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Drugs > STEP1 deck 4 > Flashcards

STEP1 deck 4 Flashcards

1
Q

Nitroprusside OD

A

metabolized to NO and cyanide => cyanide poisoning

cyanide blocks ETC

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2
Q

cyanide toxicity tx

A 
sodium thiosulfate (enhances cyanide metabolism by rhodanese)
also give hydroxocobalamin and sodium nitrite
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3
Q

omalizumab

A

anti-IgE Ab for severe asthma

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4
Q

hypertrophic cardiomyopathy histology

A

myofiber disarray with interstitial fibrosis

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5
Q

impaired clotting factor carboxylation

A

vitamin K deficiency

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6
Q

carotid sinus reflex

A

afferent: baroreceptors in carotid sinus to vagal nucleus via CN IX
efferent: CN X

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7
Q

saphenous vein

A

medial leg; drains into femoral vein near the pubic tubercle

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8
Q

vit D deficiency affects on Ca, phosphate, and PTH

A

low Ca, low phosphate, high PTH

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9
Q

AV node blood supply

A

PDA (can be from RCA or LCx coronary artery depending on dominance)

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10
Q

hydroxychloroquine SE

A

retinopathy

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11
Q

MTX SEs

A

ulcers, alopecia, BM suppression, hepatotoxicity, and pulmonary fibrosis

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12
Q

gonadal artery origin and venous drainage

A

abdominal aorta just below the renal arteries

L vein drains into renal vein while right drains into IVC

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13
Q

isoniazid hematologic SE

A

causes deficiency of active vit B6, which is required by ALA synthase (rate-limiting step in heme synth) => sideroblastic anemia

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14
Q

ovarian cancer protective factors

A

combined OCPs, multiparity, breastfeeding, and salpingo-oophorectomy

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15
Q

renal cell carcinoma origin

A

(clear cell carcinoma)

from epithelium of the PCT

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16
Q

sirolimus

A

binds FKBP, which blocks mTOR, interrupting IL-2 signalling

used as an immunosuppressant in transplant pts

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17
Q

multiple myeloma complications

A

hypercalcemia from bone destruction
immunosuppression
amylid (AL) deposition => renal failure

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18
Q

how avoid FA synth/beta ox futile cycle?

A

Malonyl-Coa is made in the rate-limiting step of FA synth and inhibits mitochondrial carnitine acyltransferase (needed for beta-ox)

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19
Q

isolated systolic hypertension

A

aortic stiffening - age-related

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20
Q

reverse T3

A

inactive T3 mostly made from T4 (exogenoust T3 => less T4 via feedback => less rT3)

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21
Q

juxtaglomerular cell origin

A

modified smooth muscle cells

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22
Q

leg lymph drainage

A

lateral foot to popliteal and then inguinal; medial straight to inguinal

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23
Q

isolated prolonged PT cause

A

factor VII deficiency (only factor in extrinsic pathway)

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24
Q

ezetimibe moa

A

inhibits cholesterol absorption at the brush border

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25
Q

spleen histo in SCD kids and adults

A

kids - congestion during exacerbations

adults - hemosiderosis, fibrosis, and atrophy (autosplenectomy)

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26
Q

Osler-Weber-Rendu sy

A

hereditary hemorrhagic telangiectasia

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27
Q

Sturge-Weber sy

A

encephalotrigeminal angiomatosis (facial and leptomeningeal angiomas)

associated with mental retardation, sz, hemiplegia, track-track calcifications

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28
Q

fenofibrate

A

lowers TG levels by activating PPARa => decreased VLDL production and increased LPL activity

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29
Q

post-tussive emesis

A

pertussis (unimmunized kids or adults who haven’t had boosters)

no fever in paroxysmal phase

G- coccobacillus

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30
Q

Wernicke encephalopathy mechanism

A

B1 deficiency => decreased transketolase activity (PPP) => impaired glucose utilization; buildup => mammillary body destruction

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31
Q

NF-kB

A

proinflammatory TF that => increased cytokine production

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32
Q

buspirone

A

only for GAD, slow onset

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33
Q

epithelial ovarian cancer marker

A

CA-125

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34
Q

dermatomyositis ca associations

A

ovarian, lung, CRC, non-Hodgkin lymphoma

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35
Q

CN III palsy

A

down and out, mydriasis, and ptosis

aneurysm at PCA/ internal carotid junction

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36
Q

GAS main VF

A

protein M on cell surface blocks phagocytosis and complement activation

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37
Q

kyphoscoliosis and high plantar arch

A

friedrich ataxia

also hypertrophic cardiomyopathy

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38
Q

polymyositis presentation, labs, histo

A

insidious onset of proximal muscle weakness

elevated CK, ANA, and anti-Jo (histidyl-tRNA synthetase)

