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Uworld Journal > General > Flashcards

General Flashcards

1
Q

Why does carcinoid syndrome only occur after the carcinoid tumor has metastasized?

A

When localized to the GI system, the vasoactive substances released from the tumor are metabolized by the liver via the first pass effect.
When metastasized to the liver, the vasoactive substances produced enter directly into the systemic circulation resulting in the various symptoms.

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2
Q

Which hepatitis is able to integrate into the host genome and why?

A

Hepatitis B:

  • DNA virus
  • contains a reverse transcritpase
  • integrates itself into the host genome and can remain latent in cells
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3
Q

How does therapeutic ionizing radiation work? (2 methods)

A
  • Double stranded DNA breaks

- Free radical formation (ROS) that cause damage to cells and DNA

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4
Q

What does the HIV Env gene encode =

A

gp160 -> gp120 + gp41

mutations indicate that the HIV virus is resistant to certain anti-retroviral drugs

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5
Q

What does the HIV Pol gene encode =

A

reverse transcriptase, integrase, protease

mutations indicate that the HIV virus has developed resistance to anti-retroviral drugs (NNRTI, NRTI, protease inhibitors, integrase inhibitors)

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6
Q

What LN?

  • skin from the umbilicus downwards,
  • distal anus (below the pectinate line)
  • distal vagina
  • vulva
  • scrotum
A

superficial inguinal nodes

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7
Q

Mechanism of warfarin induced skin necrosis?

A

Decreased production of protein C -> prothrombotic state -> increased thromboses in skin vessels -> ischemia -> necrosis

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8
Q

adult + pseudopallisading necrosis in the brain + intracranial mass =

A

Glioblastoma multiforme

Most common primary brain neoplasm in adults.

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9
Q

most commonly injured organ in “blunt abdominal trauma”

A

spleen rupture

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10
Q

proliferation fraction (Ki-67) indicates

A

mitotic index

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11
Q

What type of liver injury occurs with carbon tetrachloride exposure?

A

lipid peroxidation -> fatty change with hepatic necrosis

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12
Q

What does heterochromatin consist of? And what does it’s presence indicate about that piece of DNA?

A
  • methylated DNA
  • deacylated histones

if DNA is in this structure, it indicates there is a low transcription level.

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13
Q

Hypertrophy

A

increase in size

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14
Q

Hyperplasia

A

increase in number

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15
Q

Cyanosis + Chocolate colored blood + Decreased SaO2 + Normal PaO2

A

Methemoglobinemia (Fe2+ is oxidized to Fe3+ which cannot bind oxygen)

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16
Q

Hallmark of reversible cell injury

A

cellular swelling

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17
Q

Hallmark of irreversible cell injury

A

membrane damage

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18
Q

AL amyloid (Ig Light chain) =

A

primary systemic amyloidosis

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19
Q

AA amyloid (serum amyloid associated protein)

A

secondary systemic amyloidosis

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20
Q

non-mutated transthyretin =

A

senile cardiac amyloidosis

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21
Q

mutated transthyretin =

A

familiar amyloid cardiomyopathy -> restrictive cardiomyopathy

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22
Q

“tumor cells in an amyloid background” =

A

medullary carcinoma of the thyroid

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23
Q

beta-2 microglobulin deposition in joints =

A

dialysis-associated amyloidosis

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24
Q

Pain mediators = (2)

A
  • Bradykinin

- PGE2

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25
Q

Neutrophil rolling is mediated via =

A

on endothelial cells =

  • P selectin - from Weinel-Palade bodies mediated by histamine
  • E selectin - induced by TNF and IL-1

on leukocytes =
-sialyl Lewis X

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26
Q

Neutrophil adhesion is mediated via =

A

on endothelial cells =
-ICAM and VCAM - induced by TNF and IL-1

on leukocytes =
-integrins - induced by C5a, LTB4

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27
Q

SCCID=

A

Selectins and Carbohydrates
Chemokines
Integrins
Diapodesis

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28
Q

1 gram of protein = ? Calories

A

4 Calories

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29
Q

Where on tRNA does the AA attach?

A

The 3’ end on the CCA tail

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30
Q

(CGG)n =

A

Fragile X Syndrome

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31
Q

(GAA)n =

A

Freidrich ataxia

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32
Q

(CAG)n =

A

Huntington Disease

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33
Q

(CTG)n =

A

Myotonic Dystrophy

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34
Q

Which creatine kinase is most specific for an MI

  • CK-MM
  • CK-MB
  • CK-BB
A

CK-MB - only found in cardiac tissues

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35
Q

“cherry red mucous membranes”

A

carboxyhemoglobin accumulation

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36
Q

High Km = ? affinity

A

High Km = Low affinity

inverse relationship

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37
Q

Is DNA positively charged or negatively charged?

