Uw 05-31-12

Front 1

What is the pathogenesis of Scleroderma?

Back 1

Excessive collagen deposition and fibrosis throughout the body
d/t TCells → TGF-ß → Fibroblasts → ↑ collagen

Front 2

What are the causes of Raynaud's phenomenon?

Back 2

1) MCTD
2) SLE
3) CREST

Front 3

What are the features of MCTD?

Back 3

Similar signs/symptoms to SLE, Scleroderma, and Polymyositis BUT rarely renal involvement
a/w Anti-RNP Ab's

Front 4

What is clozapine?

Back 4

Atypical antipsychotic
Blocks D4 instead of D2 receptors (so no parkinsonians)
HOWEVER causes life-threatening agranulocytosis so must watch white blood cells!

Front 5

What is ziprasidone?

Back 5

Atypical antipsychotic
SE = Prolongs QT therefore must get EKG's

Front 6

Which medication can cause full-blown hepatitis?

Back 6

INH (Isoniazid)

Front 7

What are the drugs commonly known to cause renal failure?

Back 7

Aminoglycosides (Gentamycin)
Vancomycin

Front 8

Which medications can cause hypothyroidism?

Back 8

Lithium (mood stabilizer)
Amiodarone (class III K+ antiarrhythmic)
Sulfonamides

Front 9

Why does someone w/ Conn's have normal sodium levels?

Back 9

"Aldosterone Escape"
Conn's = 1º Hyperaldosteronism (HTN, MAlk, ↓K, ↓ Renin)
Aldosterone causes Na and Cl to be retained → ↑ volume
ANP released d/t ↑ volume → compensatory Na loss, so almost balances

Front 10

What is marantic endocarditis?

Back 10

Non-Bacterial Thrombotic Endocarditis (NBTE)
usually a/w underlying visceral adenocarcinoma (lung/pancreas)

Front 11

What are the causes of HIV related esophagitis and their gross findings?

Back 11

1) Candida albicans = patches of grey/white pseudomembranes, erythematous mucosa, adherent
2) HSV-1 = Small vesicles that evolve into "punched out" ulcers
3) CMV = Linear ulcerations

Front 12

What are the causes of pure RBC aplasia?

Back 12

1) Thymoma
2) Parvovirus B19
3) Idiopathic

Front 13

What is Ehlers-Danlos syndrome?

Back 13

Faulty collagen synthesis (d/t failure to cleave N- and C- terminals from procollagen)
Causes hyperextensible skin, hypermobile joints, and bleeding (Type III Collagen = bruising/bleeding)

Front 14

Which type of kidney stone is radiolucent?

Back 14

Uric acid stone

Front 15

Which type of kidney stone is a/w UTI's?

Back 15

Triple Phophate = Ammonium Mg Phosphate
need alkaline urine (urease producing UTI bugs)
lead to Staghorn calculi

Front 16

What are the causes of Oxalate crystals?

Back 16

1) Ethylene glycol (antifreeze)
2) Vitamin C abuse
3) Chron's Dz?

Front 17

What cofactor is used in the first step of heme synthesis?

Back 17

B6 (as pyridoxal phosphate) catalyzes d-ALA Synthase to combine Glycine and Succinyl CoA into ALA

Front 18

What is basophilic stippling and what is its cause?

Back 18

Aggregation of ribosomes in erythrocytes d/t Lead poisoning
Lead inhibits rRNA degradation (that leads to this) - Heme production has been increased too, so there are nlots of ribosomes

Front 19

What is cilostazol and what is it used for?

Back 19

PDE 3 inhibitor used for intermittent claudication
(↑cAMP in platelets inhibits aggregation; plus it's a vasodilator)
other e.g. is Dipyridamole

Front 20

What is Milrinone and what is it used for?

Back 20

PDE 3 inhibitor used for Cardiogenic Shock
(↑cAMP promotes intracellular calcium in cardiac myocytes → ↑inotropy)

Front 21

What is Sildenafil and what is it used for?

Back 21

Selective PDE 5 Inhibitor (cGMP specific)
inhibits breakdown of cGMP in the corpus cavernosum = Tx for ED

Front 22

What is Abciximab and what is it used for?

