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zz - step 4 - uworld > UW9 > Flashcards

UW9 Flashcards

1
Q

JVD, hypotension, tachycardia

A

cardiac tamponade vs. tension pneumothorax

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2
Q

Signs of tamponade

A

hypotension, distended neck veins, distant heart sound (Beck triad), tachycardia. Pulses paradoxes

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3
Q

signs of acute fibrinous pericarditis

A

Pleuritic chest pain and pericardial friction rub

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4
Q

what will you hear on auscultation in cardiogenic shock

A

rales ( pulmonary edema)

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5
Q

initial stage of septic shock

A

lower vascular resistance and increased cardiac output

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6
Q

quadriplegia, pseudobulbar palsy ( head neck muscle weakness, dysphagia, dysarthria)

A

central pontine myelinolysis

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7
Q

Rapid correction of hypernatremia

A

Cerebral edema/ herniation

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8
Q

aromatase

A

converts androstenedione to estrone. Testosterol to estradiol

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9
Q

high androgen and low estrogen levels in a female fetus. Maternal virulization

A

Aromatase deficiency

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10
Q

Maternal Hirsutism, clitoromegaly, femal pseudohermaphrodism, primary amonorrhea, osteoporosis, tall stature

A

Aromatase deficiency

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11
Q

ambiguous genitalia, hypotension

A

21 hydroxylase deficiency

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12
Q

ambiguous genitalia, hypertension

A

17 hydroxylase deficiency

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13
Q

what is accomodation

A

Focusing on near objections (reading)

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14
Q

what happens in accomodation

A

ciliary muscle contraction relaxes zonular fibers causes thickening of lens ( more convex)

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15
Q

presbyopia

A

inability to focus on near objects. Impaired lens elasticity from protein denaturation, diminished ciliary muscle strength (image focuses behind retina)

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16
Q

Myopia

A

image focuses in front of retina. Presbyopia can compensate for myopia

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17
Q

Risks for femoral head osteonecrosis

A

vasculitis (lupus), corticoisteroids, sickle cell, alcoholism

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18
Q

dermal and epithermal thinning, fattening of dermoepidermal junction, decreased number of fibroblasts and reduced synthesis and increased breakdown of collagen and elastin

A

Skin rhytides (wrinkles) due to aging

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19
Q

Ciliary mucles and zonular fibers in relaxed pupil

A

Ciliary muscle relaxed and zolular fibers contracted (lens flattened)

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20
Q

Ciliary mucles and zonular fibers in accomodated pupil

A

Ciliary muscle contracted and zolular fibers relaxed (thickening of lens)

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21
Q

Lens changes in prebyopia

A

Hardened lens is unable to thicken leading to loss of accomodation (cant focus on near objections)

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22
Q

findings in isolated diastolic heart failure. LVEDP, LVEDV, LV ejection fraction

A

increased end diastolic pressure, normal end diastolic volume, normal ejection fraction

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23
Q

diastolic heart failure can be due to

A

impaired myocardial relaxation or increased intrinsic ventricular wall stiffness (amyloid). Filling problem = ejection fraction is normal

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24
Q

what is the problem in diastolic heart failure

A

filling problem (decreased ventricular compliance) which means end diastolic volume is decreased.

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25
Q

what can cause systolic heart failure

A

acute massive MI

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26
Q

What is the problem in systolic heart failure

A

decreased contractility. Decrease ejection fraction, decreases stroke volume and cardiac output. EDP and EFV must both increase to maintain normal cardiac ouput

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27
Q

excessive daytime sleepiness, morning headaches, impotence, poor judgement, depression, snoring

A

obstructive sleep apnea

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28
Q

Abnormal ventilation during sleep

A
  1. Apnea ( cessation of breathing >10 s) or 2. hypopnea (redued airflow) SaO2 decreases >4%
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29
Q

poor REM sleep, excessive daytime sleepiness, cataplexy, sleep attacks, sleep paralysis

A

Narcolepsy

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30
Q

increased PaCO2, reduced PaO2 in obesity

A

Obesity hypoventilation syndrome. Obesity impedes expansion of chest wall leading to decreased respiratory drive.

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31
Q

How many calories are in a gram of protein or carb?

