Uworld Flashcards
(657 cards)
1
Q
Bronchiectasis is associated with:
A
Bronchial obstruction, poor ciliary motility (smoking, kartagener syndrome), cystic fibrosis and aspergillosis.
2
Q
Heteroplasmy?
A
Different mitochondrial genomes within a single cell. Ex: ragged skeletal muscle fibers
3
Q
Fragile X syndrome?
A
most common inherited cause of intellectual disability, the defect is an unstable expansion of trinucleotide repeats CGG in the FMR1 gene, located on the long arm of the X chromosome. Classic physical features include macrocephaly, long narrow face, prominent forehead, jaw, chin and ears.
4
Q
Paroxysmal supraventricular tachycardia?
A
Sudden onset palpitations and rapid regular tachycardia Vagal maneuvers such as carotid sinus massage, valsalva and cold water immersion can be used to acutely terminate PSVT.
5
Q
Carotid sinus massage effect:
A
increases vagal parasympathetic tone, this slows conduction through the AV node and prolongs the AV node refractory period, helping to terminate the reentrant tachycardia.
6
Q
Cholesteatoma?
A
collections of squamous cell debris that form a round, pearly mass behind the tympanic membrane in the middle ear.
7
Q
Hepatitis A histologically?
A
spotty necrosis with balloting degeneration (hepatocyte swelling with wispy/clear cytoplasm), councilman bodies (eosinophilic apoptotic hepatocytes) and mononuclear cell infiltrates.
8
Q
Warfarin prolongs…
A
PT time
9
Q
ACE inhibitors stimulates…
A
Bradykinin
10
Q
Acyclovir S.E.
A
Nephrotoxicity, give enough hydration
11
Q
Heparin increases the effect of….
A
antithrombin III
12
Q
Carbamazepine SE:
A
Bone marrow suppression, which may lead to anemia, agranulocytosis and thrombocytopenia, and SIDH, leading to hyponatremia.
13
Q
Valproate use:
A
Anticonvulsant used to treat bipolar disorder with manic episodes.
14
Q
Dopamine effects at low and high doses:
A
At lower doses, stimulates D1 receptors in the renal vasculature and tubules, inducing an increase in renal blood flow, glomerular filtration rate amd sodium excretion. As the dosage increases, dopamine begins to stimulates B1 adrenergic receptors in the heart, increasing cardiac contractility, heart rate and systolic blood pressure.
15
Q
Influenza infection can alters the risk of…
A
secondary bacterial pneumonia, which the leading pathogen are: S. pneumonia, S.aureus and H. influenza.
16
Q
Mosaicism classification…
A
the presence of multiple different cell lines within the body. It can be divided in somatic and germline. Somatic produce disease manifestation, whereas germline does not, but can be pass to the offsprint.
17
Q
Complete monosomy X disease:
A
Turner syndrome
18
Q
Histology of MS:
A
perivenular inflammatory infiltrates made up primarily of auto reactive T lymphocytes and macrophages directed against myelin components.
19
Q
Varenicline MA:
A
Partial stimulation of receptor, reduces nicotine withdrawal, prevents nicotine from binding and inducing reward response. Is a partial agonist that compites with nicotine and prevents it from binding.
20
Q
Middle cerebral artery stroke symptoms:
A
contralateral paralysis and sensory loss, face and upper limb. Aphasia if in dominant hemisphere. Hemineglect if lesion affects non dominant side.
21
Q
Anterior cerebral artery stroke symptoms:
A
contralateral paralysis and sensory loss of lower limbs.
22
Q
Lenticulo-striate artery stroke symptoms:
A
contralateral paralysis and sensory loss of face and body.
23
Q
Anterior spinal artery stroke symptoms:
A
contralateral paralysis of upper and lower limbs, decreased contralateral proprioception and ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally).
24
Q
Posterior inferior cerebellar artery stroke symptoms:
A
vomiting, vertigo, nystagmus, decreased pain and temperature sensation from ipsilateral face and contralateral body, dysphagia, hoarseness, decreased gag reflex, ipsilateral horner syndrome, ataxia and dysmetria.
25
Anterior inferior cerebellar artery stroke symptoms:
vomiting, vertigo, nystagmus, paralysis of the face, decreased lacrimation, salivation, decreased taste, ipsilateral pain and temperature of the face, contralateral of the body. Ataxia and dysmetria.
26
Basilar artery stroke symptoms:
vertical eye movement, blinking, quadriplegia, loss of voluntary facial, mouth and tongue movements.
27
Posterior cerebral artery stroke symptoms:
contralateral hemianopia with macular sparing.
28
Huntington disease PF:
Atrophy of the caudate nucleus, which is caracterized by the insidious onset of chorea, dementia and behavioral abnormalities.
29
Atrophy of the lentiform nucleus...
Wilson disease (hepatolenticular degenerarion) which is caracterized by liver (hepatitis, cirrhosis), psychiatric (depression, personality changes), and neurologic (dysarthria, movement disorder) abnormalities.
30
Degenerarion of the substancia nigra occurs in...
Parkinson disease, which is characterized by bradykinesia, rigidity and resting tremos.
31
Damage to the subthalamic nucleus...
Can decrease excitation of the globus pallidus, thereby reducing inhibition of the thalamus. This may result in contralateral hemiballism, a movement disorder characterized by wild, involuntary, large-amplitude, flinging movements involving the proximal limbs on one side of the body.
32
Theophylline...
Asthma drug that inhibits phosphodiesterase, increasing cAMP by inhibiting cAMP hydrolysis. Usage is limited because of narrow therapeutic index (cardiotoxicity, neurotoxicity), metabolized by cytochrome p450. Blocks action of adenosine and can cause tachyarrhythmias and seizures.
33
Necrotizing pancreatitis by pancreatic inflammation and autodigestion...
Trypsinogen
34
Kinesin function...
Carries vesicles amd organelles away from the cell body and toward the nerve terminal. Is a microtubule associated motor protein.
35
Influenza immunity is given by...
Antibodies against hemagglutinin
36
Friedreich ataxia...
```
AR
Gait ataxia
Pes cavus
Kyphoscoliosis
Diabetes mellitus
Complicarions from cardiomyopathy: cardiac arrhytmias, congestive heart failure.
```
37
Tamoxifen
A selective esteogen receptor modulator that acts as an estrogen antagonisy in the breast, can reduce the risk of gynecomastia in these patients.
38
Major receptors involved in stimulating the vomiting reflex in the area postrema and adjacent vomiting center nuclei are:
M1, D2, H1, 5-HT3, NK1 (neurokinin-1)
39
Duchenne muscular dystrophy is most commonly caused by:
Deletions resulting in frameshift mutations or nonsense mutations.
40
Dermatomyositis is a...
systemic autoimmune disease characterized by proximal weakness resembling polymyositis, but with additional inflammatory features involving the skin. May occur along or as a paraneoplastic syndrome of an underlying malignancy.
41
Gilbert syndrome pathophysiology:
Mildly decreased UDP-glucuronosyltransferase conjugation and impaired bilirubin uptake.
42
Crigler-Najjar syndrome pathophysiology:
Absent UDP-glucuronosyltransferase. Presents early in life; patients die within a few years.
43
Dubin-Johnson syndrome pathophysiology:
Conjugated hyperbilirubinemia due to defective liver excretion. Grossly black liver. Benign.
44
Rotor syndrome pathophysiology:
Conjugated hyperbilirubinemia due to defective liver excretion, but milder in presentation without black liver.
45
Reumatoid factors
Antibody specific for the Fc component of IgG, anti-CCP antibodies.
46
5-alpha-reductase function:
conversion of testosterone to DHT
47
Ayer Martin Agar media contents:
Selectively favor growth of Neisseria by inhibiting growth of gram + organisms with Vancomycin, gram - organism except Neisseria with Trimethoprim and Colistin, and fungi with Nystatin.
48
Triad of WPW:
shortened PR intervals, widening of the QRS interval and slurred and broad initial upstroke of the QRS complex, referred to as delta waves.
49
Las of 3'-5' exonuclease activity
Hep C virus
50
Propranolol effects in the thyroid synthesis:
Inhibits the conversion of T4 to T3 in the periphery.
51
Transthyretin gene mutation manifestation:
Cardiac amyloidosis seen in age-related (senile)
52
beta-myosin heavy chain gene mutation manifestation:
Hypertrophic cardiomyopathy
53
Mononucleosis-like syndrome manifestation:
Fever, fatigue, splenomegaly, atypical lymphocytosis
Causes: CMV,HHV-6, HIV and toxoplasmosis.
54
Serotonin Syndrome tx:
Cyproheptadine
55
Cefuroxime use and MA:
Second gen. cephalosporins that inhibit cell wall synthesis... HENS PEcK
56
Second generation antihistamine:
Loratadine
57
First generation anti-histamine side effects:
cholinergic (urinary retention, blurred vision, constipation, glaucoma and delirium), alpha-adrenergic (dizziness and fall) and serotonergic (weight gain)
58
Methotrexate SE:
Pulmonary fibrosis, restrictive lung disease (honey combs)
59
LMN symptoms:
muscle weakness, fasciculations and atrophy.
60
UMN symptoms:
spasticity, hyperreflexia, and pathologic reflexes.
61
Mutation seen in ALS:
mutation of the gene that codes for cooper-zinc superoxide dismutase
62
Tx for ALS:
Riluzole which decrease glutamate release
63
Poliomyelitis PF:
IS AN ENTEROVIRAL INFECTION THAT DAMAGES MOTOR NEURONS OF THE ANTERIOR HORNS. iT IS A PURE LOWER MOTOR NEURON DISEASE.
64
Huntington disease PF:
AD disease, that leads to atrophy of the caudate nucleus and putamen.
65
Friedrich ataxia is associated with:
Hypertrophic cardiomyopathy, kyphoscoliosis, foot abnormalities and diabetes.
66
terminating codon encodes for
releasing factors
67
Parasites that can cause disease in RBC's include:
Plasmodium (malaria) and Babesia (babesiosis, transmitted by a Ixodes tick).
68
Parvovirus B19 presentation:
SS DNA virus, that can be acquired respiratory, congenital or hematogenous. In child erythema infectious, in adults acute symmetric arthropathy, chronic hemolytic anemia, transient aplastic crisis.
69
Cheyne-Stokes Breathing?
It is seen in CHF, is a combination of episodes of apnea and low and high tidal volumes (hyper and hypoventilation)
70
Kussmaul breathing
deep and labored breathing, seen in DKa patients.
71
Neurofibromatosis type 1 manifestations
Café-au-lait spot= hyperpigmented macules over the trunk soon after birth and are at increased risk of developing CNS neoplasms.
Cutaneous neurofibromas= manifest during early adolescence as multiple, raised, fleshy tumors. These are benign nerve sheath neoplasms predominantly comprised os Schwann cells, derived from neural crest cells.
72
Hypocalcemia after transfussion is due to...
Chelating agents in transfused blood, like citrate anticoagulant.
73
Linkage disequilibrium
Gamete posibilities varies in frequency
74
Penetrance
Proportion of people with a given genotype who express its associated phenotype.
75
Pleiotropy
Is the occurrence of multiple phenotypic manifestations, often in different organ systems, which result from a mutation in a single gene.
76
PPV depends on...
Sensitivity, specificity, and prevalence.
