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UWorld > Set 4 (Hepatic) > Flashcards

Set 4 (Hepatic) Flashcards

1
Q

Fluke infection of biliary tree

A

Brown pigment stones

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2
Q

Thiamine: cofactor for?

A

Transketolase
alpha-ketoglutarate dehydrogenase
pyruvate dehydrogenase

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3
Q

Pyruvate –> acetyl CoA

A

Pyruvate dehydrogenase

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4
Q

Rate limiting step of TCA

A

Isocitrate dehydrogenase

isocitrate –> alpha-ketoglutarate, FIRST NADH produced

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5
Q

Alpha-ketoglutarate dehydrogenase

A

a-ketoglutarate –> succinyl-CoA

second NADH

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6
Q

Alpha-ketoglutarate dehydrogenase: cofactors

A

Thiamine
Lipoic acid
CoA
FAD, NAD

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7
Q

Succinyl CoA –> Succinate

A

Succinyl CoA synthetase

substrate level phosphorylation, GTP produced

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8
Q

Succinate dehydrogenase

A

Succinate –> fumarate

production of FAD

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9
Q

Malate dehydrogenase

A

Malate –> Oxaloacetate

Third NADH

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10
Q

Chloroquine: most serious long-term A/E

A

retinopathy

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11
Q

Chloroquine

A

Eliminates suceptible ERYTHROCYTIC forms of ALL plasmodia species.

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12
Q

Primaquine

A

Added to tx of P. vivax and ovale to eradicate INTRAHEPATIC stage (prevent relapse)

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13
Q

PANlobar lymphocytic infiltrate
Ballooning hepatocytes
Hepatocyte necrosis and apoptosis (Councilman bodies)

A

Acute viral hepatitis

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14
Q

Budd-Chiari syndrome

A

Hepatic vein thrombosis

Centrilobular congestion and fibrosis

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15
Q

Acetominophen toxicity: liver biopsy

A

CENTRIlobular hepatic necrosis

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16
Q

Portal HTN: hepatic histology

A

NO CHANGE!

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17
Q

Liver disease and associations:
IDA
Basal ganglia atrophy
Fat malabsorption and osteoporosis

A

IDA: untreated sprue or celiac syndrome.
BG atrophy: Wilson’s disease.
Fat malasorption, osteoporosis: cholestasis

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18
Q

Wilson’s disease: tx

A

Penicillamine (chelation therapy)

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19
Q

Lactulose: tx for?

A

Cirrhosis-related hepatic encephalopathy

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20
Q 
Lead poisoning
(encephalopathy, abdominal colic w/o hepatits or cirrhosis): tx
A

Dimercaprol, DETA (chelating agents)

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21
Q

Pathogenesis of alcohol induced hepatic steatosis

A

Decrease in free fatty acid oxidation
(2/2 EXCESS NADH production by alcohol and aldehyde dehydrogenase)

(also: impaired lipoprotein assembly, increased peripheral fat catabolism)

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22
Q

Mutation in hemochromatosis

A 
HFE (HLA class 1 like molecule) on chrom6
C282Y (Cysteine --> Tyrosine)
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23
Q

m/c/c of acute hepatitis in YOUNG ADULTS

A

HepA

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24
Q

Pyruvate carboxylase

A

Gluconeogenesis
Pyruvate –> oxaloacetate (MITOCHONDRIA)
Biotin = cofactor
Acetyl CoA=allosteric activator

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25
Q

Ornithine transcarbamoylase

A

Urea cycle

Ornithine + carbamoyl phosphate –> citrulline (MITOCHONDRIA)

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26
Q

HYPERammonemia
Mental retardation
a/w what enzyme deficiency

A

Ornithine transcarbamoylase

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27
Q

TCA: location

A

MITOCHONDRIA!

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28
Q

HMG CoA results from?

