Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
85 Cards in this Set
- Front
- Back
|
Mechanism of hereditary spherocytosis? Presentation? What is acute presentation triggered by?
|
Red cell cytoskeleton abnormalities involving spectrin and ankyrin cause hemolytic anemia, jaundice, and splenomegaly after an infection.
|
|
|
Young boy with difficulty breathing, fever, not eating or drinking, neck swelling with paralysis of the palate and a gray pharyngeal exudate- dx? Mechanism of virulence factor and its name? Transmission of organism? Tx? MOA of Tx? Mortality from what complication?
|
Diphtheria has an AB exotoxin that is specific for neural and cardiac tissue that ribosylates and deactivates elongation factor 2 thus inhibiting protein synthesis. Treat with diphtheria antitoxin very quickly because it is a passive immunization that only inactivates circulating toxins as a preformed antibody. Also can give PCN/erythromycin and prevent future infections with active immunization through a DPT vaccine. Mortality is from cardiomypoathy.
|
|
|
Dx- dipolopia worsening towards end of day? Treatment and its MOA? What if there is exacerbation of this disease, what do you do?
|
Myasthenia gravis should be treated with a long acting acetylcholinesterase inhibitor like pyridostigmine, and if there is worsening of condition, you should add the short acting acetylcholinesterase inhibitor edrophonium to see if there is improvement. If there is improvement, you should increase the pyridostigmine dose and if there is worsening then you temporarily discontinue it and decrease the dose.
|
|
|
How do cancer cells evade apoptosis using the Fas receptor-ligand interaction? With which cell type does this normally lead to apoptosis?
|
They can use alternative splicing to remove the exon coding for the transmembrane domain of the Fas receptor to make it soluble and thus evade apoptosis. Otherwise, Fas receptor-ligand interaction drives apoptosis via the cytotoxic T cell extrinsic pathway when it is recognized.
|
|
|
Testicular germ cell tumors secrete what substance? Levels of what else would you find to be high and why? What is this called?
|
Germ cell tumors secrete hCG which is very similar in structure to TSH so you will have paraneoplastic hyperthyroidism.
|
|
|
Ankylosing spondylitis presentation? What is the genetic association? What class is this genetic feature in?
|
Lower back pain with sacroiliac joint narrowing and vertebral fusion due to class 1 HLA B27 allele.
|
|
|
Major determinant of symptom severity in tetralogy of Fallot?
|
Degree of right ventricular outflow obstruction (more obstruction means more cyanosis)
|
|
|
Homocysteine is converted to what by addition of a methyl group from methyl tetrahydrofolate? What vitamin is needed for this reaction and what enzyme is used? What else can homocysteine be made into and what vitamin is needed for that reaction? What happens if you dont have these products being made from homocysteine?
|
Methionine synthesis by methionine synthase needs vitamin B12 but cystathionine and then cysteine synthesis requires B6. Otherwise, these is an increase risk of thrombotic and cardiovascular events.
|
|
|
Exernal hemorrhoids below the dentate line hve cutaneous somatic nervous innervation from which branch of which nerve?
|
Inferior rectal nerve is a branch of the pudendal nerve
|
|
|
Only males are affected by a disease, and the affected males are offspring of unaffected parents- what kind of inheritance is this?
|
X linked recessive
|
|
|
Cell markers for B cells?
|
CD19 and CD20
|
|
|
Equation for volume of distribution?
|
Amount of drug given (mg) / plasma concentration of drug (mg/L)
|
|
|
Average total body water volume? Extracellular portion of this fluid? Plasma volume?
|
41L, 14L, and 3L
|
|
|
What are the characteristics of a drug with the highest volume of distribution?
|
Low molecular weight, uncharged (hydrophobic or lipophilic), and thus low plasma protein binding allow a drug to be distributed beyond plasma volume and even beyond total body water since they will accumulate in the cells.
|
|
|
What malignancies are associated with EBV?
|
Burkitt lymphoma and nasopharyngeal carcinoma
|
|
|
What does the ureter pass anterior to when it is behind the gonadal vessel? What about when it is medial to the gonadal vessel? What is in front of it in this second situation?
|
Common/external iliac artery and then internal iliac artery. The uterine artery or spermatic cord.
|
|
|
MOA of penicillins?
|
Inhibit transpeptidase by binding covalently to its active site (resembles D-ala-D-ala) in order to prevent synthesis of the bacterial peptidoglycan wall.
|
|
|
What is the arterial supply of the spleen, what does that branch from?
|
Splenic artery branches from the celiac trunk.
|
|
|
Describe Corynebacterium diphtheriae? How does it stain? What is the MOA of its main virulence factor?
