UWorld Mock Blocks 1/17-1/20 Flashcards
1
Q
Radiation causing cell death
A
Double strand breakage (single strand breaks would be repaired by polymerase)
Free radical formation
2
Q
Green color of sputum
A
Neutrophil myeloperoxidase
3
Q
Chronic transplant rejection
A
Fibrotic destruction of small airways (lung)
w/in 5 years of transplant
Dyspnea + dry cough. Drop in FEV1 and FEV1/FVC
Causes bronchiolitis oblierans - obstructive lung disease in small bronchiole
4
Q
Acute rejection
A
w/in first 6 months
perivascular and interstitial mononuclear infiltrates
5
Q
Ischemia-reperfusion injury
A
Pulmonary edema w/in the first few days of transplant.
6
Q
Migratory thrombophlebitis
A
Cancer - hyper coagulability is a paraneoplastic syndrome of visceral adenocarcinomas of pancreas, colon, and lung.
Trousseau syndrome - migratory thrombophlebitis
Trousseau sign - hand/forearm muscle spasm in hypocalcemia
7
Q
Osler-weber-rendu syndrome
A
Hereditary hemorrhagic telangiectasia
Skin and mucosal telangiectasis and recurrent severe nosebleeds.
Autosomal dominant inheritance of congenital skin and mucous membrane telangiectasia
Rupture of telangiectasia: G.I. bleeding, epistaxis, hematuria
8
Q
Sturge-weber strauss
A
Cutaneous facial angiomas and leptomeningeal angiomas
Mental retardation, seizures, hemiplegia, skill radio opacities.
Tram track calcifications in the skull
9
Q
Selective IgA deficiency
A
Recurrent sinopulmonary and GI infections.
Severe deficiency - anaphylaxis during transfusion
Concomitant autoimmunity (e.g. celiac) is common
10
Q
Meglitinides/sulfonylureas
A
e.g. repaglinide
MOA: increase insulin secretion by inhibiting beta-cell Katp channel
Given with meals to reduce postprandial glucose excusrions
SE’s: Hypoglycemia, weight gain
11
Q
Biguanides
A
Metformin
Stimulates AMPK, decreases glucose production and insulin resistance
SE: Lactic acidosis
12
Q
Thiazolidinediones
A
Pioglitazone, rosiglitazone
Activates transcription regulator PPAR-y, decreases insulin resistance
SE’s: fluid retention, weight gain
13
Q
GLP-1 agonist
A
Exenatide, liraglutide
Increase glucose-dependent insulin secretion, decrease glucagon secretion, delay gastric emptying
SE: pancreatitis
14
Q
DPP4 inhibitors
A
Sitagliptin, saxagliptin
Increase endogenous GLP-1
SE: nasopharyngitis
15
Q
alpha-glucosidase inhibitors
A
Acabarose, miglitol
Reduce intestinal disaccharide absorption
Diarrhea and flatulane
16
Q
SGLT2 inhibitors
A
Canagliflozin, dapagliflozin
Increase renal glucose excretion
UTI, hypotension
17
Q
Giant cell arteritis
A
Mediated by cell mediated immunity.
Correlated w/ IL-6. Give Il-6 inhibitor tocilizumab for treatment
18
Q
Primary hyperaldosteronism
A
Nodules in zona glomerulosa
Findings: hypertension, low renin, hypokalemia, metabolic alkalosis
19
Q
Dubin-johnson syndrome
A
Bening - defective hepatic excretion of bilirubin glucuronides –> direct hyperbilirubinemia and jaundice
Liver appears black due to decreased excretion of epinephrine metabolites
20
Q
Precursor B-ALL
A
CD10+, cd19+
21
Q
Erosions
A
Don’t extend through muscular mucosa
22
Q
Essential fructosuria
A
fructokinase deficiency - benign
Autosomal recessive, asymptomatic
Hexokinase takes over fructose metabolism and converts fructose to fructose-6-phosphate
23
Q
Hereditary fructose intolerance
A
Aldolase B deficiency
Hypoglycemia and vomitting after fructose ingestion.
