uWorld 3 Flashcards
most common intra0abdominal organ injured during blunt trauma is
SPLEEN (not a foregut derivative but is supplied by an artery of the foregut- splenic artery off the celiac)
intraperitoneal orago derived from the MESODERM of the dorsal mesentery
what is a case-control study
designed by selecting patients with a particular disease (cases) and without that disease (controls) and then determining their previous exposure status
what is a cross-sectional study
prevalence study
characterized by simultaneous measurement of exposure and outcome
snapshot of study seeing that frequently uses surveys
relatively inexpensive and easy to perform
what is often large and sessile and can have velvety or cauliflower-like projections in the colon
Villous Adenoma (long glands with villi-like projections extending from the surface
can SECRETE large amounts of MUCUS leading to SECRETORY DIARRHEA, hypovolemia, and electrolyte abnormalities
most likely adenoma to undergo MALIGNANT TRANSFORMATION
what are tubular adenomas composed of and what do they look like
dysplastic colonic mucosal cells that form tube-shaped glands and tend to be smaller and pedunculated
what is a harmatomatous polyp and when are they seen
disorganized mucosal glands, smooth muscle, and connective tissue
can cause bleeding and intussusception (not secretory diarrhea)
Pout-Jeghers syndrome
Juvenile polyposis
what is seen histologically in an intestinal carcinoid
insular and trabecular assess of monotonous SMALL ROUND CELLS with peripheral palisading, finely granular cytoplasm, small nucleoli, and SALT and PEPPER chromatin
what is a hyperplastic polyp
well-differentiated mucosal cells that form glands and crypts
also always asymptomatic
what is projection
immature defense mechanism that involves MISATTRIBUTING ONE’S OWN unconscious, undesired thoughts or FEELINGS to ANOTHER person who does not actually have them
erythrocyte glutathione reductase activity may be decreased in patients with what deficiency
riboflavin (B2)
FAD is a cofactor used by glutathione reductase to reduce disulfide bonds
pyruvate kinase deficiency presents how
AR
congenital hemolytic anemia due to impaired glycolytic ATP generation
erythrocyte transketolase is deficient in what patients
B1 (thaimine) deficiency which causes Wernicke-Karsakoff syndrome and beriberi
transketolase is an enzyme of the hexose monophosphate pathway
polyribosylribitol phosphate (PRP) is a major virulence factor of what and what does it do
Haemophelus Influenza
capsule which protects bacterium against phagocytosis and complement-mediated lysis by binding FACTOR H ( a circulating complaint control protein that prevents compleknt deposition on host cells)
what is the Hib vaccine
PRP conjugated to tetanus toxoid
what is trehalose dimycolate
cell wall component and major virulence factor of Mycobacterium tuberculosis
protects M. Tb from being killed by macrophages and simulates granuloma formation
how does toxic shock syndrome toxin (TSST) work
SUPERANTIGEN
MACROPHAGES (or another APC) and T CELLS receptor to cause a nonspecific WIDESPREAD activation of T lymphocytes
IL-2 from T cells
IL-1 and TNF from macrophages
capillary leakage, circulatory collapse, hypotension, shock, fever, skin findings, and multi organ failure
what is fetal hemoglobin made up of
alpha2gamma2
what is a compilation that can arise form a pudendal nerve block
inadvertent injection into internal pudendal artery or inferior gluteal artery (run medial to the PN) can lead to HEMATOMA or ARRHYTHMIA from intravascular infiltration of local anesthetics
landmarks: ISCHIAL SPINES and SACROSPINOUS LIGAMENT
the pudendal nerve is derived from what roots and provides sensory to what and mortar to what
S2-S4
sensory: genials and perineum
motor: sphincter urethrae and external anal sphincter
what is the course and innervation of the genitofemoral nerve
courses along the anterior surface of the psoas muscle
innervates scrotum/labia majora and the medal thigh
injury during ABDOMINAL RETRACTORS during LAPAROTOMY
