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zz - step 4 - uworld > UW2 > Flashcards

UW2 Flashcards

1
Q

Thin curivilinear areas of lucency that parallel the lumen

A

Pneumatosis intestinalis ( necrotizing enterocolitis)

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2
Q

double bubble on xray

A

doudenal atresia ( air in stomach and proximal duodenal pouch)

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3
Q

Failure to to pass meconium in first 48 hours. Contrast enema with narrow caliber transition zone

A

Hirschsprung

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4
Q

Non-bilious vomiting after feeding and palpable ball of muscle

A

Pyloric stenosis

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5
Q

Calculate incidence

A

new cases/ population risk (total population- people who already have disease)

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6
Q

fatigue, easy bruising, low reticulocyte count, no splenomegaly. Low platelet, low Hb

A

aplastic anemia

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7
Q

Hypocellular marrow filled with fat cells and fibrotic stroma

A

aplastic anemia

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8
Q

Hypercellular marrow with megaloblastic hematopoiesis

A

Myelodysplastic syndrome or megaloblastic anemia (macrocytosis)

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9
Q

Hypergranular promyelocytes with auer rods

A

Promyelocytic leukemia (AML)

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10
Q

Hypercellular marrow filled with blast forms

A

Myeloproliferative disorders, myelodysplastic syndrome, AML

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11
Q

Decreased left ventricular chamber size that causes ventricular septum to acquire a sigmoid shape. Increased interstital connective tissue. Accumulation of cytoplasmic granules with brownish pigment

A

Normal aging ( lipofuscin pigment)

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12
Q

Increased left ventricular size

A

dilated cardiomyopathy

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13
Q

Asymmetrical septal wall hypertrophy with disproportionate thickening of ventricular septum compared to L ventricular free wall

A

Hypertrophic cardiomyopathy

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14
Q

Subendocardial vacuolization and fibrosis

A

Chronic ischemia heart disease

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15
Q

What drug should be given to pts who has hx of MI and congestive heart failure

A

ACE inhibitor

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16
Q

Drug for essential HTN without CHF or diabetes

A

Thiazide

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17
Q

Net renal excretion

A

Total filtration (GFR-measured by inulin * Px) - tubular reabsorption

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18
Q

Empiric treatment of S. auerus with hx of hospitalization

A

Vancomycin

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19
Q

Reactive arthritis after campylobacter, shigella, salmonella, yersinia, chlamydia, bartonella is associated with what antigen

A

HLA B27

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20
Q

PDA is associated with what infection?

A

congenital rubella

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21
Q

Anti-mitochondrial antibodies ( with Florid duct lesions)

A

Primary biliary cirrhosis

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22
Q

Hepatocellular swelling and necrosis, mallory bodies, neutrophilic infiltration, fibrosis

A

alcoholic hepatitis

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23
Q

Liver failure and centrilobular necrosis

A

Acetaminophen overdose

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24
Q

Microvesicular steatosis

A

Reyes syndrome

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25
Q

Liver is reddish purple and develops a tense capsule. Severe centrilobular congestion and necrosis

A

Budd chiari (increased intrahepatic BP due to thrombosis of hepatic vein)

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26
Q

steps of collagen synthesis

A

Signal sequence directs growing polypeptide chain into ER (prepro-alpha chains). Signal sequence is cleaved to pro-alpha chain. Hydroxylation of proline and lysine (vitamin C). Glycosylation of lysine residues. Assembly of pro-collagen. Terminal peptidases cleaved by pro-collagen peptidases to make tropocollagen. Collagen fibrils assemble. Crosslinking by lysyl oxidase

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27
Q

abnormally thin type I collagen fibrils that have disulfide rich globumar domains

A

procollagen peptidase deficiency causes impaired cleavage of N and C terminals to cause more soluble collagen that does not crosslink properly

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28
Q

PFTs with Hyperinflated lungs and flattened diaphragm

A

Normal or decreased FVC, decreased ratio, normal lung capacity, increased functional residual capacity. Normal diffusion

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29
Q

why is Diffusion capacity decreased in emphysema?

