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STEP1 Uworld > Deck 3 > Flashcards

Deck 3 Flashcards

0
Q

A patient with wernicke’s has trouble utilizing glucose for energy, name 3 enzymes that are impaired:

A
  • Pyruvate dehydrogenase
  • alpha-ketoglutarate DH
  • Transketolase (HMP shunt…. pentoses –> Glyceraldehyde-3-P)
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1
Q

What type of bacteria can typically survive very high temperatures (past 100 deg C)?

A
  • Spore-forming ones

e. g. Bacillus and Clostridium

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2
Q

TZD diabetes drugs like Pioglitazone’s most common side effect is _________. Because of this, you dont wanna give it to patients who have ________.

A
  • EDEMA and weight gain (2/2 edema)

- patients with HF

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3
Q

WHat are some clues to tell you a patient with SLE has anti-phospholipid antibodies?

A
  • prolonged aPTT (in vivo though, they are actually Hyper-coagulable)
  • False positive non-treponemal tests
  • recurrent miscarriages
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4
Q

The __________ nerve runs right above the superior thyroid artery. injury causes loss of innervation to the _________ muscle.

A
  • Superior laryngeal nerve
  • Cricothyroid muscle (external branch)
  • internal branch —> sensory innervation of Larynx above vocal cords

*All other laryngeal muscles done by RECURRENT Laryngeal nerve

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5
Q

How does the killed influenza virus prevent infection?

A
  • increases host circulating antibodies against Hemaglutinin
  • The antibodies interfere with the binding of Hemaglutinin to the sialic acid on host cell plasma membranes —> prevents viral entry into host cells via rec.-mediated endocytosis.

*In general, killed vaccines generate a humoral response instead of a strong cell-mediated response

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6
Q

The presence of hemosiderin-laden macrophages is detectable by _______ staining. Their presence in pulmonary alveoli indicates _________.

A
  • Prussian blue staining

- chronic elevation of capillary hydrostatic pressures. (usually L sided HF)

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7
Q

How do PPI’s work?

A

-Inhibit active transport of H+ out of gastric cells by inhibiting H+/K+ ATPase

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8
Q

How does McArdle’s disease typically present and what enzyme is deficient?

A
  • Decr exercise tolerance
  • myoglobinuria
  • Muscle pain with physical activity

-Glycogen phosphorylase (myophosphorylase in muscle)

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9
Q

What is a common side effect of colchicine?

A
  • GI distress

* affects microtubules, including those of GI mucosal cells –> diarrhea, N/V, abd pain

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10
Q

___________ forms precursor mRNA from the DNA template

A

-RNA polymerase 2

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11
Q

Pro-carcinogens are converted to carcinogens by ________, the same enzymes responsible for metabolizing steroids, alcohol, toxins, etc?

A

-P450 monooxygenase

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12
Q

What is Mifepristone used for? How does it work? Side effects?

A
  • Medical abortion
  • Progesterone antagonist
  • Side effects related to its stimulation of Prostaglandin release: Abd cramps, nausea, vaginal bleeding
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13
Q

What are Homeobox genes?

A
  • Highly conserved DNA sequences

- code for DNA-binding transcription factors…which alter expression of genes involved in morphogenesis

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14
Q

Acutely, corticosteroids cause an increase in _________ (cells), and a decrease in _________ (cells)

A
  • Neutrophils

- Lymphocyte, monocyte, basophil, eosinophil

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15
Q

What is the treatment for Acetomeniphen toxicity?

A
  • Sulfhydryl group supplementation (N-acetyl cysteine aka NAC)
  • Also acts as a glutathione substitute and binds to the toxic metabolite
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16
Q

What is the effect on TSH, Reverse T3, and T4 ….from supplementation of exogenous T3?

A

-All decrease

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17
Q

Communicating hydrocephalus usually occurs 2/2 dysfunction or obliteration of ________

A

-Subarachnoid villi (granulations)

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18
Q

Where should thoracoscentesis be performed?

