UWorld Flashcards
Drug classes used to treat BPH
5-alpha reductase inhibs (finasteride) and alpha-adrenergic blockers (prazosin), antimuscarinics
What are the humoral and cell components of Type III hypersensitivity?
Antibody-antigen complexes, complement; neutrophils
E coli virulence factor in bloody diarrhea
Verotoxin (Shiga-like)
What areas is drained by para-aortic nodes?
Testes, ovaries, kidneys, uterus
Cofactors of branched chain alpha-ketoacid dehydrogenase, pyruvate dehydrogenase, alpha-ketoglutarate dehydrog
Thiamine (B1), FAD (B2), NAD (B3), Acetyl CoA (B5), lipoate
Cancer of rectum below dentate metastasizes to
Lungs (enters systemic circ thru internal iliac)
What’s in the carpal tunnel?
Flexor digitorum profundus tendons, flexor digitorum superficialis tendons, flexor pollicis longus tendon, median nerve
anti-centromere
CREST
What rxn is catalyzed by aldose reductase?
Glucose to sorbitol (sorbitol accums in DM)
granular muddy brown casts
ATN
Triceps reflex
C7, C8
Toxic component of lipopolysaccharide
Lipid A
Biceps/brachioradialis reflex
C5, C6
Howell Jolly bodies
Basophilic nuclear remnant in RBCs (should have been removed by spleen). Occurs in sickle cell and post-splenectomy
What enzyme is primarily responsible for NADPH pdtion?
G6PD
painless, spontaneous lower GI bleeding in a child
Meckel diverticulum
What causes a left shift in O2-hemoglobin curve?
Left shift=less O2 to tiss: decr H+ (high pH), decr 2,3 BPG, decr temp
What’s the protein defect with elevated chylomicron and VLDL remnants?
ApoE
Intestinal lipase inhibitor used for weight loss
orlistat
lung cancer assoc with gynecomastia and galactorrhea
large cell carcinoma
cAMP signal pathway
lots pituitary: FSH, LH, ACTH, TSH, CRH, hCG, ADH, MSH, PTH, calcitonin, GHRH, glucagon, histamine, epinephrine
Lymph node that drains lower rectum to anal canal above pectinate
Internal iliac
Infections with catalase positive bugs
Chronic granulomatous disease
Ecthyma gangrenosum
P aurigonsa
Fetus with limb and craniofacial abnormalities, neural tube defects, abortion
MTX
Probenecid MOA
Blocks organic anion transporter in kidney to incr conc in serum (penicillin) or urine (urate)
Where’s glucokinase?
Beta cells of pancreas and liver
CN for carotid sinus reflex
IX in, X out
Neuroleptic malignant syndrome symptoms
Hyperthermia, lead pipe rigidity, autonomic instability, altered mental status
Cell types seen in inflammatory diarrhea or dysentery
Leukoctyes +/- RBCs
Severe intermittent abdominal pain that presents with currant jelly stool
Intussusception
Niacin synth’d from (blank)
tryptophan
Drugs that inhibit NF-kB
Corticosteroids
What areas are drained by internal iliac nodes?
Rectum to anal canal, bladder, vagina, cervix, prostate
Solid, cystic, and calcified mass in brain
Craniopharyngioma
bilious emesis, abdominal pain and failure to pass meconium
Hirschsprung disease
Passes thru foramen magnum
Brainstem, spinal root of CN XI, vertebral arteries
Ketogenic aa’s
Leucine and lysine
Screening test for fetal lung maturity
Lecithin-sphingomyelin ratio (<1.5 predictive of NRDS)
antiandrogen therapy that blocks androgen receptors
flutamide, spironolactone
Function of malonyl-CoA
Fatty acid synthesis and blocks beta oxidation thru inhib of carnitine acyltransferase
CML translocation and mutation
t(9;22); BCR-ABL inhibs apoptosis and promotes tyrosine kinase
waxy casts
ESRD
CN in medulla
IX, X, XI,, XII
Murmurs heard with handgrip
AR, MR, VSD
anti-Smith
specific for SLE
Injury to superior gluteal nerve
Motor: thigh abduction
Pre-existing recipient antibodies react to donor antigen
hyperacute transplant rejection
Type III collagen
reticulin–skin, blood vessels, uterus, fetal tiss, gran tiss
bronchiolitis obliterans, accelerated atherosclerosis, chronic graft nephropathy, vanishing bile duct
chronic transplant rejection
What are the CV defects associated with with Kartagener?
