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UWorld Journal > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

what is tachyphylactic in terms of drug interactions?

A

acute decrease in response to a drug after initial/repeated administration

ex) nitrates, niacin, phenylephrine, LSD MDMA

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2
Q

how can Wilson disease lead to basal ganglia atrophy?

A

copper accumulates in the brain (basal ganglia)

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3
Q

how can nitroprusside cause cyanide toxicity

A

nitroprusside is metabolized in body to release nitric oxide and cyanide ions

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4
Q

how to treat cyanide toxicity

A
  • sodium nitrite: promotes methemoglobin formation, which combines cyanide to form cyanmethemoglobin
  • sodium thiosulfate: serves as sulfur donor to promote hepatic rhodanese-mediated conversion of cyanide to thiocyanate to be excreted in urine
  • hydroxocobalamin: binds to cyanide ions and forms cyanocobalamin to be excreted in urine
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5
Q

osteocytes are connected to each other through

A

gap junctions

can sense mechanical stresses and send signals to modulate the activity of surface osteoblasts, so they help regulate bony remodeling

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6
Q

mechanism of action of colchicine

A

inhibits leukocyte migration and phagocytosis by blocking tubulin polymerization

used to treat acute gouty arthritis in those who can’t take NSAIDs (normally the first line treatment)

side effects: nausea and diarrhea

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7
Q

how does anterior dislocation of the humerus presents

A

flattening of the deltoid prominence, protrusion of the acromion, and anterior axillary fullness (due to humeral head’s movement into this location)

injured axillary nerve which innervates deltoid and teres minor muscles and provides sensory innervation of the skin overlying the lateral shoulder

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8
Q

1st pharyngeal pouch derivatives

A

middle ear cavity, eustachian tube, mastoid air cells

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9
Q

2nd pharyngeal pouch derivatives

A

epithelial lining of the palatine tonsil

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10
Q

3rd pharyngeal pouch derivatives

A

dorsal wings–> inferior parathyroids

ventral wings–> thymus

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11
Q

4th pharyngeal pouch derivatives

A

dorsal wings–> superior parathyroids

ventral wings–> ultimobranchial body, parafollicular (C) cells of thyroid

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12
Q

what is developmental field defect

A

multiple malformations that occur secondary to an embryonic disturbance in an adjoining group of cells

initial embryonic disturbance leads to multiple malformations by disrupting the development of adjacent tissues and structures within a particular region

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13
Q

what are caspases and what do they do?

A

proteolytic enzymes that cleave cellular proteins- activated by cytochrome c

apoptosis can occur through either intrinsic (mitochondria-mediated) pathway or the extrinsic (receptor-initiated) pathway

both pathways converge in the activation of caspases

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14
Q

lymph nodes of the lower extremities

A

divided into superficial lymphatic vessels (follow venous system) and the deep lymphatic vessels (follow the arterial system)

superficial divided into medial and lateral tracks
-medial track runs up the superficial inguinal lymph nodes, bypassing the popliteal nodes

lesions on the medial foot cause inguinal lymphadenopathy, whereas lateral lesions are more likely to cause lymphadenopathy in both the popliteal and inguinal areas

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15
Q

what is responsible for synthesizing cytosolic proteins

A

free ribosomes floating in the cytosol- translate proteins found found within the cytosol, nucleosol, peroxisome matrix, and nuclear-encoded mitochondrial proteins

the ribosomes on RER synthesizecell membrane proteins

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16
Q

homocystinuria-what is the cause and what happens to the individuals affected by this

A

cause by cystathionine synthase deficiency

affected individuals have marfanoid habitus, ectopia lentis, and developmental delay

many patients respond dramatically to pyridoxine (vitamin B6) supplementation

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17
Q

which are the stop codons

A

UAA, UAG, UGA

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18
Q

duchenne muscular dystrophy is caused by what type of mutation

A

frameshift mutations (most common) or nonsense mutations in the dystrophin gene that lead to the formation of truncated, defective protein

nonsense mutations introduce premature stop codons int he coding sequence of the mRNA

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19
Q

how is isoniazid metabolized

A

metabolized by acetylation

speed of which a patient is able to acetylate drugs depends on whether they are genetically “fast” or “slow” acetylators

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20
Q

what is tuberous sclerosis

A

autosomal dominant condition characterized by cortical tubers and subependymal hamartomas in the brain, with consequent seizures and cognitive disability, cardiac rhabdomyomas, facial angiofibromas, and leaf-shaped patches of skin lacking pigment (ask-leaf patches)

associated with renal angiomyolipoma (benign tumor composed of blood vessels (angio), smooth muscle (myo), and fat (lipoma)

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21
Q

amino acid binding site of tRNA

A

3’ CCA tail

aminoacyl tRNA synthetase is the enzyme responsible for “loading” the appropriate amino acid to the 3’ terminal hydroxyl group of the CCA tail

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22
Q

role of ubiquitin proteasome pathway

A

breakdown of intracellular proteins, both native and foreign, and helps recycle them into the amino acid building blocks

for immune response–> degrade foreign intracellular proteins and couple them to MHC I to present to CD8+ T-cells.

