* Second Pass Facts Flashcards
(361 cards)
1
Q
types of symptoms not improved with addition of carbidopa to levodopa
A
central (e.g. anxiety, behavioral)
actually worsen due to increased central avail of l-dopa
2
Q
sorbitol to what in lens of healthy
A
Fructose
(by sorbitol dehydrogenase)
[glucose –> sorbitol by aldose reductase]
3
Q
bounding pulses,
carotid pulsations,
head-bobbing
A
aortic regurgitation
4
Q
Bcl-2
A
ANTI-apoptotic
increased in follicular cell lymph
5
Q
loss of sensation of 5th digit;
nerve?
A
ulnar
sensation of medial 1/2 of hand
6
Q
disaccharride containing fructose
A
sucrose
7
Q
gait instability,
degen of posterior columns and spinocerebellar tracts
(gen and vit def)
A
Friedreich ataxia
Vitamin E deficiency
8
Q
Cornybacterium get ability to make pseudomembrane via
A
phage conversion–>
exotoxin production
9
Q
Rabies bind to which receptor
A
Ach (nicotinic)
10
Q
- skin/resp infxs
- light skin/hair
- horiz nystag
- giant cytoplasmic granules in neutrophils/monocytes
Disorder?
A
Chediak-Higashi
11
Q
psammoma bodies;
adult brain tumor
A
Meningioma
arise from arachnoid villi
12
Q
decreases crystalization in urine
A
increased citrate
13
Q
acidic ph - stone types
A
uric acid
cystine
calcium OXalate
14
Q
type of necrosis in MI
A
coag necrosis
15
Q
pneumonia agent that needs a complex acellular medium enriched with cholesterol in order to grow
A
mycoplasma pneumoniae
16
Q
ApoE 3&4
A
Chylomicron and VLDL remnant uptake
17
Q
ApoA-1
A
LCAT activation
18
Q
ApoB-48
A
chylomicron assembly in intestine
19
Q
ApoB-100
A
LDL particle uptake by EXTRAhepatic cells
20
Q
ApoC-II
A
LPL activation
21
Q
Oral bioavailability calculation
A
Area under oral curve DIVIDED by area under IV curve
curve of serum concentration after admin
22
Q
common resp infx in CF
A
pseudomonas
23
Q
bisphosphoglycerate mutase
A
makes 2,3 BPG in erythrocetes
24
Q
lupus + false positive RPR/VDRL + increased aPTT
A
- recurrent miscarriages
- venous and arterial thromboembolism
(antiphospholipid Ab aka lupus anticoagulant –> HYPERcoaguable state in vivo)
25
sudden muscle relaxation reflex
golgi tendon
arranged in series
(very sensitive to tension, NOT to passive stretch)
1b sensory --> inhib interneuron
26
maintains muscle length
muscle spindles (intrafusal muscle fibers)
arranged in parallel
mediates stretch reflex--> causes cntx
1a sensory --> alpha motor neuron
27
myotatic reflex (aka deep tendon reflexes) mediated by...
muscle spindles
| cause contraction
28
highest oral bioavail nitrate
isosorbide mononitrate
29
difference in effect of therapy/risk modifiers on based on time exposed due to...
```
latent period
(initial steps of pathogenesis occur long before clinical manifestations)
```
30
HbF last until when
~6 months (gradual change)
31
non-typable Hflu cause...
otitis media
sinusitis
bronchitis
(part of normal upper resp tract)
nontypable = no capsule
32
cytokines released during tissue injury that DOWN-regulate infl
TGF-B
| IL-10
33
Volatile anestetic effects
increase cerebral blood flow (increases ICP)
myocardial depression, hypotension, resp depression, decreased renal fx
34
malignant htn vessel process
onion-like concentric thickening of arteriolar walls
35
mucous secreting cauliflower-like mass in colon
villous adenoma
36
hiccups, shoulder pain -
| which nerve roots
C3-C5
37
spleen of sickle cell firm and brown
vascular occlusions --> infarcts --> eventual autosplenectomy
38
IV MRSA abx --> muscle pains/increased CK
mech of drug?
maintenance of membrane potential (depolarization) and inhib DNA/RNA/protein synth
Daptomycin
39
Facial nerve (CN VII)sensory
somatic - pinna and external auditory canal
40
Facial nerve (CN VII) autonomic
parasymp to lacrimal, submandibular, and sublingual glands
41
mass in rt temportal lobe --> what visual defect?
contralateral SUPERIOR quadrantanopia
[ "Try the pie in the SKY" - Temporal = upper
"Leave the Poop on the GROUND" - Parietal = lower"]
42
holosystolic murmer that increases in intensity on inspiration
tricuspid regurg
43
sweat glands of axillae are what type of glands
apocrine
| sweat secreted in membrane bound vesicles into hair follicles
44
length of phase 1 depolarizing blockade
| of succinylcholine
20 mins (depends on metabolism)
| enhanced by neostigmine in phase 1, counteracted in phase 2
45
histoplama histology
ovoid cells within macrophages
46
symptoms of septic shock
TNF- alpha
| and IL 1 and IL 6
47
Toxic Shock - what cells?