Situs inversus
projection
attributing one’s own feelings to others (thinking someone is angry with you when you’re angry with them)
vitamin deficiency with peripheral neuropathy and cardiac involement
wet beriberi from thiamine deficiency (wet involves heart)
antiandrogen therapy that blocks conversion of testosterone to DHT at peripheral tissues
5-alpha-reductase inhibs eg finasteride
Receptor tyrosine kinase signal pathway
MAP kinase growth factors: insulin, IGF-1, FGF, PDGF, EGF
Horizontal nystagmus, abducens palsy, ataxia, encephalopathy
Wernicke enceph (damage to mamillary bodies)
Marfinoid body habitus plus intellectual disability and thrombosis
Homocystinuria. Cystathione beta synthase mutation leads to buildup and methionine and homocysteine
fatty casts
nephrotic syndrome
Injury to tibial nerve
Sensory: Bottom of foot to lateral edge; Motor: foot inversion, plantar and toe flexion
Traverses foramen ovale
V3
Osteogenesis imperfecta mutation
Type I collagen
Cyanotic congenital heart disease
Tet of Fallot; truncus arteriosus; transposition; tricuspid atresia, total anomalous pulm venous connection
E coli virulence factor in bacteremia and septic shock
Lipopolysaccharide
What antibody protects from Giardia?
IgA
vasculitis of graft vessels with interstitial lymphocytic infiltrate
acute transplant rejection
DNA polymerase with 5’ to 3’ exonucleases activity that excises RNA primers on lagging strand
DNA polymerase I
Meds that can cause hyperkalemia
Nonselective beta-blockers, ACE-I, ARB, K+ sparing diuretics, Cardiac glycosides, NSAIDs
antimitochondrial Abs
PBC
Injury to common peroneal nerve
Sensory loss along lateral shin and dorsum of foot; Motor: Foot eversion, dorsiflexion, toe extension
Malrotation of midgut
Usually asymptomatic but can lead to ischemia and volvulus
Oxidase positive
P aeruginosa, Neisseria, Vibrio, Campylobacter, H pylori, Legionella
Granulomatous inflammation and destruction of intrahepatic, interlobular bile ducts
Primary biliary cirrhosis
Branches of celiac trunk
Common hepatic, splenic, left gastric
Cerebellar ataxia, telangiectasias, incr risk of sinopulmonary infections
Ataxia telangiectasia (mutation in gene responsible for DNA break repair)
Dyslipidemia with premature CAD, tendon xanthomas, xanthelasmas
Familial hypercholesterolemia. Defect in LDL receptor and ApoB
number needed to treat
NNT=1/ARR
Common causes of septic arthritis in sickle cell
S aureus, salmonella
Congenital heart dz, dysmorphic facies, hypocalcemia
DiGeorge
Halflife equation
.7*Vd/Cl
Genitofemoral nerve
Sensory: scrotum/labia majora; medial thigh; Motor: cremaster
Biochem processes exclusively in mito
Fatty acid oxidation, TCA, gluconeogenesis (pyruvate carboxylation)
Causes of osteomyelitis in sickle cell
Staph aureus, Salmonella
Type IV collagen
basement memb, basal lamina, lens
Causes of osteomyelitis in IVDU
Pseudomonas, candida, S aureus
Bite cells and Heinz bodies
G6PD deficiency
Fetus with Ebstein anomaly, nephrogenic diabetes insipidus, hypothyroidism
lithium
Injury to obturator nerve
Sensory loss on inner thigh; Motor: thigh adduction
pyuria without casts
acute cystitis
Upward gaze palsy from damage to..
