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1
Q

Side effects of amphotericin B

A

nephrotoxicity: decreases GFR but also has direct toxic effects on the tubular epithelium. Can lead to anemia (secondary to decrease EPO production) and electrolyte abnormalities.
Hypokalemia and hypomagnesia are common due to an increase in permeability of the distal tubule
hypokalemia can cause weakness and arrhythmias (PVCs, U waves)

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2
Q

what are the 4 voltage gated Na toxins?

A

tetrodotoxin (pufferfish), saxitoxin (“red tide” fish) - binds to Na channels, inhibiting Na influx and preventing action potential conduction.

ciguatoxin (exotic fish and Monteray eel), & batrachotoxin (South American frogs) - binds to Na channel and keeps it open causing persistent depolarization

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3
Q

symptoms and treatment of terodotoxin posioning

A

dizziness, weakness, loss of reflexes, parasthesias on the face and extremities, nausea, vomiting, diarrhea

higher exposures - hypotension and general paralysis

death from respiratory failure and hypotension

treatment: supportive care and intestinal decontamination with charcoal and gut lavage

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4
Q

symptoms of lead posioning

A

neuro

  • cognitive impairment
  • behavior problems
  • encephaly

GI

  • constipation
  • abdominal pain
  • decreased vitamin D metabolism

renal
-interstitial nephritis

hematologic
-anemia

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5
Q

what brush border enzyme activates trypsin?

A

enteropeptidase

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6
Q

what is the role or trypsin?

A

degredation of complex polypeptides, tripeptides, and AA while activating other pancreatic enzymes.

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7
Q

manifestations of enteropeptidase deficiency

A

impaired protein and fat absorption

diarrhea, failure to thrive, and hyponatremia

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8
Q

thiamine deficiency: what is a chronic syndrome causing this?

A

alcoholism

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9
Q

thiamine deficiency: necessary cofactors of the TCA cycle using this

A

Alpha-KG dehydrogenase complex (AKG to Succinyl CoA)

also pyruvate to acetyl CoA requires it (entry into TCA)

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10
Q

5 risks of secondhand smoke exposure

A
  1. premature birth weight/prematurity
  2. SIDS
  3. Asthma
  4. respiratory tract infections
  5. middle ear disease (otitis media)
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11
Q

RAS G proteins - what receptor type associated with? and how are they activated?

A

activated when bound to GTP

tyrosine kinase signal transduction - MAPK pathway

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12
Q

Post Herpetic Neuralgia topical management

A

capsaicin - loss of membrane potential in nociceptive fibers; irritant found in chili pepper family

excessive activation of a cation channel builds up intracellular calcium that eventually defunctionalizes the fiber

also causes depletion of substance P

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13
Q

what is base excision repair used for?

A 
non-bulky DNA base alterations:
depurination
alkylation
oxidization
deamination

correct single base DNA defects induced spontaneously or exogenous chemicals

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14
Q

steps of base excision repair

A
  1. glycosylates remove defective base
  2. endonuclease and lyase cleaves and removes corresponding sugar phosphate site
  3. DNA polymerase fills in missing spot
  4. ligase seals the nick
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15
Q

1,2,3 standard deviation rule

A

68/95/99

95% lie within 1.96 standard deviations

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16
Q

risk factors and microbiology for septic abortion

A

staph aureus & gram negative bacilli (ecoli)

risk: pregnancy termination with retained products of conception

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17
Q

presentation of septic abortion

A

fever, chills, lower abdominal pain, blood vaginal discharge
boggy and tender uterus with dilated cervix
pelvic ultrasound showing retained products of conception, increased vascularity, echogenic material in the cavity, and thick endometrial stripe

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18
Q

long term complications of septic abortion

A

synechia (adhesions) in the uterine cavity

asherman’s syndrome (secondary ammenorrhea and infertility)

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19
Q

silicosis - presentaiton, histopath, and symptoms

A

presents 10-20 years after exposure (occupational)

histo - calcification of rim hilar nodes (eggshell calcification), and birefrengent silica particles surrounded by fibrous tissues

symptoms - frequently asymptomatic but can present with dyspnea on exertion and productive cough

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20
Q

PTH is responsible for ___ reabsorption in the ________ of the kidney

A

calcium
distal tubules and collecting ducts

low levels of PTH cause hypercalciura; but serum calcium is still high because the loss in the urine doesn’t outweight the bone resorption happenning (in the case of multiple myeloma)

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21
Q

_______ is a fast acting, depolarizing muscular blocking agent used for rapid sequence intubation that causes equal reduction of all 4 twitchs during train of stimulation (phase I blockade).

