Day 4 Flashcards

Which 3 antiarrhythmics belong to class IA?

Q______

P______

D______

What is the clinical use for disopyramide?

A______ arrhythmias
V______ arrhythmias

Which class IA antiarrhythmic causes heart failure?

D______

Which 3 antiarrhythmics belong to class IB?

L______

P______

M______

How does the local anesthetic lidocaine reach its site of action?

Lidocaine penetrates the cell membrane in an {charged/uncharged} form, then binds the ______ channel in a {charged/uncharged} form

Which 2 antiarrhythmics belong to class IC?

F______

P______

What are the 4 typical class III antiarrhythmic drugs?

A______

I______

D______

S______

Which antiarrhythmic drug is lipophilic and has the effects of antiarrhythmic classes I, II, III, and IV?

What lab tests are required to be done regularly for patients taking amiodarone?

P_______ function tests
L________ function tests
T________ function tests

Why must thyroid function be monitored regularly in a patient taking amiodarone?

Amiodarone has an _______ component and can cause _______ or _______

What are the 3 most common adverse cardiovascular effects caused by amiodarone?

Heart b________
{Tachycardia/Bradycardia}
Heart f________

What are the hapten-related side effects of amiodarone therapy?

Blue/gray skin deposits that may result in p______

C______ deposits

Which 2 class III antiarrhythmics are used in the management of ventricular tachycardia?

A________

S________

What class I antiarrhythmic causes cinchonism?

_______

Which class II antiarrhythmic has the shortest duration of action?

e_______

Which two β-blockers are especially useful in the treatment of supraventricular tachycardias?

m_______

e_______

What is first line for herpes zoster?

F_______

Why does acyclovir interfere with viral DNA synthesis and not human DNA synthesis?

It requires ________ by the ________ ________ of HSV or varicella-zoster virus

Inactive in ________ cells

An HIV-positive patient has a CD4⁺ count of < 100 cells/mm³ and must receive prophylactic therapy for Pneumocystis pneumonia and toxoplasmosis. Which medication is indicated?

_________-_________

An HIV-positive patient has a CD4⁺ count of < 200 cells/mm³ and must be treated with prophylaxis for Pneumocystis pneumonia. What medication is indicated?

_________-_________

_____ _____ use pathways other than those requiring oxygen as a terminal electron receptor to generate ATP

When oxygen is unavailable, facultative anaerobes generate _____ primarily through _____ or _____ _____.

What is the mechanism of action of aminoglycosides?

They are [bactericidal/bacteriostatic] antibiotics that [reversibly/irreversibly] inhibit the initiation complex by binding to _____ → Blocks _____→ Misreading of mRNA

What organisms are aminoglycosides used against?

Gram-_______ _______

Gram-negative rods (4)

Which class of antibiotics is not effective against anaerobes?

_____

Aminoglycosides require _____ to enter a bacterial cell.

Although anaerobes are pathogenic in most tissues, where are they most commonly part of the microflora?

_____ _____

Why do anaerobes have increased susceptibility to oxidative damage?

They lack the enzymes _____ _____ and/or _____

What properties with regard to oxygen use do Clostridium, Bacteroides, Fusobacterium, and Actinomyces israelii share?

They are all [aerobes/anaerobes]
They cannot survive in oxygen-[rich/poor] environments

A 24-year-old male presents to the emergency department with trismus, difficulty swallowing, and spastic muscular contractions of the neck and shoulders. He was wounded during a yard work accident 10 days ago. The patient did not seek medical attention after the accident. Past medical history reveals a lack of vaccinations since childhood. Physical examination reveals a homemade bandage on the right leg that is covering a deep puncture wound. The most likely organism responsible for the presentation is a(n)

A. anaerobic, Gram-negative rod

B. catalase-positive, Gram-positive coccus

C. encapsulated, Gram-negative diplococcus

D. spore-forming, Gram-positive rod

E. tick-bite-transmitted spirochete

Low activity of which neurotransmitters results in the spastic paralysis, risus sardonicus, trismus, and opisthotonos caused by tetanospasmin?

____

____

Tetracyclines, such as doxycycline, are a component of bismuth quadruple therapy for H. ______ infections and are frequently associated with ______.

spastic paralysis, risus sardonicus, trismus, and opisthotonos are caused by _______ _______

Which class of bacteria, known for having a foul smell and being difficult to culture, produces CO₂ and H₂ gas in tissues?

[Aerobes/Anaerobes]

How does the heat-stable toxin of enterotoxigenic Escherichia coli cause watery diarrhea?

By decreasing the ability of the gut to reabsorb _____ and _____ secondary to overactivation of guanylate cyclase

What is the mechanism of the heat-labile toxin of enterotoxigenic Escherichia coli?

_____ _____ is activated causing greater secretion of Cl^- and H₂O in the gut

Heat-stable toxin from enterotoxigenic Escherichia coli overactivates _____ _____ → increases _____ → decreases intestinal absorption of NaCl.

Identify the exotoxin responsible for persistent cough for 3 months in a teacher who teaches students not currently fully vaccinated.

____ toxin

Which bacteria have exotoxin A, which inactivates EF-2 to trigger host cell death?

_____ _____

Pseudomonas aeruginosa causes ______ ______ and hot tub ______.

A 40-year-old female presents to the clinic for evaluation of numerous small, pruritic, red papules on her back, extending to her buttocks. She mentions having recently taken her children to a theme park and spent much of the day going down the waterslide and other water rides. She has a medical history of diabetes, for which she takes metformin. Vital signs are unremarkable. Closer examination of the papules reveals central pustules. What is causing her problem?

______ ______

Name the functions of the A and B components of ADP ribosylating AB toxins found in Corynebacterium diphtheriae.

The A component is _____
The B component binds and triggers _____

In a patient with scarlet fever caused by Streptococcus pyogenes, what specific toxin is to blame for the symptoms?

_____ _____ _____

This causes ____ ____ -like syndrome.

Name three toxins produced by Staphylcoccus aureus and their associated symptoms.

_____ _____ _____ toxin → Rash, fever, and shock
_____ toxin → Scalded-skin syndrome
_____ → Diarrhea and vomiting

Bacillus anthracis is a _______ forming gram-_______ rod that has been used as a bioterrorism agent. When inhaled, it can cause fatigue, fever, dyspnea, cough, diaphoresis, vomiting, and a widened _______ on chest x-ray.

What is the mechanism of anthrax toxin, released by Bacillus anthracis?

Mimics _____ _____ → Edematous borders of [color] _____

A 44-year-old female presents to the emergency department with a complaint of extreme fatigue. She states that the onset of fatigue was about 24 hours ago. It has been accompanied by fever up to 102.1ºF, sweats, cough, and shortness of breath. Review of systems is significant only for one episode of vomiting. Upon further questioning, you discover that she works in a government office and her job requires her to handle mail within the building. Chest x-ray shows widening of the mediastinum. Which of the following best describes the organism causing her symptoms?

A. double-stranded DNA virus

B. enveloped negative-strand RNA virus

C. facultatively anaerobic gram-negative rod

D. spore forming gram-positive rod

E. strictly aerobic gram-negative rod

What is the mechanism by which the Shiga toxin causes damage to the gastrointestinal mucosa and dysentery?

Removes ____ from rRNA → Inactivation of the ____ ribosomal subunit

What is the mechanism by which streptolysin O toxin leads to hemolysis?

Streptolysin O degrades red blood cell _____ → _____ -hemolysis

What is the mechanism of botulinum toxin?

