Doctors In Training Flashcards

Front 1

What are the side effects of atropine?

Back 1

Hot as a hare, dry as a bone, mad as a hatter, red as a beet, blind as a bat.

Front 2

What are 5 classes of medications used to treat glaucoma?

Back 2

Alpha antagonist- epinephrine
Beta blockers- timolol, decreased aqueous humor secretion
Diuretics- acetazolamide
Chlinomimetics - pilocarpine, physostigmine echo.

Prostaglandins- latanoprost

Front 3

What are the signs of PCP intoxication? (FA p448)

Back 3

Belligerence, impulsiveness, fever, psychomotor agitation, vertical and horizontal nystagmus, tachycardia, ataxia, homicidality, psychosis, delirium

Front 4

What enzyme is deficient in alkaptonuria? What are the manifestations of alkaptonuria?
(FA p108)

Back 4

Also known as ochronosis, deficiency of homogentisic acid oxidase in the degradative pathway of tyrosine. Autosomal recessive. Benign disease.

Dark connective tissue, pigmented sclera, urine turns black on standing. Debilitating arthalgias.

Front 5

What would you expect to find in the synovial fluid of a pt with gout? with pseudogout? (FA p380)

Back 5

Painful big toe MTP joint. Tophus formation – Synovial fluid of gout will have monosodium urate crystals, mainly from underexcretion, Crystals are needle shaped and negatively birefringent – yellow crystals under parallel light. Treat with colchicine, nsaids, probenecid, allopurinol.

Front 6

Chagas’ disease –

Back 6

Trypansoma cruzi
Dilated cardiomyopathy, megacolon, megaesophagus,
Transmitted by Reduviid bug

Front 7

- amoebic dysentery

Back 7

Entamoeba histolytica
Bloody diarrhea, liver abcess, RUQ pain, Flask shaped ulcers if submucosal abcess colon ruptures.

Front 8

protozoal vaginitis

Back 8

Trichomonas vaginalis
Foul smelling, greenish discharge, itching and burning.

Front 9

- malaria

Back 9

Plasmodium vivax/ovale; Falciparum; malariae
Cyclic fever, headache, anemia splenomegaly
Vivax: cycles occur every other day; dormant form in liver is treated with primaquine
Falciparum: Severe daily cycles, parasitized RBCs occlude capillaries in brain, kidneys and lung

Front 10

- spiking fevers hepatosplenomegaly, pancytopenia

Back 10

Leishmania donvani – Sandfly, Macrophages contain amastigotes

Front 11

bloating, flatulence, foul-smelling diarrhea in campers and hikers

Back 11

Giardia lamblia- bloating, flatulence, foul smelling, fatty diarrhea. Cysts in water.
Ghirardelli chocolates for fatty stools.

Front 12

What is the most common site of a berry aneurysm? What diseases are often a/w berry aneurysms? (FA p401)

Back 12

Occur at bifurcations in the circle of willis. Most common site is bifurcation of the ACA. Assoicated with ADPKD, Ehlers-Danlos, Marfans. Also age hypertension, smoking, blacks.

Front 13

What enzyme converts alcohol to sorbitol? What diabetic complications can be attributed to sorbitol induced osmotic damage? (FA p104)

Back 13

Aldolase reductase: used to trap glucosein the cell to convert it to its alcohol coutnerpart.

Sorbitol is osmotically active because it cannot freely cross the membrane in glucose. Prolonged hyperglycemia lead to sorbitol accumulation, creates osmotic prssure that causes water to enter the cell and produce osmotic damage.

Front 14

What is the underlying cause of physiologic jaundice in the newborn? How is it treated? (FA p326)

Back 14

Kernicterus: because immature UDP-glucuronyl transferase leads to build up of unconjugated hyperbilirubinemia,
Treat with phototherapy (converts UCB to water soluble form)

Front 15

What are the common causes of restrictive cardiomyopathy? (FA p269)

Back 15

Sarcoidosis, amyloidosis, postradiation fibrosis, enocardial fibroelastosis, Lofflers syndrome, and hemochromatosis.

Front 16

What is the difference between a desmosome and a hemidesmosome? (FA p366)

Back 16

Desmosome (Macula adherens) – small discrete sites of attachments in bewteen cells, cadherins connect to intermediate filaments.

Hemidesmosome – connects cells to underlying extracellular matrix

Front 17

What are the important cytokines?

Back 17

Hot T-Bone stEAk
IL-1: Fever, IL-2: T-cells, IL-3: B cells, IL-4: IgE, IL-5: IgA

Clean up on isle 8 = neutrophils = IL-8

Front 18

What gives rise to the jugular venous a, c, and v waves? (FA p398)

Back 18

a wave: atrial contractions
c wave: RV contraction
v wave: increased atrial pressure due to filling against closed tricuspid valve

Front 19

What are the different etiologies of Cushing’s syndrome? How is the level of ACTH different in each? (FA p291)

Back 19

In general an increase in cortisol.

Exogenous: steroids #1 cause; decrease ACTH

Endogenous:
Cushing’s disease: due to ACTH secretion from pituitary adenoma increased ACTH

Ectopic ACTH: from nonpituitary tissue making ACTH (small cell carc)

Adrenal: adenoma, carcinoma, nodular adrenal hyperplasia. Decrease ACTH

Findings: Hypertension, weight gain, moon facies, truncal obesity, buffalo hump, hyperglycemia, osteoperosis, amenorrhea, and immune suppression.

Front 20

What is the cause of cystinuria? What is the treatment for cystinuria? (FA p108

Back 20

Hereditary defect (AR) of renal tubular amino acid transporter for cysteine, ornithine, lysine and arginine in the Proximal convoluted tubule of the kidneys.

Excess systine in urine = cystine staghorn kidney stones. Cystine= cysteine + cysteine by a disulfide bond.

Front 21

implantation

Back 21

Week 1 : hCG secretion begins after this event

Front 22

Organogenesis:

Back 22

Week 3-8 (embryonic period)

Front 23

heart begins to beat:

Back 23

week 4

Front 24

can distinguish male or female genitalia:

Back 24

week 10

Front 25

gastrulation

Back 25

3 weeks

Front 26

formation of primitive streak and neural plate

Back 26

week 3

Front 27

Which type of e. coli causes traveller’s diarrhea? (p 153)

Back 27

ETEC enterotoxigenic e coli. The toxin is called labile/stable toxin.

Front 28

causes diaper rash

Back 28

candida albicans

Front 29

- opportunistic mold with septate hyphae that branch at a 45 degree angle

Back 29

Aspergillus fumigatus- lung cavity aspergilloma, invasive aspergillosis in those with chronic granulomatous disease.

Front 30

opportunistic mold with irregular nonseptate hyphae that branch at wide angles (>90 degrees)

Back 30

Mucor and Rhizopus. Related to ketoacidotic diabetes. Causes infarction and necrosis of distal tissue. Rhinocerebral frontal lobe abcesses.

Front 31

dimorphic fungi common to SW US (San Joaquin Valley fever)

Back 31

Coccidiodomycosis – southwestern US, California. Causes pneumonia and meningitis; can disseminate to bone and skin. Case rate increases after earthquakes

Front 32

causes thrush in immunocompromised pts and vulvovaginitis in women

Back 32

Candida albicans- systemic superficial fungal infection. Oral and esophageal thrush in immunocomprimised.

Front 33

dimorphic fungi with broad-based budding yeast

Back 33

Blastomycosis- broad based bud

Front 34

- known for causing pneumonia in AIDS pts  start Bactrim prophylaxis when CD4 <200

Back 34

Pnumocystis jiroveci – diffuse bilateral CXR appearance.

Front 35

dimorphic fungi common to Mississippi and Ohio river valleys

Back 35

Histoplasmosis

Front 36

causes a skin infection in those pricked by a thorn

Back 36

sporthrix schenckii- unequal budding

Front 37

5. What is the cause of Chronic Granulomatous disease? What are the consequences of Chronic Granulomatous disease? (FA p212)

Back 37

Lack of NADPH oxidase, decreased reactive oxygen species and absent respiratory burst in neutrophils.
Increased susceptibility to catalase positive organisms. (s aureus, ecoli, aspergillus)

Labs: Negative nitroblue tetrazolium dye reduction test.

Front 38

6. What are the two most common complications after an MI? (FA p268)
What is Dressler’s syndrome? (FA p268)

Back 38

Cardiac arrhythmia- common cause of death before reaching hospitals

Left ventricular failure and pulmonary edema

Dressler’s syndrome – autoimmune phenomenom resulting in fibrinous pericarditis

Front 39

7. Compare the leading causes of death in ages 1-14 to those in ages 15-24? (FA p58)

Back 39

Injuries number one for both categories, 1-14 has cancer, and congenital anomalies as the second leadin cause, whereas 15-24 is homicide. And then suicide.

Front 40

. What is the A-a gradient, and what might an increased A-a gradient indicate? (FA p506)

Back 40

It’s the difference between the oxygen content of air in the alveoli (A) and air in the in the pulmonary arteries. If the barrier between the two becomes thickened it can prevent perfusion and thus increase the ratio, because the alveoli will still have the same oxygen content, but the arterial blood will not.

Increased A-a gradient may occur in hypoxemia; causes include shunting, V/Q mismatch. Fibrosis.

Front 41

In which order elimination is the rate of elimination proportional to the drug concentration?
(FA p229)

Back 41

First order elimination is proportional to the drug concentration.
Concentration exponentially down with time.

Zero order means that the rate of elimination is constant regardless of Concentration. Linear elimination with time. PEA = zero order drugs, and a pea is round like the number zero. Phenytoin, Ethanol, Aspirin.

Front 42

Where can you find nicotinic acetylcholine receptors in the body? (FA p231)

Back 42

Nicotinic ACh receptors are ligand-gated Na/K channels Nn are found in autonomic ganglia, and Nm are found in neuromuscular junctions.

Muscarinic Ach are G-protein coupled receptors that act through 2nd messengers, 5 Subtypes M1-5.

Front 43

What is the most common tumor of the appendix? (FA p296)

Back 43

Carcinoid tumor. Derived from neuroendocrine cells of GI tract. They secrete high levels of serotonin. Not seen if the tomor is limited to the GI tract. Diarrhea, cutaneous flushing, asthmatic wheezing and right sided valvular disease. Increased 5-HIAA in urine.

Front 44

- SE: teeth discoloration (FA p188) –

Back 44

Tetracyclines (Tetracycline, doxycycline, demeclocycline, minocycline)
Bacteriostatic bind to 30S prevent attachment of aminoacyl-tRNA
Doxycycline is fecally eliminated and can be used in patients with renal failure.
Vibrio cholerae, Acne, Chlamydia, Ureaplasma, Urealyticum, Mycoplasma pneumoniae, Tularemia, H. pylori, Borrelia burgdorferi, Rikettsia.
VACUUM THe BedRoom

Front 45

- SE: tendonitis (FA p190)

Back 45

Fluoroquinolones- Ciprofloxacin (all floxacin endings)
Inhibit DNA gytase , bactericidal.
Gram Negative rods of urinary and GI tracts.
FlouroquinoLONES hurt attachments to your BONES

Front 46

- SE: red man syndrome (FA p187)

Back 46

Vancomycin – inhibits cell wall mucopeptide formation by binding D-ala D-ala portions of cell wall precursors. Resistance can occur if amino acids change to D-ala D-lac.
Used for serious multidrug resistant organisms including S. aureus, and Clostridium difficile.

