UWorld QBank Facts - 1st round Flashcards
What is the treatment for restless leg syndrome?
First line - remove causative factors (e.g. treat kidney disease or iron deficiency, no alcohol/caffeine, no glucocorticoids, lithium, SSRIs)
2nd line - Dopamine agonist (e.g. Pramipexoloe)
A patient presents with MI and following thrombolytic therapy develops decreased level of consciousness, assymetric pupils and irregular breathing. What is occuring?
Intracerebral hemorrhage
What is the mechanism and side effects of streptokinase?
Cleaves plasminogen –> plasmin –> cleaves fibrin
Plasminogen+streptokinase complex –> destroys fibrinogen and factors 5 and 7
Side effects: intracerebral hemorrhage
What effect does parvovirus infection have on adults?
Arthritis of PIP joints, metacarpal, knee and ankle joints
What is the most common elbow injury in children and how does it occur?
Radial head subluxation (nursemaid’s elbow) - annular ligament tears from radial head
occurs when hand is sharply pulled with forearm pronated and elbow extended
What is a 72 kD enzyme that is often detected in inflammatory cells and macrophages, but often not present in normal tissue?
COX2
What does infliximab bind to?
TNF-alpha, an intercellular signaling protein
What effect does inspiration have on lungs and heart?
decreased pressure in pleural space and lung interstitium –> Increased pulmonary vascular capacitance –> drop in venous inflow to left heart
What drugs are first line in isolated systolic hypertension (non-diabetic and diabetic)?
Non-DM: Thiazides or dihydropiridine calcium antagonists (e.g. Amlodipine, NIfedpine)
Diabetic: ACE-I or ARB
What are some key side effects of Amlodipine?
bilateral ankle swelling and flushing
What is the most common side effect of nitrates?
Headache
Can also get flushing
What is the most common form of carpal bone fracture, and what is the patient at risk of?
Scaphoid fracture - tenderness in anatomical snuff box
risk for avascular necrosis
What is Dupuytren’s contracture?
benign slowly progressive fibroproliferative disorder of palmar fascia
Nodules form on palm and fingers lose flexibility
What are the signs of Tardive dyskinesia?
Acute dystonia?
TD - involuntary face and tongue movements, grimacing and writhing
AD - develops abruptly 4hrs - days after receiving AP Tx –> Muscle spasms/stiffness, tongue protrusion/twist, forced upward gaze
What is the most common cause of spontaneous lobar hemorrhages (especially in elderly >60 y/o)?
Cerebral amyloid angiopathy - weakens many vessels -> prone to rupture
What drug in conjunction with statins increases the risk of myopathy?
Fibrates - Gemfibrozil
What is the problem with giving statins with bile acid binding resins?
decreased absorption of statin
dose drugs 4 hrs apart
What drug can decrease circulating levels of catecholamines?
Stimulation of central alpha2 adrenergic receptors (e.g. Clonidine)
What muscles does the musculocutaneous nerve innervate?
Sensory innervation of medial arm?
Major upper arm flexors: biceps, choricobrachialis, and brachialis and sensation of lateral arm/forearm
ulnar nerve (medial cutaneous nerve)
What is the MoA of Etanercept?
TNF-alpha inhibitor for moderate/severe RA
Check PPD before using!!
What is deposited in joints and tissues in pseudogout?
CALCIUM PYROPHOSPHATE (hence, CPPD, calcium pyrophosphate deposition disease)
Rhomboid crystals with weakly positive bifiringence
What is seen in mycoardial tissue 0-4 hrs after MI? What about 4-12 hrs after MI?
MINIMAL CHANGE - normal mycoardium
4+ hrs = Cytoplasmic hypereosinophilia (early sign of COAGULATIVE NECROSIS), edema + punctate hemorrhages
After a stroke a patients brain is examined in autopsy showing a cystic cavity surrounded by gliosis. What is the cause for this lesion?
Lysosomal digestion of tissue (released from ischemic neurons in the region)
What results in granulomatous reaction in an area of necrosis?
Mycobacterial infections –> Caseous necrosis
Cheesy area surrounded by histiocytes and multinucleated giant cells
A patient exhibits intense pain when trying to extend leg, especially at the hip. What could be the problem and what muscle is most likely affected?
