Primer 0 Flashcards
1
Q
Name 7 teratogens.
A
[A Valiant Punks Lidia Till We Exile]
- ACE inhibitors
- Valproate
- Phenytoin
- Lithium
- Tetracycline
- Warfarin
- Excess vit A.
2
Q
Which areas of the hypothalamus regulate the autonomic nervous system?
A
Anterior hypothalamus: Controls the parasympathetic nervous system.
Posterior hypothalamus: Controls the sympathetic nervous system.
3
Q
What is the classic clinical presentation of a thyroglossal duct cyst?
A
Asymptomatic midline neck mass.
4
Q
What conditions are associated with an elevated ESR (erythrocyte sedimentation rate)?
A
- Infection, inflammation, neoplasm.
- Osteomyelitis
- Polymyalgia rheumatica
- Temporal arteritis
- Rheumatoid disease.
5
Q
What is the clinical use for tiotropium?
A
Inhaled anticholinergic drug used in COPD.
6
Q
What abnormality is associated with the buzzword “Boot-shaped heart”?
A
Right ventricular hypertrophy.
7
Q
What abnormality is associated with the buzzword “continuos machine-like murmur”?
A
PDA
8
Q
What abnormality is associated with the buzzword “tendon xanthomas”?
A
Familial hypercholesterolemia.
9
Q
What abnormality is associated with the buzzword “Cafe-au-lait spots”?
A
Neurofibromatosis type 1 as well as McCuna-Albright.
10
Q
What abnormality is associated with the buzzword “tuft of hair on back”?
A
Spina bifida occulta.
11
Q
What structures are at risk for injury with an anterior shoulder dislocation?
A
Axillary nerve Posterior circumflex artery Supraspinatus tendon Anterior glenohumeral ligament Glenoid labrum Posterolateral humeral head
12
Q
What are the layers of the epidermis?
A
[CLGSB] [Californians Like Girls in String Bikinis].
Corneum Lucidum Granulosum Spinosum Basalis
13
Q
What clinical presentations might lead you to suspect a patient may have lymphoma?
A
Painless lymphadenopathy
Fever
Weight loss
Night sweats
14
Q
What form of leukemia matches “Most common leukemia in children”?
A
ALL (acute lymphoblastic leukemia).
15
Q
What form of leukemia matches “Most common leukemia in adults in US”?
A
CLL (chronic lymphoblastic leukemia).
16
Q
What form of leukemia matches “characteristic Auer rods”?
A
AML (acute myeloid leukemia).
17
Q
What form of leukemia matches “greated than 20% blasts in marrow”?
A
Acute leukemia (AML or ALL)
18
Q
What form of leukemia matches “Leukemia with more mature cells and less than 5% blasts”?
A
Chronic leukemia (CML or CLL)
19
Q
What form of leukemia matches “PAS (+) acute leukemia”?
A
ALL (acute lymphoblastic leukemia).
20
Q
What brain structure is responsible for extraocular movements during REM sleep?
A
Paramedian pontine reticular formation (PPRF).
21
Q
What form of leukemia matches “always positive for the Philadelphia chromosome (t 9;22)”?
A
CML (chronic myelogenous leukemia)
22
Q
What form of leukemia matches “acute leukemia for peroxidase”?
A
AML (acute myelogenous leukemia)
23
Q
What form of leukemia matches “solide sheets of lymphoblasts in marrow”?
A
ALL (acute lymphoblastic leukemia)
24
Q
What form of leukemia matches “always associated with BCR-ABL genes”?
A
CML (chronic myelogenous leukemia)
25
What histological change takes place in the trachea of a smoker?
[Smokers play Counter Strike]
| Columnar to squamous metaplasia.
26
A 55-year old man who is a smoker and heavy drinker presents with a new cough and flu-like symptoms. Gram stain shows no organisms; silver stain of sputum shows gram-negative rods. What is the diagnosis?
Legionella pneumophila (Legionnaire's disease)
27
What is the classic presentation of a patient with temporal arteritis? What lab findings help diagnose temporal arteritis?