endomysial infiltrate and patchy necrosis

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39
Q

omeprazole

A

proton pump inhibitor

reduced HCL from H2, vagal, and gastrin signalling

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40
Q

PAD tx

A

graded exercise program

and cilostazol

plt phosphodiesterase inhibitor => increased cAMP => decreased aggregation

also => arterial vasodilation

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41
Q

B blockers in diabetics

A

reduce SNS response to hypoglycemia; avoid in diabetics

retain cholinergic sx of hypoglycemia: sweating, hunger, and paresthesias

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42
Q

syndrome similar to vit E def

A

friedreich ataxia (ataxia, loss of position and vibration sense, and loss of DTRs)

subacute combined degeneration from B12 def

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43
Q

hepatitis mech for increased HCC risk

A

hep B - turnover from active infection, then persistence of HBV DNA in host genome (p53 inactivation)

hep C - only turnover from active infection (no RT)

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44
Q

depersonalization/derealization disorder

A

feeling like an outside observer
experiencing surroundings as unreal

intact reality testing

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45
Q

dissociative amnesia

A

can’t recall personal info after trauma

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46
Q

dissociative identity disorder

A

discontinuity in identity and loss of agency with fragmentation into 2 or more distinct personalities

associated with severe trauma

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47
Q

ribavirin use and MOA

A

HCV, RSV

guanosine nucleoside analog, blocks RNA polymerase

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48
Q

EMB agar

A

lactose fermenters (e. coli) make green metallic sheen

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49
Q

leukemoid reaction histo

A

increased band cells, myelocytes, and granules (Dohle bodies) in neutrophils

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50
Q

Hartnup disease

A

AR neutral AA transporter def

=> niacin def => pellagra-like sx

tx: high-protein diet and B3

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51
Q

lymphedema complication

A

cutaneous angiosarcoma (Stewart-Treves sy) poor prognosis

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52
Q

internal laryngeal nerve function and cause of lesion

A

cough reflex

food lodged in piriform recess

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53
Q

triple sugar iron agar

A

shigella doesn’t make H2S

salmonella and proteus do make H2S (black color)

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54
Q

main shigella VF

A

ability to invade mucosal M cells

also make shiga toxin but that’s less important

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55
Q

rabies post-exposure prophylaxis

A 
rabies immune globulin
rabies vaccine (inactivated vaccine)
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56
Q

azathioprine

A

immunosuppressant
metabolized to 6-MU, a purine analog that blocks purine (IMP) synthesis

concentration greatly increased by allopurinol

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57
Q

common mech of aminoglycoside resistance

A

drug-modifying enzymes (eg acetylation)

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58
Q

ataxia telangiectasia

A

AR DNA damage repair deficiency (ionizing radiation)

=> cerebellar atrophy, oculocutaneous telangiectasias, immunodeficiency, cancer risk

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59
Q

venous insufficiency and complications

A

involves superficial veins, can => non-healing ulcers

but doesn’t increase DVT risk b/c that happens in deep veins

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60
Q

insulin for postprandial hyperglycemia

A

monomeric (rapid-acting) insulin

lispro, aspart, glulisine

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61
Q

papillary muscle blood supply

A

anterior - dual from LAD and LCx

posterior - PDA

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62
Q

NADPH role in metabolism

A

used in cholesterol and FA synth, glutathione antioxidant mechanism

63
Q

tracheal deviation towards completely opaque R lung field

A

R mainstem bronchus intubation

64
Q

increased hemoglobin A2 cause and mut

A

(a2d2)
beta-thalassemia minor
beta-globulin mRNA transcription, processing, or translation problem

65
Q

resistance in a blood vessel

A

viscosity * length / r^4

66
Q

heteroplasmy

A

different mitochondrial genomes within a single cell

67
Q

mech for myocyte swelling in ischemia

A

lack of ATP => failure of Na/K ATPases and sarcoplasmic reticulum Ca ATPases => increased intracellular Na and Ca => swelling

68
Q

Rb checkpoint

A

G1-S

69
Q

cyclosporin + tacrolimus moa

A

immunosuppressants

inhibit calcineurin, which is needed for IL-2 production

70
Q

Reye sy histo

A

microvesicular steatosis

71
Q

main source of Hep B transmission

A

vertical, then sex and ivdu

72
Q

increased risk of drug-induced SLE

A

slow acetylators

73
Q

familial retinoblastoma cancers

A

retinoblastoma early, osteosarcoma later

74
Q

additional joints affected by RA

A

cervical spine

75
Q

common melanoma mutation

A

BRAF V600E

76
Q

hep B histo

A

ground glass hepatocytes with homogenous, pale eosinophilic cytoplasm

77
Q

myeloma cast nephropathy

A

excessive free light chain production from multiple myeloma => renal failure with large, glassy, intensely eosinophilic casts on microscopy

