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Flashcards in UWorld Deck (190):
1

Streptomycin mechanism

Inhibits initiation of protein synthesis by binding to and distorting the structure of the prokaryotic 30S ribosomal subunit. (aminoglycoside class)

2

Screening for carcinoid syndrome

5-hydroxyindoleacetic acid (Breakdown product of carcinoid syndrome)

3

Screening for mast cell degranulation

Tryptase (specific to mast cells)

4

Melanocytes are derived from what tissue

Neural crest

5

Aortic regurgitation

early diastolic murmur

6

most common cause of aortic reguritation

aortic root dilation (murmur is often best heard at the right sternal border) or bicuspid aortic valve

7

Goodpasture syndrome

C3 and IgG are deposited along the glomerular basement membrane. IF shows linear deposits of these complexes

8

Poststreptococcal glomerulonephritis

Preceded by skin or pharyngeal infections with group A beta-hemolytic streptocci.

IF shows diffuse granular pattern of IgG and C3 depostis within the glomerular capillary walls and mesangium

9

Rifampin

Halts bacterial protein synthesis by inhibiting bacterial DNA-dependent RNA polymerase, preventing transcription of DNA into mRNA

10

Streptomycin uses

Mycobacterial
Yersinia pestis
Tularemia

11

Ciprofloxacin drug class

Fluoroquinolone.

Inhibits DNA gyrase

12

Isoniazid action

antimycobacterial agent inhibiting synthesis of mycolic acids

13

Burkitts lymphoma

t8;14

c-myc: nuclear phosphoprotein functioning as a transcription activator controlling cell proliferation, differentiation, apoptosis

Ig heavy chain region

14

Follicular lymphoma

t14;18

bcl-2 gene: apoptosis inhibitor protein

15

CML

t9;22

BCR-abl: fusion gene encoding a proteint hat inhibits apoptosis while promoting mitogenesis and increased tyrosine kinase activity

16

Mantle cell lymphoma

t11;14

cyclin D1: promoter of G1 to S phase

17

Wilson disease mechanism

inadeq. hepatic copper excretion and failure of copper to enter circulation as ceruloplasmin.

18

Wilson disease s/s

Copper is Hella BAD

Cirrhosis, corneal deposits (kayser-Fleisher rings)

Hemolytic anemia

Basal ganglia degeneration (parkinsonian symptoms
Asterixis
Dementia, dyskinesia, dysarthria

19

Indicator of mitral stenosis severity

A2-OS interval, shorter is worse

20

Myocardian stunning

less severe form of ischemia-induced reversible loss of contractile function than hibernation.

Brief ischemic episodes

21

Ischemic pre-conditioning

development of resistance to infarction by cardiac myocytes previously exposed to repetitive non-lethal ischemia

22

Myocardial hibernation

persistentnt or repetitive low flow state, that can be reversed by reperfusion

23

Parts of tRNA

tRNA anticodon site-ribosome complex selects soley upon its anticodon sequence, red in teh 3' to 5' direction

D loop-dihydrouracil residues used for recognition by proper aminoacyl tRNA synthetase

Variable loop

Tarm-contains TpsiC loop necessary for binding of tRNA to ribosomes. Has thymidine,pseudouridine, cytidine residues. ONLY RNA SPECIES CONTAINING NUCLEOSIDE THYMIDINE

Acceptor stem-CCA hanging off 3' end with hydroxyl accepting amino acid by aminnoacyl tRNA synthetase action

24

Vitamin B1 (thiamine) deficiency symptoms

beriberi and wernicke syndrome

25

Vitamin B2 (riboflavin) deficiency

cheilosis
stomatitis
glossitis
dermatitis
corneal vascularization
ariboflavinosis

26

Vitamin B6 (pyridoxine) deficiency

cheilosis, glossitis, dermatitis, peripheral neuropathy

27

Folic acid deficiency characterized by

megaloblastic anemia
neural tube defects int he fetus

28

Vitamin K deficiency

bleeding diathesis, but not painful gums

29

zinc deficiency

acrodermatitis enteropathica, growth retardation, infertility

30

Scurvy

hemorrhages, subperiosteal hematomas, bleeding into joint spaces, gingival swelling, secondary periodontal infection, anemia, hyperkearatotic papular rashes, impaired wound healing, weakened immune response to local infections

31

what causes angiogenesis?

