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STEP1 Uworld > Deck 4 > Flashcards

Deck 4 Flashcards

0
Q

1, 2, and 3 standard deviations from the mean = ______, _______, _______ % of the data

A
  • 68
  • 95
  • 99.7
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1
Q

aromatase converts ________ to estrone and ________ to estradiol. Placental aromatase deficiency causes __________ in the mother and ______ in the neonate.

A
  • Androstenedione
  • Testosterone
  • virilization in mom
  • ambiguous external genitalia in female infants (normal internal genitalia)
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2
Q

What are cholinergic agonists’ effect on vasculature?

A

-bind to muscarinic receptors on endothelial cells –> promote release of NO —> activation of Guanalyl cyclase –> decr endoth calcium conc, —> Vasodilation

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3
Q

________ co-occurs in more than half of patients with temporal arteritis……What are the Sx of this?

A
  • Polymyalgia rheumatica

- neck, torso, shoulder, pelvic girdle pain and morning stiffness….possibly also fever, fatigue, and weight loss

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4
Q

What is the initial treatment for staph epidermidis infection?

A
  • Vancomycin
  • possibly add rifampin or gentamicin

*frequently methicillin resistant

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5
Q

Through which foramen do cranial nerve 9, 10, and 11 leave?

A
  • Jugular foramen

* part of 11 also leaves through foramen magnum

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6
Q

Where is somatostatin released from? WHat does it do?

A
  • Pancreatic delta cells

- suppresses release of secretin, CCK, glucagon, insulin, and gastrin

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7
Q

CO poisoning causes a _______ shift in the O2-Hgb dissociation curve

A

-Left shift

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8
Q

Accumulation of lipids WITHIN muscle fibers is seen in what diseases? Example?

A
  • Lipid myopathies

- Carnitine palmitoyltransferase deficiency

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9
Q

Pregnant lady with HIV who hasnt taken antiretrovirals…..whatdo you do?

A
  • Start Zidovudine at 14 weeks!
  • continue throughout pregnancy, IV administration during labor
  • **Oral ZDV to the infant for 6 weeks post-partum
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10
Q

What areas of the brain are selectively more vulnerable to ischemic irreversible damage?

A
  • HIPPOCAMPUS is first area damaged during global cerebral ischemia, damage to pyramidal cells
  • Neocortex
  • Purkinje cells of the cerebellum
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11
Q

CN3 exits the midbrain and courses between the _________ and ________ arteries.

A
  • Posterior cerebral

- superior cerebellar

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12
Q

Aneurysm of the AICA can compress ________

A
  • CN7

- CN8

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13
Q

What is Bethanechol used for? mech of action?

A
  • Muscarinic agonist
  • used to improve bladder emptying in patients with post-surgery urinary retention
  • normal post-void resid. volume is < 50 cc
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14
Q

What is the most common benign lung tumor? What is it made out of? How is it found?

A
  • Hamartoma
  • disorganized cartilage, fat, fibrous tissue
  • Usually found incidentally on CXR in 50-60 yr olds. Coin lesion with “popcorn” calcification
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15
Q

WHat are the 4 types of non-neoplastic colonic polyps?

A
  • Hyperplastic = well diff, form glands and crypts
  • Hamartomatous = mucosal glands, SM, conn. tissue (peutz jeghers, Juvenille polyposis)
  • Inflammatory = UC and crohns (regenerating intestinal mucosa)
  • Lymphoid = kids …mucosa infiltrated with lymphocytes
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16
Q

Which type of polyp is pre-malignant? what 3 things determine potential for malignant transformation?

A
  • Adenomatous
    1. Degree of dysplasia
    2. Histologic pattern –> villous more likelly to transform than tbular
    3. Size —> >4cm have 40% chance of transformation
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17
Q

What condition causes you to see hemosiderin-containing macrophages in the alveoli?

A
  • aka “siderophages” , aka “heart failure cells”
  • Chronic left heart failure!
  • repeated episodes of pulm edema –> RBC extravasate into alveoli due to incr pulm vascular pressures –> hemosiderin dep in macrophages who eat it
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18
Q

What are some 1st-generation anti-histamines and what are their side effects?

