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UWorld > 2015.04.15 > Flashcards

2015.04.15 Flashcards

1
Q

Virion/Virion protein binding specificities

A

CD4 (and coreceptor CCR5 or CXCR4) and HIV gp120

CD21 and EBV gp350

Erythrocyte P antigen and Parvovirus B19

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2
Q

Congenital Torticollis

A

Develops 2-4 weeks of age. Head is tilted to affected side.

Caused by birth trauma or malposition of the head in utero which results in sternocleidomastoid muscle injury and fibrosis.

May have hip dysplasia, metatarsus adductus (adduction of forefoot) and talipes equinovarus (clubfoot).

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3
Q

Defective fetal collagen synthesis

A

causes osteogenesis imperfecta (brittle bone disease)

Patients with lethal variety die in utero or in infancy due to severe fractures, pulmonary failure, or intracerebral hemorrhage

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4
Q

Fetal Alcohol Syndrome

A

poor growth, functional developmental deficits, characteristic facial abnormalities: smooth philtrum, thin vermillion border, and small palpebral fissures.

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5
Q

Inferior MIs is due to which artery?

A

Blockage of the right coronary artery (usually responsible for SA and AV nodes) leading to bradycardia.

Atropine (antimuscarine) is given to block vagal influence on SA and AV node and increases heart rate.

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6
Q

Mental retardation, dysmorphic facial features (large jaw, protruding ears), macroorchidism

A

Fragile X Syndrome

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7
Q

Short stature, broad (shield) chest, webbed neck, low hair line

streaked ovaries leading to primary amenorrhea

A

Turner’s syndrome (45 XO)

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8
Q

Tall stature, gynecomastia, small, firm testes

Decreased testosterone secretion by fibrotic testes causes oligospermia and infertility

A

Klinefelter Syndrome (47 XXY)

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9
Q

Arachnodactlylyl, scoliosis, aortic root dilation, lens dislocation (ectopia lentis), mitral valve prolapse

A

Marfan Syndrome

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10
Q

Cleft palate associated with which disorder?

A

Trisomy 13 (Patau syndrome)

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11
Q

Polydactylyl is associated with?

A

Trisomy 13 (Patau syndrome)

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12
Q

Rocker-botton feet is associated with?

A

Trisomy 13 + 18

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13
Q

Minimal Change Disease

A

Selective proteinuria: LMW proteins such as albumin and transferrin are excreted because loss of negatively charged molecules on glomerular basement membrane (no charge to repel albumin) allows small proteins through filtration barrier.

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14
Q

Tubular proteinuria

A

Proximal tubular function is disrupted (like in tubulointerstitial nephritis)

Proteins that are normally filtered by glomerulus and completely reabsorbed by proximal tubule are lost - LMW proteins, b2-microglobulin, Ig light chains, aa, retinol-binding protein.

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15
Q

Dorsal pancreatic bud

A

forms the pancreatic tail, body, most of the head, and the small accessory pancreatic duct.

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16
Q

Ventral pancreatic bud

A

Uncinate process, inferior/posterior portion of the head, and major pancreatic duct (of Wirsung).

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17
Q

Pancreatic divisum

A

failure of dorsal and ventral pancreatic buds to fuse.

Pancreatic ductal systems remain separate, with accessory duct (of Santorini) draining the majority of the pancreas.

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18
Q

Obesity, hirsutism, oligomenorrhea

A

Polycystic ovarian syndrome (PCOS)

Due to abnormality of the hypothalamic-pituitary-ovarian system.

Androgen (testosterone and androstenedione) and LH levels are elevated, whereas FSH levels are normal.

High levels of unopposed estorgen on endometrium increases risk of endometrial hyperplasia and endometrial adenocarcinoma.

Increased insulin resistance puts at risk for DM2

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19
Q

Vaginal adenosis

A

replacement of vaginal squamous epithelium with glandular columnar epithelium.

due to exposure of diethylstilbestrol (DES) when pregnant

precursor for clear cell adenocarcinoma of the vagina

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20
Q

Central chemoreceptors

A

located in medulla

stimulated by decreases in pH of CSF

Increased PaCO2 is the major stimulator, leading to increase in respiration.

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21
Q

Peripheral chemoreceptors

A

found on carotid and aortic bodies

primary sites for sensing arterial PaO2 and are stimulated by hypoxemia

can also be stimulated by PaCO2 levels and blood H+ concentration, but central chemoreceptors are more responsive to hypercapnia

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22
Q

Small nuclear ribonucleoprotein particles (snRNPs)

A

important components of the spliceosome, a molecule which functions to remove introns from pre-mRNA during processing within the nucleus

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23
Q

Nucleosomes

A

Histone protein cores around which dsDNA is wrapped.

Nucleosomes are important for compact packaging of dsDNA into chromosomes.

