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UWorld Review > 4/14/19 > Flashcards

4/14/19 Flashcards

1
Q

Luteal phase (proliferative) of the menstrual cycle looks like?

A

Decidualized endometrium only
dilated, coiled endometrial glands
vascularized edematous stroma
under the influence of progesterone

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2
Q

What does the uterus look like in a molar pregnancy to spontaneous abortion?

A

Enlarged chorionic villi

avascular edematous stroma

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3
Q

Early proliferative phase of the menstrual cycle looks like?

A

straight, short endometrial glands
compact stroma
4-7 days after onset of menses

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4
Q

chronic alcoholic pancreatitis results in

A

pancreatic exocrine insufficiency

malabsorption

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5
Q

Tx for methanol and ethylene glycol poisoning

A

Fomipazole - competitive inhibitor of alcohol dehydrogenase
Ethanol - sometimes used as competitive inhibitor

Both decrease the conversion rate of poison into toxic metabolite

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6
Q

Toxic metabolites of methanol poisoning

A

Formic acid

causes retinal injury/blindness

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7
Q

Toxic metabolites of ethylene glycol poisoning

A

oxalic acid
glycolic acid
glyoxylic acid
causes AKI d/t cytotoxicity and crystalline obstruction

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8
Q

What do chelators (deferoxamine) do?

A

Bind to heavy metals and form inert complex that is cleared renally

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9
Q

How does activated charcoal work?

A

Absorbs toxins in stomach
prevents absorption into the body
use in phenobarbital and acetaminophen poisoning
doesn’t absorb alcohol

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10
Q

Boy w/Hx of bone cancer + lung tumor with sheets of uniform, smalll, round cells

A

Ewing sarcoma

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11
Q

Histology of Ewing sarcoma

A

uniform, small, round cells w/clear scan’t cytoplasm
separated by fibrous septae
patches of necrosis/hemorrhage

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12
Q

Ewing sarcoma involves translocations of?

A

EWSR1 and FLI1

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13
Q

Ewing sarcoma believed to arise from?

A

mesenchymal stem cells

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14
Q

Histology of osteosarcoma

A

Pleomorphic
spindle-shaped cells
produce new osteoid and bone

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15
Q

Histology of MM

A

Eccentric nuclei with “clock-face” chromatin
perinuclear clearing
abundant basophilic cytoplasm

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16
Q

Histology of chondrosarcoma

A

neoplastic chondrocytes in hyaline cartilage matrix

usually w/small calcifications

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17
Q

Histology of adenocarcinoma of the lung

A

neoplastic glands lined by mucin-producing cells

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18
Q

Hepatitis D virus does not encode for ?

A

viral envelope proteins
cannot generate viral progeny on its own
“replication-defective”

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19
Q

Hepatitis D is what kind of virus

A

small
enveloped RNA
does not contain replicase or RNA polymerase
needs co-infection with HBV or superinfection in chronic HBV carrier

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20
Q

Aortic regurgitation is characterized by

A

rapid loss of aortic pressure during diastole

d/t back flow of blood in L ventricle

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21
Q

Hemodynamic changes in aortic regurgitation

A

reduced aortic diastolic pressure
elevated LV diastolic pressure
aortic and LV systolic pressure are increased

Aortic pressure = 160/60
LV pressure = 160/20

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22
Q

Changes in the heart from AR

A

LV becomes dilated
increased EDV
eccentric hypertrophy
compensatory for increase in SV and CO

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23
Q

Cardiac changes in a normal aging heart

A

decreased LV cavity size
sigmoid shape of ventricular septum
increased collagen within ventricular wall

myocardial cells w/brownish (lipofuscin pigment) perinuclear cytoplasmic inclusions - d/y indigestible byproducts of sub cellular membrane lipid ox)

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24
Q

Skeletal muscle is not affected by Verapamil bc?

