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102 Cards in this Set

  • Front
  • Back

Osteocytes remain connected to one another via ______________

gap junctions

In the presence of ADH, which parts of the tubule contain the most concentrated fluid? the most dilute?

most concentrated - collecting tubules

most dilute - thick ascending limb and DCT

Test where pt serum is mixed with cardiolipin, cholesterol, and lecithin

Rapid plasma reagin (RPR) test - nonspecific treponemal serologic test; if this is positive, confirm with FTA-ABS

what occurs in the lymph node germinal centers?

B cell differentiation, isotype switching

formula for clearance

(urine concentration x flow rate) / (plasma concentration)

orotic aciduria

disorder of pyrimidine metabolism

defective enzymes: orotate phosphoribosyl transferase and OMP decarboxylase - they catalyze the conversion of orotate to UMP

symptoms + tx of orotic aciduria

symptoms: megaloblastic anemia, neuro abnormalities, growth retardation

tx: uridine supplementation (inhibits carbamoyl phosphate synthetase II)

How does diphtheria acquire virulence?

via bacteriophage-mediated "infection" with the tox gene (lysogenization), which codes for the diphtheria AB toxin

Why must the dose of digoxin be reduced in order to prevent toxicity in elderly patients?

because their renal clearance decreases

which heart defect can lead to paradoxical embolization?

PFO (much more common than ASD) and ASD (very rare)

How would a sample from a VZV infected vesicle appear under light microscopy?

intranuclear inclusions in keratinocytes and multinucleated giant cells (positive Tzanck smear)

clinical findings in primary aldosteronism

HTN, low plasma renin, hypokalemia (muscle weakness, cramps, rhabdo, arrhythmias) , metabolic alkalosis

what does the common cardinal vein give rise to?

SVC and other components of systemic venous circulation

what's another word for precision?


What occurs in the nucleolus? Which enzyme is involved?

Site of ribosomal maturation and assembly; RNA polymerase I synthesizes the vast majority of rRNA from within nucleolus

Which enzyme deficiency results in excess of both mineralocorticoids and androgens?


how does the actual cell structure between osteoblasts and osteoclasts vary?

osteoblasts have a single nucleus (arise from mesenchymal cells) while osteoclasts originate from mononuclear phagocytic cell lineage and are formed when several precursors create a large multinucleated cell (osteoclasts in Paget's can have up to 100 nuclei - normal is 2 to 5)

most important factors for osteoclast differentiation

M-CSF and receptor for activated nuclear factor kappa- B ligand (RANK-L)

pramipexole and ropinirole

nonergot dopamine agonist

what effect do loop diuretics have on prostaglandins?

they increase their release, which increases GFR

where does the hydroxylation of proline and lysine residues in collagen occur?

rough ER

what is one mechanism of mycobacterial resistance to isoniazid?

decreased activity of bacterial catalase-peroxidase (which is needed to convert INH to active metabolite)

which receptor does rabies virus bind?

nicotinic Ach receptors in the PNS - then it travels retrograde to CNS

which drugs would you use to combat visceral nausea? vestibular nausea? nausea associated with migraine?

visceral - 5HT3 antagonist

vestibular - H1 or M1 antagonists

migraine - D2 antagonist

where does the right testicular vein drain?

directly into IVC; left testicular vein drains into left renal vein first

kidney tumor composed of BVs, smooth muscle, and fat

angiomyolipoma; seen with tuberous sclerosis

which type of cancer has increased in incidence and mortality in women in the last four decades?

lung cancer

what can lead to increased fetal urine output (and subsequently polyhydramnios)?

high fetal cardiac output (alloimmunization, parvovirus infection, fetomaternal hemorrhage) or twin to twin transfusion

what would the absence of IL-12 receptors lead to?

the inability of helper T cells to differentiate into TH1 cells (which produce IFN-gamma)

what is the main side effect of TZDs?

