Yet more... Flashcards
(350 cards)
1
Q
hypertension, hyperlipidemia, pt. complains of muscle pain, has increased serum creatine kinase?
A
look for statin plus fibrate (i.e., atorvastatin plus gemfibrozol) as culprits. Gemfibrozol inhibits hepatic clearance, leads to increased statin and stain myopathy side effect
2
Q
first symptom of alcohol withdrawl?
A
tremor; note that First Aid says hallucinations from alcoholic hallucinosis, a separate phenomenon from DT
3
Q
mechanism of alcohol tolerance?
A
downregulation of GABA receptors
4
Q
pharmacodynamic vs pharmacokinetic action?
A
pharmacodynamic –> drug potentiation greater than additive effect with two drugs administered simultaneously
pharmakokinetic –> duration of normal drug activity is longer of shorter based on increased or decrased CYP450 or other enzyme metabolism
5
Q
surprising location for CYP450 enzymes?
A
gut wall
6
Q
diarrhea, weight loss, epigastric calcifications?
A
chronic alcoholic with pancreatitis –> pancreatic exocrine insufficiency
7
Q
Growth Hormone pathway?
A
GH binds receptor in liver, activates JAK-STAT signalling to nucleus via dimerized STAT molecule –> increased transcription of Insulin-like Growth Factor 1 (IGF-1)
8
Q
enterococcal endocarditis?
A
patient underwent cytoscopy of GU tract or maybe colonoscopy of GI tract; not a dental procedure complication, as enterococcus is not normal oral flora like Strep sanguinis
9
Q
unintentional weight loss, look for what on stomach biopsy?
A
signet ring cells –> signet ring carcinoma
- well-formed glands –> intestinal-type adenocarcinoma
10
Q
most common cause of a continuous murmur, maybe split S2 to boot?
A
PDA, not ASD (don’t think ASD gives continuous murmur
11
Q
Homocysteine degradation pathways? (2)
A
to methionine via methionine synthase and B12
to cystathionine and cysteine via cystathionine synthase and B6
12
Q
drug to prevent breast cancer and osteoporosis? how?
A
Raloxifene; SERM that antagonizes ER on breast and uterus, agonize ER on bone –> stops resorption
13
Q
suprascapular nerve innervates which muscles of the rotator cuff?
A
supraspinatus and infraspinatus
14
Q
subscapularis innervation?
A
upper and lower subscapular nerve
15
Q
adenosine injection? why? SE? mechanism?
A
great quick drug to resolve arrythmias; SE include transitory flushing, burning in the chest, shortness of breath; slows conduction through AV node by hyperpolarization
16
Q
mechanism of liver injury in HBV?
A
CD8+ T lymphocyte response to viral antigens on the cell surface –> hepatocyte damage (the virus itself does not damage the liver)
17
Q
child with spontaneous bursts of non-rhythmic eye movements, hypotonia, myoclonus?
A
Neuroblastoma, from neuroblasts of the adrenal medulla (N-myc amplification)
18
Q
signs of abusive head trauma (shaken baby syndrome)? (4)
A
acute on chronic subdural hemorrhage
retinal hemorrhage (bilateral)
full anterior fontanelle
posterior rib fractures
19
Q
recurrent episodes of abdominal pain plus facial swelling?
A
angioedema; deficiency in C1 inhibition –> increased bradykinin; also will see inappropriate activation of complement cascade
20
Q
name 2 peripheral calcium channel blockers? clinical use? SE?
A
amlodipine, nefidipine; commonly prescribed anti-hypertensive agents; headache, flushing, dizzyness, peripheral edema
21
Q
mild depression in response to life changes?
A
Normal sadness (social, occupational fx not impaired)
22
Q
suspected etiology of fibromyalgia?
A
abnormal central processing of painful stimulus
23
Q
IgA protease allows what? organisms?
A
facilitates bacterial adherence to mucosa; N. gonorrhea, N. meningiditis, S. pneumo, H. influenza
24
Q
pulmonary sequelae of CREST? mechanism?
A
pulmonary hypertension, right heart failure, cor pulmonale; due to intimal thickening at pulmonary arterioles (collage deposition)
25
nifty trick to prevent calcium stone formation?
apply citrate to solution, binds free calcium blocks precipitation
26
rivaroxaban target? similar drug?
Factor Xa; rivaroXaban, apiXaban
27
Describe fat absorption? (4 steps)
1) Digested in duodenum by pancreatic enzymes
2) Bile released into duodenum to emulsify fatty acids and monoglycerides
3) Passive absorption of fatty acid mycells occurs in the jejunum
4) Bile salts (and B12) absorbed in the ileum
28
Factor Xa inhibitors?
rivaroxaban and apixaban
29
which part of nephron is impermeable to H2O?
Thick and thin ascending limbs of loop of Henle
30
resting potential of cardiac myocytes? why?
-90 mV, due to membrane permeability of K+; lower than skeletal muscle (-75 mV) to make depolarization harder --> fewer arrhythmias
31
which phase of cardiac cycle is plateau phase? Due to?
Phase 2 --> Open L-type calcium channels, Ca++ influx
32
which phase of cardiac cycle is depolarization?
Phase 0 --> voltage-gated sodium channels open, Na+ rushes in
33
what happens in Phase 1 of the cardiac cycle?
sodium channels close, start repolarization just before plateau phase
34
what happens in Phase 3 of the cardiac cycle? Due to?
Late rapid repolarization; close Ca++ channels, open K+, restore membrane resting potential
35
Distinctive feature of the cardiac action potential?
Plateau phase due to Ca++ influx (extended period of non-excitability)
36
upshot of cardiac action potential?
increased membrane permeability to Na+, Ca++, decreased K+ permeability
37
patient shows initial resistance to passive extension followed by sudden release?
"clasp-knife" spasticity --> upper motor neuron lesion
38
transient DI?
damage to posterior pituitary or infundibulum interferes with release of ADH; as long as hypothalamus is intact, then neurons of the posterior pituitary can regenerate, normalizing ADH release
39
crescent formation on light microscopy?
(glomerulus) --> rapidly progressive glomerulonephritis
40
what does p
This means that the null value for something (RR=1) is NOT included in the 95% confidence interval; i.e., if RR is 1.02-1.85 in 95% CI, then p
41
Describe holocrine secretion and example?
cell lysis releases entire contents of the cytoplasm and cell membrane; sebaceous glands (acne), meibomian glands
42
Describe merocrine secretion and examples?
cells secrete via exocytosis; salivary and sweat glands
43
Describe apocrine secretion and examples?
cells secrete via membrane bound vessicle -- mammary glands
44
compensatory behavior in bulimia nervosa?
vomiting is most common, but watch out for strenuous exercise, fasting, laxatives, diuretics, diet pills
45
drug that reduces platelet activation and also acts as a direct arterial vasodilator?
Cilostazol -- good for long-term management of peripheral arterial disease; phosphodiesterase inhibitor
46
QRS complex represents?
ventricular depolarization, phase 0 of the cardiac cycle
47
chest x-ray reveals pleural thickening and calcifications on the posterolateral midlung region and diaphragm?
Asbestos exposure
48
Nodular densities and eggshell calcifications of the hilar nodes?
pulmonary silicosis
49
two classes of Ca++ channel blockers?
Dihydropyridines --> vascular smooth muscle vasodilators
| Nondihydropyridines --> cardiac muscle
50
"-dipine" suffix (5 specific?)
Dihydropyridine Ca++ channel blockers; nifedipine, amlodipine, nicardipine, clevidopine, felodipine
51
Non-dihydropyridine Ca++ channel blockers (2 specific)? Does what?
Diltiazem, verapamil --> decrease myocardial O2 demand by acting as a negative inotrope and chronotrope, lower systemic BP
52
Dihydropyridine safe during pregnancy?
