USMLE-Rx Question Log Flashcards
(200 cards)
1
Q
What are the AEs for nortriptyline?
A
Remember the 3 Cs:
Coma
Convulsions
Cardiotoxicity (arrhythmia/prolonged QT)
2
Q
What is dipalmitoyl phosphatidylcholine?
A
surfactant
Made most abundantly at week 35
At 28 weeks, not high enough
Measured by lecithin: sphingomyelin ratio ( >2 is good)
3
Q
What are toxicities of amiodarone?
A
Get PFTs, LFTs, and TFTs pulmonary fibrosis hepatotoxicity hypo OR hyperthyroid also photodermatitis & constipation
4
Q
Which class of antiarrhythmics has greater effect on cardiac tissue that depolarizes frequently?
A
Class I
Block Na+ channels in the open state (“use dependence”)
Selectively depress tissue that is frequently depolarized (fast tachy) or relatively polarized at rest (hypoxia)
Arrhythmic tissues more often depolarized; drugs can selectively target these tissues
5
Q
How can you correct and untreatable ACD?
A
Erythropoietin
6
Q
In a patient with bone metastases, what will your levels of Calcium and alk phosph be?
A
Calcium decreased
Alk phosph increased
Ca low b/c it’s being used to build new bone in area of mets
7
Q
What is the molecule that is causing hypertension in 11B-hydroxylase deficiency?
A
11-deoxycorticosterone(mineralocorticoid precursor)
8
Q
What is the formula for sensitivity?
A
TP/ (TP + FN)
9
Q
What are the most common sites for PAD?
A
Affects arteries
Abd aorta, iliac, femoral, politeal, tibial, and peroneal
Treat w/ antiplatelets or surgical revascularization
10
Q
Where does mumps cause inflammation? What is the epithelium in this area?
A
epididymis
pseudostratified columnar epithelium w/ stereocilia
11
Q
What are the symptoms of tracheoesophageal fistula? What does it mean if air is seen in the stomach?
A
choking, coughing, salivation, cyanosis during feeding
If air in stomach, this means the lower esophagus/stomach is communicating with the trachea in some way
12
Q
How does dangerous hyperkalemia manifest on an EKG?
A
peaked T waves
13
Q
Meds that cause torsades de pointes?
A
"Some Risky Meds Can Prolong QT" Sotalol Risperidone (antipsychotics) Macrolides Chloroquine Protease inhibitors (-nivir) Quinidine (Class Ia & III) Thiazides
14
Q
Tanner Stage 3
A
Peak growth height
1 year after initial breast development
enlargement of breast/areola w/ single contourgrowth of darker, coarse, curled pubic hair
15
Q
Milestones for a 7-11 month old
A
Sitting alone standing w/ aid crawling wave bye bye say mama/dada Stranger anxiety Babinski relfex (disappears at 1 year)
16
Q
Where are proteins tagged with mannose-6-phosphate?
A
Golgi
17
Q
How does measles typically present?
A
Blanching red rash
Starts on face, moves to trunk and limbs, resolves in same order
SSPE is a rare complication in 7-9 yos
18
Q
Which RNA polymerase produces each type of RNA?What toxin is produced by Amanita phalloides and which polymerase does it inhibit?
A
rRNA- RNA pol I
mRNA- RNA pol II
tRNA- RNA pol III
alpha-amantin-> inhib RNA pol II (mRNA). Leads to severe hepatoxicity
19
Q
What types of defects does Valproic acid cause?
A
Neural tube
20
Q
Deficiency of what neuropeptide causes narcolepsy? Where is it produced
A
Orexins A & B
Lateral hypothalamus
21
Q
AEs of steroid treatment
A
Cushing-like symptoms, cataracts, HTN, increased appetite, hyperglycemia, insomnia, profound mood changes (steroid psychosis)
22
Q
What toxin does aspergillus flavus produce? What are its effects?
A
aflatoxin
Causes hepatocellular carcinoma
Think Asia/Africa
23
Q
Which COX inhibitor irreversibly binds COX?