A

Diffusing capacity depends on thickness of surface area and volume of capillary blood. Interalveolar wall destruction decreases the alveolar-capillary surface area thus decreasing diffusing capacity

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30
Q

why is lung elastic recoil decreased in emphysema?

A

destruction of interalveolar walls causes lung elastic recoil to decrease

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31
Q

leukocytosis, hypotension, tachycardia

A

septic shock

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32
Q

Causes of lactic acidosis

A

Enhanced metabolic rate, reduced oxygen delivery, diminished lactate catabolism, decreased oxygen utilization, enzymatic defects in glycogenolysis or gluconeogenesis

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33
Q

Incereased anion gap, decreased bicarb

A

metabolic acidosis

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34
Q

anion gap

A

Na- (Cl + HCO3)

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35
Q

Predisposing factors for aspiration pneumonia

A

altered consciouness imparing cough reflex and glottis closure, dysphagia due to neurologic deficiets, upper GI tract disorders (GERD), mechanical compromise of aspiration defenses, protracted vomiting, large volume tube feedings in recumbent position

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36
Q

Pancreatic insufficiency, infertility due to absent vas deferens

A

Cystic fibrosis

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37
Q

Situs inversus, infertility due to immotile spermatozoa

A

Primary ciliary dyskinesia

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38
Q

why do NSAIDS result in decreased loop diuretic response?

A

NAIDS inhibit prostaglandin synthesis. Proastaglandins have a vasodilatory effect to increase renal blood flow and increase GFR. Loop diuretics also increase proastaglandin release

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39
Q

ANP and BNP

A

vasodilation, natriuresis, diuresis in response to volume expansion

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40
Q

weak forearm flexion, absent bicep reflex, decreased sensation in lateral forearm

A

musculocutaneous n (upper trunk)

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41
Q

posterior arm sensation

A

radial nerve

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42
Q

posterior forearm sensation

A

radial nerve

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43
Q

medial forearm sensation

A

ulnar

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44
Q

thenar eminence sensation

A

recurrent branch of median nerve

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45
Q

bilious vomiting after first 24 hours of life

A

intestinal stenosis and atresia secondary to vascular accidents in utero

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46
Q

apple peel atresia

A

missing a segment of large bowel with distal ileum winding around vascular stalk

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47
Q

what should you check in metabolic alkalosis

A

volume status and urine chloride

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48
Q

how does hemolytic anemia lead to macrocytic changes?

A

Predisposition to folic acid deficiency due to increased erythrocyte turnover

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49
Q

central collection of tightly clustered epithelioid macrophages surrounded by rim of mononuclear cells

A

non-caseting granuloma

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50
Q

hilar adenopathy, pulmonary infiltrates, non-caseating granuloma in AA female

A

sarcoidosis

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51
Q

TH1 cells

A

drive cell mediate immunity. Secreted by CD4 T cells. Autocrine proliferation of TH1

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52
Q

CD4 T cells secrete what cytokines?

A

IL2 and interferon gamma

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53
Q

TH2 cells

A

stimulates eosinophil production and activation by secretion of IL5. B cell synthesis of IgA

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54
Q

Fever, pruritic skin rash and arthralgias after administration of chimeric monoclonal antibody. skin biopsy shows fibrinoid necrosis and neutrophil infiltration involving small blood vessels.

A

Acute Serum sickness. Deposition of circulating immune complex (type III HSR). Deposition of IgG or IgM complement fixing antibodies result sin localized complement consumption and hypocomplemntemia (low serum C3). Aso seen in PCN, cefaclor and TMP-SMX

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55
Q

Anaphylaxis, allergies are examples of what type of HSR

A

Type I (immediate), IgE, Basophils and mast cells

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56
Q

Autoimmune hemolytic anemia, Goodpasture’s are examples of what type of HSR?

A

Type II (cytotoxic), IgG, IgM autoantibodies. Phagocytes, complement mediated cell injury.

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57
Q

Serum sickness, PSGN, lupus nephritis are examples of what type of HSR?

A

Type III (immune complex), Deposition of antibody-antigen complexes. Neutrophils, complment activation

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58
Q

Contact dermatitis, TB skin test are examples of what type of HSR?

