UWorld Key Points Wks 1-2 Flashcards
Pentose phosphate pathway end products (2)
NADPH and ribose 5 phosphate
SSx of polymyositis
Symmetrical proximal muscle weakness
+/- muscle aches (vs polymyalgia rheumatica)
Endomysial mononuclear infliltration is characteristic of which condition?
Polymyositis
3 antioxidant enzymes in the body
Superoxide dismutase
glutathione peroxidase
catalase
tetrahydrobiopterin is a cofactor for which 3 reactions
Serotonin synthesis
Phenylalanine –> Tyrosine
Tyrsone –> DOPA
What does retrograde arterial flow suggest
Steal syndrome (obstruction in vessel causes proximal hypotension –> branches distal to obstruction flow backwards)
2nd pharyngeal arch components (3)
Styloid process
lesser horn of hyoid
stapes
Number needed to Harm equation
NNH = 1/ARR
mechanism for nitrite therapy in Cyanide poisoning
Oxidize Fe2+ –> Fe3+ (methemoglobin) so that Hb has greater affinity for cyanide. This increases PaO2 and decreases free cyanide
Acid a-glucosidase deficiency
Pompe Disease
3 types of aspergilosis
Allergic (wheezing, patchy inflitrate)
Colonizing (aspergilloma)
Invasive (lung, brain, immunocompromised)
Northern blot
mRNA
Southern Blot
DNA
Western blot
Protein
lactose intolerance Stool pH and osmolarity
Acidic pH (lactose metabolism by gut flora produces fatty acids) Increased osmolality (increased lactose)
All cutaneous structures inferior to the umbilicus are drained by which lymph nodes
superficial cutaneous nodes
Kid with hyperkalemia, hyponatremia and hypotension
21 hydroxylase deficiency
Acute onset abdominal pain, brown urine that darkens over time
AIP
Acute intermittent porphyria Tx
Glucose (inhibit ALA synthase)
Most important cell and mediator in atherosclerosis
Platelets secreting PDGF
endothelial cells and foam cells produce PDGF too
dividing groups based on current risk factors then comparing disease prevalence at present time
Cross Sectional study
half life eq
t1/2= (0.7 x Vd)/CL
What inhibits beta oxidation of fatty acids, particularly the carnitine shuttle
Malanoyl CoA
CD14 is a unique surface marker for
Macrophages
Cancer that Trisomy 21 pts are at increased risk for
Acute Lymphoblastic Leukemia
Mechanism by which eosinophils kill parasites
Ab dependent cell mediated cytotoxicity
Ab dependent cell mediated cytotoxicity mechanism (2 steps)
Fc receptor on eosinophil binds IgE/IgG on the parasite –> triggers degranulation and release of Major Basic protein –> destroy the parasite
Patients with urea cycle disorders should rectrict eating
protein
Hyperphenylalanemia + hyperprolactinemia
Dihydrobiopterin reductase deficiency (increased phenylaline and decreased dopamine production)
Anterior cerebral artery supplies blood to which part of the sensory/motor cortex
Lower limb (medial aspect of each lobe)
2 most important factors to determine cause of metabolic alkalosis
Urine Chrloride
Volume status
Heart dominance
Whichever artery supplies the posterior descending
Which artery supplies the AV node?
Right dominant- right coronary
Left dominant- Circumflex artery
2 mechanisms by which DKA causes K loss in urine
1- osmotic diuresis (increases K gradient in DCT)
2- increase aldosterone secretion (from hypovolemia)
Cellular mechanism of HIV associated dementia
Activation of microglial cells –> microglial nodules
Serum sickness hypersensitity type
Type III
Type III hypersensitivity lab values and primary cell type
Low levels of Circulating C3
Neutrophils predominate
First line therapy for isolated hypertriglyceridemia
Fibrates (fenofibrate, gemfibrozil)
Adrenal medulla cells (type) are stimulated by which NT
Chromaffin cells are stimulated by Acetylcholine from SNS preganglionic neurons
Contents of inundibulopelvic ligament and clinical relevance
Ovarian n.a.v.