A

succynylcholine

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22
Q

prolonged administration of succynylcholine (or use in patients with abnormal plasma cholinesterase activity) causes what?

A

causes a transition to it being a phase II (nondepolarizing) block, seen as a progressive reduction in the 4 twitches on TOF (train of four) stimulation

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23
Q

phospholipase A2 receptor antibodies (IgG) + proteinuria cause:

A

membranous nephropathy
indicative of glomerulonephritis.
PLA2 is found on podocytes and thought to be a major antigen of idiopathic membranous nephropathy

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24
Q

side effects of rifampin

A

GI, rash, red-orange body fluids, cytopenias

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25
side effects of isoiazid
neurotoxicty (vit B6 deficiency), & hepatotoxicity neurotoxic effects can be prevented with vitamin b6 (pyridoxine) supplementation
26
side effects of pyrazinamide
hepatoxicity and hyperurecemia
27
side effects of ethambutol
``` optic neuropathy (decreased visual acuity, central scotoma, or color blindness) can be reversed with discontinuation of the drug ``` tx of tuberculosis
28
clinical features of Tricyclic antidepressant overdose: | CNS, cardio, and cholinergic effects
CNS: mental status changes, seizures, respiratory depression cardio: sinus tachy, hypotension, prolonged heart intervals (all), arrythmias, cholinergic: dry mouth, blurred vision, dilated pupils, urinary retention, flushing, and hyperthermia
29
depersonalization/derealization disorder
persistent or recurrent experiences of 1 or both: 1. depersonalizations (detachment feelings or feeling as if you are observing yourself) 2. derealization (experiencing surroundings as unreal) intact reality testing
30
clinical findings of Wiscott Aldridge Syndrome
eczema, recurrent infections, thrombocytopenia X linked recessive (males) thrombocytopenia causes petichiae, purpura, hematemesis, and epistaxis
31
immunodeficiency in WAS syndrome
combined B and T cell type increased risk of pyogenic infections and infections caused by bacteria with a capsule
32
treatment of WAS
bone marrow transplantation
33
common causes of generalized malabsorption
``` defects in pancretic secretion (chronic pancreatitis, CF) mucosal disorders (celiac disease, IBD) bacterial overgrowth (GI surgery, abdominal motility) pancreatic diseases (giardia) ``` testing for fat malabsorption is the most sensitive strategy to confirm malabsorption disorders
34
stain that identifies unabsorbed fat and confirms malnutrition
sudan III stain
35
"red neurons" are seen in lesions how long after hypoxic injury?
12-24 hours
36
hypertrophic cardiomyopathy (HCM)
haphazardly arranged myocytes and bundles interstitial spaces have fibrosis sudden death under stressful circumstances 50% are familial cases and autosomal dominant with variable expression
37
spleen origin embryonically and blood supply embryology
intraperitoneal organ derived from the mesoderm of dorsal mesentery unique because it's blood supply (the splenic artery off the celiac trunk) is foregut derived venous return through the splenic vein
38
surgical ligament cut for treatment of carpal tunnel syndrome
transverse carpal ligament
39
symptoms & presentation of homocysteinuria disease
autosomal recessive disease presents at age 3-10 with lens dislocation/subluxation half of patients have intellectual disability marfanoid habitus high risk for thromboembolic occlusion of large and small vessels (including brain, kidneys, and heart) - this is the major cause of death in these patients
40
homocysteinuria pathophys and enzymes; | treatment
deficiency of cystathione beta synthase, and enzyme that requires vitamin B6 as a cofactor (pyridoxine) about 50% of patients respond to supplementation in high doses because it improves activity of residual enzymes and reduces plasma homocysteine levels. additional treatment includes dietary restriction of methionine
41
hyperacute transplant rejection: what is the onset time, etiology, and morphologic findings
