Quick Associations Flashcards Preview

STEP 1 RECALL > Quick Associations > Flashcards

Flashcards in Quick Associations Deck (289):
1

Best screening test for ACROMEGALY

Somatomedin-C (IGF-1)

2

Failure to appropriately concentrate the urine

DIABETES INSIPIDUS (inadequate ADH or failure of kidneys to respond to ADH)

3

Antimicrosomal and anti thyroglobulin antibodies

High in chronic lymphocytic thyroiditis (HASHIMOTOS)

4

Thyroid stimulating immunoglobulin (TSIG)

High in Graves' disease

5

Labs in Graves' disease (TSH , T4 level?)

Low TSH, HIGH T4 ... And high TSIG

6

Autoimmune, PAINLESS thyroiditis

Chronic lymphocytic thyroiditis (ie: HASHIMOTOS)

7

Viral thyroiditis, very very PAINFUL , elevated ESR

Subacute granulomatous thyroiditis (de Quervains)

8

Elevated TSH is diagnostic for ------?

HYPOTHYROIDISM

9

Breast milk is low in what 2 vitamins?

D & K (breastfed babies need sunlight or vit D supplement ,,,and a vit K injection at birth)

10

An ovulated egg is arrested in what phase until fertilization?

Metaphase of Meiosis 2. (Until it "Met" a sperm)

11

What is the relationship btw confidence interval, RR and p- value?

RR> 1 means the exposure IS associated with the dz. A C.I. Of 95% -- to be significant must NOT contain the null value of 1.0 When the 95% C.I. lacks 1.0 , this means that the p-value must be < 0.05 and the association is significant

12

Pregnant woman with low grade fever, maculopapular rash spreading from head to trunk and extremities, post-auricular lymphadenopathy....

Think MEASLES (rubeola), or GERMAN MEASLES (rubella) Rubella-- particularly assoc with post-auricular lymph nodes Puts mom at risk for polyarthralgias and fetus at risk for deafness/ cataracts

13

What kind of epithelial lining do ovaries have?

Simple cuboidal ("germinal epithelium")

14

The ovaries and testicles lymph drain to --------??

Para- aortic lymph nodes

15

Lymph from the scrotum drains to the ------?

Superficial inguinal nodes

16

Purulent urethritis indicates chlamydia or N. gonorrhoeae and can ascend to cause PID--> what is the correct treatment?

Third gen cephalosporin + azithromycin or doxycycline (Treatment of gonorrhea always include tx for chlamydia too!)

17

What is 1st line tx for HTN in a pregnant woman?

Methyldopa

18

The only four situations where you can disclose patient information without their consent...?

1- when you suspect child or elder or spousal abuse 2- when the pt has had a gunshot or stabbing injury 3- when the pt has a reportable communicable disease 4- when a pt threatens to kill/ harm someone else and has means to do so

19

Marker for astrocytes

GFAP

20

CA-125 is a marker for----?

Ovarian cancer ( but not very specific-- it's good for monitoring progression of the cancer, not screening for it)

21

Call-Exner bodies

Granulosa cell tumors ("Call your GRAN-E")

22

Pt. with new onset achalasia, megacolon, megaureter... From Central or South America ...

CHAGAS disease (Trypanosoma cruzi)

23

Child with fever, malaise, pharyngitis, generalized vesicular and pruritic rash, most lesions have crusted over within 6 days

Chicken pox (Varicella Zoster)

24

Children in daycare with dysuria, hematuria (UTI) ....most common viral cause ?

Adenovirus (Most common viral cause of acute hemorrhagic cystitis in kids)

25

Pt in septic shock from E.coli.... Which bacterial factor is responsible for the condition of the pt ?

Lipid A (the toxic component of LPS--> endotoxin) Lipid A causes activation of macrophages--> release of IL-1 and TNF-alpha--> signs of shock

26

Which cytokine (IL-?) is responsible for antibody isotype (class) switching??

IL-4

27

Which bacteria is the most common cause of osteomyelitis in pts with sickle cell disease??

Salmonella (These pts have functional asplenia, so are at risk to encapsulated bacteria)

28

Inflammatory arthritis after chlamydia infection...

Reiters syndrome

29

Hypokalemia can cause ------?

Muscle weakness

30

Right sided endocarditis

Typically IV DRUG users, caused by S. aureus

31

Most common type of collagen in the body, found in tendon, ligaments, bone, dentin, cornea, blood vessels, scar tissue...

TYPE 1 collagen

32

Type of collagen in basement membranes? Associate with what syndrome?

Type 4 Alport's syndrome

33

Type of collagen associated with osteogenesis imperfecta and scar tissue long after a heart attack

Type 1

34

Type of collagen in cartilage, nucleus pulposus and vitreous humor

Type 2

35

Type of collagen associated with Ehlers Danlos syndrome And found in skin, lungs, intestines, blood vessels...

Type 3

36

Strep bovis septicemia or endocarditis, associated with??

COLON CANCER

37

Gray sub-retinal membranes, vision loss

Wet Age related Macular degeneration Wet= neovascularization / new blood vessels

38

Which vessels are most susceptible to the effects of Nitroglycerin?

