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88 Cards in this Set

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A liver biopsy shows large hepatocytes filled with finely granular, homogeneous, pale cytoplasm

Hepatitis B: causes hepatocellular cytoplasm to fill with HBsAg, fine granular, dull eosinophilic, "ground glass" appearance

Hepatitis B: causes hepatocellular cytoplasm to fill with HBsAg, fine granular, dull eosinophilic, "ground glass" appearance

Headaches, nausea, tremulousness, sweating

BP: 200/120 standing 190/110 supine

Increase urinary Vanillylmandelic acid excretion

CT: Right sided adrenal mass on CT scan

Which one is the embryological origin of thyroid cells in this disease?

Description indicates pheochromocytome, usually associated with MEN syndromes:

MEN 1: Pth, Pan, Pit

MEN 2A: M.C.Th, Pheo, Pth

MEN 2B: M.C.Th, Pheo, Muc. Neuromas

Chromaffin cells and parafollicular cells (c-cells) of the thyroid originate from neural crest

Phenoxybenzamine description

Non selective, irreversible a1, a2 adrenergic antagonist that reduces the number of receptors available for norepinephrine binding

Mechanism of actions of Thiazolidinediones

Pioglitazone, Rosiglitazone

Decrease insulin resistance by binding to PPARy, alter gene expression and protein synthesis, can result in a delayed in action to several days

Up regulates:

Glut 4: increase glucose uptake

Adiponectin: increase insulin response of adipocytes

Mechanism of action of Sulfonylureas

1 generation: tolbutamide, chlorpropamide

2 generation: Glyburide, glimepiride, glipizide

Increase insulin release from the pancreatic B cells

Close K+ channel in B cell, insulin release via increase Ca++ influx

Mechanism of action of Biguanides: Metformin

Non competitive inhibitor of mitochondrial glycerol 3 phosphate dehydrogenase, important for maintaining hepatic redox state. Inhibition of this enzyme causes a significant reduction in hepatic glucose production

Hyperthyroidism radioactive therapy 131 I

Which substances can decrease the uptake by competitive inhibition?

Perchlorate and Pertechnetate ions absorbed into the thyroid gland via Na- Iodide symporter

15 year old caucasian male with gait instability, frequent falls, kyphoscoliosis, per caves, lower extremity ataxia, impaired position and sensation (dorsal column degeneration)

Autosomal recessive, mutation chromosome 9, increase number of trinucleotide repeats, Friederich Ataxia, patient most likely will die of cardiomyopathy, also complicated with DM

Baby with poor feeding, weakness, constipation, complete loss of extremity muscle tone, vaccines up to date, nutrition fruit and honey. Which test you would ask for?

Stool for bacterial toxins, looking for C. botulinum spores

In adults the same disease can results for consumption of canned foods

Patient receives a liver transplant. 1 week after the surgery develops desquamating skin rash, bloody diarrhea, multiple ulcerations of intestinal mucosa. What is the cause?

(GVHD) Graft vs host disease mediated by T- lymphocytes of the donor tissue that are sensitized against MHC antigens of recipient. Skin, liver and intestine are commonly involved.

When a transplant rejection is Hyperacute?

Within minutes, pre existing recipient antibodies react to donor antigen (type II reaction), activate complement

Widespread thrombosis of graft vessels- ischemia/ necrosis

Graft must be removed

When a transplant rejection is Acute?

Weeks to months, Cellular: CTL's activated against donor MHC's

Humoral: similar to hyper acute, except antibodies develop after transplant

Vasculitis of graft vessels wit dense interstitial lymphocytic infiltrate

Prevent/ reverse with immunosuppresants

When a transplant rejection is Chronic?

Months to years

Recipient T cells perceive donor MHC as recipient MHC and react against donor antigens presented

Cellular and humoral

Irreversible. T cell antibody- mediated damage

Heart atherosclerosis, Lung bronchiolitis obliterans, Liver vanishing bile ducts, Kidney vascular fibrosis, glomerulopathy

Oral lesions scraping cells with intranuclear inclusions.

Herpes simplex virus type 1, Enveloped double stranded DNA, gingivostomatitis

What are the types of urinary incontinency, etiology and symptoms?

Stress: loss of urethral support, IAB pressure exceeds urethral sphincter pressure, due to coughing, sneezing, laughing, lifting

Urge: Detrusor overactivity, sudden, overwhelming or frequent need to empty the bladder

Overflow: Impaired detrusor contractility, bladder outlet obstruction, constant involuntary dribbling and incomplete emptying.

