PQ review Flashcards
(234 cards)
1
Q
Organophosphate poisoning
A
Common in farmers, due to pesticide exposure. Irreversibly inhibits CHOLINESTERASE in both Mus and Nic synapses. Atropine only reverses the muscarinic symptoms. Nicotinic muscle paralysis risk continues.
2
Q
DUMBELS (excessive cholinergic stimulation - Muscarinic)
A
Diarrhea/diaphoresis Urination Miosis Bronchospam Emesis Lacrimation Salivation
3
Q
Pralidoxime
A
Reverses both muscarinic and nicotinic effects of organphosphates.
4
Q
Standard deviation bell curves
A
68% within 1SD (in either direction)
95% within 2SD, the tails are each 2.5%
99.7% within 3SD.
5
Q
CF enzyme supplementation
A
CF pts present with recurrent URI (Pseudomonas aureginosa), chronic diarrhea and subsequent weightloss. The diarrhea is due to fat malabsorption, thick mucus plugs the pancreatic ducts, and can be treated with pancreatic lipase supplementation.
6
Q
IL8
A
IL8 a chemokine produced by MO, induces chemotaxis of PMN. Other chemotactic agents, LTB4, C5a, bacterial products
7
Q
what are the host defenses against mycobacterium?
A
Depend on i/a between MO and Th1 cells. MO infected with mycobacterium secrete IL12 which stimulates Th1 release of INF-gamma. IFN-gamma binds on the MO receptor and triggers the JAK/STAT1 pathway, leading of transcription to promote mycobacterium killing.
8
Q
Right suprarenal and gonadal veins vs. Left
A
RIGHT: Go straight to the IVC.
LEFT: Go the left renal vein first.
9
Q
On which side are varicocceles more common?
A
On the left, the left gonadal vein enters teh left renal vein perpendicularly. Also the left renal vein passes underneath the Superior Mesenteric artery and aorta, can ge compressed.
10
Q
What is the most common shoulder dislocation?
A
Anterior dislocation. Usually due to injuries involving external rotation and abduction of shoulder. Classic flattening of deltoid with loss of sensatin over lateral arm (axillary nerve).
11
Q
What are the geographical variations of Schistosomiasis?
A
Urinary-Middle to North Africa
Intestinal - Sub sahara Africa, South America
Hepatic - Asia
12
Q
1/TPR
A
1/R1 + 1/R2 + 1/R…
13
Q
What needs to be given with Foscarnet?
What about Amphotrecin B?
A
Magnesium and Calcium. Foscarnet is a pyrophosphate analog and can chelate calcium. Foscarnet also induces renal wasting of magnesium.
Amphotrecin B - Potassium and magnesium.
14
Q
What determines the onset of action of a gas anesthetic?
A
Depends on solubility in the blood. More soluble drugs have a slower onset of action and require more drug to saturate blood.. Poorly soluble drugs have a quick on set of action with less needed to saturate blood.
15
Q
How do you prevent Malaria relapse?
A
Treat with Primaquine, specially important if patient contrats Malaria in a choloroquine sensitve region (Africa).
16
Q
What are the complications of Chronic Kidney Disease?
A
Osteodystrophy (defective bone formation)
Decrease in GFR + decreased formation of 1, 25 vit D with phosphate retention. The two lead to a hypocalcemic state. In addtion, there is secondary hyperparathyroidism due to high serum phosphate and low serum calcium.
17
Q
What do VIPomas do?
A
non-beta cell pancreatic tumors. Lead to pancreatic cholera, aka WDHA syndrome. Watery diarrhea, hypokalemia, and achlorhydria.
18
Q
What is the histological presentation of Kaposi Sarcoma?
A
Spindle shaped tumor cells with small vessel proliferation
19
Q
What are essential tremors and how are they treated?
A
Also called familial tremor, may follow AD inheritance pattern. It is a slow progressive symmetric tremor, associated with position and most common in the upper extremities. Treat with Propranolol.
20
Q
What is the treatment for viral bronchitis?
A
Usually due to RSV (respiratory syncytial virus). Use Ribavirin (inhibits IMP dehydrogenase).
21
Q
How do Granulosa cell tumors present?
A
Granulosa cell tumors produce a lot of estrogen. They present as endometrial hyperplasia with an adnexal mass (ovary or fallopian tube). On histo: CALL-EXNER BODIES. small follicles with eosinophilc secretions.