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24
Q

Low-grade fever, headache, malaise, and upper respiratory syndromes followed up sudden appearance of erythematous malar rash with circumoral pallor 2-5 days later

A

Erythema Infectiosum (“fifth disease”) due to Parvovirus B19.

Virus is highly tropic for erythroid precursor cells and replicates predominantly in the bone marrow.

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25
MacConkey agar
gram - organisms that ferment lactose, cause drop in pH, resulting in colonies with a pink-red appearance E. coli, Klebsiella, Enterobacter
26
Major virulence factor among E. coli strains that cause neonatal meningitis
K1 capsular antigen (immunogenic) anti-capsular antibodies are protective
27
Anesthesia near the tip of ischial spine
Pudendal nerve block (S2-S4 nerve roots) which provides sensory innervation to the perineum and genitals as well as motor innervation to sphincter urethrae and external anal sphincter
28
Warfarin elimination
Cytochrome P450 Inhibit P450 2C9: increase warfarin's anticoagulant activity - Cimetidine, amiodarone, and TMP-SMX Increase P450 activity: decrease warfarin's anticoagulant activity - Rifampicin, phenobarbital, phenytoin
29
Rituximab
Monoclonal antibody directed against CD20 antigen. Used in lymphoma immunotherapy
30
Infliximab
Chimeric (human/murine) IgG1 monoclonal antibody to TNF-alpha. Rheumatoid arthritis, ankylosing spondylitis, fistulizing Crohn's disease
31
Imatinib mesylate
Potent inhibitor of the BCR/ABL protein tyrosine kinase inhibits cellular proliferation of BCR/ABL-expressing cells. Treatment of CML
32
Abciximab
Chimeric mouse-human monoclonal antibody against the platelet GP IIb/IIIa receptor blocks final step in platelet aggregation administered during angioplasty in patients with acute coronary syndrome
33
Trazodone
Sedating effects and can be used with Fluoxetine to treat patients with depression and accompanying insomnia. No anticholinergic or cardiac effects cause priapism
34
Positive Tinel and/or Phalen test
Tinel sign - tapping over flexor surface of the wrist reproduces symptoms Phalen sign - flexion of wrist reproduces symptons Carpal Tunnel Syndrome.
35
Lipopolysaccharide (LPS)
O antigen Core Polysaccharide Lipid A - responsible for toxic properties of LPS and lead to gram- sepsis and endotoxic septic shock (activates macrophages and granulocytes - IL-1, PG, TNF-a, interferon)
36
Fimbriae, pili, are a virulence factor in which organisms?
Neisseria meningitidis Urothpathogenic and diarrheogenic E. coli Bordetella pertussis Vibrio cholerae
37
Flagellar (H) antigen
heat-labile protein which is one component of the serologic classifciation of enterobacteriaceae
38
Superior mesentery artery syndrome
transverse portion of duoden is entrapped between the SMA and aorta (decreased aortomesenteric angle secondary to dimished mesenteric fat, pronounced lordosis, or surgical correction of scoliosis), causing symptoms of partial intestinal obstruction.
39
Chemoreceptor trigger zone (CTZ) location
dorsal surface of medulla at the caudal end of the fourth ventricle in a region known as the area postrema (receives blood from fenestrated vessels - absent blood-brain barrier - which allows it to sample chemicals circulating in the blood)
40
Treating hypertension or CHF in a woman who is at risk for osteoporosis
Hydrochlorothiazide (increases absorption of calcium from the DCT, also helps lower renal stones) Furosemide (loop diuretic) will increase urinary calcium loss, making it a poor choice.
41
Phase 4 of Cardiac pacemaker cells
slow, inward sodium current during this diastolic depolarization phase augmented by transient inward calcium currents Verapamil is calcium channel blocker and class IV antiarrhythmic drug - slows depolarization in phase 0 and latter phase 4 (decreases SA node firing and slows AV node conduction)
42
Medications with negative chronotropic effects (decreased heart rate)
Beta-blockers Non-dihydropyridine calcium channel blockers (verapamil, dilitiazem) Cardiac glycosides (digoxin) Amiodarone and sotalol Cholinergic agonists (pilocarpine, rivastigamine)
43
Combined use of non-dihydropyridine calcium channel blockers (verapamil, diltiazem) and beta-blockers
negative chronotropic effects yielding severe bradycardia and hypotension
44
Vasodilation and reflex tachycardia
ACE inhibitors Nitrates Peripheral a1-selective adrenergic blockers (prazosin)
45
Nifedipine
Dihydropyridine calcium channel blocker with minimal effects on SA node and cardiac conduction. Predominantly used as vasodilator and can cause a reflex increase in heart rate
46
Proton pump inhibitors and osteoporosis
long-term acid suppression with proton pump inhibitors decrease calcium absorption (calcium needs acidic environment for proper absorption) and thus leads to increased risk of osteoporotic hip fractures.
47
VIPomas
