UWorld Block 2 Flashcards
Clonidine mechanism
å-2 adrenoreceptor in brainstem resulting in reduced sympathetic. outflow from CNS leading to decrease in peripheral vascular resistance, heart rate and BP.
Eastern USA and central america mycosis
Blastomyces
Filtered load ,excretion rate , reabsorption rate, secretion rate
Filtered load : GFR X [plasma]
Excretion rate: V X [urine]
Reabsorption rate= filtered load- excretion rate
Secretion rate: excretion rate- filtered load.
Postoperative urinary retention
Anasthesia and analgesia contribute to :
-over distention of bladder, decreased micturition reflex
-decreased contractility of detrusor muscle and incomplete empyting.
Contraction of detrusor is stimulated by muscharinic cholinergic agonist (eg bethanecol)
Large friable vagitations on valve cusps along with destruction of valve leaflets
Mitral stenosis due to infective endocarditis.
Acyclovir mechanism of action
In infected host cells, acyclovir (a neucleoside analogue) is converted into acyclovir monophosphate —> acyclovir triphosphate –> competes with deoxygunanosine triphosphate for DNA polymerase.—> acyclovir triphosphate incoporated into replicating viral DNA—> DNA synthesis stops.
Hepatitis B serological markers
- HBsAG: detectable during acute infection, persistence implies chronic infection.
- Anti-HBs: appearance indicates resolution of acute infectionor vaccination. (Long term immunity)
- Anti HBc IgM: present during windows phase when both HBsAg and anti-HBs are absent,
- Anti HBc IgG: not present after vaccination. Present in both acute and chronic.
- HBeAg: marker of high viral replication in chronic infection
- Anti-HBe: presence in chronic infection indicates low viral replication and infectivity.
Phenylpherine effect on bladder
It encourages the trigone and sphincter to contract. –> urinary retention .
Endocarditis with intact valve, etiology
S.aureus
Doest vasectomy affect the volume of ejaculation
Semen is composed primarily of fluid secreted from the seminal vesicles and prostate, spermatozoa consists onlt of 2-5% of semen by volume.
Fungal cell wall- target for which antifungal
Major polysacharide component of fungal cell wall is 1,3 beta D glucan.
Caspofungin and other “fungin” anti fungals blocks glucan synthesis.
They are especially effective against candida and aspergillus.
What is the most common cause of mitral stenosis
Rheumatic fever
Celiac disease presentation
Diarrhea, weight loss , and abdominal pain. Some patients presents with constipation.
Paraclinical : elevated serum transglutaminase
Microglia in post-stroke
As neurons disintegrate their fragments begin to be phagocytosed by microglia. The abundance of lipids seen in the cytoplams of the microglia results from extensive phagocytosis of myelin breakdown products.
Ependymal cells are
Cilliated glial cells that lines the ventricles of the brain and the central canal of the spinal cord.
Urge incontinence drugs
Anticholinergic such as oxybutyinin
Case: Paroxysmal hypertension, flushing, diaphoresis, and episodic headache
Pheochromocytoma
Coccidiosis immitis :clinical
- pulmonary form : flu-like illness, cough ,erythema nodosum.
- disseminated: affects skin, bones, and lungs.
Subflacine herniation
Cingulate gyrus herniates under the falx cerebri, potentially compressing the ACA.
Galactosemia: enzyme affected
Glactose 1 phosphate uridyl transferase defeciancy (galt)
Normal :galactose –> galactose 1 phosphate –> glucose 1 phosphate .
Galactosemia: galactose 1 phoshpate __X__ —> glucose 1 phosphate.
This means accumulation of galactose 1 phosphate.
Cat scratch disease
Bartonella henselae (bacillary angiomatosis) (pic)
In case of portal hypertension signs with normal liver in biopsy the most likely cause would be
Portal vein thrombosis
Reduced ß-globin synthesis results in
- microcytic microchromic anemia
- precipitation of unpaired å chain within red cell precursors in the bone marrow (ineffective erythropoiesis) and lysis of circulating erythrocytes (extravascular hemolysis)
Blastomyces
Culture 25˙ : branching hyphae,
biopsy: large round yeast with doubly refractile wall and single broad based bud.
FISH
Fluorescence in situ allows direct visualization of genes to their respective chromosomes by using labeled DNA probe complementary to the sequence of interest.
Paracoccidioides brasiliensis
Culture 25C˙ : multiple blastoconidia
Biopsy: cells covered in budding blasoconidia.
Lateral nucleus of hypothalamus
Mediate hunger,injury –> increased satiety.
ß-blockers intoxication, signs and symptoms
Bradycardia , hypotension and hypoglycemia.
Glucagon is the antidote
Repair mechanism in CNS after injury(stroke)
Repair is performed by astrocytes the migrate to the are within 2 weeks of injury (timeline is important). As necrotic tissue is resorbed a cystic space forms that is then surrounded by astrocytes and newly formed capillaries.
MAC complex deficiency– predisposition to ?
- neiseseria species.
- clinically patients experiences recurrent infections by neisseria.
