uWorld 33 Flashcards
the COLA transporter is fucked in what
CYSTINURIA
what is seen in Cystinuria
COAL transporter fucked (free cysteine, ornithine, lysine, and arginine can’t be absorbed)
no amino acid deficiencies because absorbed as oligopeptides in gut
high urinary cystine concentration leads to CYSTINE KIDNEY STONES (FLAT, YELLOW, HEXAGONAL “SIX”tine for the 6 sides)
risk facts are LOW URINE pH, the presence o a preexisting CRYSTAL NIDUS, and URINE SUPERSATURATION
what is found to be SODIUM CYANIDE NITROPURRSIDE TEST positive
CYSTINURIA
what is SERTRALINE
SSRI
causes sexual dysfunction
how do influenza vaccines work
introduce NEUTRALIZING ANTIBODIES against he HEMAGGLUTININ ANTIGEN in select viral strains
what kind of vaccines strongly stimulates MCH class I antigen-processing pathway and can great CD8+ T cells that kill infected cells
LIVE-ATTENUATED
BOUNDING FEMORAL and CAROTID PULSES (marked by abrupt dissension and quick collapse (“water hammer” pulses) due to wide pressure pulses and HEAD BOBBING with CAROTID PULSATIONS (de MUSSET SIGN) due to momentum of left ventricle stroke volume to the head and neck is seen in what
AORTIC REGURGITAION (diastolic decrescendo murmur)
what is the cause of phenylketonuria if both hyperphenylalanemia and elevated prolactin are present, why
DIHYDROBIOPTERIN REDUCTASE (produces the cofactor TETRAHJYDROBIOPTERIN (BH4))
BH4 is required for PHENYLALANINE HYDROXYLASE (turns phenylalanine into TYROSINE) and also for TYROSINE HYDROXYLASE (converts tyrosine to DOPA)
without DOPA, dopamine cannot be produced via DOPA decarboxylase
with lower dopamine levels prolactin isn’t inhibited as well as normal
how can you tell von Willebrand and Bernard Soulier appart
both have abnormal ristocetin but in Bernard Soulier since vWF levels are normal the addition of normal plasma will not correct the aggregation
in vWD addition of normal plasma corrects the ristocetin test
what does ristocetin do
activates Gp1b receptors on platelets and makes them available for vWF binding
what is first line treatment for females with menorrhagia due to von Willebrand Disease
combined oral contraceptives
desmopressin may be used too
what is seen in congenital deficiency of factor XII (hangman factor)
prolonged PTT without bleeding diathesis
tendency for thromboembolic complications
any suprasellar mass with 3 components (solid, cystic, calcified) is highly suggestive of what
craniopharyngioma
present in childhood with visual defects and mass effect (hypopituitarism)
what causes DECEREBRATE (extensor) posture
lesion AT or BELOW the RED NUCLEUS (midbrain TEGMENTUM, PONS)
due to loss of descending excitation of the upper limb flexors (via rubrospinal tract) and extensor predominance (due to unopposed vistublospinal tract output)
what causes DECORTICATE (flexor) posturing
lesions ABOVE the RED NUCLEUS (cerebral hemisphere)
due to loss of descending inhibition of the red nucleus and subsequent hyperactivity of upper-extremity flexor muscles
damage to the cerebellar vermis does what
fucks up balance and coordination of the axial/proximal limb muscles, resulting in gait and truncal ataxia
maybe nystagmus and vertigo
damage to the internal capsule typically results in in what
contralateral motor/sensory deficits
cortical signs (aphasia, agnosia, neglect, apraxia, hemianopsia) are classically absent
damage to the dorsal midbrain (tectum) usually results in what
vertical gaze palsy (inability to look up) due to its proximity to the superior colliculus
may also cause light-near dissociation (pupils constrict for accommodation but not light)
bilateral damage to the thalamus can result in what
coma
what drug is a motilin receptor agonist used for gastroparesis
ERYTHROMYCIN
what 5 receptors regulate vomiting reflex
M1 muscarinic D2 dopamine H1 histamine 5-HT3 serotonin- good for chemo neurokinin 1 (NK1)- good for chemo
what is a CHOLESTEATOMA
collections of SQUAMOUS CELL DEBRIS that form a round, PEARLY MASS behind the tympanic membrane in the middle ear
cause painless OTORRHEA
primary- a result of chronic negative pressure in the middle ear causing retraction pockets int he tympanic membrane that become cystic
secondary- occur after squamous epithelium migrates to or is implanted in the middle ear (“skin in the wrong place”)
a chromosome 16 inversion is observed in what
M4Eo (eosinophilic) subtype of AML
what is used to treat RECURRENT C. DIFF infection in someone who is allergic to penicillin
FIDAXOMICIN (a macrolicyclic antibiotic-related to macrolides- that inhibits sigma subunit of RNA polymerase
bactericidal
oral vanc works for recurrent but not in allergic patient
dilated pupils are seen with what drugs
cocaine intox
opioid withdrawal
cortical watershed infarcts typically appear how
BILATERAL WEDGESHAPED strips of necrosis over the cerebral convexity, parallel and adjacent to the longitudinal fissure
severe carotid stenosis may develop unilateral
charcot-bouchard infants typically involve what structures
basal ganglia, cerebellar nuclei, thalamus, pons
cerebral amyloid antipathy results in what type of hemorrhage
lobar (occipital, parietal)
particularly in elderly
where do lacunar infantry occur
basal ganglia
internal capsule
pons
thalamus
what is the most common cause of viral gastroenteritis in developed countries
(especially in schools, hospitals, cruise ships, nursing homes)
NOROVIRUS- incubation period of 2 DAYS, fecal-oral spread, watery non bloody diarrhea
