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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
Calcium moves in what direction in skeletal muscle?
Release calcium out of the cell from sarcoplasmic reticulum
26
Calcium moves in what direction in SM and cardiac muscle?
influx of extracellular calcium activates sarcoplasmic RyR channels induces release of additional calcium from sarcoplasmic reticulum (calcium-induced calcium release)
27
Infraspinatus does what?
external rotation | supra scapular nerve
28
subscapularis does what?
adduction internal rotation upper & lower sub scapular nerve
29
teres minor does what?
adduction external rotation axillary nerve
30
supraspinatus does what?
abduction (first third, followed by deltoid, then trap) | supra scapular nerve
31
G6PD deficiency is what type of inheritance?
XR
32
Vitamin D resistant rickets has what type of inheritance?
XD
33
Most blood cell structural abnormalities have what kind of inheritance?
AD | hereditary spherocytosis
34
Most enzyme deficiencies are what kind of inheritance?
AR | G6PD deficiency
35
Internuclear ophthalmoplegia a disorder of?
conjugate horizontal gaze | damage to heavily myelinated fibers of medial longitudinal fasciculus
36
Medial longitudinal fasciculus is?
paired neural tract that medicates communication between CN III and VI coordinated horizontal eye movements
37
Unilateral MLF lesions can occur with?
Lacunar stroke in the pontine artery distribution | dorsal pons
38
What is usually preserved in MLF lesions?
Convergence | pupillary light reflex
39
Bilateral MLF lesions are seen in?
MS
40
MLF lesions present with?
``` affected eye (ipsilateral to lesion) unable to adduct contralateral eye abducts w/nystagmus ```
41
Insulin independent receptors
``` GLUT-1, 2, 3, 5 Brain Kidney Liver Intestine RBCs ```
42
Insulin mediated receptors
GLUT-4 muscle cells adipocytes
43
Tetanus toxoid vaccine acts by
stimulates a humoral antibody response | prevents neurological damage
44
Stress incontinence etiology
decreased urethral sphincter tone | urethral hyper mobility
45
Stress incontinence symptoms
leakage with coughing, lifting, sneezing
46
Urge incontinence etiology
Detrusor hyperactivity
47
Urge incontinence symptoms
sudden overwhelming urge to urinate
48
overflow incontinence etiology
impaired detrusor contractility | bladder outlet obstruction
49
overflow incontinence symptoms
incomplete emptying | persistent involuntary dribbling
50
In a male, non-fusion of the urethral folds causes
hypospadias more common than epispadias
51
In a female, non-fusion of the urethral folds causes
vestibule of the vagina (labia minora)
52
Epispadias happens because
faulty positioning of genital tubercle in 5th week gestation
53
Bifid scrotum happens because
malunion of labioscrotal folds
54
In a female, the labioscrotal folds forms the
labia majora
55
Strep that can cause cavities
``` Viridans strep (mutans and sanguinis) make dextran (insoluble extracellular polysaccharides) using sucrose as substrate ``` can cause infective endocarditis too
56
P. aeruginosa toxin and mech
Exotoxin A Inactivates EF-2 via ribosylation inhibits host cell protein synthesis
57
Clostridium perfringins toxin and mech
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)
58
Severity of tetralogy of fallot based on
degree of pulmonary stenosis | right ventricular outflow tract obstruction
59
Tetrology of fallot includes
VSD overriding aorta right ventricular outflow obstruction (stenosis) RV hypertrophy
60
Phenylephrine binds to
alpha-1 rec on vascular smooth muscle | Gq
61
Gq receptors
active phospholipase C --> IP3 + DAG DAG stim protein kinase C --> SM contraction IP3 increase intracellular calcium --> stim protein kinase C
62
Extramedullary hematopoiesis is associated with
chronic hemolytic anemias (b-thalessemia)
63