Back 22

Monoclonal Ab vs platelet GpIIb/IIIa proteins → prevents aggregation of activated platelets
used in Acute Coronary Syndrome

Front 23

Why is diphtheria specific to cardiac and neuronal cells?

Back 23

The diphtheria toxin of Corynebacterium diphtheriae has 2 parts (AB):
- B = Binding - binds to the heparin-binding epidermal growth factor receptor (found on cardiac and neural cells)
- A = Active - cataylzes ADP-ribosylation of EF-2 (needed for tRNA to insert new AA's) - halting protein synthesis

Front 24

What risk factors are shared and different b/w thoracic aortic aneurysm and aortic dissection?

Back 24

Same (2):
- HTN (#1)
- Cystic Medial Necrosis (Marfan's)
Thoracic only = Syphillis (3º) leading to vasa vasorum endoarteritis → weakening adventitia → inflammation & ischemia

Front 25

What liver condition gives you microvesicular fatty change? How about micronodular appearance?

Back 25

1) Reye's - children d/t ASA use (only allowed if they have Kawasaki's medium vessel vasculitis)
2) Alcoholic cirrhosis has micronodular, shrunken "hobnail" appearance; central vein sclerosis (zone III)

Front 26

What is the chloride shift?

Back 26

Cl- shifting into and out of RBC's:
Cl- shifted OUT in arterial blood
Cl- shifted IN in venous blood
(happens d/t movement of HCO3- in opposite direction)

Front 27

What are the signs of methotrexate SE? How can they be prevented?

Back 27

1) Pancytopenia (BM is rapidly dividing)
2) Aphthous (painful mouth) ulcers
Prevented w/ Folinic Acid (Leucovorin) - doesn't need DHFR to activate (like Folic acid does)

Front 28

What is Folinic Acid?

Back 28

THF derivative - used in MTX toxicity (replaces THF that's depleted d/t MTX DHFR inhibition)

Front 29

What is the rescue for 5 fluorouracil toxicity?

Back 29

Thymidine (leucovorin/folinic acid won't work)

Front 30

How can you inhibit uptake of Iodine by the thyroid gland?

Back 30

Using something that competes for the NIS (sodium iodine symporter) which includes:
- perchlorate
- pertechnetate
You could give Potassium Perchlorate for e.g.

Front 31

What are flushed skin and pupillary dilation commonly found with?

Back 31

Muscarinic blockade

Front 32

What is Homan's sign? How would you treat the disorder?

Back 32

Dorsiflexion of foot causing a tender calf muscle = sign of DVT
Tx:
- Acute = Heparin (rapid onset) → activates Antithrombin III
- Long term Tx = Warfarin (longer onset) → inhibits vit-K-dependent glutamic acid carboxylation of clotting factors II, VII, IX, X

Front 33

What are the causes of mono-like symptoms?

Back 33

1) EBV (HHV4) = 90%
2) CMV (HHV5) - most common monospot (heterophile) negative
3) HHV6 (Rubeola)
4) Toxoplasmosis

Front 34

Where is the primary site of K+ regulation in nephron? What factors increase K+ secretion in urine?

Back 34

1) Cortical Collecting Duct (intercalated cells = H+/K+ ATPase)
2) Factors increasing K+ loss in urine:
- ↑K+ consumption (diet)
- Aldosterone (Na+ retention)
- Alkalosis (H+ preservation)
- Diuretics (Loop, Thiazide) → increased flow rate; dilute fluid

Front 35

What is kernicterus?

Back 35

Bilirubin deposition in the brain (bilirubin encephalopathy)
d/t Crigler-Najjar syndrome Type 1 = AR absence of UDP-glycuronyl transferase (↑ unconjugated bilirubin)

Front 36

What are the hereditary diseases causing hyperbilirubinemia?

Back 36

1) Gilbert's = Mildly ↓ Uptake or Conjugation (↑ bilirubin w/ fasting/stress)
2) Crigler-Najjer = No Conjugation (absent UDP-glycuronyl transferase)
3) Dubin-Johnson = No Excretion (of conjugated) → black liver
4) Rotor's = Less Excretion (milder form of Dubin-Johnson)

Front 37

How does Anorexia cause amenorrhea?

