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Flashcards in UWorld part 2 Deck (289):
1

what does the middle meningeal artery branch off of

Maxillary artery

2

What does the maxillary artery branch off of

External carotid artery.

3

What is tachyphylaxis

Rapidly declining effect after a few days of use

4

alpha adrenergic agonists have tachyphlaxis, resulting in..

rebound rhinorrhea (which is nasal congestion w/o cough, sneezing, or post nasal drip. Rhinorrhea may or may not be present)

5

Nitroglycerine and tachyphylaxis

Dimished release of NO from target cells. ergo why you need drug free intervals of 8-10 hours.

6

How is fibromyalgia dx?

Dx made in pt with chronic pain and fatigue for >3 months in absence of physical or laboratory findings suggestive of an inflammatory etiology

7

tx of fibromyalgia

gradual incremental aerobic exercise
TCA
SNRI

8

Ankylosing spondylitis

Chronic inflammatory disease of the axial skeleton characterized by progressive pain and stiffness of the spine, sacroiliitis, and positive HLA-B27 serology

9

Dermatomyositis

autoimmune condition causing bilateral proximal muscle weakness assoc with violaceous eruption on the eyelids and knuckles and elevated creatine kinase levels

10

Polymalgia rheumatica is what

frequently assoc with what

Inflammatory disorder that affects patients >=50 yo and causes bilateral pain and morning stiffness in the shoulders and hips, weight loss, fever, malaise, and an elevated ESR

Freq assoc with giant cell (temporal) arteritis

11

Lichen planus

What might be on the plaque surface

5 Ps
-Polygonal
-Planar
-Pruritic
-Purplish
-Plaques
on the wrists, hands, trunk, and legs

Finely reticulated scale termed Wickham's striae may be present on the plaque surface.

12

Dermatitis herpetiformis presents how?

Strong association?

erythematous pruritic papules, vesicles, and bullae ahtat appear bilaterally and symetrically on the extensor surfaces.

Strongly assoc with celiac disease

13

why is dietary fructose rapidly metabolized compared to other sugars (glucose/galactose/mannose)

Dietary fructose is phosphorylated in the liver to F1P and is rapidly metabolized b/c it bypasses PFK-1, the major RLS of glycolysis.

14

Bone specific alk phos reflects ___ activity

osteoblastic activity.

15

what markers for osteoclastic activity and which is most reliable?

Urinary deoxypyridinoline (most reliable)
tartrate resistant acid phosphatase
Urinary hydroxyproline

16

How is bone specific ALK phos differentiated from liver alk phos

Bone specific is easily denatured by heat (bone=boil)

17

how to treat post operative urinary retention w/ incomplete bladder emptying?

Muscarinic agonist (bethanechol)
or
Alpha1 blocking drug

18

Enfuvirtide mechanism

binds to heptad repeat 1 (HR1) of gp41, preventing from undergoing conformational changes necessary for the viral membrane to fuse w/ the target cellular membrane. as a result HIV genome denied entry into uninfected CD4+ t cells

19

why does left ventricular ruptured free wall cause death

profound hypotension from cardiact tamponade, restriction of ventricular filling during diastole.

20

cardiac tamponade triad

-elevated jugular venous pressure
-profound hypotension
-muffled heart sounds

21

First step in dx malabsorption

Sudan III stain of stool identifying fecal fat >7 g/day

22

schistocytes are dx of

traumatic mechanism, either Microangiopathic hemolytic anemia
or
Mechanical damage

23

HUS vs. DIC

in HUS, Coag system is not activated so coag tests are normal (pt and ptt)

24

causes of microangiopathic hemolytic anemia

-HUS
-TTP
-DIC
-Malignant hypertension
-Metastatic carcinoma

25

pathophys of HUS

endothelial cell injury, isolated activation of platelets and formation of microthrombi.

26

TTP vs. HUS

TTP in adults w/ predominant neurological symptoms

HUS in children with predominant renal involvement

27

What characteristics common to both TTP and HUS

Fever
Thrombocytopenia
Microangiopathic hemolytic anemia

28

Tx for TTP or HUS

Emergent plasmapheresis

29

Dx for dubin johnsons yndrome

conjugated hyperbilirubinemia w/ direct bilirubin fraciton of at least 50% and an otherwise normal liver function profile must be present

Confirm w/ elevated urinary coproporphyrin I

30

histo feature of dubin johnson

normal but a dense pigment composed of epinephrine metabolites w/in the lysosomes can be seen

31

how does streptokinase work

forms complex with plasminogen, cleaving it to form plasmin. Plasmin cleaves fibrin, thereby dissolving thrombi

Streptokinase-plasminogen complex also destroys fibrinogen and clotting factors V and VII

32

SE to streptokinase

hemorrhage

hypersenstivity (b/c protein synth by beta hemolytic streptococci)

33

organism most commonly assoc with cryoglobulinemia is

hepatitis C virus

34

what organisms assoc with hemadsorption (hemagglutinins or glycoproteins w high affinity for RBCs expressed on the host cell)

Influenza

Parainfluenza

35

flucytosine use

mechanism

used in combo with amphotericin B for cryptococcal meningitis in AIDS patients

Nucleotide analog that competitively inhibits RNA synthesis in fungal cells

36

caspofungin mechanism
use

Blocks synth of glucan component of the fungal cell wall

active against candida and aspergillus.

