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UWorld Question Review > 1 > Flashcards

1 Flashcards

1
Q

What is component of LPS is responsible for DIC and sepsis?

A

Lipid A

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2
Q

Phenotype of CAH due to 17 hydroxylase deficiency?

A

Ambiguous genitalia, decreased androgens, hypokalemia due to increased mineralocorticoids

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3
Q

How does propionyl coa become succinyl coa?

A

Propionyl CoA becomes methylmalonyl CoA via a carboxylase reaction (with biotin), methylmalonyl CoA becomes succinyl CoA via a mutase reaction with B12

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4
Q

Very first substate to be used in gluconeogenesis

A

Alanine creates pyruvate via ALT, pyruvate into gluconeogenesis

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5
Q

What does the drug PCP produce in users?

A

Aggression, amnesia, ataxia.

Trauma is most likely lethal outcome

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6
Q

Why add primaquine to plasmodium vivax/ovale infection?

A

To prevent relapse.

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7
Q

Thiazide diuretics effect on electrolytes

A

Hyponatremia (because medullary gradient is still intact), hypercalcemia

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8
Q

How does mutant huntingtin work?

A

A gain of function due to CAG expansion silences transcription via histone deacetylation (chromatin remains tightly wrapped).

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9
Q

What process uses DNA rearrangement?

A

VDJ recombination in B and T cells during development. Takes place in bone marrow and thymus

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10
Q

How is CFTR screwed up in CF?

A

3BP deletion that causes poor post-translational modification of the CFTR and proteosomal degradation.

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11
Q

Findings in down syndrome

A

Single palmar crease, prominant epicanthic folds, upwards turning eyes, flat nasal bridge.

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12
Q

Major findings in VHL

A

On chromosome 3 (microdeletion), 40% of VHL will have renal cell carcinoma. Hemangioblastoma and pheochromocytomas too.

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13
Q

What causes turner syndrome genotype

A

Most commonly paternal meitotic nondisjunction. Loss of X causes missing shox gene which is normally responsible for long-bone growth (so short stature)

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14
Q

Inheritance of Leber hereditary optic neuropathy

A

Mitochondrial

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15
Q

Two types of elastase in lungs?

What inhibits each type?

A

Neutrophil elastase, inhibited by alpha 1 antitrypsin.

Macrophage elastase, inhibited by tissue inhibitors of metalloproteinases.

Macrophage elastase degrades alpha 1 antitrypsin, and neutrophil elastase inhibits tissue inhibitor of metalloproteinase (TIMP.

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16
Q

C1 deficiency causes

A

Infection with encapsulated organisms. Often seen in SLE.

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17
Q

What is one of the major causes of SCID?

A

Adenosine deaminase deficiency, also IL2 receptor deficiency

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18
Q

Hb2a

A

Beta 2 delta 2. Increased in beta thalassemia minor, very increased in beta thalassemia major

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19
Q

Amifostene

A

Decreases nephrotoxicity from cisplatin and carboplatin

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20
Q

23S component of bacterial ribosome?

A

A component of the 50S subunit, responsible for creating peptide bonds during translation. Macrolides bind here.

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21
Q

MEN1

A

Parathyroid, pituitary, pancreas tumors

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22
Q

What drug causes a disulfiram reaction with alcohol?

A

Metronidazole

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23
Q

What does acute lung rejection cause?

A

CD8+ T cell mediated destruction of the lung vasculature

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24
Q

What does chronic lung rejection (years later) cause?

A

Bronchiolitis obliterans. Don’t confuse this with chronic renal transplant rejection, which does cause vascular destruction

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25
Q

Stages of aspirin toxicity

A

Immediately causes respiratory alkalosis (due to direct stimulation of respiratory centers).

Then causes metabolic acidosis (due to build up of salicylate)

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26
Q

Ethambutol

A

Causes retinopathy, inhibits arabinosyl transferase, decreasing carbohydrate synthesis in bacteria

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27
Q

Conduction speed in heart?

A

Purkinje fibers>atrium>ventricles>av node

Park at ventura avenue

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28
Q

Cysteinuria is due to… and causes…

A

Defect in COLA transporter… causes Kidney stones!

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29
Q

Cyp inducers

A

Modafinil

Carbamazipine
Rifampin
A
Phenytoin

Griseofulvin
Phenobarbital
St. John’s Wort

Nevirapine/chronic alcohol

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30
Q

Cyp450 inhibitors

A 
Acute alcohol
Gemfibrozil
ciprofloxacin
isoniazid
grapefruit juice
quinidine
Amiodarone
ketoconzole
macrolides
sulfonamides
cimetidine
ritonavir
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31
Q

CYP450

A 
Anti depressants
anti epileptics
antipsychotics
theophylline
warfarin
statins
OCPs
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32
Q

Hemolytic disease of newborn

A

Destruction of fetal RBC by maternal IgG. Happens when baby is Rh+ and mom is Rh-. Doesn’t happen with ABO because Igs are usually IgM, plus A and B aren’t expressed heavily.

