Usmle Memorize

Front 1

Deficiency in homocystinuria

Back 1

cystathionine synthase

Front 2

Can't make in homocystinuria

Back 2

met

Front 3

Vitamin that can help homocystinuria

Back 3

pyridoxine

Front 4

Pathway for methionine --> cystine or THF, methionine

Back 4

Methionine (S-adenosylmethionine synthase)→ SAM → SA-homocysteine → adenosine + homocystine.


Homocysteine an go to make cystine using B6 or make methionine + THF using B12 → ↓ THF, methionine

Front 5

Inducer or inhibitor? Quinidine

Back 5

Inducer

Front 6

Inducer or inhibitor? Barbiturates, phenobartial

Back 6

Inducer

Front 7

Inducer or inhibitor? St. John's wort

Back 7

Inducer

Front 8

Inducer or inhibitor? Phenytoin

Back 8

Inducer

Front 9

Inducer or inhibitor? Griseofulvin

Back 9

Inducer

Front 10

Inducer or inhibitor? Chronic alcohol sue

Back 10

Inducer

Front 11

Inducer or inhibitor? Macrolides

Back 11

Inhibitor

Front 12

Inducer or inhibitor? Amiodarone

Back 12

Inhibitor

Front 13

Inducer or inhibitor? Isoniazid

Back 13

Inhibitor

Front 14

Inducer or inhibitor? Protease inhibitors

Back 14

Inhibitor

Front 15

Inducer or inhibitor? Acute alcohol use

Back 15

Inhibitor

Front 16

Inducer or inhibitor? Ciprofloxain

Back 16

Inhibitor

Front 17

Inducer or inhibitor? Ketoconazole

Back 17

Inhibitor

Front 18

Inducer or inhibitor? Sulfonamides

Back 18

Inhibitor

Front 19

What drugs cause agranulocytosis?

Back 19

Clozapine, carbamazepine, colchicines, propylthiouracil, methimazole, dapsone

Front 20

What drugs cause hyperglycemia?

Back 20

Niacin, tacrolimus, protease inhibitors

Front 21

What drugs cause gout?

Back 21

Furosemide, thiazides, niacin, cyclosporine, pyrazinamide

Front 22

What drugs cause myopathy?

Back 22

Fibrates, niacin, colchicines, hydroxychlorquine, IFN alpha, penicillamine, glucocorticoids

Front 23

MOA of bacitracin

Back 23

Inhibits phosphorylation/dephosphorylation of the lipid carrier required to transfer peptidoglycan to the cell wall

Front 24

MOA of sulfonamides

Back 24

PABA analogs --> inhibition of dihydropteroic acid synthase (PABA + dihydropterine --> dihydropteroic acid --> --> THF

Front 25

Sulfonamides bactericidal or static?

Back 25

Bacteriostatic

Front 26

Sulfonamide side effects

Back 26

GI, phototoxic, Stevens Johnson, especially if immunocompromised

Front 27

Why are sulfonamides contraindicated in neonates?

Back 27

Displace bili from albumin --> kernicterus

Front 28

MOA of trimethoprim

Back 28

Competitively inhibits dihydrofolic acid reductase (DHF--> THF)

Front 29

Side effects of trimethoprim

Back 29

Leukopenia, thrombocytopenia

Front 30

Sulfonamide mechanism of resistance?

Back 30

Increasing PABA, decreased target affinity, uptake of exogenous folic acid

Front 31

Side effects of fluoroquinolones

Back 31

GI is common. Dizziness, insomnia, photosensitivity, QT interval prolongation. Gatifloxacin can cause hyperglycemia but hypoglycemia with oral hypoglycemics - this is mainly only for ophthalmic use

Front 32

Mechanism of fluoroquinolone resistance

Back 32

Efflux pumps, gyrase mutations

Front 33

First generation cephalosporins? Spectrum?

Back 33

Cefazolin, cephalexin - gram positive cocci, Proteus mirabilis, E. coli, Klebsiella pneumoniae

Front 34

Second generation cephalosporins? Spectrum?

Back 34

cefoxitin, cefaclor, cefprozil, cefuroxime (crosses BBB) - Gram positive cocci, H. flu, Enterobacter aerogenes, Neisseria, Proteus mirabilis, E. coli, Klebsiella pneumoniae, Serratia marcescens

Front 35

Third generation cephalosporins? spectrum?

Back 35

ceftriaxone, cefotaxime (pseudomonas), cefdinir (ear infections), ceftazidime, cefoperazone (disulfram-like reaction)- serious gram negative infections resistant to other beta lactams, S. pneumo.
• Cefdinir can be used for resistant ear infections

• Cefoperazone not good for meningitis (doesn’t cross BB, lipophilic – highly protein bound, eliminated in bile, remember - disulfram)

Front 36

What amino acids are localization signals (out of the nucleus) rich in?

Back 36

lysine, arginine, proline

Front 37

How to ribosomes attach to the RER?

Back 37

Riboporins - recognize large subunit

Front 38

The N-oligosarccharides on what amino acid are modified in the golgi?

Back 38

Aspargine

Front 39

O-oligosaccharides are added to what amino acids in the golgi?

Back 39

Serine, threonin

Front 40

Describe some trafficking proteins

Back 40

COP I (golgi to ER), COP II (RER to cis golgi), clathrin

Front 41

How does clathrin work in endocytosis

Back 41

Thing bind the membrane receptor, this binds to adaptin, which lets the receptor interact with clathrin, clathrins interact with each other, and the membrane folds inward. Dynamin pinches it off.

Front 42

Vimentin stains for what cancers?

Back 42

Sarcoma (is important in connective tissue)

Front 43

What intermediate filaments would you stain for in neuroblastoma?

Back 43

Neurofilament

Front 44

What step is defective in collagen synthesis in Ehler's Danlos

Back 44

Cleaving the C and N terminal ends

Front 45

What amino acids is elastin rich in?

Back 45

Proline, glycine

Front 46

Where does ketogenesis take place?

Back 46

Mitochondria

Front 47

Where does the pentose phosphate pathway take place?

Back 47

Cytoplasm

Front 48

Where does the HMP shunt take place?

Back 48

Cytoplasm

Front 49

What does adenine deaminate to?

Back 49

Guanine

Front 50

What does cytosine deaminate to?

Back 50

Uracil

Front 51

Uracil can be methylated to what?

Back 51

Thymine (involved thymidilate synthase, targeted by 5FU)

Front 52

What amino acids is DNA methylated on?

Back 52

Cytosine, adenine

Front 53

What DNA polymerases are used in eukaryotes?

Back 53

Alpha lagging, delta leading, beta and epsilone filll gapas in the lagging strand.

Front 54

What is nucleotide excision repair used for?

Back 54

Bulky adducts like thymine dimers

Front 55

What is base excision repair used for?

Back 55

An abnormal base, like in spontanous deamination. Glycosylase forms the AP site, endonuclase cuts the 5' end, lase cuts the 3' end

Front 56

What is the MOA for alpha amantin (death cap mushroom)?

Back 56

Inhibits RNA polymerase II

Front 57

What is a P body?

Back 57

An entity in eukaryotic cells involved in mRNA regulation, repression

Front 58

What sequence is an amino acid loaded on in the tRNA?

Back 58

CCA on the 3' end

Front 59

Whats a defining sequence on the T arm of a tRNA?

Back 59

thymidine psi (pseudouracil) cytadine sequence

Front 60

What antineoplastic targets the G2 stage?

Back 60

Bleomycin

Front 61

What cyclin/CDK rleases Rb from TF-E2F?

Back 61

Cyclin D/CDK 4. This activates cyclin E

Front 62

What cyclin/CDK allows progression into S phase?

Back 62

Cyclin E/CDK2

Front 63

What cyclin/CDK complex allows progression to mitosis?

Back 63

Cyclin A/CDK2

Front 64

What cyclin/CDK is inovlved in initiating mitosis?

Back 64

Cyclin B/CDK1, activated by CDC 25. Breaks down nuclear laminin, etc

Front 65

What is lyonization?

Back 65

Random X inactivation

Front 66

What inheritence pattern is hereditary hemorrhagic telangiectasia?

Back 66

AD (Osler-Weber-Rendu)

Front 67

What inheritence pattern is hereditary spherocytosis?

Back 67

ADCGG

Front 68

What trinucleotide repeat is present in fragile X?

Back 68

CGG

Front 69

What trinucleotide repeat is present in Freidrich's ataxia

Back 69

GAA

Front 70

What trinucleotide repeat is present in myotonic dystrophy?

Back 70

CTG

Front 71

What does a Southern blot do?

Back 71

DNA with a DNA probe

Front 72

What does a Northern blot do?

Back 72

RNA using a DNA probe

Front 73

What does a Southwestern blot do?

Back 73

DNA binding proteins/TFs with an oligonucleotide probe

Front 74

What does a Western blot do?

Back 74

Protein with an antibody probe

Front 75

What is the Shine Delgarno sequence?

Back 75

RNA sequence ribosomes recognize

Front 76

Rate limiting step for de novo pyrimidine synthesis?

Back 76

Carbamoyl phosphate synthetase II

Front 77

Rate limiting step for de novo purine synthesis?

Back 77

Glutamine PRPP amidotransferase

Front 78

Rate limiting step for urea cycle?

Back 78

Carbamoyl phosphate synthetase I

Front 79

Rate limiting step for fatty acid oxidation?

Back 79

Carnitine acyltransferase I

Front 80

How much ATP is generated in the heart and liver?

Back 80

32 ATP (malate-aspartate shuttle)

Front 81

Hexokinase/glucokinase (glucose --> G6P) characteristics

Back 81

Glucokinase is in the liver and pancreas. Step uses 1 ATP

Front 82

What is PFK 1 regulated by (F6P-->F1,6BP)

Back 82

Inhibited by ATP, citrate. Activated by AMP, F-2,6-BP

Front 83

What is fexodenadine?

Back 83

2nd/3rd generation H1 blocker

Front 84

What neurocutaneous disorder is associated with angiomyolipoma?

Back 84

Tuberous sclerosis, especially bilateral renal angiomyolipomas.

Front 85

If you see someone with ash leaf spots, you might suspect what other problems?

Back 85

Angiomyolipomas, cortical tubers, subependymal hamartomas, seizures, MR, cardiac rhabdomyoma, facial angiofibromas

Front 86

What comes from the ventral pancreatic bud?

Back 86

Uncinate process, part of the head (inferior), and the proximal main pancreatic duct.

Front 87

What are the two ducts of the pancreas (fail to fuse in pancreas divisum)?

Back 87

Dorsal duct of Santorini drains most of it, drains into the minor papilla. Ventral duct of Wirsung opens into the major papilla, drains the uncinate process

Front 88

Side effects of carbamazepine?

Back 88

Bone marrow suppression, hepatotoxicity, SIADH, p450 induction

Front 89

Spectrum for ampcillin, amoxicillin

Back 89

Gram positive cocci, but not staph, listeria. H. pylori, H. flu, E. coli, borreila

Front 90

What is amikacin?

Back 90

Aminoglycoside

Front 91

What do you use for bubonic plague and tularemia?

Back 91

Streptomycin. Also works against TB

Front 92

What are the side effects of aminoglycosides?

Back 92

Nephrotoxic, ototoxic, contact dermatitis (neomycin). Neuromuscular blockade due to decreased acetyl CoA release (like botulinism toxin)

Front 93

What is terbenafine?

Back 93

Blocks squalene epoxidase and thus ergosterol synthesis. For dematophytes. Can cause hepatotoxicity

Front 94

What antibiotics inhibit formation of the initiation complex?

Back 94

Aminoglycosides (30s), linezolid (50s)

Front 95

What antibiotics inhibit amino acid incorporation?

Back 95

Tetracyclines (30s), dalfopristin, quinupristin (50s) - block the attachment of the tRNA to the acceptor site

Front 96

What antibiotics block peptide bond formation?

Back 96

Chloramphenicol. Inhibits the activity of peptidyltransferase.

Front 97

What antibiotics block translocation?

Back 97

Macrolides and clindamycin (50s)

Front 98

What is varenicline?

Back 98

Nicotine partial agonist to treat nicotine addiction.

Front 99

What are the high potency neuroleptics?

Back 99

Fluphenazine, thiothixene, haloperidol, trifluoperazine (moderate potency) – extrapyramidal symptoms predominate

Front 100

What are the low potency neuroleptics?

Back 100

Chlorpromazine, thioridazine – more anticholinergic, antihistamine, and alpha blockade effects

Front 101

What's an interesting side effect of chlorpromazine?

Back 101

Corneal deposits. A low potency typical neuroleptic

Front 102

What's an interesting side effect of thioridazine?

Back 102

Retinal deposits. A low potency typical neuroleptic

Front 103

What is trihexyphenidyl?

Back 103

Anti muscarinic. Used in Parkinson's and neuroleptic drug side effects

Front 104

What is clozapine? What is an important side effect?

Back 104

Atypical antipsychotic. Agranulocytosis.

Front 105

What is risperidone?

Back 105

Atypical antipsychotic.

Front 106

What is ziprasidone?

Back 106

Atypical antipsychotic.

Front 107

What atypical antipsychotic prolongs the QT interval?

Back 107

Ziprasidone

Front 108

What are imipramine, desipramine and clomipramine?

Back 108

Tricyclic antidepressants. Desipramine is the least sedating and has a lower seizure threshold of the TCAs.

Front 109

What are doxepin and amoxapine?

Back 109

Tricyclic antidepressants

Front 110

What is milnacipran?

Back 110

SNRI, often used for fibromyalgia

Front 111

What is duloxetine?

Back 111

SNRI, predominant NE effect, can be used in diabetic peripheral neuropathy

Front 112

What is sibutramine?

Back 112

SNRI used for weight loss

Front 113

What is tranylcypromine?

Back 113

MAOI

Front 114

What is isocarboxazid?

Back 114

MAOI

Front 115

What is selegiline?

Back 115

Selective MAO B inhibitor used in Parkinsons

Front 116

What is maprotiline?

Back 116

Norepinephrine reuptake inhibitor

Front 117

What is produced in the reaction 1,3 BPD --> 3 phosphoglycerate by phosphoglycerate kinase?

Back 117

1 ATP via substrate level phosphorylation

Front 118

What is produced in the reaction PEP --> pyruvate by pyruvate kinase? How is it regulated?

Back 118

1 ATP via substrate level phosphorylation. Inhibited by ATP and alanine. Activated by F1,6,BP

Front 119

How is the pyruvate dehydrogenate (pyruvate --> acetyl CoA) complex regulated? What are the components of the complex?

Back 119

Inhibited by ATP, NADH, acetyl CoA. Activated by NAD, ADP, and calcium (thus can be activated by muscle contraction).
TPP, FAD, NAD, CoA (from pantothenate), lipoic acid

Front 120

How do you manage a pyruvate dehydrogenase deficiency?

Back 120

They will have low acetyl CoA and thus high lactate, oxaloacetate and alanine. Give ketogenic amino acids and high fat intake.

Front 121

What are the ketogenic and glucogenic amino acids?

Back 121

Isoleucine, tyrosine, tryptophan, phenylalanine

Front 122

Where does fructose enter glycolysis?

Back 122

As glyceraldehyde, skips PFK1

Front 123

What does the citric acid cycle produce?

Back 123

3 NADH, 1 FADH2, 2 CO2, 1 GTP per acetyl coA = 24 ATP per glucose

Front 124

What is citrate synthase inhibited by (acetyl CoA to citrate)

Back 124

ATP; it is irreversible

Front 125

What are nalbuphine and pentazocine?

Back 125

Kappa receptor agonists, so cause spinal analgesia, but dysphoria. Mu antagonist, so can precipitate withdrawal

Front 126

What is methylnaltrexone used for?

Back 126

Used to reverse opiate induced constipation. Mainly stays in the gut.

Front 127

What could you give to treat opiate withdrawal?

Back 127

Clonidine (alpha 2 blockade)

Front 128

What is loperamide?

Back 128

Opiate anti-diarrheal

Front 129

What would you use to prevent cisplatin nephrotoxicity?

Back 129

Amifostine

Front 130

What inhibits the pyruvate dehydrogenase complex?

Back 130

ATP, acetyl CoA, NADH

Front 131

What is produced by isocitrate dehydrogenase (isocitrate to alpha ketoglutarate)? What is it regulated by?

Back 131

Produces CO2 and NADH. Inhibited by ATP

Front 132

What is citrate synthase inhibited by? (acetyl CoA to citrate)

Back 132

ATP

Front 133

What is alpha ketoglutarate dehydrogenase inhibited by?

Back 133

Inhibited by NADH and ATP

Front 134

What is produced by succinyl CoA synthetase? (succinyl CoA to succinate)

Back 134

Produces GTP (substrate level phosphorylation) and CoA. The GTP can be used to form PEP in gluconeogenesis to using PEP carboxykinase

Front 135

What is produced in the reaction from succinate to fumarate?

Back 135

FADH2

Front 136

What is produced in the reaction of malate to oxaloacetate?

Back 136

NADH

Front 137

What inhibits complex I of the ETC?

Back 137

Barbiturates (amytal), rotenone (fish poison), 1-methyl-4-phenylpyrimidinum (MPP - from MPTP)

Front 138

What inhibits complex III of the ETC?

Back 138

antimycin A

Front 139

What inhibits complex IV of the ETC?

Back 139

CN-, CO, azide (N3), H2S

Front 140

What is oligomycin?

Back 140

ATP synthase inhibitor

Front 141

What is the step in gluconeogenesis analogous to PFK1?

Back 141

Fructose 1,6 bisphosphatase (F16BP to F6P). Inhibited by AMP and F26BP

Front 142

What 2 steps in gluconeogenesis are analogous to pyruvate kinase?

Back 142

Pyruvate carboxylase (pyruvate --> oxoaloacetate) in the mitochondria. Requires biotin (adds CO2) and ATP. Activated by acetyl CoA.

PEP carboxykinase (oxaloacetate --> PEP) in the cytosol. Requires GTP

Front 143

How can odd chain fatty acids be used as a glucose source?

Back 143

Broken down to propionyl CoA, which is a precursor for succinyl CoA.

Front 144

What acts via cAMP to phosphorylate glycogen phosphorylase kinase which phosphorylates glycogen phosphorylase? Is GP-P active? How else can this happen?

Back 144

Epinephrine and glucagon. Yes. It is also activated by calcium/calmodulin (allosteric) and increased AMP.

Front 145

What are the basic steps of glycogen synthesis

Back 145

Glucose 6 P → Glucose 1P (UDP glucose phosphorylase) → UDP glucose → straight chain glycogen

Front 146

What is the enzyme deficiency in Von Gierke's disease?

Back 146

Glucose 6 phosphatase


Glycogen (glycogen phosphorylase) →> G1P (phosphoglucomutase) → G6P (glucose 6 phosphatase)→ glucose

Front 147

What is the enyzme deficiency in Pompe's?

Back 147

Lysosomal alpha 1,4 glycosidase.

Glycogen (lysosomal alpha 1,4 glycosidase) → Glucose + P

Front 148

What are the steps in fatty acid synthesis?

Back 148

Citrate is transferred from the mitochondrial matrix to the cytoplasm using the citrate shuttle. Using ATP and citrate lyase, citrate is converted to acetyl CoA. Acetyl coA is converted to malonyl CoA using acetyl CoA carboxylase (rate limiting), and CO2 from biotin --> Malonyl CoA → palmitate

Front 149

What does ApoE do?

