Ms2 - Test 4 - Week 2

Front 1

What are the 4 drugs that are used as initial therapy for TB?

Back 1

Isoniazid (INH)

Rifampin (RIF)

Pyrazinamide (PZA)

Ehtambutol (ETB)

Front 2

What are 4 drugs that are famous INDUCERS of Cyt. P450?

Back 2

Rifampin

Ethanol

Non-nucleoside ART (Anti-retroviral therapies)

Anticonvulsants (Carbamazapime, Phenytoin, Phenobarbital)

Front 3

What anti-TB drug is unique in that it may cause optic neuritis -> color blindness?

Back 3

Ethambutol

Front 4

What anti-TB drugs can be given by itself as prophylaxis (AKA tx for a latent infection)?

Back 4

INH

Front 5

What anti-TB drug is used for control of M avium complex in AIDs patients?

Back 5

Clarithromycin – is used in atypical TB

Front 6

What kind of mutation causes

a change in a different amino acid but may or may not change activity

a change in the codon but the protein is the same

Back 6

Missense mutation - change in amino acid

Silent mutation - change in codon but same amino acid

Front 7

In bacterial conjugation what segment of the plasmid being shared is transferred first? Transferred last?

Back 7

Transferred first = oriT (origin of replication)

Transferred last = tra genes

Front 8

In an Hfr x F- conjugation, the recipient cell may receive some genes but not become F+ or Hfr, why?

Back 8

B/c they may not have recieved the tra genes

Front 9

What is the only kind of phage that can cause specialized transduction?

Back 9

Temperate phage that has undergone the lysogenic cycle

Front 10

What makes transposons unique?

Back 10

They move into DNA by NON-HOMOLOGOUS recombination

Front 11

The process of infecting human cells with viral material is called?

If this occurs with naked (-) ssRNA or dsRNA will it cause an infection?

Back 11

Transfection

No infection b/c viruses need RNA dependent RNA polymerase

Front 12

What are the 3 leading causes of chronic kidney dz in the US in order?

Back 12

Diabetes

Hypertension

Glomerular dz

Front 13

True or False

The fractional excretion of H20 INCREASES as GFR falls?

Back 13

True

Front 14

True or False

If a patient with CKD comsumes more than 500 mLs of H20, they will develop HYPERnatremia?

Back 14

False

They will develop HYPOnatremia b/c they can only excrete 500 mL of H20 tops

Front 15

True or False

Kidneys in end-stage chronic kidney disease present large and abnormal

Back 15

False

They present small and with cortical thinning

Front 16

What is the earliest clinical marker for detecting glomerular injury due to hyperfiltration?

Back 16

Albumin in the urine

Front 17

What is the cause of loss of appetite and vomiting seen in Chronic Kidney Dz?

Back 17

Uremic Syndrome

High BUN!!!

Front 18

What molecule is the cause for peripheral neuropathy seen as a consequence of uremic syndrome?

How does it do this?

Back 18

Parathyroid hormone

Is a neurotoxin by opening voltage gated Ca channels in excitable tissue

Front 19

What are the two mechanisms explaining why HTN is seen as a complication of chronic kidney failure?

Back 19

Increased intravascular(ECF) volume

Increased RAAS = increased Renin production

Front 20

What is the murmur most common in uremic syndrome?

Back 20

Low-grade blowing diastolic murmur

Pulmonic regurg

Front 21

What is the mechanism for:

Microcytic anemia in CKD?

Normocytic normochromatic anemia in CKD?

Back 21

Microcytic = Bleeding

Normocytic = decreased EPO from renal interstital fibroblasts and b/c Creatinine > 3

Front 22

What is the cause for epistaxis, menorrhagia, easy bruising, and GI bleeding in Uremic syndrome?

Back 22

Platelet dysfunction

Front 23

Why are giving ACE inhibitors and ARB's detrimental in late chronic kidney disease?

Back 23

Causes hyperkalemia

B/c the compensatory mechanism is increasing Aldo -> increasing K secretion

Front 24

What two factors cause INHIBTION of Na reabsorption as GFR falls to <3 in chronic kidney disease?

Back 24

PGE2

Natriuretic peptide

Front 25

What are three methods to slow the progression of chronic renal failure?

Back 25

ACE inhibitors and ARB’s – cause dilation of efferent arteriole = decreased GFR and SNGFR = decreased hyperfiltration of macromolecules

Protein restricted diet –

Strict BP control (120/75 mm Hg)

Front 26

True or False

Insulin Dependent diabetics require MORE insulin when they have chronic kidney disease?

Back 26

False

They require less, b/c the kidney normal metabolizes insulin

Front 27

True or False

in general protein synthesis inhibitors are "bacterioSCIDAL"

Back 27

False

They are bacterio "static"

Front 28

What is the DOC of an aspergillus infection?