37

griseofulvin mech

use

interacts w/ fungal cell microtubules, inhibiting mitosis

accumulates in keratin containing tissues and treats dermatophyte infections (microsporum, epidermophyton, trichophyton)

38

cyclosporine mech

and use

immunosuppressant in transplant patients to prevent rejection by decreasing IL2 production (thus inhibit T cell prolif)

39

Polyenes examples

mech

Amphotericin B and nystatin

Binds ergosterol molecules in fungal cell membranes and creates pores causing cell lysis. (especially leakage of K+)

40

most common locations for colon cancer

rectosigmoid is most common

ascending colon is 2nd most common

41

left sided vs. right sided colon tumors presentation

left sided tend to be smaller and cause obstruction

right sided cause bleeding, so iron deficiency anemia

42

what differentiates the different presentations of m leprae

lepromin skin test (m leprae antigens injected intradermally) differentiate between tuberculoid and lepromatous

43

deficiencies of C3 predispose to

encapsulated organism recurrent infections

44

deficiencies of C5-9 predisposes to

recurrentinfxn of neisseria meningitidis or n gonorrhoeae

45

leukocyte adheison deficiency is caused by what?

presents as

defect in D18, common component in many integrins, responsible for leukocyte adherence and transmigration through endothelial walls

presents with
-Delayed separation fo the umbilical cord
-Recurrent cutaneous infection w/o pus formation
-poor wound healing

46

inherited defect involving interferon gamma results in

disseminated mycobacterial disease in infancey or early childhood. need lifelong treatment w antimycobacterial agents.

47

xla predisposes to

recurrent lower respiratory tract and giardia lamblia infection

48

use dependence of class I antiarrhythmics

1C>1A>1B

49

platelet derived growth factor receptor mutations play a role in

chronic myelomonocytic leukemia

50

tartrate resistant acid phosphatase stains positively in.

this condition presents with

hairy cell leukemia. the neoplasti cells are B lymphocyte precursors and are CD20+.


presentation
-splenomegaly
-fatigue
-pancytopenia

51

Terminal deoxynucleotidyl tranfserase (TdT) is responsible for what?

is positive in what?

Adding nucleotides to the VDJ regions of the antibody gene for antibody diversity.

marker of immature lymphocytes both B and T.

Neoplastic cells in acute lymphoblastic leukemia (ALL) are TdT positive.

52

auer rods found in myeloblasts in AML stain positive for what

peroxidase.

auer rods indicate myeloid differentiation

53

prognosis of colorectal adenocarcinoma is directly related to what and not to what

related to stage of the tumor

NOT TO THE GRADE

54

what are the 3 clinical phenotypes of 21-hydroxylase deficiency

classic salt wasting

classic non salt wasting

non classic, delayed

55

treatment of congenital adrenal hyperplasia

administer low dose exogenous corticosteroids to suppress ACTH secretion. thus decrease androgen production.

56

medullary carcinoma of the thyroid gland is characterized by

extracelluar deposits of amyloid formed by calcitonin secreted from neoplastic parafollicular C cells

57

P450 Inhibitors

SICKFACES.COM

Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol binge/acute
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole

Grapefruit juice

58

P450 inducers

CRAP GPS induce me to madness

Carbamazepines
Rifampin
Alcohol chronic
Phenytoin
Griseofulvin
Phenobarbital
Sulfonylureas

59

what artery runs w/ the radial nerve

deep brachial artery

60

dermatomyositis presentation

-proximal muscle weakness

-violaceous discoloration of the upper eyelids (heliotrope rash)

-Raised violaceous scaling eruption on the knuckles (Gottron's sign)

-CPK levels elevated

61

How does PTH act on osteoclasts to cause bone resorption?

binds to osteoblasts, stimulating them to release RANK-ligand and monocyte colony stimulating factor (M-CSF).

These two factors stimulate osteoclastic precursors to differentiate into bone-resorbing, mature osteoclasts

Also decreases release of Osteoprotegerin (OPG) a decoy receptor for RANK-ligand. this allows more interaction between RANK-ligand and the osteoclasts.

62

Where in the body is oxygen extraction the highest

myocardium. resting is 75%-80%, up to 90%.

63

in heart ischemia, how quickly do you lose contractility

how long before irreversible dmg

w/in 60 seconds. Although total ATP may still be normal, it is rapidly depleted from areas of the cell w/ high metabolic demand (cytosol surrounding the contraction fibers and electrolyte transport pumps)

reversible if less than 30 minutes. Keep in mind it won't come back right away is it is stunned

64

heterophile antibody negative mononucleosis like syndrome dx is

cytomegalovirus infection

65

aseptic meningitis and herpangina (fever, posterior pharyngeal gray vesicles/ulcers) in children

Coxsackie A

66

PML from JC virus presentation

hemiparesis

visual field defects

cognitive impairment

67

What are the two major risk factors for developing ARDS, adult respiratory distress syndrome

what does it cause?

Sepsis and Shock are the two major risk factors for ARDS.

Presents with:

Non-cardiogenic pulmonary interstitial

intra-alveolar edema,

inflammation,

alveolar hyaline membranes

68

first line antiplatelet drugs

aspirin or clopidogrel

69

ticlodipine SE

neutropenia presenting as fever and mouth ulcers

70

where is low frequency sound heard best

at the apex of the cochlea near the helicotrema

71

where is high frequency heard best

at the base of the cochlea near the oval and round windows

72

acanthosis is what

and is assoc with what

increase in thickness of the stratum spinosum (b/w the granular cell layer and the basal layer of the epidermis)

Associated with psoriasis

73

Spongiosum is what

assoc with what

intercellular epidermal edema that histologically appears as an increase in the width of spaces b/w cells.

associated with spongiotic dermatitis,

74

acantholysis is what

assoc with what

loss of cohesion b'/w keratinocytes in the epidermidis or in adnexal structures.

assoc with spongiotic dermatitis.