|
Nonmotile, unencapsulated, gram positive rods that stain with aniline dyes (methylene blue) due to cytoplasm containing metachromatic granules. Its AB exotoxin B subunit binds to cardiac and neural cells and induces exocytosis of the toxin while the A subunit inhibits host cell protein synthesis by catalyzing the ADP-ribosylation of protein elongation factor 2 (EF-2).
|
|
|
What cervical pathology is detected by nucleic aid amplification testing? Presentation and cause? Complications? Treatment?
|
Endocervical infection (cervicitis) is usually caused by neisseria gonorrhoeae and chlamydia. If untreated, in can progress to PID and infertility. You should treat with azithro and ceftriaxone.
|
|
|
Diagnosis if there is female obesity, menstrual irregularities, hirsutism, acne, alopecia, and sometimes insulin resistance? What if these patients want to get pregnant and its MOA?
|
Polycystic ovary syndrome. Use clomiphene (SERM) to prevent negative feedback inhibition on hypothalamus and pituitary by circulating estrogen to increase gonadotropin production (FSH and LH) and hence, ovulation.
|
|
|
What does insulin do to glucagon secretion?
|
Inhibits it
|
|
|
What is the toxic component of LPS in E. coli, what does it do, and what condition does it cause?
|
Lipid A is the toxic component of LPS and it activates macrophages leading to widespread release of IL-1 and TNF-alpha causing septic shock.
|
|
|
Where are endotoxins found and in what organisms?
|
In the outer membrane of gram negative bacteria which is composed of LPS
|
|
|
Which two genuses of bacteria are spore forming and found in soil (can survive boiling)?
|
Bacillus and Clostridium
|
|
|
MOA of isoniazid and how can resistance to it develop?
|
Inhibition of mycolic acid synthesis in TB after processing by mycobacterial catalase peroxidase, so you can get resistance through non expression of the catalase peroxidase enzyme or through genetic modication of the INH binding site on mycolic acid synthesis enzyme
|
|
|
Streptomycin MOA?
|
Disables the bacterial ribosomal 30S subunit
|
|
|
Resistance to rifampin occurs how?
|
Mutation in the gene encoding for DNA dependent RNA polymerase necessary for transcription and RNA prolongation
|
|
|
How to get resistance to pyrazinamide?
|
MTB can alter their pyrazinamidase to prevent activation of the drug
|
|
|
MOA of ethambutol? Resistance occurs how?
|
Inhibits synthesis of MTB cell wall, and resistance happens when the MTB increases arabinosyl transferase to make more cell wall.
|
|
|
Metabolic side effects of chlorthalidone and what is the class of drug?
|
Thiazide diuretics can cause hyponatremia, hypokalemia, hypercalcemia, hyperglycemia (they decrease insulin secretion), and hypercholesterolemia (LDL and triglyceride)
|
|
|
Tx for Lyme disease?
|
Doxycycline or ceftriaxone
|
|
|
What molecules are needed to connect extracellular collagen to intracellular actin (adhesion of cells to the extracellular matrix)?
|
Collagen binds fibronectin, which binds integrin, which binds the plasma memrane and then actin.
|
|
|
What do you pierce through when you want to do a suprapubic cystostomy?
|
Aponeurosis of the abdominal wall muscles (along with superficial fascia, transversalis fascia, and extraperitoneal fat)
|
|
|
What condition is it when you have restlessness and jerking movements 3 months after a sore throat? What is this symptom called? What are other complications of this disease?
|
Acute rheumatic fever presents this way with Sydenham chorea involving anti strep antibodies reacting with the basal ganglia. You also have the risk of rheumatic heart disease which causes mitral stenosis/regurg.
|
|
|
What happens in endometriosis?
|
Endometrial tissue is present outside of the uterus causes nulliparity, early menarche, and prolonged menses leading to local inflammation and then adhesions (can cause retroverted uterus) and infertility (also painful intercourse)
|
|
|
Common side effects of nondihydropyridines calcium channel blockers and what drugs are in this class? What are they used to treat?
|
Diltiazem and verapamil cause constipation, new onset second degree AV block, bradycardia, syncope, and worsening heart failure in patients with reduced left ventricular function through a negative inotropic effect. They are used to treat Afib.
|
|
|
What artery supplies blood to the liver? What does it branch from?
|
Proper hepatic artery is a branch of the common hepatic artery which is a branch of the celiac trunk (first branch of the aorta).
|
|
|
What is the treatment for simple febrile seizures?
|
Supportive care and sometimes tylenol/ibuprofen to treat the fever but this does not prevent further seizures.
|
|
|
What do you have with acute depression, fatigue, vivid dreams, hypersomnia, and hyperphagia?
|
Cocaine withdrawal
|
|
|
Neurofibromatosis type 1 inheritance? Presentation?
