KYCOM Block 11

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Oseltamivir is given orally to treat influenza type A and B. It is important to know that it must be given within ___________ hours of illness onset.

horizontal (10 degrees in kids, 40 for adults)

Otitis Media is more common in infants and young children because of the _____________________ angle of the Eustachian tube, allowing pathogens from the nasal pharynx to go to the ear easier. The angle chances because of vertical growth of the skull.

Malignancy (cancer)

Petechiae is indicative of thrombocytopenia and is usually associated with ITP, but if the child also has hepatosplenomegaly and fever of unknown origin and headaches, it could be a red flag of a ______________________.

bone marrow

Pseudorosettes are clumps of tumor cells that are characteristic of a neuroblastoma that has metastasized to the _________________.

left-sided heart failure

Pulmonary edema is when the lungs are 2-3x normal weight, with frothy-blood-tinged fluid. It is most commonly caused by ____________________________.

hydroxyamphetamine

This is a drug used to localize the lesion in Horner's syndrome. It causes release of NE, so it will dilate the normal pupil in a 1st or 2nd order lesion, but will not in a 3rd order lesion.

dry eyes

Treatment of this condition include: artificial tears (first choice and least invasive), lubricating ointment at night, punctual occlusion, and environmental modification.

increases outflow

Muscarinic agonists like pilocarpine can be used to treat glaucoma. It lowers IOP by _________________________ (increasing outflow or decreasing production) of aqueous humor.

mydriasis (dilation), cycloplegia (accommodation to far vision, paralysis of accommodation, won't have the M3 ciliary muscle)

Muscarinic antagonism causes which two things?

glaucoma

Muscarinic antagonists are used for dilated eye exams but may decrease aqueous humor outflow and cause increased IOP. Therefore, it is important to check for _________________ in your patient before you do a dilated eye exam.

miosis (contraction), accommodation (near vision)

Muscarinic stimulation of the eye causes which two things?

GTPase

Mutant RAS lose ______________ activity, making it constitutively activated. It cannot be dephosphorylated so it cannot shut itself off.

dominant

Mutant growth factor protein receptors deliver continuous mitogenic signals to cells. An example of this is constitutive activation of EGF receptor in absence of EGF or TFG-a.

Lowenstein-Jensen (agar)

Mycobacteria is difficult to culture because they grow so slowly. They typically grow faster in liquid than in solid media, but are still grown on solid media such as the _________________________________ agar.

cold (abscess)

Mycobacterial adenitis can form which type of abscesses that have little or no sign of warmth or overlying inflammation early in the course of the adenitis?

thoracic aorta (and branches of the middle cerebral artery)

Mycotic aneurysms are aneurysms arising from infection of the arterial wall, usually bacterial, and seen in infective endocarditis and IV drug use. What are the common locations it is seen at?

PCP (phencyclidine), ketamine

NMDA receptors play a role in synaptic plasticity related to learning and memory and is blocked by anesthetic ____________ and _______________.

OH (hydroxyl)

Nucleoside reverse transcriptase inhibitors (NRTIs) are called chain terminators because when they get implemented into the DNA chain, they lack a 3' _______________ group, thereby stopping the chain formation and replication.

Munchausen syndrome

A rare cause of diarrhea is ________________________ caused by proxy-laxative abuse.

asthma

A side effect of nonselective beta blocker eye drops like timolol is that it can cause _________________.

G6PD deficient

A side effect of primaquine (tissue schizonticide) is that it can cause hemolysis in ____________________________ patients.

acute

Acute or chronic segmental facilitation? Increased temperature, increased moisture or skin drag, prolonged red reflux, boggy and fusiform muscular changes, articular motion restrictions without a firm, stiff end point.

chronic

Acute or chronic segmental facilitation? Thickened skin and subcutaneous tissues, rapidly fading red reflex, localized muscle contraction, hard muscles, stiff joints with firm end feel.

Hep B (even though emtricitabine/lamivudine and tenofovir used for HIV, can also be used for Hep B)

Adefovir with Interferon-a used to be the treatment options for ____________________ but they are extremely toxic with myelosuppression and other bad effects. New treatment options include use of emtricitabine and tenofovir.

EGF (epidermal growth factor receptor VIII to be specific)

Adenocarcinoma with constitutive activation of the __________ receptor is seen with increased frequency among East Asian populations.

Central adiposity (central fat distribution), insulin resistance (hyperglycemia)

Adverse effects of all protease inhibitors include disordered lipid and carbohydrate metabolism, leading to which two effects?

prolactin (causes amenorrhea and galactorrhea in women, and gynecomastia in men)

Adverse effects of dopamine D2 blockers (drugs for schizophrenia) on the endocrine system include increased ___________________ levels (all typical and risperidone), because dopamine naturally inhibits it.

MAOi (monoamine oxidase inhibitor), tyramine (like red wine and cheese)

Phenelzine and tranylcypromine are ____________________ (drug class) and can be used to treat depressive disorders. However they have many side effects, including a hypertensive crisis with foods containing ___________________, and also serotonin syndrome.

heme

Chloroquine is a blood schizonticide that causes accumulation of toxic _____________ in the parasite. Resistance is due to decreased drug accumulated in the parasite due to the action of efflux pumps on the membrane.

Chronic diarrhea (increased frequency and fluidity of stool) is usually defined as lasting for _______ days or longer.

coccidioidomycosis

Complement fixation is a test that measure complement-consuming antibodies in serum or CSF. The test is used for the diagnosis of some viral and fungal infections, particularly ______________________________.

girls (shorter urethra, perineal colonization)

Do boys or girls have a higher risk of a urinary tract infection (UTI)?

Yes

Does this describe a Chapman's point? It must be discretely palpable, very tender, and have tissue texture changes. There is no radiation and they are not relieved by stretching or shortening the muscle (because they're not in the muscle)

slow inhibitory (because mainly D2 receptors)

Dopamine is found in the brain and brainstem, like in the substantial nigra and hypothalamus. Dopamine generally exerts a ___________________ (slow or fast) ____________________ (inhibitory or excitatory) action on CNS neurons.

prolactin

Dopamine is involved in the tuberoinfundibulnar tract to inhibit ________________, and is involved in maternal behavior.

above (like femoral, iliac, popliteal, the ones under the knee are too small)

Pulmonary thromboembolism is a very significant cause of death in the US, with most emboli originating from deep leg veins above or below the level of the knee?

ceftriaxone (also cefotaxime)

Pyelonephritis (inflammation of the kidney, typically due to a bacterial infection like E.coli coming from a UTI) is treated with IV antibiotics (not oral). What is the drug of choice for pyelonephritis?

E2F

Rb is a tumor suppressor protein that is normally bound to ________________, not allowing it to go to the nucleus to drive cell replication. When Rb is phosphorylated/absent/non-functional, it is no longer bound to it.

SSRIs (selective serotonin reuptake inhibitors)

Escitalopram, paroxetine, and sertraline are all examples of what class of drug?

lymphatic (carcinoma), hematogenous (sarcoma)

Extravasation of a metastatic tumor can be predicted by which type of tumor it is. Carcinomas usually have a ________________ spread, while sarcomas usually go with a ___________________ route.

lipoprotein

Genetic derangements in ___________________ metabolism is a huge risk factor for atherosclerosis. Hypertension, diabetes, hyperlipidemia, cigarette smoking are all other risk factors for atherosclerosis.

M, a1

TCAs (tricyclic antidepressants) are not used as first line drugs because of their side effects. It is mostly related to a block of ________ receptors, causing dry mouth, tachycardia, sedation, and weight gain, as well as block of _________ receptors, which can cause orthostatic hypotension and tachycardia.

bronchogenic carcinoma, mediastinal lymphoma

Superior vena cava syndrome is caused by a neoplasm compressing or invading the SVC. It is mainly associated with which two diseases?

lengthens (lifts medial longitudinal arch)

Supination (adduction, plantar flexion, inversion) effectively _____________ (lengthens or shortens) the leg.

cocaine

This is a drug that is used as a diagnostic for Horner's syndrome (if taken and no dilation, then confirms). It works by blocks NE uptake, which dilates the pupil, and has no effect in Horner's syndrome regardless of location.

disruption

Genetic syndromes can happen because of types of problems in morphogenesis. Which type of sequence is caused by a breakdown of normal tissue, like Pierre-Robin syndrome (micrognathia and cleft palate)?

dysplasia

Genetic syndromes can happen because of types of problems in morphogenesis. Which type of sequence is caused by abnormal organization of cells in a tissue, like polycystic kidney disease?

malformation

Genetic syndromes can happen because of types of problems in morphogenesis. Which type of sequence is caused by poor formation of the tissue?

deformation

Genetic syndromes can happen because of types of problems in morphogenesis. Which type of sequence is caused by unusual forces on normal tissue, like clubbed foot?

2 NRTIs (emtricitabine or lamivudine + zidovudine or tenofovir), 2 PIs (ritonavir + atazanavir or lopinavir)

HIV treatment during pregnancy should include what?

Crohn's disease (it is never ulcerative colitis, it is continuous)

If you see discontinuous/skip lesions, is that more common in Crohn's disease or ulcerative colitis?

x-ray, CT

If you suspect an intraocular foreign body, what two tests could you obtain in order to scan the orbit?

full sepsis (CBC, blood culture, CXR, urinalysis and culture, and spinal tap)

If your patient has a high fever of unknown origin for less than two months and you can't figure out the focus, what type of work up should be done?

bacteremia (CBC, blood culture, CXR, urinalysis and culture, NO spinal tap)

If your patient has a high fever of unknown origin for over 2 months and you can't figure out the focus, what type of work up should be done?

endoscopy with esophageal biopsy

In kids younger than 1 year, an esophageal pH study can be used to see if there is gastric reflux. What is the test of choice for older kids to see if there is reflux?

inhibitory (5-HT1a receptors and GABA-B receptors share the same potassium channel)

In most areas of the CNS, 5-HT has a strong ____________________ action.

laminin

In order for tumor cells to invade the ECM, the tumor cells must attach to the matrix components. Carcinoma cells have ________________ receptors all around the cell membrane to do this.

E-cadherin

In order for tumor cells to invade the ECM, they must first detach from each other. Because of this, ____________________ function is lost in almost all epithelial cell cancers.

isoniazid, pyrazinamide, ethambutol

Of the 5 1st line drugs used for M. tuberculosis, which ones are TB-specific? (Isoniazid, rifampin, pyrazinamide, ethambutol, streptomycin)

rifampin, streptomycin

Of the 5 1st line drugs used for M. tuberculosis, which ones are multipurpose drugs? (Isoniazid, rifampin, pyrazinamide, ethambutol, streptomycin)

iodine (parasites), methylene blue (leukocytes)

On a direct wet mount, feces + _______________ can show fecal parasites. Feces + _________________________ can show fecal leukocytes.

glaucoma

On posterior segment exam of the eye, if you see a large C/D ratio (cup/disc) with an asymmetry of 0.2 or larger, what do you suspect?

prednisone

Once temporal/giant cell arteritis is diagnosed, high dose ___________________ should be started as soon as possible.

lorazepam

One of the main goals when treating status epilepticus is to stop the seizure, so a drug that has rapid onset of action with a relatively prolonged duration is good. What is the best drug for that?

India Ink (background field rather than organism is stained so the organism looks like a halo)

What stain do you use to visual Cryptococcus neoformans (the only encapsulated pathogenic yeast)?

silver (stain)

What stain is used to visual Pneumocytis jiroveci?

SMX/TMP (bactrim)

What systemic oral antibiotic can be used to treat impetigo? Topical antibiotics can be used as well. It is also important to decolonize the skin.

strabismus (or tropia)

When doing a Hirschberg test and the reflexes change between a monocular vs binocular view, what does this represent?

shigella

When doing a comparison of clinical findings in acute infectious diarrhea, which one(s) do you commonly see bronchitis in? (of shigella, salmonella, campylobacter, and rotavirus)

salmonella, rotavirus

When doing a comparison of clinical findings in acute infectious diarrhea, which one(s) do you commonly see vomiting in? (of shigella, salmonella, campylobacter, and rotavirus)

vWF (von Willebrand factor), CD31

When doing immunohistochemistry for angiosarcomas, the endothelial cells are positive for _________ and _____________.

leukocytes (PMNs)

When examining stool smears, presence of ______________________ usually indicates that the origin of the diarrhea is bacterial, while lack of them means it is viral.

epithelial (like happens in epithelium of the organ)

When naming tumors, if the tumor is malignant, the root "carcin-" is added if the tumor is of ____________________ origin.

mesenchymal

When naming tumors, if the tumor is malignant, the root "sarc-" is added if the tumor is of _______________________ origin.

female

When observing a _______ (male or female) patient with a UTI and pyelonephritis, there is no need to do a renal sonogram after the first UTI. After 2nd UTI, do a renal sonogram and a VCUG (voiding cystourethrogram).

male

When observing a _______ (male or female) patient with a UTI and pyelonephritis, there is no need to do a renal sonogram after the first UTI. After 2nd UTI, do a renal sonogram. After the 3rd UTI, do a VCUG (voiding cystourethrogram).

macrolides (like erythromycin, azithromycin, clarithromycin)

Which antibiotics have good activities against gram positive cocci and atypicals, such as Chlamydia, mycoplasma, and legionella?

ganciclovir

Which antiherpes drug has the adverse effect of bone marrow suppression?

cidofovir

Which antiherpes drug is only activated by host kinases and is useful in TK- (thymidine kinase, the viral enzyme that phosphorylates the drug 100x faster than host enzymes) strains of Herpes?

clozapine

Which atypical antipsychotic, in addition to being a 5-HT2 blocker, is also a H1 blocker (causing sedation), D4 blocker, and must have WBC counted weekly?

Klebsiella (pneumoniae), E. Coli, Enterobacter (cloacae)

Which bacteria are lactose fermenters?

von Willebrand disease

Which bleeding disorder is characterized by platelets not being able to bind to collagen even with normal Gp1b and GpIIb-IIIa receptors?

Glanzmann thrombasthenia

Which bleeding disorder is characterized by platelets not being able to bind to each other through fibrinogen due to lack of GpIIb-IIIa receptor complex?

chloroquine

Which blood schizonticide prevents polymerization of the hemoglobin breakdown product heme into hemozoin, therefore making intracellular heme accumulation toxic to the parasite?

lung (and bronchus)

Which cancer is the leading cause of death in men and women?

nematodes (trematodes lack a digestive tract and cestodes lack a digestive tract and mouth)

Which category of helminths is the only one that has a digestive tract? Nematodes/roundworms, trematodes/flukes/flatworms, or cestodes/tapeworms?

macrolide(s)

Which class of antibiotics stimulate motion receptors and cause GI distress? They can also cause reversible deafness at high doses.

Which dopamine receptor is the most prominent in the CNS and opens potassium channels via Gi?

SNRIs (serotonin norepinephrine reuptake inhibitors)

Which drug has a mechanism of action of blocking both SERT and NET to inhibit the reuptake of serotonin and norepinephrine to prolong their action?

first (cefozolin, cephalexin)

Which generation cephalosporins can be used for surgical prophylaxis, strep, MSSA, and cannot enter the CNS?

H1 (H2 is G2, H3 and H4 are Gi)

Which histamine receptor causes decreased K+ conductance and increased IP3 and DAG? The most prominent ones are located on glia and vessels as well as various neurons. Inhibition of this receptor also causes drowsiness.

methotrexate

Which inhibitor of folic acid synthesis can inhibit dihydrofolate reductase (just like trimethoprim and pyrimethamine) and can also be used for cancer or rheumatoid arthritis?

appendix

Which organ(s) has a posterior Chapman's point at the right T11 transverse process?

liver

Which organ(s) has a posterior Chapman's point at the right T5 and T6 transverse processes?

gallbladder

Which organ(s) has a posterior Chapman's point at the right T6 transverse process?

pancreas

Which organ(s) has a posterior Chapman's point at the right T7 transverse process?

pyloris

Which organ(s) has a posterior Chapman's point at the right T9 transverse processes?

Intestine peristalsis

Which organ(s) has a posterior Chapman's point between T10 and T11 transverse processes?

cerebellum

Which organ(s) has a posterior Chapman's point superior to the C1 transverse process?

kidneys

Which organ(s) has an anterior Chapman's point 1'' lateral and 1'' superior to the umbilicus?

adrenals

Which organ(s) has an anterior Chapman's point 1'' lateral and 2'' superior to the umbilicus?

intestine peristalsis

Which organ(s) has an anterior Chapman's point 1-2'' inferior and lateral to the ASIS?

colon

Which organ(s) has an anterior Chapman's point at the anterior iliotibial bands?

uterus

Which organ(s) has an anterior Chapman's point at the inferior pubic rami?

prostate, broad ligament

Which organ(s) has an anterior Chapman's point at the lateral iliotibial bands?

retina, conjunctiva

Which organ(s) has an anterior Chapman's point at the lateral superior humerus?

stomach acidity

Which organ(s) has an anterior Chapman's point at the left medial 5th intercostal space?

stomach peristalsis

Which organ(s) has an anterior Chapman's point at the left medial 6th intercostal space?

spleen

Which organ(s) has an anterior Chapman's point at the left medial 7th intercostal space?

rectum

Which organ(s) has an anterior Chapman's point at the lesser trochanters?

esophagus, thyroid, heart, bronchus

Which organ(s) has an anterior Chapman's point at the medial 2nd intercostal spaces?

tongue

Which organ(s) has an anterior Chapman's point at the medial 2nd ribs?

upper lung

Which organ(s) has an anterior Chapman's point at the medial 3rd intercostal spaces?

lower lung

Which organ(s) has an anterior Chapman's point at the medial 4th intercostal spaces?

small intestine

Which organ(s) has an anterior Chapman's point at the medial 8th and 10th intercostal space?

