6-12 Msk, Repro, Gi, Cardio

Front 1

woolsorter's dz

Back 1

b.anthracis

Front 2

b.anthracis virulence factors (2)

Back 2

1) EDEMA FACTOR: adenylate cyclase --> inc cAMP; 2) LETHAL FACTOR: stims macrophages to release TNFa

Front 3

Rb normal fxn

Back 3

arrest cell at G1

Front 4

Sx of endometriosis

Back 4

ASx, or: severe dysmenorrhea, dyspareunia (pain during intercourse), and infertility; latter 2 are from adhesions

Front 5

genetics of turner syndrome

Back 5

classic (but minority) are XO; most are XX with mosaiced monosomic cells

Front 6

role of type I vs type II fibers

Back 6

TYPE I mainly postural maintenance, work by aerobic metabolism (high myoglobin and mitochondria); TYPE II: rapid, forceful pulses of movements

Front 7

typical presentation of serum sickness

Back 7

type III hypersensitivity -- arthralgias, pruritic skin rash, vasculitis with fibrinoid necrosis and neutorphil inflam

Front 8

lab findings in serum sickness

Back 8

decreased C3 -- complement binds immune complexes

Front 9

type of allergic reaction provoked by sulfas

Back 9

serum sickness (type 3)

Front 10

causes of palm and sole rash (4)

Back 10

RMSF, syphilis, coxsackie A

Front 11

examples of dystonia

Back 11

neurological movement disorder involving involuntary muscle contractions and movements; eg CERVICAL DYSTONIA (head turning), BLEPHAROSPASM (rapid blinking --> complete closure of eyelids), WRITER's CRAMP

Front 12

shaken baby syndrome

Back 12

shaking baby violently --> movement of brain against skull --> tearing of bridging veins --> SUBDURAL HEMATOMA; congested renal veins --> BILATERAL RETINAL HEMORRHAGES; suggests CHILD ABUSE;

Front 13

hawthorne effect

Back 13

change in behavior of study population because of knowledge that they are being studied

Front 14

pygmalion effect

Back 14

researcher's beliefs in the efficacy of treatment affects the outcome

Front 15

relation of Ca to Phosphorus

Back 15

generally, high Ca = low Phosphorus, and vice versa

Front 16

steroid-mediated skin changes

Back 16

dermal atrophy from inhibition of collagen and GAG production (presents as thinning dry skin, telangiectasias, easy brusiing, and striae -- think cushings)

Front 17

mech and use of terbinafine

Back 17

MECH: inhibits squalene epoxidase (upstream of ergosterol synth); USED for dermatophytes (often in conjunction with griseofulvin);

Front 18

what drugs bind to ergosterol?

Back 18

amphotericin B and nystatin

Front 19

mech and use of flucytosine

Back 19

transformed to 5-FU --> interferes with mRNA->protein; USED in systemic fungal infec (along w/ amphotericin B; like amp/gent, amphotericin B punches holes, allows flucytosine in)

Front 20

what does digital clubbing look like and what does it suggest

Back 20

thickening of distal phalanges; suggests chronic hypoxic disease (lung dz: cancer, TB, CF, bronchiectasis, pHTN; heart: congenital cyanotic heart diseases, esp tetralogy of fallot)

Front 21

mech and use of capsofungin

Back 21

inhibits fungal CELL WALL SYNTHESIS (beta-D-glucan, a main component in cell wall of CANDIDA and ASPERGILLUS)

Front 22

types of benign breast tumors

Back 22

FIBROADENOMA (MCC <25yo, small, mobile, firm, well demarcated, fluctuates with preg); PHYLLODES (leaf-like projections); INTRADUCTAL PAPILLOMA (serous/bloody nipple discharge)

Front 23

paget's dz of breast

Back 23

eczemtaous patch on nipple; paget cells: large cells w/ c lear halo

Front 24

medullary carcinoma of breast

Back 24

sheets of cells w/ LYMPHOPLASMACYTIC infiltrate

Front 25

post-op persistence of muscle paralysis after AChEi administration

Back 25

suggests use of DEPOLARIZING muscle relaxant (not affected by AChEi)