A
  • Chlorpheniramine, diphenhydramine, promethazine, hydroxyzine
  • Anti-muscarinic, serotonergic (appetite stim) , alpha adrenergic (dizziness, orthostatic HoTN)
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19
Q

In scleroderma, deposition of collagen in tissues happens bc monoclonal ________ cells secrete _________ , increasing the production of collagen and ECM proteins by fibroblasts

A
  • Monoclonal T-cells

- various cytokines, especially TGF-BETA

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20
Q

What are the 3 phases and characteristics of ATN from ischemia to kidney?

A
  1. Initiation:
    - original insult
    - start of damage, GFR starts to fall, UOP decreases
  2. Maintenance (oliguric phase)
    - renal tubule injury established
    - GFR stabilizes at well below normal
    - lasts for 1-2 weeks
    - microscopy = granular casts in tubular lumina, tubular epith. necrosis
  3. Recovery phase:
    - re-epithelization of tubules
    - polyuria and gradual normalization of GFR
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21
Q

IL-4 is responsible for ______, while IL-5 is responsible for ______

A
  • B-cell growth and isotype switching, IgE secretion, diff. of naive T cells
  • B-cell differentiation, IgA production, eosinophil activity
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22
Q

What protein is secreted by Eosinophils, causing Bronchial epithelial damage in pts with allergic asthma? What else does it do?

A
  • Major basic protein

- kills helminths!

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23
Q

What is seen in the urine of patients with cystinuria? How is presence of cysteine tested?

A
  • Hexagonal cystine crystals
  • Sodium Cyanide nitroprusside test: detects cystine’s sulfydryl groups

*Cyanide converts cystine to cysteine, nitroprusside then binds to cysteine –> turns purple

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24
Q

Dofelitide is a class _____, ______- blocking agent used for arrhythmia. It affects phase ______ of the cardiac myocte AP

A
  • class 3
  • K+ blocking
  • phase 3
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25
Q

Describe Osler-Weber-Rendu syndrome:

A
  • Autosomal dominant

- telangiectasias of the skin and mucous membranes (lips, oronasopharynx, resp tract, Gi tract, urinary tract)

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26
Q

Function of BRCA genes?

A

DNA repair

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27
Q

Why do people get neuro sx during panic attacks?

A
  • Decr CO2 –> Vasoconstriction of cerebral vessels

* CO2 is normally a very potent vasodilator in the brain …….PO2 has much less of an effect

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28
Q

How can you differentiate between sarcoidosis and hypersensitivity pneumonitis?

A
  • CD4/CD8 ratio = high in sarcoid, low in others

* sarcoid also can have hypercalcemia and hilar adenopathy

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29
Q

What receptors does carvedilol antagonize? What is it particularly useful for?

A
  • Beta 1 and 2
  • Alpha 1

-CHF!

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30
Q

What enzyme induces class switching in B cells?

A
  • DNA recombinase

* remember the order…. Ig M, D, G, E, A

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31
Q

Mechanism of pulsus paradoxus?

A

-Incr venous return with inspiration —> poor compliance of pericardium causes RV to bulge into LV space —> decr LV filling and subsequent SV —> decr BP with inspiration

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32
Q

How is digoxin cleared?

A

Renally

  • half life 1.5 days
  • older patients get lower dose bc of declining renal function
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33
Q

What arteries supply the ureters?

A
  • Upper 1/3 = branches of renal artery

- Lower 2/3 = branches from aorta, iliac, gonadal, vesical

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34
Q

______ is a polypeptide precursor of beta-endorphins, ACTH, and MSH?

A

-POMC (propiomelanocortin)

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35
Q

What is the most common clinical manifestation of botulism in adults?

A
  • 3 D’s
    1. Diplopia
    2. Dysphagia
    3. Dysphonia
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36
Q

What drugs can cause hepatic granulomatosus? (hint: MHQ)

A
  • Methyldopa
  • Hydralazine
  • Quinidine
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37
Q

Which cancers of the thyroid are associated with the RET proto-oncogene?

A
  • Medullary thyroid cancer

* associated with MEN 2A and 2B

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38
Q

What does medullary thyroid cancer look like on histology?

A

-Spindle-shaped cells in an amorphous background

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39
Q

In males, incomplete fusion of the ________ causes hypospadias

A

-Urogenital folds

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40
Q

What do you need to periodically monitor in patients taking Lithium?

A
  • blood lithium levels
  • TSH
  • renal function
41
Q

What is the most common renal malignancy and what does it look like on histology?