A

4

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32
Q

how many calories are in a gram of fat?

A

9

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33
Q

how does inspiration affect alveolar vessels

A

Increased lung v. cause alveolar expansion which reduces the diameter of alveolar blood vessels. Increases vessel resistance

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34
Q

How does expiration affect extraalveolar vessels

A

Decreased lung volumes cause extraalveolar arteries to become narrow leading to increase in vessel resistance

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35
Q

When is pulmonary vascular resistance the lowest?

A

At functional residual capacity (inspiration and expiration both increase resistance in vessels)

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36
Q

Side effect of Amphotericin B

A

Nephrotoxic. Causes a decrease in GFR and has direct toxic effects on tubular epithelium. Hypokalemia and hypomagnesemia (increased permeability of distal tubule)

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37
Q

ECG findings in hypokalemia

A

T wave flattening, ST depression, prominent U waves, PVC

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38
Q

Side effect of doxorubicin

A

Dose dependent cardiotoxicity

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39
Q

Chloramphenicol, zidovudine, phenybutazone, gold containing medications are examples of drugs that can cause what side effect

A

Bone marrow suppression

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40
Q

Acetaminophen and halothane are examples of medications that can cause what side effect

A

liver necrosis

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41
Q

what are some drugs that can cause pulmonary fibrosis

A

Busulfan and bleomycin

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42
Q

sudden onset abdominal pain, gross hematuria, new varicocele

A

renal vein thrombosis

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43
Q

maltese cross under polarized light

A

oval fat bodies in urine. Lipiduria due to increased synthesis of lipoproteins by liver in nephrotic syndrome

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44
Q

what are some proteins that can be loss in nephrotic syndrome

A

Albumin (edema), ATIII (hypercoagulable), Immunoglobulins (infections)

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45
Q

Mechanism of Nesiritide

A

recombinant BNP used for decompensated LV dysfunction leading to congestive heart failure

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46
Q

Where are ANP and BNP secreted from

A

ANP from atria and BNP from ventricle. Vasodilation, diuresis, natriuresis and decrease in BP

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47
Q

Endothelin

A

vasoconstriction

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48
Q

transmural inflammation of arterial wall with fibrinoid necrosis

A

Polyarteritis nodosa

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49
Q

vasculitis linked to smoking

A

atherosclerosis, thromboangiitis obliterans

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50
Q

Vasculitis linked to asthma

A

Churg strauss

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51
Q

vasculitis: granulomas with eosinophilic necrosis in smaller vessels

A

Churg strauss

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52
Q

most common vasculitis from antibiotic use

A

Microscopic polyangiitis ( type III HSR) often due to Penicillin

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53
Q

pes cavus

A

high plantar arch

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54
Q

Pes cavus, hyphoscoliosis, hypertrophic cardiomyopathy, DM

A

Friedreich ataxia (chr 9 frataxin gene) AR

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55
Q

degeneration of spinocerebellar tracts causing gait ataxia, loss of position and vibration sensation, muscle weakness

A

Friederich ataxia

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56
Q

why is there an increased risk of TB in silicosis

A

impairs macrophage kiling of phagocytosed mycobacteria due to disruption of phagolysosome

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57
Q

negative skin TB test after M. TB exposure suggests

A

weak cell mediated immune response seenin HIV, Sarcoidosis

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58
Q

what transporter does the liver use to pick up unconjugated bilirubin

A

Organic anion transporting polypeptide

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59
Q

How does conjugated bilirubin exist the liver?

A

active transport by ATP Binding Cassette protein (MRP2)- organic anion transporter into biliary system

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60
Q

isolated conjugated hyperbilirubinemia

A

inhibition of canalicular active organic anion transporter that secretes conjugated bili into biliary system

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61
Q

unconjugated hyper-bili

A

excessive production of bili, decreased uptake, impaired conjugation

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62
Q

conjugated hyper-bili

A

decreased hepatocellular excretion, impaired bile flow

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63
Q

Acute attacks of hepatic porphyria can be precipitated by what drugs

A

Cyp p450 inducers (phenobarbitol, griseofulvin, phenytoin)

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64
Q

enzyme defect in acute intermittent porphyria

A

Prophobilinogen deaminase. Tx with heme and glucose (inhibits ALA synthase)

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65
Q

from which embryonic layer is the spleen derived from?

