uWorld 44 Flashcards
production of what cytokine correlates with severity of giant cell arteritis
IL-6
why is TOCILIZUMAB
monoclonal antibody to Il-6 that is effective in treating Giant Cell arteritis
what is the measure associated with case-control studies
exposure ODDs RATIO
what is the MOA of NITROGLYCERINE
VENOdilator (large veins in particular)
cardiac workload is decreased b/c blood collects in the venous system (redistribution) thereby decreasing PRELOAD
decreased preload decreased ventricular wall stress thereby decreased O2 demand
what is Osler-Weber-Rendu
hereditary hemorrhages telangiectasia
AD
congenital telangiectasis to the skin and mucous membranes
mucosal involvement may affect the lips, oronasopharynx, respiratory tract, gastrointestinal tract, urinary tract
rupture can cause: EPIStAXIS, GI BLEEDS, HEMATURIA
what is Surge-Weber
neurocutaneous disorder
cutaneous facial angiomas (leptomeningeal angiomas)
mental retardation
seizure
hemiplegia
skull radiopacitites
“tram track” calcifications on skull radiograph
what is seen in Tuberous sclerosis
kidney, lover, pancreatic cysts
CNS cortical and subependymal hamartomas
AD disorder
cutaneous angiofibromas (adenoma sebaceum), visceral cysts, and a variety of other hamartomas
renal angiomyolipomas
cardiac rhabdomyolipomas
seizure is major complication
when taking sexual history do you ask if they are straight, gay, bi or male/female/both
ask male, female, both b/c its less judgmental
what do you use in treatment-resistant schizophrenia (if haloperidol and risperidone have been tried and failed)
try CLOZAPINE
what is the order of the adenoma carcinoma sequence
APC (progression for normal mucosa to small polyp) then KRAS (increase in size) then p53 and DCC (malignant transformation)
what is injured in fracture of the neck of the fibula
common peroneal (fibular) nerve (most commonly injured nerve of the leg)- courses laterally around the neck of the fibula
FOOT DROP
- loss of DORSIFLEXION (anterior compartment- deep peroneal)
- loss of EVERSION (lateral compartment- superficial peroneal)
LOSS OF SENSATION of DORSUM of FOOT
- superficial peroneal does forum
- deep peroneal does area b/w 1st and 2nd toes
where does the common peroneal come from
branches off the sciatic (with he tibial were) posteriorly in the thigh just proximal to the popliteal fossa
what innervates the medial aspect of the leg
saphenous nerve (largest pure sensory branch of the femoral nerve)
what does the tibial nerve do
TIP
INVERSION and PLANTAR flex (gastroc, soles, tibialis posterior)
toe flexion
sensation to the sole of the foot, posterior calf, lateral foot
TISSUES of KNEE JOINT
dorsiflexion and/or eversion of the ankle can cause what kind of sprain
HIGH ANKLE sprain affecting the syndesmotic structures (interosseous membrane and anterior, posterior, and transverse tibiofibular ligaments)
these structures connect the tibia and fibula
unstable ankle joint with tenderness at the distal tibiofibular joint, but no significant swelling
what injury typically causes hemiballismus
LACUNAR STROKE (long standing htn or dm) of the SUBTHALAMIC NUCLEUS
what are the stool findings in watery diarrhea (noninflammaroty-ENTEROTOXIN)
NO FECAL LEUKOCYTES
NO RED CELLS
MUCUS and some SLOUGHED EPITHELIAL CELLS
vibrio, ETEC, bacillus cereus, staph aureus, some viruses, Giardia, Crypto, Cyclospora, microsporidia
what are the stool findings in dysentery or inflammatory diarrhea (inflammatory- invasion or cytotoxin)
fecal PMNs
with or without red cells
Shigella, Salmonella, Campy, EIEC, Yersinia enterocolitica, C diff, entamoeba histolytica
what are the stool findings in enteric fever (penetration and possible disseminate)
fecal MONONUCLEAR leukocytes
Salmonella TYPHI
what drugs can cause hyperkalemia
nonselective beta blockers (mess w/ beta-2 mediated intracellular uptake)
ACEI
ARBs
potassium sparing diuretics
DIGOXIN
NSAIDS (impaired PGs reduced renin and aldosterone secretion)
in a person with 6-months of progressively worsening impotence and loss of libido with suspected prolactinoma (elevated prolactin and blurring of peripheral vision) what are the levels of GnRH, LH, and Testosterone
GnRH: DECREASE (protecting down regulated this)
LH: decreased
Testosterone: decreased
what kind of protein is amyloid precursor protein
transmembrane glycoprotien
