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1
Q

first line therapy for pts w/ hypercholesterolemia

A

statins

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2
Q

MOA of statins

A

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

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3
Q

affect of cholestyramine on hepatic cholesterol production

A

INCREASES hepatic cholesterol production

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4
Q

how do bile acid binding resins like cholestyramine work?

A

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

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5
Q

why do we give combination of simvastatin w/ cholestyramine

A

together they increase hepatic uptake of cholesterol>

lower LDL

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6
Q

origin of chromaffin cells of adrenal medulla and parafollicular cells

A

NCC

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7
Q

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

A

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

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8
Q

Increased urinary VMA excretion and adrenal mass

A

pheochromocytoma

assoc w/ MEN 2A and 2B

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9
Q

tumor:
pituitary
parathyroid
pancreas

A

MEN 1

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10
Q

tumor:
medullary thyroid cancer
parathyroid
pheo

A

Men 2A

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11
Q

medullary thyroid cancer
neuromas
pheo

A

Men 2B

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12
Q

genetic defect assocaited w/ MEN 2A and 2B

A

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

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13
Q

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

A

parafollicular cells

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14
Q

parafollicular cells

A

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

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15
Q

autoimmune destruction of parietal cells (chronic atrophic gastritis)

A

pernicious anemia

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16
Q

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

A

parietal cells

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17
Q

progressive fatigue
lower extremity paresthesias
megaloblastic RBC

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

A

pernicious anemia

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18
Q

loss of parietal cells w/ lymphocytic and plasma cell infiltraiton

A

chronic atrophic gastritis (autoimmune gastritis)

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19
Q

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

A

parietal cells

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20
Q

TP

A

Sensitivity * number of pts w/ disease

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21
Q

FN

A

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

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22
Q

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

A

ethylene glycol ingestion

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23
Q

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

A

wobble

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24
Q

catalase negative

A

streptococci

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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

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