Unilateral headache and jaw claudication. Blindness or impaired vision at later stages of the disease.
Labd: Elevated SED rate. Temporal artery biopsy for definitive diagnosis.
28
A 30-year-old woman presents with a low grade fever, a rash across her nose that gets worse when she is out in the sun, and widespread edema. What blood test would you order to confirm your clinical suspicion?
ANA. Think of lupus.
29
In the dark, both pupils are dilated. In the light, the control pupil is miotic white the pupil given drug X remains mydriatic. What drug is X?
X can be a sympathetic agonist like epinephrine or it can be an anticholinergic like atropine.
30
What are some of the clinical uses for somatostatin?
1. Pituitary excess: Acromegaly, TSH-secreting tumor, ACTH-secreting tumor.
2. GI endocrine excess: Carcinoid syndrome, Zollinger-Ellison syndrome, VIPoma, glucagonoma, insulinoma.
3. Diarrhea (off-label)
4. Reduces splanchnic blood circulation: Cirrhosis with bleeding esophageal varices, and bleeding peptic ulcers.
31
What is the name given to a thyroid-secreting teratoma?
Struma ovarii
32
Where does erythropoiesis take place in the fetus? Which bones in adults synthesize RBCs?
Fetus: [Young Liver Synthesizes Blood]
- Yolk sac
- Liver
- Spleen
- Bone marrow
Adult: Vertebrea, sternum, pelvis, ribs, cranial bones, tibia and femur.
33
What adult structures are derived from the 3rd aortic arch?
Common carotid artery
| Proximal part of internal carotid
34
What adult structures are derived from the 4th aortic arch?
Left: Aortic arch
Right: Proximal part of right subclavian artery.
35
What adult structures are derived from the 5th aortic arch?
No adult structure.
36
What adult structures are derived from the 6th aortic arch?
Proximal part of pulmonary arteries
| Ductus arteriosus
37
What cell wall inhibitor is used in next step in treatment of otitis media if resistant to amoxicillin?
Amoxicillin with clavulanic acid.
38
What cell wall inhibitor is used in prophylaxis against bacterial endocarditis?
Penicillin V, aminopenicillin, 1st gen cephalosporin.
39
What cell wall inhibitor increases the nephrotoxicity of aminoglycosides?
Cephalosporins
40
What cell wall inhibitor is sufficient for the treatment of syphilis?
Penicillin G
41
What cell wall inhibitor is used in single dose treatment for gonorrhea?
Ceftriaxone
42
What germ layer gives rise to the retina?
Neuroectoderm.
43
What germ layer gives rise to the salivary glands?
Surface ectoderm
44
What germ layer gives rise to the pancreas?
Endoderm
45
What germ layer gives rise to the muscles of the abdominal wall?
Mesoderm
46
What germ layer gives rise to thymus?
Endoderm
47
What germ layer gives rise to spleen?
Mesoderm
48
What germ layer gives rise to the aorticopulmonary septum?
Neural crest
49
What germ layer gives rise to the anterior pituitary gland?
Surface ectoderm.
50
What germ layer gives rise to posterior pituitary gland?
Neuroectoderm
51
What germ layer gives rise to the bones of the skull?
Neural crest
52
What germ layer gives rise to the cranial nerves?
Neural crest
53
What are the clinical for 1st generation cephalosporins?
```
[PEK]
Proteus mirabilis
E. coli
Klebsiella pneumoniae
G(+) cocci
```
54
What are the clinical uses for 2nd generation cephalosporins?
[HEN PEKS]
H. influenzae
Enterobacter
Neisseria sp.
```
Proteus mirabilis
E. coli
Klebsiella
Serratia marcescens
G(+) cocci
```
55
What are the clinical uses for 3rd generation cephalosporins?
```
Serious G(-) infections
Pseudomonas
Neisseria gonorrhea
```
56
What are the clinical uses for 4th generation cephalosporins?
G(+) infections
G(-) infections
Pseudomonas
57
What are the classical symptoms of carcinoid syndrome?
[Carcinoid is Big Fucking Deal, Right?]
