Comlex: Dit : Day 15

Front 1

what immunosuppresant matches the following:

Derivative of 6-MP:
Nephrotoxic in 75% of pts:
Inhibits dihydrofolate reductase:

Back 1

Derivative of 6-MP: Azathropine
Nephrotoxic in 75% of pts: Cyclosporine (prevent with mannitol)
Inhibits dihydrofolate reductase: MTX

Front 2

what enzyme is deficient in the following dz's?

Fructose intolerance:
essential fructosuria:
classic galactosemia:

Back 2

Fructose intolerance: aldolase B
essential fructosuria: fructokinase
classic galactosemia: galactose-1-phosphate uridyltransferase

Front 3

what might you see in a first trimester ultrasound of a fetus with Downs

Back 3

increased nucal translucency

Front 4

which protozoa fits the following:

Ixodes tick is the vector:
Sodium stibogluconate is the tx:
Maltese cross seen in RBC:
severe diarrhea in AIDS:

Back 4

Ixodes tick is the vector: bebesia
Sodium stibogluconate is the tx: Leschmania
Maltese cross seen in RBC: Babesia
severe diarrhea in AIDS: cryptosporidium

note: babesia is often a co-infection of Lyme and gives malaria like sx

Front 5

what is the result of a glycolytic enzyme def? What is the result of a def in pyruvate dehydrogenase

Back 5

RBC hemolysis

Neurologic defects

Front 6

what is responsible for the release of renin?

Back 6

JG apparatus, specifically the JG cells secrete it, while the macula densa senses the amount of Na

Front 7

give the breakdown of your % body water

Back 7

60% total body water
40% ICF
20% ECF

Front 8

what is the water under the bridge idea?

Back 8

ureters pass under the uterine artery or ductus deferens

Front 9

CL=

Back 9

UV/P

u-urine conc of X
p=plasma conc of X
v=urine flow rate

Front 10

FF=?

Back 10

GFR/RPF

Front 11

GFR can be estimated with?

RPF?

Back 11

GFR--creatinine

RPF--PAH

Front 12

what segment of the renal tubule matches the following statement

reabsorbs 67% of fluid and electrolytes filtered by the glomerulus:

segment responsible for concentrating urine:

site of secretion of organic anions and cations:

always impermeable to water

permeable to water only in the presence of ADH

Back 12

reabsorbs 67% of fluid and electrolytes filtered by the glomerulus: Prox tub

segment responsible for concentrating urine: Collecting duct

site of secretion of organic anions and cations: Prox

always impermeable to water: ascending loop

permeable to water only in the presence of ADH: collecting duct

Front 13

what segment of the renal tubule matches the following statement

site of Na/2Cl/K cotransport:

site of isotonic fluid reabsorption:

site responsible for diluting urine:

only site where glucose and amino acids are reabsorbed:

water reabsorption in the loop of henle:

Back 13

site of Na/2Cl/K cotransport: ascending loop

site of isotonic fluid reabsorption: prox tub

site responsible for diluting urine: thick ascending

only site where glucose and amino acids are reabsorbed: prox tub

water reabsorption in the loop of henle: thin descending

Front 14

where are Ca and Mg reabsorbed? What happens with water here

Back 14

Thick ascending limb

water cannot get in

Front 15

where in the kidney does PTH have its effect on Ca?

Back 15

leads to calcium reabsorption in the early distal tubule

Front 16

what is the role of principle cells and intercalated cells? where does this occur

Back 16

Principle: reabsorb H2O/Na, secrete K

Intercalated cells: secrete H/HCO3, reabsorb K

collecting duct

Front 17

What are the 2 types of intercalated cells

Back 17

Alpha: secrete Acid

Beta: secrete bicarb

Front 18

what affect does aldosterone have on the intercalated cells and principle cells of the collecting duct?

Back 18

intercalated: stimulates H secretion

principle: Na reabsorption and K secretion

Front 19

tx for hyperkalemia?

Back 19

Insulin to shift K into cells

must also give glucose to prevent hypoglycemia

Front 20

what diuretic would you use for a woman with HTN and osteoporosis?

