Uw 06-01-12

Front 1

What are the segmented viruses? What type of genetic info exchange can they participate in?

Back 1

All RNA = BOAR
- Bunya
- Orthomyxo (flu)
- Arena
- Reo
undergo reassortment (exchange whole segments)

Front 2

What is the nitroblue tetrazolium test for?

Back 2

NAPDH-Oxidase deficiency = Chronic Granulomatous Dz (XLR)

Front 3

What do hydrocephalus, intracranial calcifications, and chorioretinits in an infant represent?

Back 3

Congenital Toxoplasmosis (mother handled cats)
Transmission is transplacentally in the first 6 months of development

Front 4

What are the physical signs specific for Dermatomyositis?

Back 4

Gottron's papules (on bony prominences: MCP/PIP/DIP)
Heliotrope rash (upper eyelids, periorbital skin)

Anti-Jo-1 Ab's in both DMyo and PolyMyo

Front 5

What causes hemorrhagic disease of the newborn?

Back 5

Vitamin K deficiency
- adults get from plants (Phylloquinone) and gut bacteria (Menaquinone)

Front 6

What causes cerebral vasodilation in a COPD patient?

Back 6

pCO2 high (hypercapnia) = most potent cerebral vasodilator

Front 7

When is Rifampin monotherapy used?

Back 7

Prophylaxis of exposure to N. meningitidis (meningococcus) and H. influenzae

Front 8

What is Vitamin B5?

Back 8

Pantothenic Acid = CoA

Front 9

What causes a patient to develop flushing, diaphoresis, and nausea accompanied by low BP and HR?

Back 9

Cholinergic agonists (e.g. Bethanechol) used to treat postoperative ileus / bladder atonia;

Front 10

What condition is extramedullary hematopoeisis a/w?

Back 10

Chronic severe hemolytic anemias like ß-Thalassemia

Front 11

What causes chipmunk facies?

Back 11

Marrow expansion d/t ß-thalassemia major

Front 12

What is Gower's maneuver?

Back 12

Using one's hands to raise from a squat/seat - seen in proximial muscle weakness (e.g. Duchenne's Muscular Dystrophy)
DMD d/t XLR deletion of Dystrophin gene

Front 13

What organisms use IgA proteases to evade mucosal protective mechanisms and invade?

Back 13

Neisseria sp.
(Gonococcus in genital region; Meningococcus in nasopharynx)

Front 14

What is the Dx of a kid that has vesicular blistering eruptions that eventually form a golden yellow crust?

Back 14

Impetigo - usually Staph aureus or GAS (pyogenes)
if GAS, can lead to PSGN (Rheumatic fever only in throat infx)

Front 15

What autoimmune illness classically follows a chlamydia infection?

Back 15

Reiter/Reactive Arthritis → Urethritis, Uveitis/Conjunctivitis, and Arthritis (large joints)

Front 16

What histological change in the adrenals occurs in Cushing's syndrome?

Back 16

HyperPLASIA of the Fasciculata (actually more cells) leading to increased Cortisol secretion

Front 17

What is the S-100 tumor marker a/w?

Back 17

1) Schwannomas (Sh-One-oma)
2) Melanoma

Schwann cells and melanocytes both from Neural Crest origin

Front 18

What are the Adult Primary Brain Tumors (in order of most to least common)

Back 18

1) Glioblastoma Multiforme (Butterfly glioma; pseudopalisading)
2) Meningioma (Psammoma)
3) Schwannoma (S-100)
4) Oligodendroglioma (Fried Egg)
5) Pituitary Adenoma (PRL usually; Rathke's pouch, Bitemporal hemianopsia)

Front 19

Which esophageal cancer is a/w smoking and drinking? Which one w/ heartburn?

Back 19

1) Squamous Cell Carcinoma (African Americans and Asians)
2) Adenocarcinoma (Barrett's Esophagus; GERD)

Front 20

What are the types of Xanthomas and their associations?

Back 20

1) Eruptive = ↑Chol/TG
2) Tuberous/Tendinous
3) Plane = PBC
4) Xanthelasma = eyelids/periorbial; 50% no lipid abnormalities (and no inflammation)

Front 21

Which lung cancers are a/w with syndromes?

Back 21

Small cell = Cushing (ACTH), SIADH (ADH), Lambert-Eaton
Squamous Cell = Hypercalcemia (PTH)

Front 22

Which lung cancer is a/w gynecomastia & galactorrhea?

Back 22

Large Cell Carcinoma of the Lung

Front 23

What the hell is cor pulmonale?????

