4/17 Uworld review Flashcards
non-membrane bound cytoplasmic lipid that shifts and sometimes causes scalloping of the nucleus.
-what am i describing?
liposarcoma.
anisocoria
-define:
unequal size of pupils.
-can be benign or pathological.
difficult swallowing & choking when drinking liquids.
-which nerve is possibly damaged?
vagus.
HCM
-w/regard to preload & afterload, how do you reduce the murmur/outflow tract obstruction?
-Murmur is quieter w/increases in preload & afterload.
IgA deficient pt getting blood products from normal person. Risk of what reaction?
anaphylaxis.
-type 1 HSR.
DNA rep:
-which enzyme replaces RNA primers w/DNA?
DNA pol 1
DNA rep:
-which enzyme replaces RNA primers w/DNA?
DNA pol 1
-only then does ligase join the DNA segments together.
DNA rep:
-which enzyme replaces RNA primers w/DNA?
DNA pol 1
-only then does ligase join the DNA segments formed by DNA Pol 3 to the new segments formed by DNA Pol 1.
(1-specificity) = __________ rate
(1-specificity) = false positive rate.
*specificity is about the true negatives. So true negatives + the false positives has to = 1.
TP + TN / all obersvations =
accuracy
(TP + TN) / all obersvations =
accuracy
glyburide
-what is it?
sulfonylurea.
alkaptonuria
-only non-benign Sx that can occur?
debilitating arthralgias.
alkaptonuria
-only non-benign Sx that can occur?
debilitating arthralgias.
- due to deposition of the pigment in the joint cartilage.
- only happens once its built up a lot, so when pt is 40-50 yo.
rigidity w/passive wrist flexion:
parkinsons
cogwheel rigidity
-seen in what disease?
parkinsons
foam stability test for fetal lung maturity
-what do you add to what?
ethanol + surfactant.
What vertebral level is the pancreas?
L1
why is heparin safer choice than warfarin during pregnancy?
heparin can not cross the placenta bc its water soluble.
- warfarin is lipid soluble & can cross the placenta.
- water soluble materials (ie. direct bilirubin) do not cross the placenta but lipophilic materials (ie. indirect bili) do.
N. gonnorrhea
-virulence factor?
pili
-doesn’t have capsule like n. meningitidis.
cotton-wool exudates on ophtho exam in AIDS pt?
CMV retinitis.
recidivism
-define?
relapsing.
-ie. quitting smoking then starting back up again.
Influenza: viral HA and NA proteins are coded by different segments.
good to know!
Influenza: viral HA and NA proteins are coded by different segments.
-what does this predispose to?
allows genetic reassortment.
Influenza: viral HA and NA proteins are coded by different segments.
-what does this predispose to?
allows genetic reassortment which = antigenic shift.
phenotypic mixing
-define:
when 2 viruses infect the same cell & progeny viruses exhibit coat or envelope proteins not coded for by their genetic material.
JVP tracing (aka RA pressures) -a wave?
RA contraction.
JVP tracing (aka RA pressures)
- a wave?
- absent in which disease?
RA contraction.
-absent in afib.
JVP tracing
- c wave?
- absent in which disease?
RV contraction pushes tricuspid in & causes inc in RA pressure.
-absent in tricuspid regurg (i believe).
nadir
-define:
lowest point.
JVP tracing
- c wave?
- absent in which disease?
RV contraction pushes tricuspid in & causes inc in RA pressure.
JVP
- x descent
- absent in which disease?
- negative pressure as blood flows across from RV contraction.
- absent in tricuspid regurg.
Whats the only thing that will reverse the flow of a VSD?
Eisenmenger.
Damage to sup. colliculus
-what sort of gaze palsy?
paralysis of conjugate vertical gaze.
-parinaud syndrome.
How does phenylephrine dec. pulse pressure?
- reflex brady = dec. inotropy = dec. systolic.
