Usmle Step 1 Superset (Part 1)

Front 1

What are the 5 main platelet abnormalities?

Back 1

1) ITP: peripheral platelet destruction, antiplatelet antiboides, increased megakayrocytes
2) TTP: increased platelet aggregation leads to thrombosis and schistocytes, increased LDH (There are neurologic & renal symptoms, & fever)
3) DIC: schistocytes & increased fibrin split products
4) Aplastic anemia
5) Drugs (e.g. immunosuppressive agents)

Hint 1

A schistocyte or schizocyte (from Greek schistos for "divided" or schistein for "to split", and kytos for "hollow" or "cell") is a fragmented part of a red blood cell.
- irregularly shaped, jagged and asymmetrical.
- a true schistocyte does not have central pallor.

Front 2

What are the signs of platelet abnormalities?

Back 2

1) MICROhemorrhage: mucous membrane bleeding, epistaxis, petechiae, purpura
2) increased bleeding time

Hint 2

- Epistaxis = nosebleed
- Petechiae = a small (1-2mm) red or purple spot on the body
- Purpura - small (0.3-1 cm) red or purple discolorations on the skin that do not blanch on applying pressure. Caused by bleeding underneath the skin.

Front 3

What are the 3 main coagulation factor defects?

Back 3

1) Hemophilia A (factor VIII deficiency)
2) Hemophilia B (factor IX deficiency)
3) vW disease: mild, most-common (deficiency of vonWillebrand factor leads to a defect in platelet adhesion and a decrease in factor VIII survival)

Front 4

What are the signs of a coagulation factor defect?

Back 4

1) MACROhemorrhage: hemarthroses (bleed into joints), easy bruising
2) Increased PT &/or PTT time

Front 5

What is the initial response to high-altitude induced hypoxia?

Back 5

1) Hemoglobin-O2 curve shifts right as a result of increased 2,3-DPG) in order to release more O2 to tissue
2) The P50 (partial pressure of O2 @ 50% saturation of hemoglobin) will increase

Front 6

What is one chronic response to high-altitude induced hypoxia?

Back 6

Increased hemocrit due to increased erythropoietin

Front 7

What is the action of 2,3-DPG?

Back 7

1) It binds to the beta chains of deoxyhemoclogin and DECREASES the affinity of hemoglobin for O2
2) This right-shifts the Hemoglobin-O2 curve
3) Is a response to high-altitude hypoxia

Front 8

What is the pulmonary vascular response to increased altitude?

Back 8

B/C barometric pressure decreases, there is a decrease in alveolar partial O2 pressure.
- This causes hypoxic vasoconstriction in the pulmonary vessels
- This increases pulmonary arterial pressure (i.e. pulmonary vascular resistance)
- If prolonged = Right heart hypertrophy

Front 9

What causes acromegaly?

Back 9

Unsuppressed secretion of growth hormone (GH), usually due to a pituitary adenoma

Front 10

What causes the visual disturbances often seen with acromegaly?

Back 10

If the cause is a pituitary adenoma, this tumor can press on the optic chiasm

Front 11

What are the main functions of growth hormone (GH)?

Back 11

1) Human growth and development
2) Stress response to starvation

Front 12

How does growth hormone (GH) respond to starvation?

Back 12

GH is released in response to hypoglycemia & acts directly to REDUCE glucose uptake by cells & to increase lipolysis inorder to INCREASE blood sugar levels

Front 13

How is growth hormone (GH) used in the Dx of acromegaly?

Back 13

- In a healthy person, a glucose tolerance test should depress GH levels.
- However, in acromegaly, the GH levels would not be affected

Front 14

What is the growth hormone (GH) response to obesity?

Back 14

it's secretion is reduced

Front 15

What is the growth hormone (GH) response to pregnancy?

Back 15

GH secretion decreases

Front 16

What are somatomedins and when are they released?

Back 16

1) Somatomedins = insulin-like growth factors
2) Mediate metabolic changes necessary for growth & development
3) Act on hypothalamus & anterior pituitary via negative feedback to reduce growth hormone (GH) secretion

Front 17

What is somatomedin's effect on GH secretion

Back 17

1) It is part of the negative feedback system that regulates GH secretion
2) Synthetic forms can be used to treat acromegaly

Front 18

What are the primary findings in acromegaly?

Back 18

1) Cause: excess GH in adults
2) Features:
- Large tongue with deep furrows
- Deep voice
- Lg. hands & feet
- Coarse facial features
- Impaired glucose tolerance (insulin resistance)

Front 19

What does excess GH cause in adults? In children?

Back 19

In adults: acromegaly
In kids: gigantism

Front 20

What is the Tx for acromegaly?

Back 20

Pituitary adenoma resection followed by octreotide administration

Hint 20

Octreotide: mimics natural somatostatin pharmacologically; a more potent inhibitor of growth hormone, glucagon, & insulin than the natural hormone.

Front 21

How is acromegaly diagnosed?

Back 21

1) Increased serum IGF-1
2) Failure to suppress serum GH following oral glucose tolerance test

Front 22

When is growth hormone (GH) normally increased?

Back 22

Stress, exercise, & hypoglycemia

Front 23

How does acetazolamide work?

Back 23

Inhibits carbonic anhydrase in the PCT (luminal/basolateral membrane & cytoplasm)
- t/f decreases kidney reabsorption of bicarbonate in the proximal tubule & increases K+, Na+, & Cl- loss
- ALKALINIZES Urine

Hint 23

ACIDazolamide causes ACIDosis

Front 24

What is acetazolamide used for?

Back 24

ACE family:
- Altitude sickness
- metabolic Alkalosis
- Alkalinizing urine
- glauComa
- Epilpsy
- Familial periodic paralysis

Front 25

What is the potential toxicity of acetazolamide?

Back 25

PACE:
- Potassion depletion (hypokalemia)
- Acidosis (Hyperchloremic metabolic) due to excretion of HCO3
- Allergy (SULFA-based)
- Ca nephrolithiasis
- Encephalopathy in patients with hepatic cirrhosis due to decreased NH4+ excretion

Front 26

What drugs increase urine NaCl?

Back 26

ALL diuretics:
- Carbonic anhydrase inhibitors
- Loops
- Thiazides
- K+-sparing

Front 27

Which drugs increase urine K+

Back 27

All diuretics, except K+ sparing

Front 28

Which diuretics cause acidemia?

Back 28

1) Carbonic anhydrase inhibitors
- reduced HCO3- reabsorbtion
2) K+ sparing
- hyperkalemia leads to K+ entering all cells (via H+/K+ exhcanger) & H+ exiting cells

Front 29

Which diuretics cause alkalemia?

Back 29

Loops & Thaizides:
1) "Contraction Alkalosis": Volume contraction -> increased ATII -> Na+/H+ exchange in proximal tubule-> increased HCO3-
2) K+ loss leads to: K+ exiting all cells (via H+/K+ exchanger) & H+ enters cells
3) "Paradoxical aciduria": In a low K+ state, H+ (rather than K+) is exchanged for Na+ in principle cells, leading to alkalosis

Front 30

Which diuretics cause an increase in urine Ca2+?

Back 30

1) Loops
2) Mechanism:
- Abolish lumen-positive potential in thick ascending limb of loop of Henle -> decrease in paracellular Ca+ reabsorption -> hypocalcemia

Front 31

Which diuretics cause a decrease in urine Ca2+?

Back 31

1) Thiazides
2) Mechanism:
- Block luminal Na+/Cl- cotransport in DCT -> increased Na+ gradient -> increased interstitial Na+/Ca2+ exchange -> hypercalcemia

Front 32

In acute renal failure, what is the indication for dialysis?

Back 32

1) Severe hyperkalemia (elevated blood level of potassium)
2) A rapidly-rising potassium value
3) Severe acidosis
4) BUN >80 mg/dl or S/S uremia
5) Na Concentration <120mEq/L or >155mEq/L
6) Toxins: lithium or salicylates

Front 33

What is a broad definition of acute renal failure?

Back 33

Abrupt decline in renal function + increased creatinine and BUN over a short period of several days

Front 34

What are the 3 stages of acute renal failure?

Back 34

1) prerenal azotemia
2) intrinsic renal
3) postrenal

Front 35

What are the characteristics of prerenal azotemia?

Back 35

1) Decreased RBF (e.g. hypotension)
2) Reduced GFR
3) Na+/H2O & urea retained by the kidney

Front 36

What are the characteristic lab values of prerenal azotemia?

Back 36

1) Urine osmolality: >500
2) Urine Na: <10
3) Fe of Na: <1%
***4) BUN/Cr ratio: >20

Front 37

What are the characteristic lab values of the intrinsic renal stage of acute renal failure?

Back 37

1) Urine osmolality: <350
2) Urine Na: >20
3) Fe of Na: >2%
4) BUN/Cr ratio: <15

Front 38

What are the characteristic lab values of the postrenal stage of acute renal failure?

Back 38

1) Urine osmolality: <350
2) Urine Na: >40
3) Fe of Na: >4%
4) BUN/Cr ratio: >15

Front 39

What are the characteristics of the intrinsic renal stage of acute renal failure?

Back 39

1) Causes: acute tubular necrosis or ischemia/toxins.
2) Patchy necrosis leads to debris obstructing tubule & fluid backflow across necrotic tubule leads to a decrease in GFR
3) Urine has epithelial/granular casts

Front 40

What are the characteristics of the postrenal stage of acute renal failure?

Back 40

1) Cause: outflow obstruction (stones, BPH, neoplasia)
2) NB: ONLY develops with bilatral obstruction

Front 41

What are the 2 forms of renal failure?

Back 41

1) Acute: usually due to acute tubular necrosis
2) Chronic: usually caused by hypertension & diabetes

Front 42

What are the 8 possible consequences of renal failure?

Back 42

1) Anemia: failure of erthropoietin production
2) Renal osteodystophy: no vit. D production
3) Hyperkalemia: possible cardia arrhythmias
4) Metabolic acidosis: decreased acid secretion & reduced HCO3- production
5) Uremic encephalopathy
6) Na & H20 excess: CHF & pulmonary edema
7) Chronic pyelonephritis
8) Hypertension

Front 43

What is uremia?

Back 43

A clinical syndrome marked by increased BUN & creatinine & associated symptoms

Front 44

What type of exchange limitation is caused by emphysema?

Back 44

1) Diffusion-limited exchange
2) Destruction of alveoli leads to a decreased surface area for gas exchange
3) T/F increased perfusion will not improve the exchange

Front 45

In a diffusion-limited situation, will O2 fully equilibrate along the length of the pulmonary capillary?

Back 45

1) No.
2) As blood is oxygenated, the gradient driving O2 into the blood decreases.
3) T/F further equilibration would take more time &, in a diffusion-limited situation, there is not enough time & O2 will not equilibrate by the time it reaches the end of the capillary.

Front 46

What gasses are perfusion-limited?

Back 46

1) O2 (in normal health)
2) CO2
3) N2O

Front 47

What does it mean for a gas to be perfusion-limited?

Back 47

1) Gas equilibrates early along the length of a pulmonary capillary
2) Diffusion can be increased ONLY with an indrease in blood flow

Front 48

What does it mean for a gas to be diffusion-limited?

Back 48

Gas does not equilibrate by the time the blood reaches the end of the pulmonary capillary

Front 49

What gasses are diffusion-limited?

Back 49

1) O2 (emphysema & fibrosis)
2) CO

Front 50

What is the most severe consequence of pulmonary hypertension?

Back 50

Cor pulmonale & RV failure (JV distention, edema, hepatomegaly)

Front 51

How is the diffusion equation affected by emphysema?

Back 51

Decrease in Area

Front 52

How is the diffusion equation affected by pulmonary fibrosis?

Back 52

Increase in Thickness

Front 53

Give the diffusion equation.

Back 53

Vgas = A/T x Dk(P1-P2)

A = area
T = thickness
Dk(P1-P2) = difference in partial pressures

Front 54

What are the pulmonary function findings in a case of COPD?

Back 54

Obstructive Pattern:
Increase in RV
Decrease in FVC
Decrease in FEV1
Decrease FVC
Decrease FVC1/FVC ration (**)
V/Q mismatch

Front 55

What is the pathology of Chronic Bronchitis (Blue Bloater)?

Back 55

1) Hypertrophy of mucus-secreting glands in the bronchioles (small airways)
2) Reid index >50
3) Productive cough for > 3 consecutive months in 2(+) years
4) Findings: wheezing, crackles, cyanosis (early-onset hypoxemia due to shunting), late-onset dyspnea

Hint 55

Reid index = gland depth / total thickness of bronchial wall

Front 56

What are the types of emphysema?

Back 56

1) Centriacinar: smoking
2) Panacinar: alpha-1-antitrypsin deficiency (or liver cirrhosis)
3) Paraseptal: bullae that rupture causing pneumothorax (often = otherwise healthy, young males)

Front 57

What is the pathology of Emphysema (Pink Puffer with barrel-shaped chest)?

Back 57

1) Enlargement of air spaces and decrease in recoil resulting from destruction of alveolar walls
2) Increased elastase activity
3) Increased compliance due to loss of elastic fibers
4) Px exhale through pursed lips to increase airway pressure and prevent airway collapse during exhalation

Front 58

What are the clinical findings in Emphysema?

Back 58

- Dyspnea
- Decreased breath sounds
- Tachycardia
- Late-onset hypoxemia due to eventual loss of capillary beds (loss of alveolar walls)
- Early-onset dyspnea

Front 59

What is the pathology of asthma?

Back 59

1) Bronchial hyperresponsiveness causes reversible bronchoconstriction
2) Smooth muscle hypertrophy & Curschmann's spirals (shed epithelium from mucous plugs)

Front 60

What triggers asthma?

Back 60

- Viral URIs
- Allergens
- Stress

Front 61

What are the clinical findings of asthma?

Back 61

- Cough, wheezing, dyspnea
- Tachypnea
- Hypoxemia
- Reduced I/E ratio
- Pulsus paradoxus
- Mucus plugging

Front 62

What is the pathology of Bronchiectasis?

Back 62

Chronic necrotizing infection of bronchi leads to permanently dilated airways, purulent sputum, recurrent infections, and hemoptysis

Front 63

What is Bronchiectasis associated with?

Back 63

- Bronchial obstruction
- CF
- Poor ciliary motility
- Kartagener's Syndrome
- Development of Aspergillosis

Front 64

What does an isolated prolonged PTT indicate?

Back 64

One of the following:
1) Factor XI, IX, & VIII deficiency
2) Presence of factor VIII inhibitor
3) Use of Heparin
4) Presence of lupus anticoagulant

Front 65

If the PT test is prolonged, what other test will automatically be abnormal?

Back 65

the INR will be prolonged as well (that is, what is monitored in Warfarin Therapy

Front 66

What does a prolonged PT (& INR) indicate?

Back 66

One of the following:
1) Warfarin therapy
2) Liver Disease
3) Factor VII deficiency
4) Vitamin K deficiency

Front 67

What does a combination of prolonged PT, INR, and bleeding time indicate?

Back 67

One of the following:
1) Warfarin therapy
2) Liver Disease
3) Factor VII deficiency
4) Vitamin K deficiency
5) vWF deficiency

NB: the same as PT & INR, + vWF for platelet

Front 68

What does prolongation of all coagulation parameters indicate?

Back 68

vWF deficiency or DIC

Front 69

What are the lab test results that indicate thrombocytopenia?

Back 69

1) Reduced Platlet Count
2) Increased Bleeding time
3) NORMAL PT & PTT

Front 70

What are the lab test results that indicate Hemophilia A or B?

Back 70

All normal, except increased PTT

Front 71

What are the lab test results that indicate von Willebrand disease?

Back 71

1) Increased Bleeding Time
2) Increased PTT

Front 72

What are the lab test results that indicate DIC?

Back 72

1) Decreased: platlet count
2) Increased: PT, PTT, & Bleeding Time

Front 73

What are the lab test results that indicate Vitamin K deficiency?

Back 73

Increased PT & PTT

Front 74

What are the lab test results that indicate Bernard-Soulier disease?

Back 74

1) Decreased platelet count
2) Increased bleeding time

Hint 74

Bernard-Soulier Disease: defect of platelet adhesion (reduced GP Ib)

Front 75

What are the lab test results that indicate Glanzmann's thrombasthenia?

Back 75

1) Increased bleeding time

Hint 75

Glanzmann's Thrombasthenia = defect of platelet aGgredation (reduced GP IIb-IIIa)

Front 76

What factors are tested by PT?

Back 76

Extrinsic factors: II, V, VII, & X

Front 77

What factors are tested by PTT?

Back 77

Intrinsic: ALL, except VII

Front 78

What are Lewy bodies?

Back 78

1) Pink inclusions (aggregation of alpha-synclein proteins) in neurons of the substantia nigra
2) Patients with Parkinson's or Lewy body dementia

Front 79

What are the clinical characteristics of Parkinson's?

Back 79

TRAP
1) Tremor (At rest)
2) cogwheel Rigidity
3) Postural instability

4) Bradykinesia

Hint 79

bradykinesia: "slow movement", a slowness in the execution of movement.

Front 80

What disease classically presents with myoclonic fasciculations?

Back 80

Creutzfeld-Jacob

Hint 80

1) Myoclonus: sudden, involuntary jerking of a muscle or group of muscles.
2) Fasciculation (or "muscle twitch"): a small, local, involuntary muscle contraction (twitching) visible under the skin arising from the spontaneous discharge of a bundle of skeletal muscle fibers.

Front 81

What type of muscle weakness is seen in Guillain-Barre syndrome and amyotrophic lateral sclerosis?

Back 81

symmetrical

Front 82

What types of diseases present with tongue fasciculations?

Back 82

degenerative neurological diseases (e.g. spinal muscular atrophy & amyotrophic lateral sclerosis)

Front 83

What is the pathology of Parkinson's disease?

Back 83

1) A degenerative disorder of the CNS
2) Histo: Lewy bodies (alpha-synuclein)
3) Gross: depigmentation of the substantia nigra pars compacta (loss of dopaminergic neurons)
4) Rare cases linked with exposure to MPTP (a contaminnant in illicit street drugs)

Front 84

Define "aphasia"

Back 84

Higher-order inability to speak

Front 85

Define "dysarthria"

Back 85

motor inability to speak

Front 86

Define Broca's aphasia.

Back 86

Broca's Broken Boca:

1) Nonfluent aphasia with intact comprehension
2) Broca's area: infereior frontal gyrus

Front 87

Define Wernicke's aphasia.

Back 87

Wernicke's is Wordy buy makes no sense: Wernicke's = "What?"

1) Fluent aphasia with impaired comprehension
2) Wernicke's area: superior temporal gyrus

Front 88

Define Global aphasia.

Back 88

1) Nonfluent aphasia with impaired comprehension
2) Both Broca's and Wernicke's areas are affected

Front 89

Define Conduction aphasia.

Back 89

1) Poor repetition, but fluent speech
2) Intact comprehension
3) Arcuate fasciculus: connects Broca's & Wernicke's areas

Front 90

Where is a lumbar puncture taken?

Back 90

Between L4 & L5 (Level of iliac crests)

Front 91

What structures are pierced in a lumbar puncture?

Back 91

1) Skin/Superficial fascia
2) Ligaments (Supraspinous, interspinous, ligamentum flavum)
3) Epidural space
4) Dura mater
5) Subdural space
6) Arachnoid

NOT PIA: Pia is not Pierced

Front 92

What is the likely tumor at the epiphyseal end of the femur in a 30-year-old woman?

Back 92

Giant cell:
1) Benign, primary bone tumor, aggressive
2) Radiography: double bubble or soap bubble sign
3) Histo: oval or spindle-shaped cells along with scattered multinucleated giant cells
4) Epidemiology: 20-40 year old, usually women

Front 93

What patients are most susceptible to chondrosarcoma?

Back 93

1) Older men (30-60)
2) Malignant cartilaginous tumor of the pelvis, spine, scapula, humerus, tibia, or femur.
3) May be primary bone or from an osteochrondroma
4) Gross: expansile glistening mass within the medullary cavity

Front 94

What is the most common benign bone tumor?

Back 94

osteochondroma: it occurs in men less than 25 years old, in the metaphysis of long tubular bones

Front 95

What is Ewing's sarcoma?

Back 95

Going out for Ewings & onion rings!

1) Aggressive malignant bone tumor; early met but responsive to chemo
2) Epidemiology: boys less than 15 years old
3) Histo: lamellated, "onion skin" periosteal reaction: uniform sheets of anaplastic, small blue cells
4) Gross: DIAPHYSIS of bones, pelvis, scapula, ribs
5) 11:22 translocation

Front 96

What is osteosarcoma?

Back 96

2) Epidemiology: Males, 10-20 years old
3) Gross: METAPHYSIS of long bones
4) Radiography: 2 growth patterns:
- Codman's Triangle: elevated periosteum
- Sunburst growth pattern: reactive bone formation

Front 97

List the 6 benign bone tumors.

Back 97

1) Osteoma
2) Osteoid Osteoma
3) Osteoblastoma
4) Giant Cell (Osteoclastoma)
5) Osteochondroma (exostosis)
6) Enchondroma

Front 98

List the 3 malignant bone tumors.

Back 98

1) Osteosarcoma (osteogenic sarcoma)
2) Ewing's Sarcoma
3) Chondrosarcoma

Front 99

What is an osteoma?

Back 99

1) Benign bone tumor
2) New pieces of bone grows on another piece of bone, often in the SKULL
3) Associated with Gardner's syndrome (FAP)

Front 100

What is an osteoid osteoma?

Back 100

1) Benign bone tumor
2) Interlacing trabeculae of woven bone are surrounded by osteoblasts
3) <2cm; proximal tibia or femur
4) Men <25 years old

Front 101

What is an osteoblastoma?

Back 101

1) Benign bone tumor
2) Interlacing trabeculae of woven bone are surrounded by osteoblasts
3) can be large; vertebral column
4) 20-40 year old Px

Front 102

What is a Giant Cell tumor?

Back 102

1) Locally aggressive benign tumor often around the distal femur, proximal tibial region (KNEE)
2) Radiology: "double bubble" or "soap bubble"
3) Spindle-shaped cells with mutinucleated giant cells
4) 20-40 year old Px

Front 103

What is a Osteochondroma?

Back 103

1) MOST COMMON BENIGN bone tumor
2) Mature bone with cartilaginous cap
3) Males <25 years of age
4) Origin: long metaphysis

Front 104

What is an enchondroma?

Back 104

1) Benign cartilaginous neoplasm found in intramedullary bone
2) Usually DISTAL extremities

Front 105

What is an osteosarcoma?

Back 105

1) 2nd most common primary malignant tumor of bone (after multiple myeloma)
2) Peat incidence: males 10-20 years old
3) METAPHYSIS of long bones: distal femur, proximal tibial region (knee)
4) Predisposing factors: Paget's disease of bone, bone infarcts, radiation, familial retinoblastoma
5) Radiography: Codman's triangle or sunburst pattern
6) Poor prognosis

Front 106

What is the mechanism of albuterol?

Back 106

Increases conversion of cAMP by adenylate cyclase:
- activates B2-adrenergic receptors on smooth muscle cells to activate adenylate cyclase.
- Adenylate cyclase then converts ATP to cAMP
- SMOOTH MUSCLES RELAX

Front 107

What lymphoma presents with aggressive onset of thrombocytopenia, anemia, and a lg. mediastinal mass?

Back 107

ALL (Acute Lymphoblastic Lymphoma):
- lymphoblasts in blood and bone marrow
- Epidemiology: children < 15 years old

Front 108

What makes a pneumonia "atypical"?

Back 108

1) insidious onset
2) Nonproductive cough
3) streaky interstitial infiltrate on chest radiograph
4) Most common cause: Mycoplasma (confirm with cold agglutinin test): contains cholesterol in membrane
5) Rx: Erythromycin or tetracyclin (b/c NO CELL WALL)

Front 109

What is the pathogenesis of acute intermittent porphyria (AIP)?

Back 109

1) Deficiency is porphobilinogen deaminase
- leads to a deficiency in heme synthesis & buildup of intermediates like aminolevulinic acid & porphobilinogen
2) Acute attacks of GI, neurological/psychiatric, & heart symptoms
3) Onset after puberty, more common in women
4) Symptoms can be brought on by drugs that INDUCE cytochrome P450

Front 110

What drug prevents growth, survival, and division of Estrogen-positive cancer cells and is thereby prescribed to certain breast cancer patients?

