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158 Cards in this Set
- Front
- Back
rapid recovery from thiopental is due to
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redistribution of the drug into other tissues, NOT from metabolism
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adverse effect of organophosphate poisoning not treated by atropine
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muscle paralysis
organophosphate poisoning affects both muscarinic and nicotinic junctions since atropine only works on muscarinic, pts are just in danger of the nicotinic effect which is muscle paralysis this can be helped by pralidoxime |
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Downs pts have an increased risk of?
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ALL and AML
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primidone
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an antiepileptic that is metabolized into phenobarbital and phenylethymalonamide (PEMA)
this can cause sedation and lethargy |
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MCC of death in DM pts
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MI
also more than 50% of pts with ESRD die from ishemic heart disease |
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33-32
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.
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pain in URQ with opioid use
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opioids can cause contration of the smooth muscles in the sphincter of Oddi, creating an obstruction and gall bladder distention
this pain is called biliary colic it is thought meperidine does this less often, for just use NSAIDS like ketorolac |
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why elastin has plasticity and recoil ability
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unique crossbridging of lysine
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area of nephron for the action of ADH
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ADH works to increase water reabsorption in the medullary segments of the collecting ducts
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gene defect and cause of ataxia telangiectasia
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ataxia telangiectasia is due to mutated gene, ATM, that is responsible for DNA break repairs
triad of cerebellar ataxia, telangiectasias, and increased pulmonary infections (due to IgA def) |
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why edema is not initally seen in early COPD
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increased lymphatic drainage can compensate for increased central venous pressure seen in COPD to a small degree, initally preventing edema
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consequence of left heart failure
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pulmonary HTN can be from reactive vasoconstriction secondary to pulmonary venous congestion
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DNA pol that has 5-3' exonuclease activity
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DNA pol I is the only one with 5-3' exonuclease activity
DNA pol III has the 3-5' exonucleast activity |
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benzos to use in pts with an increased risk of falling
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long acting benzos increase the "hangover" effect with daytime drowsiness and the risk of falling
these include diazepam, clorazepate, and flurazepam |
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short acting benzos
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short acting benzos: alprazolam, triazolam, oxazepam
they have less risk of hangover effect, but higher risk of dependence |
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isoniazid effect on TB staining
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isoniazid inhibits mycolic acid formation, so it cause TB to loss it's acid fast staining quality
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location on cochlea of high freq sounds
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high freq sounds are heard by the base close to the oval and round windows
low freq sounds are heard at the apex closest to the helicotrema |
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helicotrema
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helicotrema is at the apex of the cochlea where the scala vestibuli and scala tympani meet
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MAO of resistance in chemotherapy
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chemotherapy reistance is largely due to the human multidrug resistance gene (MDR1) that codes for a P-glycoprotein that is an ATP-dep transmembrane protein that pumps out the drugs
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ras gene MOA
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ras gene is a GTP dependent system
mutations are due to inability of ras to split the GTP to inactivate, leading to cancer |
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MCC of mitral stenosis
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chronic rheumatic heart disease
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association with imperforate anus
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imperforate anus is commonly suspected with inability to pass meconium
this is often seen with other malformations of the GU tract |
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NBTE consequence
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NBTE (non-bacterial thrombotic endocarditis) involves a hypercoag state, similar to that of Trousseau's sign seen in pancreatic carcinoma
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risk factors for infective endocarditis
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risk factors in infective endocarditis include prosthetic heart valves, prior valvular inflammation and scarring (often a consequence of rheumatic heart disease)
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mechanism of increased ESR
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IL-1, IL-6, and TNF-alpha mediate acute phase proteins, like fibrinogen, and are responsible for an increased ESR
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Class 3 anti-arrythmics
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Class 3 antiarrythmics reduce K flow and are:
amiodarone, ibutilide, dofetilide, and sotalol |
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major virulence factor of Strep pyogenes
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protein M of Strep pyogenes is the major virulence factor, inhibiting phagocytosis and compliment activation
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CT features of constrictive pericarditis
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calcification can thickening of the pericardium > 4mm are common features of constrictive pericarditis on CT
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alkaptonuria
