Other Flashcards
(440 cards)
1
Q
hyponatremia, abd pain with fasting, worsens with barbitruates
A
Acute Intermittent Porphyria
2
Q
blisters on skin, tea colored urine that turns pink under woods lamp
A
porphyria cutanea tarda
3
Q
Snail
A
schistoma
4
Q
tsetse fly
A
trapanosoma brucei; african sleeping disease
5
Q
Treatment for bacillus ceres
A
supportive
6
Q
Infective steatorrhea
A
Giardia
7
Q
Naegleria fowleri sx
A
abd pain, N/V, CNS changes–>rapid coma
8
Q
Counsilman bodies
A
eosinophilic round granules in hepatocytes…yellow fever
9
Q
HNPCC–>name 2 cancers
A
colon and endometrial
10
Q
Ileal resection –>at risk for what?
A
Gall stones; B12 deficiency
11
Q
Gastroparesis treatment?
A
metoclopromide, erythromycin
12
Q
What is a drug contraindication when using Allopurinol?
A
azathioprine–>will accumulate due to allopurinol inhibition of XO; will cause hemolytic anemia
13
Q
Drugs for Gaves?
A
PTU methimazole–>inhibition of thyroid peroxidase
14
Q
hyperglycemia, weightloss, diarrhea–>doesn’t respond to metformin
necrolytic migratory erythemia
dx?
A
glucagonoma
15
Q
acromegaly treatment
A
Octreotide
16
Q
short 4th and 5th metacarpals
A
psuedohypoparathyroidism–>high PTH low calcium because organs cannot sense PTH
17
Q
Pt has hashimoto’s what else in predisposition
A
DM1; and celiac’s
18
Q
thyroid hormone is what kind of hormone?
A
steroid
19
Q
PTU side effect?
A
agranulocytosis
20
Q
air above liver upon xray
A
GI perforation
21
Q
still born baby with edematous hands and feet
A
Turner syndrome
22
Q
lung mass, hypercalcemia on labs. what is dx? why is calcium high?
A
spquamous cell carcinoma; due to PTHrP
23
Q
pt admitted for angina or MI. develops DVT a couple days later. What do you suspect? how do you treat?
A
HIT. treat with direct thrombin inhibitors (bivalirudin, dabigatran, argatroban)
24
Q
abciximab, eptifibatide mech?
A
IIb/IIIa inhibitor. thus platelet aggregation inhibitor
25
how does estrogen affect thyroid hormone?
decreases TBG catabolism. thus increasing bound Thyroid hormone... thus increasing over all pool of thyroid hormone. NO difference in free/active thyroid hormone.
26
what is chromatolysis?
neuronal changes post axonal damage. neuron revs up protein synthesis and nissl body expands
27
Dystrophic versus metastatic calcification. location/diseases/serum calcium status?
dystrophic is due to damage/necrosis (aging heart valve, TB, monkeberg, psammoma body). pt is normocalcemic
metastatic caclification is due to overall hypercalcemia -->such as in sarcoidosis, vitaminosis D...etc. you see calcifications everywhere
28
prepatellar bursa is where?
| pes anserina is where?
-pretellar bursa is in the lower pole of patella
| pes anserina is on the medial leg
29
first line tx for RA? others? which is the fastst thing for sx relief?
methotrextate= firstline tx; corticosteroids=fastest relief. leflunomide, TNFalpha inhibitors, and steroids
30
is stool usually lower or higher in osmolarity than blood? in what case will this gap increase?
it's usually lower. the gap will increase with indigestible things which will osmotically hold on to the water making it even more hypoosmotic (ex: lactose intolerance)
31
centrilobular necrosis of the liver
acetaminophen toxicity-->liver damage/failure
| or ischemic damage
32
which lung cancer is nonsurgical
small cell carcinoma
33
alpha amatoxin causes what symptoms?
because it halts RNA pol II-->stops protein synthesis thus cells with rapid turnover are affected.
N,V,D/ liver failure/renal failure (PT especially)
34
NK cells express what CDs?
16, 56
35
what activates NK cells
cytokines: IFNY, IL12
| lack of MHCI on cell
36
which drugs are used to treat mild rheumatoid arthritis?
sulfasalazine, hydroxychloroquine, minocycline
37
heterophile antibody negative mono?
CMV. READ YOUR QUESTIONS CAREFULLY
38
patient on opioid has severe abdominal pain. Why?
mu agonists will cause smooth muscle contraction (hence constipation? hence miosis?)
therefore contraction of sphincter of oddi may lead to colicky obstructive pain
39
opioid pain treatment of choice for biliary/pancreatic pain source?
meperidine. mu agonist but has less effect on Oddi constriction compared to other mu agonists
40
what is the mechanism of organophosphates?
they're irreversible cholinesterase inhibitors
treat: atropine, prailadoxime
41
how do you treat serotonin syndrome/SSRI overdose?
cyproheptadine (first generation histamine inhibitor with 5HT blocking properties)
42
Ecthyma gangrenosum
| causal organism? factors?
pseudomonas. pyocyanin (ROS), exotoxin A, phospholipase C, elastase
43
name 2 H1 inhibitors
chlorpheniramine, diphenhydramine
44
what are sedatives that should not be used together?
alcohol, benzodiazepine, barbiturates, antihistamines, antipsychotics
45
brain tumor with hemorrhage and necrosis. what type of cell is the tumor made of?
this is glioblastoma multiforme. therefore, astrocytes
46
brain tumor with calcifications? what kind of tumors could this be?
oligodendoglioma (or it could also be meningioma with psammoma bodies)
cranial pharyngioma
47
brain tumor with calcifications? what kind of tumors could this be?
oligodendoglioma (or it could also be meningioma with psammoma bodies)
48
name the enteroviruses? are they acid labile or stable?
echovirus, poliovirus, and coxackie virus
these are all acid STABLE thus enterovirus!
Rhinovirus is the only acid labile picornavirus...thus it's in the nasal passage
49
what are hnRNA?
heterogenous nuclear RNA. these are the newly transcribed RNA that have not gone through RNA processing. they're in the nucleus, duh!
50
what is the RNA processing/storage center in the cytoplasm called?
P bodies
51
you hear holosystolic murmur...what could it be?
mitral valve regurg, tricuspid regurg, VSD
52
holosystolic murmur that increases with inspiration
tricuspid valve regurgitation
53
mucosal bleeding, petechiae are seen in what kind of bleeding disorders?
platelet aggregation disorders--->vWBD
54
hemearthrosis, intramuscular bleeds, prolonged bleeding with dental work? bleeding disorder?
hemophilia
55
G6PD is deficient in what?
NADPH; thus can't reduce glutathione
56
what is Osler-Weber-Rendu
hereditary hemorrhagic telangiectasia; autosomal dominant
| arteriovenous malformations, telangiectasia/skin discoloration, epistaxis, hematuria, GI bleeds
57
syncope, angina, and dyspnea. with heart murmur
aortic stenosis
58
sudden cardiac death in a young person. What do you have to think about?
HCM, WPW, cor pulmonale
59
etiology of WPW?
| what do you see on EKG
reentrant circulation through bundle of KENT by passing slow AV node.
EKG: delta wave, and shortened PR interval, resulting in SVT
60
what mutation will predispose someone to disseminated mycobacteria infections?
