Uworld Review Flashcards
Chronic abdominal pain that is postprandial and accompanied by weight loss in a patient with a history of atherosclerosis is highly suspicious for
Findings also show one shrunken, atrophic kidney, and the other being enlarged and HTN indicates
Intestinal ischemia
Renal artery stenosis- other kidney compensates and becomes enlarged while the stenotic one becomes atrophied.
Differentiating between tuberculoid and lepromatous leprosy with the lepromin skin test (like a PPD test)
MOA of each type
Tuberculoid will have an indurated response to the intradermal injection due to the activity of TH1 response. Well defined, few hypopigmented lesions with diminished sensation
Lepromatous leprosy will not have a reaction due to a weak TH1 response. This type is usually due to TH2 response and is a more widespread infection with poorly demarcated plaques and development of leonine facies
Acute cholecystitis is caused by ______ in more than 90% of cases
How will this appear on US and cholescintigraphy?
Obstruction with a gallstone of the cystic duct
gallbladder wall thickening, pericholecystic fluid and positive sonography Murphy sign. Presence of gallstones alone is not diagnostic!
*Gallbladder will not be able to be visualized with the radiotracer dye due to obstruction
Tumors cells develop resistance via ______gene; whose product is a ______
Where else in the body is this protein product found?
MDR1 gene- produces a P-glycoprotein (normally in intestinal and renal epithelium to eliminate foreign compounds, and on the BBB) that is a TM proteins functioning as an ATP-dependent efflux pump
Normal cardiac pressure readings in the chambers of the heart, PA and aorta are?
Systolic atrial pressure= diastolic ventricular pressure since valves are open
Increased by contraction- higher Systolic ventricle pressure=respective valve systolic pressure
Atria only have diastolic pressures*
RA= 5 so RV= 25/5 so PA= 25/10
PCWP estimates LA= 10-12 so LV=130/10 and aorta =130/90
Which diuretic would most likely improve survival in a patient with acute decompensated HF with decreased EF
Spironolactone- block the deleterious effect of aldosterone on the heart as well, which typically causes regression of myocardial fibrosis and improvement in ventricular remodeling
Usually given in addition to standard ACE-i and beta blockers
Pathogenesis of diverticulosis (false diverticula) involves what term
What is the term for inflammation and subsequent scarring of the gut wall creating diverticula
Pulsion- an increased intraluminal pressure created during strained bowel movements
Traction- results in pulling and out pouching of all gut wall layers- true
BH4 is a cofactor in synthesis of what 3 products?
—>Tyrosine—->DOPA
Tryptophan—5HT
________ us a metalloprotease that cleaves and inactivated endogenous peptides including natriuretic peptides, glucagon, oxytocin and bradykinin
Used pharmacologically?
Neprilysin
Sacubitril- inhibit this metalloprotease to increase levels of endogenous natriuretic peptides in HF
5 medication classes that are associated with osteoporosis fractures:
Anticonvulsants that induce P450 (phenobarbital, phenytoin, CM)- increase vit D catabolism
Aroma tase inhibitor/medroxyprogesterone- decrease estrogen
GnRH agonist- decrease estrogen and testosterone
PPI- decrease calcium absorption
Glucorticoids- decrease bone formation
Carbidopa is added to levodopa to:
What AE is likely to remain or worsen after addition of carbidopa?
Decrease the peripheral conversion of levodopa- increases DA in CNS
Anxiety and agitation- central effects of DA (others: insomnia, confusion, hallucinations, behavior changes)
*DA stimulating nausea/vomitting in the emetic center of the brainstem which is located OUTSIDE the BBB, so DA decarboxylase inhibitors help with this AE
Difference in symptom presentations of vWF deficiency and VIII deficiency
VWF- bleeding from skin and mucosal sites: gingiva, nasal mucosa, endometrium, GI
VIII- deeper tissue bleeding, joints and muscles, hematuria, GI
Organism that contaminates food and can cause differing presentations in three likely populations of patients
Immunocompromised- invasive infection; meningoencephalitis, sepsis
Pregnant women- flu-like diarrhea, vomiting, muscle aches. Causes preterm labor and newborn has generalized skin rash (or sepsis)
Listeria
Stroke affecting the _______ artery, results in vertigo/nystagmus from vestibular nucleus damage, ipsilateral cerebellar signs from inferior cerebellar peduncle damage, loss of pain/temp sensation in ipsilateral face and contralateral body (spinal trigeminal nucleus and spinothalamic tract), and dysphagia due to bulbar weakness of nucleus ambiguous damage, and descending sympathetic fibers damage causing Horner’s
PICA- lateral medullary syndrome (Wallenburg)
PICA is a branch of the vertebral artery
An untreated small prolactinoma that is causing elevated prolactin and secondary amenorrhea is at risk for developing ______
MOA?
Decreased bone density- low estrogen levels leads to increased production of inflammatory cytokines, especially IL-1 an TNF-alpha, increasing the expression of RANKL and resulting increased osteoclasts activity
LPL is normally bound to ______ on vascular endothelium, allowing it to interact with chylomicrons and VLDL to ______
A deficiency of LPL will have elevated:
Likely clinical outcomes if untreated are:
Heparin sulfate (heparin admin releases these lipases allowing LPL to be measured in serum)
Release FFA into adjacent tissues
Chylomicrons and TG- causing acute pancreatitis, milky-appearing vasculature and eruptive xanthomas (extensor surfaces surrounded by erythema)
______ deficiency is likely to cause tendon xanthomas, xanthelasmas (eyelid deposits), and early MI
LDL receptor or B100 deficiency
A low frequency, diastolic heart sound is heart shortly after S2 is _________
Best heart with patient in what position and doing what
Best heard where on the chest?