Back 110

Raloxifene: it also increases bone mass

Front 111

What is the expected respiratory carbon dioxide change expected for every 1-mEq/L bicarbonate increase?

Back 111

- The PCO2 should increase by 0.7mm Hg per 1mEq/L increase in bicarbonate.
- A normal bicarbonate is 24 mEq/L & a normal PCO2 is 40 mmHG.

Front 112

What are the causes of secondary cardiac tamponade?

Back 112

1) Trauma
2) hypothyroidism
3) Myocardial rupture
3) Complication of pericarditis (esp. due to malignancy or uremia)

Front 113

What is Beck's Triad?

Back 113

Signs of cardiac tamponade:
1) Distant heart sounds
2) Increased JVP
3) Hypotension

Also, pulsus paradoxus: systolic Bp drops by >10mmHg on inspiration

Front 114

What is the best treatment for cardiac tamponade?

Back 114

1) First: Immediate volume resuscitation (IV fluids) to maintain cardiac output & increase preload
2) 2nd: Positive iontropes (dobutamine & pericardiocentesis)

Front 115

What drug has the side effect of a brown darkening of the iris?

Back 115

Latanoprost: prostaglandin prodrug used to increase the outflow of aqueous humor in glaucoma or increased intraocular pressure
- side effect occurs in 10% of patients

Front 116

What is Wallenberg's syndrome?

Back 116

AKA: lateral medullary syndrome:
1) Stroke: dissection & thrombosis of vertebral artery & posterior inferior cerebellar artery

Front 117

What symptoms indicate an infarction of the lateral medulla?

Back 117

1) Spinal trigeminal nucleus: loss of pinprick sensation on the right face
2) Spinothalamic track: loss of pinprick sensation on the left below the neck
3) Inferior cerebellar peduncle: ataxia
4) Vestibular nucleus: nystagmus
5) Dorsal motor nucleus of vagus: hoarsness
6) Descending sympathetic fibers: Horner's syndrome (ptosis, miosis, anhidrosis)

Front 118

Where in the medulla do vibratory & proprioceptive info course?

Back 118

Medial: medial lemniscus

Front 119

What paraneoplastic syndrome is produced by small cell carcinoma?

Back 119

Cushing's syndrome (ectopic ACTH)

Front 120

What paraneoplastic syndrome is caused by squamous cell carcinoma of the lungs?

Back 120

Hypercalcemia: cells produce parathyroid homone-related peptide.

Front 121

What type of drugs for CHF cause a urinalysis with the following findings:
- pH 5.5
- increased NaCl, K, Ca concentrations

Back 121

Loops (like furosemide): Loops Lose calcium, stimulate acidification by increasing distal Na delivery & transport (this causes a favorable electric gradient for K & H+ secretion)

Front 122

Can there be "carriers" of AD diseases?

Back 122

No.

Front 123

In diseases that cause a decrease in intestinal cells, what step of lipid digestiong & absorbtion is impaired?

Back 123

Chylomicron formation, this step occurs within the intestinal cells (reestrification)

Front 124

What cause croup?

Back 124

Parainfluenza virus is a common cause

Front 125

What is arcus lipoides

Back 125

Opaque rings found on the endge of the iris that indicate type IIa familial dyslipidemia (familial hypercholesterolemia)

Front 126

What is the difference in prognosis for those heterozygous and homozygous patients with familial hypercholesterolemia?

Back 126

This disease is AD:
1) Homozygous: MI in 1st decade of life
2) Heterozygous: elevated LDL that may manifest in middle age

Front 127

What brain tumor is a feature of vonHippel-Lindau disease?

Back 127

Hemangioblastoma (benign) of the cerebellum or retina:
- Patients present with headache
- Findings include papilledema, nystagmus, & ataxia (& 2ndary polycytemia due to epo secretion by the tumor)
- Tx: surgical resection

Front 128

What is the cause of von Hippel-Lindau disease?

Back 128

- AD disease that results in a deletion of a tumor suppressor gene on Chromosome 3
- Features: cysts of kidney, pancrease, polycytemia, hemangioblastoma of cerebellum or retina

Front 129

What are the signs of chronic vitamin A (retinol toxicity)?

Back 129

- Ataxia
- Alopeica
- Headache
- Fatigue
- Bone & joint pain
- Muscle pain
- Visual disturbances
- Hyperlipidemia
- Hepatotoxicity
- Dry mucous membranes
- Lip Fissures

Front 130

What are the signs of acute vitamin A (retinol toxicity)?

Back 130

1) Nausea
2) Vomiting
3) Vertigo
4) Blurry vision

Severe: drowsiness & altered mental status

Front 131

What is the pathogenesis of the allergic reaction to aspirin

Back 131

increase leukotriene syntheses leads to bronchoconstriction: b/c the cyclooxygenase-catalyzed prostaglandin pathway is blocked

Front 132

What drug can stop the bronchoconstriction due to aspirin allergy?

Back 132

Zileuton: Inhibits the 5-lipoxygenase pathway to block the conversion of arachidonic acid to leukotrienes

Front 133

What are the most common arteries targed by peripheral atherosclerosis?

Back 133

1) abdominal aorta
2) Iliac
3) Femoral
4) Popliteal (can present with intermittent claudication)
5) tibial
6) popliteal

Front 134

What is the mechanism of action of zanamivir?

Back 134

Inhibits neuraminidase enzyme that is critical to the influenza life cycle (A & B) & blocks the release of progeny virons as there is no cleavage of neuraminic acid to release the viron with host cell membrane cover.

Front 135

What cell types and cytokines drive asthma?

Back 135

1) hyperresponsive T lymphocytes in the lung (esp. Th2)
2) Il-4, Il-5, Il-3

Front 136

What are the main causes of eosinophilia?

Back 136

- Asthma
- Neoplasms
- Parasites
- Collagen vascular diseases
- Allergic processes

Front 137

What is the microscopic pathology of hypertrophic obstructive cardiomyopathy (or asymmetric septal hypertrophy and idiopathic hypertrophic subaortic stenosis)

Back 137

AD in 50% of cases:
myofiber hypertrophy & disarray

Front 138

What triad indicates classic carcinoid syndrome?

Back 138

1) Chronic diarrhea
2) Intermittent facial flushing
3) Tricuspid stenosis murmur

Front 139

Under what conditions are carcinoid syndrome present?

Back 139

When there is a liver metastases of a GI carcinoid (b/c then the liver cannot metabolize the serotonin produced within the liver)

Front 140

What is the pathogenesis of the right heart valvular disease of cardinoid syndrome?

Back 140

Serotonin-mediated fibroelastosis

Front 141

What urine test finding is diagnostic of carcinoid syndrome?

Back 141

Elevated 5-HIAA

Front 142

Which viruses establish latency in the dorsal root gangila?

Back 142

1) Herpes simplex 1 & 2
2) Varicella-zoster

Front 143

What is one of the 1st signs seen in a post-MI biopsy within 12 hours of the infarction?

Back 143

Contraction bands @ the margin of the necrotic area due to elevated intracellular calcium & the resultant hypercontraction.

Front 144

What is the principle function of the anterior cruciate ligament?

Back 144

To prevent anterior subluxation (misalignment) of the knee relative to the femur anterior in the fully extended position.

Front 145

How does hydroxyurea help sickle cell patients?

Back 145

It increases fetal hemoglobin production in place of hemoglobin S & thereby reduces RBC sickling and complications there of.

Front 146

What infects does the spleen clear? What if the spleen is gone?

Back 146

1) Encapsulated bacteria
2) Prophylaxis with fluorquinolones and macrolides

Front 147

What are the 2 major clinical features of nephrotic syndrome?

Back 147

1) Edema: low plasma oncotic pressue due to protein wasting & sodium retention from the collecting tubules
2) Massive proteinuria, hypoalbuminemia, hypercholesterolemia

Front 148

What is Ortner's syndrome?

Back 148

An enlarged left atrium compresses the left recurrent laryngeal nerve:
- Causes hoarseness
- Is a branch of the vagus & innervates on "glossus", the palatoglossus

Front 149

What muscles does the hypoglossal nerve innervate?

Back 149

All intrinsic & extrinsic tongue muscles (except the palatoglossus, which is innervated by the vagus & helps to raise the back of the tongue)

Front 150

Explain the process of serum sickness? What type of immune reaction is it?

Back 150

- Type III: immune complex deposition (in skin: rash, in kidney: glomerulonephritis)
- Humoral immune response against foreign protein: 7-10 days later as antibodies must be produced (requires T-helper cells)

Front 151

What is the toxicity of oligomycin?

Back 151

This antibiotic blocks ATP synthesis by binding to the stalk of the ATP synthases. T/F it blocks protein re-entry to the matrix.

Front 152

What is the toxicity of 2.4 Dinitrophenol?

Back 152

It is an uncoupling protein that results in decreased ATP

Front 153

What is the toxicity of Antimycin A?

Back 153

Binds to cytochrome c reductase & prevents further continuation of the electron transport chain in ATP synthesis.

Front 154

What is the toxicity of Cyanide?

Back 154

Binds the Fe3+ of cytochrome oxidase a3 & prevents the last enzyme of oxidative phosphorylation & ATP production?

Front 155

What is Rotenone's toxicity?

Back 155

Inhibits transfer of electrons to ubiquinone & thus stops ATP production

Front 156

How does E. coli acquire the Shiga-like toxin that can cause bloody diarrhea & hemolytic-uremic syndrome?

Back 156

specialized tranduction transfer: a lysogenic bacteriophage incorporates foreign DNA into its host.

Front 157

What is conjugation?

Back 157

1 bac extends its mating pili to another without the F plasmid & transfers this plasmid to the 2nd bac (& maybe also some adjacent DNA)

Front 158

What is bacterial transformation?

Back 158

DNA is taken up directly from the environment by a bac

Front 159

What is bacterial transposition?

Back 159

DNA segments can jumpt to various locations within a genome as well as in a plasmid & can then by passed on.

Front 160

What does the trochlear nerve innervate?

Back 160

IV: superior oblique muscle. Injury leads to CN IV palsy: diplopia that worsens when they look down and away from the affected side

Front 161

What is the first line drug choice for BPH & what is that drug's mechanism of action?

Back 161

Tamsulosin:
- Smooth muscle tension is mediated by alpha-1-adrenergic receptors and these are selectively blocked.

Front 162

How do integrases treat HIV?

Back 162

Prevents the formation of a proviral infection

Front 163

What is the mechanism of the gram-negative rod Bordetella pertussis's toxin?

Back 163

- The A subunit inhibits membrane-bound Gi proteins that results in the accumulation of cAMP.
- This results in histamine sensitization, increased insulin synthesis, lymphocytosis, and the inhibition of phagocytosis.
- Result: whooping cough

Front 164

What is the mechanism of the alpha toxin of S. aureus and Streptolysin O of S. pyrogens?

Back 164

Binds to the membrane and allows ions and small molecules to enter the cell. This leads to swelling & eventual cell lysis.

Front 165

What is the mechanism of action of C. diptheriae's exotoxin & P. aeruginosa's exotoxin A?

Back 165

Inactivates elongation factor 2, causing pharyngitis & the pseudomembrane of the throat.

Rx: antitoxin (to prevent membrane spread & airway obstruction), penicillin or erthyromycin & DTP vaccine

Front 166

What is the mechanism of action of C. botulinum's toxin?

Back 166

Inhibition of the release of acetylcholine into the synaptic cleft. This leads to muscle weakness and paralysis?

Front 167

What is an endotoxin?

Back 167

Lipopolysaccharide-lipid A, a part of the bacterial membrane of all gram-negative bac (except L. monocytogenes)

Front 168

What is a common extraintestinal manifestation of Chron's disease?

Back 168

migratory polyartheritis

Front 169

Which has a higher cancer risk: UC or Crohn's?

Back 169

Ulcerative colitis

Front 170

Which disease almost always affects the rectum: UC or Crohn's

Back 170

UC: 50% of UC cases are even limited exclusively to the rectum

Front 171

Which condition is associated with sclerosing cholangitis: UC or Crohn's

Back 171

UC. This results in dilation of the biliary ducts, fibrosis of the liver & eventual hepatic failure.

Front 172

What is another name for Guillain-Barre syndrome?

Back 172

acute inflammatory demyelinating polyradiculopathy.

NB: radiculopathy: disease of spinal nerve roots and spinal nerves

Front 173

What is the histological findings in Guillain-Barre syndrome?

Back 173

- Segmental demyelination of areas of peripheral nerves (possibly including inflammation of the axons themselves)
- This results in slower conduction velocity of action potentials through peripheral nerves & spinal nerve roots

Front 174

How do you calculate Mean Corpuscular volume (MCV)?

Back 174

[Hematocrit/RBC count] x 10

Front 175

How can you histologically distinguish iron deficiency anemai from a thalassemia?

Back 175

- Thalassemia will have target cells
- Both will be microcytic & hypochromatic

Front 176

What is the Mentzer index?

Back 176

- RBC MCV/RBC
- < 13 in Px with iron deficiency anemia & <13 in patients with thalassemia

Front 177

What Mentzer index values distinguish iron deficiency anemia from thalassemia?

Back 177

> 13 is iron deficiency
< 13 is thalasemia

Front 178

What is Lambert-Eaton syndrome?

Back 178

Oat (small) cell carcinoma produces antibodies against presynaptic Ca channels @ the neuromuscular junction:
- proximal muscle weakness
- decreased deep tendon reflexes
- diplopia

Front 179

What is another name for nonbacterial thrombotic endocarditis?

Back 179

Libman-Sacks endocarditis (a symptom of SLE):
- single or multiple 1- to 3-mm verrucous deposits on the edge of either surface of the valve leaflets on any heart valve
- Usually, mitral, aortic, & tricuspid
- Histo: immune complexes, mononuclear cells, hematoxylin bodies, fibrin, & platelet thrombi
- Healing = fibrosis, scarring, & calcification = valve damage, regurg, & predisposition to bac. endocarditis
- fibrin & platelet thrombi may embolize systemically

Front 180

What is the Whipple triad & what does it indicate?

Back 180

1) episodic hypoglycemia, CNA symptoms (confusion, stupor, convulsions, & coma), & reversal of CNS symptoms with glucose
2) insulinoma (islet; that is, B cell tumor), either benign or malignant = elevated C peptide & insulin levels

Front 181

What are the characteristic symptoms of Hodgkin's lymphoma?

Back 181

- Night sweats, fever, & weight loss
- Also, mediastinal lymphadenopathy
- Histo: Reed-Sternberg cells: cells with large, "owl eye" binucleate cells; and reactive lymphocytes

Front 182

What is the short-term compensation for high-altitude hypoxia?

Back 182

An increase in 2,3-diphosphoglycerate (2,3-DPG) to release more O2 to tissues)
- This causes an increase in the P50 (partial pressure of O2 at 50% saturation of hemoglobin) and a right shift in the hemoglobin-O2 curve

Front 183

What are the principle functions of thyroid hormone in development?

Back 183

Bone Growth
CNA maturation

Front 184

What are the primary functions of somatostatin?

Back 184

1) Inhibits all GI & pancreatic exocrine & endocrine functions & inhibits the release of insulin
2) Inhibits GH & prolactin release by the pituitary

Front 185

What are the side effects of octreotide (exogenous somatostatin) administration?

Back 185

Nausea
Vomiting
Diarrhea
Gallstone-related illness

Front 186

What are the characteristics of Renal Tubular Acidosis (RTA)?

Back 186

Non-anion gap, hyperchloremic, metabolic acidosis

Front 187

What problem is associated with ngiotensin-converting enzyme inhibitors, timethoprim, and heparin?

Back 187

RTA IV: inability to secrete sufficient acid into the urine due to hypoaldosteronism
- hypoaldosteronism leads to decreased Na reuptake in the distal convoluted tubule & collecting duct
- This decreases excretion of K into the urine = kyperkalemia
- Hyperkalemia results into H+ ion shift to the extracellular fluid to maintain a K balance = metabolic acidosis
- The alkalotic environment of the renal tubule cells = low ammonia & H+ production & secretion. T/F the kidney cannot secrete the excess bodily acid
- Low ammonia = unbuffered urine & a low pH (below 5.5)

Front 188

What are the stimuli for insulin secretion?

Back 188

1) Hyperglycemia (primary stimulus)
2) Increase in fatty acids in the blood
3) Increase in amino acids in the blood
4) Cortisol
5) GH
6) Gastrointestinal inhibitory peptide

Front 189

What causes a physiological right-shift of the Oxygen-Hemoglobin curve in exercising persons?

Back 189

Right shift = decrease affinity of hemoglobin for O2 & more tissue-unloading of O2:

1) Decrease: tissue pH (up H+ concentration)

2) Increase: Temperature & partial pressure of CO2

Front 190

Why are excercising patients not loosing too much CO2 due to increased respiration?

Back 190

Tissue CO2 production due to aerobic respiration

Front 191

What is the formula for physiologic dead space (Vd)?

Back 191

tidal vlume x ([arterial CO2 pressure - expired air CO2 pressure] divided by the arterial CO2 pressure

or

Vt x ([PaCO2 - PeCO2] / PaCO2)

Front 192

What is the equation for renal blood flow? What can be done to increase flow?

Back 192

1) Flow = (change in pressure) / resistance
2) Decreasing resistance will increase flow:
- low levels of dpamine dilate renal arterioles
- bradykinin induces vasodilation of arterioles

Front 193

What is the equation for renal blood flow? What can be done to decrease flow?

Back 193

1) Flow = (change in pressure) / resistance
2) Increasing resistance will decrease flow:
- Stimulating afferant alpha1-adrenergic receptors will vasoconstrict the arteriole
- Stimulating afferant angiotension II receptors will vasoconstrict the arteriole

Front 194

What is the iodine status of a pregnant woman?

Back 194

Relative deficiency: due to increased renal clearance

Front 195

What lab values indicate an isolated respiratory alkalosis?

Back 195

low CO2 and low HCO3- levels

Front 196

What can cause an isolated respiratory alkalosis?

Back 196

hyperventilation due to anxiety/panic/pain (sympathetic stimulation) or high altitude or low O2

Front 197

What type of limited gas is O2, diffusion or perfusion?

Back 197

Perfusion: gas exchange can only increase or decrease with an increase or decrease in blood flow.

Front 198

What hormone maintains lactation?

Back 198

Prolactin from the anterior pituitary

Front 199

How does lactation prevent ovulation?

Back 199

- Inhibits secretion of GnRH (Gonadotropin-releasing hormone) from the hypothalamus.
- This inhibits secretion of LH and FSH from the anterior pituitary

Front 200

What are 2 common causes of hyperprolactinemia?

Back 200

1) Tumors
2) Antipsychotic drugs (dopamine antagonists = increase prolactin as dopamine usually inhibits prolactin release)

Front 201

Is pepsin a high or low pH active enzyme?

Back 201

Low; if antacids or used protein digestion can be impaired and patients will often have constipation

Front 202

What are the steps to DNA binding from circulation that a steroid hormone undergoes?

Back 202

1) Enters cell membrane (lipophilic)
2) Binds to an intracellular receptor in the cytoplasm or within the nucleus
3) The hormone-receptor complex transforms to reveal the hormone's DNA binding domain
4) The hormone binds to the DNA enhancer element & generates gene transcription.

Front 203

What respiratory cause of hypoxemia cannot be overcome by supplimental O2?

Back 203

A shunt, e.g. alveolar collapse, where blood flows through some capillaries without any gas exchange

Front 204

Which respiration problems result in a large A-a gradient?

Back 204

1) Shunt
2) ventilation-perfusion mismatch
3) Diffusion impairment

Front 205

How does imipramine change a patient's sleep pattern?

Back 205

- Decrease in stage 4 or slow wave (delta: large & slow wave) sleep.
- Stage 3 &4 is when disorders including night terrors, sleepwalking, and enuresis take place.

Front 206

How do central chemoreceptors respond to blood pH and partial gas pressures?

Back 206

1) Increase PCO2 or decreased pH = increase in total peripheral resistance
2) Mechanism: systemic vasoconstriction via sympathetic outflow

Front 207

How does the Na+/H+ exchanger in the proximal tubule facilitate Na & water resorption?

Back 207

1) H+ is pumped into the tubual lumen
2) Luminal H+ then returns to the tubular cell in the process of HCO3- resorption:
- H+ & HCO3- join to form H2O via carbonic anhydrase at the brush boarder
- H20 & CO2 diffuse into the tubular cell
3) HCO2 is regenerated in the tubular cell (& sent to the bloodstream) & H+ is left behind to participate in the exchanger again.

Front 208

What is the physiology of high fat food pain in patients with gallstones?

Back 208

CCK (cholecystokinin) is released in the duodenum after a fatty meal (& amino acids) to induce gallbladder contraction & thus the stone obstruction causes pain.

Front 209

Which Coombs test detects antibodies attached to RBCs & which detects antibodies circulating in serum?

Back 209

Direct: antibodies on RBCs
Indirect: antibodies in serum

Front 210

What is the correct order of MI blood test markers?

Back 210

1) Troponin I (elevated w/in 4 hours; remains for 7-10 days)
2) CK-MB (peaks w/in 24 hours & falls off) - best for monitoring post-MI for a new infarct w/in 1 wk
3) AST (increases over 1st 2 days; slowly declines): NOT SPECIFIC, like myoglobin
4) LDH (elevated 2-day post MI; remains elevated for 7 days)

Front 211

What is contraction alkalosis?

Back 211

- Loss of volume without losing bicarbonate
- E.G. Excessive diuresis with a loop diuretic; CF patient outside too long on a hot day

Front 212

What is the mechanism of action of Losartan?

Back 212

Inhibits angiotension II receptor: angiotension II is formed from angiotension I by the ACEnzyme in the lung capillaries

Front 213

During which interval does isovolumetric relaxation occur in the heart?

Back 213

During early ventricular diastole: ventricles relax with aortic & matral valves closed

Front 214

What side effect is shared by Demeclocycline & lithium?

Back 214

- Nephrogenic diabetes insipidus: these drugs inhibit the kidneys' response to ADH.
- DDx: Exogenous ADH administration or a hold on fluids will not improve symptoms.

Front 215

Which form of diabetes insipidus will be corrected by exogenous ADH administration?

Back 215

Central DI

Front 216

How is prolactin secretion regulated?

Back 216

- Prolactin increases dopamine synthesis & secretion from the hypothalamus
- Dopamine itself inhibits prolacin secretion from the anterior pituitary

Front 217

In what environment is one more likely to isolate deoxyhemoglobin? What about oxygemoglobin

Back 217

1) Deoxyhemoglobin (T form): low-O2 affinity state = peripheral capillaries
2) Oxyhemoglobin (R form): high O2 affinity state = pulmonary capillary bed

Front 218

What does the P wave represent?

Back 218

Depolarization of the atria (NOT contraction)

Front 219

What does the PR segment represent?

Back 219

- isoelectric (flat) portion of AV node conduction

Front 220

What does the PR interval represent?

Back 220

Time of initial depolarization of the atria to the initial depolarization of the ventricles (a pathological delay can occur here)

Front 221

What does the QRS complex represent?

Back 221

Vetricular depolarization

Front 222

What does the T wave represent?

Back 222

ventricular repolarization

Front 223

What does the ST segment represent?

Back 223

- Legnth from the end of QRS to initial deflection of T wave
- That is, the end of ventricular depolarization to the beginning of ventricular repolarization

Front 224

What does the QT interval represent?

Back 224

Time between the start of ventricular depolarization and the end of ventricular repolarization
- from the onset of the QRS complex to the end of the T wave

Front 225

What is the change in menapause that brings on the usual lab results of increased LH and FSH?

Back 225

Follicular depletion with a resultant decrease in estrogen secretion; this leads to no negative feedback on:
- gonadotropin-releasing hormone
- follicle-stimulating hormone (FSH)
- luteinizing hormone (LH)

Front 226

What is the action of infliximab?

Back 226

- It is a chimeric monoclonal antibody. It bings to soluble TNF-alpha (secreted by macrophages & found in high [] in Crohn's patients)
- Rx: Crohn's; a single infusion = clinical response in 65% of Px
- Side Effects: Headache, GI distress, increased upper respiratory infections

Front 227

What drugs, in combo with St. John's wort cause serotonin syndrome?

Back 227

SSRs (liek sertraline)

Seratonin Syndrome: mental status changes, autonomic changes (fever, diaphoresis, tachycardia, tremor, rigidity)

Front 228

What CSF findings indicate bacterial meningitis?

Back 228

- Increased protein
- Decreased glucose

Front 229

What is the most common cause of meningitis in infants (0-3 months old)?

