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USLME Kiss my ass and pray > USLME - Grab Bag > Flashcards

USLME - Grab Bag Flashcards

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1
Q

Hypertrophy - types of cells that only do this (3)

A

Growth of cell through organelle production

  • cardiac, skeletal, nerve
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2
Q

Hyperplasia

A

new cells from a stem cell

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3
Q

Dysplasia

A

disordered cell growth

also reversible

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4
Q

atrophy

A

decrease in stress -> decrease in organ size
Both:
apoptosis - lower cell #
smaller size - ubiquitin proteosome degradation and autophagy

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5
Q

Metaplasia

A

change in stress -> change in cell type
Reversible
chronic-> dysplasia

apocrine metaplasia of breast only one not increased risk for cancer

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6
Q

Aplasia

A

failure of cell production - embryogenisis

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7
Q

Hypoplasia

A

decreased cell production - embryogenesis

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8
Q

Ischemia

A

decreased blood flow

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9
Q

hypoxemia

A

low partial pressure of O2 in the blood

PaO2 <60mmHg

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10
Q

Coagulative necrosis - What is it and seen in?

A

necrotic tissue remains firm, cell structure is preserved

```
ischemic infarction (wedge shaped) - pale
except brain
~~~

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11
Q

liquefactive necrosis - What is it and seen in(3)?

A

necrotic tissue becomes liquified, enzymatic lysis

Brain infarct
abcess
pancreatitis

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12
Q

Gangrenous necrosis - what? and seen in (2)?

A

Resembles mummified tissue -

Ischemia of lower limp and GI

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13
Q

Caseous necrosis - what? and seen in (2)?

A

soft friable - cottage cheese
combination of coagulative and liquefactive

Seen in TB and fungal infections

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14
Q

Fat necrosis - what? and seen in(2)?

A

necrotic adipose w/ chalky white appearance w/ Ca deposit

Trauma to fat and pancreatitis mediated damage

Ca deposits on dead tissue - dystrophic calcification and normal serum [Ca] vs. metastatic which has high serum [Ca]

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15
Q

Fibrinoid necrosis - What? and seen in(2)?

A

necrotic damage to blood vessel - leaking proteins into vessel wall (pink)

Malignant HTN and vasculitis

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16
Q

PAS staining - periodic acid schiff

A

used to detect polysaccharides such as glycogen, and mucosubstances such as glycoproteins, glycolipids and mucins in tissues

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17
Q

Psommona Body tumors (4)

A

Papillary carcinoma of thyroid
Meningioma
papillary serous endometrial carcinoma
mesothelioma

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18
Q

Priaprism

A

Painful errection > 4 hrs

  • tazadone, hydralazine, prazolin, chlorpromazine, PDE inhibitors, alprostadil SE
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19
Q

Neural crest cell derivatives

A 
PNS
Melanocytes
chromaffin
parafollicular cells
schwann
 cells
pia/arachnoid
nines of skull
odontoblasts
aortiocpulmonary
corner
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20
Q

Mutation in HOXD13 lead to

Caused by?

A

synpolydacyly

retinoic acid

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21
Q

desmoplasia

A

excessive formation of fibrous tissue, seen around some tumors

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22
Q

Type 1 collagen

A

Strong
-bONE, skin, tendons, scar tissue

defective in ostogenesis imperfecta

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23
Q

Type 2 Collagen

A

Slippery

-cartilage, CarTWOlage, vitreous body, nucleus puposis

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24
Q

Type 3 Collagen

A

Bloody

-Reticulin, skin, blood, vessels, granulation tissue(beefy red)

