UWorld Flashcards
Furosimide SFx
hypokalemia, hyperuricemia, hypovolemia
Methotrexate SFx
hepatotoxicity, pulmonary fibrosis, bone marrow suppression
Metoprolol SFx
Selective B1-andrenergic blocker, few SFx
Penicillin SFx
hypersensitivity
What else to screen for with Major Depressive Disorder?
History of bipolar disorder (rule out unipolar disorder)
MDD = SIG E CAPS
multiple episodes, over last 6-12 mo, 5/9 following
*pt w/fast onset SSRI could be clue of mania
Pharyngeal Arches (and pouch/clefts) -rules
mesoderm forms: muscle, vascular neuroectoderm: bone, CT -each arch innervated by own CN *just think about arch number and associated place on upper body, with DIT rules, should be able to get there Arch 1 = M and T Arch 2 = S (stapes) Arch 3 = pharyngeus everything Arch 4 and 6 = Cricoid, thyroid, larynx
Antibody structure
Light chain = binds the antigen at FAB (fragment ag binding region)
Carboxy end of heavy chain = (farthest from LC is where Frc region) binds the Fc R on phagocytes
LC ag binding signals phagocytosis of ag
Neurophysin
Hypothalamus transports for OTC and VPN
Gene MT could lead to Central DI because no VPN/ADH will be released
Rapid glomerulonephritis with crescent formation
macrophages and t cells enter bowmans space, dmg capillaries, BM gets gaps, fibrin deposits and fibrosis occurs
Infection and risk of abscess at this muscle for HIV, DM, IV drug users
iliopsoas muscle (primary iliopsoas muscle abscess)
Fragile X syndrome
mild intellectual disability, CGG repeat, macrocephaly, long narrow face, macroorchidism
FMR1 gene
*small gap near tip of long arm of X chromosome (cytogenetic studies)
Oxygen-Hb Dissociation Curve (R/L Shift)
Right shift (left shift is opposite) = Hb decrease affinity for oxygen "ACE BATs right" Increase: Acid CO2 Exercise 2,3 - BPG Altitude Temperature If Hb has an increased affinity for oxygen (or decrease in above), less oxygen will be released, leading to errythrocytosis (via EPO release)
Withdrawal Sx for: alcohol, stimulants (cocaine, amphetamines), benzodiazepines, heroin, nicotine
alcohol: delirium,agitation, PE: tremor, seizure
stimulants: intense psychomotor agitation with severe depression, no PE
benzodiazipines: agitation, anxiety, tremor, PE: seizure
nicotine: increased appetite, no PE
Heroin: N/V, abd pain, PE: yawning, lacrimation, dilated pupils
Achondroplasia - genetics/heritability
Sporadic MT, AD heritable, MT Fibroblast GFR3 (FGFR3),
Krukenberg tumor met to ovaries - describe features of this malignant CA and met statistics
Tumor - primary GI tumor that met to the ovaries (#1 met to ovaries is GI CA), Histo: signet ring cells with large amounts of mucin displacing the nucleus. It spread by lymphatics and seeded the peritoneum
Px - weight loss, early satiety (met), epigastric pain
B Cell maturation including VDJ/VJ and Isotype
B Cells:
1 - proliferate/mature in bone marrow (go to lymphoid organs)
-VDJ (heavy chain) / VJ (light chain) rearrangement occurs via DNA rearrangement
2 - Ag exposure/activation (some go into blood with IgM specificity ST, some go on as plasma cells, others go to follicle of LN for further maturation)
3 - Follicle: Germinal center, cortex of LN - isotype switching (IgG to.. IgA). Activated B-cell expresses CD40 and connects with CD40L CD4+, CD4+ cytokines mediate isotype switching (IL 2/4/5/6, INF-gamma)
-subsequent Ag encounters by B cell release IgG (IgA for mucin)
*negative selection is T cells in the thymus
Heart pressures RA, RV, PA, LA, LV, Aorta
RA <5, RV 25/5, PA 25/10, LA <10, LV 120/10,
Aorta 120/80
Bacterial endocarditis - Aortocavitary fistula - where does blood flow?
because Aortic P»_space;»» RV P,
blood with CONTINUOUSLY flow from aorta to the RV with a fistula between them
Where is most water absorbed in the nephron?