- arteriolar vasoconstriction = inc. diastolic.
does epinephrine vasoconstrict or vasodilate?
vasodilate
-preferential action on beta-2 over alpha-1.
What is a TATA box?
part of DNA
-promotes txn of the DNA into RNA.
What is a TATA box?
part of DNA
- promotes txn of the DNA into RNA.
- binding site of RNA Pol 2.
What is a TATA box?
part of DNA
- promotes txn of the DNA into RNA.
- binding site of RNA Pol 2.
- the TATA sequence itself is NOT transcribed.
what is a CAAT box?
same as TATA box.
what is a CAAT box?
same as TATA box.
-initiates TXN.
defect in lysyl hydroxylase
-which disease?
Ehlers Danlos.
stellate cell
- where is it found?
- aka?
- functions?
- liver
- ito cell
- vitamin A storage & can differentiate into myelofibroblast upon injury to liver & play big role in fibrosis of liver.
Which ABxs bind to 23s of 50s ribosome?
macrolides, clindamycin,
Cloramphenicol
-mech:
Block peptidyltransferase at 50S ribosome.
Cloramphenicol
-mech:
Block peptidyltransferase at 50S ribosome.
Which ABxs bind to 23s of 50s ribosome?
macrolides, clindamycin.
Which ABXs are neutralized by modifying the drug?
chloramphenicol & aminoglycosides.
spleen contains ~ 1/2 the total Ig producing B cells in the body.
-another reason why sickle cell w/splenic infarct get infections.
spleen contains ~ 1/2 the total Ig producing B cells in the body.
-another reason why sickle cell w/splenic infarct get infections - bc IgG = needed for opsonization.
Radiation exposure
-leads to which cancers?
leukemia, papillary carcinoma of thyroid, sarcoma, breast cancer.
High serum albumin level
-may indicate what?
hemoconcentration.
Mab vs IL-2 receptor:
basiliximab
tardive dyskinesia
- what causes it?
- Tx:
- long term use of typical anti-psychotics. these meds block D2 receptors, and tardive dyskinesia happens bc the D2 receptors are then upregulated (w/concomitant dec. in ACh).
- Tx: stop all anti-cholinergic meds & ween off the anti-psychotic.
*much less common if using atypical anti-psychotics.
tardive dyskinesia
- what causes it?
- Tx:
Long term use of typical anti-psychotics. These meds block D2 receptors, and tardive dyskinesia happens bc the D2 receptors are then upregulated (w/concomitant dec. in ACh).
-Tx: stop all anti-cholinergic meds & ween off the anti-psychotic.
- aka, hypersensitivity to D2.
- much less common if using atypical anti-psychotics.
dopamine => NE
-which enzyme?
dopamine beta-hydroxylase.
respiratory Sxs is SVC syndrome
-due to what?
laryngeal edema.
What enzyme used by RNA viruses to replicate their genome?
RNA dep. RNA polymerase.
painful pharyngeal muscular spasms & neuro problems
-which bug?
rabies.
where are negri bodies found?
- purkinje cells of cerebellum.
- hippocampus.
most common cause of human rabies in the USA?
bats
painful pharyngeal muscular spasms & neuro problems
-which bug?
rabies.
-hydrophobia results due to choking while drinking.
baroreceptor firing frequency & BP
- relationship?
- directly or inversely related?
directly related.
reflex tachy
-mediated by which nerves?
- dec. vagal tone
- inc beta-1 tone
are corticosteroids okay to use in pregnancy?
yes
-they are category C - so they can be used.
sulfasalazine
-can be used in which diseases?
IBD & RA.
Category A, B, C, D
-can these be used in pregnancy?
yes
*category D has risks but can be used in some cases.
Category X
-can it be used in pregnancy?
no
orlistat
-mech?
inhibit intestinal lipase.
blood from most pelvic organs drain into which vein?
internal iliac vein.
blood from most pelvic organs drain into which vein?
internal iliac vein.
