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318 Cards in this Set
- Front
- Back
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Niacin reduces the synthesis of what lipoprotein?
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VLDL synthesis by the liver (reducing TGs)
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Is lens subluxation/disclocation more indicative of Marfans or Ehler Danlos?
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Marfans
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How many positive antigens are needed for a positive HIV western blot? If positive next step?
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2/3; profile CD4/T cell count for risk
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What vasodilator substances are normally produced by the intima of a blood vessel?
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NO and prostacyclin (PGI2)
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What are the signs of porphobilinogen deaminase deficiency?
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Acute intermittent porphyria: attacks of gastrointestinal, neurologic/psychiatric and cardiac symptoms. Also urine turns dark when exposed to air.
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What are the two essential amino acids usually missing in someone with only a plant based diet (e.g. kwashiorkor)?
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Tryptophan and lysine
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What are some examples of Gq receptors? What is their downstream function?
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alpha-1 adrenergic, Histamine-1, Musc-1,3; activate protein kinase C and increase intracellular Ca
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What are some examples of Gi receptors? What is their downstream function?
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alpha-2 adrenergic, musc-2, dop-2; decrease cAMP and thus PKA activity.
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What are some examples of Gs receptors? What is their downstream function?
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beta-1, 2 adrenergic, dop-1, hist-2; increase cAMP and thus PKA activity.
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What are some clinical findings of cyanide poisoning?
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Bright red retinal vessels and "bitter almond" breath.
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What kind of receptor is the angiotensin receptor type 1 (i.e. the one that Ang. II binds to at the efferent renal artery)?
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Gq receptor: that activates phospholipase C which makes IP3 (incr. Ca) and DAG (activate PKC)
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What cardiac complications can occur in Marfan's syndrome?
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Aortic dissection and dilation of the aortic root (aortic regurgitation)
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What chromosome is the fibrillin gene on?
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15 (a mutation can lead to Marfan's syndrome)
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In the setting of coronary artery disease what protein appears to be correlated with atherosclerotic burden and future acute cardiac events?
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CRP
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How would the breath of a type 1 diabetic treated with insilin and experiencing DKA differ from a type 2 diabetic treated with metformin and experiencing lactic acidosis?
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The type 1 with DKA would have "fruity" breath (acetone) whereas the type 2 with lactic acidosis would have breath smelling of alcohol.
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What enzyme in the heme synthesis pathway does lead inhibit? What are some of the symptoms of lead poisoning?
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aminolevulinic acid dehydratase; anorexia, irritability, altered sleep, abdominal pain, vomiting going to coma/seizures, porphyria, in a child loss of speech milestones
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What is a "rescue" treatment for the myelosuppression caused by methotrexate?
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Folinic acid (Leucovorin) whichis reduced to methylene tetrahydrofolate bypassing the methotrexate inhibited dihydrofolate reductase step.
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What is a leukoriene receptor inhibitor?
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Montelukast
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What are the symptoms of homocystinuria? What is a common cause of death?
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Mental retardation, marfanoid habitus (tall and thin build), lens subluxation; a common cause of death is thrombotic events in 20's-30's (1/3 of untreated patients die by this mechanism)
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Methionine synthase deficiency causes which disease?
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Homocystinuria (the enzyme is also known as homocysteine methyltransferase)
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How does exercise increase insulin sensitivity?
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By increasing the translocation of GLUT-4 to the plasma membrane of myocytes and adipocytes
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What happens to RBC's affected by lead poisoning?
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Basophilic RBC stippling
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What TCA cycle intermediate is reduced during conditions of ammonemia?
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alpha-ketogluterate (converted to glutamate)
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As opposed to other leukotrienes LTB4 has this primary function in asthma?
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LTB4 is chemotactic for neutrophils, where as the other leukotrienes cause bronchoconstriction and increase vascular permeability (zafirlukast and montelukast do not block LTB4 but are as efficaious as zileuton, which does, suggesting LTB4 may not play a significant role in asthma)
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What type of patient do mucor and rhizopus commonly infect? What is a complication of sinusitus by these organisms?
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Diabetics; meningitis
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What organism causes malaria like symptoms and is spread by the ixodes tick? What does it look like on peripheral blood smear? What is the treatment?
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Babesia; tetrads of merozoites; quinine
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Immunocompromised patients with no travel history who present with watery diarrhea are likely infected with what? What is the usual treatment? How can you diagnose this disease?
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Cryptosporidium; Fluid/electrolyte replacement, supportive care (Nitrazoxanide could also be given); oocysts on an acid-fast stain of a stool smear
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What drug is used for tuberculosis prophylaxis?
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Isoniazid
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What is seretonin syndrome?
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Seretonin syndrome is characterized by diarrhea, fever, diaphoresis, tachycardia, tremor, hyperreflexia and rigidity. It is caused by certain drug combinations with a SSRI that increase synaptic seretonin to toxicity. Notable drugs are: St. John's Wort, MAOIs, Linezolid, opioids (e.g. meperedine; act as reuptake inhibitors), LSD/MDMA and cocaine.
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What is the stereotypical history for someone who develops a spontaneous pneumothorax? Is there usually tracheal deviation? In what instances is there tracheal deviation to the other side?
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Male smoker with a family history; usually no tracheal deviation; contralateral tracheal deviation usually happens in compression atelectasis (pleural effusion, tension pneomothorax).
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What enzymes in the prostaglandin/leukotriene synthesis pathway do steroids inhibit?
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Phospholipase A2 and COX-2
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What familial diseases/syndromes is pheochromocytoma asscoiated with? What is the treatment?
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MEN2A (parathyroid tumor, pheochormocytoma and medullary thyroid tumor), MEN2B (pheochormocytoma, medullary thyroid tumor and gliomas), neurofibromatosis 1; phenoxybenzamine.
