uWorld 9 Flashcards
what causes coordinated, synchronous labor contraction
increase in GAP JUNCTIONS b/w myometrial cells due to ESTROGEN increases myometrial excitability
increase in UTEROTONIC (OXYTOCIN) receptors due to estrogen which mediate claim transport though ligand-activated calcium channels
what kind of murmur is aortic regurgitation
decrescendo diastolic murmur that begins (and PEAK INTENSITY) immediately after A2 (AORTIC VALVE CLOSURE)- when pressure gradient b/w aorta and left ventricle is at its maximum
loss of dicrotic notch, high peaking left ventricular and aortic pressures during systole, steel diastolic decline in aortic pressure (resulting in wide pulse pressure)
best heard along the left sternal border at the third and fourth intercostal spaces while the patient is siting up and leaning forward with his breath held at end-expiration
what kind of vaccine is the rabies vaccine (what other vaccines are like this)
inactivated (killed) vaccine "RIP Always" Rabies (inactivated by beta-propiolactone) Influenza (injected) Polio (Salk) HAV
what vaccines are subunit vaccines
HBV (antigen = HBsAg)
HPV (types 6, 11, 16, 18)
PPSV23 step pneumo
what could bind a repeated sequence of deoxythymine residues fixed to latex beads
POLY-A TAIL of MATURE mRNA
what is telemorase
Rna-Dependent DNA polymerase that makes telomeres that contain TTAGGG repeats
how is carbon dioxide carried in the blood
as carbamate in hemoglobin
bicarb in the plasma
chloride shift makes high RBC chloride content in venous blood (maintain electroneutrality b/c of bicarb leaving cell)
what is Asherman syndrome
causes secondary amenorrhea via obstruction from carrying of the uterine cavity
typically sequela of uterine infection (postpartum endometritis) or procedures (dilation and curettage)
what is an imperforate hymen
obstructive lesion caused by incomplete degeneration of the central portion of the fibrous tissue band connecting the walls of the vagina
at birth, vaginal secretions stimulated by the mother’s estrogen can cause mucocolpos (accumulation of mucus in the vaginal canal), may manifest as building intriitus
what are the signs and symptoms of imperforate hymen
PRIMARY AMENORRHEA and normal secondary sexual characteristics with CYCLIC abdominal or PELVIC PAIN due to accumulation of menstrual blood int he vagina and uterus (HEMATOCOLPOS)
vaginal budge or mass palpated anterior to the rectum
secondary sexual characteristics are normal
what is seen in endometriosis
severe dysmenorrhea (nor amenorrhea) with lower abdominal cramps 1-2 days BEFORE MENSES common site is endometrial implants is he pouch of Douglas, which presents as painful defecation, dyspareunia, and palpable nodularity on rectovaginal examination
what is kallman syndrome
impaired synthesis of gonadotropin-releasing hormone by the hypothalamus
presents as primary amenorrhea, absent secondary sexual characteristics, and an OLFACTORY SENSORY DEFECT
what nerve is fucked up in gluteal gait
superior gluteal (gluteus medius and minimus, tensor fascia lata) caused by pelvic trauma or iatrogenic damage occurring during hip surgery or buttocks injections
when STANDING pelvis SAGS to UNAFFECTED (contralateral) side when patient stands on the affected leg
when WALKING patients LEAN towards the AFFECTED SIDE to compensate for the hip drop (GLUTEUS MEDIUS LURCH)
what is seen if the inferior gluteal nerve is injured
gluteus maximus is injured (extension and external rotation of thigh at the hip fucked up)
difficulty raising leg from a seated position and climbing stairs
femoral nerve innervates what and injury to it results in what
muscles responsible for flexion of the thigh at the hip (iliac and sartorius muscles) and extension of the leg at the knee (quadriceps femurs)
sensory to skin on the anterior thigh and medial leg
injury results in KNEE BUCKLING and LOSS of PATELLAR REFLEX
injury to the obturator nerve results in what
impaired thigh adduction and medial thigh sensory loss
the sciatic nerve innervates what
muscles in the posterior compartment of the thigh (hamstrings)
divides into tibial and common fibular/common peritoneal nerves (motor and sensory to leg and foot)
bilateral lens opacities (cataracts) with large amounts of galactose in urine, otherwise asymptomatic. Enzyme contributing to this?