Vasectomy: procedure and consequences
- resection of vas deferens( its function isnt only transporting sperm rather store and protect it)
- vasectomy blocks the transport of new spem from the epididymis, but has no effect on sperm distal to the ligation.
- patients can still have viable sperm in the distal vas for 3 months and at least 20 ejaculations after vasectomy.
- sexual intercourse may be resumed within 1 week , however pregnancy will still be probable. Another method of contraception should be done untill azospermia is confirmed.
Isoproterenol, mechanism of action
Non selective ß adrenergic agonist.
- It increases cardiac contractility by acting on ß1
- decrease systemic resistance by acting on ß2
- negligible effect on å-adrenergic receptor.
Decrease in both extra and intra-cellular potassium is seen in
- Mineralocortiocoids excess
- Diuretics
- Chronic GI loss
Prolonged isoniazid treatment can lead to
B6 vitamin deficiency. This may lead to siderblastic anemia.
Isoniazid inhibits the enzyme pyridoxine phosphokinase which in turn activates vitamin B6. Activated B6 is a cofactor for ∂-aminolevulinic acid synthase (ALA).
What is the normal post void residual urine volume
Less than 50 cc
Gliosis (glial scar formation)
The enlargement and proliferation of astrocytes peripherally around the are of necrosis after injury (e.g stroke)
Why is stress incontinence more common in women
- Because injury to EUS or pudendal nerve is common during vaginal child birth.
- In post menopause: decreased estrogen –> weak pelvic floor support.
Lyme disease: stages
Stage 1- early localized erythema migrans, flu-like symptoms
Stage 2- early disseminated secondary lesions, carditis, AV block, facial nerve palsy, migratory myalgia/transient arthritis.
Stage 3- late disseminated, encephalopathies, chronic arthritis.
Histoplasma diagnosis
Culture: 25C˙ : branching hyphae
Biopsy : oval yeast cells within macrophages.
Iron poisoning clinically
Hematemesis and melena( iron is toxic to gastric mucosal cells)
Multiple sclerosis is
Autoimmune demylinating disorder the typically affects young women with neurological deficits( eg, blurry vision ,diplopia ,focal weakness and numbness, dysarthria, bowel/bladder dysfunction).
- common initial manifestation is optic neuritis, characterized by monocular visual loss with pain on eye movement and an afferent pupillary defect.
- MS involves autoimmune response targeting oligodendrocytes, the mylin producing cells of the CNS.
Fibrillin -1 gene mutation leads
Autosomal dominant marfan syndrome
Azoles (itraconazole etc.. ) mechanism of action
Inhibit synthesis of ergosterol
Histoplasma capsulatum
Dimorphic fungus that is found as mold in soil.
Mississippi and ohio river basins.
In Lungs. Fungus is ingested by macrophages and seen on light microscopy as small intracellular oval bodies.
Opoid intoxication signs
- Severe sedation
- Respiratory depression
3.constricted pupils.
Naloxone antidote
Stress incontinence is due to
Urethral sphincter dysfunction.
- The internal urethral sphincter is mainly smooth muscles controlled by the autonomic nervous system. (Sympathetic -contraction, parasymphatetic- relaxation).
- the external urethral sphincter (EUS) is mostly pelvic floor skeletal muscles under voluntary control.
- after bladder is full, parasympthateic system contracts detrusor muscle and relaxes internal sphincter, but EUS prevents leaking of urine, in case of problems in EUS, stress inconteinence results .
Sporthrix schenckii
Associated with gardening , clinically : pustules ulcers and subcutaneous nodules along lympahtics
Theophylline side effects
In low to moderate cases: cortical arousal and insmonia
Acute: nausea, vomiting , abdominal pain, diarrhea, cardiac arrhythmia, and seziures.
Kozak consensus sequence
Is analogue to shine-dalgarno sequence in E.coli. Its defined by the following sequence: (gcc)gccRccAUGG, in which R is either adenine (A) or (G)guanine.
If R isn’t A or G but instead C this can impair the initiation of translation. (Check image)
Lead poisoning complication in children
Neurologic , GI, renal and hematologic
- Neurologic : loss of milestone/ cognitive impairment, behavioral problems and encephalopathy
- GI: constipation , abdominal pain and decreased vitamin D reabsorption.
- Renal: interstitial nephritis
- Hematologic: Anemia, sideroblastic
Microscopical sequence of stroke
First 48 hrs
3-5 days
Week
- First 48 hrs after injury –> irreversible damage (red neurons)
- neutrophils initially move into ischemic area followed by microglia (important) 3-5 days after the onset of ischemia.
MEN IIB result from mutation in
Germilne mutation in RET proto-oncogene.
Co-transational protein targeting is mediated by
N-terminal amino acid sequence of an elongating polypeptide. The signal sequence is recognized by a signal recognition particle which helps transport the protein to the RER
Portal vein thrombosis
Portal hypertension, splenomegaly , and varicosities at portocaval anastamoses. However it doesnt cause histologic changes to hepatic parynchema.
Ascitis is uncommon as the obstruction is presinusoidal