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alkaptonuria is a def of homogentisate oxidase, stopping tyrosine from eventually becoming fumarate
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35-19
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SE of direct arteriolar vasodilators
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direct arteriolar vasodilators like hydralazine and minoxidil work as antiHTN, but cause reflex SANS activation leading to sodium/fluid retention and tachycardia
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broncioloalveolar carcinoma
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bronchioloalveolar carcinoma is a subtype of adenocarcinoma arising from the alveolar epithelium and does not have a risk due to smoking
histo shows tall columnar cells linng the alveloar septa without vascular or stroma invasion |
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atopic dermatitis is associated with
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asthma and allergic rhinitis
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formula for the confidence interval of 95%
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mean +/- 1.96*SD/( sqrt of n)
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result of thiazolidinediones (TZDs)
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activate PPAR-gamma, a nuclear receptor, decreasing insulin resistance
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polymyositis
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symmetric proximal muscle weakness
muscle biopsy shows inflammation and necrosis of muscle fibers overexpression of MHC I on the sarcolemma leading to CD8 infiltration |
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bosentan
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competitive antagonist of endothelin receptors blocking the vasoconstriction of endothelin and reducing pulmonary HTN
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crystals seen in gout
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monosodium urate
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decrease CO, like in HF, does what to arteriolar resistance
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RAR system will increase arterial resistance to increase BP, but this exacerbates problems with the already failing heart
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Klinefelter's labs
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small testes and damaged seminiferous tubules lead to decreased testosterone and sperm count
this limits pituitary feedback, so serum LH and FSH are increased |
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what removes the CAP from the binding domain in the lac operon
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glucose induced decrease in adenylate cyclase leads to low cAMP, which causes poor binding of CAP, reducing expression of the lac operon
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name the sulfonylureas
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.
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function of the 16S rRNA
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a portion of the 30S ribosomal unit, it is a complementary strand to the mRNA Shine-Dalgarno sequence
this binding is necessary for the initation of translation |
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MOA of niacin
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inhibits hepatic VLDL production
it also increases HDL (this is the primary reason for prescribing) |
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MOA of statins
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inhibit cholesterol synthesis, thereby up-regulating LDL receptors
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protein phosphatase-1
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increases glycogen synth
decreases glycogenolysis |
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Wilson's disease: S/S, dx
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advanced disease has Parkinsonian-like tremor, rigidity, ataxia, slurred speech
labs will have increased transaminases, low serum ceruloplasmin, high hepatic copper, and Kayser-Fleischer rings that are best seen with a slit lamp exam |
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HbA2
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normal hemoglobin is HbA1, in beta-thalassemia minor and intermediate, its production is impaired, so there is elevated production of HbA2
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what do you do to confirm a malabsorption syndrome?
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with a hx of diarrhea, steatorrhea, wieght loss, or vit def, suscpect malabsorption, take a stool sample, and stain with Sudan III which will identify fecal fat and conclude a type of malabsorption. Then further investigation is needed
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what causes tissue distruction in TB infections?
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a type IV delayed hypersens rxn
this creates the caseous necrosis |
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possible consequence of axillary LN dissection following breast cancer
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chronic lymphedema of the ipsilateral arm that can predispose to angiosarcoma
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proto-oncogenes (where an activating mutation leads to cancer)
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Ras, n-myc, ERB/B1, sis, abl
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tumor suppressors (where an inactivating mutation leads to cancer)
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BRCA1/2, NF-1, APC, DCC, p53, RB, WT-1
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consequence of hypokalemia
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muscle weakness, paresthesias, arrythmias
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Cushing's ulcers are caused by
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increased ICP
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what should be monitored in pts with chronic back pain/stiffness and are HLA-B27 positive
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chest expansion, which can decrease in the setting of ankylosing spondylitis
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gastric erosion vs ulcer
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gastric erosion are mucosal defects that do NOT penetrate the muscularis mucosa, if they do then it is termed an ulcer
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what do homeobox genes code for?
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DNA binding transciption factors important in morphogenesis
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the first commited steps in gluconeogenesis
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conversion of pyruvate to oxaloacetate via biotin dependent pyruvate carboxylase, then to PEP via PEPCK (phosphoenopyruvate carboxykinase)
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Langhans cells in TB caseating granulomas are formed by what cells?
