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Step 3 > Heston Step 1 > Flashcards

Heston Step 1 Flashcards

1
Q

Depending on oxygen availability, what two pathways do cells use to produce energy?

A

Anaerobic glycolysis and Oxidative Phosphorylation

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2
Q

when does anaerobic glycolysis occur?

A

occurs in oxygen poor states; coverts glucose to pyruvate to lactate in the cytosol which is excreted from the cell.

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3
Q

when does Oxidative Phosphorylation occur?

A

Occurs in oxygen rich states; moves pyruvate from the cytosol to the mitochondria where it is converted to acetyl-coa and runs through the tricarboxylic acid cycle

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4
Q

where do stem cells and cancer cells generate most of their energy?

A

Anaerobic glycolysis; despite the presence of adequate oxygen (Warburg effect)

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5
Q

what is the Warburg effect?

A

cells produce more lactate than a normal terminally differentiated cells (stem and cancer cells) as almost all the glucose is converted to lactate and excreted

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6
Q

symptoms of tuberculosis?

A

cough, hemoptysis, night sweats, fever, weight loss , chess pain

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7
Q

what is silicosis?

A

occupational lung disease caused by inhalation of crystalline silica and characterized by multiple rounded nodules in the upper lobes. patients may develop calcification of the rim of hillier lymph nodes (eggshell calcification)

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8
Q

silicosis and impaired macrophage function

A

silicosis is associated with increased risk of mycobacterial infections, particularly mycobacterium tuberculosis, due to impaired macrophage function

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9
Q

what can cystic fibrosis cause?

A

recurrent pulmonary infections due to impaired pathogen clearance. (impaired mucociliary clearance0

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10
Q

what is sickle cell disease (SCD)?

A

autosomal recessive disorder caused by the predominance of hemoglobin S, causing red blood cells to sickle. hemolyze and cause vascular obstruction. (offspring of carrier parents have a 3/4 chance of inheriting at least 1 mutated allele)

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11
Q

symptoms of sickle cell disease?

A

anemia, swelling (hands and feet), pain episodes, frequent infections, delayed growth, Vision problems

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12
Q

unaffected parents of an affected sickle cell offspring means?

A

both parents are carriers and the probability of inheriting each of the three possible genotypes (AA, Aa,aa) is determined using a Punnett square (75% chance of being affected)

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13
Q

verrucuos, skin colored genital lesions are most consistent with?

A

condylomata acuminatum (anogenital warts)

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14
Q

Cause of condylomata acuminatum?

A

HPV (human papillomarvirus) most common sexually transmitted disease

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15
Q

What kind of cells does HPV affect?

A

basal epithelial cells; predilection for stratified squamous epithelium, found in the anal canal, vagina and cervix. those same cells are found in the vocal chords

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16
Q

how can infants be affected by HPV?

A

infants can acquire papillomatosis via passage through the birth canal of mothers infected by the virus. (warty growths on the true vocal chords can lead to weak cry hoarseness and stridor

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17
Q

the presence of “Gowers Sign” (use of hands to rise from squat or from chair to compensate proximal weakness) and calf enlargement in a boy age 2-5 is classic for?

A

DMD ( Duchenne muscular dystrophy )

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18
Q

structural component of skeletal muscle fibers that provides mechanical stability to the sarcolemma

A

Dystrophin

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19
Q

what does dystrophin do?

A

links a component of the cytoskeleton (actin) to transmembrane proteins that are connected to the extracellular matrix

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20
Q

frameshift mutations

A

deletions that are not a multiple of 3 change the reading frame. which results in non functional proteins and severe clinical manifestations of DMD (Duchenne muscular dystrophy)

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21
Q

pregnancy of twins with different sexes can only occur in? and why?

A

Dizygotic twins; due to the fertilization of 2 oocytes by two different sperm.

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22
Q

dizygotic twins are almost always?

A

diachorionic & diamnotic (because they have two separate chorions and amnions

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23
Q

what are the longterm changes in gas exchange in the lungs

A

The alveolar arterial (A-a) oxygen gradient progressively widens over decades which causes the arterial partial pressure (PaO2) to fall but the carbon dioxide (PaCO2) does not change

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24
Q

acute compartment syndrome (ACS)

A

pressure in the fascia compartment rises causing severe pain and tissue ischemia after long bone fractures, crush injury or thermal injury

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25
Q

Most common site for ACS (acute compartment. syndrome)

A

anterior compartment of the leg which includes extensor muscles, anterior tibial artery and deep perineal (fibular) nerve; can cause decreased sensation in the first and second toes

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26
Q

legionella pneumonia (gram negative rod)

A

fever, headaches, diarrea. sputum gram stain shows many neutrophilis but few to no organisms.

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27
Q

what happens to vasopressin during septic shock?

A

it is suppressed, vasodilatory mediators overwhelm endogenous vasoconstrictor mechanisms

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28
Q

manifestations od sepsis

A

Low blood pressure, fever, leukocytes elevated.

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29
Q

what is sepsis?

A

inflammatory response to infectious pathogen

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30
Q

vasopressin deficiency contributes to unbalanced vasodilation and refractory hypotension causing?

