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Flashcards in Uworld Added 3 Deck (431):
1

Mechanism of Edema and Lethal factors (anthrax)

Edema = cAMP; Lethal = Protease that inhibits MAPK

2

Bordatella pertussis toxins

Pertussis = Gi ribosylation --> cAMP; AC toxin = AC --> cAMP

3

Location and symptoms of Germinomas

Pineal --> (1) Precocious puberty, (2) Obstructive hydrocephalus, (3) Parinaud

4

Functions of Thyroid Peroxidase

(1) Oxidation of iodide to iodine; (2) Iodination of thyroglobulin tyrosine residues; (3) Iodotyrosine coupling to form T3 and T4

5

Anti-TPO

Hashimoto's

6

Chronic lymphedema is a risk for developin what skin tumor

Angiosarcoma

7

Spongiosa filling medullary canal with no mature trabeculae

Osteopetrosis

8

Squatting vs Passive leg raise

Squatting increases both Preload and Afterload, while Passive leg raise just Preload

9

How to decrease MVP murmur

Decr LV volume, bringing valve leaflets into a more normal anatomic arrangement

10

In severe MVP, the murmur becomes more

Holosystolic

11

Histology of MVP

Attenuation of fibrosa (collagen) layer; Thickening of spongiosa layer thru deposition of mucoid (myxomatous) material; Thinning of collagenous core of chordae tendineae

12

Chromium deficiency

Glucose intolerance (GLUT cofactor), Peripheral neuropathy

13

Selenium deficiency

Muscle pain and weakness, Dilated CM

14

Copper deficiency

Microcytic anemia (ferrochetolase), Aortic dissection (elastic tissue), Poor wound healing (lysyl oxidase)

15

Only bile acid that is not reabsorbed in the terminal ileum

Lithocholic acid

16

Magnesium def

Hypocalcemia with Tetany, Tachycardia

17

Magnesium excess

Neuromuscular depression, Bradycardia

18

Congenital defect in Cytochrome b5 reductase

This reduces ferrous hb to ferric in methemoglobinemia

19

Free radicals from drugs and alcohol-related fatty change affect which zone of liver

III

20

Ubiquinated cytokeratin intermediate filament in hepatocytes in alcoholic liver disease

Mallory bodies

21

Nephrocalcinosis

Metastatic calcification of renal tubules --> Diabetes insipidus

22

Chemo regimen for Hodgkin

Adriamycin, Bleomycin, Vinblastine, Dacarbazine

23

AE of Dacarbazine

Azospermia

24

Ecthyma gangrenosum is strongly associated with

P aeruginosa

25

Virulence factors of Pseudomonas in Ecthyma gangrenosum

Exotoxin A (protein synthesis), Elastase, PLC, Pyocyanin (ROS)

26

Exposure to bats or bird droppins in Ohio or Mississippi area

Histo (resembles tuberculosis)

27

Chlorthalidone

Thiazide diuretic

28

Holocrine glands

Associated with sebaceous - entire cells secreted

29

Apocrine vs Eccrine

Apocrine secretes into hair follicles, Eccrine directly onto skin

30

Rapid y descent that becomes deeper and steeper during inspiration

Constrictive pericarditis

31

Timeline of T cell response to MTB

2-4 weeks after infection

32

Most dangerous complication of UC

Toxic Megacolon

33

Sacral micturation center

S2-S4 - parasympathetic fibers travel with pelvic nerves

34

Pontine Micturation Center

Pontine Reticular Formation

35

Medium chain acyl-CoA DH deficiency causes

Hypoglycemia, Hypoketonemia

36

Each round of FA beta oxidation produces

1 NADH, 1 FADH2, 1 AcetylCoA

37

During rapid beta oxidation, the TCA cycle is overwhelmed -->

Shunting acetyl-CoA toward production of ketone bodies

38

Acetyl-CoA Carboxylase

RLS - first step in FA synthesis

39

Anti-cholesterol meds that should be used with caution in patients with pre-existing GB disease

Bile acid resins, Fibrates

40

Parvovirus binds what antigen

Erythrocyte P antigen

41

EBV envelope glycoprotein gp350 binds what

C3d complement component (CR2 or CD21)

42

Hydrocephalus, Intracranial calcifications, Chorioretinitis

Congenital Toxo

43

What type of enzyme is telomerase

RNA-dependent DNA polymerase (RT)

44

Rifampin monotherapy

Exposure to H flu or N meningitidis

45

Tx of MAC

Macrloide + Rifampin + Ethambutol

46

Hurthle Cells

Hashimoto's

47

Beta-Galactosidase

Lactose --> Glucose + Galactose

48

Lac operon

Lack of glucose increases cAMP, Presence of Lactose binds repressor

49

FFA's and insulin resistance

Increase resistance, also decrease insulin secretion

50

Pyogenic granuloma

Polypoid form of capillary hemangioma - Resemble hypertrophic granulation tissue

51

Cystic hygroma

Endothelium-lined lymph spaces beneath epidermis - Differ from cavernous hemangiomas by absence of luminal vessels

52

Liver hemangiosarcomas are associated with

Arsenic (pesticides), Thorotrast (contrast), Polyvinyl chloride

53

Diet recommended for PDH deficiency

Ketogenic (Leucine, Lysine)

54

Glucogenic AA's

Methionine, Valine, Histidine (met sugary valiant hunk)

