Uw 05-24-12

Front 1

What is primidone?

Back 1

An anti-epileptic that is metabolized to 2 other anti-epileptics:
- Phenobarbital
- PEMA

Front 2

Which coagulation marker should you watch when someone's taking Warfarin? Heparin?

Back 2

Warfarin - PT (extrinsic VII)

Heparin - PTT (intrinsic

Front 3

What are alternatives to Heparin (ie. if someone has HIT)

Back 3

1) Thrombin inhibitors = Bivalirudin & Lepirudin

2) FXa inhibitor = Fondaparinux

"I don't wanna get HIT for being RUDe & eating Jane FONDA's H-amburger, so I'll order myself a B-L-T w/ F-rench F-ries"

Front 4

How do you treat thrombolytic toxicity?

Back 4

Aminocaproic acid (inhibits fibrinolysis)

Front 5

What is Ochronosis, what causes it, and what is the usual presenting complaint?

Back 5

d/t Alkaptonuria, a deficiency in homogentisic acid oxidase (so tyrosine can't degrade to fumarate)

The homogentisic acid binds to CT collagen and is visible as blue-black pigment on ears, nose, cheeks.

Presenting complaint is urine that turns black on standing.

Front 6

What is parinaud syndrome?

Back 6

Inability to gaze upward (or of convergence)

d/t compression of the Superior Colliculi (e.g. Pinealoma)

Front 7

What chemotherapeutic agents act at the M phase of Mitosis? How do they work?

Back 7

Microtubule Inhibitors:
1) Vinca Alkaloids - prevent formation of MT's
- Vincristine
- Vinblastine
2) Taxols = Paclitaxel - prevent breakdown of MT's

Front 8

What are the crescenting glomerulonephrites and what are their associated Ab's?

Back 8

RPGN:
I) Goodpasture syndrome = anti-GBM (pulmonary and glomerular capillaries)
II) Wegener's Granulomatosis = c-ANCA
III) Microscopic polyangitis = p-ANCA

Front 9

What are the common mets for gastric cancer called?

Back 9

1) Virchow's node = Left supraclavicular node
2) Krukenberg's tumor = Ovaries (mucin, signet-ring)
3) Sister Mary Joseph nodule = Periumbilical

Front 10

In what conditions is Hydrocephalus ex Vacuo observed?

Back 10

1) Alzheimer disease
2) Advanced HIV / AIDS
3) Pick's Disease

Front 11

What drug preferentially vasodilates arterioles vs venules? What do you have to worry about?

Back 11

Hydralazine

Want to avoid reflex tachycardia (so give ß-Blockers) and edema (so use diuretics)

Front 12

What drug preferentially vasodilates arterioles vs venules? What do you have to worry about?

Back 12

Hydralazine

Want to avoid reflex tachycardia (so give ß-Blockers) and edema (so use diuretics)

Front 13

What drug preferentially vasodilates arterioles vs venules? What do you have to worry about?

Back 13

Hydralazine

Want to avoid reflex tachycardia (so give ß-Blockers) and edema (so use diuretics)

Front 14

What are the treatments for Malignant HTN?

Back 14

N-o F'ing D-joke!

1) Nitroprusside (NO release → ↑cGMP; toxicity = cyanide)
2) Fenoldopam (D1 - good for renal insufficiency)
3) Diazoxide (KV opener → hyperpolarizes; toxicity = hyperglycemia)

Front 15

What are the two types of NMJ blocking drugs and how are they reversed?

Back 15

1) Depolarizing = Succinylcholine (can't be reversed in phase I - only broken down by AChEsterase; phase II can be reversed w/ AChE inhibitors e.g. neostigmine)

2) Nondepolarizing = Tubocurarine, pancuronium (-curoniums) - reversed w/ AChE-I like neostigmine

Front 16

What are the toxins released by C. difficile?

Back 16

Toxin A = Enterotoxin
- binds the brush border; attracts PMN's → inflammation, damage, and loss of fluid (diarrhea)

Toxin B = Cytotoxin
- destroys cytoskeleton (prevents actin polymerization) → pseudomembranous collitis

Front 17

How would a heart attack affect lung compliance?

Back 17

If the MI affected the LV (like an LAD blockage) then this would decrease LV contractility → ↑end diastolic pressure in the pulmonary circulation → transudate (edema) in lungs, that would ↓ compliance of the lungs

Front 18

What causes maple syrup urine disease?

Back 18

A deficiency of α-ketoacid DH so you can't break down the BCAA's:
- Leu (→ Acetyl CoA)
- Val (→ propionyl CoA → TCA)
- Ile (→ propionyl CoA → TCA)

Front 19

What bacterial exotoxins inhibit protein synthesis?