Back 149

Mediates remnant uptake, present on everything but LDL

Front 150

What does Apo A-I do?

Back 150

Present on chylomicrons and HDL. Activates LCAT, which catalyzes cholesterol esterification.

Front 151

What does ApoC-II do?

Back 151

A cofactor for LPL present on chylomicrons and IDL

Front 152

What does ApoB-48 do?

Back 152

On chylomicrons and chylomicron remnants, mediates chylomicron secretion.

Front 153

What does ApoB-100 do?

Back 153

Binds LDL receptor. Present on VLDL, IDL, and LDL

Front 154

What vitamin is needed by transamination reactions?

Back 154

Pyridoxal phosphate (B6)

Front 155

How does excess NH4 limit the TCA cycle?

Back 155

Depletes alpha ketoglutarate

Front 156

What can you use benzoate and phenylbutyrate for?

Back 156

Binding amino acids to increase excretion in hyperammonemia

Front 157

What are the oxidative (irreversible) steps of the HMP shunt?

Back 157

G-6-P + NAD→ phosphogluconolactone + NADPH via G6PD ,

6phospho gluconolactone + NAD+→ ribulose-5-P + NADPH via 6phosphogluconate dehydrogenase

Front 158

What does the non oxidative part of the HMP hunt do?

Back 158

Makes ribose 5P from ribulose 5P, as well as G3P, F6P. Transketolases are used, which require TPP

Front 159

What are some properties of carbamoyl phosphate synthetase II?

Back 159

Involved in pyrimidine synthesis, is in the cytosol, get its N from glutamine

Front 160

What are some properties of carbamoyl phosphate synthetase I?

Back 160

Involved in the urea cycle, is in the mitochondria, gets its N from ammonia.

Front 161

What is the basic outline of pyrimidine synthesis?

Back 161

Start with orotic acid and add a sugar and phosphate, then modify the orotic acid to the appropriate base. In purine synthesis, a base is just added to ribose and phosphate.

Front 162

What is an alcohol dehydrogenase inhibitor?

Back 162

Fomepizole

Front 163

What do you use fomepizole in?

Back 163

Methanol, ethylene glycol poisoning

Front 164

Why is there hypoglycemia with alcohol intake?

Back 164

Ethanol leads to increased NADH, so more pyruvate is diverted to lactate and more OAA to malate since both of these reactions increase NAD+. At the same time this stimulates fatty acid synthesis because of increased NADPH

Front 165

What is the translocation in M3 AML?

Back 165

t(15;17)

Front 166

What are the symptoms of vitamin A toxicity?

Back 166

Alopecia, hyperlipidemia, hepatotoxicity, arthralgia, sore throat

Front 167

What happens in vitamin A deficiency?

Back 167

Keratinized squamous metaplasia underlies a lot. In the lungs, increases risk for infection. In the eyes, it causes keratomalacia (wrinkling, clouding of the cornea), Bitot spots (drry, silvery plaques on the bulbar conjunctiva). In the skin, it causes follicular hyperkeratosis and thus alopecia.

Front 168

Thyamine is needed for what 4 enzymes?

Back 168

3 need TLCFN - pyruvate dehydrogenase, alphaketoglutarate dehydrogenase, branched chain amino acid dehydrogenase.

Transketolase only needs thiamine

Front 169

What happens in hereditary transketolase mutation?

Back 169

Decreased affinity for TPP leads to Wernicke Korsakoff without the beriberi.

Front 170

How do you diagnose thiamine deficiency?

Back 170

See transketolase activity with thiamine addition

Front 171

What are some reactions riboflavin is important in?

Back 171

Succinate dehydrogenase, fatty acyl CoA dehydrogenase, glycerol phosphate dehydrogenase. It is also important in complex I and II of the ETC

Front 172

What are the symptoms of riboflavin deficiency?

Back 172

B symptoms + dermatitis, corneal neovascularization

Front 173

What amino acid is niacin derived from? What does it need?

Back 173

Tryptophan, using B6

Front 174

What are some causes of niacin deficiency?

Back 174

Hartnup disease (decreased tryptophan absorption), carcinoid (increased tryptophan metabolism), isoniazid (decreased B6), diet

Front 175

What does pantothenate do?

Back 175

It's part of CoA and fatty acid synthase

Front 176

How does pantothenate deficiency present?

Back 176

Dermatitis, enteritis, alopecia, adrenal insuffciency

Front 177

What is pyridoxal phosphate used in?

Back 177

Transamination reactions (e.g. by AST) - this is why alcohol can cause B6 deficiency, decarboxylation reactions, glycogen phosphorylase, cystathione, heme, niacin and GABA synthesis

Front 178

What are the symptoms of B6 deficiency?

Back 178

Decreased GABA - convulsions, peripheral neuropathy. Impaired heme synthesis causes sideroblastic anemia. Dermatitis, glossitis, cheilosis. Can also be caused by oral contraceptives.

Front 179

What is propinoyl CoA carboxylase involved in?

Back 179

Breaking down propionyl CoA to methylmalonyl coA. Priopionyl CoA is from the metabolism of Valine, Odd chain fatty acids, Methionine, Isoleucine, Threonine (VOMIT)

Front 180

What is biotin a cofactor for? What does deficiency cause?

Back 180

The ABC enzymes (need ATP, biotin, CoA) used in carboxylation. Pyruvate carboxylase - fasting hypoglycemia. Acetyl coA carboxylase - decreased fatty acid synthesis. Propinoyl CoA carboxylase - alopecia, bowel inflammation, muscle pain

Front 181

Where is folic acid absorbed?

Back 181

Distal ileum

Front 182

What is B12 a cofactor for?

Back 182

Homocysteine methyltransferase converts homocysteine + methylTHF to methionine and THF. Untraps folate from storage form.

Methylmalonyl CoA mutase is involved in VOMIT breakdown (val, odd carbon fattty acids, met, ile, thr). Also a succinyl CoA source

Front 183

What vitamin toxicity could cause a false negative guiac?

Back 183

Vitamin C. Can also cause GI symptoms

Front 184

What happens in vitamin E deficiency?

Back 184

Erythrocyte gragility, dorsal column, SCT demyelination.

Front 185

What can vitamin E toxicity cause?

Back 185

Hemorrhagic stroke in adults, necrotizing entercolitis in infants

Front 186

Gamma carboxylation via vitamin K requires what?

Back 186

Calcium

Front 187

What worsens vitamin K deficiency in a newborn?

Back 187

Phenobarbital, carbamazepine use during pregnancy

Front 188

What transporters are involved in iron absorption?

Back 188

Diavalent metal transporter-1 gets it across the luminal membrane. It enters circulation through ferroportin. There it is bound to ferritin.

Front 189

How does hepcidin work?

Back 189

It binds ferroportin so it degrades it. If there is too much iron or inflammation, increased hepcidin decreases ferroportin so there is less absorption and less release from macrophages.

Front 190

How are the kidneys involved in iron homeostasis?

Back 190

They release lactoferrin which binds free iron in the urine so it is recovered

Front 191

What are some enzymes zinc is necessary for?

Back 191

Lactate dehydrogenase, carbonic anhydrase

Front 192

What are some symptoms of zinc deficiency?

Back 192

Decreased adult hair, hypogonadism, dysgeusia, acrodermatitis enteropathica (rash around eye, mouth, anus, etc), diarrhea, decreased night vision

Front 193

What does cadmium poisoning cause?

Back 193

Alveolar macrophage necrosis, causing obstructive lung disease. Also a lung cancer risk and calcium loss

Front 194

What are the gluogenic amino acids?

Back 194

Met, val, arg, his

Front 195

What is the order of phenylalanine to epinephrine synthesis?

Back 195

Phenylalanine (by phenylalanine hydroxylase)→ tyrosine (tyrosine hydroxylase)→ Dopa (dopa decarboxylase; inhibited by carbodopa)→ dopamine → NE (facilitated by cortisol) → epinephrine. Dopa can form melanin.

Front 196

What can tryptophan make?

Back 196

Niacian via pyridoxine. Serotonin and melatonin via tetrahydrobiopterin

Front 197

What amino acid is porphyrin from?

Back 197

Glycine

Front 198

What is derived from glutamate?

Back 198

GABA, glutathione

Front 199

Describe the step deficient in PKU

Back 199

Phenylalanine (phenylalanine hydroxylase; requires tetrahydrobiopterin – BH4) → tyrosine.

BH4 is regenerated using dihydrobiopterin reductase

Front 200

What enzyme converts NE to epi?

Back 200

Norepinephrine (phenylethanolamine-N-methyltransferase – PNMT; requires SAM)→ epinephrine

Front 201

What step of collagen synthesis is defective in Ehler's Danlos?

Back 201

Cleaving of C and N terminal ends from procollagen forming tropocollagen. This uses collagen peptidases.

Front 202

What is Leigh syndreom?

Back 202

A mitochondrial myopathy subacute sclerosing encephalopathy. Leber's hereditary neuropathy is also one, cause an acute loss of central vision.

Front 203

What are the symptoms of cytochrome C oxidase deficiency?

Back 203

Weakness, hypotonia, encephalopathy. (autosomal recessive)

Front 204

What enzyme is missing in homocystinuria?

Back 204

Cystathionin synthetase - error of methionine metabolism

Front 205

What is the pathway of methionine metabolism

Back 205

Methionine (S-adenosylmethionine synthase)→ SAM → SA-homocystine → adenosine + homocystine;

1. Homocysteine (cystathionine synthase, B6) → cystathionine (cystathionase, B6) → cysteine

2. Or, homocysteine + N5-methyl THF (B12) → methionine + THF

Front 206

How does homocystinuria present?

Back 206

MR, vision problems, thrombosis. Can look like Marfan's.

Front 207

What vitamin is helpful in homocystinuria?

Back 207

B6, a cofactor for cystathionine synthase

Front 208

What happens in arginase deficiency?

Back 208

Converts arginine to urea + ornithine. Spasticity. Treat with low protein diet, supplementing essential amino acids.

Front 209

What enzyme is deficient in orotic aciduria?

Back 209

Orotic acid phosphoribosyl transferase or orotidine 5' phosphate decarboxylase. Thus orotic acid cannot be converted to UMP. Causes megaloblastic anemia, no hyperammonemia. Treat with oral uridine

Front 210

What kind of acid base abnormality occurs in propionyl coA carboxylase deficiency?

Back 210

Anion gap acidosis

Front 211

What does HGPRT deficiency cause?

Back 211

↓ conversion of hypoxanthine → IMP; guanine → GMP
The pathway is shunted towards uric acid and denovo production (thus ↑ uric acid AND PRPP – which would ↑ PRPP amidotransferase activity by mass effect)

Front 212

What are the symptoms of fructose intolerance?

Back 212

Hypoglycemia, jaundice, cirrhosis, vomiting

Front 213

What is missing in classic galactosemia?

Back 213

Absence of galactose 1-P uridyl transferase, thus G1P and galactilol accumulate.

Front 214

How does classic galactosemia present?

Back 214

Jaundice, hepatomegaly, infantile cataracts, MR, vomiting, hyperchloremic metabolic acidosis, aminoaciduria

Front 215

What are some lab abnormalities of Von Gierke's?

Back 215

Increased blood lactate and uric acid

Front 216

What is deficient in Pompe's (type II)?

Back 216

↓ lysosomal alpha 1,4 glucosidase (acid maltase) – mnemonic 2x2=4

Front 217

What is deficient in Cori's (type III)?

Back 217

↓ debranching enzyme (alpha 1,6 glucosidase) – mnemonic 2x3=6
Normal blood lactate levels, hypoglycemia is mild. Abnormal glycogen.

Front 218

What is deficiency in Andersen's (type IV)

Back 218

Branching enzyme, abnormal glycogen

Front 219

What is a tetrahydrobiopterin reductase deficiency?

Back 219

Malignant PKU. Used for both phenylalanine and tyrosine hydroxylase. Supplementation in tyrosine will still cause dopamine deficiency. BH4 deficiency will present similarly

Front 220

What is deficient in McArdles (type IV)?

Back 220

↓ skeletal muscle glycogen phosphorylase

Front 221

What is deficient in Hers (type V)

Back 221

Hepatic glycogen phosphorylase (like McArdles for liver)

Front 222

How does PKU present?

Back 222

Seizures, fair skin (↓ melanin from phenylalanine), eczema, musty odor (↑ aromatic amino acids)

Front 223

What is homogentisic acid oxidase involved in?

Back 223

Tyrosine to fumarate

Front 224

What can cause atherosclerosis in childhood?

Back 224

Homocystinuria

Front 225

How do you treat cystathionine synthase deficiency?

Back 225

Homocystinuria - ↓ Met, ↑ Cys, B12, serine and folate

Front 226

How do you treat homocysteine methyl transferase deficiency? This enzyme requires B12.

Back 226

Homocystinuria - ↑ methionine

Front 227

What causes cystinuria?

Back 227

Defect of renal tubular amino acid transporter for cystine, ornithine, lysine, arginine in the PCT. Treat with acetazolamide to alkalinize urine and prevent stones.

Front 228

What vitamin supplementation could help maple syrup urine disease?

Back 228

Thiamine

Front 229

Describe Hartnup disease

Back 229

↓ neutral amino acids absorbed in gut, ↑ excreted → pellagra (tryptophan → niacin) with symptoms that wax and wane.
Tryptophan is a precursor for nicotinic acid, serotonin and melatonin.

Nicotinic acid, nicotinamide, ↑ protein in diet
Proline and hydroxyproline will be normal.

Front 230

How does I cell disease present (failure of addition of mannose 6 phosphate to lysosome proteins)

Back 230

Coarse facial features, corneal clouding, restricted joint movement, lysosomal enzymes in the plasma, skeletal abnormalities, hepatosplenomegaly

Front 231

What is deficient in Fabry's?

Back 231

Alpha galactosidase A deficiency → ↑ ceramide trihexose

Front 232

How does Fabry's present?

Back 232

Peripheral neuropathy, angiokeratomas (dark red, non blanching macules and papules), CV/renal disease.
Death is usually due to renal failure

Front 233

What is deficiency in Gaucher's? (Hint, starts with a G)

Back 233

Glucocerebrosidase deficiency → ↑ glucocerebroside

Front 234

How does Gaucher's present?

Back 234

Hepatosplenomegaly, aseptic necrosis of femur, Gaucher cells

Front 235

What is deficient in Neimann Pick?

Back 235

Sphingomyelinase deficiency – ↑ sphingomyelin

Front 236

How does Neimann Pick present?

Back 236

Sphingomyelin accumulates → foamy histocytes that accumulate in the liver, spleen, and CNS. Retina deposition → blindness. Hepatosplenomegaly, progressive hypotonia. Normal initial development.

Front 237

What is deficient in Tay Sachs?

Back 237

Deficiency of hexosaminidase A → ↑ GM2 ganglioside

Front 238

How does Tay Sachs present?

Back 238

Neurodegeneration, lysosomes with onion skin. No hepatomegaly vs Neimann Pick.

Front 239

What is the X linked lysosomal storage disease?

Back 239

Fabry's

Front 240

What is deficient in Krabbes?

Back 240

Galactocerebrosidase --> build up of galactocerebroside

Front 241

How does Krabbes present?

Back 241

Peripheral neuropathy, developmental delay, optic atrophy, globoid cells (giant, mononucleate)

Front 242

What is deficient in metachromatic leukodystrophy?

Back 242

Deficiency of arylsulfatase A, ↑ cerebroside sulfate

Front 243

How does metachromatic leukodystrophy present?

Back 243

Central and peripheral demyelination, ataxia, dementia

Front 244

What is deficient in Hurler's and Hunter's?

Back 244

Deficiency of alpha L iduronidase → ↑ heparan sulfate, dermatan sulfate

Front 245

What is type Ia dyslipidemia?

Back 245

↑ chylomicrons → ↑ TG, cholesterol. Lipoprotein lipase deficiency or altered apo C-II

Front 246

What is deficient in abetalipoproteinemia?

Back 246

↓ apo B-100 (VLDL, LDL) and apo B-48 (chylomicrons) → inability to synthesize lipoproteins

Front 247

How does abetalipoproteinemia present?

Back 247

Within first few months – steatorrhea, acanthocytosis, ataxia, night blindness

Front 248

What is the quad screen in Downs like?

Back 248

↓AFP, estriol; ↑ hCG, inhibin A

Front 249

How does Edwards present?

Back 249

Trisomy 18: severe mental retardation, rocker bottom feet, micrognathia (small jaw), low set ears, clenched hands, prominent occiput, heart defects

Front 250

What is the quad screen in Edwards like?

Back 250

↓ AFP, hCG, estriol; normal inhibin A

Front 251

How does Patau's present?

Back 251

Trisomy 13: Rocker bottom feet, microphthalmia, microcephaly, cleft lip, cleft palate, holoproencephaly – cyclopia, polydactyly, heart defects, hole in the iris, deafness, etc

Front 252

How is the quad screen like in Pataus?

Back 252

Normal

Front 253

What is the nasal transepithelial potential difference like in CF?

Back 253

More negative due to increased sodium reabsorption

Front 254

How does Cri-du-chat present (microdeletion at 5p)?

Back 254

Microcephaly, MR, high pitched cry, epitcanthal folds, heart defects – esp VSD

Front 255

How does William's syndrome present (microdeletion at 7q)?

Back 255

Elastin is deleted. Elvin facies, MR, hypercalcemia (↑ sensitive to vitamin D), good verbal skills, extremely friendly, cardiovascular problems

Front 256

What does sonic hedgehog do?

Back 256

Produced at limb bases in the zone of polarizing activity, involved in anterior-posterior axis. Mediates ectodermal function.
Deficiency: holoprosencephaly

Front 257

What does Wnt-7 do?

Back 257

Produced at apical ectodermal ridge (at the disal end of each limb). Involved in the dorsal-ventral axis

Front 258

What does homeobox do?

Back 258

Involved in craniocaudal segmental organization. Mutation can cause appendages in the wrong direction (e.g. synpolydactyly – an extra fused digit)

Front 259

What structures in development become the ligaments in the abdomen?

Back 259

Umbilical vein – ligamentum teres of the liver, which is in the falciform ligament.


Umbilical arteries – medial umbilical ligaments.


Ductus venosus – ligamentum venosum.

Allantois/urachus – median umbilical ligament

Front 260

What part of the placenta secretes hCG? What makes cells?

Back 260

Syncitiotrophoblast makes hcg. CYTOtrophoblast makes cells

Front 261

What is a malformation vs deformation? Aplasia?

Back 261

Malformation is an intrinsic disruption in the embryonic period. Deformation is extrinsic and is later. Aplasia is an absent organ despite present primordial tissue

Front 262

What embryonic layer is the lens from?

Back 262

Surface ectoderm

Front 263

What embryonic layer is the oral cavity lining from?

Back 263

Surface ectoderm

Front 264

What embryonic layer are the salivary, sweat and mammary glands from?

Back 264

Surface ectoderm

Front 265

What embryonic layer is the adenohypophysis from?

Back 265

Surface ectoderm

Front 266

What embryonic layer is neurohypophysis from?

Back 266

Neuroectoderm

Front 267

What embryonic layer are oligodendroglia and astrocytes from?

Back 267

Neuroectoderm

Front 268

What embryonic layer are ependymal cells from?

Back 268

Neuroectoderm

Front 269

What embryonic layer is the pineal gland from?

Back 269

Neuroectoderm

Front 270

What embryonic layer is the retina from?

Back 270

Neuroectoderm

Front 271

What embryonic layer is the spinal cord from?