FTT, liver, and renal failure
24
Q
Treatment for grave’s dz opthalmopathy
A
Prednisone
25
Glut-4
Only insulin dependent glucose transporter - found only in muscle and adipocytes
26
Glut-1,2,3,5
Insulin independent glucose transporters
Found in brain, intestine, liver, kidney, and RBCs
1 (RBCs and BBB)
2 (hepatocytes, pancreatic beta cells, renal tubules, small intestine)
3 (placental and neuronal glucose transport)
5 (fracture transporter in spermatocytes and GI tract)
27
Isosorbide dinitrate
Used for angina treatment
Low bioavailability due to extensive first pass hepatic metabolism.
Notably, sublingual nitroglycerin is absorbed directly from oral mucosa into venous circulation and has high bioavailability requiring a lower dose.
28
effect of efferent arteriole constriction
Increase GFR and FF
Increases glomerular capillary hydrostatic pressure d/t decrease in glomerular blood outflow --> increased GFR
Reduces RPF - increased GFR and reduced RPF --> increased FF
FF=GFR/RPF
More renal plasma flor, FF goes down, less RPF FF increases
29
Retinopathy of prematurity
Caused by concentrated oxygen therapy in neonatal respiratory distress syndome
Retinal vessel proliferation and retinal detachment with blindness may occur
30
Hemolytic anemia lab findings
Increase in indirect bilirubin
Hemoglobinemia and hemoglobinuria
Increased serum LDH
Decreased haptoglobin - Haptoglobin binds free hemoglobin to promote uptake. Haptoglobin decreases in intravascular hemolysis when there is free excess hemoglobin
31
MEN 1
ZOLLINGER-Ellison
Primary hyperparathyroidism (hypercalcemia
Pituitary tumors (prolactinoma, visual defects)
Pancreatic tumors (gatrinoma, zollinger ellison)
Start w/ the 3 P's - primary HPTH, Pituitary, pancreatic
32
MEN 2A
PARATHYROID HYPERPLASIA
Medullary thyroid cancer (calcitonin, also in 2B)
Pheochromocytoma (also in 2B)
Parathyroid hyperplasia
33
MEN 2B
MARFANOID
Medullary thyroid cancer (calcitonin, also in 2A)
Pheochromocytoma (also in 2A)
Mucosal neuromas/marfanoid habitus (differentiates 2B)
34
Crescent formation in RPGN
Fibrin deposition
Crescents consist of: glomerular parietal cells, monocytes, macrophages, and abundant fibrin.
Crescents become sclerotic disrupting glomerular function. Irreversible renal injury.
35
Lesch- Nyhan
HGPRT deficiency --> Defect in purine salvage pathway --> increased demand for de novo purine synthesis --> increased activity of PRPP for de novo purine synthesis
X-linked recessive
Dystonia, self-mutilation, hyperuricemia
36
Cytokines in granuloma formation
IFN-y, IL-12, TNF-alpha
37
IL-4
Stimulates T cell -->TH2
Stimulates B cell growth and isotope switch to IgE
38
IL-5
Promotes growth and differentiation of B cells and eosinophils and stimulates isotope switching to IgA
39
Leukotriene C4, D4, and E4
vasoconstrictor, increase vascular permeability, and cause bronchospasm
(increased in aspirin sensitivity due to decrease in TXA)
40
Thromboxane A2
Platelet aggregator and vasoconstrictor
41
Primary CNS lymphoma
Mostly B-lymphocytes
Late complication of HIV infection
42
Case control study
Compare groups of people w/ disease to those w/o
Odds ratio is measure of association
43
Mcardle disease
Type V
Glycogen phosphorylase (myophosphorylase) deficiency (in muscle)
Weakness and fatigue w/ exercise
No rise in blood lactate levels after exercise
Consume simple sugars before exercise
44
Cori disease
Type III
Deficiency of debranching enzymes
Hepatomegaly, ketotic hypoglycemia, hypotonia and weakness
Abnormal glycogen w/ short outer chains
45
Pompe
Type II
Acid-alpha-glucosidase deficiency
Normal glucose levels
severe cardiomegaly
glycogen accumulates in lysosomes
46
Von Gierke
Type I
Glucose-6-phosphatase deficient
Hepatomegaly and statosis, fasting hypoglycemia, lactic acidosis, hyperuricemia and hyperlipidemia
47
polymyositis
Symmetric proximal muscle weakness. Difficulty climbing stairs, getting up from chair, carrying heavy objects.