Back 20

Thiazide

saves Ca

Front 21

what is the acid base disorder

pH: 7.42
HCO3: : 32
pCO2: 64

Back 21

Mixed

normal pH: 7.35-7.4
normal pCO2: 35-45
normal HCO3: 22

Front 22

what is the acid base disorder

pH: 7.66
HCO3: 36
pCO2: 30

Back 22

combined alk

normal pH: 7.35-7.4
normal pCO2: 35-45
normal HCO3: 22

Front 23

what is the acid base disorder

pH: 7.10
HCO3: : 15
pCO2: 50

Back 23

Combined acidosis

normal pH: 7.35-7.4
normal pCO2: 35-45
normal HCO3: 22

Front 24

what is the acid base disorder

pH: 7.34
HCO3: : 31
pCO2: 62

Back 24

resp acid with compensation

normal pH: 7.35-7.4
normal pCO2: 35-45
normal HCO3: 22

Front 25

what is the acid base disorder

pH: 7.39
HCO3: : 12
pCO2: 22

Back 25

mixed

normal pH: 7.35-7.4
normal pCO2: 35-45
normal HCO3: 22

Front 26

what is the equation of anion gap?

Back 26

Na - (Cl + HCO3)

Front 27

what are the causes of increased anion gap

Back 27

MUDPILES

Methanol (formic acid)
Uremia
Diabetic ketoacidosis
Paraldehyde/phenformin
Iron tablets or INH
Lactic acidosis
Ethylene glycol (oxalic acid)
Salicylates

Front 28

where do type 1, 2, and 4 RTA occur? what are K levels like

Back 28

1: distal (collecting tubule can't excrete H); hypokalemia

Type 2: proximal (defect in prox tubule HCO3 reabsorption); hypokalemia

type 3: hypoaldosteronism or lack of collecting tubule response to aldosterone, hyperkalemic

Front 29

what effect will a renal stone that obstructs the ureter have on GFR and FF?

Back 29

decrease both

Front 30

what is the maximal serum glucose conc at which glucose can be absorbed in the tubules

Back 30

350micro grams/dL

Front 31

what change in the metabolic panel might you see in a young pt on a B-agonist for status asthmaticus?

Back 31

B-agonists will lead to hypokalemia

Front 32

What diuretic can be used in the following situations:

Edema a/w nephrotic syndrome:
Increased intracranial pressure:

Back 32

Edema a/w nephrotic syndrome: Loop

Increased intracranial pressure: Mannitol

Front 33

what type of diuretic are the following

Bumetanide:
Metolazone:

Back 33

Bumetanide: Loop
Metolazone: Thiazide

Front 34

if you have casts in the urine what does this tell you in general

Back 34

that the problem is in the kidney

Front 35

most common glomerular dz in HIV pts

Back 35

FSGS

Front 36

EM shows tram-track. what is this and what is it associated with?

Back 36

type I MPGN--associated with HBV and HCV

(also: SLE, subacute bacterial endocardititis, mixed cryoglobulinemia)

Front 37

EM shows dense deposits. What is this an what is it associated with?

Back 37

MPGN type II

C3 nephritic factor

Front 38

what 3 things can lead to using up complement?

Back 38

Post strep
MPGN type II
SLE

Front 39

which glomerular dz causes the following:

IF: granular pattern of immune complex deposition; LM: hyperceullar glomeruli:

LM: Segmental sclerosis and hyalinosis:

Back 39

IF: granular pattern of immune complex deposition; LM: hyperceullar glomeruli: Acute post strep

LM: Segmental sclerosis and hyalinosis: FSGS

Front 40

GLomerular histology reveals multiple mesangial nodules. What is this indicactive of?

Back 40

Diabetic glomerulonephropathy

Front 41

4 yo with facial edema and proteinuria. Tx?

Back 41

this is MC

Corticosteroids

Front 42

proteus causes stag horn calculi, what is the content of these stones

Back 42

Ammonium magnesium phosphate

Front 43

pt with gout or leukemia is likely to get what kind of kidney stone

Back 43

uric acid

Front 44

what happens in acute interstitial nephritis? what will you see? what is it due to?

