uWorld 17 Flashcards
what clears particles stuck in the terminal bronchioles of the lungs
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
when do macrophages clear stuff from the lungs
distal to the terminal bronchioles
when is the ACTH stimulation test used
adrenocortical insufficiency
give them METYROPONE (which blocks conversion of 11-doxycortisol to cortisol)
in primary insufficient addition of metyropone
what is caused by absent tyrosinase activity
albinism (AR)
defects in biosynthesis of melanin most commonly due to tyrosinase activity (converts DOPA to dopaquinone)
what is the earliest lesion of atherosclerosis and what is the predominant cell type in this structure
FATTY STREAK
made up of lipid-laden macrophages (foam cells) in the intimal that can eventually progress to atherosclerotic plaques
what is the sequence of atherosclerotic progression
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
what anti epileptic drugs can also be used as mood stabilizers for bipolar
VALPROATE
carbamazepine
lamotrigine
stimulation of what adrenergic receptor decreases insulin secretion and what increases it. what is the overall effect
alpha 2- decreases secretion
beta 2- increases secretion
alpha-2 effects predominate thus inhibition insulin secretion
M3 receptors work through what kind of G protein and have what effect on insulin secretion
Gq
increase insulin secretion
what is glucagon-like peptide 1
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
H2 receptor stimulation has what effect on insulin secretion
increases it
what is the normal pressure in the SVC and Right atrium
1-6 mmHg
what is the normal pressure of the right ventricle
systolic: 15-30 mmHg
diastolic: 1-6 mmHg (just below RA pressure)
what is the pulmonary artery pressure normally
systolic: 15-30 mmHg (no change from right ventricle)
diastolic: 6-12mmHg
what is the normal pulmonary capillary wedge pressure (what does it represent)
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)
A1AT deficiency typically manifests with what kind of emphysema
EASLY-ONSET
lower lobe-predominant
panacinar
what accounts for the rubber-like properties of elastin
formation of DESMOSINE CROSS-LINKS b/w neighboring polypeptides by LYSYL OXIDASE prewires copper) oxidatively delaminating some of the lysine residues of tropoelastin
what do the disulfide bridges formed during collagen synthesis do
bring the chains of the C-terminal propertied regions of the 3 alpha chains into favorable alignment for triple helix assembly
in cryptorchidism what becomes atrophic and hyalanized, why
seminiferous tubules
result of temperature-induced damage
(Leydig cells not affected as much)
what is mono neuritis multiplex
peripheral neuropathy of multiple individual nerves
associated with a variety of diseases- Wegener and PAN
what is the MOA of risperidone
INHIBITS D1 and D2
inhibits serotonergic and alpha-adrenergic pathways
what characterizes polycystic ovary disease
INFERTILITY OLIGOMENORRHEA HYPERANDROGENISM most pts are OBESE insulin resistance is thought to play a role in pathogenies
what characterizes primary ovary syndrome
AMENORRHEA
HYPOESTROGENISM
elevated gonadotropin levels in women under 40
uterine fibroids have what effect on menses
menorrhagia
disruption of the arcuate fascicles leads to what
CONDUTION APHASIA
fluent speech, intact comprehension, impaired repetition
what is the hypothalmospinal tract
projects form hypothalamus to the ciliospinal center of the intermediolateral cell column (T1-T2)
providing sympathetic innervation to IPSILATERAL eye and face
HORNER SYNDROME
pt with depression, suicidal ideation, and impulsivity (substance abuse, unprotected sex) in the setting of feeling rejected are characteristic of what personality disorder
BORDERLINE
patients with borderline disorder frequently come to clinical attention due to what
suicidal behavior or threats during an interpersonal crisis
modd swings that occur in response to interpersonal stressors
what patients are at increased risk for severe disease with V vulnificus
chronic liver disease (like hepatitis)
in what situations is the infectious dose of V cholera less than normal
decreased acidity in the environment (increases in gastric pH)- antacid use or any condition causing achlorhydria
what nerve innervates the area of internal hemorrhoids (above dentate line)- covered in columnar epithelium
INFERIOR HYPOGASTRIC PLEXUS
only sensitive to stretch and not pain, temp or touch
has both sympathetics and parasympathetic
what nerve innervates external hemorrhoids (below dentate line)- covered in modified squamous epithelium
INFERIOR RECTAL NERVE a branch of the PUDENDAL NERVE supply the perineum and external genitalia in males and females
the ilioinguinal nerve does what
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
what nerve roots make up the inferior gluteal nerve
L5, S1, and S2
supplies gluteus max
what is the pelvic splanchiv nerves
derived from S2, S3, and S4
provide parasympathetic innervation to the pelvic and genital organs
what is used to treat arsenic poisoning (garlic smell)
dimercaprol (british anti-lewisite)
DMSA
how does arsenic work
binds SULFHYDRYL groups, impairing CELLULAR RESPIRATION via INHIBITION OF PYRUVATE DEHYDROGENASE and disruption of gluconeogenesis and glutathione metabolism
what ar the manifestations of acute and chronic arsenic poisoning
acute: WATERY DIARRHEA, delirium, HYPOTENSION, abdominal pain, vomiting, QTc PROLONGATION, GARLIC ORDOR
chronic: hypo/hyperpigmentation, hyperkeratosis, stocking-glove neuropathy
