Uw 06-02-12

Front 1

How do enterococci develop resistance to Gentamycin?

Back 1

Aminoglycoside resistance = Enzymes that modify them by transferring chemical groups (acetyl, adenyl, and PO4) so they can't bind ribosomes

Front 2

what types of intracellular connection is responsible for BBB?

Back 2

Tight junctions

Front 3

What is demeclocycline?

Back 3

It's a tetracycline that is an ADH antagonist; useful to Tx SIADH (along w/ water restriction)
Can also be the CAUSE of nephrogenic DI (antagonizes ADH @ the CD so can't concentrate the urine)

Front 4

What is the short term and long term tx for atopic asthma?

Back 4

1) Short term = M3 blocker (inhaled Ipratropium)
2) Long term = LTD4 R blocker (zafirlukast and montelukast)

Front 5

What are the atypical pneumonias?

Back 5

CML
Chlamydia
Mycoplasma
Legionella

Front 6

What pnemonia has an xray finding of unilobar infiltrate & is a/w GI symptoms? What lab abnormalities would you find?

Back 6

Legionella Pneumophila
Hyponatremia
Tx = Erythromycin

Front 7

What disease causes a grey pharyngeal exudate in kids???

Back 7

Diphtheria (corynebacteria diphtheriae)

Front 8

What bacteria are grown on Thayer-Martin medium?

Back 8

VCN medium for Neisseria spp

Front 9

What bacteria are grown on Cysteine-tellurite agar?

Back 9

Diphtheria (corynebacteria diphtheriae)

Front 10

What bacteria are grown on Bordet-Gengou medium?

Back 10

BORDETella pertussis = whooping cough

Front 11

What is the prophylaxis for the mycobacteria?

Back 11

TB = INH
MAC = Azythromycin
Leprae - n/a

Front 12

What is the treatment for Mycobacterium avium complex?

Back 12

Azythromycin, Rifampin, Ethambutol, Streptomycin (ARES for AVES)

Front 13

Which type of rapidly progressive glomerulonephritis doesn't have deposits on immunofluorescense?

Back 13

Wegener's (Type III - Pauci-immune)
a/w crescenting glomerulonephritis, c-ANCA and hemoptisis
(other RPGN's are Goodpastures [anti-GBM] and Immune-complex mediated)

Front 14

What is Phytanic acid and how is it pathological?

Back 14

It's a BCAA from Chlorophyll - accumulates in Refsum Dz (peroxisome dz so can't perform α-oxidation to break down Phytanic acid)
Leads to neurological disturbances

Front 15

What is Zellweger syndrome?

Back 15

Peroxisomal disorder (in the ß-oxidation of VLCFA's)
Infants can't properly from myelin in CNS leading to:
- Hypotonia
- Seizures
- MR
- Hepatomegaly
- Early death

Front 16

How is cortisol involved in catecholamine synthesis?

Back 16

Upregulates the activity of PNMT (Phenylethanolamine-N-methyltransferase) in the adrenal medulla that converts NE → Epi

Front 17

What are the sources of Nitrogen atoms in Urea? What is the RLE of Urea cycle? What activates the enzyme?

Back 17

1) N from NH3 and Aspartate
2) RLE = CPS 1 (carbamoyl phosphate synthetase I in mitochondria)
3) NAG (N-Acetylglutamate) stimulates it

Front 18

What is Urea and where does it get its components?

Back 18

Urea is NH2-(C=O)-NH2
The C=O is from CO2 and one of the NH2's is from NH4 (combined in the RLS into carbamoyl phosphate)
The other NH2 is from Aspartate

Front 19

What is Mifepristone?

Back 19

RU-486 is a progesterone receptor antagonist (stronger than real progestins so it helps w/ abortion)

Front 20

What is Misoprostol?

Back 20

An abortifacient that's a PG analog - stimulates uterine contraction and cervical dilation
Used in conjunction w/ Mifepristone

Front 21

What psych meds affect chloride channels?

Back 21

BEnzo's = Cl- FrEquEncy (shorter t1/2)
BArb's = Cl- DurAtion (longer t1/2) - not for insomniA

Front 22

What drugs are a/w increased uric acid (and therefore gouty attacks)?

Back 22

- Niacin (for dyslipidemia)
- Diuretics = Furosemide & Hydrochlorothiazide
- Cyclosporine (immune suppresent)
- Pyrazinamide (anti-TB)

Front 23

What does TIBC indicate and what causes it to increase?