IFNY R
61
What receptor does IFNY act through?
Jak 1 and 2, upregulating phagocytosis, MHC, and antimicrobial elements
62
recurrent lower respiratory tract infections and recurrent Giardia infections? what is the immune def
X linked Agammaglobulinemia=Bruton's
63
C3 deficiency leads to recurrent what infections?
encapsulated
64
delayed detachment of umbilical cord, poor wound healing with no pus production. what is the dx and what receptor is missing?
defect in leukocyte adhesion. lack of CD18 is a common defect of integrins
65
RBC lifespan
120 days
66
what bacterium has protein A as its virulence factor? what does it do?
Staph aureus--> binds Fc of IgG
67
bacterium with cytoplasmic polyphosphate granules upon methylene blue
diphtheria
68
diphtheria toxin ribosylates elatongation factor 2. what does elongation factor 2 do?
protein synthesis elongation
69
Which class of antiarrhythmics has use dependent sodium channel blocking ability? list the subclasses
```
class 1-->the sodium channel blockers.
subclasses listed by duration of binding 1C>1A>1B
```
70
What is the action of class 1c antiarrhythmics and why is it rarely used?
prolonging K channels and inhibiting Na/Ca channels can both elongate QT interval and thus may allow reentrance and arrythmias
71
How long must a couple wait after vastectomy to not use contraception? why
viable sperm remain in the proximal vas-->thus must wat 3 months or 20 ejaculations
72
why is there still a significant amount of ejaculate post vasectomy?
ligation is done at vas that is near the testes...thus not affecting the seminal vesicle, prostate, and bulbourethral glands
73
ambiguous genitalia at birth; normal male sex characteristics develop at puberty. what is missing?
5 alpha reductase
74
17 alpha hydroxylase deficiency
what is low and what is high?
what are the sx/characteristics of these patients?
High: mineralcorticoids
low: glucocorticoids and sex hormones (both estrogen and androgens)
genetic males will have female external genitalia and male internal genitalia.
all pts will fail to develop secondary sexual characteristics due to general lack of sex hormones
Hypertension, hypokalemia, and low renin will be seen.
75
which structure of the celiac trunk is not endodermal derived? what is its origin?
liver and pancreas ARE endoderm outpouching derived.
| Spleen is NOT--> it's mesodermal from dorsal mesentery
76
Gottron's nodules
Dermatomyositis
77
which spinal levels are in the femoral nerve?
L2-L4
78
Which spinal levels are in the sciatic nerve?
L4-S3
79
can't plantar flex is injury of what nerve?
| can't dorsi flex is injury of what nerve?
plantar flexion is accomplished by S1
| dorsiflexion is accomplished by L5
80
what is diastolic depolarization. How is it affected by calcium channel blockers?
diastolic depolarization occurs in SA and AV node where sodium current drift into cells in phase 4 (repolarization). at the end of phase 4 calcium flows in until action potential is triggered in phase 0.
thus calcium channels block the end of phase 4 and phase 0 therefore slowing the pacing of the heart.
81
resistance is the greatest where in the lung? it's the least where in the lung?
greatest at 2-5th generation of lung due to turbulent flow.
| least in the small branches/alveoli due to large cross area
82
what is natural competency? what bacteria are naturally competent?
abilityto uptake naked DNA strands drom environment (transformation)
Strep pneumo
haemophilus
neisseria gon and mening
83
alkaptonuria is a result of defect in which pathway (which amino acid is converting to what?)
Tyrosine to fumarate; homogenisate oxidase is defective
84
what is leucine metabolized to?
acetoacetate and acetyl coa
85
what are isoleucine and valine metabolized to?
succinyl coa
86
name the vessels most affected by atherosclerosis?
abd aorta, coronary artery, popliteal artery, internal carotid artery, circle of willis
87
anticholinergic meds, severe head ach and eye pain
close angle/narrow angle glaucoma
88
what are 4 classes of drugs used for glaucoma? what are the mechanisms?
beta blockers and acetazolaminde--> decrease aqueous humor production from ciliary epithelium
prostaglandin F2a ( latanoprost, unoprostone, travoprost) and cholinomimetics (pilocarpine, carbachol) increase outflow
89
what produces aqeous humor?
ciliary epithelium in the ciliary body...which is in the posterior chamber
90
hemoptysis, nasal mucus ulceration, chronic sinusitis, renal disease. dx
wegener C anca
91
what kind of skin changes can you see in chronic venous insufficiency
venous insufficiency=varicose veins...
| you can see dermatitis, dermal fibrosis, and hyperpigmentation
92
which enzyme involved in some glycolytic pathways may be affected in gestational diabetes?
glucokinase. It's pancreas's way of sensing and trapping glucose. Therefore this may be overwhelmed in pregnancy. The direct glycolytic enzymes do NOT cause gestational DM
93
what's similar and what's different about Rubella and Rubeola?
both start on head and spread downward (rash)
Rubella travels faster and is not as dark/convelscent, postauricular lymphadenopathy
Rubeola is dark and convelscent but spreads slower
94
what is german measels, what is measels?
measles is rubeola;
| german measels is rubella
95
Rubeola is what kind of virus?
paramyxovirus
96
German measles is what kind of virus?
togavirus
97
postauricular lymphadenopathy is associated with rubeola or rubella?
Rubella
98
What is winter's formula. What do you use it for?
to determine if low pCO2 in metabolic acidosis is due to compensation or due to a mixed disease.
paCO2=1.5(HCO3)+8 +/-2
if it's not predicted then this is likely a MIXED disorder. meaning metabolic acidosis + respiratory alkalosis/acidosis
99
what kind of metabolic abnormalities do you see in salicylate poisoning?
first you get respiratory alkalosis
few hours in you will get worsening metabolic acidosis because salicylate UNCOUPLES ELECTRON CHAIN TRANSP, inhibits TCA cycle, and increases lipolysis-->build up of pyruvate, ketoacids, lactate
100
what is the mechanism of reflex tachycardia
dilation of arterial vessels-->drop in pressure-->decreased baroreceptor firing-->triggers SNS-->tachycardia/contraction/REnin/angiotensin system activation
101
What may be the benefit of giving hydralazing and a beta blocker togeter?
hydralazine will dilate the vessels, and beta blocker will prevent SNS activation of reflex tachycardia AND renal sodium retention
102
congenital bilateral absence of vas deferens
CF! (or unilat renal agenesis)
103
what is azoospermia
no sperm in semen
104
what does xeroderma pigmentosa literally mean
pigmented dry skin
105
statin indication? side effects?
high LDL; SE: hepatic injury, increased LDL
106
niacin indication? side effects?
indicated for low HDL;
| Flushing, hyperglycemia, hyperurecemia, hepatic injury
107
cholestyramine indication? side effect?
indication: high LDL
SE: GI sx, malabsorption, gall stones
108
Fibrates indication? side effects?
indication: high Triglycerides
SE: gallstones, myopathy with statins
109
phenylephrine stimualtes which receptor(s)?
alpha 1
110
Dopamine stimulates waht receptors?
