Uworld

Front 1

Systemic mastocytosis

Back 1

mast cell proliferation in bone marrow and other organs

Hint 1

leads to increased histamine secretion (increased gastric acid secretion)

Front 2

Opioid side effects

Back 2

cause contraction of smooth muscle cells, such as the sphincter of Oddi, leading to constriction and spasm

Front 3

Growth factor signal transduction

Back 3

GF binds RTK -> auto-phosphorylation of receptor ->interaction w/ SOS protein -> Ras activation (GTP necessary) -> MAP kinase activation -> gene transcription

Front 4

Osteoclasts

Back 4

large, multinucleated cells that originate from the phagocytic cell lineage in the marrow

Hint 4

stain w/ TRAP and stimulated by M-CSF

Front 5

Bronchial lavage w/ increased CD4 and high CD4:CD8 ratio

Back 5

sarcoidosis

Hint 5

compare to AIDS or hypersensitivity pneumonitis which has a low CD4:CD8 ratio

Front 6

polymyositis

Back 6

CD8 infiltrate and MHC I protein overexpression on muscle cells

Front 7

rT3

Back 7

peripheral thyroid hormone that is converted from T4. Therefore, it is not seen if T3 is given exogenously

Front 8

Ureteropelvic junction

Back 8

last site in GU to canalize, also most common site of obstruction

Front 9

SCID

Back 9

also has absence of thymic shadow

Hint 9

compared to DiGeorge, SCID has more bacterial infections, more common hypogammaglobulinemia, and no facial abnormalities or cardiac defects

Front 10

Prepatellar bursa

Back 10

chronic trauma from repeated kneeling can cause bursitis (housemaid's knee)

Front 11

Attributable risk percent (ARP)

Back 11

represents the excess risk in a population that can be explained by exposure to a particular risk factor

Hint 11

ARP = (RR-1)/RR

Front 12

Male sexual differentation

Back 12

MIF inhibits development of the uterus and the fallopian tubes and testosterone induces the formation of the epididymis, vas deferens, seminal vesicles

Hint 12

therefore, if only sertoli cells are deficient, the patient will have internal male and female genitals and external male genitals

Front 13

Two tissues that are resistant to cancer cell infiltration

Back 13

elastic tissue and cartilage

Front 14

Antibody site that binds complement

Back 14

complement binds to the Fc portion closer to the hinge region

Front 15

Surgery to thyroid may damage this nerve

Back 15

external branch of the superior laryngeal nerve, which travels with the superior thyroid artery and vein

Hint 15

loss of innervation to the cricothyroid

Front 16

imperforate anus

Back 16

most commonly associated w/ genitourinary tract malformations (renal agenesis, hypospadias, epispadias, bladder extrophy)

Hint 16

also associated w/ VACTERL, but not as commonly as with GU problems

Front 17

VACTERL

Back 17

vertebral defects, anal atresia, cardiac anomalies, tracheoesophageal fistula, esophageal atresia, renal anomlaies, limb anomalies

Hint 17

associated w/ imperforate anus

Front 18

Conductivity of heart muscle

Back 18

Purkinje > atria > ventricles > AV node

Front 19

Elastin

Back 19

compared to collagen, it has less prline and lysine residues that are hydroxylated, no triple helix is formed

Hint 19

elastin's plasticity and abiliyt to recoil upon release of tension is due to desmosine crosslinking between lysine residues on different chains (crosslinking is done by lysyl hydroxylase)

Front 20

Female tract epithelium

Back 20

ovary (simple cuboidal), fallopian (simple columnar), uterus (simple pseudostratified columnar), cervix (simple columnar and stratified squamous), vagina (stratified squamous non-keratinized)

Front 21

Tuner syndrome

Back 21

short stature, webbed neck, low posterior hair line, streak ovaries

Hint 21

most commonly associated w/ monosomy (45, XO), but also seen w/ mosaicism where there was a mitotic error early in development

Front 22

IL-12 deficiency

Back 22

lack of IL-12 prevents differentation of TH0 cells into TH1 cells. Thus, TH1 cells won't be around to make IFN-gamma. Low IFN-gamma then prevents activation of macrophages

Hint 22

treatment for this would be giving IFN-gamma

Front 23

Lecithin:sphingomyelin ratio

Back 23

cortisol has the greatest effect on increasing this ratio

Hint 23

prolactin, and thyroxine also increase the ratio, but not as much as cortisol

Front 24

Helicotrema

Back 24

the helicotrema is at the apex of the cochlea. The apex is large and flexible and responds best to low-frequency sounds (large and flexible enough so that low energy waves can move it). The base responds to high frequency sounds (thin and rigid)

Hint 24

transmission of sound: tympanic membrane -> vibration of ossicles -> oval window -> movement of perilymph in scala vestibuli -> scala tympani -> basilar membrane -> hair bending

Front 25

Ehlers-Danlos syndrome

Back 25

heritable connective tissue disease assoicated w/ abnormal collagen

Hint 25

clincally manifests as over-flexible joints, over-elastic skin, fragile tissue susceptible to bruising, wounding, hemarthrosis

Front 26

Neurophysin

Back 26

carrier proteins for oxytocin and vasopressin from paraventricular and supraoptic nuclei, respectively

Hint 26

They are coupled to the hormones, packaged into neurosecretory vesicles, and secreted by the posterior pituitary

Front 27

ADH effect on kidney

Back 27

primarily exerts its effect on the medullary collecting duct

Front 28

Killed virus vaccine mechanism

Back 28

decreases virus entry into cells

Hint 28

as opposed to a live-attenuated vaccine that sensitizes T-cells to infected cells

Front 29

Nasal transepithelial potential difference

Back 29

CF patients have a more negative potential difference than normal due to increased luminal sodium resoprtion

Hint 29

CFTR is responsible for chloride secretion and an inhibitory effect on opening of apical sodium channels. Defect in CFTR leads to increase sodium resorption

Front 30

Anterior Urethral injury

Back 30

commonly due to pelvic fractures, which cause a hematoma below the prostate w/ upward displacement of the gland (damage to the posterior urethra)

Hint 30

this leads to a full bladder sensation, blood if a foley catheter is placed, and pain

Front 31

Posterior urethral injury

Back 31

most commonly due to a saddle injury, where the bulbous urethra is injured

Front 32

Respiratory tract cells

Back 32

mostly pseudostratified, columnar, mucus-secreting (paranasal sinuses, laryngeal vestibule, false vocal cords, tracheal bifurcation)

Hint 32

the true vocal cords are stratified squamous epithelium

Front 33

plaque rupture in acute coronary syndrome

Back 33

fibrous cap holds the plaque together and enzymes like metalloproteinases (produced by inflammatory macrophages) can break the cap down

Front 34

Patient information

Back 34

cannot be disclosed to others, even a wife, without explicit consent of the patient

Front 35

Cryoglobulinemia

Back 35

think HCV and multiple myeloma

Front 36

Metyrapone test

Back 36

Metyrapone blocks cortisol synthesis by inhibiting 11-B-Hydroxylase, leading to a buildup of 11-deoxycortisol. Thus, serum cortisol levels are reduced and feedback to ACTH is lost, leading to increased ACTH release

Hint 36

11-deoxycortisol metabolites are measured as 17-hydroxycorticosteroids in the urine

Front 37

Superior orbital fissure

Back 37

carries CN III, IV, V1, VI, superior ophthalmic vein

Front 38

DNA replication

Back 38

Okazaki fragments are synthesized 5' -> 3', but DNA ligase then constructs them 3' -> 5'

Front 39

GTP production in TCA cycle

Back 39

occurs when succinyl-CoA is converted to Succinate by succinyl-CoA synthetase

Hint 39

this GTP can be used for a bunch of things, such as the conversion of PEP to oxaloacetate by PEP carboxykinase in gluconeogenesis

Front 40

Carotid massage

Back 40

pressure on carotid leads to increased afferent baroreceptor firing rate -> decreased sympathetic action on heart and increased parasympathetic action -> slower conduction through AV node

Hint 40

Parasympathetic nervous system primarily functions to slow the heart rate by slowing conduction through the AV node

Front 41

Femoral neck fractures

Back 41

medial femoral circumflex artery makes the largest contribution to blood supply of this region and is vulnerable to damage from femoral neck fractures

Front 42

Lung parenchyma

Back 42

extends to the level just above the clavicle

Front 43

anti-D Rh immuneglobulin

Back 43

IgG type because Fc receptors on phagocytic cells have the greatest affinity for the Fc fragments of IgG

Hint 43

multivalent IgM antibodies are generally more effective than IgG antibodies at promoting agglutination of foreign cells

Front 44

COX-2

Back 44

undetectable in most tissues except inflammatory cells

Hint 44

COX-1, on the other hand, is expressed in all cells

Front 45

Effect modification

Back 45

effect of a main exposure on the outcome is modified by the presence of another variable. It's not the same as confounding

Hint 45

Here's an example: a test was done to see the effects on a drug on DVT. Smokers who took the drug had a decreased rate vs. smokers who didn't. Non-smokers who took the drug were the same as non-smoker who didn't. This looks like confounding at first, but it's actually effect modification

Front 46

MYC proteins

Back 46

mammalian transcription factors that bind to DNA

Front 47

Bypass grafting for coronary artery disease

Back 47

usually the LAD is replaced by the left internal mammary artery (left internal thoracic)

Hint 47

when multiple coronary arteries or vessels other than the LAD need fixing, the great saphenous vein is used, usually accessed just below the pubic tubercle

Front 48

Osteoporosis

Back 48

Decreased bone density that involves cancellous bone and presents w/ fractures of vertebral column, distal radius, hip, and neck of femur

Hint 48

serum calcium and PTH levels are within the normal range

Front 49

Supraspinatus

Back 49

abduction of the humerus

Front 50

Small bowel atresia in neonate

Back 50

usually due to vascular accidents in utero, most commonly the SMA

Hint 50

leads to "apple peel" atresias where the mesentery of the bowel is absent

Front 51

Glycogen metabolism

Back 51

glycogen is broken down by glycogen phosphorylase, which is active in the phosphorylated state and inactive in the dephosphorylated state. Phosphorylase kinase regulates the phosphorylation.

Hint 51

Phosphorylase kinase itself is phosphorylated by PKA in response to increased cAMP (increased due to epinephrine or glucagon). Phosphorylase kinase activity can also be increased directly by Ca2+

Front 52

Hyperparathyroidism effect on bone

Back 52

subperiosteal thinning is characteristic with cystic degeneration

Hint 52

may also have renal stones, GI upset, and psychiatric disorders

Front 53

Glucose stores

Back 53

glucose level is achieved through gluconeogenesis after 24 hours

Front 54

Pathways requiring NADPH

Back 54

cholesterol and fatty acid synthesis (both anabolic pathways)

Front 55

Croup

Back 55

usually due to paramyxovirus (MCC parainfluenza, followed by RSV)

Front 56

Tuberculosis containment

Back 56

CD4+ cells and macrophages

Front 57

Mental retardation, eczema, mousy/musty body odor

Back 57

PKU

Front 58

BUN in cirrhosis

Back 58

Decreased liver function leads to impaired urea cycle -> decreased BUN levels

Hint 58

Hepatic encephalopathy is likely precipitated by hematemesis, which led to increased ammonia and nitrogen absorption in the gut. Other causes include GI bleed, hypovolemia, hypokalemia, sedative, and infection.

