STEP 1 Week 5 Flashcards
(219 cards)
1
Q
Innervation above and below the dentate line
A
Above: Inferior hypogastric plexus
Below: Inferior rectal nerve, branch of pudendal nerve
2
Q
Leuprolide effect on GnRH
A
It is a GnRH agonsit but also exhibits inhibition of endogenous GnRH release
So eventual drop in GnRH, LH, and FSH
3
Q
What kind of receptors on macrophages leads to inflammatory resposne
A
Activation of toll-like receptors by PAMPS
Leads to increased NF-kB
4
Q
What is the most hemodynamically neutral anesthetic
A
Etomadiate - no effect on heart rate, BP, CO
Can decrease cortisol so not used in shock
5
Q
Rifaximin MOA
A
It is a GI abx that reduces bacterial production of ammonia - good for hepatic encephalopathy
6
Q
Drug tx for bulimia
A
Fluoxetine - SSRI
7
Q
What CN is most impacted in uncal herniation
A
CN III - will have a blown pupil
8
Q
What is Hawthorne effect vs Pygmalian effect
A
Hawthorne - observation. bias, change in behavior when you know youre. being watched
Pygmalian - researchers act differently based on beliefs in efficacy of treatment that can impact outcome
9
Q
Where do squamous cell carcinomas spread first
A
Regional lymph nodes
10
Q
Complications associated with sjogrens
A
Non-hodgkins lymphoma (B cell mediated so can become neoplastic)
Corneal damage, dental carries
11
Q
Production of what 3 things required tetrahydrobiopterin (BH4)
A
Tyrosine, serotonin, DOPA
12
Q
What can be seen on micro weeks to months after axonal damage
A
Persistent myelin debris with eventual glial scar (triggered by astrocytes)
13
Q
What does ingestion of carbon tetrachloride cause (CCl4)
A
Produces free radicals (CCl3) that causes lipid peroxidation and hepatic injury
14
Q
What happens in the right heart during a pulmonary embolism
A
Increase in size of the RV cavity and flow obstruction
15
Q
What kind of reaction is serum sickness
A
Type III hypersensitivity - complexes and complement activation
16
Q
Metabolic changes in methymalaonic coa mutase deficiency
A
AGMA, hypoglycemia, ketosis, hyperammonemia
17
Q
Equation for a confidence interval of 95%
A
CI = mean +/- 1.96 x (SD/sqrt of n)
18
Q
How to differentiate alcohol-related pancreatitis
A
Usually will have macrocytosis because of vitmain deficiency
19
Q
Which hypertensive drugs can cause edema
A
Calcium channel blockers - preferentially dilate arteries which increases capillary pressure
20
Q
Component of Hib capsule that makes it so virulent
A
polyribosylribitol phosphate (PRP)
Binds factor H which allows for avoidance of complement opsonization
21
Q
What causes paraneoplastic cerebellar degeneration
A
Immune response against tumor cells that cross react with Purkinje neuron antigens - dizziness, disarhria, visual disturbance
Anti-yo, anti-hu, anti-p/q
22
Q
What cells mediate formation of lung abscesses
A
Neutrophils - released granules cause liquefactive necrosis
23
Q
How is insulin excreted
A
Both in the liver and kidney
In CKD diabetic patients, exogenous insulin can rise without excretion and cause hypoglycemia
24
Q
Why is epinephrine administered with lidocaine
A
Epinephrine leads to vasoconstrichtion which:
- Reduces bleeding
- Increases duration of action (more remains at site of action)
- Less chance of side effects bc lower systemic absorption
25
Affinity of myoglobin for oxygen
Much higher than oxygen
Beta subunits of hemoglobin are similar in structure to myoglobin
26
Cherry vs strawberry hemangioma
Cherry - adult, benign tumor of blood vessels, dont regress
Strawberry - baby, can be deep, usually regress
27
What is the breakdown of the fluid compartments
28
What is capitation
The payment plan of HMOs
Doctors are payed a flat fee per patient from a providing organization
29
Effects of removing CD3+ cells from bone marrow transplant graft
Helps reduce the chance of graft-verus host but also dont get the benefit of donor T cells attacking any leukemia or current infections
30
What does the pressure volume look like for exercise
Preload increases and contractiltiy increases
31
APC and KRAS activating/inactivsting mutations
APC - inactivating, it is a tumor suppresor gene
KRAS - activating, it is a protooncogene
32
What vessels are likely to be ruptured in a penetrating ulcer to the lesser curvature of the stomach
Left and right gastric
33
Examples of bisphosphonates and MOA
alendronate and risedronate
