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Drugs > STEP1 deck 3 > Flashcards

STEP1 deck 3 Flashcards

1
Q

gas gangrene bacterium, toxin

A

clostridium perfringens

lecithinase (alpha toxin/phospholipase C) => phospholipid splitting => cell lysis, tissue necrosis, and edema

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2
Q

newborn Turner syndrome findings

A

post. neck mass (cystic hygroma)
extremity edema
diminished femoral pulses (aortic coarctation)

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3
Q

SLE-specific Abs

A

anti-dsDNA Ab in 60%

anti-snRNP (anti-Smith) Ab in 20%

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4
Q

antimitochondrial Abs

A

primary biliary cirrhosis

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5
Q

rheumatoid factor

A

anti-IgG Fc IgM - RA an other collagen tissue disorders

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6
Q

anti-centromere Abs

A

CRESt syndrome

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7
Q

most common cause of community-acquired pneumonia

A

strep pneumoniae

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8
Q

medullary thyroid cancer association, origin, and histo

A

MEN2

parafollicular calcitonin-secreting C cells

sheets of polygonal cells with extracellular amyloid deposits (congo-red +)

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9
Q

chronic AV fistula

A

SNS + renal compensation for initially decreased TPR => increase contractility, vascular tone, and blood volume

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10
Q

free v. ER-attached ribosome protein product destinations

A

free - proteins bound for cytosol, nucleus, peroxisome, and mitochondria

attached - proteins bound for PM + nuclear membrane, ER, golgi, and lysosomes

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11
Q

causes of polyhydramnios

A

increased fetal urination (parvovirus, hemorrhage)

impaired fetal swallowing (obstruction, anencephaly)

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12
Q

anorexia nervosa tx

A

CBT, nutrition

Olanzapine (antipsychotic that => weight gain)

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13
Q

bulimia nervosa tx

A

CBT, nutrition

Fluoxetine (SSRI)

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14
Q

binge-eating disorder tx

A

CBT, weight loss therapy, SSRI, lisdexamfetamine, topiramate

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15
Q

imperforate hymen

A

at birth => mucocolpos => bulging itroitus

at menarch => primary amenorrhea + hematocolpos => pelvic pain

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16
Q

mechanism of hepatic encephalopathy

A

hyperammonemia => increased glutamate uptake and glutamine production within astrocytes => increased osmolarity and impaired glutamine release => decreased glutamate available to neurons and decreased excitatory neurotransmission

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17
Q

structures near parts of the duodenum

A

duodenum hugs pancreas
1st part: R gastroepiploic; intraperitoneal
(2-4 retroperitoneal)
2nd part: head of pancreas
3rd part: between abdominal aorta and SMA
4th part: becomes jejunum at ligament of Treitz

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18
Q

phenoxybenzamine

A

irreversible a1 and a2 adrenergic antagonist

used to block NE effects from pheochromocytoma

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19
Q

phentolamine

A

reversible, competitive a-antagonist

used to block NE effects from pheochromocytoma

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20
Q

Rett syndrome

A

X-linked dominant (mostly girls) MECP2 mut

=> normal development for 5-18mos, then regression of motor and language skills, slowed head growth, and hand twisting

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21
Q

mechanism for development of esophageal varices

A

cirrhosis => increased pressure in portal vein => L + R gastric veins, => esophageal veins

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22
Q

pulsus paradoxus

A

drop > 10 mmHg in BP during inspiration

tamponade, constrictive pericarditis

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23
Q

Initial cells infected by Shigella

A

M (microfold) cells at base of Peyer patch

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24
Q

cutaneous neurofibroma tissue type, origin, and association

A

benign nerve sheath neoplasm made of schwann cells
derived from neural crest
associated with NFT I (von Recklinghausen)

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25
Q

characteristics of drugs with low volume of distribution

A

(trapped in plasma compartment)

high molecular weight, binding to plasma proteins, high charge, hydrophilicity

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26
Q

components of LPS

A 
O antigen
core polysaccharide
lipid A (responsible for toxic properties => sepsis
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27
Q

rate limiting step in acyclovir action

viruses it works on and doesn’t

A

monophosphorylation by viral thymidine kinase

more effective against HSV and VZV than EBV and CMV b/c make different thymidine kinases.

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28
Q

ADH effect on urea and secondary benefit

A

(vasopressin)
activates urea transporters in the medullary collecting duct, which transport urea down gradient (now that more H2O reabsorbed) => decreased urea excretion

secondary benefit is more urea in interstitium allows more H2O absorption in loop of Henle

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29
Q

aortic regurg murmur and location

A

early diastolic murmur best heard at left sternal border

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30
Q

medications that => immediate rash and mechanism

A

opioids, contrast, and vancomycin

IgE- independent mast cell degranulation by activation of PKA and PI3 kinase

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31
Q

hyperacute transplant rejection timing, mech, gross appearance, and histo

A

min-hrs
preformed anti-graft Abs
mottling and cyanosis
arterial fibrinoid necrosis and capillary thrombotic occlusion

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32
Q

acute transplant rejection timing, mech, and histo

A

<6 mos
donor ag => activation of naive immune cells
C4d, neutrophilic infiltrate, and necrotizing vasculitis, or
lymphocytic interstitial infiltrate and endotheliitis