Anti-nuclear and anti-jo-1 (anti-histidyl-tRNA) antibodies
Elevated muscle enzymes (CK and aldolase)
Bx: Endomysial inflammatory infiltrate and patchy muscle fiber necrosis
Lacks skin findings of dermatomyositis
48
Thyroid peroxidase
Oxidation of iodide to iodine, iodination of thyroglobulin tyrosine residues, iodotyrosine coupling reaction that forms T3 and T4.
Antibodies to thyroid peroxidase in 90% of Hashimoto's thyroiditis patients.
49
Ventromedical hypothalamic nucleus
responsible for satiety - destruction --> hyperphagia and obesity
Grow ventromedially
50
Lateral hypothalamic nuclease
Responsible for hunger - destruction --> anorexia, Shrink laterally
51
RBF
RBF = (PAH clearance) / (1-hematocrit)
52
Standard deviation in normal distributaion
1 SD - 68%
2 SD - 95%
3 SD - 99/7%
53
Mitral stenosis
Loud S1, early diastolic HIGH frequency opening snap after S2, low pitched diastolic rumble.
OPENING SNAP of mitral valve opening.
54
Retinal hemmorrhage
hypertension - flame shaped hemmorrhage
55
Central retinal artery occlusion
atherosclerosis, cardioembolic disease, or vasculitis - cherry red spot
56
Effect of prostaglandins/NSAIDS on glomerulus
Prostaglandins vasodilator afferent arteriole --> increase in GFR
Prostaglandins inhibited by NSAIDs --> Afferent constriction and decrease in GFR
Antiotensin II vasoconstrictor afferent arteriole
ACE/ARB's decrease angiotensin II levels --> vasodilation of efferent arteriole --> decreased GFR (can cause acute renal failure)
57
Tissue factor
Tissue factor (thromboplastin) is found in high levels in placental trophoblast, when the placenta is ruptured it mediates DIC in pregnancy. Most common cause of DIC is placental injury (abruption)
Abruption is most common cause of DIC in pregnancy
58
PTH
Increases bone reabsorption by acting on osteoCLASTS indirectly. Osteoblasts have PTH receptor --> up regulation of RANK-ligand and M-CSF.
Increased bone resorption --> release of Ca and phosphorus from bone.
PTH --> increased serum calcium, decreased serum phosphate (lost in urine)
PTH increases absorption of ca and decreases absorption of P from kidney tubules. As urine phosphate increases, serum CA increases
High levels of calcium downregulate PTH release
59
Glucose-6-phosphate --> 6-phosphogluconate
HMP shunt - deficient in G6PD deficiency
60
Scarlet fever
Strep pyogenes
Rash, grey-white exudates on oropharynx, strawberry tongue
Can result in rheumatic fever
Circumoral pallor
61
Orchitis
Common complication of mumps
Mumps: Fever, malaise, HA's, and myalgia, followed by parotitis w/in 48 hours
62
Kawasaki
fever, rash, strawberry tongue, conjunctival injection
Can result in coronary artery aneurysm
63
Tazobactam
beta-lactamasde inhibitor
64
Erythroblastosis fetalis
Rh (-) mom has been previously sensitized
hemolytic Dz of the newborn - maternal IgG opsonizes fetal erythrocytes and causes hemolysis
(+) direct coombs test
Anemia, jaundice, excess fluid (hydrops fetalis)
extramedullary hematopoiesis
65
Adamts13
thrombotic thrombocytopenia purport - primary microangiopathy --> hemolytic enamia and thrombocytopenia
Tx w/ plasma exchange therapy
66
Anesthetic solubility
High solubility = large arteriovenous concentration gradient --> slow onset of action
Low solubility = low arteriovenous concentration gradient --> rapid onset of action
67
Mydriasis
Caused by alpha-1 stimulation - contraction of pupillary dilator muscle
Phenylephrine - Selective alpha agonist - used to dilate pupil for exam
68
Uterus relaxation
beta-2 agonists relax uterus - tocolytic to defer labor
69
TNF-alpha
Produces symptoms of cachexia - leads to appetite suppression in hypothalamus and increases BMR
Produces fever in bacterial infections
70
IL-3
Stimulates growth and differentiation of myeloid cells
71
TGF-B
inhibits inflammatory response, decreases T cell proliferation and cytokine production
72
Interferon-alpha
antiviral and anti-tumor activity
73
Thoracodorsal nerve
Lattissmus dorsi - extention, adduction, and medial rotation of humerus
74
MSH2
Mismacth repair gene a/w lynch syndrome --> colorectal cancer, endometrial cancer, ovarian cancer
75
Clear cell carcinoma
originates from proximal renal tubules
76
TGF-B
critical for fibroblast migration, proliferation, and CT synthesis.
