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Smart Book 2 Flashcards

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1
Q

What causes polyhydramnios?

A

anencephaly and GI obstruction

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2
Q

oral macrocyclic antibioic that has becteriocidal activity and minimal absorption for C. Diff?

A

Fidaxomicin

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3
Q

Bacterial vaginosis diagnostic test?

A

KOH prep (whiff test)

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4
Q

Rifampin - MoA

A

inhibition of bacterial DNA-dependent RNA polymerase

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5
Q

How do alcohols act as disinfectants?

A

Disruption of cell membranes and protein denaturation

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6
Q

Probability that a female sibling of a male affected by an X-linked recessive disease will give birth to an affected child?

A

1/8

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7
Q

Factors required for osteoclast differentiation?

A

M-CSF and RANK-L (receptor for activated nuclear factor kappa B ligand), TGFbeta

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8
Q

Histone acetylase

A

Relaxes DNA coiling, allowing for transcription

“Histone acetylation makes DNA Active”

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9
Q

What are the adverse affects of Clozapine?

A

Agranulocytosis, neutropenia,

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10
Q

Most important thing for making a diagnosis of tetanus?

A

History and physical diagnosis, no toxoid screen is available

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11
Q

How does glucagon function?

A

stimulated G-protein on hepatocytes -> increased cAMP -> protein kinase A -> activates glycogen phosphorylase -> decreases fructose-2,6-bisphosphate levels

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12
Q

Intraductal papilloma- sign, cause

A

blood-tinged nipple discharge, caused by poliferation of papillary cells with a fibrotic core

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13
Q

Vertebral subluxation

A

vertebral malalignment -> can lead to paralysis with decreased or absent reflexes below the level of the compression

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14
Q

Galactokinase deficiency-

A

Cataracts, rarely pseudotumor cerebri

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15
Q

Side effects of Chloramphenicol during pregnancy?

A

“grey” baby syndrome

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16
Q

How to minimize type II errors?

A

Increased number, instrument sensitivity

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17
Q

What happens 2-4 weeks after infections with TB?

A

interferon secretion by activated T-lymphoctes

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18
Q

Painful ulcers on the tongue, gingiva, swollen gums, and certival lymphadenopathy

A

gingivostomatitis- primary infection if herpes simplex virus

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19
Q

Burkitt lymphoma translocation and function

A

t(8:14)

c-Myc a nuclear phosphoroprotein that functions as a transcription activator controlling cell proliferation, differentiation, and apoptosis

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20
Q

Leuprolide-MoA

Pulsitative? Constant?

A

gonadotropin-releasing hormone analog

Pulse-promoted LH and FSH

Chronic- reduces LH, FSH

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21
Q

How do alpha-1 blockers treat BPH

A

Promote smooth muscle relaxation -> increased urine flow through bladder, prostate

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22
Q

What organ produces EPO?

A

Liver

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23
Q

Function of helicase?