Back 37

Low body fat causes the hypothalamus to stop pulsatile GnRH release - stops LH and FSH secretion from the anterior pituitary → low circulating E2

Front 38

What is the mutation and mechanism underlying hereditary hemochromatosis?

Back 38

HEF mutation - Protein on basolateral surface of intestinal epithelia that regulates endocytosis of Fe by transferrin - w/o it, there is too much absorption!!

Front 39

What regulates bone turnover?

Back 39

The balance of RANK-L and OPG (Osteoprotegrin)
(↑RANK-L → ↑ bone turnover)

Front 40

Which statin is not metabolized by the liver?

Back 40

Pravastatin

Front 41

What is the tuberoinfundibular pathway?

Back 41

The pathway from Hypothalamus to Pituitary (anterior)
This is how DA is secreted to inhibit PRL release

Front 42

What is Doxazosin? What can it treat?

Back 42

Selective α-1 Inhibitor; tx = HTN & BPH urinary retention

Front 43

What is a Call-Exner body?

Back 43

Sign of Granulosa Cell Tumor (E2 secreting Ovarian tumor)
(small follicles that are filled w/ eosinophilic secretions)

Front 44

What is the preferred tx for a round yeast on KOH that has a single broad based bud?

Back 44

Dx = Blastomycosis
Tx = Itraconazole

Front 45

Which hormones use a Gs Receptor?

Back 45

Glucagon
TSH
PTH
ß-adrenergics (both 1 and 2)

Front 46

Which cancer is a/w ACTH and/or ADH secretion? Which with PTHrP?

Back 46

1) Small Cell Carcinoma of lung (ACTH/ADH)
2) Squamous Cell Carcinoma of lung (PTHrP)

Front 47

Which fungus forms "germ tubes" @ 37 degrees?

Back 47

Candida albicans
most common opportunistic mycosis
lives in the oral cavity, skin, vagina, and intestine

Front 48

What is Trazodone?

Back 48

Atypical antidepressant used to tx insomnia (takes high doses for antidepressant effects)
SE's include priapism so it's contraindicated in teenage boys

Front 49

What is the sympathetic output to the adrenals?

Back 49

ACh is released; stimulates NACh Receptors
NOTE: preganglionic fibers (no ganglion)

Front 50

Which skin disorder of the elderly looks "pasted on"?

Back 50

Seborrheic Keratosis
tan→brown, round, flat, greasy, coin-like lesion w/ "stuck on" appearance

Front 51

What does fixed splitting of S2 that doesn't change w/ respiration mean?

Back 51

ASD

Front 52

What does a systolic ejection murmur accentuated by standing represent?

Back 52

Hypertrophic Obstructive Cardiomyopathy

Front 53

What does an early diastolic decrescendo murmur that decreases w/ amyl nitrite mean?

Back 53

Aortic Regurge

Front 54

What does a late diastolic murmur that's elminated by AFib signify?

Back 54

Mitral (and/or Tricuspid) Stenosis

Front 55

What is the result of shaken baby syndrome?

Back 55

Subdural hematoma and bilateral retinal hemorrhages
d/t rupture of the bridging veins (hematoma) and retinal veins (retina)

Front 56

What dz is a/w endoneural inflammatory infiltrate?

Back 56

Guillain-Barre syndrome - cross reacting Ab's to Campylobacter jejuni attack myelin in peripheral nerves
Infiltrate consist of lymphocytes and macrophages

Front 57

What is a glomus tumor?

Back 57

Benign, painful red-blue tumor under the nail;
Glomus body is smooth muscle cells that shunt blood to/away from surface depending on temperature

Front 58

Of what aortic arch does is the ductus arteriosus a remnant?

Back 58

6th Aortic Arch
Closes d/t PGE stopping (can be forced to close w/ indomethacin)

Front 59

In skeletal muscle, what does Ca2+ bind to/do? ATP?

Back 59

Ca2+: binds troponin C → conformational change → Tropomyosin moves to allow cross-bridging b/w actin and myosin head
ATP: Binding the contracted myosin head releases it from the actin filament (w/o ATP, get "rigor mortis")

Front 60

What is Raloxifene?

Back 60

SERM:
- Bone - decreases net bone resorption (slows osteoporosis)
- Breast/Uterus - E-R Antagonist (prevent and tx cancer)