55

Glucogenic/Ketogenic AA's

Phenylalanine, Isoleucine, Threonine, Tryptophan

56

Ketogenic AA's

Leucine, Lysine

57

Mutation of Myelin protein gene

Charcot-Marie-Tooth (weakness of foot dorsiflexion)

58

Additional manifestations of Polycythemia Vera

Peptic ulceration, Pruritis, Gouty arthritis

59

Measure of fetal lung maturity

Incr ratio of phosphatidylcholine (lecithin) to sphingomyelin ratio

60

Primary abnormality in Paget's

Excessive osteoclastic bone resorption

61

Phenazopyridine

Urinary analgesic - provides symptomatic relief of dysuria, urinary frequency, urgency

62

Ascorbic acid accelerates what reactions

Hydroxylation, Amidation

63

Workup of all patients with gastrinoma should include

Serum calcium, PTH, and Pituitary hormones - MEN-1

64

Anti-MTB drug that requires acidic intracellular environment

Pyrazinamide

65

INH MOA

Synthesis of mycolic acid

66

Ethambutol MOA

Blocking Arabinosyl Transferase

67

Segmented viruses

Reovirus (rota, colti), Orthomyxo, Arena, Bunya

68

Excessive rise in left atrial systolic pressure (v wave) is characteristic for

Mitral Regurgitation

69

Differentiate bone-specific ALP

Easily denatured by heat (bone = boil)

70

Urinary hydroxyproline and deoxypyridinolin excretion

Osteoclast activity (most common measures), also TRAP

71

Antipsychotic most notorious for causing prolonged QT

Ziprasidone

72

Cardiac medication that can cause hypothyroidism

Amiodarone

73

Clozapine acts on what receptors

D4

74

Prevent intracelllular dehydration in sickle cell

Gardos channel blockers (ca-dep K channel)

75

Specificity of tPA

Can only bind plasminogen strongly in presence of fibrin = clot-specific

76

Most common elbow injury in children

Radial Head Subluxation = Tear of annular ligament

77

Blanching of vein into which NE is being infused + induration and pallor

NE extravasation --> a1 vasoconstriction --> Phentolamine

78

Respiratory muscarinic antagonists

Ipratropium, Tiotropium, Glycopyrrolate

79

Eye muscarinic antagonists

Atropine, Homatropine, Tropicamide

80

GI muscarinic antagonists

Hyoscyamine, Dicylomine

81

GU muscarinic antagonists

Oxybutynin, Solifenacine, Tolterodine

82

Flunisolide

Inhaled GC for prophylactic treatment of asthma (bronchial)

83

Calcific Tendonitis

Deposits of calcium hydroxyaptite crystals in periarticular soft tissues (esp tendons, rotator cuff)

84

Anti-EGFR Ab

Cetuximab

85

Muromonab

Anti-CD3 (acute rejection treatment for liver, kidney, heart)

86

Most common bugs causing sepsis in sickle cell

Pneumococcus, H flu

87

How does radiation kill cells

DNA ds break, ROS

88

Secretin stimulates pancreas to release

Bicarb rich, Cl poor fluid (Cl to produce NaCl)

89

High levels of what increase ESR

Fibrinogen stimulted by Acute Phase Reactants

90

Pure Red Cell Aplasia is associated with

Parvo B19, Thymoma, Lymphocytic Leukemias

91

Invasive Mole vs Choriocarcinoma

Hydropic villi and proliferated trophoblast vs Atypical cytotrophoblastic and syncytiotrophoblastic cells w/ foci of hemorrhage and necrosis

92

Pulsus alternans

LV dysfunction - Beat to beat variation in magnitude of pulse pressure in presence of regular rhythm

93

Dicrotic pulse

Two distinct peaks - Severe dystolic function

94

Pulsus parvus et tardus occurs in

Aortic stenosis

95

Hyperkinetic pulse

Rapid ejection of large stroke volume against decr afterload

96

Paget disease of nipple

DCIS spreads to nipple skin without having crossed basement membrane

97

Ductal dilation, Inspissated breast secretions, Chronic granulomatous inflammation in the periductal and interstitial areas

Mammary Duct Ectasia

98

Most common benign tumor of esophagus

Esophageal Leiomyoma

99

Adenosine MOA

AV node - slows conduction and decreases automaticity by hyperpolarizing cells

100

Usefulness of Methacholine challenge

High sensitivity, Low specificity

101

UG Sinus vs Wolffian Ducts in males

UG sinus = Bladder, urethra, prostate, bulbo's; Wolffian = Epididymis, Ductus, Seminal vesicles

102

In a healthy individual, airway resistance is smallest when

lungs are inflated - radial traction of pulmonary tissue on conducting airways

103

Repetitive ischemia of cardiomyocytes or persistent hypoperfusion -->

Hibernation - Chronic but reversible loss of function

104

Myocardial stunning

Less severe form of ischemia-induced reversible loss of contractile function than hibernation (from brief ischemic episodes)

105

Long term lithium requires monitoring of

Thyroid and Renal function

106

PCWP =

LA EDP, which should equal LVEDP

107

Regulatory step for Pyrimidine synthesis

ATP, CO2, Glutamine --> Carbamoyl Phosphate

108

Treatment of Orotic Aciduria

Can't for UMP, so supplement with uridine (--> UMP)