A

unwinds the double stranded DNA @ replication fork

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24
Q

Hemoglobin A2

A

alpha2, gamma 2

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25
Shortness of breath soon after MI-pathology? Chronically?
Initially- tranudate accumulating in the alveolar lumen Chronic- numerous hemosiderin-ladened macrophages in alveoli
26
Myelofibrosis
Replacement of the bone marrow by fibrosis -\> causes Dacrocytes (abnormally shaped RBCs)
27
Beta-thalasemia minor vs major
Minor increased HbA2, lower Hb A Major, no HbA, very high HbA2
28
What dopmine pathway supplies the pituitary?
Tuberoinfundibular
29
Drugs that will improve survival in patients with heart failure
Beta blockers (carvedilol, metropolol), ACE-I, ARBS, aldosterone antagonists
30
Confounding
exposure-disease relationship is muddled by the effect of an extaneous factor assoicated with both exposure and disease "kids with bigger shoe sizes have higher IQ's, however, it is a difference in age.
31
What other findings are associated with alchohol induced acute pancreatitis?
Mean corpuscular voluume of 108 fl, think folate deficiency
32
What are the retroperitoneal structures?
SAD PUCKER Suprarenal Aorta and IVC Duedenum (except 1st part) Pancreas (head and body) Ureters Colon (Ascending & descending) Kidneys Esophagus Rectum (mid-distal)
33
Side affects of antidepressents?
induction of mania, especially if family history is positive
34
Etoposide-MoA
targets topoisomerase II, transient breaks in both strands (positive and negative supercoiling), vs, 1, which only nick single strand (negative supercoiling
35
Lysyl Oxidase
strengthens extracellular collagen fibers by mediating cross-link formation
36
What nerves can be affected by cerebellopontine angle schwannomas?
CN VII, CN V, CV VIII
37
How to hypertriglycerides cause acute pancreatitis?
Triglycerides \> 1000 mg/dL exceeds binding capasity of albumin -\> direct injury to pancreatic acinar cells
38
Permissiveness
One hormone allows another to exert its maximal effort
39
What affect do granulomatous diseases have on calcium?
Granulomatous disease increase PTH-conversion due to expression of 1-alpha-hydroxylase on activated marcophages
40
How do tumor cells develop resistance to chemotherapy?
multidrug resistance 1 gene- APT-dependent efflux pump
41
Budding yeast with thick capsule-systemic risk?
meningoencephalitis
42
Palpable gallbladder and extensive calcification? Risk?
Porcelain gallbladder, increased risk for chronic cholecystitis
43
Severe fatique, splenomegaly, bone marrow fibrosis? Receptor?
STAT/JAK2, primary myelofibrosis
44
McCune-Albright syndrome
GNAS gene encoding stimulatory alpha subunit og G protein, cafe-au-tait spots, endochrine abnormalities, fibrous dysphagia
45
Signs of hypercalcemia
mental status changes, muscle weakness, constipation, polyuria/polydipsia, and dehydration
46
optimal site for femoral nerve block?
Inguinal crease at the lateral border of the demoral artery
47
Signs of Bell's palsy?
Sudden onset of unilateral facial paralysis (impaired eye closure, eyebrow sagging, inabilty to smile, disappearance of the nasolabial fold)
48
cause of calcium deposits in acute pancreatitis?
digestion of adipose cells by lipase -\> fatty acids that bind calcium salts
49
What type of defect in pyloric stenosis?
Primary developmental defect
50
What cells are derived from neural crest cells?
MOTEL PASS Malenocytes, odontoblasts, tracheal cartilage, enterochromaffin cells, laryngeal cartilage, parafollicular cells fo the thyroid, adrenal medulla and all ganglia, scwann cells, and spiral membrane
51
Exposure odds ratio
Compared odds of exposure of people with the disease to those without
52
Fever, cough, rhinorrhea, conjunctivitis in an unvaccinated child
Think measles, also develop a maculopapular exanthem (vesicular rash) that starts on face and spreads down
53
How can you reduce apoptosis due to folic acid deficiency?
supplement with thymidine, to increase dTMP production
54
Diffuse, medium-sized lymphocytes and a high poliferation index
EBV
55
Enlarged cells with intranuclear inclusion
CMV
56
Where does deep brain stimulation for parkinson's disease work?
globus pallidus internus or subthalamic nuclei -\> thalamo-cortical disinhibition
57
Myelinated myelinated afferents
Pain, temp, sensory
58
How to you treat mild hypoglycermia?
Seetened fruit juice
59
Clusters of gram-positive cocci on gram stain suggests?
Staphylococcal species
60
Enzymes inhibited by lead
Ferrochekatase and delta-aminolevulinic acid -\> elevated zinc protoporphyrin
61
What enzyme inactivated 6-MP? activates?
Inactives- Xanthine Oxidase Activates - HGPRT
62
How is glucose transported into cells?
Facilitated diffusion -\> preferential for D-glucose
63
Acquired thrombocytopenia
epistaxis, ecchymoses, marked thrombocytopenia
64
Taxols-MoA
Hyperstabilize microtubules in M phase so miotic spindles cannot break down
65
Social anxiety disorder
marked anxiety about more than 1 situation for longer than six months Fear of humiliation/embarrassment Sociation situations are avoided, or endured with intense distress Marked impairment Tx-SSRI, SNRI, beta blocker (performance-only)
66
Signs of meurocysticercosis?
South and Central America Presents with seizures Diagnosis CT/MRI- cysts, scolex Tx- albendazol
67
Signs of lead poisoning?
Long-standing behavioral problems, developemental delay/regression, financially-restricted in deteriorating human houses prior to 1978
68
tingling, difficulty concentrating, recurrent episodes of nonspecific abdominal pain? Cause? Treatment?
Acute intermittent porphyria, caused by porphobilinogen deaminase deficiency Tx- infuse hemin, which downregulated hepatic aminolevulinate synthase or glucose
69
Keratoses- tranformation
Invasive squamous cell carcinoma
70
erythema, scaling, and subsequent hyperpigmentation
Xeroderma pigmentosum -cause by a decreased ability to repair DNA following damage by UV light
71
Risk with Familyial chylomicronemia syndrome (type 1)
Acute pancreatitis, lipemia retinalis, eruptive skin zanthomas, hepatosplenomegaly
72
Smooth muscle cells in the afferent renal flow
Guxtaglomerular apparatus cells (macula densa and JG cells)
73
Subacute sclerosing panencephalitis?
Cause by absent matrix protein, causes accumulation of viral nucleocapsid within neurons -\> inflammation, gliosis
74
INF-gamma release assays?
Test for latent T-B infections by measure the tesponse to
75
Hyperplastic arteriolosclerosis
results from diastolic pressures \> 120-130 mm Hg, presents as onion-like concentric thickening of the walls of the arterioles due to laminated smool muscles cells and reduplicated BM
76
Axonal reaction signs?
cellular edema (rounded cell), niddl substance becomes fine, granular and dispersed throughout cytoplasm
77
When someone has desires about a physician, what should you do?
Ask a chaperone to join them
78
How does right ventricular myocardial infarction present?
hypotension, elevated jugular venous pressure and clear lungs
79
When does aortic stenosis occur in patients with a bicuspid aortic valve?
\> 50 years of age
80
Folinic acid, alternative name?
Leucovorin
81
Stem cells fo the lungs?
Type 2 pneumocytes
82
Phentolamine-MoA
Alpha receptor blocker, counteracts an alpha agonist
83
How does end-organ hypoperfusion lead to lactic acidosis?
decreased tissue oxygenation -\> decrease oxidative hosphorylation -\> increased NADH -\> shunting of pyruvate to latate
84
hemiballism
flinging of the limbs
85
Mutation that causes paroxysmal nocturnal hemoglobinuria?
PIGA -\> synthesize GPI anchor protein -\> attach CD55, CD59
86
Cholchicine-MoA, SE
inhibits mucrotubular polymerization -\> disrupts chemotaxis, phagocytosis, and degranulation Also reduces the formation of leukotriene B4 SE- nausea, diarrhea
87
Concentric hypertrophy- sign? Cause?
Sign- increased wall thicknesss, myocardial mass, enlarged left atrium Cause- long-standing hypertension
88
Polyarteritis nodosa-associations
Hepatitis B
89
Vsalproate - teratogenic affects
Neural tube defects
90
Capitation
A payor pays a fixed, predetermined fee to cover all the medical services required by a patient-similar to how a HMO works
91
Vesciculoulcerative lesions at the enterance to the vagina? Tx?
Herpes, tx- acyclovir
92
Echinocandins-examples, MoA, Use
"fungin" Inhibit cell wall synthesis by inhibiting synthesis of beta-glucan Use: Invasive aspergillosis, Candida
93
antibodies that react with the alpha3 chain of collagen type IV? Clincal manifestations?
goodpasteur syndrome, hemoptysis, oliguria
94
What causes an increased ESR?
Acute phase proteins -\> fibrinogen caues erythrocytes to form stacks (roueaux) that sediment at a faster rate than individual erythrocytes
95
Warfarin- teratogenic effects
nasal hypoplasiaa, stippled epiphysis
96
Vincristine, MoA
Disruption of neuronal microtubules -\> stops organelle transport between body and axons (Acts in S phase)
97
Philadelphia chromosome
t(9:22) BCR-ABL (tyrosine kinase activity
98
how to ACE inhibtors cause hyperkalemia?
inhibition of angiotensin II -\> decreased aldosterone secretion
99
Drugs that when combined with ACE-inhibitors can lead to hyperkalemia?
Amiloride, triamterene, spironolactone, or K+ supplementation
100
What can better transition a patient from hospital to home with improved adherence?
Checklist
101
Cushing's ulcers
Elevated ICP -\> increased direct vagus nerve stimulation -\> Ach release )\> hypersecretion of gastric acid
102
"clasp-knife" spasticity
Upper motor neuron lesion -\> internal capsule damage (stroke)
103
Side effects of Statins?
Hepatotoxicity, muscle toxicity
104
What type of receptors are nicotininc receptor?
ligand-gated ion channels
105
Long-term effect of CKD?
increased phosphate, decreased calcium -\> increase PTH -\> osteodystrophy
106
Signs of tetenus?
paroxysmal involuntary muscle contractions involving jaw, neck, and trunk
107
Signs of esophagus squamous cell carcinoma? Prognosis?
dysphagia, fatique, retrosternal discomfort, weight loss \*look for keratin pearls Prognosis? Poor
108
HIV-infected patient with sensory atacia and argyll-robertson pupils?
Tabes dorsalis, treponema pallidum
109
Mood symptoms in schizophrenia?
Absent
110
Physiological shunt
Area that is well perfused but underventilated
111
What is the role of CD40?
Allow for class switching
112
Where is the superior gluteal nerve located?
Uppermedial portion of butt
113
Arginase -
enzyme that produces urea and ornithine from arginine
114
Left-sided lesions vs right-sided lesions in the frontal lobe
Right- disinhibited behavior left-executive function
115
Well-demarcated, scaly erythematous plaques involving extensory surface? Increased risk for?
Psoriasis increased risk for psoriatic arthritis, Inc. risk with HLA-B27
116
Decreased potassium outflor and resultant prolongation of the action potential, risk of death?
Ventricular tachycardia and sudden death
117
How are triglycerides processed?
Colipase displaces bile salts from MiCells, pancreatic lipase attached to the surface and digests the Mucell
118
Foremen rotundum
Maxillary deivision fo the trigeminal nerve
119
Anti-cardiolipid antibodies
Antiphospholipid antibody syndrome -\> recurrent venous thrombosis and/or pregnant loss Can occur with SLE
120
Where are extended-spectrum beta-lactamase genes located? Alternative Tx?
Plasmids, treat with Carbapenems
121
Foscarnet
used for ganciclovir-resistent CMV, can chelate calcium, and renal wasting of magnesemia -\> seizure risk MoA- bind with viral-encoded enzymes: DNA polymerase, RNA polymerase, reverse transcriptase
122
How does a L-type calcium channel blocker affect skeletal muscle?
Extracellular channel is blocked, so no calcium influx into the cell. However, calium influx still occures becuase of the interaction between the l-type Ca2+ receptor and RYR1 receptor Thus, no affect on skeletal muscle contraction
123
Cyanide poisoning cs Chronic Blood Loss?
Cyanide - normal Oxygen content Anemia- low oxygen content
124
Complications of N meningitidis bacteremia?
Sepsis (sppoking fevers, chilld, arthralgias) and Waterhouse-Friderichsen syndrome (adrenal gland destruction, DIC, and shock)
125
Signs of iron deficiency?
Plumber-Vinson syndrome, dysphagia, iron deficiency anemia, koilonychia (spoon-shaped nails), shiny red tongie (papillae atrophy)
126
Hageman factor
Factor XII of the clotting cascade
127
How do you medically treat gallstones when surgery has been declined?
Hydrophilic bile acids
128
Agammaglobulinemia
B-cell defects that can manigfest with recurrent sinopulmonary bacterial infections -\> no opportunistic infections
129
Epithelial ovarian cancer signs:
ascities, bowel obstruction, ovarian mass
130
What is the confirmatory test to diagnose Strongyloidiasis?
Rhaboitiform larvae in the stool
131
Effects of high levels of ammonia?
vomiting and confusion/coma
132
What defect allows acute bacterial access to the kidneys?
Vesicoureteral reflex
133
Treatment for restless leg syndrome
avoid aggravating factors (alcohol) Support measures (leg massage Dopamine agonists (pramipexole)
134
Signs of decompensated congestive heart failure
exertional dyspnea, orthopnea, bibasilar crackles, elevated JVP, lower extremity edema
135
Obsessive-compulsive disorder
Recyrrent, intrusive anxiety-provoking thoughts, urges, or images time consuming
136
Where is type IV collagen found?
Basement membrane
137
non-rhythmic conjugate Opsoclonus-myoclonus conjugate eye movement
Neuroblastoma
138
Major depressive order- signs
\>/= 2 weeks Must have 5 of the following: * Depressed mood, loss ofinterest of pleasure, * changes in appetite or weight * insomnia or hypersomnia * pschomotor retardation * low energy * poor concentration * thoughts of worthlessness * recurrent thoughts of death of suicide No history of mania or hypomania Not due to substance or medical condition