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33
Q

chronic transplant rejection timing, mech, and histo

A

mos-yrs
chronic, low-grade response
vasculat wall thickening, luminal narrowing, interstitial fibrosis and parenchymal atrophy

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34
Q

cancers associated with Down syndrome

A

ALL, AML

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35
Q

elevated alk phos follow-up test

A

GGTP to confirm from liver, not bone

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36
Q

chronic kidney disease effect on PTH and Ca

A

decreased GFR => decreased phosphate clearance => increased Ca binding => hypocalcemia

decreased vitamin D activation in kidneys also => hypocacemia

hypocalcemia => secondary hyperparathyroidism

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37
Q

lidocaine mech and use

A

class IB antiarrhythmic that binds inactivated Na channels and rapidly dissociates

preferentially works in depolarized, ischemic, tissue; no QRS prolongation

used for ventricular arrythmias post-MI

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38
Q

fibrate function and side effect

A

(fenofibrate, gemfibrozil)
upregulate LPL

inhibit cholesterol 7a-hydroxylase => decreased bile acid synth => cholesterol gallstones

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39
Q

mitral valve opening on pressure tracing

A

when LV pressure falls below LA pressure

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40
Q

sulfonylureas and meglitinides MOA and SEs

A

(glypizide, glyburide, blimepiride) increase insulin secretion by blocking pancreatic B-cell potassium channels

hypoglycemia (less with glypizide b/c short-acting), weight gain

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41
Q

metformin MOA and SEs

A

stimulates AMPK, decreasing glucose production and insulin resistance

lactic acidosis

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42
Q

thiazolidinediones, MOA, and SEs

A

pioglitazone and rosiglitazone

activate PPAR-y (TF) => decreased insulin resistance

fluid retention, weight gain

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43
Q

exenatide, liraglutide MOA and SEs

A

GLP-1 agonists

increased glucose-dependent insulin secretion, decrease glucagon secretion, delay gastric emptying

pancreatitis

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44
Q

sitagliptin and saxagliptin MOA and SEs

A

inhibit DPP4 => increased endogenous GLP-1 and GIP levels

nasopharyngitis

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45
Q

acarbose and miglitol MOA and SEs

A

a-glucosidase inhibitors => reduced intestinal disaccharide absorption

diarrhea, flatulence

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46
Q

canagliflozin and dapagliflozin MOA and SEs

A

inhibit SGLT2 => increased renal glucose exretion

UTIs, hypotension

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47
Q

1st and 2nd most common causes of meningitis in adults

A

strep pneumoniae, then neisseria meningitidis

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48
Q

PSGN histo, EM, and IF

A

enlarged, hypercellular glomeruli (leukocyte infiltration and cell proliferation)

epithelial humps

starry sky IgG and C3 deposits

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49
Q

things below the left sternal border at the 2nd and 4th intercostal spaces

A

2nd: pulmonary trunk
4th: right ventricle

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50
Q

mech of zenker diverticulum formation

A

cricopharyngeal motor dysfunction => dysphagia => increased pressure => herniation => diverticulum (false)

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51
Q

why is pus green?

A

neutrophil myeloperoxidase (catalyzes HClO production during respiratory burst)

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52
Q

pO2 at altitude

A

can be in the 50s

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53
Q

porcelain gallbladder cancer association

A

gallbladder adenocarcinoma

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54
Q

strawberry v. cherry hemangioma

A

strawberry is the most common benign vascular tumor in children (bright red, sharply demarcated borders, regress by age 5)

cherry is the most common benign vascular proliferation in adults (small bright red cutaneous papules; don’t regress)

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55
Q

nerve at risk curing thyroidectomy and muscle it innervates

A

external branch of the superior laryngeal n.

cricothyroid muscle

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56
Q

thyroid hormone receptor type

A

intracellular zinc finger TF

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57
Q

arteries commonly affected by spontaneous deep intracerebral hemorrhage and cause

A

penetrating branches (eg lenticulostriate arteries)

from hypertensive vasculopathy

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58
Q

renal vein thrombosis pathophys and presentation

A

nephrotic syndrome => excretion of antithrombin II => renal vein thrombosis (flank pain, hematuria, new left-sided varicocele, and elevated LDH)

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59
Q

most common urea cycle disorder, labs, and mech

A

ornithine transcarbamylase deficiency

=> carbamoyl phosphate buildup => increased pyrimidine synth => orotic aciduria

loss of urea cycle function also => hyperammonemia

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60
Q

wegener’s granulomatosis Abs and target

A

C-ANCA

neutrophil proteinase 3

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61
Q

pip-tazo mechanism

A

piperacillin - beta lactam

tazobactam - beta lactamase inhibitor

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62
Q

beta lactamase inhibitors

A

tazobactam, clavulanate, sulbactam

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63
Q

tetralogy of fallot development

A

abnl neural crest cell migration => deviation of the infundibular septum (between aorta and pulmonary artery) => VSD and overriding aorta

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64
Q

glycerol kinase

A

liver enzyme that catalyzes conversion of glycerol from TGs to Glycerol 3-phosphate, which can then => glucose

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65
Q

short acting benzos

A

<6 hrs triazolam, oxazepam, midazolam

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66
Q

intermediate acting benzos

A

6-24 hrs
ATOM
alprazolam, temazepam, oxazepam, lorazepam

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67
Q

long acting benzos

A

> 24 hrs

diazepam, chlordiazepoxide, flurazepam

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68
Q

age 3 milestones

A

play imaginatively in parallel, speak in 3 word sentences, copy a circle, use utensils, and ride a tricycle

