qbq3 Flashcards
(225 cards)
1
Q
Recurrent Neisseria bacteremia?
A
C5-C9 deficiency. Complement disorder, or MAC (membrane attack complex) disorder
2
Q
Oral thrush and seizures, multiple ring enhancing lesions on MRI in brain
A
Toxoplasmosis
3
Q
You see foreign DNA in someone’s sacral sensory ganglia. Think?
A
Sacral: HSV-2. Trigems: HSV-1 or VZV. JC is also neurotropic but doesn„¢¯t affect sensory ganglia.
4
Q
First line for SVT?
A
Adenosine.
5
Q
You think a kid is being abused because he keeps coming in with broken bones, but then you notice his eyes are blue„¢?
A
Osteogenesis imperfecta. Problem with type I collagen –> problem forming triple helix in collagen (occurs in ER)
6
Q
Sphingomyelin
A
Neimann-Pick (Neimann Sphick)
7
Q
Hypertriglyceridemia leads to?
A
Pancreatitis
8
Q
sNRPs?
A
Role in pre-mRNA splicing out introns. Part of spliceosomes
9
Q
How do you make niacin and what can go wrong?
A
Niacin from tryptophan. Requires B6. With Hartnup (decreased tryptophan absorption), carcinoid (increased tryptophan metabolism because serotonin), and INH (decreased B6), can get pellagra –> diarrhea, dermatitis, and dementia (similar to B12 deficiency)
10
Q
DNA replication of prokaryotes
A
Helicase unwinds DNA at fork and single stranded binding proteins keep it open. Topos (gyrase= topo 2) create nicks to prevent supercoils while this is happening. Primase makes an RNA primer on which DNA poly III can replicate, then DNA poly III does 5–>
11
Q
What are the purines vs pyramidines?
A
PUR As Gold, CUT the PY
12
Q
Which two glycogen storage diseases go together like Gilbert and Crigler Najjar? How can you differentiate them?
A
Von Gierke’s (Type 1) is glucose 6 phosphatase deficiency (can’t finish gluconeogenesis). Cori’s disease (type III) is debranching enzyme deficiency. Type I has tons of blood lactate and type III has normal blood lactate. Also, type I has fatty liver, typ
13
Q
Slow growing painless growth on neck. Translocation and disease?
A
14;18, Follicular lymphoma. BCL-2 upregulated –> antiapoptosis. Can progress to diffuse large B-cell lymphoma
14
Q
Which vitamin carboxylates glutamate?
A
K
15
Q
Painful corners of mouth?
A
Riboflavin deficiency
16
Q
How does the intrinsic pathway of apoptosis work? Extrinsic?
A
Intrinsic: Growth factor withdrawn or injury –> p53 activates Bax, allowing cytochrome c to leave the mitochondria (Bcl-2 normally keeps cyt c in mito)–> activation of cytosolic caspases –> cellular breakdown. Extrinsic: Cd95(Fas-R) bound –> apoptosi
17
Q
UTI in sexually active woman
A
Straph saproliticus. Novobiocin resistant
18
Q
Wet beriberi vs dry beriberi. What else might you see in a patient with this?
A
Thiamine deficiency: impaired glucose breakdown because all those big enzymes need it (pyruvate dehydrogenase, transketolase, alpha ketogluturate, branched-chain amino acid dehydrogenase) –> really aerobic tissues affected first (heart and brain). Wet: High output cardiac failure (dilated cardiomyopathy), edema. Dry: polyneuritis, symmetrical muscle wasting. May also see wernicke-kersakoff –> ataxia, confusion, opthalmoplegia
19
Q
Fatty stools and fatty intestine with fat soluble vitamin deficiencies and low serum cholesterol?
A
Abetalipoproteinemia. 116 for biochemistry of it.
20
Q
What causes hemiballismus?
A
STN stroke (lacunar) –> figure out what vessel!
21
Q
Transmural inflammation of arterial wall with fibrinoid necrosis? What organ system are you worried about?
A
Polyarteritis nodosa, associated with hep B (Bolyarteritis nodosa)
22
Q
Abdominal pain, neuropsychiatric symptoms, and color change in urine that all improve with glucose?
A
Acute intermittent porphyria –> effed up heme synthesis so porphyrin builds up and causes symptoms. But earlier than prophyria cutanea tarda, so NO PHOTOSENSITIVITY! Treat with glucose and heme, which inhibit ALA synthase (first step)
23
Q
Chronic back pain, normocytic anemia, hypercalcemia. What else might you see?
