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STEP1 Uworld > Deck 6 > Flashcards

Deck 6 Flashcards

0
Q

What meds for diabetes act on SGLT-2 receptors and what is the result? What lab do you need to check before admin?

What are some side effects?

A
  • Canagliflozin and dapagliflozin
  • Decr proximal tubule reabsorption of glucose via SGLT-2 transporter
  • Check BUN/creatinine first

-SE: UTI and genital mycotic infections 2/2 glucosuria, HoTN from osmotic diuresis

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1
Q

What is the mechanism of digoxin toxicity leading to Vtach and death?

A

-Delayed after-depolarizations from high intracellular calcium

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2
Q

In an adult with nephrotic syndrome and a malignancy, suspect _______

A

membranous glomerulopathy

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3
Q

What are the histologic features of membranous glomerulopathy?

A
  • uniform, diffuse thickening of glom. capillary wall, without hyperplasia
  • EM = irregular dense deposits that form spikes when stained with silver (IgG and C3)
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4
Q

Positive Latex agglutination test detects the presence of ______.

A
  • Cryptococcal polysaccharide capsular antigen

- LM = budding yeast

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5
Q

What happens to Mitral valve prolapse murmur with squatting?

A
  • diminishes

* Incr venous return and incr afterload –> incr LV volume –> brings valve leaflets into more normal arrangement

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6
Q

What are 2 drugs used to treat HepC?

A
  • IFN-alpha

- Ribavirin

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7
Q

What is the mechanism of action of Ribavirin?

A

Nucleoside antimetabolite with the following actions

  • lethal hypermutation
  • inhibits RNA polymerase and IMP DH (depleting GTP)
  • defective 5’cep formation
  • Modulates more effective immune response
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8
Q

Describe the entire process of Insulin release following Glucose entry into pancreatic beta cells:

A
  • glucose enters via GLUT-2
  • undergoes metabolism –> glycolysis –> TCA
  • generates ATP
  • high ATP/ADP ratio –> closure of K+ channels by ATP-binding
  • K+ cannot leave the cell –> cell depolarization
  • opening of voltage-gated Calcium channels
  • Incr intracellular calcium –> Insulin release
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9
Q

Manifestations of vitamin E deficiency

A

Normally protects membranes from oxid. damage:

  • skeletal myopathy
  • spinocerebellar ataxia
  • pigmented retinopathy
  • Hemolytic anemia
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10
Q

What is the most common cause of aseptic meningitis? How is it transmitted?

A
  • Enteroviruses (echovirus, coxsackie, polio)

- Fecal-oral transmission (ENTERO-viruses)

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11
Q

How does rifampin work?

What about fluoroquinolones?

A
  • Blocks RNA synthesis (not via ribosomes)

- Bind to and inhibit DNA gyrase in bacterial cells —> DNA chain fracture

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12
Q

Why do you have to wait 2 weeks following MAOi d/c to start an SSRI? What happens during this time?

A
  • Avoid serotonin syndrome

- MAOi is re-generated

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13
Q

What is responsible for the delayed clinical effects of antidepressants?

A

-Down-regulation of post-synaptic Monoamine receptors, decreasing their density within the synaptic cleft

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14
Q

What intubation induction agent can cause life threatening hyperKalemia? In what patient populations especially?

A
  • Succinylcholine
  • Burn victims, myopathies, crush injuries, denervating injuries or disease

*happens bc nACh receptors are non selective, so allow K+ efflux as well when acted upon by succinylcholine

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15
Q

What feature in herpes virus confers resistance to nucleoside analogs?
-What are tx options in those cases?

A
  • Absence of viral thymidine kinase (phosphorylating enzyme) –> resistant to Acyclovir, Gancyclovir, Valacyclovir, Famciclovir
  • Cidofovir or foscarnet

*cedofovir requires only a cellular kinase rather than a virally-encoded kinase

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16
Q

How is status epilepticus treated?

A
  • First = IV Lorazepam )or other fast-acting benzo)

- simultaneously administer IV Phenytoin (acts on Na channels to reduce their ability to recover from inactivation)

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17
Q

Other than insulin resistance, what can cause acanthosis nigricans?

A
  • Malignancy (GI and GU tracts especially)

- most common is gastric adenocarcinoma

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18
Q

What are some clinical features of a glucagonoma?

A
  • Diabetes
  • NECROLYTIC MIGRATORY ERYTHEMA: face, groin, extrem….elevated painful and pruritic rash. Papules/plaques coalesce to form large lesions with central clearing of BRONZE-colored induration
  • glossitis, chelitis
  • Normocytic, normochromic anemia
  • incr glucagon in serum
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19
Q

How would a somatostatinoma present?

