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U world Composite > Second 50 > Flashcards

Second 50 Flashcards

0
Q

Equation for filtration fraction
GFR
Effect of urethral constriction

A

GFR/RBF
GFR is Kf ((difference in hydrostatic pressure between glomerula capillaries and bowmans space)- (difference in oncotic pressure across both spaces)). Urethral constriction increases hydrostatic pressure proximal to the constriction and this is transmitted to bowmans space, henc decrease GFR and FF

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1
Q

SSSS, describe it, toxin associated etc.,

A

Due to exfoliatin exotoxin from Staph. Leads to bullous impetigo which is more localized and epidermal necro lysis or epidermolysis with Nikolskys sign positive, where epidermis separates from dermis with gentle pressure.
Exfoliatin acts as a protease that cleaves desmoglein in desmosomes

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2
Q

Most common CFTR abnormally and its effect. What does the channel do

A

Channel is activated by cAMP phosphorylation and is gated by ATP. It is a chloride channel. Most common is deltaF506 which is a three base deletion at this amino acid phenylanine. Post translational modification by the rER does not occur and protein is degraded by proteosomes. High chloride content in sweat, receptor absent in apical epithelial cells

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3
Q

In atheroma formation, what cytokines and cells are important

A

Platelets ( also damaged endothelium and infiltrating macrophages) secrete PDGF which allows for SMC to migrate from media to intima, TGFBETA allows SMC chemotaxis and collagen formation

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4
Q

Define cholestasis, its pathophysiology and effects

A

Bike cannot flow from liver to duodenum
Can be obstructive or non obstructive
Intrahepatic:-
Drugs like erythromycin and contraceptives, primary biliary cirrhosis, pregnancy cholestasis, primary sclerosing Cholangitis
Extrahepatic:-
Choledocholithiasis
Malignancy of the pancreas or gall bladder

Leads to malabsorption of ADEK, hence e,g, osteomalacia with decreased bone density due to decreased mineralization.

Green brown plugs in dilated bile canaliculi and pigment in hepatic parenchyma

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5
Q

Gp41 drugs

A

Fusion inhibitors such as enfuvirtide
It is a transmembrane polypeptide that changes its shape to allow viral membrane to fuse. Contrast with gp120 that mediates attachment to cd4 membrane

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6
Q

SAH POST operative complication

A

Vasospasm. Relieved by nimodipine, a calcium channel blocker. Ruptured berry aneurysm from ADPKD IS A risk factor

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7
Q

Third aortic arch, pharyngeal membrane and cranial nerve

A

In development, head, neck and upper thorax develop from pharyngeal arches associated with an aortic arch and a cranial nerve

The third is associated with glossy pharyngeal or IX and the common carotid artery and proximal internal carotid artery. Think 3 for the carotid sheath

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8
Q

What is a hysterogram

A

It involves putting radio opaque material into the uterus via the os then xraying the pelvic regio

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9
Q

What are the paramesonephric ducts and what happen if these do not fuse. In males?

A

They form the uterine tubes, uterus, cervix and superior 1/3rd of the vagina. If these do not use a bicornuate uterus which is a partially separate uterus attached to a single cervix and vagina is formed. The worst presentation is a didelphys’ where it does not fuse at all and there are two of everything including uterine horns

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10
Q

Mesonephric ducts and tubules in males and females

A

Mesonephric differentiate into efferent ductules and each takes sperm from testes to epidydymis in males. In females, they form gartners duct

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11
Q

Urethral folds in males and females

A

These fuse to form urethra. Incomplete fusion in males leads to hypo spadia where the urethra opens on the ventral surface of the penis rather than the distal end of the glans

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12
Q

Class 1C antiarrhymatics

A

Qrs is about .08-.12 and slightly increase during exercise
These drugs treat supra ventricular tachycardia caused by a-fib. Bind to fast Na channels that do phase 0 depolarization. Blocks Na movement in, increases QRS.
SHOW SLOW DISSOCIATION FROM THE NA CHANNEL. HENCE USE DEPENDENCE SUCH THAT THE EFFECT INCREASES AT HIGHER HEART RATES
- example is flecainamide, propafenone

