What would expect to find in a pt with a lesion of CN XII?  CN X? (FA p416)

CNXII – Hypoglossal è tongue movement

CNX – Vagus è Taste, swallowing, palate elevation, midline uvula, talking, coughing, thoracoabdominal viscera,                    monitoring aortic arch chemo- and baroreceptors

* Deleted elastin gene from Chromosome 7 => elvin facies, retardation, sensitive to Vit D (hypercalcemia), well- developed verbal skills, extremely friendly with strangers, CV problems

On which cells would you find CD3 molecules?  On which cells would you find CD4 molecules?  To what do CD4 molecules bind?  On which cells would you find CD8 molecules?  To what do CD8 molecules bind?  (FA p195)

CD3 – associated with TCR for signal transduction

CD4 – on Helper T cells => binds MHCII

CD8 – on Cytotoxic T cells => binds MHCI

What causes the S1, S2, S3, and S4 heart sounds? (FA p257)

S1 – Mitral and tricuspid valves close

S2 – Aortic and pulmonary valve close

S3 – Increased filling during diastole (normal in children and preg)

S4 – “Atrial kick” against hypertrophied LV 

Name five or more drugs that inhibit acetylcholinesterase.  What is the clinical application for each? (FA p238)

Neostigmine – postop and neurogenic ileus and urinary retention, MG, rev of neurmusc jxn blockade

Pyridostigmine – MG (long-acting), does not penetrate CNS

Edrophonium – dx of MG (short-acting)

Physostigmine – Glaucoma (crosses BBB) and atropine overdose

Echothiopate – Glaucoma

What are the main differences between nephritic syndrome and nephrotic syndrome?  (FA p467)

Nephritic = inflammation. In glomerulus è hematuria and RBC casts

Nephrotic = proteinuria, hyperlipidemia, fatty casts, and edema

What are the acidic and basic amino acids?  Where can you find high concentrations of basic amino acids?   Why are these amino acids found in these areas?  (FA p104)

Basic : Arg, Lys, His

Acidic : Asp and Glu

Arg and Lys are high in histones, which bind negatively charged DNA and required during periods of growth

What bacteria are known for causing bloody diarrhea? (FA p176)

Campylobacter                   

Salmonella

Shigella

Enterhemorrhaic E. Coli

Enterinvasive E. Coli

Yersinia enterocolitica                                        Daycare outbreaks

C.Difficile                                       Pseudomembranous colitis

Entamoeba histolytica

What nerve injury would you suspect in a pt with the following motion deficits? (FA p376)

·         foot drop (loss of dorsiflexion) => tibialis anterior (Common Peroneal N., L4-S2)

·         loss of plantar flexion => gastrocnemius and soleus (Tibial N. L4-S2)

·         loss of knee jerk => quads (Femoral N. L2-L4)

·         loss of hip adduction => Adductor groups (Obturator N. L2-L4)

What are the leading causes of death in infants? (FA p66)

1. Congenital Anomalies

2. Short Gestation

3. SIDS

4. Maternal Pregnancy Comp.

What is the equation for determining a drug’s volume of distribution?  (FA p232)

Volume of distribution = amount of drug in body / plasma drug concentration

What are the clinical features of hyperammonemia? (FA p105)

Amonia Intoxication – vomiting, tremor, slurring of speech, cerebral edema, blurring of vision

What changes in sleep patterns and sexual anatomy are seen in the elderly?  (FA p70)

Less REM, slow-wave sleep, increased latency and awakenings

Slower erection/ejaculation, longer refractory period

Vaginal shortening, thinning, and dryness

Describe the probe and sample to which the probe binds in the following molecular biology techniques: Southern blot, Northern blot, and Western blot.  (FA p86)

Southern Blot – DNA

Northern Blot – RNA

Western Blot - Protein

What are the diagnostic criteria for major depressive episode? What changes in sleep patterns are seen in pts with depression? (FA p423)

At least 5 of 9 depression symptoms for 2 or more weeks.

What is the clinical definition of chronic bronchitis? (FA p510)

Chronic Bronchitis (“Blue Bloater”) = hypertrophy of mucucs-secreting glands in the bronchioles è Reid index =                      gland depth / total thickness of bronchial wall; in COPD, Reid index > 50%

What is the blood supply to the embryonic foregut, midgut, and hindgut?  What adult structures arise from these primitive guts?  (FA p299)

Foregut – Celiac Trunk

Midgut – Superior Mesenteric Artery

Hindgut – Inferior Mesenteric Artery

Which tract of the spinal cord relays sensory information from the body?  Which tract relays pain and temperature sensation?  Which tract relays motor sensation to the body?  (FA p388)

Sensory = Dorsal Columns (Fasiculus cuneatus = UE ; Fasiculus grancilis = LE)

Pain and Temp = Spinothalamic

Lateral Corticospinal

What is the most common tumor of the salivary gland?  What is the most common malignant tumor of the salivary gland? (FA p321)

Tumor = pleomorphic adenoma

M.Tumor = Mucoepidermoid CA

A BEAM

Acebutolol

Betaxolol

Esmolol

Atenolol

Metoprolol

Ventricular tachycardia, characterized by shifting sinusoidal waveforms. 

Mean GNATS can NOT kill anaerobes?

