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206 Cards in this Set
- Front
- Back
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Gross Painless Hematuria in older adult
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Urothelial cancer until proven otherwise - most often Renal, clear cell carcinoma, full of glycogen and lipids
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Why does silicosis increase the risk of TB?
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Silicosis -> impairs macrophage function (effector arm) -> main defense against TB
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Where is the most common location of aortic injury?
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Aortic isthmus - the connection between ascending and descending aorta
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Where is the most common location of a hamartoma?
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Lung (native tissue) - Alveolar growth pattern without invasion
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What is aldosterone escape?
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When increased Na+ and Cl- absorption -> hypervolemia -> ANP -> increased excretion of Na+, so you may not see hypernatremia in aldosterone excess
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What happens in muscle contraction when ATP binds?
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Myosin head detaches from the actin filament
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What does folate deficiency inhibit the synthesis of?
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dTMP; which limits DNA synthesis -> megaloblastic anemia
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Characteristic liver histo finding in Reye's disease?
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Microvesicular steatosis of hepatocytes without inflammation or cerebral edema
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What increased risk do you see in Type B (antrum) chronic gastritis?
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increased risk of MALT lymphoma
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This benign hemangioma is composed of capillaries separated by CT
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Strawberry hemangioma
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Host cell/virion binding specificities: CD4, CD21, erythrocyte P antigen
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CD4 - HIV gp120
CD21 - EBV erythrocyte P antigen - Parvovirus B19 |
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gp120 vs gp41
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gp120 - attachment to host T cell
gp41 - fusion and entry |
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What is the major cause of morbidity and mortality in theophylline intoxication?
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Seizures (next is tachyarrhythmias)
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Which symptom of Graves' is not reversed by B-blockers?
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Exopthalmos (via GAGs/ground substance and fibroblasts)
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Lack of oxygen to which organ stimulate the production of Epo?
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hypoxia sensed by renal cortical cells of kidney
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What causes tissue damage and resultant abscess formation in lungs?
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Lysosomal enzyme release from neutrophils and macrophages
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Air-fluid levels seen in CXR
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Lung abscess
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Is bladder wall relaxation cholinergic or anticholinergic?
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Anti-cholinergic
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What is the origin of carcinoid syndrome cells?
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Enterochromaffin (endocrine); minimal-to-no variation in size and shape (very uniform)
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Most common location of intestinal carcinoids?
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Ileum, the appendix/rectum
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What level is most useful in diagnosing the cause of metabolic alkalosis?
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Cl- levels
Loss of H+ - low urinary Cl- Diuretic use - high urinary Cl- Hyperaldo - high urinary Cl- |
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Which bug can cause complication of asthma that result in eosinophilia and high serum IgE levels
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Aspergillus
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Anastrazole/Exemestane MOA
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Aromatase inhibitor
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Akathisia
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"restless leg syndrome" or feeling "on edge"
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Warfarin induced skin necrosis MOA
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Defect in Protein C synthesis
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How does citrate reduce calcium stone formation?
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Citrate can bind to free Ca2+ in urine -> prevents precipitation and facilitates excretion
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What causes pain and palpable flank mass that radiates to groin most cervical cancer surgery
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hydronephrosis, may be due to accidental ligation
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Nonbacterial thrombotic endocarditis is similar to Trousseau's syndrome in what way?
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These are induced by disseminated cancers
NBTE - mucinous adenocarcinoma of the pancreas or adenocarcinoma of the lung Trousseau - pancreatic adenocarcinoma |
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Dystonia
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sustained, involuntary muscle contractions, may be a result of impaired basal ganglia
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Marantic endocarditis
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Nonbacterial thrombotic endocarditis (NBTE) w/ disseminated cancer
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Left testicular vs. Right testicular vein drainage
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L -> L renal vein -> IVC
R -> IVC |
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What is responsible for the hypercoagulable state in nephrotic syndrome?
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Loss of anticoag factors in urine, mostly ATIII
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What is the purpose of IgA protease?