Front 59

Treatment of acute mania

Back 59

Lithium, valproate, carbamazepine

Front 60

Treatment of asthma

Back 60

Fibrous cap holds the plaque together and enzymes like metalloproteinases (produced by inflammatory macrophages) can break the cap down

Front 61

Bastomyces dermatitidis

Back 61

can cause pulmonary disease in immunocompetent people

Front 62

Elimination of counfounding in an experiment

Back 62

matching can eliminate confounding

Front 63

Obstructive sleep apnea

Back 63

associated w/ systemic hypertension and can eventually lead to pulmonary hypertension and right heart failure

Front 64

FAS gene

Back 64

regulates deletion of autoreactive T lymphocytes

Hint 64

a defect in the FAS gene may lead to an increase in T lymphocytes that are autoreactive. FAS gene mutation is thought to be a posisbly etiology for SLE

Front 65

Insuline resistance

Back 65

thought to be due in part to increased FFA and serum triglycerides

Front 66

Innervation of the submandibular and sublingual gland

Back 66

parasympathetic fibers originating in the superior salivatory nucleus carried on the facial nerve via the chorda tympani

Front 67

Course of the ureter

Back 67

exit the kidney, move inferiorly, cross over the common/external iliac vessels and under the gonadal vessels, then pass lateral to the internal iliac vessels and medial to the gonadal vessels as they enter the true pelvis

Front 68

Natriuretic peptide

Back 68

ANP is secreted by the atria in response to volume overload, while BNP is predominantly secreted by the ventricles in volume overload

Front 69

Propionyl CoA

Back 69

derived from amino acids (Val, Ile, Met, and Thr), odd-numbered fatty acids, and cholesterol side chains

Hint 69

congenital deficiency of propionyl CoA carboxylase, leads to development of propionic acidemia

Front 70

Pyruvate dehydrogenase deficiency

Back 70

ketogenic diet is required, consisting of leucine and lysine, as well as phenylalanine, isoleucine, and tryptophan (although these 3 are also glucogenic)

Hint 70

the disease can present w/ neonatal death to mild episodic symptoms in adulthood

Front 71

pulmonary embolism

Back 71

causes acute hypoxemia, hyperventiliation (hypocapnea), and respiratory alkalosis

Front 72

Bloom syndrome

Back 72

generalized chromosomal instability that leads to susceptibility to neoplasms

Front 73

Methylmalonic aciduria

Back 73

defect in isomerization of methylmalonyl CoA into succinyl CoA

Front 74

Mu Opioids

Back 74

activate G-protein receptors and lead to increased potassium efflux from the cell, leading to hyperpolarization of postsynaptic neurons and blocking pain transmission

Front 75

Peroxisomal disease

Back 75

inborn error where perioxisomes are either absent or nonfunctional

Hint 75

Normally, very long chain fatty acids (VLCFA) and branched chain fatty acids cannot undergo mitochondrial beta-oxidation and are instead broken down via a specialized form of beta-oxidation or alpha oxidation in the perioxisomes. Zellweger and Refsum disease are examples of this.

Front 76

Caudal regression syndrome

Back 76

neonates are born w/ agenesis of the sacrum and occasionally lumbar spine w/ paralysis of legs, dorsiflexed feet, and urinary incontinence

Hint 76

usually associated w/ uncontrolled maternal diabetes

Front 77

Myocardial hiberation

Back 77

persistent or repetitive low flow state in the heart causes hibernation of myocardium that can be reversed by reperfusion

Hint 77

Myocardial stunning is a similar concept, but it on a short term basis, as opposed to hibernation, which is due to chronic low flow.

Front 78

Ischemic preconditioning of myocardium

Back 78

development of resistance to infarction by cardiac myocytes previously exposed to repetitive non-lethal ischemia

Front 79

Loss to follow-up

Back 79

creates a potential for selection bias

Front 80

Fragile X Syndrome

Back 80

increased CGG trinucleotide repeats leads to hypermethylation of the FMR1 gene, which leads to the constellation of symptoms in Fragile X

Front 81

Abnormal migration of neural crest cells through the primitive truncus and bulbus cordis

Back 81

Tetralogy of Fallot, transposition of the great vessels, and persistent truncus arteriosus

Front 82

Serum sickness

Back 82

type III hypersensitivity reaction w/ fever, urticaria, arthralgias, glomerulonephritis after exposure to an antigen

Hint 82

sulfonamides are a common cause of this that cause immune complex formation w/ IgG or IgM and resultant complement fixation, leading to a decrease in serum C3

Front 83

Gift accepting

Back 83

don't accept gifts of more than $10 value, if preferential treatment is expected, or if the patient is demented. Except to this would be a one time gift of a small or token value

Front 84

Acid excretion from body

Back 84

occurs in the form of free hydrogen ions and titratable acids (NH4+ or H2PO4-)

Front 85

mitochondrial myopathy

Back 85

presence of lactic acidosis and ragged red skeletal muscle fibers. Include disorders like myoclonic epilepsy w/ ragged red fibers (MERRF), leber optic neuropathy, mitochondrial encephalopathy w/ stroke like episodes and lactic acidosis (MELAS)

Hint 85

mitochondrial disorder with variable expression due to heteroplasmy

Front 86

Loss of myocyte contractile function

Back 86

occurs within 60 seconds of total ischemia

Hint 86

after 30 minutes of total ischemia, ATP levels have dropped to 15% and irreversible ischemic injury is likely

Front 87

Hereditary angioedema

Back 87

inherited autosomal dominant condition that causes episodes of painless, non-pitting, well-circumscribed edema

Hint 87

due to a lack of C1 esterase inhibitor, which normally suppresses C1 classic complement pathway and also inactivates kallikrein. Kallikrein normally catalyzes conversion of kininogen to bradykinin, which increases vascular permeabiltiy and edema

Front 88

Midshaft facture of humerus

Back 88

injury to deep brachial artery and radial nerve

Front 89

Supracondylar fracture of humerus

Back 89

injury to brachial artery

Front 90

Most common reason for elevated AFP

Back 90

dating error, where the fetus's age is underestimated and therefore, AFP is thought to be too high

Hint 90

date is confirmed using ultrasound

Front 91

Treatment of staph epidermidis endocarditis

Back 91

vancomycin, because S. epidermidis is usually resistant to penicillin G and many other antibiotics

Front 92

Adrenal crisis

Back 92

immediately treat w/ corticosteroids

Front 93

Breast milk contents

Back 93

contains proteins, carbs, fat, vitamins, trace minerals and immunoglobulins. The only thing that is missing is vitamin D and K

Front 94

Cisplatin treatment

Back 94

MOA: form reaction oxygen species that can form DNA crosslinks. S/E: nephrotoxicity

Front 95

Drug induced parkinsonism

Back 95

can be due to antipsychotic treatment. Treat with centrally-acting antimuscarinic agents. Do NOT treat w/ levodopa, because that can induce psychosis

Front 96

Dihydrobiopterin reductase deficiency

Back 96

most common cause for deficiency of BH4 and results in atypical or malignant phenylketonuria. BH4 is used in the synthesis of tyrosine, DOPA, serotonin, and NO

Front 97

Verapamil's effect on diastolic depolarization

Back 97

Slows diastolic depolarization (slope of phase 0). The reason why it's diastolic is because the electrical impulse is traveling through the heart when the heart is relaxed, and this will eventually lead to contraction/systole

Front 98

Lesch-Nyhan syndrome

Back 98

deficiency in HGPRT/salvage pathway means that de novo purine synthesis must be upregulated, and PRPP synthetase and amidotransferase are both enzymes in this pathway

Front 99

Carboxyhemoglobin

Back 99

Hemoglobin bound w/ CO, thus preventing O2 binding

Hint 99

in contrast to methemoglobinemia, where the Fe2+ is oxidized to Fe3+ due to drug exposures and some enzyme deficiencies

Front 100

Neonatal tetanus

Back 100

can be prevented by ensuring that the pregnant mother is vaccinated to allow transfer of protective IgG antitoxin antibodies across the placenta

Front 101

Airway resistance

Back 101

majority of resistance is located in the medium and small-sized bronchi greater than 2mm in diameter. Resistance is maximal in the second to fifth generation airways including segmental bronchi, and minimal in the bronchioles (because they are parallel)

Front 102

Fastest metabolized sugar

Back 102

Fructose-1-phosphate: only sugar that can bypass PFK-1

Front 103

Parvovirus replication

Back 103

occurs in the bone marrow

Front 104

N-acetylglutamate

Back 104

essential activator of carbamoyl phosphate synthase I and is formed by N-acetylglutamate synthetase from acetyl-CoA and glutamate

Front 105

space constant

Back 105

measure of how far along an axon an electrical impulse will travel

Hint 105

demyelination decreases the space constant

Front 106

Gamma-glutamyl transferase (GGT)

Back 106

when liver enzymes are reved up, there is a GGT elevation

Front 107

Common cardinal veins

Back 107

derive the SVC and other constituents of the systemic venous circulation

Front 108

Amphotericin B treatment

Back 108

can cause renal toxicity, so it's important to monitor serum potassium and magnesium

Front 109

Thyroglobulin synthesis

Back 109

TSH induces gene transcription of thyroglobulin, leading to thyroglobulin synthesis

Hint 109

thyroglobulin is later attached to iodide by thyroid peroxidase. Thyroid peroxidase also catalyzes the breakdown of iodinated thyroglobulin into MIT and DIT

Front 110

Craniopharyngioma

Back 110

calcified cystic tumor of rathke pouch derivative that can commonly have yellow, cholesterol rich fluid in the cysts

Front 111

Auditory canal innervation

Back 111

posterior external canal is innervated by the vagus, and touching it may produce a vasovagal syncopal episode

Hint 111

the rest of the auditory canal is innervated by CNV3

Front 112

Superior gluteal nerve

Back 112

found in the superomedial quadrant of the buttock

Hint 112

damage can lead to trendelenberg gait because it innervates the gluteus medius

Front 113

GLUT transport

Back 113

facilitated diffusion where glucose moves down its gradient into cells with the help of a carrier protein

Front 114

Reperfusion injury

Back 114

occurs secondary to oxygen free radical generation, mitochondrial damage, and inflammation

Hint 114

in muscle, this can lead to cell membrane damage and release of creatine kinase

Front 115

Diptheria

Back 115

neural and cardiac toxicity are serious potential sequelae. immunization leads to circulation of IgG against the circulating exotoxin B protein, preventing the disease

Front 116

Bile acid-binding resins + fibrates

Back 116

increase cholesterol excretion by the liver, leading to an increased risk of gallstone formation

Front 117

Propranolol and thyrotoxicosis

Back 117

decreases the sympathetic adrenergic impulses caused by increased thyroid hormones and also decreases the peripheral conversion of T4 -> T3

Front 118

Coronary steal phenomenon

Back 118

collateral microvessels are arterioles that form adjacent pathways for blood flow to areas that are distal to occluded vessels. Blood flow is redistrubuted from ischemic areas to non-ischemic areas through vasodilated collateral microvessels and this can worsen the ischemia of the occluded artery