Nephrotoxicity, Ototoxicity, Thrombophlebitis, Diffuse flushing = red man syndrome.
Well tolerated in general does NOT have many problems.

Front 47

- SE: gray baby syndrome (FA p188)

Back 47

Chloramphenicol , inhibits 50S peptidyltransferase activity. Bacteriostatic.

Used to treat meningititis. (H. influenzae, Neisseria meningitidis, S. pnuemoniae)

Toxicity anemia, aplastic anemia, gray baby syndrome, (babies lack UDP-glucuronyl transferase)

Front 48

SE: nephrotoxicity (esp. with cephalosporins), ototoxicity (esp. with loop diuretics)
(FA p187)

Back 48

Aminoglycosides (Gentamicin and the rest of have mycin in name)
Bactericidal, inhibit formation of initiation complex and causes misreading of mRNA. Require O2 and are ineffective against anaerobes.

Used in severe gran negative rod infections (synergistic with B-lactam antibiotics) Give neomycin for bowel surgery.

“Mean” GNATS canNOT kill anaerobes (gentamicin, neomycin, amikacin, tobramycin, streptomycin) NOT = nephrotoxicity, Ototoxicity and Teratogen.

Front 49

SE: pseudomembranous colitis (FA p185), (FA p188)

Back 49

Ampicillin/amoxicillin = same as penicillin but wider spectrum
AMPed up penicillin. amOxicillin has a greater Oral bioavailability than ampicillin.
Coverage: HELPS kill enterococci.
H. influenzae, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella.

Clindamycin – Blocks peptide bond formation at the 50S ribosomal subunit. Treats anaerobes from above the diaphram

Front 50

Describe the steps involved in the pupillary light reflex. (FA p419)

Back 50

light causes retina to send a signal via CN II to pretectal nuclei in midbrain that activate bilateral Edinger-Westphal nuclei; BOTH EYES constrict

Marcus Gunn pupil = aafferent pupillary defect (due to optic nerve damage or retinal detachment) causes bilateral pupillary constriction when light is shone in affected eye.

Front 51

Which diuretic is used to lower intracranial pressure? What are the contraindications to the use of this diuretic? (FA p473)

Back 51

acetazolamide is a carbonic anhydrase inhibitor. Causes self limited NaHCO3 diuresis and reduction of total body HCO3 stores.

Causes ACIDOSIS!!

Front 52

What are the common causes of eosinophilia? (FA p337)

Back 52

NAACP

Neoplastic
Asthma
Allergic processes
Collagen Vascular diseases
Parasites (invasive)

Defends against helminthic and protozoan infections.

Front 53

In a normal Gaussian curve, what percentage of the sample population falls 1 standard deviation, 2 standard deviations, and 3 standard deviations?

Back 53

68% 95% 99.7

Front 54

What structures give rise to the glomerular filtration barrier? Which disease results from a loss of the negative charge glomerular filtration barrier? (FA p457)

Back 54

Fenestrated capillary endothelium (size barrier)
Fused basement membrane with heparan sulfate (negative charge barrier)
Epithelial layer consisting of podocyte with foot processes

Nephrotic syndrome results if the charge barrier is lost, resulting in albuminuria, hypoproteinemia, generalized edema and hyperlipidemia.

Front 55

What substance activates the classic complement pathway? What substance activates the alternative compliment pathway? (FA p206)

Back 55

Activated by IgG or IgM in the classic pathway

Activated by molecules on the surfaace of microbes (especially endotoxin) in the alternative pathway

Front 56

What clinical scenario is most commonly seen in Reye’s syndrome? What are the characteristics of Reye’s syndrome? (FA p325)

Back 56

Fatal childhood hepatoencephalopathy. Findings: mitochondrial abnormalities, fatty liver, hypoglycemia, coma.
Associated with viral infection (VZV and influenza B) that has been treated with salicylates. Mechanism: aspirin metabolites decrease beta oxidation by reversible inhibition of mitochondrial enzyme. Aspirin is not recommned for CHILDREN.

Front 57

Which anticancer agent fits the following description? (FA p360 - FA p363)

• toxicity is increased by allopurinol

Back 57

6-mercaptopurine – purine analog, decreases de novo purine synthesis. Used in leukemias, lymphomas. Metab by xanthine oxidase, therefore increased toxicity with allopurinol

Front 58

. Which anticancer agent fits the following description? (FA p360 - FA p363) • cardiotoxic; monitor patients using ejection fraction

Back 58

Doxorubicin, Adriamycin, daunorubicin – generate free radical. Noncovalently intercalates in DNA, breaks in DNA, decreased replication. Part of ABVD regiment for Hodgkins lymphoma.

Front 59

. Which anticancer agent fits the following description? (FA p360 - FA p363)
blocks polymerization of tubulin

Back 59

Vincristine/vinblastine. Binds tubulin in Mphase blocks polymerization. Part of MOPP regiment for Hodgkins lymphoma, Wilm’s tumor, choriocarcinoma

Vincristine = neurotoxicity and paralytic ileus.
Vinblastine = Blasts Bone Marrow

Front 60

. Which anticancer agent fits the following description? (FA p360 - FA p363)
hyperstabilizes polymerized microtubules

Back 60

Paclitaxel – It is TAXing to stay polymerized.
Ovarian and breast carcinomas.

Front 61

. Which anticancer agent fits the following description? (FA p360 - FA p363)
known to cause hemorrhagic cystitis

Back 61

can be prevented by mesna
cyclophosphamide – covalently X-link DNA at guanine N-7, require bioactivation by liver.
Non-Hodgkin’s lymphoma, breast and ovarian carcinomas. Also immunosuppressant.

Front 62

. Which anticancer agent fits the following description? (FA p360 - FA p363) crosses blood-brain barrier; used in brain cancers

Back 62

nitrosoureas –(carmustine, lomomustine, semustine, streptozocin)
Require bioactivation. Cross blood-brain barrier  CNS

Front 63

What are the two different types of second degree AV block? How do they differ?
(FA p260)

Back 63

Mobitz 1 = Progressive lengthening of the PR interval until a beat is “dropped” (a p wave not filled by a QRS complex) Usually asymptomatic

Mobitz II = dropped beats that are not preceded by a change in the length of the PR interval. These abrupt, nonconducted P waves result in a pathologic condition. It is often found as a 2:1 block, where there are 2 P waves to 1 QRS complex. May progress to 3rd degree block.

Front 64

What are the principle signs and symptoms of Lesch-Nyhan syndrome? What enzyme is defective in this syndrome, and what is its biochemical role? (FA p69)

Back 64

Defective purine salvage owing to absence of HGPRT which converts hypoxanthine to IMP and guanine to GMP. Results in excess uric acid production.

Findings: Retardation self mutilation, aggression, hyperuricemia, gout, choreoathetosis. X-linked recessive. He’s Got Purine Recovery Trouble

Front 65

What hormone is responsible for the proliferative phase of the endometrial cycle? (FA p481)

Back 65

Estrogen stimulates endometrial proliferation, Progesterone maintains endometrium to support implantation.

Front 66

What changes in sleep patterns and sexual anatomy are seen in the elderly?
(FA p63)

Back 66

Decreased REM, and slow wave sleep; Increased latency and awakenings

Men – slower erection/ejaculation, longer refractory period
Women – vaginal shortening, thinning and dryness

Front 67

What are the symptoms of pheochromocytoma? What lab test can be used to diagnose pheochromocytoma? What class of drug is used to treat pheochromocytoma? (FA p292)

Back 67

Most common adult tumor of the adrenal medulla. Derived from chromaffin cells.
Secrete epinephrine, NE and dopamine, and can cause episodic hyertension
Urinary VMA (breakdown product of NE) is found in urine
Treatments = alpha antagonist especially phenoxybenzamine (nonselect, irreversible)
5 Ps = Pressure (BP) Pain (headache) Persipiration, Palpitations (tachy) Pallor

Front 68

What type of lymphoma has the histological appearance of a “starry-sky” pattern? What virus is associated with this type of lymphoma? (FA p352)

Back 68

Burkitts’ lymphoma, (8,14) c-myc gene
Associated with EBV. Jaw lesion in endemic africa; pelvis or abdomen in sporadic.

Front 69

What are the common causes of pericarditis? What clinical findings would lead to suspject pericarditis as a diagnosis? (FA p272)

Back 69

Serous: SLE, rheumatoid, viral infection, uremia
Fibrinous: Uremia, MI (Dressler’s), rheumatic fever
Hemorrhagic: TB, Malignancy

Pericardial pain, friction rub, pulsus paradoxus, distant heart sounds. ECG changes with ST segment elevation.

Front 70

What are the rate-limiting enzymes for the following metabolic processes? (FA p95)
• glycogen synthesis

Back 70

glycogen synthase

Front 71

What are the rate-limiting enzymes for the following metabolic processes? (FA p95) • glycogen breakdown

Back 71

glycogen phosphorylase

Front 72

What are the rate-limiting enzymes for the following metabolic processes? (FA p95) fatty acid synthesis

Back 72

Acetyl- CoA carboxylase (ACC)

Front 73

What are the rate-limiting enzymes for the following metabolic processes? (FA p95) fatty acid oxidation

Back 73

Carnitine acyltransferase I

Front 74

What is the difference between an illusion, delusion, and hallucination? (FA p441)

Back 74

Illusions: Misinterpretations of actual external stimuli (seeing a light and thinking it’s the sun)

Delusion: False beliefs not shared with other members of culture that are firmly maintained in spite of obvious proof of the contrary. (thinking the CIA is spying on you)

Hallucinations: perceptions in the absence of external stimuli (seeing a light that is not actually present.

Front 75

What are the clinical manifestations of polycystic ovarian syndrome? What is the treatment?
(FA p488)

Back 75

Increased LH production leads to anovulation, hyerandrogenism due to deranged steroid synthesis by theca cells. Enlarged bilateral cystic ovaries manifest clinically with amenorrhea, infertility, obesity, and hirtuism. Increased risk of endometrial cancer
Treat with weight loss, OCPS, gonatropin analogs, clomiphene or surgery.

Front 76

What neoplasm is a/w Paget’s disease of the bone? What is the enzyme marker for Paget’s disease of the bone? (FA p222 , FA p376)

Back 76

Secondary osteosarcoma and fibrosarcoma.

Abnormal bone architecture caused by increase in both osteoblastic and osteoclastic activity.
Serum calcuium, phosphorus, and PTH levels are normal. Increased ALP. Mosaic bone pattern, long bone chalk-stick fractures.

Hat size increase, hearing loss is common due to auditory foramen narrowing.

Front 77

What is Lambert-Eaton syndrome? Which neoplasms can cause Lambert-Eaton syndrome?

Back 77

Autoantibodies to presynaptic Ca channel results in decreased ACh release leading to proximal muscle weakness. Extra ocular muscles are spared. Symptoms improve with muscle used. No reversal of of symptoms with AchE inhibitors alone.