A

septic shock

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31
Q

The thick white patches seen on this patients tongue are indicative of?

A

oral thrush (oropharyngeal candidiasis)

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32
Q

Treatment for oropharyngeal candidiasis?

A

Nystatin (polyene antifungal) it is not absorbed in the gastrointestinal tract

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33
Q

Risk factors of thoracic aortic aneurysm?

A

above age 60, smoking, hypertension, family history, connective tissue disease (Marfan syndrome)

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34
Q

clinical presentation of thoracic aortic aneurysm?

A

usually asymptomatic, vague chess or back pain, hoarseness or dysphagia, hemodynamic instability, majority involve ascending aorta.

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35
Q

imaging findings in thoracic aortic aneurysm?

A

wide mediatinum, large aortic knob, traqueal deviation

36
Q

what is alkaptonuria?

A

autosomal recessive disorder caused by deficiency homogentisic acid deoxygenase (metabolizes homogentisic acid into maleylacetoacetate)

37
Q

symptoms of alkaptonuria?

A

pigment deposits in connective tissue throughout the body (blue-black deposits) often appear in sclarae, ear, large joints and spine causing motion restriction and significant pain.

urine of these patients turn black when exposed to air because of oxidation of homogentisic acid

38
Q

major depressive disorder characterization

A

lasts 2 weeks more or less, has significant function impairment, depressed mood and sidecaps

39
Q

persistent depressive disorder characteristics

A

chronic depressed mood that lasts at least two years; has two or more of the following: appetite disturbance, sleep disturbance, low energy, low self esteem, poor concentration, hopelessness

40
Q

adjustment disorder with depressed mood characteristics

A

onset within 3 months with identifiable stressor, marked distress &/or functional impairment

41
Q

avoidant personality disorder characteristics

A

onset in early adulthood life with pattern of pervasive inhibition, feelings of inadequacy, hypersensitivity to evaluation

42
Q

chronic fatigue syndrome characteristics

A

more than 6 moths of significant reduction in activity with the fatigue not relieved by rest, drastic worsening of symptoms after activity, sleep impairment and cognitive impacts (brain fog)

43
Q

what morphological change occurs due to direct tissue damage from a burn?

A

histamine and other preformed vasoactive mediators from mast cells release in minutes following a burn which leads to the dilation of superficial skin capillaries

44
Q

In the heart of an athlete what happens?

A

maximum cardiac output is increased, left ventricle cavity size is increased but the fraction of ejection stays the same

45
Q

carcinoembryonic antigen (CEA) is a glycoprotein found in what organs?

A

embryonic pancreas, liver and intestine

46
Q

Carcinoembryonic antigen (CEA) levels are elevated in most patients with colon cancer; elevated preoperative levels of CEA are are associated with a worse prognosis and failure to normalize suggests?

A

A risidual disease

47
Q

To perform a cricothyrotomy procedure creating an airway through the placement of a tube between the thyroid and cricoid, incisions must be made through which structures?

A
  1. Skin
  2. Superficial cervical Fascia
  3. investing and petracheal layers of deep cervical fascia.
  4. Cricothyroid membrane
48
Q

Symptoms of epiglottitis?

A
  1. Childs fever
  2. respiratory distress ( inspiratory stridor)
  3. inflamed epiglotis
49
Q

Epiglotitis is most commonly caused by?

A

Haemophilus Influenzae type b

50
Q

What is the major virulence factor of Haemophilus influenza type b (HIB)?

A

its polycacharide capsule, composed of the polymer cpolyribosylribitol phosphate

51
Q

azathioprine is a an immunosuppressant used in what cases?

A
  1. prevention of organ transplant rejection
  2. treatment of autoimmune diseases such as rheumatoid arthritis, inflammatory bowel disease and autoimmune hepatitis
52
Q

Proximal muscle weakness resembling polymyositis, inflammatory skin finding including heliotrope rash in the periorbital area (shown in picture) and cheeks and grotton papules (raised erythematous plaques over the joints and bony prominences of the hand are indicative of what systemic autoimmune disease?

A

Dermatomyositis
- may occur alone or as a pareneoplastic syndrome of underlying malignancy
- most commonly due to underlying adenocarcinoma
- common symptom are “groton papules)

53
Q

symptoms of general anxiety disorder (GAD)

A

excessive and chronic worrying, feeling on edge, muscle tension, insomnia

54
Q

General anxiety disorder is treated with cognitive behavioral psychotherapy and/or antidepressant medication such as?

A
  1. Selective serotonin reuptake inhibitors (SSRI’s) such as citalopram 2. serotonin noreprephine reuptake inhibitors (SNRI’s)

first line treatments

55
Q

why are benzodiazepines such as alprazolam, clonazepam and diazepam considered as second line treatment for General anxiety disorder?

A

the risk of dependance and tolerance and the potential for rebound and withdrawal syndrome with abrupt discontinuation

56
Q

chronic kidney disease results in impaired conversion of 25-hydroxyvitamin D to 1,25 dihydroxyvitamin D due to what factors?