Back 271

Neuroectoderm

Front 272

What embryonic layer is the ANS from?

Back 272

Neural crest

Front 273

What embryonic layer are the cranial nerves from?

Back 273

Neural crest

Front 274

What embryonic layer is the pia/arachnoid from?

Back 274

Neural crest

Front 275

What embryonic layer are the inner ear bones from?

Back 275

Neural crest

Front 276

What embryonic layer are the sensory organs of the ear from?

Back 276

Surface ectoderm

Front 277

What embryonic layer are schwann cells from?

Back 277

Neural crest

Front 278

What embryonic layer are chromaffin cells from?

Back 278

Neural crest

Front 279

What embryonic layer are parathyroids from?

Back 279

Endoderm

Front 280

What embryonic layer is the urethra and vagina from?

Back 280

Mesoderm

Front 281

What embryonic layer are serosal linings from?

Back 281

Mesoderm

Front 282

What embryonic layer are the testes and ovaries from?

Back 282

Mesoderm

Front 283

What embryonic layer is the eustachian tube from?

Back 283

Mesoderm

Front 284

What embryonic layer is the adrenal cortex from?

Back 284

Mesoderm

Front 285

What embryonic layer is the dermis from?

Back 285

Mesoderm

Front 286

What forms from the first aortic arch?

Back 286

part of the maxillary artery, a branch of the external carotid

Front 287

What forms from the second aortic arch?

Back 287

Stapedial and hyoid artery?

Front 288

What forms from the third aortic arch?

Back 288

Common carotid, proximal internal carotid

Front 289

What forms from the fourth aortic arch?

Back 289

L: aortic arch, R: proximal subclavian

Front 290

What forms from the sixth aortic arch?

Back 290

Proximal pulmonary arteries

Front 291

What kind of tissue are the branchial arches?

Back 291

Mesoderm, neural crest. Nerves grow in.

Front 292

What is the innervation of the first branchial arch?

Back 292

CN V2, V3

Front 293

What is the innervation of the second branchial arch?

Back 293

CN VII

Front 294

What is the innervation of the third branchial arch?

Back 294

CN IV

Front 295

What is the innervation of the fourth branchial arch?

Back 295

CN X - superior laryngeal

Front 296

What is the innervation of the sixth branchial arch?

Back 296

CN X - recurrent laryngeal

Front 297

What are the muscles, bones and cartilage of the first arch?

Back 297

Innervation:, CN V2 – maxillary, CN V3 – mandibular

Muscles: muscles of mastication, digastric anterior belly, mylohyoid, tensor tympani, tensor veli palatini

Bones: malleus, incus, maxilla, mandible

Cartilage: Meckel’s cartilage – mandible, sphenomandibular ligament

Anterior 2/3 of the tongue

Front 298

What are the muscles, bones and cartilage of the second arch?

Back 298

Innervation: CN seven

Muscles: muscles of facial expression, digastric posterior belly, stylohyoid, stapedius

Bones: stapes, styloid process, lesser horn and upper body of hyoid

Cartilage: Reichert’s cartilage – stylohyoid ligement

Front 299

What are the muscles, bones and cartilage of the third arch?

Back 299

Innervation: CN IX

Artery: common carotids

Muscle: stylopharyngeus (thus the only muscle innervated by CN IX)

Bones: greater horn and lower body of hyoid

3rd and 4th form the posterior 2/3 of the tongue

Front 300

What are the muscles, bones and cartilage of the fourth arch?

Back 300

Innervation: CN X (superior laryngeal n)
Artery: Right subclavian, aortic arch

Muscles: Muscle of pharynx, soft palate, cricothyoid

Front 301

What are the muscles and arteries from the 6th branchial arch?

Back 301

Innervation: CN X (recurrent laryngeal)

Artery: pulmonary arteries, ductus arteriosus

Muscles: Intrinsic muscles of larynx except the cricothyroid

Front 302

What is Treacher Collins syndrome?

Back 302

Failure of neural crest migration --> mandibular hypoplasia, facial abnormalities

Front 303

What does the first cleft become?

Back 303

External auditory meatus

Front 304

What comes from the first pharyngeal pouch?

Back 304

Middle ear cavity, eustachian tube, mastoid air cells

Front 305

What comes from the second pharyngeal pouch?

Back 305

Palatine tonsil epithelium

Front 306

What comes from the third pharyngeal pouch?

Back 306

Dorsal wing: inferior parathyroids; ventral wing: thymus

Front 307

What comes from the fourth pharyngeal pouch?

Back 307

Superior parathyroids

Front 308

Prosencephalon --> telencephalon --> diencephalon. What are the derivatives?

Back 308

The telencephalon becomes the hemispheres and the lateral ventricles. It also includes the basal ganglia and hippocampus.
The diencephalons becomes the thalamus and third ventricle, as well as the hypothalamus and the optic tract.

Front 309

Rhombencephalon ---> metencephalon, myelencephalon. What are the derivatives

Back 309

The metencephalon becomes the pons and has the upper part of the 4th ventricle

The myelencephalon becomes the medulla and has the lower 4th ventricles

Front 310

What are the derivatives from the bulbus cordis and right horn of the sinus venousus?

Back 310

Smooth parts of ventricles, smooth right atrium.

Front 311

What are the derivatives from the left horn of the sinus venosus?

Back 311

Coronary sinus

Front 312

What are the derivatives from the right cardinal veins?

Back 312

SVC

Front 313

What causes an annular pancreas?

Back 313

The dorsal bud cleaves in two

Front 314

What occurs with a defect in the caudal fold of the anterior gut wall?

Back 314

Bladder exstrophy?

Front 315

What occurs with a defect in the lateral fold of the anterior gut wall?

Back 315

Gastrochisis, Omphalmocele

Front 316

What happens in atresia of the ileum?

Back 316

Atresia distal to the duodenum is due to vascular accident (apple peel lesion - bowel spirals)

Front 317

What is the analog to the corpus spongiosum and cavernosum in the female?

Back 317

Vestibular bulbs (from the genital tubercle

Front 318

What is the female analog to the Cowper (bulbourethral) glands?

Back 318

Bartholins (greater vestibular) glands

Front 319

What does the gubernaculum become?

Back 319

Ovarian/round ligament; anchors testes in scrotum.

Front 320

Why are alkalating agents teratogenic?

Back 320

Absence of digits

Front 321

Why is carbamazepine teratogenic?

Back 321

NTDs, craniofacial defects, nail hypoplasia, growth retardation

Front 322

Why is phenytoin teratogenic?

Back 322

Fetal hydantoin syndrome - microcephaly, craniofacial anomalies, nail/finger defects, cardiac defects

Front 323

What are 4 obligate aerobes?

Back 323

Nocardia, P. aeruginosa, M. tuberculosis, Bacillis

Front 324

What are 3 obligate anaerobes?

Back 324

Clostridium, actinomyces, bacteriodes (ABC)

Front 325

What are 8 facultative intracellulars?

Back 325

• Salmonella, neisseria, brucella, mycobacteria, listeria, francisella, legionella, Y. pestis

Front 326

What are some urease positives?

Back 326

Nocardia, cryptococcus, klebsiella

Front 327

What toxins are related to lysogenic phages?

Back 327

Shiga-like toxin, botulinum toxin, cholera toxin, diphtheria toxin, erythrogenic toxin of S. pyogenes

Front 328

What gram negative makes sports?

Back 328

Coxiella burnetti

Front 329

How do you tell apart coag negative staph?

Back 329

Novobiocin sensitive – S. epidermidis. Novobiocin resistant – S. saprophiticus

Front 330

How do you differentiate alpha hemolytic strep?

Back 330

Optochin and bile sensitive – s. pneumo. Optochin and bile resistant – S. mutans

Front 331

How do you tell apart beta hemolytic strep?

Back 331

Bacitracin sensitive – S. pyogenes. Bacitracin resistant – S. agalactiae

Front 332

What are some properties of S. aureus?

Back 332

Beta hemolytic, ferments mannitol, salt tolerant.

Front 333

What are the S. aureus virulence factors and toxins?

Back 333

Protein A – binds the Fc region of Ig to prevent opsonization, complement fixation and phagocytosis

TSST-1 (binds MHC II). Can cause desquamation on the palms and soles weeks later

Alpha toxin (hemolysis),

enterotoxins (food poisoning),

exfoliative/epidermolytic toxin (scalded skin syndrome),

beta toxin - sphingomyelinase,

Gamma toxin – proteins a&B → hemolysin, proteins B&C → leukocidin

Front 334

What are some properties of staph epidermidis?

Back 334

Gamma hemolytic cocci in clusters. Sensitive to novobiocin.

Front 335

How do you treat S. epidermidis?

Back 335

Usually resistant to methicillin. Treat with vancomyin and rifampin or gentamicin

Front 336

What are some properties of staph saprophyticus?

Back 336

Gamma hemolytic, resistant to novobiocin

Front 337

What are some properties of strep pneumo?

Back 337

Alpha hemolytic diplococcus sensitive to optochin.

Front 338

What are step pneumo's virulence factors?

Back 338

Capsule - necessary (acquired by transformation).

Pneumolysin - kills epithelial cells and reduces oxidative burst.

Front 339

Pyruvate carboxylase, required to make glucose out of pyruvate forming substances is increased by what?

Back 339

Acetyl CoA

Front 340

What is the antidote for arsenic poisoning?

Back 340

Dimercaprol (though this is nephrotoxic and can cause hypertension)

Front 341

What is the MOA for selegilline?

Back 341

MAO-B inhibitor used in Parkinsons.

Front 342

What medicine can cause generalized lymphadenopathy without a seum sickness like syndrome?

Back 342

Phenytoin. Also causes acne, hirsuitism, gingival hypertrophy

Front 343

What is recombination?

Back 343

A host cell is coinfected with segmented viruses that exchagnge whole segments.

Front 344

What is phenotypic mixing?

Back 344

A host cell is coinfected by 2 stains, and a virion is made with the genome of one and the capsid of another

Front 345

What occurs in iron poisoning?

Back 345

Cells die due to lipid peroxidation. There are acute GI bleeds and erosions. Chronically, there is metabolic acidosis, scarring, and GI obstruction

Front 346

When do brown pigment stones form in the gallbladder?

Back 346

Infection, which results in the release of beta glucuonidase by injured hepatocytes and bacteria. They increase the amount of unconjugated bilirubin in the bile.

Front 347

How do bases attach to the sugar in DNA?

Back 347

Glycosidic bonds

Front 348

What is mismatch repair used for?

Back 348

Corrects errors in replication. Uses hMSH2 and hMLH, which are mutated in Lynch syndrome.

Front 349

What disease is caused by a defect in nonhomologous end joining?

Back 349

Ataxia telangiectasia (autosomal recessive mutation of ATM)

Front 350

How does ataxia telangiectasia present?

Back 350

Cerebella atrophy and ataxia, blanching telangiectasias, sinopulmonary infections (B&T cells involved, btu mainly IgA), skin discolorations, AVMs, epistaxis, poor smooth pursuit, increased AFP after 8 months, increased risk of hemotologic malignancies

Front 351

What do BRCA 1 and 2 do?

Back 351

Double strand break repair

Front 352

What is wrong in bloom syndrome?

Back 352

Usually due to helicase deficiency leading to genommic instability.

Front 353

Which are the helix-loop-helix, leucine zipper, helix-turn-helix, and zinc finger structural motifs for transcription factors?

Back 353

A. Helix turn helix
E. Zinc finger
G. Leucine zipper
H. Helix loop helix

Front 354

Can a subdural hematoma cross the falx or tentorium?

Back 354

No

Front 355

Can an epidural hematoma cross the falx or tentorium?

Back 355

Yes

Front 356

Why can a lumbar puncture in a subarachnoid hemorrhage be yellow?

Back 356

Bilirubin

Front 357

How do you treat vasospasm due to blood breakdown after a subarachnoid hemorrhage?

Back 357

Nimodipine

Front 358

What is an alternative to aspirin in angina?

Back 358

Clopidogrel - irreversible ADP receptor blocker

Front 359

What neurotransmitter may be involved in narcolepsy?

Back 359

Orexin (hypocretin)

Front 360

What's the treatment for beta blocker overdose?

Back 360

Glucagon

Front 361

What is pergolide?

Back 361

Dopamine agonist

Front 362

What is chlorpromazine?

Back 362

Typical neuroleptic. Can cause corneal deposits.

Front 363

What is fluphenazine?

Back 363

Typical neuroleptic. High potency. EPS common.

Front 364

What is thioridazine?

Back 364

Typical neuroleptic. Strongly muscarinic and alpha blocking. Can cause retinal deposits

Front 365

What is haloperiodol.

Back 365

Typical neuroleptic. High potency. EPS common.

Front 366

What is clozapine?

Back 366

Aypical neuroleptic. Has muscarinic and alpha blocking properties as well as 5HT2, D2c. Causes agranulocytosis, seizures and increased salivation. No risk of tardive dyskinesia

Front 367

What is olanzapine?

Back 367

Aypical neuroleptic. Blocks D2c and 5HT2. Blocks D2c, not A so less EPS risk

Front 368

What is risperidone?

Back 368

Aypical neuroleptic. Blocks D2c and 5HT2.

Front 369

What is apaprazole?

Back 369

Aypical neuroleptic. Partial agonist of dopamine D2 receptors. Also blocks 5HT2

Front 370

Back 370

Front 371

Where does the lateral corticospinal tract go through the thalamus?

Back 371

VA

Front 372

What diseases affect the anterior horn?

Back 372

West nile, polio, ALS (and UMN), Werdnig Hoffman (autosomal recessive)

Front 373

What gene defect is associated with ALS

Back 373

SOD1

Front 374

What is the treatment for ALS?

Back 374

Riluzole (↓ glutamate release)

Front 375

What's the difference versus the anterior and lateral STT?

Back 375

Anterior: crude touch, pressure. Lateral: pain and temperature.

Front 376

What is mutated in Freidrichs ataxia?

Back 376

trinucleotide repeat (GAA) in the gene that endcodes fraxatin, impairing mitochondrial functioning

Front 377

What are the symptoms of Freidrichs ataxia?

Back 377

Ataxia, nystagmus, pes cavus, hammer toes, HOCM (cause of death), kyphoscoliosis.

Front 378

Why is there ptosis in Horner's?

Back 378

Superior tarsal

Front 379

Where does the biceps reflex test?

Back 379

C5

Front 380

Where does the triceps reflex test?

Back 380

C7

Front 381

Where does the patellar reflex test?

Back 381

L4

Front 382

Where does the achilles reflex test?

Back 382

S1

Front 383

Back 383

Front 384

Back 384

Front 385

Back 385

Front 386

What is the Gallant reflex?

Back 386

Stroking one side of the spine with the baby held prone causes lateral flexion of the begs towards the stimulated side

Front 387

What CN is responsible for salviation of the submandibular and sublingual glads, lacrimation, and the stapedius?

Back 387

CN VII

Front 388

What CN is responsible for salivation from the carotid, the carotid body and sinus, and stylopharyngeal?

Back 388

CN IX

Front 389

What CN is responsible for palate elevation, the uvula, and monitoring the aortic chemo and baroreceptors?

Back 389

CN X

Front 390

What are the cranial nerve nuclei of the midbrain?

Back 390

III, IV

Front 391

What are the cranial nerve nuclei of the pons?

Back 391

V, VI, VII, VIII

Front 392

What are the cranial nerve nuclei of the medulla?

Back 392

IX, X, XI, XII

Front 393

What does the dorsal motor nucleus do?

Back 393

Parasympathetics to the heart, lungs, GI

Front 394

What goes through the optic canal?

Back 394

CN II, ophthalmic artery, central rentinal vein

Front 395

Back 395

Front 396

What goes through the superior orbital fissure?

Back 396

CN III, IV, V1, VI, ophthalmic vein, sympathetics

Front 397

What goes through the foramen rotundum?

Back 397

V2

Front 398

What goes through the foramen ovale?

Back 398

V3

Front 399

What goes through the foramen spinosum?

Back 399

MMA

Front 400

What goes through the internal auditory meatus?

Back 400

VII, VIII

Front 401

What goes through the jugular foramen?

Back 401

IX, X, XI, jugular vein

Front 402

What does a CN V motor lesion do?

Back 402

Jaw deviation toward the lesion do the unopposed opposite pterygoid.

Front 403

What are the signs of conductive heading loss?

Back 403

Abnormal Rinne (bone>air), Weber localizes to the affected ear.

Front 404

What are the signs of sensorineural heading loss?

Back 404

Normal Rinne (air>bone), Weber localizes to the unaffected ear.

Front 405

What are the branches of CN VII?

Back 405

To Zanzibar by motor car:
Temporal, zygomatic, buccal, mandibular, cervical

Front 406

Back 406

Front 407

What diseases do you see Bell's palsy in?

Back 407

AIDS, lyme, herpes, sarcoidosis, tumors, diabetes. Bilateral - lyme, Guillain Barre.

Front 408

What goes through the cavernous sinus?

Back 408

III, IV, V1, V2, VI, post ganglionic sympathetics, ICA

Front 409

What conditions are associated with anterior uveitis?

Back 409

HLA B 27 - Reiters, ankylosing spondylitis, sarcoidosis. Iritis is a form.

Front 410

Where is aqueous humor produced?

Back 410

Ciliary epithelium. Under beta adrenergic stimulation.

Front 411

What are some properties of S. viridans (S. mutans, sanguis)

Back 411

Alpha hemolytic, optochin resistant

Front 412

What are some properties of group A strep (S. pyogenes)?

Back 412

Beta hemolytic, bacitracin sensitive, PYR +

Front 413

What are GAS virulence factors?

Back 413

M protein prevents phagocytosis, streptolysin O (oxygen labile), streptolysin S (oxygen stable), erythrogenic, pyrogenic, exotoxin A (TSS-like)

Front 414

What's the rash in scarlet fever called?

Back 414

Erythema marginatum

Front 415

What are some properties of GBS (S. agalactiae)?

Back 415

Beta hemolytic, bacitracin resistant

Front 416

What are some properties of S. bovis?

Back 416

Any hemolysis, PYR+, can hydrolyze esculin (black), do not grow in hypertonic saline, do grow in bile salts. Remember they can cause urinary and biliary infections

Front 417

What are some properties of enterococci?

Back 417

Cocci in chains, can grow in hypertonic saline or bile. Can cause biliary infections, endocarditis after GU procedures.

Front 418

What is the treatment for enterococci?

Back 418

Vancomycin (or penicillin) + aminoglycoside

Front 419

What are some properties of Corynebacterium diphtheriae?

Back 419

Catalase +, club shaped rod. Grows in cysteine tellurite agar – black, iridescent colonies or Loffler’s – cytoplasmic metachromatic granules. Elek test for toxin – metachromatic (blue and red) granules

Front 420

What are some properties of diphtheria toxin?

Back 420

Coded for by a beta prophage. Inhibits protein synthesis by ADP ribosylating EF-2

Front 421

How do you treat diphtheria?

Back 421

Antitoxin, then antibiotics (penicillin, erythromycin), then vaccinate

Front 422

How does diphtheria present?

Back 422

Bluish skin coloration, sore throat, hoarseness, cough, headache, difficulty swallowing, painful swallowing, difficulty breathing, rapid breathing, foul-smelling bloodstained nasal discharge, grey pseudomembranes

Front 423

What are some properties of listeria?