Front 78

What cofactors are required for the proper function of pyruvate dehydrogenase? What enzyme is very similar to pyruvate dehydrogenase? (FA p99)

Back 78

1. Pyrophosphate (B1 thiamine)
2. FAD (B2 riboflavin)
3. NAD (B3, niacin)
4. CoA (B5 pantothenate)
5. Lipoic Acid

The complex is similar to alpha ketoglutarate dehydrogenase complex (same cofactors, similar substrate and action) which converts alpha ketoglutarate  succinyl CoA (TCA cycle)

Front 79

councilman bodies

Back 79

Yellow fever virus (flavivirus) – transmitted by Aedes mosquitos.
Seen in liver as acidophilic inclusions
High fever black vomitus, jaundice.

Front 80

Koplick spots

Back 80

Rubeola/measles – Cough, Coryza, Conjunctivitis.. Giant Cell pneumonia.
Red spots with blue-white center on buccal mucosa.

Front 81

meningitis + orchitis (inflammation of testes) + parotitis

Back 81

Mumps! Make your parotid glands and testes as big as POM-poms

Front 82

negri bodies

Back 82

Rabies. Cytoplasmic inclusions in neurons infected by rabies. Bullet shaped capsid

Front 83

(+) heterophil antibody

Back 83

EBV – infects B cells. Fever, hepatosplenomegaly, pharyngitis, and lymphadenopathy
Positive monospot test by agglutination of sheep RBCs

Front 84

fever + cervical lymphadenopathy + hepatosplenomegaly

Back 84

Mononucleiosis

Front 85

What are the sites of fetal erythropoiesis? (FA p124)

Back 85

1. Yolk Sac (3-8 wks) Young Liver Synthesizes Blood
2. Liver (6-20 wks)
3. Spleen (9-28 wks)
4. Bone marrow (28 wks)

Front 86

Which structures perforate the diaphragm? At what level do they perforate the diaphragm?
(FA p501)

Back 86

T8 = IVC
T10 = Esophagus, vagus
T12 = Aorta (red) thoracic duct (white) azygous vein (blue)

Diaphram innervated by C3, C4, and C5 keep the diaphram alive.

Front 87

What is the difference between malingering and factitious disorder? (FA p445)

Back 87

Malingering – patient conciously fakes or claims to have a disorder in order to gain (avoiding work, obtaining drugs) Complaints cease after gain

Factitious disorder – Patient consciously creates a physical and or psychological symptoms in order to assume “sick role” and to get medical attention (primary gain

Front 88

What amino acids are necessary for purine synthesis? (FA p67)

Back 88

Glycine
Aspartate
Glutamine

Purines are PUR As Gold= (Adenosine, Guanine)

Front 89

What symptoms are seen with excess administration / toxicity of an acetylcholinesterase inhibitor? What substances are known for causing this type of toxicity? (FA p234)

Back 89

Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating and Salivation.
SLUDE, or DUMBBELSS.

Typical drugs are parathion and other organophosphates. Irreversible inhibitors.

Antidote: atropine and pralidoxine.

Front 90

What is the difference between preeclampsia and eclampsia? (FA p485)

Back 90

Pregnancy induced hypertension
Preeclampsia- hyertension, proteinuria, and edema. Eclampsia= Preeclampsia + seizures.

Front 91

Where would you expect to find B cells in a lymph node? Where would you find T cells, plasma cells, and macrophages? (FA p198)

Back 91

Follicle = B-cell
Medulla = medullary cords (closely packed lymphocytes and plasma cells) also macrophages.
Paracortex = House T cells. Region of cortext between follicles and medulla. In extreme immune response becomes greatly enlarged, not well developed in patients with DiGeorge.

Front 92

What are the R’s of Rifampin? (FA p191)

Back 92

RNA polymerase inhibitor
Revs up microsomal P-450
Red/orange body fluids
Rapid resistance if used alone

Front 93

In your own words, describe what type I error is (FA p56)

Back 93

False positive ... to mistakenly accept the experimental hypothesis and reject the null hypothesis

Front 94

Compare the leading causes of death in ages 15-24 to those in ages 25-64? (FA p58)

Back 94

In 25-64, the order is cancer, heart disease, injuries, suicide, stroke
In 15-24 the order is Injuries, homicide, suicide, cancer, heart disease

Front 95

What is the cause of tabes dorsalis? What part of the spinal cord is damaged in tabes dorsalis?
(FA p407 – FA p408)

Back 95

Caused by tertiary syphillis. Damages the dorsal columns of the spinal cord. Also Argyll Robertson pupils, reactive to accommodation but not to light.

Front 96

blood supply to motor and sensation of leg and foot

Back 96

Anterior Cerebral Artery

Front 97

blood supply to internal capsule, caudate, putamen, globus pallidus

Back 97

Lateral striate, a branch of MCA

Front 98

blood supply to Broca’s and Wernicke’s speech areas

Back 98

Middle cerebral artery

Front 99

blood supply to motor and sensation of face

Back 99

Middle cerebral artery

Front 100

blood supply to motor and sensation of arms

Back 100

middle cerebral atrery

Front 101

What is the classic presentation of pt with temporal arteritis (giant cell arteritis)? What lab finding helps diagnose temporal arteritis? (FA p275)

Back 101

Unilateral headache, jaw claudication, impaired vision (occlusion of opthalmic artery that may lead to irreversible blindness)

Increased ESR, half of patients have systematic involvement and polymyalgia rheumatica.

Most common vasculitis affecting medium and large arteries, usally brances of the carotid artery. Focal, granulomatous inflammation. Affects elderly females

Front 102

2. What are the signs of portal hypertension? What are the signs of liver failure? (FA p324)

Back 102

Portal hypertension = Esophageal varices and hematemsis, Splenomegaly, Caput Medusae (umbilical varices), hemorrhoids, portal hypertensive gastropathy.

Liver failure signs = Coma, scleral icterus, breath like corpse (fetal hepaticus), Spider nevi, gynecomastia, jaundice, testicular atrophy, astetixis (hand tremor), bleeding tendency (decreased prothrombin and clotting factors), anemia, ankle edema.

Micronodular = metabolic insult (alcohol, hemochromatosis, wilson’s)

Macronodular = hepatic necrosis, post infectious, increased risk for hepatocellular carcinoma.

Front 103

In which glomerular disease would you expect to see the following changes?
foot process effacement (electron microscope)

Back 103

Minimal change disease, selective loss of albumin, not globulins, GBM polyanion loss,
May be triggered by recent infection, most common in children. (Nephrotic)

Front 104

In which glomerular disease would you expect to see the following changes? • wire-loop appearance (light microscope)

Back 104

Diffuse proliferative glomerulonephritis
Subendothelial DNA-anti-DNA ICs.
Most common cause of death in SLE and MPGN, can present as nephrotic.

Front 105

In which glomerular disease would you expect to see the following changes? mesangial deposits of IgA (electron microscope)

Back 105

Berger’s disease- increased synthesis of IgA. LM and IF, Immune Complexes deposit in mesangium.
Ofter presents/flares with a URI or acute gastroenteritis

Front 106

In which glomerular disease would you expect to see the following changes? crescent-moon shaped lesion (light microscope)

Back 106

Rapidly progressive glomerulonephritis – Crescents consists of fibrin and plasma proteins with glomerular parietal cells, monocytes, and macrophages.
Goodpastures (type II hypersensitivity; antibodies to GBM, linear IF)
Wegeners (c-ANCA)
Microscopic polyarteritis (p-ANCA)

Front 107

In which glomerular disease would you expect to see the following changes? segmental sclerosis and hyalinosis (light microscope)

Back 107

Focal segmental glomerulosclerosis. Most common in HIV patients and IV drug users (nephrotic)

Front 108

What structures arise from the Mesonephric ducts? What other name is given to the Mesonephric ducts? (FA p134)

Back 108

Develops into male internal structures (except prostrate) Seminal vesicles, Epididymis, Ejaculatory Duct, Ductus Deferens. (SEED) Also known as wolffian duct

Mesonephric ducts must be induced to remain by increased androgens from the testes.
SRY on Y chromosome codes for testis-determining factor. Mullerian inhibiting substance secreted by testes..

Front 109

5. What are the two types of diabetes insipidus? What is the cause of each? (FA p295)

Back 109

Both are characterized by intense thirst and polyuria, with an inability to concentrate urine owing to lack of ADH.

Central DI- pituitary tumor, trauma, surgery or histiocytosis X
Nephrogenic- Hereditary or secondary due to hypercalcemi, lithium, or demeclocycline (ADH antag)

Water deprivation test to determine if its (central/nephrogenic) then if is do desmopressin test and Central will respond, nephrogenic wont.

Front 110

6. What is endometriosis? What is the classic gross appearance? (FA p487)

Back 110

Non-neoplastic endometrial glands/stroma in abnormal locations outside the uterus. Characterized by cyclic bleeding from ectopic endometrial tissue, resulting in blood filled “chocolate cysts”
Severe menstrual pain. Often results in infertility.
Due to retrograde menstrual flow or ascending infection.

Front 111

7. What are the advantages and disadvantages of oral contraceptive use in females? (FA p497)

Back 111

Advantages : reliable, decrease reisk of endometrial and ovarian cancer, decrease risk of ectopic pregnancy, decreased pelvic infections, regulation of menses


Disadvantages: taken daily, no protection against STDs, increased triglycerides, depression, weight gain, nausea, hypertension, hypercoaguable state.

Front 112

1. What is the WAGR complex? (FA p468)

Back 112

Wilms tumor
Aniridia
Genitourinary malformation
Mental-motor retardation

Front 113

2. What pathologic changes are seen in joints with osteoarthritis? What pathologic changes are seen in rheumatoid arthritis? (FA p378), (FA p379)

Back 113

Osteoarthritis destruction of articular cartilage, subchondral cysts, sclerosis, osteophytes, eburnation(polished ivory appearance of bone), Heberden’s nodes (DIP)

Rheumatoid – affects synovial joints, pannus fomration in joints. Subcutaneous nodules (fibrinoid necrosis surrounded by palisading histiocytes), ulnar deviation, subluzation, bakers cysts (behind the knee) NO DIP involvement.

Front 114

What asthma medication fits the following statement (FA inhaled treatment of choice for chronic asthma p513)

Back 114

beclomethasone, prednisone - inhibit synthesis of all cytokines. Inactivate NF-kb the transcription factor that induces the production of TNF - alpha

Front 115

What asthma medication fits the following statement (FA p513) inhaled treatment of choice for acute exacerbations

Back 115

albuterol – relaxes bronchial smooth muscle

Front 116

What asthma medication fits the following statement (FA p513) narrow therapeutic index, drug of last resort

Back 116

Theophylline – likely causes bronchodilation by inhibiting phosphodiesterase thereby decreasing cAMP hydrolysis. Cardiotoxic, Neurotoxic metabolized by P-450. Blocks actions of adenosine

Front 117

What asthma medication fits the following statement (FA p513) blocks conversion of arachidonic acid to leukotriene

Back 117

zileuton – 5-lipoxygenase pathway inhibitor.

Front 118

What asthma medication fits the following statement (FA p513) inhibits mast cell release of mediators, used for prophylaxis only

Back 118

cromolyn sodium – prevents release of mediators from mast cells.

