uWorld 26 Flashcards
what is the mechanism of Henoch-Schonlein purpura
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
what is antibody-dependent cellular cytotoxicity
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
B7 is a cofactor in what reactions
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)
what signs and symptoms of biotin deficiency
mental status changes
myalgia
anorexia
chronic DERMATOLIC CHANGES (macular dermatitis)
METABOLIC ACIDOSIS (pyruvate converted to lactic acid)
what enzymes are required for the pyruvate dehydrogenase complex (PYRUVATE to ACETYL-CoA)
B1 B3 B3 B5 LIPOIC ACID
transaminase reactions typically require what vitamin cofactor
B6
what is sulfasalazine (and mesalamine)
5-aminosalicylates used to treat inflammatory bowel diseases like Crohn’s and ulcerative colitis
inhibit cytokine, prostaglandin, and leukotriene synthesis during inflammation
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?
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)
what is the most common liver neoplasm in children and what is it associated with
HEPATOBLASTOMA
associated with FAP and Beckwith-Wiedman syndrome
what are the time criteria for separation anxiety disorder
more than 4 WEEKS in a child
more than 6 MONTHS in an adult
when doing Kegle exercises what muscle is worked
LEVATOR ANI
prolonged labor can damage what structure resulting in urinary incontinence
EXTERNAL urethral sphincter (innervated by PUDENDAL NERVE)
the internal urethral sphincter is controlled by what
SMYPATHETIC NERVOUS SYSTEM controls it to contract and prevent urine leakage
what are the uterosacral ligament
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
what is stress urinary incontinence and how can it be treated
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
what is the levator ani muscle
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)
what muscle compresses the vestibular bulb and constricts the vaginal orifice
BULBOSPONGIOSUS (part of SUPERFICIAL UROGENITAL TRIANGLE of the PERINEUM)
what eye nerve is fucked up if you can’t read things close up or walk down the stairs
TROCHLEAR (responsible for INTORTION and DEPRESSION while ADDUCTED, as well as adduction)
where are shots normally given in the ass and where are they given when they give you gluteal gait
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)
where should gluteal injections be given
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
what is the major virulence factor for group A strep
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)
what does the DNase of step progenies do
extracellular enzyme that depolymerizes viscous DNA in pus and disintegrates polymorphonuclear leukocytes, allowing step to move more freely in the tissue
what does streptokinase do
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
what are teichoid acid and lipoteichoic acid
substances that are integrated into the peptidoglycan cell wall of some Gram-positive bacteria such as Staph Aureus
minor lipopolysaccharide-like endotoxin effect
what is STRESS-MEDIATED MUCOSAL disease
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
cushing ulcers are a consequence of what
DIRECT VAGUS NERVE STIMULATION caused by elevated INTRACRANIAL PRESSURE, resulting in acetylcholine release and hypersecretion of gastric acid
found in esophagus, stomach, or duodenum
what is a curling ulcer
proximal duodenal ulcer that is related to severe TRAUMA or BURNS
what do you give someone with febrile seizures
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)
what do you give to someone with heat stroke
rapid external cooling
what is xanthochromia and when is it seen
BLOOD in CSF
Subarachnoid hemorrhage
most SENSITIVE screening for SAH is xanthochromia in the clinical setting of suspected SAH
what should be suspected in sudden cardiac death in an otherwise healthy young individual
Wolff-Parkinson-White (WPW) syndrome
what is seen histologically in temporal (giant cell) arteritis
granulomatous inflammation of the MEDIA
INTIMAL THICKENING
ELASTIC LAMINA FRAGMENTATION
GIANT CELL FORMATION (without distinct granulomas)
histologically identical to Takayasu arteritis
why is the pressure in the left renal vein often higher than the right (what is this called)
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
in isolated DIASTOLIC heart failure what are the left ventricular end-diastolic pressure, left ventricular end-diastolic volume, and left ventricular ejection fraction
left ventricular end-diastolic pressure: ↑
left ventricular end-diastolic volume: NORMAL
left ventricular ejection fraction: NORMAL
diastolic dysfunction can be due to what
conditions that decrease LV COMPLIANCE- impaired myocardial relaxation (ischemia, hypertophy) or increase intrinsic ventricular wall stiffness (from amyloid deposition, hypertrophy)
conditions that reduce ventricular compliance lead to what
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
what anticoagulant (unfractioned hep, enoxaparin, or fondaparinux) is best at inactivating thrombin
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
what is Meziere disease
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
what is otosclerosis
inherited condition seen in middle age
conducive hearing loss due to bony overgrowth of the footplate of the stapes
no vertigo
what is labyrinthitis
inflammation of the vestibular nerve that causes:
acute-onset vertigo
nausea
vomiting
usually occurs in a SINGLE EPISODE FOLLOWING a VIRAL syndrome
neisseria gonorrhoeae can be cultured on Thayer-Martin VCN, this is a SELECTIVE medium made up of what
Vancomycin (kills gram positives)
Colistin (kills gram negatives other than neisseria)
Nystatin (kills fungi)
trimethoprim (kills gram negatives other than neisseria)
what is a differential media
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
what is enrichment media
contain special growth factors required for some organisms
FACTORS X and V required by HAEMOPHILUS
or
the ANAEROBIC conditions needed by CLOSTRIDIUM
what is a reducing media
THIOGLYCOLATE BROTH
remove oxygen and are used to culture anaerobic organisms
what is a synthetic medium
any chemically-defined medium for which all of the chemical contents are known
when Gq is activated what happens
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)
what is the mechanism underlying HYPOXIC PULMONARY VASOCONSTRICTION
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
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
always look at THYROID
what are the side effects of lithium
nephrogenic diabetes insipidus
hypothyroidism (appear tired, weight gain despite trying to eat healthy or exercise)
tremor
Epstein anomaly
dry skin
hairloss
constipation
elevated homocysteine are an independent risk factor for what
THROMBOTIC EVENTS:
venous thromboses
coronary artery disease
ischemic stroke
thought to be due to direct and indirect induction of ENDOTHELIAL DAMAGE
what is homocysteine metabolized into
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)
low levels of what vitamins are associated with hyperhomocysteinemia
B12 (cobalamin)
B6 (pyridoxine)
B9 (Folate)
the EML4-ALK (echinoderm microtubule-associated protein-like4 - anaplastic lymphoma kinase) fusion protein is assisted with what and has what kind of activity
NON-SMALL CELL LUNG CANCER
TYROSINE KINASE activity
what is Li-Fraumeni
AD predisposition to variety of cancers
SARCOMA, BREAST, BRAIN, ADRENAL CORTEX
p53
if patient has syphilis lesion but also has occasional headaches and memory loss what is it?
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