Back 229

- Lysteria monocytogenes (gram positive rod)
- E. coli (gram - rod)
- Group B strep (gram + cocci)

Front 230

What is the anti-cancer action of etoposide?

Back 230

G2 phase action: inhibits topoisomerase II (results in irreversibel ds breaks in DNA) & prevents synthesis of components needed for mitosis

Front 231

Which cells are "output" cells of the cerebellum? What neurotransmitter do they employ?

Back 231

1) Purkinje cells
2) GABA: all these outputs are inhibitory

Front 232

What artery supplies both the head of the pancreas & the duodenum?

Back 232

gastroduodenal artery (branch of the celiac trunk) & superior mesenteric

Front 233

What are the 3 ps of Multiple Endocrine neoplasia type 1?

Back 233

3 tumors:
Pancrease
Pituitary
Parathyroid

Front 234

What physical diagnosis finding is characteristic of parathyroid-hormone-secreting adenoma?

Back 234

History of renal stones & neck nodule

Front 235

What is the genetics of myotonic dystrophy?

Back 235

Autosomal dominate with a CTG trinucleotide repeat with anticipation

E.G. a mom with a 50-100 repeat can have a symptomatic child with a 1000-1500 repeat

Front 236

Where is the narrowing in a Px with infantile coarctation of the aorta?

Back 236

Preductal: between subclavian artery & ductus arteriosus

Front 237

What is the MOPP regiment & what is it used to treat?

Back 237

1) Mechlorethamine, vincristine (Oncovin), Procarbazine, & Prednisone
2) lymphoma, Wilm's tumor, Choriocarcinoma

Front 238

What is the action of Vincristine?

Back 238

Vinca alkaloid: binds to tubulin & prevents polymerization into microtubules. T/F there is no mitotic spindle formation & no mitosis.

Rx: testicular carcinoma & Hodgkin's & non-Hodgkin's lymphomas

Front 239

What is the action of methotrexate?

Back 239

- It is a DNA and protein synthesis inhibitor
- Folic acid antagonist: inhibits dihydrofolate reducatase during the S phase

Front 240

What is a good drug to compliment methotrexate therapy?

Back 240

- Leucovorin: it is folinic acid & helps to replinish the body's supply of folic acid.
- T/F it inhibits the myelosuppressive effects of methotrexate

Front 241

What is the equation for PPV?

Back 241

- True Positives divided by those who tested positive
- Higher prevalence = higher PPV (increased numerator & denominator) & lower NPV (increased denominator only)

- Lower prevalence = lower PPV (increase in denominator only) & greater NPV (increase in numerator & denominator)

PPV = TP/(TP+FP)
NPV = TN(TN+FN)

Front 242

What is a complication of neonatal meningitis?

Back 242

1) Menigeal scarring: can lead to a decrease in CSF absorption by arachnoid villi (= nonobstructive/communicating hydrocephalus)
2) Tx: shunt

Front 243

What is a side effect of nonselective B-blockers?

Back 243

Vasoconstriction of peripheral vessels by blocking B2-mediated vasodilation

Front 244

How is T. gondii transmitted?

Back 244

Cysts in raw meat
Cat feces

Front 245

What is the treatment for toxoplasmosis?

Back 245

Sulfadiazine & pyrmethamine

Front 246

What class of antiarrhythmics is Lidocaine?

Back 246

Class Ib:
- it blocks sodium channels & decrease action potential duration
- selective for ischemic or depolarized purkinje & ventricular tissue

Other Ib: mexiletine & tocainide

Front 247

Which part of the myocardium is the first to undergo necrosis due to prolonged ischemia?

Back 247

ventricular wall (last to be perfused)

Front 248

Where is a Pancoast tumor located?

Back 248

Superior pulmonary sulcus; grows towards thoracic inlet & can damage structures that exit that region:
- bracial plexus, stellate ganglion, & sympathetic chain

Front 249

What are the 3 major mechanisms that limit the extent of coagulation?

Back 249

1) activity of tissue factor pathway inhibitor
2) activity of antithrombin III
3) activity of activated proten C with cofactor protein S

Front 250

When a Px is vitamin K deficient, why do they exhibit a coagulation overactivation?

Back 250

Protein C is not gamma-carboxylated & thus does not become active to cleave factors Va & VIIIa

Front 251

Where are bile acids recirculated to the liver?

Back 251

Terminal ilium via a Na-bile cotransporter

Front 252

Where is iron absorbed?

Back 252

Duodenum

Front 253

What drugs cause a lupus-like syndrome?

Back 253

1) quinidine
2) minocycline
3) isoniazid
4) valproate
5) hydralazine
6) penicillamide
7) sulfasalazine
8) procainamide

Front 254

What are the % risks for needle-stick contraction of Hep B, C, & HIV

Back 254

Hep B: 30%
Hep C: 10%
HIV: 0.3 - 0.45%

Front 255

What is Waldenstrom's macroglobinemia?

Back 255

B-cell neoplasm secreting lg. amounts of IgM:
- headaches & vision problems (impaired crania blood flow)
- weakness
- weight loss
- increased bleeding (due to inhibited clotting factors)
- monoclonal M spike on serum protein electrophoresis (lg. spike in the gamma region)

Front 256

Why are some B-blockers nephrotoxic?

Back 256

- B/C they can induse rhabdomyolysis & T/F excretion of myoglobin by the kidneys.
- Myoglobin is nephrotoxic = ATN

Front 257

What is an early sign of salicylate toxicity?

Back 257

Tinnitus

Front 258

What part(s) of the body are associated with the 2nd stage of Lyme disease?

Back 258

Skin, CNS, heart, & joins

Front 259

What is damaged when a Px presents with expressive aphasia?

Back 259

Broca's area (inferior frontal gyrus)

NB: this is near the primary motor cortex, so lower arm & face paralysis can also occur.

Front 260

What is the symptoms of a C. trachomatisis congenital infection?

Back 260

1) Eye inflammmation with purulent discharge & eyelid swelling at 5-14 days after birth
2) Can spread to the lungs & cause pneumonia between 4-11 weeks of life: rapid breathing, cough, & respiratory distress
3) Histo: BIG intracytoplasmic inclusions push the nucleus to the cell periphery.

Front 261

What bacteria presents with abdominal cramps, fever, & bloody diarrhea? (There are C-shaped organisms on stool analysis)

Back 261

Campylobacter jejuni (Rx: erythromycin)
- Untreated: Guillain-Barre syndrome - acute symmetric ascending muscle weakness with parethesias that begins in the lower extremities that results from an inflammation & demyelination of peripheral nerves

Front 262

How does the kidney respond to hypovolemic shock?

Back 262

Increases glomerular capillary hydrostatic pressure through intravascular fluid retention & efferent arteriole constriction to retain GFR

Front 263

What is the clinical presentation of Lesch-Nyhan syndrome?

Back 263

1) Hyperuricemia
2) Excessive production of uric acid = GOUT
3) Neuro: self-mutilation choreoathetosis, spasticity, mental retardation, aggressive behavior

Front 264

What kind of disorder is Lesch-Nyhan and what is the pathogenesis?

Back 264

1) Genetic: X-linked recessived
2) Deficiency in the production of hypoxanthine guanine phosphoribosyltransferase (HGPRTase) --> overproduction of purine & the accumulation of uric acid

Front 265

Patients with what genetic disorder are at risk for anemia when treated with isoniazid?

Back 265

1) G6PD deficiency
2) The anemia will show histologically as Heinze bodies (dark inclusions of precipitated globin chains) & bite cells
3) anemia can also be produced after exposure to sulfonamides, antimalarial drugs and oxidative stress.

Front 266

What intermediate of the TCA cycle inhibits the rate-limiting enzyme of glycolysis & activates the rate-limiting enzyme of fatty acid synthesis?

Back 266

Citrate
- inhibits phosphofructokinase
- activates acetyl CoA arboxylase

Front 267

What is the mechanism of diptheria toxin?

Back 267

Inhibits elongation factor EF2-alpha:
- Normally: EF2-alpha complexes with guanosine triphosphate & binds to the ribosome to initiate the translocation step of protein synthesis.

Front 268

Which antibiotics inhibit the 30S subunit of prokaryotic ribosomes?

Back 268

Tetracycline
Aminoglycosides

Front 269

What is the mechanism of action of the botulinum toxin?

Back 269

inhibition of acetylcholine release, which results in flaccid paralysis

Front 270

What results from damaging the accessory nerve root?

Back 270

winging of the scapula (trapezius) and impaired neck rotation (sternocleidomastoid)

Front 271

Damaging which nerve will result in a monotone voice?

Back 271

external laryngeal nerve (terminal branch of the superior laryngeal, a branch of the vagus)

Front 272

What does the phrenic nerve supply?

Back 272

- diaphragm, mediastinal pleura, pericardium
- it arises from C3-C5

Front 273

What nerve damage results in "waiter's tip" palsy?

Back 273

suprascapular nerve: loss of lateral roation of the humerus at the shoulder (supraspinatus & infraspinatus)

Front 274

What are the symptoms of 17-alpha-hydroxylase deficiency?

Back 274

- primary amenorrhea
- lack of 2ndary sexual characteristics
- elevated aldosterone = hypokalemia (low potassium) & hypertension

Front 275

What is the inheritance pattern for hereditary spherocytosis?

Back 275

Autosomal dominant defect in spectrin protein of erythrocyte membranes
- increased mean corpuscular hemoglobin concentration
- large RBCs w/o a central pallor
- Dx: osmotic fragility test
- late complications: bilirubin gallstones & cholecystitis

Front 276

How is autoimmune hemolytic anemia differentiated from hereditary spherocytosis?

Back 276

Autoimmune hemolytic anemia will have a positive direct Coomb's test

Front 277

What is the mechanism of HIV encephalitis?

Back 277

Infection of brain macrophages & microglia:
- Histo: microglial nodule = multinucleated giant cells (fusion of HIV-infected microglial cells

Front 278

What cells are infected by the JC virus?

Back 278

oligodendrocytes: results in progressive multifocal leukoencephalopathy

Front 279

What is the immunofluorescent picture in Berger's disease?

Back 279

AKA: IgA nephropathy (post-infectious nephritic)
- Nonlinear IgA deposits in the mesangium
- Rx: ACE inhibitors & corticosteroids

Front 280

How does Horner's syndrome affect pupil constriction?

Back 280

The pupil cannot dilate b/c there is an absence of norepinephrine (there is a lesion in the postganglionic neuron, which prevents neuroepinephrine from being released) & t/f no stimulation of the ciliary muscle

Front 281

How does cocaine dilate pupils?

Back 281

It inhibits norepinephrine reuptake and thus keeps the ciliary muscle stimulated

Front 282

What is the action of hydroxyamphetamine?

Back 282

It causes the release of norepinephrine

Front 283

If hydroxyamphetamine is given as an eye drop to diagnose a nerve lesion, what would a pupilary dilation indicate? What if there is no response?

Back 283

Dilation: a problem from the preganglionic neuron:
- since this drug initiates norepinephrine release in the postganglionic neuron, if the pupil dilates, then this neuron is not damaged and the problem is earlier in the pathway.

No change: the problem is with the postganglionic neuron as it SHOULD dilate with this drug

Front 284

What are the main "things" innervated by the 3-neuron oculosympathetic pathway?

Back 284

Sweat glands of the forehead
Smooth muscles of the eyelid
Pupilary ciliary muscle

- Interruption of any of the 3 neurons results in Horner's syndrome

Front 285

What characterizes the optical pathology of Horner's syndrome?

Back 285

Abscence of norepinephrine & no stimulation of the ciliary muscle: NO DILATION

Front 286

What is the usual presentation of preeclampsia?

Back 286

1) Hypertension
2) Proteinuria
3) Nondependent edema (face & hands)

Front 287

What are the symptoms of sever preeclampsia?

Back 287

1) Headache
2) Blurry vision
3) Right upper quadrant abdominal pain
4) Hyperreflexia

Rx: magnesium sulfate as a seizure prophylaxis

Front 288

What type of anti-depressants cause serotonin syndrome when combined?

Back 288

SSRIs (e.g. paroxetine, fluoxetine, sertraline, citalopram) + MAO inhibitors (e.g. Tanylcypromine, phenelzine)

Front 289

What are the symptoms of serotonin syndrome?

Back 289

1) Hyperpyrexia
2) Muscle rigidity
3) Cardiovascular collapse
4) Mental status changes

Front 290

What is the common presentation of glioblastoma?

Back 290

headache, focal neurologic findings, nausea, vomiting, seizure

Front 291

What is the histological difference between an anaplasitc astrocytoma and a glioblastoma?

Back 291

Astrocytoma lacks necrosis and vascular or endothelial cell proliferation

Front 292

Where in the brain are anaplasic oligodendrogliomas located?

Back 292

usually: frontal lobes

Front 293

Where are cystic astrocytomas found?

Back 293

posterior fossa of children (these are low-grade astrocytomas)

Front 294

What is tumor lysis syndrome?

Back 294

complicationof lymphomas & other bulky cancers due to cytotoxic therapy & dying tumor cell contents overwhelm the body:
- Excess potassium = heart arrhythmias & weakness
- Excess uric acid (DNA breakdown) = gout & renal failure

Rx: allopurinol (to reduce uric acid production) & glucose/insulin to combat hyperkalemia

Front 295

What are the Ann Arbor staging notation for lymphoma?

Back 295

I = single lymph node or single extralymph organ

II = >/=2 sites on the same side of the diaphragm

III = >/=2 sites on both sides of the diaphragm
- A without constitutional symptoms
- B without constitutional symptoms

IV = disseminated disease (extralymphatic organs)

Front 296

What is the Rx for chronic hepatitis B?

Back 296

Interferon-alfa to block viral RNA & DNA synthesis

Front 297

What is Foscarnet used for?

Back 297

Ganciclovir-resistant cytomegalovirus: binds to pyrophosphate binding site of viral DNA polymerase

Front 298

What is Ganciclovir used for?

Back 298

Cytomegalovirus

Front 299

What is Ivermectin used for?

Back 299

Onchocerciasis (River Blindness)

Front 300

What usually causes systemic miliary TB?

Back 300

Mycobacterium tuberculosis: hematogenous spread via seeding of the pulmonary venous return to the heart to affect the liver, bone marrow, spleen, adrenal glands, meninges...

Front 301

How does cirrhosis show up in a liver biopsy?

Back 301

bridging fibrous septae (that look like brad scars linking portal tracts)

Front 302

What processes lead to centrolobular necrosis of the liver?

Back 302

hypoperfusion + retrograde congestion = left or right-sided heart failure or shock

Front 303

What is the liver histological picture of a chronic alcoholic?

Back 303

Clear, macrovesicular globules of hepatic steatosis
- Grossly: large, yellow, & greasy
- Reversible

Front 304

What is the usual triad for adult normal pressure hydrocephaus (NPH)?

Back 304

"Wet, wobbly, & wacky": excessive cerebrospinal fluid production, decreased absorption, or both
1) Incontinence
2) Gait difficulty (Magnetic: feet appear to stick to the floor)
3) Mental decline

Rx: ventriuloperitoneal shunt
Dx: MRI to rule out a mass lesion

Front 305

What is the most common etiology of acute-onset of pleuritic chest pain in otherwise young, healthy men?

Back 305

Pneumothorax

Front 306

What is bronchiectasis?

Back 306

dilation of the bronchial tree secondary to mucus plugging (usually seen in Px with a history of repeated lung infections; e.g. CF Px)

Front 307

What are the cluster C personality disorders?

Back 307

Anxiour or worried with abnormal fears about relationships, separation, & control:
1) Avoidant
2) Obsessive-compulsive
3) Dependent

Front 308

What are the 2 most common porphyrias?

Back 308

Acute intermittent (AIP)
Porphyria Cutanea tarda (PCT)

Front 309

What is the mechanism of AIP (Acute intermittent porphyria)?

Back 309

Defect in the enzyme PBG (3rd step in heme synthesis): porphobilinogen deaminase (aka: uroporphyrinogen I synthase)
- Result: aberrant accumulation of ALA (aminoleuvlinate) & PBG
- Symptoms: neurovisceral: abdominal pain, muscle weakness, & anxiety/paranoia/depression & high PBG in urine (severe: port wine urine)

Front 310

What is the mechanism of Porphyria cutanea tarda (PCT)?

Back 310

Defect in the enzyme URO decarboxylase (5th step in heme pathway):
- aberrant accumulation of URO
- deficiency is inherited or acquired (iron, alcohol, estrogens, Hep C or HIV)
- Symptoms: photosensitivity, chronic, blistering lesions on sun-exposed skin, no neuropsychiatric signs

Front 311

What is the pathology of X-linked sideroblastic anemia?

Back 311

ALA synthase deficiency (the 1st & rate-limiting step in heme synthesis)

Front 312

What is erythropoeitic porphyria?

Back 312

Deficiency of ferrochelatase (no iron incorporation into protoheme)
- disorder begins in childhood with marked photosensitivity

Front 313

What catalyzes the oxidation of heme to biliverdin?

Back 313

Heme oxygenase

Front 314

What genetic defect results in Marfan's?

Back 314

Mutation of the fibrillin-1 gene on chromosome 15 = defective microfibrils
- elastin in aorta
- suspensory ligaments of the lens of the eye

Front 315

What precipitates DeQuervain's throiditis?

Back 315

Viral illness causes a transient hypothyroidism:
- tender thyroid gland
- elevated ESR
- fatigue, cold intolerance, cool skin, decreased delirium tremens

Rx: nothing

Front 316

What are the key dermatome locations for the following disc locations:
C2
C3
C4
T4
T7
T10
L1

Back 316

C2 = head (covers the poserior 1/2 of a skull cap)
C3 = upper neck
C4 = between neck & shoulders
T4 = nipples "T4 at the teat pore"
T7 = xiphoid process
T10 = umbilicus
L1 = inguinal ligament (Oblique in shape)

Front 317

What is the action of metformin?

Back 317

Stimulates glycolysis in peripheral tissues, decreases intestinal glucose absorption, & decreases hepatic gluconeogensis
- Side effects (of all biguanides): lactic acidosis; t/f always give hospitalized patients (who have to stop their metformin) IV insulin

Front 318

What is the mechanism of insul & insulin analogs?

Back 318

Bind to insulin receptor on cell membranes that activate tyrosine kinase that leads to glucose absorption.
- Result: increased glycogen storage in the liver & glycogen & protein synthesis in muscle

Front 319

What is the mechanism of sulfonylureas (glyburide & glipizide)?

Back 319

Stimulate the release of endogenous insulin stores: close potassium channels in B-cells that leads to an influx of Ca, cell, depolarization, & insulin release

Front 320

What is the mechanism of glitaxones (rosiglitazone, pioglitazone)?

Back 320

Thiazolidinediones: increase sensitivity to insulin
- Stimulate peroxisome proliferator-activated receptor-gamma; this leads to increased glucose uptake in muscle & adipose

Front 321

What is undulant fever?

Back 321

Infection by Brucella:
- E.G.: B. melitensis (gram -, coccobacilli, intracellular bac that stains with a modified acid-fast)
- From contaminated milk products or contact with sick livestock
- Symptoms: undulating fever, weakness, loss of appetite

Front 322

What bac is the cause of cat scratch?

Back 322

Bartonella henselae

Front 323

How does Pasteurella infection present?

Back 323

- Cellulitis, high fever, hepatosplenomegaly (septic arthritis in PEDs)
- Route of infection: Dog or cat bite

Front 324

What causes a rapid-onset food poisoning with nonbloody diarrhea after eating reheated rice?

Back 324

- Bacillus cereus exotoxin
- S/S: nausea, vomiting, diarrhea
- "food poisioning from Reheaded Rice (diarrhea)? Be Cerious!"

Front 325

What causes a late-onset food poisoning with bloody diarrhea after eating reheated rice?

Back 325

Campylobacter jejuni: enterocolitis

Rx: erythromycin or ciprofloxacin

Front 326

What is the treatment for Cholerae?

Back 326

- Prompt H2O & electrolytes replacement
- Tetracyclines to reduce the disease course

Front 327

What is used to treate a severe Shigella infection (bloody diarrhrea)?

Back 327

Fluroquinolones

Front 328

What are the 4 major causes of food poisioning, nonbloody diarrhea?

Back 328

1) Staphylococcus aureus
2) Clostridium perfringens
3) Enterotoxigenic E. coli (traveler's diarrhea)
4) Bacillus cereus

Front 329

What is the mechanism of Gemfibrozil?

Back 329

1) increases the activity of lipoprotein lipase & enhances clearance of triglycerides
2) Fibric acid derivative that acts on peroxisome proliferator-activated receptor-alpha protein

Front 330

What is the action of statins?

Back 330

Reduce cholesterol biosynthesis in the liver by preventing the formation of the precursor mevalonate

Front 331

What is the mechanism of action of ezetimibe?

Back 331

- Blocks cholesterol absorption in the small intestine brush boarder
- Usually dosed along with statins

Front 332

What is the action of resins (cholestyramine & colestipol)?

Back 332

Bind bile acids and steroids in the small intestine & prevent their absorption

Front 333

What is the most common cause of pneumonia in CF patients?

Back 333

Pseudomonas

Rx: Gentamicin

Front 334

What is the mechanism of action of aminoglycosides like gentamicin?

Back 334

Bactericidal: inhibit formation of the initiation complex & cause misreading of mRNA
- require O2 for uptake (ineffective against anaerobes)
- Use: severe gram - rod infections
- Tox: nephrotox, Oto, teratogenic

Front 335

What type of drug is Ampicillin & what is it used for?

Back 335

- Aminopenicillin
- penicillnase-sensitive
- combined with clavulanic acid to enhance spectrum
- Rx: Gram + & Gram - : H. influenzae, E. coli, Listeria, Proteus, Salmonella, enterococci, Shigella
- Tox: hypersensitivity & pseudomenbraneous colitis

Front 336

What can cause SIADH?

Back 336

- Cancer: lymphoma, sarcoma, carcinoma of duodenum or pancreas
- CNS: meningitis, brain abscess, trauma
- Pulmonary: oat cell carcinoma, TB, pneumonia, abscess

Front 337

What is the key call mediator in the pathogenesis of atherosclerotic plaque?

Back 337

Platlet-Derived Growth Factor: recruits platlets and smooth muscle to intimal lining to produce an extracellular matrix that becomes a fibrous plaque

Front 338

What is the pathogenesis of a vascular fatty streak?

Back 338

1) Endothelial Injury
2) Subendothelial space accumulates lipoproteins
3) lipoproteins are glycoslyated or oxidized and this recruits monocytes to the vessel walls
4) Monocytes enter the subendothelial space and convert to macrophages
5) Unregulated macrocytosis of the LDL cholestrol occurs that yields foam cells

Front 339

What does a hydrops fetalis newborn look like?

Back 339

- Gross hepatosplenomegaly & Ascities
- Peripheral edema & purpura

- Placenta is pale, thickened, & enlarged

Front 340

What are the finding in a patien with toxic aspirin ingestion?

Back 340

- Metabolic Acidosis with Respiratory alkalosis or Acidosis with anion gap
- Symptoms: coma, respiratory depression, cardiovascular collapse

Asprin Tox: increase sensitivity of respiratory centers in the brain, uncouple oxidative phosphorylation, increase metabolism, inhibit Krebs cycle & platelet aggregation

Front 341

When does Acetaminophen become toxic?

Back 341

When its metabolism is saturated & N-acetyl-p-benzoquinone imine (NAPQI) is produced. This damages hepatocytes
- NAPQI cannot be detoxified by endogenous glutathione
- Lab: Huge elevations in aspartate aminotransferase & alanine aminotransferase (due to centrilobar necrosis)

Rx: activated charcoal within 4 hours & N-acetylcysteine

Front 342

What confirms a Benzo overdose?

Back 342

Reversal of symptoms (coma & respiratory depression: both are rare) by flumazenil

Front 343

What is the toxicity of Ephedra?

Back 343

CNS & cardiovascular stimulation, arrhythmia, stroke, seizures

Front 344

What is the toxicity of drain cleaners?

Back 344

NaOH or KOH = GI erosion & metabolic alkalosis

Front 345

What is the equation for clearance? (L/min)

Back 345

Rate of drug elimination / plasma drug concentration

Front 346

How does spironolactone cause gynocomastia, testicular atrophy, and decreased libido?

Back 346

- It binds to steroid receptors outside the kidney
- Its therapeutic effect is as an antagonist at the renal aldosterone receptor in the DC tubule
- It is potassium-sparing

Front 347

What are the main side effects of B-blockers?

