uWorld 60 Flashcards
what happens in proliferative phase (days 1-14_ of menstrual cycle
starts with first day of menses and ends with ovulation
ESTROGEN stimulates proliferation of stratum FUNCTIONALE
normal proliferative endometrium consists of NONBRANCHING, NONBUDDING, uniform glands evenly distributed throughout a uniform stroma
mid-proliferative phase- glands are TUBULAR, NARROW, and lined with pseudo stratified, elongated, mitotically active epithelial cells
stratum functional contains compact, non edematous stroma
uterine glands have increased length and girth but still remain relatively STRAIGHT
endometrial biopsy AT OVULATION shows what
late proliferative endometrium with COILED GLANDS and occasional cytoplasmic vacuoles in the granular epithelium
what is seen in the secretory phase (days 15-28) of the menstrual cycle
PROGESTERONE secreted by CORPUS LUTEUM in the ovary promotes the development of secretory endometrium
the glands increase in size and becomes MORE COILED, and the cells lining the lgnads acquire large cytoplasmic VACUOLES
glycogen-rich mucus is released into the glandular lumens
stroma becomes increasingly edematous, and the prominent sSPIRAL ARTERIES extend to the ENDOMETRIAL SURFACE
beta-thalassemia can be due to the inherited beta global gene mutation in what
KOZAK SEQUENCE, a consensus sequence that helps start translation in eukaryotes
EUKAYOITC TRANSLATION INITIATION requires the assembly of ribosomal sobuines (60S and 40S), mRNA, initiation factors, initiator tRNA charged with methionine, and guanosine-5’-triphosphate (GTP)
the small ribosomal subunit (40S) initially binds to the 5’ cap of mRNA and scans for the METHIONINE START CODON (AUG)
when this star codon is positioned near the beginning of an mRNA molecule and is surrounded by the Kozak consensus sequence, it serves as the initiator of translation
the KOZAK CONSENSUS SEQUENCE is analogous to the Shine-Dalgarno sequence in E. coli
co-translational protein targeting is mediated by what
N-terminal amino acid sequence of an elongating polypeptide
signal sequence is recognized by a signal recognition particle, which helps transport the protein to the rough endoplasmic reticulum
peptide bond formation is catalyzed by what
peptides transferase, an RNA enzyme (“ribozyme”) that resides in the large ribosomal subunit
a defect in rRNA coding for ribosomes would be required to interfere with this process
ribosomal translocation during polypeptide elongation requires what
elongation factor 2 and requires GTP hydrolysis
this advances the peptides tRNA from the A site to the P site (translocation)
what is the mutation in sickle cell
A to T mutation in the beta global gene that results in glutamate being substituted with valine at position 6
what causes the damage the the RBC membrane in beta thalassemia
decreased beta global chain synthesis results in UNPAIRED ALPHA CHAINS that precipitate within red cells and cause membrane damage, leading to ineffective erythropoiesis and extravascular hemolysis
what does Aldolase B catalyze
fructose-1-phosphate to DHAP and glyceraldehyde
glyceraldehyde is then converted to glyceraldehyde-3-phosphate (glycolysis) by TRIOKINASE
what is seen in aldolase B
hereditary fructose intolerance starts after breastfeeding is DONE and fruits started
VOMITING and HYPOGLYCEMIA about 20-30 minutes after fructose ingestion
IRRITABILITY, JAUNDICE, HEPATOMEGALY, FAILURE to THRIVE
undiagnosed eventually develops LIVER and RENAL FAILURE
TX: no more fructose
glactose-1-phosphate uridyl transferase (classic galactosemia)
AR
vomiting, feeding intolerance, neonatal jaundice, hepatomegaly, death if untreated
starts soon after breastfeeding is INITIATED
tryptophan is the precursor for what
niacin, serotonin, melatonin
what is the MOA of rifaximin
non absorbable antibiotic that alters GI flora to DECREASE INTESTINAL PRODUCTION and ABSORPTION of AMMONIA
someimtes used to treat traveler’s diarrhea, as it inhibits bacterial RNA synthesizes through binding with DNA-depended RNA polymerase
generally used in addition to lactulose (catabolized in the intestine bacterial flora to shoot chain fatty acids, lowering the colonic pH and increasing conversion of ammonia to ammonium)
what do phosphate binders (calcium acetate) do
lower serum phosphate in patients with end-stage renal disease
what does sodium polystyrene resin do
exchanges intraluminal sodium for potassium ions and can lower serum potassium in patients with hyperkalemia
what are the recommendations for prevention of CENTRAL VENOUS CATHETERS (CVC)
HAND HYGIENE with an ALCOHOL SANITIZER or SOAP and WATER
maximal BERIEF PRECAUTIONS during insertion (surgical mast, sterile gloves, long-sleeved surgical gown, and a large sterile sheet drape)
