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uworld 000 Flashcards

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USMLE® Step 1 flashcards
1
Q

function of leptin

A

leptin inhibits pulsatile gnrh release,could be associated with hypothalmic amenorrhea Leptin acts on the arcuate nucleus of the hypothalamus to inhib production of NPY (↓ appetite) and stim production of α- MSH (↑ satiety). Muts in the leptin gene or receptor result in hyperphagia and profound obesit

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2
Q

what causes heriditary diabeties insipidus

A

oint muts in NP-II underlie most cases of HHDI, a disorder resulting from insuff ADH release into the syst circulation. Carriers oxytocin and vasopressin from hypothalamus to post pit (and store there) Neurophysin 2 ; Specific vasopressin binding site involved in transport and packagin of vasopressin through ER and golgi AD Hereditary Hypothalamic Diabetes Insipidus: mutation resulting in abnormal vasopressin

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3
Q

activationo f hormone sensitive lipase

A

Hsl responds to epi and corticoids to break down tg in fat cells during fasting. Pancreatic lipase breaks down fat in gut for digestion.

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4
Q

mechanism of cortisol

A

• Cortisol receptor (in cytoplasm) are bound to heat shock protein > cortisol binds to knocks off heat shock protein > receptor dimerization > homodimer translocated to nucleus > alter transcription alpha MSH of ACTH stimulates MSH receptors causing hyperpigmentation For example, cortisol increases vascular and bronchial smooth muscle reactivity to catecholamines and increases glucose release by the liver in response to glucagon.Glucocorticoid promote ulcer formation (especially in combination wth NSAIDs)

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5
Q

what causes decreased MG2+

A

alcohol,diarrhea,amingolycosides,diuretics

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6
Q

does secondary hyperaldoestrinism worsen edema

A

yes secondary hyperaldoestrinism impairs aldoestrone escape mechanism

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7
Q

homer wright rossetes seen in

A

medulloblastoma, and neuroblastoma which genes fucked ( classified as apud tumor)

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8
Q

what is jose bensdow phenomenon

A

Iodine-induced hyperthyroidism. Occurs when a patient with iodine deficiency and partially autonomous thyroid tissue (eg, autonomous nodule) is made iodine replete

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9
Q

weird features of thyroid

A

Hyperthyroid
• Can cause hypercoag state,Thyroid follicular cells Mesoderm associated with vitilgo

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10
Q
A
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11
Q

inapt apoptosis

A

Inappropriate apoptosis

• Type 1 diabetes

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12
Q

px of hypothroidism of newborn

A

After maternal T4 wanes, infants develop constipation, lethargy, hypotonia, macroglossia, an umbi hernia, and a large ant fontanelle.

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13
Q

thyroid cancer

A

anaplastic-Marked pleomorphic cells, biphasic spindle,associated with p53 cells,follicular adenoma-Colloid containing microfollicles,associated with ras

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14
Q

symotoms of thyrotoxiciosis

A

auses a hyperadrenergic state that can lead to atrial fibrillation, high- output heart failure, and worsening of angina pectoris.

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15
Q

does acromegaly cause cancer risk

A

risk of colorectal polyps and cancer.

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16
Q

difference between lid lag and lid retraction

A
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17
Q

mechanism of osteoporoiss in thyroid

A

t3 stimulates osteoclasts

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18
Q

why ptu prefered over methimazole

A

Propylthiouracil is generally preferred over methimazole for the initial treatment of thyroid storm because it additionally inhibits peripheral conversion of T4 to T3.

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19
Q

empty sella syndrome associated with

A

common in obese females; associated with idiopathic intracranial hypertension

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20
Q

why do we have abdominal pain in DKA

A

The state of ketoacidosis leads to irritation of the peritoneum. This can cause diffuse abdominal tenderness on palpation with guarding, possibly even to the extent that an acute abdominal pathology is suspected.

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21
Q

complications of DKA

A

cerebral edema, arrythmia and mucormycosis

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22
Q

what is teritiary adrenal insufficiency

A

abrupt cessation of corticosterios suppeession of axis

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23
Q

difference between pseudohypopth and pseudopseudopth

A

the second one structiral feautes same but tetany not present and also there is imprintation similar to praderwilli, paternal mutation maternal works

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24
Q

amylin

A

A polypeptide that is co-secreted with insulin from pancreatic β cells. It inhibits glucagon secretion, delays gastric emptying, and increase

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25
Q

wdiffeernce between cytosolic and thyroxine receptor

A

thyroxine binds to nuclear receptor whereas steriods intracytosolic

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26
Q

kliefielter syndrome why they have gynecomastia

A

high testrosterone converted to estrogen

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27
Q

effects of growth hormone deficiency

A

Growth hormone deficiency can lead to fatigue and a decrease in lean body mass as well as bone mineral density. I

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28
Q

which fetal defortmities methimazole causes

A

as aplasia cutis congenita, choanal atresia, and omphaloce

PTU should then be switched to methimazole in the second trimester for the rest of pregnancy to avoid the risk of PTU-induced hepatotoxicity.

