Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
918 Cards in this Set
- Front
- Back
What is Staph. saprophyticus known for causing?
|
UTIs
|
|
Two most common drugs/classes used to treat UTIs?
|
TMP SMX, FQNs, can also use Nitrofurantoin for E. coli
|
|
Childhood rash, begins at head and moves down, postauricular lymphadenopathy. What is the disease?
|
Rubella (Togavirus)
|
|
Childhood rash, begins at head and moves down, preceded by cough, coryza, conjunctivitis, koplik spots. What is the disease?
|
Measles (paramyxovirus)
|
|
Can have rash, parotitis, meningitis (orchitis or oophoritis in young adults). What is the disease?
|
Mumps (paramyxovirus)
|
|
Erythematous, sandpaper-like rash, fever, sore throat. What is the disease?
|
Scarlet fever, caused by Strep. pyogenes
|
|
Vesicular rash on palms and soles, ulcers in oral mucosa. What is the disease?
|
Hand foot mouth disease, caused by Coxsackievirus Type A (Picornavirus)
|
|
Squamous cells with perinuclear cytoplasmic clearing.
1) What are they called? 2) When are they seen? |
1) Koilocytes
2) Seen in HPV |
|
Which type of hepatitis is sexually transmitted?
|
Hepatitis B, you can get it in BED!
|
|
What two forms does candida albicans take?
|
At 20 deg. C- pseudohyphae and budding yeasts
At 37 deg. C- germ tubes |
|
What is Fitz-Hugh Curtis syndrome?
|
Infection of the liver capsule and adhesions of parietal peritoneum to liver, secondary to PID
|
|
What bacteria would you suspect in a traumatic open wound infection?
|
C. perfringens
|
|
What bug would you suspect in a childhood infection if no other information given?
|
H. influenza
|
|
What bacteria would you suspect after a dog or cat BITE?
|
Pasteurella multocida
|
|
Which bacteria is identified by a positive PAS stain?
|
T. whippelii (Whipple's disease)
|
|
What is the histological finding in Whipple's disease?
|
PAS-positive macrophages in intestinal lamina propria & mesenteric LNs.
|
|
What does PAS stain actually stain?
|
Stains glycogen and mucopolysaccharides.
"PASs the sugar" |
|
Name the (4) urease positive bacteria.
|
Proteus, Klebsiella, H. pylori, Ureaplasma
"Particular Kinds Have Urease" |
|
What does elevated maternal AFP indicate?
|
Neural tube defects or abdominal wall defects (spina bifida, omphalocoele, etc.)
|
|
What is the DOC for cardiogenic shock and what is its mechanism of action?
|
1) Dobutamine is DOC
2) Mechanism of action is sympathomimmetic, stimulates beta 1 receptors |
|
What is the DOC for anaphylactic shock?
|
epinephrine
|
|
What is the DOC for septic shock?
|
Norepinephrine (have alpha 1 actions with alpha beta 1)?
|
|
Which two antibiotics are used for narrow spectrum anaerobic coverage?
|
metronidazole or clindamycin
|
|
What is mydriasis?
|
mydrIasis is dIlation of the pupil.
|
|
Describe the difference between displacement and projection.
|
Displacement- your feelings are transferred to a neutral person/object (like yelling at your sig. other when you mess something up)
Projection- your feelings are directed purposefully at an external source (eg man who wants to cheat who suspects his wife of cheating or closet homosexual hates homosexuals) |
|
Describe the defense mechanism identification.
|
Identifying with someone who is more powerful (child who is abused becoming an abuser)
|
|
What is the difference between rationalization and anticipation?
|
Rationalization is using a logical reason to describe why you did something that wasn't your true reason for doing it. Anticipation is planning realistically for future discomfort.
|
|
What is reaction formation?
|
Reaction formation is when a warded off feeling is replaced by an unconscious desire for the opposite. (E.g. someone with overwhelming sexual desires decides to be a monk)
|
|
What is the difference between repression and suppression?
|
Repression is when you CAN'T remember something painful, Suppression is when you purposely withhold an idea or feeling from consciousness.
"Suppression has two Ps and so does PurPose". You are withholding on purpose. |
|
What is anaclitic depression?
|
depression in an infant attributable to continued separation from caregiver.
|
|
What can you give to an ADHD patient at night if they can't sleep?
|
Clonidine (alpha-2 agonist)- will decrease NE release.
|
|
What is the difference between fluoxetine and fomepizole?
|
Fluoxetine- SSRI
Fomepizole- inhibits alcohol dehydrogenase and is an antidote for methanol/ethylene glycol poisoning |
|
What neurotransmitter changes do you see in depression?
|
Dec. NE, Dec. 5HT, Dec. dopamine
|
|
What neurotransmitter changes do you see in anxiety?
|
Inc. NE, Dec. GABA, Dec. 5HT
|
|
What neurotransmitter change do you see in both Alzheimer's and Huntington's?
|
Decreased ACh
|
|
What two neurotransmitters are decreased in Huntington's disease?
|
GABA and ACh
|
|
What neurotransmitter changes are seen in schizophrenia?
|
Increased dopamine
|
|
What neurotransmitter changes are seen in Parkinson's disease?
|
Decreased dopamine, Increased serotonin, Increased ACh
|
|
What are the plaques and the tangles made of in Alzheimer's disease?
|
Plaques- Extracellular beta amyloid with neuronal fibers wrapped around them
Tangles- Intracellular, tau protein, abnormally phosphorylated |
|
Two differences between Alzheimer's and Pick's disease?
|
1) Alzheimer's has neurofibrillary tangles (hyperphosphorylated tau protein) and Pick's has "intracellular aggregated tau". In both cases, it accumulates in neurons.
2) Alzheimer's usually starts with memory loss, Pick's starts with personality change before memory loss |
|
What part of the brain does Pick's disease spare?
|
Parietal lobe and posterior 2/3 of superior temporal gyrus.
|
|
What is a Lewy body?
|
Abnormal aggregate of alpha-synuclein in a nerve cell
|
|
In what 3 diseases would you see Lewy bodies?
|
Parkinson's, Lewy Body dementia, and one type of Alzheimer's
|
|
Name the high potency neuroleptic (antipsychotic drugs). (2/3)
|
Haloperidol, trifluoperazine (possibly moderate), fluphenazine
|
|
Name the low potency neuroleptic drugs (2)
|
thioridazine, chlorpromazine
|
|
What is the difference between schizoaffective and schizophreniform disorder?
|
Schizoaffective- you have two weeks of just schizo symptoms with no mood disorder, but also sometimes have mania/depression
Schizophreniform- just like schizophrenia but greater than 1 month and less than 6. |
|
What are the two categories of antibiotics that shouldn't be taken with antacids?
|
Tetracyclines (VACUUM The BedRoom
Vibrio cholera, acne, uroplasma, urolytica, mycoplasma pneumonia, tularemia, H. pylori, Burelia burgdorferi, Rickettsia) & Fluoroquinolones Gram negative rods of urinary and GI tracts |
|
Which cancers would metastasize to Virchow's node?
|
stomach (probably most likely in question), mediastinal, neck
|
|
How long after eating before glycogen reserves are gone and gluconeogenesis takes over?
|
1 day, less if exercising (16-24 hours); another source said 12 hours.
|
|
Antibodies to centromeres are found in what illness?
|
CREST scleroderma
|
|
Antibodies to SS-A (Ro) and SS-B (La) are found in which illness?
|
Sjogren syndrome
|
|
Which is more common in the US, chlamydia or gonorrhea?
|
Chlamydia
Gonorrhea is GONE from the US :) |
|
Name the classes of drugs (5) that would cause galactorrhea as a side effect.
|
Typical Antipsychotics (haloperidol)
TCAs Dopamine depleting drugs (methyldopa, resperidone), opiates, and H2 blockers (cimetidine) |
|
What is the inheritence pattern of Bruton's agammaglobulinemia?
|
X-linked recessive
|
|
What is the most accurate molecule to estimate exact GFR?
|
Inulin
|
|
What molecule slightly over-estimates GFR?
|
Creatine
|
|
What is phenylephrine and what are its effects?
|
It's an alpha agonist, alpha1 > alpha2. It causes pupillary dilation, vasoconstriction, and nasal decongestion (because of smooth muscle contraction)
|
|
What virus is associated with polyarteritis nodosa?
|
Hepatitis B (in 30% of patients)
|
|
What is the mechanism of Reye's syndrome?
|
Aspirin metabolites inhibit beta oxidation by reversible inhibition of mitochondrial enzymes --> fatty liver and liver failure --> hypoglycemia and hyperammonemia bc urea cycle happens in the liver
|
|
If you see FASICULATIONS, think...
|
Lower Motor Neuron
|
|
Drugs/categories that can cause SIADH (6)
|
TCAs, SSRIs, MAOIs, antipsychotics, carbamazepine (seizure/mood disorder) and anti-neoplastics
|
|
What psych disease is associated with Tourette's syndrome?
|
OCD
|
|
What is the difference between buspirone and buproprion?
|
Buspirone- 5-HT4 agonist that is used to treat generalized anxiety disorder, period.
Buproprion- increased dopamine and NE via unknown mechanism, used to treat depression and quit smoking |
|
What is the difference between bromocriptine and dobutamine?
|
Bromocriptine- dopamine agonist
Dobutamine- primarily beta 1 agonist, used to treat heart failure & cardiogenic shock |
|
What is naloxone/naltrexone and what are they used for? (2)
|
Opiod antagonist
1) Used for acute opioid OD 2) Used to treat alcoholism (when person is NOT drinking and desires not to start again) |
|
How does suboxone work? (combo of naloxone & buprenorphine)
|
buprenorphine is an opioid which is what the patient wants. If they take it orally, the naloxone is inactive so they get the opioid effects. If they try to inject it, the naloxone (opioid antagonist) is active so the patient doesn't get the benefit of the buprenorphine
|
|
What is miosis?
|
Pinpoint pupil
Remember because "i" looks like a pinpoint and the "o" is like an eye and comes right after. |
|
What is the difference between Wernicke and Korsakoff?
|
Wernicke- classic triad of confusion, ophlamoplegia (paralysis of one or more extraoccular muscles), and ataxia
Wernicke's can PROGRESS to Korsakoff psychosis which is irreversible memory loss, confabulation, personality change *Might want to think "Korsakoff is Konfabulation" |
|
Wernicke-Korsakoff syndrome is associated with what sort of pathological brain damage?
|
Periventricular hemorrhage & necrosis of the mammillary bodies
|
|
How do you calculate standard error of the mean?
|
Standard deviation/ (sq. root of sample size)
|
|
What's the difference between t-test, ANOVA, and chi-squared?
|
t-test compares TWO means,
ANOVA compares more than two means, chi-squared compares categorical outcomes (like black/white/hispanic) |
|
What kind of virus is each type of hepatitis?
|
A- Picorna (RNA)
B- Hepadnavirus (DNA) C- Flavivirus (RNA) D- Deltavirus (RNA) E-HepEvirus (RNA) |
|
In a normal type of gaussian distribution, what percent of the population fall 1, 2, and 3 STDs from the mean?
|
1- 68%
2- 95% 3- 99.7% |
|
What are the 5 parts of the apgar score?
|
A- appearance
P- pulse G- grimace A- activity R- respiration |
|
Which drugs can be given to shorten stage 4 sleep? Why would they be given?
|
imipramine, benzodiazepines
Would be given for night terrors, bed-wetting |
|
What is the key to initiating sleep?
|
Serotonergic predominance in the raphe nucleus.
|
|
Describe the pathway that leads to melatonin release.
|
Retina detects darkness --> NE release from SCN (suprachiasmatic nucleus) --> signeals pineal gland which releases melatonin
|
|
In what disease would you see polyuria, acidosis, growth failure, and electrolye imbalances?
|
Fanconi Syndrome
|
|
Red urine in the morning
|
Paroxysmal Nocturnal hemoglobinurea
|
|
Which tumors would you see with von hippel lindau disease?
|
renal cell carcinoma, hemangioblastomas (brain/eyes), angiomatosis, pheochromocytoma
|
|
Retinal hemorrhages with pale centers? What are they called and what do they indicate?
|
Roth's spots, bacterial endocarditis
|
|
Situs inversus, chronic sinusitis, bronchiectasis, infertility. What is the disease?
|
Kartagener's syndrome
|
|
What is Kartagener's syndrome?
|
Dynein defect affecting cilia
|
|
Smooth, flat, moist white lesions on genitals might indicate what?
|
Condylomata lata (2ndary syphilis)
|
|
Name 4 enzymes that thiamine is a cofactor for.
|
Pyruvate dehydrogenase (pyruvate --> acetyl coA)
alpha ketoglutarate dehydrogenase (alphaketoglutarate --> succinyl coA) transketolase (HMP shunt, reverse part that makes ribose 5 phosphate) branched chain AA dehydrogenase (degrading branched chain AAs) |
|
Most common cause of meningitis in all adults
|
Strep. pneumo. Note that if scenario was college kid or military recruit, it would probably be N. meningitidis.
|
|
In order to prevent tetany, what part of the C. tetani bug do you have to create a response to?
|
The toxin, NOT the bacteria itself
|
|
What do pigmented gallstones look like?
What (risk factors) are they associated with? |
They look black and crumbly, have not very much cholesterol in them, and are radio-paque. They are made when there is too much unconjugated bilirubin around.
They are found mostly in chronic hemolysis but also alcoholic cirrhosis, advanced age, and biliary infection (like liver fluke) |
|
What do cholesterol gall stones look like?
What (risk factors) are they associated with? |
radiolucent, i'm guessing they look more like cholesterol
Can happen in obesity, crohn's disease, CF, advanced age, clofibrate, estrogens, multiparity, and rapid weight loss, and Native Americans |
|
How long after ischemic damage do you get loss of myocyte contractility?
How long does it take for irreversible damage? |
60 seconds
30 minutes |
|
How do you calculate attributable risk % when given relative risk?
|
RR-1/RR = attributable risk percent
|
|
Describe what the aortic baroreceptor reflex detects and the afferent/efferent limbs.
|
1) It detects INCREASED bp
2) Afferent- vagus nerve, efferent- vagus nerve |
|
Describe what the carotid baroreceptor reflex detects and the afferent/efferent limbs.
|
1) Detects increased and decreased BP
2) Afferent limb- glossopharyngeal, efferent limbs- vagus nerve *Think about it this way - you have TWO carotids, the carotid baroreceptor detects TWO things (inc. and dec. BP), and there are TWO nerves (glossopharyngeal and vagus) |
|
What is the difference between pO2 and O2 content (arterial)?
|
pO2 = dissolved O2
O2 content = dissolved O2 + O2 bound to Hgb |
|
What do all the apoproteins do?
A-1 B-48 B-100 C-II E 3/4 |
A-1- LCAT activation
B-48- chylomicron assembly/secretion by intestine B-100- LDL uptake by extrahepatic cells; Goljan says it's assembly and secretion of VLDL by liver. Both B100 & VLDL have 4 letters. Apo C-II- LPL activation Apo E 3/4- VLDL/chylomicron remnant uptake by liver |
|
Describe central pontine myelinosis aka osmotic demyelination syndrome.
|
When you rapidly correct hyponateremia, water rushes out of cells, leading to demyelination of axons in the basis pontis.
|
|
What are the symptoms of central pontine myelinosis?
