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1

Half life equation

t half= 0.7* Vd/ CL

2

Where is elastase produced in the lungs?

Macrophages and neutrophils

balanced by serum and tissue protease inhibitors

3

What is the effect of excess elastase activity in the lungs?

emphysema

4

paramesonephric duct is also called

mullerian duct

5

Law of conservation of mass

total flow=flow velocity x cross section area=constant

6

IL-12 does what?

stimulate Th1--> IFN gamma, IL-2--> macs and CD8 t cells

7

breakdown of odd chain FA, branched chain aa (valine, isoleucine), threonine, methionine leads to production of what?

propionic acid

can eventually enter TCA cycle as succinyl CoA

8

CGG repeat

Fragile X

Hypermethylation of FMR1 gene

9

Cystic hygroma and bilateral extremity swelling with decreased femoral pulses in a baby

Turners syndrome
loss fo paternal X

10

Reactive arthritis signs and symptoms

Can't pee, Can't see, can't climb a tree + sacroilitis (HLA-B27 association)

11

Psychosis during depressed episode

Major depressive disorder w/ psychotic features

12

Psychotic symptoms +/- mood disorder

Schizoaffective disorder

13

Dystrophic calcification

Ca deposition in abnormal (injured or necrotic) tissues
localized calcification (aortic stenosis)
Nl levels of Ca

damage can be from aging

14

local calcification of abnl tissue with normal Ca levels

Dystrophic calcification

15

Canagliflozin

SGLT2 inhibitor that blocks reabs of glucose in PCT

16

Contraindication for SGLT2

Renal impairment

17

what is in the femoral ring?

Lymphatics coming out of femoral canal

18

what is in the femoral sheath?

Femoral artery, vein, lymphatics

19

from lateral to medial what is the femoral triangle

Nerve, Artery, Vein, lymphatics (NAVeL)

20

effects of a chronic AV shunt on the heart

increased CO output
decreased total peripheral resistance
increased mean systemic pressure (renal retention)

Acute AV shunt no change in mean systemic pressure

21

Effects of pulmonary fibrosis on breathing?

rapid shallow breaths
increase elastic resistance

22

Immune SE of corticosteroids

Neutrophilia--> demargination
Immunosuppression
Increased risk of infection

23

Fever, generalized lymphadenopathy, facial edema, skin rash, eosinophilia + drugs

Drug reaction with eosinophilia and systemic symptoms (DRESS)

phenytoin, allopurinol, sulfonimides
2-8 wks after

24

Viral reassortment

only in segmented viruses
BOAR
Bunyavirus
Orthomyxovirus
Arenavirus
Reovirus

25

mutation in hemochromatosis

C282Y on HFE gene--> increases iron absorption in intestines
decreases hepatocyte hepcidin synthesis

HLA-A3

26

parotid gland hypertrophy with low body weight

Anorexia of the binging and purging flavor

27

parotid gland hypertrophy with normal body weight

Bulimia

28

Majority of OD deaths

opioids

29

Reaction formation

responding in a manner opposite one's actual feelings

30

Tx for mycobacterium avium

Azithromycin + rifavutin or ethambutol

31

fever, wt loss, diarrhea, anemia, hepatosplenomegaly, elevated alkaline phosphatase and lactate dehydrogenase, bacteria grows well at high temp

Mycobacterium avium

CD4 count

32

Proglitazone MOA

PPAR gamma binding
nuclear transcription regulator increases insulin sensitivity

33

tx for essential tremor

propranolol

34

Thiopental

Barbiturate
short acting general anesthetic
high lipid solubility so rapidly redistributed from brain to skeletal muscle and fat

35

cause of SE from Niacin

Prostaglandins (PGD2 and PGE2) cause flushing, warmth, itching

tx: aspirin

36

Diuretic that improves survival in pts with CHF + decreased EF

SPIRONOLACTONE
k sparing and improved remodeling of ventricles

37

Chlordiazepoxide

Benzo used for alcohol withdrawal

38

Chlorthalidone

Thiazide

39

Metabolic effects of Thiazide

HyperGLUC
Glycemia
Lipidemia (decreased insulin secretion increased resistance)
Uricemia
Calcemia