A
Amyloidosis, renal insufficiency, increased infections. Multiple myeloma, plasma cells replacing everything in bone marrow and activating osteoclasts
24
Q
Order of syphilitic lesions
A
Primary = chancre. Secondary = condyloma lata (gray warts). Tertiary = gumma (painless indurated granulomatous lesions–> can progress to white-gray rubbery lesions and can ulcerate). Can tell secondary from tertiary other than appearance, tert would have
25
What is diptheria cultured on? What does it look like on gram stain?
Cystine-tellurite agar. Makes black colonies. On gram stain shows gram positive rods with blue and red granules
26
Poison mushroom MOA
Blocks RNA poly II. Mushtwoom. Hepatotoxicity (concentrated in liver cells), GI upset, hetapic/ renal failure.
27
Celecoxib
COX 2 selective, use this NSAID for peptic ulcer disease
28
A guanosine derivative antiviral works differentially in different viruses. Why?
It's acyclovir. Needs thymidine kinase to activate it (needs to be phosphorylated to work). Some viruses are better at doing that than others.
29
What is the key word with CF?
Inssipated
30
3 conditions that would cause protoporphyrin buildup
Iron deficiency anemia, lead poisoning, erythropoietic protoporphyria
31
How do you distinguish B12 deficiency from folate deficiency?
B12 has buildup of methylmalonic acid, folate does not. This buildup impairs myelin synthesis --> subacute combined degeneration. Don„¢¯t see neuro problems with folate deficiency
32
What do you give prophylactically when you give cisplatin?
Cisplatin crosslinks DNA and can cause nephrotoxicity and acoustic nerve damage. Prevent nephrotoxicity with amifostine (free radical scavenger) and chloride diuresiss
33
What is fomepizole?
NOT an omeprazole. Antidote for methanol or antifreeze ingestion because binds alcohol dehydrogenase and prevents conversion to toxic metabolites
34
What do you give prophylactically when you give doxorubicin?
Doxo causes DNA breaks and causes cardiotoxicity (CHF) --> give dexrazoxane to prevent
35
Rabies vaccine type?
Killed
36
Ketoacidosis and black necrotic eschar
NOT ANTHRAX, MUCORMYCOSIS! Mucor and Rhizopus love ketones and go to brain through cribiform plate. On histo see nonseptate hyphae with right angle branching (need biopsy to tell from invasive aspergillosis). Treat with debridement and amphotericin B.
37
JAK STAT and early satiety?
Myelofibrosis
38
JAK STAT and thrombotic symptoms?
Essential thrombocytosis or polycythemia vera. Essential --> increased platelets, poly --> increased RBCs (will have pruritis from increased basophils too)
39
How can you tell diabetic arteriolosclerosis from malignant HTN arteriolosclerosis?
Diabetic --> hyaline. Structure maintained, intima thickened, lumen narrowed. HTN --> onionskin
40
Amiodarone vs amlodipine vs amiloride
Amiodarone = K blocker. Amlodipine = peripheral Ca blocker. Amiloride = aldosterone blocker
41
7 alpha hydroxylase
Turns cholesterol --> bile acid, then conjugation with taurine and glycine --> bile salts
42
Elevated PTT and PT, normal TT. What drug?
X inhibitor
43
Kid with bleeding post wisdom teeth and hemarthrosis. Bleeding time normal, PT elevated, PTT normal. What is deficient?
VII deficiency
44
Positive pregnancy test and symptoms of an PID?
Gonorrhea or chlamydia and ectopic
45
What kind of receptor is JAK?
Non-receptor tyrosine kinase. EGFR is a receptor tyrosine kinase, as a contrast
46
Elderly patient presents with progressively worsening shortness of breath and fatigue.
Give parenteral B12, assume atrophic gastritis --> deficiency --> anemia
47
Zellweger syndrome
Messed up peroxisomes so can't break down super long chain fatty acids (too long for beta oxidation) --> messed up myelination.
48
Refsum disease
Messed up peroxisomes (alpha oxidation) so can't break down super branched fatty acids (too branched to beta oxidation) --> treat with avoidance of chlorophyll in diet. Phytanic acid builds up
49
You see a smear where there is some sort of big lymphoblast-looking thing hugging all these RBCs
EBV. Infects CD21 of B cells and causes CD 8 T cell response --> atypical T cells released into periphery that are too big and hug everyone (think kissing disease)
50
Parenteral
Not enteral, direct to blood
51
How does amytriptyline OD kill you?
Blocking fast sodium channels in heart -> arrythmias. Have to give sodium bicarb to treat. Other SE's: anticholinergic and anti-alpha 1 (also blocks reuptake of NE). Also blocks serotonin reuptake.
