Step 3 Flashcards
(147 cards)
1
Q
Azithromycin MOA
A
Macrolide not aminoglycoside
binds 50s subunit of the ribosome
2
Q
Txmnt of pseudomonas
A
Double coverage w/ 2 of 3
Anti-pseudomonal beta lactam (pipi/tazo, cefepime, ceftazadime, aztreonam)
Resp FQ (levofloxacin)
Aminoglycoside (gentamycin or tobramycin)
3
Q
Cardiac fxn curve increases along the same line and venous return fxn curve shifts right, cause?
A
The CO has increased due to increased venous return, but the cardiac fxn has not changed. The increased cardiac output is due to Frank-Starling not increased contractility
4
Q
Cardiac fxn curve shifts up to a new line and venous return curve shifts right, cause?
A
Exercise/sympathetic stimulation
Increased contractility-> cardiac fxn shift
Venoconstriction-> increased preload, right shift
5
Q
Cardiac fxn curve moves up or down along the same line, what does it mean?
A
Up along the same line = arteriolar dilation (decrease preload-Increase CO)
Down along same line= arteriolar constriction (increase preload-decrease CO)
6
Q
Cardiac fxn curve moves up to a new line
A
Increased cardiac contractility
7
Q
Venous fxn curve moves left or right along the same line
A
Left - decreased vascular volume, venodilation. CO goes down
Right- volume up, venoconstriction. CO goes up
8
Q
9 yo w/ sensorineural hearing loss, bowing of anterior tibias, frontal bossing, and flattened nose
A
Congenital syphilis
Deafness
Saber shins
Saddle nose
9
Q
Hutchinson’s triad
A
Congenital syphilis
Deafness
Interstitial keratitis
Notched incisors
10
Q
Which cells release secretin?
A
D cells
11
Q
What hormone is increased secondary to Zollinger Ellison syndrome?
A
Gastrinoma increases gastrin acidifying the lumen. Secretin from the D cells is increased to increase the pH
12
Q
Signs of VIPoma
A
watery diarrhea and hypokalemia
13
Q
What do G cells secrete?
A
Gastrin
Found in antrum of stomach and duodenum
14
Q
What do D cells secrete?
A
Somatostatin
Found in pancreatic islets and GI mucosa
15
Q
What do I cells secrete?
A
CCK found in duodenum and jejunum
16
Q
What do S cells secrete?
A
Secretin (duodenum)
17
Q
What do K cells secrete?
A
Glucose-dependent insulinotropic peptide-gastric inhibitory peptide (GIP) (duodenum and jejunum)
18
Q
Increased End diastolic volume, same end diastolic pressure, decreased diastolic pressure, increased systolic pressure, same end systolic pressure, and same contractility
A
Increased preload w/o increased LA pressure
Increased pulse pressure
Same contractility
Aortic regurg w/ dilated LV
19
Q
What happens to the conjugated bilirubin in cholestasis?
A
Conjugated bilirubin has increased urinary excretion (tea pee)
Decreased secretion of conjugated bilirubin in the gut, so it is not metabolized by bx into urobilinogen - decreased urinary urobilinogen
20
Q
What acid base disturbance do diuretics (furosemide) and antacid abuse have?
A
Metabolic alkalosis
21
Q
What kind of pt has hypoxemia that can not be corrected by 100% O2?
A
Right-left shunt
No matter how oxygenated the blood gets, some of the deoxygenated blood is continually sent into the systemic circulation
22
Q
Ziehl-Nielsen stain
A
Acid fast carbol fuchsin stain
Nocardia, TB, cryptosporidium
23
Q
Scaly red plaque w/ ulceration and/or bleeding on the face, neck, or hands
A
Squamous cell CA
Precursor-actinic keratosis (sun damage)
24
Q
Molluscum contagiosum Description and virus
A
Flesh colored papule w/ central depression
Pox virus
25
Verruca vulgaris, description and virus
Common wart-HPV
26
Dysplastic nevi may be a precursor to what CA
Melanoma
27
If the femoral n was injured, what would be affected?
