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UworldSUN > uworld > Flashcards

uworld Flashcards

1
Q

man with HIV, LAD in the superficial inguinal nodes, where is the origin?

A

anal orifice; cutaneous lymph below umbilicus drains to superficial inguinal lymph nodes except penis and posterior calf

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2
Q

mediastinal mass in teenager, causing dysphagia with blasts on smear

A

T-cell ALL

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3
Q

northern blot with 3 different transcripts identified exhibits what principle?

A

alternative splicing

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4
Q

spherocytosis effect on MCV, and other parameters?

A

normal or low, due to dehydration and MCHC is also high because smaller

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5
Q

woman with anemia given folate, comes back with neuro deficits?

A

B12 deficiency treated with folate worsens neurological symptoms

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6
Q

different stages and colors of bruises caused by what enzyme?

A

heme oxygenase

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7
Q

what receptors used for antiemetic drugs? in chemotherapy?

A

Neurokinin1 and 5-HT3

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8
Q

15,17 balanced translocation in person with bleeding, Pt/PTT increased, d-dimer increased, low fibrinogen. what protein is mutated in this patient? Diagnosis and mechanism?

A

retinoic acid receptor in acute promyelocytic leukemia, accumulation of cells with primary granules, which increase risk of DIC

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9
Q

chloramphenicol in pregnancy

A

“Gray baby” syndrome

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10
Q

bactrim in pregnancy

A

neural tube defects

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11
Q

mRNA processing steps and location

A

5’ methylated cap, poly A tail, intron/exon splicing- exit nucleus, then P bodies in cytoplasm regulate and degrade

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12
Q

what contributes to the pathology of T2DM?

A

free fatty acids; they cause impaired glucose uptake and increases hepatic gluconeogenesis

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13
Q

hemorrhagic cystitis with cyclophosphamide, can give what to prevent it?

A

mesna, 2-mercaptoethane sulfonate

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14
Q

mediterranean guy with microcytic anemia with pokilocytes and target cells, Hb A2 is elevated, what is the mechanism of anemia?

A

mRNA processing defect in Beta thalassemia

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15
Q

mechanism of radiation therapy

A

breaks double strand DNA and formation of free radicals

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16
Q

vincristine SE and mechanism

A

neurotoxicity due to inhibition of MT polymerization

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17
Q

person travelling to africa gets meds and vaccinated, then comes back with jaundice: dx and pattern of inheritance; what do you see on peripheral smear

A

G6PD, X-linked recessive, heinz bodies

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18
Q

aminoglycosides in pregnancy

A

otoxtoxicity and vestibulotoxicity

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19
Q

malignant tissue biopsy has blue cells, what enzyme is active? and where

A

RNA polymerase 1, in nucleolus- makes rRNA

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20
Q

2 unique things about Ecoli O157:H7

A
  1. does not ferment sorbitol. 2. no glucoronidase
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21
Q

what is 2,3 BPG, how is it produced, and its function?

A

a byproduct of glycolysis produced in RBCs, which sacrifices a net gain of ATP to make this. 2,3 BPG decreases Hb affinity for oxygen (causes right shift in O-H curve) and thus facilitates increased delivery of O2 in times of hypoxia and chronic anemia

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22
Q

light’s criteria

A
  1. fluid protein/serum protein > 0.5; 2. fluid LDH/serum LDH >0.6; 3. fluid LDH > 2/3 normal limit of serum LDH
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23
Q

why is HbS clinically worse than HbC? what are the mutations? how does HbS affect O-H curve

A

glu –> valine and glu –> lysine, respectively. Because valine is hydrophobic and lysine is charged, hydrophobic valine can cause clumping of Hb and sickling of RBC. Causes right shift because it favors deoxygenated state.

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24
Q

mutation in the protein that interacts with transferrin receptor, what is it and what does it lead to?

A

HFE, causes upregulation of DMT1, then hemochromatosis, cirrhosis and HCC

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25
Q

thrombocytopenia with no other features, pt is normal, dx?

A

ITP; vWD does not have thrombocytopenia and has prolonged pt

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26
Q

immigrant with anemia, pyruvate kinase deficiency and splenomegaly. what is mechanism for spleno?

A

pyruvate kinase deficiency causes hemolytic anemia because ATP from RBC is not generated and membrane gradient cannot be maintained. The red pulp removes dead RBC, so undergoes hyperplasia

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27
Q

STAT pathway, non-tyrosine kinase mutation in a hematopoietic cells, anemia and splenomegaly. what group of diseases?

A

chronic myeloproliferative diseases, except CML

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28
Q

folate deficiency, can give what else to prevent apoptosis?

A

thymidine

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29
Q

man with CRAB, treated with agent that blocks proteasome site, mechanism of action?

A

proteasome inhibition leads to accumulation of proteins that cause apoptosis. IgG is mass produced in multiple myeloma so very effective

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30
Q

on hemoglobin electrophoresis, rank A,S,C in terms of distance from - charge, and give rationale

A

C,S,A because of Valine is neutral, Lysine (HbC) is positive

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31
Q

girl with infectino, giant pronormoblasts in bone marrow biopsy with inclusions, dx and epi?