1. Gentamycin, Neomycin, Amikacin, Tobramycin, Streptomycin

2. SE = Nephrotoxicity, Ototoxicity, Tetatrogenic

3. MOA = Bactericidal ; bind 30s subunit => inhibit initiation complex ; ineffective vs anaerobes

What is the difference between a case-control study, a cohort study, and a clinical trial? (FA p50)  Which studies use odds ratios, and which use relative risks? (FA p52)

Case-control study = compares a group with a disease to a group without è Odd’s Ratio

                - Looks at prior exposure to risk factors

Cohort study = Compares a group with a given exposure or risk factor to group without è Relative Risk

                - Does exposure increase risk

Cross-sectional study = Collects data from different group of people to assess frequency of a disease è Disease prevelance

                - Disease prevelance

Clinical Trial = experimental study involving humans comparing therapeutic benefits of 2 or more treatments

Three days ago you hospitalized a 40-year-old male for myocardial infarction.  He has been given all of the usual medications.  Today you notice that his platelet count is 30,000.  What do you suspect is the cause of his low platelets? (FA p362)

Low platelets = Thrombocytopenia ç HEPARIN

Thrombolytics have NO change in platelet count (cleave plasminogen to plasmin è clot busting

Aspirin has no effect on platelet levels è blood thinning

Warfarin does not lower platelets

What are the different etiologies of Cushing’s syndrome?  How is the level of ACTH different in each? (FA p296)

1. Cushing’s disease (~70%) = ACTH secretion from pituitary adenoma (HIGHER ACTH(

2 . Ectopic ACTH (15%) = nonpituitary tissue making ACTH (small cell CA, bronchiole carcinoids) (HIGHER)

3. Adrenal (15%) = adenoma, CA, nodular adrenal hyperplasia (LOWER ACTH)

Which virus is responsible for the following disease?  (FA p168)

1. Croup in children

2. Common cold (2 types)

3. #1 cause of fatal diarrhea in children

4. Bronchiolitis in infants

-          croup in children – Parainfluenza (paramyxovirus – RNA)

-          common cold (2 viruses) – Coronavirus and Rhinovirus (Coronavirus and Picornavirus –RNA)

-          #1 cause of fatal diarrhea in children – Rotavirus (Reovirus – RNA)

-          bronchiolitis in infants (especially premature) – RSV (Paramyxovirus- RNA)

How many half-lives does it take for a drug infused at a constant rate to reach 94% of steady state?  What variables determine the half-life of a drug?  (FA p232)

4 = 93.75%

T ½ = (0.7 x Volume of distribution) / Clearance

Vd = amount / concentration in serum

Cl = rate of elimination / plasma concentration

What structures of the inner ear are responsible for the sensation of linear and angular acceleration? (FA p398)

Utricle and Saccule

What is the basic equation for cardiac output?  What is the Fick principle?  What factors affect stroke volume?  (FA p254)

CO = SV x HR

Fick principle = rate of O2 consumption / (arterial O2 content – venous O2 content)

SV = affected by Contractility ; Afterload ; Preload

What are the two most common causes of chronic renal failure? (FA p470)

Hypertension and Diabetes

What is the most common cause of Erb-Duchenne palsy?  What are the characteristic findings of Erb-Duchenne palsy? (FA p354)

Blow to shoulder or trauma during surgery

Paralysis of abduction, medially rotated, forearm is pronated (waiter’s tip)

What are the signs and symptoms of poliomyelitis?  If you suspected polio in a pt with yours, where would you seek to obtain a viral sample from the pt?  (FA p389)

Mailase, HA, F, N, Abd pain, sore throat, LMN lesions è weakness, atrophy, fibrilliation, hyporeflexia

CSF

What are the 3 different eukaryotic RNA polymerases?  What type of RNA does each make? (FA p78)

RNA Poly I           - rRNA

“        “      II           - mRNA

“        “      III         - tRNA

What is Chediak-Higashi Sydrome?

1. Defect

2. Symptoms

1. Microtubule polymerization defect => decreased phagocytosis

2. Recurrent pyogenic infections, partial albinism, peripheral neuropathy

How many umbilical vessels are there?  Which umbilical vessel has the highest oxygen content? (FA p124)

2x umbilical arteries (deoxygenated) ; 1 x umbilical vein (oxygenated)

What are Brunner’s glands? (FA p304)  What are Peyer’s patches?  (FA p303)  How can these structures help you identify the location from which a histological specimen was taken? 

Peyer’s Patches = unencapsulated lymphoid tissue found in lamina propria and submucosa of small intestine.                           Contain specialized M cells that take up Ags. B cells è IgA-secreting plasma cells

Brunner’s Glands = Secrete alkaline mucus to neutralize acid contents entering the duodenum from the stomach.

What is the rate-limiting enzyme for ketone synthesis? for cholesterol synthesis? (FA p95)

Ketone Syn = HMG-CoA synthase

Cholesterol = HMG-CoA Reductase

What is the classic triad of symptoms in multiple sclerosis? With what disorders do pts with multiple sclerosis commonly present?  (FA p425)

Charcot’s classic triad (SIN)

                - Scanning speech

                - Intention tremor (incontinence, internuclear opthalmoplegia)

                - Nystagmus

Disorders : optic neuritis, MLF, hemipaersis, hemisensory sx, incontinence

What class of drugs is used in the treatment of ADHD, narcolepsy, and obesity? (FA p240)

ADHD, Narcolepsy , Obesity – Ephedrine and Amphetaime

What is the definition of first-degree heart block? (FA p263)

PR interval is prolonged >200msec (assymptomatic)

What is the classic presentation of a patient with gonococcal arthritis? (FA p384)

Monoarticular, migratory arthritis with an asymmetrical pattern. Joint is swollen, red, and painful

What is the difference between malingering and factitious disorder? (FA p424)

Both patients consciously fake Sx but for different gains.