Quadricep weakness
| paresthesis/anesthesia of anterior medial thigh, medial shin, and arch of the foot
28
Difference btwn PCP and cocaine on PE?
PCP - miosis constricted pupils
| Cocaine - Mydriasis dilated pupils
29
Amaurosis fugax
Transient monocular blindness - Carotid stenosis
30
Evans Syndrome
Thrombocytopenia and autoimmune hemolytic anemia
31
Lateral aspect of thigh, dorsal foot, decreased sensation in the 1st and 2nd toe web space
L5
32
Patellar reflex is what nerves?
L3, L4
33
Egg yolk agar for what organism
Clostridium perfringens
34
Chocolate agar for what organisms
N. menigitidis
| w/ factors X (heme) and V (NAD) - H. influenzae
35
Cystine-tellurite agar for what organism
Corynebacterium diphtheriae
36
What chromosome has a mutation in Alpot dz?
X chromosome -Males get Alport
| Females w/ one copy just get hematuria
37
Renal dz w/ mutation on chromosome 6
AR PCKD
| Kids
38
Renal dz w/ mutation on chromosome 16
ADPKD adults
39
AKI w/ fever, eosinophilia, and urticarial rash. What is the likely cause, what is injured, and what type of hypersensitivity?
Drug induced acute interstitial necrosis - abx, NSAIDS, thiazides, PPI
Type IV sensitivity even though there are eosinophils
40
Is ristocetin cofactor assay normal or abnl in Von Willebrand dz?
Abnl, using ristocetin (activates Gp1b) doesn't cause Plt agglutination, b/c the VWF is too low
41
Hydroxyurea MOA
Increases Fetal Hgb, which inhibits the polymerization of HgbS
42
What should be measured regularly in a pt taking hydroxyurea?
CBC for myelosuppression and LFT for hepatotoxicity
43
Compliance, radial traction, FEV1, and DlCO in obstructive dzs
Compliance is increased -damaged alveoli (floppy)
Radial traction is decreased due to alveoli damage, radial traction pulls airways open, FEV1 is decreased -less ability to push air out
DlCO - Low due to alveolar wall damage
44
Where in the lung is centriacinar emphysema?
Smoking emphysema upper lobes
45
Where in the lung is panacinar emphysema?
Alpha 1 antitrypsin deficiency
| Lower lobes
46
What cause rouleaux formation?
Excessive IgG causes RBCs to stick together
47
What effect does a PPI have on the blood?
Higher Cl in the blood
Inhibits H/K ATPase so less bicarb and H is generated, less bicarb means less Cl entering the cell via bicarb/Cl antiporter, more in venous blood
48
Stage 2 pubic hair vs Stage 3
2-scanty long hair at base of penis
| 3- small amount of dark, curly, coarse hair
49
Testes size
| Stage 1-5
```
1 -1.5 cc
2 -4 cc
3 -10 cc
4 -16 cc
5 -20 cc
```
50
```
Allotype
Idiotype
Isotype
Subisotype
of Ig
```
Allotype-part of constant region dictated by inheritance
Idiotype -antigen recognizing sections
Isotype- IgG or IgA
Subisotype - IgG4
51
Which factor is most important in mediating septic shock?
TNF-alpha
Activated by LPS
Leads to vasodilation and activation of cytokines
52
What NSAID should be avoided in person w/ sulfa drug injury?