```
T lymphocytes (--> IL2)
Macrophages (--> IL1 and TNF)
```
48
pioglitazone mech
transcription modulation
| increase adiponectin
49
nephrotic syndrome with underlying malignancy suggests...
membranous glomerulonephropathy
50
nephrotic syndrome with diffuse increased thickness of glomerular basement membrane w/o increased cellularity
membranous glomerulonephropathy
51
membranous glomerulopathy --> left vericocele
etio?
loss of antithrombin III --> hypercoag --> renal vein thrombosis
(flank pain, hematuria, vericocele)
52
MC lung cancer in
non smokers
women
adenocarcinoma
| form glandular or papillary structures
53
lamellar bodies of type II pneumocytes
release pulmonary surfactant
54
maculopapular rash head--> trunk WITH postaruicular lymphadenopthy
Rubella
| Toga Virus
55
IL2 --> what cells
- Th cells
- monocytes
- NK cells
- T cells (to make INF gamma)
- B cells (increase division)
56
ulcer through posterior wall of duodenal bulb - what vessel?
gastroduodenal
57
bias - know you're being observed
Hawthorne
58
bias - only hosp pts
Berkson
| selection bias
59
present in 90% of hashimoto's pts
anti- thyroid peroxidase
60
lupus pt + cushinoid features... what do the adrenals look like?
bilateral cortical atrophy
| taking exogenous glucocorticoids
61
NF 1 and NF 2 genetics/inheritance
Autosomal Dom
NF1 - 17
NF2 - 22
62
tx vasospasm 4-12 days post SAH
nimodipine
63
immunocompromised pt with skin lesions that are ulcerated in appearance w/ occasional necrotic center (looks kinda like kaposi) -
what bacteria
psuedomonas aeruginosa
64
neutropenia = at risk for what kind of bacteria
gram neg
65
opiods + biliary colic - mech?
contraction of smooth muscles in sphincter of oddi
66
glucocorticoids acutely increase what kind of cell in serum
neutrophils (demarginalization)
67
adult brain tumor with focal necrosis and hemorrhage
glioblastoma multiforme
- from astrocytes
- MC
68
adult brain tumor - well circumscribed gray mass, possibly with calcifications
oligodendrogiomas
69
excess copper - med?
penicillamine (chelator)
70
hypothalamic nuclei involved in circadian rhythm regulation
suprachiasmatic
71
ethambutol SE
optic neuritis -->
- color blindness
- central scotoma
- decreased visual acuity
72
Abs specific for SLE
anti-dsDNA (60% have)
anti-Smith/anti snRNP (20-30% have)
73
polyethylene glycol similar to what pathophys
lactase deficiency (osmotic laxative/osmotic diarrhea)
74
gray discoloration of macula w/adjacent hemorrhage
| dx and tx target
age-related macular degeneration
(wet subtype)
tx: target VEGF
75
dry age related macular degen
gradual vision loss (difficulty driving/reading)
drussen depoits w/ pigment abnormalities on fundoscopy
76
recurrent severe nosebleeds +
| telangectasias on oral/nasal mucosa, face, and arms (e.g.)
Osler-Weber-Rendu syndrome
| AD - hereditary hemorrhagic telangiectasia
77
barroreceptor firing rate when high pressure
increases!
(ah! so high!!)
--> increases PARAsymp invluence on heart and vessels, prolongs AV node refractory period
78
side effects of thiazolidinediones (TXDs)
| e.g. pioglitazone
fluid retention --> wt gain and edema
**can exacerbate underlying CHF
79
End-stage renal disease - metabolic derangement
renal osteodystrophy
- hypocalcemia via renal retention of phosphate and decreased renal synth of calcitriol
- hypocalcemia + resultant hyperPTH --> osteodystrophy
80
Left border of heart
LV forms apex and reaches as far as the 5th intercostal space at the left midclavicular line
(all other chambers to the rt of midclavic line)
81
stab through 5th intercostal space at midclav line - what hit?
lung
(overlies much of anterior heart)
- possibly LV if DEEP enough
82
XX ambig genitalia with hypokalemia and high BP
11-beta
83
markers indicative of small cell carcinoma (lung)
```
neuroendocrine markers
(neurofilaments, neurosecretory granules)
```
tumor of neuroendocrine origin
84
env gene mt induced by
evasion of host neutralizing antibodies
85
pol gene mt induced by
anti-retroviral meds
86
small yellow retinal lesions in macula- expected visual defect?
central scotoma
87
positive "whiff" test
bacterial vaginosis
| clue cells
88
yellow-green foamy foul-smelling discharge
trichomonas
89
failure of recanalization mechanism of atresia where in GI
duodenum only!
distal to duodenum= vascular accidents in utero
90
psoriasis med that activates nuclear transcription factor
topical vit D analogs --> inhibit keratinocyte prolif and stim differentiation
calcipotriene
calcitriol
tacalcitol
91
psoriasis med that blocks NFAT from entering nucleus --> decreases prod and release of IL2
cyclosporine
92
bisphosphonates are structural analogues of...
pyrophosphate
| component of hydroxyapatite
93
PR interval
beginning of atrial depolarization to beginning of ventricular depolarization
94
chronic lymphedema = risk for...