VEGF
FGF

32

What indirectly causes angiogenesis?

proinflammaotry cytokines like IL-1 and INF-gamma (increased VEGF expression)

33

Reaction formation

transformation of an unacceptable impulse or emotion into the opposite. (patient acting extremely relaxed around physician, saying she finds her appointments to be very soothing to defend against underlying anxiety)

34

Classical conditioning

neutral stimulus repeatedly paired with non-neutral stimulus that elicits a reflexive, unconditioned response.

35

Tardive dyskinesia

involuntary movements after chronic use (lip smacking, choreoathetoid movements)

36

Neuroleptic malignant syndrome

fever, rigidity, mental status changes, autonomic instability

37

Acute dystonic reaction

Sudden onset, sustained muscle contractions

38

Drug-induced parkinsonism

tremor, rigidity, bradykinesia, masked facies

39

main transmission paths of Hepatitis B

sexual
percutaneous
Vertical

40

Familial pulmonary arterial hypertension cause/results/treatment

Inactivating mutations in pro-apoptotic BMPR2 gene.

41

Familial pulmonary arterial hypertension consequences

Medial hypertrophy (arteriolar smooth muscle) intimal fibrosis, significant luminal narrowing

42

Familial pulmonary arterial hypertension treatment

Definitive is lung transplant

Vasodilators can improve symptoms

Bosentan: endothelin receptor antagonist blocking effects of endothelin (potent vasoconstrictor that also stimulates endothelial proliferation. ) decreasing pulmonary arterial pressure and lesson progression of vascular and right ventricular hypertrophy

43

Major side effect to amphotericin B

Renal toxicity
-renal vasoconstriction, reduction in the GFR
-Direct toxin on renal epithelial cells
-acute tubular necrosis
-electrolyte disturbance
-renal tubular acidosis
-normochromic normocytic anemia

-Hypokalemia
-Hypomagnesemia
are the most serious electrolyte disturbances that require supplementation.

44

Phenotypic mixing

co-infection of a host cell by two viral strains, resulting in progeny virions that contain nucleocapsid proteins from one strain and the genome of the other strain. Though no change to underlying viral genomes, so next generation of virions revert to original unmixed phenotypes

45

Interference (viral)

inhibition of one virus of the replication and/or release of a second virus that is infecting the same cell.

46

Transformation (viral)

incorporation of viral DNA into a host cell chromosome. alters genetic composition of the host cell, but typically no genomic changes to virus

47

Transformation

Uptake of naked DNA by a prokaryotic or eukaryotic cell

48

Viridans streptococci virulence factor for adherence

Produce extracellular polysaccharides (dextrans) using sucrose as a substrate. Facilitates adherence to fibrin.

(fibrin and platelets are deposited at sites of endothelial trauma, providing a site for bacterial adherence and colonization during bacteremia leading to teh formation of a valvular vegetation)

49

Action of heparin

Activate antithrombin III, thereby decreasing activity of
thrombin
Clotting factors IX, X, XI, XII

50

Most important environmental risk factor for pancreatic cancer

Smoking

Others include:
Age >50
Chronic pancreatitis
Diabetes mellitus
Genetic: Hereditary pancreatitis, MEN syndromes, Hereditary non polyposis colon cancer, Familial adenomatous polyposis syndromes

51

Risk for colon adenocarcinoma

low fiber diet

52

Alcohol as a risk factor

Head/Neck/Esophagus/Liver

Chronic pancreatitis

However, moderate alcohol use in absence of chronic pancreatitis does not add risk for pancreatic cancer

53

H. pylori as a risk factor

Gastric adenocarcinoma
Gastric lymphoma

54

S/S for adenocarcinoma at head of pancreas

(compressing the common bile duct)
Palpable but nontender gallbladder (courvoisier sign)
Wt loss
Obstructive jaundice (pruritism, dark urine, pale stools)

55

S/S for pancreatic cancers of body and tail.