A

Leucine (ketogenic amino acid)

HMG CoA synthase

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29
Q

HMG CoA lyase

A

Ketogenesis from HMG CoA

MITOCHONDRIA

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30
Q

Occur exclusively in MITO

A 
b-oxidation
Ketogenesis
TCA
Parts of urea cycle (carbamoyl phosphate synthetase 1, ornithine transcarbamoylase)
Pyruvate carboxylation
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31
Q

Reactions that occur in CYTOplasm of liver

A

pentose phosphate pathway

transketolase; cofactor=thiamine

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32
Q

Impaired faty acid transport into MITO

Restricted ketone body production

A 
Carnithine deficiency
(Myoglobinemia, weakness following exercize, elevated muscle TG, HYPOketonemia)
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33
Q

Beta-oxidation of FA produce

A

Acetyl-CoA

which –> acetoacetate –> one of the 3 primary ketone bodies

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34
Q

Acetoacetate

A

ketone body

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35
Q

Suppresses cholesterol 7a-hydroxylase activity

A

Fibrates

reduce cholesterol –> Bile acid, increase cholesterol stones!

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36
Q

Estrogen and Cholesterol stones

A

Estrogen increase HMG-CoA reductase activity (more cholesterol production)

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37
Q

Neonatal hepatitis w/ cholestasis; suspicious for?

A

A1AT deficiency

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38
Q

Utilize glycerol produced by degradation of TG by hormone sensitive lipase

A

ONLY the liver!

use glycerol for triacylglycerol synthesis, gluconeogenesis, intermediate in glycolysis

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39
Q

Necessary for definitive diagnosis of acute calculous cholecystitis

A

Positive HIDA scan (cystic duct obstruction)

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40
Q

Serum-sickness like prodrome

fever, fatique, joint pain, skin rash

A

Hepatitis B

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41
Q

Herpes virus: envelope?

A

YES, bud through and acquire enveloped from host cell NUCLEAR membrane.

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42
Q

Adenovirus: envelope?

A

NOPE

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43
Q

HPV: envelope?

A

NOPE

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44
Q

Lipoic acid: cofactor for?

A

PDH (deficiency=lactic acidosis)
alpha-ketoglutarate DH
branched-chain ketoacid DH (maple syrup urine disease)

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45
Q

Statin: A/E

A

Liver toxicity

Myopathy

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46
Q

Aldolase B deficiency

A

Hereditary fructose intolerance

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47
Q

Galactosemia: deficiency in?

A

Aldolase reductase

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48
Q

HepE

A

high mortality in PREGNANT women
fecal-oral transmission
UNenveloped, ssRNA virus

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49
Q

Primary means of HBV transmission

A

Blood

semen, saliva, sweat, tears, milk, effusions

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50
Q

Acute aclaculous cholecystitis

A

Acute inflammation of gallbladder in absence of gallstone

hospitalized, severely ill

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51
Q

Severely malnourished
Paresthesias and dysesthesias (“burning feet syndrome”)
GI distress

A

Pantothenic acid deficiency

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52
Q

Panthothenic acid active form

A

Coenzyme A

Binds oxaloacetate in TCA –> citrate –> succinyl CoA

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53
Q

Superior rectal vein drain into?

A

Portal circulation (via inferior mesenteric vein)

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54
Q

Inferior rectal vein drain into?

A

Systemic circulation (via internal pudental veins)

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55
Q

Middle rectal vein drain into?

A

Systemic circulation (via internal iliac vein)

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56
Q

Pneumobilia (air in biliary tract)

A

Gallstone ileus

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57
Q

CYP450 INDUCERS

A

Rifampin
Griseofulvin
Barbiturates, Carbamazepine, Phenytoin

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58
Q

CYP450 INHIBITORS

A

TMP
Isoniazid
Azole antifungals
Cimetidine, SSRI, Amiodarone

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59
Q

Raltegravir

A

Integrase inhibitor (tx of HIV)

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60
Q

Zidovudine

A

Nucleoside reverse transcriptase inhibitor
(tx of HIV)

Incorporated into viral genome as thymdidine analog w/o 3’OH group (making 3’-5’ phosphodiester bond formation impossible)

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61
Q

Hydatid cyst

A

Echinococcus

Eggshell calcification

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62
Q

Translocation

A

Ribosome advance to next mRNA codon to be translated

Elongation factor G (energy from GTP)

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63
Q

Peptidyltransferase (prokaryote)

