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Esther's Step 1 UWorld Tests > UWorld Test 5/14/2014 > Flashcards

UWorld Test 5/14/2014 Flashcards

1
Q

How does silicosis affect immunity. More susceptible to?

A

Affects macrophage effector arm of cell mediated immunity. Internalized silica particles disrupt macrophage phagolysosomes and therefore macrophage killing of intracellular mycobacteria may be impaired. Increased susceptbility, therefore to TB

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2
Q

Compared to epinpehrine, NE is more selective for?

A

NE more selective for alpha 1 receptors

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3
Q

What is dobutamine

A

Sympathomimetic. Beta1 receptor > beta2, and alpha receptor

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4
Q

What are signs of anaphylactic shock?

A

1) Hypotension = collapse of peripheral vascular resistance, leakage of capilary fluid, increases in vascular permeability 2) Dyspnea = smooth muscle stimulation in bronchial wall with increased secretions 3) Skin symptoms like angioedema, urticaria may occur secondary to vasodilation and increased vascular permeability of skin capillaries. Increases in GI smooth muscle tone may lead to diarrhea, cramping, etc. 3) tachycardia

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5
Q

Drug of choice for anaphylatic shock?

A

Epinephrine = alpha 1 stimulation leads to vasoconstriction => counteracts the effects of vasodilation, and increase BP 2) beta 1 stimulation leads to increased contractility and B2 stimulation leads to bronchodilation

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6
Q

Thyroid hormone receptors are located in?

A

In the nucleus

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7
Q

Receptors for steroid hormones are typically located in?

A

Initially present in Cytoplasm and then moves to nucleus once activated.

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8
Q

Which monosaccharide - 1 - phosphate has the highest rate of metabolism in glycolysis?

A

Fructose 1 phosphate. Fructose is phosphorylated in the liver and F-1-phosphate enters after the RLS of PFK-1 wherease the other monosacchardies such as Glucose 6 phosphate, glucose 1 phosphate, galactose 1 phosphate, mannose 1 phosphate enter before the RLS.

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9
Q

Signs of staphylococcus scalded skin syndrome? Caused by?

A

Epidermal necrolysis, nikolsky sign (skin slipping with pressure), fever and pain a/w rash. Exfoliative toxin shows pathology specific to epidermis.

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10
Q

In the ascent of a horse-shoe kidney, what does it get stuck under?

A

Inferior mesenteric artery

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11
Q

What is the agent of choice in hypertensive emergency?

A

Nitroprusside

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12
Q

Nitroprusside Toxicity? Antidote?

A

Nitroprusside is metabolized to cyanide and and nitric oxide. Cyanide is converted to thiocyanate by liver rhodonase that attaches sulfur to cyanide to make it thiocyanate. Treat cyanide toxicity with sodium thiosulfate which donates sulfur to liver rhodonase.

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13
Q

Formula for half life

A

T1/2 = (Volume of distribution x ln2) / CL, ln2 = 0.693

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14
Q

What bacteria has polar granules that stain deeply with aniline dyes?

A

Cornyebacterium diphtheria.

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15
Q

What is the pathogenicity of cornyebacterium diphteria

A

Inhibits protein synthesis by ADP-ribosylation of host cell elongation factor-2 (EF-2)

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16
Q

What is seen on light microscopy for Candida albicans infection

A

Yeasts, pseudohyphae, and positive germ tube test.

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17
Q

What do eosinophils contain? How can you ID them on histology?

A

They are multilobed usually show around 2. Neutrophils have 3 or more lobes. They contain eosinophilic granules that contain major basic protein (MBP) and it is anti-helminthic. It is also thought to contribute to bronchial eptihelial damage sustained by patients with atopic (extrinsic allergic) asthma.

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18
Q

Chronic thiamine deficiency affects the brain how?

A

Diminishes ability to utlize glucose. This is because thiamine is in thiamine pyroposphate, a cofactor for several dehydrogenase enzyme reactions. 1) pyruvate dehydrogenase 2) alpha ketoglutarate dehydrogenase 3) transketolase (first three relevant for brain I think not sure) 4) branched-chain ketoacid dehydrogenase

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19
Q

How does waterhouse friderichsen syndrome present?