Front 119

Human multidrug resistance gene (MDR1)

Back 119

produces a P-glycoprotein that is a transmembrane ATP-efflux pump that pumps cancer drugs out of cells. THis is a mechanism of resistance

Front 120

Muromonab-CD3

Back 120

anti-CD3 antibody that inhibits T-lymphocytes and is used for transplant therapy

Front 121

Fat embolism syndrome

Back 121

triad: acute-onset neurologic abnormalities, hypoxemia, and petechial rash

Hint 121

usually occurs after long bone fractures when fat globules dislodge and travel into pulmonary microvessels. The rash is due to FFA toxic damage and platelets coating the fat globules, leading to thrombocytopenia and petechiae

Front 122

Actinic keratoses

Back 122

appear on chronically sun-exposed areas of skin and are erythematous papules w/ central scale and "sandpaper-like" texture

Front 123

Sorbitol dehydrogenase

Back 123

found in lens, converts sorbitol into fructose. In states of high glucose, sorbitol builds up, leading to increased osmotic pressure and influx of water, leading to cataract formation

Front 124

Nitroglycerin

Back 124

rapidly acting agent that venodilates, leading to decreased preload in the ventricles, leading to decrease O2 consumption and alleviation of angina symptoms

Front 125

Maple syrup urine disease (MSUD)

Back 125

defect in branched chain alpha-keto acid dehydrogenase. Urine has a distinctive sweet odor, much like burned caramel. Supplementation w/ thiamine might be beneficial

Front 126

Urea composition

Back 126

NH3 from aspartate

Front 127

Aqueous humor production

Back 127

produced by the ciliary epithelium and is sensitive to Beta-adrenergic block. This is why timolol blocks aqueous humor production and improved glaucoma

Front 128

Shigella infection

Back 128

mucosal invasion is the essential pathogenic mechanism for Shigella and is the most important factor of disease. The shiga toxin can cause further disease by destroying cellular protein synthesis, but is considered less important in teh pathogenesis of shigellosis

Front 129

Neuroleptics

Back 129

high potency drugs are more likely to produce extrapyramidal symptoms and less likely to produce anticholingergic and antihistamine symptoms, while low potency drugs are the exact opposite

Front 130

Atrial fibrillation

Back 130

the heart rate is due to the AV nodal refractory period, leading to an HR of about 120 bpm

Front 131

Inhaled-anesthetic hepatotoxicity

Back 131

type 1: associated w/ aminotransferase elevation and mild to no symptoms. Type 2: severe of fulminant hepatits leading to rapid atrophy and a shrunken liver.

Hint 131

Labs: marked AST levels, prolonged prothrombin time, and eosinophilia. Albumin would be normal because the liver injury is acute

Front 132

Induced mania in bipolar disorder

Back 132

TCAs/antidepressents

Front 133

Distal duodenal ulcer

Back 133

suggests zollinger-ellison (most PUD ulcers are found in the duodenal bulb). In ZE, there is an increased basal:maximal gastric acid secretion

Front 134

Latent period (in reference to experiments)

Back 134

defined as the time elapsed from initial exposure to clinically apparent disease.

Hint 134

example: a prospective study is done to determine the effects of vitamins on heart disease. It is shown that heart disease is decreased in people who took the vitamins for more than 5 years, but not for those who took the vitamins for <5 years.

Front 135

Creutzfeld jakob disease

Back 135

rapidly progressive dementia and myoclonic jerks. on microscopic examination, multiple vacuoles are seen in gray matter (spongiform encephalopathy)

Front 136

Endothelium-derived relaxing factor (EDRF), aka NO

Back 136

cholinergic agonsts bind to muscarinic receptors on endothelial cells and promote release of NO, which leads to vasodilation

Front 137

Antidepressent in patients who don't want sexual side effects

Back 137

Buproprion

Front 138

Pentazocine

Back 138

opioid narcotic specifically designed to produce analgesic effects w/ little to no abuse potential. As a result, if given to someone who is dependent on opioids, it will induce withdrawal

Front 139

vitamin B6 effect on levodopa

Back 139

increases the peripheral metabolism of levodopa, decreasing its effectiveness

Front 140

vitamin A overdose

Back 140

acute: nausea, vomiting, vertigo, blurred vision. Chronic: alopecia, dry skin, hepatotoxicity, hepatosplenomegaly, papilledema

Front 141

Global cerebral ischemia

Back 141

hippocampus is the first area to be damaged during global cerebral ischemia

Front 142

Parkinson's tx

Back 142

amantadine increases synthesis, release, and EFFECT of endogenous domaine; Entacapone/tolcapone are COMT inhibitors that increase levodopa availability to the brain

Front 143

lacunar infarcts

Back 143

result of hypertensive changes in arterioles that leads to liphyalinosis and microatheromas. Also seen in diabetes

Hint 143

seen in infarcts of the posterior limb of internal capsule, VPL/VPM, base of bons

Front 144

Cerebral amyloid angiopathy

Back 144

most commonly causes hemorrhaging within the cortex and subcortical white matter and is not associated w/ ischemic stroke

Front 145

Rabies

Back 145

restlessness, agitation, dysphagia progressing to coma in 30-50 days after exposure to caves/bats.

Hint 145

Vaccination (killed virus) for individuals at high-risk is preventative

Front 146

Bradycardia tx after inferior MI

Back 146

Atropine is indicated b/c it decreases vagal influence on the SA node. Side effects are increased intraocular pressure and may precipitate closed angle glaucoma

Front 147

Mycoplasma genus

Back 147

lack a cell wall (includes mycoplasma and ureaplasma)

Front 148

Rapid plasma decay of thiopental

Back 148

due to redistribution of the drug to other tissues of the body (skeletal muscle and adipose tissue), NOT metabolism

Front 149

Treatment of concurrent tonic-clonic and absence seizures

Back 149

valproic acid

Front 150

Theophylline intoxication

Back 150

moa: decrease cAMP levels, possibly by activating phosphodiesterase. Intoxication results in abdominal pain, vomiting, diarrhea, cardiac arrhythmias, and seizures. Seizures are most important.

Hint 150

Tx of intoxication includes giving Beta blockers and benzos for the seizures

Front 151

Atypical depression

Back 151

MAOi are first line treatment (phenelzine, tranylcypromine)

Hint 151

Atypical depression is characterized by mood reactivity, leaden fatigue, rejection sensitivity, increased sleep and apetite

Front 152

polycistronic bacterial mRNA

Back 152

means that one mRNA can code for several proteins, which is how the lac operon can upregulate 2 proteins at the same time

Front 153

Calcineurin

Back 153

an essential protein in IL-2 activation which promotes growth and differentiation of T cells

Front 154

alpha-galactosidase

Back 154

membrane-bound disaccharidases on the intestinal brush border that break down disaccharides into monosaccharides for absorption. Acarbose and miglitol are taken by diabetes to prevent absorption of glucose

Front 155

Intrapleural pressure at FRC

Back 155

-5 mmHg H20

Front 156

Hepatocyte injury in viral hepatitis

Back 156

diffuse swelling termed "ballooning degeneration". Hepatocyte death is characterized by lobular architectural disruption and confluent hepatocyte necrosis, a process called "bridging necrosis." Fever and dark urine would be seen in the patient

Front 157

Thrombin time (TT)

Back 157

increased by drugs that directly inhibit thrombin formation, such as heparain

Hint 157

Factor Xa inhibitors (idraparinux, rivaroxaban, apixaban, ultralow weight heparin) increased PTT and PT, but don't affect TT

Front 158

Severity of mitral regurgitation

Back 158

presence of S3 indicates severe regurg and left ventricular volume overload and is a predictor of the severity of the MR

Hint 158

a presence of S4 may indicates late stage decompensation of severe MR

Front 159

Adenosine effect on heart

Back 159

reduces the rate of spontaneous depolarization in cardiac pacemaker cells, slowing the heart rate

Front 160

Membranous glomerulopathy

Back 160

associated w/ systemic diseases, solid tumors, drugs, and infections. Diffuse thickening of the glomerular capillary wall on LM w/o cellularity and dense subepithelial deposits

Front 161

Mycobacterium tx

Back 161

pyrazinamide works best in an acidic environment and thus works best against intracellular bacteria that are within phagolysosomes. Isoniazid, rifampin, and ethambutol have better activity against extracellular MTB

Front 162

Senile cardiac amyloidosis

Back 162

atrial natriuretic peptide is the precursor protein

Front 163

ACEi + beta blockers

Back 163

beta blockers already decrease renin levels, so giving ACEi wouldn't alter ATII levels much and wouldn't have a compound effect on BP

Front 164

Recurrent hemorrhagic stroke

Back 164

most commonly caused by cerebral amyloid angiopathy, which leads to lobar hemorrhage

Hint 164

compared to lobar hemorrhage associated w/ hypertension, lobar hemorrhage assoicated w/ amyloid angiopathy has a more benign course and lower mortality

Front 165

Artery posterior to the duodenal bulb

Back 165

gastroduodenal artery. ulceration into this artery can lead to life-threatening hemorrhage

Front 166

TCA side effects

Back 166

presynaptic NE release (tremor, insomnia), cardiac fast Na+ channels (conduction defects, arrhythmias, hypotension), central and peripheral muscarinic AChR (hyperthermia, flushing, dilated pupils, intestinal ileus, urinary retention, sinus tachycardia), peripheral alpha-1 receptors (orthostatic hypotension), H1 receptors (sedation)

Front 167

Pituitary hypoplexy

Back 167

acute bleeding in a patient w/ preexisting pituitary adenoma. Cardiovascular collapse occurs because of ACTH deficiency

Front 168

Salicylate poisoning time frame

Back 168

Respiratory alkalosis is the first disturbance because the medullary center is directly stimulated resulting in hyperventilation. A few hours after ingestion, an anion gap metabolic acidosis begins to develop, making it a mixed respiratory alkalosis/metabolic acidosis.

