UWorld Facts Flashcards
What do you initially treat Coag Negative Catalase + staph with?
Vanco - assume resistance
What is the normal value in ARDS?
Pulmonary wedge pressure - an elevated pressure would be indicative of cardiogenic pulmonary edema
A bimodal curve in the concentration of a drug indicates what?
Slow/fast Acetylation - I.E. Isoniazid
How do nitrates relieve chest pain in patients with stable angina?
Vasodilate veins
Decrease LV volume/Preload
A man who thinks the neighbors are poisoning him despite no proof has what?
Delusional
What are the two types of congenital QT?
Romano-Ward (AD) Cardiac only
Jervell and Lange-Nielson - (AR) + sensorineural deafness
What is the major pathophysiologic abnormality seen with prolonged NSAID use?
Chronic Interstitial nephritis and papillary necrosis
When treating someone with amphotericin B what might you need to supplement?
K and Mg - Inc. distal tubular membrane permeability
Desmosine cross-linking between 4 lysines via lysyl-hydroxylase forms what?
Elastin
Menkes disease
Impaired copper absorption and decreased activity of lysyl oxidase - kinky/brittle hair - growth retardation - hypotonia
Osteogenesis imperfecta
Dec. synthesis of normal Type 1 collagen - impaired matrix formation - blue sclera
What stage of collagen formation occurs extracellularly?
Cleavage of disulfide terminal regions of procollagen
Covalent lysine|hydroxylysine cross-linking - lysyl oxidase (Cu)
Granulomas in the GI tract
Crohns (Th1 response)
UC w/ pANCA
Primary sclerosing cholangitis - onion skinning, hyper IgM, inc. risk for 2 biliary cirrhosis and cholangio
Why is htere an incrased risk of gallstones with Crohn’s disease
Decreased reuptake of bile salts/acids - cholesterol stones fall out of solution
β-glucuronidase
Bacterial enzyme that deconjugates bilirubin - pigment stones
Ingestion of the “death cap mushroom” leads to what?
Bind to RNA Pol II - block mRNA synthesis
Abdominal pain, vomiting, diarrhea
Increased volume of endolymph in inner ear
Meniere’s Disease
Tinnitus, vertigo, sensorineural hearing loss
Knocking out the ACA can lead to what
Contra motor/sensory problems of the lower extremities
Urinary incontinence
Behavioral changes
Mitochondrial vacuolization indicates what?
Irreversible injury/cell death
What disease can cause cystic degeneration of the putamen?
Wilsons Disease
What layers will you pass thru during a cricothyrotomy
Superficial cervical fascia
Cricothyroid membrane
What causes the flushing after a dose of niacin?
Prostaglandins
What is the most common cause of elevated AFP?
Dating error
Lung Bx: Spherules packed with endospores
Coccidioides immitis
Acute acalculous cholecystitis
Acute inflammation of the GB in the absence of stones - hospitalized and severely ill
How does doxycycline and the other tetracyclines act?
Block A site tRNA binding
How can you diagnose a thiamine deficiency
Measure erythrocyte transketolase levels (decreased)
The mean arterial pressure remains fairly stable during exercise due to an adaptive decrease in what?
Systemic Vascular Resistance
What is the major long-term hemodynamic compensatory response to volume overload of Aortic Regurg?
Inc in preload
LV end-diastolic volume (eccentric LVH)
Analyzing associations of dietary habits (i.e. Vitamin D intake) and prevalence of a disease is an example of what?
Ecological study - analyzing population
Analyzing exposures and outcomes of interest in an individual at a given point in time is called what?
Cross-sectional survey
What are the 3 effects of ANP
- Dilate afferent arterioles, limit Na resorption (PT, IMCD), inhibit renin secretion
- Restricts aldosterone secretion
- Relaxes vascular SM
What is the action of hypophosphorylated Rb?
Active Rb - prevents G1/S transition
What are preterm newborns at risk for?
Vitamin K deficiency - Hemorrhagic disease of the newborn
An erosion can extend into, but not through what layer?
Muscularis mucosa
*Once it enters the submucosa it is an ulcer
What is the most common location to find colon cancer?
- Rectosigmoid colon
2. Ascending colon
Pathogenesis of EtOH-induced hepatic steatosis is due to what?