A

Mesoderm (arises in mesentary of stomach)

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66
Q

Forgut organs

A

Esophagus to secondar part of duodenum, liver, gall bladder, part of pancreas ( develop as outpouching of primitive gut tube)

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67
Q

From what embryonic layer is the liver derived from

A

Endoderm from diverticulum of primitive gut tube in ventral mesentary

68
Q

From what embryonic layer are the kidneys formed from

A

Mesoderm

69
Q

From what embryonic layer is the pancreas formed from

A

Endoderm

70
Q

What does the arteriovenous concentration gradient in an anesthetic reflect?

A

Tissue solubility

71
Q

What compartments does an anesthetic move through

A

Inhaled air–> lungs–> blood–> brain

72
Q

What determines anesthetic concentration in inhaled air

A

partial pressure of anesthetic in inspired gas

73
Q

What determines anesthetic concentration in lungs

A

pulmonary ventilation rate (rate of rise of gas tention is alveoli is directly proportional to both rate and depth of respiration)

74
Q

What determines anesthetic concentration in blood

A

Solubility of anesthetic in blood (blood/gas partition). Higher blood gas solubility means more anesthetic must be absorbed by blood before it can be transferred to other tissues

75
Q

What determines anesthetic concentration in brain

A

solubility of anesthetic in peripheral tissues. Higher peripheral tissue solubility means more anesthetic must be absorbed to saturate the blood and then the brain.

76
Q

Hows does a high arteriovenous concentration gradient affect the activity of an anesthetic

A

high gradient= higher amount taken up in tissues= low venous concentration= more anesthetic required= slower onset of action

77
Q

how would low tissue solubility and uptake affect actions of an anesthetic

A

smaller arteriovenous gradient (less peripheral uptake) less absorbed by tissue = higher concentration in brain ( equilibrates faster)

78
Q

how is the potency of an anesthetic determined

A

MAC. Minimal alveolar concentration that prevents movement in 50% of people exposed to noxious stimuli. Potent= Low MAC

79
Q

Does the arteriovenous gradient of an anesthetic affect potency or rate of induction?

A

Rate of induction

80
Q

DOC for Hairy cell leukemia

A

Cladribine ( adenosine analog) that is resistant to adenosine deaminase (allows drugs to reach high concentrations to cause dsDNA breaks)

81
Q

Mechanism of action of Cladribine

A

adenosine analog that is resistant to adenosine deaminase

82
Q

how will a competitive antagonist change ED50 and Emax on a dose response curve

A

increase ED50 (right shift) no change in Emax

83
Q

how will a noncompetitive antagonist change ED50 and Emax on a dose response curve

A

ED50 is unchanged and decreased Emax

84
Q

pH in pulmonary embolism

A

V/Q mismatch causes hyperventilation leading to respiratory alkalosis (pH >7.45). pCO2

85
Q

high pH, low PaCO2, low pO2

A

PE

86
Q

increased A-a gradient

A

V/Q mismatch, diffusion limited, right to left shunt

87
Q

why is HTN a risk for aortic dissection

A

medial hypertrophy of aortic vasa vasorum causes decreased blood flow to aortic media leading to loss of smooth muscle cells (aortic enlargement and increased wall stiffness) ultimately leads to intimal tearing

88
Q

hyperglycemia and anion gap metabolic acidosis

A

DKA

89
Q

appropriate compensation in metabolic acidosis

A

PaCO2= [1.5x HCO3] +8

90
Q

Appropriate compensation in metabolic alkalosis

A

increase in PaCO2 by 0.7 mmHg for every 1 mEq/LHCO3

91
Q

Appropriate compensation in acute respiratory acidosis

A

Increase serum HCO3 by 1 mEq/L for every 10 mmHg in PaCO2

92
Q

Appropriate compensation in acute respiratory alkalosis

A

decrease in serum HCO3 by 2 for every 10 mmHg decrease in PaCo2

93
Q

Normal anion gap

A

8 to 12

94
Q

delayed separation of umbilical cord, lack pus formation

A

Leukocyte adhesion deficiency (LAD I) due to absence of CD 18

95
Q

abdominal pain, bloody vagina discharge, orthostatic hypotension, positive pregnancy test

