uWorld 18 Flashcards
the vertebral venous plexus communicates with many things what connections allow for spread of prostate, breast, and lung cancers to the thoracic spine
prostate- prostatic venous plexus
lung and breast- Azygous Vein
what are lumacaftor and ivacaftor
CFTR-modulating medications that can potentially help pts with CF by restoring CFTR proteins to the membrane and also by enhancing protein function (chloride transport) at the membrane, respectively
has been shown to improve predicted FEV and decrease rates of pulmonary exacerbations
what parts of the pleura does the phrenic nerve innervate
DIAPHRAGMATIC and MEDIASTINAL PELURA
costal and cervical are innervated by intercostal nerves and are felt more locally
as the airways move distally what is the last thing to disappear as the epithelium changes along the respiratory tube
cilia (not found in alveolar ducts or alveoli themselves but everywhere else)
what part of the G-protein coupled receptor has 20 amino acids consisting mainly of valine, alanine, and isoleusine
TRANSMEMBRANE DOMAIN (anchors to the cell membrane) has many non polar, hydrophobic amino acids (Ala, Val, Leu, Ile, Phe, Trp, Met, Pro, Gly arranged in ALPHA HELIX and project hydrophobic R groups outward, ANCHORING the transmembrane region of the protein to the hydrophobic core of the PHOSPHOLIPID BILAYER
hormone sensitive lipase is activated and inhibited by what
activated by stress hormones (catecholamines, glucagon, ACTH) via Gs receptors on adipocytes inc cAMP and PLA and PKA phosphorylating and activating HSL- stimulating lipolysis
inhibited by INSULIN
what does hormone sensitive lipase do
enzyme found in adipose tissue that catalyzes the mobilization of stood TBs into FREE FATTY ACIDS (FFAs) and GLYCEROL
the FFAs can be oxidized by the liver to acetyl-coA, which can be further metabolized into KETONE BODIES or shunted into TCA to generate energy for gluconeoenesis
glycerol used primarily as carbon source for GLUCONEOGENESIS
what does glycogen phosphorylase do
rate-limiting step of GLYCOGENOLYSIS- process that frees glucose-1-phosphate from stored glycogen chains
increases blood glucose levels during first several hours of fasting (no effect on FA oxidation)
what does mitochondria HMG-CoA Synthase do
plays a role in keynote production
what does testosterone influence the development of
internal male genetalia
spermatogenesis
male sexual differentiation at poverty (muscle mass, libido)
what does DHT influence the development of
external male genitalia
growth of prostate
male-pattern hair growth
amplifies the effects of testosterone due to high affinity for testosterone receptor
prenatal cocaine abuse increases the risk of what
preeclampsia
spontaneous abortion
fetal demise
placental abruption
what is gestation diabetes associated with
mascrosomia caudal regression syndrome hypoglycemia hypocalcemia hypertrophic cardiomyopathy
what happens if leydig cells are functional but Sertoli cells are not in a fetus that is 46XY w/ testes
both female and male internal genitalia
male external genitalia
w/o MIF from sertoli cells the mullerian ducts will form female internal genitalia (fallopian tubes, uterus)
what is testes determining factor (TDF) and where is it found
responsible for gonadal differentiation into testes
found on STY gene no the Y chromosome
what tumor has characteristic waxing and waning of lymph nodes
FOLLICULAR t(14,18) blc-2overexpression
ALL is the most common leukemia in children, how does it present
lymphadenopathy hepatosplenomegaly fever bleeding bone pain
who does diffuse b-cell lymphoma typically present
rapidly enlarging nodal (neck, abdomen, mediastinum) or extranodal symptomatic mass
Waldeyer’s ring (oropharyngeal lymphoid tissue) and GI tract are often involved
B-symtposm (fever, weight loss, drenching night sweats) can also be seen
how does hairy cell leukemia present
splenomegaly and pancytopenia in older men
tartrate-resistant acid phosphatase (TRAP) positive cells with hairlike cytoplasmic projections