Neisseria meningitides reaches the brain how
pharynx --> blood --> chord plexus --> meninges
64
Cotton-wool spots and micro aneurysms
nonproliferation phase of diabetic retinopathy (early)
65
neovascularization in eye of DM
proliferative phase of diabetic retinopathy (late)
66
Epithelia of the ovary
simple cuboidal
67
epithelia of fallopian tube
simple columnar ciliated cells transport egg damage can cause infertility, hydrosalpinx, ectopic prego
68
epithelia of uterus
simple columnar
69
epithelia of cervic
``` ectocervix = stratified squamous non-keratinized endocervic = simple columnar ```
70
epithelia of the vagina
stratified squamous non-keratinized
71
Posterior part of the external auditory canal is innervated by
small auricular branch of the vagus nerve | stimulation can cause vasovagal syncope d/t PNS outflow via vagus = decreased HR and BP
72
Majority of the external ear receives cutaneous innervations from
great auricular nerve lesser occipital nerve auriculotemporal nerve
73
External auditory canal innervated by
mandibular branch of trigeminal V3 | auriculotemporal branch
74
Diuretic used for acute angle-closure glaucoma
Acetazolamide inhibits carbonic anhydrase in the proximal tubule block HCO3- reabsorption enhanced HCO3- and water excretion increased urinary pH potential metabolic acidosis
75
Nitrates predominately affect
large veins ventilation and increased venous capacitance decreased preload reduced LV EDV and pressure decreased myocardial oxygen demand (relieves angina symptoms)
76
Tardive dyskinesia looks like
involuntary movements associated with long term DA antagonists (antipsychotic, metoclopramide)
77
Akanthisia looks like
subjective restlessness with inability to sit still extrapyramidal SE of antipsychotics
78
symptoms of neuroleptic malignant syndrome
fever rigidity mental status changes autonomic instability
79
TCA affects on the heart
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
Little kid with increased blood ammonia levels and orotic acid in urine
ornithine transcarbamylase (OTC) deficiency MC urea cycle disorder
81
Ornithine transcarbamylase deficiency results in
excess carbamoyl phosphate stimulates pyrimidine synthesis decreased citrulline and urea
82
Filtration fraction is
GFR/RPF
83
GFR can be estimated with
inulin or creatinine clearance
84
RPF can be determined by
PAH clearance
85
Clearance of any substance
C = ([Urine conc. of X] x [urine flow rate]) / (plasma conc of X)
86
pleural plaques with lower lung fibrosis in elderly
pleuropulmonary asbestosis interstitial fibrosis association with ferruginous bodies
87
asbestos fibers can be differentiated from other ferruginous bodes (carbon, talc) by
translucent fiber core
88
Secondary hyperparathyroidism is seen in
chronic kidney disease phosphate retention decreased production of 1, 25 - dihydroxyvitamin D
89
Primary hyperparathyroidism cause
parathyroid hyperplasia or adenoma
90
large, red, lingual mass causing difficulty creating, hoarseness, dysphagia
lingual thyroid that failed to migrate
91
DM type 1 is caused by
pathologic apoptosis of pancreatic beta cells
92
Charcot-Bouchard aneurysms are
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
Gestational diabetes affects the baby how
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
Polycythemia is caused by
``` abnormal transduction of erythropoietin growth signals JAKSTAT pathway (cytoplasmic tyrosine kinase) ```
95
Burkitt lymphoma is caused by
translocation of c-myc oncogene on Christmas 8 to Ig heavy chain on Christmas 14
96
c-myc is a
growth-stimulating transcription factor
97
flank pain, hematuria, and wedge-shaped kidney lesion on CT
renal infarction
98
MCC of renal infarction
systemic thromboembolism from left atrium or ventricle | common with afib
99
why are the brain and kidney more likely to suffer embolic infarctions?
