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Step 1 Journal RC > UWorld > Flashcards

UWorld Flashcards

1
Q

Streptomycin mechanism

A

Inhibits initiation of protein synthesis by binding to and distorting the structure of the prokaryotic 30S ribosomal subunit. (aminoglycoside class)

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2
Q

Screening for carcinoid syndrome

A

5-hydroxyindoleacetic acid (Breakdown product of carcinoid syndrome)

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3
Q

Screening for mast cell degranulation

A

Tryptase (specific to mast cells)

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4
Q

Melanocytes are derived from what tissue

A

Neural crest

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5
Q

Aortic regurgitation

A

early diastolic murmur

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6
Q

most common cause of aortic reguritation

A

aortic root dilation (murmur is often best heard at the right sternal border) or bicuspid aortic valve

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7
Q

Goodpasture syndrome

A

C3 and IgG are deposited along the glomerular basement membrane. IF shows linear deposits of these complexes

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8
Q

Poststreptococcal glomerulonephritis

A

Preceded by skin or pharyngeal infections with group A beta-hemolytic streptocci.

IF shows diffuse granular pattern of IgG and C3 depostis within the glomerular capillary walls and mesangium

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9
Q

Rifampin

A

Halts bacterial protein synthesis by inhibiting bacterial DNA-dependent RNA polymerase, preventing transcription of DNA into mRNA

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10
Q

Streptomycin uses

A

Mycobacterial
Yersinia pestis
Tularemia

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11
Q

Ciprofloxacin drug class

A

Fluoroquinolone.

Inhibits DNA gyrase

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12
Q

Isoniazid action

A

antimycobacterial agent inhibiting synthesis of mycolic acids

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13
Q

Burkitts lymphoma

A

t8;14

c-myc: nuclear phosphoprotein functioning as a transcription activator controlling cell proliferation, differentiation, apoptosis

Ig heavy chain region

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14
Q

Follicular lymphoma

A

t14;18

bcl-2 gene: apoptosis inhibitor protein

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15
Q

CML

A

t9;22

BCR-abl: fusion gene encoding a proteint hat inhibits apoptosis while promoting mitogenesis and increased tyrosine kinase activity

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16
Q

Mantle cell lymphoma

A

t11;14

cyclin D1: promoter of G1 to S phase

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17
Q

Wilson disease mechanism

A

inadeq. hepatic copper excretion and failure of copper to enter circulation as ceruloplasmin.

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18
Q

Wilson disease s/s

A

Copper is Hella BAD

Cirrhosis, corneal deposits (kayser-Fleisher rings)

Hemolytic anemia

Basal ganglia degeneration (parkinsonian symptoms
Asterixis
Dementia, dyskinesia, dysarthria

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19
Q

Indicator of mitral stenosis severity

A

A2-OS interval, shorter is worse

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20
Q

Myocardian stunning

A

less severe form of ischemia-induced reversible loss of contractile function than hibernation.

Brief ischemic episodes

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21
Q

Ischemic pre-conditioning

A

development of resistance to infarction by cardiac myocytes previously exposed to repetitive non-lethal ischemia

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22
Q

Myocardial hibernation

A

persistentnt or repetitive low flow state, that can be reversed by reperfusion

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23
Q

Parts of tRNA

A

tRNA anticodon site-ribosome complex selects soley upon its anticodon sequence, red in teh 3’ to 5’ direction

D loop-dihydrouracil residues used for recognition by proper aminoacyl tRNA synthetase

Variable loop

Tarm-contains TpsiC loop necessary for binding of tRNA to ribosomes. Has thymidine,pseudouridine, cytidine residues. ONLY RNA SPECIES CONTAINING NUCLEOSIDE THYMIDINE

Acceptor stem-CCA hanging off 3’ end with hydroxyl accepting amino acid by aminnoacyl tRNA synthetase action

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24
Q

Vitamin B1 (thiamine) deficiency symptoms

A

beriberi and wernicke syndrome

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25
Q

Vitamin B2 (riboflavin) deficiency

A 
cheilosis
stomatitis
glossitis
dermatitis
corneal vascularization
ariboflavinosis
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26
Q

Vitamin B6 (pyridoxine) deficiency

A

cheilosis, glossitis, dermatitis, peripheral neuropathy

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27
Q

Folic acid deficiency characterized by

A

megaloblastic anemia

neural tube defects int he fetus

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28
Q

Vitamin K deficiency

A

bleeding diathesis, but not painful gums

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29
Q

zinc deficiency

A

acrodermatitis enteropathica, growth retardation, infertility

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30
Q

Scurvy

A

hemorrhages, subperiosteal hematomas, bleeding into joint spaces, gingival swelling, secondary periodontal infection, anemia, hyperkearatotic papular rashes, impaired wound healing, weakened immune response to local infections

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31
Q

what causes angiogenesis?