Excess TGF-B --> hypertrophic/keloid scarring and/or fibrosis of lung, liver, and kidney w/ chronic inflammation
77
TNF-A
promotes leukocyte recruitment, induces systemic inflammatory response, regulates apoptosis
78
NF-Kb
proinflammtory transcription factor. Regulates cytokine production, adhesion molecule expression, cell survival. Increased activity in cancers and inflammatory disease
79
IL-17
recruits neutrophils, stimulates production of antimicrobial peptides. Improves host defense against fungi and bacteria at mucosal surfaces
Dysregulated in autoimmunity
Made by TH17
80
Dandy walker malformation
absence of cerebellar vermis, cystic dilation of 4th ventricle, posterior fossa enlargement.
Presents w/ developmental delay and skull enlargement in infancy.
81
modafinil
Treatment for narcolepsy
82
Wegener's - granulomatosis with polyangiitis
C-ANCA - target neutrophil proteinase 3
Necrotizing vasculitis of the upper and lower respiratory tract. Nasaul ulcerations, sinusitis, hemoptysis. Causes rapidly progressive glomerulonephritis
Can look like Good pasture
83
Anti-smith Ab
Lupus autoantibody to snRNPs
84
Anti-GBM ab's
Goodpasture
linear deposits of IgG and C3 in the glomerular basement membrane
Attack type 4 collagen
Crescent w/ infiltration of monocytes and macrophages on light microscopy
85
Mebranoproliferative glomerulonephritis
Basement membrane splitting on light microscopy
Granular on immunofluoresence
86
Duodenal atresia
failure of gut recanalization
87
Failure of neural crest migration
Hirschsprung - delayed passage of meconium, abdominal distention, and mills emesis
88
Omphalomesenteric duct
Vitelline fistula (failed obliteration of duct)
Meckel diverticulum (partial failure)
89
Intestinal malrotation
intestinal obstruction d/t compression by adhesive bands and midgut volvulus
90
Lowest point of PVR
functional residual capacity
91
Carcinoid syndrome
Formation of valvular fibrous plaques R>L
Forms tricuspid regard or R side HF
Pathogneumonic
Elevated 24 hour urinary 5-HIAA
92
Thiamine deficiency
Baseline erythrocyte transketolase activity is low, but increases after addition of thiamine pyrophosphate.
Co-factor for:
Pyruvate dehydrogenase (pyruvate-->acetyl CoA)
alpha-ketoglutarate dehydrogenase (catabolism of branched chain alpha ketoacid dehydrogenase - catabolizes branched chain amino acids
Transketolase - enzyme on pentose phosphate pathway
93
Procollagen peptidase
Cleave n-terminal pro peptides from pro collagen - defective in EDS
94
Edwards syndrome
Trisomy 18
Micrognathia (small mouth), prominent occiput (big back of head), low set ears, heart defects, renal defects, CLENCHED hands w/ overlapping fingers, limited hip abduction. Fetal growth retardation, hypertonia (clenched hands), ROCKER bottom feet.
95
Patau syndrom
trisomy 13
Midline facial defects (cleft lip/palate, holoprosencephaly), MSK abnormalities (polydactyly), g.i. anomalies. NO overlapping fingers.
96
Cri-du-chat syndrome
5p deletion
Cat-like cry, hypotonia, FTT, developmental delay. Microcephaly, low set eats, hypertelorism, broad nasal bridge.