low dose-->D1-->increased GFR and mesenteric blood flow (BOTH BY VASODILATION)
med dose-->D1 and beta 1-->cardiac output/renal increase GFR (BETA WILL CAUSE VASOCONSTRICTION)
high dose D1, beta1, alpha 1-->increase BP
111
why might implementation of ACE inhibitors lead to rise in creatinine? especially in patients with renal artery stenosis
ACE keeps GFR up in renal stenosis by vasoconstriction. ACE I will targetedly dilate efferent arteriole, so if there's underlying GFR compromise, the compensatory mechanism is taken away
112
pleuritic pain is transmitted to where? along what nerve?
to the shoulder/neck area via phrenic nerve C3-5
113
4 features of neurleptic malignant syndrome? what drugs cause this?
sx: hyperthermia, muscle rigidity, unstable ANS, and altered mental status
Drugs: antipsychotics especially ones that have D2 inhibition
114
mitral valve thickening small vegetations on both sides
SLE LIBMAN SACKS
115
preeclampsia sx
edema, hypertension, proteinuria
116
crohn's disease is associated with what type of kidney stones? how does this occur?
oxalate stones;
poor reabsorption of fats in the GI tract lead to fat binding Calcium and are excreted. This results in increased oxalate (unable to bind calcium) absorption and thus accumulates
117
How long after MI will red wavy fibers, edema, and punctate hemorrhage show up?
4-12 hrs
118
tetanus toxin is transported retrograde in neurons and inhibit what neurotransmitters?
GABA glyciine
119
what are the risk genes for EARLY onset alzheimer's
APP on Chr 21, Presenillin 1 (chr 14) and Presenillin 2 (chr1)
120
What genes are indicated as risk factors in LATE onset alzheimers? what's protective?
ApoE4 is risk factor. ApoE2 is protective
121
common mutation in HCM?
beta myosin chain
122
Von Hippel Lindau gene does what? why does this make sense given clinical presentatioN?
VHL gene induces Hypoxia Inducible Factor--> endothelia and blood vessel proliferation. THIS IS why you get the hemagiomas, RCC, and pheochromocytoma...
123
what chromosome is Von hippel Lindau on?
chr 3
124
3 classic histology signs of B6, B12 deficiency
megaloblastic anemia, hypersegmented neutrophils (6+ lobes), and crazy platelets
125
what is side chain cleavage enzyme? what if it's deficient?
It catalyzes conversion of cholesterol to pregnenolone. without it cholesterol will accumulate in adrenals and lead to damage of adrenal gland. There also will not be ANY steroid hormones
126
what is the amino acid mutation of Sickle Cell?
Glu to Val
127
what is the amino acid mutation of HbC?
Glu to Lys
128
HbA, HbS, and HbC. what are the expected charges?
HbA is negative charged
HbS-->Glu to Val--> Neg charged to neutral charged. Still negative but less so than HbA
HbC-->Glu to Lys-->more positive than BOTH HbA and HbS
129
false neutrophil elevation. What's probably the cause?
corticosteroids--> demargination of neutrophils; while decreasing all the other leukocytes
130
dry mouth, tachycardic, hyperphagia, inappropriate laughter, conjunctival injection. What drug is this?
Marijuana
131
what are Ruffini receptors?
slow adapting mechano receptors in skin
132
What do Golgi Organs prevent? how do they do it?
too much muscle contraction. travel through Ib--to InhiBit alpha motor neurons
133
What do intrafusal fibers prevent? how do they doit?
too much muscle lengthening--travel through Ia and II neurons to trigger alpha motor neuron (contraction)
134
thalamic strokes knocks out what?
| internal capsule strokes knock out what?
thalamic is sensory body/face
| internal capsule is mortor body/face
135
pink patches in white matter tracts; oligodendrocyte apoptosis. dx?
MS
136
yello renal tumor; microscopically polygonal cells filled with glycogen and lipid with eccentric nucleus. Where in the kidney/nephron did this tumor originate?
Proximal tubule, clear cll carcinoma
137
renal pelvis tumor. What is it called? and what's the histology?
transitional cell carcinoma; it often is papillary
138
Renal Oncocytoma. Where is it usually found? what is a characteristic histo feature?
collecting duct; it has abundant mitochondria
139
why might you hear a murmur with ASD?
L to R shunting will cause volume increase in R heart... increased flow across Pulmonic valve is the reason for the murmur.
In ASD you usually don't hear a murmur
140
why does hyperventilation cause you to pass out?
hypocapnea causes vasoconstriction-->decreased perfusion to brain.
141
```
Antivirals...what are the
vudines?
cyclovirs?
fovirs?
navirs?
Raltegravir?
```
```
vudines=reverse transcriptase inhibitors
cyclovirs=nucleoside analogs that need viral T kinase
fovirs=nucleotide analogs
navirs=protease inhibitors
raltegravir=integrase inhibitor
```
142
ambiguous genitalia in baby girl; maternal hirsutism in pregnancy. what's missing? what will happen at puberty?
aromatase is missing; at puberty the female will NOT get period, be tall in stature, and have early osteoporosis (all due to lack of estorgens)
143
what type of patient is most at risk for mucormycosis?
| What type of patient is most at risk for aspergillosis?
mucor=DM pt
| aspergillus=neutropenia
144
black eschar in nasal mucosa; diabetic ketoacidosis. What is it? how do you find out?
Mucormycosis/Rhizopus, do biopsy
145
what type of patient is most at risk for mucormycosis?
| What type of patient is most at risk for aspergillosis?
mucor=DM pt, neutropenia
| aspergillus=neutropenia
146
middle meningeal artery/vein pass through what hole in the skull?
foramen spinosum
147
vancomycin generally is used to treat what class of bacteria?
G+
148
Polymyxin=Colistin is used for waht class of bacteria? what does it NOT work against?
G- bacteria EXCEPT for Neisseria
149
heated blood agar with vancomycin, colistin, nystatin, and trimetheprim...what is this agar?
theyar martin
150
which antibiotic has a disulfram-like side effect?
metronidazole
151
Sabouraud agar grows what?
Coccidioides immitis
152
LOC due to severe hypoglycemia is treated how in in hospital? NOT in hospital?
If there's IV access--> push dextrose/glucose slowly
| If no IV access--> IM glucagon (IM glucose is NOT useful)
153
What are TWO effects of digoxin
increase contractility via potentiation of intracellular calcium. decrease
AV node conduction via increasing PNS stimulation
154
mullerian inhibition factor is secreted by what cells?
sertoli
155
why do you get alcoholic hepatic steatosis?
because alcohol DH and acetaldehyde DH are taking up all the NAD and reduced it to NADH. This stops TCA cycle and beta oxidation, and gluconeogenesis. thus accumulates fats (especially as triglyceride synthesis is also increasing)
156
glucocorticoids increase protein synthesis in waht organ?
liver (gluconeogenesis and glycogenesis proteins)
157
CF. what is the amino acid mutation?
deleted phenylalanine
158
What organism produces acid in glucose fermentation?
shigella
159
what organism produces H2S?
Salmonella
160
what happens in the first few weeks of TB primary infection
the respiratory drops carry TB in to lungs, and they replicate until Mphage burst...they continue to replicate and infect macrophages to prevent T cell signalling...thus T cell response will occur about 3 weeks post exposure.
Then the Th1 and macrophages will attack TB and wall it off in granulomas
161
aconitase contains what elements
iron, sulfur
162
which steps in Gluconeogenesis are in the mitochondria? what is the enzyme that leaves the mitochondria?
