Usmle Step 1 Superset (Part 3)

Front 1

What is Fitz-Hugh & Curtis syndrome?

Back 1

When a Neisseria gonorrhoeae infection spreads from the reproductive organs to the liver capsule resulting in acute perihepatitis

Front 2

What is the most likely organism to cause infection in patients with indwelling catheters or those with prosthetic joint replacements?

Back 2

Staphylococcus epidermidis: gram -, coagulase +, can form BIOFILMS on prosthetics

Front 3

What is it called when TB involves the vertebral bodies?

Back 3

Pott's disease or tuberculous spondylitis
- osteomyelitis & arthritis in 2(+) vertebra

Front 4

What are the 4 most popular typical antipsychotics?

Back 4

D2 dopamine receptor blockers:
1) Thioridazine
2) Haolperidol
3) Fluphenzaine
4) Chlorpromazine

Front 5

What is the MOA of atypical antipsychotics?

Back 5

block 5-HT2 & dopamine receptors

Front 6

Why do patients with Chediak-Higashi disease sometimes present with partial albinism?

Back 6

This AR disease is characterised by a failure of phagolysosome formation
- melanosomes are derivatives of lysosomes & thus can be dysfunctional as well

Front 7

To what type of infection are patients with chronic granulomatous disease most susceptible?

Back 7

Microbes that produce their own catalase (e.g. Staphylococcus & Candida)
- Due to NO NADPH oxidase
- Dx: negative tetrazolium dye reduction

Front 8

How do patients with selective IgA deficiency present?

Back 8

Sinus & Lung infections due to lack of enough functional IgA in mucous membranes

Front 9

What immunodeficiency presents with severe, recurrent bacterial, viral, protozoal, & fungal infections?

Back 9

SCIDs b/c of a defect in early stem-cell differentiation

Front 10

What is the product of the p53 gene?

Back 10

- a transcription factor that regulates apoptosis & prevents defective cells from undergoing division.
- mutation causes uncontrolled cell division

Front 11

What are the products of the BCR1 (ch. 17) & BRCA2 (ch. 13) genes?

Back 11

DNA repair products

Front 12

What is the product of the APC gene (ch. 5)?

Back 12

Membrane cell adhesion products

Front 13

What drug is used to prevent chemo-induced nausea/vomiting and has the SE of headache & constipation?

Back 13

Ondansterol (5-HT antagonist)

Front 14

What is the MOA of metoclopramide?

Back 14

- Prokinetic agent that promotes GI motility
- Potent dopamine antagonist that enters the CNS & makes it antiemetic & SE of extrapyramidal (i.e. Parkinsonian-like adverse effects)

Front 15

What is Trimethobenzamide used for?

Back 15

- Nausea & vomiting
- MOA = unknown
- SE: headache, depression, muscle cramps, dizziness

Front 16

What are the derivatives of the 1st aortic arch?

Back 16

Maxillary artery (part of it is derived from this arch)

Front 17

Define "hot T-Bone Steak"

Back 17

IL1 = fever (Hot)
IL2 = T lymphocyte stimulator
IL3 = Bone marrow stimulator
IL4 = IgE stimulation
IL5 = IgA stimulation

Front 18

What cancers is recombinate IL2 (adesleukin) used to trat?

Back 18

Renal cell & Metastatic melanoma

Front 19

What are the 3 pathologic stages in RDS?

Back 19

1: exudative stage with intra-alveolar hyaline membrane formation

2: proliferation stage with increase in type II pneumocytes & fibroblast

3: fibrotic stage with lung remodeling & fibrosis

Front 20

What anti-hypertriglyceridemia drug is contraindicated in patients with cholesterol gallstones?

Back 20

Gemfibrozile b/c fibrates can increase the development of gallstones

Front 21

What antihypertensive drugs are most useful for patients with asthma?

Back 21

A BEAM: (selective B1-blockers)
- Acebutolol
- Betaxolol
- Esmolol
- Metoprolol

Front 22

What is the CD marker on all lymphocytes of thymic origin

Back 22

CD2 is on all helper T-cells, cytotoxic T-cells, & natural killer cells

Front 23

What lymphocytes have CD3?

Back 23

All CD4 & CD8 cells, but NOT natural killer cells

Front 24

What is the T-cell (TCR) receptor?

Back 24

alpha/beta heterodimer encoded by genes undergoing V(D)J recombination that is expressed by each clone of the T lymphocyte that gives it antigen binding specificity

Front 25

Why does prolonged diarrhea & vomiting cause hyponatremia (& t/f seizures)?

Back 25

1st: Loss of solute & H20 loss
2nd: Hypovolemia induces secretion of ADH (conserves H2O without Na)
3rd: Hyponatremia -> neurologic dysfunction induced by cerebral edema

Front 26

Why does metabolic alkalosis result in hypokalemia?

Back 26

More H2O & bicarb are delivered to the distal K-secretory site in the kidney & aldosterone is released = renal loss of potassium

Front 27

How does hyperkalemia present?

Back 27

- Weakness progressing to flaccid paralysis
- Metabolic acidosis
- Cardiac conduction disturbances by peaked T wave on ECG

Front 28

What is the most common H. influenzae type to cause acute otitis media?

Back 28

NTHi = Haemophilus influenzea nonencapsulated (nontypable):
- 75% of adults & children carry this bac in their nasopharynx
- NB: Type B is covered by the childhood vaccine

Front 29

What are the 3 most common causes of acute otitis media?

Back 29

1) Streptococcus pneumoniae (aerobic, gram + coccus)
2) Haemophilus influenzea (NTHi)
3) Moraxella catarrhalis (gram -, diplococci)

Front 30

How does a Nocardia asteroides present in an immunocompromised patient?

Back 30

lung abscesses & cavitations
- late erosion of blood vessels and dissemination to brain: abscesses
- gram +, filamentous, weakly acid-fast

Rx: sulfonamides (dihydropteroate synthetase blockers = blocks nucleotide synthesis)

Front 31

What is the MOA of amphotericin B?

Back 31

Antifungal that binds ergosterol & membrane pores in the outer membrane

Front 32

What fructose metabolism enzyme is missing in patients that experience severe hypoglycemia, vomiting, jaundice, & hemorrhage?

Back 32

Aldolase B
- No conversion of fructos-1-phosphate to glyceraldehydes & dihydoxyacetone phosphate
- Result: intracellular trapping of fructose-1-phosphate

Front 33

What vasculitis is associated with Hep B infection in 10% of cases?

Back 33

Polyarteritis nodosa:
- NO lung involvement
- Livedo reticularis: puplish discoloration skin rash
- transmural infalmmation of s/m arteries -> fibrous, thickened vessel wall (each lesion is at a different age)
- episodes last a few weeks to moths & <10% relapse

Front 34

What diabetic drug causes GI adverse effects including abdominal cramps, diarrhead, & flatulence? & is contraindicated in cirrhosis & requires liver function monitoring?

Back 34

Acarbose: alpha-glucosidase inhibitior
- MOA: decreases hydrolysis & absorption of diaccharides & polysaccharides at the intestinal brush border
- Reduces postprandial hyperglycemia

Front 35

What patients cannot be prescribed metformin?

Back 35

those with renal insufficiency (b/c of the risk of lactic acidosis)

Front 36

Why were 1st generation thiazolidinediones (like troglitazone) taken off the market?

Back 36

- Extreme hepatotoxicity
- MOA: sensitizes the peripheral tissues to insulin's action

Front 37

What is lacking in Factor V Leiden disorder?

Back 37

Mtation resulting in an arginine-to-glutamine substitution @ position 506 in factor V & is thus resistant to cleavage by protein C

Front 38

What should be ruled out in all patients >50 years old that complain of nonremitting, yet, tolerable, flank pain & hematuria without signs of infection?

Back 38

Malignancy
- check for renal cell: contrast-enhancing, solid renal mass arising from the renal cortex upon imaging

Front 39

What is the antidote for methanol or ethylene glycol (antifreeze) tox?

Back 39

Fomepizole

Front 40

What is the antidote for tricyclic antidepressant tox?

Back 40

NaHCO3

Front 41

What is the antidote for cyanide tox?

Back 41

Thiosulfate

Front 42

What are non-oncologic uses of methotrexate?

Back 42

MOA: folic acid analog natimetabolite that inhibitis dihydrofolate reductase:
- Ectopic pregnancy
- Psoriasis
- Inflammatory bowel disease
- Rheumatoid arthritis

Front 43

Why are tetracyclines used in early rheumatoid arthritis?

Back 43

Inhibit the activity of metalloproteinases that are involved in join destruction by the rheumatoid synovium

Front 44

What are non-oncologic uses for cyclophosphamide?

Back 44

MOA: alkylating agent
- SLE immunosuppressant
- MS
- Autoimmune hemolytic anemia

Front 45

What is the MOA of B-blockers?

Back 45

- Inhibit B-receptors & inhibit the G-proteins/cAMP mechanism
- Decreased cAMP & protein kinase A = decreased Na+ & Ca2+ current within the AV node
- T/F decrease the slope of phase 4 & ) = suppression of abnormal pacemakers

Front 46

Where are the nicotinic receptors of ACh?

Back 46

Direct membrane receptor coupling to a Na+/K+ ion channel:
- ANS ganglia
- Skeletal neuromuscular junctions
- CNS

Front 47

Where are the GABAa receptors that are directly coupled to Cl ion channels?

Back 47

CNA

Front 48

What receptors increase cAMP to activate protein kinase A to phosphorylate tissue specific substrate enzymes?

Back 48

Gs:
- catecholamines (beta)
- dopamine (D1)
- glucagon
- histamine (H2)
- prostacycline
- 5HT

Front 49

What receptors decrease cAMP to down regulate protein kinase A & lower phosphorylate tissue specific substrate enzymes?

Back 49

Gi:
- Catecholamines (alpha 2)
- ACh muscarineic (M2)
- Dopamine (D2 subtypes)
- Several opiod & 5HT subtypes

Front 50

Which receptor systems activate phospholipase C to release IP3 & DAG from membrane PIP2 (IP3 then releases Ca2+ from the SR, which with DAG activates protein kinase C to phosphorylate tissue specific substrate enzymes?

Back 50

- ACh (M1 & M3)
- Norepinephrine (alpha 1)
- Angiotension II
- Several opioid & 5HT subtypes

Front 51

What is the mechanism of vascular smooth muscle vasodilation?

Back 51

- Cyclic GMP is the 2nd messanger
- Facilitates dephosphorylation of myosin light chains to prevent their interaction with actin

Front 52

How does Nitric oxide (NO) promote vasodilation?

Back 52

Released from endothelial cells by vasodilatiors (e.g. H1 & M3 agonists, or nitrates) to activate guanylyl cyclase to increase cGMP

Front 53

What receptors mediate the first steps in insulin & growth factor signaling?

Back 53

EGF: endothelial growth factor
PDGF: platelet derived growth factor
ANF: atrial naturitic factor

Recognition sites extracellularly + tyrosine kinase cytoplasmic domains that are dimerized upon ligand binding & result in tissue-specific substrate protein phosphorylation

Front 54

What are Nn receptors?

Back 54

Nicotinic: PANS & SANS ganglia & adrenal medulla

Front 55

What are Nm receptors?

Back 55

Nicotinic: skeletal muscle motor endplate

Front 56

What are M receptors?

Back 56

Muscarinic: organs/tissues innervated by post-ganglionic nerves of the PANS & thermoregulatory sweat glands of SANS

Front 57

What are α & β receptors?

Back 57

Adrenoceptors: organs/tissues innervated by post-ganglionic nerves of SANS

Front 58

What receptors use ACh as a neurotransmitter?

Back 58

N & M receptors of innervated tissues:
- Nicotinic: skeletal muscle motor endplate
- Muscarinic: organs/tissues innervated by post-ganglionic nerves of the PANS & thermoregulatory sweat glands of SANS

Front 59

What receptors use NE as the neurotransmitter?

Back 59

Most adrenoceptors in innervated tissues

Front 60

What receptors use DA (dopamine) as the neurotransmitter?

Back 60

D1 receptors in renal vasculature

Front 61

What receptors use E (Epinephrine) as the neurotransmitter?