What is the radiographic finding in this disease? |
Acute paralysis, dysarthria (can't talk), dysphagia (can't swallow), and diplopia (double vision), LOC
You will see abnormal increased signal in the PONS on T1 weighted MRI |
|
How does liver use TG breakdown to form glucose?
|
First off, remember that TGs break into FA + Glycerol. Liver can't use fatty acids to make glucose (except odd chain which are rare), but it CAN use glycerol:
Glycerol --> glycerol 3 phosphate (glycerol kinase) --> DHAP --> gluconeogenesis |
|
What is the mechanism of action of amphotericin B and why does it have such bad side effects?
|
MOA- binds ergosterol (sterol in fungal cell walls) and makes a hole
Why so bad in humans? Bc it can also bind cholesterol --> side effects like fever/chills, hypotension, nephrotoxicity, arrhythmias, anemia |
|
What drug is used specifically to treat the ophthalmopathy associated with graves' disease?
|
glucocorticoids
|
|
Draw out the tryptophan metabolite pathways.
|
*Hint: "Who tripped before sara? meredith" and "fan peered in"
p. 107 FA |
|
isosorbide dinitrate is what kind of drug?
Name two main side effects. |
- it's a nitrate
- flushing and headache due to vasodilation |
|
What is transference?
|
When you see in someone (say, your therapist) characteristics of someone else (say, your father), so you start to treat your therapist like your father.
|
|
What enzyme are you missing in chronic granulomatous disease?
What does that enzyme normally do? What test will be negative? What bugs (class) are you susceptible to and why? |
1) NADPH oxidase
2) Normally turns O2 into a reactive oxygen species so it can kill bacteria 3) Nitroblue tetrazolium dye reduction test 4) Susceptible to catalase positive bugs because a person with CGD can still use H2O2 (made by bacteria) to hurt bacteria, but catalase positive bacteria can neutralize their own H2O2 so humans can't hurt them |
|
Androgen --> estradiol in egg
Where does it occur? What enzyme catalyzes? Hormone that up-regulates it? |
1) In granulosa cells
2) Aromatase 3) FSH |
|
Describe the features of cauda equina syndrome.
|
saddle anesthesia, loss of anocutaneous reflex (poke anus & sphincter contracts), associated with S2-S4 nerve roots.
|
|
What hormone changes are seen in Addison's disease?
|
Decrease in cortisol and aldosterone
|
|
What 5 classes of medications are used to treat glaucoma?
|
alpha agonist, beta blockers, certain diuretics like carbonic anhydrase inhibitors & mannitol, cholinomimetic drugs, prostaglandins
|
|
What is the difference between ash leaf spots and cafe au lait spots? What diseases are they associated with?
|
Ash leaf- lighter spot, cafe au lait-darker spot
Ash leaf assoc. with tuberous sclerosis, cafe au lait assoc. with neurofibromatosis type I |
|
What types of cancer are associated with tuberous sclerosis?
|
- renal cysts and renal angiomyolipomas, cardiac rhabdomyomas, and astrocytomas
|
|
What is achalasia? What is it due to? How do you diagnose it?
|
- lower esophageal sphincter unable to relax
- due to loss of auerbach's plexus - diagnose with a barium swallow |
|
What is the difference between Wegener's granulomatosis and Goodpasture's syndrome (mechanism)?
|
Goodpasture's syndrome = anti-gbm antibodies on immunofluorescence
Wegener's syndrome = ANCA antibodies (c-ANCA), vasculitis *Both can have lung and kidney manifestations, Wegener's involves the upper airway w/ sinusitis and stuff |
|
Which glomerulonephritis has a tram track appearance on electron microscopy? Which has wire loop on LM?
|
Membranoproliferative GN has tram track
Lupus has wire loop (LUPus has wire LOOP) |
|
What are the uses for metronidazole?
|
GET GAP on the METRO
Giardia, entamoeba, trichomonas Gardinerella vaginalis, anaerobes, H. Pylori |
|
What are the two most common complications after and MI?
|
1) cardiac arrhythmias
2) Left. ventricular failure --> right ventricular failure |
|
What is the WAGR complex?
|
Mnemonic for things you can see with a Wilms' tumor (renal tumor, most common tumor of early childhood).
W- wilms A- anorida (lack of iris) G- genitourinary malformation R- retardation (mental/motor) |
|
What is Km
|
It's the amount of substrate required to reach 1/2 Vmax for a reaction.
|
|
On a lineweaver burke plot, what is on the x axis, the y axis, and the slope?
How about the x intercept and y intercept? |
x axis is 1/[s], y axis is 1/velocity, and slope is km/vmax.
X intercept = -1/km, y intercept= 1/vmax |
|
Describe what would change on a lineweaver burke plot in presence of a competitive inhibitor? non-competitive inhibitor?
|
Competitive inhibitor will keep Vmax the same but will increase Km
Non-competitive inhibitor will keep Km the same but will decrease Vmax |
|
Write out the 4 pharm eqs that are need to know.
|
1) Vd= drug given (IV) / drug measured (plasma drug [ ])
2) CL = (.7 x Vd) / half life 3) LD = Css x Vd 4) MD = Css x CL |
|
How much drug (%) is left after 4 half lives?
|
93.75%
|
|
What is the difference between 0 order and first order elimination?
|
zero order- no matter how much there is in the body, it gets eliminated at the same rate
first order- the more there is in the body, the faster it gets eliminated |
|
Name three drugs that follow zero order kinetics for elimination.
|
Phenytoin, aspirin, ethanol
|
|
Name three acidic drugs and describe what you would give to treat an OD.
|
aspirin (salycylATE), methotrexATE, phenobarbitol
Would give NaHCO3 to force the acidic drug to be in it's charged (dissociated) form and get trapped in urine. |
|
Name one basic drug and describe what you would give to treat an OD.
|
AmphetaMINES.
Would give NH4Cl to force drug to be in its protonated (NON-dissociated) form. |
|
Phase I vs. Phase II metabolism.
When does cytochrome p450 work? When does conjugation occur? Which phase is lost first in geriatric patients? |
- Phase I = cytochrome p450
- Phase II = conjugation - Phase I = lost first in geriatric patients |
|
Name some drugs that have a low therapeutic index (4).
|
Lithium, warfarin, phenobarbitol, digoxin
Also pheytoin, gentamycin, 5FU, and AZT |
|
Which part of the autonomic nervous system controls erection? ejaculation?
|
Think "Point and Shoot"
Parasympathetic controls erection, Sympathetic controls ejaculation |
|
What other pathology is myasthenia gravis associated with (4 things)?
|
50% have thymic hyperplasia, 20% have thymic atrophy, 15% have thymoma, not sure the % but can also be associated with bronchogenic carcinoma
|
|
What is cycloplegia? What can cause it?
|
Paralysis of the ciliary muscle of the eye --> loss of accommodation
Can be caused by muscarinic antagonism |
|
What type of receptors are nicotinic AcH receptors? Muscarinic?
|
Nicotinic- Na/K channels, ligand gated
Muscarinic- G-protein coupled receptors that act through second messengers |
|
Describe (in general) the products of phase I metabolism.
What types of reactions occur in phase I? |
1) Generally slightly polar and slightly more water soluble.
2) Reduction, oxidation, hydrolysis |
|
Describe (in general) the products of phase II metabolism.
What types of reactions occur in phase II? |
1) Generally very polar and no longer active.
2) Acylation, glucuronydation, and sulfation |
|
What do you use to prophylax close contacts for N. meningitidis?
|
Rifampin
|
|
What is the difference between Li Fraumini Syndrome and Von Hippel Lindau Syndrome? (cause & presentation)
|
Li Fraumini- caused by germline mutation of p53 tumor suppressor gene. Associated with breast cancer, brain tumors, acute leukemia, sarcomas (soft tissue & bone)
Von Hippel Lindau- caused by mutation tumor suppressor gene (VHL) on chromosome 3. Presentation is: cavernous hemangiomas in skin, mucosa, and organs. Bilateral renal cell carcinoma. Hemangioblastoma in retina, brain stem, cerebellum. Pheochromocytomas. Autosomal dominant. |
|
To which LNs do the following drain?
1) Stomach 2) Duodenum, jejunum 3) Sigmoid colon |
1) Celiac nodes
2) Superior mesenteric 3) Colic --> inferior mesenteric |
|
To which LNs do the following drain?
1) Rectum (above pectinate line) 2) Anal canal (below pectinate line) 3) Testes |
1) Internal iliac
2) Superficial inguinal 3) para-aortic |
|
To which LNs do the following drain?
1) Scrotum 2) Thigh (superficial) 3) Lateral side of dorsum of foot |
1) Superficial inguinal
2) Superficial inguinal 3) Popliteal |
|
Which parts of the body does the right lymphatic duct drain?
|
Right arm and right half of head
|
|
Which three cytokines enhance the activity of NK cells?
|
IL-12, IFNbeta and IFNalpha
|
|
What's the name of the more old-fashioned test for paroxysmal hemoglobinuria and what is the test?
|
- Ham's test
- When red blood cells lyse at a very low pH |
|
After which exposures would you give pre-formed Ab?
|
tetanus, rabies, HBV, botulinum, also RSV (premature babies)
"To Be Healed Rapidly" |
|
What's the difference between bullous pemphigoig and pemphigous vulgaris?
|
Bullous pemphigoid- antibodies against hemidesmosomes;
Integrins are involved (FA p. 370) Pemphigus vulgaris- antibodies against desmosomes cadherins connect intermediate filaments (keratin/desmoplakin) |
|
What three antibodies are associated with SLE?
|
Anti-ANA, Anti-dsDNA, Anti-Smith
|
|
Which antibody is associated with drug-induced lupus?
|
Anti-histone
|
|
Which antibody is associated with rheumatoid arthritis?
|
Anti-IgG (Rheumatoid Factor)
|
|
Which antibody is associated with CREST scleroderma?
|
Anti-centromere
|
|
Which antibody is associated with diffuse scleroderma?
|
Anti-Scl-70 (aka anti-DNA topoisomerase I)
|
|
Which antibody is associated with primary biliary cirrhosis?
|
Antimitochondrial
|
|
Which antibodies are associated with Hashimoto's thyroiditis?
|
Antimicrosomal (anti-thyroid peroxidase), Anti-thyroglobulin
|
|
Which antibody is associated with polymyositis/dermatomyositis?
|
Anti-Jo-1
|
|
Which antibodies are associated with both SLE and Sjogren's syndrome?
|
Anti-SS-A (Anti-Ro) and Anti-SS-B (Anti-La)
|
|
Anti-U1 RNP (ribonucleoprotein) antibody is associated with which disease?
|
mixed connective tissue disease
|
|
Which disease is anti-smooth muscle antibody associated with?
|
Autoimmune hepatitis
|
|
Which disease is anti-glutamate decarboxylase antibody associated with?
|
Type 1 diabetes mellitus
|
|
Which disease is c-ANCA associated with?
|
Wegener's granulomatosis
|
|
Which antibody is Churg-Strauss/Microscopic polyangiitis associated with?
|
p-ANCA
|
|
Which disease is mpo-ANCA associated with?
|
Pauciimmune crescentic glumerulonephritis
|
|
What is the only disease that Goljan says ESR is useful in diagnosing?
|
Temporal arteritis
|
|
Name the disease and symptoms:
Defect in BTK gene blocks B cell differentiation/maturation. |
Bruton's agammaglobulinemia
Recurrent bacterial infections after 6 months, will see low Ig of all classes and no circulating B cells. |
|
Name the disease and signs/symptoms:
Defective CD40L on helper T cells --> inability to class switch |
Hyper-IgM Syndrome
Severe pyogenic infections early in life. |
|
Name the disease and signs/symptoms:
Defective isotype switching --> deficiency in a certain class of Igs |
Most commonly it's Selective IgA deficiency
Would see decreased secretory IgA, sinus & lung infections, milk allergies & diarrhea, and anaphylaxis if you give them blood products containing IgA |
|
Name the disease and signs/symptoms:
Defect in B-cell maturation due to various causes |
Common variable immunodeficiency
Onset in late teens/early twenties, have B cells in peripheral blood but decreased Ig/plasma cells, have increased risk of autoimmune disease, lymphoma, sinopulmonary infections, and GI infections. |
|
Name the disease and signs/symptoms:
22q11 deletion (usually) |
Thymic aplasia (DiGeorge Syndrome)
Symptoms: Facial abnormalities, hypoparathyroidism --> hypocalcemia --> tetany, cardiac malformations, depression of T cell numbers, recurrent viral/fungal infections |
|
Name the disease and signs/symptoms:
Decreased TH1 and NK cells |
Disease- IL12 receptor deficiency
Symptoms- disseminated mycobacterial infections (TB, leprosy), decreased IFN gamma. |
|
Name the disease and signs/symptoms:
Th cells fail to produce IFN gamma so neutrophils can't respond to chemotactic stimuli |
Disease- Hyper IgE (aka Job's) syndrome'
Signs/Symptoms- Coarse facies, cold (neutrophils can't get there) staph. abscesses, retained primary teeth, increased IgE, dermatologic problems (eczema) |
|
T cell dysfunction with candida albicans infections of skin and mucous membranes is called?
|
Chronic mucocutaneous candidiasis
|
|
Name the two mutations associated with SCID that we learned.
|
IL2 receptor (most common), and adenosine deaminase deficiency
|
|
What are the symptoms of SCID?
|
Recurrent viral, bacterial, fungal, and protozoal infections
|
|
Defect in either "kinase involved in cell cycle" or "DNA repair enzymes" --> IgA, IgE deficiency. What is the disease and symptoms?
|
The disease is ataxia-telangiectsia
The symptoms are: cerebellar defects (ataxia), spider angiomas (telangiectsia), and IgA deficiency |
|
Name the disease and signs/symptoms:
Progressive deletion of B & T cells |
Disease- Wiskott-Aldrich syndrome
Symptoms: Thrombocytopenic purpura, Infection, Eczema (notice in this one you have eczema so you can remember increased IgE), also increased IgA but decreased IgM |
|
Name the disease and signs/symptoms:
Defect in LFA-1 integrin (CD18) protein on phagocytes |
Disease- leukocyte adhesion deficiency (type 1)
Symptoms- recurrent bacterial infections, absent pus formation, delayed separation of umbilicus, neutrophilia |
|
Name the disease and signs/symptoms:
Defect in microtubular function that make it so lysosome can't fuse with phagosome |
Disease- Chediak-Higashi syndrome
Signs/Sx- Recurrent pyogenic infection by staph & strep, partial albinism, peripheral neuropathy (or other neuro problems), giant inclusion bodies in leukocyte precurser cells |
|
Name the disease and signs/symptoms:
Lack of NADPH oxidase --> decreased ROS and respiratory burst |
Disease- Chronic granulomatous disease
Signs/Sx: Increase susceptibility to catalase positive organisms such as S. aureus, E.coli, Aspergillus, candida, klebsiella |
|
Which organisms are catalase +/-?
|
Basically all aerobic bacteria are catalase positive except for strep and the enterococci.
|
|
What is the normal relationship between the pulmonary artery and the aorta (physical)?
|
The pulmonary artery is anterior and to the left of the aorta.
|
|
Transposition of the great vessels is due a failure of what embryonic process?
|
Septation
|
|
What chromosome is VHL mutation located on?
|
Chromosome 3 (can remember bc Von Hippel Lindau has three words)
|
|
What hematologic finding would you expect in an alcoholic?
|
Increased MCV (macrocytosis) - can be increased even without thiamine deficiency
|
|
What is the mechanism of action of nitroprusside?
|
Balanced arterial and venous vasodilator, so it decreases both preload and afterload. Increases cGMP leading to increased NO.
|
|
For how many hours after an MI will you see no histological change?
|
4 hours
|
|
What type of proteins are the myc proteins?
|
Mammalian transcription factors (DNA binding)
C-myc is over-expressed in burkitt lymphoma |
|
What types of infections are asplenic patients at risk of?
|
Encapsulated bacteria-
Salmonella, Klebsiella, H. flu, Neisseria meningitidis, Strep. pneumo, Group B Strep. |
|
What kind of agar does H. flu need to be grown on?
|
Chocolate agar with factors V (NAD+) and X (hematin).
|
|
What is the treatment for gonorrhea?
|
Ceftriaxone (for the gonorrhea) + azithromycin for the chlamydia the person also probably has.
|
|
Name the three anti-TNF antibodies and which one is a receptor mimic?
|
Etanercept, Infliximab, Abalimumab
Etanercept is the receptor mimic |
|
What are the clinical effects of the following?