                Malingering = secondary gain (drugs, avoiding work, etc)

                Factitious = wants to assume sick role

What are the rate-limiting enzymes for the following metabolic processes? (FA p95)

1. Glycogen synthesis

2. Glycogen breakdown

3. Fatty acid sythesis

4. Fatty acid oxidation

·         glycogen synthesis – glycogen synthase

·         glycogen breakdown – glycogen phosphorylase

·         fatty acid synthesis – Acetyl CoA carboxylase (ACC)

·         fatty acid oxidation – Carnitine Acyltransferase I

What are the risk factors for colon cancer? (FA p329)

Genetics – Familial Adenomatous Polyposis (FAP), Gardener’s Syndrome, Turcot’s syndrome, Hereditary non-polyposis colorectal cancer (HNPCC/Lynch Syndrome)

IBD, Strep. Bovis, tobacco, large villous adenomas, juvenile polyposis Syndrome, Peutz-Jeghers Syndrome

Lead Poisoning

1. Presentation

2. Signs

3. Symptoms

4. Tx

1. Wrist and foot drop

2. Lead lines on gingivae (Burton lines) and on epiphyses of long bones on xray

3. Abdominal colic and sideroblastic anemia

4. EDTA is 1st line. Succimer for kids

(It "sucks" to be a kid who eats lead chips)

What is the difference between prevalence and incidence? (FA p62)

Prevalence – number of cases in population during time period

Incidince – number of new cases (unit time)

What physiology accounts for the automaticity of the AV and SA nodes?  (FA p261)

Slow diastolic depolarization – membrane potential spontaneously depolarizes as Na+ conductance increases

How does the emphysema caused by smoking differ from the emphysema caused by alpa-1-antitrypsin deficiency? (FA p510)

Smoking – centriacinar (respiratory bronchiole is expanded)

Alpha-1-Antitrypsin – panacinar (entire respiratory acinar from bronchiole to alveoli are expanded)

What is the difference between Meissner’s corpuscle and a Pacinian corpuscle? (FA p375)

Meissner’s Corpuscle – Large, myelinated fibers in glabrous skin. Senses position

Pacinian Corpuscle –Large myelinated fibers in deep skin layers, ligaments, and joints. Senses vibration and pressure.

What syndrome causes the triad of sterility, bronchiectasis, and recurrent sinusitis?  What is the primary defect in this syndrome? (FA p83)

Kartagener’s syndrome – immotile cilia due to a dynein arm defect.

In which glomerular disease would you expect to see the following changes? (FA p467-468)

·         foot process effacement (electron microscope) 

·         wire-loop appearance (light microscope)

·         mesangial deposits of IgA (electron microscope) 

·         crescent-moon shaped lesion 

·         segmental sclerosis and hyalinosis (light microscope)

·         foot process effacement (electron microscope) è Minmal change disease

·         wire-loop appearance (light microscope) è Diffuse proliferative gomerulonephritis (SLE or MPGN)

·         mesangial deposits of IgA (electron microscope) è Berger’s Disease

·         crescent-moon shaped lesion (light microscope) è Rapidly progressive glomerulonephritis (goodpastures, wegener’s, microscopic polyangitis)

·         segmental sclerosis and hyalinosis (light microscope) è focal segmental glomerulosclerosis

What clinical scenario is most commonly seen in Reye’s syndrome?  What are the characteristics of Reye’s syndrome? (FA p330)

Rare, often fatal hepatoencepalopathy. Sx : mitchodrial abnormalities, fatty liver, hypoglycemia, coma. 

What would you expect to find in the synovial fluid of a pt with gout?  with pseudogout?  (FA p384)

Yellow crystals in parallel light vs. yellow when perpendicular and blue when parallel

What effects do prostaglandins and thromboxane have on platelet aggregation?  (FA p369)

Thromboxane = pro-aggregation

Prostaglandins = anti-aggregation

When is a fetus most susceptible to damage from teratogens?  What drug used in the treatment of hypertension is a teratogen?  What effect does this have on the fetus?  (FA p120)

3-8 weeks

ACE inhibitors è renal damage

Distinguish the following types of organ transplant rejection.  (FA p215)

Hyperacute ; acute ; chronic

hyperacute rejection         Preformed Abs è vessel occlusion and ischemia (minutes)

acute rejection                    Cell mediated (T-lymph.) react with foreign MHC (weeks)

chronic rejection                T-cell and Ab-mediated cascular damage (months-years)

What is Zollinger-Ellison syndrome?  (FA p291)

Gastrin-secreting tumor of pancreas or duodenum. Stomach shows rugal thickening with acid hypersecretion. Causes recurrent ulcers. May be associated with MEN type 1

What type of collagen is abnormal in patients with Alport’s syndrome? (FA p85)

Type IV collagen è structural component of the basement membrane of the kidneys, ears, and eyes

In which order elimination is the rate of elimination proportional to the drug concentration? (FA p233)

What is the most common tumor of the adrenal medulla in adults?  in children? (FA p287)

Adults = Pheochromocytoma (5 P’s – Pressure (BP); Pain (HA); Perspiration; Palpitations; Pallor)

Children = Neuroblastoma (HT; anemia; weight loss)

What lab abnormalities would you expect to see in a pt with SIADH? (FA p291)