Botulinum toxin inhibits release of acetylcholine at the _______ junction by cleaving _______ proteins

A 23-year-old man presents to the emergency department with an extremely painful leg wound. He developed a deep wound in the left leg while doing yardwork a couple of days ago, and the pain has progressively worsened. He cleaned the wound with soapy water at the time of the incident but did not seek medical attention. Vital signs reveal a temperature of 39.4°C (103°F). Physical examination reveals a deep leg wound with an area of necrosis surrounded by extensive erythema and edema. Crepitus is noted on palpation of the wound. Biopsy of the wound reveals numerous Gram-positive rods. The most likely etiologic agent is

A. Bacillus anthracis

B. Bacillus cereus

C. Clostridioides difficile

D. Clostridium perfringens

E. Clostridium tetani

What is the mechanism of action of the alpha toxin of Clostridium perfringens?

Alpha toxin is a phospholipase that degrades p_____ → m_____ and h_____

Clostridium perfringens is an anaerobic, spore-producing, Gram-positive rod. C. perfringens can cause _____ _____, a necrotizing soft tissue infection characterized by severe pain, rapid progression, and systemic toxicity.

During infection, C. perfringens produces _____, which can be detected as crepitus on palpation of the affected tissue.

Why does Clostridium perfringens lead to hemolysis when cultured in a blood agar?

This is due to the _____ toxin→ Forms a _____ zone of hemolysis on blood agar

On blood agar, Clostridium perfringens classically causes a double zone of hemolysis:

Inner zone = _____ hemolysis
Outer zone = _____ hemolysis

What is the mechanism of the offending toxin of Bordetella pertussis?

The pertussis toxin disables the _____ protein

This overactivates _____ _____.

Name two common gram-positive bacteria that can cause a rash and septic shock.

_____ _____

_____ _____

How does the AB toxin in Vibrio cholerae cause water diarrhea?

AB toxin permanently activates _____ protein → Stimulates _____ _____ → Increases Cl^- and H₂O secreted in the gut

What is the mechanism by which superantigens cause toxic shock syndrome?

Superantigens binds to MHC ____ molecules and ____-cell receptors → Overwhelming release of ____

What is the mechanism of the diphtheria toxin?

Inactivates ______ via ______ ______→ Pseudomembranous pharyngitis, bull neck, and myocarditis

A 35-year-old male presents to the clinic with the complaints of sore throat and trouble swallowing. The patient is an Iranian immigrant who states that his throat discomfort has been getting worse over the past 4 days. The patient says he has not been eating because of the pain. Physical examination reveals mild fever and a dark gray coating in the back of the mouth. Palpation of the neck reveals enlarged cervical lymph nodes and signs of edema. The organism causing this disease has which mechanism of action?

A. blocks neuronal transmission

B. blocks protein synthesis

C. blocks release of acetylcholine

D. causes increase of cAMP

Exotoxin A from Pseudomonas aeruginosa and diphtheria toxin from Corynebacterium diphtheriae both inhibit ______

Furosemide _____ Ca²⁺ excretion

On which part of the nephron do loop diuretics act?

______ limb of the loop of Henle

Which class of diuretics acts on the boxed part of the nephron in the image?

In ethanol toxicity, the overproduction of lactic acid causes what metabolic disorder evident on lab findings?

_____ anion gap metabolic acidosis

The symptoms of Bartter syndrome and Gitelman resemble what iatrogenic conditions?

Bartter syndrome resembles chronic use of _______ diuretics
Gitelman syndrome resembles chronic use of _______ diuretics

Loop diuretics and thiazide diuretics ________ blood pH

What is the effect on urinary Ca²⁺ excretion of loop diuretics and thiazide diuretics?

Loop diuretics ______ Ca²⁺ in urine

Thiazide diuretics ______ Ca²⁺ in urine

How do loop diuretics and thiazide diuretics differ in their effect on serum calcium?

Loop diuretics ______ serum Ca²⁺

Thiazide diuretics ______ serum Ca²⁺

Loop diuretics increase calcium excretion ("loops lose calcium") and can be used in conditions of hypercalcemia, such as _____ _____.

A 62-year-old male presents to the office with a pruritic rash after beginning therapy with a diuretic medication. The medication was prescribed for his history of shortness of breath. He experienced a similar rash when he took trimethoprim-sulfamethoxazole for pneumonia 2 years ago. The most likely medication causing this patient's rash is

A. ethacrynic acid

B. furosemide

C. lisinopril

D. mannitol

E. spironolactone

Ethacrynic acid is much more ______ than the sulfonamide loop diuretics

If a patient with mononucleosis is wrongly prescribed amoxicillin, what would you expect?

______ ______

Where are ryanodine receptors of muscles located?

_____ _____

Ryanodine receptors are coupled with which receptors on the sarcoplasmic reticulum membrane?

______ receptors

What is released by activation of the mechanically coupled ryanodine receptor from the sarcoplasmic reticulum?

_____ ions

Epstein-Barr virus is most commonly associated with which four malignancies?

_______ carcinoma
_______ lymphoma
_______ lymphoma
_______ _______ lymphoma

If the receptor CD21 is blocked, what virus will have difficulty infecting cells?

______-______ virus

Why are contact sports avoided in patients with mononucleosis?

Risk of ______ rupture

What cells are infected by Epstein-Barr virus?

Infects ______ cells via ______

A 15-year-old girl is brought to the office because of a pruritic and diffuse maculopapular rash that she first noticed this morning. Seven days ago, she was prescribed amoxicillin after presenting to an urgent care with a fever and sore throat. She has also experienced significant fatigue during this same period of time and says that she is barely able to get out of bed. Physical examination reveals a diffuse maculopapular rash and cervical lymphadenopathy. Nontender splenomegaly is present on abdominal examination.

A peripheral blood smear is most likely to reveal:

A. atypical lymphocytes

B. eosinophilia

C. greater than 20% lymphoblasts

D. Howell-Jolly bodies

A 41-year-old African American male presents to the office with an abnormal plaque on his tongue. He first noticed the lesion 2 weeks ago and says that it will not scrape off with light brushing of his tongue. He has a history of injection drug use and currently uses intravenous heroin 3-4 times each week. He has no medical records and is unsure if he received the recommended childhood immunizations. Oral examination reveals a white plaque on the lateral tongue, which is shown in the exhibit. Laboratory testing confirms that the patient has HIV and his CD4+ cell count is 410/mm³ (reference range: 500–1,500 cells/mm³). This patient's condition is most likely caused by

A. Candida albicans

B. Corynebacterium diphtheriae

C. cytomegalovirus

D. Epstein-Barr virus

E. human herpesvirus-8

A 19-year-old female presents to the office with a 1-week history of malaise, pharyngitis, and fatigue. She recently started a new romantic relationship, although the couple is not sexually active. She is up to date on vaccinations. Vital signs reveal a temperature of 38.3°C (101°F). Physical examination reveals cervical lymphadenopathy and white exudate on the tonsils. Laboratory studies reveal the presence of heterophile antibodies. Peripheral blood smear reveals atypical, enlarged lymphocytes. The most likely pathogen responsible for this patient’s symptoms is a

A. DNA virus

B. Gram-negative rod

C. Gram-positive coccus

D. Gram-positive rod

E. RNA virus

What test detects heterophile antibodies via agglutination of sheep or horse red blood cells?

______ test

What is the most common causative agent of lactational mastitis?

______ ______

What is the treatment for lactational mastitis?

A________

Recommendation for continued b________

What two processes can activated B cells that produce IgM undergo?

_____ switching

_____ maturation

What syndrome might result if a lingual thyroid is removed surgically?