Back 347

impotence
bronchoconstriction
hypoglycemia
cold extremities

Front 348

What is the main action (& side effects) of hydrochlorothiazide?

Back 348

- Action: Inhibit luminal Na & Cl entry to the DC tubule cells, Potassium-wasting
- SE: hypokalemia, give potassium supplements

Front 349

How does long term steroid use induce diabetes?

Back 349

Decreased glucose tolerance & counterregulatory action of the hormone:
- increase glucose production by the liver by stimulating glconeogenesis & proteolysis in the skeletal muscle to release glucogenic amino acides into the vasculature

Front 350

What are teh 2 main causes of Diabetes insipidus?

Back 350

- Pituitary dysfunction
- Failure of kidneys to respond to ADH

Front 351

Why do Cushing's disease patients develop hyperpigmentation of the skin?

Back 351

- Primary pituitary adenoma secretes ACTH
- ACTH stimulates melanocytes

Front 352

Does steroid use result in hyper or hypotension?

Back 352

Hypertension due to the mineralocorticoid properties of steroids (increased Na retention)

Front 353

How does Cushing's syndrome manifest in muscle tissue?

Back 353

Wasting due to catabolic effects of cortisol

Front 354

What ADHD medication is not a controlled substance?

Back 354

- Atomoxetine - a selective norepinephrine reuptake inhibitor
- it has no abuse potential

Front 355

What is the drug treatment for carcinoid syndrome?

Back 355

Octreotide: somatostain analog that inhibits secretion from neuroendocrine tumors (also used with VIPomas that secrete vasoactive intestinal polypeptide)

Front 356

What does aflatoxin cause?

Back 356

1) Hepatocellular carcinoma
2) This toxin is produced by Aspergillus flavus growing on peanuts & grains and intercaltes into host DNA
3) Contamination is a problem in Asia & Africa

Front 357

How does AZT stop reverse transcriptase on a molecular level?

Back 357

It is converted in cells into a nucleoside triphosphate & becomes incorporated into DNA. However, without a hydroxyl at the 3' carbon, it cannot form a phosphate bond & elongate.

Front 358

What is the function of zonula occludens?

Back 358

Tight Junctions:
- Prevent leakage across the intracellular space
- Found toward luminal side of epithelial cells

Front 359

What is the function of zonula adherens?

Back 359

- Components: actin filaments & E-cadherins
- Connects cytoskeletal elements of neighboring cells
- Below zonula occludens
- Allows cells to create a functional unit

Front 360

What is the function of a desmosome?

Back 360

Aka: Spot-adhering junction
- Contents: keratin & desmoplakin (desmoglein), actin, & E-cadherin
- Function: joins small, discrete sections of neighboring cells

Front 361

What is the function of Gap junctions?

Back 361

- Function: Cell communication
- Structure: connexins with central channel

Front 362

What are the causes of eosinophilia?

Back 362

NAACP: (release Major Basic Protein)
1) Neoplasia
2) Asthma
3) Allergies
4) Collagen vascular diseases
5) Parasitic infection

Front 363

What are the main infections that can result in Gillain-Barre?

Back 363

1) Herpesvirus, CMV, EBV, HIV
2) Campylobacter jejuni gastroenteritis

+ stress

Front 364

How does E. histolytica infection present?

Back 364

It is an amoebal dysentery associated with liver abscess formation

Front 365

What foods can be contaminated with L. monocytogenes?

Back 365

- Delicatessen meats & soft cheese
- Gram + rod with tumbling motility

Front 366

What is prophylthiouracil used to treat?

Back 366

- hyperthyroidism: inhibits the synthesis of T4 & the peripheral conversion of T4 to triiodothyronine.
- (rare) Tox: agranulocytosis, rash, edema

Front 367

What is the clinical use of Leuprolide?

Back 367

- Infertility, prostate cancer, uterine fibroids
- MOA: Gonadotropin-releasing hormone analog = dosage suppresses release of LH & downregulates the hypothalamic-pituitary-gonad axis
- SE: gynecomastia, decreased libido, nausea, vomiting

Front 368

Which anticoagulant does not require any laboratory monitoring?

Back 368

LMWH = low-molecular-weight heparin
- activates antithrombin III
- administer subcutaneously

Front 369

What is the MOA of spironolactone?

Back 369

Potassium-Sparing diuretic:
- Competitive aldosterone receptor antagonest: Na reabsorption & K secretion are inhibited @ the cortical collecting duct
- it is a steroid

Front 370

What is the molecular picture of nephrogenic diabetes insipidus?

Back 370

Loss of arginine vasopressin receptor 2 function

Front 371

Which stage of the cardiac cycle is prolonged in a patient with atrial stenosis?

Back 371

- Isovolumetric contraction: it must overcome the resistance of the valve & open it
- Sound: ejection click & cresendo-decrescendo murmur @ right sternal boarder that radiated to the neck

Front 372

What is the pathogenesis of the tetralogy of Fallot?

Back 372

Anterosuperior displacement of the infundibular septum during development in utero:
- overriding aorta
- pulmonary stenosis
- right ventricular hypertrophy

Front 373

What is the classic behavior of a child with tetralogy of Fallot?

Back 373

They squat during cyanotic spells to compress the femoral arteries to decrease their right-to-left shunt

Front 374

What causes venous abnormalities that can lead to impotence?

Back 374

- Insufficient relaxation of smooth muscle due to excessive adrenergic tone or damaged parasympathetic innervation
- this can result in a leak into the dorsal & saphenous veins & results in venous outflow abnormality

Front 375

What is the normal physiology of an erection?

Back 375

Accelerated blood flow increases pressure within the intracavernosal spaces & this blocks penile venous outflow.
- abnormalities in venous outflow (e.g.e leak from dorsal vein to saphenous vein) can result in failure to attain &/or maintain an erection

Front 376

What is accumulated in Lesch-Nyhan syndrome?

Back 376

Uric Acid:
- There is a deficiency of HGPRT in the purine salvage pathway.
- T/F guanine & hypoxanthine cannot be recycled to IMP & GMP respectively
- Guanine & hypoxanthine are instead converted to uric acid

- ALSO: de novo purine synthesis is increased & this results in MORE uric acid

Front 377

What gene fusion is characteristic in Acut promyelocytic leukemia (APL)?

Back 377

t(15:17) = PML + retinoic acid receptor

Rx: retinoic acid to mature the leukemic cells

Front 378

What gene fusion is characteristic in Chronic myelogenous leukemia (CML)?

Back 378

- Philadelphia chromosome
- t(9:22): BCR-ABL fusion protein

Front 379

What genetic translocation results in Burkitt's lymphoma?

Back 379

t(8:14): C-myc (Ch. 8) & immunoglobulin heavy chain (Ch. 14) locus

Front 380

What is Ras?

Back 380

- a plasma membrane protein that has GTP binding and GTPase abilities.
- its activity is increased in some cancers BUT, it is not associated with translocations

Front 381

Which anti-inflammatory drug is best to avoid gastric side effects?

Back 381

Celecoxib: selective COX-2 inhibitor
- decreases conversion of arachiodonic acid to prostaglandin G2
- Prescribe with caution due to heart side effects

Front 382

How does COX-1 inhibition lead to ulcers?

Back 382

Removes the prostaglandin syntheses that is protective to gastric mucosa

Front 383

What is the mechanism of primary hemochromatosis?

Back 383

AR inheritance: mutation in HFE gene
- body over absorbs iron in the GI

Front 384

What are some causes of sideroblastic anemia?

Back 384

incomplete synthesis of heme:
- Drug interactions (ethanol, isoniazid, chloramphenicol)
- Lead poisoning
- Nutritional deficiencies of pyridoxine/copper
- genetic disorders

Front 385

What is the toxicity of tricyclic antidepressants?

Back 385

MOA: inhibit neuronal reuptake of norepinephrine, seratonin, & other amines
- Mental status changes
- Hypotension
- Anticholinergic tox: flushing, hyperthermia, dilated pupils, intestinal ileus, urinary retention
- Ventricular arrhythmias

Front 386

What day post MI is a patient at risk for ventricular wall rupture?

Back 386

4-7: severe hypotension & results in cardiogenic shock

Front 387

What is the preferred antibiotic for community-acquired lobal pneumonia (high fever, productive cough, acute onset)?

Back 387

ceftriaxone: broad spectrum, 3rd-generation cephalosporin against:
- S. aureus
- H. influenzae
- S. pneumoniae

Front 388

What is clindamycin used for?

Back 388

Anaerobics: (often combined with an aminoglycoside)
- penetrating wound infections of abdomen
- UTIs in women

Front 389

What is doxycycline particularly useful for?

Back 389

Px with renal failure needing an antibiotic:
- it binds to the 30S subunit & prevents attachment of aminoacylt-tRNA
- Rx: atypical pneumonia (Chlamydia & Mycoplasma)
- SE: GI distress, photosensitivity, rash

Front 390

What is the 1st line therapy for P. jiroveci pneumonia?

Back 390

Trimethoprim-sulfamethoxazole

Front 391

Which anemia is caused by lead poisoning?

Back 391

sideroblastic:
- Lead binds to sulfhydryl groups of heme-synthesis enzymes: alpha-aminolevulinic acid dehydratase & ferroketolase)

Front 392

What are the 4 toxicities of lead?

Back 392

1) inhibits heme synthesis (binds to alpha-aminolevulinic acid dehydratase & ferroketolase)
2) competes with Ca ions for binding to other molecules
3) inhibits membrane enzymes (e.g. 5'-nucleotidase & Na-K pumps) causing hemolysis, renal cell damage & hypertension
4) inhibits active vit. D production

Front 393

What drugs cause aplastic anemia?

Back 393

Chloramphenicol
Sulfonamides
Alkylating agents

Front 394

What lab test can distinguish between iron deficiency anemia and lead poisoning anemia? They both present with hypochromatic, microcytic anemia

Back 394

Transferrin saturation:
- In iron-deficiency, it is increased (b/c there is no iron to saturate)
- in lead poisoning, it is elevated or normal (b/c there is no iron loss)

Front 395

What is elevated in Vit. B12 deficiency?

Back 395

1) Homocysteine = No B12 co-enzyme for its conversion to methionine
2) Methylmalonic acid = No B12 for methylmalonyl-CoA mutase to convert this to succinyl-CoA & metabolize odd-chain fatty acid

Front 396

What are the clinical symptoms of B12 deficiency?

Back 396

1) Fatigue
2) Peripheral neuropathy
3) Macrocytic anemia

Lab: elevated homocysteine & Methylmalonic Acid

Front 397

What is the most common serum antibody seen in Multiple Myeloma?

Back 397

IgG (55%)
Iga (25%)

Front 398

In what cancer will a pathologist be able to see Auer rods?

Back 398

- Acute myelogenous leukemia
- These are in myeloblast cytoplasm

Front 399

What are the characteristics of Waldenstrom's macroglobulinemia?

Back 399

- Monoclonal IgM
- Epistaxis
- Bleeding Gums

Front 400

What are the common symptoms of Multiple Myeloma?

Back 400

CRAB:
hyperCalcemia
Renal insufficiency/failure
Anemia
Bone/Back pain (lytic lesions)

Front 401

What are the common physical findings in Rickets?

Back 401

Areas of bone growth:
- wrists (widened)
- ankles (widened)
- costrochondral junctions (rachitic rosary)

These are all unmineralized, soft oseoid

Front 402

What are the common lab findings in Rickets?

Back 402

Decreased: Ca, PO3, vit D, alkaline phosphatase

Increased: PTH

Front 403

What is vitamin D's main function?

Back 403

Promotes Ca & PO3 absorption from the GI

Front 404

What genetic mutation renders a patient immune to infection with certain strains of HIV?

Back 404

Mutated CCR5 (homozygous):
- CCR5 receptor is a chemokine receptor on macrophages that facilitates viral entry into cells.

Front 405

What is injured in the "straddle injury"?

Back 405

- When the urethra below the urogenital diaphragam (at the junction of the membranous & penile) ruptures due to trauma
- Result: urine flows into the scrotum & perineal region.

Front 406

What are the 3 parts of the male urethra?

Back 406

1) prostatic
2) membranous - through the urogenital diaphragm
3) penile

Front 407

What will cause the anterior bladder wall to rupture?

Back 407

- Fractured Pelvis
- Urine wile flow into the retropubic space

Front 408

What would cause a penile urethra rupture?

Back 408

- Crush Injury
- Urine will flow into the deep fascia of Buck within the penis

Front 409

What will cause the superior bladder wall to rupture (dome rupture)?

Back 409

- Forceful compression of a full bladder
- Urine will flow into the peritoneal cavity

Front 410

What will cause a urethral rupture above the urogenital diaphragm (@ the junction of the prostatic & membranous urethra)?

Back 410

- Fractured pelvis or improper catheter insertion
- Urine will flow into the retropubic space

Front 411

What is the toxicity of polymyxins?

Back 411

Nephro & Neuro: dizziness, drowsiness, confusion, nystagmus, blurred vision

Front 412

What is the MOA of polymxins?

Back 412

Bind to Gram - bacterial cell membrane phospholipids & act like a detergent

Front 413

What drugs commonly cause granulocytopenia (neutrophils, eosinophis, & basophils)?

Back 413

- Clozapine
- Ticlopidine
- Sulfasalazine
- Antithyroid drugs
- Trimethoprim
- Dapsone

Front 414

What drugs, especially in combination, cause ototoxicity?

Back 414

Aminoglycosides
Vancomycin

Front 415

What drugs ill precipitate a severe anemia with jaundice, pallor, dark urine, & back pain in patients with G6PD?

Back 415

Primaquine
Sulfonamides

Front 416

What is the treatment for ulcerative colitis?

Back 416

Sulfasalazine: compo of sulfapyridine (antibacerial) & mesalamine (anti-inflammatory)
- SE: malaise, nausea, sulfonamide tox, reversible oligospermia

Also, 6-mercatopurine & methotrexate can be used

Front 417

What is Sucralfate used for?

Back 417

Ulcers & traveler's diarrhea: it binds to an ulcer base & provides protection

Front 418

What is Infliximab used for?

Back 418

- Monoclonal antibody to tumor necrosis factor alpha
- Crohn's & a 2nd line for UC

Front 419

What is Nizatidine used for?

Back 419

- Peptic ulcer, gastritis, mild GERD
- Reversible histamine-2 blocker

Front 420

What is Omeprazole used for?

Back 420

- HYPERsecretory states:Peptic ulcer, gastritis, esophageal reflux, ZE syndrome
- Proton pump (H+/K+ATPase) of stomach parietal cells inhibitor
- SE: headache, GI distrubances

Front 421

What is Ondansetron used for?

Back 421

- Antiemetic
- 6-hydroxytryptamine-3 agonist that is centrally-acting

Front 422

What are the symptoms of atropine poisoning?

Back 422

- Blind as a bat: mydriasis
- Red as a beet: flushed skin
- Mad as a hatter: delirium & disorientation
- Hot as a hare: fever from inhibited sweat glands
- Dry as a bone: lacrimal gland inhibition - no tears or saliva
- Plugged Up: constipation & urinary retension

Front 423

What is the antidote for atropine poisoning?

Back 423

Physostigmine: reversibly inhibits acetylcholinesterases to increase the amount of acetylcholine at the cholinergic receptor
- ONLY use in SEVER overdose

Light poisoning: supportive care, activated charcoal, benzos

Front 424

What is Clonidine used for?

Back 424

Hypertension: it is an alpha2-receptor agonist

Front 425

What type of drug is Lisinopril?

Back 425

ACE inhibitor used for hypertensive Px.

Front 426

What type of drug is Metoprolol?

Back 426

Hypertension: a cardioselective B-blocker

Front 427

What are natural sources of atropine & scopolamine?

Back 427

Poisonous plants: deadly nighshade & jimson weed

Front 428

Which part of the nervous system controls accomodation or cycloplegia?

Back 428

parasympathtic control of the ciliary muscle via cholinergic receptors

Front 429

What action does Acetylcholine have at muscarinic receptors in the eye?

Back 429

- Miosis (pupil constriction)
- Ciliary muscle contraction (accommodation)

NB: atropine (a muscarinic agonist) has the oppose effect: mydriasis & cyloplegia. Physostigmine restores the parasympathtic response in atropine poisoning

Front 430

What is the MOA of Pilocarpine?

Back 430

It is an acetylcholine mimetic - causes miosis & contraction of the ciliary muscle
- Rx: open (wide-angle) & closed (narrow-angle) glaucoma

Front 431

How can you calculate the PPV if given the sensitivity, specificity and pre-test probability?

Back 431

PPV =
1) Convert the pre-test probability to an odds ratio
2) Calculate the the test's positive likelihood ratio (LR+) = sensitivity / (1-specificity)
3) Multiply #1 x #2

Front 432

How does etoposide induct apoptosis?

Back 432

It stabilizes topoisomerase II-DNA complex during the G2 phase & prevents G2 completion & DNA strands break. This triggers apoptosis.

Front 433

What is the MOA of paclitaxel?

Back 433

- Hyperstabilizes microtubules and directly prevent anaphase (M1 arrest)
- Rx: ovarian & adjuvant to breast cancer

Front 434

What is the MOA of Beomycin?

Back 434

Causes the formation of free radicals after binding DNA, which causes single- & double-strand breaks within the DNA

Front 435

Which TB drug induces p450?

Back 435

Rifampin

Front 436

What are the main drug types that induce the cytochrome p450 system?

Back 436

Rifampin
Fluconazole
Protease inhibitors
Digoxin
Warfarin
Oral Controceptives

Front 437

What is the MOA of ethanbutol?

Back 437

It inhibits arabinsyl transferase enzymes needed for mycobacterial cell wall formation

Tox: hyperuricemia, GI distress, optic neuritis, visual loss

Front 438

What is the toxicity of isoniazid?

Back 438

Hepatitis
hemolysis in G6PD Px
lupus-like syndrome
Neurotoxicity

Front 439

What is the MOA of streptomycin?

Back 439

Aminoglycoside that binds the 30S subunit & inhibits protein synthesis.

Tox: neuromuscular blockade & ototoxicity

Front 440

Which cancer causes parathyroid hormone-related peptide problems?

Back 440

- Squamous Cell
- Results in hypercalcemia & suppressed levels of PTH

Front 441

What causes central diabetes insipidus?

Back 441

- decreased ADH production
- hypernatremia & increased plasma osmolaity

Front 442

What newborn umbilical cord abnormality can indicated another congenital abnormality (usually cardiovascular)?

Back 442

A single umbilical artery (there should be 2: to take deoxygenated blood from the fetus to the placenta)

Front 443

What is the MOA of Methotrexate?

Back 443

- It is an analog of folic acid & inhibits dihydrofolate reducatase & thus prevents tetrahydrofolate regeneration (metabolically active folic acid
- Therefore DNA, RNA, & protein synthesis is decreased

Front 444

What is pyridoxine used for?

Back 444

Pyridoxine = vit. B6
- cofactor in amino acid catabolism, heme synthesis, & glycogen breakdown

Deficiency: angular stomatitis, glossitis, dermatitis, & seizures

Front 445

What does cobalamin deficiency result in?

Back 445

Vit B12 deficiency: decreased methionine synthesis from homocysteine
- megaloblastic anemia (no folate derivatives for DNA synthesis are recycled b/c methyltetrahydrofolate is not converted to tetrahydrofolate)
- paresthesias & ataxia due to subacute combined degeneration (of the dorsal & lateral spinal columns)
- Reduced epinephrine, creatine, & melatonin b/c methionine is a precursor

Front 446

What is the treatment for a benzodiazepam overdose?

Back 446

Flumazenil: a competitive antagonist of the GABAergic receptor

Front 447

What is the treatment for opiate overdose?

Back 447

Naloxone

Front 448

What can be given to counter a B-blocker overdose?

Back 448

Glucagon

Front 449

What happens after vasopressin binds to the V2 receptor?

Back 449

- Activation of a Gs to activate adenylyl cyclase
- Increased AMP then leads to the insertion of aquaporin proteins into the apical membrane of the collecting duct epithelium
- mutations in the V2 receptor can cause diabetes insipidus

Front 450

How do fibrates increase HDL?

Back 450

Induce the synthesis of the major HDL cholesterol apolipoproteins (apoA-1 & apoA-2)

Front 451

How do fibrates reduce lipids?

Back 451

- Increase lipoprotein lipase-mediated lipolysis & this removes triglycerides from the peripheral circulation
- E.G. Gemfibrozil & fenofribrate

Front 452

What is the mechanism of statins?

Back 452

Inhibit HMG-CoA reductase (3-Hydroxyl-3-methylglutaryl-CoA) the rate-limiting step of cholesterol biosynthesis

Front 453

What is the enzyme that converts arachidonic acid to leukotrienes?

Back 453

5-lipoxygenase

Front 454

What is the 1st committed step of fatty acid synthesis?

Back 454

The synthesis of malyonyl-Coa via Acetyl-CoA carboxylase

Front 455

What is the MOA of thrombolytics?

Back 455

- Indirect or direct assistance of the conversion of plasminogen to plasmin
- plasmin cleaves thrombin & fibrin clots

Front 456

What extra problem is associated with ovarian teratomas?

Back 456

Can contain thyroid tissue (struma ovarii) & cause a hyperthyroid state

Front 457

What lab value indicates that a fetus will have Down's?

Back 457

AFP reduction: "AFP goes down in Down's Syndrome"

Front 458

What lab value indicates a neural tube defect in a fetus?

Back 458

Dramatic increase in AFP (reduce risk with prenatal folate)

Front 459

What is the MOA of abciximab

Back 459

- Monoclonal antibody against the glycoprotein IIb/IIIa receptor on the surface of platelets
- It impairs platelet aggregation

Rx: acute coronary syndrome

Front 460

What is the MOA of heparin?

Back 460

Complexes with Antithrombin II and increases its activity by 2000-fold

Front 461

What is the treatment for Enterobacter species?

Back 461

Carbapenems (i.e. imipenem & meropenem) when resistant to penicillin/penicillinase via B-lactamase

Front 462

What is the mechanism of C. difficile infection?

Back 462

- Pseudomembranous colitis: Exotoxin that results in enterocyte death & watery diarrhea
- Often follows ampicillin or clindamycin treatment

Front 463

What is the toxicity of C. perfringens?

Back 463

Lecithinase exotoxin that results in myonecrosis, gas gangrene, & hemolysis

Front 464

What are the signs of nephrotic syndrome?

Back 464

1) Azotemia
2) Hematuria
3) Oliguria
4) Hypertension

Front 465

What is the initial treatment for esophageal dysmotility?

Back 465

Metoclopramide: promotility agent

Front 466

What is Ondansetron used for?

Back 466

- 5-HT3 receptor antagonist
- Used to treat refractory or severe nausea & vomiting

Front 467

What are the two types of diabetes insipidus (DI)

Back 467

- Central (reduced ability to produce ADH)
- Nephrogenic (lack renal response to ADH) & can be a rare toxicity of Lithium

Front 468

What is the toxicity of valproic acid

Back 468

- Liver & pancreatic toxicity along with neural tube defects if the patient is pregnant.
- This drug is an antiepileptic

Front 469

What is the risk factor for developing Ebstein's anomaly?

Back 469

Lithium exposure during gestation:
- apical displacement of the septal & posterior tricuspid valve leaflets = atrialization of the right ventricle & displacement of the anterior leaflet

Front 470

What is fetal hydantoin syndrome?

Back 470

Phenytoin-associated fetal defects:
- growth deficiencies
- skull & facial feature abnormalities
- mental retardation
- underdevelopment of nails in the fingers & toes

Front 471

What are the risk factors for the Tetralogy of Fallot?

Back 471

Phenytoin
Alcohol

Also: 22q11 syndrome association

Front 472

What physical symptoms characterize ALS?

Back 472

- Upper & lower motor neuron signs: fasciculations, hyperreflexia in lower extremities and areflexia in the upper limbs
- Biopsy of muscle: muscular atrophy due to lack of neuronal input

Front 473

What type of viruses are capable of genetic/antigenic shift?

Back 473

Those with segmented genomes that can exchange segments (e.g. influenza: negative-stranded RNA virus) & can result in periodic changes int he surface antigen of the virus:
- H antigens: hemaglutinin
- N antigens: neuraminidase

Front 474

What family of viruses is Influenza a member?

Back 474

Orthomyxovirus

Front 475

What viruses are a member of the paramyxovirus family?