Bronchospasms and wheezing
Flushing
Diarrhea
Right sided heart murmurs or lesions
58
What is the target HgbAIC for every diabetic patient?
Less than 7.0
59
What are the five hereditary thrombosis syndromes?
1. Factor V Leiden
2. Prothrombin 20210 mutation
3. Protein C deficiency
4. Protein S deficiency
5. Antithrombin deficiency
60
Which Mycobacterium spp. causes leprosy?
Mycobacterium leprae.
61
Which Mycobacterium spp. causes pulmonary TB-like symptoms in COPD patients?
Mycobacterium kansasii
62
Which Mycobacterium spp. causes a cervical lymphadenitis in children?
Mycobacterium scrofulaceum.
63
Which Mycobacterium spp. causes a disseminated disease in AIDS patients?
Mycobacterium avian complex (MAC)
| Mycobacterium avian intracelulari (MAI)
64
Which Mycobacterium spp. causes hand infection in aquarium handlers?
Mycobacterium marinum.
65
What are the 3 different mechanisms cell employ to break down proteins?
1. Ubiquitin protein ligase.
2. Lysosomes
3. Calicum-dependent enzymes.
66
Which medication used in the treatment of HIV is know for causing bone marrow suppression?
Zidovudine (AZT) is the most common.
67
What is the treatment for lead poisoning?
Adults: Succimer or EDTA
Children: Succimer, EDTA, Dimercaprol
68
What enzyme catalyzes peptide bond formation during synthesis?
Peptidyl transferase
69
What conditions are associated with target cells?
```
[HALT]
HbC disease
Asplenia
Liver disease
Thalassemia
```
70
What name is given to anemia resulting from mechanical destruction of erythrocytes due to aortic stenosis or prosthetic heart valves?
Macroangiopathic anemia.
71
What G protein class does alpha1 receptor stimulate?
Gq
72
What G protein class does alpha2 receptor stimulate?
Gi
73
What G protein class does beta1 receptor stimulate?
Gs
74
What G protein class does beta2 receptor stimulate?
Gs
75
What G protein class does M1 receptor stimulate?
Gq
76
What G protein class does M2 receptor stimulate?
Gi
77
What G protein class does M3 receptor stimulate?
Gq
78
What G protein class does D2 receptor stimulate?
Gi
79
Which anticancer drugs is used for treatment for choriocarcinoma?
Methotrexate, vincristine, vinblastine
80
Which anticancer drugs is used for AML?
Cytarabine
81
Which anticancer drugs is used for CML?
Imatinib
82
Which anticancer drugs is used for prevention of breast cancer?
Tamoxifen
83
Which anticancer drugs is used for treatment for testicular cancer?
Etoposide, bleomycin, cisplatin, ifosfamide
84
What is the rate-limiting enzyme in purine synthesis?
Glutamine PRPP aminostransferase.
85
What is the rate-limiting enzyme for pyrimidine synthesis?
Carbamoyl phosphate synthetase 2.
86
How many ATP are yielded from aerobic metabolism?
32. 30 if G3P shuttle is used.
87
How many ATP are yielded from anaerobic metabolism?
2 ATPs + lactate molecule.
88
An 80-year old woman comes because her family is concerned about yellowing skin. Exam reveals yellowing of the skin including palms and soles but no scleral icterus. What question could you ask the patient that would most likely identify the cause of the yellowing?
Carotenemia: excess beta-carotene in the body due to excess consumption of carrots.
89
Which hormones share a common alpha subunit?
TSH, LH, FSH, hCG
90
What is the difference between a case-control study, a cohort study, and a clinical trial? Which studies use odds ratio, and which use relative risks?
Case-control (OR): Retrospective observational study. It starts with a diseased population with a specific outcome, and we are looking for exposure.
Cohort study (RR) : Prospective or retrospective observational study. It starts with a exposed population and looks for specific disease or outcome.
Clinical trial: Prospective experimental study.
-Case-control allows you to generate odds ratio.
-Cohort studies allows you to generate relative risks.
91
Which neoplasm is most commonly resposible for ACTH production that leads to Cushing syndrome?
Small cell lung cancer.