Back 423

Beta hemolytic rod with tumbling motility, V or L formations. Forms actin rockets to move between cells. DOES have LPS. Has a narrow zone of beta hemolysis, multiplies at 4c

Front 424

How do you treat listeria?

Back 424

Ampcillin. Remember it is engulfed by macrophages but can survive intracellularly.

Front 425

What are C. dificile's toxins?

Back 425

Toxin A: enterotoxin. Binds to the brush border of the gut. Neutrophil chemoattractant → inflammation, loss of water, and mucosal death

Toxin B: cytotoxin. Depolymerizes actin → loss of cytoskeleton integrity → cell death. Stimulates fibrin deposition

Front 426

What is C. perfringen's toxin?

Back 426

Produces alpha toxin (lecithinase), a phospholipase. Causes myonecrosis and hemolysis. Remmber it's spores can cause watery diarrhea.

Front 427

What does B. anthracis look like on a plate?

Back 427

“medusa head” colonies in long chains

Front 428

What does B. anthracis's edema factor do?

Back 428

calmodulin dependent adenylate cyclase that causes cAMP ↑. It suppresses neutrophil function and leads to edema (similar to Bordetella pertussis’s extracellular adenylate cyclase)

Front 429

What gram positive is weakly acid fast?

Back 429

N. asteroides. Treat with sulfonamides.

Front 430

How do you treat actinomyces israelli?

Back 430

Penicillin

Front 431

What are the oxidase negative rods that don't ferment lactose?

Back 431

shigella, salmonella, proteus. pseudomonas is oxidase positive

Front 432

What are the fast lactose fermenting rods?

Back 432

Klebsiella, E. coli, enterobacter

Front 433

What are the slow lactose fermenting rods?

Back 433

Citrobacteri, serratia

Front 434

How do you treat H. flu meningitis?

Back 434

Ceftriaxone, prophylaxis with rifampin.

Front 435

What is the Hib vaccine?

Back 435

Vaccine is a polysaccharide conjugated with diphtheria toxin. Other carriers include N. meningitides outer membrane protein complex, tetanus toxoid

Front 436

How do you treat legionella?

Back 436

Fluoroquinolones, newer macrolides.

Front 437

What are some properties of pseudomonas aeruginosa?

Back 437

Aerobic, non lactose fermenting, oxidase positive, encapsulated, catalase positive

Front 438

What is pseudomonas's toxins?

Back 438

Produces exotoxin A – inactivates EF-2 by ribosylation. Also makes collagenase, elastase, fibrinolysin, phospholipase C, DNAse

Front 439

What can cause sepsis with black skin lesions (ecthyma gangrenosum - less edematous than anthrax), malignant otitis externa in diabetics, osteomyelitis from shoes, corneal infections in contact lens wearers.

Back 439

Pseudomonas

Front 440

How do you treat pseudomonas?

Back 440

aminoglycoside + extended spectrum penicillin (e.g. piperacillin, ticaricillin)

Often sensitive to fluroquinolones, cefepime, aztreonam, aminoglycosides, extended spectrum penicllins, polymyxins

Front 441

Describe E. coli EIEC

Back 441

Invasive, causes dysentery. Necrosis and inflammation, similar presentation to shigella. Does not produce toxin

Front 442

Describe E. coli EPEC

Back 442

Causes diarrhea in children. No toxins. Adheres to villi and flattens them, prevents absorption.

Front 443

Describe E. coli EHEC

Back 443

Produces shiga-like toxin (verotoxin – inhibits 60s ribosome). Causes dysentery, HUS. Unlike other strains, does not ferment sorbitol

Front 444

What are some properties of C. jejuni?

Back 444

Comma shaped, oxidase positive, grows at 42 degrees C. Can occur prior to Guillain Barre

Front 445

How do you treat C. jejuni?

Back 445

Erythromycin or fluroquinolones, but self limiting.

Front 446

Describe Vibrio chorerae

Back 446

Comma shaped, oxidase positive, grows in alkaline media. Very acid sensitive → increased risk with PPIs, even with food due to buffering capacity

Front 447

How does Yersenia entercolitica present?

Back 447

Diarrhea. Can cause mesenteric adenitis that looks like Crohns or appenditicits. (via pet feces, milk, pork)

Front 448

What does CN XII not innervate?

Back 448

Palatoglossus

Front 449

What are common etiologies of otitis media?

Back 449

S. pneumo, non Hib H. flu, M. catarrhalis

Front 450

How does Sturge Weber present?

Back 450

Port wine stains, ipsilateral leptomeningeal angioma, pheochromocytoma. Calcification of skull causes tram track appearance on xray. Can cause glaucoma, seizures, hemiparesis, MR. Sporadic, NOT genetic

Front 451

What causes granuloma inguinale

Back 451

Klebsiella granulomatus. Papules that ulcerate can become exophytic, soft painless mass with indurated borders, scarring and stricture. Tropical. Treat with erythromycin.

Front 452

How does tuberous sclerosis pressent?

Back 452

CNS/retinal and skin hamartomas, Subependymal giant cell astrocytoma, Adenoma sebaceum (cutaneous angiofibromas), Mitral regurgitation, Ash leaf spots, Rhabdomyomas, MR, Renal angiomyolipoma, Seizures

Front 453

How does neurofibromatosis I present?

Back 453

• Café au lait spots, inguinal/axillary freckles
• Lisch nodules (pigmented iris hamartomas)
• Neural tumors (meningiomas, etc)
• Cutaneous lesions are skin colored/pink, rubbery, “buttonholing” – looks like goes into the skin with gentle pressure
• Optic nerve glioma
• Skeletal disorders (e.g. scoliosis, sphenoid dysplasia, congential pseudoarthritis)
• Pheochromocytoma

Front 454

What does meningioma look like on histology?

Back 454

Histology shows spindle cells concentrically arranged in a whorled pattern, psammoma bodies

Front 455

What tumor marker is positive in a schwannoma?

Back 455

S-100

Front 456

What is diphenoxylate?

Back 456

Opioid analgesic, used for diarrhea

Front 457

What are the short acting benzodiazepines?

Back 457

triazolam, oxazepam, midazolam

Front 458

What is treatment for H. pylori?

Back 458

o PPI, clarithromycin, amoxicillin or metronidazole
o Or bismuth, metronidazole, tetracycline, PPI

Front 459

What are some P. mirabilis characteristics?

Back 459

Oxidase negative, nonlactose fermenting, catalase +, nitrase +, makes urease. Characteristic swarming pattern; motile

Front 460

What can cause bacillary angiomatosis?

Back 460

Bartonella (cat-scratch)

Front 461

How is brucella transmitted?

Back 461

Unpasteurized dairy, animals (undulant fever)

Front 462

What causes yaws?

Back 462

T. pertenue. Causes keloids, nasal/cartilage destruction

Front 463

What causes condyloma lata?

Back 463

Syphilis

Front 464

How does leptospirosis present?

Back 464

A question marked shape spirochete. Causes flu-like illness, jaundice, photophobia, abdominal pain. Can also cause Weil's disease - azotemia, jaundice, hemorrhage, anemia.

Front 465

What do you call the rash in lyme disease?

Back 465

Erythema chronicum migrans

Front 466

How do you treat borrelia?

Back 466

Doxycycline, ceftriaxone for later stages

Front 467

What are TB's virulence factors?

Back 467

• Sulfatides – allow for intracellular proliferation (by preventing lysosome fusion)
• Cord factor – blocks macrophage activation by IFN gamma, induces TNF alpha secretion. It blocks neutrophils and damages mitochondria. In vitro, it allows cord formation. It is the main drug resistance factor. It is a mycoside – 2 mycolic acids bound to the disaccharide trehalose.

Front 468

What are cold agglutinins seen in?

Back 468

M. pneumoniae, EBV, hematologic malignancies

Front 469

How do you treat M. pneumoniae?

Back 469

Tetracycline, erythromycine, azithromycin

Front 470

How does coxiella burnetti present?

Back 470

Interstitial pneumonia

Front 471

What is a Weil-Felix reaction?

Back 471

o Serum mixed with Proteus antigens; antirickettsial antibodies react with O antigen and agglutinate

Front 472

How does lymphogranuloma venerum prestent (C. trachomatis L1, L2, L3)

Back 472

Acute lymphadenitis, primary ulcers, rectal disease mimicking IBD, papule → several draining ulcers weeks later, red eyes, inclusion bodies and granulomatous inflammation with stellate abscesses. Can cause anogenital fibrosis

Front 473

How does legionella pneumonia cause?

Back 473

High fever, reltive bradycardia, headache, confusion, watery diarrhea, hyponatremia - specific. Unlike other atypical pneumonias CXR shows unilobar infiltration → consolidation

Front 474

Where do you find histoplasma?

Back 474

Midwest. Associated with bird and bat droppings

Front 475

What does histoplasma look like on a smear?

Back 475

Dimorphic. Macrophages filled with it, where it multiples. Culture shows hyphae

Front 476

How does disseminated histoplasmosis present?

Back 476

Hepatosplenomegaly, tongue ulcers, diffuse pulmonary infiltrate, hilar lymphadenopathy

Front 477

Where do you find bastomyces?

Back 477

Eastern US. Found in the soil, mold form predominates (transmitted through aerosols)

Front 478

Where does alpha 1 act?

Back 478

Gq. Arterioles (increases diastolic BP), veins (increases systolic BP), vas defrens, liver (glycogenolysis), decreases renin release from the kidney

Front 479

What tissues does alpha 2 act on?

Back 479

Pancreas (decreases insulin secretion), platelets (promotes aggregation)

Front 480

What does beta 1 act on?

Back 480

Heart (SA, AV, atria, ventricles), kidneys (increase renin release - usually more sensitive than alpha receptors)

Front 481

What does beta 2 act on?

Back 481

Mostly not innervated, so less effect from norepinephrine.
Blood vessels (vasodilation, more sensitive than alpha 1). Relaxes uterus, bronchioles. Increases glycogenolysis in muscles. Liver (increases gluconeogenesis, glycogenosysis), increases insulin secretion (beta is more sensitive).

Front 482

What do D1 receptors do?

Back 482

Increase RBP and GFR, dilates coronaries. At higher doses, it acts more like norepinephrine, so you add adrenergic actions.

Front 483

What is fenoldopam?

Back 483

D1 partial agonist, used as an antihypertensive (can be used in hypertensive crisis)

Relaxes renal vascular smooth muscle, also mesenteric anc coronary beds. Increases sodium and water excretion

Front 484

ow do you treat endometritis?

Back 484

cefoxitin, ticarcillin-clavulanate, ampicillin-sulbactam

Front 485

How does disseminated blastomycosis present?

Back 485

Papules, pustules, ulcer, verrucous lesions, bone pain (lytic lesions), granulomatous nodules (cauliflower lesion). Remember it is dimorphic.

Front 486

How does coccidiodes present?

Back 486

Causes pneumonia (acute is most common, can be chronic progressive), pulmonary nodules/cavities, extrapulmonary disease and meningitis that can disseminate to bone and skin (erythema nodosum). Can cause a thin walled cavity in the lung leading to hemoptysis

Front 487

How does paracoccidiodes present?

Back 487

Granulomas in the mucus membranes and skin.

Front 488

How does paracoccidiodes look microscopically?

Back 488

Buds with captains wheel formation. Large

Front 489

How does malassezia furfur cause tinea versicolor?

Back 489

Degrades lipids that produce acids → damage melanocytes

Hyper/hypopigmented patches, usually on trunk, begin as nonpruritic macules → scaling plaque

Front 490

What does M. furfur look like on KOH?

Back 490

Spaghetti and meatballs

Front 491

Are dermatophytes dimorphic?

Back 491

No, just mold form. Treat with turbenafine or azoles

Front 492

How do you treat systemic candidiasis?

Back 492

Fluconazole, caspofungin, or amphoterecin B

Front 493

How does aflatoxin cause HCC?

Back 493

G to T mutation in p53. Remember aspergillus is a mold only

Front 494

What does N. neoformans look like on a slide?

Back 494

Yeast form only, round or oval encapsulated cells with narrow based buds, wide capsular halos and unequal budding

Front 495

How do you treat cryptococcus?

Back 495

Amphoterecin B and flucytosine, prophylaxis with fluconazole

Front 496

What mold (no yeast form) is related to increased susceptibility with iron overload, especially with deferoxamine?

Back 496

Mucor and rhizopus

Front 497

What do mucor and rhizopus look like?

Back 497

irregular, broad, nonseptate hyphae branching at wide angles

Front 498

What does pneumocystis look like?

Back 498

disk shaped yeasts (no mold form) on methenamine silver stain

Front 499

How do you treat sporothrix?

Back 499

itraconazole or potassium iodide

Front 500

What does sporothrix look like?

Back 500

Cigar shaped budding yeast (dimorphic)
Histology shows a granuloma made of histiocytes, giant cells, neutrophils, surrounded by plasma cells.

Front 501

How do you treat enamoeba histolytica?

Back 501

metronidazole or tinidazole, followed by iodoquinol to eliminate cysts

Front 502

How do you diagnose cryptosporidium?

Back 502

Cysts on acid fast stain. Resistant to chlorination

Front 503

How do you treat T. gondii?

Back 503

sulfadiazine + pyrimethamine and folinic acid

Front 504

What does congenital toxoplasmosis look like?

Back 504

o Hydrocephalus
o Intracranial calcification
o Chorioretinitis – white/yellow scars on retina
o Hepatosplenomegaly, rash, seizures, altered muscle tone, ocular movement defects

Front 505

What disease does Naegleria fowleri cause?

Back 505

Rapidly fatal meningoencephalitis, from freshwater

Front 506

How do you treat T. brucei?

Back 506

Suramin if early, melarsoprol if CNS involvement

Front 507

How do you treat T. cruzi?

Back 507

Nifurtimox

Front 508

What does babesia present like?

Back 508

Fever, hemolytic anemia, worse if asplenic (remember it is transmitted by the ixodes tick so common in eastern US)

Front 509

What does babesia look like on a smear?

Back 509

maltese cross (merozoite) and ring form (trophozoite - looks like P. falciparum) in RBCs

Front 510

How do you treat babesia?

Back 510

Quinine, clindamyclin

Front 511

How do you treat Leishmania?

Back 511

cutaneous with stibogluconate, visceral with liposomal amphoterecin B

Front 512

How does visceral Leishmanias presents (kala-azar)?

Back 512

spiking fever, hepatosplenomegaly, pancytopenia

Front 513

What are the nematodes (roundworms?

Back 513

Enterobius vermicularis, ascaris lumbricoides, trichenella spiralis, strongyloides steroralis, ancytlostoma duodenale, necator americanus, dracunculus medinesis, onchocerca voluvus, loa loa, wuchereria bancrofti, toxocara canis - most are treated with bendazoles, some with pyrantel pamoate, a couple with niridazole or diethylcarbamazine

Front 514

How does trichenella spiralis present?

Back 514

A nematode, found in undercooked meat. Causes muscle inflammation, periorbital edema, fever.

Front 515

What are the hookworms?

Back 515

A nematode. Ancyclostoma duodenale, necator americanus. Sucks blood from the inestinal walls and causes anemia. Burrows into the skin

Front 516

How is drancunculus medinensis spread?

Back 516

A nematode. Spread through drinking water. Causes skin inflammation and ulceration. Treat with niridazole

Front 517

How does onchocera volvulus present?

Back 517

A nematode. Hyperpigmented skin, river blindless. Can cause an allergic reaction. Transmitted by female blackflies. Treat with ivermectin.

Front 518

What is loa loa?

Back 518

A nematode. Spread by flies. Causes swelling in the skin, worms can be seen in the conjunctiva. Treat with diethylcarbamazine.

Front 519

What does wuchereria bancrofti cause?

Back 519

A nematode. Elephantiasis. Spread by mosquitos. Treat with diethylcarbamazine.

Front 520

How does toxocara canis infection present?

Back 520

granulomas, if in retina, can cause blindness. Visceral larva migrans (skin disease). Treat with diethyl carbamazine

Front 521

How do you treat T. solium?

Back 521

Praziquantel and dexamethasone (dying larvae can cause an immune response. Treat cystercercosis with bendazoles.

Front 522

How does Echinococcus granulosus present?

Back 522

A cestode (tapeworm). Eggs in dog feces are ingested → hydatid cysts in liver. They are encapsulated with eggshell calcification, fluid, budding cells.
Treat with albendazole

Front 523

What can Schistosoma mansoni cause?

Back 523

A trematode (fluke). Spleen and liver inflammation → portal hypertension and splenmegaly. Can also cause swimmer's itching with granulomas

Front 524

What can Schistosoma hamatobium cause?

Back 524

Squamous cell carcinoma of the bladder. Treat schistosoma with praziquantel

Front 525

What is clonorchis sinensis associated with?

Back 525

Cholangiocarcinoma, causes biliary tract inflammation and pigmented gallstones. Treat infection with praziquantel or albendazole

Front 526

How does paragonimus westermani present?

Back 526

A trematode. From cooking undercooked crab. Causes inflammation of the lung, secondary bacterial infection, hemoptysis.

Front 527

What microbes have IgA protease?

Back 527

S. pnuemo, Hib, Neisseria, all of which cause meningitis

Front 528

What bacteria have type III secretion systems?

Back 528

E. coli, Salmonella, Yersinia, P. aeruginosa, Chlamydia

Front 529

What are some exotoxins inhibiting protein synthesis?

Back 529

C. diphtheriae – diphtheria toxin
o Inactivates elongation factor EF-2

P. aeruginosa – exotoxin A
Inactivates elongation factor EF-2

Shigella – shiga toxin
Inactivates 60s ribosome by cleaving rRNA

EHEC – shiga-like toxin
Inactivates 60s ribosome by cleaving rRNA

Front 530

How does diphteria toxin work?

Back 530

Inactivates EF-2, was transferred via a lysogenic phage

Front 531

How does Pseudomona's exotoxin A work?

Back 531

Elongates EF-2

Front 532

How does shiga toxin work?

Back 532

Inactivates 60s ribosome by cleaving rRNA

Front 533

How does shiga-like toxin work?

Back 533

In EHEC, but does not invade. Inactivates 60s ribosome by cleaving rRNA

Front 534

How does ETEC heat labile toxin work?

Back 534

Overactivates adenylate cyclase and increases Cl secretion

Front 535

What endotoxins increase fluid secretion?

Back 535

ETEC
o Heat labile toxin – overactivates adenylate cycline → ↑ Cl- secretion
o Heat stabile toxin – overactivates guanylate cyclase → ↓ NaCl reabsorption

Yersenia entercolitica – heat stable toxin
o Overactivates guanylate cyclase → ↓ NaCl reabsorption.

Bacillus anthracis – edema factor
o Mimics adenylate cyclase to ↑ camp.

Vibrio cholerae – cholera toxin
o Permanently activates Gs

Front 536

How does ETEC heat stabile toxin work?

Back 536

Overactivates guanylate cycles to decrease NaCl reabsorption

Front 537

How does yersenia entercolitica heat stable toxin work?

Back 537

Like ETEC's - overactivates guanylate cyclase

Front 538

How does B. anthracis edema factor work?

Back 538

Mimics adenylate cycline

Front 539

How does cholera toxin work?

Back 539

Permanently activates Gs

Front 540

What are pertussis's toxins?

Back 540

o Pertussis toxin - disables Gi to overactivate adenylate cyclase
o Adenylate cyclase toxin ↓ leukocyte chemotaxis
o Tracheal cyctotoxin kills epithelial cells

Front 541

What S. pyogenes toxin causes shock?