Attach to hydroxyappetite on the bone and when they are taken up by osteoclasts they induce apoptosis
34
How does hypocalcemia cause constipation
Causes impaired smooth muscle contraction and gastric motility by inhibiting nerve polarization - interferes with movement of sodium
35
What occurs during the proliferation phase of wound healing
Occurs 5 days-3 weeks
Fibroblasts migrate and proliferate, excrete ground substance and Type III collagen
Also secrete FGF and VEGF which leads to new vessek formation
36
TX for restless leg syndrome
Iron replacement and dopamine agonists - pramipexole and ropinirole
37
Where to perform a femoral nerve block
Right below the inguinal ligament, lateral to the femoral artery
38
Sx of allergic bronchopulmonary aspergillosis
High IgE and eosinophils
Asthma of CF, mucus plugs that can cause bronchiectasis
39
What diuretic can cause ototoxicity
Loop diuretics
There is a Na/K/2Cl symporter in the ear
40
**Best** drugs to stop alcohol cravings and MOA
Naltrexone - blocks mu opioid receptors and pleasure reward centers
Acamprosate - modulates glutamate in the NMDA receptors
41
Drugs with the most benefit for heart failure
Beta blockers and hormone regulators (ACEi, ARBs, Aldosterone bockers)
42
Impact of PEEP on FRC
Increases
43
What is the only DNA molecule with 5' to 3' exonuclease capability
DNA polymerase I
All of them can do proofreaading and exonuclease 3' to 5'
44
What two conditions can give you a small anion gap
Multiple myeloma and hypoalbuminemia
45
Effect on diffusing capacity of carbon dioxide in emphysema and AAT deficiency
Decreases
Due to destruction of alveoli and cappilary beds
46
What blocks beta oxidation of fatty acids
Malonyl-coA
Inhibits carnitine acyltransferase so that newly synthesized FA arent immediately broken down
47
What kind of proteins are made in the RER
RER is especially developed in organs with lots of excretion
The RER makes proteins for extracellular excretion or for insertion into the membrane, along with proteins for the RER, GB, lysosome system
48
Where does calcium bind on thin filaments
On troponin
Then causes a conformation change to shift tropomyosin
49
What would be punctured at the left midclavicular line 5th intercostal
Left lung
Apex of the heart is at this point but deep to the lung
All other heart chambers lie medial to the MCL
50
What makes up the wall of a false diverticulum
Mucosa and submucosa
51
Dupuyetron contracture
Fibroblasitic proliferation and thickening of palmar fascia
52
What causes pus and sputum to be green
Myeloperoxidase - it i a blue-green heme based pigment
It helps neutrophils to form hydrochoorous acid for oxidative burst killing
53
What causes most infections in neutropenic patients (like due to chemo)
Patient's own endogenous bacterial flora
Chemo damages the barrier in the gut that usually keeps bacteria in the gut, so they can travel to the blood
54
What would work well against a g(-) rod with B lactamase activity
Extended spectrum penicillin (like piperacillin) with a tazobactam/clavulanic acid
55
Drugs to avoid in elderly
56
What vessels should be ligated during uteral bleeding after birth
Internal iliac - where the uterine arteries. branch from
57
What causes ptosis
CN III paulsy - controls the levator palpebrae
58
What microscopically indicates axonal damage due to shearing of the white matter tracts
Widespread axonal swelling, accumulation of axonal transported proteins - **amyloid precursor and alpha synucelin**
59
What causes thrombocytopenia in HIT
When heparin-platelet-IgG complexes (from reaction with PF4) circulate they are removed by the liver causing a decrease in platelet number
They can also form clots that then cause even more platelets to be used
60
How can squatting reduce the murmur of mitral regurg
Squatting increases venour return, which increases the stretch on the LV, which helps to pull the valve more taught
61
Why is clear cell renal carcinoma clear
The cells have a high concentration of glycogen and lipid - removed on staining
62
What electrolyte imbalance does pancreatitis cause
Hypocalcemia and hypomagnesemia - necrotic fat oulls them out of the serum
63
What would be the first step in diagnosing malabsorption (what test specifically)
Looking for fat in the stool - sudan III stain
64
How can hypothyroidism cause prolactin release
Lactotrophs have TRH receptors so an increase in TRH can lead to an increase in prolactin