92
Which neoplasm is most commonly resposible for PTH-related peptide that causes hypercalcemia?
- Squamous cell cancers
- Renal cell cancers
- Breast cancers
93
Which neoplasm is most commonly resposible for Erythopoietin that causes polycythemia?
1. Renal cell carcinoma
2. Hemangioblastoma
3. Hepatocellular carcinoma
4. Pheochromocytoma
94
Which neoplasm is most commonly resposible for ADH production that causes SIADH?
Small cell carcinoma.
95
In a randomized, placebo-controlled study of a new blood pressure medication, members of the study group received their supply of pills at a monthly clinic visit at which the blood pressure was checked, and at which the clinic nurses were available to answer questions and to instruct the patient on the importance of controlling blood pressure through diet, exercise, and weight loss. Members of the control group received their supply of placebo pills in the mail each month. After 6 months, the study group's mean systolic blood pressure had decreased 11 points from baseline, compared to 2 point decrease in the control group. What type of bias might have contributed to the difference in outcomes between the 2 groups?
Procedure bias- the counseling by the nurses.
96
What is Reynold's pentad for cholangitis?
Charcot's triad (Fever, jaundice, RUQ pain) + hypotension and altered mental status.
97
What are some of the inducers of cytochrome P450?
```
[Kenytoin Rides Shotgun in Barbie's Girl Car]
Phenytoin
Rifampin
St. John's wort
Barbituraes
Griseofulvin
Carbamazepine
```
98
Which agents are often used in the treatment of urge incontinence?
```
Oxybutynin
Tolterodine
Darifenacin
Solifenacin
Trospium
```
99
What group of genes is responsible for skeletal development?
HOX genes.
100
Which cell types are derived from the neural crest?
```
[AAABCCCDOPPTLMS]15
Autonomic nervous system
Aorticopulmonary septum
Arachnoid matter
Bones of the skull
Celiac ganglia
Cranial nerves
Chromafin cells of the adrenal medulla
Dorsal root ganglia
Odontoblasts
Pia matter
Parafollicular (C) cells of the thyroid
Thyroid cartilage
Laryngeal cartilage
Melanocytes
Schwann cells
```
101
What are the symptoms of normal pressure hydrocephalus?
[The three Ws: Wacky, wet and wobbly]
Dementia
Urinary incontinence
Ataxia
102
In which genetic disorder would you find acanthocytosis of RBC's and excess lipids in eNTEROcytes?
Abetalipoproteinemia
103
What disorder is associated with the mutation of FGF receptor 3?
Achondroplasia
104
What disorder is associated with FMRI gene?
Fragile X syndrome.
105
Where do neurons of the lateral corticospinal tract synapse prior to exiting the spinal cord to affect movement?
Cell body of anterior horn.
106
What disease specifically damage the motor neurons of the anterior horn?
Polio
West Nile virus
ALS
107
After taking a course of amoxicillin, an adult patients develops toxic megacolon and diarrhea. What is the mechanism of the diarrhea?
Clostridium difficile overgrowth:
- Colitis
- Amoxicillin disrupts of normal GI flora
- C. diff is producing the toxin
- Pseudomembranes, necrosis.
108
What neoplasm is associated with nitrosamines?
Esophageal, stomach and colon cancer.
109
What neoplasm is associated with asbestos?
Mesothelioma, bronchogenic carcinoma.
110
What neoplasm is associated with napthalene?
Transitional cell bladder cancer.
111
What neoplasm is associated with arsenic?
Squamous cell skin cancer.
| Angiosarcoma of the liver.
112
What neoplasm is associated with EBV?
- Burkitt lymphoma
| - Nasopharyngeal carcinoma
113
What neoplasm is associated with schistosoma haematobium?
Squamous cell cancer of the bladder.
114
What neoplasm is associated with HPV?
Genital and anal cancer.
115
What is the cause of ITP (idiopathic thrombocytopenic purpura)?
Anti-glycoprotein IIb/IIIa antibodies.
116
What is the mechanism of action of Streptokinase?
Converts plasminogen to plasmin which cleaves fibrin.