Nifedipine
53
First line therapy for Prinzmetal angina? also can treat?
Ca++ channel blockers; also for Raynaud's or other vasospastic condition
54
Ca++ blocker causing gingival hypertrophy? also may cause?
Verapamil; also causes constipation
55
criteria for hypertensive emergency?
SP > 180 or DP > 120
56
IV calcium channel blockers for emergency? (hypertensive)
Nicardipine and clevidipine
57
hypertensive emergency in pregnancy drug? but watch out for?
hydralazine; Lupus like syndrome SE
58
nitroprusside metabolizes to?
cyanide --> long-term exposure toxicity
59
stomach and ovarian cancer raises suspicion for? histology?
Krukenburg tumor; primary gastric cancer that metastasizes to ovaries; see signet ring cells on histology
60
inducible enzyme undetectable in most tissues until inflammatory cells are activated? implication?
COX-2 (COX-1 is constitutively active); COX-2 inhibitory drugs like celecoxib only block active inflammation, good if concerned about GI/duodenal ulcers, for instance
61
looks like ALS, but also sensory loss? MoA?
Syringomyelia - central cystic dilation that damages anterior horns and ventral white commisure
horns --> motor symptoms
commisure --> sensory symptoms
62
First line OCD treatment? signs?
SSRI; rituals, obesession with contamination, counting, may present with skin problem due to compulsive hand washing
63
Niacin deficiency, what is alternate pathway to end product? alternate start point?
End product is NAD or NADP; without niacin, start with tryptophan and can get niacin or bypass to get to NAD/NADP; Thus, tryptophan will be down in B3 deficiency;
Can also start with nicotinamide, which is part of niacin anyway
64
sleep aid for older adults?
Ramelteon --> melatonin agonist, binds melatonin receptors of the suprachiasmatic nucleus
65
Distinguish malingering from factitious disorder?
Very similar, but malingering suggests an ulterior motive (gain sick leave, financial benefit), while factitious disorder has perhaps no motive other than role-playing;
66
High incidence of factitious disorder in?
Health care professionals, more women than men.
67
pain fibers of diaphragmatic and mediastinal pleura are carried by? Activated when? Referred where?
Phrenic nerve; painful inspiration during pleuritic episode, i.e., pneumonia or other scenario; The pain is referred to the neck and shoulder (C3-C5)
68
which atrium is posteriorly located?
Left Atrium - against esophagus
69
HIV+ but lymphocyte count > 800?
Treat as an immunocompetent individual --> i.e., strep pneumonia, not p. jirovecii pneumonia
70
RFLP on a child with trisomy 21?
If 3 bands for 21, then three different chromosomes are present; presumable one from the father plus both of mother's --> nondysjunction in Meiosis I (most common etiology of trisomy 21)
If 2 bands are present for 21, then one band is probably thicker than the other, and represents two copies of the same chromosome from mom plus the one from dad --> nondysjunction in Meiosis II (less common)
71
hot to treat varicella zoster virus with no phosphorylating enzyme? Details?
The phosphorylating enzyme is thymidine kinase. This enzyme (produced by the virus) is necessary to activate acyclovir, valcyclovir, famcyclovir, and gancyclovir. In the absence of this enzyme, must use cidofovir (pre-phosphorylated) or foscarnet (a viral DNA polymerase inhibitor)
72
viral-dependent nucleoside drugs? nucleotide drugs?
acyclovir, valcyclovir, fancyclovir, famcyclovir;
| cidofovir, tenofovir
73
Describe diabetic mononeuropathy?
most common diabetic etiology; central infarct of unilateral CN III results in nerve ischemia --> loss of motor function while sparing parasympathetic function
74
presentation of diabetic mononeuropathy?
pupils equal in size and reactive to light (parasympathetic III functional), but "down-and-out" gase of affected eye (motor III non-functional)
75
bortezimib structure and MoA; clinical use?
boronic acid containing dipeptide; inhibits proteasome action, results in toxic accumulation of protein byproducts --> triggers apoptosis; use in multiple myeloma, lots of protein synthesis --> specificity of drug action
76
patient presents with hepatic encephalopathy; Describe brain effect?
Astrocytes --> ammonia combines with glutatmate via glutamine synthase to make glutamine; glutamine then transforms to glutamate via glutaminase
Neurons --> ammonia combines with alpha-ketoglutarate via glutamate dehydrogenase to make glutamate via glutaminase;
So increased glutamate (causes symptoms) and decreased alpha-keto glutarate (board question)
77
well-recognized comlication of UC? How to diagnose?
Toxic megacolon; check with plain film abdominal x-ray.
78
major virulence factor of M. tuberculosis? Does what?
cord factor --> inactivates neutrophils, damages mitochondria, induces release of TNF
79
platelet released factor that is chemotactic for smooth muscle cells?
TGF-beta -- part of atherosclerotic plaque formation
80
drop blood pressure without slowing heart (i.e., patient is already bradycardic)?
Dihydropyridine - nifedipine, amlodipine, felodipine, etc. --> vascular muscle relaxant (arterial smooth muscle) via Ca++ channel blockade, does not affect cardiac muscle
81
G protein system that elevates protein kinase A?
Gs --> increased cAMP --> activate PKA
| Gi --> decreased cAMP --> less active PKA
82
hypoketotic hypoglycemia suggests?
Defect in fatty acid beta-oxidation --> decreased Acyl-CoA dehydrogenase
83
slow action potential cells?
pacemaker cells
84
fast action potential cells?
cardiac muscle cells
85
Calculate RR from table?
risk of outcome among exposed divided by risk of outcome among unexposed
RR = [a/(a+b)]/[c/(c+d)]
86
Ca++ membrane potential?
+123 mV
87
Na+ membrane potential?
+67 mV
88
K+ membrane potential?
-92 mV
89
Cl- membrane potential?
-70 mV
90
Automaticity threshold potential causes?
Start at -60mV, slow Na+ leak then opens Ca++ channels at -40mV, channels close at +1- mV, then K+ opens to drive membrane potential negative again
91
Differentiate SCID from DiGeorge
DiGeorge is a subset of SCID where the patient will also have facial abnormalities in addition to immune deficiencies related to embryology
92
Mullerian inhibiting factor secreted where? does what? absence means?
MIF secreted by Sertoli cells; causes involution of the paramesonephric ducts; No sertoli cells or MIF means paramesonephric ducts develop to internal female genitalia
93
male internal genitalia develops from? in response to? External genitalia?
Mesonephric (Wolffian) ducts, in response to testosterone from Leydig cells; External genitalia development triggered by dihydrotestosterone (made from testosterone via 5-alpha-reductase)
94
What induces male type external genitalia?
Dihydrotestosterone (so need Leydig cells plus 5-alpha-reductase)
95
Most important risk factor bar none for chronic bronchitis?
cigarette smoking
96
hypoxia, thickened bronchial walls with neutrophilic infiltrates and mucous gland enlargement?
chronic bronchitis (smoking, CF, etc.)
97
Enzyme responsible for removing the short primer fragments of RNA during DNA replication in prokaryotes?
DNA polymerase I - 5' -> 3' exonuclease activity
98
Statin MoA? Clinical use? SE?
Inhibits HMG CoA reductase, the enzyme responsible for the RLS in cholesterol synthesis; used to lower total cholesterol, LDL, and triglycerides; primary SE is myopathy (and hepatitis)
99
triumvirate of anthrax exotoxin?
protective antigen, edema factor, lethal factor
| - must have protective antigen to be naughty
100
B. anthracis has what kind of capsule?
antiphagocytic, poly D-gamma-glutamic acid capsule
101
two organisms with edema factor? Does what?