This is the site of injury in ovarian torsion
Chain of decision making for individual with no health care proxy
Spouse –> Family member –> close friend
Functional Mitral Regurgitation (Cause and Tx)
Seen in volume overloaded hearts where the mitral valve is stretched and the high LV EDV reguritates back into L atrium.
Tx is to reduce preload
Site in tubule of most concentrated urine in absence of ADH
Junction of descending and ascending loops of henle
Effects of steroid abuse on hematocrit
Increases
Most anterior portion of the heart and the one that gets pierced if the person is stabbed in the chest
Right ventricle
Cause of infertility in cystic fibrosis vs primary ciliary dyskinesia
CF - absence of the vas deferens = AZOSPERMIA
PCD- immotile spermatozoa = have sperm but they dont work
Hyponatremia with a normal water restriction test that doesn’t significantly change when ADH is given
Primary Polydipsia
DI would have hypernatremia and inability to concentrate urine
Destruction of misfolded proteins is mediated by which pathway
Ubiquitin and Proteosomes
Enzyme deficiency in Maturity-Onset Diabetes of the Young, and its normal function
Glucokinase. Normally converts glucose –> G6P in the pancreatic beta cells
Major risk of prescribing an antidepressant to a patient with a history or FHx of bipolar?
induction of a manic episode
During radical prostatectamy, the nerves surrounding the prostate are damaged. What are the nerves and what is the effect?
Prostatic plexus.
Erectile dysfunction b/c cavernous nerves come from prostatic plexus
Innervation below the dentate line (i.e. external hemorrhoids)
Inferior rectal nerve via the pudendal nerve
c-myc, n-myc, l-myc functions
nuclear regulators that faciliate mRNA translation
prophylactic treatment for neonatal GBS
INTRAPARTUM penicillin/ampicillin
Most important prognostic factor in determing severity of mitral regurg
Presence of S3 suggests heart is volume overloaded = severe mitral regurg.
At which point in the respiratory tree do cilia disappear and macrophages appear?
Resipratory bronchioles
terminal bronchioles have cilia and no macrophages
Why are vaccines with capsular antigens coupled with a protein/toxin conjugate?
To induce a T cell response and confer longer immunity (good in infants)
Polysaccharide capsules only confer a B cell response and don’t last long (not good in infants)
Most important mechanism of pathogen removal in the terminal bronchiole
Ciliated epithelial cells
Lateral nucleus of the hypothalamus
Hunger center (destruction = anorexia)
Ventromedial nucleus of hypothalamus
Satiety center (destruction = hyperphagia)
RIght vs Left frontal lobe lesions/trauma
Right = disinhibited behavior (impulsivity)
Left= apathy and depression
Histone H1 vs H2-H4
H2-H4 are central
H1 is external and links the DNA segments
Which enzyme is overactive in Fructokinase deficiency
Hexokinase
Fructose –> Fructose 6 Phosphate
Modified smooth muscle cells in the kidney
Juxtaglomerular cells and macula densa
Seizures + Myopathy + Ragged muscle fibers
Mitochondrial Myopathy
Maternal inheritance
Epithelial ovarian cancer tumor marker
CA 125
2 components of MCHII vs MHC1
MHC1 = Heavy chain + B2 globulin
MHCII = alpha chan + beta chain
Specific cause of papilledema in idiopathic intracranial HTN
Compression of optic nerve, impairing axoplasmic flow
Cellular target of C. diff Toxin A and B
inactivation of Rho-regulatory proteins –> destruction of actin and tight cell junctions
Why does tranfusion of packed RBCs lead to hypocalcemia?
It contains citrate, which chelates calcium
Rash on sun exposed areas + ataxia + neutral aminoaciduria
Hartnup Disease –> defective neutral aminoacid transporter
Tx for hartnup
Niacin
PCL origin and insertion
Origin- Anteriolateral surface of medial femoral condyle
Insert- Posterior intercondylar area of tibia
MCC genotype of complete molar pregnancy
46XX»_space;> 46XY
Time frame for maintaining BGL during a fast (<18hrs and >18hrs)
<18 is maintained by glycogenolysis
> 18 is maintained by gluconeogenesis
Time course of salicylic acid RespAlk / Met Acidosis
Resp Alk occurs first then 12 HOURS LATER pateitns develop Met Acidosis
Positive vs Negative T cell selection
Positive selection occurs first- Keep T cells that bind self MHC
Negative selection - destroy T cells that bind self MHC too tightly
Location of positive vs negative selection
Positive = thymic cortex Negative = thymic medulla
2 Supplementation for homocystinuria
Pyridoxine B6 and Cysteine
Microsomal Monooxygenase function
Convert carcinogenic substances to their active forms
Most common toxin found in wild mushrooms and its mechanism
Amatoxins –> inhibit RNA Pol II –> decrease mRNA
Thyroid nodule. Biopsy shows cells with large nuclei and sparse chromatin
Orphan annie nuclei –> Papillary carcinoma
Vessels anterior and posterior to ureter
Anterior = Gonadal vein/a.
