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zz - step 4 - uworld > UW10 > Flashcards

UW10 Flashcards

1
Q

Watery diarrhea, headache, confusion, recent travel

A

Legionella (dx with urine antigen test)

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2
Q

Labs for legionella

A

hyponatremia, gram stain with many neutrophils but few or no organisms

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3
Q

Pulmonary infiltrates, bronchiectasis with eosinophilia. Elevated IgE. Hx of athsma

A

allergic bronchopulmonary aspergillosis (ABPA)

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4
Q

small, bright-red papuplar lesions in adult. Sharply circumscribed areas of congested capillaries and post-capillary venules in papillary dermis

A

Cherry Hemangioma

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5
Q

dilated vascular spaces with thin walled endothelial cells. Soft blue, compressible masses up to a few cm in size

A

Cavernous hemangioma

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6
Q

Cavernous hemangioma of the brain and viscera are associated with what disease

A

Von Hippel Lindau

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7
Q

lymphatic cysts lined by endothelium

A

cystic hygroma

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8
Q

Cystic Hygromas are associated with what diseases

A

Turner sydrome and Down syndrome

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9
Q

what are some risk factors for gallbladder hypomotility

A

pregnancy, rapid weight loss, prolonged TPN, octreotide, high spinal cord injuries

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10
Q

what is biliary sludge

A

bile precipitation containing cholesterol monohydrate crystals, calcium bilirubinate, mucus. Precursor to stones.

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11
Q

Brown pigment stones

A

Biliary tract infection

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12
Q

Black pigment stones

A

Intravascular hemolysis

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13
Q

Mechanism of type IV HSR

A

antigen is taken up by DC and presented to T cells. TH1 cells release IFN-g and recruit macrophages

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14
Q

Neutrophils can be falsly elevated in what patients?

A

Corticosteroids. Cause demargination (release from vascular walls)

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15
Q

Café au lait, neurofibromas, lisch nodules

A

NF-1 ( chr 17)

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16
Q

Hypersensitive to rejection, desires relationship with others

A

Avoidant personality

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17
Q

Pattern of distrust and suspiciousness of others

A

Paranoid personality

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18
Q

Detachment from social relationships, self absorbed, little pleasure in intimacy

A

Schizoid personality

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19
Q

what channels open when the cell membrane of skeletal muscles are depolarized

A

Opens L type ca channels in T-tubule system

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20
Q

What causes release of ca from intracellular stores in the sarcoplastic reticulum in skeletal muscle

A

L type calcium-RyR mechanical coupling

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21
Q

Does skeletal muscle require ca to enter from extracellular space to cause ca release in the cell?

A

no. this is why CCB do not effect skeletal muscles.

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22
Q

What does ca bind to in a depolarized skeletal muscle cell?

A

Binds to troponin C

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23
Q

What does ca-troponin C binding cause?

A

moves tropomyosin out of the way. Myosin releases ADP leading to power stroke

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24
Q

what causes ca influx in cardiac cells?

A

Depolarization causes L type Ca chennels to open and allow extracellular ca to enter and activae RYR2 channels (CICR)

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25
Q

What is the mechanism of smooth muscle contraction

A

Ca influx (L type) leads to CICR. Ca binds to calmodulin which activates myosin light chain kinase leading to phosphorylation of myosin (binds to actin)

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26
Q

T tubules are present in what types of muscle cells

A

Skeletal and cardiac. Not smooth muscle

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27
Q

why is skeletal muscle resistant to effects of ca channel blockers

A

L type- RyR mechanical coupling (does not relay on extracellular ca for excitation-contraction coupling)

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28
Q

What types of muscle cells depend on extracellular ca for excitation-contraction coupling

A

Cardiac and smooth muscle (Targets of Verapamil)

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29
Q

How does aldosterone affect K and H+ secretion

A

Increases secretion leading to a loss of K+ and H+

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30
Q

Perifollicular hemorrhages and coiled hairs

A

vitamin C deficiency

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31
Q

Loss of sensation of right upper and lower extremities and right side of face

A

Thalamic syndrome (damage to VPN and VPL) leads to complete sensory loss. Proprioception is affected leading to falls

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32
Q

5-6mm cavities in deep structure of the brain filled with clear fluid

A

Lacunar stroke (hipohyalinosis, microatheroma)

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33
Q

spindle cells with hair like glial processes associated with microcytes. Rosenthal fibers and granular eosinophilic bodies

