UWorld, Day Four Flashcards
Increased ADH = increased reabsorption of what (other than Na)
urea
Define T-tubules
they are invaginations of the muscle cell membrane - they have VGCaC (DHPs), so they transmit depolarization signals to the SR, resulting in Ca release.
25 hydroxycholecalciferol —(___)—> 1,25 dihydroxycholecalciferol (active)
what is the enzyme and what is the location?
1-alpha-hydroxylase (stimulated by PTH)
in the kidney (this step impaired in CKD)
What vessel holds venous blood with the least amount of oxygen?
coronary sinus
definition of carboxyhemoglobin
define PaO2
define methemoglobin
What changes occur in CO poisoning
increased - CO bound to Hb
normal - PaO2 is the amount of O2 dissolved in plasma
normal - occurs when ferrous (Fe2+) is oxidized into ferric iron (Fe3+)
What does prednisone do to the HPA-axis? (CRH, ACTH, cortisol)
suppresses all
wide splitting
delayed RV emptying (i.e. pulmonic stenosis… dt possible eisenmenger (L->R that turned R–>L with pulmonary artery thickening)
fixed split
ASD
what synapses on an inhibitory interneuron from a skeletal muscle?
what is tested during a DTR?
golgi tendon organ
muscle spindle (they mediate stretch/myotactic reflex)
a woman gave birth a few weeks ago in which she had ongoing vaginal bleeding. she presents now with dyspnea and hemoptysis. endometrial curretage shows proliferation of cytotrophoblasts and syncytiotrophoblasts. what is it?
choriocarcinoma
what is this (in uterus):
- B9 tumor of bundles of smooth muscle cells
- diffusely hydropic chorionic villi
- fetal tissue with triploid karyotype
- diffusely hydropic chorionic villi with diffusely enlarged trophoblasts with myometrial invasion
- myoma (fibroid)
- complete mole
- partial hydatidiform mole
- invasive mole
HA, visual and muscular disturbances, enlarged temporal artery, elevated ESR and IL-6
Giant cell arteritis (temporal arteritis)
Female with proximal muscle weakness.
Female with proximal muscle weakness and inflammatory involvement of skin.
polymyositis
dermatomyositis - associated with paraneoplastic syndrome of cancers of lung, ovary, colorectal, or NHL
both are anti-Jo1/mito2/SRP
IGF-1 is associated with what state?
What type of signaling pathway and where is IGF-1 made?
Gigantisim - hypersecretion on GH from ant pit, inducing liver’s IGF-1 - involved in JAK-STAT
At person presents with polyuria and polydipsia. Think what three DDx:
- elevated plasma sodium and no urine osm change in response to water deprivation test
- high blood glucose
- hyponatremia and low initial urine osm
- DI (central - no ADH, or nephrogenic - decreased response to ADH)
- DM
- Primary (psychogenic) polydipsia
hypotension, elevated jugular pressure, muffled heart sounds. hear drop in pulse amplitude with inspiration
beck triad - cardiac tamponade
- what two drugs stop levodopa degradation by COMT to 3-OMD, thus potentiating levodopa’s effects
- what drug stops levodopa degradation into dopamine in the PERIPHERY
entacapone and tolcapone
cabidopa
64 year old female wtih sudden right arm weakness and difficulty speaking that resolves on its own in 20 min. What is this and give what med?
AE at high doses of this med?
TIA
give NSAID (low dose ASA)
at high dose ASA, can get vertigo, tinnitus, hearing loss, hyperapnea (stim resp drive)
MOA of med given for panic attack.
Benzo - binds allosterically to Cl- channel, potentiating GABA effects in frequency of opening.
tx of idiopathic Pulmonary ARtery HTN
bosentan - endothelin receptor antagonist
use what antihistamine (H1) in elderly?
second generation - loratidine and cetirizine
What drug causes bronchiodilation by blocking action of ACh at muscarinic receptors?
ipratroprium (atropine derivative)
Use what drug class in restless leg syndrome?
Use what drug class in antipsychotic induced akithisia?
