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Flashcards in Test 30 Deck (86):
1

first line therapy for pts w/ hypercholesterolemia

statins

2

MOA of statins

competitively inhibit HMG CoA reductase> DECREASED cholesterol synthesis>
upregulation of LDL receptors>
increased uptake of LDL from circulation>
lowers LDL

3

affect of cholestyramine on hepatic cholesterol production

INCREASES hepatic cholesterol production

4

how do bile acid binding resins like cholestyramine work?

bile acid binding resins bind BA in GI tract>
BA can't be recycled>
hepatic synthesis of new bile acids>
consumes liver cholesterol>
hepatic uptake of LDL from circualtion is increased> activates HMG Co A reductase>
increased cholesterol synthesis

5

why do we give combination of simvastatin w/ cholestyramine

together they increase hepatic uptake of cholesterol>
lower LDL

6

origin of chromaffin cells of adrenal medulla and parafollicular cells

NCC

7

what causes tumors in BOTH the adrenal medulla and the thyroid?

germ-line mutation in NCC seen in MEN syndromes 2A and 2B

8

Increased urinary VMA excretion and adrenal mass

pheochromocytoma

assoc w/ MEN 2A and 2B

9

tumor:
pituitary
parathyroid
pancreas

MEN 1

10

tumor:
medullary thyroid cancer
parathyroid
pheo

Men 2A

11

medullary thyroid cancer
neuromas
pheo

Men 2B

12

genetic defect assocaited w/ MEN 2A and 2B

RET proto-oncogene> afffects multiple endocrine organs b/c they all have the same origin (NCC)!!

13

arises from the 4th pharyngeal pouch and fuse iwth thyroid follicular cells to form the thyroid gland

parafollicular cells

14

parafollicular cells

C cells
assocaited w/ thyroid
secrete calcitonin> TONES DOWN Ca

15

autoimmune destruction of parietal cells (chronic atrophic gastritis)

pernicious anemia

16

secrete HCL and IF and are found in the SUPERFICIAL region of gastric glands

parietal cells

17

progressive fatigue
lower extremity paresthesias
megaloblastic RBC

atrophy of gastric body and body (where parietal cells are) and normal antrum

pernicious anemia

18

loss of parietal cells w/ lymphocytic and plasma cell infiltraiton

chronic atrophic gastritis (autoimmune gastritis)

19

oxyntic cells found in the UPPER GLANDULAR layer that secrete acid and IF

parietal cells

20

TP

Sensitivity * number of pts w/ disease

21

FN

(1-sensitivity) * (number of pts w/ disease)

22

leads to acute renal failure and precipitation of Ca oxalate crystals in renal tubules> ca oxalate crystals in urine

AG metabolic acidosis
increased osmolar gap

ethylene glycol ingestion

23

each tRNA can bind a few different codons for the same AA

wobble

24

catalase negative

streptococci

25

catalase positive

staphylococci

26

beta hemolytic
bacitracin susceptible
pyrrolidonyl arylamidase positive

GAS

27

bile soluble
optochin susceptible

strep pneumoniae

28

dark urine
facial puffiness
pustular skin lesions that broke down and formed thick scabs on lower extemities
urine w/ RBC cell casts

Impetigo- caused by S. pyogenes

*staph is MC cause

29

PYR (pyrrolidonyl arylamidase) test

specific for s. pyogenes (bacitracin test is nto very specific)

30

associated w/ prior strep pharyngeal or skin infection

glomerulonephritis

31

pain and numbness of the dorsum of the right foot
can't dorsiflex right ankle

peroneal nerve

32

MC nerve injured in the leg

common peroneal nerve

superficial location around the lateral neck of hte fibula

**lateral blows, tight plaster casts

33

sciatic nerve braches

common peroneal nerve
tibial nerve

34

superficial branch of peroneal nerve

innervates muscles of the lateral compartment of hte leg

gives off braches that provide sensory innervation to majority of foot

EVERTS foot

35

innervates anterior compartment of hte leg, muscles dorsiflex foot and toes

deep peroneeal nerve

36

regulates circadian rhythm

suprachiasmatic nucleus

SLEEP to be charasmatic

(processes light info from the retina and relays it to ohter hypothalamic nuclei and pineal gland to modulate body temp and production of hormones like cortisol and melatonin

37

tx for insomnia associated w/ jet lag

melatonin

38

stimulated by leptin
mediates satiety

ventromedial

if you zap your ventromedial nucleus you'll grow ventarlly and medially

39

inhibited by leptin
triggered when you're HUNGRY

lateral nucleus (lesion you shrink LATERALLY)

40

cooling via PNS
destruction leads to hyperthermia

Anterior

AC needed for anterior cooling

41

mediates heat conservation via sns
destruction leads to hypothermia

posterior nucleus

zap your POSTERIOR nuceuls you become a poikilotherm (snake)

