STEP 1 Week 2 Flashcards
(299 cards)
1
Q
Most hypotonic region of the renal tubule in setting of ADH and non-ADH
A
ADH - distal convoluted tubule (remains mostly impermeable to water)
Low ADH - collecting duct, no porins inserted so becomes less concentrated
2
Q
What causes vasoconstriction and increased proliferation in the lunc
A
Thromboxane and endothelin
3
Q
Treatment for Myasthenia gravis
A
Pyrostigmine - and AchE inhibitor
If too low - will respond to edrophonium test (aother AchE)
If too high - Desensitized muscles, wont respond to edrophonium (stop pyrostigmine temporarily)
4
Q
How to measure severity of mitral stenosis
A
A2 to opening snap time interval
Shorter in more severe cases (the snap is when the mitral valve reaches its maximal diameter)
5
Q
Symptoms and histo of hypersensitivity pneumonitis
A
6
Q
Most common ligament injured in the ankle
A
Anterior talofibular ligament (lateral)
7
Q
Function of fibroblast growth factor 23
A
Secreted by osteocytes in response to high phosphate levels
Inhibits synthesis of 1,25 hydroxyvitamin d in the kidney, so leads to a drop in calcium and phosphate absorbption in the kidney and intestine
8
Q
Function of each of the rotator cuff muscles
A
Supraspinatus - abduction (first 15)
Infraspinatus - external rotation
Teres minor - external rotation and adduction
Subscapularis - internal rotation and adduction
9
Q
What is stress hyperglycemia
A
In times of metabolic stress, the body releases chatecolamines, cortisol, and other inflammatory cytokines that increases hepatic gluconeogensis and glycogenolysis
High blood sugar with no diabetes
10
Q
Function of type II pnuemocytes
A
Secerte surfactant
Regeneration of alveolar lining after damage
Can differentiate into type I pneumocytes
11
Q
Histo of Lewy body dementia vs alzheimers vs frontotemporal dementia vs parkinsons
A
Lew body dementia - alpha synuclein
Alzheimers - Beta emyloid, presinilin, tau (tangles)
Frontotemporal - Tau protein inclusions, TDP-43
Parkinsons - Lewy bodies (alpha synuclein)
12
Q
What is a cholesteotoma
A
A pearly mass of squamous cell debris in the middle ear behind the tympanic membrane, caused by chronic negative preasure
13
Q
What causes dissemenated mycobacterium infections in childhood
A
Deficiency in the INF-gamme pathway (JAK-STAT)
Macrophages cant be activated appropriately - wont secrete IL-12 to induce phagolysosome killing and wont form granulomas
14
Q
Methotrexate fetal effects
A
Cardiac, urinary, neural tube defects
Blocks dihydrofolate reductase
15
Q
Treatement for acute gouty arthritis
A
NSAIDS (COX inhibitors)
Colchicine
16
Q
Lymph drainage of the testes
A
Testes - para-aortic lymph nodes
Scrotum - superficial inguinal nodes
17
Q
HIV/HSV drug that does not require phosphorylation
A
Foscarnet
18
Q
Lesions of the macula cause:
A
Central scotoma
Like in macular degeneraion
19
Q
Side effects of dopamine receptor blockers (metochlopramide)
A
Can cause dopamine blockade that can lead to cholinergic activity = extrapyramidal symptoms
Give with something with anticholinergic activity like diphenhydramine
20
Q
What induces P and E selectins
A
P-selectins = weibel-palade bodies
E-selectins = Il-1 and TNF
21
Q
Label the regions
A
Ach stimulates the medulla chromaffin cells
22
Q
Side effects of amiodarone
A
23
Q
Types of analysis to do based on type of independent and dependent variables (qualitative or quantitative)
A
24
Q
Physical manifestations of cystic fibrosis
A
Nasal polyps, bronchiectasis, recurrent infections, digital clubbing
Pancreatic insufficiency, absence of vas deferens (inferitility), failure to thrive
CFTR gene helps developement of wolffian structures
25
Course of the great saphenous vein
Begins on the medial fit, courses up medial to medial melleolus then uo medial aspect of leg and thigh. Joins femoral vein in the femoral triangle (bounded by inguinal ligament, sartorius, adductor longus), inferior to pubic tubercle
26
Cancer and PD-1
Cancer cells often have mutations that make them express less PD-1, which would usually bind PD-L1 (programmed death ligand 1) on cytotixic T cells and cause lead to destruction
27
What cell surface signal is lacking in leukocyte adhesion deficiency
CD18 - see leukocytosis because neutrophils and macrophages cant enter tissues
28
Innervation of inner ear muscles
Tensor tympani - CN V3
Stapedius - CN VII
29
What will a mutated PRPP enzyme cause (phosohoribosyl pyrophosphate)
Gout due to increased purine synthesis
30
Causes of gongenital hypothyroidism (4) and hormone levels
Primary hypothyroidism
Thyroid hormone resistance
Central hypothyroidism
Transient due to maternal exposure
31
Normal pancreas development
Dorsal - tail, body, most of head, accessory duct
Ventral - Main duct, uncinate provess, part of head
32
Is pregnancy prothrombotic or antithrombotic? why?