The large veins

39

What substance would provide the fastest reversal of the effects of Warfarin?

Fresh frozen plasma (contains all coagulation factors) Vitamin K would also reverse warfarin effects, but slower, because it requires time for clotting factor resynthesis..

40

Frothy, foamy urine..

PROTEINURIA or bile salts in the urine

41

Treatment for systemic fungal infections ...

Amphotericin B

42

Protein that is responsible for anterograde transport (moving intracellular vesicles and organelles toward the + end (rapidly growing end) of microtubules) --- ie: away from the nucleus

Kinesin

43

Protein that is responsible for retrograde transport (moving items back toward the nucleus (- end of microtubules) )

Dynein

44

Lung abscess in an alcoholic patient Cause? Treatment?

Anaerobes, treat with Clindamycin

45

Pustules that spread and infect several hair follicles Cause? Treatment?

Skin infections are often caused by penicillinase producing S. aureus Treat with Nafcillin, Methicillin, or Oxacillin ((For MRSA use Vancomycin))

46

Nausea and vomiting 1 hour after a meal.... Cause & tx?

So soon after a meal suggests food poisoning from a pre-formed exotoxin, commonly the heat stable S. aureus Treat with fluids, supportive care (not ABX because it is toxin mediated illness))

47

Facial swelling and dark urine after a recent skin infection... Cause & tx?

Post-streptococcal glomerulonephritis after a streptococcal skin infection Tx is supportive, usually resolves on own

48

Long term effect of topical corticosteroid use on skin?

Decrs collagen production and glycosaminoglycans, leads to atrophy of the dermis w/ loss of collagen, drying, cracking, tightened skin Atrophic striae may also be found

49

Flat red skin lesion with central clearing ...what bacteria?

Borrelia burgdorferi (cause Erythema Chronicum Migrans-- the classic lesion of Lyme disease)

50

Pt with palmoplantar erythematous macular or petechial rash that spreads proximally to the trunk, with headache, fever, red eyes... Bacteria? Tratment?

Tick borne Rickettsia rickettsiae ( causing Rocky Mountain Spotted Fever) Treat with Doxycycline

51

Regional lymphadenopathy, malaise and fever after a cat scratch or bite...

Gram negative Bartonella henselae ( Cat Scratch Fever)

52

Hemorrhages, subperiosteal hemotomas, gingival swelling/ painful gums, hemarthralgias ... What vitamin is likely deficient??

Ascorbic acid (vit C) -- Scurvy Cannot be made in the body, must get from diet (Deficiencies common in the elderly, alcoholic, poor)

53

Autoantibodies to the hemidesmosomes along the basement membrane of the dermal/ epidermal junction

Bulbous pemphigoid

54

Pt with diffuse skin erythema, epidermis comes off easily with gentle pressure....cause? Endo or exotoxin?

Staph Scalded Skin Syndrome (SSSS) caused by the exfolatin exotoxin of certain Staph. species, mostly in infants and kids,( "Nikolsky's sign" = sloughing of skin with gentle pressure)

55

What type of cells have intracytoplasmic granules that look like tennis raquets?

Langerhans cells - APCs of the skin and mucous membranes, derived from myeloid cell line, contain "Birbeck granules"

56

Warty papules on skin of middle aged person (any color) that look "stuck on" ( could be scraped off)

Seborrheic keratosis

57

Defective Intestinal and renal absorption of tryptophan--- what is this disease and what causes it?

Hartnup Disease (defective absorption of tryp leads to Niacin (B3) deficiency and symptoms of Pellagra) -dementia/ ataxia - diarrhea - dermatitis

58

PABA esters protect skin from what kind of UV radiation?

UVB only

59

dimpling of the skin on the breast & nipple inversion -- indicates ?

infiltration of the suspensory ligament (Cooper's ligament)

60

peau d' orange indicates___?

lymphatic obstruction -- assoc with inflammatory breast cancer

61

ABX needed to treat beta-lactamase producing bacteria?

an antibiotic + a Beta-lactamase inhibitor (Tazobactam, Sulbactam or Clavulinic Acid)

62

What is the correct order of progression of mutations responsible for the development of colon adenocarcinoma? (the adenoma --> carcinoma sequence)?

APC tumor suppressor gene (dev of polyps) --> K-Ras mutation (polyp growth) --> p53 mutation (malignant transformation to carcinoma)

63

DNA methylation --> does what to transcription level?

Methylation is assoc with LOW TRANSCRIPTIONAL activity (heterochromatin)

64

Loop diuretics (like Furosemide) have what major side effects?

OTOTOXICITY (hearing loss) , HYPO-kalemia, -magnesia & -calcemia , decr GFR, volume depletion, hypotension..