+ psoas sign (psoas major muscle)
-possible psoas abcess
What is the appearance of monosodium urate crystals under polarized light?
long and negatively bifiringent
What condition usually leads to poor ventricular wall compliance?
Cor pulmonale - RV thickening with eventual dilation of RV chamber
What is the heart sound associated with Mitral Stenosis?
Mid-diastolic heart sound heard best at apex
What is a key feature on serum labs for hemolytic anemia?
Increased serum indirect BR and lactate dehydrogenase
decrease in serum haptoglobin
What is sickle cell dactylitis?
Swelling of hands and feet and pain (hand and foot syndrome)
From vasoocclusive crysis leading to small infarctions of marrow and trabeculae of small bone
What is a unique characteristic of Class 1C antiarrhythmics? For fun, give some examples of this drug class…
Use-Dependance - sodium blocking effects intensify with increasing heart rate, because less time between action potentials for meds to dissociate from receptor.
Flecainide, Propafenone
What is the order of sodium channel binding strength among class 1 antiarrhytmics greatest to least? And what are the low binding strength ARs useful for?
1C > 1A > 1B
C more likely to stay on –> use dependance
B more likely to come off –> good for ischemic induced ventricular arrhythmias
What is the drug of choice in beta-blocker overdose and why?
Glucagon –> increases cAMP in cardiac myocytes
What is the most likely deficient enzyme in SCID?
Adenosine deaminase
If you reduced the flow through a vessel by a factor of 16 (compared to the same normal, healthy vessel), how much would the radius be reduced by? (assume all other variables are consistent)
50% (halving the radius results in 1/16th of normal flow)
Which disease results from a t(15;17)? t(14;18)? inv(16)?
Acute Promyelocytic Leukemia (APL) - a subtype of AML
non-Hodgkin Follicular small cleaved cell lymphoma
M4Eo (eosinophilic) - subtype of AML
Which chromosomal translocations are found in burkitt lymphoma?
t(8;14), t(8;22), t(8;2)
What genetic mutation results in classic galactosemia and what is the inheritance pattern?
Autosomal Recessive mutation of galactose-1-phosphate-uridyl transferase gene
What sort of genetic mutation leads to Hemophilia B (+inheritance pattern)?
X-linked recessive Factor IX deficiency
as such, mostly males will be affected
What problem can arise when a pregnant woman lies supine on her back?
Compression of IVC –> hypotension
What are patients with multiple myeloma at great risk of developing?
- Normocytic anemia
- Bone resorption (from IL1 and IL6 by cancer cells) –> Hypercalcemia
- Increased susceptibility to infection
- AL amyloidosis
- Renal Failure
What are the proto-oncogenes? Anti-oncogenes?
ras, myc, ERB-B1/2, TGF-alpha, sis, abl
p53, BRCA, NF1, APC/beta-catenin, DCC, Rb, WT1
What is Fabry disease, and what are patients with it at greatest risk for developing?
Angiokeratoma corporis diffusum –> inherited def. of alpha-galactosidase A –> build up of ceramide trihexoside
Increased risk of Renal insufficiency –> Renal Failure
Which enzyme is deficient in Pompe’s disease? (hint: type II glycogen storage disease)
acid (lysosomal) alpha-glucosidase
Muscle hypotonia, feeding difficulties, hepatomegaly and severe cardiomegaly
What is Li-Fraumeni syndrome and how is it acquired?
Autosomal dominant mutation of p53 that leads to early cancer formation
-Be suspicious when there are multiple family members with various cancer types
What blocks peripheral conversion of T4 –> T3?
Propylthiouracil, beta blockers, ipodate (contrast agent)
Which muscles does the nerve passing through the obturator foramen innervate?
Obturator nerve –> Adductors of the leg
Which muscles are innervated by the femoral nerve?
Quadriceps femoris muscle group –> leg extension
Which bones are derivative of the first pharyngeal arch?
Second pharyngeal arch?
Assoc w/ CN V –> Maxilla, zygoma, mandible, vomer, palatine, incus, malleus
Assoc. w/ CN VII –> Styloid process, lesser horn of hyoid, stapes (hint closer into the ear like CN VIII)
What are the two major side effects of metformin use?
GI upset and lactic acidosis (contraindicated in renal failure!!)
Which drugs increase the risk of inducing mania in susceptible patients?
anti-depressants (previous unnoticed bipolar disorder etc.)
