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Round Review

Round 3 Rx Review

QuestionAnswer
What are common symptoms of Left-sided heart failure? Respiratory failure and the subjective sensation of SOB
What is a result of elevated LV diastolic filling pressures? Transudation of fluid into the pulmonary interstitium
What is the result of Transudation into the Pulmonary interstitium? Causes area of V/Q mismatch and overall decrease in lung compliance.
Common long-acting B-2 agonist? Salmeterol
In refractory asthma, what medication are co-administrated with Salmeterol? Inhaled glucocorticoid and short-acting B-agonist
What causes a stimulation of B-2 agonists? Inhibition of Myosin light-chain kinase (MLCK)
What system is used to stage Hodgkin Lymphoma? Ann Arbor staging system
What are the parameters taken in account in Ann Arbor Staging system? - Content of lymph node involvement - Extranodal involvement
What is a common cause of HTN emergency or urgency? Fibromuscular dysplasia
What is the most typical or characteristic of Fibromuscular Dysplasia? "Beads on a string" appearance
Fibromuscular dysplasia is often the cause of __________________. Hypertensive emergency
What does "B" represents in statistics? 1. The chance of a Type II error to occur or, 2. Failure to reject a null hypothesis when the alternative hypothesis is actually correct.
(1-B) = Statistical power of a test
How can B (statistics) be enhanced? Increasing the sample size
What is Null Hypothesis (Ho)? Hypothesis of NO DIFFERENCE or relationship. No association with disease and risk factor
Alternative hypothesis (H1)? Hypothesis of SAME difference or relationship
What is the equation for Power of statistics? 1-B
What does B (stats) represent? Type II error
What symbol is used to represent Type 1 error? alpha (A)
Study does not reject Ho + Ho = Correct hypothesis
Which phase are oocytes arrested until ovulation? Prophase I
Which phase are oocytes arrested until Fertilization? Metaphase II
What is anergy? Occurs when a T-cell receives a FIRST signal (peptide-MHC II) but NOT second signal.
What signal is missing in Anergy? Second signal which represents the co-stimulation via interaction of B7 on APCs and CD28 on the T-cell
What is the second signal in T-cell stimulation ? Interaction of B7 on APCs and CD28 on the T-cell
What causes anergy on the cell? Cell refractory to any further stimulation
When can you suspect of anergy? In a cell that does not respond to stimulation
How does anergy aid or help the immune system? 1. Maintain effective T-cells 2. Remove self-tolerant or overactive T-cells
How is A and B blood types expressed? Codominantly
Type O blood is expressed ___________________. Recessively.
What is associated with Duodenal ulcers? Hyperplasia of Brunner glands
At what times in the course of the day is the abdominal pain usually worst in patient with Duodenal ulcers? Night-time and upon waking up in the morning
What kind of medication are associated with exacerbation G6PD deficiency? Oxidizing agents, such as Sulfonamides
What is the mode of action of Sulfonamides? Inhibit Dihydropteroate synthase
What is the translocation associated with CML? Philadelphia chromosome (t(9:22))
What is the Philadelphia chromosome? t(9:22)
What characteristics are associated with CML? - Philadelphia chromosome (t(9:22)) - Production of BCR-ALB fusion protein
What is the treatment of CML? Imatinib
What is the BCR-ALB fusion protein? A constitutively active Tyrosine Kinase receptor that promotes proliferation of malignant cells in CML.
What kind of antibiotics are usually used in prevention of surgical site infections in cardiac procedures? Cephalosporins (first and second generation)
Cephalosporins are excellent against gram_______________ bacteria. Positive
What is a complication of Aortic dissection? Cardiac tamponade
Clinical presentation of Aortic dissection? Tearing chest pain radiating to the back and asymmetric pulses
What is the characteristic pulse description aortic dissection? Asymmetric pulses
What drug is used for anesthesia to tissues locally? Bupivacaine
MoA of Bupivacaine Binds to the intracellular portion of voltage-gated Na+ channels and clox the influx of Na+ into neurons, which prevent neuron from depolarizing.