A
  1. increased levels of FGF23 (growth factor) which inhibits 1-alph-hydroxylase
  2. limited delivery of 25-hydroxvitamin d to proximal tube cells
  3. reduced functional renal mass which emits production of 1-alpha-hydroxylase
57
Q

During an orchiopexy (placement and fixation of testis in scrotum), the malpositioned testis will be pulled through what physiological opening?

A

superficial inguinal ring which is a physiological opening in the external oblique aponeurosis above the pubic tubercle

58
Q

Positive anti-HAV Igm indicates?

A

acute or recent hepatitis A infection, most commonly caused by close contact with an infected person, consuming contaminated food or drinks. outbreaks often occur in vrowded places like health care facilities, prisons or daycare centers

59
Q

symptoms of Hepatitis A?

A

loss of appetite, nausea, vomitting, fatigue, fever, abdominal pain . diarrhea

60
Q

in chronic obstructive pulmonary disease (COPD) (an advanced hypoxic lung disease) vasoconstriction con promote pulmonary hypertension causing what affect on the heart?

A

increased right ventricle afterload

61
Q

zolpidem, zaleplon and eszopiclone are hypnotics and examples of what class of drugs?

A

non-benzodiazepines

62
Q

Nonbenzodiazepines, like benzodiazepines bind to GABA receptors are the benzodiazepine receptor site where they act as?

A

GABA agonists

63
Q

Benzodiazepines produce what effects?

A

anxiolytic, muscle relaxant and anticonvulsant effects

64
Q

H pylori is prevalent in what parts of the world?

A

asia and South America

65
Q

PUD (peptic ulcer disease) or most patients with duodenal ulcers a have concomitant?

A

Helicobacter Pylori Infection

66
Q

treatment and prevention of ulcer reoccurrence require the eradication of H-Pylori infection with the use of what medication?

A

Combination of antibiotics such as (tetracycline, metronidazole) and proton pump inhibitor such as (omeprazole)

67
Q

shigella gastroenteritis symptoms?

A
  1. abrupt high fever
  2. abdominal cramping
  3. stool that starts watery before mucus and blood appears
  4. left side abdominal tenderness

(stool culture diagnostic)

68
Q

common causative organisms in bacterial gastroenteritis with bloody diarrhea include?

A

escherichia coli, shingella and campylobacter

69
Q

Edema of the proximal trachea causes what sounds upon breathing?

A

inspiratory trader, barking cough and hoarseness

70
Q

Symptoms of Croup

A

rhinorrhea, nasal congestion, barking cough, retractions and inspiratory stridor

71
Q

Cause of croup?

A

viral infection caused by the parainfluenza virus, most commonly seen in children ages 6 months to 3 years

72
Q

respiratory acidosis occurs due to retention of CO2 in the lungs and presents with low pH and high PaCO2

Metabolic acidosis occurs due to depletion of HCO3 and is characterized by?

A

low pH and low HCO3

73
Q

pancreatic neuroendocrine tumor symptoms?

A

epigastric pain, weight loss, jaundice, palpable mass

74
Q

both functional and nonfunctional pancreatic neuroendocrinic tumors are well circumscribed lesion composed of what type of cells?

A

uniform tumor cells with organoid architecture (nested, granular, ribbon or pseudorosette arrangement

75
Q

Wilsons disease

A

defective copper transporter within hepatocytes, resulting in copper accumulation in the liver, eye, and brain

76
Q

treatment of Wilsons disease?

A

Penicillamine, a copper chelating agent, which causes it to be excreted in urine. common adverse effect is nephrotic syndrome causing proteinuria due to membranous nephropathy

77
Q

the treatment for patients with gouty arthritis is nonsteroidal anti inflammatory drugs but these medication are contraindicated in patients with what disease?

A

peptic ulcers

78
Q

pharmaceutical treatment for patient with acute gout

A

colchicine; inhibits tubulin polymerization into microtubules

79
Q

if patients from Southeast Asia have weight loss, cough, apical infiltrate with acid fast bacilli, it raises strong suspicion of what disease?

A

pulmonary tuberculosis

80
Q

a learning disorder is characterized by difficulties in what key academic skills?

A

reading, writing or mathematics
(learning disorders can be the cause of anxiety, stress, emotional outburst, hyperactivity or inattention

81
Q

newborn patient with bilious emesis, and abdominal distention can be at risk of?

A

midway malrotation

82
Q

midgut malrotation can result in narrow mesenteric base that is vulnerable to twisting around the mesenteric artery resulting in?

A

MIDGUT VOLVULUS

83
Q

symptoms are low-grade fever, , flank pain, nausea, vomiting

what is the most likely diagnosis

A

renal infarction: commonly caused by cardioembolitic disease. originating from the left atrium or ventricle

84
Q

what are common lab abnormalities associated with renal infarction?

A

elevated lactate dehydrogenase( suggestion cell necrosis, hematuria, mild leukocytosis.

pathology shows sharply demarcated yellow, white wedge shaped infarcts

85
Q

heart failure causes increased hydrostatic in pulmonary circulation due to backup of blood flow from what failing heart structure?

A

the left ventricle

86
Q
A

Step 3 (3 decks)

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