Front 119

What asthma medication fits the following statement (FA p513) inhaled treatment that blocks muscarinic receptors

Back 119

Ipratropium- competitive block of muscarinic receptors preventing, bronchostriction

Front 120

What asthma medication fits the following statement (FA p513) inhaled long-acting beta-2 agonist

Back 120

Salmeterol , tremor and arrhythmia.

Front 121

What asthma medication fits the following statement (FA p513) blocks leukotriene receptors

Back 121

zarilukast, montelukast

Front 122

3. How many half-lives does it take for a drug infused at a constant rate to reach 94% of steady state? What variables determine the half-life of a drug? (FA p228)

Back 122

4 half lives. Volume of distribution and Clearance are the two variables that determine half life.

1 = 50 %, 2 = 75%, 3 = 87.5%, 4 = 93.75%

Front 123

What asthma medication fits the following statement (FA p513) inhibits mast cell release of mediators, used for prophylaxis only

Back 123

cromolyn sodium – prevents release of mediators from mast cells.

Front 124

What asthma medication fits the following statement (FA p513) inhaled treatment that blocks muscarinic receptors

Back 124

Ipratropium- competitive block of muscarinic receptors preventing, bronchostriction

Front 125

What asthma medication fits the following statement (FA p513) inhaled long-acting beta-2 agonist

Back 125

Salmeterol , tremor and arrhythmia.

Front 126

What asthma medication fits the following statement (FA p513) blocks leukotriene receptors

Back 126

zarilukast, montelukast

Front 127

3. How many half-lives does it take for a drug infused at a constant rate to reach 94% of steady state? What variables determine the half-life of a drug? (FA p228)

Back 127

4 half lives. Volume of distribution and Clearance are the two variables that determine half life.

1 = 50 %, 2 = 75%, 3 = 87.5%, 4 = 93.75%

Front 128

4. What is the cause of achalasia? How is achalasia diagnosed? (FA p316)

Back 128

Failure of relaxation of lower esophageal sphincter (LES) due to loss of myenteric plexus.
High LES opening pressure, associated with Chagas and CREST
Diagnosed with barium swallow.

Front 129

5. What drugs are known for causing diabetes insipidus? What drugs are used to treat diabetes insipidus? (FA p295)

Back 129

Can be induced by hypercalcemia, lithium, demeclocycline (ADH antagonist)

Treated by Adequate fluid intake. For central DI- intranasal desmopressin (ADH analog)
For nephrogenic DI = hydrochlorothiazide, indomethacin, or amiloride.

Front 130

6. What is the antidote for t-PA or streptokinase overdose? (FA p239)

Back 130

Aminocaproic acid

Front 131

7. What are 4 examples of encapsulated bacteria? What test can be used to detect encapsulated bacteria? (FA p141)

Back 131

Klebsiella pneumoniae, Salmonella, Streptococcus pneumoniae, Haemophilus influenzae type B, and Neisseria meningitidis. (Kapsules Shield SHiN)

Capsules serve as an antiphagocytic virulence. They have positive quellung reaction – if present capsule swells.

Front 132

8. Compare the leading causes of death in ages 25-64 to those in ages 65+? (FA p58)

Back 132

Age 25 – 64 = Cancer, heart disease, injuries, suicide, stroke
Age 65+ = Heart disease, cancer, stroke, COPD, pneumonia, influenza.

Front 133

9. What is the underlying problem in Wilson’s disease? What are the characteristics of Wilson’s disease? What is the treatment for Wilson’s disease? (FA p327)

Back 133

Inadequate hepatic copper excretion and failure of copper to enter circulation as ceruloplasmin.

Characterized by Asterixis, Basal Ganglia Degeneration, Ceruplasmin decrease, Cirrhosis, Corneal deposts, copper accumulation, carcinonma, choreiform movements, Dementia

Treat with penicillamine, autosomal-recessive inheritance.

Front 134

What electrolyte abnormality is associated with the following signs and symptoms?
(FA p471)
excess free water intake, coma

Back 134

Low serum [Na] = disorientation, stupor, coma.

Front 135

What electrolyte abnormality is associated with the following signs and symptoms?
(FA p471) flattened T waves on EKG

Back 135

low serum [K]

Front 136

What electrolyte abnormality is associated with the following signs and symptoms?
(FA p471) kidney stones, abdominal pain

Back 136

high serum [Ca]

Front 137

What electrolyte abnormality is associated with the following signs and symptoms?
(FA p471) decreased reflexes  respiratory arrest

Back 137

high serum [Mg]

Front 138

What electrolyte abnormality is associated with the following signs and symptoms?
(FA p471) peaked T waves on EKG

Back 138

High serum [K] also wide QRS

Front 139

What electrolyte abnormality is associated with the following signs and symptoms?
(FA p471) dehydration, delirium, coma

Back 139

High serum [Na] = Neurologic, irritability, delirium, coma

Front 140

What electrolyte abnormality is associated with the following signs and symptoms?
(FA p471) neuromuscular irritability

Back 140

low serum [Ca]

Front 141

12. Which adrenergic antagonists can be used to treat hypertension as well as urinary retention in pts with benign prostatic hyperplasia (BPH)? (FA p237)

Back 141

prazosin, terazosin, doxaozosin.

Front 142

13. What changes are seen in an infant when there is long-term deprivation of affection?
(FA p439

Back 142

4 W’s: weak, wordless, wanting, wary

Front 143

14. What is the underlying cause of hereditary spherocytosis? What microscopic findings and lab values would you suspect in a pt with hereditary spherocytosis? (FA p346)

Back 143

Defect in proteins interacting with RBC membrane skeleton and plasma membrane (ankyrin, band 3.1, or spectrin)

Less membrane causes small and round RBCs with no central pallor  premature removal of RBCs by spleen.

Findings: splenomegaly, aplastic crisis. Howell-Jolly bodies present after splenectomy

Labs: positive osmotic fragility test.

Front 144

15. What are all of the possible side-effects of glucocorticoid use? (FA p362)

Back 144

Cushing-like symptoms, immunosuppression, cataracts, acne, osteoporosis, hypertension, peptic ulcers, hyerglycemia, psychosis.

Front 145

1. What virus is primarily responsible for roseola? What is the characteristic presentation of roseola? (FA p168)

Back 145

HHV-6 : High fevetrs for several days that can causes seizures, followed by diffuse macular rash.

Front 146

2. What is the mechanism of action and clinical use for methylphenidate? (FA p450) (FA p233)

Back 146

(ritalin) Increases presynaptic NE vesuclar release (like amphetamines). Used to relieve ADHD

Front 147

3. What is the most common cause of Erb-Duchenne palsy? What are the characteristic findings of Erb-Duchenne palsy? (FA p371)

Back 147

Erb-Duchenne = waiter’s tip. Traction or tear of the upper trunk of the brachial plexus (C5 and C6 roots); Follows blow to shoulder or trauma during delivery.

Findings: Limb hangs by side (paralysis of abductors), medially rotated (paralysis of lateral roators), forearm is pronated (loss of biceps)

Front 148

4. What is the mechanism of action of the following cholinergic agents?
pralidoxime

Back 148

reversibly binds cholinesterase. Used to combat organophosphate poisoning and nerve agents

Front 149

4. What is the mechanism of action of the following cholinergic agents?
neostigmine

Back 149

anitcholinesterase, incrases endogenous Ach, no CNS penetration. NEO CNS = NO CNS pen

Used for postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of neurmuscular junction blockade.

Front 150

4. What is the mechanism of action of the following cholinergic agents? bethanechol

Back 150

Cholinomimetic = direct agonist. Activates bowel and bladder smooth muscle resistant to AchE. Beth Anne, call me if you want to activate your Bowels and Bladder.

Front 151

What is the mechanism of action of the following cholinergic agents? hexamethonium

Back 151

Nicotinic agonist, Ganglionic blocker. Used in experimental models to prevent vagal reflex responses to changes in blood pressure. (reflex bradycardia caused by NE) “put a hex on smokers (nicotine) to help them quit”

Front 152

What is the mechanism of action of the following cholinergic agents?
atropine

Back 152

muscarinic antagonist. Blocks DUMBBELSS (cholinesterase inhibitor poisoning)

Front 153

What is the mechanism of action of the following cholinergic agents?
carbachol

Back 153

Cholinomimetic = used to treat glaucoma, pupillary contraction, and release or intraocular pressure.

Front 154

4. What is the function of MacConkey’s agar? (FA p140)

Back 154

To determine if organisms are lactose fermenting enterics …. If they are they will turn plate pink

Front 155

6. For what reasons are tetracyclines and fluoroquinolones not given to children?
(FA p188) (FA p190)

Back 155

Tetra = in children causes discoloration of teeth and inhibits bone growth.

Fluoro = Damages cartilage in children, also causes leg cramps and myalgias.

Front 156

8. A depressed pt of yours has suicidal ideation. What would you take into consideration when determining the likelihood of this person actually committing suicide? (FA p444)

Back 156

SAD PERSONS = Risk for suicide completion = Sex, Age(teenager or elderly), Depression, Previous attempt, Ethanol or drug use, loss of Rational thinking, Sickness, Organized plan, No spouse, Social support lacking

Front 157

8. How does standard deviation differ from standard error of the mean? (FA p56)
Which is used in calculating confidence intervals? (FA p57)
8. How does standard deviation differ from standard error of the mean? (FA p56)
Which is used in calculating confidence intervals? (FA p57)

Back 157

SEM = standard deviation/ square root of n

Therefore SEM < standard deviation and SEM decreases as n increases

SEM is uesd for confidence intervals. (1 std = 68%, 2std = 95%, 3std = 99.7)

Front 158

. What is the structure of collagen? What steps are involved in the formation of collagen?

Back 158

Most abundant protein in human body.
Be (So Totally) Cool, Read Books.
Type 1 = Bone Skin Teeth
Type 2= Cartilage, vitreous body, nucleus pulposus
Type 3 = Reticulin (skin, blood vessels, uterus) ehlers-danlos
Type 4 = Basement membrane of basal lamina and lens of eye

Front 159

10. What problem / abnormality is a/w the following buzzwords?
boot-shaped heart

Back 159

Tetralogy of Fallot = PROVe = Pulmonary stenosis, RVH, Overriding aorta, VSD

Caused by anterosuperior displacement of the infundibular septum

Front 160

10. What problem / abnormality is a/w the following buzzwords?
continuous machine-like murmur

Back 160

PDA= Patent Ductus areteriosus = indomethacin closes it, PGE keeps it open

Front 161

10. What problem / abnormality is a/w the following buzzwords?
- (FA p483) webbing of the neck

Back 161

Turner’s syndrome = XO, no barr body. Preductal coarctation, most common cause of amenorrhea

Front 162

10. What problem / abnormality is a/w the following buzzwords?
- (FA p483) Barr body

Back 162

Klinefelter syndrome (XXY)

Front 163

10. What problem / abnormality is a/w the following buzzwords?
- (FA p88) simian crease

Back 163

Down syndrome = Flat facies, prominent epicanthal folds, and simian crease

Front 164

10. What substances are derived from the amino acid phenylalanine? What substances are derived from the amino acid tryptophan? (FA p106)

Back 164

Phen = tyrosine = Dopa (side product melanin(lack in albinism)) = Dopamine = NE = Epi

Tryptophan = Serotonin = melatonin
Tryptophan = Niacin = NAD+/NADP+

Front 165

12. What structures arise from the Paramesonephric ducts? What other name is given to the Paramesonephric ducts? (FA p134)

Back 165

Develops into fallopian tube, uterus, and upper 1/3 of vagina (lower 2/3 from urogenital sinus)

Also known as mullerian.