Bupivacaine prevents the neuron's Depolarization
What is a serious side effect of Hydralazine? Reflex tachycardia
What is the clinical presentation of Reflex tachycardia? Increased myocardial demand and Angina
Which patients are contraindicated to use Hydralazine? Coronary artery disease
What percentage indicates lymphoblastic leukemia? 20%
What kind of WBC deficiency is seen in Lymphoblastic leukemia? Neutropenia
What are the Inactivated or killed vaccines? Rabies Influenza (IM) injection Polio (Salk) Hepatitis A Typhoid (Vi polysaccharide, IM)
What kind of immunity is stimulated with killed vaccines? Humoral immunity
Aminoglycosides work exclusively on what kind of organisms? Gram negative bacteria
What is the mode of action of Aminoglycosides? 1. Irreversible inhibition of Initiation complex through binding of the 30S subunit 2. Can cause misreading of mRNA 3. Block translocation 4. Rqures O2 for uptake
Why are aminoglycosides ineffective to anaerobes? Aminoglycosides require oxygen for uptake
What kind of bacteria is not affected by aminoglycosides? Anaerobes
What is reflection in an medical interview? Reflective listening and empathic with the patient
Denervation atrophy is commonly seen in ____________. ALS
How are muscular fibers in denervation atrophy biopsy? Small, angular muscle fibers
The Stylopharyngeus muscle is derived form which Pharyngeal arch? 3
What nerve innervates the Stylopharyngeus muscle? Glossopharyngeal nerve
Mode of action of TSST-1? Activates large population of T-lymphocytes by cross-linking MHC-II and T-cell receptors
Toxic Shock syndrome Toxin presents with a triad of? 1. Fever 2. Shock 3. Desquamating rash
alpha-1 antagonists are first line of treatment of _____________. BPH
What is a common 5a- reductase used in treatment of BPH? Finasteride
What enzyme commonly stimulates prostate stromal hyperplasia seen in BPH? DHT
In a negative skew graph, which is value his the highest number? Mode
Acute, autoimmune demyelinating polyradiculopathy that affects the PNS, usually manifesting as ascending paralysis, loss of deep tendon reflexes,and autonomic dysfunction. Guillain-Barre syndrome
What is the treatment for Guillain-Barre syndrome? IV immunoglobulins and plasmapheresis
What is measured in patient on Warfarin? Prothrombin time and INR
Which kind of cardiac arrhythmia is most related to the formation of a thrombus? Atrial fibrillation
What is the MC treatment for chronic prevention of thrombus formation? Warfarin
What common animal is usually the carrier of Francisella Tularensis? Rabbit
What condition is caused by Francisella Tularensis infection? Ulceroglandular tularemia
Description of Ulceroglandular tularemia Characterized by skin lesion with a black base, along with systemic symptoms
Xeroderma pigmentosum is due to a defect in ____________________________ repair. Nucleotide excision
What is affected by the defective nucleotide excision repair in Xeroderma pigmentosum? Cell's ability to repair damage induced by UV radiation
What are the 2 MC H-2 blockers? Cimetidine and Ranitidine
Ranitidine is a __________________ blocker. H-2
Ranitidine and _________________ are H2 blockers. Cimetidine
What is a common condition treated with H-2 blockers? Peptic ulcer disease
What is an advantage of Ranitidine over Cimetidine? Ranitidine does not produce the anti-androgenic effects
Clomiphene is a ____________. SERM
What is the MOA of Clomiphene? Acts as anti-estrogen, which leads to increased secretion of GnRH and ultimately increased testosterone
What hormone level is elevated with Clomiphene that aids in male fertility treatment? Testosterone
What are two results or complication of Renal Artery stenosis (RAS)? 1. Resistant hypertension 2. Hypokalemia
The activation of the RAAS system by RAS, causes: 1. Resistant hypertension 2. Hypokalemia
The Ulnar nerve originates from which nerve roots? C8- T1
The C8 - T1 nerve roots form the ____________________ of the Brachial plexus. Lower trunk
What muscles are innervated by the Ulnar nerve? 1. Hypothenar muscles 2. 2 of the lumbrical muscles 3. All interosseous muscles
Injury to the Ulnar nerve causes? Sudden upward pulling on an abducted arm
What kind of palsy is due to damaged or injured Ulnar nerve? Klumpke's palsy
Upper trunk injury causes: Erb's palsy
Posterior cord of the brachial plexus damage causes: Wrist drop
What nerve is injured in "Pope's blessing" hand deformity? Median nerve
Median nerve injury cause a decrease in function of which finger? Thumb
What kind of intracranial hematoma is most commonly in elderly due to rupture of Bridging veins? Subdural Hematoma
Subdural hematomas have _________________-shaped areas in the CT scan. Crescent
What levels of metabolism are elevated in fasting states? Glucagon and Epinephrine
Glucagon and Epinephrine act via which pathway? Gs pathway
Elevation of glucagon and Epinephrine causes activation of Gs pathway, leading to: Increase Fructose 2, 6- bisphosphate levels, which decreases the PFK-2 level, and decreases the breakdown of glucose .