A

VEGF

FGF

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32
Q

What indirectly causes angiogenesis?

A

proinflammaotry cytokines like IL-1 and INF-gamma (increased VEGF expression)

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33
Q

Reaction formation

A

transformation of an unacceptable impulse or emotion into the opposite. (patient acting extremely relaxed around physician, saying she finds her appointments to be very soothing to defend against underlying anxiety)

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34
Q

Classical conditioning

A

neutral stimulus repeatedly paired with non-neutral stimulus that elicits a reflexive, unconditioned response.

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35
Q

Tardive dyskinesia

A

involuntary movements after chronic use (lip smacking, choreoathetoid movements)

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36
Q

Neuroleptic malignant syndrome

A

fever, rigidity, mental status changes, autonomic instability

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37
Q

Acute dystonic reaction

A

Sudden onset, sustained muscle contractions

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38
Q

Drug-induced parkinsonism

A

tremor, rigidity, bradykinesia, masked facies

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39
Q

main transmission paths of Hepatitis B

A

sexual
percutaneous
Vertical

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40
Q

Familial pulmonary arterial hypertension cause/results/treatment

A

Inactivating mutations in pro-apoptotic BMPR2 gene.

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41
Q

Familial pulmonary arterial hypertension consequences

A

Medial hypertrophy (arteriolar smooth muscle) intimal fibrosis, significant luminal narrowing

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42
Q

Familial pulmonary arterial hypertension treatment

A

Definitive is lung transplant

Vasodilators can improve symptoms

Bosentan: endothelin receptor antagonist blocking effects of endothelin (potent vasoconstrictor that also stimulates endothelial proliferation. ) decreasing pulmonary arterial pressure and lesson progression of vascular and right ventricular hypertrophy

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43
Q

Major side effect to amphotericin B

A

Renal toxicity

  • renal vasoconstriction, reduction in the GFR
  • Direct toxin on renal epithelial cells
  • acute tubular necrosis
  • electrolyte disturbance
  • renal tubular acidosis
  • normochromic normocytic anemia

-Hypokalemia
-Hypomagnesemia
are the most serious electrolyte disturbances that require supplementation.

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44
Q

Phenotypic mixing

A

co-infection of a host cell by two viral strains, resulting in progeny virions that contain nucleocapsid proteins from one strain and the genome of the other strain. Though no change to underlying viral genomes, so next generation of virions revert to original unmixed phenotypes

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45
Q

Interference (viral)

A

inhibition of one virus of the replication and/or release of a second virus that is infecting the same cell.

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46
Q

Transformation (viral)

A

incorporation of viral DNA into a host cell chromosome. alters genetic composition of the host cell, but typically no genomic changes to virus

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47
Q

Transformation

A

Uptake of naked DNA by a prokaryotic or eukaryotic cell

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48
Q

Viridans streptococci virulence factor for adherence

A

Produce extracellular polysaccharides (dextrans) using sucrose as a substrate. Facilitates adherence to fibrin.

(fibrin and platelets are deposited at sites of endothelial trauma, providing a site for bacterial adherence and colonization during bacteremia leading to teh formation of a valvular vegetation)

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49
Q

Action of heparin

A

Activate antithrombin III, thereby decreasing activity of
thrombin
Clotting factors IX, X, XI, XII

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50
Q

Most important environmental risk factor for pancreatic cancer

A

Smoking

Others include:
Age >50
Chronic pancreatitis
Diabetes mellitus
Genetic: Hereditary pancreatitis, MEN syndromes, Hereditary non polyposis colon cancer, Familial adenomatous polyposis syndromes
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51
Q

Risk for colon adenocarcinoma

A

low fiber diet

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52
Q

Alcohol as a risk factor

A

Head/Neck/Esophagus/Liver

Chronic pancreatitis

However, moderate alcohol use in absence of chronic pancreatitis does not add risk for pancreatic cancer

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53
Q

H. pylori as a risk factor

A

Gastric adenocarcinoma

Gastric lymphoma

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54
Q

S/S for adenocarcinoma at head of pancreas

A

(compressing the common bile duct)
Palpable but nontender gallbladder (courvoisier sign)
Wt loss
Obstructive jaundice (pruritism, dark urine, pale stools)

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55
Q

S/S for pancreatic cancers of body and tail.

