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zz - step 4 - uworld > UW11 > Flashcards

UW11 Flashcards

1
Q

How does chronic renal disease change phosphate levels

A

decreases phosphate excretion and thus increases serum phosphate

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2
Q

How does chronic renal disease change calcium levels

A

high phophate levels complex with calcium and decreases it. Also decreases calcitriol (1,25vitD) production leading to decrease Ca absorption

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3
Q

Bone pain, osteopenia, soft tissue calcifications in pt with polycystic renal disease

A

Renal osteodystrophy

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4
Q

Calcitonin

A

secreted by parafollicular cells of Thyroid in response to elevated ca. Lower serum Ca by promoting bone mineralization and decrease intestinal Ca absorption

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5
Q

Drug of choice for benign essential tremor

A

Primidone (secondary= beta blocker- propranol)

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6
Q

What is a potential side effect of Primidone

A

Sedation can occur during drug initiation or in toxicity. Metabolite is phenobarbitol and serum concentrations should be monitored

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7
Q

Target protein identified using a DNA probe

A

SouthWestern blot. Identifies DNA binding proteins

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8
Q

What are some examples of proteins that bind DNA

A

Transcription factors, steroids, thyroid proteins, vitamin D receptors, retinoic acid receptors, DNA transcription and replication proteins

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9
Q

What is the function of C-myc

A

Transcription factor

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10
Q

what is the function of IGF-1

A

insulin like growth factor is produced in the liver (stimulated by GH). Anabolic and anti-apoptotic effects

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11
Q

What is released by mast cells during anaphylaxis

A

Histamine and tryptase

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12
Q

What is used to screen for carcinoid syndrome

A

5 hydroxyindoleacetic acid (breakdown product of serotonin)

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13
Q

What is used as a marker for mast cell activation

A

Tryptase

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14
Q

What receptor on mast cells and basophils mediate the allergic response

A

High affinity IgE receptor (FceRI) binds Fc portion of IgE leading to aggregation of FceRI and results in activation of non-receptor tyrosine kinases that lead to mast cell degranulation

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15
Q

elevated mood, decreased need for sleep, grandiosity with delusions/hallucination and more than 2 weeks of delusions with no mood symptoms

A

Schizoaffective

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16
Q

Psychotic symptoms occur exclusively during mood episodes

A

Mood disorder with psychotic features (Bipolar or major deression)

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17
Q

Schizophrenia

A

positive sxs: Delusion, Hallucination, Disorganized speech, disorganized or catatonic behavior. Negative sxs: flat affect, withdrawal, lack of motiovation, speech or thought. MORE than 6 mo

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18
Q

Schizophreniform

A

less than 6 mo of sxs

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19
Q

Schizoaffective disorder

A

psychotic symptoms with concurret mood symptoms (mania or depression). Must have an interval of only psychosis without mood sxs

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20
Q

Major depression with psychotic features

A

psychosis ONLY occurs with mood symptoms

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21
Q

What mediates relaxation in skeletal muscle

A

Na/Ca exchange and Ca-ATPase sequesters Ca in the SR to re-establish gradient

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22
Q

After a normal tidal volume, what is the airway pressure?

A

zero. Inward pull of lungs and outward pull of chest is balanced.

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23
Q

After a normal tidal volume, what is the intrapleural pressure?

A

negative (approx =-5 cm H2O). Prevents a pneumothorax.

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24
Q

Pneumothorax

A

Negative pleural pressure equates with atmospheric pressure. Lung will collapse and chest wall springs out.

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25
Q

Collecting tubules, major & minor calyces, renal pelvis, ureters are derived from

A

Uteric bud

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26
Q

Glomeruli, Bowman’s space, PT, LOH, DCT are derived from

A

Metanephric mesoderm (blastema)

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27
Q

Gastric carcinoma that typically arises from precursor lesions

A

Intestinal adenocarcinoma (cells look like colonic adenocarcinoma)

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28
Q

Gastric carcinoma characterized by signet ring cells

A

Diffuse adenocarcinoma

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29
Q

Opioid analgesic leading to severe RUQ pain

A

Opiod induced biliary colic (caused by contraction of SMC in sphincter of Oddi leading to increased common bile duct pressures)

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30
Q

complication of hydrocephalus

A

hypertonicity and hyperreflexia due to stretching of periventricular pyramidal tracts

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31
Q

what causes the inflammatory response in gram negative septic shock?

