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443 Cards in this Set
- Front
- Back
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Syndromes associated with pheochromocytoma.
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MEN 2A and 2B
von Hippel-Lindau NF1 |
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What is the basic underlying problem in von Hippel-Lindau?
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Hemangioblastomas throughout the body, particularly within the CNS
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SSx: Homocysteinuria
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MR with ectopia lentis, marfanoid habitus, osteoporosis, and thrombophilia
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Most common cause of a lung abscess
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Aspiration of oropharyngeal anaerobes (Peptostreptococcus, Fusobacterium, Bacteroides)
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Common pathogens involves in lung abscess formation
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Necrotizing pneumonias = Dirty "SEKS"
S. aureus E. coli K. pneumoniae S. pneumoniae |
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Top three causes of a lung abscess
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1. Aspiration of oropharyngal anaerobes (e.g. alcoholism, seizures)
2. Bacterial pneumonias (S. aureus, S. pneumoniae, etc.) 3. Septicemia/bacterial endocarditis (often multiple) |
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What process underlies wrinkling/skin aging?
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Decreased elasticity due to decreased synthesis and net loss of mature collagen fibrils
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What structures in the respiratory tree have squamous epithelium?
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Oropharynx, laryngopharynx
Anterior and upper half of posterior epiglottis True vocal cords |
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Cell surface marker: CD31
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Endothelium.
CD31 = PECAM1, endothelial cell adhesion protein |
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Where is resistance to flow greatest in the respiratory tree?
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Approximately the first ten generations of bronchi, which includes segmental bronchi.
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How does resistance to flow change as you travel through the respiratory tree?
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It is initially fairly high in the nasopharynx, oropharynx, and trachea, then it actually increases slightly in the first few bronchial segments, and then rapidly decreases as the bronchioles rapidly divide
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What intracellular pathway do BNP and ANP use?
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Act on guanylyl cyclase ---> increased cGMP
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What are the principal effects of BNP and ANP?
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Vasodilitation and natriuresis.
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What are three principal functions of TGF-beta?
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Cell cycle arrest (tumor suppression)
Angiogenesis Stimulation of fibroblasts |
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What is the mechanism of C. difficile A toxin?
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Neutrophil chemoattractant ---> mucosal inflammation, secretory diarrhea, cell death
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What is the mechanism of C. difficile B toxin?
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Actin depolymerization ---> loss of cytoskeletal integrity ---> cell death ---> mucosal necrosis.
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What are the most common sources of mets to the brain?
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In order:
Lung, breast, melanoma |
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In which patient populations are Pseudomonas infections most prevalent?
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Neutopenics
CF patients Burn patients Patients with chronically indwelling catheters. |
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What dermatologic infection is classically associated with P. aeruginosa sepsis?
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Ecthyma gangrenosum: round, necrotic lesions with an erythematous rim
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What is the mechanism of formation of ecthyma gangrenosum?
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Perivascular invasion by P. aeruginosa within the dermis and subQ tissues ---> toxin and protease release ---> necrosis
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What is the classic presentation for erysipelas?
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Superficial skin lesion with very painful, erythematous plaque with raised, well-demarcated borders
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What is the differential for a holosystolic murmur?
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Mitral regurg
Tricuspid regurg VSD |
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What is the differential for a fixed splitting of S2?
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ASD
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What is the differential for a paradoxical splitting of S2?
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Aortic stenosis
LBBB |
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What is the differential for a wide splitting of S2?
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Pulmonic stenosis
RBBB |
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What is the jugular 'a wave'?
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Atrial contraction
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What is the jugular 'c wave'?
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RV contraction with bulging of the tricuspid valve back into the RA
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What is the jugular 'v wave'?
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Elevated RA pressure due to filling against a closed tricuspid valve
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On a CO/EDV curve, what is the x-intercept equal to?
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Mean arterial pressure
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To what physiologic change does a CO elevation correspond to on a CO/EDV curve?
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Lowered TPR and positive inotropy e.g. exercise
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To what physiologic change does a CO depression correspond to on a CO/EDV curve?
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Elevated TPR and negative inotropy e.g. hemorrhage
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In which condition is a decreasd femoral-to-brachial blood pressure ratio observed?
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Coarctation
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In which condition is a "spike and dome carotid pulse upstroke" seen?
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Hypertrophic cardiomyopathy
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What labs are classic in Klinefelter's?
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Elevated FSH, LH, estradiol
Low testosterone |
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What are the principal side effects of selective arterial vasodilators like hydralazine and minoxidil?
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Reflexive sympathetic activation ---> tachycardia and Na+/water retention
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Which drugs classically can cause non-immune-mediated mast cell degranulation?
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Vancomycin and opiates
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What is the classic appearance of bone in a patient with long-standing hyperparathyroidism?
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Subperiosteal thinning with bony cysts.
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Which bone disease classically features marrow cavities filled with unmineralized, spongy bone?
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Osteopetrosis
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From which cell are neurofibromas derived?
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Schwann cells.
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What structures derive from the surface ectoderm?
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Skin and appendages
Oral and nasal epithelium Anal epithelium below pectinate line Lens and cornea |
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Describe the process of base excision repair.
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Specific glycolases recognize abnormal base, excise it
AP endonuclease cleaves at the 5' end Lyase cleaves at the 3' end DNA pol fills in the gap Ligase closes the gap |
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How can fructose be used in patients with essential frustosuria?
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Converted to fructose-6-phosphate by hexokinase.
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What is the principal function of prokaryotic 16S rRNA?
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Binds the Shine-Delgarno sequence on mRNA
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What is the classic presentation of neutropenia in patients taking ticlopidine?
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Fever and oral ulcers.
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Mutations in which three genes are implicated in early-onset Alzheimers?
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Amyloid precursor protein
Presenilin 1 Presenilin 2 |
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A mutation in which gene is implicated in late-onset Alzheimer's disease?
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Apo E4
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What is the main mechanism of action of isotretinoin in the treatment of acne?
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Inhibition of follicular epidermal keratinization.
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What is the name of the bias in which study participants behave differently when they know they are being studied?
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Hawthorne effect
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What is the name of the bias when a researcher's beliefs regarding research outcome potentially influence that outcome?
