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1 UWorld > April 13 > Flashcards

April 13 Flashcards

1
Q

Occurs when the ventral and dorsal parts of the pancreas fail to fuse at 8 wks–generally asymptomatic, but may cause chronic abdominal pain and/or pancreatitis?

A

Pancreas divisum

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2
Q

What is telomerase?

A

An RNA-dependent DNA polymerase that adds DNA to 3’ ends of chromosomes to avoid loss of genetic material with every duplication
–long telomeres are seen on stem cells and short on mature cells–myocardial cells, neurons, pancreatic B-cells

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3
Q

Within in the lungs, binding of O2 to Hb drives _____ and ____ from Hb (haldane effect). Within peripheral tissue, binding of ____ and ____ facilitate O2 unloading from Hb (Bohr effect).

A

CO2 and H+

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4
Q

What is the key tumor marker for Choriocarcinoma, which can occur secondary to complete mole?

A

B-hCG

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5
Q

Why should SSRIs and MAO inhibitors be administered together?

A

Potential for serotonin syndrome–excessive serotonin in the synaptic cleft due to decreased reuptake and decreased degradation

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6
Q

How do tumor cells become resistant to anticancer drugs?

A

P-glycoprotein ATP-dependent transport

–Actively removes chemo drugs from the cell–especially hydrophobic ones like the anthracyclines

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7
Q

What is the presentation for Femoral (L2-L4) nerve injury and how can this occur?

A

Pelvic fracture or compression from hematoma/abscess

Sensory loss over anterior and medial thigh
Difficulty with stairs
Frequent falling secondary to knee buckling
Patellar reflex diminished
Decreased thigh flexion and leg extension

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8
Q

How does Right sided colon cancer present?

A

Ascending colon

Exophytic mass
Iron deficiency anemia
Weight loss

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9
Q

How does Left sided colon cancer present?

A

Descending colon and rectosigmoid colon

Infiltrating mass
Partial obstruction
Colicky pain
Hematochezia

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10
Q

Cardiac ischemia causes intracellular accumulation of what?

A

Ca
Na

No ATP available for ATPase

Causes cell and mitochondrial swelling due to accumulation of H2O

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11
Q

ETOH induced hepatic steatosis is caused by what?

A

Decreased free fatty acid oxidation secondary to excess NADH production by the 2 major ETOH enzymes–Alcohol dehydrogenase and aldehyde dehydrogenase

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12
Q

What are the non-pharmacological treatments for insomnia?

A

Sleep hygiene–Environment and what you do before bed
Stimulus control–eliminating stimuli in bedroom and only going to be when sleepy
Relaxation
Sleep restriction
CBT

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13
Q

What is Hawthorne effect?

A

Change of behavior as a result of awareness of it being studied

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14
Q

What class I of anti arrhythmics prolong AP duration, which shorten AP and which ones have no effect on AP duration?

A

Class IA– Prolong AP duration–prolong depolarization with K channel activity
Class IB–Shorten AP duration
Class IC–No change in AP duration

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15
Q

What is the cause of Lesch-Nyhan syndrome and what is unregulated because of the deficiency?

A

Defective purine salvage due to absent HGPRT

  • Hyperuricemia
  • Gout
  • Pissed off
  • Retardation
  • Dystonia

Increased PRPP amindotransferase to supply sufficient purine nucleotides due to increased uric acid production and demand for de novo purine synthesis

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16
Q

Damage to what area of the brain will cause “pie in the sky” upper quadratic anopia?

A

Temporal lobe lesion

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17
Q

How is RPF calculated?

A

RBF x (1-HCT)

FF= GFR/ RPF

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18
Q

What is the suprachiasmatic nuclei of the hypothalamus responsible for?

A

Circadian rhythm

Pineal gland function

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19
Q

What is the lateral nuclei of the hypothalamus for?

A

Hunger

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20
Q

What is the ventromedial area of the hypothalamus for?

A

Satiety–stimulated by leptin

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21
Q

What is the anterior hypothalamus for?