65

what is most commonly injured when the humerus is dislocated anteriorly?

the axillary nerve --> resulting in deltoid paralysis and loss of sensory over the deltoid muscle , the shoulder will also appear flettened bc the humeral head has been displaced

66

what is the mechanism of Colchicine & what is it indicated for?

inhibition of microtubules --> binds to tubulin, impairs leukocyte (neutrophil) migration & phagocytosis --> reducing inflammation in ACUTE GOUTY ARTHRITIS ((diarrhea is a common side effect))

67

trabecular thinning with fewer interconnections

Osteoporosis

68

more metabolically active than long bones--osteoporosis typically involves this kind of bone

trabecular bone, aka spongy / cancellous bone, (makes up most of axial skeleton)

69

bone type that is very strong, serves as mechanical support and sites of muscle attachment , makes up most of the appendicular skeleton

cortical bone (long bones)

70

marked osteoclastic activity followed by osteoblastic activity --> net result is formation of abnormal bone (mosaic pattern of lamellar bone with the sections linked by cement lines)

Paget's dz of the bone

71

Hyperparathyroidism causes osteoclasts to resorb bone --> primarily involves what type of bone?

Cortical bone (long bones)-- classic is subperiosteal thinning of long bones

72

increased deposition of unmineralized osteoid -- characteristic of ??

Vitamin D deficiency (b/c you need Vit D to absorb Calcium & Phos)

73

child with poor wound healing, late separation of the umbilical cord, recurrent skin infection with NO pus & gingivitis/periodontitis --> what is the diagnosis?

Leukocyte Adhesion Deficiency -- autosomal recessive absence of CD18 --> can't form INTEGRINS --> leukocytes cannot roll, adhere, or extravasate (hence NO pus)

74

late separation of the umbilical cord

Leukocyte adhesion deficiency (CD18 / Integrin defic)

75

this deficiency allows all bacteria to stay alive in phagocytes

Myeloperoxidase

76

this deficiency allows some organisms (catalase negative) to stay alive in phagocytes

NADPH oxidase deficiency --> causes Chronic granulomatous disease **Absence of NADPH oxidase = inability to form H2O2 so MPO has no substrate! (organisms that are catalase positive, however, make their own H2O2 and can be acted upon by MPO & killed)

77

Transcobalamin II is a carrier protein for ----?

B12 from the Ileum

78

Ceruloplasmin is a carrier protein for _______ & is low in ____________ disease

copper , Wilson's dz

79

homeless/alcoholic with swollen gums, bruising, nosebleeds, hyperkeratosis, poor wound healing

SCURVY -- vitamin C deficiency leads to inability to hydroxylate the proline & lysine residues of pro-collagen--> decr collagen = decr strength of blood vessel walls & other connective tissue ((even worse bleeding & bone deformities are seen in kids with Scurvy)

80

during skeletal muscle contraction, Calcium binds to ________?

Troponin C

81

pt with nodule containing long yellow crystals , neg birefringent under polarized light--> what are these crystals?

Monosodium Urate crystals (acute attack of Gout)

82

what kind of crystals are seen in pseudogout?

Calcium pyrophosphate -- will appear as blue rhomboid crystals, positively birefringent, commonly affects the knee

83

young man with chronic low back pain, morning stiffness better with activity & HLA-B27 + , RF -

Ankylosing Spondylitis

84

sustained, involuntary muscle contractions

Dystonia (ex: Cervical dystonia is called Torticollis)

85

Which diuretic can also cause an INCREASE in calcium absorption at the DCT and therefore decr the risk of osteoporosis and renal stones ??

HCTZ (Thiazide diuretics) --((loop diuretics do the opposite and would increase the risk for osteoporosis))

86

RANK receptor / RANK ligand

assoc with osteoclasts, bone resorption (low estrogen states --> more RANK --> resorption of bone)

87

what ligament is affected in a radial head subluxation (yanking of a child's arm)

annular ligament

88

diabetic pt with fever, flank pain, pain when walking --> pt lies supine in fetal position, resists extension of his leg

r/o Psoas Abscess (risk factors include DM, HIV, IV drug use, immunosuppressed)

89

"moldy" grains in China associated with G ---> T mutations in p53 gene

Aflatoxin B1 from moldy peanuts, soy or corn --> highly associated with hepatocellular carcinoma

90

alveolar cells with 'golden cytoplasmic granules' that turn dark blue w/ Prussian blue staining --> what are the granules & what is the dz?

Hemosiderin (iron) , associated with Left sided heart failure macrophages eat the iron that is leaked out of congested capillaries ("heart failure cells")

91

AST higher than ALT

alcoholic hepatitis

92

ALT >> AST

acute viral hepatitis

93

patient with bilateral femur fractures with acute onset hypoxemia, petichiae & confusion

fat emboli in the pulmonary microvasculature

94

male infertility, situs inversus, recurrent sinusitis & bronchiectasis

Kartagener's syndrome (dynein defect)

95

peaked T waves on EKG

Hyperkalemia ( at risk for ventricular arrythmias)

96

virus associated with mono, nasopharyngeal carcinomas and Burkitt's lymphoma

EBV

97

the main mechanism of excess copper removal from the body is ___________

hepatic excretion into bile

98

black pigment gallstones

chronic extravascular hemolysis (ie: sickle cell, B-thalassemia & spherocytosis)

99

keratin pearls

SCC

100

the most important environmental risk factor for pancreatic cancer

smoking!