52
What is a choledocal cyst?
Dilation of the common bile duct
53
No vas deferens?
Cystic fibrosis
54
Which vasculitis hits the nose?
Wecener's
55
How do you convert grams to calories?
1 gram protein --> 4 cal energy, same for carbs. Fats are like twice as good so 9
56
Guy besides VEGF that promotes angiogenesis?
FGF
57
Superior sulcus tumor vs mediastinal mass
Superior sulcus tumor = pancoast tumor in apex. Affects cervical sympathetic plexus and causes horner's. Mediastinal mass = SVC compression, usually by small cell lung CA. Edema of head.
58
First part of brain damaged in global cerebral ischemia?
Hippocampus
59
You see loss of anterior horn cells, loss of lateral CST, atrophy of precentral gyrus, loss of CN V, IX, X, XII nuclei, and the patient died of pneumonia. What treatment might have helped?
ALS. Does UMN and LMN apparently not just in spinal cord but in brainstem and brain too. Treatment: riluzole. Decreases glutamate release, modestly increases survival
60
CD that marks macs?
CD 14
61
Phenytoin, Carbamazepine side effects
Phenytoin:
CNS: nystagmus, diplopia, ataxia, sedation
Gingival hyperplasia (because increased PDGF --> macs stimulate proliferation of gingival cells and alveolar bone-- reversible
Hirsutism
Lupus like syndrome
Lymphadenopathy
Megaloblastic anemia (messes with folate metabolism)
Teratogen (fetal hydantoin syndrome)
Induces p450
```
Carbamazepine (first line for like, everything):
Agranulocytosis, aplastic anemia
Liver toxicity
Induces p450
siADH
Steven Johnson syndrome
Teratogen
```
62
Zileutin vs lukasts
Zileutin blocks lipoxygenase and lukasts blocks receptors
63
Histo of an intracranial mass: spindly cells with compact and loose areas, S-100 positive. Symptoms? Associations? Another S-100?q
Schwannoma. 3rd most common primary brain tumor. CN VII --> acoustic schwannoma (NF2)--> cranial nerves are covered by schwann cells and thus can be affected. Can also have lateral pons effect --> CNVII/ CBT --> face paralysis etc, CN V --> loss of corneal reflexes. Compact fibers = antoni A, loose = antoni b. Another S-100 positive is melanoma, melanocytes and schwann cells both derived from neural crest
64
Unfractionated vs LMWH? Uses, how do you treat OD?
Unfractionated heparin is a little bigger, so you can use it for pregnant ladies AND it can bind ATIII and thrombin at the same time and bring them together, so antithrombin can hit Xa AND thrombin (only hits Xa with LMWH). OD --> bleeding, thrombocytopenis (HIT), osteoporosis. Treat with protamine sulfate for unfractionated, LMWH is not easily reversible.
65
Mammillary body damage
Wernicke-Korsakoff syndrome. Thiamine deficiency. Worsened by glucose administration
66
Funduscopic exam of an HIV patient with yellow/white clouds around vessels and red dots. What do you treat with?
CMV --> treat with gancyclovir
67
Abdominal aneurysm vs thoracic aneurysm vs dissection
Abdominal aneurysm --> atherosclerosis --> pulsatile mass. A and A. Thoracic aneurysm --> HTN, cystic medial necrosis like in Marfan, and syphilis. Dissection --> HTN! --> weakening of media --> mediastinal widening, horrible pain. Also associated with Ma
68
Blond hair, blue eyed boy with mousy body odor. What aa is likely essential?
Tyrosine. This kid has PKU.
69
You have a 2 month old with meningitis. You give ceftriaxone and ampicillin. Why do you give ampicillin and not just cef?
To cover for listeria. Causes in newborns = GBS, E coli, Listeria.
70
Cherry vs strawberry hemangioma
278
71
3 year old boy with multiple flesh-colored umbilicated papules on trunk. How does this guy replicate?
Molluscum contagiosum = pox virus. Replicates in cytoplasm and makes intracytoplasmic inclusion bodies.
72
Cow vet presents with fever of unknown origin.
Brucella. Gram negative coccoid. Get from dairy. Causes chronic granulomatous disease with caseating granulomas --> fever of unknown origin, endocarditis (aortic then mitral)
73
Phenoxybenzamine vs phentolamine
Phenoxybenzamine is irreversible nonselective alpha 1 alpha 2 antagonist. Phentolamine is also nonselective but is reversible. Can give to patients on MAO inhibitors who eat tyramine containing foods
74
Patient has an MI in her RCA and has bradycardia. What are the leads that are elevated? Also, then you give her a drug for her bradycardia and her BP and HR go up and she has SUDDEN EYE PAIN! What caused her eye pain?