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29
Q

what is cosyntropin

A

synthetic acth

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30
Q

what does hypocrtisolism cause,why we have glucose defiecny

A

it triggeres ADH release, decrease in synthesis of gluconeogenic enxymes

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31
Q

which GLUT transporter is bidirectional, compare different glut transporters int terms of affinity

A

Bidirectional transporter: allows hepatocytes to uptake glucose for glycolysis and release glucose during gluconeogenesis

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32
Q

placenta has which glut

A

1/3 ( low concentration needed to transport, glut 2 diffuses only at high concentration

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33
Q

hyponatremia in 1 vs 2 adrenal insufficiency

A

Hyponatremia from corticosteroid-related adrenal insufficiency is often not as pronounced as the hyponatremia seen in primary adrenal insufficiency. This is because aldosterone secretion from the zona glomerulosa remains intact.

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34
Q

which diabetic drug facilitates weight loss

A

liraglutide ( dpp4) - and metformin

35
Q

ectopic parathyroid gland

A

The derivatives of the 3rd branchial pouch include the inferior parathyroid glands and the thymus. The primordial inferior parathyroid glands are connected to the primordial thymus. Normally, the tissue connecting the thymus and inferior parathyroid glands degenerates by the time the inferior parathyroid glands reach the lower poles of the thyroid gland. If this tissue does not degenerate, the inferior parathyroid glands descend along with the thymus, which continues to migrate into the superior mediastinum. Because of this relatively long course of descent, the location of the inferior parathyroid glands is more variable and can be found anywhere between the inferior poles of the thyroid lobes and the superior mediastinum. Therefore, the ectopic mediastinal parathyroid tissue seen on the Tc99m-sestamibi scan is most likely to be a derivative of the 3rd branchial pouch. Despite originating caudally in the 4th branchial pouch, the superior parathyroid glands attach themselves to the developing thyroid gland and come to rest on the posterior side of each superior pole of the thyroid lobes.

EMBRYOGENESIS

36
Q

Mcalbright syndrome leads to what

A

precocious puberty and accelrated growth

37
Q

MCC of hyperthyroid after graves

A

toxic multinodular goiter

38
Q

compliations of graves disease in neonates

A

but severe disease can result in tachycardia, diaphoresis, failure to thrive, hyperphagia, stridor (due to compressive goiter), and microcephaly (attributable to craniosynostosis).

39
Q

what causes hthyroid atrophy

A

levothyroxine use

40
Q

neonate hypothyroidism

A

Maternal thyroxine (T4) crosses the placenta and enters fetal circulation, ensuring adequate hormone levels for normal fetal brain development. This patient has thyroid aplasia and is, therefore, unable to synthesize thyroid hormone himself. He was supported perinatally by maternal T4, which has a half-life of 5–7 days.

41
Q

how would the clinical features of a person be with obstructive sleep apnea

A

facial plethora redness and hypertension that is due to increased sympathetic actoivity due to hypoxia,Chronic hypoxia can also trigger a sympathetic response, which could explain this patient’s hypertension.

42
Q

wwhat causes destruction of colon in crohns

A

T cells also differentiate into TH1 cells, which activate cytoplasmic fibroblasts to release matrix proteases. This leads to the destruction of the intestinal architecture with villus atrophy, crypt hyperplasia, and the loss of the brush border.

43
Q

where are dysplastic vessels in angiodysplasia located

A

The dysplastic vessels seen in angiodysplasia are typically located in the cecum and ascending colon (in > 75%

44
Q

what is associated with angiodysplasia

A

onditions associated with angiodysplasia include von Willebrand disease and end-stage renal disease.

45
Q

gastric induced ulceration of ileal mucosa is casused by

A

which can also cause lower GI bleeding as a result of gastric acid induced ulceration of the ileal mucosa.

46
Q

mcc of death in hemochromatosis,which joints affected

A

HCC,mcp

47
Q

gilbert disease mutation associated with what gene

A

A mutation in the promoter sequence of the UGT1A1 gene causes decreased activity of UDP-glucuronosyltransferase, which is the underlying pathomechanism of Gilbert syndrome.

48
Q

a person has a valve replacement gets jaundice lab values of rbs is normal what could it be

A

gilbert, if hemolysis ldh elevathed hct lowe

49
Q

what is pseudomembrane consist of

A

pseudomembranous plaques on the colonic mucosa due to necrosis of the colonic mucosa and exudation of fibrin

50
Q

what disorder develops first cleft lip or palat e

A

Cleft lip is caused by failure of fusion of the maxillary prominence with the medial nasal prominence. Normally, children have two copies of GSTT1, a gene that is protective against the development of a cleft lip. However, embryos with only one copy of this gene (e.g., in some European and Asian ancestry) have a 20-fold increase in developing a cleft lip if exposed to cigarette smoke in utero.