how does mycosis fungicides present
cutaneous T-cel lyphonoma
proliferating CD4+ infiltrate dermis and epidermis, forming POUTRIER MICROABCESSES
manifests with PLAQUES (often on trunk or buttocks)
that may be confused with eczema or psoriasis
granulized erythema and scaling of the skin (erythroderma) may result
what nerve is found in the lateral compartment of the leg
superficial peroneal nere
blood drained by peroneal veins
ACS can produce- loss of sensation in the lower leg and dorsal of the food as well as foot drop
what nerve is found in the deep posterior compartment of the leg
tibial nerve
posterior tibial nerve and veins
peritoneal artery and veins
ACS of this compartment- decreased sensation of plantar surface, decreased toe flexion, and pain with passive toe expression
what nerve is found in the anterior compartment of the leg
deep peroneal (fibular) nerve anterior tibial artery and veins
most common site of compartment syndrome- foot extensors fucked (foot drop, decreased sensation b/w 1st and 2nd toes)
what is the course of the great (long) saphenous vein
dorsum of food and runs along medial leg and anterior thigh b4 merging with he common femoral vein in the femoral triangle
what are two complications of hereditary spherocytosis (AD)
PIGMENTED GALLSTONES (any hemolytic anemia has this) aplastic crisis from parvovirus B19 infection
pigmented gallstones are a complication of any what
hemolytic anemia
increased bilirubin from lysed RBCs precipitates as calcium bilirubinate, forming pigmented stones in the gallbladder
femoral avascular necrosis is seen in what RBC issue
SICKLE CELL
in a patient with both tonic-clonic seizure and absence seizures, what medication is the drug of choice
VALPROATE (treats both absence seizures and generalized tonic-clonic)
ethosuximide only treats absence seizures but will not be effective against generalized tonic-clonic
carbamazepine is the drug of choice for what type of seizures
complex (loss of consciousness) partial seizures but is also effective in generalized tonic-clonic
feared ADR of agranulocytosis or aplastic anemia
what are the classic 3D’s of C botulism
DIPLOPIA
DYSPHAGIA
DYSTONIA
develop within 12-36 hours of consumption
what is the toxin found in pufferfish and what does it do
tetrodotoxin leads to inhibition of sodium influx into nerve endings manifests as: weakness paresthesias (face, extremities) loss f reflexes sometimes severe hypotension patients commonly remain conscious although paralyzed
what is seen on peripheral blood smear of P falciparum
multiple small rings- TROPHOZOITES
banns-shaped gametocytes
what is necessary to kill the dormant liver forms (hypnozoites) of P vivid and ovale
PRIMAQUINE must be added to their therapy
what is pentamidine used for
prophylaxis tx in pneumocystis jirovecii pneumonia in pts with HIV
treats African sleeping sickness
treats leishmaniasis
if relative risk equals 1 what does that mean
null value, there is no association b/w the exposure and the disease
if relative risk if greater than 1 what does that indicate
exposure is associated with increased risk of the disease
if relative risk is less than 1 what does that indicate
the exposure is associated with decreased risk of disease
when 95% confidence interval does NOT include the null value (1), this gives a corresponding what
P-VALUE LESS THAN 0.5 and an association b/w exposure and outcome is considered statistically significant
what lab values are elevated in polycystic ovary syndrome
Lh is increased
insulin usually increased (insulin resistance)
androgen production increased
estrogen increased (inc androgens)- endometrial hyperplasia
what is used to treat polycystic ovary syndrome
weight loss
dural estrogen-progestron oral contraceptives- to minimize endometrial proliferation, reduce androgenic symptoms and prevent unwanted pregnancy
what is used in patients with POLYCYSTIC OVARY SYNDROME who WISH to GET PREGNANT
