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zz - step 3 - uworld > uWorld 17 > Flashcards

uWorld 17 Flashcards

1
Q

what clears particles stuck in the terminal bronchioles of the lungs

A

CILIATED CELLS
mucociliary clearance is responsible for removing particles from most of the bronchial tree
ciliated cells reach up to the proximal portions of the respiratory bronchioles

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2
Q

when do macrophages clear stuff from the lungs

A

distal to the terminal bronchioles

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3
Q

when is the ACTH stimulation test used

A

adrenocortical insufficiency
give them METYROPONE (which blocks conversion of 11-doxycortisol to cortisol)
in primary insufficient addition of metyropone

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4
Q

what is caused by absent tyrosinase activity

A

albinism (AR)

defects in biosynthesis of melanin most commonly due to tyrosinase activity (converts DOPA to dopaquinone)

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5
Q

what is the earliest lesion of atherosclerosis and what is the predominant cell type in this structure

A

FATTY STREAK

made up of lipid-laden macrophages (foam cells) in the intimal that can eventually progress to atherosclerotic plaques

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6
Q

what is the sequence of atherosclerotic progression

A

ENOTHELIAL INJURY/DYSFUNCITON causing increased vascular permeability and enhanced leukocyte adhesion
accumulation of lipoproteins (LDL) within the vessel wall)
MONOCYTE ADHESION to the endothelium,followed by migration and transformation into lipid-laden MACROPHAGES (FOAM CELLS)
release of growth factors by the adherent platelets, activated macrophages, and endothelial cells
recruitment of T cells and SMOOTH MUSCLE CELL PROLIFERATION, which lead to extracellular metric production

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7
Q

what anti epileptic drugs can also be used as mood stabilizers for bipolar

A

VALPROATE
carbamazepine
lamotrigine

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8
Q

stimulation of what adrenergic receptor decreases insulin secretion and what increases it. what is the overall effect

A

alpha 2- decreases secretion
beta 2- increases secretion
alpha-2 effects predominate thus inhibition insulin secretion

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9
Q

M3 receptors work through what kind of G protein and have what effect on insulin secretion

A

Gq

increase insulin secretion

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10
Q

what is glucagon-like peptide 1

A

incretin hormone secreted by the intestinal L-sells in response to food and acts on receptor found on pancreatic beta cells to potentiate glucose-induced insulin release
blocking these receptors reduces insulin please

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11
Q

H2 receptor stimulation has what effect on insulin secretion

A

increases it

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12
Q

what is the normal pressure in the SVC and Right atrium

A

1-6 mmHg

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13
Q

what is the normal pressure of the right ventricle

A

systolic: 15-30 mmHg
diastolic: 1-6 mmHg (just below RA pressure)

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14
Q

what is the pulmonary artery pressure normally

A

systolic: 15-30 mmHg (no change from right ventricle)
diastolic: 6-12mmHg

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15
Q

what is the normal pulmonary capillary wedge pressure (what does it represent)

A

usually quell to PA diastolic pressure: 6-12mmHg

reflective of the venous pressure in the left heart (Left Atrial pressure and left ventricular diastolic pressure)

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16
Q

A1AT deficiency typically manifests with what kind of emphysema

A

EASLY-ONSET
lower lobe-predominant
panacinar

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17
Q

what accounts for the rubber-like properties of elastin

A

formation of DESMOSINE CROSS-LINKS b/w neighboring polypeptides by LYSYL OXIDASE prewires copper) oxidatively delaminating some of the lysine residues of tropoelastin

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18
Q

what do the disulfide bridges formed during collagen synthesis do

A

bring the chains of the C-terminal propertied regions of the 3 alpha chains into favorable alignment for triple helix assembly

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19
Q

in cryptorchidism what becomes atrophic and hyalanized, why

A

seminiferous tubules
result of temperature-induced damage
(Leydig cells not affected as much)