leprosy (hansen) disease is a deforming infection primarily of what
SKIN and NERVES (like schwann cells), also testicles and eyes
transmitted via respirator trout or prolonged skin-to-skin contact
ARMADILLOS is carrier in US
Tuberculoid: intact Th1 response (intact cell mediated immunity)
-mild skin plaques and are associated with hypo pigmentation, hair follicle loss, and focally decreased sensation
Lepratomous: intact Th2, no Th1 (weak cell mediated immunity)
-diffuse skin thickening, plaque-like hypopigmentation (with hair loss), leonine facies, paresis, regional anesthesia, testicular destruction, and blindness
whats the fasted and most direct method for diagnosis of syphilis
DARK-FIELD MICROSCOPY of material scraped from the surface of a cutaneous syphalic lesion (MOTILE HELICAL ORGANISM)
can also use serologic testing:
- nontreponemal tests: VDRL, rapid plasma antigen (RPR)- both for cardiolipin
- treponemal tests: fluorescent treponema antibody absorption, microhemagglutination assay for T palladium- both detect antibodies to specific treponema antigens (PTS REMAIN POSITIVE ON THESE FOR LIFE- antitreponemal therapy doesn’t get rid of them)
shallow, painful genital ulceration with regional lymphadenopathy that grows on a culture with factor X (hematin)
CHANCROID from Haemophilus ducreyi
describe ataxia telangiectasia
AR
CEREBELLAR ATROPHY- leads to ataxia in 1st years of life
OCULOCUTANEOUS TELANGIECTASIA
severe immunodeficiency with REPEATED SINOPULMONARY infections
risk of CANCER in these peeps in increased b/c INEFFICIENT DNA REPAIR (high rate of radiation-induced genetic mutation on cultured cells)
what inherited disorder are caused by deficient DNA-repair enzymes
Ataxia-telangiectaisa- DNA hypersensitivity to ionizing radiation
Xeroderma pigmentosa- DNA hypersensitivity ot UV radiation
Fanconi anemia- hypersensitivity to DNA cross-linking agents
Bloom Syndrome- generalized chromosomal instability (increased susceptibility to neoplasms)
HNPCC: defect in DNA mismatch-repair enzymes
physiologic insulin resistance occurs during 2nd and 3rd trimesters due to shunting of carb metabolism toward supplying glucose and amino acids to the fetus, this is primarily due to what
HUMAN PLACENTAL LACTOGEN (hPL aka chorionic somatomammotropin)- a peptide creased and secreted by syncytiotrophoblasts
leads to INCREASED GLUCOSE in MATERNAL circulation (glucose crosses freely into the fetus and is continuously confused for fetal energy
lateral lipolysis and proteolysis is also increased by hPL (fatty acids and ketones provide energy to moms)
how does gestational diabetes happen
the pancreatic function is not sufficient to overcome the pregnancy-related increase in insulin resistance (hPL STIMULATES PANCREATIC BETA ISLET CELL INSULIN PRODUCTION)
testing is more accurate in 3rd TRIMESTER with ORAL GLUCOSE CHALLENGE and measure serum glucose 1 hour after
what is seen in theophylline toxicity
acute: nausea/vomiting, abdominal pain, diarrhea, cardiac arrhythmias, seizures
SEIZURES And TACHYARRHYTHMIAS are major concerns
Tx: ACTIVATED CHARCOAL, beta blockers for the heart stuff, benzos for seizures
bradycardia, hypotension, and hypoglycemia are seen with what medication toxicity
beta blocker
GLUCAGON is the antidote (increased cAMP and cardiac contractility)
what are some examples of medications that can cause sideroblastic anemia
ISONIAZID (B6 is cofactor for ALAS)
chloramphenicol
linezolid
cystathionine synthase is fucked up in what
pyridoxine-dependent enzyme that catalyzes the formation of cystathionine from homocysteine
HOMOCYTINURIA happens (AR) that has marfanoid body habitus (BUT EYE IS DOWN AND IN), atherosclerosis, kyphosis, retard, osteoporosis
what is seen in pyruvate kinase deficiency
AR
hemolytic anemia
normocytic, normochromic anmeia
reticulocytois
elevated indirect bilirubin
whats a transtentorial herniation
uncal herniation
medial temporal lobe (uncus) herniates through gap b/w crus cerebri and the tentorium
FIRST SIGN is FIXED and DILATED PUPIL
ipsilateral CN III compression (ipsilateral down and out)
ipsilateral PCA compression (CONTRALATERAL HOMONOMYOUS HEMIANOPSIA w/ MACULAR SPARING)
compression of contralateral cerebral peduncle (crus cerebri) against tentorium (damage to contralateral corticospinal tract leads to IPSILATERAL HEMIPARESIS)