A

23S rRNA in 50S ribosomal subunit

Facilitate peptide bond formation in protein translation

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64
Q

Prokaryote 16S rRNA

A

Found in 30S ribosomal subunit

Contain sequence complementary to Shine-Dalgarno sequence of mRNA (binding of the two seq necessary for initiation of translation)

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65
Q 
Dilated pupils
Piloerection
Hyperactive bowel sounds
LACRIMATION
YAWNING
A

Opioid withdrawal

ex: heroin

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66
Q

Heroin

A

Opioid

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67
Q

Withdrawal leads to tachycardia and seizures

A

Alcohol

Benzodiazepine

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68
Q

Intense psychomotor retardation
Severe depression (“crash”)
Withdrawal sx from?

A

Stimulants

ex: cocaine, amphetamines

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69
Q

Hydrocephalus in infants: presentation

A

Macrocephaly
Irritability, Poor feeding
muscle HYPERtonicity, HYPERreflexia (UMN damage by stretching of periventricular pyramidal tracts0

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70
Q

LE HYPOreflexia

A

Damage to LMN of LE

Poliomyelitis, Werdnig-Hoffman disease

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71
Q

DEPRESSED PATIENT W/ HTN CRISIS after WINE/CHEESE PARTY

A

MAO INHIBITOR-TYROSINE CRISIS

Ex: Phenelzine

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72
Q

Posterior wall of external auditory canal: sensation

A

Vagus n. (small auricular branch)

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73
Q

Most of external auditory canal: sensation

A

Trigeminal n. (mandibular division auriculotemporal br)

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74
Q

Inner surface of tympanic membrane: sensory innervation

A

Glossopharyngeal n.

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75
Q

Chorda tympani

A

Facial n.

carries taste from anterior 2/3, and innervates submandibular and sublingual salivary glands

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76
Q

All sensory pathways except __________have relay nuclei in thalamus.

A

Olfaction (smell)

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77
Q

VPL

A 
Spinothalmic tract (pain, temperature)
Medial lemniscus (position, proprioception)
78
Q

VPM

A

Trigeminal pathway

Gustatory pathway

79
Q

Lateral geniculate bodies

A

Visual relay nuclei

80
Q

Medial geniculate bodies

A

Auditory relay nuclei

81
Q

Wound –> neuron axons –> salivary glands

A 
Rabies virus
(motor neuron -->cerebellum, brainstem, hippocampus --> salivary gland)
82
Q

Fibrinous exudate –> systemic circulation –> cortical neuron

A

Diphtheria toxin

83
Q

Food –> systemic circulation –> meninges

A 
Listeria monocytogenes (Gram+ food born pathogen)
(Meningitis in neonates, IMC-)
84
Q

Food –> systemic circulation –> peripheral nerves

A

Botulinum toxin

Adult food born botulism

85
Q

Wound –> motor neuron –> spinal cord

A

Tetanospasmin (C. tetani)

inhibit inhibitory interneurons –> tetany

86
Q

Jaw stiffness
Trismus
Risus sardonicus
Opisthotonos

A

Tetanus

87
Q

Ventricles above obstruction enlarged

Ventricle below obstruction normal

A

NON-communicating hydrocephalus
(ventricle –> subarachnoid space CSF flow disrupted)

ex: aqueductal stenosis, Arnold-Chiari, Dandy-Walker.

88
Q

All ventriculi symmetrically enlarged

A 
Communicating hydrocephalus
(dysfunction/obliteration of subarachnoid villi)
89
Q 
Hydroxyzine
Promethazine
Chlorpheniramine
Diphenhydramine
Fexofenadine
A

Anti-histamines

Fexofenadine is the ONLY second-gen listed

90
Q

1st gen anti-histamine (H1 histamine receptor): A/E

A

Muscarinic (blurry vision, dry mouth, urinary retention)
Serotonergic (appetite stimulation)
Alpha-adrenergic (postural dizziness)

91
Q

Carbamazepine: used for?