- missing C1 esterase - missing C3 - missing C5-C8 - missing DAF (CD55-59) |
-missing C1 esterase- hereditary angioedema and increased bradykinin
- missing C3- severe, recurrent pyogenic sinus and respiratory tract infections, inc. susceptibility to type III hypersensitivity - missing C5-C8- Neisseria bacteremia infections - missing DAF - paroxysmal nocturnal hemoglobinuria |
|
What is erythema chronica migrans?
|
The bullseye rash in lyme disease.
|
|
What are the proteins (on leukocyte and on vasculature) that mediate rolling?
|
Leukocyte- sialyl lewis x
Vasculature- E-selectin, P-selectin |
|
What are the proteins (on leukocyte and on vasculature) that mediate tight binding?
|
Leukocyte- LFA-1 (integrin)
Vasculature- ICAM-1 |
|
What proteins on leukocyte and on vasculature mediate diapedesis?
|
PECAM-1 on both.
|
|
What cytokine, released from macrophages, leads to granuloma formation?
|
TNF-alpha
|
|
In what three cases would you see a decreased ESR?
|
Sickle cell (altered shape), polycythemia (too many), CHF (don't know why)
|
|
How does iron poisoning cause death?
|
Peroxidation of lipid membranes.
|
|
What are the symptoms of acute and chronic iron poisoning?
|
Acute- gastric bleeding
Chronic- metabolic acidosis, scarring leading to GI obstruction |
|
Name the type of amyloid and what it is derived from in the following disease:
Primary amyloidosis |
AL, Ig light chains (this is seen in multiple myeloma)
"L" for Light chain |
|
Name the type of amyloid and what it is derived from in the following disease:
Secondary amyloidosis |
AA, serum amyloid associated proteins (SAA)- present in chronic inflammatory disease
Think "A" for acute phase reactants |
|
Name the type of amyloid and what it is derived from in the following disease:
Senile cardiac amyloidosis |
AF, Transthyretin
Think "F" for old fogies. |
|
Name the type of amyloid and what it is derived from in the following disease:
Diabetes mellitus type II |
AE, Amylin
Think "E" for endocrine |
|
Name the type of amyloid and what it is derived from in the following disease:
Medullary Carcinoma of the thyroid |
A-CAL, Calcitonin
Calcitonin is made in the thyroid (parafollicular cells) |
|
Name the type of amyloid and the protein it is derived from in Alzheimer's
|
beta-amyloid, derived from APP (amyloid precurser protein)
|
|
Name the type of amyloid and the protein it is derived from in Dialysis associated amyloidosis
|
beta2 microglobulin, derived from MHC class I proteins
|
|
What is the difference between hyperplasia and hypertrophy?
|
Hypertrophy- increase in size of cells
Hyperplasia- increase in number of cells |
|
Which skin cancer is xeroderma pigmentosum and albinism most especially associated with?
|
squamous cell carcinoma of skin
|
|
What condition is associated with squamous cell carcinoma of the esophagus vs. esophageal adenocarcinoma?
|
Squamous- Plummer vinson syndrome
Adeno- Barrett's esophagus |
|
What malignancies are associated with Paget's disease of bone?
|
Secondary osteosarcoma and fibrosarcoma
|
|
Which cancers are associated with acanthosis nigricans?
|
Visceral malignancies (stomach, lung, breast, uterus)
|
|
Which cancers are associated with radiation exposure?
|
Sarcomas & papillary thyroid cancer.
|
|
Name the associated cancer & gene product:
abl |
Cancer- CML
Gene product- tyrosine kinase |
|
Name the associated cancer and gene product:
c-myc |
Cancer- Burkitt's lymphoma
Gene product- Transcription factor |
|
Name the associated cancer & gene product:
bcl-2 |
Cancer- Follicular and undifferentiated lymphomas
Gene production- "anti-apoptotic molecule" |
|
Name the associated cancer & gene product:
erb-B2 |
Breast, ovarian, and gastric carcinomas
Tyrosine kinase |
|
Name the associated cancer & gene product:
ras |
Colon carcinoma
GTPase |
|
Name the associated cancer & gene product:
L-myc |
Lung tumor
Transcription factor |
|
Name the associated cancer & gene product:
N-myc |
Neuroblastoma
Transcription factor |
|
Name the associated cancer and type of gene product:
ret |
MENIIa and IIb
Tyrosine kinase |
|
Name the associated cancer and type of gene product:
c-kit |
GIST
Cytokine receptor |
|
Name the cancer(s) that is associated with the following oncogene:
Rb |
retinoblastoma, osteosarcoma
|
|
Name the cancer(s) that is associated with the following oncogene:
p53 |
Most human cancers, Li-Fraumeni syndrome
|
|
Name the cancer(s) that is associated with the following oncogene:
BRCA1 |
Breast and ovarian cancer
|
|
Name the cancer(s) that is associated with the following oncogene:
BRCA2 |
Just breast cancer
(BRCA2 only causes breast cancer bc it's "2" for 2 breasts) |
|
Name the cancer(s) that is associated with the following oncogene:
p16 |
Melanoma
|
|
Name the cancer(s) that is associated with the following oncogene:
APC |
Colorectal cancer (associated with FAP)
|
|
Name the cancer(s) that is associated with the following oncogene:
WT1 |
Wilms' tumor
|
|
Name the cancer(s) that is associated with the following oncogene:
NF1/NF2 |
Neurofibromatosis type 1 and type 2
|
|
Name the cancer(s) that is associated with the following oncogene:
DPC |
Pancreatic cancer
DPC = "deleted in pancreatic cancer" |
|
Name the cancer(s) that is associated with the following oncogene:
DCC |
Colon cancer
DCC = "deleted in colon cancer" |
|
Prostate acid phosphatase is a marker for?
|
Prostate carcinoma
|
|
CEA is a marker for ?
|
non-specific, but produced by colorectal/pancreatic cancers, also gastric, breast, and thyroid medullary carcinomas
|
|
AFP is a marker for what cancers?
|
hepatocellular carcinomas and nonsemimnomatous germ cell tumors of the testis (yolk sac tumors)
|
|
beta hCG is a marker for what cancers?
|
Hydatidiform moles, choriocarcinomas, and gestational trophoblastic tumors
|
|
CA-125 is a marker for what tumors?
|
Ovarian and malignant epithelial tumors
|
|
S-100 is a marker for what tumors?
|
melanoma, neural tumors, and astrocytomas
|
|
Alkaline phosphatase is a marker for what cancers?
|
metastases to bone
|
|
Bombesin is a marker for what cancers?
|
Neuroblastoma, lung & gastric cancer
|
|
TRAP is a marker for what cancer?
|
Hairy cell leukemia
"TRAP the hairy animal" |
|
CA-19-9 is a marker for what cancer?
|
Pancreatic adenocarcinoma
|
|
Calcitonin is a marker for what cancer?
|
Thyroid medullary carcinoma
|
|
HTLV-1 is associated with which cancers?
|
Adult T-cell leukemia/lymphoma
|
|
Schistosoma haemotobium is associated with what cancers
|
squamous cell carcinoma of transitional epithelium (bladder)
|
|
Name the four tumors that form psammoma bodies.
|
- Papillary (thyroid)
- Serous papillary (ovary) - Meningioma - Mesothelioma Can think "PSaMM" |
|
Name the types of cancer that would be likely to metastasize to the brain.
|
"Lots of Bad Stuff Kills Glia"
Lung, Breast, Skin, Kidney, GI |
|
Name the types of cancer that would be likely to metastasize to the liver.
|
"Cancer Sometimes Penetrates Benign Liver"
Colon > Stomach > Pancreas > Breast > Lung |
|
Name the types of cancer that would be likely to metastasize to bone.
|
"PT Barnum Loves Kids"
Prostate, thyroid, testes, breast, lung, kidney |
|
What types of lesions would lung, prostate, and breast cancer form in bones?
|
lung = lytic
prostate= blastic Breast = lytic & blastic |
|
What vitamin deficiency leads to pellagra?
|
Niacin (B3)
|
|
Hartnup disease is the inability to reabsorb what type of AAs?
|
nonpolar (esp. tryptophan)
|
|
What is role of chromium?
|
Cofactor for insulin; helps insulin do its job
|
|
What is the most important (for boards) role of copper in the body?
|
Cofactor for lysyl oxidase which cross-links collagen and elastic tissue.
Deficiency --> weak collagen/elastic tissue (dissecting aortic aneurysm) |
|
What is the role of selenium in the body?
|
Component of glutathione peroxidase- helps convert H2O2 to water (aka anti-oxidant)- FA p. 102
|
|
What are two situations when you would restrict protein in the diet?
|
- Cirrhosis (can't do urea cycle)
- Chronic renal failure (can't excrete urea) |
|
What is a leiomyoma?
|
Benign tumor of smooth muscle
|
|
Name the four sections of the adrenal gland and what is made in them.
|
Zona glomerulosa (mineralocorticoids), Zona fasiculata (glucocorticoids), and Zona reticularis (sex hormones), and medulla (catecholamines)
|
|
Where are Peyer's patches located?
|
Terminal ileum
|
|
Which lymphoma is the most common of the B cell lymphomas and is inactivation of an apoptosis (bcl-2) gene?
|
Follicular B cell lymphoma
|
|
What drugs would precipitate G6PD flare-up?
|
Oxidizing agents like fava beans, sulfonamides, primaquine, anti-TB drugs, bactrim, dapsone, nitrofurantoin
|
|
What bacteria is described by "motile Gram positive rods that produce a very narrow zone of beta-hemolysis on sheep blood agar"
|
Listeria
|
|
What kind of immunity do you need to fight Listeria? Why?
|
Cell-mediated, bc Listeria is facultative intracellular and reproduce in cytoplasm. Think of it kind of like TB.
|
|
What is the mechanism of ibuprofin?
|
Reversible COX-1 and COX-2 inhibitor. Note- same mechanism as acetaminophen but acetominophen doesn't have peripheral (anti-inflamm) effects.
|
|
Name the cytochrome p450 inducers.
|
Think BCG PQRS
B- barbiturates C- carbamazepine G- griseofulvin P- phenytoin Q- quinidine R- Rifampin S- St. John's Wort |
|
Name the cytochrome p450 inhibitors.
|
Think "Inhibit yourself from drinking beer from a KEG because it makes you ACUTEly SICk"
Protease inhibitors ketoconazole Erythromycin Grapefruit juice Acute alcohol abuse Sulfonamides Isoniazid Cimetidine |
|
Which antibiotic has a side effect of aplastic anemia?
|
Chloramphenicol
|
|
How long does it take for glycogen to be depleted during fasting?
|
8-12 hours.
|
|
EBV is associated with which three types of cancer?
|
Hodgkin's lymphoma, non-Hodgkin's lymphoma, and nasopharyngeal carcinoma.
|
|
How do osteocytes communicate with each other?
|
Gap junctions
|
|
What is the toxicity that nitroprusside can cause? How would you treat it/why?
|
CN toxicity, treat it with sulfur (sodium thiosulfate) because then you get SCN instead of CN. (It helps your body do what it would normally do).
Also treat with nitrite and hydroxocobalamin. |
|
Describe three ways you might identify strep. pneumo in lab.
|
1) Alpha hemolytic
2) Optochin sensitive 3) Bile soluble (Remember viridans is the optochin resistance one bc they are in dental caries and "not afraid of the CHIN") |
|
What is the enzyme that converts G6P to glucose?
|
Glucose 6 phosphatase
|
|
Name three treatments for CN poisoning and how they work.
|
- Nitrite (like amyl nitrite)- the nitrite induces the formation of methemoglobin, which can bind and sequester CN in the blood
- thiosulfate- helps body add S to CN to make SCN, which is ectreted in urin - hydroxocobalamin - binds CN to form the harmless form of B12 "cyanocobalamin" |
|
High serum levels of antibodies against polyribitol ribose phosphate would be seen in which baterial infection?
|
H. flu (the capsule is made of PRP); we kill H. flu through antibodies --> complement and opsonization
|
|
Which anti-cancer drug is unique for having neurotoxicity inc. peripheral neuropathy as a side effect? Where does it work?
|
Vincristine- works during M phase to block polymerization of microtubules.
|
|
What is the difference between and alkaloid and an alkylating agent?
|
Both are anti-cancer.
Alkaloids are drugs vincristine, vinblastine, and taxols that inerfere with microtubules during the M phase Alkylating agents add alkyl groups to DNA that is already formed and affect the entire cell cycle as well as resting cells (but less so). They are also called "nitrogen-mustard type" (at least one category is). |
|
What chromosome is the myc gene on (aka what translocations would you see myc gene messed up in?)
|
Anything with chromosome 8
|
|
What gene mutation and cancer would you suspect with translocation (14;18)?
|
Bcl-2, follicular lymphoma
|
|
What is risperidone?
|
Atypical anti-psychotic, special side effect is galactorrhea
|
|
Draw the sarcomere, including:
Z line, M line, H zone, A band, I band, myosin, and actin. |
FA p. 377
|
|
What nerve innervates the posterior half of the external ear canal?
|
The auricular branch of the vagus nerve
|
|
What nerve innervates the anterior half of the external ear canal?
|
The 5th cranial nerve (trigeminal)
*The nerves go in alphabetic order- trigeminal is outer, vagal (later in the alphabet) is further into the ear |
|
What is the enzyme in the TCA cycle that generates FADH2?
|
succinate dehydrogenase
|
|
What's the treatment for toxoplasmosis?
|
Sulfadiazine and pyrimethamine
|
|
What two drugs would you give specifically to lower TGs?
|
Fibrates first, then niacin
|
|
How might you recognize TCA side effects in a question stem?
|
anti-cholinergic + arrhythmias
|
|
What do you use to treat TCA arrhythmias?
|
NaHCO3
|
|
Name 4 MAOIs.
|
Phenelzine, tranylcypromine, isocarboxacid, selegiline
|
|
Which antifungals affect the cell WALL vs. the CELL membrane?
|
Caspofungin- cell wall
Azoles, amphotericin, nystatin, and terbinafine- cell membrane |
|
In which cancer are RAS mutations found?
|
Follicular thyroid cancers and some follicular adenomas
|
|
What are the two "exceptions" to the way the autonomic nervous system is innervated?
|
1) The sweat glands are part of the sympathetic nervous system but their post-ganglionic receptors are ACh/muscarinic, 2) and the adrenal medulla is part of the sympathetic nervous system but it is acted upon directly from spinal cord by cholinergic fibers.- Need to add to this card what kind of receptors at the adrenal medulla (musc. or nic.)
|
|
What is the MOA of clavulinic acid?
|
Decreases bacterial cleavage of the beta lactam ring of amoxicillin
|
|
What is the first cell after the stem cell in any WBC lineage?
|
"blasts"
|
|
What does low leukocyte alkaline phosphatase indicate? high?
|
Low- indicates CML
High or normal- indicates leukemoid reaction Low levels in leukemia. |
|
What two cells are cross-linked in a superantigen reaction?
|
T cell (helper) and APC (like macrophage or dendritic cell)
|
|
Radiation has what effect on DNA?
|
Double-stranded DNA breaks + formation of free radicals --> damage
|
|
What type of virus will have a phospholipid-containing particle surface?
|
An enveloped virus
|
|
What specific family of viruses gets their envelope from the host cell nuclear membrane?
|
The herpesviridae
|
|
What is E. coli's pathogenic factor in cystitis/pyelonephritis?
|
Fimbriae
|
|
What is E. coli's pathogenic factor in pneumonia neonatal meningitis?
|
K capsule
|
|
What is E. coli's pathogenic factor in septic shock?
|
LPS endotoxin
|
|
What is the step of galactose metabolism that is messed up in classic galactosemia?
|
Galactose 1-P --> glucose 1-P + UDP galactose via (galactose 1-P) uridyl transferase
|
|
Reversible or irreversible
Decreased ATP synthesis |
Reversible
|
|
Reversible or irreversible?