preparation of the insertion site with CHLORHEXIDINE antiseptic
use of SUBCLAVIAN or INTERNAL JUGULAR insertion sites (femoral vein has high risk of infection)
prompt removal of the catheter when it is no longer needed
what are the GAS antigens that there are antibodies for in acute rheumatic fever
M PROTEIN
N-ACETYL-BETA-D-GLUCOSAMINE
whats a cystic hygroma look like on physical
LOBULATED, COMPRESSIBLE, usually
TRANSILLUMINATES
what is seen histologically in deQuervaine thyroiditis
aka subacute GRANULOMATOUS thyroiditis
inflammatory infiltrate with macrophages and GIANT CELLS
increase ESR and CRP
decreased radio nucleotide uptake
transient hyperthyroid symtoms
PAINFUL thyroid enlargement
onset following VIRAL ILLNESS
when do you see HURTHLE CELLS (eosinophilic epithelial cells)
HASHIMOTO THYROIDITIS
anti TPO (microsomal) antibody
painless
GERMINAL CENTERS
what is RIEDEL thyroiditis
characterized by extensive FIBROSIS of the thyroid that EXTENDS into surrounding tissues
thyroid gland is hard and non-tender
what are possible causes of monocular scotoma
macular degeneration or optic neuritis
partial lesion in the retina, optic disc, optic nerve
in a patient with fucked up patella what might allow them to have partially spared knee extension
if lateral and medial RETINACULUM are intact
what are the knee flexors
hamstring muscles (biceps formis, semitendinosus, semimembranosus), gracilis, gastrocnemius, sartorius
what gallstones can be seen on ultrasound and how can they be treated non surgically
CHOLESTEROL (most common type of stone)
HYDROPHILIC BILE ACID supplements (ursodeoxycholic acid) reduce biliary cholesterol secretion and increase biliary bile acid concentration, which promotes GALLSTONES DISSOLUTION by improving cholesterol solubility
what are disease modifying anti rheumatic drugs (DMARDs)
methotrexate (typically first-line) sulfasalazine hydroxychloroquine minocycline tumor necrosis factor alpha inhibitors
RESPONSE usually TAKES WEEKS
short term are systemic and intranucelar GLUCOCORTICOIDS (prednisone) or NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs) can provide rapid temporary relief of symptoms in patients start gin DMARD
how do glucocorticoids exert their anti-inflammatory effect
inhibition PHOSPHOLIPASE A2, decreases PG and leukotriene synthesis
depress immune response by inhibiting the transcription of multiple cytokines and adhesion proteins, which reduces leukocyte recruitment and activation (neutrophilic)
what is the pathophysiology of indirect inguinal hernia
patent PROCESSUS VAGINALIS
seen in male infants
content protrudes through DEEP INGUINAL RING
travels lateral to inferior epigastric vessels
what is the pathophysiology of direct inguinal hernia
weakness of TRANSVERSALS FASCIA (floor of hasselbachs triangle)
seen in older men
contents protrudes through HASSELBACH TRIANGLE
travels medial to inferior epigastric vessels
goes through EXTERNAL (SUPERFICIAL) INGUINAL RING
covered by EXTERNAL SPERMATIC FASCIA ONLY
what is the kussmaul sign
jugular venous pressure (JVP) INCREASED during INSPIRATION in patients with CONSTRICTIVE PERICARDITIS (restrictive cardiomyopathies, right atrial or ventricular tumors too)
due to volume-RESTRICTED RIGHT VENTRICLE is unable to accommodate the inspiratory increase in VR
normally JVP decreases during inspiration
a loud P2 is heard in what
pulmonary HTN
the S3 heart sound occurs due to what
sudden deceleration of incoming blood as the ventricle reaches its elastic limit
reduced intrinsic ventricular wall compliance (restrictive cardiomyopathy) is a cause of S3
what cures constrictive pericarditis
idiopathic or VIRAL pericarditis, cardiac surgery or radiation therapy, tuberculosis (in endemic areas)
thickened, rapid pericardium forms a noncompliant casing surrounding the heart, limiting ventricular expansion during diastolic filling
increase in JVP, KUSSMAUL SIGN, PULSUS PARADOXUS, PERICARDIAL KNOCK
what is a pericardial knock
sharper more accentuate sound heard earlier in diastole than the S3 sound
how does actinic keratosis present
erythematous papule with overlying WHITISH SCALE
“FELT MORE THAN SEEN” have a rough, SANDPAPER-LIKE TEXTURE on palpation
small and flat at first, enlarge and become elevated
hyperkeratosis in such lesions may become prominent and for CUTANEOUS HORNS
due to EXCESSIVE SUN EXPOSURE
PREMALIGNANT CONDITION
what does seborrheic keratosis look like
“stuck-on” appearance
deeply pigmented or flesh-colored lesions with velvety or “greasy” surface
can have keratin filled cysts (horn cysts)
what is a GALACTOCELE
a mass filled with breast milk, can occur with hyperprolactinemia but is more often associated with pregnancy and breastfeeding