78
Q

ANCA

A

antineutrophil cytoplasmic Abs

79
Q

adenocarcinoma in situ

A

doesn’t invade but grows along alveolae and can transform

80
Q

t(14;18) v t(14;8)

A

t(14;18) => Bcl-2 overexpression => follicular lymphoma

t(14;8) => c-myc overexpression => Burkitt lymphoma

81
Q

nursemaid’s elbow

A

kids; radial head slides out of the annular ligament which holds it to the ulna

82
Q

arteries with most atherosclerosis

A

lower abdominal aorta, coronary arteries

83
Q

inhaled anesthetic arteriovenous concentration gradient

A

determined by solubility in peripheral tissues; if high, onset of action will be slow

84
Q

PPARy

A

intracellular nuclear receptor; target of thiazolidinediones (pioglitazone)

85
Q

anti-PLA2R Abs

A

IgG, anti-podocyte

idiopathic membranous nephropathy

86
Q

cause of low HbA1C

A

increased RBC turnover

87
Q

terbinafine MOA

A

inhibits fungal squalene epoxidase, blocking ergosterol synth

88
Q

vitamin missing in vegan diet

A

B12

89
Q

role of sunlight in vit D metabolism

A

7-dehydrocholesterol -> cholecalciferol

90
Q

pulmonary actinomycosis

A

actinomyces aspiration => lower lobe consolidation with air bronchograms and sulfur granules (purple and fuzzy on H&E, yellow grossly)

91
Q

bacterial causes of septic abortion

A

staph aureus
E. coli
GBS

92
Q

heparin reversal

A

protamine (protected area)

93
Q

silicosis v berylliosis

A

silicosis: eggshell hilar calcifications, birefringent particles
berylliosis: nodular /irregular opacities, granulomatous

94
Q

enzyme related to likelihood of cholesterol plaque rupture

A

stability of plaque depends on strength of fibrous cap; metalloproteinases from macrophages in the plaque can degrade ECM => rupture

95
Q

PDA (severe) findings

A

differential clubbing and cyanosis without BP or pulse discrepancy between UEs and LEs

96
Q

mitral prolapse murmur

A

midsystolic click folowwed by systolic murmur best heard at the apex; disappears with squatting

97
Q

gamma-glutamyl carboxylase

A

activates factors II, VII, IX, and X

needs vit K

98
Q

femoral nerve block site

A

inguinal crease at the lateral border of the femoral artery

99
Q

familial hypocalciuric hypercalcemia mut

A

decreased Ca sensitivity from mut in calcium-sensing R (transmembrane GPCR)

100
Q

nondepolarizing NMJ block eg and train-of-four stim test

A

vecuronium

fading pattern - less Ach released with each impulse

101
Q

depolarizing NMJ block eg and train-of-four stim test

A

succinylcholine
phase I - constant, diminished
phase 2 - fading pattern

102
Q

blastomyces histo

A

dimorphic

warm: large broad-based budding yeast
cold: branching hyphae

103
Q

opiate moa

A

activate mu receptor (Gi) => reduced Ca influx and thus less presynaptic neurotransmitter release

also open postsynaptic K channels => K efflux and membrane hyperpolarization

104
Q

collagen structure

A

Gly-X-Y

105
Q

high-grade CIN

A

atypical cells invaded beyond the lower 1/3 of the cervical epithelium (to the epithelial surface) but not over the BM

106
Q

BMI

A

Kg/m^2

107
Q

diabetic ophthalmoplegia

A

iscemia => central infarction of CNIII

down + out eye, ptosis, but no miosis

108
Q

glossopharyngeal nerve fcn

A

CN IX - jugular foramen
motor to stylopharyngeus (elevates larynx for swallowing)
PNS to parotid gland
sensory to TM, eustacian tube, posterior tongue, tonsils, upper pharynx, carotid body, and carotid sinus
taste to posterior third of tongue

109
Q

superficial inguinal ring

A

opening in the external oblique muscle aponeurosis

110
Q

transaminases

A

AST + ALT

111
Q

a1 targets

A

peripheral vasculature
bladder
eye

112
Q

B1 targets

A

heart

113
Q

B2 targets

A

peripheral vasculature of skeletal muscle
bronchi
uterus

114
Q

dystrophin role

A

links actin cytoskeleton to dystrophiglycans in ECM

115
Q

relative erythrocytosis

A

(low blood volume)

identified by normal RBC mass

116
Q

spinal metastasis presentation

A

constant pain, worse at night, not positional

117
Q

embryonic origin of ductus arteriosus

A

6th aortic arch

118
Q

musculocutaneous n fcn

A

forearm flexors and lateral forearm sensation

119
Q

congenital torticollis

A

malposition in utero or birth trauma => contracture by 2-4wks; kid prefers head to one side and may have muscle lump