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Allow for mucosal penetration of bacteria (SHiN)
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Rx for serotonin syndrome
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Cyproheptadine (Histamamine antag, 5-HT antag)
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This histology of Primary Biliary Cirrhosis is similar to what?
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GVHD - granulomatous bile duct destruction, lymphocyte-predominant portal tract infiltrate
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Why do you see xanthelasmas in primary biliary cirrhosis?
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You get cholestasis -> hypercholesterolemia
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What drugs increase lithium levels?
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Thiazides, NSAIDs, Ace-Inhibitors
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Why do diuretics (ie. Thiazides) increase lithium levels?
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Lithium gets reabsorbed similarly to Na+. So w/diuretics, you get higher levels of Na+ reabs in PCT, as well as lithium reabs
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What are melanocytes derived from?
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Neural Crest cells
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Malignant melanoma to the CNS would present how?
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Seizure
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What is the action of a 3'-5' exonuclease?
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Proofread activity - remove mismatched nucleotides
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Where in the nephron does Lithium work?
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In the CT; inhibits the ability of vasopressin to bind to receptors on the collecting duct
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Why can HSV1/2 and VZV be treated with acyclovir, but now EBV or CMV?
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EBV and CMV do not produce the same thymidine kinase as HSV1/2 and VZV that are necessary to convert acyclovir to its triphosphate active form
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what is the most common cause of CA-pneumonia in adults?
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Strep pneumoniae
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Passive vs. Active transport of bilirubin
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Passive - liver takes up indirect bilirubin using Organic Anion Transporting Polypeptide
Active - liver secretes direct bilirubin via ATP-binding cassette (MRP2) |
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Which monosaccharide has the highest rate of metabolism in the glycolytic pathway?
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Fructose; its comes in latest; Enters with Glyceraldehyde 3 phosphate. This bypasses the rate-limiting step of glycolysis (PFK-1)
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What enzyme does AML stain positive for?
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Peroxidase (myeloperoxidase); azurophilic granules
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Causes of reperfusion injury (as observed by increased CK)
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ROS, mito damage, inflammation
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What is the initial clinical presentation of alcohol withdrawal?
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Autonomic (tremors, tachycardia), then psychotic sxs (hallucinations), then confusion
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How are fistulas formed in Crohn's?
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Ulcers can penetrate the FULL thickness of the wall
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What do homeobox genes encode for?
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Transcription factors that play an important role in morphology
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Eosinophils: Type 1 vs. Type 3 hypersensitivity
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Type 3 - when stimulated by IgE; destroys parasite via antibody-mediated cell tox
Type 1 - histamine, leukotrienes, peroxidase |
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Site for complement binding on the immunoglobulin?
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In the constant region, above the area of the Fc receptor
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Most common locations for dermatomyositis cutaneous manifestations?
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MCPs, PIPs, DIPs
(Gottran and Heliotrope rashes) |
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What liver enzyme can utilize glycerol (from TG breakup) to use for energy and glucose?
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Glycerol Kinase (makes glycerol 3-phosphate) -> Glycolysis and Gluconeogenesis
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Diastolic HF vs. Systolic HF
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D - only increases LVEDP
S - increases LVEDV and LVEDP |
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Why are Crohn's patients more susceptible to gallstones?
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Increased bile acid excretion because they cannot get reabsorbed
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Which fungus can cause pulmonary infection in immunocompetent hosts?
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Blastomycoses
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Which oral nitrate has almost a 100% bioavailability?
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Isosorbide mononitrate - the active metabolite of isosorbide dinitrate
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How can you blunt the flushing effect of niacin
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Asprin (to prevent the PGE action)
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What time of depression are MAO-I's used for?
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Atypical
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In lung transplants, where do you see the fibrosis in chronic lung transplant rejection?
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Small airways (bronchiolitis obliterans syndrome)
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What glomerular disease do you see antibodies to PLA2R, a transmembrane receptor on glomerular podocytes?