Back 23

TIBC = total iron binding capacity, an indirect measure of Transferrin (the transport protein of iron in the blood)
Increased in both Iron-Deficiency and Pregnancy/OCP use d/t increased production by the liver (in FeD, b/c it's trying to increase the chance of saturation; in OCP/Preg it's d/t Estrogen increasing hepatic protein productino all around)

Front 24

What are the characteristics of aplastic anemia?

Back 24

Triad:
1) Anemia = Low Hb
2) Thrombocytopenia
3) BM w/o hematopoietic cells
in person w/ normal renal fx, will have ↑EPO

Front 25

What condition a/w chest pain that radiates to back accompanies lower BP in right arm than left?

Back 25

Dissecting Aortic Aneurysm
The hematoma will expand and compress the proximal brachiocephalic trunk that feeds to the right extremity, reducing it's BP)

Front 26

What is a Charcot-Bouchard pseudoaneurysm?

Back 26

Small (1mm) pseudo-aneurysms that form in the small arteries that perfuse the basal ganglia & internal capsule d/t HTN induced hyaline arteriosclerosis; Can hemorrhage and cause sudden onset focal deficits (vs ischemic strokes that usually evolve over hours)

Front 27

What is Kussmaul's sign?

Back 27

Paradoxical INCREASE in JVD during inspiration (should decrease)
d/t Constrictive Pericarditis (most commonly d/t TB or SLE)

Front 28

What causes a late systolic crescendo murmur w/ a midsystolic "click"?

Back 28

Mitral valve prolapse (MVP)
most frequent

Front 29

What cancer is a/w Arsenic and Vinyl chloride exposure and how do you ID it?

Back 29

hepatic Angiosarcoma = highly lethal
has CD31 = PECAM1 (on endothelia that allows diapedesis)

Front 30

What are the 2 non-selective α-blockers and what differentiates them?

Back 30

1) Phentolamine = reversible/competitive (used for PHeo, MAOI crisis, cocaine OD)
2) Phenoxybenzamine = irreversible (used for Pheo)

Front 31

What is the preferred Tx for combo Absent and Tonic-Clonic Seizures?

Back 31

Valproate

Front 32

What is GIlbert's Dz?

Back 32

Problem w/ bilirubin conjugation and uptake by the liver - leads to mild jaundice and hyperbilirubinemia (unconjugated) in times of stress

Front 33

What is pulsus paradoxus & what causes it?

Back 33

Drop in Systolic BP >10mmHg during inspiration d/t
- Heart = severe tamponade, pericarditis
- Respiratory (obstructive) = Asthma, OSA, Croup

Front 34

In determining the FF, what measurements can you substitute?

Back 34

Clearances
GFR = CL of either INULIN (exact) or Cr (overestimate)
RPF = PAH
the clearances are the [urine]x(urine flow) divided by [plasma]

Front 35

What gram negatives are oxidase positive?

Back 35

1) the Comma Shaped Rods:
- Vibrio Cholera = Alkaline media
- Campylobacter jejuni = 42 degrees (HOT)
2) Pseudomonas = Non-Lactose Fermenting Rod

Front 36

How do Galactose, Fructose, and Mannose enter glycolysis?

Back 36

1) Galactose - phosphorylated→ Ga1P then mutased to G1P→G6P
2) Mannose - phosphorylated → M6P → F6P
3) Fructose bypasses the RLS of Phosphfructokinase 1 (PFK1) by going from F → F1P and then by Aldolase B → Glyceraldehyde and finally Triokinase → G3P

Front 37

What is Lymphogranuloma venerium?

Back 37

It's a dz caused by the L1-L3 serotypes of Chlamydia trachomatis
1) small papule emerges on genital mucosa
2) Inguinal lymph nodes become swollen, painful → coalesce, ulcerate, and rupture

Front 38

What is HbF made from?

Back 38

α2y2 (gamma chains can be stimulated by hydroxyurea so more HbF is made)

Front 39

What drug for PSVT has the side effects of flushing, chest burning and SOB?

Back 39

Adenosine - drug of choice (t1/2 of <10 seconds)
(chest burning and SOB are d/t bronchospasm; also causes hypotension and high grade AV block)

Front 40

What drugs can be ototoxic?

Back 40

AminoglYCosides (gentamycin)
CIsplatinum
saliCYlates
Loops = Furosemide e.g.

Front 41

What is Thiopental?

Back 41

IV anesthetic - Short acting Barbiturate (affects GABA-Cl durAtion)
- used for induction d/t its rapid action (1 min equilibration w/ brain tissue; 5-10 min rapidly REdistributed to muscle/fat)

Front 42

What is first line tx for trigeminal neuralgia?