A
Aspirin (via acetylation)
24
Q
When should you give rabies immunoglobulin? How many rabies vaccines should you give?
A
If not immunized, give immunoglobulin
Give everyone vaccine (4 if never received; 2 if previously received)
25
In an HIV patient with CD4 count < 200, what types of organisms are most difficult to control?
Those controlled by cell-mediated arm of immune system
Intracellular organisms such as L. monocytogenes
26
What type of deficiency can be caused by phenytoin?
Folate
| look out for macrocytic anemia
27
What drug can be used for both parkinsons and as influenza prophylaxis?
Amantidine
28
What are the AEs of amantidine?
ataxia
dizziness
slurred speech
Be careful in seizure patients
29
Which hepatitis viruses are spread fecal-oral route?
Hepatitis A & E
30
Homocystinuria Deficiency? Presentation?
Def in cystathionine synthase
Similar to Marfan's (subluxation of lens and tall stature)
Life threatening thromboembolic events
31
What is an anti-IgG antibody?
Rheumatoid Factor
32
Where do you see squamous cell carcinoma in the lung? What protein can it produce and what symptoms will this cause?
```
Central bronchogenic carcinoma
Can produce PTHrP
Increase calcium
Decrease phosphate
constipation & polyuria
```
33
What toxicity can nitroprusside cause? Symptoms? What should you give prophylactically to prevent this complication?
```
Cyanide toxicity (inhib cyt oxidase--> blocks ETC)
decreased O2 utilization, lactic acidosis, possible death
Admin sodium thiosulfate (cyanide--> thiocyanate by rhodanese)
```
34
Which lymphoma has high expression of bcl-2 gene?
Follicular lymphoma
| t(14;18)
35
Which amino acids are lost in cystinuria? What is the complication and how is it treated?
Lose lysine, arginine, cystine, and ornithine
Causes stone formation
Treat with hydration and alkalization of urine with acetazolamide
36
Most common cause of septic arthritis in adults and children?
s. aureus
37
What is echinococcus granulosus? How does it present? How is it treated?
Dog tapeworm
Hydatid cysts in the liver contain larvae
Can cause anaphylaxis when it ruptures
Treatment is surgical excision
38
What do you need to measure after putting someone on heparin?
Platelets every 2-3 days to prevent HIT
39
What is naphthalene? What can it cause?
```
Aniline dye (textiles)
transitional cell carcinoma of bladder
```
40
What is a deficiency of uridine diphosphate glucuronyl transferase called and what does it cause?
```
Crigler-Najjar syndrome type 1
Causes inability to conjugate bilirubin
Increased unconjugated bilirubin leads to:
-jaundice
-kernicterus
-bilirubin deposition in brain
```
41
What is commonly the first presentation of vWD?
```
Mucocutaneous bleeding (after a dental extraction)
Prolonged PTT, decreased factor VIII, reduced ristocetin-induced platelet aggregation
```
auto dominant
42
What cells are capable of transforming into activated ameboid cells with CNS tissue damage? What is their embryonal origin?
Microglia (resident phagocytes of CNS)
| Mesoderm (circulating blood monocytes)
43
What types of vacuoles are tennis racket-shaped? What cell type are they found in? What is activated by this cell type?
Birbeck granules founds in Langerhans cells
| Langerhans cells activate Helper T cells
44
Treatment and drug MOA for Wilson's disease?
N-penicillamine
| copper chelating agent
45
How should you measure a B12 deficiency?
High MMA (product of methymalonyl CoA)
Methymalonyl CoA usually converted to succinyl CoA w/ cofactor B12. W/o B12, it becomes MMA.
MMA high with low B12.
Don't use B12 b/c it is mostly protein bound
46
What is milk alkali syndrome?
Hypercalcemia, metabolic alkalosis, renal insufficiency
Caused by calcium carbonate (OTC antacid)
Can cause severe renal toxicity if not discontinued
47
Characteristics of organism causing cat scratch fever
Bartonella heneslae
gram negative coccobacillus
oxidase positive
catalase positive
48
What urinary symptoms occur in sickle cell trait?
