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UWorld mixed > usmle2: block4 > Flashcards

usmle2: block4 Flashcards

1
Q

HIV protease inhibitors

A

specifically cleave gag (p24) and pol (enzymes) gene products into functional pieces

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2
Q

VHL

A
  1. hemangioblastoma
    - cerebellum & retinal
  2. renal cell carcinoma
  3. pheochromocytoma

also cysts in kidney and pancreas

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3
Q

how does CO cause hypoxia

A
  1. binds to heme w/ higher affinity than O2
  2. shifts hemoglobin dissociation curve all the way to left (no longer sigmoidal)
    - - doesn’t release o2 anymore
  3. impairs ETC
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4
Q

why does HbF have greater affinity for oxygen than HgA?

A

bc HbF doesn’t bind to 2,3BPG

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5
Q

where does Cu2+ in wilson’s disease deposit in eye (Kayser-Fleischer ring)

A

cornea: descement’s membrane

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6
Q

how does wilson’s disease present

A

30-40s,
hepatitis, splenomegaly, hemolytic anemia

basal gangia (lentiform nuc) damage: dystonia, tremor, dysarthria

kayser-fleisher ring

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7
Q

what is the main enzyme responsible for oxidative damage by neutrophils

A

NADPH oxidase, unique
converts O2 into superoxide
main task!

superoxide dismutase acts as either 1. scavenger for these free radicals, in all cells
2. or helps made H202, and w/ MPO, making bleach for further attacking

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8
Q

where is NADPH oxidase located

A

membrane protein of phagosome

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9
Q

aldehyde dehydrogenase

A

converts aldehyde into carboxylic acid
impt for alcohol metabolism.

blocked by disulfram

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10
Q

how does sclerosing adenosis present

A

usu as a density on mammogram / incidentally on biopsy

usu not a mass

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11
Q

most common causes of palpable nodular masses in breast

A

fibrocystic changes

usu poorly defined, diffuse increase in consistency throughout breast tissue

often multiple and painful, w. tenderness during premenstrual phase of cycle

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12
Q

presentation of mammary duct ectasia

A

ill-defined, palpable periareolar mass

may be confused w/ carcinoma

can have skin retraction and thick creamy or bloody nipple discharge

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13
Q

dermoepidermal junction aggregates of large cells that fuse w/ adjacent nests

atypical cells w/ irregular nuclear contours, hyperchromasia, round/spindle shaped

A

dysplastic nevus, which can evolve into melanoma

recall: nevus can be junctional, compound, or intradermal. malignant melanoma w/ pleomorphism

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14
Q

squamous cell carcinoma on histology

A

will have keratin pearls

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15
Q

basal cell carcinoma on histology

A

basaloid tumors either

  1. budding from epidermis or
  2. residing within the dermis w/ nuclear palisading & retraction artifact evident along periphery of cell nests
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16
Q

dysplastic nevus syndrome

A

chr 9p21

‘familial melanoma’

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17
Q

dermatofibrosarcoma protuberans

A

fibroblasts in a cartwheel/storiform patteerm
&
supernumerary ring chromosomes

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18
Q

langerhans cell histiocytosis

A

prolfierative disorders of dendritic langerhans cells from monocytic lineage

presentation:
lytic bone lesion & skin rash in child
or
recurrent otitis media with a mass involving mastoid bone

cells = functionally immature, do not efficienctly stimulate primart T lymphocytes via antigen presentation

express S-100 (mesodermal origin)
Bierbeck granules = TENIS racket on eM

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19
Q

Bierbeck tennis racket granules on EM

A

langerhans cell histiocytosis

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20
Q

flumazenil

A

bind to & blocks GABAb at the benzodiazepine binding spot

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21
Q 
exercise on LV:
HR
LV end-systolic vol
LV end-diastolic vol
LV end-diastolic pressure
A
  • HR increases (less parasymph, more sympth
  • LV end systolic decreases (more preload, less afterload
  • LV end diastolic vol increases

LV end-diastolic pressure does not change
–> decrease in TPR counterbalanced by increased cardiac output

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22
Q

clinical signs of alcoholic cerebellar degeneration

A

degenerate cerebellar vermis and anterior cerebellar lobes

wide-based gait, truncal instability, ataxia, nystagmus, dysarthria

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23
Q

3 important DNA binding protein domains?

A
  • leucine zippers (alpha helix)
  • helix-loop-helix
  • zinc finger motifs
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24
Q