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69
Q

anti-pseudomonal drugs

A

cefepime, ceftazidime, pip-tazo, ciprofloxacin, levofloxacin, aminoglycosides, carbapenems

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70
Q

effects of hyperventilation in cerebral edema

A

drop in PaCO2 => vasoconstiction => decreased cerebral blood volume => decreased ICP

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71
Q

cystic medial degeneration

A

myxomatous degeneration with pooling of proteoglycans (ECM) and basket weave pattern in the media of large arteries => aortic aneurysm

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72
Q

brown kidney stones

A

bilirubin stones from biliary tract infection

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73
Q

black kidney stones

A

bilirubin stones from hemolysis

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74
Q

irreversible complication of ASD

A

pulmonary vascular sclerosis from pulmonary HTN => Eisenmenger

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75
Q

mech of radiation for Ca

A

dsDNA breaks + free radical formation => DNA damage

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76
Q

side effects of inhaled anesthetics

A

decreased CO, increased internal pressures

respiratory depression

decreased CNS vascular resistance and increased cerebral blood flow => increased ICP

decreased RPF and GFR

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77
Q

ventricular response in AFib

A

depends on AV node refractory period => rate of 90-170

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78
Q

purkinje pacemaker rate

A

<40 bpm

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79
Q

matrix metalloproteinases and overactivation

A

degrade collagen other ECM proteins -> wound contraction

increased MMP activity => contracture

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80
Q

arachnoid granulations, route of damage, and consequences

A

(villi) - allow CSF to enter the sinuses => bloodstream

damaged 2/2 meningeal infection (eg TB meningitis) or subarachnoid hemorrhage

=> communicating hydrocephalus

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81
Q

mech for neuro sx of B12 deficiency

A

B12 is cofactor for methylmalonyl-CoA mutase and methionine synthase, so def => elevated methylmalonic acid and homocysteine => dysruption on myelin synthesis => subacute combined degeneration

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82
Q

primary location of nitro action

A

large veins

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83
Q

PAH

A

paraaminohippuric acid

freely filtered and secreted by carriers in the PCT

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84
Q

peau d’orange

A

itchy, erythematous rash with firm, coarse skin and brease edema

inflammatory breast cancer => lymphatic obstruction

poor prognosis

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85
Q

poor prognostic factors in PSGN

A

increased age, pre-existing kidney disease

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86
Q

electrolyte abnormality in babies with CF

A

hyponatremia from excessive salt wasting in sweat

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87
Q

GI sx of CREST sy

A

Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactyly, Telangiectasia

Esophageal dysmotility is from atrophy and fibrous replacement of th emuscularis in the lower esophagus => GERD

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88
Q

targets of deep brain stimulation in Parkinson

A

globus pallidus internus, subthalamic nucleus (indirect pathway)

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89
Q

electrolyte abnormality associated with ganulomas

A

(sarcoid, TB)
macrophages make activated vitD => hypercalcemia

also in some lymphomas

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90
Q

diptheria treatment

A

in order of importance:
diptheria antitoxin (passive immunization)
penicillin or erythromycin
DPT vaccine

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91
Q

gallstone ileus formation and sx

A

large gallstone => fistula between gallbladder and duodenum, then gets lodged in the terminal ileum => small bowel obstruction, pneumobilia (gas in biliary tree and gallbladder)

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92
Q

papilledema mech

A

increased ICP compresses optic nerves => impaired axoplasmic flow => optic disc edema

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93
Q

isoproterenol

A

(iso-pro-tunnel)
B1 + B2 agonist
=> increased CO (HR and contractility) and decreased SVR (vasodilation)

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94
Q

Li-Fraumeni sy

A

AD p53 mut

=> leukemia, sarcomas, breast, brain, and adrenal cancer

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95
Q

idiopathic /familial pulmonary arterial hypertension

A

EMPR2 mut => endothelial smooth muscle proliferation => luminal narrowing, intimal fibrosis

tx: lung transplant, vasodilators, bosentan

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96
Q

bosentan

A

endothelin-receptor antagonist

used in idiopathic pulmonary arterial hypertension

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97
Q

lung transplant chronic rejection

A

mos-yrs
major cause of mortality
inflammation of small bronchioles (bronchiolitis obliterans)

diff from vascular rejection in kindey/abdominal transplants

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98
Q

blotchy red muscle fibers on Gomori trichrome stain

A

(ragged red fibers)
mitochondrial myopathy
maternally inherited

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99
Q

3 common mitochondrial myopathies

A

myoclonic epilepsy with ragged red fibers (MERRF)

leber optic neuropathy (blindness)

mitochondrial encephalopathy with stroke-like episodes and lactic acidosis (MELAS)

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100
Q

mycobacterium avium complex sx, distinguishing features, tx, and prophylaxis

A

CD4 <50
more anemia, hepatosplenomegaly, elevated alk phos and LDH than in TB

grows best at 41 C

tx with macrolide + rafabutin or ethambutol

prophylax with azithromycin

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101
Q

reticulocyte appearce

A

large, blue on Wright-Giemsa stain b/c of ribosomal RNA

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102
Q

auer rods

A

stain positively for myeloperoxidase

found in APL

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103
Q

campylobacter transmission

A

fecal-oral

can be spread by domestic animals and contaminated food

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104
Q

optimal site for femoral vascular access

A

common femoral artery below the inguinal ligament

if above, increase risk of retroperitoneal hemorrhage which can’t be controlled via compression

