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Drugs > STEP1 deck 2 > Flashcards

STEP1 deck 2 Flashcards

1
Q

fragile X sx

A

macroorchidism, intellectual disability, long narrow face with prominent mandible

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2
Q

dopamine agonists

A

bromocriptine - ergot
pramipexole and ropinerol - non-ergot
1st line for PD - delay need to start L-dopa

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3
Q

St. John’s Wort

A

Cyp450 inducer

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4
Q

meningioma histo

A

psammoma bodies

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5
Q

VLCFA metabolixm

A

degraded in peroxizomes; dysrupted in Zellweger Sy and X-linked adrenoleukodystrophy

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6
Q

hypoxic-ischemic encephalopahty

A

watershed infarct - wedge-shaped areas of necrosis

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7
Q

haptoglobin

A

binds circulation hemoglobin, reduces renal excretion of free hemoglobin, preventing tubular injury
decreased in SCD b/c used up

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8
Q

SCD sx in kids

A

dactylitis (vasoocclusion), increased indirect bilirubin and lactate dehydrogenase, decreased haptoglobin

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9
Q

CYP 450 inhibitors

A 
=> increased warfarin effect
acetaminophen/NSAIDs
antibiotics/antifungals (metronidazole) - except rifampin
Amiodarone
Cimetidine
Cranberry juice, Ginkgo biloba, vitE
Omeprazole
Thyroid hormone
SSRIs (fluoxetine)
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10
Q

CYP 450 inducers

A 
=> decreased warfarin effect
carbamazepine, phenytoin
ginseng, St. John's wort
OCPs
Phenobarbital
rifampin
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11
Q

translation initiator

A

Kozak consensus sequence
(gcc)gccRccAUGG
initiates translation in people - mutated in B-thalassemia

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12
Q

paroxysmal nocturnal hemoglobinuria

A

hemolytic anemia, hypercoagulability, and pancytopenia exacerbated by any inflammatory trigger
acquired mutation of PIGA gene w/in clonal population of hSCs
PIGA is part os synthesiss of GPI anchor, the attachment for cell-surface proteins like CD55 (DAF) and CD59 (MAD inhibitory factor) which protect self-cells from complement
hemolysis increased at night due to increased complement activation in decreased pH
clotting is from release of clotting factors from lysed cells

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13
Q

cells expressing CD14

A

monocytes + macrophages

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14
Q

porphyria cutanea tarda

A

uroporphyrinogen decarboxylase deficiency

earlier deficiencies => neuro changes but not photosensitivity

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15
Q

G6PD

A

rate-limiting step of pentose phosphate pathway, catalyzed G-6-P -> 6-phosphogluconolactone
needed to generate NADPH and ribose-5-P

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16
Q

multiple myeloma

A

plasma cell cancer => bone pain, fatigue, anemia, kidney disease, and hypercalcemia
plasma cells secrete tons of Ig, and are thus susceptible to proteasome (recycling center) inhibitors such as bortezomib (boronic acid-containing dipeptide) => pro-apoptosic protein buildup

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17
Q

hereditary spherocytosis

A

AD cytoskeletal mut => hemolytic anemia, jaundice, splenomegaly (spherocytes stuck in spleen)
labs show increased MCV, spherocytes, negative Coombs, increased osmotic fragility
causes pigmented gallstones and aplactic crisis with parvovirus B19 infection
treat with splenectomy

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18
Q

cardiac tissue conduction velocity

A

fast - purkinje>atrial>ventricular>AV node - slow

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19
Q

Paget’s disease and association

A

increased bone turnover with production of disorganized + fragile bone - associated with osteosarcoma

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20
Q

osteopetrosis

A

oseoclasts fail to resorb bone => decreased remodeling, increased osteosclerosis, fractures

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21
Q

oseltamivir and amantidine fcn

A

oseltamivir blocks NA which does viral release

amantidine prevents viral envelope assembly via M2, now used for Parkinson dyskinesia

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22
Q

follicular BC lymphoma mutation and progression

A

t(14;18) => increased BCL2 => evasion of apoptosis

indolent, growing and shrinking

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23
Q

atropine

A

belladonna - competitive muscarininc R antagonist => action on M3 => decreased smooth muscle contraction

used in MI with bradycardia - prevents parasympathetic from slowing heart without stimulating it too much

ipatropium and tiotropium are inhaled versions

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24
Q

anticholinergics and sx

A

atropine (belladonna), Jimson weed

hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter

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25
Q

acute promyelocytic leukemia

A

t(15;17) => pancytopenia, DIC

histo with abnormal promyelocytes with Auer rods

treat will all-trans retinoic acid

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26
Q

IL-2

A

made by Ag-stimulated TCs to activate more TCs (clonal proliferation of TCs specific for this Ag), BCs, NKcs, and macrophages

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27
Q

Il-1

A

made by macrophages -> activated lymphocytes; also a primary inflammatory molecule => fever, lethargy, anorexia

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28
Q

TNF-a

A

made by activated macrophages => systemic inflammatory response (sepsis in v. high doses)

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29
Q

INF-a

A

made by monocytes, macrophages, BCs, and NKcs - antiviral, makes you sick

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30
Q

GM-CSF

A

made by everything, stimulated granulocyte and monocyte stem cell production

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31
Q

hemidesmosomes

A

cell-BM connection

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32
Q

desmosomes

A

cell-cell connection

made of cadherins

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33
Q

pancreas bicarb secretion

A

acidic chyme in stomach => gallbladder bile release and stimulates S cells in cryps to Lieberkuehn to release secretin => pancreas => bicarb

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34
Q

knee dislocation

A

risk of injury to popliteal a, tibial n, and common peroneal n

if ant. or post., popliteal artery is at greatest risk b/c fixed tightly above and below the joint

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35
Q

craniopharyngioma

A

slow growing suprasellar tumor from Rathke’s pouch - kids and elderly

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36
Q

ptsd cutoff

A

1 month; less than that = acute stress disorder

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37
Q

schizophrenia time cutoffs

A 
<1mo = brief psychotic disorder
<6mo = schizophreniform
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38
Q

HSV encephalitis

A

most common kind of encephalitis - affects both immunocompetent and immunosuppressed

all encephalitis => fever, HA, malaise

affects temporal lobe => CT changes and also sz, personality changes, and psychosis

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39
Q

acute intermittent porphyria

A

porphobilinogen deaminase def => intermittent AP, neuro sc, dark urine, but no photosensitivity

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40
Q

Lhermitte’s phenomenon

A

shock-like sensation radiating to the feet with neck flexion, cognitive dysfunction

caused by MS or cobalamin deficiency

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41
Q

ca cause of myasthenia gravis

A

thymoma

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42
Q

Eaten-Lambert Sy

A

autoimmune disorder of the NMJ acquired with small cell lung ca - more extremity weakness> ptosis

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43
Q

septic arthritis histo

A

PNMs and bacteria in the joint space

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44
Q

DKA Na and K changes

A

pseudohyponatremia happens to maintain osmolar balance - Na pulled into cells b/c so much glucose outside

hyperkalemia b/c K/H antiporter pulling H into cells to reduce acidemia (note total body K stores depleted)

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45
Q

pheochromocytoma medications

A

treatment is designed to avoid hypertensive crisis

start with long-acting alpha blocker such as phenoxybenzamine

then add beta blocker (propranolol) but don’t give it alone because unopposed alpha-stimulation causes vasoconstriction and life-threatening hypertensive crisis

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46
Q

medications causing interstitial lung disease

A

amiodarone (class III antiarrythmic), nitrofurantoin, MTX, bleomycin

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47
Q

side effects of amiodarone

A

interstitial pneumonitis, arrythmias, hepatic injury, thyroid, blue/gray skin discoloration

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48
Q

ASA-induced asthma

A

ASA blocks Cox1+2, blocking prostaglandins => increased LOX pathway and increased leukotrienes, which are pro-inflammatory

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49
Q

nitrates effects on heart and vessels

A

cause systemic vasodilation => reflex tachycardia

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50
Q

pseudohypopartathyroidism

A

type 1a = Albright hereditary osteodystrophy (AD GNAS1 mut FROM MOM) => short stature, short metacarpal and metatarsal bones, plus PTH resistance

GNAS1 mut FROM DAD => developmental defects with normal PTH (pseudopseudohypoparathyroidism)

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51
Q

allelic heterogeneity v. polygenic

A

allelic heterogeneity - diff types of mutations at same gene cause same disease

polygenic - muts of diff genes cause same disease

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52
Q

pleiotropy

A

mut of one gene has multiple effects

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53
Q

exercise-induced asthma and tx

A

exercise => eosinophils and mast cells make leukotrienes (especially D4) which => bronchospasm and increased mucus secretion

tx with anti-leukotriene (montelukast)

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54
Q

bronze diabetes

A

hemochromatosis => hyperpigmentation, arthalgias, liver damage, diabetes, cardiomyopathy, increased susceptibility to listeria, vibrio, and yersinia enterocolitica

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55
Q

cirrhosis pressure changes

A

cirrhosis => portal HTN => splenic vein HTN (b/c splenic vein empties into portal system) => splenomegaly (cause of hepatosplenomegaly)

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56
Q

causes of impetigo

A

GAS, staph aureus

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57
Q

efflux pumps

A

bacterial resistance via exporting drug is usually via a H+/drug symporter and thus can be dysrupted by increased extracellular H+

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58
Q

achonroplasia

A

FGFR3 pt mut => nl head circumference but decreased cartilage => shortening of the long bones and digits, midface hypoplasia, frontal bossing

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59
Q

osteogenesis imperfecta

A

COL1A1 mut => defective type I collagen (procollagen), short stature, femoral bowing and recurrent fractures, blue sclerae, dearing difficulties (abnl ossicles) and tooth cavities (no dentin)

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60
Q

fragile X

A

FMR1 mutation => intellecutal disability (subtle physical changes at birth => prominent forehead, chin, macroorchidism in adolescence)

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61
Q

fetal alcohol syndrome

A

smooth philtrum thin vermilion border, short palpebral fissure, CNS changes

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62
Q

maternal isotretinoin use

A

ear anomalies, micrognathia, depressed nasal bridge, transposition of the great arteries, hydrocephalus, microcephaly

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63
Q

Red safranin O

A

colors cartilage, mast cell grnules, and mucin red

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64
Q

vanillylmandelic acid

A

metabolite of epi and NE

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65
Q

PE ABGs

A

V/Q mismatch => hypoxemia (low PaO2) but not hypercapnia b/c we have excess CO2 elimination capacity

hypoxemia => hyperventilation => low PaCO2 and respiratory alkalosis

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66
Q

carcinoid tumor sx and tx

A

sx: flushing, HoTN, diarrhea, ronchospasm, valve lesions
tx: octreotide (somatostatin analogue which +> reduced secretion of bioactive peptide)

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67
Q

translation of proteins needed for apoptosis

A

eukaryotic initiation factors (eIFs) are degraded during apoptosis, so proteins needed for apoptosis are translated via internal ribosome entry

IRES (different nucleotide sequence in the 5’ UTR) lets translation start in the middle of the mRNA sequence

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68
Q

thiazolidinediones

A

TZDs - oral DM2 meds (pioglitazone, rosiglitazone) - increase transcription of insulin-responsive genes => GLUT4 upregulation and increased adipocyte differentiation => increased insulin sensitivity

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69
Q

most frequent site of Crohn disease

A

terminal ileum

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70
Q

lactulose

A

treats hepatic encephalopathy by acidifying intestinal contents => NH4+ (ammonia)production which then gets pooped out

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71
Q

beta agonist biochem

A

bind seven transmembrane G protein-couple receptors that activate Gs=>adenyl cylcase => cAMp => smooth muscle relaxation

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72
Q

osteomalacia

A

vit D def => hypophosphatemia => decreased mineralization of newly deposited osteoid => fractures

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73
Q

peripheral artery disease

A

PAD - caused by arterial atherosclerosis => claudication, rest pain, skin thinning, loss of leg hair

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74
Q

innervation by recurrent laryngeal n

A

branches from the vagus and innervates intrinsic muscles of larynx responsible for sound production (have arytenoid in name) - except the cricothyroid - can be damaged by aortic aneurysm

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75
Q

hashimoto v. graves histo

A

hashimoto (hypoT) diffuse lymphocytic infiltration of thyroid by BCs and TCs, with germinal centers and Huerthle cells (enlarged epithelial cells with eosinophilic cytoplasm and prominent nucleoli

graves (hyperT) tall, crowded follicular epithelium with scalloped colloid

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76
Q

right-way eyes

A

destruction of frontal eye fields => ipsilateral deviation

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77
Q

unmyelinated nerves

A

(group C) postganglionic autonomic nerves, afferent heat sensation, afferent slow-onset dull, burning, or visceral pain, first order biporal sensory olfactory nerves

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78
Q

invariant chain

A

sits between a and B chains of MHCII in antigen-binding site; degraded and replaced by antigen during macrophage antigen processing

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79
Q

prader-willi

A

microdeletions on paternal copy or maternal uniparental disomy

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80
Q

PCOS

A

increased LH:FSH ratio => increased androgen production by theca interna cells => anovulation

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81
Q

cellular dedifferentiation

A

driven by TFs

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82
Q

cause pupillary constriction

A

muscarinic cholinergic agonists (pilocarpine)