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25
Type 4 collagen
Basement membrane | defective in alport syndrome
26
Vitamin C is necessary for what in collagen
hydroxylation of lysine and proline
27
AA necessary for collagen formation(3)
Glysine, lysine and proline | -latter 2 are hydroxylated
28
AA for elastin production(2)
Glysine and proline
29
Ehlers Danslos syndrome is characterized by and due to?
Classic -hyper extensible skin and hyper mobile joints -AD mutation in alpha chain of collagen and cross linking Vascular - Easy bruising and bleeding disorders -Auto recessive mutation
30
Hereditary nephritis, cataracts and sensoorineural hearing loss
Alport syndrome - due to Type IV collagen defect
31
hyperflexible, arachnodactyly, aortic dissection, lens dislocation
Marfans - defect in fibrillin scaffolding
32
Connection between elastin and emphysemia
alpha 1 antitripsin deficiency does not protect from elastase breakdown of elastin -defective alpha 1 antitrypsin also builds up in the liver -> hepatitis
33
Mutliple fractures at different stages seen on x ray think (2)
Osteogenisis imperfecta - look for blue sclera and hearing loss and dental imperfections (defect in Type 1) Child abuse
34
HAVe 1 M&M
Gq receptors w/ increased Ca as a result phospholipase C-> PIP2 split into DAG and IP3 DAG-> protein kinase C IP3 -> increased Ca intracellularly and smooth muscle contraction
35
Renal cell carcinoma paraneoplastic
PTHrP -> hypercalcemia w/ excess PTH Erythropoietin -> polycythemia
36
Aspiration of peanut goes where? upright and supine
lower portion of R inferior lobe- upright superior portion of R inferior lobe -supine -exits superior off the bronchi
37
Metformin is contraindicated when?
Renal failure - due to lactic acidosis adverse effect Glipizide instead (not if hepatic dysfunction)
38
Hemolytic anemia in a neonate w/ + coombs suggestive of?
ABO or Rh incompatibility See jaundice
39
Coombs reagent is?
Anti human IgG indirect -> testing serum, normal RBC-> see if all 3 react direct-> testing for Ab on RBCs in serum and see agglutination
40
Winged scapula injury?
long thoracic nerve
41
Acetazolamide causes what metabolic dysfunction?
Acidosis w/ inhibition of carbonic anhydrase you have local diuretic loss of bicarb w/out replacement - counter indicated in any acidosis
42
nerve exits from the spinal cord location?
C1-C7 above its vertebrae | C8, T1-12, L1-5 below its corresponding vertebra
43
Structure responsible for bone growth post fracture
periosteum containing osteoblasts
44
alpha fetoprotein tumor secretors(3)
heptaocellular carcinoma yolk sac nonseminomatous germ cell tumors
45
efficacy Km and Vmax
maximal effect a drug can produce | -directly related to Vmax, NO effect on Km
46
potency Km and Vmax
amount of drug to achieve a given effect | - high potence= high receptor affinity, inversely related to Km
47
kernicterus
neo natal high bilirubin levels -> brain dysfunction ex- sulfonamides in pregnancy
48
Abx to avoid in pregnancy (8)
``` sulfonamides - kernicterus aminoglycosides - ototoxicity fluoroquinolones - cartilage damage Clarithromycin - embryotoxix tetracyclines - teeth ribavirin - teratogenic griseofulvin - teratogenic chloramphenical - grey baby ```
49
women's oocytes are arrested in what stage for most of her life
prophase 1 Metaphase 2 right before conception
50
Poor prognosis cancers
Pancreatic adenocarcinoma | esophageal adenocarcinoma
51
MEN Type I tumors (3)
Pituitary - prolactin or GH Parathyroid Pancreatic endocrine - Zollinger Ellison, insulinomas, VIPoma, Angiofibromas and lipomas common "the diamond"
52
delerium Tremons
Seen in severe alcohol withdrawal w/ autonomic hyperactivity
53
presentation of failure to thrive, steatorrhea, acanthocytosis (Spiculated RBCs), ataxia and night blindness is? Due to?
abetalipoproteinemia Due to defect in microsomal tryglyceride transfer protein gene inability to add B48 and B100 on VLD and chylomicrons to export out
54
Best way to test for chronic alcohol in the system
Serum gamma gutamyl transpeptidase (GGTCP) Tox screen - acute alcohol levels
55
deficiency in arysulfitase A
metachromic leukodytrophy accum of cererbroside sulfates
56
deficiency in beta-glucocerebrosidase
Gaucher disease | -> springolipidosis
57
Deficiency in beta-galactocerebrosidase
Krabbe disease | -> springolipidosis
58
Deficiency in sphingomyelinase
Niemann Pick disease cherry red spots w/ Tay Sachs
59
Deficient in hexosaminididase A
Tay Sachs Cherry red w/ Niemann Pick
60
t(11:22)
Ewing Sarcoma Onion skin appearance on bone - w/ annaplastic small blue cell malignant tumors Boys less than 15 yrs
61
yellow testicular tumor in young males? Follow what marker
yolk sac tumor follow AFP
62
Glycogen storage disease w/ cardiomegaly and other systemic findings (weakness w/ skeletal muscle) implicated enzyme
Pompe lysosomal alpha 1-4 glucosidase
63
Start a patient on anticoag (maybe post PE or acute coronary) and see a thrombocytopenia Stop what drug and replace w/
Heparin due to HIT lepirudin or bivalirudin - does not use platelet factor 4 and have IgG activate against the complex
64
ixoide tick carried
borrelia burgidorferi babesia microti
65
dermacentar tick carries
franciella tularnsis rickettsia rickettsii
66
See a PE think of as a cause
DVT like from the femoral vein
67