42

secretes DA
GHRH
GnRH

arcuate

43

ADH
CRH
oxytocin
TRH

paraventricular

44

supraoptic

ADH
oxytocin

45

what causes increased afterload, excess fluid retention and cardiac remodeling in a pt w/ CHF?

compensatory activation of RAS and SNS leads to an increase in HR, vasoconstriction and ECV

46

What causes CHF?

heart is unable to pump a sufficient amt of blood to meet body's metabolic demands>
decreased CO

47

decreased CO seen w/ CHF leads too...

compensatory neurohumoral stimulation to maintain BP

48

pulsus paradoxus

decrease in systolic BP greater than 10 mmHG w/ inspiration

49

cuases of pulsus paradoxus

acute cardiac tamponade**
constrictive pericarditis
severe obstructive lung disease
restrictive cardiomyopathy

50

what causes pulsus paradoxus

increased right ventricular volume that occurs with inspiration pushes hte interventriculiar septum LEFT

so left heart volume/stroke volume are reduced leading to decreased system blood pressure during inspiration

*normally, inspiration causes an increase in systemic venous return, causing the RV to expand into hte pericardial space w/ litle impact on left side of the heart. Can't do that when heart is RESTRICTED

51

pulsus paradoxus can occur insettings of severe obstructive pulmonary disease like asthma. who do you tx this?

beta adrenergic agonists

control actue asthma exacerbatoins by causing bronchial SMOOTH MUSCLE RELAxation by increasing cAMP

52

MC pathogen causing cystitisa nd acute pyelonephritis

E. coli

53

second MC uUTI in sexually active owmen

staph saprophyticus

54

when should screening for group B strep occur in pregnant women?

vaginal rectal culture at 35-37 weeks to identify women who require INTRAPARTUM antibiotics

55

What intrapartum antibiotics are used to prevent neonatal GBS sepsis, pneumonia and meningitis

peniciliin
ampcillin

56

first line therapy for tx of acute gouty arthritis

NSAIDS> COX inhibitor

colchicine is second line d/t nausea and diarrhea

Glucocorticoids in pts w/ renal failure

57

Recurrent respiratory infection by Pseudomonas, chronic diarrhea, FTT

+ early sibling death from pulmonary infection

CF

58

cause of steatorrhea and FTT in pt w/ CF

pancreatic insuficiency

59

tx for CF pt w/ pancreatic insufficiency

pancreatic lipase

60

decreass gut motility, blood flow, and endocrine/exocrine pancreatic function (decreass secretion of pancreatic enzymes into intestine)

octreotide

61

causes depolarization of bacterial cellular membrane and inhibition of DNA/RNA and protein synthesis

Daptomycin

62

SE of Daptomycin

increased CPK (creatine phosphokinase)
myopathy

63

TU daptomycin

gram + orgs (MRSA)

64

drugs commonly used for invasive MRSA

vanco
dapto
linezolid

65

blocks glycopeptide polymerization by binding tightly to D alanyl D alanine

vancomycin

66

depolarizes cell membrane

daptomycin

67

inhibits bacterial protein synthesis by binding 50S

linezolid

68

red man syndrome

vanco

69

thrombocytopenia
optic neuritis
high risk for 5HT syndrome

linezolid

70

prevention of red man syndrome

pre treatment w/ antihistamines and slow infusion rate

71

irreversible effects on COX

NSAID

72

selective COX2 inhibitor

Rofecoxib

73

reversibly inhibit cox 1 and 2

aspirin
ibuprofen
naproxen
indomethacin
ketrolac
diclofenac

74

Malignancy is going to be removed from the htird part of hte duodenum. What sturcutre is at greatest risk for directe penetration by the tumor?

SMA

75

thickened bronchial walls
neutrophil infiltrate
mucous gland enlargement
patchy squamous metaplasia of bronchial mucosa

chronic bronchitis

76

leading cause of chronic bronchitis

smoking

77

lethal tissue ischemia in myocardium (and most tissues) causes

coagulative necrosis

78

ischemic cell death in CNS

liquefactive necrosis

79

fat necrosis

acute pancreatitis

80

caseous necrosis

most TB infections and some fungal infections (histoplasmosa, cryptococcus, coccidioides)

81

how do you make hte dx for tetanus

CLINICAL

hx of penetrating wound in pt who hasn't been VACCINATED

82

trismus
sardonic smile
muscle spasma

high clincial suscpision for tetanus

83

what is used to excise RNA primers in prokaryotes

bacterial DNA pol I (has 5' to 3" exonuclaease activity)

*used to excise RNA primers

gaps are then replaced by DNA pol I in 5' to 3' direction

*has same fxn as DNA pol III but also can excise primer

84

T cell maturation process htat occurs in the thymic medulla

negative selection

85

t cell maturation process that ocurs in the thymic cortex

positive selection

86

negative selection

eliminates T cells that bind SELF MHC/Ags wtih HIGH affinity

*if these selves were permitted to survive they would induce immune/inflammatory rxns against SELF rxns and lead to autoimmune disease