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What is the eventual effect of etoposide on cancer cells?
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It binds and stabilizes Topoisomerase II, halting the cell in G2, causing DNA strand breaks, which ultimately leads to apoptosis.
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What is hektoen anteric agar used for?
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To identify Shigella (produces clear green colonies) and salmonella (produces colonies with a partially black center, because it produces H2S) (both do not ferment lactose and are clear on MacConkey agar)
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How would you change urine pH to help treat toxicity by weak bases? Weak base examples?
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Acidify the urine, which can be done with ammonium chloride; examples include amphetamines
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How would you change urine pH to help treat toxicity by weak acids? Weak acid examples?
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Alkalinize the urine, which can be done with acetazolamide; examples include phenobarbital, methotrexate, tricyclic antidepressants and aspirin
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What is Bipolar II?
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It is characterized by instances of major depression and hypomania (but not mania, that would automatically be bipolar I)
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What would be some drugs of choice for hypertrigyceridemia?
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Niacin (decr. TGs and LDL, incr. HDL), Gemfibrozil for severely high TGs.
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What are the major side effects associated with statins?
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myopathy and transient elevation of liver function tests (hepatotoxic)
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What effect do large doses of epinephrine have on blood pressure? After alpha blockade?
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increase blood pressure; after treatment with say phentolamine it decreases blood pressure.
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What is the treatment for E. coli O157:H7?
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supportive, use of antibiotics can increase the risk of HUS.
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What is the triad of HUS?
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Hemolytic anemia, thrombocytopenia and acute renal failure
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What is the classic triad of preeclampsia?
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Hypertension, edema, proteinuria.
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What is a big immediate concern in eclampsia?
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grand mal seizure
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What are the characteristics of neuroleptic malignant syndrome? What is it caused by?
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Fever, delirium, muscle rigidity; marked decrease in dopamine effects (usually associated with typical antipsychotics, e.g. haloperidol, chlorpromazine)
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What are the effects of tricyclic antidepressant overdose?
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CCC: coma, convulsions, cardiotoxicity; mixed acidosis and hypokalemia; hypotension, respiratory depression, anticholinergic, sinus tachycardia and arrhythmias.
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Which HLA alleles are associated with Diabetes mellitus type 1?
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HLA DR3 & DR4
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How does the cholera toxin cause diarrhea?
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It ADP ribosylates a Gs protein to induce cAMP production and activation of CFTR, which will increase Cl release and increase water in the GI lumen.
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What is p53 and what chromosome is it encoded on?
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Transcription factor; 17
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What drug may be used in cardiogenic shock due to mitral valve regurgitation?
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Dopamine
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What drugs can be used for WPW syndrome?
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Amiodarone (K+ channel blocker), procainamide (Na+ channel blocker)
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What are the characteristics of the rabies virus?
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Enveloped single-stranded RNA virus
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What are the symptoms of a molar pregnancy?
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Hyperemesis, vaginal bleeding and hyperthyroidism (because hCG shares the alpha subunit of TSH)
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What are the characteristics of the HPV virus?
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Non-enveloped double-stranded DNA virus
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What antiarrhythmics cause torsades de pointes?
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Quinidine (Class 1A) and amiodarone (class III; all except bretylium do) do by increasing the QT interval.
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What is used to prevent hemorrhagic cystitis caused by cyclophosphamide or ifosfamide?
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Mesna
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What effects can lithium toxicity have?
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Memory impairment, confusion, vomiting, tremors, ataxia, hyperreflexia, nephrogenic diabetes insipidus, and hypothyroidism; as a teratogen it can cause ebstein's anomaly.
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What treatment can be used for patients experiencing extrapyramidal symptoms from neuroleptics?
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anticholinergics: neuroleptics can inhibit dopamine receptors more than cholinergic receptors shifting balance towards hyperkinesia.
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What kind of organisms are usually present in lung abscesses due to aspiration? What is often given as treatment?
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Anaerobes from the GI; clindamycin
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If a patient in the middle east has hepatosplenomegaly, anemia, leukopenia, malaise, weight loss and amastigotes in macrophages what do they have? What is it transmitted by?
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Leishmania donovani; sandfly
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What tissues does T. cruzi infect? What transmits it? What is used to treat acute disease?
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Cardiac (myocarditis->DCM), colonic nerves (constipation, megacolon, megaesophagus) and acutely the dermis (granulomas); reduvid bug; Nifurtimox (metabolized by nitroreductase to form damaging free readicals)
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What is the structure of EBV?
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enveloped linear double-stranded DNA
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What are 2 common scenarios for staphylococcal toxic shock?
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Tampons and surgical wound infections
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How can cyclophosphamide induced hemorrhagic cystitis be prevented?
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Mesna or N-acetylcysteine detoxify acrolein
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What marker can be used to differentiate an infective hepatitis B state from a less infective state?
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HBeAg (a cleavage product of the viral core)
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What is a common treatment for anorexia?
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an SSRI
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What is damaged in the spinal cord with ALS? Polio? Syrngiomyelia? B12 deficiency? Syphilis?
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corticospinal tracts (UMN) & anterior horns (LMN); anterior horns; anterior white commisure; posterior columns and corticospinal tracts; posterior columns
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What cells develop hyperplasia in asthmatics? How are airways obstructed in an asthmatic?
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Bronchial submucaosal glands and goblet cells; mucoid exudate->cast, eosinophils and charcot-leyden crystals (from eos).
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What is the cardinal ligament composed of?
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Uterine artery and vein
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What is the pathology of hyper-IgM syndrome?
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Defect in T cell CD40L; little isotype switching; can present with P. jiroveci and neutropenia, low IgA and IgG
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What are pigment gallstones composed of? How are they seen on X-Ray?