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83
Q

nl RBC size

A

should be able to fit 5 RBCs in one neutrophil

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84
Q

pernicious anemia

A

autoimmune destruction of parietal cells => decreased IF production and B12

also => decreased HCL production => hypochloridia and alkalinization of gastric juice => increased gastrin production

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85
Q

acanthosis nigricans

A

associated with insulin resistance and obesity

can also signal GI malignancy if sudden growth

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86
Q

Peutz-Jeghers Sy

A

rare AD disease => pgmented mucocutaneous macules and hamartomatous GI polyps which can eventually => malignancy

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87
Q

DiGeorge

A 
Catch 22
Conotruncal (outflow tract) cardiac defects
Abnormal facies
Thymic aplasia
Cleft palate
Hypocalcemia
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88
Q

Gaucher

A

(couch) - most common lysosomal storage disorder (AR) => B-glucocerebrosidase accumulation in macrophage lysosomes (wrinkled tissue paper) => hepatosplenomegaly, pancytopenia, osteopenia (lysosome buildup => release of inflammatory enzymes)

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89
Q

infliximab

A

anti-TNFa mab

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90
Q

cox1 v cox2

A

cox1 - (TXA2) plt aggregation

cox2 - proinflammatory

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91
Q

transduction v. transformation

A

transduction: phage transfers genetic information
transformation: bacteria take up naked DNa from the environment

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92
Q

FSGS

A

HIV-associated, => nephrotic sy (high proteinuria) - some glomeruli collapse and sclerose - BM collapse, hyalinosis, (in HIV, get collapsing glomerulopathy => tubular injury and microcyst formation)

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93
Q

causes of anion gap metabolic acidosis

A 
MUDPILES
Methanol
Uremia
DKA
Propylene glycol
Isoniazid/Iron
Lactic acidosis
Ethylene glycol (antifreeze)
Salicylates (ASA)
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94
Q

ethylene glycol poisoning

A

anion gap metabolic acidosis
sudden-onset flank pain, hematuria, and oliguria

metabolized to oxalate => envelope/dumbbell-shaped calcium oxalate crystals (positively birefringent on polarization)

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95
Q

maxillary sinuses

A

most common site of acute rinusinusitis; live below each orbit, empty into the middle nasal meatus

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96
Q

osteocyte communication

A

long intracanalicular processes linked via gap junctions allow nutriend and waste exchange

also able to sense mechanical stress and modulate osteoblast activity

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97
Q

bisphosphonates

A

(alendronate, risedronate) - used for osteoporosis tx

chemical structure similar to pyrophosphate - bind hydroxyapatite binding sites on bone surfaces, preventing osteoclast adhesion

also => osteoclast apoptosis

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98
Q

atropine SEs and complications

A

mydriasis (acute angle-closure glaucoma)
loss of accommodation
sedation, psychosis
tachycardia (used in MI with bradycardia)
decreased tears, sweat, saliva, GI, bronchial secretions
detrusor relaxation
bronchodilation

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99
Q

fat embolism sx

A

respiratory distress
neuro sx
petechial rash

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100
Q

Huntington pathogenesis

A

AD CAG repeat expansion => huntingtin gain-of-fcn mutation => histone deacetylation => silencing of genes needed for neuron survival

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101
Q

babesiosis

A

transmitted by Ixodes tick (sames as lyme) => intraepithelial ring inclusions (looks like malaria) and Maltese crosses

found in NE US, => flu-like sx, ARDS, CHF, DIC, splenic rupture

labs show anemia, thrombocytopenia, increased LFTs

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102
Q

motor innervation of the tongue

A 
CN XII (hypoglossal) except for palatoglossus muscle which is CNX (vagus)
10, 12
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103
Q

general sensory innervation of the tongue

A 
touch, pain, pressure, temp
ant. 2/3: mandibular branch of trigeminal n (CN V3)
post. 1/3: glossopharyngeal n. (CN IX)
tongue root: vagus n (CN X)
V3, 9, 10
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104
Q

taste innervation of the tongue

A

ant. 2/3: chorda tympani branch of facial n. (CN VII)
post. 1/3: glossopharyngeal n. (CN IX)
tongue root, larynx, upper esophagus: vagus n. (CN X)
7, 9, 10

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105
Q

adjustable gastric banding

A

inflatable, goes around cardiac part of stomach (upper 1/3, including LES), has to pass through lesser omentum (hepatogastric portion)

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106
Q

analgesic nephopathy

A

large amts of NSAIDs over a long time concentrate in medulla and papillae => glutathione depletion and tubualr and endothelial cell damage => chronic interstitial nephritis

histo: patchy interstitial inflammation with fibrosis, tubular atrophy, papillary necrosis and scarring, and distortion of caliceal architecture

papillary calcifications may be visible on renal imaging

can also => decreased prostaglandins => constriction of vasa recta => ischemic papillary necrosis

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107
Q

asthma sputum histo

A

eosinophils (granule-containing) and Charcot-Leyden crystals; eosinophils are recruited and activated by IL-5 from Th2 cells

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108
Q

medications used in stress testing

A

adenosine, dipyridamole (coronary vasodilators)

can => coronary steal syndrome

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109
Q

arteries damaged by stomach ulcers

A

most stomach ulcers form along the lesser curvature, so the R and L gastric arteries are at greatest risk

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110
Q

primary biliary cholangitis

A

chronic autoimmune destruction of hepatic bile ducts => cholestasis

causes fatigue, itching, hepatomegaly, increased alk phos, and antimitochondrial antibodies

biopsy shows pathcy lymphocytic inflammation with destruction of intrahepatic bile ducts, necrosis, and micronodular regeneration - looks similar to GVHD b/c both immune

mostly middle-aged women, associated with other autoimmune diseases

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111
Q

base excision repair

A

fixes single-base DNA defects
glycosylase removes defective base
endonuclease and lyase remove empty sugar-phosphate site
DNA polymerase replaces missing nucleotide
Ligase seals remaining nick

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112
Q

11-hydroxylase deficiency

A

CAH => females with ambiguous genitalia, HTN 2/2 buildup of 11-deoxycorticosterone (weak mineralocorticoid)

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113
Q

timeline of cardiomyocyte ischemia

A

seconds - transition to anaerobic glycolysis
<60 sec - loss of contractility
<30 min - contractility gradually recovers over hrs to days
>30 min - cellular adenine stores depleted => irreversible injury

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114
Q

hypertensive emergency tx

A

IV fenoldopam (short acting, selective, peripheral D1 - receptor agonist) => systemic arteriolar vasodilation, most pronounced in kidneys

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115
Q

x-linked SCID

A

most common cause of SCID

mutation of IL-2RG (common gamma chain) => no T or B lymphocyte growth

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116
Q

alpha-1 blockers

A

doxazosin, prazosin, terazosin => smooth muscle relaxation in arterial and venous walls (used for HTN)

also => smooth muscle relaxation in bladder neck and prostrate (used for urinary retention in BPH)

start at low dose to avoid HoTN

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117
Q

antiphospholipid antibody syndrome

A

=> recurrent miscarriage, placental insufficiency, preeclampsia; DVT, PE, stroke
labs: lupus anticoagulant effect (paradoxical PTT prolongation not reversed with mixing study), antiphospholipid (anticardiolipin, anti-beta2-glycoprotein-1) antibodies - these can => false-positive RPR and VDRL

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118
Q

methylmalonic acidemia

A

methylmalonyl-CoA mutase deficiency => newborn with lethargy, vom, tachypnea

labs; hyperammonemia, ketotic hypoglycemia, metabolic acidosis, high methylmalonic acid and propionic acid

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119
Q

thoracic outlet syndrome

A

2/2 cervical rib, scalene muscle anomalies, or repetitive overam movements

compression of lower trunk of brachial plexus => UE paresthesias and weakness

can also compress subclavian vein => UE swelling or subclavian artery => exertional arm pain

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120
Q

disseminated gonorrheal infection and VF

A

arthritis, dermatitis, and tenosynovitis - from n. gonorrhoeae

VF: makes IgA protease which cleaves IgA at its hinge region, preventing it from binding bacterial membrane proteins and keeping them from adhering to mucosa

IgA is not a good opsonin

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121
Q

developmental field defect

A

initial embryonic disturbance => multiple malformations by disrupting the development of adjacent tissues and structures (holoprosencephaly => facial defects)

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122
Q

CD 31

A

PECAM1 - immunoglobulin expressed on endothelial surface which functions in leukocyte migration through the endothelium

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123
Q

liver angiosarcoma

A

rare malignant vascular ca associated with arsenic (pesticide), thorotrast (radioactive contrast), or polyvinyl chloride (industry) exposure

expresses CD31 (PECAM1)

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124
Q

intraductal papilloma

A

most common cause of bloody nipple discharge

papillary cells in duct wall with fibrovascular core; may contain DCIS foci (cancer)

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125
Q

G1->S transition

A

proliferation signals activate ADK4 => Rb protein phosphorylation, releasing E2F transcription factor, initiating S phase

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126
Q

influenza A resistance

A

via either exposure or vaccination - anti-HA Abs (anti-NA Abs have mild protective effect)

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127
Q

pathogenesis of HBV-related HCC

A

integration of viral CNA into cellular genome => neoplastic changes

chronic inflammation and regeneration also => accumulation of mutations

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128
Q

capitation v. global payment

A

capitation: payor pays a fixed, predetermined fee to cover all the medical services required by a patient or group of patients (common in HMOs)

global payment: insurer pays a single payment to cover all the expenses associated with an incident of care, including follow-up visits (common in elective surgeries)

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129
Q

centriacinal emphysema pathogenesis

A

smoking => oxidative injury to respiratory bronchioles => activation of alveolar macrophages => inflammatory recruitment of neutrophils

macrophages and neutrophils release proteases and generate free radicals which block protease inhibitors => protease-antiprotease imbalance => acinar wall destruction and airspace dilation

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130
Q

edrophonium

A

short-acting AChE inhibitor used in “Tensilon test” to differentiate between worsening of MG due to undertreatment (sx improve with edrophonium, tx: increase pyridostigmine dose) or cholinergic crisis (sx don’t improve, tx: temporarily discontinue pyridostigmine)

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131
Q

insulin action on hepatocytes

A

tyorsine kinase receptor activates MAP K and PI3K pathways

MAP K => cell growth, DNA synthesis

PI3K => glycogen, lipid, and protein synthesis, increased GLUT-4 expression via activation of protein phosphatase, which activates glycogen synthase

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132
Q

key steps in glucagon signalling

A

GPCR/adenylate cyclase pathway => PKA => activated glycogen phosphorylase => glycogen breakdown

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133
Q

renal osteodystrophy

A

CKD => hyperphosphatemia + hypocalcemia => secondary hyperparathyroidism => increase osteoclast activity => osteopenia

can also => PTH resistance => low bone turnover + osteomalacia (inadequate mineralization)

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134
Q

hepatic pyruvate metabolism

A

either pyruvate dehydrogenase -> acteyl-CoA-> CAC
or pyruvate carboxylase -> oxaloacetate -> glucose

high Acetyl-CoA feedback-inhibits pyruvate dehydrogenase and activates pyruvate carboxylase => increased gluconeogenesis

this allows hepatocytes with enough energy to make glucose to release into the blod

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135
Q

minimal change disease

A

most common cause of nephrotic syndrome (hematuria and proteinuria) in kids

immune dysregulation (post-URI) => podocyte damage => loss of BM anions + loss of charge barrier => albuminuria

tx: corticosteroids

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136
Q

POMC

A

proopiomelanocortin (polypeptide precursor) modified to form beta-endorphins, ACTH, and MSH (melanocytes stimulating hormone)

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137
Q

anticholinergic toxicity

A

Mad as a hatter (AMS)
hot as a hare (hyperthermia)
red as a beet (flushing)
dry as a bone (decreased saliva and sweat)
blind as a bat (mydriasis)
the bowel and bladder lose their tone (constipation, urinary retention)
and the heart runs alone (tachycardia)

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138
Q

mucormycosis

A

facial pain, HA, and nasal eschar in pt with DKA

can go to brain => AMS and death

histo shows ribbon-like nonseptate hyphae with right-angle branching

tx: amphotericin B, surgery

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139
Q

innervation to the external auditory canal

A 
mostly trigeminal (CN V3)
posterior portion is from vagus (CN X)
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140
Q

major blood supply to femoral head/neck

A

medial femoral circumflex a.

injury via femoral neck fx can => osteonecrosis of the femoral head

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141
Q

diastolic heart failure

A

from decreased LV compliance (restrictive cardiomyopathy)

caused by transthyretin mut => amyloid accumulation (infiltrative cardiomyopathy), sarcoidosis, HTN, and obesity

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142
Q

sertoli and leydig roles in development

A

Sertoli -> AMH => loss of mullerian ducts
Leydig -> testosterone => development of Wolffian ducts and male secondary sex characteristics

losing Sertoli => dual internal genitalia and male external genitalia

losing Leydig => no internal genitalia (except testes), female external genitalia

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143
Q

Alzheimer’s MRI and tx

A

MRI: cortical atrophy (worst in hippocampus and temporoparietal lobes) without other reversible cause to sx

tx: 1) increase cholinergic neurotransmission (donepezil)
2) protect neurons via antioxidants (vitamin E)
3) NMDA R antagonists (memantine)

