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UWorld > 2015.04.16 > Flashcards

2015.04.16 Flashcards

1
Q

Kinesin

A

microtubular transport for anterograde transport (moving vesicles and organelles toward the +, rapidly growing end)

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2
Q

Dynein

A

retrograde transport

functions in ciliary and flagellar movement

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3
Q

Starvation

A

Induces the breakdown of triglycerides stored within adipocytes, releasing free fatty acids that can be metabolized to ketone bodies via B-oxidation within mitochondria in the liver (generates energy).

Acetyl-CoA, the end product of each round of B-oxidation, is further oxidized to CO2 in TCA cycle, generating more energy.

During rapid B-oxidation, TCA cycle is overwhelmed, shunting acetyl-CoA to production of ketones.

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4
Q

First step of B-oxidation pathway

A

Acyl-CoA dehydrogenase

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5
Q

Primidone

A

first line medication for benign essential tremor

narrow-spectrum anticonvulsant to treat partial seizures

Metabolizes into phenobarbital and phenylethylmalonamide, which have anticonvulsant effects

Sedation is potential side effect.

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6
Q

Most common side effect of inhaled glucocorticoids

A

oropharyngeal candidiasis

using a spacer and rinsing mouth helps prevent this complication

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7
Q

Polycistronic mRNA

A

mainly found in prokaryotes

code multiple genes on one strand of mRNA

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8
Q

Mechanism of action of Benzodiazepines

A

Bind and modulate the GABAa receptor-chloride channel in CNS neurons, increasing its frequency of opening

increase in chloride permeability hyperpolarizes and stabilizes the membrane

its a sedative hypnotic drugs with anxiolytic, muscle relaxant and anticonvulsant actions

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9
Q

Inhibition of norepinephrine and serotonin reuptake

A

Tricyclic antidepressants

prescribed for insomnia and depression

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10
Q

Mechanism of action of Barbiturates

A

Increase the duration of opening of the GABAa receptor-chloride channel in CNS neurons

same neurophysiological effects as benzodiazepines, but thend to have longer half lives and residual sedation or hangover effects

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11
Q

Duodenal bulb

A

region that begins at the pylorus and ends at the neck of the gallbladder

anterior wall ulcers likely to perforate

poster wall ulcers likely to cause hemorrhage of gastroduodenal artery

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12
Q

Treatment of BPH

A

a-adrenergic blockers, which relax the smooth muscle in the bladder neck

5-a reductase inhibitors which reduce hormal influence on the prostate (prevent T to DHT)

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13
Q

Progressive dyspnea, fine crackles, clubbing, diffuse reticular opacities

A

Interstitial lung disease which can cause pulmonary fibrosis with thickening and stiffening of pulmonary interstitium

Leads to increased lung elastic recoil (tissue more stiff), which leads to airway widening due to increased outward pulling (radial traction) by the surrounding fibrotic tissue

FEV1/FVC ratio is typically increased because FVC decreases more than FEV1

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14
Q

When does O2 equilibration become diffusion limited?

A

Emphysema and pulmonary fibrosis and phsyiologically in states of very high pulmonary blood flow, such as exercise.

Alveolar gas does not equilibrate with the blood gass by the time that a given volume of blood reaches the end of the alveolar capillary.

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15
Q

POMC (proopiomelanocortin)

A

Beta-endorphins, ACTH, and MSH

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16
Q

Ischemia and cardiocyte contractility

A

Within 60 seconds: loss of cardiomyocyte contractility (ATP rapidly depleted)

Less than 30 mins: restoration of blood flow leads to reversible contractile dysfunction (myocardial stunning) with contractility gradually returning to normal over the next several hours to days.

After 30 mins: Total ischemia, ischemic injury becomes irreversible

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17
Q

Wide, fixed splitting of the second heart sound

A

ASD which can cause chronic pulmonary hypertension as a result of L-R shunt.

Eisenmenger syndrome is the late-onset reversal of the L-R shunt due to pulmonary vascular sclerosis that is irreversible.

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18
Q

How to differentiate between complete central, complete partial and nephrogenic diabetes insipidus?

A

Injection of vasopressin and measuring urine osmolality

Less than 10% response: nephrogenic

10%+ increase: partial central DI

50% increase: complete central DI

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19
Q

Where are H1 receptors found?