Bordatella pertussis and Bacillus anthracis
Edema factor acts as a calmodulin-dependent adenylate cyclase --> increase [cAMP] --> fluid accumulation, suppress neutrophil and macrophage activity
102
painless genital ulcers with inclusion bodies? Add in lymphadenopathy?
```
C. trochamatis --> chlamydia infection (serotypes D-K)
Lymphogranulosa venerium (LGV, serotypes L1-L3)
```
103
Mom has STI and delivers; newborn develops conjunctivitis and/or pneumonia. What was the STI? Treatment for conjunctivitis in newborn?
N. gonorrhea --> very quick presentation, 2-4 days after delivery
Chlamydia --> slower onset, 1-2 weeks after delivery
For treatment, use oral, not topical, macrolides
104
What type of blot analyzes for mRNA? How? (3 steps)
Northern Blot
1) mRNA sample is separated via gel electrophoresis
2) Bands transferred to membrane
3) Use hybridized probes with complementary sequence to identify mRNA of interest
105
What type of blot analyzes DNA? How? (3 steps)
Southern Blot
1) DNA fragments separated via gel electrophoresis
2) Bands transferred to nitrocellulose membrane
3) Use complementary radiolabeled DNA probe to identify fragment of interest
106
What type of Blot analyzes for protein? How? (4 steps)
Western Blot
1) Protein sample is separated via gel electrophoresis
2) Bands transferred to nitrocellulose membrane
3) Probe with primary antibody specific for protein of interest
4) Wash membrane and apply secondary antibody to bind primary antibody that is detectable
107
Chloramphenicol SE? (2)
1) Dose-dependent, reversible anemia, thrombocytopenia, and leukopenia
2) Dose-independent, irreversible, aplastic anemia
108
Leukocytes vs. lymphocytes? Ranges on CBC?
Leukocytes are ALL white blood cells including neutrophils, monocytes, lymphocytes, eosinophils, and basophils (4,000-11,000/uL)
Lymphocytes are B and T cells (1,500-3,000/uL)
109
Three key ingredients --> cholesterol stones?
Increased cholesterol
Decreased bile salt
Decreased phosphatidylcholine
110
Fibrate medications MoA? (2)
1) Upregulate lipoprotein lipase --> results in increased oxidation of fatty acids
2) Inhibit cholesterol 7-alpha-hydroxylase, which catalyzes RLS in bile acid synthesis --> bye-bye cholesterol, maybe hello stones
111
Most common urea cycle disorder? Describe?
Ornithine transcarbamylase deficiency (OTC)
Excss carbamoyl phosphate stimulates pyrimidine synthesis; the intermediate compound orotic acid accumulates --> increased orotic acid in urine
112
Young child with vomiting and lethargy, blood shows increased ammonia? Other finding? Inheritance pattern?
OTC deficiency --> results in hyperammonemia due to impaired ammonia excretion; Metabolic emergency; see orotic acid in urine; X-linked recessive inheritance
113
Treatment for OTC
Low protein diet with nitrogen scavenging agents; Liver transplant curative; Gene therapy trial was disastrous
114
Most common CFTR gene mutation? Results in?
3 base pair deletion --> delta F508; results in misfolding and subsequent impaired post-translational modification --> ER detects and destroys via proteasomal degradation
115
characteristics of miscarriage?
116
presentation of partial molar pregnancy?
vaginal bleeding, positive pregnancy test (they won't say way increased beta-hCG, b/c that gives it away), no fetal cardiac activity
117
How to distinguish molar pregnancy from miscarriage on pathology?
With molar pregnancy, see some normal villi, some edematous villi, and focal trophoblastic proliferation (normal villi and no edematous villi in miscarriage)
118
Injury that manifests as Trendelenburg gait? Example?
Contralateral superior gluteal nerve, innervates gluteus medius, results in unstable pelvis and hip drop on the other side when opposite foot is lifted. Bad injection placement (i.e., medial instead of lateral butt) can damage nerve, always inject lateral site, not medial
119
Fastest-acting insulin meds? (3)
Aspart, glulisine, lispro
120
Longest-acting insulin meds? (2)
Detemir, Glargine
121
Basal-Bolus approach?
To mimic physiologic insulin release, a long-acting insulin (glargine) keeps a basal insulin level, while a short-acting (lispro) insulin provides a bolus at meal time
122
biochemistry of short-acting insulins?
amino acid substitution at the C terminal of the beta chain prevents polymerization, allowing rapid absorption into blood
123
lymphatic drainage of the testis?
paraaortic nodes (that's where they started out)
124
lymphatic drainage of the glans penis?
Deep inguinal nodes
125
cutaneous lymphatic drainage from umbilicus to feet, excluding glans penis and lower dorsal leg? Includes?
Superficial inguinal lymph nodes; includes the scrotum (i.e., scrotal abscess), but not the testes (paraaortic)
126
Coronary steal phenomenon? Drugs used, why?
Selective vasodilation of coronary vessels diverts blood flow away from ischemic areas (thing of resistance/pressure relationships). Very useful for angiogram, highlights ischemic areas; Use adenosine and dipyradimole
127
mab against CD20, use?
rituximab; used in lymphoma immunotherapy
128
antibody specific for systemic sclerosis? How about limited scleraderma?
anti-DNA topoisomerase antibodies
| CREST syndrome --> anti-centromere antibodies
129
pneumonia plus ring-enhancing focal lesion in brain? sputum shows? treatment?
Consider Nocardia, especially in immunocompromised. Sputum gram stain will show branching, gram positivive organisms; treat with sulfonamides (Toxoplasma gondii diagnosis would be through serology or seeing cysts or tachyzoites)
130
mast cell granules contain?
histamine and heparin
131
distinguish basophils from mast cells?
Both CD34+ initially, but basophils enter blood stream as mature cells, mast cells mature in target tissue; both contain histamine and heparin, both IgE activated
132
Bupropion MoA and contraindications?
NDRI for major depression, no associated weight gain or sexual side effects; however, lowers seizure threshold especially in patients with eating disorders; not for seizure disorder, anorexia, or bulimia nervosa patients
133
name 2 echinocandin drugs?
caspofungin and micafungin
134
Target of echinocandin drugs?
antifungal --> blocks glucan synthesis, unique ability to suppress cell wall synthesis
135
most frequent cause of traveller's diarrhea?
ETEC - Enterotoxic E. coli
-- LT is Labile Toxin --> increased cAMP
-- ST is Stable Toxin --> increased cAMP
(eL Agua de San Gabriel)
136
progression of capillary hemangioma?
benign; grows in proportion to child, then regresses, gone by puberty or even younger
137
sciatic nerve main branches?
tibial and common peroneal
138
tibial nerve runs where? Innervates what?
Posterior lower leg; innervates gastrocnemius, plantar surfaces, responsible for plantar flexion
139
peroneal nerve runs where? Innervates what?
Anterior lower leg, splits to deep and superficial branches
- Deep --> anterior compartment muscles and toe extensors (responsible for "foot drop" injury)
- Superficial --> eversion of foot, sensation
140
Common nerve injury by lateral neck of fibula?
common peroneal (could be compression injury from lying on side and not moving, in addition to trauma)
141
What nerve carries the afferent cough reflex? Anatomic concern?
Internal laryngeal nerve via superior laryngeal/CNX
| - located just under mucosal layer of piriform recesses, susceptible to injury
142
Aschoff Body histology description?
(context: ARF sequelae) --> interstitial fibrous deposit with central lymphocytes and macrophages, maybe slender chromatin ribbons (also called catterpillar cells or Anitchkow cells)
143
Rhomboid-shaped crystals? Treatment?
Actually more like rectangles or coffin-shaped crystals --> calcium pyrophosphate --> pseudogout; Treat with aspiration, steroids, NSAIDS
144
Prevention for all types of renal calculi?