22
Q
What does GFAP and Synaptophysin stains tell you?
A
GFAP positive stains indicate tumors of glial origin.
Synaptophysin positive stains indicate tumors of neuronal origin.
23
Q
How do you treat Hemochromatosis “bronze diabetes”?
A
Deferoxamine, iron chelator.
24
Q
How do you treat lead poisoning?
A
Dimercaprol or EDTA (Calcium sodium edetate)
25
PAH
Both filtered and secreted. A good approximation of RPF. Secretion is enzyme mediated and can be saturated.
26
How does hypercalcemia happen in sarcoidosis?
Due to actived MO converting vit D to its active form.
27
What are intracytoplasmic yellowish brown granules in a myocardial cell?
Lipid peroxidation causes this. Due to free radical injury and lipid peroxidation. Usually seen in the heart and liver of aging malnourished patients.
28
What causes chronic mesenteric ischemia?
Atherosclerosis, just like angina. There is a diminished blood supply to an area. At times of increased metabolic need pain presents due to insuffiencent perfusion. This helps to explain the presentation of post prandial (meal) pain, weight loss (fear of eating), with a normal esophageal series
29
How does botulin toxin work? How does it present?
It prevents the binding and fusion of acetylcholine containing vesicles with plasma membrane. It presents as a descending paralysis with diploia, difficulty speaking and dysphagia as the first set of symptoms.
30
RRR equation
RRR= [AR (control) - AR(treatment)]/AR (control)
31
How does mushroom poison work?
Amatoxins found in mushrooms are transported to the liver via portal circulation. There AMATOXINS bind to RNA polymerase II and halt mRNA synthesis. Other organs with high turnover are also affected.
32
How does hydrocephalus present?
Irritability, poor feeding, and huge heads (2 SD) due to enlarged ventricles. Causes UMN lesions due to streching of periventricular pyramidal tract.
33
What are the clinical characteristics of Friedreich Ataxia?
AR inheritance. Mutation on chromosome 9, trinucleotide repeats. Associated with hypertrophic cardiomyopathy, DM, kyphoscoliosis, and foot deformities.
34
What's the most potent diuretic?
Loop diuretics. Inhibit the NKCC symporters of the ascending thick limb of the loop of henle. s/e: hypokalemia, hypomagnesimia, hypocalcemia.
35
What's a juvenile hemangioma?
Strawberry colored benign and very common. Usually get larger before they regress. They are composed of unencapsulated aggregates of closely packed thin walled capillaries.
36
What to look for in Alzheimer's pt MRI?
Hippocampal atrophy.
37
What are the two general causes of polyhydramminos?
fetus is not swallowing or peeing too much.
38
What is the main limitation of Hep D?
It is replication deficient. Can only cause infection when encapsulated with HBsAg. Hep D infection is either a co infection with Hep B, or a superinfection in a chronic Hep B patient.
39
What is the main characteristic of the endoplastic reticulum of steroid producing cells?
A well formed SMOOTH ER.
40
Which diuretic should be used in a pt with hypercalciuria?
Hydrochlorothiazides. One of their effects is increases calcium reabsorption. You can also use citrate to acidify the urine and prevent stone formation.
41
What do Diffuse Esophageal Spasm mimic?
Angina. DES are uncoordinated contractions of the esophagus. May cause dysphagia and c/p.
42
What's a common side effect of Nitrates?
Headaches and cutenaus flushing.
43
What should be the main concern for young patients with recurrent kidney stones?
Think of metabolism errors. Cystinuria is due to renal proximal tubules defect, failure to reabsorb cystine. On AU pathognomonic HEXAGONAL CYSTINE CRYSTALS. The sodium-cyanide-nitroprusside test (urine turns RED) is diagnostic.
44
How do you treat HIT?
d/c heparin, start on direct thrombin inhibitors that do not require antithrombin III. HIRUDIN, LEPIRUDIN, AND ARGATROBAN.
45
What's the first factor to be affected in liver dz?
Factor VII, shortest half-life. PT, extrinsic pathway.
46
What's the diagnosis in a patient with elevated METHYLMALONIC ACID in both urine and blood?