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105
Q

common 5a-reductase deficiency presentation

A

small phallus, hypospadias

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106
Q

left frontal lobe lesion sx

A

apathy, depression

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107
Q

right frontal lobe lesion sx

A

disinhibition

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108
Q

non-dominant parietal lobe lesion (right) sx

A

hemi-neglect, apraxia

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109
Q

dominant parietal lobe lesion (left) sx

A

Gerstmann syndrome (right/left confusion, difficulty with writing and math)

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110
Q

metyrapone stimulation test

A

blocks 11-B-hydroxylase => reduced cortisol => increased pituitary ACTH secretion => increased 17-hydroxycortisone production

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111
Q

carrier regenerated by anaerobic lactate formation

A

NAD+, needed for glycolysis

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112
Q

congenital hypothyroidism

A

initially normal, then maternal T4 wanes

lethargy, enlarged fontanelle, protruding tongue, umbilical hernia, poor feeding, constipation, dry skin, and jaundice

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113
Q

colchicine indications and SEs

A

used for gout in people who can’t take NSAIDS (ulcers)

=> diarrhea, nausea, vomiting, and AP

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114
Q

Wilson’s disease

A

AR Cu retention

=> liver accumulation, eventually liver damage => cu escape => Kayser-Fleischer rings, basal ganglia atrophy

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115
Q

krukenberg tumor and histo

A

primary gastric cancer that metastasizes to ovaries

signet ring cells from mucin displacing the nucleus

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116
Q

snRNP function

A

spliceosome

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117
Q

spinal muscular atropy

A

mutation in SMN1 gene => imapired assembly of snRNPs in lower motor neurons => loss of splicing => flaccid paralysis, degeneration of anterior horn cells in spinal cord

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118
Q

location of most deoxygenated blood

A

coronary sinus because myocardial oxygen extraction is very high

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119
Q

most common cause of extramedullary hematopoiesis

A

severe chronic hemolytic anemia (B-thalassemia)

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120
Q

imaging to diagnose toxic megacolon and causes of same

A

abdominal XR

from ulcerative colitis and c. diff.

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121
Q

rotator cuff muscles and functions

A

supraspinatus - abduction
infraspinatus - external rotation
teres minor - adduction, external rotation
subscapularis - adduction, internal rotation

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122
Q

causes of hyaline arteriolosclerosis

A

chronic poorly controlled HTN

diabetes mellitus

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123
Q

developmental source of female internal genitalia

A

paramesonephric ducts (mullerian)

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124
Q

sotalol

A

class III antiarrhythmic (K channel blocker) used to treat AFib

prolongs QRS => long AT and torsades

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125
Q

abetalipoproteinemia histo and sx

A

AR, no apoB, so no chylomicrons or LDL

lipids accumulate in enterocytes

malabsorption, low plasma TG and cholesterol, ADEk deficiency => neuro changes

126
Q

muscles sandwiching the median nerve

A

flexor digitorum profundus and superficialis

127
Q

dengue fever transmission

A

aedes mosquito

128
Q

chikungunya transmission

A

aedes mosquito

129
Q

dysmorphic features of Down syndrome

A

epicanthal folds, upslanting palpebral fissures, protruding tongue, excessive skin at nape of neck

130
Q

AV node location

A

inside the right atrium, on the interatrial septum, near the tricuspid valve and the orifice of the coronary sinus

131
Q

solutes whose concentrations increase along the PCT

A

PAH, creatinine, inulin, urea

132
Q

solutes whose concentrations decrease along the PCT

A

bicarb, glucose, amino acids

133
Q

compensatory behaviors in bulimia

A

vomiting, fasting, exercise, laxatives, enemas, diuretics, diet pills

134
Q

cal’gram of protein, carbs, ethanol, and fat

A

protein and carbs - 4 cal/g
ethanol - 7 cal/gram
fat - 9 cal/gram

135
Q

appendectomy landmark

A

convergence of the three teniae coli

136
Q

digoxin metabolism

A

renally cleared

137
Q

landmark separating direct and indirect inguinal hernia

A

inferior epigastric vessels

138
Q

cause of S4

A

reduced ventricular compliance

139
Q

cause of S3

A

early ventricular filling

140
Q

amiodarone

A 
class III antiarrhythmic
blocks K channels, prolonging repolarization => long QT

little risk of torsades b/c consistent throughout heart

141
Q

diastolic heart failure

A

decreased LV compliance (hypertrophy from HTN, MI, amyloid)

=> increased LV pressure with normal LV volume and EF

142
Q

gardnerella tx

A

metronidazole or clindamycin

143
Q

stages and main complications of acute tubular necrosis

A

initiation: ischemic injury
maintenance: fluid overload, hyperK
recovery: diuresis, hypo-K, Mg, PO4, Ca

144
Q

McCune-Albright syndrome

A

mosaic GNAS mut => constitutive G protein action and hormone overproduction

=> precocious puberty, cafe-au-lait spots, polyostiotic fibrous dysplasia

can => thyrotoxicosis, acromegaly, and cushing sy

145
Q

allergic contact dermatitis histo

A

type IV hypersensitivity

spongiosis (edema => highlighting of intercellular bridges)

acanthosis and hyperkeratosis (raised scaly plaques) happen with prolonged exposure, like in eczema