97
Dobutamine
Beta and alpha 1 agonist - mostly beta-1
Activates Gs --> increased cAMP --> increased intracellular Ca2+ --> positive inotropy
Also positive chronotropy (increase in HR)
98
Hawthorne effect
study subjects change behavior when they know they are being studied
99
Silicosis
calcification of the rim of hilarity nodes and birefringent silica particles in fibrous tissue
100
Klinefelter's
Destruction of sertoli and leydig cells - inhibin and testosterone levels are decreased. Lack of feedback inhibition by inhibin and testosterone --> increased FSH and LH.
Most have no sperm
101
Primary hyperparathyroidsm
```
elevated calcium (increase in renal absorption)
Increased Vit D production --> increased Ca absorption from intestine
Increase in bone resorption
```
Bone pain, renal stones, G.I. disturbance, psych disorders.
Results in subperiostwal thinning and erosions
102
Paget dz of bone
disorganized lamellar bone in mosaic pattern
Ca and Phosphorus are normal
103
Vit D deficiency
osteoid matrix accumulation around trabecular
Excessive unminieralize ostoid
Low wine calcium
104
Osteoperosis
trabecular thinning w/ fewer interconnections.
105
HF with recent viral infection
Dilated cardiomyopathy caused by viral myocarditis - dilation and enlargement of heart chambers w/ decreased ventricular contractility
106
Potassium perchlorate - competitively inhibits iodine transport
Prevent iodine from entering thyroid in hyperthyroidsm
107
Amiodarone
can cause hypothyroidism or hyperthyroidism- 40% iodine by weight.
Do TSH before intitiating treatment
108
Acute salicylate toxicity
nausea/vomitting, confusion, dizziness, tinnitus, fever, tachypnea
1. respiratory alkalosis
2. anion gap metabolic acidosis - 12 hours later d/t organic acid accumulation in the blood
can have normal pH w/ decreased PaCO2 (res. alkalosis) and decreased HCO3 (metabolismc acidosis, bicarb bound by free floating acids.
109
Germinomas - most common pineal gland tumor - present w/ obstructive hydrocephalus.
Midline malignant tumor in children
110
Chlamydia treatment
Doxycycline OR azithromycin
| + ceftriaxone for gonorrhea.
111
Transketolase
Part of pentose phosphate pathway - uses thiamine as co-factor to shuttle 2 carbon fragments between sugars
112
NK cells
Kill cells w/o MHC I - e.g. virus infected or tumor cells
Contain perforin and granzyme
Induce apoptosis of target cells
113
Hox genes
DNA binding transcription factors - play role in segmental organization of embryo from cranial - caudal
114
Vit D in skin
7-dehydrocholesterol --> cholecalciferol (D3) (occurs from sunlight in skin)
Cholecalciferol --> 25-hydroxyvitamin D (occurs via 25-hydroxylase in liver)
25-hydroxyvitamin D --? 1,25-dihydroxyvitamin D (active vit D, from 1-alpha-hydroxylase in Kidney's)
115
DEsmopressin/vasopressin
V2 mediates increase in water and urea permeability at medullary collecting duct
Increased urea reabsorption (decreased clearance) --> enhanced osmotic gradient --> maximally concentrated urine
Renal clearance of urea decreases most after vasopressin administration
116
Buspirone
Slow onset of action
Partial agonist at 5HT1A receptor
used in GAD NOT panic disorder
No risk of tolerance/dependence
117
quinidine, procainamide, disopyramide
Class IA anti-arrhythmics
Intermediate inhibition of phase O
Lengthens AP
118
Lidocaine, mexelitine
Class IB anti-arrhythmics
Weak inhibition of phase 0
Shortened AP
119
Flecainide, propafenone
Class IC anti-arrhythmics
Stron inhibition of phase 0
No change in AP
120
11beta-hydroxylase deficiency
Hypertension - male appearing female genitalia (ambiguous) - increased androgens
121
17 alpha hydroxyls deficiency
Hypertension - males have female genitalia due to lack of androgens
122
21-hydroxylase deficiency
Hypotension - male appearing female genitals (ambiguous) due to increased androgen production
123
Bleeding in renal failure
Uremic toxins impair platelet aggregation and adhesion
Prolonged bleeding time w/ normal platelet count and all coag factors normal.
