophan, Phenilalanine

24

Basic/Positive AA's

Shallow HAL is positive - Hystidine, Arginine, Lysine

25

Acidic/Negative AA's

Glutamate, Aspartate

26

Hydrophilic uncharged AA's

Come, Take My GAS! - Cysteine, Threonine, Methionine, Glutamine, Asparaine, Serine

27

When is Arginine essential?

During + nitrogen balance

28

Non-lactose fermenting, Oxidase negative organism in Sickle Cell Osteomyelitis

Salmonella

29

Oxidase Positive bugs

Vibrio, Pseudomonas, Campylobacter, Helicobacter, Neisseria, Moraxella, Legionella

30

Main virulence factor of S aureus in osteomyelitis

Adhesion to collagen

31

Apo E4 predisposes to

Late-onset familial Alzheimer's

32

Hypertrophic CM trait

AD - Beta myosin heavy chain

33

MOA and use of Dezrazoxane

Iron chelating agent to prevent cardiotoxicity from Anthracyclines

34

Location of 5-HT3 receptors implicated in chemo n/v

Peripherally in presynaptic nerve terminals of vagus in GI, Centrally in CTZ and Solitary nucleus/tract

35

Loop diuretics stimulate release of

Prostaglandins --> incr renal BF

36

Most common benign tumor of breast

Fibroadenoma (<35, often bilateral, cyclinc)

37

Fibroadenoma histology

Cellular, often myxoid stroma that encircles and sometimes compresses epithelium-lined glandular and cystic spaces

38

Function of vWF

Platelet adhesion by crosslining GpIb with exposed collagen underneath damaged endothelium

39

Secondary role of vWF

Carrier protein for factor VIII

40

Proteins C and S act to inactivate

V and VIII

41

Thrombin is produced from Prothrombin by

Activated Factor X

42

Growth Hormone binds to a __ receptor

JAK-STAT

43

Lecithin-Sphingomyeline Ratio is a marker for

Lung maturity (>1.9 = mature)

44

Mechanism of methicillin resistance

Alterations in PBP2a (also affects cephalosporins)

45

Immunity to reinfection by influenza is mediated by

Circulating antibodies against Hemagluttinin

46

Tumor originating from collecting duct cells

Renal Oncocytoma

47

Transitional cell tumors of pelvis are often what morphology

Papillary

48

Niacin-induced flushing is mediated by

Prostaglandins

49

___ reduces pain by decreasing level of substance p in PNS

Capsaicin

50

Clinical uses of Valproate

Anticonvulsant (absence, myoclonic, grand mal) AND mood stabilizer (acute mania, bipolar)

51

Anticonvulsants used as mood stabilizers in bipolar

Valproate, Carbamazepine, Lamotrigene

52

Carbamazepine indications

Trigeminal Neuralgia, Manic episodes, Partial and generalized seizures

53

MOA and use of Olanzapine

second gen antipsychotic

54

QT interval reflects

Myocyte AP duration

55

Two congenital syndromes that cause QT prolongation

1. Jervell Lange-Nielson (AR, neurosensory deafness); 2. Romano-Ward (AD, no deafness)

56

Mutations affecting cardiac cell cytoskeletal proteins or mitochondrial enzymes of ox phos are though to cause

Genetic Dilated CM's

57

Mutations of calcium-binding SR protein might underly

Arrhythmogenic RV Cardiomyopathy --> Progressive fibrofatty replacement of RV

58

Extramedullary hematopoesis is most frequently associated with

Chronic Hemolytic Anemias (eg beta thal)

59

Pentazocine

Opioid narcotic designed to produce analgesia with little to no abuse potential (weak antagonist at mu)

60

Short-acting benzos

ATOM - Alprazolam, Triazolam, Oxazepam, Midazolam

61

Long-acting benzos

Choose Carefully Due to Falls - Chlordiazepoxide, Chlorazepate, Diazepam, Flurazpam

62

Malabsorption, Diarrhea, PAS-positive granules in intestinal macrophages

WHIPPLES DISEASE - Tropheryma whippelii

63

Recurrent infections with Strep pneumo, H flu, and Moraxella indicate

Humoral immunodeficiency

64

Pneumocystis and chronic mucocutaneous candidiasis indicate

T cell deficiency

65

Immotile cilia syndrome presents in newborn period with

Respiratory distress --> Recurrent Otitis Media, Bronchitis, Sinusitis (opprotunistic infections like PCP unusual)

66

Agammaglobulinemia means susceptible to

Extracellular, encapsulated bacteria

67

Exchange of viral dna in coinfection by non-segmented viruses

Recombination

68

Viral phenotypic mixing

Coinfection leads to one virus with nucleocapsid protein from another

69

AE's of TZD's

Weight gain, edema, CHF

70

Damage to the Caudate is associated with

Transient hemiparesis and frontal lobe symptoms such as inattentiveness, abulia, forgetfulness

71

Compression fracture in elderly woman --> Calcium and PTH?