146
Q

penicillin structure + mech

A

similar to D-ala-D-ala

inhibit transpeptidase

147
Q

mech for anemia in lead poisoning

A

Pb inhibits ferrochelatase and ALA dehydratase in heme biosynthesis

148
Q

hairy cell leukemia sx and histo

A

slow BC cancer => BM fibrosis and massive splenomegaly

lymphocytes with cytoplasmic projections

149
Q

builds up in Niemann-Pick

A

sphingomyelin

150
Q

builds up in Tay-Sachs

A

ganglioside (GM2)

151
Q

builds up in Fabry

A

blobotriaosylceramide

152
Q

builds up in Gaucher

A

glucocerebrosid

153
Q

builds up in Krabbe

A

galactocerebroside

154
Q

builds up in metachromatic leukodystrophy

A

sulfatides (cerebroside sulfate)

155
Q

parotitis lab changes

A

elevated serum amylase

156
Q

glucagonoma

A

pancreatic alpha cell tumor => DM2 and necrolytic migratory erythema

elevated painful, pruritic rash affecting face, groin, and extremities - central brown/bronze clearing

157
Q

osteomyelitis common location

A

metaphysis of long bones - mostly kids

158
Q

ovarian venous drainage

A

left ovarian vein -> left renal vein -> IVC

right ovarian vein -> IVC

159
Q

95% confidence interval

A

mean +/- 1.96 *(SD/(n)^.5)

160
Q

medications that can cause hyperkalemi

A

nonselective B blockers, ACEis, ARBs, K-sparing diuretics, digoxin, NSAIDS

161
Q

K-sparing diuretics

A

amiloride, triamterene, spironolactone

162
Q

duodenal atresia mech

A

failure of recanalization (8-10 wks)

double-bubble, down sy

163
Q

jejunum/ileum atresia mech

A

vascular injury in utero

apple-peel deformity, bilious emesis, abdominal distension

164
Q

most specific RA Ab

A

anti-CCP (cyclic citrullinated peptide) Abs

165
Q

polyarteritis nodosa histo and association

A

multisystem involvement, biopsy with segmental transmural inflammation of small to medium arteries and fibrinoid necrosis

can be associated with hep B

166
Q

true cyst v. pseudocyst

A

true cyst is lined by epithelium

pancreatic pseudocyst is lined by granulation tissue and fibrosis

167
Q

fifth disease

A

erythema infectiosum
parvovirus B19
slapped cheek rash, then lacy trunk/extremities rash
replicated in erythrocyte precursors

168
Q

atherosclerosis fibrous cap formation

A

cytokines promote vascular smooth muscle cell proliferation and synthesis of ECM proteins => cap

169
Q

Mesna MOA and use

A

antioxidant which inactivates toxic metabolites in urine

given with cyclophosphamide to reduce risk of hemorrhagic cystitis

170
Q

McArdle and labs

A

muscle glycogen phosphorylase def

increased CK, no lactate produced during exercise

171
Q

I-Cell disease mech, histo, presentation

A

N-acetylglucosamine-1-phosphate transferase deficiency

can’t target proteins from golgi to lysosome and accidentallly secrete them instead (inactivated tho)

lysosomes don’t work so get inclusion bodies

presents like Hurler’s, with developmental delay, “gargoylism”, airway obstruction, corneal clouding, hepatosplenomegaly

172
Q

candida gram strain

A

elliptical purple budding organisms

173
Q

cause of persistent truncus arteriosus and association

A

absent cardiac neural crest

associated with DiGeorge Syndrome

174
Q

ash leaf

A

tuberous sclerosis

175
Q

shunt v dead space

A

shunt: V/Q = 0 (no ventilation)

dead space: V/Q = infinite (no perfusion)

176
Q

G+ filamentous branching rods

A

nocardia, actinomyces

177
Q

gram indeterminate bacteria

A

don’t stain

chlamydia, m. pneumoniae, rickettsia

178
Q

gardnerella gram stain

A

gram variable - red or purple

179
Q

main source of bias in case-control studies

A

biased recall of exposure

180
Q

cimetidine and specific side effects

A

H2 blocker, used for GERD

inhibits P450; reduced metabolism of drugs like diazepam (long-acting benzo)
also => gynecomastia, impotence, and elevated prolactin

181
Q

Zollinger-Ellison staining

A

tumor stains + for gastrin

182
Q

nitro mechanism

A

increases cGMP in vascular smooth muscle (grump)

183
Q

parietal cell histo

A

pink, tooth-shaped, dark nucleus

184
Q

feature and example of fast-acting inhaled anesthetic

A

low blood:gas partition coefficient => low blood solubility => fast onset and short duration
nitrous oxide

185
Q

potency of an inhales anesthetic

A

1/Mean Alveolar Concenctraiton

186
Q

acute tubular necrosis v. acute interstitial nephritis

A

ATN is from ischemic injury => oliguria

AIN is from drugs/toxins - type IV hypersensitivity => fever, rash, renal failure

187
Q

PCOS labs

A

decreased FSH, increased LH: increased LH:FSH ratio
increased testosterone
increased insulin (insulin resistance)