Sxs: jaundice anemia, edema. nucleated reds, HSM

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33
Q

C peptide?

A

Released with insulin into circulation after cleavage.

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34
Q

Embryonic kidney development

A

Pronephros- regresses
mesonephros- becomes wolffian structures
metanephros – ureteric bud becomes collecting system (including collecting duct), metanephric mesoderm is the tubules and glomerulus

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35
Q

How to treat toxoplasmosis

A

Pyrimethamine and sulfadiazine (with folic acid)

Substitute clindamycin if sulfadiazine sensitive.

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36
Q

Why do barbiturates wear off so fast

A

Tissue redistribution into cells and out of blood.

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37
Q

What is a major side effect of inhaled anesthetics?

A

Massive hepatic necrosis, especially with halothane.

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38
Q

Daptomycin

A

used to treat mrsa, depolarizes cell membranes. Causes myopathy and increased CPK. Inactivated by surfactant.

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39
Q

How does linezolid work? Side effects

A

binds to 50S, causes thrombocytopenia, optic neuritis. high risk for serotonin syndrome.

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40
Q

Rubber factory workers?

A

Transitional cell carcinoma

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41
Q

What causes green color of sputum during pneumonia?

A

Myeloperoxidase

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42
Q

Number needed to harm

A

1/Attributable risk

AR is calculated taking the #complications/total in experimental group - # complications/total in placebo

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43
Q

Short acting benzodiazepine?

A

Triazolam (Just give it a try)

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44
Q

Long acting benzodiazepine

A

Diazepam, flurazepam, chlordiazepoxide

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45
Q

Peripheral chemoreceptors

A

In carotid/aortic bodies, sense hypoxemia.

Central receptors respond to increased CO2

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46
Q

True vocal chords epithelium

A

Stratified squamous

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47
Q

Mechanism of resistance to aminoglycosides in enterococci

A

Add modifying groups like acetyls, adenyls, or phosphates

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48
Q

Drug property that predisposes to predominantly hepatic metabolism?

A

High lipophilicity and large VD

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49
Q

Retinal neovasularization in neonates due to?

A

O2 supplementation after respiratory distress in premature babies. This is called retinopathy of prematurity

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50
Q

Anaplasia

A

Primitive cell formation. Often with giant cells

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51
Q

When to use colchicine for acute gout

A

When in renal failure or with peptic ulcer disease (or other contraindications to NSAID use)

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52
Q

BBB protected by?

A

Tight junctions and astrocyte foot processes

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53
Q

Diseases of hemidesmosomes

A

Bullous pemphigoid, junctional epidermolysis bullosa

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54
Q

Breathing pattern of restrictive diseases

A

Fast and shallow

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55
Q

Breathing pattern of obstructive diseases

A

Slow and deep

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56
Q

INH needs what to work?

A

Needs to be activated by bacterial catalase peroxidase in order to work.

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57
Q

Side effect of niacin

A

Hyperuricemia, hyperglycemia, flushed face that decreases with aspirin

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58
Q

Conversion disorder

A

Stress related somatiform disorder where neurologic symptoms. Don’t seem concerned

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59
Q

Akathesia

A

Subjective sensation of restlessnes from D1 blockers

60
Q

Human placental lactogen

A

Involved in maternal insulin resistance to provide baby with glucose needed for survival. Increases maternal glucose levels, also increases lipolysis and proteolysis to provide nutrients to mother. Produced by syncitiotrophoblasts.

61
Q

Where are type I muscle fibers located?

A

Slow twitch fibers with lots of myoglobin, located in paraspinal and soleus. Mostly use ATP

62
Q

Which nerve is injured during thyroidectomy?

A

Superior laryngeal which innervates the cricothyroid (vagus)

63
Q

EBV in HIV patients

A

Causes burkiits lymphoma and cns lymphoma

64
Q

Key lesion in minimal change disease

A

podocyte effacement

65
Q

Hydrocele due to

A

Patent processus vaginalis

66
Q

How to treat TCA cardiac abnormalities?

A

Give sodium bicarbonate.

67
Q

What are the TCA cardiac abnormalities

A

Longer QT and QRS widening.

68
Q

If wrong AA is placed on tRNA what ahppens?