109

Presentation of Orotic Aciduria

Hypochromic megaloblastic anemia, Neuro, Growth

110

Hydroxyurea inhibits

Ribonucleotide Reductase

111

Leflunomide blocks formation of

Orotic Acid

112

Peptide YY

Ileum and Colon --> ECL --> Inhibit gastrin-stimulated histamine release from ECL's

113

Bladder lymph drainage

Superior to External Iliac, Inferior to Internal

114

Traction diverticula

Due to inflammatino and scarring --> True (eg mediastinal lymphadenitis, periesophageal scarring)

115

Pathophys of aortic dissection from hypertension

Medial hypertrophy of aortic vasa vasorum --> Reduced BF for aortic media --> Medial degeneration

116

PABA esters block

UVB (290-320)

117

UV what is major cause of sunburn, photo-aging, and carcinogenesis

UVB

118

Avobenzone

UVAI and UVAII

119

Zinc Oxide sunscreen

UVB, UVAI, UVAII

120

Stomatitis in treatment of RA

MTX (supplement folic acid)

121

Serious potential AE of Hydroxychloroquine

Permanent retinal damage

122

Lack of GC's means response to what will be limited

Vasopressors

123

Strong predisposing factor to Mallory Weiss

Hiatal hernia

124

Which MEN has marfanoid habitus

MEN2b

125

Which lung cancer is not surgically approached

Small cell

126

Primary mechanism of combination OCP's

Suppression of FSH, LH (no midcycle LH spike for ovulation); Secondary mechanism is blocking sperm and preventing implantation

127

Neuro-endocrine markers

Neuron-specific enolase, Chromagranin, Synaptophysin

128

Vimentin is used to dx

Sarcoma (mesenchymal origin)

129

Thrombin Time

Fibrinogen to Fibrin

130

Chronic HTN causes what microvascular changes in brain

Lipohyalinosis, Microatheroma

131

Lacunar infarct in Base of Pons

Ataxia-Hemiplegia; Dysarthria-Clumsy Hand syndrome

132

Lacunar infarct in Genu of Internal Capsule

Dysarthria-Clumsy Hand Syndrome

133

Initial presentation of Charcot Bouchard vs Lacunar Infarct

Charcot Bouchard would show hemorrhage on initial CT

134

First sign of puberty

Testicular and breast enlargement

135

What causes LV outflow obstruction in HCM

Abnormal systolic anterior motion of anterior leaflet of mitral valve toward hypertrophied IV septum

136

Garlic odor after poisoning

Arsenic --> Dimercaprol (which itself causes nephrotoxicity and HTN)

137

EDTA is used for

Lead and Mercury poisoning

138

Well-developed smooth ER

Steroid-producing cells (eg adrenals, gonads, liver); Detoxification

139

Most specific marker for dx of acute HepB

Anti-HBc IgM

140

All females with Mullerian defects should undergo

Renal ultrasound (coexisting urologic abnormality)

141

Relative speed of conduction in cardiac components

Purkinje > Atrial Muscle > Ventricular Muscle > AV node (Park At Ventura Avenue)

142

Why do cryptorchid testes not secrete Inhibit

Temperature degenerates seminiferous tubules selectively

143

Chronic gastritis with antral sparing vs antral-predominant

Autoimmune spares antrum; H pylori mostly affects antrum

144

Most common bening vascular tumors in adults

Cherry Hemangiomas (do not regress)

145

Superficial Hemangioma

Infantile, Capillary, Strawberry - Grow rapidly and regress

146

B1 is a cofactor for

Pyruvate DH, a-KG DH, Transketolase

147

QRS complex in exercise

Normally decr; If prolonged --> 1c anti-arrhythmic (use-dependent)

148

Use dependence of Class III anti-arrhythmics

Reverse use-dependence = Slower heart rate means more QT prolongation

149

Digoxin and K

Toxicity causes HyperK, but can be exacerbated by HypoK

150

Citrullination

Tissue inflammation --> Arginine enzymatically converted to citrulline

151

GABAa vs GABAb

A = Cl influx; B = GPCR (K efflux, decr Ca influx, inhibit AC)

152

Clinical manifestations of Chronic Interstitial Nephritis

(1) Modest elevation in creatinine; (2) Evidence of tubular dysfunction - polyuria, nocturia; (3) Fanconia syndrome - Aminoaciduria, Glycosuria, Hypophosphatemia, Hypouricemia

153

NSAID-associated chronic renal injury is morphologically characterized by

Papillary Necrosis; Chronic Interstitial Nephritis

154

Myelofibrosis

Atypical Megakaryocytic Hyperplasia --> Activate fibroblast prolifation

155

Myelodysplastic syndromes - BM bx

BM bx shows disordered differentiation affecting all non-lymphoid lineages, Ringed siderblasts, Megaloblastoid maturation

156

Myelophthisic anemia

Space-occupying lesion sof bone marrow - All lines affected (pancytopenia)

157

Most common causes of Myelophthisic anemia

Infiltration by met carcinomas w/ associated fibrosis; Also granulomas

158

Ergot Dopamine agonists

Bromocriptine, Pergolide

159

Non-ergo Dopamine agonists

Pramipexole, Ropinirole

160

CEA is a marker for

Colon, Pancreatic

161

CA-125

Maligant ovarian carcinoma

162

Congenital Long QT and Sensorineural deafness

Jervell and Lange-Nielsen (AR)

163

Congenital Long QT, pure cardiac

Romano-Ward

164

Virus with lipid solubule envelope are susceptible to

Diethyl Ether, Chloroform, 50% trichlorofluoroethane

165

Most common benign lung tumor

Hamartoma (Pulmonary chondroma) - Coin lesion

166

Lung lesion with alveolar growth pattern along alveolar septae without fascular or stromal invasion

Bronchioalveolar Carcinoma

167

Sporicidal compounds

Hydrogen Peroxide, Iodine (not alcohols or chlorhexidine, which disrupt membrane)

168

Chlorhexidine works by

Destabilizing cell membranes and coagulating intracellular constituents

169

Formaldehyde and Glutaraldehyde work by

Alkylating and cross-linking DNA and proteins

170

Matching is used to control

Confounding

171

Viruses that cleave one polyprotein via protease

#NAME?