Failure of Methylmalonly CoA Isomerase (vit B12 cofactor). Isomerizes Methylmalonyl CoA to Succinyl CoA (enter the TCA cycle).
47
What are the histological characteristics of HCM?
Myofiber disarray and interstitial fibrosis. Due to gene mutation that codes for cardiac sarcomere proteins (beta myosin heavy chains)
48
What causes ischemia of the inferior wall of the heart?
Occlusion of the RCA. Would also present with bradycardia, due to ischemia of the AV node supplied by the RCA.
49
What is the best test to confirm Temporal artheritis?
ESR. then give corticosteroids until confirmed by temporal artery biopsy.
50
DKA metabolic changes
Elevated anion gap due to accumulated acetoacetate. A compesatory metabolic response leads to decreaesd bicarb, and hyperventilation causes a a compensatory respiratory alkalosis. So patient will have low pH, low PCO2 and low Bicarb.
51
Besides imaging, how can you tell the difference between adult and infant type coartations of the aorta?
Enalrged palpable intercostal vessels. These indicate collateral circulation distal to the coarctation. There will be notching of the ribs on X-ray
52
What's the difference between a myoclonus and a dystonia?
myoclonus are sudden and brief. Epilepsy and CJD
| Dystonias are sustained involuntary muscle contractions. eg Torticollis.
53
What does anemia with neurological abnormalites point to?
Vit B12 deficiency. Leads to a megaloblastic anemia.
| Neurological damage comes from abnormal myelination.
54
What are the symptoms of congenital hypothyroidism?
Lethargic, poor feeding, prolonged jaundice, constipation and muscle hypotonia. There is also large tongues and myexdema. In addition to neruological symptoms.
55
What is the median?
Number that separates top and bottom halfs of data set.
56
Prolactin regulation
Prolactin secretion is inhibited by the hypothalamus via dopamine production.
57
What is the mutation in Douchenne's muscular dystrophy?
A mutation of the dystrophin gene (on X chromosome). Dystrophin is a structural component of skeletal muscle fibers.
58
How to treat female infertility?
Give menotropin (acts like FSH) and then give a single dose of hCG to stimulate LH surge and ovulation.
59
What's the phosphorylation state of active Rb and what does it do?
The active state of Rb is hypophosphorylated. It prevents damaged cells to go from G1 to S.
60
What doe Homeobox genes code for?
Transcription regulators
61
How do pulmonayr abscess form?
These are local suppurative collections c/i lung parnechyma. They present as round densities with air-fluid level. They are due to lysosomal content release by MO/PMN.
62
What does candida albicans look like?
Ball and stick. Described as budding yeast with pseudohyphae.
63
Who fights candida albicans infections?
T-cell mediated for local infections and PMN for systemic. Helps to explain why HIV pts get localized candida albicans infections more often than systemic.
64
Childhood mucocutaneous bleeding
Glanzmann thrombasthenia (defect in GIIb/IIIa
65
What's the treatment choice for pt with absence and tonic clonic seizures?
Valproate if both.
| Ethosuximide for absence seizures only.
66
What enzyme metabolises 6-MP?
Xanthine Oxidase, this is why drug dose has to be alterd for pts on Allopurinol
67
What's the best treatment option for Staph Epidermidis (coag neg, cat +, gram pos cocci)?
Vancomycin. They tend to be resitant to Penicilin and Methicilin
68
What do the Aspergillus aflatoxon affect?
P53 in liver cells, leads to HCC.
69
What's the main s/e of Amphotericin B?
Nephrotoxic
70
What is the characteristic hepatic finding in Reye's syndrome?
Microvesicular steatosis.
71
Where is the majority of air resistance in the airways?
In the medium and small sized bronchi. Airway resistance is minimal in the bronchioles.
72
What's a cranipharyngioma?
Calcified cystic masses. They are derived from remnants of Rathke's pouch, the embryonic precursor to Anterior pituitary.
73
Describe the neurological syndrome associated with Vit B12 deficiency.
Vitamin B12 deficiency leads to abnormal myelin synthesis and degeneration of the dorsal columns (vibration/propiception presenting as gait abnormalities c eyes closed).
Lateral corticospinal tract (UMN type lesion)
Axonal degeneration of peripheral nerves numbness and paresthesias (burning, prickiling)
74
What's the most common cause of urination problems in men?