Back 475

Parainfluenza
RSV
Mumps
Measles

Front 476

What is the MOA of amphetamines for ADD treatment?

Back 476

Promote the release of catecholamines (dopamine & norepinephrine):
- increases the concentration in the synaptic cleft
- Dopaminergic activity in the CNS stimulates & leads to increased attention

Front 477

When is atropine indicated for heart therapy?

Back 477

Advanced cardiac life support to block parasympathetic input to the heart:
- Increases heart rate

Front 478

What is the common MOA of cocains and tricyclic antidepressants?

Back 478

Block reuptake of catecholamines into the presynaptic terminals

Front 479

What is the MOA of Reserpine?

Back 479

Blocks catecholamine storage within the presyaptic neuron by preventing storage withing the presynaptic vesicles

Front 480

What tract is responsible for the dopaminergic control of prolactin?

Back 480

tuberoinfundibular: antagonists to D2-receptors in this region will cause hyperprolactinemia.

E.G. Chlorpromazine (antipsychotic) is such a drug that antagonizes this receptor.

Front 481

What tract is antagonized by typical anti-psychotics and thought to exacerbate negative symptoms of schizophrenia?

Back 481

Mesocortical (cognition pathway) D2-receptors

Front 482

What results in D2-receptor antagonism by chlorpromazine in the mesolimbic tract?

Back 482

Decrease in positive symptoms of schizophrenia (hallucination, delusions, & frank psychosis)

Front 483

What is the function of the nigrostriatal tract?

Back 483

Basal ganglia involved in movement production:
- antagonism of D2-Receptors results in Parkinson-like movement & tardive dyskinesia (typical antipsychotics act here)

Front 484

What is the DDx for organisms causing long branching filaments?

Back 484

Fungi
Nocardia asteroides
Actinomyces israelii

Front 485

What is the treatment for a Nocardia pneumonia?

Back 485

Sulfa-based antibiotic, IV, high dose: sulfamethoxazole

Front 486

What are the catalase, hemolytic, and coagulase properties of S. aureus?

Back 486

Catalase-positive
Coagulase-positive
B-hemolytic

Front 487

What are the catalase and coagulase properties of S. epidermis?

Back 487

Catalase-positive
Coagulase-negative

Front 488

What bacterial cause of pneumonia is a gram-positive cocci that grows in chains and possesses a glycoprotein capsule?

Back 488

S. pneumoniae; it is also bile soluble

Front 489

Which type of ulcer results in weight loss & pain with food?

Back 489

gastric

Rx: 14-day triple therapy
- Bismuth
- Omeprazole
- Amoxicillin or tetracycline

Front 490

What are the symptoms of acut gastritis?

Back 490

Nausea
Vomiting
Hematemesis

Histo: diffuse erythematous patches on the lumen of the stomach

Front 491

What is the MOA of Sildenafil?

Back 491

Inhibits cGMP phosphdiesterase (PDE5) which increases cGMP leading to smooth muscle relaxation in the corpus cavernosum to increase blood flow to the corpus vascularity

Front 492

What is Clomiphene used for?

Back 492

Female infertility:
- it is a selective estrogen receptor modulator and partial agonist of the estrogen binding site on the hypothalamus & pituitary
- it increases secretion of gonadotropin-releasing hormone

Front 493

What is the MOA of Alprostadil?

Back 493

Intraurethral prostaglandin pellet that increases arterial inflow & decreases venous outflow via binding G proteins & stimulating adenylyl cylase

Tox: priapism if given as an intracavernosal injection

Front 494

What structures run through the tarsal tunnel (posterior to the medial malleolus)?

Back 494

Superior to Inferior: "Tom, Dick, And Very Nervous Harry":
- Tibialis posterior tendon: plantar flexion & inversion
- flexor Digitorum longus tendon: plantar flexion of foot & flexion of the 2nd-5th toes
- posterior tibial Artery
- posterior tibial Vein
- tibial Nerve
- flexor Hallucis longus tendon

Front 495

What are fibromuscular dysplasias of the kidney?

Back 495

Inherent structural defects of the renal artery wall that impair perfusion:
- leads to stimulation of the renin-angiotension-aldosterone axis that leads to vasoconstriction & volume expansion
- Rx: surgery

Front 496

What is a catecholamine-screting tumor of the adrenal medulla?

Back 496

Pheochromocytoma:
- increased plasma epinephrine & norepinephrine
- Symptoms: hypertension, diaphoresis, headaches, heart palpitations

Front 497

What are the symptoms of Conn's syndrome (primary hyperaldosteronism)? What is the treatment?

Back 497

- New-onset hypertension
- Alkalosis & hypokalemia (can manifest as muscle weakness or paralysis)
- Low plasma renin

Rx: Aldosterone antagonist (e.g. spironolactone)

Front 498

What antidepressants have the best cardiac profile?

Back 498

1st Choice: SSRIs

2nd Choice: Monoamine oxidase inhibitors (MAOs)
- also good for BPH patients b/c there are no anticholinergic activity

Front 499

What causes "red man" syndrome (RMS)?

Back 499

Too rapid infusion of vancomycin

Rx: slow or pretreat with antihistamine

Front 500

What is a common sequela of Rotavirus infection?

Back 500

Transient lactose intolerance due to brush border of the small intestine being shed.

Front 501

Where can patients contract Chagas disease?

Back 501

Central & South America via the reduvidd bug
- chagomas (dermal granuloma)
- myocarditis
- CHF if not treated

Chronic: arrhythmias, dilated cardiomyopathy, megacolon, megaesophagus

Front 502

Where do G. lamblia trophozoites colonize?

Back 502

Duodenum & jejunum: cause malabsorption & diarrhea

Rx: Metronidazole

Front 503

What is Oral Rehydration Therapy? as used for Cholera?

Back 503

Glucose-containing sodium solution in a ration not exceeding 2 glucose molecules per 1 sodoum molecules
- prevents dehydration by shifting fluid from the intestinal lumen into the circulation as a 2ndary effect of glucose-coupled Na transport into the mucosal cells

Front 504

What is Gerstmann's syndrome

Back 504

Damage to the visual association cortex (angular gyrus):
1) Inability to distinguish right from left
2) Inability to identify fingers
3) Agraphia
4) Acalculia or dyscalcuia

Front 505

What results from injury to the left posterior inferior frontal lobe?

Back 505

Broca's (expressive aphasia) & (sometimes) brachiofacial weakness

Front 506

What results from injury to the left posterior superior temporal gyrus?

Back 506

Wernicke's (fluent/receptive) aphasia & may involve visual dificits

Front 507

What results from injury to the left sylvian region?

Back 507

global aphasia, hemianopia, hemiplegia

Front 508

What results from injury to the left temporopareto-occipital junction?

Back 508

Transcoritical sensory aphasia:
1) poor comprehension
2) good repetition
3) nonfluent speech

Front 509

What cause of sudden death does malignant hypertension predispose to?

Back 509

Thoracic aortic dissection: pain radiates to the back & ECG will appear normal!

Front 510

What does the Achilles tendon reflex test?

Back 510

S1-2 nerve roots
- a diminished deep tendon reflex = LMN injury

NB: "Count up"
Achilles reflex (S1, S2)
Knee jerk (L3, L4)
Biceps (C5, C6)
Triceps (C7, C8)

Front 511

What infections does the complement pathway clear?

Back 511

gram negative

Front 512

What are the most common causes of otitis & sinusitis?

Back 512

H. influenzae (gram -)
Moraxella catarrhalis (gram -)

Front 513

How do IgG & IgM bind to gram - back in the classical complement pathway?

Back 513

with the Fc region

Front 514

What is C7 radiculopathies?

Back 514

Damage (usually via herniation) to the C7 nerve root:
- Tricep weakness: elbow extension limited
- Weakness in extension of wrist & fingers
- Sensory: pain & paresthesia of the middle finger

Front 515

Do cervical roots emerge on top or below corresponding vertebrae?

Back 515

ABOVE

Front 516

What would a C4-C5 disc herniation result in?

Back 516

Impingement upon the C5 root: limited shoulder abduction
- Weak deltoid
- Weak infraspinatus
- Sensory: shoulder & upper, lateral arm

Front 517

What would a C5-C6 herniation result in?

Back 517

C6 nerve root problems:
-weak wrist extensors & biceps
- Absence of right bicep & brachioradialis relex
- Sensory: 1st & 2nd fingers

Front 518

Why is alkalosis coupled with potassium wasting?

Back 518

Kidneys avidly take up H+ to restore the pH and these are exchanged with potassium

Front 519

What is the DDx for target cells on a peripheral blood spear?

Back 519

HALT:
Hemoglobin C disease
Asplenia
Liver disease
Thalassemia

Front 520

What is within the omental foramen?

Back 520

hepatoduodenal ligament that contains the common bile duct, hepatic artery proper & hepatic portal vein

Front 521

What is the MOA of isoniazid?

Back 521

Inhibits mycobacterial cell wall formation by inhibiting enzymes required for mycolic acid synthesis.

Front 522

What is the MOA of Ethambutol?

Back 522

It inhibits arabinosyl transferase to decrease arabinogalactan (a component of mycobacterial cell walls)

Front 523

What is the MOA of pyrazinamide?

Back 523

Unknown; however, its activity requires conversion by pyrazinamidase

Front 524

What is the presentation of a patient with pheochromocytoma?

Back 524

Neoplasm of the chromaffin cells (neural crest derivatives that synthesize & release catecholamines):
- Hypertension (bursts or chronic)
- Palpitations
- Headache
- Tremor
- Sweating
- Sense of apprehension

Front 525

What syndrome develops rapidly (days to weeks) with adrenocortical insufficiency and an overwhelming bacterial infection (N. meningitidis), rapidly progressive hypotension, shock, DIC, & widespread purpura?

Back 525

Waterhouse-Friderichsen syndroma

Front 526

What is bronchiectasis?

Back 526

abnormal dilation of the proximal & medium-sized bronchi (>2mm in diameter) caused by destruction of the muscular and elastic components of the bonchial walls

Front 527

What Reid index value indicates chronic bronchitis and hyperplasia of submucosal glands?

Back 527

>0.4

Front 528

How can you definitively diagnose a B12 deficiency?

Back 528

Check methylmalonic acid levels:
- B12 is a cofactor for the conversion of of Methylmalonyl CoA to succinyl CoA
- Without B13, Methylmalonyl CoA is converted to methylmalonic acid

Front 529

What causes the "penis-at-12" phenomenon?

Back 529

5alpha-reducatase deficiency:
- genetic males with testes & ambiguous or female external genitalia
- @ puberty, increased testosterone causes masculinization of the external genitalia
5alpha reductase converts testosterone to dihydrotestosterone that is required in utero to develop external genitalia

Front 530

What does 21-hydroxylase do?

Back 530

It converts progesterone to deoxycorticosterone on the way to aldosterone
- without this, there is a virilization of the female genitalia at birth
- without this, there is no feedback inhibition on renin & Px have elevated Bp

Front 531

What does 17alpha-hydroxylase do?

Back 531

Converts pregnenolone & progesterone to 17alpha-hydroxypregnenolne & 17alpha-hydroxyprogesterone respectively
- Deficiency leads to increased sex hormone levels, decreased corisol levels & increased mineralocorticoid levels

Front 532

What deficiency causes chronic granulomatous disease?

Back 532

NADPH oxidase: no superoxides from molecular O2

Front 533

What is pregnenolone?

Back 533

an intermediate in the conversion of cholesterol into adrenal steroids

Front 534

What ovarian tumor presents with symptoms of hyperthyroidism in 5-15% of patients?

Back 534

Struma ovarii:
- monodermal teratoma that contains thyroid tissue
- Increased risk of malignant thyroid carcinoma arising from this tumor

Front 535

What can cross the vilous epithelial cell membrane of the small intestine via simple diffusion?

Back 535

free fatty acids & monoglycerides: breakdown product of triglycerides by pancreatic lipase & bile salts

Front 536

How are carbohydrates absorbed across the apical membranes?

Back 536

SGLT-1: glucose & galactose
GLUT5: fructose

Portal circulation access is through GLUT2 cotransporter

Front 537

What is the histological sign of extramedulllary hematopoiesis?

Back 537

dacryocytes or "teardrop cells"

Front 538

What is idopathic myelofibrosis?

Back 538

myeloproliferative syndrome in which bone marrow is gradually replaced by collagen fibrosis
- Lab: anemia, mild thromocytosis, mild neutrophilia
- Gradual bone marrow failure results in extramedullary hematopoiesis in spleen

Front 539

What is the DDx for target cells

Back 539

1) asplenia
2) alpha & beta thalassemia

Front 540

What is another term for hemoglobin clumping?

Back 540

Heinz Bodies (e.g. G6PD deficiency)

Front 541

What is the histological appearance of intravascular hemolysis?

Back 541

helmet cells & schistocytes

Front 542

What is the lab finding in a child with ITP (idiopathic thrombocytopenia purpura)?

Back 542

- Antiplatelet antibodies
- Thrombocytopenia
- Blood smear: large platelets due to increased production

Front 543

What is the genetics of Hunters & Hurlers?

Back 543

X-linked recessive

Front 544

What is the pathology of Hunter's & its clinical presentation?

Back 544

1) Pathology: deficiency in lysosomal iduronate sulfatase; accumulation of dermatan & heparan sulfate
2) Clinical: Mild mental retardation, hearing loss, coarse facies, hepatosplenomegaly, agressive behavior, airway obstuction, but NO corneal clouding

Front 545

What is the clinical presentation of Job's syndrome?

Back 545

1) Recurrent staph abscesses
2) Pruritic eczema (papulovesicular dermatitis)
3) Multiple "cold" (i.e. noninflamed) skin lesions

LAB: High levels of IgE:
- T-helper cells cannot produce IFN-gamma & thus do not activate phagocytic cells
- T/F -> a failure of neutrophil chemotatic response

Front 546

What are the lab values & symptoms of a patient with Wiskott-Aldrich

Back 546

MALE (x-linked)

Symptoms: (TRIAD)
- Recurrent pyrogenic infections
- Eczema (itchy erythematous rash)
- Thrombocytopenia


LAB:
- Elevated IgA, IgE
- Normal IgG
- Low IgM = pathology b/c there is no IgM response

Front 547

When is Amiodarone indicated & what are its toxicities?

Back 547

Indication: Vfib

TOX:
hypotension, PULMONARY FIbrosis, thyroid dysfunction, hepatotox, ocular changes, bradyarrhythmia & torsades

Front 548

When are Class IC agents (flecainide & encainide) indicated?

Back 548

Vtach or intractable supraventricular tachycardia

MOA: phase 3 of the action potential
Tox: increased post-MI mortality

Front 549

When is Procainamide indicated?

Back 549

1) Re-entrant & ectopic suptraventricular & ventricular tachycardia
2) MOA: (Class 1a Na-channel blocker) increase action potential duration & increased QT interval = decrease in myocardial excitability & conduction velocity

Front 550

What are the digoxin toxicities?

Back 550

- Color vision disturbances (esp. yellow-green)
- Nausea
- Vomiting
- Diarrhea
- Arrhythmias

Front 551

What is the MOA of Digoxin?

Back 551

Directly inhibits Na+/K+ATPase, this indirectly inhibits the Na+/Ca2+ exchanger & increases intercellular calcium.
- POSITIVE INOTROPY
- Rx: CHF & atrial fib

Front 552

What is a toxicity of Quinine?

Back 552

torsades de pointes
- This drug is an isomer of quinidine, an antiarrhythmic
- Antiprotozoal action: prevents separation of dsDNA & thus inhibits DNA replication & transcription

Front 553

What is the treatment for Chagas?

Back 553

nifurtimox

Front 554

What are the 6 most common causes of DIC?

Back 554

1) Gram - sepsis
2) Malignancy
3) Acute pancreatitis
4) Trauma
5) Transfusion reactions
6) Obstetric complications

Front 555

What infections are sickle cells, asplenic patients more at risk for?

Back 555

Encapsulated Organisms:
- Pneumococci
- Meningiococci
- Haemophilus

& Salmonella osteomyelitis

Front 556

@ what level of saturation does glucose stop being reabsorbed in the proximal tubule via the Na-gluclose cotransport?

Back 556

200 mg/dl

Front 557

What is the pathogenesis of Bruton's?

Back 557

X-linked agammaglobulinemia:
- NO signaling molecule (Bruton's tyrosine kinase) to tell B cells to develop = NO immunoglobulins (low IgG & IgM, NO IgA) b/c of a mutation on the X chromosome (Xq21.22)
- Susceptible to extracellular pyogenic bacterial infections: H. influenzea, S. pyogenes, S. aureus, S. pneumoniae

Front 558

If a patient has no T lymphocytes, what infections are they susceptible to?

Back 558

Viral & intracellular bacteria

Front 559

What cell type should be stimulated when a patient is at risk for neutropenia & throbocytopenia (e.g. because of cancer chemo)?

Back 559

Meloid stem cell: progenitor of neutrophils, basophils, eosinophils, macs, & platelets

Front 560

What enterococcus infection treatment can lead to pseudomembrane formation?

Back 560

ampiclin

Front 561

What anaerobic bacteria infection can result in pseudomembranous colitis when treated with Clindamycin?

Back 561

Bacteroides Fragilis

Front 562

What metabolic disease can mimic Parkinson's?

Back 562

Wilson's: copper builds up in the putamen
- Dx: low leves of serum ceruloplasmin, increased heaptic copper content, & increased urinary copper excretion
- Rx: D-penicillamine (copper chelator)

Front 563

Why do patients on repeated broad spectrum antibiotics develop spontaneous bleeds?

Back 563

- Gut flora are wiped out & thus Vit. K is not produced & there is a deficiency in the Vit. K clotting factors: II, VII, IX, X, C & S.
- VII is deficient 1st b/c it has the shortest 1/2 life & thus prothrombin time is prolonged 1st.

Front 564

What vein is the source of the bleed when an alcoholic bleeds from the mouth?

Back 564

Left gastric (b/c of the anastomoses between the left gastric and the azygos)

Front 565

What is the MOA of Gemcitabine?

Back 565

- Inhibits DNA polymerase & ribonucleotide reductase when phosphorylated intracellularly
- It inhibits nucleotide synthesis by inhibiting the formation of deoxyribonucleotides

Front 566

What is the MOA of Cyclophosphamide?

Back 566

- Alkylating agent: alkylates DNA (esp. at the N7 position of guanine) that results in interstrand linkages
- This leads to DNA strand breaks & abnormal base pairing.
- T/F Interferes with DNA replication

Front 567

What is the MOA of Dactinomycin?

Back 567

Binds to & intercalates with dsDNA to prevent RNA synthesis (particularly rRNA)

Front 568

What is the MOA of Etoposide?

Back 568

- Inhibits topoisomerase II & t/f causes dsDNA breaks & interferes with cell division at the late-S to G2-phase

Front 569

What drugs should not be combined with cephalosporins (e.g. cefoxitin)?

Back 569

- Aminoglycosides (Tobamycin, gentamicin, streptomycin).
- The combination results in ATN which reduces GFR & increases serum creatinine. Can be reversed with discontinuation of the drugs

Front 570

What is the scope of Azithromycin and what are it's SEs?

Back 570

- Gram + organisms
- Allergic hepatitis & Thrombophlebitis

Front 571

What is the main SE of piperacilin?

Back 571

- Hypersensitivity in 10% of patiensts
- Effective against Klebsiella

Front 572

What is the difference in cough between croup & epiglottitis?

Back 572

- Croup: barking (leads to inspiratory stridor)
- Epiglottitis: stridor & hoarseness (leads to respiratory distress & can require surgery to establish an airway)

Front 573

What two diseases can causes a dilation of the aorta & dilation of the aortic ring that results in aortic regurgitation?

Back 573

1) T. pallidum (syphilis)
2) Coarctation of the aorta

Front 574

What heart murmur is associated with congenital bicuspid aortic valves?

Back 574

Crescendo-decrescendo sytolic ejection following an ejction click: aortic stenosis (resulting from valvular calcification)

Front 575

What heart pathology is associated with Ehlers-Danlos syndrome?

Back 575

Mitral valve prolapse

Front 576

What is the most common heart pathology after chronic rheumatic heart disease?

Back 576

mitral stenosis

Front 577

What does an ST-elevation indicate? What about an ST-depression? Q wave?

Back 577

ST-Elevation = transmural
ST-Depression = subendocardial
Q wave = transmural

Front 578

What is the MOA of the cholera toxin

Back 578

- ADP ribosylation of the GTP-binding protein
- Keeps adenylate cyclate in the active state & thereby increases chloride secretion

Front 579

What is the most common non-Hodgkin's lymphoma?

Back 579

Follicular t(14:18), bcl-2 protein (antiapoptotic) overproduced

Front 580

What translocation is associated with APL version of AML?

Back 580

t(15:17)
- Rx: all-trans retinoic acid to restore differentiation & conventional chemo

Front 581

What receptors do Heroin & other opiates target?

Back 581

u stimulation in brain and GI:
- Brain = pleasure
- GI = decreased motility & constipation

Front 582

How does Clofibrate increase the risk of gallstones?

Back 582

- It up regulates lipoprotein lipase (to increase triglyceride clearance from the bloodstream) but down regulates the rate of bile acid secretion.
- Bile is supersaturated with cholesterol & this increases the risk for stones

Front 583

What is the fucntion of Transforming growth factor-Beta?

Back 583

Dampens the immune response

Front 584

What is the function of Clara cells?

Back 584

1) Location: terminal bronchiole
2) Produce the protein component of surfactant
3) Transport Cl ions
4) Site of cytochrome p450-dependent mixed-function oxidase in the lung

Front 585

What are Bronchial cells of Kulchitsky?

Back 585

Endocrine cells of the trachea:
- vesicles contain ADH, serotonin, calcitonin, somatostatin

Front 586

Where do gram + organisms inhibit penicillin?

Back 586

Those with B-lactamase--including some S. aureus strains--secrete it into the surrounding space (there is no space between the cytoplasmic membrane & the peptidoglycan layer of the cell wall)

Front 587

What acne drug is absolutely contraindicated for pregnant women?

Back 587

isotretinoin

Front 588

What are the microbio risk factors for B12 deficiency?

Back 588

H. pylori
D. latum infection

(both can affect directly/indirectly absorption in the terminal ilium)

Front 589

What areas of the CNS are affected by a B12 deficiency?

Back 589

1) Dorsal Columns: loss of propioception, pressure, vibration, & light touch
2) Lateral corticospinal tract: descending fibers to control limb movement
3) Spinocerebellar tract: modulation of movement & gait

Front 590

What is the triad of a molar pregnancy?

Back 590

1) Hyperemesis
2) Vaginal bleeding
3) Hyperthyroidism

Front 591

Why does a molar pregnancy present with hyperthyroidism?

Back 591

B-hCG has a alpha subunit shared with TSH & can sometimes cross-react with the TSH receptor

Front 592

What Bunyavirus can cause ARDS?

Back 592

Hantavirus - transmitted via rodent droppings & saliva

Front 593

What are the symptoms of PMR associated with giant cell arteritis?

Back 593

Aching of proximal muscles & girdle stiffness

Front 594

What is the MOA of Vancomycin?

Back 594

Gram +s: prevents the cross-linking of D-ala-D-ala subunits of the bacterial cell wall

Front 595

What is the MOA of Doxycycline?

Back 595

Binds the 30S ribosomal subunit and prevents aminoacyl-tRNA attachment

Front 596

What is the definitive test for chronic granulomatous disease?

Back 596

- Nitroblue tetrazolium dyn reduction: negative result

Front 597

What is the pathogenesis & presentation of Ataxia-telangiectasia?

Back 597

- Defect in DNA repair enzyme (Ch. 11q22-23 mutation) & IgA deficiency
- Presentation: cerebellar problems (ataxia) & spider angiomas (telagiectasia) @ a young age
- Also: impaired organ maturation, x-ray hypersensitivity, predisposition to malignancy

Front 598

What is the most common selective immunoglobulin deficiency?

Back 598

IgA: sinus & lung infections

Front 599

What is the classic presentation of Bruton's agammaglobulinemia?

Back 599

- X-linked affected Male
- Normal T-cell count
- Recurrent bac infections after 6m = . influenzae, S. pneumo, S. aureus

Front 600

What is neuroleptic malignant syndrome?

Back 600

Life-threatening extrapyramidal side effect of antipsychotic agents:
- hyperpyrexia
- autonomic instability
- severe rigidity

Rx: Dantrolene (muscle relaxant), discontinuation of all neuroeptics, & supportive care

Front 601

What is treatment for a benzo overdose?