A

Seizures

Trigeminal neuralgia

92
Q

Zolpidem

A

NON-benzodiazepine hypnotic (for insomnia)

93
Q

Rx Tx of narcolepsy

A

Psychostimulants:
First line = modafinil (non-amphetamine stimulant)
Second line = amphetamine

94
Q

Modafinil

A

Non-amphetamine stimulant

First line for narcolepsy

95
Q

Homebox genes

A

DNA binding TF that play role in MORPHOGENESIS (formation and placement of tissues/organs)

HIGHLY conserved DNA seq (180 nucleotides)

96
Q

Phenobarbital is used for?

A

Generalized tonic-clonic seizures

97
Q

DOC for trigeminal neuralgia

A

Carbamazepine

inhibit neuronal high-frequency firing by reducing ability of Na channel to recover from inactivation

98
Q

Carbamazepine: A/E

A

Aplastic anemia

p450 INDUCER

99
Q

MOA of penicillins and cephalosporins

A

IRREVERSIBLE binding to PBP (ex: transpeptidases)

100
Q

Transmembrane efflux pumps confer resistance to these antibiotics

A

Tetracyclines

Macrolides

101
Q

Inherited condition w/ onset in middle-age
Conductive hearing loss
Bony overgrowth of footplate of stapes

A

Otosclerosis

102
Q

Tinnitus
Vertigo
Sensorineural hearing loss

A

Meniere’s disease

Weber: lateralization to healthy side

103
Q

Increased volume and pressure of endolymph in vestibular apparatus

A

Meniere’s disease

104
Q

Low potency vs. high potency 1st gen anti-psychotics

A

Low potency: NON-neurological a/e (sedation, anti-cholinergic, orthostatic hypotension)

High potency: NEUROLOGIC a/e (extrapyrimidal sx due to potent D2 antagonist in nigrostriatal pathway)

105
Q

Chlorpromazine

Thioridazine

A

Low potency antipsychotics

106
Q

Haloperidol

Fluphenazine

A

High potency antipsychotics

107
Q

Rapid recovery from anesthesia is from?

A

Redistribution into skeletal and adipose tissue

108
Q

Thiopental

A

Short-acting barbiturate anesthetic

Increase inhibitory potential of GABA receptor

109
Q

TOC of listeria

A

Ampicillin

NOT sensitive to cephalosporins

110
Q

Ceftriaxone: cover listeria?

A

NO, ampicllin does.

111
Q

m/c/c of meningitis in adult

A

Strep pneumo

112
Q

m/c/c of neonatal meningitis, sepsis, pneumonia

A

GBS (agalactiae)

113
Q

Acute stress disorder: time line

A

4 weeks)

114
Q

Gram+ rod w/ tumbling motility

Grows in cold enrichment

A

Listeria monocytogenes

115
Q

Listeria: population it affects

A

Neonates, Elderly, IMC-

contaminated food

116
Q

GFAP +

A 
Astrocytoma
Oligodendrogliomas
Glioblastoma multiforme
Ependymoma
Peripheral neural sheath tumor
(Collectively: gliomas)
117
Q

Synaptophysin

A

Presynaptic vesicle of neuron, neuroendocrine, neuroectodermal cells
CNS tumors of neuronal origin stains +

118
Q 
Cerebellar ataxia
Loss of position and vibratory sense
Kyphoscoliosis
Hypertorphic CM
Foot abnormalities
DM
A

Friedreich ataxia

AR, trinucleotide repeat

119
Q

Loss of anterior horn of spinal cord occurs in?

A

Poliomyelitis
ALS
(flaccid paralysis, atrophy, areflexia, muscle fasciculations)

120
Q

Tracts involved in Friedreich ataxia

A 
Spinocerebellar tracts (gait ataxia)
Dorsal columns, DRG (loss of position and vibratory sensation)
121
Q

Neisseria meningitidis: transmission

A

Direct contact w/ contaminated respiratory secretion or airborne droplets

122
Q

Neisseria meningitidis: prophylaxis

A

Rifampin
(followed by ceftriaxone)

Only these eliminate NASAL carriage.

123
Q

Bupropion

A

Mixed dopamine and NE reuptake inhibitor

tx: depression, smoking addiction

124
Q

Acute mania: tx

A 
Mood stabilizer (lithium, vaproate, carbamazepine)
\+
Atypical antipsychotic (olanzapine)
125
Q

SSRi in acute mania?