172

BH4 is cofactor for synthesis of

Tyrosine, DOPA, Serotonin, NO

173

Xanthomas are most characteristic of

Hypercholesterol or Hypertriglyceride

174

Familial hypercholesterolemia etiology

LDL Receptor

175

Peutz-Jeghers mutation

Serine/Threonine kinase 11 (STK11) on 19

176

Peutz-Jeghers manifestations

Skin lesions within first few years, intestinal polyposis follows

177

Buccal mucosa pigmented lesions

Pathognomonic for Peutz-Jeghers

178

Histology of Rhabdomyoma

Fascicles of polygonal cells with vacuolated cytoplasm and peripherally placed nuclei

179

Where do Rhabodmyomas occur

Head and neck of younger males

180

Dermoepidermal junction autoantibodies to type VII collagen

Epidermolysis Bullosa Acquisita

181

Clomiphene is best used to

Achieve fertility in women with ovulatory failure who are normogonadotrophic, normoprolactinemic, euthyroid

182

hCG therapy can be used to trigger

ovulatory cascade in an oocyte donor when her follicles are deemed mature

183

HOCM murmur is louder/softer with

Louder with decreases in Preload or Afterload; Softer with increases

184

IgA deficiency can lead to incr incidence of

Atopic, Autoimmune disease

185

Excise RNA primers and replace with DNA

DNA Polymerase I

186

AFP is associated with what repro malignancy

Yolk Sac tumors

187

Classic AE's with Prednisone

Avascular necrosis of femoral head, Insomina, Psych

188

Glyburide

Sulfonylurea

189

Cytoplasmic what accumulation is a hallmark of ischemic injury

Ca2+

190

Tamm-Horsfall

Exclusively secreted by renal tubular epithelial cells in ascending LOH (Prerenal azotemia and low urine flow rate --> Accumulation to form hyaline casts)

191

Findings in homocysteinuria

Marfanoid, Lens down and in, Thrombosis, Athersclerosis, Osteoporosis

192

Warfarin embryopathy

Midfacial hypoplasia, Chondrodysplasia punctata, Hemorrhage, Organ hypoplasia, CNS

193

Changing of pili in neisseria

Phase variation (on-off) and Antigenic variation

194

Complementation

Production of distinct phenotypic trait resulting from homozygous mutations in more than on egene

195

Important finding NOT found in McArdle's

Hypoglycemia (liver glycogen phosphorylase intact)

196

Glycogen synthase deficiency

Infancy = Hypoglycemia, Ketosis, Metabolic acidosis, Growth delays

197

Effects of beta blocker on K

Hyperkalemia

198

EKG signs of hyperkalemia

Peaked T, Loss of p, Prolonged PR, Widen QRS, Slow HR

199

EKG signs of hypokalemia

QT prolongation, U waves, ST depression --> Torsades

200

EKG signs of Hypo vs Hypercalcemia

Hypo causes QT prolongation; Hyper causes QT shortening

201

In general, a medullary lesion would result in

Contralateral spastic paresis, Ipsilateral CN XII defect

202

Phenylephrine

Selective alpha 1 agonist

203

Dobutamine

Mostly Beta 1 agonist - little effects on PVR

204

Isoproterenol

Non-selective beta agonist; Incr HR/CO/PP, Decr PVR

205

Epinephrine effects on HR and PVR

Incr HR, Decr PVR

206

CAAT box

Promoter - binding site for RNA polymerase II

207

Promoters/Binding sites for RNA polymerase II

CAAT, TATA

208

Enhancers are unique in that

they can be located very far away

209

Sublimation

Converting unacceptable feelings or drives into socially acceptable ones

210

Hepatic sinusoidal endothelial cells are unique in that

Fenestrated, Lack BM

211

Stellate cells

Vit A storage; Diff into myofibroblast upon injury --> Fibrosis

212

Block 23S rRNA of 50S

Macrolides, Clindamycin

213

Inhibition of 50S peptidyltransferase

Chloramphenicol

214

Decreasing [Kin]

Increases likelihood of neuronal depolarization w/out altering AP amplitude

215

Increasing [Kin]

Hyperpolarize neuron without altering AP amplitude

216

Mechanism for age-related lactase deficiency

Decr gene expression

217

Cyclosporine MOA

Binds cyclophilin --> inhibits calcineurin --> Inhibit calcium-dependent promotion of IL2 transcription

218

Basiliximab, Daclizumab MOA

mAb that blocks IL-2R

219

Tacrolimus MOA

Binds FKBP --> inhibits calcineurin --> inhibit calcium-dependent promotion of IL-2 transcription