Back 19

1) EF-2 Inactivation
- Diphtheria Toxin
- Toxin A (pseudomonas)
2) 60S Inactivation (& HUS)
- ST = Shiga Toxin
- SLT = Shiga-Like (EHEC)

Front 20

What bacterial exotoxins inhibit neurotransmitter release?

Back 20

Both cleave SNARE protein (needed for NT release)
Both = Clostridium

1) C. tetani = Tetanospasmin = ↓GABA & Glycine
2) C. botulinum = Botox = ↓ACh

Front 21

What bacterial exotoxins lyse cell membranes?

Back 21

Perfringens & Pyogenes

1) C. perfringens = α-toxin = Phospholipαse

2) S. pyogenes (GAS) = Streptolysin O (SLO) degrades RBC's cell membranes

Front 22

What bacterial exotoxins cause shock?

Back 22

SUPERANTIGENS!! (bind both MHC-II and TCR's and set off crazy release of IFN-g & IL-2

1) GAS = Exotoxin A (puts the A in GAS)

2) S. aureus = TSST-1

Front 23

Which bacterial exotoxin prevents phagocytosis?

Back 23

ONLY ONE = Pertussis!!

Bordetella pertussis
(disables Gi, so overactive Adenylate cyclase = ↑cAMP)

Front 24

How do you calculate an anion gap?

Back 24

Normal = 8-12 mEq/L

Anion gap = Na - (Cl + HCO3)

Front 25

What's the difference b/w cherry and strawberry hemangiomas?

Back 25

Strawberry = infancy, regress

Cherry = elderly, do not regress

Both = benign

Front 26

What are two major non-selective alpha blockers? What is the difference b/w them?

Back 26

1) Phenoxybenzamine (irreversible; good for Pheochromocytoma)

2) Phentolamine (reversible; good for pt on MAO-I that eats something w/ tyramine in it)

Front 27

How do you treat thyrotoxicosis?

Back 27

Propranolol (non-selective ß-blocker)
MOA:
1) TH has upregulated the ß-receptors, so stress leads to ↑ catecholamines, now w/ more effect; ß-blocker stops this
2) ↓ peripheral conversion of T4→T3 (unknown MOA)

Front 28

What drugs are both mood stabilizers (good for bipolar) and anticonvulsants (for epileptics)?

Back 28

Valproate
Carbamazepine

Front 29

Which lipid lowering drugs would increase the risk of gallstones?

Back 29

1) Bile acid binders (e.g. cholestyramine)
2) Fibrates (e.g. gemfibrozil)

Front 30

What bacterium is ID'd using Periodic Acid-Schiff?

Back 30

Tropheryma whippelii = Whipple's Dz

It stains the polysaccharide cell wall bright magenta

Front 31

What are the only diuretics that can help decrease the amount of calcium in the urine?

Back 31

Thiazides

Front 32

What is the tx for cluster headaches?

Back 32

Sumatriptan

Front 33

Which non-foregut derivative gets its blood supply from the foregut's blood supply?

Back 33

Spleen = Mesoderm

Blood supply from Celiac Trunk

Front 34

What are the phagocyte dysfunction disorders?

Back 34

1) LAD = Leukocyte Adehsion Deficiency (↓CD18) [AR]
2) CHS = Chediak-Higashi syndrome (xLYST → can't fuse lysosomes w/ phagosomes) [AR]
3) CGD = Chronic Granulomatous Dz (xNADPH Oxidase → no respiratory burst)

Front 35

What is a major radiological difference b/w a spontaneous and tension pneumothorax?

Back 35

Spontaneous = trachea deviates TOWARDS affected lung

Tension = trachea deviates AWAY from affected lung

Front 36

What is the treatment for an HIV patient that has "ring enhancing lesions" on brain CT?

Back 36

Pyrimethamine + Sulfadiazine

toxo-P-la-S-ma

Front 37

What is the Tx for narcolepsy?

Back 37

Modafinil

2nd line is amphetamines

Front 38

What disease causes "black liver"?

Back 38

Dubin-Johnson Syndrome

Defective MRP2 active organic anion transporter - so cannot excrete conjugated bilirubin into the bile

Front 39

What is believed to cause narcolepsy?

Back 39

Low levels of NT Orexin (hypocretin) produced in lateral hypothalamus; responsible for maintaining wakefulness

Front 40

What is preeclampsia? What causes it? What can it lead to?