Cellular swelling |
Reversible
|
|
Reversible or irreversible?
Nuclear chromatin clumping/disaggregation of nuclear granules |
Reversible
|
|
Reversible or irreversible?
Decreased glycogen |
Reversible
|
|
Reversible or irreversible?
Fatty change |
Reversible
|
|
Reversible or irreversible?
Ribosomal detachment |
reversible
|
|
Reversible or irreversible?
mitochondrial swelling |
reversible
|
|
Reversible or irreversible?
Nuclear pyknosis, karyolysis, karyorrhexis |
Irreversible
|
|
Reversible or irreversible?
Ca2+ influx |
Irreversible (leads to caspase activation)
|
|
Reversible or irreversible?
plasma membrane damage |
irreversible
|
|
Reversible or irreversible?
lysosomal rupture |
irreversible
|
|
Reversible or irreversible?
mitochondrial permeability and vauolization |
irreversible
|
|
Which cells in male produce testosterone?
|
Leydig cells (can remember bc it's the male hormone, and boys "lie" and "dig").
|
|
Which cells in male produce inhibin and what does inhibin do?
|
Sertoli cells
Inhibin inhibits FSH release from the anterior pituitary |
|
What three classes of drugs would cause toxicity when given with lithium?
|
thiazide diuretics, NSAIDs, and ACE inhibitors
|
|
What kind of cells make renin?
|
JG cells
|
|
How would you treat homocysteinuria due to a cystathionine synthases deficiency?
|
Decrease Met in diet, Increase Cys in diet, and increase B12 & folate in diet
|
|
How would you treat homocysteinuria due to a decreased affinity of cystathionine synthases for pyridoxal phosphate?
|
Increased vitamin B6 in diet
|
|
What medium do you use to stain cryptococcus & what does it look like?
|
India ink
Looks like bright circles on dark background- the bright circles are the thick capsule that doesn't stain |
|
What do you use to treat cryptococcus?
|
Amphotericin B
|
|
Which hepatitis virus gets integrated into the human genome and causes cancer that way?
|
Hep. B
|
|
Describe the difference between hepatitis B core antigen and eAg.
|
Antibody to the core antigen is the only thing present during the window period. Antigen E vs. antibody to antigen E is how you determine infectivity in a chronic infection (if they have the eAg but not Ab, it's high infectivity)
|
|
What three microbes can cause HIV associated esophagitis?
|
Candida (would see white/grey membranes)
HSV-1- small punched out ulcers CMV- linear ulceration |
|
What does isospora belli cause in HIV patients?
|
chronic, watery diarrhea
|
|
How is dixogin excreted?
|
Renally
|
|
What things make dixogin toxicity worse?
|
Renal failure (including decreased activity due to aging), hypokalemia (bc then dig can bind at the K+ binding site on the Na/K ATPase), quinidine (due to decreased clearance)
|
|
What types of drugs can induce mania in bipolar disorder?
|
Anti-depressants (such as TCAs)
|
|
Where in the renal tubule does ADH act?
|
In the collecting tubules, acts at V2 receptors.
|
|
What is the mechanism of action of flutamide?
|
It is a nonsteroidal, competitive inhibitor of androgens at the testosterone receptor; used to treat prostate carcinoma
|
|
Why do women/pregnant women get cholethiasis?
|
1) bc they have estrogen induced cholesterol hypersecretion
2) bc they have progesterone induced gallbladder hypomotility |
|
What is the embryologic origin (tissue layer) of the lens of the eye vs. the retina?
|
The retina derives from the neuroectoderm and the lens of the eye derives from the surface ectoderm.
|
|
What major organs does portal circulation include?
|
Gut, spleen, pancreas
|
|
What's the difference between neurofibrmatosis type 1 and tuberous sclerosis?
|
NF1- you get
|
|
What are the anaphylatoxins?
|
c3a nd c5a
|
|
osteomyelitis in normal child causative organism?
|
s. aureus
|
|
osteomyelitis in child w. sickle cell anemia?
|
salmonella
|
|
infection of post-partum mom (breasts). organis?
|
s. aureus
|
|
Give examples of intrinsic tyrosine kinase receptors (that signal via MAP kinase)
|
EGFR, PDGFR, FGFR
|
|
Give examples of receptors that do NOT have intrinsic tyrosine kinase activity and signal via the JAK STAT pathway
|
Cytokine receptors, growth hormone, prolactin, IL-2
|
|
Why does arterial resistance increase in lungs as blood oxygen decreases?
|
To divert the blood away from underventilated areas and towards more well-ventilated areas.
|
|
Is paramesonephric duct found in males or females?
|
Females (Think females are Pretty and they have the Paramesonephric duct)
|
|
What are the tumors of MEN1 syndrome?
|
Pituitary, parathyroid, and pancreas tumors
|
|
What two genetic disorders can have webbing of the neck?
|
Down Syndrome and Turner's
|
|
What is the mechanism of action and use for prazosin?
|
It's an alpha 1 blocker used to treat hypertension and urinary retention in BPH.
|
|
Hydrocholric acid and alcohol are used to decolorize after staining with carbolfuschsin in a ______ stain?
|
acid-fast
|
|
Describe sex hormones, aldosterone, and 17-hyrdoxyprogesterone levels for 17alpha hydroxylase deficiency.
|
Sex hormones - decreased
Aldosterone - increased (HTN) 17-hydroxyprogesterone - low |
|
Describe sex hormones, aldosterone, and 17-hyrdoxyprogesterone levels for 21 hydroxylase deficiency
|
Sex hormones- increased
Aldosterone- decreased (hypOtension) 17-hydroxyprogesterone- increased |
|
Describe sex hormones, aldosterone, and 17-hyrdoxyprogesterone levels for 11 beta hydroxylase deficiency
|
sex hormones- elevated
aldosterone- decreased, but mineralocorticoids are elevated (HTN) bc 11 deoxycorticosterone can bind aldosterone receptors 17-hydroxyprogesterone levels- increased |
|
Lung mass + hyponatremia makes you think?
|
SIADH
|
|
What is the only thing you absolutely need to supplement after total gastrectomy?
|
Vitamin B12 (parenteral); can no longer absorb due to loss of IF.
|
|
Myoglobin-rich, glycogen-poor muscle fibers with many mitochondria describes which type of muscle?
|
Type I (slow twitch); they perform mostly by aerobic metabolism and have lots of myoglobin for O2 storage and mitochondria for aerobic respiration.
|
|
Where are thyroid hormone receptors located?
|
IN the nucleus (as opposed to other steroid hormones that are in the cytoplasm like glucocorticoids, mineralocorticoids, etc.)
|
|
Describe how HgbC would move on gel electrophoresis?
|
It's a missense mutation that forms a more positively charged molecule, so it migrates more slowly towards the positive charge.
|
|
Which direction do proteins move on a gel?
|
towards the positive (cathode)
|
|
Dextrans facilitate streptococcal adherence to ________?
|
Fibrin
|
|
Erythemia infectiosum looks like what and is caused by what?
|
slapped cheek rash, caused by parvovirus B19
|
|
Roseola infantum looks like what and is caused by what?
|
Looks like very high fever for a few days followed by maculopapular rash that starts on trunk and spread peripherally; caused by Herpes virus type 6
|
|
What is the mechanism of action of amlodipine?
|
Anti-hypertensive, anti-anginal ca2+ channel blocker that causes coronary and peripheral vasodilation. Can be used to treat Prinzmetal's angina.
|
|
What is the MOA and use for ergonovine?
|
MOA- agonist for alpha adrenergic and serotonergic receptors
Use- to test if someone has vasospasm (Prinzmetal's angina) |
|
Name a very virulent bacteria that you only need ten organisms in you to get sick...
|
Shigella
|
|
What is the difference between effect modification and confounding?
|
Effect modulation is when you design the study fine, but something might be modifying the effect you measure. For example, you find that risk of sunburn is higher in beach-goers that don't wear sunscreen vs. non-beach-goers that don't wear sunscreen. What you have measured is a true effect (going to the beach --> more sunburn), but there is also an EFFECT of not wearing sunscreen that may be modifying your results.
Confounding would be if you compared beach-goers that don't wear sunscreen to non beach-goers that do wear sunscreen and blamed the results on going to the beach without accounting for wearing sunscreen. |
|
What does DNA polymerase III (3' to 5' exonuclease) do?
|
Removes improper base-pair nucleotide nduring replication
|
|
What is a hurthle cell and when do you see it?
|
You see it in Hashimoto's thyroiditis, it's a thyroid follicular cell that undergoes metaplastic change, leaving large, oxyphilic cells with granular cytoplasm
|
|
What nerve is at increased risk during thyroidectomy?
What muscle? |
superior laryngeal n (external branch)
Cricothyroid is the only laryngeal muscle supplied by that nerve |
|
The H. flu vaccine is specifically against what part of the bug and what is it conjugated to?
|
Against the capsule, conjugated to diptheria toxoid or other protein
|
|
Patient presents with hydrocephalus, chorioretinal lesions, enlarged ventricles, and scattered intracranial calculi acquired in utero. Diagnosis?
|
Toxoplasmosis
|
|
What's the difference between neurofibromatosis (type I) and tuberous sclerosis?
|
Tuberous sclerosis- ash leaf spots, facial lesions (adenoma sebaceum), cortical and retinal hamartomas, seizures, MR, renal cysts and renal angiomyolipomas, cardiac rhabdomyomas, increased incidence of astrocytomas
Neurofibromatosis- cafe au lait spots, neural tumors, lisch nodules (pigmented iris hamartomas), skeletal disorders, optic pathway gliomas |
|
Name the intraperitoneal organs (13).
|
Stomach, First part of the duodenum [5 cm], fourth part of the duodenum, jejunum, ileum, cecum, appendix, transverse colon, sigmoid colon, Rectum (upper 1/3), liver, spleen, pancreas (only tail).
|
|
Name the retroperitoneal organs (12).
|
The rest of the duodenum (2nd and 3rd parts), ascending colon, descending colon, Rectum (middle 1/3), pancreas (except tail), kidneys, adrenal glands, proximal ureters, renal vessels, gonadal vessels, inferior vena cava, aorta
|
|
Cryoglobulinemia is associated with which hepatitis?
|
Hep. C (C for both cryo and Hep C).
|
|
What are the need to know enzymes in purine synthesis?
|
PRPP synthetase
|
|
What are the need to know enzymes in pyrimidine synthesis?
|
carbamoyl phosphate synthetase II, ribonucleotide reductase, thymidylate synthase, dihydrofolate reductase (part of regenerating N5N10 methylene THF to use to make dTMP)
|
|
Patient presents, lucid, after fracture of temporal bone. Most like type of hemorrhage?
|
Epidural
|
|
Patient presents with slow onset of symptoms; patient is elderly or alcoholic or shaken baby. Most likely type of hemorrhage?
|
Subdural hematoma
|
|
Patient has "worst headache of life" and bloody or yellow spinal tap. Patient might have Marfan's, Ehlers-Danlos, or APCKD. Most likely type of hemorrhage?
|
Subarachnoid
|
|
Lesion of which cranial nerve would lead to hyperacusis?
|
Cranial nerve VII, bc it innervates the stapes? which dulls sound
|
|
What organism and subtype causes lymphogranuloma venereum?
|
Org- chlamydia
Subtype- L1-L3 (L for lymphogranuloma) |
|
What cancers are commonly found in MEN1?
|
Parathyroid, Pituitary (prolactin or GH), and Pancreas (endocrine)
|
|
What cancers are commonly found in MEN2a?
|
Medullary thyroid carcinoma (secretes calcitonin), Pheochromocytoma, Parathyroid tumors
|
|
What cancers are commonly found in MEN2b?
|
Medullary thyroid carcinoma (secretes calcitonin), pheochromocytoma, and oral/intestinal ganglioneuromatosis
|
|
Which bacteria causes gas gangrene and late food poisoning?
|
C. perferingins
|
|
What's the difference between Reiter's syndrome and Reye's syndrome?
|
Reye's - giving a child aspirin during a viral infection
Reiter's- reactive arthritis. It has a triad of conjunctivitis/anterior uveitis, urethritis, and arthritis (can't see, can't pee, can't climb a tree) |
|
What TNF alpha blocker Ab is particularly known for predisposing patient to infection?
|
Infliximab
|
|
Where in kidney is erthyropoietin made?
|
In the endothelial cells of the peritubular capillaries
|
|
What is the mechanism of action of tamsulosin and what is it used to treat?
|
MOA- alpha 1 antagonist (selective for alpha 1 A & D), used to treat BPH. Doesn't bind to vascular alpha 1 receptors.
|
|
What's the difference between citrate and ascorbic acid?
|
Citrate is part of the TCA cycle and ascorbic acid is vitamin C (collagen, scurvey, etc.)
|
|
Which STD (or sometimes STD) has a positive whiff test?
|
Bacterial vaginosis
|
|
What's the difference between protein A and IgA protease?
|
Protein A- binds the fc region of IgG and inhibits opsonization and phagocytosis
IgA protease- cleave IgA, is secreted by strep pneumo and H. flu type B and Neisseria and S. aureus, and it's how they colonize mucosa. |
|
What's the difference between urea and uric acid and orotic acid?
|
Urea- the way the body gets rid of NH4+ (via the UREA cycle) in the liver
Uric acid or urate-is what builds up in gout. Associated pathologies are Lesch Nyhan syndrome. Orotic acid- an intermediate in the normal de novo pyrimidine synthesis pathway |
|
How are the urea cycle and orotic acid related?
|
Carbamoyl phosphate synthetase is an enzyme in both the pyrimidine synthesis pathway and the urea cycle.