139
Haptoglobin
binds free hemoglobin and reduced renal excretion of free hemoflobin preventing tubular injury
140
Which factors can activate complement?
IgM, IgG
141
Risks for transitional cell carcinoma of the bladder
smokers, occupation exposure to dyes, textiles, leather
142
Glucose urine dipstick
Uses glucose oxidase to ascertain the presence of urinary glucose, will not react to fructose or galactose
143
Where does reactived TB affec the lungs? Primary?
Upper lobes-2ndary Lower lobes-1ary
144
Rb mutation risks?
osteosarcoma, other sarcomas (only if familial
145
What are the steps in repairng UV-associated damage to DNA?
Recognition (endonuclease), single stand cleavage, damaged DNA is discarded, DNA repair (polymerase), remaining gap sealed (ligase)
146
Determinant of symptom severity in Tetrology of Fallot?
Right ventricular outflow tract obstruction
147
DKA- signs
Kassmaul breathing, renal failure
148
Neuroblastoma-Characteristics
@ years of age, solid sheets of small cells with dark nuclei and scant nuclei Retroperitoneal mass Dumbell tumor on mets N-myc amplification
149
Allergic bronchopulmonary aspergillosis
hypersensitivity reaction to aspergillus, high serum IgE, and eosinophilia -\> leads to bronchiectasis
150
pOLYARTHERITIS NEDOSA- signs?
Systemic, muscular, Gi symptoms, with biopsy showing transmural inflammation of the arterial wall with fibroid necrosis
151
Gram-positive cocci in chains after cystoscopy?
Enterococcus- gamma hemolysis of blood agar
152
What is effect modification
effect of an exposure on an outcome is modified by another variable
153
Pyridoxine deficiency
sideroblastic anemia, neurologic deficits, dermatitis, involved in the first step of heme synthesis
154
Sharp pain and bright red rectal bleeding on defectation? Location?
Anal fissure, occur distal to dentate line
155
How does bulimia nervosa affect bicarb?
Increases, along with pH, Also see decreased K+, with normal anion gap
156
Finasteride-MoA, Tx
decreases conversion of peripheral testosterone to dihydrotestosterone via inhibition of 5-alpha-reductase Tx-BPH
157
Malingering
Falsification of exaggeration of symptoms to obtain external incentives (secondary gain)
158
What conversion pathway is deficientin alkaptouria?
Tyrosine to Fumarate
159
What are the class III antiarrhythmic drugs?
Amiodarone, sotalol, dofetilide, Ibutalide
160
How to calculate number needed to treat?
1/Attribultable risk (difference in percentage)
161
Drugs that cause pancytopenia
cabamazepine, chloramphenicol, suldonamides
162
Ethosucimide-MoA
T-type Ca2+ channel blocker
163
Incidence
Number of new cases divided by the populaton at risk
164
Reliability-definition
consistently provides the same value when measuring a fixed entity
165
What is the continued risk associated with a subarachnoid hemorrhage?
Vasospasm, rebleeding (lesser risk)
166
chalky white lesions in the mesentery with fat cell destruction and calcification?
Acute pancreatitis
167
Clinical signs of endometriosis?
Dysmenorrhea, pelvic pain, dyspareunia, ingertility
168
How to you treat severe hypoglucemia?
Intramuscular glucagon kits or byccal glucose paste (as last resort)
169
Signs of alcohol withdrawal? Tx?
tremulousness, agitation, elevated pulse and BP 48 hours following admission Tx-long-acting Benzodiazapines (diazapam, chlordiazepoxide)
170
Straining on urination
Bladder outflow obstruction
171
What causes acute dystonic reactions?
D2 antagonism in the nigrostriatal pathway -\> decreased dopamine with causes excess cholinergic activeity -\> M1 activation
172
What does filtered fraction equal?
GFR/RPF
173
How can humans contract Bacillus anthracis?
Contact with infected animals
174
MAOI-names; MoA
Phenelzine, tranylcypromine, selegilinel used treatment-resistant depression
175
Multinucleated giant cells occur in
herpes infections (such as shingles)
176
Diagnosis of cardiac temponade?
ECG- low voltage QRS complexes Chest x-ray- enlarged water-bottle-shaped heart
177
Signs of anaplastic tumors
loss of cell polarity, with disruption of normal architecture Significant veriation in the shape and size of cells Disproportionately large nuclei Abnormal mitotic figures Giant, multinucleated giant cells
178
Prolyl hydroxylase
hydroxylation of proline on procollagen chains,, forms stabilized collagen chain
179
Ulcerative Cholitis light microscopy findings:
Diffuse inflammation of the colon, limited to mucosa and submucosa, no granulomas
180
Signs of arginase deficiency? Treatment?
Spastic dipiegia, abnormal movements, growth delay, increased arginine levels Tx- low protein diet
181
Polycystic ovary syndrome
Hirsutism, acne, androgenic alopecia, menstrual irregularities, polycystic ovaries, glucose intolerance, obesity
182
Cryptorchidism- hormone abnormalities?
Decreased inhibitin
183
What artery supplies the SA? AV?
Right coronary artery
184
Cause of unilateral fetal hydronephrosis?
Ureteropelvic junction -\> palpable abdominal mass and enlarged kidney
185
How does tuberculoid leprosy present?
intact cell mediated immunity (Th1), mild skin plaques, hypopugmentation, hair follicle loss, and focally decreased sensation
186
Long-term risk of varicose veins?
Skin ulcerations
187
Pathological presentation of reye's syndrome on the liver?
Microvescivular steatosis
188
Where are M2 receptors located?
Heart
189
Zero-order kinetics vs. First-order kinetics
Zero-order- same amount metabolized no matter the concentration First-order- same proportion metabolized, no matter the amount
190
High potency first generation antipsycholitcs
Names: haloperidol, fluphenazino AE- acute dystonia, asathisia, parkinsonism
191
Sentinel event
Enexpected occurrence involving death of serious physical inhury (suicide, full-term infant death)
192
Where are endotoxins location?
outer membrane of gram-negative bacteria, called LPS Three regions- o-antigen, core polysaccharides, and Lipid A (toxic properties -\> sepsis)
193
siderophages
hemosiderin laden macrophages
194
Junctional nevi
aggregated of nevus along the dermoepidermal junction (appear flat)
195
Saddle pulmonary embolus -\> caused by hypercoagulable state
196
Bones of the wrist
So long to the pinky, Here Comes The Thumb
197
Polymyositis antibodies
ANA, anti-Jo-1 (histidyl-tRNA sunthetase)
198
Treatment for bipolar disorder?
Valproate, lithiu, . and quetiapine Lamotrigine (prevents depression more than mania)
199
DiGeorge Syndrome- Cardiac Abnormalties
Tetralogy of Hallot, interrupted aortic arch
200
Adult-type coarctation of the aorta- risks
berry aneurysms, aortic arch hypertension
201
CD14 marker? Describe?
Monocyte/Macrophage, large cells with abundent pale cytoplasm
202
What can low testosterone cause?
Gynocomastia, ED
203
Lipid-lowering agent that prevents future CV events?
Statins
204
Stop the spread of methicillin-sensitive staphylococcus aureus?
Hand hygiene
205
What does the capsule do in E. Coli?
K-1 capsule -\> Meningitis
206
Disease? Presentation?
Gaucher cell, Gaucher disease Presentation: bone pain, easy bruising and bleeding, hepatosplenomegaly
207
Family history of a bleeding disorder?
von Willebrand disease
208
Cause of ecthyma gangrenosum?
P aeruginosa bacterium
209
Alpha fetoprotein is a common tumor marker for what cancers?
Hepatocellular carbinoma, Germ cell tumors
210
What cells are involved in Ulcerative Cholitis?
Th2 cells
211
Cause? Surgical risk?
Echinococcus granulosus-\> rupture of cysts can cause anaphylaxis
212
Tuberous Sclerosis-Cardiac defects
Valvular obstruction due to cardiac rhabdomyomes
213
Flutamide-MoA
competitive testosterone receptor inhibitor
214
Ethosuximide-MoA
blocks T-type Ca2+ channels that trigger and sustain rhythmical burst discharges in thalamic neurons
215
What effect does a decreased IP3 have on later protein activation?
Decreased protein kinase C
216
Where are central lines inserted to? Derivation?
Into the superior vena cava; derived from the cardinal veins
217
kidney shaped organisms located in polymorphonuclear leukocytes?
N. Gonorrhoeae
218
Nonncleoside reverse transcriptase inhibitors Are they phosphorylated?
Nevirapine and Efacirenz Do not require activation via intracellular Phosphorylation
219
Organophosphate poisoning antidote?
Atropine, pralidoxime
220
Schizoid personality characteristics?
Prefers to be a loner, detached, unemotional
221
ACE-inhibitor, first dose hypotension
In patients taking diuretics, the addition of an ACE-I may lead to volume depletion from diuretics volume depletion and lack of PVR
222
How does glucose affect insulin release?
Glucose enters beta cells-\> increased ATP -\> closure of K+ channels -\> depolarization of caclium channel -\> increase in Calcium -\> insulin release
223
Schitzotypal persaonality
Eccentric, odd thoughts, perceptions & behavior Magical thinking (superstitiousness, clairvoyance)
224
Monospot test
agglutination on horse/sheep erythrocytes positive for EBV
225
Signs of embolism? Cause, post surgery?
blue toe, livedo reticularis, with normal peripheral pulses Cause- atheroembolic disease -\> cholesterol containing debris gets lodges in smaller vessels
226
In what order are vessels affected in atherosclerosis?
Abdominal, coronary, popliteal, internal carotids, circle of willis
227
Ecthyma Gangrenosum
228
How to communicate medicine delivery
Durg, dose, route
229
Uncontrolled diabetic mother, affect on child
Beta cell hyperplasia -\> hyperinsulemia at birth
230
Where are M1 receptors located?
Brain
231
Signs of vWF disease?
increased bruisability and mucosal bleeding, due to inability to form initial platelet plug -\> dental surgery
232
Dystonia
neurological movement disorder characterized by sustained involuntary muscle contractions
233
How do first generation antihistamines act?
Agonist at H1, antagonist at muscarinic 3 (m3\_ receptors
234
Penetration through the fourth intercostal space (nipple) @ left sternal border?
Right ventricle myocardium
235
Turner syndrome: signs
Streak ovaries, bicuspid aortic valve, coarctation of the aorta, short stature, shield chest, webbed neck
236
What causes an umbilical hernia in an infant?
Incomplete closure of the umbilical ring
237
When does liquefaction occur?
Brain infarct, bacterial abscess
238
Jervell and Lange-Neilsen syndrome
AR, congenital QT prolongation with neurosensory deafness
239
Transpeptidases
Penicillin-binding protein that function to cross-link peptidoglycan in the bacterial cell wall
240
Diffuse fibrous thickening and distortion of the mitral valve leaflets?
Mitral stenosis, think Rheumatic fever
241
What does a deficiency in enteropeptidase cause?
Protein and fat malabsorption -\> diarrhea, failure to thrive and edema
242
How does morphine act?
Stimulates G-protein receptors that activate potassium conductance -\> hyperpolerization of cells, terminating pain signal Also activate adenylyl cyclas, inhibt calcium conductanc, and inhiition of transmitter release
243
What is the karyotype of a complete mole?
46, XX
244
Dissociative amnesia
inability to recall important personal infomration (trauma); not explained by another disorder
245
Tumor, Correct statement
Cavernous Hemangioma- most common benign tumor
246
What is the most important risk for UTI with catheter insertion
Duration of catheterization
247
Whilms tumor
nephroblastoma, children 2-4, palpable flank mass microscopic sample resembles primitive metanephric tissue
248
What enters the eye through the superior orbital fissure?
trochlear nerve (IV) abducens nerve (IV), and superior ophthalmic vein, CNIII
249
What does the vaccine target in H. influenze?
Hib capsid, not encapsulated can still be infected
250
Chronic granulomatous disease-most common infections
Catalase-positive organisms (S. Aureus, Burkholderia cepacia, Serratia marcescens, nocardia, aspergillus
251
Tx for combined tonic-clonic/absence seizures?
Valproate acid
252
Keratoses-light microscopy
hyperkeratosis, parakeratosis, atypical keratinocytes
253
Signet-ring carcinoma
cells that do not form glands, but contain abundant mucin and push the nucleus to one side, diffuse involvement, and a loss of E-cadherin
254
Phenotypic mixing
host cell is coinfected with 2 viral strains and the progeny contain unchanged parental genome from one strain and nucleocapsid for another. Next generation will revert.
255
Viral dependent nucleosides?
Acyclovir, calacyclovir, famciclovir, ganciclovir
256
Prevelence
Number of persons with a disease dividied by the total population at a specific time point
257
Antibody that causes tinnitus and hearing loss? MoA
Aminoglycosidse, also nephrotoxic Irreversibly bind to 30s, causing genetic code misreading, and effects translocation
258
Dactylitis
Painful swelling of the hands and feet; common presentation of sickle cell disease in children
259
What type of damage does carbon tetrachloride cause?
free radical injury -\> via free radical generation via lipid peroxidation
260
Dimished first heart sound with an apical holosystolic murmur radiating to the axilla? Treatment?
Mitral reguritation, tx- reduce left ventricular afterload
261
Epithelial ovarian cancer- risk reduction
OTC, breastfeeding, tubal ligation
262
thick, brownish-yellow fluid rich in cholesterol in the brain? Derivation of?
Craniopharyngioma, arise from Rathke's pouch (precursor to anterior pituitary
263
What type of receptors are muscarininc?
Second messenger (m1 + m1 are IP3, M2 is CAMP)
264
What hemoglobin has decreased interaction with 2,3-BPG?
fetal hemoglobin (hemoglobin F)
265
Signs of carcinoid syndrome?
Flushing, watery diarrhea, bronchospasm,valvular fibrous plaques
266
What canges does UV light introduce into the skin?
Pyrimidine-pyrimide dimers