fluid retention due to increased Na+ reabsorption in the renal collecting tubules leading to weight gain, peripheral edema, and decompensation of underlying CHF

foreign bodies lodged in the piriform recess can damage which nerve?

internal laryngeal nerve, resulting in impaired cough reflex

palpable but nontender gallbladder (Courvoisier sign), weight loss, and obstructive jaundice

adenocarcinoma at the head of the pancreas obstructing the common bile duct

which compound is an allosteric activator of gluconeogenesis that acts by increasing the activity of pyruvate carboxylase?


what is the primary route of copper elimination?

secretion into the bile

what can the prolonged use of appetite suppressants lead to?

secondary pulmonary HTN

which bacteria are pyrrolidonyl arylamidase (PYR) positive?

S. pyogenes and enterocci (the PYR test has largely replaced the test for bacitracin sensitivity)

preferred imaging test for dx of acute cholecystitis? and alternate test if first test is inconclusive?

Preferred - ultrasonography to identify signs of inflammation (e.g. wall thickening, pericholecystic fluid)

Alternate - nuclear medicine hepatobiliary scanning (cholescintigraphy) to assess cystic duct patency

first order vs zero order kinetics

first order - constant fraction of drug is metabolized per unit time

zero order - constant amount of drug is metabolized per unit time

failure to metabolize ceramide trihexoside

Fabry disease (XR) - deficiency of alpha-galactosidase A

What kind of internal/external genitalia would result from functioning Leydig cells but nonfunctioning sertoli cells in an XY genotype?

both female and male internal genitalia (because sertoli cells secrete MIF) and male external genitalia

linkage disequilibrium

two allele loci are said to be in linkage disequilibirium when a pair of alleles from two loci are inherited tougher in the same gamete (haplotype) more or less often would be expected by random chance alone given their corresponding allele frequencies

Diphtheria toxin is most similar to which other toxin?

Exotoxin A of Pseudomonas - both inactivate EF-2 via ribosylation, thus inhibiting host cell protein synthesis

which T cells play the pivotal role in TB infection?

CD4+ TH1 cells

which nitrate has the best bioavailabity when taken orally?

isosorbide mononitrate

when does the murmur of VSD become audible?

4-10 days after birth, when pulmonary vascular resistance declines, enabling left to right shunting

histology of Hep B vs Hep C

Hep B: finely granular, dull eosinophilic, "ground glass" appearance (pale pink cytoplasm)

Hep C: lymphoid aggregates within the portal tracts and focal areas of macrovesicular steatosis

what is the mechanism by which diabetics can get cataracts following a prolonged hyperglycemic state?

Oversaturation of the polyol pathway: Aldose reductase converts glc into sorbitol; sorbitol dehydrogenase (this enzyme has a lower Vmax and thus becomes saturated) converts sorbitol into frc

how does pulmonary vascular resistance change with breathing?

inhalation: increases alveolar vessel resistance

exhalation: increases extra alveolar vessel resistance

PVR = alv R + extra alv R

Thus PVR is increased at high and low lung volumes, and it is lowest at the FRC

Which organ(s) can use the glycerol produced by the degradation of TGs by hormone sensitive lipase? How is it used?

Only the liver - glycerol kinase is used to turn glycerol into DHAP for gluconeogenesis or glycolysis; glycerol can also be used for TG synthesis

caudal regression syndrome

rare condition in which an infant is born with a genesis of sacrum/lumbar spine and experience flaccid paralysis of legs, dorsiflexed contracts of feet, and urinary incontinence

related to poorly controlled maternal diabetes

which NT is involved in morphine tolerance?

Glutamate binds NMDA receptors and causes increased phosphorylation of opioid receptors and increased NO levels leading to tolerance

which drugs can prevent morphine tolerance?

drugs with NMDA antagonist properties such as ketamine and dextromethorphan

what is the mechanism of drugs given to reduce alcohol cravings?

Naltrexone blocks mu opioid receptor - blocks rewarding and reinforcing effects of alcohol

Is to possible for Turner pts to become pregnant?