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Membranous glomerulonephropathy
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Why can eukaryotes replicate so much more than eukaryotes?
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Multiple origins of replication
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What inhibits progesterone synthesis?
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Elostane, Trilostane
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How does desmopressin (DDAVP) treat vWF disease?
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Increases the endothelial release of vWF
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What is one of the major causes of age-related isolated systolic HTN?
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Stiffening of the aorta
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What 2 chemokines are critical for SMCs to proliferate in atherosclerosis?
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PDGF and TGF-b
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Acute Intermittent Porphyria classic signs (3)
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Abdominal Pain
Neuropsych - confusion Color change in urine when standing up |
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What enzyme is deficient in Acute Intermittent Porphyria?
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Porhobilinogen deaminase (accumulation of ALA and Porphobilinogen)
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What can be used to treat Acute Intermittent Porphyria?>
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Glucose -> inhibits ALA synthase (decreases the ALA accumulation)
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What factors (3) increase ALA synthase activity? (breakdown of heme into bilirubin)
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Alcohol
Hypoxia Barbituates |
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Where are anal fissures normally found?
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POSTERIOR midline distal to dentate line
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When does polycythemia develop in relation to a shift of the Hb curve?
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Shifted to the L; decreased disassociation of O2 to tissues -> tissue hypoxia
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Why do you get urinary incontinence with normal pressure hydrocephalus?
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Stretching of descending cortical fibers (spinal cord also causes, but not affected in NP hydrocephalus)
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Where are the 3 locations of micturition reflex control?
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Sacral center - S2-S4
Pontine center - reticular formation Cerebral cortex - inhibits sacral micturition |
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What are 2 causes of lipofuscin?
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ROS and lipid peroxidation
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Which occluded vessel causes avascular necrosis of the hip?
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Middle circumflex artery
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What is bronchiectasis?
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Persistent dilation of the bronchioles due to inability to clear mucus
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What is the endothelium of the pseudocyst made of?
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Fibrous and granulation tissue
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Which opioid receptor does Naloxone work on to rx opioid intox or overdose?
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Mu
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Syphilis aortic "tree barking" is due to what?
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Aortic vaso vasorum obliteration
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What type of skin lesion arises without trauma, do not blanch under pressure, look like bruises, and are >1 cm?
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Ecchymosis
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Red blood cell extravation: what are the differences in size between petechiae, purpura, and ecchymoses
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Pet - <5mm
Purp - 5mm - 1cm Ecc - >1cm |
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What cardiac condition of toe cyanosis, but no finger abnormality?
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Coarctation of the aorta
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What is the most common cause of elevated AFP levels in a triple test?
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dating error (an UNDERestimation of the gestational age)
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What is stasis dermatitis?
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a result of varicose veins where incompetent venous valves allow retrograde blood flow to superfical veins
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If you see elevated PaCO2 in DKA, what is your concern?
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Respiratory failure, not compensating well for metabolic acidosis
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What is the initiating event in atherosclerosis?
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repetitive ENDOTHELIAL cell injury
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Cystic dilations in the medullary collecting ducts; painless hematuria
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Medullary Sponge Kidney - at high risk of kidney stones -> does NOT lead to chronic renal failure
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What are atrial myxomas composed of?
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Mucopolysaccharide stroma, abnormal blood vessels, hemorrhaging
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What is the best way to prevent HIV transmission to fetus?
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NRTI prophylaxis in mother
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Where are the most common sites of dystrophic calcification (hallmark of cell necrosis)
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Damaged aortic valves and atheromatous plaques
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What cancer does chronic lymphadema predispose to?
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Angiosarcoma
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What are the earliest lesions of atherosclerosis?
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Intimal streaks (comp
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What is a cutaneous SE of topical corticosteroids?
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Dermal atrophy - loss of dermal collagen
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What is the medicine of choice for maternal diabetes?
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INSULIN
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Alendronate
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Bisphosphanates -| osteoclast activity
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How do you treat extreme hypoglycemia?
