1.

--- ---
2. -dronates
analogue of, MOA
pyrophsophate (important component of hydroxyapatitie). Make hydroxyapatite more
insol, and dec bone reab by interfering w/ osteoclasts.
Tx: osteoporosis, pagets, malig induced hypercalcemia.
3. . .
4. % of sickle cell traite. Aggregate with what? ie. HbA 60%, HbS 40%.
nml peripheral smears, indices, retic count and MCHC.
sicle w/ Na metabisulfite
5. 1,3-beta-D-glucan major polysaccharide component of fungal cell wall
6. 1 hypothyroidism feat: fatigue, weight gain, constipation, slow relaxation of DTR, and dry, coarse skin
TSH rise occurs well before low thyroid hormone level seen=>best marker for Dx
*exception in cases of central hypothyroidism (deficiency in TSH) but cases are rare
7. 2 factors that contribute to angiogenesis? VEGF and FGF
8. 2 factors that contribute to angiogenesis?* VEGF and FGF
9. 2 sample t test compare means of 2 populations: with 2 mean values, variances and sample sizes.
Then calculate the p value.
10. 2 sx specific for hyperthyroidism due to
grave's
Infiltrative dermopathy (pretibial myxedema) and exophthalmos
T cell->cytokines>Fibroblast and sec of glycoasminoglycans
TSH R in adipocytes and fibroblasts
11. 3-hydroxy-3-methylglutaryl-CoA (HMG
CoA) lyase
mitochondrial enzyme
responsible for ketogenesis from HMG CoA
HMG CoA results from degradation of leucine, a strictly ketogenic AA, and also from
synthesis by HMG CoA synthase
an intermediate in the formation of cholesterol
12. 7a-hydroxylase concerts cholesterol to bile acids
13. 24hr urinary cortisol and dexmethasone
suppression test screening
tests for Cushing syndrome
feats: central obesity, skin striae, rounded facies, deposition of supraclavicular fat, and
proximal weakness
14. 69y female no identifiable cause of
anemia. Cx?
B12 def.
cx:
Gastric atrophy
intrinsic factor deficiency
terminal ileal disease
(dietary far less common).
15. 99mm Tc-pertechnetate scan detects presence of gastric mucosa
accumulation in the RLQ of the abdomen is Dx of Meckel diverticulum that contains
ectopic gastric mucosa
16. abdominal CT useful for detecting calcification of chronic pancreatitis
17. abnormal midgut rotation around SMA leads to intestinal malrotation=>intestine fixed by fibrous adhesive bands
can cause to intestinal obstruction
18. Abx that causes pancytopenia chloramphenicol
Combo with Uworld and 3 others
Study online at quizlet.com/combine/45908121,45907999,45907876,45907750
19. ACE I can cause dec renal filtration fraction
in what pts?
Pts with renal artery stenosis (CAD).
20. acetylcholine and coronary autoregulation neurotransmitter released from parasympathetic neurons
acts on muscarinic receptors=>inhibitory effects on heart
*nervous input has very little effect on coronary blood flow
21. acetylcholinesterase in amniotic fluid
indicates
neural tube defect:
AFP and ACHE appear if neurpore doesn't fuse (opening b/w neural tube and
amniotic cavity)
22. achalasia classically present with dysphagia for liquids and difficulty belching in assoc with
dilated esophagus and absent paralysis in smooth muscle portion of esophagus
most often congenital disorder
always caused by dysfxn of ganglion cells of myenteric plexus
*if seen in pt from Central or South America suspect infxn by Trypanosoma cruzi
23. Acholic stools (no BR pigment) and bone
pain
chronic cholestatic prcoess (primary biliary cirrhosis)
24. action of ANP inc peripheral vasodilation, inc urinary excretion of Na and water.
25. action of atropine, cimetidine,
lansoprazole, sucralfate, bethanechol,
lansoprazole
block parietal cell M3 Ach R
block gastric parietal cell H2 R
Binds base of mucosal uclers to protect form acid
cholinomimetic muscarinic agonist to treat ileus and urinary retention.
PPI
26. Active TB never treated with drug
monotherapy because:
fast emergence of mycobacterial antibiotic resistance form rapid, selective gene
mutations.
27. acute adrenal insufficiency characterized by mineralcorticoid deficiency=hyperkalemia and mild hyperchloremic
acidosis
28. acute appendicitis classically present with periumbilical pain that migrates to RLQ, nausea, vomiting,
diarrhea, and fever
occurs in all age groups with peak incidence in children 6-10
caused by obstruxn of appendicular lumen
*most commonly by fecaliths=>other causes include: hyperplastic lymphoid follicles,
foreign bodies, nematodes, and carcinoids
retained mucus causes appendicular wall to distend=>impairs venous
outflow=>hypoxia=>ischemia and assoc bacterial invasion
inflamm and edema of appendicular wall cause further distention
**necrosis of wall with rupture may follow=>peritonitis
29. acute chest syndrome in Sickle cell dz ...
30. Acute effects of corticosteroidson CBC: inc neutrophil count (from demargination of neutrophils previously attached to vessel
wall)
Dec lymphocyte, monocyte, basophil, and eosinophil counts.
31. Acute intermittent porphyrias: d ALA
and phorphobilinogem responsible for
acute abdominal pain and neurological
sx.
Regulated by
dec heme-->inc hepatic ALA synthase -->inc d AlA and porphobilinogen.
Administration of heme relieves symptoms.
32. acute lymphocytic leukemia (ALL) predominantly affects children
blast cells positive for CD10 antigen (CALLA) suggest good prognosis
33. acute marginal branches arise from right coronary artery
supplies wall of right ventricle=>provides collateral circulation in pts with LAD
occlusion
34. acute MI and ventricular remodeling involves expansion, thinning, and fibrous healing of infarcted zone
regional dysfxn of infarct causes vol overload for remaining viable
myocardium=>hypertrophy of remaining myocardium=>compensation for loss of
contractile fxn
*net result: dilated ventricular hypertrophy with enlargement of LV cavity
35. Acute pancreatitis -->pancreatic
pseudocyst which consist of :
collection of fluid rich in enzymes, and infl debris. Walls have granulation tissue, and
fibrosis.
36. acute promyelocytic leukemia (APL) M3 AML subtype
have WBCs that produce aberrant protein with affinity for retinoic acid
results from t(15;17) mutation where gene for retinoic receptor alpha (RAR-alpha) is
transferred from c'some 17 to c'some 15 where it fuses with the PML gene=>PML/RAR-
alpha=>abnormal receptor unable to signal for differentiation for myeloid precursors
Tx with all-trans-retinoic acid stim differentiation of myeoblasts to mature granulocytes
and induces remission in about 90% of pts with APL
37. acute pyelonephritis present with pyuria
WBC casts=>indicate renal origin of pyuria
38. acute transplant rejection occurs weeks following transplantation
primarily cell-mediated process
histopathologic analysis: dense mononuclear lymphocytic infiltrate primarily T-
lymphocytes against MHC Ag with cardiac myocyte damage
Tx: immunosuppressive drugs
*chronic rejection would show scant inflammatory cells and interstitial fibrosis months
to years after transplantation
39. acute tubular necrosis characterized by increased serum Cr
40. Adaptive immune mx that prevents
reinfect w/ influenza virus:
anti-hemagglutinin IgG (circulation)
mucosal anti-hemaglutinin IgA (nasopharynx)
41. Addison's disease autoimmune condition=>adrenal glands bc markedly atrophic
*assoc with diffuse atrophy of adrenal cortex
42. Addison's disease assoc with atrophic adrenal glands
43. Adenosine
Use, SFX
Rapidly acting antiarrhythmic used to convert people out of PSVT (DRUG
OF CHOICE).
rapidly clearted (Th 10s).
sfx: chest burning (bronchospasm), flushing, high grade block (adverse
reactions).
44. Adenosine effect on pacemaker cell? Similar rx? Open K channel (slow I funny), inhibit Ca influx (inc Th). Ach similar.
45. ADPKD destroy kidney parenchyma
Flank pain, hematuria, HTN, urinary ifxn, progressive renal failure.
PKD1 (ch16) or PKD2 (Ch4)
Assoc: berry aneurysm, MVP, benign hepatic cysts.
46. Adrenal crisis presentations.
Treatment?
Px: hypotensive, tachycard, hypoglycemic, hx (vomiting, abdominal pain,
weight loss, hyperpig).
Tx: corticosteroids
47. Adrenal crisis:
MCC
depression of entire hypothal-pit-adrenal axis by glucocorticoid therapy
mcc of adrenal insufficiency.
Precipitated under stressful sit (infxn, surg)
48. adrenergic receptors and coronary autoregulation alpha 1 cause constriction of blood vessels among other effects
alpha-2 centrally located and cause inhibition of SNS
-1 cause excitation of heart
-2 cause vasodilation (NOT stim by NE)
49. adrenergic sx of hypoglycemia sweating, tremor, palpitations, hunger, nervousness (due to Epi, NE
release)
CNS sx develop later and at lower gluocse levels. (behavioral changes,
confusion, visual distrub, stupor, seizures).
50. Adverse effects of succinylcholine malignant hyperthermia (w/ halothane) in genetically susceptible
Severe hyperK in pts w burns, myopathies, crush injuries, denervation
(quadrepleg, Gullane)
Bradycardia from parasymp stim or tachy from symp anglionic efeects.
51. affinity maturation process of enhancing hypervariable region of Ag binding affinity that
occurs after initial binding of Ag to membrane-bound immunoglobulin on
nave B lymphocyte and subsequent migration of that B-lymphocyte to a
lymph node
within germinal center of lymph node affinity maturation accomplished by
process of somatic hypermutation where DNA coding for new
immunoglobulin variable region is mutated randomly at a very high
rate=>results in new immunoglobulins with similar, better, or worse
affinity for the Ag
only B cells expressing Ab with enhanced affinity for Ag will be selected
for
*does not occur in T-lymphocyte maturation
52. African american given prophylactic tx before trip to
africa. Returns 4d later w/ jaundice, dark urine.
Labs: anemia, reticulocytosis, and indiret
hyeprbilirubinemia. Smear: dark inclusions w/
crystal violet.
cx: Hemolytic anemia from oxidative stress (antimalarial drugs) G6PD
def.
Crysatl violet : stains heinz bodies.
X recessive.
53. African form of
Burkitt lymphoma
primarily effects children; typically presents as a maxillary or madibular mass; strongly assoc with EBV infxn
light microscope: monomorphic, intermed-sized lymphocytes with round nuclei, multiple prominent nucleoli, and
vacuolated basophilic cytoplasm; high mitotic index and high cell death rate commonly seen; benign M that
phagocytize the resulting cellular debris ("tingible body M) are diffusely distributed thruout malignant tissue;
clear spaces that surround M contribute to "starry sky" appearance
demonstrate translocation of c-myc oncogene on long arm of c'some 8 with the Ig heavy chain region of c'some
14 [t(8;14)]
*product of c-myc is nuclear phosphoprotein that fxns as a transxn activator controlling cell prolif,
differentiation, and apoptosis
54. Age of presentation
of ADPKD and
ARPKD
40-50; and birth to 1 year of life.
55. akathesia inner restlessness due to anti-psychotic tx
56. alcohol toxicity and
cardiomyopathy
type
dilated CMP
systolic dysfxn the main mech of heart failure
57. alcoholic low in
folate or b12?
folate.
58. aldolase B
deficiency
life-threatening disorder bc aldolase B needed for metabolism of fructose-1-phosphate to generate dihydroxy
acetone phosphate (DHAP) and glyceraldehyde
pts bc symptomatic only after ingesting fructose-containing foods
*infants commonly present with FTT, hepatomegaly, and cirrhosis
Tx: eliminating dietary fructose
59. aldose reductase enzyme that concerts glucose to sorbitol
plays role in development of chronic complications of diabetes
has low affinity for glucose; *in normal indiv very little glucose metabolized by this enzyme but in diabetics
glucose metabolism by this enzyme is high due to chronically high blood glucose concentrations
60. Alendronate: Synthetic biosphosphonate analog of pyrophosphte. bone resorption inhibitor prevents osteoporosis in post
menopausal women.
61. Allergic
bronchopulmonary
aspergillosis
May complicate asthma. --> transient recurrent pulm infiltrates and eventually proximal bronchiectasis.
62. alpha-
ketoglutarate
dehydrogenase
complex
converts alpha-ketoglutarate to succinyl-CoA
coenzymes required:
thiamine
lipoic acid
CoA, FAD, NAD+
63. amenorrhea in
nervosa and
atheletes
low hypothal-pit gonadotropin secretion.
64. amino acids with three
titratable protons
histidine
arginine
lysine
aspartic acid
glutamic acid
cysteine
tyrosine
65. aminocaproic acid,
tranexamic acid
inhibits fibrinolysis
66. amlodipine dihydropyridine Ca2+ channel blocker=>selective for vascular smooth muscle
most common adverse effects:
peripheral edema
reflex tachycardia=>avoid in pts with acute coronary syndrome
67. amphotericin B polyene antifungal that binds ergosterol in fungal membrane=>pore formation and cell lysis
68. amyl nitrite effective in Tx of cyanide poisoning
forms methemoglobin that binds cyanide ions and forms non-toxic compound
cyanomethemoglobin=>prevents cyanide from binding to mitochondrial enzymes in tissues
69. anaplastic tumors undifferentiated tumors: dont' resemble tissue of origin. composed of pleomorphic cells w/ large,
hyperchromatic nuclei , disorganized growth. Numerous abnl mitosis and giant tumor cells.
70. anatomy of middle mengial
artery branch off
branch of maxillary artery, branch of ext carotid
71. angiotensin II and coronary
autoregulation
very pwrfl vasoconstrictor=>acts to regulate systemic (NOT local) blood flow
72. annular pancreas abnml migration of ventral pancreatic bud. encircles teh descending part of duodenum and may lead
to sx of duodenal obtxn in neonates.
73. anthracycline chemotherapeutic agents (doxorubicin, daunorubicin, epirubicin, idarubicin)
form free radicals in myocardium
most severe side effect is cumulative dose-related dilated cardiomyopathy
*presents with Sx of L and R ventricular CHF=>dyspnea on exertion, orthopnea, peripheral edema;
swelling of sarcplasmic reticulum is the morphologic sign of early stage of doxorubicin-associated
cardiomyopathy=>followed by loss of cardiomyocytes
*most effective method of preventing doxorubicin cardiomyopathy is dexrazoxane
74. anti-psychotics low and high
potency.
low pot: non neuro SFX (sedation, antichol, ortho hypoTN)
high pot: extrapyr sx
75. Antibodies prevalent in
Hashimoto's Thyroiditis?
Anti-thyroid Peroxidase (TPO) and Anti-thyroglobulin antibodies.
76. Antibody types for A, B, and O IgM, IgM and IgG
77. anticoagulant protein C neg reg of blood coagulation=>prevent XS coagulation
activated protein C deactivates factor V and VIII by proteolysis
actions of protein C are increased in presence of protein S
78. antiepileptic that casues
elevated phenobarbital and
phenylethylmalonamide
Primidone
79. Antiepileptic that is metabolized to
phenobarbital and
phenylethylmalonamide (PEMA)
Primidone
80. Antithyroid drugs and complications Agranulocytosis. Need WBC coutn and differential (methimazole or PTU presentign
with fever)
81. antiviral medications that cause Stevens-
Johnson syndrome
nevirapine
efavirenz
82. aortic dissection chest scans usually show widened "double barrel" descending thoracic aorta
primary even is intimal tear=>give rise to hematomas as more blood creeps behind
medial wall
can extend both proximally and distally
*HTN is the single most imp risk factor for development of intimal tears leading to
aortic dissections
**cystic medial degen (seen in Marfan syndrome) also predisposes pts but relatively
infrequent
***3 syphilis known for thoracic aortic dissections but not common in US
83. aortic regurgitation hemodynamics murmur of AR diastolic decrescendo murmur
*heard loudest in early diastole=>press gradient greatest btwn aorta and left ventricle
maximal=>typically best heard at L sternal border with pt leaning forward and at end
expiration
84. aortic stenosis harsh crescendo-decrescendo systolic ejection murmur=>classic auscultatory
finding=>heard best in R 2nd intercostal space with radiation to carotids
*pts usually aSx for prolonged time and first present with exertion and can include
syncope, dizziness, angina or heart failure
*bicuspid aortic valve common cause of aortic stenosis in US
85. AP and verapamil Ca2+ channel blocker and class IV antiarrythmic drug=>slows phase 0 depol=> rate
of SA node and slows AV node conduction
*phase 0 depol of cardiac conduction system occurs during diastole=>slows diastolic
depol
clinical use:
angina
HTN
SVT
86. APC mutations progression: nml epi-(APC)->early adenoma -(KRAS)->late adenoma-(p53)->adenoCA
87. Aplastic Anemia Radio ->Fanconi (Idiopath) using Drugs and Viruses (b19, EBV, HIV, HCV)
88. aplastic anemia classically present with decreased reticulocyte count in presence of anemia
89. Aplastic crisis
Example
sickle cell anemia pt with infection (ie parvovirus-nonenveloped ssDNA). Anemia and
no reticulocyte response (aplastic).
Cx: destruction of erythroid precursor cells.
90. Apolipoprotein E4 associated w/ late-onset familial alzheimer dz.
early onset: APP (ch21) presenilin 1 and 2.
91. ards abnl and nml : anml: inc pulm cap perm, dec compl, inc work of breathing, worse V/Q.
Nml: PCWP
92. aromatase expressed in ovarian tissue and present in subcutaneous fat, normal breast tissue, and cancerous
breast tissue
*in postmenopausal state, extraovarian aromatase maintains a low level of estrogen in peripheral
circulation
93. aromatase catalyzes conversion of androgens to estrogens
94. aromatase inhibitors anastrazole, letrozole, exemestane
aromatase inhibitors that inhibit synthesis of estrogen from its androgenic substrate=>suppressing
estrogen to postmenopausal levels
*in Tx of metastatic cancer aromatase inhibitors are equivalent or superior to tamoxifen
**3rd generation are highly selective and potent
95. arsenic poisoning inactivates numerous enzymes in cellular metabolism
acute poisoning commonly occurs due to ingestion of arsenic-containing insecticides
present: GI Sx-nausea, vomiting, abdominal pain, and dirrrhea; decreased level of consciousness,
hypotension, tachycardia, and garlic odor breath
Tx: dimercaprol
96. AS murmor heard @ peak of Aortic pressure between Ao, Ac.
97. Aseptic meningitis
presentations
fever, ha, photophobia, painful extraocular movements. -->myalgias, asymmeteric paralysis.
98. aspirin irreversibly acetylates platelet COX-I=>decreased formation fo TXA2
used as 1 and 2 prevention of MI and strokes
99. aspirin inhibits: cox-1 and cox-2
cox-2 is not nmly expressed in cells.
100. Association with MG, LE? MG: thymoma
LE: pre-existing malignancy (ie lugn cancer)
101. At which is HPV
recommended?
Both males and females only between ages 9-26
102. atheromas lipid-filled intimal plaques that bulge into arterial lumen
103. atherosclerosis risk factors HTN, smoking, diabetes, hypercholesterolemia
predisposes to aneurysm formation=>esp abdominal aortic
104. atrial septal defect wide, fixed splitting of the 2nd heart sound is characteristic finding in ASD
can prod chronic pulmonary HTN as result of L=>R intracardiac shunting
Eisenmenger syndrome is the late-onset reversal of L=>R shunt due to pulmonary vascular sclerosis
resulting from chronic pulmonary HTN
105. atrial septal defect and
ventricular remodeling
shunting of blood from L to R atrium=> pulmonary blood flow
*net result: vol overload of RV=>right-sided dilated ventricular hypertrophy
106. atropine and parietal cell blocks gastric parietal cell at M3 acetylcholine receptor
107. Atropine poisoning: blind as a bat, mad as a hatter, red as a beet, hot as hare, dry as a bone, bowel and bladder lose their
tone and heart runs alone. Reverse with physosotigmine.
108. autoimmune hypophysitis inflammation of pituitary sometimes seen during late pregnancy or early postpartum
present: acute with headaches, visual field defects, and cortisol deficiency
109. autosomal and sex chromosomal inherited
disorders associated with CV developmental
defects and/or pathology
Down syndrome: endocardial cushion defects (ostium primum ASD, regurgitant
AV valves)
DiGeorge syndrome: tetralogy of Fallot and interrupted aortic arch
Friedreich's ataxia: hypertrophic cardiomyopathy
Marfan's syndrome: cystic medial necrosis of aorta
Tuberous sclerosis: valvular obstruction due to the cardiac rhabdomyomas
110. avitaminosis A squamous metaplasia can keratinize
111. avitaminosis E infertility, dec serum phospholipids
112. azoles ketoconazole, fluconazole, itraconazole, voriconazole
antifungal meds that inhibit demethylation of lanosterol into ergosterol (essential
component of fungal cell membrane)
*also inhibit P450 cytochrome oxidase system=>increases toxicity of drugs
metabolized by liver P450 system (e.g., warfarin, cyclosporin, tacrolimius,
phenytoin, isoniazid, rifampin, oral hypoglycemics)
cytochrome oxidase inducers (rifampin, phenytoin, carbamazepine,
phenobarbital) increase azole metabolism=>lower their concen in serum
113. B6 effects on levidopa, carbidopa increase metabolism and dec effectiveness.
114. Babesia divergens endemic on northeaster coast of US
transmitted by tick bites and causes babesiosis=>malaria-like illness with
predilection for asplenic pts
115. bacteria associated with PID N gonorrhoeae, c trachomatis
can cx ectopic preg if sex act.
116. bacteria G+ rod: narrow zone beta hemolysis.
motile. can grow at 4c.
Listeria monocytogenes. cell mediated immunity needed.
117. bacteria that can cause infection with low
counts?
shigella, campylobacter (500), Entamoeba histolytica (1), giardia (1)
118. bacteria that proliferate in lymph nodes Salmonella typhi
Yersinia enterocolitica
*when cause lymph node infxn mesenteric nodes can enlarge and bc
inflamed=>RLQ pain confused clinically with
appendicitis=>"pseudoappendicitis"
119. bacterial casues of anterior uveitis herpes, syphillis, lyme dz
120. base excision repair removal of abnormal bases and replacement with correct base
abnormal bases recognized and removed by specific glycosylases without
disruption of phosphodiester backbone
removal prod apurinic and apyridimidic sites that are cleaved by specific
nucleases=>gap then filled by DNA polymerase and joined by ligase
121. Benzos and sfx ...
122. Beriberi infantile: appears between ages 2-3 months with fulminant cardiac syndrome with cardiomegaly,
tachycardia, cyanosis, dyspnea, and vomiting
adult dry: symmetrical peripheral neuropathy accompanied by sensory and motor impairments, esp
distal extremities
adult wet: neuropathy with cardiac involvement
high-output congestive heart failure and neurological Sx strongly suggest wet beriberi (thiamine
deficiency)
123. Berksons
pygmalion
hawthorne
Selection bias (hops pts)
researcher's beliefs
Knowledge of study (study affects pop)
124. best drugs for tx of
hypertryglycerdiemia
Fibrates and niacin.
125. Best imaging study to work
up someone with NF type 2?
MRI of the head
126. Best test to asses damage of
liver?
Elevated PT
127. Best test to preform when
suspecting an Aortic
dissection?
Transesophageal Echocardiogram
128. Beta blocker action in
thyrotoxicosis
Dec sympathetic adrenergic impulses @ target organs. Dec rate of peripheral conversion of T4 to T3.
129. bethanechol cholinomimetic muscarinic agonist
clinical use: ileus and urinary retention
somewhat selective for M2 muscarinic receptor=>can increase gastric acid secretion
130. bile acid prod in liver=>excreted with bile=>reabsorbed in terminal ileum as micelles with fat droplets
*can be lost with feces if terminal ileum is inflamed (as in Crohn's dz)=>less bile acid present in
bile=>ratio of cholesterol/bile acid increases=>cholesterol precipitates in bile of gallbladder and
forms gallstones
131. bile acid-binding resins bile acid sequestrants=>bind bile acids in GI=>excretion of bile acids=>increase hepatic synthesis of
new bile acids that consumes liver cholesterol stores
*hepatic cholesterol reduction is activating factor for HMG CoA reductase=>increased hepatic
cholesterol synthesis=>increased risk of prod gallstones
132. bile acid-binding resins bind bile acids in GI tract=>interfere with enterohepatic circulation of bile acids
primarily used in combo with statins for Tx of hypercholesterolemia
increase hepatic TG prod=>can cause elevations in serum TG
133. bilobed (malignancy) reed sternberg; hodgkin
134. Bioavail F= AUC oral x dose IV/ AUC IV x dose oral
135. Black pt with frequent visits
to the hospital for painful
crisis:
what is she treated with and
what does she have?
Painful, vaso-occlusive crises. Respond well to oxygen, IV fluids, and high dose narcotics.
136. blot procedures southern: DNA fragments
western: proteins
northern: mRNA
southwestern: DNA-bound proteins (transxn factors, nucleases, histones, etc.)
137. BRCA1, BRCA2 DNA repair enzymes
mutations assoc with breast cancer, ovarian cancer, Lynch syndrome, xeroderma pigmentosum, Fanconia
anemia
138. Broken 12th rib kidney. pain radiates to back (11 and 12 are floating)
139. bromodeoxyuridine thymidine analog used for grading tumors
uptake is consistent with high-grade tumor and a poor prognosis
140. bronchoalveolar
carcinoma
subtype of lung adenocarcinoma
uncommon, 10% of all lung cancers; occurs in non smokers
tumor arises from alveolar epithelium and located at periphery of lung and often multifocal
microscope: tumor is well-diff, composed of tall, columnar cells that line alveolar septa without evidence of
vascular stromal invasion
imaging: pneumonia-like consolidation
141. Brucella melitensis acquired by drinking infected milk or by direct contact with infected sheep and goats
present: fever, malaise, lymphadenopathy, and hepatosplenomegaly
*extremely rare in US
142. Buerger's histo acute and chronic inf of arterial walls / thrombosis
Can extend into contiguous veins and nerves.
143. Bupropion CI in
what patiens
patients with seizure d/o and bulimia, anorexia.
144. C diph culture
Sx?
in cysteine-tellurite agar.
septiciemia, UTI, erythrasma, endocarditis in IC.
gray pharyngeal exudate in not vacc.
145. c tetani
vaccicination
Toxin can cross placenta, developing countries can vaccinate young adults. It is formalin -inactivated toxin
(toxoid)
146. cAMP 2nd messenger in G-protein/adenylate cyclase 2nd messenger system
utilized by hormone receptors including -adrenergic receptors, V2 ADH receptors, and calcitonin, glucagon,
TSH, ACTH, and HCG receptors, among many others
147. Campylobacter
fetus
opportunistic pathogen that infects immunocompromised persons
infxn can cause septicemia in newborns, women in 3rd trimester of pregnancy, and debilitated elderly pts
148. campylobacter
transmission
domestic animals or contaminated food.
149. CaNa2EDTA chelating agent of choice for Tx of acute lead and mercury poisoning
acts by forming complexes with mono-, di- and trivalent ions
150. candida albicans component of normal human skin and mucous membrane flora
exists as single-celled budding yeast with pseudohyphae (formed from yeast
cells)
does not cause disseminated infxns in healthy ppl=>can induce serious dzs
when immune system weakened
*opportunist pathogen
host antifungal defense is T-lymphocytes and neutrophils
1. T-lymphocytes (in particular T(H) cells) are imp for prevention of superficial
Candida infxn
*why localized candidiasis common in HIV+ pts
2. neutrophils prevent hematogenous spread of Candida; can cause R-sided
endocarditis, liver and kidney abscesses, and candidemia
*why neutropenic indiv more likely to have systemic dz
151. capsaicin reduces pain by reducing susbtance P
152. capsofungin echinocandin antifungal that blocks glucan synthesis
153. Carbon tetrachloride effects on liver p450 microsomal oxidase --detoxifies.
poisoning -->produces free radicals that lead to liver necoriss and fatty change.
154. cardiac output use Fick principle to calculate
CO=O2 consumption/arteriovenous O2 diff
155. Carpal tunnel syndrome associated with what
d/z
hypothyroidism, DM, RA, dialysis assocaited amyloidosis
156. carvedilol -blocker
nonspecifically antagonizes:
-1
-2
alpha-1
157. Catalase + organisms PLACESS
Pseudomonas, Listeria, Aspergilus, Candida, E.coli, S. aureus, Serratia
CGD: recurrent infxns
158. Caudal regression syndrome: cx and sx maternal diabetes; sacral agenesis w/ lower exteremity paralysis and urinary
incontience.
159. Cause of AAA atherosclerosis which starts as a fatty streak. Then weakens underlying media
of aortic wall.
160. cause of adding carbidopa to levidopa only tx inc anxiety, agitation
161. cause of gout (mt) mt in PRPP synthetase-->inc pdtn of purines-->hyperuricemia
162. cause of lynch syndrome (AD) abnml nucleotide mismatch repair. MSH2, MLH1 genes.
163. cause of paraneoplastic sydrome of
hypercoagulability (trousseau's syndrome):
cancer (adenocarcinoma of panceas, colon, lung). visceral cancer.
