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91 Cards in this Set

  • Front
  • Back
What is the difference between a case-control study, a cohort study, and a clinical trial?
Case-control: compares a group of people with disease to a group without.
Cohort-compares a group with a given risk factor to a group w/o to assess whether the risk factor increases the likelihood
of disease.
Clinical trial: experimental study involving humans. compares the therapeutic benefits of 2 or more Tx or of tx and placebo. Best( randomized, controlled, double-blinded)
Which studies use odds ratios, and which use relative risks?
Case-control: odds ratio
Ask, What happened

Cohort: relative risk
Asks, what will happen?"
Three days ago you hospitalized a 40-year-old male for myocardial infarction. He has been given all of the usual medications. Today you notice that his platelet count is 30,000. What do you suspect is the cause of his low platelets?
Heparin-induced thrombocytopenia (HIT)- heparin binds to platelets, causing autoantibody production that destroys platelets and overactivates the remaining ones, resulting in a thrombocytopenic, hypercoaguable state.
What are the different etiologies of Cushing’s syndrome? How is the level of ACTH different in each?
Pit Adenoma; Inc ACTH
Adrenal hyperplasia/neoplasia:INC ACTH
Ectopic ACTH(Small cell) Inc ACTH
Iatrogenic(steroid use); Decr ACTH - MOST COMMON

Htn, weight gain, moon facies, hyperglycemia (insulin resistance), amenorrhea, and immune suppression.
Which virus is responsible for the following disease?
- croup in children
- common cold (2 viruses)
- #1 cause of fatal diarrhea in children
- bronchiolitis in infants (especially premature)
-ParaInfluenza(PaRaMyxovirus)
-Rhino(Pico) & Corona(Corona)
-Rota(Reo)
-RSV(PaRaMyx); Tx: Ribarvirin
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?
4t(1/2). 1-50, 2-75, 3-87.5
-properties of 1st order elimination
t(1/2)= 0.7*Vd/(CL)
What structures of the inner ear are responsible for the sensation of linear and angular acceleration?
Linear: Utircle and Saccule (contain Macculae)

Angular: Ampullae in SemiCircle canals
What is the basic equation for cardiac output? What is the Fick principle? What factors affect stroke volume?
CO= SV * HR
Fick: rate of oxygen consumption/ (art 02- venous 02)

Pulse pressure is proportional to stroke volume
What are the two most common causes of chronic renal failure?
Hypertension and Diabetes
What is the most common cause of Erb-Duchenne palsy? What are the characteristic findings of Erb-Duchenne palsy?
Waiters Tip (C5/C6)
Traction or tear of the upper trunk of the brachial plexus
-paralysis of abductors, medially rotatated(paralysis of lateral rotators), forearm is pronated (loss of biceps)
What are the signs and symptoms of poliomyelitis? If you suspected polio in a pt with yours, where would you seek to obtain a viral sample from the pt?FA p389
PolioVirus and Anterior horn destruction

Malaise, headache, fever, nausea, abd pain, sore throat

-LMN lesions( muscle weakness, atrophy, fasiculations, fibrillation, hyporeflexia)

-Virus sample: throat or stool

CSF- lymphocytic pleocytosis; no change in CSF glucose
What are the 3 different eukaryotic RNA polymerases? What type of RNA does each make? (FA p78)
RNA 1 - rRNA
RNA 2- mRNA
RNA 3- tRNA

prokaryotes only have 1 and they make all 3 types..

alpha-amantin (mushroom caps) inhibits RNA poly 2
How many umbilical vessels are there? Which umbilical vessel has the highest oxygen content? (FA p124)
umbilical arteries (2)- returns deoxygenated blood from fetal internal iliac arteries to placenta.

