uWorld 38 Flashcards
glomerular sclerosis and hyalinosis is seen in what
diabetic nephropathy
ischemic tubular necrosis in the kidney results from what
hemorrhage, low-flow states (such as MI), or systemic vasodilatation (such as sepsis)
symptoms are those of acute renal failure:
oliguria, increased serum BUN and creatine (azotemia), fluid overload, and electrolyte disturbances
what is seen in pulmonary actinomyces
ASPIRATION and can be confused with lung abscess, malignancy, or tuberculosis
microscopic findings include FILAMENTOUS, branching, gram-positive bacteria and SULFUR GRANULES
FOUND in DENTAL CARIES and at MARGIN of GUMS in pts w/ poor dentition
tx: penicillin
when do CD4+ and when CD8+ T cells predominate in bronchiolar lavage
CD4+ in SARCOIDOSIS
CD8+ in HYPERSENSITIVITY PNEUMONITIS
what is thePI3K/Akt/mTOR pathway
intracellular signaling pathway that is important for cellular proliferation
activated when a growth factor binds to its receptor tyrosine kinase, causing autophosphorylation of specific tyrosine residues within the receptor
these phosphotyrosine residues activate PHOSPHOINOSITIDE 3-KINASE (PI3K), which then PHOSPHORYLATES PIP2 found in the plasma membrane to PIP3
this leads to activation of Akt (or PROTEIN KINASE B) a serine/threonine-specific protein kinase
Akt activates mTOR (mammalian target of rapamycin), which translocates to the nucleus to induce genes involved in cell survival, ANTI-APOPTOSIS, and ANGIOGENESIS
HIGHLY ACTIVE IN CANCER CELLS (increased activity of PI3K or Akt or loss of PTEN
what inhibits mTOR activation
PTEN (phosphatase and tennis homolog)- a tumor suppressor protein that removes the phosphate group form PIP3
tRNA that is charged with the incorrect amino acid (AND NOT CORRECTED by AMINOACYL-tRNA SYNTHETASE PROOFREADING) will do what
incorporate the wrong amino acid into the growing peptide chain
DNA glycosylases are involved in what
DNA base excision repair
following water deprivation where URINE most DILUTE
DISTAL CONVOLUTED TUBULE (b/c ascending limb of loop is where dilution occurs in the tubule
what is absorbed in the ascending limb of the loop of henle
ELECTROLYTES NOT WATER (main place of urine DILUTION though absorption of NaCl straight up w/ no water)
the iliohyogastric nerve arises form what root(s)
L1
suprapubic and gluteal regions and motor function to the anterolateral abdominal wall muscles
APPENDECTOMY can damage the nerve and cause decreased sensation and/or burning pain at the suprapubic region
what does the genitofemoral nerve do
L1-L2 and provides sensation to the upper anterior thigh and motor function to parts of the genital (cremasteric reflex in men, mons pubis in females)
what the lateral femoral cutaneous nerve
L2-L3 provides sensation to lateral thigh
what the femoral nerve do
L2-L4
sensation to upper thigh and inner leg
muscles that extend knee and flex at the hip
what is the most common indicator of obesity related lung disease (especially morbid, central obesity)
REUDCTION in EXPIRATORY RESERVE VOLUME (ERV) and FUNCTIONAL RESIDUAL CAPACITY (FRC)
FEV1, FVC, and TLC are also usually decreased
FEV1, FVC, and TLC may be increased in whom
trained athletes
dietary lipids(TGs, phospholipids, and cholesterol esters) are primarily DIGESTED in the DUODENUM via pancreatic enzymes. what happens next
bile salts emulsify lipid breakdown products, forming WATER-SOLUBLE MICELLES that facilitate lipid absorption in the JEJUNUM
most cholecystectomy patients can tolerate fatty foods in the diet because bile is constantly being released into the duodenum
mucicarmine stains what red
cryptococcus neoformans
due to POLYSACCHARIDE CAPSULE
what is the inheritance of hypertrophic cardiomyopathy
AUTOSOMAL DOMINANT (SARCOMERE GENES: beta-myosin heavy chain and myosin-binding protein C)
