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UWorld mixed > test #47 5.6 > Flashcards

test #47 5.6 Flashcards

1
Q

POMC is a polypeptide cleaved to make..

A

ACTH
MSH
enkephalins

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2
Q

enkephalins, endorphins, dynorphins all bind to

A

endogenous opoids

bind to mu, delta, fatta receptors

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3
Q

somatomedin C

A

= IGF-1

released in response to growth hormone

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4
Q

middle meningeal artery is a brach of..

A

maxillary artery, which is a branch of the external carotid artery

epidural hematoma

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5
Q

occipital artery

A

branch of external carotid

supply posterior scalp & SCM

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6
Q

opthalmic artery

A

branch of internal carotid:
serves eye & orbit contents

also eyelid, forehead, nose, nasal mucosa

(internal carotid has no branch in neck)

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7
Q

artery responsible for nosebleeds

A

kiesselbach’s plexus,

sphenopalatine artery (branch of maxillary artery) anastamoses w/ opthalmic & facial

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8
Q

facial artery

A

branch of external carotid
couses over mandible anterior to insertion of masseter

supply oral region & nose & buccal

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9
Q

how does middle mengingeal artery enter skull

A

foramen spinosum

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10
Q

touch to anterior 2/3 of tongue

A

trigeminal V3

lingual n

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11
Q

touch to posterior 1/3 of tongue

A

glossopharyngeal CN IX

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12
Q

intrinsic muscles of tongue innervated by (2)

A

most: CN XII hypoglossal

palatoglossus -> CN X vagus

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13
Q

taste in pharynx & epiglottis

A

vagus CN X

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14
Q

ESR increased due to

A

acute phase reactants released by IL-6

fibrinogen, ferritin, CRP, serum amyloid A, serum amyloid P, complement

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15
Q

why does erythroyte sedimentation increase w/ inflammation

A

fibrinogen causes RBC to rouleaux –> sediment faster

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16
Q

cytokines impt for systemic inflammation (3)

A

IL-1, IL-6, TNF-alpha

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17
Q

bradykinin effects (4)

A

vasodilation
vascular permeability
smooth muscle contraction
pain

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18
Q

PAF effects

A

vasoconstriction
bronchoconstriction
platelet stimulation

also enhances leukocyte adhesion to endothelium, chemotaxis, phagocytosis, degranulation

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19
Q

epinephrine for anaphylactic shock

A

counteracts the..
1. vasodilation
by alpha-1 agonist vasoconstrction

  1. increased vascular permeability
    by increases CO, B1 agonist
  2. bronchoconstriction
    by bronchodilating, B2 agonist
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20
Q

morphology of crytococcos neoformans

A

yeast only
round/oval encapsulated w/ narrow based buds

virulence: thick polysacch capsule

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21
Q

flutamide, cyproterone

A

blocks androgen receptor

testosterone/DHT

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22
Q

leuprolide, goserelin, nafarelin, histrelin

A

GnRH agonists

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23
Q

anorexia induced amenorrhea due to..

A

hypothalamic dysfunction

nonpulsatile GnRH

(NOT problem in pituitary/gonad)