A

parvovirus B19 causing aplastic crisis, esp in patients with hemolytic dz

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32
Q

person with pneumonia, and WBC and LAP is up, what other findings are there?

A

basophilici granules called dohle bodies

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33
Q

HCC with foreign DNA

A

HBV, inserts DNA into host

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34
Q

mechanism of multiple myeloma and signs of mm

A

RANK activation leads to osteoclast stimulation; CRAB

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35
Q

GVHD

A

occurs after bone marrow transplantation OR of any organ rich in lymphocytes such as liver. Systemic involvement in GI, skin, and liver point to it being a GVHD as opposed to transplant rejection which affects only the transplanted organ

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36
Q

agitated elderly woman with BPS symptoms, what drug?

A

haloperidol and not lorazepam because of SE of latter

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37
Q

tachyphylaxis

A

when use of drug causes negative feedback and rebound symptoms because endogenous products are not made, i.e decongestants

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38
Q

hemophilia carrier in mother, whats the chance it will be passed to child of unknown sex?

A

1/8

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39
Q

CO poisoning, effect on dissociation curve and PaO2

A

decreases o2 content but not dissolved o2 (PaO2) and decreases unloading of O2 in tissues

40
Q

cerebellum brain tumor in child, solid and cystic components

A

pilocytic astrocytoma

41
Q

leukocytosis with promyelocytes and myelocytes, and leukocyte alkaline phosphatase is low, dx?

A

CML, because it’s ALP is low, usually high in leukemoid reaction

42
Q

forceps or vacuum can lead to?

A

subdural hematoma (cortical bridging veins) or epidural hematoma (middle meningeal artery)

43
Q

anterior mediastianal mass with progressively declining response on EMG, what anesthesia drug is powerful?

A

MG- because receptor number is low, a non-depolarizing agent like vercuronium is very powerful. succinylcholine is depolarizing agent, which is a competetive agonist competing for the same spot, so not as effective

44
Q

patient with cLL, given tx that inhibits BCL-2, result?

A

activation of caspases via leak of cytochrome C

45
Q

sickle cell trait:

A

normal, asymptomatic, more Hb F and Hb A than Hb S, protective against malaria

46
Q

anemia after infection with walking pneumonia, why does it resolve after 2 months?

A

IgM from cold agglutinins disappear, they are initially formed due to molecular mimicry

47
Q

what is this test- take a protein of interest, gel electrophoresis, transfer to filter, then use Ab to IHC? how about for DNA binding protein, DNA, RNA?

A

western blot; southwestern, southern, northern respectively

48
Q

extra nitroprusside treatment

A

cyanide poisoning; so must give sulfur group (using sodium thiosulfate) to make thiosulfate –> which is less toxic and excreted in urine.

49
Q

what causes cachexia in cancer and what is the mechanism?

A

TNF-a; suppresses appetite in the hypothalamus and increases basal metabolic rate

50
Q

chronic opioid use leads to?

A

tolerance of analgesic and side effects, except constipation and miosis

51
Q

old man with paresthesia and gait ataxia, what is the cause?

A

B12 deficiency due to strict vegan diet for 6 years

52
Q

CNS lymphoma in HIV caused by?

A

EBV virus, predominant in B lymphocytes

53
Q

cause of macrocytosis in sickle cell

A

increased folic acid requirements due to high turnover of erythrocytes

54
Q

telomerase activity highest in?

A

stem cells; because they need to reproduce often, must stay alive longer!

55
Q

mucor infection what to look out for after initiating rx?

A

magnesium and potassium because Ampho B can cause nephrotoxicity

56
Q

which enzyme, when overactive, causes cancer? and how

A

microsomal monooxygenase (Cytochrome P450); by converting procarcinogens into carcinogens

57
Q

excretion rate of susbstance A?

A

total filtration rate - total reabsorption rate of A

58
Q

where does complement bind antibody?

A

Fc region, near the hinge point

59
Q

tumor cells with mismatch repair and high microsatellite instability, why are they especially susceptible to PD-1 immunotherapy?

A

because a lot of neoantigens. a lot of non-self proteins which will be recognized as T-cells as foreign and destroyed, now that PD-1 immune evasion strategy is not working

60
Q

leukocyte migration PECAM-1 involved in which step?

A

Transmigration- PECAM-1 inbetween endothelial cells

61
Q

bone cancer that mets to lungs, sheets, and vascular fibrous septae, diagnosis and epidemiology?

A

Ewing sarcoma, 2nd most common bone cancer of childhood after osteosarcoma

62
Q

anterior pituitary gland embryological origin

A

surface ectoderm

63
Q

pneumocystic pneumonia, oral ulcers and a new rash, cause?

A

HHV-8, Kaposi’s sarcoma

64
Q

chemotherapy patient having neurological symptoms, caused by which drug and what mechanism?

A

vincristine, MT inhibitor, prevents M phase of cell cycle

65
Q

heparin overdose causing intracranial bleed, rx?