164. Cause of trisomy 13 secondary to non dsjxn of maternal meiosis I. associated w/ cleft lip, palate,
polydactyly, rocker bottom, holoprosencephaly
165. Causes of Down syndrome? % DS due to meiotic non dysjxn > robertsonian t14:21 t21:22 (3-4%)
166. causes of megaloblastic anemia deficiencies of vit B12 and/or folate
assoc with number of drugs (methotrexate and phenytoin) and some inborn
metabolic errors
167. Causes of
normotensive
hypokalemia
alkalosis?
1. vomiting
2. diuretic abuse
3. Bartter's
4. Gitelman's
**Vomiting is the only with decreased urinary chloride levels.
168. cavernous
hemangiomas
consist of dilated vascular spaces with thin-walled endothelial cells
soft blue compressible masses up to a few cm; appear on skin, mucosa, deep tissues and viscera; when
appears on skin most frequently based in dermis
less likely to regress spontaneously than capillary hemangiomas
*assoc with Hippel-lindau dz w hen found in brain and viscera
169. CCl4 effect on liver free radical injury=>oxidized by p450 whchi forms CCl3.-->reacts w/ lipids in cell membrane (degradation
and H2O2 formaiton)..Lipid peroxidation.. hepat nec
170. celiac disease gluten-sensitived enteropathy
*gluten a component of wheat and some other related grains
characterized by Sx of malabsorption: diarrhea, weight loss, and deficiencies of vitamins and minerals
*Sx subside with exclusion of gluten-containing products from diet
may manifest early or later in life
Dx when flattening of mucosa with loss of villi and chronic inflamm infiltration of lamina propria seen on
small intestine biopsy; IgA anti-tissue transglutaminase and IgA endomysial Ab are very sensitive and
specific for Dx
*most pronounced changes seen in duodenum and proximal jejunum bc concentration of gluten higher there
171. celiac disease
mechanism
occur by immune-mediated mech in genetically-susceptible indiv
abnormal response to tissue transglutaminase, a enzyme that participates in metabolism of gluten
IgA Ab to gliadin (mixture of polypeptides extracted from gluten) typical finding in pts
other Ab frequently found in pts with celiac dz are anti-endomysial and anti-reticulin
172. cell adhesion
molecules
proteins located on cell surface that mediate binding with other cells or with ECM
ex) selectins, integrins, and cadherins
*usually downreg in malignant tumors=>allows cells to spread from their site of origin
173. cells causing swelling
in acute gout? tx and
MOA
neutrophils. Colchicine inhibits chemotaxis of neutrophils by preventing microtubule formation.
174. central
chemoreceptors
located in medulla
indirectly sensitive to changes in PaCO2=>directly sensitive to pH changes
*NOT sensitive to PaO2
175. cervix epithelium simple columnar (endocervix); stratified squamous (ectocervix)
charac: contains cervical glands; secretion undergoes cyclic changes allowing for less viscous mucus at time
of ovulation
assoc tumors: condyloma acuminatum, squamous cell CA, adenocarcinoma
176. characeristics of aktinic keratosis hyperkeratosis and parakeratosis
177. Characteristics of Blastomycosis? Found in soil or rotting wood. CXR will reveal multiple nodules or dense
consolidation. Can cause skin lesions, osteolytic bone lesion, and prostate
involvement. Not usually seen in immunocompromised hosts.
178. Characteristics of Histoplasmosis? Found in Ohio river valley. Palatal ulcers, hepatosplenomegaly, and
pancytopenia.
CXR will reveal interstitial pneumonitis.
179. characteristis of turner primary amenorrhea, high arched palate, widely spaced nipples, ovarian
dysgenesis (streaked), short.
180. chemotherapeutic agents and cardiomyopathy
type
dilated CMP
systolic dysfxn main mech of heart failure
ex) doxorubicin
*dose-dependent cardiotoxicity
181. cherry hemangiomas small, vascular, bright-red, papular lesions; always cutaneous and not found on
mucosa or deep tissues
most common benign vascular tumors in adults; do not regress spontaneously; #
often increases with age=>why referred to as senile hemangiomas
*appear during 3rd or 4th decade of life
**maraschino cherries are in cocktails
histo: sharply circumscribed areas of congested capillaries and post-capillary
venules in papillary dermis
182. Chi square test 2x2: test association b/w variable and effect (+/-)
183. child presents with barking cough, hoarseness
and respiratory distress. what is the dx?
Croup- 2/2 parainfluenza
184. Child with history of trauma to soft palate then
develops s/s of stroke. what is the dx?
Internal Carotid Artery Dissection
185. child with hyperpyrexia is treated by: cooling blankets first, then acetaminophen which takes longer to act.
186. child with meningtis + petechial rash? meningococcemia
187. Child, fever, painful gingival ulcers, swollen
gums, cervical lymphadenopathy. Oral ulcer
base scraping---> interpretation.
Oral ulcer base scraping--Tzanck test (look for multinucleated giant cells).
HSV, VZV: present w/ fever, vesiculoulcerative (herpatic) gingivostomatitis,
cervical lymph for PRIMARY INFXN.
Reactivation: limited perioral blister.
188. Cholecystitis acute or chronic infl of GB.
cx: mc cholelithiasis; (block->2nd ifxn)
inc ALP (if bile duct involved)
Dx: US or HIDA
189. Cholinergic crisis lack of response from edrophonium. Need to stock cholinesterase inhibitors. if
positive response--> continue or inc dose of neostigmine
190. chronic lymphedema disposes to: angiosarcoma (stewart-treves syndrome)
191. chronic lymphocytic leukemia frequently seen in elder pts
presents with lymphadenopathy, hepatosplenomegaly, and anemia
has an indolent course
neoplastic cells resemble mature B-lymphocytes
192. chronic myelogenous
leukemia (CML)
translocation of c-able gene from c'some 9 to c'some 22 [t(9;22)]=>philadelphia c'some
bcr-abl the resulting fusion gene=>encodes protein that inhibits apoptosis while promoting
mitogenesis and increased tyrosine kinase activity
193. chronic pancreatitis often caused by alcoholism=>exocrine insufficiency
present: severe abdominal pain, stool that floats in toilet bowel (due to XS fat content), and weight
loss
194. Churg-Strauss vasculitis linked to asthma
lesions typically occur in small vessels and characteristically accompanied by granulomas and
eosinophilic necrosis
195. CI for OCP prior hx of thromboembolic event or stroke
hx of estrogen-dependent tumor
>35 who smoke heavily
hypertriglyceridemia
Decompensated or active liver disease (steroid met is impaired)
Pregnancy.
196. CI for OCP* prior hx of thromboembolic event or stroke
hx of estrogen-dependent tumor
>35 who smoke heavily
hypertriglyceridemia
Decompensated or active liver disease (steroid met is impaired)
Pregnancy.
197. cimetidine and parietal cell blocks gastric parietal cell histamine H2 receptor
198. Cimetidine use and sx H2 r antagnoist for ulcers. SFX: gynecomastia. also inhib p450.
199. Cimetidine:
Use, moa, sfx
H2 R antagonist dec hydrochloric gastric aci production.
SFX: Gynecomastia.
200. circulatory regulation IV fluid infusions intravascular vol=> preload=> ventricular myocardial sarcomere length=>
stroke vol and CO
201. cirrhosis and albumin classically present with decreased serum albumin levels from decreased prod
202. citrullemia urea cycle disorder
results from deficiency of arginosuccinate synthetase
ATP is the cofactor required
203. cleft lip:
Cleft palate:
maxillary prominenece fail to properly fuse w/ intermaxillary segment.
Palatine shelves of maxiallary prominence fail to properly fuse w/ one another or primary palate.
204. clinical manifestations of
Wilson disease
liver involvement:
aSx liver fxn abnormalities
chronic hepatitis
fulminant hepatitis
portal HTN
liver cirrhosis
neuropsychiatric sequela:
parkinsonian-like tremor
rigidity and/or catatonia
ataxia
slurred speech
personality changes
depression or paranoia
205. clomiphene selective estrogen receptor modulator=>prevents neg feedback inhibition on hypothalamus
by circulating estrogen=>increased gonadotropin prod
common Tx for PCOS and women who want to get preggo=>induces ovulation
206. clomiphene antiestrogen=>interferes with neg feedback of estrogens on hypothalamus and pituitary
increases synthesis of GnRH=>increases gonadotropins
used to Tx infertility esp when assoc with anovulation
207. Clostridium difficile colonizes colonic mucosa and releases toxins that cause mucosal inflamm, cell damage,
and ultimately cell death with mucosal necrosis
present in 2-3% of healthy adults and in about 70% of healthy infants as part of gut's
normal microbial flora
dz results when pt uses antibiotics that kill large portion of commensal organisms in gut
(what normally keeps the C. difficile in check)
pathogenic strains prod AB toxin:
A-enterotoxin; acts as neutrophil chemoattractant=>mucosal inflamm, loss of water into
gut lumen (prod diarrhea), and mucosal death
B-cytotoxin=>actin polymerization, loss of cellular cytoskeleton integrity, cell death and
mucosal necrosis
toxins bind to specific receptors on intestinal mucosal cells and are internalized where they
exert their intracellular effects
208. Clostridium perfringens alpha toxin lecithinase causes cell membrane integrity loss
frequently assoc with clostridial myonecrosis and gas gangrene (rapidly progressive form
of fasciitis assoc with penetrating injury by soil-contaminated objects
*can also cause transient watery diarrhea
209. CML and CLL causes neutropenia
which can lead to what fungal
infection:
invasive aspergillosis. (lung MC affected). Hemoptysis, lung granulomas. + Aspergillus
has predilection for blood vessels--> spread hematog and cx infarcts in skin, paranasal
sinuses, kdiney, endocard, brain.
210. co ...
211. Coarctation of aorta : eventually leads
to death by
hypertension associated complication. LVF, rupture dissecting Ao aneurysm, IC
hemorrhage
212. Colchicine sfx diarrhea, N/V
MOA: inhibit tubulin polymerization
213. Cold agglutinins infxn and dz Mycoplama pneumoniae, EBV, hematologic malignancy
214. colonoscopy used to Dx ulcerative colitis and Crohn's dz involving large intestine
also used to screen for colon cancer
215. common causes of liver cirrhosis alcoholism
chronic hepatitis B and C
216. Common causes of primary
amenorrhea in female w/ secondary
sexual characteristics :
imperforate hymen or mullerian duct anamoly.
undx imperforate hymen presents w/ cyclic abdominal or pelvic pain and hematocolpos.
217. Common cx for inc prevalence? improved quality of care.
218. Common cx of atypical DVT? factor V leiden mut.
Pt given Protein C and PTT doesn't change (Nml)--due to Va resistance.
219. Common findings
seen in Paget's
disease?
Due hyperfunctioning Osteoclasts. Elevated Alk. Phosph., femoral bowing on x-ray, and loss of CN VII
activity due to enlarging cranial bones.
220. common side effects
of digoxin?
GI : nausea, vomiting, anorexia
221. Common sx of
infectnious mono
cx:
sore throat, high fever, cervical lymphadenopathy, splenomegaly
cx: 90% EBV (CMV, HIV, toxo are non-EBV mono)
222. complement
deficiency
deficiency of C1, C2, and C4 leads to increased susceptibility to infxns and SLE-like dz
low levels of C5, C6, C7, C8, and C9 predispose indiv to infxns with Neisseria gonorrhea and Neisseria
meningitidis
223. concentric ventricular
hypertrophy
uniformly thickens ventricular wall while other dimensions of ventricle remain virtually
unchanged=>narrowed ventricular cavity
*often seen in pts with longstanding HTN bc LV afterload
224. congenital adrenal
hyperplasia
encompasses a group of disorders that stem from various defects in enzymes involved in cortisol
biosynthesis=>increased cortisol precursors proximal to enzyme deficiency
21-hydroxylase deficiency the most common cause=>90%; converts 17-hydroxyprogesterone to 11-
deoxycortisol in zone fasciculata; converts progesterone to deoxycorticosterone in zona glomerulosa
*accum cortisol precursors diverted towards adrenal androgen biosynthetic pathway=>increased adrenal
androgens
**low cortisol levels stim ACTH prod=>further increases adrenal androgens production
***female infants get masculinized and males look normal
225. congenital pyloric
stenosis
infant:
RUQ mass (hypertrophy of SM)
Projectile vomit *non bilious
226. Congenital rubella cataracts, deaf, PDA
227. Congenital torticollis noted by 2-4wks of age. hold head tilted to one side.
Cx: malposition of head in utero or birth trauma.
Tx: conservative therapy and stretching exercises.
228. Conn's syndrome increased aldosterone secretion=>hypertrophy of glomerular layer of adrenal cortex
229. Consequences of
reduced hemoglobin
p50?
reduced release of O2-->renal hypoxia, inc Epo, inc erythrocytosis.
230. control of respiration PaCO2 in healthy indiv major stim of respiratory drive=>CO2 readily crosses BBB and forms H+ ions that
directly activate medullary respiratory center
*PaO2 and pH are of secondary imp except when abnormalities are present (e.g., COPD)
PaO2 sensed in carotid and aortic bodies; plays little role when >70mmHg but in profound hypoxemia
(<60mmHg)=>mech plays more imp role in maintaining respiratory drive
*chronic and profound hypercapnia =>high [CO2] cease to stim respiratory center=>O2 bc the only
stim=>bad if rapidly increase O2 bc pt loses respiratory drive stim=>respiratory failure
231. coronary occlusion
and collaterals
rate of occlusion=>major determinant of whether or not coronary artery plaque will cause ischemic
myocardial injury
*slowly developing occlusion allows formation of collaterals=>could prevent myocardial necrosis
232. coronary steal
syndrome
paradoxical in blood flow to an area of ischemic myocardium bc blood will preferentially flow thru
pharmacologically dilated arteries of the heart not obstructed by atherosclerotic coronary vessel narrowing
233. Corynebacterium
diptheriae
causes diptheria: acute bacterial dz that initially affects oropharynx
spread by respiratory droplet transmission and causes dzs via AB exotoxin; B subunit allows penetration of A
subunit into cell to inhibit ribosome fxn=>transfers a ribose residue from NAD to a histidine on EF-
2=>essential for peptide chain translocation on ribosome in process of translation=>causes cell death by
inhibiting protein synthesis thru EF-2 inactivation
neural and cardiac toxicity are serious potential sequelae
immunization with diptheria toxoid induces production of circulating IgG against exotoxin B
subunit=>effectively prevents dz
234. CPx of
choriocarcinoma
Arises from trophoblast.
MC from evacuated hydatidiform mole, but also abortion, nml preg, ectopic preg.
Px: vag bleeding, uterine enlargement, inc hCG.
Met hematogenously (lungs).
Tx: chemo sensitive.
Macro: soft, yellow white. Necrosis and hemorrhage.
Cytotrophoblast and syncytiotrophoblast. No villi
235. CPx of glucagonoma DM, necrolytic erythema, and anemia.
236. craniopharyngioma
(histo, origin,
calcified cyst, w/ squamous epithelium, kertain pearls, viscious fluid rich in xol.
Derived from Rathke's pouch
237. crescents in
glomerulonephritis
consists of:
parietal cells, monocytes, macrophages, fibrin.
238. CREST : pathophys CD4 lymph -->secretions-->fibroblast -->collagen-->tissue fibrosis.
LES muscle replaced by fibrous tissue.
239. CREST syndrome Calcinosis
Raynaud's phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia
assoc with anti-centromere Ab
240. cricopharyngeal
muscle dysfunction
due to diminished relaxation of pharyngeal muscles during swallowing=>more force required to move food
bolus down
more intense contractions of pharyngeal muscles increase oropharyngeal intraluminal press
*with time pharyngeal mucosa will herniate thru muscle fibers in zone of weakness (post hypopharynx)=>form
Zenker diverticulum (false diverticulum)
Sx: "high dysphagia"-difficulty swallowing felt "at the throat," coughing, choking, and sometimes even nasal
regurgitation
present: oropharyngeal dysphagia, coughing, choking, and recurrent aspiration
241. cricothyrotomy cuts
through
superficial cervical fascia and crycothyroid membrane.
242. cryptorchidism incomplete descent of the testes into the scrotum
undescended testes are usually found in abdominal cavity or in inguinal canal
can lead to sterility and increases risk of testicular carcinoma
243. cryptorchidism seminiferous tubules are damaged
interstitial Leydig cells are preserved
244. Cushing's dz assoc with hyperandrogenism and obesity
245. Cushing's sydrome XS cortisol production
246. cx and presentation of
cricopharyngeal muscle
dysfxn
diminsed relaxation of pharyngeal muscle during swallowing. Inc intralum pressure causes mucosa to
herniate leading to zenker diverticulum. Present with dysphagia, coughing, chokcing, recurrent
aspiration.
247. cx of apple peel in GI: SMA obtxn. Intestinal atresia distal to duodenum due to vascular accidents in utero.
248. cx of charcot bouchard small and pts w/ hypertension (longstanding).
249. cx of clubbing prolonged hypoxia:
large cell lung ca, tuberculosis, CF, empyema, bronchiectasis, chronic lung abscesses
250. cx of delirium infection, electrolyte disbalance.
251. cx of DS nondysjxn>robertsonian translocation>mosaicism
252. cx of frothy urine proteinuria. due to nephrotic syndrome.
253. cx of gallstones in crohn's dec bile acid reabs and lost in feces inc lithogenicity of bile. xol precipitates and forms gallstones.
254. cx of green sputum in
bacterial infection in
lungs?
Myeloperoxidase (neutrophil azurophilic granules).. used to produce HCOL for resp burst.
255. cx of hyperosmotic vol
contraction
isoosmotic vol contxn
vol exp and hypoosm
hypoosmotic vol ctxn
hypertonic vol exp
DI or sweating (hypotonic)
diarrhea or hemorrhage
Psychogenic polydypsia
Adrenal insuff (Na wasting)
hypertonic saline infus
256. Cx of insulin resistance in
overweight individuals
high free fatty acids and serum triglycerides
257. cx of pancytopenia and
glomerulonephritis in SLE
AutoAb vs blood cells (TII HS).
immune complex deposition w/in glomerulus (TIII HS)
258. Cx of recurrent lobar
hemorrhages and
association
cerebral amyloid angiopathy due to age (associated w/ HTN)
259. Cx of reperfusion injury? 1. oxygen free radical (parenchymal, endothelial, leukocytes),
2. mito damage
3. inflamm (neutrophil recruit)
4. complement
260. cx of subarachnoid
hemorrhage?
AV mal and saccular aneurysm
261. Cx of tissue damage in
lung abscess:
lysosomal enzyme released from neutrophils or macrophages.
262. cystic fibrosis present: recurrent respiratory infxn with Pseudomonas aeruginosa, chronic diarrhea, weight loss
*P. aeruginosa common pulmonary pathogen in CF
**diarrhea and weight loss occur as result of malabsorption due to obstructive fibrosis and progressive
insufficiency of exocrine pancreas
263. cystic hygromas lymphatic cysts lined by thin endothelium
benign tumors often present at birth; most commonly located on neck and lateral chest wall
*frequently found in neonates with Turner syndrome and Down syndrome
264. cystitis common organisms: E. coli, S. saprophyticus, P. mirabilis, Klebsiella, Enterococci
Sx: may be aSx or Sx; suprapubic pain and tenderness, frequent urination
labs: UA and micro show +leukocyte esterase, +nitrites, +bacteria, +WBC, +RBC occasionally
265. cytochrome P450
monooxygenase
enzyme present in hepatic microsomes and endoplasmic reticula of varied other tissues
metabolizes steroids, alcohol, toxins, and other foreign substances
*renders them soluble and easier to excrete
**converts pro-carcinogens into carcinogens capable of causing mutations in human DNA
266. cytomegalovirus causes "heterophil-negative" mononucleosis in immunocompetent hosts
in immuocompromised pts it casues various systemic infxns: pneumonia, hepatitis, retinits, esophagitis,
and diarrhea
267. D-glutamate B anthracis capsule instead of polysacch
268. D-xylose test monosaccharide. differentiate malab of pancreatic vs GI mucosal etiology
269. Damage of scleroderma
on pulm vessels
Pulmonary hypertension due to damage of pulmonary vasculature. prolif and accum of monoclonal T cells
in affected tissues secrete cytokines (TGF-beta) that inc pdtn of colalgen and ECM protein by fibroblasts.
270. danazol synthetic androgen
clinical use: endometriosis, hereditary angioedema
side effects: hirsutism, masculinization, fluid retention, and weight gain
271. Daptomycin:
use, sfx , moa
G+ inc MRSA. depolarization of bacterial cellular membrane and inhibition of DNA, RNA, protein sythesis.
INc CPK and incidence of myopathy
272. deamination of bases can occur spontaneously or 2 to exposure to certain chemicals
cytosine=>uracil
adenine=>xanthine
guanine=>hypoxanthine
273. Death by TCAs mech refractory hypotension and cardiac arrhythmias. Inhibit fast Na ch in cardiac myocytes. Tx: nml saline +
hypertonic Na bicarb
274. Dec glomerular
pressure with ACE I
occurs in:
pts with renal artery stenosis.
275. decreased BUN associated with liver dz bc less ammonia converted to urea
276. def in late complement
comp
No MAC--> neiss infetions
277. Def in Propionyl CoA
carboxylase leds to:
propionic acedemia,
Poor feeding, vomiting, hypotonia, lethargy, dehydration, anion gap acidosis.
278. defect terminal
compleent casacade
infxsn
nisseria
279. deferoxamine chelating agent used to Tx iron poisoning in pts receiving multiple blood transfusions for conditions such
as thalassemia and in pts who consume large amounts of supplemental iron
binds iron in bloodstream and facilitates urinary excretion
280. deglutition 3 phases:
oral-voluntary; food bolus collected at back of mouth and lifted upwards to post wall of
pharynx=>initiates pharyngeal phase
pharyngeal phase-involuntary pharyngeal muscle contractions=>propel food bolus to esophagus
esophageal phase-food enters esophagus and stretches walls; peristalsis begins juts above site of
distention and moves food downward; relaxation of LES follows=>allows food bolus enter stomach
281. dermatomyositis autoimmune disorder
presents: proximal muscle weakness and skin involvement including a violaceous discoloration of
upper eyelids (heliotrope rash), and a raised, violaceous, scaling eruption on the knuckles
(Gottron's sign)
CPK levels are typically elevated
282. Describe 2nd stage of
syphillis?
condylamata lata and maculopapular rash invovling entire trunk and extremities. rash also on
palms and soles
283. Describe an essential tremor? Tremor that is suppressed at rest but exacerbated toward the end of a goal directed activity.
284. Describe Cystinuria? 1. recurrent kidney stones
2. stones are hard and radioopaque
3. crystals are hexagonal
4. urinary cyanide nitroprusside test is positive
285. Describe Diffuse Esophageal
Spasm?
Spontaneous pain and discomfort with hot or cold food. Best to proceed with Esophageal motlitiy
study will reveal non-peristaltic, high amplitude contractions.
286. Describe Homocystinuria? Marfan's syndrome + Mental retardadtion + thromboembolic events+ downward dislocation of the
lens
TXT: Vitamin B6
287. Describe polymyostitis? characterized by weakness and difficulty arising from chair and or stair climbing.
288. Describe post-operative
cholestatis?
Commonly seen after seizures with
1. hypotension
2. Extensive blood loss into tissues
3. Massive blood replacement
Pt will have jaundice few days after surgery and mildly elevated AST and ALT, with elevated
bilirubin levels.
289. Describe Prader Willi
Syndrome?
Deletion in chromosome 15
Hypogonadism, hypotonia, macrophagia
mental retardation, small down turned mouths,diamond shaped eyes
290. Describe renin-angtiotensin-
aldosterone pathway?
1. Renin produced by JGA in kidney 2/2 hypoperfusion
2. Renin cleaves angiotensinogen into angiotensen I
3. angio. I is converted to angio. II by ACE (released by lungs)
4. Angio. II: vasocontrictor, promotes ADH release from pituitary, and aldosterone production in
adrenal cortex.
291. Describe saline responsive
metabolic alkalosis?
Metaoblic alkalosis with urine chloride less than 20. Due to :
1. Vomiting
2. volume depletion
3. diuretic abuse
txt with isotonic saline
292. Describe the pattern of
esophageal dysmotility in
scleroderma?
decreased peristaltic contractions in lower 2/3 of esophagus.
decreased LES tone
"food gets stuck in throat"
293. Describe the symptoms of
Pancoast tumor?
2/2 lung tumor in superior sulcus
compress brachial plexus and cause shoulder pain radiating to arm in ulnar nerve distribution
tumor invades CN 8 and T1
294. Describe the two sample t-test? used to compare the mean of two groups of subjects
295. Describe what imaging studies of invasive
aspergilliosis would look like?
CXR: rapidly progressive dense consolidation
CT: Pulmonary nodules with "Halo" signs or lesions with air crescent.
296. desmolase catalyzes formation or destrxn of carbon-carbon bonds within a molecule
plays sig role in respiration and fermentation
297. dexrazoxane iron-chelating agent that formation of oxygen free radicals by
doxorubicin and other anthracyclines
298. Diamond-Blackfan anemia? congenital hypoplastic anemia
macrocytic anemia, low reticulocyte count, and congenital anomalies:
webbed neck, triphalangeal thumb, shielded chest
299. diastolic heart failure characterized by ventricular diastolic compliance BUT normal ventricular
contractile performance=>LVEDP must be to achieve near-normal
LVEDV and stroke vol
*only see in LVEDP
300. diastolic HF vs Systolic HF: Diastolic: dec ventricular diastolic compliance but nml ventricle contractility
SHF: dec ventricular contractil performance (dec EF)-->inc LVEDP, LVEDV
301. didanosine side effects pancreatitis
302. Diff b/w brachiocephalic and SVC obstruction? SVC bilateral. brachiocephalic drains ipsilateral jugular and subclavian
vein.
303. Diff b/w central and partial DI? less than 10% change: nephrogenic
Complete central: >50%
304. Diff b/w hepatocyte injury and death injury: diffuse swelling (ballooning degeration)
Death: lobular architectural disruption and confluent hepatoyte necrosis
(bridging necrosis).
305. Diff b/w HSV, syphilis, and Chlam HSV ulcers -painful, heal in 10 days
S: ulcer heals in weeks.
Chlam - painless, heal few days.
306. diff b/w LMWH and unfract both bind antithrombin to inc activity against Xa. but Unfract binds both
antithrombin and thormbin
307. Diff b/w MEN2A and 2B 2A: Parathyroid hyperplasia, medullary CA, pheochromocytoma
2B: medullary CA, pheochromocytoma, oral/intest mucosal neuromas.
308. Diff b/w myocardial hibernation, stunning,
remodeling..?
hibernation: reversed by reperfusion adn more serious than stunning
(ischmeia-induced reversibel loss of contractile fxn).
Ischemia preconditioning: resistance to infarction due to repetitive non-
letha isch.
Ventricle remodeling: change in mass, vol, shape, myocyte comp of heart.
309. difference between comma shaped gram - bacteria
that cause diarrhea, ox + :
campylobacter cannot grow in alkaline rich medium while cholera can.
310. Difference between malignant HTN and long
standing non malig HTN on arterioles? Assoc with
other disease?
Hyaline arteriolosclerosis w/ longstanding nonM and diabetes.
Malignant HTN--> homogenous, onion-like, concentric thickening of
walls.
311. Difference between malignant HTN and long
standing non malig HTN on arterioles? Assoc with
other disease?*
Hyaline arteriolosclerosis w/ longstanding nonmalignant and diabetes.
Malignant HTN--> homogenous, onion-like, concentric thickening of
walls.
312. Difference between persistant granulomatous
inflammation and excessive granulation tissue
1: chronic inflammation from activated MO (may be due to presence of
foreign antigen/suture).
2: keloid.
313. Difference of mycoplasma and mycobacteria
walls?
Mycoplasma has mycolic acid (long brached chain sat. FA). Mycobacteria has
no wall.
314. differentiate between Toxolplasmosi, CNS
lymphoma, and PML in HIV pt?