65
Path of CN V2
Passes through the foramen rotundum thenthe pterygopalantine fossa then exits the skull through the infraorbital foramen
66
Damage to what part of the brain causes locked in syndrome
Bilateral ventral pons
67
What causes ganglion cysts
Mucoid degeneration of periarticular tissue leading to outpouching of tissue that serves as one way valve for mucinous fluid
68
How does prone position help in ARDS
Normally, the posterior parts of the lung are weighed down by the heart and abdominal organs pushing against the diaphragm
Prone position takes this pressure away allow for a more even ventialtion-perfusion match as collpased posterior basal alveoli open up
69
Eye side effects of PDE5 inhibitors
They can impact the PDE6 in the retina which can cause blue vision and **nonarteritic anterior ischemic optic neuropathy** - monocular vision loss with populary defect and optic disc edema
70
What antitussive can cause serotonin syndrome
Dextromethorphan
71
MOA of dextromethorphan
Inhibition of medullary cough center through sigma receptor activation
72
Inhivition of what enzyme can help reduce risk of colon cancer
COX-2 - NSAIDS
COX may play a role in prostogulandin production which aids in epithelial proliferation
73
What causes basophilic stippling
Lead poisoning
74
Cortisol and ADH relationship
Cortisol usually inhibits ADH
75
How does a carotid massage slow heart rate
Increases parasympathetic tone - prolonged AV/SA node refractory period
76
Flow of aqueous humor through the eye
Produced by the epithelial cells of the ciliary body and then flow through the pupil into the anterior eye chamber
Drained by the trabelcular network into the canal of schlemm and into conjunctival veins
77
MOA of timolol
Nonselective B blocker that lowers production of aqueous humor by the ciliary body
78
What finger movements does the median nerve control
Thumb abduction, thumb opposition, thumb flexion
Thumb adduction is ulnar
79
What are the contents of the portal triad
Hepatic artery, portal vein, common bile duct
If bleeding continue from liver after clamping, likely hepatic vein or IVC
80
What layers do you go through in a cricothyrotomy
1. Skin
2. Superficial cervical fascia (fat, part of platysma)
3. Deep cervical fascia
4. Crycothyroid membrane
81
Sx of chediak higashi
- Immunodeficiency from neutrophil phagosome-lysosome fusion dysfunction. Granules cant be released so see them in neutrophils
- Albinism
- Eye problems
82
How does ACTH/cortisol impact production of catecholamines
Cortisol activates phenyethaolamine-N-methyltransferase (PNMT) which converts norepinephrine into epinephrine
Pituitary damage/low cortisol would reduce activity of PNMT and reduce epinephrine
83
What drives LV remodeling after an MI
Angiotensin II
Acei can help stop remodeling and maintain a normal LV shape
84
What would mycobacterium avium complex look like on histo
Would look at bone marrow - Foamy macrophages, acid fast bacilli, possibly granulomas
85
What causes the vasovagal response (like after a vaccine)
Cardioinhibition and vasodepressor response that causes bradychardia and hypotension
86
Where is the damage in wernicke korsakov
Anterior and dorsomedial thalamic nuclei, mammilary bodies
87
Sequelae of etherothrombotic disease
Would see cholsterol clefts
88
Most common childhood brain tumor and location
Pilocytic astrocytoma - cerebellum
89
What coenzymes are necessary for alphaketoglutarate/pyruvate/branched chain dehydrogenase
B1,B2,B3, B5, lipoate
90
Location of lesion for decerebrate vs decordiate posturing
Decorticate (flexor) - above red nucleus (hemisphere, internal capsule)
Decerebrate (extensor) - below red nucleus (pons)
91
How does the Huntington mutation cause disease
Gain of function mutation that causes acetylation of histones that turn off genes necessary for cell survival
92
What is the only molecule with a gradient that draws it out of the cell
POtassium
93
Function of ristocetin
Activates Gp 1b to induce vWF to bind to the endothelial surface and cause aggregation of platelets
94
Where is inflammation localized in guillan barre
In the endoneurium - macrophages digest myelin
95
Damage to what part of the brain could cause hemiballism (uncontrolled movement)
Subthalamic nuclei
96
What would levels of CO2 and O2 be in PE/poor V/Q match