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144
Q

IL-4

A

made by Th2 cells => growth of BCs and Th2 cells, => isotype switching to IgE

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145
Q

PSGN

A

edema, hematuria, hx GAS infection
type III hypersensitivity reaction => immune complex deposition (anti-strep Abs bound to strep Ags)

EM shows subepithelial humps; IF (anti-IgG and C3) shows granular depositions in mesangium and capillary walls

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146
Q

PTT v PT

A

PTT - intrinsic + common

PT - extrinsic + common

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147
Q

Addison disease

A

chronic primary adrenal insufficiency - adrenal atrophy or destruction (autoimmune or TB) => decreased aldosterone and cortisol => hyponatremia and HoTN, hyperkalemia, metabolic acidosis, hyperpigmentation (MSH is byproduct of ACTH production as ACTH goes up to try to stimulate cortisol release)

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148
Q

aldosterone

A

increased Na reabsorption and K and H secretion - in response to low volume or hyperkalemia

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149
Q

sympathomimetic overdose

A

tachycardia, tachypnea, temp 102-104, big pupils (mydriasis), increased bowel sounds and secretions

agitation, AMS, sz

cocaine, meth, MDMA (also thirsty), bath salts, pseudoephedrine, epi, NE

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150
Q

opiod overdose

A

bradycardia, slow RR, cold, miosis (pinpoint pupils), no bowel sounds, clammy

decreased level of counsciousness

heroin, etc

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151
Q

anticholinergic overdose

A

tachycardia, hot, dry, big pupils (mydriasis), decreased bowel sounds

altered (mad as a hatter)

belladonna, Jimson weed, plants, TCAs, antihistamines, AChR blockers

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152
Q

cholinergic overdose

A

bradycardia, bronchospasm, increased secretions and sweat, fasciculations, increased bowel sounds, miosis

decreased level of consciousness

paralysis if nicotinic

carbamates, organophosphates, sarin gas, shrooms

tx: atropine and pralidoxine, intubation

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153
Q

sedative/hypnotic overdose

A

low RR, otherwise nl vitals

alcohol, benzos, barbs, antiepileptics, date rape drugs

no response to narcan

tx: intubation, time

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154
Q

sodium correction in hyperglycemia

A

increased serum glucose pulls water out of the cells => relative dilutional hyponatremia

Corrected Sodium = Measured sodium + 0.016 * (Serum glucose - 100)

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155
Q

DKA effects on potassium

A

acidosis pushing H+ into cells which is exchanged for K+ => hyperkalemia but total body K depletion

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156
Q

Wiskott-Alrich syndrome

A

X-linked WASp (RBC cystoskeleton protein) mut => eczema, recurrent infections, and thrombocytemia

BC and TC defect => encapulated and opportunistic infections starting at 6mos

tx: bone marrow transplant

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157
Q

melanocyte developmental origin

A

neural crest

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158
Q

TMP and sulfa targets

A

TMP - bacterial DHFR (same as MTX - ppl and pyrimethamine - fungi)
sulfa - dihydropteroate synthetase

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159
Q

renal blood flow calculation

A

(urine[PAH] * urine flow rate) / (plasma[PAH]*(1-hematocrit))

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160
Q

neoplastic and non-neoplastic colon polyps

A

neoplastic: villous >tubular >serrated

non-neoplastic: hyperplastic, submucosal, inflammatory, mucosal

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161
Q

trigeminal nerve brainstem level

A

CN V exits the brainstem at the pons at the level of the middle cerebellar peduncles

damage to CN V => facial paresis including forhead muscles

if forehead muscles are spared it’s a lesion of the corticobulbar cract

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162
Q

amphotericin B side effects

A

nephrotoxicity => anemia, hypokalemia, and hypomagnesemia

hypokalemia => weakness and arrythmias (PVCs, VT, VF)

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163
Q

hypokalemia EKG

A

T wave flattening, ST depression, prominent U waves, arrythmias

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164
Q

hyperkalemia EKG

A

tall peaked T waves, P wave flattening, PR interval lengthening, QRS widening

=> sine wave pattern => VF

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165
Q

muddy brown casts

A

acute tubular necrosis (ATN) - from acutely decreased renal perfusion - usually affects thich ascending loop of Henle and proximal tubules

increased creatinine and BUN, nl BUN/cre ratio, oliguria

usually regenerates in about 3 wks

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166
Q

renal papillary necrosis

A

from UTI/obstruction, analgesic ingestion, DM2, or SCD

=> gross hematuria, flank pain, tissue fragments in urine

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167
Q

RPGN

A

nephritic - HTN, hematuria, moderate proteinuria

anti-GBM IgG targets type IV collagen => C3 deposition => crescentic glomerulonephritis on light microscopy and linear Ig deposits on IF

Goodpasture syndrome: RPGN + pulmonary hemorrhage from anti-GBM Abs cross-reacting with alveolar BM

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168
Q

sudden cardiac death

A

in first 48 hrs after MI, most likely from VF

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169
Q

pseudogout

A

calcium pyrophosphate crystals - mostly knee joint

rhomboid-shaped positively birefringent

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170
Q

class 1C antiarrythmic effects on EKG

A

(flecainide) - block Na channels which cause phase 0 (rapid depolarization) of cardiac AP, which => wide QRS without long QT

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171
Q

normal tracheal pO2, alveolar pO2, and alveolar pCO2

effects of perfusion and diffusion defects

A

normal tracheal pO2 = 150 mmHg
normal alveolar pO2 = 104 mmHg
normal alveolar pCO2 = 40 mmHg

if alveolar pO2 rises to match tracheal that’s due to a failue of equilibration with venous blood

if drops Co2 and raises O2, it’s usually due to perfusion defect, but if it only raises O2 that’s from a diffusion limitation

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172
Q

hormones that signal via cAMP

A

FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2), MSH, PTH, calcitonin, GHRH, glucagon, histamine (H2)
(Gs and Gi receptors)

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173
Q

hormones that signal via cGMP

A

BMP, ANP, EDRF (NO)

vasodilators

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174
Q

hormones that signal via IP3

A

GnRH, Oxytocin, ADH (V1), TRH, histamine (H1)

Gq receptors

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175
Q

hormones that signal via intracellular receptor

A

progesterone, estrogen, testosterone, cortisol, aldosterone, T3/T4, vitamin D
(adrenal cortex products + T and D)

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176
Q

hormones that signal via receptor tyrosine kinase

A

(MAP K pathway)
insulin, IGF-1, FGF, PDGF, EGF
(growth factors)

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177
Q

hormones that signal via nonreceptor tyrosine kinase

A

(JAK/STAT pathway)

prolactin, cytokines, GH, G-CSF, erythropoietin, thrombopoietin

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178
Q

aortic arch derivatives

A

1 - maxillary artery (branch of internal carotid)
2 - stapedial and hyoid arteries
3- common carotid and proximal internal carotid
4 - L aortic arch, R proximal subclavia
6 - proximal pulmonary arteries and ductus arteriosus

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179
Q

branchial cleft derivatives

A

(clefts = outside ridges)
1 - external auditory meatus
2-4 - temporary cervical sinuses
if persist, => immobile cyst in lateral neck

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180
Q

branchial arch derivatives

A

1 - maxilla, mandible, malleus, incus, muscles of mastication, CN V2, V3
2 - stapes, styloid process, stylohyoid ligament, muscles of facial expression, stapedius, stylohyoid, CN VII
3 - greater horn of hyoid, stylopharyngeus, CN IX
4-6 - arytenoids, cricoid, corniculate, thyroid, pharyngeal constrictors and intrinsic larynx muscles, 4-> CN X, 6 -> recurrent laryngeal (CN X)

chew, smile, swallow stylishly, simply swallow, then speak

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181
Q

branchial pouch derivatives

A

(pouches = inside ridges)
1 - middle eat, eustacian tube (endoderm)
2 - epithelial lining of palatine tonsil
3 - inferior parathyroids, thymus
4 - superior parathyroids, parafollicular (C cells) of thyroid (make calcitonin)
ear, tonsils, bottom to, top

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182
Q

sperm pathway

A 
seven up
seminiferous tubules
epididymis
vas deferens
ejaculatory ducts
(nothing)
urethra
penis
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183
Q

sperm precursors

A

-gonium is going to be a sperm; -zoon is zooming to the end

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184
Q

gestational HTN

A

BP>140/90 after 20th wk without pre-existing HTN

tx: hydralazine, a-methyldopa, labetalol, nifedipine (hypertensive moms love nifedipine)

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185
Q

preeclampsia

A

gestationl hypertension + proteinuria or end0organ dysfunction

from abnormal placental spiral arteries => endothelial dysfcn, vasoconstriction, and ischemia

tx: hydralazine, a-methyldopa, labetalol, nifedipine
IV magnesium sulfate, delivery

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186
Q

eclampsia

A

preeclampsia + maternal sz

tx: IV magnesium sulfate, antihypertensives, delivery

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187
Q

HELLP syndrome

A

Hemolysis, Elevated Liver enzymes, Low Platelets
schistocytes on blood smear; => hepatic subcapular hematomas => rupture and severe HoTN

tx: delivery, antihypertensives, magnesium sulfate, corticosteroids

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188
Q

Ca from DES exposure in utero

A

clear cell adenocarcinoma

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189
Q

HPV ca mech + histo

A

HPV 16+18 make E6 (blocks p53) and E7 (blocks Rb) => proliferation => cervical cancer

koilocytes (dark nucleus with halo) are pathognomonic for HPV

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190
Q

drugs => gynecomastia

A

Spironolactone, Hormones, Cimetidine, Ketoconazole

some hormones create knockers

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191
Q

Peyronie disease

A

Louis XIV
fibrous plaque in tunica albuginea => abnormal curvature of penis and erectile dysfcn
tx: surgical repair once curvature stabilizes

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192
Q

falciform ligament connection and structures contained

A

liver to ant. abdominal wall

contains ligamentum teres (from umbilical vein)

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193
Q

hepatoduodenal ligament \ connection and structures contained

A

liver to duodenum
contains portal triad (proper hepatic a, portal v, common bile duct)
can pinch to control bleeding
part of lesser omentum

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194
Q

gastrohepatic ligament connection and structures contained

A

liver to lesser curvature of stomach
contains gastric arteries
separates greater and lesser sacs
part of lesser omentum

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195
Q

gastrocolic ligament connection and structures contained

A

greater curvature of stomach and transverse colon
contains gastroepiploid arteries
part of greater omentum

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196
Q

gastrosplenic ligament connection and structures contained

A

greater curvature of the stomach and spleen
contains short gastric a.s, left gatroepiploic v.s
separates greater and lesser sacs
part of greater omentum

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197
Q

splenorenal ligament connection and structures contained

A

spleen and post. abdominal wall

contains splenic a. and v., tail of pancreas

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198
Q

kupffer cells

A

specialized liver macrophages

form lining of sinusoids

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199
Q

Ito cells

A

hepatic stellate cells
in space of Disse (lymph drainage)
store vitA when quiescent
produce ECM when activated

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200
Q

primary sources of damage to liver zones

A 
zone I (portal triad) - ingested toxins and viral hepatitis
zone II (canalliculus and sinusoid) - yellow fever
zone II (central vein) - ischemia, metabolic toxins, alcoholic hepatitis
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201
Q

sites of Fe, B9, and B12 absorption

A

Iron Fist, Bro
Fe2+ (iron) in duodenum
B6 (folate) in small bowel
B12 (cobalamin) in terminal ileum via IF

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202
Q

3 causes of gastric ulcers

A

NSAIDS -> decreased PGE2 -> decreased protection
Burns -> hypovolemia -> mucosal ischemia
Brain injury -> increased vagal stimulation -> increased ADh -> increased acidity

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203
Q

adenomatous polyps

A

can => neoplasia via chromosomal instability pathway (APC -> KRAS -> p53 muts)
villous more malignant than tubular

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204
Q

serrated polyps

A

can => neoplasia via microsatellite instability pathway (BRAF, mismatch repair mut)

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205
Q

familial adenomatous polyposis

A

(FAP) AD APC mut (chromosome 5) => thousands of colorectal polyps after puberty => CRC
tx: prophylactic colectomy

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206
Q

Gardner syndrome

A

(FAP-plus)
thousands of colorectal polyps after puberty => CRC
osseous and soft tissue tumors, congenital retinal pigment epithelium hypertrophy, impacted/supernumerary teeth

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207
Q

Turcot syndrome

A

FAP/Lynch syndrome plus malignant CNs tumor
FAP - colon polyps/CRC
Lynch - CRC and endometrial, ovarian, and skin ca

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208
Q

Peutz-Jeghers syndrome

A

AD, => numerous GI hamartomas, hyperpigmented mouth, hands, genitalia
increase risk of breast and GI ca

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209
Q

Juvenile polyposis syndrome

A

AD - numberous GI hamartomatous polyps <5 yo => CRC

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210
Q

Lynch syndrome

A

(HNPCC) AD mismatch repair mut => microsatellite instability => CRC, endometrial, ovarian, and skin ca

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211
Q

ischemic stroke histo

A

12-24 hrs - red neurons
1-3 days - neutrophilic infiltration
3-7 days - macrophages and microglia
1-2 wks - reactive gliosis and vascular proliferation (liquefactive necrosis macroscopically)
>2 wks - glial scar formation, macroscopically cystic area surrounded by fibrosis

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212
Q

H. influenzae

A

G- coccobacilli
can’t grow on sheep blood agar - require hematin and NAD+ (released by S. aureus => satellite colonies if plated together)