BPH. Causes straining on urination. Symptoms include frequency, urgency, and nocturia. Plus hesitancy to start flow. The increase in pressure causes characteristic hypertrophy, with atrophy of the urether and calyces.
75
What does HBeAg tell you?
A marker of viral replication and infectivity.
76
Where is the lowest osmolarity in the nephron?
At the distal convoluted tubule.
77
How do thyroid hormones work?
They bind to THR, a nuclear receptor and control gene expression.
78
Where is the lowest pulmonary vascular resistance?
At functional residual capacity. FRC = ERV + RV.
79
What happens to skin when we get old?
Wrinkles, due to decreased synthesis and net loss of dermal collagen and elastin.
80
What can give you diarrhea and can also come from domestic animals?
Campylobacter infections. Cause inflammatory gastroenteritis.
81
What are the classifications of hearing loss?
Conductive and Sensorineural
82
To which ears does Weber localize in conductive hearing loss?
In conductive it is localized to the affected ear.
83
To which ear does Weber localize in sensorineural hearing loss?
In sensorineural it is localized to the unaffected ear.
84
What does an abnormal Rinne test tell you?
If bone>air, abnormal. A conductive loss.
85
What's the best way to diagnose mucormycosi>
Mucosal biopsy. Broad nonseptate hypae at righ angles. The mucormycosis include Mucor, Rhizopus and Absidia. Usually seen in diabetics in DKA. Usually present with necrotic tissue in nasal cavity.
86
What are nafcillin, methicillin and oxacillin used for?
These are penicillinase resistant penicillins used for penicillinase producing S. Areus. Commonly given for skin infections, where staph is the usual causitive agent.
87
Which drugs can cause myopathy?
Fish N CHIPS Give you MYOPATHIES. Fibrates, Niacin, Colchicine, Hydroxychloroquine, Interferons, Penicillamine, Statins, Glucocorticoids
88
What do you need for PCRs?
Primers to the regions flanking the desired sequence.
89
What's degenerated in Freidreich Ataxia.
ascending and descending spinocerebellar tracts - cause of the ataxia.
They also have high foot arches, DM, and hypertrophic cardiomyopathy.
90
What class of drugs is contraindicated with benzodiazepines?
First geneartion H1 blockers. Massive sedation when combined.
91
What stays normal in ARDS?
Capillary Wedge Pressure. Indicates that pulmonary congestion in ARDS is not from cardiac complications.
92
What do Takayasu arteritis and temporal arteritis have in common?
Granulomatous inflammation of the media.
93
What cancer is CA-125 a marker for?
Ovarian
94
What happens to pancreas in DM type 2?
Pancreatic islet amyloid deposition. Early in the disease course insulin production increases to counter the increased peripheral resistance. Amylin is cosecreted with insulin and accumulates in the pancreas of diabetic type 2.
95
What is the most common cancer in nonsmokers and smokers?
Adenocarcinoma for both cohorts.
96
What disease is associated with non-rhythmic conjugate eye movement, hypotonia and myoclonus (twich)?
Neuroblastomas
97
What are the consequences of Vit E deficiency?
Increased susceptibility of neuronal and erythrocyte membranes to oxidative stress.
98
What are the classic signs of a GLUCAGONOMA?
Diabetes mellitus, necrolytic erythema usually affecting the groin and anemia.
99
What are the adverse effects of Succinylcholine (depolirizing neuromuscular blocking agent)?
```
Malignant hyperthermia (specially with halothane)
SEVER HYPERKALEMIA in pts with burn, myopathies and crush injuries.
```
100
How do you prevent Strep Agalactiae vertical transmission?
Intrapartum ampicillin to the mother.
101
How do ras mutations affect the cell?
ras is a proto-oncogene that codes for proteins that participate in MAP-kinase signal transduction pathway.
102
what is the final water and sodium state in SiADH?
The increased water retention leads to dilutional hyponatremia. It also leads to a transient increase in ECF. However, compensatory response leads to further loss of Na (to normalize the ECF). You end up with a NORMAL ECF. EUVOLEMIC HYPONATREMIA.
103
What are the effects of ANP?
Kidney - dialates afferent arterioles. increases GFR and urinary Na and water excretion.
Adrenal gland - restricts aldosterone secretion
Blood vessels - relaxes vascular smooth muscle arterioles and venules.