117
What is the mechanism of action of Aspirin?
Irreversibly inhibits COX-1.
118
What is the mechanism of action of Clopidogrel?
Blocks ADP receptors.
119
What is the mechanism of action of Abciximab?
Binds to GP (Glycoprotein) IIb/IIIa.
120
What is the mechanism of action of Tirofiban?
Binds to GP IIb/IIIa
121
What is the mechanism of action of Ticlopidine?
Blocks ADP receptors.
122
What is the mechanism of action of Enoxaparin?
Low molecular weight heparin that catalyzes AT(anti-thrombin) III formation and activation.
123
What is the mechanism of action of Eptifibatide?
Binds to GP IIb/IIIa receptor on platelets.
124
What effect does changing Km and Vmax have on potency and efficacy?
-Lower Km: higher potency.
Km is inversely related to potency.
Changing Km does not affect efficacy.
-Higher Vmax: Higher efficacy.
Vmax is directly related to efficacy.
Changing Vmax does not alter potency.
125
What are the 4 main pharmacokinetics equations?
1. Vd (volume of distribution): amount of drug given (IV)/[drug]plasma.
2. Clearance (CL): 0.7 x Vd/ t1/2(half-life)
3. Loading dose (LD): Css (Concentration of steady state) x Vd.
4. Maintenance Dose (MD): Css x CL
126
What enzyme is deficient in PKU? What are the symptoms?
Phenylalanine hydroxylase.
| Symptoms: Musty odor, growth retardation, mental retardation, seizures, eczema, fair skin.
127
What is the equation of Volume of distribution?
Amount of drug give in IV over Concentration of drug in plasma.
Drug X (IV)/([Drug] in plasma)
128
What is the equation for clearance?
CL: (0.7 x Vd)/(t1/2).
Vd: volume of distribution.
t1/2: half life
129
What is the equation of Loading dose?
LD: Css x Vd
Css: Concentration of steady state.
Vd: Volume of distribution.
130
What is the equation of Maintenance Dose?
MD: Css x CL
Css: Concentration of steady state.
CL: Clearance
131
What are the 2 HIV envelope proteins and the drugs that interfere with them?
1. Gp120. Maraviroc interferes with this protein.
| 2. Gp41. Enfuvirtide interferes with this protein.
132
A patient has a genetic disease in which the treatment includes protein restriction to prevent mental retardation, ketoacidosis, and death. What is the diagnosis?
Maple Syrup Urine Disease.
133
What pathology has opacities seen on x-ray on both sides of the carina?
Sarcoidosis.
134
What pathology has dermatitis, diarrhea, dementia, possibly death?
Niacin (Vit B3) deficiency (pellagra).
135
What pathology has greenish rings around the periphery of the iris?
Wilson disease.
136
What pathology has elastic skin and joint hypermobility?
Ehlers-Danlos syndrome.
137
What pathology has enlarged, hard, left supraclavicular lymph node?
Virchow's node.
138
What patient populations are particularly susceptible to mucormycosis?
1. Leukemia.
| 2. Diabetic ketoacidosis (DKA).
139
Chromosome analysis of a leukemia patient reveals the presence of the Philadelphia chromosome t(9;22). What is the treatment?
Causes CML. You treat this with Imatinib.
140
Which tumor marker would you use to follow ovarian cancer?
CA-125.
141
Which tumor marker would you use to follow hepatocellular cancer?
Alpha-fetoprotein.
142
Which tumor marker would you use to follow pancreatic cancer?
CA 19-9.
| CEA.
143
Which tumor marker would you use to follow melanoma?
S-100.
144
Which tumor marker would you use to follow colon cancer?
CEA.
145
A patient comes to your office and before you notice any other symptoms, you see that the patient's uvula deviates to the right when she says "ah". What neurological areas might be damaged in order for this abnormality to be seen?
Damage to any one of the following 4 areas:
1. Left vagus nerve (CN X).
2. Left nucleus ambiguus.
3. Right corticobulbar tract.
4. Soft palate portion of right motor cortex.
146
Which fungus is associated with causing San Joaquin Valley fever?