A
  • Clear cell carcinoma

- Rounded or polygonal cells with abundant clear cytoplasm (packed with glycogen and and lipids)

42
Q

What is the formula for half-life?

A

half life = 0.7 x Vd / CL

43
Q

After blunt trauma to the eye…..If the inferior orbit is broken, blood would leak into the _______, and if the Medial orbital wall is damaged, blood would leak into the _________.

A
  • Maxillary sinus

- Ethmoid air cells

44
Q

What drugs are used to treat Cholinergic toxicity (organophosphates)?

A
  • Atropine (does not prevent muscle paralysis however, bc it doesn’t work on Nicotinic receptors)
  • Pralidoxime reverses both nicotinic and muscarinic by “restoring” cholinesterase
45
Q

Describe the pathophys of a serum sickness type of reaction:

A
  • Type 3 hypersensitivity (immune complex deposition)
  • Fever, pruritic rash, arthralgias 7-14 days after exposure to antigen
  • small vessel vasculitis with fibrinoid necrosis and neutrophil infiltration
  • Low complement!!!*** bc consumed locally in affected tissues
  • neutropenia

*reaction to non-human proteins…..including the “mab” monoclonal Ab drugs

46
Q

Dobutamine is mainly _________ - selective, and used for ________

A
  • Beta-1

- Heart failure for chronotropy and inotropy….also for stress tests (chemical)

47
Q

SIADH can be caused by paraneoplastic syndrome of what lung cancer?

A
  • Small cell carcinoma

* Clinically normal body fluid volume!!

48
Q

What virulence factor allows E. Coli to survive in the bloodstream and establish meningeal infection?

A
  • K1 capsule

- prevents recognition, complement deposition, and subsequent phagocytosis

49
Q

When do myoclonic seizures normally occur in a patient with myoclonic syndrome?

Treatment?

A
  • in the morning, typically induced by lack of sleep or stress
  • Valproic acid
50
Q

What is the function of the 16S rRNA in prokaryotic ribosomes?

A
  • Found in the 30S subunit
  • Contains a sequence complementary to the shine-dalgarno sequence on mRNA
  • necessary to bind mRNA for initiation of protein translation
51
Q

What are some aggravating factors, including meds, of restless-leg syndrome?

A
  • alcohol
  • nicotine
  • caffeine
  • glucocorticoids
  • SSRIs
  • Lithium
52
Q

What is the most crrucial gene regulated by PPAR-gamma?

A

-Adiponectin (cytokine secreted by fat tissue….low in diabetics)

53
Q

Male infants with 21-hydroxylase have _______ genitalia.

A

Normal !

-females have ambiguous (virilization)

54
Q

How do you calculate renal plasma flow from renal blood flow?

A

(1 - hematocrit) x renal blood flow

55
Q

What do xanthelasmas look like on histology?

A

-benign-appearing macrophages with abundant, finely vacuolated (foamy) cytoplasm containing cholesterol (free and esterified), phospholipids, and TGs

56
Q

Blood type A or B moms have ____ immunoglobulins, whereas O moms have _______.

A
  • IgM (cant cross the placenta)

- IgG

57
Q

What lab value is abnormal in both hemophilia A and B?

A

-PTT

58
Q

The 3rd pharyngeal arch is associated with the _______ aortic arch and the _______ nerve, and gives rise to _________

A
  • 3rd aortic arch
  • glossopharyngeal nerve
  • parts of hyoid bone, stylopharyngeus muscle, common and proximal internal carotid arteries
59
Q

Pt with a lung mass (or breast, ovarian, uterine) has progressively worsening dizziness, limb and truncal ataxia, dysarthria, visual disturbances……….brain tissue shows extensive cerebellar purkinje cell degeneration.

-What is the diagnosis and what is the underlying patholog. process?

A
  • Paraneoplastic cerebellar degeneration
  • immune response against tumor cells that cross-reacts with with purkinje neuron antigens —-> acute onset rapid degeneration of the cerebellum
  • Anti-Yo, anti-P/Q, and anti-Hu
60
Q

PsychoPharm: _________ is associated with retinitis pigmentosa, while _______ is associated with corneal deposits

A
  • Thioridazine

- chlorpromazine

61
Q

Which beta-blocker also has class 3 anti-arrhythmic properties? How does it work and what are some side effects?