A

Negatively charged

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38
Q

Which nucleotides on the template strand are methylated in DNA replication? (2)

A
  • Cytosine

- Adenine

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39
Q

Which nucleotide has a methyl group?

A

Thymine

THYmine = meTHYl

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40
Q

Which AA are needed for purine synthesis? (3)

A
  • Glycine
  • Aspartate
  • Glutamine
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41
Q

Child who is Hyperuricemic + has Gout + is Pissed off all the time + Retarded + dysTonic =

A

Lesch-Nyhan syndrome

HGPRT = enzyme deficiency
HGPRT = symptoms
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42
Q

DNA topoisomerase VS Helicase

A

DNA topoisomerase = breaks the DNA double helix to relax the supercoils

Helicase = unwinds the DNA at the replication fork

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43
Q

Where is heme synthesized?

A

partly in mitochrondria and partly in the cytosol

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44
Q

Stop codons (3)

A
  • UAA
  • UAG
  • UGA
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45
Q

2,3-bisphosphoglycerate does what to hemoglobin-oxygen relationship?

A

23BPG stabilizes the taut Hgb configuration therefore decreasing Hgb’s affinity for oxygen and making it easier for the oxygen to be delivered to the tissues.

increased 23BPG = O2 release off of Hgb = right shift = anoxia (decrease in oxygen on Hgb)

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46
Q

Is phosphorylated-glycogen synthase active? Or is de-phosphorylated-glycogen synthase active?

A

De-phosphorylated glycogen synthase is the active form.

Insulin -> Insulin R (tyrosine kinase R) on hepatocyte -> phosphorylation of Insulin R Substrate-I (IRS-1) -> (+)MAP Kinase pathway and (+)PI3K pathway

PI3K pathway = (+) protein phosphatase -> dephosphorylates glycogen synthase -> active glycogen synthase makes glycogen!

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47
Q

Cofactors for BCalphaKADH, PDH, and alpha-KGDH (5)

A
  • thiamine pyrophosphate (B1)
  • FAD (B2 - riboflavin)
  • NAD (B3 - niacin)
  • CoA (B5 - pantothenic acid)
  • lipoate
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48
Q

Prokaryotic DNA Polymerase III actions (2)

A
  • 5’->3’ DNA synthesis

- 3’->5’ exonuclease activity (proof reading)

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49
Q

Prokaryotic DNA Polymerase I actions (3)

A
  • 5’->3’ DNA synthesis
  • 3’->5’ exonuclease activity (proof reading)
  • 5’->3’ exonuclease activity (removing primer)
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50
Q

Prokaryotic DNA Polymerase II actions (1)

A

-3’->5’ exonuclease activity (proof reading)

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51
Q

Northern blot is used to identify =

Type of probe used for Northern Blot technique =

A

specific RNA sequences

SS-DNA or SS-RNA

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52
Q

Southern blot is used to identify =

Type of probe used for Southern Blot technique =

A

specific DNA sequences

SS-DNA or SS-RNA

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53
Q

Western blot is used to identify =

Type of probe used for Western Blot technique =

A

proteins/antibodies

Antibody

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54
Q

Type of probe used for Southwestern Blot technique =

A

DS-DNA

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55
Q

uracil is found in DNA/RNA/Both?

A

RNA only

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56
Q

amatatoxins (found in poisonous mushrooms) inhibits what?

A

Eukaryotic RNA polymerase II -> decreases production of mRNA

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57
Q

Eukaryotic RNA polyermase I makes =

A

rRNA

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58
Q

Eukaryotic RNA polymerase II makes =

A

mRNA

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59
Q

Eukaryotic RNA polymerase III makes =

A

tRNA

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60
Q

Priority of surrogates (5)

A

spouse > adult children > parents > adult siblings > other relatives

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61
Q

APGAR Scores

Total =

A

Appearance, Pulse, Grimmace, Activity, Respiration

Total = 10 points (0,1,2 for each)

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62
Q

When are APGAR scores taken?

A

1 minute after birth

5 minutes after birth

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63
Q

Sensitivity =

A

a/(a+c)

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64
Q

Specificity =

A

d/(b+d)

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65
Q

PPV =

A

a/(a+b)

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66
Q

NPV =

A

d/(c+d)

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67
Q

95% CI =

A

mean +/- 1.96 SD/sqroot n

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68
Q

99% CI =

A

mean +/- 2.58 SD/sqroot n

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69
Q

_ is used to compare the exposure of people with the diseases to exposure of people without the disease

A

Odds Ratio - case control studies

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70
Q

68/95/99 rule of normal distribution

A

Under a normal distribution bell curve:
68% = 1 st dev
95% = 2 st dev
99% = 3 st dev

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71
Q

Competitive inhibitor (reversible) - what happens to Vmax and Km

A
  • Vmax stays

- Km increases (therefor affinity decreases)

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72
Q

Noncompetitive inhibitor - what happens to Vmax and Km

A
  • Vmax decreases

- Km stays

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73
Q

What order kinetics are Phenytoin, Ethanol, and Aspirin?