Bacteria associated w/ transformation
SHiN Strep pneumo H. influenza Neisseria
68
Don't forget if a kid presents w/ weight loss
may be diabetic and not bulimic look at glucose levels
69
Presentation of seizures, renal, fever, thrombocytopenia, microangiopathic hemolytic anemia, w/ schistocytes and purport
Def in ADAM 13 cleavage Thrombotic thrombocytopenic purpura seen in younger women lack of Fibrin split products and normal PT and PTT r/o DIC very similar to HUS but here minus the mental ∆
70
Adenoyosis looks like endometriosis in presentation except
the uterus is enlarges, endometrium w/in the myometrium
71
Muscle responsible for protrusion of the tounge
genioglossus
72
3 oncogenes associated w/ tyrosine kinase
HER2-neu abl ret
73
glalactose 1 phosphate uridyltransferase deficiency - presentation similar to what other disease in theory
Auto recessive Galactosemia - STOP milk FTT, jaundice, hepatomegaly, cataracts, retardation, Vomitting, diarrhea Similar to aldose B deficiency and fructose - losing phosphates on sugars that can't be utilized
74
2 virus families w/ reverse transcriptase capabilities
hepadnavirus - Hep B Retrovirus - HIV uses a RNA dependent DNA Polymerase
75
hemochromatosis presentation?
Bronze diabetes - skin pigmentation - DM - Cirrhosis prussian blue stains for Fe
76
infected RBCs are cleared by?
NK cells due to lack of MHC I
77
HSV encephalitis affects which lobe
temporal
78
soap bubble lesions in the brain? cause and type? Test w?
Monomorphic yeast cryptococcous neoformans lattex agglutination 1st india ink not as sensitive (heavily encapsulated)
79
most common cause of death before reaching the hospital w/ Acute MI
arrhythmia V fibrillation w/in 24-48 hrs
80
prosopagnosia
inability to recognize faces bilateral lesion of visual cortex
81
Na stibogluconate
Rx for Leishmania donovani Carried by the sandfly
82
Triad of mono? histo feature
Fever Pharyngitis LAD CMV or LAD Downey or atypical cells (C8 in origination though look like B cells)
83
Products seen in fasting?(2)
actetoacetic acid 3 betahydroxybutric acid
84
FAP is associated w/ mutation on chromosome?
5q21
85
CEA levels are elevated in ?
Colorectal cancer - not a good screener, great for monitoring Seen in pancreatitis also
86
Hemophilia A due to
Hemophelia "Aight" VIII deficiency B is 9
87
Initiating factors of the coat pathway Intrinsic -> Extrinisic
Sub endothelial collagen - Factor 12, 11, 9, 8 Tissue factor release by endothelial Factor 7 All meet at 10
88
Goal of Coag pathway ?
make thrombin which catalyzes the transformation of Fibrinogen to fibrin Plasin (from plasminogen) breaks it up
89
Low K effects which coag factors
2, 7, 9, 10 7 being key for extrinsic -> PT and INR in warfarin monitoring
90
D dimer vs fibrin degeneration products?
D dimer is specific to clots made w/ thrombin - activity of both thrombin and plasmin must be present FDPs come from fibrin (mainly and circulating fibrinogen precursor)
91
Importance of conjugate vaccines?
provides a a protein antigen to facilitate the conversion of IgM to IgG w/ T cells stimulation polysaccharide only gets IgM
92
hyper pigmented mouth, lips, palms, soles and skin w/ harmatomas, crampy abdominal pain at increased risk for?
AD Peutz jeghers Colorectal cancer and other visceral malignancies (pancreatic etc.)
93
weird barbiturate name?
thiopental
94
Wide QRS may indicate (3)
signal not from purkinje: - premature ventricular contraction (PVC) - ventricular tachy - bundle branch block narrow QRS indicates though the conduction system no matter what path or normal pays may be causing it
95
normal little box on ECG is
0.04sec
96
5 little boxes or 1 big box is? Associated path if larger?
0.2 sec If PR interval is bigger may have primary heart block
97
Normal PR interval
less than 200 msec (1 big box)
98
normal QRS interval
less than 120 msec (3 little boxes)
99
Common causes of L axis deviation (5)
``` inferior wall MI L anterior fasicular block L ventricular hypertrophy high diaphragm LBBB ```
100
Common causes of R axis deviation (5)
``` R ventricular hypertrophy Acute R heart strain (PE?) left posterior fasicular block RBBB dextrocarida ```
101
Positive deflection in ECG means? Normally travels?
that the QRS is more above the line vs below (+) in the lead given Normally travels down and to the left Example positive in L I and LII normally
102
Lead where it is never normal to have positive deflection?
aVR
103
Target cells seen in?(4)
Thalassemia hemoglobin C Liver disease asplenia - (sickle cell eventually)
104
Mutation of dystropin is found where
on the X gene- | need both for a girl(higher incidence in turner syndrome), one for a guy (recessive)
105
hernia travels through the inguinal canal through both deep and superficial rings and is lateral inferior epigastrics
Indirect hernia
106
hernia that only goes through the superficial ring by tearing a hill in the weak part of the abdominal wall in inguinal triangle medial to inferior epigastrics
direct hernia
107
stones, bones and groans presentation?
osteritis fibrosa cystica due to primary hyperparathyroidism stones - renal stones bones - increased alk phis and cystic spaces in the bones groans- constipation/ weakness
108
Adductor pollicis inervated by?
Ulnar nerve
109
Lumbricals innervated by?
Lateral 2 median | Medial 2 ulnar
110
Interosseous muscle innervated by?
