Uworld NTK_week1 Flashcards
What deficiency can happen with biliary disorders, exocrine pancreatic insufficiency, or intestinal malabsorption?
Deficiency in Fat-Soluble vitamin.
Vitamin A ~ night blindness and hyperkeatosis
What biliary diz is ~w/ middle-aged WOMEN?
Primary Biliary Cholangitis (PBC); destruction of small bile ducts in the liver.
Have generalized pruritus d/t bile acid accumulation in the skin.
Late-onset familial Alzheimers ~w/ ?
Apo-E4 genotype
Early-onset familial Alzheimers ~w/ ?
three gene mutations:
- APP (Chr. 21)
- Presenilin 1 (chr.14)
- Presenilin 2 (chr. 1)
M3 receptors on endothelial surface of peripheral blood vessels. activation leads to what?`
promotes NO synthesis and increase cGMP which activate myosin light chain phosphatase ===> VSMC relaxation and vasodilation.
In contrast to M3 activation at other organs, which does muscle CONTRACTIONS!!!
Proteins ~w/ gap junctions?
Connexins, for intracellular communications
Proteins of tight junctions?
Claudins, occulins; (Para cellular barriers)
Proteins of adherins junctions?
Cadherins for cellular anchor)
Proteins of desmosomes?
Cadherins (desmogleins, desmoplakin)
Hemidesmosones proteins?
Integrins (Cellular anchor)
What biostats number is the probability of developing a disease over a certain period of time?
-affected / # of total subject pop.
Risk!
What drug’s MOA is a N-Methyl-D-Aspartate receptor antagonist?
PCP (phencyclidine)
NDMA
What drugs can help accelerate fetal lung maturation by stimulating surfactant production?
Betamethasone or Dexamethasone
give to decrease risk of neonatal RDS
Caviare TB is usually due to primary infection or reactivation?
Reactivation of mycobacterial infection
____ abscesses are common complications of aspiration pneumonia?
Lung Abscesses.
high risk pt; alcoholics, dementia, chronic illness
How do you Tx narcolepsy?
scheduled daytime naps
psychostimulants (Modafinil) for daytime sleepiness
What are the 3 Sx of Anaphylatic shock?
What do you use to Tx it?
- Vasodilation
- Increased vascular permeability
- Bronchoconstriction
Tx w/ Epi. it stimulates alpha-1 receptors of both cutaneous and viscera vasculature.
Stim of beta-2 ==> bronchodilation
What amino acid is the precursor for Serotonin?
Tryptophan
How do you Tx serotonin syndrome?
anti-histamine with anti-serotonergic properties like Cyproheptadine.
How do you Tx serotonin syndrome?
anti-histamine with anti-serotonergic properties like Cyproheptadine.
What are the physical features of a Pt. with Fragile X syndrome?
- Neurobehavioral problems
- Prominent forehead
- Large ears
- Long narrow face
- prominent chin
- MACRO-orchidism, Large Balls!!!
What is the major ADR with Sccinylcholine drug use, esp. in Pt. with severe burns, myopathies, enervating injuries?
HyperK+
What accounts for the difference in the values between minute and alveolar ventilations?
Dead Space
What are the premature stop codons?
UAA
UAG
UGA
Myasthenia gravis and Goodpastures are examples of what immune response?
Type 2 hyper-sensitivity
What is the MOA of Dantrolene?
Inhibition of Ca2+ ion relase from sarcoplasmic reticulum of skeletal m.
Used to Tx Hypertermic Maligantant syndrome of anathesia
AND
Tx Neuroleptic Malignat Syndrome (NMS) from anti-psychotic medication overdose!
The toxin produced by what two bacteria that causes bloody diarrhea has the same action of inhibiting the 60S ribosomal subunit in human cells –> blocking protein synthesis by preventing tRNA binding?