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Pygmalion effect
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What is the classic location for tumors associated with Lynch syndrome?
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Right-sided colon tumors plus endometrial, gastric, and ovarian tumors.
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What is the classic triad of antiphospholipid antibody syndrome?
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Venous thromboembolism
Arterial thromboembolism Recurrent miscarriage |
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Which thalamic nucleus carries taste?
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VPM
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What are the Brodmann numbers for the primary somatosensory cortex?
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3, 1, 2
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What are the Brodmann numbers for the primary auditory cortex?
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41, 42
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What are the signs and symptoms of B6 deficiency?
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Convulsions
Hyperirritability Peripheral neuropathy Sideroblastic anemia |
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In which reactions is B6 required?
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Transamination (AST/ALT)
Decarboxylations Glycogen phosphorylase Cysthathionine synthase Heme synthesis Niacin synthesis |
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Which cell contains granules filled with histaminase and arylsulfatase?
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Eosinophils
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What is the formula for attributable risk percent?
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ARP = (RR - 1)/RR
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What force is primarily responsible for secondary protein structures?
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Hydrogen bonding
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What are the classic toxicities of methotrexate?
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Stomatitis (oral ulcers)
Hepatotoxicity Pulmonary toxicity |
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Which nerves derive from the posterior trunk of the brachial plexus?
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Radial and axillary
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Which vasculitis classically involves transmural arterial wall inflammation and fibrinoid necrosis?
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PAN
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What are the most common S/Sx in PAN?
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Fever, abdominal pain, peripheral neuropathy, weakness.
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Excessive matrix metalloproteinase activity is associated with what dermatologic finding?
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Excessive skin contraction with wound healing.
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What must happen for HDV to become infective?
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HDV must first become coated by HBsAg from HBV to become infective.
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A large number of patients lost to follow-up during a study can introduce which bias?
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Selection bias
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A fracture at the femoral neck is mostly likely to injure which vessel?
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Medial circumflex artery
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The ureters pass immediately lateral to which structures?
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Internal iliac arteries.
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What is the primary mechanism of opioid-induced decreases in neural transmission?
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Increased K+ efflux ---> hyperpolarization
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What are classic S/Sx associated with serum sickness?
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Fever, urticaria, arthralgia, glomerulonephritis, and lymphadenopathy
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What laboratory findings are characteristic of serum sickness?
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Low C3 due to widespread immune complex deposition
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What is the intrapleural pressure at FRC?
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-5 cm H2O
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What is the intrapleural pressure during tidal inspiration?
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-7.5 cm H2O
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Diagnosis: acute-onset, mid-chest pleuritic pain that decreases when sitting forward and up
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Acute pericarditis
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Which are the most common forms of acute pericarditis?
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Fibrinous, serofibrinous
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When would you observe pulsus paradoxus?
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Cardiac tamponade
Chronic pericarditis Cor pulmonale |
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What is Kussmaul's sign?
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Paradoxical increase in JVP with inspiration
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When is Kussmaul's sign observed?
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Chronic pericarditis (MCC)
Restrictive cardiomyopathy Cardiac tamponade Severe right heart failure Tricuspid stenosis |
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What is "reaction formation"?
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A defense mechanism in which impulses are redirected into the opposite action
E.g. An alcoholic rallying for prohibition |
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The defense mechanism of "splitting" is a hallmark of which disorder?
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Borderline personality disorder
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What is Kussmaul's sign?
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Paradoxical increase in JVP with inspiration
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Why should TCAs be avoided in patients with BPH?
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TCAs classically have potent anticholinergic effects ---> exacerbation of urinary retention
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When is Kussmaul's sign observed?
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Chronic pericarditis (MCC)
Restrictive cardiomyopathy Cardiac tamponade Severe right heart failure Tricuspid stenosis |
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What are the classic toxicities of TCAs?
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Antimuscarinic effects
Anti-α adrenergic effects Antihistamine effects (sedation) Arrhythmias Repiratory depression Mental status changes |
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What is "reaction formation"?
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A defense mechanism in which impulses are redirected into the opposite action
E.g. An alcoholic rallying for prohibition |
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What is the treatment for serotonin syndrome?
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Cyproheptadine
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The defense mechanism of "splitting" is a hallmark of which disorder?
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Borderline personality disorder
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What are the classic findings in serotonin syndrome?
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Hyperthermia
Muscle rigidity Cardiovascular collapse Flushing Diarrhea Seizures |
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Why should TCAs be avoided in patients with BPH?
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TCAs classically have potent anticholinergic effects ---> exacerbation of urinary retention
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Which diuretic improves mortality in CHF patients?
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Spironolactone
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What are the classic toxicities of TCAs?
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Antimuscarinic effects
Anti-alpha adrenergic effects Antihistamine effects (sedation) Arrhythmias Repiratory depression Mental status changes |
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What is the treatment for serotonin syndrome?
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Cyproheptadine
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What are the classic findings in serotonin syndrome?
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Hyperthermia
Muscle rigidity Cardiovascular collapse Flushing Diarrhea Seizures |
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Which diuretic improves mortality in CHF patients?
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Spironolactone
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Which three drugs are classically associated with a risk of seizure?
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Bupropion
Imipenem INH |
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What is the mechanism of action of the fibrates?
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PPAR-alpha stimulation ---> ↑ LPL expression, activity
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What is the primary indication for the fibrates?
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Hypertriglyceridemia (also, a fairly good HDL effect)
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What is the overall best intervention for low HDL?
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Niacin
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Which nerve provides general sensory innervation for the anterior 2/3 of the tongue?
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V3
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Which nerve provides general sensory innervation for the posterior 1/3 of the tongue?
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CN IX
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Which nerve provides general sensory innervation for the root of the tongue?
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CN X
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What is the MOA of caspofungin?
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Fungal glucan synthesis inhibitor
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What is the MOA of griseofulvin?
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Microtubule poision
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What is the MOA of terbinafine?
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Squalene epoxidase inhibitor ---> decreased ergosterol
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Which antibiotic requires intracellular activation by bacterial catalase-peroxidase?
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INH
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What is a pulsion diverticulum?