Back 61

- Adrenal medulla
- Activates most adrenoceptors whether or not the tissues are innervated

Front 62

What receptors use 5HT, purines, & opioid peptides as the neurotransmitter?

Back 62

ENS & many ANS fibers in the GI tract

Front 63

What is the neural response to an increase in Bp?

Back 63

- Baroreceptor discharge
- Increase in PANS activity -> bradycardia
- Decrease in SANS -> decrease in HR & decrease in contraction & decrease in vasoconstriction

Front 64

What is the neural response to a decrease in Bp?

Back 64

- ANS neural feedback:
- decrease PANS outflwo & increased SANS -> increased CO & TPR

Front 65

What is the hormonal response to decrease mean Bp (i.e. hypotension)?

Back 65

- Decrease in renal blood flow -> decrease in renal pressue
- Increase in renin release -> increase in angiotensins
- Angiotensin II increases aldosterone release from the adrenal cotex
- Retention of Na & H2O to increase blood volume
- Increased venous return increases Co
- Angiotension II also causes vasoconstriction to increase TPR

Front 66

What is the target of indirect-acting cholinomimetics?

Back 66

AChE: the amjor mechanism of termination of ACh actions

Front 67

How does the Cholinergic neuroeffector junction work?

Back 67

ACh is synthesized via ChAT & accumulates in synaptic vesicles
- Excitation opens voltage-dependent Ca2+ channels and there is a Ca2+ INFLUX
- ACh is released and activates post-junctional receptors

Front 68

Where does Botulinum toxin act?

Back 68

Blocks ACh release at Cholinergic neuroeffector junctions

Front 69

Name the cholinomimetics that target postjunctional cholinergic receptors (direct-acting cholinomimetics)?

Back 69

- Nicotinic: Nicotine
- Muscarinic: bethanechol, methacholine, pilocarpine

Front 70

Name the cholinoceptor antagonists that target postjunctional cholinergic receptors (direct-acting antagonists/blockers)?

Back 70

- Nicotinic (Nn): hexamethonium, mecamylamine
- Nicotinic (Nm): tubocurarine, atracurium, succinylcholine
- Muscarinic: atropine, benztropine, glycopyrrolate, scopolamine

Front 71

What are the Muscarinic receptors of the Eye?

Back 71

M3:
- Sphincter (contracts = miosis)
- Ciliary muscle (contract = accomodation for near vision)

Front 72

What are the Muscarinic receptors of the Heart?

Back 72

M2:
- SA node: decrease in HR: negative inotropy
- AV node: decrease in conduction velocity

Front 73

What are the Muscarinic receptors of the Lungs?

Back 73

M3:
- Bronchioles: contract/bronchospasm
- Increased secretion

Front 74

What are the Muscarinic receptors of the GI?

Back 74

M3: increased motility = cramps
M1: increased secreation
M3: contraction = diarrhea

Front 75

What are the Muscarinic receptors of the bladder?

Back 75

M3:
- Wall: contraction
- Sphincter: relaxation

Front 76

What does activation of M3 receptors generally do to sphincters?

Back 76

Relaxes them
EXCEPT lower Esophageal

Front 77

What are the Muscarinic receptors of the glands?

Back 77

M3:
- increases secretation (sweat = thermoregulatory)
- increases salivation
- increases lacrimation

Front 78

What are the Muscarinic receptors of the glands?

Back 78

M3:
- dilation VIA NO or EDRF (not innervation)

Front 79

What are the Nicotinic receptors of the Adrenal medulla?

Back 79

Nn: secretion of E & NE

Front 80

What are the Nicotinic receptors of the Autonomic ganglia?

Back 80

Nn:
- Stimulation: effects depend on ANS innervation & dominance:
- BV = SANS = vasoconstriction
- GI = PANS = increased motility & secretions

Front 81

What are the Nicotinic receptors of the Neuromuscular junction?

Back 81

Nm:
- Stimulation = twitch/hyperactivity

Front 82

What is the mechanism of M1 & M3 receptors?

Back 82

Cholinergic, Gq:
- Increase DAG & IP3 = increased intracellular Ca2+

Front 83

What is the mechanism of M2 receptors?

Back 83

Cholinergic, G1:
- Decreased adenylyl cyclase = decreased cAMP

Front 84

What is the mechanism of Nn & Nm receptors?

Back 84

NO 2nd Messengers:
- Activation = opening of Na+/K+ channels

Front 85

What is the activity, AChE hydrolysis, & clinical use for bethanechol?

Back 85

Direct-Acting Cholinomimetic
- Activity: M receptors
- AChE hydorlysis: none
- Rx: ileus (post-op/neurogenic), - urinary retention

Front 86

What is the activity, AChE hydrolysis, & clinical use for methacholine?

Back 86

Direct-Acting Cholinomimetic
- Activity: M > N receptors
- AChE hydorlysis: yes
- Rx: bronchial hyper-reactivity

Front 87

What is the activity, AChE hydrolysis, & clinical use for pilocarpine?

Back 87

Direct-Acting Cholinomimetic
- Activity: M receptors
- AChE hydorlysis: none
- Rx: glaucoma (topical), xerostomia

Front 88

What is the action & clinical use of edrophonium?

Back 88

Indirect-acting Cholinomimetic:
- Action: short-acting
- Use: Dx myasthenia from cholinergic crisis

Front 89

What is the action & clinical use of physostigmine?

Back 89

Indirect-acting Cholinomimetic:
- Action: tertiary amine (enters CNS), intermediate action
- Use:glaucoma, antidote in atropine tox

Front 90

What is the action & clinical use of neostigmine/pyridostigmine?

Back 90

Indirect-acting Cholinomimetic:
- Action: quaternary amine (no CNS entry), intermediate action
- Use: ileus, urinary retention, myasthenia, myasthenia, reversal of non-depolarizing NM blockers

Front 91

What is the action & clinical use of donepezil, tacrine?

Back 91

Indirect-acting Cholinomimetic:
- Action: lipid soluble (CNS entry)
- Use: Rx = Alzheimer's disease

Front 92

What is the action & clinical use of organophosphates?

Back 92

Indirect-acting Cholinomimetic:
- Action: lipid-soluble, long-acting irreversibel inhibitors
- Use: NONE (insecticides: malathion, parathion; NERVE GAS)

Front 93

What are the symptoms of AChE inhibitor poisoning?

Back 93

DUMBELS:
Diarrhea
Urination
Miosis
Bronchoconstriction
Excitiation (muscle & CNS)
Lacrimation
Salivation & Sweating

Front 94

What is the management for AChE poisoning?

Back 94

2 drugs, give together:
- Atropine (enters the CNS)
- Pralidoxime (2-PAM) to regenrate phosphorylated AChE

Front 95

What type of drug is atropine?

Back 95

- Muscarinic receptor antagonist; PARASYMPATHOLYTICS
- Tertiary amine (enters the CNS)

Front 96

What does atropine do?

Back 96

"Dry as a bone; red as a beet, hot as a pistol, blind as a bat, mad as a hatter"

- Heart: low dose = decreases HR, moderate dose = increases HR
- Decreases secretions (salivary, bronchiolar, sweat)
- Mydriasis & cycloplegia
- Hyperthermia with resulting vasodilation
- Decreased GI motility
- DELUSIONS & HALLUCINATIONS

Front 97

How do you manage an atropine OD?

Back 97

symptomatic +/- physostigmine

Front 98

What are the clinical uses of atropine?

Back 98

Muscarinic receptor antagonist; PARASYMPATHOLYTIC:
- Antispasmodic
- Antidiarrheal
- Antisecretory
- AChE inhibitor Overdose

Front 99

What is the clinical use of tropicamide?

Back 99

Muscarinic receptor antagonist; PARASYMPATHOLYTIC:
- Opthalmology (topical)

Front 100

What is the clinical used of ipratropium?

Back 100

Muscarinic receptor antagonist; PARASYMPATHOLYTIC:
- Ashtma & COPD (inhalational)
- NO CNS entry

Front 101

What is the clinical use of scopolamine?

Back 101

Muscarinic receptor antagonist; PARASYMPATHOLYTIC:
- Antimotion sickness
- SE: causes sedation & short-term memory block

Front 102

What is the clinical use of Glycopyrrolate?

Back 102

- Antispasmodic
- Antisecretory
- Anti-ulcer

NO CNS entry

Front 103

Where do ganglionic blocking agents act?

Back 103

Competitive antagonists at the Nn rectpors in ANS ganglia

Front 104

What determines the effect of ganglionic blockers?

Back 104

Blockers REDUCE dominate TONE

- PANS dominate in tissues with dual innervation (SA & AV nodes; pupil, GI/GU muscles & sphincters) = BLOCKER -> tachycardia, mydriasis, & muscle relaxation & sphincter closure

- SANS dominate in vascular tone & sweat glands
= BLOCKER -> vasodilation & reduced secretion

Front 105

What are the 3 ganglionic blockers?

Back 105

- Hexamethonium
- Mecamylamine
- Trimethaphan

Front 106

What is the use of ganglionic blockers?

Back 106

Shows whether a drug action is direct (e.g. on heart rate) or due to ANS reflex response (blocks reflex brady/tachycardia elicited by change in mean Bp)

Front 107

What happens when hexamethonium is given after phenylephrine is administered?

Back 107

- Phenylephrine will cause vasocontriction
- Hexamethoium will block the reflex bradycardia

Front 108

What happens when hexamethonium is given after a M-receptor activator is administered?

Back 108

Nothing, the action is direct on the heart & not a reflex that Hexamethonium can block

Front 109

What are the general characteristics of a nondepolarizing NMJ blocker? List the 3 main drug examples

Back 109

- Competitive antagonist of NM muscle endplate
- Reversible by AChE
- E.G.: tubocurarine, atracurium, pancuronium

Front 110

What are the general characteristics of a depolarizing NMJ blocker?

Back 110

- Agonist at NM receptors
- Initial fasciculation then paralysis through persistent membrane depolarization
- NOT reversibel by AchE inhibitors
- E.G. succinylcholine

Front 111

Explain the main steps of NE synthesis?

Back 111

1) Tyrosine is converted to DOPA (dihydroxyphenylalanie) via tyrosine hydroxylase
2) DOPA is converted to dopamine (DA) via L-aromatic amino acid decarboxylase (DOPA decarboxylase)
3) DA is converted to NE via DA beta-hydroxylase & is taken up & stored in granules

Front 112

How does inactivation of NE via MAO occur?

Back 112

Regulation/reduction in prejunctional levels in the mobile pool, but has NO effect on granular NE (i.e. already NE already stored in granules)

Front 113

Explain the mechanism of NE release?

Back 113

1) Membrane excitation opens voltage-dependent Ca2+ channels
2) Ca2+ influx
3) NE released from granules into the neuroeffector junction
4) NE activates postjunctional receptors & effect depends on the alpha or beta adrenoceptor subtype

Front 114

What are the 4 ways that NE action can be terminated?

Back 114

1) NE transporter system (reuptake)
2) Activation of prejunctional alpha2 adrenoceptors that are then feedback inhibitors
3) Diffusion from neuroeffector junction
4) Taken up by target cells & inactivated by COMT

Front 115

What are MOA of MAO inhibitors?

Back 115

- Drugs: phenelzine, tranylcypromie
- Increase prejunctional NE

Action: inhibits MAO A & B:
- MAO A (in liver) = also metabolizes NE, 5HT, & tyramine
- MAO B: mainly in Brain & metabolizes DA

Front 116

What drugs act on the mobile pool of NE (indirect acting sympathomimetics)?

Back 116

Amphetamine, Ephedrine, Tyramine
- MOA: displaces NE & t/f enhances post-junctional actions

Front 117

What indirect sympathomimetic inhibits NE reuptake to increase postjunctional NE?

Back 117

Cocaine

Front 118

What adrenoreceptor drugs activate prejunctional alpha receptors to inhibit tyrosine hydroxylase & t/f NE release from synaptic vesicles?

Back 118

- Clonidine
- Alpha methyldopa

Front 119

What drugs block the granular uptake of NE within neurons?

Back 119

Reserpine: decreases prejunctional levels of NE available for release

Front 120

What drugs block the release of NE from granules to decrease postjunctional actions of NE?