(do not compress common bile duct)
No symptoms until invading splanchnic plexus causing midepigastric abdominal pain.

56

Courvoisier sign

Palpable but nontender gallbladder

57

Obstructive jaundice s/s

Pruritis
Dark urine
Pale stools

58

What is Lipofuscin

sign of wear and tear or aging in the heart and liver of aging or cachectic malnourished patients

Insoluble pigment composed of lipid polymers and protein complexed phospholipids

59

Oseltamivir class and action

What is it used for

Neuraminidase inhibitor, prevent release of virus from infected cells and spread within the respiratory tract

Influenza A and B

60

Eaton-Lambert syndrome mechanism

Autoab reacting with presynaptic calcium channels preventing release of ACh

Paraneoplastic syndrome assoc w. small cell carcinoma of the lung

61

Eaton-Lambert clinical presentation

resembles myasthenia gravis.

62

Valsalva, what is it
and what does it do
and what affect does it have on murmurs

straining to blow air out like a balloon but closed mouth and nose.

Decreases preload of heart.

Makes LVH murmur louder and mitral valve prolapse
Most other murmurs softer (aortic stenosis, pulmonic stenosis, tricuspid regurgitation)

63

Handgrip maneuvar

Increases afterload

64

M protein

major virulence factor for Strep pyogenes (group A)

Present in cell wall and antiphagocytic, interfereing with opsonization by alternative complement pathway.

Binds to fibrinogen, resluting in inflammatory mediator release and vascular leakage.

65

Wacky Wobbly and Wet indicates what?

How does it happen?

What does CT scan show?

What is the specific order of symptoms?

Normal pressure hydrocephalus (NPH)

Communicating hydrocephalus due to diminished reabsorptive capacity of the arachnoid villi.

CT scan shows symmetric dilation of ventriculi

(Gait abnormality, urinary incontinence are the first symptoms. Progresses to progressive dementia and emotional blunting)

66

How to test for Meckel diverticulum?

99-Pertechnetate study for ptake by ectopic gastric mucosa

67

How does Meckel's diverticulum occur?

Failure of obliteration of the omphalomesenteric duct. May contain ectopic acid-secreting gastric mucosa and or pancreatic tissue

68

Presentations of Meckel's Diverticulum

-RLQ pain (similar to acute appendicitis)
-Intussusception (colicky abd pain and currant jelly stools)
-Volvulus
-Obstruction near terminal ileum

Rule of 2s

69

What is the rule of 2s

-2 inches long
-2 feet from ileocecal valve
-2% of population
-Presents in the first 2 years of life
-May have 2 types of epithelial (gastric/panceratic)

(Meckel's diverticulum)

70

Mutations affecting cardiac cell cytoskeletal proteins or mitochondrial enzymes of oxidative phosphorylation

Genetic form of Dilated Cardiomyopathy (DCM)

71

Mutations in cardiac cell sarcomere proteins (beta myosin heavy chain)

Hypertrophic cardiomyopathy

72

Mutations of a calcium binding sarcoplasmic reticulum protein

Arrhythmogenic right ventricular cardiomyopathy (ARVC), a progressive fibrofatty replacement of the right ventricular myocardium of uncertain pathogenesis

73

Mutations in K+ channel protein contributing to delayed rectifier current IK of the cardiac action potential (long QT), risk for Torsades de pointes

Romano-Ward syndrome

Jervell and Lange-Nielson syndrome

74

Superior mesenteric artery syndrome what is it and what are some causes

When the transverse portion of the duodenum is entrapped b/w the SMA and the aorta, causing symptoms of partial intestinal obstruction.

Aortomesenteric angle critically decreased secondary to
-Diminished mesenteric fat
-Pronounced lordosis
-Surgical correction of scoliosis

75

What to check for confirming menopause.

