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Flashcards in Mixed Block Notes 3 Deck (101):
1

2

Defect in Chediak-Higashi

Phagosome-Lysosome fusion --> Recurrent pyogenic infections with Staph and Strep

3

Features of Chediak-Higashi

Immunodef, Albinism, Neurologic (nystagmus, cranial neuropathies)

4

Phosphorylation of NRTI's vs NNRTI's

NRTI's must be phosphorylated

5

Most important mechanism of lead poisoning

Affinity for sulfhydryl groups --> Inhibition of d-ALA dehydratase and ferrochetolase

6

Formation of d-ALA

Succinyl-CoA and Glycine via Pyridoxal Phosphate cofactor

7

Cause and manifestation of acute serum sickness

Type 3 (IC deposition) --> Fever, Pruritic skin rash, Arthralgias, Fibrinoid necrosis, Hypocomplementemia

8

Serum sickness can be caused by

Chimeric monoclonal Ab's, Nonhuman Ig's, Nonprotein drugs (eg penicillin, cefaclor, bactrim)

9

Osteolytic phase of Paget's is due to excess

RANK signaling, NFKB activation

10

Pattern of bone in Osteoblast phase of Paget's

Dense, hypovascular, mosaic pattern of lamellar bone with irregular, haphazardly oriented sections separated by prominent cement lines

11

What stimulates Inhibin B secretion

FSH stimulation of Sertoli cells

12

MOA of trihexyphenidyl

centrally-acting anti-muscarinic

13

Anti-cholinergics such as benztropine and trihexyphenidyl should be avoided in elderly patients, esp with

BPH, Angle-Closure Glaucoma

14

S-100 protein function

Homodimeric calcium-binding proteins, important for protein p-lation, cell growth, and differentiation

15

S-100 marks what cells

Neural Crest (melanocytes, Schwann), Langerhans and other dendritic

16

DLCO depends on

Thickness and total SA of alveolar capillary membrane, Hematocrit, Total volume of pulmonary capillary blood

17

DLCO in emphysema vs chronic bronchitis

Reduced in Emphysema, Normal in CB

18

Mechanism of Bohr effect

CO2 --> H+ and HCO3+ --> H+ binds histidine side chains of Hb --> Stabilize deoxygenated form of Hb

19

What happens to H+ and HCO3 in RBC from CO2

H+ binds Hb; HCO3 exchanged for Cl (Cl enters)

20

Which step of Glycolysis utilizes NAD+

G3P --> 1,3-BPG

21

When is FADH2 produced

During conversion of succinate to fumarate

22

Synthesis of Carnitine

Lysine + Methionine via Vit C cofactor

23

Citrate is formed from

Condensation of Acetyl CoA w/ OAA

24

Heart Failure definition

(1) Cannot pump enough blood to meet demand; or (2) Can onliy do so from elevated ventricular filling pressure

25

Diarrhea in pellagra results from

Columnar epithelium atrophy

26

NAD functions as a coenzyme for

Dehydrogenases involved in metabolism of fats, carbs, and amino acids

27

Niacin can be synthesized endogenously from

Tryptophan

28

Populations that primarily subsist on __ are prone to developing pellagra

Corn (niacin in corn is bound and unabsorbable)

29

Pellagra is less commonly seen in what patient populations

Carcinoid, Prolonged INH, Hartnup (more commonly in alcoholics and chronic disease)

30

Arginine is a precursor of

NO, Urea, Ornithine, Agmatine, Creatine

31

Orotic acid is a precursor of

Pyrimidine

32

Ab-dependent cellular cytotoxicity is defense against

Virus, Parasite

33

Function of MPO

Hypochlorite from H2O2 and Chlorine

34

Testicular feminization syndrome =

Complete Androgen Insensitivity = Absent Wolffian and Mullerian structures

35

Pulmonary hypertension is usually found in patients with

Scleroderma

36

H1 receptors are found in

Vascular endothelium, Bronchial smooth muscle

37

5 important classes of meds with Anti-muscarinic effects

Atropine, TCA's, H1 blockers, Neuroleptics, Anti-Parkinson - NATHA

38

MOA of Ribavirin

Nucleoside antimetabolite - (1) Lethal hypermutation, (2) Inhibit RNA polymerase and IMP DH (depleting GTP), (3) Defective 5'-cap formation on viral mRNA, (4) Modulating a more effective immune response

39

Bone turnover is regulated by ratio of

RANKL to OPG - incr when RANK-L high and OPG low

40

How does PTH activated Osteoclasts

Stimulates Osteoblasts to upregulate RANKL and secrete M-CSF --> Osteoclast maturation

41

Function of Osteoprotegrin

Decoy RANK-L receptor

42

Arachnodactyly, Scoliosis, and Aortic Root Dilatation are signs of

Marfan

43

Macroorchidism, Large Jaw, and Intellectual disability are signs of

Fragile X

44

Top 3 causes of meningitis in neonates

GBS, E coli, Listeria

45

Courses between Biceps brachii and Coracobrachialis

Musculocutaneous

46

Courses between Flexor Carpi Ulnaris and Flexor Digitorum Profundus in forearm

Ulnar

47

Courses between Flexor Digitorum Profundus and Flexor Digitorum Superficialis

Media N

48

Substrate for PRPP synthetase

Ribose-5-Phosphate

49

Gout occurs with increased frequency in patients with activating mutations of

PRPP Synthetase

50

First line for Acute Gouty Arthritis

NSAIDs (Colchicine second)

51

How does pregnancy affect gallstones?

