Daily Review

Front 1

what happens to gray: white ratio as you move down spinal cord?

Back 1

increases in gray matter (the butterfly)

Front 2

calculating NNH

Back 2

1/AR

AR= rate of event in group 1- rate of event in group 2

Front 3

describe changes of neuron following axon being severed

Back 3

= axonal reaction, wallerian degradation

edema (nissl condensed pushed to side) rounded, nucleus in periphery

reflects increased protein synthesis for repair!

Front 4

reassortment vs. recombination

Back 4

reassortment only happens in segmented viruses like influenza, two viruses coinfect cells and then exchange genome segments

recombination happens in nonsegmented viruses through crossing over

Front 5

acyclovir mechanism

Back 5

nuceloside analog, incorporates into DNA

Front 6

supplements needed in breastfed infants

Back 6

vit D (higher doses in darker skin tones) and vitamin K (injection given at birth)

Front 7

most common cause of hydronephrosis in utero

Back 7

abnormal recannulization at URETOPELVIC junction

Front 8

microsomal monooxygenase overactivity

Back 8

p450, increase conversion of pro-carginogens to carcinogens (ex. benz(o)pyrene)

Front 9

green color in pus

Back 9

myeloperoxidase (heme containing pigmented molecule) from neutrophilic azurphilic granules

Front 10

phenyleprhine

Back 10

selective a1-agnoist (increased SVR, increased afterload)

Front 11

tamoxifen effects

Back 11

increased bone density

anti-estrogenic in breast

stimulates endometrium!

Front 12

Filtration fraction =

Back 12

GFR/RPF

Front 13

in the prescence of lactose...

Back 13

lactose binds the repressor preventing it from binding the promoter region and turning off transcription

Front 14

without glucose (lac opereon)...

Back 14

increased AC activation results in increased cAMP, cAMP binds CAP which binds to a region upstream of the promoter and acts as a positive regulator

Front 15

intraventricular hemorrhage of premature newborns occurs in...

Back 15

germinal matrix. lacks glial increasing risk

Front 16

MEN I

Back 16

para, pan, pit

parathyroid tumor (PTH), pancreatic tumor (gastrin), pituitary adenoma (prolactin, ACTH)

Front 17

MEN 2A

Back 17

MPP

medullary thyroid (calcitonin, like 2B), pheo (like 2B), parathyroid (like MEN I)

Front 18

MEN 2B

Back 18

medullary thyroid (like 2A), pheo (like 2A), marfan habitus, mucosal neuromas

Front 19

increased H+ from lack of aldosterone leads to a compensatory increase in...

Back 19

CL-

Front 20

MIF vs. testosterone vs. DHT

Back 20

TDF from SRY gene causes development of testes

MIF (from sertoli cells) causes degeneration of female internal organs, testosterone (from leydig cells) creates male internal organs, DHT creates male external genetalia

Front 21

Toxic shock syndrome is mediated by ...

Back 21

macrophages and T lymphocytes

toxin interacts with MHC

Front 22

bullous phemphgoid mediated by autoantibodies against

Back 22

hemidesmosomes

Front 23

kozak sequence

Back 23

where ribosomes bind on mRNA upstream of AUG

Front 24

heparin MOA

Back 24

binds antithrombin III and increased the effect, first line prophylaxis and treatment for DVT!

Front 25

ticlopidene, clopidogrel

Back 25

used in percutaneous coronary intervention, inhibit ADP mediated platelet aggregation

Front 26

what is the only sensory pathway not processed through the thalamus?

Back 26

smell!!

Front 27

gout composition

Back 27

monosodium urate

Front 28

psuedogout composition

Back 28

calcium pyrophosphate

Front 29

cause of PAH in heart failure

Back 29

VASOCONSTRICTION due to pulmonary venous congestion

Front 30

SMA syndrome

Back 30

tranverse portion of duodenum is trapped between SMA and ab aorta giving the impression of bowel obstruction.

occurs with decreased aorticmesenteric angle due to diminished mesenteric fat (crash diet), pronounced lordosis, or scoliosis correction surgery

Front 31

B1, B2, B3

Back 31

thiamine, riboflavin, niacin

Front 32

B5, B6, B7

Back 32

pantothenicacid, pyridoxine, bioin

Front 33

B9, B12

Back 33

folic acid, cobalamin

Front 34

vit A deficiency

Back 34

night blindness, follicular hyperkeratosis, Bitot's spots

Front 35

excess vit A

Back 35

increased intracranial pressure (pappilledema, convulsions), bone pain, liver tox (stored in liver), birth defects