A

Vascular endothelium and bronchial smooth muscle where they help to mediate vascular permeability and bronchoconstriction.

H1 antagonists used to treat allergic rhinitis

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20
Q

Drugs with antimuscarinic effects

A

Atropine

Tricyclic antidepressants

H1 receptor antagonists

Neuroleptics

Antiparkinsonian drugs

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21
Q

H2 receptor antagonists

A

block gastric acid secretion by parietal cells

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22
Q

Doxazosin

Prazosin

Terazosin

A

alpha-1 blockers useful for treatment of BPH and hypertension.

Relaxation of smooth muscle in arterial and venous walls leading to decrease in PVR.

Relaxation of smooth muscle in the bladder neck and prostate

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23
Q

Coronary artery disease and heart failure along with hypertension

A

cardioselective beta-blockers

24
Q

Essential hypertension first-line medication

A

Hydroclorothiazide

25
Q

Amlodipine vs. Verapamil

A

Dihydropyridine calcium channel blocker that is selective for the vascular SM and does not affect the heart as verapamil does

second-line antihypertensive

useful for patients with vasospasm such as Raynaud phenomenon, Prinzmetal angina

26
Q

Reye syndrome

A

Hepatic failure (microvesicular steatosis of hepatocytes without inflammation and cerebral edema) and acute encephalopathy associated with use of aspirin in patients 5-14 year old

27
Q

Apoptosis of hepatocytes, acinar necrosis, and periportal mononuclear inflammatory infiltration

A

viral hepatitis

28
Q

Bile duct destruction, periductal granulomatous inflammation and bile duct proliferation

A

Primary biliary cirrhosis

29
Q

Trimethoprim-Sulfamethoxazole

A

Pneumocystis jiroveci, Toxoplasma gondii, Nocardia, and Stenotrophomonas maltophilia

30
Q

Treatment of Pseudomonas aeurginosa

A

Penicillins (Ticarcillin, Piperacillin)

Cephalosporins (Ceftazadime - 3rd gen, Cefepime - 4th gen)

Aminoglycosides (Amikacin, Gentamicin, Tobramycin)

Fluoroquinolones (Ciprofloxacin, Levofloxacin)

Monobactams (Aztreonam)

Carbapenems (Imipenem, Meropenem)

31
Q

Ceftriaxone

A

3rd gen cephalosporin used for CA-pneumonia and bacterial meningitis

Gram+ : S. pneumoniae, S. pyogenes

G- : H. influenzze, K pneumoniae, E. coli

(unlike cetazidime - also 3rd gen - no activity against P. aeurginosa)

32
Q

Adult vs. congeital rubella

A

Adult: polyarthritis and polyarthralgia

Fetal: sensorineural deafness, cataracts, cardiac malformations (PDA)

33
Q

Clostridium perfringens

A

spores germinate in anaerboic environment into vegetative toxin-producing cells.

phospholipase attacks cell membranes and cause cell death

causes late-onset food poisoning characterized by transient watery diarrhea

myonecrosis (gas gangrene) due to metabolizing carbohydrates

34
Q

Individual subunits of hemoglobin molecule are structurally analogous to?

A

Myoglobin

35
Q

Conversion disorder

A

unconscious manifestation of neurologic symptoms (Not just pain or sexual dysfunction) when pathophysiological explanations for the symptoms cannot be found.

most common in woman and after a significant life stress

36
Q

Factitious disorder

A

purposeful faking of symptoms in order to receive medical attention

feigned symptoms may be physical, psychological, or both

“Munchausen’s syndrome”: chronic factitious disorder with physical symptoms

37
Q

Malingering

A

purposeful faking of symptoms for secondary gain, typically financial

38
Q

Hypochondriasis

A

Somatoform disorder that refers to fear of having, or belief that one has, a serious physical disease

misinerterpretation of bodily symptoms or normal functions

common in those with anxiety

39
Q

Somatization disorder

A

patients with numerous physical complaints over the course of years for which no physical explanation can be found.

symptoms must start before 30 y.o. and must have significantly impacted their social or occupational functioning

4 pain, 2 GI, 1 sexual, 1 pseudoneurological symptom

40
Q

Organophosphate poisoning treatment

A

Muscarinic antagonists like atropine in addition to Pralidoxime, a cholinesterase enzyme reactivator.