There would be low CO2 from hyperventilation but O2 wouldnt be high because hemoglobin in the perfused area can only absorb so much O2- cant comoensate for unperfused part
So low CO2 and low O2
97
How are lysosomal storage deficiencies treated
You can replace the deficient enzyme
Have to use IV because the enzymes are large polyproteins - enter the cell by endocytosis
98
Morphine and renal failure
Morphine is metabolized into two active metabolites that are renally excreted
In renal failure, these metabolites can cause OD
99
Odds ratio formula
OR = (a/c)/(B/d)
100
MAB that targets CD20+ cells
Rituximab
101
What could cause a pure red cell anemia
Autoimmune destruction of red cell rpecursors - thymoma or parvovirus
102
Best diagnostic tool for toxic megacolon (bloody diarrhea, abdominal pain, shock, fever)
Plain abdominal X-ray
103
What to give post MI in the case of bradycardia
Atropine - anticholinergic effects
104
Where to biopsy for celiac
Duodenum and PROXIMAL jejunum
105
What is persistent depressive disorder (dysthymia)
depressed mood for 2 years with \>2 sx
106
What happens to the vena cava in cardiac tamponade
Becomes engorged because of restricted diastolic filling
107
Complement vs phagocyte?
D - complement
E - phagocyte
108
What cells are targeted by azithioprine
It is not specific - B and T cells, so drop in IL-2 and Ig
109
How to diferenciate bw demyelinating and axonal nerve damage
Demyelinating - delayed conduction
Axonal damage - lower amplitude of impulse
110
What is abiraterone
It is a 17-alpha-hydroxylase inhibitor used for refractory prostate cancer - stops the production of androgens in the adrenals
111
What are angiosarcoma and expsure risks
A vascular tumor that is highly aggresses - expresses CD31 (PECAM 1)
Risks: PVC, arsenic, thorotrast (contrast medium)
112
What are causes of dilated cardiomyopathy
Infection (chagas, viral), chemical (alcohol), familial (mutation in titin gene)
113
Most common lung cancer cause of SIADH
Small cell lung cancer
114
What is rasburicase
It is an analog of an enzyme called urate oxidase that turns uric acid into allantoin, a more soluble metabolits
Good for tumor lysis syndrome
115
IMpact of an arteriovenous fistula on SVR, SV, etc
Decreased SVR - less pressure
Increased venous return - higher preload
Higher SV
116
Where is preload on a AV curve
It is the volume during isovolumic contraction
117
What causes bleeding in diverticulosis
Disruption to the vasa recta - diverticuli often occur where the vasa recta penetrate the smooth msucle and then the vessels can become damaged
118
What kind of virus has infectious RNA - the RNA itself can cause infection
+SS RNA - must be able to use the host machinery without any other proteins being produced
EX: rhinovirus
119
What would be present within an unstable plaque
Many macrophages that release metaloproteases that degrade the collagen of the cap and lead to possible rupture
120
What is pralidoxime
Reactivates cholinesterase - would be used after atropine in an organophosphate poisoning to reverse neuromuscular sx (atropine doesnt work in muscle)
121
Innervation of pelvic floor muscle and external anal/urethral sphincters
Pudendal nerve
Can lose anal wink reflex bcause skin from S2-S4 is no longer innervates
122
What causes a change in skin color in chronic venous insufficiency
Statis dermatitis - deposits of hemosiderin after RBC. have gone into the extracellular space
123
How to tell if a frameshift mutation has occured
The number of bases that has changed will not be divisible by 3
124
What is Kallman syndrome
Presents as **delayed puberty** due to a failure of GnRH secreting neurons to migrate to the hypiothalamus from the olfactory placode - also presents as **anosmia**
125
When is prinzmetal angina worse
At night - when vagal tone is highest
126
How to treat ingestion of rat poison
Rat poison contains "super warfarin" so would give FFP
127
What is it called when there is only one safe medical option
Directive counseling
128
What is stained by PAS
Polysaccharides (fungal), mucosubstances, glycoprotein (whipples)
129
What happens to pulm artery systolic pressure in left MI
Increases due to increased PCWP and LA pressure
130
What causes achalasia
Reduced number of inhibitory neurons in the esophagus so there is an imbalance favoring contraction - decreased peristalsis in upper esophagus and increased contraction in lower
131
Blood supply of papillary muscles
Anterolateral pappilary - LAD and left circumflex