Pyruvate is converted to Oxaloacetate in the mitochondria by pyruvate carboxylase to malate, which leaves
malate is converted back to oxaloacetate in the cytoplasm
163
cataplexy is often triggered by what? what's the other presentation?
emotions--> loss of muscle tone pt is conscious;
| OR abnormal facial movements without emotional trigger
164
14-3-3 protein in CSF?
creuzfeld jakob
165
homovanilic acid is a metabolite of what?
dopamine (thus Epi/NE too)
166
increased AFP in gestation can indicate what 3 things?
multiple gestation
open neurotube
open anterior abd wall
167
low AFP, low conjugated estriol, high hCG, high inhibin A.
what is this?
This is the QUAD screen of second trimester
| screening for down syndrome
168
Which two parental things can lead to higher risk of downsyndrome?
maternal age >35; and robertsonian translocation of 21 and 14
169
what is in the gonadal "round ligament"?
artery of sampson. rarely a source of bleeding
170
how can you tell the difference between absolute erythrocytosis versus relative erythrocytosis?
(relative erythrocytosis=volume contraction...NOT bleeding)
LOOK AT RBC MASS!!!
171
erythropoitin production site in adults? fetuses?
kidney in adults; liver in fetuses
172
when in the respiratory cycle is the perfusion the best?
its the best at the end of tidal volume since the stretch from inspiration is the least yet the pressure is not dominated by postitive inward pressure
173
what are the correlated events in venous pulse wave?
a, c, x, v, y
```
a=atrial contraction
c=trCuspid bulge
x=atrial relaXation
v=ventricular contraction
y=passive flow in to atrium
```
174
what could steep y decend wave indicate?
restrictive pericarditis
175
What causes carboxyhemoglobinemia
| what causes methemoglobinemia?
carboxy=CO-->CARBON MONOXIDE!
| met=Fe3+ -->Nitro drugs/sulf drugs
176
how does carboxyhemoglobinemia affect oxygen curve? PaO2?
it will L shift the curve and bring it down...it decreases amount of Hb available to bind O2 and decreases Hb ability off load O2.
HOWEVER. PaO2=/=HbSaturation=/=O2 content. PaO2 is dependent on atm PaO2 and diffusion/perfusion.
177
TNFalpha, catecholamines, glucocorticoids, and glucagon induce insulin resistance. How is this accomplished?
Serine/thr kinase phosphorylates IRS complex, so that the receptor cannot send the signals in.
178
ACL inserts on the anterior or posterior aspect of Tibia?
anterior
179
Isoniazid resistance by TB is accomplished how?
decrease in activating enzyme catalase peroxide
| mutation in binding protein
180
what is acrolein?
toxic metabolite of cyclophosphamide when metabolized by kidneys. Mesna can bind acrolein to reduce risk of hemorrhagic cystitis
181
sterile small non destructive fibrinous vegetations lining the closure cusps of heart valves. what is this?
non-bacterial thrombotic endocarditis. MARANTIC. due to procoagulant state
182
marantic valvular vegetations/nonbacterial thrombotic endocarditis is associated with with what diseases?
CANCERS...pancreatic adenocarcinoma or lung adenocarcinoma
183
what is the function of lysysl oxidase in collagen?
disulfide crosslinking between collagen
184
rabies virus binds to what receptor?
nicotinic ach receptor-->then retrograde travel
185
Rhinovirus binds to what receptor?
ICAM1 (CD54)
186
cytomegalovirus binds to what receptor?
Integrins
187
EBV binds to what receptor?
CD21 (CR2)
188
which pneumoconeosis resembles sarcoidosis?
Berrylliosis---> LOOK FOR EXPOSURE TO MINES
189
How does N acetylcystein help acetaminophen toxicity?
| How does N acetyl cystein help CF patients?
Acetaminophen tox--> it regenerates glutathione
| CF-->cleaves disulfide bonds in mucin glycoproteins-->looser mucus
190
thiopental is a barbiturate anesthetic. What is the mechanism responsible for patients waking up quickly from it?
It is NOT metabolized rapidly. Rather it is distributed to skeletal muscles and fat
191
fever, maculovesicular rash, renal failure with RBCs, eosinophils and neutrophils in urine.
What is this called? what is it caused by?
Acute Interstitial Nephritis.
| -Sulfonamides, Rifampin, NSAID, diuretics
maybe you should listen to goljian tell you about this
192
Acute Interstitial Nephritis you see peripheral eosinophilia with waht stains?
Hansel stain
| wright stain
193
papillae necrosis of kidneys; 3 ddx?
SICKLE CELL, pyelonephritis, DM
194
why is busprione only used for GAD?
| what are some advantages of buspirone over benzos?
GAD because it takes weeks to become effective..thus not for acute relief
advantages is there's no dependency, no sedation, no muscle relaxant, no seizure prophylactic effect. JUST aniety
195
What are two advantages of Celecoxib?
No interaction with thromboxane (therefore nl platelet fxn),
No corrosive actions in GI
196
Hypertensive emergency and patient has renal concomitant renal insufficiency. WHAT DO you use?
WHY?
Fenoldapam--> SELECTIVE D1 agonist. with NO effect on alpha and beta receptors.
It vasodilates as well as maintain renal perfusion and promotes diuresis
197
Wilm's tumor mutation?
WT1
198
spontaneous bursts of random eye movements and myoclonus+hypotonia in child. Abdominal mass. what is this disease? what's the mutation?
This is neuroblastoma of the adrenal medulla due to N-myc amplification.
this results in increased metanephric precursors
199
what is the disease if a child presents with pheochromocytoma like sx?
neuroblastoma
200
spontaneous bursts of random eye movements and myoclonus+hypotonia in child. Abdominal mass. what is this disease? what's the mutation?
Opsoclonus-myoclonus
This is neuroblastoma of the adrenal medulla due to N-myc amplification.
this results in increased metanephric precursors
201
isolated systolic hypertension. calcification of abdominal aorta see on xray
monkenberg sclerosis
202
acute intermittent porphyria... what's the def?
porphobilinogen deaminase
203
Urine that darkens... ddx?
alkaptonuria
| acute intermittent porphyria
204
how do you make acute intermittent porphyria better?
you try to stop ALAsynthase so that less products are sent down the heme synthesis pathway.
Use HEME and GLUCOSE to stop ALAs via neg feedback
205
what makes intermitten porphyria worse?
CYPP450 inducers
206
what makes intermitten porphyria worse?
CYPP450 inducer durgs, alcohol, smoking
207
two types of bone ossification
endochondral--long;
| intramembranous
208
two types of bone ossification
endochondral--long;
| intramembranous-flat bones
209
three main compensatory components of reduced cardiac output?
increase SNS stimulation,
Renin-ang-aldo pathway increase
Increased ADH release
210
three main compensatory components of reduced cardiac output?
how can this be bad?
increase SNS stimulation,
Renin-ang-aldo pathway increase
Increased ADH release
fluid/sodium retention will worsen afterload thus put more pressure on the heart. Aldosterone also lead to cardiac remodeling and fibrosis
211
what cells participate in late phase anaphylaxis?
mainly eosinophils, but also neutrophils and basophils
212
What is the main component of eosinophil granules?
major basic protein
213
what is the main component of basophil granules
histamin, heparin, and SRSA
214
What is the main component of eosinophil granules?
major basic protein-->destroys outer membrane of helminths
215
what is the role of mTOR?
activation leads to cell proliferation.