A
  • Sotalol
  • blocks K+ channels, slows repolarization
  • Side eff = QT prolongation, PR interval prolongation
62
Q

Decreased heme concentration leads to increase in ___________ activity, which can cause porphyria

What things can precipitate acute attacks of intermittent hepatic porphyria?

A

-ALA synthase

  • Phenobarb, griseofulvin, phenytoin
  • alcohol and low calorie diet too
63
Q

How does morphine exert its effects via Mu receptors?

A
  • G-protein coupled –>activation of K+ channels –> increased efflux of potassium –> hyperpolarization of post-synaptic neurons –> decr pain
  • Can also inhibit adenalyl cyclase –> decr calcium conductance –> decr transmitter release
64
Q

What does alpha-1-antitrypsin look like in the liver?

A

-reddish-pink, PAS + granules of un-secreted polymerized A1AT in the periportal hepatocytes

65
Q

Triad of cerebellar ataxia, incr risk of pulmonary infxns, and telangiectasia…..diagnosis?

-underlying pathophys and inheritance?

A
  • Ataxia telengiectasia
  • Autosomal recessive
  • mutates ATM gene –> responsible for DNA break repair. Pts hypersensitive to X-rays and UV rays
  • IgA deficiency –> airway infections
  • incr risk of hematologic malignancies
66
Q

In liver disease, when synthetic function declines, the first factor depleted is factor ________, which causes prolongation of the _______ first.

A
  • Factor 7

- PT

67
Q

WHat type of cancer is never treated with surgery, even if localized?

A

-Small cell carcinoma

68
Q

C3a of the complement system recruits and activates _______ and _____.

A
  • Eosinophils

- Basophils

69
Q

Tumors in ovaries that are poorly differentiated and heavily loaded with mucous…..most likely came from where?

A

-Stomach (adenocarcinoma)

70
Q

Where is the thrombus in budd chiari? and what is seen on Liver pathology?

A
  • Hepatic vein

- Centrilobular congestion and fibrosis

71
Q

What are the 3 signs of pre-eclampsia?

A
  • HTN
  • Proteinuria
  • Edema

*sometimes TCP

72
Q

WHat is HELLP syndrome?

A
  • Hemolytic anemia
  • Elevated liver enzymes
  • Low platelets

Pre-eclampsia may progress to this!

73
Q

What is a glomangioma and what cells does it arise from?

A

-Bluish neoplasm found underneath the nail bed
Glomus bodies:
-Neurovascular organs found in the dermis of nail bed, pads of fingers and toes, and ears
-function = shunt blood away from skin in cold temps and vice versa

74
Q

Celecoxib is a _________ inhibitor, and causes fewer side effects, such as ________

A
  • Selective COX-2

- GI ulcers/bleeding

75
Q

When does ventricular free wall rupture normally occur, and why?

A
  • 3-7 days after onset of total ischemia
  • Coagulative necrosis, neutrophil infiltration, enzymatic lysis of connective tissue —> weakens the infarcted myocardium
76
Q

T or F……amyloid is not seen in the brains of patients with Vascular dementia

A

-True

77
Q

Renal embryology:

  • The ureteric bud ultimately gives rise to the ________
  • The metanephric blastema gives rise to the _________
A
  • collecting tubules and ducts, major and minor calices, renal pelvis, ureters
  • Glomeruli, bowman’s space, proximal tubules, loop of henle, DCT
78
Q

What kind of drug is Raltegravir?

A
  • Integrase inhibitor

- prevents viral ds-DNA integration into host genome, therefor decreasing mRNA transcription

79
Q

What are contraindications to metformin?

A
  • Renal failure (Cr > 1.5 males or 1.4 females)
  • hepatic dysfunction
  • hypersensitivity to metformin
  • severe CHF and alcoholics –> due to incr risk of lactic acidosis
80
Q

Pathophys of Pompe disease and clinical presentation?

A
  • Glycogen storage disease type 2
  • Deficiency of alpha-1,4-glucosidase in lysosomes —> accumulation of abnormal glycogen in lysosomes
  • Clinically: NO Hypoglycemia, HEPATOMEGALY, incr risk of cirrhosis, HYPOTONIA, FEEDING difficulty, cardiomegaly
81
Q

What organism, usually acquired after travel to 3rd world, manifests with Hepatosplenomegaly, low fever, rose-colored spots on abdomen, Diarrhea OR constipation

A

-Salmonella typhi or paratyphi

  • can lead to sepsis, bloody diarrhea, peritonitis, carrier state
  • fecal-oral route
82
Q

What fungus can infect immunocompetent people, causing flu-like illness, cough with sputum production, possible hemoptysis, dyspnea, pleuritic cp?