A

Lipid A of LPS

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32
Q

Atenolol

A

Selective B1 antagonist which decreases HR and decreases renin release. B1 receptors are found on cardiac tissue and on renal juxtaglomerular cells. Not on vascular smooth muscle.

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33
Q

Bilateral loss of pain and temperature. Flaccid paralysis and atrophy of intinsic hand muscles

A

Syringomyelia (affects spinalthalamic tracts and anterior horn)

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34
Q

loss of strength with preserved vibratory senses after a disc herniation

A

Anterior spinal injury

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35
Q

regulation of the lac operon

A

Negatively by binding of repressor protein to the operator locus. Positively by cAMP-CAP binding

36
Q

How lactose affect production of B-galactosidase in the lac operon

A

presence of lactose prevents repressor from binding operator. Regulatory gene is always making Repressor protein

37
Q

How does cAMP affect the lac operon?

A

increased cAMP binding causes CAP (catabolite activator protein) to bind in low glucose situations

38
Q

Basic amino acids

A

Lysine, Histidine, Arginine

39
Q

When do proteins dissociate in a solution?

A

When pH exceeds PKA. Physiologic pH=7.4

40
Q

skin hyperpigmentation, CM, pigment cirrhosis with hepatomegaly

A

Hemochromatosis

41
Q

Pancytopenia with red cell casts and proteinuria

A

SLE (IgG against erythrocytes and Type III HSR causes lupus nephritis)

42
Q

hemolytic anemia, hypocomplementemia, proteinuria, elevated creatinine, Serositis, arthritis

A

SLE

43
Q

Diplopia when reading newspaper or walking down stairs

A

Vertical diplopia due to lesion of trochlear nerve

44
Q

how do Thiazides increase Ca reabsorption

A

Inhibits Na/Cl- co transporter to decrease intracellular Na. Leads to activation of basolateral Na/Ca antiporter resulting decrease in intracellular Ca leading to an increase in Ca reabsorption. Also, hypovoluemia causes an increase in Na and water reabsorption in PT (and thus paracellular Ca reabsorption)

45
Q

Tx for reccurent C.diff

A

Fidaxomicin (RNA pol inhibitor= bacteriocidal) with minimal systemic absorption

46
Q

hearing loss with bony deformity. Mutinucleated giant cells positive for tartrate resistant acid phosphatase with over 100 nuclei

A

Paget’s disease

47
Q

What is FGF important for

A

stimulates osteoblast leading to increased bone matrix formation. Angiogenesis

48
Q

Blurred vision, headache, polymyalgia rheumatica

A

Temporal arteritis. Tx with corticosteroids to prevent blindness

49
Q

Galatosemia

A

Classically, a defect in Galactose 1-phosphate uridyl transferase (galactose to UDP galactose and Glu-1-P)

50
Q

Breast lesion with malignant clonal proliferation that does not extend beyond ductal basement membrane

A

DCIS (comedocarcinoma)

51
Q

Breast biopsy: sheets of vesicular, pleomorphic cells with lymphocytic infiltrate

A

Medullary Invasive carcinoma

52
Q

Breast biopsy: Central acinar compression by fibrotic tissue and periductal dilation

A

Sclerosing adenosis

53
Q

Ductal dilation, inspissated breast secretions and chronic granulomatous inflammation in periductal and interstitial areas

A

Mammary duct ectasia

54
Q

dysmenorrhea, menorrhagia, enlarged, soft uterus

A

Adenomyosis

55
Q

Dysmenorrhea, dyspareunia, dyschezia, infertility with normal sized uterus

A

Endometriosis

56
Q

elevated LDH-1

A

Hemolytic anemia

57
Q

lymphoid hyperplasia with recurrent sinopulmonary infections with defect in class switching

A

HyperIgM (defect in CD40L)

58
Q

telangiectasias in skin, mucous membranes, respiratory, GI, GU tracts that can cause bleeding.