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Unconjugated/indirect bilirubin; they are radiopaque compared to cholesterol which is radiolucent if they are not calcified (10-20% are).
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Which systemic fungi exhibits broad-based budding?
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Blastomyces dermatiditis
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What are the classic side effects of amiodarone?
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Pulmonary fibrosis (restrictive), hyperthyroidism, hepatotoxicity
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Isoniazid is classically known as a P450 inducer or inhibitor?
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CYP inhibitor
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What is Heerfordt Waldenstrom syndrome?
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A syndrome of sarcoidosis (Th1 noncaseating granulomas): fever, parotid enlargement, anterior uveitis, and facial nerve palsy.
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What is left upper quadrant pain, left shoulder pain and vomiting in a patient with thrombotic history suggestive of? What artery feeds the splenic artery?
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splenic infarct; the celiac trunk
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What is a common nosocomial source of UTI that may have a red pigment on petri dish? what are its characteristics?
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Serratia marcescens; faculative anaerobe gram negative bacillus
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What is a side effect of clarithromycin?
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cholestatic hepatitis
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What is common pathology of locked-in syndrome? What are the symptoms?
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Basilar artery thrombosis; Patient can only move eyelids, but has full sensory modalities and consciousness
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What blood constituent test can be examined for DIC?
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Fibrin split products
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What is a genetic defect that can predispose to malignant hyperthermia? What are some potential complications?
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Ryanodine receptor defect: leading to leaking of Ca and buildup to promote contraction/heat production; hypotension, arrhythmias, DIC and rhabdomyolysis (can lead to renal failure)
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What is the most common type of kidney disease in SLE? What treatment is used to treat severe SLE kidney disease?
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Diffuse proliferative glomerulonephritis; cyclophosphamide
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What is the cause of medial medullary syndrome? symptoms?
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Anterior spinal artery thrombosis; one sided hyperreflexia and loss of ipsilateral proprioception and vibration sensations, tongue deviation to contralateral side.
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Ethosuximide is known to cause what syndrome?
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Stevens-Johnson syndrome
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What severe kidney disease can crush injury cause?
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Acute tubular necrosis, caused by rhabdomyolysis
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What kind of inclusions are indicative of Chlamydia?
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Basophilic intracytoplasmic inclusions
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What is a key difference in the presentation of galactosemia and fructose intolerance?
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Fructose intolerance does not present with cataracts.
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What is a common sequela due to shedding of the brush border with rotavirus infection?
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Transient lactose intolerance
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Pudendal nerve block for the vaginal area/perineum involves what spinal levels?
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S2-4
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What is a dietary concern for patients taking procarbazine?
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Avoiding tyramine, because procarbazine is a MAOI and can lead to hypertensive crisis
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A defect in FGF-3 can result in a common disease known as...
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achondroplasia (which results in a defect in endochondral ossification
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What is a common cause of TTP?
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Antibodies against ADAMTS13 protease, a metalloproteinase that cleaves von willebrand multimers
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What is a common risk factor for duodenal ulcers?
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smoking
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What are Heberden's nodes in osteoarthritis?
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Bulging of the distal interphalangeal joints due to osteophyte formation (bony outgrowths)
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What is Turcot syndrome?
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There are two gene mutations: 1-APC gene leading to polyposis and meduloblastoma; 2- hMLH1 DNA mismatch repair gene leading to polyposis and glioblastoma multiforme.
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What are the signs, symptoms and treatment for adult lead poisoning?
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Constipation, abdominal pain, difficulty concentrating, darkened painless gingival lesions and wrist/foot drop; treatment is dimercaprol or EDTA
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What is the timeline for some of the early presentations in the first day of an MI?
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No changes 2-4hrs; contraction bands after; neutrophils 12-24hrs-4days
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What is the usual treatment for post-streptococcal glomerulonephritis?
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supportive care
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Babies with fetal alcohol syndrome are known to have cardiac defects, what is a common example?
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ASD: fixed split S2
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How is Alzheimer's dimentia often differentiated from Wernicke-Korsakoff syndrome?
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In Wernicke-Korsakoff syndrome there is usually nystagmus and gait ataxia as well as the mamillary bodies are usually affected (hippocampus in AD)
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When do the symptoms of delirium tremens occur? What are they? How are they treated?
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2-5d; Tachycardia, fever, hypertension, hallucinations and delusions; a benzodiazepine like chlordiazepoxide
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What is lateral medullary/Wallenberg syndrome? What is it caused by?
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Loss of pain/temp on contralateral side of body and ipsilateral face, damage to inferior cerebellar peduncle can cause ipsilateral falling, damage to nuc. ambiguus can cause dys-arthria/phagia, damage to nuc. solitarius caan cause decreased taste; caused by occlusion of vertebral artery or PICA.
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What are the soluble factors involved in muscle cell recruitment in an atherosclerotic plaque?
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PDGF & TGF-b
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What is a skin manifestation of ulcerative colitis? What is it treated with?
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Pyoderma gangrenosum; oral corticosteroids
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What restrictive lung disease occurs in the elderly who have no exposure to smoking or other irritants and is not sarcoidosis? What is the histology? Treatment?
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Idiopathic/interstitial pulmonary fibrosis; proliferation of mesenchymal cells; lung transplant
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Where are non skin locations for kaposi sarcoma? What symptoms can be seen?
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Lung, GI & biliary tree; GI: melana, hematemesis
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What are common lab findings in multiple myeloma? What imunoglobulin is increased?
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anemia, hypercalcemia, high protein; IgG
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What treatment would be given to a child with erythroblastosis fetalis? What is given to the mother during pregnancy?
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Matched Rh- blood; Rhogam (Ig)
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With what benzodiazepines is dependence more likely to develop?