while you may think ROTAVIRUS in developed countries due to VACCINATION it is not most common cause. it is however in underdeveloped countries
what is the most common way that humans are infected with Bacillus anthracis
contact with infected animals or animal products or through use of biochemical weapon
phenylephrine, xylometazoline, and oxymetazoline are alpha adrenergic agonists that have prominent vasoconstriction in the nasal mucosa, making them effective decongestants. what is a draw back to their use
TACHYPHYLAXIS- rapidly declining effect after a few days of use
decreased production of endogenous norepi from the nerve terminals due to a negative feedback mechanism, resulting in relative vasodilation and subsequent EDEMA and CONGESTION
leads to EXACERBATION of nasal congestions symptoms
what is rebound rhinorrhea (rhinitis medicamentosa)
nasal congestion without cough, seeing, or postnasal drip (may or may nor have rhinorrhea)
associated with topical decongestants for MROE THAN 3 DAYS
STOP THE ADRENERGIC AGONIST DECONGESTANT
if patient has nonspecific symptoms but clearly has MALABSORPTION what test should be done to work up the condition
STOOL test with SUDAN III STAIN which test for FAT MALABSORPTION
this is done before further workup of celiac or anything in a case that is nonspecific and doesn’t point towards another problem to at least confirm the presence of malabsorption before further testing
if person is on warfarin and PT is increased but INR is below reference range what is going on
warfarin is NOT WORKING properly and a CYP INDUCER is being used with it
PT is up but in patient with clotting deficiency its not supposed to be normal so its actually low in this patient who is supposed to have a PT 2-3x normal which is represented by an INR of 2-3
what common antibiotics inhibit warfarin metaboism
METRONIDAZOLE
BACTRIM
in cystic fibrosis what causes the mucus in the lungs to be thick
increased sodium absorption
CFTR normally inhibits the apical epithelial sodium channel but can’t what its fucked up
REMEMBER THIS IS THE OPPOSITE IN THE SWEAT- the CFTR channel removes chloride from sweat and acts to resorb luminal chloride and activate ENaC to resorb sodium too making sweat hypotonic- but this is fucked in CF and sweat is then hypertonic
what is seen in the intestinal type adenocarcinoma
resembles colonc cancers
well-formed glands that consist of columnar or cuboidal cells
grow as nodular, polypoid, and well-demarcated asses that RAPIDLY EXPAND within the gastric lumen
often ulcerate/bleed and must be differentiated from peptic gastric ulcers by biopsy
rural thickening with acid hyper secretion is characteristic finding in the stomach of a patient with what
Zollinger-Ellison
what is Ménétrier disease
gastric hyperplasia of mucosa leading to HYERPTROPHIED RUGAE (looking like BRAIN GYRI
excess MUCUS PRODUCTION with resultant protein loss and PARIETAL CELL ATROPHY with DECREASED ACID PRODUCTION
Precancerous
H. pylori is found in highest concentrations where
gastric antrum (pre-pyloric area)
what is cinacalcet
calcimimetic that allosterically activates the calcium sensing receptor in the parathyroid gland decreasing PTH release
used for secondary hyperparathyroidism in dialysis patients
what is sevelamer
non-absorbable phosphate-binding polymer that decreases absorption of phosphate in the GI tract
used to treat hyperphosphatemia in dialysis patients
what is AGE-REALTED MACULAR DEGENERATION (AMD)
dry AMD : GRADUAL vision loss in one or both eyes and can cause difficulty with driving/reading
-likely due to chronic oxidative damage of the retinal pigment epithelium and chroiocapillaries, leading to subretianl inflammation with abnormal extracellular matrix formation (DRUSEN DEPOSITS)
wet AMD: ACUTE vision loss (days to weeks) with METAMORPHOSIS (distortion of straight line)
-GRAYISH-GREEEN sub retinal discoloration with adjacent fluid/hemorhage
TX: SMOKING cessation, VEGF inhibits (ranibizumab, bevacizumab) for WET AMB
epidermal growth factors (eroltinib, gefitinib) are used to treat what
non-small cell lung cancer
what is a P body
distinct foci found within eukaryotic cells the tare involved in mRNA regulation and turnover
occurs ONLY IN CYTOPLASM
function as a from of mRNA storage (some mRNA can be incorporated into P bodies only to be later release and utilized for protein translocation
what processing steps have to occur before mRNA can leave nucelus
5’-capping
poly A tail addition
intron splicing (snRNPs)
hypo chromic, microcytic anemia
always think iron deficiency and OCCULT BLOOD LOSS from GI Tract (EVEN IF PATIENT doesnt have dark stools or menorrhagia
the medial forearm sensory is from what
branch of medial cord off brachial plexus (medial cutaneous branch of the forearm)
how is minimal change disease treated
corticosteroids
what is the function of the posterior limb of the internal capsule
separate the globes pallid us and putamen form the thalamus and carries corticospainal motor and somatosensory fibers as well as visual and auditory fibers
what is the gene (“knee”) of the internal capsule
b.w anterior and posterior branches and carries corticobulbar fibers
what is the anterior limb of the internal capsule
separates the caudate from the globes pallid us and putamen
carries portion of the thamocortical fibers
berry aneurysms are associated with what two congenital disorders
Ehlers danlos
ADPKD
what is the main purpose of blinding in a clinical trial
prevent patient or researcher expectancy form interfering with the determination of the outcome