angiosarcoma
(Stewart-Treves syndrome)
multiple firm violaceous nodules
95
Diffusion capacity in COPD
decreased (due to destruction of alveoli and adjoining capillary beds)
96
antiarrhythmic that increases AP duration and decreases phase 0 slope
Class 1A
97
Class of Type 1 antiarrhythmics that has strongest effect on phase 0
1C
98
class of type 1 that has weakest effect on phase 0
1B
99
where does V3 exit skull
foramen ovale
100
where does V2 exit skull
foramen rotundum
101
steroid use signs
- increased hematocrit
- soft small testes
- acne
- hepatic abnormalities
102
induces secretion of bicarb rich/chloide poor fluid from pancreas
secretin
| from S endocrine cells in duodenum
103
biggest O2 difference from aorta
coronary sinus
104
When do microglia appear (post ischemia)
3-5 days
105
What cells form the glial scar post ischemic infarct
astrocytes
106
medullary thyroid cancer histo
nests of polygonal cells with congo red-positive deposits
| extracellular deposits of amyloid formed by calcitonin
107
enzyme detected in inflammatory cells (e.g. machrophages) during inflammatory response but not detectable in most normal tissues
COX- 2
108
induces production of HbF
hydroxyurea
109
prevents efflux of K and water from cells, preventing dehydration of erythrocytes and reducing sickling
calcium dependent potassium (Gardos) channel blockers
110
incidence - when calculating don't forget to account for what in the population
people who already have the disease (subtract from pop)
111
methotrexate leads to build of what
DIhydrofolate POLYGLUTAMATE
112
Amph B electrolyte disturbances and etio
hypoK
hypoMg
due to distal tubular membrane permeability (disfx)
113
Beta 2 microglobulin
MHC I
114
dobutamine
| - mycardial O2
increases myocardial O2 consumption
| increases HR, contractility, conduction velocity - beta1 agonist
115
apoptotic hepatocytes - histo
shrink
nuclear frag
intensely eosinophilic
"acidophil bodies"
"councilman bodies"
(due to acute viral hepatitis)
116
elastases produced from what cells; what inhibits
infiltrating neutrophils
- inhib by serum alpha-1 antitrypsin
and alveolar macrophages
- inhib by tissue inhibitors of metaloproteinases (TIMPs)
* can degrade eachother's (not their own) inhibitors
117
prevent acidification of lysosomes in APC --> ?
impaired interaction w/ Tcells b/c low expression of MHC II
| load antigen in endosome/lysosme or phagosome/lysosome fusion
118
where is MHC I loaded
RER
119
genetic defect in ataxia-telangiectasia
Auto Recessive
mt in ATM gene
(DNA break repair)
120
cortisol receptor location
intracellular
121
superficial inguinal lymph nodes drain...
all cutaneous lymph from umblilicus to feet
| including external genitalia and anus to dentate
122
prostate drains to what lymph nodes
internal iliac
123
lymph from bladder...
superior --> external iliac
| inferior --> internal iliac
124
charcot-bouchard aneurysm
- due to chronic hypertension
| - deep brain structures (not lobar)
125
cerebral amyloid angiopathy
- beta amyloid deposition in walls of small/medium arteries --> weaken
MCC of spontaneous lobar hemorrhage in elderly (usu same protein as in alzh)
(not a/w systemic amyloidosis)
126
Lesch-Nyhan inheritance
XR
127
Classical galactosemia inheritance
AR
128
Rapid plasma decay of barbituate-like IV anesthetic (e.g. thiopental) due to
redistribution into other tissues throughout body
129
CD55
| CD59
CD55 - accelerates complement decay
CD59 - inhibits MAC
(deficiency usually due to lack of GPI anchor)
130
kid w/ URI --> STRIDOR vs WHEEZING
Stridor
- croup (laryngotraceitis)
- parainfluenza virus (paramyxo)
Wheezing
- bronchiolitis
- RSV
131
poor feeding
hypotonia
cardiomegally
enlarged PAS+ lysosmes in muscle
acid alpha-glucosidase deficiency
Pompe disease
132
BRAF mt
melanoma
| protein kinase
133
dilates veins
dilates arterioles
promotes diuresis
(endog)
BNP
| both ANP and BNP activate Guanylate cyclase
134
bile acids reabsorbed from...
terminal illium
135
location of thyroid hormone receptors
intra-Nuclear
136
valproate teratogenic effects
neural tube defects
(valproate inhibits intestinal folic acid absorbtion)
e.g. - menigocele
137
ACL/PCL locations
APEX
-Anterior cruciate runs Posteriorly and inserts on EXternal femoral epicondyle
PAIN
- Posterior cruciate runs Anteriorly and inserts on INternal epicondyle
138
delusional d/o vs paranoid personality d/o
paranoid personality d/o = pervasive pattern of suspiciousness w/o clear delusions
(no clear delusions in personality d/o)
NB: delusional d/o must have delusions for at least 1 mo
(no clear bizarre behavior apart from delusion)
139
recurrant neiserria infx
complement def
140
drug that causes priaprism
| not ED drug
trazodone
- for pts with depression and insomnia
(contraindicated in adolescent boys)
141
MC site of hematogenous osteomyelitis
(MC in children)
usually affects metaphysis of long bones
142
isoniazid SE
hepatoxicity
143
FIRST step in coronary disease involves what cells
endothelial
| begins with endothelial dmg
144
location of atherosclerosis
large elastic arteris and large/medium muscular arteries
145
half life
t(1/2)= 0.7(Vd)/(Cl)
146
noncoronary atherosclerotic disease, DM, and CKD are at some risk for ______ as _____
CV events as pts with known coronary heart disease
147
MCC of death in DM
MI
| coronary heart disease
148
choriocarcinoma (histo)
abnl prolif of both cyto and syncytiotrophoblasts
| no villi
149
foot drop
common peroneal
150
order of enzymes in synth
17
21
11
17 - (over to cortisol/androgens)
21 - (down to pre aldo and pre cortisol)
11 - (down to aldo and cortisol)
151
Niacin antilipid action
inhibit VLDL production (liver)
- partially due to suppression of FFA release from periph tissue
used to increase HDL
152
Inulin estimates ...