Front 26

sx of leptospirosis

Back 26

Weil disease: hepatic dysfunction --> conjugated hyperbilirubinemia; renal dysfunction; thrombocytopenia

Front 27

receptors for hypothalamic hormones

Back 27

all Gq except CRH = Gs (C-RH :: C-AMP)

Front 28

receptors for pituitary hormones

Back 28

Gs, except oxytocin and V1 of ADH: Gq

Front 29

hesselbach's triangle

Back 29

direct inguinal hernias; borders: LATERAL: inf epigastric a.; MEDIAL: rectus abdominis m.; INFERIOR: inguinal ligament

Front 30

branchial POUCH derivatives

Back 30

1: ear; 2: palatine tonsil; 3: thymus (ventral wings) + INFERIOR parathyroid glands (dorsal wings); 4: SUPERIOR thyroid glands

Front 31

which part of bone most susceptible to hematogenous osteomyelitis?

Back 31

metaphysis; most richly vascularized

Front 32

actinic vs seborrheic keratoses

Back 32

SEBORRHEIC: "stuck-on" appearance, velvety/greasy surface; ACTINIC: erythematous papules with central scaling due to hyperkeratosis --> SANDPAPER-like;

Front 33

common site of RCC met?

Back 33

to lungs

Front 34

what vitamin needed for methionine synth?

Back 34

B12

Front 35

what vitamin needed for transamination?

Back 35

B6

Front 36

what vitamin needed for purine synthesis?

Back 36

folate

Front 37

what vitamin needed for oxidative decarboxylation of ketoacids

Back 37

B1

Front 38

which nerve and muscle indicated by positive trendelenburg sign?

Back 38

superior gluteal (glut med and min)

Front 39

which nerve and muscle implicated by diffifulty rising from seated position / climbing stairs?

Back 39

inferior gluteal (glut max)

Front 40

which vitamin useful in measles infection?

Back 40

Vit A

Front 41

lettering of HLA class I vs HLA class II

Back 41

Class I: A, B, C; Class II: DR, DP, DQ

Front 42

presentation of fibromyalgia vs polymyalgia rheumatica

Back 42

POLYMYALGIA rheumatica: >50yo; morning stiffness of neck/shoulder/pelvic girdle; a/w wt loss, fever, inc ESR, and temporal arteritis; FIBROMYALGIA: 20-50yo; widespread MSK pain a/w stiffness, paresthesias, poor sleep, and emotional disturbances, exacerbated by exercise; multiple, symmetric, TENDER SPOTS over muscles/joints/tendons

Front 43

fibromyalgia vs ankylosing spondylitis

Back 43

can both present with back pain, but FIBROMYALGIA WORSENS with exercise, while ANKYLOSING SPONDYLITIS (along with the other RAs) IMPROVES with exercise

Front 44

type of necrosis in most exogenous injuries

Back 44

coagulative

Front 45

liquefactive necrosis where

Back 45

CNS (ischemic strokes)

Front 46

Fat necrosis where

Back 46

acute pancreatitis

Front 47

caseous necrosis where

Back 47

TB

Front 48

wound w/ fruity odor

Back 48

pseudomonas (blue-green)

Front 49

hemorrhagic skin lesions by size, ascending

Back 49

petechiae, purpura, ecchymoses

Front 50

which skin lesions a/w celiac sprue?