Posteromedial - Posterior descending (just one supply so more easily ruptured)
132
What allows influenza A to enter a cell
The surface glycoprotein - hemagglutinin
133
What is the diagnostic tests for TTP
Peripheral blood smear that shows thrombocytopenia and hemolysis
Some have fever, neurologic sx, kidney disease
134
What causes weak bones in osteogenesis imperfecta
Deficient type 1 collagen leads to less osteoid production by osteoblasts
135
What causes spinal stenosis and sx
Usually caused by degenerative arthritis where the intervertebral disk starts to bulge into the spnal canal, leads to a change in pressure and thickening of ligamentum flavum
Neurogenic claudication - parasthesias, pain walking, weakness, worse with extension
136
First line TX for OCD
SSRIs
137
How do glucorticoids lead to weaker bones
1. Inhibit osteoblasts
2. Block osteoprotegrin and increase expression of RANK/RANK-L
3. Block intestinal absorption of Ca
138
How can large stable plaques allow for no symptoms
They are slow growing and the gradual shift to ischemia allows for time for collateral vessels to form
139
What causes petechial rash and CNS sx in fat embolism
Small arteriovenous shunts allow for fat to flow into the CNS and skin
140
Salivary changes in elderly
Acinar atrophy with fatty infiltration - reduced saliva production
141
What eye problem can occur in neonatal CMV
Chorioretinitis
142
What causes a zenker diverticulum
Cricopharyngeal motor. dysfunction - abnormal spasm or diminished relaxation that leads to increased pressure and creation of a false diverticulum
143
Clonidine MOA
Alpha 2 agonist in the rostral ventrolateral medulla that leads to decreased presynaptic release of norepinephrine - slower HR and vasodilation
144
Histo of medullary thyroid carcinoma
Polygonal cells in an amyloid stroma - stains with congo red
145
Glioblastoma multiforme histo
Increased vascularity with pseudopalisading tumor cells around areas of necrosis
146
Signs of a pure motor stroke
Clasp-knife rigidity, hyperreflexia, positive babinski
Would be in the internal capsule
147
MOA of sirolimus
Binds to FKBP which inhibits the mTOR cellular pathway to stop the transcription cascade started by IL-2
148
What causes billirubin stones
Occurs when a large amount of unconjugated billirubin is released into the billiary system
Usually secondary to an infection - damaged hepatocytes release **beta glucaronidase** that hydrolizes billirubin and leads to an accumulation of unconjugated billirubin
149
What neurotransmitters are used in each type of SNS and PNS tracts
Notable : SNS uses Ach in adrenals and eccrine sweat glands
150
Where are T cells and B cells located in the lymph node
T - paracrotex
B - germinal centers and medullary cords
151
What is given in a heparin OD
Protamine sulfate - binds to heparin and forms a complex with no anticoagulant effect
152
What defines a mild cognitive impairment
Abnormal cognitive assesment (\<26/30) but still functioning independently
153
Effects. of androgen deprivation in men
154
Aneurysmal compression of CN III vs diabetic opthalmoplegia
In compression, there is primarily mydriasis - SNS fibers are on periphery, and then can become down and out
In diabetic ischemia, the core of the nerve is impacted first, where the motor fibers are. This causes down and out first with preservation of pupillary reflexes
155
What can cause hypocalcemia after a transfussion
There is citrate in the blood to stop coagulation but it can bind to calcium and chelate causing hypocalcemia
156
What occurs in germinal centers
B cells undergo isotype switching or remain as memory cells, also undergo affinity maturation (hypermutation for best Ig fit)
157
What levels would be low in SLE
Low C3 and C4 because circulating immune complexes would cause complement activation
158
What disease has anti-mitochondrial antibodies
PBC
159
What is. the acid-base disturbane in pregnancy
There is chronic hyperventilation - progesterone triggers a feeling of being short of breathe and there is horme related laxity of. the chest wall leading to a higher TV
This leads to a **respiratory alkalosis** with a renal compensation of increased bicarb excretion
160
Neck finding in Turner syndrome
Cystic hygroma - posterior neck mass composed of cystic. spaces and connective tissue
Due to lympphedema
161
Is eisenmenger syndrome reversible?