101

acute onset heart failure after a viral infection

suspect viral myocarditis

102

enzyme that converts cholesterol to bile acids

7- alpha hydroxylase

103

bruising, bleeding, immature myeloid cells with Auer rods , t (15:17)

Acute Promyelocytic Leukemia (M3) AML --> treat with ATRA

104

what is deposited within Bowman's space in RPGN?

Fibrin

105

thyroid nodule with calcified structures & ground glass appearance

Papillary carcinoma (w/ Psammona bodies)

106

sudden cardiac death in a young athlete

hypertrophic cardiomyopathy

107

deficiency of CD 55 & 59 is diagnostic

Paroxysmal nocturnal hemoglobinuria (PNH) -- can't inactivate complement , recurrent thrombosis, hemolytic anemia, pancytopenia

108

antibodies against alpha3 chain of Type IV collagen _____ associated with ?

Goodpasture's syndrome -- anti-GBM antibodies --> develop RPGN and hemoptysis

109

child with retinoblastoma is at a great risk for what other type of neoplasm?

Osteosarcoma

110

ANP and sildenafil both act on what second messenger system?

cGMP

111

drug of choice for oropharyngeal candidiasis?

Nystatin ("swish & swallow" agent)

112

Pt with colicky abd pain, constipation, HA, impaired short term memory, wrist or foot drop, microcytic anemia with basophilic stippling

Lead poisoning

113

Mechanism by which cells become resistant to chemotherapy drugs?

ATP dependent transporter (they pump the drugs out of the cell)

114

drugs that block the Na-Cl symporters in the DCT causing more Na, Cl and water excretion, but can also cause incrs Calcium absorption & hyperuricemia

Thiazide diuretics

115

Carbonic anhydrase inhibitors work at what part of the nephron?

PCT (they incrs bicarb excretion)

116

side effects of Methotrexate?

stomatitis, hepatotoxicity (elevated LFTs) , myelosuppression (incrs risk for infection)

117

Spironolactone mechanism and side effects?

K+ sparing diuretic, causes gynecomastia and testicular atrophy in men (blocks androgen receptors) , may be used to treat Hirsutism in females

118

What is the recommendation for pregnant women who have positive Group B strep cultures from 35-37 wga?

intrapartum penicillin or ampicillin

119

Chronic lung transplant rejection (months to years later) affects what part of the lungs mainly?

inflammation of the small bronchioles ("bronchiolitis obliterans") contrasts to chronic rejection of an abdominal organ which presents with vascular obliteration

120

hemolytic anemia, thrombocytopenia & acute renal failure (oliguria, hematuria) in a child

Hemolytic Uremic Syndrome (most cases due to E. coli or Shigella dysentery)

121

What are three most common causes of cancer in US women? What are the three most deadly cancers in US women in order?

Incidence: Breast, Lung, Colon Deaths: Lung, Breast, Colon

122

trachea deviated toward the opacified hemithorax on XRAY

lung volume loss / atelectasis ((ie: tumor blocking the main bronchus on that side))

123

trachea deviated away from the opacified lung on XRAY

large pleural effusion (something pushing the trachea away)

124

A child with a Strawberry Hemangioma -- what do you tell the parents?

It is a benign congenital tumor made of capillaries, it will grow in proportion to the child for a few years and then regress (most gone by age 7)

125

early diastolic murmur heard at the left sternal border

Aortic regurgitation

126

(9:22) translocation leads to the ________ oncogene which codes for a fusion protein with constitutive _______ activity

BCR-ABL gene --> tyrosine kinase activity uncontrolled --> proliferation of granulocytic precursors --> CML

127

t (14:18)

follicular lymphoma , overexpression of the anti-apoptotic protein Bcl2

128

t( 11:14)

Mantle cell lymphoma, cyclin D1 overexpressed -- promotes G1 --> S phase of cell cycles

129

What is on chromosome 14 that gets translocated in follicular , burkitt's & mantle cell lymphomas??

the Immunoglobulin heavy chain

130

t (8:14)

Burkitt's lymphoma -- c-myc overexpression, activates transcription (fast growing tumors)

131

pt with hemoptysis, HTN, hematuria and a + c-ANCA , but absence of immune deposits

Wegener's --a Rapidly progressive (crescentic) glomerulonephritis (absence of immune deposits r/o goodpastures)

132

EBV envelope glycoprotein gp350 binds to the complement receptor on ________ called _________

CD21 on B cells

133

Inflammatory bowel disease that can involve the entire GI tract from mouth to anus and commonly causes fistulas b/c it causes transmural (full thickness) inflammation

Crohn's disease

134

lack of aldosterone and cortisol (upper 2 adrenal cortex layers) -- what enzyme is lacking?