188
Q

regulation of androgen and estrogen production in women

A

LH tells theca cells to make androgens

FSH tells granulosa cells to turn them into estrogen

189
Q

GI blood supply

A

celiac trunk: liver, spleen, to 1st part of duodenum
SMA: duodemum to ascending colon
IMA: transverse colon to rectum

190
Q

structure most at risk from SMA occlusion

A

jejunum b/c no collateral circulation (in middle of SMA territory)

191
Q

Klinefelter’s and presentation

A

XXY
small, scrotal testes
infertility
tall, gynecomastia

192
Q

meningitis causes in neonates

A

GBS, e. coli, listeria

193
Q

meningitis causes in children

A

strep pneuoniae, neisseria, HiB, enteroviruses

194
Q

meningitis causes in adults

A

strep pneumoniae, neisseria, enteroviruses, HSV

195
Q

meningitis causes in elderly

A

strep pneumoniase, gran - rods, listeria

196
Q

horseshoe kidney surgery complications

A

anomalous blood supply

197
Q

buspirone

A

anxiolytic, used in GAD and as a supplement in MDD

presynaptic 5HT agonist, low addictive potential

198
Q

schizophrenia treatment

A

atypical antipsychotics - mostly treat positive sx

risperidone, clozapine, quetiapine, olanzepine, aripiprazole

199
Q

MDD with psychosis treatment

A

combo of antipsychotics and antideperessants, or ECT

200
Q

sites of acute and chronic mesenteric ischemia

A

acute - SMA

chronic - celiac, SMA, IMA

201
Q

lamivudine

A

NRTI (dine suffix)
sir lancelot
also used for hep B

202
Q

enfuvirtide

A

fusion inhibitor, binds gp41

203
Q

niacin MOA and SEs

A

vitamin B3

raises HDL
decreases hepatic VLDL secretion => decreased TGs and LDL

SE: flushing (prevent with NSAIDs), hyperglycemia, hyperuricemia, hepatotoxicity

204
Q

hyperparathyroidism GI consequences

A

hypercalcemia => elevated gastrin => ulcers

calcium stimulates gastrin release from G cells

205
Q

structure inferior to ovary

A

ureter

206
Q

kallikrein

A

trigger for intrinsic clotting pathway (PTT)
activates bradykinin
tumor marker - PSA

207
Q

Reye syndrome mech and presentation

A

viral infection in a kid treated with ASA inhibits mitochondria => hepatic encephalopathy

hypoglycemia, vomiting, hepatomegaly, coma, cerebral edema

208
Q

lamellar bodies

A

secretory organelles found in type II pneumocytes and keratinocytes

209
Q

most common site for sacular aneurysm

A

(berry aneurysm)

women: posterior communicating artery
men: anterior cerebral artery

210
Q

myxoma

A

pedunculated benign heart tumor, can block mitral valve

most common heart tumor in adults

211
Q

rhabdomyoma

A

benign heart tumor

most common heart tumor in kids

212
Q

p. vivax and ovale

A

add primaquine to normal chloroquine, b/c hide out in liver

213
Q

tx for chloroquine-resistant malaria

A

atovaquone/proguanil

214
Q

tx for life-threatening malaria

A

quinidine or artesunate

215
Q

cleft lip cause

A

maxillary prominence fails to fuse with intermaxillary segment

week 5-6

216
Q

cleft palate cause

A

palatine shelves fail to fuse with another or wih primary palate

week 5-6

217
Q

angiogenesis signals

A

VEGF

FGF-2 (fibroblast growth factor)

218
Q

cell type that does glycolysis without generating any ATP and enzyme responsible

A

erythrocytes
sometimes make 2,3-BPG on the way to pyruvate, which decreases hemoglobin O2 affinity but skips the ATP generating step

requires bisphosphoglycerate mutase

219
Q

MHC I structure

A

heavy chain and B2-microglobulin

220
Q

MHC class II structure

A

alpha and beta polypeptide chains

221
Q

polyceythemia vera labs and mech

A

increased RBCs, Plt, and WBC. decreased epo

caused by constitutively active JAK2 (epo R downstream signalling)

222
Q

parvovirus sx in adults

A

acute symmetric arthralgias of hands, wrists, kneees, or feet +/- rash

223
Q

parvovirus fetal infection sx

A

interrupted erythropoiesis => anemia, CHF, and hydrops fetalis (pleural effusions with secondary pulmonary hypoplasia and ascites)

224
Q

koplik spots

A

measles (rubeola)

225
Q

paroxysmal nocturnal hemoglobinuria complications

A

anemia, jaundice, thrombosis, pancytopenia, hemosiderosis (Fe deposition in the kidney)

226
Q

cytokine driving giant cell arteritis and tx

A

IL-6

tocilizumab (anti-IL-6 Ab)

227
Q

retroperitoneal abdominal organs

A 
SAD PUCKER
Suprarenal (adrenal) glands
Aorta and IVC
Duodenum (2-4)
Pancrease (head+body)
Ureters and bladder
Colon (not transverse)
Kidneys
Esophagus
Rectum
228
Q

claudication cause

A

PAD (atherosclerosis)

229
Q

mechanism for kidney stones in Crohn’s

A

damage to terminal ileum => decreased bile acid reabsorption => impaired fat absorption => increased bowel lipids binding Ca in gut => decreased Ca absorption => decreased Ca-oxalate complexes => increased oxalate absorption => oxalate kidney stones