_______

What is the most common cause of hypothyroidism in iodine-sufficient regions?

______ ______

What is the term for swelling in the face and periorbital region, commonly associated with hypothyroidism?

______

Which two drugs are notable for causing hypothyroidism?

______

______

How does hypothyroidism alter prolactin levels?

Hypothyroidism increases ______ → p______ secretion → Inhibits ovulation

By which process does IgA cross epithelial cells?

______

How does IgA protect itself from breakdown by luminal proteases?

It picks up a s______ component from epithelial cells, thereby shielding its ______ portion from luminal proteases

An 18-year-old female presents to the emergency department in respiratory distress after spending the afternoon walking in a park. She has had similar episodes several times in the past couple of years, especially when pollen counts are high. She uses a combination glucocorticoid-formoterol inhaler daily. Physical examination reveals prolonged expiration, accessory muscle use, tachypnea, tachycardia, and decreased breath sounds. Lung auscultation reveals the findings heard in the audio exhibit. Pulmonary function tests reveal reversible reduction of forced expiratory volume in one second (FEV₁) and FEV₁/forced vital capacity ratio. After the patient is successfully treated for this acute episode, what medication would be the most specific treatment to add to her maintenance therapy?

A. denosumab

B. ipratropium

C. methacholine

D. omalizumab

What molecule does the antibody omalizumab target?

______

Which monoclonal antibody may be used to treat refractory allergic asthma?

______

What is the mechanism of action of omalizumab?

It is a monoclonal anti-IgE antibody that binds ______ IgE and blocks FcεRI ______

A 24-year-old woman is brought to the emergency department after having a seizure at home. Her boyfriend, who witnessed the seizure, reports that the patient has had worsening episodes of confusion and agitation over the past 2 days prior to the seizure. CT of the head shows edema within the temporal lobes. A lumbar puncture is performed. Spinal fluid analysis reveals normal opening pressure, lymphocytic pleocytosis, elevated protein, and normal glucose. A Gram stain of the cerebrospinal fluid reveals no bacteria.

What condition does this pt have?

_____ _____

What medication is used to treat allergic asthma resistant to inhaled corticosteroids and β₂-agonists?

______

Which two muscarinic antagonists are used in the treatment of asthma and COPD?

I______

T______

A 64-year-old female presents to the office with the complaint of 18 hours of waxing and waning nausea and right flank pain that radiates to the groin. Her medical history is significant for chronic obstructive pulmonary disease and a recent diagnosis of squamous cell carcinoma of the lung. The urine dipstick is positive for blood in the urine. Urinalysis reveals many red blood cells, with no evidence of white blood cells, leukocyte esterase, or bacteria. Abdominal CT scan demonstrates a radiopaque stone in the ureter. Which of the following stone compositions is most likely responsible for her symptoms?

A. calcium oxalate

B. cholesterol

C. cystine

D. struvite

E. uric acid

A 69-year-old male with a 40-year history of smoking is brought to the emergency department with shortness of breath and a productive cough. This is the third time in 2 months that he has been brought to the emergency department for similar complaints. Vital signs include a temperature of 36.1° C (97° F), blood pressure of 150/100 mmHg, and a heart rate of 100/min. Pulse oximetry is obtained and reveals a 91% oxygen saturation. A chest radiograph is performed and reveals a flattened diaphragm and an increased retrosternal airspace. Recent pulmonary function tests reveal a forced expiratory volume of < 43% without significant reversibility after administration of a bronchodilator. He is started on oxygen along with medication therapy and is cautioned to expect a dry mouth with a specific drug. Which of the following drugs is most likely responsible for this adverse effect

A. albuterol

B. dextromethorphan

C. ipratropium

D. omalizumab

E. triamcinolone

An 8-year-old female is brought to the office due to episodes of “spacing out” at school. These episodes occur many times per day, and the girl has no recollection of them. She had previously taken ethosuximide but did not tolerate its side effects, and it did not seem to effectively treat her symptoms. The most appropriate next step is to administer

A. carbamazepine

B. diazepam

C. levetiracetam

D. topiramate

E. valproic acid

Ethosuximide is the first-line treatment for which type of seizures?

_____ seizures

What are the primary methods of CMV transmision?

_____ contact

Organ _____

What findings might be seen on fundoscopic exam in a patient with vision loss due to cytomegalovirus retinitis?

H_____

C_____-_____ exudates

The C_____-_____ exudates are associated with _____.

How can cytomegalovirus present in immunocompetent patients compared to immunocompromised patients?

_________→ Mononucleosis

_________→ Retinitis, esophagitis, and infection

Which virus has the classic histological findings of "owl eyes"?

A corneal reflex is performed. The patient pulls her head back but is unable to close her eyes. The stimulated afferent nerve during this reflex exam exits the skull through the

A. foramen ovale

B. foramen rotundum

C. internal auditory meatus

D. jugular foramen

E. superior orbital fissure

Pineal gland tumors (pinealoma) can compress the superior colliculus, resulting in ______ gaze palsy (Parinaud syndrome).

What three underlying conditions can cause Parinaud syndrome?

H_______
S_______
P_______ gland tumor

How does a pineal gland tumor result in Parinaud syndrome?

A tumor of the pineal gland causes _____ of the _____ → _____ gaze palsy

What is the mechanism of action of isoniazid?

Decreases _____ acid synthesis

How can you prevent peripheral neuropathy in a patient being treated for tuberculosis with isoniazid?

By coadministering ______ to prevent vitamin ______ deficiency induced by isoniazid

A patient requests prophylaxis against Mycobacterium tuberculosis before travel. What is the one drug that can be used as solo prophylaxis?

______

Why do patients require different dosages of isoniazid?

People are either slow or fast ______

Which bacterial enzyme is needed to activate isoniazid?

______-______

How does isoniazid affect cytochrome P-450?

______ cytochrome P-450

What is unique regarding seizures induced by isoniazid toxicity?

Seizures caused by isoniazid toxicity are refractory to b________

What is the most likely diagnosis of a liver mass in a man who has worked for 30 years at a polyvinyl chloride pipe manufacturing facility?

______ ______

Which vascular tumor is associated with vinyl chloride and arsenic exposure?

______ ______

Environmental exposure to which carcinogen increases the likelihood of hepatic angiosarcoma in a plumber?

______ ______

What carcinogen associated with Aspergillus can lead to hepatocellular carcinoma?

______

Against which organism are dicloxacillin, nafcillin, and oxacillin useful?

______ ______

Name the narrow-spectrum, penicillinase-resistant antibiotics.

_____

_____

_____

What is the mechanism of action of dicloxacillin, nafcillin, and oxacillin?

Inhibition of peptidoglycan _____-_____ in bacterial cell walls

What are the different names given to monocytes depending on the tissue they are present in?

Outside the blood → ________
Liver → ________ cells
Connective tissue → ________
Skin → ________ cells
Bone → ________
Brain → ________ cells

Name the four antigen-presenting cells.

______
______ cells
______ cells
______ cells

Which immunodeficiency syndrome may cause disseminated mycobacterial and fungal infections?

IL-____ deficiency

What are the two main functions of IL-12?

Activates ____ ____ cells
Induces differentiation of T cells to ____ ____ cells

Which cytokines are involved in the induction, facilitation, and maintenance of granulomas in tuberculosis?

____-____ → Activates macrophages to induce granuloma formation
____-____→ Facilitates granuloma formation
____-____ → Maintains granuloma

Allergic asthma and anaphylaxis are what type of hypersensitivity reaction?

