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Usmle > Block 22 > Flashcards

Block 22 Flashcards

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USMLE® Step 1 flashcards
1
Q

Protinease anti protinease balance in the lung

A
  1. Protineases: elastase (made by neutrophils and contained in alveolar macrophages), cathepsin G, matrix metalloproteinases.
  2. Antiproteinases: å1 antitrypsin, å2 macroglobulin, TIMPS.
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2
Q

Transcription enhancer sequence

A
  • it can be located upstream, downstream, or within the introns of the gene.
  • enhancer sequence bind activator proteins that facillitate bending of DNA. DNA bending allows activator proteins to interact with general transcription factors and RNA polymerase II at the promoter, increasing the rate of transcription.
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3
Q

Why mesthynic patients feels relieved when cold ice pack is placed on muscle

A

-because actylcholeneterase (ACHE) is inhibited at low temperature

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4
Q

Acidphillic bodies are formed in (liver)

A

Apoptotic hepatocytes form round acidophilic bodies known as councilman bodies, usually present at acute HEP A

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5
Q

Sex steroids effect on bones

A
  • They initially increases linear growth, but they also encourage closure of epiphyseal growth plates.
  • once the growth plates have closed, linear growth is irreversibly stopped.
  • in case of precocious pubrty, linear growth is achieved relatievely fast —> tall girl, but epiphysial growth plates closes —> she will stop getting tall —> short girl .
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6
Q

Acute hemolytic transfusion reaction

A
  • condition presents with fever, chills, hypotension ,dyspnea, chest and/or back pain and hemoglobinuria.
  • pts may also develop renal failure and DIC
  • acute hemolytic transfusion are an example of Type II H.S reaction—> antibodies leads to activation of complement —> complement mediated lysis.
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7
Q

Aortic regurgitation presentation

A

Blowing diastolic decrescendo murmur best heared at left sternal border in the 3rd and 4th intercostal spaces.

  • the precordial impulse is hyperdynamic and displaced laterally and downward.
  • bounding femoral and carotid pulses, marked by abrupt distension and quick collapse (water-hammer puleses)
  • some patients exhibits head bobbing with carotid pulsation (de musset sign)
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8
Q

Impaired transport of ornithine into the mitochondria

A
  • ornithine translocase deficiency
  • result in defect in the hepatic urea cycle
  • urea cycle defects causes urea to ammonia to accumulate —> symptoms
  • lathergy, vomiting,seziures, and cereberal edema( may cause hyperreflexia and abnormal posturing when severe)
  • protein restriction is useful.
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9
Q

Cerbellar hemisphere lesion

A
  • ipsilateral dydiachokinesia
  • limb dysmetria
  • intention tremor
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10
Q

Pancreatic islet amyloid deposition

A

Type II D.M
-amylin (islet amyloid polypeptide), is one factor responsible for beta cell dysfunction, its stored in insulin secretory granules and is co secreted with insulin from pancreatic beta cells.

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11
Q

Adenovirus

A

DsDNA virus, direct contact, fecal-oral or respiratory droplets

  • can lead to pharyngoconjuctival fever
  • outbreaks usually in crowded quarters (day care centers, camp dermitories, millitary barracks
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12
Q

abacavir side effects and usage

A

NRTI used in HIV/AIDS.

  • Abacavir hypersensitivity reaction is an allergic rectin that develops in 2%-8% of patients and is strongly associated with the HLA-B*57:01 allel of human leukocyte antigen system.
  • this appers due to binding of abacavir to segment on the HLA-B57:01 molecule which alters the presentation of self peptides to the immune system and results in a delayed hypersenstivity reaction type IV.
  • fever malaise, Gi symptoms and delayed rash
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13
Q

Hetrophile negative mononucleosis

A
  • splenomegaly with atypical lymphocytosis.
  • fever , fatigue
  • CMV can be acquired during the transfusion of leukocyte laden blood products as the virus infects leukocytes of granules macrophages lineage
  • other causes include HHV 6, or T.gondii
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14
Q

Biliary sludge

A

Incomplete gallbladder emptying in response to CCK stimulation is consistent with gallbladder hypomotility.
- the gallbladder function to actively absorb water from bile; conditions tha cause gallbladder hypomotility result in excessive dehydration of bile.
-this promotes the precipitation and accumulation of particulate material in bile forming viscous biliary slude.
Sludge formation may be asymptomatic or cause biliary colic and is known precursor to stone formation
-RISK factor: pregnancy, rapid weight loss, high spinal cord injuries , prolonged use of total parenteral nutrition or octerotide.

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15
Q

Brown vs black bile stones

A

Brown stones are found in infections and blakc found usually after hemolytic anemia.

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16
Q

Failure of fusion of the maxillary prominence and intermaxillary segment

A

Cleft lip,
Lip and palate form during the fifth-sixth week
1. First pharyngeal arch splits into the upper maxillary prominance and lower mandibular prominance
2. Fusion of the 2 medial nasal prominances forms the midline intermaxillry segment
3. The left and right maxillary prominances then fuse with midline intermaxillary segment to form upper lip and primary palate. If one of the maxillary prominences fail to fuse with intermaxillary segment, a unilateral cleft lip results, if bilaterally , bilateral cleft lip

17
Q

Erythema multiforme (EM)

A

Acute inflammatory disorder that can involve the skin of the extremities, face, trunk ,and neck.