216
What activates mTOR? what inhibits it?
PI3K-->AKT-->mTOR pathway is activating
| PTEN inhibits mTOR
217
why are Turner syndrome patients usually short?
they're ususally missing a SHOX gene from the missing X which influences long bone growth
218
Which X is usually missing in Turner syndrome?
paternal
219
dihydrorhodamine test. what is it used to test?
presence of superoxides and thus Neutrophilic NADPH oxidase activity..if deficient-->chronic granulomatous disease
220
Nitroblue tetrazolium. what is it used for?
testing for ROS in neutrophil in chronic granulomatous disease... if ROS is present the yellow liquid will turn blue
221
what are two tests used for chronic granulomatous disease?
nitroblue tetrazolium, dihydrorhodamine
222
loss of hearing and finding of a brain tumor +/- facial/trigemnal nerve palsy. what is this likely? where is the tumor?
Neurofibromatosis 2-->schwannoma
| location=cerebellar pontine angle
223
where is the pineal gland located?
dorsal midbrain
224
falcine superficial brain tumor. what is it?
meningioma
225
what is the difference between Pica and normal pregnancy cravings?
pica is often due to iron deficiency anemia.
However the difference is pica is eating nonfoods/nonstaple foods
versus cravings are of normal foods
226
what drugs cause Serotonin syndrome?
You were dancing when you tripped over a line and caused trauma...and now you're depressed.
Ondansetron, Tryptans, Linezolid, Tramadol, antidepressants (SSRI, SNRI, MAO, Tricyclics)
227
Doxycycline sideeffects
this is just all the tetracycline SE: photophobia, pill esophagitis, teeth stains
228
what is a common gene mutated in dilated cardiomyopathy?
dystrophin
229
what are SE of first gen antihistamines that second generation does not have?
antimuscarinic, antiserotonergic, anti alpha adrenergic, and more CNS sedation
230
name 4 first generation antihistamines
diphenhydramine, chlorpheniramine, hydroxyzine, promethazine
231
warfarin is metabolized how?
CYP2C9
232
what is neurophysin
chaperone protein for ADH and Oxytocin.
233
Autosomal dominant inherited Diabetes Insipidus is caused by what?
point mutation in neurophysin...which causes misfolding and removal of the hormones from ER. Thus pt will lack ADH and oxytocin
234
first, second, and third line of gout tx?
NSAID (don't use with renal failure, hepatic failure, GI bleed), colchicine (GI SE), and corticosteroids
235
endothelin action
vasoCONSTRICTION
236
pt >50 years old with systolic hypertension but nl diastolic. what is the mechanism causing this?
aortic stiffening (possibly monkenberg?)
237
normal MABP?
90-100
238
how to calculate MAP using DBP and SBP?
DBP+ 1/3(SBP-DBP)=MAP
239
renal failure's effect on calcium, PTH, calcitriol, and phosphate?
high phosphate, low calcitriol-->low calcium-->high PTH
240
common pathogens for reactive arthritis?
Campylobacter, chlamydia, shigella, salmonella, Yersinia, and Bartonella
241
C1 inhibitor deficiency is linked to what?
hereditary angioedema (due to lack of C1 inhibition thus overactive complement system)
242
What is the process by which bruises become green and then brown?
Heme is oxidized by heme oxidase into biliverdin (green) then spontaneously oxidizes further to bilirubin.
243
what are c diff's toxin's and what do they do? what's the mechanisms?
C diff has toxin A (enterotoxic) and toxin B (cyto toxic)
but their mechanism of action are the same. disruption of Rho protein thus destabilizing actin, also disrupting tight junctions leading to diarrhea
244
clostridium perfringens... what's the toxin?
Lecithinase
245
lens dislocation. ddx? wht are they at risk for?
marfans --> dissection; and homocysteinuria -->thromboses
246
homocysteinuria...what enzyme is missing?
cystathione synthetase
247
what dietary thing can worsen homocysteinuria?
excess methionine in diet..increases homocystein even more
248
what dietary thing can worsen homocysteinuria?
| what dietary supp can make it better?
excess methionine in diet..increases homocystein even more
| B6
249
AIDS patient with ring enhancing brain lesions. How do you treat?
pyrimethamine and sulfadiazine
250
two top diagnoses for ring enhancing brain lesions in AIDs pt?
toxo and primary CNS lymphoma
251
what is the microbe responsible for CNS lymphoma?
EBV
252
drug of choic for myotonic seizures?
Valproate
253
what kinds of seizures can valproate be used for?
myoclonic, tonic clonic, and absence
254
hemachromatosis. what is the mutation on what gene? what chromosome?
Cysteine to Tyrosine at amino acid 282 on HFE gene on chromosome 6
255
MTMP is oxidized to MPP and can damage dopaminergic neurons. What enzyme catalyzes this?
MAO B
256
Why is it useful to use MAO I in parkinson's?
it's helpful because dopamine breakdown leads to ROS that damages substantia nigra. thus. MAO Inhibition will lower monoamine breakdown
257
inhaled glucocorticoids...what's the most common SE? what are some others? how do you prevent?
oral candidiasis is most common. You can also get cataracts and osteoporosis. Prevent by oral rinsing
258
which layer of the stomach is are parietal cells located?
the upper glandular layer that is right underneath the epithelial layer
259
pure red cell aplasia is associated with what two causes?
thymoma and parvoB19 infection
260
how are eosinophils able to kill helminths?
helminths are coated with IgG which then bind to eosinophils causing degranulation
THIS IS ANTIBODY DEPENDENT CYTOTOXICITY
261
how are eosinophils able to kill helminths?
helminths are coated with IgG which then bind to eosinophils causing degranulation
THIS IS ANTIBODY DEPENDENT CELL MEDIATED CYTOTOXICITY
262
rotavirus infection. what comes before the diarrhea?
upper respiratory infection
263
white OR blue spots with underlying erythema on buccal mucosa
koplik spots. measles=rubeola
264
name the top few risk factors for cervical carcinoma
HPV, HIV, low socioeconomic status, multiple sex partners, and smoking
265
dual blood supply of lung?
pulmonary arteries and bronchial arteries
266
ppost op hydration helps with what
renal function
267
post op breathing exercise prevent what?
atalectasis
268
how to prevent post op PE?
heparin
269
how are particles 10micron+, 2-10 microns, and
10+ will be coughing/sneezing
2-10 microns will be mucociliary transport
and
270
what decreases risk of ovarian cancer?
OCP, multiparity, breast feedng
271
able to follow command and answers questions appropriately. However has trouble writing and has slowed speech. What region of brain is affected?
Broca's area
272
Wiskott Aldrich syndrome. when does it onset?
about 6 months after maternal passive immunity has worn off.
273
fevers chills, back pain, hemoglobinuria hours after blood transfusion. What is this called? what type of hypersensitivity?
acute hemolytic transfusion reaction.
| This is type II hypersensitivity mediated by Ab and Complements
274
Crohn's and UC. which one is more likely to have bloody diarrhea, which one is more likely to have abdominal pain?