Posterior = INTERNAL iliac
2 holocrine glands, 1 apocrine gland
apocrine = breast
Holocrine = sebaceous and meibomian glands
Which process is most important in removing intracellular organisms from the body?
Cell mediated immunity via macrophages…NOT complement mediated lysis b/c intracellular organisms are “shielded” from complement and T cells
Ingestion of houshold substance, now has N/V/D and garlic breath. (overdose and antidote)
ArseNIC = garLIC breath
Dimercaprol –> binds sulfhydrl groups to inhibit cellular respiration
Most appropriate test for determining the presence of malabsorption in general…not necessarily a specific cause of malabsorption.
Stool microscopy with Sudan III Stain
Effect of excess ammonia in astrocytes
Increased ammonia = increased glutamine production –> astrocyte swelling –> impaired glutamine release
MCC site of aortic arch injuries (in car accidents)
Isthmus (just distal to the subclavian a) , b/c it is secured by the ligamentum arteriosum
Dihydrorhodamine flow cytometry test (use and positive result)
Used to assess for NADPH ox deficiency.
Normal neutrophils will produce a green flouresence. Cells lacking NADPH oxidase will not floursce as much
Which urea cycle disorder will present WITHOUT hyperammonemia?
Arginase deficiency
Main inhibitor of LACTATION in pregnancy
Progesterone
Calcium Sensing Receptor of PTH is coupled to which kind of receptor
GPCR
Sudden upward jerking of arm followed by weakness in all hand muscles. Injured structure?
Lower trunk of brachial plexus –> klumpkes palsy
Recurrent small lobar hemorrhages in an elderly individual without intraparenchymal hemorrhage. Cause?
Amyloid angiopathy
2 major examples of a true diverticulum. What layers are involved?
Meckels diverticulum and the appendix
Submucosa, mucsoa and muscularis propria
After illness, child’s cardiac biopsy shows a granuloma and fibrosis. organism?
GAS –> acute rheumatic fever
DOC for reducing inflammation both chronically and acutely in COPD/Asthma
Corticosteroids
Study results show a perceived association between an exposure and an outcome, but that association can actually be explained by an outside, unaccounted for variable
Confounding
2 major risk factors for Rhizopus infection
DKA
Immunosuppression
Origin and insertion sites of ACL
Origin- Anterior intercondylar area
Insertion- Medila portion of the LATERAL condyle
Patient was treated for a bacteremia a week ago, now presents with bone pain
Osteomyelitis
Two lung cells that contain elastases/proteases
Neutrophils and Macrophages
Ductus arteriosus is a derivative of which aortic arch?
6th
Molecular mechanism by which the mutated huntingtin gene causes disease
Transcriptional repression –> causes histones to be DEacetylated –> impaired neuron survival
Polyribosylribitol phosphate capusle…organism?
H. influenzae
Tx for PCOS patients that still wish to get pregnant?
SERMs that block negative feedback of estrogen on pituitary –> improved FSH/LH production
How do irreversible inhibitors affect kinetics?
Decrease Vmax
ST elevation in leads I and aVL. Artery?
Left circumflex artery
Mechanism by which M3 receptors cause vasodilation? most important amino acid?
Endothelium dependent vasodilation
ARGININE gets converted to NO which incresaes cGMP
What process occurs in the nucleolus
Transcription of rRNA
Progressive loss of hearing with + exposure to loud sounds. Imaging shows high frequency hearing loss. Site of damage?