A

(do not compress common bile duct)

No symptoms until invading splanchnic plexus causing midepigastric abdominal pain.

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56
Q

Courvoisier sign

A

Palpable but nontender gallbladder

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57
Q

Obstructive jaundice s/s

A

Pruritis
Dark urine
Pale stools

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58
Q

What is Lipofuscin

A

sign of wear and tear or aging in the heart and liver of aging or cachectic malnourished patients

Insoluble pigment composed of lipid polymers and protein complexed phospholipids

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59
Q

Oseltamivir class and action

What is it used for

A

Neuraminidase inhibitor, prevent release of virus from infected cells and spread within the respiratory tract

Influenza A and B

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60
Q

Eaton-Lambert syndrome mechanism

A

Autoab reacting with presynaptic calcium channels preventing release of ACh

Paraneoplastic syndrome assoc w. small cell carcinoma of the lung

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61
Q

Eaton-Lambert clinical presentation

A

resembles myasthenia gravis.

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62
Q

Valsalva, what is it
and what does it do
and what affect does it have on murmurs

A

straining to blow air out like a balloon but closed mouth and nose.

Decreases preload of heart.

Makes LVH murmur louder and mitral valve prolapse
Most other murmurs softer (aortic stenosis, pulmonic stenosis, tricuspid regurgitation)

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63
Q

Handgrip maneuvar

A

Increases afterload

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64
Q

M protein

A

major virulence factor for Strep pyogenes (group A)

Present in cell wall and antiphagocytic, interfereing with opsonization by alternative complement pathway.

Binds to fibrinogen, resluting in inflammatory mediator release and vascular leakage.

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65
Q

Wacky Wobbly and Wet indicates what?

How does it happen?

What does CT scan show?

What is the specific order of symptoms?

A

Normal pressure hydrocephalus (NPH)

Communicating hydrocephalus due to diminished reabsorptive capacity of the arachnoid villi.

CT scan shows symmetric dilation of ventriculi

(Gait abnormality, urinary incontinence are the first symptoms. Progresses to progressive dementia and emotional blunting)

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66
Q

How to test for Meckel diverticulum?

A

99-Pertechnetate study for ptake by ectopic gastric mucosa

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67
Q

How does Meckel’s diverticulum occur?

A

Failure of obliteration of the omphalomesenteric duct. May contain ectopic acid-secreting gastric mucosa and or pancreatic tissue

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68
Q

Presentations of Meckel’s Diverticulum

A
  • RLQ pain (similar to acute appendicitis)
  • Intussusception (colicky abd pain and currant jelly stools)
  • Volvulus
  • Obstruction near terminal ileum

Rule of 2s

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69
Q

What is the rule of 2s

A
  • 2 inches long
  • 2 feet from ileocecal valve
  • 2% of population
  • Presents in the first 2 years of life
  • May have 2 types of epithelial (gastric/panceratic)

(Meckel’s diverticulum)

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70
Q

Mutations affecting cardiac cell cytoskeletal proteins or mitochondrial enzymes of oxidative phosphorylation

A

Genetic form of Dilated Cardiomyopathy (DCM)

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71
Q

Mutations in cardiac cell sarcomere proteins (beta myosin heavy chain)

A

Hypertrophic cardiomyopathy

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72
Q

Mutations of a calcium binding sarcoplasmic reticulum protein

A

Arrhythmogenic right ventricular cardiomyopathy (ARVC), a progressive fibrofatty replacement of the right ventricular myocardium of uncertain pathogenesis

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73
Q

Mutations in K+ channel protein contributing to delayed rectifier current IK of the cardiac action potential (long QT), risk for Torsades de pointes

A

Romano-Ward syndrome

Jervell and Lange-Nielson syndrome

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74
Q

Superior mesenteric artery syndrome what is it and what are some causes

A

When the transverse portion of the duodenum is entrapped b/w the SMA and the aorta, causing symptoms of partial intestinal obstruction.