104
What are the effects of IL-2?
Stimulates B cells, induces proliferation/differentiation of helper T-cells, Activates MO and NK cells. Promotes growth and INF gamma secretion from Th1 cells.
105
Which NTs reuptake are inhibited by coccain
Dopamine, NE, seratonin. Same MOA as TCAs
106
Where does H. pylori like to live?
In the PREPYLORIC AREA, there are less acid secreting parietal cells.
107
What's the best way to prevent catheters infections?
Wash your paws.
108
What is the marker for small cell carcinomas?
Neurofilaments. SCC show evidence of neuroendocrine differentiation. So they stain for neuronal markers such as enolase, chromogranin, and synaptophysin.
109
How do tetracyclines work?
interfere with t-RNA binding to A site
110
How does streptomycin work?
inhibits initiation of protein synthesis. binds to 30S ribosomal subunit.
111
What composes most of the anterior surface of the heart?
Right ventricle.
112
What's the reason behind hepatic encephalopathy?
Failure of the liver to process nitrogenous waste products. Leads to increased levels of ammonia.
113
What's a saccular aneurysm?
Same thing as a berry aneurysm. Usually leads to subarachnoid hemorrahge and classic sudden onset of super headache.
114
What is hCG similar to?
TSH. In patients with testicular tumors secreting large amounts of hCG hyperthyroidism can develop.
115
What's the difference between ectopic and metaplasia?
Ectopic is a congenital malformation, tissue where is not supposed to be. Metaplasia is the change from one type to another in response to a stress.
116
Whats the best treatment for bendy worms?
Mebendazole
117
What's the best treatment for schistosomas?
Praziquantel
118
How do you manage malignant hypertension?
Nitroprusside and Fenoldopam (D1 agonist)
119
What's the best drug for a pt with HTN and low renal perfusion?
Fenoldopam. Improves renal perfusion and lowers BP. It also promotes Na and Water excretion.
120
What's the first line test for DM type 1?
Fasting blood sugar.
121
What are the ranges for confidence interval (alpha = 0.05)?
Mean +/- 1.96 x SD/√n
122
What causes warfarin induced necrosis?
Pts with deficient protein C or S. The absence of either causes an exagerrated imbalance, causing a hypercoagulable state with thrombotic occlusion and skin necrosis.
123
What's the most common hemolytic anemia due to RBC defect?
Hereditary spherocytosis. Due to mutations in plasma scaffolding proteins, spectrin and ankyrin.
124
Which mutation is needed for adenomatous polyps in normal colonic mucosa?
APC
125
To which side does the trachea deviate in pleural effusions?
It deviates away from the opacified site. The higher pressure in the opacified side pushes the trachea away, towards the unaffected lung.
126
To which side does the trachea deviate in obstructive lesions?
It deviates towards the collapse lung. The collapse lung has less pressure than the functioning lung and the trachea gets pushed towards the lower pressure side.
127
Why does PMN count increase after prednise use?
PMN count increases after glucocoricoid use due to demargination of leukocytes previously attached to vessel wall.
128
What are the classic clinical features of osmotic demylination?
Quadriplegia (due to demyelination of corticospinal tract) and psedobulbar palsy (due to myelination of CN IX, X, and XI). Shows as head and neck muscle weakness, dysphagia,, and dysarthria.
129
What's the difference between a benign lymph node enlargement and malignancy?
Benign enlargement is associated with a polyclonal proliferation. Malignancy (cancer) enlargment is associated with monoclonal expansion.
130
Hematuria with a renal mass, what can it be?
Renal Cell Carcinoma, often associated with VHL mutations, located in the 3p chromosome arm.
131
What's the cause of cottage cheese vulvovaginitis?
Candida infection, often facilitated by antibiotic regimens that knock out the Gram pos vegitation of the veggie.
132
What's the golgi tendon organ?
A feedback system that monitors and maintains muscle force. Sensitive to increases in muscle tension but not to passive stretch. When a muscle exerts too much force, the golgi tendon organ inhibits contraction of the muscle, sudden relaxation occurs.
133
What causes right sided endocardial fibrosis (pulmonary stenosis and restrictive cardiomyopathy)?
