Uworld Added 3 Flashcards
Mechanism of Edema and Lethal factors (anthrax)
Edema = cAMP; Lethal = Protease that inhibits MAPK
Bordatella pertussis toxins
Pertussis = Gi ribosylation –> cAMP; AC toxin = AC –> cAMP
Location and symptoms of Germinomas
Pineal –> (1) Precocious puberty, (2) Obstructive hydrocephalus, (3) Parinaud
Functions of Thyroid Peroxidase
(1) Oxidation of iodide to iodine; (2) Iodination of thyroglobulin tyrosine residues; (3) Iodotyrosine coupling to form T3 and T4
Anti-TPO
Hashimoto’s
Chronic lymphedema is a risk for developin what skin tumor
Angiosarcoma
Spongiosa filling medullary canal with no mature trabeculae
Osteopetrosis
Squatting vs Passive leg raise
Squatting increases both Preload and Afterload, while Passive leg raise just Preload
How to decrease MVP murmur
Decr LV volume, bringing valve leaflets into a more normal anatomic arrangement
In severe MVP, the murmur becomes more
Holosystolic
Histology of MVP
Attenuation of fibrosa (collagen) layer; Thickening of spongiosa layer thru deposition of mucoid (myxomatous) material; Thinning of collagenous core of chordae tendineae
Chromium deficiency
Glucose intolerance (GLUT cofactor), Peripheral neuropathy
Selenium deficiency
Muscle pain and weakness, Dilated CM
Copper deficiency
Microcytic anemia (ferrochetolase), Aortic dissection (elastic tissue), Poor wound healing (lysyl oxidase)
Only bile acid that is not reabsorbed in the terminal ileum
Lithocholic acid
Magnesium def
Hypocalcemia with Tetany, Tachycardia
Magnesium excess
Neuromuscular depression, Bradycardia
Congenital defect in Cytochrome b5 reductase
This reduces ferrous hb to ferric in methemoglobinemia
Free radicals from drugs and alcohol-related fatty change affect which zone of liver
III
Ubiquinated cytokeratin intermediate filament in hepatocytes in alcoholic liver disease
Mallory bodies
Nephrocalcinosis
Metastatic calcification of renal tubules –> Diabetes insipidus
Chemo regimen for Hodgkin
Adriamycin, Bleomycin, Vinblastine, Dacarbazine
AE of Dacarbazine
Azospermia
Ecthyma gangrenosum is strongly associated with
P aeruginosa
Virulence factors of Pseudomonas in Ecthyma gangrenosum
Exotoxin A (protein synthesis), Elastase, PLC, Pyocyanin (ROS)
Exposure to bats or bird droppins in Ohio or Mississippi area
Histo (resembles tuberculosis)
Chlorthalidone
Thiazide diuretic
Holocrine glands
Associated with sebaceous - entire cells secreted
Apocrine vs Eccrine
Apocrine secretes into hair follicles, Eccrine directly onto skin
Rapid y descent that becomes deeper and steeper during inspiration
Constrictive pericarditis
Timeline of T cell response to MTB
2-4 weeks after infection
Most dangerous complication of UC
Toxic Megacolon
Sacral micturation center
S2-S4 - parasympathetic fibers travel with pelvic nerves
Pontine Micturation Center
Pontine Reticular Formation
Medium chain acyl-CoA DH deficiency causes
Hypoglycemia, Hypoketonemia
Each round of FA beta oxidation produces
1 NADH, 1 FADH2, 1 AcetylCoA
During rapid beta oxidation, the TCA cycle is overwhelmed –>
Shunting acetyl-CoA toward production of ketone bodies
Acetyl-CoA Carboxylase
RLS - first step in FA synthesis
Anti-cholesterol meds that should be used with caution in patients with pre-existing GB disease
Bile acid resins, Fibrates
Parvovirus binds what antigen
Erythrocyte P antigen
EBV envelope glycoprotein gp350 binds what
C3d complement component (CR2 or CD21)
Hydrocephalus, Intracranial calcifications, Chorioretinitis
Congenital Toxo
What type of enzyme is telomerase