non-beta cell pancreatic islet cell tumors that hypersecrete vasoactive intestinal polypeptide (VIP) causes excess loss of water, sodium, and potassium in stool and inhibits gastric acid secretion Watery diarrhea, hypokalemia, achlorhydria (WDHA)
48
Inactivated viral components vaccine
Influenza vaccines are inactivated when adminstered by injection. Generate a humoral immune response (instead of cell-mediated which is generated by live-attenuated viral vaccines) Neutralizing antibodies are induced against the hemagglutinin antigen (antibodies will inhibit binding of hemagglutinin to sialyated receptors on the host cell membrane, preventing live virus from entering cells via endocytosis)
49
Oseltamivir
sialic acid that competitively inhibits influenza neuramidase (cleaves terminal sialiac acid residues on glyconjugate receptors, allowing for release of attached influenza virions from infected cells), preventing release of viral progeny
50
Aldolase B
participates in fructose metabolism, deficiency in this enzyme results in fructose intolerance hypoglycemia following fructose ingestion due to phosphate trapping in fructose-6-phosphate fructose and sucrose should be removed from diet
51
Watershed infarction
systemic hypotension (due to abdominal aortic aneurysm for example) can cause ischemia and necrosis of intestinal wall in areas with slow perfusion. Splenic flexure and distal sigmoid colon most susceptible Splenic flexure: "border" area between the distribution of SMA and IMA arteries. Distal sigmoid colon: between areas supplied by IMA and hypogastric arteries
52
Lac operon regulation
1. Negatively by binding of the repressor protein (made from lac I) to the operator locus 2. Positively by cAMP-CAP (catabolite activator protein) binding upstream from the promotor region (cAMP levels need to be high, glucose decreases activity of adenylyl cyclase, reducing intracellular cAMP; thus lac operon is repressed in high-glucose conditions) Lac operon encodes for lac Z (b-galactosidase) and lac Y (permease - allows lactose to enter bacterium)
53
Hemosiderin
aggregation of ferritin micelles (iron binds to apoferritin when iron is deposited in cells)
54
Paraneoplastic cerebellar degeneration
progressively worsening dizziness, limb and truncal ataxia, dysarthria, and visual disturbances due to immune response against tumor cells that cross-react with Purkinje neuron antigens, leading to acute-onset rapid degeneration of the cerebellum Anti-Yo, anti-P/Q and anti-Hu are most common.
55
Subacute thyroiditis (de Quervain's thyroiditis or granulomatous tyroiditis)
thyrotoxicosis (due to release of stored thyroid secondary to thryoid inflammation, tenderness over the thyroid gland, increased ESR, and markedly reduced radioactive iodine uptake (no excess production of thyroid hormone, which is why iodine uptake is decreased). Mixed, cellular inflammation with occasional multinucleate giant cells surround the fragmented colloid thryotoxic phase is followed by hypothyroid phase for a few months
56
Hashimoto's thyroiditis
diffuse mononuclear infiltration with formation of germinal centers (infiltrate contains lymphocytes and plasma cells) thyroid enlargement (goiter) and/or hypothyroidism differenatiate from other thyroid dysfunction: normal ESSR, nontender thyroid gland with rubbery texture, high titers of antithyroid peroxidase antibody, hypothyrodism
57
Riedel thyroiditis
extensive fibrosis involving the thyroid gland. fibrosis can extend into surrounding structure.
58
True hydrocephalus
increase in CSF volume and pressure that occurs due to abnormal production, flow, or absorption of CSF the pressure then causes ventricular enlargement
59
Hydrocephalus ex vacuo
ventricular enlargement due to brain atrophy and is not accompanied by increase in CSF pressure occurs in Alzheimer, Pick disease, advanced HIV infection etc secondary to atrophy of the brain
60
Communicating hydrocephalus
CSF flows freely between the ventricules and subarachnoid space caused by decreased CSF reabsorption secondary to subarachnoid villi inflammation (as in subarachnoid/intraventricular hemorrage or meningitis) or certain congenital malformations entire ventricular system is dilated
61
Pseudotumor cerebri (idiopathic intracranial hypertension)
elevated intercranial pressure with normal CSF content and normal neuro-imaging in young, obese women and manifests as headache and papilledema optic nerve atrophy and blindness are possible sequealae
62
Lissencephaly
agyria congenital absence of gyri severe mental retardation brain surface has smooth appearance
63
Transtentorial (Uncal) herniation
due to intracranial mass or cerebral edema herniation of parahippocampal uncus through the tentorial incisure leads to compression of ipsilateral CN III and posterior cerebral artery fixed, dilated pupil on same side as lesion is the first sign of uncal herniation

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