Back 23

RVH (w/ or w/o CHF) d/t pulmonary hypertension
- COPD is most common (obliterating the pulmonary vasculature)
- Idiopathic (women 20-40

Front 24

What is polyglutamation?

Back 24

It is a biochemical mechanism that prevents Folic Acid and DHF from leaving the cell, essentially storing for later; The same occurs to MTX, as it is a folic acid analog

Front 25

What would cause sudden onset abdominal /flank pain, gross hematuria, and a varicocele?

Back 25

Renal vein thrombosis d/t Nephrotic syndrome (probably Membranous = #1 most common cause)
Loss of AT-III in the urine leads to a hypercoagulable state and the formation of a thrombus int he renal vein blocks drainage from the L testicle → varicocele

Front 26

What are the symptoms of a Pheochromocytoma?

Back 26

Episodic:
- ↑ BP
- Flushing
- Diaphoresis
- Headaches

Front 27

What disorders are a/w an "M Peak" on serum protein electrophoresis (SPEP)?

Back 27

1) Multiple Myeloma
2) Waldenstrom macroglobulinemia
3) some lymphomas

Front 28

Why would a woman w/ SLE be more @ risk to have recurrent miscarriages?

Back 28

If she is 10-30% of SLE pts that have lupus anticoagulant (APLA Syndrome)

Front 29

What muscle is affected by severing the long thoracic nerve?

Back 29

Serratus anterior → Winged scapula

Front 30

What mediates the vascular reaction to endothelial injury (intimal hyperplasia and fibrosis)??

Back 30

Smooth muscle cells that migrate from the media to the intima (activated by growth factors like PDGF)

Front 31

What conditions predispose to Uric acid kidney stones and in what part of the nephron do they form?

Back 31

U-ric acid:
1) goUt
2) leUkemia
3) tUmor lysis syndrome
Most acidic parts of the nephron = Distal tubules and Collecting ducts

Front 32

What renal measurement can be calculated using the PAH clearance?

Back 32

The Renal Plasma Flow (RPF)
CL(PAH) = ([PAH]urine x urine flow rate)/[PAH]plasma

Front 33

Which amino acids have 3 titratable protons?

Back 33

CHArLy got Tyr-ed and thrown in Acid
Cystine
Histidine
Arginine
Lysine
Tyrosine
Glutamic Acid
Aspartic Acid

Front 34

How do you differentiate a leukamoid reaction w/ a leukemia?

Back 34

Leukamoid has HIGH leukocyte Alkaline Phosphatase

Front 35

What is Imatinib?

Back 35

It's a RTK inhibitor specific for the bcr-abl one in CML (Philadelphia chromosome)

Front 36

What lab value do you need to follow if someone's on Metformin? What groups are contraindicated from using it?

Back 36

Want serum Cr to check renal function b/c of increased risk of lactic acidosis.
Contraindicated in patients w/ Renal failure as well as:
- Liver dysfunctino (alcoholics included)
- CHF
- Sepsis

Front 37

What lab value do you need to follow if someone's using Amiodarone? What are side effects?

Back 37

Class III - KV blocker = Check TFT's, LFT's, and PFT's:
- Thyroid (hypothyroidism; is 40% Iodine by weight)
- Hepatitis (drug related)
- Pulmonary fibrosis
- Skin = blue-grey discoloration
- Eyes = corneal micro deposits

Front 38

What combo of drugs for hyperlipidemia increases risk of myopathy? Gallstones?

Back 38

Myopathy = Fibrates + Statins
Gallstones = Fibrates + Bile acid-binders (cholestyramine)

Front 39

What causes secondary polycythemia?

Back 39

Anything that causes the kidneys to experience chronic hypoxia: (& peritubular cells of cortex release EPO)
- OSA
- COPD
- Right to Left shunts (the T's)
- High altitude

Front 40

What are the side effects of thiazide diuretics?

Back 40

Hypers: Glycemia, Lipidemia, Uricemia, Calcemia
Hypos: K+, H+ (MAlk), BP (that's the goal)
Allx: Sulfa

Front 41

What are the Polyenes, what is their MOA and what do they Tx?

Back 41

Amphotericin B and Nystatin - bind Ergosterol in fungal membrane
- AmphoB = Systemic
- Immunocompromised = Candida, Aspergillus, Crypto
- Immunocompetent = Histo, Blasto, Coccidio
- Nystatin = Oral/Topical (too toxic)
- "Swish and Swallos" for oral candidiasis
- TOP for vaginal/diaper candidiasis

Front 42

What is the e.g. of a pyrimidine antifungal?

Back 42

Flucytosine - inhibits DNA synthesis by conversion to 5-FU
used in Cryptococcal Meningitis in AIDS (along w/ Ampho-B)

Front 43

What are the Echinocandins and what do they tx?

