uWorld 43 Flashcards
whats in rat poison
BRADIFACOUM (SUPERWARFARIN) a long acting 4-hydroxycoumarin derivative
depletes vitamin K clotting factors resulting in a coagulopathy similar to WARFARIN tox
use FRESH FROZEN PLASMA if emergency situation or vitamin K (if just the coagulation tests are fucked but no symptoms)
what is CRYOPRECIPITATE
obtained from fresh frozen plasma
contains factors VIII, XIIII, vWF, and fibrinogen
what accounts for dyspnea in left sided heart failure
DECREASED LUNG COMPLINACE (from fluid accumulation)
left ventricular contractility significantly decreases, reducing left ventricular output
resulting HIGH END-DIASTOLIC PRESSURE imparts diastolic return of blood TRANSUDATION of FLUID from the pulmonary capillaries into the lung interstitial
presence of fluid in the pulmonary intertisitium causes distortion (swelling) of affected tissue increasing resistance of movement (DECREASING LUNG COMPLIANCE)
as a result, the negative pressure generated during normal inspiratory effort is not sufficient to adequately distended the lungs, resulting in poor gas exchange and shortness of breath
what are some causes of decreased lung compliance
left sided heart failure
pulmonary fibrosis
insufficient surfactant
what enteric bacteria release AB5 toxins that activate electrolyte transport
Campy
Vibrio
what mediates cholesterol uptake
ENDOCYTOSIS via LDL receptor
GLUT transporters are examples of what
carrier mediated transport (FACILITATED DIFFUSION)
GLUT-4 is INSULIN SENSITIVE for UPTAKE of glucose found in SKELETAL MUSCLE and ADIPOCYTES
GLUT-2 facilitates export of glucose FROM the LIVER, SMALL INTESTINES, KIDNEYS into circulation
sickle cell causes what changes in hemoglobin
acidic glutamic acids (glu) residue at 6th position on beta-globing chain is replaced by NONPOLAR (neutral charge) VALINE (val) residue
leads to alteration of the region on the beta-globing SURFACE that interacts with a complementary site on another Hb molecule
the HYDROPHOBIC INTERACTIONS that occur cause aggregation of the Hb molecules (under anoxic conditions)
tertiary structure changed on surface
what happens in HbC
glutamic acids replaced by BASIC POLAR (positively charged) LYSINE
presence of lys causes HbC to have decreased mobility on electrophoresis
what is Familial Hypocalciuric hypercalcemia (FHH)
AD disorder due to defective CALCIUM SENSING by PARATHYROID and RENAL TUBULES
prevents PTH from being SUPRESSED in response to an INCREASE in CALCIUM
results in HYPERCALCEMIA with NORMAL-to-HIGH serum PTH levels
HYPOCALCIURIA due to impaired renal calcium sensing
what is seen in secondary hyperparathyroidism
chronic renal failure or vitamin D deficiency
hypocalcemia and elevated PTH
what is seen primary hyperparathyroidism
increased calcium and PTH
tetrahydropterin is needed for synthesis of what neurotransmitter
SEROTONIN (tryptophan hydroxylase needs it)
also Dopa, Norepi, and Epi (cuz phenylalanine hydroxylase and tyrosine hydroxylase needs it)
tetrahydropterin defieiceny causes what
disrupted neuronal and glial development (high phenylalanine development)
neurologic deterioration (low serotonin and other neurotransmitters)
developmental delay, hypotonia, dystonia, and seizures
low phenylalanine diet and BH4 supplementation
how is glutamate made
glutamine from glutaminase
how is GABA made
via glutamate decarboxylase
what patients are predisposed to priapism
sickle cell
multiple myeloma
how does trazodone work
serotonin modulator (antagonizes receptors and and inhibits reuptake)
alpha 1 blocker
H1 blocker
what causes mallory weiss tears
increased intraluminal gastric pressure due to retching, vomiting, or other abdominal straining
medicare is offered to whom
patients 65 or older who have worked and paid into the system
younger peeps with disabilities, end-stage renal disease, or ALS
what are the parts of medicare
part A: inpatient hospital visits
Part B; seller number of outpatient services and medical devices
Part C: optional captivated plan with additional benefits (vision, dental)
Part D: optional prescription drug plan
who is covered by medicaid
homeless
undocumented immigrants
PREGNANT WOMEN
LOW-INCOME families
what are causes of secondary hyperaldosteronism
renovascualr hypertension
malignant hypertension
renin-secreting tumor
diuretic use
what is superior mesenteric artery syndrome
if the angle between the SMA and aorta is less than 20 degrees (its normally 45 degrees), the TRANSVERSE PORTION of the DUODENUM can get trapped b/w the SMA and aorta, leading to symptoms of PARTIAL BOWEL OBSTRUCTION
happens when aorticomesenteric angle critically decreases, secondary to diminished mesenteric fat, pronounced lordosis, or surgical correction of scoliosis
narrowing of the aortomesenteric angle can occur with what
