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uWorld Flashies > uWorld 26 > Flashcards

uWorld 26 Flashcards

1
Q

what is the mechanism of Henoch-Schonlein purpura

A

IgA IMMUNE COMPLEX mediated vasculitis (Type III HYPERSENSITIVITY)
generally FOLLOWING an URI

PALPABLE PURPURA
ARTHRALGIAS
ABDOMINAL PAIN, intussusceptions
renal disease similar to IgA nephropathy (HEMATURIA)

IgA DEPOSITION in blood vessels

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2
Q

what is antibody-dependent cellular cytotoxicity

A

type II HYPERSENSITIVITY
part of body’s defense against viral and parasitic infections
antibodies bound to antigen on the surface of infected cells are recognized by Fc receptors on effector cells (NK, neutrophils, eosinophils) that then destroy the infected cells by releasing cytolytic granules

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3
Q

B7 is a cofactor in what reactions

A

functions as a CO2 carrier for many CARBOXYLASE enzymes (important role in carb, lipid, and amino acid metabolism)

PYRUVATE carboxylase: pyruvate to oxaloacetate (gluconeogenesis)

ACETYL-CoA carboxylase: acetly-Coa to malonyl-CoA (fatty acid synthesis)

PROPIONYL-CoA carboxylase: propionyl-CoA to methylmalonyl-CoA (fatty acid oxidation)

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4
Q

what signs and symptoms of biotin deficiency

A

mental status changes
myalgia
anorexia
chronic DERMATOLIC CHANGES (macular dermatitis)
METABOLIC ACIDOSIS (pyruvate converted to lactic acid)

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5
Q

what enzymes are required for the pyruvate dehydrogenase complex (PYRUVATE to ACETYL-CoA)

A 
B1
B3
B3
B5
LIPOIC ACID
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6
Q

transaminase reactions typically require what vitamin cofactor

A

B6

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7
Q

what is sulfasalazine (and mesalamine)

A

5-aminosalicylates used to treat inflammatory bowel diseases like Crohn’s and ulcerative colitis

inhibit cytokine, prostaglandin, and leukotriene synthesis during inflammation

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8
Q

multiple dark spots on liver on CT with contrast (stomach might look like a super bright white ball on right next to liver)
serum alk phos elevated and marginally elevated ALT
31 pound weight loss
anorexia and abdominal discomfort
the fuck he got?

A

METASTATIC cancer (liver is second most common site of spread (after lymph) due size, dual blood supply, high perfusion rate, and the filtration function of Kipper cells)

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9
Q

what is the most common liver neoplasm in children and what is it associated with

A

HEPATOBLASTOMA

associated with FAP and Beckwith-Wiedman syndrome

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10
Q

what are the time criteria for separation anxiety disorder

A

more than 4 WEEKS in a child

more than 6 MONTHS in an adult

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11
Q

when doing Kegle exercises what muscle is worked

A

LEVATOR ANI

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12
Q

prolonged labor can damage what structure resulting in urinary incontinence

A

EXTERNAL urethral sphincter (innervated by PUDENDAL NERVE)

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13
Q

the internal urethral sphincter is controlled by what

A

SMYPATHETIC NERVOUS SYSTEM controls it to contract and prevent urine leakage

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14
Q

what are the uterosacral ligament

A

runs long the LATERAL PELVIC WALLl and anchor the UTERUS and VAGINAL APEX by attaching to the SACRUM

weakening of these ligaments contributes to UTERINE and VAGINAL APICAL PROLAPSE

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15
Q

what is stress urinary incontinence and how can it be treated

A

involuntary urine loss with increased intraabdominal pressure (coughing, laughing, straining from constipation) and no bladder contraction

first line treatment: life-style modification (increased dietary fiber to prevent straining)

urethral support via pelvic floor strengthening (Kegel Exercises) targets the LEVATOR ANI to improve support around the urethra and bladder

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16
Q

what is the levator ani muscle

A

iliococcygeous, pubococcygeous, and puborectalis muscles make up the levator ani

holds the bladder and urethra in the appropriate anatomic positions

injury to these can result in URETHRAL HYPERMOBILITY and/or pelvic organ prolapse (CYSTOCELE)

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17
Q

what muscle compresses the vestibular bulb and constricts the vaginal orifice

A

BULBOSPONGIOSUS (part of SUPERFICIAL UROGENITAL TRIANGLE of the PERINEUM)

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18
Q

what eye nerve is fucked up if you can’t read things close up or walk down the stairs

A

TROCHLEAR (responsible for INTORTION and DEPRESSION while ADDUCTED, as well as adduction)

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19
Q

where are shots normally given in the ass and where are they given when they give you gluteal gait