Back 120

Guanethidine

Front 121

What distinguishes typical viral meningitis from CNS invasion by HSV?

Back 121

- CSF will show RBCs present due to necrosis of infected brain tissue & resultant cerebral hemorrhage
- Otherwise, the CSF findings will be viral: increased lymphocytes, normal/elevated protein, normallow glucose

Front 122

How can selective COX-2 inhibitors (like Celecoxib) cause renal failure?

Back 122

- Inhibits prostaglandin synthesis
- If a patient becomes DEHYDRATED, they have no physiological mechanism to retain renal blood flow (vasodilation of the afferent & efferent arterioles)

Front 123

Where is the macula densa in the kidney?

Back 123

portion of the thick ascending limb adjacent to the hilus of the glomerulus

Front 124

What does inhibition of cycloxygenase-2 enzyme result in?

Back 124

Decrease in production of:
- prostaglandins
- thromboxane
- prostacyclines (reduce platelet function)

Front 125

What does myxedema look like?

Back 125

Nonpitting edema on the anterior surface of both legs with overlying skin that is dry & waxy & may have several diffuse, slightly pigmented papules

Front 126

What is the MOA of propylthiouracil & methimazole?

Back 126

Block tyrosine iodination (i.e. organification) & coupling
- Prophylthiouracil also decreases peripheral conversion of thyronine to triodothyonine

Rx: hyperthyroidism (e.g. Grave's)

Front 127

What determines blood flow at the base of the lungs when a person is standing?

Back 127

difference between arterial & venous pressure (arterial pressure is greatest & alveolar pressure is weakest)

Front 128

In the middle lobes of the lung, what has the greatest pressure: arterial, alveolar or venous?

Back 128

arterial > alveolar > venous

Front 129

What is the treatment for nephrogenic diabetes insipidous?

Back 129

Hydrochlorothiazide: inhibits reabsorption of Na from the H20-impermeable early distal convoluted tubule. Inhibits hyperdilution

Front 130

How is the late distal convoluted tubule & collecting duct made amenable to H20 absorption?

Back 130

Hypertonic intersitium enabled by the thick ascending limb: solute transport & deposition of ions into the medullary interstitial fluid

Front 131

What organ clears the body of capsulated organisms?

Back 131

spleen

Front 132

Why does Wilson's cause extrapyramidal symptoms?

Back 132

Basal ganglia degeneration

Front 133

What lab results indicate Wilson's?

Back 133

- Severe hepatic impairment -> hemolytic anemia
- Reduction in serum levels of cerulopasmin (copper carrier protein)

Front 134

What is the DOC for Wilson's

Back 134

penicillamine

Front 135

What disease is caused by the loss of debranching enzyme?

Back 135

Cori's
- accumulation of glycogen in liver, heart, & skeletal muscle
- S/S: (like Von Gierke's but milder) hyperlipidemia, fasting hypoglycemia, heaptomegaly

Front 136

Where does glucocerebroside accumulate in Gaucher's?

Back 136

Monocytes & macrophages = enlarged histiocytes with "wrinkled tissue paper" appearance

Front 137

Where does heparan sulfate & dermatan sulfate (mainly) accumulate in patients with Hurler's

Back 137

Heart
Brain
Liver

Front 138

What melena indicated?

Back 138

Blood loss in the upper GI (lower GI blood loss = RED stools)

Front 139

What is the most common cause of iron deficiency anemia in postmenopausal women?

Back 139

Occult blood loss: usually from a GI source

Front 140

What are the adrenoreceptors in the eye?

Back 140

Alpha1:
- Radial (dilator) muscle: contraction/mydriasis

Front 141

What are the adrenoreceptors in the arterioles (skin/viscera)?

Back 141

Alpha1:
- Contraction = increased PVR & afterload

Front 142

What are the adrenoreceptors in the veins?

Back 142

Alpha1:
- Contraction = increased venous return & preload

Front 143

What are the adrenoreceptors in the bladder trigone & sphincter?

Back 143

Alpha1:
- Contraction = urinary retention

Front 144

What are the adrenoreceptors in the male sex organs?

Back 144

Alpha1
- Vas deferens contraction = ejaculation

Front 145

What are the adrenoreceptors in the liver?

Back 145

Alpha1:
- increased glycogenolysis

Front 146

What are the adrenoreceptors in the prejuctional nerve terminals?

Back 146

Alpha2:
- decreased transmitter release & NE synthesis

Front 147

What are the adrenoreceptors in the platelets?

Back 147

Alpha2:
- aggregation

Front 148

What are the adrenoreceptors in the pancreas?

Back 148

Alpha2:
- decreased insulin secretion (these are the dominate receptors)

Front 149

What are the adrenoreceptors in the heart?

Back 149

Beta1:
- SA node = increased HR (+ chronotrophy)
- AV node = increased conduction velocity (+ dromotropy)
- Muscle = increased force of contration (+ inotrophy), conduction velocity, CO & O2 consumption
- His-PUrkinje = increased automaticity & conduction velocity

Front 150

What are the adrenoreceptors in the kidney?

Back 150

Beta1:
- Increased renin release

Front 151

Define each: chronotropy, dromotropy, inotropy

Back 151

Chronotrophy: HR
Dromotrophy: conduction velocity
Inotropy: force of contraction

Front 152

What are the adrenoreceptors in the blood vessels?

Back 152

Beta2:
- Vasodilation -> decreased PVR, diastolic pressure, afterload

Front 153

What are the adrenoreceptors in the uterus?

Back 153

Beta2: relaxation

Front 154

What are the adrenoreceptors in the bronchioles?

Back 154

Beta2: dilation

Front 155

What are the adrenoreceptors in the skeletal muscle?

Back 155

Beta2: increased glycogenolysis -> contractility (tremor)

Front 156

What are the adrenoreceptors in the liver?

Back 156

Beta2: increased glycogenolysis

Front 157

What are the adrenoreceptors in the pancreas?

Back 157

Beta2: increased insulin secretion

Front 158

What is the dominace of adrenoceptor when drugs active on beta & alpha receptors are given at low & high doses?

Back 158

Low: beta dominance
High: alpha dominance

E.G. Epinephrine

Front 159

What type of adrenoceptors does dopamine activate?

Back 159

D1 (peripheral) in renal, mesenteric, & coronary vasculature
- Result: VASODILATION
- In Kidney = increased GFR, RBF, & Na+ excretion

Front 160

What type of receptor is alpha1?

Back 160

- Adrenergic
- Gq coupled: increase in DAG & IP3 = increased intracellular Ca2+

Front 161

What type of receptor is alpha2?

Back 161

- Adrenergic
- Gi coupled: decreased adenylyl cyclase = decreased cAMP

Front 162

What type of receptor are beta2, beta1, and D1?

Back 162

- Adrenergic
- Gs coupled: increased adenylyl cyclase = increased cAMP

Front 163

What is the action of alpha1 agonist drugs? Give 2 examples.

Back 163

- MOA: increase Bp (& reflex bradycardia)
- Phenyleprine: decongestant (mydriasis w/o cyloplegia)
- Methoxamine: Paroxysmal Atrial tachycardia + vagal reflex

Front 164

What is the action of alpha2 agonist drugs? Give 2 examples.

Back 164

- MOA: CNS actions -> decreased vasomotor outflow & decrease in mean Bp
- Clonidine: abrupt D/C causes rebound HTN
- Alpha methyldopa: pro-drug forming alpha-methyl NE

Front 165

What is the action of beta1&2 nonselective agonist drugs? Give 1 example.

Back 165

- MOA: increase in HR, SV, CO (beta1) & decrease in PVR (beta2)
- increase in mean Bp = increase in pulse pressure & no reflex on heart
- Rx: bronchospasm, heart block, bradyarrhythmias
- SE: flushing, angina, arrhythmias

- ISOPROTERENOL

Front 166

What is the action of beta1 > 2 nonselective agonist drugs? Give 1 example.

Back 166

- MOA: increase in HR, SV, CO (beta1) & no change in PVR, GFR, or RBF
- Rx: acute CHF (tachyphylaxis)

- DOBUTAMINE

Front 167

What are the 4 main selective beta2 agonists and what is the use of each?

Back 167

Ashtma: metoproterenol, albuterol, terbutaline

Premature Labor: ritodrine

Front 168

What is the action of Norepinephrine used as a drug?

Back 168

MOA: alpha1, apha2, beta1 agonist
- increased PVR = increase DIASTOLIC pressure
- increased HR & SV = increased SYSTOLIC pressure & small increase in PP
- increased mean BP w/ reflex bradycardia

Front 169

What is the action of Epinephrine used as a drug?

Back 169

MOA: Alpha 1+2, beta 1+2 agonist
- LOW dose: beta dominance = increase in HR & small decrease in mean Bp
- HIGH dose: alpha dominace = increase PVR & increase diastolic pressure = reflex bradycardia

- bronchodilation & increased liver glycogenolysis, muscle glycogenolysis & glycolysis, increased FFA (activates lipase)

- Rx: Anaphylaxis, cardiac arrest, adjunct to local anesthetics, glaucoma

Front 170

What is "epinephrine reversal"?

Back 170

- The effect of using an alpha blocker after eliciting a hypertensive response with a HIGH does of epinephrine
- When alpha1 is blocked, then there is an unmasking of epinephrine's beta2 activation = HYPOtension

Front 171

What type of drug is amphetamine? What is its action & clinical use?

Back 171

Indirect adrenoceptor agonist
- Releases NE from the mobile pool
- Peripheral = sympathetic stimulation
- CNS = release of both NE & DA

Rx: ADHD, weight loss, narcolepsy

Front 172

What type of drug is amphetamine? What is its action & clinical use?

Back 172

Indirect adrenoceptor agonist
- Releases NE from the mobile pool
- Peripheral = sympathetic stimulation
- CNS = release of both NE & DA

Rx: decongestant (also pehnlypropanolamine)

Front 173

What type of drug is Dopamine? What is its action & clinical use?

Back 173

LOW dose: D1 = increased renal/mesenteric blood flow -> increase RBF & GFR

MEDIUM dose: B1 = increased CO (+ inotropy)

HIGH dose: A1 = vasoconstriction + increased systolic & diastolic Bp

Front 174

What is the action of alpha adrenoceptor antagonists?

Back 174

- Decrease PVR & mean Bp -> tachycardia & H2O retention
- Marked reflex tachycardia if alpha2 receptors are blocked too (reduced feedback inhibition)

Front 175

Which alpha adrenoceptor antagonists are used to treat pheochromocytoma?

Back 175

Phenotolamine & Phenoxybenzamine:
- Decrease PVR & mean Bp -> tachycardia & H2O retention
- Marked reflex tachycardia if alpha2 receptors are blocked too (reduced feedback inhibition)

Front 176

What type of drug is Prazosin? What is its clinical use?

Back 176

- Prototyle alpha1 selective blocker
- Less reflex tachycardia
- 1st-dose syncopy = postural hypotension

Front 177

What drugs have the same MOA as prazosin?

Back 177

doxazosin
terazosin
amulosin

All are alpha1 selective blockers:
- decrease PVR & mean Bp -> (a bit of) tachycardia & H2O retention

Front 178

What is the MOA of beta adrenoceptor antagonists?

Back 178

- Heart: decreased contractility, HR, CO, O2 demand & Bp
- Delayed hypoglycemis b/c reduced glycogenolysis
- Decreased ciliary epithelial secretions = decreased IOP
- SE: AV block & heart failure, bronchospasms in asthmatics

Front 179

What type of drug is propranolol? What are its SE?

Back 179

- Prototype non-selective beta blocker
- Chronic used can lead to increased LDL-C & TGs

Front 180

What are the benefits & limitations of selective beta blockers?

Back 180

- Benefits: safer in asthma, diabetes, & PVD
- LImits: less effects on vasculature, bronchioles, uterus, & metabolism

E.G. acebutolol, atenolol, metoprolol

Front 181

What are the beta blockers with ISA?

Back 181

ISA = intrinsic sympathomimetic activity
- have less bradycardia & minimal change in plasma lipids
- acebutolol & pindolol

Front 182

Which beta-blockers have NO CNS entry? Which have a particularly long halflife?