FSH

76

Thiopental distribution

Equilibrates in brain tissue within 1 minute, ergo used fo induction of anesthesia.

Rapidly redistributes to skeletal muscles and fat.

77

Microvesicular fatty change in liver

Reye syndrome (children 5-10 after treatment with salicylates)

78

Macrovesicular fatty change

Fatty liver from chronic ethanol consumption

79

Drug induced cholestasis

OCP
Anabolic steroids
Chlorpromazine

80

Hepatic granulomatosis is associated with..

Methyldopa
Hydralazine
Quinidine

81

Massive hepatic necrosis
What causes it

What is seen on histo

clinical presentatino

Rare but severe complication of halothane exposure (especially halothane), due to direct liver injury by halothane metabolites and formation of autoantibodies against liver proteins. Occurs 2 days to 4 wks after the exposure.

Massive centrilobular hepatic necrosis

Hepatomegaly, liver tenderness, increased LFTs

82

Von Hippel-Lindau disease characterization

Gene defect?

AD

Cerebellar hemangioblastoma
Clear cell renal carcinoma
Pheochromocytoma

Deletion of VHL gene on chromosome 3p

83

RB location

implication of mutation

Normal Mechanism

Chr 13

Mutations lead to
-Retinoblastoma
-Osteosarcoma

Inhibits E2F normally blocking G1-->S phase

84

WT-1 location

implication of mutation

Chr 11
Wilms tumor

85

Alkaptonuria mechanism

Presentation

Congenital deficiency of homogentisate oxidase in the degradative pathway of tyrosine to fumarate

Autosomal recessive, benign. Dark connective tissue, brown pigmented sclerae, urine turns black on prolonged exposure to air. May have debilitating arthralgias (homogentisic acid toxic to cartilage)

86

How is Cysteine made

Sulfur containing amino acid synthesized from amino acid Serine and Homocysteine (which is derived from methionine)

87

Drug of choice for preventing venous thrombosis in non-ambulatory patients or patients undergoing elective surgery especially hip and knee.

Mechanism?

Heparin Unfractionated and also low molecular weight heparins

Increases the effect of the naturally occuring anticoagulant antithrombin III. Unfractionated heparin binds to antithrombin III by pentasaccharide in the heparin chain, causing a conformational change of antithrombi III, in turn increasing antithrombin binding and neutralization of thrombin

88

Drug of choice for managing heparin induced thrombocytopenia

Lepirudin
Argatroban

Direct thrombin inhibitors, do not require antithrombin III

89

Drug of choice following Percutaneous coronary intervention PCI and for treating unstable angina and non-Q wave MI

Ticlopidine and Clopidogrel

ADP inhibitors

90

Drug of choice for primary and secondary prevention of MI and strokes. NOT as effective for preventing perioperative thromboembolism

Aspirin

Acetylates COXI, decreased Thromboxane A2

91

Olanzapine use

mechanism of action

SE

Mood stabilizing in bipolar

2nd generation antipsychotic

SE:
Wt gain and metabolic side effects

92

What organisms produce IgA proteases?

What is the point?

Streptococcus pneumoniae and Neisseria gonorrhoeae

Cleaves IgA antibodies preventing them from interfering with bacterial adhesion to mucous membranes.

93

Characteristics of Klebsiella

Encapsulated
Lactose fermenting
Gram negative bacillus
Mucoid in culture

94

Warfarin action

Inhibits Vitamin K dependent carboxylation of glutamic acid residues of factors 2, 7, 9, 10. also protein C and protein S.

95

Drug of choice for long term anticoagulation to prevent venous thrombosis and resultant pulmonary embolism (VTE)

Warfarin

96

What is keratin a marker for

Epithelial cell origin

97

markers for endothelium

CD34, vWF, others

98

muscle tissue identification

smooth muscle actin
Caldesmon
Desmin
others

99

Lymphocyte pan T cell marker

CD3

100

Most common location for intestinal carcinoids?