Single umbilical artery is assoc with congenital and chromosomal anomalies

All derived from Allantois
umbilical vein (1) --supplies oxygenated blood
What are Brunner’s glands? (FA p304) What are Peyer’s patches? (FA p303) How can these structures help you identify the location from which a histological specimen was taken?
Brunners: doudenal submucosa; hypertrophy of glands in PUD

Peyer's: small intestine; contains specialized M cells that take up antigen. Lamnia Propia.
What is the rate-limiting enzyme for ketone synthesis? for cholesterol synthesis? (FA p99)
Ketone - HMG CoA synthase

Chl - HMG CoA reductase
What is the classic triad of symptoms in multiple sclerosis? With what disorders do pts with multiple sclerosis commonly present? (FA p403)
SIN:
Scanning Speech
Intention Tremor,
Incontinence,
Internuclear Ophthalmoplegia
Nystagmus

Present with Optic Neuritis, MLF syndrome, hemiparesis, hemisensory symptos, or bladder/bowel inctontinence
Which penicillin fits the following description? (FA p179)
- often the drug of choice against Enterococcus sp.
- effective against Pseudomonas sp.
- good for otitis media because it covers Strep. pneumo. and H. influenza
- a/w interstitial nephritis
- a/w rash (especially in pt’s with mononucleosis)
Ampicillin/Amoxicillin-often the drug of choice against Enterococcus sp.

Pseudomonas: Ticarcillin, Carbenicillin, piperacillin

Otitis media(S. pneu, HIB): Ampicillin, Amoxicillin

a/w interstitial nephritis: Methicillin, nafcillin, dicloxacillin( Pcase-resis)

a/w rash (especially in pt’s with mononucleosis): Ampicillin
What class of drugs is used in the treatment of ADHD, narcolepsy, and obesity? (FA p230)
Indirect Sympathomimetics
Amphetamine: indirect general agonist, releases stored catecholamines
What is the definition of first-degree heart block? (FA p254)
The PR interval is prolonged (>200msec) asymptomatic
What is the classic presentation of a patient with gonococcal arthritis? (FA p363)
Monoarticular, migratory arthritis with an asymmetric pattern. Affected joint is swollen red and painful
What is the difference between malingering and factitious disorder? (FA p424)
Patient consciously fakes or claims to have a disorder in order to attain a specific gain. Avoids Tx. Complaints cease after gain (Malingering)

Factitious disorder: wants to assume sick role to get get attention.
-Munchauses: Chronic factisious
-Munch by proxy: illness caused by caregiver-- child abuse
What are the rate-limiting enzymes for the following metabolic processes? (FA p99)
• glycogen synthesis
• glycogen breakdown
• fatty acid synthesis
• fatty acid oxidation
glycogen synthesis - glycogen synthase
• glycogen breakdown - glycogen phosphorylase
• fatty acid synthesis- Acetyl-CoA carboxylase (ACC)
• fatty acid oxidation - Carnitine AcetylTransferase 1
Which adrenergic antagonists can be used to treat hypertension as well as urinary retention in pts with benign prostatic hyperplasia (BPH)? (FA p231)
ZOSIN
Prazosin, Terazosin, Doxazosin
-1st dose orthostatic hypotension
What are the risk factors for colon cancer? (FA p316)
Colorectal villous adenomas, chronic IBD (esp ulcerative colitis, Inc with age), FAP, HNPCC,
What is the difference between prevalence and incidence? (FA p62)
Prevalence = total cases at a given time

Incidence= new cases in population over a given time
What physiology accounts for the automaticity of the AV and SA nodes? (FA p252)
Phase 0 : VG Ca channel
Phase 2: plateau is absent
Phase 3: Inactivation of the Ca channel and Inc activation of K chnl(efflux)
Phase 4: slow diasolic depolarization as Na conductance↑-- this is the automaticity

SLOPE of PHASE 4 determines the Heart Rate
How does the emphysema caused by smoking differ from the emphysema caused by alpa-1-antitrypsin deficiency? (FA p482)
Smoking:CENTRIacinar

Alpha 1 Antitrypsin:PANacinar
What is the difference between Meissner’s corpuscle and a Pacinian corpuscle? (FA p375)
Meissner’s corpuscle: Glabrous (hair less) skin-- fine touch manipulation and adaptation

