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Review / Wrong Answers > 5/26 - UWorld > Flashcards

5/26 - UWorld Flashcards

1
Q

What is CREST syndrome

A

· Calcinosis / anti-centromere antibody

· Raynoud

· Esophageal dysmotility

· Sclerodactyly (tightening of skin with loss of wrinkles)

· Telangiectasias

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2
Q

Cause and presentation of Hyper-IgE Syndrome (aka Job)

A

o Deficiency in IFN-y lead to impaired neutrophil recruitment

o Presentation - FATED

§ F – coarse Facies

§ A – Abscesses

§ T – retained primary Teeth

§ E – increased IgE (all other immunoglobulins are normal)

§ D – dermatologic problems (eczema)

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3
Q

Release and function of TNF-a

A

§ Secreted by activated macrophages

§ Mediates septic shock

§ Causes neutrophil and lymphocyte recruitment

§ Responsible for fever, anorexia, corticotrophin releasing hormone, septic shock, and cachexia

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4
Q

Infliximab

A
  • TNF-a inhibitor
    • Recall: TNF-a is an acute phase reactant produced by activated macrophages to mediate inflammation by accelerating neutrophil migration, and facilitate lymphocyte proliferation; TNF-a is responsible for fever, anorexia, corticotropin releasing hormone, septic shot, and cachexia
  • Mechanism of action:
    • Is a monoclonal antibody to TNF-a
  • Uses:
    • Used for autoimmune conditions due to anti-inflammatory effect
    • Rheumatoid arthritis, psoriasis, ankylosing spondylitis
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5
Q

Cyclosporine

A
  • Immunosuppressant
    • Blocks lymphocyte activation and proliferation
  • MOA:
    • Binds cyclophilin (protein within cytosol of T-cells)
    • Inhibits calcineurin (which stimulates IL-2) = prevention of IL-2 transcription
  • Uses:
    • Transplant rejection
    • Psoriasis
    • Rheumatoid arthritis
  • Toxicity
    • Nephrotoxicity
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6
Q

Tacrolimus

A
  • Immunosuppressant
    • Blocks lymphocyte activation and proliferation
  • MOA:
    • Binds FK506 binding protein
    • Inhibits calcineurin à prevention of IL-2 transcription
  • Uses:
    • Transplant rejection prophylaxis
  • Toxicity:
    • Nephrotoxicity
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7
Q

Sirolumus (aka Rapamycin)

A
  • Immunosuppressant
    • Blocks lymphocyte activation and proliferation
  • MOA:
    • Binds FKBp12 = inhibition of mTOR
    • Prevents response to IL-2
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8
Q

Dacluzimab

A
  • Immunosuppressant
    • Blocks lymphocyte activation and proliferation
  • MOA:
    • Binds CD25 (IL-2 receptor) = preventing response to IL-2
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9
Q

Describe Wiskott Aldrich syndrome

A
  • X-linked recessive immunodeficiency
    • Mutation in WASp gene
    • T cells unable to reorganize actin skeleton = defective antigen presentation
  • WATER - Wiskott Aldrich, Thrombocytopenia, Eczema (especially truncal), Recurrent infections
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10
Q

Antibody associated with mixed connective tissue disease

A

Anti-U1 RNP (ribonucleoprotein)

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11
Q

What are the different defects that cause homonymous hemianopia with macular involvment vs homonymous hemianopia with macular sparing

A
  • E: homonymous hemianopia with macular involvement is consistent with involvement of the temporal lobe (e.g. occlusion of the middle cerebral artery)
  • H: homonymous hemianopia with macular sparing is consistent with occlusion of the posterior cerebral
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12
Q

When after fertilization will b-hCG become positive in maternal serum and urine?

A
  • ~8 days after fertilization in maternal serum
  • ~14 days after fertilization in urine
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13
Q

What are the muscles of the rotator cuff?

A

Supraspinatus

Infraspinatus

Teres minor

Subscapularis

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14
Q

What is the supraspinatus test?