Back 42

Carbamazepine
also FLT for all the types of partial seizures (simple, complex, tonic-clonic)
Stops rapid firing of neuron by lengthening the inactivation of Na channels

Front 43

What is fenfluramine?

Back 43

It's an appetite suppressant (fenfluramine, dexfenfluramine, and phentermine) that if used for more than 3 months can lead to secondary pulmonary hypertension

Front 44

What causes hyaline membranes in the alveoli of an adult?

Back 44

This is ARDS - diffuse alveolar damage leads to increased capillary permeability and protein-rich leakage into the alveoli
e.g. Pancreatitis releasing lipases and amylases into the vasculature

Front 45

What forms the GTP needed to phophorylate Oxaloacetate to PEP in gluconeogenesis?

Back 45

In the TCA cycle, SuccinylCoa → Succinate generates GTP
(enzyme = succinyl-Coa synthase / succinate thiokinase)

Front 46

What kidney problem shows as diffuse increased thickness of GBM w/o cellularity increase, "spike and dome" appearance on silver stain, and has granular deposits on IF?

Back 46

Membranous Glomerulopathy

Front 47

What enzymes does lead poisoning affect?

Back 47

1) ALA Dehydratase
2) Ferrochelatase
LEAD = ferroche-L-atas-E, A-la D-ehydratase

Front 48

What causes Isolated systolic hypertension?

Back 48

Decreased compliance (increased stiffness) of the aorta and its proximal branches

Front 49

Male w/ delayed puberty and anosmia?

Back 49

Kallmann's syndrome = failure of GnRH neurons to migrate from outside CNS to hypothalamus (d/t KAL-1 or FGF-1)

Front 50

What infection is a/w myocarditis?

Back 50

Cocksackie B

Front 51

What are the Class 1A Antiarrhythmics?

Back 51

Double Quarter Pounder (Intermediate, prolonged AP)
-Disopyramide
-Quinidine
- Procainamide

Front 52

What are the Class 1B Antiarrhythmics?

Back 52

Lettuce, Tomato, Mayo (Weak, shortened AP)
-Lidocaine
-Tocainide
-Mexiletine

Front 53

What are the Class 1C Antiarrhythmics?

Back 53

MOre Fires Please (Strong, no change to AP)
-Moricizine
-Flecainide
-Propafenone

Front 54

What is "Holiday Heart Syndrome"?

Back 54

AFib precipitated by binge drinking

Front 55

What do an absence of P waves on EKG signify?

Back 55

AFib d/t loss of coordinated atrial contraction

Front 56

What is triamterene?

Back 56

K+ Sparing diuretic - blocks Na channels in DT and CD

Front 57

Which diuretic has been shown to decrease mortality in heart failure patients?

Back 57

Spironolactone (Aldosterone antagonists) - prevents neurohormonal effects of aldosterone on the heart (remodeling and fibrosis)

Front 58

A lesion of what nerve causes Trendelenburg sign?

Back 58

Superior Gluteal (innfervates gluteus medius and minimus) and causes "gluteus medius limp"

Front 59

How can you tell the difference b/w a benign or malignant carcinoid tumor?

Back 59

Benign won't have clinical symptoms b/c excess seratonin, bradykinin, and PG's are metabolized by liver.
Mets to the liver will result in the classic symptoms

Front 60

What is Berkson's Bias?

Back 60

Selection bias created by selecting hospitalized patients as your control.

Front 61

What kind of mole is triploid?

Back 61

PARTIAL mole (complete are diploid)

Front 62

What kind of irregular RBC's are a/w DIC on PB smear?

Back 62

Schistocytes d/t damage squeezing through the microemboli in small vessels

Front 63

What are Acanthocytes?

Back 63

RBC's w/ irregularly spaced surface projections - extreme ones are called Spur cells and a/w abetalipoproteinemia

Front 64

What are Teardrop cells?

Back 64

RBC's a/w myelofigbrosis; they must squeeze out of the fibrous marrow which gives them characteristic teardrop shape

Front 65

What are the layers of the testicle?

Back 65

From outside in:
- external spermatic fascia (from external oblique fascia)
- cremasteric spermatic fascia (from internal oblique fascia)
- internal spermatic fascia (from transversalis fascia)
- tunica vaginalis (from peritoneum) --> is the location of hydrocele formation

Front 66

What are the types of RNA polymerase in eukaryotes?

Back 66

RNA polymerase I = rRNA (nucleolus)
RNA polymerase II = mRNA
RNA polymerase III = tRNA, snRNP, and 5C rRNA
I and III are constitutively active, while II is under regulatory control