77
Donepezil
Cholinesterase inhibitor used in AD
78
Age-related macular degeneration (AMD)
Vascular endothelial growth factor (VEGF): Ranibizumab, bevacizumab
79
Transmembrane domains composed of alpha helices with hydrophobic amino acids residues helps...
Help anchor the protein to the phospholipid bilayer of the cell membrane.
80
Common medical conditions with polygenic inheritance
```
Androgenetic alopecia
Epilepsy
Glaucoma
Hypertension
Ischemic heart disease
Schizophrenia
Type II diabetes mellitus
```
81
Polygenic traits
Exhibit incomplete dominance so the phenotype displayed in offspring is a mixture of the phenotypes displayed in the parents.
82
Sedating antidepressant associated with priapism:
Trazodone
83
Trazodone MA:
Serotonin modulator (antagonizes postsynaptic serotonin receptors and inhibits serotonin reuptake)
84
Aspergillus fumigatus
Can cause lung disease in immunocompromised patients. In tissue samole it is seen as septate hyphae that at 45-degree angles.
85
Candida albicans
Small oval yeast with narrow-based budding.
86
Coccidioides immitis
Dimorphic fungus seen as spherules (round encapsulated structures containing many endospores).
87
Cryptococcus neoformans
Forma yeast with variable sizes and narrow-based buds.
88
Multiple myeloma Tx:
Bortezomib, a proteasome inhibitor
89
CML translocation
(9:22) BCR-ABL
90
RT-PCR
detects mRNA
91
Shiga-like toxin may cause
Kidney damage, HUS, hemolytic anemia, increased increased indirect bilirubin
92
Prolonged and untreated obstructive sleep apnea can cause:
pulmonary hypertension and right heart failure.
93
Pancreas divisum occurs when...
ventral and dorsal pancreatic buds fail to fuse. The ventral bud gives rise to posterior portion of the head and the major pancreatic bud.
94
Clinical features of amniotic fluid embolism:
Cardiogenic shock, hypoxemic respiratory failure, disseminated intravascular coagulation and seizures or coma.
95
Anaerobic bacterias from the mouth that can cause aspiration pneumonia...
Peptostreptococcus, prevotella, bacteroides and fusobacterium.
96
Presence of erythroid precursor cells in the liver indicates...
extra medullary hematopoyesis
97
Myosin light chain dephosphorilation causes...
relaxation of vessels.... (nitrates)
98
Leuprolide mechanism of action...
it is an agonist of GnRH when given in a pulsatile manner causing a transient rise of LH. Continuos stimulation of GnRH suppressed the pituitary LH release, and subsequent production of testosterone from Leydig cells.
99
Small cell lung carcinoma express...
neuron-specific enolase, chromogranin, synaptophysin
100
Sarcoidosis mode of presentation...
fever, malaise, macules or erythema nodosum, non-caseating granuloma, hilar lymphadenopathy.
101
Vitamin A helps...
differentiation of epithelial cell into specialized cells (pancreatic cells, mucus-secreating cells).
102
Cleft palate PF:
failure of fusion of the maxillary prominence and intermaxillary segment
103
Filtration factor division:
GFR/RPF
104
PPAR'S effect:
Increase fatty acid uptake
adiponectin production
increase insulin sensitivity
decrease leptin production
105
Can occur after an administration of monoclonal antibodies:
Serum sickness
106
Serum sickness symptoms:
fever, pruritic rash and arthralgia, vessel vasculitis, fibrinoid necrosis and neutrophil infiltration. Type III H.S.
107
SSRI's side effects:
sexual dysfunction: decreased libido, decreased arousal, anorgasmia in woman and increased ejaculationlatency in men.
108
PTSD requires symptoms for how long:
1 month
109
familial erythrocytosis
mutation in the b-globin resulting in a reduced binding to 2-3bpg
110
Benzodiazepine mechanism of action:
binds allosterically GABA receptors.
111
Innulin and Manitol are (in the kidney)...
freely filtered and excreted, no reabsorption or secretion occurs.
112
PAH is (in the kidney)....
filtered and also excreted.
113
Giant cell arteritis...
visual and muscular symptoms, headaches, enlarged temporal artery, elevated erythrocyte sedimentation rate, associated with poly myalgia rheumatica. The production of IL-6 appears to correlate with the severity of the disease. Tx: monoclonal antibody against IL-6 (tocilizumab)
114
Clozapine tx:
treatment-resistant schizophrenia and schizophrenia associated with suicidality. Adverse effects includes: agranulocytosis, seizures, myocarditis and metabolic syndrome.
115
Anaphylaxis reaction produce:
mast cell and basophil degranulation and histamine and tryptase release.
116
5-hydroxyindoleic acid
metabolite of serotonin, measured in serotonin syndrome.
117
Scurvy manifestations:
Petechiae, hemarthrosis, swollen gums, poor wound healing, hemorrhages and myalgia. Due to a Bit C deficiency.
118
Dystrophin is:
a structural component of skeletal muscle fibers that provides mechanical stability to the sarcolemma.
119
Neurophysins are...
are carrier proteins of oxytocin and vasopressin.
120
MCC of osteomyelitis in children with Sickle cell disease:
Salmonella
121
Turner syndrome PF:
lack of the paternal chromosome (45,X). Presents with streak ovaries, webbed neck, coarctation of the aorta, bicuspid aortic valve, horseshoe kidney, short stature, widely separated nipples, low hairline and high arched palate.
122
Cryptoccocus neoformans stain:
Stains red with mucicarmine.
123
paraneoplastic cachexia mediators...
IL-1, IL-6 and TNF-alpha
124
Aqueous humor is produced by:
Ciliary bodies
125
Glioblastoma arises from:
astrocytes
126
brain metastases typically appears as:
multiple, well-circumscribed masses at the junction of the white and gray matter.
127
Meningiomas are:
benign adult brain tumors that arise from arachnoid cells.
128
complications of hereditary spherocytosis:
aplastic crisis from Parvovirus B19 infection
129
Entacapone effects:
COMT inhibitor; lowers the degradation of levodopa at peripheral level
130
Influenza virus can infect different species via:
genetic reassortment. IV is a orthomyxovirus.
131
Milrinone mechanism of action:
Inhibits de degradation of cAMP to AMP, thus promotes vasodilation and heart muscle contractility, by Gs receptor.
132
Intraductal papilloma PF:
papillary cells in a duct or cyst wall with a fibrovascular core.
133
fibrocystic changes of the breast
premenstrual breast pain with lumps, often multifocal and bilaterally. Non proliferative lesions include simple cyst, papillary apocrine change, stromal fibrosis.
134
age-related macular degeneration
causes central scotomas, the tx is ranibizumab. Can be dry (deposition of yellowish material or wet (neovascularization).
135
In pernicious anemia we will see...
increased gastrin levels, increased pH and decreased parietal cells.
B12 deficiency do to decreased intrinsic factor production by the parietal cells.
136
Hyper-IgM syndrome:
defective or absent CD40Ligand, causes severe infections (cryptosporidium) and increased IgM. It is a combines B and T cell disorder.
137
Hernias more prone to incarceration and strangulation:
femoral hernias because the femoral canal is small, and they can not be reduced.
138
Sideroblastic anemia results of:
ALA synthase deficiency, B6 deficiency, Isoniazid, alcohol, myelodysplastic syndrome and cooper deficiency. It forms ringed sideroblast. Tx is B6.
139
Lead poisoning results from:
ALA dehydratase and ferrochelate inhibition by lead. Presents with foot drop, encephalopathy, lead lines.
140
Homocystinuria results from:
Cystathionine synthase deficiency or B6 deficiency, which catalyzes the conversion of cystathionine to homocysteine. It presents with marfanoid habits and hyper coagulation.
141
Sumatriptan for the tx of:
cluster headache and migraine. It is a serotonin agonist. Inhibit trigeminal nerve activation, prevents vasoactive peptide release and induce vasoconstriction.
142
DNA polymerase I
removes RNA primers and replace them with DNA. Is the only DNA polymerase with 5 to 3 exonuclease activity.
143
Tests used to diagnose Chronic granulomatous disease:
NBT testing (can reduce NBT from yellow to dark blue) and DHR flow cytometry which measure the conversion of DHR to rhodamine, a fluorescent green compound that can be detected by flow cytometry. Both detects properly functioning neutrophils.
144
Corynebacterium diphtheriae vaccine creates:
IgI against circulating proteins
145
Perchlorate and pertechnetate MA:
competitive inhibitor of the sodium-iodide symporter. Iodine uptake is regulated by TSH.
146
Manifestations of Graves ophthalmopathy usually responds to:
glucocorticoid therapy.
| They are immune mediated.
147
Neurofibromatosis manifestations:
cafe au last spot, gliomas, cutaneous neurofibromas, bone abnormalities and lisch nodules and pheochromocytoma.
148
Fidaxomicin use and mechanism of action:
to treat C.difficile. It inhibits the sigma subunits of RNA polymerase leading to protein synthesis impairment and cell death.
149
decreased number of functional t-tubules leads to:
uncoordinated muscle contraction of myofibrils which manifest as muscle weakness.
150
PAH is:
freely filtered and secreted by a carrier protein-mediated process.
151
The red cell index most specific for spherocytosis is:
an elevation in mean corpuscular hemoglobin concentration (MCHC)
152
Primary site for ribosome synthesis and assembly:
nucleolus; except the 5S rRNA.
153
Torsades de pointes can be precipitated by:
antiarrhythmics class I and III(sotalol, quinidine), antipsychotics (haloperidol) and antibiotics(macrolides and fluoroquinolone)
154
Warfarin induced skin necrosis is due to:
Protein C or Protein S deficiency. The tx include stop treatment with Warfarin and nice fresh frozen plasma or Protein C concentration.
155
Accessory nipples are due to:
failure of involution of the mammary ridge.
156
Insulin-dependent Glucose transporter:
GLUT-4 (skeletal muscle and adipocytes)
157
GLUT-1,2,3,4,5:
GLUT-1 brain and adipocytes
GLUT-2 hepatocytes, pancreatic b-cells, renal tubules and small intestinal mucosa.
GLUT-3 placental and neuronal glucose transport
GLUT-4 skeletal muscle and adipocytes
GLUT-5 fructose transporter found in spermatocytes and GI tract.
158
MHC Class II is presented on
antigen presenting cells to present bacterias to TH cells and activate the humoral and cell mediated inmune response
159
MHC Class I consist of:
one heavy chain and a beta2 microglobin and is present in all nucleated cells to induce apoptosis of viruses, tumor proteins,
160
Thyroid dermopathy
caused by stimulation of fibroblast by TRAb and activated T-cells, leading to excess production of glycosaminoglycans and adipogenesis, this lead to induration and thickening of the skin over the shins.
161
Glucocorticoids effect on calcium:
glucocorticoids decrease the G.I. absorption of calcium, inhibit collagen synthesis by osteoblasts, decrease GnRH (leading to hypogonadism) and increase urinary calcium loss.
162
Turner syndrome findings:
cystic hygroma, lymphedema (bilateral extremity swelling) and coarctation of the aorta.
163
Androgen insensitivity syndrome
results from a deficit in testosterone receptors. The typical presentation is a 46,XY adolescent who appears phenotypically female but has primary amenorrhea due to the absence of an internal female reproductive tract and the presence of cryptorchid testes.