Copious hydration
145
genital tubercle becomes?
glans penis/glans clitoris
146
urogenital folds become?
ventral aspect of penis/labia minora
147
genital swellings become?
scrotum/labia majora
148
the work of breathing overcomes? How to minimize? Balance point?
1) elastic resistance (faster, shorter breaths to minimize work)
2) Air flow resistance (slow, deep breaths to minimize)
Balance point is at 15 breaths per minute
149
Robertsonian translocation? "Opposite"?
t(14;21) --> effective trisomy 21 if offspring inherits translocated genes in addition to two normal chromosome 21 genes. However, patient will be 46XX or 46XY (not 47 with +21) due to receiving the balanced Robertsonian translocation gene from parent. If offspring receives the unbalanced translocation, most likely will miscarry due to loss of genetic material. So history of miscarriage with subsequent Down's Syndrome offspring is highly suggestive of Robertsonian Translocation, though parents will have no symptoms or other history.
150
"Extra" skin on neck versus "webbed" neck?
Down's Syndrome vs. Turner's Syndrome
151
Right arm and face impaired venous drainage? What about both sides? Etiology?
Blocked or compressed Right Brachiocephalic vein (not SVC) - perhaps caused by tumor or other lung mass. If both sides not draining, then consider SVC blockage or compresesion (SVC drains right and left brachiocephalic)
152
normal findings in aging heart?
decreased LV volume (sigmoid shape), accumulation of lipofuscin pigment --> looks like brownish cytoplasmic granules
153
looks like toxoplamosis but no cats in sight?
Surprise, still toxo! Can be transmitted in contaminated foods! Other key signs are candida overgrowth, signalling immunocompromised state
154
What is pes cavus? Association?
Fixed, plantar flexion of the foot, giving a very high instep when bearing weight. Think about Friedrich's Ataxia or Charcot-Marie-Tooth
155
Cause of death in Friedrich's Ataxia?
Cardiomyopathy
156
What is secretin, and what does it do?
Secretin - hormone secreted by intestinal S cells in response to gastric acid in duodenum --> acts on exocrine pancreatic ductal cells to release bicarbonate-rich, chloride-poor fluid
157
Source of gastrin? Does what?
G cells of the gastric antrum, increases parietal cell acid production
158
muffled heart sounds, hypotension, and elevated jugular venous pressure?
Beck triad --> cardiac tamponade
159
short term protection from congenital hypothyroidism
Maternal T4 lasts for a few weeks, then baby becomes lethargic, floppy, feeds poorly...also see glossitis and reducible umbilical hernia
160
What do you see in congenital hypothyroidism?
Baby is normal, then baby becomes lethargic, floppy, feeds poorly...also see glossitis and reducible umbilical hernia. Might be a homebirth scenario without newborn screen
161
Mood reactivity? Opposite?
Mood brightens in response to positive events --> mood does not brighten in response to positive events
162
Common MAOIs? act on? risk?
phenelzine, selegiline, tranylcypromine; inhibit oxidative deamination of serotonin, norepinephrine, and dopamine; risk SE of hypertensive crisis and serotonin syndrome
163
Bizarre neural cause of hiccups? Cosymptoms?
Phrenic nerve irritation can cause hiccups; if shoulder pain is present, it is referred from diaphragm peritoneum via phrenic nerve (C3-C5)
164
gluteus maximus innervated by?
inferior gluteal nerve (rise from seated position, extend thigh)
165
gluteus medius innervated by?
superior gluteal nerve (stabilizes pelvis, Trendelenburg gait)
166
MSUD cofactors (5)?
Tender Loving Care For Nancy -->
| Thiamine, Lipoate, Coenzyme A, FAD, NAD
167
Healthy baby at birth, but comes back in a couple months showing jaundice, dark urine, light colored stools? Treatment?
Biliary atresia --> progressive partial or complete obstruction of extrahepatic bile ducts. See increased bilirubin, firm hepatomegaly; Treatment is surgical intervention to avert liver cirrhosis/death.
168
Internal urethral sphincter control?
Parasympathetic --> relax
| Sympathetic --> contract
169
"rough" rash on breast? caused by?
Peau d'orange (orange peel); caused by lymphatic obstruction
170
mechanism behind cafe-au-lait macules? associated conditions?
Persistent G-protein stimulatory activity in melanocytes. Bilateral suggests NF-1
Unilateral suggests McCune Albright Syndrome
171
Precoscious puberty, CALMs, osteolytic lesions of hip and pelvis?
McCune Albright Syndrome -- cafe-au-lait spots unilateral, as opposed to bilateral in NF-1
172
Parkinsonian Drug to use first? Why?
Pergolide -- dopamine agonist against D2; use this before levodopa to delay SE of levodopa treatment
173
ATN recovery phase complication?
Hypokalemia due to high-volume, hypotonic urine
174
How does the immune system fight intracellular bacteria? examples?
Cell-mediated immunity, not immunoglobulins. Think Chlamydia, Legionella, Lysteria, etc.
175
Insecticide ingestion? Treatment?
Arsenic -- inhibits cellular respiration -- demercaprol antidote and consider psych if suicidal
176
Adenylyl cyclase substrate, cofactor, and products?
Converts ATP to cAMP and pyrophosphate, using magnesium as a cofactor
177
Drug that lowers plasma cholesterol levels by decreasing cholesterol absorption in the small intestine?
Ezetimibe - second line therapy when other cholesterol-lowering medications are not tolerated, or together with statins when statins alone do not control cholesterol.
178
Sunburn is an example of what kind of burn?
First degree only
179
If a burn has blisters, what kind of burn is it?
Second degree
180
Describe third degree burn. How painful is it?
All layers of the skin are destroyed, and the butn extends into the subcutaneous tissues. Areas can appear black or white, and will be dry, perhaps with leathery texture. No pain! all of the nerve endings are destroyed!
181
Distinguish anemia of chronic disease from iron deficiency anemia based on lab findings
In iron deficiency anemia, ferritin will be down and TIBC will be up, as the body has no iron and is desperate for more. In anemia of chronic disease, ferritin will be up and TIBC will be down, as the body has plenty of iron, but has it hidden away in the macrophages of the bone marrow and doesn't want anymore.
In both instances, FEP (Free Erythrocyte Protoporphyrin) will be up, as this process is not affected and FEP builds up as a precursor molecule for heme that isn't being synthesized due to lack of iron availability.
182
RLS in protoporphyrin synthesis? Cofactor? Where?
Conversion of Succinyl CoA to amino levulinic acid by amino levulinic acid synthase (ALAS) with vitamin B6 as a cofactor; Occurs in the mitochondria of erythroblast.
183
Most common cause of congenital sideroblastic anemia?
Defect in ALAS (amino levulinic acid synthase, RLS in protoporphyrin production)
184
Next step in protoporphyrin synthesis after ALAS?
ALAD (amino levulinic acid dehydrogenase), get to porphobilinogen from delta-amino levulinic acid
185
Three causes of acquired sideroblastic anemia?
```
Alcohol (mitochondrial poison)
B6 deficiency (cofactor for ALAS)
Lead poisoning (denatures ALAD and ferrochelotase)
```
186
alpha globin chromosome?
16
187
beta globin chromosome?
11
188
Unsuccessful pregnancy, autopsy shows hemoglobin Bart?
Hydrops fetalis - no copies of alpha allele for alpha globin in the fetus. HgB is a tetramer of gamma globins.
189
Anomolous finding on gel electrophoresis in someone with alpha thalasemia?
Hemoglobin H - tetramer of beta globins, prolly means 3 gene deletion in patient
190
Difference between alpha and beta thalassemia genetics?
alpha thal is due to gene deletions
| beta thal is due to gene mutations
191
Increase in HbA2 suggests?