Hint 168

Late stage salicylate poisoning becomes metabolic acidosis

Front 169

Drugs that cause seizures

Back 169

buproprion, isoniazid, imipenem

Front 170

Pathogenesis of Strep. viridans endocarditis

Back 170

viridans can produce dextran from sucrose. dextrans facilitate strep adherence to fibrin. Therefore, viridans can bind to fibrin-platelet aggregates deposited at the site of endothelial trauma

Hint 170

dextrans can also aid viridans in formation of dental carries

Front 171

Cyanide poisoning

Back 171

binds to iron-containing enzymes (cytochrome complex in oxphos). Nitrites are given as a rescue because they induce the formation of methemoglobin, which has a high affinity for CN, and can sequester it. Sodium thiosulfate is then given, which combines w/ CN to make thiocynate (less toxic), which can be excreted

Hint 171

symptoms include rapidly-developing cutaenous flushing, tachypnea, headache, and tachycardia, w/ nausea, confusion and weakness

Front 172

Incidence of esophageal SCC:adenocarcinoma

Back 172

0.5:1

Front 173

Orotic aciduria

Back 173

due to deficiency in orotate phosphoribosyl transferase and OMP decarboxylase (these two enzymes represent separate active domains on a single polypeptide, which is why a single mutation causes dysfunction of both)

Hint 173

treat w/ uridine supplementation

Front 174

Villous adenoma

Back 174

large, sessile w/ cauliflower or velvety projections. May secrete large amounts of mucus, leading to mucus diarrhea and may lead to hypovolemia or electrolyte imbalances

Front 175

Antiphospholipid antibody (APLA) syndrome

Back 175

due to lupus anticoagulant may occur in SLE and is associated w/ venous thromboembolism, arterial thromboembolism, and increased fetal loss

Hint 175

lupus anticoagulant is the most common cause of prolonged PTT and false positive VDRL in patients with lupus

Front 176

HIV proteins

Back 176

gag gene (p24, p7), env gene (gp120, gp41), pol gene (important enzymes). gp120 aids in binding to the cell surface and gp41 aids in fusing to the cell membrane and entry of the virus

Hint 176

polyprotein precursors are encoded for by the structural genes (gag, pol, and env). gp160 is formed from the env gene and then cleaved to form gp120 and gp41

Front 177

Ca2+ channel blocker S/E

Back 177

dihydropyridine (amlodipine, nifedipine): peripheral edema, flushing, dizziness. NO AV NODE BLOCK

Hint 177

non-dihydropyridine (verapamil): constipation, gingival hyperplasia

Front 178

Abetalipoporteinemia

Back 178

inability to synthesize apolipoprotein B. Microscopically, you see lipids piled up in the small intestines because they can't get out

Front 179

Corticosteroid effect on tissues

Back 179

skeletal muscle (proteolytic -> weakness), bones (decreases bone mass), liver (increases gluconeogenesis)

Front 180

Marked one sided kidney atrophy

Back 180

suggestive of renal artery stenosis (RAS) that occurs in elderly individuals due to atherosclerotic changes in the arterial intima. Hypertension and abdominal bruit are present

Hint 180

The atrophy is most likely due to lack of oxygen and nutrients

Front 181

Graft-versus-host disease (GVHD)

Back 181

occurs after allogenic bone marrow transplantation where the graft T-cells sensitize against the host MHC antigens within 1 week of transplantation. SIgns include liver damage, jaundice, diarrhea, intestinal bleeding, abdominal cramping, skin desquamation

Front 182

BRCA gene

Back 182

tumor supressor genes that function in gene repair and regulation of the cell cycle

Front 183

HIV esophagitis

Back 183

caused by candida (patches of adherent, grey pseudomembranes), HSV-1 (small vesicles that evolve into punched out ulcers), and CMV (linear ulceration)

Front 184

amiodarone S/E

Back 184

thyroid dysfunction (check TSH), corneal micro-deposits, blue-gray skin discoloration, drug-related hepatitis, pulmonary fibrosis

Front 185

c-jun

Back 185

transcription factor proto-oncogene

Front 186

Sickle-cell dactylitis

Back 186

painful swelling of hands and feet seen in young children. Hemolysis occurs, leading to a decrease in serum haptoglobin levels

Front 187

Cell swelling due to ischemia

Back 187

ischemia leads to decreased ATP, which leads to ion pump failure, which leads to an increase in intracellular Ca2+ and Na+

Front 188

Gestational diabetes treatment

Back 188

insulin

Front 189

Cidofovir

Back 189

a nucleoside monophosphate that doesn't require action by cellular kinases for conversion to active nucleoside triphosphate form and is thus a good tx for viruses w/o phosphorylation activity

Hint 189

acyclovir, valacyclovir, famciclovir, and ganciclovir all require a herpesviral kinase

Front 190

Erythrocyte sedimentation rate (ESR)

Back 190

IL-1, IL-6, and TNF-alpha mediate systemic inflammatory response and stimulate secretion of acute-phase proteins (such as fibrinogen). High levels of fibrinogen increase ESR, which is a nonspecific marker of inflammation

Front 191

Treatment of peripheral neuropathy

Back 191

TCAs

Front 192

Long QT syndrome

Back 192

unprovoked syncope in a previously asymptomatic young person. The two congenital syndromes associated w/ long QT are Romano-Ward syndrome and Jervell an Lange-Nielsen syndrome. Both of these are thought to be results of mutations in K+ channel protein that contributes to the delayed rectifier current of the cardiac action potential

Hint 192

may predispose to torsades de pointes. agents that prolong QT include procainamide, sotalol, amiodarone, disopyramide, dofetilide, phenothiazines, and TCAs

Front 193

Coronary sinus dilation

Back 193

MCC is elevated right-sided heart pressures secondary to pulmonary artery hypertension

Front 194

Digitalis (digoxin) overdose

Back 194

AV block, vTach, nausea, vomiting, anorexia, confusion, blurry vision, changes in color perception, hyperkalemia

Hint 194

Example: patient w/ CHF presents w/ disturbed color perception, anorexia, nausea, vomiting, and diarrhea. What is the most likely complication? Answer: Arrhythmias

Front 195

Dystrophic calcification of aortic valve

Back 195

hallmark of cell injury and death, occuring all types of necrotic tissue. Aged or damaged cardiac valves and atheromatous plaques are a favorite

Front 196

anovulation

Back 196

common in the first 5-7 years after menarche and last ten years before menopause, and manifests with marked menstrual cycle variability

Front 197

Idiopathic pulmonary hypertension

Back 197

autosomal dominant w/ variable penetrance. abnormal bone morphogenic protein receptor type 2 (BMPR2) as first insult, which predisposes to pulmonary vascular disease. A second insult activates the disease process, resulting in proliferation of vascular smooth muscle

Front 198

Treatment of hypertension + chronic ischemic myocardial failure

Back 198

ACEi. Prevents remodeling and deterioration of ventricular contractile function, in addition to reducing BP. Beta blocker would also be beneficial

Front 199

Pick's disease

Back 199

destruction of the frontal and temporal lobes, Pick bodies (cytoplasmic tau inclusions), behavioral abnormalities like socially inappropriate behavior, speech and language decline, urinary incontinence (this is in contrast to AD, which has slow, progressive memory loss)

Front 200

Toxoplasmosis in neonate

Back 200

Early infection is usually asymptomatic, but can lead to necrotizing encephalitis or disseminated disease. When organism infects mother in later trimesters, there is a greater likelihood of infection and it will have the classic triad of toxo

Front 201

Hypothyroidism

Back 201

can see elevated creatinine phosphokinase (CPK) because there is atrophy of the type II muscle fibers

Front 202

RANK and RANKL mechanism

Back 202

differentiation of osteoclasts is mainly governed by RANKL and GM-CSF, both of which are produced by osteoblasts. RANKL binds to RANK on osteoclasts. Osteoblasts also secrete osteoprotegerin (POG) and this acts as a decoy receptor for RANKL and inhibits its action.

Hint 202

lack of estrogen leads to overexpression of RANK, which causes an increase in osteoclast activation and increased bone resportion.

Front 203

Exercise in diabetics

Back 203

lowers blood glucose by teh following mechanism: increases muscle uptake by sensitizing muscle cells to action of insulin, and increases insulin-independent glucose uptake

Hint 203

To prevent hypoglycemia in DM1 treated w/ insulin: eat 15-40g carbs immediately before exercise, check blood sugar before, during, and after exercise, time dosage so that insulin peak doesn't occur during exercise, do not inject insulin in limbs that will be exercised

Front 204

Germinoma of the pineal gland

Back 204

similar to testicular seminomas. classic symptoms: precocious puberty, Parinaud syndrome (paralysis of upward gaze), obstructive hydrocephalus

Front 205

Hyaline arteriolosclerosis

Back 205

caused by diabetes mellitus and NONmalignant hypertension

Hint 205

malignant hypertension causes hyperplastic arteriolosclerosis

Front 206

Chronic mesenteric ischemia

Back 206

most often caused by atherosclerotic narrowing of celiac trunk leading to "angina-like" symptoms of the bowel

Front 207

Marantic endocarditis

Back 207

small, sterile, non-destructive fibrinous vegetations along the lines of the closure of cardiac valve cusps. Due to a appendix or pancreas tumor that leads to a hypercoagulable state, which leads to the endocarditis

Front 208

DIffuse medium-sized lymphocytes w/ high proliferation index (high Ki-67)

Back 208

Burkitt lymphoma

Front 209

Malignant melanoma pathogenesis

Back 209

BRAF, a protein kinase involved in signaling pathways in melanocytes, can be mutated leading to greatly increased risk of activation of signaling pathways for melanocyte growth, survival, and metastasis

Front 210

Colon adenocarcinomas and COX-2

Back 210

recent studies have shown an increased activity of COX-2 w/ colon adenocarcinomas and in inherited polyposes syndromes. Patients taking NSAIDs regularly have been shown to have lower incidence of adenomas compared to general population

Front 211

Normal aging of the heart

Back 211

decreased left ventricular chamber size, particularly in the apex to base dimension, causing the basal septum to bulge into the outflow tract (sigmoid septum). Atrophy of cardiac myocytes results in increased interstitial connective tissue and in some cases, deposition of amyloid

Front 212

Anaplastic characteristics

Back 212

loss of cell polarity, significant variation in shape and size (pleomorphism), deep staining of nuclei (hyperchromatism), larger nuclei, abnormal mitoses, giant-multinucleated tumor cells

Front 213

Kidney segments most dependent on blood flow

Back 213

PCT and ascending loop of Henle already have low blood flow and are highly dependent on ATP, so decreased blood flow will damage them first, leading to acute tubular necrosis

Front 214

Jurvell and Lange-Nielsen syndrome

Back 214

congenital long-QT syndrome w/ neurosensory deafness

Front 215

bisphosphoglycerate mutase

Back 215

converts 1,3-BPG into 2,3-BPG in erythrocytes. Increased concentration of 2,3-BPG leads to right shift of Hb curve and dumping of O2 to tissues

Front 216

Cauda equina syndrome

Back 216

saddle anesthesia and loss of anocutaneous reflex due to damage to S2-S4 nerve roots

Front 217

Protease inhibitor S/E

Back 217

hyperglycemia, lipodystrophy, drug-drug interactions due to inhibition of cytochrome P-450

Front 218

Cladribine

Back 218

purine analog that is the drug of choice for hairy cell leukemia. resistant to degradation by adenosine deaminase

Front 219

Diphtheria treatment

Back 219

diphtheria antitoxin, antibiotics (streptomycin) and immunization. Antitoxin is the most important and has the greatest effect on prognosis

Hint 219

MC COD is cardiomyopathy

Front 220

Gibbs free energy (G)

Back 220

G is negative in a spontaneous reaction. If G is negative, the equilibrium constant, K, will have to be greater than 1 (G = -RTlnKeq). If G is positive, K will have to be less than 1

Front 221

Neuron degeneration/damage

Back 221

irreversible damage seen w/ red neurons (first 48 h), followed by neutrophils and macrophages. Three to five days after onset of ischemia, neurons disintegrate and their fragments are phagocytized by macrophages (lipid filled because they are eating up myelin). Within 2 weeks, astrocytes migrate in and begin gliosis and scar formation

Front 222

Drugs that are excreted by liver as opposed to the kidney

Back 222

high lipophilicity (since high lipophilicity means they rapidly cross tubular cell membranes after filtration and reenter tissues and allows them to cross cellular barriers and enter hepatocytes) as well as high volume of distribution.

