Uworld- block 1 Flashcards
Most common causes of metabolic alkalosis
- Vomiting or nasogastric tube(hypotension)
- Thiazide or loop diuretics
- Mineralcorticoids excess(hypertension)
What are the most important steps in the workup of metabolic alkalosis
Checking the patients volume status and urine chloride
Differential diagnosis of metabolic alkalosis
In case of low chloride in urine: vomiting, nasogastric aspiration and prior diuretic use.
High chloride in urine: if euvolemia or hypovolemia are present -> bartter and gitelman syndromes
And if hypervolemia is present that means a status of excess mineralocorticoids
Which are saline responsive and unresponsive in treatment of metabolic alkalosis
Saline responsive : vomiting, nasogastric, diuretics
Saline unresponsive: barrter and gitelman syndrome, as well as excess mineralocorticoids.
Restlessness and purposeless jerking movement after a history of sore throat
Acute rheumatic fever -> sydenham chorea
Jerking extremity movement in Parkinson disease patients
Its seen only in case of levodopa intoxication
What is the role of thiamine in brain
Thiamine i a key coenzyme for pyruvate dehydrogenase which is involved in glucose metabolism. Its deficiency results in patients inability to metabolize glucose into energy. The most affected area in case of thiamine deficiency in the brain is the mammillary body( part of circuit of papez)
What is the character of inheritance for hemophilia a and b
X-linked recessive disorder
GRaft versus host disease (gvhd)
It can occur following transplantation of organs rich in lymphocytes.
This occur because the patients are severely immunodeficient due to immunosuppressant medications.
This is done via sensetization of T-cells and not B-cells.
GRaft versus host disease (gvhd) presentation
Any organ might be the target of this disease, but usually skin, liver , and gi tract are the most frequently affected. Early signs include a diffuse maculopapular rash the has predilection for palms and soles and may desquamate in severe cases.
Classification of MEN I
MEN I:
- Primary hyperparathyroidism.
- Pituitary tumors( prolactin, visual defects).
- Pancreatic tumors.
MEN II-A
MEN II-A:
- Medullary thyroid cancer(calcitonin).
- Pheochromocytoma.
- Parathyroid hyperplasia.
MEN II-B
MEN II-B:
- Medullary thyroid cancer
- Pheochromocytoma
- Mucosal neuromas, marfanoid habitus.
Thiamine is a cofactor for
- Pyruvate dehydrogenase
- A-ketoglutarate dehydrogenase
- Branched chain a ketoacid dehydrogenase
- Transketolase.
A deficiency in thiamine means that all these enzymes might not work prroporelly.
Chronic thiamine deficiency
If patients with chronic thiamine deficiency is given glucose infusion without thiamine supplementation, acute cereberal damage may occur. It can be diagnosed if baseline erythrocyte transketolase activity is low but increase after addition of thiamine pryiphosphate.
What is the most abundant amino acid in collagen
Glycine
Triple helix
The triple helical conformation of collagen molecules occurs due to the simple and repetitive amino acid sequence within each alpha chain in which glycine occupies every third amino acid position.
Proline in collagen
Proline residues are essential for alpha helix formation because of their ring configuration introduces a kink in the polypeptide chain, enhancing the rigidity oh the helical structure.
When does Hemoglobin F replaced b hemoglobin A
After 6 months.
Hemoglobin H diseaes
It manifests as chronic hemolytic anemia. It has 4 beta chains and its part of a-thalassemia. This have very high affinity for o2 that it doesnt release it.
Melanocyte embryonic derivative
Neural crest cell
Malignant melanoma can lead to
Focal neurological deficit which may manifest as tonic clonic seizures.
Most common cancers that lead to brain metastases
- Lung cancer
- Renal cancer
- Melanoma
Squatting in teratology of fallot- mechanismv
Squatting relieves tet spells. This posture increases systemic vascular resistance (important), without changing the pulmonary vascular resistance, increasing svr:pvr ratio. The increased svr forces a higher proportion of right ventricular output to enter the pulmonary circulation and oxygenate in the pulmonary capillary beds, increasing arterial oxygen concentration and relieving tet spell.
Hypoglycemia signs
Disorientation, sweating, tremor and palpitations.
Predisposing factors for hypoglycemia in diabetes I
Excessive insulin dose, inadequate food intake and exercise .
How is glucose uptake by skeletal muscle is mediated
GLUT-4
Hyperglycemia in type I diabetes patients causes:
Pain, infections, sleep deprivation. Stressful situations increase catecholamines release which raises glucose by decreasing pancreatic insulin secretion and by increasing glycogenolysis and gluconeogenesis
Types of adverse drug reactions: Type A
Type A: predictable reaction due to known pharmacological properties of the drug such as (e.g gastritis following NSAIDs use or nephrotoxicity following aminoglycosides)
Types of adverse drug reactions:Type B
- Exaggerated sensitivity: predictable reaction occurring at lower than expected exposure. (E.g tinnitus after one aspirin use)
- Idiosyncratic: unpredictable reaction in certain patients (e.g non immune hemolytic anemia with primaquine in G6PD deficiency)
3.immunologic (drug allergy): unpredictable, specific immunological reaction.
Examples:
A. {Rapid urticaria or anaphylaxis-> type I}
B. {drug induced hemolysis -> type II}
C. {serum sickness -> type III}
D. {contact dermatitis -> type IV}
Chronic aspirin use- side effects
Tinnitus
ACEI effect on kidney
Decrease efferent arteriolar resistance and systemic vascular resistance.
Spastic bladder
Urinary frequency and urge incontenince.
Usually due to upper motor neuron lesion in the spinal cord.
Its common in MS patients after weeks of spinal cord injury.
Reduced urine flow or elevated urethral pressure present in
Mechanical obstruction such as enlarged prostate or urethral stricture along the urinary tract.
Flaccid bladder
Typically occur in the setting of lower motor neuron lesions such as cauda equina syndrome. Patients will have residual volume (large) of urine after attempted emptying and at the end of the day will experience urinary incontinence.
Heteroplasmy
FA: Presence of both normal and mutated mtDNA, resulting in variable expression in mitochondrically inherited diseases. E.g lactic acidosis or myopathy.
UWORLD: having different mitochondrial genomes within a single cell. The severity of mitochondrial diseases is often directly related to the proportion of abnormal to normal mitochondria within patients cells.
C-section in case of large for gestational age baby
C-section typically involved midline vertical separation of the rectus abdominis muscle, but in case of large for gestational age infant, horizontal transection of the rectus abdominis muscle may be considered.( due to weight or position). If rectus abdominis transacted horizontally, the inferior epigastric arteries must be identified and ligated bilaterally (they are susceptible to injury)
Rectus abdominis covering
Above the arcuate line( below umbilicus- horizontal line), rectus abdominis is surrounded by anterior and posterior sheaths, while below the arcuate line its covered only by anterior sheath.
Insulin effects
- Increase glucose uptake
- Increase glycogen synthesis and decrease glycogenolysis
- Decrease glucagon synthesis (it acts directly on alpha cells in pancreas-> prevents glucagon from interfering )
- Decrease lipolysis and ketogenesis
- Increase protein synthesis in muscles
- Increase renal reabsorption of sodium.