|
Single gene autsomal dominant mutation on chromosome 17 with café au lait spots, neurofibromas, lisch nodules (pigmented hamartomas of the eyes), and pseduoarthrosis. Also brain tumors.
|
|
|
What are the major neutrophil chemotactic agents?
|
Leukotriene B4, 5-HETE, C5a, and IL-8
|
|
|
Anemia, jaundice, and dark urine after certain drugs or infection- Dx? What is the problem? Peripheral smear shows what? Deficiency of what other enzyme would lead to this presentation?
|
Glucose 6 phosphate dehydrogenase (G6PD) deficiency means that there is no NADPH to reduce glutathione so it remains oxidized and hemolytic anemia and jaundice with Heinz bodies precipitate in RBC and are then removed by splenic macrophages to leave bite cells. A deficiency of glutathione reductase would present similarly because it is needed to reduce glutathione (which converts hydrogen peroxide to water).
|
|
|
Klinefelters have what characteristic hormone levels?
|
Elevated estrogen, FSH, and LH but decreased testosterone.
|
|
|
Giant cell arteritis has what irreversible complication if not treated promptly? How is it treated?
|
Blindness is prevented with immediate glucocorticoids
|
|
|
High altitude sickness causes hypobaric hypoxia leading to what changes in respiratory rate, pH, pCO2, and pO2?
|
Increased respiratory rate with respiratory alkalosis, decreased pCO2 but with decreased pO2 (high renal excretion of bicarb is the compensation)
|
|
|
What happens to PaO2, SaO2, and oxygen content in CO poisoning?
|
Normal, decreased, decreased
|
|
|
What happens to PaO2, SaO2, and oxygen content in cyanide poisoning?
|
Normal, normal, normal
|
|
|
What happens to PaO2, SaO2, and oxygen content in anemia?
|
Normal normal decreased
|
|
|
What happens to PaO2, SaO2, and oxygen content in plycythemia?
|
normal normal increased
|
|
|
What happens to PaO2, SaO2, and oxygen content at high altitudes?
|
all decreased
|
|
|
What is the effect of concurrent verapamil and atenolol? Why?
|
Bradycardia and hypotension due to additive negative chronotropic effects
|
|
|
What does sensitivity of a test equal?
|
Number of true positives divided by total number of subjects who actually have the disease whether they tested positively or negatively
|
|
|
How do you calculate the number of true positive in a study?
|
Sensitivity times numbers of patients actually with the disease
|
|
|
How do you calculate false negatives in a study?
|
(1-Sensitivity)*(Number of patients actually with the disease)
|
|
|
Adverse effects of chronic topical corticosteroid administration?
|
Atrophy/thinning of the dermis with loss of collagen, cracking, telengiectasias, and ecchymoses
|
|
|
Rapidly progressing fever, severe sore throat, drooling, progressive airway obstruction with stridor, and cherry red epiglottis in a young boy- dx?
|
H flu
|
|
|
What is it when you have pharyngocunjunctival fever at an overnight camp or day care or military barracks?
|
Adenovirus
|
|
|
Contaminated dairy products with gasteroenteritis, septicemia, and meningoencephalitis?
|
Listeria
|
|
|
What is the physiologic cause of urge incontinence in MS and what happens in this condition?
|
Detrusor muscle overactivity from spinal cord lesion (hyperreflexia) causes sudden, overwhelming or frequent need to empty bladder
|
|
|
What happens in pulsus paradoxus? What conditions is this phenomenon seen in?
|
Decrease in systolic blood pressure by more than 10 with inspiration (detected by gradually deflating a blood pressure cuff and listening for decreased heart sounds on inspiration) because the heart cannot expand as in tamponade of restrictive pericarditis so the interventricular septum bulges into the left ventricle and greatly decreases the stroke volume.
|
|
|
Treatment for asthma and COPD and its MOA at the cellular level?
|
Beta agonists (beta 2) cause bronchial smooth muscle relexation by a Gs protein coupled receptor intracellular cAMP
|
|
|
Why is there pulsus paradoxus in asthma or COPD?
|
A drop in intrathoracic pressure is exaggerated and is transmitted to extrathoracic structures leading to drop in blood pressure with inspiration
|
|
|
Old lady with STEMI gets treatment for the acute condition and associated bradycardia but then suffers severe right sided eye pain- what happened?
|
Patient was treated with atropine to increase blood pressure but has antimuscarinic side effects includes mydriasis resulting in narrowed anterior chamber angle and diminished outflow of aqueous humor and thus acute closed angle glaucoma.
|
|
|
What is contained in the suspensory ligament of the ovary?
|
Ovarian artery, vein, lymphatics, and nerves
|
|
|
Turner syndrome karyotype?
|
45, XO
|
|
|
How does GH promote growth?