41
Q

Thiamine Deficiency is associated with?

A

Infantile and adult beriberi

Wernicke-Korsakoff syndrome in alcoholics

42
Q

Infantile vs. Adult Beriberi

A

Infantile: occurs at 2-3mo. fulminant cardiac syndrome with cardiomegaly, tachycardia, cyanosis, dyspnea, vomiting

Adult: Dry - symmetrical peripheral neuropathy accompanied by sensory and motor impairments, esp. distal extremities

Adult: Wet - neuropathy as well as cardiac involvement (cardiomegaly, cardiomyopathy, CHF, peripheral edema, tachycardia)

43
Q

Eosinophils and antibody-dependent cell-mediated cytotoxicity

A

In reaction to parasites, IgG and IgE antibodies that bind the Fc receptors located on the eosinophil cell surface causes eosinophil degranulation and release of cytotoxic proteins (major basic protein) and ROS intermediates to kill the parasites.

ADCC also in macrophages, neutrophils, and NK cells

44
Q

Ankylosing spondylitis

A

Musculoskeletal: Enthesopathies (inflammation at sites of tendon insertion)

Respiratory: enthesopathies of costovertebral and costosternal junctions which can limit chest wall expansion, leading to hypoventilation

CV: ascending aortitis leading to dilation of the aortic ring and aortic insufficiency

Eye: anterior uveitis - pain, blurred vision, photophobia, conjunctival erythema

45
Q

Cleft lip

A

failure of maxillary prominences to properly fuse with the intermaxillary segment (formed when two medial nasal prominences fuse in midline)

46
Q

Midline intermaxillary segment

A

philtrum of upper lip

four medial maxillary teeth

primary palate

47
Q

Cleft palate

A

palatine shelves of the maxillary prominence fail to properly fuse with one another or with the primary palate

48
Q

Blast cells in the peripheral blood

A

suggestive of leukemia

49
Q

Acute lymphoblastic leukemia (ALL)

A

Most common pediatric malignancy. Fever, fatigue, pallor, petechiae, bleeding. Lymphadenopathy, hepatosplenomegaly, bone pain.

T-cell ALL (CD 2,3,4,5,7,8) presents with large anterior mediastinal mass that can compress the great vessels, esophagus, trachea.

Can also be from B-lymphocytes (CD10, 19, 20).

Both lineages contain TdT.

50
Q

CEA

A

present in colon cancer, pancreatic, gastric and breast malignancies, IBD, cirrhosis and pancreatitis, and smokers

CEA level is sensitive indicator of colorectal cancer recurrence

51
Q

Actinic keratoses (AKs)

A

erythematous papules with overlying whitish scale.

rough sandpaper-like texture

small and flat initially, but may enlarge and become elevated. Hyperkeratosis in such lesions may become prominent and form cutaneous horns

excessive sun exposure in 40-60 yos

Premalignant condition to squamous cell carcinoma

52
Q

Psoriasis

A

well circumscribed raised papules and plaques covered with a thick silvery scale

lesions located on scalp, trunk, and extensor areas of the extremities

53
Q

Iron deficiency anemia

A
  1. decreased bone marrow iron stores (ferritin and hemosiderin)
  2. decreased serum ferritin
  3. increased serum TIBC, reflecting increased serum transferrin
  4. decreased serum iron concentration
  5. decreased blood hemoglobin
  6. microcytic, hypocrhomic RBCs
54
Q

Phenytoin

A

inhibits neuronal high-frequency firing of action potentials by blocking Na+ channels and prolonging their rate of recovery.

treatment of tonic-clonic seizures and status epilepticus

55
Q

Phenobarbital for what kind of seizures?

A

generalized tonic-clonic seizures

56
Q

Chronic arteriovenous shunt

A

increase cardiac output because of increased sympathetic stimulation the heart, decreased TPR, and increased venous return

Venous return curve shifts to the right in chronic conditions because the circulating blood volume is increased through renal retention of fluids and because venous pooling is reduced by the increased sympathetic tone

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