A

Cooling—A/C is for cooling

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22
Q

What is the posterior hypothalamus for?

A

Heating

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23
Q

A penetrating wound to the left sternal border at the 4th intercostal space is most likely to penetrate through what part of the heart?

A

Right ventricle–makes up most of the anterior surface of the heart

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24
Q

Chronic granulomatous disease pts are susceptible to catalase-positive organisms. Name these…

A

Cats Need PLACESS to Belch their Hairballs

Nocardia
Pseudomonas
Listeria
Aspergillus
Candida
E. coli
Staphylococci
Serratia
B. cepacia
H. pylori

Genetic defect in NADPH oxidase

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25
Q

What is the origin of melanocytes?

A

Neural crest

26
Q

Prolonged, untreated obstructive sleep apnea can result in what?

A

Pulmonary HTN and right sided HF

27
Q

What can change in order to compensate for right sided HF and increased central venous pressure, in order to prevent edema?

A

Lymphatic drainage can increase which will compensate for the increased CVP and prevent edema–However CVP can increase to a point where lymphatic drainage can’t keep up–edema ensues

28
Q

What can be given to decrease ETOH cravings and what is the MOA?

A

Naltrexone –blocks mu-opioid receptors —blocks the reward and reinforcing effects of ETOH

Disulfiram–inhibits aldehyde dehydrogenase and cause adverse side effects when ETOH is consumed
–so this is used to get them to stop drinking the shit

29
Q

Transmural inflammation and fibrinoid necrosis of the arteries is associated with what disease and what is commonly seen in pts with this disease?

A

Polyarteritis nodosa

Commonly associated with HepB

30
Q

What is the principal stabilizing force for secondary structure of proteins?

A

Hydrogen bonds

  • -a-helix
  • -b-sheets
31
Q

Post-partum bleeding that can not be controlled in a G2P2 who underwent C-section in first delivery and V-back for second?

A

Placenta accreta/increta/percreta

to muscle/in muscle/through muscle

32
Q

Child with palpable purpura on buttocks/legs, arthralgias and abdominal pain that occur shortly after URI?

A

Henoch-Schonlein purpura–Vasculitis secondary to IgA immune complex deposition

33
Q

Tendency for certain alleles at 2 linked loci to occur together more or less often than expected by chance?

A

Linkage disequilibrium

  • -Measured in a population and often caries in different populations
  • -Can occur even if the genes are on different chromosomes
34
Q

What is the role of Kinesin?

A

Anterograde to microtubule— (-)–> (+)
–Involved in slow axoplasmic transport in neurons

Anterograde transport of intracellular vesicles and organelles toward to + end of microtubule–rapidly growing end

35
Q

snRNPs are important components of _______, which are used for splicing of pre-mRNA.

A

Spliceosomes
–Spinal muscular atrophy is infantile disorder resulting from defect in snRNPs leading to flaccid paralysis due to LMN damage in the anterior horn of the spinal cord

36
Q

How does homocystinuria present and what is used for tx?

A

All forms result in excess homocysteine

Findings:

  • Increased homocysteine in urine
  • intellectual disability
  • osteoporosis
  • marfanoid habitus
  • kyphosis
  • lens subluxation
  • thrombosis
  • Atherosclerosis–stroke/MI

Tx: Increased cysteine, B12, B6

37
Q

What is the difference btw repression and suppression?

A

Repression is involuntarily withholding an idea or feeling from conscious awareness–Immature defense

Suppression is intentionally withholding an idea or feeling from conscious awareness–temporary and mature defense

38
Q

What artery runs anterior to the 3rd portion of the duodenum?

A

SMA

39
Q

Adult brain tumor that Central areas of necrosis and hemorrhage with surrounding pseudopalisading tumor cells?

A

Glioblastoma multiforme

40
Q

What class of diuretics improves mortality in HF pts?

A

Spironolactone and eplerenone

  • -Mineralocorticoid receptor antagonists
  • -block the binding of aldosterone to receptors and block the deleterious of aldosterone on the heart–causing regression of myocardial fibrosis and improvements in ventricular remodeling
41
Q

What is the MOA of the bisphosphonates?