UC-bloody diarrhea,
| Crohn's abd pain
275
process of liquifactive necrosis?
lysosomal degradation
phagocytic removal of material
astrocyte proliferation and gliosis
276
necrosis with preserved architecture?
coagulative
277
necrosis with giant cells and granulomas
caseous
278
most prominent atrophy in brain regions of alzheimer's?
temporoparietal and hippocampus
279
achondroplasia. what gene is mutated? pattern of inheritance?
FGFR3; autosomal dominant. homozygous is lethal
280
medusa head/serpentine on microscopy. micro
Bacillus anthracis
281
wool sorter
bacillus anthracis
282
bacillus anthracis disease progression
inhaled and generates toxin in mediastiunal lymphnodes... fever, malaise, then hemorrhagic mediastinitis/pleural effusion
283
name the three dihydrofolate inhibitor drugs
methotrexate, pyrimethamine, nd trimethoprim
284
antismith ab...is against what exactly?
snRNP
285
Pt with musculoskeletal pain, fatigue, and depression. dx?
Fibromyalgia
286
Young female pt with musculoskeletal pain, fatigue, and depression. dx?
Fibromyalgia
287
Young female pt with musculoskeletal pain, fatigue, and depression. dx? tx?
Fibromyalgia. exercise, SSRI, and anticonvulsant
288
Primase; what kind of polymerase is it?
DNA dependent RNA pol
289
where are ribosomal proteins synthesized? where are they assembled? and where do they function?
after transcription in the nucleolus, the proteins are synthesized in the cytoplasm. They target back to nucleolus and are assembled as rRNA/60S/40S structures. then it's sent out to cytoplasm for tranlsation functions
290
what is lactose also known as?
galactose beta 1,4 glucose
291
techoic acid of strep A is a part of what structure?
peptidoglycan
292
What does protein M do?
antiphagocytic and cytotoxic to neutrophils, inhibit complement activation, and facilitates attachment
293
why is liver resistant to infarct?
dual blood supply of hepatic artery and portal vein. Also arteries from phrenic branches, adrenal branches will supply it.
294
apical subpleural blebs are associated with what?
tall thin males in their 20s, and smoking
295
what kind/shape of nucleic acid do herpes viruses have? what kind of core?
linear dsDNA, icosahedron
296
Dane particle. what is it? what kind of nucleic acid? waht kind of core?
partially double stranded circular DNA. hexagonal core. This is HepB!
297
"worst headache of my life"...name 3 types of people at risk for this the most
this is subarachnoid hemorrhage
| Ehler Danlos, Polycystic kidney disease (AD), atrioventricular malformation
298
aortic regurgitation is best heard how?
patient leaning forward during expiration.
299
high pitched blowing diastolic decrescendo murmur. +/- presence of A2
aortic regurgitation
300
What is A2 heart sound?
S2=A2 and P2; A2 is first and loud. P2 is usually very quite and only heard in the P area
301
high pitched blowing early diastolic decrescendo murmur. +/- presence of A2
aortic regurgitation
302
what are two diuretics that work in the PT? what are their sideeffects?
inhibitors of carbonic anhydrase (Acetazolamide); SE=metabolic acidosis
osmotic diuretics Mannitol; SE pulmonary edema, increased intracranial pressure
303
pseudotumor cerebri tx?
Acetazolamide
304
sweating is controlled by what ANS branch and how
SNS via cholinergic stimulation
305
succinylcholine mechanism of action?
it mimics acetylcholine and depolarizes NMJ resultingin paralysis
306
How does neostigmine affect succinylcholine action in phase I and phase II?
Phase I neostigmine potentiates succinylcholine and results in prolonged paralysis
Phase II neostigmine inhibits succinylcholine and stops paralysis
307
What is syrup of Ipecac
emetic to induce vomiting immediately post ingestion of poison...but this is only effective if given immediately prior to metabolic derangements
308
what is in cryoprecipitate?
VWBF, fibrinogen, factors XIII and factorVIII
309
What do you give in rat poisoning?
this leads to depletion of vitamin K and all the factors
| Thus give vitamin K and fresh frozen plasma
310
molecular effect of NO?
increase in cGMP -->decreased calcium-->myosin light chain kinase dephosphorylation-->relaxation
311
acne in adult athelete...what do you think of?
taking androgens
312
4 key components of acne
1. excessive epidermal follicular proliferation
2. excessive sebum production
3. inflammation
4. p. acnes
313
cushingoid habitus. glucocorticoid excess causes this, but what OTHER pharm therapy causes this?
HAART therapy for HIV. mostly protease inhibitors inhibit chylomicron uptake and triglyceride clearance
314
babies can be falsely positive for HIV in the first few months why?
anti-gp120 crosses placenta...thus it will be positive on ELISA and western
315
do you treat osteoarthritis with steroids?
injections yes, systemic NO
316
H. pylori destroys what cells?
D cells (somatostatin decrease thus elevated acid)
317
what cancers are associated with H pylori?
gastric adenocarcinoma, gastric lymphoma, MALToma
318
what cancers are associated with H pylori?
gastric adenocarcinoma, gastric lymphoma
319
pulsus paradoxus definition? what is associated with it?
drop in systolic BP of more than 10 mmHg with inspiration
| cor pulmonale and constrictive pericarditis
320
sharp mid sternal pain that gets better with sitting up and worse with breathing
pericarditis
321
common causes of pericarditis. name 3
MI, rheumatic fever, uremia
322
cherry hemagioma
benign in elderly due to venous congestion. nevus looking but redder
323
strawberry hemagioma
AKA superficial hemagiomas
| in infants either bright if superficial or purple if deeper. often spontaneously disappears in late infancy
324
spider angiomas
increased estrogen due to pregnancy, OCP, or cirrhosis (decreased metabolism of estrogen)
325
HIV uses what receptor to bind CD4 and CCR5?
gp120
326
which part of the aorta is most suseptible to tearing during blunt trauma like a car accident? which part is the next susceptible part?
very first part of descending arota at the site of ligamentum arteriosum
distal ascending aorta
327
which part of the aorta is most suseptible to tearing during blunt trauma like a car accident? which part is the next susceptible part?
very first part of descending arota at the site of ligamentum arteriosum
distal ascending aorta is the next most susceptible
328
what reaction is most important in containing TB and subsequently causes damage?
delayed hypersensitivity
329
precision is the same as what
reliability
330
accuracy is the same as what
validity
331
Inhibition of mast cell degranulation is what drug?
Cromolyn (and Nedocromil)
332
intravenous/centra catheters are associated with increased incidence of what?
bacteremia. esp things that are naturally apart of skin flora... Staph epi, staph aureus, candida, enterococcus
333
What is "preexcitation syndrome"? what's the classic EKG findings (3 things)
It's wolff parkinson white... where the ventricle is "preexcited" by the bundle of kent.
Result: short PR interval, delta wave, and long QRS
334
what are the branches of celiac trunk?
common hepatic, L gastric, and splenic artery
335
What branches off the splenic artery?
Left gastroepiploic, short gastric
336
what branches off L gastric artery?
esophageal artery, and L gastric
337
What are the two large branches off common hepatic, and waht are their tributaries?