Elevated leads are called inferior leads: II, III, aVF. Please review the cardiac hit list. AND you gave her antimuscarinics for bradycardia which closed her angle and gave her glaucoma (see neuro hit list for glaucoma review).
75
Is neurofibromatosis neural crest or neuroectoderm?
Neural crest. With caf¡? auleit (sp?) in NF1, think melanocytes which are neural crest. And that means that schwann cells are from the neural crest (remember schwannoma, NF2?)
76
Describe the ventricular flow.
Lateral goes to 3rd via foramen of monroe. 3rd goes to 4th via cerebral aqueduct. 4th goes to spinal cord via lateral --> foramina of Luschka, and medial: foramen of Magendie.
77
A boy presents with recurrent episodes of resp infection and diarrhea. He has decreased proprioception and ankle reflexes. He also has mild anemia. What should you give him?
Vitamin E. He has CF, so he is ADEK deficient. A causes night blindness and dry skin and you have lots of stores, D causes rickets, and K causes increased bleeding like warfarin. So that leaves E. E is an antioxidant so it protects membranes from free radical damage. Without it, you get RBC damage --> anemia, muscle weakness, and posterior column and spinocerebellar tract demyelination (looks exactly like B12 deficiency!)
78
B12 deficiency looks like (neurologically)?
Vitamin E deficiency!
79
Loss of gag reflex on right and uvula deviation to left, weakness of SCM and trapezius. What hole is probs affected?
Jugular foramen --> CN X and CN XI. Also FYI CN IX goes through there and so does the jugular vein
80
What malignancy are you worried about with persistent lymphadema?
Lymphangiosarcoma.
81
What should you give a kid who presents with a dislocated lens and a ton of thromboembolic episodes?
B6 (pyridoxine). This kid has homocysteinuria, and the buildup of homocysteine causes all those things. B6 is the cofactor for turning homocysteine into cysteine, getting rid of the toxicity. Also restrict dietary methionine, which can turn into homocyste
82
Which anti-TB drug makes the TB lose its acid-fastness? Important side effect?
INH. B6 deficiency --> neruotoxicity. Also hepatotoxicity
83
This guy comes in with mouth ulcers and fever. He had been put on a drug for TIA's. His white counts are low. What's up?
Ticlopidine was given to him. Side effect is neutropenia. For MOA, think of clopidogrel
84
What is a leukomoid reaction and how do you tell it from cancer? Which cancer in particular does it look like?
Acute inflammatory response to infection. Increased cells, left shift, and increased leukocyte alk phos. With CML, have decreased leukocyte alk phos. CML is the one with bcr-abl
85
Classic clinical triad of: urinary incontinence, cognitive dysfunction, and ataxia?
Normal pressure hydrocephalus. Results in increased subarachnoid space volume but NO increase in CSF pressure. Expansion of ventricles distorts fibers of corona radiata leading to symptoms
86
Compare the MOA of PCNs vs vanco
PCNs are analogs of D-ala-D-ala, bind to enzyme that does crosslinking and blocks. Vanco directly binds D-ala-D-ala portion of cell wall precursors to inhibit cell wall formation.
87
Pulsus paradoxus vs Kussmaul's sign
Pulsus is the drop of more than 10 mm Hg in BP with inspiration. Kussmaul's sign is the paradoxical increase in JVP with inspiration. Both are due to tamponade, but can also both be present with chronic pericarditis. Pulsus can happen with obstructive sle
88
What is associated with nasopharyngeal carcinoma?
EBV. Infects CD21 of B cells and causes CD 8 T cell response --> atypical T cells released into periphery that are too big and hug everyone (think kissing disease)
89
How is the serratus anterior nerve commonly injured?
Mastectomy. It is the long thoracic nerve (C5-C7).
90
Name a drug besides glucorticoids that can cause buffalo hump?
Protease inhibitors for HIV ("navirs"). Cause fat redistribution
91
Other drug besides vanco that can kill MRSA?
Linezolid --> clindamycin
92
NAC
563
93
Filgrastim
G-CSF stimulator to give after chemo
94
Which brain tumor arises from arachnoid cells?
Meningioma. 447
95
This guy dies and on autopsy his lung is pale, firm, and airless. You see fragmented RBCs, neutrophils, and fibrin. What stage of pneumonia did he die in? What are the other stages?
Gray hepatization. 560
96
A liver kinda looks like it has cysts in it. What would happen if a surgeon just was like fuck it let's go get those cysts out.