Hyponatremia and low urine osmolality

What drugs are used in the treatment of Parkinson’s disease? (FA p412)

BALSA (Bromocriptine ; Amantadine ; Levodopa ; Selegiline ; Antimuscarinics)

What are the common side effects of beta-blockers?  Which pt populations should use caution when taking beta-blockers? (FA p242)

Impotence, exacerbation of asthma, CV effects (bradycardia, AV block, CHF), CNS effects (sedation, sleep alterations)

Diabetics, Asthmatics

What are the signs of right-sided heart failure?  What are the signs of left-sided heart failure? (FA p274)

Right - Edema, Jugular venous distension, hepatmegaly (nutmeg liver)

Left – Dyspnea on exertion, pulmonary edema, paroxysmal nocturnal dyspnea, orthopnea

What asthma medication fits the following statement (FA p515)

·         inhaled treatment of choice for chronic asthma

·         inhaled treatment of choice for acute exacerbations - 

·         narrow therapeutic index, drug of last resort

·         blocks conversion of arachidonic acid to leukotriene 

·         inhibits mast cell release of mediators, used for prophylaxis only 

·         inhaled treatment that blocks muscarinic receptors 

·         inhaled long-acting beta-2 agonist 

·         blocks leukotriene receptors 

·         inhaled treatment of choice for chronic asthma – Corticosteroids (Beclomethasone, prednisone)

·         inhaled treatment of choice for acute exacerbations - Albuterol

·         narrow therapeutic index, drug of last resort

·         blocks conversion of arachidonic acid to leukotriene – Zileuton

·         inhibits mast cell release of mediators, used for prophylaxis only - Cromolyn

·         inhaled treatment that blocks muscarinic receptors - Ipratropium

·         inhaled long-acting beta-2 agonist - Salmeterol

·         blocks leukotriene receptors  - Antileukotienes (Zariflukast, montelukast)

What bacterium causes leprosy (AKA Hansen’s disease)?  What part of the body is infected?  What animal is a reservoir in the US? (FA p149)

Mycobacterium leprae

Infects skin

Reservoir is armadillos

What are the symptoms of Kluver-Bucy syndrome?  What area of the brain is damaged in this syndrome?  (FA p403)

Hyperorality, hypersexuality, disinhibited behavior

Amygdala (bilaterally)

Why should a “Hot T-bone steak” come to mind when someone asks you about interleukins? (FA p199)

Hot – IL-1 = fever

T – IL-2 = T-cells

Bone – IL-3 = Bone marrow

stEAk – IL-4 = IgE and IL-5 = IgA

Compare the leading causes of death in ages 1-14 to those in ages 15-24? (FA p56)

Injuries, cancer, congenital, homicide, heart disease vs. injuries, homicide, suicide

What are the side effects of neuroleptic toxicity?  (FA p453)

1. Storage in body fat

2. Extrapyramidal SE

3. Endocrine SE (hyperprolactinemia => galactorrhea)

4. Anti-muscarinic (anti-SLUDGE)

What is the composition of a nucleosome?  Which histone ties nucleosomes together?  (FA p66)

Core histones = H2A, H2B, H3, H4

Tied together by H1

What are the causes of normocytic, normochromic anemia?  (FA p351)

Anemia of Chronic disease

Aplastic Anemia (radiation and drugs ; virus ; Fanconi’s anemia) ; Idiopathic => failure of myeloid stem cells

Kidney disease => decreased erthropoietin

What 5 classes of medications are used to treat glaucoma? (FA p430)

Anti-cholinesterase (cholinomimetics)

Alpha-agonists

Beta-blockers

Diuretics

Prostaglandins

What infections are caused by Chlamydiae?  What is the treatment for most Chlamydia infections?  (FA p156)

C.trachomatis => reactive arthritis, conjunctivitis, nongonoccal urethritis, PID

C.pneumoniae and C.psittaci => atypical pneumonia

Tx: Azithromycin or doxycycline

What are the characteristics of thoracic outlet syndrome?  (FA p375)

1. atrophy of the thenar and hypothenar eminences

2. atrophy of the interosseus mm

3. sensory deficits on the medial side of forearm and hand

4. disappearance of the radial pulse upon moving the head toward the ipsilateral side

What abnormal lab values would lead you to suspect alcoholic hepatitis? (FA p331)

AST > ALT (ratio >1.5)

What are the most common locations for atherosclerosis? (FA p270)

Abdominal aorta > coronary artery > popliteal artery > carotid artery

What vitamin deficiencies would you expect to see in a pt with a malabsorption syndrome such as cystic fibrosis or celiac sprue? (FA p87)

CF - Fat soluable vit deficiencies (A,D,E,K)

Celiacs – malabsorption of gliadin (wheat)

What types of pancreatic tumors are often seen in MEN type I? (FA p303)

Pancreatic Endocrine Tumors – Zollinger-Ellison syndrome ; insulinomas ; VIPomas ; glucagonomas

What nerves innervate the tongue? (FA p129)

Taste – VII, IX, X

Pain – V3, IX, X

Motor - XII

What is the classic presenting symptom in a pt with Lyme disease?  (FA p153)

Erthema chronicum migrans (expanding bull’s eye red rash with central clearing)

What are the stages of dying according to Kubler-Ross? (FA p61)

Denial ; Anger ; Bargaining ; Grieving ; Acceptance

Explain the development of the thyroid gland. (FA p130)