220

Sirolimus (Rapamycin) MOA

Binds FKBP --> Blocks mTOR --> Prevents IL-2 response

221

Tardive Dyskinesia mechanism

Upregulate D receptors; Concomitant decr in cholinergic activity in Striatum

222

The plateau phase of cardiomyocyte AP corresponds to

ST segment (isoelectric)

223

Virus that carries its own DNA-dep RNA polymerase

Pox

224

What can decrease glomerular capillary filtration coefficient

Chronic HTN, DM --> Drop in GFR

225

Calcipitriol

Vit D analog for treatment of Psoriasis (topically)

226

Antibiotic efflux pumps are found in what type of bugs

Typically gram negative

227

Orlistat MOA

Lipase inhibitor

228

McArdle's disease severity

Typically begin in young adulthood --> Muscle cramps, Fatigue, Transient myoglobuinuria --> normal lifespan

229

Lipofuscin is produced when

ROS --> Membrane Lipids

230

Cholesterol Ester Storage disorder

Partial defect in lysosomal acid lipase --> Accumulation of cholesterol ester, TG's --> Hepatic fibrosis, Premature atherosclerosis

231

Clinical manifestations of Cryptosporidium

Mild enterocolitis with water, non-bloody diarrhea

232

Toxoplasmosis in immunocompetent

Nonspecific --> Fever, headaches, myalgia, lymphadenitis

233

Nephrotic Syndrome in adults

Membranous Glomerulonephritis

234

Methenamine silver stain showing thickening of glomelar BM

Membranous Glomerulonephritis

235

CCB's in pregnancy

Limb loss - decreased placental perfusion

236

BB's in pregnancy

Generally safe

237

Incr in endothelium-bound LPL activity

Insulin resistance

238

Increased cholesteryl ester storage in hepatocytes and endothelial cells

Cholesteryl Ester Storage disease - Lysosomal acid lipase defect

239

Insulin effect on Adipocyte vs Endothelial LDLR's

Upregulate on hepatocytes, Downregulate on endothelial cells

240

Complicated non-gonoccocal urethritis

Epididymitis --> 2 wks of doxy or 1 wk azithromycin

241

Probenicid and Penicillin

inhibits renal tubular secretion of penicillins, most cephalosporins,

242

Cilastatin and Imipenem

Prevent proximal tubular brush border hydrolysis of imipenem by dehydropeptidase

243

Stimultion of auricular branch of vagus nerve

Reflex coughing or vomitting

244

Bloom syndrome

Photosensitivity, Short stature, Erythema, Telangiectasias - Defect in DNA helicase gene -- Predisposed to lymphoproliferative and gastrointestinal malignancies

245

ATM gene is important for

DNA repair following ionizing radiation - Telangiectasias in eyes and ears, Lymphoproliferative malignancies

246

Tumors in Li Fraumenia

Breast cancer, Soft tissue sarcoma

247

Location of Lynch syndrome polyps

proximal

248

Histology of Follicular Lymphoma

Effacement; Small cleaved cells (centrocytes), Larger non-cleaved cells w/ multiple nucleoli (centroblasts)

249

Presentation of Sporadic Burkitt's

Ascites and abdominal mass from ileum, cecum, or mesentery

250

Manifestations of hyperestrogenism in cirrhosis

Spider angiomas, Palmar erythema, Dupuytren's, Decr body hair

251

Niacin MOA

(1) Impair VLDL production; (2) Inhibit Hormone Sensitive Lipase --> Decr TG; (3) Incr HDL by limiting cholesterol transfer form HDL to VLDL, slowing HDL clearance

252

intestinal Kaposi

Hemorrhagic nodules by endoscopy

253

Most common cause of Restriction Fragment Length Polymorphism

SNPs

254

RNA virus that replicates in nucleus

Influenza

255

High blood ammonia and Increased urinary orotic acid

OTC deficiency (Increased Carbamoyl Phosphate shunted to Orotic Acid)

256

Uncal herniation findings

CNIII, Contralateral muscle paresis (cerebral peduncle)

257

Somatic Symptom Disorder vs Illness Anxiety Disorder

Minimal or no actual physical symptoms in Illness Anxiety

258

Pseudodementia

Cognitive dysfunction that occurs in patients with severe psych illness

259

Why hypoglycemia in MCAD

Acetyl-CoA is consumed by medium chain fatty acids that accumulate --> Low concentrations of AcetylCoA inhibit conversion of pyruvate to OAA (inhibiting gluconeogenesis

260

Anti-SRP antibodies

Autoimmune Myositis

261

MHC II pathway is particularly important for generating helper T response against

Extracellular and Intracellular membrane-bound pathogens

262

T lymphocyte antigen recognition is determied by

Specificity of TCR for both MHC variant allele and peptide fragment bound to it

263

Positive T lymphocyte selection

Thymic cortex - Responsible for generating T cells compatible with person's HLA haplotype

264

Individuals with HLA haplotypes that cannot bind certain polypeptide fragments

will not be able to mount T cell dependent immune response against these antigens

265

Most common opportunistic viral infection affecting GI tract of HIV patients

CMV - Ulcers, Mucosal erosions, Large cells with basophilic intranuclear & intracytoplasmic inclusions

266

Biopsy in HIV Cryptosporidium diarrhea

Organism confined to microvilli - basophilic parasites attached to mucosal brush border