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False diverticulum created by increased intraluminal pressure e.g. sigmoid diverticulosis
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Which proteins are most important for adhesion of cells to basement membranes?
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Cellular integrins ---> basement membrane fibronectin, collagen, and laminin
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Which glycosaminoglycan molecular contains galactose?
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Keratan sulfate
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Which enzyme is deficient in acute intermittent porphyria?
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Porphobilinogen deaminase
AKA "hydroxymethylbilane synthase" |
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Diagnosis: Acantholysis with net-like intercellular IgG deposits
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Pemphigus vulgaris
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Diagnosis: Rash with microabscesses of dermal papillae
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Dermatitis herpetiformis
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Diagnosis: Rash with inclusions and multinucleated giant cells
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VZV
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Pregnant lady with gallstones: Mechanism?
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Estrogen increases cholesterol synthesis and progesterone causes gallbladder hypomotility.
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What are the acid/base consequences of acute PE?
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Acute V/Q mismatch ---> hypoxemia ---> hyperventilation ---> respiratory alkalosis
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Diagnosis: Brain mass with calcification and cystic spaces filled with cholesterol-rich fluid
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Craniopharyngioma
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Which viruses express hemagglutinin?
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Influenza
Parainfluenza Mumps Measles |
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DVT treatment causes elevation in both PT and PTT, but an unchanged TT. Which drug was given?
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Xa inhibitor ---> affects both intrinsic and extrinsic pathways, but doesn't affect thrombin
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Orthostatic hypotension is a common side-effect of which antidepressants?
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MAOIs and TCAs
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Arrhythmias are a side-effect of which antidepressants?
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TCAs
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Urinary retention is a side-effect of which antidepressants?
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TCAs
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On a CO/EDV curve, what would CHF look like?
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A decrease in CO/venous return AND an increase in EDV/RA pressure.
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What are three classic causes of increased blood viscosity?
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Polycythemia vera
Hyperimmunoglobulinemias (multiple myeloma, Waldenstrom's macroglobulinemia) Hereditary spherocytosis |
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Underyling cardiac defect: Tetralogy of Fallot
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Anterosuperior displacement of the infundibular septum
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Cardiac defect: Transposition of the great vessels
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Failure of the aorticopulmonary septum to appropriately pivot
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Coarctation is associated with which other two cardiac problems?
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Bicuspid aortic valve
Aortic regurgitation |
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Maternal diabetes is associated with which congenital cardiac defects?
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Transposition
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22q syndromes are associated with which congenital cardiac defects?
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Truncus
Tetralogy |
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Down syndrome is associated with which congenital cardiac defects?
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VSD
ASD AV septal defects |
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Congenital rubella is associated with which congenital cardiac defects?
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Septal defects
PDA Pulmonary stenosis |
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CXR findings: Aortic dissection
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Widening of the mediastinum
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Diagnosis: bacterial endocarditis in a child
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HACEK bugs
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Colon cancer patient with endocarditis: pathogen?
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S. bovis
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MC valve affected in endocarditis in IV drug abusers
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Tricuspid
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Diagnosis: Sterile vegetations on both sides of a valve
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Libman-Sacks
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Early cardiac lesion: Rheumatic fever
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MVP
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Late cardiac lesion: Rheumatic fever
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Mitral stenosis
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Jones Criteria for rheumatic fever
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Pancarditis
Polyarthritis Sub-Q nodules Erythema marginatum Sydenham's chorea |
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Diagnosis: tachycardia, hypotension, JVD, distant heart sounds
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Pericardial effusion with tamponade
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Diagnosis: Pleuritic pain, distant heart sounds, ST elevation
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Pericarditis
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Classic triad of Wegener's granulomatosis
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1. Necrotizing vasculitis
2. Necrotizing granulomas in lung, upper airways 3. Necrotizing glomerulonephritis |
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What three factors exacerbate digoxin toxicity?
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1. Renal failure ---> poor excretion
2. Hypokalemia 3. Quinidine ---> displaces digoxin from tissue binding sites ---> decreased digoxin clearance |
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How do you treat a β-blocker overdose?
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Glucagon
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Diagnosis: anterosuperior displacement of the infundibular septum
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Tetralogy of Fallot
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Diagnosis: systolic murmur that gets worse with decreased preload
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Hypertrophic cardiomyopathy
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Diagnosis: asthma, sinusitis, skin lesions, and peripheral neuropathy
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Churg-Strauss
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Diagnosis: Fever, weight loss, headache, rash, melena, abdominal pain, arthralgias
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Polyarteritis nodosa
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Which vasculitis: eosinophilia
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Churg-Strauss
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Which vasculitis: lesions of different ages within the same area
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Polyarteritis nodosa
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Diagnosis: fever, conjunctivitis, lymphadenopathy, desquamative rash
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Kawasaki's disease
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Diagnosis: fever, arthralgias, night sweats, erythema nodosum, ocular disturbances, weak pulses
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Takayasu's arteritis
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First-line treatment for hypertension in pregnancy?
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Hydralazine + methyldopa
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MOA: fibrates
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Upregulation of LPL
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Toxicity: Niacin
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Hyperglycemia, hyperuricemia
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EKG findings: digoxin toxicity
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PR prolongation
QT shortening T wave inversion |
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Use: Class 1A antiarrhythmics
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Reentry and ectopic supraventricular and ventricular tachyarrhythmias
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Use: Class 1B antiarrhythmics
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Post-MI arrhythmias
Digoxin-induced arrhythmias |
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Use: Class 1C antiarrhythmics
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V-tach that progresses to V-fib
Severe SVT |
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Use: Class II antiarrhythmics
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V-tach
SVT A-fib A-flutter |
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Effect on action potential: Class IA antiarrhythmics
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↑ AP duration
Also: ↑ ERP QT prolongation |
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Effect on action potential: Class IB antiarrhythmics
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↓ AP duration
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Effect on action potential: Class IC antiarrhythmics
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No effect on AP duration
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Effect on action potential: Class II antiarrhythmics
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↓ AV nodal conduction velocity ---> ↑ PR interval
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Effect on action potential: Class III antiarrhythmics
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↑ AP duration
Also: ↑ ERP QT prolongation |
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Effect on action potential: Class IV antiarrhythmics
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↓ AV nodal conduction velocity ---> ↑ PR interval
↑ EPR |
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MOA: Adenosine
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Causes transient complete heart block by effectively shutting off the AV node for just a few seconds; acts by temporarily ↑ K+ conductance
|
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Diagnosis: Recurrent pulmonary infiltrates with esoiniphilia and elevated IgE in an asthmatic
|
Allergic bronchopulmonary aspergillosis
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Diagnosis: Recurrent pulmonary infiltrates with esoiniphilia and elevated IgE in an asthmatic
|
Allergic bronchopulmonary aspergillosis
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Which lymphoid cells do not undergo maturation in the thymus?