Front 36

Vit E deficiency

Back 36

hEmolytic anmiea, peripheral neuropathy, post columnar degradation, retinal degen, myopathy, looks like B12 but not methlmalonic acid or megaloblastic

Front 37

excess vit E

Back 37

synergist with warfarin

Front 38

vit K deficiency

Back 38

increased PT and PTT, bleeding

Front 39

CYP40 INducers

Back 39

carbamazepine, phenobarbital, phenytoin, griseofulvin...decrease plasma concentration/action of drug

Front 40

CYP450 inhibitors

Back 40

Cimetidine, cipro, erthyromycin, azole antifungal, grapefruit juice, isoniazid, ritonavir (protease inhibs)

increases plasma concentration and toxicity of drugs

Front 41

cyclophosphamide side effects

Back 41

alkylating agent, hemorrhagic cystitis (cleared renally), prevent with MESNA

Front 42

--mustine use

Back 42

alkylating agent, non polar croses BBB to tx CNS

Front 43

Cisplatin side effects

Back 43

nephrotoxic (prevent with mannitol or amifostine?), ototoxic, and MAJOR vomiting (cisplat makes you go splat)

alkylating agent

Front 44

bisulfan side effects

Back 44

alkylating agent, pulmonary fibrosis + hyperpigmentation

Front 45

procarbazine side effects

Back 45

alkylating agent, disulfram like rxn, MAO action (no tyramine!)

Front 46

methotrexate side effects and action

Back 46

inhibits dihydrofolate reductase (decreased folate, decrased thymidine)

lungs (fibrosis), kidney! (hepatotoxic, neurotoxic), apthous ulcers

reverse toxicity with LEUCOVORIN (folate)

Front 47

Purine analogs

Back 47

anti-metabolite (S phase) anti-cancer

ex. 6MP- mercaptopurine, thiguanine

allopurinol potentiates (normally inactivated by xanthene oxidase)

Front 48

Pyrimidaine analogs

Back 48

5-FU, binds folate creates complex that decreases dTMP

causes photosensitivity

toxicity reverse with thymidine WORSE with leocovorin (folate)

Front 49

hydroxyurea action

Back 49

inhibits ribonucleotide reductase (anti-metabolite anti-cancer, S phase)

Front 50

anthracyclines side effects

Back 50

doxorucibin, danorubicin- anti-cancer antibiotic

dilated cardiomyopathy (rales)

toxic extraversion (necrosis)

Tx dexrazonane to prevent (dex for dox)

Front 51

bleomycin MOA and side effects

Back 51

only cell cycle specific antibiotic anti-cancer (G2!)

lung fibrosis

Front 52

eptoside

Back 52

plant alkaloid anti-cancer, inhibits topoisomerase II

Front 53

vincristine/vinblastine

Back 53

vincristine: neurotoxic (neuropathy!), paralytic ileus,bone marrow ok (christ saves the bone marrow)

vinblastine: destroys bone marrow

Front 54

what enzyme causes pancreatitis?

Back 54

trypsinogen self activates to trypsin activating all other enzymes (normally cleaved by enterokinase in duodenum)

Front 55

Lesch-Nyhan syndrome

Back 55

X-linked recessive, defect in hypoxanthine-guanine phosphoribosylratransferase (HGPRT), results in failure of purine salvage pathway, increased amounts of the purine bases, hypoxanthine, and guanine are degraded to uric acid. De novo purine synthesis must increase to replace the lost bases (Phosphoribosyl pyrophosphage amidotransferase activity will be increased (acts on PRPP, first committed step of de novo purine)

Front 56

PAH

Back 56

freely filtered by the kidney, majority secreted in proximal tubule. NOT resabsorbed by any portion of the neprhon. therefore lowest concentration must be in bowman's space

Front 57

homeobox genes

Back 57

code for DNA-binding transcription factors that play an important role in morphogenesis (proper formation and PLACEMENT of lungs and organs throughout the body)

Front 58

Isolated systolic hypertension

Back 58

SBP > 60 with a normal DBP > 90. Caused by age-related decreases in the compliance of the aorta (stiffining) and its branches (vs. renal stenosis which would increase diastolic AND systolic)

found in 1/3 of people >80

Front 59

NO dilates...

Back 59

venodilator! (blood pools in veins) decreases preload which decreases oxygen demand and thereby treats angina

Front 60

Benzos should not be taken with...

