6/2 UWorld Flashcards
1
Q
MOA and use of 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
2
Q
MOA and use of Cyclosporine
A
- Immunosuppressant
- Blocks lymphocyte activation and proliferation
- MOA:
- Binds cyclophilin (protein within cytosol of T-cells)
- Inhibits calcineurin (which stimulates IL-2) à prevention of IL-2 transcription
- Uses:
- Transplant rejection
- Psoriasis
- Rheumatoid arthritis
- Toxicity
- Nephrotoxicity
3
Q
MOA and use of Sirolumus
A
Aka Rapamycin
- Immunosuppressant
- Blocks lymphocyte activation and proliferation
- MOA:
- Binds FKBp12 à inhibition of mTOR
- Prevents response to IL-2
4
Q
MOA and use of Etanercept
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:
- Mimics TNF-a receptor (aka it intercepts TNF-a before it can reach its target)
- Uses:
- Used for autoimmune conditions due to anti-inflammatory effect
- Inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis, psoriasis
5
Q
MOA and use of 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
6
Q
MOA of Dacluzimab
A
- Immunosuppressant
- Blocks lymphocyte activation and proliferation
- MOA:
- Binds CD25 (IL-2 receptor) à preventing response to IL-2
- THINK: Da-clu = da claw = claw grabbing on to the receptor
7
Q
What is the defect and associated triad in Ataxia telangiectasia?
A
Defect in ATM gene - failure to repair DNA double strand breaks
Triad: ataxia, telangiectasia, IgA deficiency
8
Q
MOA and use of Paclitaxel
A
- MOA:
- Hyperstabilization of polymerized microtubules in M phase so that mitotic spindle cannot break down and anaphase cannot occur
- Uses:
- Used to treat ovarian and breast carcinoma
- Also prevents intimal hyperplasia, so can be used as coating in stent placement to prevent stent restenosis
9
Q
What biochemical process is often defective in patients with accumulation of misfolded proteins (e.g. Parkinson’s and Alzheimers)
A
Ubiquination - misfolded proteins unable to be marked for degradation
10
Q
What is the embryologic origin of the ureteric bud
A
Mesonephros:
- Forms temporary kidney during 1st trimester
- Later contributes to male genital system – Wolffian ducts
11
Q
What structures are formed by the ureteric bud
A
- Caudal end of the mesonephros becomes the ureteric bud which gives risk to ureter, pelvises, calyces, collecting ducts
12
Q
What structures are formed by the metanephros
A
- Interaction with the ureteric bud (caudal portion of mesonephros) induces differentiation and formation of glomerulus, Bowman’s space, proximal tubule, loop of Henles, and distal convoluted tubule
13
Q
What is the cause behind higher insulin levels in oral glucose vs. IV glucose
A
Incretins (hormones produced bby gut mucosa) stimulate pancreatic insulin secretion in response to sugar-containing meals
This response occurs independent of blood glucose levels
14
Q
What is temporomandibular disorder (TMD)
A
o Characterized by constellation of symptoms:
§ Unilateral face pain that worsens with jaw movement
§ Headache
§ Ear discomfort
15
Q
What nerve may be involved in temporomandibular disorder (TMD)
A
- Mandibular nerve
- Largest branch of trigeminal nerve, containing both motor and sensory components
- Sensory:
- Sensation to TMJ, mandibular teeth, flood of mouth, inside of cheeks, anterior tongue, skin of lower face
- Motor:
- Muscles of mastication (medial and laterl pterygoid, masseter, temporalis)
- Muscle of floor of mouth (mylohyoid)
- Tensor veli palatati
- Tensor tympani of middle ear
16
Q
Rank these in order from fastest to slowest speed of conduction:
Atria, ventricles, AV node, purkinje fibers
A
- Purkinje > atria > ventricles > AV node
- Purkinje fibers must travel fastest to ensure that ventricles contract in a bottom-up fashion (necessary for efficient propulsion of blood into the pulmonary artery and aorta)
17
Q
Rank the rate of the different pacemakers from fastest to slowest (SA node, Bundle of His, AV node)
A
- SA > AV > bundle of His/Purkinje/ventricles
18
Q
Describe the function of each of the 4 muscles of the rotator cuff
A
- (1) Supraspinatus
- Suprascapular nerve
- Abducts arm initially (before deltoid kicks in)
- Most common rotator cuff injury
- Assessed with “empty can” test
- (2) Infraspinatus
- Suprascapular nerve
- Laterally rotates arm
- (3) Teres minor
- Axillary nerve
- Adducts and laterally rotates arm
- (4) Subscapularis
- Upper and lower subscapular nerves
- Medially rotates and adducts arm
19
Q
What type of drug is Chlordiazapoxide
A
Benzodiazepine
20
Q
What are the complimentary amino acids (G, A, U, C)