You can get orotic aciduria from a blockage at the orotic acid step in DNA synth, and the urea cycle can't help you out. But you can ALSO get a blockage at the carbamoyl phosphate step in the urea cycle, so the CP can get funneled into DNA synthesis instead. |
|
What's the difference between transketolase and aldolase?
|
Transketolase catalyzes the reversible steps of the HMP shunt.
Aldolase B catalyzes the breakdown of fructose (F 1 P --> ?) |
|
Serum sickness often causes decreased levels of?
|
Complement proteins
|
|
Vitamin B6 (pyridoxine) is required as a cofactor in:
|
Transaminase reactions, decarboxylation reactions, glycogen phosphorylase, cystathionine synthesis, and heme synthesis. Also needed to convert tryptophan --> niacin
|
|
Thiamine is a required as a cofactor in which reactions?
|
transketolase, alpha ketoglutarate dehydrogenase, pyruvate dehydrogenase
|
|
Riboflavin is required as a cofactor in which reaction?
|
TCA cycle succinate --> fumarate (succinate dehydrogenase)
|
|
Biotin is needed as a cofactor in which reactions?
|
Carboxylase- pyruvate carboxylase, acetyl co-A carboxylase, propionyl coA carboxylase, and 3-methylcrotonyl-coA carboxylase
|
|
What is folate needed for in the body?
|
nucleic acid synthesis
|
|
Which testicular vein drains into the renal vein on that side --> varicocele?
|
LEFT
|
|
What can be use to get rid of symptoms of VIPoma?
|
Somatostatin
|
|
Patient presents with murmur, bounding femoral pulsations, and head-bobbing. Diagnosis?
|
Aortic regurgitation
|
|
Which are the 4 short-acting benzodiazepines?
|
Alprazolam, Triazolam, Oxazepam, Midazolam
Think MOAT bc it's a short swim across a moat. |
|
What are the side effects of methotrexate?
|
Myelosuppression, macrovascular fatty change in liver, mucositis (mouth ulcers), teratogenic, neurotoxicity
|
|
What can methotrexate be used to treat?
|
leukemia, lymphoma, choriocarcinoma, sarcoma + abortion, ectopic pregnancy, RA, psoriasis
|
|
Myxomatous degeneration of the arteries would lead to...
|
dissecting aortic aneurysm aka "dissecting hematoma"
|
|
What prevents lactation during pregnancy bc prolactin levels are increased?
|
estrogen & progesterone; they stimulate it's secretion but block its action at the breast
|
|
What is the dexamethasone test?
|
It's a glucocorticoid that you give to ppl with Cushing syndrome to see where the cause of the problem is
|
|
Name three oxidase positive, gram negative bacteria.
|
Pseudomonas, campylobacter, vibrio cholerae
|
|
What is erythema gangrenosum?
|
It's a necrotic skin infection seen in septic patients infected with pseudomonas. It looks like bruises of different sizes in photo.
|
|
What's a bacteria that invades Schwann cells?
|
Mycobacterium leprae
|
|
What is the mechanism of enterococci resistance against aminoglycosides?
|
Transferase enzymes that inactivate the drug by acetylation, phosphorylation, or adenylation
|
|
What are the results of acute salicylate intoxication?
|
First- hyperventilation leading to respiratory alkalosis
Second (within a few hours)- anion gap metabolic acidosis due to accumulation of organic acids in the blood |
|
Which birth defects are most commonly associated with anal atresia?
|
GU tract defects like epispadias, hypospadias, bladder exstrophy
|
|
What does VACTERL stand for?
|
vertebral defects, anal atresia, cardiac anomalies, tracheoesophageal fistula, esophageal atresia, renal anomalies, and limb anomalies
|
|
Name 5 class III anti-arrhythmics
|
Sotalol, ibutilide, bretylium, dofetilide, amiodarone
|
|
Which TB drug requires processing by mycobacterial catalase peroxidase to be activated?
|
Isoniazid
|
|
What biochemical intermediate activates pyruvate carboxylase?
|
Acetyl-coA
|
|
What would you see on cardiac catheterization with mitral regurgitation?
|
You'd see an increased left atrial pressure during filling/diastole bc there is already going to be blood in there that regurgitated up during the previous systole.
|
|
Hyperplastic arteriosclerosis has what pathologic finding?
|
Onion-skin like concentric thickening of arteriolar walls
|
|
What is the result of Hep C infection in most patients?
|
Stable, chronic hepatitis
|
|
What are the causes of acute pancreatitis?
|
GET SMASHED
Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune disease, Scorpion sting, Hypercalcemia/HyperTG, ERCP, Drugs |
|
Name 4 drugs that can cause pancreatitis.
|
Dedanazine, retinivir, stavudine, sulfa drugs
|
|
Amino groups are primarily transferred to what molecule during the metabolism of amino acids?
|
Alpha ketoglutarate
|
|
What would you have to supplement if you had a folic acid deprivation?
|
Thymidine bc there's no other way to make it without using folate. FA p. 68
|
|
What heart defect is associated with Turner's syndrome?
|
Coarctation of the aorta. World also says bicuspid aortic valve and aortic dissection in adulthood.
|
|
What would you give to treat someone who was exposed to heavy iodine isotopes?
|
Potassium iodide, which would encourage uptake of the KI instead of the bad stuff they were exposed to because it all goes through the "sodium iodide symporter" (NIS) & into follicular cells.
|
|
What is the life-threatening side effect associated with lamotrigine?
|
hypersensitivity that manifests as a skin rash
|
|
What is the reaction & cofactor for eye damage in diabetes?
|
Glucose --> sorbitol, via aldose reductase, cofactor is NADPH
|
|
Draw the circle of willis (13 arteries + optic chiasm and CN III)
|
FA p. 405
|
|
Which mycosis is described as a "spherule filled with endospores"?
|
Coccidiomycosis
|
|
What's the STATIN of choice when you are also giving a cyt p450 inhibitor?
|
pravastatin
|
|
How are statins normally metabolized?
|
The cyt p450 system
|
|
What is the effect of angiotensin II on the glomerular arteries?
|
It constricts both, but preferentially the efferent.
|
|
What is the effect of an ACE inhibitor on the glomerular arteries?
|
Will dilate both but more effect on the efferent bc that's that one angiotensin II constricts more
|
|
When do you see spongiosis in skin?
|
Eczematous dermatitis INCLUDING:
atopic dermatitis allergic contact dermatitis photoeczematous dermatitis primary irritant dermatitis |
|
Keratin is present in what types of cells?
|
Epithelial
|
|
Name the live virus vaccines
|
smallpox, yellow fever, chickenpox, Sabin's polio, MMR
|
|
What is the appropriate response to the vestibuloccular reflex test?
|
COWS
Cold water- fast phase of nystagmus to opposite side Warm water- fast phase of nystagmus to same side If it's messed up, lesion is on the same side. |
|
Newborn presents with enlargement of head, cranial sutures separated, normal weight. US shows thinning of cerebral cortex + enlargement of lateral ventricles. Diagnosis?
|
Stenosis of the aqueduct of sylvius
|
|
Name two spore-forming bacteria that can survive high temperatures.
|
Bacillus and Clostridium
|
|
What are the symptoms and cause of graft vs host disease?
|
Sx: diarrhea, skin rash, jaundice, hepatosplenomegaly
Cause: T cells from graft attack patient's own cells |
|
What nerve could be damaged by severing the inferior thyroid artery?
|
recurrent laryngeal nerve
|
|
What nerve could be damaged by severing the superior thyroid artery?
|
the superior laryngeal nerve (external branch) aka external laryngeal nerve
|
|
What kind of RBCs would you see in DIC?
|
schistocytes bc they are getting mechanically damaged by the clots.
|
|
What would phosphate levels be in chronic kidney disease?
|
high, because kidney can't clear phosphate
|
|
Talk about the reversibility of dysplasia vs. neoplasia
|
Dysplasia considered reversible, neoplasia isn't
|
|
An ulcer in the inferior curvature of the stomach could penetrate which artery?
|
Left gastric
|
|
What is the only fungus (pathogenic) that has a polysaccharide capsule?
|
cryptococcus
|
|
What two stains can you use to stain for cryptococcus?
|
mucocarmine (looks red) and india ink (shows up bright on black background)
|
|
Describe the difference in diffusion of CO2 vs. O2?
|
CO2 diffuses much faster, so if you have a diffusion issue, you'd expect CO2 to look ok but O2 diffusion to be messed up.
|
|
Which is the anti-viral that doesn't require viral thymidine kinase to be active?
|
Cidofovir
|
|
Why does patient with Tetralogy of Fallot squat?
|
Because squatting increase TPR, which decreases the rt to left shunt and allows more blood to go through the pulmonary circulation
|
|
What seizure drug is first line for absence seizures?
|
ethosuximidie
|
|
What is the MOA of ethosuximide?
|
blocks T-type Ca2+ channels
|
|
What is the mechanism of action of trimethoprim?
|
inhibits bacterial dihydrofolate reductase (purine synthesis)
|
|
What are the side effects of hydralazine?
|
reflex sympathetic activation leading to increased heart rate, contractility, and increased renin activity + nausea/headache
|
|
Describe the mechanism of action of nitric oxide on smooth muscle.
|
NO leads to increased cGMP which leads to decreased Ca2+ entry --> decreased activity of MLCK and thus dephosphorylation of myosin and relaxation
|
|
What is the first step in evaluation for fat soluble vitamin malabsorption?
|
a sudan III satin, which will identify the presence of fat in a stool sample. If >7 mg/day are excreted, it's described as malabsorption
|
|
Patient presents with history of pain & stiffness in shoulders & knees + darkening of sclera and cartilage. Diagnosis?
|
alkaptonuria
|
|
What IS alkaptonuria?
|
It's a deficiency of homogentisic acid oxidase which is needed to turn tyrosine into fumarate. You get the pigment due to accumulated homogentisic acid
|
|
Which two diseases have granulomatous thickening of the media of the arteries?
|
Takayasu's arteritis + temporal arteritis
|
|
Which vasculitis has immune complex-mediated transmural damage with fibrinoid necrosos?
|
Polyarteritis nodosa
|
|
What histologic changes would you see 10-14 days post MI?
|
granulation tissue + neovascularization
|
|
Which transporter transports Glucose/galactose in from the intestine?
|
SGLT-1
|
|
Which transporter transports fructose in from the intestine?
|
GLUT-5
|
|
Which glucose transporter is insulin responsive?
|
glut 4
|
|
Which glucose transporter transports sugars across basal intestinal side into bloodstream?
|
GLUT 2
|
|
What glucose transporter do the brain and RBCs use?
|
GLUT 1
|
|
Which cells secrete renin
|
JG cells of kidney
|
|
Which branchial pouch forms superior parathyroids and which one forms inferior?
|
3rd- inferior, 4th- superior
|
|
Where in kidney is 1 alpha hydroxylase located?
|
proximal tubule
|
|
Which hormones signal via IP3?
|
GOAT
GnRH, Oxytocin, ADH, TRH |
|
Which hormone has an intranuclear receptor?
|
T3/T4
|
|
Which hormones signal via the JAK/STAT pathway and what kind of receptor do they use?
|
GH, prolactin, IL-2, using a receptor-associated tyrosine kinase receptor
|
|
Why do you get skin hyperpigmentation in Addison's syndrome?
|
because you have low cortisol --> high ACTH, and MSH (causing the skin pigmentation) is a by-product of the ACTH production from POMC precurser protein
|
|
How would you distinguish Addison's from secondary adrenal insufficiency?
|
secondary wouldn't have elevated ACTH (because it would be due to LOW ACTH) so you wouldn't get skin hyperpigmentation or hyperkalemia (no mineralocorticoid effects)
|
|
What is acute, primary adrenal insufficiency due to adrenal hemorrhage called?
|
Waterhouse Friderichsen syndrome
|
|
What is the embryological origin of the chromaffin cells?
|
Neural crest
|
|
Which types of MEN syndrome is pheochromocytoma associated with?
|
2A and 2B
|
|
What is the rate-limiting step in catecholamine synthesis?
|
Tyrosine hydroxylase (Tyr --> L DOPA)
|
|
What gene over-expression is bad prognosis in neuroblastoma?
|
n-myc
|
|
What HLA subtype is Hashimoto's thyroiditis associated with?
|
HLA-DR5
|
|
Pot-bellied, pale, puffy-faced child with protruding umbilicus and protuberant tongue. Dx?
|
severe fetal hypothryoidism (aka cretinism)
|
|
Self-limited hypothyroidism with granulomatous inflammation after flulike illness =?
|
de Quervain's thyroiditis
|
|
Rock-hard thyroid, replaced by fibrous tissue, painless = ?
|
Riedel's thyroiditis
|
|
Stress-induced catecholamine surge leading to death by arrhythmia; complication of Graves' is called?
|
thyrotoxicosis
|
|
Are hot thyroid nodules malignant?
|
not usually
|
|
What's the most common type of thyroid cancer?
|
papillary thyroid carcinoma
|
|
How do you tell the difference between primary and secondary hyperparathyroidism?
|
Primary - PTH first --> Hypercalcemia
Secondary - Hypocalcemia first --> increased PTH So bottom line is that primary has hypercalcemia and secondary has hypocalcemia (usually secondary to dec. vitamin D due to renal disease) |
|
Patient presents with cystic bone spaces filled with brown fibrous tissue & bone pain. Dx?
|
osteitis fibrosis cystica secondary to hyperparathyroidism
|
|
What's the name for bone lesions due to secondary or tertiary hyperparathyroidism due, in turn, to renal disease?
|
Renal osteodystrophy
|
|
Explain Chvostek's sign and Trousseau's sign
|
Chvostek's- tap on facial nerve --> contraction of facial muscles
Trousseau's- tighten BP cuff around brachial artery and generate carpal spasm Both are signs of tetany secondary to hypocalcemia |
|
Patient presents with hypocalcemia, high PTH, shortened 4th/5th digits, and short stature. Diagnosis?
|
pseudohypoparathyroidism aka Albright's hereditary osteodystrophy
|
|
What's the most common type of pituitary adenoma?
|
prolactinoma
|
|
What is the relationship of growth hormone to insulin?
|
Growth hormone inhibits insulin release and prevents you from breaking down carbs
|
|
Where is EPO released from?
|
endothelial cells of peritubular capillaries
|
|
Where does IgA accumulate in IgA nephropathy?
|
the mesangium
|
|
Where do you see immune complexes in post-strep GN?
|
Sub-epithelial
|
|
Where do you see immune complexes in lupus?
|
sub-endothelial
|
|
Which diuretic decreases calcium excretion?
|
thiazide
|
|
How are the urea cycle/the TCA cycle related?
|
Urea cycle uses alphaketoglutarate to hold onto NH4+ until it can be put through urea cycle. If urea cycle is messed up, that deplates alphaketoglutarate and inhibits the TCA cycle
|
|
Which virus family acquires their envelope from the nuclear membrane?
|
Herpes
|
|
What are the side effects of isoniazid?
|
Think INH damages Neurons and Hepatocytes; also causes drug-induced lupus
*Remember, giving B6 can help prevent neurotoxicity and lupus |
|
Patient presents with mild urethritis. He doesn't have gonorrhea. A few weeks later, he gets acute conjunctivitis, right knee pain, and rash on his palms & soles. Dx?
|
Reiter syndrome.
