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most likely complication of digoxin
arrythmias due to hyperkalemia
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Conditions that are polygenic
- androgenic alopecia (baldness) with variable pentrance in males and females
- epilepsy
- heart disease
- schizo
- glaucoma
- type II DM
- hypertension
-
Side effects of a drug prescribed for bradycardia
- atropine
- acute closed angle glaucoma in elderly (increases IOP)
- hyperthermia in infants
- M3 antagonist ae.
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Patient has a metabolic acidosis. How to predict if there's a compensatory respiratory alkalosis or not?
paCO2 = 1.5 x HCO3- + 8 (+/- 2)
- if low, indicates compensatory respiratory alkalosis
- if higher than predicted, indicates a problem of compensation = respiratory failure
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Thalessemia intermedia
replacement of G with C in the B-globin gene mRNA upstream from the AUG codon
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Allergic bronchopulmonary aspergillosis
- hx of bronchial asthma
- high IgE levels (eosinophilia)
- IgG antibodies against aspergillus
- recurrent pulmonary infiltrates and proximal brochiectasis
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Pituitary apoplexy
- hemorrhage into a prexisting pituitary adenoma
- decreased ACTH = adrenocortical insufficiency = heart collapse
-
4 enzymes of gluconeogenesis
- 1. pyruvate carboxylase: pyruvate --> OAA (mitochondria)
- 2. PEP carboxykinase: OAA --> PEP (cytosol)
- 3. Fructose 1,6 bisphosphatase: F1,6BP --> F6P (**RLS**) (cytosol)
- 4. glucose 6-phosphatase: G6P --> glucose (ER)
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ulcer location on the terminal sulcus 1 cm anterior to the foramen cecum. pain sensation by what nerve?
mandibular br. of the trigeminal nerve
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how does squatting/tight hand grip help a kid with his cyanosis in tetralogy of fallot?
- main concept is to increase afterload (due to pressure constriction)
- because of afterload, pressure in the LV has to increase to overcome for the pump of blood flow out of heart
- initially: pulmonic stenosis has a high pressure: blood goes from RV-LV via the VSD = cyanosis
- later: LV pressure increases, so blood goes from RV - pulmonary artery to get oxygenated in the lungs (helps with the cyanosis)
-
Piloglitazone binds to PPAR-gamma transcription regulator. What kind of receptor?
- intracellular nuclear receptor
- regulation of genes involved in lipid and glucose metabolism
-
Drugs with adverse effects of SLE are metabolized by what mechanism
- liver N-acetylation
- slow acetylators = increased drug = greater risk for developing SLE
-
drugs that increase the sensitivity of insulin to tissues, and that increase insulin secretion
metformin, glitazones
sulfonylureas
-
colonizing vs. invasive aspergillosis
colonizing: grows in old lung cavities: TB, emphysema, or sarcoidosis. Forms a fungus ball "aspergilloma"
invasive: infects lung tissues; opportunistic infections in immunosuppressed and neutropenic patients
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pol gene mutations
env gene mutations
acquired resistance to RT and protease inhibitors
enable escape from host neutralizing antibodies
-
how do benzos and barbituates work at GABA receptors
allosteric binding to keep the GABA channels open
high []: barbituates show direct gating of ion channels without the need of GABA
-
CGD has a defect in what enzyme
- neutrophil oxidase
- increased risk for catalase + organisms
-
Rapid acting anti-arrythmetic drug that causes adverse effects of: flushing, shortness of breath, chest burning (bronchospasm)
- adenosine
- increases K efflux out of cells
-
patient dies of middle cerebral artery thrombosis and old renal infarcts. vitamin deficiency?
- B6
- homocystinuria
- (presents like marfans except downward subluxation of lens)
-
how can plaques rupture to produce an MI
activation of metalloproteinases (activated macrophages contribute to collagen degradation)
-
what type of agar does H.influenza grow on?
enriched agar with factors V and X
-
N. gonorrhea grows on what type of agar?
- selective agar:
- vanco kills gram + organisms
- gram (-) other than neisseria
- fungi by nystatin
-
cells responsible for a type I HS reaction
- mast cells (tissues)
- basophils (blood)
- contain Fc receptors for IgE and release histamine and heparin
-
adverse affects of verapamil
- constipation
- gingival hyperplasia
- bradycardia --> AV block
-
Drug used to treat absence seizures and tonic-clonic seizures
valproate
- phenytoin can treat TC seizures, but not absence.
- carbamazepine treats TC seizures, but serious adverse effects
-
pathway of saphenous vein
- starts at medial malleolus, drains on the medial aspect of leg.
- joins the femoral vein in the femoral triangle, just inferior to the pubic tubercle
* not located in the popliteal fossa (for the popliteal artery (branch of femoral a.) and vein along with the tibial a.))
-
patient on INH therapy and develops fever, anorexia, and nausea one month later. damage?
- hepatocytes
- transient increase in ALT, AST, and bilirubin
- liver fx tests can return to baseline.
-
ADH and aldosterone work on what segments of the collecting duct
- ADH: medullary (water reabsorption)
- aldosterone: cortical (sodium reabsorption)
-
Top 2 causes of meningitis > 60 y.o.
- Strep pneumo
- N. meningitis
-
cholestasis can cause intestinal malabsorption and nutritional deficiences of?
- fat soluble vitamins
- - D: osteomalacia
-
ureter crosses over the common iliac a. and then passes in what direction to the external and internal iliacs
- lateral to the internal iliac
- medial to the external iliac
- (ureters enter medial to the ovarian vessels before entering the true pelvis)
-
how do patients who receive blood tranfusions develop parasthesias?
- citrate is added to stored blood
- citrate chelates calcium and magnesium
-
mast cell degranulation releases what substances?