A

Type IV (delayed), T cells and macrophages

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59
Q

Harsh crescendo-decrescendo systolic ejection mumur along lower left sternal border and apex

A

Hypertrophic cardiomyopathy (left ventricular outflow tract obstruction)

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60
Q

what will increase the intensity of a murmur in Hypertrophic CM?

A

Decrease preload or afterload reduce LV chamber size, which decreases the separation between the mitral valve and interventricular septum, increasing obstruction

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61
Q

What maneuvers will decrease preload?

A

Sudden standing, valsalva or Nitroglycerin administration

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62
Q

What maneuvers will increase preload and/or afterload?

A

Squatting, sustained handgrip, passive leg raise

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63
Q

99mTc-pertechnetate scan

A

Detects presence of gatric mucosa. Accumulation in right lower abdominal quadrant is diagnostic for Meckel diverticulum ( ectopic gastric mucosa) Failure of obliteration of omphalomesenteric duct

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64
Q

Black, tarry stool, right lower quadrant pain in a two year old

A

Meckel diverticulum

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65
Q

anal agenesis or imperforate anus

A

failure of hindgut descent along IMA

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66
Q

Muscarinic effect on peripheral blood vessels?

A

Vasodilation. Binding of muscarinc receptors on endothelial cells causes release of NO (endothelium derived relaxing factor) which activates guanylate cyclase and increases cGAMP. cGAMP activates Ca pump that causes smooth muscle relaxation

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67
Q

Cholinergic effects on smooth muscle of visceral walls

A

Increase smooth muscle tone to increase motility and secretions in GI tract. Anti-cholinergics relax GI wall and increase contraction of sphinters causing constipation

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68
Q

Drugs with anti-muscarinic effects

A

Atropine, TCA, H1 antagonist, neuroleptics, antiparkinsonian

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69
Q

Upper motor neuron signs

A

spastic paralysis, hyperreflexia and upgoing plantar reflex

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70
Q

Lower motor neuron signs

A

Flaccid paralysis, areflexia, atrophy and fasciculation

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71
Q

stab wound above clavical between midclavicular and lateral stenal line

A

lung apice and cervical pleura extend above clavical injury can punchture pleura and cause pneumothorax

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72
Q

Hypotension, tachypnea, hypoxemia, absent breath sounds and hyperresonance on affected side

A

tension pneumothorax

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73
Q

surgery involve posterior triangle of neck can damage which nerve

A

Accessory (CN 11), posterior triangle= scm, trapezius and clavicle

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74
Q

Penetrating trauma to neck above cricoid

A

Damange to ansa cervicalis (C1-3) innervates sternohyoid, sternothyroid and omohyoid

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75
Q

What stimulates activation of endothelial nitric oxide synthase and what does it do?

A

stimulated by AcH, bradykinin and shear stress. Synthesizes NO from Arginine and O2 to make NO and citrulline. NO activates Guanylate cyclase to increase cGMP

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76
Q

Rb mutations increase risk for what cancers?

A

Retinoblastoma, Osteosarcoma

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77
Q

Visual field defect in macular degeneration, optic neuritis

A

Mono-ocular scotoma. Lesion can be in retina, optic disc or optic nerve. Ipsilateral

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78
Q

Visual field defect in retinal artery occlusion

A

Anopia. Lesion in optic nerve. Ipsilateral

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79
Q

Visual field defect in pituitary tumor, craniopharyngioma

A

Bi-temporal hemianopia. Lesion in optic chiasm

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80
Q

Visual field defect due to calcification or aneurysm of R. internal carotid artery

A

Right peri-chiasmal lesion leading to right nasal hemianopia. Compression causes impingement of uncrossed fibers

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81
Q

Visual field defect due to occlusion of anterior choroidal artery or occlusion of MCA or posterior limb of internal capsule

A

Lesion in Right optic tract or radiation leads to contralateral homonymous hemianopia.