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13
Q

Classes III ANTIARRYTHMATICS

A

Amiodarone, Sotalol, Dofelitide. These block the outward potassium current during repolarization. Increases QTc without affecting QRS. REVERSE USE DEPENDENCE. Slower the heart rate

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14
Q

Class IV

A

Calcium channel blocker like verapamil slow down SA NODE and AV node conduction, verapamil increases coronary flow and reduces myocardial oxygen flow that masks ischemia during stress test. Does not change QRS

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15
Q

Selective beta 1 blockers and digoxin in exercise testing

A

Atenolol does not change QRS but can limit maximal heart rate with exercise ECG
Digoxin causes false positive ST depression during exercise testing and lowers maximal rate, no effect on QRS

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16
Q

Long term control of HTN in a CHF PATIENT

A

Ace inhibitors as angiotensin II mediates left ventricular modeling and hypertrophy

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17
Q

Effect of pulmonary embolism on blood gas values

A

Leads to respiratory alkalosis due to hypoxemia and hyperventilation. Hence pH will be increased and reduced paO2 and paCo2

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18
Q

Vinca alkaloids on M phase

A

Bind to beta tubulin, prevents polymerization of microtubule proteins

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19
Q

Leading strand in what direction of synthesis versus lagging strand. Role of polymerase

A

5 to 3 for leading and 3 to 5 for lagging towards replication fork.
Polymerase 5 to 3 exonuclease removes primers and damage DNA while 3 to 5 exonuclease. But the only have 5 to 3 polymerase activity

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20
Q

Complete vs partial hydatidiform mole

A

Complete- bigger uterus size, extremely high bhcg, complete paternal 46xx or XY..only trophoblastic tissue and no fetal origins..looks like grapes
Partial- normal uterus, high to normal bhcg, triploid 69xxx or XY..some fetal origins

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21
Q

Paget’s disease of the bone

A

Excessive osteoclasts resorption….usually comes with impaired hearing,

22
Q

TGFbeta function

Igf1

A 
TGFBETA 
Osteoblast precursor replication
Increases collagen
Osteoclasts apoptosis
IGF1
Decreased collagen degradation by inhibiting MMP13
Its higher post natally than IGF2
Osteoblast replication and increased collagen synthesis.
23
Q

Strength of the class 1 anti arrthymatics

A

C>A>B
C has most use dependence and slowly dissociates. Can promote arrhythymia due to the to delay in conduction speed that is out of proportion to prolongation of refractory period. Therefore this happens in ischemic or structural heart disease
B more selective for ischemic myocardium….post MI important cause of death
A

24
Q

Mitral valve stenosis and opening snap

A

Happens early diastole after the valve has opened just as left ventricular pressure falls below atrial pressure. The snap is caused by the valves leaflets tightening. The worse the stenosis the closer the A2-OS interval,

25
Q

What drug benefits overall survival in a pt with CHF

A

Aldosterone antagonist spironolactone…RALES Trial.

26
Q

Most abundant pneumocytes type and functions

A

Type 1 most abundant ..flat cells and type 2 regenerates type 1 and makes surfactant..cuboidal cells
Clara cells inhibit neutrophil recruitment

27
Q

Histopathology of the intestine

Celiac, Crohn’s, whipple, ulcerative colitis, lymphomas

A

Crohn’s has non caseating granulomas that’s scattered and some inflammation
Lamina propria infiltration with atypical lymphocytes seen in GI lymphomas
Neutrophils in crypt lumina with ulcerative colitis
Distended macrophages in lamina propria for whipped
Marked intestinal villi atrophy in celiac