Which 3 drugs are mood-stabilizers often used in acute mania and maintenance of bipolar disorder?
Carbamazepine, Lithium, and Valproate
What are the effects of Prostacyclin and what diseases is it used in synthetic form?
Inhibits platelet aggregation and adhesion to vascular endothelium, vasodilates, increases vascular permeability, and stimulates leukocyte chemotaxis
Tx for: Pulmonary hypertension, peripheral vascular disease, and Raynaud Syndrome
What are some alpha1 agonists and what effect would they have on the vagal influence on the heart?
Phenylephrine and Methoxamine
causes vasoconstriction and increase systemic BP –> stimulates baroreceptors in carotid sinus and aortic arch –> reflex increase on vagal influence on heart –> inhibit SA node activity –> slowed conduction through AV node –> decreased HR, contractility and conductance
Which amino acids are exclusively ketogenic? (hint: would not lead to increased lactic acid)
Leucine and Lycine
What happens when there is a deficiency of pyruvate dehydrogenase?
increased conversion of pyruvate into lactate via lactic acidosis
What is the difference between a gastric ulcer and erosion?
Ulcer extends into submucosa and muscularis propria
Erosions may extend into but not past muscularis mucosa
How do you calculate number needed to treat?
NNT = 1/ARR
ARR = Control rate - Treatment Rate
How do you calculate number needed to harm?
NNH = 1 / AR
Attributable Risk = Difference in risk between exposed and unexposed groups
What happens to the hemoglobin concentration in RBCs in hereditary spherocytosis?
INCREASED
Which enzyme allows for fructose to still be utilized even with fructokinase deficiency?
HExokinase
What is the purpose the enzyme aldose reductase?
Converts glucose –> sorbitol
Which immune deficiency is likely to present with absent thymic shadow? What are other characteristics of this disease?
SCID -> DEF. of T Cells!!
Severe bacterial and viral infections in infancy, chronic diarrhea, and mucocutaneous candidiasis
What is deficient in Alkaptonuria and what is the presentation in later adulthood?
AR def. of homogenistic acid oxidase –> accumulation of homogenistic acid throughout connective tissue
Apparent in sclera and ear cartilage
What structure lies between the external and internal iliac arteries in the female pelvis?
Ureter
What cofactor is necessary in the conversion of glutamate to aspartate, with oxaloacetate as a substrate in the reaction as well?
Pyridoxine (V. B6)
What is the purpose of NF-kB?
transcription factor responsible for cytokine production
What allows for valve colonization in bacterial endocarditis with S. Aureus? How does damage get propagated?
Minor endothelial disruption/damage
Tissue factor expression –> platelet and fibrin deposition –> Valve vegetation
What are the signs of hyperaldosteronism (as with Conn’s Syndrome)? What is the treatment?
Hypertension, hypokalemia, Metabolic alkalosis, decreased plasma renin activity
Tx: Aldosterone antagonist (Spironolactone, Eplerenone)
Which hepatitis virus results in high mortality among pregnant women?
Hep E –> NON-enveloped single stranded RNA virus
What acid/base abnormality results with pulmonary embolism?
V/Q Mismatch –> Respiratory alkalosis
Hypoxemia stimulates respiratory drive
A child presents with many blast cells what is the most likely diagnosis?
ALL
How might a child with pre-T lineage ALL present?
Anterior mediastinal mass –> SVC Syndrome + dysphagia + dyspnea + inspiratory stridor
What are the features of SVC syndrome?
Neck and upper extremity edema (with increased JVD)
Check for facial plethora (blanching after finger tip pressure)
How can you diagnose thiamine deficiency in an alcoholic?
Increase in erythrocyte transketolase activity after thiamine infusion
What is the first line treatment for essential tremor?
Propranolol
What is the purpose of Benztropine?`
Anti-cholinergic used to treat tremor in Parkinson’s and to counteract extra-pyramidal side effects of neuroleptics like Haloperidol
What is the most common cancer in non-smokers? (hint: usually on periphery of lung)
Smokers? (usually central)
Adenocarcinoma
Squamous Cell Carcinoma
What decreases risk of non-hereditary ovarian cancer?