Hypo natremia --> inhibition of Na/Cl in DCT
Hypokalemia--> K wasting

40

patient with treated symptomatic coronary artery dz with myopathy

statin induced myopathy
esp when used with vibrates or niacin

41

SE of CCB

Peripheral edema, dizziness or lightheadedness, constipation

42

Amlodipine

CCB that acts on vascular SM
tx for HTN

43

Triamterene

diuretic
blocks Na+ channels in cortical collecting tubule
K sparing

44

tx for trauma pt who is obtunded with HTN

Mannitol

45

Tx for decompensated systolic HF

beta blocker (carvedilol)
decrease work and after load

46

beta blocker treatment for glaucoma

decrease aqueous production by ciliary epithelium

47

Tx for Psoriasis that activates a nuclear transcription factor

Topical Vit D analogs
calcipotriene, calcitriol, tacalcitol

48

Calcipotriene

Tx for psoriasis
activates a nuclear transcription factor
inhibit keratinocyte proliferation and stimulate keratinocyte differentiation

49

SE of glyburide

hypoglycemia

sulfonyurea (inhibit ATP depends K channels in beta cells leading to exocytosis of insulin)

50

SE of long term use of omeprazole

decreased Ca abs--> osteoporotic hip fracture
decrease serum Mg+

51

Ribavirin MOA

interfere with duplication of viral genetic material

52

SE of mu opioid (morphine)

smooth muscle contraction of the sphincter of Oddi
increases common bile duct pressure

also addiction, constipation, pin point pupils

53

effect of rat poison

super warfarin (brodifacoum)
deplete vitamin K clotting factors--> like warfarin toxicity
Tx: FFP

54

Medial hypertrophy in lung vessels, intimal fibrosis, luminal narrowing

Idiopathic pulmonary arterial HTN--BMPR2 gene

55

TX for pulmonary arterial HTN

Bosetan
endothelin receptor antagonist
vasodilator--> decreases PA pressure and decreases hypertrophy

56

interstitial myocardial granuloma with plump macrophages and increased cytoplasm.

Aschoff bodies with anitschkow cells

Rheumatic fever--> young kid with myocarditis

57

Fibular neck fracture

injured common peroneal n.

PED= Peroneal Everts and Dorsiflexes
Foot dropPED

58

Knee trauma

Tibial n. injury

TIP
Tibial Inverts and Plantarflexes
can't stand on TIP toes

59

RA antibodies

Anti-CCP (anti-cyclic citrullinated peptide)
Rheumatory factor (IgM anti IgG)

60

disease frequency in hardy weinberg

q^2

61

Interferon alpha and beta

Interfere with viruses
prime uninfected cells for viral defense
halt protein synthesis in uninfected cells

62

Interferon gamma

Th1 differentiation, increased expression of class II MHC APC, Improves intracellular killing by macs

produced by T cells and NK cells

63

Cause of pulses paradoxus with no pericardia effusion or constrictive pericarditis

Asthma and COPD

64

Down regulation of gastric acid production?

Intestinal infuence
peptide YY binds ECL
somatostatin and prostaglandins

65

Dyspnea, tachypnea, prolonged expiration, bilateral wheezing

obstructive pulmonary disease exacerbation

Tx; Beta agonist increases cAMP

66

Carbon tetrachloride

Free radical injury to liver (H2O2)
lipid per oxidation

67

where are intracranial schwannomas located?

cerebellopontine angle--> between cerebellum and lateral pons

68

Buprenorphine

partial opioid agonist
precipitates withdrawal

69

Uncle herniation effects

Down and out (oculomotor nerve palsy)
Blown pupil (dilated pupil)

70

Anxious, fearful of rejection, wants relationships, timid

Avoidant personality

71

How to test for fat malabsorption?

Sudan III stain of stool

72

Causes of SCC of the esophagus

Alcohol use, tobacco, smoked foods

73

Borderline personality disorder

SPLITTING
unstable relationships and mood
impulsive, self-mutilitation, emptiness

74

Colorectal, endometrial, ovarian cancer

Lynch syndrome

75

mutation in lynch syndrome

MSH2 and MLH1

76

Excessive emotions, attention seeking, sexually provocative, overtly concerned with appearance

histrionic personality disorder

77

Hormone sensitive lipase

degrades TGs stored in adipocytes
creates FFA and glycerol

activated by stress hormones (starvation)
inhibited by insulin

78

NF kappa B

controls transcription, cytokine production, cell survival

79

osteoclasts histology

multinucleate (2-5)

100s of nuclei in paget's

80

Receptor activation of NF kappa B ligand

RANKL--> differentiation of osteoclasts

81

Differentiation of osteoclasts

RANK-L and Mac colony stimulating factor

82

Osteoprotegerin

OPG
decoy receptor decrease binding of RANK-L to RANK
decreases differentiation of osteoclasts
increase bone density