21-hydroxylase -- most common form of CAH ----> ( or less commonly 11-beta hydroxylase)

135

lack of cortisol and androgens (lower 2 layers of adrenal cortex)

17- alpha hydroxylase -- these have HTN and hypokalemia

136

fever, rash & oliguria 1-3 weeks after an B-lactam antibiotic (or sulfa, NSAID, rifampin or diuretics)

Drug induced acute interstitial nephritis

137

ascending muscle weakness after recovery from respiratory or GI infection (esp Campylobacter) or after immunization

Guillain-Barre syndrome -- DTR disappear, ascending weakness

138

phospholipase C cleaves phospholipids to form ___ & ____

IP3 & DAG --> which causes Ca++ to increase in the cell & activates PkC

139

Left shift on an Oxygen dissociation curve?

increased pH (basic) , decr 2,3 DPG, or decreased temp (hypothermia) ((INCREASED AFFINITY of Hb for OX)) ----((LEFT = Hb releasing O2 more in the LUNGS))

140

Right shift on an Oxygen dissociation curve?

decreased pH, incrs 2,3 DPG, or increased temp (( Hb releasing O2 more in the tissues)) Decrs affinity for O2

141

Why is pus from a bacterial infection green?

MPO is a blue/green heme based pigmented molecule -- so when it is breaking down all this bacteria and making pus

142

adult onset asthma, eosinophilia, mono or polyneuropathy, pulmonary infiltrates and paranasal sinus abnormalities

Churg-Strauss vasculitis

143

What is the afferent nerve at the carotid sinus baroreceptor ??

Herings nerve ( branch of Glossopharyngeal CN IX)

144

Overdose of the TCA Amytriptyline can cause symptoms similar to ____________

Atropine (( Anytriptyline blocks muscarinic receptors))

145

this drug inhibits the reuptake of Norepinephrine at the synaptic cleft

Cocaine or Tricyclic antidepressants

146

It is common for people over 70 or 80 to have HTN, especially high systolic pressure ((Isolated systolic HTN)) , why?

Loss of aortic compliance as you age (aortic stiffening)

147

Formula for Mean Arterial Pressure

MAP = CO x TPR

148

What is derived from the common cardinal veins?

SVC

149

Murmur with an 'opening snap' early in diastole

Mitral stenosis

150

a young woman with RVH -- what is the most likely cause?

Primary pulmonary HTN --> idiopathic in young people, leads to cor pulmonale

151

How long after total ischemia do the myocytes stop contracting ?

about 60 seconds --> they run out of ATP & start to accumulate toxins (however, if ischemia is reversed within 30 mins, the function can be restored)

152

Exercising muscle releases adenosine, ATP, K+, CO2 & Lactate --> what do these all do?

Local Vasodilation --> to lower systemic resistance

153

A shortened PR interval could indicate ___?

the PR interval represent the conduction through the AV node --> if this is shorter than normal you could have an accessory conduction pathway that is bypassing the AV node & causing arrhythmias (ie: WPW syndrome)

154

characteristic EKG of a pt with WPW syndrome

Short PR interval, wide QRS, and a delta wave (early upslope of the QRS complex)

155

EKG with narrow QRS & no P waves

Atrial fibrillation ("irregularly irregular with no P waves"

156

How do you treat a-fib?

B-blockers, calcium channel blockers or digoxin AND warfarin (prevent clots!)

157

PR interval longer than 200 msec & otherwise asymptomatic

1st degree AV block

158

progressive lengthening of the PR interval until a beat is dropped ("going, going, gone")

2nd degree -- Mobitz Type 1 (Wenkebach) AV block

159

Normal PR intervals with random dropped QRS complexes

2nd degree block -Mobitz Type 2

160

In a patient with a-fib, what determines the rate of ventricular contraction??

the AV node refractory period ( the atrial myocytes are contracting wildly and on their own at a very fast rate...so the refractory period of the AV node is what determines how often one of the chaotic atrial contraction impulses is let through) -- Most atrial impulses are actually not let through, or else the ventricular rate would be much higher!

161

Which has less oxygen content, the pulmonary artery or the coronary sinus?

The coronary sinus ( the cardiac muscle extracts 90- 100% of the O2 from coronary flow)`

162

Which part of the heart is most prone to ischemia?

the endocardium (force of contraction is highest here)

163

Why don't calcium channel blocker drugs (verapamil) affect skeletal muscle too?

b.c skeletal muscle does not have to rely on extracellular calcium (it has calcium from the t-tubules and intracellular SR)

164

Three major causes of Aortic Stenosis

Bicuspid aortic valve, calcifications, or rheumatic heart disease

165

Wide splitting of S2 that does not vary with respirations

indicates a congenital ASD

166

early diastolic decrescendo murmur decreased by amyl nitrate

Aortic regurg

167

lat diastolic murmur eliminated by a-fib

Mitral / tricuspid stenosis

168

what ion is responsible for the slow phase 4 depolarization of the SA & AV node tissue

Na+ (inward sodium "funny" current)

169

in most people the SA & AV nodes are supplied by branches of what artery?

RCA (right coronary artery)

170

what is the most posterior chamber of the heart?

Left Atrium (enlargement can cause dysphagia or hoarseness)

171

a wide pulse pressure is indicative of _____?