Front 223

Difference between superior vena cava syndrome and brachiocephalic syndrome

Back 223

SVC syndrome affects both sides of the face, neck chest, and both arms. Brachiocephalic obstruction only affects the right face, right arm and right side of the neck.

Front 224

Chronic treatment of asthma

Back 224

inhaled glucocorticoids are most effective anti-inflammatory agents

Front 225

Types of necrosis

Back 225

coagulative necrosis: most common, preserved cell outlines (spider bites, organ ischemia), pyknosis, karyorrhexis, and lysis. Liquefactive necrosis: CNS, ischemic strokes, cells undergo fragmentation and are phagocytized by macrophages and form a cystic cavity

Front 226

Anorexia nervosa and amenorrhea

Back 226

loss of pulsatile secretion of GnRH from the hypothalamus

Front 227

Topical decongestants (phenylephrine, xylometazoline, oxymetazoline)

Back 227

characterized by rapid decline of effectiveness after a few days (tachyphylaxis). This is due to decreased production of endogenous NE. This leads to exacerbation of nasal congestion symptoms (rebound rhinorrhea)

Front 228

Organophosphate rescue

Back 228

atropine for all symptoms except muscle paralysis, pralidoxime for muscle paralysis

Front 229

Polyribosyl-ribitol-phosphate (PRP)

Back 229

a component of the Hib capsule that is conjugated to diphtheria or tetanus toxoid for a vaccine.

Front 230

Mucicarmine stain

Back 230

used to detect polysaccharide of Cryptococcus neoformans. Cryptococcus is the only pathogenic fungus w/ a polysaccharide capsule

Front 231

Prevention of TIA

Back 231

low dose aspirin

Front 232

Samter's triad

Back 232

triad of asthma, aspirin hypersensitivity: nasal symptoms, bronchospasm, facial flushing. Nasal polyposis can occur in 10%

Front 233

Hypocalcemia after whole blood transfusions

Back 233

due to calcium chelation by citrate anticoagulant

Front 234

hypertriglyceridemia in patients on bile acid-binding resins

Back 234

cholestyramine causes the liver to have to make 10x more bile, and it also upregulates the formation of VLDL and triglycerides

Hint 234

cholestyramine is usually given with statins. However, because cholestyramine decreases the absorption of statins, the drugs have to be taken 4 hours apart

Front 235

Anesthetic pharmacokinetics

Back 235

inspired air (lower MAC = higher potency), lungs (rate of rise of gas tension in alveoli and the blood is directly proportional to both the rate and depth of ventilation), blood (high solubility aka blood/gas partition coefficient = slow onset of action), target tissues such as the brain (higher arteriovenous concentration gradient = slower onset of action)

Front 236

Amino acids w/ 3 titratable protons

Back 236

histidine, arginine, lysine, aspartic acid, glutamic acid, cysteine, tyrosine

Front 237

Primary vs. reactivation HSV infection

Back 237

Primary: fever, vesiculoulcerative gingivostomatitis, and cervical lymphadenopathy

Hint 237

Reactivation: targets the face w/ perioral blisters and "cold sores"

Front 238

Blood supply of ureter

Back 238

proximal 1/3 is supplied by the renal artery, which is why in a kidney transplant, the proximal ureter is preserved and fused to the recipients bladder

Front 239

Ether's effect on viruses

Back 239

ether and other organic solvents can inactivate the enveloped viruses, which leads to a loss of viral infectivity

Front 240

Receptor tyrosine kinases vs. tyrosine-kinase associated receptors

Back 240

Receptor tyrosine kinase: cytosolic domain has enzymatic activity, leads to activation of MAP-kinase, phosphorylation of Ras protein, and downstream second messengers. Includes Growth factor receptors (EGF, PDGF, FGF, insulin)

Hint 240

Tyrosine-kinase associated receptors: cytosolic domain lacks enzyme activity. JAK/STAT pathway is involved. Includes cytokines, GH, prolactin, IL-2

Front 241

Maternal hyperglycemia

Back 241

fetus is likely subjected to relatively high blood glucose levels during gestation. This leads to increased fetal release of insulin and transient hypoglycemia once the infant is born

Front 242

Biliary sludge

Back 242

usually caused by gallbladder hypomotility. This leads to bile precipitation and the formation of biliary sludge

Hint 242

gallbladder hypomotility can be seen w/ pregnancy, rapid weight loss, parenteral nutrition, or octreotide

Front 243

Fenoldopam

Back 243

D1 agonist that vasodilates the renal vessels and also leads to sodium and water excretion

Front 244

Neutrophil margination w/ corticosteroid therapy

Back 244

Neutrophil counts increase following glucocorticoid administration as a result of "demargination" of leukocytes previously attached to vessel wall

Front 245

Chloride shift

Back 245

to maintain electrical neutrality, chloride ions diffuse into RBCs to take the place of bicarb as it moves out. Since venous blood has increased CO2 levels, that means it is more acidic, and bicarb must leave the RBC to act as a buffer. This causes chloride to come in, leading to low chloride levels in venous blood

Front 246

Digoxin MOA

Back 246

increases cardiac contractility by blocked Na-K-ATPase and also decreases AV nodal conduction by increasing vagus nerve/parasympathetic activity

Front 247

Oral bioavailability

Back 247

determined on a graph by taking the area under the curve of the oral divided by the area under the curve of the IV dose

Hint 247

F = (AUC oral x IV dose) / (AUC IV x oral dose)

Front 248

Reticulocytes

Back 248

larger than RBCs, have bluish cytoplasm and reticular precipitates of residual rRNA

Front 249

Bicuspid aortic valve

Back 249

becomes aortic stenosis in patient's sixties

Front 250

Anti-phospholipase A2 receptor antibodies

Back 250

seen in membranous nephropathy

Front 251

Fructose metabolism in patients w/ essential fructosemia

Back 251

fructose is metabolized by hexokinase to fructose-6-phosphate. This pathway is not significant in normal individuals

Front 252

HCL + EtOH + carbolfuchsin

Back 252

this describes an acid-fast stain that stains mycobacteria w/ mycolic acid in their cell walls. Carbolfuchsin is an aniline dye

Front 253

HbC disease

Back 253

caused by a missence mutation where lysine is substituted for glutamate at the 6th position in the beta globin chain. Since lysine is positively charged, the HbC molecule will travel further than the HbS molecule on a gel

Front 254

Hypercalcemia in Sarcoidosis

Back 254

due to activation of macrophages, which leads to intrinsic activity of 1alpha hydroxylase, which increases calcitriol formation, leading to hypercalcemia

Front 255

Chronic rejection in lung transplant

Back 255

results in bronchiolitis obliterans, where the bronchiolar walls are narrowed, obstructed, inflamed, and fibrotic

Front 256

Diphenoxylate

Back 256

opiate anti-diarrheal that binds mu opiate receptors in the GI tract and slows motility

Hint 256

octreotide is helpful for secondary diarrhea

Front 257

Conjunctival injection

Back 257

aka red eye

Front 258

P bodies

Back 258

cytoplasmic proteins that play an important role in mRNA transcription regulation and mRNA degradation

Front 259

Argatroban

Back 259

similar to lepirudin, argatroban is a direct thrombin inhibitor that is used in patients with heparin-induced thrombocytopenia (HIT)

Front 260

Protein structure

Back 260

Primary (peptide bonds), secondary (hydrogen bonds), tertiary (ionic bonds, hydrophobic interactions, hydrogen bonds, and disulfide bonds)

Front 261

Why verapamil doesn't work on skeletal muscle

Back 261

skeletal muscle is not dependent on extracellular calcium influx and thus, a Ca2+ channel blocker wouldn't do anything to it

Front 262

Ethambutol

Back 262

antimycobacterial agent that inhibits carbohydrate polymerization, thereby preventing peptidoglycan synthesis. Optic neuritis is a side effect

Hint 262

Man walks in w/ TB and decreased visual activity. Once drug is eliminated from regimen, his vision improves

Front 263

Gestational hyperglycemia

Back 263

may be due to decreased activity of the glucokinase enzyme. Glucokinase acts as a glucose sensor in the liver and pancreas and deficiency of this enzyme may lead to mild hyperglycemia that can be exacerbated by pregnancy

Front 264

Wet AMD

Back 264

Ophth exam: eye reveals a gray subretinal membrane. Patient has blurry and distorted vision

Hint 264

treat w/ VEGF inhibitors

Front 265

Inflammatory breast carcinoma

Back 265

skin retraction is due to infiltration of cooper ligaments. Can also invade the lymphatics and cause a peau d'orange look

Front 266

Mast Cell degranulation

Back 266

When antigen binds IgE, multiple IgEs aggregate and cross-link, leading to mast cell degranulation. Mast cells release histamine, tryptase, and other chemotactic/vasoactive peptides. Tryptase is relatively specific to mast cells and is used as a marker for mast cell activation

Front 267

Macrocytosis in Sickle cell anemia

Back 267

classic cause of megaloblastic anemia is folate deficiency. Sickle patients have increased RBC turnover and thus, a higher demand for folate.

Front 268

Colon adenocarcinoma location and presentation

Back 268

Left-sided: infiltrate the intestinal wall and encircle the lumen, manifests w/ partial intestinal obstruction.

Hint 268

Right-sided: grow exophytic masses that manifest w/ iron deficiency anemia, fatigue, and weight loss

Front 269

Blood supply to heart during exercise

Back 269

vasodilation is the primary way the heart gets more oxygen, and the actual blood flow is dependent on the duration of diastole

Front 270

Sample size effect on P

Back 270

if two studies both get the same RR, but one study has a slightly higher p-value, then chances are that that study didn't have a large enough population

Front 271

Cilostazol, Dipyridamole

Back 271

decrease activity of platelet phosphodiesterase. Cilostazol also inhibits platelet aggregation. The result is direct arteriolar vasodilation, as well as inhibition of platelet aggregation

Front 272

Pulsus alternans

Back 272

seen in patients w/ left ventricular dysfunction. Defined as beat to beat variation in magnitude of the pulse pressure in the presence of a regular cardiac rhythm

Front 273

7alpha hydroxylase

Back 273

estrogenic influence during pregnancy facilitate biosynthesis of choleterol by increasing the activity of HMG-CoA reductase. If 7alpha hydroxylase activity is reduced, then cholesterol isn't converted to bile acids, resulting in excess cholesterol secretion in bile and the formation of cholesterol stones

Front 274

Phenytoin S/E

Back 274

generalized lymphadenopathy (psuedolymphoma)

Front 275

Mycobacterium avium (MAC)

Back 275

causes disseminated disease in HIV+; weekly azithromycin is used as prophylaxis in patients at high risk for MAC. Treatment for MAC is clarithromycin/azithromycin + rifabutin + ethambutol

Hint 275

presents w/ nonspecific symptoms, fever, weight loss, diarrhea. Blood cultures are usually positive for acid-fast bacteria that grow best at 41C

Front 276

Fibronectin

Back 276

part of the extracellular matrix (long w/ collagen and laminin), bind integrins. Involved in the formation of granulation tissue