23
Q

presentation of trisomy 18 (Edwards syndrome)

A

“election age”

micrognathia, prominent occiput (back of head), low-set ears, heart defects, clenched hands with overlapping fingers, renal defects, limited hip abduction, rocker-bottom feet

24
Q

promoter region of transcription in eukaryotic cells

A

TATA and CAAT boxes located approximately 25 and 75 bases upstream form the transcription start site, respectively

25
Q

primary site for ribosome synthesis and assembly

A

nucleolus

all ribosomal RNA except 5S rRNA is transcribed in the nucleolus

26
Q

body’s reaction to high-altitude sickeness

A

hypobaric hypoxia

low barometric pressure so decreased pO2 in air and blood

–> tissue hypoxia stimulates peripheral chemoreceptors, causing hyperventilation in an attempt to improve oxygenation

–> decreased partial pressure of CO2 (pCO2) and increased pH (respiratory alkalosis)

–> renal bicarb excretion to compensates

increased pH, decreased pCO2 and pO2

27
Q

drug and volume of distribution

A

if large molecular weight–> bound extensively to plasma proteins, or highly charged, then drug remaining the plasma compartment and the volume of distribution is usually low (3-5 liters)

if small molecular weight, but is hydrophilic, then can distribute into the interstitial fluid compartment outside of blood vessels and intravascular compartment (volume of distribution is limited to a total volume of about 14-16 liters (plasma + interstitial))

small molecular weight and uncharged–> dross cell membranes and reach intracellular compartment have the highest volume of distribution (41 liters)

28
Q

financial arrangement:

define capitation

A

payer (individual, employer, or government entity) pays a fixed, predetermined fee to cover all medical services required by a patient

payment structure underlying HMO

29
Q

Beers criteria: common drugs to avoid in older patients

A
  • anticholinergic: first gen antihistamines (diphenhydramine), GI antispasmodics
  • cardio: alpha-1 blockers, centrally-acting alpha-2 agonists, many antiarrhythmics
  • CNS: tricyclic, antipsychotics, barbituates, benzo, and other hyponotics
  • endocrine: long-acting sulfonylureas, sliding-scale insulin
  • pain: non-selective NSAIDS, and skeletal muscle relaxants
30
Q

drug distribution by organs

A

after IV administration, highly lipophilic drug will rapidly distribute to organs with high blood flow (brain, liver, kidneys, lungs)

then to tissues with lower blood flow (skeletal muscle, fate, and bone)

31
Q

what causes increased ESR?

A

high levels of circulating fibrinogen

cytokines IL-1, IL-6, and TNF-alpha mediate systemic inflammatory response and stimulate hepatic secretion of acute-phase proteins (eg, fibrinogen)

32
Q

function of prokaryotic DNA polymerase

A

Prokaryotes have 3 types of DNA polymerase: I, II, and III

all 3 DNA polymerases are capable of removing mismatched nucleotides via their 3’ to 5’ exonuclease (proofreading) activity

only DNA polymerase I has 5’ to 3’ exonuclease activity, which is used to remove the RNA primer synthesized by RNA primase

33
Q

how does glycogen degradation synchronized with skeletal muscle contraction

A

due to release of sarcoplasmic calcium

calcium causes activation of phosphorylase kinase, stimulating glycogen phosphorylase to increase glycogenolysis

34
Q

phosphatidylinositol 2nd messenger system

A

ligand binds to G protein-coupled receptor–> activates phospholipase C, which is broken down into DAG and IP3–> protein kinase C is activated by DAG and calcium–> protein kinase C phosphorylates downstream intracellular proteins to produce its physiologic effects (eg, smooth muscle contraction)

IP3 increase intracellular calcium to activate more protein kinase C

35
Q

what characteristic of drugs are more likely to be processed by the liver for metabolism