Type _____ hypersensitivity reaction

Which hypersensitivity reaction has a delayed response and does not involve antibodies?

Type _____ hypersensitivity reaction

What hypersensitivity reaction is associated with vasculitis and systemic manifestations?

Type _____ hypersensitivity reaction

Myasthenia gravis, Graves disease, and pemphigus vulgaris are examples of what type II hypersensitivity mechanism?

Cellular ______

What immunoglobulin isotype most commonly forms the immune complexes implicated in type III hypersensitivity reactions?

____

What type of hypersensitivity reaction occurs in patients with persistent infections resulting in chronic inflammation?

Type _____ hypersensitivity reaction

What syndrome is associated with genetic deficiency of FOXP3?

_____ syndrome

What does the “I” in IPEX represent?

A. Immunodeficiency

B. Immune dysregulation

C. Inflammation

D. Intolerance

What does the “P” in IPEX represent?

A. Polyendocrinopathy

B. Polyneuropathy

C. Pancytopenia

D. Proteinuria

What does the “E” in IPEX represent?

A. Encephalopathy

B. Enteropathy

C. Endocarditis

D. Erythrocytosis

What inheritance pattern is represented in IPEX?

A. Autosomal dominant

B. X-linked

C. Autosomal recessive

D. Mitochondrial

Which four diseases are most commonly associated with the HLA-B27 subtype?

_____ arthritis
_____ _____
_____ _____ disease-associated arthritis
_____ arthritis

Which recombinant cytokine may be used to treat multiple sclerosis?

____-__

How are women affected by anabolic steroid use?

They experience physical signs of ______

What is the most common severe lupus nephritis class?

A. Class I

B. Class II

C. Class III

D. Class IV

Class IV lupus nephritis is also called:

A. Minimal mesangial nephritis

B. Diffuse proliferative glomerulonephritis

C. Membranous nephropathy

D. Focal proliferative nephritis

Which other autoimmune diseases are commonly associated with Sjögren syndrome?

______
______ ______

______ ______

What are the 2 types of scleroderma? Which has a more benign clinical course?

______ scleroderma
______ scleroderma (more benign)

Widespread skin involvement, early visceral involvement, and rapid progression are indicative of what type of scleroderma?

______ scleroderma

Which 2 antibodies are associated with diffuse scleroderma?

Anti-______-______ antibody
Anti-______ ______ ______ antibody

Which antibody is highly specific for diffuse scleroderma?

A. Anti-Scl-70

B. Anti-centromere

C. Anti-histone

D. Anti-SS-A

What 2 lung pathologies are associated with scleroderma?

Interstitial _______

Pulmonary _______

What condition involves autoimmunity, noninflammatory vasculopathy, and excessive fibrosis and collagen deposition?

_______

What is the underlying pathophysiology of acid reflux and dysphagia associated with CREST syndrome?

_______ of esophageal smooth muscle → _______ lower esophageal sphincter pressure and _______ in distal esophagus → Acid reflux and dysphagia

What enzyme do mycophenolate and ribavirin inhibit?

_____ _____

What is the mechanism of action of mycophenolate mofetil?

Mycophenolate mofetil reversibly inhibits _____ _____ → Prevents _____ synthesis in T cells and B cells

What is beneficial about the side-effect profile of mycophenolate mofetil?

Less _____ and _____ than other immunosuppressants

Which viral infection is associated with mycophenolate mofetil?

______

Both mycophenolate mofetil and azathioprine inhibit the de novo production of what type of nucleotides?

______

What autoimmune disease commonly presents in middle-aged women with xerostomia, keratoconjunctivitis sicca, and inflammatory joint pain?

______ syndrome

Interferons are effective in the immune response against which type of pathogens?

______

What are the three major types of interferons?

______

______

______

What types of immunity are mediated by B cells and T cells?

B cells mediate ________ immunity
T cells mediate ________-________ immunity

Activation of which cell type is required for B-cell activation?

Activation of ________ ________ cells

Which type of vaccines often induce strong, lifelong immunity?

______ ______ vaccines

What type of vaccine is composed of a denatured bacterial toxin with an intact receptor binding site?

______ vaccine

Which two cell surface proteins are suggestive of natural killer cell lineage?
_____

_____

Which receptor found on natural killer cells binds to the Fc region of IgG?

_____

HLA-DR4 is associated with which _____ _____.

A patient has septic shock due to a gram-negative organism. What receptor triggered the shock response?

The lipis ______ component of bacterial lipopolysaccharides binds to ______ on ______

What type of active immune response is triggered by inactivated or killed vaccines?

______ response

What is the difference between anti-HBc IgM and anti-HBc IgG?

IgM is a marker for _____ or _____ infection
IgG is a marker for _____ _____ or _____ infection

Which disease is associated with anti-hemidesmosome autoantibodies?

_____ _____

A 29-year-old male from Nepal presents to the emergency department with a 2-month history of sores in his mouth and a 1-week history of a painful, nonpruritic rash on his body. During this time, he has felt progressively fatigued. He reports that the skin lesions form as blisters that easily burst and release clear fluid. His past medical history is significant for gonorrhea 3 months ago, which was treated successfully. On examination, he is afebrile, with diffuse flaccid bullae and erosions on his arms, legs, trunk, and neck. There are several erosions on his gingiva and buccal mucosa. There are no lesions on his penis or anus. With gentle pressure to an intact bulla, the top layer of skin separates off. Which of the following is most likely to be found in the workup of this patient

A. biopsy with direct immunofluorescence in a linear dermal–epidermal distribution

B. biopsy with direct immunofluorescence showing antibodies on the surface of keratinocytes

C. duodenal biopsy showing mucosal atrophy, loss of villi, and crypt hyperplasia

D. positive culture grown on chocolate agar

E. positive enzyme-linked immunoabsorbent assay for retrovirus

Pemphigus vulgaris is an autoimmune blistering disease caused by _____ antibodies against desmosomes located on the surface of _____, resulting in flaccid bullae and erosions on the skin and oral mucosa. It is associated with the use of certain drugs, including _____.

In pemphigus vulgaris, with gentle pressure to an intact bulla, the top layer of skin separates off. This is _______ sign.

bullous pemphigoid does not have this

_____ _____, also called axial spondyloarthritis, is a type of inflammatory disease that mainly affects the spine. Over time, the inflammation can cause some of the bones in the spine, called vertebrae, to fuse _____. This fusing makes the spine less _____ and can lead to a hunched posture

In what demographic group is ankylosing spondylitis most commonly diagnosed?

(Males/Females) between _____ to _____ years of age

What diseases are commonly associated with anti-U1 snRNP antibodies?

______

______ ______ ______ disease

Other ______ diseases

The presence of high titers of anti-U1 ribonucleoprotein antibodies and the absence of severe _____ disease distinguish mixed connective tissue disorder from other rheumatic diseases.

Mixed connective tissue disorder: presents with features of _____, _____ _____, and _____ with a positive titer of anti-U1 RNP antibodies.

Both dermatomyositis and polymyositis cause proximal muscle weakness. What presenting symptoms differentiate the two?

Dermatomyositis presents with ______ findings

What would be seen on a muscle biopsy specimen obtained from a patient with polymyositis?

_____ T cells

Polymyositis is a rare, chronic autoimmune disease that causes inflammation and progressive weakness in the muscles closest to the _____ of the body

Polymyositis generally causes progressive muscle weakness of which muscle groups?

______ muscle groups

What would be seen on a muscle biopsy specimen obtained from a patient with dermatomyositis?