Front 166

13. What cell type produces PTH? What cell type produces calcitonin? (FA p288, FA p289)

Back 166

Chief cells of parathyroid = Increases bone resorption of calcium and phosphate, Increases kidney reabsorption of calcium in distal convoluted tubule, decrease kidney resorption of phosphate.
Increases kidney production of Vit D.

If serum Ca is low PTH is secreted, If serum Mg is low decreases PTH secretion.

Calcitonin is secreted by the parafollicular cells of thyroid.
Opposes action of PTH., Decreases bone resoption of calcium
Increased serum Ca causes calcitonin secretion.

Front 167

14. What are some of the signs and symptoms of Parkinson’s disease? (FA p397

Back 167

T remor at rest, pill rolling
R cogwheel Rigidity
A kinesia
P ostural instability

Front 168

15. What side effects are common with ACE inhibitor administration? (FA p474)
Captopril

Back 168

Captopril
Cough, Angioedema, Proteinuria, Taste changes, hypOtension, Pregnancy problems (fetal renal damage), Rash, Increased renin, Lower angiotensin II.

Hyperkalemia. Contraindicated in Bilateral renal artery stenosis

Front 169

Which medications, commonly used after MI or cardiac cath with stent placement, inhibit platelet aggregation by inhibiting the ADP pathway involved in fibrinogen binding? (FA
p359)

Back 169

Clopidogrel and ticlopidine = decrease incidence or recurrence of thrombotic stroke

Front 170

2. What is ankylosing spondylitis? What is the typical profile of a pt with ankylosing spondylitis?
(FA p381)

Back 170

Chronic inflam disease of spine and sacroiliac joints  ankylosis (stiff spine due to fusion of joints), uveitis, and aortice regurge. No RF, but HLA-B27

Front 171

What are the potential metabolic fates of pyruvate? (FA p99)

Back 171

Converted to alanine

Converted to oxaloacetate to replenish the TCA cycle of be used for gluconeogenesis

Converted to Acetyl CoA to transition from glycolysis to the TCA Cycle

Converted to lactate as an end of anaerobic glycolysis

Front 172

4. Which antifungal drug fits the following description? (FA p192- FA p193)
- swish and swallow for oral candidiasis (thrush)

Back 172

nystatin  binds to ergosterol disrupting fungal membranes

Front 173

. Which antifungal drug fits the following description?
- side effect: nephrotoxicity

Back 173

Amphotericin B = tears holes in fungal membranes by forming pores.
Fever/chills, hypotension, nephtrotoxicity, arrthymias, IV phlebitis, Hydration reduces nephrotoxicity

Front 174

. Which antifungal drug fits the following description?
- deposits in keratin-containing tissue (nails)

Back 174

griseofulvin –interferes with microtubule function. Oral for superficial infections such as tinea and ringworm.

Front 175

. Which antifungal drug fits the following description?
used for cryptococcal meningitis in AIDS

Back 175

Azoles – inhibit fungal sterol synthesis.
Hormone synthesis inhibition, liver dysfunction, (inhibits cytochrome p-450)

Front 176

- side effect: teratogenic, carcinogenic

Back 176

Griseofulvin

Front 177

5. What are the 3 common androgens in order from the most potent to the least potent? Which antiandrogen drug is useful in the treatment of benign prostatic hyperplasia? How does this agent work?

Back 177

DHT > Testosterone > androstenedione

Finasteride = 5 alpha reductase inhibitor (decreases conversion of testosterone to dihydrotestosterone)

Front 178

6. By what mechanisms does vitamin D alter serum calcium and phosphate levels? (FA p289

Back 178

Increases absorption of both calcium and phosphate, and bone resorption of Ca and Phosphate

Front 179

7. What are the risk factors for endometrial carcinoma? (FA p487)

Back 179

Prolonged use of estrogen without progestins, obesity, diabetes, hypertension, nulliparity, and late menopause.

Front 180

8. How do NSAIDS cause renal damage? (FA p458, FA p461)

Back 180

NSAIDS inhibit prostaglandins (which typically dilate afferent areteriole) so there is decreased GFR and FF.

Front 181

9. What is Zollinger-Ellison syndrome? (FA p296)

Back 181

Gastrin secreting tumor of pancrease or duodenum. Causes recurrent ulcers. Maybe associated with MEN type 1.
To confirm give secretin injection which should normally inhibit gastrin secretion but increases in ZES

Front 182

10. What are the muscles of mastication? (FA p415)

Back 182

Ms Munch, Lateral lowers

Masseter
teMporalis
Medial pterygoid

Lateral pterygoid
All inervated by the trigeminal nerve (V3)

Front 183

11. What agent can be given as an inhaled drug to loosen mucus plugs, can be given orally to treat acetaminophen overdose, and can be given orally as prophylaxis against IV contrast-induced nephropathy in those with preexisting renal disease? (FA p239, FA p514

Back 183

N-acetylcysteine – Mucolytic = can loosen mucous plugs in CF patients. Also used as an antidote for acetaminophen overdose.

Front 184

12. What syndrome causes the triad of sterility, bronchiectasis, and recurrent sinusitis? What is the primary defect in this syndrome? (FA p78)

Back 184

Kartagner’s syndrome, immotile cilia due to a dynein arm defect. Associated with situs inversus

Front 185

What is the cause of I-cell disease? (FA p77

Back 185

inherited lysosomal storage disorder; failure of addition to mannose-6-phosphate to lysosome proteins. (enzymes are secreted outside the cell instead of being targeted to the lysosome) Coarse facial features, clouded corneas, restricted joint movement.

Front 186

What structure traps the inferior poles of a horseshoe kidney? (FA p134)

Back 186

Get trapped underneath inferior mesenteric artery.

Front 187

Which anticancer agent fits the following description? (FA p360- FA p363) given for estrogen sensitive breast cancers

Back 187

tamoxifen and raloxifene, blocks binding of estrogen to esterogen receptor positve cells
tamoxifen increases risk for endometrial carcinoma

Front 188

Which anticancer agent fits the following description? (FA p360- FA p363) S-phase antimetabolite; myelosuppression reversible with leucovorin

Back 188

folic acid analog that inhibits dihydrofolate reductase  decreased dTMP  Decreased DNA and protein synth. Used for leukemias, lymphomas, choriocarcinoma, sarcomas. Also abortions ectopic pregnancy, rheumatoid arthritis and psoriasis

Front 189

Which anticancer agent fits the following description? (FA p360- FA p363) ototoxic and nephrotoxic (much like aminoglycosides and loop diuretics)

Back 189

cisplatin – cross links DNA, used for testicular, bladder, ovary and lung carcinomas

Front 190

Which anticancer agent fits the following description? (FA p360- FA p363) 2 agents known for causing pulmonary fibrosis

Back 190

bleomycin – G2 phase specific. Induces formation of free radicals, which causes breaks in DNA strands

Busulfan – alkylates DNA.

Front 191

15. Which anticancer agent fits the following description? (FA p360- FA p363)
- inhibits topoisomerase II

Back 191

etoposide – small cell carcinoma of lung and prostate, also testicular carcinoma.

Front 192

1. What are the different zones of the adrenal cortex? What hormones are generated in each zone of the adrenal cortex and in the adrenal medulla? (FA p284)

Back 192

Zona Glomerulosa = Aldosterone

Zona Fasciculata = Cortisol, Sex Hormones

Zona Reticularis = Sex Hormones (androgens)

Medulla = Catecholamines

Front 193

What ligaments support the female reproductive system? What structures do they support?

Back 193

Suspensory Ligaments of the ovaries
- Connects ovaries to lateral pelvic wall, Contains Ovarian vessels

Cardinal Ligament
- Connects the cervix to side wall of the pelvis, contains the uterine vessels.


Round ligament of the uterus
- Connects uterine fundus to labyia majora. Contains zero vesssels Derivative of gubenaculum, travels through round inguinal canal

Broad Ligament
Connects uterus, to fallopian tubes and ovaries to pelvic side wall. Contains the ovaries, fallopian tubes and round ligaments of the uterus

Ligament of the ovary
- Connects the ovary to uterus.

Front 194

croup in children

Back 194

Parainfluenza

Front 195

common cold (2 viruses)

Back 195

Rhinovirus

Coronavirus

Front 196

#1 cause of fatal diarrhea in children

Back 196

rotavirus

Front 197

bronchiolitis in infants (especially premature)

Back 197

RSV

Front 198

How do nicotinic acetylcholine receptors differ from muscarinic acetylcholine receptors in their mechanisms of action?

Back 198

Nicotinic ACh are ligand-gated Na/K channels (autoantibodies in Myasthenia Gravis)

Muscarinic Ach receptors are G protein-couples receptors that act through 2nd messengers M1-5

Front 199

What antibiotics are well known for causing both ototoxicity and nephrotoxicity? (FA p187)

Back 199

Vancomycin and Aminoglycosides (needs 02)

Front 200

6. What structures give rise to the gas exchange barrier? (FA p500)

Back 200

Type 1 cells (97%) line the alveoli. Squamous for optimal gas diffusion
Type 2 cells (3%) secrete pulmonary surfactant
Clara cells – nonciliated; columnar with secretory granules. Degrade toxins

Front 201

deficiency causes Rickets and osteomalacia

Back 201

Vitamin D2, from plants, D3 consumed in milk made in skin

Front 202

deficiency causes beriberi or Wernicke-Korsakoff

Back 202

Thiamine (vitamin B1) Cofactor for Pyruvate dehydrogenase, Alpha ketaglutarate dehydrogenase (TCA cycle), Transketolase (HMP shunt), Branched-chain AA dehydrogenase

Front 203

deficiency causes macrocytic, megaloblastic anemia

Back 203

B12 – cobalamin – cofactor for homcysteine methyltransferase, methylmalonyl-CoA mutase

Front 204

• deficiency causes scurvy

Back 204

Vitamin C – necessary for hydroxylation of proline and lysine in collagen synthesis.
Also facilitates iron absorption by keeping in Fe2+ state (more absorbable)

Necessary for dopamine beta hydroxylase, which converts dopamine to NE

Front 205

deficiency causes an increase in PT and PTT

Back 205

Vitamin K – necessary for clotting factos II, VII, IX, X, and protein C and S
Warfarin is vitamine K antagonist

Front 206

deficiency causes night blindness and dry skin

Back 206

Vitamin A

Front 207

deficiency causes cheilosis and corneal vascularization

Back 207

Vitamin B-2 (riboflavin)

Front 208

What is the mechanism of action of and clinical indication for the drug sucralfate?
(FA p332)

Back 208

Used for ulcers, binds to ulcer base, providing physical protection, and allow HCO3 secretion to reestablish pH gradient in the mucous layer

Front 209

What is the mechanism of action of and clinical indication for the drug misoprostol?
(FA p332)

Back 209

Prevention of NSAID rinduced peptic ulcers; maintas PDA, also induce labor

A prostangalndin analog, increases production oand secretion of gastric mucous barrier and decreases acid production.