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IM glucagon -> glycogenolysis and gluconeogenesis
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What is the best way to prevent non-hereditary ovarian cancers?
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OCPs -> decrease the number of lifetime of ovulations
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Which skin layer is decreased in psoriasis?
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Stratum spinosum
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What is N-acetyglutamate?
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An essential activator of carbamoyl phosphate synthetase I in the urea cycle
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What is the earliest sign of atherosclerosis?
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Fatty streaks - are in all individuals over the age of 10
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What effect on the heart does a carotid massage have?
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Increases parasympathetic tone -> prolongs the AV node refractory period -> stops re-entry circuits
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What substance is necessary for Ach release from synaptic clefts?
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Ca2+ - stimulates fusion of presynaptic vessels with plasma mem for exocytosis
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An HIV pt with new onset anal ulcerative mass with pain, itching, and rectal bleeding.
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HPV
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Why would a speculum exam to the external auditory meatus cause a patient to pass out?
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posterior part of the ext aud meatus is innervated by CNX
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What is the inner surface of the tympanic membrane innervated by?
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CNIX; glossopharyngeal
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What enzyme do you try to repress to reduce porphyria symptoms?
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ALA synthase
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What drug is used to prevent surrounding people from getting Neiss meningitidis?
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Rifampin
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What is in charge of the initial peristaltic wave in the esophagus?
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Circothyroid muscle
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What drug can prevent the conversion of T3 from T4?
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B-blockers
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Which lymphocytic origin of ALL will present with dyspnea, tachypnea, and inspiratory stridor?
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T-lymphocyte -> mediastinal mass -> compresses vessels, trachea, esophagus
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What class of drugs to hydralazine and procainamide fall into that may cause SLE-like symptoms?
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These drugs are metabolized by N-acetylation of the liver
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What type of damage is endoneural inflammation often associated with?
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Demyelination of nerves (Guillan Barre)
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What affect do glucocorticoids have on levels of neutrophils, lymphocytes, monocytes, basophils, and eosinophils?
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Neutrophils are increased (demargination) and the rest are decreased
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What does SVC syndrome present with on a CXR?
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mediastinal mass
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Germinomas are most common form of what brain tumor?
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Pineal gland
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What GI hormone has a trophic effect on parietal cells -> hyperplasia?
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Gastrin
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What 2 types of FA chains cannot be oxidized if peroxisome is defective?
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VLCFA
FAs with branch points at odd-numbered carbons |
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Tinnitus, Vertigo, Hearing loss
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Meniere's disease - endolymph accumulation
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Transamination and decarboxylation reactions require which Vitamin?
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B6 (pyridoxine)
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Which hyperlipidemic agent increases TG levels?
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Bile acid binding resins (cholestyramine, colestipol, colesevelam)
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Defect in the transport of cystine, ornithine, lysine, and arginine
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Cystinuria
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Intranuclear inclusions in keratinocytes with multinucleated giant cells (in a dermatomal pattern)
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VZV
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In which disease do you see mononuclear, parenchymal infiltration with well-developed germinal centers in the thyroid?
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Hashimotos
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What spinal cord lesion do you see with neurosyphilis
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Tabes dorsalis (dorsal columns)
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How exactly does Protein A prevent complement activity?
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Binds to Fc portion of IgG
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Deposition of IgA-containing immune complexes (Type III hypersensitivity)
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Henoch-Schoelin
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After equilibration with the brain, what tissues does thiopental distribute to?
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Skeletal muscle and fat
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What substrate can allosterically activate gluconeogenesis by increasing levels of pyruvate carboxylase
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Acetyl-CoA
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Increased intra-abdominal pressure that causes tears in the distal esophagus
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Mallory-Weiss Syndrome
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Which bacteria has mycolic acid in their outer portion of peptidoglycan cell wall?
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Mytobacterium TB
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What 3 toxicities to all protease inhibitors have?
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Hyperglycemia
Lipodystrophy Inhibition of P-450 |
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What drugs are used to treat Graves' opthalmopathy?