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Short acting (Triazolam, oxazepam, midazolam)
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What is the usual presentation for subacute thyroiditis? What is the progression? Treatment?
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Sore throat, enlarged tender thyroid and fever following an upper resp. viral infection; hyperthyroid phase then hypothyroid phase; NSAIDs
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What treatment is most effective for increasing HDL?
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Niacin
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What CD marker do natural killer cells express?
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CD16
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What are the symptoms of kawasaki disease? What is the treatment? What is a dangerous complication?
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Fever, cervical lymphadenopathy, edema of the dorsal hand, injected conjunctivae and lip fissures; IV immunoglobulin and aspirin (self-limited necrotizing granulomas); coronary artery aneurysm
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What is a common treatment regimen for hodgkin's lymphoma?
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DBVD (Doxorubicin, bleomycin, vinblastine, dacarbazine), if treatment is too myelosuppressive filgrastim or molgramostim can be given
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For someone with a-1-antitrypsin deficiency how is the liver stained to identify disease?
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intracellular PAS-positive globules
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What vascular changes are common in chronic graft rejection?
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Arteriosclerosis
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What are the symptoms of gaucher disease?
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Hepatosplenomegaly, aseptic crisis of femur, bone crises, pancytopenia, "crumpled tissue paper" macrophages/histiocytes (and abundant, bluish, fibrillar cytoplasm)
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What is cyclobenzaprine? Side effects?
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It is a drug used for muscle spasms with painful musculoskeletal conditions; it has anticholinergic side effects and can aggravate glaucoma.
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What anticoagulant Can cause skin necrosis? What are risk factors for this reaction? How does it manifest?
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Warfarin; HIT, protein C, protein S deficiency; Erythematous and purpuric patches of skin.
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Which HLA are associated with Buerger disease?
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HLA-A9/B5
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Do autistic children show separation anxiety?
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No
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Which cluster A personality disorder involves magical thinking and interpersonal awkwardness?
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Schizotypal personality disorder
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What are the PPARs?
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DNA enhancer elements
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Where can malignancies of the inner breast drain to? Upper breast? (besides axillary nodes)
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Internal mammary chain nodes; supraclavicular nodes
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What according to kaplan is currently the most common cause of nephrotic syndrome?
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focal segmental glomerulonephritis
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What can the seminiferous tubules look like in klinefelter syndrome?
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They will have a certain degree of hyalinized ghosts or may appear as primitive tubules
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What is the classic triad presentation for gonorrhea?
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Migratory polyarthritis, tenosynovitis, and a dermatitis/vesicopustular rash on the palms arms and legs
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What is the most common inherited defect of beta oxidation? What are key features of this type of defect?
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Medium-chain acyl dehydrogenase deficiency; hypoglycemia and decreased ketone bodies
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What symptoms can people with osteoarthritis have in the morning?
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Morning stiffness
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What is the primary sterol in protazoan?
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cholesterol
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What is a common etiology of mitral valve prolapse?
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Myxomatous degeneration
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What is the function of the common fibular/peroneal nerve? How can it be injured?
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It is responsible for foot dorsiflexion and eversion, as well as sensation to the anterior leg and the dorsum of the foot; fracture to the neck of the fibula.
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What is the DNA coding strand? template strand?
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The coding strand is essentially the mRNA (+introns) strand that if translated; the template strand is the DNA segment that is transcribed
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What type of patient besides an alcoholic can experience thiamine deficiency? What worsens the symptoms of wernicke-korsakoff? What is a non dehydrogenase enzyme that requires thiamine?
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Chronic illnesses (e.g. leukemia); glucose administration; transketolase
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Which cells other than neutrophils are affected in chediak-higashi syndrome?
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NK cells and cytotoxic T cells
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What is a second treatment choice for rickettsia?
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Chloramphenicol (it is considered less teratogenic than tetracyclines (class C v D)
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What is a common cause of otitis externa?
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Pseudomonas
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What are the ECG findings of prinzmetal angina? what is a common treatment for it?
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ST elevation and T-wave inversion; nifedipine and amlodipine
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What are the characteristics of tonic-clonic seizures? First treatment options would be?
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A seizure that alternates between stiffening and moving (ECG shows low-voltage, fast (10Hz) neuron activity; phenytoin, valproate, carbamazepine.
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What property of C. difficile allows it to cause escape antibiotics and cause pseudomembranous colitis?
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Spore formation
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What is a common extrapulmonary finding in sarcoidosis?
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erythema nodosum
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What is a gram negative bacilli skin flora that can cause subacute endocarditis?
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Eikenella corrodens
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What kind of receptor is 5HT3?
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A ligand-gated ion channel
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What is the inheritance of hemophilia?
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X-linked
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When can children turn a door knob? climb the stairs? Cut with scissors?
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2;1; 3
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What is caused by a deficiency of CD18?
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Leukocyte adhesion deficiency (poor wound healing and susceptibility to infection)
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What is given to reduce frequency and severity of infections in patients with CGD?
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interferon gamma
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Malignant melanoma can metastasize to what part of the GI system?
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The serosa of the small intestine
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What nerves mediate the corneal reflex?
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V1 (afferent), CNVII (efferent)
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What ear abnormality could a lesion of CNVII cause?
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Hyperacusis
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Why do strepococcus pneumoniae inhibit H. influenzae?
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Because it produces hydrogen peroxide because it does not have catalase
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What Is are three complications from Paget's disease of bone?
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High-output CHF, hearing loss, osteogenic sarcoma
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What antifungal can be used to treat cushing's syndrome?
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Ketoconazole, which inhibits P450 enzymes and inhibits steroid production
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Which Tanner stage also occurs when girls are at their peak height velocity?
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Tanner stage 3 (pubic hair gets darker and curled)
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What are some side effects of beta-blockers?