asymmetric left ventricular hypertrophy
adjustment disorder is not diagnosed if the patient meet the criteria for what
full criteria (sufficient number and severity of symptoms) for a MAJOR DEPRESSIVE EPISODE so then they have major depressive disorder
what are the criteria for major depressive episode
depressed mood loss of interest sleep disturbances appetite disturbances loss of energy psychomotor agitation or retardation impaired concentration guilt suicidal thoughts
what is premenstrual dysphoric disorder
depressive symptoms must remit with the onset of menses and diagnosis must be confirmed by daily prospective rating over several cycles
syncope and ECG recordings during the episodes showing POLYMORPHIC QRS COMPLEXES that CHANGE in AMPLITUDE and CYCLE LENGTH. Between the episodes ECG shows QT prolongation
whats he got and whats causing it
LONG QT SYNDROME with associated TORSADES de POINTS
electrolyte imbalances (hypokalemia, hypomagnesimia)
CLASS IA and III ANTIARRYTHMICS (quinidine, stall)
macrolides, fluoroquinolone
methadone
antipsychotics (haloperidol)
what is SOTALOL
a CLASS III ANTIARRYHTMIC
K+ channel blocker used for treatment of AFIB
prolonges action potential duration, resulting in QT interval PROLONGATION
tuberoeruptive and palmar xanthomas are sound in what hyperlipoproteinemia
Familial DYSBETALIPOPROTEINEMIA (type III)
APO E defect
ChYLOMICRON and VLDL remnants build up
also see PREMATURE CORONARY ARTERY DISEASE and peripheral vascular disease
lipoprotein lipase deficiency (or Apo C-II) is seen in what
FAMILIAL CHYLOMICRONEMIA SYNDROME (type I)
SEE SUPERNANANT LAYER IN PLASMA
chylomicrons build up
at risk for: ACUTE PANCREATITIS lipemia retinalis eruptive skin xanthomas hepatosplenomegaly
accelerated coronary artery disease, tendon xanthomas, and xanthelasmas are seen in what
familial hypercholesterolemia
defect in LDL receptor or ApoB-100
LDL builds up
can also see corneal arcus
klebsiella is a common cause of spontaneous bacterial peritonitis and nosocomial pneumonias as well as UTIs. what kind of organism is it
LACTOSE FERMENTING gram-negative rob
DERMATOMYOSITIS is a paraneoplastic syndrome of what cancers
OVARIAN
LUNG
colorectal
non-hodgkin lymphoma
what is seen in dermatomyositis
systemic autoimmune disease characterized by proximal muscle weakness resembling polymyositis but with additional inflammatory features of the skin
HELICOTROPE RASH in the peri-orbital area and checks along with GOTTRON’s PAPULE, which are raised erythematous places over the joints and bony prominences of the hands
muscle biopsy: mononuclear PERIMYSIAL INFILTRATES, perifascicular atrophy, and patchy necrosis
what is seen in Whipple disease
arthritis, diarrhea, fever
hyper pigmentation maybe
inflammatory disease of MUSCLES and SKIN and you are completely fucking lost
DERMATOMYOSITIS and its probably a paraneoplastic syndrome of:
OVARIAN, LUNG, colorectal, non-hodgkin lymphoma
what is a highly sensitive (but not specific) measure than can detect the degree of bronchial hyperactivity in suspected asthma
methacholine challenge test
sense its sensitive a negative test will help RULE OUT asthma
all patients with major depression should be screened for what
PAST HISTORY of MANIC EPISODES to differentiate major depressive direr form BIPOLAR DISORDER
especially in patients with past repaid responses to SSRIs (usually take 2 weeks to take effect)
acute retinal hemorrhage is most likely due to what
severe HYPERTENSION
can cause pre capillary arterioles to have endothelial disruption, leakage from plasma into the arteriolar wall, and fibrinous necrosis
necrotic vessels can then bleed into the nerve fiber layer, which can be seen on examination as DOT- or FLAME-shaped hemorrhages