Estrogen-induced cholesterol hypersecretion (HMG CoA Reductase); Progesterone reduces bile acid secretion and slows gallbladder emptying

52

Fluid-filled cavitiy in liver + Fever, Chills, RUAbdominal Pain

Most likely bacterial abscess in developed nation

53

Pyogenic bacteria most commonly gain access to liver via

Biliary tract, Portal vein pyema, Hepatic artery

54

How does RBC carry CO2

15% as carbamate on Hb, Remained as bicarb ion w/in RBC

55

Diuretic often used in management of Cerebral edema and Incr ICP

Mannitol

56

Overaggressive treatment with osmotic diuretic therapy

Excessive volume depletion and eventual hypernatremia

57

Osmotic diuretics should be used cautiously in what patients

CHF, Pre-existing pulmonary edema

58

Spironolactone side effects

Hyperkalemia, Gynceomastia, Decr libido, Erectile dysfunction

59

The risk of statin myopathy is increased when

Fibrates and/or Niacin also used

60

Drugs that can cause myopathy

SGFC PHIN - Statins, GC's, Fibrates, Colchicine, Penicillamine, Hydroxychloroquine, IFNa, Niacin

61

MOA of Fenodolpam

Benazepine derivative of DA --> Selective DA-1 agonist with no effect on alpha or beta receptors

62

Stimulation of DA receptors in kidneys

Improves RBF and Na and Water excretion

63

Fenoldopam is indicated for

Short term management of severe HTN

64

Use and risk of Nitroprusside

Most effective agent for most cases of HTN emergency --> Cyanide toxicity

65

Vimentin is a marker for

Mesenchyme

66

Chromogranin A

Neuroendocrine tumors

67

Imperforate anus is most commonly associated with

GU malformation - VACTERL (vertebral, anal atresia, cardiac anomalies, TE fistula, esophageal atresia, renal anomalies, limb anomalies)

68

Fibrinous pericarditis is most commonly caused by

MI, RF, Uremia; Also viral

69

Pericardial knock

Brief, high frequency, precordial sound heard shortly after S2 in constrictive (chronic) pericarditis

70

Heme in the liver is synthesized for

CYP450 system

71

Acute Intermittent Porphyria can be precipitated by

Phenobarbital, Griseofulvin, Phenytoin, Low calorie diet, Alcohol --> All decr hepatic heme --> Incr ALA synthase activity

72

Heme synthesis enzymes inhibited by lead

ALA dehydratase, Ferrochetolase

73

Influenza vaccine induces

Neutralizing antibodies against Hemagglutinin

74

Why don't killed vaccines stimulate CD8 response

They don't enter host cell for MHC Class 1 presentation

75

Sensory nerve to parietal pleura

Phrenic to Diaphragmatic and Mediastinal; Intercostal to remainder

76

Superficial Inguinal Nodes drain

Nearly all cutaneous lymph from umbilicus to feet, including external genitalia and anus

77

Lymph from Glans penis and cutaneous portion of posterior calf drain into

Deep inguinal lymph directly (bypassing superficial)

78

Effect of cyanide poisoining

Inhibits cytochrome C oxidase - SaO2 of venous blood increases due to failure of oxygen unloading

79

Crescents of RPGN are composed of

Proliferated glomerular parietal cells, Monocytes, Macrophages, Fibrin

80

Inactivated HFE increases iron by

(1) Incr DMT1 on enterocytes; (2) Decr hepcidin --> Incr ferroportin expression

81

Atypical antipsychotics most and least likely to cause EPS

Clozapine least likely, Risperidone most likely

82

Top 3 risk factors for Coronary Heart Disease

Noncoronary Athersclerotic Disease, Diabetes Mellitus, CKD

83

Pineal Tumors most commonly cause

Parinauds, Precocious puberty, Obstructive hydrocephalus

84

Short acting insulins

Lispro, Aspart, Glulisine

85

When to use regular insulin

DKA

86

What accounts for delayed onset of regular insulin

Dimer and hexamer formation (short acting are monomers)

87

NPH insulin works by

Crystalline suspension with protamine and zinc --> Delays absorption

88

Detemir insulin works by

FA bound to lysine --> Binds albumin and slowly dissociates

89

MAOi's

MAO Takes Pride In Shanghai = Tranylcypromine, Phenelzine, Isocarboxazid, Selegline (B selective)

90

SSRI's

Flashbacks Paralyze Senior Citizens = Fluoxetine, Paroxetine, Sertraline, Citalopram

91

SNRI's

Venlafaxine, Duloxetine

92

How quickly after ischemia does loss of contractility occur in cardiomyocytes?

60 seconds

93

At what timepoint is myocardial ischemia irreversible

30 minutes

94

Ligands for Receptor Tyrosine Kinase vs JAK/STAT

Growth Factors bind RTKs; JAK/STAT bound by Cytokines, Growth Hormone, Prolactin, IL-2, EPO

95

Microscopy of Membranous Glomerulopathy

LM - Mesangial proliferation; IF - Ig and C3; EM - Spike and Dome

96

T-ALL is most likely to present

Anterior Mediastinal mass that compresses great vessels and esophagus

97

EKG progression of Acute Transmural Infarct

Peaked T waves --> STE --> Q waves

98

Imaging in Gallstone Ileus shows

Intestinal gas (obstruction), Air in biliary tree

99

Boerhaave Syndrome

Transmural tear (vs Mallory Weiss which is mucosal)

100

Cricopharyngeal motor dysfunction occurs due to

Diminished relaxatin of pharyngeal muscles during swallowing

101

Renal consequences of Ethylene Glycol ingestion

Oxalate crystals, Tubular epithelial damage (ballooning and vacuolar degeneration mostly in PCT)