Hint 276

integrins can also bind to collagen or laminin

Front 277

Chronic topical corticosteroid therapy

Back 277

leads to atrophy/thinning of the dermis w/ loss of dermal collagen, drying, cracking, and or tightening of the skin, telangiectasias, ecchymoses

Front 278

Somatomedin C

Back 278

peptide that is structurally similar to insulin and is released in response to GH and stimulates growth in target cells

Front 279

Proopiomelanocortin (POMC)

Back 279

polypeptide precursor that goes through enzymatic cleavage and modification to produce beta-endorphins, ACTH, and MSH

Front 280

Reserpine

Back 280

MOA: VMAT inhibitor that prevents packaging of presynaptic vesicles of monoamines. Has been used as a cheap and old antihypertensive drug

Hint 280

S/E: predisposes to depression because it depletes NE and 5-HT

Front 281

Course of the median nerve

Back 281

arises from lateral and medial cords of the brachial plexus, courses with the brachial artery in the groove between the biceps and brachialis, crosses the medial aspect of the antecubital fossa, between the humeral and ulnar heads of the pronator teres, between the flexor digitorum superficialis and digitorum profundus, through the flexor retinaculum and into the hand

Front 282

Treatment for measles infection

Back 282

vitamin A

Front 283

Insulin profiles

Back 283

the best basal, long-acting insulin is glargine insulin. THe best short-acting insulin is aspart and lispro

Front 284

Most common antibody in the US

Back 284

anti-CMV antibody

Front 285

Jaundice of the newborn

Back 285

Day 1: ABO incompatibility. Day 2: Jaundice of the newborn

Front 286

Rhogam

Back 286

anti-Rh-IgG

Hint 286

IgG is used because the Fc receptors on phagocytic cells have the greatest affinity for Fc fragments of IgG antibodies. These specific IgGs also don't cross the placenta

Front 287

Chlamydia pneumoniae

Back 287

some relationship w/ atherosclerosis

Front 288

Difference between superior vena cava syndrome and pancoast tumor

Back 288

superior vena cava syndrome is due to a mediastinal mass, most commonly a bronchogenic carcinoma. Pancoast tumor is seen in the superior sulcus of the lung and leads to Horner's syndrome, not SVC syndrome.

Front 289

Differentiating complete and partial diabetes insipidus

Back 289

central DI has a more than 10% increase in urine osmolality after administration of desmopressin. Partial DI has a more moderate response, indicating that some vasopressin is present, but not enough to allow normal kidney function

Front 290

Treatment of hypertriglyceridemia

Back 290

First line: fibrates (activate PPAR-alpha and increases LPL activity). Second line: Niacin (decrease synthesis of hepatic VLDL and triglycerides)

Front 291

Nephrotic syndrome and hypercoagulable state

Back 291

Nephrotic syndrome, many important substances are lost in the urine, such as anticoagulant factors, especially antithrombin III. THis may lead to renal vein thrombosis and a hypercoagulable state. A varicocele may be a sentinel marker for this

Front 292

Lipofuscin

Back 292

a product of lipid peroxidation, it accumulates in aging cells (especially in patients w/ malnutrition and cachexia).

Hint 292

Example: patient dies from esophageal cancer. On autopsy, the heart is small and has no atherosclerosis. However, the cardiac cells have prominent intracytoplasmic granules that are tinged yellowish-brown

Front 293

Abnormal bleeding in patients w/ uremia

Back 293

uremia (seen in patients on dialysis) can cause a qualitative platelet disorder w/ normal PT, PTT, and platelet count

Front 294

Myoglobin

Back 294

the individual subunits of hemoglobin are structurally analogous to myoglobin. if separated, their graph will look like a myoglobin graph

Front 295

Her2/neu

Back 295

transmembrane glycoprotein that has intracellular tyrosine kinase activity. It is an epidermal growth factor that plays a role in growth and differentiation. Overexpression of the oncogene is seen in 30% of invasive cancers

Front 296

Cough, low grade fever, malaise after trip to the Great Lakes

Back 296

blastomyces dermatitidis

Front 297

Facial pain, headache, black necrotic eschar in nasal cavity + DKA

Back 297

mucormycosis. Best to take a biopsy to confirm diagnosis, not blood culture

Front 298

Ricketsia MOA

Back 298

invades endothelial cells, leading to vasculitis

Front 299

Megestrol acetate

Back 299

for patients who are taking chemotherapy and have lost their appetite, megestrol acetate increases appetite

Front 300

Acute viral hepatitis histology

Back 300

ballooning degeneration, hepatocyte necrosis, portal inflammation. Hepatitis B shows cytoplasm filled w/ spheres and tubules of HBsAg and the cytoplasm takes on a finely granular, eosinophilic "ground glass" appearance

Front 301

Prokaryotic rRNA/ribosomes

Back 301

16s rRNA sequence is found in the 30S ribosomal unit and contains a sequence that is complementary to the Shine-Dalgarno sequence on mRNA. The 23S rRNA of the 50S subunit facilitates peptide bond formation. Elongation factor G facilitates translocation, with energy supplied by GTP

Front 302

Androgenic alopecia (male pattern baldness)

Back 302

demonstrates polygenic inheritance w/ variable penetrance. Circulating androgens are thought to be correlated w/ severity

Front 303

HBsAg facts

Back 303

component of the HBV envelope, it's a noninfective glycoprotein that forms spheres and tubules 22 nm in diameter. Infected hepatocytes secrete enormous amounts of HBsAg, considerably exceeding the amount needed. This is why HBsAg levels are not indicative of virus replication

Front 304

Fenfluramine, dexfenfluramine, phentermine (phen phen)

Back 304

associated w/ secondary pulmonary hypertension

Hint 304

Example: 35 year old obese female presents w/ progressive dyspnea and dizziness w/ exertion. She follows a diet and has taken appetite suppressant medications in the past.

Front 305

Acyclovir crystalline nephropathy

Back 305

acyclovir crystals can precipitate if the patient is not adequately hydrated

Front 306

Fatty oxidation inhibitors

Back 306

newer agents that inhibit fatty acid oxidation and shift energy production to glucose oxidation. Glucose oxidation is thought to be more oxygen efficient and for this reason, fatty oxidation inhibitors are good for angina

Front 307

Atheroembolic disease of the renal arteries

Back 307

cholesterol-containing debris gets pushed from larger arteries and lodges in smaller vessels, causing ischemia. Renal biopsy shows needle-shaped cholesterol crystals that partially or completely obstruct the renal arterioles

Hint 307

73-year old male develops cyanotic toe discoloration following coronary angioplasty w/ elevated serum creatinine

Front 308

Risk factors for bone mass

Back 308

Low BMI, smoking history, glucocorticoid therapy, early menopause

Hint 308

Black race has higher bone density than caucasian race

Front 309

Diuretics w/ maximum amount of diuresis in a short period of time

Back 309

Loop diuretics (furosemide)

Front 310

How to increase HDL levels

Back 310

Niacin is the best agent for increasing HDL. Lifestyle modifications also increase HDL, but only 5-10%, whereas Niacin can increase it 25-35%. Statins (2-15%), fibrates (10-25%) are also helpful, but not first line

Front 311

Cystinuria and sodium cyanide-nitroprusside test

Back 311

defect in renal proximal tubules (COAL). This leads to aminoaciduria and precipitates stone formation. Kidney stones at a young age!

Hint 311

cyanide-nitroprusside test detects sulfhydryl groups and is a rapid qualitative determinant of the presence of urine cystine. Purple discoloration indicates amino acids in the urine

Front 312

Mycobacterium w/ twisted, serpentine cords

Back 312

this indicates "cord factor." Cord factor is a mycoside, meaning it is composed of two mycolic acid molecules bound to a disaccharide. The presence of cord factor correlates w/ virulence. Cord factor inactivates neutrophils, damaging mitochondria, and induce release of TNF

Front 313

Difference between dysplasia and carcinoma

Back 313

dysplasia is reversible, whereas carcinoma is irreversible

Front 314

PABA containing sunscreens

Back 314

widely used to prevent UVB damage. DO NOT block UVA wavelength range

Hint 314

Avobenzone can be added to PABA agents to absorb UVAI and UVAII. Many zinc oxide containing sunscreens provide base braod spectrum protection against UVB, UVAI, UVAII

Front 315

Huntington Disease pathogenesis

Back 315

alteration of gene expression in HD is thought to occur due to hypermethylation of histones. These hypermethylated histones bind DNA and prevent transcription of certain genes (such as a decrease in BDNF)

Front 316

Diseases w/ elevated CPK

Back 316

hypothyroidism, autoimmune disease (polymyositis/dermatomyositis), muscular dystrophies, and HMG-CoA reductase inhibitors

Front 317

Bioavailability of nitrates

Back 317

isosorbide mononitrate has the highest oral bioavailability (100%). Isosorbide dinitrate has a lower oral bioavailability because it undergoes first pass metabolism. Nitroglycerin is placed under the tongue and is absorbed systemically, but if it were to be swallowed, it would have a low bioavailability

Front 318

LPS

Back 318

Three regions: O antigen, core polysaccharide, and Lipid A. Lipid A is responsible for toxic properties of LPS that lead to sepsis and shock. O antigen is used to classify bacteria

Hint 318

LPS is released from bacterial cell membranes with cell-death or during cell division. It is not actively secreted by bacteria

Front 319

Ethical issue of telling someone if someone is a patient of yours

Back 319

it's unethical to discuss information regarding a patient's diagnosis, treatment, prognosis. The physician should neither confirm nor deny whether the person of interest is even a patient.

Front 320

Candida and the human immune system

Back 320

Local defense against candida is performed by T-cells, whereas systemic infection is prevented by neutrophils. For this reason, localized candidiasis is common in HIV-positive patients, while neutropenic individuals are more likely to have systemic disease

Front 321

Lactase-deficient individuals

Back 321

increased stool osmotic gap, increased breath hydrogen content, decreased stool pH upon lactose challenge

Front 322

Berkson's bias

Back 322

selection bias created by selecting hospitalized patients as the control group

Front 323

Acute gingivostomatitis

Back 323

think HSV-1

Hint 323

example: 1-3 year old comes in w/ fever, irritability, decreased oral intake, swollen gums w/ ulcerative lesions, enlarged, tender cervical lymph nodes. Oral scrapings demonstrate cells w/ intranuclear inclusions

Front 324

Serum sodium less than 120

Back 324

SIADH

Front 325

Ristocetin test

Back 325

activates GP Ib-IX receptors on platelets and makes them available for vWF binding. When vWF levels are decreased, there is poor platelet aggregation in the presence of ristocetin

Front 326

Anti-inflammatory cytokines

Back 326

IL-10 and TGF-B. TGF-B inhibits Th2 lymphocyte differentiation, cytotoxic T-cell activities, and B-cell immunoglobulin secretion.