|
B cells and NK cells
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Which drug is used to reduce the risk of fetal HIV transmission during pregnancy?
|
Zidovudine
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What are three classic consequences of uncal herniation?
|
Ipsilateral ptosis (CNIII compression)
Contralateral homonymous hemianopsia (ipsilateral PCA compression) Ipsilateral paresis (contralareal cerebral peduncle compression) |
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Diagnosis: heterogeneously-enhancing brain lesion
|
Glioblastoma multiforme
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Diagnosis: STI with inclusion conjuncitivitis
|
C. trachomatis
|
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Which two substances are most significant in driving angiogenesis?
|
VEGF and FGF
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What is the 'helicotrema'?
|
The tip of the basilar membrane: low-freq. sounds
|
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What are classic first signs of botulism?
|
Cranial nerve signs (diplopia, dysphagia, dysarthria, etc.)
|
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What compound inhibits choline acetyltransferase?
|
Bromoacteylcholine
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|
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Elevation of vaginal pH is associated with which infections?
|
Bacterial vaginitis and Trichomonas (but not Candida!)
|
|
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What are common triggers for Candida vaginitis?
|
Abx
Contraceptives Corticosteroids Poorly controlled DB Immunosuppression |
|
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Which factors are considered protective against ovarian cancer?
|
OCPs
Multiparity Breastfeeding |
|
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What are the classic low-inoculum gastroenteritides?
|
Shigella
Campylobacter E. histolytica Giardia |
|
|
When does Wallerian degeneration occur?
|
When a segment of axon loses connection with its cell body
|
|
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What is "axonal reaction"?
|
It is the cell body version of Wallerian degeneration = what happens in the cell body when its axon has been severed
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What are the features of axonal reaction?
|
Swollen, rounded cell body
Nucleus displaced to the periphery Fine, granular Nissl substance dispersed throughout the cytosol |
|
|
Diagnosis: recurrent lobar hemorrhages in an elderly patient
|
Cerebral amyloid angiopathy
|
|
|
What is the pathogenesis of cerebral amyloid angiopathy?
|
Beta-amyloid deposition within cerebral arterial walls ---> focal weakening ---> risk of rupture
|
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What are the classic S/Sx of theophylline overdose/poisoning?
|
Abdominal pain with N/V
Tachyarrhythmias Seizures |
|
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Diagnosis: Latent period with subsequent massive hepatic necrosis
|
Acetaminophen overdose
|
|
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Classic manifestations of iron poisoning?
|
Hemetemesis, melena
|
|
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Classic manifestations of iron poisoning?
|
Hematemesis, melena
|
|
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What causes urate crystals to precipitate?
|
Low pH
|
|
|
Diagnosis: genital papule with painful lymphadenopathy and intracellular inclusions
|
Lymphogranuloma venereum (C. trachomatis)
|
|
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What is the potential manifestation of ALL enteroviruses?
|
Viral encephalitis
|
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What two structures does the median nerve run between at the elbow?
|
The humeral and ulnar heads of the pronator teres
|
|
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What two structures does the median nerve run between at the wrist?
|
Flexor digitorum superficiales m. and the flexor digitorum profundus m.
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Which nerve runs directly between the biceps brachii and coracobrachials mm.?
|
Musculocutaneous n.
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What two structures does the ulnar nerve run between at the wrist?
|
Flexor carpi ulnaris m. and flexor digitorum profundus m.
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What two structures does the ulnar nerve run between at the elbow?
|
Medial humeral epicondyle and olecranon
|
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What does the radial n. pass through at the wrist?
|
Supinator m.
|
|
|
Diagnosis: neuromuscular symptoms, lactic acidosis, and "ragged red fibers"
|
Mitochondrial encephalomyopathy
|
|
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Which thalamic nucleus in implicated in Korsakoff syndrome?
|
Medial dorsal.
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Which symptom of Wernicke-Korsakoff syndrome does NOT return with thiamine administration?
|
Memory loss.
|
|
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Which type of rejection: fibrinoid vascular necrosis with neutrophilic infiltrate?
|
Hyperacute rejection
|
|
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Which type of rejection: dense interstitial infiltrate with CD4+/CD8+ predominance
|
Acute rejection
|
|
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Which type of rejection: obliterative vascular smooth muscle hypertrophy and fibrosis
|
Chronic rejection
|
|
|
Which rejection: pre-formed anti-donor antibodies
|
Hyperacute rejection
|
|
|
Which type of rejection: pre-formed anti-donor antibodies
|
Hyperacute rejection
|
|
|
Name the three different blood sources of the ureter
|
Upper 1/3: renal a.
Middle 1/3: common iliac a. Lower 1/3: Sup. vesical a. |
|
|
What are the two sources of nitrogen for the urea cycle?
|
NH4+ and aspartate
|
|
|
What is the activating factor for CPS-1?
|
N-actylglutamate
|
|
|
Diagnosis: fever, fatigue, joint pain, and rash with elevated LFTs
|
HBV
|
|
|
How long after ovulation is hCG detectable in maternal serum?
|
Around 8 days
|
|
|
How does H. pylori cause hyperchlorhydria?