Which one is the most important mediator of coronary vascular dilation?

Nitric oxide, large arteries, pre arteriolar vessels, synthesized from argininine and O2 by endothelial cels, causes vascular smooth muscle relax ion by a guanylate cyclase mediated cGMP second messenger system.

Adenosine, a product of ATP metabolism, acts as vasodilatory in small coronary arterioles

Southern Blot, Northern Blot, Western Blot, Southwestern

DNA, RNA, Protein, DNA binding protein

Cardiac tissue conduction velocity, faster to slower

Purkinje system, Atrial muscle, Ventricular muscle, AV node

Park At Ventura Avenue

What is the Kozak sequence?

Play a role in the initiation of translation (mRNA binding to ribosomes), a mutation 3 bases upstream from the start codon (AUG) in this sequence is associated with thalassemia intermedia.

Causes of lactic acidosis

1) Enhanced metabolic rate (seizures, exercise)

2) Reduced oxygen delivery (cardiac or pulmonary failure, shock, tissue infarction)

3) Diminished lactate catabolism due to hepatic failure or hypo perfusion

4) Decreased oxygen utilization (cyanide poisoning)

5) Enzymatic defects in glycogenolysis or gluconeogenesis

How decrease oxidative phosphorylation in septic shock increases anion gap?

In septic shock there is an impaired tissue oxygenation, leading to the shunting of pyruvate to lactate after glycolysis, increasing the lactic acid formation

Name the causes of reversible cell injury (with O2)

1) ATP depletion

2) Cellular/mitochondrial swelling (decrease ATP-> decrease activity of NA/K pump)

3) Nuclear chromatin clumping

4) Decrease glycogen

5) Fatty change

6) Ribosomal/Polysomal detachment (decrease 7) protein synthesis)

8) Membrane blebbing

Name the causes of irreversible cell injury

1) Nuclear pyknosis, karyorrhexis, karyolysis

2) Plasma membrane damage ( degradation of phospholipid)

3) Lysosomal rupture

4) Mitochondrial permeability / vacuolization

Phospholipid- containing amorphous densities within mitochondria

How you can enhance morphine tolerance?

Activation of NMDA receptors by glutamate, increasing phosphorylation of opioid receptors and increasing nitric oxide levels

NDMA blockers like ketamine, block the actions of glutamate and decrease morphine tolerance

What is the mechanism of erythroblastosis fetalis?

Most common due to maternal sensitization to Rh during a prior pregnancy with an Rh(D)+ fetus.

In subsequent Rh(D)+ pregnancies, maternal anti-Rh(d) IgG antibodies cross the placenta and cause fetal hemolysis

Clinical findings: anemia, jaundice, generalized edema (hydrops fetalis), nucleated erythrocytes, extramedullary hematopoiesis.

What is Infectious dose ID50%?

Name microorganisms that can cause diarrhea with small inoculum

Corresponds to the minimum number of organisms required to cause disease in 50% of affected individuals

Shigella (10-500 cells), Campylobacter jejuni (500 cells), E.Histolytica (1-10 organisms), Giardia lamblia (1-10 organisms)

When you use chi square?

To test the association between 2 categorical variables, patients are divided in 2 groups based on exposure, and the number of patients that experience each outcome is recorded in 2x2 table.

When you use two sample zest and two sample t test?

To compare 2 group of means, not categorical variables, ex. fibrinogen levels as numerical values mg/dL instead of categorically

When you use analysis of variance (ANOVA)?

To compare the means of 2 or more groups. Ex. ANOVA analysis could be used to assess for differences in mean blood pressure among 3 sample populations grouped by exercise status (never exercise, occasionally, frequently)

What is the mechanism of the statins?

Inhibit conversion of HMG-CoA to mevalonate (a cholesterol precursor)

Causes hepatocytes to increase their LDL receptor density as a means of increasing their uptake of circulating LDL

* LDL decreases, HDL increases, Triglycerides decreases

What are the side effects of statins?

Hepatotoxicity (increase LFT's)

rhabdomyolysis (esp with fib rates and niacin)

What is the bile acid resins mechanism of action? Cholestyramine, colestipol, colesevelam)

Prevent intestinal reabsorption of bile acids; liver must use cholesterol to make more

*LDL decrease, HLD increase, TGL increase

What are the side effects of bile acid resins?

GI disconfort

Decrease absorption of fat soluble vitamins

Cholesterol gallstones

What is the mechanisms of action of Niacin (B3) as a lipid lowering agent?