Remember: Can't see, can't pee, can't climb a tree (and apparently you get a rash also). |
|
Name two symptoms specific for Graves' disease
|
pretibial myxedema & exophthalmos
Pretibial myxedema- accumulations of GAGs in the dermis leading to non-pitting edema on lower legs that looks like "orange peel" |
|
Which HLA type is associated with type 1 diabetes?
|
HLA-DR 3/4
|
|
What is the histolic finding in type 1 diabetes?
|
islet cell leukocytic infiltrate
|
|
What is the histologic finding in type 2 diabetes?
|
islet amyloid deposits
|
|
How would you diagnose Zollinger Ellison disease?
|
serotonin; inhibits regular gastrin but not the gastrin being released by the tumor
|
|
What's the difference between zollinger-ellison and Menetrier's disease?
|
ZE- gastrin hyper-secretion due to tumor, stomach shows rugal thickening
Menetrier's- gastric hypertrophy with protein loss, parietal cell atrophy, and increased mucous cells; rugae are so hypertrophied they look like brains |
|
What cancers are found in MEN2A vs. MEN2B?
|
MEN 2A- medullary thyroid carcinoma, pheochromocytoma, parathyroid tumors
MEN2B- medullary thyroid carcinoma, pheochromocytoma, oral/intestinal ganglioneuromatosis |
|
What is rhizopus?
|
a yeast that acts like mucor
|
|
What is absidia?
|
a yeast that acts like mucor
|
|
What is the MOA of donepezil?
|
acetylcholinesterase inhibitor (used to treat Alzheimer's)
|
|
What is the INITIAL lesion in Paget's disease of bone caused by (cell type)?
|
osteoclasts
|
|
What type of drug is cefazolin?
|
1st generation cephalosporin
|
|
Name the first generation cephalosporins.
|
cefazolin, caphalexin
|
|
Name the Ca2+ channel blockers that work on blood vessels.
|
nifedipine, amlodipine
|
|
Name the Ca2+ channel blockers that work at the heart.
|
Verapamil, diltiazem
|
|
Which ca2+ blockers works the most at the heart and the least at vessels?
|
Verapamil
|
|
What types of arteries does atherosclerosis affect vs. hyaline arteriosclerosis?
|
athero- large muscular/elastic arteries
hyaline arteriosclerosis- arterioles |
|
What does the law of laplace say?
|
As radius increases, so does stress on the walls
|
|
Syphilis is a vasculitis of what type of blood vessels?
|
arterioles
|
|
What particular vessels does syphilis damage in the aorta?
|
vasa vasorum
|
|
Why does aortic regurg cause bounding pulses?
|
because you have increased EDV but your heart also works fine so you have increased stroke volume on each beat (as opposed to mitral regurg secondary to left heart failure, where you have increased EDV bc heart can't pump out well enough)
|
|
What is the pattern of inheritance and chromosome of marfan syndrome?
|
autosomal dominant, chromosome 15
|
|
Why do you get hyperestrogenism in cirrhosis?
|
bc liver can't metabolize estrogen, AND liver can't metabolize 17 keto steroids so they get turned into estrogen
|
|
How is petechiae different from telangiectasia?
|
petechiae is non-blanching
|
|
Lesion only seen in AIDS patients, looks like kaposi sarcoma. Name & causative organism
|
Bacillary angiomatosis, caused by bartonella hensliae.
|
|
How do you visualize bartonella hensliae?
|
silver stain
|
|
What two diseases does baronella hensliae cause?
|
cat scratch disease and bacillary angiomatosis
|
|
Name two side effects of cyclophosphamide.
|
Myelosuppression, hemorrhagic cystitis
|
|
What is mesna used for?
|
Give when treating with cyclophosphamide; thiol group binds toxic metabolite and reduces hemorrhagic cystitis
|
|
What is polyarteritis nodosa?
|
immune complex mediated transmural vasculitis that affects small and medium arteries
|
|
Which arteries does polyarteritis nodosa tend to avoid?
|
pulmonary
|
|
What disease is associated with polyarteritis nodosa?
|
hepatitis B
|
|
Describe the rash of rocky mt. spotted fever.
|
begins on hands and feet, moves to trunk
|
|
Name three spirochetes
|
treponema, borrelia, leptospira
|
|
Melanoma is a malignany of what type of cells?
|
melanocytes
|
|
What embryologic layer do melanocytes derive from?
|
neural crest
|
|
Describe the diarrhea of Crohn's vs UC.
|
Crohn's is sometimes bloody, US is always bloody
|
|
Which nerve runs between biceps brachii and corachobrachialis?
|
musculocutaneous
|
|
Which nerve runs between flexor carpi ulnaris and flexor digitorum profundus?
|
ulnar n.
|
|
Which nerve runs between olecranon and medial epichondyle of humerus?
|
ulnar
|
|
Which nerve runs through the supinator near the head of the radius?
|
radial n.
|
|
Which nerve runs between the humeral and ulnar heads of pronator teres and then between flexor digitorum superficialis and flexor digitorum profundus before entering the wrist?
|
median n.
|
|
Name two microbes associated with Guillain Barre syndrome
|
campylobacter and herpesvirus
|
|
Why can acetazolamide be used to treat glaucoma?
|
bc it decreases HCO3 and decreases aqueous humor formation
|
|
What's the difference in the rash of rubella vs. measles?
|
Measles spreads from head to toe, rubella is truncal
|
|
Where are you tender in rubella?
|
postauricular tenderness
|
|
What is the other MOA of metoprolol besides just beta blocker/actions at the heart?
|
It blocks catecholamine induced renin release by the kidney
|
|
What's the actual stimulus for renin release?
|
decreased blood volume
|
|
What are the side effects of acetazolamide?
|
hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy
|
|
What are the side effects of thiazide diuretics?
|
hypokalemic metabolic alkalosis, hyponatremia, hyperglycemia, hyperlipidemia, hyperUricemia, and hypercalcemia + sulfa allergy
|
|
Why would an adult sickle cell patient have jaundice?
|
due to hemolytic anemia
|
|
Why would a sickle cell patient have increased MCV?
|
folate deficiency due to increased cell turnover
|
|
Which anti-depressant can be used to treat diabetic neuropathy?
|
amitryptaline
|
|
What type of drug is sertraline?
|
SSRI
|
|
Which anti-depressant can be used to treat diabetic neuropathy?
|
amitryptaline
|
|
What type of drug is sertraline?
|
SSRI
|
|
What parts of the kidney are most susceptible to ischemic damage?
|
1) straight portion of proximal tubule
2) In medulla- Na/K/2Cl cotransport channel in the thick ascending limb is most susceptible to hypoxia |
|
What parts of the nervous system are most susceptible to ischemic damage?
|
- Purkinje cells in cerebellum & neurons in laters 3,5, and 6 of the cerebral cortex
|
|
In a normal cell, describe which way the Na/K ATPase pump works?
|
It PUMPs K+ into cells and PUMPS Na+ out (Na+ has tendency to rush in and K+ has tendency to rush out)
|
|
What are the lethal effects of increase Ca2+ in the cytosol of a cell?
|
- enzyme activation (proteases, endonucleases, etc.)
- Reentry of Ca 2+ into mitochondria- increased mitochondrial membrane permeability and releases cytochrome c into the cytosol --> apoptosis |
|
Where is myeloperoxidase found and what does it do?
|
Found in phagolysosome; combines hydrogen peroxide with chloride to form bleach
|
|
What does superoxide dismutase do?
|
converts superoxide free radicals to peroxide and O2
|
|
What does catalase do?
|
degrades peroxide into O2 and water
|
|
Name three anti-oxidant vitamins/minerals
|
Vitamin E, vitamin C, and selenium
|
|
What protein are microtubules made out of?
|
tubulin
|
|
What is the MOA of etoposide and bleomycin?
|
They prevent synthesis of tubulin in G2 phase of cell cycle
|
|
What is the MOA of vinca alkaloids/colchicine?
|
bind to tubulin in microtubules; interferes with assembly of mitotic spindle
|
|
What is hte MOA of paclitaxel?
|
enhances tubulin polymerization so the mitotic spindle can't disassmble
|
|
Name three intermediate filament proteins
|
keratin, desmin, vimentin
|
|
What are mallory bodies?
|
damaged, ubiquinated intermediate filaments in hepatocytes in alcoholic liver disease
|
|
What is the normal action of bcl-2
|
anti-apoptotic
|
|
What is normal BAX gene action?
|
pro-apoptotic
|
|
What's the rate-limiting step of the TCA cycle?
|
isocitrate dehydrogenase
|
|
Name 4 things that pyruvate can be made into
|
acetyl coA, OAA, lactate, ALANINE
|
|
What is the point of the alanine cycle?
|
transports ammonia from muscle to liver
Pyruvate + NH3 --> alanine (which is then transported to liver) NH4+ then undergoes urea cycle in liver |
|
Why are alanine and glutamine found in such high concentrations in blood?
|
They are two major carriers of nitrogen from tissues
|
|
Describe a transaminase reaction
|
AA-NH3 + alpha-ketoglutarate --> ketoacid (like pyruvate) + glutamate
|
|
Absence of pyruvate dehydrogenase would lead to?
|
lactic acidosis + neurologic defects
|
|
Which way is the tail pointing in positive skew?
|
To the right
|
|
Which measure of average is the lowest in positive skew?
|
mode < median < mean
|
|
What is the formula for power?
|
1-beta
|
|
How do you calculate standard error of the mean?
|
standard dev. / (sq. root n)
|
|
What's the formula for confidence interval?
|
CI = mean - Z (SEM) to mean + Z (SEM)
Z for 95% CI is 1.96 |
|
chi squared test is used to compare?
|
categorical outcomes
|
|
Which hepatidites can you immunize against?
|
Hep A & Hep B
|
|
What are the reportable STDs?
|
HIV, gonorrhea, syphilis
|
|
What are the reportable Hepatidites?
|
Hep A, B, and C
|
|
What are the reportable diseases "of children"?
|
measles, mumps, rubella, chicken pox
|
|
What are the reportable diarrheal disease?
|
salmonella & shigella
|
|
What bacterial lung disease is reportable?
|
TB
|
|
Describe medicare parts A, B, C, D
|
A- hospital/inpatient
B- outpatient/doctors C- combo of A & B D- DRUGS |
|
What's the difference between sleep patterns in the elderly vs. in depression?
|
Elderly- decreased slow wave, decreased REM
Depression- decreased slow wave, increased REM |
|
Describe the suicide rate & rate of mental illness in the eldery.
|
Decreased incidence of psychiatric disorders but increased suicide risk
|
|
How long can normal grief last?
|
Up to 2 months
|
|
What's the formula for BMI?
|
weight in kg/ height in meters^2
|
|
What's the BMI cutoff for obese?
|
30
|
|
During which sleep stage does bruxism occur?
|
Stage 2
|
|
What neurotransmitter is key in intiating REM sleep? Which neurotransmitter reduces REM sleep?
|
AcH increases REM sleep, NE reduces REM sleep
|
|
In what disease would you see early morning wakening?
|
depression
|
|
What treatments do you use for narcolepsy?
|
amphetamines, modafinil (stimulant), sodium oxybate
|
|
galactose + glucose =
|
lactose
|
|
glucose + glucose =
|
maltose
|
|
fructose + glucose
|
sucrose
|
|
Where does digestion of proteins begin?
|
In stomach
|
|
What's the official name for omega 3 fatty acid?
|
linolenic acid
|
|
Where does digestion of primary triglycerides begin?
|
small intestine
|
|
Which apoprotein is needed to transfer chylomicron from intestine into blood?
|
B48 - remember because the 8 is twisted up like an intestine
|
|
What hormones are decreased in anorexia?
|
estrogen, secondary to decreased gonadotropin releasing hormone
|
|
Describe the pathogenesis of arrhythmia in bulimia.
|
Vomiting, so you have a metabolic alkalosis. That leads to H+ leaving cells, and in return K+ moves into cells, so you basically have hypokalemia --> arrhythmia
|
|
High leptin means?
|
you are full - tells you not to eat
|
|
What does insulin do to sodium?
|
Increases sodium retention --> hypertension, etc.
|
|
What does it mean when alk phos is elevated?
|
That bone mineralization is being allowed to happen (bc you are inhibiting the thing that normally inhibits mineralization)
|
|
What is the effect of a cytochrome p450 activator on vitamin D?
|
It will increase vitamin D metabolism into inactive metabolite (so it'll look like vitamin D deficiency)
|
|
What are the side effects of vitamin A toxicity?
|
hepatic and papilledema (headaches, increased ICP)- think of the bear hunter eating bear liver presenting with headaches
|
|
What other fat soluble vitamin issue causes bleeding besides Vit. K deficiency?
|
Vitamin E overdose
|
|
Why do you get neuropathy with thymine deficiency?
|
bc you can't make ATP so you can't make myelin --> neuropathy
|
|
Which drug can lead to reduced vitamin B6?
|
Isoniazid
|
|
What are the two anti-oxidant effects of vitamin C?
|
It regenerates vitamin E and thus decreases oxidized LDL
It also neutralizes hydroxyl free radicals |
|
What is dry beriberi?
|
peripheral neuropathy
|
|
Deficiency of vitamin B6 would give you what symptoms?
|
sideroblastic anemia, convulsions, peripheral neuropathy (needed for heme synthesis and neurotransmitter synthesis)
|
|
What can cause zinc deficiency?
|
alcoholism, diabetes, chronic diarrhea
|
|
What are the sx of zinc deficiency
|
poor wound healing (involved in collagen remodeling), dysguesia, anosmia, perioral rash
|
|
What are the sx of selenium deficiency?
|
muscle pain/weakness, cardiomyopathy
|
|
What does insoluble vs. soluble fiber do?
|
insoluble- absorbs water, binds carcinogens (like estrogen)
soluble- decreases cholesterol, increases fecal bacterial mass |
|
What chromosome is prader willi/angelman on?
|
15
|
|
What would be an immunological sign that a fetus has a congenital infection?
|
Increased IgM in cord blood (normal fetus doesn't have that)
|
|
What is the most common cancer metastatic to bone?
|
breast
|
|
gyn cancer deaths?
|
look up:
Goljan says Endometrial, then ovarian, then cervical, but I think Endo/ov are switched |
|
What cancer is a sequelae of clonorchis sinensis and opisthorchis viverrini infection?
|
cholangiocarcinoma of the bile ducts
|
|
Rb gene is on what chromosome?
|
13
|
|
Would bilateral retinoblastoma be hereditary or spontaneous?
|
hereditary
|
|
Wt-1 is associated with what tumor and is on what chromosome?
|
Tumor= Wilms, chromosome- 11
|
|
DCC is on what chromosome?
|
18
|
|
What is the order of genes mutated in APC colon cancer?
|
APC --> Ras --> DCC --> p53
|
|
Which cdk/cyclins are in charge of G1 to S transition?
|
cdk 2, cyclins D & E
|
|
Which cdk/cyclins are in charge of G2 to M transition?
|
cdk 1, cyclin A & B
|
|
Where in the cell cycle does p53 work?
|
G1 to S transition
|
|
Which hepatitis is associated with IV drug use?
|
B
|
|
What kind of damage is CCl4 associated with?
|
liver (centrilobular necrosis, fatty change)
|
|
What kind of damage are nitrosamines (smoked foods) associated with?
|
esophagus, stomach
|
|
What kind of damage is arsenic associated with?
|
skin (squamous cell carcinoma), liver (angiosarcoma)
|
|
What kind of damage is naphthalene (aniline dyes) assoc. with?
|
bladder (transitional cell carcinoma)
|
|
What kind of damage are alkylating agents associated with?