Pacinian corpuscle:Deep skin layers, joints, ligaments, vibration, pressure
What syndrome causes the triad of sterility, bronchiectasis, and recurrent sinusitis? What is the primary defect in this syndrome? (FA p83)
Karatagener's Syndrome

immotile cilia due to a dynein arm defect

Male and female infertility
In which glomerular disease would you expect to see the following changes? (FA p445)
• foot process effacement (electron microscope)
• wire-loop appearance (light microscope)
• mesangial deposits of IgA (electron microscope)
• crescent-moon shaped lesion (light microscope)
• segmental sclerosis and hyalinosis (light microscope)
- Minimal Change Disease
-SLE
-IgA nephropathy(Bergers)
-RPG
-FSG
What clinical scenario is most commonly seen in Reye’s syndrome? What are the characteristics of Reye’s syndrome? (FA p317)
Assoc with viral infection (esp Infl B and VZV) that has been treated with salicylates.

childhood hepatoencephalopathy: fattly liver, hypoglycemia, coma
What would you expect to find in the synovial fluid of a pt with gout? with pseudogout? (FA p363)
Monosodium Urate crystals - negatively birefringent

Calcium pyrophosphate(weakly positivey birefringent)
What effects do prostaglandins and thromboxane have on platelet aggregation? (FA p369)
Thromboxane(TXA2)- Increases platelet aggregation and leads to vasoconstriction

PGI2- Platelet gathering inhibitor

LTB4- neutrophils arrive B4 others
When is a fetus most susceptible to damage from teratogens? What drug used in the treatment of hypertension is a teratogen? What effect does this have on the fetus? (FA p122)
3rd to 8th week(embryonic to Organogenesis)

b4 week 3 all or none, after week 8 growth and function affected

ACE Inhibtors = Renal Damage
Distinguish the following types of organ transplant rejection. (FA p206)
Mechanism Time Frame
hyperacute rejection
acute rejection
chronic rejection
HyperAcute: preformed antidonor antibodies; within minutes

Acute: cell mediated due to cytotoxic T lymphocytes reacting against foreign MHCs. Occurs weeks after transplantation. Reversible with cyclosporine and OKT3(Murmonab)

Chronic: T cell and antibody mediated vascular damage. months to years after transplantation. Irreversible. Class 1 MHC nonself is pervieved by CTLs as class 1MHC self presenting a nonself antigen
What is Zollinger-Ellison syndrome? (FA p291)
Gastrin secreting tumor of pancreas or duodenum. Causes reccurrent ulcers. Maybe associated with MEN type 1.
What type of collagen is abnormal in patients with Alport’s syndrome? (FA p85)
abnormal type 4 collagent. associated with renal, ear, and eye basement membranes.
In which order elimination is the rate of elimination proportional to the drug concentration? (FA p223)
1st order elimination

Examples of zero order: phenytoin, ethanol, aspirin
What is the most common tumor of the adrenal medulla in adults? in children? (FA p287)
Adults- Pheochromocytoma
VMA in urine
tx: phenoxybenzamine

Children-Neuroblastoma
HVA in urine, less likely to have Htn. N-MYC gene
What lab abnormalities would you expect to see in a pt with SIADH? (FA p291)
Hyponatriema
urine osmolarity > serum osmolarity
What drugs are used in the treatment of Parkinson’s disease? (FA p412)
Dopamine receptor Agonists: Bromocriptine, pramipexole, ropinirole
Increase dopamine: Amantidine, Ldopa/Carbidopa
Prevent dopamine breakdown: Selegiline(MAO B ihib) and entacpone, tolcapone (COMT inhib)
Curb excess cholinergic: Benzotropine
What is the rule of 2’s associated with Meckel’s diverticulum? (FA p314)
The Five 2's:
2 inches long
2 feet from the ileocecal valve
2% of population
Commonly presents in first 2 years of life
May have 2 types of epithelia (gastric/pancreatic)
The thalamus is a relay station that conducts signals to and from the brain. Which thalamic nuclei are the relay stations for the following body sensations/activities? (FA p377)

auditory sensation
visual sensation
motor to the body
facial sensation
body sensation
auditory sensation: MGN
visual sensation: Lateral geniculate body
motor to the body: VA/VL
facial sensation: Ventral posterior nucleus, medial part (VPM)
body sensation: Ventral posterior nucleus, lateral part (VPL)
What is Eisenmenger’s syndrome? (FA p258)
Uncorreted VSD, ASD, or PDA causes compensatory vascular hypertrophy, which results in progressive Pul HtN.