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82
Q

Visual field defect due to stroke of temporal lobe

A

Right temporal lobe (meyer’s loop) leads to left homonymous superior quadrantanopia

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83
Q

Visual field defect due to stroke involving parietal lobe

A

Right parietal lobe (dorsal optic radiation) causes left honomymous inferior quadrantopia. Contralateral

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84
Q

Visual field defect due to PCA

A

Left homonymous hemianopia with macular sparing due to lesion in occipital lobe. Contralateral

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85
Q

Pain and stiffness in knee, brown spots on sclera and darkening of helix on the ear

A

Alkaptonuria. Autosomal recessive caused by deficiency in homogentisic acid oxidase. Accumulated homogentisic acid deposits in connective tissues. Urine turns black when exposed to air

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86
Q

Enzyme defect in PKU

A

Phenylalanine hydroxylase

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87
Q

Enzyme defect in Albinism

A

Tyrosinase

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88
Q

Enzyme defect in maple syrup urine disease

A

Branched chain ketoacid

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89
Q

Add primaqine for treatment of which species of malaria

A

vivax and ovale

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90
Q

Fasting hypoglycemia

A

Defect in gluconeogenesis or glycogenolysis

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91
Q

Lactic acidosis

A

tissue hypoxia or oxidative phosphorylation defects

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92
Q

Treatment of CF

A

N acetylcysteine is a mucolytic agent that cleaves disulfide bonds to loosen thick sputum. Dornas alpha (DNAse) to clear leukocytic debris

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93
Q

DOC for aspiration pneumonia

A

Clindamycin

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94
Q

Cervical spinal cord

A

ovoid with more white matter than grey. Both gracilus and cuneate present. Large ventral horns

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95
Q

Thoracic spinal cord

A

Intermediolateral cell column (preganglionic sympathethic)

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96
Q

Lumbar spinal cord

A

More gray matter. No lateral horns. Dorasal nerve root, ventral nerve root, prominent ventral horn

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97
Q

Muromonab

A

OKT3 inhibits T lymphocytes (anti-CD3 antibody) useful for treatment of acute rejection in pts with kidney, heart and liver transplants

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98
Q

recent viral infection, discomfort in neck, reduced radioactive iodine uptake

A

De Quervains thyroiditis (granulomatous thyroiditis). Mixed, cellular infiltration with multinucleate cells

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99
Q

Branching papillary structures with concentric calcifications in thyroid gland

A

Papillary thyroid cancer

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100
Q

Diffuse mononuclear infiltration with germinal centers in thyroid

A

Chronic lymphocytic thyroiditid (hashimoto)

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101
Q

Extensive fibrosis of thyroid gland

A

Riedel thyroiditis

102
Q

treatment of acute leukemia with uric acid crystals

A

Tumor lysis syndrome. High cell turnover causes uric acid to be released in serum and filtered by kidney. pH is lowest in PT DT and CT so they can cause precipitation (acidic)

103
Q

diplopia, disphagia, dysphonia

A

Botulism

104
Q

Diseases associated with travel

A

infectious diarrhea, malaria, hepatitis, yellow fever, dengue fever, hantavirus

105
Q

STDs

A

Gonorrhea, Chlamydia, Mycoplasma hominis, Ureaplasma, Treponema, Haemophillus, HIV, HSV, Hep B, HPV, trichomonas

106
Q

Family history of recurrent infections

A

Agammaglobulinemia, Wiskott aldrich syndrome

107
Q

Embryology: Unilateral aplasia of fibula

A

Failure of proliferation

108
Q

Embryology: Autoimmune disease due to persistence of autoreactive T or B cells

A

Failure of apoptosis

109
Q

Embryology: Branchial cleft cyst

A

Failure of obliteration

110
Q

Embryology: Hirshsprung disease

A

Failure of migration of neural crest cells

111
Q

Embryology: Hypospadiase

A

Failure of fusion (urethral folds)

112
Q

most common GI cancer

A

Colon adenocarcinoma in the rectosigmoid colon

113
Q

Western blot

A

Protein ( translation)

114
Q

Northern blot

A

RNA (trascription)

115
Q

Southwestern blot

A

RNA bound protein (transcription factors)