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CD4 Th1 cells
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what stimulates proliferation in athersclerotic plaques?
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while the process is started with exposed endothelial cells, proliferation is induced by PDGF from platelets
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gene mutation found in medullary thyroid cancer
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ret gene, as also seen in MEN2 syndromes
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what happens to renal clearance of urea after vasopression injection
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it decreases, as more water is reabsoped, more urea will be reabsorbed as well
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ticlopidine
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like clopidogrel, but rarely used due to SE, which include mouth ulcers, fever, and neutropenia, so CBC monitoring is needed
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unique adverse effect of bile acid binding resins
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they increase blood triglyceride lvls
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MCC of sudden cardiac death in young atheletes
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hypertrophic cardiomyopathy
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unique property of amiodarone compared to other Class II antiarrhythmics
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while it prolongs the QT interval like all the other Class III's (and Class 1As), it does NOT predispose to torsade de pointes like they do
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severe adverse effect of amphotericin B
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renal toxicity leading to hypokalemia and hypomagnesemia
this renal toxicity can also decrease epo leading to normo/normo anemia |
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MOA of scurvy
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vit C def that decreased collagen production due to the inability to hydoxylate proline and lysine
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medullary sponge kidney (MSK)
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common and generally benign congenital disorder with cystic dilations of the medullary collecting ducts
most common complication is kidney stones |
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secretin stimulates what
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secretiin is released in response to increased duodenal H+ and stimulates the pancreas to secrete bicarb
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taste of the tongue
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.
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general sensation of the tongue
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.
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motor of the tongue
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.
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the only clinically sig non-enveloped ssDNA virus
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parvo B19
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cilostazol
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a phosphodiesterase inhibitor used in PAD to treat intermittent claudication
it inhibits platelet aggregation and is a direct arterial vasodilator |
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muscles of mastication are innervated by what nerve passing through what foramina?
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V3 of CN V passing through the foramen ovale
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what is the fasted metabolized monosaccharide?
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fructose because it can bypass PFK-1
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what defect can cause gout due to increased purine production?
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activating mutation of PRPP synthase
this will increase purine production and result in hyperuricemia |
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adhesion of cells to the basement membrane and the extracellular matrix involves what integrins
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fibronectin, collagen, and laminin
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cystic tumor in the cerebellum of a child
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most likely a pilocystic astrocytoma
histo shows spindle cells, hair-like glial processes, Rosenthal fibers, and granular eosinophilic bodies |
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statins when given with p450 inhibits cause
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myopathy and rhabdomyolysis that can then lead to acute renal failure
classic example is a person on a statin is given a macrolide for an infection |
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atypical depression includes
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hyperphagia and hypersomnia
MAO inhibitors are particularly useful in these pts, like phenelzine |
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CF pts with malabsorption can be treated with what?
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pancreatic enzyme supplementation, like pancreatic lipase
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monitoring to be done with thiazolidinediones
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LFTs, because when 1st introduced, they were hepatotoxic
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glucocorticoids action in liver vs other tissues
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glucocorticoids are mostly catabolic, causing muscle weakness, thin skin, impaired wound-healing, osteoporosis, and immunosuppression
but in liver, it increases protein synth, especially in enzymes involved in gluconeogenesis and glycogenesis |
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acute acalculous cholecystitis
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acute inflammation of the gallbladder in the absence of gallstones, most commonly seen in the hospitalized and severely ill
thought to occur due to gallbladder statis and ischemia |
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function of bcl-2
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inhibits apoptosis and promotes cell survival
when mutated, as in 14:18 trans, it leads to follicular lymphoma |
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consequence of Wegner's
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progressive crescentic glomerulonephritis (RPGN)
also has c-ANCA positive staining |
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vit C used for hydroxylation in collagen synth is performed in what organelle?
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RER
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location to perform thoracocentesis along the mid-axillary line
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between the 7th and 9th ribs
going lower you will hit the liver |
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cause of post-streptococcal glomerulonephritis
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Strep pyogenes
note that it is bactitracin sens |
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blood supply of the diaphragmatic surface of the heart
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inferior wall of left vent forms most of the surface and in 90% of people is supplied by the RCA
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widespread mast cell degranulation release what?