Hint 326

IL-10 is produced by a variety of cells (mostly Th2) and inhibits IL-2 and IFN-gamma production by Th1 cells, while enhances Th2 activity. It also inhibits TNF-alpha and IL-12 production

Front 327

Amiodarone and Long QT

Back 327

Amiodarone increases the QT interval, but it has a low associated w/ torsades de pointes

Front 328

Bosentan

Back 328

oral endothelin-receptor antagonist recently approved for treatment of pulmonary hypertension. Since endothelin is a potent vasoconstrictor, bosentan prevents vascular and right ventricular hypertrophy by decreasing pulmonary arterial pressure

Front 329

Foscarnet

Back 329

induces renal wasting of magnesium and may lead to hypomagnesemia. Hypomagnesemia may reduce release of PTH, leading to hypocalcemia. Both of these electrolyte abnormalities may lead to seizure.

Hint 329

Example: 43 yo male w/ HIV comes in w/ impaired vision (supposed to know that this is CMV). Third day of hospitalization, he develops generalized seizures and is found to be hypocalcemia and hypomagnesemic

Front 330

Hemorrhagic cystitis in a kid

Back 330

adenovirus: small urinary infection outbreak among children in a daycare center. several boys develop acute onset dysuria and hematuria. Urine detects viral fragments

Front 331

Fibromyalgia

Back 331

chronic disorder of unclear etiology w/ diffuse musculoskeletal pain, insomnia, and emotional disturbances

Hint 331

contrast to polymyalgia rheumatica, where the patient is usually over 50, has pain and stiffness w/ fever, malaise, and weight loss, and is associated w/ temporal cell arteritis

Front 332

Liver and glycerol metabolism

Back 332

only the liver can utilize glycerol produced by the degradation of triglycerides by hormone sensitive lipase. In the liver, glycerol is used for tiacylglycerol synthesis, gluconeogenesis, and as an intermediate in glycolysis. The liver specific enzyme glycerol kinase converts glycerol into glycerol-3-phosphate

Front 333

"On-Off" phenomenon in Parkinson's

Back 333

unpredictable and dose-independent, where the levodopa effects are lost and hypokinesia and rigidity come back

Hint 333

The "wearing off" phenomenon of Parkinson's is due to progressive destruction of striatonigral dopaminergic neurons over a period of time

Front 334

D-xylose

Back 334

monosaccharide whose absorption is not affected by pancreatic insufficiency. Oral administration can be used to differentiate between malabsorption of pancreatic insufficiency and gastrointestinal mucosal etiology

Front 335

Glomus tumor (glomangioma)

Back 335

tender, small red-blue lesion under the nail bed. Originates from the modified smooth muscle cells that control thermoregulatory functions of dermal glomus bodies

Front 336

Increase in staphylococcal infections over the past 20 years

Back 336

due to increase in intravascular devices

Front 337

Penicillin structure

Back 337

structural analogs of D-ala-D-ala that bind to transpeptidases and inhibit them

Front 338

Treatment of bacteroides fragilis

Back 338

Piperacillin-tazobactam

Front 339

Janeway lesions

Back 339

due to microemboli to cutaneous blood vessels

Front 340

Multiple myeloma

Back 340

Easy fatigability (anemia), constipation (hypercalcemia), back pain (bone lesions), and azotemia (renal failure). On kidney biopsy, large eosinophilic casts composed of Bence-Jones proteins are seen

Front 341

Cheat sheet on antiarrhythmics

Back 341

Class IA: slow phase 0, prolonged phase 3, prolonged action potential. Class IB: little effect on phase 0, shortens phase 3, shortened action potential. Class IC: Drastic slowing of phase 0, no effect on phase 3. Digoxin, Adenosine, Ca2+ blockers: no changes to action potential

Front 342

Bronchioalveolar carcinoma

Back 342

arises from alveolar cells, represents 10% of all lung cancers. On light microscopy, the tumor is composed of tall columnar cells that line the alveolar space and secrete mucus into the alveoli. No evidence of stromal or vascular invasion

Front 343

Trigeminal nerve anatomy

Back 343

arises at the level of the middle cerebellar peduncle

Hint 343

don't confuse w/ facial nerve, which arises at the cerebellopontine angle

Front 344

HIV prophylaxis in pregnant women

Back 344

Nucleoside analog zidovudine reduces the risk of perinatal transmission by about 2/3

Front 345

Secretin and pancreatic juice composition

Back 345

as secretin increases and flow rate increases, HCO3- increases and Cl- decreases

Front 346

E. coli neonatal meningitis

Back 346

capsule (K-1 antigen) is the most important virulence factor

Front 347

C. difficile toxins

Back 347

toxin A (enterotoxin): neutrophil chemoattractant leading to mucosal inflammation, loss of water in gut lumen, and mucosal death. Toxin B (cytotoxin): causes actin depolymerization, loss of cellular cytoskeleton integrity, cell death, and mucosal necrosis

Front 348

What to do if a patient doesn't want to know the results of a biopsy

Back 348

asks if he or she has a family member who could make further decisions about health care

Front 349

BH4 cofactor

Back 349

used in hydroxylase enzymes for the synthesis of tyrosine, dopa, and serotonin, and NO

Front 350

Reid index

Back 350

ratio of thickness of mucous gland layer in the bronchial wall submucosa to teh thickness of the whole bronchial wall (bronchial epithelium, submucosa, don't include cartilage)

Front 351

Chronic interstitial nephritis

Back 351

chronic renal injury due to NSAID in patients with chronic pain

Front 352

Pancreatitis

Back 352

destruction of blood vessel walls can cause hemorrhage into necrotic areas. areas of white chalky fat necrosis are visible in pancreatic tissue. they can spread into the mesentery, omentum, and other parts of the abdominal cavity

Front 353

strawberry hemangioma

Back 353

first increase in size w/ the baby, then spontaneously regress

Front 354

Allosteric activator of gluconeogenesis

Back 354

Acetyl-CoA acts on pyruvate carboxylase to increase its activity

Front 355

Treatment of status epilepticus

Back 355

Infusion of benzodiazepine to stop current seizures and simultaneous administration of phenytoin to prevent recurrence of seizures

Front 356

Bromodeoxyuridine uptake

Back 356

indicates that a tumor has a high number of cells in the S phase and that they are preparing to divide, indicating a high grade tumor

Front 357

Type of insulin used for DKA tx

Back 357

Regular insulin, not lispro or aspart. Regular insulin is a short-acting insulin that takes action in 30 minutes, peaks at 2-4 hours, and lasts for six to eight hours

Front 358

Neuropathy in Diabetes mellitus

Back 358

caused by diabetic microangiopathy which leads to nerve ischemia. Sorbitol can also lead to osmotic nerve injury

Front 359

Pathogenesis of alcohol induced hepatic steatosis

Back 359

decrease in FFA oxidation secondary to excess NADH production

Front 360

Pro-carcinogens

Back 360

metabolized by cytochrome P450 monooxygenase, an enzyme system present in hepatic microsomes and the ER of varied other tissues. This system metabolizes steroids, alcohol, toxins, and other foreign substances by rendering them soluble and easier to excrete. However, this system also converts some pro-carcinogens, such as benz(o)pyrene into carcinogens

Front 361

Eosinophil defense against parasites

Back 361

stimulated by IgE bound to a parasitic cell, they destroy the parasite via antibody-dependent cellular cytotoxicity

Front 362

Niacin effets on hypertensives and diabetic treatments

Back 362

Niacin potentiates the effects of some anti-hypertensives medications, such as vasodilators and ganglion blocking agents, because of its vasodilatory effects (must decrease dose of antihypertensives). Niacin also increases insulin resistance, which sometimes manifests as acanthosis nigricans. Therefore, the dose of diabetic treatment should be increased

Front 363

Lac operon

Back 363

Lactose present in the cell binds the repressor protein, removing it from the operator, and allowing transcription of the lac genes. If glucose is present, it will inhibit adenylate cyclase, leading to a decrease in cAMP. cAMP will therefore not be around to bind CAP. cAMP-CAP is normally an activator of the lac operon. So with glucose, the lac operon is inhibited

Front 364

How to differentiate galactosemia and fructosemia

Back 364

Galactosemia presents w/ problems right when you start breastfeeding, whereas fructosemia starts after you start eating real food

Front 365

Adiponectin

Back 365

Increased by pioglitazone, leading to decreased insulin resistance

Front 366

Lobar pneumonia stages

Back 366

Congestion (first 24h): affected lobe is red, heavy, boggy w/ vascular dilation, alveolar exudate that contains mostly bacteria. Red hepatization (2-3 days): red, firm lobe w/ alveolar exudates that contain RBCs, neutrophils, and fibrin.

Hint 366

Gray hepatization (4-6 days): gray-brown firm lobe w/ RBCs disintegrate, alveolar exudate that contains neutrophils and fibrin. Resolution: restoration of normal architecture w/ enzymatic digestion of the exudate

Front 367

Bile transport in hepatocytes

Back 367

The liver takes up indirect bilirubin through a passive process (OATP organic anion transporting polypeptide) and secretes direct bilirubin through an active process (MRP2 organic anion transporter, a specific ATP powered pump). Thus, inhibiting the MRP2 pump would lead to decreased conjugated bilirubin in the bile ducts, but conjugated bilirubin would still leak out of the hepatocytes via the OATP and into the serum, resulting in a conjugated bilirubinemia

Front 368

Holiday heart syndrome

Back 368

alcohol binge consumption may lead to episodes of atrial fibrillation

Front 369

Pulmonary vascular resistance

Back 369

PVR is lowest at functional residual capacity (FRC). Inhalation increases PVR due to pressure placed on pulmonary vessels by the expanding alveoli. Forced exhalation increased PVR as well due to collapsing positive pressure placed on the lung parenchyma

Front 370

Biliary atresia

Back 370

occurs due to complete obstruction of extrahepatic bile ducts. Patients develop jaundice, dark urine, white stool, and a conjugated hyperbilirubinemia. Liver biopsy shows marked intrahepatic bile duct proliferation, portal tract edema and fibrosis, and parenchymal cholestasis

Front 371

Aortic rupture due to MVA

Back 371

most common site of injury is the aortic isthmus, which is the connection between the ascending and descending aorta distal to where the left subclavian artery branches off the aorta

Front 372

Xanthelasma and primary biliary cirrhosis

Back 372

Biliary cirrhosis can produce cholestasis, which can lead to hypercholesterolemia, which can lead to xanthelasma

Front 373

Wallerian degeneration

Back 373

occurs in the segment of the axon that has lost connection with the cell body. First, there is swelling and irregularity is noted in teh distal segment of the axon. Within a week, Schwann cells and macrophages begin digesting the axon.

Hint 373

Changes in the neuronal body after the axon is severed is called axonal reaction. It becomes swollen, rounded, with teh nucleus displaced to the periphery. Nissl substance becomes fine, granular and dispersed throughout the cytoplasm. These changes reflect an increased synthesis of protein by the cells in order to regenerate the severed axon

Front 374

Cortisol control of catecholamines

Back 374

Cortisol regulates PNMT, which is responsible for the production of epinephrine from NE

Front 375

Dobutamine effects

Back 375

Positive inotropic effect, weak chronotropic effect, increased cardiac conduction velocity

Front 376

Endometrium changes w/ ectopic pregnancy

Back 376

Endometrial biopsy would reveal decidual (gestational) changes without chorionic villi. This is due to the hormonal changes that occur during pregnancy (even though it's ectopic)

Front 377

Side effects of levodopa even with carbidopa

Back 377

Adding carbidopa reduces most peripheral side effects except for behavioral changes such as anxiety and agitation. In fact, they can get worse w/ carbidopa because carbidopa will increase levodopa going to the brain

Front 378

NF-kB

Back 378

Transcription factor responsible for cytokine production in the immune response to infectious pathogens. Crohn's disease is associated w/ an increased activity of NF-kB protein.