Echinococcus granulosis (echinobarkus granuliver--> eating eggs from dog shit-- >cysts in liver. Would have anaphylaxis. Have to treat with ethanol before surgery to remove cysts. Treatment = bendazoles
97
Fenoldopam
279
98
What's the only histone not in the nucleosome core?
H1 (all by itself, 1)
99
What is a good marker for anaphylaxis?
Triptase. Released specifically by mast cell degranulation.
100
What is another word for crosslinking IgE with receptors?
Aggregation
101
Pralidoxime
Regenerates active ACHE with organophosphate poisoning
102
Hormones of sarcoid, small cell, and squamous cell
Sarcoid: vitamin D activation, ACE. Small cell: ACTH, ADH, lambert eaton. Squamous: PTHrp
103
Dystonia vs myoclonus vs hemiballismus
Dystonia = sustained involuntary muscle contraction over time (eye twitch, writer's cramp)„¢? myoclonus is jerky, sudden, uncontrolled contraction (hiccups, jerks)-- common with metabolic abnormalities such as liver failure. Hemiballismus is a sudden, wild flinging of one arm +/- ipsilateral leg due to contralateral STN damage
104
Order of involvement for atherosclerosis
Abdominal aorta > coronary artery > popliteal > carotid. Kind of the way you'd hear about them.
105
What causes cachexia in cancer?
TNF-alpha. Via hypothalamus. Also causes decreased lipoprotein lipase and insulin resistance. In infection, causes fever with IL-1 and shock, also increases acute phase reactants like CRP and fibrinogen
106
What do you use for oral candidiasis?
Nystatin (baby amp B)
107
Sympathetic innervation of sweat glands, cardiac, bladder, renal vasculature, adrenal medulla? Like what NT
Sweat: Ach onto M! Cardiac: NE. Bladder: NE. Renal vasculature: DA. Adrenal medulla: Ach again! (can think about this one like a pre-ganglionic connection)
108
How do granulomas cause increased vitamin D levels?
They increased vitamin D activation by macrophages (increased 1-alpha hydroxylase activity)! WTF!
109
How do you get such a rapid recovery from IV anesthetics?
Redistribution to other tissues
110
First line for myoclonic seizures?
Valproic acid. Don't confuse with absence, which is ethosuximide, or Tourette's, which is haloperidol
111
What vitamin must you replenish when you give phototherapy for neonatal jaundice?
Riboflavin (vitamin B2). Degrades with light
112
First site of hemaglobin synthesis
Yolk sac, then liver and RBCs before lose nuclei
113
Essential amino acids?
Phenylalanine, valine, tryptophan, threonine, isoleucine, methionine, histidine, arginine, lysine, and leucine
114
What kind of cells make up the endocardial cushion?
Neural crest
115
Wacky, wobbly, and wet (from peeing self)
Normal pressure hydrocephalus. Results in increased subarachnoid space volume but NO increase in CSF pressure. Expansion of ventricles distorts fibers of corona radiata leading to symptoms
116
Lining of gut tube is fibrotic. What layer is fucked.
Paraxial mesoderm
117
Large fontanels, midface hypoplasia, hepatomegaly, cryptorchidism. Increased long chain fatty acids, phytanic acid, pipecolic acid. Absence of which organelles?
Peroxisomes. Zellweger syndrome. 113
118
Right sided aortic arch, full cheeks, low-set ears, small chin, decreased calcium concentration. Mutation in arches, pouches, or grooves and which ones?
Third and fourth branchial pouches. DiGeorge. 511. Hypocalcemia (failure of parathyroid)
119
What layer is spinal cord?
Neuroectoderm
120
What kind of amyloid do you see with RA?
AA amyloid --> acute phase reactant with chronic inflammatory conditions. Can deposit in heart and such.
121
Innervation of the tongue
Ant 2/3 = V for sensation and VII for taste. Post 2/3 = IX for both. XII does motor of all tongue except palatoglossus
122
How do you treat carcinoid syndrome?
Octreotide
123
Patient is a young boy who has corneal clouding and hyperplastic gums. Labs reveal elevated levels of acid hydrolases and glycosylases. What does he have?
I-cell disease. Defective enzyme that phosphorylates mannose on enzymes destined for the lysosomes so end up extracellularly (default pathway)
124
Most sensitive indicator of recent alcohol abuse?
Serum GGT
125
Which antihypertensive can cause dyslipidemia?
Metoprolol and thiazides
126
A normal 30 year old man has two siblings who died from Tay-Sachs. What is the risk that he is a carrier?
2/3. There are only three outcomes: he isn't a carrier, he is from his mom, or he is from his dad.