A

little dependence on extracellular calcium influx

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25
Q

Calcium moves in what direction in skeletal muscle?

A

Release calcium out of the cell from sarcoplasmic reticulum

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26
Q

Calcium moves in what direction in SM and cardiac muscle?

A

influx of extracellular calcium
activates sarcoplasmic RyR channels
induces release of additional calcium from sarcoplasmic reticulum (calcium-induced calcium release)

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27
Q

Infraspinatus does what?

A

external rotation

supra scapular nerve

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28
Q

subscapularis does what?

A

adduction
internal rotation
upper & lower sub scapular nerve

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29
Q

teres minor does what?

A

adduction
external rotation
axillary nerve

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30
Q

supraspinatus does what?

A

abduction (first third, followed by deltoid, then trap)

supra scapular nerve

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31
Q

G6PD deficiency is what type of inheritance?

A

XR

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32
Q

Vitamin D resistant rickets has what type of inheritance?

A

XD

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33
Q

Most blood cell structural abnormalities have what kind of inheritance?

A

AD

hereditary spherocytosis

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34
Q

Most enzyme deficiencies are what kind of inheritance?

A

AR

G6PD deficiency

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35
Q

Internuclear ophthalmoplegia a disorder of?

A

conjugate horizontal gaze

damage to heavily myelinated fibers of medial longitudinal fasciculus

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36
Q

Medial longitudinal fasciculus is?

A

paired neural tract that medicates communication between CN III and VI
coordinated horizontal eye movements

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37
Q

Unilateral MLF lesions can occur with?

A

Lacunar stroke in the pontine artery distribution

dorsal pons

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38
Q

What is usually preserved in MLF lesions?

A

Convergence

pupillary light reflex

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39
Q

Bilateral MLF lesions are seen in?

A

MS

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40
Q

MLF lesions present with?

A 
affected eye (ipsilateral to lesion) unable to adduct
contralateral eye abducts w/nystagmus
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41
Q

Insulin independent receptors

A 
GLUT-1, 2, 3, 5
Brain
Kidney
Liver
Intestine
RBCs
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42
Q

Insulin mediated receptors

A

GLUT-4
muscle cells
adipocytes

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43
Q

Tetanus toxoid vaccine acts by

A

stimulates a humoral antibody response

prevents neurological damage

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44
Q

Stress incontinence etiology

A

decreased urethral sphincter tone

urethral hyper mobility

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45
Q

Stress incontinence symptoms

A

leakage with coughing, lifting, sneezing

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46
Q

Urge incontinence etiology

A

Detrusor hyperactivity

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47
Q

Urge incontinence symptoms

A

sudden overwhelming urge to urinate

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48
Q

overflow incontinence etiology

A

impaired detrusor contractility

bladder outlet obstruction

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49
Q

overflow incontinence symptoms

A

incomplete emptying

persistent involuntary dribbling

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50
Q

In a male, non-fusion of the urethral folds causes

A

hypospadias

more common than epispadias

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51
Q

In a female, non-fusion of the urethral folds causes

A

vestibule of the vagina (labia minora)

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52
Q

Epispadias happens because

A

faulty positioning of genital tubercle in 5th week gestation

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53
Q

Bifid scrotum happens because

A

malunion of labioscrotal folds

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54
Q

In a female, the labioscrotal folds forms the

A

labia majora

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55
Q

Strep that can cause cavities

A 
Viridans strep (mutans and sanguinis)
make dextran (insoluble extracellular polysaccharides) using sucrose as substrate

can cause infective endocarditis too

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56
Q

P. aeruginosa toxin and mech

A

Exotoxin A
Inactivates EF-2 via ribosylation
inhibits host cell protein synthesis

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57
Q

Clostridium perfringins toxin and mech

A

Most important is Lecithinase (aka phospholipase C or alpha toxin)
lethal and necrotic effects
catalyzes splitting of phospholipid molecules
causes cell lyses

also uses carbs for energy which produces gas (gas gangrene)