Inhibit lipolysis in adipose tissue; reduces hepatic VLDL synthesis

*LDL Decrease, HDL increase, TGL decrease

What are the side effects of Niacin used as a lipid lowering agent?

Red, flushed face, which is decreased by aspirin or long term use.

Hyperglycemia (acanthosis nigricans)

Hyperuricemia (exacerbates gout)

What is the mechanism of action the Cholesterol absorption blockers? Ezetimibe

Prevent cholesterol absorption at small intestinal brush border

*LDL decrease, HDL no change, TGL no change

What are the side effects of Cholesterol absorption blockers? Ezetimibe

Rare, increase LFT's, diarrhea

What is the mechanisms of action of the fib rates? Gemfibrozil, clofibrate, benzafibrate, fenofibrate

Upregulate LPL

Increase TG cleareance

Activates PPARa to induce HDL synthesis

* LDL decrease, HDL increase, TGL decrease a lot

What are the side effects of fibrates?

Myositis (increase risk with statins)

Hepatotoxicity (increase LFT's)

cholesterol gallstones (esp with bile acid resins)

Describe the main characteristics of the Primary Hyperaldosteronism

Cause: Adrenal hyperplasia or aldosterone secreting adrenal adenoma (Conn syndrome)

Hypertension, hypokalemia, metabolic alkalosis, LOW PLASMA RENIN.

Normal Na+ due to aldosterone escape = no edema

May be bilateral or unilateral

Tx: Surgery to remove the Tu and or spironolactone

Describe the main features of the Secondary Hyperaldosteronism

Cause: Renal perception of low intravascular volume results in an overactive renin- angiotensin system

Due to Renal artery stenosis, CHF, cirrhosis, nephrotic syndrome.


Tx: Spironolactone (K+ sparing, aldosterone agonist)

What is the mechanism of action of Methotrexate?

Folic acid analog that inhibits dihydrofolate reductase, decrease dTMP, decrease DNA, and protein synthesis

What are the side effects of Methotrexate?

Myelosuppression (reversible with leucovorin (folinic acid))

Macrovesicular fatty change in liver




Why is important the bacterial growth pattern "Serpentine cords" in Mycobacterium Tuberculosis?

Secondary to the presence of a cord factor a mycoside (2 mycolic acid), establish virulence through neutrophil inhibition, mitochondrial destruction and release of TNF

A patient experience blurred vision after ingest several tablets of diphenhydramine, why?

H1 receptor blockers decrease the activity of this receptor increasing the proportion of inactive H1 receptors (reverse blockade)

1st generation antihistaminics (Clorpheniramine, diphenhydramine) have antimuscarinic, anti a adrenergic, anti serotonergic properties

Anticholinergic: pupillary dilation (blurry vision) muscarinic, dry mouth, urinary retention, constipation.

Patient with V/Q defect that does not match a ventilation defect in the lungs?

Deep vein thrombosis that cause a pulmonary embolism

Most common cause of fetal hydronephrosis

Inadequate recanalization of the ureteropelvic junction, the junction between the kidney and the ureter

Role of lysosomal enzymes for abscess formation

Digest the offending pathogens, and tissue debris, chemotactically summon additional neutrophils or macrophages to the area. Occasionally the enzymes will also damage the surrounding parenchyma, setting the stage for abscess formation

Chloroquine is the Tx of choice for uncomplicated malaria, it eliminates susceptible erythrocytic forms of all Plasmodia species, why adding Primaquine is needed?

To treat P.vivax, P ovale in roder to eradicate the intrahepatic stages of these 2 malarial species and prevent relapsing.

What is the leukemia related with Trisomy of 21?

Acute lymphoblastic leukemia

Acute myelogenous leukemia

Patient with "right hand clumsiness", decrease sensation over the 5th finger, flattened hypothenar eminence, which nerve is injured and where?

Ulnar nerve injury "claw hand" deformity, can be injured either near the medial epicondyle of the humerus or in Guyon's canal near the hook of the hamate and pisiform bone in the wrist

Damage of which nerve will result in wrist drop?

Radial nerve provides sensory innervation to the skin of the posterior arm, forearm, and dorsal lateral hand, motor innervation to all of the extensor muscles of the upper limb below the shoulder.

Site of action of:

1) Acetazolamide

2) Mannitol

3) Furosemide

4) Hydrochlorothiazide

5) Amiloride

6) Spironolactone

1) Proximal tubule

2) Descendind limb of Henle's loop

3) Thick ascendinf limb of Henle's loop

4) Distal convoluted tubule

5) Collecting duct (Na+ channel blocker)

6) Collecting duct (Aldosterone receptor antagonist)

Patient with DM1, uncontrolled voiding without any sensation of a full bladder , chronic kidney disease, gastroparesis, why?

