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100 Cards in this Set
- Front
- Back
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Stimuli for glycogenolysis in muscle tissue |
Both cAMP and Ca2+ stimulate phosphorylase kinase, which activates glycogen phosphorylase to increase glycogenolysis |
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what does vasopressin do? |
produces a V2 receptor-mediated increase in permeability to water and urea |
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This is a picture of infarcted brain tissue. What type of cell does the arrow point to? |
microglia: they move into the area 3-5 days following infarction and stain darkly on lipid stain due to the abundance of lipids in their cytoplasm from myelin breakdown products |
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can beta blockers influence K+ levels? |
Yes, non-selective beta blockers interfere with beta-2-mediated intracellular K+ intake |
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where do anal fissures most often occur? |
distal to the dentate line most often on posterior midline |
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what causes the "on-off" phenomenon in Parkinson's pts being treated with levodopa? |
These unpredictable fluctuations in motor fxn are seen with long-term tx; its is thought to be due to nigrostriatal degeneration leading to a decreased therapeutic window for levodopa |
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what is the defect in acute intermittent porphyria? |
porphobilinogen deaminase |
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how do symptoms of porphyria differ based on where in the pathway the defect exists? |
deficiencies in early steps cause neurovisceral symptoms (acute porphyrias), while deficiencies later (uroporphrinogen decarboxylase) result in photosensitivity (cutaneous porphyries) |
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a roughly two-fold increase in creatinine suggests what kind of effect on GFR? |
50% reduction in GFR, meaning 75% of renal glomeruli have been affected |
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number needed to harm (NNH) |
1 / Attributable Risk (AR) where AR = (Adverse event rate in treatment group) - (Adverse event rate in placebo group) |
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which HTN drug can lead to increased potassium and creatinine? |
ACE inhibitors (the increase in creatinine reflects decreased renal pressure and decreased GFR) |
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the conversion of alpha-helices to beta-sheets involves what? |
breaking and reforming of hydrogen bonds; H bonds are the principle stabilizing force for the secondary structure of proteins |
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first choice drug for lowering triglycerides |
Fibrates (eg gemfibrozil) - they work by activating PPAR-alphas, which increase LPL activity *statins, niacin have a smaller effect on lowering TGs |
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who should you report an impaired physician to? |
physician health program |
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who should you report a physician to if sexual misconduct was involved? |
state medical board |
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how is potassium related to digoxin toxicity? |
Hypokalemia increases susceptibility to digoxin toxicity but the actual toxicity can result in hyperkalemia |
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how can a blood transfusion result in hypocalcemia? |
pts receiving more than one body blood volume (5-6 liters) of whole blood transfusions or packed RBCs can develop elevated plasma citrate, which chelates Ca2+ and Mg2+ |
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where is the murmur of aortic regurgitation best heard? |
left sternal border when the pt is leaning forward at the end of expiration |
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which pancreatic bud forms the small accessory pancreatic duct? the main duct? |
small accessory - dorsal pancreatic bud main duct - ventral pancreatic bud |
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what kind of proteins are nicotinic receptors? |
Ligand-gated ion channels; they open after binding Ach, resulting in an immediate influx of Na+ and Ca+ and outflux of K+ |
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what cellular feature is the last to disappear from respiratory epithelium as you move deeper into the lungs? |
cilia; they persist up to the end of the respiratory bronchioles *bronchioles lack goblet cells, cartilage, and glands |
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which two ions contribute most to the resting membrane potential of a cell? |
Na+ (some influx) and K+ (high efflux) |
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Lesch-Nyhan syndrome leads to an increased activity of which enzyme and why? |
phosphoribosyl pyrophosphate synthetase; HGPRT functions in purine salvage so without it, there is an increased demand for de novo purine synthesis - PRPP synthetase catalyzes the first step |
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positive selection of T cells |
Cells expressing a TCR able to bind to self MHC are allowed to survive; occurs in thymic cortex and involves interaction with thymic cortical epithelial cells expressing self MHC |
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negative selection of T cells |
Occurs after positive selection and is the process by which T cells possessing TCRs with high affinity to self Ag or MHC I or MHC II are eliminated via apoptosis; occurs in thymic medulla and involves interaction with thymic medullary epithelial and dendritic cells |