230
Q

trisomy 18 and neonatal sx

A

Edwards syndrome

micrognathia, prominent occiput, low-set ears

clenched hands with overlapping fingers, rocker-bottom feet, hip problems

heart and renal defects

231
Q

chloramphenicol MOA and SEs

A

ribosomal 50S subunit inhibitor

reversible anemia, leukopenia, and thrombocytopenia

irreversible severe aplastic anemia

232
Q

HLA I v HLA II serotypes

A

HLA I: -A, -B, -C

HLA II: -DP, -DQ, -DR

233
Q

amatoxin source and sx

A

poisonous mushrooms
block mRNA synthesis (RNA polymerase II) in liver cells => apoptosis

6-24 hrs post-ingestion develop AP, vomiting, and severe possibly bloody diarrhea, then acute hepatic and renal failure

234
Q

area of highest airway resistance

A

medium-sized bronchi (generations 2-5) b/c highly turbulent airflow

235
Q

aspiration pneumonia microbes and treatment

A

anaerobic oral flora 9bacteroides, prevotella, fusobacterium, and peptostreptococcus) mixed with aerobic bacteria

clindamycin works on oral anaerobes and covers G+ aerobes

236
Q

AML v. CML

A

AML has band cells

CML has mature cells (myelocytes and metamyelocytes)

237
Q

CML v. leukemoid reaction

A

CML has decreased leukocytes alk phos b/c abnl cells

Leukemoid reaction has normal or high alk phos

238
Q

type of infarction in pulmonary embolism

A

hemorrhagic 2/2 dual blood supply to lung

239
Q

cause of PE in INDU

A

septic pulmonary emboli from tricuspid valve endocarditis (multiple)

240
Q

Hep B viral replication sequence

A

dsDNA -> +RNA template -> protein and dsDNA progeny

uses reverse transcriptase

241
Q

dihydropyridine CCBs and SEs

A

amlodipine, nifedipine

LE edema, lightheadedness

242
Q

trigeminal neuralgia v. cluster HA timing

A

TN: seconds
cluster: 30 min - 1hr

243
Q

theophylline toxicity

A

theophylline = adenosine R antagonist and PDE inhibitor used for asthma and COPD

metabolized by cyp, which is inhibited by ciprofloxacin

sx: tremor, insomnia, sz, hypotension, tachycardia, and arrhythmias

244
Q

cause of skin retractions in breast cnacer

A

invasion of the suspensory ligaments (cooper ligaments)

245
Q

Kiesselbach plexus

A

common site of epistaxis at the anterior nasal septum

246
Q

PCP v meth sx

A

both cause violence and psychosis

PCP => nystagmus, ataxia, memory loss, and hallucinations

meth => diaphoresis, tachycardia, HTN, choreiform movements, and tooth decay

247
Q

upper motor neuron lesions

A

spasticity, rigidity, hyperreflexia, babinski sign

248
Q

lower motor neuron lesions

A

flaccid paralysis, hypotonia, hyporeflexia, atrophy, and fasciculations

249
Q

most common cause of retinitis in HIV and treatment

A

CMV, when CD4 <50

tx: ganciclovir (more specific for CMV DNA polymerase than acyclovir)

250
Q

main site of PAH secretion

A

PCT

251
Q

K-sparing diuretics mechanism and location of action

A

late DCT and collecting duct; antagonize aldosterone

252
Q

chlorpheniramine MOA and SEs

A

1st gen antihistamine (like benadryl) that blocks central and peripheral H1 Rs

main SE is sedation

253
Q

alpha fetoprotein tumor associations

A

hepatocellular carcinoma

germ cell tuors

254
Q

CA 19-9 tumor associations

A

pancreatic ca

255
Q

CA 125 tumor associations

A

ovarian ca

256
Q

carcinoembryonic antigen tumor associations

A

gastrointestinal (colorectal) cancer

257
Q

hCG tumor associations

A

choriocarcinoma

germ cell tumors

258
Q

causes of vitamin A deficiency

A

low intake, malabsorption (pancreatic insufficiency, biliary obstruction)

259
Q

familial chylomicronemia

A

defect in LPL or ApoC-2
elevated chylomicrons
acute pancreatitis, xanthomas

260
Q

familial ypercholesterolemia

A

deftect in LDL R or ApoB-100
elevated LDL
premature atherosclerosis, tendon xanthomas

261
Q

familial dysbetalipoproteinemia

A

defect in ApoE
elevated chylomicron and VLDL remnants
premature atherosclerosis, palmar xanthomas

262
Q

familial hypertriglyceridemia

A

polygenic
elevated VLDL
MI, pancreatitis, diabetes

263
Q

celecoxib

A

selective COX 2 inhibitors

anti-inflammatory; lower risk of GI ulceration and bleeding (don’t impair platelet aggregation)

264
Q

adenovirus characteristics and sx

A

dsDNA

year-round, self-limiting pharyngoconjunctival fever (fever, cough, congestion, pharyngitis, and conjunctivitis)

265
Q

area affected by Hirschsprung disease

A

rectum

266
Q

attachments of patellar ligament

A

tibial tuberosity to patella to rectus femoris tendon

267
Q

Osgood-Schlatter disease

A

overuse injury of secondary ossification center of the tibial tubercle (insertion pt of patellar ligament)

ligament separation => pain and swelling

adolescent athletes

268
Q

sulfonylurea eg and moa

A

glyburide

increase insulin secretion of remaining pancreatic B cells

269
Q

thiazolidinedione eg and moa

A

rosiglitazone, pioglitazone

increases insulin sensitivity, GLUT4 expresion, and adipocyte differentiation via PPARy