A
  • abd pain
  • gallstones
  • constipation
  • hyperglycemia
  • steatorrhea
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20
Q

What 3 mutations are associated with early-onset alzheimers?

A
  • Amyloid precursor protein on chromosome 21
  • Presenelin 1 on chromosome 14
  • Presenilin 2 on chromosome 1

*late onset alzheimers = ApoE4

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21
Q

What are some features of myotonic dystrophy?

A
  • Autosomal dominant
  • Trinucleotide CTG repeats with anticipation
  • early childhood to late adulthood varied presentation
  • Difficulty relaxing handgrip or doorknob
  • Cataracts
  • Frontal balding
  • gonadal atrophy
  • Biopsy = Atrophy of muscle fibers, type 1 more affected
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22
Q

WHat is mutated in Li-Fraumeni syndrome? Most common cancers?

A
  • p53…AD…inherited p53 mutation in one allele, need second hit for dz
  • Breast, brain, adrenal cortex, sarcomas and leukemias
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23
Q

How do primary CNS lymphomas appear microscopically? most common type

A
  • dense, cellular aggregates of uniform, atypical lymphoid cells
  • majority arise from B cells
  • diffuse large B-cell lymphoma is most common type
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24
Q

What mutation is associated with MEN2A and 2B? Cells affected by this have what embryological origin?

A
  • RET proto-oncogene
  • Neural crest cells!
  • these migrate to several locations, including the 4 pharyngeal pouches and adrenal meculla (hence medullary thyroid cancer of parafollicular C-cells, and pheo of mesothelial adrenal cells in medulla)
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25
Q

What translocation is associated with Burkitt lymphoma? What is the function of the resultant protein?

A
  • t(8;14) –> c-myc

- c-myc phosphoprotein is transcriptional activator, controls cell proliferation, diff, apoptosis, etc

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26
Q

What are some derivitive of the 1st pharyngeal arch?

A
  • Trigeminal nerve
  • Mandible
  • Malleus
  • incus
  • maxilla
  • zygoma
  • vomer
  • palatine
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27
Q

Which neoplasm has an indolent course, causing waxing and waning painless LAD?

A

-Follicular lymphoma t(14;18) bcl-2

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28
Q

What is seen in pancreatic cells of pts with type 2 diabetes?

A

-Amyloid deposition (amylin)

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29
Q

What causes pigmented stones in someone who had recent cholecystitis?

A
  • infection –>release of Beta-glucoronidase by injured hepatocytes and bacteria
  • Beta-glucoronidase –> hydrolysis of bili glucoronides –> incr amount of unconjugated bili in the bile –> brown pigment stones

*common in rural asian populations, and usually E. Coli, Ascaris lumbricoides, Opisthorchis sinensis

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30
Q

Kid presenting with fever, gingivostomatitis, and lymphadenopathy….diagnosis? histo findings?

A
  • Primary HSV-1 infection

- Intranuclear inclusions (replicate within host cell nucleus)

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31
Q

How do bisphosphonates work?

A

Alendronate, risedronate, ibandronate:

  • structural analogues of pyrophosphate, an important component of hydroxyapetite
  • makes hydroxyapetite more insoluble
  • decr bone resorption by interfering with osteoclasts
  • poor mucosal absorption…take on empty stomach with lots of water….causes reflux
  • unchanged renal excretion
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32
Q

How can nitrates cause a paradoxical increase in myocardial O2 demand? What can overcome this?

A
  • Vasodilation can cause reflex tachycardia, increasing demand
  • Beta blockers by slowing AV conduction
  • selective CCBs like diltiazem or verapamil may also work, but not as well
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33
Q

What is the pathology of Polyarteritis nodosa? What arteries are SPARED?

A
  • segmental, transmural, necrotizing inflammation of medium to small sized arteries in any organ
  • —> ischemia, infarction, hemorrhage

-PAN spares the pulmonary arteries and rarely involves bronchial arteries

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34
Q

What do you give someone with exposure to radioactive isotopes and why?

A
  • Potassium-Iodide
  • thyroid takes up Iodine, including radioactive…..so give them normal iodine to compete with radioactive form for absorption in the thyroid gland
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35
Q

WHat is the diagnosis in a kid with “differential cyanosis”, where his lower extremities are affected, but not his upper extremities?

A

-PDA…..bc happens after branches for UE come off the aorta

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36
Q

Name 3 things that cause LEFT shift of O2-Hgb dissoc. curve, and 3 things that cause RIGHT shift?