onset - minutes to hours; usually diagnosed by the surgeon in the OR etiology - PREFORMED antibodies against the graft in the patients circulation; type II hypersensitivity with preformed IgG antibodies morphology - gross molting and cyanosis; arterial fibrinoid necrosis and capillary thrombotic occulsion
42
acute transplant rejection: what is onset time, etiology, and morphologic findings
onset - less than 6 months etiology - exposure to donor antigens induces cellular and humoral response of naive immature cells morphology - humoral = Cd4 deposition, neutrophillic infiltrate, and necrotizing vasculitis; cellular = lymphocytic interstitial infiltrate and endothelialitis
43
chronic transplant rejection: onset time, etiology, and morphologic findings
onset - months to years etiology - chronic, low-grade immune response refractory to immunosuppressants morphology - vascular wall thickening and luminal narrowing. interstitial fibrosis and parenchymal atrophy
44
Zellweger syndrome
defective production of peroxisomes; problems with VLCFA oxidation, because they don't make peroxisomes and cannot undergo beta oxidation. presents in infancy with craniofacial abnormalities, hepatomegaly, and profound neurologic defects. death usually occurs within months of initial presentaiton
45
X-linked adrenoleukodystrophy
- defective transport of VLCFAs into perioxisomes - presents in childhood or early adulthood with neurologic deterioration and adrenal insufficiency as VLCFAs accumulate in the brain and adrenal glands
46
elevated levels of homocysteine are an independent risk factor for _________
thrombotic events venous thromboses, CAD, and ischemic stroke mechanism thought to be due to direct and indirect endothelial damage
47
homocysteine can be metabolized to ______ via remethylation. homocystein can be metabolized to _______ via transsulfuration
methionine cystathionine
48
hyperhomocysteinemia is most commonly due to genetic mutations in critical enzymes or deficiencies of what 3 vitamins?
B12 (colbalamin) B6 (pyridoxine) folate
49
chronic granulomatous disease: major test, major enzyme deficiency, and inhertiance pattern
NBT (nitrotoluene blue test) - failure to turn blue! enzyme: NADPH oxidase inheritance pattern: X linked recessive
50
function of NADPH oxidase
formation of ROS in phagosomes. that act as antimicrobial agents and also activates granule proteases
51
CGD presentation
recurrent bacterial and fungal infections caused by catalase positive organisms that can destroy the hydrogen peroxide with their own enzymes catalase negative organisms cannot prevent the accumulation of their own H2O2 within phagosomes, allowing for some killing activity despite lack of host superoxide production
52
nitroprusside's effects on the cardiovascular pressure volume loop
short acting balanced venous and arterial vasodilator. decreases LV preload and afterload, allowing adequate cardiac output to be delievered at a lower LV end diastolic pressure. LVEDP (preload) is decreased and after load (mean systolic interventricular pressure) is decreased, without a reduction in stroke volume.
53
follicle hair growth in heavily influenced by _____, which is produced by the enzyme ______.
dihydrotestosterone testosterone-5-alpha-reductase
54
what medications minimize progression of hair loss (androgeneic allopecia) if started early?
5 alpha reductase inhibitors (ie finasteride) decrease DHT conversion to testosterone
55
Meniere's Disease TRIAD
disease of inner ear caused by increased pressure and volume of endolymph fluid - thought to be due to ineffective resorption. 1. low frequency tinnitis 2. vertigo 3. sensiorineural hearing loss
56
follicular lymphoma
- B cell tumor comprised of centrocytes and fewer number of centroblasts - low magnitude is packed follicles that resemble follicular hyperplasia BUT they express BCL2 (anti-apoptotic protein) - translocation is 14;18 is found in 90% of these
57
mechanism of the cholera toxin
- noninvasive organism; secretes toxin that activated AC --> increased cAMP - enhanced Cl excretion, and decreased Na absorption --> net water movement out into the gut lumen! - rehydration therapy works! - toxin also induces mucin ejection by goblet cells
58
southern blots analyze
DNA fragments
59
western blots analyze
protein
60
northern blots analyze
mRNA - assess gene expression
61
southewestern blots analyze
DNA boud proteins
62