A

“empty can” test

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15
Q

What murmur might radiate to the neck

A

Aortic stenosis

Turbulent blood pushed out of the aorta may still be turbulent when it reaches the carotids

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16
Q

What murmur is associated with an opening snap vs. an ejection click

A

Opening snap = mitral stenosis

Ejection click = Aortic stenosis

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17
Q

Common side effects of Chloramphenicol

A

Pancytopenia: anemia, leukopenia, and/or thrombocytopenia

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18
Q

What are the parasites that can cause disease in red blood cells

A

Plasmodium (malaria) and Babesia

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19
Q

What is the most common location of patients infected with Babesia

A

NE United States (NE on maltese cross on floor)

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20
Q

Presentation of babesiosis

A

Fever and hemolytic anemia (can result in jaundice)

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22
Q

Blood smear of Babesiosus

A

Ring form or Maltese cross

23
Q

Clinical manifestation of carcinoid syndrome

A

Bronchospasm, Flushing, Diarrhea, R-sided heart disease/murmur

24
Q

Describe the mechanism behind glucose-induced insulin release

A
  • Glucose enter beta cells of pancreas through GLUT-2 transporters
  • Glucose is metabolize by glucokinase to glucose-6-phosphate
  • Glucose-6-phosphate is further metabolized by glycolysis and the Krebs cycle to produce ATP
  • High ATP leads to closure of ATP-sensitive potassium channels
  • Closure of potassium channels leads to depolarization which results in opening of voltage-gated calcium channels (= inflow of calcium)
  • High intracellular calcium causes exocytosis of insulin vesicles
25
Where is the inflammation and with what T-cell (CD4+ or CD8+) is inflammation caused by in Dermatomyositis vs. Polymyositis
* Dermatomyositis * Perimysial (THINK: periphery b/c of muscle + skin involvement) inflammation with CD4+ T cells * Polymyositis * Endomysial inflammation with CD8+ T cells
26
What are Class I vs Class II human leukocyte antigens
Class I: HLA-A, HLA-B, and HLA-C Class II: HLA-DP, HLA-DQ, and HLA-DR
27
What are the seronegative spondyloarthopathies
PAIR: Psoriatic arthritis, ankylosing spondylitis, inflammatory bowel disease, reactive arthritis
28
What human leukocyte antigen is associated with the seronegative spondyloarthropaties
HLA-B27
29
What human leukocyte antigen is associated with Rheumatoid arthritis
HLA-DR4
30
What is the procedure performed in a vasectomy?
Transection of the vas deferens Viable sperm can remain in the portion of the vas deferens distal to ligation for 3 months and at least 20 ejaculations
31
Occlusion of the L circumflex artery will affect what part of the heart, which corresponds to ST elevations in what leads?
L circumflex artery provides to the lateral aspect of L ventricle Will see ST elevations in leads I and aVL
32
Describe the presentation of the 3 phases of Lyme disease
* o Stage I * Erythema Chronic Migrans ("Bulls Eye" rash) = “Stage 1” with bulls eye with spiral arrow (spirochete) * Non-painful and non-pruritic * Sweating and feverish, flu like illness = Sir Wright is sweating and looking feverish - * Stage II * Heart block caused by myocarditis = heart shield * Bilateral facial nerve palsy = 2 bells for Bell’s Palsy * o Stage III * Joint pain arthritis of large joints, symptoms may move from joint to joint (migratory polyarthritis) à * Arrow in knee = arthritis of large joint * Straw man swinging back and forth = migratory polyarthritis * Subtle encephalopathy = Memory difficulty, lymphocytic meningitis. * Arrow in the head of straw man and Sir Giemsa is confused
33
Treatment of Lyme disease
Stage 1 = Doxycycline Later stages = Ceftriaxone
34
Cause of acute primary adrenal insufficiency