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what is the purpose of plating H. influenzae together with S. aureus? |
H. influenzae needs both X (hematin) and V (NAD+) factors for growth. S. aureus produces both of these factors (b/c it hemolyzes RBCs and that is where these factors come from) and thus when plated together there is a "satellite phenomenon" where H. influenza grows only near the Staph |
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what metabolic process is defective if there is a problem transporting ornithine from the cytosol to the mitochondria? |
urea cycle |
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which condition should be tested for in cases of unexplained elevated creatine kinase? |
hypothyroidism - myoedema can occur secondary to slow reabsorption of calcium by the SR; myocyte damage leads to leakage of CK |
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focal mounding of muscle following percussion |
myoedema |
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barr body |
inactive X chromosome condensed into heterochromatin composed of heavily methylated DNA in tight associated with deacetylated histones |
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what exactly is the role of calcineurin? |
it is an essential protein in the activation of IL-2 |
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how much of a coronary artery lumen must be obstructed to induce angina? |
at least 75% |
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which step in the HMS is defection in G6PD deficiency? |
conversion of G-6-P to 6-phosphogluconate |
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how can you measure the intensity of mitral stenosis on auscultation? |
A2-opening snap interval: As MS worsens, higher pressures cause the MV to open more forcefully and thus the A2-OS interval decreases as LAP increases |
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what is the current standard for dx and determination of MS severity? |
measurement of mean transvalvular pressure gradients via 2D doppler echo |
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what type of muscle fibers are myoglobin-rich, glycogen poor with many mitochondria? |
Type I (slow twitch): the fact that they are glycogen poor means that they don't derive much energy from anaerobic glycogenolysis and subsequent glycolysis as Type II fibers do |
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significant proteinuria + circulating IgG4 antiboies to phospholipase A2 receptors (found on podocyte foot processes) |
idiopathic membranous nephropathy |
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how should purulent urethritis be treated? |
treat for both gonorrhea (ceftriaxone or other 3rd gen ceph) and chlamydia (azithromycin or doxycycline) |
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how do penicillins/cephalosporins work? how does this differ from vancomycin |
By binding PBPs such as transpeptidases. Vancomycin binds to cell wall glycoproteins and prevents transpeptidases from forming cross-links |
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what is the cause of wrinkles with age? |
a decrease in collagen fibril production and elastic fibers |
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which part of the male urethra is most susceptible to injury in a pelvic fracture? |
posterior urethra, particularly the membranous segment which is relatively unsupported by the adjacent tissues and is the weakest point (bulbomembranous junction) |
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what gives elastin its ability to stretch and recoil? |
desmosine cross linking (by lysyl hydroxylase) between four different lysine residues on four different elastin chains |
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Which disorder results in constitutive tyrosine kinase activity and subsequent cytokine-independent activation of STAT transcription factors? |
myeloproliferative diseases (JAK2 TK mutation) |
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Which cells do LH and FSH act on in the male? What do those cells produce in response? |
LH acts on Leydig cells to produce T FSH acts on Sertoli cells to produce inhibin |
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behavioral disorder of childhood characterized by argumentative and defiant behavior toward authority figures |
oppositional defiant disorder (differs from conduct disorder in that it doesn't involve the violation of rights of others) |
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most common benign liver tumor |
cavernous hemangioma |
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flutamide mechanism |
nonsteroid anti-androgen that acts as a competitive inhibitor of testosterone receptors |
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tx for severe hypoglycemia with loss of consciousness in non-medical setting |
IM glucagon (in a medical setting IV glc would be used) |
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what kind of diverticulum is Meckel's? |
True - it consists of all parts of intestinal walls |
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benign disorder leading to cataracts without hepatic involvement? |
galactokinase deficiency; leads to increased production of galactitol by aldose reductase (contrast with galactose-1-phosphate uridyl transferase deficiency which causes the severe classic galactosemia) |
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which lipid lowering agents can actually increase TGs? |
bile acid resins (e.g. cholestyramine) |