Superior colliculus
Acidic aa’s
Aspartate, glutamate
Treatment for organophosphate
Atropine (antichol) to counteract cholinesterase inhib
nephrotic syndrome in those with hepatitis
membranous nephropathy
Pudendal nerve
Sensory: perineum and external genitalia; motor: external urethral and anal sphincters
What’s the function of micro RNA?
gene silencing and mRNA degradation
Drugs that prevent IL-2 txn
Cyclosporine and tacrolimus
Traverses foramen rotundum
V2
E coli virulence factor in infant meningitis
K1 capsular polysaccharide
Fetus with nasal hypoplasia, stippled epiphysis
Warfarin
MOA botulinum toxin
cleaves SNARE and blocks exocytosis of ACh NTs
Type II collagen
cartilage
lung cancer assoc with Cushing syndrome, Lambert-Eaton, SIADH
small cell carcinoma
What’s the protein defect with elevated LDL?
LDL receptor, ApoB-100
donor T cells proliferate in immunocompromised host and reject host cells
graft vs host disease
What activates Th1? What inhibs Th1?
Activate: IL-12, IFN-gamma; Inhib: IL-4, 10
Nutrients that can contribute to serotonin syndrome
Tryptophan, omega 3 fatty acids
Hypoketotic hypoglycemia
Failure of fatty acid degradation from lack of carnitine or acyl-CoA dehydrog
Cell types seen in watery diarrhea
No inflammatory cells, just mucus and sloughed epithelial cells. Enterotoxin which is noninflamm
Enzyme defic in hereditary fructose intolerance
Aldolase B
Treatment for maple syrup disease
Restriction of valine, luceine, isoleucine; supplementation of thiamine
What are the CV defects associated with Down Syndrome?
Endocardial cushion defects: ASD, VSD, single AV node (ostium primum and regurge)
pacemaker rates
Fastest to slowest: SA, AV, bundle of his/Purkinje/ventricles
precursor of pyrimidine
orotic acid
E coli virulence factor in watery diarrhea
Heat stable/labile enterotoxin
Traverses jugular foramen
IX,X,XI, jugular vein
Arthralgias, skin findings, ACE elevation, hilar lymph nodes
Sarcoidosis
CN for gag reflex
IX in, X out
Symptoms of right sided vs left sided colon cancer
Right: bleeding and iron defic anemia; Left: obstruction
Follicular lymphoma
t(14;18); Bcl-2 is antiapoptotic
Failure of gut recanalization
Duodenal atresia
Lymph node that drains foot and calf
Popliteal
Burkitt lymphoma translocation and mutation
t(8;14); c-Myc is transcription activator
vasculitis common in patients with hepatitis
polyarteritis nodosa
What’s the function of small nuclear RNA?
mRNA splicing and transciption regulation
Drugs that increase coronary vasodilation
CCBs (both di and nondi)
Type I collagen
bone, skin, tendon
What are the CV defects associated with DiGeorge?
3 Ts: tetrology of Fallot, truncus arteriosus, transposition of great arteries
Structures supplied by IMA
Distal 1/3 of transverse colon to upper part of rectum
Child with Intellectual disability, seizures, hypopigmentation
Phenylketonuria
cardiac tissue conduction velocity
Fastest to slowest: purkinje, atrial muscle, ventricular muscle, av node (mnemonic: park at venture ave)
Congenital toxo
Chorioretinits, cranial calcifications, hydrocephalus
Lateral gaze palsy from damage to
Frontal eye fields or abducens nerve in pons
Lymph node that drains anal canal below pectinate
Superficial inguinal
Cancer of rectum above dentate metastasizes to
Liver (enters portal circ thru inf mesenteric)
Structures supplied by celiac artery
Pharynx, lower esophagus to proximal duodenum, liver, gallbladder, pancreas, spleen
Enfuvirtide MOA
fusion inhib by binding to gp41
What’s in the aortic hiatus of diaphragm?
aorta, thoracic duct, azygos vein
heterophile abs against sheep erythrocytes
Mono
absolute risk reduction
ARR=control rate - treatment rate
What are the humoral and cell components of type IV hypersensitivity?