1. gastroduodenal--> supraduodenal, R epiploic, and superior pancreaticoduodenal
2. proper hepatic-->L/R hepatic, and cystic artery, R gastric artery
338
How can you tell acute respiratory acidosis from chronic respiratory acidosis?
acute will not have renal HCO3 compensation (30)
339
What is contraction alkalosis?
loss of volume-->aldosterone increase-->increased Na reabsorption and loss of H and K thus resulting in metabolic alkalosis
340
which cells are affected by sorbitol in DM and why?
lens, pheripheral nerve (schwann cells), blood vessels, kidney
because they don't depend on insulin to uptake glucose
341
which cells are affected by sorbitol in DM and why?
lens, pheripheral nerve (schwann cells), blood vessels, kidney
because they don't depend on insulin to uptake glucose. conversion to sorbitol increases osmotic pressure
342
what does stimulation of mu receptor do down stream?
mu receptor is a G protein...downstream it will inhibit adenylyl cyclase and cause decreased calcium. It will also increase Potassium efflux
343
constrictive lung diseases versus obstructive lung diseases...which one would benefit from lower frequency breathing which one would benefit from higher frequency breathing.
constrictive lung diseases=faster
obstructive= slower
both are trying to optimize workload. Elastic forces are greater at higher tidal volumes (AKA slower rate), and obstructive forces are greater at low volumes (AKA high er rate)
344
during ischemia... at what time point does myocyte stop contracting?
within a minute due to ATP depletion.
345
during ischemia...at what time point does myocyte dysfunction become permanent?
30 minutes
346
If ischemic myocyte is perfused after less than 30 min of injury... the myocyte will return to normal slowly over days. what is this called?
this is myocyte stunning
347
In global cerebral ischemia...what cells are most susceptible to injury?
hippocampal pyramidal cells and purkinje cells of the cerebellum
348
which vitamin deficiency develops after YEARS of dietary insufficiency?
cobalamin, B12
349
NADPH synthesized via HMP shunt is used to do what?
synthesize fatty acids, cholesterol, and steroids
350
Ribulose 5-phosphate is produced where and what are its fates?
HMP shunt.
| it can be catabolized in glycolysis OR used anabolically to build nucleotides and aromatic aminoacids
351
what is the committed step in purine syntehsis?
PRPP conversion to IMP via PRPP amidotransferase
352
PRPP is used in what pathways?
both de novo (PRPP amidotransferase) and salvage (HGPRT) pathways.
353
what is the committed step in purine syntehsis?
PRPP conversion to 5 phosphoribosylamine via PRPP amidotransferase
354
PRPP is used in what pathways?
both de novo (PRPP amidotransferase) and salvage (HGPRT) pathways.
355
Lesh Nyhan...what is decreased enzyme what is the increased enzyme?
decreased is HGPRT. increased PRPP leads to an increased activity of PRPP amidotransferase
356
what is Shiga toxin also called?
Verotoxin
357
what virulence factor does E. coli use to cause meningitis?
K1 antigen =CAPSULE. Most meningeal species have capsule
358
What does E. Coli use as virulence factor to cause spetic shock?
Lipid A -->recruitment of Macrophages -->IL6, IL1, TNFa
359
Ethambutol mechanism. SE?
mech: inhibits arabinosyl transferase-->inhibition of TB cell wall cross linking
SE: visual changes, and hepatic toxicity
360
Rifampin mechanism?SE??
RNA pol inhibitor. SE: orange secretions, hepatotoxicity
361
Isoniazid mechanism?SE?
inhibits mycolic acid synthesis. hepatotoxicity and peripheral neuropathy
362
Which elements are in the bronchi that are not in the bronchioles? what is the cell feature that disappears last in bronchioles
cartillage, serous, mucus glands stop at the smallest bronchi
Cilia continues in bronchioles to sweep up the fallen mucus.
363
how does cavedilol decrease overall mortality in CHF
it decreases cardiac work and decreases afterload
364
Milrinone mechanism? functional use?
it is a phosphodiesterase inhibitor. It increases cardiac contractiility and decrease BOTH preload and afterload (smooth muscle vasodilatioN)
365
tricyclic antidepressants can be effective for insomnia in what kind of pt
depressed pts
366
Buproprion. mechanism of action? use?
blocks Dopamine (mostly) and norepinephrin reuptake. Used for major depression (atypical antidepressant), smoking sessation.
Does NOT have sexual dysfunction SE thus great!
367
Buproprion contraindication
seizure pts, pts with hx of anorexia and bulimia
368
Potential seizure causing drugs? name 5
Buproprion, Isoniazid, clozapine, ciprofloxacin, Imipenem
369
Clozapine serious SE
agranulocytosis
370
persisting vitellin duct is related to what
meckles diverticulum
371
delayed puberty; cannot smell
Kallman syndrome. hypogonadotrophic hypogonadism
372
delayed puberty; cannot smell
Kallman syndrome. hypogonadotrophic hypogonadism due to hypothalamic dysfunction
373
Cryptococcus neoforman. Three types of stains for it?
India ink, mucicarmine (bright red), methenamine silver
374
which type of erythroblastosis fetalis can occur in the very first pregnancy, and which type occurs in the second pregnancy.
A/B antibody type in O mothers occur in the first pregnancy because A/B antigen exposure is likely through food throughout life.
Rh antibodies occur after exposure in the first pregnancy and affect the second baby.
375
Which antibody/antibodies cross placenta
only IgG
376
metformin SE?
GI and lactic acidosis.
377
metformin contraindications?
liver dysfunction, renal dysfunction, CHF, alcoholics, and sepsis
378
metformin general biochem action?
increase glycolysis, decrease GI glucose absorption, and decrease gluconeogenesis
379
multiple lesions in liver what is it? why is this common?
mets,
| liver is large, highly perfused via dual blood supply, and Kupffer cell filter all the bad things and keep it.
380
hepatic adenoma in a female? in a male? risk?
OCP=female; steroids=male; risk of rupture
381
hepatoblastoma is associated with what two conditions?
children with FAP, Beckwith-Weidemann
382
When is oral glucose tolerance test preferred over the fasting glucose measurement?
gestational diabetes
383
Type 1 diabetes could onset following what?
viral infection; especially in young white person
384
transmural segmental necrotizing inflammation of small and medium arteries. what is this? what organs are MOST affected?
this is polyarteritis nodosa. most affected are Kidney, GI, heart, and liver
385
esophageal varices without liver abnormalities?
portal vein thrombosis
386
what's the difference between budd chiari syndrome and portal vein thrombosis
budd chiari is in the hepatic vein...thus you will see hepatic congestion
portal vein thrombosis is in the portal vein prior to the liver. thus will NOT have any liver abnormlaities
387
mutation of neurofibromin in NF1 results the unchecked upregulation of what?
Ras
388
Tuberous sclerosis. Pts get rhabdomyomas and what other cardiac abnormality?
mitral valve regurgitation
389
what types of tissues may be in meckle's diverticulum? how is this detected?
gastric and pancreatic.
| 99mmTc Pertechnetate detects ectopic gastric mucosa (acid causes bleeding)
390
what types of tissues may be in meckle's diverticulum? how is this detected?
gastric and pancreatic.
| 99mmTc Pertechnetate detects ectopic gastric mucosa
391
Why can meckle's diverticulum lead to bleeding?
ectopic gastic mucosa... leading to acid excretion in to small bowel
392
what types of tissues may be in meckle's diverticulum? how is this detected?
gastric and pancreatic.
| 99mmTc Pertechnetate detects ectopic gastric mucosa in RLQ
393
how is copper excreted from the body? 2 routes...which one is the main one?