Back 44

acute renal failure
will see eosinophillia

due to drugs (1-2 weeks after administration

kids: ABX
adults: NSAIDs

tx: 2 weeks corticosteroids

Front 45

+4 blood in urine, no RBC on urine cell count...

Back 45

Rhabdomyolysis / myoglobinuria

Front 46

what causes prerenal azotemia? what will BUN/Cr be like?

Back 46

decreased RBF (hypotension: dehydration,shock,renal vasoconstriction, hepatorenal syndrome)

BUN/Cr >20 (BUN is really high because you are trying to hang on to everything)

Front 47

what causes intrinsic renal failure? BUN/cr lvls?

Back 47

acture tubular necrosis or ischemia/toxins

<15

Front 48

what causes post renal azotemia? what is BUN/Cr like?

Back 48

outflow obstruction (stones, BPH, neoplasia, congenital anomalies)

>15 (10-20, this is in a normal range)

Front 49

sorry, i couldn't help myself...

what are the 2 most common causes of chronic kidney dz

Back 49

HTN

Diabetes

Front 50

ADPKD vs ARPKD

leads to potters:
hepatic fibrosis:
polycystic liver dz:
Berry aneurysms:
death can be due to malignant HTN:

Back 50

leads to potters: AR
hepatic fibrosis: AR
polycystic liver dz: AD
Berry aneurysms: AD
death can be due to malignant HTN: (i had a question on this, it was an adult, and this is what killed him, so I am saying AD for now)

Front 51

U waves on ECG is due to what

Back 51

Low K

Front 52

disoreintation stupor, or coma is assoc with what ion?

Back 52

Na

Front 53

pt is getting an infusion with substance X. Later the pt has decreased DTRs, delirium, and cardiopulmonary arrest. What was substance X

Back 53

Mg

Front 54

most common tumor of the urinary tract system?

histological appearance of renal cell ca?

histological appearance of chronic pyelonehpritis?

can assoc with schistosoma haematobium?

Back 54

most common tumor of the urinary tract system: TCC

histological appearance of renal cell ca: Polygomal Clear Cell

histological appearance of chronic pyelonehpritis: Thyroidsim

can assoc with schistosoma haematobium: Bladder SCC

Front 55

IF granular pattern of immune complex deposition; LM: diffuse capillary thickening

Back 55

Membranous

Front 56

IF granular pattern of immune complex deposition; LM: hypercellular glomeruli

Back 56

Post strep glomerulinephritis

Front 57

HYQ: CT scan reveals massively enlarged kidneys bilaterally. Diagnosis?

Back 57

ADPCKD

Front 58

what is responsible for the biconcave shape and flexibility of RBCs

Back 58

spectrin

Front 59

Anisocytos=

Poikilocytosis=

Back 59

Anisocytos= varying RBC size

Poikilocytosis= varying RBC shape

Front 60

survival time of RBCs?

platelets?

Back 60

RBC=120

Platelets=8-10

days

Front 61

what is the DNAAACP for eosinophils

Back 61

Drugs
Neoplasm
Asthma
Allergic process
Addisons
Collagen vascular dz
Parasites

Front 62

what type of cell are barr bodies in?

Back 62

Neutrophils

Front 63

What are the phagocytes for the following locations:

Brain:
Liver:
Joint:
Lung:

Back 63

Brain: microglia
Liver: kupffer cell
Joint: A cells
Lung: Dust cells

Front 64

what cell traditionally has memory and plays a role in immunizations

*

Back 64

B lymphocyte

Front 65

what is the bridge btw coagulation and complement pathway

Back 65

factor XII

Front 66

why do you get purple toes etc with starting Warfarin

Back 66

while warfarin will eventually inhibit 10,9,7,2, they accutely inhibit C and S leading to hypercoaguability

give Heparin for first few days to prevent this

Front 67

MOA of heparin

Back 67

inhibits thrombin (factor II)

co factor of antithrombin

ACTIVATES ANTITHROMBIN WHICH IN TURN INHIBITS THROMBIN

Front 68

warfarin or heparin

which if either can be used in pregnancy

Back 68

Heparin

Front 69

pt is on anticoagulant and develops thrombocytopenia which was it?