A

NO, can precipitate manic episode.

CI!

126
Q

Status epilepticus: tx

A

First line: Benzodiazepines (Lorazepam = DOC)
Simultaneous admin Phenytoin (prevent recurrence)

If still fail: phenobarbitol
If still fail: intubate, give general anesthesia

127
Q

Phenytoin: MOA

A

Inhibit neuronal high freq firing by reducing ability of Na channel to recover from inactivation

128
Q

DOC for absence seizures

A

Ethosuximab

Blocks T-type calcium channel in thalamic neurons

129
Q

Benzodiazepines
Barbiturates
Alcohol
MOA

A

Bind to GABA(A) receptor component: ligand gated CHLORIDE channel –> enhance inhibitory action of GABA and increase chloride current.

130
Q

Valproic acid: MOA

A

Reduce abnormal electric activity in brain by blocking NMDA receptors and affecting K+ current.

Also affect Na+ channel and GABA receptors.

131
Q

HyperSNT of DNA to x-linking agents

A

Fanconi anemia

132
Q

DNA HyperSNT to ionizing radiation

A

Ataxia-telangiectasia

133
Q

Generalized chromosomal instability

A

Bloom syndrome

134
Q

HNPCC occurs due to?

A

Defect in DNA mismatch-repair enzyme

135
Q

Posterior column involvement seen in?

A

VitB12 deficiency

Syphilis

136
Q

Cerebellar ataxia (cerebellar atrophy) in early life
Repeated sinopulmonary infections
Increased incidence of malignancy
Oculocutaneous telangiectasis

A

Ataxia-telangiectasia

AR, defect in DNA-repair genes

137
Q

Serotonin release neurons ONLY found in?

A

Raphe nuclei of brainstem

brainstem, pons, medulla

138
Q

NE-secreting neurons found in?

A

Nucleus ceruleus

Dorsal pons

139
Q

Red nucleus

A

Anterior midbrain

Motor coordination of UE

140
Q

Striatum=

A

Caudate + Putamen

（陈佩-斯）

141
Q

House cell bodies of CHOLINERGIC neurons

A

Nucleus basalis of Meynert

142
Q 
Intracranial HTN (papilledema)
Skin changes (alopecia, dry skin)
HSM
A

VitA overuse

143
Q

Niacin deficiency called?

A

Pellagra

144
Q 
Older, mentally slow women
Northern EURO
"Lemon colred"
Smooth, shiny tongue (atrophic glossitis)
Shuffling, broad-based gait
A

VitB12 (cobalamin) deficiency

145
Q

Large dose of VitC

A

False- stool guaiac test

Diarrhea, abdominal bloating

146
Q

Major a.a. responsible for transferring nitrogen to liver for disposal

A

Alanine

alanine –> amino group to alpha-ketoglutarate –>glutamate –> urea

147
Q

Hyperacusis

A

Paralysis of stapedius muscle (Facial n.)

148
Q

Only 2 skeletal muscle that participates in transmission of sound from tympanic membrane to inner ear.

A 
Stapedius (Facial n.)
Tensor tympani (Trigeminal V3)
149
Q

Accumulation of GM2 ganglioside

A

Tay-Sachs disease

AR, deficiency of Beta-hexosaminidase A

150
Q

Cherry-red macula

A

Niemann-Pick (HSM)

Tay-Sachs (NO HSM)

151
Q

m/c/c of aseptic meningitis

A

Enterovirus (coxsackievirus, echovirus)

152
Q

Immediate source of nitrogen for urea in urea cycle

A

Aspartate

153
Q

Hypothalamic nucleus that regulate circadian rhythm

A

Suprachiasmatic nucleus

154
Q

VM nuclei of hypothalamus

A

Satiety

Stimulated by leptin

155
Q

Lateral nuclei of hypothalamus

A

Hunger

Inhibited by leptin

156
Q

Anterior nuclei of hypothalamus

A

Heat dissipation via PNS

157
Q

Posterior nuclei of hypothalamus

A

Heat conservation via SNS

158
Q

Arcuate nuclei of hypothalamus

A

Secrete dopamine, GHRH, GnRH

159
Q

Paraventricular nuclei of hypothalamus

A

Oxytoxin
Thyrotropin-releasing hormone
Corticotropin-releasing hormone

160
Q

Supraoptic nuclei of hypothalamus

A

ADH

161
Q

Hep B or Hep C: integration into DNA

A

Hep B

162
Q

Hepatic encephalopathy appears 2/2?