| PAH estimates....
inulin - GFR
| PAH - PLASMA renal flow
153
uses CD21 to invade cells
EBV
| complement receptor
154
Lynch syndrome mech (mt)
Auto Dom
DNA mismatch repair defect
(hereditary nonpolyposis colon cancer)
155
nipple inversion
suspensory ligament infiltration by invasive breast cancer
156
OS on cath tracing of mitral stenosis
when ventricular pressure drops below atrial pressure (early diastole)
157
drug --> liver abnormalities and oral ulcers
methotrexate
158
possible sickle cell + gross hematuria
papillary necrosis
159
delayed separation of umbilical cord
defect in integrins
leukocyte adhesion deficiency
- Auto Recessive
- absence of CD18 --> inability to synthesize integrins
160
recurrent skin infections WITHOUT pus formation
leukocyte adhesion deficiency
AR mt-> absence of CD18 --> no integrins
161
high levels of prolactin --> what risk for women
osteoporosis
high PRL --> hypogonadism --> low estrogen --> accelerated bone loss
162
Why are Chlamydia trachomatis and Ureaplasma urealyticum (causes of NGU) not effectively treated by penicillins/cephalosporins?
Chlamydia lacks peptidoglycan w/in cell wall
Ureaplasma lacks cell wall entirely
163
DKA with normal CO2
respiratory failure
164
Apoliprotein E-4 increases risk for...
Alzheimer (late onset familial)
165
Risks for early onset Alzheimer
```
APP (ch 21)
Presinillin 1 (ch 14)
Presinillin 2 (ch 1)
```
166
budding yeast forms with thick capsules
cyrptoccocus
usu causes meningitis (dx w/india ink) but can also cause pneumonia (dx with mucicarmine staining)
(in immunocompromised)
167
fetal lung maturity ratio
Lecithin (phosphadidylcholine):
sphyingomyelin
L/S >= 2 (mature)
168
tx of toxo
pyrimethamine
sulfadiazine
(TMP-SMX)
(can sub clindamycin for sulfadizine if sulfa allergy)
169
Primary central nervous system lymphoma (cell origin/association)
B cell origin
EBV
similar lesions to toxo, but more commonly a single lesion (though can have multiple)
170
mifipristone
anti-progestin
171
hydrophobic (non-polar) amino acid residues
```
valine
alanine
isoluecine
methionine
phenylalanine
```
(typically in transmembrane domains of alpha helices)
172
pramipexole
stimulates dopamine receptors
173
classes of dopamine agonists
ergot:
- bromocriptine
- pergolide
non-ergot:
- pramipexole
- ropinirole
174
pt in adrenal crisis - tx
corticosteroids
| response to vasopressors usually subobtimal
175
HbC more mild than HbS bc...
HbS allows hydrophobic interaction among hemoglobin molecules
(leads to polymerization)
176
Same in HbS, HbC, and HbA
binding affinity for O2 and 2,3 DPG
NB: does NOT result in significant change in folding
177
- skin anesthesia
- hypopigmentation
- bacterial invasion of Schwann cells
Mycobacterium leprae
178
d-xylose
monosaccharide
| i.e. does not need enzymes to be absorbed but can be decreased in malabsorption (like celiac)
179
pt with aggetation/agression ---> tx and cooperative ---> high fever, confusion, muscle rigidity
neuroleptic malignant syndrome 2/2 tx w/ haloperidol
180
caclified cystic mass in young (is)
craniopharyngioma
| cyst fluid rich in cholesterol
181
maximum stool osmolality
max approaches serum osmolality
| normal stool osmolar gap = 50-100
accounts for non-electrolyte osms
182
Lactase-def labs after lactose challenge
- increased stool osmotic gap
- increased breath hydrogen content
- decreased stool pH
183
5-HIAA
| 5-hydroxyindoleacetic acid
serotonin metabolite
184
prevents renal impairment from tumor lysis syndrome (can happen during chemotherapy)
rasburicase
- urate oxidase
- uric acid --> allantoin (exreted in urine)
allopurinol
185
tumor lysis syndrome characterized by...