CLOMIPHENE- selective estrogen receptor modulator that prevents negative feedback inhibition on the hypothalamus and pituitary by circulating estrogen, resulting in increased gonadotropin production (FSH and LH) and OVULATION
what are the two major processes that maintain plasma glucose between meals, what order to they work in
glycogenolyisis- primary source first 12-18hours of fasting
gluconeogenesis- once liver runs out of glycogen stores this is major process using lactate, glycerol, and gluconeogenic amino acids
what enzymes are bypassed in gluconeogensiss
hexokinase
phosphofructokinase and pyruvate kinase
(all unidirectional)
what is the first committed step of fluconeogenesis
biotin-dependent carboxylation of pyruvate to oxaloacetate by mitochondrial PYRUVATE CARBOXYLASE
what is the malate shuttle
part of gluconeogenesis
oxaloacetate made in mitochondria is converted to malate there by malate dehydrogenase
malate can leave the mitochondria where it is converted back into oxaloacetate by malate dehydrogenase in the cytosol
what does phosphoneolyruvate carboxykinase (PEPCK) do
converts oxaloacetate to phosphoenolpyruvate
what two enzymes of gluconeogesesis work together to bypass pyruvate kinase
pyruvate carboxylase
and PEPCK
what gluconeosnesis enzyme bypasses phosphofructokinase
FRUCTOSE-1,6-BISPHOSPHATASE
what gluconeogenesis enzyme bypasses hexokinase
GLUCOSE-6-PHOSPHATASE
what is palmitic acid
first fatty acid produced from acetyl CoA during lipogenesis in the fed state
conversion of acetoacetyl-CoA to 3-hydroxy-3-methylglutaryl-CoA occurs during the synthesis of what
cholesterol and keynote bones
if rotator cuff is fucked but you can abduct you just can externally rotate, what is fucked up
infraspinatus (only function is to externally rotate)
supra scapular nerve
what is the origin, insertion, action, and innervation of supraspinatus (rotator cuff)
O: supraspinatous fossa
I: greater tuberosity
A: abduction
N: supra scapular nerve
MOST COMMON ROTATOR CUFF INJRUY
what is the origin, insertion, action, and innervation of infraspiantous (rotator cuff)
O: infraspinatous fossa
I: greater tuberosity
A: external (lateral) rotation
N: suprascapular nerve
PITCHING INJURY (or football quarterback)
what is the origin, insertion, action, and innervation of Teres Minor (rotator cuff)
O: lateral border
I: greater tuberosity
A: adduction and external (lateral) rotation
N: axillary nerve
what is the origin, insertion, action, and innervation of subscapularis
O: sub scapular fossa
I: lesser tuberosity
A: adduction and internal (medial) rotation
N: upper and lower sub scapular nerve
what opioids treat diarrhea
loperamide
diphenoxylate
what can be used breast beta-lactamase producing bacterodies
piperacillin-tazobactam
what is the cephalic phase of acid section within the stomach
mediated by cholinergic and vagal mechanisms
triggered b the thought, sight, smell, and taste of food
what is the gastric phase of acid section within the stomach
mediated by the presence of gastrin (which stimulates histamine secretion and therefore, indirectly, acid secretion), and is triggered by the CHEMICAL STIMULUS of FOOD and the DISTENTION of the stomach
what is the intestinal phase of acid secretion within the stomach
initiated when protein-containing food enters the duodenum, but this phase plays only a minor role in stimulating acid secretion
what is effective in down-regulating gastric acid secretion after a meal
INTESTINAL INFLUENCES
ileum and colon release peptide YY, which binds to receptors on the endocrine, histamine-containing cells described as enterochromaffin-like cells
this counteracts the cephalic and gastric phases of acid secretion by inhibiting gastrin-stimulated histamine relate from ECLs
somatostatin and prostaglandins also inhibit acid secretion
what is receptive relaxation
the reflex that allows the gastric fundus to dilate in anticipation of food passing though the pharynx and esophagus
hyperparathyroidism (evidence by renal stones fixed by neck surgery) and starts getting bitemporal visual field defects, what should you suspect