A
G - C
A - U
21
Q
What are the stop codons
A
UGA, UAG, UAA
22
Q
What type of HSR is acute hemolytic transfusion reaction
A
Type II HSR
Anti-ABO antibodies in the recipient will bind to donor erythrocytes, leading to complement activation
23
Q
What type of HSR is hemolytic disease of the newborn
A
Type II
24
Q
What type of HSR are each of the following (also include time frames):
- Hyperacute transplant rejection
- Acute transplant rejection
- Chronic transplant rejection
- Graft-vs-host disease
A
- Hyperacute
- Within minutes
- Type II HSR (pre-existing antibodies)
- Acute
- Weeks-months
- Type IV HSR
- Cellular and humoral:
- Cellular – CD8+ T-cells against donor MHCs
- Humoral – antibodies develop after transplant
- Chronic
- Months-years
- Type II and IV HSR
- Cellular and humoral
- Cellular – CD4+ T-cells respond to recipient APCs presenting donor peptides
- Graft-vs-host disease
- Timing varies
- Donor (foreign) bone marrow is transplanted into the patient, and then the donor cells begin to attack the host
25
What is Kussmaul sign, and what disorder is it found in
Kussmaul sign = JVD with inspiration (instead of normal decreased JVD)
Occurs in chronic constrictive pericarditis
26
What is pulsus paradoxus and what disorder is it found in?
* Decrease in amplitude of systolic BP by \> 10 mm Hg during inspiration
* Usually when you inspire this decreases intrathoracic pressure and causes the ventricular septum to deviate to the L, causing a smaller LV and a normal but slight decrease in BP
* In pulsus paradoxus, there will be an exaggerated decrease in BP
* Seen in cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, croup
* Occurs in cardiac tamponade \> constrictive pericarditis (vs. Kussmaul sign)
27
What is struma ovarii
teratoma comprised of thyroid tissue, which can present with hyperthyroidism
28
Describe the timeframe of twinning
* 0-4 days – dichorionic/diamniotic
* 4-8 days – monochorionic/diamniotic
* 8-12 days – monochorionic/monoamniotic
* \>13 days – conjoined twins
29
With what type of twins can twin-twin transfusion syndrome occur?
Occurs in monochorionic/diamniotic twins
Arterio-venous anastamosis leads to shunting of blood
Donor – anemic, pale, growth restricted
Recipient – polycythemic, plethoric, overloaded, heart failure
30
What presents with "snowstorm" appearance on US
Hydatidiform mole
31
What is another term for endodermal sinus tumor, and what serum marker will be elevated
Yolk sac tumor
Elevated AFP
32
Presentation of placenta abruption
* Premature separation of placenta from uterine wall before delivery
* Presentation:
* Abrupt, painful bleeding in the 3rd trimester (vs. placenta previa which is painless)
* Possible DIC, maternal shock, fetal distress
* Life threatening for mother and fetus
33
Differentiate between placenta accreta/increta/percreta and describe general presentation
* Defective decidual later – placenta improperly implants into the myometrium
* Presentation:
* No separation of placenta after delivery
* Postpartum bleeding
* Types:
* Placenta accreta – placenta attaches to myometrium without penetration
* Placenta increta – placenta penetrates into myometrium
* Placenta percreta – placent penetrates and perforates through the myometrium
* Can attach to rectum or bladder
34
Presentation of placenta previa
* Attachment of placenta to lower uterus over internal cervical os
* Presentation:
* Painless third trimester bleeding (vs. placenta abrupta which is painful)
* Often requires C-section
35
Diagnostic criteria of preeclampsia
HTN: BP \> 140/90 after 20th week of gestation
Proteinuria
Edema
36
Histology of granulosa-theca cell tumor
* Call-Exner bodies
* Granulosa cells arranged haphazardly around collections of eosinophilic fluid, resembling primordial follicles
37
Histology of Sertoli-Leydig cell tumor
Reinke crystals
38
What does HELLP syndrome stand for and what is the reasoning behind the symptoms
* Stands for:
* H - Hemolysis (anemia)
* EL - Elevated Liver enzymes (RUQ pain, jaundice)
* LP - Low Platelets (bruising bleeding)
* Preeclampsia + thrombotic microangiopathy
* Hemolysis = thrombi causing schistocytes
* Liver enzymes = lack of RBCs leads to infarction of liver tissue
* Platelets = all used up in thrombi
39
What is Meigs syndrome
Triad of: ovarian fibroma, ascites, pleural effusion
40
Quad screen values in trisomy 21 (AFP, bhCG, estriol, inhibin A)
* Decreased alpha-fetoprotein
* Increased b-hCG
* Decreased estriol
* Increased Inhibin A