What are the criteria for Systemic Inflammatory responses Syndrome (SIRS)? 1. Heart rate > 90/min 2. Respiratory rate >20/min 3. WBC count <4,000 or > 12,000 4. Temperature <36 C or > 38 C
How many findings of the SIRS criteria are needed to make diagnosis? 2 or more
First aortic arch gives Part of the Maxillary artery
The second aortic arch give rise to: Stapedial and Hyoid arteries
What arteries are derived from the 3th aortic arch? Common Carotid and proximal parts of the Internal Carotid artery
What is formed by the 4th aortic arch? 1. LEFT --> aortic arch 2. RIGHT --> Proximal part of the Right Subclavian artery
What structure is formed by the Left side of the 6th Aortic arch? Ductus arteriosus
Which aortic arch gives rise to the Proximal part of the Pulmonary artery? Sixth Aortic arch
What kind of granulomas are seen in Crohn's disease? Non-caseating
What are the MC extraintestinal manifestation seen with Crohn's disease? Arthritis, erythema nodosum, ankylosing spondylitis
Placenta previa occurs as: The placenta overlies the cervical os
What is the common presentation of Placenta Previa? PAINLESS bleeding in the 3rd trimester
What are the two most common risk factors for Placenta previa? Multiparity and prior C-section.
Defective Bruton Tyrosine Kinase (BTK) leads to development of? X-linked Agammaglobulinemia
What is the role of BTK? Essential in the maturation of B-cells, and its absence leads to a decreased immune function and increased risk of bacterial infections
Which cells are mot affected in X-linked agammaglobulinemia? B-cells
What is the treatment of X-linked agammaglobulinemia? IV g-globulin injections
What labs or levels are seen with Hemochromatosis? 1. Serum Iron surplus 2. Elevated LFTs 3. Diabetes, arthralgias, impotence, weakness, and lethargy
Why is TIBC decreased in Hemochromatosis? Due to downregulation and saturation of transferrin
Which gene is affected/mutated in Hemochromatosis? HFE gene
Which muscle is not supplied by the 6th Branchial arch? Cricothyroid muscle
Which branchial arch supplies all the muscles required for speaking? 6th Branchial arch
A prolactinoma cause what type of ocular condition? Bitemporal hemianopsia
What is compressed in Prolactinoma that cause a vision deficit? Optic chiasm
What are the effects of increased prolactin in men? Decreased libido, erectile dysfunction, and gynecomastia
What are the adverse effects of increased prolactin levels in women? 1. Decreased libido 2. Galactorrhea, amenorrhea, and Infertility.
What is the cause of Uterine prolapse? Loss of support of by the Cardinal, Uterosacral, or Pubocervical ligaments that suspend the uterus in the pelvic cavity.
