Uworld Test 1 Flashcards
What is damaged in acute respiratory distress syndrome?
pneumocytes and endothelial cells
presentation of ARDS?
bilateral pulmonary edema and hypoxemia in absence of heart failure/fluid overload
pathophys of ARDS?
pulmonary contusions/fat embolus from trauma -> injury t pneumocytes and endothelium -> cytokines and neutrophils migration -> increased permeability, diminished surfactant production, protein-rich fluid and necrotic debris -> respiratory failure
what will the glomeruli look like in rapidly progressive glomerular nephritis?
they will have crescents
what does diabetic nephropathy look like (what will the glomeruli look like?)
mesangial expansion, GBM thickening, and glomerular sclerosis
May have kimmelstiel-Wilson lesions
what is the speed of conduction of the AV node and where is it located?
0.05m/s - slowest part of the system
Found near tricuspid valve along the interatrial septum
what is the fastest part of the hearts conduction system?
bundle of his/left right bundle branches, with a speed of 2.2 m/s
patients with pagets disease have an increased risk for which type of cancer?
osteosarcoma
what are the radiographic findings of osteosarcoma?
Codmans triangle (lifting of the periosteum) Destruction of normal trabecular bone Mixed sclerotic and lytic areas Sunburts patten (calcification of adjacent soft tissue)
What is a globus sensation of the esophagus?
Abnormal feeling of tightness, foreign body or fullness in the throat. Worse when swallowing, may be alleviated by eating/drinking. No structural abnormality.
Medical treatment of endometriosis?
NSAIDs and OCP
laprascopy if needed
what is osteltamivir?
Tamiflu - inhibits neuraminodsae of influenza A and B
ribavirin MOA
inhibits viral RNA polymerase
What does DNA laddering on electrophoresis indicate?
apoptosis (cell is being chopped up into even sized peices of 180bases)
how does atropine effect smooth muscle?
It causes relaxation - it competitively inhibits Ach from binding the M3 receptor
is atropine cholinergic or anticholinergic?
anticholinergic
how does anticholinergic toxicity present?
hot as a hare - hot from decreased sweating
dry as a bone - decreased gland secretions
red as a beat - vasodilation to dissipate heat
blind as a bat - paralysis of ciliary muscles
mad as a hatter - affects CNS - permeates BBB
full as a flask - decreased bladder activity
fast as a fiddle - tachycardia from decreased vagal tone
name a cytokine that is only produced by lymphocytes?
IL-2
what is the function of interleukin-2?
stimulates growth and differentiation of B cells, T cells and NK cells and macrophages
what virus causes molluscum contagiosum?
poxvirus
what will be seen on histo of molluscum contagiosum?
molluscum bodies - large eosinophilic cytoplasmic inclusion bodies
what is a common infection after C section?
post-partum endometritis - caused by Gardnella vaginalis, pepto, bacteriodes, staph or group B strep)
which area becomes engorged with blood during an erection?
corpus cavernosum
which substances released from the pancreas vary with flow rate and which are constant?
Na and K - constant
Bicarb and Cl - vary with flow rate (bicarb increases with flow rate and Cl decreases)
how long must a patient have symptoms to be diagnosed with PTSD?
1 month
what is the duration of acute stress disorder?
3 days to 1 month
how long does schizophreniform symptoms last?
1 to 6 months (any longer is schizophrenia)
treatment of herpes encephalitis?
IV acyclovir
brain imaging findings of herpes encephalitis?
hemorrhage or edema of temporal lobe
what is the most common cause of sporadic encephalitis
HSV 1
what causes myasthenia gravis?
antibodies against Ach receptor
lambert eaton sydrome is associated with what cancer?
small cell lung cancer
hyperplasia of the thymus and thymoma is commonly seen in which patients ?
those with myasthenia gravis
What is the RB1 gene?
retinoblastoma - tumor suppressor gene
what is hereditary retinoblastoma?
these patients are born with one mutated form of RB1, and thus they require only 1 additional hit for malignant transformation
what is the pathophys behind digeorge syndrome?