Toxo: multiple ring enhancing lesions in basal ganglia
CNS lymphoma: Solitary ring enhancing lesion. presence of EBV DNA in CSF
PML: multiple non enhancing lesions with no mass effect
315. Differentiate false labor? 1. No cervical changes seen on exam
2. lower abdominal pain relieved by sedation
3. irregular contractions
316. differentiation between erosion and ulcer:
border?
muscularis mucosa (not penetrated by erosion)
317. digoxin clinical use:
impaired left ventricular fxn
AFib
common adverse side effects:
nausea
vomiting
diarrhea
318. dimercaprol chelating agent used in Tx of arsenic poisoning
displaces arsenic ions from sulfhydryl groups and enzymes and facilitates their
excretion
319. diphenoxylate opiate anti-diarrheal structurally related to meperidine
binds to mu opiate receptors in GI tract and slows motility
lower therapeutic doses allow for potent anti-diarrheal effects w/o sig opiate
effects (euphoria and physical dependence)
higher doses can produce morphine like euphoria and physical
dependence=>usually combined with atropine to discourage abuse
common side effects: bloating and mild sedation
320. Diphenoxylate: use, moa, sfx anti-diarrheal opiate (related to meperidine), binds mu to slow motility.
Euphoric at high dose
321. diphtheritic myocarditis and cardiomyopathy
type
ultimately progresses to dilated CMP
systolic dysfxn the main mech of heart failure
322. direct arteriolar vasodilators effective antihypertensives
can cause sig arterial vasodilation=>reflex sympathetic activation=>tachycardia
and edema
to counteract compensatory effects prescribe with sympatholytics and diuretics
323. direct thrombin inhibitors directly inhibit thrombin-mediated fibrin formation
*mainly prolong TT
lepirudin and argatroban are primarily used for management of heparin-induced
thrombocytopenia
324. DNA cross-linking induced by numerous chem and physical agents
*most notably caused by alkylating agents used in Tx of cancer
325. DNA methylation epigenetic phenomenon used to silence or reduce expression of certain genes
only template strand is methylated early in course of DNA replication=>enzymes can
differentiate between template and daughter strand=>adenine methylation guides DNA repair
in newly synthesized DNA
*how tumor suppressor genes frequently silenced in malignant cells
326. Dominant hemoglobin in infants HbF. begins to switch during frist 6 mo
327. Dopamine no effect on CNS due to: tight jxns in BBB. (levodopa, however, can cross).
328. Down and out lesion with PCA damage
329. Down sydrome most common c'somal abnormality
2nd most common cause of mental retardation
assoc with advanced maternal age and can be Dx prenatally
indicated by low AFP=>indicates amniocentesis=>karyotyping of fetal cells contained in
amniotic fluid can Dx Down syndrome
90% have trisomny 21; parents are normal and abnormality from meiotic non-dysjunction
(failure of c'some 21 to divide during meiosis); occurs in ovum, explaining assoc of Down
syndrome with increased maternal age
330. Drug for sickel cell anemia to
increase HbF. other drugs
hydroxyurea.
Gardos channel blocker to prevent dehydration
331. Drug induced lupus drugs
metabolized by:
N acetylation in liver. (hydralazine and procainamide).
332. Drug of choice for human and dog
bites?
Amoxicillin + Clavulunate
333. drug to reduce tobacco withdrawal
cravings and attentuate reward
efects of nicotine
Varenicline : partial agonists of nicotine Ach R.
334. Drugs for motion sickness: 1st gen antihistaminic drugs (meclizine, dimenhydrinate) Scopolamine (antimusc seffects).
SFX: blurry vision, dry mouth, palpitations, urinary retention, constipation.
335. Drugs met by p450
Drugs that induce or inhibit p450
enzyme
...ie: phenytoin inc met by phenobarb, carbama, rifampin.
336. drugs that target secretory diarrhea bismuth subsalicylate
probiotics
octreotide
337. Drugs treat what
Oseltamivir, ganciclovir,
lamivudine, amantidine
oseltamivir: inhib Influ A, B viral neuroaminidases.
Ganciclovir: HSV (guanine nucleoside analogue), CMV (HIV)
Lamivudine: anti-retroviral nucloside RT (HIV)
Amantidine: impair uncoat of influe A virion after endo
Ribavirin: RSV bronchiolitis
338. Drugs treat what
Oseltamivir, ganciclovir,
lamivudine, amantidine
oseltamivir: inhib Influ A, B viral neuroaminidases.
Ganciclovir: HSV (guanine nucleoside analogue)
Lamivudine: anti-retroviral nucloside RT (HIV)
Amantidine: impair uncoat of influe A virion after endo
Ribavirin: RSV bronchiolitis
339. drugs with antimuscarinic effects: (flushed
skin, mydriasis)
atropine, TCA (amitryptiline), H1 r AA (diphenhydramine), neuroleptics,
antiparkinsonian drugs
340. Ductus arteriosus corresponds to what
embryonic counterpart
6th embryonic arch.
341. DUMBELS (CPx of organophosphate
poisoning);
Diarrhea, Urination, Miosis, Bronchospasm/Bradycardia, Emesis, Lacrimation,
Salivation
342. DVT drugs of choice vit K inhibitors (warfarin)
direct factor Xa inhibitors:
idraparinux
rivaroxaban
apixaban
ultralow molecular weight heparin
direct thrombin inhibitors:
argatroban
dabigatran
343. DVT prevention short and long term short: heparin (bind antithrombin tightly)
long: warfarin (block glutamate residue carboxylation)
344. dx of Candida endopthalmitis Opthalmoscopy
345. Dx of Wilson disease gold standar: liver biopsy demonstrating quantitative hepatic copper level >250
mcg/gram dry weight
confirmed by presence of low serum ceruplasmin (<20 mg/dL) in conjunction with
increased urinary copper or Kayser-Fleischer rings
*almost all neuropsychiatric involvement will also have Kayser-Fleischer
rings=>can be identified on slit lamp examination
346. Dx:
mild hypochromatic microcytic anemia,
inc HbF, hemoglobin A2, target celsl
Beta-thalassemia minor
cx: mut -->defective txn, processing, tln of b-globin mRNA.
347. dysplasia abnormal cell growth confined to epithelium
often pleomorphic (differing in size and shape)
may lose alignment along BM and often cease to group together in organized
fashion
dysplastic nuclei typically stain very intensely bc more chromatin is present
(hyperchromatism)
# of mitoses of dysplastic epithelium may increase or appear very bizzare
nucleus to cytoplasm ratio (N:C) is elelvated
reversible process and doesn't necessarily proceed to cancer
low-grade dysplasia does not involve entire thickness of epithelium=>high grade
does but doesn't penetrate BM; AKA carcinoma in situ
*once penetrate BM no longer considered reversible
348. dz assoc w/ impaired DNA repair fanconi anemia (AR, hypersen to DNA x linking agents, bloom syndrome (AR HS to
UV damage and Chemotx agents), xeroderma pig(AR UV light).
349. early menarche,
nullparity and obesity
are risk factors for
endometrial cancer.
350. EBV associated with
what malig
Burkitt lymphoma, nasopharyngeal CA (chinese)
IC: CNS lymphoma, post transplant lymphoprolif disorder
351. EBV mononucl like
symptoms caused by:
CMV, HHV-6, toxo
352. eccentric ventricular
hypertrophy
caused by vol overload=>leads to dilatation of ventricle
*associated with in chamber size=>also seen in dilated CMP and after MI
353. Ecoli not able to
ferment sorbitol or
produce
glucuronidase
EHEC
354. Ecthyma
gangrenosum
cutaneous necrotic dz (pseudomonas aeruginosa bacteremia and septicemia). It invades perivascularly and
releases tissue destructive exotoxins causing vasc destxn and resultant insuff of BF to patches of skin that
beocme edematous and subseq necrose. (common in neutropenia, hosp. pts,, burns, chronic indewll)
355. Effect of beta
hemoglobin chains
being very similar to
myoglobin?
"isolated" beta globin chains will have diss curve like myoglobin
356. Effect of epi on
diastolic BP
depends on dose (a1 or b2 predominates).
357. effect of steroids on
erythrocytes
causes erythrocytosis.
358. effect potentiation drug's ability to increase pharmacologic effect of another agent
359. effects of epinephrine
on insulin release
Dec release (alpha action)> inc release (beta action).
Alpha blocker causes inc release. (ie phenoxybenzamine)
360. Effects of muscarinic
agonist on endothelial
surface R?
release of NO, and endothelium-derived relaxing factor (EDRF). NO -->inc GC-->inc cGMP-->Ca efflux --
>vascular wall sm relax
361. Effects of niacin other
than nml use:
POtentiate anti-hypertensive meds (vasodilatory effects); insulin resistance
362. Effets of human
placental lactogen
inc Insulin resistance, stim proteolysis, and inhibits gluconeogenesis.
363. EHEC cannot make: ferment sorbitol, or produce glucuronidase
364. Ehler's Danlos
syndrome
heritable CT disorder characterized by skin hyperextensibility, joint hypermobility, tissue fragility, poor
wound healing, and easy brusing
365. Electrophresis and
hemoglobin problems
HbS-- mut in both beta chains
HbC-- mut in both beta chains (Missense Glu->lys) neg
Hb Sc: 1Hbs 1 HbC (2 bands)
thalassemias-- non fxnl globin chains (alpha- frameshift
366. endometrial
hyperplasia
presents clinically as dysfxnal uterine bleeding
caused by elevated estrogen unopposed by progesterone acting on endometrial lining
XS estrogen can be exogenous as in HRT that does not contain progesterone or it can be endogenous such as
with an estrogen-secreting ovarian tumor or with increased aromatization of androgens to estrogens in
adipose tissue of obese women
367. energy supply from metabolism of protein, fat,
and carbohydrates
1 g protein/carb=4 cal of NRG
1 g ethanol=7 cal of NRG
1 g fat=9 cal of NRG
368. Enzyme responsible for green color of bruises Heme oxygenase turns heme to biliverdin then to bilirubin.
369. Epi effects
Epi and Propanolol
Epi: inc SBP (a1,B1), inc HR (b1). inc or dec DBP (a1 or b2)
pro: elimin vasodil and tachy-->only a effect-->vasoctxn
370. epinephrine and glucose metabolism increases glucose by multiple mech:
1. liver-increased glycogenolysis and gluconeogenesis
2. skeletal muscle-decreases glucose uptake; increases alanine released from
skeletal m.=>serves as source of gluconeogenesis in liver
3. adipose tissue-increases breakdown of TG=>increasing FA and glycerol in
circulation=>utilized as gluconeogenetic substrates
*glucagon has insig effect on adipose tissue and skeletal m.
371. Equation for filtration fraction GFR/RPF
372. erythroblastosis fetalis, hemolytic anemia
presentation:
infant w/ anemia, hepatosplenomegaly, jaundice, death.
Maternal Ab (IgG) to fetal RBC ... Rh- mother and Rh+ infant @ 2nd birth.
Type II HS
373. essential fructosuria in pts with essential fructosuria=>metabolism of fructose by hexokinase to
fructose-6-phosphate is 1 method of metabolizing dietary fructose
*this pathway not sig in normal indiv
374. essential fructosuria benign rare autosomal recessive aSx disorder due to fructokinase deficiency
detected through clinitest tablets=>nonspecific test for presence of reducing
sugar
* will have neg urine dipstick bc it utilizes glucose oxidase=>specific for
glucose
reducing sugars: glucose, galactose, fructose
375. ether sensitivity of viruses depends on: presence of lipid bilayer enveoope
376. Euchromatin vs heterochromatin euchro : acetylation (high txn)
hetero: methylation (low txn)
377. extramedullary hematopoesis chronic hemolytic anemias
378. Extramedullary hematopoiesis cx by severe chronic hemolytic anemias (b thalassemia)
379. extrapyramidal sx due to psych drugs haloperidol, fluphenzine: acute extrapyr sx (spasmotic torticollis) are dystonic
reactions, akathisia, parkinsonism
380. ezetimibe selectively inhibits intestinal absorption of cholesterol
primarily used in conjunction with statin
causes modest reductions in serum TG and modest elevations in serum HDL
381. F pt with anemia. Hgb 9.2, MCV 72 , low ferritin.
Heavy menstrual period, epistaxis. Cx
von willebrand dz (AD-- lifelong hx of gingival bleeding, epistaxis, mucosal
bleeding, menorrhagia.
382. fabry ...
383. factors that stability of atheromatous
plaques
thin fibrous cap
rich lipid core
active inflammation
*potentially promote rapid coronary occlusion via superimposed thrombosis if plaque
ruptured
384. failure of hindgut descent failure of proper descent can lead to different degrees of anal agenesis or imperforate
anus
385. fallopian tube epithelium simple columnar
charac: ciliated cells: help transport the egg/embryo; peg cells: secrete nutrients
assoc tumors: rare
386. Familial retinoblastoma at risk for
secondary tumor..?
Osteosarcoma
387. Fanconi's anemia? autosomal recessive disorder
pancytopneia and macrocytosis
average age at diagnosis is 8
cafe au lait spots, microcephaly, horseshoe kidneys, absent thumbs
388. Fatty streaks seen in : pts of all ages. As early as 1, and commonly in 10 and up.
389. Features of ataxia telangiectasia cerebellar ataxia, telangiectasia, inc risk of sinopulm infxns,
AR inheritance. defect in gene ATM - role in DNA break repair.
IgA deficicency and predisposes to ifnx of upper and lower airways.
390. Features of chronic bronchitis thickened bronchial walls, neutrophil infiltration, mucous gland enlargement, patchy
squamous metaplasia of bronchial mucosa
cx: environmental exposure and smoking.
391. Features of HEV unenveloped, ssRNA, transmitted fecal-oral rout. high mortality in infected pregnant
women.
392. fenoldopams action d1 dopamine agonist: vasodilator and natriuretic.
393. A Fib drug that inc QRS duration in a
rate-dependent manner.
class Ic (ie flecainide)
Class III antiarr are reverse use-dependent (slow HR the more the QTc interval is
prolonged).
394. fibrates 1st line therapy for hypertriglyceridemia=>decreases serum TG by 20-50%
mech: activate PPAR-alpha
395. filtration fraction FF=GRF/RPF
increases in hypovolemia as RPF drops proportionately more than GFT due to
compensatory mechanisms of RAA system
396. findings of DIC prolonged PTT, PT
thrombocytopenia and microangiopathic hemolytic anemia
low fibrinogen
Elevated fibrin split pdts (d -dimer)
Low factor V, VIII
397. First dose hypotension:
drug associated and risks
ACEI:
predisposing risks: hyponatremia, hypovelemia (diuretics), low baseline BP, high
renin, or aldos, renal impairment, heart failure.
398. First step in the management of
Epiglottitis?
Endotracheal intubation with a set up for tracheostomy
399. fish oils (omega-3 FA) used to Tx hypertriglyceridemia
decrease hepatic VLDL prod and decrease serum TG by 20-30%
400. flutamide inhibit testosterone and DHT binding
401. flutocytosine inhibits both DNA (replication) and RNA (protein synthesis) in fungal cells
*mainly used as synergistic agent with amphotericin B=>particularly imp in Tx of cryptococcal
meningitis
402. focal myocardial scarring commonly results from MI
403. folate deficiency inhibits formation of dTMP=>limits DNA synthesis
promotes megaloblastosis and erythroid precursor cell apoptosis in bone marrow
404. follicular lymphoma translocation of IgH heavy chain gene for c'some 14 to 18 [t(14;18)]
on c'some 18 the gene located near the bcl-2 gene=>apoptosis inhibitor protein Bcl-2 is expressed
405. formation of pyrimidine-
pyrimidine dimers
DNA damage from exposure to UV radiation
406. foscarnet side effects electrolyte abnormalities:
hypocalcemia
hypokalemia
hypomagnesemia
hypophosphatemia
407. Friedrich's ataxia is mimicked
by:
Vit E def
408. functional regurgitation acute hemodynamic changes prod fxnal heart murmurs in absence of fixed valve lesion
dilatation of LV in response to preload=>fxnal mitral regurgitation=>eliminated by preload
reduction and reduced by afterload reduction
409. Fungal infections:
Local and systemic
disseminations
T lymphocytes local
Neutrophils: systemic.
example candida.
410. Fxn and dz associated with :
Mesolimbic-mesocortical
Nigrostriatal
Tuberoinfundibular
MM: behavior (schizoprenia)
NS: coord voluntary movmnt. parkinsonism
TI: Prolactin release. Hyperprolactinoma
411. Fxn of Vit C
Epid of def?
hydroxylation of proline and lysin residues in pro-colagen. (prolyl, lysyl hydroxylases)
homeless, alcoholic, drug user.
Px: perifollicular hemorrhages, easy bruising, gum dz
412. galactosemia autosomal recessive disorder
characterized by neonatal jaundice, bleeding diasthesis, feeding intolerance, hypotension and
death if unTx
caused by absent fxn of galactose-1-phosphate uridyl transferase
Tx: elimination of all milk products from diet and feeing with soy-based infant formula
413. ganciclovir interferes with human host cell DNA synthesis than acyclovir
clinical use: CMV
*commonly administered to pts with advanced HIV
major adverse effects: neutropenia, anemia, thrombocytopenia, and impaired renal fxn
414. GAS: RF and acute post-
strep GN..
RF follows strep throat only. APSGN can follows impetigo or pharyngitis.
415. gastric ulcers majority occur at the lesser curvature at border btwn acid-secreting and gastrin secreting mucosa
left and right gastric arteries run along lesser curvature and are likely to be damaged=>cause gastric
bleeding
416. Gene transfer via
conjugation
sex pilus: pili in E.coli, ABx resistance
417. genetic hemochromatosis defect in intestinal absorption of dietary iron=>storage of .5-1.0 g of iron each year
*storage primarily in the parenchymal organs
typically silent until early adulthood when at least 20g of iron have been accumulated
present: abdominal pain, skin pigmentation, hepatomegaly, deranged glucose homeostasis, cardiac
dysfxn, atypical arthritis, hypogonadism
*men typically present after 40 years of age; women present after menopause but accumulate iron at a
faster rate
**women present later due to physiologic iron loss thru menstruation and pregnancy
418. GFR estimation estimated by calculating the clearance of innulin
419. glomerular nephritis and
deposits
C1q: MPGN type 1(subendothelial)
Ige: SLE confined to cap wall. poor prog
IgG, IgM, C3 in mesangium PSGN
420. Glucagon has effects on Liver.. Insignificant on skeletal and adipocytes.
421. Glucocorticoid effects on
liver and other enzymes:
Potent stimulator of liver gluconeogenesis. also peripheral antagonism of insulin contributing to
hyperglycemia.
422. glucose-6-phosphatase converts glucose-6-phosphate to glucose
*only found in liver
423. glucose-6-phosphate
metabolism
can be metabolized 3 ways:
1) conversion to G1P by phosphoglucomutase=>used for glycogen synthesis
2) conversion to glucose by glucose-6-phosphatase
*this enzyme absent in muscle
3) conversion to 6-phosphogluconolactone by glucose-6-phosphate dehydrogenase in first step of PPP
424. glucuronide transferase converts bilirubin into soluble bilirubin diglucuronide in hepatocytes
425. glutathione-S-transferase involved in detoxification of some chem carcinogens
converts toxic substances into inactive metabolites
426. Goodpasture's syndrome caused by anti-GBM that targets alpha3-chain of collagen type IV
path: develop RPGN=>ARF with crescentic formation (fibrin deposition) on light microscopy; RBC
casts; mild proteinuria; anti-GBM cross react with BM in lung alveoli=>pulmonary hemorrhage
IF: "linear" IgG and C3 deposition
427. grading degree of tumor differentiation
low grade: well-differentiated and resemble tissue of origin; likely to be benign
high grade: less-differentiated; lost features of primary tissue; likely to be malignant; display cellular and
nuclear pleomorphism (variations in shape and size); high # of mitoses; tend to be invasive; usually
radiosensitive
428. Gram negative cocci? Neisseeria
429. Gram negative rods? Heamophillus, Pseudomonas, Klebsiella and legionella
430. Gram positive rods? Listeria and Bacillus
431. Gram stain with gram
positive cocci in
clusters?
Staph.
432. Gram stain with gram
positive diplococci?
Strep. Pneumoniae
433. Greatest prognostic
factor of liver function:
Serum albumin level and prothrombin.
434. griseofulvin enters fungal cells and binds microtubules=>inhibits mitosis
435. Group A streptococcal
pharyngitis
can lead to rheumatic fever via antigenic mimicry
GAS and cardiac myocytes have similar antigenic protein sequences=>immune system mounts response
against GAS=>can cause myocarditis and valve destrxn over time
436. H. pylori gram- spiral shaped bacteria
assoc with formation of duodenal ulcers due to increased gastric acidity
increased gastric acidity caused by decreased somatostatin-secreting cells in gastric mucosa=>unchecked
gastrin prod
*strongly assoc with gastric ulcers, gastritis, gastric adenocarcinoma, and gastric lymphoma
437. H. pylori strongly assoc with peptic ulcer dz and gastric adenocarcinoma
438. HACEK organisms Hameophilus
Actinobacillus
Cardiobacterium
Eikenella
Kingella
*can cause endocarditis and do not grown on standard blood culture
439. hamartomas most common benign lung tumors
usually aSx and detected incidentally on CXR as peripheral "coin lesion"
histo: areas of mature hyaline cartilage mixed with CT, smooth muscle, and fat
440. haptoglobin serum protein that binds free Hb
promotes excretion via reticuloendothelial system
will be decreased in intravascular hemolysis
441. HAV inactivation via: Water chlorination, bleach (1:100), formalin, UV irr, boiling 85C for 1 min.
442. Hb in newborns, For
how long?
a2gamma2. switches in first 6mo of life.
443. HbA2 elevation in b thalassemia minor (trait) an intermedia because b globin
chain underproduction dec synth of HbA1.
444. HbS problem and aggregation occurs w/ Val->glut: aggregates with loss of O2, low pH, high 2,3DPG
445. HCG secreted by placenta to support CL early phases-->secretes
progesterone which maintains endometrium.
446. Heart defects due to abnml migration of neural crest cell
through the primitive truncus arteriosus and bulbus cordis.
TOF, Transp of great vessels, Truncus arteriosus
447. Heat killed bacteria
Recomb bacterial outer sruface protein
inactivated toxin
Live-attenuated org
bordetella pertussis, v cholerae, yersinia pestis
Borrelia burgdorferi (recomb bact outer surface protein)
c dpigh, clostridium tentani (inactivated toxoid)
BCG vaccine (TB), francicella, salmonella typhi.
448. Hemadsorption hemagglutinins, glycoproteins aff to RBC (influenza,
parainfluenza)
449. Hematogenous osteomyeltitis:
childhood
Sickle cell
Pott
DM
recumbent, impaired mob
ortho surg, trauma
S aureus (bacteremia)
Salmonella, S aureus (infarcted bone)
M TB (lung)--vertebrae
Polymicrobial (foot ulcer)-- feet bones
Polymicrobial (contiguous pressure sores)-- sacrum, heels
polymicrobial (direct)
450. hemochromatosis classically see increased serum irons
assoc with cirrhosis, increased incidence of hepatocellular
cancer, skin darkening, and insulin resistance
451. hemochromatosis and ventricular remodeling can result in accumulation of iron in myocardium as
hemosiderin
*net result: dilated CMP with LV cavity=>pts present with
signs and Sx of CHF
452. Hemolysin and superantigens. not in cell wall of staph.
453. hemolytic anemia characterized by:
decreased haptoglobin level
increased LDH
increased bilirubin
schistocytes
454. hemolytic anemia, hypercoag state (thrombosis) and dec
blood counts
paroxysmal nocturnal hemoglobinuria.
Def in CD55, CD 59.
455. hemoperitoneum free blood in peritoneal space
can be caused by lacerations or rupture of intraperitoneal
organs: transverse colon, liver, and spleen
456. hemosiderin-laden macrophages "heart failure cells"
presence in macrophages in alveoli indicate chronic elevation of
pulmonary capillary hydrostatic press=>usually result of LHF
457. heparin unfractionated heparin is the most commonly used anticoagulant in hospital setting
mech: increases effect of naturally occurring anticoagulant antithrombin-III
*activated partial thromboplastin time (aPTT) is meas to monitor therapeutic effect of heparin
complications: bleeding; heparin-induced thrombocytopenia
*Tx is with protamine
458. Hepatic abcess: protal vein, arterial supply ascending biliary tract infection, directin invasion from adjacent source, penetrating
injury.
IE. Staph aureus through hematogenous seeding of liver.
Enteric GN bacilli, and enterococci.
459. hepatic
encephalopathy
reversible decline in neurologic fxn precipitated by hepatic damage=>increased levels of ammonia in circulation due
to failure of liver to metabolize waste prod
ammonia initially enters circulation thru GI tract after having been created during enterocytic catabolism of
glutamine and bacterial catabolism of dietary protein in the colon=>goes to liver thru portal vein for detoxification
to urea
precipitants of hepatic encephalopathy: GI bleeding, hypovolemia, hypokalemia, metabolic alkalosis, hypoxia,
sedative usage, hypoglycemia, and infxn
*any stressor that alters ammonia balance
Tx: lactulose
460. hepatic
encephalopathy:
CPx , labs
alcoholic, vomiting, delirium, asterixis, gynecomastia. Altered mental status due to: -inc load of nitrogenous subs
abs in gut. (bleed)
Inc NH3 pdtn (diet protein, GI bleed, constip, ifxn)
Dec NH3 removal (renal failure, diuretics, post-TIPS)
Tx: lactulose (inc NH4+), low protein diet, rifaximin (kill intestinal bacteria)
461. hepatitis C virus has 6 or more genotypes and multiple subgenotypes=>genetic differences in two envelope
glycoproteins=>hypervariable region of envelop glycoprotein prone to frequent mutation
*production of host Ab lags behind prod of new mutant strains
no proofreading 3'-->5' exonuclease acivity=>RNA polymerase makes erros during replication=>several subspecies
of HCV present in blood at any one time
462. HER2/neu many pts with breast cancer overexpress this protein
involved in cell prolif=>assoc with worse prognosis
inhibition of epidermal growth factor and HER2/neu pathways can lead to apoptosis of breast cancer cells
*monoclonal Ab against HER2/neu receptors (e.g., trastuzumab) have been successful in Tx of breast cancer
463. hereditary
pancreatitis
rare disorder that results from mutation in gene that encodes trypsinogen gene=>leads to synthesis of abnormal
trypsinogen that is not susceptible to inhibition by either trypsin or PSTI
pts experience recurrent attacks of acute pancreatitis
464. Hereditary
pancreatitis cx/
mutation in trypsinogen resulting in no trypsin
465. herpesvirus acquires lipid bilayer from host cell nuclear membrane
*most enveloped nucleocapsid viruses acquire lipid bilayer envelopes from budding thru plasma membrane of host
cell
466. Heterophile Ab
test
sens and spec for EBV assoc infectious mono
467. heteroplasmy. coexistance of mt and wild type mit genomes
468. Hib vaccination not good against nontypable strains of H influenza that cause otitis media, sinusitis, bronchitis.
469. high AFP levels assoc with abdomina wall defects (omphalocele), gastroschisis, multiple gestation, and neural
tube defects (spina bifida, anencephaly)
470. High bomodeoxyuridine uptake by
tumor reflects:
its a thymidine analog: so many tumors in S phase-->high grade -->poor prognosis
471. high waist to hip ratio
associations
insulin resistance
metabolic syndrome
DM II
*meas visceral obesity
472. highly active retroviral therapy
(HAART)
includes inhibitors of HIV reverse transcriptase and protease
assoc HIV drug resistance bc high mutation rate of HIV genome and selective press exerted by
antiretroviral drugs
473. hindgut part of primitive gut that gives rise to:
distal third of transverse colon
descending colon
sigmoid colon
rectum
uppar part of anal canal
474. Hirschsprung disease failure of neural crest migration to bowel wall=>submucosal and myenteric plexi do not
develop
manifests with intestinal obstrxn in first days of life:
failure to pass meconium
bilious vomiting
abdominal distention
475. hirsutism male-like pattern terminal hair (coarse, curly, and pigmented) growth in females
idiopathic: increased conversion of testosterone into DHT by 5-alpha-reducatase or due to
higher sensitivity of hair follicles to DHT
*occurs due to increased testosterone secretion or increased conversion of testosterone to DHT
causes: idiopathic (most likely cause if reg menses and no Sx of virulization), PCOS, Cushing
syndrome, ovarian and adrenal tumors
Tx: spironolactone (blocks androgen receptors), flutamide (testosterone receptor antagonist),
finasteride (5-alpha-reductase inhibitor)
*should be distinguished from virilization
476. histamine and coronary
autoregulation
potent vasodilator released primarily from mast cells when there is tissue damage
capillary permeability=>local edema
477. histidinemia rare autosomal disorder that causes increased histidinemia=>pts deficient in
histidase=>required for catabolism of histidine
clinical manifest: speech defects, pschomotor and gen retardation, emotional disturbance
*most frequent inborn metabolic disorder in Japan
478. Histo: Chlamydia and HSV C: intracyto inclusion bodies
HSV: multinucl giant cells % intranuclear inc
479. HIV env gene mutations code for structural glycoproteins
responsible for viral escape from host neutralizing Ab
480. HIV gene polyprotein that is
glycosylated and cleaved
env gene: gp160 and cleaved in ER to make gp120 and gp41.
481. HIV gene that undergoes further
processing:
Env->glycosylated to gp160, cleaved w/in ER, and GA to form envelope glycoprotein
gp120, gp41.
482. HIV pol gene mutations responsible for acquired resistance to HIV reverse transcriptase inhibitors and HIV
protease inhibitors
responsible for emergence of:
1. HIV protease variants that are resistant to standard protease inhibitors
2. structural changes in HIV-1 reverse transcriptase that render enzyme resistant to
standard nucleoside and non-nucleoside reverse transcriptase inhibitors
483. Homobox genes code DNA binding txn factors : role in morphogenesis
484. How can MGUS be differenetiated
from multiple myeloma?
with the absence of renal insuffeicieny, hypercalcemia, anemia and lytic bone lesions
485. How can you differentiate the uterus
in adenomyosis and fibroids?
adenomyosis: symetrically enlarged
fibroids: irreguarly
486. How do pts with 5 alpha reductase def.
present?