A

protamine- binds to heparin and inactivates it

66
Q

what causes left shift of Hb dissociation curve?

A

ACE bats right- acid, co2, exercise, 2-3bpg, altitude, temperature

67
Q

tetracycline in pregnancy

A

teeth staining

68
Q

lack of which organelle affects heme production?

A

mitochondria

69
Q

how do tumor cells evade immune system and how to prevent?

A

PD-1 ligand to exhaust T cell, can give PD-1 antibody

70
Q

hemolytic anemia, hypercoagulability, and pancytopenia, lack of CD55, dx and mechanism?

A

PNH, no GPI, which prevents DAF/MIRL which prevent complement activation

71
Q

pigment inclusion in lysosomes in liver, epinephrine metabolites

A

Dubin-Johnson, GC/DR = direct hyperbilirubinemia, defect in transport

72
Q

what does oxygen dissociation curve look like if Hb subunits are separated?

A

hyperbolic like myoglobin

73
Q

patient just started on warfarin, skin necrosis happens, mechanism?

A

warfarin inhibits epoxide reductase, which blocks new production of factors and protein C and S. Protein C has short half life, which means skin necrosis!

74
Q

PCR, what do you need to amplify?

A

flanking region sequence to make primers to anneal

75
Q

neurophysins

A

proteins involved in posttranslational hormone processing and stabilization during axonal transport for ADH and oxytocin

76
Q

woman with GN, rash, arthralgia has prolonged APTT and falsely positive VDRL, common complication for this woman and dx

A

antiphosphoipid antibodies in SLE, causing recurrent miscarriages due to thromboembolism

77
Q

ectopic pregnacy, given methrotrexate, what accumulates in embryonic tissue?

A

dihydrofolate polyglutamate; MTX inhibts DHF reductase which reduces folic acid to DHF and THF. so DHF will increase because it cannot be made in to THF

78
Q

horse erythrocytes agglutinate when exposed to patient’s serum, what is the cancer caused by the agent?

A

NPC- EBV

79
Q

arginase deficiency

A

arginase is used in urea cycle, deficiency causes spastic diplegia, growth delay, abnormal movements. tx: arginine free diet

80
Q

dysthymia criteria

A

2 years, 2 sxs + depression

81
Q

2 ways of calculating CO

A

CO = HR * SV or CO = rate of o2 consumption/(arterial O2 -venous O2)

82
Q

spleen of sickle cell patients

A

fibrosis and scarring due to repeated infarctions and vaso-occlusions. after autosplenectomy more vulnerable to encapsulated organisms

83
Q

digeorge syndrome, where in the lymph node is there degeneration?

A

paracortex

84
Q

DNA-binding proteins include (4)

A

steroid hormone, thyroid hormone, transcription factors, fat soluble vitamin receptors

85
Q

rRNA is synthesized in which intracellular organelle?

A

nucleolus

86
Q

SSSS

A

caused by exotoxin from staph species, usually in young children with nikolsky’s sign

87
Q

how does HOCM lead to SCD

A

due to ventricular arrhythmia, aberrant course of conduction

88
Q

gingival bleeding girl, platelet with riscocetin doesn’t work well. give normal plasma and it works: dx and mechanism

A

VWD; riscocetin activates GP1b on platelets so it can agglutinate to vWF, but if don’t have in first place then no use

89
Q

what to give in atropine toxcity (drug and class)

A

physostigmine (anticholinergic) because it can cross bbb unlike pyridostigmine, neostigmine, edrophonium.

90
Q

pregnant mom with woody hard uterus, and signs of DIVC. Cause and mechanism?

A

tissue thromboplastin in maternal circulation, damage to placenta releases TT in mom’s circulation, causing activation of extrinsic pathway, leading to widespread consumption coags and platelets

91
Q

vWF binds where and what does it do

A

binds subendothelial collagen, then platelets can bind vWF using Gp1b receptor. vWF also stabilizes clotting factor VIII

92
Q

inferior surface of heart is supplied by?

A

right coronary artery; 85-90% of people are right dominant, meaning RCA supplies PDA (posterior descending artery) which supplies inferior part

93
Q

neonatal IVH

A

originates from germinal matrix in premature, low-birth weight infants because of a lack of glial fiber support and autoregulation of BP

94
Q

iron is regulated by what in the body and produced where and what does it do?

A

hepcidin from hepatic parenchymal cells, it regulates iron via ferroportin. hypoxia and increased erythropoiesis lowers hepcidin, inflammation and high iron levels increases hepcidin.

95
Q

multiple ring-enhancing lesions in CNS for HIV patient

A

toxoplasmosis; treat with fansidar (pyrimethamine and sulfadiazine)

96
Q

CCl4 mechanism of damage/cell injury, liver necrosis?

A

CCl4 is converted to CCl3, a free radical, by the P450 system. This leads to lipid peroxidation and cell injury which leads to fatty change and necrosis

97
Q

metachromatic granules, aniline dyes and mechanism of toxin

A

diphteria, AB toxin causes impairment of protein synthesis by ADP-ribosylating EF-2

UworldSUN (11 decks)

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