uWorld 46 Flashcards
what is the inheritance pattern of classical galactosemia
autosomal recessive
what is the inheritance pattern of Lesch-Nyhan syndrome
x-linked recessive
so is hemophilia B
what is tetanospasmin
protein toxin produced by C. tetani that can ravel by retrograde axonal transport into the CNS
binds GABA and GLYCINE receptors
TETANUS TOXOID (formaldehyde-inactivated tetanus toxin) vaccine- illicit HUMORAL IMMUNITY SPECIFIC for the TETANUS TOXIN
toxoid vaccines produce what kind of response
production of ANTITOXIN antibodies (active immunity)
immune defense against bacteria that the bacteria itself circulates causing infection produces what kind of response
antibodies that fix complement
regurgitant flow from the aorta into the left ventricle in chronic aortic regurgitation leads to an increase in left ventricular end-diastolic volume (preload) and wall stress, with resultant eccentric hypertrophy. Increases in left ventricular chamber size increases what that maintains the cardiac output
increases in STROKE VOLUME
nasal ulcerations, sinusitis, hemoptysis in setting of rapid progressive glomerulonephritis
Wegners
c-ANCA (targets neutrophil proteinase 3)
what are the first line medications or bipolar
lithium
valproate
quetiapine
squatting during Tet spells does what
increases SVR and decreases right-to-left shunting, thereby increasing pulmonary blood flow and improving oxygenation status
in the setting of low ADH where is the highest and lowest urine concentrations
highest: bottom of loop
lowest: distal convoluted tubules and connecting duct
beta thalassemia is due to what
mutations that result in defective transcription, processing, and translation of beta-globin mRNA
what buds are resistant to cephalosporins
LISTERIA (resistant PBPs)
MERSA (resistant PBPs)
ENTEROCOCCI (resistant PBPs)
Mycoplasma, Chlamydia (no cell wall)
what is the most common cause of meningitis in children over 28 days old
STREP PNEUMO
penicillin resistant so 3rd gen cephalosporin is first line
what drug is used to stop vasospasm after subarachnoid hemorrhage
calcium channel blocker No-mo-toppings NIMODIPINE
what is exaggerated sensitivity adverse drug reaction
predictable reaction occurring at lower than expected exposure
Tinnitus after single aspirin dose
what is idiosyncratic adverse reaction drug reactions
unpredictable reaction in certain patients
non immune hemolytic anemia with primaquine in G6PD deficiency
what is pierced in a suprapubic cystostomy
APONEUROSIS of the abdominal wall muscles, along with layers of the superficial fascias, transversals fascia, and exztraperitoneal fat
abduction of the thigh is done by what
gluteus medius and minimus (superior gluteal nerve)
tensor fascia lata
what does extension of the leg
quadriceps femrois muscle group
what does extension of the thigh
gluteus maximus (inferior gluteal nerve) exits through greater sciatic foramen below the piriformis
flexion of thigh is done by what
psoas, iliacus, and sartorial muscles
psoas innervated by lumbar plexus
iliacus is innervated by femoral nerve
the major determinant of whether or not a coronary artery plaque will cause ischemic myocardial injury is what
the RATE at which it occludes the involved artery
this allows for the collaterals that could prevent myocardial necrosis
the extent of tumor expansion is characterized by what
STAGE
not grade (degree of differentiation- well differentiated, mitotic figures)
in meningococcal meningitis blood levels of what correlate closely with morbidity and mortality
lipooligosaccharide (LOS)
decreased levels of consciousness, asymmetric pupils, and irregular breathing after alteplase administration
INTRA CEREBRAL HEMORRHAGE
atrial fib is associated with increased risk of systemic thromboembolism, where does this form
left atrial appendage is most common site of thrombus formation
what may contribute to the squamous metaplasia of the epithelial lining of pancreatic exocrine ducts
Avitaminosis A
vitamin A and its metabolite, retinoid acid, are required to maintain orderly differentiation of specialized epithelia, including mucus-secreting columnar epithelium
xi in a monoclonal antibody means what
chimeric (human constant regions/ foreign variable regions)
zu in a monoclonal antibody menas what
humanized (human constant and variable regions, except complementarity determining regions)
what is CERTOLIZUMAB
humanized monoclonal antibody that targets TNF-alpha
used in treating autoimmune disorder associated with elevated levels of TNF-alpha
imatinib treats what
philidelphia chromosome-positive CML
KIT-positive GIST
tyrosine kinase receptor inhibitor
what is VITILIGO
relatively common condition
partial or COMPLETELY LOSS of epidermal MELANOCYTES
flat, well-circumscribed macule and patches of absent pigment, varying in size
loss of melanocytes and a complete absence of melanin pigment
what is post inflammatory hypopigmentation
redistribution of existing melanin within the skin
may be associated with reduced transfer of melanin to keratinocytes
what skin lesion shows increased melanosome aggregates within the melanocyte cytoplasm
CAFE AU LAIT SPOTS
what are causes of polyhydramnios
Impaired Swallowing:
- fetal GI obstruction (esophogeal, duodenal, or intestinal atresia)
- anencephaly
Increased fetal urination:
-high fetal cardiac output (alloimmunization, parvovirus, fetomaternal hemorrhage)
maternal diabetes and multiple gestations can too but milder forms
what seen in pemphigus vulgaris
antibodies to gesmoglein 3 and 3 (desmosomes)
INTRAEPIDERMAL cleavage
ACANTHOLYSIS (detached keratinocytes)
tombstone cells along basal layer
net like appearance of IgG on immunofluorescence
oral/mucosal involvement
FLACCID bull
nikolski sign positive
what is seen in bulls pemphigoid
anti-bollous pemphigoid antigens 1 and 2 (hemidesmosomes)
SUBEPIDERMAL clevage
no pacantholysis
linear IgG at basement membrane on immunofluorescence
elderly
TENSE bull
rareoral/mucosal involvement
adhesion of cells to the extracellular matrix involves integrin-meidated binding to what
FIBRONECTIN, COLLAGEN, and LAMININ
differential expression of integrin subtypes affects adhesion properties of individual cells, and has been found to create with malignant behavior in number of tumors
what are examples of NMDA agonists
glutamate, aspartate, D-cycloserine
what drugs are NMDA antagonsits
KETAMINE
PCP
what are signs of PCP intoxication
dissociative and anesthetic effects but can cause psychosis and severe agitation leading to violent trauma
Ataxia, horizontal and vertical NYSTAGMUS, and delirium can be present
what is the ESSENTIAL pathogenic mechanism for SHIGELLA infection
MUCOSAL INVASION of M cells overlying the Peyer’s patches
what is silicosis
pneumoconioses
presents (10-20 years after initial exposure) with dyspnea on exertion and productive cough
nodular densities and calcifications of the rim of hilar nodes (eggshell calcification)
BIREFRINGENT SILCIA PARTICELS surrounded by fibrous tissue
APICAL LUNG regions
what is seen in berylliosis
dyspnea and ill-defined nodular or irregular opacities on CXR
noncaseasting epithelia granulomas without obvious, assicaoted particels
what is seen in coal workers pneumoconiosis
exertional dyspnea
nodular intertial opacities on CXR
nodal and perilymphatic lung tissue shows accumulations of coal dust-laden macrophages (coal macules)
wha is hypersensitivity pneumonitis
inhalation of organic dusts
exertional dyspnea
diffuse nodular interstitial infiltrates on CXR
nodal tissue may reveal noncaseasting granulomas
how is the diagnosis of tetanus made
history and physical examination