Beta thalassemia - not enough beta globin to go around, so make more alpha2-delta2 groups
192
Etiology of megaloblastic anemia?
Insufficient B12 or folate, both of which are necessary for DNA synthesis. Insufficient DNA synthesis leads to fewer divisions of erythroblasts, leaving larger RBCs. Other cells in the body that need to divide will also be affected. Megaloblastic anemia is a subset of macrocytic (MCV > 100) anemias.
193
Describe folate deficiency. Drug effect?
Folate usually derived from leafy greens, absorbed in jejunum, body has stores for a couple months. Drugs like methotrexate will contribute to folate deficiency, dihydrofolate reductase antagonist.
194
How do you get a B12 deficiency? Most common cause?
Takes a long time - huge stores of cobolamin in the liver - but hard core vegans can do this in a year or so. Most common cause of B12 deficiency is lack of intrinsic factor produced by parietal cells (autoimmune destruction most commonly) leading to no B12 absorption in the ileum.
195
Parietal cell Ps (3)?
Pink, proton-pumping, pernicious anemia
196
What are the two reactions that Vitamin B12 is involved in (that we worry about for boards, at least)?
1) DNA precursor activity - receives methyl group from folate
2) Conversion of methylmalonic acid to succinyl CoA - leads to build up of methylmalonic acid in the myelin of the spinal cord --> subacute combined degeneration of the spinal cord, not seen in folate deficiency (think of alcoholism type questions)
197
Lab findings in B12 deficiency?
Decreased B12 (duh)
Increased homocysteine
Increased methylmalonic acid
198
Normocytic anemia findings in the urine?
Hemosiderinuria - hemoglobin in the blood is filtered, reabsorbed by renal tubular cells, which eventually slough off
199
Mechanisms of resistance to Penicillins
Beta-lactamase
Mutated PBP
Mutated porin protein
200
Mechanisms of resistance to Vancomycin
Mutated peptidoglycan cell wall
| Impaired influx/increased efflux
201
Mechanisms of resistance to Quinolones
Mutated DNA gyrase
| Impaired influx/increased efflux
202
Mechanisms of resistance to Aminoglycosides
Aminoglycoside-modifying enzymes (acetylation, adenylation, phosphorylation, etc.)
Mutated ribosomal subunit protein
Mutated porin protein
203
Mechanisms of resistance to Tetracyclines
Impaired influx/increased efflux
| Inactivated enzyme
204
Rifamycins
Mutated RNA polymerase
205
Microscopically observable signs of Huntington's Disease?
Loss of neurons in the caudate nucleus and putamen
206
Macroscopically observable signs of Huntington's Disease?
Pronounced atrophy of caudate nucleus
| Moderate atrophy of the putamen and frontal lobes
207
Biochemical changes in Huntington's Disease?
Decrease in GABA, acetylcholine, and substance P in the striatum (caudate nucleus and putamen)
208
What makes a patient high-risk when leaving hospital?
Multiple medical problems, low health literacy, complex medication regimens, poor social support
209
Effective strategy for decreasing adverse outcomes and preventing avoidable readmissions?
Comprehensive discharge checklist from hospital (or provider).
210
Dx familial hypercholesterolemia. Genetics?
Mutation in LDLR (LDL receptor) protein, so that LDL is not removed from circulation; also could be mutation in apolipoprotein B (ApoB), the part of LDL that binds the LDL receptor protein.
211
Coronary heart disease in childhood or adolescence?
Consider Homozygous Familial Hypercholesterolemia (severe form of FH)
212
Patient has PKU. What amino acid is now essential? Another downstream effect?
Tyrosine. In PKU, phenylalanine is not converted to tyrosine due to lack of phenylalanine hydroxylase enzyme. The build-up o phenylalanine inhibits tyrosinase, leading to decrased melanin (i.e., fair-skinned, blonde presentation)
213
Cardioselective beta blockers? Acute use and contraindication?
metoprolol, atenolol, bisoprolol, nebivolol
Used in setting of acute MI to reduce myocardial oxygen demand by reducing heart rate and cardiac output. Contraindicated in cases of bradycardia or heart block, hypotension, and overt heart failure. Non cardioselective beta blockers can trigger bronchospasm due to underlying conditions.
214
What are neurophysins? Where are they made?
Neurophysins are chaperone proteins for oxytocin and vasopressin. Made in the supraoptic and paraventricular nuclei along with oxytocin and vasopressin, shuttle the hormones to nerve terminals in the posterior pituitary.
215
Entire lung is opaque, trachea deviated?
Consider collapsed lung due to bronchial obstruction. Causes include cnetral lung tumors or other obstruction of mainstem bronchus.
216
Enterococcus can be described as?
Gram positive cocci in pairs or chains that is bile insoluble, grows in 6.5% NaCl, PYR positive, and gamma hemolytic. Does not convert nitrates to nitrites, so urinalysis nitrite will be negative in UTI.
217
Define pica
Compulsive consumption of a nonfood and/or non-staple food source for more than one month. Cause is unclear, but seems to be associated with iron and zinc deficiencies and anemia of any etiology
218
Common substances consumed in pica?
Earth/soil-rich substances, raw starch such as flour or cornstarch, and ice. The person might skip their iron supplements.
219
Symptoms of a lesion involving the jugular foramen?
Vernet syndrome - cranial nerves IX, X, and XI are affected. Dysphagia, hoarseness, loss of gag reflex on the ipsilateral side, deviation of the uvula toward the normal side. Reduced strength of shoulder shrug on affected side.
220
Mechanisms of transmission for HBV?
sexual (hetero and MSM, unvaccinated), percutaneous, and vertical.
221
Mandibular nerve function?
Largest branch of the trigeminal nerve, contains both motor and sensory components. Sensation of TMJ, mandibular teeth, floor of mouth, inside of cheeks, anterior tongue, much of the skin on the lower part of the face.
Motor fibers innervate the muscles of mastication, muscles of the floor of the mouth, tensor veli palatini and tensor tympani.
222
Patient presents with both jaw pain and otologic symptoms?
Mandibular nerve issue.
223
A patient with atrial fibrillation will lack what on jugular venous tracing?
No a wave, which is due to atrial contraction.
224
Calcification and thickening of the pericardium seen on CT? Clinical signs?
Constrictive pericarditis - slowly progressive dyspnea, peripheral edema, and ascites.
225
Role of kinesin?
Microtubule-associated, ATP-powered motor protein that facilitates the anterograde transport of neurotransmitter-containing secretory vesicles down axons to synaptic terminals.
226
Two possible pharm treatments for absence seizures?
Ethosuximide and sodium valproate
227
Baclofen indication and MoA? Alternative?
Treatment of spasticity in MS; works by agonizing at the GABA-B receptor. Tizanidine is also effective and commonly used.
228
What causes spasticity in patients suffering from MS?
Loss of descending inhibitory control from the upper motor neurons results in lower motor neuron overactivity, leading to increased tone and hyperreflexia.
229
Common polypharm problems in older adults, Beers list type stuff?
```
First-generation antihistamines and other anticholinergic drugs
alpha blockers
TCAs
sulfonylureas
muscle relaxants
```
230
Most common anal fissure location? Symptoms?
Posterior midline distal to the dentate line; Sharp pain and bright red rectal bleeding on defecation.
231
Common and uncommon sequelae of varicose veins?
Venous stasis ulcers are very common and often occur over the medial malleolus.
Superficial venous thrombosis (not DVT), rarely leads to thromboembolism
232
Why is prolonged QT interval a problem? Clinical signs?
Leads to ventricular arrythmias and torsades de pointes. Can present as syncope, seizures, or sudden cardiac death.