S3 heart sound
LLdecubitus and at end expiration (decreasing lung volume and bringing the heart closer to the chest wall)- listening over the cardiac apex
Cryptococcus neoformans can be found in what two morphologies?
Yeast with a thick polysaccharide capsules
Round cells with narrow based budding yeast
______ is the tendency of study subjects to change their behavior as a result of their awareness that they are being studied
_____ is selection bias by choosing hospitalized patients as the control group
____ is the effect of when a researcher’s beliefs in the efficacy of treatment can potentially affect the outcome
Hawthorne’s effect (observer effect)
Berkson’s bias (selection bias)
Pygmalion effect
The venous components of internal hemorrhoids drain into the ________, which is ligated to cut the blood supply to the hemorrhoid, causing them to degenerate
External hemorrhoids drain via _____
Supervisor rectal vein- branch of the inferior mesenteric vein
Via inferior rectal vein into the internal pudendal vein
The most common indicator of obesity-related disease is a reduction in ________
Expiration reserve volume
Reduction in chest wall compliance due to increase weight and a reduction in lung compliance due to microatelectasis, results in a restrictive lung disease panel
TSH receptor is also present on ______, which is why Grave’s opthalmopathy is caused by stimulation of orbital ______, leading to excess deposition of extracellular GAGs, accompanied by a massive _______, which expands the extraocular muscles and retro-orbital tissues more
Treatment for Grave’s opthalmopathy?
Fibroblasts! (Also on adipocytes and other cell types)
Stimulates orbital fibroblasts by thyrotoxicosis receptor ABs
Accompanied by a massive T cell activation and inflammatory infiltrate
Glucorcorticoids- reduces the inflammation (they also decrease peripheral conversion of T4–>T3
_____ is a 5HT1a receptor agonist for GAD. It does not cause sedation, addiction or tolerance. It takes 1-2 weeks to take effect, so cannot be used for acute anxiety.
Buspirone
Patient with recurrent pulmonary infections, unsteady gait and discoordination of eye movements when looking at moving objects, and numerous superificial blanching nests of distended capillaries on sun exposed skin likely a mutation in what?
ATM gene—> failure to detect dna damage and failure to half progression of the cell cycle
Ataxia-telangiectasia- Ataxia, Angiomas, igA deficiency, high AFP
Immunocompromised Patient with neutropenia is most likely susceptible to ______
Patient presents with sepsis and multiple dark skin patches with necrotic centers and occasional ulcerations, normal platelet count/PT/PTT likely has _____. What are the four important virulence factors?
How does this infection presentation differ from necrotizing fasciitis?
Gram negative sepsis
Ecthyma gangrenosum- strongly associated with P aeroginosa bacteremia* (Dalmatian on sketchy spots)
Exotoxins A- EF-2 ADP ribosylation
Endotoxin- fever, shock
Phospholipase C- degrades cell membranes
Pyocyanin pigment
Presents with a single site of infection with erythema, edema, pain out of proportion to PE, then progresses to pruritic discoloration, bullae, sensory loss due to necrosis
in diabetic ketoacidosis, one enzyme is responsible for the generation of FFA and ketones to be utilized for energy needs
Will appear as a normal fasting serum glucose during starvation and positive urine ketones
Hormone sensitive lipase- found in adipose tissue to break down TGs into FFA and glycerol, providing substrates for ketone production and GNG, respectively.
> 90% of Viral causes of meningitis is by what pathogen?
Enterovirus (Coxsackie, poliovirus, and echovirus)
Negative gram stain and sterile culture aseptic meningitis
Diphtheria acquires its virulence factor via ________, allowing it to produce pseudomembranous pharyngitis
Strep pneumo acquire the ability to produce capsules via
E.coli acquire the ability to form pili via _____
Environmental influences permitting the toxin synthesis occurs in :
Phage conversion of Tox gene, encodes for exotoxin AB
Transformation (bacteria bind and import short pieces naked DNA from prior bacterial cell lysis)
Bacterial conjugation (direct transfer of plasmids via sex pilus)
Spore forming organisms
Patient with cirrhosis presents with vomiting bright red blood and subsequently develops hepatic encephalopathy. What is the precipitating factor for the encephalopathy?
GI bleeds cause increased nitrogen delivery to the gut in the form of Hb, which is converted to ammonia and absorbed into the blood
High molecular weight, high plasma protein binding, and high charge and hydrophilicity tend to have low ______
Vd (3-5L)
These characteristics trap the drug in the plasma compartment
What occurs if on observation the cell body of the neuron is enlarged, there is an eccentric nucleus, enlargement of the nucleolus and dispersion of Nissl?
Neuronal atrophy will appear as
Axonal reaction from loss of axon
Loss of neurons and reactive gliosis
_______ is a SERM used in treatment of estrogen positive breast cancer. It is a prodrug that is metabolized by ______ to its active metabolite
Tamoxifen- metabolized by CYP2D to endoxifen
Patients with mutations in the CYP2D are exposed to decreased active substance and have a higher risk of disease relapse
______ is a cell membrane protein that drives efflux of a number of substance out of the cell. It is the primary mechanism by which tumor cells cause multi drug resistance
P-glycoprotein