Prothrombotic
## Footnote
1. Increased clotting factors - like fibrinogen
2. Decreased anti-clotting factors - like protein S
3. Less fibrinolysis
33
Levels of the sciatic nerve
L4-S3
34
What muscles does the median nerve course between
Humoral and ulnar heads of the pronator teres
flexor digitorum superficialis and flexor digitorum profundus
35
Inhibitory checks on trypsin activity
Trypsin inhibitors (encoded by **SPINK 1 gene**) are released in the pancreas
Tryspin also can cleave another molecule of trypsin at a second site different from activation that inactivates it - stops excessive cascade
36
Main cause of epiglottitis vs steeple sign
Haemophilus influenza type B = epiglottitis
Croup = steeple sign
37
Nondisjunction in meiosis I vs meisosis II
38
What blood changes would be seen after several days at high altitude
Slightly high pH, low O2, low CO2, low bicarb
Low O2 in air increases respiration (chemoreceptors) that leads to loss of CO2 and resp alkalosis. This leads to loss of bicarb in kidneys
39
Effects of fetal hyperglycemia (from uncontroled maternal diabetes)
Lots of glucose crosses to placenta so big baby (macrosomia)
Leads to increase in fetal insulin and beta cell hyperplasia - after birth see hypoglycemia so have to give glucose
40
APC vs KRAS vs TP53
APC - progression from normal mucosa to polyp (B catenin accumulation)
KRAS - Increase size of adenoma
TP53 - malignant transformation
41
Most likely cause of fatigue, fever, and new heart murmur
Infective endocarditis
proliferative glomerulonephritis can be secondary (nephritic syndrome)
42
Cause of fetal midgut atresia
Vascular injury
43
Hematologic cancers associated with downs syndrome
**Acute lymphoblastic leukemia**
Acute megakaryoblastic anemia
44
Effects of raloxifene in different areas of the body
Estrogen agonist in bone (good for osteoporosis)
Estrogen antagonist in the breast and uterus
45
What increases urea reabsorption and where
Vasopressin (ADH) in collecting tubule
46
Function of calcium in neuronal transmission
Triggers fusion and release of neurotransmitter vesicles
47
Nerve most at risk during ablations involving the right atrium
The right phrenic nerve
48
Why are ischemic occlusions rare in the lung
Dual blood suply bc anastamoses between bronchial and pulmonary arteries. Broncial arteries can continue to supply nutrients
49
How is blastomyces described histologically
Branching hyphae
large round yeast with doubly retractile walls and a **single broad based bud**
50
Is cystic fibrosis obstructive or restrictive
Obstructive - progressive bronchiectasis, mucus plugging
51
Effect of acetazolamide on Na and K in urine
In the proximal tubule, it blocks reabsorption of Na.
But later in the collecting duct, Na is reabsorbed in exchange for K leading to an overall increase in K in the urine
52
Pathophys of high altitude pulmonary edema
Drop in O2 leads to vasoconstriction. If this is uneven, can lead to increase in pulmonary arterial pressure and perfusion in a certain area that can cause **capillary membrane disruption** and lead to edema
53
Pathophys of a staghorn calculus
Urease producing organisms (proteus, klebsiella) cause an increase in urea that is converted to ammonia in the urine. This **alkalinizes the urine** and causes precipitation of **struvite crystals**
Continuous urea production makes stones grow very rapidly, can lead to renal atrophy
54
Pathophys of cachexia
**TNF-alpha** is produced by macrophages and some neoplastic cells
Decreases appetite due to affect on hypothalamus and increases basic metabolic rate = musle wasting
55
Histology of mesothilioma
Flattened cells or spindle cells
Immunohistochemistry: cytokeratins, abundant tonofilaments
56
Effect of ATP on muscle contraction
ATP binds to myosin light chain and causes a releases from actin = relaxation
57
A - caudate
B - internal capsule
D- putamen
E - globus pallidus
58
Muscle that takes up most of the sciatic foramen and can compress the sciatic nerve
Piriformis - external rotation
59
Changes in the endometrial tissue throughout menstruation
60
Where is most water absorbed in the tubule
THE PROXIMAL TUBULE
\>60% regardless of hydration status
61
Potency of neuromuscular blocking agents in myasthenia gravis
Nondepolarizing (rocuronium, vecuronium) - more potent because fewer receptors that they compete for
Polarizing (succinylcholine) - less potent, fewer receptors so cant produce same effect
62
Fungal infection most associated with central venous catheter
Candida - pseudohyphae and blastoconidia
63
Main regulator of depth and rate of respiration
Respiration center in medulla based on peripheral and central chemoreceptors
Carotid and aortic bodies are main site that monitor PaO2 during hypoxemia
64
Most common causes of COPD exacerbations
Viral or bacterial illnesses - usually rhonovirus, influenza, H. flu, moraxella catarrhalis, strep pneumo
65
MOA of hydroxyurea
Inhibits ribonucleotide reductase = myelosuppression
Also shifts beta globin expression to gamma globvin, increasing fetal hemoglobin
66
Vincristine MOA and toxicity
Inhibits formation of microtubules - effective in stopping M phase
Neurotoxicity (peripheral neuropathy)
67
Side effects of statins
Muscle toxicity
Hepatotoxicity - check transaminases before starting
68
Treatment for simple cystitis
Nitrofurantoin or trimethoprim-sulfamethoxazole
69
Skin manifestations in syphillis stages
primary - chancre
secondary - diffuse macular rash, condyloma lata
tertiary - gumma (panless, indurated, granulomatous lesion)
70
Medications for weight loss and MOA
71
Why is peripheral edema initially avoided in chronic heart failure
Increased lymph flow
72
MOA of 5-FU
Creates a complex between tetrahydropholate and thymidilate synthetase, causing an inability to get back to DHF
73
Drug used to "rescue" cells during methotrexate use
Leucovorin (folinic acid) - a tetrahydrofolate derivative that can yield DNA synthesis without DHF reducatse that is inhibited by methrotrexate