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Sedation, depression, diarrhea, pruritis, impotence and sleep cycle disturbances
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What drug is an alternative to amphetamines for narcolepsy?
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Modafinil
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What is Atomoxetine?
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It is an SNRI used for adult ADHD/ADD
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Patau's syndrome is characterized by...
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Cleft lip/palate, microcephaly, polydactyly, micropthalmia, heart and renal defects and rocker-bottom feet
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Pancoast tumors are usually what type of tumor?
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Squamous cell carcinoma
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What layer protects against polyspermy?
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The vitelline layer hardens and the space between it and the PM swells
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What are the four gram negative coccobacilli?
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Bordetella, pasteurella, brucella, haemophilus
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What RA drug can lead to reactivation of TB?
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Etanercept (Against TNF which is an important factor released by macrophages to recruit immune cells)
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What kind of molecule is the GPI involved in PNH?
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a cell surface anchoring molecule
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What would the results of radioactive iodine uptake be in a patient with thyrotoxicosis factitia?
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Little uptake
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|
|
What does HSV produce in neurons during latency?
|
Latency-associated mRNA that is not translated into protein.
|
|
|
What diabetes medications are most known for causing weight gain? Hypoglycemia?
|
Thiazolidinediones; sulfonylureas (also insulin)
|
|
|
What are the major adverse effects of amiodarone?
|
Hyper/hypothyroidism (either), pulmonary fibrosis, hepatotoxicity, photodermatitis, and neurologic effects.
|
|
|
Hemangioblastomas are associated with what 2 symptoms?
|
Ataxia and polycythemia
|
|
|
How do you calculate an odds ratio?
|
(#of cases (w/ disease) exposed to RF x # of controls (w/o disease) not exposed to RF) / (# of cases not exposed to RF x # of controls exposed to RF)
|
|
|
Beta blockers should be avoided in diabetics taking what medications?
|
While there are more sulfonylureas have been particularly associated with hypoglycemia and beta blockers would mask the signs of hypoglycemia
|
|
|
What kind of receptor is the somatostatin receptor?
|
GPCR (type s)
|
|
|
What are bone conditions associated with NF1?
|
sphenoid dysplasia and scoliosis
|
|
|
Dorsiflexion and foot inversion are controlled by what nerves? Nerve roots?
|
Deep peroneal nerve and tibial nerve; L4-5
|
|
|
Otitis externa can lead to what complications?
|
Osteomyelitis and facial nerve palsies
|
|
|
What is an appropriate treatment for listeria meningitis (once that bacteria is identified)?
|
Ampicillin (ceftriaxone prior to ID)
|
|
|
What is used to treat bleeding in von Willebrand's disease?
|
Desmopressin (increases vWF release and factor VIII activity)
|
|
|
What is the relation of the internal jugular vein to the common carotid? vagus?
|
lateral; anterior
|
|
|
Where is the site of lymph drainage in the liver?
|
The space of disse
|
|
|
Acute intermittent porphyria is caused by a deficiency in which enzyme? Porphyria cutanea tarda? Which has neuropsychiatric symptoms?
|
Porphobilinogen deaminase (uroporphyrinogen synthase); Uroporphyrinogen decarboxylase; AIP
|
|
|
What are the 4 extrapyramidal side effects caused by antipsychotics?
|
Acute dystonia (after 4 hours), Akinesia (4 days), Akasthisia (4 wks), Tardive dyskinesia (4 mos)
|
|
|
Where is the chemoreceptor trigger zone?
|
medulla
|
|
|
Asbestosis increases the risk of what 2 cancer types?
|
Mesothelioma and bronchogenic carcinoma
|
|
|
Meniere's disease results from dysfunction of what?
|
endolymphatic sac
|
|
|
What is a big risk factor for an MI in a woman?
|
Age, postmenopause as estrogen is cardio-protective
|
|
|
What histology may be seen on acute postreptococcal GN?
|
Subepithelial humps
|
|
|
Adult RDS is often the result of damage to what cells/structures?
|
Endothelial cells
|
|
|
What is the anatomical location of the AV node?
|
The interatrial septum, near the right AV orifice
|
|
|
Dislocation of the knee with displacement of the tibia can put what structure at risk?
|
The popliteal artery (the tibial nerve also in the popliteal fossa more often injured by penetration)
|
|
|
What microbe is the most common cause of postpartum endometritis?
|
Bacteroides (also mixed aerobic/anaerobic flora)
|
|
|
When a kidney is removed what is the highest percentage of GFR the remaining kidney can recover after about 4 weeks?
|
~80%
|
|
|
How do you calculate the number needed to treat?
|
absolute risk reduction = mortality (avoided event) risk in treated - mortality risk in untreated; then take the reciprocal of that.
|
|
|
Which heart sound occurs during rapid filling of the ventricles?
|
S3
|
|
|
Transudates generally have ______ protein? LDH? cells?
|
Low; low; low
|
|
|
What does a splenectomy in patients with hereditary spherocytosis prevent?
|
gallstone formation
|
|
|
What are some complications of prematurity?
|
RDS, intraventricular hemorrhage (esp. in germinal matrix), necrotizing enterocolitis
|
|
|
What is a major side effect of cisplatin?
|
hearing loss (damages stereocilia) esp. high frequency
|
|
|
What is a protein modification that helps anchor the carboxy tail of receptors into the PM?
|
palmitoylation
|
|
|
With nitroglycerin how does heart rate change?
|
Increases (although total O2 demand drops)
|
|
|
What are antibiotic efflux pumps powered by?
|
The movement of protons out of the cell
|
|
|
What is the function of the hydrophobic core of a transmembrane protein when translated?
|
Signal recognition particles (SRP's) bind the hydrophobic core and traffic it to the RER
|
|
|
Testosterone levels in the seminiferous tubules require what? made by what cells?