A

Ectopic pregnancy

96
Q

MVA with sudden deceleration, hypotensive

A

blunt aortic injury (traumatic aortic rupture) occurs most commonly at aortic isthmus (ligamentum arterosum is fixed and immobile compared to descending aorta)

97
Q

Facial nerve CN VII functions

A

Motor to facial muscles, parasympathetic to lacrimal, submandibular, sublingual glands, anterior 2/3 for tast, afferent from pinna and external auditory canal

98
Q

Major basic protein is found in

A

Eosinophils

99
Q

TdT positive cells are found in

A

ALL (immature lymphocytes)

100
Q

TRAP +

A

Hairy cell leukemia

101
Q

Peroxidase + cytoplasmic inclusions

A

Auer rods (AMP)

102
Q

HTN + BPH

A

Alpha 1 blockers ( Prazosin, Doxazosin, Terazosin)

103
Q

HTN + CHF

A

Beta-blocker ( metoprolol, atenolo)

104
Q

First choice for essential HTN

A

Hydrochlorothiazide

105
Q

HTN + osteoporosis

A

HCTZ

106
Q

Tx for stable angina

A

Isosorbide dinitrate (venodilation decreases preload)

107
Q

Acute transplant rejection

A

host T cells against graft MHC. Tx: corticosteroids and calcineurin inhibitors

108
Q

Hyperacute graft infection

A

preformed antibodies against ABO antigens (mottling seen immediately)

109
Q

Chronic graft rejection

A

Host B cell and T cell sensitization against graft MHC

110
Q

Graft vs Host disease

A

Bone marrow transplant. Graft T cells against host MHC

111
Q

How does Hepcidin regulate iron

A

Binds ferroportin and degrades it ( decreases intestinal absorption) and inhibits release of iron by macrophages

112
Q

Transported responsible for iron uptake

A

Divalent metal transporter 1 (DMT1)

113
Q

what causes an increase or decrease in hepcidin levels

A

High iron and inflammatory conditions increase hepcidin. Low hepcidin levels cause increase in intestinal absorption and stimulate iron release by macrophages

114
Q

What is the erythrocyte sedimentation rate?

A

Increased acute phase protein (fibrinogen) causes erythrocytes to form stacks (aggregate)

115
Q

Major risk factors for esophageal squamous cell cancer

A

alcohol, tobacco, nitrite containing foods

116
Q

Risk factors for esophageal adenocarcinoma

A

Barretts, GERD, Obesity, Tobacco

117
Q

Mechanism of OCPs

A

suppresses FSH and LH, causes thickening of cervical mucus (prevent sperm from accessing uterus), prevents growth of endometrium (prevent implantation)

118
Q

Function of paneth cells in intestinal crypts

A

secrete lysozyme, defensins

119
Q

PaO2 in hypoxemia

A

less than 80mmHg

120
Q

normal A-a gradient

A

does not exceed 10-15 mmHg

121
Q

Hypoxemia with a normal A-a gradient

A

high altitude or hypoventilation

122
Q

cause of hypoventilation

A

Suppressed respiratory drive ( sedative OD, sleep apnea) or decreased inspiratory capacity (myasthenia gravis, obesity)

123
Q

Increased A-a gradient is seen in

A

alveolar hyaline membrane disease ( decreased diffusion) Right to left shunt (venous blood bypasses lung), V/Q mismatch (poor ventilation of well perfused alveoli)

124
Q

When is V/Q mismatch seen

A

poor ventilation of well perfused alveoli: pneumonia, obstructive pulmonary disease, pulmonary embolism

125
Q

which enzyme is responsible for removing RNA primeres in prokaryotes?

A

DNA pol I ( has 5’ to 3’ exonuclease activity)

126
Q

surgical operation outside of US

A

probably used halothane

127
Q

Side effect of Halothane

A

Massive liver necrosis. Rapid atrophy leads to shrunken liver. Thought to be a hypersensitivity reaction

128
Q

elevated PT is seen aute hepatic failure, why?

A

failure of hepatic function leads to deficiency of Factor VII which has the shortest half life.