233
Cause of congenital long QT syndrome?
Mutations in a K+ channel protein contributing to the outward-rectifying potassium current.
234
What signal molecule attracts neutrophils? Source?
Leukotriene B4. Derived from phospholipid membrane --> arachidonic acid --> lipoxygenase pathway.
235
Role of Leukotriene B4?
Chemotaxis (pro-inflammatory)
236
Role of LTC4, LTD4, and LTED4?
Vasoconstriction, increase vascular permeability, bronchospasm (pro-inflammatory)
237
Role of Lipoxin A4 and Lipoxin B4?
Decrease leukocyte recruitment (anti-inflammatory)
238
What is a glomus body?
Glomus bodies are numerous small, encapsulated neurovascular organs found in the dermis of the nail bed, the pads of the fingers and toes, and the ears. Each glomus body is composed of an afferent arteriole connected to a richly innervated, muscular arteriovenous anastomosis, which is then connected to an efferent vein, surrounded by modified smooth muscle cells.
239
Role of the glomus body?
Thermoregulation -- shunts blood away from the skin surface in cold temperatures in order to prevent heat loss, direct blood flow to the skin surface in hot environments.
240
Mechanism of holoprosencephaly? Time frame?
Incomplete division of the forebrain into two hemispheres. Normally occurs at 5 weeks gestation.
241
Newborn shows close set eyes, midline mass consistent with a proboscis?
Holoprosencephaly - failure of division of the forebrain and associated structures.
242
What cells types should stain positive for GFAP?
Astrocytes, oligodendrocytes, and ependymal cells. See these cell types in gliomas.
243
What cell type would stain positive for synaptophysin?
Presynaptic vesicles off neurons, neuroendocrine, and neuroectodermal cells.
244
Discuss host defense against superficial and systemic candida infection
Local defense against Candida is performed by T cells, whereas systemic infection is prevented by neutrophils. For this reason, localized candidiasis is common in patients who have HIV, but neutropenic individuals are more likely to have the systemic form of the disease.
245
Leukocyte adhesion deficiency cluster designation?
CD18 - necessary for formation of integrins.
246
Which glucose transporter type responds to insulin? Where is it located?
GLUT-4 - located on muscle cells and adipocytes. Increasing insulin concentration causes translocation of glut-4 to cell surface.
247
Which glucose transporters are constitutively active? Where are they located?
GLUT-1 --> erythrocytes and BBB
GLUT-2 --> hepatocytes
GLUT-3 --> placental and neuronal glucose transport
GLUT-5 --> fructose transporter on spermatocytes
248
Describe what happens to circulating immune complexes in SLE.
The complexes deposit in various organs (kidneys) and trigger complement activation. For instance, active SLE is characterized by consumption of complement with reduced serum complement levels.
249
nitroglycerin or nitroprusside MoA?
breakdown to nitric oxide, which activates guanylate cyclase in smooth muscle to convert GTP to cGMP --> acts to decrease intracellular calcium --> decreased activity of myosin light-chain kinase --> dephosphorylation of myosin light chain leading to smooth muscle relaxation. Reduce afterload.
250
Which artery would be implicated in a fracture of the pterion?
Middle meningeal artery - epidural hematoma
251
Mucicarmine stain shows big red balloons?
Cryptococcus neoformans, probably from a bronchoalveolar lavage
252
Medication that can rapidly lower triglycerides? MoA?
Fibrates - activate peroxisome proliferator-activated receptor alpha (PPAR-alpha) which increases lipoprotein lipase activity.
253
Obese patient has abdominal pain and vomiting, no other particular history, PE notable for epigastric tenderness?
Acute pancreatitis brought on by severe hypertriglyceridemia.
254
Milrinone MoA?
PDE-3 inhibitor, reduces rate of cAMP degradation in cardiac tissues, promoting increased levels of calcium influx into cardiac myocytes --> positive inotrope
255
Good medication for treatment-resistant schizophrenia?
Clozapine - affinity for multiple dopamine and serotonin receptors.
256
Side-effect of potassium sparing diuretics?
Decrease in hydrogen ion secretion from the collecting tubules
257
Hormone responsible for gall bladder contraction? Produced where?
Cholecystokinin (CCK) - produced by the I cells of the duodenum and jejunum when fat-protein-rich chyme enters the duodenum.
258
First action by TB upon infecting a new individual?
Aerosolized secretions (i.e., cough spray) deposit organisms in the alveoli of lower lung fields. These organisms are engulfed by alveolar macrophages that allow for intracellular bacterial proliferation.
259
Peripheral blood smear shows very large (compared to RBCs) nucleated cells with scant cytoplasm? What should you look for in those cells?
Blast cells, suggestive of acute leukemia. Look for Auer rods, diagnostic for AML.
260
newborn presents with floppy legs, absent ankle reflexes, lumbar spine/sacral anamoly?
Caudal regression syndrome (1:60,000 live births), associated with maternal diabetes
261
How does insulin suppress glucagon?
acts directly on alpha cells to inhibit release
262
Insulin released by? Why? Simultaneous effect on alpha cells?
Beta cells - decreased serum glucose inhibits insulin release and enhances glucagon release; However, increased [glucose] stimulates insulin release while having no effect on glucagon release.
263
Murmur of aortic stenosis sounds like?
Ejection or midsystolic murmur of crescendo-decrescendo configuration with maximum intensity over the right second intercostal space, radiating to neck and carotid arteries. Represents degenerative calcification of the aortic valve leaflets.
264
Medication that might help prevent the adenoma-to-carcinoma sequence in the setting of colon cancer?
Aspirin - COX-2 inhibitor - mechanism not well-understood
265
Deletion or insertion of 1 or 2 nucleotides results in what type of mutation?
Frameshift - any non-multiple of 3 will result in a frameshift mutation.
266
Side effect of Linezolid to watch out for? Other SE?
Linezolid is used to treat infection caused by gram-positive bacteria, particularly cancomycin-resistant enterococcus and methicillin-resistant S. aureus. Linezolid has MAOI activity and therefore can precipitate serotonin syndrome when used concomitantly with an SSRI.
Also can cause optic neuropathy, peripheral glove-and-stocking neuropathy, and thrombocytopenia.
267
Explain the pathway by which intracellular pathogens are expressed at the cell surface
The ubiquitin proteasome pathway is essential for breakdown of intracellular proteins, both native and foreign, and helps recycle them into amino acid building blocks. In the immune response, proteins are degraded and then coupled to MHC I in the ER before presentation on the cell surface for recognition by cytotoxic CDC8+ T lymphocytes.
268
S1 heart sound is obscured by whumping noise or something similar - like fdu-lub-dub, fdu-lub-dub?
That's an S4 heart sound, due to decrease in left ventricular compliance. Not too unusual in an older adult, always pathologic in younger patients. May be due to left ventricular hypertrophy or restrictive cardiomyopathy.
269
Heart sound has a mid-systolic click and mid- to late-systolic rumble?
Mitral valve prolapse.
270
CMV treatment?
Gancyclovir
271
Name three hormones or signaling compounds derived from proopiomelanocortin (POMC)?
ACTH, MSH, and beta-endorphin.
272
ACTH, MSH, and beta-endorphin are all derived from?
Proopiomelanocortin (POMC)
273
PCOS adrenal enzyme association?
Increased activity of 17-alpha-hydroxylase and 3-beta-hydroxysteroid dehydrogenase --> more testosterone and cortisol, less aldosterone
274
Long-term risk associated with PCOS?
Endometrial hyperplasia and adenocarcinoma; anovulatory cycles result in fertility difficulties.
275
Episodic loss of motor tone triggered by emotion and inability to move on awakening suggest?
Narcolepsy. Also excessive daytime sleepiness, but they might not mention that in a case presentation.