Episodic hematuria and impaired ability to concentrate urine
| Result of microscopic thromboembolic events within renal medulla
49
Where is the most common CF defect located?
defective processing from ER to the golgi of the CFTR protein
end result is altered conductance
Second most common is defective protein synthesis causing complete lack of CFTR protein
50
Hypertension + hyperkalemia with a genetic basis.Diagnosis? Treatment?
Liddle's syndrome-> constitutively activated ENaC in CT of kidney
Treat with traimterene or amiloride
51
What do rotavirus and coltivirus have in common?
double stranded segmented RNA virus
52
Which neoplasm is associated with Down syndrome (20x increased incidence)
ALL(may also see AML; less common)
53
Kid comes in with weight gain/edema and proteinuria. What is the next step?
Assume MCD b/c most common cause and begin empirical treatment with steroids
Should only biopsy if they don't respond to steroids
54
Decreased urine output with hepatic failure and no proteinuria/hematuria. What will imaging reveal and why?
```
Normal pathology
reduced GFR due to declining hepatic function.
Splanchnic vasodilation (3rd compartment type syndrome)
prerenal type azotemia
```
55
How do fibrates activate LPL?
activate PPAR-alpha protein
56
AEs of thiazide diuretics
hypokalemic metabolic alkalosis
hyponatremia
hyperGLUC--> glycemia, lipidemia, uricemia, calcemia
57
How is status epliepticus defined? Drug of choice?
Seizure activity continued more than 5-10 minutes w/o regaining consciousness b/w episodes
Diazepam is DOC b/c of short duration of action
58
Role of phospholamban in cardiac myocytes?
Dephosphorylation of phospholamban causes it to bind SERCA2 and decrease its affinity for calcium, reducing the influx of calcium into the sarcoplasmic reticulum/terminal cisternae
SERCA2 is the SR calcium ATPase that pumps calcium back into the SR following an AP
59
What is the Schilling test?
```
Radioactive oral B12 &
Stage 1: Unlabled IM B12
Stage 2: Oral Intrinsic Factor
Stage 3: Oral antibiotics
Stage 4: Pancreatic Enzymes
```
```
Measure B12 in urine
Diagnosis if high
Stage 1-> dietary deficiency
Stage 2 & 3-> pernicious anemia
Stage 4-> Pancreatic insufficiency
```
If still low in stage 4, look for other causes such as ileal resection
60
What are the intrinsic laryngeal muscles (except the cricothyroid m) a derivative of?
sixth branchial (pharyngeal) arch
61
What is Hunter's? What are the symptoms? How can you distinguish it from Hurler's?
X-linked deficiency of iduronate sulfatase
Symptoms include coarse facies, aggressive behavior, and pearly skin lesions on the scapulae
Hunter's does NOT have corneal clouding
62
What is Hurler's? What are the symptoms? How can you distinguish it from Hunter's?
Deficiency in alpha-L-iduronidase
Musculoskeletal abnormalities, hepatosplenomegaly, severe mental retardation
Hurler's WILL have corneal clouding
It is more severe and is diagnosed within the first year of life
63
Symptoms of sarcoidosis? Treatment and AE?
AA woman with lung symptoms w/ bilateral hilar lympadenopathy & interstitial infiltrates, negative PPD, and HIGH ACE.
Treatment is corticosteroid taper. OD can lead to iatrogenic Cushing's syndrome.
64
What role does calcium-calmodulin complex play in constriction of smooth muscle?
activates myosin light-chain kinase, which then phosphorylates myosin light chains.
Phosphorylated myosin light chains then facilitate cross-bridge formation
65
How does Angiotensin II act on vascular smooth muscle cells? What type of receptor does it bind?
Angiotensin II binds Gq
This causes contraction of renal arterioles
66
What is the treatment for Hepatitis B? MOA? AE?
alpha-IFN
degrades viral mRNA and inhibits protein synthesis
Stimulate NK and CD8 T cells
```
AEs:
Dose-limiting neutropenia
pancytopenia in general
psych disturbances
flu-like symptoms
```
67
Symptoms of cyanide poisoning
Treatment
Almond breath odor
Confusion
headache
Creates a metabolic lactic acidosis (high anion gap)
Treatment:
Sodium thiosulfate
amyl nitrite
68
What is the primary reducing agent in cells that produce steroids?