74
What is seen grossly in TB meningitis
- Thick, gelatinous exudate on basal portion of brain
- Tubular vasculitis causing multiple bilaterla brain infarctions
- Hydrocephalus causing ventriculomegaly
75
Desmosomes vs hemidesmosomes
Both are spot-like junctions made of keratin intermediate fillaments but desomosomes are between adjacent cells and hemi-desmosomes are with the basement membrane
76
Type of cell junction of the BBB
Tight junctions - only transport by diffusion across membranes or. transporters
77
Usual location of third degree heart block
Av or bundle of his - bundle of his usually able to take over but not under control of SA
78
What does the HIV env gene do
Codes for polyprotein gp160 that is extensively **glycosylated.** Cleaved in the golgi into gp 120 and gp41 which allow for virion attachment to target cells
79
Histologic features of legionella
Poorly gram stains and does not grow on conventional agar
**Will silver stain**
Grow on **buffered charcoal yeast extract agar** with l-cysteine and iron
80
What is length-time bias
Screening test is less likely to pick up those with very quickly progressing disease than those with a slowly progressing disease that already have a better prognosis
Falsely elevated survival time
81
What enzymes are inhibited in lead poisoning
ALA dehydratase and ferrochetalase
82
What drugs can trigger G6PD
Bactrim (TMP/SMX), dapsone, antimalarials, nitrifurantoin
Fava beans
83
What is countertransferance
A therapists concious or uncocnious response to a patient based on past personal relationships
84
Fucntion of methimazole and propylthiouracil
Decrease production of thyroid hormones
Block thyroid peroxidase which adds iodine to tyrosine in colloid
85
SX of vitamin E deficiency
Hemolysis
Neurologic symptoms - ataxia, loss of proprioception, loss of sensation, loss of deep tendon reflexes (looks like freidrichs ataxia)
86
What is thyroglobulin
large glycoprotein made in the thyroid that is used to contribute tyrosine residues. Released when thyroid productio is occuring
87
Innervation of teeth and lower lip
Branches of CN V3
Teeth - inferior alveolar nerve
Lower lip - mental nerve
88
MOA and side effects of sulfonylureas
Close K+ channels in pancreatic beta cells cause depolarization - insulin release due to calcium influx
Side effects: hypoglycemia, weight. gain
89
Symptoms of digoxin toxicity
Arrhythmias, vague sx, vision changes, hyperkalemia
90
What causes swelling of hands and feet in SC infants
Vasoocclusion - infarctions. in the. bone of the extremities causes swelling and pain. More commoninnfants because. still hematopoetic tissue
91
Pathophys of fragile X syndrome
Many CGG repeats on X chromosome leads to increased methylation of FMR1 gene - leads to impaired neural development
92
What is a delayed hemolytic transfusion reaction
Occurs when someone. has previosly been exposed to a foreign minor red blood cell antigen (non-ABO) like pregnancy or transfusion
After reexposure, B cells produce a large numebr of antibodies resulting in hemolysis - **amnestic response**
SX: often asymptomatic, hemolysis, positive coombs test
93
How is the lac operon regulated in E. Coli
1. negatively. by the binding of repressor protein the lac operator locus
2. positively by cAMP-CAP binding upstream from lac operon -- inhigh levels of cAMP, CAP will bind upstream and turns on lac cAMP. low in the presend of glucose
94
Coagulation and nephrotic syndrome
Nephotic. syndromes cause a hypercoagulable state due to a loss of anticoagulant factors in the urine - especially antithrombin III
Can cause a renal vein thrombosis - would see flank pain, hematuria, elevated lactate dehydrogenase, possible left sided varicocele
95
Pathophys of postpartum thyroiditis
Autoimmune destruction of the thyroid gland - get release of thyroid hormine
Lymphocytic infiltrate with possible germinal centers
96
Medications associated with gout exacerbations
Reduced uric acid secretion - diurectics, cyclosporine, ACE inhibitors, salicylates
Increased production - cytotoxic chemotherapy (bc cell lysis)
97
Nerve most ofte injured during repair of inguinal hernias
Illioinguinal nerve - pain in anterior scrotum (labia majora), base of penis (mons pubis), medial thigh
98
Loading of MHC I vs MHC II
MHC I - proteasomes break down product and bring into ER via **TAP** proteins. MHC is assembled and sent to membrane
MHCII - MHC II is sent out from ER and fuses with lysosomes that contain bacterial products, MHC II forms within vesicle and then goes to membrane
99
What genes are affected by HPV
Decreased activity of p53 and Rb = unregulated cell proliferation
100
What is chronic granulomatous disease and common infections
Deficiency in NADPH oxidase, so cant turn O2 into radical to do oxidative burst in neutrophils
Can use H2O2 formed by catalase (-) bacteria, but catalase (+) bacteria remove H202
Staph aureus, **burkholderia (pseudomonas) cepacia,** serratia marcecens, nocardia, aspergillus
101
What is MGMT
Gene that helps to repair DNA damage, especially alkylating DNA damage
102
What happens to bicarb if chloride increases
Goes down - this is a NAGMA
103
Signs of cyanide poisoning and treatment
Reddish skin coloration, tachypnea, headache, tachycardia, nausea/vomiting, weakness
TX: Amyl nitrite
Converts iron (fe2+) to ferrous iron (fe3+) to make methemaglobin which binds to cyanide and sequesters it
104
How to treat heart valve infections
Vancomycin
Coagulase negative staphylococci are assumed to be methicillin resistent, otherwise would use nafcillin or oxacillin
105
Obstructions at the level of the larynx (epiglottitis) have _____ stridor
Inspiratory
106
What is mastocytosis
Abnormal proliferation of mast cells with increased histamine release
SX: hypersecretion of gastric acid by parietal cells, hypotension, flushing, urticaria, pruritis.