RNA-dependent DNA polymerase (RT)
Rifampin monotherapy
Exposure to H flu or N meningitidis
Tx of MAC
Macrloide + Rifampin + Ethambutol
Hurthle Cells
Hashimoto’s
Beta-Galactosidase
Lactose –> Glucose + Galactose
Lac operon
Lack of glucose increases cAMP, Presence of Lactose binds repressor
FFA’s and insulin resistance
Increase resistance, also decrease insulin secretion
Pyogenic granuloma
Polypoid form of capillary hemangioma - Resemble hypertrophic granulation tissue
Cystic hygroma
Endothelium-lined lymph spaces beneath epidermis - Differ from cavernous hemangiomas by absence of luminal vessels
Liver hemangiosarcomas are associated with
Arsenic (pesticides), Thorotrast (contrast), Polyvinyl chloride
Diet recommended for PDH deficiency
Ketogenic (Leucine, Lysine)
Glucogenic AA’s
Methionine, Valine, Histidine (met sugary valiant hunk)
Glucogenic/Ketogenic AA’s
Phenylalanine, Isoleucine, Threonine, Tryptophan
Ketogenic AA’s
Leucine, Lysine
Mutation of Myelin protein gene
Charcot-Marie-Tooth (weakness of foot dorsiflexion)
Additional manifestations of Polycythemia Vera
Peptic ulceration, Pruritis, Gouty arthritis
Measure of fetal lung maturity
Incr ratio of phosphatidylcholine (lecithin) to sphingomyelin ratio
Primary abnormality in Paget’s
Excessive osteoclastic bone resorption
Phenazopyridine
Urinary analgesic - provides symptomatic relief of dysuria, urinary frequency, urgency
Ascorbic acid accelerates what reactions
Hydroxylation, Amidation
Workup of all patients with gastrinoma should include
Serum calcium, PTH, and Pituitary hormones - MEN-1
Anti-MTB drug that requires acidic intracellular environment
Pyrazinamide
INH MOA
Synthesis of mycolic acid
Ethambutol MOA
Blocking Arabinosyl Transferase
Segmented viruses
Reovirus (rota, colti), Orthomyxo, Arena, Bunya
Excessive rise in left atrial systolic pressure (v wave) is characteristic for
Mitral Regurgitation
Differentiate bone-specific ALP
Easily denatured by heat (bone = boil)
Urinary hydroxyproline and deoxypyridinolin excretion
Osteoclast activity (most common measures), also TRAP
Antipsychotic most notorious for causing prolonged QT
Ziprasidone
Cardiac medication that can cause hypothyroidism
Amiodarone
Clozapine acts on what receptors
D4
Prevent intracelllular dehydration in sickle cell
Gardos channel blockers (ca-dep K channel)
Specificity of tPA
Can only bind plasminogen strongly in presence of fibrin = clot-specific
Most common elbow injury in children
Radial Head Subluxation = Tear of annular ligament
Blanching of vein into which NE is being infused + induration and pallor
NE extravasation –> a1 vasoconstriction –> Phentolamine
Respiratory muscarinic antagonists
Ipratropium, Tiotropium, Glycopyrrolate
Eye muscarinic antagonists
Atropine, Homatropine, Tropicamide
GI muscarinic antagonists
Hyoscyamine, Dicylomine
GU muscarinic antagonists
Oxybutynin, Solifenacine, Tolterodine
Flunisolide
Inhaled GC for prophylactic treatment of asthma (bronchial)
Calcific Tendonitis
Deposits of calcium hydroxyaptite crystals in periarticular soft tissues (esp tendons, rotator cuff)
Anti-EGFR Ab
Cetuximab
Muromonab
Anti-CD3 (acute rejection treatment for liver, kidney, heart)
Most common bugs causing sepsis in sickle cell
Pneumococcus, H flu
How does radiation kill cells
DNA ds break, ROS
Secretin stimulates pancreas to release
Bicarb rich, Cl poor fluid (Cl to produce NaCl)
High levels of what increase ESR
Fibrinogen stimulted by Acute Phase Reactants
Pure Red Cell Aplasia is associated with
