uWorld 24 Flashcards
low bone density is a well known complication of hyperprolactinemia. What causes this
GnRH suppression from the hypothalamus leading to HYPOGONADISM, anovulation, and amenorrhea
if untreated the LOW ESTROGEN (hypogonadism) causes accelerated bone loss (same process as postmenopausal osteopenia/osteoporosis
also see vaginal dryness (low estrogen)
amniocentesis performed on a pregnant women; amnionic fluid bilirubin levels check for what
erythroblastosis fetalis
HIGH ANDROGEN levels and LOW ESTROGEN with CLITOROMEGALY and AMIGUOUS GENITALIA in a female fetus MATERNAL VIRILIZATION (HIRSUTISM and VOICE DEEPENING) during pregnancy
AROMATASE deficiency
at puberty: amenorrhea, osteoporosis, and tall stature (low estrogen delays fusion of the epiphyses
male fetuses with aromatase deficiency have what
tall stature and osteoporosis
no genital abnormalities
what is peripheral tolerance
T cell anergy- functional inactivation of T-cells that are reactive to self antigens
what is central tolerance
acquired within the fetal thymus during negative selection
what is the most common cause of CORONARY SINUS DILATION
elevated RIGHT-SIDED HEART PRESSURE secondary to PULMONARY HYPERTENSION
also: anomalous venous drainage into the coronary sinus, including persistent left superior vena cava and total anomalous pulmonary venous return
what can cause MEDICATION-INDUCED IgE-INDEPENDENT mast cell activation
OPIOIDS (MORPHINE)
RADIOCONTRAST AGENTS
some antibiotics (VANCOMYCIN)
activation of PROTEIN KINASE A and PI3 KINASE
release of histamine, bradykinin, heparin, and a number of enzymes and chemotactic factors
DIFFUSE ITCHING and PAIN, BRONCHOSPASM, and localized swelling (URTICARIA)
what takes over the role of fructose metabolism in fructokinase deficiency
HEXOKINASE
what happens to T3 levels in hashimotos
stays relatively normal until late in the disease then it drops
what is alirocumab
monoclonal antibody against PCSK9 that blocks this effect, resulting in increased availability of LDL receptors on hepatocyte membranes and subsequently increased clearance of LDL from the blood
as the testicles descend what two things they pass through
DEEP INGUINAL RING (TRANSVERSALS FASCIA)- the transversus abdomens muscle laterally and the inferior epigastric vessels medially
testis then passes anteromedially to exit the canal via the SUPERFICIAL INGUINAL RING, which is formed by an opening in the EXTERNAL OBLIQUE MSUCEL APONEUROSIS above and medial to the pubic tubercle
what is the conjoint tendon
common tendon of the transversals abdomens and internal oblique muscle
forms part of the posterior wall of the inguinal canal
the internal oblique aponeurosis contributes to what
formation of the conjoint tendon and rectus sheath
FREE ribosomes remain floating in the cytosol throughout protein synthesis. What are they responsible or translating
proteins found in the: CYTOSOL NUCLEOSOL PEROXISOME matrix NUCELAR-ENCODED MITOCHONDRIAL proteins
ATTACHED ribosomes bind to the RER after protein translation begins. what do they syntehsize
most SECRETORY proteins
the integral membrane proteins of the NUCLEUS and CELL MEMBRANE
proteins within the ER, GOlGI NETWORK, LYSOSOMES
how do ribosomes attach to the RER
TRANSLOCON- protein complex continuing ribophorins that bind the large 60s subunit
in what tow parts of the cell is ATP made
cytosol- glycolysis
mitochondria- oxidative phosphorylation
proteins in both these cellular compartments come from FREE ribosomes in the cytosol
steroid hormone synthesis and drug detoxification are performed by various proteins found in what
smooth ER
SEE does not bind ribosomes b/c it lacks the translocon complex
aging is associated with increased ARTERIAL STIFFNESS caused by what
endothelial dysfunction and a change in extracellular matrix composition (decreased elastin, increased collagen deposition)
this leads to decreased compliance of the aorta and major peripheral arteries, causing elevated pressures during systole- ISOLATED SYSTOLIC HYPERTENSION
what are some causes of isolated systolic hypertension
arterial stiffness (aging) severe aortic regurgitation systemic causes (anemia, hyperthyroidism)
celiac disease is a chronic malabsorptive disorder caused by hypersensitivity to gluten, a protein found in wheat, barley, and rye
what is seen on histology
VILLOUS ATROPHY
CRYPT HYPERPLASIA
INTRAEPITHELIAL LYMPHOCYTE INFILTRATION
DUODENUM and JEJUNUM fucked the most
when does celiac disease present and what screening can be done for it
6-24 months after the introduction of gluten into the diet w/ symptoms of malabsportion (diarrhea, flatulence, steatorrhea, nutrient deficiencies, weight loss)
IgA anti-endomysial antibodies
IgA anti-tissue transglutaminase antibodies
what is the most effective preventative intervention in almost all patients (and especially true in those with diabetes)
SMOKING cessation
what is the most common primary cerebral neoplasm in adults
GLIOBLASTOMA
arises from ASTROCYTES and is typically located within the CEREBRAL HEMISPHERES