A
  • Midclavicular –> above rib 7
  • Midaxillary –> above rib 9
  • posterior scapular –> above rib 11
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19
Q

Burkitt’s lymphoma is associated with what translocation?

A
  • C-MYC gene

- usually onto the Ig heavy chain region of chromosome 14 ( t(8;14) )

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20
Q

High levels of aflatoxin from aspergillus is associated with a __________ transversion in the _______ codon of the p53 gene. This greatly increases the risk of ________.

A
  • G:C —> T:A
  • 249 codon
  • Hepatocellular carcinoma

*most common is aflatoxin B1

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21
Q

Describe Estrogen’s effects on Thyroid hormones:

A
  • Estrogen increases TBG

- This leads to increased TOTAL T3 and T4, but Free T3 and T4 remain unchanged, as does TSH

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22
Q

Sulfonylurea or meglitinide abuse shows increases in ________.
The same is true for what tumor?

A
  • Insulin, pro-insulin, c-peptide
  • Insulinoma

*Insulin abuse would show low c-peptide

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23
Q

What is the mechanism of action for chloramphenicol? What are some notable side effects?

A

-binds the 50s ribosomal subunit and inhibits peptidyl transferase enzyme —> inhibition of protein synthesis

  • Dose-related Anemia, Leukopenia, and/or TCP (reversible with med withdraw)
  • Dose-independent Aplastic anemia (usually severe and fatal without marrow tpx)
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24
Q

What is the mechanism of action of etanercept and what is it used for? Patients should first be screened for _______.

A
  • TNF-alpha inhibitor
  • Tx of mod-severe RA, particularly in pts who failed methotrexate.
  • TB

*also incr risk of infxn with fungi, and other mycobacteria

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25
Q

A child with ulcerative gingivitis, fever, and cervical LAD may have ________. Sample from one of the ulcers shows multinucleated giant cells with some intranuclear inclusions.

A
  • HSV-1 primary infection

* Q 1499

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26
Q

What viruses are the most common causers of aseptic meningitis?

A

Enteroviruses:

  • coxsackie
  • Echovirus
  • polio
  • enterovirus
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27
Q

Which bacteria is Gram positive rod in clusters, non-motile, and has polar granules that stain deeply with aniline dyes?

How does its toxin work?

A
  • Corynebacterium diphtheriae
  • AB toxin
  • B toxin –> endocytosis of toxin and affinity for cardiac and neuronal cells
  • A toxin —> Inhibits EF-2 by ADP-ribosylation –> inhib prot synthesis
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28
Q

Inhaled anesthetics with high A-v O2 gradients have _______ tissue solubility, and _______ onsets of action.

A
  • High
  • Slower
  • slower bc tissues extract a lot of drug, meaning it takes longer to get a good concentration in the brain
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29
Q

In a Methacholine challenge, decrease in FEV1 by more than ______ from baseline indicates diagnosis of bronchial asthma

A

-20%

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30
Q

Pathway for pupillary light reflex:

A

-Afferent on CN2 –> Pretectal nucleus in the superior colliculus —> fibers project to ipsilateral and contralateral Edinger westphal nuclei —> efferent fibers of CN3 leave EW nuclei travel within CN3 to the ciliary ganglion —–> synapse in ciliary ganglion with post-synaptic parasympathetics —> ciliary muscles —> constriction

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31
Q

What is the clinical presentation involved with cyanide poisoning?
What are 2 treatment options and how do they work?

A

Symptoms (rapidly developing):

  • cutaneous flushing
  • tachypnea
  • headache
  • tachycardia
  • N/V
  • confusion
  • weakness

Tx options:

  1. Nitrites: induce formation of metheboglobin by oxidizing Iron –> strongly binds Cyanide and doesnt let it interact with O2 utilizing cells
  2. Sodium Thiosulfates = combine with cyanide to form less-toxic thiocyanate –> urinary excretion
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32
Q

What is the Sudan III stool stain used for?

