uworld 6?? Flashcards by Vidhi Jhaveri

type 1 collagen

dermis, bone, tendons, ligaments, dentin, cornea, blood vessels, scar tissue

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type 2 collagen

cartilage, vitreous humor and nucleus pulposus

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type 3 collagen

skin, lungs, intestines, blood vessels, bone marrow, lymphatics and granulation tissue!

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type 4 collagen

basement membranes

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how is calcium high in sarcoidosis?

T cells are active –> secrete gamma interferon which increases the activity of 1 alpha hydroxylase activity in macrophages–> converts 25 hydroxy vit D to 1, 25 hydroxy vit D.

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where is 1 alpha hydroxylase normally found?

kidneys. macrophages have some too, but usually doesn’t do much unless have some chronic granulomatous thing when they’re super activated

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what does ristocetin do?

activates gp1b receptors on platelets and makes them aailable for vWF binding

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gingival bleeding, platelet count is normal, platelets aggregate normally to ADP but poorly to ristocetin. what is this?

vWF deficiency

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what do you give for vWF deficiency? how does it work?

desmopressin. stimulates the release of vWF from endothelial cells. if super severe, then give blood products that have vWF…

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mucocutaneous bleeding, incr bleeding time, platelet aggregation normal to ristocetin, decreased with ADP

Glanzmann thrombasthenia

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what does glanzmann’s not have?

deficiency of GP2b/3a receptors

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CYP 450 inducers

carbamazepine
phenobarbital
phenytoin
rifampin
griseofulvin

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CYP 450 inhibitors

cimetidine
ciprofloxacin
erythromycin
azole antifungals
grapefruit juice
isoniazid
ritonavir (protease inhibitors)

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neoplastic lymphocytes that have CD 19 and CD 5

mature B cell leukemia (eg. CLL or SLL)

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red urine that darkens upon standing for 24 hours

Acute intermittent prophyria

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mode of inheritance of acute intermittent prophyria?

autodom

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what deficiency causes acute intermittent prophyria?

porphobilinogen deaminase deficiency

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what is the nucleolus made of?

mainly rRNA–> mady by RNA pol 1

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bilateral renal angiomyolipomas associated with what?

tuberous sclerosis. AD. cortical tubers and subendymal hamartomas in the brain. cardiac rhabdomyomas, facial angiofibromas, and ash leaf patches

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cerebellar hemangioblastomas, retinal hemangiomas, and liver cysts are associated with what?

VHL dz. AD. at high risk for bilateral renal cell carcinomas!!

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facial port wine stain and leptomeningeal capillary venous malformation is associated with what?

Sturge Weber syndrome. rare congenital vascular disorder

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multiple telangiectasias on skin and mucosa–> typical presentation is recurrent epistaxis or GI bleeding (melena) is associated with what?

osler-rendu-weber syndrome or hereditary hemorrhagic telangiectasias

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what cytokines are critical in granuloma formation?

IFN gamma, IL 12, TNF alpha.

macrophages release IL 12 to induce Th1 differentiation.
mature Th1s produce interferon gamma to activate macrophages and improve their ability to kill the ingested TB.
activated macrophages produce TNF alpha to recruit addnl monocytes and macrophages to the area.

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what does IL 4 do?

promotes Th2 differentiation which stimulates B cells to isotype switch to IgE

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what does C3a do?

stimulates mast cell histamine release --> vascular permeability and vasodilation

what does Leukotriene C4 do?

same as D4 adn E4 --> vasoconstriction, bronchoconstriction, and incr leukocyte adhesion to endothelium. (if sups low, then causes vasodilation and incr permeability of venules)

what does IL5 do?

growth and diff of b cells, eosinophils and isotype switch to IgA

where is the most common site of colonization of S aureus?

anterior nares...

where does all skin from the umbilicus down, including the anus (up to the dentate/pectinate line) but excluding the posterior calf drain to?

superficial inguinal lymph nodes.

where does the posterior calf drain?

popliteal lymph nodes

mutation for sickle cell

A-T in the betaglobin gene results in glutamate substituted by valine at position 6

what is homocysteine converted to?

methionine using BH4 and cobalamin cysteine using B6 and serine

How is plasma glucose converted to sorbitol?

Aldose reductase. | Osmotic cellular injury => cataracts and peripheral neuropathy

alprazolam, triazolam, oxazepam are...?

short acting Benzos ( increased dependance, but decreased fall risk in elderly (shorter daytime drowsiness "hangover"

estazolam, lorazepam, emazepam are...?

medium Benzos (10-20 hours)

chlordiazepoxide, chlorazepate, diazepam, flurazepam are...?

Long acting Benzos (days) --> decreased risk of dependance but increased risk of fall in the elderly (longer daytime drowsiness "hangover")

spherules containing endospores. presents as...?

Cocci!! ``` presents as: 1. acute pheumonia (most common) 2. chronic progressive pneumonia 3. pulmonary nodules and cavities 4. extrapulmonary nonmeningeal dz 5. meningitis (more severe for immunocompromised) ```

pigeon droppings. presents as...?

Crypto (yeast form) | pulm dz, meningoencephalitis in immunocomp.

bird and bat droppings in mississippi or ohio river basins

Histo!!!

what fungi are patients with asthma at risk for developing?

an allergic reaction to Aspergillus fumigatus called allergic bromchopulmonary aspertillosis. symptoms: cough, dyspnea, wheezing, fever, migratory pulmonary infiltrates

how do penicillins and cephalosporins work?

irreversibly bind to penicillin binding proteins such as transpeptidases

glomerular sclerosis and hyalinosis most often seen when?

diabetic nephrosclerosis

hypoxemia causes what in the pulmonary vascular bed?

vasoconstriction! hypoxic vasoconstriction occurs int eh small musculary pulm arteries to divert blood flow away from underventilated regions of the lung to more well ventilated areas

marfanoid hibitus, flesh colored nodules (mucosal neuromas), thyroid malignancy is what?