Tx? MOA?

Back 69

heparin- Heparin induced thrombocytopenia (causes hypercoaguable state)

Lepiruidn or bivalirudin--directly inhibit thrombin

Front 70

what drug inhibits ADP induced expression of GpIIb/IIIa

Back 70

Clopidogrel

Ticlopidine

Front 71

what are the following RBCs seen in

Basophilic stippling:

Bite Cells:

Schistocyte/helmet cell:

Target Cells:

Heinz bodies:

Howell-Jolly bodies:

Back 71

Basophilic stippling: Lead

Bite Cells: G6PD

Schistocyte/helmet cell: DIC/TTP/HUS/traumatic hemolysis

Target Cells: HbC dz, Asplenia, liver dz, thalassemia (THAL)

Heinz bodies: G6PD def

Howell-Jolly bodies: asplenia (sickle cell, ITP, splenic trauma)

Front 72

what is the change in the Hb of sickle cell

Back 72

Glu-->Val in B chain

Front 73

4 causes of microcytic hypochromic anemia...what is the MCV

Back 73

MCV<80

Iron def
Thalassemia
Lead poisoning
sideroblastic

CKD -apparently starts normocytic

Front 74

marrow hyperplasia leading to chipmunk facies and crew cut xray

Back 74

B-thal major

Front 75

tx for lead poisoning in adults/kid

Back 75

adult: dimercaprol

kid: succimer

Front 76

hypocellular bone marrow with fatty infiltration....

Back 76

Aplastic anemia

(pancytopenia--anemia, neutropenia, and thrombocytopenia)

Front 77

if you have sickle cell or hereditary spherocytosis, what can lead to aplastic crisis?

Back 77

parvo B19

Front 78

what can you use in the treatment of sickle cell anemia?

Back 78

Hydroxyurea to increase HbF

bone marrow transplant is curative

Front 79

what are the 5 causes of megaloblastic anemia

Back 79

Methotrexate
AZT
Phenytoin
Liver dz
Ethanol

MAPLE

Front 80

what is the cause of anemia given the following statement:

Microcytic anemia reversible with B6:

HIV positive pt with macrocytic anemia:

normocytic anemia and elevated creatinine :

Back 80

Microcytic anemia reversible with B6: sideroblastic anemia

HIV positive pt with macrocytic anemia: Zidovudine

normocytic anemia and elevated creatinine : kidney failure

Front 81

pt presents with painful abdomen, port red urine, polyneuropathy, and psychological disturbances. What is this and what drug might they be on? enzyme affected

Back 81

Acture intermittent porphyria

Barbiturates

porphobilinogen deaminase

Front 82

man presents with blisters on sun exposed areas of his body and he has darkening of his face with a large amount of hair. What does he have? affected enzyme?

Back 82

Porphyria cutanea tarda

Uroporphyrinogen decarboxylase

Front 83

decreased Gp1b-->defect in platelet to collagen adhesions

Back 83

Bernard soulier dz

Front 84

GpIIb/IIIa antibodies-->peripheral platelet destruction

Back 84

Idiopathic thrmobocytopenic purpura (ITP)

Front 85

decreased GpIIb/IIIa -->defect in platelet to platelet aggregation

Back 85

Glanzmann's thrombasthenia

Front 86

pt has neurologic and renal sx, fever, thrombocytopenia, and microangiopathic hemolytic anemia...what does he have? what is deficient?