Carcinoid syndromes. Severity correlates with levels of seratonin or it's metabolite 5-hydroxyindoleacetic acid
134
What does the brachiocephalic vein drain?
Ipsilateral jugular and subclavian veins. Obstruction causes one sided SVC syndrome.
135
What's the embryological origin of Neurofibromatosis I?
Neural crest cells. It presents with cafe au lait spots and gliomas. NF1 mutation on chromosome 17.
136
Which amino acids are only ketogenic?
Lysine and Leucine (the L's like the K's)
137
How does Corynebacterium diphtheriae acquire its capacity to make pseudomembranous pharyngitis?
Phage conversion permiting exotoxin production. Acquires tox gene, codes for diphtheriae AB exotoxin.
138
Women cancer incidence and mortality
incidence breast>lung>colon
mortality: lung>breast>colon.
colon at the end.
139
Bipolar with seizures. What's the best treatment
Valproic acid, both an anticonvulsant and mood stabilizer.
140
What are the three mood stabilizing agents?
Lithium, valproic acid and carbamazepine.
141
Which SERM is associated with endometrial hyperplasia?
Tamoxifen. Although it is also usefull for osteoporosis.
142
What's the main mechanism for the development of varicose veins?
Imcompetence of venous valves.
143
What is the main cause of hepatic steatosis?
Decreased free fatty acid oxidation
144
How does Meniere's disease present?
Tinnitus, vertigo and sensorineural hearing loss.
145
What's the cause of urine coming out through the umbilicus?
Perisistent allantois remnant. The allantois forms the urachus, a duct between the bladder and the yolk sac.
146
What are fibronectins?
Mediate the integrin binding to BM and ECM. Mediated by integrins to fibronectin, collagen, and laminin.
147
What's the deficiency in Hemochromatosis?
Deficient intestinal absorption of dietary iron, leading to excessive absorption and storage.
148
What's the neurological manifestation of wilson disease?
Basal ganglia atrophy (neuropsychiatric complications)
149
Which systemic mycoses hides inside macrophages?
Histoplasma (Ohio and Mississippi River valleys)
150
What's the most common presentation of amyloid angiopathy?
Recurrent hemorrhagic strokes in elderly patients. Due to beta amyloid deposition in the arterial wall, leads to weakening and rupture.
151
What's the main difference between hypertensive hemorrhagic strokes and recurrent hemorrhagic strokes?
Hypertensive strokes tend to be larger and involve the basal ganglia.
Recurrent strokes are lobar and smaller in degree and severity.
152
Where's the damage in Korsakoff syndrome?
Medial Dorsal Nucleus
153
Why can you get recurrent Neisseria gonorrhoeae infections?
High variability of microbial antigenic structure. You never get the same gonorrhea twice.
154
How does Sporothrix schenckii present?
Initial lesion - a reddish nodule that later ulcerates. It spreads along lymphatics. Histo would show a granuloma.
155
What's are classic lab values of a metabolic alkalosis?
high pH, HCO3 and pCO2. Most commonly due to vomiting. Check volume state and chloride levels.
156
What class of drugs can exacerbate Prinzmental anginas?
5HT agonist. Sumitriptan (used for migranes).
| Ergonovine - an ergot alkaloid (affects both adrenergic and serotonin receptors).
157
What's the difference between B1 and B2 blockade?
B1 blockade decreases heart rate
| B2 blockage causes bronchoconstriction and wheezing.
158
Thiamine (vit B1) is a cofactor for which reactions in glucose metabolism?
Pyruvate Dehydrogenase (glycolysis to TCA)
alpha-ketoglutarate dehydrogenase (TCA)
Transketolase (HMP shunt)
159
What are the complications of EBV infection?
Mono, nasopharyngeal carcinoma, and Burkitt's lymphoma.
160
What are the effects on the fetus of maternal rubella infection?
Deaf (sensinural), cataracts, and PDAs
161
What's the only drug that increases contractily and RBF?
Dope dopamine.
162
What's the best way to correct QRS elongations due to TCAs?
Sodium bicarbonate. Corrects the QRS prolongation, reverses hypotension, and treat ventricular dysrhythmias.
163
What's Jervell and Lange-Nielse syndrome?
AR conditition with congenital QT interval prolongation (torsades du pointes) and neurosensory deafness.
164
Where does the green color come from in some sputum samples?