Waterhouse-Friederichsen syndrome Acute primary adrenal insufficiency due to adrenal hemorrhage associated with septicemia (usually Neisseria meningitides), DIC, endotoxic shock
35
Which hormones use the cAMP pathway (Gs and Gi)
Most hormones of anterior pituitary FSH, LH, ACTH, TSH, hCG, MSH, GHRH, CRH, PTH, calcitonin, glucagon, V2 vasopressin receptor * THINK: FLAT ChAMP * FSH, LH, ACTH, TSH, CRH and calcitonin, hCG, ADH (V2), MSH, PTH
36
Which hormones use IP3 pathway (Gq)
Hormones of posterior pituitary minus V2 GnRH, TRH, oxytocin, V1 vasopressin receptor, H1 histamine receptor, angiotensin II, gastrin * THINK: GOAT HAG * GnRH, Oxytocin, ADH (V1), TRH, Histamine (H1), Angiotensin II, Gastrin
37
Which hormones use cGMP pathway
Vasodilators: Nitric oxide (NO), Atrial natriuretic peptide (ANP)
38
Which hormones use steroid receptors
Estrogens, progesterone, testosterone, glucocorticoids, aldosterone, thyroid hormone (T3/T4), vitamin D * THINK: VETTT CAP * Vitamin D, Estrogen, Testosterone, T3, T4, Cortisol, Aldosterone, Progesterone
39
Which hormones use tyrosine kinase receptors
Insulin, insulin-like growth factor (IGF-1), platelet derived growth factor (PDGF), fibroblast growth factor (FGF)
40
Which hormones use nonreceptor tyrosine kinase (e.g. JAK/STAT)
Prolactin, cytokines (IL-2, IL-6, IFN), GH, G-CSF, Erythropoietin, Thrombopoeitin * THINK: PIGGLET * Prolactin, Immunomodulators (cytokines, IL-2, IFN), Growth hormone, Granulocyte colony stimulating factor, (No L), EPO, Thrombopoietin
41
MOA of Psyllium
* Bulk-forming laxative * Is an indigestible hydrophilic colloid = will absorb water = distention = peristalsis * Used for treatment of constipation * May lead to increased bloating and flatulence
42
MOA of Docusate
* Stool softener * Facilitates the penetration of stool by water and lipids
43
MOA of Senna
* Stimulant laxative * Directly stimulate the enteric nervous system and colonic secretions * Chronic use causes melanosis coli (brown pigmentation of the colon)
44
MOA of Bismuth
MOA: Binds to ulcer base, providing physical protection and allowing HCO3- secretion to reestablish pH gradient in the mucus layer USES: Increased ulcer healing Traveler's diarrhea
45
What are the rapid-acting, intermediate-acting, and long-acting insulins
* Rapid acting = Girls and Lads * Glulisine, Aspart, Lispro * Intermediate acting = Rest Now * Regular insulin, NPH * Long acting = Don't Go * Detemir, Glargine
46
47
What type of drug are Tolbutamide and Chlorpropramide?
1st generatino sulfonylureas ("-amide" = goose in maid outfit) Treat T2DM
48
MOA of Exanatide and Liraglutide
"-tide" = GLP-1 agonists * These drugs activate GLP-1 receptor (glucagon-like peptide receptor) – opposite of glucagon * Increases insulin release and satiety * Decreases glucagon release and gastric emptying
49
MOA of Sitagliptin and Linagliptin
"-gliptin" = DDP-4 inhibitors * DPP-4 (dipeptidyl peptidase) is the enzyme that breaks down endogenous GLP-1 * If you inhibit DPP-4, you will have more endogenous GLP * Increased insulin and decreased glucagon * Increased satiety and delayed gastric emptying
50
MOA of Pramlintide
* Amylin analog * Amylin is a peptide normally present in insulin secretory granules and secreted along with insulin * At pharmacologic doses, it reduces glucagon secretion, gastric emptying, and appetite * Used to control postprandial glucose spike in both Type I and Type II DM
51
MOA of alpha-glucosidase inhibitors (Acarbose and Miglitol)
Sketchy: A-carb wigglers MOA: Inhibition of a-glucosidase on the intestinal brush border decreases the conversion of disaccharides to absorbable monosaccharides --\> delayed carbohydrate absorption USES: Type 2 DM ADVERSE EFFECTS: Diarrhea, flatulence (due to fermentation of undigested carbs)
52
MOA of SGLT2 inhibitors ("-flozin")
Sketchy: Flossing teacher and Salty Glucose Co. bag MOA: Inhibition of the sodium-glucose cotransporter in the proximal tubule USES: Type 2 DM ADVERSE EFFECTS: UTI Vaginal candidiasis Dehydration

Review / Wrong Answers (140 decks)

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