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how do right and left sided colon cancers present differently? |
right sided: large, bulky, more likely to bleed left sided: smaller, encircle lumen, may lead to obstruction |
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What is the biologically active form of pantothenic acid; what does it do? |
coenzyme A; binds oxaloacetate in the first step of the TCA to form citrate; also involved in FA oxidation and synthesis |
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Gram (+) bacteria that has polar granules that stain deeply with aniline dyes |
C. diphtheriae |
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what can cause trisomy? |
Failure of homologous chromosomes to separate during meiosis I or failure of sister chromatids to separate during meiosis II |
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if a RFLP of a child with Down syndrome showed only two bands, what could you conclude about the mechanism of nondisjunction? |
that it occurred during meiosis II; the child inherited two of the same chromosomes from one parent instead of two different chromosomes from one parent (in which case they would have three bands and nondisjuction would have occurring during meiosis I) |
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which anti fungal drugs inhibit synthesis of the polysaccharide glucan, an essential component of the fungal cell wall? |
echinocandins (eg capsofungin and micafungin) |
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which anti fungals target the cell membrane and how? |
polyene (Amphotericin B): binds ergosterol -azoles: inhibits synthesis of ergosterol |
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calcified cystic brain tumor composed of thick fluid rich in cholesterol crystals |
craniopharyngioma |
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most common cause of coronary sinus dilation |
pulmonary HTN; anything that increases right atrial pressure may cause dilation of the coronary sinus since that is where it drains |
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What happens to C peptide once it is cleaved from insulin? |
It is packaged into secretory granules along with insulin and secreted in equimolar concentrations |
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What does the following describe: a region of a protein containing several alpha-helical regions composed of approx. 20 amino acid residues such as valine, alanine, isoleucine, methionine, and phenylalanine |
This describes the transmembrane region of a G-protein coupled membrane bound receptor. The named AAs are non polar and hydrophobic and thus must be located in a position away from water. |
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best method to determine whether a gene of interest is being expressed? |
analyze for the presence of its mRNA using a Northern blot |
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Chronic lithium toxicity can be precipitated by volume depletion and drug interactions with what? |
Thiazide diuretics, ACEi's, and NSAIDs Anything that decreases GFR can potentially result in toxicity due to the subsequent increase in reabsorption of Na+ and Li+ at the proximal tubule |
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if you inserted a needle at above the 10th rib at the mid-axillary line, what would you puncture? |
the liver |
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where should the needle be inserted for thoracocentesis when inserted at the mid-axillary, mid-clavicular, and paravertebral lines? |
mid-clavicular: above 7th mid-axillary: above 9th posterior scapular (paravertebral) line: above 11th |
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what is an example of dynamic left ventricular outflow obstruction? |
HCOM |
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what can cause an S3 heart sound? |
1. Forceful, rapid filling of a ventricle that has a normal or elevated compliance 2. Normal or even decreased filling rates when ventricular compliance is low 3. Blood flowing into an overfilled ventricle with high end-systolic volume |
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where does the pentose phosphate pathway occur? |
cytoplasm, thus the enzymes involved (i.e. transketolase) will reside here |
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what branches does the splenic artery give off? |
It's a main branch of the celiac trunk and it gives off the pancreatic, short gastric, and left gastroepiploic arteries |
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which cellular receptor does EBV bind? |
CD21 on the surface of B lymphocytes |
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How does antigen processing differ for MHC I and MHC II? |
For MHC II, material is taken up from the environment and degraded by acidification after endosome-lysosome fusion For MHC I, endogenous material (proteins) are degraded in the cytoplasm by proteasomes and delivered to the rough ER where they are loaded onto MHC |
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which acid base abnormalities occur with salicylate toxicity? |
1. Respiratory alkalosis (occurs first) 2. Anion gap metabolic acidosis (occurs after a few hours) |
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which anti-arrthymic drug is associated with lengthening the QT interval but has a lower risk of Torsades de pointe than other drugs that prolong the QT? |
amiodarone |
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which antimycobacterial agent inhibits carbohydrate polymerization, thereby preventing peptidoglycan cell wall synthesis? |
ethambutol |