perfused at a higher rate
100
Hand foot and mouth disease is caused by
enterovirus coxsackie virus A or B can also cause myocarditis leading to CHF, dysrhythmia, acute circulatory collapse
101
spontaneous gas gangrene caused by clostridium septicum are triggered by underlying
colonic malignancy creates a portal of entry for the bacteria also, IBD and immunosuppression
102
clostridium perfringens gas gangrene is associated with
trauma
103
patients with hemochromatosis are at increased risk of infection with
fulminant vibrio vulnificus (dependent of free iron)
104
indwelling catheters increase risk for
candidemia
105
MM at most risk for infections with
pneumococcus and H. flu- PNA | e. coli - UTI
106
Genetic instability with hepatitis C virus is due to
3'-->5' exonuclease activity no proofreading built into the vision encoded RNA polymerase
107
Guillain-Barre syndrome is associated destruction of
schwann cells
108
AV nodal blocking drugs for rate control
beta blockers calcium channel blockers prevent rapid ventricular response
109
Rhythm control for paroxysmal a fib
sotalol flecainide amiodarone class III
110
Class III antiarrhythmics
sotalol flecainide amiodarone block potassium channels inhibit outward repolarizing currents during phase 3 of AP increased AP duration, QT interval prolongation
111
class III antiarrhythmics are associated with
Torsades de pointes from QT interval prolongation less with amiodarone than sotalol
112
Drug induced lupus caused by
``` hydralazine procainamide isoniazid minocycline quinidine ```
113
IL-2's anti tumor effects due to
increased activity of T cells and NK cells
114
IL-2 therapy currently used in what cancers
metastatic melanoma | RCC
115
Bevacizumab MOA
interferes with VEGF receptor activation | inhibits angiogenesis
116
Alemtuzumab MOA
anti-CD52 to treat CLL | binds to CD52, direct cytotoxic effect via complement fixation and Ab-dependent cell-mediated cytotoxicity
117
Chemotherapeutics MOA etoposide vincristine cyclophosphamide
induce apoptosis
118
Interferon gamma increases
MHC I MHC II improving antigen presentation in all cells
119
Hawthorne effect
tendency of study subjects to change their behavior as a result of their awareness that they are being studied
120
pygmalion effect
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
immotile at body temp but tumbling at room temp
listeria monocytogenes
122
elimination of intracellular pathogen relies on
cell-mediated immune response
123
increased urinary ______ prevent kidney stones
citrate
124
Duchenne's muscular dystrophy is due to
deletions of dystrophin gene (frameshift) | links a component of the cytoskeleton to transmembrane proteins that are connected in extracellular matrix
125
``` Floppy baby large anterior fontanelle umbilical hernia macroglossia nonpitting edema (puffy face) ```
congenital hypothyroidism
126
congenital hypothyroidism is caused by
``` thyroid dysgenesis (genesis, hypoplasia, ectopy) iodine deficiency ```
127
Mycoplasma pneumonia infection can be diagnosed with
cold agglutinins clumping in cold temp from developing cross reactive IgM antibodies on erythrocytes also see in infectious mononucleosis and certain hematologic malignancies
128
common cause of tracheobronchitis and walking pneumonia in adolescents
mycoplasma pneumoniae
129
Methylxanthines (theophylline and aminophylline) cause bronchodilation by
blocking phosphodiesterase | increasing intracellular cAMP
130
Ipratropium MOA
blocks acetylcholine | inhibits bronchoconstriction
131
What happens to the endometrium after progesterone stops
increase prostaglandin synthesis vasoconstriction of spiral arteries apoptosis of endometrial epithelium degeneration of functionalists layer = mesntrual flow
132
Prolonged exposure to estrogen at the uterus
hyperplasia precancerous state suppressed by progesterone and medroxyprogesterone
133
The first step of gluconeogenesis is
Pyruvate to oxaloacetate with pyruvate carboxylase needs acetyl-coa
134
ADH is made in the
paraventricular and supraoptic nuclei of hypothalamus
135
ADH is stored in the
posterior pituitary
136
Damage to hypothalamic nuclei causes permanent
diabetes insipidus (central)
137
damage to posterior pituitary/infundibular can cause