107
What is transpeptidase
A type of penicillin binding protein that penicillin or cephalosporins would bind to
108
First line therapy for atopic dermatitis
Topical glucorticoids - PLA2 inhibitor
109
Function of CN IX (hypoglossal)
Somatic motor: stylopharyngeus m (elevate palate during swallowing)
Parasympathetic: parotid gland (runs with V3)
General sensory: inner surface of tempanic membrane, eustachian tube, posterior 1/3 of tongue, tonsilar region, upper pharynx, carotid body and sinus
Special sensory: taste on posterior 1/3 of togue
110
Most common place for ulnar nerve damage
Fracture of the hook of the hamate as it passes through Guyon canal
111
MOA of PCP
N-methyl-D-aspartate receptor antagonism
Leads to dopamine dysregulation
112
Derivatives of ectoderm
113
Derivatives of mesoderm
114
Derivatives of endoderm
115
What is dilated cardiomyopathy
Direct insult to the myocardium leads to leads to ventricular dysfucntion and increased ventricular cavity size
Cause: viral, drugs, disease, idiopathic (familial - TTN gene)
116
What is titin
An elastic fiber that binds myosin heavy chain to the Z disk, contributes to passive myocardial tension
117
Examples of exocrine pancreatic enzymes
Lipase, elastase, amylase, trypsin, chymotrypsin
Low levels would indicate oancreatic insuffficiency
118
What is severe combined immune deficiency
**Defect in T cell production** - get loss of cellular and humoral immunity. B cells cant be activated
See: recurrent fungal, viral, bacterial, opportunistic infections. DIarrhea and failure to thrive
119
Cells involved in type IV hypersensitivty
**Macrophages, CD4, CD8**
NO B CELLS
120
DNA-binding proteins examples
Transcription factors, steroid hormone receptors, thyroid hormone receptor, fat-soluble vitamin receptors, DNA transcirption/replication proteins
121
Nerve most likely to be injured during thyroid surgery and muscle it innervates
External laryngeal nerve
Cricothyroid m.
Runs with superior thyroid artery and vein
122
Best rehydration for viral diarrhea
Hypotonic sodium-glucose solution
Sodium will pull water in
123
Treatment for nephrogenic diabetes insipidus
Water replacement and thiazide diuretic
Thiazide causes a mild volume depletion that leads to sodium and water reabsorption in the proximal tubule
124
What can lead to inactivation of fluoroquinolones
Chelating agents that contain calcium, iron, aluminum, magnesium
Antacids would be a common cause
125
MOA of heparin
Binds and induces antithrombin III, an anti-clotting facor
See prolonged thrombin time and PTT, decreased activity of factor Xa
126
What penicilins and cephalosprins are effective agaionst P. aurugenosa
Tcarcillin and pipercillin
cefepime and ceftazadime
127
SX of dissemenated histoplasmosis
Growi inside macrophages so can travel through reticuloendothelial system
hepatosplenomegaly, lyphmadenopathy, pancytopenia, tongue ulcerations
128
Contents of femoral triangle from lateral to medial
Femoral nerve, femoral artery, femoral vein, deep inguinal nodes
129
Pathophys of acanthosis nigricans
Caused by an increase in free fatty acids
Insulin insensitivity leads to lipolysis
130
Condition associated with HLA-B27 and what to monitor
Ankylosing spondylitis
Can limit chest wall mobility so monitor chest expansion
Can also cause dilation of the aortic ring and anterior uveitis
131
Cardiac problem associated with SLE
Fibrinous pericarditis - pleuritic chest pain that may radiate to shoulder, diffusely elevated ST segments
Would see fibrin-containing exudate
132
Nerves injured during prostatectomy that causes erectile dysfunction
Prostatic plexus in fascia of prostate - cavernousn nerves carry post-ganglionic parasympathetics to penis
133
Function of HIV gp120 and gp41
Gp 120 allows for attachment to T cell
Gp41 allows for fusion and insertion of viral core
134
What causes a mid-systolic crescendo decrescendo murmur
Aortic or pulmonary valve stenosis
135
Estrogen effects on epiphyseal growth plate
Initially triggers increased growth, but then causes epihphyseal growth plate closure
136
What is somatomedin C
Insulin like growth factor 1
137
Lung manifestation of RA
Pulmonary fibrosis - restrictive lung disease
138
Risks for diverticulitis
Dietary - high in red meat, fat, low in fiber
Obesity
Physical inactivity
Smoking
139
Most common cause of pericarditis
Viral illness
140
What usually causes serum sickness
Exposure to nonhuman proteins in antitoxins, antivenom, MABs, vaccines
Causes type III hypersensitivity with deposition in tissue - fever, urticarial rash, arthralgia
141
Segmented viruses
Bunya
Orthomixo
Arena
Reo
142
What ligament is often injury in radial head subluxation (nurse maids elbow)
Annular ligament
143
What do menotropin and hCG due for ovulation
Menotropin serves as FSH, allowing for the maturation of a dominant follice
hCG serves as the LH surge, inducing ovulation
144
Vitamin deficiency associated with measles
Vitamin A - can give occular complications so give. A
145
Histo of emphysema
Interalveolar septal destruction with bronchial wall inflammation
146
Function of leptin
Leptin is made by adipocytes and **reduces appetite**
Reduces production of neuropeptide Y (appetitie stimulant) and increases POMC (inhibits food intake), both in the arcuate nucleus of hypothalamus
147
Histo of poxvirus molluscum contagiosum
intracytoplasmic eiosinophilic inclusion bodies
148
Sensory innervation of the parietal pleura
Phrenic nerve: diaphragmatic and mediastinal pleura - get pain in neck and shoulder bc C3-C5
Intercostal nerves: Costal and cervical
149
Pathophys of febrile seizure
hyperthermia-induced diffuse neuronal injury
150
Toxicities of common chemotherapy agents
151
What is patiromer
Drug to treat hyperkalemia - binds to colonic potassium in exchange for calcium
152
When is alk phos elevated
In disorders of the bile ducts (stasis)