Back 60

alcohol, barbiturates, neuroleptics, or 1st generation antihistamines (chlorpheniramine, diphenhydramine (benadryl), promethazine, and hydroxyzine

2nd gen antihistamines dont affect CNS

Front 61

how can you detect minimal change disease?

Back 61

normal light and IF microscopy. use ELECTRON MICROSCOPY to detect podocyte effacement

Front 62

sporadic colon cancer progression

Back 62

APC-K-ras-p53/DCC

Front 63

what happens to the lungs during sepsis or shock?

Back 63

ARDS!!! widespread injury to pulmonary microvascular endothelium and/or alveolar epithelium causes alveolocapillary membrane to be leaky

fluid accumulation in alveolar sacs.

Front 64

differential cyanosis (aka cyanosis in lower body)

Back 64

most suggestive of patent ductus arteriosus (PDA) with reversal of shunt flow.

whole-body cyanosis seen in reversal of septal defects or tetrology

Front 65

TB immune reaction

Back 65

Type IV hypersensitivity

Front 66

MOA Of skin retraction and peu de orange in breast cancer

Back 66

retraction = infiltrates the suspensory Cooper ligaments

peu de organce = blockage of lymph drainage

Front 67

bilirubin handling in liver

Back 67

passively takes up unconjugated/indirect, but secretes direct/conjugated through an active process (energy dependent organic anion transport)

Front 68

excess blood conjugated bilirubin

Back 68

water soluble, loosely bound to albumin, excreted in urine!

Front 69

causes of membranous neprhopathy

Back 69

systemic-diabetes, SOLID TUMORS (lung and colon), immune disorders (SLE)

drugs- gold, penicillamine, and NSAIDs

Infections- hep B, C, malaria, syphilis

Front 70

mastetomy injurty

Back 70

to long thoracic nerve- paralysis of serratus anterior

cannot abduct arm above 90 degrees

winged scapula (when pressing anteriorly on a wall, can't hold medial border of scapula against posterior chest wall)

Front 71

flattened facies and epicanthal folds, oblique palpebral fissures, endocardial cushion defect

Back 71

think DOWN SYNDROME

Front 72

first action when addressing medical errors

Back 72

ROOT CAUSE ANALYSIS (dont be fooled by the word 'system based')

Front 73

what is the net-result of Mys G. on post-synaptc muscle cell

Back 73

reduced motor end-plate potential!! (due to decreased actyelcholine receptors)

Front 74

superficial hemangiomas

Back 74

aka strawberry appear during first few weeks of life, grow rapidly, and then regress pontaneously

bright red when near surface, pruprly when deeper

kind of adult version of cherry, but those are premanent

Front 75

tuberous sclerosis inheritance

Back 75

AD

Front 76

kartagener inheritance

Back 76

AR

Front 77

friederich ataxia inheritance

Back 77

AR

Front 78

marfan inheritance

Back 78

AD

Front 79

what is responsible for polyp?

Back 79

APC mutation, chromosome 5

Front 80

caclium oxalate stone

Back 80

X shaped (square)

Front 81

AMP stone

Back 81

coffin lid/rectangular

Front 82

Uric acid stone

Back 82

rhombus (diamond)

Front 83

cysteine/amino aciduria stone

Back 83

hexagon, use sodium nitroprusside test

Front 84

what mutation (if any) is responsible for gestational diabetes?

Back 84

defects in glucokinase- a glucose sensor on B cells. results in mild hyerpglycemia that is exacerbated by pregnancy

Front 85

what increases risk of myopathy with statin?

Back 85

fibrate (ex. gemfibrozil)

Front 86

what increases risk of cholesterol stone with bile acid resins (ex. cholestyramine)

Back 86

fibrates! (ex. gemfibrozil)

Front 87

prazosine

Back 87

a-1-adrenergic antagonist

Front 88

pilocarpine

Back 88

nonselective muscarinic receptor agonist

Front 89

scopolamine

Back 89

antimuscarinic

Front 90

pyridostigmine

Back 90

cholinesterase inhibitor

Front 91

describe GI side effects of MG treatment

Back 91

pyridostigmine causes excessive cholinergic stimulation of gut leading to GI side effects (cramping, nausea, diarrhea), can be tx with scopoloamine (selective muscarnic acetylcholine antagonist) this wont effect skeletal muscles b/c they use nicotinic receptors