Back 541

Exotoxin A

Front 542

How does C. perfringens alpha toxin work?

Back 542

A phospholipase that degrades tissue and cell membranes

Front 543

How does streptolysin O work?

Back 543

Degrades cell membranes, lyses RBCs, oxygen labile

Front 544

What microbes need cysteine to culture?

Back 544

Francisella, brucella, legionella, pasteurella

Front 545

What do you culture N. gonorrhoeae on?

Back 545

Thayer martin (VPN) - vancomycin, polymyxin, nystatin

Front 546

What do you culture D. diphtheriae on?

Back 546

Tellurite, Lofflers

Front 547

What do you stain with Giemsa?

Back 547

Borrelia, plasmodium, trypanosomes, chlamydia

Front 548

What do you use a silver stain for?

Back 548

Fungi, legionella

Front 549

What toxins are associated with lysogenic phages?

Back 549

Shiga-like toxin, botulinum toxin, cholera toxin, diphtheria toxin, erythrogenic toxin (S. pyogenes)

Front 550

What are the naked viruses?

Back 550

Mnemonic: naked CPR (RNA) and PAPP (DNA, including HPV) smears
• Calcivirus, picornavirus, reovirus, hepevirus
• Parvovirus, adenovirus, papillomavirus, polyomavirus

Front 551

What virus's envelope is from the nuclear membrane?

Back 551

Herpes

Front 552

What viruses naked genomes are infective?

Back 552

Naked genome of dsDNA (except pox and HBV) and + ssRNA are infectious

Front 553

What are the nonlinear DNA viruses?

Back 553

All are linear except papilloma, polyoma (circular) and hepadna (partially circular)

Front 554

What DNA virus does not re[licate in the nucleus?

Back 554

Poxvirus, also the only nonicosahedral

Front 555

What are the DNA viruses?

Back 555

hepadna, herpes, adeno, pox, parvo, papilloma, polyoma

Front 556

What are complications of VZV?

Back 556

ENcephalitis, giant cell pneumonia

Front 557

How can reactivation CMV present?

Back 557

Interstitial pneumonitis, retinitis (full thickness necrosis and edema), hepatitis, colitis. Treat with ganciclovir, foscarnet, or cidofovir.

Front 558

How do you treat kaposi sarcoma?

Back 558

allotretinoin, vinblastin, danorubicin

Front 559

What order do HBV antigens present in?

Back 559

SECES. Remember HBV has reverse transcriptase

Front 560

What HBV serologic marker is present in the window phase?

Back 560

Anti-HBcAg IgM

Front 561

How does adenovirus infection present?

Back 561

• Hemorrhagic cystitis, especially in males and children; resolves spontaneously
• Pharyngoconjunctival fever - low grade fever, throat pain, red eyes, cervical lymphadenopathy– self limited.
• Pneumonia
• Conjunctivitis – watery pink eye

Front 562

What is parvovirus's genome?

Back 562

Unenveloped linear negative sense DNA

Front 563

What is molluscum contagiosum caused by?

Back 563

Poxvirus

Front 564

What is the only dsRNA virus?

Back 564

Reoviruses (reovirus, rotavirus)

Front 565

What kind of virus is HBV?

Back 565

Hepadnavirus

Front 566

What are the positive stranded RNA viruses?

Back 566

Retro, toga, flavi, corona, hepe, calci, picorna

Front 567

What are the segmented RNA viruses?

Back 567

Bunya, orthomyxo, arena, reo (BOAR)

Front 568

What RNA viruses don't replicate in the cytoplasma?

Back 568

Influenza, retroviruses

Front 569

What are RNA viruses that start with an H, A or P?

Back 569

hepevirus, picornavirus, paramyxovirus, arenavirus

Front 570

What are some reoviruses?

Back 570

Icosahedral DS linear RNA.

Coltivirus - colorado tick fever (self limited)
Rotavirus - URI, then diarrhea, especially in the winter. Villous atrophy decreases Na absorption.

Front 571

What are some picornaviruses?

Back 571

Icosahedral + linear RNA

Poliovirus, echovirus, rhinovirus, coxsackievirus, HAV. Enteroviruses are the most common cause of asceptic meningitis

Front 572

How does echovirus present?

Back 572

Picornavirus. Asceptic meningitis, myocarditis, and URI in the summer

Front 573

What does coxsackie virus cause?

Back 573

Picornavirus. Asceptic meningitis, herpangina (febrile pharyngitis, sores in mouth, odynophagia), hand-foot-mouth (vesicles, papules), myocarditis

Front 574

What do you do for hepatitis A prophylaxis?

Back 574

Picornavirus. Give Ig

Front 575

What is a hepevirus?

Back 575

HEV. Icosahedral + linear RNA

Front 576

What are some symptoms for yellow fever?

Back 576

Flavivirus: icosahedral + linear RNA.
Causes jaundice, black vomitus, bleeding, increased LFTs, flaccid paralysis

Front 577

What are some togaviruses?

Back 577

Icosahedral + linear RNA.

Rubella (German measles), equine encephalitis (arbovirus)

Front 578

How does rubella present?

Back 578

Toga virus.
Post auricular tenderness, rash with face first.
Congenital rubella causes PDA, pulmonic stenosis (pulmonary artery hypoplasia), cataracts, sensorineural deafness, blueberry muffin rash, microcephaly

Front 579

What gene is HIV's gp120, gp41 from? What do they do?

Back 579

env. gp120 mediates host cell attachment via CD4, gp41 mediates fusion and entry.

Front 580

What gene encodes HIV's capsid protein?

Back 580

gag (p24)

Front 581

What gene encodes HIV's reverse transcriptase?

Back 581

pol

Front 582

What diseases do you start to see at a CD4 count of <100

Back 582

Toxoplasmosis, histoplasma

Front 583

What do you start seeing at a CD4 of under 200?

Back 583

PCP pneumonia, cryptosporidium, JC virus reactivation

Front 584

What do you start seeing at a CD4 of under 50?

Back 584

CMV (retinitis, etc), cryptococcus, MAC

Front 585

What are some properties of coronavirus?

Back 585

Helical, + sense linear RNA

Front 586

What are some properties of orthomyxoviruses (flu)?

Back 586

Helical, + linear RNA

Front 587

What are some paroxymyxoviruses?

Back 587

Helical - linear RNA.
Rubeola (only one with a rash), mumps, parainfluenza virus, RSV

Front 588

How does rubeola present?

Back 588

paroxymyxovirus. Cough, coryza, conjunctivitis, Koplic spots, rash (eventually involves hands and feet unlike rubella)

Front 589

How does the mumps present?

Back 589

paroxymyxovirus. Parotitis, orchitis, asceptic meningitis

Front 590

What are some filoviruses?

Back 590

Helical - linear RNA.
Ebola, marburg

Front 591

What are some arenaviruses?

Back 591

Helical - circular RNA with 2 segments.
Lymphocytic choriomeningitis and Lassa fever

Front 592

What are some bunyaviruses?

Back 592

Helical - circular RNA with 3 segments. California encephalitis, sandfly/rift valley fever, crimean-congo hemorrhagic fever (all arboviruses, and hantavirus

Front 593

What is a deltavirus?

Back 593

Helical - circular RNA. Hepatitis D virus. is double shelled. Requires HBsAg as an envelope.

Front 594

What is an inherited prion disease?

Back 594

Gerstmann-Straussler-Scheinker syndrome

Front 595

What 3 bacteria most commonly mimic appendicitis?

Back 595

Y. entercolitica, C. jejuni, slamonella

Front 596

What bugs cause bloody diarrhea?

Back 596

campylobacter, salmonella, shigella, EHEC, EIEC, Y. entercolitica, E. histolytica

Front 597

What commonly causes pneumonia COPD patients?

Back 597

H. flu

Front 598

How does congenital CMV present?

Back 598

Hearing loss, seizures, peticheal rash, blueberry muffin rash

Front 599

How do you prophylax meningococcus?

Back 599

Ciprofloxacin, rifampin, minocycline, or ceftriaxone

Front 600

What antibiotics should you avoid in pregnancy?

Back 600

clarythromycin, sulfonamides (kernicterus), aminoglycosides, fluoroquinolones, metronidazole in the first trimester, tetracycline, ribavirin, griseofulvin, chloramphenicol

Front 601

What are the clinical uses of penicillins?

Back 601

Gram positives (GBS, S. pyogenes, S. pneumo, actinomyces), Syphilis; Can be used for clostridum, listeria, bacillis, neisseria.

Penicillin can cause hemolytic anemia

Front 602

What are the resistance mechanisms for beta lactams?

Back 602

Beta lactamase, PBP changes, changes in porin structure

Front 603

What are the methicillin, oxacillin, nafcillin, and dicloxacillin?

Back 603

Beta lactamase resistance penicillines

Methichillin causes interstitial nephritis.

Front 604

What is the spectrum of aminopenicllins?

Back 604

Wider spectrum than penicillin – H. flu, E. coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, Shigella, enterococci, borrelia. Can be used for neonatal infections + aminoglycosides and UTIs

Front 605

What are the carboxypenicillins? What are they used for?

Back 605

Ticarcillin, carbenicillin, piperacillin. Pseudomonas, gram negative rods, anaerobes

Front 606

What do you use first generation cephalosporins for?

Back 606

UTI, URI, viridans strep endocarditis

Front 607

What can aztreonam be used for?

Back 607

Only gram negative rods, no anaerobes. Good for renal insufficiency, allergy. Beta lactamase resistant

Front 608

What does cilastatin inhibit?

Back 608

Renal dihydropeptidase I which inactivates imipenem. Carbapenums are not useful for MRSA

Front 609

What is tobramycin?

Back 609

Aminoglycoside

Front 610

What is neomycin?

Back 610

Aminoglycoside

Front 611

What is the MOA of aminoglycosides

Back 611

Inhibits the formation of the initiation complex, causing mRNA misreading - therefore, the only bactericidal protein synthesis inhibitor. Needs O2 for uptake.

Front 612

What are some mechanisms of resistance to aminoglycosides?

Back 612

Transferase enzymes inactivate the drug by acetylation, phosphorylation, adenylation

Front 613

What are the side effects of aminoglycosides?

Back 613

Nephrotoxic (especially with cephalosporin), ototoxic (especially with a loop), congenital deafness

Front 614

What is minocycline?

Back 614

A tetracycline. Prolonged use can cause blue skin pigmentation

Front 615

What can tetracyclines be used for?

Back 615

Borrelia burgdorferi, M. pneumoniae, Rickettsia, Chlamydia (accumulates intracellularly). Also, V. cholera, ureaplasma, tularemia, H. pylori

Front 616

What is the MOA for tetracyclines?

Back 616

Binds to 30S subunit and prevents the attachment of aminoacyl tRNA. Ok in renal failure

Front 617

What is the MOA of chloramphenicol?

Back 617

Blocks peptide bond formation at 50S subunit. Resistance is due to acetyltransferase activation

Front 618

What are the streptogramins?

Back 618

Quinupristin, dalfoprisitin

Front 619

What is the MOA for streptogramins?

Back 619

Streptogramin A – binds peptidyl transferase of 50s (like chloramphenicol)

Streptogramin B – prevents protein chain extension

Front 620

What can streptogramins be used for?

Back 620

MRSA, VRE, Staph and Strep skin infections

Can be hepatotoxic

Front 621

What is the MOA for clindamycin (a lincosamide)?

Back 621

Blocks peptide bond formation at 50s. Is effective against MRSA

Front 622

What is clarithromycin?

Back 622

A macrolide

Front 623

What is the MOA for macrolides?

Back 623

Inhibits protein synthesis by blocking translocation (macroslides). Binds 23s rRNA of the 50S subunit like linezolid.

Front 624

What are macrolides used for?

Back 624

Atypical pneumonias, URIs, STDs, gram positive cocci (Step in penicillin allergies), Neisseria

Front 625

What are resistance mechanisms to macrolides?

Back 625

Inactivation by enzymes modifying the drug (phosphorylation, adenylation, acetylation, etc). Pseudomonas ↓ entry. Methylation of 23s rRNA binding site.

Front 626

What are the side effects of macrolides?

Back 626

Prolonged QT (especially erythromycin), GI discomfort, eosinophilia, skin rashes.

Erythromycin – acute cholestatic hepatitis

Front 627

What is the MOA of linezolid?

Back 627

Binds 23s rRNA of the 50s subunit, interacts with bacterial initiation complex

Front 628

What is the clinical use of linezolid?

Back 628

VRE, MRSA

Front 629

What is the MOA of sulfonamides.

Back 629

PABA antimetabolite - inhibits dihydropteroate synthesis

Front 630

What are sulfonamides used for?

Back 630

Gram positives, gram negatives, nocardia, chlamydia

Front 631

What are the side effects of sulfonamides?

Back 631

Nephrotoxicity (tubulointerstitial nephritis), photosensitivity

Displaces other drugs from albumin → kernicterus if used during pregnancy (displaces billi), ↑ toxicity (e.g. warfarin)

Front 632

What is the MOA of trimethoprim?

Back 632

Inhibits dihydrofolate reductase? (like methotrexate)

Front 633

What are the uses for trimethoprim?

Back 633

UTIs, Shigella, Salmonella, MRSA skin infection

Front 634

What is enoxacin?

Back 634

A fluoroquinolone. Nalidixic acid is a quinolon.

Front 635

What is the MOA for fluoroquinolones?

Back 635

Inhibits DNA gyrase (topoisomerase II) - bactericidal

Front 636

What is the clinical use of fluoroquinolones?

Back 636

Gram negative rods - urinary and GI, pseudomonas, Neisseria, some gram positives (S. pneumo for later generations)

Antacids inhibit absorption

Front 637

What is the MOA of metronidazole?

Back 637

Form free radical toxic metabolites. Bactericidal

Front 638

What is the MOA of nitrofurantoin?

Back 638

Reduced to reactive metabolite by bacteria that inactivates the ribosome. Bactericidal. Not useful for proteus.

Front 639

How can M. avium be treated?

Back 639

azithromycin, rifampin, ethambuton, streptomycin

Front 640

How can M. leprae be treated?

Back 640

dapsone, rifampin, clofazimine

Front 641

What is the MOA for isoniazid?

Back 641

Inhibits mycolic acid synthesis. A prodrug that must be converted by catalase peroxidase. Resistance can be due to KatG mutation, target mutation

Acetylated hepatically then excreted in the urine.

Front 642

What are the side effects of isoniazid?

Back 642

o Hepatitis – initial ↑ LFTs, fever, anorexia, nausea → jaundice, ↑ bilirubin
o SLE in slow acetylators (can prevent with B6)
o ↓B6 → sideroblastic anemia (microcytic – ↑ iron, ↑ % sat, ↑ ferritin, ↓ TIBC), peripheral neuropathy

Front 643

What is a side effect of rifampin?

Back 643

Hepatitis

Front 644

What is the MOA of ethambutol?

Back 644

Blocks carbohydrate polymerization of cell walls by blocking arabinogalactan

Front 645

What are the side effects of pyrazinamide?

Back 645

Hepatitis, hyperuricemia

Front 646

What are the side effects of amphoterecin B?

Back 646

Renal toxicity → hypokalemia, hypomagnesia due to ↑ distal tubule membrane permeability.
Fever, chills, hypotension, arrythmias, anemia, phlebitis

Front 647

What is the MOA of pyrazinamide?

Back 647

Blocks pyrazinamidase → inhibits mycolic acid production. Good in the acidic phagolysosome

Front 648

What is the MOA of flucytosine?

Back 648

Antifungal that converts to 5FU by cytosine deaminase. Good for systemic infections + amphoterecin

Front 649

What are the clincial uses of azoles?

Back 649

o Fluconazole – crosses blood brain barrier → cryptococcal meningitis. Candida
o Ketoconazole – blastomyces, coccidioides, histoplasma, candida, hypercortisolism
o Itraconazole – first line for dimorphic fungi (e.g. sporothrix)
o Voriconazole – good for aspergillus
o Posaconazole – good for refractory infections, like mucor (class can generally be used for mucor)
o Clotrimazol, miconazole – topical

Front 650

What are the side effects of azoles?

Back 650

Decreased hormone synthesis, liver dysfunction, fever, chills

Front 651

What are the side effects of flucytosine?

Back 651

GI, bone marrow suppression

Front 652

What is the MOA of caspofungins?

Back 652

Inhibits cell wall synthesis (not membrane like ergosterol) by inhibiting beta glucan synthesis. This causes lysis.

Front 653

What are mycofungin and anidulafungin?

Back 653

Caspofungins

Front 654

What are caspofungins used for?

Back 654

Invasive aspergilosis, candida

Front 655

What are the side effects of caspofungins?

Back 655

Flushing, GI

Front 656

What is the MOA of terbinafine?

Back 656

Inhibits squalene epoxidase, and thus ergosterol synthesis

Front 657

What is terbinafine used for?

Back 657

Dermatophytes

Front 658

What are the side effects of terbinafine?

Back 658

Abnormal LFTs, visual disturbances

Front 659

What is the MOA of griseofulvin

Back 659

Inhibits microtubule function. Used for dermatophytes because it deposits in keratin containing tissure. Induces P450

Front 660

What do you treat with pyrimethamine?

Back 660

Toxo and P. faciparum

Front 661

What is the MOA of chloroquine?

Back 661

Blocks plasmodium heme polymerase.

Front 662

What are the side effects of chloroquine?

Back 662

Retinopathy, cinchonism (vision changes, GI distress) due to alpha/muscarinic antagonism, bad in G6PD deficiency

Front 663

What is the MOA of mebendazole?

Back 663

↓ glucose uptake, microtubular structure

Front 664

What is the MOA of pyrantel pamoate?

Back 664

Nicotinic receptor antagonist – causes contraction, then spastic paralysis → worm falls off

Front 665

What is the MOA of praziquantel?

Back 665

For cestodes and trematodes. ↑ Calcium influx, vacuolization → spasm

Front 666

What is the MOA of amantadine?

Back 666

Blocks penetration/uncoating (M2 protein – commonly mutated). Causes dopamine release (rimantidine does not cross the BBB).

Front 667

What is the MOA of ribavirin?

Back 667

Inhibits guanine nucleotide synthesis by competitive inhibition of IMP dehydrogenase.
Can cause hemolytic anemia

Front 668

What is the MOA of acyclovir?

Back 668

o A guanosine analog → causes chain termination
Must be converted to acyclovir monophosphate using thymidine kinase (rate limiting) → active triphosphate form.

Can also be used in VZV, but famclovir is better.

Front 669

What are the side effects of acyclovir?

Back 669

renal toxicity (crystal nephropathy), neurotoxicity (delerium, tremor)

Front 670

What are the side effects of ganciclovir?

Back 670

Neutropenia (do not use with HIV), lekopenia, thrombocytopenia → bone marrow suppression. Renal toxicity

Front 671

What is the MOA of foscarnet?

Back 671

A pyrophosphate analog → directly inhibits DNA polymerase. Does not requires thymidine kinase activation. Will inhibit reverse transcriptase in HIV.

Front 672

What are the side effects of foscarnet?

Back 672

Nephrotoxicity (can cause Mg wasting), hypocalcemia (chelates calcium), hypokalemia, anemia

Front 673

What is the MOA of cidofovir?

Back 673

An antiviral used for refractory CMV/HSV. Inhibits DNA polymerase like foscarnet.

Is nephrotoxic. Give with probenecid.

Front 674

What are the protease inhibitors?