Back 28

Voriconazole

Front 29

What is the most common cause of a kidney infection that results from bacterial endocarditis?

Back 29

Staphylococcus

Front 30

What are the three symptoms most commonly found in acute cystitis?

Back 30

Frequency,

Urgency

Dysuria (pain on urination)

Front 31

What are the 3 symptoms most commonly found in acute pyelonephritis?

Back 31

Back pain

Tenderness to costo-vertebral percussion

Fever & chills (b/c septicemia)

Front 32

A kidney with U-shaped scars, most likely has what dz?


A kidney with V-shaped scars, most likely has what dz?

Back 32

Chronic Pyelonephritis


Vascular (Renal infarct)

Front 33

What are the 4 common causes of papillary necrosis?

Back 33

Diabetes mellitus

Severe pyelonephritis

Hydronephrosis

Sickle cell anemia

Front 34

What are the only kind of kidney stones that are NOT VISIBLE on radiographs?

Back 34

Urea stones

Front 35

Hyaline arteriolosclerosis = ?

Back 35

Benign nephrosclerosis due to systemic HTN

Front 36

True or False

Most cases of benign nephrosclerosis progress to malignant hypertension?

Back 36

False

Most do NOT, only some do

Front 37

What are the two factors that stimulate PTH secretion in the later stages of CKD?

Back 37

Hypocalcemia

Increased FGF-23

Front 38

What are the 3 hallmarks of secondary hyperparathyroidism?

Back 38

Hypocalcemia

Hyperphosphatemia

PTH elevation

Front 39

What dz presents with subperiosteal erosions and a "salt and pepper" skull?

What is the mechanism?

Back 39

Osteitis fibrosa cystica

Increased bone turnover

Front 40

What are the two elevated biomarkers for secondary hyperparathyroidism?

Back 40

Alkaline phosphatase (Increased osteoblastic activity)

Tartrate-resistant acid phosphatase 5b (increased osteoclastic activity)

Front 41

What drug is used to decrease PTH release by increasing sensitivity of chief cell receptors to Ca in the parathyroid gland?

Back 41

Cinacalcet

Front 42

Why does metabolic acidosis develop in CKD?

Back 42

B/c Damaged kidneys are unable to sufficiently increase ammoniagenesis

Front 43

What are the 3 most likely causes of pruritus in a pt w/ CKD?

Back 43

Systemic inflammation = increased cytokines

Over expression of opiod receptors = increased Beta endorphin

Excess histamine production = more mast cells

Front 44

What is the second most common cause of death in CKD?

What is the 1st?

Back 44

Infection

CVD

Front 45

What are the 4 characteristic features of adynamic bone disease?

Back 45

Low PTH
Decreased osteoclasts and osteoblasts
Decreased osteoid
Decreased bone turn-over

Front 46

What term does the following definition represent:

- determined by the NUMBER of solute particles dissolved in a Kg of H20

Back 46

Osmolality

Front 47

True or False

Changes in BUN concentration, change plasma osmolality but NOT the plasma tonicity

Back 47

True

Front 48

True or False

In the abscence of insulin, glucose raises the plasma omolality AND the plasma tonicity

Back 48

True

Front 49

Osmoregulation have to do with changes in the levels of what in the ECF compartment?

Back 49

H20 content

Front 50

What is the main determinant of plasma tonicity?

What is the main determinant of plasma osmolalility?

Back 50

Na

Na

Front 51

What are the two places that aldosterone mediates Na reabsorption?

Back 51

Distal convoluted tubule

Cortical collecting duct

Front 52

Urine osmolality reflects ________ release and activity


Urine Na excretion reflects _________ release and activity

Back 52

ADH (aka AVP - Arginine Vasopressin)


RAAS

Front 53

What are the two causes for which AVP may be released causing high urine osmolality (>400 mOsm)?

Back 53

Increase in plasma tonicity (increased Na)

Decrease in intravascular volume

Front 54

True or False

Urinary Na excretion is regulated by changes in plasma Na concentration?

Back 54

False

By changes in dietary Na intake & intravascular volume

Front 55

What is the chief determinant of urine osmolality?

Back 55

Amount of H20 excreted into urine

Front 56

What antimicrobial works by inhibiting DNA-directed RNA polymerase?

Back 56

Rifampin

Front 57

What does the E-test in micro provide?

Back 57

Minimal Inhibitory Concentration (MIC)

Front 58

What are the ESKAPE pathogens?

Back 58

Enterococcus
Staphylococcus
Klebsiella
Acinetobacter
Pseudomonas
Enterobacter/E.coli

Front 59

What is the mechanism by which MRSA is resistant?