Normal

72

Driver of respiratory function in COPD vs normal

pO2 in COPD vs pCO2 normally --> Supplementary O2 in COPD will lead to respiratory suppression and coma

73

Main toxin of C perf

Lecithinase (phopholipase C, alpha toxin)

74

Insular cortex is associated with

Integrating body states w/ emotions (limbic); ANS control; Conscious experience of visceral sensations

75

Damage to internal vs external Globus Pallidus

Internal --> Excessive movement; External --> Decreased

76

Role of D arm of tRNA

Dihydrouracil residues --> Helps facilitate correct tRNA recognition by proper Aminoacyl tRNA synthetase

77

Role of T arm of tRNA

Binding tRNA to ribosomes

78

Only RNA that contains thymidine

T RNA

79

NE to Epinephrine requires

SAM - PNMT enzyme

80

BH4 is required for synthesis of

Tyrosine, DOPA, Serotonin, Prolactin

81

Winter's Formula

PaCO2 = (1.5*HCO3) + 8 +/- 2

82

Media for growing V cholerae

Alkaline - extremely acid sensitive organism

83

Mechanism of hepatocyte damage in Hep B

CD8 response to viral antigens on cell surface

84

Regulatory HIV genes required for replication

Tat, Rev

85

Structural HIV genes

Gag, Pol, Env

86

Products of Gag, Pol, Env genes in HIV

Gag - p24, p7; Pol - RT, Integrase, Protease; Env - gp120, gp41

87

Function of HIV nef gene? Rev? Tat?

Nef - Downregulate CD4 and MHC 1; Rev - Transport of unspliced viral transcripts out of nucleus; Tat - Protein that transcriptionally activates other viral genes

88

Features of Colitis-associated CRC vs sporadic

(1) younger; (2) Flat or non-polypoid dysplastic precursor; (3) Mucinous and/or signet ring morphology; (4) early p53 and late APC - opposite of sporadic; (5) proximal colon; (6) Multifocal

89

MOA of Varenicline

Partial agonist at nicotinic ACh receptor

90

Pentamidine is used for

Prophylaxis and tx of PCP

91

Nifurtimox is used for

Chagas treatment

92

Normal alveolar pO2

104 mmHg (if higher, poor perfusion)

93

When is O2 equilibration diffusion-limited

Emphysema, Fibrosis, Very high blood flow (ie exercise)

94

A, I, and H bands

A is thick myofilament, I is Actin only, H is Myosin only

95

Pharmacodynamic Drug Antagonism

Drug can antagonize or prevent effect of another drug or endogenous substance

96

Pharmacokinetic drug interaction

eg CYP inducers

97

Treatment of recurrent C diff colitis

Fidaxomicin

98

MOA of Fidaxomicin

Inhibits sigma subunit of RNA polymerase; Less effect on normal flora; Poor oral

99

Most common cystic fibrosis mutation and result

dF508 --> Impaired post-translational processing and results in proteasome degradation

100

AA's with three titratable protons

Acidics, Basics, CT = Glutamate, Aspartate, Histidine, Arginine, Lysine, Cysteine, Tyrosine

101

Salicylate acid base disorder

(1) Rapid respiratory depression causing alkalosis; (2) A few hours later metabolic acidosis

102

Effect of ANP on kidney, Adrenals, BVs

Dilates afferent arterioles, Inhbitis Na reabsorption, Restrict aldosterone secretion, cGMP-mediated veno- and arteriodilation

103

Type of MI usually associated with Bradycardia

Inferior - SA/AV nodal branch block

104

ANS drug that can cause Glaucoma

Atropine --> Midriasis --> Narrowing of anterior chamber

105

Anti-mitochondrial Ab's

Primary biliary cirrhosis

106

Anti-Smith Ab's

Anti-snRNP = Specific for SLE

107

Rapid atrophy and shrinkage of liver on autopsy

Halone-induced liver failure

108

Shortest half life pro-coagulant factor

Factor VII (PT)