  • severe cases can also affect oral mucous membranes and the tongue. —The apperance can vary but typically present as erythmatous, round papules that evolve into target lesions with a dusky central area, a dark red inflammatory zone surrounded by a pale ring, and an erythematous halo in the lesion periphery.
  • EM, represent cell mediated immune response (CD8+).most commonly associated with inefctions especially HSV and mycoplasma, also can be due to medication, malignancy and collagen
18
Q

Erythema multiforme as a side effect for which medication

A

Sulfonamides

19
Q

Auscultation of murmurs

Methods that affects it

A
  1. Inspiration increases intensity of right sided murmur and decrease intensity of left sided murmurs
  2. Valsalva maneuver/abrupt standing : increass MVP and HCM and decreases most other murmers
  3. Squatting/ passive leg raise: decreases MVP and HCM and increases all other murmurs intensity
  4. hand grip: increases AR,MR,VSD and decreases HCM and AS murmurs .
20
Q

Na/Ca exchange pump

A

this pump is found on cardiac muscle, it assists in relaxation and is responsible for taking out 3 Na in exchange for Ca+

21
Q

Genital HSV infection clinical

A

-multiple painful genital ulcers, dysuria , tender lymphadenopathy and systemic symptoms in the setting of new partner

22
Q

Rivaroxaban inhibits

A

Direct Factor Xa inhibitor

23
Q

Changes after prolonged renal artery stenosis

A
  • the reduced blood flow is sensed by the JG apparatus which consists of macula densa and JG cells. —> macula densa cells are tall, narrow cells located in the distal tubule that monitor salt content and tubular flow rate this information is transmitted o the nearby JG cells that are located mainly in the wall of afferent arterioles.
  • renal hypoperfusion —> increase in renin secretion by JG cells —> increased AG II —> JG cells (found on afferent arterioles) undergoes hyperplasia due to the fact that they secrete RENIN
24
Q

Digoxin toxicity predisposing factors

A
  1. Renal failure
  2. Hypokalemia
  3. Drugs that displace digoxin from tissue binding sites and decrease clearance
25
Q

T-tubules

A

Invaginations of the muscle cell membrane located in close proximity to the terminal cisterns of the SR.

  • they are.found in striated muscle and contain voltage gated L-type Ca+ channels (dihydropyridine receptors)
  • during muscle contraction T-tubules rapidly depolarize impulse rapidly propogate through the interior of the muscle fibers., this ensure Ca+ release from SR occurs uniformaly throughout the fiver allowing for synchronized contraction of myofibril.
  • in girdle muscular dysrophy decrease number of functional T-tubules in affected muscle fibers lead to uncordinated contraction of myofibrils.
26
Q

Anti biotic that causes serotonin syndrome

A

Linezolid (it has MAOI activity)

27
Q

Serotonin syndrome

A
  1. Autonomic instability (hyperthermia, tachycardia and HTA)
  2. Altered mental status (agitation confusion)
  3. Neuomuscular hyperactivity (tremor,hyperreflexia,,myoclonus)
  4. GI symptoms and diaphoresis
28
Q

Segmental demylination and endoneural inflammatory infiltrates are seen in

A

Gullain barre syndrome.

Manifest ascending muscle weakness. Paralysis may ascend to cranial nerves or respiratory muscles.

29
Q

Scapies

A
  • rapidly spreading ,pruritic rash with erythmatous papules and excoriation on the extremities.
  • spreads through person to person contact
  • present with intense itching
  • rash is often worse at night and is due to type IV H.s (DELAYED) reaction to the mite.
  • linear burrows are the most specific finding in scabies
  • diagnosis is done using light microscopy visulization
30
Q

Transketolase enzyme is found in which organelle

A

Cytosol

31
Q

Polyarteritis nodosa affect what organs

A
  • kidney,heart,liver,and GI are commonly affected,

- it typically spares the lungs

32
Q

Parotid gland tumor can lead to

A

Facial droop (due to facial nerve injury present in there)

33
Q

Ovarian cancers signs and symptoms

A

Pelvic mass, ascitis, peritoneal metastasis that result in decreased appetite , abdominal distention and bowel or bladder changes.
Histology shows : anaplasia of epithelial cells, with invasion of the stroma, multiple papillary formations with cellular atypia and occasional psammoma bodies.

34
Q

Primary carnitine deficiency pathogenesis

A

The condition is caused by defect in protein responsible for carnitine transport across the plasma membrane , without suffeceint carnitine , FA cant be transported fron cytoplasm into the mitochondria as acyl-carnitine.

  • the mitochondria therefore cant ß-oxidize the fatty acids into actyl coa the carbon substrate for the citric acid cycle. As a result cardiac and skeletal myocytes cant generate ATP from FA and liver is unable to synthesize ketone bodies when glucose levels are low.
  • hypoketotic hypoglycemia results
35
Q

Primary carnitine defeciency symptoms

A 
Muscle weakness,
Cardiomyopthy
Hypoketotic hypoglycemia
Myalgia
Elevated muscle triglycerides
Tirdefulness
Easy fatiguability

Usmle (45 decks)

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