28
Q

Reliability versus Precision

A

Reliable means same value consistently. Accurate means close to actual value

29
Q

Complication from flu virus infection

A

Secondary bacterial pneumonia, happens especially in the elderly. Characterized by recurrent fever, dyspnea and productive cough. Due to the virus that destroys mucociliary clearance mechanisms of the respiratory epithelium…Usually Strep, Staph and H flu related

30
Q

What do these bugs cause, Listeria, klebsiella and non TB mycobacterium

A

Listeria causes septicemia and purulent meningitis in neonates

Klebsiella causes nosocomial UTI’s, nosocomial pneumonia and pneumonia in alcoholics and IV drug users

MAC causes disseminated disease in AIDS, Kansassi causes TB like symptoms, Leprae causes cutaneous leprosy and Scrofulaceum causes cervical lymphadenitis in children

31
Q

PKU or phenylketonuria

A

-Autosomal recessive
-Mutation in phenylanine hydroxylase
-Mental retardation, eczema and mousy musty body odor
Probability kid has it implies heterozygous carriers for both parents, hence probability that mum passes multiplied by dad

32
Q

Rasburicase
Denosumab
Probenecid

A

Rasburicase:_ recombinant urate oxidase, enzyme present in some mammals but not humans, It converts uric acid to allantoin- which is soluble and urinally excreted…Helps with hyperuriciemia due to tumor lysis syndrome

Denosumab is a humanized mAB. Prevents Osteoclast activation. Binds to RANKL, prevents its interaction with RANK (similar to Osteoprotegerin or OPG). Osteoclast inhibiting agents decrease risk of bone loss and fractures in pts with bone mets

Probenecid is a uricosuric agent, increases uric excretion in urine. Treat gout and hyperuricemia in pts with good renal function. NOT good for pts with risk of nephrolithiasis or uric acid nephropathy

33
Q

Superior mesentery artery syndrome

A

Aortomesenteric angle gets narrowed due to diminished mesenteric fat including low body weight, recent weight loss, severe burns/catabolism inducers/prolonged bed rest, lordosis, surgical correction of scoliosis.

Note:- The SMA leaves aorta at L1, (usually 45, if less than 20 leads to symptoms of partial bowel obstruction) supplies duodenum and pancreas to left colic flexure. Transverse duodenum is L3 between aorta and SMA.

34
Q

Major determinant of fetal lung maturity

A

amniotic fluid phosphotidyl choline or lecithin/sphingomyelin ratio. Sphingomyelin is a membrane phospholipid. Both are equal until middle 3rd trimester when type II pneumocytes make surfactant, hence lecithin (component of surfactant) increases sharply while sphingomyelin stays the same. Ratios of 2 or higher indicate maturity.
Surfactant = dipalmitoyl phosphotidylhcoline or Lecithin, L. and phosphatidylglycerol. L starts to increase at 36 weeks, and the later at 36 weeks

35
Q

Treatment for primary pulmonary HTN

Describe patient population and symptoms

A

Usually young women 20-40
Dyspnea and exercise intolerance
Increased thickness of SM of arterioles (medial hypertrophy) and fibrosis of the lumen hence narrowed vessel
Treat with Bosentan:- Oral endothellin receptor antagonist used to treat pulmonary HTN. Endothelin is a potent vasoconstrictor and endothelium proliferation stimulator. Drug prevents rise in pulmonary arterial pressure decreases RVH

36
Q

What dampens gastric acid stimulation

A

Gastric acid secretion has cephalic (sight and food smell), gastric (gastrin) and intestinal phases (protein containing food in duodenum).