46 XY
1. can't convert testosterone to DHT. have female external genitalia but show virilization
at puberty.
487. How do pts with Androgen
Insensitivity present?
46 XY
1. Mullerian inhibiting factor secreted by testes prevents development of internal female
organs
488. How do pts with Mullerian Agensis
present?
46 XX
1. Blind ended vaginal pouch
2. No uterus
489. How do you calculate an APGAR
score?
Appearance:
0= body and extremities are blue
1= body pink, extremities blue
2= body and exttremitis are pink
Pulse:
0=No heart activity
1= pulse < 100
2= pulse > 200
Grimace ( reaction to nasal stimulation)
0=no response
1= grimace to
2= active cough
Activity
0= no activity
1= some flexion
2= full flexion
Respiration
0= completely absent
1= slow and irregular
2= full respiratory effort
490. How do you differentiate between a pt that
presents with dementia and gait problems?
Can be either Alzheimer's or Normal pressure:
It depends on when it started.
Gait abnormality is an EARLY finding in Normal pressure.
491. How do you differentiate between Gastroischisis
and Omphalocele?
Gastroschiasis: Bowel WITHOUT protective covering.
Ompahlocele: Bowel without protective covering, associated with other
congenital abnormalities
492. How do you differentiate between the oral ulcers
of HSV and CMV and what are txt options?
HSV: Small, multiple and well circumscribed with bx showing ballooing
degernation and eosinophilic intranuclear inclusions. TXT: Acyclovir
CMV: Large, shallow and superficial with bx showing intranuclear and
intracytoplasmic inclusion. TXT: IV Ganciclovir
493. How do you differentiate chlamydia pnemonia
from RSV bronchilitis?
Chlamydia doesn't have fever or wheezing
494. How do you differentiate Transient Synovitis
from Septic Arthritis?
If pt has 3 of the following - Septic Arthritis:
1. WBC > 12000
2. Fever Temp > 39
3. ESR > 40
4. Refusal to bear weight
495. How do you distinguish DVT from cellulitis? Cellulitis has lymphadenopahty
496. How do you treat Stress (hairline) fractures? Rest, analgesia and hard soled shoe
497. How do you txt a pancreatic pseudocyst? It spontaneously resolves
498. How does a pt with Neurocardiogenic (vasovagal)
syncope present?
Have the following prior to passing out:
1. Nausea
2. Diaphoresis
3. Tachycardia
4. Pallor
2/2: pain, stress, and situations like needles or urination
dx with tilt table test
499. How does Achlasia present? Dx: LES does not relax, muscles with absent neurons in myenteric plexus,
manometry shows absent peristalsis.
500. How does Adenomyosis present? dysmenorrhea and menorrhagia
enlarged, symmetrical painful tender uterus
501. How does Diabetes affect CN III function? Causes nerve ischemia. Only affects the somatic function of CN III- eye is
down and out.
Parasympathetic function remains unaffected- normal light and
accommodation reflexes.
502. How does Diffuse Esophageal Spasm present and
what is the txt?
Dx: chest pain and dysphagia, manometry demonstrates high amplitude
peristaltic contractions. barium enema reveals corkscrew esophagus
txt: antispasmodics, supportive care
503. How does disseminated gonococcal infection
present?
1. polyarthraligsas
2. tenosynovitis
3. vesiculopustular lesions
504. How does esophaeal dysmotility 2/2 scleroderma
present?
Dx: Loss of peristatlis in esophagus, fibrosis and atrophy of smooth muscle,
LES is incompetent leads to reflux and strictures
505. How does metastatic spine cancer present? The pain is worse with rest, when the patient is sleeping
506. how does N-acetylcysteine loosen mucus
glycoproteins
cleaves disulfide bonds
507. How does one define status epilepticus and what is the
txt?
seizure activity greater than 5-10 minutes that does respond to anti-
seizure activity.
txt:
1. Benzo's- first line
2. Phenytoin (phenobarbital)- second line
508. How does one differentiate between ligamentous tear
and meniscal tear?
Both can have "popping" sounds:
Ligamentous: immediate swelling 2/2 hemarthrosis. immediate
inability to bear weight
menisceal: gradual joint swelling,
509. How does one differentiate CML from Leukomoid
reaction?
Check Leukocyte Alkaline Phosphatase (LAP)
it is elevated in leukomoid reaction
510. How does one txt duodenal hematomas? Nasogastric suction
Parenteral nutrition
511. How does one txt mucoormycosis? 1. Surgical debridement
2. Systemic chemotherapy + IV amphotericin
512. How does pregnancy cause the compensated metabolic
alkalosis?
Stimulatory effect of progesterone on the medullary respiratory
system.
513. how does vitamin c def. present? 1. ecchymosis
2. petechiae
3. bleeding gums
4. hperkeratosis
514. How does Vitreous hemorrhage present? Sudden loss of vision with floaters,
**Fundus hard to visualize
515. How does Zenker's diverticilum present and what is the
txt?
Dx: food sticking in throat, halitosis, regurgitation, NO pain
Txt: Surgery
516. How is Herpes Simplex keratitis characterized and what
do you txt it with?
DX: corneal vesicles and dendritic ulcers
TXT: Antiviral therapy (oral or topical)
517. How long should Clopidogrel be continue for pt after
UA/NSTEMI?
12 months
518. How long should Clopidogrel be continue if pt got drug
eluting stent vs bare metal stent?
bare metal: 30 days
drug eluding: one year
519. how long should Warfarin be continued in pt with
idiopathic cause of DVT?
6 months
520. how long should warfarin be continued in pt with
reversible cause of DVT?
for 3 month
521. How should one txt a pregnant pt with syphillis but is
allergic to penicillin?
First confirm allergy
Must txt with penicillin so desensitizes patient.
522. How would a pt with a small bowel obstruction present? nausea, vomiting, abdominal distention
523. hyaline arteriosclerosis marked by homogenous deposition of hyaline material in intima and
media of small arteries and arterioles
underlying structure of vessel wall is maintained but intima is
thickened and the arterial lumen narrowed
*usually component of diabetic microangiopathy
524. hydatidiform mole usually presents early in pregnancy with vaginal bleeding and fundal
size greater than dates
525. hydatidiform mole form of gestational trophoblastic dz
classified as:
1. complete-no fetal structures; composed entirely of large edematous and disordered chorionic
villi that appear grossly as clusters of vesicular structures with a "bunch of grapes" appearance;
always have 46 XX karyotype; all C'somes paternally derived
2. partial-shows formation of some fetal structures grossly; typically results from fertilization
of ovum by two or more sperm=>karyotypes 69XXY or 69XXX
526. hyperplastic arteriosclerosis onion-like concentric thickening of arteriolar walls due to laminated smooth muscle cell and
reduplicated BM
can result from malignant HTN (diastolic press > 120 mm Hg)
most commonly affected areas: kidneys, retinas, and intestinal arterioles
*can affect arterioles in all tissues and muscles less likely to be symptomatically involved
527. Hypertensive depressed patient
came back froma wine and cheese
party: drug cx
ie Pizza restaurant
MAO I
528. hypertorphic cardiomyopathy autosomal dominant disorder caused by mutation of -myosin heavy chain
529. hypertriglyceridemia Tx niacin and fibrates are the most effective Tx
530. Hypervariability of HCV is due to
what cellular component ?
lacks 3-5 proofreading exonuclease in RNA polymerase.
531. Hypocretin 1 -2 promote wakefulness
532. hypogammaglobulinemia predisposed pts to bacterial infxns
533. hypoglycemia initially manifests with pallor and sweaty skin=>worsens with bizarre behavior, convulsions,
and unconsciousness can develop
caught early can be self-Tx with consumption of 15-30 g of fast-acting carbs (e.g., glucose
tablets, sweetened fruit juices, milk, soft drinks, or hard candy)
when severe enough to induce unconsciousness parenteral Tx is required=>intramuscular
glucagon injection in non-medical setting =>correct hypoglycemia by increasing hepatic
glycogenolysis and gluconeogenesis=>return to consciousness within 10-15min
*in medical-setting Tx with IV dextrose
534. hypoglycemic agent that inc
insulin release in DM2
Glyburide
535. idiopathic pulm fibrosis ...
536. IgA the Ab most strongly assoc with antigenic mucosal contact
537. IgA protease seen in what
organism?
N meningitidis, gonorrhea
538. IM infection shows increased
proliferation of what cells?
Tc 8 cells. Used to kill infected B cells.
539. Imaging study for child with
developmental dysplasia of the
hip?
If < 4 months - Ultrasound
if > 4 months - X-ray
540. Immunocom (HIV) patients at risk
for developing reactivation of what
infections? leads to waht?
latent EBV-->NH diffuse B cell lymphoma
541. implication of testicular mass on
Thyroid?
hCG structural similarities to TSH. High concenstration seen in testicular tumors and can
stimualte TSH receptors and cause hyperthyroidism
542. in A fib, ventricular contraction rate is
determined by:
the AV node refractory period
543. In which condtions does one see Vitamin
B3 def (niacin)?
1. alcoholics
2. long term isoniazid therapy
3. carcinoid syndrome
4. hartnup disease
544. In which disease does one see sharp,
triphasic and synchronus discharges?
Cretzfeuldt-Jakob disease
545. In which renal condition does one see
Broad or Waxy casts?
Chronic renal faliure
546. in which renal condition does one see
fatty casts?
Nephrotic syndrome
547. In which renal condition does one see
muddy brown casts?
ATN
548. In which renal condition does one see
RBC casts?
Glomerulonephritis
549. In which renal condition does one see
WBC casts?
1. Interstitial Nephritis
2. Pylonephritis
550. In which situations will one see torsades
de pointes?
1. Alcoholics (hypomagensia)
2. Meds. ( TCA's, anti-fungals, amiodaraone, sotalol)
txt with MgSO4
551. increased BUN suggests renal failure, heart failure, or dehydration
552. increased GABA thought to be directly responsible for altered mental status seen in hepatic
encephalopathy
553. Indications for aortic valve replacement? 1. Symptomatic patient with AS
2. Patients with severe AS undergoing CABG or other valvular surgery
3. Asymptomatic patients with severe AS with either severe LV dysfunction, LV
hypertrophy > 15mm, valve area < 0.6 cm2 or abnormal response to exercise
554. indications for Tx with cortisol used as immunosuppressive drug in Tx of allergic rxns
can be injected or applied topically
555. indications for Tx with desmopression used to Tx central diabetes insipidus and nocturnal enuresis
also increases circulating levels of von Willebrand factor (factor VIII:R) and promotes
coagulant activity of factor VIII:C
556. indications for Tx with subcutaneous
epinephrine
indicated primarily for Tx of anaphylaxis
557. Infarct at anterior portion of medial pons
:
dysarthria, contralateral ataxic hemiparesis.
Trigeminal arises here.
558. infective endocarditis vs rheumatic fever
heart dz
1st is destructive. latter is fibrotic.
559. Inferior thyroid artery travels close to __
nerve
recurrent laryngeal.
560. Influenza virus antibodies against: hemagglutinin - IgA and IgG
561. infxn with capsulated organisms can
occur in pts
that dont' have spleen or defective complement pdtn.
no spleen in pts with sickle cell or removal from trauma.
562. infxns due to x linked
agammaglobulinenma of bruton
strep, staph but good response by clel medated immun to listeria, viruses, and fungi
563. inhaled
glucocorticoids
most commonly used prophylaxis for persistent bronchial asthmas
well tolerated and rarely cause systemic side effects; most common one is oropharyngeal candidiasis=>avoided with
spacer and rinsing one's mouth after inhalation; systemic effects can be seen with higher doses=>increased
intraocular press, cataracts, growth retardation in children, bone loss, suppression of HPA axis
564. Inheritance of
achondroplasia
AD: 50% inheritance of an affected parent.
565. insulin acts via tyrosine kinase that also has cytosolic tyrosine kinase activity=>*activates protein
phosphatase=>dephosphorylates (activates) glycogen synthase=>glycogen synthesis
*protein phosphatase dephosphorylates and inactivates F16BP=>inhibits gluconeogenesis
anabolic hormone that promotes synthesis of glycogen (in liver and skeletal m.), TG, nucleic acids, and proteins
inhibits glycogenolysis and gluconeogenesis
566. insulin vs.
glucagon
insulin opposes glucagon action
glucagon stim insulin secretion from pancreas, glycogenolysis, gluconeogenesis, lipolysis, and ketone body prod
insulin increases glucose, AA and K+ uptake by cells, inhibits ketoacid formation and inhibits lipolysis
567. insulins: long: glargine, detemir
NPH: 18hr (2/day)
Short: lispro, aspart, glulisine (3/day w/ meals) rapid onset
568. intermittent
claudication
muscle pain with exercise that remits with rest
almost always result of atherosclerosis of larger named arteries=>obstrxn of flow results from fixed stenotic
atheromatous lesions=>prevents sufficient increase in blood flow to muscles during exercise=>ischemic muscle pain
pain rapidly relieved by rest bc residual blood flow adequate to meet metabolic demands of resting, but not exercising,
muscle
569. interstitial
pneumonia
usually caused by Mycoplasma pneumoniae
usually affects young pts
CXR: area of patchy infiltration
light microscope: inflamm infiltrate confined to interstitium
570. ischemic acute
tubular
necrosis
most common cause of intrinsic renal failure (ARF) in hospitalized pts
triggers hypoxic changes in tubular epithelial cells=>decreasing their fxnal capacity
proximal tubules and thick ascending limb of Henle's loop located in outer medulla of kidney=>more susceptible to
hypoxia in conditions of low blood supply and will suffer first
histo: flattening of epithelial cells, loss of brush border in PCT, cell necrosis and denudation of tubular BM
*muddy brown casts=>pathognomonic
571. Isolated
systolic
hypertension
stiffening of aorta (age related) ie 180/90
572. Isoniazid
effects on
vitamins and
px
similar to B6. inc excretion of pyridoxine. and competes for binding sites -->defective synth of GABA. need suppl. Px:
sensory ataxia, dec pain sensation
573. Isospora belli causes chronic, water, profuse diarrhea in immunocompromised pts
*esp those with AIDS
574. isotype switching switching is a process that occurs in nave B-lymphocytes upon initial exposure to Ag
this process does not occur in T-lymphocyte maturation
575. ITP ...
576. janus protein kinase (JAK) 2nd messenger system for peptide hormones in JAK-STAT pathway
*signal transducers and activators of transxn
JAK has tyrosine kinase activity
577. jejunal, ileal, colonic atresia
(apple atresia)
result of vascular accidents in utero
*not congenital malformations
diminished intestinal perfusion leads to ischemia of a segment of bowel=>subsequent narrowing or
obliteration of lumen
**ileum is affected most often
if major vessel occluded (such as SMA), area of wall necrosis is large=>apple peel
atresia=>mesentery of bowel is absent and assoc bowel segment forms a spiral around the affected
blood vessel
common cause of intestinal obstruction
578. Jimson weed poisoning:
belladonna alkaloids
Strong anticholinergic properties. (similar to atropine) Block visceral muscarinic R. Reverse by
giving physostigimine which inc acetylcholine.
579. jun DNA-binding protein=>binds DMa for transcriptional control
gene that codes for jun is is a proto-oncogene
*proto-oncogenes are genes that can bc an oncogene following a mutation or with constitutive
expression
580. K concentrations along
nephron?
100% at capsule-->reabs along tubule (2/3 in PT, 1/4 in TAL).
a-interalated cells of late distal and cortical CT are primary mediators of K regulation.
581. Kallman's syndrome congenital absence of GnRH-secreting neurons
582. ketoconazole and estrogen
production
antifungal agent that decreases androgen synthesis by inhibiting multiple enzyme pathways
involved in synthesis of androgens
583. Klinefelter syndrome typical genotype: 47 XXY; most clinical manifestations result of extra X c'some; can occur whe there
is "non-disjunction" of sex c'somes during meiotic division in either parent
presentation: hypogonadism, small firm testes, elongated limbs, gynecomastia
seminiferous tubules progressively destroyed and hyalinized=>testes small and firm; serum inhibin
decreased, decreased Leydig cells=>low testosterone, ED, increased LH and FSH
*hypogonadism causes delayed epiphyseal fusion=>elongated limbs
**most are infertile
584. knee bursa ...
585. Kozak sequence and the
consequence
Plays a role in inititation of translation. gccRccAUGG. Mt in Guanin replacing Cytosine 3rd
position upstream causes thalassemia intermedia.
586. Lab findings associated with
Anti-phospholipid Syndrome?
1. Will have positive VDRL but negative FTA-ABS
2. Prlonged PTT
3. Thrombocytopenia
587. labs after Iv hydration w/ nml saline and
insulin in DKA
dec serum glucose, osmolality, potassium. Inc serum bicarb, and sodium.
588. lactase deficiency most common cause of selective carbohydrate malabsorption
lactase a mucosal enzyme responsible for digestion of lactase
pts typically complain of GI Sx including gaseous distention and diarrhea after the
ingestion of dairy products
589. lactulose and ammonia used to lower blood ammonia levels
bacterial action on lactulose=>acidification of colonic contents=>converts
absorbably ammonia into nonabsorbable ammonium ion
*ammonia trap
590. Langerhan cell histiocytosis
(Px, marker)
tennis racker (birbeck granules
monocyte linease
child: lytic bone lesions and skin rash or reccurent otitis media w/ mass (mastoid
bone)
S-100 and CD1a
591. Langhans cell giant cell (MO and horseshoe nuclei). activated by Th1
592. Lead time bias buzz words new screening test
test for poor prognostic dz (lung, pancreatic)
593. lecinthinase exotoxin released by Clostridium perfringens=>degrades membrane phospholipids
(including lecithin)=>leads to cell membrane destrxn and cell death
C. perfringens causes gas gangrene
594. lecithin/sphingomyelin (L/S) ratio commonly used to meas fetal lung maturity from amniotic fluid; ratio 1:1 until middle
of 3rd trimester then type II pneumocytes begin secreting surfactant=>lecithin
concen increases sharply while sphingomyelin remains unchanged
*by 35wks gestation ratio averages 2:1 or higher=>indicating lung maturity
phosphatidylcholine (lecithin): component of pulmonary surfactant
sphingomyelin: common membrane phospholipid
595. left anterior descending artery/anterior
interventricular branch
supplies:
anterior 2/3 of interventricular septum
anterior wall of left ventricle
part of anterior papillary muscle
596. left circumflex coronary artery supplies lateral and posterior superior walls of left ventricle via obtuse marginal
branches
597. left main coronary artery gives rise to LAD and left circumflex coronary arteries
598. lesion at jugular foramen jugular foramen (vernet) syndrome: dysfxn of CN IX,X,XI
599. Lesion in optic tract can give contralat
homonymous hemianopia and relative aff
pupillary defect in contral eye. How?
Marcus Gunn pupil: nasal portion of retina contributes more input to pretectal
nucleus than temporal portion of retina.
600. leukamoid vs cml both have inc WBC count. but enzyme neutrophil alkaline phosphatase is nml or
elevated in leukemoid rxn and dec in CML.
601. Leukemia with Vit A association: acute myeloid leukemia (M3 FAB variant- acute promyelocytic leukemia assc w/
15;17.)
retinoic acid R alpha for ch 17 transferred to chromosome 15.
602. Leukemia with Vit A association: acute myeloid leukemia (M3 variant- acute promyelocytic leukemia assc w/ 15;17.)
retinoic acid R alpha for ch 17 transferred to chromosome 15.
603. Leukocyte adhesion def (AR)
absense in
CD18.. inability to synth integrins necessary for leuk to exit bloddstream.
604. lidocaine clinical use: ventricular arrhythmias=>esp after acute MI
605. Ligament injured with radial head
subluxation:
annular ligament tear
606. Linear regression vs correlation
coeff
LR: relationship b/w dependent variable and independent.
CC: single number to report strength and magniuted b/w two things.
607. Lipohyalinosis and
microatheromas
destructive vessel lesion characterized by loss of nml aterial architecture, mural foam cells;
accum of lipid-laden MO w/ in itimal layer of vessel . Assoc with lacunar infarct.
608. lipoprotein lipase deficiency chylomicrons aren't hydrolyzed to release triglycerides. -->inc serum chylomicrons.
Hyperlipidemia, pancreatitis, lipemia retinalis, eruptive skin xanthomas,
hepatosplenomegaly.
Heparin releases endothelium-bound lipases, but reduced in these pts.
609. lipoxygenase enzyme involved in arachidonic acid metabolism
responsible for pathway that synthesizes leukotrienes
610. liver biopsy useful for evaluation of chronic hepatitis and cirrhosis
611. local factors influencing coronary
blood flow
*adenosine
prostaglandins
serotonin
ANS neurotransmitters
bradykinin
mechanical sheer stress
thrombin
*NO (endothelium derived relaxation factor)
*most important
612. location of esophagus between trachea and vertebral bodies in superior thorax
typically collapsed with no visible lumen on CT images of the chest
613. Long term neurlogic sequelae
associated with bacterial
meningitis?
1.) Hearing Loss
2.) Loss of cognitive functions ( neuronal loss of the dentate gyrus in the hippocampus)
3.) seizures
4.) mental retardation
5.) spacticity or paresis
614. loop diuretic inhibit NaK2Cl symporters in TAL of Henle=>block Na and Cl transport and increase Na, Cl,
and fluid excretion
commonly used to Tx pulmonary edema, venous and pulmonary congestion 2 to CHF, and
peripheral edema
common side effects: hypokalemia, hypomagnesemia, and hypocalcemia
615. Low freq detected @
High freq
LF: apex of cochlea, near helicotrema
HF: base of cochlea, near oval and round window
616. low haptoglobin hemolytic anemia
617. Low serum Na found in what
organism causing pneumonia?
legionella.
618. low-grade non-Hodgkin lymphoma usually effects middle aged and elderly pts
present: fever, malaise, anorexia, and lymph node enlargement
lymph node biopsy reveals prolif of atypical lymphocytes
619. Lxn of enhancer, repressors,
promoters
enhancer and repressors: anywhere
Promotors: 25-70b upstream of assoc gene
620. Lxn of neonatal intraventricular
hemorrhage? RF
fragile germinal matrix
inc ferq w/ dec age and birth weight.
621. lymph node drainage below
umbilicus
retroperitoneal (paraaortic) lymph nodes: testes
superficial inguinal lymph nodes: all cutaneous structures inf to umbilicus, including
external genitalia and the anus up to the pectinate line
*located on ant thigh inf to inguinal ligament
deep inguinal nodes: receive afferents from superficial inguinal nodes and deep lymphatic
trunks along femoral vessels; lymphatics from glans penis and clitoris also drain here
**located under fascia lata on medial side of femoral vein
external iliac nodes: superficial and deep inguinal nodes, and deep lymphatics of
abdominal wall below umbilicus
common iliac nodes: internal and external iliacs
***located alongside common iliac artery
622. lysogenization c dipth gains tox gene via bacteriophage infecting host bacterium and integrating genome
to cause AB exotoxin productiong
623. lysogenization* c dipth gains tox gene via bacteriophage infecting host bacterium and integrating genome
to cause AB exotoxin productiong
624. Lytic vs lysogenic phage Lytic: phage infects bacterium-->cleavage of bact DNA-->some parts packed in viral capsid
Lysogenic: infects bacterium-->incorp into bacterial chrom. Excised w/ flanking gene.
ABCDE: ShigA-like, Botulinum, Cholera, Dipth, Erythrogenic (strep pyogenes)
625. major defense of s pneumo polysach capsule
626. major determinant for bladder cell
carcinoma?
penetration of bladder wall.
627. Major determinant for viral tropism
to spec tissues of specific hosts -->
surface glycoprotein (attaches host cell plasmalemma R)
628. Male 1-2week old child px w/
vomiting, hypotension, hypoNa,
hyperK. Dx
salt wasting 21 hydroxylase def.
Deficient cortisol and aldosterone synth w/ adrenal androgen overpdtn.
M: nml genitelia, F: ambiguous.
629. malformation
deformation
disruption
sequence
agenesis
1. primary defect in cells or tissue that form an organ (intrinsic dev abnml)
2. extrinsic mechanical forces(ie. pressure in uterus)
3. 2ndary breakdown of prev nml tissue structure. (amniotic band syndrome)
4. # of abnl from single primary defect (potter syndrome)
5. complete absence of organ
630. malignancy in child presenting with
resp sx, dysphagia, SVC syndrome.
ALL (T cell)- mediastinal mass
631. Malignant otitis externa in diabetes
pts
Pseudomonas
632. Mallory-Weiss syndrome describes mucosal tears that occur around the esophagogastric-squamocolumnar junction
these tears caused by increased intraluminal press in stomach that occurs during retching
or vomiting
633. management of ACE inhibitor the best Tx of chronic cough caused by an ACE inhibitor is replacement with an ARB like losartan
ARBs are beneficial for both HTN and diabetic neuropathy; they do not interfere with catabolism of
bradykinin as ACE inhibitors do
634. mannitol osmotic diuretic used in management of cerebral edema and increased ICP
mech: rapidly increases plasma or tubular fluid osmolality=>water moves from interstitial space into
vascular space or tubular lumen
*in brain water redist from tissues to plasma helps reduce cerebral edema and ICP
common side effects: headache, nausea, vomiting
overaggressive Tx: XS vol depletion and hypernatremia, vol expansion, dilutional hyponatremia,
metabolic acidosis, hyperkalemia, pulmonary edema from increased hydrostatic press
635. mannitol use and tox Cerebral edema.
SFX: pulmonary edema.
636. mantle cell lymphoma translocation between cyclin D1 locus on c'some 11 and immunoglobulin heavy chain (IgH) locus
on c'some 14 [t(11;14)]=>increased prod of cyclin D1 a promoter of G1 to S-phase transition during
the cell cycle
637. Marfan's syndrome murmur
and heart disease
associated with aortic root dz=>aneurysmal dilatation, aortic regurgitation, and aortic dissection
*aortic regurgitation causes diastolic murmur
638. Marfanoid habitus tall
slender
disproportionately long arms, legs, fingers
639. Marker of osteoblast activity
osteoclast activity?
Osteoblast: ALP
Osteoclast: TRAP, urinary hydroxyproline, deoxypyridinoline*
640. Marker seen in MS? IgG in CSF
641. markers for breast tumor tx
and px
ER/PR+: tamoxifen
ERB-B2+ (aggressive): trastuzamab
642. MC aseptic meningitis
infections?
enteroviruses: coxsackie, echo, entero, polio
643. MC bacterial cx of acute otitis
media, sinusistis,
conjunctivitis?
strep pneumo, nontyp H influ, moraxella.
644. MC SFX of inhaled
glucocorticoids:
oropharyngeal candidiasis. dysphonia
645. McArdle's disease type 5 glycogen storage disease=>myophosphorylase deficiency=>failure of glycogenolysis
*glycogenolysis provides immed NRG for strenuous muscle contraction
clinical manifest: decreased exercise tolerance, myoglobinuria, muscle pain with physical activity
646. MCC of hydronephrosis in
fetus:
Uretopelvic jxn. Last to canalize.
647. MCC of pneumonia in adults? S penumoniae, followed by N .meningetitis.
648. MCC of thrombocytopenia in
hospitalized patients
Heparin: heparin induced thrombocytopenia
tx: direct thrombin inhibitors (hirudin, lepirudin, argatroban)
649. MDRI gene codes for P-glycoprotein=>transmembrane ATP-dependent efflux pump that
has broad specificity for hydrophobic compounds
can both reduce influx of drugs into cytosol and increase efflux from
cytosol=>prevent action of chemo drugs
*in tumor cells it actively removes chemo agents=>particularly hydrophobic
agents like anthracyclines
normally expressed in intestinal and renal tubular epithelial cells=>eliminate
foreign compounds from the body
650. Meckel diverticulum occurs due to failure of obliteration of omphalomesenteric duct
present: lower GI bleeding, melena, RLQ pain
*lower GI bleeding is most common manifestation and occurs due to acid
secretion by ectopic gastric mucosa present in diverticulum=>ulceration and
bleeding
**when inflamed clinical appearance almost impossible to differentiate from
acute appendicitis
can predispose intestine to intussesception=>manifests as a colicky abdominal
pain and "currant jelly" stools
651. Meckel diverticulum presentations and dx lower gi bleed, RLQ location. Ectopic gastric mucosa -->acid ->ulceration,
bleed. Pertechnetate scan dx RLQ. adn gastric epith .
652. medium sized tumor cells, basophilic
cytoplasm, proliferation farction (ki-67
fraction) of >99%.
burkitts (EBV)
653. medroxyprogesterone (Depo Provera) progesterone-only OC administered as intramuscular injection once every
12wks
654. meds causing seizures bupropion, clozapine, isoniazid, ciprofloxacin
655. Medullary CA of thyroid gland characterized by:
and assoc w/
extracell deposits amyloid formed by calcitonin secreted form neoplastic
parafollicular C cells.
