USLME - Grab Bag Flashcards Preview

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

Flashcards in USLME - Grab Bag Deck (295):
1

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

Growth of cell through organelle production

- cardiac, skeletal, nerve

2

Hyperplasia

new cells from a stem cell

3

Dysplasia

disordered cell growth

also reversible

4

atrophy

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

5

Metaplasia

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

apocrine metaplasia of breast only one not increased risk for cancer

6

Aplasia

failure of cell production - embryogenisis

7

Hypoplasia

decreased cell production - embryogenesis

8

Ischemia

decreased blood flow

9

hypoxemia

low partial pressure of O2 in the blood
PaO2 <60mmHg

10

Coagulative necrosis - What is it and seen in?

necrotic tissue remains firm, cell structure is preserved

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

11

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

necrotic tissue becomes liquified, enzymatic lysis

Brain infarct
abcess
pancreatitis

12

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

Resembles mummified tissue -

Ischemia of lower limp and GI

13

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

soft friable - cottage cheese
combination of coagulative and liquefactive

Seen in TB and fungal infections

14

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

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]

15

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

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

Malignant HTN and vasculitis

16

PAS staining - periodic acid schiff

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

17

Psommona Body tumors (4)

Papillary carcinoma of thyroid
Meningioma
papillary serous endometrial carcinoma
mesothelioma

18

Priaprism

Painful errection > 4 hrs

- tazadone, hydralazine, prazolin, chlorpromazine, PDE inhibitors, alprostadil SE

19

Neural crest cell derivatives

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

20

Mutation in HOXD13 lead to

Caused by?

synpolydacyly

retinoic acid

21

desmoplasia

excessive formation of fibrous tissue, seen around some tumors

22

Type 1 collagen

Strong
-bONE, skin, tendons, scar tissue

defective in ostogenesis imperfecta

23

Type 2 Collagen

Slippery
-cartilage, CarTWOlage, vitreous body, nucleus puposis

24

Type 3 Collagen

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

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