267
Claudication ? Cause?
muscle pain with exercise that receeds when rested; caused by decreased blood flow due to artery constriction cause: Atherosclosis of larger arteries (lipid filled intimal plaque)
268
Elderly patient with dementia and hemiparesis, think
Dysphagia -\> aspiration pneumonia
269
How converts triglycerides in the fat into glycerol and fatty acids?
Hormone sensitive lipase
270
Side effects of COX 1 inhibition?
Gastric ulceration, increased beeding
271
How does human placental lactogen (somatomammotropin\_ cause insulin resistance in a pregnant woman?
Secreted by synchrotrophoblast -\> increased shunting of carbs to glucose, also stimulated pancreastic beta cell insulin production (when insufficient, this causes diabetes)
272
What is the first step in catecholamine synthesis?
Tyrosine to DOPA (via tyrosine hydroxylase)-rate limiting step
273
Pheneizine-MoA
monoamine ocidase inhibtor
274
How is glycogen broken down in muscles?
Hlycogen phosphorylase a, which is activated by phosphorylase kinase (PK). In skeletal muscle, calcium can activate PK -\> glycogen breakdown This is in contrast to the liver where epinepghrine and glucagon activate PK via increased cAMP
275
Physiological respose to pulmonary embolism?
Hyperventilation -\> respiratory alkylosis, decreased Co2, but normal HCO3 until about 48 hours have passed
276
Elderly person with "intracytoplasmic granules that are tinged yellowish-brown"?
Lipofuscin, caused by lipid oxidation
277
Only product that is overexpressed in a hypothalamus lesion?
Prolactin
278
Treatment sfor bipolar disorder?
Lithiu, , valproate, and Lamotrigine
279
What cells are involved in the pathogenesis of Chron's disese?
Th1 cells, which form granulomas
280
Cause of death in athletes under age 35? histology?
Cardiomyopathy (massive cardiac hypertrophy) -\> ventricular fibrillation Irregular shaped myocytes and arrangements
281
Lung mass, cerebellar symptoms and Purkinge cell degeneration
paraneoplastic cerebellar degeneration
282
How do the ovaries drain?
left ovarian -\> left renal vein right ovarian -\> IVC
283
RNA polymerase I, II, III
I- ribosomal II-messenger, snRNA III-transfer, ssribosomal
284
Obsessive-compulsive personality disorder
lifelong pattern on insistence on control, orderliness and perfections and does not involve compulsions
285
Accuracy-definition
gives a measurement close to the actual value
286
How do activated macrophages cause increased calcium?
Secretion of 1-alpha-hydroxylase
287
Recurrent C. Diff infections and predisposed to reoccurances, tx? MoA?
Fidaxomicin (bacteriocidal, inhibits sigma subunit of RNA polymerase -\> decreased protein synthesis and cell death
288
Where is type I collagen found?
Dermis, bone, tendons, ligaments, dentin, cornea, blood vessels, scar tissue
289
What biochemically occurs leading to DKA?
Triglycerides in adipose tissue are phosphorylated by glycerol-3-phosphate via glycerol kinase -\> energy and glucose
290
Wernicke encephalopathy- damage
Hemorrhage and necrosis in the mammillary bodies and periaqueductal gray matter
291
What organ is least likely to infact?
Liver, dual supply of arteries (inferior phrenic, adrenal, intercostal arteries, etc.)
292
Bacteria that cause transient bacteremia after dental procedures? How do they binds to heart valves?
Strep Viridans, bind to fibrin and platelet aggregates on damages portions of valve
293
Histological findings for asporation pneumonia?
inglammation and a foreign body response with giant cells
294
Cause of Hepatocelluar carcinoma worldwide
Hepatitis B
295
Tetrology of Fallot-signs
VSDRight ventricular outflow tract obstruction, right ventricular hypertrophy
296
Galactose-1-phosphate uridyl transferase deficiency
Vomiting, feeding intolerance, neonatal jaundice, and death (if untreated) soon after breast feeding is intiated.
297
What is constant in ARDS?
Pulmonary capillary wedge pressure
298
Penetration at the left sternal border, 2nd intercostal space?
Pulmonary trunk
299
Primary biliary cholangitis- manifestations
fatigue, itching, and hepatomegaly ANA-titers are positive
300
Signs of septic shock
Fever, leukoctosis, hypotension, tachycardia
301
What else is derived from the same precursor at ACTH? parent protein?
beta-endorphin, derviced from proopiomelancortin (POMC)
302
What cells are present during chronic inflammation?
Macrophages/monocytes/lymphocytes/fibroblasts
303
Kappa receptor affects?
Miosis, dysphoria, sedation
304
Smith protein-function
complexes with small nuclear RNA in the cytoplasm -\> forming small nuclear ribonucleoproteins =\> Removal of introns from RNA transcripts
305
Takayasu arteritis
\< 4- years old, giant cell aortic lesions
306
Paraneoplastic cerebellar degeneration-cause
Cross reaction with purkinji neuron antigens, specifically anti-Y, P/Q, and Hu
307
How to treat hemophilia acutely?
Administration of thrombin, will lead to blood clotting
308
asymptomatic patient with a history o an inborn error of sugar metabolish?
essential fructosuria- fructokinase deficiency
309
What causes congenital torticollis?
breech delivery, malposition of the head in tero-caused by fibrosis of the SCM
310
What is HSP?
Boys 2-10, preceeded by viral/streptococcal URI IgA-mediated leokocytoclastic vasculitis
311
Cause of Sepsis
TNF alpha -\> activated marcophages
312
infant with lactic acidosis and neurological deficits, think? Tx?
Pyruvate dehydrogenase deficiency, tx. in a ketogenic diet Lysine and leucine are strickly ketogenic and cannot be made into pyruvate, decreasing symptoms
313
Epicanthal folds, upslanting palpeebral fissures, protruding tongue and excessive skin at nape of neck?
Down syndrome
314
Describe a reticoulocytes?
Larger and bluer than a mature RBC, lacks nucleaus, but contains a mesh-like (reticular) network of residual ribosomal RNA, which appears aftee the wright stain
315
SCID signs
Failure of T-cell development, with B-cell dysfunction Recurrent severe viral, fungal, opportunistic infections, failre to thrive, chronic diarrhea Tx- stem cell xplant
316
Leukemoid Reaction
reactive increase in the white blood cell count, which can mimic leukemia; removal of the underlying cause will correct it
317
Where is the chemreceptor trigger zone located?
Doral surface of the medulla at the caudal end of the fourth ventricle
318
Test to determine if the means of two groups are equal?
Two-sample t test
319
Phenytoin- teratogenic effects?
Neural tube deefects, orofacial clefts, microcephaly, nail or digit hypoplasia
320
Pseudomonas aeruglinosa-Exotoxin A MoA
Inactivation of EF-2 via ribosylation -\> inhibted host cell protein synthesis
321
Which cells in males produces testosterone?
Leydig cells
322
Overdose of vitamin C
Galse-negative stool guaiac, diarrhea, abdominal bloating
323
What is your primary concern when an elderly patient comes in with exxhymoses in various stages of healing on the upper extremities?
Address their safety
324
What forms an AV shunt?
AV fistula 0\> allows blood to directly enter the benous system
325
What direction of Hep C has no proof-reading?
3'-5' exonuclease activity
326
What affect does cholestyramine have on hepatid cholesterol synthesis?
increases it
327
Crest components
Calcinosis, Raynaud phenomenon, esophageal dysmotility (fibrous replacement of the muscularis in the lower esopghagus), sclerodactyly, telangiectasia
328
Persistent hypotension despite rapid infusion
Cardiogenic shock
329
How long does it take for warfarin's effect to kick in? Why?
Several days Long half-life of facotr II (antithrombin)
330
New onset of anxiety with no prior psychiatric history and prominent physicial finding on examination suggets
Anxiety due to a general medical condition
331
Pneumocystic pneumonia and painful oral ulcers, think?
HIV
332
Hybernating myocardium
Chronic myocardial ischemia, -\> decreased contractility and left ventricular dysfunction
333
Linear IgG and C3 deposits on immunoflourescent microscopy of the renal?
Goodpasteur
334
Lateral force leads to widening of the medial joint line?
MCL damage
335
Synaptophysin
transmembrane glycoprotein found int he presynaptic vescicles of neurons, neuroectodermal and neuroendocrine cells
336
Ciprofloxacin
fluoroquinolone class of antibiotics, interact with DNA gyrase
337
equation for sensitivity?
TP/(TP+FN\_
338
Tamoxifen
Treatment for Er or PR tumor expression, a selective estrogen receptor modulator
339
What does the smooth ER do?
Synthesize steroids and phospholipid biosynthesis
340
Follicular lymphoma-translocation
t(14:18), BCL2
341
Diagnostic test for Trichomonas vaginalis?
Saline microscopy (wet mount)
342
VHL signs
capillary hemangioblastomas in the retina and/or cerebellum, congenital cysts and/or neoplasms in the kidney, liver, pancreas; increased risk for RCC
343
Bacterial resistance to cephalosporins?
Modification of PBP
344
TGF-beta -MoA
Promote the differentiation of fibroblasts into myofibroblasts
345
Large individual with chronic, mild dyspnea and fatique?
Chronic hypoventilation due to obesity
346
Rifaximin- MoA
nonabsorbable antibiotic that alters GI flora to decrease intestinal production and absorption of pneumonia
347
Increased blood ammonia and orotic acid excretion in urine. defect?
Ornithine transcarbamylase
348
What is required for the fusino and release of neurotransmitter vescibles into the synaptic cleft? Drug example?
Voltage-gated ion channels Gabapentin
349
Homocystinuria-treatment
pyridoxine (B6) which is a cofactor for the deficient enzyme cystathioinine beta synthase
350
What is the only affect of Grrave's disease not relieved by beta blockers?
Exophthalmos
351
What cell type produces interferon-gamma?
T-cells and NK cells
352
Nests of uniform round cells with inconspicuous nucleoli and few mitotic figures at the basal portion of the epi and upper dermis?
Compound melanocytic nevus
353
Ornithine transcarbamylase-action
catalyzes the combination of ornithine and carbamoyl to form citrulline in the urea cycle.
354
How to calculate total filration rate of a substance
Inulin clearance X ([plasma substance A])
355
History of prolonged bleeding following procedures and spontaneous hemorrhage into joints?
Hemophilia (related to either VIII or IX
356
Side effects of aminoglycosides during pregnancy?
Ototoxiicity, vestibulotoxicity
357
What type of receptors are hormone receptors?
G-protein activated
358
Cause of renal size differences in individuals at risk for athersclerosis?
Renal artery stenosis
359
What zone of the adrenal glands is affected in cushings?
Zone gasciculate
360
Where is type III collagen found?
skin, lungs, interstines, blood vessels, bone marrow, lymphatics, granulation tissue
361
What is a Ghon complex?
lower lung lobe lesion with ipsilateral hilar adenopathy, associated with primary TB
362
Stages of lobar pneumonia
1. congestion - vasodilation, exudate contains bacteria 2. red hepatization 0\> exudate contains erythrocytes, neytrophils, fibrin 3. grey hepatization -\> exudate contains disintegrated RBC, neutrophils, fibrin 4. Resultion - enzymatic digestion of exudate
363
Prazosin- MoA
alpha 1 adrenergic blocker causes vasodilation and reflexive tachycardia
364
What two things should you check when metabolic alkylosis is a concern?
Urine chloride, volume status
365
Effect of alpha1 -adrenergic agonist on the heart?
Increased vagal stimulation -\> decreased pacemaker activity
366
Why are piperacillin and tazobactam linked?
stops pipercilin destruction via beta-lactamase
367
Ischemic preconditioning
Brief, repetitative episodes of myocardial ischemia followed by reperfusion protect the myocardium from prolonged episodes of ischemia
368
How to decreased renal plasma flow and increase filtration fraction?
Constriction of the efferent arteriole
369
Precision- definition
low level of variability when used to assess a fixed entity
370
What are the characteristics of S. Pneumoniae?
gram-positive, lancet-shaped cocci, bile soluble
371
Uncomplicated umbilical hernias are associated with?
Down Sydrome, hypothyroidism, Beckwith-Wedemann syndrome
372
Upper extremily numbness, tingling, and weakness with upper extermity edema
Thoratic outlet syndrome- salene triangle, cause by cervical rib or muscle deformity
373
Klinefelter syndrome
47, XXY- mental retardation, tall stature, gynecomastia, azoospermia
374
Actions of Cholinergic antagonists?
Increase GI smooth muscle tone -\> nausea, vomitin, cramps, diarrhea, decrease heart rate, atopic baldder (non-obstructive urinary retention
375
Thyroid Peroxidase- function
Thyroglobulin iodination forms (T3/T4)
376
Depersonalization/derealization disorder
Feeling of detachment from or being on outside observer of one's self eperiencing surroundings as unreal \*\*Intact reality testing\*\*
377
Sustained generalized tonic-clonic convulsions without fully regaining consciousness between episodes? Treatment? MoA?
Status epilepticus Tx- intravenous benzodiazepam (lorazepam); Enhances post-synaptic chloride influx
378
First step in management of a request for opiod medication?
Confirmation of the patient's prescription history
379
Epithelial ovarian cancer- marker
CA-125
380
Preferred vein for bypass grafting?
internal mammary artery
381
Sertoli-Leydig tumor
Ovarian tumor that presents with large adnexal mass with amenorrhea and virilization by a rare sex-stromal tumor
382
What causes anaphylactic reactions?
Mast cell and basophil degranulation -\> histamine and tryptase release (mast cell specific)
383
Signs on heroin withdrawal
nausea, vomiting, abdominal cramping, muscle arches, See dilated pupils, yawning, lacrimation on PE
384
Cardiac abnormalities in Marfan syndrome?
Cystic medial necrosis (aortic dissection & aneurysm) and Mitral valve prolapse
385
Transthyretin