Back 601

Flumazenil (competative antagonist at the y-aminobuteric acid receptor

Front 602

What is the period of maximum susceptibility to teratogens?

Back 602

Organogenesis: between weeks 3 & 8 of development

Front 603

What is the fetal period of resistance?

Back 603

Week 1 & 2: either the fetus will be survive the teratogen or it will fail to survive at all. "all-or-none" response

Front 604

What are possible squalae of celiac sprue?

Back 604

1) T-cell lymphoma
2) Dermatitis herpetiformis (pruritic papular lesions located on the trunk & extensor surfaces)

Front 605

What is the electron & light microscopic picture for membranoproliferative glomerulonephritis (MPGN)?

Back 605

- Electron: subendothelial "hump-like" immune deposits & mesangial interposition into the capillary wall
- Light: tram-tracking of capillaries

- Young Px (8-30 years old)

Front 606

What is the difference between primary and 2ndary Membranoproliferative glomerulonephritis?

Back 606

1) Primary = idiopathic
2) 2ndary = hep C & B, cryoglobulinemia, lupus, rheumatoid arthritis, maligancy cause

- In either case, 20 years to end-stage renal disease

Front 607

What is Berger's disease?

Back 607

IgA nephropathy:
- IgA in the mesangium
- most common cause of nephritic syndrome worldwide
- Concurrent with an upper respiratory infection

Front 608

How is Warfarin monitored?

Back 608

Prothrombin time (PT): prevents synthesis & gamma-carboxylation of vitamen K-depenent factors (II, VII, IX, & X, proteins C & S) via vit. K antagonism

Mneumonic: WEPT: Warfairin, Extrinsic, PT

Front 609

What muscle lowers the jaw?

Back 609

Lateral pterygoids: innervated by mandibular branch of the trigeminal

"Lateral Lowers, M's Munch"
M = Masseter, teMporalis, Medial pterygoid

Front 610

What are the classic lab findings for obstructive jaundice?

Back 610

- Elevation in alk phosphatase & Direct bilirubin
- Decreased Urine urobilnogen

Light stools

Front 611

What is the treatment for Gilbert's disease?

Back 611

Indirect hyperbilirubinemia: mild decrease in glucoronyltransferase activity

Rx: phenobarbital

Front 612

What is the difference between direct and indirect bilirubin?

Back 612

Direct: conjugated
Indirect: unconjugated

Front 613

What are the 2 main risk factors for hepatocellular carcinoma?

Back 613

1) Chronic hepatitis
2) Exposure to toxins (aflatoxin)

Front 614

What is the histological pattern of Creutzfeld-Jakob disease (CJD)?

Back 614

spongiform degeneration:
- vaculated appearance of the cortex due to deposition of abnormal PrPsc prtoein along with reactive astrocytosis
- decreased number of neurons in the cortex in the absence of inflammatory changes

Front 615

What is the clinical presentation of Creutzfield-Jakob disease (CJD)?

Back 615

- Rapidly progressive demintia & ataxia (cerebellar involvement) & involuntary muscle jerks "startle myoclonus)
- Die within 6 m., onset in the 7th decade

Front 616

What disease causes hemosiderosis & gliosis of the mamillary bodies?

Back 616

Wernicke-Korsakoff syndrome = secondary to vitamin B1 (thiamine) deficiency in chronic alcoholics

- Hemosiderin is due to repeated hemorrhages

Front 617

What are the 3 phases of posterior pituitary acute trauma?

Back 617

1) Ceasation of secretion of ADH
2) Death of pituitary: release of all stored ADH
3) Persistent diabetes insipidus dues to injury to posterior pituitary

Front 618

What does a mild B6 deficiency cause?

Back 618

- Reduced decarboxylation reactions
- Inhibited neurotransmitter production: symptoms of depression, irritability, confusion, convulsions
- Cheliosis & glossitis
- Microcytic anemia

- Always supplement with isoniazid treatment b/c isoniazid inactivates pyridoxine by binding with B6

Front 619

What distinguishes a case of phyelonephritis from a UTI?

Back 619

Presence of WBC casts in the urine. Indicates renal parenchyma involvement

Front 620

What causes bilateral acoustic neuromas?

Back 620

Aka: vestibular schwannomas

Cause: Neurofibromatosis Type 2
- Mutation of the summor suppressor on Chromosome 22q

Symptoms: hearing loss, headache, tinnitus, vertigo

Front 621

What is the mutation involved with Wilms' tumor?

Back 621

Loss of WT1 tumor suppressor gene on chromosome 11q

Front 622

What genetic mutation ca result in reintoblastoma and osteosarcoma?

Back 622

Rb tumor suppressor gene on chromosome 13q

Front 623

What chromosomal abnormality results in Li-Fraumeni syndrome?

Back 623

- AD: Loss of p53 tumor suppressor on Chromosome 17p
- Leaves patients at a significant rick for malignancy as children or young adults: osteosarcoma, soft-tissue sarcomas, early-onset breast cancers, adrenocortical tumors, leukemias

Front 624

What genetic mutation can cause colorectal cancer?

Back 624

Loss of the APC tumor suppressor gene on chromosome 5q

Front 625

What is the role of the pylorus?

Back 625

limit the rate of gastric emptying: it contracts in response to each peristalic wave

Front 626

How does swallowing work?

Back 626

1) Initiation: touch receptors near the pharyngeal opening are stimulated
2) Signals are sent to the swallowing center in the medulla & lower pons
3) Swallowing center sends impulses to the muscles of the pharynx & esophagus via cranial nerves

Front 627

What nerve ends mediate pressure, coarse touch, vibration, & tension

Back 627

Pacinan (large, ovid, 1-2 mm by 0.1-0.7 mm)

Front 628

What nerve structures are involved in proprioception?

Back 628

Golgi tendon organs & muscle spindles (encapsulated mechanoreceptors)

Front 629

What nerve structures are responsible for light discriminatory touch?

Back 629

Meissner's (small, encapsulated, on dermal papillae of glabrous/hairless skin)

Front 630

What nerve receptors are sensitive to pain caused by mechanical stress, extreme temperatures, & cytokines such as bradykinin & histamine?

Back 630

nociceptors

Front 631

What nerve structures respond to temperature changes?

Back 631

Thermoreceptors (naked, small, nonmyelinated nerve fibers)

Front 632

What nerve structures respond to static touch?

Back 632

Merkel's disks (cup-shaped, encapsulated)

Front 633

What can help DDx a chest pain to be a pulmonary embolism?

Back 633

Low O2 saturation

Front 634

What type of familial hypercholesterolemia is associated with a defect of LDL cholesterol receptors?

Back 634

Type IIa

Front 635

What syndrome is associated with a defect in collagen type III?

Back 635

Ehlers-Danlos

Triad: Loose joins, decreased skin elasticity, genu recurvatum of the knee (knee is fixed in hyperextension)

Front 636

What causes scurvy?

Back 636

Vit. C deficiency resulting in a defect in hydroxylation of proline & lysine residues of collagen

Front 637

What does a P. aeruginosa ear infection present with?

Back 637

(Swimmer's Ear) External or malignant otitis externa: ear pain & itchiness

MOA: produces exotoxin A that ADP ribosylates elongation factor 2 & impairs host cell protein synthesis

P. aerugoinoa: gram -, non-lactose-fermenting rod that forms blue-green colonies & has a fruity odor

Front 638

What is the MOA of lipopolysaccharidea (LPS)?

Back 638

Binds & activates toll-like receptor 4

Front 639

What is the MOA of Shiga toxin?

Back 639

cleaves rRNA of the host cell

Front 640

What is the MOA of the superantigen that causes TSST-1 (toxic shock syndrome) by S. aureus?

Back 640

Nonspecificallly binds & activates lympocytes: fever, rash, shock

Front 641

What is the primary defect in diabetes type 2?

Back 641

Peripheral insulin resistance due to decreased glucose uptake in muscle & adipose
- Possible cause: defective downstream signaling pathways causing either a decreased number of insulin receptors on the cell surface or signaling errors after insulin has bound to the receptor

Hyperglycemia presents with polyuria, polydipsia

Front 642

Why do obese patients often have hyperestrogenism?

Back 642

Adipose contains aromatase that converts androgens into estrogens

Front 643

Why is there an increase in hepatic glucose production in type 2 DM?

Back 643

insulin resistance results in a decreased ability to suppress gluconeogensis in the liver

Front 644

What is the pathogenesis of paroxysmal nocturnal hemoglobinuria?

Back 644

There is an insufficient synthesis of glycosyl-phosphatidylinositol anchors, which stabilize proteins that protect RBCs from complement-mediated cell lysis

Front 645

What is the pathogenesis of throbotic thrombocytopenic purpura?

Back 645

Absences of von Willebrand factor protease & there is hemolysis due to shear trauma in the vessels

Front 646

What causes RBC lysis in autoimmune hemolytic anemai?

Back 646

IgG targets RBC antigens

Front 647

How is a PDA maintained in an infant & how is it medically closed?

Back 647

Prostaglandin I2

Rx: indomethacin inhibits PGI2 formation

Front 648

What are the 3 congenital heart lesions that cause late cyanosis (L to R shunt)?

Back 648

VSD
ASD
PDA

Front 649

What does Thromboxane A2 cause?

Back 649

- Platelet aggregation & vasoconstriction
- Inhibited by aspirin

Front 650

What results from prostaglandin E2 activation?

Back 650

increase in body temperature

Front 651

What results from prostaglandin F2alpha activation?

Back 651

Uterine contractions & bronchoconstriction

Front 652

What are the symptoms of Kawasaki's? What is the treatment?

Back 652

1) Px < 5 years old
2) Fever (40C/104F)
3) Red eyes = injected conjunctivae
4) Erythematous rash on palms & soles + edema
5) Tachycardia & mucosal inflammation
6) Lymphademopathy
7) Lab: Normocytic anemia & neutrophilic leukocytosis & elevated ESR

Rx: Aspirin & IV Ig (prevent coronary artery aneurysm due to necrotizing vasculitis of sm/m muscular arteries)

Front 653

What is Busulfan used for?

Back 653

Alkylator used to treat CML

Front 654

What is cylophosphamide used for?

Back 654

Nitrogen mustard alkylating agent

Rx: cancer, Wegener's granulomatosis & polyarteritis nodosa

Front 655

What are the main uses of penicillin G?

Back 655

- Syphilis
- Gram- & gram +s that are not penicillin resistant

Front 656

For what autoimmune disease is prednisone contraindicated?

Back 656

Kawasaki's b/c it might increase the risk for coronary aneurysm

Front 657

What amino acid can donate methyl groups?

Back 657

Methionine (S-adenosyl-L-methionine)

E.G. used in the synthesis of phosphatidylcholine

Front 658

What are the lab results that indicates Edwards' syndrome?

Back 658

Low: maternal AFP, estradiol, B-human chorionic gonadotropin

Front 659

What genetic mutation results in DiGeorge's? What are the characteristic features of this disease?

Back 659

22q11 microdeletion

CATCH-22:
Cleft palate
Abnormal facies
Thymic aplasia
Cardiac defects
Hypocalcemia
22 deletion

Front 660

What lab value distinguishes Edwards' from Downs?

Back 660

1) b-hCG: elevated in Down's and decreased in Edwards

2) SAME: low AFP & low estradiol

Front 661

What is the picture of Pneumocystis infection?

Back 661

S/S: dry cough, dyspnea, hazy bilateral hilar infiltrate on chest X-ray

Rx: Trimethoprim/Sulfamethoxzaole

Front 662

What type of fracture is most likely due to child abuse from bone twisting?

Back 662

Spiral fracture

Front 663

What type of fracture is caused by compression and results in a bulging or buckling of the periosteum?

Back 663

Buckle: usually caused by accidents

Front 664

What catalyzes the production of testosterone by Leydig cells?

Back 664

17alpha-hydroxylase (& 17beta-hydroxysteroid dehydrogenase)

Front 665

What does 11beta-hydroxylase assist in the formation of?

Back 665

- Cortisol & corticosterone in the adrenal cortex
- without this, biological males will be born with female external genitalia that will be virilized @ puberty

Front 666

What is type 1 5alpha-reductactase for?

Back 666

Conversion of testosterone to dihydrotestosterone in the skin

Front 667

What is type 2 5apha-reductase for?

Back 667

Conversion of testosterone to dihydrotestosterone in the prostate & genital target tissues

Front 668

What is the maximum point value for APGAR & what is each area evaluated?

Back 668

10:
- 7(+) = good survival
- 4(<) = mortality risk

0-2 for each:
Appearance
Pulse
Respiration
Grimace
Activity

Front 669

What is the treatment for mycoplasma pneumoniae infection?

Back 669

Macrolides (e.g. azithromycin)

Front 670

What is a common cause of nosocomial UTI & subacute endocarditis?

Back 670

Enterococcus

Rx: ampicillin or vancomycin (if resistant)

Front 671

What is the MOA & use of piperacillin?

Back 671

Inhibits bacterial cell wall synthesis

Rx: gram +, P. aeruginose, Enterobacteriaceae

Use in combo with B-lactamase inhibitor such as tazobactam

Front 672

What is female pseudohermaphroditism?

Back 672

Ovaries are present & external genitalia are virilized/ambiguous

Front 673

What is required for development of the penis & scrotum during embryogenesis?

Back 673

Dihydrotestosterone via functional 5alpha-reductase to convert testosterone to dihydro...

Deficiency causes phenotypical female with bilateral testes & male internal urogenital tract. @ puberty, external genitalia will be masculinized

Front 674

What are the symptoms of rhabdomyolysis?

Back 674

muscle pain, weakness, "coca-cola colored" urine

Front 675

What is the muscle-related complication of statin use?

Back 675

myalgia or rhabdomylosis

Especially when combined with any inhibitor of cytochrome P450 enzyme CYP3A4 (that metabolizes statins)
- E.G. erythromycin

Front 676

What is the pathogenesis of pyomyositis?

Back 676

S. aureus infection of skeletal muscle
- due to bacteremia from IV drug use or dental work)
- often large leg muscles
- S/S: muscle pain, swelling, fever

Front 677

What genetic disorder predisposes patients to thromboses in unusual locations (e.g. mesenteric veins) at an early age (<50)?

Back 677

Factor V Leiden thrombophilia
- heterozygous have a higher risk for thrombotic events

Front 678

What does Fanconi's anemia predispose patients to?

Back 678

These patients have pancytopenia and have an increased risk of infection, anemia, fatigue, & bleeding

Front 679

How is von Hippel-Lindau disease characterized?

Back 679

abnormal blood vessel growth leading to angiomas and hemangioblastomas in the:
- Retina
- Brain
- Spinal Cord
- & elsewhere

Front 680

How does von Willebrand's present?

Back 680

Prolonged bleeding time after trauma, surgery, nosebleeds, & hematomas

Front 681

How does Giant Cell arteritis present histologically?

Back 681

- Nodular thickening that reduces the size of the lumen
- Granulomatous inflammation with mononuclear & giant cells
- Fragmentation of the internal elastic membrane

Front 682

What infection causes tabes (i.e. shriveled) dorsalis?

Back 682

T. pallidum = neurosyphilis progressively demyelinates & scleroses the posterior nerve roots
- reduced reflexed, decreased pain, decreased proprioception (will show a positive Romberg test)

Rx: doxycycline

Front 683

What is Pott's disease?

Back 683

- When TB invades the spinal column & causes bone destruction & compresses region of the spinal cord
- 1st symptom is pain

Rx: isonizaid + rifampin

Front 684

Where does poliovirus affect the spinal cord?

Back 684

Motor neurons in the anterior horn

Rx: prevent via vaccine

Front 685

How does alpha1-antitrypsin deficiency harm the liver?

Back 685

intrahepatic accumulation of abnormal alpha1-antitrypsin protein

Front 686

What are the ester-type local anesthetics?

Back 686

Tetracaine
Chloroprocaine
Procaine
Novacaine
Propoxycaine

If a Patient is allergic to one, avoid all

Front 687

What are the amide-type local anesthetics?

Back 687

Bupivacaine
Etidocaine
Lidocaine
Prilocaine

Front 688

What vessel prohibits a horseshoe kidney from ascending?

Back 688

inferior mesenteric artery

Front 689

What is Waterhouse-Friderichsen syndrome?

Back 689

Bilateral necrosis & hemorrhage of the adrenals cause by infection with N. meningiditis

Dx: high potassium level, low Na, & no increase in serum cortisol level in response to ACTH administration

Rx: cephalosporin, penicillin, chloramphenicol & glucocoritcoid replacemtn therapy with hydrocortisone

Front 690

What is the MOA of statin-inducted ATN?

Back 690

secondary to obstruction or via toxic effect on renal tubules

Front 691

What color is a patient's urine when they have myoglobinuria?

Back 691

Tea-colored

Front 692

What are causes of interstitial nephritis?

Back 692

- Allergic reaction to drugs (NSAIDS, diuretics, antibiotics)
- Infections
- Infiltrative process

Front 693

What is the typical presentation of a Becker's (BMD) patient?

Back 693

- Muscle weakness &/or cardiac disease a mid adolescence
- Cause: an in-frame deletion in the dystrophin gene: partially functional protein is produced (vs. DMD = out of frame that results in truncated or absent dystrophin)

Front 694

What is the most common cause of mitral stenosis?

Back 694

Rheumatic heart disease
- delayed, rumbling, late diastolic murmor

Front 695

What is the most common valvular lesion?

Back 695

mitral prolapse
- late systolic murmor with a midsystolic click
- predisposes to infective endocarditis

Front 696

What are the main causes of aortic stenosis?

Back 696

Calcified valve
Congenital bicuspid aortic valve
Rheumatic heart disease

Front 697

What are the physical exam finding that indicate aortic regurg?

Back 697

high-pitched blowing diastolic murmur with widened pulse pressure

Front 698

What are the physical exam finding that indicate aortic stenosis?

Back 698

- Crescendo-decrescendo systolic ejection murmur that radiates to the carotid
- Weak peripheral pulse (pulsus parvus et tardus)

Front 699

What are the physical exam finding that indicate mitral regurg?

Back 699

holosytoci high-pitched blowing murmor @ the base of the heart with a radiation to the left axilla

Front 700

What are the physical exam finding that indicate mitral stenosis?

Back 700

Opening snap with a delayed, rumbling late-diastolic murmur

Front 701

How does the kidney respond to a high sodium diet?

Back 701

- Volume expansion will increase stretch in baroreceptors located in the afferent arteriole
- This leads to a reduced sympathetic activity
- This leads to vasodilation of the glomerular afferent arterioles
- Increases GFR & decreases Na reabsorption

Front 702

When is atrial natriuretic peptide secreted?

Back 702

By the atria in response to increased extracellular fluid volume & causes dilation of the glomerular afferent arterioles

Front 703

What are the toxicities of cisplatin?

Back 703

- Nephrotoxicity & acoustic nerve damage

- It is a cell cycle nonspecific drug that alkylates DNA (cross-links and inhibits DNA synthesis)

Front 704

What are the side effects of Busulfan?

Back 704

DNA alkylator

- PULMONARY FIBROSIS
- hyperpigmentation
- bone marrow suppression
- GI & CNS: insomnia, anxiety, headache

Front 705

What is the toxicity of Doxorubicin?

Back 705

DNA intercalator that leads to strand breaks (Rx: breast cancer)

- Cardiotox (dilated cardiomyopathy)
- Myelosuppression & alopecia

Front 706

What are the side effects of etoposide

Back 706

plant alkaloid that acts in the late S and early G2 & inhibits topoisomerase II

- Tachycardia
- Nausea, vomiting
- Shortness of breath
- hematuria
- melena
- myelosuppression
- alopecia

Front 707

What is methotrexate used for?

Back 707

Antimetabolite that inhibits dihydrfolate reductase in the S phase b/c it is structurally similar to folic acid: decreases purine nucleotide synthesis

carcinoma
leukemia
trophoblastic disease
rheumatoid arthritis
ectopic pregnancy
psoriasis
abortifactant

Front 708

What are the side effects of methotrexate?

Back 708

myelosuppression
mucositis
elevated liver enzymes
renal toxicty

Front 709

What is the use of ondansetron?

Back 709

antiemetic: selective serotonin receptor antagonist

SE: headache, malaise, constipation

Front 710

What is the MOA of Vinblastine?

Back 710

binds tubulin and blocks microtubule polymerization & mitotic spindle assembly

SE: bone marrow suppression, alopecia, SIADH

Front 711

What is the MOA of acyclovir, ganciclovir, and famciclovir?

Back 711

Inhibits viral DNA polymerase

Front 712

What 5 types of antibiotics inhibit protein synthesis?

Back 712

1) chloramphenicol & clindamycin
2) linezoid
3) erythromycin
4) tetracycline & doxycycline
5) aminoglycosides

Front 713

What is the treatment for Rocky Mountain spotted fever (R. rickettsii) & Lyme disease (B. burgdorferi) infection?

Back 713

Doxycycline (inhibits protein synthesis)

Front 714

What is the treatment for ectopic pregnancy?

Back 714

laparoscopic rescection

Front 715

What is the frequency of the slow waves of the stomach and small intestine?

Back 715

Stomach: 3Hz
Small intestine: 12 Hz

Front 716

What is Whipple's triad for an insulinoma?

Back 716

1) Hypoglycemia
2) Hypoglycemic symptoms (headache/irritability)
3) Relief of symptoms with calorie intake

LAB: high C-peptide (indicates taht serum insulin is endogenous)

Front 717

How is Pneumocystis jiroveci pneumonia diagnosed?

Back 717

Methenamine silver stain of lung biopsy tissue

Rx:
- Sulfamethoxazole-trimethoprim
- pentamidine
- dapsone

Front 718

What is the MOA of sulfamthoxayole-trimethoprim & trimethoprim?

Back 718

Inhibit folate synthesis: pteridine & PABA are incorporated into folic acid

= inhibition of nucleic aci & amino acid formation

Front 719

What is the MOA of antifungals like fluconazole & terbinafine?

Back 719

Inhibition of ergosterol synthesis

Front 720

What antibiotics inhibit the 50S subunit?

Back 720

Chloramphenicol
Erythromycin
Clindamycin
Linezolid

Front 721

How is N. gonorrhoeae cultured?

Back 721

Thayer-Martin agar (chocolate agar plate suffused with vancomycin, colistin, & nystatin (VCN) to suppress endogenous growth)

Front 722

What is Bordet-Gengou (aka potato) agar or Regan-Lowe medium used to culture

Back 722

- Bordetella pertussis (gram + rod: whooping cough)
- Also collect with calcium alginate swabs

Front 723

What agar is used to cuture Legionella pneumophilia?

Back 723

Charcoal yeast extract with increased iron & cysteine

Front 724

What agar is used to culture TB

Back 724

Lowenstein-Jensen (no growth of gram-positive respiratory flora)

Front 725

What is MacConkey's agar used to culture?

Back 725

Lactose-fermenting enterics:
E.coli
Klebsiella

Front 726

What drugs can cause SIADH?

Back 726

1) High-dose IV cyclophosphamide
2) Carbamazepine
3) Vincristine
4) Vinblastine
5) Amitriptyline
6) Amiodarone
7) MAO inhibitors

Front 727

What are the clinical features of SIADH?

Back 727

nausea
lethargy
seizures
coma

Lab:
- hyponatremia
- serum hypo-osmolality
- urine hyperosmolarity
- decreased hemocrit (2ndary to dilution

Front 728

What are 2 drugs that can be used to treat nephrogenic DI?

Back 728

Indomethacin
HCTZ (hydrochlorothiazide)

Front 729

What is a direct Coomb's test?

Back 729

1) Coombs reagent is added to the patient's blood
2) Binds to autimmune Ig bound to several RBCs & causes agglutination

Front 730

What can IgM cold agglutinin immune hemolytic anemia occur concuurently with?

Back 730

- Mononucleosis
- Mycoplasma pneumoniae
- Lymphoid neoplasm (chronic anemia only)

Front 731

What is an indirect Coombs' used to assess

Back 731

Blood compatibility (before a transfusion): detects unbound antibodies that can bind to RBCs from a normal, healthy doner.

Front 732

What is a neural complication of overaggressive treatment of hyponatremia (correction of the Na level at a rate faster than 1mEq/L/Hr)?

Back 732

Central pontine myelinolysis (Osmotic demyelination): rate of osmolarity outstrips the brain's ability to adapt to the rising osmolarity -> neuronal shrinkage & death

Clinical: dysarthria, dysphagia, flaccid quadriparesis (can lead to spastic or locked-in syndrome)

Front 733

What is locked-in syndrome?