|
Androgen binding proteins; made by sertoli cells
|
|
|
The gubernaculum has what function in development? In the female what do the superior and inferior parts persist as?
|
Movement of the genitals inferiorly; the superior part persists as the suspensory ligament of the ovary and the inferior part persists as the round and ovarian ligaments
|
|
|
What happens to pH, pO2 and pCO2 during a pulmonary embolism?
|
Hypoxemia (low pO2) -> hyperventilation and respiratory alkalosis (high pH and low pCO2)
|
|
|
How do Sulfa and penicillin reactions differ from vancomycin?
|
Pen & sulfa are hypersensitivities, IgE mediated, non dose dependent, vancomycin causes nonspecific activation of mast cells and is dose dependent
|
|
|
What is a common cause of menorrhagia?
|
Leiomyomas
|
|
|
An increase in enzyme concentration does what to the Km and Vmax?
|
no change and increase
|
|
|
What is a common oral presentation in crohn's disease?
|
Aphthous ulcers
|
|
|
What is a treatment for cirrhotic ammonemia and thus neurologic dysfunction?
|
Acidification of intestinal content
|
|
|
Leg ulcers, thinned skin and hair loos in a diabetic are often caused by...
|
Atherosclerosis (PAD, femoral artery)
|
|
|
What are some signs of iron deficiency other than anemia?
|
Glossal pain, dry mouth, atrophy of tongue papillae, alopecia, craving for ice
|
|
|
What are the symptoms of lichen sclerosis?
|
White macules on the skin (usually around genitals in women) that coalesce to form a white plaque. It presents pruritis, dysuria and pain with defecation and sex. Increases risk of squamous cell carcinoma.
|
|
|
What part of the kidney does acute tubular necrosis usually manifest? What drugs can cause it?
|
Medulla; aminoglycosides and amphotericin B
|
|
|
Is prader willi syndrome due to paternal deletion or activation?
|
deletion
|
|
|
What layer of the skin is thickened in the formation of a callus?
|
Stratum corneum
|
|
|
What soluble molecules promote cell differentiation?
|
Transcription factors
|
|
|
What are three conditions commonly associated with focal segmental glomerulosclerosis?
|
HIV, heroin use, sickle cell disease
|
|
|
What are some treatments for a pneumothorax?
|
Needle aspiration or chest tube placement.
|
|
|
What symptoms are characteristic of anemia? leukopenia? thrombocytopenia?
|
fatigue; opportunistic infection; bleeding problems
|
|
|
What is the virulence factor of aspergillis?
|
vascular invasion
|
|
|
What is the treatment of choice for esophageal varices?
|
Octreotide (because it causes splanchnic vasoconstriction by inhibiting glucagon and VIP, thus shifting blood flow to the systemic circulation, and does not cause universal vasoconstriction)
|
|
|
What is Clorpropamide? What is one problem if it is taken with alcohol?
|
A first generation sulfonylurea; disulfiram like reaction-hangover symptoms (vomiting, tachycardia, headache, nausea)
|
|
|
What step in atherosclerosis may actually occur before/cause endothelial dysfunction in people with high cholesterol?
|
LDL cholesterol oxidation
|
|
|
What appears to be an effective treatment for von Willebrand disease?
|
estrogen/OCPs
|
|
|
What is the mechanism of action of bisphosphonates? what are some complications?
|
Decreasing the number of osteoclasts-> inhibit resorption; avascular necrosis, GI toxicity, hypocalcemia
|
|
|
What is Refsum's disease or adrenoleukodystrophy caused by?
|
Oxidation-reduction mechanisms of long chain fatty acids in peroxisomes especially in myelinating cells.
|
|
|
What are the two main sweat glands? Location? Stimulated by?
|
Apocrine and eccrine glands; eccrine are in all skin and secrete a serous fluid, apocrine are at the axilla, areaola, genitals and anus are ctivated in puberty and have oily secretions; eccrine are stimulated by the Sympathetic nerves, apocrine are stimulated by circulating catecholamines
|
|
|
What is the affect of angiotensin II on the HCO3 and H+ in the PT?
|
Increases HCO3 absorption with no effect on H+ (H+ is recycled, incr. Na/H+ transport) -> contraction alkalosis when volume deplete
|
|
|
What has spiky trophozoites, can conteminate contact lens solution and cause keratitis and encephalitis?
|
Acanthamoeba
|
|
|
Males with androgen insensitivity develop normal ________
|
gonads
|
|
|
How does ataxia telangiectasia present?
|
Defect in DNA repair that presents with ocular & cutaneous telangiectasias, Ig (usually IgA) deficiency, recurrent sinus infections, cerebellar ataxia, x-ray sensitivity, inr risk of malignancies and impaired organ development.
|
|
|
How can liver disease cause thrombocytopenia?
|
By sequestering platelets in the spleen
|
|
|
What is the prodrome for Stevens-Johnson syndrome?
|
Fever and fatigue (can occur a week after drug initiation)
|
|
|
Which hormone is involved with the increase in temperature near ovulation?
|
Progesterone
|
|
|
Myotonic dystrophy is catagorized by...
|
Muscle wasting, cataracts, heart defects and myotonia (it can result in anticipation)
|
|
|
What should be confirmed before removal of a thyroglossal duct cyst?
|
A normal thyroid gland
|
|
|
What is a Foley catheter used for?
|
To relieve the obstruction in BPH
|
|
|
How would an endoscopy of the stomach differentiate Zollinger-ellison caused PUD from H. pylori?
|
Gastric fold hypertrophy
|
|
|
What is the triad of symptoms for acute GVHD? How long until it is defined as chronic GVHD?