Vero-cytotoxins of Shiga and EHEC
What is the best drug of choice to Tx pregos with VTE (other clotting/anti-coag)>
LMWHeperins. Enoxaparin
Neonate comes to clinic with constipation, lethargy, hypotonia, macroglossia, umbilical hernia and large anterior fontanelle. What is the Dx and what is the dX and the associated pathophysio?
Congenital HypOthyroidism
Neonate aSx at birth b/c mom’s T4 is still in their system. takes a few months to show sX.
What adverse shit can happen if you mech-vent a pt. who has COPD with excessively high Oxygen?
Pt. will get increased CO2 retention (O2-inducecd hypercapnia) ===> confusion and depresses consciousness.
This is d/t the reversal of hypoxic pulmonary vasoconstriction –> imcreases physiologic dead space. (V-Q mismatch)
“dead space ventilation”
What STD typically presents as a single PAINLESS genital lesion (chancre) after initial infections?
Syphilis (T. pallidum)
What derm layer does the spleen come from and what is it’s blood supply?
Mesodermal (dorsal mesentery)
splenic artery (branch of celiac trunk, major supplier to foregut)
Hyponatremia is a lab abnormality that occurs with pneumonia caused by what bacteria?
Legionella.
Think: dry couch, GI and Neuro issues, and recent cruises (travel with stranger water sources)
Infection with what bacteria can result in cold aggultinin formation?
Mycoplasma
What is the adverse effect of combo of a b-blocker and a CCB?
additive chronotrophic effects ==> severe bradycardia and hypotension.
Leukocyte Adhesion Deficiency is ~w/ the absence of what antigen?
CD18; needed for the formation of integrins to adheare to endotheial surfaces.
LAD ~infections lack purulence and have persistent leukocytosis b/c they can’t migrate out of blood vessels.
What is the func. of EGF?
mitogenic influence on epitheial cells, hepatocytes and fibroblast. EGF does NOT play a role in angiogenesis like VEGF or FGF-2.
What are the substances that drive angiogenesis?
VEGF & FGF-2
What Sx are pathognomonic for a larde patent ductus arteriosus complicated by eisenmenger syndrome (reversal of shunt flow from left-to-right to right-to-left)
differential clubbing and cyanosis in the toes WITHOUT blood pressure or pulse discrepancy.
What does PTH do to serum Ca+ and serum phosphate levels?
PTH increases serum Ca2+ and
DECREASES serum Phosphate (via urinary excretion)
Photosensitivity dermatitis, diarrhea, dementia think?
Pellagra, Vitamin B3 (Niacin) Def.
XP is and Auto-R disorder d/t a defective nucleotide excision repair often caused by a deficient what?
UV-specific endonuclease
What does the 3’ –> 5’ exonuclease mean?
“proof-reading” ability of DNA polymerase.
~w/ Hereditary nonpolyposis colon cancer associated with DNA mismatch repair gene mutation.
S3 in a older man –> ?
d/t increase left-ventricular end-systolic volume.
which occurs in the setting of left ventricular systolic failure
Auto-Abs against Desmosomes ==> ?
Pemphigus vulgaris
What causes bullous pemphigoid?
Auto-Abs to hemidesmosomes
Rheumatic fever/heart diz is a common cause of what heart sound in underdev. nations?
mitral regurg; blowing holosystolic murmur
Loss of neurons in the substantia nigra occurs is what disease?
Parkinsons
Damage to nucleus ambiguous of the medulla –> ?
myoclonus
Increased risk of intracerebral hemorrhage and seizures –> ?
Cavernous hamangiomas
hyperpigmented macules and increase ICP and headaches –> ?
Cafe au Lait spots, NF-1 schwann cells, neural crest cells.
The Phrenic n. is derived from what nerve roots?
C3-C4-C5 keeps you alive.
Muscle weakness and atrophy, auto-dom, and cataracts –>
Myotonic Dystrophy (d/t increased number of trinuc repeats.
also can Sx of frontal balding and gonadal atrophy.