Aortomesenteric angle critically decreased secondary to

  • Diminished mesenteric fat
  • Pronounced lordosis
  • Surgical correction of scoliosis
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75
Q

What to check for confirming menopause.

A

FSH

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76
Q

Thiopental distribution

A

Equilibrates in brain tissue within 1 minute, ergo used fo induction of anesthesia.

Rapidly redistributes to skeletal muscles and fat.

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77
Q

Microvesicular fatty change in liver

A

Reye syndrome (children 5-10 after treatment with salicylates)

78
Q

Macrovesicular fatty change

A

Fatty liver from chronic ethanol consumption

79
Q

Drug induced cholestasis

A

OCP
Anabolic steroids
Chlorpromazine

80
Q

Hepatic granulomatosis is associated with..

A

Methyldopa
Hydralazine
Quinidine

81
Q

Massive hepatic necrosis
What causes it

What is seen on histo

clinical presentatino

A

Rare but severe complication of halothane exposure (especially halothane), due to direct liver injury by halothane metabolites and formation of autoantibodies against liver proteins. Occurs 2 days to 4 wks after the exposure.

Massive centrilobular hepatic necrosis

Hepatomegaly, liver tenderness, increased LFTs

82
Q

Von Hippel-Lindau disease characterization

Gene defect?

A

AD

Cerebellar hemangioblastoma
Clear cell renal carcinoma
Pheochromocytoma

Deletion of VHL gene on chromosome 3p

83
Q

RB location

implication of mutation

Normal Mechanism

A

Chr 13

Mutations lead to

  • Retinoblastoma
  • Osteosarcoma

Inhibits E2F normally blocking G1–>S phase

84
Q

WT-1 location

implication of mutation

A

Chr 11

Wilms tumor

85
Q

Alkaptonuria mechanism

Presentation

A

Congenital deficiency of homogentisate oxidase in the degradative pathway of tyrosine to fumarate

Autosomal recessive, benign. Dark connective tissue, brown pigmented sclerae, urine turns black on prolonged exposure to air. May have debilitating arthralgias (homogentisic acid toxic to cartilage)

86
Q

How is Cysteine made

A

Sulfur containing amino acid synthesized from amino acid Serine and Homocysteine (which is derived from methionine)

87
Q

Drug of choice for preventing venous thrombosis in non-ambulatory patients or patients undergoing elective surgery especially hip and knee.

Mechanism?

A

Heparin Unfractionated and also low molecular weight heparins

Increases the effect of the naturally occuring anticoagulant antithrombin III. Unfractionated heparin binds to antithrombin III by pentasaccharide in the heparin chain, causing a conformational change of antithrombi III, in turn increasing antithrombin binding and neutralization of thrombin

88
Q

Drug of choice for managing heparin induced thrombocytopenia

A

Lepirudin
Argatroban

Direct thrombin inhibitors, do not require antithrombin III

89
Q

Drug of choice following Percutaneous coronary intervention PCI and for treating unstable angina and non-Q wave MI

A

Ticlopidine and Clopidogrel

ADP inhibitors

90
Q

Drug of choice for primary and secondary prevention of MI and strokes. NOT as effective for preventing perioperative thromboembolism

A

Aspirin

Acetylates COXI, decreased Thromboxane A2

91
Q

Olanzapine use

mechanism of action

SE

A

Mood stabilizing in bipolar

2nd generation antipsychotic

SE:
Wt gain and metabolic side effects

92
Q

What organisms produce IgA proteases?

What is the point?

A

Streptococcus pneumoniae and Neisseria gonorrhoeae

Cleaves IgA antibodies preventing them from interfering with bacterial adhesion to mucous membranes.

93
Q

Characteristics of Klebsiella

A

Encapsulated
Lactose fermenting
Gram negative bacillus
Mucoid in culture

94
Q

Warfarin action

A

Inhibits Vitamin K dependent carboxylation of glutamic acid residues of factors 2, 7, 9, 10. also protein C and protein S.

95
Q

Drug of choice for long term anticoagulation to prevent venous thrombosis and resultant pulmonary embolism (VTE)

A

Warfarin

96
Q

What is keratin a marker for

A

Epithelial cell origin

97
Q

markers for endothelium

A

CD34, vWF, others

98
Q

muscle tissue identification

A

smooth muscle actin
Caldesmon
Desmin
others

99
Q

Lymphocyte pan T cell marker

A

CD3

100
Q

Most common location for intestinal carcinoids?