|
Dermatitis, hepatitis, gatroenteritis; >100days
|
|
|
How may haloperidol effect the breasts?
|
By blocking dopamine it can remove inhibition of prolactin and thus cause galctorrhea
|
|
|
What sinus is the primary location for drainage of arachnoid granulations?
|
The superior sagittal sinus
|
|
|
What are some treatment options for Kaposi sarcoma?
|
interferon-alpha, radiation, doxorubicin, paclitaxel
|
|
|
As fluid is released from salivary glands what electrolytes are changed (initial secretion is plasma-like)? When secretion rate is increased?
|
Na & Cl are reabsorbed, K & HCO3 are secreted, making it hypotonic; Less transport occurs except more HCO3 is secreted by PS stimulation
|
|
|
What is the structure of cardiolipin like?
|
The inner mitochondrial membrane (2 FA groups attached to a glycerol)
|
|
|
What is a serious GI side effect of bisphosphonate treatment?
|
Corrosive esophagitis (ulcers of esophagus or stomach-> need be upright for an hour after taking it)
|
|
|
What is a side effects of cyclosporine?
|
Renal toxicity
|
|
|
What is a treatment for diabetic glomerulonephropathy?
|
ACE inhibitors
|
|
|
What does G-CSF or GM-CSF act on?
|
A transmembrane receptor
|
|
|
Low voltage ECGs can be caused by?
|
Increased space between electrodes and heart: obesity, COPD, pericarial effusion
|
|
|
What is the most common malignancy of the parotid gland? how can it differ from a benign tumro?
|
Mucoepidermoid carcinoma; it can metastasize and injure the facial nerve
|
|
|
What does chlamydia lack in it's membranes?
|
A "cell wall": it lacks muramic acid and thus peptidoglycan, but does have an inner and outer membrane.
|
|
|
What is osmotic demyelination?
|
It occurs when a patient is hyponatremic and the brain compensates by reducing its osmolarity to prevent water build-up in cells, if this hyponatremia is too quickly corrected then the CNS cells shrink and die: S/S- dysarthria, dysphagia, flaccid quadriparesis that can progress to locked-in syndrome
|
|
|
Which Hep. C drug can cause hemolytic anemia? weight loss, flu, and liver tox?
|
Ribavirin; interferon
|
|
|
What is the presentation of dermatomyositis? what is a common malignancy that it can be accompanied by?
|
proximal muscle weakness, dysphagia, violet eyelids, periorbital edema, erythematous rashes on knuckles, elbows and knees; lung cancer/some visceral cancer
|
|
|
What is a concerning heart symptom with hydralazine treatment?
|
Angina; from excessive reflex tachycardia
|
|
|
Patients who survive CO poisoning have an increased risk for what complication?
|
Heart disease (MI, etc)
|
|
|
What treatment is used for patients with diabetes mellitus type 2 suffereing from hypoglycemia as a side effect of one of their medications?
|
Switching them to a drug that increases insulin sensitivity
|
|
|
What pH disturbance can iron toxicity cause?
|
Metabolic acidosis
|
|
|
Tamoxifen can predispose to what cancer?
|
Endometrial cancer
|
|
|
What are the symptoms of ragged red fiber myopathy? inheritance?
|
Ophthalmoplegia, dysphagia, proximal muscle weakness, cerebellar ataxia, sensorineural hearing loss, heart block; deletion in mitochondrial DNA-> inclusions, mitochondrial inheritance
|
|
|
What bone structural abnormalities are indicative of marfanoid habitus?
|
pectus excavatum, scoliosis, pes cavus, high arched palate
|
|
|
Acute pancreatitis can cause what serious blood complication?
|
DIC
|
|
|
What is a treatment for anemia of chronic disease in a patient where the primary cause cannot be cured?
|
EPO
|
|
|
In Crohn's disease what happens to oxalate absorption?
|
It is increased which leads to an increased susceptibility to renal calculi
|
|
|
What blood labs increase with chronic inflammation?
|
ESR, CRP
|
|
|
What does the cerebrocerebellum control?
|
The extremities-> dysdiadokinesias, intention tremors
|
|
|
What is the cause of hypertension and high renin levels in a young healthy person?
|
Fibromuscular dysplasia
|
|
|
Patients with primary sclerosing cholangitis would be positive for what antibodies?
|
p-ANCA
|
|
|
How would you treat a patient with warm-reactive autoimmune hemolytic anemia?
|
corticosteroids
|
|
|
What is a good site to look at to differentiate bells palsy from UMN CN VII damage?
|
Eyebrow movement
|
|
|
What is the rickettsial infection carried by dog ticks?
|
Ehrlichia chafeensis
|
|
|
In patients with CLL what is the cause of anemia?
|
Warm-reactive autoimmune hemolytic anemia
|
|
|
In hepatorenal syndrome what does the kidney look like?
|
normal
|
|
|
How can neuroblastoma present?
|
fever, periorbital ecchymosis, proptosis, hypertension and blue subcutaneous nodules
|
|
|
What is Juvenile idiopathic arthritis(Stills disease in adults)/how does it present? Associated with? Treatment?
|
Recurring fevers, polyarticular joint pain and an evanescent macular, salmon-pink rash that fluctuates with the fever; hemophagocytic syndrome, uveitis and decreased growth; NSAIDs, steroids, methotrexate and etanercept.
|
|
|
What is an adverse effect of gancyclovir?
|
leukopenia, neutropenia, and thrombocytopenia
|
|
|
What is a first line treatment for trigeminal neuralgia?
|
Carbamazepine
|
|
|
What are three risk factors for squamous cell carcinoma?
|
Sun exposure, immunosuppression (transplant pts, HIV, etc) and arsenic
|
|
|
What are some causes of appendicitis?