75

Dyskeratosis is what


assoc with what

abnormal premature keratinization of individual keratinocytes. may be strongly eosinophilic and have small basophilic nuclear remnants.

found in diseases like scc

76

urticaria/hives is characterized by

superficial dermal edema and lymphatic channel dilation.

no epidermal changes are present

77

what has a high specificity for rheumatoid arthritis

antibodies to citrullinated peptides/proteins

78

what is citrullination

tissue inflammation causes arginine residues in proteins like vimentin to be enzym converted into citrulline. this changes protein shape and can serve as antigen.. Exaggerated response to this is seen specifically in Rheumatoid Arthritis.

79

what CD is found on all NK cells and binds to the constant region of IgG

CD16

80

what CD inhibits complement C9 binding

CD55 and CD59

81

What CD is endotoxin receptor found on macrophages

CD14

82

carcinoid syndrom

BFDR
Bronchospasm and wheezing
Flushing
Diarrhea
Right sided heart lesion (valvular lesion and HEart murmurs)

83

if patient is on cyp450 3a4 inhibitor, what statin can u give them

pravastatin

84

ataxia telangiectasia is caused by what (mech)

presentation

defect in ATM gene leading to DNA double strand breaks and cell cycle arrest

(the As!!)
cerebellar defects (Ataxia),

spider Angiomas (telangiectasia),

IgA deficiency (repeated sinopulmonary infections)

increase in AFP

85

catalase positive organisms that become problematic in CGD

Staph aureus

Burkholderia cepacia

Serratia maracescens

Nocardia

Aspergillus

86

AFP marker

useful marker in cirrhotic pt at increased risk for hepatocellular carcinoma. regularly monitoring in this pt population is recommended.

87

CEA marker assoc with what

used for what

assoc with colorectal cancer

used for staging/planning. NOT screening

88

CA125 marker assoc w/

used for

assoc w/ ovarian cancer. also other malignancies and other benign.

not effective screening. monitoring temporal changes may be of benefit

89

PSA use

establish extent of prostate cancer and evaluate response to cancer treatment. controversial to screen.

90

Acid phosphatase marker assoc with

undergoing active osteoclast initiated bone resorption

91

LAD coronary supplies

anterior 2/3 of the interventricular septum

the anterior wall of the left ventricle

part of the anterior papillary muscle

92

left circumflex coronary artery supplies

lateral and posterior superior walls of the left ventricle via obtuse marginal branches

93

acute marginal branches arise from the right coronary areteyr to supply

wall of the rigth ventricle

94

what is carbamazepine used for

mech?

generalized tonic clonic seizures

simple and complex partial seizures

mood stabilizer in bipolar

trigeminal neuralgia

Mech: blocks voltage gated Na channels in cortical neurons, stabilizing in an inactivated state.

95

SE of carbamazepine

Bone marrow suppression

Hepatotoxic

ADH secretion (so SIADH)

96

ethosuximide mechanism

blocks T-type Ca2+ channels and decreases calcium current in thalamic neurons

97

detection of elevated amounts of ____ helps dx creutzfeldt jakob disease

14-3-3 protein

98

how to treat neonatal opioid withdrawal

tincture of opium

99

most common cause of meconium ileus

CF

100

Most common cause of death for CF patients

Pneumoniae

101

what is identified in about 50% of systemic b cell lymphomas and almost all primary CNS lymphomas occuring int he setting of HIV infection?

Epstein Barr Virus

102

in patients with Hypertrophic cardiomyopathy, how does dynamic left ventircular outflow tract obstruction occur

due to abnormal systolic anterior motion of the anterior leaflet of the mitral valve toward a hypertrophied interventricular septum

103

what drugs can increase serum uric acid levels

Niacin
Hydrochlorothiazide
Cyclosporine
Pyrazinamide

104

SE of niacin

increased uric acid
facial flushing/warmth (prevent w/ aspirin)
Hepatotoxicity at high dose
Worsening hyperglycemia in diabetic patients.

105

SE of statins

hepatitis
myopathy
myalgias

106

SE of fibrates

hepatotoxicity
myopathy (increased when in combo with statins)
Increase risk of cholesterol gall stones

107

SE of bile acid binding resins

GI upset
Impaired nutrient absorption and drugs
Hypertriglyceridemia

108

SE of ezetimibe

mechanism of ezetimibe

Elevations in liver enzymes
Myopathy

Mech: selectively inhibits intestinal absorption of cholesterol

109

Isoniazid MOA

inhibits mycolic acid synthesis

110

Rifampin MOA

inhibits bacterial DNA dependent RNA polymerase

111

Ethambutol MOA

Inhibits mycobacterial cell wall synthesis but with no effect on creation of mycolic acid. Unclear mechanism how.

112

Streptomycin MOA

Aminoglycoside antibiotic, inhibits bacterial 30S ribosomal subunit, halting protein synthesis.