164
Gap junctions protein
connexins
165
tight junction protein
claudine, occludin
166
Adherens junction protein
cadherins
167
desmosomes protein
cadherins (desmoglzins,desmoplakin)
168
hemidesmosomes protein
integrins
169
McArdle disease enzyme deficient
glycogen phosphorylase
170
Pompe disease enzyme deficient
acid alpha-glucosidase
171
Cori disease enzyme deficient
debranching enzyme
172
von Gierke disease enzyme deficient
glucose 6-phosphatase
173
Bulimia nervosa Tx:
fluoxetine (SSRI)
174
Anorexia nervosa Tx:
Olanzapine
175
Homocystinuria
defect in cystathionine synthase, resulting in an inability to form cysteine from homocysteine. Homocysteine buildup leads to elevated methionine. Homocysteine is prothrombotic, resulting in premature thromboembolic events (atherosclerosis, acute coronary syndrome)
176
Polymialgias antibodies
antinuclear antibodies (ANA) and anti-histidyl synthetase (anti-Jo)
177
Serotonergic neurons are primarily found in
Raphe nuclei
178
Norepinephrine-secreting neurons are found in
The locus ceruleus
179
Cholinergic neuron nucleus
The nucleus basalis of Meynert
180
Red nucleus participates in
motor coordination of the upper extremities.
181
Substantia nigra contains
dopaminergic neurons.
182
Ankylosing spondylitis is characterized by:
stiffness and fusion of axial joint, enthesitis, uveitis, aortic deficiency and respiratory expansion problems.
183
Narcolepsy criteria:
Recurrent passes into sleep or naps more than 3 times a week for 3 months, cataplexy, low cerebrospinal fluid levels of hypocretin-1 and shortened REM sleep latency.
184
Sarcoidosis manifestations:
hilar adenopathy, pulmonary infiltrates and non-caseating granulomas.
185
TH1 type CD4+ helper T cell is a....
cell mediated immunity
186
TH2 type CD4+ helper T cell is a
humoral immune response.
187
Niemann-Pick disease
AR
SPHINGOMYELINASE DEFICIENCY
lipid-laden foam cells,hepatosplenomegaly, hypotonia, neurologic degeneration and cherry-red macular spot.
188
Metachromatic leukodystrophy
arylsulfatase A deficiency
| central and peripheral demyelination leads to peripheral neuropathy and ataxia.
189
Krabbe disease
galactocerebrosidase deficiency
| developmental delay, regression, hypotonia, optic neuropathy and seizures.
190
Fabry disease
alpha-galactosidase deficiency
| neuropathic pain and dermatologic pathology (telangiectasis, angiokeratomas)
191
Gaucher disease
beta-glucocerebrosidase deficiency
| hepatosplenomegaly, pancytopenia and skeletal problems.
192
alpha1-antitrypsin function:
inhibits neutrophil elastase and prevents hydrolization of elastin.
193
congenital hypothyroidism clinical manifestations:
lethargy, enlarged fontanelle, protruding tongue, umbilical hernia, poor feeding, constipation, dry skin, jaundice. Diagnosis: high TSH and low free T4. Tx: levothyroxine.
194
Viral-dependent nucleosides are
all nucleoside analogues that require both herpes viral and cellular kinase for conversion to their active nucleoside triphosphate form.
195
Viral-dependent nucleoside drugs:
Acyclovir, valacyclovir, famciclovir and ganciclovir.
196
Efficacy does not depend on the presence of a virally encoded kinase...
Cidofovir (Nucleotide)
197
Cell-dependent nucleoside:
zidovudine and lamivudine
198
Features of drug-induced lupus erythematous:
```
new onset lupus symptoms, ANA and anti-histone antibodies present.
Implicated drugs (hydrazine, procainamide, isoniazid, minocycline, quinidine).
```
199
Q fever
zoonosis caused by Coxiella burnetii, from air contaminated by animal waste. Usually in farm workers exposed to waste from cattle and sheep. Common symptoms includes: headaches, fever, myalgia, fatigue and Pneumonia. Classic laboratories includes: thrombocytopenia and increased liver enzymes.
200
In hypertrophic cardiomyopathy, how to increase and decrease murmur intensity:
Increased murmur preload can be obtained by: sudden standing, valsalva or nitroglycerin. Decreased murmur intensity can be obtained by squatting, sustained hang grip or passive leg raise.
201
Topiramate
blocks Na channels and increase GABA action, anti epileptic also used for migraine prevention.
202
Zolpidem, zaleplon and Eszopiclone
nonbenzodiazepine hypnotics, act via BZ1 subtype of the GABA receptor. Used for insomnia.
203
Raloxifene
selective estrogen receptor modulator, which have agonist activity on bone, which decreases bone resorption and improves bone density, has estrogen antagonist effect on breast tissue and can decrease the risk of breast cancer, it also acts as an estrogen antagonist in the uterus and does not increase the risk of endometrial cancer.
204
Small intestinal bacteria overgrowth is characterized by overproduction of:
Vitamin K and folate, associated with nausea, bloating, abdominal discomfort and malabsorption.
205
Fabry disease
alpha-galactosidase A deficiency (X-linked recessive), which can present with cataracts, neurological findings like numbness, tingling, burning pain and angiokeratomas.
206
Tay-Sachs disease
hexosaminidase A deficiency, affected infants have retinal cherry-red spots and loss of motor skills.
207
TCA's side effects
inhibit fast sodium channel conduction, slowing down myocardial depolarization and leading to cardiac arrhythmias.
208
live attenuated vaccines:
rotavirus, varicella and measles-mumps-rubella vaccinations.
209
Notochord becomes the ______ in adults
Nucleus pulpous of the intervertebral disk
210
JAK2 inhibitor fot tx of primary myelofibrosis
Ruxolitinib
211
JAK2 (nonreceotir cytoplasmic tyrosine kinase)
Activates de STAT pathway
212
Conversion disorder
is characterized by neurological symptoms that are incompatible with a neurological disease.
213
Parvovirus
slapped cheek(fifth disease), arthalgias, and hydros fetalis(can lead to interruption of erythropoyesis.
214
Xeroderma pigmentosum
a condition characterized by severe photosensitivity and the development of skin cancer at young age.
215
Pyramidine dimers
abnormal covalent bonds between adjacent thymine or cytosine residues do to ultraviolet rays.
216
Nucleotide excision repair
a specific process where an endonuclease complex detects abnormalities in the DNA structure caused by the formation of DNA photoproducts.
217
Early and late-onset Alzheimer disease is associated with_______mutation:
Early: APP in Cr 21, presenilin 1 and presenilin 2; Late:is associated with apolipoprotein E4 genotype.
218
anti-centromere
CREST syndrome
219
Anti-mitochondrial antibodies
primary biliary cirrhosis
220
Hirschsprung disease
arrest of migration of neural crest cells
221
Squatting in Tetralogy of Fallot:
increases systemic vascular resistance and decrease right-to-left shunting, thereby increasing pulmonary blood flow and improving oxygenation status.
222
Gerstmann syndrome
results from damage to the angular gyrus of the dominant parietal lobe and is characterized by agraphia, acalculia, finger agnosia and left-right disorientation.
223
Hypospadias
abnormal opening of penile urethra on ventral surface of penis due to failure of urethral folds to fuse.
224
Epispadias
abnormal opening of penile urethra on dorsal surface of penis due to faulty positioning of genital tubercle.
225
Becomes the penis in males and the clitoris in female
genital tubercle
226
Thiazides
hydrochlorothiazide, chlorthalidone
227
Hypokalemia
muscle weakness, cramps and possible rhabdomyolysis.
228
Extrinsic apoptosis is induced by
tumor necrosis factor (TNF) and Fas ligand
229
Caspases are activated by
cytochrome C
230
Caspases are
proteolytic enzymes that destroy cell components, they contain cysteine and are able to cleave aspartic acid residues.
231
Metalloproteinases are
zinc-containing enzymes that degrade the components of the extracellular matrix, they are essential for proper tissue remodeling during wound healing.
232
Phenylalanine byproducts
tyrosine, thyroxine, melanin, dopamine, NE, Epinephrine
233
Tryptophan byproducts
NAD+/NADP+ and melatonin
234
Histidine byproducts
histamine
235
Glycine byproduct
Heme
236
Glutamate byproducts
GABA, glutathione
237
Arginine byproducts
creatine, urea, nitric oxide
238
Park At Venture Avenue
Conduction in cardiac impulses:
| Purkinje, Atrial muscle, Ventricular muscle and AV node
239
Desmopressin effect on central diabetes insidious and nocturnal enuresis
binds to V2 receptors in renal tubular cells, leading to increased aquaporin channels, increased water reabsorption and decreased urine output.
240
Effect of desmopressin in hemophilia A and vWf disease
Increases circulating factor VIII and endothelial secretion of vWF to stop bleeding, endothelial produced!!!
241
Hemochromatosis side effects
skin pigmentation, hepatomegaly, impaired glucose homeostasis, cardiac dysfunction, atypical arthritis, hypogonadism.
242
Enveloped virus are sensitive to
ether
243
Naloxone
pure opioid receptor antagonist, used in the setting of acute opioid intoxication or overdose.
244
Sodium bicarbonate is used to threat:
the overdose of tricyclic antidepressants
245
Neonatal abstinence syndrome(opioids) presents with
irritability, hypertonia, jittery movements, seizures, diarrhea, vomiting, feeding intolerance, sweating, sneezing, pupillary dilation. Tx:opioid therapy (morphine, methadone).
246
Causes of fibrinoid necrosis
malignant hypertension and vasculitis
247
Heme is converted to biliverdin(green color) by:
heme oxygenate, then to unconjugated bilirubin by biliverdin reductase.
248
Congenital rubella triad:
congenital cataracts (white pupils), sensory-neural deafness and patent ductus arteriosus.
249
Rubella vaccine type
live-attenuated vaccine
250
Killed vaccines examples
hepatitis A and rabies
251
Live vaccines examples
Measles, mumps and rubella vaccines.
252
1,25-dihydroxyvitamin D effects
Bone (increased mineralization)
Small intestine (increase calcium and phosphate absorption-major effect)
Kidney (increase calcium and phosphate reabsorption)
Parathyroid glands(decrease PTH secretion)
253
TCA antidepressant overdose symptoms
mental status changes, seizures, respiratory depression, tachycardia, hypotension, prolonged PR, QRS,QT intervals, arrhythmia and anticholinergic effects (dry mouth, blurred vision, dilated pupils, urinary retention, flushing and hyperthermia. Tx with sodium bicarbonate.
254
Opioids overdose symptoms:
miosis and respiratory overdose.
255
NMYC
oncogene seen in neuroblastoma
256
Methotrexate mechanism of action
competitive inhibition of dihydrofolate reductase
257
Minocycline
tetracycline antibiotic with photosensitivity dermatitis side effect.
258
Hyaluronidase
enzyme used by bacterias (S. aureus, S. progenies and C perfringens) to digest extracellular ground substance and enhance their ability to spread.
259
Drug-induced Parkinsonism occurs in the
nigrostriatal pathway, by dopamine D2 receptor blockade
260
Neuroleptic malignant syndrome Tx
dantrolene (skeletal muscle relaxant)
261
Galactose intolerance (galactosemia)
patients are predispose to E. Coli sepsis
262
The marginal artery of Drummond
colateral circulation of the descending colon between the SMA and the IMA.