83

late muscle changes in Duchenne muscle dystrophy

muscle in distal extremities replaced by fat and connective tissue (pesudohypertorphy)

84

Thinning of glomerular BM

Alport syndrome (type 4 collagen)
hearing loss, ocular abnormalities, hematuria, progressive renal insuff

85

Nesiritide

Synthetic BPN
dilates arterioles and veins
increase cGMP in smooth muscle
decrease after load and preload

86

Use of clevidipine

HTN emergency

87

equations for CO

SVxHR
=(rate O2 consumption)/(arterial O2 content - venous O2 content)

88

calculation of MAP

CO x TRP=2/3 diastolic + 1/3 systolic

89

Ejection fraction eq

EF=SV/EDV= (EDV-ESV)/EDV

90

SE of Doxorubicin

Dilated cardiomyopathy prevent with dexarzoxane

91

Nitrates effect

VENOdilator, decrease LVEDP and preload

92

Cilostazol

Phosphodiesterase III inhibitor
increases cAMP in plts inhibits plt aggregation
vasodilator
tx for claudication

93

Statin MOA

block HMG-CoA reductase leads to increased surface expression of LDL receptors

94

Dilated cardiomyopathy

ABCCCDHS
Alcohol abuse
(wet) Beri Beri
Chagras
Chronic Cocaine use
Chagas Dz
Doxorubicin toxicity
Hemochromatosis
Sarcoid

95

Causes of restrictive cardiomyopathy

diastolic dys
sarcoid, amyloid, post radiation
loftier syndrome (endomyocardial fibrosis w/ eosinophilic infiltrate)

96

DNA polymerase I

Degrades RNA primer

97

Which direction are deoxynucleotides added

3'end so building from 5 to 3

reading original strand 3 to 5

98

where are GI stem cells

Crypts of liberkuhn

99

Von Gierke enzyme

G6Pase

100

Enlarged hilar lymph nodes on CXR, elevated ACE and scattered granulomas in liver

Sarcoidosis

arthralgia

101

D cells in pancreatic islet and gut mucosa

Produce somatostatin

102

Diret inguinal hernia cause

breakdown of transversals fascia

older men

103

DIP joint pain, hard, bony enlargement of joints, brief morning stiffness

Osteoarthritis

DIP nodules--heberden
PIP nodules--bouchard nodes

104

Paranoid personality disorder vs. delusional disorder

Paranoid--pattern of suspiciousness or odd beliefs w/ no clear delusions

Delusional disorder--one or more delusions for >1mo. Otherwise normal behavior

105

Acute morbidity due to rheumatic fever

Pancarditis (inflammation of the endocardium myocardium and epicardium)

106

Associations with coarctation of the aorta

Turners, bicuspid aorta, other heart defects, Berry aneurysms of the circle of willis

107

Cause of death in adult type coarctation of aorta

HTN associated complications
LV failure, ruptured dissecting aortic aneurysm, intracranial hemorrhage

108

Effects of efferent arteriole constriction on GFR and FF

GFR increases
RPF decreases
FF increases

109

Hematuria, mild proteinuria and Discrete subepithelial humps on EM (recently treated for sore throat)

Post streptococcal glomerulonephritis

M protein
cola-colored urine
granular IF--lumpy bumpy deposits of IgG and C3

110

Schizoid vs. avoidant

Schizoid--voluntary withdrawal
Avoidant--Desires contact anxious about rejection and socially inhibited

111

CYP450 inhibitors

AAA RACKS IN GQ Mag
Acute Alcohol Abuse
Ritonavir
Amiodarone
Cimetidine
Ketoconazole
Sulfonamides
INH
Grapefruit juice
Quinidine
Macrolide's (minus azithro)

112

Neural crest cell derivatives

MOTEL PASS
Melanocytes
Odontoblasts
Tracheal cartilage
Enterocromaffin cells
Laryngeal cartilage
Parafollicular cells
Adrenal medulla
All ganglion
Schwann cells
Spiral membrane (heart)

113

fever, puritic skin rash and arthralgias 7-14d after exposure

Acute serum sickness
Type III hypersensitivity rxn

Decreased C3

small vessel vasculitis w/ fibrinoid uncross and PMNs

114

Type III hypersensitivity rxn

Immune complex
deposition of Ab-Ag complexes
leads to localized complement consumption--> decreased serum C3