Chromosome 22q11.2 deletion->defective development of pharyngeal pouches
how does digeorge syndrome present?
Cardiac abnormalities Abnormal facies Thymic hypoplasia (t cell deficiency) Craniofacial deformities (cleft palate) Hypocalicemia/hypoPTH
serum levels of K and Na in diabetic ketoacidosis?
high and low, respectively (although TOTAL body K is low)
how does 5 alpha reductase deficiency present?
ambiguous genitalia in newborn
how does complete androgen insensitivity syndrome (defective androgen receptor) present?
XY males with a female phenotype - breasts will develop and vagina will be present, but testes will remain and secrete high levels of testosterone. No uterus/ovaries because anti-mullerian hormone was present.
what is a cephalohematoma?
a rupture of subperiosteal blood vessels that can occur after traumatic birth (suction, forceps) and presents as a scalp swelling that does not cross suture lines
when does the germinal matrix start to disappear?
28 weeks and will completely involute by term (this is why premature babies are at risk for intraventricular hemorrahage)
name 3 drugs that may cause interstitial lunge disease?
amiodarone, bleomycin, methotrexate
what effect do prostaglandins have on acid secretion in the stomach?
Prostaglandin E inhibits cAMP which normally causes more acid secretion, thus they DECREASE H in the stomach
MOA of misoprostal?
prostaglandin E analog -> inhibits cAMP and thus decreases acid secretion
do H2 (histamine receptors) increase or decrease acid in the stomach?
INCREASE via increased cAMP
what effect does somatostatin have on H secretion?
DECREASES via inhibiting cAMP
what effect does Ach and gastrin have on H secretion. inthe stomach?
increase, via IP3/Ca
intercellular bridging and keratin pearls (central keratinization with concentric layers of squamous cells) are characteristic of which cancer?
squamous cell carcinoma
pseudohypoparathyroidism is a group of disorder characterized by…
end-organ PTH resistance
what is familial hypocalciuric hypercalcemia caused by?
autosomal dominant ca sensing abnormalities
what is albright hereditary osteodystrophy?
AD form of pseudohypoparathyroidism that also has skeletal defects
what gene is defective in albright hereditary osteodystrophy?
GNAS1
B-thalasemia can be caused by different mutations in the same gene locus. This is an example of. ..
allelic heterogeneitity
what is hemochromatosis?
autosomal recessive disease characterized by excessive Fe absorption
how is the excess iron in hemochromatosis stored?
its stored as hemosiderin in dermal tissue and organs
what may be seen in the hand of a patient with achondroplasia?
trident hand (space between third and fourth fingers)
what is bruton agammaglobulinemia?
defect in brutons tyrosine kinase (intracellular cell signalling) that is important for B cell maturation.
Dysfunction results in a lack of B cells in the blood and recurent infection -> recurrent infections
how is brutons agammaglobulinemia inherited?
on the X chromosome
what is the cofactor of alpha-ketoacid dehydrogenase?
Thiamine (B1)
what causes arterial pulmonary hypertension?
hereditary BMPR2 mutation
what changes will occur in the blood vessels of someone with arterial pulmonary hypertension?
thickening of SM in medial layer and hyperplasia of intimal layer of small arteries and arterioles
Progressive fibrosis -> onion skin
what is the function of acyl-coa dehydrogenase?
its the enzyme that catalyzes the first step of beta oxidation, which is the process that breaksdown fatty acids
how does acyl-coa dehydrogenase deficiency present?
presentation in the first few years of life with hypoketotic hypoglycemia, nausea/vomiting, seizure, liver dysfunction, sudden death
how are some mRNAs necessary for apoptosis still tranlsated when mRNAs are being ubiquidinated?
via internal ribosome entry - proteins needed for apoptosis are translated starting at the internal ribosome entry site (in the middle of the mRNA)
how do azole antifungals effect CYP450s?
they inhibit them leading to higher concentrations of other drugs
what molecule is responisble for neurologic symptoms in hepatic encephalopathy?