Other locations?

Ileum is most common location for intestinal carcinoids

Appendix and rectum also

101

Histo of carcinoid tumors

nests or sheets of uniform cells

Eosinophilic cytoplasm and oval to round stippled nuclei

102

Where are carcinoid tumors derived from?

Enterochromaffin cells of intestinal mucosa are the source of carcinoid tumors

103

What is the polysarrharide-protein capsule of H. influenzae comprised of.

Linear polymer composed of ribose, ribitol, and phosphate (polyribosyl-ribitol-phosphate PRP)

104

Adenoma to carcinoma sequence

APC inactivation

Methylation abnormalities
[hyperproliferative epithelium]
COX-2 overexpression

K-ras activation
[adenoma]
DCC inactivation

p53 inactivation
[carcinoma]

Further accumulations of genetic abnormalities

105

What is the enzyme that controls glycolysis/gluconeogenesis

Bifunctional enzyme composed of PFK2 and 2,6-bisphosphatase.

106

How is PFK2/2,6 bisphosphatase regulated?

bifunctional enzyme.

Glucagon causes phosphorylation, inactivates kinase, activates phosphatase. Decrease in Fructose 2,6 bisphosphate. Inhibition of PFK1 and increased gluconeogenesis.

Insulin causes dephosphorylation, Inactivates phosphatase and activates the kinase. Increased Fructose 2,6 bisphosphate. Stimulates PFK1 and increased glycolysis.

107

periodic acid schiff stains for what

Stains glycogen, mucopolysaccharides, used to dx Tropheryma whipplei (Whipple disease).

and

Alpha1-antitrypsin deficiency (reddish-pink, PAS+ granules of unsecreted, polymerized A1AT in the periportal hepatocyteS)

108

Whipple disease
What causes it
how dx?
Presentation
Mnemonic?

Caused by Infection with Tropheryma whipplei (Gram positive)

Dx with PAS+ stain

Presents w/:
Foamy macrophages in intestinal lamina propria, mesenteric nodes.
Cardiac symptoms
Arthralgias and
Neurologic symptoms are common.

Commonly in old men
FOAMY WHIPPed cream in a CAN

109

Bronchial hyperreactivity is the hallmark of

chronic asthma

110

Intraalveolar substance accumulation is a finding in

Interstitial pneumonitis

111

Alpha1-Antitrypstin deficiency (A1AT) is what kind of disorder.

Genetics (alleles?

Autosomal co-dominant disorder affecting lungs and liver.

MM is normal
ZZ has decreased synthesis of AAT by the liver.

112

Ghon focus
Ghon complex

Small area of granulomatous inflammation.

Ghon complex: Hilar lymphadenopathy + Peripheral granulomatous lesion in middle or lower lung lobe

113

Healing of TB lung lesion may be complicated by

This persistent cavity may become secondarily infected with Aspergillus flavus and form fungus balls

114

How is potency of inhaled anesthetics measured?

MAC, minimal alveolar concentration (alveolar concentration preventing movement in 50% of patients exposed to noxious stimuli)

115

Arteriovenous concentration gradient influences what, not what?

why?

Influences the rate of induction, not anesthetic potency (MAC)

because high gradients mean you need more anesthetic to replace that uptaken by peripheral tissues

116

How does thyroid bring iodine into the follicle?

What does this also bring in?

Na+/I- symporter

Perchlorate and Pertechnetate

117

Nuclei involved in Pupillary light reflex

Pretectal nucleus
followed by
Edinger-Westphal nucleus
followed by
Ciliary ganglion

118

vWF function

1. Platetlet adhesion by binding to and crosslinking platelet gliycoproteins (GpIb) and exposed collagen underneath damaged endothelium

119

Vitamin A overuse

Intracranial hypertension (papiledema)
Skin changes
Hepatosplenomegaly

120

Vitamin C overdose

False negative stool guaiac results
Assoc with diarrhea and abdominal bloating
Calcium oxalate nephrolithiasis maybe