culture-negative endocarditis is due to what organisms
Bartonella Coxiella Mycoplasma Histoplasma Chlamydia HACEK organisms (Haemophilus, Actinobacilus, Cardiobacterium, Eikenella, Kingella)
what are the 3 big inherited pheochromocytoma
VHL gene (con hippel-lindau)
RET gene (MEN 2)
NF1 gene (neurofibromatosis)
what is the rule of 10s with pheochromocytoma
10% bilateral
10% extra adrenal (paragangliomas)
10% malignant
whats pseudotumor cerebri
idiopathic intracranial hypertension
obese young chicks
headache, papilledema, possible visual loss due to optic neuropathy
transtentorial uncal herniaton can occur due of what
intracranial mass (tumor, hemorrhage) or cerebral edema
compression of ipsilateral oculomotor nerve and posterior cerebral artery
FIXED, DILATED PUPIL on same side as lesion is FIRST SIGN
what are the major risk factors for squamous cell esophageal carcinoma
alcohol use
tobacco smoking
consumption of N-nitroso- containing foods
plummer-vinson is associated with it
what are the major risk factors for adenocarcinoma of esophagus
Barrett’s esophagus
GERD
obesity
tobacco use
activating mutations in what can lead to constitutive activation of epidermal growth factor receptor (EGFR)
KRAS- results in increased CELL PROLIFERATION and growth
this causes resistance to anti-EGFR therapy (cetuximab and panitumumab)
what does the APC gene do
tumor supressor gene that helps degrade beta-catenin, preventing uncontrolled cell growth
INACTIVATING genes fuck it up = FAP
whats another name for Kawasaki disease
MUCOCUTANOUS LYMPH NODE SYNDROME- vasculitis of medium arteries
conjunctivitis, cervical lymphadenopathy, periungual desquamation, and mucocutnaous changes (strawberry tongue)
what is one of the most common autosomal dominant disorders
familial hypercholesterolemia
N-MYC on chromosome 2 is seen in what disease
NEUROBLASTOMA
NEUTROPHIL (a neuritic process) is pathognomonic feature of neuroblastoma cells
NSE, chromogranin, synaptophysin, and S-100 (+)
HVA and VMA levels elevated
spindle cells with hair like glial processes and are associated with micro cysts
cystic brain tumor in kids
PILOCYTIC ASTROCYTOMA
ROSENTHAL FIBERS-eosinophilic bodies
what is kallman and what causes it
failure of GnRH secreting neurons to migrate from olfactory placed to they normal anatomic position in hypothalamus
KAL-1 or fibroblast growth factor receptor-1 gene mutations
central hypogonadism and ANOSMIA (cleft lip and palate maybe too)
present with delayed puberty
the reinforcing effects of nicotine that lead to dependence ar through to be caused by stimulation of what
alpha4beta2-nicotinic ACh receptor present int eh CNS
VARENICLINE is a partial agonist of this receptor that competes with nicotine (a full agonist) and prevents it from binding- helps reduce symptoms of nicotine withdrawal by mildly stimulating the receptor
partial agonist activity rests in less stimulation of the reward pathway than nicotine
why are the symptoms and macro/microscipic appearance of glioblastoma multiforme
headache, SEIZURE, mental status change, focal neurologic symptoms
PSEUDOPALSIAIDN NECROSIS (foci of necrosis surrounded by tumor cells)
new vessel formation
small round cells, bizarre giant cells, large number of mitoses
areas of necrosis and hemorrhage (variegated appearance)
poorly demarcated from the surrounding tissue
what is a colloid cyst
bengin tumor usually found in THIRD VENTRICLE
cyst formation and rare mitosis are seen
can cause lethal obstructive hydrocephalus
what is a pleomorphic zanthoastrocytoma
astrocytoma found in children and young adults
RETICULIN deposits and chronic inflammatory infiltrates
campylobacter jejuni can be caused by acquired how
domestic animals (cattle, sheep, dogs, chickens)- common in farm and lab workers
contaminated food, like undercooked poultry and unpasteurized milk
what are the common clinical manifestations of vitamin E deficiency
NEUROMUSCULAR DISEASE (skeletal myopathy, spinocerebellar ataxia, polyneuropathy) and HEMOLYTIC ANEMIA
dorsal columns, spinocerebellar, peripheral nerve dysfunction (hyporeflexia)
what drugs cause ANA + SLE
HYDRALAZINE PROCAINAMIDE ISONIAZID minocycline quinidine
ANTI-HISTONE ANTIBODIES ARE SEEN
what is seen in a meningioma
well-circumscribed mass attached to the dura commonly found at the falcon, parasagittal, or lateral convexity regions of the brain
SEIZURE can occur
headache, nausea, and vomiting may result form increased intracranial pressure
worsens during recumbency and with sleep (due to increased intracranial blood volume)
may develop focal neurologic deficits
slow growing tumor of meningeal ARACHNOID CELLS, PSAMMOMA BODIES, and WHORL PATTERN of cellar growth that forms syncytial nests