Back 50

dermatitis herpetiformis (IgA and IgG against gliadin cross-react with reticulin -- anchoring fibril in epidermal BM)

Front 51

epi of bullous pemphigoid

Back 51

OLD people

Front 52

sx of lichen planus

Back 52

5Ps: planar, polygonal, purple, pruritc plaques on wrists/hands/trunks/legs

Front 53

clinical presentation of rickets

Back 53

bowed legs, rachitic rosary, growth retardation

Front 54

Call-Exner bodies

Back 54

GRANULOSA CELL TUMOR; small follicles filled with eosinophilic secretion; ("CALL EXNER: he'll bring the CEG [Call-exner Estrogen Granulosa]")

Front 55

sx of Buerger's disease

Back 55

thromboangiitis obliterans -- causes vasoocclusion --> claudication, raynaud's, GANGRENE

Front 56

neurotox of bilirubin

Back 56

only unconjugated bilirubin (eg Crigler-Najjar) is a threat; conjugated bilirubin gets excreted in the urine

Front 57

presentation of chronic mesenteric ischemia

Back 57

epigastric / periumbilical abd pain 30-60 mins after meals (atherosclerotic arteries can't meet blood flow demands); weight loss: pain w/ eating; benign physical exam (no physical findings, just sporatic pain)

Front 58

duod vs gastric ulcer

Back 58

DUOD better linked with acid, gets better after eating/antacids (neutralizes acid) --> a/w wt GAIN; GASTRIC only 70% linked with acid, doesn't get better with food --> a/w weight LOSS

Front 59

what does QT interval represent?

Back 59

cardica myocyte action potential duration

Front 60

changes in coronary blood flow with exercise

Back 60

most coronary blood flow during diastole; during exercise, HR inc --> dec diastole --> dec filling time; to compensate, adenosine vasodilates coronary vessels ==> increase flow rate up to 5x;

Front 61

relationship of pulmonary trunk to aorta at emergence from base of heart

Back 61

anterior-ish and to the left (remember spiral septation)

Front 62

what is a derivative of the common cardinal veins?

Back 62

SVC

Front 63

Beck's triad of cardiac tamponade

Back 63

1) Hypotension (dec CO); 2) distended neck veins; 3) distant/muffled heart sounds; (4) tachycardia (reflex)

Front 64

pulsus paradoxus

Back 64

steep drop in BP with inspiration -- indicates TAMPONADE (decreased LV compliance, inspiration --> increased RH filling --> septal shift --> dec LV filling --> dec CO)

Front 65

tamponade vs constrictive pericarditis TIMING

Back 65

constrictive pericarditis is a CHRONIC process, tamponade can develop acutely (eg viral pericarditis --> effusion)

Front 66

MCC cause of intermittent claudication

Back 66

atherosclerosis (almost always)

Front 67

Sx of monckeberg arteriosclerosis

Back 67

none! Usu asymptomatic; causes medial band-like calcifications, usu of ppl > 50yo

Front 68

cause of hyaline arteriosclerosis

Back 68

diabetic microangiopathy / essential hypertension

Front 69

most reliable indicator of MS severity

Back 69

A2-OpeningSnap interval (shorter = more severe)

Front 70

bovis in the blood

Back 70

cancer in the colon

Front 71

what do you do if you find s.INTERMEDIUS in the blood

Back 71

INTERMEDIUS --> IMMEDIATELY ASSEESS for ABSCESS

Front 72

signs of carcinoid tumor

Back 72

wheezing, diarrhea, facial flushing, syncope

Front 73

medical tx of carcinoid tumor

Back 73

OCTREOTIDE (somatostatin analog with longer half-life; neutralizes 5-HT)

Front 74

histologic appearance of abetalipoproteinemia

Back 74

lipid taken up by intestinal mucosal cells can't be exported in chylomicrons ==> get foamy cytoplasm filled with lipids

Front 75

sequelae of abetalipoproteinemia

Back 75

serum lipid deficiency --> membrane damage (RBCs --> ACANTHOCYTES [spiny membrane projections]; neurons --> neuro abnormalities)