LOW calcium
HIGH phosphate
HIGH potassium
HIGH uric acid
186
fever
pharyngitis
rash (blanches?)
strawberry tongue
scarlet fever
caused by pyrogenic exotoxins
187
which receptors prevent cerebral hypoperfusion upon standing
alpha 1
188
inhibition of saturation of long, branched lipids--> inhibits what bacteria
mycobacterium
| mycolic acid= long branched saturated fatty acids
189
TB drug structurally similar to pyridoxine
isoniazid
190
transient tingling that fully resolves within minutes... tx
probably a TIA (if other things ruled out)
start with asprin (risk of GI bleeding)
191
HBV helps HBD with what
coating of viral particles --> allows it to infect hepatocytes
(coating done by HBsAg)
192
munro microabsesses
(in psoriasis)
spongiotic clusters in superficial dermis and parakeratotic stratum corneum
193
what complement protein is usually normal in PSGN
C4
| decreased C3 and total compliment levels
194
recurrent mycobacterium infx
interferon gamma signalling pathway d/o
195
used post SAH
nimlodipine
(calcium channel blocker)
to prevent vasospasm
196
CMV esoph findings
linear ulceration
| both intranuc and cytoplamic inclusions
197
ACA occlusion
contralateral motor and sensory deficits of LOWER extremities, behavioral changes, and urinary incont
198
glyburide
sulfonurea
| - increases insulin secretion
199
no apparent liver disease w/ mild unconj hyperbilirubinemia when triggered by a stressor
Gilbert
200
pneumococcal vaccine type for old
outer polysacharide
201
H2O deprivation test cutoff to be considered "complete" central DI
>50% increase in urine osm = complete central
| > 10% increase in urine osmolarity after vasopressin suggests central DI
202
deposits in PSGN
C3
IgG
IgM
in mesangium and BM
"starry sky"
203
main virulence factor in shigella infx
invasion of mucosa
| M cells that overlie Peyer's patches
204
substances involved in path of asthma that have therapeutically beneficial pharm antagonists
LTC4
LTD4
LTE4
Ach
205
mech of increased expiratory flow rates in pulmonary fibrosis
(when corrected for low lung volume)
increased elastic recoil --> increased radial traction on airways --> decreased airflow resistance
206
P bodies
cytoplamic proteins that regulate mRNA translation and degredation
207
MC CV manifestation of SLE
pericarditis
208
enzyme that increases carcinogen's effect
microsomal monooxygenase
*most carcinogens enter body in inactive state (pro-carcinogens) and are converted to active metabolite by cyp450 oxidase system
209
superior sulcus tumors (pancoast tumors) a/w
- rib destruction
- atrophy of hand muscles
- pain in C8, T1, and T2 nerve root dist
- edema of upper extremity (compr of subclavian)
- Horner
*severe pain in shoulder that radiates toward axilla and scapula is MC presenting symp
210
Remember DM and Beta blockers....
Non selective or B2 antag
- decrease
glucagon secretion --> may cause hypoglycemia in pts with DM
- beta blockers ALSO decrease/mask symptoms of hypocglycemia
211
Serum marker that increases risk of vertical transmission of Hep B
HBeAg
212
Meds with antimuscarinic (anticholinergic) effects:
atropine
TCAs (e.g. amitryityline)
H1 blockers (e.g.diphenhydramine)
neuroleptics
antiparkinson drugs
213
double vision while walking down stairs
trochlear nerve
| vertical diplopia most noticable when affected eye looks toward nose - e.g. reading or walking down stairs
214
Histo for contact dermititis
spongiosis
| fluid in intercellular spaces - blisters
215
pulsus paradoxus
decrease SBP >10 w/insp
increased RV volume pushes septum into LV b/c no room in pericardium to expand
a/w constrictive pericarditis, severe obstructive lung disease, restrictive cardiomyopathy, (acute cardiac tamponade)
216
black necrotic eschar in nasal cavity
mucor or rhyzopus
*esp in setting of DKA
217
age of aoritic stenosis symptom presentation
7th decade -
senile calcific aortic degen
6th decade -
congenital bicuspid valve
symptoms (SAD): exertional syncope, angina, dyspnea
218
Hflu vaccine type
cell wall polysacharide conjugated with protein toxoid from diptheria or tetanus
(can be given as early as 2mo)
219
tyrosine kinase receptor
| fx (generally)
accelerate cell proliferation
| responds to growth factors
220
IV acyclovir SE
crystalline nephropathy
need ensure adequate hydration
221
Dyspnea 2/2 HF caused by
| general
decrease in lung compliance due to fluid accumulation in lung interstitium
222
Drugs with predominantly hepatic clearance (spare kindeys) tend to...
- be highly lipophilic
| - high volume of distribution
223
Potency of inhaled anesthetic correlates to...