127
OCD therapy
Clomipramine or SSRIs
128
Pretibial myxedema
Graves
129
NF1 and NF2, inheritance?
AD. Same with tuberous sclerosis and von-hippel lindau
130
Atrophy of type 1 fibers. Cataracts, frontal baldness, and gonadal atrophy. What is this and how is it inherited?
Myotonic dystrophy. Can't let go. CTG trinucleotide repeat. AD.
131
Sympathetic effects on insulin
Beta agonists increase insulin, alpha 2 agonists decreases insulin
132
Cryptococcus neoformans.. spherules or budding yeasts?
Budding yeasts
133
How does echovirus make proteins?
Uses host to make one huge protein and then part of that protein is a protease and cuts up the proteins. Problem with viruses is that you have one strand of material and eukaryotes are monocistronic (only make one protein from the material), whereas viruses are polycistronic (code for everything in that strand). Can separate by segmented (like influenza), or promoters, or proteases, or alternative splicing
134
Most use dependent class I antiarrhythmic?
C. I know you used to remember flecainide as fleecainide, but it doesn't flee! It binds tight and stays. All the class I drugs bind to inactive or active more strongly, and resting --> leave. So the tighter you bind to inactive/active, the more specific you'll be for fast beat. Strength goes 1C>1A>1B
135
What enzyme is responsible for the cataracts with galactose intolerance?
Aldose reductase. Turns galactose --> galacticol.
136
Mechanism of MRSA resistants to nafcillin?
Naf for staph, but MRSA has a PCN binding protein with decreased affinity for beta lactam.
137
Does calcium bind to troponin or tropomyosin?
Troponin to kick of tropomyosin.
138
What nerve/ reflex can be injured with a chicken bone lodged in the piriform recess?
Internal laryngeal (branch of superior)--> only does sensory above vocal cords--> efferent of cough reflex
139
Patient is a 23 year old male with large ears, long face, prominent mandible, large testes, hyperextendable hand joints, pes cavus, and single palmar crease. What would you expect to hear if you listened to his heart?
Mitral valve prolapse. This guy has Fragile X.
140
Dipoplia, dysphagia, dysphonia
3 D's of botulism
141
Patient is being treated for bipolar and has side effects of constipation, dry skin, hair loss, and weight gain. What is the drug?
Lithium. HYPOTHYROID!
142
Vaccine against N. meningitis?
Polysaccharide capsule components. Doesn't last for very long, only give to at risk groups.
143
Sharp pain, worse on inspiration, in neck and shoulders. What nerve covers it?
Phrenic! Does motor to diaphragm but also pleural sensation--> pleuritic pain in C3-C5
144
Which hepatitis has ground glass/ fine cytoplasmic inclusions?
Hep B. Is that Hep B or HSV? All the ground glass looks the same to me!
145
You give dipyridamole to a patient with angina and their symptoms get worse. Why? What is the MOA of dipyridamole?
Dipyridamole is a PDE III blocker... increases cAMP in platelets to block aggregation, and vasodilates. But vasodilates coronary arteries, so end up with less blood flow going to ischemia area and more blood going to where it was already going.
146
How do you treat Lyme?
Tetracycline or PCN derivatives
147
Abdominal pain, arsenic exposure, CD31 marker
Liver angiosarcoma. CD31 = PECAM 1, marks endothelium and facilitates leukocyte transmigration
148
Only vitamin deficiency you'd see after 4 whole years
Vitamin B12. A will last 6 months, D will last months, folate will last months, the rest are flushed pretty quickly,
149
Which thyroid malignancy has psamomma bodies?
PTC. Remember, MTC's thing is the amyloid!
150
What do ribosomes on the RER make?
Secretory proteins, membrane bound proteins, and lysosomal proteins
151
How do eo's kill parasites?
Antibody dependent cytotoxicity. IgE antibody on bug
152
Patient on hyperthyroid medications presents with fever and sore throat?
Watch out for agranulocytosis! AE of both methimazole and PTU
153
Which step in the TCA generates GTP
succ coA --> succ. Remember succ --> fum = FADH2, not GTP (F for fumarate)
154
RNA poly I-III
I --> rRNA, II --> mRNA, III--> tRNA
155
120 bpm with irregularly irregular rhythm, narrow QRS, and no p waves. What is determining rate of contraction of ventricles?
AV refractory time. Classic description of A fib. No P waves because fibbing
156
Describe a lung hamartoma
Cartilage, fat, fibrous tissue. Coinlike, peripherally located
157
Drug that decreases hepatic production of VLDL and lipolysis, used to treat high TGs
Niacin. Fibrates are also used to treat high TGs, different MOA
158
You give phentolamine and the BP drops causing an increase in HR. Then you give drug X and HR increases even more but BP stays the same. What was drug X?