(nasal) sinuses

Which organ(s) has an anterior Chapman's point at the medial inferior clavicles?

neck

Which organ(s) has an anterior Chapman's point at the medial superior humerus?

tonsils

Which organ(s) has an anterior Chapman's point at the middle lateral edge of the manubrium?

middle ear

Which organ(s) has an anterior Chapman's point at the middle superior clavicle?

pyloris

Which organ(s) has an anterior Chapman's point at the midline body of the sternum?

bladder

Which organ(s) has an anterior Chapman's point at the periumbilical area?

ovaries, urethra

Which organ(s) has an anterior Chapman's point at the pubic tubercles?

liver

Which organ(s) has an anterior Chapman's point at the right medial 5th and 6th intercostal spaces?

gallbladder

Which organ(s) has an anterior Chapman's point at the right medial 6th intercostal space?

pancreas

Which organ(s) has an anterior Chapman's point at the right medial 7th intercostal space?

appendix

Which organ(s) has an anterior Chapman's point at the right tip of the 12th rib?

pharynx

Which organ(s) has an anterior Chapman's point at the superior lateral edge of the manubrium?

cerebellum

Which organ(s) has an anterior Chapman's point at the tip of the coracoid process?

strep pneumo

Which organism is the most likely one to cause bacteremia?

caseous (necrosis)

Which pattern of necrosis has a cheese-like morphology, has loss of tissue architecture, is like a granuloma, and is characteristic of a tuberculosis infection?

liquefactive (necrosis)

Which pattern of necrosis has pus if it is active and is characteristic of bacterial or fungal infections or a brain infarct?

neuroblastoma

Which pediatric malignancy has bluish tinged subcutaneous nodules that are like blueberry muffins?

sexual dysfunction (such as delayed orgasm and diminished arousal)

Which side effect of SSRIs is one of the main reasons for discontinuation?

cyclothymia

Which type of Bipolar disorder has hypomania but less severe form of depression? It is a chronic fluctuation between sub syndrome depressive and hypomanic episodes.

(bipolar) I

Which type of Bipolar disorder has one or more manic or mixed episodes at any time? No depression, just manic episodes.

(bipolar) II

Which type of Bipolar disorder has recurrent major depressive episodes with hypomanic episodes?

stomach (perhaps to do with the diet)

Which type of cancer is more common in Japan than in the United States? The United States has more breast cancer.

JC, BK (human polyomaviruses)

What are two viruses (same family, two different ones) that can cause UTIs? During pregnancy, they can reactivate, and reactivation also occurs in immunocompromised patients and lead to hemorrhagic cystitis.

yersinia

What bacteria is transmitted through food/water/wild and domestic animals, etc, usually in cool weather? They will have diarrhea, blood in stools, vomiting, fever, signs that are like appendicitis, etc.

H. pylori

What bacteria that causes duodenal ulcers is treated with an H2 antagonist, amoxicillin or tetracycline, metronidazole, and bismuth subsalicylate?

maxillary, palatine, zygomatic

What bones make up the orbital floor?

NNRTI (non-nucleotide reverse transcriptase inhibitor)

What class of drug is efavirenz, a drug used to treat HIV, usually in combination with?

Fusion inhibitor

What class of drug is enfuvirtide and maraviroc, drugs used to treat HIV?

NtRTI (nucleotide reverse transcriptase inhibitors)

What class of drug is tenofovir (TDF), a drug used to treat HIV?

Integrase inhibitor(s)

What class of drugs are Raltegravir, Dolutegravir, and Elvitegravir? They can be used to treat HIV.

Non-BZ GABA-A agonists

What class of drugs are Zolpidem, Zalephon, and Eszopiclone? They are potential drugs used to treat insomnia by binding to the BZ1 receptor for sedation.

Protease inhibitors (PIs)

What class of drugs are ritonavir, lopinavir, atazanavir, and darunavir?

pseudorosettes

What do you see on biopsy specimen for a person with neuroblastoma? They are clumps of tumor cells and are characteristic of a neuroblastoma metastasized to the bone marrow.

Gabapentin

What drug can be used for the neuropathic pain caused by Herpes Zoster/Shingles?

diloxanide

What drug can be used to treat mild amebiasis?

prostaglandins (next is beta blockers, then other adrenergic agonists or carbonic anhydrase inhibitors)

What drug class is the first line for glaucoma?

epinephrine

What drug do you first want to use for anaphylaxis?

strep

What gram positive bacteria look like chains on gram stain?

Staph

What gram positive bacteria looks like clusters of grapes on gram stain?

collagen

What initiates the intrinsic pathway for the coagulation cascade? It goes from 12 to 11 to 9, works with 8 to activate 10, then works with 5 to activate 2, then to 1.

succinylcholine

What is a Nm agonist that persistently stimulates skeletal muscle until it causes paralysis? It may cause hyperkalemia and can be treated by Dantrolene (block calcium release from SR).

concussion

What is a complex pathophysiologic process affecting the brain, induced by traumatic biochemical forces? It can be caused by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head. Usually has rapid onset of short lived impairment of neurological function that resolves spontaneously. It may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury. Standard neuroimaging studies may be normal.

status epilepticus

What is a continuous convulsion lasting over 30 minutes/serial convulsions without normal consciousness in between?

eflornithine (gets to the CNS and is much less toxic than melarsoprol)

What is a drug that can treat the 2nd stage T. brucei gambiense species of African trypanosomiasis (African sleeping sickness)?

melarsoprol (highly toxic and can cause fatal reactive encephalopathy)

What is a drug that can treat the 2nd stage T. brucei rhodesiense species of African trypanosomiasis (African sleeping sickness)?

SMX/TMP (sulfamethoxazole, trimethoprim)

What is the antibiotics of choice to treat a urinary tract infection?

Protein C

What is the anticoagulant that cleaves (stops) cofactors V and VIII?

mycobacteria (tuberculosos, or atypical mycobacteria)

What is the bacteria that causes cold abscesses? It is a low-grade inflammation and no rapid accumulation of pus there. There is a slow stretching of the skin so it is not very tender and not warm to touch as well.

mycoplasma (also strep pneumonia)

What is the bacterial cause of bullous otitis media (bullous myringitis)? It will cause excruciating ear pain because the bullous is in the same layer as the pain fibers.

mefloquine

What is the blood schizonticide that is used primarily as the drug for prophylaxis of malaria in chloroquine-resistant areas?

Reed-Sternberg cell (also called Owl's eye cells)

What is the cardinal histologic feature of Hodgkin's Lymphoma? It will be found in the lymph nodes.

Aflatoxin (B1, produced by aspergillus)

What is the chemical carcinogen that causes a greater incidence of hepatocellular carcinoma in Africa?

quinine

What is the main anti-malaria drug that you will see cinchonism in? More specifically, the key feature is tinnitus.

strep pyogenes (Group A strep, can test with throat swap, treat with amoxicillin)

What is the main bacterial etiology of pharyngitis?

acetylcholine

What is the main excitatory (not most powerful) neurotransmitter in the CNS? It is also has inhibitory effects in the PNS.

fever (seen in pyelonephritis)

What is the main feature distinguishing cystitis and pyelonephritis?

primaquine

What is the primary tissue schizonticide (kills schizonts in the liver)?

SSRI(s)

What is the primary treatment drug for OCD (obsessive-compulsive disorder)?

SSRIs (for 8-12 weeks)

What is the primary treatment drug for PTSD?

antidepressants (SSRIs or SNRIs)

What is the primary treatment drug for SAD (social anxiety disorder) in patients with comorbid depression? GABA analogs were also effective.

BZs (benzodiazepines are the most effective, safe, and commonly used drugs for rapid relief of acute anxiety)

What is the primary treatment drug for acute GAD (generalized anxiety disorder)?

BZs (benzodiazepines like alprazolam, clonazepam, lorazepam, and diazepam for long-acting)

What is the primary treatment drug for acute panic disorder?

avoidance of CNS depressants (like alcohol or hypnotics, and drugs that promote weight gain, but there is no specific drug therapy for OSA)

What is the primary treatment drug for obstructive sleep apnea (OSA)?

GpIIb-IIIa

What is the receptor that binds platelet to platelet on fibrinogen in secondary hemostasis?

Gp1b (glycoprotein)

What is the receptor that the platelets bind to on von Willebrand factor in primary hemostasis?

fluconazole

What is the selected initial therapy (just give the antibiotic) for an acute infection of oral or esophageal candidiasis?

SMX/TMP (sulfamethoxazole-trimethoprim)

What is the selected initial therapy (just give the antibiotic) for an acute infection of pneumocystis jiroveci pneumonia?

amphotericin B (take it IV, with or without flucytosine), flucytosine, (then follow up with) fluconazole

What is the selected initial therapy (just give the antibiotics) for an acute infection of cryptococcal meningitis?

vergence (like convergence or divergence, moving in opposite directions)

What is the suffix that describes binocular movement of the eyes in opposite directions, aka disconjugate eye movement?

versions (like conversions, moving together)

What is the suffix that describes binocular movement of the eyes in the same direction, aka conjugate eye movement?

ductions (like adduction, abduction, supraduction, infraduction)

What is the suffix that describes the movement of one eye only?

T1-T6

What is the sympathetic innervation for the heart (aortic arch T1-T5)?

T1-T6

What is the sympathetic innervation for the mammary glands?

T10-T11

What is the sympathetic innervation of the adrenal gland?

T12

What is the sympathetic innervation of the appendix?

T2-T8

What is the sympathetic innervation of the arms?

T12-L2

What is the sympathetic innervation of the bladder and urethra?

T1-T4

What is the sympathetic innervation of the head and neck region? This includes the sinuses, Eustachian tube, lacrimal glands, salivary glands, and thyroid.

T10-T11

What is the sympathetic innervation of the kidneys?

T11-L2

What is the sympathetic innervation of the legs?

T5-T6

What is the sympathetic innervation of the lower 2-3rds of the esophagus?

T12-L2

What is the sympathetic innervation of the lower GI tract? (left colon, sigmoid, rectum)

T12-L2

What is the sympathetic innervation of the lower ureters?

T10-T11

What is the sympathetic innervation of the middle GI tract? (includes small intestine, transverse colon, and ascending colon)

T10-T11

What is the sympathetic innervation of the ovaries and testes?

What is the sympathetic innervation of the penis, seminal vesicles, and clitoris?

T12-L2

What is the sympathetic innervation of the prostate, uterus, and cervix?

T1-T6

What is the sympathetic innervation of the respiratory system? This includes trachea T1-T6, bronchi T1-T6, lungs T2-T4, and lung visceral pleura T2-T4.

T5-T9

What is the sympathetic innervation of the upper GI tract? (includes the stomach, liver, gallbladder, spleen, duodenum, and pancreas)

T10-T11

What is the sympathetic innervation of the upper ureters?

hypotropia

What is the term that describes when an eye is turned down?

esotropia

What is the term that describes when an eye is turned in?

exotropia

What is the term that describes when an eye is turned out?

hypertropia

What is the term that describes when an eye is turned up?

cyclotropia (so can be incyclo or encyclo)

What is the term that describes when the top of the eyeball is rotated in or out?

Synagis (Palivizumab)

What is the trade name for the drug used to prevent RSV infections? It is an antibody towards RSV and lasts for about 4 weeks.

Emtricitabine, tenofovir, raltegravir (usually)

What is the treatment strategy for post-exposure prophylaxis to HIV (blood contact, postcoital, post-injection drug use)?

Tenofovir, emtricitabine

What is the treatment strategy for pre-exposure prophylaxis (PrEP)? It is used for people who do not have HIV but are high-risk for exposure through sex or IV drug use?

tardive dyskinesia

What is the worst side effect of taking typical antipsychotic drugs (D2 blockers)? It has chronic EPS, years of therapy, and can become irreversible.

coagulative (necrosis)

What pattern of necrosis is seen with firm texture that looks like the tissue architecture has been maintained? It is also eosinophilic and is characteristic of infarcts (except in brain).

a1 (adrenergic), mydriasis (dilation) (need to get A's to get into radiology, also need to open eyes wide to see the radiographs)

What receptor is on the iris radial muscle? If stimulated, what does it cause?

M3 (cholinergic), miosis (constriction) (anal sphincter gets tight and constricts, also pooping is parasympathetic so M)

What receptor is on the iris sphincter muscle? If stimulated, what does it cause?

decreasing production

(nonselective) Beta-blockers are used to treat glaucoma (ciliary body epithelium mostly B2). They work by ______________________ (increasing outflow or decreasing production) of aqueous humor.

50% of abdominal aortic aneurysms larger than ______ cm will rupture in 5 years and will be potentially fatal.

small cell carcinoma of the lung

50% of the time, Cushing syndrome is a paraneoplastic syndrome for which form of underlying cancer?

100,000

75% of ALL (acute lymphoblastic leukemia) will have a platelet count less than ____________________.

deep leg veins

90% of cases of thrombophlebitis or phlebothrombosis involve _________________________. Others include pelvis veins, portal veins, etc.

rotavirus

A 6-24 month child is having 7-8 episodes of large amounts of stool, causing them to be extremely dehydrated (also losing lots of salt). It is transmitted fecal-orally and can be seen on ELISA or latex agglutination test. What does the child have?

CML (chromic myeloid leukemia because of Philadelphia chromosome/9:22 translation)

A BCR-ABL fusion found on karyotype is diagnostic for which disease?

viscerosomatic

A Chapman's point represents a ______________ (visceral or somatic) to ______________ (visceral to somatic) reflex.

A Glasgow-Coma scale can be used to judge how severe a head injury is. A score of _______ or below shows severe associated multi system trauma.

nutmeg

A ___________ liver describes central regions of hepatic lobules that are red-brown and depressed due to cell death. There is centrilobular necrosis, loss of hepatocytes and hemorrhage, and hemosiderin-laden macrophages.

mural

A ______________ thrombus is a thrombus that develops in the cardiac chambers of the aorta. It can be predisposed in places of turbulence with stenotic valves.

unilateral (and constant too, not using it so no input)

A __________________ strabismus is more likely to cause amblyopia, while an intermittent or an alternating strabismus is less likely to lead to amblyopia.

barium swallow, esophageal pH

A _____________________ and upper GI series test can be used to evaluate whether someone has gastric reflux. However, it can produce false negatives, so a __________________ study could be done for 24 hours, for kids younger than a year.

Western blot

A _______________________ test detects antimicrobial antibodies in the patients' serum by their reaction with the target antigens that have been immobilized onto a membrane by blotting. It is used to confirm a positive result obtained with a screening.

subdural hematoma (collection of blood between dura and cerebral mantle)

A ________________________ is because of a rupture of the bridging cortical veins. It is characteristic of shaken baby syndrome/abusive head trauma. Symptoms may include vomiting, and retinal hemorrhages will likely be seen too.

Haemophilus ducreyi

A chancroid is caused by __________________________ and is characterized by painful genital ulcers. It can manifest as painful non-indurated genital ulcers and local lymphadenitis.

nephrotoxicity

A common adverse effect to the -ovir/Antiherpes drugs is ___________________, which is why it is good to stay well-hydrated when taking them.

3-5 (mm)

A depressed skull fracture greater than ___________ mm will likely need correction or if associated with a neurological deficit.

Trichomonas (should be moving on there), candida (yeast)

A direct wet mount with wet prep can be used to visual which two organisms?

spinal tap

A full sepsis work up and a bacteremia work up both include a complete blood count (CBC), blood culture, chest radiograph (Chest X-ray), and urinalysis and culture (also maybe stool culture if they have gastrointestinal symptoms). What is included in the full sepsis workup that is not in the bacteremia workup?

tonic-clonic

A generalized _________________ seizure is usually associated with aura, can have apnea and cyanosis, loss of bladder control, and a postictal phase. Vomiting may occur during or after the seizure. It can be precipitated by fever, infection, or medications.

lipoprotein A

A genetic change that causes ______________________, the altered form of LDL that can be consumed by macrophages and lead to an atherosclerotic plaque, is a risk factor for atherosclerosis.

A lift for short leg syndrome must be used at all times so the body isn't constantly trying to accommodate to changing leg lengths. If a lift greater than ____________ mm is needed, it must be applied to the outside of the shoe to avoid Achilles contracture.

congenital heart defects

A major cause for early mortality in people with Down syndrome is ____________________________. It can also lead to pneumonia.

Good (T cells are worse, high WBCs is worse)

A patient needs a bone marrow transplant in order to treat ALL (Acute lymphoblastic leukemia). The patient is between 1-10 years old, has under 100,000 WBCs, doesn't have a mediastinal mass or CNS involvement, and is a B-cell immunophenotype. Is the prognosis good or bad?

neuroblastoma

A patient presents to the clinic with an abdominal mass, hepatosplenomegaly, and bluish tinged subcutaneous nodules like a blueberry muffin. It has already metastasized and you see ecchomyosis of proptosis in the orbits (subcutaneous bleeding and abnormal protrusion of the eyes). Urine test shows excessive VMA (Vanillylmandelic Acid). What do you think they have?

superior vena cava syndrome

A patient presents with cyanosis, telangiectasia, and dilation of veins of the head, neck, and arms, with respiratory distress. They have a history of bronchogenic carcinoma and mediastinal lymphoma. What do they have?

bridging (cortical) veins

A subdural hematoma is most likely because of rupture of __________________________.

supraclavicular

A swollen, painless _____________________ lymph node seen in teenagers is a lymphoma until proven otherwise.

gene sequence

Activation of growth-promoting oncogenes occurs by a change in the ________________________, resulting in a new protein that loses its ability to be regulated by inhibitory signals. Loss of gene regulation leads to overexpression of the normal protein.

both

A2 agonists like apraclonidine are Gi coupled and can be used to treat glaucoma. Do they work by reducing aqueous humor production (postsynaptic a2 receptor) or enhancing uveoscleral outflow (presynaptic a2 receptor) or both?