Proximal convoluted tubule (beginning), just like everything else, the rest of nephron is for lesser adjustments (electrolytes, acid/base dumping, water reabsorbing) and concentrating the urine
Mullerian aplasia/vagina agenisis/MRKH syndrome
variable uterine development, no upper vagina, primary amenorrhea, normal development of ovaries, regular development of secondary sexual characteristics (breasts, etc.)
Sexual development-Mullerian vs Wolfian
Mullerian is default, wolfian ducts will degenerate without anything. Male - testosterone will cause mullerian ducts to degenerate and wolfian ducts to grow
Vaginal adenosis
children of mothers who took diethylstilbestrol, causes replacement of the vaginal squamous epithelium with columnar, risk for vaginal clear cell carcinoma
Turner Syndrome
45X, premature ovarian failure (=high LH and FSH)(streak ovaries), no breasts or menses. Can also have bicuspid valve or coarctation of aorta
Relative Risk = ?
Coronary event / No Coronary Event ACEI No ACEI RR = (a/(a+b)) / (c/(c+d)) can remove the equalizer that joins both groups (here the Q was patient populations with DM)
Failure in rotation of the midgut
omphacele or gastrochisis
Down syndrome has what abdominal abnormality?
uncomplicated hernia as a newborn (defect in linea alba)- failure of closure of the umbilical ring. Will likely resolve spontaneously
Failure of physiologic occlusion and subsequent recanalization of the midgut results in:
Duodenal atresia
Persistent processus vaginalis
Congenital inguinal hernia forms - processus vaginalis, an outpouching of the peritoneum, fails to obliterate, allowing a path for bowel contents to go into the inguinal canal
Delayed Hypersensitivity Reaction: tests, process
PPD test, Candida extract skin reaction, contact dermatitis, granulomatous inflamtion
-T-lypmphocyte mediated (Th1). Dendrites in skin bring to T cell –> Th1 call macrophages with INF-y. 48-72hr.
Transplant reactions: hyperacute, acute, chronic
hyperacute (min-hr) - preformed Ab in recipient
acute (less than 6 mo) - humoral, cellular response
chronic (mo-yrs) - low grade immune response, thickening and fibrosis
neurocysticercosis
T. solium
Gastric cell layers (top->bottom) in gastric body (5)
simple columnar epithelial cells - secrete mucus
upper grandular layer - parietal cells
deeper aspect of gastric glands - chief cell (pepsinogen)
muscularis mucosea - lamina from submucosa
submucosa - vascular and CT
Number Needed to Harm - calculation
NNH = 1 / AR AR = Event rate (tx) - Event rate (placebo)
Huntington Dz impact on other genes - mech of action?
AD, CAG repeats -> results in gain of function of the huntington gene -> causes deacetylation of histones, will silence other genes/decrease gene expression
Resolving hematoma - blood breakdown path
Heme is broken down by heme oxygenase into:
biliverdin (green), CO, ferrous iron
biliverdin broken down to yellow pigment bilirubin, transported to liver by albumin
cauda equine syndrome
S2-S5
pain low back to legs, saddle anesthesia, loss ancutaneous reflex (finger in rectum), bowel/bladder dysfunction
Rhuem A - test
anti-CCP present
arginine -> citruline in pr vimentin
Translocation Down Syndrome
46, XX t(14;21)
Robertson translocation - (nrm balanced) DS = unbalanced translocation - lose 2 short arms chrome
Non-modifiable risk factors for bone fracture
advanced age female white, Hispanic, asian (African americans protective) Fhx early bone fractures
Appendix identification for appendicitis
teniae coli - 3 separate smooth muscle ribbons travel longitudinally outside of the colon and converge at the root of the vermiform appendix
If have cavity from TB infection and Aspergillus settles forming an aspergilloma, what is this called?
colonization
NOT INVASION!