Aortic regurgitation (or decr compliance of the aorta)

172

S1 heart sound =

mitral & tricuspid valve closure

173

S2 heart sound =

aortic & pulmonic valve closure

174

S3 heart sound =

physiologic in young & pregnant --> pathologic in elderly --> associated with increased volume / filling pressure

175

S4 heart sound =

always pathologic --> "atrial kick" in late diastole, assoc with LVH , high atrial pressure against hypertrophic left ventricle wall

176

JVP waves : the "a wave" =

atrial contraction

177

JVP waves: the "c wave" =

RV contraction

178

Normal S2 splitting -- why?

because the aortic valve closes before the pulmonic valve (inspiration increases the diference)

179

Wide S2 splitting cause

pulmonic stenosis or RBBB (takes longer than normal for the pulmonic valve to close)

180

Fixed S2 splitting (regardless of breathing)

associated with an ASD

181

Paradoxical splitting (pulmonic valve closes before aortic)

caused by anything that delays the aortic closure --> aortic stenosis, LBBB

182

Valsalva will increase your perception of which murmur?

Mitral Valve Prolapse (you are decreasing venous return, so most murmurs will actually decrease in intensity but MVP will be louder

183

Inspiration increases the intensity of sounds from which side of the heart?

Right side

184

Squatting / hand gripping increases the intensity of which murmur?

Mitral or tricuspid regurgitation (moves that increase TPR) -- expiration will also increase intensity of all Left sided sounds

185

most frequent valvular lesion, late systolic crescendo murmur with a mid-systolic click

Mitral prolapse

186

high pitched, blowing diastolic murmur, wide pulse pressure, bounding pulses & head bobbing

Aortic regurgitation

187

opening snap, late diastolic rumbling

Mitral stenosis (assoc with rheumatic fever)

188

continuous machine like murmur

PDA

189

the plateau in cardiac myocyte AP is due to influx of _________

Calcium (phase 2 plateau) -- allows for myocytes to contract at the same time

190

cardiac myocytes are electrically coupled by _______

gap junctions

191

U wave on an EKG

hypokalemia or bradycardia

192

treatment of Torsades de pointes

Magnesium Sulfate

193

Lyme disease can cause what type of heart block

3rd degree (complete) heart block

194

p waves & QRS complexes are present but they are completely dissociated

3rd degree heart block ( need a pacemaker)

195

What organ gets the largest share of Cardiac output?

LIVER

196

Pulmonary cap wedge pressure is a good measurement of which heart chamber?

Left Atrium

197

man with confusion, lethargy and an anion-gap metabolic acidosis

DKA -- give insulin & normal saline

198

Which cells are responsible for stimulating the proliferation of an atherosclerotic plaque? (calling other cells to the scene?)

Platelets ---> they respond to the endothelial cell injury and release PDGF & TGF-beta

199

List the cardiac tissues in order of fastest to slowest conduction velocity

Purkinjie --> Atrial muscle --> Ventricular muscle --> AV node

200

a decrease of systolic BP > 10mmHg upon inspirtaion

"pulsus paradoxus" --> indicates constrictive pericarditis, tamponade, restrictive cardiomyopathy ...

201

triad of muffled heart sounds, elevated JVP & profound hypotension =

pericardial tamponade

202

What type of cell is directly responsible for the intimal thickening in people with atherosclerosis?

Smooth muscle cells

203

What are the possible causes of an anion-gap metabolic acidosis?

MUDPILES Methanol Uremia (renal failure) DKA Propylene glycol Isoniazid Lactic Acidosis Ethylene glycol Salicylates (Aspirin)

204

autosomal dominant condition with telangiectasias on the skin and mucous membranes & sometimes in the brain, liver, spleen --> predisposed to bleeding (epistaxis, GI bleeds, etc..)

Osler-Weber-Rendu Syndrome ("Hereditary Hemorrhagic Telangiectasis")

205

0-4 hours post MI changes

minimal to no changes

206

4-24 hours post MI changes

coagulation necrosis, edema, hemorrhage, "wavy fibers"

207

1-5 days post MI changes

neutrophils infiltrate (inflammatory stage) --> biggest risk is fibrinous pericarditis at this stage

208

5-10 days post MI changes

Macrophages come in -- phagocytize dead cells --> biggest risk is rupture of free wall or papillary muscles

209

10-14 days post MI changes

granulation tissue begins, neovascularization

210

1-2 months post MI changes

collagen deposition , scarring, fibrosis --> biggest risk is aneurysm, mural thrombus or Dressler syndrome at this point

211

Renal artery stenosis in an otherwise healthy 20-30 year old woman --> with "string of beads" renal artery

Fibromuscular dysplasia

212

Marked, one-sided kidney atrophy

renal artery stenosis (look for HTN & abd bruits)

213

a pt with prolonged QT interval is at risk for _________ & what is happening to their outward K+ current (phase 3 repol)

at risk for Torsades de pointes, their outward K+ current is slower / decreased, so that the repol phase is slower and prolonged (QT int)

214

tumor that is CD31 + and is associated with polyvinyl chloride, thorotrast & arsenic exposure

Liver angiosarcoma (rare, aggressive liver tumor) *CD31 is PECAM1 -- functions in leukocyte migration thru endothelial cells

215

Most common congenital heart defect in Turner's syndrome?

Bicuspid aortic valve

216

Drug used to close a PDA

Indomethacin (an NSAID, inhibits PGE2)

217

PDA is most closely associated with what illness?