109

What enzyme produces urea in Urea cycle

Arginase (Arginine --> Urea + Ornithine)

110

Excessive amounts of Orotic acid are usually found in

OTC deficiency, Citrullinemia, Arginosuccinate aciduria

111

Low levels of C1 esterase inhibitor

Hereditary Angioedema

112

Mechanisms of C1 esterase inhibitor

Inhibit C1 --> Activated C1; Inactivates Kallikrein (which converts Kininogen to Bradykinin)

113

16S rRNA function

Component of 30S subunit --> Expresses sequence complementary to Shine-Dalgarno in all prokaryotic mRNA

114

23S rRNA function

Peptidyltransferase - Peptide bond formation

115

Pontiac Fever

Legionella --> Acute, flu-like, self-limited disease

116

Features of Legionnaire's Disease

Recent expsoure to contaminated water, Pneumonia, High Fever; Sometimes GI, Relative bradycardia, neurologic

117

Most common lab finding in Legionnaire's

Hyponatremia

118

Bilateral ACA occlusion

LE motor, Behavioral (abulia), Urinary incontinence

119

Spread of H flu vs N meningitidis to meninges

H flu uses lymphatics, N men is hematogenous, Both from Pharynx

120

MOA of Organophosphates

AChE inhibitors

121

Bromoacetylcholine MOA

Inhibits Choline Acetyltransferase

122

Nicotininc receptor antagonists

Pancuronium, Tubocurarine

123

Hemicholinium MOA

Choline import into presynaptic terminal

124

Train of Four seen in Non-depolarizing blockade

eg Tubocurarine - Slanted within group, Group increases each 4

125

Train of Four seen in Depolarizing blockade

Equal within group, Group increases each four (phase 1) --> Resembles slanting of non-depolarizing in phase 2

126

Neostigimine in Phase 1 vs 2 of Succinylcholine NMB

Augments blockade in Phase 1, Reverses it in Phase 2

127

Duration of Succinylcholine action depends on

Diffusion out of NMJ and metabolism by plasma cholinesterase

128

Nitrate with best bioavailability

Isosobide Mononitrate

129

Hep B Window Period

Time lag betwee HBsAg disappearing and Anti-HBs appearing

130

Most specific marker for diagnosis fo acute Hep B

Anti-HBc IgM --> Present in window period

131

Vitamin E deficiency manifestations

Neuromuscular disease (myopathy, ataxia, pigmented retinopathy, dorsal column) and Hemolytic anemia

132

Vitamin E primarily serves to

Protect fatty acids from oxidation --> Neurons and erythrocytes most susceptible

133

Vitamin C excess

Nausea, Abdominal pain, Diarrhea, Stones

134

Physostigmine vs Neostigmine and Edrophonium

Neostigimine and Edrophonium are Quaternary Amines and can't cross BBB

135

Tarry stool and fatigue are seen with what CT agents

Alkylating agents (upper GI bleed)

136

Abdominal pain and jaundice may be seen with what CT agent

Mercaptopurine (cholestasis and hepatitis)

137

Flagellate skin discoloration is seen with what CT agent

Bleomycin (along with pulmonary fibrosis)

138

Nitroblue Tetrazolium testing

Properly functioning PMNs produce ROS that reduce yellow NBT to dark blue formazan that precipitates within the cells

139

DHR flow testing

NADPH oxidase shows decr fluorescence

140

NBT and DHR testing in MPO deficiency

Normal

141

Pyruvate kinase deficiency is a common cause of

Chronic Hemolytic Anemia

142

Ortner Syndrome

Mitral Stenosis --> LA enlargement --> Impingement on Recurrent Laryngeal N

143

Location of Glut-2

Regulation of Insulin Release --> Hepatocytes, Beta cells, Renal tubular cells, Small intestine

144

Location of Glut-3

Placenta, Neurons

145

What is commonly found regarding uterus on vaginal vaginal examination in Endometriosis

Nodularity of uterosacral ligaments, Fixed retroversion of uterus

146

Ectopic endometrial tissue secretes

PG's --> Interfere with ovulation and tubal function --> Infertility

147

Adenomyosis

Presence of endometrial glands w/in uterin myometrium (presents with bleeding, painful menses, and enlarged uterus unlike endometriosis)

148

When to give Ribavirin with RSV?