|
blood (leukemia)
|
|
Paraneoplastic effects: small cell lung carcinoma?
|
ACTH, ACTH-like peptide, ADH
|
|
Paraneoplastic effects: intracranial neoplasms?
|
ADH
|
|
Squamous cell lung carcinoma, renal cell carcinoma, breast carcinoma paraneoplastic effects?
|
PTH-related peptide, TGF-beta, TNF, IL-1
|
|
Paraneoplastic effects of renal cell carcinoma, hemangioblastoma, hepatocellular carcinoma, pheochromocytoma?
|
EPO
|
|
Paraneoplastic effects of thymoma, small cell lung carcinoma
|
Abs against presynaptic Ca2+ channels at NM junction (Lambert Eaton syndrome)
|
|
Paraneoplastic effects of leukemias & lymphomas
|
Hyperuricemia due to excess nucleic acid turnover (ie cytotoxic therapy)
|
|
Where is antigen loaded for MHC I?
|
In RER of mostly intracellular peptides
|
|
Where is antigen loaded for MHC II?
|
acidified endosome- following release of invariant chain
|
|
HLA A3 associated with what disease?
|
hereditary hemochromatosis
|
|
HLA B8 associated with what dissease?
|
Graves' disease
|
|
HLA DR2 associated with what diseases?
|
MS, hay fever, SLE, Goodpasture's
|
|
HLA SR4 associated with what (2) diseases?
|
RA, type 1 diabetes
|
|
HLA DR5 associated with what diseases?
|
Pernicious anemia, Hashimoto's thyroiditis
|
|
HLA DR7 associated with what diseases?
|
steroid responsive nephrotic syndrome
|
|
What cytokine(s) induce NK cells?
|
IL12, IFNalpha, IFNbeta
|
|
Describe signal 1 & signal 2 for activation of TH cells (general)
|
signal I - MHC II binding to TCR
Signal II- B7 on APC binding to CD28 on TH cell |
|
Describe signal I and signal II for activation of cytotoxic T cells.
|
1) CD8+ T cell binding to MHCI
2) TH1 cell releasing IL2 which binds to IL2R on CD8+ t cell |
|
Describe signal I and signal II for B cell class switching
|
1) cytokines (IL4/IL5, released by TH2 cells)
2) CD40L (TH2 cell) binding to CD40 (B cell) |
|
Which type of antibody crosses the placenta?
|
IgG
|
|
What makes something a thymus independent antigen?
|
if it lacks a peptide component
|
|
What does IL3 do?
|
stimulates bone marrow
|
|
Which cytokine activates macrophages & TH1 cells?
|
IFN gamma
|
|
Which antibody types does IL4 increase?
|
IgE, IgG
|
|
Which Ab types does IL5 increases?
|
IgA
|
|
What bug is associated with waterhouse friederichsen syndrome?
|
N meningitidis!!
|
|
What type of cells have CD45?
|
all leukocytes
|
|
What type of cells have CD14?
|
macrophages
|
|
What type of cells have CD56?
|
NK cells
|
|
What type of cells have CD16?
|
NK cells
|
|
What type of cells have CD1?
|
histiocytes
|
|
What type of cells have CD15/30
|
Reed Sternberg cells (Hodgkin's lymphoma)
|
|
What type of cells have CD10?
|
B cell leukemias
|
|
How does endotoxins/LPS stimulate macs?
|
directly, without Th cells, by stimulating CD14
|
|
Why do you get calcium elevation in granulomatous disease?
|
Because macrophages (giant cells) secrete vitamin D which --> increased calcium
|
|
Which chromosome is HLA system found on?
|
Short arm of chromosome 6
|
|
What vitamin can be of benefit in the treatment of measles?
|
Vitamin A
|
|
What's the main treatment for gestational diabetes?
|
insulin
|
|
Eosinophils are found in what renal pathology?
|
drug induced interstitial nephritis
|
|
What test is used to monitor warfarin? heparin?
|
warfarin - PT, heparin, aPTT
|
|
risperidone can have what unwanted side effect?
|
hyperprolactinemia, leading to galactorrhea and amenorrhea
|
|
Where do carcinoid tumors arise from?
|
Endocrine (enterochromaffin) cells of the intestinal mucosa; if carcinoid is symptomatic (for ex. in liver), it is metastatic
|
|
Branching structures with interspersed calcified structures. What kind of thyroid cancer?
|
Papillary carcinoma
|
|
What type of fat will cause an supranate (floating on top?)
|
excess chylomicrons
|
|
What type of fat will cause an infranate (floating at the bottom)?
|
VLDL, bc it has more protein than a chylomicron
|
|
What vitamin is MOST decreased in abetalipoproteinemia?
|
Vitamin E... don't understand why, other than that it's fat soluble
|
|
What is a marker for disrupted athersclerotic plaques?
|
C reactive protein (serum)
|
|
What does the junction of communicating branches with main cerebral vessels in the brain lack?
|
internal elastic lamina, smooth muscle
|
|
In aortic dissection, describe the pathogenesis (2 parts)
|
cystic medial degeneration (due to tissue problems or hypertension) followed by an intimal tear (either due to the weakness or due to hypertension)
|
|
Why do you get stasis dermatitis with DVTs?
|
You basically have a back-up of pressure and it causes the penetrating branches (which normally carry blood from superficial to deep branches) to rupture --> ulceration, etc.
|
|
What's the difference bt Charcot-Bouchard & Berry aneurysms?
|
Charcot-bouchard- associated with hypertension- bursts and causes intraparenchymal hemorrhage
Berry- associated with Marfan/Ehler's Danlos- bursts and causes subarachnoid hemorrhage |
|
What part of the intestine does Hirschsprung always affect?
|
rectum
|
|
What nerve is involved with salivary secretion from submandibular/sublingual glands?
|
CN VII (actually paraysmpathetic)
|
|
What does malassezia furfur cause?
|
hypo/hyperpigmented patches
|
|
What does BNP do?
|
dilates arterioles/veins & promotes diuresis
|
|
Which cell count is increased with glucocorticoids?
|
Neutrophils, bc of demargination of PMNs that used to be attached to vessel walls
|
|
Which histone is not part of the core?
|
H1
|
|
What would pH, PaO2, and PaCO2 be in PE?
|
hypoxemia --> hyperventilation --> resp. alkalosis
inc. pH, dec. paO2, dec. paCO2 |
|
1 week post-stroke, lipids in brain would be?
|
Macrophages eating products of myelin breakdown
|
|
How do you rescue from MTX tox?
|
give leucovorin, which allows you to replenish folate derivates that are needed for DNA synthesis.
|
|
Where is urine the most dilute in H2O deprived animal?
|
ascending loop of henle and distal convoluted tubule
|
|
What are the side effects of thiazolidinediones?
|
1) hepatotox (check liver enzymes)
2) cardiotox |
|
Where would s. aureus be carried if you were a carrier?
|
nares
|
|
What is the mechanism of pulmonary hypertension in CHF?
|
reactive vasoconstriction secondary to pulmonary venous constriction
|
|
What would be going on if nucleoli were increased in size?
|
increased RNA polymerase activity --> rRNA synthesis
|
|
Rb gene is associated with what two tumors?
|
osteosarcoma, retinoblastoma
|
|
Damage to what part of brain --> hemibalismus?
|
STN
|
|
Stimulation of which adrenergic receptors increase insulin release?
|
beta receptors
|
|
Cofactor for homocysteine --> methionine?
|
B12-CH3
|
|
Cofactor for homocysteine --> cystathionine
|
B6
|
|
Why wouldn't you give fibrates and statins together?
|
increased risk of myopathy/myositis
|
|
baby has rigidity and spasms after dad cuts umbilical cord with knife. Dx?
|
tetanus
|
|
What LNs do testicles drain to?
|
para-aortic (retroperitoneal)
|
|
Side effects (2) of verapamil?
|
constipation, AV block
|
|
Bone changes in hyperparathyroidism?
|
subperiosteal resorption with cystic degeneration
|
|
What lobe is broca's area in?
|
frontal lobe
|
|
What lobe is Wernicke's area in?
|
temporal lobe
|
|
What neurotransmitter is associated with morphine tolerance?
|
glutamate
|
|
Major virulence factor of s. pneumo is?
|
capsule
|
|
What are the stones in pseudogout made of?
|
calcium pyrophosphate
*note- calcific tendonitis has calcium hydroxyapatite stones & renal stones are calcium oxalate |
|
What is the treatment for acute intermittent porphyria?
|
glucose + heme (bc they decrease ALA synthase activity)
|
|
What's the difference between a tumor that causes Horner's syndrome vs. SVC?
|
Horner's - superior sulcus tumor
SVC- mediastinal mass |
|
Pt with history of UC, non-compliant with meds, presents with fever, bloody diarrhea, tender/distended abdomen. Dx?
|
toxic megacolon
|
|
What's the diagnostic test for toxic megacolon?
|
x-ray (plain film)
|
|
What's the antidote for arsenic?
|
demercaprol
|
|
Which type of esophageal cancer is associated with smoking?
|
squamous esophageal cancer
|
|
Which type of esophageal cancer is associated with Barrett's esophagus?
|
adenocarcinoma
|
|
How is Hep A transferred?
|
fecal oral; could be via raw/steamed shellfish or contaminated water
|
|
What do you do to fix severe hypoglycemia outside of the hospital?
|
IM glucagon injection
|
|
Why do cells synthesize interferon in response to viral infection?
|
the interferon tells other cells to stop transcribing viral DNA
|
|
What drug class besides glucocorticoids --> buffalo hump/hyperlipidemia?
|
HIV protease inhibitors
|
|
What's the mechanism of action of isoproteronol?
|
b1/b2 agonist (increases HR, dec. vascular resistance)
|
|
Which specific cells are responsible for the damage in atherosclerosis?
|
smooth muscle cells
|
|
What is the diagnosis of urine osmolality increases greater than 50% during a water deprivation test?
|
complete central DI
|
|
Ulcer in distal duodenum with high basal acid secretion. Dx?
|
zollinger ellison (non-gastric neoplasm)
|
|
What hormone is a granulosa theca cell tumor likely to excrete?
|
estrogen
|
|
What are the 2 worst prognostic factors for liver failure?
|
increased PT, decreased albumin
|
|
t(15;17)- cancer?
|
AML
|
|
t(9;22)- cancer?
|
CML
|
|
t(14;18)- cancer?
|
follicular lymphoma
|
|
t(8;14)- cancer?
|
Burkitt's lymphoma
|
|
t(11;14)- cancer?
|
mantle cell lymphoma
|
|
Pear-shaped trophozoite?
|
giardia
|
|
What lecithin/sphingomyelin ratio indicates fetal lung maturity?
|
2:1
|
|
What's another name for lecithin?
|
phosphatidylcholine
|
|
What causes facial wrinkles?
|
decreased collagen fibril production
|
|
At what point of pulmonary function tests is PVR lowest?
|
FRC (air isn't putting too much pressure but neither is surrounding musculature)
|
|
What bacterial cell wall is made up of long, branched lipids?
|
mycobacterium
|
|
What do combined OCPs do to inhibit pregnancy?
|
Increase estrogen/progesterone --> inhibited FSH/LH (so you don't get LH surge and ovulation)
|
|
What is the MOA of terbinafine?
|
inhibits fungal squalene epoxidase
|
|
A benign hamartoma of lung would contain what type of tissue?
|
hyaline cartilage
|
|
Alkoptonuria prevents which reaction from taking place?
|
tyrosine --> fumarate
|
|
Long QT syndrome predisposes to?
|
torsades de pointes --> sudden death
|
|
Pol gene mutations in HIV indicate what (with respect to meds)
|
Resistance to protease inhibitors and nucleoside/non-nucleoside RT inhibitors
|
|
What are the three types of antigens that enterics have some combination of?
|
O antigen (external component of LPS), K antigen (capsule, covers O), H antigen (flagella, if the bacteria has flagella)
|
|
VDRL false positives are caused by?
|
Think "VDRL"
V- viruses D- drugs R- rheumatic fever L- lupus/leprosy |
|
What's the murmur of coarctation of the aorta?
|
systolic murmur between the shoulder blades
|
|
Most common cause of infectious endocarditis (overall)
|
s. viridans
|
|
Most common cause of infectious endocarditis in IVDA?
|
s. aureus
|
|
Most common cause of infectious endocarditis in ppl with prosthetic valves?
|
Staph epidermidis
|
|
Most common overall valve involved with infectious endocarditis?
|
mitral valve
|
|
What is the definition of ARDS?
|
Acute onset lung dysfunction, pulmonary edema, normal LA pressure, and PaO2/FiO2 of <200
|
|
What is the cause of ARDS?
|
Endothelial cell damage --> leakage into the alveoli
|
|
Where are SA node & AV node?
|
SA node is near opening of SVC, AV node is "interatrial septum near AV orifice" or nearby the pulmonary artery, seems like
|
|
What type of cancer is associated with Paget's disease of bone?
|
osteosarcoma
|
|
What type of cancer is described as "often occurs in metaphysis, has Codman's triangle/sunburst pattern of bone from elevation of periosteum"
|
osteosarcoma
|
|
What is globus hystericus?
|
sensation of lump in throat, no physical findings
|
|
What is histology of leiomyoma?
|
whorled pattern of smooth muscle bundles
|
|
What is the histology of endometriosis?
|
non-neoplastic endometrial glands/stroma; basically looks like an endometrial gland but isn't in the endometrium
|
|
How long are the base pairs in DNA laddering and what do they mean?
|
180 bp, they mean apoptosis
|
|
What is the inheritence of osteogenesis imperfecta?
|
autosomal dominant
|
|
If two children present with an autosomal dominant dis. but parents have no sx, what's up?
|
Could be germline mosaicism. Means some germ cells are affected, some aren't.
|
|
What structure is most likely to be damaged in anterior or posterior dislocation of knee joint (tibia relative to femur)?
|
popliteal artery
|
|
Patient presents with lower abdominal pain, fever low BP after giving birth. Tender uterus and foul-smelling vaginal discharge. Dx and organism?
|
Dx- endometritis
Organism- commonly bacteroides; caused by mixed flora |
|
What is sublimation?
|
Mature defense mechanism where you convert unacceptable feelings/drives into acceptable ones
|
|
Once you take away a kidney, what is the new GFR, right after & then six weeks after?
|
50% (right after), 80% (weeks after)
|
|
Where in the brain is a craniopharyngioma found?
|
near the pituitary gland (so it would cause the same visual problems)
|
|
How long do sx have to last before it's considering schizophrenia?
|
6 months
|
|
Associated with temporal encephalitis?
|
Herpes Simplex (1)
|
|
Acute Intermittent Porphyria is from a failure to transform what to what?
|
Porphobilinogen to Hydroxymethylbilane
|
|
What enzyme is messed up in acute intermittent porphyria?
|
porphobilinogen deaminase
|
|
Describe LDH characteristics of an exudate.
|
Exudates have either- pleural fluid/serum protein > 0.5, pleural fluid LDH/serum LDH > 0.6, or pleural fluid LDH more than 2/3 the upper limit of normal serum LDH
|
|
Patient complains of difficulty chewing gum & diplopia when reading or watching TV for long periods. Has has no extremity weakness or other med problems. Dx?
|
Myasthenia gravis
|
|
Thymus is formed by what embryonic structure?
|
third pharyngeal pouch
|
|
What is a Dandy Walker malformation?