- also from middle rectal vein.
- inf rectal vein => internal pudendal.
blood from most pelvic organs drain into which vein?
internal iliac vein.
- also from middle rectal vein.
- inf rectal vein => internal pudendal => internal pudendal.
Hydrophobic AAs:
glycine, alanine, valine, leucine, isoleucine, phenyalanine, tryptophan, methionine, proline.
Only sinus that receives blood from facial veins?
cavernous sinus.
Only sinus that receives blood from facial veins?
cavernous sinus.
*acute infection of face could spread here.
which sinus drains finally into the IJ?
sigmoid sinus.
Is VSD ever going to cause cyanosis in an infant?
For our purposes, NO.
-answer is probably going to be tetrology of fallot.
severe anemia does not usually result in cyanosis.
good to know.
amebiasis
- refers to infection w/what?
- why is it seen in homos?
entamoeba histolytica
-can be spread oral-anal.
lumbar lordosis
-which muscles are flexed too much?
hip flexors.
*not extensors!
hypertensive woman that gives birth to baby w/congenital renal problems.
-you can assume the mother was on what meds?
ACE inhibitors.
Why do they call apoB-48 this?
its a truncated version of apoB-100.
-its 48% of the size.
Lisch nodules
- which disease
- what is it? what exactly is pigmented?
- NF1
- pigmented iris hamartomas.
niacin
-mech:
- dec liver VLDL synthesis.
- dec. HSL activity so less lipids are sent to bloodstream.
friable, inflamed mucosa in rectum + neutrophils in crypt lumina.
-which disease?
UC.
friable, inflamed mucosa in rectum + neutrophils in crypt lumina. multiple pseudopolyps.
-which disease?
UC.
Drug eluting stents
- which drugs typically used?
- for what purpose?
- paclitaxel or sirolimus.
- to prevent intimal hyperplasia - so you dont get stenosis again.
herpesvirus
-whats special about it w/regards to assembly?
- assembles in nucleus and has a nuclear envelope.
- dsDNA virus.
Only RNA viruses that replicate in nucleus?
influenza & retroviruses.
Only DNA virus that replicates in cytoplasm?
poxvirus.
HHV-3
-which virus is this?
herpes zoster
-aka shingles.
Upon termination of insulin action, how is GLUT-4 taken back into the cell?
clathrin-coated pits.
saphenous nerve
-pure motor or pure sensory?
pure sensory nerve.
saphenous nerve
- pure motor or pure sensory?
- for which part of body?
pure sensory nerve for medial leg & foot.
NF-kB
- what does it do?
- what are corticosteroid actions on it?
- its the txn factor that encodes inflammation. It induces production of TNF-alpha & other pro-inflammatory chemicals.
- corticosteroids inactivate NF-kB.
H-bonding btwn hydroxyproline residues stabilizes the triple helix structure (which is formed in the RER).
-good to know
lysyl oxidase
- what does it do?
- whats its cofactor?
- problem w/this = what disease?
- cross links extracellular collagen fibers via covalent bonds.
- copper
- problem w/cross-linking = Ehlers Danlos.
Generalized transduction
- can the virus w/bacterial DNA infect another cell?
- can it produce progeny?
- yes it can infect another bacteria.
- no it can not produce progeny bc it has bacterial DNA in it, not its own viral DNA.
Huntingtons
-whats the cause?
atrophy of the caudate.
Huntingtons
-whats the cause?
atrophy of the caudate.
-dec GABA & ACh.
Huntingtons
- whats the trinucleotide thats repeated?
- what amino acid does it code for?
- CAG
- glutamine.
MCAD deficiency
- what is it?
- Sxs:
- inability to degrade medium chain FAs.
- fasting hypoglycemia.
MCAD deficiency
- what is it?
- Sxs:
-inability to degrade medium chain FAs.