121

B2 deficiency (riboflavin)

Cheilosis
Stomatitis
Glossitis
Dermatitis
Corneal vascularization
Ariboflavinosis

122

B12 deficiency

Older mentally slow woman of northern Euro descent lemon colored (anemic and icteric) smooth shiny tongue (atrophic glossitis) shuffling broad based gait

123

niacin deficiency

3 Ds of pellagra,
dementia
dermatitis
diarrhea

124

Thiamine deficiency

Infantile and adult beriberi
wernicke korsakoff

125

First line Treatment of trigeminal neuralgia

mechanism

SE

Carbamazepine

By reducing ability of sodium channels to recover from inactivation, inhibits neuronal high frequency firing.

Aplastic anemia is a potential SE as well as
P450 inducer

126

2nd line treatment of trigeminal neuralgia

Baclofen
Valproic acid

127

trigeminal neuralgia presentation

first line treatment
2nd line treatment

brief episodes of sudden and severe electric shock like or stabbing pain in the distribution of CN V (particularly V2 and V3)

Carbamazepine is 1st line
Baclofen and valproic acid are second line treatments

128

histo finding for granulosa cell tumor

Call-Exner bodies, small follicle like structures filled with eosinophilic secretions

129

short acting benzodiazepines

Triazolam or alprazolam

130

Intermediate acting benzodiazepines

Lorazepam

131

long acting benzodiazepines

diazepam
flurazepam
chlordiazepoxide

132

treatment of GAD or panic disorder

SSRI (Fluoxetine) but needs 4 wks to start and there is sometimes an initial transient worsening of symptoms.

Give Benzodiazepine initially (preferably short acting like Alprazolam or trazolam)

133

what is assoc with mitochondrial toxicity

Cyanide

NRTIs

134

Ribosomal protein synthesis inhibited by what toxins

Shiga toxin (Shigella)

Shiga-like toxin (ETEC enterohemorrhagic E. coli O157:H7)

135

lithium side effects

Hypothyroidism
Nephrogenic diabetes insipidus
Ebstein's anomaly in preg

136

Carbamazepine SE

Aplastic anemia (CBC required to monitor)

137

Citalopram SE

Sexual dysfxn

138

Clozapine se

agranulocytosis and seizures

139

Lamotrigine SE

Rash, stevens johnson syndrome

140

Risperidone SE (also what kind of drug is it)

atypical antipsychotic, agranulocytosis and seizures

141

SE of trazodone

Painful erection (priapism)
Orthostatic hypotension
Sedation

142

Transtentorial herniation can result in compression of what and what does this cause in each case?

1. Ipsilateral oculomotor nerve (dilated fixed pupil down and out)
2. Ipsilateral posterior cerebral artery compression (contralateral homonymous hemianopsia w/ macular sparing)
3. Compression of contralateral of cerebral peduncle. or ipsilateral peduncle. (This results in hemparesis of ipsi or contra respectively.)
4. Brainstem hemorrhages (Duret hemorrages, pons and midbrain due to stretch and rupture of basila artery. Fatal)

143

Why is heat sensitivity seen in MS

Decreased axonal transmission assoc with increased heat

144

What enzyme can convert procarcinogens into an active carcinogenic state in the body

Cytochrome P450 oxidase system (microsomal monooxygenase)

145

at what lung volume is total pulmonary vascular resistance the lowest

FRC (higher than that you get stretching of alveolar capillaries, decreasing radius increasing resistance. Lower than that you get compression radially of extraalveolar vessels)

146

What is seen in
Hyperacute rejection of lung

Acute rejection of lung

Chronic rejection of lung

Hyperacute rejection: graft blood vessel spasm and diffuse intravascular coagulation with resultant ischemia (due to preformed ab against ABO or HLA)

Acute rejection: 1-2 wks after, vascular dmg. Perivascular and peribronchial lymmphocytic infiltrates. Dyspnea, dry cough, low grade fever. Perihilar and lower lobe opacities (due to ricipient rxn to the HLA of the graft cell mediated imune response and CD8 t cells play central role)