Celecoxib
| Sulfonamide side chain
53
Sulfa drugs w/o sulfa in the name:
```
Celecoxib
Diuretics
Anticonvulsants: topiramate, zonisamide
Bosentan
Arrhythmic drugs - Dofetilide, sotalol, dronedarone
Sumatriptan
Tamsulosin
```
54
Tramadol MOA
Very weak opioid
Block reuptake of NE and 5HT
Risk of 5HT syndrome
55
Hyperammonemia w/ decreased citrulline, low BUN
Ornithine transcarbamylase deficiency
| Ornithine and carbamoyl phosphate to citrulline
56
Protein losing gastroenteropathy in elderly w/ enlarged rugal folds
Menetrier dz
Hyperplasia of mucus secreting foveolar cells
Parietal cell atrophy->decreased acid
57
Keratizing or non-keratizing squamous cell carcinoma in the nasopharynx of an Asian man
Nasopharyngeal carcinoma associated w/ EBV
58
Pill OD: impaired cognition, slurred speech, ataxia, nystagmus, and muscle weakness
BZD toxicity
| Tx w/ flumazenil
59
Pill OD: Diarrhea, increased urination, miosis, bronchospasm, bradycardia, Lacrimation, sweating, salivation
Atropine OD
| Tx w/ physostigmine - Phyxes atropine OD
60
Pill OD: nausea, vomiting, and abd pn
Acetylcystine (tylenol)
| Tx w/ N-acetylcysteine
61
Pill OD: hyperventilation, tinnitus
Asprin OD Tx w/ bicarb to alkalinze the urine and remove acid
62
3 Cs of TCA OD
Convulsions, Coma, Cardiotoxicity
63
Cinacalcet MOA
Calcimimetic that increase the sensitivity of the PTH CaSR to Ca
64
What med should be used for pts w/ ESRD who have secondary hyperPTH?
Cinacalcet increases PTH's sensitivity to Ca -> decreased PTH
65
Is the most important pathogenic attribute of Pseudomonas the capsule or pigment formation?
Capsule protects from phagocytosis
66
What do pyocyanin and pyochelin do for Pseudomonas?
Pyocyanin - impairs cilia, injures respiratory epithelium, and increases inflammation
Pyochelin - Siderophore that sequesters Fe to enhance growth in low Fe states
67
Hour glass shaped stomach
Sliding hiatal hernia
68
Near complete absence of smooth muscle peristalsis and LES tone
Systemic scleroderma
69
Difficulty swallowing (motility unaffected), anemia, and atrophic glossitis
Plummer -Vinson
| Esophageal webs
70
Inherited Hemolytic anemia affecting both men and women
Pyruvate kinase deficiency
Autosomal recessive
RBC can't produce enough pyruvate to undergo oxidative phosphorylation. Low ATP -> hemolysis
71
Acute intermittent Porphyria: 5 Ps
```
Peripheral neuropathy
Painful abd
Pink urine
Psych - depression, hallucination
Paralysis
```
72
What can exacerbate AIP?
Drugs that induce CYP450 (barbs, smoking , drinking) and sulfonamides
73
Nerves affected by C5-C6 n injury
Suprascapular n.
Musculocutaneous n.
Axillary n.
74
Long thoracic n. affects what muscle, what on PE?
Serratus anterior
winging of the scapula
Weakness of the ability to protract the scapula
75
Nerve roots of FPL and FPB
FPL: C7 C8
FPB: C8, T1
76
Angiogenesis is primarily driven by which two factors?
VEGF and FGF
77
Cleaved and noncleaved follicular cells, waxing and waning LAD
Follicular lymphoma t(14,18)
| Bcl-2
78
Classic triad of paroxysmal nocturnal hemoglobinuria
Hemolytic anemia (heomglobinuria)
Pancytopenia
Thrombosis at abnl sites
Can cause hemosiderosis in the kidney
79
Erythematous maculopapular lesions on the chest and trunk w/ bloody diarrhea? Shigella or Salmonella
Salmonella - Salmon colored spots
80
Phenytoin CNS SE
Ataxia and nystagmus
81
Phenytoin long term use SE
Gingival hyperplasia, coarsening of facial features, hirsutism
82
Phenytoin hematologic SE
Megaloblastic anemia-Interferes w/ folic acid
83
Phenytoin SE in pregnancy
Fetal hydantoin syndrome (teratogen)
84
Why do asians have higher incidence of gastric CA?