Ulnar nerve | - digital abduction and adduction
111
flexor pollicis brevis inervated by?
median nerve Carpol tunnel and have them make an O w/ pinky and thumb - thumb opposition
112
3 Paraneoplastic seen in small cell carcinoma
ACTH -> cushing ADH -> SIADH Abx against presynaptic Ca Channels -> lambert eaten syndrome
113
FeNa less than 1%
prerenal cause (hypovolumeia)
114
FeNa >2%
Intra renal cause like acute tubular necrosis
115
Normal BUN:creatine ratio
~15:1 usually pathological >20:1 thinking prerenal causes less than 15:1 interregnal issues like acute tubular necrosis could also be causes w/ out flow like BPH leading to increased reabsorbtion of BUN into the blood
116
Increased aldosterone like in Conn syndrome leads to what metabolic disorder and why
metabolic alkalosis increased aldosterone -> increase in K secreting channels in the cortical ducts in addition to eNaC Channels sequestering Na from the lumen The K is lost but some of the K in the lumen also stimulates the loss of H as eel (alpha intercalated cells a little later on) -> H and K loss and alkalosis
117
Chronic renal failure can lead to this hormone imbalance? Rx?
secondary hyperparathyroidism due to impaired phosphate excretion and ultimately hypocalcemia Calcimimetrics -> Cinacalate: increases sensitivity of PTH Ca sensing receptors decreasing PTH levels
118
Cinacalate?
increases sensitivity of PTH Ca sensing receptors of chief cells of parathyroid decreasing PTH levels for secondary hyperparathyroidism
119
increasing the radius of a vessel drops resistance?
1/ (r^4)
120
Pure mucinous gland in the mouth?
Sublingual - sub mandibular mix parotid - serous
121
Supracondylar fracture damages what nerve? seen w/ what deviation of the wrist?
median nerve innervates flexor carpi radialis flexor carpi ulnaris is unopposed (Ulnar nerve) leading to ulnar deviation
122
endocarditis in SLE
aseptic vegitations libman-sacks endocarditis
123
LPL enzyme is found where?
endothelial cells
124
In addition to bleeding what other toxicity is associated w/ Warfarin (2)
skin/tissue necrosis w/ protein C deficiency(hypercoaguable and microvascular thrombosis) -> sharp, demarcated erythematous, purpuritic Drug- drug
125
lymph node biopsy shows large binucleated cells w/ prominent nucleoli and eosinophilic cytoplasm
Hodgkins
126
Key feature of PTSD
disturbance lasting > 1 month -Regardless of symptoms Acute stress disorder 2 days - 1 month
127
DVT predisposed by (3)
Stasis hypercoagulability - defects in cascade (factor 5 - pregnant) endothelial damage - exposed collagen
128
Vitamin K's function? Synthesized where?
gamma carboxylation of glutamic acid synthesized by intestinal flora, risk w/ broad spectrum Abx long term
129
Lactulose given for? MOA?
hepatic encephalopathy -> increased NH3 w/ urea cycle failure reduces NH3 absorption from GI due to bacteria breaking it down and making it an acidic environment trapping NH3 and NH4+
130
Cardiac amyloidosis w/out other organs involved?
transthyretin (TTR) of primary amyloidosis
131
Fibrinoid necrosis can be seen in | - Fuck you pathoma (4)
Malignant hyper tension preeclampsia Vasculitis Rheumatoid arthritis (w/ palisading epitheliod cells)
132
Hypertension and BPH think of using a?
Alpha 1 antgonist Prazosin/Terazosin
133
metabolic alkalosis is a common problem w/ these drugs? (2)
Loop dieuretics - hyponatremia -> aldosterone and loss of K/H directly by alpha intercalated thiazide diuretics - volume depletion -> aldosterone
134
axillary nerve runs w/ what artery?
Posterior Circumflex
135
See homovanillic acid, vanillylmandelic acid and metanephrine in the urine think of
Pheochromocytoma COMT, MAOI -degradation products of Dopamine NE Epi
136
CD14 found on also has
Macrophages CD40
137
CD 56 found on also has?
NK cells CD16
138
CD 28 found on
T cells
139
Most common cause of neonatal meningitis?
Streptococcus agalactia - E coli 2nd -listeria - 3rd -
140
associated maladsorption complication w/ CF due to
deficiency in fat soluble vitamins ADEK w/ lack of lipase from the pancreatic duct
141
tender thyroid cause?
Dequervians, sub acute throiditis, - post viral presents symptomatically like Hashimoto's otherwise
142
+ combs test and hemolytic anemia >37 degrees C which antibody?
means warm agglutinin - will see hyperbilirubinemia, unconjugated Found in SLE, drugs and other auto immune IgG
143
IgM against RBCs characteristic of
Cold agglutins w/ + combs at cold temps Mycoplasma pneumonia or lymphoma cause
144
Immediate hypersensitivity
Type 1
145
Cytotoxic disease/hypersensitivity
Type 2
146
Delayed hypersensitivity
Type 4
147
Arthus Reaction
Type 3
148
eruptive xanthomas
yellow papules due to elevated tryglycerides
149
Rx for pregnant HTN (2) how does it work?
Worry when diastolic > 100mmHg Clonidine -> direct alpha 2 agonist alpha methydopa -> converted to alpha methynorepiniphrine -> alpha 2 agonist
150
Known ethambutol complication
neurotoxin -> optic neuropathy TB drug
151
non infectious cause of hand-foot erythema and desquamatizing rash Concerned w?
``` Kawasaki on kids < 5 Also see -Cervical LAD -Fever* -conjunctival injection /bilateral -strawberry tongue/ pharyngeal erythema ``` concern of coronary aneurisms
152
hyperventilation leads to what changes in pH? vascular diameter