A

PEA = 0 = Zero order kinetics

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74
Q

reduction, oxidation, hydrolysis = what stage of metabolism?

A

Stage I

produces slightly polar, water soluble metabolites (still active)

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75
Q

What is Stage II of metabolism?

A

congugation (glucoronidation, acetylation, sulfation)

produces polar, inactive metabolites that are then excreted via the kidneys

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76
Q

Elderly patients rely on metabolism Stage I/II/both

A

II only

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77
Q

Organophosphate Poisoning

A 
DUMBBELSS - Ach overload
Diarrhea 
Urination
Miosis 
Bronchospasm
Bradycardia
Excitation of CNS and muscles 
Lacrimation
Salivation
Sweating
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78
Q

What is the single most preventable cause of death?

A

Tobacco use

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79
Q

Probability of concluding there is no difference when there really is one =

A

Beta (Type II error)

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80
Q

Probability of concluding there is a difference when there really isn’t one =

A

Alpha (Type I error)

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81
Q

Treatment for a young sexually active person with STI type symptoms =

A

Treat for N gonococci and C trachomonous

Ceftriaxone (cefalosporin)
Azithromycin (macrolide) OR Doxycycline (tetracycline)

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82
Q

Epithelium of

  • true vocal cords
  • false vocal cords
A
  • true vocal cords = stratified squamous ep

- false vocal cords = ciliated pseudostratified columnar ep

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83
Q 
Clinical trials phases:
Phase I=
Phase II=
Phase III=
Phase IV=
A

Phase I = small number of healthy volunteers

Phase II = small number of patients with disease of interest

Phase III = Large number of patients randomly assigned to treatment or best available treatment (or placebo)

Phase IV = Post-marketing surveillance of patients. Drug is already approved.

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84
Q

Partial thromboplastin time =

A

PTT

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85
Q

Amyloid structure

A

beta-pleated sheets

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86
Q

Cardiomegaly + individual myofiber necrosis with mixed inflammatory infiltrate + travel to South America

A

T. cruzi

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87
Q

Gluconeogenesis locations (3)

A

Liver
Kidney
Intestinal epithelium

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88
Q

Why do some vaccines have the antigen conjugated with a carrier protein?

3 examples

A

The main antigen of encapsulated bacteria are their polysaccharide capsules. These polysaccharide antigens cannot be presented to T cells alone. They are conjugated with a carrier protein thereby enhancing their immunogenicity and activating T-cells

Examples:

  • Pneumococcal (PCV) (the other pneumococcal vaccine (PPSV) is not conjugated with anything, therefore less effective)
  • H. influenzae type B (conjugated with diphtheria toxoid)
  • Meningococcal vaccine
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89
Q

Nerve that travels in the mandible

A

inferior alveolar nerve

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90
Q

Age (months) of standing alone with no support

A

10 months

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91
Q

Age (months) of first steps/cruising

A

12 months

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92
Q

Age (months) of parallel play

A

24-36 months

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93
Q

Age (months) of climbing stairs

A

18 months

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94
Q

Age (months) of drawing

A

4 years

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95
Q

Multiple seizures, pins and needles around mouth and hands and feet, random spasms leading to flexion of wrists, diffuse hyperreflexia - what serum electrolyte abnormality?

A

low calcium

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96
Q

Dermatome at the umbilicus

A

T10

BellybutTEN

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97
Q

Acute phase cytokines that are released during inflammation/help precipitate inflammation (3)

A

IL-1
IL-6
Tumor necrosis factor-alpha

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98
Q

In DIC is fibrinogen high or low

A

Fibrinogen is low because it is all used up in the clots

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99
Q

Function of TGF-beta in wound healing

A

Stimulates angiogenesis, fibrosis, cell cycle arrest

Inhibits inflammation

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100
Q

What stains blue on a Prussian blue stain?

A

Intracellular iron

Lipofuscin doesn’t stain

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101
Q

Branches of the external carotid artery (3)

A

External carotid ->

  • Facial artery
  • Occipital artery
  • Maxillary artery
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102
Q

Injury of what cells release creatine kinase?

A

Cardiac, Brain, Skeletal muscle cells

103
Q

What type of damage results in increased serum creatine kinase?

A

membrane damage, irreversible cell injury

104
Q

Mechanism of ischemic cell swelling?

A

Ion pump failure due to lack of ATP -> intracellular accumulation of Na and Ca -> draws water into the cell -> swelling

105
Q

Intercostal vein, nerve and artery lie in the subcostal groove on the upper/lower border of the rib?