Back 674

indinavir, lopinavir, atazanavir, darunavir, fosamprenavir, saquininavir, ritonavir

Front 675

What is the MOA of protease inhibitors?

Back 675

Inhibits HIV-1 protease from the pol gene. Not used as monotherapy?

Front 676

What are the side effects of protease inhibitors?

Back 676

Lipodystrophy, hyperglycemia, P450 inhibition, hypertriglyceridemia, GI upset

Front 677

What are the side effects of indavir?

Back 677

nephrotoxicity and nephrolithiasis

Front 678

What are the side effects of ritonavir?

Back 678

rare pancreatitis. Inhibits P450 → can be used to ↑ other drug concentrations

Front 679

What are the side effects of atazanavir?

Back 679

nephrolithiasis, ↑ billirubin

Front 680

What are the NRTI HIV drugs?

Back 680

Tenofovir, emtricitabine, abacavir, lamivudine, zidovudine, didanosine, stavudine, zalcitabine

Front 681

What is tenofovir?

Back 681

NRTI HIV drug

Front 682

What is abacavir?

Back 682

NRTI HIV drug

Front 683

What is emtricitabine?

Back 683

NRTI HIV drug

Front 684

What is didanosine?

Back 684

NRTI HIV drug

Front 685

What is zalcitabine?

Back 685

NRTI HIV drug

Front 686

What is the MOA of NRTI HIV drugs?

Back 686

Competitive inhibitory of nucleotide binding to reverse transcriptase. Must be phosphorylated by a thymidine kinase

Front 687

What are the side effects of NRTI HIV drug?

Back 687

VERY common bone marrow toxicity, use G-CSF or EPO. Peripheral neuropathy, lactic acidosis (except abacavir), rash

Front 688

What are the side effects of abacavir?

Back 688

NRTI HIV drug. Causes hypersensitivity, but no lactic acidosis

Front 689

What are the side effects of didanosine and stavudine?

Back 689

NRTI HIV drugs. Pancreatitis, peripheral neuropathy, hepatic steatosis/increased LFTs

Front 690

What are the side effects of zalcitabine?

Back 690

NRTI HIV drug. Pancreatitis, peripheral neuropathy.

Front 691

What are the NNRTI HIV drugs?

Back 691

Nevirapine, efavirenz, delviridine. They do not need to be phosphorylated.

Front 692

What is nevirapine?

Back 692

NNRTI HIV drug

Front 693

What is delavirdine?

Back 693

NNRTI HIV drug

Front 694

What are the side effects of NNRTI HIV drug?

Back 694

Like NRTIs. Can cause hepatic failure with encephalopathy in the first 6 weeks, Stevens Johnsons

Front 695

What are the side effects of efavirenz?

Back 695

Nightmares, dizziness, depression, false positive marijuana test, teratogen

Front 696

What is raltegravir?

Back 696

Reversible integrase inhibitor?

Front 697

What are the side effects of raltegravir?

Back 697

Hypercholesteorelmia, lipodystrophy

Front 698

What is enfurvitide?

Back 698

Binds gp41, and inhibits fusion. Used for refractory treatment. Increases risk of bacterial pneumonia, causes nodules at injection site.

Front 699

What is maraviroc?

Back 699

A CCR5 antagonist, inhibits gp120 conformation change. Not used in dual tropism

Front 700

What increases NK cell activity?

Back 700

W↑ activity with IL-12, IFN B and IFN A. Secretes IFN gamma → macrophage activation

Front 701

What cytokines do TH1 cells make?

Back 701

IL-2, IFN gamma. Inhibited by IL-10

Front 702

What cytokines do TH2 cells make?

Back 702

IL-4, IL-5. Inhibited by IFN gamma.

Front 703

What is the second signal for B cell activation?

Back 703

IL-2, IL-5, IL-6 from TH2 cell

Front 704

What cytokines do T-regs produce?

Back 704

IL-10, TGF beta

Front 705

What are the steps of leukocyte extravasation?

Back 705

↑ by PAF

Rolling (E-selectin, Sialyl LewisX; L-selectins)

Tight binding (ICAM-1, LFA-1 -integrin; abnormal in LAD)

Diapedesis (PECAM-1)

Migration

Front 706

Where are the high endothelial venules in the lymph nodes?

Back 706

In the paracortex?

Front 707

Where are the macrophages and reticular cells in the lymph node?

Back 707

Medullary sinuses

Front 708

How is the thymus divided?

Back 708

The cortex has immature T cells. The medulla is pale with mature T cells, reticular cells.

Front 709

What are some encapsulated bacteria?

Back 709

E. coli, K. pneumo, P. aeruginosa, C. neoformans, Salmonella, S. pneumo, H. flu, N. meningitides

Front 710

What HLA subtype is associated with hemochromatosis?

Back 710

A3

Front 711

What HLA subtype is associated with Graves disease?

Back 711

B8

Front 712

What diseases are HLA DR2 associated with?

Back 712

MS, hay fever, SLE, Goodpasture’s

Front 713

What HLA subtype is steroid responsive nephritic syndrome associated with?

Back 713

DR7

Front 714

What diseases are HLA DR4 assocaited with?

Back 714

RA, DM I (DM also with DR3)

Front 715

What disease is HLA DR5 associated with?

Back 715

Pernicious anemia, hashimotos thyroditis

Front 716

What cytokines are secreted by macrophages?

Back 716

IL-1, IL-6, IL-8, IL-12, TNF-a

Front 717

What does IL-1 do?

Back 717

Acute phase. Pyrogen, inflammatory. Activates endothelium to express adhesion molecules, ↑ chemokine secretion to recruit leukocytes

Front 718

What does IL-6 do?

Back 718

It is an acute phase pyrogen

Front 719

What does IL-8 do?

Back 719

Neutrophil chemotaxis (also with c5a, leukotriene B4)

Front 720

What does TNF-a do?

Back 720

Fever, causes release of acute phase proteins, cachexia

Front 721

What does IL-3 do?

Back 721

Stimulates bone marrow. Secreted by activated CD4 cells

Front 722

What does IFN gamma do?

Back 722

Activated macrophages and TH1, suppresses TH2

Front 723

What does IL-4 do?

Back 723

Increases TH2 differentiation, B cell growth, IgE class switching, also IgG

Front 724

What does IL-5 do?

Back 724

Increases B cell differentiation, IgA class switching, eosinophils

Front 725

What does IL-10 do?

Back 725

Inhibits activated T cells and TH1, activates TH2. Secreted by TH2 cells and Tregs. Similar to TGF-b

Front 726

What does IFN gamma do?

Back 726

Increase MHC I and II

Front 727

What cell surface proteins do T cells express?

Back 727

TCR, CD3 (associated with TCR), CD28(binds B7), CD2

Front 728

What cell surface proteins do B cells express?

Back 728

CD19, CD20, CD21 (EBV receptor), CD40, B7

Front 729

What cell surface proteins do macrophages express?

Back 729

CD14 (LPS receptor), CD40, B7, Fc receptors, C3b receptors

Front 730

What cell surface proteins do NK cells express?

Back 730

CD16 (binds Fc of IgG), CD56

Front 731

What do CD 55 and 59 do?

Back 731

Inhibits complement C9 binding/MAC. Expressed by all cells.

Front 732

What do C1-C4 do?

Back 732

Neutralize virus

Front 733

What things inhibit complement?

Back 733

Decay accelerating factor (CD55, 59), C1 esterase inhibitor

Front 734

How do superantigens work?

Back 734

↑ IFN gamma release from TH1 cells → IL-1, IL-6, TNF alpha from macrophages

Front 735

What kind of vaccine is the rotavirus vaccine?

Back 735

Live attenuated

Front 736

What kind of vaccine is the varicella vaccine?

Back 736

Live attenuated

Front 737

What kind of vaccine is the smallpox vaccine?

Back 737

Live attenuated

Front 738

What kind of vaccine is the hepatitis A vaccine?

Back 738

Killed

Front 739

What kind of vaccine is the cholera vaccine?

Back 739

Killed

Front 740

What are 2 recombinant vaccines?

Back 740

HBV, HPV

Front 741

What is involved in VDJ/VJ recobination?

Back 741

RAG1 and 2 recognize the recombination activating gene. Nucletides are added by terminal deoxynucleotidyl transferase.

Front 742

What autoantibodies are present in CREST syndrome?

Back 742

Anticentromere

Front 743

What autoantibodies are present in diffuse scleroderma?

Back 743

Anti-scl-70 --> antitopoisomerase

Front 744

What autoantibodies are present in primary biliary cirrhosis?

Back 744

Antimitochondrial

Front 745

What autoantibodies are present in pemphigus vulgaris?

Back 745

Antidesmoglein

Front 746

What are antimicrosomal antibodies seen in?

Back 746

Hashimotos

Front 747

What autoantibodies are present in polymyositis and dermatomyositis?

Back 747

Anti-Jo-1

Front 748

What autoantibodies are present in diabetes mellitus I.

Back 748

Antiglutamate decarboxylase, anti glutamic acid

Front 749

What is anti ribonucleoprotein seen in?

Back 749

Mixed connective tissue disease

Front 750

What autoantibodies are present in autoimmune hepatitis?

Back 750

Anti smooth muscle, anti liver/kidney microsomal

Front 751

What autoantibodies are present in pauci immune crescentic glomerulonephritis?

Back 751

MP-ANCA

Front 752

What kind of hypersensitivity is eczema?

Back 752

Mainly type I

Front 753

What kinds of hypersensitivity is complement involved in?

Back 753

Type II and III

Front 754

What is serum sickness and the arthus reaction?

Back 754

Serum sickness - antibodies are produced in about 5 days, IC's fix complement, causing fever, urticaria, arthralgia, proteinuria, lymphadenopathy, vasculitis with vessel wall necrosis.

The arthus reaction is after an injection, causing edema, necrosis and complement activation

Front 755

What kind of hypersensitity is polyarteritis nodosum?

Back 755

Type III

Front 756

What kind of hypersensitivity is hypersensitivity pneumonitis?

Back 756

Type III

Front 757

What kind of hypersensitivity is Hashimoto's thyroiditis?

Back 757

Type IV

Front 758

What type of hypersensitivity is Guillain Barre?

Back 758

Type IV

Front 759

What kind of hypersensitivity is graft vs host disease?

Back 759

Type IV

Front 760

What infections do T cell deficiencies cause?

Back 760

Viral, candida, PCP pneumonia, bacterial sepsis

Front 761

What kind of infections do B cell deficiencies cause?

Back 761

Encapsulated bacteria, enteroviral encephalitis, polio, giardiasis

Front 762

What kind of infections do granulocyte deficiencies cause?

Back 762

Staph, pseudomonal, candida, aspergillus

Front 763

What causes hyper IgM syndrome?

Back 763

Defective CD40L on T cells, other mutaitons

Front 764

What is defective in Bruton's agammaglobulinemia?

Back 764

Defective BTK means pro B cells do not become pre B cells. All Igs low

Front 765

How does common variable immunodeficiency present?

Back 765

Normal B cell number, but fewer plasma cells and Ig. Defective maturation, increased risk of autoimmune disease and lymphoma

Front 766

How does IL-12 deficiency present?

Back 766

Increased risk of mycobacterial infections due to reduced TH1 response. Labs show reduced IFN gamma

Front 767

What causes Job syndrome?

Back 767

TH cells do not produce IFN gamma. They have eczema and 2 rows of teeth. Increased eosinophils and IgE

Front 768

What are the causes of SCID?

Back 768

X linked --> IL-2 receptor defect
Autosomal recessive --> adenosine deaminase deficiency (thus feedback inhibition of ribonucleotide reductase)

Front 769

What is bare lymphocyte syndrome?

Back 769

A type of SCID with defective expression of HLA II on APCs

Front 770

What immune cell deficiencies does ataxia telangiectasia cause?

Back 770

B cell and T cell

Front 771

How does WIskott Aldrich present?

Back 771

Thrombocytopenic purpura, infections, eczema, bloody diarrhea. Low B and T cells. They have increased IgE and IgA, but decreased IgM

Front 772

What does a defect in LFA-1 integrin (CD18) on phagocytes cause?

Back 772

Leukocyte adhesion deficiency. No pus

Front 773

What is mutated in Chediak higashi?

Back 773

Lysosomal regulator trafficking gene, microtubule defect

Front 774

How does Chediak Higashi present?

Back 774

Partial albanism, peripheral neuropathy, nystagmus, seizures, giant cytoplasmic granules

Front 775

What are patients with chronic granulomatous disease susceptible to?

Back 775

Staph aureus, pseudomonas cepacia, serratia marcescens, norcardia, aspergillus, klebsiella, candida, E. coli

Front 776

What is deficient in hereditary angioedema?

Back 776

C1 esterase inhibitor deficiency → ↑ C4 breakdown → ↓ serum C4. Don't use ACE inhibitors

Front 777

How does C3 deficiency present?

Back 777

Recurrent pyogenic infections, increased type III sensitivity reactions.

Front 778

What does decay accelerating factor deficiency look like?

Back 778

Paroxysmal nocturnal hemoglobinuria. Mutated PIG-A so CD 55 and 59 don't anchor.
There may also be thrombosis, pancytopenia, Budd-Chiari syndrome. Diagnose with Ham's test (pH). Treat with iron, anticoagulation, marrow transplant.

Front 779

How do cyclosporins work?

Back 779

Binds to cyclophilins, this complex blocks T cells by inhibitng calcineurin → ↓ IL-2 and IL-2R production

Front 780

What are the side effects of cyclosporine (an immunosuppressant)?

Back 780

Nephrotoxic (prevent with mannitol), gout, lymphoma

Front 781

What is the MOA of tacrolimus?

Back 781

An immunosuppressant, decreases IL-2 by binding to the FK binding protein. Can be used topically for eczema.


Inhibits calcineurin activation (calcineurin dephosphorylates nuclear factor of activated T cells, which binds an IL-2 promotoe in the nucleus) - same as cyclosporine.

Front 782

What are the side effects of tacrolimus?

Back 782

nephrotoxicity, peripheral neuropathy, hypertension, pleural effusion, hyperglycemia

Front 783

What is sirolimus?

Back 783

An immmunosuppressant. binds to FK-binding protein. Inhibits mTOR (mammalian target of rapamycin) → ↓ T cell proliferation in response to IL-2

Front 784

What is rapamycin?

Back 784

An immunosuppressant. binds to FK-binding protein. Inhibits mTOR (mammalian target of rapamycin) → ↓ T cell proliferation in response to IL-2

Front 785

What are the side effects of sirolimus and rapamycin?

Back 785

Immunosuppressants. Cause hyperlipidemia, thrombocytopenia, leukopenia

Front 786

What is daclizumab?

Back 786

Monoclonal antibody to the IL-2 receptor on activated T cells - immunosuppressant

Front 787

What is muronomab?

Back 787

Immunosuppressant. Monoclonal antibody to epsilon chain of CD3

Front 788

What cytokine does thaliomide effect?

Back 788

TNF alpha

Front 789

How doe mycophenolate mofetil work?

Back 789

Inhibits IMP dehydrogenase so that less guanine is produced.

Front 790

How does azathioprine work?

Back 790

Precursor of 6MP

Front 791

What is Aldesleukin?

Back 791

Recombinant IL-2, used in RCC and metastatic melanoma

Front 792

What is sargramostim?

Back 792

Recombinant GM-CSF

Front 793

What is IFN-a used in?

Back 793

Hepatitis B, hepatitis C, Kaposi sarcoma, leukemia, malignant melanoma

Front 794

What is oprelvekin?

Back 794

Recombinant IL-11, used in thrombocytopenia

Front 795

What is infliximab?

Back 795

TNF alpha inhibitor, used in Crohns, RA, seronegative arthropathies

Front 796

What is etanercept?

Back 796

TNF alpha inhibitor

Front 797

What is abciximab?

Back 797

A glycoprotein IIb/IIIa inhibitor

Front 798

What is omalizumab?

Back 798

IgE inhibitor

Front 799

What are some things that can cause granulomas?

Back 799

In Bartonella hensleae, syphilis, berylliosis, listeria, etc

IFN gamma from TH1 activates the macrophages → TNF alpha from macrophages is important in maintaining granuloma formation

Front 800

What is the amyloid protein formed in multiple myeloma?

Back 800

Bence Jones proteins --> AL protein

Front 801

What is the amyloid protein formed in chronic disease?

Back 801

Serum amyloid associated protein --> AA

Front 802

What is the amyloid protein formed in senile cardiac amyloidosis?

Back 802

Transerythrin --> AF

Front 803

What is the amyloid protein formed in type II diabetes?

Back 803

Amylin --> AE protein

Front 804

What is the amyloid protein formed in dialysis associated amylodosis?

Back 804

MHC class I --> beta 2 microglobulin

Front 805

What is a permissive drug interaction?

Back 805

One drug doesnt have an effect on its own, but increases the effect of another.

Front 806

What are some noncompetitive inhibitors?

Back 806

Phenoxybenzamine, digoxin, allopurinol, PPIs, aspirin

Front 807

What are some weak acids?

Back 807

Phenobarbital, methotrexate, penicillins, cephalosporins, loops, thiazides. Treat OD with bicarb. All tend to increase uric acid.

Front 808

What is the equation for volume of distribution?

Back 808

Volume of distribution = amount of drug in body / plasma drug concentration

Front 809

How do you calculate clearance using half life?

Back 809

Clearance = 0.7 Vd /t1/2

Front 810

How do you calculate loading dose?

Back 810

Loading dose = target plasma concentration x Vd

Front 811

How do you calculate maintenance dose?

Back 811

Maintenence dose = target plasma concentration x clearance

Front 812

What G receptor mechanism is alpha 1?

Back 812

Gq

Front 813

What do alpha 1 receptors do?

Back 813

Increase vascular and sphincter tone, cause pupillary dilator contraction

Front 814

What G receptor mechanism is alpha 2?

Back 814

Gi

Front 815

What do alpha 2 receptors do?

Back 815

Decrease sympathetic outflow, increase platelet aggregation, decrease insulin release.

Front 816

What G receptor mechanism is beta 1?

Back 816

Gs

Front 817

What do beta 1 receptors do?

Back 817

Increase heart rate, contractility, renin, lipolysis

Front 818

What G receptor mechanism is beta 2?

Back 818

G2

Front 819

What do beta 2 receptors do?

Back 819

Vasodilate, bronchodilate, icnrease lipolysis, increase insulin and glucagon release, decrease uterine tone

Front 820

What G receptor mechanism is M1?

Back 820

Gq. Acts on the CNS

Front 821

What G receptor mechanism is M2?

Back 821

Gi. Acts on the heart.

Front 822

What G receptor mechanism is M3?

Back 822

Gq.

Front 823

What do M3 muscarinic receptors do?

Back 823

Increase gland secretions, peristalsis, bladder contraction, bronchoconstrict, pupillary sphincter contraction, ciliary muscle contraction

Front 824

What G receptor mechanism is D1?

Back 824

Gs. Relaxes renal vasculature.

Front 825

What G receptor mechanism is D2?

Back 825

Gi. Modulates neurotransmitter release

Front 826

What G receptor mechanism is histamine H1?

Back 826

G1

Front 827

What G receptor mechanism is histamine H2?

Back 827

Gs

Front 828

What G receptor mechanism is vasopressin V1?

Back 828

Gq. Increases vascular tone

Front 829

What G receptor mechanism is vasopressin V2?

Back 829

Gs. Increases water reasbroption.

Front 830

What does hemicholinium do at the nerve terminal?