Front 379

Angiogenesis

Back 379

driven by 2 substances: VEGF and FGF. IL-1 and IFN-gamma can also be involved, but indirectly, because they stimulate the release of VEGF.

Front 380

Acute Chest Syndrome

Back 380

vaso-occlusive crisis localized to the pulmonary vasculature that can occur in patients w/ sickle cell anemia.

Front 381

Inactivation of Hep A

Back 381

chlorinated water, bleach, formalin, UV irradiation, or boiling at 85C for one minute

Front 382

Native valve bacterial endocarditis (NVBE)

Back 382

mitral valve prolapse is the most common cardiac abnormality predisposing to NVBE in 15-60 year olds. Rheumatic valvular disease is also a potential, although less common, precipitant of NVBE

Front 383

Transmural inflammation w/ fibrinoid necrosis of arteries

Back 383

Polyarteritis nodosa. Associated w/ HBV!

Front 384

Anal fissure

Back 384

longitudinal tear in the mucosa of the distal anal canal. Majority of fissures occur at the posterior midline of the anal verge

Front 385

Prognostic factor in poststreptococcal glomerulonephritis

Back 385

Age. 95% of children resolve completely, whereas only 60% of adults do. The rest lead to chronic GN or RPGN

Front 386

Fatty streaks

Back 386

earliest lesion of atherosclerosis and are present in individuals after age 10. Composed of intimal, lipid-filled foam cells, derived from macrophages and SMC that have engulfed lipoproteins

Hint 386

Although some may progress to athersclerotic plaques, in general their occurrence and location in a child do not predict the occurrence of atheromatous plaques later in life

Front 387

Endometriosis facts

Back 387

Nodularity of the uterosacral ligaments and fixed retroversion of the uterus are commonly seen. Painful intercourse is a result of retroversion of the uterus and endometrial implants on the uterosacral ligaments

Front 388

Paraneoplastic cerebellar degeneration

Back 388

most commonly associated w/ cancers of the lung, breast, ovary, and lymphoma. Antibodies seen: anti-Yo (ovary and breast), anti-P/Q (lung), and anti-Hu (lung). These antibodies react against tumor cells and also cross react w/ cerebellar Purkinje neurons, leading to ataxia, dysarthria, and nystagmus.

Front 389

Rituximab

Back 389

Monoclonal antibody against CD20 antigen and is used to treat some lymphomas

Front 390

Thiamine dependent enzymes

Back 390

Pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase, transketolase, branched chain ketoacid dehydrogenase

Front 391

Zolpidem

Back 391

short-acting hypnotic agents structurally unrelated to benzos. Used for short-term treatment of insomnia and has less potential for tolerance and addiction, no anticonvulsant properties, and no muscle relaxing properties

Front 392

Cell that has long, branched lipids within its bacterial wall

Back 392

Mycobacterium. This is referring to mycolic acids, which are long branched saturated fatty acids

Front 393

Liver biopsy w/ dense pigment composed of epinephrine within lysosomes

Back 393

Dubin-Johnson syndrome

Front 394

Sweat glands

Back 394

Apocrine: secretion is initially odorless but can become malodorous secondary to bacterial decomposition on the skin surface. Eccrine (merocine): present throughout the body and secrete watery fluid rich in sodium and chloride. Holocrine: found in association w/ sebaceous glands

Front 395

Zenker's diverticulum

Back 395

Can be due to cricopharyngeal muscle dysfunction. This will increase intraluminal pressure in the oropharynx and cause the mucosa to herniate through the wall and the point of weakness, forming the diverticulum

Front 396

Pancytopenia in SLE

Back 396

due to warm-hemolytic anemia

Front 397

Drug Combos

Back 397

Permissive: when one drug has an effect and the other doesn't, but when given together, the combined effect is increased. Synergistic: when two drugs have effects, but when added together, it's more than their sum. Additive: when two drugs have effects, and when added together, it's the sum of them.

Front 398

Post-herpetic neuralgia

Back 398

most common neurological complication of VZV

Front 399

Radiation effect on cells

Back 399

induces DNA damage through DNA double-strand fractures and the formation of oxygen free radicals

Front 400

Congenital developmental abnormalities

Back 400

Malformation: primary defect in cells or tissues that form an organ (Holoprosencephaly). Disruption: secondary destruction of a previously well-formed tissue or organ (amniotic band syndrome). Deformations: secondary to extrinsic compression (hip dislocation, clubbed feet). Sequence: single primary defect leads to a number of abnormalities (Potter syndrome)

Front 401

Serine and threonine phosphorylation and relationship w/ insulin resistance

Back 401

aberrant serine and threonine residue phosphorylation by serine kinase leads to insulin resistance. These aberrant phosphrylations can occur in the presence of TNF-alpha, catecholamines, glucocorticoids, and glucagon

Front 402

Colonization of MRSA on human

Back 402

asymptomatic colonization of the nasopharynx is the most common. This increases the risk of infections following surgery, peritoneal dialysis, and hemodialysis

Front 403

Leuprolide treatment

Back 403

initial increase in DHT and T levels, then a concordant decrease in DHT and T levels

Hint 403

This is in contrast to finasteride, which causes a concordant decrease in DHT levels

Front 404

Treatment of neonatal meningitis

Back 404

Ceftriaxone for Group B, HiB, Strep pneumo, and ampicillin for Listeria!

Front 405

Chronic lithium side effects

Back 405

Because it is exclusively excreted by the kidneys, anything that leads to increased PCT sodium absorption will lead to increased lithium levels. NSAIDs, thiazides, and ACEi are examples of drugs that do this

Hint 405

Example: woman w/ bipolar disorder comes in w/ involuntary movements, ataxia, and tremor that started 2 weeks ago.

Front 406

Renal stones that aren't seen on plain films

Back 406

Uric acid stones: only radiolucent stones, so they can't be visualized on plain films.

Front 407

Kozak consensus sequence

Back 407

found on eukaryotic mRNA 3 bases upstream of the AUG start codon. It serves as the initiator for translation. If a G replaces a C, then thalassemia intermedia is the result

Front 408

Subclinical hepatitis infection

Back 408

Most often HAV, where the patient is infected but never knows it, and then the infection resolves.

Front 409

Crohn's disease and kidney stones

Back 409

most often calcium oxalate kidney stones. This is due to impaired bile acid absorption in the terminal ileum, which leads to increased fat malabsorption. Lipids then bind calcium ions, and the resulting soap complex is excreted. Free oxalate can now be absorbed in the intestines, and this forms urinary calculi.

Front 410

Pure red cell aplasia

Back 410

rare form of marrow failure characterized by marked hypoplasia of marrow erythroid elements in the setting of normal granulopoiesis and thrombopoiesis.

Hint 410

Associated w/ thymoma and parvovirus B19 infection

Front 411

Carpal tunnel syndrome

Back 411

caused by median nerve compression. Most commonly associated w/ repetitive wrist movements, but also seen in hypothyroidism, DM, RA, and dialysis associated amyloidosis.

Hint 411

Hemodialysis MOA: may develop deposition of B2-microglobulin/amyloid deposition that can lead to median nerve compression and often manifests as BILATERAL carpal tunnel syndrome

Front 412

Treatment of hyperthyroidism w/ radioactive iodine

Back 412

Pretreatment w/ potassium perchlorate or pertechtenate will decrease the effects of the therapy because these compounds competitively inhibit the sodium-iodine transporters (NIS) at the basolateral membrane of the follicular cell

Front 413

First pass metabolism bypass

Back 413

Can be bypassed via IV, sublingual, or rectal administration of a drug

Front 414

Phases of ATN

Back 414

Initiation: injury to renal tubules. Maintenance: decreased urine output, fluid overload, hyperkalemia, metabolic acidosis. Recovery: gradual increase in urine output, hypokalemia

Front 415

Porcelain gallbladder

Back 415

bluish, brittle, calcium-ladden gallbladder wall that can develop in patients w/ chronic cholecystitis. Patients are often symptomatic. 11-33% of this patient population will eventually develop gallbladder carcinoma

Front 416

Non-rhythmic conjugate eye movements w/ myoclonus (opsoclonus-myoclonus)

Back 416

Neuroblastoma. MC extracranial childhood cancer, most commonly in the adrenal medulla. The opsoclonus-myoclonus part is a paraneoplastic syndrome. N-myc association

Front 417

Anastrozole

Back 417

selective aromatase inhibitor used in the treatment of breast cancer

Front 418

Location of colon cancer

Back 418

rectosigmoid > ascending colon

Front 419

Isoniazid S/E

Back 419

hepatotoxic: can cause acute mild hepatic dysfunction, or, in a small percentage of cases, cause frank hepatitis w/ fever, anorexia, and nausea

Front 420

Pancreatic pseudocyst epithelium

Back 420

Epithelium consists of granulation tissue and fibrotic tissue. Unlike a true cyst, pseudocysts are not lined by epithelium

Front 421

EPO production

Back 421

endothelial cells of the peritubular capillaries of the kidneys

Front 422

Primidone

Back 422

antiepileptic that is metabolized to phenobarbital and phenylethylmalonamide (PEMA)

Hint 422

Clinical scenario: 24 year old with a history of seizures comes into the ER sedated and not oriented. Labs show an elevation of phenobarbital levels (answer choices don't show any obvious barbiturates)

Front 423

Workup of metabolic alkalosis

Back 423

check urine chloride: decreased indicates loss of HCl from stomach (vomiting or nasogastric suction), diuretic use shows increased urine Cl, increased aldosterone secretion which increases Cl concentration in the urine (this one, unlike the first 2, is saline-resistant because giving saline will not fix the metabolic alkalosis)

Front 424

Spongiosis

Back 424

primary histologic finding in patients w/ eczematous dermatitis (contact dermatitis)

Front 425

Pulsion

Back 425

constant pressure in a hollow organ that leads to things like diverticuli in the colon (false since the mucosa and submucosa punch out of the muscularis)

Front 426

Pulmonary hamartoma (pulmonary chondroma)

Back 426

Most common benign lung tumors that present in the periphery. They are composed of disorganized cartilage, fibrous and adipose tissue

Front 427

Presence of erythroid percursors in organs such as the liver and spleen

Back 427

indicative of extramedullary hematopoiesis, a condition characterized by EPO-stimulated, hyperplastic marrow cell invasion of extramedullary organs. Seen in severe chronic hemolytic anemias, such as B-thalassemia, and myelofibrosis

Front 428

Monitoring for symptoms in patients w/ ankylosing spondilitis

Back 428

Enthesopathies (inflammation at sites of tendon insertion) are common in ankylosing spondylitis. Involvement of the costcovertebral and costrosternal junctions may cause limitation of chest movements, resulting in hypoventilation, which is why the chest expansion should be checked often

Front 429

Tracheal deviation clues in a smoker

Back 429

Towards side of lesion: most