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UWORLD Review Topics > Pre-Dedicated > Flashcards

Pre-Dedicated Flashcards

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
Q

side effects of isoiazid

A

neurotoxicty (vit B6 deficiency), & hepatotoxicity

neurotoxic effects can be prevented with vitamin b6 (pyridoxine) supplementation

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26
Q

side effects of pyrazinamide

A

hepatoxicity and hyperurecemia

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27
Q

side effects of ethambutol

A 
optic neuropathy (decreased visual acuity, central scotoma, or color blindness)
can be reversed with discontinuation of the drug

tx of tuberculosis

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28
Q

clinical features of Tricyclic antidepressant overdose:

CNS, cardio, and cholinergic effects

A

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

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29
Q

depersonalization/derealization disorder

A

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

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30
Q

clinical findings of Wiscott Aldridge Syndrome

A

eczema, recurrent infections, thrombocytopenia

X linked recessive (males)
thrombocytopenia causes petichiae, purpura, hematemesis, and epistaxis

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31
Q

immunodeficiency in WAS syndrome

A

combined B and T cell type

increased risk of pyogenic infections and infections caused by bacteria with a capsule

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32
Q

treatment of WAS

A

bone marrow transplantation

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33
Q

common causes of generalized malabsorption

A 
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

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34
Q

stain that identifies unabsorbed fat and confirms malnutrition

A

sudan III stain

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35
Q

“red neurons” are seen in lesions how long after hypoxic injury?

A

12-24 hours

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36
Q

hypertrophic cardiomyopathy (HCM)

A

haphazardly arranged myocytes and bundles
interstitial spaces have fibrosis
sudden death under stressful circumstances
50% are familial cases and autosomal dominant with variable expression

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37
Q

spleen origin embryonically and blood supply embryology

A

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

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38
Q

surgical ligament cut for treatment of carpal tunnel syndrome

A

transverse carpal ligament

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39
Q

symptoms & presentation of homocysteinuria disease

A

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

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40
Q

homocysteinuria pathophys and enzymes;

treatment

A

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

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41
Q

hyperacute transplant rejection: what is the onset time, etiology, and morphologic findings

A

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

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42
Q

acute transplant rejection: what is onset time, etiology, and morphologic findings

A

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

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43
Q

chronic transplant rejection: onset time, etiology, and morphologic findings

A

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

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44
Q

Zellweger syndrome

A

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

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45
Q

X-linked adrenoleukodystrophy

A
  • 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
Q

elevated levels of homocysteine are an independent risk factor for _________

A

thrombotic events

venous thromboses, CAD, and ischemic stroke
mechanism thought to be due to direct and indirect endothelial damage

47
Q

homocysteine can be metabolized to ______ via remethylation.

homocystein can be metabolized to _______ via transsulfuration

A

methionine

cystathionine

48
Q

hyperhomocysteinemia is most commonly due to genetic mutations in critical enzymes or deficiencies of what 3 vitamins?

A

B12 (colbalamin)

B6 (pyridoxine)

folate

49
Q

chronic granulomatous disease: major test, major enzyme deficiency, and inhertiance pattern

A

NBT (nitrotoluene blue test) - failure to turn blue!

enzyme: NADPH oxidase

inheritance pattern: X linked recessive

50
Q

function of NADPH oxidase

A

formation of ROS in phagosomes. that act as antimicrobial agents and also activates granule proteases

51
Q

CGD presentation

A

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
Q

nitroprusside’s effects on the cardiovascular pressure volume loop

A

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
Q

follicle hair growth in heavily influenced by _____, which is produced by the enzyme ______.

A

dihydrotestosterone

testosterone-5-alpha-reductase

54
Q

what medications minimize progression of hair loss (androgeneic allopecia) if started early?

A

5 alpha reductase inhibitors (ie finasteride)

decrease DHT conversion to testosterone

55
Q

Meniere’s Disease TRIAD

A

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
Q

follicular lymphoma

A
  • 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
Q

mechanism of the cholera toxin

A
  • 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
Q

southern blots analyze

A

DNA fragments

59
Q

western blots analyze

A

protein

60
Q

northern blots analyze

A

mRNA - assess gene expression

61
Q

southewestern blots analyze

A

DNA boud proteins

62
Q

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 _______

A

veriform appendix

63
Q

_____ is the name of an acute phase reactant synthesized by the liver that acts as the central regulator of iron homeostasis

A

hepcidin

64
Q

name things that increase or decrease the body’s production of hepcidin (iron homeostasis)

A

increase: high iron levels and inflammatory conditions
decreased: hypoxia and increased erythropoiesis

65
Q

low hepcidin does what to intestinal cells and macrophages?

A

increase intestinal absorption of iron and stimulates iron release from macrophages

66
Q

hypothyroid myopathy

A
  • 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
Q

how does a low estrogen state cause osteoperosis?

A

decrease estrogen causes a decreased amount of osteoprotegrin, increased RANKL production, and increased RANK expression in osteoclast precursors.