Food preservatives
Nitrosamine
Polycylic hydrocarbons found in smoked fish, red meats, and preserved food
85
Classic tests for identifying PNH
Sucrose and Ham test
| Serum is acidified to activate complement and then PNH cells are added to lyse
86
Fluphenazine MOA
High potency typical antipsychotic
| D2-R blocker like haloperidol
87
Trazodone class and MOA
Atypical antidepressant
used mainly for insomnia
Block 5HT, Alpha 1, and H1
88
Menopause: GnRH, FSH, and LH
All are increased due to no Estrogen being produced
89
What is the name for fragmented and helmet shaped cells? Why?
Schistocytes due to mechanical damage including massive trauma
90
Difference btwn acetazolamide and latanoprost and when to use them
Acetazolamide - Carbonic anhydrase that decreases aqueous humor production. Turns down faucet. Acute close angle glaucoma
Latanoprost - Opens drain. open angle glaucoma. Topical agent
91
Most common cause of 1st trimester pregnancy loss
Chromosome abnormalities
92
Most common cause of 2nd and 3rd trimester pregnancy loss
Chorioamnionitis-ascending infxns
93
Common cause of 3rd trimester pregnancy loss
Abruptio placentae and Placenta previa
94
Why would you see prolonged PT and mildly prolonged PTT in pancreatitis?
Poor fat soluble vitamin absorption
| Vit K is low
95
Fibrosis of the intrahepatic and extrahepatic bile ducts
Primary sclerosing cholangitis often associated w/ UC
96
3 potential complications of MI from days 5-10
Free wall rupture
Papillary muscle rupture
Ventricular septal perforation
97
What does papillary muscle rupture lead to following MI?
Acute mitral valve prolapse
98
True ventricular aneurysms, when are they likely to occur after MI and what makes them true?
Occur several weeks later
| Outpouching of damaged tissue lined by fibrosis
99
Adverse effects of glucocorticoids
```
Hypocalcemia
Fluid retention
Hypokalemia
Hyperglycemia
HTN
chronic use - osteoporosis and vascular necrosis
```
100
1st line disease modifying antirheumatic drug. What do you bridge with?
Methotrexate
| Bridge w/ glucocorticoids
101
How to remember Glucocorticoid adverse effects?
```
Mineralocorticoid SE, insulin resistance, and osteoporosis
HTN
Hypokalemia
Hyperglycemia
Hypocalcemia - > osteoporosis
```
102
Effects of cocaine, prazosin, and phenoxybenzamine on NE
Cocaine potentiates NE
NE reuptake blocker
Prazosin is a competitive inhibitor
Phenoxybenzamine is a noncompetitive inhibitor
103
7 week kid w/ pneumonia and conjunctivitis
Chlamydia trachomatis
| Chlamydia pneumonia
104
Large, round densely eosinophilic viral inclusions in epithelial cells
Molluscum contagiosum
| Pox virus
105
AA amyloid
Acute phase reactant amyloid (rheumatoid arthritis
106
AL amyloid
Light chain
Multiple myeloma
B cell lymphomas
107
AF amyloid
Familial and old fogies
| Transthyretin
108
A Cal amyloid
Calcitonin
| Medullary carcinoma of the thyroid and pancreatic islet cell adenomas
109
Punched out ulcers in the esophagus of a HIV pt
HSV
110
Glassy, basophilic intranuclear eosinophilic inclusions in cells of esophageal ulcer
HSV
111
Where does urobilinogen come from?
Bilirubin passing through the GI tract gets changed to urobilinogen and can be excreted through urine or feces. Low in cholestasis
112
What do you look for in urine to confirm cholestasis?
Urinary bilirubin not urobilinogen
113
How do you tx acute RA?
NSAIDS -Celecoxib
114
DMARD drugs
Methotrexate and sulfasalazine
115
What is one thing aspirin can do that acetaminophen can not?