|
Enlarged posterior fossa w/ absent or shrunken cerebellar vermis replaced by a large, midline cyst that = expanded 4th ventricle
|
|
MOA and use for phenoxybenzamine?
|
irreversible alpha blocker, non-selective, use for pheochromocytoma
|
|
What is the MOA of phentolamine?
|
reversible non-selective alpha blocker
|
|
The alpha-1 selective alpha blockers end in?
|
-zosin
|
|
What is the germinal matrix?
|
Highly cellular & vascular region where cells migrate of during brain development
|
|
Where does intraventricular hemorrhage usually arise in premature infant?
|
germinal matrix
|
|
Which anti-neoplastic is associated with acoustic nerve damage?
|
cisplatin/carboplatin (think about "PLAYing the piano"
|
|
What process attaches receptor carboxyl tails to the plasma membrane?
|
palmitoylation
|
|
What is the effect of Nitroglycerin on heart rate?
|
Decreases preload, leading to reflex tachycardia (increases HR)
|
|
43 y old man, inc. tiredness, dry mouth, impotence. Mild hepatomegaly, atrophic testes. High blood glucose. Urine pos. for glucose, neg. for ketones and protein. Has strange skin pigmentation. Dx?
|
Hereditary hemochromatosis!!
|
|
What does androgen binding protein do and what secretes it?
|
sertoli cells secrete; it keeps levels of testosterone up in the seminferous tubules/epididymis by making testosterone less lipophilic so it can't leave
|
|
which sympathetic structure controls tarsal muscle, lacrimal gland, radial muscle of iris, and salivary glands?
|
cervical sympathetic ganglion
|
|
Which sympathetic structure controls sweating (axilla)?
|
thoracic sympathetic trunk
|
|
What's the difference bt the macula densa and the JG cells?
|
Macula dense- part of the distal tubule that loops back around and touches the glomerulus- senses decreased sodium in tubule and causes afferent arteriole to relax + causes JG cells to release renin
JG cells- IN the afferent arteriole, sense decreased BP and release renin in response |
|
Which kidney is taken during living kidney donation & why?
|
L, bc it has a longer renal vein
|
|
Describe % of total body weight that is water, ECF, and ICF.
|
Remember the 60-40-20 rule
60% water, 40% intracellular, 20% extracellular fluid *Note: all the numbers are with respect to total body mass |
|
What molecule is used to measure extracellular volume?
|
inulin
|
|
What molecule is used to measure plasma volume (1/4 of extracellular volume)?
|
radiolabeled albumin
|
|
Formula for Clearance?
|
Cx = [Urine] * Urine flow rate / [Plasma]
|
|
What is a normal GFR?
|
~100 mL/min
|
|
What can be used to estimate an effective renal plasma flow?
|
PAH
|
|
How is renal plasma flow different from renal blood flow?
|
RBF is larger- plasma only makes up a portion of renal blood flow
|
|
What is the formula for renal blood flow?
|
RBF = RPF/(1-Hct)
|
|
What two molecules can be used to estimate GFR?
|
inulin & PAH
|
|
What is the result of increased plasma protein concentration on GFR?
|
Decreased GFR
|
|
What is the result of constriction of ureter on GFR?
|
decreased GFR
|
|
What is the threshold where you start seeing glucose in urine?
|
160-200 mg/dL glucose
|
|
What is the phosphate level in renal failure and WHY?
|
Phosphate is HIGH, bc kidney can't filter it. Don't get confused- PTH is also high (so you might think phosphate was low), but PTH is high as a REACTION to the high phosphate (and low calcium).
|
|
Why does angiotensin II lead to contraction alkalosis (think about proximal tubule)
|
bc it activates a sodium/H+ transporter. You reabsorb more sodium which means you excrete more H+ --> alkalosis
|
|
Where does PTH act to increase calcium retention by kidney?
|
Early distal convoluted tubule (increases Ca2+/Na+ exchcange which leads to increased Ca2+ reabsorption)
|
|
When aldosterone is reabsorbing Na+, what is getting secreted?
|
H+ and K+
|
|
Where in the kidney does ADH work?
|
In the collecting tubule (SAME as aldosterone)... don't be confused by Justin's picture
|
|
Where is angiotensinogen released from?
|
liver
|
|
What does ADH normally respond to?
|
changes in osmolality
|
|
What does take precedence in terms of ADH response?
|
low blood volume takes precedence over osmolality
|
|
What does aldosterone normally respond to/regulate?
|
blood volume
|
|
Where is ADH released from?
|
posterior pituitary
|
|
What is PTH's indirect action on Calcium/Phosphate?
|
PTH stimulates proximal tubule cells to make vitamin D which increases calcium and phosphate absorption
|
|
Besides decreased renal arterial pressure, what ELSE do JG cells release renin in response to?
|
Increased sympathetic discharge (beta 1 activation)
|
|
How does ANP work to increase Na+ loss & water loss?
|
It increases GFR which increases Na+ filtration, but there's no increase in reabsorption later on. This leads to Na+ loss & water loss bc water follows Na+
|
|
Why doesn't renin basically do the same thing as ANP?
|
bc the renin angiotensin system also leads to aldosterone release which leads to Na+/water reabsorption. So you inc. GFR but you don't lose volume like you do with ANP
|
|
Hypo or Hyper K:
Digitalis |
hyper
|
|
Hypo or Hyper K:
b blocker |
hyper
|
|
Hypo or Hyper K:
insulin |
hypo
|
|
Two ions- when you don't have them, you get arrhythmias?
|
K+, Mg+
|
|
What is Winter's formula and when is it used?
|
It is PCO2 = 1.5 (bicarb) + 8 +/- 2
It's used to calculate appropriate respiratory compensation to metabolic acidosis |
|
Name the mnemonic used to describe increased anion gap metabolic acidoses.
|
MUDPILES
Methanol, Uremia, Diabetic ketoacidosis, Paraldehyde/Phenformin/Propylene glycol, Iron/INH, Lactic acidosis, Ethylene glycol, Salicylates |
|
What is uremia?
|
abnormally high level of nitrogen waste products in blood (aka pre-renal azotemia)
|
|
Patient presents with basic urine (pH > 5.5) and hypokalemia and calcium kidney stones. Dx and cause?
|
Dx: Type 1 (distal) renal tubular acidosis
Cause: can't excrete H+ in collecting tubule |
|
Patient presents with hypokalemia, hypophosphatemia, and mildly basic urine. Dx & cause?
|
Dx: Type II (proximal) renal tubular acidosis, caused by Fanconi syndrome
Cause: defect in proximal tubule HCO3- reabsorption *Note: the hypophosphate is due to generally messed up proximal tubule, NOT related to bicarb directly |
|
Patient presents with kyperkalemia, and pretty much normal urine; which type of renal tubular acidosis & cause?
|
Type IV
Cause: Lack of collecting tubule response to aldosterone or hypoaldosteronism |
|
What is a way you can tell apart post-strep and IgA nephropathy via sx?
|
post-strep normally has periorbital edema/peripheral edema whereas IgA just has bouts of hematuria
|
|
calcium oxalate forms what type of stones?
|
kidney
|
|
Ammonium magnesium phosphate makes what kind of stone?
|
kidney stone, assoc. with urease positive organisms
|
|
Uric acid causes what kind of stones?
|
kidney (5%) + implicated in gout
|
|
Cystine creates what kind of stones
|
kidney (assoc. with cystinuria)
|
|
What histo/path would you expect to see in renal cell carcinoma?
|
polygonal CLEAR cells
|
|
Wilms' tumor presentation (just the tumor)
|
HUGE palpable flank mass
|
|
Transitional cell carcinoma is associated with the following toxins?
|
Think Pee SAC
phenacetin, smoking, aniline dyes, and cyclophosphamide |
|
white cell casts + UTI = ?
|
pyelonephritis (infection of cortex, spares glomeruli/vessels)
|
|
What cell type is associated with drug-induced interstitial nephritis?
|
EOSINOPHILS
|
|
What is biggest problem when recovering from ATN?
|
high volume diuresis leading to hypokalemia
|
|
What renal path is associated with shock, sepsis (ischemia), crush injury, or toxins?
|
Acute tubular necrosis
|
|
Muddy brown casts are associated with?
|
acute tubular necrosis
|
|
Patient presents with oliguria, anorexia, flank pain, high anion-gap metabolic acidosis & osmolar gap. Calcium oxalate crystals in urine, ballooning and vacuolar degeneration, mostly in proximal convoluted tubules. Dx?
|
ethylene glycol poisoning
|
|
What would you think if you saw a medullary cyst & small kidneys?
|
medullary cystic disease, poor prognosis, can lead to progressive renal insufficiency
|
|
resp or conducting? terminal bronchioles
|
conducting
|
|
Which characteristic of the respiratory conducting zone extends the furthest?
|
pseudostratified ciliated columnar cells- extend to respiratory bronchioles; NOT to alveoli
|
|
What do clara cells do?
|
secrete a component of surfactant & degrade toxins
|
|
Which should be higher, lecithin or sphingomyelin to indicate fetal lung maturity?
|
lecithin
|
|
If there's elastase in intra-alveolar fluid, where did it come from?
|
infiltrating neutrophils or macrophages
|
|
Describe the relation of the pulmonary artery to the bronchus at each lung hilus.
|
RALS
right anterior, left superior |
|
Name two muscles used for active inspiration?
|
scalene, sternomastoid (also external intercostals)
|
|
What organ makes ACE?
|
lungs
|
|
What protein ACTIVATES bradykinin?
|
kallikrein
|
|
What's the formula for collapsing pressure?
|
2 (surface tension) / radius
|
|
What's the difference between FRC and RV?
|
Residual volume is the one you can't measure- what's left when you maximally expire.
FRC- what's left when you breathe out normally = RV + ERV |
|
Describe why the apex is the largest contributor of functional dead space?
|
Because there's so much extra oxygenated air in the apex vs. blood flow (V/Q is like 3 or something)
|
|
What's the formula to calculate dead space?
|
VD = Tidal volume * (PaCO2-PeCO2)/PaCO2
PeCO2= expired air CO2 |
|
Which form of hemoglobin has low affinity for O2?
|
taut form
Think about an uptight person who wants to everything alone- doesn't want to work with O2 or carry it around |
|
Which form of Heme (Fe2+ or Fe3+) likes to carry oxygen?
|
Fe2+
|
|
What does Fe3+ oxygen have an affinity for?
|
CN-
|
|
What is methemglobin?
|
oxidized form of heme that doesn't bind O2 well (Fe3+)
|
|
What pO2 would have a Hgb saturation of >75%?
|
50 mmHg (or greater)
|
|
What specifically (which variable) causes diffusion issues in emphysema?
|
decreased Area for diffusion
|
|
What specifically (which variable) causes diffusion issues in pulmonary fibrosis?
|
increased thickness due to fibrosis
|
|
What is value for pulmonary hypertension?
|
>25 mmHg
|
|
What gene can cause primary pulmonary hypertension?
|
BMPR2 gene
|
|
Given pressure in pulmonary artery, P in L atrium, and CO, what's PVR?
|
R = Ppulm artery-PLatrium / CO
*Note: this is arearrangement of P = Q * R |
|
What is the equation for blood oxygen content?
|
O2 content = Hgb * O2 binding capacity (1.34) * % sat + dissolved O2 * .003
|
|
What's the equation for alveolar PAO2 (estimate)?
|
PAO2 = 150 - PACO2 / 0.8
|
|
Particles of what size would reach the terminal bronchioles and get phagocytized by macrophages?
|
2-2.5 uM
|
|
What is the main way of transporting CO2 from tissues to lungs?
|
As bicarbonate
|
|
What is the haldane effect?
|
In lungs, O2 hops on to Hb which promotes H+ release, H+ in blood combines with HCO3 --> H20 + CO2, so CO2 can get
|
|
How much bicarb do you normally re-absorb?
|
most of it
|
|
What is the imaging test of choice for a PE?
|
CT angiography
|
|
What's Homans' sign?
|
When you have a tender calf upon dorsoflexion of the foot; sign of DVT
|
|
Which type of emphysema is caused by smoking?
|
centriacinar
|
|
Which type of emphysema is caused by alpha1 anti-trypsin deficiency?
|
panacinar
|
|
In what disease would you see PAS positive hepatocytes?
|
alpha 1 ant-trrypsin deficiency?
|
|
What is a Curschmann's spiral?
|
Spirals of a mucus substance with cells attached that are coughed up in asthma
|
|
What part of the lung is affected in bronchiectasis?
|
bronchi
|
|
Patient presents with "eggshell calcification" of hilar LNs in upper lobes. Dx?
|
silicosis
|
|
Patient presents with "ivory white" calficied pleural plaques and gloden-brown fusiform rods (that look like dumbbell) inside macrophages. Dx?
|
asbestosis
|
|
What part of lung does asbestosis effect (upper or lower)
|
lower
|
|
What would you give MOM before birth of baby to prevent RDS?
|
steroids
|
|
Which way does trachea deviate in tension pneumothorax?
|
away from the lesion
|
|
Why would someone have renal problems & lung cancer?
|
Can get a calcium stone from hypercalcemia related to PTHrP being released from a squamous cell tumor
|
|
What histologic finding is mesothelioma associated with?
|
psammoma bodies
|
|
MOA of theophylline?
|
causes bronchodilation by inhibiting phosphodiesterase, decreasing cAMP hydrolysis
|
|
What's the MOA of guaifenesin?
|
expectorant, doesn't suppress cough
|
|
Why might you use N-acetylcysteine in CF?
|
to loosen mucus plugs
|
|
What is the MOA of bosentan?
|
competitively antagonizes endothelin-1 receptors, decreasing pulmonary vascular resistance- used to treat pulmonary HTN
|
|
What is endothelin-1?
|
Protein that constricts blood vessels and causes hypertension
|
|
What is diagnostic IQ score for MR?
|
<70
|
|
What's the difference between classical and operant conditioning?
|
classical- natural response is elicited by a learned stimulus (salivation elicited by bell)
operant- learning in which a particular action is elicited bc it produces a reward |
|
Desired reward produces action is called?
|
positive reinforcement
|
|
removal of aversive stimulus elicits behavior is called?
|
negative reinforcement
|
|
application of an aversive stimulus extinguishes unwanted behavior is called?
|
punishment
|
|
discontinuation of reinforcement eliminates behavior is called?
|
extinction
|
|
Which type of reinforcement schedule will lead to rapid extinguishment?
|
reward after every response
|
|
How can you remember the freudian structure of the mind?
|
the shortest word (id) is the most primal, longest (superego) is the most refined/elevated
|
|
What brain path would you see in ADD?
|
decreased frontal lobe volume
|
|
Treatment for Tourette's?
|
haloperidol (anti-psychotics)
|
|
Name two things that differentiate Rett's from Childhood disintegrative disorder.
|
1) Rett's is mostly in girls, CDD mostly in boys
2) Rett's has hand-writing, CDD doesn't |
|
Would delirium or dementia have an abnormal EEG?
|
delirium
|
|
What type of hallucination is common in schizophrenia?
|
auditory
|
|
What is a risk factor for schizophrenia in teens?
|
marijuana use
|
|
How long do you have to have depression sx before you dx major depression?
|
2 weeks
|
|
Name two drug classes you would use to treat atypical depression
|
SSRIs, MAOIs
|
|
How long do PTSD sx have to last to be considered PTSD?
|
1 month
|