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24
Q

most important mediator of sepsis

A

TNF-alpha

also IL-1, IL-6

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25
liver cyst in person from endemic region (middle easy, south america, iceland, australia, new zealand, africa) or sheep/dog exposure
echinococcus granulosus encapsulated calcified cyst rupture: eosinophilia --> ANAPHYLAXIS rx: bendazole
26
mitral stenosis can cause hoarseness bc..
compression of left recurrent laryngeal via really enlarged left atrium
27
recurrent laryngeal innervates
all intrinsic muscles of larynx except cricothyroid
28
p-ANCA suggests..
microscopic polyangiitis or churg-strauss (eosinophilia)
29
characterize churg strauss
``` adult onset asthma eosinophilia history of allergy mono or poly-neuropathy migratory/transient pulmonary infiltrate paranasal sinus abnormalities ```
30
mechanism of glucose-induced inhibition of lac operon
glucose decreases adenylyl cyclase, depleting cAMP REDUCTION of cAMP, low CAP-DNA binding (not related to repressor binding to operon)
31
operon
DNA sequence that has at least 2 regulatory sites: promoter & regulator (operon) in addition to gene coding for protein
32
lac operon
proteins required for metabolism of lactose regulatory gene, - repressor for lac operon promoter gene, - binding site for RNA pol operator gene - binding site for repressor 3 structural gene - b-gal - permease low cAMP, (caused by glucose) shuts it off
33
culturing e. coli in lactose. what happens in lac operon
lactose (inducer) binds to repressor protein, which can no longer bind to operon. increases transcription of lac operon.
34
anti-reticulin, anti-endomysial antibodies
along w/ anti-gliadin in celiac sprue
35
urticaria (hives) histologically
DERMIS: mild, superficial infiltrate of mononuclear cells & eosinophils around dermal venules. collagen bundles are parted by DERMAL EDEMA and lymphatic channels dilated w/ excess transudate no epidermal changes antigen induced degranulation of focal mast cells due to IgE antibody sentization or, direct activatio nof mast cells microvasculature hyperpermeability
36
urticaria vs. eczematous dermatitis
urticaria (wheel): DERMAL edema eczematous dermatitis: spongiosis (epidermal edema) w/ acantholysis
37
staph aureus food posioning due to
exotoxin formed prior to ingestion highly heat stable enterotoxin rapid onset: less than 6 hrs usu mayo containing (potato, macaroni salad) (similar to b. cereus, but diff food)
38
b. cereus food poisioning
similar to staph aureus! exotoxin formed prior to ingestion heat stable but, diff food: here, reheated rice
39
exotoxin staph aureus diseases (3)
1. toxic shock 2. scalded skin 3. gastroenteritis
40
pulsatile notching vessels under ribs
coarctation of aorta could also have headache & epistaxis from HTN in blood to head -- post-ductal in adults
41
3 major risk factor for squamous cell carcinoma of esophagus
alcohol smoking n-nitroso-containing foods (smoked fish, etc) (asia: chewing betel nut & n-nitroso compounds)
42
3 major risk factors for adenocarcinoma
barrett's esophagus GERD obesity tobacco use
43
anytime you see a squamous cell carcinoma
expect keratin pearls
44
mu opiod receptor responsible for
respiratory & cardiac depression reduce GI motility also: dependence, euphoria, sedation
45
kappa opiod receptor responsible for..
miosis also: dysphoria, sedation
46
delta opiod receptor responsible for..
antidepressant effects
47
naloxone
opiod receptor antagonist, especially mu good for overdose / intoxication rx
48
terbinafine antifungals act on..
block squalene expoidase prevent conversion of langosterol to ergosterol
49
rx for dermatophytosis (i.e. tinea corporis)
terbinafines
50
MRI of MS
periventricular plaques of demyelination (axons in tact)
51
MLF damage
impaired adduction of eye during lateral gaze BUT intact adduction w/ ocular convergence i.e. not a problem w/ nerve or muscle
52
what's inside an acute MS plaque?