compression of ipsilateral cerebral peducle (CONTRALATERAL HEMIPARESIS)
brainstem hemorrhages (DURET hemorrhages) in the PONS and MIDBRAIN due to stretching and rupture of the basilar artery (usually fatal)
subfalcine herniation
CINGULATE GYRUS herniates under the fall cerebri, potential compressing the ANTERIOR CEREBRAL ATERY
tonsillar herniation
cerebellar tonsils displace through formate magnus and compress the medulla
COMA and RESPRIATORY DEPRESSION
due to link between hyperthyroidism and depression, TSH is a routine screen for depression. a physician not noticing a high TSH and prescribing antidepressants instead of fixing the thyroid problem is an example of what
preventable adverse event which resulted in DELAYED DIAGNOSIS
what is a preventable medical error
involve harm to the patient by ACT of COMMISSION or OMISSIOn rather than from the underlying disease and are the result of FAILURE to FOLLOW evidence-based BEST PRACTICE GUIDELINES
what is malpractice
LEGAL TERM- situations where treatment is blow accepted standard of practice and has resulted in injury or death to the patient
NOT A TYPE OF MEICAL ERROR
what is a near miss
medical error that is RECOGNIZED BEFORE any harm is done to the patient (patient is prescribed lethal doe of medication but the error is caught by pharmacist)
what is a NON-PREVENTABLE adverse event
complication that cannot be prevented given the current state of medical knowledge (allergic reaction to a medication in a patient with no known history of drug allergies)
what is a sentinel event
occurrence involving DEATH or SERIOUS PHYSICAL or PSYCHOLOGICAL INJURY (inpatient suicide, death of full-term infant, retained object after surgery) that requires IMMEDIATE INVESTIGATION
what will INCREASE the intensity of a hypertrophic cardiomyopathy murmur
DECREASE IN PRELOAD (or after load): decrease the separation b/w mitral valve and interventricualr septum, increasing obstruction
VALSALVA (straining phase)
ABRUPT STANDING (from sitting or supine position)
NITROGLYCERINE ADMINSTIRIAON
what will DECREASE the intensity of a hypertrophic cardiomyopathy murmur
SUSTAINED HANDGRIP (increased after load)
SQUATTING from standing position (increased after load and preload)
Passive leg raise (increased preload)
PHENYLEPHRINE infusion (selective alpha-1 agonist)- increased after load
what characterizes leukocytoclastic vasculitis (microscopic polyangitis, microscopic polyarteritis, hypersensitivity vasculitis)
segmental fibrinoid necrosis
what is rheumatoid arteritis
hypersensitivity vasculitis affecting arterioles and arteries of any size
produces VISCERAL INFARCTS after long standing rheumatoid arthritis
whats up with the SERMS
competitive inhibitor of estrogen binding
mixed agonist/antagonist action
both used to PREVENT BREAST CANCER in high-risk peeps
TAMOXIFEN- adjuvant TX of BREAST CANCER
RALOXIFENE: postmenopausal OSTEOPOROSIS
ADRs: photoflashes, venous thromboembolism
tamoxifen ADRs: endometrial hyperplasia and carcinoma
hospitalized patient for MI gets decreased urine flow and muddy brown casts, whats up in the kidneys
ISCHEMIC ACUTE TUBULAR NECROSIS due to decreased renal perfusion during cardiac arrest
one of most common causes of kidney injury in hospitalized patients
what is seen in acute tubular necrosis
due to reduced renal perfusion form severe hypovolemia, shock, or surgery
increased serum creatinine and BUN
normal cratinine/BUN ratio
OLIGURIA
predominately affects RENAL MEDULLA, which has low blood supple under normal conditions
straight portion of PROXIMAL TUBUE and THICK ASCENDING LIMB of HENLE are particularly susceptible to hypoxia, as they participate in the active (ATP-consuming) transport of iOS and have high O2 demand
what is seen histolgoically in acute tubular necrosis
FATTENING of PROXIMAL TUBULAR EPITHELIAL CELLS with LOSS of BRUSH BORDER
cell necrosis and denudation of the tubular basement membrane
MUDDY BROWN CASTS are variant of GRANULAR PIGMENTED CASTS that are PATHOGNOMONIC for ATN
most cases tubular epithelium REGENERATED and renal function typically returns to baseline acer 3 weeks
how does renal papillary necrosis present
GROSS HEMATURIA
FLANK PAIN
URINE TISSUE FRAGMENTS
due to urinary tract obstruction/infection, interstitial nephritis due to analgesic injection, or microvascular disease (DM or sickle cell)