No humoral; T cells and macrophages
Syringomyelia
Bilateral loss of pain and temperature. Occurs in Chiari I malformation
What does Th1 release?
IL-2, IFN-gamma, TNF-alpha
reaction formation
doing something that’s the opposite of what you’re feeling
RBC casts
glomerulonephritis, malignant HTN
Precursor of vit A
carotene
Enzyme that’s deficient in lead poisoning
ALA dehydrotase or ferrochelatase
Anticholinergic toxicity
Hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter, full as a flask (urinary retention), fast as a fiddle (tachycardia)
widespread thrombosis of graft
hyperacute transplant rejection
What antibody binds mast cells and basophils?
IgE
Albinism, pyogenic infections, progressive neuro dysfunction
Chediak-Higashi
lung cancer assoc with clubbing and hypertrophic osteoarthropathy
adenocarcinoma
Iliohypogastric nerve
Sensory: suprapubic; motor: abs and obliques
drugs that cause arterial dilation and decr afterload
dihydropyridines (nifedipine)
What are the CV defects associated with Marfan?
Aortic dissection and aneurysm, mitral valve prolapse
Drugs that prevent response to IL-2
Sirolimus
frontal bossing, macrocephaly, short arms and legs, midface hypoplasia
achondroplasia (FGFR3 mut)
Causes of agglute neg mono-like syndromes
CMV, HHV-6, HIV, Toxo
Bacterial and viral infections in infancy, chronic diarrhea, mucocutaneous candidiasis
Severe combined immunodeficiency disorder
Porphyria with blistering and photosensitivity
Porphyria cutanea tarda; uroporphyrinogen decarboxylase
IP3 signal pathway
GnRH, Oxytocin, ADH, TRH, Histamine, ang II, gastrin
sustained, involuntary muscle contractions
dystonia
CN for pupillary light reflex
II in, III out
IgM against Fc portion of IgG
Rheumatoid factor
CN in midbrain
III, IV
cGMP signal pathway
vasodilators: ANP, BNP, EDRF (NO)
Where’s hexokinase?
Most tiss (not liver or pancreas)
Enzyme that’s deficient in sideroblastic anemia
ALA synthase
Drug that inhibits pancreatic enzymes needed to digest complex carbs
Acarbose
What enzyme is deficient in homocystinuria and what builds up?
Defic of cystathione beta-synthase leads to high levels of homocysteine and methionine
Patellar reflex
L3, L4
Horizontal gaze center in
pons
Newborn with hyperammonemia
Ornithine transcarbamylase defic is most common. Presents with high orotic acid and low citrulline. Carbamoyl phos synthetase defic results in low orotic and citrulline
drugs that decrease HR
beta blockers and nondihydropyridines (verap and dilti)
Causes of myopathy with increased creatine kinase
Autoimmune (polymyositis), musc dystrophy, hypothyroid, statins
What’s in the esophageal hiatus of diaphragm?
Esoph, vagus nerve, left gastric artery
What are the humoral and cell components of Type II hypersensitivity?