MEN 2B

parathyroid gland tumor, anterior pit tumor, and pancreatic timor is what?

MEN 1

parathyroid hyperplasia (not CA!), pheochromocytoma, medullary thyroid CA

MEN 2A

diarrhea, weight loss, and epigastric region calcification is a patient with chronic alcoholism is what?

chronic pancreatitis with resulting pancreatic exocrine insufficiency and malabsorption

most common benign liver tumor

cavernous hemangioma.

eggshell calcification of hilar nodes and birefringent particles surrounded by fibrous tissue

silica pneumoconioses

calcified pleural plaques and ferruginous bodies

asbestosis

noncaseating granulomas (and not sarcoidosis) in lung

berylliosis and hypersensitivity pneumonitis. but indistinguishable from sarcoidosis without the actual particles

perilymphatic accumulations of coal dust laden macrophages

coal miners lung

SUPS wide pulse pressure is caused by what?

aortic regurg

what are the absolute contraindications for OCP use? (6)

1. prior thromboembolic event or stroke 2. history of estrogen dependent tumor 3. women over 35 who smoke heavily 4. hypertriglyceridemia 5. decompensated or active liver dz (would impair steroid metabolism) 6. pregnancy

what is oral administration of D-xylose be used to differentiate?

between malabsorption of pancreatic vs. GI mucosa if pancreas messed up, then monosaccharides should still be absorbed just fine.

tx for atypical depression or treatment resistant depression

MAOi (eg. phenelzine or tranylcypromine)

round or oval yeast with thick walls and broad based budding. lungs primary site, and skin and bone are major sites of dissemination

blasto!

only mold. septate hyphae that branch at 45 degree angles

Aspergillius!

small oval yeast with narrow based budding. pneumonia is rare!

Candida!!

round yeast with variable sizes and narrow based buds. thick polysaccharide capsule taht appears clear with india ink and stains raed with mucicarmine

Crypto

smaller yeast form and is found intracellularly within macrophages

Histo!

broad ribbonlike hyphae with rare septations

Rhizopus

retinal neovascularization. acute vision loss and metamorphopsia with funduscopy showing a gray-green subretinal membrane and maybe hemorrhage

wet age related macular degeneration. Tx is smoking cessation and VEGF inhibitor (eg. ranibizumab, bevacizumab)

gradual vision loss in one or both eyes and can cause difficulty driving or reading. chronic oxidative damage to retinal pigment epithelium and choriocapillaries. drusen deposites with pigment abnormalities

Dry age related macular degeneration

tx: antibodies against CD 20

(rituximab) on b cells. for various lymphomas and active rheumatoid arthritis

Tx: epidermal growth factor receptor inhibitors

(erlotinib, gefitinib) used to treat advanced nonsmall cell lung CA

tx: anti- IL 2 therapy

immunosurppression in organ transplant patients and in graft vs host

tx: inhibitors of tumor necrosis factor alpha

inflammatory autoimmune conditions. eg. rheumatoid arthritis, inflammatory bowel dz, and seronegative spondylarthropathies

what arteries run along the lesser curvature of the stomach?

left and right gastric. may be penetrated by ulcers and lead to hemorrhage

when a constant fraction of the drug is metabolized per unit time based on the serum concentration, it is said this drug has what order kinetics?

first order!

when a constant amount of drug is metabolizd per unit time, independant of concentration, it is said this drug as what order kinetics?

zero order!

what is found in raphe nuclei?

the only serotonin releasing neurons in the CNS. they go everywhere and synapse everywhere.

beta blocker and epi. what happens?

eliminates the beta effects of epi (vasodilation and tachy) and leaves the alpha effects (vasoconstriction)

medullary carcinoma of teh thyroid is characterized by what?

extracellular deposits of amyloid formed by calcitonin secreted from neoplastic parafollicular C cells

an aneurysm of what artery will cause compression of CN 3 and a 3rd nerve palsy?

it courses between the posterior cerebral and superior cerebellar arteries. an aneurysm in either will cause non pupil sparing 3rd nerve palsy = unilateral headache, eyepain, diplopia, dilated non reactive pupil, and ptosis of ipsi eye in a down an out position

measure renal plasma flow

= renal blood flow times (1-hematocrit)

disorganized cartilage, fibrous, and adipose tissue in the lung

hamartoma! --> peripherally located coin lesion" in 50-60 year olds. SUPS benign!

what do you see membrane splitting in (tram track)

alport and membranoproliferative GN

how is trypsinogen activated?

by duodenal eneropeptidases.

mysthenia gravis is associated with what?

thymus abnorm (thymoma, or thymic hyperplasia)

don't have alpha galactosidase A. build up ceramide trihexoside

Fabry's

don't have B- glucosidase (glucocerebrosidase) and build up glucocerebroside

Gaucher

Don't have sphingomyelinase. build up sphingomyelin

Neimann-pick

Don't have hexoaminase a. Build up GM2 gangliosidase

Tay-sachs

Don't have galactocerebrosidase. build up galactocerebroside, and psychosine

Krabbe

Don't have arylsulfate A, build up cerebroside sulfate

Metachromatic leukodystrophy

why is there increased chololethiasis in pregnant women and those taking OCPs?

estrogen stimulated hypersecretion of cholesterol | and progesterone stimulated hypomotility of the gallbladder

why do you give topical vitamin D analogue for people with psoriasis?

analogue binds to the Vit D receptor and decreases keratinocyte proliferation and induces keratinocyte differentiation