Congenital Rubella or prematurity

218

Most common form of cardiomyopathy

dilated cardiomyopathy

219

Causes of Dilated cardiomyopathy

-genetic (AD) -myocarditis (Coxsackie A or B) -alcohol abuse -cocaine or other drugs -pregnancy

220

Asymmetrical septal hypertrophy and dynamic ventricular outflow tract obstruction are characteristic of ______

Hypertrophic cardiomyopathy (common cause of sudden death in young athletes --> the huge septum and the mitral valve leaflets block the left ventricular outlfow)

221

what is Kussmaul's sign?

a paradoxical increase in JVP when the patient breaths in (it should usually decrease upon inspiration) --> this indicates constrictive pericarditis

222

What drugs can cause a "lupus like syndrome" -- ie: drug induced lupus?

it's not "HIPP" to have lupus Hydralazine Isoniazid Procainamide Phenytoin

223

new onset lupus symptoms + anti-histone antibodies

Drug induced lupus (Hydralazine & Procainamide have highest risk)

224

Common side effects of all nitrates

Headache, flushing (due to the vasodilatory effects)

225

Drugs that slow AV nodal conduction

Ca+ channel blockers (verap & diltiazem), Beta blockers & Digoxin) -- can all cause slower heart rate

226

Which test should you routinely monitor for a patient on Warfarin?

Prothrombin (PT) time (extrinsic path)

227

Which test should you monitor for a person on unfractionated Heparin?

PTT (("Hep = PTT")) -- intrinsic path

228

Vitamin K dep clotting factors

Factors II, VII, IX and X and protein C & S

229

combined use of a beta blocker & a non-dihydropyridine Ca++ channel blocker (verapamil or diltiazem) can have what effect??

Additive neg chronotropic effect --> severe bradycardia and hypotension

230

What is the drug of choice for beta-blocker overdose?

Glucagon --> it increases cAMP and increases the Ca++ release in the cell --> increasing HR & contraction

231

Why does amenorrhea occur in women who are anorexic?

loss of GnRH pulses from the hypothalamus after the body fat falls below a certain critical level

232

unable to release handshake easily, cataracts, & frontal baldness

Myotonic Dystrophy

233

inheritance pattern of Myotonic dystrophy

Autosomal dominant, CTG repeats

234

hearing loss from loud noises is a result of damage to the ___________

hair cells of the Organ of Corti ----(shearing forces of the tectorial membrane damage the hair cells)

235

What should you do 1st for a child with hyperpyrexia (ie: 107 degrees)

1- cool with cold blankets, cool saline bags, cold water enemas 2- Acetaminophen

236

Subdural hematoma is a rupture of the _______ , classically in the elderly after minor trauma

bridging cortical veins

237

in DCIS, the _________ layer of the duct is uninvolved

basal, myoepithelial layer

238

serum ______ should be monitored in a pt at incrs risk for Choriocarcinoma

B-hCG

239

bilateral absence of the vas deferens in a young male

Cystic Fibrosis

240

B12 deficiency effects on spinal cord ---("Subacute Combined Degeneration")

1- Dorsal Column degeneration 2- Lateral Corticospinal Tract degeneration 3- Degen of peripheral nerves causes.... 1- loss of sensory 2- UMN signs (spastic paresis, hyperreflexia) 3- Numbness / paresthesias -Called "combined" b/c it effects both ascending & descending tracts!

241

deficiency of Arylsulfatase A--> leading to accumulation of cerebroside sulfate

Metachromatic leukodystrophy

242

Middle meningeal artery is a branch of the :

Maxillary artery (which is a branch of the External carotid)

243

understimulation of ______ receptors causes orthostatic hypotension

alpha-1 (a1 vasoconstriction prevents cerebral hypoperfusion upon standing)

244

pt. nasal ulcers and renal failure -- has antibodies against ________

neutrophils! (Wegener's has a + C- ANCA)

245

IL-12 deficiency

can't differentiate T cells into Th1 --> can't fight off MYCOBACTERIA

246

what is a Choriocarcinoma made up of -- histologically

proliferation of both cytotrophoblasts and syncytiotrophoblasts (no villi )

247

Neurons with rounded cell bodies, nuclei & nissl substance displaced peripherally

"Axonal reaction" -- the axon has been severed & the cell body is reorganizing to try to regenerate the axon

248

Polyarteritis nodosa is associated with a _________ infection in 10-30% of the cases

Hepatitis B

249

Pt with symptoms of mono, but the patient's serum fails to agglutinate sheep erythrocytes ..what is causal agent?

CMV -negative Monospot test

250

a stroke at the VPL or VPM of the thalamus would produce pure _______ symptoms

Sensory only

251

stroke at the posterior limb of the internal capsule

only motor hemiparesis

252

nerve that supplies innervation to the lacrimal glands

CN VII

253

brain tumor with psammoma bodies

Q image thumb

Meningioma

254

What (besides hydration) can help prevent kidney stones?

Potassium Citrate solution (citrate binds to the free ionized calcium, preventing precipitation) 

255

Neuraminidase inhibitors (Oseltamivir) prevent the virus from ____________

exiting the host cell and releasing virions 

256

a small blue tumor under the fingernail is derived from what kind of tissue ?