115

AG resistance

amino glycoside modifying enzymes that attach chemical groups and decrease ability of drug to bind to ribosomes

116

Effects of myasthenia gravis on conduction

Autoantibodies against postsynaptic nicotinic ACh receptors

Reduced motor end plate potential

117

CN VII function

Motor for face
parasymp LACRIMAL, submandibular and sublingual glands
taste of anterior 2/3 of tongue
somatic-pinna and external auditory canal

118

COPD effect on kidney

Hypoxia stimulates erythropoietin production

119

Iliohypogastic n

Risk of damage during appendectomy

L1
motor to anterolateral ab wall
sen. suprapubic region

120

Ilioinguinal n.

follows spermatic cord through superficial inguinal ring
sensation to upper and medial thigh and part of genitals

121

hypotension, distended neck veins, distant heart sounds

Beck's triad

Cardiac tamponade

+pulsus paradoxus

122

increased JVD with inspiration

Kussmaul sign

impaired filling of RV
causes: constrictive pericarditis, restrictive cardiomyopathies, RA or RV tumors

123

Smooth area of the ventricles comes from

Bulbus cordis

124

the trabeculated parts of the right and left ventricles comes from

Primitive ventricle

125

What disease is associated with sterile small vegetation's made up of platelet rich thrombi on the mitral valve

Advanced malignancy (adenocarcinoma)
or hyper coagulable states
antiphospholipid syndrome
SLE (libman-sacks endocarditis)

126

Treatment for acute obstructive pulmonary exacerbations

Beta 2 adrenergic agonist

increases intracellular cAMP
Bronchial smooth muscle relaxation

127

ACE inhibitor side effect for people with HF or on diuretics

1st dose hypotension and syncope

High plasma renin activity
removal of Ang II vasoconstriction--> drop in BP

128

Appearance of pulsus paradoxus on physical exam

Due to cardiac tamponade
Drop in pulse amplitude during inspiration

129

Beat to beat variation in pulse amplitude

Pulsus alternans
Severe LV dysfunction

130

Electrical alternans

beat to beat variation in QRS amplitude on ECG due to swinging motion of hear in pericardial fluid due to effusion or tamponade

131

Vasculitis with granulomatous inflammation of the media

Giant cell arteritis
takayasu arteritis

132

Systolic pressure gradient between the LV and aorta is suggestive of...

LV outflow tract obstruction (aortic stenosis)

remember that dilated cardio myopathy is a diagnosis of exclusion

133

Pathogenesis of IE

first disruption of normal endocardial surface
Second focal adherence of fibrin and plts making a sterile fibrin-plt nidus.

134

migratory septic arthritis in a 25yo

Nisseria gonococci

135

tx: nisseria gonococci

Ceftriaxone

136

Causes of infectious arthritis

S. aureus, streptococcus, Nisseria gonorrhoeae

migratory and asymmetric

sinusitis, tenosynovitis, dermatitis

137

Vd equation

Vd=(amount of drug in body)/(plasma drug concentration)

138

Loading dose calculation

LD=Cp x Vd/F

139

First line for otitis externa

Fluoroquinolone's (ciprofloxacin)

140

primary amyloidosis

AL amyloid made up of ig light chain

seen in multiple myeloma (abnormal plasma cell dyscrasia)

141

Secondary amyloidosis

AA amyloid
Serum amyloid-associated protein (SAA)

increased by chronic inflammation (autoimmune states, TB, RA), malignancy and familial mediterranean fever

142

Multiple myeloma

CRABB
hyperCalcemia
Renal involvement (Bence-Jones casts from high ig in the urine, nephrocalcinosis, metastatic)
Anemia
Bone lytic lesions
Back pain

Monoclonal M protein

Rouleaux formation--stacking of RBCs

143

recurrent bacterial infections and no tonsils

X-linked (Bruton) agammaglobulinemia

Defect in BTK tyrosine kinase--> no B cell maturation

decreased Ig of all classes

144

Tetany (hypocalcemia), recurrent viral/fungal infections, ToF

Thymic aplasia
DiGeorge syndrome

absent thymic shadow on CXR
decreased T cells

145

airway and GI infections, autoimmune diseases, atopy

Selective IgA deficiency

decreased IgA with normal IgG and IgM
Anaphylaxis to IgA containing products

Type I hypersensitivity rxn

146

Effect of strenuous exercise on blood gas content

skeletal muscle removes more O2-->decreased O2 in venous blood

Muscle produces more CO2--> increased CO2 in venous blood supply

Increased CO2 in venous blood leads to decreased venous pH

147

Kinesin function

move from negative to + end (anterograde) of microtubule carrying vesicles and organelles away from cell body to nerve terminal