As pul resistance increases, the shunt reverses from L to R to R to L which causes late cyanosis (clubbing and polycthemia)
What is the mechanism of disease in Guillain-Barre syndrome? What are the clinical findings in this syndrome? (FA p403)
Inflmm and demyelination of peripheral nerves and motor fibers of ventral roots (Sensory effect less severe than motor)

Symmetric ascending muscle weakness beginning in Distal lower extremities

Findings: Inc CSF protein==> papilledema

Assoc wih infections- AI attack of peripheral myelin

Campylobacter jejuni or herpesvirus

RESPIRATORY SUPPORT IS CRitical

TX: plasmapheresis, IV immune globins
Compare the leading causes of death in ages 15-24 to those in ages 25-64? (FA p66
15-24: injuries

25-64: Cancer
What are the side effects of the antiarrhythmic amiodarone? (FA p277)
Pul fibrosis
HEPATOTOX
Hypothyroidism/hyperthyroidism
photodermatitis
What are the positive symptoms of schizophrenia (adding a symptom)? What are the negative symptoms of schizophrenia (removing a normal finding/trait)? (FA p421)
+: Delsions, hallucinations(auditory), disorganized speech, catatonic behavior(need 2 or more)
-:flat affect, social withdrawl, lack of motivation, lack of speech or thought
What are the two causes of homocystinuria? How does the treatment differ for each? (FA p110)
=Cystathionine synthase defctiency (dec met and inc cys, and inc b12 and folate)
=Decr affinity of cystathionine synthase for pyridoxal phosphate(increase vit b6 in diet)
=homocysteine methyltransferase defc
What are the signs of bacterial endocarditis? (FA p266)
Bacteria FROM JANE:

Fever
Roth's spots
Osler's nodes
Murmur
Janeway lesions
Anemia
Nail-bed hemorrhage
Emboli
What viruses are associated with the following statements? (FA p165- FA p169)

councilman bodies
Koplick spots
meningitis + orchitis + parotitis
negri bodies
(+) heterophil antibody
fever + cervical lymphadenopathy + hepatosplenomegaly
councilman bodies seen in liver: Yellow fever(flavi/arbo)
Koplick spots: Rubeola(measles)
meningitis + orchitis + parotitis: Mumps(paramyxo)
negri bodies (rabies)
(+) heterophil antibody: EBV
fever + cervical lymphadenopathy + hepatosplenomegaly:
Which antibiotics are the inhibitors of protein synthesis? Which ribosomal subunit does each inhibit? (FA p181)
30S inhibitor:
-Aminoglycosides
-Tetracyclines
50S inhbitior:
Chloramphenicaol, Clindamycin
Erythomycin
Lincomycin
Linezolid

buy AT 30, ccell at 50
What is the cause of achalasia? How is achalasia diagnosed? (FA p309)
Failure of relaxation of LES due to loss of myenteric plexus aka Auerbach's plexus.

Barium swallow shows dilated esophagus

Increased risk of esophageal carcinoma

Bird's beak

can arise from Chagas
Scleroderma(Crest syndrome)
What are the common causes of anion gap acidosis? (FA p443)
High anion gap: MUDPILES

Methanol
Uremia
Diabetic ketoacidosis
Paraldehyde/Phenformin
Iron tablets or INH
Lactic acidosis
Ethylene glycol
Salicylates