Glomus tumor --> from the modified smooth m. cells ("Glomus bodies")  that control thermoregulation in the tips of fingers, toes & ears 

257

recurrent small "lobar" hemorrhagic strokes in different lobes of the brain -- usually a result of ___________

Amyloid Angiopathy (in elderly with beta amyloid deposits) 

 

-(more benign than the larger hemorrhagic strokes from HTN)

258

low levels of the stimulatory neurotransmitter Orexin (hypocretin) causes _________

Narcolepsy 

259

1st line tx for Narcolepsy 

Modafinil 

- non amphetamine stimulant 

260

Pt with recurrent renal stones, addition of sodium cyanide & sodium nitroprusside to his urine turns the urine red/purple....

Cystinuria 

-the pt has an inborn error of metabolism (Cystinuria) 

- hexagonal crystals in urinalysis 

- tx = Alkalinize the urine 

261

Treatment for TCA side effects (Convulsions, Coma, Cardiac arrythmias)

Sodium Bicarb 

262

loss of neurons in the anterior horn --> UMN or LMN lesion? 

LMN 

- the cell bodies of the anterior horn cells are LMNs

263

What feature of Methadone warrants using it for Heroin addiction treatment?

It has a long half-life --> prolonged effects that help prevent withdrawal symptoms in heroin dep patients 

264

The low-affinity nature of __________ is what allows the characteristic "rolling" action attributed to leukocytes 

Selectins 

265

A person with this pneumonia probably lacks _____ immunity 

Q image thumb

- CMV pneumonia (note the nuclear AND cytoplasmic inclusions)

- lack of T-cells / cell mediated immunity 

266

A person in a deep coma will have a high or low Glasgow Coma Scale # ??

The lowest possible GCS (the sum) is 3 (deep coma or death), while the highest is 15 (fully awake person).

267

which "- encephalon" structure does the Cerebellum and 4th ventricle develop from? (Malformed in Dandy Walker syndrome) 

Metencephalon 

A image thumb
268

Two main things that aid Diphtheria toxin in attcking the host

1- low extracellular iron 

2- Lysogenic phage that encodes the toxin **

269

Fiber type grouping indicates ________

Q image thumb

Muscle fiber type grouping occurs following denervation and reinnervation, the muscle fiber assumes the type determined by its new motor neuron

270

Phosphorylation usually occurs on _______________________residues

serine, threonine, tyrosine and histidine residues 

 

 

271

When is the maximun flow through the coronary arteries?

EARLY DIASTOLE 

272

Thyroid nodule with + calcitonin 

Medulllary thyroid cancer 

273

Mechanism of Botulism toxin 

gets into nerve terminal, cleaves SNARE proteins, prevenst Ach vesicles from being secreted 

274

a Low Fecal Elastase test indicates _____________

pancreatic insufficiency 

275

function of IL-10 

ANTI-inflammatory cytokine

-downregs MHC II, Th1 and macrophages 

276

rash on palms and feet, vomiting and liver damage in a child (after a viral illness)

Reye's Syndrome 

- parent's may have given ASA

- causes Fatty damage to the liver 

277

mechanism of nicotine 

-binds to nicotinic acetylcholine receptors (esp in brain)

-increases the levels of several neurotransmitters

-increased levels of dopamine in the reward circuits of the brain are responsible for the apparent euphoria and relaxation, and addiction caused by nicotine consumption

278

screening test for Chronic Granulomatous Dz 

Nitroblue tetrazolium test 

- abnormal : does not turn blue 

279

What structures run through the Cavernous Sinus? 

-Internal Carotid artery 

- CN II, IV, V1, V2, and VI 

A image thumb
280

Symptoms of Kawasaki Dz

-fever 

-strawberry tongue

-swelling of hands & feet

- desquamation of finger tips

-rash / erythema all over / red conjunctiva 

- coronary aneurysms *

A image thumb
281

loss of E-cadherin would allow _________

cancer to invade the basement membrane (mets) 

282

elevated AFP can indicate what kind of cancers? 

 hepatocellular carcinoma OR germ cell (nonseminoma) testicular carcinoma

283

enzyme that removes Thymine dimers after UV damage 

UV- Endonuclease 

 

(defective NER is seen in Xeroderma pigmentosum)

284

conversion of NE -----> EPI occurs in adrenal medulla by the enzyme ____________

Phenylethanolamine-N-methyltransferase  (PNMT)

285

Amatoxins (found in Death cap mushrooms) effect what cell enzyme & product?

RNA pol II --> mRNA synthesis 

286

the RLS of the Urea cycle is activated by ________

N-acetylglutamate (NAG)

- activates CPS I 

287

why do you get wrinkles as you age?

decreased synthesis of collagen and elastin (despite a good diet w/ all the vitamins!) 

288

"FABGUT"

 

-what are the life threatening enzyme deficiencies for Fructose & Glucose pathways 

life threatening Fructose pathway defect --> Aldolase B

life threatening Glucose pathway defect --> galactose 1- uridyl transferase 

289

How can TNF-alpha cause Insulin resistance?

it phosphyrylates Serine residues --> inhibits Insulin from phosphorylating Tyrosine ...