+ end is far away

148

PCP MOA

N-mentyl-D-aspartate receptor antagonism

agitation, hallucinations, violent behaviors
Horizontal AND vertical nystagmus

disorientation and memory loss

149

Diagnosis of Mucormycosis

Mucosal biopsy

150

Causes of elevated CK and myopathy

Inflammatory myopathy (polymyositis-prox ask weakness)
Statin-induced myopathy (weeks to months after starting statin)
Hypothyroid myopathy (hypothyroid features, delayed tendon reflexes and myoedema)

151

which enzyme determines the rate of glycolysis

phosphofructokinase

152

which non-glucose monosaccharide enters the glycolytic pathway downstream of phosphofructokinase?

Fructose

allows for rapid metabolism

converted to F1P-->glyceraldehyde--> G3P-->-->pyruvate

153

Histology of acute organ rejection

interstitial lymphocytic infiltrates

154

What is the purpose of giving fluids in hypovolemic shock?

Increase volume--> increase preload--> increase myocardial stretch--> increase stroke volume

155

Cancers associated with hereditary retinoblastoma

Soft tissue sarcoma
Osteosarcoma (distal femur, proximal tibia, proximal humerus)
melanoma
Brain cancers

156

Cause of Zener Diverticulum

abnl spasm or diminished relaxation of cricopharyngeal muscles while swallowing

increased pressure leads to herniation through pharyngeal mucosa through zone of muscle weakness-->false diverticulum

157

Live attenuated oral (sabin) poliovirus vaccine vs. inactivated Salk

Sabin greater mucosal secretory IgA immune response

better protection at the site of viral entry

158

chalky white lesions on mesentery with fat cell destruction and Ca2+ deposition

Acute pancreatitis

Acute interstitial pancreatitis--> edematous with Ca deposition

Necrotizing pancreatitis--> chalky white fat necrosis + hemorrhage

159

Heme-positive stools and noncaseating granuloma in colonic mucosa

Crohn dz

+ transmural inflammation
Cobblestone appearance
skip lesions

160

Microscopic morphology of ulcerative colitis

Crypt abscesses and ulcers, bleeding, NO granulomas

161

Follow up for elevated alk phos

Gamma glutamyl transferase (GGTP)

162

Abetalipoproteinemia

AR inability to synthesize apoB--> can not transport lipids from small intestine into blood--> enterocytes with clear or foamy cytoplasm

Clinical: first year malabsorption, low TG and cholesterol and NO chylomicrons or VLDL or apoB

Neurologic abnormalities (ataxia, retinitis pigmentosa)

Spiky blood cells (acanthocytes)

163

source of and cancer from G to T mutation in gene p53 associated with moldy grains

Aspergillus flavus and Aspergillus parasiticus grown on corn, soy and peanuts--> aflatoxins--> HCC

164

Gallbladder hypomotility risk factors

Pregnancy
rapid wt. loss
high spinal cord injuries
prolonged use of TPN or octreotide

165

Effect of gallbladder hypomotility

usually gallbladder reabsorbs water from bile so w/ bile stasis get bile concentration--> accumulation of particulate material--> biliary sludge

166

Black pigmented gallstones

chronic hemolytic anemia (SC) and increased enterohepatic cycling of bilirubin (crohn)

167

brown pigmented gallstones

increased amount of unconjugated bili from biliary tract infections (microbes producing beta glucuronidases)

168

Esophageal cancer prognosis

poor

169

solid food dysphagia, retrosternal discomfort, wt. loss in older man (>50) who smokes

Esophageal SCC

see keratinization and intercellular bridges

170

Right sided colon cancer

exophytic masses, iron deficiency anemia (fatigue, pallor) from bleeding. Also wt. loss, anorexia, malaise

171

Left sided colon cancer

infiltrating mass, partial obstruction, colicky pain, hematochezia, Apple core lesion.

172

What lines a pancreatic pseudocyst?

Fibrous and granulation tissue

173

abdominal wall pain, chronic diarrhea, wt. loss, regular alcohol use, calcification in the epigastric area

Chronic alcoholic pancreatitis

alcohol induced secretions of protein-rich fluids--> precipitate in duct--> duct plugs that calcify

174

what is worse Villous colonic polyps or Tubular polyps?

Villous