Back 40

1) Triad of HTN, Proteinuria, and Edema. (~20wks pregnancy → 6 wks postpartum)
2) d/t placental ischemia → ↑vascular tone
3) can lead to eclampsia (+ seizures; tx = MgSO4 & diazepam) or HELLP (hemolysis, elev LFT's, low plts)

Front 41

What are the different causes of bacterial endocarditis a/w the following conditions:
1) dental procedure
2) colon cancer
3) prosthetic valves
4) urology procedure
5) IVDA

Back 41

1) S. viridans
2) S. bovis
3) S. epidermitis
4) S. enterococcus
5) Triad of causes (damage the Tri-cuspid):
- S. aureus
- Psuedomonas
- Candida

Front 42

Which drug has both beta-blocking ability and K+ Channel blocking (Type III Antiarrhythmic)? What are its side effects?

Back 42

Sotalol

SE = TDP & excess ß-block

Front 43

What are the Type III Antiarrhythmics?

Back 43

K+ Channel blockers ("K IS BAD")
I-butilide
S-otalol
B-retyllium
A-miodarone
D-ofetilide

Front 44

What is the most common type of paroxysmal tachycardia? How is it treated?

Back 44

PSVT = Paroxysmal Supraventricular Tachycardia d/t re-entrant impulse in AV node

Tx is to ↑PANS and prolong AV refractory period via:
1) Carotid sinus massage
2) Valsalva
3) Rx = Adenosine

Front 45

What conditions cause a Left Shift in O2-Hb Dissociation curve?

Back 45

Left Shift = Less stuff (but MORE affinity):
1) ↓ H+ (alkalosis = hyperventilation)
2) ↓ 2,3 BPG
3) ↓ Temperature (hypothermia)

Front 46

What are the MAO-Inhibitors and what are they good to Tx?

Back 46

MAO Takes Pride In Shanghai:
T-ranylcypromine
P-henelzine
I-socarboxazid
S-elegiline

Good for atypical depression and tx-resistant depression

Front 47

How do you test for syphillis?

Back 47

Screen first w/ VDRL (non-specific looking for Ab's to cardiolipin - will be in blood d/t treponemal destruction of cells)

Confirm w/ FTA-ABS (immunofluorescence of Ab's in serum vs killed treponemma)

Front 48

What is Staph Aureus's unique method of evading phagocytosis?

Back 48

Protein A
- binds the Fc of IgG's

GOLD (aureus) rush to the PACiFIG
(Protein A C-F, IgG)

Front 49

What is the treatment of hypertriglyceridemia?

Back 49

1) Fibrates (↑ LPL activity - ↓↓ TG's in blood 20-50%)

2) Niacin (↓VLDL synthesis as well)

Front 50

What is the Tx for Hypercholesteremia?

Back 50

1) Statins (HMG CoA Reductase INhibitors)

2) Ezetimide (↓ Chol absorption in gut)

Front 51

What disease is associated w/ clumsiness, kyphoscoliosis, hypertrophic myopathy, and arched feet?

Back 51

Friedrich's Ataxia (GAA repeates)
AR
Frataxin mutation → impaired mitochondrial function

Front 52

What medical Tx is there for pulmonary hypertension?

Back 52

Bosentan

Endothelin-1 Antagonist

Front 53

What causes acute epiglottitis?

Back 53

Haemophilus influenza
(prevented w/ HiB vaccine)

Front 54

What conditions cause "Marfanoid Habitus"?

Back 54

1) Marfan's
2) MEN 2B
3) Homocystinuria

Front 55

What are the causes of avascular necrosis?

Back 55

1) Thrombi (sickle cell, fat, air)
2) Vasculitis (SLE)
3) Exogenous/Unknown (EtOH, Corticosteroids)

Front 56

What is amlodipine and what are its side effects? When is it first line?

Back 56

DHP Ca Channel blocker
FLT for Isolated Systolic HTN

SE's = flushing, edema

Front 57

What are the major SSRI's?

Back 57

Fluoxetine
Paroxetine
Sertraline
Citalopram

Front 58

What is the most common cause of sepsis in an asplenic person (e.g. sickle cell)? How about osteomyelitis?

Back 58

1) Strep Pneumo > H. influenza

2) Salmonella

Front 59

How does pregnancy predispose to cholelithiasis?

Back 59

↑E2 = ↑Liver Cholesterol synth (HMG CoA Reductase)

↑PROG = slows galbladder contractions = stasis

Front 60

How are the ACL and PCL named?

Back 60

Based on which part of the TIBIAL surface they're attached to

Front 61

What are the functions of PBP's?

Back 61

They are trans-peptidases that cross-link peptidoglycan

Targets of PCN's and Cephalosporins

Front 62

What drugs are a/w lung fibrosis? (5)

Back 62

ABBMM
1) Amiodarone
2) Bleomycin
3) Busulphan
4) Methysergide
5) Mitomycin C