A

Pilocytic astrocytoma

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34
Q

brain tumor in subcortical white matter that spreads across the corpus callosum. Pleomorphic astrocytic cells with necrosis and microvascular proliferation

A

Glioblastoma multiforme

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35
Q

small blue cells with Homer Wright rosettes

A

Medulloblastoma

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36
Q

Tumor with Pseudorosettes arising in 4th ventricle

A

Ependymoma

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37
Q

small round blue cells with neuropil (neuritic process)

A

Neuroblastoma (adrenal medulla- N-myc)

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38
Q

Required co-factor for urea cycle

A

Carbamoyl phosphate synthase I requireds N-acetylglutamate

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39
Q

budding yeast with pseudohyphae

A

Candida

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40
Q

Defense against Candida

A

T cells: prevent superfician Candida infection. Neutrophils prevent hematogenous spread of Candida

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41
Q

What is fluoxetine used for

A

SSRI for panic disorder, social phobia, generalized anxiety, OCD

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42
Q

DOC for generalized anxiety disorder

A

Buspirone ( 5HT1A) agonist

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43
Q

in artherosclerotic plaques what promotes the migration of smooth muscle cells from the media into the intima

A

PDGF secreted platelets, endothelial cells, macrophages

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44
Q

Young, pregnant mother in Asia with fulminant hepatitis

A

Hep E (unenveloped RNA virus)

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45
Q

Flutamide

A

competitive inhibitor of testosterone receptor

46
Q

Theophylline intoxication

A

Abdominal pain, vomiting, seizures. Tx: gastric lavage, activated charcoal, cathartics

47
Q

intoxication causing bradycardia, hypotension, cardiovascular collapse

A

Beta blocker. Reverse with glucagon

48
Q

intoxication causing severe sedation, respiratory depression, constricted pupils

A

Opiods, reverse with naltrexone, naloxone

49
Q

Intoxication causing liver damage following a latent period

A

Acetaminophen. Reverse with N-acetylcyseine (glutathione donor)

50
Q

side effect of nitrates

A

Headaches due to vasodilation

51
Q

diuretic that can precipitate gout attacks

A

Thiazide

52
Q

Drugs associated with Raynauds

A

Beta blockeres and ergotamine (headaches)

53
Q

oval yeast forms in macrophage

A

Histoplasma

54
Q

spherule filled with endospores

A

coccidiodies

55
Q

Mutation associated with melanoma

A

BRAF (valine to glutamate)

56
Q

Neurophysins

A

carrier proteins for oxytocin and vasopressin

57
Q

what enzyme is inducible in states of inflammation?

A

COX-2

58
Q

viral hepatitis that causes cytoplasm of hepatocyte to take on a granular eosinophilic appearance (ground glass)

A

Hep B ( filled with HBsAg)

59
Q

tumors of eosinophilic cytoplasma and oval stippled nuclei. No variation in shape or size of tumor. From enterochromaffin cells

A

carcinoid tumor

60
Q

Prevent dilated cardiomyopathy caused by doxorubicin

A

Dexrazoxane

61
Q

Mutation in hypertrophic cardiomyopathy

A

Beta myosin heavy chain

62
Q

fracture at neck of fibula

A

lateral compartment (everts), sensory to the dosum of foot

63
Q

Ras

A

GTP binding protein. Oncogene. Cholangiocarcinoma, pancreatic adenocarcinoma

64
Q

MYC

A

Transcription factor (Burkitt)

65
Q

ERBB1 (EGFR)

A

Receptor tyrosine kinase. Oncogene. (lung adenocarcinoma)

66
Q

ERBB2 (HER2)

A

Receptor tyrosine kinase (Breast cancer) Oncogene

67
Q

ABL

A

non receptor tyrosine kinase (CML). Oncogene

68
Q

BRAF

A

RAS signal transduction (hairy cell leukmenia, melanoma). Oncogene

69
Q

BRCA1 &2

A

Tumor suppressor. DNA repair genes (breast and ovarian cancer)

70
Q

APB/ Beta-catenin

A

Tumor suppressor. WNT signaling. FAP

71
Q

p53

A

tumor supressor. Li Fraumeni

72
Q

RB

A

tumor suppressor. Retinoblastoma, Osteosarcoma

73
Q

WT1

A

tumor supressor. Urogenital differentiation. Wilms tumor

74
Q

VHL

A

Tumor suppressor. RCC

75
Q

Concentric hypertrophy of ventricular wall

A

narrowing of ventricular cavity seen in elevated ventricular pressures (HTN or aortic stenosis)