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histamine that is the major effector
tryptase is also release and used a a marker for mast cell activation |
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what causes the degranualtion of mast cells
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crosslinking of multiple membrane bound IgE antibodies by a specific antigen, resulting in IgE-Fc receptor aggregation on the cell surface
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one manifestation of arthritis in reactive arthritis
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sacroilitis
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location of highest incidence on the bones of osteomyelitis
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lone bone metaphysis
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interpretation of vasopressin admin during water deprevation test
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less than 10% increase in urine osm means nephrogenic
if between 10% and 50% increase it is partial central DI over 50% means complete central DI |
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marfans often presents with what, and what is MCC of death
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skeletal abn (like scoliosis/kyphosis, long extremities), subluxation of lens, and cardiovasc lesions
MCC is aortic dissection secondary to cystic medial degeneration |
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benzo with the shortest 1/2 life
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alprazolam
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39-26
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porphyrin synth
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cystic hygroma
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mass of cystic spaces separated by connective tissue rich in lymphoid aggregates
Turner's syndrome often manifests with cystic hydromas and lymphedema |
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metabolic acidosis does what do the urine
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pH decreases, excretion of HCO3 decreases, excretion of titratable acids, like NH4 and H2PO4 are increased to compensate
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different stains of the CNS
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GFAP for glia derived cells, like astrocytes, oligodendrocytes, and ependymal cells
synaptophysin for neurons, neuroendocrine, and neuroectodermal cells |
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39-40
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P-bodies
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reistance to streptomycin
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altered structure of bacterial ribosomal proteins, because it is an aminoglycoside attacking the 30S ribo
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polyhydramnios associations include
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GI obstr, intestinal atresia, anencephaly
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40-11
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unfract heparin vs LMWH
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treatment for the prevention of GBS neonatal meningitis and pneumonia
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intrapartum PCN or ampicillin
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high output congestive heart failure with neuro symptoms is strongly suggestive of what?
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wet beriberi due to thiamine def
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lead inactivates what enzymes
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delta-aminolevulinate dehydratase that converts aminolevulinic acid (ALA) into prophobilinogen (PBG)
and ferrocheletase that converts protoporphyrin IX into heme the leads to a buildup of delta-ALA and protoporohyrin IX |
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why you wait 2 weeks after stopping phenelzine before you start taking sertraline
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phenelzine is MAOI and sertraline is an SSRI
if they overlap there is a risk of serotonin syndrome |
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the ataxia in Ataxia-telangiectasia is due to what?
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cerebellar atrophy
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the advantage of celcoxib
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inhibits COX2, so you have the anti-inflamatory effects without the side effects of bleeding and GI ulceration
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what is thought to increase insulin resistance in overweight individuals
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free fatty acids and serum triglycerides
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ERB-B2 association
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invasice ductal carcinoma??
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vonWillebrand factor binds what?
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it is a protective carrier for factor VIII
it also binds platelet glycoproteins to collagen on injured blood vessel walls |
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arteritis's that contain granulomatous inflammation
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Takayasu arteritis and temporal arteritis
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possible S/E verapamil
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constipation and AV blocks
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levels of what enzyme are increased in lead poisoning
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pyridoxal phosphate, the cofactor needed to produce delta-ALA
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what virus that causes hepatocellular carcinoma and integrates into the host genome
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HBV
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FTA-ABS tests for what
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syphilis
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common side effects of ACE inhibitors
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decreased GFR, hyperkalemia, cough, angioedema
the decrease GFR is from the efferent arteriole not being able to constrict as much as the afferent |
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in healthy people, diff in bone density can be explained by
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genetic differences
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angiotensin II preferentially constricts what arteriole
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the efferent, to maintain GFR
this is why ACE inhibitors can reduce GFR |
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41-20
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.