NH3+
how can lactulose be used to treat hepatic encephalopathy?
lactulose is degraded by colonic bacteria to form lactic acid and acetic acid, acidifying the gut and thus converting NH3 to NH4 for excretion. More NH3 will then move into the gut
how does TMP-SMX effect CYP450s?
inhibits them
MOA of beta 2 agonists
binding of beta 2 adrenergic receptor -> Gs activation -> increased cAMP - > activation of PKA ->lower intracellular Ca and inhibition of myosin phosphorylation -> bronchodilation
With osteomalacia, there is decreased mineralization of ….
osteoid
what gene is mutated in li-fraumeni syndrome?
TP53
which nerve supplies the cricothyroid?
superior laryngeal
what nerves innervate all of hte internal laryngeal muscles exclduing the cricothyroid?
recurrent laryngeal nerves
what is the only DNA virus group to replicate in the cytoplasm?
poxvirus
what is the histopathology of hashimotos thyroidits?
Hurthle cells
Diffuse lymphocytic infiltration and lymphoid germinal centers
what will be heard on ausculation of someone with an ASD?
S2 - widely split S2, as the right ventricle will be fluid overloaded
What causes achalasia?
degeneration of inhibitory ganglion cells in esophageal wall
are the postganglionic autonomic nerves myelinated or unmyelinated?
UNmyelinated (unusual for efferent nerves)
what type of viruses are the picornoviradea?
+ ss RNA
what viruses make up the picornoviradae family?
enterovirus coxsackie viruses echovirus poliovirus hepatovirus (hep A) rhinovirus
what type of virus’s are calicivirus?
+ ss RNA
pagophobia (a craving for ice) is specific for what..
iron deficiency anemia
dry mouth, decreased taste and alopecia may occur with what type of anemia?
iron-deficiency anemia
prader-will cause?
LOSS of paternal allele -> maternal uniparental disomy
what cancer marker is increased with epithelial ovarian cancer?
CA-125
which types of antibiotics bind to the 30s subunit?
tetracylcines and aminoglycosides
pilocarpine MOA
direct cholinergic muscarinic agonist
which hormone is increased in patients with pernicious anemia?
Gastrin
Pernicious anemia leads to gastric atrophy and hypochloridia, leading to an increase in gastrin secretion
MOA of leuprolide
GnRH agonist - will decrease LH release and thus testosterone (useful in prostate cancer)
absence of the CD40 ligand is diagnostic for which syndrome?
hyperigM syndrome
pathophys of hyperigM syndrome
lack of CD40L means that class switching of antibodies cannot occur. Excess of igM and deficiency of igA, igG and IgE. X linked recessive.
which enzyme is deficiency in Gaucher disease?
Beta-glucocerebroosidase
Presentation of gaucher disease
Hepatosplenomegaly, pancytopenia (cells accumulate in spleen and spleen breaks down cells faster than they are produced -> pancytopenia), bone pain/osteopenia (lipid accumulation triggers lytic enzymes)
what will be seen on EM of someone with gaucher disease?
‘wrinkled tissue paper’ Gaucher cells
- from accumulation of beta-glucocerebrosidase in lysosoes
name two anti- TNF alpha drugs
infliximab, etanercerpt
which enzyme does aspirin inhibit?
COX 1 and COX 2 -irreversibly
what is the name of the process by which bacteria take up naked DNA from the environment?
transformation
which nephrotic syndrome is associated with HIV, heroin addiction and sickle cell disease?
focal segmental glomerulonephritis
what is hand-foot-genital syndrome?
Autosomal dominant syndrome with HOXA13 mutation that results in malformations in the hands and feet and Mullerian fusion abnormalities
PAX6 is the key regulator for the development of what?
eye and brain
anion gap formula?
sodium - (Cl and bicarb)
normal anion gap?
10-14
ethylene glycol overdose presentation
anion gap metabolic acidosis, flank pain, gross hematuria and oliguria
ethylene glycol (metabolite glycolate) causes toxicity to which organ?
kidney -> acute tubular necrosis
the mediastinum, lungs and esophagus drain to which lymph node(s)?
right supraclavicular