ALL (acute lymphoblastic leukemia) accounts for 75% of cases of leukemia in the pediatric population. What is the peak age of incidence?

familial adenomatous polyposis

APC binding to B-catenin are components of the WNT signaling pathway. Loss of APC gene function is most classically associated with which cancer?

decrease (passive congestion causes an increase in hydrogen ion concentration because increased CO2, thus lowering pH and can cause some enzymes to not work, building up metabolic waste products and decrease cellular function)

According to the Cathie hypothesis of fascia, when fascia contracts and thickens, it leads to a local passive congestion and decreased lymph flow. How does the pH change in the tissue?

40-60 (long standing cholesterol accumulation)

Age is a major risk factor for atherosclerosis, between _____ and ______ years of age, where incidence of MI increases 5x.

GPCR (G-protein coupled receptors)

All 4 subtypes of histamine receptors are _____________, a receptor type, not if it is inhibitory/excitatory.

IL-1, IL-6, TNF-a

Allostasis is the process by which the body responds to stressors in order to regain homeostasis. Because of this, nerves can release cytokines. What are 3 pro inflammatory ones?

retinal dystrophy

Almost 100% of people with Bardet-Biedl syndrome have what?

clindamycin, 3rd gen cephalosporin

Along with incision and drainage, what are the appropriate antibiotics for treatment of perirectal abscesses? Use only for extensive involvement, systemic symptoms, or in an immunocompromised host.

anterograde amnesia

Although benzodiazepines are relatively safe, some side effects include CNS depression, drowsiness, impairment of mental and motor functions, confusion, disorientation, and risk of _______________________________ (loss of memory).

HHV-8 (human herpesvirus 8)

Although the pathogenesis for Kaposi Sarcoma is unknown, 95% of KS lesions from AIDS patients are infected with __________________________. It encodes for TP53 inhibitors (control cell cycle and apoptosis) and a viral homologue of Cyclin D (facilitates cell cycling and relieving checkpoint).

8-10

Amblyopia can be treated successfully if detected before the end of the critical period between which ages? This is because the visual system is still developing.

I&D (incision and drainage)

Aspiration of abscesses can be used for diagnostic purposes. Treatment for abscesses include _________________ and appropriate antibiotics.

liposome

Amphotericin B can cause bone marrow suppression, so ____________________ encapsulation protects against nephrotoxicity as well as lower doses when combined with flu cytosine. It can also cause decrease in GFR and renal tubular acidosis with magnesium and potassium loss.

ergosterol

Amphotericin B is a drug used to treat systemic fungal infections. It binds to _____________________ in the fungal cell membrane forms pores that result in cell death. It has a very broad spectrum and is useful in serious systemic infections but is extremely toxic.

double minutes

Amplification of MYC is often visible as _________________________ in karyotype. They are essentially tiny little chromosomes with tons of repeats/replicas.

staph (aureus, but yeah it's aerobes)

An abscesses is a local collection of pus that is usually fluctuant, hot, and tender, and most commonly caused by which bacteria?

clozapine

An adverse effect of ________________, a drug used to treat Schizophrenia, is agranulocytosis (hematologic). It requires weekly WBC counts.

dissecting (can be treated with B-blockers to reduce cardiac contractility, reduction of arterial pressure, or surgery)

An aortic _________________ aneurysm is caused by a tear in the intima and frequently leads to death. The tear allows for blood to enter the media and creates a false lumen. It occurs in places where hydraulic stress is high.

abdominal aorta (in the intima, occur secondarily to atherosclerotic plaques)

An arteriosclerotic aneurysm is an aneurysm arising in a large artery, most commonly the __________________________, as a result of weakening of the wall in severe atherosclerosis. There is medial destruction secondary to plaques that originate in the intima.

middle meningeal artery

An epidural hematoma is bleeding in the extradural space and is usually caused by a rupture of the __________________________ or dural veins.

akisthisia (can't sit still because of restless muscle movement), tardive dyskinesia (involuntary movement of the face and mouth like abnormal tongue movements, eye blinking)

An important adverse effect for typical D2 blocking schizophrenic drugs is extrapyramidal system dysfunction (this is a CNS effect). This can lead to dystonia (severe muscle spasms), pseudo-parkinson (in the nigrostriatum that presents as a tremor and then rigidity) and what other two effects?

Down syndrome

Asymptomatic atlantoaxial dislocation occurs in 12-20% of individuals with ______________________.

Anticonvulsants for seizures are given until _________ years (seizure free and normal EEG), with gradual withdrawal over 3-6 months.

chronic

Antidepressants are first line agents to treat ________________ (acute or chronic) generalized anxiety disorder. They include SSRIs, SNRIs, and TCAs. Buspirone is useful in patients without comorbid depression of other anxiety disorders.

tPA (tissue plasminogen activator), thrombomodulin

Antithrombotic counter-regulation's goal is to limit the clot to just the injured site. Endothelial cells release which two proteins which help do this?

ampicillin, cefotaxime (after 4 weeks can just use ceftriaxone, ampicillin to cover listeria, and can also add in acyclovir to cover Herpes)

Appropriate antibiotics for children under 4 weeks for treatment of fever with no apparent source should be what?

ciliary body, Canal of Schlemm

Aqueous humor is secreted (production) by the ___________________ and is drained (outflow) through the __________________________.

upper extremities, mesenteric arteries, renal arteries

Atherosclerotic plaques are usually spared (except at the ostia) at which 3 locations?

abdominal aorta (then thoracic), carotid, iliac

Atherosclerotic plaques develop primarily in the elastic arteries. What are the top 3 arteries you would expect to see them at?

APC (adenomatous polyposis coli)

B-catenin is overactive in many cancers because ______________ is absent. It usually binds to B-catenin to degrade it and when it is not there it leads to B-catenin over activation leading to proliferation.

follicular lymphoma

BCL-2 over expression causes inhibiting of Bax and therefore inhibition of apoptosis. It often carries a t(14:18) mutation and is often seen in which cancer?

Edwards syndrome

Baby patient has a very prominent occiput, low set ears, clenched hands, overlapping fingers, short hallux (Big toe) dorsiflexed, narrow pelvis, short sternum, etc. Resuscitation is performed at birth but he died within the first week. What did this patient have?

Bartonella (gram negative bacilli)

Bacillary angiomatosis is an opportunistic infection of the immunocompromised involving skin, bone, brain, and internal organs. It is usually infection by which bacteria? It causes red papules/nodules or subcutaneous masses with tumor-like growth.

pregnancy, sleep apnea

Benzodiazepines can be a useful pharmacological treatment for insomnia, however it is contraindicated in __________________, in __________________, and with alcohol and CNS depressant use.

GABA-A (BZs increase inhibitory NT)

Benzodiazepines like diazepam or lorazepam act as allosteric potentiators of _________________ receptors, and increase the frequency of chloride channel opening.

polycystic kidney (kidney is totally replaced with cysts, which is a genetic utation that causes weakness and interaction between cells in the renal tubules, it's also the same genetic mutation that causes weak interactions between cells in the circle of Willis), subarachnoid hemorrage

Berry aneurysms are associated with adult _____________________ disease, and are a major cause of ___________________________.

D2 (like when treating schizophrenia, if you block the dopamine receptor, it can cause less dopamine)

Blocking the _____ receptor is the goal of "typical" antipsychotics.

5-HT (like when treating schizophrenia, if you block the serotonin receptor, it can cause less serotonin)

Blocking the _______ receptor is the goal of "atypical" antipsychotics.

8:14

Burkitt's lymphoma is a B-cell tumor caused by overpression of MYC due to which chromosomal translocation?

5-HT1a

Buspirone's mechanism of action is that it acts as a partial agonist at the ________________ presynaptic auto-receptors to increase K+ efflux, hyperpolarization, decrease Ca2+ influx, and decrease 5-HT release.

Treatment-experienced (mainly used as a backup plan)

Can Enfuvirtide (fusion inhibitor) be used in treatment-naive patients, treatment-experienced patients, or both to treat HIV?

Both (can be first line or backup plan)

Can Maraviroc (fusion inhibitor) be used in treatment-naive patients, treatment-experienced patients, or both to treat HIV?

decrease production (reduce formation of bicarbonate in the ciliary body)

Carbonic anhydrase inhibitors like Acetazolamide can be used to treat glaucoma. It lowers IOP by _________________________ (increasing outflow or decreasing production) of aqueous humor.

Turner syndrome

Cavernous lymphangioma/cystic hygroma is frequently seen in which disease?

ALL (acute lymphoblastic leukemia)

Clinical manifestations of this pediatric malignancy include signs and symptoms less than 4 weeks at the time of diagnosis, progressive bone marrow failure, fever and pallor, petechiae, low platelet count, lymphadenopathy, splenomegaly, and mediastinal mass with the T-cell subtype.

Clinical presentation of depression is 5 or more of the following symptoms for the same _________-week period. Depressed mood almost every day, diminished interested, significant weight loss, insomnia/hypersomnia), fatigue, feelings of worthlessness, recurrent thoughts of death.

Clinical significant of hemorrhage depends on site and volume. If less than ______% of blood is lost, it is tolerated, but if there is more then it could lead to hypovolemic shock.

trifluridine, ganciclovir, famcyclovir

Corneal ulcers are an ocular emergency. If it was caused by Herpes, treatment is a combination of topical and oral _____________________, ____________________ and __________________________. No steroids are used.

natamycin

Corneal ulcers are an ocular emergency. If of fungal etiology, you will likely see a "feathery" ulcer and is associated with hypopyon. Treatment includes _______________________ eye drops every 1-2 hours with possible intraocular injections necessary to save the eye. Also oral antibiotics like fluconazole can be used.

fluoroquinolone

Corneal ulcers are an ocular emergency. If there is a bacterial ulcer, it can be treated with ___________________________ eye drops every 1-2 hours. Immediate consult with an eye doctor and DO NOT patch.

100,000

Culture diagnosis of UTI depends on how the specimen was collected. If a specimen is collected via bagged method, what colonies need to grow to be a significant result?

10,000

Culture diagnosis of UTI depends on how the specimen was collected. If a specimen is collected via catheter, what colonies need to grow to be a significant result?

any (growth)

Culture diagnosis of UTI depends on how the specimen was collected. If a specimen is collected via suprapubic aspiration, what colonies need to grow to be a significant result?

increase

D1 and D5 dopamine receptors ___________________ the intracellular level of cAMP by activating adenyl cyclase.

decrease

D2, D3, and D4 dopamine receptors ______________________ the intracellular level of cAMP by inhibiting adenyl cyclase.

air (embolism)

Decompression sickness/diver's disease can cause an _________ embolism when dissolved gases (from higher pressure) come out of solution and form bubbles inside the body when at normal pressure. It can be very dangerous.

Parkinson's

Decreased dopamine in the nigrostriatal tract, normally involved in coordination of movement, can cause which disease?

Development of retinoblastoma requires "two hits" (inactivates both Rb genes which leads to cell proliferation). Which chromosome is it on?

right-sided congestive heart failure

Dependent edema is influenced by gravity and is a prominent feature of what?

Diabetic retinopathy is the leading cause of preventable vision loss in working aged people in the US. Diabetic duration and sustained hyperglycemia are the primary risk factors for development of it. In fact, it is found in ______% of diabetics who have had diabetes for 10 or more years.

increasing outflow (perhaps by same PG-mediated pathway)

Dipivefrin is a drug used to treat glaucoma (a and B receptor stimulator). It lowers IOP by _________________________ (increasing outflow or decreasing production) of aqueous humor.

abnormal blood flow, hyper coagulability

Endothelial injury is one of Virchow's triad to explain thrombosis. The other two factors are ______________________, like with aneurysms and mitral valve stenosis causing turbulence of the vasculature or long term stasis, and ______________________ which can be because of primary (genetic) reasons or secondary/acquired reasons.

gp41

Enfuvirtide is a fusion inhibitor that blocks ____________ protein on the T-cell surface to prevent HIV viral entry.

Cow's milk

Eosinophilic gastroenteropathy is a common reason for diarrhea and is sort of a food allergy, with increased IgE levels and eosinophilia. One of the more common forms includes ____________________ protein allergy.

upper (motor neurons)

Facial nerve paralysis can be because of upper or lower motor neuron paralysis. If you see a patient who's lower part of the face on the opposite side of the lesion is paralyzed, with a droopy mouth, what type of lesions do you expect?

lower (motor neurons)

Facial nerve paralysis can be because of upper or lower motor neuron paralysis. If you see a patient who's whole face is involved and has Bell's palsy, what type of lesions do you expect?

branch vessel ostia

Fatty streaks in atherosclerosis do not disturb blood flow and are seen most frequently at _____________________.

older

Faulty chromosome distribution leading to Down syndrome is more likely to occur at ____________ maternal age.

males (estrogen has protective effects and males more prone to smoke)

Gender is a major risk factor for atherosclerosis. Are males or females more prone to atherosclerosis?

doxycycline

Give an example of an antibiotic you can use for tick infections, such as Rickettsia (Rocky Mountain spotted fever) or Borrelia (Lyme disease)? It can also be used against chlamydia and mycoplasma.

clozapine (and other pines like asenapine, Olanzapine, Quetiapine), Risperidone (and the other dones like Lurasidone, Ziprasidone), Aripiprazole (partial agonist effects on D2)

Give three examples of atypical/second generation antipsychotic drugs? They block the 5-HT2 receptors among other things.

anaplasia (1 is well-differentiated, 4 is poorly differentiated)

Grading for cancer is classified as grade 1, II, III, or IV in order of increasing __________________________. Grading reflects the aggressiveness or level of malignancy, while staging reflects the current extent and spread.

recessive (the other target is genes controlling apoptosis and may be dominant or recessive based on what the target is)

Growth-inhibiting cancer suppressor genes are targets of genetic damage, creating anti-oncogenes. Are they going to be dominant or recessive?

dominant

Growth-promoting protooncogenes are a target of genetic damage, where mutant alleles become oncogenes. Are they going to be dominant or recessive?

alpha

High dose epinephrine stimulates which type of receptors?

NMS (neuroleptic malignant syndrome)

Haloperidol (D2 typical antipsychotic drug) has a CNS side effect of _________________________, which presents as a temperature > 100.4F, muscle rigidity, and altered level of consciousness.

liver

Hemangiomas (increased numbers of normal or abnormal vessels filled with blood) are usually superficial, but some occur internally, especially in the ______________.

arsenic, Polyvinvyl chloride (PVC industry workers with high incidence, more common one we will see on tests)

Hepatic angiosarcomas have a clear association with which two environmental factors? (also thorotrast)

How many percent of concussions involve loss of consciousness?

p53 (E6 and E7), Rb (E7 has greater affinity toward Rb than E2F so E2F goes to the nucleus and cell cycle goes on)

Human papilloma virus have viral proteins E6 and E7 which target and stop which two main targets?

E6, E7

Human papilloma virus types 16 and 18 are found in 75% of squamous cell carcinomas and 100% of preneoplastic disorders. The oncogenic potential is related to which two viral proteins?

squamous cell carcinoma of the lung (breast, ovarian, and renal carcinoma as well as adult T-cell leukemia/lymphoma are also forms)

Hypercalcemia that is distinct from bone metastases is a paraneoplastic syndrome for which form of underlying cancer (most likely)?

Leiden (Factor V)

Hypercoagulabilty is a factor in Virchow's triad to explain thrombosis. A primary/genetic reason for this is _________________ mutation, where the cofactor that is usually leaved by protein C is not, causing more clots. Oral contraceptive use (especially in smokers) is a secondary reason for hyper coagulability.

cat scratch disease

If you see an isolated axillary lymph node, what disease should you first think of?

ulcerative colitis (diagnostic of it)

If you see crypt abscesses, is that more common in Crohn's disease or ulcerative colitis?

fix and follow

In 6-12 month year old child, when doing an eye exam, you should check for the ability to _______________________.

parasympathetic (iris sphincter muscle not working, won't constrict in the light when its supposed to)

In a _______________________ defect, there is poor pupillary constriction to bright light. Anisocoria is greatest in the light.

sympathetic (iris dilator muscle, its not dilating in the dark so it will stay constricted, even when its supposed to open up in the dark)

In a _______________________ defect, there is poor pupillary dilation to dim light. Anisocoria is greatest in the dark.

red reflex, ocular alignment

In a newborn child to 3 month year old, when doing an eye exam, you should check for _________________ and _________________________.

cephalosporin(s)

In a patient with a penicillin allergy, if they have a rash (type 4), try ________________________. If they have anaphylaxis (type I, avoid all all beta lactams.

central necrosis

In a patient with acute suppurative lymphadenitis, increased pain and erythema, thinning of the overlying skin, and fluctuant on palpation of the lymph node signals that __________________ has occurred.

renal failure (and retinal hemorrhages and exudates)

In a person with malignant hypertension (diastolic pressure over 120 mmHg), what is one of the main consequences it can lead to?

CBC (complete blood cell count), urinalysis and culture, CXR (chest x-ray), tuberculin skin test, ANA titer (antinuclear antibody titer in older children, perhaps could diagnose JIA)

In addition to a history and physical exam, what 5 tests should be done in initial evaluation of children with fever of unknown origin (FUO)?

injury

In atherosclerosis, chronic endothelial ________________ results in endothelial dysfunction, resulting in increased permeability, leukocyte adhesion, and thrombotic potential. There can be accumulation of LDL in the vessel wall, and monocytes/macrophages/foam cells/platelets will all migrate to the intima and release factors that recruit SMC and more ECM to be formed.

heart failure

In chronic pulmonary congestion, caused by left-sided heart failure, alveolar spaces contain _________________________ cells, which are hemosiderin-laden macrophages.

lymphoma

In general, if there is a translocation with a cancer cell line with Chromosome 14, what type of cancer would it usually be?

vWF (von Willebrand factor)

In primary hemostasis, platelets bind to exposed collagen on the endothelium through _______________________________. This causes a signaling cascade and causes the platelet to degranulate and dump out a bunch of other substances like ADP and TXA2/thromboxane to recruit more platelets to the site.