_____ T cells

Which paraneoplastic syndrome has the constellation of heliotrope rash, Gottron papules, and weakness of the thighs and shoulders?

_____

What tumor is most commonly associated with dermatomyositis?

______ adenocarcinoma

Dermatomyositis is an inflammatory myopathy marked by proximal muscle weakness and characteristic skin findings including the shawl sign, Gottron papules, heliotrope rash, and Holster sign. It is associated with _____ lung disease.

What is the mechanism of aliskiren?

Direct _____ inhibition → Blocks conversion of _____ to _____ _____

Name relative contraindications to aliskiren use.

Relative contraindication → Current treatment with _____ inhibitors or _____ _____ receptor blockers

Full contraindication → _____

What is the clinical use for aliskiren?

______

How does aliskiren affect angiotensinogen, angiotensin I, and angiotensin II levels?

Angiotensinogen _______
Angiotensin I _______
Angiotensin II _______

What adverse effects can occur with aliskiren?

(Increased/Decreased) glomerular filtration rate
(Hypertension/Hypotension)
________
(Hyperkalemia/Hypokalemia)

Name two examples of type IV hypersensitivity reaction.

_____-_____-_____ disease

_____ _____

When is graft-versus-host disease potentially beneficial?

When a bone marrow transplant is done to treat ______

What autoimmune condition can be caused by methyldopa, hydralazine, minocycline, isoniazid, sulfa drugs, phenytoin, etanercept, or procainamide?

Drug-induced _____

What is the four-drug regimen commonly used to treat tuberculosis?

What is the mechanism of action of pyrazinamide?

_____

At what pH does pyrazinamide work best?

_____ pH

What are the two most common adverse effects of pyrazinamide?

_____

_____

What finding in fundoscopy indicates hypertensive emergency?

_______

What type of heart valve is commonly infected by Staphylococcus aureus and what type is commonly infected by Streptococcus viridans?

Staphylococcus aureus infects _____ heart valves

Streptococcus viridans infects _____ or _____ heart valves

What is the major morphologic difference between vegetations produced by Staphylococcus aureus and those produced by Streptococcus viridans?

Staphylococcus aureus → ______ vegetations
Streptococcus viridans → ______ vegetations

Which sinuses does the middle meatus drain?

______ sinus
______ sinus
______ ______ sinus

What is the function of haptoglobin as an acute phase reactant?

Binds to extracellular ______ → Protects against oxidative stress

What is the evolutionary theory behind the origin of anemia of chronic disease?

Sequestering iron in ______ may prevent ______ from acquiring iron for survival

What is the likely cause of anemia in a patient with chronic renal failure?

Decrease in ______ production by the diseased kidneys

What is the pathophysiology behind anemia of chronic disease?

Inflammation → Increased ______ level → Decreased release of ______ from macrophages → Decreased ______ absorption from the gut

What causes of pneumoniae are associated with alcohol overuse?

_____

(Aerobes/Anaerobes) secondary to _____

What bacteria may cause an aspiration pneumonia productive of "currant jelly" sputum?

_____

Describe the gram stain and morphology of Klebsiella.

What illnesses can Klebsiella cause?

_____ pneumonia in patients with heavy _____ use or with impaired host defenses

Healthcare-associated _____ tract infections

What paraneoplastic syndrome associated with lung cancer presents as muscle weakness that improves with activity?

_____-_____ _____ syndrome

What is the mechanism underlying Lambert-Eaton myasthenic syndrome?

Antibodies against ______ ______ channels at ______ junctions

Lambert-Eaton myasthenic syndrome is associated with what malignancy?

_____ _____ lung cancer

What are the common forms of skin cancer?

____ ____ carcinoma (most common)
____ ____ carcinoma (2^nd most common)

Relative to the upper and lower lips, where are basal cell and squamous cell carcinomas commonly found?

Basal cell carcinoma → _____ upper lip
Squamous cell carcinoma → _____ lower lip

Which skin cancer develops cells that are histologically described as having "palisading" or aligned nuclei?

_____ _____ carcinoma

A 61-year-old White man presents to the office for evaluation of a skin lesion on his right ear. It has been present for years but recently started to bleed onto his pillow. He has been applying petrolatum ointment to the lesion, but it has not healed. Past medical history reveals diabetes and hypertension. There is no family history of skin cancer. Physical examination reveals a 1-cm lesion on the helix of the right ear. It is more shiny than the surrounding skin and has rolled borders. The most likely diagnosis is

A. basal cell carcinoma

B. lentigo maligna

C. melanoma

D. Merkel cell carcinoma

E. squamous cell carcinoma

What pathogen is higher risk in unvaccinated individuals and presents with cough, runny nose, conjunctivitis, a diffuse rash, and blue-white spots in the mouth?

A. Mumps

B. Measles

C. Poliovirus

D. West Nile virus

What rare central nervous system sequelae of measles infection occurs a few days following the developement of the classic rash?

______

Describe the lymph node biopsy findings of a patient with measles.

Warthin-Finkeldey ______ cells present in a background of paracortical ______

What is the major complication of mumps orchitis?

Increased risk of ______

Mumps is most likely in a child who presents with ______ pain and enlarged ______ glands.

What are the symptoms of mumps?

______
______
______ meningitis
______

Poliovirus is higher risk in ______ individuals and presents with ______, ______, and ______.

What two vaccines can be used for poliovirus infections?

_____ vaccine (injection)

_____ vaccine (by mouth)

B-cell immunodeficiency results in predisposition to which two type of viruses?

______

______ encephalitis

What condition is caused by West Nile virus?

_______

What constellation of findings is seen in patients with congenital cytomegalovirus infection?

_____ loss
s_____
c_____
_____ muffin rash
_____ rash
_____ calcifications

A patient with prior EBV infection develops a t(8;14) MYC translocation. Which malignancy is associated?

Which infectious agent is associated with Burkitt lymphoma?

In Burkitt lymphoma, where do lesions occur in different epidemiological forms?

_____ lesions in the endemic form in Africa
_____ and/or _____ lesions in the sporadic form

How is the histologic appearance of Burkitt lymphoma, as shown in the image, described?

Which oncogene is involved in the EBV-associated t(8;14) translocation?

A. BCL2

B. MYC

C. RAS

D. TP53

What population age is associated with Burkitt lymphoma?

_______ and _______ adults

What are the physical findings of Kaposi sarcoma associated with HHV-8 infection with a CD4⁺ count < 500 cells/mm³?

Invading _____ _____ cells that form _____ tumors visible on histology

Which oncogenic virus is associated with Kaposi sarcoma?

From what cells does Kaposi sarcoma arise?

_____ cells

What virus causes disease presenting with dark, violaceous plaques/nodules resembling vascular proliferation?

______-____

What three organs are affected by Kaposi sarcoma?

______
______ tract
______

How does the rash seen in roseola infantum spread automatically?

Starts on the _____ and then spreads to the _____

Roseola infantum is another name for infection with:

A. EBV

B. HSV-2

C. HHV-6

D. VZV

What age group is mostly affected by the disease presenting with the rash in the image, caused by HHV-6 and HHV-7?

Children < _____ years old

How can you differentiate esophageal ulcers caused by HSV-1 from those caused by cytomegalovirus?

HSV-1 causes _____- _____ ulcers

Cytomegalovirus causes _____ ulcers

What brain lesion causes sudden hyperoral, hypersexual, and uninhibited behavior with a positive cerebrospinal fluid polymerase chain reaction for HSV-1?

Bilateral _____ lesions

What viral infections are associated with intranuclear eosinophilic Cowdry A inclusions?