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213
Q

oocyte arrests

A

after birth to ovulation - prophase of Meiosis I

until fertilization - metaphase of Meiosis II

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214
Q

pancreatic beta cell receptors

A

M3, glucagon, B2, and GLP-1 receptors all => increased insulin secretion (Gq and Gs)

a2 and somatostatin 2 receptors => decreased insulin secretion (Gi)

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215
Q

selective IgA deficiency

A

mild, recurrent URIs and GI infections (giardia), autoimmunity

anaphylaxis during blood transfusion (due to anti-IgA IgE recognizing donor IgA)

low or absent IgA; normal IgG and IGM

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216
Q

skeletal v. cardiac and smooth muscle Ca source

A

cardiac and smooth: extracellular Ca influx through L-type Ca channels (blocked by CCBs)

skeletal: Ca release from sarcoplasmic reticulum via RyR linked to L-type Ca channels (resistant to CCBs)

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217
Q

parvovirus B19 clinical course

A

ss DNA virus

kids: erythema infectiosum (5th disease - slapped cheek rash, fever, reticular rash on arms, legs, trunk) - ICs
adults: acute symmetric arthropahty - ICs
chronic hemolytic anemia: transient aplastic crisis

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218
Q

cholesteatoma

A

round pearly mass behind TM

collections of squamous cell debris from cysts due to chronic negative pressure

=> discharge + TM rupture

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219
Q

reassortment v. recombination

A

reassortment: mixing of genome segments in 2 segmented viruses infecting same host cell
recombination: gene exchange via corssing over of 2 ds DNA molecules

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220
Q

washout period for antidepressants

A

when switching from MAOI to SSRI need 2 wk washout period to prevent serotonin syndrome - this allows production of new MAO which was irreversibly inhibited by the MAOI

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221
Q

compensation for metabolic acidosis

A

Winter formula

PaCO2 = 1.5 (serum bicarb) + 8 +/- 2

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222
Q

compensation for metabolic alkalosis

A

PaCO2 should increase by 0.7 mmHg for every 1 mEq/L rise in serum bicarb

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223
Q

compensation for acute respiratory acidosis

A

serum bicarb should increase by 1 mEQ/L for every 10 mm Hg rise in PaCO2

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224
Q

compensation for acute respiratory alkalosis

A

serum bicarb should fall by 2 mEq/L for every 10 mmHg decrease in PaCO2

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225
Q

Ascending v. descending colon cancer sx

A

Ascending: bleeding, Fe deficiency anemia
Descending: obstruction

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226
Q

salk v. sabin

A

Sabin = oral live attenuated => stronger mucosal secretory IgA response thank Salk (only IgG)

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227
Q

Bipolar I

A

manic episode

depression common but not required

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228
Q

Bipolar II

A

hypomanic episode and at least one major depressive episode (>2 wks)

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229
Q

cyclothymic disorder

A

at least 2 yrs of fluctuating mild hypomanic and depressive sx that don’t meet criteria for hypomanic or major depressive episodes

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230
Q

etoposide

A

inhibits topoisomerase II (makes ds breaks to resolve + and - supercoiling)

prevents ability to seal breaks

used in testicular cancer and small cell lung cancer

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231
Q

koilocytes

A

HPV

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232
Q

multinucleated giant cells

A

(+ Tzanck smear)

VZV

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233
Q

chemoreceptor trigger zone location

A

(CTZ) - responsible for chemo-induced nausea

area postrema of the dorsal medulla (near the 4th ventricle)

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234
Q

arm abduction muscles and nerves

A

0-15 degrees - supraspinatus - suprascapular n
15-100 degrees - deltoid - axillary n
>90 degrees - trapezius - accessory n
>100 degrees - serratus anterior - long thoracic n

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235
Q

axillary n spine levels, causes of injury, and function

A

C5-C6
humeral neck fracture or anterior dislocation
innervation to deltoid, sensation to deltoid and lateral arm

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236
Q

musculocutaneous n spine levels, causes of injury, and function

A

C5-C7
upper trunk compression
forearm flexion and supination, lateral forearm sensation

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237
Q

radial n spine levels, causes of injury, and presentation

A

C5-T1
midshaft humerus fracture, acillary compression
damage => wrist drop, decreased grip strength, and loss of sensation over posterior arm/forearm and dorsal hand

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238
Q

median n spine levels, causes of injury, and function

A

C5-T1
supracondylar humerus fracture, carpal tunnel, wrist lac
wrist flexion, lateral finger flexion, thumb opposition, sensation over thenal eminense and lateral 3 1/2 fingers

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239
Q

ulnar n spine levels, causes of injury, and function

A

C8-T1
medial epicondyle humberus fracture, hook of hamate fracture from FOOSH injury
wrist and medial finger flexion, interossei, medial 2 lumbricals, sensation over medial 1 1/2 fingers and hypothenar eminence

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240
Q

recurrent median n spine levels, causes of injury, and function

A

C5-T1
palm lac
opposiition, abduction, thumb flexion - no sensation

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241
Q

Erb palsy injury, muscle deficit, and presentation

A

upper trunk tear
deltoid, supraspinatus, infraspinatus, biceps brachii
=> waiter’s tip

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242
Q

Klumpke palsy injury, muscle deficit, and presentation

A

lower trunk tear
intrinsic land muscles
=> total claw hand

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243
Q

thoracic outlet syndrome injury, muscle deficit, and presentation

A

compression of lower trunk and subclavian vessels
intrinsic hand muscles
=> total claw hand plus ischemia, pain, and edema

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244
Q

winged scapula injury, muscle deficit, and presentation

A

long thoracic nerve
serratus anterior
winged scapula, can’t abduct arm above horizontal

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245
Q

thenar muscles and innervation

A

opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
median n

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246
Q

hypothenar muscles and innervation

A

opponens digiti minimi, abductor digiti minimi, flexor digiti minimi brevis
ulnar n.

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247
Q

L3-L4 herniation n. affected and sx

A

femoral n

weak knee extension, loss of patellar reflex

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248
Q

L4-L5 herniation n. affected and sx

A

common peroneal n. (from sciatic)

weakness of dorsiflexion (foot drop), difficulty with heel-walking

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249
Q

L5-S1 herniation n. affected and sx

A

tibial n. (from sciatic)

weakness of plantar flexion, difficulty with toe-walking, decreased achilles reflex

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250
Q

benign and malignant bone tumors

A

benign: oesteochondroma, giant cell tumor (osteoclastoma)
malignant: osteosarcoma, ewing sarcoma

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251
Q

osteochondroma

A

common, benign, M<25 - bony “skin tag” with cartilaginous cap

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252
Q

giant cell tumor

A

20-40 yos, benign but locally aggressive => “soap bubble” on XR, epiphysis of long bones
multinucleated giant cells expressing RANKL (osteoclastoma

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253
Q

osteosarcoma

A

common, malignant, teens and >65yo
XR: triangle of elevated periosteum or sunburst pattern
tx: surgery, chemo

254
Q

Ewing sarcoma

A

aggressive, malignant, but responds to chemo
teen boys
onion skin periosteal retraction in diaphysis of long bones
anaplastic small blue cells
t(11;22) => EWS-FLI 1 fusion protein

255
Q

seronegative spondyloarthritis

A 
no rheumatoid factor (anti-IgG Ab)
associated with HLA-B27
subtypes (PAIR)
Peripheral arthritis
Ankylosing spondylitis
IBD
Reactive arthritis
256
Q

Psoriatic arthritis

A

seronegative spondyloarthropaty

associated w/ skin psoriasis, asymmetric, dactylitis, “pencil-in-cup” DIP on XR

257
Q

Ankylosing spondylitis

A

seronegative spondyloarthropaty
spine and SI joints fuse symmetrically => bamboo spine on XR
uveitis, aortic regurg
M>F

258
Q

Inflammatory bowel disease asoociations

A

Crohn and ulcerative colitis are often associated with seronegative spondyloarthritis

259
Q

Reactive arthritis

A 
seronegative spondyloarthropaty
Conjunctivitis, urethritis, arthritis
can't see, can't pee, can't climb a tree
Shigella, Yersinia, Chlamydia, Campylobacter
Salmonella
260
Q

SLE labs

A

antinuclear Abs (ANA) - sensitive, nos specific
anti-dsDNA Abs - specific, poor prognosis
anti-Smith (SnRNPs) Abs - specific
anti-histone Abs - drug-induced
decreased complement 2/2 IC formation

tx: NSAIDs, steroids, immunosuppressants, hydroxychloroquine

261
Q

polymyositis

A

progressive symmetric proximal muscle (shoulder) weakness - endomysial inflammation with CD8+ TCs
increased CK, positive ANA, anti-Jo-1, anti-SRP, and-Mi-2 Abs
tx: steroids, MTX

262
Q

Dermatomyositis

A

progressive symmetric proximal muscle (shoulder) weakness - endomysial inflammation with CD8+ TCs
plus malar, periorbital, and “shawl and face” rash, Gottron papules (red knuckles) or “mechanic’s hands”, perimysial inflammation with CD4+ TCs
increased risk of occult malignancy
increased CK, positive ANA, anti-Jo-1, anti-SRP, and-Mi-2 Abs
tx: steroids, MTX

263
Q

Lambert-Eaton

A

myasthenic syndrome; uncommon
autoantibodies to presynaptic Ca channel decrease ACh release
=> proximal muscle weakness, dry mouth, impotence with improve with muscle use
AChEis don’t help
can be caused by small cell lung cancer

264
Q

scleroderma

A

systemic sclerosis
autoimmunity, vasculopathy, collagen deposition = fibrosis
puffy taught skin, fingertip pitting
diffuse and limited subtypes

265
Q

Diffuse scleroderma

A

worse, rapid, with anti-Scl-70Ab (DNA topoisomerase I)

sclerosis of renal pulmonary (COD_, cardiovascualr and GI systems

266
Q

Limited scleroderma

A

better - confined to fingers and face, comes with CREST syndrome
Calcinosis, anti-Centromere Ab, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia

267
Q

exudate

A

cloudy, increased protein, increased LDH compared to serum

PE protein/serum protein > 0.5, or
PE LDH/serum LDH > 0.6, or
PE LDH > 2/3 upper limit of nl serum LCH

from lymph obstruction, inflammation, infection, or malignancy

268
Q

transudate

A

clear, decreased protein, decreased LDH

from increased hydrostatic pressure or decreased oncotic pressure

269
Q

acanthosis nigricans

A

mostly associated with obestity and insulin resistance, but also gastric adenocarcinoma and visceral malignancies

270
Q

hypercalcemia paraneoplastic associations

A

from PTHrP -
squamous cell carcinomas of lung, head, neck
renal, bladder, breast, and ovarian carcinomas

or from increased vit D - lymphoma

271
Q

small cell lung cancer paraneoplastic syndromes

A 
cushing syndrome (high ACTH)
SIADH and hyponatremia (high ADH)
(pulmonary neuroendocrine cells produce ACE)

opsoclonus-myoclonus ataxia syndrome
paraneoplastic cerebellar degeneration
paraneoplastic encephalomyelitis
Lambert-Eaton myasthenic syndrome (presynaptic MG)

272
Q

thymoma paraneoplastic syndrome

A

pure red cell aplasia - anemia with low reticulocytes
Good syndrome - hypogamaglobulinemia
myasthemia gravis (anti- postsynaptic ACh R Abs)

273
Q

pancreatic adenocarcinoma paraneoplastic syndrome

A

trousseau syndrome - migratory superficial thrombophlebitis

marantic (nonbacterial thrombotic) endocarditis - sterile platelet thrombi on heart valves

274
Q

ovarian teratoma paraneoplastic syndrome

A

anti-NMDA R encephalitis => psych changes, sz, etc.