Assoc w/ MEN 2(A&B)
656. megaloblastic anemia most frequently caused by folate or vit B12 deficiency
will see increased MCV
peripheral blood smear will reveal hypersegmented neutrophils (>5 lobes) and
enlarged ovoid erythrocytes (oval macrocytes)
657. MEN 1 autosomal dominant condition characterized by:
parathyroid gland
tumors of pituitary gland
tumors of pancreas
658. MEN 2B characteristics: Marfanoid habitus, mucosal neuromas, medullary thyroid
carcinoma, pheochromocytoma
659. Met potential of metastatic prostate cancer: bone (axial skeleton).. sclerotic punched out lesions.
presents w/ back pain
660. metab of drugs that cause lupus like sx : N-acetylation (hyralazine, procainamide)
661. metabolic syndrome group of risk factors:
HTN
abdominal obesity
atherogenic dyslipidemia
insulin resistance
662. metaclopramide dopamine AA w/ central and peripheral fx. Prokinetic and antiemetic prop to
treat Gi mot d/o l(gastroparessis to prevent N/V.
663. metaloproteinase degrade components of ECM and Basement membrane composed of laminin
and collagens IV, VII
664. Metformin CI in renal failure (d/t risk of lactic acid accumulation). And lactic acidosis
situations (liver dyxfxn, CHF, alcoholism, sepsis
665. Methenamine silver crypto
666. Methotrexate use, sfx RA. SFX: stomatitis (ulcers), hepatotox (hepatitis, fibrosis, cirrhosis). Folic
acid supp to red stomatitis.
667. Methotrexates side effect? First line agent for rheumatoid arthirits ( anti-metabolite agent)
1. stomatitis
2. abdominal pian
3. nausea
4. hepatotoxicity
5. anemia
to prevent this give with folic acid
668. methylene blue indicated for Tx of methemoglobinemia
reducing agent that converts iron heme from Fe3+ to Fe2+ state
669. Methylmalonic acid and homocysteine elevated
in what def?
elevated in B12 def due to dec metabolism. homocysteine elevated in folate def
only.
670. methylmalonic aciduria due to increased circulating levels of methylmalonic acid due to deficiency of vit
B12-dependent enzyme methylmalonate mutase
imp in metabolism of isoleucine, valine, methionine, thymine, threonine, odd-
chain FA, cholesterol
671. microscopic polyangiitis (leukocytoclastic
angiitis or hypersensitiity angiitis)
most common vasculitis from antibiotic use
affects small vessels only
pathogenesis: type III immune rxn; Ag is often a medication (commonly
penicillin)
672. mifepristone (RU-486) synthetic steroid with anti-progestin and anti-glucocorticoid effects
used primary as abortifacient
673. Milrinone in cardiac adn vesels PDE inhibitor : inc contractility and inc vasodilation
674. misoprostol use PDE1 analog used to prevent NSAID- induced ulcer dz
675. missense mutation when mutations alter AA sequence
can be conservative where new AA is similar in chem structure
676. mitochondrial cytochrome oxidase component of electron transport chain
reacts with molecular O2 to produce water
677. mitochondrial dz myoclonic epilepsy w/ ragged red fibers
leber optic neuropathy
mitochondrial encephalopathy with stroke-like episodes and lactic acidosis
678. mitotane andrenocorticolytic drug
clinical use: adrenocortical carcinoma
679. mitral annular calcification degen calcific deposits in fibrous ring of mitral valve=>rarely assoc with regurgitation or stenosis
most common:
women > 60
Hx of myxomatous degen of mitral valve
chronically elevated LV press
*mitral valve radius is fixed
680. mitral insufficiency and
ventricular remodeling
LVEDV=>LV dilatation and hypertrophy from load from regurgitant flow
*net result: dilated left ventricular hypertrophy and LV mass
681. mitral stenosis hemodynamics mitral stenosis due to abnormal valves may have an opening snap in early diastole shortly after the
aortic component of the second heart sound (A2)
the opening snap occurs shortly after the mitral valve opens due to tensing of the valves leaflets
after the valve cusps have completed their opening excursion
the A2-OS interval is inversely correlated with the severity of mitral stenosis
682. mitral valve prolapse prod mid-systolic click and late systolic murmur=>heard best over cardiac apex
*most common anatomical abnormality producing mitral regurgitation
683. MOA for colchicine and use acute gouty arthritis and prophylaxis of reccurent gouty arthritis;
inhibits leukocyte migration and phagocytosis by blocking tubulin polymerization. Chemotaxis of
neutrophils!
SFX: nausea, diarrhea
684. MOA of BNP activate GC-->inc intracel cGMP
685. MOA of cromolyn and
nedocromil
stabilize mast cell DEGRANULATION independent of stimulation.
686. MOA of DDAVP for bleeding induce endothelial procoagulatory protein release (including vWF); used in hemophilia A
687. MOA of entacapone block COMT which stops conversion of L DOPA to w/e in the periphery-->more L-DOPA entering.
688. MOA of leuprolide GnRH agonist -->first transient inc and then dec in T and DHT
689. MOA of nitrate drugs transformed to NO at vascular SM cell membrane. Inc cGMP-->dec intracell Ca--> myosin dephosp
690. Mockenberg's medial calcific
sclerosis
medial calcinosis characterized by calcified deposits in muscular arteries
typically affect indiv >50 years of age
visible radiologically and often times palpable on physical exam
clinically aSx bc don't narrow vessel lumen
691. mode of infection by staph
epidermidis
synthesis of extracell polysaccharide matrix
692. monitor muscle length, and
muscle force
muscle spindle system
Golgi tendon
693. Most common cause of
hypertension in children?
Fibromuscular Dysplasia
Angiogram reveals "string of beads" sign
694. Most common cause of NASH? 1. Obesity
2. Diabetes
3. Hypertryglyceridiemia
695. Most common inciting factor
for asthma
allergen. cold air has non immune mx and is related to exercise.
696. Most common reasons behind
post cholecysteomy pain?
1. Functional pain
2. Sphincter of oddi dysfunction
3. Bile duct obstruction
both 2 and 3 would present with elevated liver enzymes and ultrasound would show dilated
ducts
697. Most common solid organ injured
in blunt abdominal trauma?
Spleen
698. Mt in xeroderma pigmentosum defect in DNA excisional repair.
699. Mt that causes HNPCC DNA mismatch repair gene mt
700. multiple myeloma present: easy fatiguability (due to anemia), constipation (due to hypercalcemia), bone
pain=>most commonly in back and ribs (due to prod of osteoclast activating factor by myeloma
cells and subsequent bone lysis), renal failure
*esp seen in elderly pts
histo: large eosinophilic casts composed of Bence-Jones proteins (light chains) seem in
tubular lumens
risk factors: hypercalcemia, hyperuricemia, infiltration of kidney by myeloma cells, AL
amyloidosis, frequent infxn
701. mut in pol gene
mut in env gene
assoc w/ HIV RT inhibitors and HIV protease inhib resistnace
assoc w/ hos neutralizing Ab
702. mutation in polycythemia vera JAK2 (non-R tyrosine kinase)
703. Mx of Fondopiranoux inhibit Xa --> inc Pt, PTT. no effect on TT
704. myc proteins txn factors
705. Mycobact resistance to isoniozid non expression of catalase-peroxidase enzyme or genetic modification of isoniazid binding site
706. Mycoplasma pneumoniae
pathophys
no cell wall, but has cell membrane. Antigenic similarity b/w cell walls of host and bacteria--
>cold aglutinin destruction of host rbc-->anemia. tx w/ erythro or tetra corrects infxn and
anemia resolves. C
can also cause stevens-johnson
707. myocardial contractility
(inotropy) slope of pressure-
volume curve for left ventricle
slope=> inotropy
slope=> inotropy
708. myoglobin monomeric protein
primary O2-carrying protein of skeletal muscle of skeletal and cardiac muscles
has much higher affinity for O2 than does Hb=>has hyperbolic oxygen-dissociation curve
*each subunit of Hb has similar O2 binding physiology as myoglobin
709. Myotonic dystrophy AD d/o.
Inc # of trinucleotide repeats on myotonia-protein kinase gene. Myotonia w/ weakness and
atrophy.
cataracts, frontal balding, gonadal atrophy.
710. nasal transepithelial potential diff
measurement use:
more neg than nml value indicates
used along with sweat test. Neg value -->reduced luminal cl secreiton and inc Na and net water
abs. -->dehydrated mucus.
711. Nasal ulcer with
glomerulonephritis:
Granulomatosis with polyangiitis (wegeners)
C-ANCA (Ab to neutrophil)
712. NE IV causing blanching and
induration. Prevention?
Phentolamine (alpha 1 blocker).
713. Negative predictive value, and positive
predictive value
NPV: prob that pt doesn't have dz
PPV: prob that pt does have dz
714. negative selection in T cell maturation essential for eliminating T cells that bind to self MHC or self Ag with overly high
affinity=>if permitted to survive would likely induce immune and inflamm rxns against
self Ag leading to autoimmune dz
occurs in thymic medulla and involves interaction of developing T cells with thymic
medullary epithelial an dendritic cells
serves to eliminate T cells that may be overly autoreactive against self Ag and therefore my
place a role in autoimmunity if not destroyed=>results in a population of T cells that have
only an appropriately low affinity for self MHC molecules
715. nephrotic syndrome and albumin classically present with decreased serum albumin due to protein-wasting enteropathy
716. neural tube defects assoc with increased AFP levels and acetylcholinesterase levels in amniotic fluid
717. neurofibromatosis type 2 more "central" form
characterized by:
bilateral acoustic neuromas
brain meningiomas
shwannomas of the dorsal roots in spinal cord
718. neurofribromatosis type 1 characterized by:
caf-au-lait spots
cutaneous neurofibromas,
axillary or inguinal freckling
optic glioma
iris hamartomas
osseous lesions
719. Neuron changes in MS: length constant (signal travels a shorter distance due to dec myelination)
720. Next step for workup of someone with
anklyosing spondylitis?
X-ray of sacro-iliac joints. to demonstrate fusion.
721. Next step in management of patient
with subclavin vein thrombosis (
warm, swollen, pale with pulses)?
1. Remove catheter
2. Duplex of vein to determine if anti-coagulation is needed.
722. Next step when patient presents with
Alkali ingestion?
Upper GI endoscopy
723. NF-kB is associated with production
of:
cytokines. Overexpression in crohn's.
724. NF1 has neurofibromas that arise
from what celLS
Schwann cells --which arise form neural crest
725. niacin improves hyperlipidemia by decreasing synthesis of hepatic TGs and VLDL
726. Niacin def pellagra, dermatitis, dementia, diarrhea
727. niacin deficiency characterized by pellagra:
dementia
dermatitis
diarrhea
728. nitrate action act primarily as venodilator=> cardiac work by left ventricular filling vol/preload
729. Nitrate bioavailability orally?
(Nitroglycerin, Isosorbide dinitrate,
Isosorbide mononitrate, amyl nitrite)
Isosorbide mononitrite >> others
No 1st pass met.
Na Nitroprusside (IV)
Amyl nitrite (Inhaled)
730. Nitrate bioavailability orally?
(Nitroglycerin, Isosorbide dinitrate,
Isosorbide mononitrate, amyl nitrite)
Isosorbide mononitrite >> others
No 1st pass met.
Na Nitroprusside (IV
Amyl nitrite (Inhaled)
731. nitrate drug action mimic action of endothelial derived relaxing factor
transformed to NO at vascular smooth muscle cell membrane=>leads to cGMP,
intracellular Ca2+ and myosin dephosphorylation
732. nitrates and phosphodiesterase
inhibitors
PDE inhibitors used for ED and pulmonary HTN=>if used in combo with nitrates cause
profound systemic hypotension=>both intracellular cGMP=>vascular smooth muscle
relaxation
*use together is absolutely contraindicated
733. Nitrates can cause paradoxycal
myocardial o2 demand. Prevented with
use of
metoprolol
734. nitric oxide created and released from endothelial cells in coronary vasculature
synthesized from arginine and oxygen by endothelial nitric oxide synthase (eNOS)
released from coronary endothelium in response to neurotransmitters (ACh, NE),
platelet products (serotonin, ADP), thrombin, histamine, bradykinin, and endothelin
also released in response to pulsatile stretch and flow shear stress in coronary
arteries=>major regulator of flow-med vasodilation in large arteries and pre-arteriolar
vessels
acts w/i vascular smooth muscle cells via soluble guanylate cyclase enzyme to prod of
cyclic GMP and cause smooth muscle relaxation
735. Nitroblue tetrazolium fail to turn blue CGD
nml neutrophils reduce nitroblue -->dark blue pigment
736. norepinephrine and coronary
autoregulation
neurotransmitter released from sympathetic neurons that stim adrenergic receptors
737. Normal light microscopic findings in a
patient with Nephrotic syndrome
suggest what?
Minimal Change disease
738. octreotide somatostatin analogue=>decreases gut motility, gut blood flow, and gut endocrine and
exocrine fxn
*decreases secretion of pancreatic enzymes into intestine
739. Opioid drug that causes withdrawl sx? Pentacozin ***
740. Opioids and RUQ pain Opioids act on smooth muscle (contraction) at sphincter of Oddi -->inc pressures in
bile duct and gall bladder.
741. ornithine transcarbamoylase catalyzes 2nd step of urea cycle where ornithine and carbamoyl phosphate are
combined to form citrulline
occurs within mitochondria
deficiency in this enzyme leads to hyperammonemia and mental retardation
742. orotic aciduria due to defective pyrimidine synthesis resulting from deficiency of enzyme orotate
phosphoribosyl transferase
*this enzyme requires glutathione as a coenzyme
743. Oseltamivir neurominidase inhib -->tx and prevent inf A and B. impairs release of new form virions, impairs
penetration of mucus secretions
744. osteocytes remain connected
to each other by
gap jxns.
745. Osteogenesis imperfecta? autosomal dominant
type 1 collagen defect
1. hearing loss
2. opalescent teeth-discolored
3. blue sclera
746. ovary epithelium simple cuboidal
charac: also known as germinal epithelium; transitions to peritoneum at the broad ligament of the
uterus
assoc tumors: serous, mucinous, endometrioid, clear cell, Brenner (urothelial)
*site of origin for many benign and malignant ovarian neoplasms
747. P bodies Foci w/in eukar cells that suppress translation of mRNA by binding it in the cytoplasm.
748. Painful ulcers on genetilas haemophilus ducrey, HSV 1,2
749. painless ulcers on genitals Klebsiella inguinale, trepobema pallidum, Chlamidia trachomatis
750. pancreas divisum failure of ventral and dorsal buds to fuse
usually aSx and only found incidentally
751. pancreatic secretory trypsin
inhibitor (PTSI)
prevents trypsin-mediated activation of other proteolytic enzymes and autodigestion of pancreatic
tissue
secreted by pancreatic acinar cells
inhibits any trypsin abnormally activated within the pancreas
*inhibitory capacity can be exceeded by large amounts of active trypsin which can act as its own
inhibitor
752. papillary necrosis assoc with:
DM
analgesic nephropathy
sickle cell dz
753. parietal cell stimulation acetylcholine
histamine
gastrin
*proton pump inhibitors block final common pathway of gastric acid secretion from parietal cells
754. parkinson on off and wearing
off
on off is unpredictable moments where pts gains mobility w/out restriction. wearing off is dyign off
of dopamenergic neurons -->dec response to drug
755. Particles of what size can
reach alveoli?
<2uM
756. Parvovirus and aplastic
anemia
non-enveloped single stranded DNA virus
most common viral cause of an aplastic crisis in pts with sickle cell anemia or other chronic
hemolytic disorders
mech: infects erythroid precursor cells in bone marrow
*dimishes number of reticulocytes available to replace deformed and/or removed erythrocytes
757. Parvovirus B19 in children
and adults
children: erythema infectiosum (fifth disease)
Adults: arthritis that mimics RA
758. PAS stains glycoprotein in cell walls of G+ actinomycete Tropheryma whippellii
759. patent ductus arteriosus and Tx associated with prematurity and congenital rubella infxn
*large shunts can cause dyspnea, cyanosis, and frequent respiratory infxns
therapy with indomethacin and ibuprofen (NSAIDS) successfully closes defect
*in neonates prostaglandins help maintain PDA
760. Path of biventricular pacemaker lead
2
coronary sinus (in AV groove of posterior aspect of heart)
761. Path of infection of tetanus wound-->retrograde motor neuron-->spinal cord: inhibit inhibitory interneurons
762. Patho in osteoporosis loss of total bone mass resulting in trabecular thinning.
763. patho of thromboangiitis obliterans vasculiitis of arteries, veins and extension to surrounding tissue
764. pathogen associated with
cryoglobulins
Hep C vrius
765. pathogenesis of cushing ulcers? INC ICP-> vagus activation-->inc HCl release
766. Pathogenesis of MG AI against skeletal muscle Receptors (Type II HS)
767. pathogenicity of H influenzae capsule.
768. Pathophys is diffuse scleroderma
esophageal hypomotility:
Atrophy and fibrous replacement of muscularis leading to incompetence of lower esoph
sphincter. Dilation -->reflux -->barrett and esoph adenoCA
769. pathophys of insecticidse organophosphates -->irreversible binding to cholinesterase-->stim nicotinic and
muscarinic.
Cholinergnic excess -->salivation, diaphoresis, urinary incont, diarrhea, emesis, miosis,
bradycardia.
770. pathophys of kidney stones in
chron's iliocolitis
crohn's-->oxalage kidney stones
Impaired bile acid abs @ terminal ileum--> loss of bile acid in poop (fat malab). lipids bind
Ca and soap complex is excreted.
Free oxalate (nmly bound by Ca to form unabs complex) is abs and froms urinary calculi.
771. pathophys of temporal arteritis Granulomatous inflammation of media
772. pathways exclusive to mitochondria -oxidation of FA
ketogenesis
citric acid cycle
parts of urea cycle (carbamoyl phosphate synthetase 1 and ornithine transcarbamoylase)
pyruvate carboxylase
773. Patients with recurring giardia
infxns?
a gammaglobulinemia, other immune def : no IgA which fights giardia.
774. PCOS (Stein-Leventhal
syndrome)
characterized by:
elevated estrogen, androgen, and LH
hyerandrogenisms
chronic anovulation=>infertility
oligomenorrhea
multiple ovarian cysts
common features:
obesity
insulin resistance
dyslipidemia
*increase risk of diabetes and CV dz
775. pericardial fibrosis usually follows:
cardiac surgery
radiation therapy
viral infxns of the pericardium
776. pericardial tamponade
and pulsus
combo of:
JVD
hypotension
pulsus paradoxus
*if previously healthy and suffered penetrating/blunt chest trauma to pericordial region=>high
suggestive of tamponade
*breath sounds will be normal
777. pertussis toxin AB exotoxin released by Bordetella pertussis=>stim intracellular G-proteins to increase cAMP prod
leads to:
increased insulin prd
lymphocyte and neutrophil dysfxn
increased sensitivity to histamine
778. pharmacodynamic drug
interaction
ability of drug, as part of its MOA, to antagonize/prevent the effect of another drug or endogenous
substance
779. pharmacokinetic drug
interaction
how drugs used together in a patient affect the absorption and elimination of each other
780. phosphatidylglycerol major component of surfactant and its levels in amniotic fluid increase after 36wks (lecithin after
30wks) gestation in parallel with increased surfactant production by maturing fetal lung
781. phospholipase C active in G-protein/IP3/Ca2+ 2nd messenger system
hormone binds receptor and activates G-protein=>activates PLC=>degrade phospholipids to IP3 and
DAG
*both DAG and increased intracellular Ca2+ caused by IP3 will activate PKC
782. Pictures with enlarged
ventricles: TB meningitis.
condition related to
impaired fxn of :
arachnoid granulations
783. PID mucopurulent cervicitis with cervical motion tenderness is frequent indicator of PID
manifested as endometritis, salpingitis, tubo-ovarian abscesses or pelvic peritonitis
most serious risk is permanent damage to repro system=>infertility
*can lead to ectopic pregnancy and infertility due to scarring of fallopian tubes if not Tx appropriately
assoc with N. gonorrhoeae and Chlamydia
occurrence of infertility as sequela of PID est to be 15-20% for women who have single episode of PID and 50-
85% for women with multiple episodes
784. pigment stones common in rural asian populations with increased incidence in women and elderly
brown pigment stones usually arise 2 to infxn of biliary tract=>release of -glucuronidase by injured
hepatocytes and bacteria=>increases hydrolysis of bilirubin glucuronides and increases amount of
unconjugated bilirubin in bile
*biliary infxn with E. coli, Ascaris lumbricoides, or liver fluke Opisthorcis sinesis sig elevates risk of
developing brown pigment stones
785. pituitary cancer 1 cancer is extremely rare=>more prone to metastases due to rich vascular supply
present: tumor mass effects
*infiltrative lesions involving suprasellar space typically compress the pituitary stalk=>decreased
hypothalamic dopamine and loss of inhibition of pituitary lactotrophs=>increased prolactin
786. pituitary hypoplexy hemorrhage into preexisting pituitary adenoma=>medical emergency
present: acute, severe headache, ophthalmoplegia, and altered sensorium
Tx: urgen neurosurgical consultation and stress doses of glucocorticoids
787. pol gene mut and
HIV
HIV RT inhibitors and HIV protease inhibitors
788. polyarteritis nodosa *transmural inflamm of the arterial wall with fibrinoid necrosis is characteristic of polyartertitis nodosa
(PAN); inflamm can occur in any organ except lung
segmental, transmural, necrotizing inflamm of med to small sized arteries
Sx: fever, abdominal pain, melena, peripheral neuropathy, malaise, weakness, weight loss, diffuse muscular
aches and pains
*assoc with HBV (10-30% cases; peak incidence in young adults; not linked to cigarette smoking
789. polycystic kidney
disease
inherited condition with juvenile and adult forms
present:
HTN
flank pain
recurrent UTI
hematuria
abdominal mass
causes thickened endometrium due to XS estrogen=>risk of developing endometrial hyperplasia and carcinoma
790. polycystic ovary
syndrome (Stein-
Levanthal)
characterized by young females with infertility, acne, hirsutism, insulin resistance, and central obesity as well
as characteristic bilateral ovarian cysts
791. polyethelene glycol osmotic laxitive
792. Polyribosyl-ribitol-phosphate component of Hib capsule. (conjugated in dipth or tet toxoid)
793. Pompe disease acid alpha glucosidase deficiency or acid maltase deficiency
glycogen storage dz II
presents with hepatomegaly, cardiomegaly and increased risk for cirrhosis
794. porcelain gallbladder:
cx, px
cx: chronic cholecystitis
Tx: prophylactic cholecystectomy (high risk of GB CA)
795. positive selection in T cell maturation process by which only T cells expressing TCR that is able to bind self MHC are allowed
to survive=>those not specific for self MHC are signaled for elimination by apoptosis
occurs after TCR DNA rearrangement and prior to negative selection
occurs in thymic cortex and involves interaction of T cells with thymic cortical epithelial
cells expressing self MHC
responsible for development of a T cell repertoire that can recognize self
796. post op urinary retention Involves dec micturition reflex activity: dec contracitlity of bladder detrusor and inc
vescle vesicle sphincter tone. Tx w/ muscarinic agonist (bethanachol) or a1 blocking.
797. Posterior urethra injuries
Anterior urethra injuries
Pelvic fracture-: inab to void w/ full bladder sensation
Straddle injury
798. Potency = higher affinity for receptor
799. Potter syndrome bilat renal aplasia, oligohydraminos, facies, hypoplas.
800. Presentation and labs for pt w/
halothane associated lethal fulminant
hepatitis:
elevated aminotransferase , prolonged PT time, eosinophilia. Shrunken liver
Centrilob hepatocell necrosis and inflammation off portal tracts adn parenchyma.
present with: fever, anorexia, nausea, myalgia, arthralgias, rash.
801. Presentation of acute hepatitis: (HAV Fever, malaise, fatigue, anorexia, nausea, vomitting
Mid abd pain, dark urine (inc serum bilirubin).
Hepatomeg and jaundice.
Inc AST, ALT followed by inc BR, ALP.
802. Presentation of Alkaptonuria AR d/o. def of homogentisic acid oxidase (breakds down tyrosine bypdt homogentisic
acid (alkapton))
->pigment deposits in connective tissue
803. Presentation of HUS: young children
acute renal failure, microangiopathic hemolytic anemia, thrombocytopenia.
labs: dec RBC count, hematocrit, platelet count, inc BT, LDH, BUN and creatinine.
804. presentation of wiskott-aldrich
syndrome
Triad: eczema, thrombocytopenia, combiend B and T deficiency.
Onset early in life w/ thrombotycotpenia present at brith and eczema and repeated infx
(capsulated) at 6-12mo.
805. presentations of congenital
toxoplasmosis
transplacental infection.
Hydrocephalus, intracranial calcifications, chorioretinitis. (tell expectant mother sto
avoid cat feces)
806. Presentations of intestinal malrotation
embryology?
cecum in RUQ. Ladd's bands. midgut fixed to SMA.
compl: intestinal obxtn, midgut volvulus.
807. Presentations of pulmonary HTN? second heart sound, signs of RHF.
808. Prevalance affects PPV, and NPV
809. prevention of DVT heparin is the DOC
unfractionated and low molecular weight heparins most commonly used for
prevention of DVT in inpatient settings=>esp in pts undergoing elective surgery
increases effect of naturally occurring anticoagulant antithrombin-III
unfractionated heparin bind to antithrombin-III by pentasaccharide in heparin
chain=>conformational change of antithrombin-III=>increases antithrombin
binding and neutralization of thrombin
810. primary biliary cirrhosis
Labs,
Assoc
AI rxn -->lymphoycte infiltrate + granulomas. dxtn of intralob bile ducts.
Labs: inc conj bili, inc xol and inc ALP.
addtl: inc serum mito Ab (IgM). associated with CREST, Sjogren, RA, celiac.
811. problem with fragile x syndrome hypermethylation of cytosine bases
812. problems in pts with ankilosing spond Back; Enthesopathies (inflammation at sites of tendon insertion). involves
costovertebral and costoternal jxn (can limit chest mvmvts -->hypoventilation
Other problems: anterior uveitis, asc aortitis.
813. Problems with benzos and other drug that
may cause sedation:
1st gen H1 histamimne R antagonists (diphenhydramine, chlorpheniramine).
814. problems with dna mismatch repair HNPCC or lynch syndrome.
815. producers of endotoxin gram neg organisms organisms
816. prolactin inhibition inhibited by dopamine=>acts on D2 dopamine receptor of lactotrophs
*dopamine secreted by hypothalamus
817. Prolonged pruritis and fatigue primary sclerosing cholangitis (inf and fibrosis of biliary tract).
818. Properties of cancer resistant cell
membrane protein?
human multidrug resistance (MDR1) gene codes -->P-glycoprotein (ATP-dependent
efflux pump). specificity for hydrophobic compounds.
819. propyl hydroxylase
lysyl oxidase
procollage peptidase
metalloproteinases
first three streghten collagen, last one breaks it down --leading to thrombus and MI.
procollagen peptidase deficient in ehler danlos.
820. protamine sulfate peptide antagonist of heparin
binds to heparin forming a complex that has no anticoagulant activity
not very effective in Tx toxicity caused by molecular weight heparin
821. protein kinase A primary intracellular affector enzyme in G-protein/adenylate cyclase 2nd messenger
system
increased levels of cAMP stim PKA
822. PRPP synthase mut that inc Vmax--> gout
823. Pt on chemo. Develops renal problems. Best
prevented with:
Allopurinol or Rasburicase (urate oxidase)-->no allantoin
824. Pt presents with acute motor and sensory
loss, loss of rectal tone and urinary
retention?
Cauda Equina Syndrome
Surgical Emergency!!
825. pt presents with blurred vision,
constipation and vomiting, what type of
medication would cause this?
Anti-cholinergics:
Trihexyphenidyl
826. pt presents with dull ache over eye with swollen eyelid, edematous
conjunctivae, and exudates in anterior chamber, after recent eye
surgery?
Post-op endophthalmitis
827. Pt presents with iron deficiency, foul smelling stool, easy bruising.
What could it be?
Think Celiac's disease
decreased iron, vitamin K and A
828. Pt presents with lobar pneumonia and vomiting and diarrhea? Think of Legionella pneumonia
txt with Azithromycin or Levofloxacin
829. pt presents with pain in MCP and PIP joints, but no redness or
swelling, only 15 min. stiffness in am, what do you suspect?
Viral arthritis, commonly seen in adults around children
Most likely Parvovirus, symmetric, multiple joints
Check Anti-B19 IgM
830. pt presents with persistent nasal blockage and episodes of
bronchoconstriction, also takes aspirin what is this?
High yield:
Aspirin sensitivity syndrome- pseduo allergic reaction
txt: leukotriene receptor antagonists**
831. Pt presents with refractory mania despite therapy with mood
stabilizer what should be done next?
1. Check urine toxicology screen
2. Check urine lithium levels
832. Pt undergoes surgery w/ general anesthesia. Post op has elevated
AST, ALT, confusion, nausea, fever. liver bx will show:
massive hepatic necrosis due to halothane. Ab against
liver proteins. Massive centriloular hepatic necrosis.
833. Pt w/ anemia, inc LDH, and indirect bilirubin:
Postivie osmotic frag test
Complications:
hemolytic anemia
D/t hereditary spherocytosis.
Pigmented gallstones.