A

Increased level of AMMONIA in circulation

NOT BUN, which = renal failure

163
Q

Hepatocellular cytoplasm filled w/ spheres and tubules

Finely granular, eosinophilic appearance (ground glass)

A

HepB infection

164
Q

Hemochromatosis: inheritance

A

AR

165
Q

m/c benign liver tumor

A 
Cavernous hemangioma
(do NOT biopsy!)
166
Q

Thyroidization of kidney

A

Chronic pyelonephritis

167
Q

Brown pigment stones

A

Infection of biliary tract –> release of Beta-glucuronidase –> increased UCB.
(vs. Black pigment stones=hemolysis)

168
Q

Desmolase

A

Catalyzes formation/destruction of carbon-carbon bonds.

169
Q

7-alpha-hydroxylase

A

Cholesterol –> bile acids

170
Q

Hepatoblatoma

A

m/c liver neoplasm of CHILDREN

a/w FAP and Beckwith-Wiedemann syndrome

171
Q

Vinyl chloride
Arsenic
Thorotrast

A

Hepatic angiosarcoma

172
Q

G6PD important for?

A

HMP shunt: generation of NADPH.

cholesterol and fatty acid synthesis
(Reducing glutathione)

173
Q

Hepatitis vaccine

A

A, B only

HepC envelope has too many antigenic variety

174
Q

Transmission of Entamoeba histolytica

A

Foodborne exposure

175
Q

Hepatic abscess (developed country) usually from?

A

Staph aureus: hematogenous seeding

Enteric bacteria: ascending biliary infection/direct invasion from adj. area

176
Q

Hepatic abscess (developing country) usually from?

A

Parasitic infection:
Amebic
Echinococcal

177
Q

Basal ganglia atrophy: seen w/ this metal?

A

Copper (Wilson Disease)

178
Q

Hypertrophic cardiomyopathy: inheritance

A

AD (cardiac sarcomere)

179
Q

Centrilobular congestion in liver a/w

A

Right HF

180
Q

Histological finding of Reye syndrome

A

MICROvesicular steatosis of hepatocyte
(NO necrosis or inflammation)
(EM shows decreased # of mito and glycogen depletion)

181
Q

PBC a/w what AI disease?

A

Sjogren’s
Scleroderma
Thyroid dz
Celiac dz

182
Q

Hepatocyte accumulation of epinephrine metabolite in lysosomes
Increased CB

A

Dubin-Johnson syndrome

black liver, defect excretion of CB across canalicular mem

183
Q

Isoniazid is metabolized by?

A

Acetylation

Hydralazine, Procainamide, Dapsone as well

184
Q

No thymic shadow, Hypocalemic tetany
Cleft palate, mandibular deformity, low set ear
Aortic arch abnormality

A

DiGeorge

185
Q

3rd branchial arch

A

9th CN
Stylopharyngeus
Portion of Hyoid
Posterior 1/3 of tongue

186
Q

4th branchial arch

A

Superior laryngeal br of CN10 (vagus)

Soft palate and pharynx m. (EXCEPT tensor veli palatini, stylopharyngeus)

187
Q

Tensor veli platini

A

CN5 (1st branchial arch)

188
Q

Liver: outpouching of?

A

FOREgut

189
Q

Most important mediator of coronary vascular dilation in LARGE arteries and pre-arteriolar vessels

A

NO

synthesized from arginine and oxygen

190
Q

NO: MOA

A

Vascular smooth muscle relaxation via:

cGMP second messenger

191
Q

Adenosine

A

Vasodilatory element in small coronary arterioles

192
Q

Direct arteriolar vasodilator: A/E

A

Reflex sympathetic activation –> tachycardia, edema

UWorld (17 decks)

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