Normal:
diarrhea, glue sniffing, RTA, hyperchloremia
What structures arise from the Paramesonephric ducts? What other name is given to the Paramesonephric ducts? (FA p133)
aka Mullerian

develops into fallopian tube, uterus, and upper 1/3 of vagina(lower 2/3 from urogenital sinus
What drugs are known for causing diabetes insipidus? What drugs are used to treat diabetes insipidus? (FA p291)
hypER calcemia
lithium
demeclocycline(ADH antag)

tx:
central- desmopressin
nephrogenic- hydrochlorothiazide, indomethacin, amiloride
What drugs are known for causing diabetes insipidus? What drugs are used to treat diabetes insipidus? (FA p291)
hypER calcemia
lithium
demeclocycline(ADH antag)

tx:
central- desmopressin
nephrogenic- hydrochlorothiazide, indomethacin, amiloride
Which ketone body imparts a fruity odor to breath during ketoacidosis? Which ketone body is not detected by a urine test? (FA p115)
fruity odor- acetoacetate
Urine test for ketones does not detect B-hydroxybutyrate
What is the most common primary cardiac tumor in adults? in children? (FA p268)
adults: myxomas (90% in atria)
children: Rhabdomyomas (assoc with tuberous sclerous)
What are the clinical findings in a pt with lead poisoning? (FA p233)
Lead lines on gingivae(Burton lines)
Encephalopahty and Erythocyte basophilic stippling
Abdominal colic and sideroblastic anemia
Drops: wrist and foot drop

Tx: Dimercaprol and EDTA 1st line
for kids: Succimer

LEAD

It "sucks" to be a kid who eats lead
Which anticancer agent fits the following description? (FA p344 – FA p347)

toxicity is increased by allopurinol
cardiotoxic; monitor patients using ejection fraction
blocks polymerization of tubulin
hyperstabilizes polymerized microtubules
known to cause hemorrhagic cystitis
crosses blood-brain barrier; used in brain cancers
toxicity is increased by allopurinol -- 6-mercaptopurine (6-MP)
blocks denovo purine synthesis; activated by HGPRTase; metabolized by xanthine oxidase thus increased toxicity with allopurinol

cardiotoxic; monitor patients using ejection fraction --Doxorubicin(adriamycin)/ daunorubicin
blocks polymerization of tubulin -- Vincristine/vinblastine
hyperstabilizes polymerized microtubules -- paclitaxel
known to cause hemorrhagic cystitis -- cyclophosphamide
crosses blood-brain barrier; used in brain cancers -- Nitrosoureas
What are the side effects of clonidine? (FA p272)
Dry mouth, sedation, severe rebound htn
Which artery is most often the culprit in a myocardial infarction? (FA p262)
LAD>RCA>Circumflex
What is exstrophy of the bladder? What condition is associated with this abnormality? (FA p134)
Exostrophy of the bladder is assoc with Epispadias
What serotonin agonist can be used to treat migraine headaches? (FA p413)
5HT (1b/1d) agonist

causes vasoconstriction, inhibition of trigeminal activation,

Tox: coronary vasospasm
What are the clinical uses of ondansetron? (FA p324)
5HT(3) antagonist. powerful central acting antiemetic..

used in patients recieved chemo
What is a syringomyelia? What symptoms are commonly seen in pts with syringomyelia? (FA p129)
Enlargemnet of the CC of spinal cord.
Crossing fibers of spinthalamic tract are damaged.

Cape-like bilateral loss of pain and temp sensation in upper extremities with preservation of touch sensation

presents in patients with Chiari II

MC at C8-T1
What are the side effects of clonidine? (FA p272)
Dry mouth, sedation, severe rebound htn
Which artery is most often the culprit in a myocardial infarction? (FA p262)
LAD>RCA>Circumflex
What are the side effects of clonidine? (FA p272)
Dry mouth, sedation, severe rebound htn
Which artery is most often the culprit in a myocardial infarction? (FA p262)
LAD>RCA>Circumflex
What are the side effects of clonidine? (FA p272)
Dry mouth, sedation, severe rebound htn
Which artery is most often the culprit in a myocardial infarction? (FA p262)
LAD>RCA>Circumflex
What problem / abnormality is a/w the following buzzwords?