Parvo B19, Thymoma, Lymphocytic Leukemias
Invasive Mole vs Choriocarcinoma
Hydropic villi and proliferated trophoblast vs Atypical cytotrophoblastic and syncytiotrophoblastic cells w/ foci of hemorrhage and necrosis
Pulsus alternans
LV dysfunction - Beat to beat variation in magnitude of pulse pressure in presence of regular rhythm
Dicrotic pulse
Two distinct peaks - Severe dystolic function
Pulsus parvus et tardus occurs in
Aortic stenosis
Hyperkinetic pulse
Rapid ejection of large stroke volume against decr afterload
Paget disease of nipple
DCIS spreads to nipple skin without having crossed basement membrane
Ductal dilation, Inspissated breast secretions, Chronic granulomatous inflammation in the periductal and interstitial areas
Mammary Duct Ectasia
Most common benign tumor of esophagus
Esophageal Leiomyoma
Adenosine MOA
AV node - slows conduction and decreases automaticity by hyperpolarizing cells
Usefulness of Methacholine challenge
High sensitivity, Low specificity
UG Sinus vs Wolffian Ducts in males
UG sinus = Bladder, urethra, prostate, bulbo’s; Wolffian = Epididymis, Ductus, Seminal vesicles
In a healthy individual, airway resistance is smallest when
lungs are inflated - radial traction of pulmonary tissue on conducting airways
Repetitive ischemia of cardiomyocytes or persistent hypoperfusion –>
Hibernation - Chronic but reversible loss of function
Myocardial stunning
Less severe form of ischemia-induced reversible loss of contractile function than hibernation (from brief ischemic episodes)
Long term lithium requires monitoring of
Thyroid and Renal function
PCWP =
LA EDP, which should equal LVEDP
Regulatory step for Pyrimidine synthesis
ATP, CO2, Glutamine –> Carbamoyl Phosphate
Treatment of Orotic Aciduria
Can’t for UMP, so supplement with uridine (–> UMP)
Presentation of Orotic Aciduria
Hypochromic megaloblastic anemia, Neuro, Growth
Hydroxyurea inhibits
Ribonucleotide Reductase
Leflunomide blocks formation of
Orotic Acid
Peptide YY
Ileum and Colon –> ECL –> Inhibit gastrin-stimulated histamine release from ECL’s
Bladder lymph drainage
Superior to External Iliac, Inferior to Internal
Traction diverticula
Due to inflammatino and scarring –> True (eg mediastinal lymphadenitis, periesophageal scarring)
Pathophys of aortic dissection from hypertension
Medial hypertrophy of aortic vasa vasorum –> Reduced BF for aortic media –> Medial degeneration
PABA esters block
UVB (290-320)
UV what is major cause of sunburn, photo-aging, and carcinogenesis
UVB
Avobenzone
UVAI and UVAII
Zinc Oxide sunscreen
UVB, UVAI, UVAII
Stomatitis in treatment of RA
MTX (supplement folic acid)
Serious potential AE of Hydroxychloroquine
Permanent retinal damage
Lack of GC’s means response to what will be limited
Vasopressors
Strong predisposing factor to Mallory Weiss
Hiatal hernia
Which MEN has marfanoid habitus
MEN2b
Which lung cancer is not surgically approached
Small cell
Primary mechanism of combination OCP’s
Suppression of FSH, LH (no midcycle LH spike for ovulation); Secondary mechanism is blocking sperm and preventing implantation
Neuro-endocrine markers
Neuron-specific enolase, Chromagranin, Synaptophysin
Vimentin is used to dx
Sarcoma (mesenchymal origin)
Thrombin Time
Fibrinogen to Fibrin
Chronic HTN causes what microvascular changes in brain
Lipohyalinosis, Microatheroma
Lacunar infarct in Base of Pons
Ataxia-Hemiplegia; Dysarthria-Clumsy Hand syndrome
Lacunar infarct in Genu of Internal Capsule
Dysarthria-Clumsy Hand Syndrome
Initial presentation of Charcot Bouchard vs Lacunar Infarct