Back 86

Thrombotic thrombocytopenic purpura (TTP)

def of ADAMTS 13 (vWF metalloprotease)-->degrades vWF thrombosis

Front 87

what are some of the causes of DIT

Back 87

STOP Making New Thrombi

Sepsis (G-)
Trauma
Obstetric
Pancreatitis
Malignancy
Nephrotic syndrome
Transfusion

Front 88

What is the rate-limiting step in heme synthesis

Back 88

aminolevulinic acid synthase

Front 89

what are the following tests associated with:

Hams:
DEB:
Heinz body:
D-Dimer:
Basophilic stippling:
Osmotic fragility test:
(+) ristocetin test:

Back 89

Hams: Paroxsymal nocturnal hemoglobinuria
DEB: Fanconi's anemai
Heinz body: G6PD
D-Dimer: DIC
Basophilic stippling: Thalassemia, ACD, Iron def, LEAD POISONING
Osmotic fragility test: hereditary spherocytosis
(+) ristocetin test: vWF dz

Front 90

Hodgkin vs Non-Hodgkin

Reed-Sternberg Cells
Bimodal distribution:
Assoc with HIV
B symptoms:
Mostly involves B cells:
Peripheral nodes, noncontiguous spread:
Local nodes: contiguous spread:

Back 90

Reed-Sternberg Cells: H
Bimodal distribution: H
Assoc with HIV: NH
B symptoms: H
Mostly involves B cells: NH
Peripheral nodes, noncontiguous spread: NH
Local nodes: contiguous spread: H

Front 91

what is the most common type of AML and the translocation associated?

Back 91

M3 type

t(15,17)

Front 92

Leukemia buzzwords:

Smudge cell:
Children:
TRAP:
Philadelphia chromosome:
Auer Rods:

Back 92

Smudge cell: CLL
Children: ALL
TRAP: Hairy cell
Philadelphia chromosome: CML
Auer Rods: AML

Front 93

What is most likely to cause progression to AML

Back 93

CML

Front 94

What drug targets the Philadelphia chromosome? what is this treating?

Back 94

Imatinib

CML

Front 95

what leukemia/lymphoma is most likely to cause bone pain

Back 95

ALL

Front 96

Birbeck granules ("tennis rackets" on EM)

Back 96

Langerhans cell histiocytosis

Front 97

woman says she itches when she is in the shower. She says she has pain in her hands/fingers that is relieved with aspirin. what does she have

Back 97

polycythemia vera

Front 98

give the hematological dz that matches the following:

AML assoc with Downs:

Leukemia with more mature cells and less than 5% blasts:

PAS + acute leukemia:

Back 98

AML assoc with Downs: M7 AML (ALL is most common)

Leukemia with more mature cells and less than 5% blasts: Chronic leukemia

PAS + acute leukemia: ALL

Front 99

give the hematological dz that matches the following:

Greater than 20% blasts in marrow:

myleodysplastic/proliferative disorders may progress to:

numerous basophils, splenomegaly, and negative for leukocyte alkaline phosphatase (LAP):

Back 99

Greater than 20% blasts in marrow: acute leukemia

myleodysplastic/proliferative disorders may progress to: AML

numerous basophils, splenomegaly, and negative for leukocyte alkaline phosphatase (LAP): CML

Front 100

give the hematological dz that matches the following:

most common neonatal leukemia:

associated with the BCR-ABL genes:

assoc with sjogren, hashimoto's thyroiditis, and h pylori:

Back 100

most common neonatal leukemia: M7 AML

associated with the BCR-ABL genes: CML

assoc with sjogren, hashimoto's thyroiditis, and h pylori: Marginal cell MALToma

Front 101

give the hematological dz that matches the following:

acute leukemia positive for peroxidase:

solid sheets of lymphoblasts in marrow:

PAS (-) acute leukemia:

Back 101

give the hematological dz that matches the following:

acute leukemia positive for peroxidase: AML

solid sheets of lymphoblasts in marrow: ALL

PAS (-) acute leukemia: AML

Front 102

describe the following in DIC

BT:
PT:
PTT:
Platelet count:

Back 102

BT: increase
PT: increase
PTT: increase
Platelet count: decrease

Front 103

HYQ: 11 year old child presents with a chronic non-healing ulcer on his foot and imaging shows a small calcified spleen. What drug can improve his sx?

Back 103

This is sickle cell

Hydroxyurea