Cilia on the hair cells are damaged
Why is hypernatremia rarely seen in hyperaldosteronism>
Aldosterone escape
What is aldosterone escape?
Increased Na reabsorption = increased water retention = incresaed RBF = increased Na FILTRATION to counteract the increased Na reabsorption
Kinesin function
Anterograde transport towards + end of microtubule
from nucleus towards periphery
2 substances that can be used to calculate GFR
Inulin
Creatinine
Where is the area postrema located?
Dorsal midbrain at the level of the 4th ventricle
Enoxaparin drug class
Low molecular weight heparin
2 Main differences in function b/w DNA Pol I and DNA Pol III
DNA Pol I removes the okazaki fragments and has 5–> exonuclease activity
DNA Pol III has 3–>5 exonuclease activity
2 cells affected by toxic shock syndrome toxin
Macrophages and T cells
Respiratory side effect of mannitol
Pulmonary edema
Cystic fibrosis patient with normal sweat chloride levels. What other ion defect could they have?
Increased Na reabsorption from the lumen = more water reabsorption = thick mucus
Is the anterior pituitary more closely associated with the optic chiasm or the mammilary body?
Optic chiasm. Posterior pituitary is on the same side as the mammillary body
Increased muscle contractions, weakness, cataracts, gonadal atrophy and frontal balding
Myotonic dystrophy
Subendothelial space in arterioles shows homogenous substance that stains pink with PAS. What is the condition? MCC?
Hyaline arteriolosclerosis
DM and essential HTN
Which type of immune response do inactivated vaccines induce? Live vacciens?
Induce antibodies against the pathogen (don’t enter host cells)
Live vaccines produce CD8T cell response b/c the vaccine enters cells and is expressed on MHCI
Acute onset of neurologic disturbance, hypoxemia, shortness of breath and a petichial rash on the chest
Fat embolism (Fat causes local toxic injury to the endothelium –> petichae)
Histologic difference between osteoblasts and osteoclasts
Osteoblasts are uninucleated
Osteoclasts have multiple nuclei…in pagets, they can have up to 100 nuclei!
How to differentiate b/w myoclonic seizure and simple motor seizure?
Myoclonic is bilateral, simple motor seizure is unilateral
generalized seizures affect both hemispheres. Focal seizures affect one hemisphere
Main difference in spirometry between pulmonary fibrosis and obesity?
Fibrosis = decreased RV Obesity = normal RV
Which artery does polyarteritis nodosa spare?
Pulmonary artereis
Hypertension, bradycardia, fixed dilated pupils with loss of light reflexes
Uncal herniation
Drug used for preventing RECURRENCE of status epileptics
Phenytoin
Flutamide MOA
Binds DHT/Testosterone receptor and inhibits its effects
What is the reason for rapid onset and recovory from highly lipophilic drugs?
Quickly enters brain then redistributes to other body tissues
Thyroid condition with mononuclear / lymphocyte infiltration with germinal centers
Hashimoto Thyroidits
Pt rolled ankle and is tender over anterolateral aspect. Injured ligament?
Anterior talofibular ligament
MSH2, MSH6, MLH1, PMS2 mutations
HPNCC (hereditary nonpolyposis colon cancer)
Major complication of Etanercept if left unchecked?
REactivation of TB
Specific site of osteomyelitis in children
Metaphysis of long bone
Calories/Gram of Protein
4
Cause of bicornuate uterus
Failed lateral fusion of paramesonephric ducts
What 2 cellular processes on DNA and Histones reduce its ability to be transcribed?
DNA methylation completely silences transcription
Histone Methylation
Where are barr bodies located?
In the periphery of the cell as heterochromatin
What unique process do proteins targeted to the lysosomes undergo while in the Golgi?
Phosphorylation of mannose residues
What is the histologic difference between Ischemic ATN and Toxic ATN?
Toxic ATN has oxalate crystals (probably from ethylene glycol)
Ischemic ATN has all the same vacuolization but no crystals
Bloody diarrhea in an AIDS patient. Histology shows spindle shaped cells with vessel proliferation.
Kaposi Sarcoma
Melanocytes are from which embryologic derivative?
Neural Crest
What kind of immune response do Toxoid vaccines produce?