Front 210

. What is the classic triad of symptoms in hemochromatosis? What lab tests are used to diagnose hemochromatosis? What is the treatment for hemochromatosis

Back 210

Cirrhosis , Diabetes Mellitus, and skin pigmentation.
Increased ferritin, increased iron, decreased TIBC, Increased transferin saturation

Front 211

What is the difference between kwashiorkor and marasmus?

Back 211

Kwashiorkor results from a deficient MEAL: Malnutrition, Edema, and Anemia, Liver (fatty)

Marasmus results from decreased caloric intake and results in muscle wasting.

Front 212

What are the common side effects of beta-blockers? Which pt populations should use caution when taking beta-blockers? (FA p238)

Back 212

Impotence, exacerbation of asthma, cardiovascular side effects (bradycardia, AV block, CHF), CNS adverse effects (sedation , sleep alterations)

Use with caution in diabetics

Front 213

What mature structures arise from the following embryologic structures? (FA p123
bulbus cordis

Back 213

Right ventricle and smooth parts of left and right ventricle

Front 214

What mature structures arise from the following embryologic structures? (FA p123
left horn of sinus venosus

Back 214

Coronary sinus

Front 215

What mature structures arise from the following embryologic structures? (FA p123
primitive atria

Back 215

Trabeculated left and right atrium

Front 216

What mature structures arise from the following embryologic structures? (FA p123
truncus arteriosus

Back 216

ascending aorta and pulmonary trunk

Front 217

What mature structures arise from the following embryologic structures? (FA p123
primitive ventricle

Back 217

portion of left and right ventricle

Front 218

. What mature structures arise from the following embryologic structures?
• right horn of sinus venosus

Back 218

Smooth part of atrium

Front 219

. What mature structures arise from the following embryologic structures?
right common and anterior cardinal veins

Back 219

SVC

Front 220

What is the difference between mean, median, and mode? What are their relationships in a positively skewed curve and a negatively skewed curve? (FA p55)

Back 220

Positive skew is when the mean > median > mode asymmetry with tail on right

Negative skew is when the mean<Median < mode asymmetry with tail on left

Front 221

What features might be seen in pts with narcolepsy? What is the treatment for narcolepsy?
(FA p64)

Back 221

Disordered regulation of sleep-wake cycles. Hallucinations before sleep onset. They go straigh to RIM sleep, Cataplexy – loss of all muscle tone occurs in some. Treat with stimulinats (amphetamines, modafinil)

Front 222

What are the features of serotonin syndrome? When might you see it? (FA p452)

Back 222

SSRIs can cause it especially if taken with MAOI

Hyperthermia, muscle rigidity, cardiovascular collapse, flushing, diarrhea, seizures.

Front 223

What are the distinct characteristics between the rashes of rubella, measles, and
chickenpox? (FA p180)

Back 223

Rubella = Begins at head and moves down

Measles = Begins at head and moves down, but is preceded by Cough Coryza, Conjunctivitis and blue white (Koplik) spots on buccal mucosa

Chickenpox = Rash begins on trunk; spreads to face and extremities

Front 224

2. What is the difference between Wernicke’s aphasias, Broca’s aphasias, and conduction aphasias? (FA p400)

Back 224

Brocas = nonfluent aphasia with intact comprehension
Inferior frontal gyrus
Brocas Broken Boca

Wernicke’s = fluent aphasia with impaired comprehension (superior temporal gyrus)
Wernickes Wordy but makes no sense

Conduction = Poor reptition but fluent speech, intact comprehension. (arcuate fasciculus)

Front 225

What medication “cocktail” is commonly used in the treatment of chronic heart failure?

Back 225

Diuretics, ACE inhibs/ARBs, B-blockers (if compensated), K sparing diuretics

Front 226

what is the equation for determining a drug’s volume of distribution?

Back 226

Amount of drug in the body/ plasma drug concentration

Front 227

What is the clinical use for the following antimuscarinic drug(s)? ipratroprium

Back 227

Used for asthma, and COPD (I pray I can breathe soon)

Front 228

What is the clinical use for the following antimuscarinic drug(s)? atropine, homatropine, tropicamide

Back 228

Produces mydriasis and cycloplegia

Front 229

What is the clinical use for the following antimuscarinic drug(s)? benztropine

Back 229

Parkinsons disease ( PARK my Benz)

Front 230

What is the clinical use for the following antimuscarinic drug(s)? scopolamine

Back 230

Motion sickness

Front 231

How does the mechanism of action of barbiturates differ from the mechanism of action of benzodiazepines? What are the clinical uses for these medications? (FA p429, FA p430)

Back 231

Barbituates facilitate GABA action by increasing the duration of Cl channel opening, thus neuron firing. – sedative for anxiety, seizures, insomnia, induction of anesthesia
Benzodiazepines – facilitate GABA by increasing frequency of Cl channel opening. Used for anxiety, detox, night tremors, sleep walking, general anesthetic.

Front 232

What enzyme is deficient in albinism? (FA p108)

Back 232

Decreased tyrosinase (inability to synthesize melanin from tyrosine). Can also be from defective tyrosine transporters.

Front 233

What lung cells secrete surfactant? What substance can be administered to a pregnant mother prior to a preterm birth (if gestational age is less than 34 wks) to hasten the maturation of these cells? (FA p509)

Back 233

Type II pneumocyte, Give corticosteroids to mother to prevent ARDS in the baby.

Front 234

. What is the blood supply to the embryonic foregut, midgut, and hindgut? What adult structures arise from these primitive guts? (FA p305)

Back 234

Foregut = Celiac Artery = Vagus innervation = T12/L1 = Stomach to proximal duodenum, liver, gallbladder, pancreas, spleen
Midgut = SMA = Vagus Innervation = L1 = Distal Duodenum to proximal 2/3 of transverse colon
Hindgut = IMA = Pelvic innervation = L3 = Distal 1/3 of transverse colon to upper portion of rectum. (splenic flexure is watershed region)

Front 235

. What substance is used to close a patent ductus arteriosus? What substance is used to keep it open? When might you want to keep a PDA open? (FA p264)

Back 235

Indomethacin to close it
Prostaglandins (PGE kEEps it opwn)
Keep it open if there is transposition of great vessels

Front 236

11. What bacteria are known for causing bloody diarrhea?

Back 236

Campylobacter- Comma or S shaped, grows at 42
Salmonella – Lactose negative flagellar motive
Shigella – Lactose negative, very low LD, produces shiga toxin
EHEC – O157:H7 can cause HUS, makes shiga like toxin
EIEC – Invades colonic mucusa
Yersinia enterocolitica – Daycare outbreaks, pseudoappendicitis
C. difficile – pseudomembranous colitis.
Entamoeba histolytica – protozoan

Front 237

What antibiotics have the following mechanisms of action? block DNA topoisomerase

Back 237

Fluoroquinolones

Front 238

What antibiotics have the following mechanisms of action?
block the synthesis of peptidoglycans

Back 238

Bacitracin, vancomycin

Front 239

What antibiotics have the following mechanisms of action? block nucleotide synthesis

Back 239

Sulfonamides, trimethoprim

Front 240

What antibiotics have the following mechanisms of action? - block mRNA synthesis

Back 240

- Rifampin

Front 241

13. What equations are used to calculate odds ratio, relative risk, and attributable risk? (FA p54)

Back 241

Odds ratio = (a/b)/(c/d) or simplified (a*d)/(b*c) used for case control studies
Relative Risk = [a/(a+b)]//[c/(c/d)] used for cohort studies
Attributable risk = a/(a+b) – c/(c+d)

Front 242

What factors are taken into consideration when giving a newborn an apgar score? (FA p61)

Back 242

Appearance
Pulse
Grimace
Activity
Respiration

Front 243

Which artery is most often the culprit in a myocardial infarction? (FA p267)

Back 243

LAD > RCA > Circumflex

Front 244

1. What centrally acting alpha-2 agonist is commonly used to treat hypertension (especially in patients with renal disease)? (FA p237)

Back 244

Clonidine – decreases adrenergic outflow

Front 245

What is the cause of physiologic neonatal jaundice? What is the treatment (when indicated)?

Back 245

UDP-glucuronyl transferase is immature leads to unconjugated hyperbilirubinemia
Phototherapy cures it. (converts UCB to water-soluble form)

Front 246

Which Mycobacteria spp. fits the following description? (FA p150) causes leprosy

Back 246

Mycobacterium leprae – two forms lepromatous and tuberculoid.
Lepromatous presents diffusely over skin and is communicable(fail cell mediated immunity, Tuberculoid is limited to a few hypoesthetic nodules.

Front 247

Which Mycobacteria spp. fits the following description? (FA p150) • causes pulmonary TB-like symptoms in COPD pts

Back 247

M. Kansaii

Front 248

Which Mycobacteria spp. fits the following description? (FA p150) • causes cervical lymphadenitis in children

Back 248

M. Tuberculosis

Front 249

Which Mycobacteria spp. fits the following description? (FA p150) • causes a disseminated disease in AIDS pts

Back 249

M. avium-intracellulare

Front 250

4. In which patient populations is aztreonam a good choice? Against which organisms is this antibiotic effective? (FA p186)

Back 250

Aztreonam is used for patients that are allergic to penicillin. And those with renal insufficiency that cannot tolerate aminoglycosides.
Gram-negative rods – klebsiella spp. , pseudomonas spp., serratia spp, No activity against gram postive or anaerobes

Front 251

5. What is the function of the nucleus of the solitary tract? Nucleus ambiguous? Dorsal motor nucleus?

Back 251

Nucleus Solitarius – visceral sensory information (taste, baroreceptors, gut distention) (VII, IX, X)
Nucleus aMbiguus – Motor innervation of pharynx larynx, and upper esophagus. Swallowing palate elevation. (IX, X, XI)
Dorsal motor nucleus - sends autonomic fibers to heart, lungs and upper GI.

Front 252

6. What are the common causes of dilated cardiomyopathy? (FA p269)

Back 252

Alcohol abuse, wet Beriberi, Coxsackie B virus myocarditis, chronic Cocaine use, Chagas’ disease, Doxorubicin, hemochromatosis and peripartum cardiomyopathy.

Front 253

By what mechanism is digoxin a positive inotrope? (FA p279, FA p251)

Back 253

Direct inhibition of Na/K ATPase leads to indirect inhibtion of Na/Ca exchanger antiport. Increases Ca, positive inotropy. Stimulates vagues nerve.
Increases contractility (CHF), also used for atrial fib cuz it decreases conduction at AV node and depression of SA node.

Front 254

8. What is p value? What is normally an acceptable level of p value? (FA p56)

Back 254

p= probability of making type 1 error. p is judged against alpha(false positive) preset level of significance. If p < .05 then there is less than a 5% chance that the data will show something that is not really there.

Front 255

9. What are the different causes of homocystinuria? How does the treatment differ for each? (FA p108)

Back 255

All are AR, and all result in excess homocysteine. Cysteine becomes essential. Findings also include mental retardation, osteoperosis, tall stature, kyphosis, lens sublaxation, and atherosclerosis.
1. Cystathionine synthase deficiency (treatment decreased Met and inreased Cys and increased B12 and folate in diet.
2. Decreased in affinity of cystathionine synthase for pyridoxal phosphate (treat with increased vitamin B6)
3. Homcysteine methyltransferase deficiency

Front 256

10. What histological change is seen in Barrett’s esophagus? (FA p317

Back 256

Replacement of nonkeratinized (stratified) squamous epithelium with intestinal (columnar) epithelium in the distal esophagus.