-fasting hypoglycemia (need acetyl-coa from FA oxid for gluconeo).
-
Any auto recessive enzyme deficiency.
- homozygous has no enzyme activity
- what about the heterozygous? does he have full? half?
- the heterozygous has half the enzyme activity.
- the enzyme is coded for on that allele, and he only has one working allele, which means he only makes half the amount of that enzyme.
blood CPK
-whats cpk?
creatine phosphokinase.
does furosemide cause hypo or hyperkalemia?
-how?
- hypokalemia
- more Na delivered to collecting duct which means more aldo effect = wastes more H and K.
differentiating rhabdo from statins vs hypokalemia from furosemide:
- rhabdo = acute onset w/red urine.
- furosemide induced hypokalemia = will happen over a week or so.
anti-SRP
-which disease?
polymyositis/dermatomyositis.
young pt presenting w/herpes zoster
-what should you test them for?
HIV (immunosuppression).
beta-1
-inc or dec lipolysis?
inc. lipolysis
positive selection of T cells
- where in thymus does it happen?
- does this happen before or after negative selection?
- whats the selection process.
- cortex of thymus.
- before negative selection.
- testing T cells to see if they bind to MHC. If they dont, theyre disposed of.
negative selection of T cells
- where in thymus?
- does this happen before or after positive selection?
- whats the selection process?
- medulla
- after
- T cells binding too tightly to self MHC are disposed of.
RA morning stiffness
-how long does it typically last?
almost over an hour.
RA morning stiffness
-how long does it typically last?
~ 1 hr.
yellow under parallel light
-gout or pseudogout?
GOUT.
microsatellite instability
-due to what?
defects in DNA mismatch repair enzymes.
-ie. HNPCC.
red/blue or yellow/brown nodules that involve the pelvic mucosal/serosal surfaces:
endometriosis.
dysmenorrhea & pelvic pain during periods
-potential cause?
endometriosis.
dysmenorrhea & pelvic pain during periods w/random lesions in the peritoneal/pelvic cavity.
-potential cause?
endometriosis.
most common opportunistic pathogen invading GI tract of HIV pts?
CMV (a herpesvirus).
most common opportunistic pathogen invading GI tract of HIV pts?
CMV (a herpesvirus).
-CMV colitis = 2nd most common reactivation syndrome after CMV retinitis.
most common opportunistic pathogen invading GI tract of HIV pts?
CMV (a herpesvirus).
-CMV colitis = 2nd most common reactivation syndrome after CMV retinitis.
*giant cells w/large ovoid nuclei containing central intranuclear inclusions (owl eyes).
Diarrhea in HIV pt
-differential?
CMV
cryptosporidium
microsporidium
MAC
Diarrhea in HIV pt
-differential?
- CMV
- cryptosporidium
- microsporidium
- MAC (will have granulomas & acid fast stain)
raltegravire
- what is it?
- mnemonic?
integrase inhibitor for HIV.
-ralTEGRAvire = inTEGRAse inhibitor.
tortuous veins visible on lower abdominal wall
-sign of what?
upstream blockage - whether it be portal HTN or IVC blockage.
carboxyHb
- Hb w/what attached?
- whats the O2 dissociation curve look like?
- carbon monoxide.
- asymptotic instead of sigmoid.
Wilsons
-where exactly is the copper deposited to get the kaiser Fleischer rings?
in the cornea.
- myeloperoxidase found where?
- NADPH oxidase found where?
- myelo = inside lysosomes.
- NADPH oxidase = membrane protein present on phagosome.
*lysosome and phagosome will eventually fuse.
nests of nevomelanocytes w/hyperchromatic nuclei bridging w/nests in neighboring rete pegs:
dysplastic nevus.
nests of nevomelanocytes w/hyperchromatic nuclei bridging w/nests in neighboring rete pegs:
dysplastic nevus.