what does the ilihypogastric nerve innervate and what injury fucks this up
suprapubic skin innervation
injury during PFANNENSTIEL skin incisions (CAESAREAN SECTION) can result in turing pain and paresthesias
the obturator nerve innervates what and what injury fucks it up
L3-L4
motor (adduction) and sensory to the medial thigh
RETROPERITONEAL PELVIC LYMPH NODE DISSECTION can result in loss of medial thigh sensation and ability to adduct the thigh
what is the course of the lateral femoral cutaneous nerve and what injury fucks it up
courses deep to the inguinal ligament to innervate the anterolateral thigh skin
commonly injured during HYPERFLEXION of the THIGH in the LITHOTOMY POSITION for PELVIC SURGERY or a VAGINAL DELIVERY
anterior and lateral thigh numbness (meralgia parenthetic)
what forms the roof of the cubital tunnel and what does compression here cause
aponeurosis of the flexor carpe ulnas at the elbow (spans from olecranon to the medial epicondyle)
ulnar nerve runs through here so compression causes sensory symptoms involving the ulnar aspect of the hand
what is the interosseous membrane and what does disruption here cuase
thick connective tissue sheet that runs between the radius and ulna
serves as a muscular attachment point and contributes to stability of the forearm
disruption can lead to instability of the forearm
how does one access the great saphenous vein
inferolateral to the pub tubercle
longest vein in body- superiorly from medial foot, anterior to the medial malleolus, and up the medial aspect of the leg and thigh
where is the ulnar collateral ligament and what does it do, what fucks it up
medial side of the elbow joint and strengthens and ulnohumeral joint
injuries occur most commonly in throwers (baseball pitchers) due to intense values dress at the elbow
treatment requires reconstruction surgery “Tommy John” surgery
what is radial head subluxation (nursemaids elbow)
sudden ration on the outstretched and pronated arm of a child
where does the deoxygenated blood that mixes with newly oxygenated blood come from
the BRONCHIAL BLOOD (via pulmonary veins) small cardiac (THEBESIAN) veins that drain into the left atrium and ventricle also contribute to normal anatomic shunting
diffusion limited hypoxia occurs frequently due to what
pulmonary fibrosis acute respiratory distress syndrome emphysema hyaline membrane disease of the infant (gas exchange does not equilibrate by the end of its traversal through the alveolar capillaries)
what is Candida intertrigo
erythematous plaques and erosions with satellite papule or pustules that can occur in the axillae, genital areas, web spaces of fingers/toes, skin folds
what congenital adrenal hyperplasia do all patients present phenotypically female
17 alpha hydroxylase
what are proprotein convertase subtilisin kexin 9 (PCSK9) inhibitors
monoclonal antibodies that reduce LDL receptor degradation in the liver
what is expression cloning
type of DNA cloning where the signals produce large amounts of a protein of interest
1st mRNA is used as a template by reverse transcriptase to produce cDNA w/ promoter sequences (Pribnow box or -35 sequence in prokaryotes) and translation stimulatory sequences (Shine-Dalgarno)
gene is incorporated into a plasmid and subsequently transcribed and translated into protein
in order to then be radiolabeded by a DNA probe, the PROTEIN MUST BE ABLE TO BIND DNA
Ex: transcription factors, steroids, thyroid proteins, vitamin D receptors, retinoid acid receptors, DNA transcription and replication proteins
what are some examples of proteins that are able to bind DNA
transcription factors steroids thyroid proteins vitamin D receptors retinoid acid receptors DNA transcription (C-myc, N-nyc) and replication proteins
how does protein kinase A work
activated by cAMP formed by adenylate cyclase
regulates activity of target proteins by phosphorylating threonine and serine residues
what cells mediate Type IV Hypersensitivity (delayed type hypersensitive)and what are some examples of it