275
Q

opsoclonus-myoclonus ataxia syndrome

A

paraneoplastic, “dancing eyes, dancing feet”
kids- neuroblastoma
adults - smal cell lung cancer (from neuroendocrine cells)

276
Q

paraneoplastic cerebellar degeneration

A

anti-Purkinje cell Abs

small cell lung cancer, gynecologic and breast cancers, and hodgkin lymphoma

277
Q

poison ivy dermatitis

A

type IV hypersensitivity
sensitization phase => clonal expansion of TCs
elicitation phase => activated CD8+ TCs

278
Q

lactic acidosis from acute mesenteric ischemia

A

hypoxia => NADH accumulation, which inhibits pyruvate dehydrogenase => increased conversion of pyruvate to lactate

279
Q

neuroleptic malignant syndrome

A

from antipsychotics (dopamine R blockers)
=> rigidity, fever, HTN, tachycardia, and altered sensorium (no clonus)
labs: elevated CK
tx: dantrolene (ryanodine receptor inhibitor - used for succ overdose too), or bromocriptine

280
Q

serotonin syndrome

A

tremors/myoclonus, diaphoresis, HTN, hyperthermia, tachycardia, nausea, diarrhea, AMS (no rigidity)

tx: cyprohepatine (serotonin R antagonist)

281
Q

prokaryotic DNA polymerases

A

I - 5’ to 3’ and 3’ to 5’ exonuclease activity - allows it to remove RNA primer and repair damaged DNA
II and III - 3’ to 5’ exonuclease activity

282
Q

mitochondrial disorders

A

maternally inherited, display heteroplasmy due to uneven distribution of mitochondria between daughter cells => clinical variability

283
Q

important mitochondrial syndromes

A

Leber hereditary optic neuropathy (bilateral vision loss
Myoclonic epilepsy with ragged-red fibers (sz, myopathy w/exercise, irregularly shaped muscle fibers)
Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS)

284
Q

leukotriene receptor antagonists

A

used for asthma

zafirlukast, montelukast

285
Q

common peroneal nerve injury

A

from trauma or compression at nec kof fibula

wakness on dorsiflxion, decreased lateral shin and dorsal foot sensation

286
Q

transpeptidase

A

a type of PBP inhibited by ceptriaxone via irreversible binding

287
Q

best indicator of MV stenosis on ausculatation

A

time between S2 (AV closure) and opening snap

shorter = more stenosis (increased left atrial pressure)

288
Q

c perfringens sx

A

gas gangrene - penetrating injury => anaerobic environment => toxin => necrosis, gas production (crepitus)
late-onset food poisoning with watery diarrhea (spores have to germinate first)

289
Q

neonatal abstinence syndrome, tx, and RFs

A

sx: irritability, hypertonia, diarrhea, vom, diaphoresis, sneezing, pupillar dilation
tx: methadone
RF: maternal hep C infection, no prenatal care, or poor mental health

290
Q

most common causes of NSTI

A

mixed/clostridium (also causes gas gangrene), strep, staph, vibrio (in order)

291
Q

triptans MOA and SEs

A

(sumatriptan) abortive migraine therapy
5-HT1B/5-HT1D receptor agonists
act on postsynaptic receptor and inhibit release of vasoactive peptide => vasoconstriction and decreased pain signalling

SE: HTN, cardiac events

292
Q

acute tubular necrosis cause and histo

A

from toxin such as ethylene glycol
=> proximal tubular cell ballooning and vacuolar degeneration; calcium oxalate crystals and high anion gap if from ethylene glycol

293
Q

locations fo TC positive and negative selection

A

positive: thymic cortex
negative: thymic medulla

294
Q

comon causes of OM in kids <2

A

strep pneumoniase, h. influenzae - mostly nontypeable strands (no capsule, so no immunity from Hib vaccine)

295
Q

segmented viruses

A

orthomyxoviruses (flu), reoviruses(rotavirus), bunyaviruses (hanta), arenaviruses (Lassa virus)

296
Q

ASA intoxication sx, labs

A

fever, tinnitus, and tachypnea
respiratory alkalosis => mixed respiratory alkalosis and anion gap metabolic acidosis
labs: nl pH, low bicarb, PaCo2 lower than predicted compensation

297
Q

features of drugs eliminated by the liver

A 
high lipophilicity (good CNS penetration)
high volume of distribution
298
Q

prussian blue stain

A

intracellular iron

299
Q

nimodipine

A

CCB given in subarachnoid hemorrhage to reduce mortailty from cerebral vasospasm

300
Q

bleeding time

A

test of platelet function

301
Q

von Willebrand deficiency

A

mucosal bleeding

decreased platelet function and decreased factor VIII activity => prolonged bleedign time and not PPT, respectively

302
Q

sleep stages and EKG waveforms

A 
at night, BATS Drink Blood
awake, eyes open - Beta
awake, eyes closed - Alpha
N1 - Theta
N2 - Sleep spindles and K complexes
N3 - Delta (lowest frequency, highest amplitude)
REM - Beta
303
Q

reflex mnemonic

A

achilles reflex = S1, S2 - buckle my shoe
patellar reflex - L3, L4 - kick the door
biceps + brachioradialis reflexes = C5, C6 - pick up sticks
triceps reflex = C7, C8 - lay them straight
cremasteric relex = L1, L2 - testicles move
anal wink reflex = S3, S4 - winks galore

304
Q

frontal lobe lesion sx

A

disinhibition, decreased concentration, reemergence of primitive reflexes

305
Q

frontal eye field lesion sx

A

eyes look toward lesion

306
Q

paramedian pontine reticular formation lesion sx

A

eyes look away from lesion

307
Q

medial longitudinal fasciculus lesion sx

A 
internuclear ophthalmoplegia (impaired adduction of ipsilateral eye with contralateral eye abduction; nystagmus of contralateral eye with same
eg: MS
308
Q

dominant parietal lobe lesion sx

A

agraphia, acalculia, finer agnosia, L/R disorientation

eg: Gerstmann syndrome

309
Q

nondominant parietal lobe lesion sx

A

agnosia of contralateral side

eg: hemispatial neglect

310
Q

bilateral hippocampus lesion sx

A

anterograde amnesia

311
Q

basal ganglia lesion sx

A

rest tremor, chorea, athetosis

eg: Parkinson, Huntington

312
Q

subthalamic nucleus lesion sx

A

contralateral hemiballismus

313
Q

bilateral mamillary body lesion sx

A

confusion, ataxia, nystagmus, ophthalmoplegia, memory loss, confabulation, personality changes
ef: wernicke-korskoff sy

314
Q

bilateral amygdala lesion sx

A

disinhibition (hyperphagia, hypersexuality, hyperorality)

eg: Kluver-Budy sy; HSV-1 encephalitis

315
Q

superior colliculus lesion sx

A

paralysis of conjugate vertical gaze
eg; parinaud syndrome
from stroke, hydrocephalus, pinealoma

316
Q

reticular activating system lesion sx

A

(midbrain) reduced arousal/wakefulness

eg: coma

317
Q

cerebellar hemisphere lesion sx

A

intention tremor, limb ataxia, loss of balance

ipsilateral due to double cross over

318
Q

cerebellar vermis lesion sx

A

truncal ataxia, dysarthria

associated w/ chronic EtOH use

319
Q

hepatitis E virus

A

unenvelopes ssRNA
fecal-oral
usually self-limited, without chronic or carrier state
high mortality among infected pregnant women

320
Q

PRPP synthtase overactivation

A

rate-limiting step of de-novo DNa synth

overactivation => gout

321
Q

cel ltype responsible for gout sx

A

neutrophils

322
Q

NNRTIs + SEs

A

reverse transcriptase inhibitors that don’t need activation via intracellular phosphorylation
ef: nevirapine, efavirenz

SEs: hepatic failure, SJS, toxic epidermal necrolysis

323
Q

AChEi SE tx

A

AChEis (pyridostigmine) => GI side effects due to excessive choliergic stimulation of the gut

tx: scopolamine, hyoscyamine (selective muscarinic AChR antagonist without effects on nicotinic receptors on skeletal muscle

324
Q

skin maifestations of syphilis stages

A

primary - chancre
secondary - condyloma lata
tertiary - gumma (necrotizing granuloma)

325
Q

effects of normal aging on the heart

A

decreased LV size, sigmoid ventricular septum, increased interstitial connective tissue with amyloid depostion, intracellular lipofuscin accumulation

326
Q

locus ceruleus location, function, and lesion

A

posterior rostral pons near the lateral floor of the 4th ventricle
norpinephrine synthesis - level of arousal, blood pressure, anxiety
hemorrhage => coma, paralysis with extensor posturing

327
Q

UV DNA damage and repair

A

UV => pyrimidine (CT) dimers, repaired via nucleotide excision repair - endonuclease recognizes and nicks either side of dimer, polymerase replaces it, and ligase seals the nick

328
Q

hypocalcemia sx + cause

A

muscle cramps, perioral paresthesias, HoTN, laryngospasm, neuromuscular hyperexcitability
most common cause of acute hypocalcemia = parathyroid injury during thyroid surgery

329
Q

hypocalcemia causes

A

parathyroid injury (thyroid surgery), autoimmunity, sepsis, tumor lysis syndrome, pancreatitis, vitD or Mg deficiency

330
Q

reactive arthritis

A

urethritis, conjunctivitis, arthritis
HLA-B27 associated seronegative spondyloarthropathy
sacroiliitis in 20% of cases
palms and soles rash

331
Q

Lead poisoning sx and labs

A

sx: AP, constipation, neuro deficits, peripheral neuropathy, anemia, Pb lines on gum
labs: microcytic, hypochromic anemia, basophilic stippling, high Pb and Zn protoporphyrin

lead paint, ammunition, batteries

332
Q

germ tubes at 37 degrees

A

candida - colonizes oral cavity

333
Q

thiazolidinedions

A

decrease insulin resistance

activate peroxisome-proliferator activated receptor-y (TF)

334
Q

dihydroergotamine

A

ergot alkaloid used for migraine

causes vascular smooth muscle constriction via a adrenergic and serotonergic receptors

335
Q

arteriolar vasodilators

A

hydralazine, minoxidil
lower BP by reducing systemic vascular resistance, but this => sympathetic activation => RAAS activation => NA and H20 retention and edema

336
Q

Gaucher disease presentation

A

bone pain, AP, hepatosplenomegaly (especially splenic), easy bleeding and bruising, pallor, fatigue, anemia, thrombocytopenia, leukopenia

337
Q

fanconi andmia presentation

A

pancytopenia, risk of malignancy, hyperpigmented patches, short stature, hypoplastic thumbs

338
Q

MCA stroke sx

A

contralateral paralysis and sensory loss of face and UE
aphasia if in dominant (L) hemisphere
hemineglect is in nondominant (R) hemisphere

339
Q

ACA stroke sx

A

contralateral paralysis and sensory loss of LE

340
Q

lenticulostriate artery stroke sx

A

contralateral paralysis or sensory loss - face and body
no neglect, aphasia, visula field loss (cortical signs)
due to lacunar infarcts from hyaline arteriosclerosis 2/2 unmanaged HTN

341
Q

ASA stroke sx

A

contralateral paralysis of UE and LE
decreased contralateral proprioception
ipsilateral hypoglossal dysfunction

if lower, get UMN and pain/temp loss below the lesion and LMN loss at the level

342
Q

PICA stroke sx and structures damaged

A

disphagia, hoarseneess, loss of gag reflex (nucleus ambiguus)
vomiting, vertigo, nystagmus (vestibular nuclei)
decreased pain and temp from contralateral body and ipsilateral face (lateral spinothalamic tract)
ipsilateral horner syndrome (sympathetic fibers)
ataia, dysmetria (inferior cerebellar peduncle)
Wallenburg Sy - don’t pick a horse that can’t eat

343
Q

AICA stroke sx and structures damaged

A

facial paralysis, loss of lacrimation, salivation, ant. 2/3 taste (facian nucleus)
vomiting, vertigo, nystagmus (vestibular nuclei)
loss of pain and temp sensation from contralteral body, ipsilateral face (spinothalamic tract)
ipsilateral horner sy (sympathetic fibers)
ataxia, dysmetria (middle an dinferior cerebellar peduncles)
lateral pontine syndrome - facial droop means AICA’s pooped

344
Q

basilar artery stroke sx

A

preserved consciousness

quadriplegia of everything except vertical eye movements

345
Q

PCA stroke sx

A

contralateral hemianopia with macular sparing

346
Q

normal pressure hdrocephalus

A

wet wobbly and wacky with a magnetic gait
idiopathic episodes of elevated ICP => expnsion of ventricles but not subarachnoid space => urinary incontinence, ataxia, and cognitive dysfunction

347
Q

ex vacuo ventriculomegaly

A

apparently increased CSF 2/2 decreased brain tissue and neuronal atrophy - normal ICP; sx match root disease

348
Q

acute disseminated encephalomyelitis

A

postinfectious multifocal inflammation and demyelination -> progressive multifocal neurologic symptoms and AMS

349
Q

Charcot Marie Tooth disease

A

AD hereditary motor and sensory neuropathy
defect in peripheral nerve or myelin sheath protein => progressive LE weakness and sensory deficits; associated with foot deformities

350
Q

progressive multifocal leukoencephalopathy

A

reactivation of latent JC virus infection (AIDS, natalizumab, rituximab)
=> oligodendrocyte destruction => demyelination of CNS
rapidly progressive, usually fatal

351
Q

adrenoleukodystrophy

A

X-linked VLC FA metabolism defect => buildup in CNS, adrenals, testes => coma/death and adrenal gland crisis
tx: limit LC FAs

352
Q

Sturge-Weber Sy

A

encephalotrigeminal angiomatosis

mosaic (nonmosaic is lethal) activating mut in GNAQ => port-wine stain, ipsilateral leptomeningeal angioma => sz, epilepsy, intellectual disability, and episcleral hemangioma => early-onset glaucoma

353
Q

tuberous sclerosis

A

AD TSC1/TSC2 mut on chromosome 16
=> hamartomas, angiofibromas, mitral regurg, ash-leaf spots, cardiac rhabdomyoma, mental retardation, bilateral renal angiomyolipomas, sz

354
Q

NFT I

A

von recklinghausen disease - AD NF1 mut on chromosome 17
=> increased RAS activation => cafe-au-lait spots, cutaneous neurofibromas, optic gliomas, pheochromocytomas, lisch nodules (iris hamartomas)

355
Q

NFT II

A

AD NF2 mut on chromosome 22
=> bilateral acoustic schwannomas, cataracts, meningiomas, ependymomas
2 ears, 2 eyes, 2 parts of the brain

356
Q

von Hippel-Lindau

A

AD VHL deletion (chromosome 3)

=> HARP: hemangioblastomas, Angiomatosis, bilateral Renal cell carcinomas, Pheochromocytoma

357
Q

glioblastoma multiforme

A

adults - grade IV astrocytoma
common, malignant, 1 yr survival
crosses corpus callosum - butterfly glioma
GFaP + with pseudopalisading tumar cells and central areas of necrosis and hemorrhage