Yes, if they receive a donated egg they can carry a baby because they have a normal uterus and the endometrial response to E and P is normal

which vocal cords are lined by stratified squamous epithelium?

true vocal cords

Which region of the brain is damaged in preterm infants during childbirth?

intraventricular hemorrhage (IVH) usually originates from germinal matrix

How does TNF-alpha induce insulin resistance?

Through the activation of serine kinases, which then result in phosphorylation of IRS-1 serine residues, which inhibits IRS-1 tyrosine phosphorylation by insulin

Which compounds (in addition to TNF-alpha) can induce insulin resistance via phosphorylation of serine residues?

catecholamines, glucocorticoids, and glucagon

What is the oxidative portion of the Pentose Phosphate Pathway used for?

It converts G6P into Ribulose-5-P, producing NADPH, which is used for (1) cholesterol, FA, and steroid synthesis and Cytochrome P450 metabolism, (2) regeneration of glutathione, (3) respiratory burst (NADPH oxidase)

What is the non oxidative portion of the PPP used for?

Ribulose-5-P is interconverted into glycolytic intermediates for energy production

JVP tracing

JVP tracing

a = atrial contraction

c = tricuspid closure

x = atrial diastole

v = passive atrial filling

y = atrial emptying

which drug can be given to prevent recurrence of calcium oxalate stones?

hydrochlorothiazides because they decrease urinary Ca2+ excretion

which antibiotic can cause serotonin syndrome?

linezolid - it is a weak MOA inhibitor

Which medication is the best alternative to aspirin (if the pt has an allergy) for the purposes of prevention of thromboembolic disease?


Increased prothrombin time would point to a deficiency in which clotting factor?

VII (extrinsic pathway)

immune complex vasculitis in a child associated with IgA and C3 deposition

Henoch Schonlein purpura - leukocytoclastic angiitis in small vessels of dermis and GIT leading to purpuric rash, colicky abdo pain, and polyarthralgias

bisphosphonate mechanism

inhibition of mature osteoclast-mediated bone resorption - they have a chemical structure similar to pyrophosphate and attach to hydroxyappetite binding sites on bony surfaces; osteoclasts then take up the drug and undergo apoptosis

pt with membranous nephropathy, flank pain, hematuria, and right-sided varicocoele

renal vein thrombosis (loss of ATIII leads to hypercoaguable state)

actin - thin filament

myosin - thick filament

which bacterial enzyme is responsible for removing RNA primers and replacing them with DNA?

DNA polymerase I

which pathogen is responsible for anogenital squamous cell carcinoma?

HPV types 16 and 18

What causes RBC distortion in sickle cell anemia?

Glutamic acid is replaced by the non polar hydrophobic valine residue - the bulging created in the beta chain then fits into a hydrophobic site in the alpha chain resulting in polymerization when HbS is deox

most common form of congenital long-QT syndrome

Jervell and Lange-Nielsen syndrome - AR condition accompanied by neurosensory deafness

How does acute hemolytic transfusion reaction present?

Fever/chills, hypotension, dyspnea, chest/back pain, hemoglobinuria

What causes TOF?

Anterior and cephalad deviation of the infundibular septum during embryologic development, resulting in a misaligned VSD and overriding aorta

Which Class 1 antiarrhythmics are more selective for ischemic myocardium?

Class IB b/c the reduced resting membrane potential delays sodium channel transition from the inactivated to resting state, resulting in increased drug channel binding (b/c class I drugs preferentially bind the channel in the active and inactive but not resting state)

What does use dependence refer to with respect to antiarrthymics?

Higher rates of depolarization lead to increased sodium channel binding due to the channels spending less time in the resting state. Class IC exhibit the most use dependence, Class IB the least

In which condition would muscle biopsy reveal MHC class I over-expression on the sarcolemma and CD8+ lymphocyte infiltration?


What are the findings in polymyositis?

Proximal muscle weakness, increased serum CK, anti-Jo-1 antibodies

which artery supplies the diaphragmatic surface of the heart?