Charcot Bouchard would show hemorrhage on initial CT
First sign of puberty
Testicular and breast enlargement
What causes LV outflow obstruction in HCM
Abnormal systolic anterior motion of anterior leaflet of mitral valve toward hypertrophied IV septum
Garlic odor after poisoning
Arsenic –> Dimercaprol (which itself causes nephrotoxicity and HTN)
EDTA is used for
Lead and Mercury poisoning
Well-developed smooth ER
Steroid-producing cells (eg adrenals, gonads, liver); Detoxification
Most specific marker for dx of acute HepB
Anti-HBc IgM
All females with Mullerian defects should undergo
Renal ultrasound (coexisting urologic abnormality)
Relative speed of conduction in cardiac components
Purkinje > Atrial Muscle > Ventricular Muscle > AV node (Park At Ventura Avenue)
Why do cryptorchid testes not secrete Inhibit
Temperature degenerates seminiferous tubules selectively
Chronic gastritis with antral sparing vs antral-predominant
Autoimmune spares antrum; H pylori mostly affects antrum
Most common bening vascular tumors in adults
Cherry Hemangiomas (do not regress)
Superficial Hemangioma
Infantile, Capillary, Strawberry - Grow rapidly and regress
B1 is a cofactor for
Pyruvate DH, a-KG DH, Transketolase
QRS complex in exercise
Normally decr; If prolonged –> 1c anti-arrhythmic (use-dependent)
Use dependence of Class III anti-arrhythmics
Reverse use-dependence = Slower heart rate means more QT prolongation
Digoxin and K
Toxicity causes HyperK, but can be exacerbated by HypoK
Citrullination
Tissue inflammation –> Arginine enzymatically converted to citrulline
GABAa vs GABAb
A = Cl influx; B = GPCR (K efflux, decr Ca influx, inhibit AC)
Clinical manifestations of Chronic Interstitial Nephritis
(1) Modest elevation in creatinine; (2) Evidence of tubular dysfunction - polyuria, nocturia; (3) Fanconia syndrome - Aminoaciduria, Glycosuria, Hypophosphatemia, Hypouricemia
NSAID-associated chronic renal injury is morphologically characterized by
Papillary Necrosis; Chronic Interstitial Nephritis
Myelofibrosis
Atypical Megakaryocytic Hyperplasia –> Activate fibroblast prolifation
Myelodysplastic syndromes - BM bx
BM bx shows disordered differentiation affecting all non-lymphoid lineages, Ringed siderblasts, Megaloblastoid maturation
Myelophthisic anemia
Space-occupying lesion sof bone marrow - All lines affected (pancytopenia)
Most common causes of Myelophthisic anemia
Infiltration by met carcinomas w/ associated fibrosis; Also granulomas
Ergot Dopamine agonists
Bromocriptine, Pergolide
Non-ergo Dopamine agonists
Pramipexole, Ropinirole
CEA is a marker for
Colon, Pancreatic
CA-125
Maligant ovarian carcinoma
Congenital Long QT and Sensorineural deafness
Jervell and Lange-Nielsen (AR)
Congenital Long QT, pure cardiac
Romano-Ward
Virus with lipid solubule envelope are susceptible to
Diethyl Ether, Chloroform, 50% trichlorofluoroethane
Most common benign lung tumor
Hamartoma (Pulmonary chondroma) - Coin lesion
Lung lesion with alveolar growth pattern along alveolar septae without fascular or stromal invasion
Bronchioalveolar Carcinoma
Sporicidal compounds
Hydrogen Peroxide, Iodine (not alcohols or chlorhexidine, which disrupt membrane)
Chlorhexidine works by
Destabilizing cell membranes and coagulating intracellular constituents
Formaldehyde and Glutaraldehyde work by
Alkylating and cross-linking DNA and proteins
Matching is used to control
Confounding
Viruses that cleave one polyprotein via protease
NAME?
BH4 is cofactor for synthesis of
Tyrosine, DOPA, Serotonin, NO