1. demyelination w/ preservation of axon 2. accumulation of lipid-laden macrophages 3. astrocytosis (response to injury) 4. infiltration by lymphocytes / mononucear cells overtime: damage of axons, neurons, oligodendrocytes
53
hypertensive heart results in what type of dysfxn
DIASTOLIC concentric hypertrophy; net decrease in LV chamber size filling and diastolic fxn is normal though
54
what causes hepatic injury w/ hepatitis B infxn
NOT direct cytopathic effect if virus instead, MHC I expression of HbsAg & HbcAg activates CD8+ T cells to attack damage tapers when HBV is incorportated into host genome & antiviral antibodies appear risk of hepatocellular carcinoma remains elevated
55
autoimmune hepatitis
due to antigen mimicry w/ generation of self-antigen recognizing CD4+ T lymphocytes that damage hepatocytes
56
location of broca
inferior frontal gyrus
57
MCA covers what impt territories
all lateral hemispheres - frontal eye fields - broca (inferior frontal gyrus) - wernicke (posterior superior temporal gyrus) - primary motor cortex esp face/hands - some perforating branches to internal capsule & basal ganglia
58
left hemipshere is dominant (side of language) in what people
most left & right handed people
59
ACA infarct can present w/
hemiplegia of lower extremities urinary incontinence primitive reflexes
60
1. contralateral loss of pain & temp 2. ipsilateral deficits of CN V, 3. ipsilateral facial CN VII 4. ispilateral vestibulococh CN VIII 4. horner's 5. cerebellar symptoms
AICA occlusion causeslateral inferior pontine syndrome
61
``` contralateral loss of pain & temp w/ ipsilateral defecits in CN V, VIII, IX, X, & XI w/ Horner ``` notably: dysphagia & hoarseness
PICA, lateral medullary
62
abdominal pain, distension w/ fever, diarrhea, shock in ulcerative colitis patient..
think: toxic megacolon
63
toxic megacolon is more common in..
ulcerative colitis
64
pathogenesis of toxic megacolon
complete cessation of neuromuscular activity in intestinal wall. rapid colonic distension -> prone to rupture segmental necrosis perforation risk!
65
diagnosis of toxic megacolon
sufficient w/ plain abdominal x-ray: colonic dilatation, maybe fluid levels
66
1. chora 2. aggression/apathy/depression 3. dementia
hungtington
67
w/ hungtingtons, when does expansion of CAG repeats occur?
in spermatogenesis! when receive abnormal gene from father, tend to have ANTICIPATION no expansion from mama
68
emotional lability insatiable hunger & thirst in child
prader-willi mutation in chr. 15 of papa (same gene as angelman)
69
happy puppet jerky movement (like marionette) pathological happy disposition
angelman mutation in chr. 15 of mama (same gene as prader-willi)
70
multiple myeloma
neoplastic B-lymphocytes mature into plasma cells that synthesize abnormally large amounts of monogclonal Ig or Ig fragments (light chains) - impaired hematopoesis (bc bone marrow filled w/ plasma cells) - lytic bone lesions - hypercalcemia - AL amyloidosis - renal dysfxn
71
lab abnormalities in multiple myeloma
rouleaxu erytheocytes in blood bence jones protein in urine M peak on serum protein electrophoresis -- monoclonal proliferation
72
prognosis for esophageal cancer
generally poor, present w/ incurable locally advanced or metastatic disease
73
histology of reflux esophagitis (3)
elongation of papillae basal cell hypertrophy intraepithlieal EOSINOPHILS usu leads to barett esophagus
74
benign tumor of esophagus
super rare, but could be leiomyoma
75
why do colonic diverticula form? describe mechanism & fate
mechanism: pulsion structure: false mucosa & submucosa herneat through weak spots in colonic muscular layer; due to increased intraluminal pressure (i.e. constipation)
76
false diverticula (2)
colonic & zenker in upper esophagus
77
presentation of colonic diverticula
lower GI bleed
78
traction diverticula
inflammation & scarring. true: contains 3 layers example: midesophageal diverticula, which occur w/ mediastinal lymphadenitis and periesophageal scarring
79
location & predisposition for colonic diverticula
usu sigmoid colon constipation : risk factor