_______

_______

_______

How does transmission for HSV-1 and HSV-2 differ?

HSV-1 → _______ _______ and _______
HSV-2 → _______ and _______ contact

Epstein-Barr virus is more strongly associated with [anterior/posterior] cervical lymphadenopathy

Strep throat is more strongly associated with [anterior/posterior] cervical lymphadenopathy

In which type of cells do cytomegalovirus establish latency?

_______ cells

Which HSV affects genitals?

_______-_____

_______-_____

Which HSV is more likely to cause viral meningitis?

_______-_____

This is ________, that can be found in ________-____

In which part of the nervous system does HSV-1 lie dormant after initial infection?

_______ ganglia

In which part of the nervous system does HSV-2 lie latent?

_______ ganglia

What part of the nervous system does varicella-zoster virus lie latent?

_______ _______ ganglia
_______ ganglia

Which diagnostic test for HSV can reveal multinucleated giant cells?

A. PCR

B. Tzanck smear

C. Monospot

D. Viral culture

What is the advantage of using valacyclovir over acyclovir?

Valacyclovir is a prodrug of acyclovir with better ______ bioavailability

What are the three first-line antiviral agents used to treat HSV and varicella-zoster virus infections?

______
______
______

Acyclovir, famciclovir, and valacyclovir are guanosine analogs that inhibit which viral enzyme?

Viral _______ _______

Which herpesvirus is the most common cause of sporadic encephalitis?

Why are acyclovir and valacyclovir not useful against cytomegalovirus?

The virus lacks _______ _______

What is the mechanism of resistance for acyclovir and valacyclovir?

Mutation in viral _______ _______

What are two major adverse effects of acyclovir, famciclovir, and valacyclovir?

acute _____ injury

obstructive crystalline _____

What are three indications for acyclovir, famciclovir, and valacyclovir?

________-induced ________/________ lesions

________-induced ________

Prophylaxis against ________ for immunocompromised individuals or immunocompetent patients with severe/recurrent infections

What is this?

Plasma cell can give rise to what cancer?

______ ______

Where are plasma cells found?

______ ______

Neonatal respiratory distress syndrome causes atelectasis with an intrinsic etiology due to a lack of ______.

The air sacs in the baby's lungs collapse because immature lungs cannot make enough slippery ______ to keep them open.

What is the mechanism of atelectasis typically seen in a patient with sarcoidosis?

Distortion of ______ that can be caused by ______ or ______ of lung parenchyma.

What is the pathophysiologic mechanism that causes airway obstruction to lead to atelectasis?

Airway obstruction prevents new air from reaching the ______ airways.

Old air is _____ into the blood, causing the trapped gas volume to shrink until the alveoli collapses.

What is the pathophysiologic mechanism that causes external compression of the lung to lead to atelectasis?

External compression of the lung [increases/decreases] the volume of the lung

What type of vasculature is not affected in polyarteritis nodosa?

______ arteries

Polyarteritis nodosa is a medium-vessel vasculitis that presents with different stages of arterial wall ______ ______ and ______ ______.

Polyarteritis nodosa is strongly associated with which infectious disease?

______ ______

Polyarteritis nodosa is usually found in individuals of what demographic?

______-aged ______

What disease is characterized by headaches, skin lesions, and the angiogram findings shown in the image? What is the most appropriate treatment?

This is ______ ______

Treatment is ______ and ______

How does the humoral type of acute rejection differ from hyperacute rejection in its pathophysiology?

Antibodies against graft donor antigens develop _______ transplantation in acute rejection

What is the treatment for hyperacute transplant rejections?

Removal of ______

What is the pathogenetic mechanism of hyperacute transplant rejection?

Pre-existing recipient antibodies react to donor ________ → Activates ________→ ________ of graft vessels and ________

Which type of transplant rejection is characterized by the histologic findings shown?

____ ____

What is the RNA structure of the flavivirus?

(Enveloped/Nonenveloped)
_______-stranded
_______-sense
_______ RNA
_______ capsid

Name five medically significant conditions caused by flaviviruses.

Hep _____
_____ fever
_____ virus infection
_____ _____ disease
_____ fever

What is the most common mosquito-borne viral disease in the world?

______ fever

What are three possible clinical conditions associated with infection by dengue virus?

______ fever
Dengue ______ fever
Dengue ______ syndrome

What is the pathology that leads to dengue shock syndrome?

______ leakage → ______ collapse

What are the symptoms associated with dengue hemorrhagic fever?

Dengue fever with ______ and ______ leakage and extremes in ______

How is infection by dengue virus diagnosed?

P______
S______

What is the vector of transmission for the dengue virus?

______ mosquito

What portion of the liver is affected by yellow fever?

Zone ______

Yellow fever virus causes high _________, black-colored _________, j_________, h_________, and b_________.

What two groups act as reservoirs for the yellow fever virus?

M_______
H________

What vaccine is recommended to prevent travelers from being infected with yellow fever virus?

______, ______ vaccine

What are the clinical manifestations of infections with Zika syndrome in the affected newborn?

(Macrocephaly/Microcephaly)
_____ anomalies
_____ abnormalities

Describe the symptoms caused by Zika virus infection.

c_______
Low-grade ________
________ rash

Under what conditions are outbreaks of Zika virus more common?

______ climates
______ climates

What is the test of choice for the diagnosis of Zika virus?

______ -______
S______

What is the most appropriate treatment for patients infected by Zika virus?

______ care

What is the mode of transmission of the Plasmodium species that cause malaria?

Bite of the _______ mosquito

What are three general mechanisms for Zika virus transmission?

_______ mosquito bites
_______ transmission
_______ transmission

Describe the DNA structure of poxvirus.

______-stranded
______ DNA
______

Which DNA viruses have the smallest and largest structures?

_______ is the smallest
_______ is the largest

What syndrome describes unilateral facial paralysis and vesicles on the face after reactivation of herpes zoster infection?

______ ______ syndrome

What herpesvirus can cause shingles, chickenpox encephalitis, and pneumonia?

_____-_____ virus

What is the diagnosis of the unilateral rash shown in the image?

______

This itchy rash is seen on a 4-year-old boy. What is this?

______

Chickenpox presents with a vesicular rash that begins on the ______ before spreading to the face and extremities with lesions in different stages

What is the dermatologic term for the lesions shown in the image?

______. This image shows shingles

What is the most common complication of shingles?

Post-herpetic ______

A 27-year-old male presents to the clinic for weakness in his left leg. He reports that he recently returned home from Africa after studying abroad. He reports recently enduring 2 days of nausea, vomiting, sore throat, headache, and diarrhea that ended 3 days ago. History reveals that the patient has never been vaccinated due to personal beliefs. Physical examination reveals a positive Kernig sign along with muscle weakness, decreased reflexes, and fasciculations in the left leg. A lumbar puncture is performed and cerebrospinal fluid samples display elevated protein with prominent lymphocytic infiltrates, and polymerase chain reaction is positive for a single-stranded, linear RNA virus with an icosahedral capsid. The most likely etiologic agent is

A. bunyavirus

B. orthomyxovirus

C. picornavirus

D. polyomavirus

E. reovirus

What is seen on biopsy of tissues infected with cytomegalovirus?

Cells with _______ basophilic inclusion bodies

What give Klebsiella pneumoniae colonies their mucoid appearance?

Presence of numerous ________ capsules

How does hydrochlorothiazide reduce levels of Ca²⁺ in the urine?