A

Left:

  • decr H+ (incr pH)
  • Decr 2,3-BPG
  • Decr temperature (hypothermia)

Right:

  • incr H+ (decr pH)
  • incr 2,3-BPG
  • incr temperature
37
Q

How do you calculate clearance in order to calculate FF?

A

Clearance = Urine conc x Urine flow rate / plasma conc

FF = Creatinine clearance / PAH clearance

38
Q

What is the clinical presentation of ataxia-telangiectasia? and what are they at great risk for?

A
  • Autosomal recessive
  • Cerebellar atrophy –> ataxia early in life (toddler)
  • Telangiectasias later
  • repeated sinopulmonary infections***
  • Great risk of cancer due to inefficient DNA repair –> HYPERSENSITIVITY OF DNA TO IONIZING RADIATION
39
Q

Who is at risk for psoas abcess and what is the clinical presentation?

A
  • infection of adjacent tissues (appendix), diabetics, IVdu, HIV, immunosuppression
  • Fever, back or flank pain, inguinal mass, difficulty walking
  • patients will avoid stretching Psoas (psoas sign) so will have hip flexed, externally rotated, etc
40
Q

What class of antiarrythmics specifically bind rapidly depolarized cells, and is especially good for ischemic tissue (i.e ventricular arrythmias following MI)?

A
  • Class 1B

- Amiodarone, Lidocaine

41
Q

For prevention of ischemic strokes, ACS, and periph vascular disease…..if a patient cant take Aspirin or clopidigrel due to allergy, what is the next option?? What is a dangerous side effect of this drug?

A
  • Ticlopidine

- Neutropenia (fever and mouth ulcers)

42
Q

What patients get reactive arthritis with sterile joint aspirates?

A
  • HLA-27 serotypes
  • usually after infection with chlamydia, CJ, salmonella, shigella, or yersinia
  • Triad: arthritis, conjunctivitis, urethritis
43
Q

What is the cause of intestinal atresias distal to the duodenum?

A
  • Vascular accidents in utero
  • example: SMA obstructed –> apple peel atresia with blind-ending proximal jejunem with absence of a large portion of small bowel and mesentery.
  • terminal ileum distal to the atresia assumes spiral formation around the ileocolic vessel
44
Q

What GI condition would reveal distended macrophages in the intestinal lamina propria on biopsy?

What about Neutrophil collections within the crypt lumina?

A
  • Whipple disease

- UC

45
Q

After how long of total ischemia to cardiac myocytes does contractility cease? At what point does it become irreversible?

A
  • 60 seconds! –> due to depletion of ATP bc of switch to anaerobic glycolysis, accumulating lactate, etc
  • 30 minutes
46
Q

DCIS is also known as _______, and on histology shows _______

A
  • Comedocarcinoma
  • ducts distended by pleomorphic cells with prominent central necrosis
  • lesion does not extend beyond the basement membrane
47
Q

Why dont calcium channel blockers affect the skeletal muscle?

A
  • bc skeletal muscle does not require influx of extracellular calcium for excitation-contraction coupling
  • cardiac and smooth mucle cells, however, depend on extracellular calcium entering through voltage gated L-typre calcium channels
48
Q

In the brain, the putamen lies ______ to the globus palidus?

A

Lateral

49
Q

What area of the brain can cause vomiting, ex-when exposed to chemotherapy?

A
  • Area postrema

- chemoreceptor trigger zone, dorsal surface of the medulla at the caudal end of the 4th ventricle

50
Q

What agent that can be used for depression can also be used to delay the progression of parkinson’s dz? How?

A
  • Selegiline
  • MAOi –> type B is inibited –> prevention of MPTP-induced damage of dopaminergic neurons

*lots of times PD tx starts with Selegiline, anticholinergics, and amantadine until they dont work anymore….before starting Levodopa/carbidopa

51
Q

Other than colon cancer…what other malignancies are associated with Lynch syndrome (HNPCC)?

A

-type 2 can be assoc. with: endometrial, ovarian, stomach, pancreas, and urothelial tract (carcinomas)

52
Q

how/why can someone with acute GI bleeding and liver failure develop subsequent hepatic encephalopathy?

A
  • GI bleed –> incr Nitrogen delivery to gut in the form of Hemoglobin
  • converted into ammonia –> absorbed into bloodstream
  • Ammonia enters liver thru portal vein, where it is normally converted to urea….but liver failure –> failure to convert to urea –> incr serum ammonia –> encephalopathy
53
Q

Which AAs are ketogenic?

A

Ketogenic:
-Leucine and Lysine

*phenylalanine, isoleucine, and tryptophan are ketogenic and glucogenic

54
Q

What is the difference between type 1 and type 2 arnold chiari malformations?