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58
Q

Severity of tetralogy of fallot based on

A

degree of pulmonary stenosis

right ventricular outflow tract obstruction

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59
Q

Tetrology of fallot includes

A

VSD
overriding aorta
right ventricular outflow obstruction (stenosis)
RV hypertrophy

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60
Q

Phenylephrine binds to

A

alpha-1 rec on vascular smooth muscle

Gq

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61
Q

Gq receptors

A

active phospholipase C –> IP3 + DAG
DAG stim protein kinase C –> SM contraction
IP3 increase intracellular calcium –> stim protein kinase C

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62
Q

Extramedullary hematopoiesis is associated with

A

chronic hemolytic anemias (b-thalessemia)

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63
Q

Neisseria meningitides reaches the brain how

A

pharynx –> blood –> chord plexus –> meninges

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64
Q

Cotton-wool spots and micro aneurysms

A

nonproliferation phase of diabetic retinopathy (early)

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65
Q

neovascularization in eye of DM

A

proliferative phase of diabetic retinopathy (late)

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66
Q

Epithelia of the ovary

A

simple cuboidal

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67
Q

epithelia of fallopian tube

A

simple columnar
ciliated cells transport egg
damage can cause infertility, hydrosalpinx, ectopic prego

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68
Q

epithelia of uterus

A

simple columnar

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69
Q

epithelia of cervic

A 
ectocervix = stratified squamous non-keratinized
endocervic = simple columnar
70
Q

epithelia of the vagina

A

stratified squamous non-keratinized

71
Q

Posterior part of the external auditory canal is innervated by

A

small auricular branch of the vagus nerve

stimulation can cause vasovagal syncope d/t PNS outflow via vagus = decreased HR and BP

72
Q

Majority of the external ear receives cutaneous innervations from

A

great auricular nerve
lesser occipital nerve
auriculotemporal nerve

73
Q

External auditory canal innervated by

A

mandibular branch of trigeminal V3

auriculotemporal branch

74
Q

Diuretic used for acute angle-closure glaucoma

A

Acetazolamide
inhibits carbonic anhydrase in the proximal tubule
block HCO3- reabsorption

enhanced HCO3- and water excretion
increased urinary pH
potential metabolic acidosis

75
Q

Nitrates predominately affect

A

large veins
ventilation and increased venous capacitance

decreased preload
reduced LV EDV and pressure
decreased myocardial oxygen demand (relieves angina symptoms)

76
Q

Tardive dyskinesia looks like

A

involuntary movements

associated with long term DA antagonists (antipsychotic, metoclopramide)

77
Q

Akanthisia looks like

A

subjective restlessness with inability to sit still

extrapyramidal SE of antipsychotics

78
Q

symptoms of neuroleptic malignant syndrome

A

fever
rigidity
mental status changes
autonomic instability

79
Q

TCA affects on the heart

A

inhibit fast sodium channel conduction
slows down myocardial depolarization
cardiac arrhythmia in overdose

also refractory hypotension
decreased cardiac contractility
direct peripheral vasodilation (peripheral alpha 1 antag)

80
Q

Little kid with increased blood ammonia levels and orotic acid in urine

A

ornithine transcarbamylase (OTC) deficiency

MC urea cycle disorder

81
Q

Ornithine transcarbamylase deficiency results in

A

excess carbamoyl phosphate
stimulates pyrimidine synthesis
decreased citrulline and urea

82
Q

Filtration fraction is

A

GFR/RPF

83
Q

GFR can be estimated with

A

inulin or creatinine clearance

84
Q

RPF can be determined by

A

PAH clearance

85
Q

Clearance of any substance

A

C = ([Urine conc. of X] x [urine flow rate]) / (plasma conc of X)