the tinea coli are 3 seperate smooth muscle ribbons that travel longitudinally on the outside of the colon and converge at the root of the _______
veriform appendix
63
_____ is the name of an acute phase reactant synthesized by the liver that acts as the central regulator of iron homeostasis
hepcidin
64
name things that increase or decrease the body's production of hepcidin (iron homeostasis)
increase: high iron levels and inflammatory conditions decreased: hypoxia and increased erythropoiesis
65
low hepcidin does what to intestinal cells and macrophages?
increase intestinal absorption of iron and stimulates iron release from macrophages
66
hypothyroid myopathy
- hypothyroidism is a common cause of increased CK - can be first manifestation of hypothyroidism - presents with myalgia, proximal muscle weakness, cramping, and myoedema (ie patient develops bump over muscle after being hit with reflex hammer)
67
how does a low estrogen state cause osteoperosis?
decrease estrogen causes a decreased amount of osteoprotegrin, increased RANKL production, and increased RANK expression in osteoclast precursors.
68
what is heteroplasmy?
having different mitochondrial genomes inside the same cell. severity of a patient's mitochondrial disease depends on the ratio of normal to abnormal mitochondria passed down
69
lymph nodes from the testes drain where?
into the paraaortic lymph nodes (retroperitoneal)
70
lymph node drainage of the penis
deep inguinal nodes
71
dihydrobiopterin reductase - two lab findings
excess phenylalanine and elevated prolactin
72
phenylalanine is converted to tyrosine by _____. and this uses _____ as a cofactor
phenylalanine hydroxylase BH4 *dihydrobiopterin*
73
drug class that causes hepatitis after anesthesia
halothanes | metabolized by cyp450
74
halothane hepatitis
presents 2days to 3 weeks after surgery fever, nausea, jaundice, tender hepatomegaly, and elevated AST and ALT and bilirubin levels biopsy shows centrilobular necrosis treatment is supportive
75
carnitine deficiency impairs _____ transport from the cytosol to the mitochondria.
fatty acid
76
the afferent limb of the carotid sinus reflex arises from the baroreceptors in the carotid and travels through the _____ nerve to the _____
vagal nucleus and medullary centers glossopharyngeal
77
LH stimulates the _____ cells of the ovarian follicle to produce androgens.
theca interna
78
aromatase within the follicles convert androgens to estradiol under _____ stimulation
FSH
79
treatment for carcinoid syndrome
octreotide for symptomatic patients; surgery for liver metastasis
80
clinical manifestations of carcinoid syndrome
flushing, telengastias, cyanosis, watery diarrhea, cramping, bronchospasm, dyspnea, wheezing, valvular fibrosis (right>left)
81
how do you diagnose carcinoid syndrome?
elevated 24 hours urine excretion of 5HIAA and CT/MRI of pelvis to locate tumor
82
leuprolide is an analog of _____ and continuous administration suppresses release of ____ and ____
GNRH LH and FSH
83
trisomies are typically caused by which genetic fault prior to conception?
meiotic non-disjunction. gives extra copies
84
primaquine is added to chloroquine in treatment of P vivax and P ovale because....
erradicates the intrahepatic stages (hypnozoites) of these malarial species, which are responsible for relapses
85
what two interferons are produced by most virally infected cells?
interferon alpha and beta helps suppress viral replication by halting protein synthesis, promoting apoptosis, and limiting the ability of viruses to spread through tissues
86
insulin binds and works on what type of receptor?
tyrosine kinase (RTK)
87
tyrosine kinase/PI3K stimulates glycogen production by activating _____ ______, and enzyme that activates glycogen synthase
protein phosphatase dephosphorylates (activates) glycogen synthase
88
histo of crohns disease
cobblestone appearance | noncaseating granulomas and inflammatory infiltrates involving all 3 layers of the intestine (transmural)
89
the increased activity of _____ cells in crohns disease serves as evidence of the immunologic hypothesis. These cells mediate delayed hypersensitivity reactions and granuloma formations.
Th1
90
dystrophic calcification occurs in damaged or necrotic tissue in the setting of ______ calcium levels