Front 76

characteristic microscopic finding in Whipple's

Back 76

PAS (+) macrophages, rod-shaped T.whippeli bacilli

Front 77

what kind of cardiomyopathy in hemochromatosis

Back 77

DILATED cardiomyopathy --> CHF signs

Front 78

congenital cardiac defects in 22q11

Back 78

truncus arteriosus and tetralogy of fallot

Front 79

congenital cardiac defects in offspring of diabetic mother

Back 79

tranposition of the great vessels

Front 80

order of cardiac enzyme elevation after MI

Back 80

Troponin, CK-MB, AST, LDH ('i TRIPped CAL and he had a heart attack')

Front 81

causes of dilated cardiomyopathy

Back 81

ABCD: Alcohol, Beriberi, Chronic Cocaine, Coxsacke B, Chagas, Doxorubicin, Diphtheria

Front 82

most common valve affected by bacterial endocarditis

Back 82

normally MITRAL valve; in IVDU, TRICUSPID

Front 83

vegetations on both sides of valve

Back 83

LSE; no embolic risk

Front 84

findings in rheumatic fever

Back 84

FEVERSS: Fever, Erythema marginatum, Valvular damage, Elevated ESR, Red hot joints (polyarthritis), Subq nodules, Sydenham chrea

Front 85

source, activation, and action of pepsin

Back 85

secreted by CHIEF CELLS in stomach (as pepsinogen), activated (to pepsin) by LOW PH, involved in PROTEIN DIGESTION

Front 86

what GI enzyme elevated in mumps

Back 86

amylase (parotits?)

Front 87

positional pain in GERD

Back 87

increasing pain in recumbent position

Front 88

risk of hirschsprung's increases with what dz?

Back 88

down syndrome

Front 89

which IBD a/w CRC?

Back 89

UC

Front 90

"apple core" lesion on barium swallow xray

Back 90

CRC

Front 91

tx for type II crigler najjar

Back 91

phenobarbital

Front 92

causes of acute pancreatitis

Back 92

GET SMASHeD: Gallstones, EtOH, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, HyperCa/Hyperlipid, Drugs (sulfas)

Hint 92

None

Front 93

liverbiopsy of pt with alpha-1-antitrypsin deficiency

Back 93

oval-to-round intracytoplasmic hepatocyte inclusions that are strongly PAS positive

Front 94

pathophys of gallstones in crohn's dz

Back 94

ileal involvement of crohns --| bile salt recycling (enterohepatic circulation) ==> increased cholesterol: bilesalt ratio ==> cholesterol precipitation --> cholesterol GALLSTONES

Front 95

two forms of gastric adenocarcinoma

Back 95

1) INTESTINAL: intestinal glands like colonic ACA; 2) DIFFUSE: signet-ring cells; r/f include: chronic gastritis, barretts, h.pylori, nitrates, cigs

Front 96

cushing vs curling ulcers

Back 96

CUSHING: stress from head trauma / elev intracranial pressure, located in esophagus/stomach/duod, prone to perf; CURLING: a/w severe trauma / burns, located in prox duod

Front 97

cause of bleed in mallory-weiss tears

Back 97

increased intra-abdominal / gastric pressure (vom, retching, etc.)

Front 98

ras protein

Back 98

G-protein; activated by binding to GTP; part of MAP-kinase pathway

Front 99

HIV-associated causes of esophagitis (3)

Back 99

Candida, HSV, CMV

Front 100

morphology of HIV toxo

Back 100

ring-enhancing brain lesions + chorioretinitis

Front 101

what drugs raise HDL

Back 101

Niacin and gemfibrozil

Front 102

what are the s/e of HCTZ

Back 102

hyperGLUC (glycemia, lipidemia [LDL and chol], uricemia, calcemia)

Front 103

tx for s.epidermidis

Back 103

VERY resistant -- tx with vancomycin + rifampin

Front 104

INH mech and activation

Back 104

inhibits mycolic acid synthesis of M.TB; must be ACTIVATED by mycobacterial catalase-peroxidase (intracellularly)

Front 105

ethambutol mech

Back 105

inhibits synth of mycobacterial cell wall

Front 106

"Number Needed To Harm"