Chronic rejection: mo-yrs, inflammation of the small bronchioles (bronchiolitis obliterans) inflamm and fibrosis of bronchiolar walls lead to narrowing and obstruction of the affected bronchioli. Dyspnea, nonlproductive cough, wheezing. (c/f with renal transplant chronic rejection has vascular obliteration)

147

Resistance to penicillin

1. production of beta lactamase
2. production of a low affinity penicillin binding protein

148

Resistance to vancomycin

VanA ligase substitutes D-alanine D-lactate for D-alanyl-D-alanine thus preventing binding fo vancomycin.

149

Resistance to tetracyclines

1. synthesis of protein that allows ribosome to translation even in presence of drug
2. Decreeasing intracellular concentrations of the drug by increased efflux or decreased influx

150

Resistance to ciprofloxacin/fluoroquinolones

mutations in the DNA gyrase or topoisomerase genes

151

Resistance to aminoglycosides

How is it acquired?

Production of aminoglycoside modifying enzymes that transfer diff chemical groups (acetyl, adenyl, phosphate) to the aminoglycoside antibiotic molecule outside of the bacterium, thereby decreasing the ability of these drugs to bind to ribosomes and exert their antimicrobial effects.

Not chromosomally mediated but acquired resistance mediated by plasmids or transposons.

152

Human multidrug resistance gene codes for what?

P-glycoprotein, a transmembrane ATP dependent efflux pump protein that has a broad specificity for hydrophobic compounds. This can reduce the influx of drugs into the cytosol and increase efflux from the cytosol, thereby preventing the action of chemotherapeutic agents.

153

Alport syndrome mechanism

Presentation

Inherited defect in the formation of type 4 collagen

Presents with
-Thinning of the basement membrane
-Hearing loss
-Ocular abnormalities
-Hematuria
-Progressive renal insufficiency

154

Minimal change disease mechanism

Presentation

Immune dysreg and overproduction of specific cytokine (IL-13) that dmgs the podocytes->effacement and fusion of footprocesses

Presents
-Selective loss of albumin

155

Suprachiasmatic nuclei are involved in...

located immediately above the optic chiasm and receive visual input from retina via the optic tract.

Help to regulate circadian rhythms by relaying light information to other hypothalamic nuclei and to the pineal gland

156

Supraoptic and paraventricular nuclei produce what

Vasopressin

Oxytocin

157

Anterior hypothalamic nuclei coordinate what

Posterior hypothalamic nuclei coordinate what

Anterior coordinates cooling by stimulating parasympathetic NV

Posterior coordinates heat conservation and heat producxtion

158

What is a SE of oxygen therapy to a neonate in respiratory distress

Retinal damage. Becaues the temporary hyperoxia may induce upreg of proangiogenic factors like VEGF upon return to room air ventilation

159

Treatment of an acute manic episode

Mood stabilizing agent (lithium, valproate, or carbamazepine)
and
Atypical antipsychotic (olanzapine)

(mood stabilizer as monotherapy are effective in up to 60%)

160

What can the swinging flashlight test show a relative afferent pupillary defect in the pupil contralateral to the tract lesion?

the nasal portion of theretina contributes more input to the pretectal nucleus than the temporal portion of the retina

161

Lesion in the optic tract causes...

contralateral homonymous hemianopsia and a relative afferent pupillary defect (Marcus Gunn pupil) in the pupil contralateral to the tract lesion

162

Myasthenia gravis is a ___ hypersensitivity disorder

Type II

163

Contact dermatitis is a ___ hypersensitivity disorder

Type IV

164

Hypersensitivity pneumonitis is a ____ hypersensitivity

Type III

165

postinfectious glomerulonephritis is a ___ hypersensitivity disorder

Type III

166

Goodpasture syndrome is a type ___ hypersensitivity disorder

Type II

167

Sarcoidosis is a ____ hypersensitivity disorder

Type IV hypersensitivity

168

acute hemolytic transfusion rxns are an example of ___ hypersensitivity

Type II antibody mediated hypersensitivity rxns

169

avascular necrosis associations

1. High dose steroid therapy and alcoholism
2. Injury to the vessel wall (vasculitis) in SLE
3. Sickle cell disease via thrombotic occlusion of arteries. Embolic occlusion (fat or air emboli) can also cause