Thyroid diverticulum arises from floor of primitive pharynx, descends into neck. Foramen cecum = remant of thyroglossal duct

Which IV anesthetic fits the following description? (FA p434)

·         a/w hallucinations and bad dreams                      

·         most common drug used for endoscopy              

·         used for rapid anesthesia induction                     

·         decreases cerebral blood flow (important in brain surgery)      

·         a/w hallucinations and bad dreams                       Arycyclohexylamines (Ketamine)

·         most common drug used for endoscopy               Benzodiazepines

·         used for rapid anesthesia induction                      Propofol

·         decreases cerebral blood flow (important in brain surgery)          Barbituates

What is the mechanism of action and clinical use for methylphenidate? (FA p430)

Psychostimulant => ADHD

Increases activity of CNS by increasing dopamine in the brain

What is the most common urea cycle disorder?  What are the findings with this disorder? (FA p105)

Ornithine transcarbamoylase (OTC) deficiency : X-linked recessive. Interferes with ammonia elimination => orotic acid in blood and urine, decreased BUN, sx of hyperammonemia

What change is seen in Barrett’s esophagus?  (FA p310)

Glandular metaplasia => replacement of non-keratinized stratified squamous epithelium with intestinal columnar epithelium in the distal esophagus.

What is the equation for determining a drug’s clearance?  (FA p232)

Clearance = rate of elimination / plasma drug concentration 

What substance activates the classic complement pathway?  What substance activates the alternative compliment pathway? (FA p207)

Alternative = Microbial surfaces

Classic = Antigen-antibody complexes

In a normal Gaussian curve, what percentage of the sample population falls 1 standard deviation, 2 standard deviations, and 3 standard deviations? (FA p64)

1 = 68%

2 = 95%

3 = 99.7%

What is seen in Budd-Chiari syndrome?  What conditions are a/w Budd-Chiari syndrome? (FA p332)

Occluscion of IVC or hepatic vv w/ centrilobular congestion and necrosis => congestive liver disease

Associated withhypercoaguable state, polycythemia vera, pregnancy, and hepatocellular cariconam

What tests can be used to help detect the presence of an MI? (FA p272)

First 6 hours : ECG

After 4 hours : Cardiac Troponin I

CK-MB

AST

What is the equation for calculating the glomerular filtration rate?  (FA p459)

GFR = Uinulin x V/Pinulin = Cinulin

How long does it normally take for an antidepressant to start working? (FA p455)

2-4 weeks

What is the mechanism of action of cyclosporin? (FA p215)

Binds to cyclophilins. Complex blocks the differentiation and activation of T cells by inhibiting calcineurin, thus preventing the production of IL-2 and its receptor.

In which glomerular disease would you expect to see the following changes? (FA p445)

·         anti-GBM antibodies (immunoflourescence)                     

·         Kimmelstiel-Wilson lesions (light microscope)

·         “spike and dome” appearance (electron microscope) 

·         “tram track” of subendothelial humps (electron microscope)

·         subepithelial humps (electron microscope)  

·         anti-GBM antibodies (immunoflourescence)                     

·         Kimmelstiel-Wilson lesions (light microscope)                  Diabetic Glomerulonephropathy

·         “spike and dome” appearance (electron microscope)      Membranous glomeruolonephritis

·         “tram track” of subendothelial humps (electron microscope)       Membarnoproliferative glomerulonephritis

·         subepithelial humps (electron microscope)                         post-infectious glomerulonephritis

The most common cause of osteomyelitis in all patients is Staph. aureus.  What organism would you also suspect in a sickle cell pt with osteomyelitis?  What about a drug addict with osteomyelitis?  (FA p177)

Sickle Cell – Salmonella

Drug Addict – Pesudomonas aeruginosa

What amino acids are necessary for purine synthesis? (FA p68)

Glycine, Aspartate, Glutamine, THF

What is the rate-limiting enzyme for pyrimidine synthesis? for purine synthesis? (FA p95)

Pyrimidine – Carbamoyl phosphate synthetase II

Purine – Glutamine-PRPP amidotransferase

Glycine, Aspartate, Glutamine, THF

What is the rate-limiting enzyme for pyrimidine synthesis? for purine synthesis? (FA p95)

Pyrimidine – Carbamoyl phosphate synthetase II

Purine – Glutamine-PRPP amidotransferase

What are the common causes of dilated cardiomyopathy? (FA p273)

A, B, CCC, D

Alcohol abuse, Beriberi, Coxsackie B virus, chronic Cocaine use, Chagas’ disease, Doxorubicin toxicity

Also: hemochromatosis, peripartum cardiomyopathy

What hormone is detected in a positive urine pregnancy test?  How long after conception will this hormone first appear in the urine?  (FA p460)

hCG after 1 week from conception and at home by week 2

What structures give rise to the glomerular filtration barrier?  Which disease results from a loss of the negative charge glomerular filtration barrier? (FA p458)

Fenestrated capillary endothelium

Fused basement membrane with herparan sulfate (negative charged)

Epithelial layer consisting of podocyte foot processes

Dz : Nephrotic syndrome

What are the three symptoms of pellagra?  What are the causes of pellagra? (FA p95)

Cause : Vitamin B3 defeciency (niacin) or tryptophan

Sx : 4 D’s – diarrhea, dermatitis, dementia, death

What factors are considered when determining the loading dose and maintenance dose of a medication?  (FA p233)

Loading dose = target plasma concentration x volume of distribution divided by bioavailability