Back 830

Inhibits sodium driving choline into the cell

Front 831

What does vesimacol do at the nerve terminal?

Back 831

Inhibits Ach packaging into vesicles

Front 832

What does black widow toxin do at the nerve terminal?

Back 832

Stimulates Ach release

Front 833

What does reserpine do at the nerve terminal?

Back 833

Inhibits packaging of NE into vesicles (an anithypertensive)

Front 834

What does guanethedine do at the nerve terminal?

Back 834

Inhibits norepinephrine release (an antihypertensive)

Front 835

What does bretylium do at the nerve terminal?

Back 835

Blocks NE release from nerve terminals (also a class III antiarrhythmic)

Front 836

What do ephedrine and tyramine do at the nerve terminal?

Back 836

stimulates NE release

Front 837

What is carbachol?

Back 837

A direct cholinomimetic. Used for glaucoma

Front 838

What is pilocarpine?

Back 838

A direct cholinomimetic. Used in glaucomic emergency

Front 839

What is bethanechol?

Back 839

A direct cholinomimetic resistant to AchE. Used post op

Front 840

What is tropicamide?

Back 840

A muscarinic antagonist

Front 841

What is benztropine?

Back 841

A muscarinic antagonist used in Parkinsons

Front 842

What is scopolamine?

Back 842

A muscarinic antagonist

Front 843

What is oxybutynin?

Back 843

A muscarinic antagonist for urge incontinence

Front 844

What are glycopyrrolate and tolterodine?

Back 844

A muscarinic antagonist for urge incontinence

Front 845

What are darifenacin and solifenacin?

Back 845

A muscarinic antagonist for urge incontinence

Front 846

What is glycopyrrolate?

Back 846

A muscarinic antagonist that can be used in asthma

Front 847

What adrenergic receptors are affected by epinephrine?

Back 847

↑↑↑↑ alpha 1, ↑↑↑↑ alpha 2, ↑↑↑↑ beta 1, ↑↑ beta 2, no effect on dopamine

Front 848

What adrenergic receptors are affected by norepinephrine?

Back 848

↑↑↑↑ alpha 1, ↑↑↑↑ alpha 2, ↑↑ beta 1, no effect on beta 2 or dopamine

Front 849

What adrenergic receptors are affected by dobutamine?

Back 849

↑ alpha 1 and 2, ↑↑↑↑ beta 1, ↑ beta 2, no effect on D1

Front 850

What adrenergic receptors are affected by phenylephrine or pseudodphedrine?

Back 850

↑↑↑↑ alpha 1, ↑↑ alpha 2,

Front 851

What is ritodrine?

Back 851

Beta 2 agonist (< beta 1 than asthmadrugs), used to reduce uterine contractions.

Front 852

What is terbutaline?

Back 852

A beta 2 agonist, can reduce uterine contractions

Front 853

What are 3 sympathoplegics (alpha 2 agonists)?

Back 853

Clonidine, alpha methyldopa, guanfacine. Can cause rebound hypertension

Front 854

What is phentolamine?

Back 854

A reversible nonselective alpha blocker

Front 855

What are 2 beta partial agonists?

Back 855

Pindolol, acebutolol. Could be better for airway and lipids.

Front 856

What is femoldopam?

Back 856

A D1 agonist that doesnt affect alpha or beta receptors.

Front 857

What is the antidote to atropine?

Back 857

Physostigmine

Front 858

What is the antidote to theophyilline?

Back 858

Beta blocker

Front 859

What is a side effect of methyldopa?

Back 859

Coombs positive hemolytic anemia

Front 860

What antibiotic can cause hypothyroidism?

Back 860

Sulfonamides

Front 861

What are some drugs that can cause hyperglycemia?

Back 861

niacin, tacrolimus, protease inhibitors

Front 862

What antihypertensive can cause gingival hyperplasia?

Back 862

Verapamil

Front 863

What drugs can cause gout?

Back 863

furosemide, thizides, niacin, cyclosporine, pyrazinamide

Front 864

What are some drugs that can cause myopathy?

Back 864

fibrates, niacin, colchicines, hydroxychlorquine, IFN alpha, penicillamine, glucocorticoids

Front 865

What are some drugs that can cause Stevens Johnson

Back 865

ethosuxamide, penicillin, allopurinol

Front 866

What are some drugs that can cause lupus?

Back 866

hydralazine, isoniazid, procainamide, phenytoin

Front 867

What anticancer drug can cause a disulfram like reaction?

Back 867

Procarbazine (for Hodgkins)

Front 868

What does minimum alveolar concentration measure?

Back 868

Potency, potency is higher in a lipid soluble drug (thus a lower MAC)

Front 869

What does blood/gas partition coefficient measure?

Back 869

Solubility in the blood (= slow onset). Lipid soluble anesthetics are generally high protein bound in the blood and thus have a high coefficient.

Front 870

What is a side effect of halothane?

Back 870

Fulminant hepatitis

Front 871

What inhaled anesthetic is used in brain surgery?

Back 871

Isoflurane

Front 872

What inhaled anesthetic is nephrotoxic?

Back 872

Methoxyflurane

Front 873

What are some lab abnormalities seen with succinylcholine?

Back 873

Hypercalcemia, hyperkalemia

Front 874

What are pramipexole and ropinirole?

Back 874

Dopamine agonists

Front 875

What do entacapone and tolcapone do?

Back 875

Inhibit COMT, preventing L-dopa breakdown

Front 876

What does memantine doe?

Back 876

NMDA antagonist. Can cause hallucinations

Front 877

What are the Z scores for 95% and 99% confidence intervals?

Back 877

95 - 1.96, 99 - 2.58. Use SEM

Front 878

What are some developmental milestones?

Back 878

Birth – 3 mo
• Social smile


7-9 mo
• Stranger anxiety
• Object permanent, response to name, simple instructions, uses gestures

12-15 mo
• Walks
• Separation anxiety,

2 yr
• Jumping, standing on one foot
• 2 word phrases

3 yr
copy shapes, feeds self, kicks ball
• Parallel play, gender identity


• 4 yr
• Dresses self with help, runs, hops on 1 foot, toilet training, imaginary friends

Front 879

What are some drugs used in narcolepsy?

Back 879

o Modafinil (not triplicate!), sodium oxybate helps cataplexy. Venlafaxine, fluoxetine

Front 880

Back 880

CO vs venous return

Front 881

What are normal pressures in the heart?

Back 881

• RA <5
• RV 25/5
• PA <25/10
• LA/PCWP <12
• LV 130/10
• Aorta 130/90

Front 882

What is Fick's law?

Back 882

CO = O2 consumption / arteriovenous O2 difference

Front 883

What does acidosis do to contractility?

Back 883

Decreases it. So does hypercapnea, verapamil, etc

Front 884

What is the equation for MAP?

Back 884

MAP = CO x TRP (P=QR)

Front 885

What would shift the starling curve left? (preload vs stroke volume)

Back 885

Exercise, because it increases contractility so there is a larger SV for any given preload

Front 886

What are the JVP tracings?

Back 886

o a wave – atrial contraction
o c wave – starts with systole. Blood is propelled back into the atrium before tricuspid valve closure and RV contraction causes the tricuspid valve to bulge into the atrium. Peaks halfway through isovolumetric contraction.
o x descent – the base of the heart moves towards the apex during rapid ejection, reducing pressure
o v wave – atrial filling. Peak right before the tricuspid closes
o y descent – the ventricles suck blood out of the atrium
o a wave – atrial contraction

Front 887

When do you see U waves on an EKG?

Back 887

Hypokalemia, bradycardia

Front 888

What does a positive QRS in limb lead III suggest?

Back 888

Right axis devation, possible inferior MI

Front 889

What is metyrapone?

Back 889

Blocks cortisol synthesis by inhibiting 11 beta hydroxylase, which should decrease ACTH from the pituitary.

Front 890

Zidovudine is an analog of what?

Back 890

Thymidine

Front 891

What part of the forearm does the musculocutaneous provide sensory innervation to?

Back 891

Lateral forearm

Front 892

What amino acid and cofactor are needed to start heme synthesis?

Back 892

Succinyl coA and glycine

Front 893

What modulates the activity of ALA synthase?

Back 893

Inhibited by heme and glucose, activated by alcohol, barbiturates and hypoxia

Front 894

What is deficient in acute intermittent porphyria?

Back 894

HMB synthase (Uroporphyrinogen I synthase). Porphobilinogen buids up and there is a deficiency of HMB

Front 895

What can you use a mucicarmine stain for?

Back 895

Cryptococcus neoformans's capsule (appears as red yeasts)

Front 896

What 2 things are necessary for isoniozide to be effective?

Back 896

Must be processed by mycobacterial catalase-perodidase, must bind to a specific sequence in its target enzyme

Front 897

What is synaptophysin?

Back 897

A transmembrane protein in the presynaptic vesicles of neurons, neuroectodermal and neuroendocrine cells

Front 898

What are some tumors that stain GFAP+?

Back 898

Glioblastoma, oligodendrogliomas, ependymomas, and peripheral neural sheath tumors

Front 899

What do recurrent lobar hemorrhages in an elderly patient suggest?

Back 899

Central amyloid angiopathy

Front 900

What kind of axis deviation would a left posterior fascicular block look like?

Back 900

Right

Front 901

What kind of axis deviation would a left anterior fascicular block look like?

Back 901

Left

Front 902

What is the pathophys behind congenital long QT syndrome?

Back 902

Usually cardiac Na or K channel defects. Jervell and Lange-Nielsen syndrome is associated with sensorineural deafness

Front 903

What medications can prolong the QT interval?

Back 903

Macrolides, chloroquin, mefloquin, haloperidol, risperidone, methadone, protease inhibitors, class Ia and class III antiarrhythmics. Antimuscarinics!!!!

Front 904

How do you treat torsades?

Back 904

Magnesium

Front 905

What is seen on EKG of Wollf Parkinson White?

Back 905

Widened QRS, delta waves (early depolarization)

Front 906

How do you treat Wolff Parkinson White?

Back 906

Do not use adenosine, use procainamide or amiodarone

Front 907

What causes Wolff Parkinson White?

Back 907

Accessory conduction pathway, usually the bundle of Kent.

Front 908

What causes wide splitting of S2?

Back 908

Pulmonic stenosis, RBBB

Front 909

What causes paradoxical splitting of S2?

Back 909

Aortic stenosis, LBBB

Front 910

What murmurs are louder on inspiration?

Back 910

Right sided

Front 911

What murmurs are louder on expiration?

Back 911

Left sided

Front 912

What does the hand grip maneuver do?

Back 912

↑ afterload

Intensifies: mitral regurg, VSD, aortic regurg, mitral stenosis (↑ HR)

↓ aortic stenosis, HOCM

Front 913

What does the valsalva maneuver do?

Back 913

Decreases preload due to increased chest pressure.

Accentuates HOCM and mitral valve prolapse (click is early)

Front 914

What does the squatting maneuver do?

Back 914

Increases preload and afterload. Decreases mitral valvprolapse and HOCM

Front 915

What is related to pulsus parvus et tardus?

Back 915

Aortic stenosis

Front 916

What is the murmur of ASD?

Back 916

Mid systolic pulmonary ejection murmur due to increased flow across the valve

Front 917

What maternal condition is transposition of the great vessels related to?

Back 917

Diabetes

Front 918

How do you treat Prinzmetal angina?

Back 918

DHP calcium channel blocker (e.g. nifedipine)

Front 919

How does a heart 2-4 days post MI look?

Back 919

Gross: mottling/hyperemia
Microscopic : inflammation, neutrophils, loss of nuclei

Front 920

How does a heart 12-24 hours post MI look?

Back 920

Gross: Pale, mottled
Microscopic: Neutrophils, contraction bands

Front 921

How does a heart 5-10 days post MI look?

Back 921

Gross: Hyperemic, central yellow softening

Microscopic: Granulation tissue

Front 922

What lead changes suggest an anterior wall MI (LAD)?

Back 922

V1-V4

Front 923

What lead changes suggest an anteroseptal MI? (LAD)

Back 923

V1, V2

Front 924

What lead changes suggest an anterolateral MI? (LCX)

Back 924

V4-V6

Front 925

What lead changes suggest an lateral wall MI? (LCX)

Back 925

I, aVL, V5, V6

Front 926

What lead changes suggest an inferior wall MI?

Back 926

II, III, aVF

Front 927

What does ANP do?

Back 927

Vascular relaxation, constricts efferent arterioles, dilates adderent arterioles to cause diuresis. Inhibits sodium and water reabsorption in the collecting duct.

Front 928

What mediates smooth muscle proliferation in atherosclerosis?

Back 928

PDGF, TGF beta

Front 929

What is Monckeberg arteriolosclerosis?

Back 929

Benign medial calcification of the radial/ulnar, etc artery, causing pipestem arteries. Intima unaffected

Front 930

What can ingestion of B-aminopropionitrile (in sweet peas) cause?

Back 930

Inhibits lysyl oxidase, which crosslinks elastin and colagen to maintain the elastic laminia, cause aortic aneurysms

Front 931

What causes genetic dilated cardiomyopathy?

Back 931

Defects in cardiac cytoskeleton proteins (e.g. dystrophin) and mitochondrial oxidative phosphorylation enzymes

Front 932

How do you treat HOCM?

Back 932

Non DHP CCBs (verapamil), beta blockers. Increase afterload, increase preload decrease contractility

Front 933

How does giant cell arteritis look like on histology?

Back 933

Granulomas of media, fragmented internal elastic lamina. Associated with polymyalgia rheymatica

Front 934

How does polyarteritis nodosa present?

Back 934

Type III hypersensitivity.

Transmural fibrinoid necrosis with different aged lesions

Spares the pulmonary vessels, can cause melena, cutaneous deposits, neurologic problems, abdominal pain.

Treat with steroids or cyclophosphamide

Front 935

What is the triad of Henoch Schonlein purpura?

Back 935

Purpura, arthralgia, GI (e.g. melena)

Front 936

How do you treat Wegners?

Back 936

Steroids and cyclophosphamide

Front 937

How does Churg Strauss present?

Back 937

Asthma, palpable purpura, neuropathy, GI/heart/kidney problems, granulomas, eosinophils
p-ANCA

Front 938

What is this?

Back 938

Aschoff body in rheumatic fever

Front 939

What are the immune complexes made of in Henoch Schonlein purpura?

Back 939

IgA (sometimes C3), increased serum IgA.

Is self limiting

Front 940

What is a pyogenic granuloma?

Back 940

Capillary hemangioma that looks like hypertrophic granulation tissue. Associated with pregnancy and trauma

Front 941

What is a glomus tumor?

Back 941

Made of temperature receptors that shunt blood

Front 942

What is angiosarcoma related to?

Back 942

VInyl chloride, arsenic, ThO2 (radiocontrast)

Front 943

What is the rash in rheumatic fever called?

Back 943

Erythema marginatum (annulare)

Front 944

What is Kussmaul's sign seen in?

Back 944

(Increased JVD with inspiration) Pericarditis

Front 945

What is pulsus paradoxus seen in?

Back 945

Cardiac tamponade, also in diseases with exaggerated inspiration (e.g. asthma)

Front 946

How do you treat raynauds?

Back 946

DHP CCB, aspirin

Front 947

What is dipyridamole?

Back 947

Inhibits thrombus formation when given chronically and causes vasodilation when given at high doses over a short time. Inhibits thromboxane, increases adenosine, etc

Front 948

What is bepridil?

Back 948

An antianginal CCB

Front 949

What is the MOA and side effects of hyrdralazine?

Back 949

Increases cGMP.

Causes angina , lupus, edema
Contraindicated in angina and CAD

Front 950

What are some side effects of DHP CCBs?

Back 950

Gingival hyperplasia, flushing, dizziness

Front 951

What are some side effects of non DHP CCBs?

Back 951

AV block (careful with beta blockers), constipation, etc

Front 952

What is the most cardiac specific CCB?

Back 952

Verapamil > diltiazem

Front 953

What is diazoxide?

Back 953

K channel opener that hyperpolarizes smooth muscle, can be used in malignant hypertension.

Can cause hyper glycemia (reduces insulin)

Front 954

What is minoxidil?

Back 954

K channel opener that can be used in hypertension. Can cause hypertrichosis and edema.

Front 955

What is nesiritide?

Back 955

Recombinant ANP

Front 956

What is the MOA of niacin?

Back 956

Inhibits lipolysis, reduces hepatic VLDL secretion

Front 957

What are the side effects of niacin?

Back 957

Flushing, pruritis, diarrhea, hyperglycemia, hyperuricemia

Front 958

What lipid drug can increase triglycerides?

Back 958

Resins (e.g. colestipol)

Front 959

What is ezetimibe?

Back 959

blocks cholesterol absorption. May ↑ LFTs, but no problems absorbing vitamins

Front 960

How does bezafibrate work?

Back 960

Fibrates upregulate LPL

Side effects: myositis, hepatotoxicity, cholesterol gallstones

Front 961

What are 3 Ia antiarrhythmics?

Back 961

Quinidine, procainamide, disopyramide (double quarter pounder)

Front 962

What do Ia antiarrhythmics do?

Back 962

Increase AP duration, effective refractory period, QT interval. Phase 3 is more drawn out

Acts on the activated channel.

Front 963

What is procainamide?

Back 963

A class Ia antiarrhythimic that can cause drug induced lupus, is anti muscarinic, and can be used in Wolff Parkinson White. Like other Ia's, there is increased risk of arrhythmia with hyperkalemia.

Front 964

What is quinidine?

Back 964

A class Ia antiarrhythmic that is antimuscarinic and anti alpha adrenergic. It can cause cinchonism (headache, tinnitus, flushing, blurred vision, rash, N/V)

Front 965

What are 4 class Ib antiarrhythmics?

Back 965

Mexiletine, toxainide, phenytoin, lidocaine (lettuce, mayo, tomato, pickles)

Front 966

What is mexiletine?

Back 966

class Ib antiarrhythmic

Front 967

What is the MOA of class Ib antiarrhythmics?

Back 967

Acts on the inactivated form of the Na channel and blocks the plateau phase by keeping the channels refractory. This is why these are preferred post-MI, they are also used for digoxin toxicity. May shorten AP duration

Front 968

What are the class Ic antiarrhythmics?

Back 968

Flecainide, propafenone (fries please). Can block any channel, will not change AP duration

Front 969

What is Flecainide?

Back 969

class Ic antiarrhythmic

Front 970

What is propafenone?

Back 970

class Ic antiarrhythmic

Front 971

What are 5 class III antiarrhythmics?

Back 971

Ibutilide, sotalol, bretylium, amiodarone, dofetilide.

Front 972

What is ibutilide?

Back 972

class III antiarrhythmic

Front 973

What is bretylium?

Back 973

class III antiarrhythmic

Front 974

What is dofetilide?

Back 974

class III antiarrhythmic

Front 975

What are the side effects of amiodarone?

Back 975

Pulmonary fibrosis, hepatotoxicity, hypo/hyperthyroid, corneal deposits, blue/gray skin – photodermatitis, neuro problems, constipation

Front 976

What are some EKG changes with digoxin toxicity?

Back 976

↑ PR, ↓QT, ST scooping, T wave inversion

Front 977

What is adenosine blocked by?

Back 977

Theophylline

Front 978

What artery runs with the axillary nerve?

Back 978

Posterior circumflex

Front 979

What artery runs with the radial nerve?

Back 979

Deep brachial

Front 980

What artery runs with the median nerve?