129
Q

labs in anemia

A

low erythrocyte, low reticulocytes, low hemoglobin

130
Q

low retigulocytes, low RBC, normal wbc, normal platelet

A

pure red cell aplasia

131
Q

effects of anesthesia

A

myocardial depression (decrease CO), respiratory depression (hypercapnia), increased cerebral blood flow, decrease GFR, decrease hepatic blood flow

132
Q

probability of 1 event turning out differently

A

1- (probability of all events being the same)= 1-(product of the separate probabilities)

133
Q

specificity

A

True negative rate ( proportion of all people without disease who test negative)= (negative in health= if healthy tests negative)

134
Q

Sensitivity

A

True positive. Proportion of people with disease that test positive

135
Q

RPR (rapid plasma reagin)

A

cardiolipin, cholesterol and lecithin is mixed with patient’s serum. Nontreponeal serologic test because it detects antibodies against human lipids after destruction by T. pallidum

136
Q

What can dissolve viral envelopes

A

Ether and other organic solvents

137
Q

Class IA antiarrhythmic

A

Disopyramide, Quinidine, Procainamide (double quarter pounder). Prolonges AP, slows phase 0 depolarization

138
Q

Class IB antiarrhythmic

A

Lidocaine, Tocainide, Mexiletine (lettuce, tomato, Mayo). Weakly slows Phase ) depolarization. Shortens AP

139
Q

Class IC antiarrythmic

A

Moricizine, Flecainide, Propafenone (More Fries Please). Strong inhibitor of phase 0 depolarization. No change in AP

140
Q

Adenosine

A

acts at AV node to slow conduction and decrease automaticity by hyperpolarizing cell

141
Q

Digoxin

A

increases vagal output to AV node and slows conduction. Increases Ca to increase contractility

142
Q

Buproprion

A

inhibits presynaptic reuptake of dopamine and NE. Contraindicated in pts with seizure disorder or with bulimia or anorexia due to risk of seizures

143
Q

SE of clozapine

A

agranulocytosis

144
Q

Stevens johnson syndrome

A

seen as a side effect of lamotrigine

145
Q

Olanzapine side effect

A

weight gain

146
Q

anti-inflammatory cytokines

A

IL10, TGFB

147
Q

TNF alpha induces what factor to produce more inflammatory mediators

A

NFkB

148
Q

Why is DKA only seen in Type I DM

A

they have no insulin!! Not seen in DMII (insulin resistance)

149
Q

What is Hageman factor

A

Factor 12

150
Q

What is Kallikrein

A

converts kininogen into bradykinin

151
Q

Normal core body temp

A

37-38 (fever >38.3)

152
Q

Hyperpyrexia

A

> 40. treat with cold blankets and oral acetaminophen

153
Q

Phenyalanine delection

A

Common cause of CF

154
Q

Lesser omentum

A

Hepatogastric and hepatoduodenal portions

155
Q

Falciform ligament

A

Liver to anterior body wall

156
Q

Greater omentum

A

encompases the transverse colon and is divided in surgery to access anterior pancreas and posterior wall of stomach

157
Q

Splenorenal ligament

A

left kidney and spleen and contains splenic vessels and tail of pancreas

158
Q

What is selective protinuria

A

albumin loss with minimal loss of more bulky proteins (IgG and macroglobulin) (seen in Minimal change disease)

159
Q

Tubular proteinuria

A

low molecular weight proteins (b2 microglobulin, IgG light chain, amino acid) usually filtered and reabsorbed in PT

160
Q

Overload proteinuria

A

reabsorptive capacity of proximal tubules is exceeded (ie. Multiple myeloma)

161
Q

Functional proteinuria

A

change in blood flow through glomerulus

162
Q

Orthostatic proteinuria

A

Increased protein excretion in upright position but normal in supine. Seen in older tall, thin adolescents

163
Q

Isolated proteinuria

A

incidental finding with normal renal function

164
Q

holosystolic crescendo decrescendo murmur

A

aortic stenosis

165
Q

Developmental milestone at age 3

A

play in parallel, speak simple sentences, copy a circle, use utensils, ride a tricycle

zz - step 4 - uworld (18 decks)

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