Th1 lymphocytes presented antigen by dendritic cells via MHC-II which release interferon-g to cause recruitment and stimulation of macrophages contact dermatitis granulomatous inflammation tuberculin skin test Candida extract skin reaction
what drugs should be avoided in old peeps
1st generation antihistamines (diphenhydramine)
anticholinergic drugs (hallucinations, confusion, dry mouth, constipation)
alpha blockers (orthostatic hypotension)
TCAs (sedation)
sufonylureas (hypoglycemia)
muscle relaxants (sedation)
carbon tetrachloride causes what kind of injury to the liver
free radical injury- culminating in hepatocyte necrosis (and fatty change)
it is oxidized by CYP 450 oxidase system in liver resulting in formation of free radicals that react with the lipids of cell membranes (LIPID PEROXIDATION)
swelling of ER, destruction of mitochondria, increased permeability of cell membranes
what step of the citric acid cycle produces GTP (cycle is done in mitochondria)
succinate thiokinase (succinyl-CoA synthetase) succinyl-CoA → succinate
what steps of the Citric acidy cycle produce NADH (cycle done in mitochondria)
isocitrate dyhdrogenase (isoctrate → α-ketoglutarate) α-ketoglutarate dehydrogenase complex (α-ketoglutarate → succinyl-CoA) malate dehydrogenase (malate ↔ oxaloacetate)
what step of the citric acid cycle produces FADH2 (cycle done in mitochondria)
succinate dehydrogenase (succinate → fumarate)
what is an example of a GTP-hydrolyzing enzyme that converts oxalocacetate to phophoenolpyruvate during glujconeogeneis
phosphoenolpyruvate carboxykinase
total resistance in parallel is calculated how
1/TPR=(1/R1)+(1/R2)+(1/R3)….
patient with end stage renal disease who develops bleeding around the catheter exit site that is difficult to control who has NOT been on any anticoagulants probably has what problem and what lab values are changed (PT, PTT, platelet, BT)
uremic platelet dysfunction- excessive bleeding is common in patients with significant renal dysfunction in part due to accumulation of UREMIC TOXINS in the circulation
impair platelet aggregation and adhesion, resulting in QUALITATIVE PLATELET DISORDER
characterized by PROLONGED BLEEDING TIME
all other lab values are normal
can be improved by DAILYSIS to remove the toxins and partially reverse bleeding abnormality
what kind of protein is human epidermal growth factor receptor 2 (HER2 aka ERBB2)
transmembrane glycoprotein with TYROSINE KINASE activity
treat w/ trastuzumab an anti-HER2 monoclonal antibody
what chromosome is N-myc found on
2
the what is the sis porto-oncogene and when is it overexpressed
encodes platelet-derived growth factor
astrocytomas
osteosarcomas
a patient with a painful rash involving her groin an perineum that has been worsening for 2 weeks
has diabetes for 6 months
normocytic anemia 1 month
coalescing erythematous lesions w/ crusting and scaling at the borders w/ central areas of bronze-colored induration (superficial necroylsis in the lesion on biopsy)
what she got?
GLUCAGONOMA (high glucagon levels in serum)
rare tumor of ALPHA-Cells of pancreatic islets of Langerhans
necrolytic migratory erythema (elevated painful and pruritic rash of face, groin, extremities that coalesce and form large lesions w/ central clearing of bronze-colored induration)
rash also commonly affects mucous membranes leading to glossitis, cheilitis, and blepharitis
hyperglycemia leading to diabetes also happens
what are the level of amino acids like in glucagonoma and what is that thought to cause
low
necrolytic migratory erythema
excess somatostatin secretion from a somatostatinoma typically presents with what
abdominal pain gallbladder stones constipation hyperglycemia steatorrhea due to inhibition of insulin, glucagon, gastrin, secretin, CCK, and GI motility
how does zinc deficiency present
erythematous skin lesions occurring mainly around body orficies that are predominantly vesicular and pustular without a central clearing hypogonadism azoospermia hair loss impaired taste night blindness impaired wound healing