113

Uses for streptomycin

Mycobacterium tuberculae

Plague (Yersina pestis)

Tularemia (Francisella tularensis)

114

prophylaxis for MAC (mycobacterium avium complex)

Azithromycin

115

what happens to amniotic fluid total protein and albumin concentrations from early gestation to term

Decrease by 50%

116

What happens to sphingomyelin over the course of pregnancy

unchanged. (it is phosphotidylcholine aka lecithin that increases in the mid 3rd trimester)

117

acute drug intoxication of
depressed mental status/miosis/respiratory depression

heroin

118

acute drug intoxication of
choreiform movements/tooth decay/tachycardia/violent behavior and psychosis

methamphetamine

119

acute drug intoxication of
chest pain/seizures/mydriasis

cocaine

120

acute drug intoxication of

violent behavior/hallucinations/nystagmus (horizontal or vertical)

PCP/phencyclidine

121

MOA of PCP

NMDA receptor antagonist -->excess release of excitatory NT

122

differences b/w PCP and methamphetamine

Meth is longer, lasting up to 20 hours

Nystagmus (vert or horiz) only seen in PCP

123

cytoplasmic inclusions in oligodendrocytes

Describes
Progressive multifocal leukoencephalopathy

124

Microglial nodules and multinucleated giant cells are characteristic of

Viral infections of CNS, (Found in HIV assoc encephalopathy for example)

125

how does prion disease appear?

Affected gray matter undergoes spongiform change: vacuoles form within cytoplasm of neurons and neutrophils. Later grow bigger and form cysts, involving larger areas of the brain tissue.

No inflammatory changes.

126

major adaptive immune mechanism that prevents reinfection w/ the influenza virus is

anti-hemagglutinin antibodies

127

what hereditary syndromes are assoc with pheochromocytoma

MEN2A and MEN2B and Von Hippel Lindau disease

128

Rule of 10s for what condition and what are the rules

Pheochromocytoma
10% part of hereditary syndromes
10% bilateral
10% extradrenal
10% malignant

129

femoral neck fractures associated with what vessel injury

medial circumflex (which supplies the majority of the blood suppply to the femoral head and neck)

130

ergonovine test

most sensitive provocative diagnostic test for coronary vasospasm

131

moa of ergonovine

ergot alkaloid that constricts vascular smooth muscle by stimulating both alpha adrenergic and serotonergic receptors. low doses induce coronary spasm, chest pain, and ST segment elevation

132

phentolamine moa

alpha1 alpha2 adrenergic antagonist, therefore vasodilating drug

133

tx for prinzmetal's angina (variant angina)

nitrates

calcium channel blockers

134

stabilizing force for secondary structure of proteins

hydrogen bonds

135

Stabilizing force for tertiary structure of proteins

Ionic bonds
Hydrophobic interactions
Hydrogen bonds
Disulfide bonds

136

why is there increased incidence of cholelithiasis in women who are pregnant or using oral contraceptives

Estrogen induced increased cholesterol synthesis by upregulating hepatic HMG-CoA reductase activity

Progesterone reduces bile acid secretion and slows gallbladder emptying

137

meniere's disease presentation

triad of
1. tinnitus
2. vertigo
3. hearing loss

138

Mechanism of meniere's disease

increased vol of endolymph from defective resorption. This causes damage to both the vestibular and cochlear components of the inner ear.

139

what is meniere's similar to?

how is it different?

tinnitus/vertigo/hearing loss similar to mass lesions at the cerebellopontine angle (acoustic neuromas, schwannomas of CN VIII)

but the acoustic schwannoma would be progressive and constant not episodic w/ exacerbations and remissions as seen with meniere's disease

140

treatment of lung abcesses

Need to cover both anaerobic and aerobic bacteria. so give Clindamycin, the drug of choice for lung abcesses.

141

what is most common in ALL, B cell or T cell derived. how can you differentiate?

B cell responsible for 70-80%

T cell has symptoms of mediastinal compression (esophageal or superior vena caval syndrome or respiratory symptoms)

B cell has fever, malaise, bleeding, bone pain, hepatosplenomegaly

142

where does the coronary sinus empty?

right atrium

143

what can cause coronary sinus dilation

pulmonary hypertension or any factor causing dilatation of the right atrium

144

pulmonary pressure of

RA
RV
PA
LA
LV
Aorta


RA:0/8
RV:4/25
PA:9/25
LA:2/12
LV:9/130
Aorta:70/130

145

RPF is what

RPF=RBF(1-hematocrit)

146

dx of schizophrenia

2 of 5
1. delusions
2. hallucinations
3. disorganized speech
4. grossly disorganized behavior
5. negative symptoms

greater than 6 months, including PRODROMAL AND RESIDUAL PERIODS with at least 1 month of active symptoms

147

canagliflozin mechanism

SGLT2 inhibitors, leading to significant glucose urinary loss (normally 90% of filtered glucose reabsorbed in proximal tubule)

148

canagliflozin contraindication

moderate to severe renal impairment

149

what drugs do u need to test thyroid function before taking

amiodarone
lithium

150

what drugs do you need to test liver function and heart failure before taking

thiazolidinediones

151

screening tests for treponema pallidum

confirmatory tests

screening with RPR or VDRL

Confirmatory with FTA-ABS

152

isospora belli causes what

chronic watery profuse diarrhea in immunocompromised patients, especially AIDS

153

how does trypanosoma cruzi cause achalasia/megacolon/megaureter/megaesophagus

releases neurotoxin that destroys the myenteric plexus and causes intramural parasympathetic denervation of smooth muscle.