A

drugs with more lipophilic properties

processed by liver into more polar compounds to be eliminated in bile and urine

36
Q

blotting technique and what substance each detect

A

northern–> RNA (use single-stranded DNA or RNA (hybridization probe))
southern–> DNA (use ss DNA or RNA (hybridization probe))
western–> protein (antibody probe)
southwestern–> DNA-binding protein like transcription factors, nucleases, and histones (dsDNA probe)

37
Q

what is c-Jun

A

DNA-binding protein

nuclear transcription factors that directly bind DNA via a leucine zipper motif

38
Q

effects of different doses of dopamine

A

low: stimulates D1 receptors in renal and mesenteric vasculature–> vasodilation and increased blood flow to these sites

increasing doses–> stimulate beta1 and alpha 1 receptors–> increased cardiac output and eleveated systemic vascular resistance

higher dose–> increase in afterload can lead to decreased cardiac output

39
Q

efficacy of drugs

A

refers to the intrinsic ability of a drug to elicit an effect

measure of maximum ceiling of activity (Emax) of a drug with respect to a particular pharmacodynamic end point

40
Q

potency of drug

A

refers to dose of drug that is required to produce a given effect

affected by affinity of drug to receptor and amount of drug that is able to reach the target tissues

measure with ED50, lower the greater potency

41
Q

histones

A

nucleosomes are composed of DNA wrapped around a core of 8 histone proteins (2 molecules each of H2A, H2B, H3, and H4)

H1 histone is located outside of this histone core and helps package nucleosomes into more compact structures by binding and linking the DNA between adjacent nucleosomes

42
Q

what are P bodies

A

distinct foci found within eukaryotic cells that are involved in mRNA regulation and turnover

play a role in translation repression and mRNA delay and contain numerous proteins including RNA exonucleases, mRNA decapping enzymes, and constituents involved in mRNA quality control and microRNA-induced mRNA silencing

43
Q

what happens to proteins destined for the lyssome

A

they require phosphorylation of specific mannose residues to ensure proper transit through Golgi apparatus

in the lysosome, they serve as catalysts for degradation of cellular components

44
Q

triple helical conformation of collagen molecules occurs due to simple and repetitive amino acid sequence within each alpha chain with what amino acid in every third amino acid position

A

glycine

Gly-X-Y

45
Q

common causes of Down syndrome

A
  • meiotic nondisjunction: extra chromosome 21– based on maternal age
  • unbalanced translocation: all or part of additional chromosome 21 attached to another chromosome
  • mosaicism: some (not all) cells have extra copy of chromosome 21 or nondisjunction event in early embryonic life
46
Q

how many half-lives does it take for the drug (metabolized by first-order kinetics) that is given by continuous infusion to reach stead state?

A

reach steady state in 4-5 half-lives

47
Q

in hyperthyroidism, the upper eyelids are retracted, why?

A

hyperthyroidism induces increased expression of adrenergic receptors and leads to a hyperadrenergic state

excess adrenergic stimulation of the superior tarsal muscle causes increased resting tone and retraction of the lid

48
Q

what is in each of the compartments of the leg

A

anterior: deep peroneal nerve, anterior tibial artery and veins

deep posterior: tibial nerve and peroneal artery and veins

lateral: superficial peroneal nerve

49
Q

what is vitamin C used for in the body

A

necessary for hydroxylatioin of proline and lysine residues during collagen synthesis

deficiency–> capillary bleeding, poor wound healing, and periodontal disease

in children, bony deformities and subperiosteal hemorrhages

50
Q

what is deficient in alkaptonuria

A

homogentistic acid dioxygenase

can’t convert tyrosine to fumarate so accumulation of homogentisic acid leading to black urine color when exposed to air, blue-black pigmentation on the face, and ochronotic arthropathy

51
Q

what is tertiary preventsion

A

treating an established condition with the goal of minimizing its progression or complications

52
Q

what is health promotion

A

process of enabling people to increase control over their health and its determinants and thereby improve their health

53
Q

key findings with Patau syndrome (trisomy 13)

A

“puberty=13” due to secondary to meiotic nondisjunction in mothers of advanced maternal age

defective prechordal mesoderm fusion resulting in midline defects (eg, holoprosencephaly, microphthalmia, cleft lip/palate, omphalocele, polydactyly, cutis aplasia, rocker-bottom feet, renal and cardial defects,a dn umbilical hernia/omphalocele

54
Q

when does linkage disequilibrium occur?

A

occurs with two genetic loci when their respective alleles are inherited together in the same gamete more or less often than expected by chance alone given their corresponding allele frequencies

most often occurs when the genes are in close physical proximity on the same chromosome so get crossed over together

UWorld Journal (18 decks)

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