Back 59

By mecA gene producing PBP2A which has a lower binding affinity for Beta lactams

Front 60

What is the treatment of choice for serious infections due to ESBL-producing organisms?

Back 60

Carbapenems

Front 61

If a 75 year old patient presents with hematuria, flank pain, and a palpable mass in the abdomin, what should you suspect?

Back 61

Renal Cell Carcinoma

Front 62

IF a patient has lung and brain metastasis (convulsions) noted plus a renal mass, what should you suspect?

Back 62

Renal Cell Carcinoma

Front 63

What subtype of Renal Cell Carcinoma is the most common?

Where does it affect?

What gene is involved?

Back 63

Conventional (Clear Cell)

Proximal Tubule

VHL gene, 3p deletion

Front 64

Where do most transitional cell carcinomas occur?

Back 64

In the bladder

Front 65

What cancer is associated with bladder exstrophy/stones & schistosomiasis in Egypt?

Does it generally have a good or poor prognosis?

Back 65

Squamous Cell Carcinoma


Poorer prognosis than transitional cell carcinoma

Front 66

What is the most common malignancy associated with bladder exstrophy?

Back 66

Adenocarcinoma

Front 67

What is the threshold [Na] for one to classify it as hyponatremia?

Back 67

< 136 mEq/L

Front 68

What is the mechanism by which the body controls:

Osmolality?

Volume regulation?

Back 68

Osmoreceptors = supraoptic nucleus

Water balance = paraventricular nucleus

Both control ADH

Front 69

What mechanism modulates urine osmolality?

What mechanism modulates urine [Na]?

Back 69

ADH – modulates urine osmolality (maximum when Urine osmolality is >600, no release when <100)

RAAS – modulates urine [Na] - activated when [ ]<10 and inhibited when [ ] >10

Front 70

In a 70 Kg man how much:

Total water?

Water in intracellular compartment?

Water in extracellular compartment?

Back 70

Total = 42L

Intracellular = 28

Extracellular = 14

Front 71

For every 100 mg/dl increase in plasma glucose concentration above 100 mg/dl, how much does ECF [Na] decrease?

Back 71

1.6 mEq/L for every 100 mg/dl increase

Front 72

What are the two opportunistic amebas?

Back 72

Naegleria (brain) & Acanthamoeba (brain)

Front 73

True or False

Entamoeba dispar CAN BECOME pathogenic?

Back 73

False

It is non-pathogenic

Front 74

What is the only flagellate protozoan, in which the trophozoite is the diagnostic AND infective stage?

AKA has no cyst stage

Back 74

Trichomas vaginalis

Front 75

What is the vector for of transmission for all Leishmania protozoans?

Back 75

Sandfly - Phlebotomus

Front 76

The presence of an Amastigote (aka LD body) – are DIAGNOSTIC for what?

The presence of a trophozoite with RBC's inside of it is diagnositc for what?

Back 76

Leishmania infection & trypansoma cruzi (Chaga's dz)

Entamoeba histolytica infection

Front 77

True or False

The amastigote stage is found ONLY in Trypanosoma brucei (African Sleeping Sickness)

Back 77

False

Only in T. cruzi (Chagas)

Front 78

What is the difference between mode of transmission between Trypanosoma brucei & Trypanosoma cruzi?

Back 78

T. brucei -> saliva of Tsetse fly

T. cruzi -> feces of "kissing bug"

Front 79

If a patient has recurrent hematuria and/or proteinuria, what is the most likely diagnosis?

Back 79

IgA Nephropathy -> mesangial deposition

Front 80

What is the definition of polyuria?

Back 80

Urine output > 3L / day

Front 81

What fraction of ECF is found in plasma (intravascular volume)?

What fraction of ECF is found in the interstitium?

Back 81

1/4


3/4

Front 82

Upon administering 1L of isotonic saline, how much will redistribute to the Extracellular compartment?

How much will go into the plasma volume?

Back 82

1 liter into ECF

250 mL into plasma

Front 83

What is the most common cause of isovolumic hypotonic hyponatremia?

By what mechanism does this occur?

Back 83

SIADH

IL-6 stimulates ADH release from BOTH hypothalamic nuclei!

Front 84

In order to become edematous the interstitial fluid compartment needs to increase by how much?

Back 84

2-3 Liters

Front 85

True or False

An increase in ADH always causes BUN:Cr ratio >20:1 and urine osmolality >400?

Back 85

False

increase in RAAS causes this

Front 86

What class is the most common cause of hyponatremia?

What are 3 non-renal causes of this?

Back 86

Hypervolemic hypotonic hyponatremia

Heart failure, Liver Cirrhosis, & Nephrotic syndrome