UWorld Day Day Two Questions Flashcards
How is chronic rejection in the lung transplant different from other locations (i.e. kidney?
Lung transplant rejection primarily affects the small bronchioles via inflammation and obstruction/destruction causing BRONCHIOLITIS OBLITERANS. Renal rejection primarily involves the renal vasculature.
IL-4 = Ig__
IgE
IL-1 is produced by what cell to activate Th0 lymphocytes?
the same cell type also produces IL-12 to stimulate development of Th1
macrophages
IL-2 is secreted by Th__ cells to stimulate produciton of CD4, CD8 and B cells.
Th1
Th1 produces IL-__ to promote bone marrow stem cell differentiation
Th2 produces IL-__ to activate eosinophils and promotes IgA syntehsis
IL-3
IL-__ is produced by Th2 cells to inhibit IFN-gamma, leading to decreased Th1
IL-10
Why is methadone so powerful as a rehab drug? What are AE?
How is buprenorphine different than methadone?
How is naloxone different?
Full mu-agonist for heroin/opioid addiction with a LONG half life.
AE - QT prolongation and respiratory depression.
Buprenorphine is a partial mu-agonist.
Naloxone is a mu-antagonist.
Direction of DNA synthesis and what is present on lagging strand not present in leading strand?
5’ to 3’
okazaki fragments which are short stretches of newly synthesized DNA separated by RNA primers.
A patient is started on infliximab and presents a few days later with joint pain and pruritic skin rash. Biopsy shows fibrinoid necrosis and neutrophil infiltration of his small blood vessels. What is this?
Serum sickness - type 3 HSR. Complex deposition and Complement consumption (so decreased C3 serum levels).
Name chest, kidney, heart, and ovary findings in Turner Syndrome
Shield chest, horseshoe shaped kidney, coarctation of aorta, bicuspid aortic valve, streaked ovaries/amenorrhea, infertility.
Hep virus strain that has a high mortality rate i npregment women.
Hep E - unenveloped ssRNA
Chronic demyelinating disease of the CNS white matter.
Multiple Sclerosis
Babinkski indicates what lesion
UMN - hyperreflexia, spasticity, muscle paralysis/weakness
LMN damage sign
hyporeflexia/decreased DTRs, muscle atrophy, fasciculations
Type of eukaryotic polymerase that:
- forms essential ribsosomal subunits
- forms essential component of 60s
- forms small nucleus RNA
What is the round, dense, basophilic (dark staining) body seen in the nucleus?
RNA polymerase 1 (**synthesizes most of the RNA in the nucleus)
RNA polymerase 3
RNA polymerase 2
the nucleolus
Aneurysm of what artery can impinge on the optic chiasm laterally, causing ipsilateral nasal hemianopia.
Internal Carotid Body
An infant has 3-5 days of high FEVER, followed by an erythematous maculopapular rash on TRUNK
HHV6 - roseola
Child has erythematous oropharyneal ulcers and maculopapular or vesicular lesion on palms and soles.
Coxsackievirus A16
Child with painful gingivostomatitis, fever, irritability.
What if fever and seizures in newborn?
HSV-1
HSV-2
Maculopapular rash on FACE of child that spreads to trunk and extremities.
What is it fi in addition, spots on soft palate.
What if there are koplick spots on oral mucosa?
Rubella (togavirus) - spots on soft palate
Measles - koplick
Flulike illness followed by face and truncal reticular rash. May cause apastic crisis if child has sickle cell.
Barvovirus B19
Sandpaper rash on skindfolds of a chidl
sclaret fever - strep pyogenes
lysyl hydroxylase and procollagen peptidase play a role in what process and deficiency causes ____ disease.
Collagen synthesis
Ehlers Danlos
Atropine reverses ____ poisoning. but what side effect of the posioning is still at risk?
Reverses organophosphate (DUMBBELLS) poisoning.
Still at risk of muscle paralysis becuase atropine only effects mACHR. Need to administer pralidoxime to resotre AChEsterase to decrease ACh to both muscarinic AND nicotinic.
DoC for HTn, HF, Renal failure. Prevents efferent arteriole from constricting more than afferent arteriole, dcreased GFR (so expect GFR to decrease and Cr to increase initially)
ACE inhibitors -prils
Sx: HTN, hypoK, metabolic lakalosis, and decreaed renin, adrenal mass.
Dx.
Tx
Dx: hyperaldosteronism (Conn)
Tx: aldosterone antagonist - spironolactone or eplerenone
- normal BT, normal PT, prolonged PTT
- normal BT, prolonged PT, normal PTT
Factor 8 - hemophilia A
extrinsic pathway deficiency (i.e. Factor 7)
asbestos –> ___ cancer
bronchogenic carcinoma (malignant mesothelioma is rare)
Which organ releases EPO into blood stream when hypoxia (ie. due to OSA) is sensed?
kidney’s renal cortical cells
NSAIDs and Renal Failure - what type of RF?
chronic intersitital nephritis and papillary necrosis (and calcification)
What hormone is derived from POMC, therefore is similar to beta-endorphin (an endogenous opioid peptide).
ACTH and MSH
Fibrinoid necrosis seen in…
Coagulative necrosis seen in…
Liquefactive necrosis is seen in…
blood vessels
all locations except CNS
bacterial infections and CNS infarcts
Gram positive cocci that synthesize dextrans from sucrose
Viridans strep (dental carries) - strep mutans and strep sanguis
Sx: fatigue and pruritis (possible jaundice, pale stool, dark urine) in a 45 year old female
Liver biopsy: lymphocyte infiltration and granulomatous destruction of intralobular bile ducts
Primary biliary Cirrhosis
Sx: fatigue in a male with a predisposing condition
Liver biopsy: diffuse inflammation/fibrosis of large intra and extrahepatic bile ducts with periductal concentric fibrosis (onion skin) and obstruction of small ducts.
Lab: high alk phos
Wat is this and what is the associatinve condition?
Primary Sclerosing cholangitis
associated with Ulcerative Colitis
Type of stone:
- rectangular, “coffin lid”
- octahedron (square with “X” in center)
- yellow or red brown, diamond or rhombus
- flat, yellow, hexagonal
- Mg ammonium phosphate (struvite)
- calcium oXalate (“X” in center)
- uric acid
- cysteine –> COLA (cysteine, ornithene lysine, arginine)
___ = (0.7 x Vd) / CL
what are first order kinetics v. zero order?
half life
for first order kinetics, steady RATE of clearance per unit of time. Zero order is a stead AMOUNT of drug cleared per unit of time.
drug for treatment resistant schizophrenia OR schizophrenia associated with suicidality
clozapine (**agranulocytosis)
lecithinase aka alpha-toxin aka phospholipase C is the toxin for what gram positive rod? MOA?
Clostridium perfringens - catalyzes phospholipid molecule splitting
A person has afib and stops anticoagulation meds. What is the most common site of thromboembolis?
Left atrial appendage.
High lipophilicity and high volume of distribution (bc it is lipophilic; including CNS) means the drug is most likely cleared via what mechanism?
hepatically through bile (enters heaptocytes easily)
Haptoglobin decreases, LDH and BR increase when ___.
When large amounts of RBCs are released into the blood stream (i.e. intravascualr hemolysis after a valve replacement).