124
CMV esophagitis
found in HIV patients - large, shallow, linear ulcerations
125
Angiotensin II
Released in response to RAAS activation in CHF
Higher concentration in pulmonary vein than pulmonary artery.
Causes systemic vasoconstriction --> increase BP (increased after load)
Stimulates aldosterone release in kidney --> sodium retention --> increased afterload
Increasesd after load worsens CO
126
Linezolid
MAO inhibitor used to treat G(+) vancomycin resistant enterococcus and MRSA
127
Fibrates
reduce cholesterol solubility --> reduce bile acid synthesis --> gallstone formation
128
MAC
Disseminated infection when CD4<50
Administer prophylactic azithromycin w/ CD4<50
129
pneumocystis prophylaxis
CD4<200 - trimethoprim sulfmethoxazole (TMP-SMX)
130
Toxoplasmasma gondii prophylaxis
CD4<100 - TMP-SMX
131
Histoplasma capsulatum prophylaxis
CD4<150 - itraconazole (Ohio and Mississippi river valley's)
132
Charcot-bouchard aneurysm
a/w hypertension
Occurs in basal ganglia, cerebellum, thalamus, pons
Causes intracerebral hemorrhage (vs. subarachnoid w/ berry)
Progressive neurologic defecits
133
Optic disc edema
Pseudotumor cerebri
Increased ICP --> optic nerve compression --> impaired axoplasmic flow --> optic disc edema
134
ESR
measures circulating levels of fibrinogen, which are increased by Il-1, IL-6, and TNF-alpha (trigger hepatic release of acute phase proteins including fibrinogen).
135
Lead poisoning in adults
Occupational exporuse
Microcytic anemia w/ normal iron studies - basophilic stippling
Abdominal pain, constipation, lead lines on gums, peripheral neuropathy, anemia.
136
KRAS mutation
Constitutive actiavation of EGFR pathway --> promotes cell proliferation and growth.
Cells w/ KRAS mutation and resistant to anti-EGFR drugs (cetuxmiab and panitumumab)
137
Arsenic poisoning
Imparis cellular respiration
Abdominal pain, vomitting, diarrhea, hypotension, GARLIC odor.
Found in insecticides
Dimercaprol - chelating agent for treatment.
138
CN poisoning treatment
Hydroxycobalamin - forms cyanocobalamin which can be excreted in urine
139
Iron overdose treatment
Deferoxamine - facilitates urinary iron excretion
140
Pseudomonas treatment
cefepime, ceftazidime
Ticarcillin, piperacillin
SOME fluoroquinolone (chirp, levo) and carbapenems (imipenem, meropenem(
141
Dobutamine
Beta against - primarily beta-1
Increases HR and contractility --> increased myocardial O2 consumption
142
Henoch scholen purpura
IgA mediated type II hypersensitivity following infection
Systemic vasculitis due to IgA immune complexes
Palpable lower extremity purport, abdominal pain, arthralgias, hematuria
143
Craniopharyngioma
Remnant of rathe pouch - suprasellar tumor
Colin, cystic, calcified
144
Acute Hep A
Recent travel to endemic area
Prodrome: fever, malaise, anorexia, nausea/vomiting, RUQ pain
Cholestasis: jaundice, pruritus, dark urine, clay colored stools.
145
Cheyne stokes breathing
In CHF - apnea followed by hypercapnia
146
Indolent non-hodgkin lymphoma
Follicular - 14:18 translocation BCL-2 oncogene
Waxing and waning LAD
147
Typhoid fever
Travel to somewhere endemic
escalating fever, diarrhea/constipation, abdominal pain, rose spots on chest/abdomen, hemorrhagic enteritis, possible hepatosplenomegaly
148
Neurotransmitter inhibited from release in tetany
glycine and GABA
149
Panic attack
Hyperventilation --> decreased CO2, increased O2
Causes cerebral vasoconstriction - hyperventilation is used as treatment in cerebral edema
150
Dz w/ similar etiology to primary billiary cholangitis
Graft-versus host disease
lymphocytic infiltration and destruction of small and mid-sized intrahepatic bile ducts.