116
Q

Avoiding unacceptable feelings by behaving badly

A

acting out

117
Q

Behaving as if an aspect of reality does not exist

A

Denial

118
Q

Altering perception of upsetting reality to be more acceptable

A

Distortion

119
Q

Disrupting memory, identity and consciouness to cope with an event

A

Dissociation

120
Q

Transferring feelings to a more acceptable object

A

Displacement

121
Q

Substituting imagingary scenarios

A

Fantasy

122
Q

Using intellect to avoid uncomfortable feelings

A

Intellectualization

123
Q

Attributing one’s own feelings to others

A

projection

124
Q

Responding in a manner opposite to ones actual feelings

A

reaction formation

125
Q

Reverting to an earlier developmental stage

A

Regression

126
Q

Blocking upsetting feelings from entering consciouness

A

Repression

127
Q

Seeing others as all bad or all good

A

Splitting

128
Q

Avoiding negative feelings by helping others

A

Altruism

129
Q

Using humor to avoid uncomfortable feelings

A

Humor

130
Q

Channeling impulses into socially acceptable behaviors

A

Sublimation

131
Q

Putting unwanted feelings aside to cope with reality

A

Suppression

132
Q

Alpha ketoglutarate dehydrogenase

A

TCA cycle. A-kg to succinyl co-A requires Thiamine, lipoic acid, CoA, FAD, NAD

133
Q

Funciton of vWF

A

Promotes platelet adhesion at injury sites by crosslinking glycoproteins with exposed collagen and serves a carrier for factor 8 that prevents it degradation

134
Q

proximal muscle weakness, violaceous discoloration of upper eyelids, scaling eruptions of knuckles. Elevated CPK

A

Dermatomyositis

135
Q

When is captopril contraindicated?

A

C1 esterase deficiency

136
Q

Alkaptonuria

A

Tyrosine metabolism. Deficiency of homogentisate oxidase. Prevents conversion of tyrosine to fumarate

137
Q

Cysteine is formed form what amino acids?

A

Serine and homocystein (methionine)

138
Q

Epithelium of the paranasal sinus

A

ciliated, pseudostratified, columnar, mucus secreting

139
Q

larygneal vestibule epithelium

A

ciiated, pseudostratified, columnar, mucus secreting epithelium

140
Q

Trachea epithelium

A

cilated, pseudostratified, columnar, mucus secreting

141
Q

Reccurent candida infections. At risk of developing a malignant B lymphocyte proliferation associated with what virus?

A

EBV

142
Q

What is the function of transepeptidase in bacteria?

A

Penicillin binding protein that functions to cross link peptidoglycan in bacterial cell wall

143
Q

Bitemporal hemianopia with elevated prolactin. Lab values:

A

Decreased GnRH, LH, Testosterone

144
Q

Effect of TCAs

A

Tachycardiac, delirium, dilated pupils, flushing, hyperthermia, ileus, urinary retention. Peripheral vasodilation, arrhythmia, hypotension, seizures, tremors, sedation

145
Q

TCA

A

amitriptyline, nortriptyline, imipramine, desipramine, clomipramine

146
Q

Sporadic encephalitis in teenage. Aphasia, olfactory hallucinations, personality changes

A

HSV-1 has a predilection for temporal lobe

147
Q

Constriction of the efferent arteriole produces what change in GFR?

A

Increases GFR by increasing flomerular capillary hydrostatic pressure due to reduction of glomerular blood flow. Increase in GFR also leads to an increase in filtration fraction

148
Q

What is responsible for the toxic effects of N. meningitidis?

A

Lipooligosaccharide (LOS)

149
Q

What cytokines do TH2 cells secrete?