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ecthyma gangrenosum
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cutaneous necrotic disease with strong association with pseudomonas septicemia
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cause of wet age related macular degen
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increase in VEGF
S/S are acute vision loss over days to weeks treat with anti-VEGF |
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antilipid drugs that can increase gallstone formation
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cholestyramine and gemfibrozil
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schizophrenia with amenorrhea
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antipsychotics can inhibit DA and can lead to hyperprolactinemia that can then lead to amenorrhea
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gram pos bact that has polar granules that stains deeply with aniline dyes
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Corynebact diphtheriae can resemble Chinese letters
interfers with host protein synth |
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histology of hepatotropic viruses
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hepatocyte ballooning degen (hepatocyte swelling) and apoptosis and Councilman bodies (eosinophilic apoptotic heptaocytes)
seen in HAV |
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equation that relates fluid flow to cross sectional area
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Total Flow = velocity x cross sectional area
so for 2 ends of a pipe V1xA1 = V2xA2 |
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root cause of centriacinar emphysema
|
heavy smoking involves damage to the bronchioles with activation of macrophages that inlist neutophils
it is the neutrophils release of proteases, especailly elastase that overwhelm the alpha-1-antitripsin and destroy the lung tissue |
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S/S of acute opioid withdrawl
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pupillary dilation, rhinorrhea, sneezing, nasal stuffiness, diarrhea, N/V
if suspected in a newborn of drug users, the withdrawl can be mediated with a tincture of opium |
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most common presentation of HAV
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silent or subclinical anicteric is the most common presentation
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area where aqueous humor is produced
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ciliary epithelium produces aqueous humor and is inhibited by beta blockers like timolol
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drugs that can induce lupus are normally metabolized how?
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N-acetylation in the liver
|
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how biliary obstruction can cause night blindness
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biliary obstruction leads to chronic cholestasis decreasing fat soluble vitamin absorp
decrease in Vit can lead to night blindness and dry skin/puritis |
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compensatory mech that is seen on labs in aplastic anemia
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increased epo
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dofetilide
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a class III antiarrythmic, slowing K+ efflux from the cardiac myocyte
|
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indolent NHL that presents with painless waxing and waning lymphadenopathy
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follicular lymphoma
usually t(14:18) wutg overexpression of bcl-2 |
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2 ominous potential complications of hemochromatosis
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liver cirrhosis and hepatocellular carcioma
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hypercellular glomerulus with hematuria, proteinuria, and RBC casts, suspect what?
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post-strep glomerulonephritis (PSGN)
labs will show anti-streptolysin O (OSA titer) and low C3 conc |
|
MVA aortic rupture commonly occurs where along the aorta?
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at the aortic isthmus, where the ascending and descending meet, just distal to the branch of the left subclavian
|
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Zenker diverticulum in elderly can be caused by what?
|
cricopharyngeal muscle dysfunction
pts present with dysphagia, coughing, choking, and recurrent aspiration |
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muscarinic agonist cause vasodilation via what mech?
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promots release of NO (aka endothelium-derived relaxing factor, EDRF) that stimulates cGMP, effluxing Ca and relaxing cells
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oxaloacetate and glutamate form what in the urea cycle
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aspartate and alpha-kepglutarate via transamination
note that B6 is required for this!!! |
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43-20
|
.
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common side effect of thiazolidinediones
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weight gain and edema from fluid retention
|
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prevention of tetanus in kids
|
vaccination of the mother
this is often not done in developing countries |
|
dystonia
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prolonged, repetitive muscle contractions
most common focal dystonias are cervical dystonia (spasmodic torticollis), blepharospasm, and writer's cramp |
|
lung effects from MI vs CHF
|
MI will cause acute pulmonary edema with transudate accumulating in the alveolar lumen
CHF will lead to hemostiderin laden macrophages (heart failure cells) |
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lymph node enlargement
|
antigenic stimulation that is benign LN grow is usually polyclonal proliferation
monoclonial lyphocytic proliferation is strong evidence of malignancy |
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biliary cirrhosis and xanthelasma
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primary biliary cirrhosis can lead to cholestasis that can lead to hypercholestrolemia and xanthelasma
|
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liver compensation in nephrotic syndrome
|
the liver increases lipoprotein synth in response to decreased plasma albumin conc
|
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function of what organ is monitored in amiodarone therapy
|
TSH function
as it contains iodine and can lead to thyroid dysfunction |
|
apoptosis uses what as effectors
|
caspases
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