transient central DI hypothalamic nuclei intact axonal regeneration and hypertrophy can compensate
138
Lambert-Eaton is seen as
paraneoplastic syndrome small cell carcinoma of lung weakness improves with muscular repetition
139
Lambert-eaton is caused by
autoantibodies that react with voltage gated calcium channels on presynaptic membrane hampers release of acetylcholine
140
Guillain bare syndrome thought to be due to
molecular mimicry segmental demyelination endometrial inflammatory infiltrate composed of T cells and macrophages
141
acne vulgarism caused by propionibacterium acnes pathogenesis
proliferation of lipid utilizing bacteria within pilosebaceous follicles
142
persistent fluctuating LAD who may have had unrelated pharyngitis (treated with Abx)
follicular lymphoma
143
follicular lymphoma is the mc
indolent non-hodgkin lymphoma in adults from follicular B cells waxing and waning course translocation of (14:18)
144
follicular lymphoma presentations
middle aged painless lymph node enlargement abdominal discomfort from an abdominal mass long waxing and waning course
145
follicular lymphoma histology
mixture of cleaved and non cleaved follicle center in a nodular pattern
146
follicular lymphoma genetics
t(14:18) over expression of bel-2 oncogene blocks programmed cell death
147
Diffuse large B cell lymphoma presentation
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
Hairy cell leukemia presentation
older men splenomegaly lymph node enlargement not classic leukemic cells have hairlike cytoplasmic projections positive for tartrate resistant acid phosphatase (TRAP)
149
ALL presentation
``` children LAD hepatosplenomegaly fever bleeding bone pain ```
150
Hyper IgM syndrome is due to
defect in class switching in B lymphocytes
151
noncaseating granulomas of GI tract
crohn's disease
152
Crohn's disease is characterized by
transmural inflammation strictures from bowel wall edema, fibrosis, and hypertrophy of muscular mucosae fistulas abscesses skip lesions
153
Ulcerative colitis involves the
mucosa and submucosa
154
H. flu type B can cause
epiglottitis meningitis bacteremia pneumonia
155
H. flu type B virulence factor
polyribosylribitrol phosphate (PRP capsule) inhibits complement-mediated phagocytosis can invade tissues and survive in bloodstream
156
mycoplasma pneumonia is treated with
doxycycline
157
lithium induced diabetes insipidus caused by
lithium reduces ability of kidneys to concentrate urine | antagonizes action of ADH in collecting tubules and ducts
158
Etanercept is characterized as
soluble receptor decoy protein
159
Etanercept MOA
TNF alpha inhibitor | added to methotrexate to treat moderate to severe RA
160
biological agent ending in cept
receptor molecule
161
biological agent ending in nib
kinase inhibitor
162
what is derived fro the ventral pancreatic primordium
main pancreatic duct
163
The dorsal pancreatic bud makes the
pancreatic tail body superior aspect of the head accessory pancreatic duct
164
the ventral pancreatic bud makes the
uncinate process inferior/posterior part of the head major pancreatic duct (of Wirsung)
165
pancreas divisum
failure of the dorsal and ventral pancreatic buds to fuse pancreatic ductal systems remain separate accessory duct draining most of pancreas
166
Most dangerous effect of amphotericin B
nephrotoxicity renal tubular dysfunction decreased GFR
167
chronic lymphocytic (hashimoto thyroiditis) histology
intense lymphoplasmacytic infiltrate with active germinal centers residueal follicles often surrounded by Hurthle cells (large oxyphilic cells filled with granular cytoplasm)
168
special test for hashimoto
elevated antithyroid peroxidase antibody
169
graves disease histology
tall follicular epithelium and crowded with hyperactive reabsorption causing scalloping around the edges of colloid
170
Reidel thyroiditis histology
extensive fibrosis extending into surrounding structures
171
subacute granulomatous (de Quervain) thyroiditis histology
disruption of follicles and mixed cellular infiltrate with occasional multinuclear giant cells
172
subacute granulomatous (de Quervain) thyroiditis presentation
viral URI with fever and painful tender thyroid nodule

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