Myeloperoxidases from PMN azurophilic granules. MPO has heme in it.
165
Where are most anal fissures?
Midline posteriorly, distal to dentate line.
166
What happens in prion disease CJD?
There is a transformation of prion proteins from alpha to beta sheets, they become resistant to protesomal degradation and accumulate. Spongy brain.
167
What's the difference between left sided (desending) and right sided (ascending) colon cancer?
Presentation.
Left sided presents with abdominal pain, distention and nausea. Present like an obstruction.
Right sided presents with systemic findings and anemia.
168
What causes lynch syndrome?
Autosomal dominant defect in mismatch repair
169
What causes ataxia telangiectasia?
non homologous end joining.
170
What effect does fluid accumulation in LV failure have on lungs?
Decreased compliance. There is an increase in the pressure accross the system, transmitting to the pulmonary veins and causing transudate across the capillaries. The presence of fluid causes the decrease in compliance.
171
What's the female athlete triad?
Anorexia Nervosa.
| eating disorder, amenorrhea, and osteoporosis
172
What CD 4 count is associated with PCP or Pneumo.. jivorecii?
CD < 200.
173
Most common cause of pneumonia in immunocompetent host?
Strep Pneumo.
174
Drugs interactions implicated in Serotonin syndrome?
```
Antidepressant (SSRI, SNRI, MOA, TCA)
Analgesics - TRAMADOL
Antiemetics - ONDANSENTRON (5HT anta)
Antibiotics - LINEZOLID
Neuropsychiatric TRIPTANS
```
175
What risk is increased by ACE/beta blocker combinations?
Hyperkalemia.
176
What are patients at risk of with their first ACE dose?
Hypotension. Always ask about their Thiazide use.
177
What's the deficiency in SCID?
Adenosine deaminase deficiency. Prevents DNA synthesis via feedback inhibition of ribonucleotide reductase.
178
What are the neuroendocrine markers for cancers?
Enolase
Chromogranin
Synaptophysin
179
What's the best way to hear AR?
With pt leaning forward on the left sternal border at the end of expiration.
180
What's the cause of hyperchylomicronemia?
Deficiency or Lipoprotein lipase or altered apolipoprotein C-II. Causes Pancreatitis.
Autosomal recessive.
181
Describe Buerger's Disease
Also called Thromboangiitis obliterans. Usually seen in heavy smokers in 30's. Presents with segmental thrombosing vasculitis and extends into veins and nerves. Creates fibrous tissue around them.
182
What's passive immunity?
Preformed antibodies. Think of antitoxins
183
What's the cause of Esophageal dysmotility in CREST syndrome?
Fibrous replacement of muscularis.
184
How does fibromyalgia present?
Widespread msk pain associated with stiffness, paresthesias (tingling, pins), poor sleep and emotional disturbances.
185
What's a complication of any hemolytic anemai?
Pigmented gallstones.
186
List all the cyanotic congenitl heart diseases?
```
Tetralogy of Fallot
Tricuspid Atreisa
Transposition of the great vessels
Truncus arteriosus
Total anamalous pulmonary venous return.
```
187
Which cardiac condition is alleviated by squating?
TOF
188
Define anaplasia
UNDIFFERENTIATED TUMORS - DO NOT LOOK LIKE THEIR TISSUE OF ORIGIN.
189
What are the two types of hepatoxicity associated with inhaled anesthetics?
Type I mild ALT elevation
| Type II liver failure (elev ALT/AST, increased PTT). On histo: centrilobullar hepatocellular necrosis.
190
Which artery supplies Broca's and Wernicke's areas?
Middle Cerebral Artery.
191
What are the two common presentation of sciatic nerve injury and their associated root levels?
L5 - typically results in posterior and lateral thigh and leg pain shooting to the inner foot.
S1 pain in the posterior thigh and leg shooting to foot. There is accompanying weakness of plantar flexion and loss of ankle jerk reflex.
192
What's the cause of catch scratch fever?
Bartonella hensale. It can cause bacillary angiomatosis in immunocompromised patients. In immunocompetent patients, it causes low fever, lymphadenopathy (self limited)
193
How do you treat paroxysmal supraventricular tachycardia (PSVT)?
Adenosine, but be ready for the flushing, SOB, and chest burning that follows.
194
What maintains respiratory rate?