Front 257

11. What is the function of the Cori cycle? What are the main substrates involved in the Cori cycle?

Back 257

Cori cycle allows lactate generated during anaerobic metabolism to undergo hepatic glcuoneogensis and become a source of glucose for muscle/RBCs. This comes at the cost of a net loss of 4 ATP/cycle.
Shifts metabolic burden to liver, Lactate sent to liver converted to pyruvate, to glucose.

Front 258

12. What is the hallmark finding of COPD? What is the hallmark finding of a restrictive lung disease?(FA p508 – FA p510)

Back 258

Obstructive = lung volumes > normal (Increased TLC, Increased FRC, Increased RV)
FEV/FVC <80%
Restrictive lung diseases all lung volunes < normal. But FEV/FVC > 80%

Front 259

13. Which immunoglobulin isotype fits the following statement? (FA p204) associated with allergies because it is bound by mast cells and basophils and causes them to degranulate and release their histamine

Back 259

IgE mediates type 1 hypersensitivity through release of histamine. Mediates immunity to worms by activating eosinophils. This is the least concentrated immunoglobulin in serum

Front 260

13. Which immunoglobulin isotype fits the following statement? (FA p204) • present in large quantities on the membrane of many B cells

Back 260

IgD

Front 261

13. Which immunoglobulin isotype fits the following statement? (FA p204) crosses the placenta and, additionally, confers immunity to neonates in the first few months of life

Back 261

IgG – main antibody in secondary immunity/ (delayed) Most abundant. Opsonizes bacteria, neutralizes bacterial toxins and viruses.

Front 262

13. Which immunoglobulin isotype fits the following statement? (FA p204) can occur as a dimer

Back 262

IgA – prevents attachment of bacteria of viruses to mucous membranes; does not fix complement. Monomer in circulation Dimer (when secreted). Found in secretions.

Front 263

13. Which immunoglobulin isotype fits the following statement? (FA p204) • the predominant immunoglobulin in sero-mucous secretions such as saliva, colostrum, milk, tracheobronchial secretions, and genito-urinary secretions

Back 263

IgA

Front 264

13. Which immunoglobulin isotype fits the following statement? (FA p204) can be a pentamer

Back 264

IgM produces primary/immediate response to an antigen. Fixes complement but does not cross placenta. Antigen receptor on the surface of B cells. Pentamer allows it to efficiently trap free antigens out of tissue while humoral response evolves.

Front 265

14. What substances are known for causing gynecomastia? (FA p492)

Back 265

(spironolactone, digoxin, cimetidine, alcohol, ketoconazole) Some Drugs Create Awesome Knockers

Front 266

15. What neoplasm accounts for 85-90% of adult renal cancers? (FA p468)

Back 266

Renal cell carcinoma – invades IVC and spreads hematogenously, metastisizes to lung and bone. Associated with VHL – Ch 3. Polygonal clear cells. Hematuria, palpable mass, polycythemia, flank pain, fever weight loss,. Paraneoplastic syndromes.

Front 267

Which virus is responsible for the following disease? (FA p167) - erythema infectiosum (fifth disease)

Back 267

parvovirus- DNA virus- SS linear (smallest DNA virus)

Front 268

Which virus is responsible for the following disease? (FA p167) hepatitis B

Back 268

hepadnavirus- DS- partial circular - enveloped

Front 269

Which virus is responsible for the following disease? (FA p167) warts, cervical cancer

Back 269

papillomavirus – DS- circular

Front 270

Which virus is responsible for the following disease? (FA p167) smallpox

Back 270

poxvirus - DS linear (largest DNA virus)

Front 271

Which virus is responsible for the following disease? (FA p167) progressive multifocal leukoencephalopathy in HIV pts

Back 271

polyomavirus – DS circular

Front 272

Which virus is responsible for the following disease? (FA p167)
- conjunctivitis

Back 272

adenovirus- DS- linear

Front 273

2. What nerves innervate the branchial arch structures? (FA p128)

Back 273

Arch 1 = CN V2 and V3
Arch 2 = CN VII
Arch 3 = CN IX
Arch 4 and 6= CN X

One man sat chewing, two hands on his face. The third with his pharynx. Swallowed the fourth plate. “Speak up, speak up” said the 6th in return. Your cricothyroid, Makes me want to burn

Front 274

Which tract of the spinal cord relays sensory information from the body? Which tract relays pain and temperature sensation? Which tract relays motor sensation to the body? (FA p406)

Back 274

Dorsal columns carry the sensory nerve endings.

Spinothalamic tract transmit ascending pain and temperature.

Lateral corticospinal tract= motor sensation

Front 275

What are the stages in the development of a spermatid? Where does spermatogenesis take place? (FA p479)

Back 275

takes place in seminiferous tubules, produces spermatids that undergo spermiogenesis (loss of cytoplasmic contents, gain of acrosomal cap)

Primary spermatocyte = Diploid 4N
Secondary spermatocyte = haploid 2N
Spermiogenesis goes from Spermatid to spematozoan

Front 276

. What are the signs of right-sided heart failure? What are the signs of left-sided heart failure?

Back 276

Right-sided heart failure - nutmeg liver, ankle, sacral edema, JVD

Left-sided heart fairlure – Dyspnea on exertion, pulmonary edema, paroxysmal nocturnal dyspnea
Presence of hemosiderin-laden macrophages in lungs due to microhemorrhages from increased pulmonary capillary pressure

Front 277

How does the emphysema caused by smoking differ from the emphysema caused by alpa-1- antitrypsin deficiency? (FA p508)

Back 277

centracinar – caused by smoking,

panacinar – alpha 1 antitrypsin deficiency

Front 278

What is the V/Q at the apex of the lung? At the base of the lung? During airway obstruction? During blood flow obstruction? (FA p507)

Back 278

V/Q = 3 at apex of lung
V/Q = .6 base of lung

Infinity if blood flow obstruction, 0 if airway obstruction

Front 279

8. Distinguish the following types of organ transplant rejection. (FA p213) hyperacute rejection

Back 279

antibody mediated (type II) due to the presence of preformed antidonor antibodies in the transplant recipient. Occurs within MINUTES after transplantation

Front 280

. Distinguish the following types of organ transplant rejection. (FA p213) acute rejection

Back 280

Cell mediated due to cytotoxic T lymphocytes reacting against foreign MHCs. Occurs WEEKS after transplantation. Reversible with cyclosporine and OKT3

Front 281

. Distinguish the following types of organ transplant rejection. (FA p213) chronic rejection

Back 281

T-cell and antibody-mediated vascular damage (obliterative vascular fibrosis) occurs months to years. Irreversible. Class 1 MHCnonself is perceived by CTL as class I-MHCself presenting non-self antigen.

Front 282

- drug of choice for gonorrhea (FA p186)

Back 282

3rd generation cephalosporins (ceftriaxone, cefotaxime, ceftazidime)

Front 283

- drug class for Lyme disease or Rocky Mountain spotted fever (FA p188)

Back 283

tetracycline
VACUUM The BedRoom
Vibrio cholerae, Acne, Chlamydia, Ureaplasma, Ureaplasma, Urealyticum, Mycoplasma pneumoniae, Tularemia, H. pylori, Borrelia burgdorferi, Rikettsia

Front 284

- prophylaxis for those exposed to someone with H. influenza type B infection (FA p191)

Back 284

Rifampin

Front 285

prophylaxis in someone with history of recurrent UTIs (FA p191

Back 285

TMP-SMX

Front 286

used to treat Giardia lamblia (FA p190)

Back 286

metronidazole – GET GAP on the Metro!

Giardia, Entamoeba, Trichomonas, Gardnerella vaginalis, Anaerobes, H. Pylori

Front 287

can be used to treat MRSA as well as C. diff colitis (FA p187)

Back 287

vancomycin

Front 288

What lab abnormalities would you see in a pt with hyperaldosteronism? Why? (FA p291)

Back 288

Primary (conn’s syndrome) – aldosterone secreting tumor, resulting in hypertension, hypokalemia, metabolic alkalosis, and LOW plasma renin.

Secondary – kidney percepts low intravascular volume results in overactive renin-angiotensin. Renal artery stenosis, chronic renal failure, CHF, cirrhosis, Always high renin

Front 289

What is the equation for renal clearance? What will this equation tell you about reabsorption and secretion at the renal tubules? (FA p457)

Back 289

Cx= UxV/Px C< GFR = net tubular reabsorption of X
Cx > GFR net tubular secretion of X,

Front 290

12. Explain the relationship between renin, angiotensin, and aldosterone. (FA p460)

Back 290

If the kidneys sense decreased BP, decreased Na delivery, or there is an increased sympathetic tone. It will secrete renin which converts ANG to ANG I. ACE from lungs and kidney convert ANG I to ANG II.

ANG II = vasoconstriction and increased BP,
Constricts efferent areteriole of glomerulus = increased FF to preserve renal function, in low volume states.
Aldosterone = Increased Na, Creates favorable Na gradient for Na and H20 reabsorption.
Increases ADH secretion = increased water reabsorption
Stimulates hypothalamus = thirst

Front 291

What lab abnormalities would you expect to see in a pt with SIADH? (FA p295)

Back 291

Urine osmolarity > serum osmolarity

Front 292

13. What are the leading causes of death in infants? (FA p58)

Back 292

Congenital anomalies., short gestation/low birth weight, SIDS

Front 293

15. What is Budd-Chiari syndrome? What conditions are a/w Budd-Chiari syndrome?
(FA p326)

Back 293

Occlusion of IVC or hepatic veins with centrilobular congestion and necrosis, leading to congestive liver disease.

Associated with polycythemia vera, pregnancy, and HCC

Front 294

1. What are the findings of Brown-Sequard syndrome? (FA p408)

Back 294

Hemisection of the spinal cord.

Findings : Ipsilateral UMN signs (corticospinal) below lesion. Ipsilateral loss of tactile vibration and propioception below lesion (dorsal column)
Contralateral pain and temperature loss below lesion
Ipsilateral loss of all sensation at level of lesion
LMN signs (flaccid paralysis) at level of lesion

Front 295

2. What syndrome is a/w temporal arteritis? (FA p275)

Back 295

Half of patients have systematic involvment and polymyalgia rheumatica. High ESR.

Front 296

3. What is the typical presentation of a pt with pancreatic insufficiency? (FA p317) What is the treatment for pancreatic insufficiency? (FA p314)

Back 296

Due to cystic fibrosis, obstructing cancer, chronic pancreatitis, Causes malabsorption of fat and fat solumble vitamins.