DM1 can cause overflow incontinence due to inability to sense a full bladder and incomplete emptying. Post void residual testing with ultrasound or catheterization can confirm inadequate bladder emptying

Describe the permeability of the nephron to H2O by section

1) Proximal tubule, descending limb of Henle loop- HIGH

2) Ascending limb of Henle loop, early convoluted tubule- NON

3) Late distal convoluted tubule, collecting duct system- ADH VARIABLE

Patient newly dx with seizures, fever, skin rash, T38.9C, confluent erythema 60% of the body, generalized lymphadenopathy, symmetrical facial swelling, what is the diagnosis?

DRESS syndrome 2-8 weeks after exposure to a drug, anticonvulsivants, allopurinol, sulfonamides, antibiotics

Affected organs: Liver (hepatomegaly, jaundice), kidney (acute interstitial nephritis), lung (cough, dyspnea)

Labs: Eosinophilia, atypical lymphocytosis, elevated ALT

Improve with suspension of the drug

Patient with fatigue (slow onset), stools pale gray

Liver biopsy: dilated bile canaliculi wit green brown plugs and yellowish green accumulations of pigment within the hepatic parenchyma. What is the relationship of this syndrome and osteomalacia?

DIgestive disorders such as cholestasis can cause malabsorption and nutritional deficiencies, of the fat soluble vitamins, one of them Vit D

Why Chron's disease is associated with oxalate kidney stones?

Impaired bile acid absorption in the terminal ileum leads to loss of bile acids in feces with subsequent fat malabsorption.

Lipids then bind Ca++ and the resulting soap complex is excreted.

Free oxalate is absorbed and forms urinary calculi

E.coli grown on a lactose containing medium up-regulate the production of the enzymes B-galactosidase and galactoside permease

Which of the following best explains the synchronous production of both enzymes in response to lactose?

Bacterial mRNA can be polycistronic, one mRNA codes for several proteins

mRNA is the bacterial lac operon, wich codes for the proteins necessary for lactose metabolism, transcription, translation, all regulated by a single promoter, operator

Describe the mechanisms:

1) Alcohols

2) Chlorhexidine

3) Hydrogen peroxide

4) Iodine

1) Disruption of cell membranes, denaturation of proteins

2) Disruption of cell membranes, coagulation of cytoplasm

3) Produces destructive free radicals that oxidize cellular components

4) Halogenation of proteins- nucleic acids

What is reassorment? Which virus can do this?

Exchange of entire genome segments

Orthomyxoviruses (Influenza)


What are the cells most susceptible to ischemia in the SNC?

1) Pyramidal cells of the hippocampus

2) Neocortex and the Purkinje cells of the cerebellum

The hippocampus is the first area damaged during global ischemia

Mechanism of action of Biphosphonates

Chemical structure similar to pyrophosphate and attach to hydroxyapatite binding sites on bony surfaces to inhibit bone resorption by mature osteoclasts

Patient with blurred vision while cutting trees, T38.9C, BP:100/70 mm/hg, pulse: 120/min, reps: 22/min.

PE: Flushed skin and dry oral mucosa

Pupils dilated and non reactive to light

Dx and tx?

Jimson Weed (datura stramonium) poisoning, also called "Gardener mydriasis)

Belladona alkaloids (anticholinergic properties)

Jimson weed and Atropine poisoning are similar

Can be reverted with cholinesterase inhibitors (physostigmine)

Hepatic angiosarcoma is associated with the exposure to:

Arsenic, Throrotrast, polyvinyl chloride

Tu cells express CD31, an endothelial cell marker

3 month male, neurological abnormalities, impaired tetrahydrobiopterin synthesis.

Which neurotransmitter is deficient in this patient?

Serotonin, because BH4 is a cofactor used by hydroxyls enzymes in the synthesis of tyrosine, dopa, serotonin, NO.

Serotonin is synthesized from tryptophan, initial step is catalyzed by enzyme uses BH4 as a cofactor

Dihydrobiopterin reductase deficiency causes defective regeneration of BH4 and is an uncommon cause of PKU.

1) Dorsal pancreatic bud structures

2) Ventral pancreatic bud structures

1) Body, tail, most of the head

2) Wirsung (major pancreatic duct)

Failure of the dorsal and ventral pancreatic buds to fuse leads to pancreas divisum.