IgG, IgM and complement; NK cells, eos, neutrophils, macrophages
Glutamate is precursor of (2)
GABA, glutathione
Phosphorylation of mannose residues in Golgi send prot to…
lysosome
Difficulty swallowing, speaking and blurred vision
C botulinum
Murmurs that decrease with squatting and passive leg raise
MVP and HCM
Molecule necessary for glutathione antioxidant mech
NADPH
What’s the only way for more oxygen to be delivered to the heart?
increase coronary blood flow
E coli virulence factor in UTIs
P fimbriae
Alport syndrome and Goodpasture mutation/autoab
Type IV collagen
Bacterial component that aids in attachment to epithelium
Pili
Traverses foramen spinosum
Middle meningeal artery and vein
What are the CV defects associated with turners?
Aortic coarctation, bicuspid aortic valve
Fetus with renal dysgenesis, oligohydramnios
ACE-I
CN for vestibulo-ocular reflex
VIII in; III, IV, VI out
Ehlers-Danols mutation
Type III collagen
Schistocytes
Microangiopathic hemolytic anemia: DIC, TTP/HUS, HELLP, mechanical trauma
relative risk reduction
RRR=ARR/control rate
CN for cough reflex
X in, X out
Enzyme defic in essential fructosuria
Fructokinase (excess fructose metab’d by hexokinase)
hyaline casts
nonspecific
What’s the protein defect with elevated chylomicrons?
Lipoprotein lipase, ApoC-2
What recognizes toll-like receptors and PAMPS?
Cells of innate immunity
Mantle cell lymphoma translocation and mutation
t(11;14); cyclin D1 promotes G1 to S
Injury to inferior gluteal nerve
Motor: thigh extension
nephrotic syndrome in those with HIV or heroin use or sickle cess
focal segmental glomerulosclerosis
Neonatal hypotonia, hyperphagia, obesity, hypogonadism
Prader-Willi (loss of paternal allele)
Antiandrogen therapy that lowers testosterone synthesis
Leuprolide (GnRH agonist that suppresses LH when given continuously) and ketoconazole
Histidine is precursor of
histamine
Treatment for jinsonweed
Physiostigmine or other cholinesterase inhib to counteract antichol toxicity
What are the humoral and cell types in Type I hypersensitivity?
IgE; mast cells and basophils
Drugs that cause venodilation and decr preload
Nitrates
flailing of arm or leg
hemiballismus from lesion of CL subthal nucleus
Brown-Sequard (hemisection)
Lose all sensation at level of lesion, then IL dorsal column and CL spinothalamic. IL LMN signs at level of lesion, IL UMN signs below
Failure of extraembryonic gut to return to abdomen cavity
Omphalocele (covered by thin memb) or gastroschisis (not covered)
CD8+T cells against donor MHCs and development of antibodies
acute transplant rejection
sudden, brief, uncontrolled muscle contraction
myoclonus
Virulence factor that inhibits phagocytosis and complement activation
Protein M (S pyogenes)
epilepsy/seizures, ataxia, inappropriate laughter
Angelman (loss of maternal allele)
Porphyria with painful abdomen and port wine urine and polyneurophaty
Acute intermittent porphyria; porphobilinogen deaminase
CN in pons
V, VI, VII, VIII
Murmurs that decrease with handgrip
HCM and AS
Glycine is precursor of
prophyrin then heme
maculopapular rash, jaundice, diarrhea, hepatosplenomegaly
graft vs host disease
What activates and inhibs Th2?
Activate: IL-2,4; Inhib: IFN-gamma
WPW triad
short PR, wide QRS, delta wave
CN for corneal reflex
V1 in, VII out
Basic aa’s
histidine, lysine, arginine (his lyes are basic)
What causes a right shift in O2-Hb curve?
Right shift=more O2 to tiss: incr H+ (low pH), incr 2,3-BPG, incr temp
Biochem processes exclusively in cyto
Glycolysis, fatty acid synth, pentose phosphate
Intracell receptor signal pathway
Progesterone, estrogen, testosterone, cortisol, aldosterone, t3/t4, vitamin D
What enzyme is deficient in galactosemia?