can cause mass effect within midline shift and can CROSS CORPUS CALLOSUM (“butterfly glioma”)
on gross exam: soft and poorly defined with area of NECROSIS and HEMORRHAGE
highly malignant- poor prognosis
what does oligodendroglioma look like on gross exam
well-circumscribed gray masses with calcification
slow growing tumors of adults typically in white matter of cerebral hemispheres
what does primary central nervous system lymphoma present as
most often seen in the immunocompromised
multiple brain lesions involving the sep gray matter, while matter, and cortex
what lymph nodes are found bounded by the inguinal ligament, sartorious muscle, and adductor longs muscle and overlie the femoral nerve, artery, and vein
what do they drain
SUPERFICIAL INGUINAL LYMPH NODES
drain all CUTANEOUS lymph from the UMBILICUS DOWN- including external genitalia and the anus (BELOW the DENTATE LINE)
lymph from the superior portion of the bladder drains where
external iliac nodes
lymph from the prostate drains where
internal iliac nodes
also external iliac and sacral nodes (minor pathways)
lymph form the upper 1/3 of the rectum drains where
inferior mesenteric lymph node
a ureteral injury (a rare complication of pelvic surgery) presents with what
FLANK PAIN and FEVER and NO URINARY symptoms (due to other ureter working fine
the pelvic proton of the ureter starts at the level of the pelvic brim, and courses medially and anteriorly to the bifurcation of the common iliac arteries
then the ureter passes along the paterpelvic sidewall posterior to the ovarian vessels to dive under the uterine vessels (“WATER UNDER THE BRIDGE”)
what is boretezomib (a moronic acid-containing dipeptide)
a PROTEASOME INHIBITOR- induces APOPTOSIS of malignant plasma cells via accumulation of TOXIC INTRACELLULAR proteins and excess pro-apoptotic proteins
used in MULTIPLE MYELOMA plasma cells are susceptible to these b/c of increased protein production
what is seen in a newborn born to a mother with active hepatitis B
high viral load and HBeAG
highest risk for chronic infection
usually immune-tolerant (normal or mildly elevated lier enzymes, no symptoms)
Prevent w/: maternal antiviral therapy and newborn Hep B vaccination and immune globulin
interferon gamma increased expression of what
MHC I and II improving antigen presentation in all cells
how does alemtuzumab work
anti-CD52 humanized monoclonal antibody used for treatment of CLL
initiates direct cytotoxic effect through complement fixation and antibody-dependent, cell-mediated cytotoxicity
what is bevacizumab
humanized monoclonal antibody that interferes with VEGF receptor activation thereby inhabiting angiogenesis
what is ALDESLEUKIN
IL-2 tha tis used as immunotherapy for metastatic MELANOMA and RENAL CELL carcinoma
what is the inheritance patter of wilson disease
AR
edentate calcium disodium is first line treatment for what
lead poisoning
newborns have LOW VITAMIN K levels (due to poor transplacental transfer and low content in breast milk) which can IMPAIR CLOTTING FACTOR CARBOXYLATION leading to what???
BLEEDING- INTRACRANIAL HERMORHAGE (ICH) is a potentially fatal complication
signs of INCREASED INTRACRANIAL PRESSURE (altered mental status, enlarging head circumference/fontanelle, downward-driven eyes)
PREVENT: administer intramuscular vitamin K at birth
LOOK for this in AT HOME DELIVERIES
patient with febrile illness and INTRAERYTHROCYTIC INCLUSIONS (may even look maltese cross like but proly look like shit in the picture honestly)
either Plasmodium or Babesiosis if INTRAERYTHROCYTIC inclusions are there
Babesiosis is carried by the IXODIES TICK and seen in NORTHEAST US outdoor exposure in the SUMMER
Aedes mosquito is a vector for what
Dengue fever and chikungunya (found in Florida)
present with rash and arthralgia and a short incubation period (less than 14 days)
bimodal distribution of drug metabolism in a population suggests what
two apparently distinct groups- suggesting POLYMORPHISM in drug metabolizing capacity
two peas indicate two sets of responders to the drug within the population: one that rapidly converts the drug to its metabolite and another that converts the drug more slowly (leading to accumulation of the drug in the plasma)
who is isoniazid metabolized
acetylation to N-acetyl-isoniazid in the hematic microsomal system
excreted in urine
methylation is important for the biotransformation of what drugs
6-MP and azathioprine
dysostosis multiplex (enlarged skull, abnormally shaped ribs and vertebrae) and corneal clouding which can cause blindness is seen in what glycogen storage disease
HURLER (alpha-L-iduronidase deficiency)
actually a mucopolysaccharidosis
what is Bloom syndrome
small statue and infertility along with a predisposition to malignant and a classic sun-sensitive facial rash
AR that lead to chromosomal instability
neuropathic pain and angiokeratomas in adolescence and multi-organ involvement (real, cerebrovascular, cardiac) in adulthood is seen in what glycogen storage diease
Fabry
what is the most common genetic disorder among Ashkenazi jews
Goucher
hepatosplenomegaly
pancytopenia
severe bone pain