(FA p91) calf pseudohypertrophy
(FA p91) Gower’s maneuver
(FA p90) tendon xanthomas
(FA p90) subluxation of lenses
(FA p90) café-au-lait spots
(FA p128) tuft of hair on lower back
(FA p91) calf pseudohypertrophy -- Duchennes Muscular dystrophy
(FA p91) Gower’s maneuver - Duchennes
(FA p90) tendon xanthomas - familial hypercholesterolemia(hyperlipidemia IIA)
(FA p90) subluxation of lenses - Marfan's
(FA p90) café-au-lait spots -- NF 1
(FA p128) tuft of hair on lower back -- spina bifida occulta
What is the typical presentation of a pt with Hodgkin’s disease? (FA p337)
low grade fever, night sweats, weight loss
biomodal distribution
Which cancers are a/w xeroderma pigmentosa? (FA p216)
melanoma, basal cell carcinoma, sq cell carcinoma
Which cell types do not require insulin for the uptake of glucose? (FA p281, FA p112)
Brain, RBCs take up glucose independt of insulin levels (GLUT1)


BRICK L (dnt need insulin for glucose uptake)
-Brain, Rbcs, Intestine, Cornea, Kidney, Liver
What is the typical presentation of a pt with pancreatic insufficiency? (FA p310) What is the treatment for pancreatic insufficiency? (FA p307)
diarrhea, steatorrhea, weight loss, weakness
causes malabsorption of fat and fat-soluble vitamins (A, D ,E K)
Why is the murmur of aortic stenosis not heard during the first part of systole? (FA p248)
Isovolumetric contraction, the valve is still not open yet
What are the potential metabolic fates of pyruvate? (FA p103)
)
Alanine(via ALT)
Lactate(via LDH)
Oxaloacetate(via PC)
AcetylCoA(via PDH
What physical changes take place in REM sleep? (FA p71)
Increase and variable pulse, REM, inc and variable blood pressure
penile/clitoral tuescence
REM sleep is like sex: inc pulse
What nerve innervates the “glossus” muscles? What nerve innervates the “palat” muscles? (FA p397)
glossus(hypoglossus N)+palatoglossus(vagus))
palat: Vagus xcept Tensor Veli palatini (mandib of V)
Which types of cancer are associated with the following chromosomal translocations? (FA p339)

t (9;22)

t (8;14)

t (14;18)

t (15;17)

t (11;22)

t (11;14)
t (9;22): Philly CML (bcr/abl hydrobd) Philadelphia CreaML cheese

t (8;14): Burkitts (C-mycactivation)

t (14;18): Follicular lymphomas (BCL-2 actv)

t (15;17): M3 type of AML (responsive to all-trans retinoic acid)

t (11;22): Ewing's sarcoma

t (11;14): Mantle cell lymphoma
What cell type produces PTH? What cell type produces calcitonin? (FA p283, FA p284)
chief cell-PTH
parafollicular cells( C cells) of thyroid- calictonin
Which part of the cochlea is sensitive to high-frequency sound? (FA p398)
flipper is narrow/stiff at base for higher frequency
What are the vitamin K clotting factors? What drug antagonizes vitamin K? Why is heparin given concurrently as this particular drug is initiated? (FA p98)
2,7, 9 , 10 and C and S

Warfarin
What is the most common rescue agent during an asthma attack? Which adrenergic receptors are responsible for bronchodilation? (FA p230)
Albuterol for acute asthma B2>B1

Terbutaline for premature uterine contractions
A long-time pt of yours comes to your office complaining of sexual dysfunction. What is your immediate differential diagnosis? What drugs are known for

causing sexual dysfunction? (FA p70)
1Drugs(antiHTN, neuroleptics, SSRIs, ethanol)
2Disease (depresison, diabetes)
3Pyschological(performance anxiety)
What are the common causes of restrictive cardiomyopathy? (FA p264)
amylodosis, sarcoidosis, postradiation fibrosis, endocardial fibroelastosis and hemochromatosis
What are the steps in the conversion of vitamin D to its active form in the body? (FA p284)
d3 from sun exposure and d2 from diet;
both are converted to 25-oh in liver;
then 1,25 oh2 in kidney
What protozoal organism is associated with cat feces? What diseases does this organism commonly cause? (FA p159)
Toxoplasmosis gondii

can cause chorioretinitis, intracranial calcirfications, hydrocephalus in neonates