Coccidioides immitis.
147
Which fungus is associated with being found in rural Latin America?
Paracoccidioides brasiliensis.
148
Which fungus is associated with plant thorns and cutaneous injury?
Sporothrix schenckii.
149
Which fungus is associated with found in states east of the Mississippi River?
Blastomyces dermatitidis.
150
Which fungus is associated with being found in bird and bat droppings?
Histoplasma capsulatum.
151
Which fungus is associated with mold form that contains barrel-shaped arthroconidia?
Coccidiodies immits.
152
A pateint comes to the clinic complaining of anterior shoulder pain that radiates down into the forearm. On examination, you notice a swelling of the biceps muscle. What is the diagnosis?
Biceps tendon rupture.
153
After the loss of his job, a 35-year-old man has diarrhea and hemotchezia. Intestinal biopsy shows transmural inflammation. What is the dianosis?
Crohn's disease.
154
What effect will a competitive antagonist have on efficacy and potency?
Increase Km.
Decrease potency.
No change in efficacy.
155
What effect does stress have on adipocytes?
- Stress increases sympathetic tone. This activates hormone-sensitive TG lipase in fat cells, causing rapid breakdown of TGs and mobilization of fatty acids.
- Anterior pituitary releases ACTH causing adrenal cortex to secrete more glucocorticoids.
156
What is the result of glycolytic enzyme deficiency?
RBC hemolysis because RBS are dependent on glycolysis.
157
What is the result of a deficiency of pyruvate dehydrogenase?
Neurological defects.
158
Which substances serve as chemotactic agents for leukocytes?
1. IL-8
2. Leukotriene B4
3. C5a
4. Kallikrein
159
What enzyme is inhibited by PPIs? Name two different PPIs (protein pump inhibitors).
Hydrogen potassium ATPase.
| Common PPIs: Omeprazole, Lansoprazole, Pantoprazole, Esomeprazole.
160
What is the precursor molecule of ACTH synthesis?
Pro-opiomelanocortin (POMC).
161
What is required for a molecule to enter into the nucleus through a nuclear pore?
You need Nuclear localization signals. 4-8 AA sequences that are rich in Lysine, Arginine, Proline.
162
What are the various clinical applications of atropine?
1. Decrease airway secretion.
2. Pupillary dilation an cycloplegia.
3. Decrease stomach acid secretion.
4. Decrease gut motility.
5. Decrease urgency/bladder spasms.
163
What are some clinical uses for dopamine?
Shock.
164
What are some clinical uses for clonidine?
HTN (hypertension).
HTN urgency.
Renal disease.
165
What are some clinical uses for amphetamines?
```
ADHD.
Weight loss.
Daytime sleepiness.
Narcolepsy.
Major depressive disorder.
```
166
What are some clinical uses for epinephrine?
Anaphylactic shock.
167
What are some clinical uses for terbutaline?
Asthma.
| Tocolysis.
168
Where can you find nicotinic acetylcholine receptors in the body?
Neuromuscular junction and autonomic ganglion.
169
What structures are derived from the 1st brachial pouch?
1. Mastoid air cells.
2. Middle ear cavity.
3. Eustachian tubes.
170
What structures are derived from the 2nd brachial pouch?
Lining of the palatine tonsils.
171
What structures are derived from the 3rd brachial pouch?
1. Thymus
| 2. Inferior parathyroids.
172
What structures are derived from the 4th brachial pouch?
Superior parathyroids.
173
A 28-year-old woman is involved in a motor vehicle accident (MVA). She initially feels fine, but minutes later she loses conciousness. CT scan reveals an intracranial hemorrhage that does not cross the suture lines. Which bone an vessel were injured in the crash?
Classic epidural hematoma: Medial meningeal artery is the most damaged caused by damage to the temporal bone.
174
A patient presents with rose gardner's scenario (thorn prick with ulcers along lymphatic drainage). What is the infectious agent?
Sporothrix schenckii.
175
What bone disorder results from excess PTH?
Osteitis fibrosa cystica (von Recklinghausen disease of the bone.)