CBC, urinalysis and culture

In protocol for continued evaluation of children with fever of unknown origin (FUO), phase 1 is outpatient. Which two tests do you want to repeat again? Other tests include erythrocyte segmentation rate, EPV serology, review chest radiograph, blood culture, anti-streptoysin O, HIV antibody, and temperature recordings twice daily.

spinal tap (lumbar puncture)

In protocol for continued evaluation of children with fever of unknown origin (FUO), phase 2 is inpatient. The child is hospitalized for observation and a _______________________ is done to check for previous antibiotics or any toxicity in a young infant. Repeat blood cultures, sinus radiographs, eye exams, liver enzyme tests, and serologic tests to specific viruses and bacteria are also done.

malignancy

In protocol for continued evaluation of children with fever of unknown origin (FUO), phase 3 is also as an inpatient. Abdominal ultrasonography is done to check is this child has a ____________________.

osteomyelitis

In protocol for continued evaluation of children with fever of unknown origin (FUO), phase 3 is also as an inpatient. Gallium or indium scanning is done to check if this child has _________________.

fibrin

In secondary hemostasis, _______________ acts as the cement for the wall/platelet plug. Endothelial cells activate the extrinsic pathway of the coagulation factor, which activates fibrinogen to it.

externally

In short leg syndrome, the short leg is ___________________ rotated, because it makes it longer.

pentamidine, suramin

In the 1st stage of African trypanosomiasis (African sleeping sickness), the protozoa doesn't cross the CNS. What are two drugs that can be used?

I, II, III (BAD for both, ascending, descending)

In the DeBakey classification for aortic dissection aneurysms, Type ____ refers to both the ascending and descending aorta, Type _____ refers to just the ascending aorta, and Type ______ refers to just the descending aorta.

decreased (anxiety is like too much excitement so not enough inhibitory to turn it off)

In the GABA receptor model to explain anxiety, it states that _____________ levels of GABA in the cortex causes anxiety, specifically the GABA-A receptor.

A (ascending), B (descending)

In the Stanford Classification for aortic dissection aneurysms, Type ______ refers to the ascending aorta, while Type ______ refers to the descending thoracic aorta.

endothelin

In the initial hemostasis to stop the bleeding of a wound, the endothelium releases ________________, which causes a reflex vasoconstriction, which transiently/temporarily stops bleeding.

lactic acid

In the progressive stage of shock, there is widespread tissue hypoxia and anaerobic glycosides takes over, leading to excessive production of _____________________, leading to metabolic acidosis. This lowers the tissue pH and blunts vasomotor response.

decrease (serotonin is inhibitory, so less of that will cause an increase in excitatory NTs, causing anxiety, aka increased serotonin activity decreases NE activity levels in the locus ceruleus)

In the serotonin model to explain anxiety, it states a _______________ in serotonin release can cause anxiety disorders.

febrile (seizures)

In these types of seizures, a rapid rise of temperature/fever precipitates the seizure, and a rapid fall of temperature is just as bad.

mirtazapine (a2 antagonist blocking presynaptic auto receptors for both NE And 5-ST, results in higher levels of both in the synapse)

In treating a patient with PTSD, they show no response to SSRI or venlafaxine and TCAs. What else can be used to manage the patient's PTSD?

(mycobacteria) TB, cat scratch (disease), (infectious) mono, malignancy

In treatment of adenitis (like lymphadenitis/swelling of lymph nodes), treatment includes trial of antibiotics and I&D if fluctuant. If it is still persistent despite antibiotics, what are 4 other reasons for this adenitis?

2 (4 for 2), 4 (2 for 4)

In tuberculosis treatment, the initiation phase is when you use all 4 drugs (isoniazid, rifampin, pyrazinamide, ethambutol) for ________ months, and the continuation phase is when you use isoniazid and rifampin for ____________ months.

Schizophrenia

Increased dopamine in the mesocortical tract, normally associated with motivational and emotional responses, can cause which disease?

hepatocellular carcinoma, renal cell carcinoma

Inferior vena cava syndrome is caused by which neoplasms? It can also be caused by a propagating thrombus from the femoral or iliac vein. Symptoms include dependent edema, distention of superficial collateral veins in the abdomen, and proteinuria (involving the renal veins)

inhibitory (like GABA-A receptors, restricted to spinal cord and brain stem)

Is glycine an excitatory or inhibitory neurotransmitter?

anterior optic nerve

Ischemic optic neuropathy is an ischemic infarction of the _________________________. It is characterized by acute loss of vision and a pale swollen disc with splinter hemorrhages. It can be caused by arterial disease or hypotension/hypovolemia.

mycolic acid(s)

Isoniazid is a tuberculosis drug that targets the enzyme responsible for assembly of _________________s into the outer later of the mycobacteria. They account for the acid-fastness of the mycobacteria and this property is lost after exposure to INH.

catalase

Isoniazid resistance is most often due to deletion of the gene (KatG) that encodes for _____________________, an enzyme required for activation of isoniazid. (Isoniazid is a prodrug that needs it to be converted into the active form)

hyperpolarization

Ivermectin is the drug of choice for onchocerciasis/river blindness. It works by acting as a GABA agonist (maybe glutamate too) and causes __________________________ of the nerve and muscle cells, causing death of the worm.

campylobacter (other extra intestinal manifestations are septic and reactive arthritis, glomerulonephritis, meningitis, and Guillain-Barre syndrome)

Less than 1 year old patient presents with gastroenteritis from contaminated food and water via animals. You also see systemic symptoms like fever and headache. You treat him with erythromycin to avoid it progressing to an acute abdomen problem like cholecystitis, pancreatitis, or appendicitis). What did he have?

inositol

Lithium can be used as a mood stabilizer to treat bipolar disorder. It disrupts the __________________ signaling pathway, which reduces inositol concentration and synaptic transmission (lowers PIP2 and Gq pathways)

beta

Low dose epinephrine stimulates which type of receptors?

protein (not reabsorbed so lower in the serum, pre albumin is more reliable because shorter half life)

Lower serum albumin or pre albumin tests could indicate _________________ malabsorption. A fecal a1-antitrypsin and pancreatic enzyme analysis can also be done.

strep pyogenes (Group A, B-hemolytic streptococci)

Lymphangitis is inflammation of lymphatics most commonly caused by __________________. The inflammation can extend through the lymphatic wall and cause cellulitis or focal abscesses.

Burkitt lymphoma (B cell tumor)

MYC oncogenes are constitutively expressed or over expressed due to t(8:14) translocation in which tumor? MYC is moved downstream of highly-expressed IG heavy chain genes.

Fragile-X syndrome

Male patient presents to the clinic with mental deficiency, macro-orchidism, prognathism, dental crowning, etc. What do you think he has?

120

Malignant Hypertension is severe hypertension characterized a diastolic pressure greater than ________ mmHg. It can lead to renal failure, retinal hemorrhages and exudates, and if untreated can lead to death in 1-2 years.

CCR5

Maraviroc is a fusion inhibitor that blocks ____________ protein on macrophage or T-cell surfaces to prevent HIV viral entry.

hypertension, diabetes

Microaneurysms are associated with _____________________ and __________________, and can cause blindness (retina), or kidney failure (glomeruli).

SAD (society anxiety disorder)

Mid-teen woman presents with an intense, irrational, and persistent fear of being negatively evaluated or scrutinized including a fear of being embarrassed. She has a fear of speaking in public and talking to strangers. What do you diagnose her with?

pelvis (and neck, and can be confused for cancer or kidney stones)

Monckeberg medial calcific sclerosis is a non-clinically significant pattern of arteriosclerosis that occurs most often in the elderly. Calcium deposits collect in the media of the muscular arteries. What is the most likely location where these are found?

M1 (they are very prominent and slow excitatory)

Most CNS responses to Ach are mediated by which type of receptors?

Peripheral neuropathy

Most NRTI (nucleoside reverse transcriptase inhibitors) have which side effect?

lorazepam, oxazepam

Most benzodiazepines form active metabolites following phase 1 metabolism by the liver and phase 2 elimination by the kidney. What are two BZs that are not metabolized by the liver, so they are safer in the elderly and in those with hepatic dysfunction?

GPCR (G-protein coupled receptors, the other one is ionotropic)

Most serotonin receptors are _________________ except for 5-HT3.

genetic (metaplasia usually caused by stressor and can go back)

Neoplastic cells are transformed cells that result from _________________ change, so they can be passed down to their progeny. They are clonal in nature. They have lost responsiveness to normal growth controls and compete with normal cells for metabolites.

neural crest (cells), sympathetic (nervous system)

Neuroblastomas originate in the __________________________ cells of the _____________________ nervous system. 70% arise in the abdomen, 50% from the adrenal, and 20% thorax. It spread by local tissue invasion.

dantrolene (induces muscle relaxation by blocking calcium channels at Ryanodine receptors so they can't contract)

Neuroleptic malignant syndrome (NMS) is a potential side effect of haloperidol and has similar features to malignant hypothermia. What can be given to treat it?

Sturge-Weber syndrome (venous angiomatous masses in leptomeninges over the cortex, associated with mental retardation, seizures, etc)

Nevus flammeus is usually an ordinary birthmark but a special port wine stain form causes a thickening of the skin with no regression. It is commonly associated with _________________________, a congenital disorder due to faulty development of mesodermal and ectodermal elements.

congenital rubella

Newborn has a generalized blue-berry muffin rash, diffuse petechia, hepatosplenomegaly, early onset of jaundice, and neurologic depression. What do they have?

tissue factor (TF)

Nonbacterial thrombotic endocarditis is a paraneoplastic syndrome for advanced cancers. This is because of hypercoagulability, where the tumor cells make __________________________.

Bcl-2

Overexpression of ____________ causes inhibition of Bax, tying it all up which means cytochrome C cannot come out and trigger apoptosis. This is often seen in follicular lymphomas that carry a t(14:18) translocation.

Li-Fraumeni syndrome

P53 mutations are usually acquired by some are inherited. An example of this is ____________________, where one mutant allele is inherited from a parent. There is a 25x greater chance of developing a malignant tumor by 50.

Diabetic macular edema (DME)

Panretinal photocoagulation (PRP) is a treatment option for severe NPDR, high risk PDR, and others. Basically you take a laser and burn the retina to reduce the need for oxygen there (kill some NVD or NVEs). But one of the major side effects of it is that it exacerbates ___________________________.

filariasis

Parasitic worms can cause lymphatic obstruction that can lead to inflammatory responses to cause _______________________.

Schizophrenia

Pathophysiology of which CNS disorder include decreases in gray matter, increased ventricular size, or overproduction of serotonin and dopamine, with increased densities of D2 reactors at the head of the caudate nucleus?

GAD (generalized anxiety disorder)

Patient between 35 and 45 years old presents with persistent and excessive worrying that interferes with her daily activities She has had it for at least 6 months and has restlessness, fatigue, sleep disturbance, and has trouble concentrating. What do you diagnose her with?

CRAO (central retinal artery occlusion)

Patient comes in sudden, acute, and painless loss of vision in one eye. Fundoscopic exam will show a "cherry red spot," with surrounding pale retina. After checking their visual acuity, you check for hypoxia (arteries) and bleeding (vein occlusion). In patients of 70 years of age and older, giant cell arteritis is more likely to be the cause. What is it?

basilar skull fracture

Patient comes in with raccoon eyes (anterior fossa fracture), CSF otorrhea and rhinorrhea, hemotympanum (blood behind the drum), and Battle's sign (bruising of the mastoid process of the temporal bone). What do you suspect they have?

none (self limiting, just watch, if under 3 months then treat them)

Patient is a 3 year old who presents with salmonellosis. What antibiotics do you give to treat her?

aortic dissecting aneurysm (most common cause of death is rupture into pericardial, pleural, or peritoneal body cavities)

Patient presents to the clinic with excruciating pain radiating down the back, and diaphoresis. What do you suspect they have?

deletion 5p syndrome (could also be 4p or 6p)

Patient presents with a beaked nose, hypertelorism, microcephaly, cranial asymmetry, cleft palate, profound mental deficiencies, and a cry that sounds like a cat's meow. What do you expect they have?

measles (rubeola)

Patient presents with a fever, a maculopapular rash from the hairline down, intensely red eyes from severe conjunctivitis, and Koplik's spots on the mouth (blueish-white dots surrounded by red halos), what do you think they have?

epidural hematoma (bleeding in extradural space)

Patient presents with a hit to the temple, causing rupture of the middle meningeal artery or dural veins. He had a brief loss of consciousness with a lucid interval. After surgical evacuation, the patient is good.

chickenpox (varicella)

Patient presents with a pleomorphic rash of macules and papules becoming vesicles and blisters. What do they have?

angiosarcoma

Patient presents with a previous medical history for radical mastectomy about a decade ago and has a long standing lymphedema in the arm. Her arm appears very sunken and fleshy, and you see many areas of local invasion. What does she most likely have?

panic disorder

Patient presents with a series of unexpected panic attacks involving an abrupt surge of intense fear or intense discomfort. It has lasted no more than 20-30 minutes and also has chest pain, chills, palpitations, sweating, SOB, tachycardia, depersonalization, derealization, and a fear of going crazy/dying/losing control. What do you diagnose them with?

infectious mononucleosis

Patient presents with generalized lymphadenitis (multiple enlarged lymph nodes in multiple regions). What is the main cause of this?

concussion

Patient presents with headache, sensitivity to light/noise, persistent vomiting, feeling sluggish/down, emotional problems, appears stunned or dazed, confused about assignment, answers slowly, moves clumsily, and has some amnesia. What do you suspect he has?

Down syndrome (Trisomy 21 syndrome)

Patient presents with hypotonia, tongue protrusion, brachycephaly, Brushfield spots on the iris, clinodactylyl, a Simian crease, poor Moro reflex, decreased tericulahr volume, and a congenital endocardial cushion defect. What do you expect they have?

rubella (German measles)

Patient presents with pinkish-red maculopapular rash, Forchheimer spots/red palatal lesions, and occipital and posterior cervical adenopathy. What do they have?

pyloric stenosis (treatment is always surgical, treat electrolyte problems like hypokalemic, hypochloremic, metabolic alkalosis first before surgery)

Patient presents with projectile vomiting and on barium study you see a "string-like" (narrowed pyloric channel) pyloric channel. You confirm the diagnosis with an ultrasound/sonogram and see a thickened and elongated pylorus. You also feel an olive-like mass. What do they have?

Bardet-Biedl syndrome (Laurence-Moon Biedel syndrome)

Patient presents with syndromic obesity, retinal dystrophy (like retinitis pigmentosa), myopia, abnormal renal calyces, and hypertension. What do you expect they have?

Horner syndrome

Patient shows up with ptosis, miosis, anhidrosis, and ciliospinal reflex. What do they have?

shingles (Herpes zoster 3)

Patient with a history of chickenpox presents again with a dermatomal distribution of grouped vesicles. The vesicles are thin-walled and coalescent, and they lie on an erythematous base.

shigella

Patients presents with cramps and a small volume of stool that is very bloody and mucousy. The site of involvement is primarily in the distal segment of the colon and you also see leukocytosis with increased band count. You start them on antibiotics (2nd generation cephalosporins) right away to avoid them getting hemolytic uremic syndrome. What does this patient have?

HHV8

Patients with AIDS and Kaposi's sarcoma are highly likely to be associated with which virus?

transpeptidase

Pencillins (and others) all have a B-lactam ring that irreversibly inhibits _________________.

cell wall

Pencillins, cephalosporins, imipenem/meropenem, aztreonam, vancomycin all inhibit bacterial ____________ synthesis.

iliofemoral venous (thrombosis)

Phlegmasia alba dolens is also known as painful white leg or milk leg, and is a _______________________ thrombosis in pregnant women before or after delivery. The thrombus initiates a phlebitis (inflammatory response induces lymphatic blockage and painful swelling).

calcium (super important, also needed for coagulation cascade to make sure things are in the right place at the right time)

Platelets come prepackaged with __________________, which allows for molecule reactions to take place at the site of the clot. They also contain fibrinogen and factors V and VIII.

calcium

Praziquantel is the drug of choice when treating trematodes and cestodes. It works by increasing membrane permeability to _________________, causing muscle contraction followed by paralysis of muscles.

shortens (drops the medial arch of the foot)

Pronation (abduction, dorsiflexion, eversion) effectively _____________ (lengthens or shortens) the leg.

increasing outflow (through the accessory uveoscleral outflow pathway)

Prostaglandin drugs like Latanoprost (and Travoprost and Bimatoprost) are the most popular choice for treating glaucoma. They work by lowering the IOP by ______________________ (increasing outflow or decreasing production). Only one drop once a day is needed.

Inhibit (they are CYP inhibitors)

Protease inhibitors are not recommended for concurrent use with rifampin because all protease inhibitors ________________ P450 enzymes (ritonavir is the most potent)

ulcerative colitis (sometimes can happen in Crohn's disease, but you can't have ulcerative colitis without rectal disease because it's literally a disease of the colon)

Rectal bleeding and rectal disease is common in ulcerative colitis or Crohn's disease?

thymidine kinase (TK-)

Resistance to acyclovir includes mutation in the DNA polymerase and lack of ____________________, the enzyme that is involved in the virus-specific phosphorylation of acyclovir.

ulcerative colitis (will also see osteoarthropathy)

Risk of colonic cancer is greatly increased in Crohn's disease or ulcerative colitis?

Boosted

Ritonavir is the most potent p450 inhibitor of PIs and is routined used together with other PIs (atazanavir or darunavir) to take advantage of ritonavir's ability to increase plasma levels of drugs. These combinations are referred to as ______________ due to the p450 effect of ritonavir.

SSRI's are orally active and the full benefit is usually not seen for _________ weeks.