Protein tetramer produced int eh liver to carrier thyroxine and retinol, mutations can lead to amyloid protein in the myocardium
386
Lesion at or above the red nucleus
Decorticate (flexor) posturing descending inhibition of th red nucleus damage is @ pons
387
Cyclosorin-MoA
inhibts nuclear factor of activated T cells, blocking IL-2
388
Temporomandibular disorder?
unilateral jaw pain that worsens with jaw movement, headache, and derangement, pathologic contraction of the muscles of mastication, and/or hypersensitivity of the nerve that supply the jaw Caused by mandibular devision of trigeminal nerve
389
Irregular spijkes protruding from the glomerular basement membrane in the kidney? Characteristics?
Membranous glomerulopathy diffuse thickening of capillary wall on light microscopy wihtout an increase in cellularity
390
Subungual splinter hemorrhages?
Associated with microemboli, usually caused by subacute endocarditis
391
Homocystinuria-presentation
ectopia lentis, intellectual disability, marfanoid havitus
392
How do you stop increased HCL output from vagal, histamine and gastrin pathways?
Give them a proton pump inhibitor, H2 blockers only stop gastric acid secretion in histamine and gastrin, not vagal
393
Patient with history of rheumatic fever, nor presenting with exertional duspnea and diastolic murmer
Mitral stenosis (problem opening valve)
394
hypochromic, microcytic anemia, cause?
Iron deficiency
395
Dengue fever- mulitiple infections
Recovery from an infection leads to life-long immunity, however, secondary infection (with a different serotype can cause more severe illness
396
How does UV light lead to wrinkles?
decreased collagen fibril production -\> upregulation of metalloproteinases
397
What x-ray signs would establish a cholecystoenteric histula?
Air in the biliary tree (pneumobilia) from interstinal gases
398
Where is collagen synthesized?
RER, hydroxylation in the cisternae of the RER
399
Trazodone - MoA and side effects
MoA- serotonin modulator (antagonized post-synaptic serotonin receptor and inhibits reuptake Side effects0 priapism (persistent erection \> 4 hours
400
Effects of prolactinoma?
hypogonadism, anovlation, amenorrhea -\> breast milk discharge
401
Suspect abuse in a patient, what is your top priority? Questions to ask?
interview alone to avoid intimidation Questions: 1. Do you feel safe where you live? 2. Who prepares your meals 3. Who handles your checkbook
402
Sings of ARDS
Acute respiratory failure, bilateral opacities (hypoxemia, etc.)
403
Common cause of aspectic meningitis?
enterovisures (Echo, coxsachievirus, poliovirus
404
older child/ younger adult with edema, hematuria and proteinuria following skin or pharyngeal infection
post-streptococcus glomerulonephritis -\> electon-dense deposits on the epithelial side of the basement membrane
405
What does a capsule do?
Protects the organisms from opsonization
406
What is another name for an anterior prolapse?
Cystocele
407
Vision problem, difficulty chewing, trouble speaking that are worse at the end of the day
Myasthenia gravis- Type II hypersensitivity
408
Test used to check ACTH response in adrenal glands?
Adrenocorticotropic hormone stimulation test
409
Sign of renal vein thrombosis?
membranous nephropathy, flank pain, hemoturia, right-sided varicocele
410
Selective arteriolar vasodilators: types, MoA
hydralazine, minoxidil MoA- reducing systemic vascular resistance -\> baroreceptor stimulation leads to reflex sympathetic activation -\> increased sodium and fluid retention
411
Cf-Most common cause of death
Pneumonia
412
Bile acid-binding resins- side effects
"chol-" drugs, increase triglycerides by releasing of triglyceride heavy VLDL into circulation
413
Rapidly spreading pruritic rash with erythematous papules and excoriations on the extremities
Scabies or Sarcoptes Scabiei mites and eggs
414
Where does the left gastric artery run?
Along the lesser curvature of the stomach
415
What is the most important muscle involved in the Valsalva maneuver
Rectus Abdominalis
416
What is the important component of a newborn screening test?
High sensitivity- a negative diagnosis helps rule out the test- better to catch more false positives than have a false negative
417
What occupies the cavernous sinus?
Structures relating to eye movement
418
Electrolyte that can cause muscle weakness?
Hypokalcemia
419
Enzyme deficiency in porphyria cutanea tarda
Uroporphyrinogen decarboxylase
420
how does normal CSF flow?
choroid plexuss (lateral 3rd and 4th) -\> lateral ventricles, interventricular foramen on monro -\> third ventrical -\> cerebral aquaduct -\> fourth ventricle -\> Luschka, magendie -\> subarachnoid space -\> arachnoid granulations -\> Venous system
421
Isotretinoin-teratogenic effects
microcephaly, thymic hypoplasia, small ears, hydrocephalus
422
Ions permeable with a negative equilibrium?
Potassium, chloride
423
Effects of a noncompetitive inhibitor or irreversible competitive inhibitor on Vmax?
Reduces the maximum effect
424
Sign of secondary hyperaldosteronism
Increased Renin and Increased aldonsterone
425
Inspissated mass
dehydrated meconium
426
Cause of Annular pancreas
abnormal migration of the ventral pancreatic bud
427
Side effects of TCA
confusion, constipation, acute urinary retention
428
How much of a coronary artery lumen must be clocked for stable angina?
\>750%
429
Parvovirus - in fetus
pleural effusions, pericardial effusions, ascites -\> fetal hydrops
430
Hernia below the inguinal ligament?
Femoral hernia
431
Most common site of rupture in a blunt aortic injury?
Aortic isthmus (site where the ligamentus arteriosum is located
432
How long does a loss of contractility take during total ischemia
about 60 seconds
433
How to treat agitation and psychosis associated with delirium?
Haloperidol in low doses
434
Most common locations for breast cancer to spread?
Bone, brain, liver, lung
435
Persistent processus vaginalis-signs
outpouching of the peritoneum, leaving bowel contents in the inguinal canal
436
What proteins are involved with hemidesmosomes?
Integrins
437
Dopmine pathway for coordination of coluntary movement?
Nigrostriatal
438
Side effect of EPO stimulation?
Hypertension, due to increase blood viscosity from increased RBC and increased risk of thromboembolic events
439
Subclavian steal syndrome
Severe stenosis of the proximal subclavian artery -\> reversal of contralateral vertebral artery to the ipsilateral side Sides- exercise-induced fatique
440
Most usedul measure for assessing the defree of mitral stenosis?
A2 to opening snap interval (increase distance, decreased severity)
441
Basal cell carcinoma-Presentation
pearly papules with central depression of ulceration
442
Vitamin essential for transamination and decarboxylation of amino acids (ntrogen transfer)
Pyridoxine (anything with alpha-keto
443
What proteins are involved in tight junctions?
Claudins, occludin
444
What promotes the contraction of the gallbladder?
CCK from the small intestine
445
Inceased aldosterone syndrome name?
Conn's Disease
446
ACE inhibitors - teratogenic effects
Renal dysgenesis, oligohydramnios
447
Schizophrenia vs schizophreniform-time frame
Schizophrenia- \> 6 months Schizophreniform \>1 month to \< 6 months
448
Spinal stenosis vs. disk herniation
Disk herniation will present with back pain, stenosis will not. L5-S1 stenosis affects L5, herniation affects S1
449
Wen taking a long-acting benzo ,what should be avoided?
1st generation antihistamined (chlorpheniramine). alcohol, barbs, and other CNS depressents
450
Pathogenesis of HIV-associated dementia?
Inflammatory activation of microglial cells -\> form microglial nodules -\> multinucleated giant cells-\> cytokine excretion
451
Clinical manifestations of Factor I leiden
DVT, cerenral vein thrombosis,receurrent pregnancy loss
452
What vitamin is depleted in measles and should be supplemented?
Vitamin A -supplementation should be done to reduce comorbidities (ocular complications, diarrhea, pneymonia, recovery time and length of hospital stay
453
Oral vs rectal drug administration?
Increased bioavailability due to less first-pass metabolism rectally
454
CMV-related risks in infants exposed to the virus in utero
Chorioretinitis, sensorneural deafness, seizures, jaundice, hepatomegaly, microcephaly
455
Acute cerebellitis?
Post-viral cerebellar ataxia, cause in children 2-3 weeks following varicella, measles, EPV
456
Drugs that interfere with cell membrane ergosterol incorporation
Amphotericin B, nystatin, azoles
457
What inhibits platelet aggregation and adhesion to the vascular endothelium?
Prostacyclins
458
Granulosa cell tumor- clinical features
inc. estrogen, inhibit with large, unilateral adnexal mass
459
Long term effect of diabetes on the gut?
Decreased motility
460
Risk in CD18 deficiency?
Persistent leukocytosis
461
Development of atherosclerotic plaque?
Endothelial damage -\> macropage invasion -\> platelet adhesion -\> smooth mscle cell migation -\> lipid debris
462
Pepsin- activitation and function
Activated in stomach -\> starts the degredation of proteins for future digestion
463
Failure of prothrombin time to correct with vitamin K supplements?
Liver disease
464
Enkephalins, endorphins, dynorphins
Endogenous opiod peptides, part of the bodies natural opiod system
465
Side effects of Trimethoprim/sulfamethoxazole during pregnancy?
Neural tube defects
466
What parts of the spinal cord are affect in ALS?
Lateral corticospinal tract (spasticity and hyperreflexia) anterior horn -\> flaccid paralysis, atrophy, fascivulation
467
Right-sided enlargement of the scrotum, with fluid collection?
Indirect inguinal hernia (through patent process vaginalis)
468
Physiological decor receptor for decreasing binding of RANK-L to RANK
Osteoprotegerin
469
Low-potency 1st generation antipsychotics
Names: chlorpromazine, thiondazine AE- sedation, anticholinergic , orthostatic hypotension
470
What can be detected by a radiolabled DNA strand?
Things that bind (N-myc)
471
most common cause of bladder outflow obstruction?
BPH -\> urine backup -\> parenchymal pressure atrophy in the renals
472
Tzanck smear
genital herpes simplex virus
473
How to test concentration in an elderly individual
Reciting months of the year backwards
474
Negative agglutination twice spaced apart, think
CMV
475
High grade CIN
atypical cells have invaded beyond the lower one-third of the cervical epithelium
476
What proteins are involved in Gap junctions?
Connexins
477
What type of disturbances are seek in DKA?
Metabolic acidosis- low pH, low HCO3-
478
What happens during the first week after exposure to TB?
Intracellular bacterial proliferation
479
Signs of 17alpha-hydrozylase deficiency in males? Female?
Phenotypically female at birth, females develop normally; however puberty leads to the failure to develop secondary sex characteristics Excessive mineralocorticoids by adrenals leads to hypertension
480
Progressive fatigue and heart palpitations, think
anemia
481
What type of receptors are in neurons?
voltage-gated
482
Signs of PKU
high phenylalanine -\> disrupts neuronal and glial deelopment and lead to progressive neurological deterioration -\> hpotonia, dystonia, seizures
483
Progressive ddyspnea and sudden death and atypical chest pain with ventricular hypertrophy
Pulmonary arterial hypertrophy
484
Methotrexate- teratogenic effects
lumb & craniofacial abnormalities, neural tube defects, abortion
485
Organism?
Coccidioides Immitis, endemic to the desert areas of the US and mexico Culutre on Sabouraud media
486
Cause of non-bacterial thrombotic endocarditis?
Advanced Malignancy, chronic inflammatory disorders (SLE, etc.)
487
Where are normetanephrine and metanephrine created?
Chromaffin cells of the adrenal medulla
488
How does blood reach the retinal artery?
Internal carotid, ophthalmic arter-\> retinal
489
How to calculate the positive predictive value?
TP/TP+FP)
490
What enzymes are found in the cytoplasm?
Glycolysis, fatty acid synthesisi, pentose phosphate pathway
491
How to detect fructose in the urine?
Copper reduction test
492
Where does most of the water get absorbed at in the nephron?
Proximal tubules
493
Statistical Power
(1-beta) study's ability to detect a difference when one exists
494
Where does lithium affect the kidney?
Colelcting ducts Antagonizes vasopressin (ADH)
495
What gets deposited in multiple myeloma?
Ig light chains (also known as amyloid type AL (primary)
496
Measles virus-description
enveloped, single stranded RNA virus, which encodes viral hemoagglutinin (cell surface adhesion) and matrix protein (assembly)
497
Paranoid personality disorder
Pervasive pattern of distrust, and suspiciousness, beginning in early adulthood
498
c-ANCA
cytoplasmic- antineutrophil cytoplasmic antibody
499
Patient wants to cancel the surgery after anesthesia, how to respond?
Ask and address the concerns
500
Inner necrosis, with pseudopalisading cells in the brain?
Glioblastomia multiforme
501
How does gluconeogenesis get generated during fasting?
Increased Acetyl-CoA inhibits pyruvate dehydrogenase and upregulates pyruvate carboxylase
502
What causes black stones? Stone type?
Chronic hemolysis (sickle cell, spherocytoisi), or ileal diseas) cause by increased enterohepatic cycling of bilirubin (unconjugated) Calcium bilirubinate
503
INF-gamma function
Secreted by activated T-cells; recruits leokocytes and activates phagocytosis
504
What is the role of the pudendal nerve?
Innervation of the perineal region arises from s2-s54 and controls the pelvic floor as well as external urethral and anal sphincter; can lead to fecal incontinence and urinary incontinence
505
Parinaud syndrome
Tumor of the pineal gland that causes the inability to look upwards
506
What do the vitelline veins form?
Portal system
507