80
lack of peroxisomes prevents
special form of beta oxidation for very long chain fatty acids or alpha oxidation for branched chain fatty acids (phytanic acid) accumulate fatty acids in tissue
81
Zellweger syndrome
absence of peroxisomes infant unable to make myelin in CNS present: hypotonia, seizures, hepatomegaly, metal retardation, early death
82
Refsum disease
defective alpha oxidation in peroxisomes leads to neuro disturbances bc accumulate phytanic acid rx; avoid chlorophyll in diet
83
what types of fatty acids does the mitochondria NOT oxidize
very long chain fatty acids or fatty acids w/ branch points at odd number carbons (peroxisome does)
84
rx for NARDs
supplemental oxygen at high concentration nasal continuous positive airway pressure mechanical ventilation w/ intratracheal surfactant
85
concern w/ oxygen therapy in neonate
retinal damage local hyperoxia --> upregulate VEGF --> retinal detachment/blindness retinopathy or prematurity or retrolental fibroplasia
86
causes of acute MR
spontaneous rupture of chordae tendinae, infective endocarditis w/ destruction of valve leaflets, chordal rupture, ischemia /rupture of papillary muscles
87
compliance =
V/P
88
left atrial compliance in acute MR? chronic?
acute: normal compliance, so will lead to pulmonary edema chronic: increased compliance, less prone to pulmonary edema, but more protein to Afib & thromboemboli
89
thiamine deficiency on TCA cycle
most severely impairs alpha-ketoglutarate dehydrogenase --> succinylCoA dehydrogenases require thiamine, lipoate, CoA, FAD, NAD+
90
thiamine, lipoate, CoA, FAD, NAD+ are important for..
alpha ketoglutarate dehydrogenase pyruvate dehydrogenase acyl-CoA dehydrogenase
91
thiamine needed for
transketolase (specific) alpha ketoglutarate dehydrogenase pyruvate dehydrogenase acyl-CoA dehydrogenase
92
rate limting step in TCA
isocitrate dehydrogenase isocitrate -> alpha-ketoglutarate first NADH produced
93
what step of TCA makes GTP
succinyl CoA -> succinate succinylCoA synthetase substrate level phosphorylation
94
what step of TCA makes FADH
succinate dehydrogenase succinate -> fumarate
95
order things are made in TCA
starting w/ isocitrate -> alphaketo ``` NADH (isocitrate -> alpha-keto) NADH (alphaketo -> succinylcoa) GTP (succinylcoA -> succinate) FADH (succinate -> fumarate) skip (fumarate -> malate) NADH (malate -> oxaloacetate) ```
96
alcohol dehydrogenase & acetaldehyde dehydrogenase both
increase NADH/NAD+ ratio though all of TCA is inhibited w/ alcohol, thiamine dependent ones are especially inhibited
97
mifepristone RU-486
anti-progestin abortifacient decidual necrosis and expulsion of products of conception
98
misoprostol
prostaglandin analogue, also abortifacent also increases gastric mucosal barrier
99
methotrexate on pregnancy
inhibits trophoblast division used for ectopic pregnancy
100
common complication after subarachnoid hemorrhage
secondary arterial vasospasm can lead to cerebral ischemia present: new onset confusion / focal neuro defect 4-12 days after initial insult can also have rebleed: see on CT
101
rx to prevent vasospasm after a subarachnoid hemorrhage
nimodipine, selective Ca2+ channel blocker
102
linear velocity V =
Q/A or total flow = velocity x cross sectional area; where flow = constant
103
addition of what in a pt w/ hemophilia will induce clotting
thrombin! will then activate fibrinogen -> fibrin
104
fatal toxicity w/ digoxin
arrthythmia due to hyperkalemia
105
associated NF-1 findings
meningioma, astrocytoma, glioma, pheochromocytoma
106
inheritance of NF-1
single gene autosomal dominant
107
how is INH neurotoxic?
chemically similar to vitamin B6, can compete with it in synthesis of ntx (GABA) resulting in defective end products also increases urinary excretion of pyridoxine neurotoxic bc causes VITAMIN DEFICIENCY drug is not directly toxic!
108
counteract isoniazid toxicity
supplement w/ B6 neurotoxicity due to vitamin deficiency!

UWorld mixed (60 decks)

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