Back 182

- NO CNS entry: atenolol & nadolol
- Long HalfLIfe: cavedilol & nadolol

Front 183

Which beta blockers have combined alpha & beta blocking action?

Back 183

Cavedilol
Labetalol

Front 184

Why should you taper doses when discontinuing beta blockers?

Back 184

- B/C chronic use of beta blockers leads to receptor up-regulation
- T/F tapering reduces excess CV rebound of endogenous amines

Front 185

What is the action, ISA, sedation, effect on lipids, & clinical use for acebutolol?

Back 185

Action: B1-selective
ISA: yes (less bradycardia & minimal change in plasma lipids )
Sedation: yes
Lipids: NA
Clinical Use: angina, HTN

Front 186

What is the action, ISA, sedation, effect on lipids, & clinical use for atenolol?

Back 186

Action: B1-selective
ISA: no
Sedation: no
Lipids: INCREASED
Clinical Use: angina, HTN

Front 187

What is the action, ISA, sedation, effect on lipids, & clinical use for esmolol?

Back 187

Action: B1-selective
ISA: no
Sedation: yes
Lipids: no
Clinical Use: antiarrhythmic (Class IV); 10 minute T1/2

Front 188

What is the action, ISA, sedation, effect on lipids, & clinical use for labetalol?

Back 188

Action: B non-selective + alpha1
ISA: no
Sedation: yes
Lipids: no
Clinical Use: HTN & hypertensive crisis & pheochromocytoma

Front 189

What is the action, ISA, sedation, effect on lipids, & clinical use for metoprolol?

Back 189

Action: B1-selective
ISA: no
Sedation: yes
Lipids: INCREASED
Clinical Use: angina, HTN, post-MI antiarrhythmic

Front 190

What is the action, ISA, sedation, effect on lipids, & clinical use for pindolol?

Back 190

Action: B non-selective
ISA: YES
Sedation: yes
Lipids: no
Clinical Use: angina, HTN

Front 191

What is the action, ISA, sedation, effect on lipids, & clinical use for propranolol?

Back 191

Action: B non-selective
ISA: no
Sedation: YES
Lipids: YES
Clinical Use: angina, HTN, post-MI, migraine, tremor, performance anxiety, thyrotoxicosis

Front 192

What is the action, ISA, sedation, effect on lipids, & clinical use for timolol?

Back 192

Action: B non-selective
ISA: no
Sedation: YES
Lipids: YES
Clinical Use: HTN, migraine, glaucoma

Front 193

What beta blockers are linked with worsening blood lipids?

Back 193

- atenolol
- metoprolol
- protranolol
- timolol

Front 194

Which beta blocker does not cause ANY sedation (there is only 1)?

Back 194

atenolol

Front 195

Which 4 beta blockers have no affect on blood lipids?

Back 195

acebutolol
esmolol
labetalol
pindolol

Front 196

Which 2 beta blockers are used to treat migraine?

Back 196

propranolol
timolol

Front 197

Which beta blocker is used to treat glaucoma?

Back 197

timolol

Front 198

Which 2 beta blockers are indicated as antiarrhythmics?

Back 198

esmolol
metoprolol

Front 199

Which betablocker is used in hypertensive crises?

Back 199

labetalol (b/c also a A1 blocker)

Front 200

Which is the only beta blocker not used for HTN?

Back 200

esmolol (short T1/2 = 10 minutes)

Front 201

What is the PANS & SANS innervation of the SA & AV nodes

Back 201

PANS = M2 (decreases phase 4 slope by decreasing cAMP)

SANS = B1 (increases phase 4 slope by increasing cAMP)

Front 202

What does activation of B1 heart receptors (& therefore an increase in cAMP) cause?

Back 202

- Increase in upstroke velocity in pacemakers in Increasing I (C-L type)
- Decreasing action potential duration by Increasing Ik
- Increases HR by increasing If, thus increasing slope of phase 4

Front 203

What does activation of M2 heart receptors (& therefore an decrease in cAMP) cause?

Back 203

- Decreases upstroke velocity in pacemakers in decreasing I (C-L type)
- Increases action potential duration by decreasing Ik
- Decreases HR by decreasing If, thus increasing slope of phase 4
- Produces a K+ current (Ik/ACh), which slows diastolic depolarization & decreases HR

Front 204

What is the mechanism of Class IA antiarrhymics?

Back 204

- Decreases Vmax: Blocks fast Na channels (decreases Ina) "state dependent"
- Increases ADP (action potential duration) & ERP (effective refractory period: block of K+ channels (decreased Ik, delayed rectifier current)

Front 205

What is the MOA of Quinidine?

Back 205

Class IA (Na+ channel blocker)
- M-bock: increases HR & AV conduction

- SE: nausea & vomiting, cinchonism, hypotension (due to alpha block), increased QRS & QT interval -> syncopy (torsades)

Interactions:
- increases digoxin tox
- decreases effects of AChE inhibitors in myasthenia
- hyperkalemia increases tox

Front 206

What is cinchonism?

Back 206

SE of Quinidine: GI, tinnitus, ocular dysfunction, CNS excitation

Front 207

What is the MOA of procainamide?

Back 207

Class IA (Na+ channel blocker):
- Less M-block (less HR & AV conduction increase)
- Cardiodepressant
- Prolongs ADP b/c is metabolized via N-acetyltransferase (genotypic variation) to NAPA, that prolongs ADP
- SE: SLE-like syndrome (30% of patients) more likely in slow acetylators, hemotox (throbocytopenia & agranulocytosis), CNS effects (dizziness, hallucinations, CV effects (torsades)

Front 208

What is "torsades de pointes"?

Back 208

- ECG demonstrates a rapid, polymorphic, ventricular tachycardia with a characteristic twist of the QRS complex around the isoelectric baseline
- Can follow a prolonged QT intervals on ECG
- Associated with a fall in arterial Bp, which can produce fainting
- It can degenerate into ventricular fibrillation

Front 209

What are the characteristics of "Trosades de pointes"?

Back 209

- Rotation of the heart's electrical axis by at least 180º
- Prolonged QT interval LQTS
- Preceded by long and short RR-intervals
- Triggered by an early premature ventricular contraction (R-on-T PVC)

Front 210

What is the treatment for "Torsades"?

Back 210

- Withdrawal of the causitive agent (can be class IA or class III antiarrhythmics)
- Infusion of magnesium sulfate & antiarrhythmic drugs, & electrical therapy as needed

Because of the polymorphic nature of torsades de pointes, synchronized cardioversion may not be possible, and the patient may require an unsynchronized shock (or defibrillation).
[edit]

Front 211

What electrolyte imbalances predisposed to torsades?

Back 211

- Diarrhea
- Hypomagnesemia
- Hypokalemia

T/F watch malnourished individuals & chronic alcoholics

Front 212

What are the signs of PCP (phycyclidine) use?

Back 212

belligerance
impulsiveness
fever
psychomotor agitation
vertical & horizontal nystagmus
tachycardia
ataxia
homicidality
psychosis
delirium

Front 213

By what mechanism can PCP re-intoxicate a patient during withdrawal?

Back 213

When the PCP, trapped in an ionized form in the acidic gastric lumen, is reabsorbed in the alkaline duodenum
- Check for normal or small pupils

Front 214

What is the post-cocaine "crash"?

Back 214

Withdrawal: severe depression, hyper-somnolence, fatigue, malaise, & severe psychological craving

Front 215

What are the 4 mature defense mechanisms?

Back 215

- sublimation
- altruism
- humor
- suppression

Front 216

Which viruses are associated with hepatocellular carcinoma?

Back 216

HBV & HCV

Front 217

How are arbo & flaviruses transmitted?

Back 217

mosquito bites:
- Arbo: Dengue fever
- Flav: Yellow fever

Front 218

What is the main function of the Golgi complex?

Back 218

to add oligosaccharides to proteins & lipds

Front 219

What indicates that a protein is destined for the lysosomal pathway?

Back 219

mannose-6-phosphate residuses

Front 220

What are the 2 main enzymes in Peroxisomes?

Back 220

1) Oxidases for catabolic pathways (e.g. beta oxidation of long-chain fatty acids)
2) Catalase to regulate H2O2 concentration to oxidize toxic substances

Front 221

What is the main function of SER (smooth ER)?

Back 221

- Lipid biosynthesis
- Membrane synthesis/repair
- Detox of metabolic by-products

- NB: no ribosomes!!

Front 222

What is the main function of RER in the cell?

Back 222

Initiates the processing of finalized protein products

NB: Contains ribosomes

Front 223

What should one do regarding the results of a study if the P value is greater than 0.05?

Back 223

Accept the null hypothesis

Front 224

What potential error are you making if you do NOT reject the null hypothesis?

Back 224

Beta (type II) = 1-power

Front 225

What type of error does a P value represent?

Back 225

type I
- If P < 0.05, then there is less than a 5% chance that the null hypotheses was incorrectly rejected

Front 226

What is a type I error?

Back 226

Incorrectly rejecting the null hypothesis: accepting a difference when none exists (i.e. the null is true)

Front 227

What is a "CV wave"?

Back 227

- When, dues to tricuspid regurgitation, blood flows backward into the atria during ventricular systole
- This pressure is transmitted back into the RA & jugular vein & results in the JVC pressure change: joining of the C & V wave

Front 228

What sections of the nephron are responsible for Na reaborption?

Back 228

Proximal Convoluted Tubule: 67%
Thick Ascending Limb: 25%
Late Distal Convoluted Tubule: 3%

1% = excreted (i.e. NOT reabsorbed)

Front 229

What type of tumors have tartrate-resistant acid phosphatase as a marker?

Back 229

B lymphocyte neoplasms (e.g. hairy cell leukemia)

Front 230

What cancers can be marked by CEA (carcinoembryonic antigen) in 70% of cases?

Back 230

colorectal & pancreatic

Front 231

What is the marker for hepatocellular carcinoma?

Back 231

Increased levels of alpha fetoprotein

Front 232

What type of tumor is marked by S-100?

Back 232

melanomas

Front 233

What type of tumor produces bombesin (a tumor marker)?

Back 233

neuroblastomas

Front 234

What is the pathogenesis of cor pulmonale?

Back 234

dysfunction of the RV due to pulmonary hypertension in diseases affecting the lung or its vasculature

Front 235

What can a chest X-ray showing basilar hyperlucency in a young patient indicate?

Back 235

alpha1-antitrypsin deficiency

Front 236

What maternal disease can put a child at risk for transposition of the great vessels?

Back 236

Early fetal cyanosis due to maternal diabetes

Front 237

What are congenital defects that can occur if a pregnant woman contracts rubella (caused by Rubivirus, a togavirus)

Back 237

- PDA
- VSD
- cataracts
- deafness

Front 238

What infection can cause rapid death (within 3 weeks) in an AIDS patient who presents with neurological deficits of speech, memory, & coordination along with vision problems?

Back 238

JC virus causing progressive multifocal leukoencephalopathy (PML)
- causes multiple areas of demyelination throughout the white matter of the CNS

Front 239

What is a common viral casue of temporal lobe encephalitis in HIV/AIDS patients?

Back 239

Herpes simplex: rapid onset of fever & focal neurological deficits due to damage of the temporal lobe
- memory problems, personality changes, seizures

Front 240

What is a common cause of pneumonia in HIV patients with a CD4+ count below 200/mm3?

Back 240

Pneumocystis jroveci
- Dx: X-ray picture of "ground glass"

Front 241

What is a common cause of encephalitis in patients with HIV/AIDS with a CD4+ cound below 100/mm3?

Back 241

Toxoplasmosis
- S/S: seizures & headache
- X-ray: ring-enhancing lesions with surrounding edema

Front 242

What is the cellular mechanism of a type IV hypersensitivity reaction?

Back 242

- Initial exposure to antigen triggers differentiation of CD4+ T lymphocytes into T-helper type 1 lymphocytes
- Re-exposure = quick activation to secrete cytokines that mediate the local inflammation

Front 243

What are the 3 main mediators released in a type I hypersensitivity reaction?

Back 243

- Histamine
- Leukotriene
- Prostaglandin

Front 244

Describe the changes a female goes through during Tanner stages 1-5.