Ab against the toxin only
This means that they don’t activate complement and target the pathogen directly. (Vaccines against capsules will create this type of response)
Child with bilateral papilledema, upward gaze paralysis, vomiting and headache. Where is the tumor?
Pineal gland mass
Constricts aqueduct causing hydrocephalus (headache, papilidema, vomiting).
Compresses dorsal midbrain (visual symptoms)
Besides Dorsal columns and lateral corticospinal tracts, what other spinal pathway does B12 deficiency affect?
Spinocerebellar tract (contributes to the ataxia)
Lung sputum grows on Sabraoud Agar. What is it?
Coccidoides immitis
Hawthorne Effect
Subject changes their behavior once they know theyre being observed
Most common site of male urethral injury in pelvic fracture/severe trauma
Bulbomembranous junction of the posterior urethra
Most common site of male urethral trauma in straddle injuries
Bulbous segment
Pt on a diuretic was given lisinopril then developed orthostatic hypotension. Why/
First dose HTN –> Patients on diuretics are usually volume contracted. ACE inhibitors will cause vasodilation and exacerbate volume contraction
Normal HFE function
Senses serum Fe levels and releases hepcidin
BMPR2 gene mutation (dz and pathogenesis)
Idiopathic Pulmonary Hypertension caused by smooth muscle proliferation
What is the only glycogen storage disease strictly limited to skeletal muscle? why?
McArdle disease b/c glycogen phosphorylase is not present in liver or heart
Importance of the kozak sequence
It is important in the initiation of translation. The ribosome initiaton complex binds upstreatm then “scans” until it finds the kozak sequence
Which 2 cell types cannot use ketones as energy?
Erythrocytes
Hepatocytes
Specific reason for splenomegaly in extravascular hemolytic anemia
Red Pulp hyperplasia
Increased hemolysis = increased work load for the splenic macrophages = hyperplasia
Path of blood flow to retina
Internal carotid –> opthalmic –> retinal
Which cellular mediator is responsible for keloid formation?
Excess TGFB
Sporotrichosis histology
Granulomatous inflammation (its a fungus…so you expect granulomas)
Speech, comprehension, repitition and other neurologic ssx of Broca Aphasia
non fluent speech
Fine comprehension
Poor repitition
Right sided hemiparisis (face and arm)
High circulating levels of what substance are most important in the development and progression of DM II?
Free Fatty Acids
(Insulin insensitivity = increased liposlysis = increased FFA release = downregulation of insulin receptors even more = further insulin insensitivity)
Landmark for the deep radial nerve as it enters forearm, and the nerve that it gets renamed to
It pierces the supinator muscle and becomes the posterior interosseous n
Why is PaO2 slightly lower than PAO2 in a heatlhy individual?
Deoxygenated bronchial blood drains into the Pulmonary Vein
Midhumerus fracture. Damaged nerve and artery
Radial nerve
Deep brachial a.
Which Group A strep virulence factors allows it to be antiphagocytic? 2
M Protein and Hylaronic acid
streptolysin destroys RBCs and WBCs…it has nothing to do with the capsule
How to determine if angioedema from lisinopril is from bradykinin or C1 esterase deficiency
Bradykinin is in all patients, especially the ones who have never had experience with angioedema
C1esterase pts normally present in childhood
Cheyenne Stokes Breathing (who is it seen in and what is it)
Seen in CHF
Ossiliting patterns of increased tidal volume and decreased tidal volume. (See Uworld image)
What is the toxic metabolite that induces abortion in MTX therapy
Dihydrofolate polyglutamate
when MTX is in the cell, everything gets polyglutamated
2 reasons Sickle Cell patients can have a MACROcytic anemia
Extramedullary hematopoiesis –> increased retics
Folate deficiency (increased synthesis of RBCs = increased demand for folate)
what is the first initiating step in infective endocarditis (non Staph aureus)?
Damaged valve induces formation of a fibrin platelet –> bacteria can then bind to that clot
where in the cell is proinsulin cleaved to insulin and c-peptide?