Confirmed, severe RSV at risk for dz progression (immunodeficiency, prematurity, cardiopulmonary disease)

149

Mechanism of Shiga-like toxin

AB - A subunit prevents binding of tRNA to 60S ribosomal subunit

150

Bactrim is drug of choice for

Pneumocystis jiro, Toxoplasma, Nocardia

151

Hyoscyamine

Anti-muscarinic to counteract AChEi in Myasthenia Gravis

152

Side effects of Thiazide Diuretics

Hyper Glycemia Lipidemia Uricemia Calcemia

153

Medication-induced fat redistribution

Corticosteroids, HAART (Protease inhibitors)

154

Chronic Eosinophilic Bronchitis in asthmatics involves

Bronchial wall infiltration by numerous activated eosinophils in response to IL-5 by allergen-activated TH2 cells

155

Class 3 Anti-arrhythmics

Amiodarone, Ibutilide, Dofetilide, Sotalol

156

Which vitamin supplement should be given to child with Measles

Vitamin A - Reduces time to recovery from pneumonia and diarrhea, as well as risk of death

157

Which HIV drug to give to pregnant women

Zidovudine

158

Protein secondary structure is due to

Hydrogen bonds (Tertiary due to ionic bonds, hydrophobic interactions, hydrogen bonds, and disulfide bonds)

159

E coli aquired ability to form pili via

Conjugation

160

Strep pneumo aquired capsule via

Transformation

161

Function of Thyroid Peroxidase

Oxidize inorganic iodide to organic iodine; Formation of monoiodotyrosine and diiodotyrosin; Coupling of these to iodotyrosines

162

Lab studies in HUS

Only bleeding time elevated

163

Bacitracin MOA

Prevents mucopeptide transfer into growing cell wall

164

Trimpethroprin, Methotrexate, and __ inhibit DHFR

Pyrimethamine

165

Important Bactrim AE's

Hyperkalemia, Megaloblastic Anemia

166

Serotonin Syndrome effects

HARM - Hyperthermia, ANS instability, Rigidity, Myoclonus

167

Drugs that precipitate Serotonin Syndrome

TTYL - Tramadol, Triptans, trYcyclics, Linezolid

168

Features of Myotonic Dystrophy

Frontal balding, Gonadal atrophy, Arrhythmia (My toupe, my testicles, my ticker); sustained grip, type 1 fiber loss

169

Most important signalers in Coronary autoregulation

Adenosine, NO

170

What causes NO release in coronaries

Pulsatile stretch, Flow shear stress

171

What subtype not stimulated by NE

Beta 2

172

Skeletal Muscle Depolarization -->

L-type channel-RyR mechanical coupling (no significant flux of Ca across L-type Ca channel) --> RyR1 opening --> Binds Troponin C

173

Cardiac Muscle Depolarization -->

L-type Ca influx on PM --> RyR2 opening

174

Smooth Muscle Depolarization -->

v-gated L type Ca influx --> Calmodulin (no troponin) --> Myosin light chain kinase --> P-lation of myosin

175

Nonselective beta blocker with a1 blocking activity

Labetolol

176

Systemic sequelae with Diphtheria

Myocarditis, Heart Failure, Neurotoxicity

177

EKG leads for LAD

V1-V3

178

Type 3 collagen is found in

Granulation tissue, Skin, Lungs, Blood vessels

179

Bell vs Diaphragm

Bell = Low freq; Diaphragm = High

180

S3 on end expiration

More audible, Heart closer to chest wall

181

Localized amyloidosis confined to cardiac atria

ANP-derived (elderly)

182

Prolyl Hydroxylase -->

Proline on Procollagen --> Stable triple helix

183

Lysyl Hydroxylase -->

Stronger

184

Bepridil

CCB - Second line anti-anginal drug

185

Loud P2 =

Pulmonary hypertension

186

Kussmaul =

Paradoxical rise in JVP during inspiration

187

Don't use DPH-CCB with

Acute Coronary Syndrome (reflex tachycardia)

188

Digoxin toxicity

Hyperkalemia, Vision, N/V/D

189

Afib with RVR: tx -->

CCBs, BBs, then Digoxin second line

190

Lidocaine is for what arrhythmias

Ventricular, not Atrial

191

Mechanism of Fibrates

Peroxismal Proliferator-Activated Receptor Alpha --> LPL activity increase --> Decr TB, Raise HDL

192

How do assess severity of Mitral Regurg

Presence of S3 gallop