-
uridine supplementation for orotic aciduria inhibits what enzyme?
CP-II (RLS)
-
adverse affects of theophylline
- abdominal pain, vomiting, seizures
- blocks the affects of adenosine (short-acting vasodilator)
-
patient presents with weight loss, hemoptysis, and cough. Has pulmonary infiltrate in the upper lung and area of cavitation. what stage of TB?
reactivation of an old infection
-
patient has a calcified granuloma in the lower lung with hilar lymphadenopathy. stage of TB?
- primary exposure
- ghon focus = granuloma
- ghon complex = granuloma + lymphatic spread
-
meningococcal pili are responsible for what disease mechanism?
epithelial attachment to the nasopharynx --> invasion and disease
-
composition of RCC
- clear cytoplasm
- glycogen and lipids
-
associated problems with hydrocephalus in fetuses
- arnold-chiari malformation
- stretching of the periventricular tracts = UMN lesions: hypertonicity and hyper-reflexia
-
mechanism of relaxation to decreases Ca+2 levels in a muscle
- Ca+2 efflux from cytoplasm
- use of Ca+2 ATPase (needs ATP) and Ca+2/Na+ exchanger (doesn't need ATP)
-
which enzyme has a RT activity and adds TTAGGG repeats to the 3' ends of the chromosome
- telomerase
- find them in cancer cells and stem cells
-
Effect of a main exposure on an outcome is modified by another variable and is not a bias
- effect modification
- e.g. asbetos exposure on lung cancer, affected by smoking
- not due a flaw in the design or analysis of the study
-
Prescribe a B-blocker to a patient. Result on RAAS system?
- decreases renin release, decreases aldosterone
- no renal sodium and water retention
-
histology of adrenal medulla
- chromaffin cells with basophilic cytoplasm
- post-ganglionic sympathetic neurons from neural crest cells
-
complications of SLE anti-coagulants (indicated by prolonged PTT and false VDRL)
- anti-phospholipid Ab syndrome
- - hypercoagulability (venous and arterial thrombosis)
- - repeated miscarriages (2nd and 3rd trimesters)
-
low T cell count associated with Candida
low neutrophil count associated with Candida
- low T cell: local infections (oral thrush, candidiasis, vulvovaginitis)
- low neutrophil count: systemic infections (hematogenous spread - liver and kidney abscesses, candidemia)
-
Strep pneumo undergoes what mechanism to become virulent if the strains are originally not virulent - conjugation, transformation, or transduction?
- transformation
- (uptake from the environment)
conjugation occurs with E.coli mostly
-
what structures drain to the superficial inguinal lymph nodes?
umbilicus down to the feet, including anus upto the dentate line
- posterior calf drains to popliteal lymph nodes
- prostate drains to internal iliac
- superior portion of bladder to ext iliac, and inferior portion of bladder to the internal iliac
-
lipofuscin granules in organs due to aging is due to what mechanism
product of free radical injury and lipid peroxidation
-
enzyme that produces the green colour in bruises
heme oxygenase (converts heme to biliverdin)
-
HIV polyprotein cleavage is mediated by what enzyme?
HIV protease
-
if two studies have the same relative risk, but differ in statistical significance, what is a likely problem?
- sample size (due to power of the study)
- same RR: hence, there's no flaw in the study design
-
drug that provokes Prinzmetal's angina (coronary vasospasm)
ergonovine (agonist at alpha and 5HT receptors)
-
how do alcoholics develop megaloblastic anemia
folate deficiency - impairs DNA synthesis
-
sx of a glucagonoma?
- DM
- necrolytic erythema (erythematous rash over the lower extremities especially groin area)
- anemia
-
imperforated anus (failure to pass meconium) can present with what other defect
urinary tract defects (renal genesis, epispadias, etc.)
-
a boy jumps from a tree and catches a branch while falling and then swings his arm and jumps to the ground. what nerve injured?
lower trunk of brachial plexus
-
ovarian vessels run in what ligament
suspensory
-
chronic mitral regurg patients develop what complications
LA dilation (increased compliance) --> atrial fib and mural thromboembolism
-
acute rejection after a lung transplant affects what part of the lung?
pulmonary and bronchial circulation/vasculature
-
chronic rejection after a lung transplant affects what part of a lung?
small airways
n.b. airways walls and pleura are not affected
-
Strep viridans binds to damaged valves, which are identified by?
fibrin-platelet aggregates deposited at sites of endothelial trauma
-
transient MI causes heart cells to increase in size due to what mechanism?
- blood flow cannot meet heart demands, move from aerobic to anaerobic metabolism
- no ATP therefore, pumps cannot work (Na/K and Na/Ca)
- accumulation of Na and Ca that draws water in and causes cell and mitochondrial swelling
contraction stops as SR cannot take up the Ca+2
-
- cavernous hemangioma
- most common benign liver tumor
- biopsy is C/I because it can cause fatal hemorrhage
-
resistance against cephalosporins
- change in protein structure
- less sensitive to B-lactamases (like penicillins)
-
tx for serotonin syndrome
- cyprohepatadine
- anti-histamine (H1) with non-specific serotonin antagonist effects
-
purine analog that achieves high [] because of its resistance to degradation by adenosine deaminase
- cladribine
- tx for hairy cell leukemia
-
what determines if a plaque will cause ischemic myocardial injury to that vessel?
- rate of progression
- slow rate: could develop collaterals that could prevent myocardial necrosis
- fast rate: thin fibrous cap, rich lipid core, and active inflammation would all decrease plaque stability
-
In hereditary spherocytosis, is MCHC increased of decreased
- increased
- mild dehydration of the RBC
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