Front 92

heart defects associated with digeorge syndrome

Back 92

tetralogy of fallot, and aortic arch anomalies

Front 93

heart defects associated with friedereich's ataxia

Back 93

hypertrophic cardiomyopathy

Front 94

heart defects associated with tuberous sclerosis

Back 94

valvular obstruction due to cardiac rhabdomyomas

Front 95

what volume changes are seen in diabetes insipidus

Back 95

hyperosmotic volume contraction

can happen secondary to head trauma!

also can occur in profuse sweating due to hypotonic nature of sweat

Front 96

acute GI hemorrhage volume changes

Back 96

isotonic loss of ECF (no change in ICF)

also seen in diarrhea

Front 97

adrenal insufficiency changes

Back 97

hypoosmotic volume contraction

Front 98

hypertonic saline infusion volume changes

Back 98

hypertonic volume expansion of ECF

Front 99

what is the fastest metabolized sugar?

Back 99

fructose-1-phosphate

Front 100

MOA of vincristine

Back 100

inhibit microtubule formation, halt cells in M phase

Front 101

toxicities of amphotericin B

Back 101

nephrotoxicity! hypokalmia and hypomagnesemia are the two most serious electrolyte disturbances

Front 102

how to determine sight of right upper quandrant non-pulsatile bleeding

Back 102

pringle maneuver! pinch hepatoduodenal ligament- if still bleeds must be IVC or hepatic veins, if stops bleeding it is portal vein

Front 103

filgrastim

Back 103

G-CSF analog

Front 104

neisseria meningititis tx

Back 104

ceftriaxone or penicillin G

rifampin, cipro, or cef for prophylaxis

Front 105

histology of myxoma

Back 105

peduncuated mass in left atrium

composed of scattered cells within a mucopolysaccharide stroma, abnormal blood vessels, and hemorrhaging

Front 106

cells involved in granuloma formation

Back 106

Th2, Il-2 (stimulates Th2), TFN-y (recruits macrophages

Front 107

nystatin MOA

Back 107

binds ergosterol in fungal cell membrane causing formation of pores and leakage of fungal cell contents

Front 108

5' to 3' exonuclease activity, 3'-5' exonuclease, and polymerase

Back 108

DNA pol I

Front 109

risks for digoxin toxicity

Back 109

hypokalemia, hypovolemia, renal failure

Front 110

3-5'' exonuclease activity

Back 110

DNA Pol III (only)

DNA Pol I (also has 5-3)

Front 111

right hand weakness following swinging with one arm

Back 111

lower brachial plexus, C8=T1 median and ulnar nerves

Front 112

axillary nerve damage

Back 112

occurs during shoulder dislocations or fractures of the proximal humurous, weakness of deltoid and teres minor muscles

Front 113

radial nerve injury

Back 113

midshaft humorous fractures, posterior arm numbness, paralysis or arm and forearm extensors

Front 114

musculotaneous

Back 114

upper trunk brachial plexus injuries (classicaly when head and shoulder and spread apart)

biceps brachii and brachialis muscle---weakness of forearm and flexion at the elbow

Front 115

systemic mastocytosis

Back 115

abnormal proliferation of mast cells and release of histamine!

- increased gastric acid secretion (diarrhea and ulcers, N&V, malabsorption etc)

- syncope, flushing, hypotension, tacycardia, bronchospasm,

- pruritis, urticaria, and dermatographism

Front 116

homocystinuria

Back 116

most common mutation in cystathione beta synthase (normally converts homocysteine to cystathione)..can't form cysteine and require supplmentation!

premature atherosclerosis and hypercoagulability, ectopia lentis, osteoporosis, mental retardation

Front 117

hyatid cyst

Back 117

caused by Echincoccus granulosus, no aspiration because can cause anaphylaxis

give chemo, surgery, mebendazole or albendazole

monocyte and eosinophil rxn

sheep and dog exposure

Front 118

testicular cancer drainage

Back 118

para-aortic

Front 119

antimuscarinic effects

Back 119

flushed skin, mydriasis

Front 120

wilson defect and tx

Back 120

decreased ceruloplasm and impaired secretion

penicillamien and other copper chelators (trientene)

Front 121

ulcers in posterior duodenal bulb

Back 121

gastroduodenal artery

Front 122

lesser curvature ulcers

Back 122

left (proximal) and right (distal) gastric artery

Front 123

oseltamavir

Back 123

neurominidase inhibitor, prevents viral release from infected cells

Front 124

amantadine in influenza

Back 124

impairs viral uncoating within cell

Front 125

causes of xanthelasma (think about this when they do eyelid biopsy)

Back 125

primary and secondary hyerplipidemia, cholestatic conditions like PBC can also cause hyperlipidemia!