|
Decreases the number of somatostatin-secreting cells within the gastric antrum ---> upregulated gastrin release
|
|
|
MC site in the brain for partial seizures
|
Mesial temporal lobes
|
|
|
Which pathogen: Intracellular phosphate granules
|
C. diphtheriae
|
|
|
Which pathogen: + latex agglutination test
|
Cryptococcus
|
|
|
Treatment of choice: pneumococcal meningitis
|
Ceftriaxone
|
|
|
Treatment of choice: H. flu meningitis
|
Ceftriaxone
|
|
|
Treatment of choice: meningogoccal meningitis
|
Ceftriaxone
|
|
|
Treatment of choice: listeria meningitis
|
Ampicillin
|
|
|
Treatment: ALS
|
Riluzole (↓ glutamate release)
|
|
|
Classid triad: Meniere's disease
|
Tinnitus
Vertigo Sensorineural deafness |
|
|
Where is tetrahydrobiopterin important?
|
Tyrosine
DOPA Serotonin NO |
|
|
Diagnosis: neonatal cataracts and failure to develop a social smile
|
Galactokinase deficiency
|
|
|
Know this phrase: "lysosomes with onion skinning"
|
Tay-Sachs
|
|
|
Secondary causes of pure red cell aplasia?
|
Parvovirus B19
Thymoma |
|
|
Which illicit drug: Nystagmus and ataxia
|
PCP
|
|
|
Which illicit drug: Conjunctival injection and tachycardia
|
Marijuana
|
|
|
Which illicit drug: hypersalivation
|
Ketamine
|
|
|
Volume of distribution: marijuana
|
Very large (deposits within fatty tissue, very long tissue t1/2)
|
|
|
Inheritance: Leber hereditary optic neuropathy
|
Mitochondrial
|
|
|
Transmission: Cryptococcus
|
Respiratory
|
|
|
Which arm of the complement cascade is limited in the CSF?
|
Alternative pathway
|
|
|
Spinal levels: Ansa cervicalis
|
C1, C2, C3
|
|
|
Which nerve: Just deep to the sternocleidomastoid, wraps around the internal jugular vein
|
Ansa cervicalis
|
|
|
Which nerve innervates the sternohyoid, sternothyroid, and omohyoid mm.?
|
Ansa cervicalis
|
|
|
Manifestation of a bilateral recurrently laryngeal nerve lesion?
|
Respiratory difficulty due to bilateral vocal fold palsy ---> obstruction
|
|
|
Which cardiovascular drug: exacerbation of Raynaud's phenomenon
|
Beta blockers
|
|
|
MCC of acute renal failure in kids
|
HUS
|
|
|
Contraindication: colchicine
|
Renal dysfunction
|
|
|
Pathogen: mucicarmine
|
Cryptococcus
|
|
|
What is "photolyase"?
|
Enzyme found only in prokaryotes that can correct pyrimidine dimers without excision
|
|
|
How is UV-induced DNA damage dealt with?
|
Pyrimidine dimers excised by specific UV endonucleases
|
|
|
How do arcuate scotomas develop?
|
Damage to the optic nerve
|
|
|
What is "Samter's triad"?
|
Asthma
Aspirin hypersensitivity Nasal polyps |
|
|
What are the manifestations of very-high-dose salicylate use?
|
Vertigo, tinnitus, hearing loss
Hyperpnea with respiratory alkalosis that changes to respiratory acidosis |
|
|
Which murmur is almost always found with hypertrophic cardiomyopathy?
|
Mitral regurgitation
|
|
|
Which MHC: packaged together with antigen in the RER
|
MHC I
|
|
|
Which MHC: packed together with antigen in an acidified endosome
|
MHC II
|
|
|
Pheo: benign or malignant
|
Benign
|
|
|
What is the cause of tissue damage in pulmonary TB?
|
Host immune activity (type IV HS)
|
|
|
Which pathogen: exudation and alveolar hepatization
|
S. pneumoniae
|
|
|
From which cell type do renal oncocytomas arise?
|
Collecting ducts
|
|
|
Causes of a low ESR
|
Sickle cell
Polycythemia CHF |
|
|
Diagnosis: renal dysfunction with tubublar necrosis and thickened vasa recta
|
Analgesic nephropathy
|
|
|
Diagnosis: renal dysfunction with tubular necrosis and thickened vasa recta
|
Analgesic nephropathy
|
|
|
Diagnosis: subchondral "crescent sign"
|
Avascular necrosis
|
|
|
Diagnosis: "lump in the throat" feeling without evidence of organic disease
|
Globus hystericus
|
|
|
Diagnosis: 180 base pair segments on electrophoresis
|
Apoptosis
|
|
|
Define "contact inhibition"
|
The phenomenon wherein cells arrest in G1 in response to contact on all sides by other cells
|
|
|
What happened: genetic disease in children but not parents
|
Germline mosaicism
|
|
|
Who should take fish oil?
|
Patients with refractory hypertriglyceridemia
|
|
|
Pathogen: molluscum contagiosum
|
A poxvirus (MC virus)
|
|
|
Structure most at risk with posterior tibial dislocation
|
Popliteal artery
|
|
|
Structure injured: penetrating trauma to the popliteal fossa
|
Tibial n.
|
|
|
Diagnosis: neonate with HSM, petechiae, intracranial calcifications, hyperbilirubinemia, thrombocytopenia
|
Congenital CMV
|
|
|
MCC: postpartum endometritis
|
Bacteroides
|
|
|
Which defense mechanism: converting unacceptable feelings/drives into socially-acceptable ones
|
Sublimation
|
|
|
Classic example: receptor-mediated endocytosis
|
LDL
|
|
|
Which interview technique: encouraging the patient to talk about his experiences/feelings
|
Facilitation
|
|
|
Which interview technique: drawing attention to discrepancies in the patient's story
|
Confrontation
|
|
|
Does GFR return to normal post-nephrectomy?