Back 244

1: Elevation of the breast papilla only & no pubic hair
2: Small breast buds with elevation of breast & papille with sparse, straight, downy hair on the labila base
3: Enlargement of the breast & areola with a single contour & darker, coarse curled pubic hair
4: Projection of the areola & papilla with separate contous & adult-type public hair limited to the genital area
5: Mature breast & adult quantity/pattern of pubic hair that extends to the thighs

Front 245

When is organogesis?

Back 245

Weeks 3-8

Front 246

What are the findings of fetal alcohol syndrome?

Back 246

1) pre & postnatal developmental retardation
2) microcephaly
3) facial abnormalities
4) limb dislocation
5) heart & lung fistulas

MOA: inhibition of cell migration

Front 247

What fetal problems can occur if a mother takes chlorothiazide?

Back 247

fetal thrombocytopenia & jaundice

Front 248

What fetal problems can occur if a mother takes doxycycline?

Back 248

Permanent tooth staining & enamel hypoplasia

Rx: Lyme disease & genital infections

Front 249

What fetal abnormalities are associated with lithium use?

Back 249

Ebsteins & malformations of the great vessels

Front 250

What fetal abnormalities are associated with Valproic acid use?

Back 250

neural tube defects
cleft lip
renal anomalies

Front 251

Which rash moves from the trunk outward? Which moves from the extremities and moves inward? (Choices: Rocky Mountain & Typhus)

Back 251

Rickettsia prowazekii (epidemic typhus): trunk -> extremities

Rocky Mountain: extremities -> trunk

Front 252

What is the treatment for Kawasaki's?

Back 252

IV IG & asprin

Front 253

What are the physical exam findings in Kawasaki's?

Back 253

Strawberry tongue
Lymphadenopathy
Bright RED cracked lips
Conjunctivities
Swollen hands/feet

Front 254

What type of hematoma shows up as crescent-shaped on CT?

Back 254

Subdural (usually bridging veins from cerebrum to dural sinuses in the elderly)

Front 255

Where is the most common location of a Berry aneurysm?

Back 255

Posterior communicating artery

Front 256

What hematoma shows up as a biconvex disc on CT?

Back 256

epidural: usually middle meningeal artery due to trauma

Front 257

What type of hematoma usually shows no signs on CT?

Back 257

intraparenchymal due to atherosclerosis & occlusion in hypertensive patients

Front 258

What hormone is spironolactone similar to?

Back 258

Progesterone
- T/F can cause gynecomastia & erectile dysfunction

Front 259

What are the 2 top causes of erosive gastritis?

Back 259

H. pylori
NSAIDs

Front 260

What are the unique features of Zollinger-Ellison ulcers?

Back 260

1) Unusual location: beyond the 1st part of the duodenum
2) Presense of MEN type I (tumors in the parathyroid, pancreas, & pituitary)

Front 261

What type of thalassemia is lethal in utero?

Back 261

hydrops fetalis:
- no functional alpha chains are made
- only Hb Bart's si made (y4 tetramer): poor O2 delivery to peripheral tissues

Front 262

What is Cooley's anemia?

Back 262

- beta-thalassemia major (absence of both b-globin chains)
- S/S = severe hemolysis & ineffective erythropoiesis

Front 263

What results from absense of the four alpha-globin genes?

Back 263

Hemoglobin H
- microcytic anemia & mild hemolyisis

Front 264

What microbial constituents do TLRs (toll-like receptors) recognize?

Back 264

- LPS (lipid A, core sugar, + variable carb chain O antigen)
- flagellin
- unmethylated CpG DNA

Front 265

What is the MOA of fluroquinolones?

Back 265

- Drugs: Ciprofloxacin, Levofloxacin, Ofloxacin
- Inhibits DNA gyrase (topoisomerase II) that relaxes DNA supercoils

Front 266

What metabolic pathway produces 2,3 DPG (2,3-diphosphglycerate)?

Back 266

- Anaerobic glycolysis
- 2,3-DPG causes a DECREASED hemoglobin affinity for O2 (= right shift of O2-hemoglobin dissociation curve) so that more O2 is unloaded to tissues

Front 267

What dopamine receptor antagonists are used as antipsychotics and cause galactorrhea?

Back 267

D2 blockers: (typical antipsychotics)
- Chlorpromazine
- Thioridazine
- Haloperidol
- Fluphenazine

Front 268

What is the MOA of amitriptyline?

Back 268

TCA: prevents norepinephrine & serotonin reuptake from synaptic cleft

Front 269

What drug is a dopamine analog?

Back 269

Bromocriptine
- agonist at pituitary dopamine receptors & t/f prevents prolactin release
- Rx: prolactin-secreting adenomas

Front 270

What is the MOA of fluoxetine?

Back 270

- SSRI
- Rx: depression

Front 271

What is the MOA of Selegiline?

Back 271

- MOA B inhibitor that prevents the breakdown of dopamine in the synaptic cleft
- Rx: Parkinson's

Front 272

What cellular defect results in Chediak-Higashi syndrome?

Back 272

Microtubule polymerization = decreased phagocytosis

Front 273

What is the MOA of cisplatin?

Back 273

Alkylating agent" binds to guanine & forms inter/intra strand crosslinks

Front 274

Which prevents microtubule formation and which inhibits their breakdown: paclitaxel or vincristine?

Back 274

Paclitaxel: hyperstabilizes polymerized microtubules

Vincristine: prevents polymerization of microtubules

Front 275

What type of bacterial infection can present at crepitus after a penetrating wound?

Back 275

Clostridium perfringens (gas-producing anaerobe)

Rx: clindamycin

Front 276

What 3 antibiotics are most associated with C. difficile overgrowth, destruction of the colon's normal fora & pseudomembranous colitis?

Back 276

- Clindamycin
- Penicillin
- Cephalosporin

Front 277

What antiviral is associated with ataxia, dissiness, & slurred speech?

Back 277

Amantadine

Front 278

What is the structure of a steroid hormone receptor?

Back 278

- Zinc finger proteins: a polypeptide with a zinc atom bound to 4 cysteines
- Hormone binding region + a DNA binding region that activates gene transcription

Front 279

What are the 4 main actions of angiotension II?

Back 279

- Arteriolar vasoconstriction
- Thirst sensation
- Increased ADH & aldosterone secretion
- Increased Na reabsorption

Front 280

What 5 tissues have angiotension II receptors?

Back 280

Via angiotensin I neuropeptide receptor (Gq _> increase IP3 & DAG bia phospholipase C pathway):
- Vascular smooth muscle (vasoconstriction)
- CNS (increased thirst)
- Zona glomerulosa of adrenal cortex (aldosterone secretion)
- Renal tubules (increased Na reabsorption)

Front 281

What type of receptors does ANP (atrial natriuretic peptide) work on?

Back 281

GC (guanylate cyclase) receptors
- with intrinsic GC activity to produce cGMP
- to catalyze protein kinase G to phosphorylate serine & threonine protein residues
- Result: arteriole vasodilation

Front 282

Does insulin directly alter gene transcription?

Back 282

No, its second messenger (MAP kinase) enters the nucleus to alter gene transcription:
- Insulin binds to a receptor tyrosine kinase to autophyosphyrlate tyrosine within the receptor
- Intracellular proteins bind the the SH2 of this phosphotyrosine
- This activates MAP kinase (mitogen-activated protein kinase) by covalent phosphorylation of tyrosine & threonine

Front 283

What are the 2 receptor-mediated actions of vasopressin (ADH)?

Back 283

V1 receptors on arterioles:
- Activate Phospholipase C to liberate DAG & IP3 frome membrane lipids = vasoconstriction in SUPRAphysiologic doeses

V2 on principal cells of cortical & medullary collecting ducts:
- activates G proteins that in turn activate adenylate cyclase (which produces cAMP
- cAMP activates protein kinase A
- increased expression of AQUAPORIN H2O channels in the collecting duct

Front 284

What is the pathology of Lambert-Eaton disease?

Back 284

Autoimmune antibodies against presynaptic voltage-gated Ca channels & reduced muscle use
- Result: reduced release of synaptic vesicles at prsynaptic terminal b/c no Ca influx

Front 285

When a muscle stimulation test shows initial unresponsiveness but response after repetitive stimulation, what does the patient likely have?

Back 285

Lambert-Eaton: enough vesicles are released to cause activation on the postsynaptic acetylcholine receptor.
- vesicle release is impaired in this disease due to autoimmune attack of presynaptic votage-gated Ca channels
- only enough vesicles are released for post synaptic activation after repetitive stimulation

Front 286

What are the results of a muscle stimulation test that indicate myasthenia gravis?

Back 286

- Fatigability in the test
- b/c they have reduced amounts of acetylcholine receptors (due to autoimmune attack) to respond to the neurotransmitter release (& their is no pathology of release)

Front 287

What is the principle inhibitiory receptor of the CNS?

Back 287

GABAa: inhibitory Cl channel

Front 288

What diseases are associated with EBV infection?

Back 288

- Endemic African Burkitt's lymphoma
- heterophil-POSITIVE mononucleosis
- Oral hairy leukoplakia (HIV patients)
- Hodgkin's & non-Hodgkin's lymphomas in immunocompromised patients
- Nasopharyngeal carcinoma

Front 289

What infections are linked with Heterophil-negative mononucleosis?

Back 289

- CMV
- acute HIV
- Toxoplasmosis
- Herpies types 6 & 7

Front 290

What are noninfectious states are associated with hepatocellular carcinoma?

Back 290

- Cirrhosis (2ndary to alcolol or crytogenic)
- Hemochromatosis
- Aflatoxin ingestion
- Alpha1-antitrypsin deficiency

Front 291

What are the risk factors for gastric carcinoma?

Back 291

- H. pylori infection
- atrophic gastritis
- postgastrectomy states
- achlorhydria
- pernicious anemia
- Menetrier's disease
- Adenomatous polyps

Front 292

What 3 carcinomas notoriously spread hematogenously?

Back 292

- Hepatocellular
- Renal Cell
- Follicular thyroid

Front 293

Where does HCC often metastese to?

Back 293

Lung, portal vein, periportal nodes, brain, bones

Front 294

How does Hodgkin's spread?

Back 294

Continguous manner

Front 295

How does ovarian & appendiceal cancers spread?

Back 295

Pseudomyxoma peritonei: direct dissemination throughout the peritoneal cavity
- Diffuse collection of gelatinous materials in the abdomen, peritoneal surface & pelvis

Front 296

What direction is DNA synthesized?

Back 296

5'-3' direction

Front 297

What is the CD marker for pluripotent stem cells?

Back 297

CD34: cells found in the
- umbilical cord, bone marrow, endothelial progenitors of blood vessels, mast cells and certain dendritic cells

Front 298

What is the CD marker for hematopoietic stem cells that can differentiate into erythroblasts & myeloblasts?

Back 298

CD38
- Stimulated to differentiate by graulocyte colony-stimulating factor

Front 299

What is the marker of antigen-presenting cells?

Back 299

B7 protein

Front 300

What results in the loss of phosphatidylinosital glycan A?

Back 300

- Episodic acute intravascular hemolysis = paroxysmal nocturnal hemoglobinuria
- this is required for the anchoring of decay-accelerating factor on the surface of RBCs, which BLOCKS compliment activation

Front 301

Which type of hemophilia is most common in Ashkenazi Jews?

Back 301

C: Factor XI deficiency (AR)

Front 302

What are the symptoms of Horner's syndrome?

Back 302

Loss of sympathetic innervation to one side of the face:
1) Ptosis: eyelid drop
2) Hemi-Anhidrosis: lack of sweating
3) Miosis: pupil constriction

Front 303

What lung tumor is associated with Horner's?

Back 303

Pancoast: apical tumor can compress the 1st & 2nd thoracic nerve roots & t/f block sympathetic innervation of the IPSILATERAL face

Front 304

What nerve palsy leads to difficulty in lateral gaze?

Back 304

Abducens nerve palsy (CN VI)

Front 305

What nerve palsy/disruption can lead to drooping of the nasolabial fold?

Back 305

Facial (CN VII)

Front 306

What is the MOA of ganciclovir?