267

Microsporidium diarrhea in HIV

Distortion of villous architecture w/out inflammation; Small spores with diagonal or equatorial belt-like structure

268

MAC diarrhea in HIV

Necrotizing and Non-necrotizing granulomas; Acid fact staining bacilli

269

HIV protease cleaves

gag and pol products

270

Carboxyhemoglobin

HbCO --> Loss of cooperativity, Unable to unload O2

271

Sclerosing Adenosis

Incidental finding (rarely palpable mass) --> Slight incr risk, Must biopsy

272

Mammary duct ectasia

Skin retraction, Thick creamy or bloody discharge, Palpable periareolar mass

273

Fibroblasts in a cartwheel or storiform pattern

Dermatofibrosarcoma protuberans

274

Dysplastic Nevus syndrome

CDKN2A on 9p21

275

LV End systolic volume, End diastolic volume and pressure in exercise

End systolic volume decreased, End diastolic volume up, End diastolic pressure same

276

Metencephalon -->

Pons and Medulla

277

Three vs Five embryonic vesicles

Pros, Mes, Rhomb --> Tel, Di, Mes, Met, My

278

Short a-helix with leucine resides at every seventh position

Leucine zipper dimerization domain --> TF's known as Basic Zipper Proteins

279

DNA-binding motifs

(1) Zinc finger; (2) Helix-loop-helix; (3) Leucine zipper dimerization domain

280

First reaction of Pyrimidine synthesis

Glutamine, CO2, 2 ATP --> Carbamoyl Phosphate in Cytosol

281

Peroxisome function

Lipid metabolism (beta oxidation), Oxidative reactions, Purine catabolism

282

Cellular location of G-6-Phosphatase

Smooth ER

283

CYP inhibition/induction effects on Warfarin

Inhibits incr Warfarin effect (decr inactivation)

284

2 most common sites for hypertension-related intracerebral hemorrhage

Thalamus, Putamen

285

Hyptertensive hemorrhage in pons

(1) Pinpoint pupils; (2) Loss of horizontal gaze; (3) Decerebrate posturing; (4) Coma

286

mechanisms of incr ICP in brain tumors

(1) Obstruction; (2) Disrupt BBB = vasogenic edema

287

Cutaneous findings in Reiter's

Keratoderma blenorrhagica, Balanitis circinata

288

Causes of nephrogenic diabetes insipidus

(1) Hypercalcemia; (2) Hypokalemia; (3) Post-obstructive diuresis; (4) Lithium, Amph B, Gentamicin, Cisplatin

289

Eptifibatide

Gp Iib/IIIa inhibitor that inhibits platelet aggregation by binding fibrinogen site

290

Effect of CYP inhibitors/inducers of Clopidogrel

Must be activated, so inhibitors decr drug levels

291

Nomal post-void residual volume

50cc

292

Oxybutynin

Anti-muscarinic for urge incontinence

293

Histology of Hep B vs C

B = Ballooning, Necrosis, Portal inflammation, GROUND GLASS; C = Lymphoid aggregates w/in portal tracts, Focal areas of macrovesicular steatosis

294

Most common meds that cause ED other than SSRIs

Clonidine, Methyldopa, BB's

295

COMT inhibitors vs Carbidopa

Both peripheral work peripherally; Carbidopa on DOPA decarboxylase

296

Entacapone vs Tolcapone

Entacapone is peripheral only (can't Enter the CNS); Tolcapone associated with haptotoxicity

297

MOA of Ropinerole

DA agonist

298

Carrier vs Channel proteins

Carrier proteins undergo conformational changes as substrate is transported

299

Uptake of cholesterol occurs via

Receptor-mediated endocytosis

300

Transport of Glucose by Glut4 is

Carrier-mediated transport (co-transport in GI tract, renal tubule)

301

Blank requirements are lower in adrenal insufficiency

Insulin

302

Chloride in primary adrenal insufficiency

Increased to maintain electroneutrality of extracellular fluid

303

Secondary/Tertiary adrenal insufficency vs primary

Can still release aldosterone in response to AgII --> No electrolyte

304

Isolated hyperkalemia can be caused by

Insulin deficiency; Diet; Cell lysis; B1 antagonists

305

Side effects of Flutamide

Hot flashes, Gynecomastia, Impotence (androgen depletion)

306

GnRH agonists

Leuprolide, Goserelin, Nafarelin, Histrelin

307

Cyproterone MOA

Androgen receptor blocker (like Flutamide)

308

IL-2 is approved for treatment of

RCC, Melanoma

309

Translocation is catalyzed by blank and requires blank

EF2, GTP hydrolysis

310

Type of anemia in beta thal minor

Hypochromic, microcytic

311

Most common cell type in pituitary

Somatotroph

312

How to prevent HSV2 recurrences

Daily treatment with Acyclovir, Valacyclovir, Famciclovir

313

Close contact prophylaxis for Hep A

Ig, Vaccine for high risk

314

Vaginal Adenosis

Glandular metaplasia due to DES --> Clear cell adenocarcinoma

315

Blutn Aortic Injury ocurs most often at

Isthmus (attched to Ligamentum Arteriosum)