aldose reductase which converts galactose to galacticol (causes cataracts)
this is galactokinase deficiency, a form of glactosemia that has cataracts and hepatocellular manifestations
what is classic galactosemia
galactose-1-phosphate uridyl transferase (GALT) deficiency
vomiting, lethargy, and failure to thrive soon after feeding is begun
impaired liver function, hyperchloremic metabolic acidosis, and aminoaciduria
severe symptoms after initiation of breast feeding
what is responsible for HIV protease variants that are resistant to standard protease inhibitors
Pol gene mutations
also responsible for structural changes in HIV-1 reverse transcriptase that render the enzyme resistant to standard nucleoside and non-nucleoside reverse transcriptase inhibitors
Env gene mutations of HIV allow for what
escape from host neutralizing antibodies
during the healing process, fibroblast migration and proliferation are controlled by multiple growth factors including what
platelet derived growth factor (PDGF)
TRANSFORMING GROWTH FACTOR BETA (TGF-beta)
what is the role of TNF-alpha
cytokine released by activated macrophages and T cells that promotes leukocyte recruitment, induces systemic inflammatory response (fever, acute phase proteins), and regulates apoptosis
hypertrophic or disfiguring scars can ve caused by persitencly elevated levels of what
TGF-beta: this leads to increased fibroblast proliferation and activity; and connective tissue synthesis and remodeling of the ECM
increased TGF-beta receptor expression in fibroblasts of hypertrophic scars
what are the two step pneumo vaccines and who are they for
PCV-13 (pneumococcal conjugate (w/ dipheria protein) vaccine aka Prevnar)- strongly immunogenic in INFANCY and part of childhood vaccines; T-CELL RECRUITMENT
PPSV-23 (pneumococcal polysaccaharide vaccine with no conjugated protein aka Pneumovax)- protects against a wider range of serotypes but antibody levels decline over approximately 5 years; not immunogenic in children due to immature humoral antibody response
what is seen with a fracture to the orbital floor
zygomatic bone and maxilla
infraorbital nerve (continuation of maxillary) gets damaged coming out the infraorbital foramen or on its path
numbness and paresthesia of the upper cheek, upper lip, and upper gingiva
displacement of orbital contents through the floor may cause enopthalmos, and entrapment of the interior rectus muscle impairing superior gaze
what is the battle sign, when is it seen, what else is seen with it
hematomas over the mastoid process
BASILAR SKULL FRACTURE
periorbital ecchymosis (RACCOON EYES)
clear otorrhea
what is used to treat alcohol withdrawal symptoms seen in a patient who has been hostpialized for two days from another surgery and is severely agitated
benzos are first line for psychomotor agitation associated with alcohol withdrawal and to prevent progression to seizures and delirium
long-acting benzos with active metabolites like diazepam or chlordiazepoxide are preferred
what benzos should be used in pts with liver disease
those that do not undergo oxidative metabolism in the liver and have no active metabolites (LOT: lorazepam, oxazepam, temazepam)
what is the treatment of esophageal varices in the setting of cirrhosis
TIPS (transjugular intrahepatic portosystemic shunt) b/w portal vein and hepatic vein percutaneously
what is anergy
state of prolonged unresponsiveness that occurs in T lymphocytes as a form of immune tolerance
self-reactive T cells bind MHC molecules without receive the necessary costimulatory signal (binding CD28 on T cells with the B7(CD80/86) on antigen-presenting cells)
vitamin E deficiency occurs in whom and what is seen
rare but occurs in fat malabsorption and abetalipoproteinemia
hemolysis and NEUROLOGIC DYSFUNCTION (due to free radical damage of cell membranes)
mimics Friedrich ataxia (an AR disorder)- ataxia due to degeneration of spinocerebellar tracts, loss of position and vibration sense (due to degeneration of the dorsal columns) and loss of deep tendon reflexes (due to peripheral nerve degeneration)
what presents with rapidly progressive dementia and myoclonic jerks of the extremities (in an otherwise and before healthy person)
Creutzfeldt-Jakob disease (prion disease)