|
No, only to about 80% via hypertrophy and hyperfiltration
|
|
|
Two primary sources of HCO3- secretions
|
Pancreas and biliary epithelium
|
|
|
Acute distress disorder vs. PTSD
|
Acute distress disorder = <4 weeks
PTSD = > 4 weeks |
|
|
Schizophreniform disorder vs. schizophrenia
|
1 month < Schizophreniform < 6 months
Schizophrenia > 6 months |
|
|
Describe schizoid personality disorder
|
Voluntary social withdrawal
Flat affect Content being alone |
|
|
Describe schizoid personality disorder
|
Voluntary social withdrawal
Flat affect Content being alone NO hallucinations/delusions NO odd thinking/paranoia |
|
|
Describe schizotypal personality disorder
|
Schizoid + eccentric behavior and odd thinking
|
|
|
Define: false positive ratio
|
1 - specificity
|
|
|
100,000 patients
10,000 have disease X Specificity of test for X is .9 How many false positives? |
100,000 - 10,000 = 90,000 without disease
False positive ratio = 1 - specificity = 1 - 0.9 = 0.1 90,000 x 0.1 = 9,00 |
|
|
Classic manifestations of HSV encephalitis
|
Hemorrhagic encephalitis of the temporal lobes
Classically manifests with things like olfactory hallucinations, personality change, aphasia, delirium, etc. |
|
|
Define genetic heterogeneity
|
Different genes causing similar phenotypes
|
|
|
Define variable expressivity
|
Variability in severity of phenotype in people with the same genotype
|
|
|
Causes of an elevated amylase
|
Pancreatitis
Pancreatic pseudocyst Esophageal rupture Lung adenocarcinoma |
|
|
How does thrombotic risk change post-splenectomy?
|
Increased (thrombocytosis)
|
|
|
Pre- vs. Postmortem Clots
|
Pre: Lines of Zahn, attached to the vessel wall
Post: Purple/red, gelatinous, no lines of Zahn, not attached to the wall |
|
|
Diagnosis: delayed-onset pleuritis in a patient treated for arrhythmia
|
Procainamide ---> drug-induced lupus
|
|
|
MC kind of head/neck tumor
|
SCC, classically of the oral cavity (tongue, gingiva, palate, etc.)
|
|
|
Define "allelic heterogeneity"
|
Different mutations within the same genes cause similar phenotypes
|
|
|
Define "phenotypic heterogeneity"
|
Different mutations within the same gene cause totally different phenotypes
|
|
|
ELISA steps
|
1. known antigen fixed to wells
2. patient serum added, then washed 3. anti-human IgG added, binds bound antibody 4. chromogen added to demonstrate binding |
|
|
Efflux pumps depend on...
|
H+
|
|
|
Efflux pumps depend on...
|
H+ gradient (or other gradients)
|
|
|
Chromosome 7 Diseases
|
CF
Ehlers-Danlos Osteogenesis imperfecta |
|
|
Chromosome 16 Diseases
|
ADPKD
Tuberous sclerosis |
|
|
What does safranin O stain?
|
Cartilage
Mast cell granules Mucin |
|
|
Physiologic effects: PAF
|
Platelet aggregation
Severe bronchoconstriction Vasoconstriction |
|
|
Intracellular signaling pathway: PAF
|
IP3
|
|
|
OCD vs. obsessive-compulsive PD
|
OCD = ego-dystonic
OCPD = ego-syntonic |
|
|
Diagnosis: feelings of social inadequancy, hypersensitivity to rejection, desires relationships with others
|
Avoidant PD
|
|
|
Diagnosis: atrophic vulva with white patches
|
Lichen sclerosus
|
|
|
Diagnosis: recurrent infections without pus and delayed separation of the umbilical cord
|
Type 1 leukocyte adhesion deficiency
|
|
|
Diagnosis: recurrent infections without pus and delayed separation of the umbilical cord
|
Type 1 leukocyte adhesion deficiency
|
|
|
Diagnosis: retention of primary teeth with eosinophilia
|
Job's syndrome
|
|
|
Diagnosis: recurrent infections with hypoplastic or absent nodes and lymphoid tissues
|
Bruton's agammaglobulinemia
|
|
|
Diagnosis: LFA-1 integrin deficiency
|
Type 1 leukocyte adhesion deficiency
|
|
|
Diagnosis: vascular lesions, stumbling, IgA deficiency
|
Ataxia-telangiectasia
|
|
|
Diagnosis: normal B cell count but no plasma cells or Ig
|
Common variable immunodeficiency
|
|
|
Defect: ataxia-telangiectasia
|
DNA repair defect affecting p53
|
|
|
Key catalase + organisms
|
Staphylococci
--- Listeria Corynebacterium Enterobacteriaciae --- Nocardia TB --- Aspergillus Cryptococcus |
|
|
Important members of Enterobacteriaciae
|
E. coli
Enterbacter Klebsiella Shigella Salmonella Proteus Klebsiella Serratia Pseudomonas |
|
|
Diagnosis: B cells can't mature into plasma cells
|
Common variable immunodeficiency
|
|
|
What are the MC cardiac malformations in 22q syndromes?
|
Conotruncal defects:
VSD Tetralogy Truncus |
|
|
LH:FSH ratio in PCOS
|
High
|
|
|
Which muscle: lateral ribs to medial scapula
|
Serratus anterior
|
|
|
Scrotum/labia majora lymph drainage
|
Inguinal nodes
|
|
|
Glans penis/glas clitoris lymph drainage
|
Deep inguinal nodes
|
|
|
Diagnosis: "egg-shell" calcifications of the hilar nodes
|
Silicosis
|
|
|
Diagnosis: restructive lung disease that looks like sarcoidosis but isn't
|
Berylliosis
|
|
|
Unique MOA: nitroprusside
|
Balanced arterio- and venodilator ---> decreased preload AND afterload
|
|
|
Unique MOA: nitroprusside
|
Balanced arterio- and venodilator ---> decreased preload AND afterload WITHOUT changing stroke volume
|
|
|
List the important selective beta blockers
|
Metoprolol
Esmolol Atenolol Acebutolol |
|
|
1st line drug: complex partial seizures
|
Carbamazepine
|
|
|
Which nitrate agent has the highest bioavailability?
|
Isosorbide mononitrate
|
|
|
What is piperacillin MOST effective against?
|
Gram (-) enteric rods like Pseudomonas and Bacteroides
|
|
|
What are the MAJOR applications of azithromycin?
|
Chlamydia
Mycoplasma H. flu Moraxella |
|
|
Best chelator for Wilson's disease
|
Penicillamine
|
|
|
Best chelators for lead poisoning
|
EDTA and dimercaprol
|
|
|
Enolase, chromogranin, and synaptophysin are markers for what?
|
Neuroendocrine differentiation e.g. small cell lung
|
|
|
What is the natural history of immediate post-MI pericarditis?