Back 306

- Phosphorylated by viral protein kinases
- Acts as an analog to dGTP & competitively inhibits the incorporation of dGTP into viral DNA

SE: myelosuppression & nephrotox (MUST monitor Px)

Front 307

What is the MOA of Enfurvirtide?

Back 307

- Binds to the gp41 subunit of the HIV viral envelop
- prevents entry of the virus into the host cell

Rx: HIV therapy

Front 308

What is the MOA of ritnovir?

Back 308

Protease inhibitor: inhibits the cleavage of viral polyproteins

Rx: HIV
SE: GI & paresthesias

Front 309

What is the MOA of oseltamivir?

Back 309

- Inhibits viral neuraminidase & prevents release of viral progeny from infected cells

Rx: influenza

Front 310

What are the major side effects of Niacin treatment?

Back 310

- facial flushing
- Gout
- Impaired glucose tolerance

Front 311

What is the function of lipoprotein lipase?

Back 311

- degradation of VLDL cholesterol
- up-regulated by fibrates

Front 312

Where are the BCRA1 & BCRA2 genes found?

Back 312

BRCA1 = Ch. 17
BRCA2 = Ch. 13

Both are gumor suppressor genes and both alleles must be loss for the suppressive function to be lost

Front 313

When does rigor mortis set in?

Back 313

3-4 hours after death
- ATP is depleted & without it, myosin cannot be released from the contraction complex
- Muscles are frozen in a contracted in a contracted state

Front 314

What is the mechanism of muscle relaxation after rigor mortis?

Back 314

- 72 hours after death, enzymes are released (due to a drop in pH) & these hydrolyze the myosin-actin complex
- Result: muscle relaxation

Front 315

What are the histological markers of diabetic nephropathy?

Back 315

- Increase in mesangial matrix by marked nodular accumulations (Kimmelsteil-Wilson nodules)
- Diffuse glomerulosclerosis

Front 316

What is the pathogenesis of membranoproliferative glomerulonephritis?

Back 316

- Autoimmune disease of the young (8-30 years old)
- HISTO: mesangial proliferation, thickening of peripheral capillary walls by subENDOthelial depositis & mesangial interposition into capillary wall (= TRAM-TRACK)

Front 317

What is the pathogenesis of rapidly progressive (crescentic) glomerulonephritis?

Back 317

extensive capillary damage:
- accumulation of cells & fibrinous changes in Bowman's space
= "crescent" on biopsy

Front 318

What is the pathogenesis of focal segmental glomerulosclerosis?

Back 318

Nephrotic disease
- young, hypertensive, Black men with risk factors: obesity & HIV
- Injury to podocytes leads to mesangial, endothelia, & epithelial cells & later shrinkage/collapse of glomerular capillaries -> SCLEROSIS (focal & segmental pattern)
- Hyaline casts on urinalysis

Front 319

What causes cleft lip?

Back 319

- failure of the maxillary prominence to fuse with the medial nasal prominence
- can be unilateral or bilateral

Front 320

What is the marker for active viral replication of Hep B & likely transmissibility?

Back 320

HBeAg (detectable 2-4 months after exposure): marker of the virus core

Front 321

What Hep B marker indicates low trasmissibility?

Back 321

HBeAb (detectable 5 months post exposure or 1 month after detection of HBeAg)

Front 322

What Hep B marker shows former carriers or immunization?

Back 322

HBsAb (provides immunity)

Front 323

What Hep B marker indicates chronic disease?

Back 323

IgG HBcAb

Front 324

What Hep B marker indicates recent disease?

Back 324

IgM HBcAb

Front 325

What is gastroschisis?

Back 325

- Congenital abdominal wall defect: herniation of abdominal organs not covered by a membrane as they are in an omphalocele
- Complication of a patent urachus

Front 326

What embryological structure becomes the median umbilical ligament?

Back 326

urachus (a remnant of the allantosis)

Front 327

What are the 2 main drug types that are oxidative and cause oxidative stress (jaundice) in patients with G6PD deficiency?

Back 327

- Sulfa drugs (e.g. trimethoprim-sulfamethoxazole)
- Antimalarials

Front 328

What are the symptoms of HYPERcalcemia?

Back 328

- Constipation
- Poly -uria/dipsia
- HYPOreflexia
- Lethargy

Front 329

What diuretic drugs are useful to treat HYPERcalcemia?

Back 329

Loop Diuretics (Furosemide):
- Block Na+/K-/2Cl- transporter in thick ascending loop of Henle
- Blocks both Na & Ca reabsorption

Front 330

What diuretic class is useful to treat idiopathic hypercalciuria?

Back 330

Thiazides (hydrochlorothiazide):
- Inhibits Na/Cl cotransporter in the distal tubule
- Decreases Na reabsorption & increases Ca reabsorption

Front 331

What are Auer rodes?

Back 331

Fused lysosomal granules
- Cytoplasmic inclusions in myelocytic precursor cells
- Indicative of acute promyelocytic leukemai (M3 variant of AML)

Front 332

What happens if there is a sudden release of Auer rods due to rapid treatment of acute promyelocytic leukemia?

Back 332

- DIC & fatal hemorrhage
- Histo: Helmet-shaped cells & Schistocytes

Front 333

What are schistocytes and when are they often found?

Back 333

- irregular or fragmented RBCs
- result from attempts to squeeze through the fibrin meshwork of small vessel thrombi (e.g. in DIC)

Front 334

What are acanthocytes (aka "spur cells)?

Back 334

- Spiny RBCs
- Aassociated with abetalipoproteinemia & severe liver disease

Front 335

What are Burr cells (aka echinocytes)?

Back 335

- Abnormal RBCs with short, blunt projections around the periphery
- Found in: hemolytic-uremic syndrome, pyruvate kinase deficiency, ureamia...

Front 336

What are teardrop cells?

Back 336

Abnormal RBCs seen in myeloid metaplasia with myelofibrosis

Front 337

How do hormones produced in the liver enter the systemic circulation (i.e. by which vessel)?

Back 337

Hepatic Vein to the IVC

Front 338

What vessel carries O2-rich blood to the liver?

Back 338

Hepatic artery

Front 339

Describe the vessel flow through the hypophyseal portal system.

Back 339

- Blood supplied by the hypophyseal artery goes through the capillary bed supplying the hypothalamic nuclei (which secretes tropin-releasing hormones that affect the anterior pituitary)
- Then blood passes through the capillary bed that supplies the anterior pituitary

Front 340

What vessel delivers blood from the GI track to the liver?

Back 340

Portal vein

Front 341

What vessel provides venous drainage from the kidneys to the IVC?

Back 341

Renal veins

Front 342

What does dermatitis herpetiformis look like? What disease does it indicate?

Back 342

- multiple, nonblanching, purpuric, grouped lesions located on the upper & lower extremities
- Celiac disease (gluten-sensitive enteropathy) due to gladin allergy & cross-reactivity of antibodies to the small intestine villi

Front 343

What is the histological picture of Celiac disease?

Back 343

- Lymphocytic infiltrate into the epithelial layer
- Atrophic & blunted vili

Front 344

When does Celiac disease present?

Back 344

After the introduction of cereals into the diet

Front 345

What is the histological picture in lactose intolerance?

Back 345

BENIGN mucosa

Front 346

What is the pathogenesis of Whipple's disease?

Back 346

Tropheryma whippelii (rod-shaped bacili) invade macrophages:
- Distended macrophages block lymphatic blockage & lipid deposition
- S/S: arthropathy, diarrhea, & weight loss

Front 347

Which presents with relapsing blood diarrhea, Chrohn's or Ulcerative colitis?

Back 347

UC, along with mucus, abdominal pain, & cramps

Front 348

What inhibitor of peptidoglycan synthesis is only used in topical form?

Back 348

Bacitracin
- MOA: prevents transfer of mucopeptides into the bacterial cell wall
- Rx: gram-, gram+ bac via a mild skin cut

Front 349

What is the primary secretory product in 55% of cases of multiple myeloma?

Back 349

IgG

Front 350

What uncommon form of lymphoma results in plasma cells that secrete monoclonal IgM paraproteins?

Back 350

Waldenstrom's macrogloulinemia

Front 351

What is the function of histamine?

Back 351

- To promote vasodilation
- To promote leukocyte estravsation

Front 352

What do these S&S indicate: chorea, fever, polyarthritis, valvular damage?

Back 352

Rheumatic heart disease
- can cause congestive heart failure due to mitral &/or aortic valve damage
- Histo: Aschoff bodies = noncaseating granulomas with multinucleated giant cells

Front 353

What histological finding is common in elderly patients with aoritic stenosis?

Back 353

degenerative calcification

Front 354

What histological finding is associated with mitral valve prolapse?

Back 354

myxoid degeneration

Front 355

What is "contraction alkalosis"?

Back 355

- When there is rapid loss of bicarb-free fluids (e.g. stomach contents, urine) = increase in plasma [bicarb]
- Body response: stimulation of the renin-angiotension-aldosterone system:
1) angiotension-mediated increase in H+ secretion via the antiporter in the proximal tubule
2) aldosterone-triggered influx of Na & H2O with an efflux of K & H+ in the distal tubule
RESULT = metabolic alkalosis

Front 356

What is the parentral rout of transmission?

Back 356

- Sexual activity
- Blood transfusions
- Transplacental

(Think: HIV)

Front 357

What immune system deficiency most often leads to a susceptibility to Neisseria infection?

Back 357

Complement component deficiency

Front 358

What are 1/2 of viral cases of myocarditis caused by?

Back 358

Coxsackie B (icosahedral, Picornaviridae)

Front 359

What sign of hypoglycemia do beta-blockers mask?

Back 359

tachycardia

Front 360

What happens when the tubule & glomerular basement membranes are nonenzymatically glycosylated?

Back 360

Diabetic neptropathy:
- increase permeability to proteins
- cytokin release causes glomerular hypertrophy
- HISTO: diffuse mesangial expansion in the glomeruli & later nodular glomerulosclerosis (Kimmelsteil-Wilson nodules)

Front 361

What features characterize nodular glomerulosclerosis?

Back 361

- Increased cellularity
- Mesangial matrix deposition
- Hyaline masses & thickening of the lamina densa

Diabetic nephropathy

Front 362

What is the histological picture of lupus nephropathy?

Back 362

- wire-loop glomeruli
- subendothelial basement membrane deposits

Front 363

What is the most common cause of abruptio placentae?

Back 363

Rupture of defective maternal vessels in the decidua basalis
- RF: hypertension, cocaine use, smoking, uterine fibroids, advanced age, sudden uterine decompression, premature rupture of the membranes, & bleeding diathesis

Front 364

What causes Placenta accretia?

Back 364

placental villi attach directly to the myometrium due to a defect in the decidua basalis layer
- @ delivery, there is incomplete separation of the placenta
- can cause severe postpartum hemorrhage

Front 365

Define labor.

Back 365

Regular uterine contractions that result in cervical change

Front 366

Define preterm labor.

Back 366

Labor that occurs between 20 & 37 weeks of gestation.

Front 367

What are the components of prokarytoic ribosomes?

Back 367

Large (50S) subunit
- 5S rRNA molecule + 23S rRNA molecule

Small (30S) subunit
- 15S rRNA molecule

All rRNA are bound to & protected by the ribonucleoprotein component of the ribosome

Front 368

What is the best treatment for "thyroid storm"?

Back 368

1st: primary stabilization = propranolol
2nd: propylthiouracil or methimazole to inhibit endogenous synthesis of thyroxine

Front 369

Which is better during thryotoxicosis & thyroid storm: aspirin or acetaminophen?

Back 369

Aceaminophin: antipyretic

NOT asprin b/c it displaces throxine from thyroid-binding globulin & worsens symptoms

Front 370

What are the earliest visible manifestations of endometriosis?

Back 370

Whitish peritoneal plaques

Front 371

When whitish periotneal plaques are found along the uterosacral ligament, where is the endometriosis?

Back 371

- pelvic cul-de-sac
- complications = adhesions to bowel can cause obstruction

Front 372

Why does a metabolic acidosis often result in hyperkalemia?

Back 372

- Increased H+ ions are used to balance Cl- in the urine
- This prevents K+ secretion by the H+/K+ exhcanger in the distal tubule

Rx: loop diuretic (e.g. furosemide) to increase Na & K excretion in the loop of Henle

Front 373

What is the most common of inherited aplasic anemia?