RLS - use dopamine agonist
Akithisia - use B-antagonist (i.e. propranolol) - this occurs because of antipsychotic antidopaminergic MOA
An AE of levodopa admin in PD patients that persists, even after carbidopa admin.
Agitation and anxiety.
What is an agonist at GABA-B receptor? For spastiity (i.e. dt MS)
baclofen or tizanidine
Vd x 0.7 / CL = ?
half life
steady state concentration is achieved in 4-5 half lives
Cpss x CL / bioavailability fraction = ?
Cpss = concentration in plasma at steady state
maintenance dose
for IV administration, bioavailability = 1
in renal or hepatic impairment, LD is unchanged, but MD is decreased
Cpss x Vd / bioavailability fraction = ?
Cpss = concentration in plasma at steady state
loading dose
in renal or hepatic impairment, LD is unchanged, but MD is decreased
Three benzos used for people with hepatic dysfunction.
LOT - lorazepam, oxazepam, temazepam
Where do most RCCa (polygonal cells with abundant clear cytoplasm) originate?
MC renal cancer arising from the renal pelvis
proximal renal tubules
transitional cell carcinoma
2-sample t-test measures?
ANOVA measures?
chi-square measures?
Any difference between MEAN OF TWO GROUPS
Any differences in MEANS OF >2 GROUPS.
Determine if an association exists between two variables in a given outcome.
What is this: a complication of acute pancreatitis, collection of fluid rich in enzymes and inflammatory debri surrounded by GRANULATION tissue and FIBROSIS
pancreatic pseudocyst
Always choose what option on a santiation precaution question:
HAND HYGEINE
Always choose what option on a santiation precaution question:
HAND HYGEINE
CXR: well defined coin like lesion “popcorn calcification”. Often contain islands of mature hyaline cartilage, fat, smooth muscle, and clefts (cartilage, fibrous, and adipose tissue).
hamartoma - overgrowth of tissue correct for the organ
What PANS nerve goes to carotid chemoreceptors?
What goes to aortic arch chemoreceptors?
Carotid - glossopharyngeal (9)
Aortic - vagus (10)
MOA of triptans
5HT-1B/1D agonists; acute migraine (during attack)
Recombinant humanized IgG1 monoclonal ab that binds with IgE to inhibit action of IgE
omalizumab, for people with SEVERE allergic asthma
CCA
AUG and UAG
CCA is the 3’ end of tRNA
AUG and UAG are start and stop mRNA codons
What vessels does NO act on?
large veins
Right dominant heart (70%) is defined by ____ supplying the Posterior Descending Artery.
Left dominant heart (10%) is defined by ____ supplying the Posterior Descending Artery.
Right dominant - Right Coronary Artery
Left dominant - Left circumflex artery
(Posterior Descending Artery supplies AV branch - supplies the AV node).
Optimal location to insert needle for femoral nerve blcok.
At the inguinal crease, just lateral to the femoral artery.
Dialysis pt with bleeding from cath site:
think uremic toxicity, a QUALITATIVE platelet disorder increased bleeding time. (PT, PPT, Platelets normal)
murmur during sitting up and leaning over. high pitched, blowing decrescendo diastolic murmur immediately after AV closure.
AR
old man with crescendo, decrescendo systolic murmur
AS or PS
interstitial and alveolar edema and exudate formation in acute respiratory distress syndrome results in… ____
see: dec lung compliance, work of breathing, worsened V/Q. PCWP normal.
ARDS - increased pulmonary capillary permeability.
ANTIDOTE for:
- benzo overdose (CNS toxicity and respiratory depression
- opioid overdose (resp depression, miosis, vomiting, constipation, seizure, sedation)
- BBlocker overdose (bradycardia, heart block, hypotension, bronchospasm)
- alcohol (hyperventilation and visual disturbance)
- iron (child)
- benzo - flumazenil
- opioid - naloxone
- BB - glucagon
- alcohol - fomepizol
- iron - deferoxamine
5 disease that must be reported to CDC
gonorrhea, chlamydia, hep B, hep C, HIV