Fungus branching at acute angles with septations
Aspergllus
508
Enzyme essential for the conversion of fructose-6-phosphate to ribose-5-phosphate?
Transketolase
509
Cause of maturity onset diabetes in the young?
Mutation in glucokinase
510
In patients that have a total gastrectomy, what needs to be supplemented?
B12, intrinsic factor can no longer be produced
511
Young man with dyspnea on exertion and decreased exercise tolerance and central obesity?
obesity-related restrictive lung disease
512
How does alcohol lead to hypoglycemia?
Ethanol processing -\> increased NADH/NAD+ ratio -\> shuts down gluconeogenesis -\> hypoglycemia
513
Lack of anal sphincter contaction- nerve involvement?
S4
514
Patients receiving parenteral nutrition through catheter are at risk for? morphology?
Candida, pseudohyphae with blastoconidia
515
What are berry aneurysms associated with?
Ehlers-Danlos syndrome and ADPKD
516
What are the stop codors
UAA, UAG, UGA
517
How does the botulism toxin act?
Blocks release of Ach into the neuromuscular junction, toxin in heat tabile
518
Neurokinin 1 receptor antagonists?
Aprepitant, Fosaprepitant
519
Phenoxybenzamine
Alpha blocker
520
QT-interval prolongation in a young child
Congenital QT-interval prolonation-\> mutations in potassium of sodium channels. Assocated with neurosensory deafness Increased risk of Torades de Pointes
521
Buspirone
Non-benzo anxolytic used to treat GAD, slow onset of action, lacks muscle relaxant, or anticonvulsant properties and carries no risk of dependence
522
Dopamine receptor antagonists (antiemetic)
rochlorperazine, metaclopramide
523
Kallikrein
converts kininogen to bradykinin
524
What should all breast cancers be tested for?
HER2, associated with very aggressive forms
525
Function of Folic acid?
DNA single carbon donor required for purine and pyrimidine )Thymidine) bases incorporated into DNA
526
How to you culture H. Influenza?
Grow them around streaks of S. aureus, which provides NAD+ (factor V) and hematin (factor X) from the lysis of RBCs
527
DIC during pregnancy?
Cause by tissue factor (thromboplastic) found in the placental trophoblast -\> released during placental injury -\> activates complement cascade
528
What male cells secrete testosterone?
Leydig
529
Brown, firm colored spleen?
Remnants of autosplenectomy (hemosiderosis) Cause by vascular occlusion
530
Respiratory signs characteristic of asthma
Normal chest x-ray, eosinophils in sputum, reduced FEV1
531
What sugar can bypass phosphofructokinase and undergo faster metabolism?
Fructose, doe snot have to meet PFK-1
532
Anemia with schistocytes, thrombocytopenia
Thrombotic thrombocytopenic purpura, decreased ADAMTs13 leading to large vWF multimers -\> microvascular platelet-rich thrombi
533
Delusional disorder vs. paranoid personality disorder?
Delusion -\> behavior not obviously bizarre, ability to function other than delision, not due to substance abuse Paranoid- ppervasive pattern of suspiciousness or odd beliefs
534
535
Minimal change disease is what type of category?
Selective - certain size protein can get through
536
Diagnosis and microscopic characteristics?
Seborrheic Keratosis Small cells resembling basal cells with variable pigmentation, hyperkeratosis, and keratin containing cysts
537
Best treatment for pulmonay infections and abscesses in an alcoholic?
Clindamycin
538
Mxogatous changes
weakening of connective tissue-\> aortic dissections and aortic aneurysms
539
What is G6PD the rate limiting enzyme for?
Coversion to 6-phosphogluconate (first step in the pentose phosphate pathway
540
Norepinephrine extravasation
Interse alpha receptor mediated vasoconstriction which can lead to local tissue necrosis; counter acted by a alpha channel blocker, phentolamine
541
Foamy macrophages packed with both rod-shaped vacilli and PAS-positive diastase-resistant granules
Tropheryma whippelii
542
Closely packed, small, round, neoplastic cells in bone
Ewing Sarcoma
543
What proteins are involved with adherens junctions?
Cadherins
544
Light microscope findings in Chron's disease?
Transmural inflammation and noncaseating granulomas
545
Hemosiderosis
complex of ferritin found within cells and is unavailable for acccess to the body
546
Latanoprost-MoA
prostaglandin for glaucoma -\> increase outflow
547
Signs of vitamin A overdose?
Alopecia, dry skin, hyperlipidemia, hepatotoxicity, papilledema, visual difficulties
548
Signs of chronic gastritis
mucosal inflammation leading to atrophy, with hypergastrinemia
549
Gram-negative, pink-colored mucoid colonies on MacConkey's agar
Klebsilla, E. Coli, Enterobacter
550
Signs of T. whippelii infection?
middle-aged caucasian males, presenting as malabsorption with diarrhea and weight loss
551
Reversal agent for Heparin?
Protamine
552
How do you diagnose thiamine deficiency?
baseline erythrocyte transketolase activity is low, but increases after the addition of thiamine
553
Where does the great saphenous vein located?
medial side of foot -\> anterior to medial malleolus, and up the medial aspect of the leg, just inferolateral to the pubic tubercle in dives to join the femoral vein
554
Left vertebral artery- retrograde flow
blockage in the left subclavian
555
Bacterial recombination
gene exchange that occurs through crossing over of double stranded DNA molecules
556
Where is the caudate located?
Inferolateral walls of the anterior horns of the lateral ventricles
557
How does total parenteral nutrition cause gallstones?
lack of enteral passage of food into the duedenum fails to trigger release of cholecystokinin leading to contraction of the gallbladder -\> niliary stasis
558
How does N. meningitidis spread?
Via respiratory droplets; where theyy invade the epithelium and gain access to the vasculature
559
VIPoma-signs
diarrhea (persists with fasting), achlorhydrai and hypokalemia
560
What infections are found in HIV patients with a T-cell count less than 50? Tx?
Mycobacterium avium complex; grows well at higher temperatures Tx- Azithromycin
561
Where are M3 receptors located?
Peripheral vasculature, lung, bladder, eyes, gastrointerstinal , skin
562
Global payment
arrangement in which an insurer pays a provider a single payment to cover all expenses associated with an incident of care (think elective surgery, where pre- and post- op are also covered
563
How does fragile X cause symptoms?
\>200 CGG repeats -\> FMR1 hypermethylation -\> inactivated FMR1 -\> inhibits neural development
564
Factitious disorder
deliverate induction of infection without obvious external rewards ARE AWARE OF THE SYMPTOMS
565
ulcerative mass on the anus?
Think cancer, specifically HPV
566
Precursor to Uroporphyrin?
Succinyl CoA
567
Chikungunya Fever? Vector?
Februile illness with flu-like symptoms, with prominent polyarthralgia/arthiritis and diffuse maculopapular rash. Spread by Aedes Aegypti
568
Functions of protein A
virulence factor that forms part of the outer layer of S aureus, binds the Fc portion of IgG antibodies @ complement-binding site
569
Burkholderia cepacia
Aerobic gram-negative bacillus found in aquatic environments and colonized fluids in the hospital catalase positive
570
Glanzmann thrombinasthenia
Fialure of platelet to platelet aggregation due to decreased Gp IIb/IIIa aggregated with ristocetin
571
What clotting factors are produced in the liver?
2, 7 (shortest half-life), 9, 10
572
How to chronically elevated fatty acids lead to insulin resistance?
Impair insulin-dependent glucose uptake and increase hepatic gluconeogenesis
573
History of HIV, 2 ring-enhancing focal lesions (with mass effect), edema in right frontal lobe? Tx?
Toxoplasma gondii Pyrimethamine and sulfadiazine
574
What is the normal lining of the bronchi?
Pseudostratified ciliated columnar
575
Canagliflozin-MoA, SE
MoA- SGLT2 inhibitor SE-UTI and genital mycotic infections, symptomatic hypotension, renal impairment
576
Adherence to collagen?
S. Aureus virulence factor
577
In the setting of an infection-\> hypotensino, tachycardia, tachypnea, and markedly elevated or decrease body temp
Septic shock
578
How to calculate bioavailability?
(Area under the oral curve X dose) divided by (area under the IV curve x Dose)
579
Cauda equina sundrome
Compression of spinal nerve roots presents with severe bilateral radicular pain, saddle anesthesia and hyporeflexia
580
Metalloproteinases
Activated macrophages infiltrate atheroma, and cause the breakdown of extracellular matrix proteins (collagen), destabilizing the plaque
581
Potential complications of acute pancreatisit?
Leakage of pancreatic secretions into the peripancreatic space -\> inflammatory reaction in the walls -\> pseudocyst formation -\> fibrous and granulation tissue
582
Where do H. pylori occupy?
Antrum of stomach (prepyloric area)
583
Atelectasis? Cause?
Complete of partial collapse of a lung Contraction-secondary to radiation
584
lithium - teratogenic effects
Ebstain anomaly, nephrogenic diabetes insipidus, hypothyroidism
585
Six-sided crystals?
Citrate crystals -\> Increased COLA amino acids in urine
586
What do the "-ravir" drugs for HAART therapy target?
messenger RNA transcriptoin (integrase inhibitor)
587
Signs of acute rheumatic fever
Migratory arthritis, pancarditis, sydenham chorea, erythema marginatym (JONES criteria)
588
What is stress-related mucosal disease?
Acute gastric mucosal defects that develop in response to severe physiological stress (shock burns, sepsis, etc.)
589
Laboratory finding of Sarcoidosis?
hypercalcemia/hypercalciuria, elevated ACE level
590
Side effects of SSRI?
sexual dysfunction
591
Does does eosinophil enter the bronchial wall in asthmatics?
Recruited by IL-5 released by allergen-activated Th2 cells
592
Acute symmetric arthralgia/arthritis with or without rash in adults working at a school?
Parvovirus
593
Signs of cocaine withdrawal?
intense psychomotor retardation, severe depression
594
Acanthosis nigricans
Bands in axilla, other skin folds suggesting insulin resistance - \>
595
Latent period - studies?
timelapse from initial exposure to clinically apparent disease
596
Why is a two week window needed after MAOI dicontinuation?
Provide time to regenerate MAO A and B to normal levels
597
Treatment for chemotherapy, development of frequent urination, suprapublic pain, dysuria, progressive hematuria
Treated with cyclophosphamide (or analog) -\> metabolized in the kidney to acrolein, which is topic to uroepithelial cells and cause cause death with long-term exposure
598
Signs of hyperaldosterism
hypertension, hypokalemia, metabolic alkalosis and decreased renin activity
599
Cardiac abnormalities in Tyrner syndrome?
Aortic coarctation, bicuspid aortic valve
600
Leukotrienev B4-moA
Metabolite of arachidonic acid -\> stimulated neutrophil migration to the site of inflammation
601
Hypertrophic cardiomyopathy sound?
harsh crescendo-decreshendo murmur heard best at the apex and lower sternal border
602
What is the MoA of enoxaparin
Binds antithrombin III; then binds to factor Xa, stopping the convertion of prothrombin to thrombin
603
Morphology of Cryptococcus Neoformans?
Yeast only! round or oval encapsulated cells with narrow-based buds
604
Organism associated with animal waste with severe headaches and pneumonia?
Q fever, coxiella burnetii
605
Side effects of Niacin?
decreased renal exceretion or urin acid -\> acute gouty arthritis
606
Azoles- MoA, SE
MoA- supress the synthesis of ergosterol SE- cytocrome p450 inhibitor
607
Long-term effects of hypogonadism?
Low estrogen -\> vaginal dryness and low bone denisty
608
Alport Syndrome? Cause?
eye problems, sensorineural deafness, and nephritis "can't see, can't pee, can't hear a bee"\ Type IV collagen defect
609
Use for gamma-glutamyl transpeptidase?
Determine origin of elevated alkaline phosphatase (hepatic vs. bony)
610
GI abnormalities associated with Down syndrome
Duodenal Atresia
611
What proteins are involed with Desmosomes
Desmogleins, desmoplakin
612
Thickened heart valves, with multiple small vegetations on both surfaces, "wire-loop" structures in flomerular capillary
SLE, verrucous endocarditis (Libman-Sacks)
613
List anti-oncogenes? Functions?
Tumor supression, APC, BRCA1, RB, TP53
614
Warfarin interaction?
St. John's wart -\> decreased efficiency
615
What happens to Rb in order to progress from G1 to S?
Growth factors -\> activation of cyclin D, cyclin E and cyclin kinase 0\> RB hyperphosphorylation -\> inactivation and release of E2F transcription factor
616
A. Globus Pallidus- basal ganglia B. putame - medial to the insula and lateral to the globus pallidus and internal capsule C. internal capsule D. Caudate nucleus E. Amygdala
617
Treatment for HER2-positive cancer?
Treastuzumab, a tryosine kinase, which downregulates cellular proliferation and promotes cellular apoptosis via binding to an extracellular domain on the HER2 receptor
618
HUS
microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency
619
What causes the outflow ventricular obstruction in interventricular hypertrophy?
Mitral valve leafnet and interventricular septum
620
Signs of noncommunicating hydrocephalus?
Headaches, increased ICP
621
How do loops cause hearing loss?
Inhibition of Na/K/2Cl transporters in the inner ear, usually at higher dosages with preexisting CKD, rapid intravenous administration, orwhen used in concert without agent that cause ototoxicity
622
How is epinephrine produced?
Norepinephrine in converted to epiinephrine via phenylethanolamine-N-methyltransferase (which is upregulated by cortisol
623
Legg-Calve-Perthes disease
young children isolated idiopathic osteonecrosis of the hip
624
What drugs are metabolized by jetatic N-acetyltransferase?
Isoniazid and sulonamides - increased toxicity
625
Myotonia?