Back 733

When a patient is fully aware, but can move only the extraocular muscles

Front 734

What is the treatment for bulimia?

Back 734

SSRIs (e.g. fluoxetine)

Front 735

What are the clinical signs of bulimia?

Back 735

- Calluses/Scars on the dorsum of the hand (abrasion by teeth during induced gaggin)
- Parotid enlargement
- Erosion of tooth surfaces from enamel dissolution

Front 736

What is Lorazepam used to treat?

Back 736

Anxiety disorders

Front 737

What are amphetamines used to treat (main 2)?

Back 737

ADD/ADHD
Narcolepsy

Modulate dopamine, serotonin, & NE

Front 738

What is Thioridazine used to treat?

Back 738

Schizophrenia (as a last resort b/c of SE)

SE: neuroleptic malignant syndrome, cardiotoxicity, retinopathy

Front 739

At what point in meiosis does trisomy 21 occur (i.e. the nondisjunction)?

Back 739

Anaphase I or II (mitotic spindle unequally separates 21, usually in the mother's gamete)

Front 740

Where is a Robertsonian translocation?

Back 740

A translocation between chromosome 21 & long arm of a second acrocentric chromosome (usually 14 or 22)

Front 741

When does crossover or recombination occur in meiosis?

Back 741

Phrophase I

Front 742

What is characteristic of MS (anatomical changes & symptoms)?

Back 742

CNS demyelination with neurologic lesions within the white matter
- S/S that are separated in time & anatomic location
- Can have difficulty urinating or incomplete voiding
- IMPORTANT: episodic symptoms last >24 hours; MRI: periventricular plaques in >90% of Pxs

Front 743

What do intention tremors & ataxia indicated?

Back 743

Cerebellar disease (e.g. with MS)

Front 744

What is the triad for Huntington's?

Back 744

- Chorea (forceful, spastic involuntary movements of the limbs &/or facial muscles with gradual onset but become permanent)
- Muscle rigidity
- Dementia

Cause: nucleotide repeat expansion on the short arm of Ch. 4

Front 745

What happens in late-stage amyotrophic lateral sclerosis?

Back 745

Paralysis of the respiratory muscles

Front 746

What are the 4 main manifestations of NF2 (neurofibromatosis type 2)?

Back 746

- Bilateral schwannoma (neoplasm at cerebellopontine angle (CN VII & VIII can be affected)
- Eye lesions (juvenile cataracts)
- Ependymomas
- Meningiomas

- NF2 - tmor-suppressor on Ch.22 that encodes a membrane cytoskeletal protein

Front 747

What are the manifestations NF1 (Neurofibromatosis type 1)?

Back 747

- Cafe-au-lat spots
- neurofibromas
-iris hamartomas
- optic pathway gliomas
- pheochromocytoma
- scoliosis (or other skeletal disorders)
- UNILATERAL schwannomas)

Front 748

What is the origin of neurofibromas

Back 748

Schwann cells + perineural & endoneural components

Front 749

What is the classical presentation of Charcot-Marie-Tooth?

Back 749

- Distal muscle (esp. calve) atrophy
- Clumsiness

Genetic disorder that affects peripheral nerves via mutations in various myelin genes

Front 750

What are the characteristic facial features of fragile X?

Back 750

Large Ears & Jaws, & Macro-Orchidism in males

EVERYTHING (chromosome, face...) is BIG

Front 751

What is the treatment for Bruton's agammaglobulinemia?

Back 751

IV Ig

No tyrosine kinase gene = no B lymphocyte differentiation

Front 752

What lab results show elevated mineralocorticoids (along with a lack of other cortical steroids)?

Back 752

- Hypertension
- Hypokalemia
- Female w/o sexual maturation

17alpha-Hydroxylase deficiency

Front 753

What 2 enzymes are needed to produce cortisol? sex hormones?

Back 753

Cortisol:
21beta-hydroxylase
17alpha hydroxylase

Sex:
17alpha hydroxylase

Front 754

What are the ocular manifestations of a Berry aneurysm?

Back 754

Cranial nerve (CN III) compression due to the rupture of a thin-walled outpouching at a cerebral arterial branch point (anterior cerebral & communicating)
- parasympathic fibers are compressed and this results in dilated, unreactive pupils (palsy)

Front 755

How does blockage of a penetrating artery in the internal capsule present?

Back 755

pure motor or sensory deficits

Front 756

How does the blockage of an anterior cerebral artery present?

Back 756

Stroke: contralateral motor & sensory deficits in the leg & foot

Front 757

How do subdural hematomas present on CT?

Back 757

"crescent-shaped" density - bridging veins (between dura & arachnoid) rupture do to shearing forces

Front 758

What is the usual cause & presentation of a middle meningeal artery rupture?

Back 758

Epidural hematoma due to a lateral blow to the head

CT: "lens-shaped" density

Front 759

How does Ketoconazole or metyrapone inhibit ACTH effects?

Back 759

- Both inhibit cytochrome P450 in the adrenal glands (& ketoconazole inhibits ACTH)

- Can be used to treat SIADH from small cell lung cancer

Front 760

What is the MOA of Desmopressing acetate (DDAVP)?

Back 760

It is a synthetic analog of ADH & binds to V2 receptors in the collecting ducts to increase water resorption

- Used to treat diabets insipidus
- Stimulates release of vonWillebrand factor & factor VIII by stimulating the V1a receptor (used to treat coagulation disorders: vW disease, mild Hemophilia A, thrombocytopenia)

Front 761

What is the MOA & use for Finasteride?

Back 761

- MOA: Decreases conversion of testosterone to dihydrotestosterone

- Rx: BPH hypertrophy

Front 762

What is Pamidrone used to treat?

Back 762

(Bisphosphonate)

Rx: Hypercalcemia

Front 763

What is spironolactone used to treat (besides hypertension)?

Back 763

Can be used to treat Conn's (primary hyperaldosteronism)

- It is a potassium-sparing diuretic & also competitively inhibits the mineralcorticoid receptor
- It is a steroid

Front 764

What is commonly used to treat neuroleptic malignant syndrome?

Back 764

Bromocriptine (a dopamine agonist to restore the depletion of dopamine signaling caused by drugs like haloperidol that blocks dopamine receptors)

Front 765

What is Benztropine used for?

Back 765

It is an antimuscarinic that improves the tremor & rigidy in patients with Parkinson's

Front 766

What 2 antipsychotics have the highest rist of neuroleptic malignant syndrome?

Back 766

Chlorpromazine
Haloperidol

Front 767

What is the MOA of Clozapine?

Back 767

Atypical antipsychotic that blocks serotonin & dopamine receptors (D1 & D2)

SE: agranulocytosis & seizures in nonepileptic Px

Front 768

What is the MOA of Fluoxetine?

Back 768

Serotonin-specific reuptake inhibitor

Front 769

What is the pathogenesis of midgut volvulus?

Back 769

Complication of intestinal malrotation in the 1st month of life when the midgut rotates less that 270 degrees (between week 10 & 12)

Front 770

How does midgut volvulus present on X-ray? Clinically? What are possible complications?

Back 770

X-ray: Twisted & overdistened colon with a coffee-bean shape & lack of septa & haustra

Clinical: vomiting & constipation

Complications: compromised blood supply -> ischemic necrosis & perforation

Front 771

Describe the Measles rash.

Back 771

Blanching red that starts on the face & then moves down the trunk & limbs

+ fever

Front 772

What is a rare complication of measles?

Back 772

SSPE: subacute sclerosing panencephalitis
- 7-9 years after infection
- personality changes
- lethargy, difficulty in school, odd behavior
- Late changes: dementia, severe myoclonic jerking, eventyal flaccidity & decorticate rigitiy -> rip

Front 773

What is the presentation of pediatric roseola?

Back 773

High fever (3-5 days)
conjunctivits
otitis media
malaise

- Blanching macular rash on the neck and trunk that spreads to face & extremities

Front 774

What is the Rubella of rash like?

Back 774

Descending: starts on the face

- fever before (& resolves) rash, lymphadenopathy

Front 775

What is the presentation of Scarlet fever?

Back 775

Strep pyrogenes: fever, soar throat, strawberry tongue

Rash: trunk, neck, limbs, NO palms/soles.

Post rash: desquamation of palms & soles

Front 776

What is the MOA of fluoroquinolones (such as ciprofloxacin)?

Back 776

Inhibit DNA gyrase & topoisomerase of gram-negative bac.

Front 777

What nerve roots contribute to the axillary nerve?

Back 777

C5-6 (posterior cord branch)

Front 778

What is the clinical presentation of a cocaine user?

Back 778

Tachycardia
Dilated pupils
Angina
Nosebleed

MOA: sympathomimetic that inhibits neurotransmitter reuptake (e.g. NE)

Front 779

What causes prerenal azotemia?

Back 779

Reduction of GFR due to a decreased vascular supply to the kidney
- Heart failure
- Sepsis
- Renal artery stenosis

Front 780

What are the classic lab values of prerenal azotemia?

Back 780

Accumulation of BUN & Cr in blood:
- BUN rises out of proportion to Cr (Cr is filtered, no reabsorbed) = elevated BUN: Cr ratio

Front 781

How does AIN (acute interstitial nephritis) present?

Back 781

eosinophilic casts in the urine
elevated fractional excretion of Na

Front 782

What distinguishes postrenal from prerenal azotemia?

Back 782

Post: normal BUN: Cr ratio, lack of highly concentrated urine

Pre: increased BUN:Cr ration, highly concentrated urine

Front 783

What level are the nerves that control erection?

Back 783

S2-4 (sympathetic fibers)

Front 784

What level are the nerves that control erection?

Back 784

S2-4 (sympathetic fibers)

Front 785

When does fibrinous pericarditis occur post MI?

Back 785

3-5 days

S/S: sharp, pleuritic chest pain, fever, pericardial friction rub

Front 786

When is a thrombotic emboli a risk post MI?

Back 786

weeks to months later

Front 787

When is a heart rupture a risk post MI?

Back 787

4-10 days

Front 788

What are the main functions of smooth ER?

Back 788

steroid biosynthesis
membrane synthesis
repair
detoxification (liver has a lot)

Front 789

What are the S/S of Rocky Mountain spotted fever?

Back 789

fever
sever headache
red conjunctivae
rash on palms and soles

Rx: tetracycline (e.g. doxycycline) or chloramphenicol FAST (or death)

Front 790

What lab test can confirm a rickettsial infection (rash on palms & soles)?

Back 790

Weil-Felix reaction for this gram - bac
- Serologic fluorescent antibody screen
- Positive: cross-reacting antigens from Proteus vulgaris

Front 791

What type of infection is cold antibody agglutination used to detect?

Back 791

Mycoplasma

Front 792

What are the vectors for Rickettsia rickettsii?

Back 792

Dermacentor andersoni & D. variabilis (ticks)

Front 793

What is the tumor marker for breast cancer?

Back 793

CA-15-3

Front 794

In what cancers is alpha-fetoprotein elevated?

Back 794

hepatocellular carcinoma and nonseminomatous germ cell tumors (yolk sac tumor)

Front 795

What is Bombesin a tumor marker for?

Back 795

neuroblastoma, lung, & gastric cancer

Front 796

What tumors can CA-125 mark?

Back 796

Ovarian & malignant epithelial tumors

Front 797

What is S-100 a tumor marker for?

Back 797

melanoma
neural tumors
astrocytoma

Front 798

What tumors is Tartrate-resistant acid phosphatase a marker for?

Back 798

Hariy cell leukemia (a B-cell tumor)

Front 799

What is volvulus?

Back 799

A twisting of a portion of the bowel around its mesentery

- PEDs & elderly

Front 800

How doe spyloric stenosis present?

Back 800

- S/S: nausea & vomiting at 3- to 6-weeks post birth; olive-shaped mass on physical exam

- Patho: pyloric muscle hypertrophies & causes gastric outlet obstruction

- Rx: surgical pyloroplasty

Front 801

What is the pathogenesis of Meckel's diverticulum?

Back 801

Incomplete obliteration of the vitelline duct (yolk stalk)

2% of population & 2 ft. from ileocecal junction; usually asymptomatic

Complication: bleeding

Front 802

What is intussusception & how does it present?

Back 802

Invagination of intesting upon itself (usually at ileocecal junction) @ 6-36 m. old

S/S: intermittent & crampy abdominal pain with current-jelly stool due to rectal bleeding

Front 803

What is cystinuria?

Back 803

Increased levels of lysine & arginine in the urine due to a defect in amino acid reabsorption in the proximal tubule leading to a wasting of:
- lysine, arginine, cystine

Elevated cystine leads to recurrent stone formation (S/S severe pelvic pain & elevated creatinine due to postrenal failure caused by the stone)

Rx: hydration & alkalization of urine

Front 804

What level are the nerves that control erection?

Back 804

S2-4 (sympathetic fibers)

Front 805

What is the classic presentation for prolactinoma (most common pituitary adenoma) in a woman?

Back 805

Headaches
Galactorrhea
Bitemporal hemianopsia

Front 806

How does prolactin suppress menstration?

Back 806

inhibits FSH and GRH & promotes breast milk production

Front 807

What is thyroid dermopathy?

Back 807

- Pretibial myxedema (nonpitting & thickening of skin)
- Characteristic of hyperthyroidism due to Graves

Front 808

When there is truncal obesity due to a pituitary adeonma, what is the cause of the obesity?

Back 808

ACTH hypersecretion

Front 809

What are the neurofibrillary tangles of Alzheimer's composed of?

Back 809

intracellular inclusions of microtubule binding protein tau

Front 810

What is the most common cardiovascular abnormality seen in congenital rubella syndrome?

Back 810

PDA

Front 811

What is the presentation of congenital CMV infection?

Back 811

petechial rashes
jaundice
hepatosplenomegaly
sensorineural hearing loss

Front 812

How does congenital herpes infection present?

Back 812

skin (vesicles), eyes (keratoconjunctivitis), and mouth (vesicles) or localized CNS infection, all within 4 weeks of birth
- CNA: temp. instability, RDS, poor feeding, letharcy

Front 813

What is the triad for congenital toxoplasmosis?

Back 813

chorioretinitis
hydrocephalus
intracrainal calcifications

Early: maculopapular rash, jaundice, hepatomegaly

Front 814

How does congenital syphilis present?

Back 814

asymptomatic at birth

- Cranial VIII defect (hearing problems)
- Cutaneous lesions (palms & soles)
- Anemia, jaundice, hepatomegaly

Front 815

What spinal nerve controls the inguinal region dermatome?

Back 815

L1: also includes the femoral triangle and superolateral quadrant of the buttock

Front 816

What spinal nerve controls the anterior & lateral thigh dermatome?

Back 816

L2

Front 817

What spinal nerve controls the dermatome at the level of the umbilicus?

Back 817

T10

Front 818

What spinal nerve controls the dermatome directly inferior to the umbilicus?

Back 818

T11

Front 819

What spinal nerve controls the dermatome region interior to the anterior iliac crest?

Back 819

T12

Front 820

What lab values indicate an inability to dilute urine?

Back 820

- Urine osmolaity > plasma osmolality
- Normal specific gravity
- Urine Na >40mEq/L

Front 821

What ECG is indicative of WPW (Wolff-Parkinson-White) syndrome?

Back 821

Wide QRS with relatively short PR invervals & slurring of the initial parts of the QRS complex
- Cause: congenital accessory pathway leads to pre-excitation of the ventricle; the slurred upstroke is the delta wave
- Result: suptraventricular tachycardia: palpitations followed by syncopy

Front 822

What causes an S4 heart sound?

Back 822

stiffness of hypertrophied ventricle

Front 823

What heart sounds indicate hypertrophic cardiomyopathy?

Back 823

S4 (due to stiff walls)
Ejection murmur (mild outflow tract obstruction due to septal hypertrophy)

Rx: b-blocker or non-dyhydropyrine Ca channel blocker (verapamil)

Front 824

Which rotator cuff muscle medially rotates the arm?

Back 824

subscapularis

Front 825

What is the action of the infraspinatus?

Back 825

adducts the arm and laterally rotates the glenohumoral joint

Front 826

Which rotator cuff muscle is most often injured?

Back 826

supraspinatus: initiator of abduction (first 15 degrees of the arc; deltoid does the rest)

Front 827

What is the action of teres minor?

Back 827

adduct & laterally rotates the arm

Front 828

What is the key component of fungal endospores that allow them to resist dehydration, heat, & chemicals?

Back 828

dipicolinic acid (e.g. present in Coccidioides immitis: causes coccidioidomycosis in the southwest US)

Front 829

Which virus is known for its hemagglutinin antigen

Back 829

influenza

Front 830

What bacteria has a capsule made of D-glutamate

Back 830

Bacillus anthracis

Front 831

What is the action of Teichoic acid on gram + bacteria?

Back 831

induces tumor necrosis factor alpha and interleukin-1 production

Front 832

What is the ECG finding in tamponade?

Back 832

- Sinus tachycardia & low QRS voltages
- Elecrical alternans (alternations of QRS height with each beat) is pathognomonic

Front 833

What does an ECG result of PR elongation indicate?

Back 833

1st degree atrioventricular block

Front 834

What does a peaked or hyperacute T wave indicate?

Back 834

hyperkalemia (or, early MI or myocaridal ischemia)

Front 835

What are the causes of QT prolongation?

Back 835

1) Drugs:
- Class IA or III antiarrhytmics
- Phenothizines
- TCAs
2) Hypocalcemia
3) Hypothermia
4) Cerebrovascular diseases
5) Ischemic heart disease
6) Idiopathic

Front 836

What is the site of lymph drainage of the liver?

Back 836

Space of Diss (between sinusoidal endothelial cells & hepatocytes)

Front 837

What heaptic vein carries deoxygenated blood from the liver back to the heart?

Back 837

hepatic vein

Front 838

What proteins are affected by tuberous sclerosis?

Back 838

AD (Ch. ( & 16): tuberin & hamarin, they regulated cellular growth & differentiation

Tumors: cortical tubers, renal angiomyolipomas, cardiac rhadbdomyomas, astrocytomas, pulmonary lymphangioleiomyomatosis

Physical: ash-leaf spot, Shagreen patch, facial angiofibromas

Presentation: mental retardation & epilepsy

Front 839

What is the pathogenesis of Leber's hereditary optic neuropathy?

Back 839

- Mitochondrial mutation that causes degeneration of the optic nerve with rapid loss of central vision, leading to a permanent central scotoma
- Males are more affectwith & symptoms usually start in the 3rd decade

Front 840

What is the bac most often responsible for osteomyelitis in diabetic patients?

Back 840

pseudomonas aeruginosa

Front 841

What is the cellular lining of the epididymis (where sperm acquire motility)?

Back 841

pseudostratified columnar epithelium with stereocilia

Front 842

What is the cellular lining of the vas deferens (where the sperm travel after maturing in the epididymis)?

Back 842

pseudostratified columnar epithelium

Front 843

What is the cellular lining of the rete testes (@ the testicular hilum & where the sperm is transfered from the sminiferous tubules to the ductuli efferentes to the epididymis)?

Back 843

simple cuboidal cells

Front 844

What cell type lines the bladder, calyces, ureters, & upper urethra?

Back 844

transitional cell epithelium

Front 845

What is the treatment for Clozapine-induced agranulocytosis?

Back 845

1) Discontinuation of clozapine &
2) Administration of Granulocyte colony-stimulating factor (GC-SF)

Front 846

What lab results indicate primary hyperparathyroidism?

Back 846

Hypercalcemia -> metastatic calcification & duodenal peptic ulcers
hypophosphatemia
increased alk phos
increased PTH levels -> osteitis fibrosa cystic (excessive bone resoption & fibrous replacement of the marrow leaving cystic spaces (brown tumors)

Front 847

What is Osteitis fibrosa cystica and what causes it?

Back 847

- Excessive bone resoption & fibrous replacement of the marrow leaving cystic spaces (brown tumors)
- Increased PTH levels
- Presentation: bone pain & fractures

Front 848

On what chromosome is the FAP (familial adenomatous polyposis) genetic mutation found?

Back 848

5: APC locus, loss of tumor suppression & increased risk of:
- duodenal
- gastric
- liver
- thyroid
- CNS

Front 849

What is the DOC for H. ypylori infection?

Back 849

Clarithromycin, amoxicillin, & PPI
- 14 day regiment

OR

Metronidazole, tetracycline, bismuth subsalicylate, & PPI

Front 850

What is the most common cause of 2ndary hyperparathyroidism?

Back 850

- Renal failure
- Symptoms: diffuse bone pain & proximal muscle weakness (+ pruritis if there is a deposition of excess Ca)

Front 851

What is renal osteodystrophy?

Back 851

1) Nephron damage (Lab: increased creatine) reduces Ca reabsorption, impaired phosphate excretion & impaired vit. D activation.
2) Result: decreased serum Ca & increased phosphate = hypocalcemia
3) PTH increases & bone is reabsorbed: increased alk phos.

Front 852

What are the symptoms of hypocalcemia?

Back 852

tetanny & incrased neuromuscular excitability + decreased serum PTH

Front 853

How does maligancy cause hypercalcemia?

Back 853

1) Lytic metastases to bone
- up serum alk phos & hyperphosphatemia
2) PTH-related peptide production (with hypophosphatemia)

Front 854

What are the lab results that indicated Vitamin D intoxication?

Back 854

hypercalcemia
hyperphosphatemia
decreased serum intact PTH levels

Front 855

When do extrapryamidal adverse effects of typical antipsychotic set in?

Back 855

1) acute dystonia (1st hours after dose)
2) akinesia (1st few days after dose)
3) tardive dyskinesia (several months)

Front 856

What renal disease often presents in otherwise healthy young males with hemoptysis?

Back 856

Goodpasture's: Dx with anti-GBM antibodies in blood & kidney biopsy

Rx: plasmapheresis & airway protection + steroids & cyclophosphamide

Front 857

Which strands of strep tend to cause poststreptococcal glomerulonephritis?

Back 857

- M type
- Autoimmune attack begins 2-6 wks. after skin infection & 1-3 weeks after pharyngitis

Front 858

What drug can be used to "rescue" bone marrow after methotrexate administration?

Back 858

It delivers folinic acid that can be reduced to methylene tetrahydrofolate & will thereby bypass the dihydrofolate reducate enzyme that is inhibited by methotrexate

Front 859

What is Mesna used for?

Back 859

Prevent hemorrhagic cystitis in patients taking cyclophosphamide:
- supplies a free thiol group to bind to & inactivate the toxic metabolite acrolein in the kidney

Front 860

What is compartment syndrome?

Back 860

when a lacerated artery bleeds into a closed space:
- greater than expected pain
- decreased blood flow @ the site of injury

Front 861

What are the HLA b27 diseases?

Back 861

PAIR:
Psoriasis
Ankylosing spondylitis
IBD
Reiter's syndrome

Front 862

Disorders of peroxisomes result in what 2 diseases?

Back 862

1) Refsum's
2) Adrenoleukodystrophy

- peroxisomes can no longer metabolize very-long-chain fatty acids & this results in problems with making myelin & hydrogen peroxide formation = progressive neurological damage

Front 863

What test approaches 100% sensitivity for detecting syphilis?

Back 863

Veneral Disease Research Laboratory (VDRL) test: FTA-ABS absorption test

Front 864

Describe the 3 stages of syphilis?

Back 864

1) painless chancre (localized)
2) SYSTEMIC (6 wks later): maculopapular rash (palms & soles), condylomata lata
3) Gummas (chronic graulomas), aoritis (vasa vasorum destruction), neurosphyilis (tabes dorsalis), Argyll Robertson pupil. SIGNS: broad-based ataxia, positive Romberg, Charcot joints, stroke w/o hypertension

Front 865

What are the signs of congenital syphilis?

Back 865

Broad-based ataxia
Positive Romberg
Charcot joints
Stroke w/o hypertension

Front 866

What is the Tzanck preparation with Giemsa stain used for?

Back 866

1) HSV: reveals multinucleated giant cells
2) Vesicular stomatitis virus infection

Front 867

When can an individual possess the capacity for awareness of a full rectum/bladder & are able to control bowel & urinary tract sphincters?

Back 867

19-36 months

Front 868

When is the oedipal/phallic phase?

Back 868

36-6 years: strong attachment to parent of the opposite sex

Front 869

When is the oral stage of life?

Back 869

1st year: passive dependence on eating & sucking

Front 870

When is the latency phase of life?