263
Mu opioids analgesics produces:
histamine release leading to vasodilation, constipation, decreased parietal cell acid secretion and contraction of the smooth muscle cells at the sphincter of Oddi.
264
Vasovagal syncope
after stimulation of his posterior external auditory canal by an otoscope speculum. In this form of syncope, parasympathetic outflow via the vagus nerve leads to decreased heart rate and blood pressure.
265
Penile erection is initiated by
release of acetylcholine and nitric oxide from parasympathetic fibers, leading to a rise in intracellular cGMP and vasodilation of the arteries supplying the corpus cavernosum.
266
Sildenafil mechanism of action
is a phosphodiesterase-5 inhibitor that decrease degradation of cGMP
267
Atrial and brain natriuretic peptides
polypeptides hormone that exert their effect by binding ANP receptors, these transmembrane receptors are linked to a guanylyl cyclase that converts guanosine 5-triphosphate to cyclic guanosine 3,5-monophosphate cGMP.
268
Monoclonal antibodies against PD-1
prevent the binding of PD-1 to PD-1L, this blocks cell inhibition, restoring the cytotoxic response and promoting apoptosis of tumor cells. It it used in advanced melanoma and lung cancer.
269
Chemokine coreceptor 5 (CCR5)
serves as a coreceptor used by HIV to bind to CD4+ T cells.
270
Homeobox genes encode for:
DNA-binding transcription factors that play an important role in the segmental organization of the embryo along the cranio-caudal axis.
271
Strep pneumo
optochin sensitive and bile-soluble.
272
Neprilysin mechanism of action
is a metalloprotease that metabolizes brain natriuretic peptides and inactivates glucagon, oxytocin and bradykinin.
273
Temporal arteritis comorbilities
Polymyalgia rheumatica, fatigue, fever, weight loss and monocular vision loss.
274
Bile-acids resins
binds bile acids in the GI tract, inhibiting enterohepatic circulation, leading to hepatic cholesterol synthesis of new bile acids, and triglycerides.
275
Ezetimibe
selectively inhibits the intestinal absorption of cholesterol and lowers LDL levels.
276
Fibrates (gemfibrozil, fenofibrates)
inhibit hepatic production of triglycerides and are first-line tx for hypertriglyceridemia.
277
INF-gamma is produced by ___________ and serves to______________.
is produced by activated T cells and serves to recruit leukocytes and activate phagocytosis.
278
Systemic inflammatory response is induced by
TNF-alpha, IL-1 and IL-6.
279
Prevalence equals
Incidence X duration of disease
| A factor that prolongs disease duration (improved quality of care) will increase disease prevalence.
280
HbC and HbS type of mutation
Missense mutation in which a single base substitution results in a codon that codes for a different amino acid.
281
Phases of Paget disease of the bone
osteolytic (osteoclast-dominant)phase: increased numbers of osteoclasts that appear abnormally large with an excessive number of nuclei. Increased resorption activity is prominent.
MIXED: defined by a rapid increase in osteoblastic bone formation with persistent osteoclastic activity. The newly made bone is abnormal, with interspersed areas of disorganized lamellar and woven bone.
Osteosclerotic phase: characterized by continued osteoblastic bone formation and remodeling that results in a dense, hypo vascular, mosaic pattern of lamellar bone with irregular, haphazardly oriented sections separated by prominent cement lines.
The end result is a thickened, deformed bone that is weaker than normal and prone to fracture.
282
Paget disease of the bone pathophysiology
Environmental factors and gene mutations (RANK, osteoprotegerin) that results in excessive RANK and NF-kB activation, that results in accelerated bone remodeling with eventual bony overgrowth.
283
Acute intermittent porphyria pathophysiology
AD, characterized by porphobilinogen (PBG) deaminase deficiency. Management includes infusion of hemming, which down regulates aminolevunate (ALA) synthase. Symptoms includes: nausea, constipation, severe and poorly localized abdominal pain, anxiety, difficulty concentrating, poor sleep and tingling of the limbs.
284
Radiologically features of hyper parathyrodism
subperiosteal erosions in phalanges of the hand, a granular "salt-and pepper"skull and osteolytic cyst in the long bones (osteitis fibrosa cystica).
285
Paget of the bone histology
disorganized lamellar bone structure in a mosaic pattern
286
vit D deficiency histology
osteoid matrix accumulation around trabeculae
287
Osteopetrosis (marble bone disease)
persistence of the primary spongiosa in the medullary cavity with no mature trabeculae (marble bone disease)
288
Osteoporosis pathology
trabecular thinning with fewer interconnections
289
Low volume of distribution can be obtained by:
high molecular weight, high plasma protein binding, high charge and hydrophilicity, which tends to trap the drug in the plasma compartment.
290
Cross-sectional study evaluates
prevalence
291
Cohort study evaluates
incidence
292
Cystic fibrosis is most commonly due to
a 3-base pair deletion on the CF transmembrane conductance regulator (CFTR) gene at amino acid position 508. This mutation impairs post-translational processing of CFTR, resulting in shunting of CFTR toward the proteasome, with complete absence of the protein on the cell surface.
293
During inspiration, MR, TR and VSD murmur tends to
TR tends to increase do to decreased intrathoracic pressure, increasing venous return. In MR and VSD murmur decreases due to decreased left ventricular venous return from pulmonary vein due to increased pulmonary vessel capacity.
294
Transamination reactions cofactor
B6 (pyridoxine)
295
Transformation
allows bacterias to take up exogenous DNA fragments and express encoded proteins.
296
Transduction
a bacteriophage transfers DNA from one bacterial cell to another.
297
Etanercept mechanism of action
inhibition of TNF-alpha. Check for TUBERCULIN SKIN TEST
298
Vasopressin and desmopressin effect on V2 receptors
Cause a V2 receptor-mediated increase in water and urea permeability at the inner medullary collecting duct, resulting in urea reabsorption, enhanced osmotic gradient, allowing the production of maximally concentrated urine.
299
Beta-blockers work by
inhibiting the neurotransmitter-receptor interaction in adrenergic synapses.
300
ARPKD is caused by
a mutation in PKHD1, the gene for fibrocystin founded in the epithelial cells of both the renal tubule and the bile ducts.
301
Digoxin use and side effects:
CHF
S.E.: arrhythmias, anorexia, nausea and vomiting, abdominal pain, fatigue, confusion, weakness and color vision alterations.
302
Side effects of Levo-dopa
anxiety and agitation
303
RPF
```
RPF= RBF x (1-Hematocrit)
FF= GFR/RPF
```
304
Absolute Risk Reduction
event rate in the control group - event rate in the treatment group.
Event rate= #of events in the group/# of subjects in the group.
305
Congenital Toxoplasmosis classic triad
hydrocephalus (macrocephaly and enlargement of the ventricles), intracranial calcifications and chorioretinitis (white-yellow chorioretinal lesions).
306
Erythropoiesis-stimulating agents side effects
hypertension and thromboembolic events.
307
Atrial septal defect
cause left to right shunts that can facilitate paradoxical embolism due to periods of transient shunt reversal. It cause a wide and fixed splitting of S2 and can facilitate paradoxical embolism.
308
Kartagener syndrome triad
situs inversus, chronic sinusitis and bronchiectasis.
309
Acute stress disorder
after exposure to prior trauma, lasting from 3 days to 1 month, if it last more than 1 month is PTSD
310
Granuloma formation
Activated TH1 CD4+ cells secrete interferon gamma, which activates macrophages. Macrophages in response secretes TNF-alpha, which result in further macrophage maturation and formation of the granuloma.
311
Most abundant amino acid in collagen
glycine
312
Vitamin E deficiency
neurologic symptoms closely mimic Friedrich ataxia and include ataxia (due to degeneration of spinocerebellar tracts), loss of position and vibration sense and loss of deep tendon reflexes.
313
Why does calcium channel blockers do not affect skeletal muscle contractility?
because skeletal muscle is not dependent on extracellular calcium influx.
314
Troponin
is responsible for contraction of both cardiac and skeletal muscle. Unlike skeletal, cardiac muscle is affected by verapamil due to its dependence on extracellular calcium to induce calcium release from sarcoplasmic reticulum.
315
A drug with low volume of distribution tends to be
hydrophilic, protein bounded, renal excreted,
316
Genetic transition
a point mutation that results in replacement of a purine nucleotide for another purine or a pyrimidine for another pyrimidine.
317
Genetic transversion
a point mutation that results in the replacement of a purine nucleotide for a pyrimidine or a pyrimidine for a purine.
318
Wobble hypothesis
states that the first 2 nucleotide positions on the mRNA codon require traditional (Watson-Crick) base pairing, whereas the third wobble nucleotide position may undergo less stringent base pairing.
319
Neprilysin inhibitors
prevents degradation of ANP, enhancing its beneficial hemodynamic effects in heart failure patients (dilates afferent arterioles in the kidney increasing filtration, restricts aldosterone secretion and relaxes vascular smooth muscle in arterioles and venues producing vasodilation)
320
Phenytoin side effects
gingival hyperplasia, coarsening facial features and hirsutism. Can cause megaloblastic anemia.
321
Alendronate
bisphosphonate that inhibits osteoclast function
322
Cinacalcet
calcimimetic that allosterically activates the calcium-sensing receptor in the parathyroid gland, decreasing parathyroid hormone release, used for secondary hyperparathyroidism.
323
Sickle cell trait or disease can produce:
renal papillary necrosis
324
Renal papillary necrosis can be produced by
NSAID's, sickle cell trait or disease, acute pyelonephritis and diabetes mellitus.
325
Cerebellar hemisphere affection results in
dysdiadochokinesia and tremor
326
Cerebellar vermis affection results in
ataxia, nystagmus and vertigo.
327
Patellar injury results in
inability to extend the knee against gravity,
328
Anterior cruciate ligament can be injured during________ and results in ______.
Sudden acceleration and deceleration, laxity of forward movement of the tibia against a fixed femur.
329
Posterior cruciate ligament protects against
excessive posterior knee movement and is the least injured knee ligament.
330
Medial collateral ligament
protects against values stress on the knee and excessive external tibial rotation. Injury occurs after a lateral blow to the knee or indirect stress from excessive lower leg rotation or abduction.
331
Osteoarthritis involves
DIP and PIP, with osteophyte formation, in contrast of RA, which involves PIP and synovitis.
332
Nigrostriatal degeneration in Parkinson disease results in
excessive excitation of the globes pallid us interns by the sub thalamic nucleus, which in turn causes excessive inhibition of the thalamus. Reduced activity of the thalamus and its projections to the cortex consequently result in rigidity and bradykinesia.
333
Pneumocystic pneumonia is an ________ seen primarily in those with ______________.
atypical fungal infection seen primarily in those with impaired cell-mediated immunity. The cystic organism can be visualized using silver stain of respiratory secretions.
334
Inactivated version of the influenza vaccine function mainly by
inducing neutralizing antibodies against the hemagglutinin antigen in selected viral strains. These antibodies inhibit binding of hemagglutinin to sialylated receptors on the host cell membrane. This prevents thee live virus from entering cells via endocytosis.
335
Extended-spectrum beta-lactamases can be produced by_________ making _____ inactive. These genes can be transmitted between organisms through _________.
Gram-negative bacteria, cephalosporins and other beta-lactam antibiotics, plasmid conjugation.