Back 106

# of ppl that need to be tx for one adverse event to occur = 1/absolute risk increase; = 1/(%incidents1 - %incidents2)

Front 107

role or Rb

Back 107

regulate G1->S checkpoint; active when hypophosphorylated (stops cell cycle)

Front 108

PTH molecular effects

Back 108

binds PTH-receptors on OSTEOBLASTS --> upregulats RANK-ligand and M-CSF ==> stims OSTEOCLAST precursos ==> inc OSTEOCLASTS

Front 109

what kind of bias with a new screening test

Back 109

lead-time

Front 110

polyol pathway impoariment in DIABETES

Back 110

inc intracel gluc --> sorbitol --> fructose; sorbital + fructose inc osmotic pressure --> water influx --> osmotic cell injury; causes CATARACTS, PERIPHERAL NEUROPATHY

Front 111

mechanism of cataract formation in galactosemia

Back 111

galactose --> galactitol --> sorbitol --> inc osmotic pressure --> water influx --> osmotic cell injury --> CATARACTS (same mech as polyol pathyway of DM)

Front 112

alanine reaction in the liver

Back 112

alanine + a-ketogluterate -----ALT+B6-----> pyruvate + glutamate; glutamate then donates NH3 for urea cycle

Front 113

"hot tub folliculitis"

Back 113

superficial, self-limited pseudomonas infection of hair follicles

Front 114

TGF-beta roles

Back 114

1) arrests cell cycle (tumor suppressor role); 2) promotes angiogenesis ( ==> tumors resistant to TGF are helped by this); 3) stimulation of fibroblast ECM production (implicated in atherosclerosis and fibroblastic disease)

Front 115

endothelin's effect on blood vessels

Back 115

constriction

Front 116

oseltamivir mech and use

Back 116

neuraminidase inhibitor (used to tx influenza A and B); neuraminidase is reqd for relase of virus from infected cells

Front 117

amantadine mech and use

Back 117

used for INFLUENZA A; blocks viral uncoating inside host cell (diff from oseltamivir which inhibits virion release)

Front 118

CMV manifestations in immunocompromised (organ vs HIV)

Back 118

organ xplant: CMV pneumonitis; HIV: CMV retinitis

Front 119

which cholesterol reducing agents cause hypertriglyceridemia? And what are their other side effects?

Back 119

bile acid-binding resins (eg cholestyramine): decreased bile acid recycling --> 10x increase bile acid production, concomitant inc in TG and VLDL as well --> elev TG levels; primarily USED WITH STATINS; (can also cause cholesterol stones b/c of inc chol content)

Front 120

TNF's role in hypothalamus

Back 120

appetite suppression ==> cachexia

Front 121

middle meningeal is a branch of which artery?

Back 121

Facial artery (which is a branch of external carotid)

Front 122

MCC AFP elevation

Back 122

dating error (underestimation of gestational age)

Front 123

acute and painless monocular vision loss

Back 123

central retinal artery occlusion (CRAO), usu caused by emobolus; fundoscopic findings: pale retina + cherry red macula

Front 124

what two growth factors drive angiogenesis?

Back 124

VEGF (vascular endothelial GF) and FGF (fibroblast GF)

Front 125

main clinical manifestations of acute rheumatic fever (2)

Back 125

acute ARTHRITIS and CARDITIS

Front 126

what can villous adenomas cause?

Back 126

these cauliflower like polyps can cause: BLEEDING, secretory DIARHEA, and partial INTESTINAL OBSTRUCTION

Front 127

why give pralidoxime (2-PAM) w/ atropine?

Back 127

atropine only reverses muscarinic effects -- not nicotinic; with just atropine, still at risk for muscle paralysis, so give pralidoxime (AChE regenerator) to restore balance

Front 128

side effects of giving arterial vasodilator (eg hydralazine) alone?

Back 128

vasodilation --> triggers baroreceptor --> sympathetic response --> RAA activation --> sodium / water retention; ==> usu give with sympatholytics + diuretics