Other locations?

A

Ileum is most common location for intestinal carcinoids

Appendix and rectum also

101
Q

Histo of carcinoid tumors

A

nests or sheets of uniform cells

Eosinophilic cytoplasm and oval to round stippled nuclei

102
Q

Where are carcinoid tumors derived from?

A

Enterochromaffin cells of intestinal mucosa are the source of carcinoid tumors

103
Q

What is the polysarrharide-protein capsule of H. influenzae comprised of.

A

Linear polymer composed of ribose, ribitol, and phosphate (polyribosyl-ribitol-phosphate PRP)

104
Q

Adenoma to carcinoma sequence

A

APC inactivation

Methylation abnormalities
[hyperproliferative epithelium]
COX-2 overexpression

K-ras activation
[adenoma]
DCC inactivation

p53 inactivation
[carcinoma]

Further accumulations of genetic abnormalities

105
Q

What is the enzyme that controls glycolysis/gluconeogenesis

A

Bifunctional enzyme composed of PFK2 and 2,6-bisphosphatase.

106
Q

How is PFK2/2,6 bisphosphatase regulated?

A

bifunctional enzyme.

Glucagon causes phosphorylation, inactivates kinase, activates phosphatase. Decrease in Fructose 2,6 bisphosphate. Inhibition of PFK1 and increased gluconeogenesis.

Insulin causes dephosphorylation, Inactivates phosphatase and activates the kinase. Increased Fructose 2,6 bisphosphate. Stimulates PFK1 and increased glycolysis.

107
Q

periodic acid schiff stains for what

A

Stains glycogen, mucopolysaccharides, used to dx Tropheryma whipplei (Whipple disease).

and

Alpha1-antitrypsin deficiency (reddish-pink, PAS+ granules of unsecreted, polymerized A1AT in the periportal hepatocyteS)

108
Q 
Whipple disease
What causes it
how dx?
Presentation
Mnemonic?
A

Caused by Infection with Tropheryma whipplei (Gram positive)

Dx with PAS+ stain

Presents w/:
Foamy macrophages in intestinal lamina propria, mesenteric nodes. 
Cardiac symptoms 
Arthralgias and 
Neurologic symptoms are common.

Commonly in old men
FOAMY WHIPPed cream in a CAN

109
Q

Bronchial hyperreactivity is the hallmark of

A

chronic asthma

110
Q

Intraalveolar substance accumulation is a finding in

A

Interstitial pneumonitis

111
Q

Alpha1-Antitrypstin deficiency (A1AT) is what kind of disorder.

Genetics (alleles?

A

Autosomal co-dominant disorder affecting lungs and liver.

MM is normal
ZZ has decreased synthesis of AAT by the liver.

112
Q

Ghon focus

Ghon complex

A

Small area of granulomatous inflammation.

Ghon complex: Hilar lymphadenopathy + Peripheral granulomatous lesion in middle or lower lung lobe

113
Q

Healing of TB lung lesion may be complicated by

A

This persistent cavity may become secondarily infected with Aspergillus flavus and form fungus balls

114
Q

How is potency of inhaled anesthetics measured?

A

MAC, minimal alveolar concentration (alveolar concentration preventing movement in 50% of patients exposed to noxious stimuli)

115
Q

Arteriovenous concentration gradient influences what, not what?

why?

A

Influences the rate of induction, not anesthetic potency (MAC)

because high gradients mean you need more anesthetic to replace that uptaken by peripheral tissues

116
Q

How does thyroid bring iodine into the follicle?

What does this also bring in?

