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Uworld assessment 2 > block 4 > Flashcards

block 4 Flashcards

1
Q

HIV protease serves to cleave the gag and pol gene products into their functional protein subunits

A

gag (p24) capsid protein
pol - reverse transcriptase, aspartate protease and integrase.
Cant cleave pol, no replication!
-point mutations in the viral protease region of HIV pol gene leads to resistance to protease inhibitors

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2
Q

protease inhibitors end in “navir” generally

examples:

A

ritonavir (inhibitor of cP450)
indinavir

navir never tease a protease\
side effects:
hyperglycemia, GI inoterlance, lipodystrophy

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3
Q

Kayser fleicher rings found in wilsons disease are brownish or gray green rings of fine granular copper deposits in?

A

The CORNEA

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4
Q

Neutrophil oxidative burst

A
  • once phagocytosis has occured, NADPH oxidase is activated!!
  • NADPH is a membrane protein on the phagosome and leads to superoxide
  • superoxide can reaction with water to form H2O2
  • fusion with azurophilic granules to the phagosome introduces proteases, defensinsa and myeloperoxidase.
  • MPO with H2O2 produc HOCL and other oxidation products that lead to further oxidative mebrane damage of the offending organism

-defect in NADPH oxidase results in chronic granulomatous disease

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5
Q

superoxide dismutase

A

catalyzes the conversion of superoxide to H2O2 and O2

  • it functions as a free radical scavenger to protect cells from oxidative damage
  • glutathione peroxidase is ana antioxidant enzyme that converts H2O2 to water and reduces oxidation products in cell membrane lipids.
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6
Q

dysplastic nevus syndrome is assoc. with melanoma

A

mutations in CDKN2A gene on chromosome 9p21
encodes cyclin dependent kinase inhibitor 2A (p16)
this normally negatively regulates cell cycle progression at the checkpoint of G1 and S

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7
Q

The cerebellum is derived from the embyonic metencephalon which is a part of the primitive hindbrain called

A

rhombencephalon

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8
Q

Basic zipper proteins

A
  • a short 30 amino acid alpha helical fragment with leucine residues in every seventh position is a part of leucine zipper dimerization domain found on transcription factors called basic zipper proteins
  • two such helical fragments allow binding of DNA
  • other DNA binding proteins include: helix loop helix and zinc finger motifs
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9
Q

Gq protein coupled receptor

A

Gq is a phosopholipase C which catalyzes the hydrolysis of phospholipids into inosityl triphosphate (IP3) and diacylglycerol (DAG).

  • IP3 releases stored calcium from the smooth ER or SR.
  • DAG activates protein kinase C which phosphorylates regulatory proteins and TF
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10
Q

Radiolabeled CO2 in de nova synthesis of pyrimidine and purine nucleotides

A
  • the first reaction of de novo of pyrimides is in the cytosol.
  • glutamine + CO2 + 2ATP make carbamoyl phosphate, this is catalyzed by carbamoyl phosphate synthetase II (CPSII).
  • this is different than the first reaction of the urea cycle where NH3+ CO2 + 2ATP are converted to carbamoyl phosphate by carbamoyl phosphate synthetase I in the mitochondria
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11
Q

positive psoas test

A

psoas abscess, appendicitis

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12
Q

alocholic cardiomyapathy

A

dilated cardiomyopathy

wet beri beri

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13
Q

rifampin

A

inhibits bacterial DNA-dependent RNA polymerase

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14
Q

Isoniazid

A

blocks mycolic acid synthesis by binding acyl carrier protein and ketoacyl carrier protein synthase thereby resulting in mycobacterial cell death

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15
Q

stain mycobacteria use ziel-neelsen acid fast stain

A

acid fast organisms will retain the red color of carbolfuschin stain after washing with acid alcohol while other bacteria will not

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16
Q

isotretinoin

A

functions in acne to normalize epidermal differentiation, decrease sebum production and prevent obstruction of the follicular-sebaceous unit.

17
Q

esophageal hiatus of the diaphragm

A

T10
-esophagus passes with the anterior and posterior vagal trunks

the aorta passes though the aortic hiatus at T12
-the IVC passes though the central dented known as the caval opening at T8

18
Q

Glucokinase (Hexokinase of the liver and pancreas)

-defect –> MODY

A

recall) glycolysis, glucokinase makes G6P and eventually –> TCA and we get increased ATP. ATP:ADP ration leads to closure (inhibition) of the ATP-sensitive /K+ channels.
- closure of the K+ channels leads to cell depolarization and gared Ca release –> beta cell insulin excocytosis.
- no glucokinase, no glycolysis

note glucokinase has higher Km than hexokinase.

