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uWorld 60 Flashcards

1
Q

what happens in proliferative phase (days 1-14_ of menstrual cycle

A

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

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2
Q

endometrial biopsy AT OVULATION shows what

A

late proliferative endometrium with COILED GLANDS and occasional cytoplasmic vacuoles in the granular epithelium

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3
Q

what is seen in the secretory phase (days 15-28) of the menstrual cycle

A

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

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4
Q

beta-thalassemia can be due to the inherited beta global gene mutation in what

A

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

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5
Q

co-translational protein targeting is mediated by what

A

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

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6
Q

peptide bond formation is catalyzed by what

A

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

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7
Q

ribosomal translocation during polypeptide elongation requires what

A

elongation factor 2 and requires GTP hydrolysis

this advances the peptides tRNA from the A site to the P site (translocation)

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8
Q

what is the mutation in sickle cell

A

A to T mutation in the beta global gene that results in glutamate being substituted with valine at position 6

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9
Q

what causes the damage the the RBC membrane in beta thalassemia

A

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

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10
Q

what does Aldolase B catalyze

A

fructose-1-phosphate to DHAP and glyceraldehyde

glyceraldehyde is then converted to glyceraldehyde-3-phosphate (glycolysis) by TRIOKINASE

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11
Q

what is seen in aldolase B

A

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

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12
Q

glactose-1-phosphate uridyl transferase (classic galactosemia)

A

AR

vomiting, feeding intolerance, neonatal jaundice, hepatomegaly, death if untreated

starts soon after breastfeeding is INITIATED

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13
Q

tryptophan is the precursor for what

A

niacin, serotonin, melatonin

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14
Q

what is the MOA of rifaximin

A

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)

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15
Q

what do phosphate binders (calcium acetate) do

A

lower serum phosphate in patients with end-stage renal disease

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16
Q

what does sodium polystyrene resin do

A

exchanges intraluminal sodium for potassium ions and can lower serum potassium in patients with hyperkalemia

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17
Q

what are the recommendations for prevention of CENTRAL VENOUS CATHETERS (CVC)

A

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

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18
Q

what are the GAS antigens that there are antibodies for in acute rheumatic fever

A

M PROTEIN

N-ACETYL-BETA-D-GLUCOSAMINE

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19
Q

whats a cystic hygroma look like on physical

A

LOBULATED, COMPRESSIBLE, usually

TRANSILLUMINATES

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20
Q

what is seen histologically in deQuervaine thyroiditis

A

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

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21
Q

when do you see HURTHLE CELLS (eosinophilic epithelial cells)

A

HASHIMOTO THYROIDITIS

anti TPO (microsomal) antibody

painless

GERMINAL CENTERS

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22
Q

what is RIEDEL thyroiditis

A

characterized by extensive FIBROSIS of the thyroid that EXTENDS into surrounding tissues

thyroid gland is hard and non-tender

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23
Q

what are possible causes of monocular scotoma

A

macular degeneration or optic neuritis

partial lesion in the retina, optic disc, optic nerve

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24
Q

in a patient with fucked up patella what might allow them to have partially spared knee extension

A

if lateral and medial RETINACULUM are intact

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25
what are the knee flexors
hamstring muscles (biceps formis, semitendinosus, semimembranosus), gracilis, gastrocnemius, sartorius
26
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
27
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
28
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)
29
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
30
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
31
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
32
a loud P2 is heard in what
pulmonary HTN
33
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
34
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
35
what is a pericardial knock
sharper more accentuate sound heard earlier in diastole than the S3 sound
36
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
37
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)
38
what is a GALACTOCELE
a mass filled with breast milk, can occur with hyperprolactinemia but is more often associated with pregnancy and breastfeeding
39
culture-negative endocarditis is due to what organisms
``` Bartonella Coxiella Mycoplasma Histoplasma Chlamydia HACEK organisms (Haemophilus, Actinobacilus, Cardiobacterium, Eikenella, Kingella) ```
40
what are the 3 big inherited pheochromocytoma
VHL gene (con hippel-lindau) RET gene (MEN 2) NF1 gene (neurofibromatosis)
41
what is the rule of 10s with pheochromocytoma
10% bilateral 10% extra adrenal (paragangliomas) 10% malignant
42
whats pseudotumor cerebri
idiopathic intracranial hypertension obese young chicks headache, papilledema, possible visual loss due to optic neuropathy
43
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
44
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
45
what are the major risk factors for adenocarcinoma of esophagus
Barrett's esophagus GERD obesity tobacco use
46
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)
47
what does the APC gene do
tumor supressor gene that helps degrade beta-catenin, preventing uncontrolled cell growth INACTIVATING genes fuck it up = FAP
48
whats another name for Kawasaki disease
MUCOCUTANOUS LYMPH NODE SYNDROME- vasculitis of medium arteries conjunctivitis, cervical lymphadenopathy, periungual desquamation, and mucocutnaous changes (strawberry tongue)
49
what is one of the most common autosomal dominant disorders
familial hypercholesterolemia
50
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
51
spindle cells with hair like glial processes and are associated with micro cysts cystic brain tumor in kids
PILOCYTIC ASTROCYTOMA ROSENTHAL FIBERS-eosinophilic bodies
52
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
53
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
54
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
55
what is a colloid cyst
bengin tumor usually found in THIRD VENTRICLE cyst formation and rare mitosis are seen can cause lethal obstructive hydrocephalus
56
what is a pleomorphic zanthoastrocytoma
astrocytoma found in children and young adults RETICULIN deposits and chronic inflammatory infiltrates
57
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
58
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)
59
what drugs cause ANA + SLE
``` HYDRALAZINE PROCAINAMIDE ISONIAZID minocycline quinidine ``` ANTI-HISTONE ANTIBODIES ARE SEEN
60
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

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