increases pH blowing off CO2 - respiratory alkalosis Less CO2 -> less vasodilatation -> constriction - lungs are an exception
153
Only DNA virus family that contains its own DNA dependent RNA polymerase(iron associated transcriptase)
Poxvirus brick shaped complexes
154
Serum Marker for oxygen saturation
Lactic acid level
155
topical retinoid acid use and HA due to
pseudotumor cerebri Vitamin A toxicity, tetracycline, corticosteriods have been implicated
156
Direct vs indirect Combs test
Direct Combs test is testing the blood for anti RBC antibodies attached - for example, the babies blood if they are undergoing hemolytic anemia Indirect combs is testing the serum w/ test blood for the presence of anti RBC antibodies, if they cause clumping, example the mother who is Rho - and is concerned of IgG presence
157
painful sharply demarcated erythematous rah 3-10 days after atria fibrillation and Rx is started be concerned of
Warfarin skin necrosis and microthromboemboli with initial hypercoaguability and KO of protein C and S at first may present as painful red rashes
158
associated immune compromised state w/ albinoism
Chediak Higashi Syndrome Impaired microtubule function leading to NK cell disruption and other phagocytic cells
159
Hemagglutin
what our body makes antibodies to in the flu, necessary for viral attachment the h in h1n1 n is neuaminidase
160
CD18
Implicated in leukocye adhesion deficiency Lack of integrin -> increased infection and delayed wound healing delayed separation of umbilical stump
161
stapedius is innervated by?
CN7 dampens sound w/ loud noises, damage leads to hyperacusis
162
Cells that are CD30 and CD15 positive are
Reed Sternberg cells seen in hodgkins lymphoma, usually no CD20
163
Tartate resistant acid phosphatase
TRAP Used to stain for hairy cell leukemia
164
ADPCKD is associated with what major complication and treated w/ what
increased renin -> HTN Rx w/ ACE or and ARB
165
Gastric hypertrophy w/ protein losing enteropathy is? What is seen on histology?
Menetrier's disease Increased mucous cell(excess mucous production) and and decrease in parietal cells Rugae of stomach hypertrophied
166
Renal Protective HTN medication in diabetes
Ace Inhibitors - just don't use in bilateral renal stenosis
167
Retinoblastoma caused by a mutation on what gene on what chromosome
Rb1 13 gene implicated in osterosarcoma as well
168
Perfusion limited gas example and look of the graph
CO2 and N20 The graph reaches alveolar pressure early along the length of the capillary. limited by the amount of blood flowing through
169
Diffusion limited gas example and look of the graph
CO and O2 in a diseased state (emphysema/fibrosis) The graph of the partial pressure in the capillary does not reach alveolar pressure and is dependent. There is a difference
170
3 damn Pyruvate enzymes what are they- what are their products Pyruvate kinase Pyruvate dehydrogenase Pyuvate Carboxylase
PEP -> Pyruvate Pyruvate -> acetyl Co A -needs thiamine Pyruvate -> oxaloacetate (gluconeogenesis) -> PEP and eventally glucose via PEP carboxykinase (weird little circle) Biotin needed
171
Medication for GAD w/ no sedation, addition or tolerance effects Acts on what receptor
Buspirone (not buproprion/welbutrin) - takes 2 weeks to work 5HT1a agonist
172
Diuretic that retains Ca Dieretic that loses Ca
Loops lose Ca Thiazides retain (hypercalcemia w/ PTH hyperexpression)
173
Pyruvate kinase deficiency presents as?
hemolytic anemia due to increased rigidity of RBCs May be seen in a newborn Auto recessive
174
young patient comes in with mousy odor, mental retardation and eczema
PKU Auto recessive
175
Polyhydraminos is due to?(2)
lack of fetal swallowing - anencephaly - intestinal blockage(atresias...) - diaphragmatic herniation increased urination
176
Most common dislocation of the humorous?
anterior
177
vitilago vs albinism
decreased # of melanocytes in vitilago vs decreased melanin production w/ albinosim (less tyrosinase activity)
178
secondary hyperparathyroidism is seen when? Due to?
Seen in chronic renal failure due to: Decreased renal 1 alpha hydroxylase making active D3 Decreased excretion of phosphate -> high PTH w/ low Ca levels
179
Vitamin A is used to treat (3)
Measles acne AML - M3
180
Ground glass appearance of HBV
fine cytoplasmic protein granules
181
most common lasting sequel of herpes zoster
post herpatic neuralgia | - can be upwards of a month
182
thiopental rapidly redistributes to?
adipose tissue and skeletal muscle | its a barbiturate used for induction of anesthesia
183
Pellagara deficiency presents as? Can be prevented with?
Diarrhea, dermatitis and dementia due to B3 (niacin deficiency). B3 is a constituent of NAD and NADP (derived from tryptophan if made endogenously, also can come from diet)
184
Which organ suffers the least risk of infarct due to a thrombi?
Liver - dual blood supply
185
infection that sickle cell patients are especially susceptible too
Salmonella and osteomyolitis(occlusion -> necrosis -> colonization) - special capsule that prevents obsinization and vaccination functional autosplenectomy in sickle cell
186
Vitamin overdose that leads to these symptoms-> loss of appetite, stupor and hypercalcemia Similar to what pathology otherwise ?
Vitamin D similar to Granulomatous diseases - sarcoidosis and TB w/ hypercalcemia secondary to high levels of calcitriol (active Vit D)