Diagnosis?

Treatment?

A
  • Blastomyces dermatitidis
  • Sputum stain with KOH –> round yeast with doubly refractive walls, each yeast with a single, broad-based bud.
  • Tx = Itraconazole
83
Q

What is the clinical presentation of reactive arthritis?

A
  • non-gonococcal urethritis, conjunctivitis, arthritis —-> weeks after a primary infection
  • Can have skin findings as well, including vesicular rash on the palms and soles
  • HLA-B27
84
Q

What is seen histologically is aortic aneurysms?

A
  • myxomatous changes in the media of large arteries

- aka “cystic medial degeneration”

85
Q

How do you calculate the net renal excretion rate of a substance?

A

total filtration rate - total tubular reabsorption rate

total filtration rate = GFR x conc. of substance in plasma

86
Q

Overactivity of what enzyme has been implicated in the development of colon cancer?

A

COX-2

87
Q

What is an “axonal reaction” in neurons and when can it be seen?

A
  • Reaction in cell body seen when axon is severed
  • swelling of acute reversible damage is seen….first visible 24-48 hours after injury
  • reflect incr synthesis of protein to restore axon
88
Q

What does vitamin D deficiency look like in the bone, histologically?

A
  • Osteoid matrix (unmineralized) around trabeculae

- widening between osteoid seams

89
Q

Only _________ heparin can bind to both anti-thrombin and thrombin, making it the most effective at unactivating thrombin

A

-Unfractionated heparin

90
Q

What 2 vascular disorders can show granulomas in the media?

A
  • Giant cell (temporal) arteritis
  • Takayasu arteritis
  • takayasu - aortic arch, females < 40, lower BP in upper extremities, cold or numb fingers
91
Q

WHich skull foramen does the middle meningeal artery go thru?

A

-Foramen spinosum

92
Q

What aspect of the myocyte Action potential does myasthenia gravis change?

A
  • Reduces the motor end-plate potential

* partly bc of damae to motor endplate from complement fixation

93
Q

What are P bodies and where are they located?

A
  • Distinct foci in eukaryotic cells that are involved in mRNA regulation and turnover
  • control mRNA expression repression, degradation, silencing, store them for later, etc
  • happens in the CYTOPLASM
94
Q

What is the clinical presentation and histo features of Lymphogranuloma venereum?

A
  • caused by Chlamydia trachomatis
  • initial painless small ulcer on genital mucosa —> weeks later swollen, painful inguinal nodes that coalesce, ulcerate, and rupture. —> stellate abcesses may develop and coalesce into large, necrotic, draining foci

-Histo: mixed granulomatous and neutrophilic inflammation, chlamydial inclusion bodies in the epith. and inflamm. cells

95
Q

Colchicine for gout should not be used in who??

A
  • elderly

- renal dysfunction

96
Q

Name the target and use of each of the following drugs:

  • Infliximab
  • Rituximab
  • Interleuken-2
  • Imatinib
  • Abciximab
A
  • Infliximab = vs TNF-alpha –> RA, ankylosing spond, fistulizing crohns
  • Rituximab = vs CD20 —> ??
  • IL2 = activates and helps differentiate T cells —> RCC, melanoma
  • Imatinib = inhibits BCR/Abl tyrosine kinase —-> CML
  • Abciximab = vs GP2b/3a —> PCI
97
Q

Why would someone with a testicular/ovarian mass also have hyperthyroidism?

A
  • Certain tumors like teratomas (usually found in gonads) produce B-HcG
  • B-HcG is structurally similar to TSH, LH and FSH —-> binds to thyroid receptors and causes hyperthyroidism
98
Q

What is the histological feature of hodgkins?

A
  • Reed-Sternberg cells
  • Bi-lobed or double nuclei, ample cytoplasm, inclusion-like eosinophilic nucleoli, background of lymphocytes, histiocytes, eosinophils
99
Q

What are the differences in immunophenotyping in immature B-cell vs T-cell ALL?

A

B-cell:

  • TdT positive
  • CD10
  • CD19

T-cell:

  • TdT positive
  • CD1a maybe
  • CD2, 3, 4, 5, 7, 8

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