154

what bacteria produce IgA proteases

N gonorrhea
N meningitidis
Strep pneumoniae
Haemophilus influenzae

155

peptidoglycan precursor molecules consist of

disaccharide of
N-acetylmuramic acid (MurNAc)
N-acetylglucosamine (GlcNAc)

156

what do sulfonamide antibiotics compete with for incorporation into folic acid?

PABA (paraaminobenzoic acid)

157

b12 vs. b6 deficiency, how are they different and why?. what does this result in?

b12 is respon for conversion of methylmalonyl CoA to succinyl CoA. thus elevation of methylmalonyl CoA seen only in b12 def

also the incorportaion of nonphys fatty acids into neuronal lipids results in the neurologic dysfunction.

158

where do most nonsecretory adenomas arise from?

gonadotrophs. presents with mass effects and hypogonadism.

do not produce intact FSH or LH, instead overproduce alpha subunits.

grow slowly

159

most common cell type in normal pituitay

somatotrophs (secreting Growth Hormone) 50%

160

Most common pituitary denoma

prolactinoma

161

hemophilia vs. platelet disorders

platelet disorders have petechial lesions, hemophilia DOES NOT.

162

mild hemophilia is about what of normal

5% of pro-coagulant normal

163

hemophilia vs. von willebrand disease

hemophilia has spontaneous hemarthroses but von willebrand disease does not

164

platelet disorders cause

prolongation of bleeding time
petechiae

165

von willebrand disease causes

prolongation of bleeding time
increased PTT (b/c protects circulating factor VIII from degradation)

166

desmopressin treats what

mild to moderate hemophilia A

167

where does hydroxylation of proline and lysine residues in collagen occur

rough ER

168

most common complication if SAH is survived. how does it present?

how is it seen?

how is it prevented?

secondary arterial vasospasm

new onset confusion and or focal neurological deficit 4-12 days after initial insult.

may not show on CT, but transcranial color doppler may see it.

prevent w/ nimodipine, a selective CCB

169

most deadly complication of SAH

how does it present

how is it seen

rebleeding, not the most common overall (that is secondary arterial vasospasm). it is the most deadly though.

presents as sudden development of new severe headache, nasuea, vomiting, change in level of consciousness

Seen by CT

170

what is contained in the superior colliculi

conjugate vertical gaze center

171

horner syndrome is assoc with what

spinal cord lesion above T1
which occurs with...

Pancoast tumor
Brown sequard syndrome
Late stage syringomyelia

172

what are the nuclei of vagus nerve and what do they do

I. Nucleus solitarius: conveys visceral sensory information (taste/baroreceptors/gut distension)

II. Nucleus Ambiguous: Conveys visceral motor innervation (Pharynx/Larynx/Upper esophagus)

III. Dorsal motor nucleus: Autonomic fibers (Heart/Lungs/Upper GI)

173

thalamic syndrome characterized by

characterized by

total sensory loss on the contralateral side of the body.

no motor deficits

proprioceptoin profoundly affected

174

lesion of internal capsule would cause

motor deficit

175

ischemic events in pons frequently assoc w/

-coma
-bilateral paralysis
-decerebrate rigidity
-pinpoint pupils
-death

176

dmg to caudate nucelus assoc w/

transient hemiparesis

frontal lobe symptoms (inattentiveness, abulia, forgetfulness)

agitation/psychosis/choreoathetosis/dyskinesia

177

lacunar infarctions are the result of what

what are the risk factors?

result of small vessel lipohyalinosis and atherosclerosis involving the penetrating vessels supplying the deep brain structures.

uncontrolled hypertension and diabetes mellitus are risk factors for this condition

178

causes of congenital hydrocephalus

impaired csf outflow due to congen abnormalities like

-Type II arnold-Chiari malformations
-Hereditary aqueductal stenosis
-prenatal infections (toxoplasmosis)

179

presentation of congenital hydrocephalus

irritability
poor feeding
muscle hypertonicity and hyperreflexia (dmg from stretching of periventricular pyramidal tracts)

180

presentation of acute hepatitis B infection

I. Prodrome
-serum sickness like: malaise, fever, rash, pruritis, lymphadenopathy, joint pain

II. Anorexia, nausea, jaundice, RUQ pain. elevated ALT AST, bilirubin and alkphos increase

181

best way to prevent tetanus

maternal immunization w/ tetanus toxoid, this transfers protective IgG across placenta to the neonate.

182

what change in blood pressure is seen in old people?

what is it caused by?

isolated systolic hypertension (ISH)

age related decrease in compliance/increased stiffness of the aorta and its proximal major branches

183

erythrocytes and leukocytes in stool indicate

Enteroinvasive E coli
Campylobacter jejuni
Salmonella
Shigella

184

Erythrocytes w/o leukocytes in stool indicates

Enterohemorrhagic E coli O157:H7 (toxin mediated enterocyte death and intestinal hemorrhage w/o mucosal invasion)

185

leukocytes w/ monocytic predominance is typical for

typhoid fever caused by salmonella typhi

186

leukocytes w/ neutrophilic predominance is typical of

invading bacterial that cause dysentery or inflammatory diarrhea
-Shigella
-Salmonella
-Campylobacter jejuni
-EIEC

187

Watery diarrhea w/ no erythrocytes or leukocytes indicate

Vibrio cholerae
Enterotoxigenic E coli

188

thiamine is a necessary cofactor for

pyruvate dehydrogenase
alpha-ketoglutarate dehydrogenase
transketolase

189

growth pattern of strawberry type capillary hemangiomas

initially grow in proportion with patient, eventually regressing and completely by 7 yrs of age

190

what happens in cystic fibrosis mechanistically most common?