A

Type 1:

  • can present later (adulthood)
  • low-lying cerebellar tonsils extend below foramen magnum into vertebral canal
  • headaches and cerebellar symptoms

Type 2:

  • more serious, presents in neonatal period
  • abnormally formed cerebellum and medulla
  • both cerebellar vermis and medulla extend into foramen magnum
  • medulla compression Sx: diff. swallowing, dysphonia, stridor, apnea
  • Lumbar myelomeningocele and hydrocephalus almost always present
55
Q

What does actinic keratoses look like on histology?

A
  • Hyperkaratosis
  • parakeratosis (retention of nuclei in stratum corneum)
  • atypical keratinocytes
  • may also be pigment or blood vessel irregulaities

*pre-malignant–> small % transform to SCC

56
Q

What are epinephrine’s effects on adrenergic receptors?

A

-agonist of a1, B1, B2

  • Low doses = predominance of B2 in vasculature –> vasodilation
  • High doses = a1 predominates –> vasoconstriction
57
Q

What are the actions of Isoproterenol on adrenergic receptors? What effects does this have physiologically?

A
  • Non-selective Beta agonist
  • Incr HR and contraction force from B1
  • Decr vascular resistance from B2
58
Q

What are the histological characteristics of acute vs chronic renal tpx rejection?

A

Acute:
-Dense interstitial mononuclear infiltrate

Chronic:

  • Obliterative vascular fibrosis (fibrous intimal thickening)
  • shrinking of renal parenchyma
  • tubular atrophy
  • interstitial fibrosis
59
Q

Describe theophylline intoxication and its treatment:

A

-Abd pain, vom/diarrhea, arrhythmias (no QT prolongation), SEIZURES (major cause of mortality)

Tx:

  • Gastric lavage + activated charcoal and cathartics
  • Beta-blockers for arrhythmia
  • Benzos or barbiturates for seizures
60
Q

a majority of pts with acute HepC go on to develop ________

A
  • Stable chronic hepatitis

* closely followed by cirrhosis

61
Q

Work done against elastic resistance of the lung is increased when the tidal volume is ___________. Therefore, pts with incr elastic force (fibrosis) will _______ tidal volume and have a ________ baseline RR

A
  • increased
  • reduce
  • higher RR

*Opposite is true for obstructive dz….lower RR with bigger TV

62
Q

The vascular reaction to endothelial and intimal injury is _________. This is predominantly mediated by ___________ cells that migrate from the media to the intima.

A
  • intimal hyperplasia and fibrosis
  • reactive SM cells

*stimulated by injured endothelial cells who release PDGF

63
Q

What enzyme converts glucose to sorbitol? What about sorbitol to fructose?

CLinical significance?

A
  • Aldose reductase
  • Sorbitol dehydrogenase (polyol DH)
  • normal pts = normal glucose levels –> ability to convert sorbitol to fructose in the lens–> allows escape
  • Diabetes = high glucose –> high Sorbitol which cant leave cells –> sorbitol DH is overwhelmed –> accumulation and incr osmotic pressure –> incr water entry –> cataracts from lens destruction etc
64
Q

The chemotherapeutic agent _______, causes hemorrhagic cystitis. This happens when it is metabolized in the kidneys to _______, which is excreted in the urine and is toxic to uroepithelial cells.

Administration of _______ along with aggressive hydration, prevents this by _______

A
  • Cyclophosphamide
  • Acrolein
  • Mesna (2-mercaptoethanesulfonate)
  • binds and inactivates the toxic metabolites found in the urine
65
Q

NE administration causes vascular vasoconstriction via __________, and ++chronotropy and inotropy in the heart via ________.

However, there is reflex bradycardia from vasoconstriction. The end result is _____

A
  • alpha-1 –> IP3 pathway
  • Beta-1 –> Gs cAMP pathway

-Combined effect = no change or slight decr in HR

66
Q

What 2 classes of antiarrythmics cause QT prolongation? Which drug within this class has the lowest risk?

A
  • class 1A and class 3

- Amiodarone (class 3)

67
Q

What skin lesion, when examined microscopically, shows microabcesses at the tips of dermal papillae?

A

-Dermatitis herpetiformis

68
Q

What is the mechanism responsible for Desmopressin/DDAVP’s effects in stopping bleeding?

