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| What is the mechanism of vancomycin? What is the mechanism of it's resistance? | Inhibits cell wall synthesis
Altered cell wall (unable to bind)
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| What is the mechanism of quinolones? | DNA gyrase inhibition
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| What is the mechanism of amphotericin | binds sterols to alter fungal cell wall
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| Which antibiotics are bacteriocidal, with irreversible binding to 30S ribosome subunit, and resistance due to decreased active transport? | Aminoglycosides (gentamicin, neomycin, tobramycin)
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| What vitamin deficiency causes hyperglycemia (relative diabetes) and neuropathy? | Chromium
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| What vitamin deficiency causes perioral rash, hair loss, poor healing, and change in taste? | Zinc
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| What vitamin deficiency causes weakness (respiratory) and encephalopathy? | Phosphate
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| What vitamin deficiency causes anemia and neutropenia? | Copper
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| What two electrolyte abnormalities cause hyperexcitability (increased reflexes, tetany)? | Hypocalcemia and hypomagnesemia
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| What phase of the cell cycle is most sensitive to radiation therapy? | Mitosis
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| What are the effects of TGF-B? | stimulates fibroblasts and chemotactic for neutrophils (too much/too long can cause fibrosis)
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| What is the effect of PDGF? | Attracts fibroblasts and increases smooth muscle to speed matric deposition and collagen formation
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| Describe the anatomical relationship of the Portal triad | Portal vein posterior to CBD (on R) and hepatic artery (on L)
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| What is Diabetes Insipidus? | Alcohol and head injury inhibit ADH release - high UOP, low urine SG, high serum osmolarity/Na
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| What is SIADH? | Increased ADH release most often by head trauma/tumors or SCLC. Oliguria, high urine osmolarity, low serum osmolarity/Na
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| What three fractures are prone to compartment syndrome? | Calcaneous, tibia, supracondyle of humerus
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| What are the signs of gastrinoma? | Severe ulcer disease, diarrhea (lipase destruction by acid, malabsorption, incr secretion)
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| What are the symptoms of a somatostatinoma? | gallstones
steatorrhea
pancreatitis
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| What are the symptoms of a glucagonoma? Treatment? | diabetes
glossitis
stomatitis
necrolytic migratory erythema (presenting problem in 70%)
Rx = streptozocin/doxorubican (selectively destroy alpha cells) and octreotide (inhibits release)
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| What are the symptoms of VIP-oma? | WDHA syndrome = watery diarrhea hypokalemia achlorydia
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| What other abnormalities can a patient with a tracheoesophageal fistula have? | VACTERL - vertebral, anal atresia, cardiovascular, TEF, esophageal atresia, renal, limb defects - structures derived from embryonic mesoderm
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| What are the characteristics of gastroschisis? | Congenital abd wall defect, intrauterine rupture of umbilical cord, no associated defects, lateral (right) defect, no sac
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| What are the characteristics of omphalocele? | midline defect, may contain liver or other non-bowel contents, frequent anomalies, has peritoneal sac.
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| What is Conn's syndrome? | hyperaldosteronism = 80% adenoma, 20% bilateral hyperplasia - HTN, low K, high Na
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| What is Addison's disease? | low aldosterone and glucocorticoids = low Na, high K, hypoglycemia. Crisis presents similar to sepsis with hypoTN, fever; steroids are diagnostic and therapeutic
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| What is Cushing's disease? | Excessive secretion of ACTH from the anterior pituitary, usually from a pituitary adenoma. Causes 70% of non-iatrogenic Cushing's syndrome.
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| What is Cushing's syndrome? | hormone disorder with high levels of cortisol - symptoms include characteristic weight gain (truncal obesity, moon face, buffalo hump), purple striae, hirsutism, polyuria, htn, insulin intolerance
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| What is the classic vision change with pituitary mass effect? | Bitemporal hemianopsia - vision missing in outer half of both right and left visual fields
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| What is the #1 pituitary adenoma? What are the symptoms? | Prolactinoma - galactorrhea, irregular menses
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| What type of cancer demonstrates "peripheral palisading" of nuclei and "retraction artifact" | Basal cell carcinoma
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| What is the most common cause of flap necrosis? | venous thrombosis
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| What type of melanoma has the best prognosis? worst prognosis? | best = lentigo maligna; worst = nodular
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| What is MALT a precursor to? | gastric lymphoma - regresses with H. pylori treatment
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| What drugs peripherally block conversion of T4 to T3? | PTU, Propanolol, Prednisone (& other steroids) and methimazole
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| What is MEN I? | Wermer's syndrome - parathyroid, pancreas, pituitary (prolactinoma most common)
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| What is MEN IIa? | Sipple syndrome - Parathyroid, adrenal (pheochromocytoma), and thyroid
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| What is MEN IIb? | Thyroid, adrenal, mucosal neuromas/marfan
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| What is the mechanism of azathioprine (Imuran)? | 6MP derivative, purine analog that acts as an antimetabolite, decreases DNA synthesis
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| What is the mechanism of cyclosporine? | Calcineurin inhibitor - inhibits mRNA encoding of IL-2
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| What is the mechanism of mycophenolate (cellcept)? | blocks purine synthesis to decrease T and B cell proliferation
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| What is the mechanism of tacrolimus (FK506)? | Calcineurin inhibitor - blocks IL-2 expressions/production from T cells - more potent than cyclosporine
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| What is the mechanism of immunosuppression of prednisone? | blocks IL-1 from macrophages
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| What is the mechanism of sirolimus (Rapamune)? | mTOR inhibitor - inhibits the response of IL-2 thereby blocking the activation of T and B cells
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| How does aging affect PFTs? | reduces FEV1 and FRC
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| What are the effects of PEEP on the lungs? | Increased FRC, increased compliance
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| What is functional residual capacity (FRC)? | air in lungs after normal exhalation
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| What is inspiratory capacity? | maximum amount of air able to be inhaled (TV + inspiratory reserve volume IRV)
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| What is vital capacity? | greatest volume that can be exhaled (IRV + TV + ERV)
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| What are the characteristics of silvadene? | good activity against candida/pseudomonas, poor eschar penetration. risk of neutropenia
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| What are the characteristics of mafenide acetate (sulfamylon)? | painful, can cause acidosis due to carbonic anhydrase inhibition
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| What are the characteristics of silver nitrate? | Can cause hyponatremia and hypochloremia due to leeching of NaCl
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| What is a side effect of carbapenems? | Seizures
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| What are side effects of aminoglycosides? | Reversible nephrotoxicity, irreversible ototoxicity
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| What is the mechanism of metronidazole? | produces oxygen radicals that breakup DNA
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| What are side effects of metronidazole? | Disulfiram-like reaction, peripheral neuropathy
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| What vitamin deficiency causes dermatitis, diarrhea and dementia? | Niacin - this syndrome is called Pellegra
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| What vitamin deficiency causes dermatitis, hair loss, and thrombocytopenia? | Essential fatty acid deficiency
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| What does a RQ >1 indicate? What does a RQ <0.7 indicate? | >1 = lipogenesis (overfeeding); <0.7 = ketosis and fat oxidation (starving)
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