A

Lower

That is why you insert chest tubes/needles on the upper border of the rib

106
Q

Where do these things bifurcate?

  • Common carotid
  • Trachea
  • Abdominal aorta
A
  • Common carotid = C4
  • Trachea = T4
  • Abdominal aorta = L4

biFOURcates

107
Q

55 yo man + yellow sputum + poor dentition with G carries and gingivitis + alcohol abuse + lung consolidation

A

Actinomyces with sulfur granules

108
Q

Multiple telangiectasias in skin and mucous membranes + recurrent bleeds + skin discoloration + AD inheritance

A

Osler Weber Rendeu Syndrome

Hereditary Hemorrhagic Telangiectasia

109
Q

Port wine stain on V1/V2 distribution + tram track calcification in the brain + intellectual disability + glaucoma + cerebral malformations =

A

Sturge Webber Syndrome (Encephalotrigeminal Angiomatosis)

cerebral malformations = leptomeningial angiomas

110
Q

Hammartomas in CNS and skin + Cardiac rhambdomyomas + cutaneous angiofibromas + renal angiomyolipomas =

A

lots of tumors everywhere in a child

Tuberous Sclerosis

Cardiac rhabdomyomas = the only childhood heart tumor

111
Q

Dopamine
low dose ->
medium dose ->
high dose ->

A

Low dose -> D1 = kidneys - increased GFR, increased RBF, increased sodium excretion

Medium dose -> beta1 = increased contractility, increased PP, increased systolic BP

High dose -> alpha1 = generalized systemic vasoconstriction

112
Q

_ is given to prevent ischemic stroke in patients with TIA

A

low dose aspirin

113
Q

Splinter hemorrhages suggest a problem with _

A

Cardiac/valve problem - infectious endocarditis

114
Q

Congenital long QT syndrome is caused by a mutation in

A

ion channels (usually K channels)

115
Q

Thromboxane A2 function (2)

A
  • enhances platelet aggregation

- vasoconstriction

116
Q

Prostacyclin function (5)

A
  • inhibits platelet aggregation
  • inhibits platelet adhesion to vascular endothelium
  • vasodilation
  • increases vascular permeability
  • promotes leukocyte chemotaxis
117
Q

Child + palpable purpura on buttocks and legs + GI issues + arthralgias + hematria =

A

Henoch-Schonlein Purpura

type of vasculitis

118
Q

S3 =

A

volume overload

119
Q

S4 =

A

pressure overload

120
Q

chronic sinopulmonary infection + bilateral absent vas deferens =

A

Cystic fibrosis

Symptoms seem similar to Kartageer syndrome but the infertility here is due to a lack of a structure NOT a cilia issue

121
Q

testicle lymph drainage ->

A

para-aortic LN

122
Q

Scrotum lymph drainage ->

A

superficial inguinal LN

123
Q

bug that is PYR positive

A

Strep pyogenes

124
Q

L sided chest discomfort + burning pain + rash over the area that becomes vesicular =

A

Shingles - VZV reaction

125
Q

Immunodeficiency disorder with partial albinism + giant cytoplasmic granules in neutrophils and monocytes + diagnosed in childhood =

A

Chediak-Higashi Syndrome

Inhibition of lysosomal trafficking -> microtubule dysfunction

lysosomal trafficking regular gene (LYST)

126
Q

Started on a new drug, 10 days later the patient develops a rash, fever and joint pain. biopsy shows fibrinoid necrosis + neutrophilic infiltrate =

A

Serum sickness drug reaction - type III hypersensitivity

127
Q

fever and muscle rigidity soon after surgery + cyanotic skin mottling + hypertension

A

Malignant hyperthermia

treatment = dantrolene - inhibits Ca release from Sarcoplasmic reticulum

128
Q

NT inhibited in tetanus infection =

A
  • GABA

- Glycine

129
Q

Deficiency of Hypocretin-1 (Orexin-A) in CSF indicates =

A

Narcolepsy

hypocretin/orexin is produced in neurons in the hypothalamus

130
Q

Dynein vs Kinesin

A

Dynein = retrograde transport down an axon

Kinesin = anterograde transport down an axon

131
Q

Direct angiogenesis stimulators (2)

A
  • VEGF

- FGF-2

132
Q

BRCA gene function =

A

DNA repair gene

133
Q

HER2 =

A

“human epidermal growth factor receptor 2”

tyrosine kinase

134
Q

What 3 diseases drastically increase the risk for CAD related deaths?

A
  • Non-coronary atherosclerosis
  • Type 2 DM
  • Chronic kidney disease
135
Q

Acute hemolytic transfusion reaction is what type of hypersensitivity?