187
excitatory neurotransmitter involved in pain
substance P
188
lysosomal storage disease associated w/ renal failure
Fabrys disease - X linked w/ peripheral neuropathy, angiokeratomas and CV disease as well alpha glactodidase A is deficient
189
lysosomal storage disease associated w/ bone crisis and macrophages that look like tissue paper
Gaucher's disease Glucocerebrosase deficiency Auto recessive
190
suprachondylar fracture going to effect what nerve?
median nerve
191
immune deficiency problem of endoderm development
Digeorge syndrome
192
Immune deficiency due to tyrosine kinase defect
Agammaglobulinemia BTK gene (tyrosine kinase gene)
193
conversion disorder
neurologic affliction of voluntary motor or sensory (pain, optic, paralysis etc) in the presence of stressor and no medical findings can confirm it. it cannot be limited to pain or sexual dysfunction There is no secondary gain with the loss of function as well. Somatization form - multiple physical complaints
194
somatization disorder
numerous complaints starting prior to the age of 30 4 pain 2 GI 1 sexual 1 pseudoneurologic symptom No medical findings
195
rose spots on the abdomen and abdominal distress w/ hepatosplenomegaly, hemhorragic enteritis
salmonella typhi
196
chamber of the heart laying next to the esophagus
Left atrium
197
Where is the descending aorta in relationship to the esophagus?
behind
198
herpes viruses are the exception to the rule in where they get their envelope for their membrane. Where is it from
nuclear membrane
199
CD surface marker that inhibits complement from binding
CD 55 and CD 59
200
CD surface markers found on Reed Sterberg Cells
CD15 and CD30
201
deficiency in vWF will lead to what ∆s in lab values?
increased bleeding time mainly b/c it facilitates platelet aggregation/adhesion to GP Ib--1X wWf also carries factor VIII increasing its half life so ultimately prolonged PTT if deficient
202
Defect in delta aminolevulinic acid dehydratase (ALA dehydrastase) may be due to? Accumulate? What other enzyme is affected leading to basophilic stppiling
lead poisoning protoporphyrin and delta ALA in the blood Lead also blocks ferrochelatase -> blocking heme production
203
Acute intermittent porphyria enzyme defect and presentation (5)
defect in porphobilinogen (3rd step in heme synth) ``` painful ab port wine -colored urine polyneuropathy psychological disturbances precipitated by drugs ```
204
2 enzymes inactivated by lead
ferrochelatase -> final step in heme delta-aminolevulinic acid dehydrates - 3rd step in heme synthesis (excess delta ALA in the serum) ultimately microcytic anemia
205
Myoglobin construction and oxygen response
Made of only one monomer of glob in vs hemoglobin made of 2 usually (2 alpha and 2 beta) the presence of only one glob in -> lack of positive cooper ability (either all on or all off) NOT sigmoidal hemoglobin sat oxygenation curve (relative left shift)
206
Patient w/ managed hyperthyroidism comes into a clinic with fever and throat pain. What extra step should be done and why?
WBC and differential due to agranulocytosis caused by propylthiouracil and methimazole
207
seronergic neurons are found where in the brain stem
ralphe nucleus
208
Patent foramen ovale occurs in what % of adults
20-30% considered a variant of normal -Functionally closed w/ high L atrial pressure vs R -> paradoxical embolism w/ strokes and DVTs
209
History of RA w/ no alcohol Hx presents w. fatigue, R abdominal pain; labs show high ANA and ASMA, elevated IgG and no viral markers
autoimmune hepatitis ASMA = antismooth muscle Ab- Type 1
210
Liver biopsy shows elevated LKM-1 antibodies, no alcohol Hx, no viral seromarkers. See infiltration of the portal and periprotal area w/ lymphocytes
autoimmune hepatitis LKM-1 = liver/kidney microsomal Ab - Type II
211
Substance needed for relaxation of the LES
Nitric Oxide
212
Adenovirus causes (4)
DS linear virus w/o envelope Pharygitis Conjunctivitis Pneumonia hemorrhagic cystitis - most common viral cause in kids
213
Oseltamivir MOA
Acts to block neuroaminidase activity and viral release
214
2nd most common cause of osteomyolitis in kids
1. Staph aureous 2nd Strep pyrogenies
215
Patient has a fever, abdominal pain and diarrhea w/ a little blood. A couple days later he has hematuria and oliguria. Dx?
Hemolytic Uremia Syndrome Due to Shigella like toxin EHEC or from Shigella reentry thrombocytopenia No DIC
216
how does digoxin slow the HR
in addition to blocking Na/K ATPase -> increase in intracellular Ca it also activates the vagus nerve
217
Drugs used as anti nausea and sea sickness
meclizine M1 and H1 blocker Dihendrimate M1 and H1 Scopolamine - H1
218
acute pancreatitis is due to inappropriate activation of what enzyme most likely
trypsinogen -> trypsin which activates all pancreatic zymogens lipase is secreted in active form and does not need further activation
219
Thiamine deficiency is bad in alcoholics b/c
it is a cofactor in enzymes like pyruvate dehydrogenase (links glycolysis to TCA) and thus impaired glucose breakdown. -> wernicke in the acute setting (mammary bodies) Korsakoff in chronic give glucose w/out thiamine exacerbates
220
hemachromatosis is a defect in?
Iron absorption Mutation on HLA - H on chromosome 6
221
essential cofactor for transamination reactions