834. Pt w/ hx of prolonged bleeding after tooth extract (maternal uncle
with hemarthrosis). Abnmality?
Hemarthrosis due to coagulopathy: Hemophilia A MC
inherited coagulopathy. X linked inheritance. causes
PTT elongation.
835. Pt w/ recurrent h influenza infxns receives Oneg RBC packked.
develops hypotension, tachy, itching, skin rash, bronchospasm
and dies 30 min.
selective immunoglobulin def (no IgA, so develop
response to IgA in blood )
836. pt with cirrhosis and increasing creatinine that does not respond
to IV fluid bolus what should you suspect?
Hepatorenal synrome
txt: liver transplant
837. pt with comidon rash: athlete. use of anabolic steroids (methyltestosterone)
Adrogen stim follicular epidermal hyperprolif and
excessive sebum pdtn.
838. pt with contralateral lower leg weakness with sensory deficiet? anterior cerebral artery stroke
839. pt with increased FEV1/FVC ratio but normal DLCO, what is the
dx?
Chest wall weakness
840. Pt with leukemia with dry tap and TRAP stain positive. what is the
dx? and how do you txt?
Hairy Cell Leukemia
txt: Cladribine
841. Pt with pulm edema and LV failure will show cadiomegaly, pleural effusion, kerley B lines, inc vascular
shadowing.
842. Pt with type 2 DM presents with elevated LFT's what could be
causing these?
Non-alcoholic fatty liver disease 2/2 insulin resistance
843. Pts at risk for sacular aneurism (spontaneous intracranial
hemorrhea) mcc
adult type coarctation of Ao (HTN assoc), marfan?,
congenital berry aneurysm.
MCC: AV malformation, rup cerebral aneurysm, abuse of
sympathomimetic drugs (cocaine)
844. Pts that lack IL-12 have inc infectivity with what organism? Tx? mycobacteria. Tx: INF gamma
845. pts with asthma, wrist drop, eosinophilia and Ab against
neutrophil myeloperoxidase:
churg strauss
846. pulmonary infarction caused by pulmonary artery embolism
Sx: dyspnea, cough, chest pain
light microscope: hemorrhagic (red) infarct
847. pulmonary stretch receptors myelinated and unmyelinated C fibers in lungs and airways=>reg duration of inspiration and
expiration
848. Pure red cell aplasia
associated with
thymoma, lymphocytic leukemias, parvovirus B19 ifxn.
849. Px of peau d'orange pitting edema in subcut breast tissue, w/ skin thickening around exagg hair follicles. Neoplastic cells
plug dermal lymphatic channels.
850. Px of platelet sequestration splenomegaly and platelets low but above 30,000. abnl bleeeding not found
851. Px of:
VHL
Von recklinghausens
NF 2
Sturge Weber
TS
OWR
VHL: capillary hemangioblastomas (retina, cerebellum); congenital cysts/neoplasms (kidney, liver,
pancreas). inc risk RCC (bilat)
NF1: peripheral NS tumor. neurofibromas, optic nerve gliomas, lisch nodules, cafe au lait
NF2: bilat CNVIII schwannomas, and multiple meningiomas
SW: cutaneous facial angiomas, leptomeningeal angiomas, retard, seizure, hemiplegia, skull
radiopacities, skull tram track
TS: kidney, liver, pancreatic cysts, CNS (cortical subependymal hamartomas), cutaneous
angiofibromas, visceral cysts, renal angiomyolipomas, cardiac rhabdomyomas.
OWR: telagiectasias, epistaxis, Gi bleed, hematuria.
852. pyelonephritis common organisms: E. coli, S. saprophyticus, P. mirabilis, Klebsiella, Enterococci
Sx: flank pain, costovertebral angle tenderness, fever, chills, hematuria with casts
labs: UA and micro show +leukocyte esterase, +nitrites, +bacteria, +WBC, +RBC occasionally, and
maybe WBC casts idicating renal-based pyuria; CBC show elevated WBC
853. Pyridoxine def: cheilosis, glossitis, dermatitis, peripheral neuropathy
854. pyruvate decarboxylase enzyme that catalyzes initial step in gluconeogenesis
converts pyruvate to oxaloacetate
requires biotin as a cofactor
*fxns within the mitochondria
855. pyruvate dehydrogenase converts pyruvate to acetyl-Coa for entry into the citric acid cycle
coenzymes required:
thiamine
lipoic acid
CoA, FAD, NAD+
856. QRS complex duration and
changes with excercise
.08-.120: slightly reduced durign exercise in respone to inc cardiac conduction veolocity.
857. radiation and cell death 2 major mech initiating cell death:
1. DNA double strand breakage
2. formation of free radicals=>cause cellular and DNA damage
effect is more pronounced in cells that are rapidly dividing bc they have less an ability to repair
DNA damage induced by radiation
*breakage of both strands gen required to cause cell death bc single strand breaks readily repaired
by polymerases
acute side effects: damage to epithelial surfaces (e.g., bowel mucosa and skin)
characteristic cell death curve of exposure to radiation shows nearly flat line on initial exposure
followed by steep increase in amount of cell death as dose of radiation increases
*steep portion of radiation induced cell death due to sharp increase in dsDNA strand fractures
and formation of free O2 radicals
858. ras proto-oncogenet hat codes for membrane-bound G-protein
acts as 2 mediator for several hormones and cytokines that act on cell membrane receptors
activation activates MAP kinase pathway and ultimately affects transcription
859. RCC arises from what part of
kidney
proximal renal tubule. Pts 60-70
Macro: golden yellow
micr: cuiboidal, or polygonal w/ clear cytoplasm.
860. recommendations for pts with
kidney stones
drink lots of water
Pyridoxine for hyperoxaluria
Low protein diet (dec acid load and dec Ca release -->prevent hypercalciuria and calcium, uric
acid stones)
Low sodium diet (calcium stones)
861. relation b/w confidence interval
and 'p' value:
if CI does not include 1, 95% CI, then p<.05.
862. replication of HBV dsDNA->template +RNA->dsDNA progeny
863. restrictive cardiomyopathy associated with:
hemochromatosis
amyloidosis
sarcoidosis
radiation therapy
864. restrictive cardiomyopathy
etiology
heart failure due to LV diastolic dysfxn result of in diastolic LV compliance
diastolic dysfxn=>predominant mech of heart failure in restrictive CMP
*may be idiopathic or due to amyloidosis, sarcoidosis, metastatic cancer, or products of inborn
metabolic errors
865. result of valine replacing
glutamate in HbS
hydrophobic interaction among Hb molecules.
866. result of valine replacing
glutamate in HbS (beta
subunit)**
hydrophobic interaction among Hb molecules.
867. Results acute liver failure: dec PT, eosinophilia, inc aminotransferase levels
868. retention cysts formed if the duct of a gland is obstructed=>traps secretions
869. retinoic acid receptor play role in proper differentiation of myeloid precursors
interacts with retinoic acid to effect transcxn of genes required for maturation
870. retroperitoneal hematomas commonly assoc with abdominal pelvic trauma
develop in up to 1/2 of pts with blunt abdominal trauma
frequently caused by direct abdominal blows from malpositioned seat belts or by steering
wheels during automobile collisions
*pancreatic injury can cause mild Sx or be aSx
**abdominal CT scan should be performed in stable pts with blunt abdominal trauma to
exclude possible retroperitoneal hematoma
***nonexpanding hematomas in this location Tx conservatively
871. retroperitoneum space located behind peritoneal cavity and includes:
1: major vessels: abdominal aorta, IVC and their branches
2. solid organs: pancreas (except tail), kidneys, adrenal glands
3. hollow organs: parts 2 & 3 and a portion of part 4 of duodenum, the ascending and
descending colon (secondarily retroperitoneal), rectum, ureters, and bladder
4. vertebral columns and pelvic muscles
872. Reverse warfarin effect
reverse heparin effect
Vit K and fresh frozen plasma (faster)
Protamine sulfate (binds heparin causing chemical inactivation)
873. RF for aortic dissection HTN and marfans.
874. RF pathology interstitial myocardial granulomas/Aschoff bodies typically found in acute RF
Aschoff bodies contain plump macrophages with abundant cytoplasm and central,
round to ovoid nuclei with central, slender ribbons of chromatin are Anitschow cells
875. right coronary artery gives rise to posterior descending artery=>supplies inferior wall of left ventricle =>forms
most of the diaphragmatic surface of the heart
876. right ventricular overload (cor
pulmonale)
presentation: fatigue, dyspnea on exertion, peripheral edema
PE: accentuation and splitting of pulmonary component of S2, distended neck veins and
hepatomegaly with hepatojugular reflux
commonly a consequence of pulmonary HTN or left heart LHF
877. Risk factors for adenocarcinoma of
esophagus?
Barrett's Esophagus, GERD, high fat and calorie diet.
878. Risk factors for squamous cell ca of
esophagus?
Smoking, alcohol, vitamin def, and pickled foods.
879. Risperidone sfx antidopaminergic-->hyperprolactinemia->breast tenderness, amenorrhea
880. Ristocetin factor? aggregates GP Ib-IX receptor on platelets and makes them available for vWF binding.
881. Role of p450 monooxygenasae detox but also activate pro-carcinogens
882. role of Rb stop progression of cell cycle from g1 to s (dna pol act and DHF red)
883. Rx for atropine toxicity physostigmine. (CNS and peripheral effects)
884. Rx for hairy cell leukemia? properties Cladribine. Adenosine analog and not degraded by adenosine deaminase.
885. Rx for lung abscesses (bacteroides,
prevotella, fusobacterium,
peptostrepto)
Clindamycin
886. Rx for narcolepsy : psychostim (modafinil)
887. Rx for oral white plaque in infant? oral candidiasis -- Nystatin (swish and swallow) , not absorbed by GI tract.
888. Rx for person exposed to heavy isotope potassium iodide : prevent thyroid abs of radioactive iodine isotopes via competitive
inhibition
889. Rx that reverses toxicity of methotrexate in
non-cancerous cells in GI mucosa , BM.
Folinic acid
890. Rx that treats peripheral neuropathy from
DM2 but can cause urinary retention?
TCA (amitriptyline)
891. Rx to breast cancer and prevent osteoporosis (SERM) Tamoxifen/Raloxifene. binds Estrogen R and antagonizes.
SFX: endometrial cancer, thromboembolic disease
892. Rx to counteract muscarinic overstimulation
due to Cholinesterase inhibitors in MG?
Scopolamine (antimuscarinic)
893. Rx to treat hirsutism Spironolactone (antiandreogen prop)
Flutamide (inhib Testosterone R)
Finasteride (5-alpha red inhib)
894. Rx with neg chronotropic effects B blockers, non DH CCB, cardiac glycosides, amiodarone and sotalol,
cholinergic agonists (pilocarpine, rivastigmine).
895. S-100 homodimeric calcium-binding proteins
*similar in structure to calmodulin
imp in intracellular fxns like protein phosphorylation and cell growth and
differentiation
marker for cells of neural crest derivation such as melanocytes, Schwann cells,
and Langerhans
896. S/S of Constrictive Pericarditis? Elevated JVP, hepatomegaly, ascites.
2/2 Radiation, viral infection, or cardiac surgery.
897. s/s unique to legionella pneumonia? 1. GI symptoms
2. Hyponatremia
3. Elevated LFT
txt: quinolone or macrolide
898. sarcoidosis inflamm dz of unknown etiology that leads to development of non-caseating
granulomas in many organs and tissues
granulomas consists of aggregates of epithelioid cells (activated M) and
multinucleated giant cells consistent with chronic granulomatous inflamm
typical pt: young black woman with non-specific complaints of fever, malaise,
and weight loss
lung-involvement present in majority of pts and manifests clinically with cough,
dyspnea, and chest pain
skin-varied in presentation ranging from macules to plaques to erythema
nodosum
*CXR-essential for Dx
stage I-reveals bilateral hilar lymphadenopathy
stage II-bilateral hilar lymphadenopathy along with pulmonary infiltrates
commonly in upper lobes
stage III-lung infiltrates only
stage IV-lung fibrosis
899. Schilling test helps differentiate dietary deficiency from pernicious anemia and malabsorption as causes
of vit B12 deficiency and megaloblastic anemia
in dietary deficiency oral radiolabeled vit B12 is absorbed in the gut and excreted by the
kidneys in normal amounts
normal urinary excretion suggests normal absorption; diminished urinary excretion is a
sign of impaired intestinal absorption
*normal excretion only after dose given with intrinsic factor is diagnostic of pernicious
anemia; of excretion still low then suggestive of malabsorption syndrome
900. Schilling test determines cause of abnormal vit B12 absorption
used to Dx pernicous anemia=>improved absorption of vit B12 after admin of intrinsic
factor is typical
901. schistocytes/helmet cells fragmented erythrocytes=>RBCs deformed during mechanical destrxn of erythrocytes in
vasculature
artificial (mechanical valves) are more traumatic for RBCs than porcine
prosthesis=>frequently cause hemolysis
also appear if destrxn from narrowing of vascular spaces or disseminated thrombosis
902. schizo patient on risperidone has
breast tenderness, amenorrhea
cx of amenorrhea
med is antidopaminergic-->hyperprolactinemia->breast tenderness, amenorrhea
903. scleroderma and pulmonary
hypertension
pulmonary HTN develops in pts with scleroderma as result of damage to pulmonary
arterioles due to increased deposition of collagen
manifests with accentuated pulmonary component of 2nd heart sound and signs of right-
sided heart failure
904. Secondary infections following
influenza infxn? In elderly?
S. pneumo, S. aureus, H influenza
905. selective beta blockers met, aten, esmol, ace (preferred for COPD, asthma pts)
Met a 10 w/ a SMALL ASS (being selective)
906. Selective immunogloblulin def Px recurrent sinopulm and GI tract infxn due to absence of secretory IgA. recurrent otitis
media, sinusitis, bonchitis, pneumonias (encap bacteria).
Gi infxns --<acute or chronic diarrhea, due to viral, bacterial and G lamblia.
907. Septic arthritis in sxually active and
non sexually active
N gonorrhea in sexually active
S aureus in non sexually active
908. seratonin syndrome
Antidote
hyperthermia, autonomic instability, muscle rigidity, myoclonus, diaphoresis. (MOAI and
SSRI).
Antidote: cyproheptadine
909. serotonin and coronary
autoregulation
prod by neuroendocrine cells, platelets, and serotonergic neurons in CNS
little known about vasoactive effects=>has both vasoconstrictor and vasodilator effects
910. SFx of almost all nitrates HA and flushing: vasodilation in meninges and skin
911. sfx of clopidegrel mouth uclers, fevers (sounds like aspirin but its not if it presents with neutropenia)
912. sfx of ethambutol eye....
913. SFX of TCA ..
914. shaken baby syndrome bilat retinal hemorrhages, subdural hematoma.
915. Sheehan
syndrome
high estrogen levels of pregnancy stim growth of pituitary=>enlarge and bc more vascular
*sig hypotension (most common cause is postpartum hemorrhage) while still large=>ischemic
necrosis=>panhpopituitarism
commonly see prolactin deficiency (unable to lactate), hypothyroidism, and hypocortisolism
916. shiga and shiga-
like toxin mech
inhibit ribosomal protein synthesis
shiga toxin from Shigella
shiga-like toxin from EHEC
917. shiga toxin causes cell destrxn by inhibiting cellular protein synthesis
classic bacterial AB exotoxin with a single A subunit bound to five B subunits
A subunit inactivates 60S ribosome of host=>halt protein synthesis=>cell death
918. shiga toxin and
shiga-like toxin
cause inactivation of 60s ribosomal subunit
shiga toxin from Shigella
shiga-like toxin from enterohemorrhagic E. coli (EHEC)
919. Shigella gram- rod bacteria; non-motile, non-lactose fermenting that prod acid
causes hemorrhagic diarrhea
most common causing shigellosis in industrialized countries is Shigella sonnei; most common in developing
nations is flexneri
transmitted by fecal-oral route=>never a component of normal bacterial gut flora
primarily a pediatric dz but shows predilection for homosexual males and adults in skilled nursing facilities
invades GI mucosa, specifically via M cels located in Peyer's patches=>lyses containment vacuole and enters
cytosolic compartment=>induce apoptosis of host cell and spread laterally to adjacent cells via protrusions created
thru host-cell actin polymerization=>triggers robust host inflamm response largely med by neutrophils (host
response the primary cause of diarrhea)
releases shiga toxin=>cell destrxn by inhibiting cellular protein synthesis
*prod of toxins considered less imp in pathogenesis than cellular invasion bc nontoxigenic strains have been found
to cause sig dz
920. sickle cell trait
heterozygotes
have Hb composed of 35-40% Hb S
have relative protection from malaria, sickle cell crises, aplastic crises, and sequestration crises by presence of >50%
normal Hb A
usually aSx but may develop hematuria and a limited ability to concentrate urine; high incidence of UTI and splenic
infarction at high altitude have also been reported
have normal peripheral smears and indices, reticulate counts, and MCHC values
*RBCs will sickle when sodium metabisulfite is added
921. Side effect of
carbamezepine?
Aplastic Anemia
922. Side effect of
Isoniazid?
1.) Peripheral Neuropathy
2.) Hepatitis
923. Side effects seen with Carbidopa/levidopa? hallucination, agitation.
after several years will see dyskinesea
924. Signif of Hb A2, Gower, bart a2d2: 2-5% of Hb in nml adults
Gower: zeta2 epsilon2. earliest Hb foudn in fetus (Yolk sac)
Bart: 4 gamma. high o2 aff, no release--> hydrops fetalis.
925. Signs of vertical transmission of HIV from mother to
fetus? Prevention?
1st year of life: oral thrush, interstitial pneumonia, severe lymphopenia.
Prevention: Zidovudine, AZT (retroviral RT inhibitor) @ 14 wks, and
infant 6 weeks postpartum.
926. silent mutations when mutations do not alter the AA sequence=>do not alter protein
structure
927. similarity b/w non-small cancer lung carcinoma and
CML
NSCLC: inversion of short arm of C2 creating fusion gene b/w EML4 and
ALK--> active TK
CML: BCR-ABL 9;22 active TK
928. Sister mary joseph paraumbilical met of gastric ca
929. situations that cx sickle cell aggregation anoxia: low pH, high 2,3 DPG (binds 2 beta chains and stabilizes taut
which releases o2).
also tissues with high metabolic demand (Brain, muscle, placenta).
930. SLE present: combo of malar rash and pleural effusion
assoc with circulating immune complex nephritis; most are ANA+; more
specific to SLE is Ab to dsDNA and Smith
931. Small cell CA markers *** neuron specific enolase, chromogranin and synaptophysin
932. Somatomedin C: IGF-1.
933. Spath infection has defense protein on PDG wall : Protein A binds Fc on IgG and prevents complement activation. and
impaired C3b.
934. species that cause enteric bacteremia E. coli (sepsis)
Salmonella typhi (sepsis, typhoid fever)
Pseudomonas aeruginosa (sepsis, endocarditits, osteomyelitis)
Klebsiella (sepsis)
Proteus (sepsis)
935. spider angiomas bright red central papule surrounded by several outwardly radiating
vessels
occur due to dilatation of central arteriole and its superficial capillary
network are estrogen-dependent
936. Spindle shaped cell tumor w/ small-vessel prolif in
AIDs paitnet found in Gi tract
kaposi
937. spironolactone androgen receptor antagonist
used to Tx acne and hirsutism in pts with PCOS
938. spironolactone mech: aldosterone antagonist with mild diuretic effects
clinical use: K-sparing diuretic
endocrine effects: hyperkalemia, gynecomastia, decreased libido, and ED
939. spironolactone K+-sparing diuretic
anti-andronergic properties: blocks androgen receptors at hair follicles, decreases testosterone
prod
side effects: gynecomastia and testicular atrophy in men
940. spoon nails and dysphagia
Dx and mech
Fe def anemia.
Plummer-vinson esophageal webs. Patternson kelly syndrome.
941. Sporadic colon cancer
mutation steps: Adenoma to
carcinoma sequence
APC, K-RAS, p53
942. -blockers and heart failure cardiac work by slowing the ventricular rate and decreasing afterload (decreasing peripheral
resistance)
*shown to slow progression of heart failure and reduce all-cause mortality in pts with CHF
943. -hCG production detectable in maternal serum only after the blastocyst successfully implants=>gen on day 6 after
ovulation
944. 1-adrenergic receptor classic G-protein coupled receptor located in cell membrane
adenylyl cyclase cleaves ATP to form cAMP=>activates PKA
945. stages of ATN initiation stage: ischemic injury precipitated by hemorrhage, acute MI, sepsis, surgery, etc.
maintenance stage: anion gap metabolic acidosis, decreased urine output, fluid overload,
increasing Cr/BUN, hyperkalemia (>6.0 mEq/L will cause probs); hyperphosphatemia; muddy
brown casts, low urinary osmolarity (<350)
recovery phase: gradual increase in urine output leading to high-vol duresis; dehydration;
electrolyte abnormalities may include decreased concentrations of K, Mg, PO4, and Ca due to
slowly recovering tubular fxn
*hypokalemia one of the most serious complications
can be caused by aminoglycosides
946. staging refers to how much the tumor spreads into adjacent tissues and distant organs
most tumors are staged by the TNM system:
size or primary tumor
involvement of regional lymph nodes
presence of distant metastases
947. Staphylococcus aureus and
bacterial endocarditis
causes acute bacterial endocarditis with rapid onset of Sx:
shaking chills (rigors)
high fever
dyspnea on exertion
malaise
*in IVDU causes RH endocarditis with septic embolization to lungs=>pulmonary abscesses
*in non-IVDU causes rapid decompensation, heart failure, sepsis, septic embolization to brain and
other end organs
948. statin competitively inhibit HMG CoA reductase, the enzyme that converts HMG CoA to mevalonate
(rate-limiting step in hepatic cholesterol synthesis); increases LDL receptors
effects: lowers cholesterol and directly stabilizes atheromatous plaques
commonly prescribed to pts who have suffered an MI bc sig decrease both incidence of 2nd MI and
mortality
side effects: hepatotoxicity and myopathy common; myositis=>increases creatinine kinase when
high doses used; myalgias more common Sx and not assoc with rise of creatinine kinase
*risk increased when combined with fibrates and/or niacin
949. statins decrease cholesterol by inhibiting enzyme HMG-CoA reductase (imp for hepatic cholesterol
synthesis)
increase LDL receptor activity on hepatocytes
produce modest reduction in serum TG
*pts with marked hypertriglyceridemia Tx with high-dose statins have sig TG reduction (up to
20%)
950. steps in base excision repair Glycosylase (cleaves altered base)
Endonuclease (5' cleaved )
Lyase (3' cleaved)
DNA pol and ligase fill gap.
951. steps of tumor cell invasion 1. Down regulate E-cadherin (detachment)
2. Adhere to basement membrane via laminin , etc
3. invasion via metalloproteinases, cathepsin D protease
952. stop codons UGA
UAG
UAA
*mutations producing abnormally placed stop codons are called nonsense mutations=>premature
termination of protein synthesis and formation of truncated protein molecule
953. strawberry (infantile)
hemangiomas
appear during first weeks of life
initially grow rapidly then frequently regress spontaneously by 5-8 years of age
bright red when near epidermis and more violaceous when deeper
954. Streptococcus bovis and
bacterial endocarditis
part of normal flora of colon
*bacteremia or endocarditis by S. bovis associated with colonic cancer
955. Streptococcus viridians and
subacute bacterial endocarditis
most common etiologic agent in SBE following dental work
*most frequently in pts with preexisting valvular abnormality like rheumatic heart dz or congenital
heart malformations
956. strongloydes in GI and stool GI: both forms
Stool: larva only
957. Structural alteration of
enzymes inovlved in RNA
synthesis
DNA-dependent RNA polymerase -- mech of rifampin resistance.
958. Subperiosteal reabs w/ cystic
degen
Unmin osteoid
persistant primary, unmin
spongiosa in medullary canals.
hyperparathyroidism
Vit D def
osteopet
959. Succhynil choline phase I and II and how to
reverse it?
phase I: depol and paralyze train on four equal.
Phase II: depol and dec train en four
reverse with neostigmine in phase II. Augments in phase I.
960. succinate dehydrogenase enzyme of TCA cycle that fxns to convert succinate to fumarate
inner mitochondrial membrane protein
fxns as part of electron transport chain
961. sucralfate binds base of mucosal ulcers=>provide physical protection against acid
962. sulfasalazine 5-aminosalicylate=>inhibit prostaglandin and leukotriene synthesis during
inflamm
clinical use: Crohn's dz, ulcerative colitis
963. Superantigens that interact with MHC to
give widespread release of CK
enterotoxins, exfoliative toxins, TSST-1
964. Superior laryngeal nerve branches and
innervation
Recurrent laryngeal n inner
SLN: ext -->cricothyroid m; int-->sensory above vocal cords
RLN: all laryngeal m except cricothyroid. Sensory inn below vocal cords
965. Superior orbital fissure
Rotundum (face is round)
ovale
spinosum (assoc w/ epidural hematoma)
internal acoustic meatus
Jugular foramen
hypoglossal
foramen magnum
III,IV,V1,VI
V2 (maxillary-mid face)
V3 (mandibular-open mouth like an oval)
middle meningeal A/V
VII,VIII
IX,X,XI (jug V.)
XII
XI, brain stem, vertebral A.
966. supine hypotension in pregnant woman: compression of inferior vena cava-->dec venous return and cardiac output
967. suppression of xol 7alphahydroxylase
activity
Fibrates cause this. -->reduce conversion of xol to bile acids-->excess xol secretion
in bile.
968. systemic lupus erythematosus present: young woman complaining of rash on malar prominences ("butterfly
rash"), phosensitivity, malaise, anorexia, and arthralgias
969. Systemic mastocytosis Mast cell proliferation in BM and other organs. -->inc pdtn of gastric acid in
parietal cells.
N/V/cramps, gastric ulcers.
970. systolic heart failure characterized by in ventricular contractile performance = EF
requires in LVEDP to create abnormally high LVEDV and achieve near-normal
stroke vol
* seen in both LVEDP and LVEDV
971. T3, rT3, T4 T4 converted to T3 or rT3 (inactive). T3 cannot be converted into anything else.
972. Tachyphylaxis and examples Vasoctxn by a-adrenergic agonists (Phenylephrine, xylometazoline, oxymetazoline)
use >3 days causes dec NE synth.
Nitroglycerine also dec release of NO (need drug free interval of 8-10h)
973. tamoxifen acts as antagonist or partial agonist of estrogen receptor=>depending on tissue type
breast tissue: antagonizes estrogen receptor=>used as adjuvant therapy for estrogen receptor+ breast cancer
bone: partial agonist
endometrium: partial agonist
CV tissue: partial agonist
*assoc with side effects such as DVT, thromboembolism, and endometrial cancer
974. TB drug that
actts intracel ,
extra?
intra: pyrazinamide (acidic environment activation)
extra: isoniazid, rifampin
975. TCA sfx Tri C's:
convulsion, coma, cardiotox (arrhythmia).
Tx: NaHCO3 for CV tox
Inhib fx:
Central &periph M Ach R -->tachy, delirium, dilated pup, flushing, dec diaph, hyperther, intestinal ileus, urin reten
periph a-1 adre R->periph vasodil (orthos hypoTN)
Cardiac fast Na ch-->conduc defect, arrhyth, hypoTN
H1 R->sedation
presyn NT (NE, 5-HT) reuptake->seiz, trem
976. TCR DNA
rearrangement
results in XS 10^15 diff possible Ag binding sites
similar to immunoglobulin gene rearrangement in that it involves joining of V, D, J and C regions of the TCR gene
and the processes of the junctional flexibility, N and P-region nuceotide addition, alternative joining of genes, and
multiple peptides combining to form the intact receptor
mature TCR is formed from joning of an a and a b protein segment=>these proteins are membrane-bound in close
assoc with either CD4 or CD8 as well as the costimulatory CD28 and CD45
977. temporal
(giant cell)
arteritis
characterized by granulomatous inflamm of media
most common form of vasculitis in adults
*typically develops in pts above age 50
causes headache, facial pain, jaw claudication, and visual loss
978. terbanifine inhibits fungal enzyme squalene-2,3-epoxidase=>decreased synthesis of ergosterol
clinical use: dermatoophytoses
side effects: accumulates in skin and nails
979. tests for
treponema
pallidum
RPR or VDRL (screening) then confirmatory test (FTA-ABS uses Ab)
980. Tetralogy of
Fallot
caused by abnormal migration of neural crest cells thru the primitive truncus arteriosus and bulbus cordis
Tetralogy of Fallot, transposition of the great vessels, and truncus arteriosus are three major cyanotic heart dzs also
caused by this abnormal migration
981. Theophylline
intox
seizures, tachycardia
982. Thiamine deficiency associated
with ___ in infants and __ IN
ADULTS:
beriberi in both as well as Wernicke-Korsakoff in alcoholics.
Infants (2-3mo): fulminant cardiac syndrome w/ cardiomegaly, tachycardia, cyanosis,
dyspnea, vomiting.
Adult beriberi: dry or wet. Dry- sym periph neuropathy w/ sensory and motor impairments
(distal). Wet: cardiat (cardiomegaly, cardiomyopathy, CHF, peripheral edema, tachycardia).
