UWorld 2 Flashcards
What types of medications might increase osteoporosis risk? How might each of them cause this?
- anticonvulsants that induce cytochrome P450 (phenobarbital, phenytoin, carbamazepine)
- increase Vit D catabolism
- aromatase inhibitors and medroxyprogesterone
- decrease estrogen
- GnRH agonists
- decrease testosterone and estrogen
- PPIs
- decrease calcium absorption
- glucocorticoids
- decrease bone formation
What is the spleen derived from?
What is unique about the origin of its blood spupply?
mesoderm of the dorsal mesentery
blood supply is derived from a foregut derivative (splenic artery off the celiac trunk). venous return from the spleen goes through splenic vein to portal system
What is the liver derived from?
How does the liver receive blood?
endoderm derived structure of the foregut
receives arterial blood from the proper hepatic artery (via the celiac trunk) and receives venous blood from the gut via the portal vein
Where are the kidneys derived from and what are their arterial and venous connections?
mesoderm derived
retroperitoneal and supplied by renal arteries from the abdominal aorta and drained by renal veins to the IVC
The first two thirds of the transverse colon is derived from the… and supplied by…
Whereas the last one third of the transverse colon arises from the… and is supplied by …
How do the vessels anastomose?
midgut
superior mesenteric artery
hindgut
branches of teh inferior mesenteric artery
marginal artery
What is an endoderm-derived structure of the foregut that receives blood primarily from the superior and inferior pancreaticoduodenal arteries?
pancreas
Falsely conclude there is NO difference
Type II (beta) error
falsely conclude there is a difference
Type I (alpha) error
selection bias that can be created by selecting hospitalized patients as the control group
Berkson’s bias
Within a study, what will increase as sample size increases? What does this mean?
power
the larger the sample, the greater the ability of a study to detect a difference when one truly exists
What is the enzyme responsible for the production of the activated ribose necessary for de novo synthesis of purine and pyrimidine nucleotides?
What disease may have a mutation in this enzyme?
phosphoribosyl pyrophosphate synthetase (PRPP)
gout
What is responsible for the intense inflammatory response seen in patients with gout?
neutrophils
phagocytosis of urate crystals by neutrophils causes the release of various cytokines and inflammatory mediators that lead to further neutrophil activation and chemotaxis, resulting in a positive feedback loop that amplifies the inflammatory response
What is first line tx for gouty arthritis?
MOA?
What if the pt has contraindications to NSAIDs?
MOA?
NSAIDs
inhibit prostanoid biosynthesis (PGs, prostacyclin, thromboxanes) exerting a broad anti-inflammatory effect that includes inhibition of neutrophils
colchicine
impairs neutrophil migration and phagocytosis by interfering with microtubule formation and decreasing tyrosine phosphorylation in response to monosodium urate crystals
How do fibrates work to lower triglyceride levels?
What about fish oils?
activate peroxisome proliferator-activated receptor alpha, which leads to decreased hepatic VLDL production and increased lipoprotein lipase activity
with high concentrations of omega-3 fatty acids, they decrease production of VLDL and apolipoprotein B
What hydrolyzes triglycerides in chylomicrons and VLDL to release free fatty acids?
lipoprotein lipase (LPL)
Most cases of secondary bacterial pneumonia s/p influenza infection are caused by…
S. pneumo, S. aureus, and H. influenzae
reduced cardiac output in HF pts triggers compensatory activation of what systems?
What does this result in?
sympathetic nervous system and renin-angiotensin-aldosterone pathway
- resulting in vasoconstriction (increased afterload)
- fluid retention (increased preload)
- deleterious cardiac remodeling
perpetuate a downward spiral of cardiac deterioration, leading to symptomatic decompensated HF
biopsy shows endomysial inflammation without prominent vascular involvement in a scattered or patchy distribution
What autoantibodies might you see?
polymyositis
anti-histidyl-tRNA synthetase (anti-Jo-1) antibodies
What caution must you take with hydatid cysts?
Echinococcus granulosus is MCC, and spilling of cyst contents can cause anaphylactic shock
What is the MC inherited cause of intellectual disability?
What is the defect?
What does chromosomal analysis show?
Fragile X syndrome
unstable expansion of trinucleotide repeats (CGG) in the fragile X mental retardation 1 (FMR1) gene, located on the long arm of chromsome X
small gap near tip of the long arm of the X chromosome
What does the diphtheria vaccine do to prevent disease?
generates neutralizing IgG abs against the binding component of diphtheria toxin
How do alcohol-based disinfectants kill enveloped viruses?
dissolving lipid bilayer membranes
virus causing pink eye?
kids with this virus (rarely) can acquire what other pathology?
adenovirus (dsDNA, naked, linear)
hemorrhagic cystitis
ssx: febrile neutropenia w/ ecthyma gangrenosum (EG)
pathogen?
How does EG come about?
Pseudomonas aeuruginosa
perivascular invasion and release of tissue-destroying exotoxins leading to edematous skin patches that necrose