170

Cyanotic congenital heart diseases

Truncus arteriosus
Transposition of the great vessels
Tricuspid atresia
Tetralogy of fallot
Total anomalous pulmonary venous return

171

Non cyanotic congenital heart diseases

Atrial septal defect
Ventricular septal defect
Patent ductus arterosus
Coarctation of the aorta

172

3 yo with recurrent cyanotic spells they counteract by squatting. what it his characteristic for

Tetraology of Fallot

173

Fixed splitting of the 2nd heart sound is caused by

Atrial spetal defect

174

S4 is caused by

Left ventricular hypertrophy/stiff left ventricle.

In younger patients it is always pathologic (unlike S3)

175

What cause Charcot-Marie-Tooth disease

How does it present

Mutation of myelin protein gene.

"neural form" of muscular atrophy

Presents with weakness of foot dorsiflexion due to involvement of the common peroneal nerve

176

what does a triple test test?

when is it done

What is the next step if abnormal

AFP
hCG
Estriol

done at wks 16 and 18 of gestation

Abnormal triple test indicates fetal Ultrasonography (USG). If this reveals no anatomic abnormalities and development consistent with mother's dates, then amniocentesis is performed.

177

What causes increased AFP

-Dating error
-Neural tube defects
-Anterior abdominal wall defects (gastroschisis, omphalocele)
-Multiple gestation

178

What causes decreased AFP

Down syndrome

179

VSD sound

loud holosystolic murmur best heard over the left sternal border in the 3rd or 4th intercostal space

180

Isoniazid SE

Hepatotoxic
Peripheral neuropathy (if not given pyridoxine also)

181

Neuroblastoma is assoc with

caused by

assoc with opsoclonus-myoclonus, a paraneoplastic syndrome assoc with neuroblastoma

increased number of N-myc gene copies

182

most common extracranial neoplasm in children

2nd most common brain tumor in children

Neuroblastoma is the most common extracranial

Medulloblastoma is the 2nd most common brain tumor

183

culture negative endocarditis

Bartonella
Coxiella
Mycoplasma
Histoplasma
Chlamydia
HACEK (haemophilus, actinobacillus, cardiobacterium, eikenella, kingella)

184

slowly progressive symmetric postural and or kinetic tremor that most commonly affects the uppper extremities.

inheritance

other name

treatment

Essential tremor

Autosomal dominant

aka familial tremor

tx: beta adrenergic antagonist propranolol

185

insidious onset exertional dyspnea and dry cough, with restrictive profile on pulmonary function testing and interstitial fibrosis and subplerual cystic airspace enlargement

idiopathic pulmonary fibrosis

186

most common cardiac abnormality predisposing to NVBE among 15-60 yo americans. is.

what is a less common cause?

Mitral insufficiency due to myxomatous degeneration (mitral valve prolapse).

Rheumatic mitral valve deformity resulting in mitral regurgitation could predispose to bacterial endocarditis. but now treatment is better.

187

PCWP measures what

what is it nearly equal to in normal conditions that is elevated with mitral stenosis

left atrial end diastolic pressure

LV end diastolic pressure. but mitral stenosis would increase PCWP and PAEDP relative to the LVEDP

188

treatment of osteoarthritis

NSAIDs
intraarticular glucocorticoids

189

Treatment of Rheumatic arthritis

NSAIDs
Glucocorticoids
DMARDs (Methotrexate/Sulfasalazine/TNF-alpah inhibitors (etanercept/infliximab/adalimumab)

190

If given elevated Alk Phos, follow up with what to specify hepatocyte dmg

Gamma-glutamyl transpeptidase (GGTP)