CaNa2EDTA is used to treat what kind of toxicity
lead poisoning (constipation, anemia, irritability, confusion)
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
ductal carcinoma in situ
precursor to invasive ductal carcinoma MOST COMMON TYPE OF BREAST CANCER
what is a phyllodes tumor
arise from breast stoma and can progress to malignancy
histo: disorderly, diffusely hypercellular connective tissue with cellular atypia and LEAF-LIKE projections
dystrophic calcification in aged (or damaged) heart valves is though to be the result of ENDOTHELIAL and FIBROBLAST DEATH secondary to
CHRONIC HEMODYNAMIC STRESS (can be accentuated by valvular)
atherosclerotic inflammation
extracellular amyloid deposition occurs in patients with amyloidosis and can cause what heart problems
RESTRICTIVE CARDIOMYOPATHY
HEART FAILURE
not associated with calcification of aortic valve
cough that makes you puke is
PERTUSSIS (gram-negative coccobaccili)
ALWASY FUCK THE AGE IT CAN HAPPEN IN OLD PEOPLE TOO
febrile neutropenia and sepsis increases susceptibility to infections with what organisms
gram-negative like PSEUDOMONAS
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
PSEUDOMONAS AERUGINOSA (ectyhma gangrenosum (EG))
what virulence factors contribute to ecthyma gangrenosum (EG) in P aeruginosa
exotoxin A- protein synthesis inhibition
elastase- degrades elastin (important for blood vessel destruction)
phospholipase C- degrades cellular membranes
pyocyanin- generates reactive oxygen species
what is erysipelas
superficial skin lesions characterized by a painful erythematous plaque with raised, well-demarcated borders
seen in step pyogenes
what viral infection is particularly common with lung transplants
CMV- usually within first few months
valgancyclovir is used as prophylaxis
patients with femoral neuropathy develop what
what causes femoral neuropathy
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
how does femoral neuropathy present on exam
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
tight junctions are made up of what
claudins and occluding (transmembrane proteins) that associate with actin filaments, forming a BELTLIKE seal around the apical intercellular space
desmosomes (macula adherens) are made up of what
keratin intermediate filament interactions
found in STRATUM SPINOSUM
what is an intermediate junction (zonula adherens or belt desmosome)
found BELOW TIGHT JUNCTIONS
form BELTLIKE anchor b/w adjacent cells in association with actin microfilaments
maternal serum alpha fetoprotein is increased in what states
neural tube defects
ventral wall defects (omphalocele, gastroschisis)
multiple gestation
what causes skin retractions (DIMPLING) of the breast in breast cancer
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
malignant spread of ductal carcinoma to these sinuses through the ductal system may cause what
nipple discharge and superficial nipple changes
like Pagets of the nipple is characterized by an eczematous exudate over the nipple and areola
malignant spread to the mammary artery results in what
distant hematogenous mets and does not cause localized skin changes
how do nitrates cause smooth muscle relaxation
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
what is the metabolite of cyclophosphamide or one of its analogs (ifosfamide) that causes hemorrhagic cystitis
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
what is dexrazoxane
iron-chelating agent that can help prevent anthracycline-induced (doxorubicin) cardiotoxicity aka DILATED CARDIOMYOPATHY
in hemolytic disease of he newborn what kind of antibodies are fucking shit up and who they from
anti-Rh(D) IgG from moms (can cross placenta)
what neurotransmitter changes are seen in Huntingtons
dec ACh and GABA
inc dopamine
what is OVERFLOW INCONTINENCE due to
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)
what is seen in bladder of diabetic autonomic neuropathy affecting the detrusor muscle innervation (common in T1DM)
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
loss of sensation to the perineal area (saddle anesthesia) can indicate what
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
what is the piriform recesses
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
during normal swallowing what happens with food and the piriform recess
epiglotis diverts food laterally through the piriform recess int o the esophagus without endangering the airway
what nerve is found in the piriform recess and what protects that nerve
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)
the internal laryngeal nerve (branch of superior laryngeal nerve- CN X)contains what kind of fibers
sensory and autonomic
MEDIATES COUGH REFLEX
what mediates the cough reflex
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
what mediates the gag reflex
afferent: CN IX (glossopharyngeal)
efferent: CN X (bags nerve)
how does CN IX mediate salivation
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
what is referral bias
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
what is detection bias
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
what is allocation bias
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
what is sampling bias
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
what does fixing hyponatremia too rapidly resent as
central pontine demyelination
“pseudo bulbar” easy characterized by head and neck muscle weakness, dysphagia, and dysarthria (nuclei of CN remain intact)
quadriplegia
what is cardiac asthma
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