A

IL4 and IL5 which activate B cells. Some B cells transform into plasma cells that produce IgM. Majority of B cells proliferate in germinal lymph nodes and transform into memory cells. Antibody switching allows B cells to secrete IgG, IgA, IgE during subsequent encounters

150
Q

IL-4

A

B cell growth and isotype switching. Also stimulates differentiation of naïve T cells to TH2 helper

151
Q

IL-5

A

B cell differentiation. Stimulates IgA production and eosinophil activity

152
Q

IL-1

A

Produced by macrophages. Activates naïve T cells to differentiated into TH1 and TH2. Endogenous pyrogen

153
Q

IL-2

A

Secreted by Th1. Stimulates development of CD4, CD8 and B cells

154
Q

IL-3

A

Stimulates growth and differentiation of bone marrow stem cells. Produced by T helper cells

155
Q

IL-10

A

helps regulate balance between TH1 and TH2. Produced by TH2 and inhibits production of interferon gamma leading to decrease in TH1

156
Q

IL-12

A

synthesized by macrophages and stimulates growth and development of TH1

157
Q

increase orotic acid in urine. Megaloblastic anemia

A

Orotic aciduria. Defect in pyrimidine synthesis. Enzymes that convert orotate to UMP. Tx: Uridine

158
Q

Increase in orotic acid in urine. No megaloblastic anemia

A

OTC deficiency. Urea cycle. Excess orotic acid is converted to pyrimidine due to increase in carbamoyl phosphate (by CPS II)

159
Q

What is Modafinil used for?

A

Narcolepsy. (p450 inducer)

160
Q

What marker suggests good prognosis in ALL?

A

ALL mostly affects children and blast cells positive for CD10 suggests good prognosis

161
Q

Diuretic. Hypokalemia, Metabolic acidosis, Hypocalcemia

A

Loop diuretic

162
Q

Diuretic. Hyponatremia, Hypokalema, Metabolic alkalosis, Hypercalcemia

A

Thiazide

163
Q

Diuretic. Hypokalemia. Metabolic acidosis

A

Acetazolamide

164
Q

Diuretic. Hyperkalemia. Metabolic acidosis

A

Spironolactone

165
Q

Primary defect in cells or tissues that form an organ

A

Malformation (holoprosencephaly, congenital heart disease, anencephaly, polydactyly, syndactyly)

166
Q

Fetal structural anomalies that occur due to extrinsic mechanical forces

A

Deformations ( clubbed feet, congenital hip dislocation)

167
Q

Secondary breakdown of previous normal tissue or structure

A

Disruption ( amniotic band syndrome)

168
Q

abnormalities that result from a single primary defect

A

Oligohydramnios in Potter Syndrome

169
Q

Complete absence of organ

A

Agenesis (renal agenesis)

170
Q

Pill induced esophagitis is seen with what medications?

A

Tetracyclines, potassium choloride and bisphosphonates

171
Q

What is contained in the hepatoduodenal ligament?

A

Hepatic artery, portal vein and common bile duct

172
Q

Pringle maneuver

A

Occlusion of portal triad by clamping the Hepatoduodenal ligament to determine source of bleeding. If bleeding continues, source is likely to be inferior vena cava or hepatic vein

173
Q

What drugs act to antagonize leukotriene D4 receptors

A

Zafirlukast and Montelukast

174
Q

irregular tachycardia after binge drinking

A

a-fib (holiday heart syndrome). Irregularly irregular with absent p waves

175
Q

A fig EKG

A

irregularly irregular QRS with absent P (coordinated atrial contractions do not occur)

176
Q

Ventricular tachycardia, regular rate with shifting sinusoidal waveforms

A

Torsades. Tx with magnesiums sulfate

177
Q

High QRS voltage in precordial leads

A

Ventricular hypertrophy

178
Q

Prolonged QRS interval

A

Ventricular dysynchrony or slowed interventricular conduction ( bundle branch block)

179
Q

Pyruvate dehydrogenase

A

Pyruvate to acetyl coA (aerobic), TCA

180
Q

Pyruvate carboxylase

A

Pyruvate to oxaloacetate (Gluconeogenesis)

181
Q

Lactate dehydrogenase

A

Pyruvate to lactic acid (anaerobic)

182
Q

ambiguous genitalia in girls, salt wasting, hypotension, low Na, high K

A

21-hydroxylase deficiency

183
Q

Ambiguous genitalia in girls. Fluid and salt retension, hypertension

A

11B hydroxylase deficiency

184
Q

Phenotypically female, fluid and salt retention, hypertension

A

17a-hydroxylase deficiency

185
Q

Mechanism of sulfonylurea

A

increase insulin secretion of pancreatic islet B cells in TypIIDM (glyburide)

186
Q

oral antidiabetic medication that reduce hepatic glucose production and increase insulin sensitivity

A

Metformin and rosiglitazone

187
Q

Maintence dose

A

Css x Cl (adjust for dosing intervals x 60min/hr x interval)

188
Q

Half life

A

Vd x0.7/CL

189
Q

How many half lives does it take to achieve steady state concentration?