Intestinal influences down regulate gastric acid secretion:- Ileum and colon release peptide YY which binds to ECLs…counteracts cephalic and gastric phases

37
Q

Duodenal Histology

A

Mucosa
Submucosa
Muscularis Propria
Serosa

Mucosa:-

  • Duodenal lamina propria has villi that project into lumen
  • Villi are simple columnar epithelium with a brush border interspaced with goblet cells and APUD (amine precursor uptake and decarboxylation).
  • Deep within laminan are
38
Q

Merkels diverticulum

A

Omphalomesenteric duct does not obliterate but connects mid gut lumen and yolk sac…near ileocecal valve

39
Q

Lupus anticoagulant

A

Antiphospholid in close to 30% of cases. Causes venous and arterial thromboembolism. Prolongs PTT, has false positive VDRL., spontaneous abortion cause

41
Q

Renal angiomyolipoma- tumor of fat, smooth muscle and blood vessels…What condition is it associated with

A
  • Tuberous Sclerosis associated
  • Autosomal dominant
  • Cortical tubers and subependymal hamartomas leading to seizures and mental etardation
  • Cardiac rhapdomyosarcomas and facial angiofibromas and ash-leaf patches (leaf shaped pattern that lacks pigment)
42
Q

Lymph drainage of the male genitalia

A

Para-aortic:- testes
Deep inguinal: glans penis and superficial nodes
Superficial:- Scrotum

43
Q
  • Common iliac nodes
  • Inferior mesenteric
  • Infraclavicular
A
  • Common:- internal and external
  • IMA:- left colic, sigmoid, superior rectal
  • Infra clavicula:- near cephalic vein between pec major and deltoid, below clavicle. Drain portions of upper limb and breast
44
Q

What is a beta error

A

It is a non systematic error. Its a random error. Refers to a conclusion that there is no difference between groups when there is

45
Q

Rheumatic Heart Disease

-acute vs chronic

A

Mitral Stenosis happens with chronic disease. In the post acute state, fibrous thickening and mitral valve leaflet destruction. Commisural fusion of the leaflets happens
Chronically, atrial enlarges, mural thromboses happens leading to embolic stroke

46
Q

Antimetabolites

-Categories

A
  • Folate antagonist (MTX)
  • Purine analogs (6 thiopurine like 6MP/6GP), fludarabine for CLL and Cladribine for HCL
  • Pyrimidine analogs like 5FU, Capecitabine, Cytarabine, Gemcitabine
47
Q

Cladribine

A
  • Used for hairy cell leukemia
  • Resistant to adenosine deaminase
  • Reaches high intracellular concentrations
  • Incorpporated into DNA, strand breaks
  • Penetrates CNS, urine excretion (unchanged)
48
Q

Dacarbazine

A
  • Cell cycle methylation agent

- Needs liver enzyme activation

49
Q

Cyclophosphamide

Lomustine

A

Cyclo:-
Alkylating agent
Converted bt liver P450

Lomustine:-
Nitrosurea
DNA alkylate+cross bridge
-Liver non enzymatic hydrolysis
-Good CNS penetration
-Lipophilic
50
Q

Kidney embryology

A

Pronephros:- 4th week, regresses

Mesonephrosi:- 4th week
-Intermediate is mesonephric or wolffian that becomes male GU

Metanephros: 5-6th week
-Mesonephrc duct forms ureteric bud, a diveriticulum
(collecting ducts, calic, renal pelvis, ureter)

Mesoderm around bud forms metanephric vesicles (blasterma) which is renal parenchyma

51
Q

Most common cause of fetal hydronephrosis

A

Ureteropelvic junction obstruction

  • ureter is fully canalized before metanephros makes urine (8-10 weeks)
  • if it does not recanalize well at the junction between kidney and ureter, fetal hydronephrosis happens
52
Q

Mycosis Fungoides

A

Cutaneous T cell lymphoma

  • Malignant cells (sezary cells)
  • Visceral origins
  • Pautner microabcess
  • Subepidermal lymphoma
53
Q

Differential cyanosis

A

Involves lower body
e.g. PDA, usually left to right but reverses

Aortic cooarctation
-happens juxta PDA duct distal to left subclavian

Other ASDs and VSDS and more intra cardiac differential cyanosis that stert left to right shunt then Eisenmyer right to left

U world Composite (4 decks)

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