68
Q

what is heteroplasmy?

A

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
Q

lymph nodes from the testes drain where?

A

into the paraaortic lymph nodes (retroperitoneal)

70
Q

lymph node drainage of the penis

A

deep inguinal nodes

71
Q

dihydrobiopterin reductase - two lab findings

A

excess phenylalanine and elevated prolactin

72
Q

phenylalanine is converted to tyrosine by _____. and this uses _____ as a cofactor

A

phenylalanine hydroxylase

BH4 dihydrobiopterin

73
Q

drug class that causes hepatitis after anesthesia

A

halothanes

metabolized by cyp450

74
Q

halothane hepatitis

A

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
Q

carnitine deficiency impairs _____ transport from the cytosol to the mitochondria.

A

fatty acid

76
Q

the afferent limb of the carotid sinus reflex arises from the baroreceptors in the carotid and travels through the _____ nerve to the _____

A

vagal nucleus and medullary centers

glossopharyngeal

77
Q

LH stimulates the _____ cells of the ovarian follicle to produce androgens.

A

theca interna

78
Q

aromatase within the follicles convert androgens to estradiol under _____ stimulation

A

FSH

79
Q

treatment for carcinoid syndrome

A

octreotide for symptomatic patients; surgery for liver metastasis

80
Q

clinical manifestations of carcinoid syndrome

A

flushing, telengastias, cyanosis, watery diarrhea, cramping, bronchospasm, dyspnea, wheezing, valvular fibrosis (right>left)

81
Q

how do you diagnose carcinoid syndrome?

A

elevated 24 hours urine excretion of 5HIAA and CT/MRI of pelvis to locate tumor

82
Q

leuprolide is an analog of _____ and continuous administration suppresses release of ____ and ____

A

GNRH

LH and FSH

83
Q

trisomies are typically caused by which genetic fault prior to conception?

A

meiotic non-disjunction.

gives extra copies

84
Q

primaquine is added to chloroquine in treatment of P vivax and P ovale because….

A

erradicates the intrahepatic stages (hypnozoites) of these malarial species, which are responsible for relapses

85
Q

what two interferons are produced by most virally infected cells?

A

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
Q

insulin binds and works on what type of receptor?

A

tyrosine kinase (RTK)

87
Q

tyrosine kinase/PI3K stimulates glycogen production by activating _____ ______, and enzyme that activates glycogen synthase

A

protein phosphatase

dephosphorylates (activates) glycogen synthase

88
Q

histo of crohns disease

A

cobblestone appearance

noncaseating granulomas and inflammatory infiltrates involving all 3 layers of the intestine (transmural)

89
Q

the increased activity of _____ cells in crohns disease serves as evidence of the immunologic hypothesis. These cells mediate delayed hypersensitivity reactions and granuloma formations.

A

Th1

90
Q

dystrophic calcification occurs in damaged or necrotic tissue in the setting of ______ calcium levels

A

normal

dystrophic calcification occurs in all types of necrosis (eg coagulative, fat, caseous, liquefactive)

91
Q

metastatic calcification occurs in normal tissues in the setting of ______

A

hypercalcemia

92
Q

PCD vs Cystic fibrosis

A

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
Q

most common primary neoplasm of the brain in adults

A

gliblastoma

94
Q

characteristics of glioblastoma

A

-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
Q

oligodendromas typically involve the _____ matter of the brain and appear as well circumscribed gray masses with _____

A

white

calcification

96
Q

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 _________

A

Fe2+
oxidized (fe3+)

methemoglobin

97
Q

glucose 6 phosphate dehydrogenase deficiency

A

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
Q

when in the PPP active?

A

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
Q

what is the rate limiting enzyme of the PPP

A

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
Q

causes of a third heart sound

A

systolic heart failure
mitral regurgitation
high-output states

normal in people less than 40 and in pregnant women

101
Q

causes of S4

A 
younger adults, children
diastolic dysfunction (LVH)

normal in healthy older adults

102
Q

what is Meckel diverticulum?

A
  • 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
Q

Tc-pertechnetate localizes ectopic _____ muscosa, and is increased uptake is diagnostic for ______.

A

gastric mucosa

meckel diverticulum

104
Q

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

A

30S

genetic code misreading

translocation

105
Q

Mycobacterial resistance to isoniazid can be accomplished, how?

A

through non-expression of the catalase peroxidase enzyme or through genetic modification of the INH binding site on the mycolic acid synthesis enzyme

106
Q

how does streptomycin work?

A

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
Q

resistance to rifampin in M. tuberculosis

A

primarily due to a mutation in the gene that codes for a DNA-dependent RNA polymerase necessary for transcription and RNA prolongation

108
Q

M tuberculosis resistance to pyrazinamide

A

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
Q

resistance to ethambutol

A

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
Q

mechanism of action for isoniazid and

A

m

UWORLD Review Topics (1 decks)

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