A

Na+/I- symporter

Perchlorate and Pertechnetate

117
Q

Nuclei involved in Pupillary light reflex

A 
Pretectal nucleus
followed by
Edinger-Westphal nucleus
followed by
Ciliary ganglion
118
Q

vWF function

A
  1. Platetlet adhesion by binding to and crosslinking platelet gliycoproteins (GpIb) and exposed collagen underneath damaged endothelium
119
Q

Vitamin A overuse

A 
Intracranial hypertension (papiledema)
Skin changes
Hepatosplenomegaly
120
Q

Vitamin C overdose

A

False negative stool guaiac results
Assoc with diarrhea and abdominal bloating
Calcium oxalate nephrolithiasis maybe

121
Q

B2 deficiency (riboflavin)

A 
Cheilosis
Stomatitis
Glossitis
Dermatitis
Corneal vascularization
Ariboflavinosis
122
Q

B12 deficiency

A

Older mentally slow woman of northern Euro descent lemon colored (anemic and icteric) smooth shiny tongue (atrophic glossitis) shuffling broad based gait

123
Q

niacin deficiency

A

3 Ds of pellagra,
dementia
dermatitis
diarrhea

124
Q

Thiamine deficiency

A

Infantile and adult beriberi

wernicke korsakoff

125
Q

First line Treatment of trigeminal neuralgia

mechanism

SE

A

Carbamazepine

By reducing ability of sodium channels to recover from inactivation, inhibits neuronal high frequency firing.

Aplastic anemia is a potential SE as well as
P450 inducer

126
Q

2nd line treatment of trigeminal neuralgia

A

Baclofen

Valproic acid

127
Q

trigeminal neuralgia presentation

first line treatment
2nd line treatment

A

brief episodes of sudden and severe electric shock like or stabbing pain in the distribution of CN V (particularly V2 and V3)

Carbamazepine is 1st line
Baclofen and valproic acid are second line treatments

128
Q

histo finding for granulosa cell tumor

A

Call-Exner bodies, small follicle like structures filled with eosinophilic secretions

129
Q

short acting benzodiazepines

A

Triazolam or alprazolam

130
Q

Intermediate acting benzodiazepines

A

Lorazepam

131
Q

long acting benzodiazepines

A

diazepam
flurazepam
chlordiazepoxide

132
Q

treatment of GAD or panic disorder

A

SSRI (Fluoxetine) but needs 4 wks to start and there is sometimes an initial transient worsening of symptoms.

Give Benzodiazepine initially (preferably short acting like Alprazolam or trazolam)

133
Q

what is assoc with mitochondrial toxicity

A

Cyanide

NRTIs

134
Q

Ribosomal protein synthesis inhibited by what toxins

A

Shiga toxin (Shigella)

Shiga-like toxin (ETEC enterohemorrhagic E. coli O157:H7)

135
Q

lithium side effects

A

Hypothyroidism
Nephrogenic diabetes insipidus
Ebstein’s anomaly in preg

136
Q

Carbamazepine SE

A

Aplastic anemia (CBC required to monitor)

137
Q

Citalopram SE

A

Sexual dysfxn

138
Q

Clozapine se

A

agranulocytosis and seizures

139
Q

Lamotrigine SE

A

Rash, stevens johnson syndrome

140
Q

Risperidone SE (also what kind of drug is it)

A

atypical antipsychotic, agranulocytosis and seizures

141
Q

SE of trazodone

A 
Painful erection (priapism)
Orthostatic hypotension
Sedation
142
Q

Transtentorial herniation can result in compression of what and what does this cause in each case?

A
  1. Ipsilateral oculomotor nerve (dilated fixed pupil down and out)
  2. Ipsilateral posterior cerebral artery compression (contralateral homonymous hemianopsia w/ macular sparing)
  3. Compression of contralateral of cerebral peduncle. or ipsilateral peduncle. (This results in hemparesis of ipsi or contra respectively.)
  4. Brainstem hemorrhages (Duret hemorrages, pons and midbrain due to stretch and rupture of basila artery. Fatal)
143
Q

Why is heat sensitivity seen in MS

A

Decreased axonal transmission assoc with increased heat

144
Q

What enzyme can convert procarcinogens into an active carcinogenic state in the body

A

Cytochrome P450 oxidase system (microsomal monooxygenase)

145
Q

at what lung volume is total pulmonary vascular resistance the lowest

A

FRC (higher than that you get stretching of alveolar capillaries, decreasing radius increasing resistance. Lower than that you get compression radially of extraalveolar vessels)

146
Q

What is seen in
Hyperacute rejection of lung

Acute rejection of lung

Chronic rejection of lung

A

Hyperacute rejection: graft blood vessel spasm and diffuse intravascular coagulation with resultant ischemia (due to preformed ab against ABO or HLA)