NE. No action on beta 2, and minor action on beta 1, but when alpha is blocked, will cause increase in HR. Can't be isoproterenol because that does beta 1 and 2 and would decrease BP more
159
AE of cyclosporine
Nephrotoxicity
160
What antibiotic do you give for acute cholecystitis
Third gen cephalosporin --> gram negatives are most likely organism
161
How should you treat esophageal varices bleed?
Octreotide. Inhibits release of vasodilatory hormones
162
Phytonadione
Vitamin K
163
When adults get this thing that kids usually get, they get arthritits.
Parvo B19. If pregnant with RA-like stuff from virus, watch out because baby could get hyrops fetalis.
164
Ear pain and spread to mastoid. What is the bug and what is a rash associated with it?
Pseudomonas. Does external ear infections. Ecthyma gangrenosum is rash with sepsis. Black necrotic center and raised hemorrhagic ring outside.
165
Which virus gets its envelope from budding off nuclear membrane?
HSV. The rest get envelope from budding off plasma membrane
166
Staph food poisoning: what is responsible
Preformed exotoxin.
167
Donepezil
AChEi. Not to confuse with NE reuptake --> duloxetine
168
What drug do you use to treat esophageal varices and why?
Octreotide vasoconstricts the portal system and thus redirects blood to the caval system
169
Where does the kidney develop from?
Ureteric bud. Ureteric bud is also known as metanephric duct, which forms as a diverticulum of the mesonephric duct (primitive kidney/excretory system). Are you fucking kidding me? Anyway, bud forms ureters, renal pelvis, calyces, and collecting tubules. Collecting tubules induce formation of metanephric vesicles (metanephric mesenchyme) which turn into tubular components of nephron., See Pencil Picture for clarification
170
What feature is the last to go along the respiratory tube?
cilia. Bronchioles lose cartilage and glands/goblets, but don't lose Cilia.
171
Which ligament gives the ovary the nerves, arteries, and lymphatics?
Suspensory. Ovarian ligament has nothing!
172
Which ligament holds the uterine artery?
Cardinal ligament (transverse cervical ligament)
173
Kid presents with poor feeding, vomiting, hypotonia, lethargy, dehydration, anion gap acidosis. What am I thinking of and what will build up? What vitamin is required for this step that isn't working?
Propionic acidemia. Methioine and threonine, odd-chain fatty acids, and isoleucine and valine. Need biotin to turn propionyl coA to methylmalonyl coA, then b12 to make succinyl coA and enter TCA.
174
How does asparaginase work as a chemo for leukemia?
Neoplastic cells dependent on plasma asparagine and asparaginase converts it all to aspartate
175
Selection vs sampling error
Selection = losing to follow-up. Sampling = initial sample (did you get a random enough group)
176
Which vitamin does organization of epithelial differentiation?
A not E! E deficiency causes infertility and decreased serum phospholipids
177
How do you treat staph epidermidis
Vanco and rifampin
178
Euvolemic hyponatremia?
siADH because ANP and BNP step in with transient hypervolemia and makes it euvolemic and also lose even more Na+
179
Name an organ that is not a foregut derivative but receives blood supply from foregut
Spleen. Mesodermal dorsal mesentery derivative but supplied by celiac.
180
Anal ulcer very painful in HIV patient?
HPV --> squamous cell CA
181
What causes a problem with cross-linking collagen?
Ehler's Danlos.
182
Med of choice for gestational diabetes?
Insulin
183
Describe inhibins effect
Feedback to FSH of ant pit, not hypothalamus -- no effect on LH and testosterone
184
Amiodarone AE's
Check TSH (amiodarone is 40% iodine by weight), corneal deposits, pulm fibrosis, hepatotoxicity, skin deposits (blue/grey), neuro, constipation, cardiovascular (brady, heart block, CHF
185
How does prolactinoma cause amenorrhea?
Suppresses GnRH
186
Pale muscle fibers with decreased striation and deposition of mucinous material, paired with increased fatigue and increased CK without chest pain or SOB
Check TSH --> hypothyroid myopathy is what that sounds like
187
Essential tremor treatment?
Propanolol
188
Molecule and location for ADH action to enhance osmolarity of interstitum and draw more water out?
Urea from the medullary collecting duct!
189
Jejunal ulcers?
Gastrinoma
190
Vitamin B5
CoA
191
Heteroplasmy
Mixture of mitochondria inherited --> clinical variability of mito disease
192
Most common site of damage to aorta in motor vehicle accident?