A

-Detection of the presence of fat in the stool. Diagnosis of malabsorption

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33
Q

The R brachiocephalic vein is formed by the union of the R _______ and the R ________.
*compression leads to _______

A
  • R subclavian
  • R internal jugular

*compression –> R sided face, neck and arm swelling

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34
Q

What is the most common site of staph aureus colonization (including MRSA) ?

A

-Anterior nares

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35
Q

Describe the underlying pathophys of CML and what drug targets it specifically?

A
  • t(9;22) –> ABL oncogene translocated to chromosome 22, where it is placed next to the BCR proto-oncogene
  • New BCR-ABL gene codes for a protein with tyrosine kinase activity
  • Tyrosine kinase stimulates proliferation of granulocytic precursors —–> CML

-Gleevec = tyrosine kinase inhibitor, specific for BCR-ABL protein. Competitively binds the ATP binding site of the ABL portion

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36
Q

WHat facilitates auscultation of an Aortic regurgitation murmur?

A

-Patient leaning forward and fully exhaling

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37
Q

in What area is H. Pylori most typically found in greatest concentration?

A

-Pre-pyloric area of the antrum of the stomach

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38
Q

Buerger’s disease is also known as _________.

  • It is common in what population?
  • what is seen histologically?
A
  • Thromboangiitis obliterans
  • Smokers before age 35 (either direct endothelial cell toxicity or hypersensitivity to tobacco products)
  • segmental vasculitis extending into contiguous veins and nerves
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39
Q

What do kaposi’s sarcoma lesions of the GI tract typically look like? both grossly and histologically

A
  • Gross: vary from reddish/violet flat maculopapular lesions to raised hemorrhagic nodules or POLYPOID masses.
  • Histo: SPINDLE CELLS with cytologic atypia, blood vessel proliferation, extravasated RBCs with hemosiderin deposition
40
Q

What is the clinical presentation of polyarteritis nodosa?

  • histology of vessels?
  • associated with what infection?
A

Clinical:
-fever, abd pain, periph neuropathy, weakness, weight loss, diffuse muscular aches and pains.

Histo:

  • transmural inflammation of the arteries with fibrinoid necrosis
  • fibrous wall thickening

Association:
-Hep B infection (10-30% of cases )

41
Q

Saddle anesthesia and impaired anal sphincter tone are symptoms of ________, which is associated with damage to the ________ nerve roots

A
  • Cauda equina syndrome

- S2 - S4

42
Q

what are some ligands/receptors that use the phosphoinositol messenger system?

A
  • Alpha adrenergic receptors, M1 and M3 cholinergic, V1 vasopressin, Histamine, Oxytocin, Angiotensin 2, TRH, GnRH
43
Q

Which 2 organisms causing non-gonococcal urethritis are not succeptible to penicillins or cephalosporins, and why?

A
  • Chlamydia trachomatis –> lacks peptidoglycan in its cell wall
  • Ureaplasma urealyticum lacks a cell wall entirely
44
Q

Von-Hippel-lindau lesions include _________. Inheritance is_______

A
  • cerebellar or retinal hemangioblastoma
  • cysts and/or neoplasms in the kidneys, liver, and/or pancreas
  • Incr risk of RCC, sometime b/l

-Inheritance is AD

45
Q

what histologic feature is seen in meningioma?
What type of cell does a meningioma arise from?
what other cancer has this characteristic histology?

A
  • Psammoma bodies (Q 1151)….round, dense pink hyalinized things
  • Arachnoid villi
  • papillary thyroid cancer and serous papillary ovarian cancer
46
Q

Primary oocytes arrest in _________ and remain there until puberty. FSH stmulates some oocytes to complete __________, forming secondary oocytes and polar bodies. LH then stimulates release of this oocyte at day 14 of cycle, but his secondary oocyte is stuck in _______ until fertilization occurs.