Disorders with high bone turnover (paget)
153
Most common cause of aminoglycoside resistance
Antibiotic modifying enzymes - add alkyl groups, phosphates, etc to stop binding with ribosome subunit
154
Embryonic origin of pituitary
Anterior - surface ectoderm
Posterior - neuroectoderm from diencephalon
155
AA precursor of serotonin
Tryptophan
156
Histo for hep B
Ground glass appearance - homogenous, pale, opaquepink cytoplasm
Councilman bodies - eosinophilic glovules of shrunken hepatocytes
157
TX for diabetic neuropathy
Glycemic control and foot care
If painful: SNRI, TCA, gabapentinoid
158
What causes neonatal hydrocele
Patent processes vaginalis - fluid accumulates in the tunica vaginalis
Tunica albugenia is what directly covers testicle and corproa cavernosa
159
What is the accumulation effect
A certain time period or level of exposure is needed to see benefits or detriments of a risk reducer or increaser
160
Benefit of hypothermia therapy
Decreases the formation of ROS (temp dependent), lowers cerebral blood flow, lowers O2 and glucose consumption
161
Pathophys of Ehlers-Danlos
Deficiency in the cleavage of the C and N terminals of procollagen
162
What crescendo is best heard leaning forward
Aortic regurgitation
Hear a decrescendo, best heard at C
163
MOA of nitrates
Vasodilation, mostly venodilation in the periphery, so preload is reduced (LV end diastolic volume) and afterload because easier to pump
Mild coronary artery dilation, overall less cardiac oxygen demand
164
Describe mechanism of nichotinic cholinergic receptor
Ionotropic recpetor - uses ion channels that open
Binding of two acetylcholine molecules opens channel that allows for influx of calciuma nd sodium and efflux of potassium, generating end plate potential
165
Cause of lateral medullary syndrome
Damage to PICA - branches off of vertebral artery
166
Conditions associated with atopic dermatitis
Things mediated by IgE
Allergic rhinitis, asthma, food allergies
167
Changes in ghrelin, leptin, and insulin during fast
Ghrelin goes up and stimulates appetit
Weight loss leads to less fat so lower leptin, and increase in insulin sensitivity to lower insulin
168
Relationship between nitrates and PDE inhibitors
Nitrates is converted to NO which leads to an accumulation of cGMP in cells
phosphodiesterase usually degrades cGMP but PDE inhibitor will lead to further accumulation of the cGMP = profound hypotension
169
How to reverse effects of warfarin
Fresh frozen plasma
170
Morphological changes seen in superficial burns
Mast cells release histamine and other facts that cause blanching erythema
Deeper burns will damage the endothelium that causes extravasation of fluid between gaps in cells (blisters)
171
Mutation seen in CF
delta F508
CFTR Chlroide channel is messed up - chloride and sodium remain in sweat = hyponatremia
172
How does shiga toxin work
Inactivates 60s robosome subunit - cell cant produce proteins and dies
173
Most common organisms seen in aspiration pneumonia
Facultative and strict anaerobic oral organisms
Bacteroides, prevotella, peptostreptococcus, fusobacterium
174
Prolactin effect on GnRH
Inhibits - so low GnRH, LH, and testosterone
175
SX of pituitary apoplexy
176
Associations with each part of the duodenum (1-4)
2- ampulla of vater where secretions from pancreas + bile come in
3- superior mesenteric artery
177
GI bugs that can cause disease with very low numbers
Shigella, campylobacter, entamoeba, giardia
178
179
What cells make up the alveolar capillary membrane
Type I pneumocytes
180
Complications of obstructive sleep apnea
Pulmonary hypertension (pulm vasoconstriction during hypoxia)
Systemic hyeprtension, right heart failure, Afib, arrhythmias, sudden cardiac death
181
Growth factors elevated in idiopathic pulmonary fibrosis
TGF-B, PDGF, VEGF, FGF
Perfinidone is against TGF-B
Nintedanib is against FGF, VEGF, PDGF
182
Mood stabilizers for bipolar disorder
183
Location of the greater and lesser omentum
184
Causes of insulin-induced weight gain
185
effects of beta thalesemia major and minor on HBa1c and HA2
To. compensate for a loss of beta chains, the HA2 will rise, while hemoglbin A will fall, so HBA1c will fall
In minor - slight elevation of A2 and decrease in HBA
In major - no HBA and large increase in A2
186
How does a HBa1c work
Hemoglobin A1c us produced by nonreversible glycosylation of N-termus of hemoglobin - lasts as long as RBC lives
187
Effect of 2,3-BPG
Decreases the affinity of hemoglobin for O2 - leads to offloading into tissue
188
What is mullerian agenesis
Hypoplasia/aplasia of the mullerian structures - fallopian tubes, uterus, cervix, upper vagina
Will have normal secondary sex chaarcteristics and are 46, XX
189
What AAs can lead to a buildup of proprionyl coA
VOMIT
Valine, odd chain fatty acids, methionine, isoleucine, threonine
190
SX of kawasaki disease
Conjunctivitis glossitis, fissured lips, rash, erhythema and edema of distal extremities, cervical lymphadenopathy
Risk for coronary aortic aneurysm
191
Somatic vs germline mosaicism
In somatic mosaicism, the individual posses phenotypic evidence of the mutation
In germline, they do not, but can pass the mutation on to offspring
EX: Turner mosaicism 45X/46XX
192
When is hospice an option
When less than 6 months prognosis and aggressive treatment is no longer beneficial or desired
193
Part of brain that if damaged would cause disinhibition, personality change, irritability
orbitofrontal cortex
194
Targets of the four antifungal classes
195
What happens to methotrexate and DHF/folic acid inside the cell
Polyglutamation - keeps them inside the cell
196
Most common site for vestibular schwanoma
Cerebellopontine angle - would affect CN VIII, VII, V
197
Blood supply of the liver
Right and left hepatic arteries which are branches of the celiac trunk
198
Blood supply to the SA/AV and bundle of His