Back 870

6 years - puberty: children do not fixate

Front 871

What infection & CD markers are associated with Hodgkin's disease?

Back 871

EBV
CD45-,CD30+, CD15+/-

Front 872

What are the risk factors for Hodgkin's lymphoma?

Back 872

- Male Gender
- Age 15-40 or 50+
- EBV infection (history, not current)
- Immunodeficiency/AIDS
- Prolonged use of growth hormone

Front 873

How are the lymph nodes changed in Bartonella heniselae infection?

Back 873

stellate abscesses & tender

Also, there can be sterile, suppurative papules at the site of inoculation

Front 874

What does mucosis fungoides initially present as?

Back 874

- Eczematous, psoriatic-like rash

- It is a cutaneous T-lymphocyte lymphoma

Front 875

What H2-antagonist is an inhibitor of the cytochrome p450 system?

Back 875

cimetidine (Rx: ulcers; SE: headache, confusion, gyncomastia, thrombocytopenia)

Front 876

What FEV1/FVC ratio is indicative of a restrictive disease?

Back 876

>80

Front 877

What can be a severe compication of bleomycin therapy?

Back 877

pulmonary fibrosis (~1 month after initiation of treatment) & ARDS

Front 878

What prostaglandin E1 analog is contraindicated in pregnancy (& why)?

Back 878

Misoprostol: increases producing & secretion of gastric mucous barrier
- it is an abortifactant & can cause diarrhea

Front 879

What are the most common causes of IUGR (intrauterine growth restriction)?

Back 879

- Poor maternal nutrition
- Hypertension
- Infections
- Congenital anomalies
- Smoking

Front 880

What are the risks of placenta previa?

Back 880

(Placenta covers the cervical os):
- Prior cesarean section
- Multiparity
- Advanced maternal age
- Multiple gestations
- Prior placenta previa

Front 881

Where does Triatoma cruzi infect?

Back 881

- Heart: myocarditis (ventricular dilation & congestive heart failure 2ndary to myocyte necrosis & fibrosis)
- Nerve cells of the myenteric plexus: dysmotility of hollow organs (esophagus, colon, ureter) = acquired achalasia (distal 1/3) & mega-colon/ureter

Front 882

How does psoriatic arthritis present?

Back 882

psoriasis (nonpuritic scaly or silvery erthematous plaques with well-defined borders) + joint symptoms with acute onset in 1/3 of patients
- Joint swelling asymmetrically in distal interphalangeal joints
- some patients have sausage-like finger from inflammation of the digital tendon sheaths

Front 883

What skin disorder goes along with celiac disease?

Back 883

dermatitis herpetiformis: pruritic papules & vesicles

Front 884

What is deposited in joints in pseudogout?

Back 884

Ca pyrophosphate dihydrate crystals in CONNECTIVE tissues: weakly bifringent & rhomboidal in shape

Front 885

What is the most common selective Ig deficiency syndrome & how does it present?

Back 885

IgA: mucosal deficiency leads to sinus & lung infections

Front 886

What is the most common type of primary malignant tumor found in the liver?

Back 886

HCC: hepatocellular carcinoma

Front 887

What causes a bicornuate uterus?

Back 887

Failure of complete fusion of the paramesonephric ducts at there superior end.

Front 888

What causes uterus didelphys?

Back 888

- Complete failure of fusion of the paramesonephric (Mullerian) ducts
- Results in 2 seperate uterine cavities that each have a cervix & vagina

Front 889

What cause a arcuate uterus?

Back 889

(aka septate uterus)
Failure of resorption of the midline uterine septum

Front 890

Where is Schistosoma hematobium endemic? What does it cause?

Back 890

- North Africa & Middle East (parasitic flatworm)
- Infection via snails; enters bladder can cause squamous cell carcinoma of the bladder
- Rx: Praziquantel

Front 891

What does Dracunculus medinensis cause?

Back 891

(aka Guinea worm)
- Cutaneous nodules & ulceration: resides in subcutaneous tissue & the tail of adult female can protrude to from a small ulcer (usually found on the Patient's lower limb)

Front 892

Where is Necator americanus found (in the world)?

Back 892

(aka hookworm)
- Americas
- sub-Saharan Africa
- Southeast Asia

Front 893

What does Schistosoma masoni cause?

Back 893

intestinal schistosomiasis
- Intestinal cancer
- Liver infection
- Katayama fever

(sub-Saharan Africa, South America)

Front 894

What is used to treat endometriosis?

Back 894

Danazol (androgen): to decrease GRH to reduce luteinizing hormone & FSH secretion (decrease growth of endometrium)

SE: menstrual irregularities, thrombotic events, benign hepatic adenomas, benign intracranial hypertension (psuedotumor cerebri), weight gain, & acne

Front 895

What antiantrogen is used to treat BPH & male pattern balness?

Back 895

finasteride (5alpha-reductase inhibitor)

Front 896

What antiantrogen is used to treat prostate cancer?

Back 896

flutamide (competitive androgen inhibitor @ the testosterone receptor)

Front 897

What antiantrogen is used to treat hirsutism & polycystic ovarian syndrome?

Back 897

ketoconazole (inhibits adrenal desmolase needed for steroid synthesis)

Front 898

What antiantrogen is used to treat class III/IV congestive heart failure, primary hyperaldosteronism, diuretic-induced hypokalemia)?

Back 898

sironolactone (steroid binding inhibitor)

Front 899

What differentiates clomiphene & tamoxifen?

Back 899

- Tamoxifen: has agonist activity & promotes endometrial hyperplasia
- Cloomiphenes: has antagonist activity: inhibits endometrial hyperplasia

Front 900

In which tissues does clomiphene & tamoxifen act as an antagonist?

Back 900

1) CNS = vasomotor symptoms & sleep irregularities
2) Breast = breast cancer protection
3) bone PTH hormone = bone pain, hypercalcemia, arthralgias
4) Lipid profile = incrases HDL & triglycerids and decreased total & LDL cholesterol
4) Liver = increased protein synthesis, including clotting factors

Front 901

What drug often given to treat breast cancer in postmenopausal woman can cause Steven-Johnson syndrome?

Back 901

Anastrozole (aromatase inhibitor)

Front 902

What is a patient at risk for post-thyroidectomies if not given levothyroxine?

Back 902

Reduced:
- Glycogenolysis
- Gluconeogenesis
- Lipolysis

B/C thyroid receptors are located on bones in both the CNA & autonomic nervous systems

Front 903

What is the only human glycerophospholipid that is antigenic?

Back 903

Cardiolipin (Diphosphatidylglycerol): it is recognized by antibodies against Treponema pallidum

Front 904

What is the most common presentation of Burkitt's in North America?

Back 904

Loss of appetite
Sever Constipation
Abdominal pain or distention

Cause of symptoms: enlarged lymph nodes in the abdomen

Front 905

What catalyses the prodrug prednisone into prednisolone?

Back 905

11-beta-hydroxysteroid dehydrogenase

Front 906

What is the MOA of imatinib mesylate (Gleevec)?

Back 906

- Tyrosine receptor kinase inhibior that acts on Philadelphia chromosom fusion protein product Bcr-ABl in CML.
- Stops autophosphorylation & the unchecked proliferation of granulocytes in CML.

Front 907

What do glomeruli of diabetic patients with ESRD (End-Stage Renal Disease) look like histologically?

Back 907

Nodular glomerulosclerosis

Front 908

What is the most common congenital heart disease in adults? How can it present?

Back 908

Patent foramen ovale (PFO)
- Migraine with aura
- Right-to-left cardiac shunts
- Stroke in a young patient (venus thrombi bypass pulmonary circulation and cause paradoxical emboli)

Front 909

What is the treatment for a suspected rapies infection?

Back 909

1) Administer human rabies immune globulin to provide passive immunity
2) Followed with a series of 5 injections of killed rabies virus vaccination to develop active immunity

Front 910

What 2 steps make bilirubin soluable?

Back 910

1) Noncovalent binding to albumin (in liver)
2) Conjugation with glucuronate (in hepatocytes via UDP-glucuronyl transferase) to form bilirubin diglucuronide

Front 911

Where is urobilinogen producted?

Back 911

Gut: bilirubin diglucuronide is reduced by gut bacteria

Front 912

What is the typical presentation for MEN1?

Back 912

Hyperparathyroidism (hypercalcemia & hypophosphatemia)

Front 913

Besides hyperparathyroidism, what 2 signs can be indicative of MEN1?

Back 913

1) Pituitary prolacinoma (galactorrhea)
2) Duodenal ulcers (gastrinoma in the pancreas causing Sollinger-Ellison syndrome)

Front 914

What nerve roots is the pudendal nerve derived from?

Back 914

S2-4

Front 915

What is the karyotype of a complete mole?

Back 915

46 XX (haploid sperm replicates within an empty egg)

Front 916

What is the karyotype of a partial mole?

Back 916

69 XXX (2 haploid sperm fertilize a haploid egg)

Front 917

What "essential" amino acids can be synthesized by a healthy adult?

Back 917

histidine & arginine

Front 918

What is the embryological source of cranial nerve VII & muscles of facial expression

Back 918

2nd branchial arch

Front 919

Which test for syphilis is the most specific?

Back 919

FTA-ABS: dlurescent treponemal antibody absorption

Front 920

What are the early cellular changes due to ischemia? late ones?

Back 920

Early: cellular swelling, organelle swelling, ribosomal disaggregation
Late: organelle membrane damage & morphologic changes (cell blebs), cell surface deformities caused by cyoskeletal dysfunction, & nuclear changes (pyknosis, karyolysis, & karyorrhexis)

Front 921

How do renin levels distinguish 1 from 2ndary hyperaldosteronism?

Back 921

Primary: high renin
Secondary: low renin

Front 922

What is the hemodynamic picture for septic shock?

Back 922

- Increased CO
- Decreased SVR (Systemic Vascular Resistance) & PCWP (Pulmonary Capillary Wedge Pressure)

Front 923

What is the hemodynamic picture of neurogenic shock?

Back 923

- Loss of vasomotor tone
- Decreased CO
- Decreased PCWP (Pulmonary Capillary Wedge Pressure)

Front 924

What hemodynamic picture indicates hypovolemic shock?

Back 924

- Increased SVR
- Decreased CO
- Decreased PCWP (Pulmonary Capillary Wedge Pressure)

Front 925

What hemodynamic picture is seen with cardiac shock?

Back 925

- Increased SVR
- Decreased Co
- Increased PCWP (Pulmonary Capillary Wedge Pressure)

Front 926

What bacteria cause skin abscesses & are most likely transmitted via dog/cat bite?

Back 926

Pasteurella multocida (gram - rod)

Front 927

What does infection by Brucella canis cause?

Back 927

fever, malaise, hepatosplenomegaly

Front 928

What are the HACEK organisms?

Back 928

Haemophilus
Actinobacillus
Actinomycetemcomitans
Cardiobacterium hominis
Eikenella corrodens
Kingella kingae

Can all cause culture negative endocarditis

Front 929

What bacterium can be transmitted to humans via handling of rabbit tissue (or a tick or deerfly bite)?

Back 929

Francisella tularensis
- Well-demarcated skin lesion with a black base!!
- Later: systemic symptoms (fever, headache, malaise)

Front 930

What is the leading theory about how vaccine use has increased the number of allergies/autoimmune diseases?

Back 930

- Low stimulation of Th1 lymphocytes (b/c they are stimulated by bac/viruses)
- This leads to an overproduction of Th2 lymphocytes and allergen-specific IgE

Front 931

What drug is used to treat narcolepsy daytime sleepiness>

Back 931

- Modafinil: increases monoamines in the brain somehow (MOA unknown)
- Safer than amphetamines & methylphenidate

Front 932

What nerve innervates the adductor muscles of the thigh? What patients are at risk for damage?

Back 932

Obturator (athletes: can be entrapped between muscles)

Front 933

What nerve innervates the anterior compartment of the thigh?

Back 933

femoral (flexes the thigh & extends the knee)

Front 934

What nerve innervates the gluteus maximus?

Back 934

Inferior gluteal: extends & laterally rotates the thigh

Front 935

What nerve innervates the obturator internus & superior gemellus?

Back 935

Obturator internus: laterally rotates & flexes the thigh

Front 936

What muscles does the sciatic nerve (tibial & common peroneal divisions) innervate?

Back 936

Hamstrings (posterior thigh muscles): extend the thigh & flex the leg

Front 937

How is the kidney changed in hepatorenal syndrome?

Back 937

- It is not. It remains of normal shape & size.
- There change is only physiological: vasoconstriction in the vascular beds due to the activation of the renin-angiotensin system.

Front 938

In what disease do the kidneys appear grossly flea-bitten?

Back 938

Malignant hypertension

Front 939

What is the MOA of hydralazine?

Back 939

increases cGMP & causes smooth muscle relaxation (greater effect on arterioles than veins) to reduce afterload
- Rx: essentail hypertension and CHF

SE: compensatory tachycardia (angina), Up fluid retention, & lupus-like syndrome with long-term use

Front 940

What is a rare complication of long-term heparin therapy? What's the treatment?

Back 940

HIT: heaprin-induced thrombocytopenia
- Heparin-specific antibodies form complexes with heparin & platelets
- Results in platelet activation, clot formation, & steadily dropping platelet levels

Rx: Direct thrombin inhibitors (Argatroban & Lepirudin)

Front 941

What are the direct thrombin inhibitors & why aren't they 1st line therapy?

Back 941

- Argatroban & Lepirudin
- Effects are not readily reversible

Front 942

What are the physical findings that indicate I-cell disease?

Back 942

Coarse facial features
Developmental delay
Restricted joint movement

Histo: intracytoplasmic inclusions in mesenchymal-origin cells.

Front 943

What is the pathogenesis of I-cell disease?

Back 943

Improper intracellular trafficing:
- Failure to add a mannose-6-phosphate residue to proteins that should be directed to lysosomes
- Result: membrane-bound intracytoplasmic vacuoles that are filled with fibrillogranular material (lipids, mucopolysaccharides, oligosaccharides)

Front 944

How is congenital rubella infection characterized?

Back 944

Cataracts
Glaucoma
Pigmented retinopathy
Cardiac malformations
Deafness

Front 945

What is the MOA of bacterial/viral superantigens?

Back 945

Proteins that nonspecifically cross-link MHC class II molecules with certain T-cell receptor (TCR) subsets
- Inappropriate activation of these T-cells (2-20% of all T-cells)
- Supraphysiologic production of cytokins: IL-1, TNFalpha, IL-6, IL-12, interferon-gamma.

Front 946

What is oculocutaneous albinism?

Back 946

A mutation in tyrosinase (converts tyrosine into dopa) that is the key, rate-limiting step in melanin production from phenylalanine

Front 947

What enzyme is deficient in Maple syrup urine disease?

Back 947

alpha-ketodehydrogenase:
- inability to degrade branched amino acids (isoleucine, leucine, valine)

I LoV Maple Syrup

Front 948

What enzyme deficiency results in galactosemia & galactosuria?

Back 948

galactokinase: converts galactose into glucose

Front 949

What disorder is characterized by black urine (especially after long periods of standing) & arthralgias?

Back 949

Alkaptonuria (deficiency of homogentisic acid oxygenase)

Front 950

What 3 different enzyme deficiencies can result in homocystinuria?

Back 950

1) Methionine synthase
2) Cystathionin synthases (converts homocysteine into cysteine): REQUIRES B6!!
3) Decreased affinity of cystathionine synthase for pyridoxal phosphate

Result: mental retardation, osteoporosis, tall statue, kyphosis, lens subluxation

Front 951

What is the presentation of giardiasis?

Back 951

- Bloating
- Flatulence
- Foul-smelling, nonbloody, diarrhea
- Light-colored fatty stools

Front 952

What infection presents with macrophages containing amastigotes and clinical symptoms of hepatosplenomegaly, malasie, anemia, & weight loss?

Back 952

Leishmainia donovani (sandfly transmission)

Rx: Sodium stibogluconate

Front 953

What 2 important cystic infections are acid-fast staining?

Back 953

- Cryptosporidium (water: fecal-oral): severe/mild, nonbloody diarrhea (severe = HIV Px)
- Toxoplasma (raw meat or cat feces): brain abscesses in HIV Px & birth defects if congenital

Front 954

What is the treatment for T. gondii?

Back 954

Sulfadizine & pyrimethamine

Front 955

What are RBCs containing schizonts characteristic of?

Back 955

Plasmodium infection (late stage of the asexual form of the parasite) transmitted by the female Anopheles mosquito: flu-like symptoms

Front 956

What endogenous hormone inhibits HCl secretion?

Back 956

somatostatin

Front 957

How do NSAIDS cause peptic ulcer disease?

Back 957

Disrupt the mucus barrier by inhibiting prostaglandin synthesis

Front 958

What cells secrete cholecystokinin?

Back 958

I cells: promotes gallbladder contraction after ingestion of fatty acids or amino acids

Front 959

What is the action of VIP (vasoactive intestinal polypeptide)?

Back 959

Increases intestinal water & electrolyte secretion

Front 960

What is the 1st line therapy of ulcerative colitis?

Back 960

Sulfasalazine:
- Metabolized to 5-aminosalicylic acid in GI tract & decreases local inflammation
- SE: Renal insufficiency & increased risk of a bleed

Front 961

When is ciprofloxacin used to treat UC?

Back 961

When it is complicated by strictures & infections of the GI (NOT 1st line Rx)

Front 962

What do the acidophils of the pituitary secrete?

Back 962

Growth hormone
Prolactin

Front 963

What do the basophils of the pituitary secrete?

Back 963

FSH
LH
ACTH
TSH

Front 964

What are oxyphils?

Back 964

Cells of the parathyroid gland

Front 965

@ what receptors does ADH act?

Back 965

V2 (basolateral side of principal cells)
- activates Gs-mediated cyclic AMP
- This mobilizes aquaporin transmembrane channels to the luminal surface
- Net water moves from the collecting duct lumen to the hyperosmolar interstitium

Front 966

What is the course of the ureters in the female pelvis?

Back 966

- Cross iliac artery anteriorly @ its bifurcation
- Continues into the pelvis, where it passes posterior to the uterine artery
"water under the bridge"

Front 967

What presents in 10% of patients with pancreatic adenocarcinoma?

Back 967

Trousseau's Syndrome: migratory thrombophlebitis

+ normal signs of acute weight loss, steatorrhea, & atypical DM (increase thirst & urination)

Front 968

What is the blood supply of the liver?

Back 968

75%: portal vein
25%: hepatic artery

BUT, they give equal O2

Front 969

How does Brown-Sequard present?

Back 969

(spinal cord hemisection)
- ipsilateral loss of motor function & vibration/proprioception
- contralateral loss of pain & temperature sensation

Front 970

How does Syringomyelia present?

Back 970

bilateral sensory defects in the upper extremities dues to enlargement of the central canal of the spinal cord

Front 971

What is the most commonly obstructed artery in the gut & what does it supply?

Back 971

SMA (superior mesenteric artery): embryonic midgut (duodenum to the proximal 2/3 of the transverse colon)

Front 972

What artery supplies the gallbladder, stomach to proximal duodenum, pancrease & the liver?

Back 972

celiac: embryonic foregut

Front 973

What infection causes undulating fever (peaks in the evening & falls at nighttime)?

Back 973

Brucella (contaminated milk or direct livestock contact)

Front 974

Where are Yersinia pestis buboes located?

Back 974

Buboes (painful, enlarged lymph nodes) in the groin & armpits.
- then can enter bloodstream and cause sepsis, DIC, pneumonia or meningitis

Front 975

How is renal osteodystrophy treated?

Back 975

- Ca
- Phosphate binders
- calcitriol (synthetic vitamin D3) supplimentation

Front 976

What lung parameter is changed equally in obstructive & restrictive lung disease?

Back 976

decrease in vital capacity (insufficient amount of air exhaled or inhaled)

Front 977

What are the 2 ways that glucose can enter a cell?

Back 977

1) Na-independent facilitated diffusion with glucose transporters
2) Na-monosaccharide cotransporter system (intestinal cells, renal tubules, choroids plexus) SGLT-1

Front 978

Where is the GLUT-2 receptor?

Back 978

Basal surface of intestinal cells & transmits glucose into the blood

Front 979

Where is the GLUT-4 receptor?

Back 979

Muscle & adipose tissues

Front 980

Where is the GLUT-5 receptor?

Back 980

Lumen of the gut: Na-dependent absorbtion of fructose

Front 981

What is the MOA of beta-blockers that allows them to help with coronary artery disease?

Back 981

Slows phase 4 depolarization & prolong's diastole: increase coronary artery filling
- Decreased sympathetic tone decreases the inward Na+ current

Front 982

What characterizes the 2nd phase of Lyme disease?

Back 982

(Borrelia burgdorferi via Ixodes tick)
- Transient arthralgias
- Bell's palsy
- Atrioventricular nodal block
- 2ndary annular rashes
- Carditis

Front 983

What characterizes the 3rd phase of Lyme disease?

Back 983

Migratory joint pain
Chronic arthritis
Encephalopathy
Acrodermatitis

Front 984

What infection is characterized by relapsing fevers (~5 days of fever with ~ 1 week between episodes)?

Back 984

Borrelia burgdorferi (spirochete): fever pattern is due to its ability to undergo antigenic variation

Front 985

How can lymphoblasts be distinguished from mature lymphocytes?

Back 985

lymphoblasts have fine, homogenous chromatin, irregular nuclear boarders, & scant cytoplasm
- Found in ALL (Dx: peripheral blood smear)

Front 986

What heart murmur indicates a VSD?

Back 986

II-III/VI holosystolic murmur
- Best heard @ the left sternal boarder

Front 987

What 3 defects can result in a VSD?

Back 987

1) Septum of the atrioventricular canal
2) Muscular septum
3) Distal conal septum

Front 988

What are the GRAIN lab results that indicated sarcoidosis?

Back 988

gamma-Globulinemia
Rheumatoid arthritis
elevated ACEnzyme levels
Interstitial fibrosis
Noncaseating granulomas

Front 989

Where are Mallory-Weiss tears found?

Back 989

gastroesophageal junction: a nonpenetrating mucosal tear

Front 990

What is Boerhaave's perforation?

Back 990

- Transmural perforation of the esophagus
- Presents with Mackler triad: vomiting, lower thoracic pain, subcutaneous emphysema
- Dx: endoscopy & Rx: surgery

Front 991

What is the major distinguishing factor of hepatitis E?

Back 991

- Severe, often-fatal disease course in pregnant women: fulminate (20% mortality)
- Hep E = RNA herpesvirus (nonenveloped, ssRNA)

Front 992

What type of virus is Hep C?

Back 992

RNA flavivirus (Enveloped RNA)
- Blood borne

Front 993

What type of virus is Hep B?

Back 993

DNA hepadnavirus (enveloped, circular DNA)

Front 994

What type of virus is Hep D?

Back 994

Defective RNA deltavirus (requires Hep B to serve as an envelope)

Front 995

How does FSH induce the conversion of testosterone to 17-beta-estradiol in the ovaries?

Back 995

Stimulates the enzyme aromatase within the graulosa cells to convert testosterone to 17-beta-estradiol in the overian follicle.
- Testosterone gets to the granulosa cells via diffusion from the theca cells where it is produced

Front 996

What are the 4 causes of Parkinsonism?

Back 996

1) Neurodegeneration of the substantia nigra (idiopathic)
2) MPTP exposure
3) Adverse effects of neuroleptic meds
4) Ischemic damage to the basal ganglia

Front 997

What causes hemiballism of the limbs?

Back 997

lesion of the contralateral subthalamic nucleus cause uncontrollable flailing

Front 998

Describe the (INHIBITORY) indirect pathway in the brain.

Back 998

1) Substantia nigra pars compacta sense INHIBITORY neurons to the striatum.
2) Striatum sense INHIBITORY output to the external segment of the globus pallidus; this inhibits the subthalamic nucleus
3) Subthalamic nucleus sends EXCITATORY neurons to the internal segment of the globus pallidus: this increases firing of GABA neurons that run from the GPi to the thalamus
4) Movement on the contralateral side of the body is inhibited

Front 999

What brain lesion would cause a spastic paralysis of the arm & leg on one side of the body?

Back 999

On the CONTRALATERAL side of the brain either:
1) primary motor cortex
2) medullary pyramid
3) lateral white matter tract of the spinal cord above C5

Front 1000

What does paralysis in general indicate?

Back 1000

A problem in the motor neurons themselves (i.e. not a ganglion)