86
Q

pleural plaques with lower lung fibrosis in elderly

A

pleuropulmonary asbestosis

interstitial fibrosis association with ferruginous bodies

87
Q

asbestos fibers can be differentiated from other ferruginous bodes (carbon, talc) by

A

translucent fiber core

88
Q

Secondary hyperparathyroidism is seen in

A

chronic kidney disease
phosphate retention
decreased production of 1, 25 - dihydroxyvitamin D

89
Q

Primary hyperparathyroidism cause

A

parathyroid hyperplasia or adenoma

90
Q

large, red, lingual mass causing difficulty creating, hoarseness, dysphagia

A

lingual thyroid that failed to migrate

91
Q

DM type 1 is caused by

A

pathologic apoptosis of pancreatic beta cells

92
Q

Charcot-Bouchard aneurysms are

A

small
in patients with long standing HTN
found in arterioles that supply basal ganglia, internal capsule, deep white matter
cause intracerebral bleeds not SAH

93
Q

Gestational diabetes affects the baby how

A

excessive trans placental glucose transfer to fetus
stimulates insulin production in fetus and beta cell hyperplasia/hyperinsulinism

becomes hypoglycemic at birth bc insulin is still hyper functioning even though no glucose is transferred

94
Q

Polycythemia is caused by

A 
abnormal transduction of erythropoietin growth signals
JAKSTAT pathway (cytoplasmic tyrosine kinase)
95
Q

Burkitt lymphoma is caused by

A

translocation of c-myc oncogene on Christmas 8 to Ig heavy chain on Christmas 14

96
Q

c-myc is a

A

growth-stimulating transcription factor

97
Q

flank pain, hematuria, and wedge-shaped kidney lesion on CT

A

renal infarction

98
Q

MCC of renal infarction

A

systemic thromboembolism from left atrium or ventricle

common with afib

99
Q

why are the brain and kidney more likely to suffer embolic infarctions?

A

perfused at a higher rate

100
Q

Hand foot and mouth disease is caused by

A

enterovirus
coxsackie virus A or B

can also cause myocarditis leading to CHF, dysrhythmia, acute circulatory collapse

101
Q

spontaneous gas gangrene caused by clostridium septicum are triggered by underlying

A

colonic malignancy
creates a portal of entry for the bacteria

also, IBD and immunosuppression

102
Q

clostridium perfringens gas gangrene is associated with

A

trauma

103
Q

patients with hemochromatosis are at increased risk of infection with

A

fulminant vibrio vulnificus (dependent of free iron)

104
Q

indwelling catheters increase risk for

A

candidemia

105
Q

MM at most risk for infections with

A

pneumococcus and H. flu- PNA

e. coli - UTI

106
Q

Genetic instability with hepatitis C virus is due to

A

3’–>5’ exonuclease activity

no proofreading built into the vision encoded RNA polymerase

107
Q

Guillain-Barre syndrome is associated destruction of

A

schwann cells

108
Q

AV nodal blocking drugs for rate control

A

beta blockers
calcium channel blockers

prevent rapid ventricular response

109
Q

Rhythm control for paroxysmal a fib

A

sotalol
flecainide
amiodarone

class III

110
Q

Class III antiarrhythmics

A

sotalol
flecainide
amiodarone

block potassium channels
inhibit outward repolarizing currents during phase 3 of AP

increased AP duration, QT interval prolongation

111
Q

class III antiarrhythmics are associated with

A

Torsades de pointes
from QT interval prolongation

less with amiodarone than sotalol

112
Q

Drug induced lupus caused by

A 
hydralazine
procainamide
isoniazid
minocycline
quinidine
113
Q

IL-2’s anti tumor effects due to

A

increased activity of T cells and NK cells

114
Q

IL-2 therapy currently used in what cancers

A

metastatic melanoma

RCC

115
Q

Bevacizumab MOA

A

interferes with VEGF receptor activation

inhibits angiogenesis

116
Q

Alemtuzumab MOA

A

anti-CD52 to treat CLL

binds to CD52, direct cytotoxic effect via complement fixation and Ab-dependent cell-mediated cytotoxicity