316

Fall on outstretched, dorsiflexed hand

Lunate discloation

317

Onset of Otosclerosis

middle age

318

AE's of Ganciclovir

Pancytopenias, Renal

319

Major AE of Zidovudine

BM suppression

320

Foscarnet AE

Electrolytes, Renal

321

AE's common to all NNRTI's

Rash/SJS, Hepatotoxicity

322

MOA of Nitroglycerin

Dilate large veins --> Decr preload

323

Primary site of hormonal regulation of systemic BP

Small arteries and arterioles

324

Control of precapillary sphincters

NE, Epi, Local regulators

325

Rhabditiform Larvae in stool

Strongyloides --> Ivermectin

326

Parasite eggs in stool

Schistosoma mansoni or japonicum --> Praziquantel

327

Proglottids in stool

Tapeworms = Taenia, Diphyllobothrium

328

Trophozoites and Cysts in stool

Protozoa = Giardia lamblia, Entamoeba histolytica

329

Strongyloides infection

Skin penetration --> Alveoli --> Pharynx --> Intestine --> Autoinfection

330

a-Glucosidase inhibitors

Acarbose, Miglitol

331

Th in Cronhn's vs UC

Th1 in Crohn's, Th2 in UC

332

First 5 years of diabetic nephropathy

Glomerular hypertrophy, Increase GFR!

333

Gouty nephropathy

Chronic tubulointerstitial nephritis

334

First line for Wilson's

Penicillamine, Trientene

335

Vitamin store longevity for A, D, Folate, B12

A for 6 months, D for 3 months, Folate for 3 monts, B12 for 3-4 years

336

Storage of water soluble vitamins

All flushed easily except folate and B12

337

Anti-psychotics more likely to cause anti-cholinergic effects

Traditional low-potency (eg chlorpromazine, thiordazine)

338

Alleviation of negative symptoms of schizophrenia is thought to be due to

Inhibition of 5-HT2a (atypical anti-psychotics)

339

Common symptoms for sickle cell traint

Hematuria, Inability to concentrate urine

340

Lab indications of sickle cell trait

sickling test positive, all else negative

341

Dubin-Johson = absence of

MRP2

342

Deconjugation of bile acids

Anaerobes, S aureus --> Less soluble --> Less able to form miscelles --> Lipid malabsorption

343

Lower border of parietal pleura

7th --> 10th --> 12th

344

Where should thoracentesis be performed

5-7 (midclavicular) --> 7-9 (midaxillary) --> 9-11 (paravertebral)

345

Unlike ACh, Succinylcholine is not

degraded by AChEsterases

346

Succinylcholine Phase 1 vs 2

1 is depolarized, 2 is non-depolarized

347

Relaxant for intubation --> Hyperkalemia

Succinylcholine

348

AE's of Succinylcholine

(1) Malignant hyperthermia; (2) Severe hyperkalemia; (3) Bradycardia

349

Who gets hyperkalemia with Succinylcholine

Burns, Myopathies, Crush injuries, Denervation

350

Atracurium releases

Histamine --> Fall in BP, Bronchoconstriction

351

Sensory from inner tympanic membrane, eustachian tube

CN IX

352

Noninfective envelope glycoprotein that forms spheres and tubules 22 nm in diameter

HBsAg

353

Milrinone

PDE 3 inhbitor --> Incr cAMP --> Ca conductance --> + Inotropy

354

Dipyridamole, Cilostazol

Decr platelet PDE --> Incr cAMP --> Decr platelet aggregation; Cilastazol also directly vasodilates

355

Ticlopidine, Clopidogrel MOA

Block ADP receptor --> Decr Gp Iib/IIIc receptor

356

Ingestion of undercooked shellfish

V cholera, Norwalk virus, Hep A

357

VPM receives input from

Superior Olivary Nucleus, Inferior Colliculus of Pons

358

Subacute Cerebellar Degeneration

Small cell, Female repo cancers --> Anti-Yo, -P/Q, -Hu --> Cross-react with cerebellar purkinje neurons

359

Post-viral Cerebellar Ataxia

Within 3 weeks of Varicella, Measles, EBV in children --> Self-resolving

360

Clinical associations with Adenocarcinoma

Clubbing, Hypertrophic osteoarthropathy

361

Location and clinical associations with Large cell carcinoma of lung

Peripheral; Gynecomastia, Galactorrhea

362

Carcinoid syndrome is associated with decreased

Niacin

363

Liver histology Reye's syndrome

Microvesicular steatosis w/out inflammation

364

Most adults in US with Anti-HAV IgG

Have never experience icteric illness

365

Icterus in HAV infection depends on

Age (children typically anicteric)

366

Petechiae, Purpura, Ecchymoses

Pupurua 5mm to 1cm

367

Stones in IBD

Calcium binds to lipids instead of oxalate --> more Oxalate absorbed --> Stones

368

Volume depletion after activity in CF

Can't reabsorb Cl or Na in sweat

369

Direct and Indirect Factor Xa inhibitors

Direct = Rivaroxaban, Apixaban; Indirect = Fondaparinux

370

Direct Thrombin Inhibitors

Argatroban, Bivalirudin, Dabigatran

371

HBx -->

Activates synthesis of IGF-2, and IGF-1 receptors --> Cell proliferation

372

Acetyl CoA Carboxylase catalyzes

FA synthesis (--> Malonyl CoA) in cytosol

373

ATP citrate lyase

Converts Citrate --> OAA and Acetyl CoA in cytosol

374

Liver-specific enzyme serving as bridge b/t TG breakdown and Gluoneogenesis

Glycerol Kinase (Glycerol --> Glycerol-3-P)