19
Q

Von gierke disease
deect in glucose-6-phosphatease
glycogen storage disease type 1

A

provents g6p from going to glucose in gluconeogenesis and glycogenolysis
-patients will have severe fasting hypoglycemia, lactic acidosis, hyperuricemia, hyperlipidemia, hepatomegaly and renomegly

patients should avoid fructose and galactose as they cannot be converted to glucose due to a defect in gluconeogenesis

20
Q 
Pompe disease (glycogen storage disease type II)
lysosomal enzyme alpha-1,4-glucosidase (acid maltase, acid alpha-glucosidase)
A
  • degrades a small amount of glycogen
  • cause glycogen accumulation within lysosome (PAS-positive granules)
  • clinical findings in the HEART
  • signs: hypotonia, macroglossia, massive hypertrophic cardiomyapathy
21
Q

PAS stain

A
  • glycogen storage diseases (pompe)
  • adenocarcinoma (stains mucins)
  • Pagets disease of the breast
  • Whiple tophe whatever
  • alpha 1-antitrypsin deficency
22
Q

DIC labs

A
  • low fibrinogen and platelets
  • increase PT, PTT and fibrin degradation products
  • some schisotcytes maybe
23
Q

some inhibitors of CYP450 are cimetidine,metronidazole and quinidine

A

-inhibit p450, increase the amount of warfarin, leading to increased INR PT risk of bleeding

but if you induce p450, decrease warfarin, decrease PT INR and risk of embolus

24
Q

Induces of p450

A

barbituates

25
Q

cartilage/dermis/scelere with blueblack discoloration

A
  • alkaptonuria
  • autosomal recessive defect in homogentisic acid oxidase
  • which is required for the degradation of phenylalanine and tyrosine.
  • so homogentisic acid accumulates and deposits
26
Q

rheumatoid factor

A

is an IgM autoantibody directed against a patients own IgG

27
Q

Pontine hemorrhages

A

cause pinpoint pupils, loss of horizontal gaze, quadraperesis, decerebrate posturing and rapidly evolving coma culminating in death within hours. `

28
Q

Neoplastic of inflammatory lesions of the CNS can promote vasogenci edema

A

-via compromised blood-brain barrier. Increase vascular leak into the interstititum of the CNS contributes to a rising ICP

29
Q

Reiter syndrome (reactive), psoriatic athritis and ankylosing spondylitis and IBD are all HLA?

A

HLA B27 associated

30
Q

Reactive arhtritis, reiter cant see, can’t pee cant climb a tree

A

-precipitated by urogentical infection such as clamydia but can also occur in relation to intestinal infections with salmonella, shigella, campy and yesinia

31
Q

Amphotericin B is a polyene macrolide antifungal

A
  • bind ergosterol, creating pores in the fungal cell membrane, that allow for electrolyte escape and disruption of cellular homeostasis
  • side effects: nephrotoxicity, hypokalemia and hypo magnesia and renal tubule acidosis
32
Q

Echinocandian agents such as caspofungin

A

-inhibit cell wall synthesis

33
Q

Flucytosine is a pyrimidine analogue

A

its metabolites impair fungal DNA replication and RNA synthesis

34
Q

Pasteurella multocida

A

typically causes human infections following a dog or cat bite
-the disease typically begins with redness, pain, swelling and possible ulceration at the bite site followed by lymphangeitis and regional lymphadenoapthy

35
Q

water deprivation test, and urine doesnt concentrate but the serum becomes hyperosmolar

A

nephrogenic DI

-serum hyperosmolarity, dilute urine and increased serum vasopressin levels in the setting of dehydration

36
Q

hypercalcemia can cause polyuria, polydipsisia and dilute urine

A

its path is similiar to Nephrogenic DI

it is not do to osmolar diueresis

37
Q

GP IIb/III is a surface receptor on platelets that belong to a family of INTEGRIN receptors

A
  • it binds fibrinogen (a type of integrin)
  • inhibitors include:abciximab, eptifibatide and tirofiban.

epitifibatide is an analogue of the carboxy terminal of the delta chain of fibrinogen

38
Q

Clopidogrel is an inactive produrg that must be activated by CP450!!

A

so inhibitors of Cp450 like omeprazole would decrease the amount of activated clopidogrel. Clopidogrel is an ADP receptor antagonist

Uworld assessment 2 (4 decks)

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