A

Pyrophosphate analogs–bind hydroxyapatite in bone–> inhibiting osteoclast activity

42
Q

What bacteria is catalase-negative, gram + cocci that can grow in hypertonic solution and can cause endocarditis after GU instrumentation/cath?

A

Enterococcus

43
Q

What cells are involved when ALL presents with mediastinal mass?

A

T-lymphocytes

Pt will present with difficulty swallowing

44
Q

What is the primary virulence factor of Strep pneumonae that prevents phagocytosis?

A

Polysaccaride capsule

45
Q

What are the clinical clues for spinal metastasis?

A 
Constant pain
Not relieved by rest or analgesics
Worst at night 
Not responsive to positional changes
Older age
46
Q

What are the lab values seen with renal osteodystrophy?

A

Secondary hyperparathyroidism

  • Low Ca–due to decreased intestinal absorption (decreased 1,25 vit D)
  • High serum Phosphorus
  • Increased PTH and ALP
47
Q

Most common cause of CF?

A

Mutation to the deltaF508—impairs the posttranslational processing of CFTR—resulting in shunting of the CFTR toward proteasome with complete absence of the protein in the apical membrane of the affected epithelial cell

Elevated sweat chloride

48
Q

Biotin (Vit B7) is a cofactor for what 3 carboxylation enzymes?

A

Pyruvate carboxylase–Pyruvate to oxaloacetate
Acetyl-CoA carboxylase–Acetyl-CoA to malonyl-CoA
Propionyl-CoA carboxylase–Propionyl-CoA to methylmalonyl-CoA

49
Q

What 3 cytokines mediate systemic inflammatory response and stimulate hepatic secretion of acute-phase proteins?

A

IL-1, IL-6 and TNF-a

Causes an increase in ESR–nonspecific marker of inflammation –high levels of fibrinogen

50
Q

Anesthetics with high tissue solubility are characterized by what?

A

Large arteriovenous concentration gradients and slower onset of action

51
Q

Objects that get stuck in the piriform recess can cause damage to what nerve which will affect what?

A

Internal laryngeal nerve–affecting the cough reflex

52
Q

What is hibernating myocardium?

A

refers to the presence of LV systolic dysfunction due to reduced coronary blood flow at rest that is partially or completely reversible by coronary revascularization

53
Q

What drug inhibits intestinal brush border absorption of cholesterol in the small intestine?

A

Ezetimibe

54
Q

Pts with HIV often experience reactivation of latent EBV, which puts them at risk for the development of what?

A

Increased incidence of EBV induced lymphoproliferative disorders –lymphomas like burkitts

55
Q

Burkitt lymphoma involves what translocation and overexpression of what?

A

8;14 translocation with overexpression of c-MYC oncogene

56
Q

How does McCune-Albright syndrome present and what causes it?

A

Presents with unilateral cafe-au-lait spots, polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities
–onset of secondary sex characteristics before age 8
Due to mutation affecting G-protein signaling–only survivable if mosaicism

57
Q

Crescent formation is diagnostic for rapidly progressive GN. What do crescents consist of?

A

Glomerular parietal cells
Monocytes
Macrophages
Abundant fibrin

58
Q

What does squatting due for pts with tetrology of fallot?

A

Increases systemic vascular resistance and decreases left-right shunting
—increasing pulmonary blood flow and increasing oxygenation

59
Q

What is the most common malignancy associated with asbestos exposure?

A

Bronchogenic carcinoma THEN mesothelioma

60
Q

Sepsis can cause what type of pulmonary problems in older individuals?

A

Acute respiratory distress syndrome–sepsis causes cytokine release, which provoke an inflammatory response and increase neutrophils–leads to capillary damage and leakage of protein and fluid into the alveolar space

Pancreatitis can also cause ARDS–alveoli become lined with waxy hyaline membranes

1 UWorld (23 decks)

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