983. thiazide diuretics used to Tx edema 2 to heart failure, renal dz, and liver dz
common side effects: hypokalemia, hypomagnesemia
less common side effects: hypotension, vol depletion, hypercalcemia, hyponatremia
984. thigh claudication suggestive of occlusive dz of ipsilateral external iliac or common femoral arteries and/or
both superficial femoral and profunda femoris arteries
aortoiliac atherosclerosis can diminish blood flow to internal pudendal branches of the
internal iliac artery=>difficult to sustain erection
985. thrombin time (TT) prolonged by heparin and drugs that directly inhibit thrombin formation
986. thromboangiitis obliterans
(Beurger disease) risk factors
smoking-assoc vasculitis of medium and small-sized arteries
*principally tibial and radial arteries
987. Thyroid binding globulin:
role and regulated by
Inc TBG --> inc circulating total T4, adn total T3. But free thyroid hormone is nml.
Inc lvls in pregnancy, oral contraceptives, Hormone rep. tx.
988. ticlopidine and clopidogrel inhibit ADP mediated platelet aggregation
useful following PCI and for Tx of unstable angina and non-Q wave MI
989. time on insulin action starts at .5h, peak at 2-4. last 5-8h
990. time to reach stead state
concentration in drug elim by 1st
order kinetics
4-5 half lives.
991. toxic megacolon and dx plain film: presents with fever, bloody diarrhea, abdomina distenion. It is distended and
tender abdomen.
992. toxin responsible in
miningicoccemia
Meningococcal lipooligosacchardie
993. Toxins of C diff A: attaches to cell membrane
B: actin depolymerization -->loss of cellular cytoskeleton integrity
994. toxins of c diff enterotoxin A: watery diarrhea
cytotoxin B: colonic epithelial cell necrosis & fibrin deposition
995. toxoplasma infection causes mononucleosis-like illness in immunocompetent hosts and CNS involvement in
immunocompromised pts
996. Transcobolamin II def B12 carrier-->hyperseg PMN but no illness
997. Transformation take up naked DNA form environment (aka competence)
SHiN
998. transketolase enzyme of PPP
uses thiamine (vit B1) as a cofactor
999. transmembrane ion channels selectively allow certain ions to pass into or out of the cell=>facilitate formation of voltage
gradient across cell membrane
participate in formation of urine, nerve and myocyte depol, muscle contraction, sweat
formation, and exocrine secretion formation
1000. Transmission of vibrio
parahemolytics
contaminated shellfish
1001. Transmural inflammation w/ fibrinoid
necrosis.
Fever, malaise, weight loss, abdominal pain,
melena.Muscle aches.
Dx?
PAN associated with hep B infection.
1002. Treatment for acute dystonia? Anti-histamines and Dopamine Agonists (benztropine or trihexyphenidol)
1003. Treatment for Akathesia? Feeling of restlessness
Beta Blockers
1004. Treatment for Cat Scratch Disease? Usually self-resolves. But Azithromycin can speed recovery.
1005. Treatment for Immune thrombocytopenia? Self-resolves--->observe.
If platelet count falls below 30,000 treat with Corticosteroids.
1006. triamterene mech: blocks Na channels in DCT and CD=>increased Na and fluid excretion
clinical use: K-sparing diuretic
1007. triple test preformed at weeks 16-18 of gestation
1008. Triple Test
Elevated AFP:
Dec AF:
High: multiple gestation, neural tube defects (spina bifida, anencephaly),
abdominal wall defect.
Low: DS (dx w/ karyotyping).
1009. tRNA contains : pseudouridine, thymidine etc. and CCA end
1010. true diverticula of esophagus result of scarring and traction of the esophagus
usually seen in mid-portion of esophagus and result from mediastinal
lymphadenitis (tuberculosis, fungal infxns)
1011. Trypanosoma Cruzi transmitted by reduviid bug
causes Chagas's dz
prod neurotoxin that destroys myenteric plexus and causes intramural,
parasympathetic denervation of smooth muscle
esophagus: incapacitates lower esophageal sphincter=>food gets "stuck" in
esophagus
*proximal to this esophagus is markedly dilated
sigmoid colon: megacolon
ureter: megaureter
1012. Tryptase: marker for mast cell activation
1013. tuberculosis presents with malaise, weight loss, low-grade fever and cough
CXR: patchy or nodular infiltrates, cavities, or calcified nodules
PPD test and sputum culture are used for Dx
histo: caseating granulomas
1014. tumor marker for liver angiosarcoma? cd31 (endothelial cell marker)
1015. Turner's syndrome diminished femoral pulses compared to brachial pulses, Sx of inadequte perfusion of
lower extremities during ambulation, and enlarged intercostal arteries in
child/young adult =>typical of adult-type congenital coarctation of aorta
assoc with coarctation of the aorta in girls
1016. Two major causes of hematuira after
upper respiratory tract infection?
1. IgA neprhorpahty- normal complement levels
2. Post-strep GN- complement levels low
1017. Tx Fe poisoning Deferoxamine : chelating agent used to tx Fe poisoning (transfusion)
1018. Tx for acute mania Lithium, valproate, carbamazepine
1019. tx for aresenic poisoning dimercaprol: chelating agent . displaces arsenic ions form sulfhydryl groups on
enzymes (cellular metab).
Toxicity of dimercaprol: nephro and HTN
1020. tx for bradycardia post IM Atropine. dec vagal influence on SA, AV node
SFX: intraocular pressure -->acute-closed angle glaucoma.
1021. tx for bradycardia post MI Atropine. dec vagal influence on SA, AV node
SFX: intraocular pressure -->acute-closed angle glaucoma.
1022. tx for chronic hep C: interferon a and ribavirin
Ribavirin MOA :(multifocal)
Inhib RNA pol & IMP DH (depleting GTP);
Defective 5' cap formation on viral mRNA txn;
Modulating better immune respnse
1023. Tx for CMV in HIV ganciclovir. greater aff against CMV DNA polymerase
1024. Tx for CNS toxo? Pyrimethamine, and sulfadiazine
1025. Tx for crypto Amp B, flucytosine
1026. Tx for fainted diabetic? IM glucagon (IM glucose not practical)
1027. Tx for gestational GDM diet, excercise. Insulin when those fail.
1028. Tx for graves opthalmopathy HD glucocorticoids
1029. tx for h pylori 2 ABx w/ adj agent (metronidazole, tetracycline, amox, clarithro) w/ (PPI, Bismuth)
14 d.
1030. Tx for hemorrhagic cystitis during therapy
by cyclophosphamide or ifosfamide
(caused by toxic metabolite acrolein)
Agressive hydration, bladder irrigation, administration of mesa (sulfahydryl
compoudn that binds to acrolein in urine)
1031. tx for inc VLDL (hypertriglyceridemia) Fibrates and nicotinic acid tx
1032. Tx for lyme's doxycycline or penicillin-type Abx (ceftriaxone)
1033. Tx for organophosphate tox Atropine (reverses muscarinic effects) but not effects of nicotic R.
Pralidoxime-- reverses both by restoring cholinesterase.
1034. Tx for pts w/ dec libido, anorgasmia and
inc latency to ejac taking SSRI (alternative)
bupropion
1035. tx for trigeminal neuralgia carbamazipine
1036. tx lead and mercury poisoning CaNa2EDTA: complexes w/ mono, di, tryvalent ions
1037. Tx of acetaminophen and mx Nacetyl cysteine --: provides sulfhydryl groups.
1038. Tx of cyanide poisoning Sodium thiosulfate
1039. tx of cyanide poisoning amyl nitrate: forms methemoglobin that bidns to CN- -->cyanomethemoblogbin
1040. tx of drug induced parkinsonism benztropine and amantidine
Benztropine and trihexyphenidyl avoided in eldery (BPH, glaucoma)
1041. Tx of DVT in pregnancy? heparin. Warfarin (main tx is CI)
1042. Tx of N. meningiditis. Prof? Penicillin. Prof: rifampin or ceftriaxone (only ones that can eliminate from nasal).
1043. Tx of N. meningiditis. Prof?* Penicillin. Prof: rifampin or ceftriaxone (only ones that can eliminate from nasal).
1044. Tx that block radioactive iodine tx?**** Anion inhibitors (perchlorate, pertechnetate) block Iodide abs by thyroid gland via
competitive inhibition.
Thionamides (methimazole and propylthiouracil) dec formation of thyroid
hormones by inhib thyroid peroxidase.
Iodide salt inhib synth as well as release of thyroid hormones.
PTU also dec peripheral conversion of T4 to T3
1045. Tx to prevent GBS in child?
Consequences of not treating?
intrapartum antibiotic prophylaxis.
GBS -->sepsis, pneumonia, meningitis.
1046. Txt for Constrictive Pericarditis? Diuretics or Pericardiectomy
1047. Txt for disc herniation? 1. Mobilization-make sure pt moves around
2. NSAIDS
1048. Txt for Essential Tremor? First line is Propranolol.
Can also try Primodine or Topirimate.
1049. Txt for Pneumonia in a CF patient? Most likely Pseudomonas. txt with Cephalosporin/Penicillin + aminoglycoside.
1050. txt for tinea corporis? tebinafine (topical)
griseofulvin ( systemic)
Pts with extensive disease should be investigated for conditions that may cause
immunosuppresion
1051. Txt for toxic megacolon? 1. IV steroids
2. NG decompression
3. fluids
1052. Txt of choice for fibromuscular dysplasia? agioplasty with stent
1053. Txt of choice for hyperthyroidism induced
atrial fibrillation?
Beta Blockers
1054. type of renal injury associated with NSAIDS papillary necrosis and chronic intersttial nephritis
1055. tyrosine kinase receptors gen mediate effects of hormones that promote anabolism and cell growth
ex) insulin, insulin-like growth factor 1, epidermal growth factor, platelet-derived
growth factor
1056. ulcer in descending duodenum zollinger ellison
1057. urea filtration filtered at glomerulus
passively reabsorbed in PCT and inner medullary collecting ducts
passively secreted by TDL
*everywhere else urea is impermeable
1058. urethritis common organisms: N. gonorrhoeae, C. trachomatis
Sx: pain or burning sensation during urination, urgency or frequent urination
labs: UA shows +WBC
1059. Use and MOA of FA oxidation inhibitors inhibit FA ox and shfit energy pdtn to glucose oxidation--> promoting oxgen
efficiency.
Dec amt of oxygen needed to support cardiac fxn, and dec potentially toxic FA
metabolic pdtn.
1060. Use of chloroquine?
other drug added, why?
eradicates plasmodia from blood stream but not latent hepatic infections (P vivax, P ovale) Primaquine to
prevent relapse.
1061. Use of rifampin: prophylaxis of those exposed to N meningitidis.
Multidrug tx for typical and atypical mycobacgerial pulm infxn, leprosy, staph endocarditis.
1062. uterus epithelium simple (pseudostratified) columnar
charac: contains tubular glands; divided into fxnal and basal layers; undergoes cyclic changes
assoc tumors: endometrial CA
1063. UTIs most commonly caused by E. coli=>80% or more of cases; rest of cases in sexually active women are caused
by Staphylococcus saprophyticus
*most often due to invasion by enteric coliform bacteria that inhabit periurethral vaginal introitus and
ascends to bladder via urethra
Tx: 3-day course of fluoroquinolone or TMP-SMX
**Sx of fever, chills and flank pain should alert physician to possibility of pyelonephritis
1064. UV blocked by PABA
esters
UVB--cx UV radiation (sunburn), histologic skin damage and UVRinduced immun supp, skin photo-
aging, photo carcigenosis.. No block from UVA.
1065. UV damage pyrimidine dimers -endonuclease (repair by nicking strand @ thymine dimer)
1066. UV-specific
endonucleases
specifically detect abnormalities in DNA structure caused by formation of DNA photoproducts then excise
defective region
causes nicks at damaged sites to be later excised by 5' to 5' exonuclease activity of DNA polymerase=>also
synthesizes new DNA in place of damaged DNA
*lack of this enzyme results in condition known as Xeroderma Pigmentosum
1067. Vaccination for C
diptheriae
Dipth toxoid --> induces IgG against toxin B. Prevents AB toxin damage of neuro and cardiac organs.
1068. vaccine for n
meningitidis
Capsular polysaccharides (four major serotypes)
1069. Vaccine that's
conjugated with Dipth
toxoid?
Hib
1070. vaccines and
immunology
gen principle dictates that local secretory Ab synthesis is best promoted when specific mucosal surfaces are
directly stim by Ag
when both live and killed vaccines applied to mucosal surface the live attenuated viral vaccines are more
effective of two in gen prolonged mucosal IgA secretion
1071. vagina epithelium nonstratified squamous non-keratinized
charac: contains glycogen
assoc tumors: squamous cell CA
1072. varenicline Partial agonist of nicotinic AchR. Competes with nicotine to prevent binding. Limited release of dopain
(less reward). assist in tobacco cessation - reduce cravings and attenuate reward effect of nicotine.
1073. ventricular septal
defect murmur
holosystolic murmur
1074. verapamil non-dihydropyridine Ca2+ channel blocker=>slow conduction thru AV node
*most effect on heart out Ca2+ channel class and potent neg inotrope
clinical use:
rate control in AFib
anti-anginal medication
antihypertensive
most frequent adverse rxns:
constipation
gingival hyperplasia
bradycardia
1st/2nd/3rd degree AV nodal block
1075. verapamil specificity skeletal muscle is resistant to effect of Ca2+ channel blockers bc it doesn't require an
influx of extracellular Ca2+ for excitation-contraction coupling
cardiac and smooth muscle depend on extracellular Ca2+ entering cell via voltage-
gated L-type Ca2+ channels for excitation-contraction coupling=>target of verapamil
and other Ca2+ channel blockers
1076. Vibrio cholerae produces cholera toxin=>AB toxin
A-activate adenylate cyclase thru G-protein=>increased transport of Na+ and Cl- out of
gut mucosal cell and decreased sodium and chloride reabsorption=>free water loss into
gut lumen=>water diarrhea
1077. Viral cells and binding R CD4 and HIV gp120; CD21 and EBVgp350; erytrocyte antigen and parvovirus B19
1078. viral myocarditis and cardiomyopathy
type
dilated CMP
systolic dysfxn the main mech of heart failure
1079. Virchow's nod stomach met to left supraclavicular sentinel node
1080. Viridans needs to attach to fibrin-platelet aggregates.. Then it creates extracel polysacc (dextrans) w/ sucrose as a
subtrate
1081. Viridans streptococci
S. mutans and S. sanguis
viridians streptococci produce dextrans from glucose that aids in colonizing host
surfaces such as dental enamel and heart valves
cause subacute bacterial endocarditis most classically in patients with preexisting
cardiac valvular defects after dental manipulation=>why antibiotic prophylaxis used
prior to dental work in patients with valvular abnormalities
1082. virilization hirsutism
clitoromegaly
increased muscle mass
acne
increased libido
voice deepening
1083. Virion and cellular receptor:
CMV, EBV, HIV, Rabies, Rhinovirus
cellular integrins, CR2, CD4&CXCR4/CCR5, nAch, ICAM1 (CD54)
1084. Virus part that forms spheres and
tubules 22nm in diameter:
Envelope component of Hep B virus (HBsAg). Correlates poorly with viral replication.
1085. Vit B2 def: (riboflavin) cheilosis,
stomatitis, glossitis, dermatitis, corneal
vacularization, arioboflavinosis
...
1086. vit b12: pernicious anemia, smooth tongue, atrophic glossitis, shuffle broad based gait.
1087. Vit c def hemorrhage, bleeding into jiont space, gingivl swell, imapired wound healing, weak immune response
1088. Vit C mx hydroxylation of prline adn lysine residues in pro-collagen
deficiency: perifollicular hemorrahage, bruise, gum. Children-bony deform, subperiosteal hemorr
1089. Vit K and CF dec fatty vit abs. Vit E -->protect FA from oxdiation (so dec levels-->ox injury of axons and erythrocytes).
Dorsal column..
1090. vitamin A
deficiency
characterized by:
night blindness
xerophthalmia=no tear prod
vulnerability to infxn=>esp measles
1091. vitamin B1
(thiamine)
deficiency
associated with infantile and adult beriberi as well Wernicke-Korsakoff syndrome in alcoholics
1092. vitamin B2
(riboflavin)
deficiency
characterized by:
cheilosis
stomatitis
glossitis
dermatitis
corneal vascularization
ariboflavinosis
1093. vitamin B6
(pyridoxine)
deficiency
characterized by:
cheilosis
glossitis
dermatitis
peripheral neuropathy
1094. vitamin B12
(cobalamin)
deficiency
frequently associated with pernicious anemia
classic presentation: older, mentally slow woman of northern European descent who is "lemon colored" (anemic
and icteric), has a smooth shiny tongue indicative of atrophic glossitis and demonstrates shuffling broad-based
gate
1095. vitamin C
(ascorbic acid)
deficiency
characterized by scurvy:
hemorrhages
bleeding into joint spaces
gingival swelling
impaired wound healing
weakened immune response to local infxns
1096. vitamin C and
iron
enhance absorption of inorganic iron in GI tract
1097. W/u for
diarrhea, and
fatty stool
stool sample *sudan III stool stain to id fat in stool.
CC: pancreatic exocrine insuff, intestinal mucosal defects, bacterial prolif
1098. wall of
mycoplasma
org?
no PDG
1099. warfarin inhibits vit K depending-carboxylation of glutamic acid residues of clotting factors II, VII, IX, and X; also of
anticoagulant proteins C and S
inhibition of protein C can predispose pts to warfarin-induced skin necrosis=>typically occurs during first week
*activity of protein C reduced to 50% within one day along with factor VII while other procoagulant vit K dependent
factors decline as slower rate (II, IX, X)=>risk increases in pts already deficient in protein C and S=>paradoxical
thrombosis
1100. warfarin
hematoma RF
inc age, DM, HTN, alcoholism
1101. Warfirin induced lesion? Protein C or S def.
1102. Wegener's granulomatosis present: URT (sinusitis, nasal ulceration), LRT (hemoptysis), and kidneys
(RPGN)=>can develop ARF
IF: pauci-immune
assoc with c-ANCA
1103. Wegener's granulomatosis systemic vasculitis of small and med-sized arteries
presents with involvement of URT (sinusitis, nasal obstrxn, epistaxis, otitis),
lungs (hemoptysis), and kidneys (rapidly progressing glomerulonephritis)
*presence of cANCA is typical
1104. What are Howell-jolly bodies and what is their
significance?
they are the nuclear remnants of RBC's which are normally removed by the
spleen.
if present it means the spleen isn't working
1105. What are Marjolin Ulcers? Squamous Cell ca arising from burn wounds
1106. What are pts with hyperthyroidism at risk for
if left untreated?
1. bone loss - increased osteoclastic activity
2. arrhythimias- like a. fib
1107. What are some causes of restrictive
cardiomyopahty? And which can be reversed
with txt?
1. Hemochromoatosis
2. Amyloidosid
3. Sarcoidosis
4. Scleroderma
**Hemoochromatosis only one that can reversed with txt- phelbotomy
1108. What are some of the causes of bloody diarrhea
with fever?
1. Shigella
2. Campylobacter
3. Salmonella
1109. what are some of the feared complications of
Mononucleosis?
1. Autoimmune hemolytic anemia
2. Splenic rupture
1110. what are some of the presenting symptoms of
HIV in infants?
1. thrush
2. lymphadenopathy
3. hepatosplenomegaly
**serologic testing is not useful for HIV testing in nenoates use PCR, viral
culture or P24 antigen testing.
1111. what are some of the s/s of Vitamin B2
riboflavin def?
1. red and swollen oropharyngeal mucous membranes.
2. cheilitis
3. stomatitis
4. glossitis
5. seborrheic dermatitis
6. photophobia
1112. what are the absolute indications for starting
dialysis?
1. Fluid overload not responsive to medical txt
2. Hyperkalemia not responsive to medical managment
3. Uremic pericarditis
4. Refractory metabolic alkalosis
1113. What are the absorption conditions that cause
decreased B12?
1. Pancreatic insufficiency
2. Short gut syndrome
3. Bacterial overgrowth
1114. what are the causes for exudative effusions? 1. Infection
2. Malignancy
3. PE
4. connective tissue disease
5. iatrogenic causes.
1115. what are the causes of euvolemic hyponatremia? 1. SIADH
2. Psychogenic polydipisa
3. Hypothyroidism
1116. what are the causes of hypervolemic hyponatremia? 1. CHF
2. Cirrhosis
3. Chronic Kidney Diseae
1117. what are the causes of hypovolemic hyponatremia? GI losses: diarrhea, vomiting
Renal losses: diuretics,
**decreased volume leads to increase in renin,
angtiotensin, and ADH
1118. What are the causes of Pulsus Paradoxus? 1. Cardiac Tamponade
2. Tension Pneumothorax
3. Severe asthma
1119. What are the characteristics of a pt with TCA overdose? Hypotension
CNS depression
hyperthermia
and anti-cholingerics effects
1120. What are the common causes of exertional syncope? 1. Ventricular tachycardia
2. Hypertrophic cardiomyopathy
3. Aortic Stenosis
1121. What are the complications associated with measles? early: vitamin A deficiency, pneumonia, and
bronchiectasis
1122. What are the contraindications for radioablation therapy for
Grave's Disease?
1. Pregnancy
2. Severe Ophthalmopathy
1123. What are the contraindications of Triptans? 1. familial hemiplegic migraine
2. uncontrolled hypertension
3. pregnancy
4. CAD
5. Prinzemetals angina
6. ischemic stroke
7. basilar stroke
1124. What are the contraindications to breastfeeding? 1. Active drug abuse
2. TB
3. HIV
1125. What are the diagnostic features of CLL? extreme leukocytosis with predominant leukocytes
smudge cells
1126. what are the dietary recommendations for pts with renal calculi? 1. Decrease protein and oxalate
2. decrease sodium intake
3. increase fluid intake
4. increase calcium intake
1127. what are the different areas that a tumor in the superior sulcus in
the lung affect?
1. Horner's- compress sympathetic trunk
2. Pancoasts
3. Compress recurrent laryngeal nerve- Hoarenss
4. Sup. vena cava
1128. What are the exrahepatic sequalie of pt with Chronic Hepatitis C? 1. Cryoglobinuria
2. Porphyria cutanea tarda
3. Glomerulonephritis
1129. what are the indications for chest tube placement with regards to
pleural fluid findings?
pH < 7.2 or Glucose < 60
suggest epmyema
1130. what are the indications for ECT? 1. severe depression
2. depression in pregnancy
3. catatonic schizophrenia
4. refractory mania
5. neuroleptic malignant syndrome
1131. What are the indications for O2 therapy in COPD? 1. PaO2 < 55
2. SO2< 88%
3. Evidence of cor pulmonale
4. Hematocrit > 55%
1132. What are the indications for txt of chronic hepatitis C? 1. Elevated ALT levels
2. Presence of HCV RNA
3. moderate grade based on histiologic findings
**Txt with double combination of Interferon alpha and
ribavarin.
If pt has normal ALT levels then no txt is required.
If pt has mild disease txt with monotherapy with just
interferon alpha.
1133. What are the lab findings in a pt with gallstone trapped in common
bile duct?
1. Jaundice
2. Very high Alk. Phophatase
1134. What are the lab findings in primary hyperparathyroidism? Increased Calcium
Normal or increased PTH
1135. What are the major extra-renal manifestations of APKD? 1. heptic cysts
2. heart valve disease
3. colonic diverticuli
4. abdominal wall and inguinal hernia
1136. What are the most common organisms responsible to otitis media
and what is txt?
1. Strep. Pneumo.
2. Non typeable H. influenza
3. Moraxella Catarrhalis
txt: 10 day course of Amoxicillin
1137. What are the rate controlling drugs for A. Fib? Rate control + anti-coag. preferred.
Diltizaem
Metoprolol
Verpamil
Digoxin
1138. What are the risk factors for uterine atony? 1. Overdistention of uterus ( fetal macrosomia,
multiparity)
2. Uterine fatigure 2/2 prolonged labor
1139. What are the s/s of Beta blocker toxicity and what is the txt? Wheezing, bradycardia, hypotension
First give Atropine and IV fluids
then give Glucagon
1140. What are the s/s of theophylline toxicity? 1. CNS toxicity
2. GI disturbance
3. Cardiac distrubance
Ciproflxoain and Erythromycin decreases its clearance
1141. What are the sequlae associated with Aortic Dissection? 1. Cardiac tamponade
2. Aortic regurg.
3. Stroke
4. Renal failure
1142. What are the side effects of Amiodarone? 1. hepatotoxicty
2. thyrotoxic
3. pulmonary toxic
4. Corneal deposits
5. skin changes
1143. What are the three most common organisms that cause
pneumonia in patients with CF?
1. Heamophillus
2. Pseudomonas
3. Staph.
1144. what are two risks associated with Tamoxifen use? 1. Endometrial cancer
2. Venous Thrombosis
1145. What can cause inc K excretion? High extracell K levels
Inc aldosterone
Alkalosis
Inc fluid vol (vol exp, high Na intake, diuretic)
1146. what causes a syncope with clonic jerks? arrhythima-clonic jerks 2/2 brain hypoxia
1147. What causes decreased breath sounds immediately after
intubation?
Endotracheal intubation into main stem bronchus
1148. What causes exopthalmos in Graves disease? Lymphocytic infiltration of EOM
1149. What causes Foot Drop? Peripheral neuorpathy 2/2 damage to Common Peroneal
nerve or levels L4-S2.
1150. what causes smooth round cysts in liver with daughter cells in it? Sheep breeder 2/2 Echinococcosis
1151. what causes thrombocytopenia 2/2 antibody production against
platelets?
ITP
1152. what causes thrombocytopenia 2/2 platelet activation and
consumption?
1. DIC
2. TTP
3. HUS
1153. what causes thrombocytopenia is Wiskott-Aldrich syndrome? x-linked disorder
decreased platelet production
1154. what cells does Shigella invade first? M cells of peyer patches (ileum) through endocytosis
1155. What conditions are pts with Nephrotic syndrome at increased
risk for?
1. Hypercoaguable
2. Increased atherosclerosis
increased risk for stroke or MI
1156. what disease can the use of Primidone for essential tremor
precipitate?
Acute intermittent porphyria: check urine
porphobiliinogen levels- abd. pain, neuro, and psych.
abnormalities
1157. What disorders are associated with FSGS? 1. Obesity
2. HIV
3. Heroin use
More common in African Americans
1158. what do you suspect when newborn presents with failure to thrive,
bilaterla cataracts, jaundice, convusionls and hypoglycemia?
Galactosemia-deficiency in galactose 1 phopshate uridyl
transferase deficiency.
1159. What does a positive straight leg test suggest? Herniated disk
1160. What does elevated transaminase levels indicate? Ongoing hepatocyte damage as enzymes leak from cells.
1161. What does it mean if someone says Anion Gap Metabolic Acidosis? MUDPILES
1162. What does Leukocyte esterase signify? Significant Pyuira
1163. What does nitries in urine signify? Presence of enterobacteriacae
1164. What does one see on histo. of a pt with Reyes syndrome and what
is the txt?
Fatty valculoization of the liver without inflammation
txt: glucose with FFP and mannitol to decrease cerebral
edema
1165. What does pain to palpation of the back suggest? 1. infection
2. lytic lesion
1166. What does the Femoral nerve innervate? Motor: Knee extension and hip flexion
Sensory: anterior thigh and medial leg
via saphenous nerve
1167. What does the presence of bilirubin in the urine suggest? Conjugated bilirubinemia
1168. what drugs are assoicated with medication induced body fat distribution
characterized by redistr of fat form extremeities to abd viscera and subcut adip
tissue of thorax, post neck adn supraclav region
HIV-1 protease inhib and GC
1169. what drugs should be avoided in prinzmetal's angina? Beta blockers and Aspirin
they can cause vasoconstriciton
1170. What electrolytes are typically low in chronic alcoholics? 1. Hypokalemia
2. Hypomagnesium
3. Hypophosphatemia
1171. what fractures injure deep brachial a, brachial a midshaft fracture, supracondylar fracture
1172. What happens when a patient takes exogenous steroids for a disease? They suppress the secretion of CRH from
the hypothalamus. Results in decreased
ACTH and cortisol levels
1173. What is a complication of a retropharyngeal abscess? spread into medistinum
1174. What is a complication of bronchiectasis? Hemoptysis
1175. What is a side effect of Fluphenazine? High potency anti-psychotic
**Can cause hypothermia
1176. What is a side effect of Metoclopramide? It has dopamine antagonist effects
can cause Extra pyramidal symptoms
txt with Benztropine or
diphenhydramine
1177. What is another name for Klebsiella Pneumonia? Friedlander's pneumonia
gram negative rod
encapsulated
affects the upper lob
currant jelly sputum
1178. What is another name for Paget's disease? Osteitis Deformans
1179. what is associated with breath holding spells? Iron def. anemia
1180. What is best non invasive measure to use for acute exacerbation of COPD? Non invasive positive pressure
ventilation
1181. what is best way to maintain an airway in an apneic pt? Orotracheal intubation
**nasotracheal intubation is only for pts
that are spontaneously breathing
1182. What is Cauda equina Syndrome? Saddle anesthesia, bowel and bladder
dysfunction, and low back pain.