Decreased FFA oxidation
2˚ to excess in NADH prodution
Eosinophils in the urine indicate what? What drugs can cause this?
Interstitial nephritis
NSAIDs, sulfonamides, rifampin, diuretics, β-lactam
Muscle Bx: Glycogen accumulating in lysosomes
Type II: Pompe Disease
Def in acid α-glucosidase
What amino acids are metabolized to propionyl CoA?
Threonine, Methionine
Valine, Isoleucine
What nerve and artery are at risk with a midshaft fx of the humerus?
Deep brachial artery
Radial nerve
A patient with hypertensive emergency after a eating tyramine containing foods is likely on what drug?
MAOIs
What does N-acetylcystine do in acetaminophen toxicity?
- Glutathione substitute
2. Provide sulfhydryl group to enhance non-toxic sulfation elimination
Permanent Central Diabetes insipidus is caused by damage to what structure?
Hypothalamus
What are the 2 most immediate physical symptoms of marijuana?
Tachycardia and conjunctival injection
Cold agglutinins (mycoplasma pneumonia)
Antigenic similarity between m. pneumo and erythrocyte membrane
How do β-blockers help in thyrotoxicosis?
Inhibit peripheral iodothyronine deiodinase (conversion from T4 to T3)
Decrease sensitivity to catecholamines
What is a central side effect of levodopa?
Anxiety and agitation
Axonal reaction (post nerve injury - Wallerian degeneration)
Neuronal body: swollen, nucleus displaced to periphery, Nissl substance is fine and granular
Leaving bed when not sleepy/using it only for sleep/sexual activity is an example of what?
Stimulus control
True or False: Acute Hepatitis B is usually symptomatic while Hepatitis C is asymptomatic.
True
What is the mutation seen in Burkittt Lymphoma
t( 8;14) - c-myc transcription factor
How do you get schistosomiasis?
Snails
S japonicum and S mansoni cause schistosomiasis in what two locations?
S. haematobium causes schistosomiasis in what location?
S. Japonicum and mansoni = intestinal and hepatic
S. haematobium = urinary
Blanching of a vein in which NE is being infused is indicative of what?
NE extravasation - α1 mediated vasoconstriction
Palpable but non-tender gallbladder, weight loss, obstructive jaundice?
Pancreatic AdenoCA - head
**smoking
Hyperpyrexia
Body temp > 40
Cooling 1st
Antipyretics 2nd
Synaptophysin in a brain tumor indicates what origin?
Neuronal
PI3K/Akt/mTOR
Cell proliferation
mTOR is a transcription factor
Non-expression of the mycobacterial catalase-peroxidase enzyme leads to resistance against what?
Isoniazid
Waking up from barbiturates is due to what?
Tissue redistribution of the drug - not metabolism
Ticlopidine can cause what serious side effect?
Neutropenia + fever + mouth ulcers
What does a kid with cyanotic spell relieved by squatting have?
Tetralogy of Fallot
What drugs are used to treat isolated systolic HTN?
Amlodipine & Nifedipine (dyhydro)
Thiazide
What is a side effect of amlodipine?
Flushing and peripheral edema
What can causes a sudden muscle relaxation in response to inc. stress/force?
Golgi tendon organs
Painless 3rd trimester bleeding
Placenta previa - C section
Abrupt, painful, 3rd trimester bleeding
Placental abruption
bloody maternal surface
What increases the risk of placental abruption
Trauma, smoking, HTN, Preeclampsia and cocaine
What causes preeclampsia
Maternal/fetal vascular interface problem - fibrinoid necrosis
What is a common cause of death in Cervical CA?
Hydronephrosis with post renal failure - tumor invades thru anterior bladder blocking ureters
What are secondary risk factors for cervical CA?
Smoking and immunodeficiency
Absent cremasteric reflux
Testicular torsion
incomplete closure of the process vaginalis can result in what?
Hydrocele
Indirect Inguinal hernia
Thyroid hormone has β-adrenergic effects and increases the BMR - how does it do this?
Ιnc. β1 adrenergic receptors
Inc. Na/K-ATPase
Why do you get hypocholesterolemia in hyperthyroidism?