Minimal alveolar concentration
(inversely proportional)
(concentration that renders 50% of pts unresponsive to painful stimuli)
- dependent on body temperature
- decreases with increasing pt age
- UNrelated to sex, ht, wt of pt
224
hyperacusis nerve/muscle
stapedius muscle and nerve
(branch of facial)
?:
tensor typani
inserts on maleus (incrases tension on tympanic membrane)
- V3 (mandibular trigem)
225
How long from onset of total ischemia to loss of cardiomyocyte contractility
w/in 60 seconds
| irreversible after about 30 mins
226
Cherry red macula symp in lysosomal storage disease
Tay-Sachs
(no hepatosplenomeg)
Niemann- Pick
- hepatoslenomeg
227
Langhans giant cell
(NOT langERhans)
activated macrophages (epitheliod cells) that have multiple nucelii organized peripherally in the shape of a horsoe
no specific finding in granulomatous conditions
228
Filtration fraction
FF= GFR/renal PLASMA flow
229
gene mt required for emergence of adenomatous polyps from normal mucosa
APC
- tumor suppressor
- regulates cell growth and CELL ADHESION
(K-ras --> unregulated proliferation)
230
Insulin triggers tyrosine kinase which triggers...
protein phosphatase
231
Preterm infants at life-threatining risk of what vit deficiency
Vit K
232
factor V Leiden
factor V resists cleavage by protein C
| a/w risk of deep VENOUS (not arterial) thrombosis
i.e. not splenic infarcts
233
amyloid in old cardiac atria
ANP
- misfolded -> beta sheets
- senile cardiac amyloidosis --> may increase risk of aFib
- incidence >90% in 9th decade
234
neurologic symptoms that worsen with heat exposure
MS
235
pain shooting down posterior thigh/leg = what nerve root
S1
| will also have diminished ankle jerk reflex
236
location of promoter
25-70 bp upstream
237
prevents dissemination of candida
neutrophils
| T-cells for superficial
238
synaptophysin
protein in presynaptic vesicles of neurons, neuroendocrine, and neuroectodermal cells
239
fexofenadine
2nd generation anti histamine
240
hydroxyzine
promethazine
chlorpheniramine
diphenhydramine
1st gen antihistamines
241
glomerular crescent = deposition of what
fibrin!
| also glomerular parietal cells, monocytes, macrophages
242
Anticonvulsants + mood stabilizers
Valproate
Carbamazepine
Lamotrigine
(valproate is the MC used for seizure prophylaxis)
243
terbinifine
inhib squalene epoxidase
| used for tx of dermatiphytosis
244
progressive supranuclear palsy
form of parkinsonism from degen of midbrain and frontal subcortical white matter
falls, exec function loss, vertical gaze palsy
abnormally phos tau
245
vit --> intracranial htn
Vit A
| also --> hepatosplenomegaly and skin changes
246
nerves often affected by acoustic neuromas
(schwanomma that usu occurs at cerebellopontine angle b/w cerebellum and lateral pons and arises from CN VIII)
- CN VII (facial)
- CN V (trigem)
247
met process a/w drug induced lupus
```
liver acetylation
(slow acetylators = higher risk)
```
248
cortical atrophy + enlarged vetricles
hydrocephalus ex vacuo
| no increased ICP
249
blood gas in PE
LOW PaO2
LOW PaCO2
(norm?) HCO3
HIGH ph (respiratory alk)
250
testicular malignancy can also cause...
paraneoplastic hyperthyroidism
| if secreting hCG --> similar to TSH
251
stool findings in secretory diarrhea
mucous and some shed epithelial cells
NO leukocytes/blood (inflammatory)
252
tx cryptococcal meningitis
amph B
253
Cl channel affected by benzos, barbituates, and etoh
GABA (A)
(inhibitory receptor)
benzos and zolpidem:
- allosterically binds
(others bind to different components)
254
tx of seratonin syndrome
cyproheptadine
| antihistamine with ant-serotenergic properties
255
Wilsons
Kayser-Fleisher ring
Basal ganglia atrophy --> neuropsychiatric complications
256
damaged in chronic rejection of lungs
small airways
---> brochiolitis obliterans syndrome)
(vs vessels in acute rejection)
257
a/w nasopharyngeal carcinoma
EBV
258
weird looking lymphocytes w/ abundant blue cytoplasm w/ basophilic rim that's indented by neighboring RBCs
EBV
(infectious mono)
***CD 8 T cells
(B cells small portion of smear)
abundant cytoplasm + lack of nuclear changes distinguish them from hematologic malig
259
candida skin test - what cells
CD4 T
CD8 T
NK cells
260
oculomotor findings w/ wern-kors
horizontal nystagmus
| bilateral abducens palsy
261
diaphragmatic surface of heart supplied by...