336
Porphiria cutanea tarda
deficiency in the uroporphyrinogen decarboxylase. Photosensitivity presents as vesicle and blister formation on sun-exposed areas, as well as edema, pruritus, pain and erythema.
337
Pseudomonas type of infections
pneumonia in cystic fibrosis and ventilated patients,infections in burned patients, otitis externa, hot tub folliculitis and ecthyma gangrenous.
338
Antimalarials
chloroquine and mefloquine
339
Halogenated anesthetics side effects
they are metabolized by the hepatic cytochrome P450 system by which they are converted to reactive intermediates that can directly injure the liver or lead to immune-mediated hepatocellular damage.
It can show centrilobular hepatic necrosis that is distinguishable from viral hepatitis.
340
MCAD deficiency manifestation
lethargy, seizures and hypoketotic hypoglycemia following a period of fasting.
341
Insulin inhibits _______ production, in unborn child of a diabetic mother
surfactant production, due to high levels of insulin because of high levels of sugar in blood from the mother
342
Complications of Neonatal respiratory distress syndrome
patent ductus arteriosus due to low oxygen levels and necrotizing enterocolitis. Supplemental oxygen can lead to blindness and bronchopulmonary dysplasia.
343
Primary pulmonary hypertension is due to
inactivating mutations of BMPR2, leading to proliferation of vascular smooth muscle.
344
Bronchial hamartoma
benign tumor composed of lung tissue and cartilage often calcified on imaging.
345
Tumor on lung can compress
sympathetic chain, which leads to Horner syndrome characterized by ptosis, mitosis and anhidrosis; usually due to an apical Pancoast tumor.
346
Unique site for distant metastasis of the lung is the
adrenal gland
347
Lung cancers that arises from neuroendocrine cells
small cell carcinoma and carcinoid tumor.
348
Aplastic crisis in sickle cell disease is due to
Parvovirus B19
349
Neurocysticercosis is due to ________ and can cause _____________.
Taenia solium (pork tapeworm) ingestion and can cause multiple brain lesions.
350
Daptomycin mechanism of action and uses
MRSA S. aureus// depolarizes cellular membrane by creating transmembrane channels.
351
Daptomycin side effects
myopathy and CPK elevation
352
Baclofen is an______
agonist at the GABA-B receptor, effectively mono therapy for the treatment of spasticity secondary to both brain and spinal cord disease.
353
Melanoma mutation
BRAF, a protein kinase for melanocyte proliferation.
354
Gliosis
proliferation of astrocytes in an area of neuron degeneration, it leads to the formation of a glial scar which compensates for the volume loss that occurs after neuronal death.
355
Mumps is an infection with the bump virus that can result in
bilateral inflamed parotid glands, orchitis (in teenagers with high risk of sterility) and pancreatitis.
356
Pleomorphic adenoma
MC tumor of the salivary glands, benign tumor composed of stroll and epithelial cell
357
Warthin tumor
benign cystic tumor with abundant lymphocytes and germinal centers
358
Mucoepidermoid carcinoma
malignant tumor composed of mucinous and squamous cells; usually involves the facial nerve.
359
Boerhaave syndrome risk
subcutaneous emphysema
360
Metaplasia of the esophagus results in
stratified squamous epithelium to nonciliated columnar epithelium with goblet cells.
361
Primary mediators in COPD
neutrophils, macrophages and CD8+ T lymphocytes
362
Theophilline is a
adenosine receptor antagonist and a phosphodiesterase inhibitor. It increases cAMP levels. P450 metabolized.
363
P450 Substrates
Theophilline, Warfarine, OCP's and anti-epileptics drugs.
364
P450 Inhibitors (crackamigos)
Sodium valproate, isoniazid, cimetidine, ketoconazole, fluconazole, acute alcohol abuse, chloramphenicol, erythromycin(macrolides), sulfonamides, ciprofloxacin, omeprazole, metronidazole.
365
Silicosis
assoc. with sandblasting and mines. Macrophages respond to silica and release fibrogenic factors, leading to fibrosis. It is thought that silica may disrupt phagolysosomes and impair macrophages, increasing susceptibility to Tb.
366
Eosinophilic parasitic defense
eosinophil proliferation is stimulated by IL-5 produced by TH2 and mast cells. Then it is coated by IgG and IgE. This triggers eosinophil degranulation and release of cytotoxic proteins. This mechanism is an example of antibody-dependent cell-mediated cytotoxicity.
367
Smooth endoplasmic reticulum function
synthesis of steroids hormones.
368
Rough endoplasmic reticulum function
peptide hormones production
369
Dobutamine is a _________ and causes an increase in ________.
beta adrenergic agonist and causes an increase in heart rate and cardiac contractility, leading to an increase in myocardial oxygen consumption.
370
Arsenic poisoning Tx:
Dimercaprol
371
Pulmonary actinomycosis develops
following aspiration and can be confused with lung abscess, malignancy or Tb. Microscopic findings include filamentous, branching, gram positive bacteria and sulfur granules.
372
Mucor is a
ubiquitous fungus naturally found in soil and decaying material. Usually results in mucormycosis in DKa patients. Microscopic examination shows broad, ribbon-like, nonseptate hyphae with right-angle branching.
373
Sickle cell disease are more prone to
folic acid deficiency and megaloblastic anemia due to increased folic acid requirements and erythrocytes turnover.
374
Chromogranin A and synaptophysin are
markers used for neuroendocrine tumors like Small cell lung carcinoma and carcinoid tumor.
375
Vimentin is an intermediate filament present in
mesenchymal tissue and can be used to detect sarcomas.
376
Clathrin is an intracellular protein that helps form
rounded vesicles in the cytoplasm, it help mediate intracellular trafficking and endocytosis.
377
Prinzmetal angina can be precipitated by
tobacco, coccaine, amphetamines and dihydroergotamine/triptans.
378
Adenosine effect in cardiac pacemaker
prolongs phase 4, reducing the rate of spontaneous depolarization in cardiac pacemaker cells
379
The locus ceruleus is located in
the posterior rostral pons near the lateral floor of the fourth ventricle
380
Von Hippel-Lindau disease is characterized by
the presence of capillary hemangioblastoma in the retina or cerebellum as well as congenital cyst or neoplasms in the kidney, liver and pancreas.
381
Sturge Weber syndrome
is a rare congenital neurocutaneous disorder characterized by the presence of cutaneous facial angiomas as well as leptomeningeal angiomas.
382
Tuberous sclerosis presents with
cortical and subependymal hamartomas, cutaneous angiofibromas, visceral cyst, renal angiomyolipomas and cardiac rhabdomyomas.
383
Osler-Weber-Rendu syndrome
congenital telangiectasias (may cause epistaxis, gastrointestinal bleeding or hematuria).
384
Ionizing radiation induces
DNA damage through DNA double strand fractures and the formation of oxygen free radicals.
385
Ethylene glycol ingestion leads to:
toxic, acute tubular necrosis with vacuolar degeneration and ballooning of the proximal tubular cells. Typical clinical findings include high anion gap metabolic acidosis, increased osmolar gap and calcium oxalate crystals in the urine.
386
Roseola infantum
caused by HHV-6
Primary symptoms include high fever for 305 days followed by an erythematous maculopapular rash that usually starts on the trunk and spreads to face and extremities.
387
Coxsackievirus A16
common cause of hand-foot-mouth disease in children
388
Parvovirus B19 causes
erythema infectious or fifth disease, which can present as a flulike illness followed by a characteristic slapped cheek rash and truncal reticular rash.
389
Fenoldopam is a
selective peripheral dopamine-1 receptor agonist, given to lower pressure in hypertensive emergency, especially in patients with renal insufficiency. Causes arteriolar dilation, increases renal perfusion and promotes diuresis and natriuresis.
390
Centricinar emphysema associated with heavy smocking involves the release of
proteinases (elastase) from infiltrating neutrophils and alveolar macrophages.
391
Oseltamivir is a ______ and is given in _______
is a neuraminidase inhibitor useful in the tx of influenza. Neuraminidase is required for the release of virus from infected cells and for the spread of virus within the respiratory tract. Neuraminidase inhibitors cause the newly synthesized virions to adhere to the host cell surface and form viral aggregates, thereby reducing the spread of virus to other host cells.
Tamiflu
392
I-cell disease manifestations
lysosomal storage disorder, due to defects in protein targeting. A phosphotransferase enzyme catalyzes the phosphorylation of mannose residues on lysosome-bound proteins, allowing them to traverse the Golgi network and ultimately be transported to the lysosome, where they serve as catalysts for degradation of cellular components. A defective phosphotransferase enzyme causes extracellular secretion of these proteins and accumulation of cellular debris in the lysosome forming inclusion bodies.
393
Tissue plasminogen activator (t-PA) converts
plasminogen to plasmin, plasmin functions to break down fibrin, resulting in thrombolysis.
394
Down syndrome quadruple screen will show
elevated inhibin A and beta-hCG, low AFP and unconjugated estriol
395
5'-3' exonuclease activity
removes RNA primers as well as damaged DNA segments
396
3'-5' exonuclease activity
performs a proofreading function that removes and replaces mismatched nucleotides on the newly formed daughter strands.
397
lactose intolerance presents with
increased breath hydrogen content, reduced stool pH and elevated stool osmolality.
398
CCl4 produces
free radicals that start a vicious cycle of hepatic injury.
399
Succinylcholine can cause
significant potassium release and life-threatening arrhythmias
400
Malignant hyperthermia
occurs after administration of inhalation anesthetics and/or succinylcholine to genetically susceptible individuals. It is treated with dantrolene that blocks ryanodine receptors and prevents release of Calcium into the cytoplasm of skeletal muscle fibers.
401
Tinnitus and unilateral hearing loss are common presenting features of
vestibular schwannoma
402
Neurofibromatosis 1 codes for _____ protein
Neurofibromin
403
Neurofibromatosis 2 codes for _______ protein
Merlin
404
One of the side effects of ACE inhibitors is that they can produce________ due to the lack if inhibition of__________-
angioedema/bradykinin
405
Pseudogout
synovial fluid showing rhomboid-shaped calcium pyrophosphate crystals with positive birefringent
406
Efficacy refers to
the ability of a drug to elicit an effect
407
Potency refers to
the dose of drug that is required to produce a given effect.It is primarily affected by the affinity of the drug for its receptor and the amount of drug that is able to reach the target tissues.
408
Alternative splicing
process by which a single gene can code for various unique proteins by selectively including or excluding different DNA coding regions into mature mRNA.
409
Vessels involved in atherosclerotic plaques
Aorta,coronary arteries, popliteal arteries, internal carotid arteries and the circle of willis.
410
microglia
move to the area of ischemic infarct apron 3-5 days after the onset of ischemia and phagocytize the fragments of neurons, myelin and necrotic debris, a cystic space replace the necrosis and Astrocytes then form a glial scar along the periphery
411
Fail in the omphalomesenteric obliteration leads to
meckel's diverticulum, persistent vitelline duct, vitelline sinus and vitelline duct cyst.
412
Iron accumulation mechanisms
enterocytes increase apical expression of divalent metal transporter, increasing intestinal iron absorption from the lumen and hepatocytes decrease hepcidin synthesis, which increases ferroportin expression on the basolateral surface of enterocytes and promotes iron secretion into the circulation.