A

Type II hypersensitivity reaction - complement mediated cell lysis

136
Q

Adult Polycystic Kidney Disease is associated with _ hemorrhage

A

Subarachnoid hemorrhage from a berry aneurysm

137
Q

Anopheles mosquito

A

-Malaria

138
Q

Aedes mosquito

A
  • Dengue fever
  • Chikungunya
  • Yellow fever
139
Q

“Ability to decompose hydrogen peroxide” =

A

Catalase positive

Contains the myeloperoxidase enzyme

140
Q

“Possession of cytochrome oxidase” =

A

Oxidase positive

141
Q

“Epithelial cells covered in gram variable rods”=

A

Gardnerella vaginalis - clue cells

142
Q

“Multiple, painful, shallow ulcers on an erythematous base located on the labia + bilateral inguinal lymphadenopathy” =

A

HSV-2

143
Q

What type of response is eosinophils attacking parasites?

A

Antibody Dependent Cell Mediated Cytotoxicity (ADCC)

Type II hypersensitivity

1) parasite invades
2) parasite coated with IgG and IgE
3) IgE binds to Fc receptor located on eosinophils
4) eosinophils degranulate and kill parasite

144
Q

Compliment C1 deficiency predisposes to (2)

A
  • Infection with encapsulated bacteria

- SLE

145
Q

Defect in IL-2 =

A

SCID = opportunistic infections + diarrhea + failure to thrive

146
Q

Defect in IL-12 R =

A

T cell disorder: decreased number of Th1 cells mature -> decreased amount of IFN-gamma released -> decreased amount of activated macrophages -> susceptible to mycobacterial infections

147
Q

“Dysfunctional immunoglobulin gene rearrangement”

A

Hyper-IgM syndrome

  • defective CD40L on Th cells therefore cannot class switch
  • X linked recessive
148
Q

Cytokine that mainly functions to support growth and differentiation of bone marrow stem cells?

A

IL-3 - secreted by all T cells

149
Q

Nitroblue Tetrazolium (NBT) Test shows no color/no blue. Dihydrorhodamine (DHR) flow cytometry test shows no green fluorescence. What is the enzyme deficiency?

A

NADPH oxidase deficiency -> chronic granulomatous disease

If it was a myeloperoxidase deficiency, both of those tests would be opposite. NBT test would show blue coloration. DHR flow cytometry would show green fluorescence.

150
Q

3 cytokines that mediate the systemic inflammatory response

A
  • IL-1
  • IL-6
  • TNF-alpha

They all stimulate hepatic secretion of acute phase proteins

151
Q

alpha and beta interferon

  • secreted from?
  • action?
A

secreted from:
-virally infected cells

actions: interact with neighboring virally infected cells and synthesize enzymes that halt viral protein synthesis and stimulate infected-cell apoptosis

152
Q

How are herpes virus family envelopes different from other viral envelopes?

A

Obtained from host cell nuclear membranes instead of host cell plasma membranes

153
Q

What is the toxic component of gram negative LPS?

A

Lipid A

154
Q

8 yo boy + rapid and irregular movements of hands + unintentional “funny faces” + 102 degrees F + circular erythematous lesions on abdomen + new systolic murmur

A

Acute rheumatic fever post-streptococcal pharyngitis

JONES Criteria:

  • Joins
  • Carditis/murmur
  • Nodules - subcutaneous
  • Erythema marginatum
  • Sydenham chorea
155
Q

4 yo boy + fever + painful ulcers on tongue and gingiva + swollen gums + cervical lymphadenopathy

A

HSV-1

156
Q

Increased work of breathing + wheezes/crackles/rales + rhinorrhea + congestion + 1 month old

A

RSV bronchiolitis

157
Q

What vitamin deficiency can increase measles complications?

A

vitamin A

158
Q

a are important in preventing superficial candida infections
b are important in preventing hematogenous spread of candida

A

a = T lymphocytes (T helper cells specifically)

b = neutrophils

159
Q

What sjogren syndrome antibody has the ability to cross the placenta and cause neonatal lupus and congenital heart block?

A

SS-A antibody

160
Q

Absence of CD18 =

A

Leukocyte adhesion deficiency

Unable to make integrins, therefore leukocytes/neutrophils cannot leave the blood

161
Q

Patient’s serum + cardiolipin + lecithin + cholesterol

A

Nonspecific treponemal test/RPR test

Looking for coagulation -> positive
Then do antibody specific test

162
Q

Polygenic inheritance (7)

A
  • Androgenic alopecia
  • Epilepsy
  • Glaucoma
  • HTN
  • Ischemic HD
  • Schizophrenia
  • Type II DM
163
Q

Antibody against proteinase-3 of neutrophils

A

Granulomatosis with polyangitis

c-ANCA

164
Q

Antibody against myeloperoxidase of neutrophils

A

Microscopic polyangitis or Eosinophilic granulomatosis with polyagnitis

p-ANCA

165
Q

Introns vs Exons - which ones stay and which ones go?