Where in the ribosome does the first tRNA enter for the AUG (Start) codon (methionine)
P-site
Binding of aminoacyl tRNA at the A-site req. what?
GTP binding and hydrolysis.
and other elongation factors
Which ribosomal subunit binds upstream of the 5’ end and travels downstream until the AUG codon is encountered?
The small subunit 40s
What is req. during aminoacylation (tRNA charging)?
two ATP
“A for activation”
What enzyme adds UDP-glucose to a pre-existing glycogen molecule or glycogenin, a small protein that acts as a primer for glycogen?
The breaking of phosphate bonds in UDP is what provides the energy to form the bond between glucose and the glycogen chain.
Glycogen synthase
Trisomy 21 has 3 copies of what that increases risk for EARLY onset alzheimers?
3 copies of amyloid precursor protein gene
LATE onset alzheimers –>
ApoE mut.
In the first days of life, neonate has dilated stomach & proximal duodenum “double bubble sign” ==> ???
Trisomy 21 increases risk of Duodenal atresia. (MC in down synd.)
Prenatal screening with decreased maternal serum AFP and increased nuchal translucency ==>?
Trisomy 21
harsh, crescendo-decrescendo SYSTOLIC ejection murmur at the right second intercostal space == ??
aortic stenosis.
bicuspid aortic valve mcc
mid-systolic click and a late systolic murmur heard of apex == ???
Mitral Valve Prolase
Prolonged exposure to loud noises fucks with what?
hearing loss d/t damage to the stereociliated hair cells of the organ of corti
Fat guy with normal A-a gradient?
Obesity HYPOventilation syndrome.
chronic fatigue, dyspnea, PaCO2 > 45mmHg while awake.
Best pX indicator of bladder cancer?
Tumor stage; degree of invasion into the bladder wall and adjacent tissue.
Rod-shaped, “tennis racket”, cells, Langerhans cells?
Liver. Landerhans cells histiocytoses.
aka: Birbeck granules
How do you diff. schizoaffective disorder vs. schizophrenia?
schizoaffective is psychosis in the ABSENCE of significant mood symptoms (manic or depressive disorders)
Fungus that appears red on mucicarmine stain and clear “halo” with india ink
Cryptococcus neoformans, only one with polysacc capsule
fungus, with septate hyphae on silver stain?
Aspergillus fumigatus
fungus, budding yeast with pseudo-hyphae on KOH?
Candida
What layer do you biopsy if you are looking for Meissner and auerbach plexus?
submucosal
sotalol, quinidine, haloperidol, macrolides, fluoroquinolones all have what in common?
prolongs QT interval –> TdP
Platelet endothelial cell adhesion molecule 1 (PECAM-1) is ~w/ what in terms of neutrophils?
Neutrophil transmigration; squeezing out of vasculature via integrin attachments and adherence to PECAM-1.
molecules needed in neutrophil rolling?
L-selectin on neutrophils.
E-selectin/P-selectin on endothelial cells.
CD18 is part of what in terms of neutrophils?
tight adhesion and crawling.
LAD type 1 is a fucked CD18
custard, mayonnaise, salted meats, food at a potlock ~ ?
Staph aureus
Fried Rice ~ ?
Bacillis cereus
Raw oysters ~ ?
Vibrio
Vibrio parahaemolyticus & vulnificus
Raw egg and raw chicken ~ ?
Salmonella gastroenteritis
What organ is deep to the 12th rib?
the kidney
what type of reaction is d/t known pharma properties of a drug?
Type 1:
ex: nephrotoxicity d/t aminoglycosides,
increases breath hydrogen content, reduced stool pH (more acidic), elevated stool osmolality ==> ??
Lactose intolerance.
Pt. gets vasospasms following a subarachnoid hemorrhage (SAH), what you use to Tx?
CCB?
Nimodipine
What imaging is the most abnormal in minimal change disease?