117
Q

Chemotherapeutics MOA
etoposide
vincristine
cyclophosphamide

A

induce apoptosis

118
Q

Interferon gamma increases

A

MHC I
MHC II
improving antigen presentation in all cells

119
Q

Hawthorne effect

A

tendency of study subjects to change their behavior as a result of their awareness that they are being studied

120
Q

pygmalion effect

A

the fact that a researcher’s beliefs in the efficacy of treatment can potentially affect the outcome

i.e. assigning higher IQ to students and telling teachers, students did better bc teachers had higher expectations

121
Q

immotile at body temp but tumbling at room temp

A

listeria monocytogenes

122
Q

elimination of intracellular pathogen relies on

A

cell-mediated immune response

123
Q

increased urinary ______ prevent kidney stones

A

citrate

124
Q

Duchenne’s muscular dystrophy is due to

A

deletions of dystrophin gene (frameshift)

links a component of the cytoskeleton to transmembrane proteins that are connected in extracellular matrix

125
Q 
Floppy baby
large anterior fontanelle
umbilical hernia
macroglossia
nonpitting edema (puffy face)
A

congenital hypothyroidism

126
Q

congenital hypothyroidism is caused by

A 
thyroid dysgenesis (genesis, hypoplasia, ectopy)
iodine deficiency
127
Q

Mycoplasma pneumonia infection can be diagnosed with

A

cold agglutinins
clumping in cold temp
from developing cross reactive IgM antibodies on erythrocytes

also see in infectious mononucleosis and certain hematologic malignancies

128
Q

common cause of tracheobronchitis and walking pneumonia in adolescents

A

mycoplasma pneumoniae

129
Q

Methylxanthines (theophylline and aminophylline) cause bronchodilation by

A

blocking phosphodiesterase

increasing intracellular cAMP

130
Q

Ipratropium MOA

A

blocks acetylcholine

inhibits bronchoconstriction

131
Q

What happens to the endometrium after progesterone stops

A

increase prostaglandin synthesis
vasoconstriction of spiral arteries
apoptosis of endometrial epithelium
degeneration of functionalists layer = mesntrual flow

132
Q

Prolonged exposure to estrogen at the uterus

A

hyperplasia
precancerous state

suppressed by progesterone and medroxyprogesterone

133
Q

The first step of gluconeogenesis is

A

Pyruvate to oxaloacetate with pyruvate carboxylase

needs acetyl-coa

134
Q

ADH is made in the

A

paraventricular and supraoptic nuclei of hypothalamus

135
Q

ADH is stored in the

A

posterior pituitary

136
Q

Damage to hypothalamic nuclei causes permanent

A

diabetes insipidus (central)

137
Q

damage to posterior pituitary/infundibular can cause

A

transient central DI
hypothalamic nuclei intact
axonal regeneration and hypertrophy can compensate

138
Q

Lambert-Eaton is seen as

A

paraneoplastic syndrome
small cell carcinoma of lung
weakness improves with muscular repetition

139
Q

Lambert-eaton is caused by

A

autoantibodies that react with voltage gated calcium channels on presynaptic membrane

hampers release of acetylcholine

140
Q

Guillain bare syndrome thought to be due to

A

molecular mimicry
segmental demyelination
endometrial inflammatory infiltrate composed of T cells and macrophages

141
Q

acne vulgarism caused by propionibacterium acnes pathogenesis

A

proliferation of lipid utilizing bacteria within pilosebaceous follicles

142
Q

persistent fluctuating LAD who may have had unrelated pharyngitis (treated with Abx)

A

follicular lymphoma

143
Q

follicular lymphoma is the mc

A

indolent non-hodgkin lymphoma in adults
from follicular B cells
waxing and waning course
translocation of (14:18)