358
Q

oligodendroglioma

A

adults - rare, slow growing, frontal lobes - from oligodendrocytes
chicken-wire capillaries, fried egg cells, calcifications

359
Q

meningiomas

A

adults - comon, benign - outside of brain parenchyma and may have dural tail
asymptomatic/ sz
from arachnoid cells - whorled spindle cells and psammoma bodies

360
Q

hemangioblastoma

A

adults - cerebellar, asssociated with VHL, can make EPO => polycythemia
closely arranged thin-walled capillaries

361
Q

pilocytic astrocytoma

A

kids - benign, well-circumscribed; in posterior fossa and may be supratentorial
GFAP+ with rosenthal fibers (red blobs)

362
Q

Medulloblastoma

A

kids - malignant - incerebellum; can => noncommunication hydrocephalus via 4th ventricle compression of => drop metastases to spinal cord
from neuroectoderm; homer-wright rosettes (not very rosette-like) and small blue cells

363
Q

ependymoma

A

kids - malignant - in 4th ventricle, poor prognosis
from ependymal cells; perivascular roseges (large eosinophilic granuloma-like) and rod-shaped blepharoplasts near nucleus

364
Q

craniopharyngioma

A

kids - supratentorial tumor that can => bitemporal hemianopia
remnants of Rathke pouch, calcifications and cholesterol crystals in oil

365
Q

pinealoma

A

kids - pineal gland tumor; can => vertical gaze palsy, cerebral aqueduct compression, and precocious puberty from B-hCG production
germ cell tumor

366
Q

Werdnig-Hoffmann disease

A

AR congenital ant. horn degeneration (like polio) => floppy baby with tongue fasciculations => y mo survival

367
Q

Amyotrophic Lateral Sclerosis + tx

A

combined UMN and LMN deficits (no sensory or bladder/bowel sx)
can be from superoxide dismutatse 1 def
=> asymmetric limb weakness, fasciculations, death
tx: riluzole

368
Q

tabes dorsalis

A

tertiary syphilis => demyelination of dorsal columns and roots => impaired proprioception and ataxia
absent DTRs; positive Romberg sign

369
Q

syringomyelia

A

bilateral loss of pain and temp in in a cape-like distribution
associated with chiary I

370
Q

polio pathophys, sx, labsb

A

fecal-oral transmission (fever, HA, malaise) => replicates in oropharynx and gut => CNS => anterior horn LMN death
=> asymmetric weakness, fasciculations, hyporeflexia, atrophy
CSF: elevated WBC, protein
virus in stool or throat

371
Q

Brown-Sequard

A

spinal cord hemisection
=> ipsilateral sensation loss and LMN signs at level
ipsilateral proprioception/light touchloss and UMN signs below level
contralateral pain/temp/crude touch loss below level
if above T1, ipsilateral Horner sy

372
Q

friedrich ataxia

A

AR GAA repeat in frataxin gene on chromosome 9
=> loss o fmitochondrial function => weakness, loss of DTRs, vibratory sense, and proprioception
=> staggering gait, falls, nystagmus, dysarthria, pes cavus, hamer toes, DM2, hypertrophic cardiomyopathy, kyphoscoliosis
Friedrich is Fratastic: he’s your favorite frat brother, always staggering and falling but has a sweet big heart
ataxic GAAit

373
Q

CN V motor lesion

A

jaw deviates toward side of lesion

374
Q

CN X lesion

A

uvula deviates away from lesion

375
Q

CN XI lesion

A

weakness turning head to contralateral side; ipsilateral shoulder droop

376
Q

CN XII lesion

A

LMN lesion => tongue deviates towards the lesion

377
Q

hyperopia

A

farsignthedness

eye too short - give convex lenses

378
Q

myopia

A

nearsightedness

eye too long - give concave lens

379
Q

presbyopia

A

aging-related impaired accommodation (focusing on near objects) from decreased elasticity and ciliary muscle sctrength
give reading glasses

380
Q

partial (focal) sz tx

A

1) carbamazepine
2) phenytoin + fosphenytoin
3) barbituates, narrow or broad spectrum antiepileptics

381
Q

tonic-clonic sx tx

A

1) valproid acid, phenytoin, fosphenytoin
2) phenobarb for neonates
3) carbamazepine, topiramate, lamotribine, levetiracetem

382
Q

absence sz tx

A

1) ethosuximide (blocks thalamic T-type Ca channels)

2) lamotrigine, valproate

383
Q

status epilepticus tx

A

1) benzos (lorazepam)

2) prophylax with phenytoin, fosphenytoin

384
Q

short-acting benzos

A

ATOM

Alprazolam, Triazolam, Oxazepam, and Midazolam

385
Q

benzos metabolized by kidney

A

Outside The Liver

Oxazepam, Temazepam, and Lorazepam

386
Q

Barbiturates v. Benzos mechanism

A

both (and EtOH) bind GABA A Receptor (ligand-gated Cl- channel)
barbiturates increase duration of Cl- channel opening
benzos increase frequency of cl- channel opening

387
Q

timolol

A

nonselective B blocker used in open-angle glaucoma to reduce aqueous humor production by ciliary epithelium => decreased IOP

388
Q

snRNPs

A

small nuclear ribonucleoprotiens (RNA + protein) - part of spliceosomes - intranuclear
anti-Smith Ab in SLE is against these

389
Q

Filtration fraction

A 
FF = GFR/RPF
RPF = RBF * (1- Hct)
390
Q

anastrozole

A 
aromatase inhibitor (can't make estrogen from testosterone)
other aromatase inhibitors: letrozole, exemestane)
391
Q

compensation for mild-moderate edema

A

increase in tisse lymphatic drainage 2/2 increase interstitial fluid pressure

392
Q

major immune mechanisms against giardia and people at risk

A

CD4+ Th cells
secretory IgA infetion (prevents trophoxoite adherence to upper small bowel mucosa)

increased risk of chronic giardiasis if IgA def, X-linked agammaglobulinemia,, or common variable immune deficiency

393
Q

silicosis complications

A

increase risk for TB due to disruption of macrophage phagolysosomes by internalized silica particles

394
Q

low v. high potency antipsychotics SEs

A

low-potency (CHeating THIeves are LOW: chlorpromaxine, thioridazine) => sedation, anticholinergics, orthostasis

high-potency (TRy to FLy HIGH: haloperidol, fluphenazine) => extrapyramidal sx (dystonia, akathisia, parkinsonism)

395
Q

huntington disease tx

A

tetrabenazine and reserpine - inhibit vesicular monoamine transporter (VMAT) => decreased dopamine packaging and release
haloperidol - 1st gen antipsychotic and D2 R antagonist

396
Q

Riluzole

A

ALS tx that modestly increases survival via decreased glutamate excitotoxicity

397
Q

Alzheimer tx

A

memantine - NMDA receptor antagonist => confusion, hallucinations

AChE inhibitors (donepezil, glantamine, rivastigmine, tacrine) => nausea, insomnia

398
Q

IV anesthetics mnemonic

A 
The Mighty King Proposes to Oprah
Thiopental (barbiturates)
Midazolam (benzodiazepines)
Ketamine (arylcyclohexylamines)
Propofol
Opiods
399
Q

fixation

A

immature

partially remaining at a more childish level of development

400
Q

idealization

A

immature

expressing extremely positive thoughts of self and others while ignoring negative thoughts

401
Q

identification

A

immature

largely unconscious assumption of the characteristics, qualities, or traits of another person or group

402
Q

intellectualization

A

immature

using facts and logic to emotionally distance oneself from a stressful situation

403
Q

isolation

A

immature

separating feelings from ideas and events

404
Q

passive aggression

A

immature

demonstrating hostile feelings in a nonconfrontational manner/ showing indirect opposition

405
Q

projection

A

immature

attributing an unacceptable internal impulse to an external source

406
Q

rationalization

A

immature

proclaiming logical reasons for actions actually performed for other reasons, usually to avoid self-blame

407
Q

reaction formation

A

immature

replacing a warded-off idea or feeling by and (unconsciously derived) emphasis on its opposite

408
Q

regression

A

immature

involuntarily turning back the maturational clock and going back to earlier modes of dealing with the world

409
Q

repression

A

immature

involuntarily withholding an idea or feeling from conscious awareness

410
Q

splitting

A

immature
believing that people are either all good or all bad a t different times due to intolerance of ambiguity - common in borderlilne personality disorder

411
Q

sublimation

A

mature
replacing an unacceptable wish with a course of actyion that is similar to the wish but does not conflict with one’s value system

412
Q

altruism

A

mature

alleviating negative feelings via unsolicited generosity

413
Q

suppression

A

mature

intentionally withholding an idea or feeling from conscious awareness; temporary

414
Q

humor

A

mature

appreciating the amusing nature of an anxiety-provoking or adverse situation

415
Q

mature ego defenses

A

SASH

sublimation, altruism, suppression, and humor

416
Q

acting out

A

immature

expressing unacceptable feelings and thoughts through actions

417
Q

denial

A

immature

avoiding the awareness of some painful reality

418
Q

displacement

A

immature

redirection of emotions or impulses to a neutral person or object

419
Q

dissociation

A

immature
temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress. patient has incomplete or no memory of traumatic event

420
Q

serotonin syndrome

A

(antidepressants plus tramadol, ondansetron, triptans, linezolid, MDMA, dextromethorphan)

Neuromuscular hyperactivity: clonus, hyperreflexia, hypertonia, tremor, sz
Autonomic stimulation: hyperthermia, diaphoresis, diarrhea
Agitation

tx: cyproheptadine (5-HT R antagonist)

421
Q

volume of distribution

A

Vd = (amount of drug in the body) /(plasma drug concentration)

422
Q

significance of low, med, high volumes of distribution

A

low - intravascular - large, charged, or plamsa protein-bound molecules
medium - ECF - small hydrophilic molecules
high - all tissues including fat - small lipophilic and tissue protein-bound molecules

423
Q

clearance

A

CL = (rate of elimination) / (plasma concentration) = (volume of distribution) * (elimination constant Ke)

424
Q

steady state 1st order

A

in 1st order kinetics, drug infused at constant rate takes 4-5 half-lives to reach steady state and 3.3 half-lives to reach 90% of steady state level

425
Q

half life in first-order elimination

A

T1/2 = (0.7 * Vd)/CL

426
Q

therapeutic index

A

measurement of drug safety

TI = TD50 (median toxic dose) / ED50 (median effective dose)

427
Q

drugs with low TI values that need monitoring

A

Warning! These Drugs are Lethal!

Warfarin, /Theophylline, Digoxin, Lithium

428
Q

Cyp450 substrates

A

Anti-epileptics, Theophylline, Warfarin, OCPs

429
Q

sulfa drugs

A

Scary Sulfa Pharm FACTS

Sulfonamide abx, Sulfasalazine, Probenecis, Furosemide, Acetazolamide, Celecoxib, Thiazides, Sulfonylureas

430
Q

nissl substance

A

rough ER in neurons

431
Q

how do vesicles get to nerve terminals?

A

anterograde transport (kinesin)

432
Q

rheumatoid factor

A

IgM specific for Fc component of IgGfound in rheumatoid arthritis => ICs in joints

433
Q

anti-centromere Abs

A

CRESt syndrome

434
Q

anti-dsDNA Abs

A

SLE (specific)

435
Q

antimitochondrial Abs

A

primary biliary cholangitis

436
Q

antinuclear Abs

A

nonspecific

437
Q

antiphospholipid Abs

A

SLE, antiphospholipid Ab syndrome

=> hypercoagulable stae with paradoxical PTT prolongation

438
Q

sheep RBC agglutination

A

(positive monospot) - EBV

439
Q

complete hydatidiform mole

A

fertilization of empty ovum by one sperm which then duplicates => 46,XX (46,YY wouldn’t survive)
10% are due to two diff sperms

440
Q

musty body odor

A

PKU

441
Q

infections in people with neutropenia

A

gram-negative organisms like pseudomonas

442
Q

ecthyma gangrenosum

A

pseudomonas bacteremia => invasion of arteries and veins in dermis => exotoxin release (exotoxin A, elastase, phospholipase C, and pyocyanin) => skin patches with necrosis and ulceration

443
Q

mitochondrial biochemical processes

A

beta-oxidation, TCA cycle, gluconeogenesis

444
Q

cytosolic biochemical processes

A

glycolysis, FA synthesis, pentose phosphate pathway

445
Q

isoniazid and rifampin MOA

A

isoniazid - inhibits mycolic acid synth

rifampin - inhibits bacterial DNA-dependent RNA polymerase (no mRNA)

446
Q

cavernous hemangioma and complications

A

vascular malformations within the brain parenchyma

increased risk of intracerebral hemorrhage and sz

447
Q

reed-sternberg cells

A

on lymph node biopsy = Hodgkin lymphoma

big, double nuclei, owls-eyes, inclusion-like eosinophilic nucleoli

448
Q

trigeminal neuralgia sx and tx

A

sudden severe shock-like or stabbing pain in the distribution of CN V

tx with carbamazepine (slows firing frequency by increasing Na channel refractory period)

449
Q

spelinic lac sx

A

L shoulder pain, HoTN, tachycardia, hiccups (phrenic n. irritation)

450
Q

cheyne-stokes breathing

A

central sleep apnea - from CHF, brain injury

451
Q

estrogen effect on thyroid

A

estrogen => increased thyroxine-binding globulin=> decreased free T4 and T3 => increase thyroid hormone production so increased total T4 and T3 but normal free T4 and T3

452
Q

drugs that cuase lupus

A

Hydralazine, procainamide, isoniazid, monocycline, and quinidine

453
Q

orotic aciduria causes and tx

A

hereditary orotic aciduria - AR de novo pyrimidine synth mut => physical and mental retardation, megaloblastic anemia

tx with uridine supplementation

ornithine transcarbamylase deficiency (hyperammonemic encephalopathy within first few weeks of life)

454
Q

direct thrombin inhibitors

A

hirudin, lepirudin, argatroban

used for heparin-induced hrombocytopenia b/c don’t need antithrombin-III

455
Q

glomus tumor

A

bluish neoplasm under neal bed (r/o melanoma first)

glomus body is used for
thermoregulation - shunts blood away from skin in cold temp and towards in hot temp

456
Q

grapefruit juice

A

inhibits cyp450 3A in the small intestine

457
Q

how does vascular endothelium react to shear forces?