Back 980

Brachial

Front 981

What makes up the rotator cuff?

Back 981

Supraspinatus (abducts), infraspinatus (laterally rotates), teres minor (adducts, laterally rotates), subscapularis (medially roates, adducts)

Front 982

What can happen in an anterior shoulder dislocation?

Back 982

Axillary nerve, pos circumflex artery, supraspinatus tendon injury.
Bankart lesion - lower labrum tear, Hill-Sach's lesion - humeral head defect

Front 983

What artery is most at risk with a femoral neck fracture?

Back 983

Medial circumflex

Front 984

What injury can damage the axillary nerve?

Back 984

Surgical nerve of the humerus, anterior dislocation

Front 985

What injury can damage the radial nerve?

Back 985

Midshaft humeral fracture, axillary comrpession, radial subluxation

Front 986

What can be injured in a supracondylar humeral fracture?

Back 986

Median nerve

Front 987

What do the gluteus minimus and medius do?

Back 987

Abduct and medially rotate the thigh

Front 988

What movement does the tibial branch of the sciatic nerve do?

Back 988

Extend the hip, flex the knee

Front 989

What deficit will a femoral nerve injury cause?

Back 989

Loss of knee jerk, thigh flexion, leg extension. Loss of sensory

Front 990

What is the genetic deficiency in osteopetrosis?

Back 990

Carbonic anhydrase II --> abnormal osteoclasts. All labs are NORMAL. Causes pancytopenia

Front 991

Back 991

locations

Front 992

Back 992

Schaumann body in sarcoid

Front 993

Back 993

Asteroid body in sarcoid

Front 994

Where do giant cell tumors affect?

Back 994

Epiphyseal ends of long bones, soap

Front 995

What is febuxostat?

Back 995

Xanthine oxidase inhibitor

Front 996

What drugs do you use for acute gout?

Back 996

NSAIDs, colchicine, steroids

Front 997

What is probenecid?

Back 997

Inhibitor of uric acid reabsorption in the proximal convoluted tubule

Front 998

What other problems can you have with ankylosing spondylitis?

Back 998

Uveitis, aortic regurgitation, cardiac conduction abnormalities

Front 999

What microbes are associated with Reiter syndriome?

Back 999

Chlamydia trachomatis, salmonella, shigella flexeri, campylobacter jejuni, yersenia

Front 1000

What complement changes can be seen in SLE?

Back 1000

Decreased C3 and C4

Front 1001

What does biopsy show in dermatomyositis?

Back 1001

Perifascicular atrophy. Labs show increased CK and aldolase. Postive ANA and anti-Jo-1

Front 1002

What cytokine is important in scleroderma?

Back 1002

TGF beta

Front 1003

What does scleroderma pulmonary hypertension look like?

Back 1003

Intimal thickening of arterioles

Front 1004

What is parakeratosis?

Back 1004

Hyperkeratosis (corneum) + retained nuclei

Front 1005

What deposits are at the tips of the dermal papillae in dermatitis herpetiformis?

Back 1005

IgA

Front 1006

What disease is lichen planus releated to?

Back 1006

HCV

Front 1007

What is erythema nodosum related to?

Back 1007

coccidiodes, histo, TB, leprosy, strep, sarcoid

Front 1008

What do prostaglandins do?

Back 1008

Vasodilate, bronchodilate, increase uterine tone

Front 1009

What do prostacyclins do?

Back 1009

Vasodilate, bronchodilate, DECREASE uterine tone, inhibit platelet aggregation

Front 1010

What do thromboxanes do?

Back 1010

Vasoconstrict, bronchoconstrict, promotes platelet aggregation

Front 1011

What do leukotrienes C4, D4, E4 do?

Back 1011

Vasoconstrict, bronchospasm, increase vascular permeablity

Front 1012

What do lipoxins do?

Back 1012

Vasodilate, inhibit neutrophil chemotaxis, stimulate monocyte adhesion

Front 1013

What does colchicine do?

Back 1013

o Stabilizes tubulin, can reduce LTB4 production
o Causes GI side effects, do not use in renal dysfunction

Front 1014

What is etanercept?

Back 1014

Recombinant TNF alpha receptor

Front 1015

What is adalimumab?

Back 1015

Anti TNF antibody

Front 1016

What uses JAK/STAT tyrosine kinases?

Back 1016

Prolactin, GH, cytokines (IL-2,6,8)

Front 1017

In which congenital adrenal hyperplasia can no sex steroids be made?

Back 1017

17 alpha hydroxylase deficiency

Front 1018

In which congenital adrenal hyperplasia are there ambiguous genitalia in both sexes?

Back 1018

3 beta hydroxysteroid dehydrogenase

Front 1019

How does cortisol affect alpha 1 adrenergics?

Back 1019

Upregulates alpha 1 receptors on arterioles

Front 1020

How does Conn syndrome present on labs?

Back 1020

Low K, alkalosis, low renin, normal sodium

Front 1021

What gene are neuroblastomas related to?

Back 1021

N-myc, use bombesin for a tumor marker and stain for neurofilaments. Homer-wright pseudorosettes may be seen

Front 1022

What hormones share an alpha subunit?

Back 1022

TSH, LH, FSH, hCG

Front 1023

What else does TRH stimulate?

Back 1023

prolactin

Front 1024

What does somatostatin inhibit

Back 1024

GH, TSH

Front 1025

What does TNF alpha do to glucose uptake?

Back 1025

Decreases it, causing insulin resistance. Catecholamines, glucagons, and steroids can do the same thing

Front 1026

What can decrease magnesium?

Back 1026

diarrhea, aminoglycosides, diuretics, alcohol abuse

Front 1027

What does the superior laryngeal nerve innervate

Back 1027

Cricothyroid, sensory to the vocal cords

Front 1028

What artery runs by the recurrent laryngeal nerve at the thyroid?

Back 1028

Inferior thyroid artery

Front 1029

What does thyroid hormone do to beta 1 receptors?

Back 1029

Increases beta 1 receptors in the heart

Front 1030

Why should you not use aspirin or ibuprofen in Graves disease?

Back 1030

Displaces TH from TBG

Front 1031

How does papillary thyroid cancer look?

Back 1031

Orphan annie, psammoma. Associated with RET, BRAF, NTRK1

Front 1032

What does folliciluar thyroid cancer look like?

Back 1032

Hurthle cells. Associated with RAS, PPAR gamma/PAX-8

Front 1033

What is chlorpropramide?

Back 1033

First generation sulfonylurea (closes K --> depolarization, diazoxide dose the opposite)

Front 1034

What is glimepiride?

Back 1034

2nd generation sulfonyl urea

Front 1035

What should you monitor if using thiazolidinediones?

Back 1035

LFTs
(Side note: remember they increase adiponectin)

Front 1036

What is pramlintide?

Back 1036

Amylin analong - decreases glucagon, delays gastric emptying (can be used in DM )

Front 1037

What are exenatide and liraglutide?

Back 1037

GLP-1 like analogs - increase insulin, decrease glucagon, delays gastric emptying.
Can cause pancreatitis

Front 1038

What are sitagliptin and saxagliptin?

Back 1038

Inhibit dipeptidyl peptise IV, normally inactivates incretins. No hypoglycemia risk

Front 1039

Is PTU or methimazole more hepatotoxic?

Back 1039

PTU

Front 1040

What is fludrocortisone?

Back 1040

Synthetic aldosterone

Front 1041

Where is Meissner's plexus?

Back 1041

Submucosa

Front 1042

What plexus is in the muscularis externa?

Back 1042

Auerbachs myenteric plexus (motility)

Front 1043

What makes up the celiac trunk?

Back 1043

*Common hepatic – courses right, supplies the duodenum
-Hepatic proper
-Right gastric (supplies some of the lesser curve)
-Anterior superior pancreaticoduodenal
-Right gastroomental (gastroepiploic)
Splenic - runs over the pancreas, behind the stomach
-Short gastrics (poor collaterals)
-Left gastroomental (gastroepiploic)
Left gastric – supplies the lesser curve
-Esophageal branch

Front 1044

What does gastrin do?

Back 1044

o ↑ gastric H secretion
o ↑ gastric mucosal growth
o ↑ gastric motility
stimulates ECL cells to release histamine

Front 1045

What regulates gastrin?

Back 1045

o Increased release with distension, alkalinization, amino acids/peptides (especially phenylalanine, tryptophan), vagal stimulation. Calcium can also stimulate.
o Inhibited by low stomach pH

Front 1046

What does CCK do?

Back 1046

o Increases pancreatic enzyme secretion by acinar cells, relaxes the sphincter of Oddi
o Increases gallbladder contraction
o Decreases gastric emptying

Front 1047

What does secretin do?

Back 1047

o ↑ release of high bicarb, low Cl secretion of the pancreatic ductal cells. High flow secretions are high in bicarb, low flow are high in Cl.
• Pancreatic enzymes don’t function as well in an acidic environment
o ↓ gastric acid secretion
o ↑ bile secretion

Regulation: ↑ by duodenal pH <5, presence of fatty acids

Front 1048

What does GIP do?

Back 1048

By K cells in the gut. Exocrine - decreases acid secretion, endocrine - increases insulin release.

o Stimulated by fatty acids, amino acids, oral glucose (which is why an oral glucose load is used more rapidly than IV)

Front 1049

What does VIP do?

Back 1049

In parasympathetic ganglia, increases water secretion.

Regulated by distension and vagal stimulation (increased) and adrenergics (decreased)

Front 1050

How do you treat primary biliary cirrhosis?

Back 1050

Ursidiol decreases cholesterol produced by the liver

Front 1051

What is dicyclomine?

Back 1051

Anticholinergic

Front 1052

What do you treat tropical sprue with?

Back 1052

Sulfonamide or tetracycline

Front 1053

How does Whipples disease looks like on histology

Back 1053

PAS positive foamy macrophages in the lamina propria and mesenteric nodes. GIve TMP SMX

Front 1054

What is a side effect of H2 blockers?

Back 1054

Antiandrogenic, thrombocytopenia, increase serum creaotine

Front 1055

What is metoclopramide?

Back 1055

D2 agonist, increases serotonin receptors. Increases motility - used for post op gastreoparesis. Can cause seizures, diarrhea, N/V. bad with digoxin and anti diabetics

Front 1056

What is sibutramine

Back 1056

NT reuptake inhibitor for weightloss. Cannot be used in heart disease

Front 1057

What is a specific marker of mast cell activation?

Back 1057

Tryptase

Front 1058

What CDs do dendritic cells express?

Back 1058

CD80, CD86, CD40

Front 1059

What is a marker for langerhans cell histiocytosis?

Back 1059

S100, CD1a

Front 1060

What do abciximab, eptifibatide, and tirofiban do?

Back 1060

Directly inhibit GpIIbIIa

Front 1061

What do ticlodipine and clopidogrel do?

Back 1061

Inhibit ADP reception

Front 1062

What is Bernard Soulier?

Back 1062

GpIb deficiency (platelets cant bind vWF)

Front 1063

WHat is Glanzmanns thrombastenia?

Back 1063

GpIIbIIIa deficiency

Front 1064

What is basophilic stipplnig seen in?

Back 1064

thalassemia, anemia of chronic disease, iron deficiency, lead poisoning

Front 1065

What are target cells in?

Back 1065

THAL - thalassemia, HbC diease, asplenia, liver disease

Front 1066

What are the anemia labs?

Back 1066

• Iron deficiency
o ↓ iron, ↑ transferrin/TIBC, ↓ ferritin, ↓↓ transferring saturation (Fe/TIBC)
• Chronic disease
o ↓ iron, ↓ transferrin, ↑ ferritin, ↑/normal transferrin saturation
• Hemochromatosis
o ↑ iron, ↓ transferrin (saturated), ↑ ferritin, ↑↑ transferrin saturation
• Pregnancy, OCPs
o Normal iron, ↑ transferrin, normal ferritin, ↓ transferrin saturation
• Lead poisoning
o ↑ iron, ↓ transferrin, normal ferritin, ↑ transferrin saturation

Front 1067

What translocation has a better prognosis in ALL?

Back 1067

t(12;21)

Remember this is PAS +

Front 1068

What is associated with CLL?

Back 1068

Smudge ells, warm hemolytic anemia

Front 1069

What does hairy cell leukemia stain positive for?

Back 1069

TRAP

Front 1070

How does AML present?

Back 1070

Anemia, thrombocytopenia, neutropenia, sometimes with DIC.

PAS negative
M7 (megakaryocytic) is more common in Down syndrome - the only CD13, CD 33 negative (41,61+)

Front 1071

What is CML associated with?

Back 1071

Philadelphia chromosome t(9;22) bcr-abl

Associated with increase neutrophils, erythrocytes, and megakaryocytes. Associated with defective PDGF receptor

Front 1072

What are Reed Sternberg cells positive for?

Back 1072

CD 30, 15

Front 1073

What is Burkitt lymphoma associated with

Back 1073

t(8;14) c-myc, high ki-67

Front 1074

How does follicular lymphoma present?

Back 1074

Painless lymph node enlargements that come and go. t (14;18) causes decreased apoptosis
Expresses CD19, 20, 79a, 21, 10

Front 1075

What directly inhibits thrombin?

Back 1075

Lepirudin, bivalrudin, desorudin; argatroban

Front 1076

What directly inhibits factor Xa and won't affect TT?

Back 1076

Rivaroxaban, idraparinux, apixaban

Front 1077

What antiplatelet drug causes neutropenia?

Back 1077

Ticlodipine

Front 1078

What is cilostazole?

Back 1078

Dilates arteries, inhibits platelet aggregation

Front 1079

What inhibits IIb/IIIa?

Back 1079

Abciximab, etifibatide, tirofibide

Front 1080

What mediates cachexia?

Back 1080

TNF alpha (cachectin), IFN gamma (affects basal metabolic rate), IL-6

Front 1081

What cancers overexpress N-myc?

Back 1081

Neuroblastoma (Homer-Wright pseudorosettes), SCLC

Front 1082

What cancers are associated with RAS mutation?

Back 1082

o K-RAS – colon, lung, pancreas
o H-RAS – bladder, kidney (hematuria)
o N-RAS – melanoma, hematologic

Front 1083

What are the paraneoplastic syndromes?

Back 1083

• ACTH
o SCLC
• ADH
o SCLC, intracranial
• PTH-rP, TGF-beta, TNF, IL-1 - hypercalcemia
o Squamous cell of the lung, other squamous, RCC, breast carcinoma, multiple myeloma
• EPO
o RCC, hemangioblastoma, HCC, pheo
• Lambert Eaton
o Antibodies against presynaptic Ca
o SCLC
• Hyperuricemia
o Leukemia, lymphoma

Front 1084

What is cytarabine?

Back 1084

Pyrimidine analog that inhibits DNA polymerase, used for acute leukemias. Can cause megaloblastic anemia

Front 1085

What is the MOA of dactinomycin?

Back 1085

Intercalates in DNA, decreases unwinding

Front 1086

What are the anthracyclines (-rubacin)

Back 1086

Make free radicals that intercalate into DNA and cause breaks. Prevent cardiotoxicity with dexrazoxane, an iron chelator.

Front 1087

What drugs are used in testicular cancer?

Back 1087

Etoposide, bleomycin, cisplatin

Front 1088

What is teniposide

Back 1088

Inhibits topoisomerase II (like etoposide) so it cant seal its double strand breaks

Front 1089

What do ironotecan and topotecan do?

Back 1089

Inhibit topoisomerase II

Front 1090

What do cyclophosphamide and ifosfamide do?

Back 1090

Covalently links DNA at guanine. bioactivated by P450.

Prevent acrolein hemorrhagic cystitis with mesna

Front 1091

How does busulfan work?

Back 1091

Alkalates DNA, used in CML and marrow ablation. Cause pulmonary fibrosis and hyperpigmentation

Front 1092

What are side effects of vincristine

Back 1092

Neurotoxic

Front 1093

What does cisplatin do?

Back 1093

Forms ROS that cross link DNA. Prevent nephrotoxicity with amifostine

Front 1094

What does hydroxyurea do?

Back 1094

Inhibit ribonucelotide reductase. used in melanoma and CML

Front 1095

What are the hypothalamic nuclei?

Back 1095

o Lateral
• Hunger, inhibited by leptin
• Sympathetics
o Ventromedial
• Satiety, stimulated by leptin
o Preoptic/anterior
• Parasympathetic
• Cooling
• Releases GnRH
o Posterior
• Sympathetic
• Heating
o Dorsomedial
• Stimulation → obesity, savage behavior, stimulates GI system
o Arcuate
• Releases hormones affecting the adenohypophysis
• Regulates hunger, satiety
o Paraventricular
• Makes oxytocin
• Sympathetic
• Regulates food intake
o Supraoptic
• Makes ADH, with input from OVLT

Front 1096

What happens in PPRF/FEF lesions?

Back 1096

PPFR
• Eyes look away from the lesion
FEF
• Eyes look towards the lesion

superior colliculi - paralysis of upward gaze

Front 1097

How does Wallenberg (lateral medullary syndrome) - PICA present?

Back 1097

• Lateral medulla
o Vestibular nuclei → vertigo
o Lateral STT → contralateral pain/temp loss
o Spinal trigeminal nucleus → ipsilateral pain/temp loss
o Nucleus ambiguus – ispilateral dysphagia, hoarseness
• PICA specific
o Sympathetics – ipsilateral horners
o Solitary tract – ipsilateral taste
o Nucleus of CII – ipsilateral deviation
• ICP – ipsilateral ataxia

Front 1098

How does Weber syndrome present? - PCA

Back 1098

• Oculomotor – ipsilateral ptosis, mydriasis, down and out
• Cerebral peduncle
o Corticospinal tract – contralateral spastic paralysis
o Corticobulbar tract – (CN XII, VII) contralateral lower facial paralysis, tongue

Front 1099

What brain tumor has Homer Wright pseudo rosettes?

Back 1099

Medulloblastoma

Front 1100

What happens in the descending limb?

Back 1100

Concentrating - impermeable to sodium

Front 1101

What do you see on EM in post strep GN?

Back 1101

Subepithelial IC humps (Ig, C3)

Front 1102

What are 3 kinds of RPCGN?

Back 1102

Goodpasture, Henoch Schonlein, Wegeners (pauci immune - no Ig deposits)

Front 1103

How does Bergers IgA glomerulopathy present?

Back 1103

Related to Henoch Schonlein purpura. Presents after URI, acute gastrointeritis. Hematuria returns every few months. Mesangial IC deposits and prolfieration

Front 1104

What does membraneous GN show on imaging?

Back 1104

EM - spike and dome, subepithelial deposits

Front 1105

What is diffuse proliferative GN assocaited with?

Back 1105

SLE - wire looping. Subendothelial IgG deposits.
Nephritic/nephrotic

Front 1106

What does type I membranoproliferative GN present like?

Back 1106

Tram tracking, associated with HBV, HDV

subendothelial ICs

Front 1107

What does type II membranoproliferative GN present like?

Back 1107

C3 nephritic facotor (IgG antibody)
dense, ribon like deposits

Front 1108

What is Aliskiren?

Back 1108

Renin inhibitor

Front 1109

How do you calculate physiologic dead space?

Back 1109

Vd=VT (PaCO2 – PeCO2)/PaCO2

Front 1110

What's the alveolar gas equation?

Back 1110

PAO2 = 150 – (PaCO2/0.8) . Normal A - a is 10-15
Increased:
o V/Q mismatch, diffusion limitation, right to left shunt, normal aging, ↑ FiO2