Posterior descending artery
- 90% from RCA
(Inferior wall of left ventricle)
262
stop codons
UGA
UAA
UAG
263
N. meningitidis vaccine
capsular polysaccharides
264
tx of bradycardia --> eye pain
atropine
| acute closed angle glaucoma
265
tx for giardia
metronidazole
266
acute leukemia that presents as anterior mediastinal mass
T-cell
ALL
(can cause resp symp, dysphagia, or SVC syndrome)
267
contain TdT
B and T cell
| ALL
268
B cell markers
CD 10
CD 19
CD 20
269
T cell markers
```
CD 2
CD 3
CD 4
CD 5
CD 7
CD 8
```
270
chemo ---> hemorrhagic cystitis
what drug/what prevention
cyclophosphamide
ifosfamide
---> toxic metabolite acrolein
prevent:
-mesna
(sulhydryl cmpd binds acrolein in urine)
- also aggressive hydration and bladder irrigation
271
Deficiency in:
C1 esterase inhibitor
Don't give:
ACE inhib
| -pril
272
high gastrin - which MEN
MEN 1
| pancreatic gastrin secreting tumor
273
MEN 1
Parathyroid --> hypercalcemia
Pancreatic --> gastrin
Pituitary --> PRL, ACTH
274
MEN 2A
Parathyroid --> hypercalcemia
Pheochromocytoma
Medullary thyroid (calcitonin)
275
MEN 2B
Pheochromochytoma
Medullary thyroid
Mucosal neuromas (oral, etc)
Marfanoid habitus
276
Indicates irreversible myocardial cell injury
mitochodondrial vacuolization
(means they're unable to make ATP_
277
c-myc
transcription activator
controls prolif, diff, apop
(overactivation --> high mitotic intex)
278
dmg to what structure will cause permenant central DI
hypothalamic nuclei
| paraventricular and supraoptic
279
tibial nerve sensory
sole of foot
280
can't stand on tip toes
tibial nerve
| digital flexor os toes and flexors of lower leg
281
deletion of single nucleotide
frameshift
282
before giving entanercept
PPD skin test
283
mech of adenosine
(like ACh)
- acts on phase 4
- activates K+ channels and prolongs K+ flow --> membrane pot remains negative for longer period
- inhbits L-type Ca++hannels (longer to reach threshold)
- reduces rate of spontaneous depolarization
284
MCC of aseptic meningitis
enterovirus
- coxsackie
- echo
- polio
**Fecal/oral route
(but do not typically cause gastroenteritis)
285
what part of GI tract has ramified, tubular glands in submucosa that contain alkaline secretions (ph 9)
duodenum
286
Brunner's glands
-submucosa of duodenum
287
Peyers patches
ilium
288
N-acetylcysteine use in CF
cleaves disulfide bonds w/in mucus glycoproteins
| loosens thick sputum
289
Beta blockers and thyrotoxicosis
- decrease sympathetic adrenergic symptoms
| - decrease rate of periferal conversion of T4 --> T3
290
decreased outward K and prolonged APs.... most likely to suffer what
torasades
| and sudden death
291
CXR:
- unilateral pulmonary opacification
- deviation of mediastinum toward opacified lung
obstx in mainstem bronchus
| --> lung collapse
292
% of coronary vessel obst --> symptoms
75%
293
increase insulin resistance in overweight pts
FFA
| serum trigycerides
294
vitamin def associated with TB
pyridoxine (B6)
isoniazid similar and competes
295
PECAM (platelet endothelial cell adhesion molecule)
transmigration
296
rolling
L- selectin (neutrophils)
E/P selectin (endothelial cells)
(loose binding of sialated carb - e.g. sialyl lewis/PSGL)
expression greatly increased by cytokines
297
Tight adhesion/crawling
Integrins (neutrophils)
- CD18
ICAM (endothelial cells)
298
steps of getting leukocytes to tissue
```
marginalization
rolling
activation
tight adhesion/crawling
transmigration
```
299
musculocutaneous nerve
- flexion of arm at elbow
- supination
- lateral forarm (sensory)
300
directly behind esophagus
descending aorta
301
neurophysin
carrier molecule for posterior pituitary stuff from the hypothal
(oxytocin and ADH)
302
wet
wacky
wobbly
normal pressure hydroceph
303
non enveloped
single stranded
DNA
parvo
304
acute arthritis w/ opaque exudate high in neutrophils and intracellular organisms
(in sexually active young adults)
- bacterial/septic arthritis
- Niesseria gonorrhoeae
305
antiarrythmic sodium channel binding strength
1C > 1A > 1B
* 1C = most use dependance
1B has the least use dependence
i.e. the shorter binding means less time to accumullate effect
306
MCC of death in Marfans
| after infancy
aortic dissection
| cystic medial degeneration
307
blanching of tissue during norepi infusion - tx?
phentolamine
308
vessels spared in PAN
pulmonary
309
cystic tumor in cerbellum of child
- spindle cells
- hair-like glial processes
- ROSENTHAL FIBERS
- granular eosinophilic bodies
pilocytic astrocytoma
310
"holiday heart syndrome"
excessive etoh ---> a fib
- irreg'ly irreg
- no P waves
- varying R-R intervals
311
anticonvulsant that can --> bone marrow suppression
carbamazepine
| blood counts should be watched
312
check if suspect B12 def
serum methylmalonic acid
| increased
313
tx of organophosphate poisoning with only atropine leaves pts at risk for..
muscle paralysis
*add pralidoxime
314
Granuloma formation (e.g. sarcoid) mediated by what cells/cell products
TH1
IL 2
INF gamma
315
genetic predisposition to hyperglycemia in pregnancy - mt in what enzyme
gluckokinase
(sensor w/in beta cells)
mt --> mild hyperglycemia that can be exacerbated during preg
316
withdrawl symptom:
yawining
opiods
| heroin
317
fungal drug that inhibits CYP450 met of other drugs
azoles
318
- bilateral hearing loss
- bump on tibia
bx: cells with over 100 nuclei, tartrate-resistant acid phosphotase positive
Paget's disease of the bone
huge cells with many many nuclei = overactive osteoclasts
NB: osteoclasts stim by M-CSF and RANK-L (from blasts)
319
Long QT interval (hereditary)
| --> what else may pt also have
neurosensory deafness
- mutation in genes coding for potassium of sodium channels
Jervell and Lange-Nielsen syndromes
320
mech of glucagon reversal of beta-blockers
acts on g protein receptor
--->increases intracellular cAMP
---> increases release of intracellular calcium during muscle contraction
----> increases HR and contractility
321
side effects of protease inhib
hyperglycemia
lipodystrophy
drug/drug interactions (inhib cyp450)
322
muscarinic receptors on endothelial cells
- promote release of NO (EDRF) ---> activates g-cyclase --> decreases calcium concentration
323
midshaft humerus fractures - artery/nerve?