Within the secretory granule
what serum marker is most specific for Rheumatoid Arthritis?
anti-certrullinated peptide Ab (anti-CCP)
Mnemonic for the 10 Neural Crest structures
MOTEL PASS
Melanocytes Odonoblasts Tracheal cartilage Enterochromaffin cells Laryngeal cartilage Parafollicular cells of thyroid Adrenal medulla and Ganglia Schwann Cells Spiral membrane
Enteropeptidase is analagous to
Enterokinase
Converts tryspinogen to trypsin
ACUTE V/Q defect (shunt or deadspace) pH, PaO2, PaCO2, HCO3
Low PaO2 (V/Q mismatch causes hypoxemia) Low PaCO2 (hypoxemia triggers hyperventilation) High pH (hyperventilation = Resp Alkalosis) nml/mildly low HCO3 (by mass effect of low CO2. Renal compensation takes several days)
Hydrops fetalis definition and presentation
Heart failure in the fetus leads to fluid accumulation in multiple compartments
Pleural effusion, ascites, pericardial effusion etc.
Which types of hormone receptors have zinc fingers? 3 examples
Intracellular receptors (Steroids, Fat soluble vitamins and THyroid hormone)
First structure affected in alzheimers
Hippocampus
Isolated cleft lip is a defect in
Fusion of the maxillary prominence and intermaxillary segment of the nasal prominence
2 most important vasoactive metabolites in the coronary arteries
Adenosine Nitric Oxide (EDRF)
Mechanism by which vitamin D analogs improve psoriasis
Bind intracellular receptor –> activates transcription –> inhibition of keratinocyte proliferation
Calcipotriene, calcitriol, tacalcitol are examples of
Vitamin D analogs
Which inflammatory pathway can be induced by IL 1? why?
COX 2 –> cox 2 is only active during episodes of acute inflammation. IL1 is the initatior of acute inflammation
Why do microglial cells fill with lipid after an infarction?
THey consume all the dead nerve cells, which contain lots of myelin breakdown products
Preterm premature rupture of membranes suggests premature delivery is iminent. What medication should be given to improve respiratory function for the baby?
Dexamethasone (cortisol increases surfactant production)
Neonate who is unvaccinated with bulging fontanelle, downward looking eyes and an increased head circumference. Dx?
Intracranial hemorrhage due to Vitamin K deficiency
Anterolateral displacement of a supracondylar ridge fracture suggests which side was fractured?
Lateral
(the fractured bone shifts to the direction in which it was fractured. Medial supracondylar ridge Fx has anteriomedial displacement)
How does the CFTR channel get its energy?
ATP-mediated
Which osteoporosis drug is structurally similar to pyrophosphate?
Bisphosphonates
so is foscarnet…but thtats not for osteo
Effect of nitrate therapy on venous capacitance
Increases
C=V/P venodilation = increased volume in veins
Fidaxomicin indication and mechanism
Used in conjunction with metronidazole and vancomycin for C. diff
Inhibits RNA polymerase
Baby’s BGL after delivery from a mom with poorly controlled diabetes
Transient hypoglycemia
2 Most important serum markers indicating PROGNOSIS for cirrhotics
Serum albumin, bilirubin and PT time
These all measure the functional capacity of the liver
Basis of Sodium Cyanide Nitroprusside test
Put cyanide in urine to produce cysteine
Add nitroprusside which reacts with cysteine to cause red/purple color to urine.
Test is positive in cystinuria (too much cystine in urine = cyanide will have lots to react with)
Most common bursa injured in people spending lots of time on their knees
Prepatellar
Specifically, where is aqueous humor produced (cell and structure)
Epithelial cells of the ciliary body
What is the major difference between an HMO and Point of Service plan?
HMO has lowest copay.
HMO < POS < PPO
What are the 4 things that minors can consent to?
Prenaltal care (NOT ABORTION)
STD screening/testing
Contraception
Drug/Etoh rehab
In a purely breast fed baby, what 2 things does the baby need to be supplemented with?
Vitamin D Vitamin K (usually given if at birth...only have to supplement if they received no vaccines)
When does Iron need to be supplemented to a breast fed infant?
If they are low weight after 4months
Elevated levels of which 2 substances in the serum increase risk for ACUTE pancreatitis
Triglycerides
Calcium
Abdominal distention, bloody stool and vomiting in a PRETERM infant
Necrotizing Enterocolitis (Xray will show air in the bowel)
Which cause of bacterial meningitis is resistant to ceftriaxone?