A

5-Apr

190
Q

Loading dose

A

Vd x Css/bioavailability

191
Q

Mechanism of action for amantidine

A

impairs uncoating or disassembly of influenza A

192
Q

Heparin reversal

A

Protamine

193
Q

Reverse fibrinolysis

A

Aminocaproic acid

194
Q

What does cryoprecipitate contain?

A

Factor 8, Fibrinogen, vWF

195
Q

Warfarin reverse

A

Fresh frozen plasma and vitamkin K

196
Q

Dobutamine

A

Beta adrenergic agonist. Increases cardiac contractilty to increase cardiac output. Increase HR. Thus leads to increased myocardial oxygen consumption

197
Q

High blood/gas partition coefficient

A

More soluble in blood. Slower equilibrium with brain, longer onset times (Halothane)

198
Q

Low blood/gas partition coefficient

A

low solubility in blood. Saturates brain quickly. Rapid onset. Nitric oxide

199
Q

Pseudogout crystals

A

Calcium pyrophosphate

200
Q

Acid buffers in urine

A

HPO4 and NH3 in urine due to increase acid production in metabolic acidosis

201
Q

Causes of dilated cardiomyopathy

A

Coxsackie B, peripartum, alcohol, chronic SVT, Doxorubicin, Thiamine deficiency

202
Q

Changes in ischemic infarct of brain

A

1 week: ischemic area is hypodense and poorly delineated from surrounding tissue. Edema and loss of distinction of gray white matter on CT. Neurons show signs of irreversible damage ( red neurons). Neutrophils move into area, followed by microglia (days after onset). As neurons disintegrate, fragments are phagocytosed (lipids is cytoplasma of microglial is due to myelin breakdown products)

203
Q

Progression of changes after ischemia infarct of brain

A

Microglial move to ischemia infarct after 3-5 days. Cystic space forms. Astrocytes form glial scar along periphery

204
Q

relative risk

A

Ratio of (developing disease with risk factor) to (developing disease without risk factor)

205
Q

Sarcomere: H band

A

Only myosin thick filaments

206
Q

Sarcomere: A band

A

Entire thick myosin filament

207
Q

Sarcomere: I band

A

Only thin filaments

208
Q

Sarcomere: Z line

A

hold actin thin filaments

209
Q

Down syndrome comorbidities

A

Early onset alzheimer, Atrioventricular septal defect, VSD, ASD, duodenal atresia, Hirshsprung, Hypothyroidism, T1DM, obesity, acute leukemia, Atlantoaxial instabiity

210
Q

occurrence of multiple manifestations as a result of single gene defect

A

Pleiotropy

211
Q

alleles that tend to be inherited jointly because there are near one another on same strand of DNA

A

Genetic linkage

212
Q

infant with jaundice, hepatosplenomegaly, generalized edema, low HB, nucleated erythrocytes. Extramedullary hematopoiesis

A

Hemolytic disease of newborn (hydrops fetalis)

213
Q

Mechanism of Isoniazid

A

inhibits syntheisis of mycolic acids

214
Q

Mechanism of Ethambutol

A

Inhibits mycobaterial cell wall synthesis by blocking arabinosyl transferase (carbohydrate polymerization) Associated with vision changes

215
Q

Mechanism of Rifampin

A

Inhibits mycobacterial DNA-dependent RNA polymerase

216
Q

Mechanism of pyrazinamide

A

acidify intracellular environmentc in phagolysosome (after TB is engulfed by macrophages)

217
Q

blood filled vascular spaces lined with single epithelial layer in liver

A

Canvernous Hemangioma. Benign. Do not biopsy due to risk of rupture

218
Q

Subacute bacterial endocarditis after dental work

A

Viridans Strep

219
Q

Infective endocarditis after GU procedures

A

Enteroccoci

220
Q

Infective endocarditis with colonic cancer

A

Strep. Bovis

221
Q

What is the course of the esophagus in the thorax?