Anti-inflammatory
| Both have anti-pyretic and analgesic effects
116
Meperidine MOA
Opioid
117
Hyaline membranes within alveolar walls, alveolar septal thickening, neutrophilic infiltrate, no hemosiderin deposit
ARDS
| diffuse alveolar damage
118
Desquamative interstitial pneumonitis
Tobacco smoke
Hyperplasia of pneumocytes
Accumulation of histiocytes that fill alveolar cavities
119
What does hemodynamic pulmonary edema mean?
Increased hydrostatic pressure
120
Which areas of the renal tubule are impermeable to water?
Early DCT and cortical thick ascending loop of henle
121
What is MAP?
Mean arterial pressure
| Pressure as it leaves the heart - pressure that returns to the heart
122
Wrinkling of the intimal surface of the aorta?
Syphilis
| Obliterative endarteritis of the vasa vasorum of the aorta
123
3 Cs of measles
```
Cough
Coryza (rhinorrhea)
Conjunctivitis
Blanching erythematous macules
Photphobia
```
124
Do glucocorticoids affect Vitamin D or PTH?
NO
125
How do glucocorticoids cause osteoporosis?
Decrease intestinal Ca reabsorption and increase urinary Ca elimination
126
What hormone will be increased during exercise and what factor will be increased an hour after exercise?
During -GH
| 1 hr later - VEGF. Non-endothelial cells secrete VEGF in hypoxic conditions to increase endothelial proliferation
127
Mucinous cystadenoma "Jelly belly". Where is the primary disease process?
Appendix or Ovary
| Pseudomyxoma peritonei
128
Cyclophosphamide: DNA alkylator or intercalator?
Guanine alkylator facilitating DNA crosslinking
129
Chemo drug that inhibits purine synthesis?
G,A
| 6-mercaptopurine
130
Chemo drug that inhibits pyrimidine synthesis?
C,T,U
| 5-Fluorouracil
131
DNA intercalators
Doxorubicin
| Bleomycin
132
3 alkylating agents
Cyclophosphamide
Cisplatin
Procarbazine
133
What are neurofibrillary tangles made of? (Intracellular)
Hyperphosphorylated Tau
134
What are extracellular senile plaques?
A-beta amyloid
135
Rod-shaped, crystal-like eosiniphilic intracellular aggregates of actin
Hirano bodies
| Alzheimer's dz
136
Flame shaped intracytoplasmic inclusions in the neocortex and hippocampus. Consist of paired helical filaments
Neurofibrillary tangle made up of hyperphosphorylated Tau
137
Kid w/ posterior fossa tumor filling the 4th ventricle. What PE finding?
Papilledema
| Blocking 4th ventricle would lead to hydrocephalus, increased ICP and papilledema
138
What causes preeclampsia?
Placental ischemia - > Maternal HTN
139
Ovoid (nodular) hyaline masses in the periphery of the glomerulus
```
Nodular glumerolosclerosis (Kimmelstiel-Wilson nodules)
DM nephropathy
```
140
PAS +, electron dense depositis distributed along the epithelial side of the capillary basement membrane
Membranous glomerulonephritis
| SLE, HBV, NSAIDS
141
Fibrosis of the endocardium, focal myocardial necrosis and prominent inflammatory cell infiltrate
Loeffler endocarditis
| Endomyocardial fibrosis w/ (idiopathic) hypereosinophilia
142
Oka strain live attenuated vaccine
Prophylaxis for VZV in children
143
Causes of increased pulse pressure
Arteriosclerosis, aortic regurgitation. Big difference btwn systolic and diastolic
144
Causes of decreased pulse pressure
Aortic stenosis, mitral stenosis
| The systolic and diastolic pressures are close
145
Cause of increased diastolic pressure
Mitral stenosis
146
Causes of decreased diastolic pressure
Aortic regurgitation, Patent ductus arteriosus
147
Fentanyl, propofol , and midazalom are administered, what should be used to revers respiratory depression
Naloxone for fentanyl
and flumazenil for midazolam
Both opioids and BZD cause respiratory depression