Increases ______ reabsorption of Ca²⁺

Hydrochlorothiazide increases levels of both u_____ ______ and g______

What acid-base abnormality is associated with thiazide diuretic use?

[Hyperkalemic/Hypokalemic] metabolic [acidosis/alkalosis]

Serum levels of which substances are increased as a result of the effects of thiazide diuretics such as metolazone?

U______ ______

C______

G______

L______

What is the mechanism of action of thiazide diuretics?

Reduces the ______ capacity of the kidney nephron by inhibiting ______ reabsorption in the early ______

What are clinical uses for thiazide diuretics?

[Hypertension/Hypotension]
[Organ] failure
Idiopathic [hypercalciuria/hypocalciuria]
O______
Nephrogenic ______ ______

Thiazide diuretics cannot be prescribed for patients with which allergy?

_____ allergy

Hydrochlorothiazide, chlorthalidone, metolazone are examples of drugs of which class?

this is the ______

What joint disease presents with pain in the morning that improves with use?

______ ______

Is rheumatoid arthritis more prevalent in females or males?

What are the sensitive and specific antibodies used to diagnose rheumatoid arthritis?

Sensitive antibody → ______ ______
Specific antibody → ______-______ antibody

Rheumatoid arthritis has ______ joint involvement

Rheumatoid arthritis has ______ joint space narrowing

What eye pathology associated with rheumatoid arthritis causes this finding in the eye?

_______

What are 3 diseases that etanercept is indicated for?

_______

_______ _______

_______ _______

What diseases are indications for use of leflunomide?

_______ _______

_______ _______

What is the hand deformity shown in the image? What disease is it associated with?

This is a ______ ______
This is characteristic of ______ ______

What hand deformity is shown in the image? What disease is it associated with?

This is a ________
This is characteristic of ________ ________

What is Felty syndrome?

________ ________ with ________ and ________

Name the first-line pharmacologic treatments for acute and chronic rheumatoid arthritis.

Acute → __________ and __________

Chronic → __________ -__________ agents and __________ agents

What is Caplan syndrome?

Rheumatoid arthritis in the presence of _______ and rheumatoid _______.

What class of drugs, used to treat rheumatoid arthritis, do methotrexate and sulfasalazine belong to?

_______-_______ agents

Which HLA subtype is most commonly associated with rheumatoid arthritis?

HLA-______

Rheumatoid factor, often positive in rheumatoid arthritis, is an autoantibody targeting which immunoglobulin?

It is an Ig_____ antibody against the ______ region of Ig______

What is the likely diagnosis for a patient with rheumatoid arthritis and intrapulmonary nodules?

_______ syndrome

A patient with longstanding severe rheumatoid arthritis is diagnosed with osteoporosis. Which cytokine may have mediated the development of this condition?

IL-____

This is bc IL-____ causes activation of ____ which can increase ____ ____.

What are four clinical indications for treatment with adalimumab and infliximab?

______ ______ disease
______ ______
______
______ ______

What DNA virus in adults can cause pure red blood cell aplasia and rheumatoid arthritis-like symptoms?

______ ______

A patient has epigastric pain radiating to the back with the findings shown. What is the diagnosis?

______ ______

A 42-year-old man with a history of alcoholism presents with epigastric pain radiating to his back and a markedly increased serum lipase level. What is the pathophysiology?

Activation of ______ enzymes → ______ of the ______

A 39-year-old patient with a history of gallstones has acute epigastric pain radiating to the back. What other information is needed to diagnose acute pancreatitis?

Increase in either serum ______ or ______ to ______ times the upper limit of normal

______ findings that indicate acute pancreatitis

What are two clinical indications for minoxidil therapy?

Androgenetic _______
Severe refractory [hypertension/hypotension]

What is the mechanism of action of minoxidil?

Direct arteriolar [vasoconstriction/vasodilation] → Increased _______ stimulation

Where do the majority of pulmonary emboli arise from?

[Proximal/Distal] deep veins of the [upper/lower] extremity

What three circumstances may lead to increased hypercoaguability?

Genetic defect in _____ _____ proteins
_____
_____ _____ pill use

What three major factors that predispose patients to thrombosis are described by the Virchow triad?

______
[Hypercoagulability/Hypocoagulability]
______ damage

What pathophysiologic mechanism explains how endothelial damage leads to the formation of a clot?

Exposed ______ triggers the ______ cascade

DVT test of choice besides d-dimer?

______ ultrasonography with ______ ultrasound of lower leg veins

Which two viral infections are commonly treated with interferons?

Chronic hepatitis ______ virus
Condyloma ______

When do cells generally synthesize interferons?

When infected by _______

Interferons can prime local cells for self-defense against viruses by inducing downregulation of what process?

_______ synthesis

What are the five major adverse effects of interferons?

M_______
N_______
_______-like symptoms
D_______
A_______ reactions

What four types of neoplasms are treated with interferons?

______ ______ carcinoma
Malignant ______
______ sarcoma
______ ______ leukemia

Which immunodeficiency syndrome is commonly treated with interferons?

Chronic ______ disease

Interferons can prime local cells for self-defense against viruses by inducing upregulation of what process?

______ expression

What is the pathophysiologic mechanism seen in patients with sarcoidosis?

______-mediated, [caseating/noncaseating] granulomatous inflammation spread throughout multiple organs

What is the classic bronchoalveolar lavage finding in a patient with sarcoidosis?

Elevated ______/______ ratio

What patient population does sarcoidosis most commonly affect?

______ ______

What is the most common presentation of sarcoidosis?

Clinically [symptomatic/asymptomatic] with ______ on exam

What two histologic features are commonly present in the noncaseating epithelioid granulomas of sarcoidosis?

______ bodies

______ bodies

What is the pathophysiologic mechanism that causes hypercalcemia in sarcoidosis?

Increased ______ activity in macrophages → Vitamin ______ activation

What is the preferred treatment for symptomatic sarcoidosis?

______

What is this?

The following classic clinical and laboratory findings are seen in a patient with what disease?

Bell palsy
Granulomas
Lupus pernio
Uveitis
Erythema nodosum
Interstitial fibrosis
Rheumatoid arthritis–like arthropathy
Hypercalcemia

What serum marker is often elevated in patients with sarcoidosis?

_____ levels

This is a ______ ______ biopsy from sarcoidosis pt

Gentamicin
Neomycin
Amikacin
Tobramycin
Streptomycin

These belong to the _______ class of antibiotics.

Use of aminoglycoside antibiotics is absolutely contraindicated for patients with what neuromuscular disorder?

______ ______

Which antibiotic targeting bacterial protein synthesis can be given prophylactically before bowel surgery?

______

The most common and widespread resistance mechanism against aminoglycosides is the production of aminoglycoside-modifying ______ (AMEs)

Aminoglycosides are synergistic with which class of antibiotics?

______-______

Which adverse effects are associated with aminoglycosides?

N________
N________ blockade
O________
T________

What is the underlying pathophysiologic mechanism leading to stable angina?

________

What are the typical symptoms of stable angina?

Chest pain occurring with ________ that is relieved by ________ and/or ________

What ECG changes are typically seen with unstable angina?

ST ________
T-wave ________

What ECG changes are associated with stable angina compared with those seen with vasospastic angina?

Stable angina → ST ________
Vasospastic angina → Transient ST ________ even at rest

What two clinical conditions are typically seen as a result of Eustachian tube obstruction?

Otitis ________

Hearing ________

What are the two common types of pathogens that cause lung abscesses?

________ ________

(Aerobes/Anaerobes)

What is the definition of a lung abscess?