normal dystrophic calcification occurs in all types of necrosis (eg coagulative, fat, caseous, liquefactive)
91
metastatic calcification occurs in normal tissues in the setting of ______
hypercalcemia
92
PCD vs Cystic fibrosis
CF - mutation in CFTR gene - impair ion transport - pancreatic insufficiency - infertility due to absent vas deferns - failure to thrive PCD - dynein arm defect - impaired ciliary motion and mucociliary clearance - situs inversus (50% of cases) - infertility due to immtoile speratozoa - normal growth
93
most common primary neoplasm of the brain in adults
gliblastoma
94
characteristics of glioblastoma
-tumors can be large and cross the midline (butterfly glioma). on gross examination, they are poorly defined with areas of necrosis and hemorrhage. highly malignant with a poor prognosis and most patients die less than a year after diagnosis
95
oligodendromas typically involve the _____ matter of the brain and appear as well circumscribed gray masses with _____
white calcification
96
iron bound to heme is normally in the ____ state. Nitrites cause poisoning by inducing the converstion of this heme iron to the _____ state. This leads to the formation of _________
Fe2+ oxidized (fe3+) methemoglobin
97
glucose 6 phosphate dehydrogenase deficiency
G6PD catalyzes the first step in the PPP. oxidative portion generates 2 molecules of NADPH. nonoxidcative reactions reversibly convert molecules that can be used for energy production
98
when in the PPP active?
main source NADPH is PPP active in: -cells experiencing high oxidative stress -organs such as the liver and adrenal cortex that are involved in reductive biosynthesis and cytochrome P450 metabolism -phagocytic cells generating a respiratory burst
99
what is the rate limiting enzyme of the PPP
glucose-6-phosphatase dehydrogenase major source of NADPH, which is necessary for reducing glutathione and for the biosynthesis of cholesterol, fatty acids, and steroids
100
causes of a third heart sound
systolic heart failure mitral regurgitation high-output states normal in people less than 40 and in pregnant women
101
causes of S4
``` younger adults, children diastolic dysfunction (LVH) ``` normal in healthy older adults
102
what is Meckel diverticulum?
- ileal outgrowth that results from failed obliteration of the vitelline duct. - most common manifestation is spontaneous but painless lower GI bleeding. - potential lead point for intussuception, which can present with colicky abdominal pain and currant jelly stools.
103
Tc-pertechnetate localizes ectopic _____ muscosa, and is increased uptake is diagnostic for ______.
gastric mucosa meckel diverticulum
104
aminoglycosides irreversibly bind to _____ which causes _______ and bacterial protein synthesis inhibition. AGs also appear to impact ______, whereby an aminoacyl-tRNA shifted from the ribosomal A site to the P site
30S genetic code misreading translocation
105
Mycobacterial resistance to isoniazid can be accomplished, how?
through non-expression of the catalase peroxidase enzyme or through genetic modification of the INH binding site on the mycolic acid synthesis enzyme
106
how does streptomycin work?
aminoglycoside that inhibits mycobacterial protein syntheiss by disabling the bacterial ribosomal 30S subunit (which disrupts translation). Resistance to this drug primarily is achieved by a modification of the 30S subunit
107
resistance to rifampin in M. tuberculosis
primarily due to a mutation in the gene that codes for a DNA-dependent RNA polymerase necessary for transcription and RNA prolongation
108
M tuberculosis resistance to pyrazinamide
because pyrazinamide must be converted to an active form by the mycobacterial enzyme pyrazinamidase, drug resistance can occur in those organisms that have modified their pyrazinamidase to be structurally ineffective
109
resistance to ethambutol
ethambutol appears to inhibit synthesis of the mycobacterial cell wall. resistance to this drug develops when the myocbacteria increase production of arabinosyl transferase (an enzyme in the pathway to arabinogalactan, one of the key constituents of the myocbacterial cell wall)
110
mechanism of action for isoniazid and
m

UWORLD Review Topics (1 decks)

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