No - pulmonary artery remodelling to become thicker is irreversible
162
What muscles are innervated by the accessory nerve CN XI
Trapezius and sternocleidomastoid
Can be damaged in lymph node surgery
163
What would be seen in brain injury caused by seizures
Reactive gliosis - proliferation of astrocytes
164
What hemolytic disease is diagnosed by testing for increased osmotic fragility
Hereditary spherocytosis - mutation in ankyrin and spectrin leads to increased fragiloity (hemoglobin will leak out in a hypoosmptic solution)
165
What are the sx of an anterior humerus dislocation
Flattening of the deltoid muscle, protrusion of the acromium, anterior axillary fullness
Decreased sensation of the upper arm - axillary nerve is compressed
166
What would hashimotos look like on histo
Lymphoplasmacytic inflitrate with formation of germinal centers
Hurthle cells - granular and eiosinophilic cytoplasm
167
What type of amyloid is deposited in dialysis patients
B2 - microglobulin - Component of MHC I that is usually filtered out of kidney
168
Characteristics of Hyper IgE syndrome
Deficiency in Th17 cells due to STAT3 mutation - impaired neutrophil migration
ABCDEF
Abscesses, Baby teeth, Coarse facies, Derm problems (eczema), IgE, Fractures from minor trauma
169
What is the goal of randomization
To make the underlying characteristics between groups the same - not necessarily to be the same size
170
What causes hypocalciuric hypercalcemia
Calcium sensing receptors (CaSRs) in the parasthyroid (G-protein membrane) are not evry sensitive and require a higher level of calcium to release PTH
171
Bones of the Hand
Some Lovers try positions that they cant hzndle
172
How does resistance to isoniazid occur
Decreased expression of mycobacterial catalase peroxidase - needed to activate INH
173
Which speech area causes word salad
Wernicke's area - Wernicke word salad
174
What kind of necrosis happens in the brain and what does it look like
Liquefactive - Hydrolytic enzyme induced tissue digestion. CSF filled spaces after digestion
175
Signs and tx of arsenic poisoning
Basically affects all organs - long qt, vomiting, **garlic breath**
TX: **Dimercaprol** (chelates and pee out in urine)
176
MOA of Beta blockers for graves
Blocks the upregulated beta receptors and also stops conversion of T4 to T3
177
What is transferance
Unconscious shifting of desires or emotions from a person in the past to a person in the present
178
What is the HIV window period
When there is high levels of viral RNA but there has not been an immune response yet - no Ig
179
What anticonvulsant to give IV in status epilepticus and MOA
Phenytoin - Na channel blocker
180
What can be given for variceal hemorrhage
Somatostain/ocreotide or vasopression - contrict portal vessels by stopping release of hormones that usually cause dilation
181
What causes mitral dysfunction in marfans
WIthout fibrillin-1, TGF-beta can work unopposed and causes increased metalloproteases that reduce tissue integrity - fragmentation of elastin and collagen leading to **myxomatous mitral degeneration**
182
What causes anemia in chronic kidney disease
Decrease in EPO
183
What would cause portal hyopertension sx (big spleen, varices) with no liver involvement
Portal vein thrombosis
184
How is PKU inherited
Autosomal recessive
185
What are the molecules needed for osteoclast differentiation
M-CSF and RANK-L
186
What cofactor is needed for the conversion of phenylalanine to tyrosine
Dihydrobiopterin reductase (recycles BH4)
187
What is the psoas sign
Pain/resistance of leg extension - causes stretching of the muscle
188
What can lead to death in rheumatic fever
Severe regurgitation or myocarditis/pancarditis
189
Cytokines that cause systemic inflammation in sepsis
**TNF-a**, IL-1, IL-6
190
What causes minieres disease and sx
Vertigo, nausea, sensorineural hearing loss
Caused by increased pressure of endolymph in the inner ear
191
What happens if VEGF is unchecked in wound healing
Hypergranulation with lots of vasculation