- deep brachial artery
- radial nerve
(supracondylar a/w brachial artery)
324
diabetic mononeuropathy of CN III
central ischemia
--> affects somatic nerve fibers but spares peripheral paraympathetic
= down and out gaze but normal light/ accommodation reflexes
325
aneurymal compression of CN III
affect superficial parasympathetic efferents first and spare deeper motor (extraocular mvmts)
early: dilated pupil and loss of accommodation
late; ptosis and opthalmoplegia
326
GTP formed in what stage of TCA
succinyl- CoA --> succinate
327
pure motor hemiparesis
| location
posterior limb of internal capsule
or basal pons
328
pure sensory stroke
ventroposterolateral (VPL)
or
ventetroposteromedial (VPM)
thalmus
329
ataxia-hemiplegia syndrome
posterior limb of internal capsule
or basal pons
330
dysarthria - clumsy hadn syndrome
genu of the internal capsule
or basal pons
331
stage vs grade
stage - how much the tumor spreads
grade - degree of differentiation
332
duodenal ulcer - tx for long term relief
abx
333
colorectal carcinoma from IBD vs sporadic
IBD:
- multifocal
- younger
- from flat dysplasia
- mucinous/signet ring
- early p53/late APC
- proximal colon (esp chrohns or concurrent PSC)
334
NE--> what receptors
alpha 1/2
beta 1
**little on B2
(therefore only alpha on vessels)
335
calcineurin
essential protein in activation of IL-2
| activation blocked by cyclosporine and tacrolimus
336
site of greatest degree of atrophy in Alzheimer's
hippocampus
337
short term diabetic neuropathy tx that should be used with caution in pts with BPH
TCAs
(e.g. amitriptyline)
anticholinergic properties
338
low pitched holosystolic murmer that accentuates w/increased afterload (e.g. handgrip)
VSD
NB: ASD's will NOT be holosystolic (may have midsystolic pulmonic ejection murmur)
339
myotonic dystrophy
AD d/o
- trinuclotide repeats in myotia-protein kinase gene
sustained muscle contraction + weakness/atrophy
cataracts, frontal balding, gonadal atrophy
340
CD14
macrophages
341
Catalase positive organisms (5)
[predom infx in chronic granulomatous disease)
- Staph aureus
- Burkholderia cepacia
- Serratia marcescens
- Nocardia
- Aspergillus
342
Most renal cell carcinomas from where
proximal tubule (epitheilial cells)
gross: golden yellow mass
343
induce EPO
renal cortical cells sense hypoxia and synth epo
344
predom cell in sarcoid granulomas
CD 4 T
345
supplies blood to upper ureter
| prox 1/3
renal artery
346
pigment in dubin johnson
epinepherine metabolites
347
absence + tonic clonic
| med
valproate
348
time minimum for persistent depressive disorder (dysthymia)
persistent depressed mood with >/= 2 depressive symptoms, lasting >/= 2 years
no symptom free periods > 2months
(1 yr in children/adolescents)
*specifiers : pure, w/ intermittent or persistent MD episodes
349
what is right beneath the 12th rib on the left
left kindey
350
sythetic T3's effect on rT3
decreased
| decreases T4 and synthetic can't be coverted to rT3
351
patients with sarcoidosis or other granulomatous diseases are prone to hyper______
hypercalcemia
secondary to high levels of active vit D
(?why)
352
beta blockers tx glaucoma by
blocking production of aqeous humor from ciliary epithelium
353
hemibalism
subthalamic nucleus damage
| contralateral
354
crescentic glomerulonephritis w/o immunoglobulin or complement
"pauci immune"
- ANCA
355
twinning timeline
0-4d = di/di
4-8d = mono/di
8-12 = mono/mono
(>13d = conjoined)
356
vomiting center
dorsal surface of medulla at caudal end of 4th ventricle
"area postrema" - gets blood from fenestrated vessesl
357
brain tumor - necrosis and vascular proliferation
glioblastoma
358
mech of non-bacterial thrombotic endocarditis (NBTE)
- often involves hypercoagulable state
- e.g. cancer (marantic endocarditis)
- patho ~Trousseau's syndrome (migratory thrombophlebitis)
359
childhood osteomyelitis
staph aureus
360
Kid:
- non-rhythmic conjugate eye movements
- myoclonus
(opsoclonus-myoclonus syndrome)
neuroblastoma
*MC extracranial childhood cancer
adrenal medulla
N-myc (more copies)
small blue round cells
361
uniformly enlarged uterus with normal endometrial glands
adenomyosis
- endometrial glandular tissue in MYOmetrium