A

Wrong AA is incorporated into protein

69
Q

Hypokalemia symptoms

A

Muscle weakness and parasthesias

70
Q

Trendelenberg gait

A

Superior gluteal nerve injured (located superiomedially) causes opposite hip to drop when leg is in the air. Due to problems with gluteus medius

71
Q

Length constant

A

How far along an axon an electrical signal can propagate. Decreases with demyelination. Time constant increases with demyelination

72
Q

Prophylaxis when CD

A

Azithromycin for MAC

73
Q

Red neurons

A

Appear 12-48 hours after injury in brain. Really are red.

74
Q

Pathogenesis of ARDS

A

Endothelial damage causes formation of hyaline membranes

75
Q

Vaginal infection after birth caused by

A

Bacterioides. Endometritis has foul smell

76
Q

MSUD caused by

A

Defect in branched chain alpha ketoacid dehydrogenase, which requires B1 to function.

77
Q

What do sertoli cells make?

A

Androgen binding protein. Binds testosterone, makes it less lipophilic so it can remain in seminiferous tubules and epididymis

78
Q

How to treat hyperhydrosis

A

Botox at thoracic ganglion to block the release of ACh from sympathetic cholinergic postganglionic fibers

79
Q

PE breathing defect?

A

Metabolic alkalosis due to increased PaCO2 which the respiratory centers try to blow off ASAP.

80
Q

Vancomycin side effects

A

Nephrotoxicity, ototoxicity, and thrombophlebitis.

Also red man syndrome – rash and pruritus especially when dehydrated and with fast infusion rate. Treat with antihistamines

81
Q

What does elevated baseline insulin mean?

A

Some degree of peripheral insulin resistance

82
Q

Which nerve fibers are unmyelinated?

A

C fibers– pain and temp

And autonomic postgangionic fibers

83
Q

Thromboangiitis obliterans

A

AKA buerger’s disease. Seen in male smokers. Has segmental thrombosing vasculitis that involves arteries, veins, and nerves. Causes fibrous tissue to encase the structures

84
Q

Myxomatous degeneration

A

The hallmark of cystic medial necrosis

85
Q

Kussmaul sign

A

Increase in JVP on inspiration due to constrictive pericarditis

86
Q

What is a sign of very advanced mitral regurgitation?

A

The presence of an S3

87
Q

Why does lipofuscin accumulate in heart?

A

Due to lipid peroxidation and free radical injury over time.

88
Q

What structure makes of the majority of the anterior heart surface?

A

Right ventricle

89
Q

Dipyridamile and cilostazol

A

Platelet phosphodiesterase inhibitor that causes an increase in cAMP (decreased aggregation), and vasodilation

90
Q

Pulsus paradoxus

A

A paradoxical decrease in peripheral pulse on inspiration. Caused by constrictive pericarditis, cardiac tamponade, asthma, COPD, PE.

91
Q

What happens to FRC when lungs increase in elasticity?

A

FRC decreases. This occurs in pulmonary fibrosis

92
Q

What happens to FRC when chest wall increases pull or elasticity of lungs decreases?

A

FRC increases (emphysema)

93
Q

Secondary amyloidosis

A

Due to AA accumulation (SAA is an acute phase reactant). Occurs in bronchiectasis, rheumatoid arthritis, IBD. Basically anything with chronic inflammation

94
Q

Caplan Syndrome

A

Coal worker’s pneumoconiosis plus rheumatoid arthritis

95
Q

Berylliosis causes…

A

Noncaseating granulomas. Can definitely be confused with sarcoid so careful! These granulomas also produce 1alpha hydroxylase which can cause hypercalcemia.

Increased risk for lung cancer.

96
Q

Body parts affected by sarcoidosis

A

Lungs, uvea, skin (erythema nodosum), lacrimal/salivary glands (can mimic sjogren’s syndrome).

97
Q

Where does lung cancer met to most often?

A

Adrenals.

98
Q

Can recurrent PE cause pulmonary hypertension?

A

Yes

99
Q

What is the genetic defect that causes PHTN

A

BMPR2 INACTIVATION causes proliferation of vascular smooth muscle

100
Q

What are the causes of NRDS (hyaline membrane disease)

A

Maternal diabetes (fetal insulin causes decreased surfactant synthesis)
Prematurity
c-section

101
Q

What are the main causes of lung cancer

A

Asbestos, smoking (polycyclic hydrocarbons), radon ->uranium

102
Q

Causes of benign coin lesions?

A

Histoplasma (causes granulomas), benign bronchial hamartomas (which include cartilage!)

103
Q

Lung hamartoma components

A

Lung tissue and CARTILAGE

104
Q

Symptoms of legionaires disease

A

Hyponatremia, confusion, diarrhea, lung infiltrates, bradycardia.

105
Q

Effect of hyperventilation on cerebral blood flow

A

less cerebral blood flow with less CO2

106
Q

Does reid index include cartilage?

A

No

107
Q

TB virulence factors

A

Cord factor inactivates neutrophils, serves as main virulence factor. Releases TNF alpha, destroys mitochrondria.