Back 43

Inhibit fungal cell wall synthesis (ß-Glucan) = e.g. Caspofungin
- CASPofungin = CAndida and ASPergillosis

Front 44

What is Griseofulvin?

Back 44

Antifungal that disrupts MT's (mitosis) - PO but deposits in keratin containing tissues (hair and nails) to tx fungi there

Front 45

What is Terbinafine?

Back 45

Fungal Squaline Epoxidase inhibitor (so can't make lanosterol which becomes ergosterol)
Accumulates in skin and nails so used for dermatophytes and onchomycoses

Front 46

What drug causes hemorrhagic cystitis?

Back 46

Cyclophosphamide (and other Nitrogen-mustard based chemo agents)
prevented w/ Mesna (2-MercaptoEthaneSulfoNAte)

Front 47

What causes increased HbA2?

Back 47

ß-thalassemia minor or intermedia (more α than ß leads to A2 = 2α's)

Front 48

What is Jervell & Lange-Nielsen syndrome?

Back 48

It's a congenital long QT syndrome that presents w/ sensorineural deafness.

Other congenital long QT = Romano Ward (but doesn't have the deafness)

Front 49

What are the rules of 10 for Pheochromocytoma?

Back 49

10% hereditary (MEN2 A & B, vHL)
10% bilateral
10% extra-adrenal
10% malignant (90% benign)

Front 50

What is Mallory-Weiss syndrome?

Back 50

Hematemesis from longitudinal mucosal tears (from rapidly increasing intraabdominal pressure d/t repeated vomiting).
Seen in bulemia and alcoholics
10% of upper GI hemorrhages

Front 51

What is Libman-Sacks Endocarditis?

Back 51

SLE induced verrucous endocarditis (25% of SLE pts); sterile valvular vegetations d/t immune complex deoposition
Coupled w/ antiphospholipid (lupus "anti"coagulant) making it a hypercoagulable state, @ risk of coronary artery embolism → MI in someone w/o atherosclerosis

Front 52

How would you Dx Prinzmetal's Angina?

Back 52

Using Ergonavine stimulation (α and 5HT cause vasoconstrictor)
= transient anginal chest pain occuring during night

Front 53

What drug interferes with cholesterol turning into bile acids? What enzyme is affected?

Back 53

Enzyme = 7α-Hydroxylase
Drug = Fibrates (gemfibrozil) - one of the 2 ways they increase gallstones

Front 54

What causes abnormal bleeding in patients w/ uremia?

Back 54

Patients w/ ESRF (Uremia) are unable to clear platelet-inhibitory factors, so while the clotting factors (PT, aPTT) are fine, and the platelet COUNT is fine, they are not working properly so only the BT is elevated.

Front 55

What is the cause of vertical diplopia?

Back 55

CN IV - Trochlear nerve palsy

Front 56

What's the most common cause of bacterial meningitis in adults?

Back 56

Streptococcus pneumoniae
"Lancet-shaped Gram Positive cocci in pairs"

Front 57

What is Lesch-Nyhan syndrome?

Back 57

XLR deficiency of HGPRT (hypoxanthine-guanine phophoribosyltransferase) - part of the "Purine salvage" that brings hypoxanthine and guanine back up to IMP and GMP
w/o it, you have increased uric acid excretion, and purine synthesis has to rev up to make up for lost purines

Front 58

What is the method for vancomycin resistance in Enterococci?

Back 58

VRE change the D-alanine to D-lactate in their peptidoglycan cell wall precursors so Vancomycin can't bind

Front 59

Which GI adenoma can have cauliflower-like projections?

Back 59

Villous adenomas; these are larger, sessile, and more severely dysplastic than tubular adenomas

Front 60

What is Quetiapine?

Back 60

It's an atypical (2nd generation) antipsychotic
good for tx of schizophrenia b/c affects BOTH positive AND negative symptoms

Front 61

What do keratin pearls on an esophageal Bx mean?

Back 61

Squamous Cell Carcinoma of the esophagus
RF's = Smoking and Drinking
Keratin pearls indicate well-differentiated tumor

Front 62

What are NON-trisomy causes of Down Syndrome?

Back 62

Unbalanced Robertsonian Translocation (2-3%) - extra arm of 21
Mosaicism = Patient has 2 cell lines (one w/ normal, one trisomy)

Front 63

How does biliary obstruction lead to Nyctalopia?

Back 63

Night blindness d/t Vitamin A deficiency (seen along w/ dry skin)
Biliary obstruction causes malabsorption (of fat soluble vitamins A, D, E, K)