Inc. LDL receptor expression
What are teh causes of PTH independent hypercalcemia?
Malignancy
Granulomatous Disease
Vitamin D toxicity
What mediates insulin resistance in DM2
Decreased insulin receptors
What is the mechanism of a a CF kid who collapses while exercising?
Sodium loss with sweating
What does CFTR do in the respiratory/gastric glands and the sweat glands?
R/G: CFTR secretes Cl and impairs ENaC - inc. Na/H20 in mucus
S: CFTR activates ENaC to increase Na/Cl absorption
Patients with adult coarctation of the aorta are more likely to experience what complications?
HTN associated
- LV failure
- Ruptured dissecting aortic aneurysm
- Intracranial hemorrhage - ruptured berry aneurysms (Inc. risk) + HTN
What is associated with exposure to arsenic, thorotrast, and polyvinyl chloride? What is a marker for this?
Liver angiosarcoma
CD31 = PECAM1 - leukocyte migration
What are the causes of pure red cell aplasia?
Thymoma
Lymphocytic leukemia
Parvovirus B19
Lung cancer can irritate which nerves?
- Phrenic (C3-C5): hiccups, dyspnea
- Brachial plexus (C8-T1/2)
- Recurrent laryngeal - hoarseness
- SVC syndrome - central/mediastinal
- Horners: Lung apex
What is the most common muttiaon in Hypertrophic CM?
β-myosin heavy chain - cardiac sarcomere protein
If a person has inherited dilated CM, what is the mutation?
1/3 are inherited
AD mutation of cardiac myocyte cytoskeletal proteins - dystrophin or mitochondrial enzymes
What is the most common benign liver tumor?
Cavernous hemangioma
collagenous scars, and blood filled spaces
A patient with hypothyroidism after taking a meds for mood swings and sleeping problems was likely on what?
Lithium
What should you measure routinely in a patient on Lithium?
TSH (hypothyroidism)
Li - levels can build up
Renal function - Li can quickly build up
Ergonovine
Ergot alkaloid = vasoconstriction
α and 5-HT agonist
What would worsen an attack of Prinzmetal angina?
Vasoconstriction
What viruses use a protease to cleave their viral products?
Picorna (PERCH) - ss, + non-segmented RNA virus
What pH, PaO2 and PaCO2 would you expect to see in a patient at high altitude for 5 days?
Slight alkalosis
Dec PaO2, dec PaCO2
Dec in HCO3 - compensatory
Pulmonary HTN and cor pulmonale are common complications of CREST - what is the mechanism?
Intimal thickening of pulmonary arteries
Inc. TGF-β - inc. collagen and ECM by matrix proteins and fibroblasts
How do you medically treat a patient with MR?
Decrease afterload
Arterial vasodilators
What is a weird potential side effect of ACE Inhibitors?
1st dose hypotension (block AT2)
Exacerbated with diuretics, hyponatremia, high renin/aldosterone levels, renal impairment and heart failure
Vitiligo
Loss of melanocytes/melanin - autoimmune
How does the liver use glycerol produced by breakdown of TGs?
Glycerol kinase –> Glycerol-3-P –> DHAP
What are the 2 mechanisms of opioid signaling via μ-opioid receptors?
G-coupled receptors
Inc. K efflux out of cells
Block AC - decreased cAMP
Dystonia
Sustained, involuntary muscle contractions - force body parts into abnormal/painful movements or positions
Blepharospasm is an example of dystonia - what is it? What is another example of focal dystonia?
- Focal dystonia - involuntary forcible closure of eyelids
- Writers cramp
- Spasmotic torticollus - cervical dystonia - most common
Myoclonus
Brief, sudden, shock-like jerk - falling asleep, epilepsy, Creutzfeldt-J disease
Who might you see vitamin E deficiency in?
Fat malabsorption
Abetalipoproteinemia
Low birth weight infants
What does vitamin E deficiency look like?
Mimics Friedreich Ataxia/B12 deficiency
Ataxia, dysarthria, loss of vibration/prop sense
What are the characteristics of viral meningitis?
Normal glucose
Increased protein
90% lymphocytes
Osteoid matrix accumulation around the trabeculae is indicative of what?
Vitamin D deficiency