76
Q

Eccentric hypertrophy

A

Dilation of the ventricle with increased chamber size due to volume overload (aortic or mitral regurgitation, dilated cardiomyopathy)

77
Q

what does the anti-Rh(D) ig consist of

A

IgG anti-D antibodies. Binds to Rh+ RBCs that enter an Rh- mother. Give at 28 weeks

78
Q

Perfusion not matched by ventilation

A

Occluded blood flow (PE)

79
Q

Ventilation not matched by perfusion

A

Lung collapse or consolidation

80
Q

what is the Na level in hyperaldosteronism?

A

normal due to aldosterone escape. Increased sodium excretion. Increased volume also increases ANP causing natriuresis

81
Q

How does the hypokalemia in hyperaldosteronism present?

A

Profound muscle weakness

82
Q

orthopnea, crackles

A

Left sided heart failure

83
Q

Hypoxia induced vasoconstriction leading to pulmonary hypertension

A

Chronic obstructive pulmonary disease

84
Q

when is K+ excretion seen

A

High extracellular K, increased aldosterone, alkalosis, volume expansion, high Na intake, diuretic use

85
Q

Dizygotic twins ( 2 different oocytes by 2 different sperm)

A

Dichorionic/ Diamniotic

86
Q

Monozygotic twins 0-4 days

A

Dichorionic/Diamniotic

87
Q

Monozygotic twins. 4-8 days

A

Morula (1 chorion, 2 amnion)

88
Q

Monozygotic twins. 8-12 days

A

Blastocyst (1 chorion, 1 amnion)

89
Q

pleuritic chest pain that decreases with pt sits up and leans forward

A

pericarditis

90
Q

Kussmaul sign

A

paradoxical increase in jvd when inspiration. Seen in constrictive pericarditis

91
Q

pericardial knock

A

heard shortly after S2 in patients with constrictive pericarditis

92
Q

Torticollis, tongue protrusions, opisthotonus, oculogyric cirsis ( elevation of eyes)

A

Acute dystonia (4hrs to 4 days after antipsychotic use)

93
Q

how can N. gonorrhoeae evade the immune system?

A

IgA protease that degrades IgA in mucosal secretions

94
Q

wbc >100,000 in synovial fluid analysis without crystals

A

Septic arthritis (consider gonococcus)

95
Q

Wheezing, diarrhea, facial flushing

A

carcinoid tumor. Tx: octreotide

96
Q

Methyltesterone

A

Anabolic steroids. Promotes epidermal hyperproliferation and excessive sebum (acne)

97
Q

symptoms or deficients of neurological deficits without explanation after traumatic event

A

conversion disorder

98
Q

Numerous physical complaints over years for which no physical explanation can be found

A

Somatization disorder

99
Q

odds ratio

A

probabilty of an event/ (1-probability of that event)

100
Q

Enoxaparin

A

low weight molecular heparin. Binds and inactivates AT III

101
Q

Antithrombin III

A

binds and inactivates factor Xa and stops it from converting prothrombin to thrombin

102
Q

Potency of a drug

A

dose required to produce a given effect. Higher affinity= higher potency. ED50

103
Q

Efficacy

A

Max effect

104
Q

Hypertension, low renin, weakness, parathesia

A

Primary mineralcorticoid excess (hyperalodsteronism)

105
Q

Why is there a metabolic alkalosis in hyperaldosteronism

A

increase excretion of H+ and K+ leads to reactive increase in bicarb production and absorption

106
Q

Hypotension, hyponatremia, hyperkalemia, metabolic acidosis

A

Primary adrenal insufficiency (addison)

107
Q

Hyponatremia, hypokalemia, metabolic alkalosis

A

Loop or thiazide (contraction alkalosis) due to urinary Na/K loss and increase HCO- absorption

108
Q

Hyperkalemia and metabolic acidosis

A

Mineralcorticoid receptor antagonist. Decrease excretion of K+ and H+

109
Q

Mutation associated with polycythemia vera

A

JAK2

110
Q

mild pleocytosis and positive VDRL is associated with what skin lesion

A

Gumma (tertiary)! Not chancre (primary)

zz - step 4 - uworld (18 decks)

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