EM shows diffused podocytle foot process effacement and fusion.
LM and IF are normal.
Meniere disease ~ tinnitus, vertigo, sensorineural hearing loss. pathogenesis ?
d/t to INCREASE VOLULME and pressure of endolymph in the vestibular apparatus.
adhesion of cells to the ECM involves integrin-mediated binding to what? (3)
fibronectin, collagen and laminin.
large amounts of whole blood transfusion leads to an elevated plasma what in a pt. and what does this elevated substance do to calcium and magnesium?
5-6 liters + of whole blood increases plasma citrate. Citrate chelates calcium and magnesium –> decreasing their plasma levels ==> paresthesia.
excessive ingestion of raw egg whites fucks with what vitamin?
B7 (biotin)
What does hormone sensitive lipase detect?
decreases in insulin.
that’s why there is HYPERlipidemia in diabetics.
What aa becomes an essential amino acid in PKU?
Tyrosine
what does ethanol do to eth NADH:NAD ratio
increases
What are the two codons that are the exception to the degenerate/redundant aspect of the genetic code?
AUG:Methionine
UGG: Tryptophan
Does high NADH represent the high or low energy state?
High NADH = HIGH energy state
AutoDom. Defective synthesis of type 1 collegen –> impairment in bone matrix formation. small and malformed teeth.
Osteogenesis inperfecta.
Note: both endrochronal and intramembranous ossification are impaired.
Fever, pharyngitis, lymphadenopathy in a young adult ~~~ ???
infectious mononucleosis (IM) = EBV!!!
~ nasopharyngeal carcinoma
________ ________ are vascular malformation composed of abnormally dilated capillaries separated by thin connective tissue septa.
Canvernous Hemangiomas
Zoonotic infection in farm workers exposed to waste from cattle and sheep?
Q Fever. Coxiella burnetii
What is the CD that is the surface marker of the monocyte-macrophage cell linage?
CD14
CD7 = ???
CD7 is a multi-chain complex T-cell marker
night sweats, wt. loss, and cough AND:
apical pulmonary granulmonas schowing caseous necrosis ===> ???
secondary TB;
caseating granulomas of TB are made up of what cells?
large epithelioid macrophages
Where is the complement binding site on both IgG and IgM?
Fc portion closer to the HINGE REGION!!!
Delta Wave on ECG ???
Wolff-Parkinson-White syndrome.
pre-excitation.
also, short PR interval and widen QRS.
fetal renal anomaly that causes decrease fetal urine output leading to Oligohydramnios.
Potter seq.
flat facies and club foot.
Crypt hyperplasia, villous atrophy, intraepithelial lymphocyte infiltration ==> ??
Celiac disease
What is a derm diz, loss of epidermal melanocytes?
Vitiligo
What type of genome is HepE virus?
single-stranded RNA, naked, oral-fecal, poor Asian, sub-Saharan Africa.
Most common cause of congenital bilateral absence of congenital bilateral absence the vas deferens?
CFTR gene mut. (CBAVD)
CF
HbS allows what kind of interaction with Hemoglobin molecules?
Hydrophobic.
HbS normal acidic/neg-charged glu is replaced with a nonpolar val. ===> hydrophobic interactions causing polymerization and erthrocyte sickling.
Blue-green heme-based enzyme released from neurtophil azurophilic granules
myeloperoxidase;
forms bleach
interalveolar wall destruction, very reduced expiratory airflow velocity, increased residual volume, hyperinflation == ???
Chronic obstructive pulmonary disease
oxalate crystals in the renal tubular lumen ~ ?
ethylene glycol poisoning
in hemolytic disease of the newborn, what causes the lysis of fetal RBCs?
anti-Rh(D) antibodies (IgG) cross the placenta and does the lysis
45,X/46,XX ~ ?
germline mosaicism affecting sex chromosomes..
mosaicism is the presence of multiple, genetically different cell lines within the body
Prostacyclin (prostaglandin I1) ~ ?
vasodilates and inhibits platelet aggregation and increase vasulcar permability
thromboxane A2 –> ?
enhances platelet aggregation and vasoconstriction
??? is a marker of endogenous beta-cell insulin secretion?