A

Osler-Weber-Rendu (autosomal dominant)

59
Q

what maintains CO in acute aortic regurgitation

A

increase in left ventricular preload ( increase LVEDV)

60
Q

adaptation to aortic regurgitation

A

volume overload= eccentric hypertrophy

61
Q

which organisms cause invasive gastroenteritis

A

Salmonella, shigella, EHEC, Campylobacter (bloody diarrhea)

62
Q

Rate limiting enzyme in HMP shunt

A

Glucose 6 phosphate dehydrogenase

63
Q

What reaction does glucose 6 phosphate dehydrogenase catalyze?

A

Glucose 6 P –> 6 phosphogluconate (HMP shunt)

64
Q

What are the end products of the HMP shunt

A

NADPH ( glutathione, fatty acid, cholesterol synthesis) and Ribose 5 P for nucleotides

65
Q

Diagnosed with UTI a few days ago

A

probably prescribed TMP-SMX

66
Q

What enzyme is required to make ribose 5 P in the HMP shunt?

A

Transketolase (requires thiamine)

67
Q

Ankylosing spondylitis requires monitoring of chest expansion why?

A

Enthesitis at costovertebral and costosternal angles can cause hypoventilation

68
Q

cyanosis not corrected by oxygen supplementation

A

Methemoglobinemia

69
Q

what innervates the posterior part of the external auditory canal

A

small auricular branch of the vagus nerve

70
Q

what innervates the external auditory canal

A

mandibular division of trigeminal

71
Q

What are the changes that result from high altitude?

A

Decreased oxygen tension (decreases PaO2) causes increase in ventilation leading to respiratory alkalosis (breathe off CO2). Which is compensated by decreasing bicarb

72
Q

Mechanism of action for Raltegravir

A

integrade inhibitor that disrupts ability of HIV to integrate into genome innto host chromosomes and thus prevent mRNA synthesis

73
Q

Enfuvirtide

A

Brug that binds to gp41 to prevent viral membrane fusion (fusion inhibitors)

74
Q

HIV protease inhibitors

A

prevent polyprotein cleavage

75
Q

Case- control study

A

compares people with disease to group without disease. (looks for risk factors)

76
Q

Cohort study

A

Group with a given exposure to a group without exposure (looks for liklihood of developing disease)

77
Q

Isoniazid requires what enzyme to be activated in bacteria?

A

Catalase-peroxidase

78
Q

Pyrazinamide

A

Used for TB. Is converted to pyrainoic acid which lowers the pH. Must be converted to active form by pyrazinamidase

79
Q

How can TB become resistant to Ethambutol?

A

increasing production of arabinosyl transferase (component of cell wall) because ethambutol inhibits cell wall synthesis

80
Q

What Hb is elevated in beta thalassemia?

A

HbA2 due to decreased synthesis of HbA (under production of B globin chain)

81
Q

Drug induced lupus

A

Sulfa drugs, hydralazine, isoniazid, procainamide, phenytoin, etanercept

82
Q

Neuroectoderm gives rise to

A

CNS, preganglionic autonomic neurons, retina, and posterior pituitary

83
Q

Surface ectoderm gives rise to

A

Epidermis, mammary gands, lens o he eye and adenohyphophysis

84
Q

Urinary tract infection characterized by dysuria and hematuria

A

Hemorrhagic cystitis

85
Q

enterocytes with clear cytoplasm

A

abetalipoproteinemia (loss of function in MTP gene)

86
Q

Acanthocytes, low plasma TG, low cholesterol

A

abetalipoproteinemia

zz - step 4 - uworld (18 decks)

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