NADPH
Derived from B3 (niacin)
G-6-P Dehydrogenase is the enzyme that generates NADPH
69
What types of tumors are associated with NF2?
Bilateral vestibular schwannomas
Other CNS tumors, including ependymomas, meningiomas, gliomas, neurofibromas
70
What type of test might be a false positive for a patient with SLE?
VDRL (syphilis)
Remember that this test is not very specific
71
What is the pentad of thrombotic thombocytopenic purpura (TTP)?
1. fever
2. thrombocytopenia
3. Microangiopathic hemolysis
4. Neurologic symptoms
5. Renal insufficiency
72
What is the most effective medication for raising HDL levels? AEs?
Cholesterol
```
AEs:
flushing
pruritus
paresthesias
nausea
```
73
What is the visible manifestation of glucagonoma?
necrolytic migratory erythema
painful, pruritic erythematous papules that blister/erode/crust over
74
What types of disease are Aschoff bodies seen in? What types of cells do they contain?
Rheumatic heart disease
Contain multinucleated giant cells and large Anitschkow cells
75
What type of molecule is ras?
GTP-binding protein
Loss of GTPase activity results in constitutively active G protein b/c it can't be inactivated
76
What markers do smudge cells (CLL/SLL) express? From what cells do they originate?
```
They come from B lymphocytes and express B cell markers:
CD5
CD19
CD20
CD23
```
77
What muscle opens the jaw? What innervates this muscle?
Lateral pterygoid
V3
78
What protein does imatinib inhibit?
Bcr-Abl tyrosine kinase
Philadelphia chromosome t(9;22) seen in CML
79
How can you tell the difference b/w folate and B12 deficiency?
B12: high homocysteine & MMA
Folate: High homocysteine (but NORMAL MMA)
80
Which diuretic causes gynecomastia, testicular atrophy, and decreased libido? Why does this occur?
Spironolactone
Weak androgen receptor antagonist
81
As secretory flow rate increases, how does composition of saliva change?
Bicarb secreted at higher rates
Sodium increased
Potassium decreased
82
What type of vaccine can be given to pregnant women? What is an example?
Killed virus vaccine
Inactivated polio
83
What flavivirus presents histologically with eosinophilic globules (apoptosis of individual hepatocytes)?
Yellow fever
jaundice, aches, high fever
vector= mosquito
Councilman bodies on liver bx
84
PCP intoxication signs? Treatment?
```
Assaultive behavior, belligerence, & psychosis
fever
tachycardia
vertical & horizontal nystagmus
HTN
ataxia, seizures, delirium
```
Treatment: benzodiazepines or haloperidol (if severe)
85
What is erythromelalgia? What diseases is it associated with?
burning/redness of hands and feet due to platelet obstruction of blood flow in capillaries/arterioles
May do TIAs
Any type of thrombocytosis
Essential thrombocytosis can be treated with hydroxyurea
86
What things shift the oxygen-hemoglobin dissocation curve?
```
CO2
Acid
DPG
Exercise
Temperature
```
87
5 criteria of dermatomyositis/polymyositis
1. symmetric prox muscle weakness
2. heliotrope rash
3. elevated serum muscle enzymes
4. myopathic changes on electromyography
5. muscle bx abnormalities
88
What can cause drug-induced hyperthermia? How is it treated?
Inhaled anesthetics (-flurane)
Treat with dantrolene & cooling
Occurs more often in patients with mutation in ryanodine receptor--> allows for uncontrolled calcium release from SR
89
Where do T cells exist within the spleen?
Perarterial lymphoid sheath
90
Deficiency in hemophilia A & B
Hemophilia A-> Factor VIII
| Hemophilia B-> Factor IX
91
Disease-modifying treatment in MS
Beta-IFN (class 1)
Acute attacks treated with glucocorticoids
92
HLA-DR2 associations
MS
hay fever
SLE
Goodpasture's Syndrome
93
What do you see with dermatitis herpetiformis?
