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most likely complication of digoxin
arrythmias due to hyperkalemia
Conditions that are polygenic
- androgenic alopecia (baldness) with variable pentrance in males and females
- heart disease
- type II DM
Side effects of a drug prescribed for bradycardia
- acute closed angle glaucoma in elderly (increases IOP)
- hyperthermia in infants
- M3 antagonist ae.
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
replacement of G with C in the B-globin gene mRNA upstream from the AUG codon
Allergic bronchopulmonary aspergillosis
- hx of bronchial asthma
- high IgE levels (eosinophilia)
- IgG antibodies against aspergillus
- recurrent pulmonary infiltrates and proximal brochiectasis
- 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)
ulcer location on the terminal sulcus 1 cm anterior to the foramen cecum. pain sensation by what nerve?
mandibular br. of the trigeminal nerve
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
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
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)
- increases K efflux out of cells
patient dies of middle cerebral artery thrombosis and old renal infarcts. vitamin deficiency?
- (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
- gingival hyperplasia
- bradycardia --> AV block
Drug used to treat absence seizures and tonic-clonic seizures
- 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?
- 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?
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
- 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?
- (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?
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?
- necrolytic erythema (erythematous rash over the lower extremities especially groin area)
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
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?
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
- anti-histamine (H1) with non-specific serotonin antagonist effects
purine analog that achieves high  because of its resistance to degradation by adenosine deaminase
- 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
- mild dehydration of the RBC