UWORLD 2 Flashcards
patient with suspected lung cancer develops hiccups, shoulder pain, and dyspnea…affected nerve and vertebral origin?
phrenic
c3-c5
(c3,4,5 keeps diaphragm alive)
histopathologic finding in HIV associated dementia
microglial nodules (groups of activated macrophages/microgilal cells formed aorund small areas of necrosis tha tmay fuse to for multinucleated giant cells
gastric erosion vs ulcer
erosion - does not extend into MUSCULARIS MUCOSA (limited to mucosal layer)
ulcer - penetrate through the mucosal layer and extend into submucosal layer
histologic feature of acute eczematous dermatitis (eczema)
spongiosis (due to accumulation of eema fluid i tne intracellular space of epidermis)
with chronic exposure, lesions bcome less edematous with thikcening of stratum spinosum and stratum corneum (acanthosis and hyperkeratosis respectively)
what is the target of botulinum toxin
presynaptic exocytosis of ACh vesicles
painless genital ulcers that progress into painful inguinal lmyphadenopatyh (buboes) and ulceration, mild fever and malaise…cells scrapings show cytoplasmic inclusion bodies
chlamydia trachomatis
patient comes in with anemia but with normal WBC and platelet count and normal bone marrow…dx and associations
pure red cell aplasia (bone marrow failure of just pure erythroid elements) can be assocaited with inhibition of erythropoetic precursosrs by IgG autoantibodies or T lymphocytes associated with thymomas, lymphocytic leukemias and parvovirus b19
nongonoccal urethritis, arthritis, conjunctivits
reactive arthritis
assoc with keratoderma blennorhagicum (hyperkeratotic vesicles on palms and soles) and sacroilitiis
HLAb27
purpose of conjugating toxoid for Hib vaccine
since humoral immunity is immature in inffant younger than 2, conjugated toxoid induces T cell mediated immune response to help with formation of long term immunity via memory B cells
What substance is specific to mast cells that is useful in diagnosing anaphylaxis?
mast cells release HISTAMINE AND TRYPTASE…
tryptase is useful is diagnosing anaphylaxis
How do mast cells degranulate
aggregation of multiple IgE receptors brought together by multivalent antigen….this causes multiple IgE antibodies to become cross linked leading to degranulation
two mechanisms of fibrates
upregulate lipoprotein lipase which will increase TG clearance and activate PPARa to induce HDL synthesis…
also blocks cholesterol 7 alpha hydroxylase which will stop synthesis of bile acids and decrease cholesterol solubility in bile = CHOLESTEROL STONES adverse effect
difference between HLA class I and class II
class i - HLA A,B,C, expressed by all nucleated cells and prsesentendogenous to CD8 class 2 - HLA DP, DQ, DR
perifollicular hemhorrhage, myalgia, subperiosteal hematoma, gingivitis
scurvy
what two things need to be known before PCR
dNA template that includes target region to be amplified
olignonucleotide sequence of flanking regions must be known to make primers necesssary to start PCR
receptor on T cells that binds to tumor cells which will DOWNREGULATE response of T cells against tumor cells
PD-1…similar to CTLA4
so tumors that overexpress these PD1 receptors can bypass T cell apoptosis and continue to grow…antibodies designed to block these receptors can help to kill these pesky tumor cells
What does the lagging strand need more of that the leading strand does not?
increased DNA primase and ligase activity (making and glueing together alot more fragments)
cardiomegaly, hypotonia, macroglossia, hepatomegaly, normal glucose, glycogen accumulation in lysozomes
dx and deficient enzyme
pompe
deficienct in a glucosidase
recurrent vertigo, ear fullness/pain, unilateral hearing loss and tinnitus
meniere dx
due to incerased volume of endolymph in inner ear
MOA IL-2’s anter cancer effects
IL 2 producd by helper T cells and stimulateds growth of CD4 and CD8 T cells and B cells…also activates natural killer cells and monocytes which helps kill metastatic melanoma and RCC
elderly woman presents with SBO with hard mass in ileocecal valve
gallstone ileus (from gallstone that has moved into intestinal lumen through colecystoenteric fistula) associated with air in biliary tree
Mechanism of cystic fibrosis genetic defect
most COMMONLY due to 3 base pair deletion at CFTR F508 position…mutation will impair post translational processing of CFTR resulting in shunting of CFTR toward proteasome
hemolytic anemia due to failure of glycoysis and rigid erythrcyte structure associated with what
increased extravascular hemolysis which will cause splenic hyperplasia in red pulp (increased removal of deformed erythrocytes)
MOA nitrate
primary venodilator with modest effects on decreasing systemic vascular resistance
all to reduce preload via guanylate cyclase cGMP system
dense fibrous deposits around tricuspid and pulmonary valves as well as moderate pulmonary valve stenosis WITH NORMAL LEFT HEART
metastatic carcinoid syndrome
associated with flushing, watery diarrhea, bronchospasm and elevated urine 5-hiaa
histologic hallmark in neutrophils during leukomoid reaction
remember luekocyte alkaline phosphatase is normal or increased in leukomoid reaction….peripheral smear shoes Dohle bodies (blue basophilic periphearl granules in neutrophils)…also associated with increased bands, toxic grnaulation, cytoplasmic granules
hereditary spherocytosis associated with increased risk of what GI complication
pigmented gallstones NOT AUTOSPLENECTOMY (THAT'S SICKLE CELL)
early MI, fibrinoid necrosis of arterioles, pericarditis, sterile valve vegetations on BOTH valvular surfaces, fibrino…wireloop changes and glomerular capillary basement membrane thickening
SLE
holosystolic murmur best heard at apex, radiating to axilla….how to tell severity
presence of s3 gallop
(severe mitral regurg will manifest sound indicating volume overload with increased
OD on something with garlic breath and profuse watery diarrhea…what is teh agent and antidote
arsenic
treat with dimercaprol and DMSA (succimer)
absence of ganglion cells in distal colon and rectum
hisrshsprung
failure of neural crest migration
how to dx hirschsprung
rectal SUCTION BIOPSY (because ganglion resides in submucosa and umuscular)