276
What is cataplexy?
episodic loss of motor tone triggered by emotion
277
What is sleep paralysis?
inability to move on awakening
278
Narcolepsy most often caused by?
lack of 2 related neuropeptides
- hypocretin-1 (orexin-A)
- hypocretin-2 (orexin-B)
279
Where are hypocretin 1 and 2 made? Function? Where would you detect these compounds?
produced only in neurons located in the lateral hypothalamus - promote wakefulness and inhibit REM sleep-related phenomena. CSF only, no blood or peripheral tissue.
280
Transitional cell carcinoma of the bladder seen in patients exposed to?
cigarette smoke, occupational exposure to rubber, plastics, aromatic amine-containing dyes, textiles, or leather. Men more than women, and older.
281
Patient had herpes symptoms recently, now has a skin rash that looks like a bunch of round red circles with a dusky center? Etiology?
Erythema multiforme - acute inflammatory disorder that can involve the skin of the extremities, face, trunk, and neck. Papules look like target pattern, red on the outside, "dusky" in the middle. Cell-mediated immune process predominated by CD8+ lymphocytes - probably a systemic overreponse to local infection.
282
Location of intercostal vein, artery, and nerve? Procedural consideration?
All three lie in the subcostal groove on the lower border of the rib. Therefore, thoracentesis should be performed just above the upper border of the rib to prevent injury to these structures.
283
Direct thrombin inhibitors? What will be prolonged?
Argatroban, Bivalirudin, Dabigatran
| PT/aPTT normal, TT will be prolonged (thrombin time, I'd never neard of this before)
284
What does study "power" indicate?
The power of a study indicates the probability of seeing a difference when there is one.
285
What is "beta" in a study?
Beta is the type II error, the probability of concluding there is no difference between groups when one truly exists.
286
What is the relationship between study power and study beta?
Power = 1 - beta
287
Pathogenesis of smoking-related centriacinar emphysema? Similar process related to genetic issue?
Remember that cigarette smoke is chemotactic fro neutrophils. Neutrophils and macrophages release proteinases, especially elastase, which degrades the extracellular matrix. Similar to alpha-1-antitrypsin deficiency seen in panacinar emphysema, but self-inflicted!
288
Where would you find monoamine oxidase?
Mitochondrial enzyme
289
Tell me about tyramine?
Tyramine is an indirect sympathomimetic that is usually metabolized in the gi tract by monoamine oxidase. Someone on an MAOI will enter hypertensive crisis after eating certain aged cheeses, cured meats, and draft beers due to the tyramine in those products.
290
von Willebrand disease clinical symptoms, treatment, MoA?
In vWD, patient will have bleeding problem because platelets do not adhere properly to SEC, due to insufficient von Willebrand Factor. Also mild Hemophilia A b/c vWF stabilizes Factor VIII. Treat with desmopressin (DDAVP) which stimulates release of vWF from endothelial cells.
291
What happens to the therapeutic window for patients with Parkinson disease taking levodopa? Consequence?
The therapeutic window narrows over time. Thus, as serum drug levels fluctuate, they may exceed the therapeutic window (--> dyskinesia) or not reach the therapeutic window (--> bradykinesia, "off-periods"). Thus dosing can be unpredictable.
292
What happens if you take a "drug holiday" from levodopa?
Not effective in preventing motor fluctuations in PD, and also can cause condition similar to neuroleptic malignant syndrome.
293
Most important criteria for determining prognosis of tumor?
Stage (i.e., invasion - TNM staging). Advanced stage is more important than grade (i.e., "high-grade" verse "low-grade").
294
What determines tumor grade?
Tumor cell differentiation, degree of aneuploidy, and number of mitotic figures.
295
"Glomerular capillary wall thickening" is code for?
Membranous glomerulopathy - maybe this is describing "tram-track" appearance, but that description will never be in a question stem.
296
Pt has jaw pain, maybe even after an intubation. Examination shows firm swelling of postauricular area extending to angle of the mandible. Dx? Cause? Serum finding?
Parotitis, either acute viral or bacterial infection of the parotid gland. Bacterial cause is most often S. aureus or mixed oral aerobes/anaerobes. Serum testing will show elevated amylase with normal serum lipase, no evidence of pancreatitis.
297
Bronchoalveolar lavage identifies elastase. What are the cells of origin?
Macrophages in healthy individual (and neutrophils, if smoker)
298
What secretions balance elastase in the lungs?
alpha-1-antitrypsin and tissue inhibitors of metalloproteinases (TIMPs)
299
Describe club cells of the lung
Formerly known as "Clara" cells. Non-ciliated, found in the terminal portions of the bronchioles. Secrete "club cell secretory protein" (antioxidant) and surfactant components.
300
Describe goblet cells of the lung
Secrete mucin to help with mucociliary clearance
301
Major component of the surface area of alveoli?
Type I pneumocytes - end-differentiated squamous cells, don't really secrete anything
302
Describe Type II pneumocytes?
Secrete the major components of pulmonary surfactant (phospholipids and associated proteins). Small fraction of surface area, but lots of small, cuboidal cells. These are the stem cells of the lung, and serve to replenish Type I pneumocytes through division and differentiation.
303
Seizure patient switching to lamotrigine. Complication?
Up to 10% of patients using lamotrigine will develop benign rash; up to 1% will suffer Stevens-Johnson syndrome or toxic epidermal necrolysis
304
Anticonvulsants associated with SJS/TEN?
Carbamazepine, phenobarbital, phenytoin, lamotrigine - all can cause Stevens-Johnson syndrome or toxic epidermal necrolysis
305
Masculinization of a 46XX newborn with normal vital signs? Mother might show?
This is an aromatase deficiency, leading to testosterone excess. Not 21 hydroxylase, the vitals are normal so aldosterone is being made properly. Mom probably experienced hirsutism during pregnancy thanks to fetal hormones (testosterone) crossing he placenta.
306
Histological finding on autopsy of an AIDS patient with progressive dementia?
In a patient with HIV-associated dementia (not HSV or CMV encaphalitis), histopathologic finding is microglial nodules, groups of activated macrophages/microglial cells formed around small areas of necrosis that may fuse to form multinucleated giant cells.
307
When oxygen climbs aboard hemoglobin, what gets pushed off? Reverse process?
H+ and CO2. This happens in the lungs (Haldane effect). Reverse happens in peripheral tissues (Bohr effect).
308
Immune response to influenze directs antibodies against?
Hemagglutinin (not neurominadase) - keep the virus from getting into cells in the first place.
309
Name the two recombinant insulins without any amino acid modification
Regular insulin and NPH (neutral protamine Hagedorn)
310
Patient has yellow-orangish bumps around the eyes. What are they, and what is the most likely cause?
Xanthelasmas, a type of xanthoma - dermal accumulation of macrophages containing cholesterol and triglycerides. Indicate primary or secondary hyperlipidemia or dyslipidemia - usually due to an LDL receptor abnormality.
311
Agitated or delirious older adult may be medicated with? But not with?
Haloperidol or other high-potency first-generation antipsychotic. No benzos, as these can worsen confusional states.
312
Pathology of an abdominal aortic aneurysm?
Characterized by chronic transmural inflammation of the aortic wall - leads to degradation of elastin and collagen by proteases --> loss of elastin and smooth muscle cells --> abnormal collagen remodeling and cross-linking --> weakening --> aneurysm
313
Infertility patient (male) has gynecomastia and small, firm testes? Endocrine findings?
Klinefelter Syndrome (47, XXY) - Primary hypogonadism leads to elevated FSH and LH (no inhibin to give negative feedback), low testosterone
314
Diagnostic test of choice in a patient showing signs of cardiac tamponade?
Echocariography
315
Most common neoplasm of childhood? Second?