413
Myasthenia graves causes a decrease in
the number of ACh receptors, this reduces the number of postsynaptic cation channels that can open in response to Each, which reduces the amplitude of motor end plate potential and prevents muscle fiber depolarization.
414
Glycopyrrolate use
cholinesterase inhibitors may cause adverse effects related to muscarinic overstimulation, which can be ameliorated by the use of an antimuscarinic agent such as glycopyrrolate, hyoscyamine or propantheline.
415
Reye syndrome histology
micro vesicular steatosis of hepatocytes without inflammation, and cerebral edema.
416
Viridians can
adhere to fibrin-platelet aggregates and establish infection that leads to endocarditis.
417
Locus heterogeneity
refers to the ability of one disease or trait to be caused by mutations in multiple different genes.
418
Lithium can induce
Nephrogenic diabetes insipidus
419
Urachus
Remnant of the allantois that connecta the yolk sack with the bladder
420
Sebrr pharyngitis with exudates and cervical lymphadenopathy in a group of people with unknown vaccination status should raise suspicion for
Diphtheria infection
421
Hepatic steatosis is characterized by _______ in the hepatocellular cytoplasm
Triglyceride accumulation
422
Pathogenesis of alcohol-induced hepatic steatosis
A decrease in free acid oxidation secondary to excess NADH production by the two major alcohol metabolism enzymes.
423
The alteration of the hepatic NAD/NADH ratio in alcoholics induces fatty liver through inhibition of
Gluconeogenesis and fatty acid oxidation.
424
MESNA is given to prevent
Hemorragic cystitis produced by cyclophosphamide metabolite acrolein, which is toxic to uroepithelial cells and cause cell death and necrosis if allowed to be in contact with this cells for a prolonged period.
425
Down syndrome can increase risk of
ALL
426
In Status Epilepticus you should give
Phenytoin and lorazepam
427
The structures of the mesonephros persist in the male as:_____________ and in the woman as:_____________.
It persist in the male as the Wolffian Duct which laters form the ductus deferens and epididymis. In females it regress and convert in the vestigial Gartner’s duct.
428
The ureteric bud give raise to
The collecting system of the kydney, renal calyses, renal pelvis and ureters.
429
The metanephric mesoderm gives raise to (Blastema)
bowmanns space, glomeruli, proximal tubules, loop of henle and convulated tubules.
430
Asbestosis characteristics
associated with shipbuilding, plumbing, affects lower lobes. Asbestos bodies are golden-brown fusiform rods resembling dumbbells. Can be visualized with prussian blue stain.
431
Berrylliosis characteristics
asoc. with aerospace and manufacturing industries, affects lower lobes.
432
Coal workers pneumoconiosis characteristics
prolonged coal dust exposure, macrophages laden with carbon, affect upper lobes.
Anthracosis (asymptomatic condition found in many urban dwellers exposed to sooty air.
433
Silicosis characteristics
Asoc with sandblasting. May disrupt phagolysosomes and impair macrophages, increasing susceptibility to TB. Affects upper lobes and eggshell calcification of hilar lymph nodes.
434
Only cranial nerve not covered with schwann cells:
CN II, which is covered with oligodendrocytes
435
Most common site for intracranial schannomas is
cerebellopontine angle at craneal nerve VIII (acoustic neuromas)
436
Fibrates mechanism of action
inhibits cholesterol 7-alpha hydroxyls, rate-limiting enzyme in the bile salt production, leading to gallstones.
437
S3 sound is caused by
sudden limitation of ventricular movement during rapid passive ventricular filling and suggest ventricular volume overload or enlargement (aortic/mitral regurgitation, dilated or ischemic cardiomyopathy). Listening at end of expiration make it more audible by decreasing lung volume and brings the heart closer to the chest wall.
438
HAART for HIV (NRTI's) can produce
body fat redistribution
439
Chronic granulomatous disease test characteristic
failure of neutrophils to turn blue on nitroblue tetrazolium testing.
440
Methylphenidate and amphetamines side effects
decreased appetite, weight loss and insomnia.
441
Opioids side effects:
can stimulate the mu receptor in the GI tract, causing decreased secretions and gastric motility (constipation), can produce significant euphoria by dopaminergic pathways in the nucleus accumbens, nausea, respiratory depression, sedation and urinary retention.
442
Who stimulate and inhibit gastric acid secretion?
histamine, acetylcholine and gastrin increase acid secretion but prostaglandins, secretin and somatostatin inhibits it.
443
Gastrin not only stimulates HCl secretion, but it also has
trophic effect on parietal cells.
444
carotid sinus afferent and efferent limbs
afferent limb that arises from the baroreceptors in the carotid sinus and travels to the vagal nucleus via the glossopharyngeal nerve; the efferent limb carries parasympathetic impulses via the vagus nerve.
445
Ezetimibe mechanism of action
reduces the intestinal absorption of cholesterol
446
Bile acids sequestrants (colesevelam) mechanism of action
binds bile salts in the intestine, decreasing their absorption
447
Fibrates mechanism of action
activates PPAR's which leads to stimulation of lipoprotein lipase activity and a decrease in TG levels.
448
Epistacis is when
A allele from one gene interferes with the phenotipic expression of another gene
449
Mycobacterium tuberculosis can not be visualized on gran stain because of
High lipid content, mycolic acid
450
Valsalva maneuver increase the ______ using the ____________ muscle.
Increase the vagal tonenin paroxysmal ventricular tachycardia using the rectus abdominis.
451
Statins mechanism of action
Inhibits HMG CoA reductase and stimulates the LDL receptor recycling.
452
Vasa vasorum endarteritis
Mechanism by which syphilis cause thoracic aorta dilation
453
Aorta aneurism lead to
Transmural aortic inflammation
454
Drug metabolism phases
Phase I (RHO) slightly polar molecules; and phase II (SMAG) very polar molecules
455
Geriatric patients tend to lose phase ___ first
ONE; they have more phase II
456
Patients who are low acetylators have higher side effects because of lower rate of metabolism like for example
drug induced SLE (SPECIALLY HYDRALAZINE)
457
Zero-order elimination
a constant amount of drug is eliminated per unit time, they have no fixed half life. Rate of elimination is independent of plasma concentration.
Examples: phenytoin, ethanol and salicylates.
458
First order elimination
a constant fraction of drug is eliminated per unit time, rate of elimination is directly dependent of plasma concentration.
459
Steady state is reached when
rate in=rate out
460
Fragile X syndrome increased number of CGG leads to
hypermethylation and inactivation of FMR1, preventing transcription and production of fragile X mental retardation protein.
461
Tx for psoriasis
calcipotriene (calcipotriol, calcitriol, tacalcitol), binds the vit D receptor (a nuclear transcription factor that cause inhibition of keratinocyte proliferation).
462
Hallmark histologic findings of acute viral hepatitis include
Hepatocyte necrosis and apoptosis with mononuclear infiltration. Hepatocyte becrosis is characterized by cellular swelling and cytoplasmic emptying (ballooning degeneration).
463
Fibrinoid necrosis is characterized by
The deposition of amorphous material in the wall of blood vessels affected by immune vasculitis or malignant hypertension.
464
Liquefactive necrosis occurs due to
Enzymatic degradation of tissue in the central nervous system
465
Part of the spleen involved in removal of damaged RBC's
red pulp
466
Candidiasis local defense: (systemic and local)
local defense against candida is performed by t cells, whereas systemic infection is prevented by neutrophils.
467
Indole positivity
ability to convert tryptophan to indole, a characteristic of E. Coli.
468
Holosystolic murmur
Mitral valve prolapse
469
Crescendo-decrescendo systolic murmur
Aortic or pulmonary stenosis
470
Diastolic murmur
Aortic valve regurg
471
How a deug can bypass the portal circulation
Intravenous, sublingual and rectal
472
Chronic stimulation of the fetal beta cells leads to
Beta cells hyperplasia and hyperinsulinism, which contribute to increased fat deposition and enhanced fetal growth, resulting in macrosomia.
473
Serum tumor markers for HCC, GI, pancreatic, ovarian, germ cell and prostate.
```
HCC: aFP
Pancreatic: CA 19-9
Ovarian: CA 125
GI: CEA
Choriocarcinoma: bHCG
Germ cells: aFP and bHCG
Prostate: PSA
```
474
Haptoglobin function:
is a serum protein that binds free hemoglobin and promotes its uptake by the reticuloendothelial system. Haptoglobin levels decrease when significant quantities of hemoglobin are released into the circulation as occurs with intravascular hemolysis.
475
Gs is present in which receptors
glucagon, TSH and PTH, activating adenylate cyclase, and therefore protein kinase.
476
cGMP mediates which intracellular effects:
smooth muscle relaxation, platelets activation and sperm metabolism.
477
Ubiquitin proteasome pathway function:
for breakdown of intracellular proteins, both native and foreign, helps recycle the into amino acid building blocks. Ubiquitin functions as a tag that is attached to proteins to mark them for destruction. It is coupled to MHC I.
478
Light microscopy of histoplasma capsulatum:
macrophages with intracellular ovoid or round yeast
479
Light microscopy of crypto coccus neoformans:
budding yeast with a THICK POLYSACCHARIDE CAPSULE
480
Peruses should be considered in
any adult who has not had updated vaccination boosters. The clinical presentation is a paroxysmal cough lasting more than 2 weeks that is associated with post-tussive emesis or inspiratory whoop after a severe coughing episode.
481
```
Cutaneous receptors:
Merkel
Pacinian
Meissner
Krause
Ruffini
```
```
Merkel: position and static touch (textures)
Pacinian: vibration and deep pressure
Meissner: position and light touch
Krause: temperature
Ruffini: pressure and skin stretch
```
482
Nerve roots reflexes:
Ankle (S1-2)
Patellar (L3-4)
Biceps (C5-6)
Triceps (C7-8)
483
Plasma renin activity PRA is a:
measure of the amount of angiotensin I generated per unit of time. It provides a useful assessment of the renin-angiotensin-aldosterone axis. Factors that increase PRA include low sodium intake and antihypertensive medications such as diuretics, ACE inhibitors and angiotensin II receptor blockers.
484
Triad of aplastic anemia:
low hemoglobin, thrombocytopenia and absent hematopoietic cells in the bone marrow.
Compensatory reaction is an elevation of erythropoietin levels in patients with normal renal function.
485
MCC of self-limited childhood diarrhea in unvaccinated individuals:
Rotavirus, it infects villous enterocytes in the duodenum and proximal jejunum and results in villous blunting, proliferation of secretory crypt cells and a loss of brush border enzymes.
486
brown pigment gallstones due to increase of
beta-glucuronidase release by injured hepatocytes.
487
Blocks binding of RANK-L to RANK and reduces formation of mature osteoclasts:
osteoprotegerin
488
decreases osteoprotegerin production, increasing RANK-L production and increasing RANK expression in osteoclast precursor:
estrogen
489
can cause cutaneous flushing:
niacin, which is mediated by prostaglandins and can be diminished by pretreatment with aspirin.
490
GERD is caused primarily by
gastroesophageal junction incompetence and can be associated with extra esophageal symptoms (nocturnal cough) in the absence of heartburn.
Histologic findings include: basal zone hyperplasia, elongation of the lamina propia papillae and scattered eosinophils.