A

activated membrane receptors => increased Ca => activation of endothelial NO synthase, which makes NO from arginine, NADPH, and O2

458
Q

infective endocarditis RFs

A

mitral valve prolapse, rneumatic heart disease

459
Q

normal WBC differential

A 
Neurophils - 60%
Lymphocytes - 30%
Monocytes - 6%
Eosinophils - 3%
Basophils - 1%
Never Let Monkeys Eat Bananas
460
Q

important neutrophil chemotactic agets

A

C5a, IL-8, LTB4, Kallikrein, platelet-activating factor (PAF)

461
Q

mechanism of septic shock initiation

A

Lipid A from bacterial LPS binds macrophage CD14

462
Q

causes of eosinophilia

A

NAACP

NEoplasia, Asthma, Allergic process, Chronic adrenal insufficiency, Parsites

463
Q

eosinophil functions

A

defends against helminths via major basic protein, highly phagocytic for Ag-Ab complexes

464
Q

basophilia

A

sign of myeloproliferaive disease - especially CML

465
Q

basophil functions

A

mediate allergic reaction by release of granules containing heparin and histamine
synthesizes and releases leukotrienes

466
Q

mast cell functions

A

mediate allergic reaction in local tissues (type I hypersensitivity reactions)
can have IgE bound to membrane; cross-linking => degranulation + release of histamine, heparin, tryptase, and eosinophil chemotactic factors

inhibited by cromolyn sodium

467
Q

Langerhans cell

A

dendritic cell in skin

468
Q

locations of fetal erythropoiesis

A 
Young Liver Synthesizes Blood
3-8 wks - Yolk sac
6wks-birth - Liver
10-28 wks - Spleen
>18wks - Bone marrow
469
Q

ristocetin assay

A

ristocetin activates vWF to bind GpIb

failure of aggregation -> von Willebrand disease or Bernard-Soulier syndrome (GpIb deficiency)

470
Q

basophilic stippling

A

lead poisoning, sideroblastic anemia, myelodysplastic syndromes

471
Q

echinocyte

A

burr cell

ESRD, liver disease, pyruvate kinase deficiency

472
Q

ringed sideroblast

A

excess Fe in mitochondria

sideroblastic anemia

473
Q

spherocyte

A

hereditary spherocytosis, drug/infection-induced hemolytic anemia

474
Q

target cell

A

HbC disease, asplenia, liver disease, thalassemia

HALT, said the hunter to his target

475
Q

heinz bodies v howell-jolly bodies

A

heinz: blue in yellow cell - G6PD deficiency

Howell-Jolly - purple in red cell - asplenia

476
Q

Diamond-Blackfan anemia

A

rapid-onset anemia <1yr from erythroid progenitor cell defect
increased HbF but decreased total Hb
short stature, craniofacial abnormalities, and UE malformations

477
Q

INR

A

calculated from PT (common + extrinsic pathways)

478
Q

hemophilia A and tx

A

XR factor VIII def => increased PTT (intrinsic)

tx: ADH (=> vWF release) and factor VIII

479
Q

hemophilia B and tx

A

XR factor IX def => increased PTT (intrinsic)

tx: factor IX

480
Q

hemophilia C and tx

A

AR factor XI def = increased PTT (intrinsic)

tx: factor XI

481
Q

bernard-soulier sy

A

decreased GpIb -> decreased plt-vWF adhesion, large Plts

Increased BT, nl Plt ct

482
Q

glanzmann thrombasthenia

A

defect in GpIIB/IIIa => decreasted plt-plt adhesion

Increased BT, nl Plt ct

483
Q

immune thrombocytopenia

A

anti-GpIIB/IIIa Abs => consumption by splenic macrophages
increased megakaryocytes on BM biopsy
increased Bt, decreased plt ct
tx: steroids, IVIG, splenectomy

484
Q

thrombotic thrombocytopenic purpura

A 
ADAMTS 12 def => decreased degredation of vWF multimers => increased plt aggregation and thrombosis
schistocytes, increased LDH
Increased BT, decreased plt ct
CNS, renal, fever, thrombocytopenia, HUS
tx: plasmapheresis, steroids
485
Q

Acute myelogenous leukemia

A

auer rods, myeloperoxidase +, increased circulating myeloblasts
t(15;17) => DIC
tx: all-trans retinoic acid

486
Q

Chronic myelogenous leukemia

A

philadelphia chromosome BCR-ABL t(9;22)
overproduction of neutrophils, myelocytes, and basophils; splenomegaly
low LAP
tx: imatinib (bcr-abl tyrosine kinase inhibitor)

487
Q

t(8;14)

A

c-myc activation

Burkitt lymphoma

488
Q

t(11;14)

A

cyclin D1 activatoin

mantle cell lymphoma

489
Q

t(14;18)

A

BCL-2 activation

follicular lymphoma

490
Q

t(15;17)

A

AML (APL)

responds to ATRA

491
Q

langerhans cell histiocytosis

A

tissue DC proliferation -> lytic bone lesions and skin rash ina child
express S0100 and CD1a
tennis rackets/rods on EM

492
Q

tissues infected by HPv

A

stratified squamous epithelium
anal canal, vagina, cervix
true vocal cords
infants can get respiratory papillomatosis during birth => vocal cord wards => wek cry, hoarseness, stridor

493
Q

Li side effects

A

DI, hypoT, tremor, ebstein anomaly

494
Q

valproate side effects

A

hepatotoxicity

neural tube defects

495
Q

carbamazepine side effects

A

agranulocytosis, SIADH, neural tube defects

also used in trigeminal neuralgia

496
Q

lamotrigine side effects

A

benign rash, SJS

497
Q

c. diff contact precautions

A

handwasing with soap and water, gown, and nonsterile gloves

498
Q

causes of reactive arthritis

A

chlamydia, salmonella, shigella, yersinia, campylobacter, c. diff

499
Q

reactive arthritis HLA association

A

HLA B27

500
Q

bleeding control in postpartum hemorrhage

A

bilateral internal iliac artery ligation

collateral flow from ovarian arteries maintains uterine perfusion

501
Q

smooth ER function

A

steroid and phospholipid biosynthesis

well-developed in adrenals, gonads, an dliver

502
Q

calcipotriene

A

topical vitamin D analog used to treat psoriasis

binds vitD receptor (nuclear TF) and inhibits keratinocyte proliferation

503
Q

cyclosporine

A

NFAT inhibitor used to treat psoriasis by decreasing IL2 release and TC activation

504
Q

how long can myelin debris persist after wallerian degeneration in the CNS?

A

years; can overlap with glial scar formation

505
Q

nerves most at risk in laterally and medially displaced supracondylar humeral fracture

A

radial and median

506
Q

duchenne calf histology early and late

A

early - hypertrophy

late - pseudohypertrophy (replaced with fat and CT)

507
Q

primary prevention

A

preventing disease (health promotion)

508
Q

secondary prevention

A

dectecting disease before it causes sx (case finding, community screening)

509
Q

tertiary prevention

A

treating a disease to prevent complications (disability limitation, rehabilitation)

510
Q

temporal arteritis

A

medium + large arteries

HA

jaw and tongue claudication

polymyalgia rheumatica (neck, torso, shoulder, and pelvic girdle pain and morning stiffness with fatigue, fever, and weight loss)

sudden vision loss/blindiness

511
Q

supplements which bypasses folate

A

thymidine

512
Q

actinic keratosis

A

sun exposure => erythematous papules with central scaleand rough texture; may progress to squamous cell carcinoma

513
Q

lipofuscin

A

insoluble pigment made of lipid polymers and protein-complexed phospholipids - product of lipid peroxidation

normal aging

514
Q

PCP

A

NMDA receptor antagonist

also inhibits NE, dopamine, and 5-HT reuptake
also affects sigma-opioid receptors

515
Q

enteroccus

A

G+ cocci in pairs and chains

no hemolysis (gamma-hemolytic)

important cause of nosocomial UTIs

516
Q

Waterhouse-Friderichsen syndrome

A

complication of n. meningitidis infection => adrenal hemorrhage, DIC, and shock

517
Q

nerve at risk during appendectomy

A

iliohypogastric - sensation to suprapubic and gluteal regions, motor to anterolateral abdominal wall

518
Q

putamen location

A

medial to the insula, lateral to the globus pallidus and internal capsule

519
Q

osteoporosis labs

A

normal calcium, phosphorus, and PTH

520
Q

epinephrine + propranolol

A

epi - a1 and B1 agonist => HTN, tachycardia

propranolol - B blocker - with epi => only a1 => only vasoconstriction and reflex bradycardia

521
Q

clotting factors made by the liver

A

II, VII, IX, X

VII has shortest half life

522
Q

milrinone

A

phosphodiesterase-3 inhibitor => increased cAMP => increased calcium influx and cardiac contractility

in vascular smooth muscle, increased cAMP => vasodilation

523
Q

HSV encephalitis MRI and tx

A

abnormal signal in bilateral temporal lobes

tx: acyclovir (DNA polymerase inhibitor)

524
Q

psoas sign

A

pain with extension of the hip

525
Q

point of service v. HMO

A

point of service = HMO + allowed to see out-of-network providers for extra fees

526
Q

organisms that cause diarrhea with a small inoculum

A

shigella, giardia, entamoeba histolytica, and campylobacter

527
Q

photoaging

A

normal aging fro UV A => epidermal atrophy, decreased collagen fibril production, increased crosslinking, and increased collagen and elastin degredation

528
Q

aortic regurg

A

increased stroke volume => wide pulse pressure, bounding pulses, head bobbing

529
Q

adipose tissue response to fasting

A

activation of hormone-sensitive lipase => TG breakdown => FA and glycerol release, which the liver turns into ketone bodies and glucose

activated by catecholamines, glucagon, ACTH (stress hormones) and inhibited by insulin

530
Q

decreased aldosterone electrolyte effects

A

decreased Na reabsorption, decreased K and H excretion => non-gap metabolic acidosis and low bicarb => increased Cl retention

531
Q

niacin side effects

A

prostaglandin release => flushing, warmth, and itching

can be reduced by giving ASA

532
Q

mechanism of SOB in pulmonary edema

A

decreased compliance, increased surface tension via surfactant dilution

533
Q

role of vitamin B6

A

transamination and decarboxylation of AAs, gluconeogenesis

amino group (N) transfers eg: glutamate
uric acid cycle and protophyrin synth
534
Q

diabetes effects on adipose cells

A

insulin resistance => increased lipolysis and FA release which feedback => impaired insulin-dependent glucose uptake and increased hepatic gluconeogenesis

535
Q

lymphogranuloma venereum

A

from L1-L3 chlamydia

initial shallow painless ulcer

weeks later swollen painful inguinal buboes

histo: mixed granulomatous and neutrophilic inflammation with intracytoplasmic inclusion bodies
tx: doxycyline

536
Q

anaplastic tumors

A

complete lack of differentiation (bad)
loss of cell polarity + disruption of normal architecture
variation in shape and size of cells and nuclei (pleomorphism)
disproportionately large, dark nuclei
numerous mitotic figures
giant, multinucleated tumor cells

537
Q

bronchiolitis

A

severe if age<2, from RSV
runny nose, then wheezing/crackles, fever, and respiratory distress

can cause apnea in high-risk pts

538
Q

beta blockers in thyrotxtoxicosis

A

decreased effect of sympathetic stimulation on heart and organs

decrease rate of peripheral conversion of T4 to T3

539
Q

bleeding in renal dysfunction

A

uremic toxins => impaired plt aggregation => long BT despite nl plt ct

PT and PTT nl

tx: dialysis

540
Q

modafinil

A

psychostimulants - promote wakefulnes, used in narcolepsy

541
Q

exon v intron

A

exon -> mRNA

intron -> spliced out

542
Q

important frontal lobe areas

A

broca’s -> motor -> central sulcus -> sensory

543
Q

role of plt glycoproteins in adhesion

A

GIb attaches to vWF, which attaches to collagen in the subendothelium - this is the initial tethering event
GVI attaches directly to collagen in the subendothelium
GIIb/IIIa attaches to fibrinogen, which links neighboring platelets