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Glucocorticoids
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Synaptophysin is a transmembrane glycoprotein that is found in the presynaptic vesicles of what 3 celltypes?
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Neurons
Neuroectodermal cells Neuroectoderm cells |
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A-CAL amyloid protein is what what disease?
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Medullary carcinoma of the thyroid
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aka Cachectin
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TNF-a (along with IFN-y, IL-6) can cause cachexia (secondary to systemic disease
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aka Cachectin
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TNF-a (along with IFN-y, IL-6) can cause cachexia (secondary to systemic disease
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How does Flutamide work?
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competes with testosterone and DHT at the androgen receptors
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What nerve controls tearing in the eye
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CN VII
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Result of malposition of the head in utero; infant prefers to hold head one one side;
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Congenital Toricollis
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What cellular receptor does CMV?
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Cellular integrins
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What cellular receptor does EBV bind to?
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CR2 (CD21)
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What cellular receptors do HIV bind to?
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CD4 and CXCR/CCR5
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What cellular receptors does rabies bind to?
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Nicotinic Ach
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What cellular receptors does rhinovirus bind to?>
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ICAM1 (CD54)
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How is excess copper usually excreted from the body?
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Secreted into bile and excreted into the stool
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What 2 elements are necessary for smooth muscle contraction, but not skeletal muscle?
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Calmodulin and MLCK
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What ion complication is most likely during the recovery phase of ATN?
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hypokalemia
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What is the most common microangiopathic hemolytic anemia?
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HUS
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Which direction does the trachea deviate in the setting of volume loss (atelectasis)
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Towards the opacified lung
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Which direction does the trachea deviate in the setting of a large pleural effusion?
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Away from the opacified lung
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If you see disulfide-rich terminal extensions from the procollagen molecule, what step in collagen synthesis is impaired
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EC cleavage
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Deposition of what substance do you see in the IF of crescent glomerulonephritis?
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fibrin
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What drug can be used to rx tonic-clonic and absence seizures?
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Valproate
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What drug is used for the prophylaxis of Myco. avium?
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Azithromycin
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When calculating the Reid Index, is cartilage part of the denominator?
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NO!
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Which part of the Loop of Henle do loop diuretics act on?
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TAL
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In duodenal ulcers, why is the duodenum not at a high risk for cancer?
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adenocarcinoma generally does not arise in the duodenum (SI). It does in the esohagus, stomach, colon, and rectum
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Why would you see vaginal bleeding a few days after use of progesterone?
|
Endometrial cells undergo apoptosis upon withdrawal of endocrine stimulation of progesterone (or use of anti-progesterone)
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What do metabolic processes are altered in hepatic steatosis?
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decrease in FA oxidation
excess in NADH production |
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Which antiepileptic can be metabolized to phenobarbital
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Primadone
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What type of drug is Amiloride?
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a Na+ blocker
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Where is PAH filtered and where does it get secreted? Where is the lowest PAH in the nephron?
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Filtered at glomerulus (Bowman's capsule is lowest PAH concentation) and secreted in the PCT
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How are particles <2 um cleared in the resp system?
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phagocytosed by macrophages
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How are particles 2-10um cleared in the resp system?
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Mucociliary transport
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How are particles >10um cleared in the resp system?
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They get trapped in the upper resp system
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What are 4 substances that require BH4 for synthesis?
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tyrosine, DOPA, serotonin, NO
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Hyperacute, acute, or chronic rejection - Dense lymphocytic/neutophilic infiltrate
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Acute
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Hyperacute, acute, or chronic rejection - Fibrinoid necrosis and neutrophils
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Hyper acute
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How do AChE inhibitors reverse depolarizing NMJ blockers (succinylcholine)?
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They can't, they can actually enhance them
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How can Bacterial endocarditis present with glomerulonephritic syndromes?