491
Ohrenic nerve lesion symptoms:
hiccups, diaphragmatic paralysis and dyspnea. The phrenic nerve arises from C3-C5.
492
Osler-Weber-Rendu syndrome symptoms:
telangiectasia in the skin, mucus membrane (lips, oronasopharynx, respiratory tract, GI and urinary tract. Rupture may cause epistaxis,GI bleeding or hematuria.
493
Hemosiderin-laden macrophages are:
located in the lungs, and are usually the result of chronic passive lung congestion in the setting of heart failure.
494
Fomepizole MOA and uses:
a competitive inhibitor of alcohol dehydrogenase and is used for the treatment of acute poisoning.
495
Lumbar puncture site
L3-L4,L4-L5, below the spinal cord L1. The L4 vertebral body lies on a line drawn between the highest points of the iliac crests.
496
Vibrio vulnificus is a:
curved, gram-negative, free-living bacterium that grows in marine environments. Manifestations are often mild, but individuals with liver disease or iron overload are at high risk of severe, fulminant infection (sepsis and necrotizing fasciitis)
497
Pseudomonas infections are common in
patients who are neutropenic, hospitalized, have burns or have indwelling catheters.
498
Mucromycosis is:
an opportunistic infection caused by Rhizopus, Mucor and Absidia species. The clinical picture is paranasal sinus involvement in a immunosuppressed patient. The fungi form broad nonseptate hyphae that branch at right angles.
499
BNP diagnostic utility in patients with shortness of breath of unknown cause:
for patients in whom the serum BNP level is not elevated, shortness of breath is unlikely to be due to heart failure
500
stress-induced (takotsubo) is characterized by:
hypokinesis of the mid and apical segments and hyperkinesis of the basal segments of the left ventricle, resulting in systolic dysfunction. The condition is likely caused by a surge of catecholamines in the setting of physical or emotional stress. Catecholamines may cause microvascular spasm leading to ischemia and myocardial stunning or they may cause direct myocardial dysfunction. It usually affects postmenopausal women and resolves on its own within several weeks.
501
Pityriasis versicolor is caused by
Malassezia species (spaghetti and meatballs histologic appearance on KOH preparation light microscopy).
502
Prevents the action of chemotherapeutic agents
the human multi drug resistance (MDR1) gene codes por P-glycoprotein, a transmembrane ATP- dependent efflux pump protein.
503
hot tube folliculitis is a
superficial and self-limited Pseudomonas eruginosa infection of the hair follicles, that tends to occur in minor outbreaks following exposure to a pool or spa, characterized by pruritic, papulopustular rash.
504
Can insert the genome into host chromosome
HBV
505
CREST syndrome
Calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia. It affects primarily the face, forearms and fingers. The pathogenesis of systemic sclerosis involves chronic autoimmune inflammation, vascular endothelial injury resulting in chronic ischemic tissue damage (fingertip ulcers) and excessive activation of fibroblasts leading to progressive tissue fibrosis (this increases the risk of Barrett's esophagus and fibrous stricture formation).
506
DNA polymerase I special function in prokaryotes
5' to 3' exonuclease activity which function to remove the RNA primer created by RNA primase and repair damaged DNA sequences.
E Coli for ex.
507
TGF-B function
fibroblast migration, proliferation and connective tissue synthesis. Increased TGF-B activity is responsible for the hypertrophic/keloid scarring and fibrosis of the lung, liver, and kidney in chronic inflammation.
508
Sturge Weber Syndrome
developmental anomaly of neural crest derivatives that affects small vessels of: the face (port-wine stain in the face, leptomeningeal angiomas, seizures, epilepsy) and intellectual disabilities, glaucoma). GNAQ gene
509
Tuberous Sclerosis:
HAMARTOMAS in CNS and skin, mitral valve regurg, ash-leaf spot, rhabdomyoma, renal angiomyolipoma, mental retard.
510
Isoniazid MOA and MOR:
MOA: inhibition of mycolic acid synthesis by M tuberculosis.
MOR: non-expression of the catalase-peroxidase enzyme
511
Ethambutol MOA and MOR:
MOA: inhibits the synthesis of the mycobacterial cell wall.
MOR: when the mycobacteria increase the production of arabinosyl transferase.
512
Asherman syndrome is:
obstruction and scarring of the uterine cavity, this is a sequela of uterine infection or procedures.
513
Kallmann syndrome is:
impaired synthesis of GnRH by the hypothalamus, and presents with primary amenorrhea, absent secondary sexual characteristics and an olfactory sensory defect.
514
V2 passes throw:
Foramen rotundum
515
V3 passes throw:
Foramen ovale
516
Asthma and COPD exacerbations are controlled by
beta-adrenergic agonist, causing bronchial smooth muscle relaxation via increased intracellular cAMP.
517
Angiodema can occur by two ways:
1. Hereditary AD
2. Acquired, associated with ACE inhibitors tx.
In Hereditary Angioedema there's low C1 esterase inhibitor. ACE inhibitors lead to accumulation of bradykinin, because ACE converts bradykinin into inactive metabolites, if we inhibit it, it will build up.
518
Digoxin MOA:
inhibits Na/K ATPase pump in myocardial cells, leading o a decrease in sodium efflux and an increase in intracellular sodium levels. This reduces the forward activity of the sodium-calcium exchanger, causing increased intracellular calcium concentration and improved myocyte contractility.
519
How to differentiate pericarditis from angina?
Pericarditis is sharp and pleuritic and may be exacerbated by swallowing or coughing.
520
Hashimoto histology:
intense lymphocytic infiltrate with germinal centers
521
Estrogen effect on T4?
An increase in estrogen (OCP, pregnancy, hormone replacement treatment) increases the TBG, decreasing the free T4 and T3 levels.
522
pulmonary hypertension clues:
loud S2, and an impulse palpated at the left upper sternal border
523
Rheumatoid arthritis histology
is characterized by synovial hyperplasia with inflammatory infiltrates. The accelerated metabolic rate of the inflamed synovium causes local hypoxia, which leads to synovial angiogenesis.
524
Activated macrophages in sarcoidosis and other granulomatous diseases express 1-alpha-hydroxylase leading to
excess production of 1,25-dihydroxyvitamin D and hypercalcemia.
525
X-linked recessive inheritance
Duchenne and Becker muscular dystrophy, hemophilia and G6PD deficiency. All males who inherited the X chromosome will display the phenotype whereas only homozygous females will display the phenotype.
526
Wiskott-Aldrich syndrome
is a combined B and T lymphocyte disorder, with findings characteristics of eczema, recurrent infections, and thrombocytopenia. Patients are at increased risk of pyogenic infections specially organisms with a polysaccharide capsule.
527
Ataxia-telangiectasia syndrome is defined by
the presence of a progressive ataxia together with telangiectasia and an immunodeficiency due to a combined defect of both B and T-lymphocytes.
528
Polycythemia (erythrocytosis) levels in women and men
Men >52% and women > 48%.
| *Measurement of red blood cell mass is necessary to distinguish absolute from relative erythrocytosis.
529
Opioids MOA:
presynaptic mu receptor activation that leads to closure of voltage-gated calcium channels; postsynaptic binding to mu receptor causes opening of potassium channels and membrane hyper polarization.
530
In malabsorption we test for
fat in stool with Sudan III stain
531
C difficile infection can be detected with
NAAT by PCR
532
Polyethylene glycol is a
osmotic laxative
533
Hydrocephalus ex-vacuo is related with
neurodegenerative diseases like AIDS dementia, due to significant cortical atrophy, which allows the ventricles to expand while maintaining normal pressure.
534
Pseudodemetia can be seen in:
diabetes, hypothyroidism, b12 deficiency, depression, neurosyphilis, normal pressure hydrocephalus
535
Alcohol intoxication
slurred speech, AST over ALT 2:1,
536
Opioid intoxication
CNS depression, pupillary constriction (pinpoint pupils, decreased gag reflex.
tx: naloxone, naltrexone
537
Barbiturates intoxication
marked respiratory depression
538
Benzodiazepines intoxication
minor respiratory depression, ataxia
| tx: flumazenil
539
Amphetamines intoxication
pupillary dilation, tachycardia, anorexia, paranoia, hypertension, wakefulness and attention
tx: benzodiazepines
540
Cocaine intoxication
impaired judgment, pupillary dilation (mydriasis), hallucinations, angina
541
Caffeine intoxication
increased diuresis, muscle twitching
542
Phencyclidine intoxication
violence, impulsivity, psychomotor agitation, nystagmus, tachycardia, hypertension, analgesia, psychosis, delirium
tx: benzodiazepines/ antipsychotics
543
LSD intoxication
Perceptual distortion (visual, auditory), depersonalization, paranoia, psychosis
544
Marijuana intoxication
euphoria, anxiety, paranoid delusions, perception of slowed time, impaired judgment, social withdrawal, increased appetite, dry mouth, conjunctival injection, hallucinations
545
MDMA intoxication
disinhibition, hyperactivity, hypertension, tachycardia, serotonin syndrome, hyponatremia, hyperthermia
546
Heroin intoxication
euphoria, mitosis, respiratory depression.
547
Antipsychotics endocrine side effect:
hyperprolactinemia, galactorrhea, oligomenorrhea, gynecomastia,
548
Antipsychotics cardiac side effect:
can prolong QT, Torsades de point,
549
Antipsychotics MOA:
blocks D2 receptors, increasing cAMP.
550
Extrapiramidal system side effects:
Hours to days: acute dystonia (muscle spasm)
Days to months: akathisia (restlessness) and Parkisonism (bradikinesia)
Months to years: Tardive dyskinesia (orofacial chorea)
551
Neuroleptic Malignant Syndrome presentation:
rigidity, myoglobinuria, autonomic instability, hyperpyrexia, fever, encephalopathy, visual unstable.
tx:dantrolene, bromocriptine
552
Clozapine side effects
Agranulocytosis
| Only for treatment resistant patient.
553
Side effect of olanzapine
metabolic syndrome (hypercholesterolemia)
554
Risperidone side effects
hyperprolactinemia
555
General side effect of atypical antipsychotics
QT prolongation
556
Lithium side effects:
hypothyroidism, polyuria (nephrogenic diabetes insipidus), Ebstein anomaly.
557
Lithium toxicity can be obtained by:
combination with thiazides
558
Buspirone MOA
stimulates serotonin receptors
| tx: generalized anxiety disorder, does not cause sedation, addiction, or tolerance. Does not interacts with alcohol.
559
SSRI's
Citalopram, and -ine.
| inhibits serotonin reuptake
560
SSRI's side effects
SIADH, GI upset, sexual dysfunction, anorgasmia, decreased libido, anorexia, bruxism,
561
SNRI's side effect
hypertension
562
TCA's antidepressants
amitriptyline, imipramine, doxepin
563
TCA's MOA
Blocks serotonin and norepinephrine reuptake
564
TCA's side effects
sedation, postural hypotension, anticholinergic side effects, can prolong QT interval, convulsions, coma, cardio toxicity (arrhythmia due to NA channel inhibition).
use bicarbonate in toxicity.
565
MAO inhibitors
tranylcypromine, phenelzine, isocarboxazid, selegiline
566
MAO inhibitors clinical use
atypical depression
567
MAO inhibitors side effects
hypertensive crisis, CNS stimulation.
Wait 2 weeks after stopping MAO inhibitors before starting serotonergic drugs or stopping dietary restrictions.