Acute rejection: 1-2 wks after, vascular dmg. Perivascular and peribronchial lymmphocytic infiltrates. Dyspnea, dry cough, low grade fever. Perihilar and lower lobe opacities (due to ricipient rxn to the HLA of the graft cell mediated imune response and CD8 t cells play central role)

Chronic rejection: mo-yrs, inflammation of the small bronchioles (bronchiolitis obliterans) inflamm and fibrosis of bronchiolar walls lead to narrowing and obstruction of the affected bronchioli. Dyspnea, nonlproductive cough, wheezing. (c/f with renal transplant chronic rejection has vascular obliteration)

147
Q

Resistance to penicillin

A
  1. production of beta lactamase

2. production of a low affinity penicillin binding protein

148
Q

Resistance to vancomycin

A

VanA ligase substitutes D-alanine D-lactate for D-alanyl-D-alanine thus preventing binding fo vancomycin.

149
Q

Resistance to tetracyclines

A
  1. synthesis of protein that allows ribosome to translation even in presence of drug
  2. Decreeasing intracellular concentrations of the drug by increased efflux or decreased influx
150
Q

Resistance to ciprofloxacin/fluoroquinolones

A

mutations in the DNA gyrase or topoisomerase genes

151
Q

Resistance to aminoglycosides

How is it acquired?

A

Production of aminoglycoside modifying enzymes that transfer diff chemical groups (acetyl, adenyl, phosphate) to the aminoglycoside antibiotic molecule outside of the bacterium, thereby decreasing the ability of these drugs to bind to ribosomes and exert their antimicrobial effects.

Not chromosomally mediated but acquired resistance mediated by plasmids or transposons.

152
Q

Human multidrug resistance gene codes for what?

A

P-glycoprotein, a transmembrane ATP dependent efflux pump protein that has a broad specificity for hydrophobic compounds. This can reduce the influx of drugs into the cytosol and increase efflux from the cytosol, thereby preventing the action of chemotherapeutic agents.

153
Q

Alport syndrome mechanism

Presentation

A

Inherited defect in the formation of type 4 collagen

Presents with

  • Thinning of the basement membrane
  • Hearing loss
  • Ocular abnormalities
  • Hematuria
  • Progressive renal insufficiency
154
Q

Minimal change disease mechanism

Presentation

A

Immune dysreg and overproduction of specific cytokine (IL-13) that dmgs the podocytes->effacement and fusion of footprocesses

Presents
-Selective loss of albumin

155
Q

Suprachiasmatic nuclei are involved in…

A

located immediately above the optic chiasm and receive visual input from retina via the optic tract.

Help to regulate circadian rhythms by relaying light information to other hypothalamic nuclei and to the pineal gland

156
Q

Supraoptic and paraventricular nuclei produce what

A

Vasopressin

Oxytocin

157
Q

Anterior hypothalamic nuclei coordinate what

Posterior hypothalamic nuclei coordinate what

A

Anterior coordinates cooling by stimulating parasympathetic NV

Posterior coordinates heat conservation and heat producxtion

158
Q

What is a SE of oxygen therapy to a neonate in respiratory distress

A

Retinal damage. Becaues the temporary hyperoxia may induce upreg of proangiogenic factors like VEGF upon return to room air ventilation

159
Q

Treatment of an acute manic episode

A

Mood stabilizing agent (lithium, valproate, or carbamazepine)
and
Atypical antipsychotic (olanzapine)

(mood stabilizer as monotherapy are effective in up to 60%)

160
Q

What can the swinging flashlight test show a relative afferent pupillary defect in the pupil contralateral to the tract lesion?

A

the nasal portion of theretina contributes more input to the pretectal nucleus than the temporal portion of the retina

161
Q

Lesion in the optic tract causes…

A

contralateral homonymous hemianopsia and a relative afferent pupillary defect (Marcus Gunn pupil) in the pupil contralateral to the tract lesion

162
Q

Myasthenia gravis is a ___ hypersensitivity disorder

A

Type II

163
Q

Contact dermatitis is a ___ hypersensitivity disorder

A

Type IV

164
Q

Hypersensitivity pneumonitis is a ____ hypersensitivity

A

Type III

165
Q

postinfectious glomerulonephritis is a ___ hypersensitivity disorder

A

Type III

166
Q

Goodpasture syndrome is a type ___ hypersensitivity disorder

A

Type II

167
Q

Sarcoidosis is a ____ hypersensitivity disorder

A

Type IV hypersensitivity

168
Q

acute hemolytic transfusion rxns are an example of ___ hypersensitivity

A

Type II antibody mediated hypersensitivity rxns

169
Q

avascular necrosis associations

A
  1. High dose steroid therapy and alcoholism
  2. Injury to the vessel wall (vasculitis) in SLE
  3. Sickle cell disease via thrombotic occlusion of arteries. Embolic occlusion (fat or air emboli) can also cause
170
Q