Back 373

Fanconi's anemia = defective DNA repair
- radial ray abnormalities can result in abnormal or absent radii or thumbs
- Other signs: kidney malformations, hypogonadism, microcephaly, high fetal hemoglobin

Front 374

What is Diamond-Blackfan anemia?

Back 374

Congential RBC aplasia caused by primary failure of erythroid progenitor cells in the bone marrow

Front 375

What is lacking in alkaptonuria patients?

Back 375

homogentisic oxidase
= no effective tyrosine degradation (homogentisic acid to maleylacetoacetic acid)
- homogentisic acid builds up in urine
- when urine is exposed to alkali or O2 = DARK BLACK
- S/S = usually benign or presents with arthritis

Front 376

What enzyme is lacking in Maple syrup urine disease?

Back 376

alpha-ketoacid dehydrogenase, which catabolizes branched amino acids (valine, leucine, isoleucine)

Front 377

What is cystinuria?

Back 377

- a defect of amino acid (cystine) transport in the renal tubules
- can result in cystine stone formation

Front 378

What are the symptoms of homocystinuria?

Back 378

- Mental retardation
- Spinal abnormalities (kyphosis, Marfanoid habitus)
- Atherosclerosis
- Lens subluxation

MO: defect in conversion of methionine to cysteine
- 3rd decade of life = thromboembolic events increase

Front 379

What is the treatment for primary syphilis?

Back 379

benzathine penicillin G (long-acting): 1, intramuscular dose

Front 380

What is the treatment fo Chlamydia or Haemophilus ducreyi?

Back 380

Azithromycin (1 oral dose)

Front 381

What is the most common fetal neoplasm?

Back 381

sacrococcygeal teratoma (multiple tissue types = remnant of the primitive streak)

Front 382

What are the 2 types of MSUD (maple syrup urine disease)?

Back 382

Intermittent: presents during times of catabolism (e.g. after infections)

Classical: ketonuria 48 hrs to 1 week after birth

Front 383

What CSF finding is found in 80-90% of MS (multiple sclerosis) patients?

Back 383

Increased Ig levels: reflects presence of intrathecal humoral immune activation

Front 384

What CSF finding is the hallmark of Guillain-Barre syndrome?

Back 384

albuminocytologic dissociation: greatly increased protein concentration with only a modest increase in cell count

- MOA: acute demyelination of peripheral nerves (acute ascending paralysis) after a viral infection or gastroente ritis from C. jejuni infection

Front 385

What is the mechanism of basal ganglia destruction in Huntington's

Back 385

- gutamate toxicity of the ganglia in the caudate & putamen
- gliosis & neuronal depletion result in a loss of motor inhibition = chorea & athetoid movements

Front 386

What causes neurofibrillary tangles?

Back 386

- Hyperphosphorylated tau protein
- Characteristic of Alzheimer's disease

Front 387

What is the treatment for phenylketonuria?

Back 387

Dietary
- Avoid phenylalanine
- Suppliment tyrosine (b/c the phenylalanine cannot be converted to tyrosine)

Front 388

What is the most common cause of pneumonia in malnourished, debilitated, or alcoholic patients?

Back 388

Klebsiella pneumoniae (gram -, rod)
- X-ray: diffuse infiltrates (NOT lobular)

Front 389

What three "drugs" have zero-order elimination?

Back 389

1) ethanol
2) phenytoin
3) high-dose asprin

Front 390

What is lateral medullary syndrome (aka posterior inferior cerebellar artery (PICA) syndrome or Wallenberg's syndrome)?

Back 390

A Stroke Syndrome:
- Symptoms: numbness of the ipsilateral face & contralateral limbs, diplopia, dysarthria, & ipsilateral Horner's
- Cause: disruption of PICA - blood supply to dorsolateral quadrant of medulla, including nucleus ambiguus & inferior surface of the cerebellum

Front 391

What happens when the posterior inferior cerebellar artery (PICA) is infarcted?

Back 391

Lateral medullary syndrome due to dorsolateral quadrant disfunction:
- Tract of CN V = facial pain
- Vestibular nuclei = dysequilibrium
- Nucleus ambiguus = palate problems & hoarse voice
- Spinothalamic tract = contralateral pain & temperature loss
- Descending sympathetic fibers = ipsilateral Horner's

Front 392

What is the 2nd most common brainstem stroke syndrome?

Back 392

Ischemia to the Anterior inferior cerebellar artery:
- Caudal lateral pontine tementum (including spinal tegmental tract of CNV)
- Inferior surface of the cerebellum

- Symptoms: ipsilateral deafness (labyrinthine artery to cochlea & vestibular apparatus), ipsilateral facial weakness, ataxia

Front 393

What is damaged in a lacunar stroke?

Back 393

Lateral striate arteries (penetrating branches of the MCA):
- internal capsule, caudate nucleus, putamen, & globus pallidus

Front 394

What structures are damaged in a symptomatic internal carotid artery occlusion?

Back 394

- lateral geniculate body
- globus pallidus
- posterior limb of the internal capsule

Front 395

Which results in tetany: HYPO or HYPER calcemia?

Back 395

Hypocalcemia (remember DiGeorge's symptoms)

Front 396

What types of infections are you prone to if you have a T lymphocyte deficiency?

Back 396

Viral & Fungal

Front 397

What organism causes Hemolytic-uremic syndrome & what lab values characterize this problem?

Back 397

- E. coli O157:H7 (gram - , rod, lactose-fermenting)
- Low platelet count, anemia, renal failure (e.g. uremia)

Front 398

What are the symptoms of rheumatic fever?

Back 398

- Fever
- Migratory polyarthritis
- Carditis

- Can follow a Group A strep pharyngitis

Front 399

What are the signs of bacterial endocarditis?

Back 399

- Fever
- New Murmur
- Janeway lesions
- Nail bed hemorrhages

Front 400

What is the most common cause of acute & subacute endocarditis?

Back 400

- Acute: Staph aureus (10-20? of endocarditis)
- SubAcute: viridans strep (usually attacks previously-damaged valves); causes 50-60% of endocarditis

Front 401

Where does Pemphigus vulgaris attack?

Back 401

Pathogenic antibodies are directed against dsmoglein-3, a cell-cell adhesion protein expressed by epidermal keratinocytes
- Result: intraepidermal acantholysis with sparing of the basal layer
- Nikolsky's Sign: flaccid epidermal bullae that easily slough off leaving large denuded areas of skin (prone to infection)

Rx: steroids

Front 402

What is lacking in patients with essential fructosuria?

Back 402

BENIGN frutosuria b/c fructose does not enter cells & does not deplete cellular phosphate
- fructokinase: converts frutose to fructose-1-phosphate

Front 403

What is deficient in patients with hereditary fructose intolerance?

Back 403

Aldolase B (aka fructos-1.6-bisphosphate aldolase): converts fructose-1-phosphate to dihydroxyacetone-phosphate
- fructose-1-phosphate accumulates in cell
- Presentation: jaundice, hepatomegaly, vomiting, lethargy, convulsions, & hypoglycemia after ingesting fructose

Rx: AVOID fructose & sucrose (glucose + fructose)

Front 404

What dietary recommendation is made for patients with McArdle's?

Back 404

High protein + creatinine

Front 405

What is the action of endogenous opioid peptides on the GI?

Back 405

- Stimulate smooth muscle contraction
- Inhibit intestinal secretion of fluids & electrolytes

(Morphine has these properties as well)

Front 406

What is the relationship between prevalence and the PPV of a test?

Back 406

As disease prevalence decreases, the probability of a positive being a true positive decreases

Front 407

Rank infectious agent types in order of increasing susceptibility to chemical sterilants.

Back 407

Least to Most:
1) prions
2) spores
3) Myocbacteria
4) Nonenveloped viruses
5) Fungi
6) Gram+ bacteria
7) Gram- bacteria
8) Enveloped viruses

Front 408

What genetic disease results in skin that readily breaks & forms blisters with minor trauma?

Back 408

Epidermolysis bullosa
- Caused by a mutation in either keratin 14 or 5 in basal epithelial cells

Front 409

What is the classical triad of Pott's disease?

Back 409

- Spinal Pain
- Kyphosis (compromised vertebra)
- Neurologic signs (radicular pain to cord compression & paralysis)

Front 410

For what systemic infection is amphotericin the DOC?

Back 410

Disseminated mycoses:
- blastomycosis
- cryptococcus
- histoplasmosis

Front 411

What is the most common cause of a paraspinal abscess?

Back 411

Staphylococcus aureus

Rx: IV vancomycin

Front 412

What lab findings indicate Paget's disease of bone?

Back 412

Elevated Alkaline Phosphatase + normal micronutrient levels

Front 413

what are 4 typical uses of sulfa drugs, like trimethoprim?

Back 413

1) UTI
2) Nocardiosis
3) Toxoplasmosis
4) Prophylaxis for recurrent otitis media

Front 414

What sulfa drug perscription should be combined with folic acid supplementation?

Back 414

Timethoprim

Why? To reduce megaloblastic anemia, leukopenia, & granulocytopenia

Front 415

What property of quinolones (like Gatifloxacin) makes them particularly useful for treating UTIs?

Back 415

Concentrated in the urine

MOA: inhibit DNA gyrase during bacterial replication & growth

Front 416

What drug class is toxic to cartilage?

Back 416

fluoroquinolones: can lead to tendinitis & tendon rupture
- e.g. gatifloxacin

Front 417

What 5 main problems are macrolides (e.g. erythromycin) used to treat?

Back 417

1) Gram+
2) Legionnaire's
3) Syphilis
4) Mycobacterial pneumonia
5) Corynebacterial infections (e.g. diptheria)

Front 418

What broad-spectrum antibiotic is particularly effective for meningitis?

Back 418

chloamphenicol

SE: aplastic anemia & gray baby syndrome

Front 419

What are two genetic/anatomical risk factors for testicular cancer?

Back 419

- Klinefelter's (47, XXY): usually will be extragonadal, nonseminamatous testicular cancer
- Cryptorchidism

Front 420

What 2 cell types kill target cells through the release of preformed granules?

Back 420

1) NK cells: perforin & granzymes
2) CD8+

Front 421

What drug causes increased vessel permeability and subsequent edema in the face, lips, mouth, and subglottic tissue?

Back 421

ACE inhibitors:
- block the 2ndary action of ACE on the degradation of bradykinin
- High levels of bradykinin produce these symptoms

Front 422

What are the 2 main functions of prostacyclin?

Back 422

Produced by vascular endothelial cells from PGH2:
1) prevents platelet aggregation
2) potent vasodiation

Front 423

What causes watery, foul-smelling stool with leukocytosis following antibiotic treatment?

Back 423

C. difficile superinfection

Rx: metronidazole

Front 424

What are the pseduomembranes of C. difficile psuedomembranous colitis?

Back 424

inflammatory exudates on the injured mucosa due to the to protein exotoxins (A & B) of C. difficile

Front 425

How does S. aureus cause food poisoning?

Back 425

heat-labile & heat-stable exotoxin secretion

Front 426

What is the virulence factor of Clostridium perfringens?

Back 426

produces lecithinase that breaks down cell membrane lecithin (& produces gas-bubbles)

Front 427

How does Yersinia enterocolitica cause mesenteric adenitis?

Back 427

invades Peyer's patches of the gut (& 2ndary fever & diarrhea)

Front 428

What is the inhibitor (regulator) of phosophofructokinase & t/f of the rate-limiting step of glycolysis?

Back 428

citrate (from the Krebs Cycle)

Front 429

What regulates the Krebs cycle by providing negative feedback to pyruvate dehydrogenase?

Back 429

Acetyl-coenzyme A (produced from pyruvate by pyruvate dehydrogenase)

Front 430

What amino acids carries amino groups from the muscle to the liver?

Back 430

alanine (can also be convered to pyruvate to be used in the Krebs cycle & can also inhibit pyruvate kinase)

Front 431

What enzyme produces glucose-6-phosphate in the 1st step of glycolysis?

Back 431

1) In all tissues: hexokinase
2) Liver ONLY: glucokinase

Front 432

Which antidiarrheal is an opiate analog & derivative of haloperidol?