192
What is the most serious side effect of thyroid blocking drugs
Agranulocytosis - can present as a severe infection
193
What muscle is pierced by the superficial inguinal ring
External oblique
Cremaster muscle originates from internal oblique
194
Most common illnesses seen in Hib
Systemic - meningitis, bacteremia, pneumonia, epiglotitis
195
Why does GFR increase early in diabetes
Higher glucose in urine leads to more reabsorption of Na in the PT (SGLT) which leads to less in the DCT - activates JG cells and RAAS system
196
What causes myopia
Nearsightedness
increased posterior-anterior diameter of the eye - image is focused anterior to the retina
197
What causes hypercalcemia in sarcoidosis
Activated macrophages in the lung that produce 1-alpha hydroxylase which makes more activated vitamin D - hugher intestinal absorption, some bone turnover
198
Initial tests for diabetes
Fasting plasma glucose \> 126
HBA1C \> 6.5%
Random nonfasting glucose \> 200
Urinalysis may show glucose but it is not specific
199
Where are serotonergic neruons primarily found
Raphe nucleus of the brainstem - cell bodies throughout CNS
200
What bleeding disorder is seen in renal dysfunction
Uremic platelet dysfunction
Uremic toxins that arent filtered out of the kidney circulate and cause platelet dysfunction - prolonged bleeding time but normal PT, PTT, platelet count
201
MOA of entanercept
It is a biologic made uo of an Fc portion and a fake TNF-a receptor
Serves as a soluble receptor decoy protein as TNF-a binds to it instead of its real receptor
202
meaning of -mab, -cept, -nib
- mab = monoclonal antibody
- cept = receptor molecule
- nib = kinase inhibitor
203
How do mabs lead to tumor destruction
Antibody dependent cellular cytotoxicity
The mabs/IgG bind to the host or foreign cell. NK cells bind to the Fc portion (with CD16) and then release granzymes that kill the cell
204
What measure of comparison is used for case-controls
Odds ratio
205
Innervation of the auditory canal
Posterior - vagus
Rest - CN V3
206
Acid disturbance seen in chronic kidney disease
Metabolic acidosis (accumulation of uric acid) with respiratory compensation
207
What is associated with itching, fatigue, and ulcerative cholitis?
Primary Sclerosing Cholangitis
208
Cardinal sign of irreversible cellular injury
Membrane damage - plasma membrane, mitochondria (vacuoles and leaking of cyt c), lysosomes
209
Associations with ADPKD
Berry aneurysms, liver cysts, mitral valve prolapse
Hypertension, hematuria
210
Where is the bladder most likely to be damaged
Dome - less supported and extends into peritoneal cavaity - would get urine in peritoneum
211
Hormone changes after ball removal
testosterone levels out but still low sperm count because cant compensate
212
What is late stage radiation dermatitis
Fibrosis and homogenization of collagen (TGF-B), vascular damage, dilated microvasculature (telangectasia)
213
How can beta blockers impact hypoglycemia
Beta blockers can remove the signals of hypoglycemia so individuals dont realize - blocks NE/Epi which are the drivers of tachicardia and anxiety in low glucose
Epinephrine also stimulates peripheral glycogenolysis and hepatic gluconeogeneiss so none with B blockers
214
What is celecoxib
A selective COX-2 inhibitor that is good for inflammation without impacting GI
215
What breast cancer marker is indicative of aggressive cancer
HER2
216
Other than histamine what is released from mast cells in anaphylaxis
Tryptans
217
How does binding of IgE lead to degranulation
Binding of IgE to a multivalent antigen leads to a shifting of IgE receptors so that they come into closer proximity and all bind the antigen
Triggers a non-receptor tyrosine kinase that triggers degranulation
218
Pre-eclampsia is caused by ...
Abnormal cytotrophoblast invasion that leads to low perfusion and low proangiogenic chemicals so dont get vessel remodeling by VEGF - high resistance vessels
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