Maintenance dose = target plasma concentration x clearance  divided by bioavailability

What are the two types of diabetes insipidus?  What is the cause of each? (FA p300)

Central- pituitary tumor, trauma, surgery, histiocytosis X

Nephrogenic – herediatary or secondary to hypercalcemia, lithium, demeclocycline (ADH anatagonist)

What is the cause of cystinuria?  What is the treatment for cystinuria?  (FA p110)

Hereditary defect of renal tubular amino acid transporter for cysteine, ornithin, lysine, and arginine in the PCT of the kidneys

Tx: acetazolamide to alkalinize the urine

What is the WAGR complex? (FA p447)

Condition in which children are predisposed to develop a wilms tumor

What two drugs are given to those with organophosphate poisoning?  (FA p238)

Cholinesterase inhibitor poisoning (SLUDGE symptoms)

Atropine + Pralidoxime

What are some of the common causes of eosinophilia? (FA p343)

NAACP = Neoplastic, Asthma, Allergic processes, Collagen vascular diseases, Parasites

What antibiotics have the following mechanisms of action? (FA p184)

-          block DNA topoisomerase                              

-          block the synthesis of peptidoglycans          

-          block nucleotide synthesis                               

-          block mRNA synthesis       

-          block DNA topoisomerase                               Fluoroquinolones

-          block the synthesis of peptidoglycans           Bacitracin, Vancomycin

-          block nucleotide synthesis                                Sulfonamides, Trimethoprim

-          block mRNA synthesis                                      Rifampin

Compare the leading causes of death in ages 25-64 to those in ages 65+? (FA p56)

Cancer, heart disease, injuries

What are the risk factors for a fat embolus?  What are the risk factors for a pulmonary embolus? (FA p510)

Long bone fractures and liposuction

What structures arise from the Mesonephric ducts? What other name is given to the Mesonephric ducts? (FA p133)

Mesonephric Duct (aka Wolffian duct) => male internal structures (except prostate) – Epididymis, Ejaculatory duct, Ductus deferens.

Which lysosomal storage disease fits the following description? (FA p111)

·         cherry red spot on retina                                                        

·         corneal clouding + mental retardation                     

·         no corneal clouding + mental retardation                           

·         demyelinating disease affects peripheral nerves    

·         crinkled paper cytoplasm                                                       

·         sphingomyelin buildup                                                            

·         treatment is dialysis                                                                 

·         accumulation of galactocerebroside in the brain     

·         accumulation of glucocerebroside in the brain                

·         cherry red spot on retina                                                         Niemann-Pick Disease, Tay-Sachs

·         corneal clouding + mental retardation                                Hurler’s Syn

·         no corneal clouding + mental retardation                           Hunter’s Syn

·         demyelinating disease affects peripheral nerves               Fabry’s Disease

·         crinkled paper cytoplasm                                                        Gaucher’s Disease

·         sphingomyelin buildup                                                             Niemann-Pick Disease

·         treatment is dialysis                                                                 

·         accumulation of galactocerebroside in the brain              Krabbe’s Disease

·         accumulation of glucocerebroside in the brain                 Gaucher’s Disease

What are the Jones criteria for the diagnosis of acute rheumatic fever? (FA p267)

2 major or 1 major + 2 minor

Major : Migratory polyarthritis ; Carditis ; Subcutaneous nodules ; Erythema marginatum ; Sydenham’s chorea

Minor :  Fever, Arthralgia ; Raised erythrocyte sedimentation rate ; Leukocytosis ; ECG showing heart block ; evidence of strep infection ; previous rheumatic fever

What are some of the extrapulmonary causes of restrictive lung disease? (FA p511)

Goodpasture’s syndrome ; Wegener’s Granulomatosis ; Eosinophilic granulomatosis ; Drug Toxicity

What drug can be used to treat carcinoid syndrome? (FA p302)

Octreotide

What muscles compose the rotator cuff muscles? (FA p350)

Supraspinatus

Infraspinatus

Teres Minor

Subscapularis

What is the difference between Wernicke’s aphasia, Broca’s aphasia, and conduction aphasia? (FA p404)

Wernicke’s – Fluent aphasia with impaired comprehension (superior temporal gyrus)

Broca’s – Nonfluent aphasia with intact comprehension (inferior frontal gyrus)

Conduction – Poor repetition but fluent speech, intact comprehension. (arcuate fasciculus)

How do nicotinic acetylcholine receptors differ from muscarinic acetylcholine receptors in their mechanisms of action? (FA p235)

Nicotinic – ligand-gated Na+/K+ channels

Muscarinic – G-protein-coupled receptors that act through secondary messengers

What structures are injured in an unhappy triad knee injury? (FA p370)

Which fungal infection fits the following description? (FA p155- FA p157)

-          causes diaper rash

-          opportunistic mold with septate hyphae that branch at a 45 degree angle

-          opportunistic mold with irregular nonspetate hyphae that branch at wide angles (>90 degrees)

-          dimorphic fungi common to SW US (San Joaquin Valley fever)

-          causes thrush in immunocompromised pts and vulvovaginitis in women

-          dimorphic fungi with broad-based budding yeast

-          known for causing pneumonia in AIDS pts ® start Bactrim prophylaxis when CD4 <200

-          dimorphic fungi common to Mississippi and Ohio river valleys

-          causes a skin infection in those pricked by a thorn

-          yeast known for causing meningitis in AIDS pts

-          causes diaper rash                      Candida Albicans

-          opportunistic mold with septate hyphae that branch at a

-          45 degree angle opportunistic mold with irregular nonspetate                             Aspergillus fumigatus

hyphae that branch at wide angles (>90 degrees)