1183. What is central cord syndrome? presents as weakness more pronounced
in upper extremities than lower
extremities.
maybe accompanied by loss of pain and
temp. sensation
1184. What is CHADS2 and what are the criteria? Congestive Heart failure
Hypertension
Age > or = 75
Diabetes
Prior stroke ( 2 points)
pt with > 2 points start Warfarin or Dabigatran ( direct thromin inhibitor)
1185. What is classic triad of Kartegener's syndrome? 1. recurrent sinusitis
2. bronchiectassis
3. dextrocardia
2/2 Primary Ciliary Dyskinesia
1186. What is concerning about recurrent pneumonia
in the same spot?
For possible cancer- Bronchiogenic cancer
1187. What is electrical alternans? Is when the amplitude of the QRS complex varies from beat to beat.
Pathonogomic for pericardial effusion
1188. What is Enthesitis? Inflammation and pain occur at site of insertion of tendons and ligaments.
Associated with Anklysoing Spondylitits
1189. what is esodeviation of the eye? medial deviation of eye
1190. What is found in the CSF of MS pts? 1. normal protein, pressure and cell count
2. increased T lymphocytes
3. increased IgG
1191. What is Hyposthensuria? body's inability to concentrate urine.
commonly seen in pts with sickle cell
1192. What is Legg-Calves-Perthe Disease? Idiopathic avascular necrosis
1. Unilateral subacute hip pain in male child
2. Progressive antalgic gait
3. Thigh muscle atrophy
4. Decreased hip range of motion
1193. What is malignant otitis externa? ear infection in diabetics unreponsive to topical antibiotics, ear pain and ear
drainage, granulation tissue
progression can lead to osteomyelitis of the skull base and destruction of
facial nerve
2/2 pseudomonas
txt with ciprofloxacin
1194. What is mebranoproliferative
glomerulopenphritis?
basement membrane thickening with double layer train tack appearance.
IgG deposits seen on basement membrane.
nephrotic range portineuria and hematuria
positive for C3
persistent activation of alternative complement activation pathway
1195. What is Morton's Neuroma? pain in runners between 3rd and 4th foot, reproduce with palpation.
txt with bilateral shoe inserts
1196. What is most common type of kidney stone? Calcium oxalate
pts with small bowel disease, surgical resection, or chronic diarrhea
1197. What is most common type of pituitary tumor? Lactotroph adenoma- produces prolactin
1198. What is mucormycosis? Fungal infection in the nasal passages of diabetics.
1199. What is one of the most deadliest consequences of
aortic dissection?
Cardiac Tamponade
1. hypotension
2. tachycardia
3. jugular venous distention
1200. What is optic neuritis? Central scotoma, afferent pupillary defect, changes in color perception, and
decreased visual acuity.
1201. What is pin worm infection caused by and
what meds. are used to txt it?
1. Enterobius Vermicularis
txt with albendazole or mebendazole.
alternative txt is Pyrantel Pamoate
1202. What is pulsus paradoxus? A drop of greater than 12 mmHg in Systolic blood pressure during inspiration.
1203. What is reaction formation? An neurotic defense mechanism in which a person does exactly of what he/she
feels to cover socially unacceptable thoughts.
1204. What is seen in stool after vibrio cholera
infxn?
Mucus and some epithelial cells. No leukocytes or red blood cells since the
toxins only modify electrolyte handling by enterocytes.
1205. What is suppression? A mature defense mechanism in which a person voluntary suppresses
unpleasant thoughts.
1206. What is sympathetic opthalmia? Damage of one eye after a penetrating injury to the other eye it is 2/2
immunologic mechanism of uncovering of hidden antigens.
1207. What is test reliability? repeat results that are close together
1208. what is test validity? results are similar to the gold standard results
1209. What is the best imaging study used to look for
necrotizing fascitits?
CT scan
1210. What is the best measurement to assess fetal
growth?
Abdominal circumference
1211. what is the best prophylactic txt for cat bites? worry about pastrurella multicoida
txt with Amox/Clavulanate
1212. what is the best test to assess for coronary re-
occlusion after an MI?
CK-MB
because it returns to normal levels more quickly
1213. What is the best txt for pt with intrauterine
fetal demise?
immediate induction of labor
**low normal fibrinogen levels indicates impending DIC
1214. what is the best way to assess liver function in
ACUTE hepatitis?
1. Liver function tests
2. Viral serology
1215. what is the best way to assess liver function in
CHRONIC hepatitis?
Liver biopsy
1216. what is the cause of bleeding in Mallory-Weiss
tears?
Ruptured Submoucsal Arteries
1217. what is the cause of hypotension after
epidural placement?
Blood redistribution to the lower extremities and venous pooling.
1218. What is the cause of irregular menstrual
cycles in women starting menses?
Hypothalamic-Pituitary-gondal axis immaturity
1219. What is the cause of low back pain in pt in 3rd
trimester?
Increased Lumbar lordosis
1220. What is the classic triad of hydatidform mole? 1. enlarged uterus
2. hyperemesis
3. markedly elevated hcg > 100,000
1221. What is the CSF presentation of a pt with
Guillien Barre?
Increased protein
everything else normal
1222. What is the difference between Subacute and
Acute endocarditis?
Acute: pts with previously normal valves
Subacute: pts with previously defected valves
1223. What is the drug of choice for chlamydia in
pregnancy?
Erythromyocin
1224. What is the earliest renal abnormality seen in
Diabetic nephropathy?
Glomerular Hyperfiltration. Thickening of the glomerular basement membrane.
1225. what is the empiric IV therapy for pyelonephritis? IV ampicillin + gentamicin
1226. what is the empiric oral therapy for pyelonpehritis? Ciprofloxacin
1227. What is the first drug of choice for pt with OA? Acetaminophen
1228. what is the first line anti-hypertensive treatment in pregnant patients? labetaolol or methyldopa
1229. What is the first step in the management of DKA? 1. Normal Saline IV fluids + Regular Insulin
1230. What is the first step in the work up of a pt with delirium? serum electrolytes and urinalysis
1231. What is the first step in txt of a Sickle Cell pt with stroke? Exchange Transfusion
1232. What is the gold standard for dx Duchenne muscular dystrophy? Genetic studies
x-linked recessive
1233. What is the Kehr Sign? Left shoulder pain 2/2 splenic hemorrhage
irritating the phrenic nerve
1234. what is the light's criteria for exudative effusions? Has to have at least one of the following:
pleural protein/serum protein > 0.5
pleural LDH / serum LDH > 0.6
pleural fluid LDH greater than 2/3 of the upper
limit of normal for serum LDH
1235. What is the major source of estrogen in menopausal women? Peripheral conversion of androgens by aromatose
enzyme to estrogen by fat tissue
1236. What is the most cancer associated with Dermatomyositis? Ovarian cancer
1237. What is the most common adverse effect of inhaled steroid therapy for
asthma?
Thrush
1238. what is the most common cause of acute bacterial sinusitis? strep. pneumonia
1239. what is the most common cause of ambylopia? Strabismus
txt is occlusion of normal eye
1240. What is the most common cause of cerebral palsy? Cerebral Anoxia
1241. What is the most common cause of chronic inspiratory noise in infants? Laryngomalacia-flaccidity of the larynx.
self resolves by 18 months of age.
tell parents to keep child upright after feeding.
1242. What is the most common cause of congenital hypothyroidism in the
US?
Thyroid dysgenesis
1243. What is the most common cause of ductopenia? Loss of intrahepatic bile ducts
Primary biliary cirrhosis
1244. What is the most common cause of hypernatremia and what is the txt
and what complication should one try to avoid?
2/2 hypovolemia
txt: mild cases: 5% dextrose in .45% saline
severe cases: 0.9% Saline
Complications: Cerebral Edema
1245. What is the most common cause of pneumonia in nursing homes? strep. pneumoniae
1246. What is the most common cause of preventable fetal growth restriction? Smoking
1247. what is the most common cause of prinzmetal's angina? Smoking
1248. What is the most common cause of Thryoid NODULES? Benign Colloid Nodules
1249. What is the most common cause of viral arthritis? parvovirus
1250. What is the most common deficiency in Celiac's? Iron deficiency
1251. what is the most common middle ear pathology
in HIV pts?
Serous Otitis Media: presence of middle ear effusion without signs of an active
infection.
Dull tympanic membrane
1252. what is the most common mutation in Cystic
Fibrosis?
Deletion of three base pair coding for phenylalanine. (DF508). CFTR gene is
located on chromosome 7
1253. What is the most common presentation of
sickle cell trait?
Pain less hematuria
1254. What is the most common pulmonary
complication in pts with systemic sclerosis?
Interstitial fibrosis
1255. What is the most common type of neuropahty
in diabetics?
Symmetric distal polyneuropathy
1256. What is the most common type of tumor in a
child?
Astrocytoma
1257. What is the most rapidly acting med. to txt
symptoms of pulmonary edema?
Nitroglycerin
1258. What is the nephrotoxic side effect of
Acyclovir?
When giving in high doses IV: It causes crystalluria and causes renal tubular
obstruction. pt presents with oliguria, and elevated BUN and creatitine.
**must hydrate patient before
1259. what is the next step in the management of pt
with hyperthyroidism?
24 hour thyroid radioiodine uptake and scan
1260. What is the pathogenesis of Giardia? Trophozites adhere to the mucousal surface by adhesive disks and produce
malabsorption
1261. What is the pathology of Stevens-Johnson
Syndrome?
Immune complex mediated hypersensitivity
1262. What is the preferred study for the diagnosis
of Melanoma?
Excisional biopsy with narrow margins.
* If depth of melanoma is less than 1mm than can be excised with 1 cm margin
**If depth is > 1mm then should have sentinal node biopsy
1263. What is the radiologic finding one sees with
necrotizing enterolcolitis?
pneumatosis intestinalis (intramural air)
1264. What is the respiratory quotient for pt mostly
metabolizing carbohydrates?
RQ = 1
1265. What is the respiratory quotient for pt mostly
metabolizing fatty acids?
RQ = 0.7
1266. What is the respiratory quotient for pt mostly
metabolizing protein?
RQ = 0.8
1267. What is the risk of getting bipolar if one parent
has it? what bout if both parents have it?
one parent: 5-10%
both parents: 60%
1268. What is the significance of the HER2
oncogene?
Presence can be determined by immunohistochemicial staining or FISH.
Positivity means one call Traustuzamaub and anthracyclin chemotherapy
1269. What is the txt for a Hydrocele? Reassurance-self resolves by 12 months
If not resolved by 12 months-surgically remove since it has an increased risk of
inguinal hernia
1270. What is the txt for Acute Cholangitis? 1. Supportive care and Broad spectrum antibiotics
2. If pt still doesn't improve proceed to ERCP
1271. What is the txt for acute exacerbations of MS? High dose IV steroids
1272. What is the txt for acute hypercalcemia? 1. First give IV fluids since they are usually dehydrated
2. Then give loops to lose calcium
1273. What is the txt for Acute symptomatic
hyponatremia?
3% normal saline
1274. what is the txt for an empyema with thick rim that fails to improve
with a chest tube?
Proceed to Surgery.
1275. What is the txt for bradycardia in a pt that is hemodynamically
stable vs a pt who is not hemodynamically stable?
Stable: IV Atropine
Unstable: IV Epinephrine
1276. what is the txt for CML and what is the MOA? 9;22 translocation with BCR/ABL fusion gene.
Tyrosine Kinase Inhibitors which function by
inhibiting the abnormal BCR/ABL gene.
1277. what is the txt for Hep. A infection for close contacts of those
infected?
Immune globulin
1278. What is the txt for lichen sclerosis? low dose corticosteroids
1279. What is the txt for Myasthenia crisis? 1. Endotracheal intubation
2. Hold anticholinesterases for several days
1280. What is the txt for necrotizing fascitis and what organisms are
commonly involved?
Group A Strep and Staph. Aureus and anaerobes.
txt: (Ampicillin + Sulbactam + Clindamycin)
1281. What is the txt for Neuroleptic malignant syndrome? 1. Dantrole
2. Bromocriptine
3. Amantadine
1282. What is the txt for normal pressure hydrocephalus? serial large volume lumbar punctures, if successful
proceed to place ventriculoperitoneal shung
1283. What is the txt for overflow incontinence 2/2 epidural? Self-cathe.
1284. what is the txt for premature ventricular contractions? Unless they are symptomatic you do not treat them.
if you txt start with Beta blockers if that doesn't work
then proceed to Amiodarone
1285. what is the txt for solitary brain metastasis? what about multiple
brain mets?
solitary: surgical resection followed by whole brain
radiation
multiple: palliative whole brain radiation
1286. What is the txt for Tourette's? Typical antipsychotics-Haloperidol or Pimozide
1287. what is the txt for Vaginismus? 1. Relaxation
2. Kegel exercise
3. Gradual dilation
1288. What is the txt of choice for bacterial endocarditis 2/2 strep.
viridians that is susceptible to penicillin?
Either IV Pen. G or IV Ceftriaxone
1289. What is the txt of choice for MCL tears? bracing and early ambulation
1290. what is the txt of choice in fibromyalgia? 1. TCA
2. Cyclobenazprine- muscle relaxant
increase stage 4 sleep
1291. What is the txt regimen for gastroparesis? 1. Metoclopramide
2. Bethanecol
3. Erythromycin
1292. What is the typical murmur associated with Aortic regur and how
do you txt it?
Diastolic decrescendo murmur heard best at 3rd left
intercostal
txt: Decrease afterload with -- ACE-I or Ca channel
blockers
1293. What is Transient Synovitis? hip pain in children
have history of recent viral infection and present with
limp
txt with NSAIDS and restrict weight bearing
1294. what is used to raise HDL ? goal of > 40.
use Nioctonic acid
1295. What is Volkman's Ischemic Contracture? Final sequlae of compartment syndrome where necrosised
muslce has been replaced with fibrous tissue
1296. What kind of bacteria causes foul smelling cough in pneumonia
and how do you txt it?
Anaerobic bacteria
txt with Clindamycin
1297. What kind of cancer does DES exposure in utero cause? adenocarcinoma of vagina
1298. What kinds of infections do children with SCID present with? defect in T and B cell
prone to viral, fungal and bacterial infections
1299. What medications should be held prior to performing exercise
stress test?
1. anti-ischemic drugs
2. digoxin
3. beta blockers
1300. What nerve controls the stapedius muscle? Clinical consequence
of damage?
CN VII. sensitivity to sounds
1301. What organisms are children with chronic granulomatous
disease prone to?
prone to abscesses
2/2 catalse producing organisms like aspergillus and
staphylococcus
1302. What organisms are involved with Epiglottis? 1. Heamophillius Influenza
2. Strep. Pyogenes
1303. What organisms are pts with deficient B lympthocytes prone to? impaired ability to destory encapsulated orgnaiss
H. influ, s. pneumo,
lack of IgA predisposes to Giardia
1304. What part of the Ao ruptpures in MVA isthmus of aorta.
1305. What part of the pituitary is affected in Sheehan's syndrome? Anterior Pituitary
pts don't lactate because of decreased prolactin secretion
1306. What presents as a mobile cavitary mass in the lung with
intermittent hemoptysis?
Aspergiolloma
1307. what Receptors inc and dec insulin respectively. Alpha r block. beta r inc.
1308. what region of the heart forms the diaphragmatic surface? inferior wall of left ventricle. supplied by post descending
(RCA)
1309. What should be done if a child refuses to be potty trained? stop training attempts for several months and try again
when child is ready
1310. What should be given to pts who are allergic to pencillin if they
have syphillis?
Either single dose of Azithromycin or 14 days of
Doxycylicne or Tetracycline
1311. What should be suspected if a down syndrome pts presents with
upper motor neuron symptoms?
Atlanto-axial instability
1312. what should be the next step in a pt with pyelonephritis who fails
to improve with oral antibiotics after 48-72 hours?
Do renal ultrasound
1313. what should one consider when pt with BPH presents with
increased creatinine and what test should be done?
Suggest Hydronephrosis - dx with Ultrasound of
abdomen
1314. what should you do if someone get a needle stick but already got
the Hep. B vaccine?
nothing
1315. what should you do if someone get a needle stick but doesn't know
Hep. B immunity status?
Get Hep B immune globulin and Hep. B vaccination series
1316. what should you do in the work up of a pt with BPH after you have
dx with rectal exam?
1. Urinalysis
2. Serum creatitine
1317. What should you give a pt with gall stones who doesn't want
surgery?
Ursodeoxycholic Acid
1318. What should you give to pt who presents with mania but has impaired renal
function?
Lithium is contraindicated in
impaired renal function.
Give:
1. Valproic Acid or
2. Carbamezipine
1319. What should you suspect if pt is only having asthma like symptoms only at night? GERD
1320. What should you suspect if pt presents with 1. Fever 2. chest pain 3. leukocytosis 4.
widened mediastinum on CXR? how do you txt it?
Dx: Acute Mediastinitis (usually
follows cardiac surgery)
Txt: drainage, surgery, and
prolonged antibiotics
1321. What should you suspect if you see clubbing and sudden onset joint pain in a
chronic smoker?
Hypertrophic osteoarthropathy-can
be sign of lung cancer
1322. what should you suspect if you see needle shaped crystals on urinaalyasis? Uric Acid Stone
needs to evaluated by CT scan or IV
pyelography
1323. What should you suspect in a child with new onset hearing loss or chronic ear
drainage despite antibiotic txt?
Cholesteatoma
1324. what should you suspect in a young child with persistent leg pain only at night and
physical exam is negative?
growing pains,- reassure parents
1325. What should you suspect in an Asian pt with insenstate hypopigmented patch of
skin?
Leprosy
dx with skin biopsy -acid fast bacilli
1326. What should you suspect in an HIV pt with altered mental status, EBV DNA in the
CSF, and weakly ring enhancing periventricular mass?
CNS Lymphoma
*EBV DNA is pathonomic*
1327. What should you suspect in child that presents with a vomiting and abdominal pain
in which he screams and then is fine in between episodes?
Instussception
1328. What should you suspect in pt with bloody diarrhea but without fever? Enterohemorrhagic E. Coli
1329. what should you suspect in pt with chest pain mostly at night and has transient ST
eelvation on EKG?
Prinzmetal's angina
txt with Calcium channel blocker or
nitrates
1330. what should you suspect in pt with EKG that shows no discrenable P waves and and
tachycardia and irregulary irregular rate?
Atrial Fibrillation
**if hemodynamically unstable do
immediate DC cardioversion
1331. What should you suspect in young healthy pt suddenly presenting with signs of
CHF?
Myocarditis 2/2 recent viral
infection like coxsackie
1332. what should you suspect when you see child that is talkative at home but refuses to
speak in select settings?
selective mutism
1333. What structure keeps the BBB impermeable to ions? tight junctions b/w endothelial cells
of cap beds of CNS
1334. what test can be used to confirm the dx of CLL? Flow cytometry
1335. What test can be used to screen for PKU? Guthrie test
1336. What test can one perform to confirm vasovagal syncope? tilt table testing
1337. What test should be done if quadruple screen is abnormal? proceed to amniocentesis (18-20
weeks)
1338. What test should be done if you suspect a pt with Amariousis Fugax? Get Carotid Duplex ( most are 2/2
emboli)
1339. What test should can done early in the first trimester for pts with h/o genetic
diseases?
CVS
1340. What three things can one see on EKG of pt with WPW? 1. Delta waves (slur right before QRS)
2. shortened PR interval
3. Wide QRS
1341. what tool does one use to determine involvement of Paget's
disease?
Bone scan
1342. What two diseases present with increased calcium and
normal/increased PTH?
1. primary hyperparathyroidism
2. familial hypocalciuric hypercalcemia
1343. What two heart conditions are strongly associated with
Marfan's?
1. Mitral valve prolapse
2. Aortic dissection
1344. what two markers are elevated in neural tube defects? 1. AFP
2. acetylcholinesterase
1345. What type of knee injury produces popping sound and and
severe pain at time of injury?
Medical meniscus injury
1346. What type of murmur is heard in a pt with hypertrophic
cardiomyopathy?
crescendo-decrescendo systolic murmur heard best at left sternal
border does not radiate to carotids
1347. What urinary abnormality will one find in patient's with
Dubin-Johnson syndrome?
Abrormally elevated copropophryrion I levels
1348. What virus causes Measles? paramyxovirus
1349. What vitamin metabolizes levodopa: vit B6.
1350. What will one see with TTP? 1. Thrombocytopenia
2. Anemia
3. Fever
4. Mental status changes
5. Renal failure
Peripheral blood smear will reveal schistocytes
1351. when anovulation is common common during first five to seven years after menarche and the
last ten years before menopause
manifests with marked menstrual cycle variability
1352. When are steroids indicated in conjunction with TMP-
SMX for PCP in HIV pts?
1. PaO2 < 70%
2. A-a gradient > 35mmHg
1353. When do you start colo-rectal cancer screening for pt with
UC?
Start 8 years after diagnosis and continue every year after that
1354. When do you txt Paget's disease? when pt is symptomatic
txt with bisphosphonates
1355. When do you use prednisone in combination with TMP-
SMX for HIV pts with PCP?
When PaO2 is < 70
1356. When does one administer calcium gluconate for
hyperkalemia?
1. potassium level > 6.5
2. Cardiac toxicity as evidenced by EKG changes
3. Muscular paralysis
1357. When does one operate on an umbilical hernia in a child? 1. hernia persist to age 3
2. exceeds 2cm in diameter
3. causes symptoms
1358. When does one see calcium phosphate stones? common in renal tubular acidosis and hyperparathyroidism
1359. When is a c-section indicated in the case of placental
abruption?
1. If there are obstetrical indications (breech position, prior c-
section)
2. Mother or fetus are unstable
1360. When is neuroimaging required when a pt presents with a
migraine?
1. Decline in school performances
2. Early morning headaches
3. Behavior changes
4. Decline in growth
5. Abnormal growth parameters
6. Seizures
1361. when is screening for gestational diabetes performed? and
which test is used?
performed between 24-28 weeks.
Use the 50g one hour GTT
If BS> 140 then do 3 hour 100gram GTT
1362. When should one start oral Isotretinoin on a pt? 1. when they have SCARS
2. With Nodulocystic acne
3. Moderate acne unresponsive to all other forms of txt
1363. When should Rh status be checked? Should be checked at first prenatal visit and at week 28.
If at risk for Rh isoimmunization they should be given anti- Rh
immunoglobulin at 28 weeks and again at delivery
1364. When you see the "3 Sign" on a CXR what should you suspect? Aortic Coarcation
1365. where are lipids (TG, XOL, PL) digested and abs digested in duodenum and abs in jejunum
1366. where are PDA heard best left sternal border, loudest at S2
1367. Where do Actinomycosis Israelli normally present with
infection and what is the txt?
Cervicofacial, thoracic, or abdominal region.
gram positive branching bacteria
txt: high dose Penicillin for 6-12 weeks
1368. Where is the most common place for ischemic colitis to
occur?
1. splenic flexure
2. recto-sigmoid junction
watershed areas
1369. Where is the most common site for ulnar nerve entrapment? Elbow where it lies at the medial epicondylar groove
1370. Which 3 bacteria cause subacute endocarditis? 1. strep. viridians
2. staph. epidermitis
3. enterococcus
1371. Which AA can be catabolized to form propionyl CoA? Isoleucine, valine, threonine, methionine (branched AA), xol,
oddchain FA. Porpionyl coA then is converted to
Methylmalonyl CoA.
1372. which bacteria are pts with hemochromatosis or cirrhosis at
increased risk for?
Listeria Monocytogenes
1373. Which blood product contains all the coagulation factors and
should be given to pts with coagulopathy?
Fresh frozen plasma
1374. Which cancer are pts with PCOS at increased risk for? endometrial cancer
1375. which cancer has a high associated with HNPCC? Endometrial Cancer
1376. Which cranial nerve palsy is associated with Pseudotumor
Cerebri?
CN VI
1377. Which heart defect presents with a pansystolic murmur with
loudest at left lower sternal border plus diastolic murmurs at
apex?
Ventricular septal defect
1378. Which infection should you suspect if you see Bone Marrow
Transplant pt with pneumonia and abdominal pain like
symptoms?
CMV
1379. Which lab do you check when an asymptomatic person
presents with Thrombocytoopenia?
HIV antibodies
1380. Which labs are elevated in Sarcoidosis and what is the txt? Elevated calcium and ACE
txt with steroids
1381. Which medication is most commonly associated with
hearing loss?
Loop diuretics
1382. Which medication should be used for breast cancer that is
positive for HER2? and what should be performed prior to
beginning txt?
Trastuzumab
cardiotoxic so perform ECHO
1383. Which meds. should be given to schizophrenic pts who have
poor compliance with oral meds?
Depot Antipsychotics:
1. Haloperidol
2. Fluephenazine
3. Risperidone
4. Paliperidone
1384. Which nephropathy is associated with minimal change
disease?
Hodgkin's lymphoma
1385. Which nerves are injured in Erb-Duchenne Palsy? 5th and 6th cervical nerves
Absent Moro reflex
1386. Which nerves are injured in Klumpke's Paralysis? 7th and 8th cervical nerves
1st thoracic nerve
present with ipsilateral horners
1387. Which neuromuscular blocker should not be used in pts
with hyperkalemia?
Succinycholine
do not use in pts with:
1. crush or burn injuries
2. guillien barre
3. tumor lysis syndrome
1388. Which neuromuscular blocking agent can you use in pt with
renal and liver insufficiency?
Atracurium
1389. Which neuromuscular blocking agent can you use in pt with
renal insufficiency?
Rocuruonium
1390. which ogranasims are pts with iron overload at increased
risk for?
1. Yersinia entercolitica
2. Vibrio Vulnificisu
1391. which patients are at risk for developing ALL? DS, ataxia-telangiectasia, NF type 1
1392. Which pulmonary renal syndrome requires emergent
plasmpharesis?
Goodpasture's
1393. Which rash usually follows infection with herpes simplex? erythema multiforme
1394. Which statistical observation is most significantly effected
by outliers?
Mean
1395. Which substance is elevated in pts with deficiency in B12
and Folate?
Homocysteine
1396. Which substance is elevated only in B12 def. and not Folate? Methylmalonic Acid
1397. Which virus is nasopharyngeal cancer associated with? High incidence with Epstein Barr Virus
1398. WHy does haptoglobin decrease in sickel cell disease. binds free hemoglobin and rapidly cleared by liver.
1399. why does pt with lung mass and signs of SIADH (low Na)
have nml extracell vol?
transient inc in ECvol-->dec aldosterone, inc BNP-->loss of
further Na (causes neurologic sx). Normalization of fluid but
severily hyponatremic.
1400. Why is acyclovir and co better for HSV and VZV than
EBV/CMV
phosphyrylation that activates the drug (rate limiting step)
1401. WHy is is necessary to wait 14 days when switching from
MAO to SSRI drugs
avoid seratonin syndrome. allow time for enzyme resynthesis.
(MAO)
1402. Wilson's disease rare autosomal recessive dz
most often identified in younger indiv aged 5 to 40 years
mutation in gene ATP7B on c'some 13 assoc with Wilson dz and hinders copper
metabolism by reducing formation and secretion of ceruplasmin and decreasing
secretion of copper into biliary system
copper a pro-oxidant and causes damage to hepatic tissue thru gen of free
radicals=>leaks form injured hepatocytes into blood=>deposits into tissues including
cornea and basal ganglia
1403. Winter's formula range that det superimposed respiratory acidosis and respiratory failure in metabolic
acidosis
PaCO2=1.5x(HCO3-)+82
*when steady state PaCO2 persists above this range
1404. Wiskott-aldrich syndrome TIE: thrombocytopenia (@ birth), infxn, eczema. (6-12mo)
dec to nml IgG, IgM. Inc IgE, IgA.
1405. withdrawal symptoms occurs when patient forms physiologic dependence on drug/medication then
discontinued
common in patients using alcohol, opiates, BNZ, stimulants, and some
antidepressants
1406. Wolff-Parkinson-White syndrome and
ventricular remodeling
electrophysiological abnormality of AV cardiac conduction=>accessory pathways
directly connect atria and ventricles to bypass AV nodes
*net result: pre-excitation and arrythmias
1407. Work up for pt on antithyroid med and
fever, throat pain
WBC and differential
1408. young pt presents with ear drainage and
difficulty hearing, what is the dx?
Acute otitis media
1409. young pt presents with lump on neck. neg
sx of hypo, hyperthyorid except "hot".
meds for epilepsy.
phenytoin
1410. Zenker diverticulum consists only of mucosa=>false diverticulum
can cause food retention with regurgitation occurring days later
food aspiration may lead to pneumonia
can be palpated as a lateral neck mass
1411. zidovudine NRTI
can bind and inhibit some mammalian cellular and mitochondrial DNA
polymerases=>particularly - and gamma-polymerases
major adverse effect: bone marrow suppression (e.g., anemia, granulocytopenia)
1412. Zollinger-Ellison syndrome gastrin hypersecretion by pancreatic tumor=>peptic ulcer dz and diarrhea
Dx with serum gastrin measurement