544
Q

oxidizing agents

A

precipitate hemolytic anemia in G6PD

fava beans, sulfonamides, primaquine, TB drugs, and infection

545
Q

RIPE MOA

A

Rifampin - inhibits mRNA synthesis
Isoniazid - inhibits mycolic acid sythesis
Pyrazinamide - unknown mech
Ethambutol - inhibits arabinosyltransferase => dereased carbohydrate polymerization of cell wall

546
Q

HLA matching

A

match is at least 6/8 markers
little crossover withing HLA segment, so chance of sibling match is 1/4
if no exact match and no unrelated donor 6/8 match, can try haploidentical transplant from parent

547
Q

converts trypsinogen to trypsin

A

enterokinase/enteropeptidase

brush-border enzyme in duodenum and jejunum

548
Q

scurvy

A

vitamin C def => decreased activity of prolyl hydroxylase (hydroxylates proline and lysine)

549
Q

mechanism of increased bone reabsorption in hyperparathyroidism

A

PTH stimulates osteoblasts to express RANKL, which drives increased osteoclast activity (paracrine)

550
Q

bacterial ribosome inhibitors

A

buy AT 30, CCEL at 50

30s: Aminoglycosides, Tetracyclines
50s: Chloramphicol, Clindamycin, Erythomycin (and all macrolides), Linezolid

551
Q

NSAIDS

A

non-steroidal anti-inflammatory drugs
Aspirin, ibuprofen, naproxen

not acetaminophen (not anti-inflammatory b/c only blocks cox2 in the CNS)

552
Q

in situ

A

hasn’t crossed basement membrane

553
Q

drug-induced hemolytic anemia

A

positive direct coombs test

caused by penicillins, cephalosporins, other abx, and methyldopa

554
Q

substantia nigra

A 
makes dopamine
in midbrain (shorts)
pars compacta dies in parkinson's
555
Q

bile duct proliferation

A

suggests downstream bile obstruction

556
Q

PDE 5 inhibitor

A

sildenafil - blocks cGMP degredation => vascular smooth muscle relaxation

557
Q

birbeck granules

A

tennis racket/rod-shaped
langerhans cells (skin DCs)
langerhans cell histiocytosis

558
Q

steiner stain

A

h. pylori black; cells yellow

tiny black bacilli along the brush border

559
Q

ED after stroke

A

from decreased libido

560
Q

sources of glucose in starvation

A

liver, kidney make glucose from amino acids

kidney ramps up on days 5-10 while liver drops off around day 5

561
Q

long-term corticosteroid side effects

A

iatrogenic cushing sy

osteoporosis, psychosis, acne, pseudotumor, myopathy, diabetes

562
Q

hCG rule of thumb

A

10 at first missed menses
100,000 at peak (10 wks)
10,000 at delivery

563
Q

synovial pannus

A

membrane of granulation tissue over a joint affected by rheumatoid arthritis which releases inflammatory cytokines => joint destruction

564
Q

digoxin moa

A

blocks N/K ATPase => increased intracellular Na which block Na/Ca exchanger => increased Ca and thus increased contractility

565
Q

osteoblastic lesions

A

Areas of increased bone formation from osteoblast stimulation by PSA from prostate cancer

566
Q

ecological study v. cross-sectional surveys

A

ecological study: unit of analysis is population, not individual - useufl for making hypotheses but not conclusions about individuals

cross-sectional: individuals at at a given point of time

567
Q

how to diagnosis celiac disease

A

positive tissue transglutaminase igA, antiendomysial Abs, and duodenal biopsy with increased intraepithelial lymphocytes and flattened villi

568
Q

thionamides mechanism

A

methimazole, propylthiouracil
inhibit thyroid peroxidase, blocking iodine organification and coupling of iodotyrosines,

PTU also decreases peripheral conversion of T4 to T3

569
Q

spinal accessory nerve location and palsy

A

posterior triangle of neck

injury => trapezius weakness => shoulder droop, scapular winging, and impaired abduction of the arm above horizontal

570
Q

peripheral neuropathy pathophys

A

non-enzymatic glycosylation => aretiolar hyalinization and ischemic nerve damage

intracellular hyperglycemia => sorbitol buildup and osmotic damage to nerves

571
Q

structures in the right midaxillary line

A

lung until rib 8, liver starting at rib 10, and pleura in between

572
Q

thoracentesis location

A

between 6th and 8th ribs along the midclavicular line
8th and 10th ribs along midaxillary line
10th and 12th ribs along paravertebral line

573
Q

INf a and B

A

made by virally infected cells

=> synthesis of RNase L and protein kinase R => block protein synthesis only in the presense of ds RNA

574
Q

CFTR and consequences of CF

A

transmembrane Cl channel mutated in CF

=> increased Na absorption via ENaC to maintain charge balance

575
Q

nephron water permeability

A

glomerulus, PCT, and descending loop are highly permeable

ascending loop and early DCT are non-permeable,

late DCT and collecting duct depend on ADH expression

576
Q

beta blocker effect on EKG

A

slow AV nodal conduction => prolonged PR interval

no effecmit on QRS or QT

577
Q

tetrahydrobiopterin

A

cofactor in serotonin, tyrosine, and DOPA synthesis

deficiency => PKU plus serotonin deficiency (tyrosine made from phenylalanine)

578
Q

meniere disease

A

defective endolymph reabsorption => increased pressure and volume of endolymph => recurrent vertigo, ear fullness, and unilateral hearing loss/tinnitus

579
Q

G6PD deficiency inheritance

A

XR

580
Q

tissue distribution of lipophilic drugs over time

A

initially in central compartment (plasma)
quickly redistributed to well-vascularized compartment (organs, brain, heart)
slowly redistributed to poorly-vascularized compartment (skeletal muscle, bone, fat)

581
Q

where does complement bind Abs?

A

C1 binds IgG and IgM at a specific side in the constant region just behind the disulfide bonds

IgM (pentamer) initiates complement cascade via cross-linking

IgG is not a good opsonin

582
Q

where does Fc receptor bind Abs?

A

Fc receptor binds at the Fc site at the back of the constant region; may also bind the J chain of IgM and IgA

583
Q

causes of O2-hemoglobin curve R-shift

A

increased H+
increased 2,3-BPG
increased temperature

584
Q

hep C envelope protein virulence factor

A

lack of proofreading in RNA-dependent RNA polymerase => changes in envelope protein over time, faster than host defense can keep up

585
Q

major site of water reabsorption in nephron

A

proximal convoluted tubule (regardless of water status)

586
Q

erythropoietin side effects

A

HTN, clots

587
Q

abciximab MOA, use

A

blocks GP IIb/IIIa, preventing plt binding to fibrinogen

Glanzmann thrombasthenia (congenital defect of GP IIb/IIIa)
also unstable angina and ACS
588
Q

gottron papules

A

red, flat-topped papules over joints - especially hands

associated with dermatomyositis (autoimmune inflammatory myopathy

also comes with heliotrope rash (upper eyelids/eyes)

589
Q

benzo and barb MOAs

A

benzos increase freqiemcu of GABA-A receptor chloride channel opening

barbs increase duration of GABA-A receptor chloride channel opening

590
Q

lung abscess formation

A

infection => neutrophil and macrophage release of lysosomal enzymes => damage to parencyma => abscess

591
Q

picture frame vertebra cause and associated labs

A

Paget disease (disorganized bone remodeling)

elevated alk phos; nl Ca, PTH, and phosphate

592
Q

nondepolarizing NMJ blockers

A

tubocurarine, pancuronium, cisatracurium

593
Q

call exner bodies disease, gross path

A

pretty rosette with pink middle, white ring, then purple ring of cells

theca cell tumor

makes estrogen, yellow on gross from fat content

594
Q

lung volume with lowest pulmonary vascular resistance

A

functional residual capacity

balances increased resistance from increased length at high volumes and increased resistance from compression at low volumes

595
Q

Osler-Weber-Rendu syndrome

A

hereditary hemorrhagic telangiectasia

AD => telangiectasias in skin and mucous membranes => epistaxis, GI bleeding, and hematuria

596
Q

maneuvers that worsen left ventricular outflow tract obstruction

A

anything that decreases preload or afterload

sudden standing, valsalva, nitroglycerin

597
Q

renal angiomyolipoma

A

benign tumor made of blood vessels, smooth muscle, and fat

if bilateral, associated with tuberous sclerosis

598
Q

Crohn’s disease

A

abdominal pain, diarrhea with occult blood

transmural inflammation with skip lesions
noncaseating granulomas
linear ulcers

599
Q

ulcerative colitis

A

abdominal pain, bloody diarrhea, mild fever

mucosal + submucosal inflammation extending continuously from the rectum

600
Q

most posterior heart chamber and structure posterior to it

A

left atrium

descending aorta

601
Q

polymyositis

A

increased MHC I expression on sarcolemma => autoimmune myocyte destruction

=> symmetrical proximal muscle weakness, elevated CK, autoAbs

602
Q

tetrodotoxin

A

from pufferfish

inactivates v-gated Na channels in nerve and heart tissue => decreased depolarization

603
Q

essential tremor inheritance and treatment

A

AD

propranolol

604
Q

Zidovudine

A

(AZT) NRTI

used fro HIV - thymidine analog without 3’-OH group => chain termination b/c can’t form 3’-5’ phosphodiester bond

605
Q

most common form of homocystinuria and tx

A

AR cystathione synthase deficiency

tx with pyridoxine supplementation (B6) and restrict dietary methionine

606
Q

pituitary apoplexy history, sx, tx

A

pt with preexisting pituitary adenoma (HA, decreased libido) develops bacute hemorrhage into the pituitary

=> severe HA (sudden), bitemporal hemianopsia, hypotension (ACTH def) and death

tx: glucocorticoids

607
Q

pyruvate dehydrogenase deficiency

A

X-linked; can’t link glycolysis and CAC => pyruvate buildup => lactic acidosis

tx: ketogenic diet - high fat, low carb, moderate protein - lysine and leucine

608
Q

ketogenic amino acids

A

lysine and leucine

can’t be metabolized to pyruvate; only actyl-CoA

609
Q

neutrophil chemotactic agents

A

IL-8, n-formylated peptides, leukotriene B4, 5-HETE, C5a

610
Q

arginase deficiency, sx, tx

A

can’t make urea and ornithine from arginine

=> elevated arginine, spastic diplegia, abnormal movements, and growth delay

no hyperammonemia unlike other urea cycle defects

tx: low-protein, arginine-free diet

611
Q

rathke pouch embryonic origin

A

surface ectoderm

612
Q

treatment for agitation and psychosis in delirium

A

low-dose antipsychotics (haloperidol)

613
Q

cystic artery

A

supplies gallbladder

splits from hepatic artery

614
Q

hereditary hemochromatosis

A

HFE missense mutation => impaired Fe sensing at liver => increased intestinal Fe absorption, high ferritin, and organ damage

615
Q

cellular components of atherosclerotic plaques and proliferative stimuli for this

A

smooth muscle, driven by PDGF from Platelets

616
Q

mech for easy bruising in Crohn’s

A

bile acid malabsorption => fat-soluble vitamin def => vitK def > impaired coagulation

617
Q

alcohol dependence medications

A

naltrexone -blocks mu opioid receptor; can start while still drinking
disulfiram - blocks aldehyde dehydrogenase => SEs with drinking
Acamprosate - affects glutamate; only start once abstinent

618
Q

MOA for hypercalcemia in sarcoidosis

A

PTH-independent formation of 1,25, vit D by activated macrophages => increased intestinal Ca absorption

619
Q

interscalene nerve block side effect

A

diaphragmatic paralysis via ipsilateral phrenic nerve root anesthesia

620
Q

candida immune defense

A

local - TCs, systemic - neutrophils

621
Q

Henoch Schonlein Purpura

A

(HSP)
kids, post-infectious small-vessel autoimmune vasculitis with IgA and C3 ICs

=> palpable purpura, AP, and arthralgias; can progress to glomerulonephritis

622
Q

juvenile myoclonic epilepsy and tx

A

idiopathic, generalized, may be familial

=> myoclonic sz of both UEs - generalized b/c involves both cerebral hemispheres - just after waking up

broad-spectrum anticonvulsant (valproic acid)

623
Q

emancipated minor

A

homeless, parent, married, military service, financially independent, high school graduate

624
Q

medically emancipated minor

A

emergency care, STIs, substance abuse, pregnancy care (not termination), contraception

2/3 of states require parental consent prior to abortion + 1/3 requires notification but not consent

625
Q

tissues with B1 adrenergic Rs

A

cardiac tissues
renal juxtaglomerular cells
not vascular smooth muscle

626
Q

cytotoxic purine analogs and metabolism

A

6-MP and 6-TG - chemo drugs
activated by HGPRT
inactivated by xanthine oxidase and thiopurine methyltransferase in the liver

need to reduce dose by 75% if getting allopurinol too

627
Q

phenytoin side effects

A

gingival hyperplasia, ataxia, nystagmus, megaloblastic anemia

P450 inducer

628
Q

isoniazid metabolism

A

actetylation in liver

629
Q

alveolar hyperventilation

A

hypocapnia (low PaCO2)

can be from V/Q mismatch from pneumonia or PE => hypoxemia and increased respiratory drive

630
Q

GLUT-4 fcn and tissues

A

insulin-mediated glucose uptake

muscle cells and adipocytes

631
Q

GLUT 1,2,3,5 fcn and tissues

A

insulin-independent glucose uptake

brain, intestine, RBCs, kidney, liver

Drugs (5 decks)

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