Schizophrenia can be diagnosed by having two or more of the following symptoms for at least how many months? Delusions, Hallucinations, disorganized speech or thinking, grossly disorganized or catatonic behavior, negative symptoms.

hyperglycemia

Schizophrenics who take typical D2 dopamine blockers and risperidone have a higher prevalence of type II diabetes than nonschizophrenics. However, most atypical drugs may cause __________________ and weight gain.

hypoperfusion

Shock/cardiovascular collapse is characterized by systemic __________________, caused by a reduction in cardiac output or circulating blood volume. It results in hypotension, followed by impaired tissue perfusion and cellular hypoxia.

Turner syndrome (XO syndrome)

Short female patient presents to the clinic with congenital lymphedema (puffy fingers and toes), a broad chest, average IQ, webbed posterior neck with low hairline, a horseshoe kidney, and a biscupid aortic valve or coarctation of the aorta. What do you expect she has?

amphotericin B

Side effects for this drug include fevers, chills, flushing, and muscle spasms during IV infusion due to histamine release, so it can be pretreated with a steroid or antihistamine, or post treated with meperidine.

cardiac, sexual dysfunction

Side effects of SNRIs (serotonin norepinephrine reuptake inhibitors) can include tremors, ______________ effects due to NE (high BP), nausea, headache, dry mouth, and _____________________________.

Vitamin B6

Side effects to isoniazid include peripheral neuritis/paresthesia but it can be overcome with supplementation of __________________________. Other rare side effects include hepatotoxicity, sideroblastic anemia, and drug induced SLE in slow acetylators.

leptomeningeal cyst

Skull fractures usually has a good prognosis unless the meningeal vessels, sagittal sinus, or lambdoid suture is damaged. What is one major complication of skull fractures?

cirrhosis

Spider telangiectasia (condition in which widened venules cause threadlike red lines or patterns on the skin) of the face, neck, or upper chest is most frequently seen in pregnant women and ______________ patients.

hypertension (then can promote atherosclerosis)

Stress, obesity, smoking, physical inactivity, and heavy salt consumption are environmental factors that can increase the likelihood of ______________________.

Crohn's disease (can be anywhere in the GI tract)

Strictures, fistula, perianal disease, and ileal involvement is most likely seen in Crohn's disease or ulcerative colitis?

Symptomatic abdominal aortic aneurysms larger than _______ cm will have operative repair and insertion of prosthetic grafts. There is a 1-2% mortality rate (vs 50% if aneurysm ruptures).

Emtricitabine (FTC)

Tenofovir (TDF) is a nucleotide reverse transcriptase inhibitor (NtRTI) that is coformulated with ________________ as the preferred nucleoside analog combination due to its overall efficacy, favorable toxicity profile, and convenience of dosing.

squalene epoxidase (results in accumulation of squalene, which is toxic to the fungi)

Terbinafine is an anti fungal used to treat onychomycosis (nail infections). It works by inhibiting which fungal enzyme?

falciparum

The "arte" drugs, like artesunate, artemether, and dihydroartemisin are blood schizonticides that are active against Plasmodium ________________, but only for treatment and not prophylaxis due to a short half life.

9, 22

The ABL oncogene is created when the gene is translocated from chromosome ________ to ____________. It is visible in karyotype as the Philadelphia chromosome.

carbohydrate

The D-Xylose tolerance test evaluates the integrity of the villous surface area and tests for ____________________ malabsorption. Xylose is used because it is an inert sugar and it is not stored or metabolized in the liver already.

protozoa (like entamoeba or Giardia)

The Gomori-Wheatley (stain, also known as trichome stain) and iron hematoxylin stain are stains used to detect intestinal. The Gomori-Wheatley stain is used to detect microsporidia.

Phosphorylated

The Nucleoside reverse transcriptase inhibitors (NRTIs) are prodrugs and their mechanism of action is that they all must be _____________________ to the 5'-triphosphate moiety to be active. They then prematurely terminate DNA elongation and competes with natural deoxynucleotides for reverse transcriptase

ABL

The __________ gene is a protooncogene that has tyrosine kinase activity that normally localizes to the nucleus to promote apoptosis when DNA is damaged. The oncogene version is created when the gene is translocated from chromosome 9 to 22.

catalase (bubbles indicate production of oxygen gas by catalase, because catalase breaks down H2O2 to oxygen/bubbles)

The ________________ test differentiates staphylococcus and streptococcus. Staph has a positive test because it uses oxygen as the final acceptor for the ETC.

coagulase (use citrated rabbit plasma because it coagulates with coagulase)

The _________________ test differentiates Staph aureus from the other staphylococcal species like epidermidis (novobiocin sensitive) and saprophyticus (novobiocin resistant, causes honey moon cystitis/UTI).

Venturi (the reduction in fluid pressure that results when a fluid flows through a constricted section of a pipe)

The ___________________ effect states that there is a decrease in pressure at the point where two moving fluids meet and this facilitates lymphatic drainage. (The thoracic duct drains into the left subclavian vein, near its junction with the left internal jugular vein. The right lymphatic duct drains its lymph into the junction of the right internal jugular vein, and the right subclavian vein.)

Parkinson's, Huntington's

The basal ganglia forms an element of the extrapyramidal motor system (EMS). Damage to this EMS affects initial voluntary movement that can result in ________________ (tremor and rigid) and ________________________ chorea (involuntary movements).

generalization

The biggest reason why we want to treat simple partial seizures is because could have secondary _______________________, and become tonic-clonic.

1-2 PIs (protease inhibitors like ritonavir), NNRTI (non-nucleotide reverse transcriptase inhibitor like efavirenz ), Raltegravir (integrase inhibitor)

The current strategy for treatment-naive patients always include a cocktail of two NRTIs. There are three possible combinations with the 2NRTIs. What are they?

caspofungin (only antifungals to target the fungal cell walls)

The echinocandins, like ____________________, are anti fungal drugs that inhibit the synthesis of B-1,2 gluten, a critical component of fungal cell walls. It can be used for Candida and aspergillus species (as backups though). Adverse effects include infusion-related GI distress, fever, chills, rash, and flushing due to histamine release.

skin, joint capsules

The highest concentrations of nociceptors is in the _____________, with the second highest concentration in the ______________________________. So there's an interneuron in the dorsal horn of the spinal cord that acts as a gate for the ascending pain signals as well as stimulating both sympathetic and a-motor neurons.

infraorbital canal (contains infraorbital nerve)

The landmark for the orbital floor is the ________________________, which contains a branch of V2 nerve. It is most commonly damaged in orbital floor blow-out fracture

lymphocyte depletion

The least favorable histologic subtype of lymphoma and most common type with an HIV infection is a ____________________________.

lanosterol

The mechanism of Azole anti fungal drugs is to inhibit the last step of synthesis of ergosterol in the fungal cell membrane by blocking the enzyme C-14-a-demethylase. It results in an accumulation of what?

C-14 a-demethylase (a P450 enzyme

The mechanism of Azole anti fungal drugs is to inhibit the synthesis of ergosterol in the fungal cell membrane by blocking the enzyme _________________________. It results in an accumulation of lanosterol. It is more well tolerated than Amphotericin B.

SERT (neuronal serotonin transporter)

The mechanism of action for SSRIs is that they block ___________________ and inhibit the reuptake of serotonin, thereby prolonging the action of serotonin.

microtubule synthesis

The mechanism of action for albendazole or mebendazole, the drugs of choice (also pyrantel) for nematode helminths and others, is that it inhibits ______________________, as well as blocking glucose uptake in adults and larvae.

protease inhibitors (PIs)

The mechanism of action for these types of drugs can treat HIV by inhibiting HIV-1 protease, which was necessary for cleaving viral precursor proteins and critical for producing mature infectious visions.

Foscarnet

The mechanism of action for this anti-herpes drug is that it selective inhibits the pyrophosphate binding site on virus specific DNA polymerases and reverse transcriptases, so it does not require activation by TK or other kinases.

decreased

The monoamine hypothesis of depression states that there is _________________ brain levels of the NE, 5-HT, and DA neurotransmitters.

lower extremities

The most common site for venous thrombi to form are at veins of the ___________________________.

coronary, cerebral, femoral

The most common sites for arterial thrombi are at which 3 class of arteries?

trazodone

This is a drug that can be used to treat depressive disorders .It has a sedating effect and causes priapism (prolonged erection of the penis without sexual arousal.

anterior paralimbic

The patholophysiology of bipolar disorder isn't fully understood, but neuroimaging studies indicate several anatomic regions, primarily the ___________________ and adjacent prefrontal regions, may contribute to functional abnormalities in bipolar patients.

ligamentum flavum

The posterior occipital-atlantal ligament extends from the ______________________.

radiation

The prognosis for Stage 1 or Stage 2 lymphoma is almost 100% (good) and is treated with __________________.

plasminogen (TPA stands for tissue plasminogen activator)

The purpose of administering t-PA to patients presenting with MI or stroke is to activate _________________________.

colon (primarily distal segment)

The site of involvement during Shigella gastroenteritis is the _______________, which is why it starts off with vomiting and bloody and mucousy diarrhea. The volume of the stool is small but there is lots of blood in it. Also lots of cramps and bandemia can be seen.

visceral (component)

The sympathetic autonomic nervous system has two major components. Which component innervates smooth muscle, cardiac muscle, nodal tissue, and glandular organs of the thoracic, abdominal, pelvic, and perineal viscera?

vascular (component)

The sympathetic autonomic nervous system has two major components. Which component is associated with spinal nerves and innervates fascia, smooth muscle of vasculature, smooth muscle of hair follicles, and secretory cells in the sweat glands of the skin?

Non adherence to medication

Therapeutic failure to drug treatments for HIV can be a result from _________________________, because of having to take multiple pills that are hard to keep track of.

weight reduction, surgery

There is no true drug therapy for treatment of OSA (obstructive sleep apnea). A non-pharmacological therapy for it includes a positive airway pressure tube, as well as ______________________________ and ___________________.

petechiae

These are 1-2mm hemorrhages into the skin, mucous membranes, or serosa. They are associated with locally increased intravascular pressure or low platelet counts/defective clotting. They are usually grouped in an organ.

purpura

These are >3mm hemorrhages (larger than petechiae) that have the same association as petechiae, but also are secondary to trauma or vasculitis.

infantile spasm(s)

These are baby seizures of about 4-8 months of life. They are brief symmetric contractions of the head, neck, trunk and extremities. There are 3 types (flexor, extensor or mixed). The EEG pattern is of hypsrrhythmia pattern.

Kayser-Fleischer (rings)

These are brownish discolorations of the posterior part of the cornea. They are seen in hepatitis caused by Wilson's disease in copper metabolism (copper accumulation in the liver).

ecchymoses

These are large (>1-2cm) subcutaneous hematoma that are usually after trauma. The erythrocytes are degraded and phagocytosed by macrophages. (macrophages ingest the hemoglobin and break it down to bilirubin and hemosiderin)

saccade(s)

These are rapid eye movements that quickly redirect the eyes to bring an image of an object to the retina. It is extremely fast.

Wright (stain), Giemsa (stain)

These are strains used to detect parasites in the blood like Babesia and Plasmodium, Histoplasma capsulate in phagocytes and tissue cells, intracellular inclusions formed by viruses and chlamydia, trophozoites of Pneumocystic jirovceii, and some other intracellular bacteria.

paraneoplastic syndrome(s)

These are symptom complexes that occur in patients with cancer and that cannot be readily explained by local or distant spread of the tumor, or by the elaboration of hormones indigenous to the tumor's tissue of origin.

amantadine (has some usefulness in Parkinsonism), rimantadine

These are two classic drugs that used to be the drug of choice when treating influenza, but now 92% of influenza viruses are resistant to them. They target the M2 protein and work by disrupting the endosomal pH (acidic pH is required for proper endosomal function).

Auramine-rhodamine, auramine O

These are two fluorescent stains used to detect mycobacterium tuberculosis. You could also see Nocardia, Legionella, and cryptosporidium and Isospora cysts.

Warthin-Starry (stain), Dieterle (stain)

These are two variations of silver stains that are used to visualize bacteria like spirochetes, helicobacter pylori, Microsporidia, and Bartonella henselae.

retinal hemorrhage(s)

These are usually seen with subdural hematomas as discussed in class.

(simple) febrile (seizures)

These types of seizures are seen from 9 months to 5 years with peak age at 14-18 months. This is because the brain myelination is not complete at birth and is associated with fever. The seizure is usually brief, is generalized tonic-clonic, and followed by a postictal phase. It can be caused by infections.

Docosanot (abreva)

This anti-herpes drug is a topical OTC drug for cold sores. It is an allopathic alcohol that inhibits fusion of the HSV envelope and the plasma membrane thereby preventing viral entry.

acyclovir

This antiherpes prodrug is a guanosine analog that is activated/phosphorylated and becomes a competitive inhibitor of DNA polymerase, which gets incorporated into viral DNA and terminates the chain. Its sugar lacks a 3'-OH group and must be taken orally 5x a day.

APD (afferent pupillary defect, or Marcus Gunn pupil)

This can be discovered by a swinging flashlight test and can indicate a lesion of the optic nerve on the affected side. Check for light or red desaturation.

valproic acid (other anticonvulsants like carbamazepine and lamotrigine can also be used to treat bipolar disorder)

This can be used as a mood stabilizer to treat bipolar disorder. It blocks Na+ channels, CA2+ channels, and facilitates GABA. It can cause nausea and life-threatening pancreatitis. In pregnant woman, it can cause neural tube defects including spina bifida.

Wilms tumor

This childhood cancer can cause paraneoplastic syndromes of polycythemia and hypercalcemia, resulting in excessive production of erythropoietin.

rifampin

This drug induces P450 enzymes, causing urine and feces to be orange-red in color and tears may stain contact lens orange-red as well. It penetrates the CNS.

Raltegravir

This drug inhibits the HIV enzyme integrase, which was used to integrate the viral genetic material into human chromosomes. It is used in combination with other HIV drugs in treatment-naive patients or treatment-experienced patients who have failed other therapies.

TGF-B

This growth factor is a potent inhibitor of epithelial cell proliferation (also endothelial and hematopoietic cells). At least one component of the pathway (usually SMAD4) is mutated in 100% of pancreatic cancers and 83% in colon cancers.

Hep B (HBV)

This is a DNA virus that has a strong association with hepatocellular carcinoma. Among the positive posttests with hepatocellular carcinoma, 90% have viral integrations in their genome.

clavulanic acid

This is a beta-lactamase inhibit that can be used with other penicillins like amoxicillin to increase the spectrum.

quinine (main side effect is cinchonism and tinnitus more specifically)

This is a blood schizonticide that complexes with double-stranded DNA to prevent strand separation, resulting in a block of DNA replication and transcription to RNA. It's main clinical use is in Plasmodium falciparum infections resistant to chloroquine, most commonly given with doxycycline.

ribavirin

This is a classic drug that used to be used to treat RSV. It is extremely toxic and causes myelosuppression (bone marrow suppression). It is not recommended for children but may benefit some adults for other diseases.

Diabetic macular edema (DME)

This is a collection of intraretinal fluid in the macular area of the retina, with or without lipid exudates or cystoid changes. Visual acuity is generally compromised when it affects the fovea.

hyperplastic arteriolosclerosis (intense pressure leading to this)

This is a concentric, laminated thickening of the arteriole walls, causing narrowing of the lumen. It is characteristic of malignant hypertension, and necrotizing arteriolitis can be seen as well. It has been described as "onion-skin".

amblyopia

This is a condition also known as lazy eye. It occurs when the visual pathway has failed to develop properly due to inadequate stimulation as a baby. It is a loss of visual acuity that cannot be improved by collected lenses because pathway development was halted.

thoracic outlet syndrome

This is a condition caused by compression of the brachial plexus, causing waste of some hand muscles, numbness, and tingling. It could also be because of compression of the subclavian artery or vein, with dollar, edema, diminished pulses, and positive Adson's maneuver.

atherosclerosis

This is a condition characterized by intimal lesions called atheromas that protrude into and obstruct the vascular lumen, weakening the underlying media.

fourth (cranial) nerve paresis

This is a condition that can be tested with the Bielschowsky head tilt (three-step test). Most result from a head injury and it damages the only cranial nerve to emerge on the posterior surface the brainstem.

amaurosis fugal

This is a condition that has monocular dimming of vision with sudden, transient, painless visual loss because of temporary arterial obstruction. It is like an eye stroke and could signal that they are in risk of a stroke/heart attack.

otitis media

This is a condition that is more common in infants and young kids because of a horizontal Eustachian tube, baby's poor immune system, gravity by prone positions, as well as formula consumption and negative pressure.

third (cranial) nerve paresis

This is a condition that produces both horizontal and vertical diplopia and ptosis as well. Most result from a microvascular injury associated with diabetes or hypertension, or an aneurysm. They usually resolve.

DIC (disseminated intravascular coagulation)

This is a consequence of widespread activation of the coagulation system through endothelial injury, causing release of thromboplastin substances into the circulation. Hypocomplementemia is seen with low levels of clotting factors, platelets, fibrin, etc, so widespread bruising is seen and bleeding everywhere.

hamartoma

This is a developmental anomaly that contains the same tissues as the organ in which it is found, but in the wrong proportions and usually disorganized. (like a developmental fluke, same tissue but in wrong proportions)

Raynaud's (disease, the phenomenon can be seen in SLE and others)

This is a disease caused by intense vasospasm of small arteries or arterioles and is most common in young healthy women. The extremities change color during any type of temperature change (like cold temperature).

Alagille syndrome

This is a disease characterized by intrahepatic biliary hypoplasia, butterfly vertebrae, mild pulmonic stenosis, and have narrow thin faces with a pointed chin.