MEN type 1 hyperparathyroidism (hypercalcemia) pituitary tumors (prolactin, casual defects) PACNREATIC TUMORS (especially gastrinomas)
what is infliximab
chimeric IgG1 monoclonal antibody to TNF-alpha
used in rheumatoid arthritis, ankylosing spondylitis, and fistulizing Crohn’s disease
interleukin-2 is FDA-apprived for treatment of what
renal cell carcinoma
melanoma
regulates the activation and differentiation of T-cells to aid in tumor cell destruction
what is abciximab
chimeric mouse-human monoclonal antibody against platelet GpIIb/IIIa receptor
works by blocking the final step in platelet aggregation
often administered during angioplasty in pts with acute coronary syndrome
what is an anaplastic tumor
neoplastic cells that demonstrate complete lack of differentiation
what are the typical features of anaplastic tumors
- loss of cell polarity with complete disruption of normal tissue architecture; cells coalesce into sheets os islands in a disorganized, infiltrative fashion
- significant variation in the shape and size of cells (cellular pleomorphism) and nuclei (nuclear pleomorphism)
- disproportionately large nuclei (high N/C ratio) that are often deep-staining (hyperchromatic) with abundant, coarse-clumped chromatin an large nucleoli
- numerous, often abnormal, mitotic figures
- giant, multinucleated tumor cells
acute pancreatitis in an alcoholic, what other findings would one expect to see due to cause of pancreatitis
pancreatitis is causes by alcohol a lot folate deficiency (megaloblastic anemia)
how does ethanol cause panreatitis
ethanol stimulates pancreatic secretions with high protein concentration and low fluid content
these viscous secretions are prone to precipitate and form plugs that can obstruct the lumina of the pancreatic ductules
alcohol can cause spasms of the sphincter of odds and has a direct toxic effect not he acinar cells
what is URUSHIOL
product of poison ivy, poison oak, and poison sumac
a small allergenic substance the causes an immune response when attached to proteins (i.e., hapten)
abdominal aortic aneurysms are characterized by what
TRANSMURAL INFLAMMATION of the aortic wall
chronic inflammation leads to degradation of elastin and collagen by proteases, resulting in LOSS OF ELASTIN and smooth muscle cells and ABNORMAL COLLAGEN remodeling and cross-linking
these changes lead to weakening and progressive expansion of the aortic wall, resulting in ANEURYSM FORMATION
an intimal tear in the aortic wall is the primary even involved in the pathophysiology of what
aortic dissection
what is a mycotic aneurysm
caused by septic embody
present with painful, pulsatile masses and systemic signs such s fever and malaise
what is inflammatory AAA
perivascular fibrosis with an extensive lymphocytic infiltrate and thickening of the adventitia
rate cause of AAA
typically associated with systemic symbols- fever, fatigue
what happens in the first week after TB exposure
intracellular bacterial proliferation
SULFATIDE virulence factors allow for proliferation after phagocytosis
wha are posterior urethral valves
result from malformation of the Wolffian duct, and therefor only occur in MALES
can present with BILATERAL HYDRONEPHROSIS and CALCYCEAL DILATION due to obstruction of urine flow in the urethra
when does one see renal scaring most commonly at the upper and lower poles of the kidney in which compound papillae are found
chronic pyelonephritis due to vesicoureteral reflux (VUR)
seen in kids
compound papillae are alway open (unlike simple papillae in the mid kidney) and therefore much more susceptible to dilation and subsequent injury
is uncorrected vesicoureteral reflux (VUR) can lead to what
loss of nephrons and SECONDARY HYPERTENSION
what is multicystic dysplastic kidney (MCDK)
nonhereditary renal malformation characterized by multiple noncommunicating cysts with intervening dysplastic tissue
unilateral MCDK may be clinically silent, but bilateral MCDK presents with early, severe real insufficiency due to absence of functional renal tissue