Back 432

Loperamide: binds GI opiate receptors & inhibits bowel motility

Front 433

How does aluminum chloride decrease GI motility?

Back 433

Osmotic & Ionic effects

Front 434

How does Bismuth subsalicylate work?

Back 434

- Binds to the ulcer base & provides physical protection
- Also allows HCO3- secretion to reestablish the pH gradient in the mucous layer

Front 435

What is the MOA of Kaolin?

Back 435

An absorbent that binds toxic compounds from the GI wall & promotes their excretion

Front 436

What is the use of a beta-blocker in patients with chronic liver disease?

Back 436

Treats their portal hypertension

Front 437

Why do loop diuretics cause a loss of potassium?

Back 437

B/C loops block Na absorption in the thick ascending loop of Henle, the nephron attempts to absorb more Na in the distal tubule & collecting duct. In the collecting duct:
1) K+ & H+ are exchanged by the intercalated cells
2) Na & H2O are absorbed by principle cells & K+ is secreted

Front 438

How should salmonella gastroenteritis be managed?

Back 438

1) Treat dehydration with fluid & electrolyte replacement
2) Give antibiotics if there is evidence of bacteremia or focal infection. Otherwise, antibiotic treatment will increase rates of relapse

Front 439

What are the most common risk factors for ectopic pregnancy?

Back 439

1) PID
2) prior appendicitis
3) endometriosis
4) prior abdominal surgery

Front 440

List the 5 stages of neutrophil development.

Back 440

1) Promyelocytes (with primary granules)
2) Myelocytes (with 2ndary granules)
3) Metamyelocytes (with more prominent indented nuclei)
4) Band (stab) cells (horseshoe-shaped, but not yet lobulated)
5) Mature neutrophils (with clearly lobulated nuclei)

Front 441

What is internuclear opthalmoplegia?

Back 441

1) ispsilateral medial rectus palsy on attempted lateral conjugate gaze away from the lesion
2) monocular horizonal nystagmus in the contralateral abducting eye
3) Preserved convergence

Cause: damage to the ipsilateral medial longitudinal fasciculus: the connection between the abduct & oculomtor nerve, where their actions become UNLINKED
- PEDS: CNS infection or MS
- Adults: vascular disease

Front 442

What does CN III innervate?

Back 442

All extraocular muscles, except the lateral rectus (CN VI) & superior oblique (CN IV)
- Lesion: affected eye looks "down & out" when at rest (abducted & depressed)

Front 443

What 3 diseases can cause Argyll Roberson pupil?

Back 443

1) Neurosyphilis
2) Diabetes
3) SLE

Pupillary light-near dissociation: absent miotic reaction to light with preserved accommodation

Front 444

What is Marcus Gunn pupil and what causes it?

Back 444

Relative afferent pupillary defect

Cause: lesion in the afferent limb of the pupillary light reflex
- MS: retrobulbar neuritis

Front 445

What histological change in the CNS is often found in SIDS autopsies?

Back 445

Astrogliosis: nonspecific response to injury to the brain stem & cerebellum
- Hypertrophy of astrocytes
- Increase in glial fibrillary acidic protein immunostaining

Front 446

What are the histo findings in muscle tissue of patients that suffer from ALS (amyotrophic lateral sclerosis)?

Back 446

- Fiber type grouping consistent with reinnervation
- Small angular fibers consistent with deinervation & neurogenic atrophy

Front 447

What are the physical exam findings in a child with Kawasaki's?

Back 447

- Fever
- Conjunctivitis
- Erythema in the oral mucosa
- Cervical lymphadenopathy

Front 448

What is the typical clinical presentation of a patient with Buerger's?

Back 448

Patient (20-40 years, heavy smoker)
- Intermittent claudication
- Superficial nodular phlebitis
- Cold Sensitivity

Front 449

What are the physical findings in a patient with PAN (polyarteritis nodosa)?

Back 449

- Cotton-wool spots on the retina
- Microaneurysms
- Palpable purpure on the skin
(+ history of Hep B)

Front 450

What is the histo hallmark of PAN (polyarteritis nodosa)?

Back 450

transmural inflammation of the arterial walls in kidneys, PNS, & GI tract

LAB: + perinuclear anti-neutrophilic cytoplasmic antibody (against myeloperoxidase)

Front 451

What is the histo characterization of Wegener's?

Back 451

Necrotizing granulomas in the lung & upper airways + glomerulonephritis

LAB: + anti-neurophilic cytoplasmic antiboby

Front 452

What is the treatment for Lyme disease?

Back 452

oral doxycycline

Front 453

What are the classical symptoms of Cooley's anemia?

Back 453

severe beta-thalassemia:
- Hemolytic anemia
- Hepatosplenomegaly
- "Chipmunk facies" due to extramedullary hematopoiesis in facial bones)

LAB: increased HbF & HBA2 (neither require B chains), absense of HbA1 shows that there is NO beta chains

RIP: cardiac failure 2ndary to hemochromatosis

Front 454

Which Thalassemia confers a mild protective effect against Plasmodium falciparum malaria?

Back 454

Beta Thalassemia minor (heterozygous defect): b/c of shortened lifespan of RBCs

LAB: decreased HBA1

Front 455

What is the geographical distribution of thalassemias?

Back 455

beta: Mediterranean
alpha: Asia / Africa

Front 456

What is Kartagener's syndrome?

Back 456

AR disease with this Triad:
1) Chronic sinusitis (& otitis media)
2) Bronchiectasis (chronic bronchitis & recurrent pneumonia)
3) Situs inversus

Patho: poorly functioning dynein arms on all cilia in the body

Presentation: unremitting asthma & sinus pressure headaches

Front 457

What are the functions of actins in cells?

Back 457

Composition: multiple globular G-actin subunits

- Tracts for myosins: cell motility, vesicular transport, or muscle contraction

Front 458

What are the cellular functions of myosins?

Back 458

Composition: ATP-driven dimeric molecular motor proteins

- Move along actin filaments for vesicular transport, cell motility, & muscle contraction

Front 459

What is glyburide's MOA as a type II diabetic drug?

Back 459

Sulfonylurea: stimulates release of endogenous insulin to reduce blood sugar levels

Front 460

What class of drugs increase target cell sensitivity to insulin & decrease hepatic gluconeogenesis?

Back 460

Thiazolidinedines:
- Glitazone
- Rosiglitazone
- Pioglitazone

Front 461

What drugs inhibit the intestinal brush boarder enzyme alpha-glucosidase?

Back 461

alpha-Glucosidase inhibitors (acarbose)

Front 462

What is the inherited form of hyperammonemia that presents with mental retardation, seizures, and finally death?

Back 462

- Ornithine transcarboamolyase
- Normal enzyme function: combines carbamoyl phosphate & ornithine to make citrulline in the urea cycle

Front 463

What storage disease presents with generalized hypotonia, muscle weakness, & hypertrophic cardiomegaly?

Back 463

Pompe's (absent lysosomal alpha-1,4 glucosidase)

LAB: significantly elevated serum creatinine kinase

Front 464

What enzyme defect presents with vomiting, diarrhea, failure to thrive & hypotonia within the 1st few days of life?

Back 464

galactose 1-phosphate uridyltransferase galactosemia
- galactose 1-phosphate is toxic to renal, hepatic, & neuronal cells

Rx: galactose restriction. NB: patients may STILL have developmental delay, ataxia, & apraxia

Front 465

What are the 2 effects of an aldose B dysfunction?

Back 465

No splitting of fructos-1-phosphate:
1) Inhibition of glucose production
2) Depletion of adenosine triphosphate

Front 466

What enzyme deficiency presents with angiokeratomas, hypohidrosis, corneal & lenticular opacities, acroparesthesias, and vescular disease of the kidney, heart & brain?

Back 466

Fabry's: mutations in alpha-galactosidase A gene -> accumulation of ceramide trihexoside

Rx: enzyme replacement therapy

Front 467

What foods should patients with hereditary fructose intolerance avoid?

Back 467

fructose, sucrose, sorbitol

Front 468

What are the typical clinical symptoms of ureteral or bladder calculus?

Back 468

- Sharp, intermittent, excruciating pain in the lower back, abdomen, or testicular region
+ Fever, nausea, vomiting, & hematuria

Front 469

In a woman with symptoms of acute appendicitis, what hormone should be measured?

Back 469

Rule out ectopic pregnancy wiwht a beta-hCG level test

Front 470

What is Meniere's disease?

Back 470

IDIOPATHIC DISEASE WITH:
- Episodes of vertigo lasting for a period of hourse with associated fluctuation
- Progressive low-frequency sensorineural hearing loss
- Aural fullness or pressure (tinnitus)

Cause: increase in the volume of the endolyphatic system (hydrops) 2ndary to malfunction of the endolymphatic system, which is responsible for the filtration/excretion of endolymoph in the membranous labyrinth of the inner ear

Front 471

What causes BPPV (benign paroxysmal positional vertigo)?

Back 471

Freely moving crystals of Ca-carbonate within the semicircular canals cause seconds of vertigo & nystagmus

Front 472

What parts of the inner ear react to acceleration & deceleration of the head?

Back 472

utricle & saccule

Front 473

What lesion results in impairment in the high-frequency range of hearing & problems with speech discrimination?

Back 473

Cranial Nerve VIII (vestibulocochlear)

Front 474

What 3 conditions are associated with elevated beta-human chorionic gonadotropin levels?

Back 474

1) Pregnancy
2) Choriocarcinoma
3) Complete hydatidiform mole

Front 475

What 2 diseases are associated with P-ANCA elevation?

Back 475

1) Microscopic polyangiitis
2) Churg-Strauss syndrome: allergic rhinitis, asthma, & eosinophilia

Front 476

Which gyrus is the primary motor cotex?

Back 476

precentral: top = feet, bottem = face

Front 477

What is the UMN innervation of the face?

Back 477

- Upper 1/3: bilateral
- Bottom 2/3: contralateral primary motor cortex

Front 478

What is the lateral collateral ligament complex?

Back 478

Ankle joint ligment complex that protects from inversion stress:
1) anterior talofibular ligament
2) calcaneofibular ligament
3) posterior talofibular ligament

Front 479

What prevents eversion stress on the ankle?

Back 479

deltoid ligament

Front 480

What ligament is most commonly affected in ankle sprains?

Back 480

anterior talofibular ligament (usually protects against inversion stresses)

Front 481

What hormone acts on the hypothalamic thermregulatory center & slightly elevates basal body temp after ovulation?

Back 481

progesterone

Front 482

What is given as "rescue therapy" due to cyclophosphamide induced hemorrhagic cycstitis due to the accumulation of toxic metabolites in the urine?

Back 482

Mensa: converts some of the toxic metabolites (e.g. acrolein) into as less toxic form to be secreted in the urine

Front 483

What are the clinical signs of a pineoblastoma?

Back 483

- headache
- drowsiness &/or vivid dreams due to excessive melatonin production, which regulates sleep-wake cycles

MRI: contrast-enhancing pineal mass located between the thalamic bodies

Front 484

What is the classical sign of a craniopharyngioma?

Back 484

visual disturbances b/c this pituitary stalk tumor compresses the optic chiasm

Front 485

What are the 2 classical signs of a pituitary adenoma?

Back 485

- hyperprolactinemia
- bitemporal hemianopia (compresses the optic chiasm)

Front 486

How does initial ICP present?

Back 486

headache, nausea, vomiting

Front 487

What are the 2 mechanisms of iron absorption?

Back 487

1) Heme-associated iron is taken up by heme transporter in the luminal plasma membrane of the duodenal epithelial cell.
2) Free ferric iron ions are converted to ferrous iron ions by a cytochrome B enzyme on the luminal plasma membrane of the duodenal epithelial cell. Ferrous iron ions are taken up by the DMT channel. W/in the cell, iron is transferred to mucosal ferritin & then shuttled to transferrin in the plasma

Front 488

What glycogen storage disease occurs in adolescence?

Back 488

McArdle's

Front 489

What disease is a mild form of vonGierke's?

Back 489

- Cori's: deficiency in alpha-1,6-glucosidase (glycogen debranching enzyme)
- With NORMAL blood lactate levels!