-          dimorphic fungi common to SW US (San Joaquin Valley fever)                          Coccidiodomycosis

-          causes thrush in immunocompromised pts and vulvovaginitis in women           Candida Albicans

-          dimorphic fungi with broad-based budding yeast                                                     Blastomycosis

-          known for causing pneumonia in AIDS pts ® start Bactrim                                 Pneumocystis Jiroveci

prophylaxis when CD4 <200

-          dimorphic fungi common to Mississippi and Ohio river valleys                          Histoplasmosis

-          causes a skin infection in those pricked by a thorn                                                   Sporothrix Schenckii

-          yeast known for causing meningitis in AIDS pts                                                        Cryptococcus neoformas

What is the antidote for t-PA or streptokinase overdose? (FA p243)

Aminocaproic Acid

What is ankylosing spondylitis?  What is the typical profile of a pt with ankylosing spondylitis?  (FA p364)

Chronic inflammatory disease of spine and sacroiliac joints => ankylosis (stiff spine due to fusion of the joints) ;      uveitis ; aortic regurgitation

Where would you expect to find type I collage?  type II collage?  (FA p84)

Type I – Bone, Skin, Tendon

Type II - Cartilage

Describe how bromocriptine inhibits prolactin secretion. (FA p290)

By increasing dopamine release from hypothalamus

How do NSAIDS cause renal damage? (FA p463)

Inhibit renal production of prostaglandins, which keep the afferent arterioles vasodilated to maintain GFR

What is the underlying problem in the following jaundice causing diseases?  What form of bilirubin is elevated in the serum in each disease? (FA p319)

Gilbert’s syndrome-

Crigler-Najjar syndrome (type I)-

Dubin-Johnson syndrome-

Gilbert’s syndrome-                                          bilirubin uptake => increased unconjugated

Crigler-Najjar syndrome (type I)- bilirubin conjugation  => increased unconjuated

Dubin-Johnson syndrome-                               bilirubin excretion => increased conjugated

What is Lambert-Eaton syndrome?  Which neoplasms can cause Eaton-Lambert syndrome? (FA p386))

Autoantibodies to presynaptic Ca2+ ch => decreased AcH release => proximal mm weakness.

Small-cell lung cancer

Where are T cells found in the spleen?  Where are B cells found in the spleen? (FA p201)

T-cells in white pulp and periarterial lymphatic sheath

B-cells in follicles of white pulp

What gives rise to the jugular venous a, c, and v waves? (FA p257)

A wave = atrial contraction

C wave = RV contraction (tricuspid bulge)

V wave = increased right atrial pressure due to filling against closed valve

What are the beta-1-selective beta-blockers?  (FA p242)

Acebutolol ; Betaxolol ; Esmolol ; Atenolol ; Metoprolol

What embryologic buds give rise to the pancreas? (FA p131)

Dorsal and ventral pancreatic buds

What enzymes do obligate anaerobes lack?  (FA p139)

In which pt populations is Aztreonam a good choice?  Against which organisms is this antibiotic effective? (FA p180)

For pencillin-allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides

Good against Gram (-) Rods

By what mechanism is digoxin a positive inotrope? (FA p283)

Inhibits Na+/K+ ATPase => indirect inhibition of Na+/Ca2+ exchanger/antiport => increased concentration of Ca2+ => increased contractility

What are some of the signs and symptoms of Parkinson’s disease? (FA p401)

TRAP = Tremor ; Rigidity ; Akinesia ; Postural instability

Describe the steps involved in the pupillary light reflex.  (FA p400)

1. Enter’s retina

2. signal sent via CNII to pretectal nucleus

3. Activates Edinger-Westphal nuclei

4. pupils contract b/l

What is the function of the nucleus of the solitary tract?  nucleus ambiguous?  dorsal motor nucleus?  (FA p417)

Nucleus Solitarius – Visceral sensory info (taste, baroreceptors, gut distension)

Nucleus Ambiguus – Motor innervations of pharynx, larynx, and upper esophagus (swallowing, palate elevation)

Dorsal motor nucleus – Sends autonomic (parasym) fibers to heart, lungs, upper GI

What is the site of action of the following diuretic? (FA p450)

thiazide diuretic-

loop diuretic-

carbonic anhydrase inhibitor-

osmotic diuretic-

potassium sparing diuretic-

ADH antagonist-

thiazide diuretic-                                Inhibit NaCl reabsorption in early distal tubule

loop diuretic-                                       Inhibit cotransport system (Na, K, Cl) of thick ascending limb

carbonic anhydrase inhibitor-        Self-ltd NaHCO3, diereses and reduction in total body HCO3 stores (bottom of the loop of henle)

osmotic diuretic-                                                Increase tubular fluid osmolarity, producing increase urine flow (proximal)

potassium sparing diuretic-             Compretitive aldosterone inhibitor - Collecting duct

What diagnostic test allows you to distinguish between primary hyperaldosteronism (Conn’s syndrome) and secondary hyperaldosteronism? Which diuretic is often used in the treatment of hyperaldosteronism?  (FA p296)

Check Renin lvls (elevated in secondary)

Tx : Surgery to remove tumor or spirinolactone, (K+ sparing diuretic)

What centrally acting alpha-2 agonist is commonly used to treat hypertension (esp. in pts with renal disease)? (FA p241)

Clonidine ; alpha-methyldopa

What are 4 examples of encapsulated bacteria?  What test can be used to detect encapsulated bacteria?  (FA p139)

Strep. pneumoniae ; Klebsiella pneumonie ; Haemophilus influenza type B ; Neisseria meningitides ; Salmonella

Quellung reaction :  if encapsulated bug is present => capsule swells

In what time frame would you expect to see delirium tremens in an alcoholic? What are the manifestations of delirium tremens? (FA p451)

2-5 days after the last drink.