CF - CFTR MT results in what?
sweat test
nasal transepithelial difference test
CF transmembrane conductance regulator
normally secretes Cl to hydrate mucus (will dec Na/water absorption by ENaC
*this is opposite in sweat glands (dec Cl secretion)
MT - will flip
Sweat test - (+) Na and Cl will be sweat out w/ Cl
Nasal transepithelial difference test - when Na presented, Na will be absorbed
Beer’s criteria
what not to give to old people (look up phone pic)
Filtration Fraction
= GFR/RPF
RPF = renal plasma flow clearance
GFR = use inulin or creatine clearance
RPF = use PAH (all secreted into kidney goes urine)
Clearance =
(urine conc S x urine flow rate) / plasma conc of S
= (Cr Cl / PAH Cl) x 100%
Lung elastase - what produces it?
neutrophils - in alpha granules (A1 antitrypsin inhibs)
macrophages - in lysosomes (Tissue metaloprotinases inhibs-TIMPs)
-make own types, can inhibit each others
-excess elastase –> dmg and emphysema
Salmonella Typhi
watery diarrhea -> green -> become bloody (wk3) Salmon colored spots on abdomen fever hepatosplenomegaly intestinal invasion (wk 3)
classic galactosemia
AR disorder
most common and severe galactosemic Ds
deficiency enzyme: galactose-1-phosphate uridyl transferase
newborns within days: Px - jaundice, vomiting, hepatomegaly
Mycoplasma pneumoniae
causes anemia - cold agglutinins (IgM cross-reactivity) resolves with infection cure
(not due to return of cellular iron stores)
Chediak-Higashi syndrome
immodeficiency (failure phagosomal lysosomes fusing –get abn large lysosomal inclusions), albinism, neural defects (ex: nystagmus)
Cori Disease
debranching enzyme deficiency
Px: hypoglycemia, hypotonia, hepatomegaly
key feature: cytosolic accumulation of glycogen with abnormally short outer chains
Vitelline (omphalmesenteric) duct
-connects what to what and if not obliterated during 7th week embryogenesis, what can it cause?
midgut lumen with yolk sac cavity
persistent VD - fistula, meconium out of umbilicus
Meckel diverticulum - #1
vitelline sinus - partially patency at umbilicus
vitelline duct cyst - connected w/ileum and abd wall
*fibrous band attaches to everything, causes issue
cure Confounding Bias - how?
matching (match patient group to like age, race controls)
homeobox / HOX genes - code for what?
txn factors – crainal to caudal spinal alignment
Adenomyosis = Px?
=endometrial glandular tissue into uterine myometrium
pain, heavy bleeding, uniform fullness of uterus
Bx - normal endometrium appearance (secretory endometrium)
opioids = #1 cause?
Most common cause of OD death (heroin or prescription)
respiratory failure, unresponsive
sarcomere
electron micro
thin filaments + Z line = clear with black middle (I-band)
thick filaments = dark with M-line (A-band)
Persistence of processus vaginalis in male - testicle descent
leaves opening between scrotum and the peritoneal cavity via the inguinal cavity
small opening –> hydrocele
large opening –> indirect inguinal hernia w/abd organs
Palpable mass anterior to recturn
imperforate hyman - obstruction
incomplete degeneration of the fibrous tissue band connecting the walls of the vagina
poison ivy = conctact dermatitis -how Px? what HSR?
Px -intensely pruritic erythematous papules, vesicles, or bullae in linear pattern (urishiol is the poison)
Type 4 HSR - T lymphocyte mediated (bc poison ivy dermatitis is a contact allergic dermatitis)
Lupus Ab - against what?
Anti-smith = vs snRNPs, involved in removing introns with spliceosomes
bacterial IgA proteases are used to mainly do what? (think N. Meningitides invasion)
adherence to the mucosal wall (IgA binds bacterial pili and other prs that help it adhere)
NOT MAINLY vs complement and phagocytosis
CF patients - most common gene MT
CFTR 3 base pair deletion of phenylalanine at position(deltaF508) - leads to impaired post-translational processing of CFTR –> ER notices, tags for peroxisomal degradation
Two sample T test - purpose:
to see if the mean of two populations are equal
- need the 2 means, std deviation variances, and the sample sizes
- calculate t score, derive p value
- p value <0.05 = null hypothesis is true and both means are statistically different
HIV patients and Candida - what WBCs are more infected? superficial vs disseminated (candidemia)
superficial - will occur due to low T-cell count
candidemia - will occur due to low neutrophil cout/neutropenia
*therefore -superficial candida is more common in HIV patients, but candidemia is more common in neutropenic patients
SFx of 1st-line antipsychotic D2 blocker
-blockade on nigrostriatal pathway
extrapyramidal Sx -dyskinesia reactions, akathisia, parkinsonian
Prokaryotes - DNA replication, how many polymerases, what actions?