270
Q

lag changs in lactos intolerance

A

increased breath hydrogen content
reduced stool pH
elevated stool osmolality

271
Q

abdominal aortic aneurysm pathophys

A

chronic transmural inflammation => macrophages release metalloproteinases which degrade ECM => weakening and expansion of the aortic wall

272
Q

organ most resistent to ischemia from embolism

A

liver (dual blood supply)

273
Q

lab determinants of progmosis in pts with cirrhosis

A

measures of liver function more important than liver injury

low albumin, high bilirubin, and long prothrombin time (PT)

274
Q

chancroid

A

haemophilus ducreyi

1 or more deep painful ulcers with yellow/gray exudate; school of fish on microscopy

275
Q

granuloma inguinale

A

(donovanosis)
klebsiella granulomatis
progressive lesions w/o lymphadenopathy, with granulation tissue on base and G- intracytoplasmic cysts

276
Q

most common COD in pts with diabetes

A

coronary heart disease

277
Q

most common site of H. pylori infection

A

gastric prepyloric antrum

278
Q

Wallerian degeneration histo

A

Axonal reaction: cellular swelling and irregularity, with nucleus displaced to periphery and dispersed Nissl substance

279
Q

enzyme which activates procarcinogens

A

hepatic microsomal cytochrome P450 monooxygenase

280
Q

griseofulvin MOA

A

blocks fungal mitosis

281
Q

nystatin MOA

A

binds fungal ergosterol

same as amphotericin B

282
Q

azole MOA

A

inhibit synthesis of fungal ergosterol

283
Q

echinocandin eg and moa

A

caspofungin

inhibit synthesis of glucan (fungal cell wall component)

284
Q

flucytosine moa

A

converted to 5-FU inside fungal cell and blocks RNA synth

285
Q

unilateral hearing loss, facial numbness, and facial weakness

A

acoustic scwannoma

located at the cerebelloponine angle

286
Q

arsenic poisoning sx and tx

A

garlic breath, vom, watery diarrhea, long QT

dimercaprol and DMSA

287
Q

burkitt lymphoma mutation

A

t(8;14) => constitutively active c-Myc (transcription activator)

288
Q

main mechanism of excess copper removal

A

hepatic excretion into bile and elimination in stool

289
Q

urine darkens on light + air exposure

A

(not turns blue)

acute intermittent porphyria

290
Q

acute intermittent porphyria treatment

A

heme and glucose (downregulate ALA synthase)

291
Q

pineal gland location and ca sx

A

tiny little guy between the midbrain and the corpus callosum

causes obstructive hydrocephalus by blocking aqueduct => papilledema, HA, vom)
compresses midbrain => loss of upward gaze

292
Q

neurons lost in huntington’s

A

GABA neurons in the striatum (caudate and putamen)

293
Q

lymphatic drainage of the rectum proximal and distal to the dentate line

A

proximal: inferior mesenteric LN -> internal iliac LN
distal: inguinal LNs

294
Q

SLE lab abnormalities

A

anemia, leukopenia, thrombocytopenia
low complement, increased ICs
positive ANA, anti-dsDNA, and anti-Smith

295
Q

frameshift mutation

A

insertion of deletion of a number of bases not divisible by 3 int the coding region

eg 28 bp deletion

296
Q

bowel disease that => fistulas

A

Crohn disease

297
Q

Paraneoplastic cerebellar degeneration

A

small cell lung, breast, ovarian, and uterine

anti-Yo, anti-P/Q, and anti-Hu antibodies against tumor cells cross-react with Purkinje cells in the cerebellum

298
Q

most important RF for aortic dissection

A

HTN (++.intimal tear => dissection)

also cystic medial degeneration if Marfan’s

299
Q

artery torn in epidural hematoma and origin

A

middle meningeal artery, from maxillary artery (branch of external carotid)

300
Q

LP location

A

L3/L4 or L4/L5 space

landmark = highest points of iliac crests = L4 level

301
Q

c-ANCA

A

cytoplasmic antineutrophil cytoplasmic antibody
recognizes lysosomal enzymes of neutrophils and monocytes

found in Wegener’s

302
Q

Tc-pertechnetate scan

A

nuclear medicine procedure that highlights parietal cells of the gastric mucosa

increased uptake in RLQ means Meckel diverticulu

303
Q

absent vas defens

A

CF

304
Q

cromolyn

A

mast cell-stabilizing agent

inhibits degranulation, used in asthma

305
Q

olanzapine SEs and monitoring

A

metabolic syndrome

monitor weight, BP, fasting glucose, and lipid profile

same for clozapine

306
Q

Zollinger-Ellison association

A

gastrin-secreting Pancreatic tumor

associated with MEN 1

307
Q

acute hemolytic transfusion reaction

A

type II hypersensitivity reaction

Abs => complement-mediated cell lysis

308
Q

diphenoxylate

A

binds mu opiate receptors

used for diarrhea

can cross BBB so combined with atropine

309
Q

peripheral lung cancers

A

adenocarcinoma (most common), large cell carcinoma

310
Q

Kussmaul sign

A

paradoxical rise in JVP with inspiration

sign of constrictive pericarditis

Drugs (5 decks)

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