A

Courses between trachea and vertebral bodies. Typically collapsed with no visible lumen

222
Q

Where are serotonergic neurons found?

A

Raphe nuclei

223
Q

What neurons are found in the nucleus ceruleus (dorsal pons)

A

NE secreting cells

224
Q

What neurons are found in the nucleus basalis of Meynert?

A

Cholinergic neurons

225
Q

what is the function of the neurons in the red nucleus?

A

motor coordination of upper extremities

226
Q

What neurons are found in the substantia nigra?

A

Dopaminergic

227
Q

Steps in base excision repair

A

Glycosylase, endonuclease, lyase, DNA polymerase, ligase

228
Q

which biochemical processes occur in the mitochondria?

A

Beta oxidation, ketogenesisi, TCA, parts of urea cycle and pyruvate carboxylation

229
Q

Which enzyme of the pentose phosphate pathway is found in the cytoplasm?

A

Transketolase (requires thiamine)

230
Q

Regulation of insulin secretion from beta cells

A

Glucose enters (GLUT2) undergoes oxidative phosphorylation which makes ATP. ATP activates K+ channels which allow K+ to leave cell causing depolarization. Depolarization opens Ca channels that leads to insulin release

231
Q

What is used to treat SVTs (a-fib) and is use-dependant?

A

Flecainide (sodium block prolonges QRS duration) Slowest to dissociate from sodium channel so sodium blocking effects intensifies as heart rate increases due to less time between AP for medication to dissociate from receptor

232
Q

Capsule of ribose, ribitol and phosphate

A

HIB

233
Q

Schilling test

A

Normal excretion of urinary B12 suggest normal absorption. Give radiolabled B12 with IF to distinguish between pernicious anemia and malabsorption

234
Q

low radiolabled vitamin B12 not corrected by IF supplementation

A

Celiac disease or Diphyllobothrium latum

235
Q

Low urinary B12 excretion corrected with intrinsic factor

A

Pernicious anemia

236
Q

Filtration fraction

A

Calculate clearance. GFR/RPF (inulin or Cr/ PAH) Normal is usually 20

237
Q

Side effects of protease inhibitors

A

(avir) Lipodystrophy (increase fat deposition), Hyperglycemia, Inhibition of P450

238
Q

Side effects of TMP-SMX

A

Megaloblastic anemia, Stevens-johnson syndrome, toxic epidermal necrolysis

239
Q

Side effects of Zidovudine

A

NRTI. Bone marrow toxicity

240
Q

Side effects of Acyclovir

A

renal toxicity

241
Q

Side effects of Foscarnet

A

Hypocalcemia, hypomagnesemia, hypokalemia. Nephrotoxic

242
Q

complication of hysterectomy

A

hydronephrosis

243
Q

Complication of prostatectomy or bladder surgery

A

Vesicoureteral reflux

244
Q

very high fever, diarrhea, headache, confusion. Sputum gram stain shows neutrophils but no organisms

A

Legionella ( treat with fluoroquinolones)

245
Q

Aortic stenosis in eldery is usually due to what process?

A

Dystrophic calcifications ( usually a hallmakr of cell injury and death). Normal calcium levels

246
Q

Episodic angina chest pain during nighttime and ST segment elevations on Holter

A

Prinzmetal angina that can be provoked by Ergonovine

247
Q

Murmur: inspiration

A

increase venous return to R. Decrease venous return to left

248
Q

Murmur: valsalva strain

A

Decrease preload, decrease afterload

249
Q

Murmur: abrupt standing

A

Decrease preload, decrease afterload

250
Q

Murmur: squatting

A

Increase preload, increase afterload

251
Q

Murmur: passive leg raise

A

Increase preload

252
Q

Murmur: handgrip

A

increase afterload

zz - step 4 - uworld (18 decks)

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