what is the mechanism of liver injury seen in HBV if the patient is HBsAg positive
HBsAg and HBcAg ar expressed in conjunction with MHC I
activation of cytotoxic CD8+ Tcells which respond by destroying the infected heaptocytes (vision itself does not have the cytopathic effect)
what accounts for the rapid onset and rapid termination of action of propofol and other highly lipophilic drugs
the readily diffuse across membranes, quickly accumulating in tissues receiving high blood flow- accounting for rapid onset of action
these compounds are subsequently redistributed to organs getting less blood flow- explains short duration of action
Hofmann elimination is the spontaneous degradation in plasma and organ tissue of a drug. What drug dos this happen to
Atracurium (non-depolarizing NMJ blocker)
what drugs are predominately eliminated via the lungs
VOLITILE INHALED anesthetics like halothane
what causes chest pain in lupus patients
PERICARDIAL INFLAMMATION (pericarditis)- pain increases on INSPIRATION (pleuritic) and is received by SITTING UP and LEANING FORWARD (postural)
pericardial FRICTION RUB
one of the serositis seen in lupus (pleurisy, and peritonitis too)
what are the clinical manifestations of SLE
constitutional: fever, fatigue, weight loss
Symmetric, migratory ARTHRITIS
Skin: butterfly rash and photosensitivity
SEROSITIS: pleurisy, peritonitis, pericarditis
thromboembolic events (due to vasculitis and antiphospholipid antibodies)
neurologic: cognitive dysfunction and seizures
when is dating a patient unethical
ALWAYS
can be ethical if provider-patient relationship terminate d WELL BEFOREHAND (can’t encourage them to find a ew provider and date them)
epigastric calcification and hostly of alcohol use
CHRONIC ALOCHOLIC PANCRATITIS
alcohol induced secreto of protein rich fluid
the proteinaceous secretions can precipitate within the pancreatic ducts, forming DUCTAL PLUGS that may CALCIFY and be detectible on abdominal imaging
pancreatic insufficiency (like from a ductal obstruction) cause EXOCRINE INSUFFICIENCY due to atrophy of the pancreatic acinar cells and pancreatic fibrosis. what does this lead to
malabsorption diarrhea steatorrhea weight loss bulky, frothy stools
what is the course of the median nerve
emerges as a distance structure arising form the lateral and medial cord fibers of the brachial plexus (C5-T1 fibers)
courses w/ brachial artery in the groove b/w the biceps brachia and brachial muscles
gains access to forearm in the medial aspect of the antecubital fossa and immediately courses b/w the humeral and ulnar heads of the PRONATOR TERES muscle
then travels b/w FLEXOR DIGITORUM PROFUNDUS and FLEXOR DIFITORUM SUPERFICIALIS before entering the wrist/hand within the FLEXOR RETINACULUM
where and what is seen with proximal median nerve lesions
supracondylar humerus fracture or entrapment b/w the pronator heres
sensor loss in the median nerve distribution
weakness on them FLEXION/OPPOSITION
flexion of he second/third digits, and wrist flexion/ABduction
“preachers hand” deformity due to weak thenar and flexor digitorum profundus of 2nd and 3rd digits
what is the course of the musculocutaneous nerve
penetrate the coracobrachialis muscle and initially courses b/w biceps brachia and coracobrachialis muscles before descending toward the elbow between the biceps brachii and brachialis muscles
what happens if musculocutaneous nerve is injured
loss of elbow flexors (biceps, brachial, coracobrahcialis)
loss of sensation over lateral forearm
what is the course of the ulnar nerve
b.w the olecranon and the medial epicondyle of the humerus before entering the forearm
lies b/w the flexor carpi ulnas and the flexor digitorum profundus muscle
injury: loss of sensation in the medial 1.5 digits of the hand and weakness on wrist flexion/ADduction, finger abduction/adduction, and flexion of the 4th and 5th digits
what is the course of the radial nerve
through the supinator muscle near the head of the radius
injury can cause wrist drop
loss of sensation to posterior arm and forearm, dorsolateral hand, and dorsal thumb
dermatitis herpetiformis is seen in what
CELIAC
anti-gliadin IgA that deposits in the tips of the dermal papillae
what are metaglitinides (nateglinide, repaglinide)
stimulate postprandial INSULIN RELEASE by binding to ATP DEPENDENT K+ channels on beta-cell membranes (site differs from sulfonylureas)
short-acting
cause weight gain and hypoglycemia
tissue damage and resultant abscess formation is primarily caused by what
lysosomal enzyme release from neutrophils and macrophages
what is responsible for development of granulomas and caseous necrosis
IFN-gamma production causing phagolysosome formation, inducibile nitric oxide synthase release
what is the most common cause of glomerulonephritis and presents with painless hematuria WITHIN 5-7 days of an UPPER RESPIRATORY TRACT INFECTION
IgA NEPHROPATHY (BERGER DISEASE)
hematuria lasts for several days and then subsides temporarily, returning every few months or with another upper respiratory infection
mesangial hypercellularity and IgA deposits