568
Bupropion
tx: smoking cessation
569
Trazodone use
insomnia
| can cause priapism and painful erections
570
Varenicline
nicotinic ACh receptor partial agonist. used for smoking cessation.
571
Sarcoidosis laboratory findings
hypercalcemia
hypercalciuria
Elevated ACE levels
572
G6PD deficiency anemia precipitators are:
infections, drugs (dapsone, antimalarials, sulfonamide antibiotics, DKA, favism (ingestion of lava beans)
573
G6PD defiance anemia is characterized by:
bite cells and heinz body, reticulocytosis, jaundice and dark urine.
574
Whipple disease is a
systemic illness that involves the small intestine, joints and CNS, caused by the gram positive tropheryma whippelii. Classic histologic findings include small intestine mucosa containing enlarged, foamy macrophages packed with both rod-shaped bacilli and PAS-positive, diastase resistant granules.
575
Lecithinase is a
Toxin A, produced by Clostridium perfringens, inducing cell lysis and the development of gas gangrene.
576
Polyribosylribitol phosphate is a
capsule component and major virulence factor of H. influenzae type b.
577
Trehalose dimycolate is a
cell wall component and major virulence factor of Mycobacterium tuberculosis. It protects it from being killed by macrophages and stimulates granuloma formation.
578
Acute intermittent porphyria is a
AD condition caused by porphobilinogen deaminase deficiency. Symptoms includes: abdominal pain, vomiting, peripheral neuropathy, reddish-brown urine.
TX: IV glucose, heme preparations, which down regulate ALA synthase
579
Haptoglobin in sickle cell disease
decreased
580
Pronephros, mesonephros and metanephros
pronephros degenerates, mesonephros function as interim kidney then contributes to male genitalia system; metanephros is permanent.
581
Ureteric bud is derived from
mesonephric duct; and gives rise to ureter, pelvises, calyces, collecting ducts.
582
Glomerulus differentiation is induces by
ureteric bud and metanephric mesenchyme
583
Potter sequence is associated with
oligohydramnios, pulmonary hypoplasia, extremity defects, renal failure, flatted nose.
584
Causes os potter syndrome
ARPKD, bilateral renal agenesis, chronic placental insufficiency
585
Horseshoe kidney is associated with
Turner syndrome
586
Extracellular volume can be measured by
inulin or mannitol, because they can not pass to the intracellular compartment
587
Plasma volume can be measure by
radio labeling albumin
588
Cx and GFR relation
if
cx>gfr= secretion
cx
589
Inulin clearance can be used to calculate GFR because
it is freely filtered and is neither reabsorbed or secreted
590
Renal plasma flow can be measured by
PAH, because it is filtered and also secreted
591
Eritroproyectin is produced by
phagocytes and interstitial cells
592
Fanconi syndrome
generalized reabsorption defect in PCT, leading to metabolic acidosis, increased excretion of glucose, phosphate, aminoacids. Causes include hereditary defects.
593
Bartter syndrome
reabsorption defect in thick ascending loop of hence, affects NA/K/2CL cotransporter, presents similar to chronic loop diuretic use, presents with hypokalemia, hypercalciuria, and metabolic alkalosis.
594
Gitelman syndrome
reabsorption defect of NaCl in DCT, similar to using lifelong thiazides, results in hypertension, hypokalemia, metabolic alkalosis and decreased aldosterone. tx:amiloride
595
Prostaglandin and NSAID's effect in the kidney
prostaglandins vasodilator afferent arterioles and NSAID's constricts afferent arterioles.
596
PTH hormone action
increased calcium and phosphate absorption at the level of the gut, calcium absorption and phosphate excretion at the level of the kidney and 1,25-(OH)2D3 production.
597
Acidemia levels
HCO2 <20mEq/L and CO2>44mmHg
598
Respiratory acidosis causes:
airways obstruction, lung disease, opioids, sedatives, weakening of lung muscles.
599
Metabolic acidosis causes:
```
Check anion gap!
High Anion Gap: MUDPILES
methanol
uremia
DKA
Propylene glycol
iron tablets or INH
Lactic acidosis
Ethylen glycol
salicilates (aspirin) (late)
```
```
Normal Gap: HARDASS
Hyperalimentation
addison disease
renal tubular acidosis
diarrhea
acetazolamide
spironolactone
saline infusion
```
600
Alkalemia levels:
CO2<36 OR HCO3 >28
601
Respiratory alkalosis causes:
```
hysteria
hypoxemia (high altitude)
salicylates
tumor
pulmonary embolism
```
602
Metabolic alkalosis causes:
loop diuretics
vomiting
antacid use
hyperaldosteronism
603
Erythema infectiosum (fifth disease)
caused by parvovirus B19 and presents with a nonspecific prodrome, followed by a classic "slapped-cheek" facial rash and a lacy, reticular body rash. Is highly tropic for erythroid precursor cells.
604
Laboratory findings in Neuroleptic malignant syndrome
creatine kinase elevation due to rhabdomyolysis
605
Dantrolene MOA
Antagonizes ryanodine receptors and inhibits calcium release from the sarcoplasmic reticulum.
606
NMS symptoms:
diffuse muscle rigidity, hyperthermia, altered sensorium.
607
Ewing sarcoma is
the second most common malignant bone tumor of childhood, it commonly involves the lower extremity and pelvis and often metastasizes to the lungs.
608
vitamin A deficiency causes
blindness and hyperkeratosis, can be developed in patients with biliary disorders, exocrine pancreatic insufficiency or intestinal malabsorption.
609
Essential tremor is
the most common movement disorder, patients experience a slowly progressive, symmetric postural or kinetic tremor that most commonly affects the upper extremities. It is often inherited in a autosomal dominant fashion and first line treatment is propranolol.
610
Henoch-Schonlein purpura is a
small vessel vasculitis in children, preceded by an upper respiratory infection, (IgA mediated), causes abdominal pain, joint pain, lower extremities palpable purpura and hematuria.
611
Acute post streptococcal glomerulonephritis findings
low C3 levels
IgG and IgM deposition
type III HS
612
Rapidly progress glomerulonephritis findings
crescents consist of fibrin and plasma protein
613
Goodpasture syndrome findings
type II H.S.
antibodies against GBM (IgG to IgE)
Linear IF
HEMOPTISIS AND HEMATURIA
614
Granulomatosis with polyangiitis (Wegener) findings
necrotizing granuloma in upper and lower respiratory system
c-ANCA
Also presents with sinusitis
615
Microscopic polyangiitis findings
p-ANCA
upper respiratory tract only
no granulomas
616
Diffuse proliferative glomerulonephritis findings
due to SLE
| wire looping of capillaries
617
IgA nephropathy (Berger) findings
IgA deposition in mesangium
| occurs concurrently with respiratory or GI tract infection
618
Alport syndrome findings
mutation in type IV collagen
thinning and splitting of glomerular basement membrane
eye problems, sensorineural deafness
619
Membranoproliferative glomerulonephritis findings
tram-track appearance on PAS stain
| cop resents with nephrotic syndrome
620
Minimal change disease findings
most common in children
| recent infection, lymphoma
621
Focal segmental glomerulosclerosis findings
```
segmental sclerosis with hyalinosis
effacement of foot processes
most common in african american
can be due to heroin use, HIV, sickle cell,
may progress to chronic renal disease
```
622
Membranous nephropathy findings
diffuse capillary and GBM thickening
nephrotic presentation of SLE
spike and dome appearance
antibodies to phospholipase A2 receptors
623
Amyloidosis findings
congo red stain shows apple green birefringence
| in mesangium
624
Diabetic glomerulonephropathy
eosinophilic nodular glomerulosclerosis
kimmelstiel-wilson lesions
nonezymatic glycosylation of GBM=increase permeability and thickening
non enzymatic glycosylation of efferent arterioles=increase GFR and mesangial expansion
Most common cause of end-stage renal disease in US
625
Struvite stones
magnesium, ammonium and phosphate
precipitates with high pH
caused by infection with urease positive organisms (proteus, stap saprophyticus, klebsiella) that hydrolyze urea to ammonia which lead to urine alkalization. Commonly form stag horn calculi
626
Renal papillary necrosis is associated with:
diabetes, sickle cell disease, NSAID's, acute pyelonephritis
627
ADPKD chromosomes
PKD1 (Cr16) and PKD2 (Cr4)
628
ADPKD is associated with
berry aneurism, mitral valve prolaps, benign hepatic cyst
629
ARPKD is associated with
Potter sequence and liver fibrosis
630
Adverse effect of loop diuretics
gout, ototoxicity, allergy
631
Thiazide diuretics side effects
Hyper glycemic, lipidemia, uricemia and calcemia.
632
Prevents unfavorable heart remodeling
ACEI
633
DIRECT RENIN INHIBITOR
Aliskiren
634
Direct arteriolar vasodilators
hydralazine, minoxidil
635
Fluorescence in situ hybridization can be used to
identify specific chromosomal translocation, duplications or deletions. `
636
Hallmark of asbestos exposure
pleural plaques
637
D-xylose is a
monosaccharide whose absorption is not affected by exocrine pancreatic insufficiency and can be used to differentiate between pancreatic versus mucosal causes of malabsorption
638
Chronic obstructive pulmonary disease exacerbation organisms
rhinovirus, influenza, H. influenzae, M catarrali, S. pneumoniae
639
Congenital toxoplasmosis is characterized by
retinal lesions, hydrocephalus, jaundice and hepatosplenomegaly
640
Congenital rubella infection
growth restriction, hearing loss, cloudy cornea and meningoencephalitis
641
Pregnant woman should avoid unpasteurized milk to prevent
Listeria monocytogenes infection
642
Foregut, midgut and hindgut
foregut=pharynx and 3/4 duodenum
midgut=duodenum to 2/3 of transverse colon
hindgut= distal 1/3 of transverse colon to anal canal
643
Ventran pancreatic duct gives raise to
pancreatic duct
644
Dorsal pancreatic duct gives raise to
body, tail, isthmus and accessory pancreatic duct
645
The head of the pancreas came from
ventral and dorsal pancreatic duct
646
SADPUCKER
```
suprarenal glands
aorta/ivc
duodenum
pancreas
ureters
colon
kidney
esophagus
rectum
```
647
Hepatoduodenal ligament contains
portal triad: proper hepatic artery, portal vein, common bile duct
648
Celiac trunk branches
common hepatic, splenic and left gastric
649
Site of varices anastomosis
esophageal varices=left gastric with azygos
caput medusae= para umbilical with small epigastric veins of the wall
anorectal varices= superior rectal with middle and inferior rectal
650
Ito cells functions
storage of vitamin A, matrix production, collagen type II in cell injury
651
Hepatic zone I
periportal zone, affected first by viral hepatitis
652
Hepatic zone III
pericentral vein, affected first by ischemia, contains cytochrome p-450, site of alcoholic hepatitis.
653
Sliding hiatal hernias are:
gastroesophageal junction is displaced upward; hourglass stomach
654
Paraesophageal hernias are:
gastroesophageal junction is usually normal, fungus protrudes into the thorax.
655
Hernia Covered by the 3 layers if spermatic fascia
indirect hernia/ most common in young men or child
656
Hernia Covered by the external spermatic fascia only
direct hernia/ most common in older men
657
Complication of hernia repair
can compromise the vas deferens
