3/17 UWORLD test #48 Flashcards
Q 1. Name 4 second generation antihistamines. what is advantage of these drugs over first generation? why?
- loratidine
- desloratadine
- fexofenadine
- cetirizine
no anti-muscarinic, confusion/hallucination side effects
=> 2nd generation drugs do not cross CNS
Q 2. three antibodies for anti-phospholipid syndrome?
anti-cardiolipin
lupus anticoagulant
anti- beta 2 glycoprotein antibody
Q 4. how to calculate relative risk
% cancer-smoker/ % cancer-non smoker
Comparing two groups with POSITIVE DISEASE
and different exposure
- mistake I made: % cancer-smoker/% non-cancer- smoker
Q 7. What is molecular difference between glutamate and glutamine? What neuronal cell mediates this balance? How does this explain hyperamoniemia induced asterixis?
glutamate + NH3 —> glutamine
astrocyte takes up glutamate in synaptic cleft to prevent excessive neuronal excitation. Astrocytes then takes ammonia from blood, make glutamine, and recycle glutamine back to neuronal axon.
With hyperammonemia, astrocyte will make excessive glutamine, resulting in tremor
Q 7. Describe carbamoyl phosphate is associated with what reaction in urea cycle. How hyperamonemia change carbamoyl phosphate level?
carbamoyl phosphate is synthesized from
ammonia + N-acetylglutamate by CPS1 (carbamoyl phosphate synthase 1). Carbamoyl phosphate acts as primary nitrogen carrier.
hyperamonemia will result in decrease in carbamoyl phosphate
Q 8. Name three rapid acting insulin
LAG
- Lispro
- Aspart
- Glulisine
Q 8. Name two long acting insulin
detemir
glargine
Q 9. mechanism of action for nystatin? indication?
bind to ergosterol in cell membrane, make fungal cell leaky (same mechanism as amphotericin B)
tropical agent for oral/vaginal thrush by candida
Q 11. cardiac death from young healthy people. diagnosis?
hypertrophic cardimyopathy
Q 11. Inheritance pattern of hypertrophic cardiomyopathy?
autosomal dominant with variable expression
Q 12. corneybacterium diptheriae: gram positive or gram negative? what antibiotic can be used to treat it?
gram positive
vancomycin
Q 12. Antibiotic to treat N.gonorrhea?
ceftriaxone
also doxycycline/ azithromycin to treat chlamydia coinfection
Q 17. How liver cholesterol synthesis is affected with statin?
decreased
HMG-coA reductase: synthesis of cholesterol from HMG-coA (derived from acetyl-coA)
Q 19. spider telangiactasis: what disease should I think?
chronic liver disease –> liver cirrhosis
Q 19. Is hyper or hypo thyrodism associated with hypercholesterolemia?
Hypothyroidism
Hyperthyroidism is associated with hypocholesterolemia
- think like this. cholesterolemia is opposite to thyroidism
hyper-> hypo / hypo ->hyper
Q 22. complication of ARPKD?
Potter syndrome
unlike ADPKD, ARPKD doesn’t mess around with other cystic disease (berry aneurysm, hepatic cyst, MVP)
Q 23. serum creatinine begins to rise as GFR drops to what?
<60 mL/min
Q 24. Fixed S2. What heart defect?
ASD
Q 25. What amino acid is required for synthesis of NO during smooth muscle dilation? what enzyme? activated by what molecule?
L-arginine
NO synthase makes NO from L-arginine
acetylcholine/ bradykinin binding to receptor
- > increased intracellular Ca2+
- > stimulates NO synthase
Q 26. Talofibular ligament vs. Tibiofibular ligament: which one is medial? which one is lateral?
tibiofibular: medial
talofibular: lateral
* rembmer tibial artery is also medial. So things go with tibio-: medial
Q 28, What is etiology of Janeway lesions in bacterial endocarditis?
septic emobli from valvular vegetations
microemboli to skin vessel: composed of neutrophils, necrotic material, subcutaneous hemorrhage
Q 29. What is the process in response to irreversible CNS injury? what cell mediates it?
gliosis (glial hyperplasia)
mediated by astrocytes
Q 29. Is fibroblast involved in repair of irreversible CNS injury?
NO
fibroblast is involved in peripheral nervous system (or peripheral tissue), NOT in CNS
astrocytes got it for CNS
Q 29. embryological origin of astrocytes?
neuroectoderm
Q 29. Embryological origin of oligodendrocytes?
neuroectoderm
Q 29. Embryological origin of microglial cells?
monocytes
microglial cells are pretty much macrophage equivalent
Neuroectoderm is derived from what embriological cell layer? which embryological structure promotes development of neuroectoderm?
notocord stimulates ectoderm to become neuroectoderm
Neuroectoderm: what do I have to think? (4)
- astrocyte
- oligodendrocyte
- medulloblastoma
- posterior pituitary (neurohypophysis)
Q 30. How does parasympathetic nervous innervation mediates insulin secretion in pancreatic islet cells? what about sympathetic?
sympathetic -> predominantly alpha 2
-> Gi -> inhibition of insulin secretion
parasympathetic -> predominantly M3
-> Gs -> stimulation of insulin secretion
Q 33. overexpression of which molecule is associated with poor prognosis of breast cancer?
HER2
Q 33. medication for treatment of HER2 positive breast cancer?
trastuzumab
Q 34. What does leukocyte ALP (alkaline phosphatase) suggest? histological finding of leukocyte with high ALP?
leukocyte ALP helps distinguishing whether leukocytosis is due to leukomoid reaction (infection) or CML.
leukomoid reaction- high leukocyte ALP
CML- low leukocyte ALP
leukocyte with high ALP shows basophlic inclusions in mature leukocytes
Q 37. Urticaria (hives) is mediated by what cell? what type of hypersensitivity?
type 1
IgE released from mast cell degranulation
Q 40. Intimal tear in aortic wall. What is it?
aortic dissection
NOT aneurysm
Q 40. What is etiology of ABDOMINAL aortic aneurysm
weakening due to either chronic inflammation or atherosclerosis (lack of oxygen supply as abdominal aorta below renal artery lacks vasa vasorum)
Q 40. What are 4 etiologies of THORACIC aortic aneurysm?
- HTN
- bicuspid aortic valve
- Marfan syndrome
- tertiary syphilis