A localized collection of ________ within the lung parenchyma

What are the two conditions that commonly predispose a patient to lung abscess formation?

Bronchial ________
Oropharyngeal content ________

What finding on an X-ray of the chest is highly suggestive of a lung abscess?

_____-_____ levels

What classic histologic finding is commonly seen in patients with mesothelioma?

_____ _____

What effect does a history of smoking have on a patient's risk for the development of mesothelioma?

______

Mesothelioma: ______ ______ can be seen in the specimen.

What type of immunohistochemical staining is positive in mesothelioma?

______
______ ___
______ ___

What are the two classic presentations of mesothelioma?

______ pleural effusion
Pleural ______

What occupational/environmental exposure is associated with mesothelioma?

______

What are the classic electron microscopic findings in patients with mesothelioma?

______ cells with ______, ______, and ______

Which lobe of the brain is most commonly affected in herpes encephalitis?

______ lobe

What virus can act like Epstein-Barr virus, but have a negative monospot test?

______

Which herpesviruses can be transmitted by respiratory secretions?

______-______
______-______ virus
______-______ virus

Which herpesviruses can be transmitted by saliva?

______-______

______-______ virus

______virus

______-______

If a patient with mononucleosis is wrongly prescribed amoxicillin, what would you expect?

______ ______

Describe the viral structure of all herpesviruses.

[Enveloped/Non-enveloped]
[...]-stranded
[Shape] DNA

Cranial nerve V₁ involvement of varicella-zoster virus results in what disease?

Herpes zoster _______

What are the possible presentations in a patient with HSV-1?

C_______ _______
H_______ _______
K_______
E_______ _______
E_______
Temporal _______
G_______

What two viruses can cause roseola and which is the most common cause?

[...] (most common)
[...]

What gastrointestinal manifestations are associated with the disease most likely characterized by the skin findings shown in the image?

Esophageal _______

_______

Name the skin finding associated with anti-centromere antibodies shown in the image.

_______ _______. This is likely due to _______ syndrome.

Scleroderma can also cause a _______ crisis

Where do skin lesions appear in limited scleroderma or CREST syndrome?

_______
_______

What does the CREST acronym stand for?

_______ _______
_______ phenomenon
_______ dysmotility
_______
_______

What are the adverse effects of mannitol?

D_______
Pulmonary _______
_______ or _______

What is the mechanism of action of mannitol?

Increases serum _______ → Fluid shift from _______ to _______ _______ → [Increased/Decreased] urine flow → [Increased/Decreased] intracranial/intraocular pressure

What are two contraindications to mannitol use?

A_____
[Organ] failure

Name two clinical uses for mannitol.

Elevated _______ /_______ pressure
Drug _______

How do loop diuretics dilate the afferent arterioles?

By stimulating ______ release

Name eight toxicities associated with use of loop diuretics.

O______
[Hyperkalemia/Hypokalemia]
[Hypermagnesemia/Hypomagnesemia]
D______
______ allergy
Metabolic [acidosis/alkalosis]
N______
G______

What is the mechanism of action of loop diuretics?

Inhibits cotransporters in the [thick/thin] [ascending/descending] limb of the loop of Henle

Abolishes medullary [hypertonicity/hypotonicity] → Prevents ______ concentration

Increased ______ release

What are general clinical uses for loop diuretics?

[Hypertension/Hypotension]
E______ states
[Hypercalcemia/Hypocalcemia]

NSAIDs have an inhibitory effect on what aspect of loop diuretic activity?

They inhibit ______-induced afferent arteriole vasodilation

Why are ACE inhibitors contraindicated for patients with C1 esterase inhibitor deficiency?

ACE inhibitors must be avoided to prevent the adverse effect of ______

How does an ACE inhibitor slow diabetic nephropathy?

ACE inhibitors [increase/decrease] intraglomerular pressure → Slows glomerular basement membrane [thickening/thinning]

What are some clinical uses for ACE inhibitors?

P______
[Hypertension/Hypotension]
[Organ] failure
D______ nephropathy
Prevention of ______ remodeling from chronic hypertension

Why might patients with bilateral renal artery stenosis develop renal failure when taking an ACE inhibitor?

ACE inhibitors lower ______ ______ levels

Why are ACE inhibitors contraindicated in pregnancy?

They are ______
May cause fetal ______ malformations

How would you expect creatinine levels to change immediately after administration of an ACE inhibitor?

Transient [increase/decrease] of creatinine levels

Which electrolyte abnormality can cause arrhythmias in patients taking captopril?

[Hyperkalemia/Hypokalemia]

How can an ACE inhibitor cause cough and/or angioedema?

By preventing inactivation of ______

What medication replacement would you suggest for a patient experiencing a dry cough while taking lisinopril?

______ ______ receptor blocker

Why does a high serum renin level occur when ACE inhibitors are administered?

Loss of ______ feedback

What adverse effects can occur with ACE inhibitors?

C______
A______
T______
Increased ______ levels
[Hyperkalemia/Hypokalemia]
[Hypertension/Hypotension]

What finding on an X-ray of the chest is highly suggestive of a lung abscess?

____-____ levels, as it is suggestive of ____

Which individuals are predisposed to developing the pathologic finding shown in the absence of preexisting pulmonary disease?

Individuals prone to ____ of oropharyngeal contents.

This image shows a ____ ____

Which lung is more likely to be affected by abscess formation due to aspiration?

[Left/Right] lung

What are the three possible treatment options for a lung abscess?

A______
S______
D______

What is the main determinant of the location of lung abscess formation after aspiration?

The patient's ______ during aspiration

A lung abscess is a ______-filled cavity inside the lung tissue caused by a microbial infection that ______ the surrounding tissue.

What is the likely diagnosis for a patient with a history of myoclonic epilepsy who has a productive cough, fever, and the chest X-ray findings shown?

Lung _______

This is likely secondary to _______ in a patient predisposed to seizures and aspiration.

In which lobe of the right lung does an abscess typically form if a patient is upright during an aspiration episode?

______ lobe

In which lobes of the right lung does an abscess typically form if a patient is recumbent during an aspiration episode?

______ lobe
______ lobe

How would you describe the rash on a patient with SLE shown in the image?

What condition is classically associated with the rash shown in the image?

_____, this shows a _____ rash

Deficiency of which proteins leads to a decrease in clearance of immune complexes in a patient with SLE?

Deficiency of early _____ proteins

Name the 3 most common causes of death associated with SLE.

[Organ] disease (most common)
Accelerated c_____ _____ disease
i_____

Which antibody, if present in a pregnant woman with SLE, increases the risk of her newborn developing neonatal lupus?

_____-_____ (_____) antibodies

What cardiac pathology is associated with SLE?

L_____-S_____ _____

What populations are most commonly affected by SLE?

[Male/Female] patients of _____ age

Which 4 serologic findings can be positive in patients with SLE?

[...] antibodies
[...] antibodies
[...] antibodies
[...] antibodies

Describe the pathophysiologic effects SLE can have on the renal system.

Deposition of _____-_____-_____ immune complexes in glomerulus → _____ and _____

What neurologic disorders can manifest in SLE?

P_____

S_____

What autoimmune disease classically presents in a young woman with relapsing/remitting rash, joint pain, and unexplained fever?

______

What 2 types of hypersensitivity reactions are associated with SLE?

Type ______ hypersensitivity reaction (most common)
Type ______ hypersensitivity reaction

Name the 4 features associated with neonatal lupus.

Congenital ______ ______
Periorbital/diffuse ______
T______
C______

Where are ulcers commonly seen in patients with SLE?

M_____

N_____

P_____