Anti-gliadin antibodies cause:
1. celiac sprue
2. erythematous/vesicular rash (anti-gliadin abs + hyperreactive T lymphocytes)
May results in malignancy (T-cell lymphoma)
94
What is the danger in giving Celecoxib to dehydrated patients?
COX-2 inhibitor causes constriction of afferent arteriole of kidney
Risk of renal failure
95
HIV patient, CD4 count < 100, new onset seizures
Toxoplasmosis
May also see chorioretinitis
96
Which virus affecting the liver causes a higher elevation of AST compared to ALT?
Yellow fever (flavivirus)
97
Pegylated IFN. Treatment? AEs?
Hep B & C
AEs:
flu-like reaction (episodic fever/chills)
profound depression
98
Deficiency in hyperchlyomicronemia
LPL
```
High triglycerides (>1000)
Increased risk of pancreatitis
Cardiac risk unchanged (HDL/LDL normal)
```
99
Myotonic dystrophy. Type of genetic disorder? Mutation?
Auto dominant
CTG nucleotide repeat
Muscle wasting, cataracts, heart conduction defects, & myotonia
100
Late finding in CMV retinitis? Treatment?
retinal detachment
treat with ganciclovir & foscarnet
101
Where can HHV-8 appear beside the skin? How can it manifest?
50% of patients have GI involvement:
- hematochezia
- hematemesis
- melena
102
What is the most common cause of squamous cell carcinoma of the bladder?
Helminth-> schistosoma haematobium
103
Holosystolic murmur at 4ICS
In kid-> VSD
| In IVDU-> Tricuspid regurge
104
How to fat soluble vitamins first enter circulation?
Vitamins A,D,E, & K all enter circulation through the thoracic duct through lacteals and then larger lymphatics
105
Thalassemia major lab values
Hypochromic, microcytic anemia
| Reticulocyte count elevated
106
What is the most common directly fatal complication of aortic dissection?
Pericardial tamponade
Aortic insufficiency results from aortic annulus disruption following retrograde dissection into the aortic root.
- Can lead to chronic myocardial remodeling
- Can be repaired surgically
107
Protamine sulfate: chemical nature?
Cationic
binds negatively charged heparin
108
Signs of aspiring overdose
```
tinnitus
n/v
lethargy
fever
tachypnea
metabolic acidosis w/compensatory metabolic alkalosis
```
-treat with sodium bicarb to alkalize urine
109
How does cocaine affect sympathetic nerves? How does hydroxyamphetamine affect sympathetic nerves?
Cocaine: inhibits reuptake of norepinephrine
-malfunction indicates lack of neurotransmitter in synapse
Hydroxyamphetamine: causes release of NE from postganglionic neuron
-malfunction indicates problem with POSTganglionic neuron
110
Signs of ischemic bowel? Most common location?
hx of hypotension
Acidosis & tense/tender abdomen
Seen at splenic flexure of large bowel b/c it is junction b/w SMA and IMA (watershed phenomenon)
111
What does bacitracin help distinguish between?
s. pyogenes (sensitive)
| s. agalactiae (resistant)
112
Development of what systems are affected with cretinism?
bone growth and CNS maturation
113
Initial treatment for SLE-induced DPGN?
cyclophosphamide (usually given in combination with glucocorticoids)
114
What is Lhermitte's phenomenon?
A transient shock-like sensation most often triggered by flexion of the neck
associated with MS
115
What is Malonyl-CoA a building block for? What is the cofactor used in its formation?
Building block for FA synthesis
Formation fo malonyl-coa: acteyl-CoA carboxylation using biotin as a cofactor
116
What is usually the precipitating even for Berger's disease? What is seen on immunoflourescence
- respiratory infection
- GI infection
- pharyngitis
IgA deposits in the mesangium
Would see hematuria with infection as a repetitive event in the patient's life
117
What causes diffuse cortical necrosis? Triad? What are the indications for acute dialysis?