any condition that causes DIMINISHED MESENTERIC FAT, including low body weight, recent weight loss, severe burns or other inducers of catabolism, and prolonged bed rest
can also occur with prolonged lordosis or after surgical correction of scoliosis, as this procedure lengthens the spine resulting in decreased mobility of SMA
where do the gonadal arteries arise
abdominal aorta slightly below the renal arteries
right goes over IVC and below ileum
left goes behind left colic and sigmoid arteries and iliac colon
fever cough malaise
feeling sick since trip to great lakes
KOH of large yeast with SINGEL BUD that when incubated at 24C a multicellular structure with branching, tubular cells grows
fucking BLASTO
“DIMORPHIC”
SINGLE “BROAD-BASED” BUD
yeast has a DOUBLE REFRACTILE WALL
what is paracoccidioides
central and south america
CAPTAINS WHEEL on biopsy
multipel BLASTOCONIDIA on culture
mucocutaneous chronic mucocutaneous or cutaneous ulcers, can progress to lymph nodes and lungs
what looks like spaghetti and meat balls on KOH
malathesiza furfur
epidermal growth factor is implied in what cancer
HER2/neu
what is the clinical manifestation of AML
anemia
thrombocytopenia (petechiae, hemorrhages)
neutropenia (fever, opportunistic infection)
SIC
food- systemic circulation- meninges is seen in what infection
LSITERIA
gram + food born pathogen causing meningitis in neonates and pregnant
what happens to potassium in DKA
total body potassium DEFICIT but extracellular potassium is normal or increased
lack of insulin causes extracellular shifting of potassium as insulin normally promotes cellular uptake of potassium
make sure when giving insulin to give potassium too!
what the fuck is an ecological study
unit of analysis of a study is in POPULATIONS not individuals
frequency of a given characteristic (vitamin D intake) and a given outcome (multiple sclerosis) are studied using POPULATION DATA
useful to generate hypothesis but should not be used to make conclusion regarding individuals within these population (ECOLOGICAL FALLACY)
cross-sectional study is about what
PREVALENCE
collects data from a group of people to assess frequency of disease (and related risk factors) at a PARTICULAR POINT OF TIME
“What is happening”
what is the moa of digoxin
increased vagal tone (slows conduction through the av node)
Na/K ATPase inhbition- increased intracellular sodium and calcium (increases cardiac contractility)
what is seen digitoxin tox
cardiac arrhythmia and nonspecific GI (nausea, vomtiing), neurological (confusion, weakness) and visual symptoms
elevated potassium
atherosclerosis is initiated by what
repetitive endothelial cell injury
leading to chronic inflammatory state of underlying intima
how is severe hypoglycemia with loss of consciousness treated
IM GLUCAGON in a NONMETAL SETTING
IV DEXTROSE in a medical setting
what is used to treat mild hypoglycemia in a conscious patient
oral glucose
what are holocrine gland
SEBACEOUS (acne) and MEIBOMIAN glands
cells release ENTIRE contents of the cytoplasm and cell membrane
what are mercerize glands
SALIVARY, ECCRINE SWEAT, APOCRINE SWEAT
cells secrete via EXOCYTOSIS
what are apocrine glands
MAMMARY glands
cells secrete via MEMBRANE-BOUND VESICLES
what injectable insulin form of insulin that has no noticeable peak at all and lasts about 24 hours
GLARGINE (long acting that has pH of 4 and forms micropreipitate in the subcutaneous tissues after injection, resulting in a very slow release)
detemir doesn’t last quite as long as peak at 3-9 hours (starts in 2 hours)
when does regular insulin peak after injection
2-4 hours
starts after 30
lasts 5-8 hours
how is essential tremor treated
propanolol
AD familial tremor
improve with alcohol consumption
classically worsens while minting a particular posture (holding an object)
most common movement disorder
slowly progressive, symmetric postural and/or kinetic tremor that most commonly affects upper extremities
how do you prevent GBS meningitis in a neonate
intrapartum penicillin (ampicillin is an acceptable alternative)
vaginal/anal screening is done at 35-37 week gestation
what is the most common organism causing bacteria in sickle cell patients
STREP PNEUMONIAE
H flu (second most common)
recommended that all splenic patients receive penicillin prophylaxis and pneumococcal vaccination
how does pituitary apoplexy (hemorrhage) present
severe HEADACHE and visual disturbances
signs of meningeal irritation can also be seen (micmic subarachnoid hemorrhage)
can develop CARDIOVASCULAR COLLAPSE due to ATCH deficiency and subsequent
MEDICAL EMERGENCY that requires urgent neurosurgical consultation and treatment with GLUCOCORTICOIDS
what are the clinical manifestations of ALL
fever, fatigue, pallor, petechiae, and bleeding
lymphadenopathy, hepatosplenomegaly, and bone pain
most common malignancy of childhood
what is the AML M7 type
primitive megakaryoblasts
t(1;22) and Down syndrome associations