A
  • prophase of Meiosis 1
  • Meiosis 1
  • Metaphase of meiosis 2
47
Q

WHat heart manifestation is seen in fragile X?

A

-Mitral valve prolapse

48
Q

In a hydrocele, fluid is confined to what layer?

A

-Tunica vaginalis

49
Q

Bcl-2 gene overexpression is normally seen in what cancer? What is the translocation and what does Bcl-2 do?

A
  • Follicular lymphoma (clinically = lymphadenopathy)
  • translocation of the bcl-2 oncogene from chrom. 18 to the Ig heavy chain locus on chrom 14
  • Bcl-2 –> inhibits apoptosis –> tumor growth
50
Q

What is the clinical presentation of inhaled anesthetic hepatotoxicity? Gross and histo appearance? Labs?

A
  • fever, anorexia, nausea, myalgias, arthralgias, rash, death
  • extensive hepatocellular damage –> atrophy –> shrunken appearance
  • histo = centrilobular necrosis and inflamm of portal tracts and parenchyma
  • Markedly elevated transaminases and prolonged PT
  • since its acute…albumin is fine bc of half life, no portal hypertension signs
51
Q

What mutations result in a LONGER, nonfunctional protein, but with retained immunoreactivity?

A

-Splice site mutation

52
Q

In a CNS infarct, after macrophages come and clear debri etc, which cells form a wall around the resorbed cystic cavity?

A

-Astrocytes (gliosis)

53
Q

What are common findings on vaginal exam in pts with endometriosis?

A
  • Nodularity of the uterosacral ligaments

- Fixed retroversion of the uterus

54
Q

What factors can predispose someone to first-dose HoTN phenomenon of ACEi’s?

A
  • Hyponatremia
  • Hypovolemia 2/2 diuretic use (thiazide or loop)
  • low baseline BP
  • high renin or aldo
  • renal impairment
  • HF
55
Q

What Dx should you expect in an elderly pt with: Easy fatigue, constipation, bone pain (usually back/ribs), and renal failure?

What is seen in the kidneys?

A
  • Multiple myeloma

- atrophic tubules with large obstructing eosinophillic casts

56
Q

WHat are the main anti-fungal classes and how do they work?

A

Polyenes: (amphotericin and nystatin)
-bind ergosterol and create membrane pores

Triazoles: (azoles)
-inhibit ergosterol synthesis

Echinocandins: (fungins)
-inhibit glucan synthesis

Pyrimidines: (flucytosine)
-interferes with RNA and prot synthesis

57
Q

Bradykinin vs ANP/BNP actions on arterioles and veins?

A
  • ANP/BNP dilates both

- Bradykinin constricts veins and dilates arterioles

58
Q

What is seen histologically in acute viral hepatitis?

A
  • Ballooning degeneration
  • mononuclear cell infiltrates
  • councilman bodies (eosinophillic apoptotic hepatocytes)
59
Q

What is the histological appearance of renal tissue in acute pyelonephritis?

A
  • massive infiltration of interstitium with Neutrophils
  • neutrophil infiltration of tubular lamina as well
  • possible microabcesses
  • WBC casts
60
Q

How do phosphodiesterase inhibitors work for HF? example of one? Another effect?

A
  • incr cAMP –> incr intracellular Calcium –> incr contractility
  • Milrinone
  • vasodilation (careful in hypotensive pts)
61
Q

Diff between cervical and thoracic spinal cord segment cross section?

A

-Thoracic = lateral horns

62
Q

Blood from an infected patient clots in a tube with EDTA while in ice water….but rapidly un-coagulates when tube is warmed in hand. What causes this? Which organism is likely responsible?

A
  • Cold Aglutinins (IgM)
  • Antibodies produced in response to Mycoplasma directed against surface antigens –> homologous to antigens on RBC membranes

-Mycoplasma (also EBV)

63
Q

What disease is caused by deficient or defective glycoprotein 2b/3a on platelets?