Galactose-1-phosphate uridyltransferase
What areas are drained by superficial inguinal nodes?
Anal canal, skin below umbilicus, scrotum, vulva
WBC casts
pyelonephritis, inflammation, transplant rejection
precursor of tyrosine
phenylalanine
Achilles/ankle reflex
S1, S2
G6PD precipitating factors
Infection, drugs (TMP-SMX, dapsone, antimalarials), DKA, fava beans
Fetus with neural tube defects, orofacial clefts, microcephaly, nail/digit hypoplasia
phenytoin, valproate (just tube defects)
lung cancer most common in women and nonsmokers
adenocarcinoma
Inflammation and onion skin fibrosis of large bile ducts and obstruction of small ducts
Primary sclerosing cholangitis
MOA tetanus toxin
cleaves SNARE in inhibitory interneuron preventing release of GABA and glycine NTs
Arginine is the precursor of
nitric oxide, urea, ornithine, creatine
What enzymes can’t be broken down in maple syrup dz?
Leucine, isoleucine, valine (branched chain aa’s)
Structures supplied by SMA
Distal duodenum to proximal 2/3 of transverse colon
CD4+T cells respond to recipient APCs
chronic transplant rejection
Murmurs heard during valsalva and abrupt standing
MVP and HCM
Target cell
HALT: Hb C, asplenia, liver disease, thalassemia
Dyslipidemia with acute pancreatitis, skin xanthomas, and hepatosplenomegaly
Familial chylomicronemia. Defect in LPL and ApoC
What are the CV defects associated with tuberous sclerosis?
valvular obstruction due to cardiac rhabdomyomas
Zinc-containing enzyme that degrades basement membrane and ECM
Metalloproteinase (proteolytic enzyme)
Disorder that causes black urine and can progress to arthritis (and pathophys)
Alkaptonuria. Mutation in homogentistic acid dehydrogenase which breaks down phenylalnine and tyrosine
Maraviroc
Inhibs viral entry by blocking gp120–CCR5
Cremasteric reflex
L1, L2
Serotonin syndrome symptoms
Hyperthermia, hyperreflexia, shivering, clonus, autonomic instability, altered mental status
Syndromes/cancers with mutation of DNA repair enzymes
Breast (BRCA), ovarian cancer, Lynch, xeroderma pigmentosum, Fanconi anemia
restlessness and urge to move
akithisia
relative risk
RR=treatment rate/control rate
Elevated alkaline phosphate
Hepatobiliary disease and elevated osteoblastic activity
Common causes of septic arthritis
S aureus, strep, N gonorrhea
CN for jaw-jerk reflex
V3 in, V3 out
formation of fibrous Ladd bands
malrotation of gut
Fetus with microcephaly, thymic hypoplasia, small ears, hydrocephalus
Isotretinoin
hematuria without casts
cancer, stones
Fetus with mental retardation, microcephaly, smooth philtrum, thin vermillion border, limb dislocation, heart defects
Fetal alcohol syndrome
Spherocyte
Spherocytosis, drug/infection induced hemolytic anemia
Tryptophan is precursor of (2)
Niacin, serotonin
lung cancer assoc with hypercalcemia
squamous cell carcinoma
ilioinguinal nerve
runs with spermatic cord; sensory to upper and medial thigh and external genitalia
Nonreceptor tyrosine kinase signal pathway
JAK/STAT: prolactin, immunomodulators (cytokines), GH, G-CSF, erythropoietin, thrombopoietin
sublimation
channeling impulses into socially acceptable manner
What are the CV defects associated with Friedreich ataxia?
Hypertrophic cardiomyopathy
What antibody is released into secretions and breast milk?
IgA
anti-dsDNA
specific for SLE
Injury to femoral nerve
Sensory loss from inner thigh down to ankle; Motor: thigh flexion, leg extension
anti-ANA
sensitive but not specific for SLE; also in pts with other conn tiss disorders