Caused from DIC due to precipitating event (like complications from pregnancy)
Triad: abrupt onset of
- anuria
- gross hematuria
- flank pain
Indications for acute dialysis: AEIOU
Acidosis
Electrolyte abnormalities (esp high potassium)
Intoxication with drugs
Overload (volume)
Uremic symptoms (cardiac friction rub & altered mental status)
Of course, try to treat acidosis (bicarb), electrolytes, and volume (diuretics) before dialysis
118
What are the main functions of vWF?
1. adhesion of platelets to collagen via glycoproteins
| 2. carrier molecule of factor VIII
119
Defect in person getting recurrent candida infections?
Rare defect in T lymphocytes' ability to effectively fight candidiasis
120
Diverticulitis symptoms
```
lower abdominal pain
anorexia
systemic symptoms
-inflammation, fever, leukocytosis
(Bleeding uncommon in acute diverticulitis)
```
121
Why might you give allopurinol with cyclosporine?
tumor lysis syndrome can cause urate nephropathy-> acute gouty arthritis from increased urate occurs secondary to nephrotoxicity
122
EKG pattern for aortic dissection complications?
Diffuse low-voltage QRS complexes and electrical alternans
Cardiac tamponade leads to decreased vent filling and CO
Beck's triad: hypotension, increased JVP, distant heart sounds
123
EKG pattern for pulmonary embolism
S1Q3T3 pattern (specific but poorly sensitive)
Lead 1- S wave
Lead 3- Q wave and inverted T wave
124
Curling's ulcers: cause? risk factor? treatment?
overproduction of acid
burn patients
omeprazole
125
AAT histology?
intracellular periodic acid-Schiff (PAS)-positive globules
126
What would you expect with almost immediate cyanosis?
transposition of the great vessels
127
What type of sensitivity is PSGN?
Type III (antigen-Ab complexes)
128
How do you treat invasive aspergillus? AE?
voriconazole
Prolonged QT interval
129
Histologic fiding in papillary carcinoma?
Orphan annie (ground glass) nuclei w/ psammoma bodies
130
What anticoagulant is given for atrial fib? What types of drugs should be used with caution in conjunction with this drug?
Warfarin
Beware with CYP inhibitors
131
What disorder has elevated direct bilirubin and normal indirect bilirubin?
Dubin-Johnson Syndrome
impairment of transport system for removing cojugated anions into bile
Melanin-like pigment seen in hepatocytes
Jews or Iranians
Relatively benign
132
Bloody mucoid diarrhea
recent travel
hepatic abscess
Diagnosis? Treatment?
Entamoeba histolytica
Metronidazole
133
Formula for specificity?
TN/(FP + TN)
134
Idiopathic pulmonary fibrosis: characteristic appearance on chest CT
honeycombing
135
What lab will be abnormal with idiopathic pulmonary fibrosis?
hematocrit
upreg of EPO by kidneys in response to chronic decreased blood oxygen tension
136
HbA levels in Beta-thalassemia major? Beta-thalassemia minor?
Major- no HbA1
| Minor- decreased HbA1
137
```
AEs for:
enflurane
halothane
desflurane
methoxyflurane
```
Enflurane: pro-convulsant
Halothane: hepatotoxicity, hyperthermia
Desflurane: airway irritation
Methoxyflurane: nephrotoxicity
138
Lesch-Nyhan histology?
Hypersegmented neutrophils
occurs due to inability to utilize B12 leading to macrocytic anemia
139
What type of coarctation occurs with Turner syndrome?
preductal
might see small left arm due to compromised blood flow w/ involvement of left subclavian artery
140
MEN Type 1: areas involved
pancreas
pituitary
parathyroid
141
MEN Type 2: areas involved
thyroid
pheochromocytoma
parathyroid
ret oncogene
142
Person comes in with encephalopathy, confusion, gait ataxia, and nystagmus. Late stages: selective deficits in antero-/retrograde memory.
Diagnosis?
Deficiency?
Wernicke-Korsakoff syndrome
Deficient in B1 (thiamine)
143
In what setting does primary sclerosing cholangitis occur? What enzyme might be elevated with this condition?