What drug is a blocker of the GP 2b/3a receptor, inhibiting its interaction with fibrinogen?

A
  • Glanzman thrombasthenia
  • abciximab (ReoPro)
    others: eptifibatide , tirofiban
64
Q

WHat blood vessel is most at risk of damage with femoral neck fractures?

A

-Medial circumflex artery

65
Q

What type of cells secrete catecholamines, and from where? In response to what stimulus?

*What are these cells’ origin?

A
  • Chromaffin cells in the adrenal medulla
  • AcH

*They are modified post-ganglionic sympathetic neurons derived from neural crest.

66
Q

What hormone dramatically increases the secretion of pancreatic bicarbonate?
Where is it released from?
What stimulates it’s release?

A
  • Secretin
  • S endocrine cells in the duodenum
  • Release of HCl into the duodenum
67
Q

What type of drug is phentolamine?

A
  • alpha receptor blocker

- good for reversing vasoconstriction caused by certain drugs like Noreipinephrine

68
Q

Cleft Lip results when one of the ________ fails to properly fuse with the _______.

A
  • Maxillary prominences

- Intermaxillary segment

69
Q

The liver uses ________ transport to get indirect billi from the blood. It uses ________ transport to secrete Direct billi into the biliary system.

A
  • Passive (facilitated)

- Active

70
Q

Dendritic cells arise from what cell line?

A

Myeloid

71
Q

What is the pathophys of psoriasis?

What is the histology?

A

-CD4 cells activating CD8 cells in the epidermis after interacting with APCs —> cytokine production and keratinocyte growth factor production –> proliferation, inflammation

  • Histo:
  • hyperkeratosis, acanthosis
  • reduced or absent stratum granulosum
  • epidermal cell layer above the dermal papillae = thinned with dilated blood vessels
72
Q

What determines whether someone with a carcinoid tumor has carcinoid syndrome (symptoms)?

A
  • If the tumor metastasizes

* normally, when confined to intestine, the secretory products are metabolized by the liver, so no symptoms

73
Q

If a patient has an increased PT, but normal PTT and bleeding time, then there is impairment in the ________ pathway, meaning factor ______ is deficient:

A
  • Extrinsic pathway

- 7 (any others???)

74
Q

What are some anaerobic bacteria that cause lung abcess following aspiration?

A
  • Peptostreptococcus
  • Prevotella
  • Bacterioides
  • Fusobacterium
75
Q

What does it mean if someone’s PTT remains unchanged after addition of activated Protein C?

A
  • Possible Factor 5 Lieden mutation

- mutated factor 5a is resistant to inactivation by protein C

76
Q

What are the 4 main thalamic nuclei and their function?

A

VPL: —> primary somatosensory cortex

  • Spinothalamic tract - pain and T
  • Medial lemniscus - position and proprioception

VPM: —> primary sensory cortex

  • trigeminal pathway
  • gustatory pathway

Lateral geniculate body:
-relay nucleus for vision

Medial geniculate body:

  • auditory pathway
  • receives impulses from superior olivary nucleus and the inferior colliculus of the pons —-> projects to auditory cortex
77
Q

The ________ artery runs with the radial nerve, and is succeptible to damage in humeral shaft fractures

A

-Deep brachial

78
Q

What 2 features of a drug result in preferential processing in the liver rather than the kidneys?

A

-High Lipophilicity
-High volume of distribution
(low volume of dist. would mean it gets confined to bloodstream and tends not to diffuse into hepatocytes as easily)

79
Q

Atenolol is a selective/non-selective? Beta-blocker. It works by _______ cAMP in associated receptor(s)’ tissue.
Which tissues would it affect?

A
  • Selective Beta-1 antagonist at low doses
  • Decreases cAMP
  • Beta-1 found on heart and in JG cells of kidney, none in periph vessels
80
Q

How is acyclovir activated in the cell to terminate viral DNA ?