Hirschsprungs disease

This is a disease that causes constipation because of a lack of ganglion cells at the distal segment of the colon (rectum or sigmoid), resulting in a lack of receptive relaxation and therefore a state of tonic contraction. A barium enema is done and a rat tail appearance is seen.

dysplasia

This is a disorderly but non-neoplastic proliferation. It is similar to carcinoma-in-situ when it is throughout the whole thickness of the epithelium. It looks like a malignancy but there it hasn't started invading the basement membrane.

ethambutol

This is a drug specific for TB that inhibits the synthesis of mycobacterial cell walls. Adverse effects include optic neuritis, decreased visual acuity, red-green colorblindness, retinal damage with prolonged use, as well as hyperuricemia and gout.

diazepam

This is a drug that can be given as prophylaxis of status epilepticus in babies with febrile seizures. It is a rectal gel.

botulinum toxin (type A)

This is a drug that can be used for strabismus (ocular misalignment that may cause double vision) or blepharospasm (when eyelids start twitching). It works by blocking the release of ACh, causing muscle paralysis and may cause lid droop or blurred vision.

dapsone (same mechanism as sulfonamides)

This is a drug used to treat leprosy (and others like brown recluse spider bites) and the mechanism of action is that is competitively antagonizes the bacterial utilization of PABA for the synthesis of folic acid by blocking dihydropteroate synthase.

terbinafine

This is a drug used to treat superficial/dermatophytic fungal infections such as onychomycosis. It inhibits squalene epoxidase, which normally converts squalene to squalene epoxide, and is an early step in ergosterol (cell membrane) synthesis. The accumulation of squalene (not converted) is toxic to the fungus.

Acridine orange

This is a fluorescent stain used to detect certain bacteria and fungi. An example of this is Borrelia and spirochetes.

calcofluor white

This is a fluorescent stain used to detect fungi, especially dermatophytes.

Kwashiorkor

This is a form of severe protein-energy malnutrition characterized by edema, irritability, ulcerating dermatoses, and an enlarged liver with fatty infiltrates. Sufficient calorie intake, but with insufficient protein consumption, distinguishes it from marasmus.

teratoma

This is a germ cell tumor that arise in cells that are totipotent. Because of this, the tumor may contain a variety of mature and/or immature tissues from different germ layers (like hair or teeth in tumor).

Palivizumab (synagis)

This is a good drug that can be used in selected infants and children younger than 24 months to prevent RSV. It is a humanized monoclonal antibody against the RSV F glycoprotein.

stridor

This is a high-pitched breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree. It can been seen in children with croup and is very bad in younger kids when they have it at rest.

Griseofulvin

This is a historical drug used to treat superficial fungal infections such as dermatophytes. It disrupts the mitotic spindle and inhibits mitosis. It has mostly been replaced by the azaleas and terbinafine. Side effects include hepatotoxicity and has the disulfiram effect with ethanol.

hyaline arteriolosclerosis

This is a hyaline thinking of the walls of the arterioles, narrowing the lumen. It is seen in people with diabetes, essential hypertension, and in normotensive elderly patients.

phoria

This is a latent tendency for the eyes to deviate when fusion is broken. It is seen on the alternating cover test.

cerebral edema

This is a major complication of traumatic head injuries and the usual cause of death. Treatment includes adequate oxygenation, elevation of head, hyperventilation, and mannitol IV use. Surgery is performed if needed. SIADH or seizures could also be seen because of it.

strabismus (or tropia)

This is a manifest deviation of the eyes (eye turn) seen on unilateral cover test. It is defined by the direction of the non-fixated eye. It can cause double vision

choristoma

This is a mass of normal tissue in an abnormal location, such as a pancreas-like nodule in the small intestine. It isn't a neoplasm where a genetic change caused it, just an abnormal development.

Efavirenz

This is a non-nucleoside reverse transcriptase inhibitor (NNRTIs) that binds to reverse transcriptase at a site below the catalytic site (allosteric inhibition), resulting in inactivation of the enzyme. It does not require phosphorylation to become active.

Chocolate agar

This is a non-selective, enriched growth medium. It is a variant of the blood agar plate and contains red blood cells, which have been lysed by heating very slowly to 56C. It is used for growing fastidious respiratory bacteria such as Haemophilus influenzae, which needs growth factors like NAD and hematin, which are released from erythrocytes when they are lysed.

Tenofovir (TDF)

This is a nucleotide reverse transcriptase inhibitor (NtRTI) that has a single phosphate on its sugar residue (nucleotide) and must be further phosphorylated to the active form. It is used in combination with other antiretroviral agents, most commonly with an NRTI, and is very well-tolerated.

ramelteon (melatonin receptor agonist)

This is a pharmacological treatment for insomnia. It binds to melatonin receptor 1 and 2 receptors, decreasing sleep latency and increasing total sleep time. Efficacy is questionable compared to BZs and non-BZ-GABA-A agonists. Side effect includes dizziness.

BZs (estazloam, flurazepam, temazepam, triazolam)

This is a pharmacological treatment for insomnia. It decreases sleep latency and increases total sleep time, increasing stage 2 sleep while decreasing stage 3 and 4. It is contraindicated in pregnancy, sleep apnea, and alcohol/CNS depressant use. Usually it is only used for 2-4 weeks because tolerance develops.

Non-BZ GABA-A agonists (Zolpidem, Zalephon, Eszopiclone)

This is a pharmacological treatment for insomnia. These drugs bind to the BZ1 receptor for sedation and decrease sleep latency and increase total sleep time. There is less withdrawal, tolerance, and rebound insomnia, and no BZ2 effect compared to BZs.

pyogenic granuloma (lobular capillary hemangioma)

This is a polypoid form of capillary hemangioma characterized by an exophytic red nodule attached by a stalk to the skin. It bleeds easily, can develop after trauma, and can occur in the gingiva of pregnant women. It may regress spontaneously.

HIE (hypoxic ischemic encephalopathy)

This is a potential cause of neonatal seizures characterized by the blood supply to the fetal brain being compromised around the time of delivery.

Valacyclovir

This is a prodrug of acyclovir that acts like and is used like it. However it has a longer half-life so it is dosed less frequently, only twice daily (Acyclovir is 5x)

dipivefrin

This is a prodrug of epinephrine and stimulates both a and B receptors. It lowers IOP by increasing uveoscleral outflow.

Myc (In normal cells, levels fall immediately once division begins, but in the oncogene it is constitutively/overexpressed)

This is a protooncogene that is expressed in almost all cell types, and is rapidly induced when cells receive signals to divide. The protein binds to DNA, causing transcription of growth-related genes.

Spurling's (maneuver)

This is a provoking maneuver of choice for cervical nerve root impingement. Sidebend, rotate, and extend, then compress. Local pain is more of a facet test, positive if it reproduces radiating pain.

von Hippel-Lindau (disease)

This is a rare disease (but more common in Kentucky) where cavernous hemangiomas occur in the cerebellum or brain stem, and may cause pressure symptoms or rupture. They can also occur in the pancreas, liver, or kidney.

OSA (obstructive sleep apnea)

This is a sleep disorder characterized by partial or complete closure of the upper airway, posterior from the nasal septum to the epiglottis, during inspiration. It could be because of anatomical factors, intraluminal negative pressure during inspiration, and symptoms include obesity, snoring, hypertension, and daytime sleepiness.

Berry (aneurysm)

This is a small aneurysm that classically occurs at the point at which a cerebral artery departs from the circular artery (the circle of Willis) at the base of the brain. They frequently rupture and bleed.

Argyll Robinson pupil

This is a small irregular pupil that responds poorly to light, but intact response to near. It is usually always miotic/constricted.

visual axis

This is a straight line that passes through both the center of the pupil and the center of the fovea. If damaged, vision loss is likely. Structures in this include: cornea, anterior chamber, pupil, crystalline lens, vitreous chamber, retina, optic nerve.

Angelman (syndrome)

This is a syndrome that can cause microcephaly. It has characteristic mental retardation, ataxia, and seizures.

Cornelia de Lange (syndrome)

This is a syndrome that can cause microcephaly. It is characterized by anteverted nostrils, low birth weight, carp mouth, micromelia, and synophrys.

Seckel dwarf (syndrome)

This is a syndrome that can cause microcephaly. It is characterized by bony defects and joint dislocations.

Rubinstein-Taybi (syndrome)

This is a syndrome that can cause microcephaly. It is characterized by broad thumbs and toes, narrow nose, and maxillary hypoplasia.

Smith-Lemli-Opitz (syndrome)

This is a syndrome that can cause microcephaly. It is characterized by cryptorchidism, jupospadias, vomiting, and seizures.

Prader-Willi (syndrome)

This is a syndrome that can cause microcephaly. It is characterized by hypotonia, cryptorchidism, and obesity.

Hallermann-Streiff (syndrome)

This is a syndrome that can cause microcephaly. It is characterized by microphthalmia and small nose.

Cockayne (syndrome)

This is a syndrome that can cause microcephaly. It is characterized by retinal degeneration, cataracts, and brain calcifications.

vestibulo-ocular (system)

This is a system in our body that maintains fixation in line with the body when the head is moved. It is primitive and has no voluntary control. It doesn't require the cortex to work, just the brainstem.

Breath H2 analysis

This is a test that is helpful to evaluate carbohydrate malabsorption for disaccharidases. For example, if lactose is given and lactase (disaccharide) isn't there to break it down, it will go unfermented and cause accumulation of H2, which can be seen in this test.

Hirschberg (test)

This is a test that test for ocular alignment and strabismus. It is done by shining a transilluminator at both pupils and observing the corneal reflexes. The reflex should be center in both eyes, and should not change between a monocular vs binocular view.

milk scintiscan

This is a test to diagnose recurrent pneumonias in kids. It is tested by tagging and giving kids milk and seeing if it leaks out to the respiratory tract.

Bruckner (test)

This is a test used to screen for media opacities in an infant/preverbal child. It is done by shining the ophthalmoscope beam between both pupils and observing the red reflex of each eye. If both reflexes are equally bright, it confirms binocular fixation.

Nystatin

This is a topical drug for superficial fungal infections. It works the same as amphotericin B (pokes holes in ergosterol cell membrane) and is mainly used for oral Candida, given as a "swish and swallow/spit".

intravitreal anti-VEGF

This is a treatment option for center-involved diabetic macular edema for vision 20/32 or worse. It significantly reverses vision loss from DME and has fewer complications and fewer developed PDR.

focal/grid laser (focal is used to treat macular edema due to focal leakage, grid laser is to treat macular edema due to diffuse leakage)

This is a treatment option for non-center involved diabetic macular edema or patients unable to tolerate intravitreal injections. It is less effective than intravitreal anti-VEGF.

vitrectomy

This is a treatment option for persistent diabetic macular edema with vitreous traction. The vitreous humor is removed and a gas or air bubble is put in.

intraocular steroids

This is a treatment option for proliferative diabetic retinopathy and diabetic macular edema. It prevents new growth of blood pressure but has a risk of elevated intraocular pressure and increase rate of cataract development. It is less effective than the focal/grid laser treatment (last choice basically).

ACTH

This is a treatment used for infantile spasms. Side effects include hyperglycemia, hypertension, electrolyte and GI abnormalities, and infection.

hemangiopericytoma

This is a tumor derived from pericytes with slowly enlarging, painless masses. It is most commonly seen in the lower extremities (like thigh) and retroperitoneum. The recur a lot and half of them metastasize.

RB (retinoblastoma protein)

This is a tumor suppressor protein that is dysfunctional in several major cancers. It prevents excessive cell growth by inhibiting cell cycle progression until a cell is ready to divide. When the cell is ready to divide, it is phosphorylated, becomes inactive and allows cell cycle progression into S phase.

doxycycline, quinine

This is a two drug combination that can be given for treatment or prophylaxis of Plasmodium falciparum. Other options include the "Arte" drugs or a combination of the anti-folate drugs.

isoametropic (amblyopia)

This is a type of amblyopia caused by a very high refractive error in both eyes, so high that a clear retinal image cannot be obtained. This results in a bilateral decrease in visual acuity.

meridional (amblyopia)

This is a type of amblyopia caused by uncorrected high astigmatism in one or both eyes.

anisometropic (amblyopia)

This is a type of amblyopia where a child has normal refractive error with good visual acuity in one eye and a significant refractive error and reduced visual acuity in the other eye. (One good eye, one bad eye)

Reed-Sternberg cell (also called Owl's eye cells)

This is a type of cell that contains 2 nuclei, each with a prominent nucleolus and distinct nuclear membrane. The cytoplasm of this cell is relatively abundant. Presence of these cells in lymph node tissue is diagnostic of Hodgkin's disease.

monocular (diplopia)

This is a type of diplopia that is often because of an ocular etiology like a stigmatism.

binocular (diplopia)

This is a type of diplopia that resolves if either eye is closed and could be indicative of a CNS problem. Long term diplopia could result in suppression. Onset before 7 or 8 will not have this type of diplopia because of amblyopia and/or suppression.

cavernous

This is a type of hemangioma that forms large, dilated vascular channels involving deep structures of the body. They are vulnerable to ulceration and bleeding.

capillary

This is a type of hemangioma that involves subcutaneous tissues, skin, liver, spleen, kidneys, lips, etc. It is a "strawberry type" and grows rapidly in the first few months but most of them regress by age 7.

hematoma

This is a type of hemorrhage that is characterized by an accumulation of blood within a tissue. An example of this is a bruise (leakage of vessel and blood escapes into that tissue, there's color change).

Adie's tonic pupil

This is a type of pupil, usually seen in young women unilaterally. It usually means the pupil is always dilated. It is due to damage to postganglionic fibers of the parasympathetic system, causing accommodative paresis.

myoclonic

This is a type of seizure associated with brief symmetric muscle contractions with loss of body tone.

complex febrile (seizure)

This is a type of seizure associated with fevers that lasts over 15 minutes. The seizures are also focal and recurrent and an abnormal neuro exam is seen. Also could be a recurrence of seizures within 24 hours.

imipenem

This is a very very broad antibiotic that works the same as penicillins. They are in-hospital agents for empiric use in severe life-threatening infections. If not given with cilastatian, it can cause renal dysfunction/nephrotoxicity.

HPV (human papilloma virus)

This is a virus responsible for benign squamous papillomas/warts. Types 16 and 18 are associated with squamous cell cancers of the cervix. The oncogenic potential is related to viral proteins E6 and E7.

pyrazinamide (weak acid that competes with uric acid, so won't secrete as much uric acid so will see increased level of uric acid in the blood, so hyperuricemia, which is a risk factor for gout)

This is a weak acid drug used to specifically treat M. tuberculosis. It is bactericidal to actively dividing organisms. There is an increased risk of gout, with 100% of takers getting hyperuricemia (and myalgia). It competes with uric acid at the proximal tubule of the kidney.

Ketaconazole

This is an -azole anti fungal drug that is also a P450 inhibitor so it has a lot of drug interactions. It can occasionally be used to inhibit steroid synthesis, or with Cushing's syndrome or prostate cancer.

phenylephrine

This is an a1 agonist that increases BP but causes a reflex bradycardia. It can be used for dilated eye exams, as a nasal decongestant, or to increase blood pressure. In an eye exam, it causes mydriasis but has no effect on accommodation. It should be avoided in patients with glaucoma.

prazosin

This is an a1 blocker that is used in BPH and hypertension. It may cause orthostatic hypotension and reflex tachycardia.

tamsulosin

This is an alpha-1a blocker in the prostate and is used in BPH only.

form deprivation

This is an amblyogenic condition caused by a degraded image formation on the retina or occlusion. It can occur in one or both eyes. Examples of this include cataracts or ptosis.

VEGF (Vascular endothelial growth factor)

This is an angiogenic factor under the control of RAS oncoprotein (also induced by hypoxia-inducible factor-1/HIF-1). Itis a signal protein produced by cells that stimulates the formation of blood vessels.

flucytosine

This is an anti fungal drug that enters fungal cells and is converted to 5-FU, and then 5-FdUMP, which inhibits thymidylate synthase and DNA synthesis (lowers thymine production). Adverse effects include bone marrow suppression and can be used synergistically with Amphotericin B.

pyrantel

This is an anti-helminthic drug that is used for roundworms, hookworms, and pinworms. The mechanism of action is similar to succinylcholine where it persistently stimulates nicotinic receptors present at the neuromuscular junctions resulting in spastic paralysis of the worm, which are then expelled by peristalsis.

vancomycin

This is an antibiotics that kills only gram positives and can be used for serious hospital-acquired MRSA. It binds to the D-ala-D-ala site and can cause red-man syndrome if given too fast.

heparin (Syndecan-4 is a natural heparin-like molecule in the endothelial cells, Protein C will also cleave factors V and VIII)

This is an anticoagulant that can be clinically administered to minimize thrombosis. It activates antithrombin which inactivates thrombin and other clotting factors.

warfarin

This is an anticoagulant that inhibits Vitamin K epoxide reductase. It doesn't allow for the carboxylation of factors 2, 7, 9, and 10's glutamic acid residues so they can't make a bridge onto the phospholipid surface of the platelet. (Calcium is also needed)

infarction

This is an area of ischemic necrosis caused by occlusion of either arterial supply or venous drainage. 99% due to thrombotic or embolic events and almost all due to occlusion of arterial supply.

LAD (left anterior descending coronary artery)

This is an artery that is particularly prone to developing an arterial thrombus after it deviates off the circumflex artery on the heart, there's a lot of turbulence created there.

telomerase (it can also be achieved with alternative lengthening of telomeres mechanisms like recombination strategy, amplification of large blocks of DNA at chromosome ends)

This is an enzyme that adds telomere repeats to chromosome ends and is expressed in 90% of human cancers. It gives cancer cells that capacity for limitless replicative potential.

bupropion

This is an example of a drug that can be used to treat depressive disorders. It blocks the reuptake of both dopamine and NE. It can be used for smoking cessation. Side effects include increased risk of seizures, but doesn't have a sexual side effect.

nefazodone

This is an example of a serotonin reuptake inhibitor (that also acts as a serotonin receptor blocker) that can be used to treat depressive disorders. It has a main side effect of causing fatal liver failure.

glomus (tumor)

This is an extremely painful tumor most commonly seen under the fingernails (distal portion of digits). Excision is curative. (glomus bodies are modified smooth muscle cells that are involved in thermoregulation)

ulcerative colitis

This is an inflammation only in the colon and only in the mucosa. there is mucousy, bloody diarrhea with rectal bleeding and cramps abdominal pain. You will not see the normal landmarks on the colon, and will see intensely red ulcerations and crypt abscesses. A colonoscopy is diagnostic for it.

substance P

This is an inflammatory agent that can be related from a peripheral nerve terminal and is involved in the process of neurogenic inflammation and edema. When irritated, the axons can secrete it into the surrounding tissue.