Right coronary artery
199
Impact on preload, afterload, and CO during pregnancy
There is an overall drop in SVR during pregnancy, which causes a drop in afterload, and increase in preload
There is an increase in blood volume which causes increased CO and preload
200
Those at risk for serious infection with vibrio vulnificus
Liver disease, iron overload
201
What are neurophysins
They are chaperone proteins that carry vasopressin and oxytocin from the hypothalamus to the posterior pituitary
202
What type of drug to use for urge incontinence
Antagonist for muscarinic cholinergic receptors - M3 in the detrusor muscle
203
MOA of thiazide diuretics
Block the NaCl transport in DCT so less reabsorption
Also cause less excretion of calcium = good for osteoporosis
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Autosomal dominant vs recessive polycystic kidney disease
Dominant presents later in life - cysts are very smalla t birth and then grow
recessive - presents as kidney masses at birth
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Manifestations of Leischmania
Cutaneous - enlarging pinkish papule, nodule or plaque that ulcerates
Histo - Grows within macrophages as intracellular, round-oval amastigoytes with rod-shaped kinetoplasts
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Bone cancer with small, round blue cells
Ewing sarcoma
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What kind of channel is CFTR
ATP-gated
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What activates platelets
thromboxane, ADP, decreased cAMP
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What kind of hernia would travel through a patent tunica vaginalis
Indirect - passes through the inguinal canal
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What is a stratum ovarii tumor
An ovarian germ line tumor that is comprised of 50% thyroid cells - produces thyroid hormone
Appears as an oily cystic mass
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The middle meingeal artery is a branch off of \_\_\_
Maxillary artery, which comes off of external carotid
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How is CO2 carried in the blood
Preodimately in the form of HCO3-
Carbonic anhydride in the RBC converts it, and then exchanges it for chloride -- the chloride shift
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What is retinitis pigmentosa
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Gram negative rod that is lactose positive and indole positive
E. Coli -- can convert tryptophan to indole
E. cloacae is indole negative
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Venous drainage of the fundus of the stomach
Splenic vein - with thrombosis can get varices just in the fundus
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Pathophys of a hypersensitive carotid baroreceptor
When slight pressure is applied, baroreceptor thinks there is a very high blood pressure - reduces sympathetics and increases pns to the heart
Rapid vasodilation with a sinus pause
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What are the codes of intron splice sites
GU at the 5'
AG at the 3'
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What is hypertrophic osteoarthropathy
219
Most common placenta for monozygotic and dizygotic twins
Dizygotic - Diamniotic/dichorionic
Monozygotic - diamniotic/monochorionic (division around day 4-8)
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Where do carcinomas usually spread first
Regional lymph nodes
Head and neck - jugular nodes
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Significance of viridans streptococci
Often found in dental carries, heart valve infections
Can adhere to tooth enamel and platelets on damaged heart valves because they produce insoluble extracellular polysaccharides (**dextrans**) from sucrose
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What do nitrates predominately work
Large veins - decrease preload and myocardial oxygen demand
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Most prominent surface marker for monocyte-macrophages
CD-14
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Most important process in formation of shiggelosis
Mucosal invasion - Invades M cells and uses actin polymerization as it kills cells
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What first activates trypsin
Enteropeptidase on brush border
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How to measure the osmolar gap
Elevated in toxic alcohol metabolism
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Signs and risks of placental abruption
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Location of pacemaker and what can it cause
Can cause tricuspid regurgitation
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Function and innervation of latissimus dorsi
Extension, adduction, internal rotation of the humerus
Innervation is thoracodorsal (C6-C8)
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Three steps of normalk swallow
1. Displacement of the larynx superiorly and anteriorly under base of tongue to direct food to posterior esophagus
2. Tilting of eppiglotis to cover airway
3. Adducting of vocal coards to cover glottis
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What is DRESS syndrome
Drug reaction with eosinophilia and systemic systems
Reaction 2-8 weeks after starting a drug (anticonvulsants, allopurinol, abx) that shows widespread eosinophilia - lymphadenopathy, facial edema, rash
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What tests are used to diagnose GAS
1. Rapid antigen test for Group A antigen
2. Culture and look for beta hemolysis if antigen test is negative
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How to avoid ACE inhibitor first does hypotension