abnormally slow relaxation of muscles (loosening one's grip after shaking hands, inability to release a doorknob) AD inheritance, CTG repeat for myotonia-protein kinase
626
Where are dietary lipids absorbed in the interstinal track?
jejunum via passive absorption
627
Complications of measles?
Encephalitis (days), acute disseminated encephalomyalitis (weeks), subacute sclerosis panencephalitis (years)
628
Bacterial vs virus meningitis?
Viral- WBC \<500, normal glucose, protein \< 150 Bacterial- WBC \>1000, \<45 glucose,
629
site effects of "navir" drugs?
metabolic complications (lipodystrophy, duslipidemia, insulin resistence
630
NNRTI- common side effects
abrupt-onset flu-like symptoms, abdominal pain, fever, hepatic failure
631
Uterine prolapse?
Uterus slips and enters the vagina
632
Disorders that can cause Xanthomas?
obstructive biliary lesions, primary biliary cirrhosis, primary or secondary hyperlipidemia
633
Fibrates-MoA
Upregulat lipoprotein lipase, and inhibit cholesterol 7alpha- hydroxylase
634
G-protein-dependent phospholipase C pathway?
GTP -\> IP3 -\> increased intracellular Ca2+
635
Cheyne-stokes breathing can be seek with which conditions?
CHF -\> buildup of CO2 stimulated the breathng centers -\> leads to overcorrect, stop breathing again
636
Anti-inflammatory agent that does not interfere with platelet aggregation?
Celecoxib (Cox 2 inhibitor)
637
Wernicke encephalopathy- signs?
Ophthalmoplegia, ataxia, and confusion -\> coma -\> death
638
Meniere Disease
unilateral hearing loss @ tinnitus cause by increased pressure and volume in endolymph
639
viral-independent viral nucleotides
Cidofovir, tenofovir
640
what is the function of enteropeptidase?
jejnal brush border enzymes responsible for the activation of trypsinogen to trypsin
641
Recombination
exchange of genes between 2 chromosomes by crossing over within homologous regions
642
Granulomatous inflammation of the media of a vessel
temporal arteritis
643
Signs of hereditary fructose deficiency? Cause?
vomiting and hypoglycermia 30 minutes after fructose ingestion (honey, fruits, vegetables), failure to thrive, hepatomegaly Cause- Aldolase B deficiency Hypoglycemia caused by intracellular accumulation of fructose-1-phosphate and depletion of inorganic phosphate
644
Side effects of tetracyclines during pregnancy?
Teeth staining
645
Where is PAH absorbed in the nephron?
It is not absorbed, concentration is lowest in Bowman's space
646
Atypical depression
mood reactivity, leaden paralysis, rejection sensitivity, increase sleep and apetite
647
how do neural cells migrate in GI development?
Caudally, as such, rectum is ALWAYS involved
648
Buerger's disease
AKA- thromboangitis vasculitis of medium and small-sized arteries- extends into contiguous veins and nerves
649
How does dehydration afffect the kidney filtration concentration
PCT will by isotonic (free flow) Macula Densa - hypotonic (increased reabsorption of sodium with water) Medullary CT- hypertonic (increased secretion of solutes to get more water)
650
How to calculate positive predictive value?
True positive/(True positive + false negative)
651
Mucosal tear without acute inflammation
Mallory Weiss, retching/vomiting
652
Harnup disease
Enterocyte apical transport proteins involved in the absorption of tryptophan is defective -\> decreased niacin deficiency
653
Blepharosparm
involuntary forcible closure of the eyelids (starts with uncontrollable blinking)
654
Glisson's capsule
Capsule of the liver, made from fibrin
655
Cause of atrialization of the right ventricle?
Lithium (ebstein abnormality)
656
Pulmonary hypertension-signs
Second heart sounds with right-sided heart failure due to cor pulmonale
657
Function of Sertoli cells
secrete mullerian-inhibiting factor -\> absence leads to the development of female internal genitalia (paramesonephrid ducts develop)
658
Dermatitis herpetiformis-age?
4-5th decade of life on buttocks and extensor surface
659
Intranuclear acidophilic inclusion in the brain
HSV
660
What surfaces to streptococcus adhere to?
Heart valves with preexisting endothelial damage
661
How does SIADH affect the electrolytes?
hyponatremia, decreased plasma osmolarity, increased urine osmolarity, normal body fluid volume
662
46, XX t(14:21)
unbalanced Robertsonian translocation
663
hard nodules over the DIP bilaterally with moderate severe morning stiffness?
Osteoarthritis
664
Causes of acute pancreatitis?
1. Recent ERCP 2. Drugs 3. Infections 4. Hypertriglyceremia 5. Structural abnormalities 6. Surgery 7. Hypercalcenua
665
Migratory throbophlebitis, concern?
visceral cancer -\> paraneoplastic syndrome concern
666
Cause of keyloid scaring
Overexpression of TGF beta -\> scar extends beyond borders -\> raised, painful puritic lesions
667
How to approach an angry patient?
acknowledge the anger and defuse the situation
668
third heart sound and recent MI?
Decompensated heart failure
669
What are the tragets of HAART therapy?
Reverse transcriptase and protease
670
Possible cause of postprandial voluminous diarrhea and weight loss
Short bowel syndrome -\> vitamin 12 deficiency
671
Pseudocholinesterase deficiency
Abnormally slow breaking down of anesthesia
672
Prolonged PTT, PT, normal thrombin time?
Aoixaban rivaroxaban
673
Schizoaffective disorder
Major depressive or manic episodes with concurrent symptoms of schizophrenia AND \>/= 2 years of delusions of hallucinations in the absence of major depressive of manic episodes
674
What is tetrahydrobiopterin a cofactor for?
Synthesis of serotonin and DOPA
675
What causes the green color during the recovery from a hematoma?
Heme oxygenase (from macrophages) -\> biliverdin (green pigment), carbon monoxide, and ferric iron Biliverdin is reduced by biliverdin reductase to the yellow pigment, bilirubin, which is bound to albumin and transported to the liver
676
What pouch do the superior parathyroid glands come from?
4th pharyngeal pouch
677
Where does the fourth heart sound occur?
Prior to S1
678
How do TCA work? Risk of death?
inhibit the reuptake of NE and 5\_HT via the inhibition of the fast sodium channel Risk of death: cardiac arrhythmias -\> death
679
Signs of B6 deficiency
anemia, peripheral neuropathy, dermatitis
680
Biotin deficiency: Enzymes
Pyruvate carboxylase - pyruvate to oxaloacetate Acetyl-CoA carboxylase- Acetyl-CoA to malomyl-CoA Propionul-CoA carboxylase - Propionul-CoA to methylmalonyl-CoA
681
What two effects does desmopressin therapy have?
Increases circulating factor VIII and vWF to stop bleeding (hemophilia A and Type 1 con willebrand disease) Binds V2 receptor in renal cells leading to increased aquaporin channels, increasing water reabsorption and decreasing urine output
682
Curling Ulcers
Ulcers arrising in proximal duodenim in association with severe trauma/burms
683
Pancreatic calcification, think?
Chronic alcohol abuse
684
Furosemide?
Loop diuretic, blacks Na-k-2Cl
685
elevated periosteum and sunburst pattern?
osteosarcoma- new women bone is being developed
686
Equation for specificity?
TN/(TN+FP)
687
Bipolar I versus Bipolar II
Bipolar I - manic episodes (severe, 1 week, marked impairment in social or occupational functioning, psychotic features) Bipolar Type II (less sever, \>/= 4 days, no psychotic conditions)
688
What forms the right-sided bulge in the chest on X-ray
Right atrium
689
Thromboxane A2-moA
vasoconstriction and platelet aggregation
690
What does glucose-6-phosphate dehydrogenase catalyze?
First step in the pentose-phosphate pathwa -\> produces 2 NADPH while converting glucose-6-phosphate into ribulose-5-phosphate
691
Romano=Ward Syndrome
AD, QT prolongation without neural deafness
692
Myasthenia gravis antibodies?
antibodies against acetylcholine receptors
693
How do you treat pulmonary hypertension?
Bosartan (endothelian-1 antagonist)
694
How does alcohol kill viruses?
Disrupts viral envelope
695
How does precocious puberty affect children?
Lead to shorter height due to the action of sex steroids on the long bone epiphyseal plate
696
Where is type II collagen found?
Cartilage, vitreous humor, nucleus pulposus
697
Hydroxyurea- MoA
Increased fetal hemoglobin sunthesis -\> protects against polymerization of sickle cells
698
What seizure types can use Valproic acid?
Tonic-clonic, myoclonic
699
What do diabetes "glit" drugs bind to?
PPAR-gamma, an intracellular nuclear receptor
700
Brain tumor iwth whirled pattern?
Meningioma
701
Delirium
Acute changes in cognition and behavior
702
What does the Meningitis vaccine contain?
Capsular polysaccharides
703
What does an increase in enzymes responsible for DNA synthesis signify?
Transition from G1 to S
704
Drugs that cause a decreased heart rate
Beta-blockers, non-dihydropyridine receptors, cardiac glycosides, amiodarone, sotatol, cholengeric antagonists
705
Where do dihydropyridines act?
Vascular smooth muscle, "-dipine" drugs
706
Where are cavernous hemangiomas located?
Brain parenchyma above the cerebellar tentorium
707
Dubin Johnson syndrome
detect in hepatic excretion of bilirubin glucuronides due to mutation in canalicular membrane transport protein Labs: increased direct (conjugated) hyperbilirubinemia, other labs normal Stress brings on jaundice
708
How do you calculate the probability of getting at least 1 positive test result in an experient
p = 1-(%of the time the test is negative) ^ (# of tests)
709
Chronic granulomatous disease-risks
recurrent bacterial and fungal infections due to impained NADPH oxidase
710
How does glactose-1-phosphate uridyl transferase deficiency present?
Jaundice, vomiting, hepatomegaly, renal dysfunction,
711
Treatment options available for Conn's syndrome (hyperaldosterism)
spironolactone and Eplerenone
712
Bilateral knee swelling (as a child) with exertional dyspnea, think?
Rheumatic fever with mitral regurgitation
713
What infection can cause primary pericarditis?
Coxsackie
714
What are the clinical findings of preeclampsia?
New-onset elevated blood pressure at \>/= 20 weeks, proteinuria (or signs of end organ damage)
715
Recurrent HSV infection treatment?
Calacyclovir
716
Haloperidol
1st generation antipsychotic and potent D2 blocker
717
Bluish lesion under the right index finer that is extremely painful to touch? origin?
Glomangioma-modified smooth muscle cells Thermoregulation
718
Reducing nausea from gastrointestinal irritation? Vestibular?
5-HT receptor antagonists-GI H1 receptor antagonists - Vestibular
719
Oxidase-positive colonies that do not germent lactose? tx?
Peudomonas aeruginosa Tx: Cephalosporins (cefepime and ceftazidime)
720
Intradermal nevi
Epidermal nests have been lost, dermal nevus cells lose tyrosinase activity and produce little to no pigment
721
Bilobed nuclei with large eosinophilic granules
Eosinophils
722
Amniotic fluid embolism?
Caused by trauma, fluid containing arachidonic acid metabolites -\> occlusion and vasospasm of the maternal pulmonary circulation -\> left heart failure-\> cardiopulmonary arrest
723
Foreman ovale
Mandibular branch of the trigeminal nerve
724
Where to external hemorrhoids drain?
Internal pudendal vein tributaries (inferior rectal veins)
725
Dissociated identity disorder
marked discontinuity in identy and loss of personal agency with fragmentation into more than 2 personality states
726
What causes granuloma formation?
CD4 T-lymphocyte reaction that causes damage and cavitation
727
VATER Syndrome
V- vertebrae A- imperforate anus TE - tracheoesphogeal fistula R - Renal abnomalities L - limb abnormalities
728
Eplerenone
aldosterone antagonist (similar to spironolactone)
729
What does C1 inhibitor deficiency cause?
Cleaving of C2 and C4 and inhibtion of kallikrein-induced convesion of kiniogen to bradykinin
730
What causes a mahority of overdoses in the US?
Opiods (including heroin)
731
What is placed on the 5' cap on RNA stands?
methylguanosine triphosphate
732
vibrio vulnificus- characteristics
Gram negative, lactose fermenting organism
733
Where are cGMP-gated sodium channels used?
Vision
734
Effect of low-dose dexamethasone? High dose?
Does not change for any type of cushings, only ectopic, High dose only supresses pituitary
735
Sudden onset of syncopal edisodes, think?
Cardiac arrhythmia, affected by K+ channels (genetically)
736
Organism causing pneumonia in alcoholics
Klebsiella
737
What structure lies anterior to the right renal artery?
IVC
738
How to test for malabsorption?
Sudan III stain- identifies unabsorbed fat and confirm malabsorption
739
Similar pathogenesis to Giant cell arteritis (temporal)?
Takaayasu arteritis, medial granulmoas
740
Headache, retro-orbital pain, high-frade feer and joint and muscle pain with skin rash, and thrombocytopenia after travel to Brazil?
Dengue fever
741
Most common cause of Osteomyelitis in children
S. aureus- hematological spread
742
What is the problem with Friedreich ataxia?
decreased FXN expression 0\> decreased mitochondrial energy and increased oxidative stress, resulting in degeneration of neural tracts and peripheral nerves Specifically, spinocerebellar and lateral corticospinal tracts (gait ataxia) Ldegeneration of dorsal solumns and dorsal root ganglia (loss of position and vibration Hypertrophic cardiomyopathy, and CHFF Diabetes
743
cyanotic spells, improve with squatting, systolic murmur
Tetralogyof Fallot, caused by abnormal neural cell migration to anterior and cephalad deviation of the infundibular septum
744
What is responsible for a majority of drug metabolism?
Cytochrome P450 enzyme
745
Granulosa cell tumors
Yellow, lipid filled cells, in post menopausal women( Call-exner bodies) with coffee bean nuclei
746
Bacterial transformation-definition
uptake of naked DNA by a cell
747
Newer generation of antihistamines
Loratadine, cetirizine, do not cross blood-brain barrier
748
Denosumab- MoA
Inhibits the RANK/RANK-L interactions -\> increased bone density
749