3 bp deletion removing phenylalanine at amino acid 508. causes impaired posttranslational processing (improper folding and glycosylation) detected by ER. as result it is targeted for proteasomal degradation, preventing it from ever reaching the cell surface

191

se of lithium involving kidney

antagonize vasopressin on principal cells w/in the collecting duct system.

192

dysplastic vs. carcinoma is what

reversibility of changes. once the dysplastic cells have breached the basement membrane as seen in invasive carcinoma, the process is no longer considered reversible.

High grade dysplasia=carcinoma in situ

193

microsopic findings in reye syndrome

electron microscopic findings

micro: microvesicular steatosis (presence of small fat vacuoles in the cytoplasm of hepatocytes). No necrosis or inflammation in the liver.

EM: Swelling, deceased number of mitochondria, glycogen depletion

194

although u avoid giving aspirin to children under 16, what is an exception

aspirin is a mainstay of kawasaki

195

characteristic light microscopy findings for viral hepatitis

apoptosis of hepatocytes

acinar necrosis

periportal mononuclear inflammatory inflammation

196

characteristic finding in right sided heart failure patients

centrilobular congestion

197

primary biliary cirrhosis displays what

bile duct destruction

periductal granulomatous inflammation,

bile duct proliferation.

198

presentation of reye' syndrome

hepatic dysfunction

encephalopathy (hepatic dysfunction and toxic effect of hyperammonemia on the CNS leading to cerebral edema)

199

how does schilling test work

oral radiolabeled cobalamin and intramuscular unlabeled cobalamin. if URINE EXCRETION higher than 5% then normal. if lower, then repeat with intrinsic factor. If still low then pernicious anemia is ruled out and suggests malabsorption syndrome: pancreatic insufficiency/bacterial overgrowth/short gut syndrome

200

three phases of dopamine action depending on dose

low: Dopamine D1 receptors (vasodilation and increased blood flow to mesenteric and renal)

Medium: beta1 (increased cardiac contractility)

High: alpha1 (vasoconstriction)

201

what is normal in ARDS

pulmonary capillary wedge pressure is normal (elevated would suggest cardiogenic hemodynamic cause of pulmonary edema)

202

most common brain tumor and presentation

metastasis (lung, breast, kidney, skin/melanoma). multiple well circumscribed masses at the junction of gray and white matter.

203

most common adult primary brain tumor, and second, and third

glioblastoma multiforme

meningioma

acoustic neuroma

204

neurovasc pairing:

axilla/lateral thorax

surgical neck of humerus
midshaft of humerus

distal humerus/cubital fossa

popliteal fossa

Posterior to medial malleolus

long thoracic/lateral thoracic

Axillary/Posterior circumflex

Radial/Deep Brachial

Median/Brachial

Tibial/Popliteal

Tibial/Posterior tibial

205

McCune-Albright syndrome

precocious puberty

cafe au lait spots

fibrous dysplasia of bone

206

Albright heredtiary osteodystrophy (aka type 1A psseudohypoparathyroidism)

pth resist at renal tubules leading to

decreased serum calcium, increased phosphate

Increase PTH release

207

C3a does what

stimulates mast cell histamine release, causing increased vascular permeability and vasodilation

208

what is critical for formation and maintenance of granulomas

Interferon-gamma
IL-12
TNF-alpha

209

prader willi cause and presentation

maternal imprinting (normal and silent) but Paternal gene is deleted/mutated

hyperphagia, obesity, intellectual disability, hypogonadism, hypotonia.

210

Angelman cause and presentation

Gene from dad is silent and normal. MAternal gene is deleted/mutated

inappropriate laughter, seizures, ataxia, severe intellectual disability.

211

for prader willi and angelman syndromes, how else can it present other than normal silent and then deleted/mutated allele?

25% of prader willi and 5% of angelman have uniparental disomy.

212

most common cause of lung abcess

peptostreptococcus
prevotella
bacteroides
fusobacterium

213

risk factors for lung abcess

alcoholism
drug abuse
seizure disorders
stroke
dementia

(conditions increasing aspiration risk)

214

surface ectoderm gives rise to

skin and appendages
nasal and oral epithelium
anal epithelium to the dentate line
lens and cornea

215

neuroectoderm gives rise to

all neurons of the CNS
neurohypophysis
retina
pineal gland
preganglionic autonomic fibers
astrocytes
ependymal cells
choroid plexus

216

mesoderm gives rise to

muscles
bones
blood
genital tissues
dermis
most organ systems
NO EPITHELIAL SURFACES

217

endoderm gives rise to

thyroid tissues

epithelial linings of the
-GI tract
-Lung
-Urethra
-Bladder
-Outer and middle ear

Liver
Pancreas
Lungs

218

notochord gives rise to

nucleus pulposus

219

how does methyl capping work

5' end of all mRNA capped with a 7-methylguanosine residue by a unique 5' to 5' linkage which occurs in 2 stages.