|
Recurrent viral infections (adenovirus, measles) or vaccinations
|
|
|
What is a cell-cycle nonspecific alkylating agent used for CML?
|
Busulfan
|
|
|
In a patient with atypical pneumonia and a significant sexual history what is important to consider?
|
P. jirocevi (HIV)
|
|
|
In a patient with a history of gastric ulcers, a urease positive test and weight loss, night sweats and fatigue what is a probable diagnosis?
|
MALT Lymphoma
|
|
|
What is the effective mechanism of class IV antiarrythmics (ECG)? What is an unwanted effect (ECG)?
|
Prolonging the PR interval; prolonging the QT interval->arrhythmias (esp. with b-blockers or cisapride)
|
|
|
What is a side effect of zileuton that should be monitored?
|
Elevation of LFTs
|
|
|
Does emphysema result in a diffusion problem?
|
Yes, by decreasing surface area for diffusion
|
|
|
Where is C-peptide cleaved from pro-insulin?
|
Golgi apparatus
|
|
|
What serious skin side effect may occur with carbamazepine?
|
Stevens-Johnson syndrome
|
|
|
Phospholamban acts whee on cardiac myocytes?
|
Inhibits sarcoplasmic reticulum calcium ATPase (SERCA2) reuptake of Ca into the SR when dephosphorylated (reg by PKA)
|
|
|
PML is usually characterized by what impairments?
|
Speech, coordination, memory and sometimes visual defects
|
|
|
What does mumps do to the epithelium of the epididymis?
|
It damages the stereocilia of the pseudostratified columnar epithelium-> infertility
|
|
|
How can you treat hyperkalemia and metabolic acidosis (with normal-ish pH) caused by diarrhea?
|
A loop diuretic
|
|
|
What complication are patients with CLL at risk for?
|
infection
|
|
|
What limits oxygen uptake in the lung at rest? With exercise?
|
Perfusion; diffusion
|
|
|
What type of kidney disease is wegener's granulomatosis associated with?
|
Segmental necrotizing glomerulonephritis (less so crescentic)
|
|
|
What anticonvulsant can cause aplastic anemia? Infections?
|
Carbamazepine; EBV, HCV, parvovirus
|
|
|
What is a marker used to monitor the response to treatment in breast cancer?
|
CA-15-3
|
|
|
What are paneth granular cells?
|
Cells in the small intestine that release a-defensins to inhibit bacteria and fungi
|
|
|
If a child has a febrile seizure what is the next step?
|
Usually only need to look for the offending pathogen
|
|
|
What is opiate withdrawal like?
|
Flu-like symptoms, dilated pupils
|
|
|
What kind of junctions join osteocytes?
|
Gap junctions
|
|
|
What is Bartter's syndrome?
|
A defect in the Na/K/Cl transporter in the thick ascending limb; patients are normotensive, hyponetremic, hypokalemic and have matabolic alkalosis
|
|
|
What is the first line treatment for S. pneumoniae?
|
Penicillin or amoxicillin (if resistant vancomycin)
|
|
|
AV block is often associated with a defect where?
|
His-purkinje system
|
|
|
If a young healthy person presents with gross hematuria, oliguria, hypertension, no protein in urinalysis and this occurred over a few weeks without recent illness what is the likely diagnosis?
|
Rapidly progressive glomerulonephritis (not alport syndrome which may develop more gradually and with hearing/ocular problems)
|
|
|
The positive chronotropic, ionotropic and dromotropic affects of the b-1 receptor on the heart are due to?
|
Increased influx of Na, increased influx of Ca and increased influx of Ca respectively.
|
|
|
What are the signs of neonatal sepsis/meningitis? How can group B strep be prevented?
|
Fever, irritability, decreased consciousness, apnea and a full anterior fontanelle; penicillin G administration to mom
|
|
|
What is a possible complication of intussusception?
|
Venous/lymph blockage->ischemia, perforation and peritonitis
|
|
|
What is a geographic risk factor for MS?
|
The last place you are at before the age of 15 puts you at higher risk if you are farther from the equator.
|
|
|
What is a complication of cholelithiasis?
|
Smal bowel obstruction, there will be abdominal pain without pain on rebound, and if partial obstruction w/o fever or leukocytosis, w/ tachycardia and peritoneal sounds can treat with fluids and electrolyte repletion.
|
|
|
What is the difference between alcoholic hallucinosis and delirium tremens?
|
AH happens with the first day of withdrawal and can involve visual hallucinations. DT happens on the second to 5th day and has tactile hallucinations and dysautonomia (leading to potential arrythmias, poor autonomic function)
|
|
|
What are the side effects of polymyxins?
|
Nephrotoxicity and neurotoxicity
|
|
|
The perineal body is the site of convergence of what 3 structures?
|
The bulbospongiosis, external anal sphincter and perineal muscles
|
|
|
Damage to what structure can lead to fecal incontinence following pregnancy?
|
The perineal body
|
|
|
Propylthiouracil has what 3 main functions?
|
Blocking the conversion of iodide to iodine, blocking the organification of iodine with tyrosine (block mono/diodotyrosine) and the conversion of T4 to T3
|
|
|
An inferior MI with AV block is likely an indication of infarction in what vessel?
|
RCA
|
|
|
In compensated coarctation where is there a difference in pressure, flow or resistance?
|
Above the coarctation there is high blood pressure but high resistance and thus normal blood flow
|
|
|
What is the nerve that lies in the tonsillar fossa?
|
CN IX (glossopharyngeal)
|
|
|
What distinguishes pemphigus vulgaris from bullous pemphigoid?
|
PV has mucosal lesions and a worse prognosis
|
|
|
Which drugs carbamoylate AChesterase? dephosphorylate? phosphorylate?
|
-stigmines; pralidoxime; organophosphates (echothiophate)
|