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20
Q

what is mono neuritis multiplex

A

peripheral neuropathy of multiple individual nerves

associated with a variety of diseases- Wegener and PAN

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21
Q

what is the MOA of risperidone

A

INHIBITS D1 and D2

inhibits serotonergic and alpha-adrenergic pathways

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22
Q

what characterizes polycystic ovary disease

A 
INFERTILITY
OLIGOMENORRHEA
HYPERANDROGENISM
most pts are OBESE
insulin resistance is thought to play a role in pathogenies
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23
Q

what characterizes primary ovary syndrome

A

AMENORRHEA
HYPOESTROGENISM
elevated gonadotropin levels in women under 40

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24
Q

uterine fibroids have what effect on menses

A

menorrhagia

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25
Q

disruption of the arcuate fascicles leads to what

A

CONDUTION APHASIA

fluent speech, intact comprehension, impaired repetition

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26
Q

what is the hypothalmospinal tract

A

projects form hypothalamus to the ciliospinal center of the intermediolateral cell column (T1-T2)
providing sympathetic innervation to IPSILATERAL eye and face
HORNER SYNDROME

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27
Q

pt with depression, suicidal ideation, and impulsivity (substance abuse, unprotected sex) in the setting of feeling rejected are characteristic of what personality disorder

A

BORDERLINE

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28
Q

patients with borderline disorder frequently come to clinical attention due to what

A

suicidal behavior or threats during an interpersonal crisis

modd swings that occur in response to interpersonal stressors

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29
Q

what patients are at increased risk for severe disease with V vulnificus

A

chronic liver disease (like hepatitis)

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30
Q

in what situations is the infectious dose of V cholera less than normal

A

decreased acidity in the environment (increases in gastric pH)- antacid use or any condition causing achlorhydria

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31
Q

what nerve innervates the area of internal hemorrhoids (above dentate line)- covered in columnar epithelium

A

INFERIOR HYPOGASTRIC PLEXUS
only sensitive to stretch and not pain, temp or touch
has both sympathetics and parasympathetic

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32
Q

what nerve innervates external hemorrhoids (below dentate line)- covered in modified squamous epithelium

A

INFERIOR RECTAL NERVE a branch of the PUDENDAL NERVE supply the perineum and external genitalia in males and females

33
Q

the ilioinguinal nerve does what

A

mostly sensory from L1
carries sensation from skin of the upper medial part of the high, the root of the penisa nd upper part of the scrotum in makes, the mons pubis and labia majora in females

34
Q

what nerve roots make up the inferior gluteal nerve

A

L5, S1, and S2

supplies gluteus max

35
Q

what is the pelvic splanchiv nerves

A

derived from S2, S3, and S4

provide parasympathetic innervation to the pelvic and genital organs

36
Q

what is used to treat arsenic poisoning (garlic smell)

A

dimercaprol (british anti-lewisite)

DMSA

37
Q

how does arsenic work

A

binds SULFHYDRYL groups, impairing CELLULAR RESPIRATION via INHIBITION OF PYRUVATE DEHYDROGENASE and disruption of gluconeogenesis and glutathione metabolism

38
Q

what ar the manifestations of acute and chronic arsenic poisoning

A

acute: WATERY DIARRHEA, delirium, HYPOTENSION, abdominal pain, vomiting, QTc PROLONGATION, GARLIC ORDOR
chronic: hypo/hyperpigmentation, hyperkeratosis, stocking-glove neuropathy

39
Q

CaNa2EDTA is used to treat what kind of toxicity

A

lead poisoning (constipation, anemia, irritability, confusion)

40
Q

what breast pathology is characterized by microcalcifiations in asymptomatic patines with normal breast examination and by distended ducts by PLEOMORPHIC CELLS with prominent CENTRAL NECROSIS without extension beyond the ductal BM

A

ductal carcinoma in situ

precursor to invasive ductal carcinoma MOST COMMON TYPE OF BREAST CANCER

41
Q

what is a phyllodes tumor

A

arise from breast stoma and can progress to malignancy

histo: disorderly, diffusely hypercellular connective tissue with cellular atypia and LEAF-LIKE projections

42
Q

dystrophic calcification in aged (or damaged) heart valves is though to be the result of ENDOTHELIAL and FIBROBLAST DEATH secondary to

A

CHRONIC HEMODYNAMIC STRESS (can be accentuated by valvular)

atherosclerotic inflammation

43
Q

extracellular amyloid deposition occurs in patients with amyloidosis and can cause what heart problems

A

RESTRICTIVE CARDIOMYOPATHY
HEART FAILURE
not associated with calcification of aortic valve