Connection between ascending and descending distal to where L subclavian branches off aorta
193
2 mechanisms for insulin R
1. FFA's. 2. Phophorylation of serine on insulin R beta subunit --> activates serine K instead of TK. TNF alpha, glucagon, glucocorticoids all do this.
194
Mifepristone MOA
Anti-progesterone for abortion
195
What is responsible for GAS being beta hemolytic?
Streptolysin
196
NADPH oxidase def. sensitive bugs
Pseudomonas cepacia, S aureus, Serratia, Nocardia, Aspergillus
197
Hep C hypervariability?
Lacks 3->5 exonucleus
198
Decreased testosterone in seminiferous tubules and epididymis, but normal levels in blood.
Sertoli cell dysfunction. Sertoli makes androgen binding protein to keep testosterone in luminal fluid
199
What is hyaline cartilage made of?
Type II collagen. CarTWOlage
200
What is the fate of the gubernaculum in women?
Superior part is ovarian ligament (connects uterus to ovaries). Inferior part is round ligament --> goes off uterus through inguinal canal to attach to labia majora
201
What are the changes in PaCO2, PaO2, and pH with a pulmonary embolism
Increased pH, decreased PaCO2, decreased O2. Hyperventilation, not obstructive
202
Signaling mechanism of platelet activating factor for aggregation?
Gq.
203
Steps of ARDS?
1. endothelial damage --> exudative phase
2. Edema resolves and type 2 pneumocytes proliferate (proliferative phase
3. Diffuse pulm fibrosis
For ARDS, O2/FiO2 < 200
204
What is globus hystericus?
Lump in throat with emotions, no physical abnormalities
205
Most common cause of endometritis
Bacteroides. See uterine tenderness and foul discharge
206
Posterior displacement of tibia would hit?
Popliteal artery. Stuck back there by adductor magnus and soleus, so susceptible to injury with traction. Tibial nerve is hit more from penetrating trauma
207
4-6 weeks after a kidney is removed, what % of normal will your GFR be?
80%
208
How do you figure out how many people need to be treated before save one life?
Treatment mortality % - nontreatment mortality % = absolute risk reductive. do 1/ that.
209
In porphyrias, what buildup causes photosensitivity and what buildup causes CNS?
Porpho --> CNS, uroporpho --> photosensitiivty
210
You see multiples of 180 bps on gel. What is this?
DNA laddering. Marker of apoptosis (not necrosis)
211
What 2 cytokines are produced by lymphocytes?
IL-2 and IL-3. IL-2 autostimulates T cells, released with antigen stimulation. IL-3 does bone marrow (like GM-CSF)
212
3 siblings have NF1, but parents and grandparents don't. What happened?
Germline mosaicism. NF1 has 100% penetrance. Germline mosaicism is the same as germline mutation, PS.
213
Allelic heterogeneity vs genetic heterogeneity?
Allelic = same gene, different mutations --> diff symptoms. Genetic --> mutations on diff genes --> same phenotype
214
Common chrom 7 things
CF, Ehlers Danlos, osteogenesis imperfecta
215
Common chrom 16 things
PKD, TS
216
Common chrom 22 things
DiGeorge
217
A mutation decreases the hydrophobic core of a hormone. Where will it accumulate?
Cytoplasm. Hydrophobic part is signal to go to RER
218
Majority of cancers in head and neck are what and caused by what?
Squamous cell CA caused by tobacco and drinking. See in oral cavity a lot.
219
What will you see on MRI of Dandy Walker
Enlarged posterior fossa, shrunken vermis replaced by expanded 4th ventricle
220
Bruton X linked agammaglobulinemia
TK abnormal on CD19, B cells can't mature
221
Alcoholic comes in with shock-like sensation radiating to feet with neck flexion, then feels better but has decreased vibratory sensation on feet.
B12 deficiency.
222
Myasthenia gravis, what pouch and what else comes from that pouch?
3rd. See thymoma. Inf parathyroid is also 3rd pouch. 3rd pouch is fucked in DiGeorge
223
How do the pouches go?
Ear = 1, Palate = 2, Thymus and inf parathyroid = 3, Sup parathyroid = 4
224
Rubella vs rubeola
Rubella: maculopapular rash on face--> trunk and extremeties WIHT LYMPHADENOPATHY! Measles (rubeola) --> spreads faster and doesn't darken, lymphadenopathy less common
225
Marfan's vs Ehler Danlos
Kind of counterintuitive... fibrillin is associated with elastin in Marfan's, but super super stretchiness is EDS --> collagen x linking problem