144
Q

follicular lymphoma presentations

A

middle aged
painless lymph node enlargement
abdominal discomfort from an abdominal mass
long waxing and waning course

145
Q

follicular lymphoma histology

A

mixture of cleaved and non cleaved follicle center in a nodular pattern

146
Q

follicular lymphoma genetics

A

t(14:18)
over expression of bel-2 oncogene
blocks programmed cell death

147
Q

Diffuse large B cell lymphoma presentation

A

rapidly enlarging nodal (neck, abdomen, mediastinum) or extra nodal symptomatic mass

Waldeyer’s ring (oropharyngeal lymphoid tissue) and GI tract commonly involved

systemic B symptoms: fever, weight loss, drenching night sweats

148
Q

Hairy cell leukemia presentation

A

older men
splenomegaly
lymph node enlargement not classic
leukemic cells have hairlike cytoplasmic projections
positive for tartrate resistant acid phosphatase (TRAP)

149
Q

ALL presentation

A 
children
LAD
hepatosplenomegaly
fever
bleeding
bone pain
150
Q

Hyper IgM syndrome is due to

A

defect in class switching in B lymphocytes

151
Q

noncaseating granulomas of GI tract

A

crohn’s disease

152
Q

Crohn’s disease is characterized by

A

transmural inflammation
strictures from bowel wall edema, fibrosis, and hypertrophy of muscular mucosae

fistulas

abscesses

skip lesions

153
Q

Ulcerative colitis involves the

A

mucosa and submucosa

154
Q

H. flu type B can cause

A

epiglottitis
meningitis
bacteremia
pneumonia

155
Q

H. flu type B virulence factor

A

polyribosylribitrol phosphate (PRP capsule)
inhibits complement-mediated phagocytosis
can invade tissues and survive in bloodstream

156
Q

mycoplasma pneumonia is treated with

A

doxycycline

157
Q

lithium induced diabetes insipidus caused by

A

lithium reduces ability of kidneys to concentrate urine

antagonizes action of ADH in collecting tubules and ducts

158
Q

Etanercept is characterized as

A

soluble receptor decoy protein

159
Q

Etanercept MOA

A

TNF alpha inhibitor

added to methotrexate to treat moderate to severe RA

160
Q

biological agent ending in cept

A

receptor molecule

161
Q

biological agent ending in nib

A

kinase inhibitor

162
Q

what is derived fro the ventral pancreatic primordium

A

main pancreatic duct

163
Q

The dorsal pancreatic bud makes the

A

pancreatic tail
body
superior aspect of the head
accessory pancreatic duct

164
Q

the ventral pancreatic bud makes the

A

uncinate process
inferior/posterior part of the head
major pancreatic duct (of Wirsung)

165
Q

pancreas divisum

A

failure of the dorsal and ventral pancreatic buds to fuse
pancreatic ductal systems remain separate
accessory duct draining most of pancreas

166
Q

Most dangerous effect of amphotericin B

A

nephrotoxicity
renal tubular dysfunction
decreased GFR

167
Q

chronic lymphocytic (hashimoto thyroiditis) histology

A

intense lymphoplasmacytic infiltrate with active germinal centers

residueal follicles often surrounded by Hurthle cells (large oxyphilic cells filled with granular cytoplasm)

168
Q

special test for hashimoto

A

elevated antithyroid peroxidase antibody

169
Q

graves disease histology

A

tall follicular epithelium and crowded with hyperactive reabsorption causing scalloping around the edges of colloid

170
Q

Reidel thyroiditis histology

A

extensive fibrosis extending into surrounding structures

171
Q

subacute granulomatous (de Quervain) thyroiditis histology

A

disruption of follicles and mixed cellular infiltrate with occasional multinuclear giant cells

172
Q

subacute granulomatous (de Quervain) thyroiditis presentation

A

viral URI with fever and painful tender thyroid nodule

UWorld Review (35 decks)

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