44
Q

cough that makes you puke is

A

PERTUSSIS (gram-negative coccobaccili)

ALWASY FUCK THE AGE IT CAN HAPPEN IN OLD PEOPLE TOO

45
Q

febrile neutropenia and sepsis increases susceptibility to infections with what organisms

A

gram-negative like PSEUDOMONAS

46
Q

pt with febrile neutropenia history of AML, high temp, low pulse, high HR, high respirations (SEPSIS).
skin has patches with an ULCERATED appearance and occasional NECROTIC CENTER

A

PSEUDOMONAS AERUGINOSA (ectyhma gangrenosum (EG))

47
Q

what virulence factors contribute to ecthyma gangrenosum (EG) in P aeruginosa

A

exotoxin A- protein synthesis inhibition
elastase- degrades elastin (important for blood vessel destruction)
phospholipase C- degrades cellular membranes
pyocyanin- generates reactive oxygen species

48
Q

what is erysipelas

A

superficial skin lesions characterized by a painful erythematous plaque with raised, well-demarcated borders
seen in step pyogenes

49
Q

what viral infection is particularly common with lung transplants

A

CMV- usually within first few months

valgancyclovir is used as prophylaxis

50
Q

patients with femoral neuropathy develop what

what causes femoral neuropathy

A

trauma, compression from a hematoma or abscess, stretch injury, or ischemia
develop weakness involving the quads and may have weakening of the iliopsosas with more proximal nerve injuries

51
Q

how does femoral neuropathy present on exam

A

often complain of difficulty with STARIS and FOREWENT FALLING secondary to “KNEE BUCKLING”
PATELLAR REFLEX DIMINSIHED
SENSORY LOSS over the ANTERIOR MEDIAL THIGH and MEDIAL LEG is typical
acute, severe pain in the groin, lower abdomen, or back may also occur if the neuropathy is caused by a retroperitoneal hematoma

52
Q

tight junctions are made up of what

A

claudins and occluding (transmembrane proteins) that associate with actin filaments, forming a BELTLIKE seal around the apical intercellular space

53
Q

desmosomes (macula adherens) are made up of what

A

keratin intermediate filament interactions

found in STRATUM SPINOSUM

54
Q

what is an intermediate junction (zonula adherens or belt desmosome)

A

found BELOW TIGHT JUNCTIONS

form BELTLIKE anchor b/w adjacent cells in association with actin microfilaments

55
Q

maternal serum alpha fetoprotein is increased in what states

A

neural tube defects
ventral wall defects (omphalocele, gastroschisis)
multiple gestation

56
Q

what causes skin retractions (DIMPLING) of the breast in breast cancer

A

malignant infiltration of SUSPENSORY LIGAMENT of the breast (COOPER LIGAMENT) causing fibrosis and shortening, leading to traction of the skin with distortion in breast contour

57
Q

malignant spread of ductal carcinoma to these sinuses through the ductal system may cause what

A

nipple discharge and superficial nipple changes

like Pagets of the nipple is characterized by an eczematous exudate over the nipple and areola

58
Q

malignant spread to the mammary artery results in what

A

distant hematogenous mets and does not cause localized skin changes

59
Q

how do nitrates cause smooth muscle relaxation

A

conversion of GTP to cGMP which leads to DECREASED INTRACELLULAR CALCIUM, and resultant decreased activity of myosin-light chain kinase, and finally, MYOSIN LIGHT CHAIN DEPHOSPHORYLATION and vascular smooth muscle RELAXATION

60
Q

what is the metabolite of cyclophosphamide or one of its analogs (ifosfamide) that causes hemorrhagic cystitis

A

ACROLEIN which is toxic to uroepithelial cells and can cause cell death and necrosis if allowed to be in contact with these cells of ra prolonged period

MESNA and aggressive hydration can prevent this

61
Q

what is dexrazoxane

A

iron-chelating agent that can help prevent anthracycline-induced (doxorubicin) cardiotoxicity aka DILATED CARDIOMYOPATHY

62
Q

in hemolytic disease of he newborn what kind of antibodies are fucking shit up and who they from

A

anti-Rh(D) IgG from moms (can cross placenta)