Posterior descending (branch of RCA in most people) supplies the inferior wall of L ventricle (diaphragmatic surface)

what enzyme deficiency leads to clitoromegaly in an XX infant where the mother experience virilization during pregnancy?

Aromatase - which converts androgens into estrogens in the ovaries, testes, placenta, and other peripheral tissues

Extremely painful, swollen hands and feet in a young african american child

Dactylitis (small infarctions in bone and extremities) due to sickle cell disease

What can be supplemented in homocystinuria to improve outcomes?

It's most often due to a deficiency of cystathionine synthetase, which uses B6 as a cofactor - thus pyridoxine (B6) can be supplemented

What is the problem with using selective coronary vasodilators (i.e. adenosine, dipyridamole) in myocardial ischemia?

Coronary arterioles are already maximally dilated during ischemia and use of these agents causes vasodilation of coronary arterioles in nonischemic arteries, diverting blood flow from ischemic to nonischemic areas (coronary steal)

what is the criteria for referring a pt to hospice care?

life expectancy < 6 mo

lesion of the ventromedial hypothalamic nuclei

obesity due to destruction of satiety center

where is high/low frequency sound best detected?

high - base of cochlea near oval and round windows

low - apex of cochlea near helicotrema

What kind of hormone receptor do glucagon, TSH, and PTH act on?

GPCR -PKA is primarily responsible for the intracellular effects of the G protein / adenylate cyclase 2nd messenger system

Which injury results in interstitial and intraalveolar edema, acute inflammation, and alveolar hyaline membranes consisting of fibrin exudate and plasma protein-rich edema fluid mixed with cytoplasmic and lipid remnants of necrotic epithelial cells?


which enzymes does lead inhibit?

delta-ALA dehydratase (b/c of this, delta ALA levels accumulate in the blood and urine in pts with lead poisoning) and ferrochetolase

What is the first (and rate-limiting) step of protoporphryin synthesis?

Enzyme: δ-ALA synthase

This step is faulty in XL siderblastic anemia

Enzyme: δ-ALA synthase

This step is faulty in XL siderblastic anemia

which drug is contraindicated in HIV pts with HLA-B*57:01?

Abacavir - leads to hypersensitivity reaction

Drug often used for rate control in aFib that can lead to constipation, gingival hyperplasia, bradycardia and AV nodal block


The degree of LVOT (and thus the intensity of the murmur) in HCOM varies according to what?

LV-EDV: mechanisms that decrease preload (i.e. venous return) or afterload, reduce LV chamber size, which decreases the separation b/w the mitral valve and inter ventricular septum, increasing obstruction

Which mechanisms decrease preload?

Valsalva, abrupt standing, GTN administration

Which mechanisms increase after load?

Sustained hand grip, squatting

Which mechanisms increase preload?

Passive leg raise, squatting

Why does squatting cause increased preload and afterload?

Increased preload due to increased skeletal muscle tension > increased blood pumped back to heart

Increased after load due to obstruction of peripheral arteries - this only occurs in a sustained squat

A pt receives in an injection into which part of the buttock if a trendelenburg gait results?

Superomedial buttock - leading to damage of

superior gluteal nerve or gluteus medius

Where should intragluteal injections target in order to minimize the possibility of nerve damage?

Anterolateral gluteal area (von Hochstetter triangle)

Anterolateral gluteal area (von Hochstetter triangle)

An acute lacunar ischemic stroke of the medial pons at the level of the middle cerebellar peduncle can damage which cranial nerve?

CN V - trigeminal

It arises at the level of the middle cerebellar peduncle at the lateral aspect of the mid-pons

Infarcts involving the anterior portion of the medial pons can produce which symptoms?

contralateral hemiparesis/Babinski sign - corticospinal tract

contralateral lower facial palsy, dysarthria - corticobulbar tract

contralateral dysmetria and dysdiadochokinesia (ataxic hemiparesis) - disruption of corticopontine fibers (pontocerebellar)