leishmania transmission & histology

A

macrophage w/ amastigotes.
sandfly

kala-azar: spinking fever, hepatosplenomegaly, pancytopenia

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25
starting products for pyrimidine synthesis
CO2 + glutamine + 2ATP | via carbamoyl phosphate synthetase II
26
where does purine / pyrimidine metabolism occur?
cytosol
27
peroxisomes play a role in... (3)
- lipid metabolism (beta oxidation) - oxidative reactions - purine catabolism
28
positive psoas sign suggests.. (2)
- psoas abscess | - appendicitis
29
quadratus lumborum
runs from 12th rib to iliac crest. helps extend & laterally flex vertebral column fixes 12th rib during inspiration
30
alcoholic cardiomyopathy
dilated cardiomyopathy
31
causes of dilated cardiomyopathy
i'm mad my pump failed ``` iatrogenic medications (doxorubicin, danorubicin) alcohol drugs (cocaine) myocarditis pregnancy familial ```
32
causes of restrictive cardiomyopathy
my pounding 'art seems held still ``` metastasis pompe amyloidosis sarcoidosis hemochromatosis systemic sclerosis ```
33
cardio: eccentric hypertrophy vs. concentric
eccentric: added in series: dilated cardiomyopathy concentric: added in parallel: hypertrophy
34
carbolfuschin staining
acid-fast staining | retained by mycolic acid
35
presentation of choriocarcinoma
trophoblasts with NO VILLI weeks following.. - normal birth - evacuation of mole - following an abortion can present w/ metastasis to lungs, vagina, brain, liver, or kidney at time of diagnosis
36
placenta accreta results from
abscence of decidual layer placenta stuck to uterine myomatrium immediate postpartum bleeding secondary to failed placental separation
37
benzoyl peroxide
oxidizes bacterial proteins | bacteriostatic against propionibacterium acnes
38
chlorhexadine
antiseptic used as skin / dental cleanser
39
acitretin, tretinoin,adapalene, tazarotene
retinoid medications, bind nuclear receptors
40
major risk factors for ischemic heart disease. greatest?
``` smoking HTN diabetes dyslipidemia history of coronary heart disease ``` greatest: smoking
41
how does smoking risk of ischemic heart disease (2)
1. promotes atherosclerosis 2. promotes platelet aggregation have 2-3x risk of nonsmokers
42
alcohol on MI
2 standard servings per day, decreases risk of MI excessive --> other heart problems: HTN, cardiomyopathy, MI
43
how does the vagus n. enter abdomen
w/ esophagus (T10)
44
how does the thoracic duct enter abdomen
w/ aorta, T12 via aortic hiatus (median arcuate ligament of diaphragm)
45
how does the IVC enter abdomen
T8, central tendon of diaphragm
46
why are nitrates first line for angina pectoris
decrease both preload and afterload | arterial / venous vasodilation
47
type 2 maturity onset diabetes of young (MODY)
mutation in glucokinase (liver & beta pancreatic cells) even higher Km that it should, higher threshold
48
von gierke mutation
glucose 6-phosphatase only in live (glycogenolysis and gluconeogenesis) have hepatomegaly and renomegaly
49
fructose / lactose in von gierke
bad. can't be converted to glucose bc defect in gluconeogenesis.
50
deficiency in pompe
alpha 1,4 glucosidase acid maltase acid alpha glucosidase
51
prognosis of pompe
early clinical findings in heart PAS+ granules in lysosomes hypotonia, macroglossia, hypertrophic cardiomyopathy, VERY EARLY DEATH
52
pontine hemorrhage
often w/ HTN pinpoint pupils, loss of horizontal gaze, quadriparesis, decerebrate posturing, rapidly evolving coma --> death
53
vasogenic edema
often via intracerebral neoplasm disruption of blood brain barrier --> increased vascular permeability & plasma filtration into cerebral interstitium vasogenic: fingers: white matter
54
cytotoxic edema
increased intracellular fluid WITHIN neurons, glial, endothelial cells. due to impaired Na+ / K+ pump usu after ischemic insult cytotoxic: white & grey matter
55
what type of cerebral causes an increased ICP: cytotoxic / vasogenic
VASOGENIC --> net gain of fluid in intracranial space cytotoxic is a shift of fluid from extra/intracellular
56
how does an intracerebral neoplasm increase ICP?
vasogenic edema! | disrupts BBB
57
reiter's syndrome classic & extra symptoms
classic: arthritis, urethritis, conjunctivitis also: cutaneous findings; keratoderma blenorrhagica & balanitis circinata)
58
HLA B27
reiter syndrome psoriatic arthritis ankylosing spondylitis IBD
59
only structure in female genital tract w/ 2 epithlium types?
cervix: ecto --> squamocolumnear junction --> endo ectocervix: -stratified non-keratinized (like vagina), protrudes into vagina endocervical canal between external os -> internal os -simple columnar epithelium; mucus-secreting glands squamocolumnar junction: squamous abrupty converts to columnar endo
60
histology of uterus
lined by endometrium --> EPITHELIAL lining that proliferates and degenerates (stratum functionalis) reserve tissue that regenerates stratum functionalis (stratum basalis)
61
histology of fallopian tubes
simple ciliated columnar epithlelium
62
histology of ovaries
covered externally by simple cuboidal epthelium that ruptures w/ each ovulation
63
most common cause of infectious meningitis in patients w. AIDS
cryptococcos neoformans
64
amphotericin B toxicity
NEPHROTOXIC hypokalemia hypomagnesmia rental tubular acidosis
65
kaposi sarcoma vs. bacillary angiomatosis
kaposi: HHV-8 - lymphocytic infiltrate bacillary angiomatosis: bartonella hensela - neutrophilic infiltrate
66
small cell carcinoma secreting ADH causes
free water retention --> HYPONATREMIA to try to rid of water
67
squamous cell carcinoma paraneoplastic syndrome
PTHrP --> hypercalcemia
68
hypercalcemia + tumor, consider
humoral hypercalcemia of malignancy | PTHrP-secreting paraneoplastic syndrome
69
presentation of hypercalcemia
fatigue, mental status change, dehydration, nephrolithiasis can cause polyuria, polydypsia, and dilute urine (like nephrogenic diabetes insipidus) bc impairs renal concentrating ability
70
short peptide medication that is an analog of carboxyl terminal of delta chain of fibrinogen
abcixamab, eptifibatide, tirofiban
71
eptifibatide
``` (like abcixamab) GpIIbIIIa blocker (integrin) ``` binds to fibrinogen binding site
72
tirofiban
like abcixamab GpIIbIIIa blocker (integrin)
73
ticlopidine / clopidergrel bind..
ADP-receptors | GPCRs
74
clopidergel activation requires
is a prodrug must be activated by hepatic cytochrome P-450 enzyme system *note intxn w/ P450 inhibitors etc
75
zero-order kinetic metabolism
rate of enzymatic rxn independent of concentration of substrate constant AMOUNT of substrate converted to product over time

UWorld mixed (60 decks)

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