A

Introns are removed

Exons are joined together and are translated

166
Q

Spliceosomes remove introns containing _ _ @ the 5’ splice site and _ _ @ the 3’ splice site

A

5’ = G U

3’ = A G

167
Q

CD16 or CD56 =

A

NK cells

168
Q

What 5 cytokines activate NK cells?

A
  • IFN-gamma
  • IL-12
  • IL-2
  • IFN-alpha and beta (from virally-infected cells)
169
Q

What type of receptors contain zinc fingers?

A

Intracellular receptors
Bind: steroids, thyroid hormone (T4/T3), fat soluble vitamins

The zinc finger part is the DNA binding domain

170
Q

Where do repressor proteins bind?

A

Operator region

171
Q

P27 has what action?

A

Cell cycle inhibitor

  • Normal cells have high levels of p27
  • Malignant cells have low levels of p27
172
Q

Active Rb - hyperphosphorylated or hypophosphorylated?

A

Hypophosphorylated = Active
-Active -> binds to E2F transcription factor -> inhibits transcription of genes required to move from G1 to S -> stops the cell cycle

Inactive (Hyperphosphorylated) -> releases E2F transcription factor -> cells can continue from G1 to S without being checked

173
Q

O2 -a-> O2 free radical -b-> H2O2 -c-> HOCl

A 
a = NADPH oxidase
b = superoxide dismutase 
c =  myeloperoxidase
174
Q

CD 14 or CD 40

A

Macrophages cell surface marker

175
Q

Anergy

A

State during which a cell cannot be activated by exposure to its antigen. Mechanism of self tolerance.

Ex: T and B cells become anergic when exposed to their antigen without the appropriate costimulatory signal.

176
Q

P-glycoprotein action?

A

pumps out toxins, including chemotherapeutic drugs

  • ATP-dependent transporter
  • often seen in adrenal cell carcinomas
  • also called multidrug resistance protein 1 (MDR1)
177
Q

CA 15-3/CA 27-29 = markers for?

A

Breast cancer

178
Q

Caspase actions

A

Proteolytic enzyme that cleaves cellular proteins

Important in apoptosis

179
Q

What class of MHC presents endogenous antigens to T cells?

A

MHC I

180
Q

What class of MHC present exogenous antigens to T cells?

A

MHC II

181
Q

After exposure to these toxins/viruses, IVIG should be given (5)

A
  • Tetanus toxin
  • Botulinum toxin
  • HBV
  • Varicella
  • Rabies
182
Q

Metastatic calcification locations?

A
  • Kidney
  • Lungs
  • Gastric mucosa

The low pH in these environments favors calcium deposition

183
Q

Carcinoma exceptions to the lymphatic spreading rule: (4)

A
  • Renal cell carcinoma
  • Hepatocellular carcinoma
  • Follicular carcinoma of the thyroid
  • Choriocarcinoma

These carcinomas spread via the blood instead of the “rule” that all carcinomas spread via lymphatics

184
Q

Hyperkeratotic vesicles on palms and soles + reactive arthritis

A

Blennorrhagicum

The important distinguishing feature from other rashes on palms and soles is that these are vesicular

185
Q

Eosinophilic casts (2)

A

Multiple myeloma

Chronic pyelonephritis

186
Q

What happens when a stop codon is encountered in the ribosome?

A

Releasing factor proteins bind to the ribosome to facilitate release

187
Q

Granulomas require what 3 cytokines?

A

IL12
IFN gamma
TNF alpha

188
Q

Basophilic oval inclusions in mature neutrophils + increased LAP

A

Dohle bodies seen in neutrophils during a leukemoid reaction

189
Q

Genetics of classic galactosemia?

A

AR

Deficiency of Galactose 1 phosphate uridyl transferase

190
Q

Genetics of Hemophilia A, B, C?

A

A and B = X linked recessive
A = factor VIII deficiency
B = Factor IX deficiency

C = AR
C = Factor XI deficiency
191
Q

Genetics of Huntington’s disease

A

AD
CAG repeat
Anticipation more common if inherited from father

192
Q

Genetics of Leber Hereditary Optic Neuropathy

A

mitochondrial

193
Q

Order of mutations in colonic adenoma-carcinoma sequence (1, 2, 3)

A 
1 = APC - loss of function, tumor suppressor gene
2 = KRAS - gain of function, oncogene
3 = p53, DCC - loss of function, tumor suppressor gene
194
Q

Homeobox genes encode what proteins?

A

DNA binding transcription factors

Bind to regulatory regions on DNA and alter expression of genes involved in segmental organization of the fetus

195
Q

Genetics of hypertrophic cardiomyopathy?