C-peptide;
uses to know if insulin is from external sources
what to types of DM drugs improve blood glucose levels by increasing insulin secretions (thereby increasing c-peptide)
Sulfonylureas & meglitinides
fasting decreases insulin secretion/c-peptide
anterior pituitary comes from?
Rathke’s pouch (remnants) which comes from surface ectoderm.
~craniopharyngioma (calcifications)
Catecholamines secretion from the adrenal medulla chromaffin cells are stimulated by what?
ACh released from sympathetic PRE-ganglionic neurons.
Epi and NE are secreated DIRECTLY into the bloodsteam.
Dohle bodies ~ ?
Leukemoid reaction.
Dohle bodies = granules in neutrophils.
HIV integrase inhibitor?
Raltegravir
Path of N. meningitidis takes to infect CNS.
pharynx –> blood –> choroid plexus –> meninges
Large ears, long face, macroocrhisim ==?
fragile X syndrome;
trinuc repeats of CGG.
small gap near the tip of LONG ARM of X chromosome.
greenish color days after bruising d/t ?
biliberdin.
Heme Oxygenase converts heme to biliverdin.
Fucked enzyme in acute intermittent porphyria?
Porphobilinogen deaminase.
__________ nerve meditates the AFFERENT limb of the cough reflex about the vocal cords?
internal laryngeal n.
What drugs are indicated in non-obstructive urinary retentation, paralytic ileus, and claucoma?
Cholinomimetics
Pt. with parenteral nutrition via central venous catheter high risk infection from what fungus?
Candidemia;
branching pseudohyphae with blastoconidia.
Vegans deficient in what?
B12, Calcium, Vitamin D
exertional dyspnea and diastolic murmur at cardia apec ==> ??
mitral stenosis;
opening snap d/t sudden opening of mitral valve leaflets when the left ventricle pressure falls below the left atrial pressure at the beginning of diastole.
exaggerated drop (>10mmHg) in systolic blood pressure during INSPIRATION == ?
Pulsus paradoxus
Hypoxic CNS injury followed by _________ necrosis.
Liquifactive
How are hormone receptor-positive breast cancers Tx?
anti-estrogen meds to reduce tumor prolif.
ER/PR (+), over-expression
horse voice with heart issues?>
left atrial enlargement can impinge on left recurrent laryngeal nerve.
Caspases: ?
proteolytic enzymes that cleave cellular proteins.
Treating a dehydrated pt. with acyclovir can leadq to what?
crystalline nephropathy.
acyclovir is primarily excreted in the urine via GFR and tubular secretion.
Hemobox genes?
codes transcription factors.
important role in segmental organization of embryo along the cranio-caudal axis.
defects –> skeletal malform and improperly position limbs
Gallstone ileus –> ?
passage of large gallstone through a cholescystenteri fistula into the small bowel, obstructuing the ileum.
~ gas within the gallbladder and billiary tree
Waxing and waning lymphadenopathty, cleaved and noncleaved cells = ?
Follicular lymphoma.
t(14;18) and overexpression of bcl-2 oncogene.
What type of channel is the CF transmembrane ch.?
ATP-gated
trabecular thinning with fewer interconnections ~ ?
osteoporosis
Subperiosteal resorption with cystic degeneration ~ ?
hyper-parathyroidism
“Excessive unmineralized osteoid? ~ ?
Vitamin D def.
“the presistence of primary, unmineralized spongiosa in the medullary canals” ~ ?
Osteopetrosis
Coccidioides ~ ?
Arizona
Lungs, “spherules packed with endospores”
Calcification and thickening pericaridum on CT ~ ?
constrictive pericarditis?