3 polymerases, all with 3’-5’ proofreading activity
however, DNA polymerase I can also excise RNA primer with 5’->3’ exonuclease. used to repair damaged DNA.
ex: E. Coli
What neurons produce these?
DA, dynorphin, E, His, NE, orexin, OTC, ADH/VPN
DA - VTA of substantia niagra pars compacta - midbrain
dynorphin - opioid peptide - PAG, medulla, ant horn SC
E - locus ceruleus (post rostral pons, floor 4th ventricle), arousal/RAS system
NE - E->NE conversion in adrenal medulla
His/orexin - posterior hypothal
OTC/ADH - anterior hypothalamus
Major sites of metabolism in the cell (2) - what goes on there?
Mito - B oxidation FA, (TCA cycle) citric acid cycle, carboxylation of pyruvate (gluconeogenesis)
Cystol - glycolysis, FA synthesis, pentose phosphate pathway
Mixed - heme synthesis, urea cycle, gluconeogensis
Major Depressive Ds Criteria - also ask self what question when ruling out psych Ds?
great than or equal to 2 weeks 5/9 sx: SIG E CAPS Depressed mood Sleep disturbance Loss of Interest (anhedonia) Guilt with feelings of worthlessness Energy loss and fatigue Concentration problems Appetite/weight changes Psychomotor retardation or agitation Suicidal ideation Ask self - do they meet criteria? if they do, then they have it
Maternal serum alpha-feto pr levels: high vs low
High: open neural tube defects (anencephaly, open spina bifida), ventral wall defects (gastroschisis, omephacele), multiple gestation
Low: aneuploidies (18, 21)
Golgi tendon organ
Sits at jcn between muscle and tendon, sense contraction against resistance (not muscle lengthening).
If force is too great - will communicate with SC via interneurons and tell the muscle to be paralyzed to save skeletal structure
start and stop codons
start : AUG
stop: UGA, UAA, UAG
Male internal and external sex differentiation
Male bone XY
SRY gene will allow testicle development
From testicles get Sertoli and Leydig Cells
Sertoli secrete AMH, F regression insues
Leydig Cells produce testosterone = wolfian ducts go male, testosterone also made in (peripherally converted) DHT -> external development
Late Alzheimer’s Disease MT
APO E4 (apolipoprotein) - believed to form senile plaques
MVC head injury - cause diabetes insipidis -> how px?
hyperosmotic blood
- loss of free water
- decrease in intracellular/extracellular fluid
Wilson Dz - which brain degeneration part?
putamen (lateral to globus pallidus)
Most important factors for auto-regulation of coronary blood flow: (2)
NO is #1 (from arginine and oxygen - works via guanylate-cyclase)
adenosine (works small arteries)
(auto regulation by local control mostly?)
nervous system (NE via sympathetic nerves) has low input for coronary blood flow autoregulation
Diffusion speed across a semipermeable membrane (dialysis) - how to increase or decrease?
increase diffusion speed: higher molecular concentrations of gradients, large membrane surface area, increased solubility of diffusing substance
decrease: increase membrane thickness, small pore size, high molecular weight, low temperatures
Congenital association(abnormalities)- connected without known cause - mnemonic and name them
VACTERL vertebral defects anal atresia cardiac defects TE fistula renal anomalies limb abnormalities **
von Hippel-Lindau syndrome - 3 Px Sx and major gene deletion
Px - renal cell carcinoma, hemangioblastomas, pheochromocytoma
Major gene deletion = chromosome 3 gene deletion
Whats made in Basal nucleus of Meynert
Acetylcholine
whats made in ventral tegmentum, SNpc
DA
whats made in nucleus accumbens
GABA
whats made in locus ceruleus
NE
whats made in raphe nucleus
SER
Blotting -mnemonic
SNoW DRoP
Southern = DNA
Northern = RNA
Western = Protein
Read and understand the answer choices…
foramen ovale is in the atria… why did you pick some ventricle…
anti-Jo-1 =?
anti-Jo-1 = anti-histidyl-tRNA synthase
seen in polymyositis and dermatomyositis (with rash)
Gential lesions - painful, not painful? Haemophilus Ducreyi HSV1/2 Klebsiella granulomatis Treponema pallidum Chlamydia trachomatis
Haem d - yes HSV1/2 - yes Kleb - no Treponema - no Chlamydia trach - no