A

AD with variable expression

50% of cases are familial

196
Q

Young boy with depression, gait disturbances, dysarthria, elevated transaminases. Cousin diagnosed with progressive neurologic disease.

A

Wilson’s disease

-AR

197
Q

Myopia

A

Increased axial length of the eye - image focuses in front of the retina

198
Q

Most common predisposing condition for infective endocarditis in the developed world?

A

Mitral valve prolapse

Less common: valvular sclerosis, mechanical valve

199
Q

46, XX t(14;21) in a newborn infant

A

Unbalanced robertsonian translocation Down Syndrome

Balanced translocations would not be symptomatic

200
Q

13 yo boy, growth retardation, microcephaly, sun sensitive skin rash, recurrent infections, child of consanguineous marriage

A

Bloom Syndrome

  • AR
  • Mutation in BLM gene - DNA helicase does not form
201
Q

Salicylate poisoning - which process comes first?

A

1) respiratory alkalosis
2) anion gap metabolic acidosis
Usually, the pH is close to normal

202
Q

Prostatectomy can injure what nerve? What is the consequence?

A

Can transect the prostatic plexus

Contains the cavernous nerves that innervate the cavernous sinus. Without it, no penil erection

203
Q

Micrognathia =

A

Hypoplasia of the mandible

204
Q

Cytochrome oxidase =

A

Final component of the ETC

Turns O2 -> H2O

205
Q

Cricothyrotomy incision passes through what 4 layers?

A

Skin
Superficial cervical fascia (includes subcutaneous fat and platysma muscle)
Deep cervical fascia (includes investing layer and paratracheal layers)
Cricothyroid membrane

206
Q

Bilateral kidney tumors composed of fat, smooth muscle, and blood vessels? These are associated with?

A

Angiomyolipomas

  • Diagnostic for Tuberous Sclerosis
  • AD
207
Q

Multiple phenotypic manifestations resulting from a single genetic mutation

A

Pleiotropy

Occurs in most genetic illnesses

208
Q

Lacunar infarcts in the deep brain are caused by

A

Hypertensive arteriolosclerosis

Immediate CT imaging does not show the infarct because it is so small
A few weeks later, the necrotic tissue becomes a cystic space and can now be seen

209
Q

Increased 5-hydroxyindoleacetic acid is an indicator of?

A

Increased serotonin

Elevated in carcinoid syndrome

210
Q

Anaphylaxis results in increase in what 2 things

A

Histamine and Tryptase (specific for mast cell degranulation)

Anaphylaxis occurs due to mast cell and basophil degranulation

211
Q

CA-125 is a marker for?

A

Epithelial ovarian tumors

212
Q

What factor inhibits phagocytosis of group A streptococcus?

A

Protein M

Main virulence factor - inhibits phagocytosis, cytotoxic to neutrophils, mediator of bacterial attachment

213
Q

Indole positive =

A

Can turn tryptophan into indole

214
Q

Is pseudomonas motile

A 
Yes - motile 
Oxidase positive 
Catalase positive 
Non-lactose fermenting
Aerobic
Encapsulated
Type III secretion system

main virulence factor = Exotoxin A (ribosylates EF2), endotoxin (because its gram negative), phospholipase C, pyocyanin

215
Q

How does CMV present in an immunocompetent person

A

Mononucleosis-like syndrome

Fever, malaise, myalgias, atypical lymphocytosis, elevated liver transaminases

Monospot negative (no heterophile antibodies)

216
Q

Erythematous throat + gray-white tonsillar exudate + fever + chills + diffuse erythematous rash on chest and abdomen that blanches with pressure + tongue is bright red

A

Scarlet fever

  • “Sandpaper rash”
  • “Strawberry tongue”

Sequelae = acute rheumatic fever, glomerulonephritis

Only occurs in GAS strains that produce pyrogenic exotoxin/erythrogenic

217
Q

The steady state concentration of a drug that is metabolized by first order kinetics is calculated how?

A

Half-life x 4

It takes 4-5 half-lives to get to a steady concentration

218
Q

What is rebound rhinorrhea

A

Nasal congestion without a cough, post-nasal drip or sneezing

Caused by topical decongestant use for more than 3 days

Due to tachyphylaxis = decreased production of NE due to negative feedback -> vasodilation and continued nasal symptoms
Treatment = stop the decongestants

219
Q

“Fungus spherules” =

A

Coccidioides

220
Q

Main virulence factor in mycobacterium

A

Cord factor

Inhibits neutrophils, damages mitochondria

221
Q

_ allows mycobacteria to persist inside of macrophages

A

Sulfatides

Inhibits fusion of lysosomes to phagosomes

222
Q

Which E Coli causes bloody diarrhea?