X-linked mutation affecting NADPH oxidase ?
CGD
no blue or green pigment produced bt the NBT test?
CGD
Horseshoe kidney ~ ?
inferior mesentaric artery
bacterial transpeptidases ~ ?
penicillins, PBP. etc.
Tx CMV retinitis w/ ???
ganciclovir
What does CO poisoning do to pO2?
nothing.
CO poisoning increases carboxyhemoglobin concentration, but does not affect the partial pressure of oxygen and does NOT precipitate methemoglobinemia.
defective transportation of cystine, ornithine, argine and lysine across the intestinal and renal tubular epithelium == ???
Cystinuria (AR)
What is the MC type of thyroid cancer?
Papillary carcinoma
what is the hallmark sigh of HPV infections?
Koilocytosis;
pyknotic, superficial or immature squamous cells with a dense, irregularly staining cytoplasm and perinucular halo-like clearing.
decreased ventricular compliance w/ normal LV ejection fraction, normal LV end-diastolic volume, and ELEVATED LV filling pressures.
Diastolic heart failure
Pt. that progresses to diabetic nephropathy can have proteinuria. What is the best drug to lower this risk?1
ACEi/ARBs are the best anti-hypertensives drugs d/t to their BP-independent anti-proteinuria effects.
Biostats:
present when the effects of the main exposure on the outcome is modified in the presence of another variable.
Effect modificaiton
GVHD ~ ?
Graft T-cell sensitization vs. host MHC antigens
Major vascular beds most at risk for atherosclerosis?
Lower Abd Aorta & Coronary Arteries
Postpartum hemorrhage unresponsive to meds ==> ?
ligate the Internal Iliac artery
dev of external male genitalia, growth of prostate, male-pattern hair growth, amplifies the affects of testosterone == ?
DHT
What is the essential pathogenic mech of Shigella?
Mucosal invasion of M cells that overlie peyer’s patches.
Shigeela does make exotoxin, but not needed to produce shellaosis
urinary secretion of acid is in form of?
NH4+ and titratable acid (H2PO4-
a tumor that has met to the ovary and ppt w/ Wt lose, epigastric pain, adnexal masses == ?
Krukenber tumor.
gastric tumor that has mets to ovary
krukenberg tumor histo???
large amounts of mucin with apically displaced nuclei resulting in signet ring appearance.
lactate and malate inhibits ?
glucoNEOgenesis
Café-au-lait spots, lisch nodules, chr.17 ~ ?
Neurofibromatosis type 1 (NF-1)
MC eye-related comp. of congenital CMV infection?
chorioretinitis
All volatile anesthetics do what?
increase cerebral blood flow; d/t increase ICP
what drug does:
myocardial depression, hypotension, resp. depression, and decreased renal function/
inhalation anestheetics
Hemosideren-liden macrophages in palm alveoli –> ?
Left-sided heart failure.
“golden-colored”
Epicanthal folds
upslanting palpebral fissures,
protruding tongue
excessive skin at nape of nect.
Down syndrome
neonate with hypotonia and weak startled reflex (moro reflex)
down synd.
S3 gallop ~ ?
increased L. Ventricular filling rate during mid- diastole.
~w mitral regurg
thoracic aortic aneurysm ~w/ what infection?
3 syphilis. endarteritis obliterans
How do you Dx and Tx Mysathenia gravis?
Edrophonium for Dx.
Pyridostigmine for Tx
Tx Cholinesterase inhibitor poisoning?
Atropine
What are the two “holosystolic murmurs” ?
- Tricuspid regurg.
- VSD
amiodarone, sotalol, dofetilide are what?
Class 3 anti-arrhythmic drugs; K+ ch. blockers
Important for Central Venous Catheter? (5)
- proper hand hygiene
- full barrier precautions during insertion.
- Chlorhexidine skin disinfection
- Avoidance of femoral insertion site
- Removal of catheter when no longer needed.