what causes the clinical manifestations of schistosomiasis
Th2 Mediated granulomatous response directed against the eggs that is composed of infiltrating Th2 cells, eosinophils, and M2 macrophages
cholelithiasis (gallstone disease) is common in whom and what causes it
“fat, fertile, female, and forty”
estrogenic influence increases cholesterol synthesis by up regulating hepatic HMG-CoA reductase activity
progesterone reduces bile acid secretion and slows gallbladder emptying
In a patient with RIGHT VENTRICULAR MI (RVMI) due to occlusion of PROXIMAL RIGHT CORONARY ARTERY which can be seen in in leads II, III, and aVF (inferior wall MI)
if the patient is persistently hypotensive despite rapid infusion of 500mL of normal saline. Whats going on>
cariogenic shock due to RVMI
pt will have hypotension, jugular venous dissension, and clear lungs due to RV dysfunction
decreased cardiac output
normal to decreased pulmonary capillary wedge pressure (due to right side of heart being messed up and not left)
elevated central venous pressure
decreased cardiac output with elevated pulmonary capillary wedge pressure is seen in what kind of MI
acure MI with significant LV systolic function
in the pathogenies of atherosclerotic plaques realize of what by what promotes the migration of smooth muscle cells from the media into the intimal and their subsequent proliferation
Platelet Derived Growth Factor (PDGF)
locally adherent platelet, endothelial cells, and macrophages
what is special about PBP2a (an altered penicillin binding protein)
greatly reduced affinity for beta-lactam antimicrobial agents (except ceftaroline)
resistance to tetracylines and sulfonamides is due at least in part to what
decreased levels of drug accumulation duet decreased uptake and/or increased efflux
mutations to DNA gyrate confer resistance to what
fluoroquinolone
what are the beta-lacramase-resistant penicillins
nafcillin, oxacillin, methicillin
intestinal atresia of the midgut (jejunum, ileum, proximal colon) are the result of what
vascular occlusion in utero
leads to ischemia of a segment of bowl with subsequent narrowing (stenosis) or obliteration (atresia) of the lumen
if major vessel involved like SMA: result is a proximal segment that ends in a blind pouch; followed by an area of absent small bowel and associated dorsal mesentery, and finally a distal segment of ileum that assumes a SPIRAL CONFIGURATION around an ileocolic vessels (“apple peal” or “christmas tree” deformity)
what is the DD of bilious emesis in a neonate
intestinal OBSTRUCTION BELOW the 2nd part of the duodenum:
midgut volvulus
intestinal stenosis
intestinal atresia
what is the difference in cause of atresia in the distal vs proximal gut
proximal gut atresia: due to failure of recanalization
distal gut atresia: due to vascular occlusion
what is abacavir hypersensitivity reaction (AHR)
strongly associated with HLA-B*57:01 which alters the presentation of self-peptides to the immune system and results in a delayed hypersensitivity reaction (type IV)
fever, malaise, GI symptoms, delated rash
negative test for the ALLELE has almost 100% negative predictive value for AHR
when is pulmonary vascular resistance (PVR) the lowers
functional residual capacity
increased lung volumes increase PVR due to longitudinal stretching of alveolar capillaries by the expanding alveoli
decreased lung volumes also increase PVR due to decreased radial traction form adjacent tissues on the large extra-alveoli vessels
what is first line treatment of OCD
SSRI
chronic lymphedema is a risk factor for the development of what
cutaneous ANGIOSARCOMA or lymphangiosarcoma (Stewart-Treves syndrome)
radical mastectomy w/ axillary lymph node dissection is a predisposing procedure
prognosis is poor in pts with angiosarcoma b/c tumor is usually widespread at time of diagnosis
what is seen histologically in angiosarcoma
infiltration of the dermis with slit-like abnormal vascular spaces
pulmonary emboli typically appear how
multiple wedge-shaped hemorrhagic lesions in the periphery of the lung
IV drug users are at risk for developing septic pulmonary emboli as a complication of tricuspid endocarditis
what is opisthotonos
contractions of the back muscles resulting in backward arching
seen in tetanus