51
Q

which part of the stomach hpylori colonises

A

antrum

52
Q

how is acetiminopehn excreted

A

by glucorindation

53
Q

disorganised mucos cells with surrounding fibrosis is what

A

pancreatic adenocarcinoma

54
Q

pathophys of pernicious anemia

A

antibody mediated destruction

55
Q

what are the ig4 diseases

A
56
Q

gain of function mutation associated with

A

Gain-of-function mutations in KRAS are also associated with lung cancer and pancreatic cancer.

57
Q

2 mechanisms of ascites

A

Additionally, splanchnic vasodilation in patients with cirrhosis results in underfilling of the systemic arterial system, which activates the RAAS. Activation of RAAS leads to Na+ and water retention, which aggravates ascites and peripheral edema.

58
Q

complication of liver biopsy

A

biliary peritonitis

59
Q

which part of the intestine absorbs vitamin k

A

proximal part of jeejenum (fucked in whipples)

60
Q

will whipples procedure fuck up b12 vitamin

A

no because parietal cells in cardia and fundus

61
Q

what is pyknosis

A

compression of chromatin in nucleus

62
Q

what is council man bodies

A

remnant of dead hepatocytes

63
Q

what is schaumann bodies

A
64
Q

through what structure gastroschiss herniates

A

intestinal herniation through the involuted right umbilical vein, the weakest part of the fetal abdominal wall

65
Q

vagus nerve injury results in what

A

delayed gastric emptying

66
Q

cardiac effects of hemochromatosis to conduction system

A

Sinus node dysfunction (sick sinus syndrome), presents as syncope
Atrial & ventricular arrhythmias
Sudden cardiac death

67
Q

cardiac muscle pathophys of hemochromatosis

A

Early: diastolic left ventricular dysfunction (restrictive pattern)
Later: cardiac remodeling & dilated cardiomyopathy(why? freeros damage)

68
Q

mechanism of anemia in heam malignancy

A

The decrease in erythropoiesis seen in these patients results from hypersplenism or tumor replacement of bone marrow mass.

69
Q

MOA OF hemochromatosis

A

HFE mutation(receptor endocytosis of fe-transferin complex this complex degrades transferring FE released in labile pool cells detect low fe so low hepcidin high DMT1 transporter

70
Q

tell me the association of valsava manoeuver with foramen ovale

A
71
Q

what is letrozole

A

an aromatase inhibtor

72
Q

depot progrestrone

A

Depot medroxyprogesterone acetate (DMPA), a progesterone contraceptive, inhibits pituitary secretion of gonadotropins (ie, FSH, LH) to prevent ovulation. The decrease in FSH causes increased hypothalamic GnRH secretion and suppressed ovarian estrogen production.

73
Q

pelivic floor fucktion

A

pelvic muscle floor contract tos tabilise urethra against anterior vaginal wall.this contractiong decreases angle between bladder neck and urethra

waht is vesicovaginal fistula
abnormal connection between bladder and vagina occurs due to surgical or obstretric compliations

74
Q

How do c1 inhibtors work

A

C1 inhibitors remove C1r/s from the Fc portion of immunoglobulin (classical pathway) and block the activation of C2/C4 by lectin pattern recognition receptors (lectin pathway). Therefore, C1 inhibitors prevent activation of the complement cascade and increase (not decrease) complement levels.

75
Q

pathophys of irritant diapear rash

A

Irritant contact diaper dermatitis is predominantly caused by skin barrier breakdown from exposure to urine and stool trapped within the diaper. Patients with frequent stooling (eg, diarrhea) are at increased risk because urease produced by fecal bacteria causes an increase in local skin pH, which allows for activation of proteolytic enzymes that disrupt the stratum corneum. Areas of macerated skin are then prone to frictional damage from the diaper, which further exacerbates the rash.

76
Q

abnormal keratin is pathogensis of

A

psorasis

77
Q

merkel cell carcinoma

A

Merkel cell carcinoma is a rare, cutaneous tumor of neuroendocrine cell origin that presents as a rapidly expanding, firm, pink nodule. This condition is ne

78
Q

histopath of sq cell carcinoa

A

hyperkeratotic plaque

79
Q

hiarderitis supportiva

A
80
Q

acne vulgais

A

colonization causes inflammatory response

81
Q

which durgs undergo cheleation

A

Tetracyclines
Fluoroquinolones
Levothyroxine

82
Q

how do ocps work in acne

A

suppress androgenic activity and reduce production of sebum.

83
Q

ethics on patient

A

validate the patient’s concerns and gather more information

usmle (38 decks)

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