OCPs, multiparity, and breast feeding
What is moxifloxacin used to treat?
bacterial infections that cause exacerbation of COPD, sinusitis and community acquired pneumonia
not good for Pseudomonas infections
What drugs have good coverage against pseudomonas infections (like after a burn surgery)?
Cephalosporins - e.g. Cefepime and Ceftazidime
What effects does high concentrations of fructose-2,6-BP have on metabolism?
inhibits gluconeogenesis and increases glycolysis
e.g. decreased conversion of alanine –> glucose
What deficiency leads to methylmalonic acidemia?
deficient in ISOMERIZATION of methylmalonyl CoA –> Succinyl CoA –> TCA
What are some key signs of hypothyroidisim?
weight gain, dry skin, hair loss, constipation and bradycardia
What are key side effects of Lithium toxicity?
LMNOP - Lithium causes
Movement (tremor), Nephrogenic diabetes insipidus, hypOthyroidism, Pregnancy problems (ebstein’s anomaly)
What is a major pathophysiological abnormality with chronic NSAID use (like in patients with joint pain)?
Chronic interstitial nephritis
- Decreased prostaglandins –> constriction of medullary vasa recta –> ischemia –> papillary necrosis
- uncoupled oxidative phosphorylation in renal mitochondria –> direct cell damage
Nitric Oxide (NO) leads to vasodilation, but how is it formed?
Arginine, NADPH, O2 via endothelial NO synthase (eNOS) –> NO –> INcreased cGMP
What effect does hypophosphorylated Rb have on the cell?
prevention of G1/S transition in cell cycle
What is characteristic of anesthetics that have large arteriovenous gradients?
Slow onset of action and high tissue solubility
What is the most common cause of death in patients with TCA overdose? How can you prevent?
refractory hypotension and cardiac arrhythmia from inhibition of fast sodium ion channels in cardiac myocytes (His-Purkinje system)
Tx: Fluid resuscitation with normal saline and hypertonic sodium bicarbonate
What is the best way to prevent cerebral vasospasm in patients with SAH following berry aneurysm rupture?
Ca-channel blockers (nifedipine)
What neurological abnormality is associated with Adult PCKD?
Berry aneurysm
What potentially dangerous complication can result from Type 1 hyperlipoproteinemia (familial chylomicronemia syndrome)?
Acute pancreatitis (and hepatosplenomegaly can occur)
Name 3 non neuropsych drugs that can lead to serotonin syndrome:
- Linezolid (antibiotic)
- Tramadol (analgesic)
- Ondansetron (anti-emetic, 5-Ht3-R antagonist)
Which heritable disease would increase both bleeding time and PTT and why?
vonWillebrand’s Disease
Because vWF is a mediator of platelet adhesion to endothelium and also a carrier protein for Factor VIII –> absence would cause a platelet deficiency and absence of functional factor VIII
What is the control group in a case-control study?
all people WITHOUT disease who may or may not have been exposed to the risk factor in question
What family is CMV a part of and what is a unique common histological presentation for it?
Herpesviridae - double stranded enveloped DNA virus
Owl-Eye nuclei on histology
What is a patient with acute necrotizing pancreatitis at major risk for developing? What would be seen on autopsy of involved organs?
ARDS - Alveolar hyaline membranes
DIC - Microthrombi
diffuse fat necrosis - Saponification and calcium deposits long term
Pancreatic pseudocyst - lined by granulation tissue –> can rupture easily and hemorrhage
What is a child with polyribitol ribose phosphate (PRP) antibodies protected from?
Epiglottitis which is almost exclusively caused by H. Flu
The PRP-Ab is a component of the Hib Vaccine
What is fever, rash and oliguria 1-3 weeks after treatment with beta-lactam antibiotic highly suggestive of? What else can cause this?
Drug induced acute interstitial nephritis - damages interstitium leaving glomeruli intact
NSAIDs, Sulfonamides, rifampin, and diuretics
What do you give a patient with depression who is not tolerating SSRIs well?
Bupropion - atypical antidepressant
MAOIs and TCAs are last resort
What amino acid is an immediate source of nitrogen for the Urea cycle?
Aspartate
What is the significance of glutamine in the blood?
Transports ammonia from peripheral tissues to the kidney
Vitamin B12 deficiency results in build up of which compound in the blood?