What ligaments are weakened in Uterine prolapse? Cardinal, Uterosacral, and Pubocervical ligaments
What are the serie of complications of Uterine prolapse? Bilateral hydronephrosis ---> ---> Pyelonephritis
Aromatase function Converts TESTOSTERONE to ESTRADIOL and Androstenedione to Estrone
What drug is usually used to form an irreversibly to aromatase? Exemestane
What condition is exemestane usually used for? Hormone-responsive Breast cancer in Postmenopausal women
What kind of carcinoma is seen in the upper 2/3 of the esophagus worldwide? Squamous cell carcinoma
Squamous cell carcinoma of the esophagus stains positive to: Cytokeratin
What conditions are associated with development of Squamous cell carcinoma of the Esophagus? Ethanol, hot liquids, elastic strictures, smoking, and achalasia
Which carcinoma type is most commonly seen in the lower 1/3 esophagus? Adenocarcinoma
Esophageal adenocarcinoma's risk factors: Chronic GERD, Barrett's esophagus, obesity, smoking, achalia
What type of Esophageal carcinoma is most common in the United States? Adenocarcinoma
What is the role of Vitamin C in collagen synthesis? Cofactor in the HYDROXYLATION of Proline and Lysine residues and thus is an integral component of collagen synthesis
What type of chemical reaction is aided by Vitamin C during collagen synthesis? Hydroxylation
Vitamin C deficiency ---> Scurvy
What kind of deficiency is suspected in a patient with swollen, bleeding gums, as well as poor healing. Vitamin C
Where does the hydroxylation of Proline and Lysine of collagen synthesis occur? Rough Endoplasmic Reticulum (RER)
What are the two significant CBC findings of mild Thalassemia? - an increased RBC - Normal RDW
What kind of RBCs are seen in Thalassemia? Target cells
What area of the brain is affected of Wernicke Aphasia? Superior Temporal Gyrus of the Left-temporal lobe and limits comprehension.
What aphasia presents with articulate, yet nonsensical speech? Wernicke aphasia
Lesion to the Arcuate Fasciculus ---> Conduction aphasia
Broca aphasia: Lesion of Left-posterior inferior frontal lobe adjacent to the primary motor cortex.
What is the cause of Antidepressant Discontinuation Syndrome (ADS)? Result of abrupt cessation of an SSRI
What are the symptoms of Antidepressant Discontinuation syndrome? Dysphoria, fatigue, insomnia, myalgias
What is the the least likely SSRI to cause ADS? Fluoxetine
Chronic alcoholism leads to inefficient Estrogen metabolism and is manifested with: Spider angiomas, gynecomastia, loss of sexual hair, testicular atrophy, and palmar erythema.
What is the inheritance mode of Hemophilia A and B? X-linked recessive
Deficiency of factor 8 ---> Hemophilia A
What are the symptoms and signs of Hemophilia? Spontaneous hemarthrosis, excessive soft-tissue bruising, and spontaneous bleeding
What are the drugs of acute gout treatment? NSAIDs, corticosteroids, or colchicine for improvement of symptoms
What are the long term drugs used in treatment of Gout? Allopurinol, Fexobustat, and Probenecid
What is the overall role of Allopurinol, Fexobustat, and Probenecid? Decrease uric acid levels
Epinephrine acts ----> Non-selectively on ALL adrenergic receptors subtypes
If Epinephrine is given alone it causes: 1. Increase in systolic pressure via a-receptors 2. Decrease in diastolic pressure via b-receptors
How does the systolic pressure is increased by Epinephrine administration? It stimulates the a-receptors
Which receptors are stimulated or affected by Epinephrine that cause a decrease in diastolic pressure? B-receptors
What would be the result of a patient that is pretreated with an alpha-blocker prior to Epinephrine administration? Decrease in Blood pressure (diastolic)
What is the mode of action of Aminocaproic acid? Blocks conversion of Plasminogen to Plasmin
tPA induced bleeding is often reversed with: Aminocaproic acid
What is the first line of treatment of Acute Coronary syndrome? Nitroglycerin
Why is chest pain reduced with Nitroglycerin? It reduces the preload by causing venodilation and thus reducing myocardial Oxygen demand.
What milestones are to be seen in a 6 month old baby? 1. Palmar reflex disappears 2. Stranger anxiety 3. Rolls and sits 4. Passes toy hand to hand 5. Babble
Why is a daily chlorhexidine bath performed in ICU patients? Reduces the incidence of catheter-related bloodstream infections
A Root-cause analysis: Useus medical records and participants interviews to identify the underlying problems that lead to the medical error.
Duodenal atresia is associated with Trisomy _____ 21
What is the cause of Duodenal atresia? Failure of Recanalization of the GI tract during embryogenesis
What is the cause of Hirschsprung's disease? Failure of migration of neural crest cells
Created by: rakomi