Crohn's disease

This is an inflammatory bowel disease that can affect any part of the GI tract, as well as all layers of the GI tract (transmural). Diagnosis is made with endoscopy. Excessive nodules with caseating granulomas are also seen.

Ischemic optic neuropathy

This is an ocular emergency and is an ischemic infarction of the anterior optic nerve. It is characterized by acute vision loss, over 60 years old, pale swollen disc with splinter hemorrhages, visual field loss (usually altitudinal defect) and is often caused by arterial disease (like temporal arteritis) or hypovolemia (massive blood loss).

clofazamine

This is another drug to treat leprosy (other than rifampin and dapsone), and it binds to the bacterial DNA and prevents replication. Side effects include ichthyosis and pigmentation.

(cancer) cachexia

This is another term for cancer wasting syndrome, a loss of body fat and lean body mass accompanied by profound weakness, anorexia, and anemia. There is an increase in TNF causing increased basal metabolic rate and reduced food intake, among other effects.

edema

This is increased fluid in interstitial spaces due to increased capillary pressure, diminished plasma osmotic pressure, or lymphatic obstruction.

Ivermectin

This is the anti-helminthic drug of choice for onchocerciasis/river blindness. The mechanism of action is that it acts as a glutamate and GABA (probably mainly GABA) agonist causing hyper polarization of invertebrate nerve and muscle cells and death of the worm.

posaconazole

This is the broadest spectrum azalea and is the only azole used for mucormycosis.

Lithium

This is the drug of choice for bipolar disorders, however, it has a low TI and can causes toxicity, hand tremor, edema, hypothyroidism, nephrogenic diabetes insipidus by blocking V2 receptors (can't respond to ADH), and Ebstein's anomaly of the newborn in pregnant women.

voriconazole

This is the drug of choice for invasive aspergillosis and can be used in other fluconazole-resistent organisms.

fluconazole

This is the drug of choice in esophageal, oral, and vaginal candidiasis, cocidioides, cryptococcal meningitis. It is the only azole to penetrate the CNS.

arteriosclerosis

This is the general term for "hardening of the arteries", because of thickening and loss of elasticity of arterial walls. The most common form is atherosclerosis.

neuroblastoma

This is the most common extra cranial solid tumor of childhood and makes up ~8-10% of childhood cancers. The median age is 2 years and 90% of cases are diagnosed <5 years.

metastatic carcinoma

This is the most common intraocular malignancy in adults. It may be asymptomatic visually or may produce deceased or distorted vision.

IgA deficiency

This is the most common primary immunodeficiency and can cause someone to be more prone to Giardiasis. There is also a high incidence of chronic diarrhea, and can severe reactions to blood products.

Hayflick limit (or phenomenon)

This is the number of times a normal human cell population will divide until cell division stops. Empirical evidence shows that the telomeres associated with each cell's DNA will get slightly shorter with each new cell division until they shorten to a critical length.

temporal (giant cell) arteritis

This medical emergency happens more commonly in women who are about 70 years old. Symptoms include transient monocular vision loss, diplopia, and headache. It left untreated it can result in irreversible blindness, heart attack, stroke, aortic aneurysm.

RAS (reticular activating system)

This part of the midbrain/brainstem coordinates the cardio and respiratory system, swallowing and vomiting, sleep, wakefulness, and eye movements.

lymphoma

This pediatric malignancy can be suspected if there is persistent unexplained lymphadenopathy with enlarged nodes that do not regress after infectious mononucleosis.

peau d'orange

This phenomenon is shown in the picture and is a lymphatic obstruction in breast cancer. There is so much edema in the hair follicles that cause it look so pronounced and will cause surrounding edema. It usually shows a poor prognosis and advanced cancer.

pursuit

This term describes the tracking of eye movements that stabilize an image of a slowly moving object onto the fovea.

nystagmus

This term is a spontaneous jerking movements of the eye. It is usually binocular but can be monocular too. It can be indicative of poor vision in children and may be indicative of CNS dysfunction.

primaquine

This tissue drug forms cellular oxidants/oxidative stress/free radicals to kill malaria. It can be used to eradicate liver stages of Plasmodium vivax and ovale, and is used in conjunction with a blood schizonticide like chloroquine. Its side effect of hemolysis in G6Pd deficient patients is particularly important.

capillary (different from hemangiomas because no RBCs, mainly found in head/neck, and pretty small)

This type of lymphangioma occurs in the head/neck, axilla with slightly elevated lesions 1-2 cm in diameter, and can distinguished by the absence of RBCs in channels.

cavernous (cystic hygroma)

This type of lymphangioma occurs in the neck, axilla and may grow up to 15 cm. It is frequently seen in Turner syndrome.

Trousseau's syndrome

Thrombi may develop anywhere, like seen in valve cusps. What is the paraneoplastic syndrome that causes hyper coagulability, perhaps because of mucin producing activating clotting ?

neoplasia (particularly adenocarcinomas of the pancreas, lung, colon and migratory thrombophlebitis/Trousseau sign)

Thrombophlebitis is an inflammation of a venous thrombosis (phlebothrombosis is when a clot in a vein forms independently of inflammation). What is the main clinical predisposition highlighted in class? Others include cardiac failure, pregnancy, obesity, postoperative state, genetic hyper coagulability syndromes.

Transient insomnia is insomnia lasting 2-3 nights (jet lag). Short-term insomnia is lasting less than ______ months, while chronic insomnia is lasting more than those months.

dapsone, clofazamine, rifampin

Treatment of leprosy (Hansen's disease) is a triple drug regimen of _______________, ___________________, and __________________ and is given for minimum of 24 months.

6-12

Treatment of social anxiety disorder (SAD) has a recommended ______________________ months medication to improvement and decreases the rate of relapse.

SNRIs (serotonin norepinephrine reuptake inhibitors)

Tricyclic antidepressants (TCAs) have the same mechanism of action as which drugs?

True

True/False: A VCUG (voiding cystourethrogram) can be used to test for vesicoureteral reflux and pyelonephritis. It can show the grade of reflux.

True

True/False: A warning for antidepressants such as SSRIs, SNRIs, and TCAs is to closely monitor for worsening depression or emergence of suicidality particularly in pediatric patients.

True (treat burns by immediately flushing to avoid scarring)

True/False: Alkaline burns in the eye are worse than acidic burns because of saponification of fat and quick absorption in the eye. Also a red eye is better than a white eye, because that would mean all the blood vessels have been obliterated.

True (a1 is Gq, a2 is Gi, and B's are Gs)

True/False: All norepinephrine receptors are G-protein couple receptors (GPCRs).

True

True/False: Aminoglycosides, chloramphenicol, macrolides, tetracyclines, streptogramins, and linezolids all inhibit bacterial protein synthesis.

True

True/False: Antifolate drugs like pyrimethamine and proguanil (inhibit dihydrofolate reductase), sulfadoxine and dapsone (PABA analogs) can be used to treat or prevent Plasmodium falciparum.

True

True/False: Arterial thrombi are laminated with alternating layers of platelets, fibrin, RBCs, etc, while the lamination is not as prominent in veins and not present in postmortem clots.

False (don't use both together because they are cytosine analogs and would compete with each other, so pick different nucleotide analogs when using combination treatment)

True/False: Because lamivudine (3TC) and emtricitabine (FTC) are the least toxic NRTI's, combination therapy involving both of them together is effective.

True

True/False: Defects in DNA mismatch repair and defects in nucleotide excision repair are two examples of defects in DNA repair genes that can predispose individuals to cancer.

True

True/False: Fluoroquinolone, rifampin, metro and daptomycin all inhibit nucleic synthesis.

True

True/False: Germline mutations are heritable and are present in the egg or sperm, and predispose offspring to that cancer. While somatic mutations occur in nongermline tissues and are non heritable. They will usually happen later in life.

True

True/False: Hyperlipidemia (hypercholesterolemia) is a risk factor for atherosclerosis and can result from a high dietary intake of cholesterol and saturated fats. Low-density lipoproteins are bad and transport cholesterol to peripheral tissues. HDLs are good and are decreased.

True (probably too detailed to know)

True/False: In treatment of Hodgkin's lymphoma, chemotheraphy may be done, which consists of MOPP, which has nitrogen mustard, Oncovin, procarbazine, and prednisone, and ABVS, which has Adrianycin, bleomycin, vinblastine, and dacarbazine.

True

True/False: Incomitant diplopia is changes in various positions of gaze, and is usually caused by a nerve or muscle issue.

False (they do NOT require phosphorylation to become active)

True/False: Like NRTIs (nucleoside reverse transcriptase inhibitors) and NNRTIs (nucleotide reverse transcriptase inhibitors), the NNRTIs (non-nucleoside reverse transcriptase inhibitors) are prodrugs and require phosphorylation to be activated.

True (hollow cavity inside the neoplasm)

True/False: Rapidly growing malignant tumors often contain central areas of ischemic necrosis when the tumor blood supply fails to keep pace with the oxygen needs of cells. An example of this is with squamous cell carcinoma of the lung.

True

True/False: Schizophrenia has its onset in late adolescence or early adulthood and rarely occurs before adolescence or after the age of 40 years. It happens earlier in males than females.

True

True/False: Sepsis is SIRS + infection, Severe sepsis is sepsis + MODS/MOFS (multiple organ dysfunction/failure), and septic shock is severe sepsis with persistent hypotension.

True

True/False: Side effects of sulfonamides include hypersensitivity/Stevens-Johnson syndrome (crusting the lips), hemolysis in G6PD deficiency, and phytotoxicity. Trimethoprim or pyrimethamine can cause bone marrow suppression.

True

True/False: Sulfonamides, trimethoprim, and pyrimethamine all inhibit folic acid synthesis.

True

True/False: Treatment of Wilms tumor is nephrectomy for unilateral tumors even with pulmonary metastases, and then post operative radiation and chemotherapy, depending on the extent and type.

True

True/False: Treatment of a localized neuroblastoma tumor is complete surgical resection, which is curative.

True

True/False: Treatment of status epilepticus include stabilizing breathing (ABCs), giving oxygen, giving glucose, do blood samples, physical examination (like for trauma, increased ICP, papilledema or local neurological signs), and giving IV fluids and medication (like diazepam, lorazepam, phenytoin, etc).

True

True/False: Tumor cells must have access to the vasculature to metastasize. However, in their vasculature, there is no clear transition between venules and arterioles.

True

True/False: Usually you don't want to treat every kid who has reflux/spit up, but if they are cyanotic or have asthma/wheezing, or not gaining weight and having failure to thrive, and if there are recurring episodes of pneumonia or aspiration, these are reasons you should worry about it and treat it.

True

True/False: When compared with grading, staging of cancer has proved to be of greater clinical value. Staging reflects the current extend and spread/whether or not the tumor has metastasized or not.

True

True/False: When treating depression, the acute phase lasts 6-12 weeks with the goal of remission. The continuation phase is for 4-9 months with the goal to eliminate residual symptoms and prevent relapse. The maintenance phase is for 12-36 months to prevent recurrence.

False (RSV lacks hemagglutinin and neuraminidase so you can't)

True/False: You can use -ivir drugs like Zanamivir or Oseltamavir to treat Respiratory Syncytial Virus (RSV).

specific (we can label antibodies and used to detect on a biopsy if we are making too much of say HER-2 as an example)

Tumor-_____________ antigens are present only on tumor/cancer cells and offer the best potential for tumor vaccination. Examples include RAS, HER-2, oncogenic virus antigens, and oncofetal proteins such as CEA (carcinoembryonic antigen) and a-fetoprotein.

associated (It includes tissue-specific antigens and differentiation-specific antigens like prostate-specific antigen)

Tumor-___________________ antigens are present on tumor cells and some normal cells, and usually serve as diagnostic markers for type of cells involved in transformation (like with prostate cancer).

typical (block dopamine)

Typical or atypical antipsychotic drugs are more associated with movement disorders/Parkinson-like effects?

Under what CD4 count is Cytomegalovirus infections and Mycobacterium avium complex infections associated with?

200

Under what CD4 count is Pneumocystic jiroveci pneumonia associated with?

100,000 (nowadays it might be 50,000)

Under what number of WBC count is an indicator of a good prognosis for a bone marrow transplant for ALL?

attached

Unlike emboli, a thrombi is normally _________________ to the underlying vessel or heart wall.

rubella, CMV, toxoplasmosis, syphilis

What are 4 infections that can cause microcephaly?

extrinsic (pumps)

Vasomotor like arterial pulsation and muscular contraction (pulls on fascia), like smooth muscle (peristalsis), voluntary skeletal muscle, and breathing (whole body movement) are all examples of which type of lymph pump (relative to the lymphatic system)?

endothelial injury

Virchow's triad explains how clots form and what the risk factors for it are. It states that if you have ___________________________, with sites of trauma/inflammaion or a dysfunctional endothelium because of stressors, it can liberate substances that lead to abnormal clotting and thrombosis.

Fungi (makes it so you can see the hyphae better, like dermatophytes)

Visibility of _________ can be increased by applying 10% potassium hydroxide (KOH) on a direct wet mount to dissolve surrounding tissues and nonfungal organisms.

Vitamin K epoxide reductase

Warfarin is an anticoagulant that inhibits __________________________________, which means that carboxylation of factors' glutamic acid residues cannot happen. Because of this, they cannot bind to the phospholipid surface of the platelet.

facilitation

We treat Chapman's points because we want to interrupt the abnormal _____________________ reflex and potentially improve both visceral and somatic symptoms.

M3 (parasympathetic, no sympathetic activity in ciliary muscle), accommodation (it's a parasympathetic activity)

What (clinically significant) receptor is on the ciliary muscle? If stimulated, what does it cause?

staph saprophyticus

What (gram positive) bacteria can cause a urinary tract infection in a young sexually active women, known as a honeymoon cystitis?

IL-4, IL-10

What are 2 anti-inflammatory cytokines released by nerves we talked about in regards to Allostasis and Chapman's reflexes?

MSSA, MRSA, strep (Group A/pyogenes)

What are 3 bacterial agents of impetigo (superficial infection of skin and subcutaneous tissue)?

rifabutin (like rifampin, block Ran polymerase, MAC specific), azithromycin, clarithromycin (50S subunit block translocation)

What are 3 options to use for prophylaxis of mycobacterium avium complex (MAC)?

bone marrow, CNS, testicles

What are 3 potential areas of relapse for leukemia?

varicose (incompetent valves can lead to venous stasis, congestion, edema, edema, pain, etc)

What are abnormally dilated tortuous veins? They are produced by prolonged increased intraluminal pressure, with loss of vessel wall support. They are more common in over 50 year old, obese women in pregnancy.

NMDA, AMPA, KA

What are the 3 ionotrophic subtypes of glutamate receptors?

reverse transcriptase inhibitor(s), protease inhibitor(s), fusion inhibitor(s), integrase inhibitor(s)

What are the 4 main classes of drugs used against HIV?

ALL (acute lymphoblastic leukemia), Hodgkin's lymphoma, Wilm's tumor, neuroblastoma

What are the 4 most common pediatric malignancies?

Isoniazid, rifampin, pyrazinamide, ethambutol, streptomycin (backup)

What are the 5 main/1st line drugs you want to use when treating M. tuberculosis? (present as cough lasting longer than 3 weeks, hemoptysis, low grade fever at night, night wears, fatigue, malaise)

Maculopapular rash, CNS effects (like vivid dreams)

What are the adverse effects of non-nucleoside reverse transcriptase inhibitors (NNRTIs) like efavirenz?

macrolide(s)

What are the antibiotics of choice to treat community acquired pneumonia?

2, 7, 9, 10

What are the clotting factors that need to be carboxylated of their glutamic acid residues in order to bind to the phospholipid surface? It requires oxidized vitamin K.

liver, lungs

What are the most common sites of hematogenous spread for extravasation of metastatic tumors?

strep pneumo (32%), H-flu (22%), Moraxella (16%) (Others are Group A strep at 2% and nonpathogens are 25%)

What are the most likely causes of otitis media in infants and children? Most of the time it will resolve under watchful observation, but can also be treated with antibiotics like amoxicillin or trimethoprim/sulfamethoxazole.

anaerobes (85%, staph aureus is 35%, E coli is 20%, strep is 10, other aerobes is another 10%)

What are the most likely organisms recovered from a perirectal abscess in children?

glutamate

What are the most powerful excitatory neurotransmitters in all over the CNS? It is released by Ca++ dependent exocytosis.

strep pneumo, H-flu, Moraxella

What are the organisms that can cause acute sinusitis?

SSRIs (escitalopram, paroxetine, sertraline, fluvoxamine, fluoxetine), SNRIs (venlafaxine XR, good for comorbid depression)

What are the primary treatment drugs for chronic panic disorder? Which is especially useful in patients with comorbid depression?

Haloperidol (and the zines), Fluphenazine, thioridazine

What are the three highlighted examples of typical/first generation antipsychotic drugs? They block the D2 receptors among other things.

asymptomatic abdominal or flank mass, hypertension, hematuria

What are the three most common presentations of Wilms tumor, the most common childhood renal tumor?

delivery (obstetrical complications, like placenta/vasculature problems), infections (usually gram negative bacilli), cancer (tissue factors regulating/producing mucin using all the coagulation factors)

What are the three most common triggers of disseminated intravascular coagulation (DIC)?