1. addition of guanine triphopshate to teh 5' end of the mRNA catalyzed by guanlyltransferase

2. Methylation of the guanosine cap catalyzed by guanine-7-methyltransferase.

220

noninflammatory diarrhea causes

ETEC
EAEC
V cholerae
C perfringens

221

inflammatory diarrhea causes

Shigella
EHEC
EIEC
C. difficile
C. jejuni

222

presentation of elevated somatostatin

mechanism?

abd pain
gallbladder stones
constipation
hyperglycemia
steatorrhea

(b/c inhibition of...
-insulin
-glucagon
-gastrin
-secretin
-cck
-gastrointestinal motility)

223

presentation of VIPoma

intractable diarrhea
hypokalemia
achlorhydria
(hypotensive due to dehydration and vasodilatory)

224

zinc deficiency presentation

erythematous skin lesions around body orifices that are predominantly vesicular and pustular w/o a central clearing

-hypogonadism
-azoospermia
-hair loss
-impaired taste
-night blindness
-impaired wound healing.

225

presentation of glucagonoma

diabetes mellitus

necrolytic migratory erythema (elevated painful and pruritic rash affecting face, groin, extremities. over time coalesce to form large lesions w/ central clearing of bronze colored induration)

normocytic normochromic anemia resembling anemia of chronic disease

226

who wouldnt you give an ACEI to?

patients dependent on efferent arteriole constriction to maintain renal perfusion (eg: renal artery stenosis). this can lead to acute renal failure

227

heroin and pamidronate can cause

focal segmental glomerulosclerosis

228

gold therapy can cause

membranous nephropathy

229

aminoglycosides, radiocontrast media, cisplatin, amphotericin B , and foscarnet can cause

drug induced tubular necrosis (direct toxic or ischemic effects)

230

Sulfonamides, methotrexate, intravenous acyclovir, triamterene can cause

drug induced tubular obstruction (intratubular precipitation of tissue degradation products, drugs, or drug metabolites)

231

Methicillin (most common), cephalopsorin, acetazolamide, allopurinol, sulfonamides, NSAIDs, can cause

acute allergic interstitial nephritis

232

lithium and cyclosporine can cause

chronic interstitial nephritis

233

most common and second most common causes of cystitis and acute pyelonephritis

E. coli is most common 80%
Staph saprophyticus is 2nd

234

major clinical manifestations of factor V leiden

DVT
Cerebral vein thrombosis
Recurrent pregnancy loss

235

cord factor does what

mycobacterium can cause disease by
-inactivate neutrophils
-damage mitochondria
-induce release of TNF

236

dx of dubin johnson is made how

conjugated chronic hyperbilirubinemia with a direct bilirubin fraction of at least 50% and an otherwise normal liver function profile.

237

treatment of digitalis toxicity

oral activated charcoal

manage serum potassium by insulin/kayexalate/hemodialysis (not calcium gluconate)

Digoxin specific antibody fragments

238

how does PTH work?

acts on osteoblasts to stimulate secretion of monocyte colon stimulation factor and RANKligand. thus stimulating osteoclastic precursor to become mature osteoclasts.

239

immune complex vasculitis assoc with IgA and C3 deposition

Henoch Schonlein purpura

240

Henoch schonlein purpura presentation

purpuric rash
colicky abd pain
poly arthralgia

241

wegeners/granulomatosis w/ polyangiitis presentation

nasal mucosal ulcerations (saddal nose if severe)
glomerulonephritis (oliguria)
serum cytoplasmic stainining antineutrophil cytoplasmic antibodies (C-ANCA)

242

Takayasu arteritis presentation

weak upper extremity pulses, large vessel vasculitis involving aorta and proximal branches.

lesions are similar to giant cell arteritis

243

Giant cell arteritis presentation

headache and blurred vision

244

N-MYC overexpression seen in

Neuroblastoma

Small cell carcinoma of the lung

245

most common primary CNS tumors in adults

Glial origin
Meningiomas
Pituitary adenomas

246

GFAP found in

Astrocytomas (glioblastoma multiforme)
Oligodendrogliomas
Ependymomas
Peripheral neural sheath tumors

247

how are meningiomas Dx?

also where are they from

from cells of arachnoid villi. Benign.

Dx by imaging, do NOT stain for GFAP or synaptophysin

248

where is synaptophysin found

presynaptic vesicles of:
-Neurons
-Neuroectodermal
-Neuroendocrine

249

although liver is resistant to infarcts due to dual blood supply, when can it?

Transplanted liver undergoing hepatic artery thrombosis.

can develop biliary tree infarction and organ failure b/c the collateral blood supply is severed during transplantation.

250

how quickly does irrev dmg in neurons occur during complete ischemia

5 minutes

251

withdrawal of opiods

dilated pupil
piloerection
hyperactive bowel sounds
lacrimation*
yawning*

252

withdrawal of alcohol and benzodiazepines

seizures* (main diff from opioids withdrawal)
tachycardia
palpitations

253

mechanism of griseofulvin

use for griseofulvin

binding of microtubular proteins

dermatophytes only

254

SE of amphotericin B

Nephrotoxicity
Hypokalemia
Hypomagnesemia

255

treat paroxysmal supraventricular tachycardia

Increase vagal tone by
-Carotid sinus massage
-Valsava maneuvar

if this fails then IV adenosine

256

how does intestinal phase decrease gastric acid secretion

ileum and colon release peptide YY, binds to receptors on the endocrine, histamine-containing cells described as enterochromaffin like. This counteracts the cephalic and gastrin phases of acid secretion

257

untreated sleep apnea leads to

pulmonary HTN

Right sided heart failure

258

how does homocysteine get to cysteine?