63
Q

what neurotransmitter changes are seen in Huntingtons

A

dec ACh and GABA

inc dopamine

64
Q

what is OVERFLOW INCONTINENCE due to

A

mainly due to IMPAIRED DETRUSOR CONTRACTILITY or BLADDER OUTLET OBSTRUCTION (tumor obstructing the urethra)
can be due to diabetic autonomic neuropathy affecting detrusor (common in T1DM)

65
Q

what is seen in bladder of diabetic autonomic neuropathy affecting the detrusor muscle innervation (common in T1DM)

A

usually develop involuntary and continuous urinary leakage when the bladder is full and often have incomplete emptying
initially have infrequent urination due to loss of autonomic afferent innervation an inability to sense a full bladder
involvement of efferent fires to the bladder subsequently causes incomplete emptying

can develop recurrent UTIs and OVERFLOW INCONTINENCE with poor urinary stream or dribbling

pelvic floor relaxation at night combined with a full bladder can lead to nocturnal enuresis

Postvoid residual (PVR) resting with ultrasound or cath can confirm inadequate bladder emptying

66
Q

loss of sensation to the perineal area (saddle anesthesia) can indicate what

A

CAUDA EQUINA SYNDROME
commonly due to epidural cord compression from a malignancy
pts develop urinary retention late in the course of the disease, usually associated with fecal incontinence

67
Q

what is the piriform recesses

A

small cavities that lie on either side of the laryngeal orifice
bounded medially by the aryepiglottic folds and laterally by the thyroid cartilage and thyrohyoid membrane

68
Q

during normal swallowing what happens with food and the piriform recess

A

epiglotis diverts food laterally through the piriform recess int o the esophagus without endangering the airway

69
Q

what nerve is found in the piriform recess and what protects that nerve

A

thin layer of mucosa overlying piriform recess is all that protects the superficially coursing INTERNAL LARYNGEAL NERVE, a branch of the superior laryngeal nerve (CN X)

70
Q

the internal laryngeal nerve (branch of superior laryngeal nerve- CN X)contains what kind of fibers

A

sensory and autonomic

MEDIATES COUGH REFLEX

71
Q

what mediates the cough reflex

A

afferent is CN X via the internal laryngeal nerve (branch of superior laryngeal nerve) by innervating the sensory from the mucosa superior to the vocal cords
can be damaged if foreign bodies (chicken or fish bones) get suck in the piriform recess

72
Q

what mediates the gag reflex

A

afferent: CN IX (glossopharyngeal)
efferent: CN X (bags nerve)

73
Q

how does CN IX mediate salivation

A

parasympathetic fibers originating from the glossopharyngeal nerve
fivers synapse on the otic ganglion, and postganglionic fibers travel via the auriculotemporal nerve to reach the parotid gland

74
Q

what is referral bias

A

when the case and control populations differ due to admission or referral practices

cancer risk factor study done at a hospital specializing in cancer research may have cases from all over the nation, but the control population may be local

75
Q

what is detection bias

A

the fact that a risk factor may lead to extensive diagnosis investigation and increase the probability that a disease is identified
ppl who smoke may undergo increased imaging due to their smoking status, which would detect more cases of cancer in general

76
Q

what is allocation bias

A

can result from the way that treatment and control groups are assembled
may occur if subjects are assigned to the study groups of a clinical trial in a non-random fashion
ex: study comparing oral NSAIDS to corticosteroid injections for the tx of osteoarthritis; obese peeps may be preferentially put into the corticosteroid group

77
Q

what is sampling bias

A

non-random sampling of a population
can lead to a study pop having characteristics that differ from the target pop
common ex is severely ill patents are most likely to enroll in cancer trials, leading to results that are not applicable to pts with less advanced cancers

78
Q

what does fixing hyponatremia too rapidly resent as

A

central pontine demyelination
“pseudo bulbar” easy characterized by head and neck muscle weakness, dysphagia, and dysarthria (nuclei of CN remain intact)
quadriplegia

79
Q

what is cardiac asthma

A

weeping on excretion due to left-sided heart failure
exercise increases venous return to the heart, but the failing left ventricle is unable to sufficiently increase cardiac output to prevent a significant exercise-induced increase in pulmonary venous pressure

zz - step 3 - uworld (62 decks)

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