B6 pyridoxine ALT and AST -alpha leto group -> amino acid Decarboxylation reaction glycogen phosphorylase
222
the onset of action of a inhaled anesthetic is dependent on what? Example of a rapid onset drug
the lower the blood solubility the faster the onset. Spills into the brain that much faster -can be expressed as blood/gas partition coefficient; lower the coefficient the faster the effect NO2 is an example
223
Statisical power is
the capability of rejecting the null hypothesis when it is truly false 1 - beta
224
rare complication of a helical enveloped RNA virus that initially causes fever, cough, coryzea and conjunctivitis
subacute sclerosing panencephalitis - due to virus missing an M antigen leading to no antibodies to this and failure of clearance presents years later w/ataxia, myoclonus and visual disturbances
225
Live attenuated viruses(6)
``` Smallpox yellow fever chickenpox Sabins polio MMR Influenza - intranasal ```
226
Killed viruses(4)
RIP Always Rabies Influenza - injectes Polio (sabins) HAV
227
Responsible for the breakdown of very long FA
peroxisome also oxidase and catalase to metabolize toxic substances
228
holosystolic blowing murmur
mitral regurgitation
229
esophageal varices is due to anastomose between
L gastric vein and esophageal veins
230
hemorrhoids is due to anastomose between
superior rectal veins and middle/inferior rectal veins
231
Superior laryngeal nerve innervates
external branch =motor - the cricothyroid internal branch = sensory above the vocal cords Rest of the larynx innervated by recurrent laryngeal nerve - > muscle and sensory (below vocal cords) All Vagus
232
the part of the nephron w/ the highest osmolarity in absence of ADH
right after the descending loop of hence, only part really permeable to H2O if no ADH is available
233
enzyme in bacteria w/ 5-3' exonucleus activity
DNA polymerase I, removes the RNA primers and replaces w/ gap with 5'-3' Polymerase III does general replication
234
What drugs cause increased concern for Lithium toxicity if given together
Thiazide diuretics due to Li being treated like Na due to exclusive renal excretion. The loss of Na causes the proximal tubules to reabsorb more +1 cations (Na and Li) also worry about NSAIDs and ACE inhib
235
beta blockers in hyperthyroid state help in 2 ways
mitigate sympathetic stimulation block peripheral conversion of T3->T4 through some unknown way
236
18 month with fever, rhinitis and pharyngitis -> brassy cough and respiratory distress
Croup by parainfluenza
237
test for primary hypothyroidism
TSH
238
Drug induced SLE is often due to what sort of metabolism problem
slow acetylators in Phase II liver metabolism | vonjugation reactions -> very polar, inactive real excreted metabolites
239
HIV Viral proteins encoded gag env pol
gag- p24; capsid env - gp120 and gp 41; membrane pol - reverse transcriptase
240
Drug of choice in ischemic ventricular tachycardia post MI?
lidocaine - Class 1B; Amiodarone also tocainide mexliletine
241
more specific RA marker
anti cyclic citrullinated peptide | anti CCP
242
red ragged muscle fibers on gomori Trichrome stain indicates
mitochondrial mutation
243
Lambert Eaton presentation (4)
auto Abs to presynaptic Ca channels Have issues w/ proximal muscle weakness that IMPROVES w/ muscle use (vs myasthenia gravis) also antimuscarinic and CN (like III) involvement common 50% associated w/ small cell lung CA
244
cafe au late spots associated w/ (2)
neurofibromatomas type 1 mckune albrite syndrome
245
Examples of JAK kinase activators(4)
Growth hormone, prolactin, IL2, receptors for cytokines tyrsosine kinase associated
246
Examples of tyrosine kinase activators(3)
Growth factor receptors; EGF, PDGF, FGF intrinsic kinase activity that phosphorylates RAS
247
polyribisylribitol phosphate Ab indicates protection from
Haemophilus influenza - type b capsular polysaccharide conjugated to diphtheria toxoid
248
allosteric activator of gluconeogenesis is? Leads to increased pyruvate carboxylase
acetyl CoA Increased acetyl CoA( from beta oxidation of FA) -> increased pyruvate carboxylase reaction which sets the stage to get pyruvate out of the mitochondria (trapped w/ pyruvate kinase action) by converting pyruvate into oxelacetate (w/ biotin and pyruvate carboxylase) -> malate which leaves-> oxelacetate again which can be converted back to glucose (1st step PEP carboxykinase)
249
Rx for Conn's Syndrome Presentation?
Sprinolactone and epleronone hypokalemic alkalosis, decreased renin activity, hypertension and fatigue, periodic HA
250
Primary abducter of the humerous
supraspinatus - most commonly injured rotator cuff muscle, inserts superiorly on the head of the humorous and subject to impingement injury w/ acromion
251
air in the gull bladder w/ long standing Hx of choleithiathias
gallstone in the ileum
252
K1 antigen
E coli neonatal meningitis
253
what needs to be substituted when using amphotericin B
K and Mg Renal toxicity is a big side effect, cause renal vasoconstriction and decreased GFR; increased distal tubule permeability w/ necrosis
254
parvo virus in adults vs kids
kids - 5ths disease Adults is hydrous fettles if pregnant, bilateral arthritis ~ RA that is self resolving
255
Leptin is? Acts where
a protein made my adipocytes that act on the arcuate nucleus of the hypothalamus blocking the production of neuropeptide Y - says I'm full - produces alpha MSH instead