I. Serine/B6/Cystahtionine synthetase

II.B6/Cystathionase

259

how does homocysteine get to methionine

N-5-methyl-tetrahydrofolate and B6

260

how can Down syndrome occur?

1. Trisomy 21 (95%) by meiotic nondisjunction

2. Unbalanced Robertsonian translocation (2-3%) 46 chr but extra arm of chr21 attached to another chromosome

3. Mosaicism.

261

findings for obstructive lesion in a mainstem bronchus preventing ventilation of an entire lung leading to lung collapse

Unilateral pulmonary opacification

Deviation of the mediastinum toward the opacified lung

262

muddy brown cast

acute tubular necrosis

263

where does hypoxia affect most in renal

why?

Proximal Tubules
Ascending limb of Henle's loop

b/c located in outer medulla of the kidney, area w/ low blood supply.
AND
active (ATP consuming) transport of ions

264

symptoms of temporal arteritis

1. headache
2. craniofacial pain syndromes
3. polymalgia rheumatica
4. Sudden vision loss

265

polymalgia rheumatica is assoc with what?

presents how?

assoc w/ temporal arteritis/giant cell vasculitis

neck, torso, shoulder, pelvic girdle pain and morning stiffness

fatigue fever wt loss also.

266

cAMP signaling

FLAT ChAMP

FSH
LH
ACTH
TSH
CRH
hCG
ADH (V2)
MSH
PTH
Calcitonin
GHRH
Glucagon

267

cGMP signaling

ANP
NO (EDRF)

268

IP3 signaling

GOAT HAG

GnRH
Oxytocin
ADH (V1)
TRH
Histamine (H1)
Angiotensin-II
Gastrin

269

Steroid receptor

VETTT CAP

Vitamin D
Estrogen
Testosterone
T3/T4
Cortisol
Aldosterone
Progesterone

270

Intrinsic tyrosine kinase

Insulin
IGF-1
FGF
PDGF
EGF

MAP kinase pathway
Think growth factors

271

Receptor assoc tyrosine kinase

Prolactin
Immunomodulators (cytokines IL-2, IL-6, IL-8, IFN)
GH

JAK/STAT pathway
think Acidophiles and Cytokines
PIG

272

encapsulated bacteria

which are the most common

SHiNE SKiS

Streptococcus pneumoniae
Haemophilus influenzae
Neisseria meningitidis
E. coli
Salmonella
Klebssiella
Group B Strep


most common are
Strep pneumoniae
Haemophilus influenzae

273

osteomyelitis in child w/ sickle cell disease, most common cause, then the next

Salmonella is the most common cause

Staph aureus
E. coli

274

what can potency of inhaled anesthetic depend on?

what doesnt it?

can depend on
-body temperature
-decreases w/ increasing pt age

does not depend on:
type of surgery/duration of anesthesia/sex/height/wt

275

C3b function

opsonization

276

C3a, C4a, C5a function

anaphylaxis

277

C5a function

recruits and activates

neutrophil
monocytes
eosinophils
basophils

278

when do u give acute gout patients glucocorticoids

elderly w/renal dysfunction, because they can't take colchicine or NSAIDs

279

Klinefelter


cause

47 xxy
primary hypogonadism (elevated FSH and LH, low testosterone) long lower extremities
small firm testes
azoospermia

due to progressive destruction and hyalinization of the seminiferous tubules

280

kallman
cause

low LH, FSH, low testosterone, decreased sperm

due to failed migration of GnRH cells and fomration of olfactor bulb

anosmia is also seen

281

Drug induced lupus vs. SLE differentiate

DILE rarely has anti dsDNA seen in SLE.

282

drugs that induce DILE

which are highest risk?


Sulfonamides
Hydralazine
Isoniazid
Procainamide
Phenytoin
Minocycline
Quinine

highest risk seen in
procainamide
hydralazine

283

portocaval anastomoses

esophageal varices
hemorrhoids
caput medusae

[portal circulation/systemic circulation]

Left gastric vein/Esophageal vein
Superior rectal vein/Middle and inferior rectal veins
Paraumbilical veins/Superficial and inferior epigastric veins

284

main complications from varicose veins

Most common?

painful thromboses
stasis dermatitis
skin ulcerations
poor wound healing
superficial infections

Venous stasis ulcers over the medial malleolus are the most common

285

pilocytic astrocytoma vs. medulloblastoma

pilocytic astrocytoma has a cystic and solid component

medulloblastomas are always solid

286

what is milrinone

phosphodiesterase inhibitor that increases cardiac contractility and decreases both preload and afterload

287

what is the metyrapone stimulation test

blocks cortisol synthesis by inhibiting 11betahydroxylase (which converts 11 deoxycortisol to cortisol)

this should increase ACTH, serum 11-deoxycortisol, urinary 17-hydroxycorticosteroids (11-deoxycortisol is metabolized in liver to 17-hydroxycorticosteroids). failure to rise indicates HPA failure

288

most common lung cancer in general population. Also in women. also in nonsmokers.

Adenocarcinoma.

289

specific symptoms to graves disease

infiltrative dermopathy (pretibial myxedema) and exophthalmos

caused by autoimmune response against thyrotropin receptor that results in the accumulation of glycosaminoglycans w/in the affected tissues.