Medullary respiratory centers. Depends on input from central and peripheral chemoreceptors and airway mechanoreceptors.
195
What are the triggers for central and peripheral chemoreceptors?
central - pH
| peripheral - hypoxia (aortic CN X and carotid CN IX)
196
Treatment for narcolepsy?
Modafinil
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Who is at risk of mucor, rhizopus and absidia?
DKA diabetics and immunocompromised patients.
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Kidney complication s/p MI?
Acute Tubular Necrosis from low cardiac output. Low urine output with elevated BUN an creatine.
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Blotchy red muscle fibers on Gomori trichome stain
Mitochondrial myopathies.
200
Neurological complication of ADPKD?
Berry aneurysm, can burst and lead to subarachnoid hemorrhage.
201
GGT elevations, what do they point to?
Biliary injury.
202
Define dysplasia
Reversible change. Part of the progression to invasive carcinoma
203
Erythroid precursor in the liver and spleen
Indicative of extramedullary hematopoiesis. EPO stimulated hyperplastic marrow cell invasion of organs. Most frequently due to severe chronic hemolytic anemia.
204
What do you find in bacterial endocarditis vegetations?
Fibrin and platelet deposition.
205
Describe cluster headaches
Male predominant. No family hx. Severe and episodic, often unilateral temporal/periorbital pain. Tearing and nasal congestion. Punctual too, often at the same time of day.
206
What drug is most often associated with Neuroleptic Malignant Syndrome?
Haloperidol, commonly used to treat agitation.
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What causes Neuroleptic Malignant Syndrome?
Antidopaminergic activity of the antipsychotic medication.
208
Which histone is outside nucleosome?
H-1
209
ppx for N. Meningitis
Rifampin
210
Where do you find seotonergic neurons?
Raphe nuclei of brainstem
211
What's the role of the nucleus ceruleus?
fight or flight
212
MOA of ethosuximide
block T-type Calcium channels
213
Effect of maternal high blood glucose levels
Cause fetal hyperglycemia and islet cell hyperplasia
214
How do you treat drug induced Parkinsonism
Benztropine. Central acting antimuscarinic agent.
215
How do you get Hep A.
Fecal oral route. Contaminated water or food. Raw/Steamed shellfish.
216
What cranial nerve is commonly affected by transtentorial herniations?
Occulomotor nerve (CN III). First sign of transtentorial herniations are fixed dilated pupil on side of lesion.
217
Possible complication of recovery phase of ATN?
hypokalemia
218
Where is the injury in hemiballism?
contralateral subthalamic nucleus, usually due to lacunar strokes
219
Describe the Haemophilus influenza type b vaccine
bacterial capsular polysaccharide conjugated with diphtheria toxoid
220
Where's the saphenous vein?
Superficially on the medial side of the leg. Usually cut at the upper thigh, near femoral triangle.
221
What enzyme is deficient in Alkaptonuria?
homogentisic acid oxidase. Brown urine, brown spots on sclerae and ears.
222
What type of receptor is JAK2
non-receptor Tyrosine Kinase
223
What are the potential complications of hemochromatosis and wilson's dz?
HFE - liver cirrhosis and hepatocellular carcinoma
| Wilson - Basal ganglia atrophy
224
Describe Hepatitis B virus replication
ds DNA --> template +RNA --> progeny ds DNA
225
Hepatic abscess developed vs undeveloped
developed - bacterial
| undeveloped - parasitic
226
Repressors bind to?
Operator region (locus)
227
Drug induced SLE
```
HIPP associated with liver acetylation
Hydralazine,
Isoniazid
Procainamide
Phenytoin
```
228
Common side effects of ACE
decreased GFR, hyperkalemia, cough
229
What's the primary histologic finding of eczematous dermatitis (contact dermatitis)?
Spongiosis.
230
Sudden hematuria
papillary necrosis.
231
Cystic dialations of medullary collecting ducts
Medullary sponge kidney, not to be confused with ADPKD.
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Immunohistochemical marker of epithelial tissues
Cytokeratin
233
Bleeding in dialysis patients?
Due to uremia, show a prolonged bleeding time but PT/PTT and plt counts are all normal.
234
Why do Crohn patients get gallstones?
Decreased bile acid reabsorption, happens at the terminal ileum. Crohn's favorite spont