120
Q

papillary thyroid cancer histo

A

large cells with nuclei containing finely dispersed chromatin with a ground-glass appearance (orphan annie eye)

121
Q

blastomyces histo

A

at 25 degrees, branching hyphae

on biopsy, large round yeasts with single broad-based bud

122
Q

migratory superficial thrombophlebitis

A

(Trousseau sy) associated with cancer - from hypercoagulability 2/2 visceral adenocarcinomas

123
Q

splitting in VSD v ASD

A

ASD => fixed splitting

VSD => wide splitting

124
Q

most common cause of septic arthritis in young adults

A

disseminated gonococcal infection

125
Q

competitive testosterone receptor inhibitors

A

flutamide, cyproterone, and spironolactone

126
Q

diltiazem mech and SEs

A

nondihydropyridine CCB used for AF, Afluter

block L-type Ca channels

SE: donstipation, AV block

127
Q

testosterone-secreting tumor in a femal

A

sertoli-leydig cell tumor of the ovary

from sex cord stroma; secretes testosterone

128
Q

shaken baby sy

A

subdural hemorrhage and retinal hemorrhage

129
Q

inhales amyl nitrite indication and mech

A

cyanide poisoning
oxidizes Fe2 in hemoglobin to Fe3 (=> methemoglobinemia), so it binds up the cyanide, preventing it from binding and inhibiting cytochrome C in mitochondria

130
Q

potassium concentration in filtrate throughout nephron

A

100% filtered, then 65% absorbed in PCT, 30% more absorbed in loop of henle and DCT, then varying secretion in DCT

131
Q

lynch sy sx and mut

A

CRC, endometrial, and ovarian ca

MSH2, MLH1, MSH6, or PMS2 mut

132
Q

HiB labs and VF

A

G- coccobacillus that requires factors V and X to grow

VF: polysaccharide capsule

133
Q

subacute granulomatous thyroiditis path and histo

A

painful thyroid enlargement following a viral illness => transient hyperthyroid sx

inflammatory infiltrate with macrophages and giant cells

134
Q

ACL/PCL locations

A

at the level of the tibial plateau, the ACL is anterior and the PCL is posterior

135
Q

long-term glucocorticoid therapy feedback

A

decreased CRH => decreased ACTH => decreaased aldosterone

136
Q

basic A. A.s

A

his lies are basic
histidine
lysine
arginine

137
Q

most common cause of osteomyelitis in SCD + features

A

salmonella

hydrogen sulfide producer (black color), type 3 secretion system

138
Q

HIV dementia path and histo

A

inflammatory activation of microglial cells => microglial nodules around small areas of necrosis

139
Q

glial scar

A

made of astrocyte processes

140
Q

opsoclonus-myoclonus syndrome

A

nonrhythmic conjugate eye movements and involuntary jerking movements of the trunk and limbs

if <2yo, think neuroblastoma

141
Q

sudan stain

A

stool test for lipids

identifies malabsorption

142
Q

hypercalcemia in multiple myeloma

A

calcium released from bone breakdown => decreased PTH and vit D

143
Q

pityriasis versicolor

A

hypopigmented spots - caused by malassezia yeasts - on KOH see “spaghetti and meatballs”
tx: topical antifungals

144
Q

chlordiazepoxide

A

long-acting benzo

145
Q

cutaneous small vessel vasculitis and histo

A

medication-induced palpable purpura

perivascular inflammation of small blood vessels with fibrinoid necrosis

146
Q

tourette disorder

A

motor and vocal tics for > 1 yr

147
Q

tryptase

A

released by mast cells in anaphylaxis

148
Q

ammonia transporters

A

a-ketoglutarate, glutamate, and alanine

149
Q

atypical depression

A

mood reactivity, leaden paralysis, rejection sensitivity, increased sleep and appetite

150
Q

VIPoma, sx, and tx

A

pancreatic islet tumor
watery diarrhea, hypokalemia, and achlorydia
tx = somatostatin to decrease VIP production

151
Q

carcinooid heart disease

A

excess 5-HT => fibroblast growth => fibrous tissue deposition around valves in endocardium and R heart failur

152
Q

GI areas vulnerable to ischemia

A

watershed areas

splenic flexure and rectosigmoid junction

153
Q

bullous impetigo

A

has bullae and is usually caused by staph aureus

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