A

NORMALLY given in sueproLATERAL quadrant

gluteal gait (Trendelenberg gait): superoMEDIAL quadrant (fucking up the SUPERIOR gluteal nerve (L4-S1) and gluteus medius muscle- hip drop observed contralaterally)

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20
Q

where should gluteal injections be given

A

most intragluteal injections should target: ANTEROLATERAL gluteal area (von HOCHSTETTER TRAINGLE) to minimize possibility of nerve damage

superolateral quadrant is considered safest place for DORSOGLUTEAL injections- damage to SCIATIC and GLUTEAL can result here

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21
Q

what is the major virulence factor for group A strep

A

M protein

  • inhibits phagocytosis and activation of complement
  • cytotoxic for neutrophils in the serum and a mediator of bacterial attachment
  • antigenic and stimulate type-specific immunity (mad different serogroups)
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22
Q

what does the DNase of step progenies do

A

extracellular enzyme that depolymerizes viscous DNA in pus and disintegrates polymorphonuclear leukocytes, allowing step to move more freely in the tissue

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23
Q

what does streptokinase do

A

extracellular enzyme that catalyzes PLASMINOGEN to PLASMIN, resulting in fibrin digestion and facilitating the spread of streptococci in infected tissue

used pharmacologically as a thombolytic agent

24
Q

what are teichoid acid and lipoteichoic acid

A

substances that are integrated into the peptidoglycan cell wall of some Gram-positive bacteria such as Staph Aureus

minor lipopolysaccharide-like endotoxin effect

25
Q

what is STRESS-MEDIATED MUCOSAL disease

A

characterized by acute gastric mucosal defects that develop in response to severe PHYSIOLOGICAL STRESS (shock, extensive burns, sepsis, severe trauma, intracranial injury)

multiple small circulate lesions in the smooch, from superficial erosions to full-thickness ulcers (which can perforate or BLEED)

due to impaired mucosal protection due to LOCAL ISCHEMIA caused by stem tic HYPOTENSION and SPLANCHNIC VASOCONSTRICTION

26
Q

cushing ulcers are a consequence of what

A

DIRECT VAGUS NERVE STIMULATION caused by elevated INTRACRANIAL PRESSURE, resulting in acetylcholine release and hypersecretion of gastric acid

found in esophagus, stomach, or duodenum

27
Q

what is a curling ulcer

A

proximal duodenal ulcer that is related to severe TRAUMA or BURNS

28
Q

what do you give someone with febrile seizures

A

ANTIPYRETICS (ACETAMINOPHEN or IBUPROFEN) can decrease fever and improve patient comfort by INHIBITING PROSTAGLANDIN SYNTHESIS

PGE2 reductions can REDUCE the THERMOREGULATORY set point in the HYPOTHALAMUS, lowering body temp

(NOT ACTIVE COOLING)

29
Q

what do you give to someone with heat stroke

A

rapid external cooling

30
Q

what is xanthochromia and when is it seen

A

BLOOD in CSF

Subarachnoid hemorrhage

most SENSITIVE screening for SAH is xanthochromia in the clinical setting of suspected SAH

31
Q

what should be suspected in sudden cardiac death in an otherwise healthy young individual

A

Wolff-Parkinson-White (WPW) syndrome

32
Q

what is seen histologically in temporal (giant cell) arteritis

A

granulomatous inflammation of the MEDIA
INTIMAL THICKENING
ELASTIC LAMINA FRAGMENTATION
GIANT CELL FORMATION (without distinct granulomas)

histologically identical to Takayasu arteritis

33
Q

why is the pressure in the left renal vein often higher than the right (what is this called)

A

compression between the aorta and the superior mesenteric artery (“NUTCRACKER EFFECT”)
can cause HEMATURIA and FLANK PAIN

pressure can move to left gonadal vein causing VARICOCELE

34
Q

in isolated DIASTOLIC heart failure what are the left ventricular end-diastolic pressure, left ventricular end-diastolic volume, and left ventricular ejection fraction

A

left ventricular end-diastolic pressure: ↑
left ventricular end-diastolic volume: NORMAL
left ventricular ejection fraction: NORMAL

35
Q

diastolic dysfunction can be due to what

A

conditions that decrease LV COMPLIANCE- impaired myocardial relaxation (ischemia, hypertophy) or increase intrinsic ventricular wall stiffness (from amyloid deposition, hypertrophy)

36
Q

conditions that reduce ventricular compliance lead to what

A

increased LV end-diastolic pressure (LVEDP) at the same LVED volumes

causes a shift in the pressure-volume curve that goes UPWARD and to the LEFT

37
Q

what anticoagulant (unfractioned hep, enoxaparin, or fondaparinux) is best at inactivating thrombin