Stop all diuretics and start at low doses
Occurs more if angiotension II and aldosterone are high (like in volume depletion from diuretic)
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What is Henoch Schonlein purpura
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What is seen in loop diuretic overruse
Hypokalemic, hypochloric metabolic alkalosis
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Fasciculus cuneatus vs fasciculius grascilus
Both in DCML
Gracile - medial, from below T6
Cuneate - lateral, above T6
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What drugs can lead to higher levels of statins
CYP3A4 inhibitors
Macrolide abx, ketoconazole, non-dihydro Ca blockers, amiodarone, protease inhibitors
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What is the late phase of a type 1 hypersensitivity
TH2 cells release IL-5 to activate eosinophils
Eos release major basic protein and other chemicals that cause tissue damage - indurated lesion 2-10 hours later
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What is an infantile hemangioma
Endothelial cells
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Methimazole vs propylthiouracil
Methimazole is preferred for hyperthyroidism in most patients over PTU because of hepatotoxicity
Methimazole is a teratogen so PTU is used in the first trimester of pregnancy, and then patient can be switched back to methimazole
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MOA of amiloride and triamterene
Potassium sparing diuretics that block the sodium uptake channel in collecting duct
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Function of homeobox (HOX) genes
Code for **transcription factors** that regulate gene expression of different segments of the embryo
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Types of cells increased in COPD
CD 8 T cells, macrophages, neutrophils
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What is deferoxamine
Iron chelation drug
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What is Gerstmann syndrome
Stroke to the angular gyrus of the **dominant parietal lobe**
## Footnote
Finger agnosia, acalcula, agrpahia, L-R disorientation
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Pressures on the right side of the heart
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Budesonide MOA
A glucocorticoid
Binds to a cytosolic receptor that then travels to the nucleus and causes a tissue specific change in transcription - includes inhibition of proinflammatory transcription factors like NF-kB
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What is seen in photoaging
**Loss of production of collagen fibrils**, caused by UVA
See more collagen cross-linking which causes wrinkles
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What drug affects prostate volume
Finasteride - takes 6-12 months
Alpha 1 antagonists affect relaxation
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What would cause air in the billiary tree
A large gall stone can herniate through a fistula into the intestine, intestinal gas then flows back into the billiary system
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Phases of wound healing
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Embryologic origins of the kidney
Metanephros - glomeruli, bpwmans space, proximal tubules, loop of henle, DCT
Ureteric bud - collecting tubules and ducts, major and minor calyxes, renal pelvis, ureters
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Effects of muscarinic receptors on cardiovascular system
In vessels , M3 leads to vasodilation because increased NO
In cardiac muscle, M2 leads to decrease in heart rate (chronotropy) and decreased contractility (inotropy)
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Obturator nerve function
Innervates thigh adductors and sensory over medial thigh
Exits through the obturator canal
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Common causes of candida vaginosus
Reduction in the lactobacillus population that allows fop overgrowth
Can also be immunosuppression, diabetes, high estrogen
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What causes exercise-associated collapse
A sudden drop in preload to the heart
During exercise, contracting muscles push blood back to the heart. But after stop, muscles relax and BV suddenly drops to the heart and there is not enough to meet cardiac demands -- syncope, hypotension, collapse
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First order vs zero order kinetics
First order - a constant proportion of drug is metabolized
Zero - a constant amount of drug is metabolized
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Pregnancy affect on blood
Increased plasma volume, increased RBC (more erythropoetin), dilution causes lower hemoglobin
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Nerve most likely compressed in an aneurysm of the internal carotid in the cavernous sinus
CN VI - abducens
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Histo of chronic
Obliterative vascular wall thickening with tubular atrophy (kidney) and interstitial fibrosis
Mixed cell response - cell mediated and antibody mediated
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What is the Reid index
Index of the size of submucosal glands
C/(B+C+D)
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What accounts for the rubber-like properties of elastin
Desmosine cross links and the high content of. nonpolar residues like lysine
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How does variation in gonococcal pilli occur
Antigenic variation through recombination
Not plasmid - that is abx resistance
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What happens to blood volumes in the heart during inspiration