Front 297

4. Which lysosomal storage disease fits the following description?
cherry red spot on retina

Back 297

Niemann-Pick

Front 298

4. Which lysosomal storage disease fits the following description?
corneal clouding + mental retardation

Back 298

Hurler’s syndrome

Front 299

4. Which lysosomal storage disease fits the following description?
no corneal clouding + mental retardation

Back 299

Hunter’s and also has aggressive behavior

Front 300

4. Which lysosomal storage disease fits the following description?
demyelinating disease affects peripheral nerves

Back 300

Fabry’s

Front 301

4. Which lysosomal storage disease fits the following description?
• crinkled paper cytoplasm

Back 301

Gaucher’s

Front 302

Which lysosomal storage disease fits the following description?
• accumulation of galactocerebroside in the brain

Back 302

Krabbe

Front 303

Which lysosomal storage disease fits the following description?
accumulation of glucocerebroside in the brain

Back 303

Gaucher’s

Front 304

Which lysosomal storage disease fits the following description?
sphingomyelin buildup

Back 304

Niemann Picks

Front 305

5. Explain the development of the thyroid gland. (FA p131)

Back 305

Thyroid diverticulum arises from floor to primitive pharynx, and descends into neck.
Connected to tongue by thyroglossal duct, which normally disappears but may persist as pyramidal lobe of thyroid.

Foramen cecum is normal remnant of thyroglossal duct.

Front 306

6. Which conditions are a/w oligohydramnios, and which are a/w polyhydramnios? (FA p486) What is Potter’s syndrome? (FA p133)

Back 306

Polyhydramnios = >1.5 L of amniotic fluid; associated with esophageal/duodenal atresia, causing inability to swallow amniotic fluid, and with anencephaly

Oligohydramnios = < .5 L of amniotic fluid; associated with placental insufficiency, bilateral renal agenesis or posterior urethral valves and resultant inability to excrete urine. Can give rise to Potter’s syndrome

Bilateral renal agenesis  oligohydramnios  limb deformities, facial deformities, pulmonary hypoplasia.
Caused by malformation of ureteric bud.

Front 307

7. What are the risk factors for osteosarcoma? (FA p377)

Back 307

Peak incidence in men 10-20 years of age. Risk factors = Paget’s disease of bone, bone infarcts, radiation, familial retinoblastoma, .
Codman’s triangle or sunburst pattern on x-ray

Front 308

8. What diagnostic test allows you to distinguish between primary hyperaldosteronism (Conn’s syndrome) and secondary hyperaldosteronism? (FA p291

Back 308

Conn= low serum renin

Secondary = high serum renin

Front 309

9. What is the mechanism of action of propylthiouracil? What are its side effects? (FA p299)

Back 309

Inhibits organification of ioddie and coupling of thyroid hormone synthesis.
Also decreases the peripheral conversion of T4  T3

Use: Hyperthyroidism

Toxicity= tachycardia, heat intolerance, tremors, arrhythmias

Front 310

10. What are the possible causes of SIADH? What cancer is known for causing SIADH?
(FA p295)

Back 310

1. ectopic ADH (small cell carcinoma)
2. CNS disorders/head trauma
3. Pulmonary disease
4. Drugs (cyclophosphamide)

Front 311

• constituent of visual pigments

Back 311

vit A

Front 312

• constituent of NAD

Back 312

B3= niacin

Front 313

• constituent of FADH2

Back 313

B2= riboflavin

Front 314

Constituent of CoA

Back 314

B5= pantothenate

Front 315

12. Which branchial arch should make you consider your M’s and T’s? What structures are derived from this arch? (FA p129)

Back 315

Branchial arch 1

Cartilage = Meckel’s cartilage, Mandible, Malleus, sphenoMandibular ligament

Muscles = Muscles of Mastication, (temporalis, Masseter, lateral and Medial pterygoids) Mylohyoid, anterior belly of digastric, tensor tympani, tensor veli palatini, anterior 2/3 of tongue

Arteries = Maxillary artery (branch of external carotid)

Abnormalities = Treacher collins syndrome = 1st arch neural crest fails to migrate  mandibular hypoplasia, facial abnormalities.

Front 316

13. What is the most common precursor of choriocarcinoma? What are the buzzwords for the gross appearance of this? (FA p485)

Back 316

Hydatidiform mole. Increased Beta hCG, Honeycombed uterus, cluster of grapes appearance, abnormally large uterus

Front 317

14. What are the layers of the epidermis beginning with the most superficial layer? (FA p366)

Back 317

Stratum Corneum, stratum Lucidum, stratum Granulosum, stratum Spinosum, stratum Basalis.

Californians Like Girls in String Bikinis

Front 318

15. Compare the mechanisms of action of methotrexate, 5-fluorouracil, and cyclophosphamide.
(FA p360-FA p361)

Back 318

Methotrexate – Folic acid analog that inhibits dihydrofolate reductase, decreases dTMP which decreases DNA and Protein synthesis

5-fluorouracil – Pyrimidine analog bioactivated to 5F-dUMP, which covalently complexes folic acid.
This complex inhibits thymidylate synthase which decreases dTMP and decreases DNA, and protein synthesis.

Cyclophosphamide – Covalently X-link (interstrand) DNA at guanine N-7. Requires bioactivation by liver

Front 319

1. What is the classic presentation of a pt with Wegener’s granulomatosis? (FA p274)

Back 319

Hemoptysis, hematuria, perforation of nasal septum, chronic sinusitis, otitis media, mastoiditis, cough, dyspnea

Front 320

2. Diagram the phases of a myocardial action potential and describe which ion channels are responsible for each phase. (FA p256)

Back 320

Phase 0 = rapid upstroke – voltage gated Na channels open (goes straight up)

Phase 1 = Initial repolarization – inactivation of voltage gated Na Channels. Voltage gated K channels begin to open (sharp dip)

Phase 2 = plateu – Ca influx through voltage gated Ca channels balances K efflux. Ca influx triggers Ca release from sarcoplasmic reticulum and myoctye contraction

Phase 3 = rapid repolarization – massive K efflux due to opening of voltage gated slow K channels and closure of voltage gated Ca channels (curves downward)

Phase 4 = resting potential – high K permeability through K channels

Front 321

3. What is the mechanism of action of vincristine and vinblastine? What are the toxic side effects of these drugs? (FA p362)

Back 321

Alkaloids that bind tubulin in M phase and block polymerization of microtubules so that mitotic spindle cannot form. Microtubules are the vines of your cells.

vinBLASTine BLASTS bonemarrow, Also neurotoxicity, and paralytic ileus

Front 322

4. What are the clinical features of renal cell carcinoma? (FA p468)

Back 322

Hematuria, palpable mass, secondary polycythemia, flank pain, fever, weight loss. Associated with paraneoplastic syndromes

Front 323

5. Which portion of the renal tubule fits the following description? (FA p472, FA p459) impermeable to sodium, passively reabsorbs water

Back 323

Thin descending limb

Front 324

5. Which portion of the renal tubule fits the following description? (FA p472, FA p459)
Ca re-absorption influenced by PTH

Back 324

Distal convoluted tubule

Front 325

5. Which portion of the renal tubule fits the following description? (FA p472, FA p459)
reabsorbs the majority of glucose and amino acids

Back 325

Proximal convuluted tubule

Front 326

5. Which portion of the renal tubule fits the following description? (FA p472, FA p459)
Na re-absorption regulated by aldosterone

Back 326

Collecting duct

Front 327

5. Which portion of the renal tubule fits the following description? (FA p472, FA p459)
impermeable to water, actively reabsorbs Na, K, and Cl

Back 327

Thick ascending limb

Front 328

Which portion of the renal tubule fits the following description? reabsorbs the majority of bicarbonate, sodium, and water
water re-absorption regulated by ADH

Back 328

Collecting duct

Front 329

6. What is the cause of endemic cretinism? What is the cause of sporadic cretinism? What are the features of cretinism? (FA p293)

Back 329

Endemic = wherever endemic goiter is prevalent (lack of dietary iodine)

Sporadic = defect in T4 formation or developmental failure in thyroid formation

Features= pot-bellied, pale, puffy-faced child with protruding umbilicus and protuberent tongue

Front 330

What is the role of LH and FSH in spermatogenesis? What is an easy way to remember which cells LH and FSH stimulate during spermatogenesis?

Back 330

FSH -> Sertoli Cells -> Sperm production
LH -> Leydig cell -> testosterone

GnRH stimulates anterior pituitary to release LH and FSH

Front 331

Describe how bromocriptine inhibits prolactin secretion. (FA p286)

Back 331

Dopamine agonsists (bromocriptine) inhibit prolactin secretion because prolactin is tonically inhibited by dopamine from hypothalamus.

Front 332

What is the general byproduct of phase I metabolism? What is the general byproduct of phase II metabolism? What reactions take place in phase I metabolism? What reactions take place in phase II metabolism? (FA p229)

Back 332

Phase I metabolism – (reduction, oxidation, hydrolysis) usually yields slightly polar, water-soluble metabolites. (often still active) Cyt P450

Phase II metabolism – (acetylation, glucuronidation, sulfation) usally yields very polar, inactive metabolites (Renally excreted)

Front 333

10. Which cholinergic agonist can be used to treat postop and neurogenic ileus as well as urinary retention? (FA p234)

Back 333

Bethanechol – Activates bowel and bladder smooth muscle; Resistant to AchE. Beth Anne, call me if you want me to activate your bowels and bladder.

Front 334

11. What are the different medications used in the treatment of gout? (FA p380, FA p388)

Back 334

Colchicine – ACUTE – binds and stablilizes tubulin to inhibit polymerization, impairing leukocyte chemotaxis and degranulation

Probenecid – Chronic gout. Inhibits reabsorption of uric acid in PCT

Allopurinol – Chronic. Inhibits xanthine oxidase decreaseed uric acid production.

Front 335

12. What is the life span of an RBC? Define the following terms: polycythemia, anisocytosis, poikilocytosis, reticuloctye (FA p336)

Back 335

120 days

Polycythemia – increased number of red cells

Anisocytosis – varying size

Poikilocytosis- varying shapes

Reticulocyte – immature erythrocyte

Front 336

13. A pt of yours develops hypercalcemia from the most common nonmetastatic tumor arising within bones in adults. What lab findings would you suspect in this pt? (FA p353)

Back 336

Multiple Myeloma = CRAB = hyperCalcemia, Renal insufficiency, Anemia, Bone/Back pain

Monoclonal immunoglobulin spike (M protein) on serum protein electrophoresis and Ig light chains in urine (Bence Jones protein). Blood smear shows RBCs staked like poker chips (rouleaux formation).

Front 337

14. What is the underlying problem in the following jaundice causing diseases? What form of bilirubin is elevated in the serum in each disease? (FA p327)

Back 337

Gilbert’s syndrome-
Mildly decreased UDP-glucuronyl transferase or decreased bilirubin uptake. Asymptomatic. Elevated unconjugated bilirubin.

• Crigler-Najjar syndrome (type I)-
Absent UDP-gluconyl transferase. Presents early in life patients die within a few years. Findings: jaundice, kernicterus, increased unconjugated bilirubin.

• Dubin-Johnson syndrome-

Conjugated hyperbilirubinemia due to defective liver excretion. Grossly black liber. Benign.

Front 338

15. Make a list of drugs that belong to the following categories of antiviral / anti-HIV agents.

Back 338

Protease inhibitors
All have navir in the name. NAVIR (never) TEASE a proTEASE


NRTIs
Zidovudine (ZDV formerly AZT), didanosine, zalcitabine, stavudine
Also inhibits telomerases


NNRTIs

Nevirapine, Efavirenz, Delavirdine.
Never Ever Deliver nucleosides.

Preferentially inhibit reverse transcriptase of HIV