|
Short-lived, responds to aspirin, goes away in 1-3 days
|
|
|
Classic adenoviral symptoms
|
"Pharyngoconjunctival fever"
Febrile pharyngitis with cough, runny nose, conjunctivitis, and cervical lymphadenopathy |
|
|
Most important calicivirus
|
Norwalk = acute gastroenteritis
|
|
|
The most important arenavirus
|
Lymphocytic choriomeningitis virus ---> febrile aseptic meningoencephalitis from hamsters/mice
|
|
|
Cell marker: CD3
|
T cells
|
|
|
Cell marker: CD3
|
T cells
|
|
|
Which DNA pol.: removes primers, 5' to 3' exonuclease activity
|
DNA pol. 1
|
|
|
What is "MAC"?
|
Minimal alveolar concentration
The alveolar concentration of inhalational anesthetic that is required to prevent movement in response to noxious stimuli in 50% of patients |
|
|
What is the meaning of a low "MAC"?
|
Lower MAC = higher potency
|
|
|
How does the solubility of inhalational anesthetic relate to rate of onset?
|
The greater the solubility, the more is required to saturate the blood
Higher solubility = slower onset |
|
|
The concentration of inhalational anesthetic in the blood is dependent on which variable?
|
Solubility
|
|
|
The concentration of inhalational anesthetic within tissues is dependent on which variable?
|
Arteriovenous concentration gradient
|
|
|
What is the relationship between arteriovenous concentration of inhalational anesthetic and rate of onset?
|
Greater gradient = slower rate of onset
|
|
|
Diagnosis: crypt abscesses and numerous pseudopolyps
|
Ulcerative colitis
|
|
|
Why are the Chlamydiae resistant to penicillins?
|
They lack peptidoglycan and instead have membrane proteins with extensive sulfide bridges
|
|
|
How are the various rRNA particles generated?
|
They are all transcribed as a single transcript that is subsequently cleaved into the subunit particles
|
|
|
How are the various rRNA particles generated?
|
All (except 5S) are transcribed by RNA pol. 1 as a single transcript that is subsequently cleaved into the subunit particles
|
|
|
Warfarin t1/2
|
~40 hours
|
|
|
Treatment: hepatic encephalopathy
|
Lactulose
|
|
|
MOA: lactulose
|
Metabolized to lactic and acetic acids, acidifying the GI tract, and trapping NH3 as NH4+
|
|
|
Diagnosis: excessive unmineralized osteoid
|
Osteomalacia
|
|
|
"Repression" vs. "suppression"
|
Repression = immature and unconscious expulsion of undesirable feelings/thoughts
Suppression = mature, intentional expulsion of undesirable feelings/thoughts |
|
|
MC autoimmune hemolytic anemia
|
Warm agglutinin disease
|
|
|
Examples of unmyelinated sensory fibers
|
Heat
Pain Olfaction |
|
|
Examples of unmyelinated efferent fibers
|
Postganglionic autonomics
|
|
|
Define: "delusional disorder"
|
"Non-bizarre" delusions for at least 1 month
E.g. someone convinced they are being followed who cannot be dissuaded but otherwise has no hallucinations/disordered thought/etc. |
|
|
Function: CD1
|
Related to MHC 1; responsible for presenting lipid antigens to T cells
|
|
|
Function: "transporter associated with antigen presentation"
|
Transports cytosolic antigen fragments into the ER for presentation in MHC 1 on the cell surface
|
|
|
Diagnosis: microcytic anemia with mouth pain, atrophic tongue
|
Fe deficiency
|
|
|
Diagnosis: elevated baseline insulin secretion with normoglycemia
|
Early insulin resistance
|
|
|
Intrinsic causes of ATN
|
Hyperuricemia
Myoglobinuria Bence-Jones proteinuria |
|
|
Which part of the skin thickens with callus formation?
|
Stratum corneum
|
|
|
LH levels in PCOS
|
High
|
|
|
FSH levels in PCOS
|
Low
|
|
|
Use: GpIIb/IIIa inhibitors
|
ACS
|
|
|
MOA: leuprolide
|
GnRH agonist when pulsatile
GnRH antagonist when continuous |
|
|
MOA: flutamide
|
Nonsteroidal, competitive antagonist at androgen receptor
|
|
|
MOA: cyproterone
|
Androgen receptor antagonist
|
|
|
Diagnosis: teardrop cells and massive splenomegaly
|
Myelofibrosis
|
|
|
How does CCK affect glucagon?
|
Increased secretion.
|
|
|
MOA of octreotide in the treatment of varices
|
Antagonizes hormones that vasodilation of the splanchnic bed (e.g. glucagon and VIP)
|
|
|
Effect of glucagon on the splanchnic bed
|
Vasodilation
|
|
|
Where would you find dipicolinic acid?
|
Bacterial spores
|
|
|
What is "cord factor"?
|
Mycobacterial glycolipid that blocks macrophage activation by IFN-γ, induces secretion of TNFα, and causes TB to form long cord-like structures
|
|
|
Diagnosis: bacterium with D-glutamate
|
B. anthracis
|
|
|
Pathogens: + Giemsa stain
|
Borrelia, Plasmodium, trypanosomes, Chlamydia
|
|
|
Six bugs that don't Gram stain
|
Treponema
Rickettsiae Mycobacteria Mycoplasma Legionella Chlamydia |
|
|
S/Sx: disseminated blastomycosis
|
Lung disease with skin and lytic bone lesions
|
|
|
Equation: compliance
|
dV/dP
|
|
|
Key segmented viruses
|
Orthomyxoviridae and rotavirus
|
|
|
Which hernia: bowel incarceration
|
Femoral
|
|
|
EBV "receptor"
|
CD21
|
|
|
Cell: CD22
|
B cells
|
|
|
Vessel: superior orbital fissure
|
Sup. ophthalmic vein
|
|
|
Ejection fraction: diastolic dysfunction
|
Normal!
|
|
|
Diastolic dysfunction: EDV and EDP
|
EDV = Normal
EDP = Elevated |
|
|
Systolic dysfunction: EDV and EDP
|
EDV: Increased
EDP: Increased |
|
|
Diastolic dysfunction: contractility
|
Normal
|
|
|
Why is EDP high in diastolic dysfunction?