Listeria
Oral Thrush, recurrent pneumonia, lymphopenia in an infant of a mother who received no prenatal care
Vertical transmission of HIV
which inflammatory muscle condition can present as a paraneoplastic syndrome of visceral cancers?
Dermatomyositis
Within the lamellae of bony matrix are osteocytes. Which type of cell junction connects them?
Gap junctions so they can exchange nutrients and waste products
Linear, red, markings on extremities that seem to move around to different areas of the body and are painful. What is this sign?
Trousseau syndrome –> migratory thrombophlebitis
Migratory thrombophlebitis is most ocncerning for
Visceral cancer
Senile or Familial transthyretin deposition inthe heart will eventually cause which kind of heart failure?
Diastolic failure (decreased ventricular compliance)
Which sulfonylurea is LEAST likey to induce hypoglycemi? Why?
Glipizide, because it is the shortest acting
Neonate with a duodenum ending in a blind pouch, followed by an absent remainder of the small bowel. The colon is present but the terminal ileum appears tightly adhered to a blood vessel. Diagnosis?
Intestinal atresia of the midgut
MCC of intestinal atresia of the midgut
Vascular occlusion in utero
3 nerves affected by a tumor in the cerebellopontine angle
V (facial sensation, corneal reflex problems)
VII
VIII
Most important immunologic distinguishing factor between Salk and Sabin vaccines
Sabin produces LUMINAL IgA
Both produce serum IgA but that isn’t helpful for polio
Phenylcycladine MOA
NMDA receptor antagonist
Menotropin use and MOA
FSH analog that triggers formation of a follicle
Role of B-hCG supplements in treating infertility
B-HCG mimics LH surge required for ovulation…often given in conjunction with menotropin (which prepared the follice)
What is the most severe, irreversible change that occurs in Eissenmenger syndrome of an ASD/VSD
Irreversible hypertrophy/fibrosis of the pulmonary artery
When should an oral glucose tolerance test be used to screen for diabetes?
Only for gestiational DM and in CF patients
For normal pts, fasting glucose, random glucose or elevated A1C are best
Fammily Hx of leukemia, adrenal tumors and brain cancer. Pt has a sarcoma and breast mass. Gene mutation?
p53 –> Li Fraumani syndrome
3 intermediate benzodiazepines
Alprazolam
Lorazepam
Temazepam
Besides T cells, macrophages and B cells, which other cell type does IL2 directly stimulate?
NK cells
Labs of intravascular hemolysis (LDH, Haptoglobin, UCB,
High LDH
Low Haptoglobin
High UCB (elevated UCB isn’t only in extravascular hemolysis)
Pt has muscle weakness, hypertension and a low renin. No edema noted. Diagnosis?
Primary hyperaldosteronism
Weakness = hypoK
HTN= hypernatremia
No edema = aldosterone escape
Describe aldosterone escape
Increased aldosterone –> increased Na/H2O retention –> increased blood volume –> increased venous return to heart –> release ANP –> increase GFR and Na excretion
Essentially all the Na that aldosterone reabsorbed gets re-excreted so you don’t get edema
Results of quadruple screen for Downsyndrome
Low AFP (most important)
Low unconjugated estriol
Increased BhCG
Increased Inhibin A
Which colon cancer produces copious amounts of watery, mucus filled diarrhea?
Villous Adenoma
Puncture wound superior to the clavicle, between mid clavicular and lateral sternal lines. Most likely structure to be damaged and the symptoms it causes
Lung pleura leading to a tension pneumothorax
hypotension due to increased intrathoracic pressure compressing the heart/decreasing CO
tachycardia and SOB
Patient with cancer develops ataxia, dizziness, dysarithia. Most likely cause?
Subacute cerebellar degeneration
Subacute cerebellar degeneration pathogenesis
Autoimmune! anti tumor Abs cross reacti with the cerebellar purkinje cells
Subactue cerebellar degeneration serum Ab markers
Anti- Yo
Anti- P/Q
Anti-Hu
Nephrotic syndrome assiciated with IgG against phospholipase A2 receptor
Membranous nephropathy