Cyanotic congenital heart diseases

A 
Truncus arteriosus
Transposition of the great vessels
Tricuspid atresia
Tetralogy of fallot
Total anomalous pulmonary venous return
171
Q

Non cyanotic congenital heart diseases

A

Atrial septal defect
Ventricular septal defect
Patent ductus arterosus
Coarctation of the aorta

172
Q

3 yo with recurrent cyanotic spells they counteract by squatting. what it his characteristic for

A

Tetraology of Fallot

173
Q

Fixed splitting of the 2nd heart sound is caused by

A

Atrial spetal defect

174
Q

S4 is caused by

A

Left ventricular hypertrophy/stiff left ventricle.

In younger patients it is always pathologic (unlike S3)

175
Q

What cause Charcot-Marie-Tooth disease

How does it present

A

Mutation of myelin protein gene.

“neural form” of muscular atrophy

Presents with weakness of foot dorsiflexion due to involvement of the common peroneal nerve

176
Q

what does a triple test test?

when is it done

What is the next step if abnormal

A

AFP
hCG
Estriol

done at wks 16 and 18 of gestation

Abnormal triple test indicates fetal Ultrasonography (USG). If this reveals no anatomic abnormalities and development consistent with mother’s dates, then amniocentesis is performed.

177
Q

What causes increased AFP

A
  • Dating error
  • Neural tube defects
  • Anterior abdominal wall defects (gastroschisis, omphalocele)
  • Multiple gestation
178
Q

What causes decreased AFP

A

Down syndrome

179
Q

VSD sound

A

loud holosystolic murmur best heard over the left sternal border in the 3rd or 4th intercostal space

180
Q

Isoniazid SE

A 
Hepatotoxic
Peripheral neuropathy (if not given pyridoxine also)
181
Q

Neuroblastoma is assoc with

caused by

A

assoc with opsoclonus-myoclonus, a paraneoplastic syndrome assoc with neuroblastoma

increased number of N-myc gene copies

182
Q

most common extracranial neoplasm in children

2nd most common brain tumor in children

A

Neuroblastoma is the most common extracranial

Medulloblastoma is the 2nd most common brain tumor

183
Q

culture negative endocarditis

A 
Bartonella
Coxiella
Mycoplasma
Histoplasma
Chlamydia
HACEK (haemophilus, actinobacillus, cardiobacterium, eikenella, kingella)
184
Q

slowly progressive symmetric postural and or kinetic tremor that most commonly affects the uppper extremities.

inheritance

other name

treatment

A

Essential tremor

Autosomal dominant

aka familial tremor

tx: beta adrenergic antagonist propranolol

185
Q

insidious onset exertional dyspnea and dry cough, with restrictive profile on pulmonary function testing and interstitial fibrosis and subplerual cystic airspace enlargement

A

idiopathic pulmonary fibrosis

186
Q

most common cardiac abnormality predisposing to NVBE among 15-60 yo americans. is.

what is a less common cause?

A

Mitral insufficiency due to myxomatous degeneration (mitral valve prolapse).

Rheumatic mitral valve deformity resulting in mitral regurgitation could predispose to bacterial endocarditis. but now treatment is better.

187
Q

PCWP measures what

what is it nearly equal to in normal conditions that is elevated with mitral stenosis

A

left atrial end diastolic pressure

LV end diastolic pressure. but mitral stenosis would increase PCWP and PAEDP relative to the LVEDP

188
Q

treatment of osteoarthritis

A

NSAIDs

intraarticular glucocorticoids

189
Q

Treatment of Rheumatic arthritis

A

NSAIDs
Glucocorticoids
DMARDs (Methotrexate/Sulfasalazine/TNF-alpah inhibitors (etanercept/infliximab/adalimumab)

190
Q

If given elevated Alk Phos, follow up with what to specify hepatocyte dmg

A

Gamma-glutamyl transpeptidase (GGTP)

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