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Which TB drug can cause optic neuritis resulting in decreased visual acuity, color blindness, and central scotoma? |
ethambutol |
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obstruction of which vein results in similar symptoms to SVC syndrome (face/arm swelling, engorged neck veins), but only on one side? |
brachiocephalic vein - it drains right subclavian (which drains external jugular) and internal jugular |
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the musculocutaneous nerve supplies skin sensation to which area? |
lateral forearm |
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What contributes to increased risk of gallstones in Crohn's pts? |
Decreased bile acid reabsorption and wasting promote supersaturation of bile with cholesterol, resulting in gallstone formation |
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side effects of amphotericin B |
hypokalemia and hypomagnesemia due to decreased GFR and damage to renal tubules |
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what are the skeletal findings in hyperparathyroidism? |
Most commonly involve cortical (compact) bone in the appendicular skeleton; appears as subperiosteal erosions in phalanges, a granular "salt and pepper" skull, and osteolytic cysts in the long bones (osteitis fibrosa cystica) |
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AIDS pts should be treated with which drug for a VZV infection and why? |
A nucleotide such as cidofovir, or foscarnet (pyrophosphate analog viral DNA polymerase inhibitor) since they do not require activation by herpes thymidine kinase; viral strains lacking this enzyme are seen in pts with AIDS |
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drugs for treating drug-induced parkinsonism |
anticholinergics (trihexyphenidyl, benztropine) or amantadine |
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What does a high AV concentration gradient reflect when administering anesthetics? |
High gradient means high tissue solubility (more is moving out into the tissues) which means the onset of action will be slower because more anesthetic will be required to saturate the blood and thus reach the brain |
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what is the underlying mechanism for zenker diverticulum formation? |
abnormal spasm or diminished relaxation of cricopharyngeal muscles during swallowing resulting in increased oropharyngeal intraluminal pressure and subsequent herniation of pharyngeal mucosa through a zone of weakness in the posterior hypopharynx (killian's triangle) |
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Fever and sore throat in a pt with hyperthyroidism treated with medical therapy should raise concern for __________ |
Thionamide-induced (methimazole, PTU) agranulocytosis; a WBC count with differential should be obtained to confirm diagnosis |
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Ebstein's anomaly |
apical displacement of tricuspid valve leaflets, decreased volume of right ventricle, and atrialization of right ventricle |
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Mutations in which gene are responsible for the emergency of HIV variants that are resistant to HAART? |
pol gene |
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Where does fluid accumulate in a testicular hydrocoele? |
within the tunica vaginalis, which has remained patent, allowing fluid from the peritoneum to accumulate in the scrotum |
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Fever, vesiculoulcerative gingivostomatitis, and cervical LAD |
primary infection with HSV-1 |
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a congenital defect in the lower part of the interatrial septum is most likely the result of? |
failure of the endocardial cushions to completely fuse resulting in an ASD |
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In addition to ASDs, what other heart defect do Downs pts get? |
AV regurgitation |
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what causes intestinal atresia distal to the duodenum ("apple peel" atresia)? |
SMA obstruction; results in blind-ending proximal jejunum, a length of absent bowel and mesentery, and a terminal ileum spiraled around an ileocolic vessel |
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what stimulates chromaffin cells to release catecholamines? |
Ach |
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What are the two types of pneumococcal vaccines? |
1. Polysaccharide vaccine: induces a T-cell independent B-cell response 2. Conjugate vaccine: polysaccharides attached to an inactivated diphtheria toxin; induces a T-cell-dependent B-cell response |
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clomiphene mechanism of action |
Selective estrogen receptor modulator that prevents negative feedback inhibition on the hypothalamus and pituitary by circulating estrogen, resulting in increased FSH and LH and ovulation |
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what are the stop codons? |
UGA, UAG, UAA |
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erythema infectiosum |
5th disease - caused by parvovirus B19 - slapped cheek appearance (malar rash) - coryza, headache, malaise, fever - usually resolves within a week |
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Within the true pelvis, the ureters pass immediately anterior to which vessels? |
anterior to internal iliac arteries; medial to the ovarian vessels; the uterine artery crosses over the anterior surface of the ureter |
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what is the most highly oxygenated blood in the fetus carried by? |
the umbilical vein, which empties directly into the IVC via the ductus venosus |