What is stimulus control for insomnia?
Usened only for sleep and sexual activity; leave bed when unable to sleep and go to another room, fixed wake-up times (including weekends)
750
Skin lesion on upper eyelid
Xanthelasma
751
Clomiphene- MoA
selective estrogen receptor modulator - Tx for PCOD
752
What is the function of the ulnar nerve?
Wrist adduction
753
Thyroid nodue containing clusters of overlapping cells with large nuclei containing sparse, finaly dispersed chromatin?
Papillary carcinoma (orphan annie eye)
754
What promotes the formation of gallstones?
High levels of cholesterol with decreased bile salts and phosphatidylcholine (which increase solubility of cholesterol)
755
How does hypertension arrive in a cresh patient?
sclerosis of everything -\> sclerosis in the lungs -\> pulmonary hypertension
756
Lung transplant with bronchial obstruction, dyspnea, dry cough?
Chronic rejection
757
Choline O-acetyltransferase
Synthesizes ACh
758
Cause of decerebrate posturing?
Extensor posturing- loss of descending excitation to the upper lumb flexors via the rubrospinal tract (at or below the red nucleus) Damage is @ the pons
759
Spherocytes-MCHC
Increased, due to the smaller size
760
How long for a first-order kinetics drugs to reach steady state?
4-5 half-life
761
selective media containing vancomycin, collistin, nystatin, trimethoprim? Grows?
Thayer-martin, grows N. Gonorrheae
762
Uticaria
"Hives" transient hypersensitivity, due to IgE-mediated degranulation -\> causes edema of the superficial dermis
763
Acyclovir- MoA
Inhibits via reverse transcriptase via competing with deoxyguanosine triphosphate
764
Glioblastoma: characteristics
most common primary cerebral neoplasm in the cerebral hemisphere large tumors causing mass effect, can see "butterfly glioma" Necrosis and hemorrhage Poor prognosis
765
Oral thrust, interstitial pneumonia, severe lymphopenia in first year of life
Vertical transmission of HIV-1, treat with prenatal antiretroviral therapy
766
In hypoxia conditions, what glycolysis component is shunted?
Pyruvate -\> lactic acid inseat of Acetyl -CoA because of a build up of NADPH
767
Common asthma allergens
Animal dander, dust mites, cockroaches, pollens and molds
768
What does prussian blue stain detect?
Intracellular iron
769
Cyclothymic disorder
2 years of fluctuating, mild hypomanic and depressive symptoms that do not meet criteria for hypomanic episodes or major depressive
770
Signs of Dengue fever
Flu-like febrile illness with marked myalgias, retro-orbital pain, rash (white islands in a sea of red) Travel to mexico/endemic area
771
Signs of syringomyelia?
Loss of upper extremilt pain and temperature sensation, and extremity weakness
772
c-ANCA is associated with what type of kidney formation?
Creascentic glomerulonephritis (rapidly progressing glomerular nephritis
773
Down syndrome- cardiac defects
Endocardial cushion defects
774
igE-independent mast cell degranulations?
Morphine, radiocontrast, etc.,
775
What should be removed in aldolase B deficiency?
Fructose and sucrose
776
What spinal tracts are affected in B12?
Dorsal columns, lateral corticospinal, axonal degeneration of peripheral nerves
777
Harsh ejection systemolic murmur at the base of the heart, radiating to the neck
Aortic valve stenosis
778
What are the functions of ACE-inhibitors?
Systemic vasodilation Dilation of glomerular efferent arteriole (reduction in GFR, dec. perfusion with dilated vascular size) Decreases adrenal aldosterone secretion
779
Webbed neck..association
Turner Syndrome - 46, XO
780
What connects the vagina to the anus?
Perineal body
781
Mu receptor effects?
Respiratory & cardiac depression
782
What type of transmembrane is CFTR?
ATP gated ion channel
783
Ducts distended by pleomorphic cells with prominent central necrosis without externtion beyond the ductal basement membrane
Ductal carcinoma in site (microcalcification are encountered on mammography)
784
Kawasaki disease? Risk for?
Medium sized arteries in young children of Asian ethnicity. Fever for \>/= 25 days plus 4 of the following - bilateral conjunctival injection - Cervical lymphadenopathy, - mucositis (strawberry tongue) - extremity changes - rash Increased risk for development of coronary artery aneurysm from inflammation
785
factors that can lead to vitamin B12 deficiency?
Long-tern vegan diet (years, not months)
786
What do proto-oncogenes do?
stimulate cell proliferation, and their over expression (activation) leads to increased cellular proliferation and neoplastic growth
787
Signs of scurvy
Gingival swelling and perifolllicular hemorrhages and coiled hairs
788
How to AV shunts affect preload and afterload?
Increase preload, decrease afterload
789
How to calculate RPF
PAH clearance - (urine [PAH] X urine flow rate)/ plasma (PAH)
790
Hashimoto thyroiditis-hormone changes
Increased TSH, Decreased T4, nomral T3(which is converted in peripheral tissues
791
What drug provides a signifiant reduction in triglycerides? Side effects?
Fibrates Side effects: muscle toxicity, gallstones
792
MoA of calcipotriene
(topical vitamin D analog)m actuvate the vitamin D receptor (nuclear transcription factor) andd cause inhibition of keratinocyte proliferation
793
How to caoculate half-life
(0.7 x volume of distribution)/CL
794
How to revent hemorrhagic cystitis associated with nitrogen mustard-based chemotherapy?
Mesna and aggressive hydration
795
Hemorrhagic lymphocyte pleoctosis, increased protein, normal glucose?
Herpes simplex virus encephalitis
796
What nerve enters through the foramen rotundum?
CN V2 (maxillary
797
What type of immunity is antitoxin?
passive immunity
798
Signs of spinal stenosis? Cause?
bilateral pain provoked by walking, relieved by leading on something with normal strength Cause- degeneration of spinal cord leading to ligamentum flavum hypertrophy
799
Ulcers in ZE?
extend beyond duodenal bulb and are refractory to therapy
800
Name some alpha-1 blockers
Doxazosin, Prazosin, Terazosin
801
What arteries supply the ureter -proximal? Distal?
Renal artery-proximal Common iliac, internal iliac, and superior vesical artery-distal (not retained in X-plant
802
Hepatic changes in hepatitis?
Apoptosis of heratocytes, periportal inflammatory infiltration
803
Fatique, weakness, itching, cause?
uremia toxins secondary to progressive chronic kidney disease
804
Signs of HSP?
GI pain, hematemesis, IgA nephropathy, papable purpura in the buttocks and lower extremities, self-limited migratory arthalgias/arthritis
805
How do corticosteroids affect neutrophils?
Cause demargination removal of neutrophils from the edge of blood vessels and release them into circulation
806
Cause gram-positive bacteria to swell in hypotonic solutions
Interference with cell wall synthesis -\>cephalosporins, vancomycin, penicillins
807
What can relieve carple tunnel syndrome?
Longitudinal incision through the transverse carpal ligament (flexor retinaculum)
808
Very large cells with over 100 nuclei?
Osteoclasts in Paget's disease
809
How to diagnose type I diabetes?
Hemoglobin A1c \> 6.5% or fasting glucose \>/= 126
810
COX1 vs COX2 expression
Cox1 - norrmmal function tissues COX2-expressed at sites of inflammation
811
Nigrostriatal degeneration in parkanson disease results in?
Excessive excitation of the globus pallidus interbus by the subthatamic nucleus, which causes excessive inhibition of the thalamus
812
Delta receptor use?
Antidepressant effects Analgesia
813
Lambert-Eaton antibodies?
against pre-synaptic calcium channels
814
Folate deficiency, level of methylmalonic acid is?
normal
815
What does fluid infusion do the volume-pressure loop
Rightward extension of the filling portion, and increased maximal pressure
816
Immune complex vasculitis with igA and c3?
Henoch-Scholein purpura Presents with purpuric rash, colicky abdominal pain and polyarthralgia
817
With a build u of 17-hydroxyprogesterone, where is the defect?
21-hydroxylase
818
What are the effects of exogenous steroids?
Decreased gonadotropin, leading to infertility
819
Signs of cardiac tamponade?
Jugular venous distention, hypotension, diminshed heart sounds, pulsus paradoxus
820
Schiztophrenia-characteristics
Fixed delusions, frank hallucinations
821
Name the potassium sparing diuretics.
Spironolactone and Eplerenone, Triamterene, Amiloride
822
Near-miss
medical error recognized before any harm has been done
823
What is associated with delirium?
Waxing and waning levels of consciousness, hallucinations
824
Heredity bleeding disorder
Von Willibrand Factor
825
How does long-term use of Levadopa affect movement?
Long-term use leads to On-Off phenomenon that causes fluctuations in movement ability over time, as the therapeutic windows narrows due to natural of levodopa-induced nigrostriatal degeneration
826
Types of lymphocytes
B-cells and T-cells, NK cells
827
What structure contains dihydrouridine, ribothymidine, pseudoridine?
tRNA, 3' end has a CAA sequence used for recognition
828
What can a double blind study prevent?
Observer bias
829
Elderly person with hematuria suggests...
renal or urothelial neoplasm
830
Anaplasia of epithelial cells with invasion into the stroma
Epithelial ovarian cancer
831
Sertoli cells-function
Facilitate spermatogenesis Produce inhibit in response to FSH
832
Post-warfarin- reversal agent?
Protein C deficiency, Warfarin initiation leads to a drop in factor VII and protein C Tx- remove warfarin, and adminster fresh frozen plasma
833
Where does chromosome segregation occur during anaphase?
Primary spermatocyte
834
Function of BCL2
Cell death cascade
835
What receptors are involved in stimulating the vomiting reflex?
m, muscarinic, D, dopaminergic, h, histaminic (DHM) When those do not work,neurokinin 1 receptor antagonists can work
836
Signs of tanstentorial herniation?
Ipsilateral oculomotor nerve compression - fixed and dilated pupil Ipsilateral posterior cerebral artery compression (contralateral homonmous hemianopsia with macular sparing Compression of contralateral corticospinal tracts Brainstem hemorrhages (duret hemorrhage)- basilar artery
837
Postprandial rapid fluid shifts- cause? Signs?
Gastric bypass or damage to the pyloric sphincter Postprandial nausea, voliting, cramps, viarrhea, and vasomotor symptoms (diaphoresis, flushihng)
838
Hear tfilaure in the setting of recent viral infection, think?
Dilated cardiomyopathy caused by viral myocarditis
839
Pathology of Raynaud phenomenon
increased deposition of collagen in tissues
840
Pulmonary hypertension: pathogenesis?
Passive increase in pulmonary capillary and arterial pressure caused by pulmonary venous congestion
841
Wheel-like shaped virus? Structure?
Rota virus
842
Hypertension in a women \> 20 weeks pregnancy?
Pre-eclampsia
843
Highest incidence of cancer in woman?
breast
844
Drugs to manage drug-induced parkinsonism
Trihexyphenidyl, denztropine
845
KRAS
Proto-oncogene
846
What can reverse methotrexate toxicity?
Folininc Acid
847
Heparin-induced thrombocytopenia
iGG antibodies against heparin-bound platelet factor 4 \_\> activates platelets
848
Spinocerebellar tract?
Proprioception from the body to the cerebellum
849
What type of antibody is the anti-RH immune globulin?
IgG anti-D -\> opsonize Rh+ fetal erythrocytes, administered @ 28 weeks
850
What is inhibited in drug-induced parkinsonism?
Nigrostriatal pathway (D2 blockade)
851
Mutations in CML?
CHr 9:22, which causes a tyrosine kinase activation (BCR-ABL)
852
Phenoxybenzamine-moA
irreversible alpha 1 and alpha 2 inhibitor
853
SIADH- effect?
Excessive water absorption by the kidneys, -\> hypervolemia -\> sodium loss by the kidneys
854
Poorly developed sexual characteristics, cannot smell? mutation?
Kallman syndrome, failure of GnRH-secreting neurons to migrate from origin in the olfactory to the hypothalamus Muataion KAL-1, GFGR-1
855
Preventable adverse event?
harm to a patient via act of commission or omission, rather than from the underlying disease
856
Eczema after environmental exposure in a child?
Atopic dermatitis, seen with allergic rhinitis, asthma (allergic triad)
857
Pure red cell aplasia
hypoplasia of marrow erythroid elements due to inhibition of prythropoietic precursors by igG autoantibodies or cytotoxic T-lymphocytes Associated with Thymomas and lymphocytic leukemias or parvo
858
Signs of hyperaldosterism, Na, K, H level?
normal Na reabsorption, increased K+, H+ exceretion,
859
How does digoxin slow ventricular rate?
enhances vagal tone -\> slows AV node
860
What causes the removal of RNA primers and the replacement with DNA?
DNA polymerase I (5'-3' exonuclease activity)
861
Sudden, involuntary contraction of a major muscle group
Acute dystonic reaction (4 hours-4 days after the initiation of antipsychotic medications)
862
PCA infarct on vision?
homonymous hemianopia (same side of both eyes)
863
Risks in pregnant mother with diabetes?
Transient hypoglycemia for the first several days
864
How to calculate the net excretion of a substance?
(Inulin clearance X Plasma [Substance A]) - (Tubular absorption of substance A)
865
Lepromatous leprosy-presentation
Weak cell mediated immunity (Th2), leads to myobacterium dissemination -\> diffuse skin thickening, plaque-like hypopiigmentation, leonine facies, paresis, regional ansthesia,, testicular destruction, blindness
866
Small white spots with an erythematous base on buccal musosa?
Koplok spots (associated with measles)
867
Widespread narrowing of the renal arterioles with deposition of homogeneous, glassy material in the subendothelial space that stains pink with PAS?
Diabetes Mellitus
868
Bacterial DNA polymerase 1- unique features
5'-3' exonuclease activity to remove the RNA primer created by RNA primase and repair DNA sequences

USMLE (2 decks)

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