Sx : autonomic system hyperactivity (tachycardia, tremors, anxiety, seizures) ; psychotic symptoms (hallucination delusions) confusion.

Describe how ammonium is shuttled out of muscle tissue to create urea in the liver.  (FA p108)

Amino acids (NH3) react with alpha-ketoglutarate to produce alpha ketoacids and glumate (NH3), which then reacts with pyruvate to transfer the NH3 to alanine which travels to the liver

What is the main function of vitamin C? (FA p93)

Antioxidant (Iron absorption ; collagen synthesis ; converts dopamine to NE)

Compare the mechanism of action of zileuton to that of zafirlukast.  (FA p515)

Anti-leukotrienese

Zileuton – 5-lipoxygenase pathway inhibitor (blocks conversion of arachidonic acid to leukotrienes)

Zafirlukast – block leukotriene receptors. 

Which branchial pouch gives rise to the following mature structures? (FA p130)

·         middle ear cavity and eustachian tube

·         superior parathyroids

·         inferior parathyroids

·         thymus

·         mastoid air cells

·         epithelial lining of palatine tonsil

·         middle ear cavity and eustachian tube                 1^st

·         superior parathyroids                        4^th (dorsal wings)

·         inferior parathyroids                        3^rd (dorsal wings)

·       thymus                                        3^rd (ventral wings)

·         mastoid air cells                                          1^st

·         epithelial lining of palatine tonsil           2^nd

What substance is used to close a patent ductus arteriosus?  What substance is used to keep it open?  When might you want to keep a PDA open? (FA p268)

Close = NSAIDs (Indomethacin)

Open = prostaglandins => transposition of vessels

What is internuclear opthalmoplegia? (FA p424)

Lesion in the medial longitundinal fasiculus => medial rectus palsy, nystagmus in abduction

                Seen in MS

Which hormones are the precursors of estrogen? What enzyme catalyzes this reaction? (FA p282)

Aromatase

Androstenedione => Estrone

Testosterone => Estradiol

What are the R’s of Rifampin? (FA p185)

RNA polymerase inhibitor

Rev’s up cytochrome P-450

Red/orange body secretions

Rapid resistance if used alone

Which antifungal drug fits the following description? (FA p186 - FA p187)

-          swish and swallow for oral candidiasis (thrush)

-          side effect: nephrotoxicity

-          deposits in keratin-containing tissue (nails)

-          used for cryptococcal meningitis in AIDS

-          side effect: teratogenic, carcinogenic

-          swish and swallow for oral candidiasis (thrush)  Nystatin

-          side effect: nephrotoxicityb                     Amphotericin B

-          deposits in keratin-containing tissue (nails)     Terbinafine

-          used for cryptococcal meningitis in AIDS           Azoles

-          side effect: teratogenic, carcinogenic          griseofulvin

STOP Making New Thrombi

Sepsis (gram -)

Trauma

Obstetric complications

acute Pancreatitis

Malignancy

Nephrotic sx

Transfusion

What are the atypical antipsychotics?

What are they used for?

"It's atypical for Old closets to quietly risper from A to Z"

Olanzapine, clozapine, quetiapine, risperidone, aripiprazole, ziprasidone

Used for negative and positive symptoms of Schizophrenia

Enzyme : Lysosomal alpha-1,4-glucosidase

Findings : Cardiomegaly and systemic findings => early death

Enzyme : Debranching enzyme (alpha-1,6-glucosidase)

Findings : Milder form of Von Gierke's with normal blood lactate lvls

Note : Glucogenesis is in tact

Enzyme : Skeletal mm glycogen phosphorylase

Findings : increased in mm, but cannot break it down => painful mm cramps, myoglobinuria with strenuous exercise

1. Inferior epigastric artery

2. Lateral border of rectus abdominis

3. Inguinal ligament

Penetration of bowel through Hesselbach's triangle = direct hernia

They both include impaired flow of aqueous humor => increased intraocular pressure => optic disc atrophy with cupping.

Open/widened angle = obstructed outflow => silent/painless SE

Closed/narrow angle = obstruction of flow between iris and lens => pressure build up between iris and lens => severe pain, rock hard eye, and frontal headache

MOA : inhibits DNA-dependent RNA polymerase

CU : Mycobacterium tuberculosis (prophylaxis and chemoprophylaxis for those exposed to children with H.Inf(typeB)

SE : Minor hepatotoxicity, drug interactions with P450, orange bodily fluids

Hereditary angioedema

MOA : Inhibits cell wall mucopeptide formation by binding D-ala D-ala portion of cell wall precursors. Bactericidal.

CU : Gram positive only - MRSA and C.Dif

SE : Nephrotoxicity, Ototoxicity, Thrombophlebitis, diffuse flushing - "red man syndrome"

Vichow's Triad

1. Stasis

2. Hypercoagulability

3. Endothelial damage

Homan's sign - dorsiflexion of foot => tender calf muscle