TNF, IL-1

What are the two cytokines activated by macrophages and other cells that are the main players in the pathogenesis of septic shock?

Zanamivir (disk inhaler), Oseltamivir (oral, more popular)

What are the two drug of choice options when treating influenza? They block neuraminidases, thereby inhibiting the budding and release of the virus from the cells so they can't go and infect others. They are also used for prophylaxis.

lamivudine (3TC), emtricitabine (FTC)

What are the two least toxic NRTIs?

bicuspid aortic valve, coarctation of aorta

What are the two most common cardiac defects in people with Turner syndrome?

transplant-associated (seen after organ transplantation and heavy use of immunosuppressive drugs, can be fetal when it involves organs), AIDS-associated (25% of AIDs patients)

What are the two most common forms of Kaposi sarcoma? The other two former chronic (classic) and lymphadenopathic (African).

High viral load, low CD4 count

What are the two most diagnostic clinical presentations of a person with HIV?

Foscarnet, Ganciclovir

What are two anti-herpes drugs that can be used for CMV retinitis?

albendazole, mebendazole

What are two antihelminthic drug of choice options, not including pyrantel, for roundworms, hookworms, whipworms, pinworms, threadworms, trichinella, also cystic hydatid disease and cysticercosis?

myelomeningocele (Arnold-Chiari malformation), hydrocephalus

What are two congenital malformations that can cause microcephaly?

MacConkey agar, EMB (eosin methylene blue agar)

What are two culture medias used to isolate gram-negative enteric bacilli/lactose fermenters?

labetalol, carvedilol

What are two examples of alpha-1 and beta blockers?

HOTV chart, lea symbol(s)

What are two methods/things you can use to test pediatric visual acuity?

atropine, tropicamide (block M3 receptors in the eye to produce mydriasis and cycloplegia, prefer tropicamide since it doesn't last as long)

What are two muscarinic antagonists used for a dilated eye exam?

Sulfonamide allergy

What is the adverse effect of taking darunavir, a protease inhibitor?

aneurysm (can have a ballooning and dissection into the aneurysm that can extend up through the wall)

What is a localized abnormal dilation of a blood vessel of the heart? It is at a site of stress (hydrostatic pressure) or a site of weakness.

lymphedema (long standing for about a decade)

What is a major predisposing risk factor for angiosarcoma of the skin and soft tissue?

buspirone

What is a non-benzodiazepine anxiolytic that is a secondary drug of choice for GAD? It is a partial agonist at 5-HT1a presynaptic auto receptors (decreases serotonin release) so it is not a CNS depressant.

Niclosamide

What is a really good backup drug for most tapeworms if Pranziquantel cannot be used?

anisocoria (physiologic is non pathological)

What is a significant difference in pupil size between pupils?

Impetigo

What is a superficial infection of the skin and subcutaneous tissue that can be caused by MSSA or MSRA? It can be characterized by skin erosions with golden yellow crusting lesions of 1-3cm. There can be central healing in chronic scattered discrete satellite lesions with auto inoculation?

Chapman's reflexes (they're small, smooth, firm, discretely palpable nodules that are very tender and a form of viscerosomatic reflex)

What is a system of reflex points that present as predictable anterior and posterior fascial tissue texture abnormalities (plaque-like changes or stringiness of involved tissues) assumed to be reflections of visceral dysfunction of pathology?

hydroperitoneum (ascites)

What is a type of edema that describes fluid accumulation in the abdomen/peritoneum?

anasarca

What is a type of edema that describes fluid everywhere? It is severe edema with subcutaneous swelling.

hydropericardium

What is a type of edema that describes fluid in the heart?

hydrothorax

What is a type of edema that describes fluid in the thoracic cavity?

Memantine

What is an NMDA antagonist introduced for treatment of Alzheimer's dementia?

metoprolol (A-M olols)

What is an example of Beta-1 specific beta blockers?

Latanoprost

What is an example of PG (prostaglandin) analog? It works by PGF2a lowering the IOP by facilitating aqueous outflow. They also bind to the Gq coupled receptors in ciliary muscle cells.

simeprevir (evirs, also glecaprevir, grazoprevir, paritaprevir)

What is an example of a NS3/4A Hep C protease inhibitor used to treat Hepatitis C?

imipramine

What is an example of a TCA (tricyclic antidepressant)?

timolol (others include betaxolol, carteolol, levobunolol, metipranolol)

What is an example of a beta-blocker eye drop used to treat glaucoma?

pilocarpine

What is an example of a muscarinic agonist that can treat glaucoma? It contracts the ciliary muscle and facilities aqueous humor outflow.

propranolol (N-Z olols)

What is an example of a nonspecific beta-blocker?

ledipasvir (svir, also daclatasvir, velpatasvir, elbasvir, pibrentasvir, ombitasvir)

What is an example of an NS5a inhibitor that stops viral replication, assembly, and secretion to treat Hepatitis C?

sofosbuvir (uvirs, also dasabuvir)

What is an example of an NS5b RNA polymerase inhibitor used to treat Hepatitis C?

venlafaxine

What is an example of an SNRI (serotonin norepinephrine reuptake inhibitor) that has an extended release?

apraclonidine

What is an example of an a2 agonist that can be used to treat glaucoma. It works by reducing aqueous humor production (postsynaptic a2 receptor) and enhancing uveoscleral outflow (presynaptic a2 receptor).

acetazolamide

What is an example of carbonic anhydrase inhibitor that can be used to treat glaucoma? It reduces the formation of bicarbonate in the ciliary body.

Thiabendazole

What is an extremely toxic anti-helminthic drug that can cause liver failure and Stevens-Johnson syndrome?

epilepsy

What is characterized by recurrent seizures unrelated to fever or acute brain insult?

pneumonitis (pneumonia)

What is inflammation of the alveoli? It can be associated with rales or crackles, and chest pain. 3 months or younger should always be admitted to the hospital and treated with IV broad-spectrum antibiotics. 5-10 years treat with PO amoxicillin, 10-21 (could be mycoplasma) treat with macrolides.

bronchiolitis

What is inflammation of the small bronchioles? Like terminal ones, not the larynx or trachea.

RAS (mutant RAS will lose the GTPase activity to stop the signal)

What is likely the common gene impacted in cancer?

infraorbital canal (with the infraorbital nerve)

What is most commonly damaged in an orbital floor blow-out fracture?

Culture

What is normally the gold standard for identification of organisms, although results may not be available for days or weeks? It is microbial growth on or in an nutritional solid or liquid medium and it also facilitates testing of antimicrobial susceptibility.

syphilis

What is one of the major causes of ascending aortic aneurysm?

HER 2 (also named ErbB-2, with this receptor the are overly sensitive so growth will proliferate in situations where it normally would not)

What is the EGF receptor that is over expressed in ~30% of breast cancers? High levels of this growth factor receptor indicates a poor prognosis. Treatment involves drugs designed to block that receptor.

ErbB-1 (also named epidermal growth factor receptor/EGFR)

What is the EGF receptor that is over expressed in ~80% of squamous cell carcinomas of the lung?

CSME (clinically significant macular edema)

What is the class of diabetic macular edema that has retinal thickening involving the fovea? It has hard exudates close to the center of the macula and there's also zones of retinal thickening. It has a 10x greater risk of developing moderate vision loss.

Blood agar

What is the culture media used to isolate almost all bacteria, and is differential for hemolytic organisms?

Chocolate agar

What is the culture media used to isolate most fastidious pathogens such as Neisseria and Haemophilius?

(Modified) Thayer Martin agar

What is the culture media used to isolate pathogenic Neisseria species?

Hektoen enteric agar

What is the culture media used to isolate salmonella and shigella species?

Mannitol Salt Agar

What is the culture media used to isolate staphylococci and micrococci?

Bernard-Soulier syndrome

What is the deficiency when there is normal platelet count, normal von Willebrand factor, but no Gp1b receptor? So the platelets can't recognize the von Willebrand factor to bind to the collagen.

temporal artery biopsy

What is the definitive way to diagnose temporal (giant cell) arteritis?

rifampin

What is the drug for prophylaxis of isoniazid-resistant Mycobacterium tuberculosis?

chloroquine

What is the drug of choice for acute attacks of nonfalciparum/basically vivax malaria? It is also used as chemoprophylaxis in sensitive regions.

itraconazole

What is the drug of choice for blastomycosis, sporothrix, and histoplasma?

diethylcarbamazine

What is the drug of choice for filariasis (also taken with albendazole) and loa loa (eye worm disease)?

praziquantel

What is the drug of choice for schistomiasis/trematodes, and cestodes? It works by increasing membrane permeability to calcium causing muscle contraction, followed by paralysis of the muscles.

metronidazole (or tinidazole, can be used with diloxanide in severe cases)

What is the drug of choice to treat Amebiasis, mainly E. histolytica?

Nifurtimox (also benznidazole)

What is the drug of choice to treat American trypanosomiasis aka Chaga's disease?

metronidazole (can also use oral vancomycin)

What is the drug of choice to treat Clostridium difficile?

metronidazole (also tinidazole, they use a ferredoxin, can cause metallic taste mouth and a disulfiram effect if taken with alcohol)

What is the drug of choice to treat Giardia?

sodium stibogluconate (pentavalent anatomy, backup is amphotericin B)

What is the drug of choice to treat Leishmania?

SMX/TMP (sulfamethoxazole-trimethoprim)

What is the drug of choice to treat uncomplicated UTIs from E.coli? It can also be used for community-acquired MRSA, pneumocystis jiroveci, and toxoplasma gondii (actually use sulfadiazine and pyrimethamine but similar mechanism).

risperidone

What is the drug of choice when treating Schizophrenia?

ceftriaxone (gonorrhea), azithromycin (chlamydia)

What is the drug of choice when treating gonorrhea? What about chlamydia?

Pencillin G

What is the drug of choice when treating syphillis?

flumazenil

What is the drug that blocks BZ1 and BZ2 receptors to rapidly reverse the actions of benzodiazepines.

pyrimethamine, sulfadiazine (take these two antifolate drugs together, clindamycin can be used as a sub)

What is the drug(s) of choice to treat Toxoplasmosis?

fluconazole

What is the first choice drug for prophylaxis of candida species fungi infection?

fluconazole

What is the first choice drug for prophylaxis of cryptococcus neoformans?

azithromycin (or clarithromycin, basically a macrolide)

What is the first choice drug for prophylaxis of mycobacterium avium complex?

isoniazid

What is the first choice drug for prophylaxis of mycobacterium tuberculosis?

SMX/TMP (sulfamethoxazole-trimethoprim)

What is the first choice drug for prophylaxis of pneumocystis jiroveci?

ALL (acute lymphoblastic leukemia)

What is the first disseminated cancer curable with chemotherapy and irradiation? It can be subclassified according to the morphology of certain cells.

isoniazid (rifampin is best alternative, BCG has very limited use)

What is the first line agent for prophylaxis of TB?

SSRIs (fluoxetine, paroxetine, citalopram)

What is the first line drugs used to treat depressive disorders? (it can have sexual side effects due to excessive stimulation of brain and spinal cord 5-HT2 receptors)

Enfuvirtide

What is the fusion inhibitor drug to treat HIV that blocks gp41 protein on T-cell surface to prevent viral entry? It is used in combination with other HIV drugs in treatment-experience patients who have failed other therapies.

Maraviroc

What is the fusion inhibitor drug to treat HIV that blocks the CCR5 protein on macrophage (or T-cell) surface to prevent viral entry? It is used in combination with other HIV drugs in treatment-naive patients or treatment-experienced who have failed other therapies.

skeletal muscle

What is the least favored site for hematogenous spread for extravasation of metastatic tumors?

140/90 (mmHg)

What is the lower end of the systolic and diastolic pressures for someone with hypertension? (basically anything over those numbers means hypertension)

chloroquine

What is the primary blood schizonticides (kills parasites form only in the erythrocyte)?

RSV (respiratory syncytial virus)

What is the main organism that can cause bronchiolitis (small bronchioles)? Others include adenovirus and parainfluenza virus. The secretions for this virus are very thick and vicious and clog up the terminal bronchioles. There can also be wheezing.

breast

What is the most common cancer that females get?

prostate

What is the most common cancer that males get?

endocardial cushion defect (The walls separating all 4 chambers of the heart are poorly formed or absent, also the valves separating the upper and lower chambers of the heart have defects during formation)

What is the most common cardiac defect in Down syndrome patients?

alcoholism (portal hypertension, causes back flow of blood to accumulate)

What is the most common cause of chronic passive congestion of the liver?

Marfan syndrome

What is the most common cause of heritable ectopia lentis/subluxed lens?

croup

What is the most common cause of partial airway obstruction in children? It involves the big bronchioles and can present as dry cough with stridor.

Leukemia (75% ALL with peak at 4 years, 20% AML from 1-10 years and increases with adolescence, and CML and CLL are rare in children)

What is the most common childhood cancer? It accounts for 33% of pediatric malignancy.

Wilms tumor (nephroblastoma)

What is the most common childhood renal tumor?It is associated with congenital anomalies (like GU when there's a duplication of the kidneys) and the median age of diagnosis is 3 years. Patients will most likely present with asymptomatic abdominal or flank mass with hypertension and hematuria.

12:21

What is the most common cytogenetic translocation associated with a good prognosis of acute lymphoblastic leukemia (ALL)?

dry eyes

What is the most common manifestation of connective tissue disorders? Symptoms include a burning, foreign-body sensation, and photophobia (bothered by light).

pneumocystis jiroveci

What is the most common opportunity infection in AIDS patients?

otitis media (more common in kids because of the horizontal angle of about 10 degrees of the Eustachian tube, adults have it at about 40, so pathogens from the nasal pharynx have a much easier time to getting to the middle ear)

What is the most common out patient diagnosis in pediatric practice? It is more common in infants and young children.

horseshoe kidney

What is the most common renal defect in people with Turner syndrome?

HUS (hemolytic uremic syndrome)

What is the most dreaded complication of shigellosis? It can cause acute renal failure.

albumin

What is the most important protein for homeostasis? Low levels can lead to nephrotic syndrome or protein-losing glomerulopathies.

E. coli (80% Ecoli, also Klebsiella is number 2 at 10%)

What is the most likely organism to cause UTIs?

Ritonavir

What is the most potent p450 inhibitor of the protease inhibitors (PIs)?

20/50

What is the normal visual acuity for a 3 year old?

20/40

What is the normal visual acuity for a 4 year old?

20/30

What is the normal visual acuity for a 5 year old?

20/20

What is the normal visual acuity for a 6 year old?

5-HT3

What is the only excitatory serotonin receptor?

simple partial

What is the only type of seizure where consciousness is retained? It is usually pretty short and EEG shows spikes and/or waves.

Unknown

What is the origin of a greater than 100.4 F fever that happens at least twice a week for at least 3 weeks in an immunological normal host with a noncontributory physical exam?

vagus (nerve)

What is the parasympathetic innervation for the heart (aortic arch T1-T5)?

S2-S4

What is the parasympathetic innervation of the bladder and urethra?

CN III, VII, IX, X

What is the parasympathetic innervation of the head and neck region? This includes the sinuses, Eustachian tube, lacrimal glands, salivary glands, and thyroid.

vagus (nerve)

What is the parasympathetic innervation of the kidneys?

vagus (nerve)

What is the parasympathetic innervation of the lower 2-3rds of the esophagus?

S2-S4

What is the parasympathetic innervation of the lower GI tract? (left colon, sigmoid, rectum)

S2-S4

What is the parasympathetic innervation of the lower ureters?

vagus (nerve)

What is the parasympathetic innervation of the middle GI tract? (includes small intestine, transverse colon, and ascending colon)

vagus (nerve)

What is the parasympathetic innervation of the ovaries and testes?

S2-S4

What is the parasympathetic innervation of the penis, seminal vesicles, and clitoris?

S2-S4

What is the parasympathetic innervation of the prostate, uterus, and cervix?

vagus (nerve)

What is the parasympathetic innervation of the respiratory system? This includes trachea T1-T6, bronchi T1-T6, lungs T2-T4, and lung visceral pleura T2-T4.

vagus (nerve)

What is the parasympathetic innervation of the upper GI tract? (includes the stomach, liver, gallbladder, spleen, duodenum, and pancreas)

vagus (nerve)

What is the parasympathetic innervation of the upper ureters?

Seidel (test)

What test can be done to check for penetrating injury to the eye? It is done by applying tetracaine to a fluorescein strip and also to the patient's eye. The affected area at the slit lamp is painted with the strip and observed for any stream of aqueous, which which is orange color turning to a green stream, evidence for an open wound.

Hypsarrhythmia (high amplitude and irregular waves and spikes in a background of chaotic and disorganized activity)

What type of EEG pattern would you expect to see in a baby with infantile spasms?

uncomplicated (UTI)

What type of UTI refers to acute cystitis or pyelonephritis in a non-pregnant outpatient women without anatomic abnormalities or instrumentation of the urinary tract?

aortic dissecting (aneurysm)

What type of aneurysms are associated with hypertension, Marfan syndrome, Ehlers-Danlos Type IV, or anything that impacts collagen? It occurs more in males than females with a mean incidence of 40-60 years old.

arteriolosclerosis

What type of arteriosclerosis affects small arteries and arterioles?

multiplex (assays)

What type of assays are currently available for detecting biological warfare agents like Bacillus anthrasis?

aerobic gram-negative rods (anaerobes are resistant)

What type of bacteria do aminoglycosides like gentamicin treat?

severe NPDR (non-proliferative diabetic retinopathy)

What type of diabetic retinopathy classification has micro aneurysms/hemorrages in 4 retinal quadrants, venous beading in 2 or more retinal quadrants, and intraretinal microvascular abnormalities (IRMA aka new growth) in at least 1 retinal quadrant?