|
They act on cell surface receptors that stimulate production of IGF-1 in the liver leading to activation of JAK (nonreceptor tyrosine kinase) that phosphorylates tyrosine residues in the GH receptor which serve as docking sites for STAT which is also then phosphorylated by JAK. STAT dimerizes and translocates to the nucleus where it induces IGF-1 gene transcription by binding to the promotor region.
|
|
|
Why do you get acute intermittent porphyria attacks? Treatment?
|
Accumulation of ALA and PBG resulting from inherited PBG deaminase deficiency combined with induction of ALA synthase during stress. Treat with replacement blood products or glucose.
|
|
|
Cleft lip results from the failure of what?
|
Failure of maxillary prominence fusing with intermaxillary segment during fifth-sixth week of embryonic development.
|
|
|
Celft palate occurs when?
|
When the palatine shelves fail to fuse with one another or with the primary palate
|
|
|
What happens in ARDS physiologically?
|
Diffuse injury to the pulmonary microvascular endothelium and alveolar epithelium results in increased pulmonary capillary permeability and leaky alveolocapillary membrane leading to noncardiogenic pulmonary edema.
|
|
|
In ARDS, what happens to capillary permeability, lung compliance, pulmonary capillary wedge pressure, ventilation perfusion matching, and the work of breathing?
|
Capillary permeability increases, so lung compliance decreases, the work of breathing increases, and ventilation perfusion mismatches (decreased ventilation to areas of maintained perfusion) can occur. BUT, capillary wedge pressure stays normal.
|
|
|
What is linkage disequilibrium between two allele loci?
|
Pair of alleles that are inherited together in the same gamete more often or less often than would be expected given random pairing because they are located closely on the same chromosome.
|
|
|
Adverse effects of succinylcholine?
|
Malignant hyperthermia (especially with halothane), severe hyperkalemia (especially in burns, crush injuries, and myopathies), and brady cardia or tachycardia
|
|
|
What to do in a post partum hemorrhage that is unresponsive to uterine massage or uterotonic medications??
|
Bilateral ligation of the internal iliac artery to decrease uterine blood flow
|
|
|
Mechanism of action of allopurinol? If a patient is onallopurinol, which immunosuppressant would have increased activity due to allopurinol and how?
|
Allopurinol inhibits xanthine oxidase which would increase conversion of azathioprine to its active metaboliite and thus increase bone marrow suppression and decrease leukocyte production.
|
|
|
What two cancers are patients with down syndrome at an increased risk of developing?
|
ALL and AML
|
|
|
Define negative predictive value?
|
The probability of being free of disease if the test result is negative
|
|
|
Diagnosis and test for a patient with dyspnea, fatigability, unstable gait, impaired vibratory sensation in lower extremities, and conjunctival pallor? Explain the pathophysiology also?
|
Vitamin B12 deficiency has megaloblastic anemia because of impaired DNA synthesis (inability to make methionine from homocysteine) and neurologic deficits like subacute combined degeneration of dorsal column and lateral corticospinal tract from impaired myelin synthesis (inability to make succinyl coA from methylmalonic acid), so naturally you can check for increased levels of methylmalonic acid and homocysteine for this diagnosis.
|
|
|
How does glucose induce insulin release from pancreatic beta cells?
|
1-enters beta cell through GLUT2, 2-metabolized by glucokinase to glucose 6 phosphate, 3-further metabolized by glycolysis and Krebs to make ATP, 4-high ATP to ADP ratio in the beta cell closes ATP sensitive potassium channels, 5-beta cell is depolarized and thus opens voltage dependent calcium channels, 6-calcium rushes in and insulin is released
|
|
|
What do enterocysts and Meckel's diverticula have in common?
|
Both result from a failure of obliteration of the vitelline duct (omphalomesenteric duct).
|
|
|
What is an enveloped virus containing partially double stranded circular DNA and has an enzyme packed in its virion as an RNA dependent DNA polymerase? Hint- patient would present with fever and joint pain and have atypical lymphocytes in his blood?
|
HBV
|
|
|
Primary function of the nucleolus?
|
Synthesis and assembly of immature 60s and 40s ribosomal subunits that arethen exported from the nucleus to fully mature in the cytoplasm.
|
|
|
What is a cardiac side effect of a dihydroergotamine? MOA?
|
Vasospastic prinzmetal angina via stimulation of alpha adrenergic (partial agonist) and serotonergic receptors
|
|
|
4 week old boy develops dark yellow urine, pale colored stools, yellow skin, scleral icterus, and jaundice of head and upper chest, also a mildly enlarged and firm liver. Most importantly, direct bilirubin is the cause of elevated total bilirubin- whats the diagnosis?
|
Extrahepatic obstruction of bile ducts via biliary atresia
|