375

Prevent Prolactin-mediated lactation in pregnancy

Estrogen, Progesterone

376

hCG in second half of pregnancy

Very low

377

Binds 30S subunit and inhibits binding of Aminoacyl-tRNAs

Tetracyclines

378

MacConkey agar

Bile and salt containing; Inhibits gram positives; Grows enterics

379

Blood agar with saline and bile grows

Enterococci (Strep bovis grows in bile but not hypertonic saline)

380

Fever is caused by

PGE2 increasing set point in anterior hypothalamus

381

CNS cells especially sensitive to heat damage

Purkinje cells in cerebellum

382

First line for Legionella

Erythromycin

383

Arcuate nucleus of Hypothalamus

DA (inhibits prolactin), GHRH, Gonadotropin

384

Bacterial DNA Polymerase with 5->3 exonuclease activity

DNA Polymerase I

385

Fornix

Projection from Hippocampus to Mamillary Body

386

Dorsal vs Anterior Thalamus

Dorsal relays from spinal cord to cortex; Anterior part of Papez circuit

387

Lesions of Splenium of Corpus Callosum

Alexia without Agraphia

388

How can dietary fructose be used for glycolysis in Fructokinase deficiency?

Hexokinase (Fructose --> Fructose-6-P)

389

Aldose Reductase

Glucose --> Sorbitol

390

Where does intron splicing occur

Nucleus

391

P bodies

Foci involved in mRNA regulation and turnover

392

Porcelain gallbladder

Risk of GB cancer

393

LM changes in first 24 hours after MI

4-12 = Coag necrosis, Edema, Hemorrhage, Wavy; 12-24 = Coag necrosis, Contraction band

394

Neutrophil and Macrophage infiltration after MI

PMNs 1-5 days; Macrophages 5-10 days

395

When does granulation tissue form after MI

10-14 days w/ neovascularization

396

Fluid/Osmolarity changes after acute GI hemorrhage

Isotonic loss from ECF is only change

397

Fluid/Osmolarity changes after Adrenal Insufficiency

Hypertonic fluid loss = Decr osm, Decr volume, Water shifts intracellularly

398

Fluid/Osmolarity changes after Hypertonic Saline

Inc osmolarity, Fluid shifts from intracellular to extracellular

399

Fluid/Osmolarity changes after Primary Polydipsia

Fluid shifts intracellularly = Incr in intra and extracellular volume with decr in osmolarity

400

Cholesterol in bile is solubilized by

Bile salts, Phosphatidylcholine

401

Fracture of 12th rib injures

Left Kidney

402

Spleen borders what ribs

9, 10, 11

403

Ribs overlying Liver

8, 9, 10, 11

404

Most common manifestation of Botulism

Diplopia, Dysphagia, Dysphonia 12-46 hours after consumption

405

Superior infectivity due to unique binding site on intestinal M cells

Shigella

406

DMD histology

Widespread necrosis, Angulated fibers

407

Charcot-Marie-Tooth

Myelin synthesis defect --> Decr nerve conduction --> Presents with foot drop

408

Microabscesses at tips of dermal papillae

Dermatitis Herpetiformis

409

Positive straight leg raise test

Sciatic nerve root irritation (eg intervertebral disc herniation)

410

Cryoprecipitate vs FFP

FFP contains all factors, Cryoprecipitate contains only cold-soluble (VIII, Fibrinogen, vWF, Vitronectin)

411

Nedocromil MOA

Inhibit mast cell degranulation (like cromolyn)

412

Zileuton

Lipoxygenase inhibitor

413

Claudication is almost always result of

athersclerosis of larger, named arteries

414

Calories per gram of Ethanol, Carbs, Fat

7 for Ethanol, 4 for carbs, 9 for fat

415

Mechanism of reversing opioid tolerance

NMDA antagonism (activation of NMDA is though to enhance tolerance)

416

Blank is required for activation of NMDA

Glycine and Glutamate

417

Anticonvulsants and Osteoporosis

Induce CYP --> Incr Vit D metabolism --> Decr Ca

418

PPI's and Osteoporosis

Decr Ca absorption (need acid to absorb)

419

Heparin, Thiazolidinediones and Osteoporosis

Decr bone formation

420

Pseudobulbar Palsy

Central Pontine Myelinolysis - CN IX, X, XI

421

Rapid correction of hypernatremia

Cerebral edema

422

Labetalol

Antagonist of a1, B1, B2 with minor B2 agonist activity

423

Diabetic retinopathy fundoscopy

Cotton wool, Aneurysms, Dot anb blot hemorrhages

424

Amourosis Fugax

Painless, transient, monocular vision loss caused by small embolus (few seconds)

425

45yo female with long history of pruritis and fatigue who developed pale stool and xanthelasma

Primary Biliary Cirrhosis - Destruction by granulomatous inflmmation, Heavy portal tract infiltration

426

Bile tract disease associated with UC

Primary Sclerosing Cholangitis

427

Vit E deficiency may closely mimic

Friedreich's Ataxia - Ataxia, Dysarthria, Loss of position and vibration sense

428

Fever w/ relative bradycardia

Salmonella Typhi

429

Gastric Erosion

Limited to mucosa

430

Gastric Ulcers

Extend into submucosal layers

431

Limitation of chest expansion in Ankylosing Spondylitis is due to

Enthesopathy of Costovertebral and Costosternal junctions --> Hypoventilation