Accessory duct drain the majority of the pancreas

Activity related joint pain and periodic morning stiffness, firm nodules over the distal interphalangeal joints


Be aware that for Ddx rheumatoid arthritis typically affects the metacarpophalangeal and proximal inerphalangeal joints

Metabolic alkalosis

Features: High blood pH, bicarbonate, pCO2

When is saline responsive?

When is saline unresponsive?

Saline responsive: Vomiting/nasogastric suctioning and thiazide/loop diuretic use cause volume and Cl- depletion (low urine chloride)

Saline unresponsive: Hyperaldosteronism (high urine chloride)

Mechanism of action of fenoldopam

Parenteral agent, seective D1 receptor agonist

Causes arteriolar dilation and natriuresis

Improve renal perfusion, used for hypertensive crisis

Clinical presentation for organophosphate poisoning (excessive CHOLINERGIC STIMULATION)

D: Diarrhea- Diaphoresis

U: Urination

M: Miosis

B: Bronchospasm- Bronchorrhea- Bradycardia

E: Emesis

L: Lacrimation

S: Salivation

Also muscular excitation, only symptom that atropine cannot reverse


Hot as a hare

Dry as a bone

Red as a beet

Blind as a bat

Mad as a hatter

Hydrocephalus presentation

Irritability, poor feeding, increased head circumference, enlarged ventricles on CT

Long term sequelae of hydrocephalus: lower extremity spasticity due to stretching of periventricular pyramidal tracts, visual disturbances, and learning disabilities

Haemophilus Influenza requires X (hemantin) and V (NAD+) factors for growth

Growing with S.Aureus demonstrate the satellite phenomenon where this bacteria produce needed X and V factors for H. Influenza

What do you use when ultrasound is inconclusive for acute cholecystitis?

Nuclear medicine hepatobiliary scanning (cholescintigraphy)

Primary hyperaldosteronism

1) Sodium

2) Potassium

3) Bicarbonate

Primary hyperaldosteronism

1) Normal

2) Low

3) High

Dx test for cryptococcus neoformans

India ink staining in the CSF

Mucicarmine staining of lung tissues and bronchoalveolar washings

Menstrual cycle


APC for interaction with T-lymphocytes

Failure to acidify lysosomes would lead to to deficient expression of MHC II bound to foreign antigen and subsequent lack of interaction between APC's and T-cells


1) Immunity

2) Function

3) Secretion

4) Results

IL-12 stimulates the differentiation into TH1, without this = mycobacterial infections, Tx:IFN-y


1) Cell mediated

2) Activate macrophages and cytotoxic T- cells

3) IL-2, IFN-y, lymphotoxin B

4) Cytotoxicity, delayed hypersensitivity


1) Immunity

2) Function

3) Secretion

4) Results

IL4 promotes the differentiation from naive

1) Humoral (antibody- mediated)

2) Activate B-cells, promote class switching

3) IL-4, 5, 10, 13

4) Secretion of antibodies

Atropine intoxication, can be emulated by?

Tricyclic antidepressants (amitriptyline)

Cardiac output

CO= Stroke volume x Heart rate

CO= O2 consumption/ arteriovenous O2 difference

Antifungals mechanism of action

1) Cell wall

2) Cell membrane

3) DNA&RNA synthesis

1) Echinocandins (caspofungin, micafungin) inhibits glucan from cell wall

2) Triazoles (Keto,fluco,itra,vori) inhibit ergosterol synthesis

Polyenes (Anfot B, nystatin) Bind ergosterol molecules in fungal cell membranes, creating pores and lysis

Allylamines (terbinafine) synthesis ergosterol [squalene epoxidase]

3) Pyrimidines (Flucytosine) converted to 5-fluoracil within the fungal cell and interferes with RNA and protein synthesis

Patient with lump in neck, grow slowly, smoker, biopsy reveals abnormal cells with t(14:18) chromosomal translocation

Follicular lymphoma (B lymphocytes) translocation between chromosomes 14 and 18 which causes Bcl-2 over expression (protoncogene)

Causes of pure red cell aplasia

Thymoma, lymphocytic leukemias, parvovirus B19 infection

Avidly Bromodeoxyuridine uptake, what does it mean?!

High number of tumor cells in S phase, that are present, high grade, poor prognosis

Diminished relaxation of cricopharyngeal muscles during swallowing results in increased intraluminal pressure in the oropharynx. What happens if the mucosa herniate through a zone of muscle weakness in post hypo pharynx?

I form a Zenker diverticulum, presents in elderly patients with oropharyngeal dysphagia, halitosis, regurgitation , recurrent aspiration