-will become melanoma.
nests of nevomelanocytes w/hyperchromatic nuclei bridging w/nests in neighboring rete pegs:
dysplastic nevus.
-can become melanoma.
most common skin cancer?
Basal cell carcinoma.
if they’re going to describe basal cell carcinoma histologically, what will they most probably include?
nuclear palisading.
5 secondary brain vesicles
- what are they?
- mnemonic?
TDMMM
- telencephalon
- diencephalon
- mesencephalon
- metencephalon
- myelencephalon
telencephalon
-becomes what?
cerebral hemispheres.
diencephalon
-becomes what?
thalamus.
mesencephalon
-becomes what?
midbrain.
myelencephalon
-becomes what?
medulla.
Which ventricle goes through thalamus?
3rd ventricle.
aqueduct of sylvius goes thru what portion of brain?
midbrain.
alcoholic cerebellar degeneration
-caused by degeneration of which cells?
purkinje cells.
alcoholic cerebellar degeneration
-caused by degeneration of which cells?
purkinje cells.
-cerebellum derived from rhombencephalon.
alcoholic cerebellar degeneration
- Sxs:
- caused by degeneration of which cells?
- ataxia, broad-based gait, truncal instability.
- purkinje cells.
- cerebellum derived from rhombencephalon.
leucine zipper
nucleic acid binding domain.
leucine zipper
nucleic acid binding domain.
-like zinc-finger motif.
leucine zipper
nucleic acid binding domain.
-like zinc-finger motif.
*obvious not part of ligand binding domain bc every ligand binding domain will be unique.
gestational trophoblastic disease
- encompasses which diseases?
- which chemical is elevated?
- complete mole, partial mole, choriocarcinoma.
- beta-HCG.
“tretin”
-think what?
vitamin A.
dihydropyridines
-selective for what?
-arteriolar smooth muscle.
how is galactose converted to glucose?
galactose => g-1-p => g-6-p then glucose-6-phosphatase converts it to glucose.
-unless of course the pt has von-gierkes, then g-6-p builds up & cant be converted to glucose.
how is fructose converted to glucose?
fructose => f-1-p => DHAP + glyceraldehyde => g-3-p…and eventually becomes g-6-p.
-glucose-6-phosphatase converts it to glucose, unless the pt has von gierkes, then g-6-p builds up.
why do you get lactic acidosis in von-gierkes?
Cori cycle: lactic acid made by muscle sent to liver.
- converted back to pyrvuate via LDH.
- pyruvate undergoes gluconeo and converts to glucose, & liver sends glucose back into blood.
- if you have von-gierkes, you cant do last step of gluconeo (no glucose-6-phosphatase) - so lactic acid builds up.
how is galactose converted to glucose?
galactose => g-1-p => g-6-p then glucose-6-phosphatase converts it to glucose.
-unless of course the pt has von-gierkes, then g-6-p builds up & cant be converted to glucose.
*built up g-6-p shunted to glycolysis & lactic acid prod.
how is fructose converted to glucose?
fructose => f-1-p => DHAP + glyceraldehyde => g-3-p…and eventually becomes g-6-p.
-glucose-6-phosphatase converts it to glucose, unless the pt has von gierkes, then g-6-p builds up.
*built up g-6-p shunted towrard glycolysis & lactic acid production.
What stains PAS (+)?
detects polysaccs like glycogen.
-detects sugars!
Where is glycogen stored?
-where is glycogen made?
- granules in the cytoplasm.
- in the cytoplasm.
peroxisome beta-oxidation
-what is the energy used for?
generate hydrogen peroxide.
high LH levels result in inc. conversion of testosterone to estradiol.
results in gynecomastia, for instance in klinefelters.
klinefelters
- whats the genotype?
- how did it occur?
- 47 XXY
- materanl nondisjunction in meiosis.
klinefelters
- whats the genotype?
- how did it occur?
- 47 XXY
- maternal nondisjunction in meiosis.