256
AA that feeds N directly into the urea cycle
Aspartate
257
2 causes of fat redistribution due to medications
1. Glucocorticoids -> cushings syndrome | 2. HAART -> lipodystrophy; protease inhibitors
258
Major contraindication for metformin
Renal failure - Lactate acidosis is common side effect
259
Thyroid levels are monitored w/ what 2 drugs?
Lithium Amiodarone
260
albumino cytologic dissociation
CSF finding in Guillain barre syndrome where the protein is increased w/ no change in cell count
261
Arteries w/ nerves to relook at ``` anterior interosseous posterior interosseous posterior circumflex suprascapular artery deep brachial artery dorsal scapular artey lateral thoracic artery Ulnar artery brachial artery ```
anterior interosseous - anterior interossous nerve (median) posterior interosseous - deep radial posterior circumflex - axillary suprascapular artery - suprascapular nerve deep brachial artery - radial dorsal scapular artery - dorsal scapular nerve lateral thoracic artery - long thoracic nerve Ulnar artery - ulnar nerve brachial artery - median nerve
262
general empiric treatment with a baby's infection
ampicillin and gentimycin
263
SIDS When does it occur Prevention
2-4 months sleep on back avoid co sleeping smoke exposure, Preventative- breastfeeding, pacifier, fan
264
Risk factors for SIDS Maternal baby
smoker, low SES, <20 Low birth weight, male, premature, prone sleeping,
265
Low birth weight bevy defines as? Risk of (5)
<2500 g ``` infections/sepsis neonatal RDS necrotizine entercolitis (feeding too fast) circulatory problems (insufficiency) SIDs ```
266
Neplasms in kids(12)
``` ALL Astrocytoma Neuroblastoma - adrenals hemangioma Wilms tumor Hepatoblastoma retinoblastoma rhabdomyosarcoma ewing sarcoma osteogenic sarcoma lymphoma teratoma ```
267
Tanner stages in | Boys genitalia
1 -prepubital 2. enlargement - scotum /testes 3. enlargement - penis length 4. Penis grows in breadth/testes enlarge 5. Adult
268
Tanner stage in girls
1. prepubital 2. bud elevation, aereola enlarges 3. Further enlargement 4. Areola and papilla form secondary mound 5. mature
269
Female development timeline | Breasts/Growth/menarche
breasts around 11 Growth 12 menarche 13
270
Male development timeframe
tanner stage 2 - 12 | growth 14-15
271
APGAR | means? - amount
``` A- appearance - 0 cyanotic, 1 hands/feet, 2 pink Pulse -0 none, 1: 100 Grimace -0 no response 2, pulls away from neg stimulus Activity -0 -limp 2- resisits extension R - respirations 0- none; 1- gasping; 2 crying vigorus ```
272
birth - 3 months highlights
rolls over at 3 months social smile orients and respons to voice
273
7-9 month highlights
Sits alone, crawls, transfers toys from hand to hand Stanger anxiety - when someone approaches babbles and plays peek a boo, name recognition
274
12-15 months highlights
walks, babinski disappears separation anxiety - mom leaves and baby freaks few words 1-3
275
12-24 month highlights
climbs stairs, stacks blocks (6 blocks at 2) use of fork or spoon, 6 words at 15 months 2 word phrases
276
core gender identity at
2-3 yrs
277
when to begin potty training?
2-3
278
Parallel play vs cooperative play time line
2-3 yrs vs 4 yrs
279
Jumping kid and feeds w/ fork/spoon
2-3 yrs
280
copies lines and circle, stairs and complete sentences
3 yr old
281
grooms self, hops on one foot and has an imaginary friend
4 yr old
282
translocation w/ AML M3 characteristic smear/
(t 15:17) ``` Auer rods (many) -Some may be in M2 (t 8:21) ```
283
TdT - deoxynucleotidetransferase is positive when?
ALL Precursor b - CD 19 or CD10 Precursor T cells - CD 1, CD2 or CD5
284
most common clinical manifestations of Vit E deficiency (2)
neuromuscular disease -skeletal myopathy -spinocerebellar ataxia pigmented retinopathy Hemolytic anemia protects FA from beta oxidation
285
hydlrazine and minoxidil have what side effects?
reflex tachycardia and renin activation -> Na and water retention
286
Patients w/ essential fructosuria can still metabolize fructose partially through
hexokinase fructose -> fructose 6 phosphate low affinity
287
cricopharyngeal dysfunction leads to
zenker diverticulum
288
ecthyma gangreosum
necrotic black skin lesion associated w/ septic pseudomonas infections in immune compromised
289
true vocal cords are covered by? other areas w/ same covering?
stratified squamous cells includes upper half of posterior epiglottis, anterior epiglottis, oropharynx, laryngopharynx, rest is pesudostratified ciliated columnar cells
290
short acting benzo - <6hrs
triazolam or alprazolam loazepam is intermediate the rest are long - >24hrs - diazepam - flurezapam
291
RPF vs RBF
Renal plasma flow vs renal blood flow get renal blood flow from RPF/(1-Hct) RPF = [U(urine PAH) x V]/ P(plasma PAH)
292
postcervical lymph nodes(3)
EBV - mono cat scratch fever - bartonella henslae acute otitis media
293
pigmented harmatoma in the iris
Lisch nodules in neurofibromatosis
294
50 yr old man w/ new unexplained skin yellowing and no other symptoms need to r/o
pancreatic CA - Head painless jaundice
295
alpha keto acid dehydranse
deficiency implicated in maple syrup syndrome - blocks degradation of leucine, isoleucine and valine

USLME Kiss my ass and pray (33 decks)

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