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Circulating immune complex-mediated injury (acute diffuse-proliferative glomerulonephritis)
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What system works to compensate for increased plasma pressure due to CHF to prevent edema
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Increase in lympatic drainage
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These cells indicate episodes of pulmonary congestion and edema associated w/ chronic L heart failure
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Hemosiderin-containing alveolar macrophages (will stain blue in a Prussian stain)
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Where does iron absorption take place?
|
Duodenum/prox jejunum
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Why does glucose infusion exacerbate pre-existing thiamine deficienct?
|
Thiamine is necessary for glucose metabolism
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How do free fatty acids affect insulin resistance?
|
High FFAs and TG levels increase insulin resistance
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What drugs can cause pancytopenia/aplastic anemia tox?
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Chloramphenical, PTU/methimazole, benzene, NSAIDs
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Aspiration or gastric contents or oropharyngeal contents in aspiration pneumonia?
|
Oropharyngeal contents
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What cells give rise to Renal cell carcinoma?
|
Proximal tubular cells
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Is constipation a major SE for digoxin or verapamil?
|
Verapamil (digoxin gives you diarrhea)
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With increasing age, what happens to the lens of the eye?
|
Sclerosis of the lens -> presbyopia (far sighted), which may actually allow myopia pts to have been distant vision
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How do you treat CN toxicity?
|
Nitrites to oxidize the Hb
OR thioSULFATE to bind the cyanide to form thiocyanate -> renally excreted |
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Dysmorphic RBCs without central pallor
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hereditary spherocytosis (high MHCH)
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Which bacteria shares antigens with human erythrocytes, so when the body's immune mounts a response, it may cause hemolytic anemia
|
Mycoplasma pneumoniae
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Most common cause of extra-medullary hematopoiesis
|
B-thal
(and severe hemolytic anemias) |
|
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This drug works by decreasing the synthesis of hepatic triglycerides and VLDL
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NIacin
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Ischemic necrosis of the pituitary cause by post-preg hypotension
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Sheehan's syndrome
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Two common complications of Sheehan syndrome
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Hypothyroidism
Hypocortisolism |
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What analgesic and what antibiotic can cause serotinin-syndrome?
|
Tramadol and Linezolid
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Bilateral hyperreflexia and clonus, CV collapse, hyperthermia
|
Serotonin syndrome
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Which lung cancer occurs more often with asbestos?
|
Bronchogenic carcinoma > Mesothelioma
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Why is there an increased risk of kidney stones in Crohn's?
|
Normally calcium binds to oxalates -> these are insoluble and get excreted. In Crohn's, calcium binds to the excess lipids, leaving unbound oxalate that get reabsorbed
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What is dactylitis and in what disease does it commonly present in?
|
painful swelling of the hands and feet; sickle cell anemia
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Irregular menstrual cycles; unusually short/long; (5-7 years after menarche or 10 years before menopause)
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Anovulation
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Hypothyroid with severe jaw pain, early inflammation, very tender thyroid, high ESR, following flu-like symptoms
|
Subacute thyroiditis (de Quervains) - granulomatous thyroiditis
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This thyroid nodule has mixed, cellular infiltration w/ occasional multinucleate giant cells
|
Subacute thyroiditis (de Quervains) - granulomatous thyroiditis
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This thyroiditis occurs when fibrous tissue replaces thyroid tissue
|
Riedel's thyroiditis
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What 2 ways can you hear S3 better in a patient?
|
Lateral decubitis position
At the end of an exhale (decreasing the lung volumes) |
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What is pramipexole?
|
A non-ergot dopamine agonist
|
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What are the two non-ergot dopamine agonists?
|
Pramipexole
Ropinerole |
|
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What substance can inhibit
|
PFK-1
|
|
|
Which hormone helps dilate the cervix and contract the uterus during pregnancy?
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Oxytocin
|
|
|
Which CNS tumor is associated with Turcot's FAP syndrome?
|
Medullablastoma
|
|
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What extracolonic tumors are often associated with the CRC due to FAP?
|
gastric, duodenal, and thyroid cancer
|