Might occur in the setting of ulcerative colitis
Fatigue, pruritis, and scleral icterus.
You would see elevated alk phosph
144
Anti-mitochondrial Abs
primary biliary cirrhosis
145
Which biliary condition affects:
ONLY intrahepatic ducts
intra & extrahepatic ducts
ONLY intra: primary biliary cirrhosis
Intra & extra: primary sclerosing cholangitis
146
Polymyxin:
MOA?
AE?
binds to gram negative cell bacterial membrane phospholipids and destroys membranes by acting like a detergent
AE: numbness of extremities, CNS effects, nystagmus/blurry vision
Used for severe gram (-) infections
147
Cytarabine: MOA
pyrimidine analog
prodrug activated to AraCTP.
intereferes with DNA synthesis
used for leukemia
148
Hematopoiesis during development
1st- yolk sac (week 3)
2nd- liver (week 6-birth)
3rd- spleen (week 10-28)
4th- bone marrow (week 18)
149
Plummer-Vinson diagnostic triad
1. Iron deficiency anemia
2. Upper esophageal web
3. Glossitis
(1 & 2 can lead to dysphagia of solids)
Increased risk of squamous cell carcinoma of oral cavity, hypopharynx, or esophagus
150
Gerstmann's syndrome tetrad
1. inability to distinguish right from left
2. inability to identify fingers
3. writing disability (agraphia/dysgraphia)
4. can't do math (acalculia/dyscalculia)
Affected area= visual association cortex (angular gyrus)
can still read
might have visual field defects (contralateral)
151
Hartnup disease: MOA?
| Deficiency & treatment?
Defect in neutral amino acid transporters in both renal and GI tracts
affects all neutral amino acids but proline
deficiency in tryptophan: leads to decreased niacin and pellagra
152
Which skin lesions are painful: yersinia pestis or bacillus anthracis?
yersinia pestis
153
What is a complication of yersinia pestis?
DIC
154
Treatment of acute PE? What do you need to monitor when giving this drug?
Low molecular weight heparin (LMWH)
You don't have to monitor anything!
Give unfractionated heparin in patients with severe hypotension, morbid obesity, or renal failure. In this case, monitor PTT
155
Thiazolidinone. Indication? MOA?
Sensitization of muscle and liver to insulin
binds PPAR nuclear regulator--> increase insulin receptor
156
How do glucose, galactose, and fructose traverse the:
- apical membrane
- basolateral membrane
Apical:
glu/galac-> SGLT-1 (Na dependent)
fructose-> GLUT-5
Basolateral:
GLUT-2
157
Diagnosis if jaundice, anemia, increased reticulocytes, and positive warm-agglutinin test
Warm reactive autoimmune hemolytic anemia
158
Treatment of warm-reactive autoimmune hemolytic anemia (AIHA)?
corticosteroids
splenectomy if chronic or refractory, but this is NOT first line
159
Guillan barre: treatment?
plasmapharesis followed by immunoglobulins and supportive care
160
Wiskott-Aldrich symptoms
```
WATER:
Wiskott-Aldrich
Thrombocytopenic purpura
Eczema
Recurrent infections
```
161
Wiskott-Aldrich: deficiency
X=linked recessive
WASP gene
T cells unable to reorganize actin skeleton
162
What is another name for the Ziehl-Neelsen stain?
acid fast
163
What does e. coli ferment?
lactose
pink colonies on MacConkey
164
APL: which translocation? What are the two products involved? Treatment?
t(15;17)
15- PML
17- retinoic acid receptor
Treatment: Retinoic Acid
165
Displaced lens, chromosome 15... think?
Marfan's
166
Problems with swallowing post-surgery: nerve and structure it is derived from?
superior laryngeal n. of vagus
4th branchial arch
167
How does lead poisoning inhibit heme synthesis?
Blocks delta-aminolevulinic acid dehydratase
decreases iron incorporation into heme
168
What is the treatment for n. gonorrheae that persists despite treatment with a fluoroquinolone?
ceftriaxone + azithromycin
169
Which lung tumor is found to be found in the periphery of a nonsmoker's lung?