Methylmalonic acid
What is the pathogenesis leading to pure red cell aplasia? What disorders may it be associated with?
inhibition of erythropoietic precursors/progenitors by IgG antibodies or cytotoxic T-lymphocytes
- Associated with Thymomas and lymphocytic leukemias
- Could be from parvovirus B19 infection
What deficiency are patients with sickle cell disease prone to developing and why?
Folic Acid deficiency –> Megaloblastic anemia
Because of the high turn-over of cells (same is the case with other hemolytic anemias)
NF1 leads to pigmented spots and rubbery cutaneous tumors, what is the origin of these tumors?
Schwann Cells
What is the MoA of Leuprolide?
long-acting GnRH agonist –> causes continuous GnRH activity
Which purine analog is resistant to degradation by adenosine deaminase and what is it used to treat?
Cladribine - Tx for Hairy Cell Leukemia
What is a common treatment for painful diabetic neuropathy? And what are the common receptors affected by these drugs?
TCA like amitriptyline
Inhibit 5HT and NE uptake - Tremor, insomnia
Blocks cardiac fast sodium channels - conduction defects, hypotension, arrhythmia
Muscarinic Ach-R antagonism - Urinary retention, flushing, ileus, dilated pupils,
Alpha1 antagonism- periph. vasodilation, orthostatic hypotension
H1 antagonism - Sedation
What effect would Tamoxifen have on bone? What is a main side effect?
Partial estrogen antagonism –> increase in bone mineral density
Endometrial hyperplasia –> polyps etc.
What is the primary MoA of digoxin?
INhibits sodium potassium ATPase –> intracellular Na buildup –> decreased fxn of Na/Ca exchanger –> Calcium buildup in cardiac myocytes
Acts on vagus nerve –> increase PANS tone –> decreased rate of AV node conduction
What is the earliest lesion that leads to atherosclerotic plaque and could result in a AAA for example?
Intimal streak
What can occur from the release of IL6 into systemic circulation?
Release of Acute Phase Reactants, like fibrinogen which will increase ESR by causing RBCs to form Rouleaux
What are the most common clinical manifestations of Vit. E deficiency?
Neuromuscular disease (skeletal myopathy, spinocerebellar ataxia, pigmented retinopathy)
Hemolytic anemia
What is the benefit of a slowly growing atherosclerotic plaque?
Development of vascular collaterals which may keep region perfused in the event of an MI
What is the primary MoA of diphenoxylate and what is this drug structurally related to?
This is an opiate anti-diarrheal similar structurally to meperidine, and it primarily affects MOTILITY
Which drugs inhibit secretory diarrhea?
Bismuth subsalicylate, probiotics and octreotide
What is one of the main side effects of highly active antiretroviral therapy (HAART)?
HIV-associated lipodystrophy: Redistribution of fat from extremities to trunk
- Lipoatrophy - from face, extremities and buttocks
- Central fat deposition - increased abdominal girth and buffalo hump
What is a common side effect of thyroperoxidase inhibitors (methimazole, propylthiouracil)?
Bone marrow suppression (anemia and agranulocytosis)
What is the effect of cholinomimetics on bladder wall? What is its effect on blood vessels?
Increase tone of detrusor stimulating contraction –> makes you pee
Stimulates release of endothelium-derived relaxing factor (Nitric Oxide)
Which antibiotic used to treat MRSA causes increased serum creatine kinase and severe muscle pain? What is its MoA?
Daptomycin - causes depolarization of the cellular membrane
Which nitrate has the greatest oral bioavailability?
Isosorbide mononitrate
What is severe hypoxic CNS injury almost always followed by?
Liquefactive necrosis –> associated with large amounts of lipids and lysosomal enzymes in the area
Acid-fast bacterial infection in HIV infected person with CD count
Mycobacterium avium complex (MAC)
Tx: Azithromycin
What is the indication for using MAOIs?
Atypical depression and treatment resistant depression
Atypical depression includes - mood reactivity, rejection sensitivity, increased sleep and appetite
Which drug used for the treatment of claudication is also known to have direct arterial vasodilatory effects? What type of tx would it be good for?
Cilostazol - a phosphodiesterase inhibitor
Claudication and decreased sexual function
Which is the MoA of Timolol?
Along with other beta blockers it decreases the aqueous humor production by ciliary epithelium
Which compounds mediate Cachexia?
TNF-alpha, IFN-gamma, IL1 and IL6