A
  • Increases release of vWF from endothelial cells

* only helpful for pts with mild vWF deficiency

69
Q

Squamous cell keratinization is tumors is a sign of _________

A

-Well-differentiation

70
Q

What are common lab abnormalities in pancreatitis? (other than lipase/amylase)

A
  • incr WBC
  • Hypocalcemia (saponification)
  • hyperglycemia from islet destruction
  • Hypernatremia (large 3rd space fluid loss and decr fluid intake)
71
Q

What increases MORE in obstructive lung disease (asthma, COPD, emphysema)…..RV or TLC?

A
  • RV due to air trapping

* TLC does increase too, but in large part bc of incr in RV

72
Q

In what conditions is holoprosencephaly seen? WHat type of embryologic defect is this?

A
  • Trisomy 13, trisomy 18, FAS

- MALFORMATION (primary defect in the cells/tissues that form an organ)

73
Q

Mnemonic for cardiac tissue conduction speed?

A

“Park At Ventura Avenue”
-Purkinje –> Atrial muscle –> Ventricular muscle –> AV node

(fast to slow)

74
Q

Where are 90% of anal fissures located?

A

Posterior midline, distal to the dentate line

*longitudinal tear in the mucosa

75
Q

Which antifungal drugs inhibit ergosterol synthesis, and also inhibit P450?

A

-Azoles

76
Q

What hematologic abnormalities can lupus cause? What is the renal pathology in Lupus most commonly look like?

A

Heme:

  • can cause pancytopenia (decr plt, wbc, rbc)
  • formation of warm IgG Abs vs cells

Most common nephritis is Diffuse proliferative

77
Q

The presence of erythroid precursors in liver and spleen is indicative of _______. Bones would show _______

A
  • Extramedullary hematopoesis
  • EPO-stimulated marrow cell invasion of organs
  • usually from severe chronic hemolytic anemia (e.g = Beta thalassemia)

-Bones = deformities, thinning of cortex, pathologic fractures

78
Q

Cisplatin chemotx works by _________. Its main toxicity is _______.

How can you prevent its toxicity?

A
  • forming reactive O2 species that can form DNA crosslinks
  • Nephrotoxicity!

Prevention:

  • Amifostine (free rad scavenger)
  • Chloride diuresis
79
Q

The nerves, arteries, veins, and lymphatics to/from the ovaries are carried in the ________.

The uterine artery is within the _________

A
  • Suspensory ligament

- Transverse cervical (aka cardinal) ligament

80
Q

Lab abnormalities in DIC?

A
  • decr Platelets
  • decr Fibrinogen
  • decr factor 5 and 8
  • prolonged PT and PTT
81
Q

Acanthocytes are seen in what disease?

A

-Spiky RBCs seen in Abetalipoproteinemia

82
Q

What to suspect in a patient with diffuse pruritic papulopustular rash….with an oxidase positive GNR on culture?

A
  • Pseudomonas

- Hot tub folliculitis

83
Q

Sympathetic ANS neurons use NE at synapses….what are 2 exceptions to this rule?

A
  1. Adrenal glands are directly innervated by pre-ganglionic neurons using AcH
  2. Sweat glands are innervated by a 2 neuron efferent system using AcH
84
Q

How are gallstones formed in pregnancy?

A
  • Estrogen –> incr cholesterol synthesis by up-reg HMG-CoA reductase –> bile gets supersaturated with cholesterol
  • Progesterone –> reduces bile acid secretion and slows gallbladder emptying
85
Q

Treatment options for legionella PNA?

A

Azithro or Fluoroquinolones like Levofloxacin

86
Q

What are the effects of vit A toxicity?

A

Acute:
-N/V , vertigo, blurred vision

Chronic:
-alopecia, dry skin, hyperlipidemia, hepatotoxicity, HSM, visual probs, possible papilledema

Teratogenic:
-Microcephaly, cardiac anomalies, fetal death

87
Q

What is the cause for the following histological findings in arteries/arterioles?

  1. Transmural inflammation with fibrinoid necrosis
  2. Medial band-like calcification
  3. Homogenous acellular thickening of arteriolar walls
  4. onion-like concentric thickening of arteriolar walls
  5. Granulomatous inflammation of the media
A
  1. Polyarteritis nodosa
  2. Monckeberg’s medial calcific sclerosis
  3. Hyaline arteriolosclerosis (is this from DM? HTN?)
  4. Malignant hypertension
  5. Temporal arteritis….can also be Takayasu if in the aorta
88
Q

Which monosaccharides enter glycolysis at each of the following steps:

  1. G6P
  2. F6P
  3. Glyc-3-P or DHAP
A
  1. Galactose
  2. Mannose
  3. Fructose (bypasses PFK –> faster metab)
89
Q

What heart murmur may be heard with delayed closure of the tricuspid valve?

A

-Wide splitting of S1….accentuated by inspiration

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