A
  • converted to acyclovir mono-phosphate via THYMIDINE KINASE
  • rate limiting

-Then cellular enzymes phosphorylate it to active tri-phosphate form –> impairs viral DNA polymerase

81
Q

What are adaptive immune mechanisms that prevent infection with Influenza virus?

A
  • Anti-hemaglutinin IgG serum antibodies

- Anti-hemaglutinin IgA mucosal antibodies

82
Q

What is the underlying pathophys in fragile X?

A
  • mutation in FMR-1 gene on long arm of chromosome X
  • Hypermethylation of gene —> subsequent deactivation
  • <200 repeats = usually phenotypically normal
83
Q

What nerve can be damaged from objects stuck in the piriform recess? What reflex is therefore lost?

A
  • Internal laryngeal nerve
  • Cough reflex

*common for food items to get stuck there

84
Q

What are some factors that precipitate isolated episodes of A-fib?

A
  • Binge alcohol consumption
  • incr sympathetic tone
  • pericarditis
85
Q

What makes Automaticity of cardiac pacemaker cells possible?

A
  • slow, inward sodium current that occurs during phase 4

- this brings membrane potential closer to threshhold –> phase 0 calcium influx

86
Q

The _______ duct connects the midgut lumen with the yolk sac cavity in embryonic life.
It normally obliterates during the _____ week of development.
If obliteration is incomplete, the following 4 things can occur: ______

A
  • Omphalomesenteric (Vitelline) duct
  • 7th week
  • Persistent duct, Meckel diverticulum, Vitelline sinus, Vitelline duct cyst
87
Q

PCR requires primers that are complementary to _______

What are the other requirements?

A
  • regions of DNA flanking the segment of interest

- DNA template, DNA polymerase, Deoxynucleotide triphosphates

88
Q

What 2 tissues cannot use ketone bodies for energy?

A
  • RBC (lack mitochondria…cant use acetyl CoA)

- Liver (lack enzyme: succinyl CoA-Acetoacetate CoA transferase)

89
Q

Which organisms are facultatively intracellular?

A
  • salmonella
  • Neisseria
  • Brucella
  • Mycobacteria
  • Listeria
  • Francisella
  • legionella
  • Yersinia
90
Q

What drug is used for tx of tinea corporis? how does it work?

A
  • Terbinafine …or other Allylamines

- Suppresses Squalene oxidase –> decr ergosterol synthesis

91
Q

What is the tx for someone who ingested rat poison?

A
  • FFP and vitamin K

* Syrup of ipecac is an emetic that is effective if taken immediately following the ingestion

92
Q

What is Muromonab-CD3 (OKT3) and how does it work?

A
  • Drug used to reduce acute rejection in pts with kidney, heart, liver Tpx
  • Monoclonal antibody vs CD3
93
Q

Methotrexate can cause what lung complication?

A

-Interstitial pneumonitis and fibrosis

94
Q

Cytokeratin staining identifies ________ - derived cells

A

-Epithelial

95
Q

the ________ oncogene encodes for a 185-kD transmembrane glycoprotein that has intracellular tyrosine kinase activity.

What does it do?

Overexpression is seen in 30% of invasive breast cancers, and is also associated with _________.

A

Her2/neu

  • controls epithelial growth and differentiation. too much –> too much growth
  • Ovarian, gastric, and endometrial carcinomas as well
96
Q

Use of concentrated O2 therapy for neonatal respiratory distress is associated with what complication?

A
  • Retinopathy of prematurity

- Retinal neovascularization, possible retinal detachment, possible blindness

97
Q

Inheritance of G6PD deficiency?

A

X-linked recessive

98
Q

What is the adjunct test used for CF diagnosis when sweat chloride test is negative?

What does it normally show if positive?

A
  • Measurement of nasal transepithelial potential difference

- Significantly more negative nasoepithelial surface due to Na+ absorption

STEP1 Uworld (7 decks)

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