Leukemia, then brain tumors
316
Most common brain tumors in children (3)?
1) Pilcytic astrocytomas --> cerebellum, good prognosis
2) Medulloblastomas --> cerebellar vermis, malignant, poor prognosis
3) Ependymomas --> hydrocephalus presentation, tumor cells form gland-like structures called "rosettes"
317
Stop smoking drug that reduces nicotine cravings while reducing the pleasurable effects of cigarettes and other tobacco products?
Varenicline
318
Varenicline MoA?
Partial agonist and competitive inhibitor of the alpha-4-beta-2 nicotinic acetylcholine receptor. Provides relieve from cravings via partial activation of receptor, blocks reward via competitive binding to block full activation by nicotine.
319
Two pathways to induce extrinsic apoptosis?
tumor necrosis factor receptor 1 (TNFR1) binds tumor necrosis factor (TNF) (that's how the signal was named)
Fas ligand binds cell surface receptor Fas
320
Recent mom is tired and doesn't have milk coming in?
Sheehan Syndrome - during pregnancy, pituitary gland enlarges. In the setting of post-partum hemorrhage, hypotension, or other anemia, the pituitary undergoes ischemic necrosis, resulting in lack of pituitary hormones such as prolactin and oxytocin (mild production and let-down), and also hypothyroidism. But aren't all new parents tired?
321
Relevant anatomy of the femoral triangle?
Bounded by the inguinal ligament superiorly, the sartorius muscle laterally, and the adductor longus medially. From medial to lateral, through the femoral triangle passes the femoral vein, artery, and nerve (VAN). There are also deep inguinal nodes and lymphatioc vessels.
322
Gait instability and limb ataxia are symptoms of what type of problem?
Something with the cerebellum.
323
Treatment for overactive bladder syndrome?
Antagonism of muscarinic cholinergic M3 receptors.
324
The opening snap of mitral stenosis falls where?
Right at the beginning of diastole, as soon as atrial pressure exceeds ventricular pressure.
325
Random experiment identifies protein with radio-labeled DNA. What kind of protein is it?
To bind the radio-labeled DNA, the protein must be one of the proteins that endogenously can bind DNA. These would be members of the following categories: transcription factors, steroids, thyroid proteins, vitamin D receptors, retinoic acid receptors, DNA transcription and replication proteins, and "others".
326
Cornerstone of therapy for someone with persistent ashtma?
If albuterol isn't doing the trick (beta-2 adrenergic agonist), then move onto glucocorticoids like fluticasone. These have the strongest and most predictable effect on the inflammatory component of asthma, though with SE.
327
Reliability and precision in measurement?
Apparently, they mean the same thing. Reliability is not accuracy, but giving the same value with each measurement, regardless of accuracy of the measurement.
328
anemia with associated neurologic deficits on exam? Associated lab findings?
Suggestive of B12 deficiency. Since B12 is a cofactor for methylmalonyl-CoA mutase and methionine synthase, B12 deficiency consequently results in elevated levels of serum methylmalonic acid and homocysteine.
329
In looking at a diagram of the brachial plexus, name the 5 major nerves in order from C5 through T1 origination (not exactly anatomic, I know). Which one is the biggest?
```
Musculocutaneous
Axillary
Radial
Median (largest branch of the brachial plexus)
Ulnar
```
330
Fastest way to counteract excessive bleeding in a patient taking warfarin?
Fresh frozen plasma. Vitamin K may take too long to be effective.
331
Three stimuli for release of gastric acid in the stomach?
Vagal stimulation of M3 receptor
Gastrin stimulation of CCKB receptor
Histamine stimulation of H2 receptor
332
Omeprazole MoA?
Blocks K+/H+ ATPase proton pump at the gastric lumen
333
Cimetidine MoA?
Antagonize the H2 receptor, blocking stimulation by histamine.
334
Cells of the adrenal medulla will be stimulated by? Release what?
Stimulated by ACh from sympathetic preganglionic neurons (they're modified postganglionic sympathetic neurons, after all) that release catecholamines (80% epinephrine, 20% norepinephrine)
335
Two bones in the wrist most susceptible to injury, especially in FOOSH? Relative location? Important associations?
Scaphoid and lunate. Both are located at the end of the radius, with the scaphoid lateral and the lunate medial. With scaphoid injury, concern is for ischemic necrosis due to vulnerable blood supply. With lunate injury, displacement will impact the median nerve, leading to neuropathy.
336
Inheritance pattern of osteogenesis imperfecta?
Autosomal dominant
337
Picture shows blue sclera or presentation has history of easiy bone fracture. Primary impairment?
Osteogenesis imperfecta -- abnormality in type 1 collagen leads to deficient bone matrix formation.
338
Distinguish osteogenesis imperfecta from Vitamin D deficiency?
bone matrix formation problem (OI) versus defective mineralization of the bone matrix (vit D deficiency)
339
Mechanism of dilated cariomyopathy when using anthracyclines? Preventative therapy?
Daunorubicin, doxorubicin, etc. seem to cause problems via free radical formation by unbound iron. Can be prevented with dexrazoxane, an iron-chelating agent.
340
Patient has pulmonary symptoms, and you suspect either histoplasmosis or coccidioides. How can they be differentiated on histology?
Both will have little balls packed into bigger balls. If the bigger balls are bigger than the surrounding RBCs, then you are looking at Coccidioides endospores packed into spherules. If the bigger balls are smaller than RBCs, then you are looking at Histoplasmosis small yeast forms packed into macrophages.
341
Asthma patient using glucocorticoids also has eosinophilia, complains of episodic exacerbation?
This is a hypersensitivity reaction to aspergillus fumigatus, known as allergic bronchopulmonary aspergillosis - occurs in 5%-10% of corticosteroid-dependent asthmatics. Very high serum IgE levels, eosinophilia, and antibodies to Aspergillus will be found.
342
Source of blue dots in basophilic stippling (lead poisoning)?
Lead also inhibits erythrocyte 5' nucleotidase resulting in ribosomal aggregation of RNA.
343
Where would you find ringed sideroblasts, say in a question about lead poisoning?
Bone marrow aspirate, but not in peripheral blood smear (tricky, tricky...)
344
Woman with children presents due to shortness of breath, hemoptysis. Turns out she has really high beta-hCG levels. What's going on?
She probably is suffering from a gestational choriocarcinoma, which can arise after normal, abnormal, and molar pregnancies. This is a malignant tumor that arises from the trophoblast, invades the uterine wall, and spreads hematogenously. The lungs are the most common site of distal metastasis.
345
Discuss enhancer regions on genes. Opposite?
Enhancer sequences bind activator proteins that facilitate bending of DNA, and ultimately increase the rate of transcription. These sequences can be located upstream, downstream, or even in the introns of a given gene. Genes also may possess silencers to decrease the rate of transcription.
346
Where are promoter regions located?
Upstream of the relevant gene, either 25 or 75 bases away. Initiate transcription.
347
Prenatal testing shows markedly increased AFP levels?
Open neural tube and ventral wall defects, i.e., omphalocele, gastroschisis
348
Crap that cells ingest from the environment will be expressed on the cell surface via? Passes through?
MHC Class II - this is bacterial breakdown product, freely circulating antigenic material, etc. Probably went through a lysosome at some point, as opposed to endogenously produced proteins (whether normal, viral, tumor related) that are expressed on MHC Class I.
349
How does Zollinger-Ellison lead to diarrhea?
Excess gastric acid inactivates pancreatic and intestinal enzymes, interfering with normal digestion.
350
Patient has stable angina. How does sublingual nitroglycerin help?
Smooth muscle relaxant, mainly affecting venous circulation. Venodilation results in decreased preload --> decreased left ventricular end-diastolic volume and pressure