A

UNFRACTIONED HEPARIN b/c it binds ANTITHROMBIN III and increases its activity against FACTOR X and THROMBIN

LMWH can only bind antithrombin II and factor X

fondaparinux is a synthetic factor Xa inhibitor

38
Q

what is Meziere disease

A

common cause of vertigo due to-
increased volume and pressure of endolymph (ENDOLYMPHATIC HYDROPS) thought to be due to defective RESORPTION of endolymph

recurrent vertigo
ear fullness/pain
unilateral HEARING LOSS and TINNITUS (low-frequency)
sensorineural hearing loss

39
Q

what is otosclerosis

A

inherited condition seen in middle age

conducive hearing loss due to bony overgrowth of the footplate of the stapes
no vertigo

40
Q

what is labyrinthitis

A

inflammation of the vestibular nerve that causes:
acute-onset vertigo
nausea
vomiting

usually occurs in a SINGLE EPISODE FOLLOWING a VIRAL syndrome

41
Q

neisseria gonorrhoeae can be cultured on Thayer-Martin VCN, this is a SELECTIVE medium made up of what

A

Vancomycin (kills gram positives)
Colistin (kills gram negatives other than neisseria)
Nystatin (kills fungi)
trimethoprim (kills gram negatives other than neisseria)

42
Q

what is a differential media

A

help identify cultured organisms based on their metabolic and biochemical properties

MacConkey and hoisin methylene blue (EMB) agars used to culture enteric organisms

lactose fermenting organisms are pink on MacConkey but black on EMB

43
Q

what is enrichment media

A

contain special growth factors required for some organisms

FACTORS X and V required by HAEMOPHILUS
or
the ANAEROBIC conditions needed by CLOSTRIDIUM

44
Q

what is a reducing media

A

THIOGLYCOLATE BROTH

remove oxygen and are used to culture anaerobic organisms

45
Q

what is a synthetic medium

A

any chemically-defined medium for which all of the chemical contents are known

46
Q

when Gq is activated what happens

A

actives Phospholipase C which which breaks down PIP2 to IP3 and DAG

IP3 then increases INTRACELLULAR CALCIUM, which also activated PROTEIN KINASE C

DAG stimulates PROTEIN KINASE C, which phosphorylates downstream intracellular proteins to produce its physiological effects (like smooth muscle contraction)

47
Q

what is the mechanism underlying HYPOXIC PULMONARY VASOCONSTRICTION

A

increase in pulmonary artery smooth muscle cytosolic Ca2+ levels secondary to hypoxia-induced modulation of K+ channels and/or decreased production of reactive oxygen species

48
Q

if a patient gains weight despite trying to eat healthy low calorie food and/or exercise
or if a patient loses weight unintentionally despite increased hunger

A

always look at THYROID

49
Q

what are the side effects of lithium

A

nephrogenic diabetes insipidus
hypothyroidism (appear tired, weight gain despite trying to eat healthy or exercise)
tremor
Epstein anomaly

dry skin
hairloss
constipation

50
Q

elevated homocysteine are an independent risk factor for what

A

THROMBOTIC EVENTS:
venous thromboses
coronary artery disease
ischemic stroke

thought to be due to direct and indirect induction of ENDOTHELIAL DAMAGE

51
Q

what is homocysteine metabolized into

A

METHIONINE via remethylation

  • donation of a methyl group form methy-tetrahydrofolate via METHIONINE SYNTHASE (B12 is a cofactor)
  • methyl-tetrahdrofolate is regenerated by MTHFR (FAD is a cofactor)

or to CYSTATHIONINE via transulfuration

  • cystathione-beta-synthase
  • get subsequently turned into cysteine via the enzyme cystathionase (B6 is a cofactor)
52
Q

low levels of what vitamins are associated with hyperhomocysteinemia

A

B12 (cobalamin)
B6 (pyridoxine)
B9 (Folate)

53
Q

the EML4-ALK (echinoderm microtubule-associated protein-like4 - anaplastic lymphoma kinase) fusion protein is assisted with what and has what kind of activity

A

NON-SMALL CELL LUNG CANCER

TYROSINE KINASE activity

54
Q

what is Li-Fraumeni

A

AD predisposition to variety of cancers
SARCOMA, BREAST, BRAIN, ADRENAL CORTEX

p53

55
Q

if patient has syphilis lesion but also has occasional headaches and memory loss what is it?

A

GUMMAS

neurosyphilis- headaches, memory loss, cerebrospinal fluid w/ VDRL positivity, pleocytosis
-meningoencephalitis, tabes doralis

cardiovascular syphilis- asymptomatic murmur with loud S2, ascending aortic arch calcification

uWorld Flashies (62 decks)

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