Mainone is bile excretion of copper and ceruloplasmin bound copper.
about 10% is excreted via renal tubular secretion.
394
what are the 2 defense mechanisms of fungal infections?
T cells and neutrophils
395
what kind of patient is at high risk for disseminated candidaiasis?
neutropenic. (NOT low T cell. low T cell=mucocutaneous candidiasis)
396
spaghetti meat ball with cigar shapped ends. what organism? treatment?
tinea versicolor; Selsun blue is treatment (selenium shampoo)
397
Tamoxifen raises risk of what? why?
it's a partial agonist of estrogen receptors in bones, endometrium, and heart.
Thus it raises risk of endometrial cancer and thrombosis
398
anastazole/letrazole (aromatase inhibitors) are best for what two kinds of breast cancers?
post menopausal and metastatic
399
Gliosis scarring is what material?
astrocyte processes
400
eosinophilic foamy alveolar material in lung biopsy of pneumonia.
Silver stain/Giemsa stain with cup in saucer appearance
Pneumocystic jiroveci
401
what shifts potassium out of cells?
```
Digitalis
Osmolarity
Lysis
Acidosis
beta blockers
```
402
causes of increased anion gap metabolic acidosis?
```
Methanol
Uremia
Dka
Propylene glycol
Iron or Isoniazide
Lactic acidosis
Ethylene glycol
Salicylate
```
403
Normal anion gap metabolic acidosis causes?
```
Hyperalimentation
Addison's
Renal tubular acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline
```
404
Ketamine mechanism of action?
blocks NMDA
405
opioid receptor cause what? how is tolerance achieved?
opioid is a Gi protein-->decrease in cAMP-->increase K efflux and decrease Ca depolarization.
tolerance is likely protein kinase phosphorylation leading to increased cAMP in cells
406
what can prevent opioid tolerance
NMDA blockers thus preventing protein kinase signalling to phosphorylate opioid receptors.
407
eye pain, history of arm pain, fatigue after hot shower. dx?
MS
408
eye pain, history of arm pain, fatigue after hot shower. dx?
MS
| decreased axonal transmission following heated environments.
409
lead inhibits which 2 enzymes of heme synthesis?
ALAdehydratatse
| Ferrochetalase
410
child with neurological sx, anemia, and lives in an Old house...what do you think of?
lead poisoning
411
how to diagnose princemetal angina?
ergonovine test--> causes vasospasm via stimulation of alpha1 and serotonin receptors.
412
describe calcium flow in skeletal muscle contraction?
excitation leads to L type calcium channel openning and immediate opening of Ryanidine receptors. They are coupled. and almost all calcium comes from the SR-->binding to troponin C
413
describe calcium flow in cardiac muscle contraction?
excitation leads to opening of L type receptors...the influx of calcium opens ryanidine receptors (Calcium induced calcium release)...thus most of calcium is from extracellular compartment. This then binds troponinC
414
Describe calcium flow in smooth muscle contraction?
calcium enters via L type channel upon deoplarization... induces ryanidine channel release of calcium...which binds myosin light chain kinase.
415
decreased B6 causes what kind of anemia?
sideroblastic
416
spoon nails (koilonychia) and dysphagia with anemia...what kind of anemia?
iron deficiency
417
dementia, ataxia, incontinence. dx?
normopressure hydrocephalus
418
what are the three control centers of micturition?
```
Sacral micturition center (PNS dominant induces bladder contraction)
Pontine micturition center (coordinates sphincter relaxation and bladder contraction in urination)
Cerebral cortex (inhibits sacral micturition center)
```
419
what is 16S rRNA? what does it do?
the Shine Dalgarno sequence 10 bp upstream of AUG codon. 30S ribosome is recuited here to start protein synthesis... 50S will join at AUG
420
what is 16S rRNA? what does it do?
the Shine Dalgarno sequence 10 bp upstream of AUG codon. 30S ribosome is recuited here to start protein synthesis... 50S will join at AUG (prokaryotes)
421
what class of drug is Oxybutinin? what is used for?
Oxybutinin is a antimuscarinic. It's used for urge incontinence/bladder spasm...
422
Organophosphate poisoning. If you give Atropine. what is the patient still at risk of?
Organophosphates irreversibly take out cholinesterases...so you have a ton of cholines floating around
Atropine is antiMuscarinic...thus acetylcholine excess at nicotinic receptor is still are exposed. Thus pt can have depolarization of NMJ and paralysis.
Pralidoxime regenerase cholinesterases...so it's the ultimate solution
423
what are some environemental ways of lead exposure?
```
old home,
old pottery/glaze
moonshine
batteries
ammunition
alloys
occupational-Inhaled
consumer-ingested
```
424
How to reduce flushing in Niacin use?
Asprin prophylaxis
425
Nniacin reduces synthesis of what?
VLDL. and thus also LDL because VLDL is converted to LDL when broken down
426
hypertriglyceridemia is associated with which lipid lowering drug?
cholestyramine
427
Two mechanisms of DM peripheral neuropathy?
1. small vessel hyalinization leading to nerve necrosis
| 2. sorbitol accumulation in schwann cells leading to apoptosis
428
Lipid within muscle finbers?
carnitine palmitoyltransferase deficency
429
pt with small cell lung cancer develops ataxia. what is this?
neuronal paraneoplastic syndrome. anticancer antibodies are formed to crosslink with purkinje cells of cerebellum...
Anti Yo, Anti Hu, AntiP/Q
430
Anti Yo, Anti Hu, anti P/Q are seen in what? specific types?
paraneoplastic syndromes of small cell lung cancer, breast, ovarian, uterine cancer
431
pt with small cell lung cancer develops ataxia. what is this?
neuronal paraneoplastic syndrome. anticancer antibodies are formed to crosslink with purkinje cells of cerebellum leading to degeneration...
Anti Yo, Anti Hu, AntiP/Q
432
Anti Yo, Anti Hu, anti P/Q are seen in what? specific types?
paraneoplastic cerebellar degeneration syndromes of small cell lung cancer, breast, ovarian, uterine cancer
433
What are somethings that will predispose someone to SMA syndrome?
mesentaric fat loss, lordosis, scoliosis correction
434
bowel ischemia due to blood loss is going to affect what portion of bowel? how might these patients present?
systemic hypotension affects splenic flexture.
These patients will present will abd pain and bloody diarrhea due to ischemic shedding.
435
what kind of amyloidosis can occur with dialysis?
beta microglobulinemia
436
Name 5 unusual conditions associated with carpal tunnel sydrome?
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Pregnancy,
hypothyroidism
DM
rheumatoid arthritis
DIALYSIS! (amyloidosis)
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437
IgG oligoclonal band on electrophoresis from pt with neuro symptoms
MS
438
Oligodendrocyte depletion is seen in what two diseases?
MS and PML (JC virus)
439
pathogenesis of centriacinar emphysema related to smoking?
Smoke and damage activates alveolar MACROPHAGES AND NEUTROPHILS-->release of proteases, which leads to breakdown of the tissue
440
What are club cells/Cara cells
non ciliated cells in terminal respiratory epithelium. it detoxifies inhaled smoke and it produces surfactant (in addition to type II pneumocytes)