Adenocarcinomas
170
Ischemic stroke treatment
clopidogrel & ticlopidine
inhibit platelet aggregation by blocking adenosine phosphate receptors
171
anti-phospholipid antibodies: characteristics
hypercoagulability
recurrent fetal losses
prolong PTT not corrected with 1:1 FFP
172
Metformin: AE (esp in context of renal disease)
lactic acidosis (anion gap metabolic acidosis)
173
Risk factors for suicide completion
```
SAD PERSONS
Sex (male)
Age (teen or elderly)
Depression
Previous attempt
Ethanol/drug use
loss of Rational thinking
Sickness
Organized plan
No spouse
Social support lacking
```
Women try more often; men succeed more often
174
baby malformations seen with maternal warfarin use
facial/limb malformations
neurological defects
you should give LMW heparin
175
methachromatic leukodystrophy: auto recessive. Deficiency & symptoms?
lysosomal storage disease: arylsulfatase A deficiency-> converts sulfatide to galactocerebroside
tissue accumulation of cerebroside sulfatide
loss of myelination
metachromatic granules on histologic examination
176
What is a hapten?
a molecule that can't elicit an immune response on its own but can do so with a protein bound to it
177
immune thrombocytopenic purpura: blood smear appearance?
enlarged platelets & greater abundance of megakaryocytes
178
What types of cells use SGLT glucose transporters?
enterocytes and nephrons
179
Waldenstrom's macroglobulinemia: presentation?
```
high IgM
plasma cells dominate BM
mild anemia
high/normal BUN
increased total protein
```
180
molecules involved in thyroxine synthesis
iodine
| tyrosine
181
treatment for m. pneumoniae
tetracycline
182
nerve block for woman in labor: nerve and nerve roots?
pudendal nerve
| S2-S4
183
MS treatment
beta-IFN
184
What can cross the BBB?
CO2
O2
amino acids
glucose
185
Gaucher's disease: deficiency? most commonly seen in?
beta glucocerebrosidase
| Ashkenazi Jews
186
LTs that cause asthma symptoms?
C4, D4, & E4
prescribe zileuton & zafirlukast
187
stop codons
UGA
UAA
UAG
188
HSV1 encephalitis: CT
focal, unilateral temporal lobe pathology
189
extra-intestinal manifestations of Crohn's Disease
uveitis
migratory polyarthritis
erythema nodosum
renal calculi
190
IBD & kidney stones: mechanism
increased intraluminal fat in intestine binds calcium
More oxalate is absorbed than calcium
oxalate + dehydration from diarrhea = precipitation of calcium oxalate stones
191
Paneth's granular cells: location & purpose
small intestine
| release alpha-defensins & lysoszymes
192
Agar to distinguish between shigella & salmonella
Hektoen enteric agar
| black= H2S (salmonella)
193
NSAID prescribed to patients with history of GI distress
Celecoxib (COX-2 specific)
caution in patients with CV stuff
194
lymph node pain with alcohol consumption
Hodgkin's lymphoma
195
Essential amino acids
```
Leucine
Isoleucine
Lysine
Phenylalanine
Tryptophan
Methionine
Threonine
Valine
```
(histidine during periods of growth)
196
Gaucher's disease (AR-> beta glucocerebrosidase, ashkenazi jews): common symptoms
hepatosplenomegaly
aseptic necrosis of femur
bone crises
gaucher's cells (crinkle cells)
197
What 4 embryologic structures make up the diaphragm?
1. Pleuroperitoneal folds
2. Septum transversum
3. Dorsal mesentery of esophagus
4. Muscular outgrowth of lateral body wall
198
HIV:
Initial screening test?
confirmation?
Initial- ELISA
| Confirmation- Western blot
199
p. jiroveci: treatment in patient allergic to TMP-SMX?
Pentamidine
200
Malignant otitis externa: bug? first line treatment? treatment if resistant?
p.aeruginosa
treat with a fluorquinolone (cipro)
if resistant, hit it with a piperacillin/tazobactam combo