A

Enterohemorrhagic E Coli (EHEC)

223
Q

Which E Coli causes watery diarrhea?

A

Enterotoxigenic E Coli (ETEC)

  • heat labile (LT) = increases cAMP (eL Agua)
  • heat stable (ST) = increases cGMP (San Gabriel)
224
Q

4 bacteria that can take up naked DNA from the environment

A
  • Streptococcus
  • Haemophilus
  • Neisseria
  • Bacillus

Transformation

DNAse - degrades naked DNA and can inhibit transformation

225
Q

Methenamine silver stain is used to identify _

A

fungus

226
Q

Window period of HBV

A

positive for: HBcAb and HBeAb

negative for: HBsAg and HBsAb

227
Q

HBcAg is detectable when?

A

Rises before the patient becomes symptomatic and stays elevate throughout the infection (whether in window period or not)

228
Q

What Ab should be measured to test if an infant has been infected with Toxo in utero?

A

IgM - first Ab produced when B cells are stimulated

IgG levels would indicate passive immunization from mother

229
Q

What 2 things increase precision and what 1 thing decreases precision?

A

increases precision:

  • decreased standard deviation
  • increased power (1-beta)

decreases precision:
-random error

230
Q

What 1 thing decreases accuracy?

A

decreases accuracy:

-systematic error

231
Q

how to decrease the chance of making a type II error? (4)

A

increase power -> decreases beta

how to increase power?

  • increase sample size
  • increase expected effect size
  • increase precision of measurement
232
Q

Medicare is for _

A
  • elderly (>65 yo)
  • certain disabilities
  • ESRD
233
Q

Medicaid is for _

A

-very low income

234
Q

Matching strategy helps overcome what bias?

A

Confounding bias

235
Q

Randomization helps overcome what bias?

A

Selection bias

Types of selection bias:

  • Berkson bias
  • Healthy worker effect
  • Non-response bias/Attrition bias
236
Q

What type of bias?

A screening test preferentially identifies less aggressive forms of a disease and therefore increases the apparent survival time

A

Length time bias

237
Q

Drugs with high intrinsic hepatic clearance have _ lipophilicity and _ Vd

A
  • high lipophilicity

- high Vd

238
Q

16 year old boy + chewing plant seeds + progressive confusion + agitation + feeling like bugs crawling on skin + trouble seeing + very thirsty =

A

Atropine poisoning

239
Q

What type of mosaicism - genetic mutation is seen in offspring but not in parents

A

Germline mosaicism

240
Q

Can somatic mutations be passed to offspring?

A

No

They are acquired/spontaneous alterations of somatic cells

241
Q

What cell produces IL-2

A

Antigen stimulated T cells -> (+) stimulates growth of all lymphocytes (T, B, NK) and monocytes

242
Q

What cells produce IL-1?

A

monocytes/macrophages

243
Q

Angry at being abused a child so the person joins a rugby team where he is known for playing really hard

A

Sublimation

244
Q

Chronic nasal congestion + occasional headaches + atrophic nasal mucosa + thinned nasal septum + small septal perforation + been taking oral loratadine with no help of symptoms

A

Nasal cocaine abuse

245
Q

Variable phenotype in patients with the same genetic mutation. Example: Marfan syndrome, NF1

A

Variable expressivity

246
Q

One genotype presents with many problems in multiple systems. Example: PKU

A

Pleiotropy

247
Q

Different mutations at the same locus causing a similar phenotype. Example: beta thalassemia, Duchenne vs Becker muscular dystrophy

A

Allelic heterogeneity

248
Q

Defect in intracellular messenger in a CD19 cell leading to multiple infections in an infant

A

Bruton agammaglobulinemia

CD19 = B cells

Defect in tyrosine kinase gene (BTK)

249
Q

If the hydrophobic N-terminal sequence of preproinsulin is cleaved off, where would the peptide accumulate?

A

In the cytosol

The N-terminal sequence is what directs the preproinsulin towards the rER where it gets cleaved to proinsulin

250
Q

Ablation of a can be used to treat severe axillary hyperhidrosis.

Ablation of b can be used to treat severe facial hyperhidrosis.

A

a=Thoracic sympathetic trunk

b=Superior cervical ganglion

Sweating is controlled via the cholinergic postganglionic sympathetic fibers

251
Q

Cellular differentiation and dedifferentiation is controlled by _

A

Transcription factors

252
Q

Sudden appearance of acanthosis nigricans + anemia =

A

Indicates a GI malignancy or lung malignancy

The anemia indicates blood loss, leaning towards a GI malignancy with occult blood loss

253
Q

Hypoplastic first digits + mullerian fusion abnormalities + genetic

A

Hand-foot-genital syndrome

  • AD
  • Mutated HOXA13 gene

Uworld Journal (12 decks)

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