Sulfatides - inhibit phagolysosome fusion.

108
Q

ARDS Histology

A

Hyaline membranes due to capillary destruction

109
Q

Theophylline overdose

A

Causes seizures, abdominal pain

110
Q

Rifampin

A

Blocks DNA dependent RNA polymerase

111
Q

How does N-acetylcysteine break up mucus

A

Breaks disulfide bonds

112
Q

Nystatin and amphotericin

A

Binds to cell membrane (ergosterol) and poke holes

113
Q

Caspofungin

A

Inhibits glucan synthesis for fungal cell wall

114
Q

Where to perform thoracocentesis

A

Midclavicular, above 7
Midaxillary, above 9
Posterior scapular- above 11

115
Q

Bronchioalveolar carcinoma

A

Caused by clara cells. Carcinoma in situ. Mucus producing. Doesn’t invade.

116
Q

What is the CFTR

A

An ATP pump that creates hypotonic sweat

117
Q

How does sed rate increase

A

Fibrinogen is an acute phase reactant (il6 mediated). Binds RBCs and causes rouleaux formation

118
Q

Sxs of fat embolism

A

Shortness of breath, petechial rash , confusion.

SOB is dues to local toxic ards.

119
Q

Symptoms of glucagonoma

A

New onset DM, but more likely tested is necrolytic migratory erythema, which are erythematous papules on face, perineum, extremities. Bronze colored central indurated area with peripheral blistering.

120
Q

Why give beta blockers for hyperthyroidism

A

Decrease Beta activation (increased HR), but also block peripheral conversion of t4 to t3

121
Q

Myoedema

A

Swelling after hitting skin due to hypothyroidism. Ca is not taken up quickly into SR causing edema.

122
Q

Where is erythropoetin produced?

A

In the renal peritubule interstitial cells

123
Q

How does RCC spread?

A

Via the renal vein, but also spreads lymphatically to the retroperitoneal LN

124
Q

Where does bladder adenocarcinoma come from? Where is it located?

A

From remnant of urachus. Located at the dome of the bladder.

125
Q

Acyclovir side effect

A

Obstructive crystalline nephropathy if not adequately hydrated.

126
Q

Upper portion of ureter supplied by what artery?

A

Renal artery

127
Q

Il-2

A

Activates natural killer cells in addition to t cells

128
Q

Digoxin clearance?

A

Renal!

129
Q

Why doesn’t creatinine increase with decreased GFR with aging?

A

Because older people have less muscle.

130
Q

How to treat crigler najjar type II

A

Phenobarbital which increases liver enzyme synthesis

131
Q

How to treat hepatic encephalopathy

A

Rifaximin (which kills gut bacteria), lactulose

132
Q

What are mallory bodies

A

Degenerated intermediate filaments in hepatocytes in response to alcoholic hepatitis.

133
Q

How to treat wilson’s disease

A

penacillamine or trientine.

134
Q

How is copper normally excreted?

A

Into bile by atp pump encoded by ATP7b

135
Q

Histology of PBC

A

Lymphocytic invasion and granuloma formation around intralobular bile ducts

136
Q

Histology of PSC

A

Onion skinning and beads on a string of intra and extrahepatic bile ducts.

137
Q

IL1 effect on bone

A

Increased in osteoporosis, activates osteoclasts.

Also implicated in multiple myeloma

138
Q

How to treat recurrent CDiff Colitis?

A

Fidaxomicin. Which blocks RNA polymerase, stops protein synthesis and causes cell death. Has minimal systemic absorption and also doen’t affect colon flora as much as vanc or metro.

139
Q

Spread of haemophilus meningitis vs neisseria?

A

Haemophilus uses lymphatics, neisseria uses the blood and choroid plexus.

140
Q

Foscarnet side effects

A

Renal toxicity and magnesium wasting, but also chelates calcium and can cause seizures. Use for CMV retinitis in AIDS patients

141
Q

Vitiligo

A

Autoimmune destruction of melanocytes

142
Q

Interferon alpha and beta

A

Decrease protein synthesis in neighboring cells in the event of viral infection.

143
Q

Marginal zone lymphoma caused by?

A

Sjogrens (parotid), Hashimotos, H.Pylori

144
Q

Mixed connective tissue disease antibody

A

U1 Ribonucleoprotein

145
Q

Job Syndrome

A

Autosomal dominant hyper IgE syndrome caused by a STAT 3 mutation in TH17 cells. Causes FATED. Abnormal facies, noninflammed staph abscesses, retained primary teeth, and eczema.

146
Q

How to treat TCA cardiac abnormalities (long QT, tachycardia)?

A

Sodium bicarb

UWorld Question Review (10 decks)

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