Suring inspiration, intrathoracic pressures drop allowing more blood to flow into the right heart
Drop in pressure also allows for more blood in the pulmonary circuit so blood volume to left heart falls
Right heart murmurs increase with inspiration
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Function of the golgi tendon organ
Feedback mechanism that monitors and regulates muscle force - sensitive to change in. force but not stretch
Would cause sudden relaxation if something is too heavy
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Most common site of aortic rurptures
Type A - sinotubular junction
Type B - close to origin of left subclavian artery
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MOA of abciximab
GPIIb/llla inhibitor on platelets
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Location of focal seizures that have a sensory prodrome
Medial temporal lobe - hipocampus, amygdala, parahippocampal gyrus
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What are the common Na channel toxins
Pufferfish, red tide, moray eel
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MOA of alteplase
Binds fibrin on clot and converts plasminogen to plasmin = clot lysis
Adverse event is hemorrhage
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What is effect modification
When the effect of an exposure is modified by another variable
Different strata of the popualtion will have different measures of association
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Neutropenia makes you suscpetible to what kind of organism
Gram negative
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Medications associated with risk for osteoporosis
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Best antiemetic for GI irritation
5HT3 receptor antagonists
GI irritation leads to release of more serotonin which activates the vomiting center
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What is field cancerization
An area of cells are primed to form cancers because of widespread expsure to a carcinogen
Would be like all the cells in the mouth being primed due to chewing tobacco
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Right vs Left colon cancers
Right - large, tend to bleed (iron deficiency, occult blood)
Left - smaller, invade the wall and decrease lumen size so cause obstruction (bowel changes, nausea)
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Symptoms of Scleroderma (sysetmic sclerosis)
CREST
calcinosis, raynauds, esophageal dysmotility, sclerodactyly, telangectasia
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What infusion to use for volume resuscitation
Isotonic crystalloid - 0.9% saline or lactated ringers
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What does the musculocutaneous nerve innervate
Arm flexors (biceps) and lateral forearm sensory
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Nerve control of peristalsis
Vagus before splenic flexture, S2-S4 after splenic flexture
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Treatment for orotic aciduria if from PYRIMIDINE synthesis
Can supplement with uridine
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Classical vs operant conditioning
283
Respiratory muscle innervation
284
What foods are common for Hep A
Shellfish, berries - tainted food or water
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Nitrates dosing and reasing
Usually dont do an evening fose, or have a epriod of no admin
Bc vessels can become desensitized - develop tolerance
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How soon does the heart stop beating in hypoxia
Within 60 seconds
30 minutes of ischemia = irreversible damage
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What happens to blood flow in tension pneumothorax
The increasingly growing pleural space can collapse the vena cava and cause a decrease in venous return = hypotension
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Conditions that promote RBC sickling
Low oxygen content (oxygen unloading), low pH, low blood volume
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Drugs to give for malaria from chloroquine resistant areas
Atovaquone and proguanil
Give primaquin if P vivax or P ovale (liver)
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Areas most susceptible to atherosclerosis
Lower abdominal aorta and coronary arteries - areas with bends and branch points that encourage turbulent flow
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What is the arteriovenous concentration gradient for anesthetics
Difference between arteries and veins concentration - dictated by absorption into tissue.
If high, there is a large concetration in the tissues, so would take longer to have any effect on the brain
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What causes permenet central DI
Damage to the hypothalamus
Damage to posterior pituitary causes transient DI
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What is multiple myeloma
294
Why does bioavailability change with rectal drugs
Becuase less first pass metabolsim - only supply above dentate line goes to portal, below is to systemic
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Most common cause of nephritic syndrome
Immune complex deposition
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Who is most at risk for lactic acidosis on metformin
Low renal clearnace - should check creatinine before starting
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How is fetal lung development measured
Amniocentesis looking at phospholipids
The lecithin the sphingomyelin ratio is calculated - greater than 2 is mature
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Azathioprine metabolism to active form and inactive by what enzymes
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