what is seen in central retinal artery occlusion
most commonly due to atherosclerosis, cardioemoblic disease, or vasculitis
acute MONOCULAR VISION LOSS
CHERRY RED SPOT at the MCULA due to diffuse retinal ISCHEMIA
how does vanc work
binds terminal D-ala resides of CELL WALL GLYCOPROTEINS and prevents transpeptidases from forming cross-links
describe the work of breathing for patients with stiff lungs (increased elastic resistance)
minimized when the respiratory rate is high and the tidal volume is low (rapid shallow breaths are favored in disease that increase elastic resistance (pulmonary fibrosis, pulmonary edema, acute respiratory distress syndrome
graph looks like a normal patient but shifted up and to the left
synchronization of glycogen degradation with skeletal muscle contraction occurs due to what
release of sarcoplasmic calcium following neuromuscular stimulation
increased intracellular calcium causes activation of phosphylase kinase, stimulating glycogen phosphorylase to increase glycogenolysis
what is the lungs response to chronic irritation (like smoking)
squamous metaplasia
same concept seen in Barretts esophagus
what is linkage disequilibrium
pair of alleles from two loci are inherited together in the same gamete (calotype) more or less often than would be expected by random chance alone given their corresponding allele frequency
to estimate the probability of two allele appearing tother, multiple their occurrence rates others, why isnt it 2pq like hardy weinberg
Hardy-Weinberg is not applicable when comparing frequencies of two distinct loci
what is peiotropy
occurrence of multiple phenotypic manifestations, often in different organ systems, which result from a different gene
what is the law of segregations
describes the phenomenon in which gametogenesis results in the separation of paired chromosomes so that the offspring inherit only half of each parents genetic compassion
what should you emphasis to a parkinson patient experiencing “on-off”
that the drug response in unpredictable
whats going on in the “on-off” phenomenon
good mobility during “on” periods
and increased bradykinesia/rigidity during “off”periods
oftentimes fluctuations appear to correlate with serum drug levels (like reduced mobility 4 hr after last dose)
as parkinson progresses the therapeutic window for levodopa narrow, possibly due to natural or levodopa-induced NIGROSTRIATAL DEGENERATION
in advanced parkinson the motor fluctuations can occur INDEPENDENTLY of medication dosing and may become unpredictable
congestive heart failure with a normal thickness ventricle (1cm) and dilated ventricle is due to what
SYSTOLIC DYSFUNCTION (dilated cardiomyopathy or ischemic heard disease)
DECREASED VENTRICULAR CONTRACTION FORCE
high levels of 17-HYDROXYPROGESTRONE and ANDROGENS are seen in what
all forms of 21-HYDOROXYLASE DEFICIENCY
what is the classic, salt-wasting form of 21-hydroxylase deficiency
severe form of 21-hydroxylase deficiency (AR)
girls: ambiguous genitalia at birth
males: failure to thrive, dehydration, hyperkalemia, and hyponatremia after 1-2 weeks
what is the classic, NON-salt-wasting form of 21-hydroxylase deficiency
moderate form of 21-hydroxylase deficiency (AR)
girls: ambiguous genitalia at birth
males: signs of EARLY VIRILIZATION at 2-4 years old, accelerated linear growth due to shunting or corticosteroid precursors toward androgens
what is the non-classic, delayed form of 21-hydroxylase deficiency
mild form of 21-hydroxylase deficiency (AR)
premature pubarche or sexual precocity in school-age children
young women can preens with acne, hirsutism, and menstrual irregularities
how are all congenital adrenal hyperplasias treated
exogenous corticosteroids to decrease the excessive ACTH stimulation