|
Poor compliance limits EDV without an accompanying increased EDP
|
|
|
Why is EDP high in systolic dysfunction?
|
Because contractility is impaired, an increase in EDP is necessary to generate a sufficiently-large EDV to maintain adequate CO
|
|
|
DDx: acute-onset JVD with hypotension and tachycardia
|
Tamponade
Tension pneumothroax |
|
|
What causes "saline-responsive" metabolic alkalosis?
|
Loss of gastric HCl ---> vomiting or nasogastric suction
|
|
|
What is urinary chloride in saline-responsive metabolic alkalosis?
|
Low
|
|
|
What is urinary chloride in contraction metabolic alkalosis?
|
High
|
|
|
Is metabolic alkalosis secondary to hyperaldoesteronism responsive to chloride?
|
No
|
|
|
Blood lactate levels in McArdle's disease
|
No increase with exercise
|
|
|
Which GSD: hepatic steatosis
|
von Gierke's
|
|
|
Which GSD: hypertriglyceridemia
|
von Gierke's
|
|
|
Which GSD: hyperuricemia
|
von Gierke's
|
|
|
Diagnosis: hypertensive crisis with cheese
|
MAOI toxicity
|
|
|
PT/PTT: HUS
|
Normal/Normal
|
|
|
PT/PTT: TTP
|
Normal
|
|
|
Histology: eczematous dermatitis
|
Spongiosis: intercellular fluid accumulation
|
|
|
Diagnosis: bronchial thickening, neutrophilic infiltrate, mucous gland hyperplasia, and patchy squamous metaplasia
|
Chronic bronchitis
|
|
|
Diagnosis: diastase-resistant granules
|
T. whipleii
|
|
|
Association: porcelain gallbladder
|
Cholangiocarcinoma
|
|
|
Diagnosis: reticular, "lace-like" rash on a child that spares the palms and soles
|
Parvovirus
|
|
|
LH, FSH levels: Turner's
|
High/high
|
|
|
Drainage: superficial inguinal nodes
|
All cutaneous lymph from the umbilicus to the feet, including external genitalia and anus but excluding the posterior calf
|
|
|
Lymph drainage: bladder
|
Internal and external iliac nodes
|
|
|
Lymph drainage: prostate
|
Internal and external iliac nodes
|
|
|
Which CNS structures are prominently affected in Alzheimer's?
|
Nucleus basalis and hippocampus
|
|
|
Diagnosis: NMDA receptor depletion in the striatum
|
Huntington's
|
|
|
MOA: epostane/trilostane
|
Progesterone synthesis inhibitors
|
|
|
Effect on deoxyhemoglobin saturation curve: CO poisoning
|
Left shift
|
|
|
ARDS: effect on pulmonary function tests
|
Impairs compliance, leading to a restrictive physiology
|
|
|
Tx: staphylococcal endocarditis
|
IV antistaphylococcal penicillin (e.g. nafcillin) + aminoglycoside
|
|
|
Diagnosis: painful thyroid with giant cells and a preceding viral illness
|
de Quervain's/subacute/granulomatous thryoiditis
|
|
|
What is responsible for different Herpesvirus susceptibilities to acyclovir?
|
Differences in intraviral phosphorylation rates between different members of the Herpesviridae
|
|
|
What factor explains CMV's high sensitivity to ganciclovir relative to other Herpesviridae?
|
Different viral DNA pol. structure
|
|
|
The Na+/I- cotransporter in thryoid follicles can be competitively inhibited by what compounds?
|
Anions like perchlorate or pertechnetate
|
|
|
Histology/radiography: HSV encephalitis
|
Edema, hemorrhage of the temporal lobes
|
|
|
Personality changes caused by viral encephalitis are due to effects on which CNS structure?
|
Amgydala
|
|
|
Which part of the bone is predominantly affected by hyperparathyroidism?
|
Cortical bone
|
|
|
Which bony tissue is most metabolically active (other than marrow)?
|
Trabecular/spongy bone
|
|
|
Tx: Graves' ophthalmopathy
|
Glucocorticoids
|
|
|
Test has a sensitivity of 95%; what is probability of false positive with 8 subsequent tests?
|
1 - .95^8
|
|
|
Chromosome: Rb
|
13
|
|
|
What branch of the immune system is most important for fungal infections?
|
Cell-mediated/T cells
|
|
|
MOA/Use: memantine
|
NMDA antagonist
Alzheimer's |
|
|
Which vitamin is used in Alzheimer's treatment?
|
Vit. E for antioxidation
|
|
|
What protein is "amyloidized" in dialysis-associated amyloidosis?
|
β2-microglobulin
|
|
|
What is the most common manifestation of amyloidosis?
|
Myocardial deposition ---> arrhythmias
|
|
|
Diagnosis: segmental demyelination with endoneural inflammation
|
Guillain-Barre
|
|
|
What is "subacute combined myelopathy"?
|
The neurologic manifestations of B12 deficiency
|
|
|
Which atypical antipsychotics are the most and least likely to cause extrapyramidal symptoms?
|
Most likely: risperidone
Least likely: clozapine |
|
|
Two possible treatments for acute dystonia
|
Anticholinergics
Antihistamines |
|
|
Where do the bronchial veins drain?
|
LA
|
|
|
Diagnosis: rapidly-progressive dementia and myoclonus
|
Creutzfeldt-Jakob
|
|
|
CNS histology: prion diseases
|
"Spongiform" = vaculoes and cysts
|
|
|
Angiosarcoma risk factor
|
Chronic lymphedema
|
|
|
MC site within a bone for hematogenous osteomyelitis
|
Metaphysis
|
|
|
Diagnosis: alveoli filled with high columnar cells but no invasion; looks like a pneumonia on CXR
|
Bronchioalveolar carcinoma
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Pulmonary vascular resistance is lowest at which lung capacity ?
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FRC
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How does ulcerative colitis-assoc. CRC differ from sporadic CRC?
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1. Tumors arise from non-polypoid tissue
2. Higher histologic grade 3. Multifocal 4. p53 mutation first, APC mutation later |