A

acute primary renal insufficiency due to adrenal hemorrhag a/w N meningitidis septicemia, DIC (see as petechiae) and endotoxic shock. N meningitidis sepsis does not necessarily include meningitis.

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20
Q

What nucleoside analogues require both viral and host cell kinases? What drug requires only cellular kinase for activation?

A

Nucleoside analogues that require both viral and cell kinases include acyclovir, famciclovir, valacyclovir. Cidofovir is a nucleotide and just needs cellular kinase.

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21
Q

What is the most common appendiceal tumor?

A

Carcinoid tumor

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22
Q

Symptoms of carcinoid syndrome? What is diagnostic of carcinoid syndrome?

A

carcinoid tumors are neuroendocrine cells - espeically metatstatic small bowel tumors that secrete lots of serotonin. Not seen if tumor is limited to GI tract because serotoninin is metabolized on first pass. Rare - caused by carcinoid tumors. Asthmatic wheezing, cutaneous flushing, diarrhea, right sided valvular disease. Increased 5-hydroxyindoleacetic acid in urine, niacin deficiency (pellagra).

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23
Q

Tx of carcinoid syndrome?

A

Resection, somatostatin analog like octeotride - whch acts on somatostatin receptors and inhibits secretion of many homrones and hormone like substances.

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24
Q

Weak wrist extension but intact sensation indicates damage to what nerve at what location?

A

Deep radial nerve damange - deep radial nerve extends wrist. Superifical radial nerve supplies sensation to dorsal of hand (to half of third digit). Nursemaid’s elbow - radial head subluxation causes damage to deep nerve - occurs at hea dof the radius.

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25
Q

What hormone causes secretory diarrhea?

A

VIP from VIPomas

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26
Q

where is VIP secreted from and what does it do?

A

Non beta pancreatic islet cells and neurons in GI mucosa. Causes relaxation of GI smooth muscle, inhibition of gastric H+ secretion and stimulation of pancreatic bicarbonate and chloride secretion. Excess of VIP causes secretoary diarrhea with potassium, sodium and water loss.

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27
Q

What is used to treat the sx of VIPoma

A

Somatostatin inhibits VIP secretion and decreases diarrhea sx.

28
Q

What are examples of H1 blockers. What are the main toxicities?

A

Diphenhydramine, chlorpheniramine, diphenhydrinate. Causes sedation, anti-muscarinic and anti-alphaadrenergic.

29
Q

Vertical diplopia is characterize of what nerve palsy

A

Trochlear nerve palsy

30
Q

Axillary lymph node dissection is a RF for?

A

Development of chronic lymphedema.

31
Q

Chronic lymphemdema predisoposes to the development of ?

A

Angiosarcoma

32
Q

Neonate with turner’s syndrome ppts with what?

A

Cystic hygromas (neck mass) and lymphedema

33
Q

How does pyruvate kinase deficiency affect the spleen?

A

Pyruvate kinase converts phosphoenol pyruvate to pyruvate in glycolysis. In RBCs, the main metabolite of glycosis is lactate. With pyruvate kinase deficiency, there is decreased ATP production and resultant hemolysis. Xs erythrocyte destruction leads to splenomegaly because of work hypertrophy. Spleen workin ghard to remove RBCs

34
Q

What is the most common lethal sequelae associated with PCP

A

Trauma / violent behavior

35
Q

High oxygen affinity hemoglobin leads to what response?

A

High oxygen affinity hemoglobin means decreased oxygen release => leads to renal hypoxia => leads to EPO generation => compnesatory eyrthrocytosis.

36
Q

What is the major component of adaptive immunity against Giardla?

A

Secretory IgA which impairs adherence of of giardia to duodenal and jejunal mucosa. Giardia attache at the intestinal brush border and release stuff that elicits inflammatory response.

37
Q

HLA B27 is what class serotype?

A

HLA Class I serotype

38
Q

What antineoplastic drug achieves high concentration because of its resistance to adenosine deaminase?

A

Cladibrine. PURINE analog. It reaches high concentration and gets incorporated into DNA, causing DNA strand breaks.

39
Q

What is prostacylin? What is it secreted by?

A

Prostacyclin is derived from prostaglandin H2 from prostacyclin synthase. It is from the COX/arachidonic acid pathway. It’s actions are 1) INHIBITION of platelet aggregation 2) INCREASED vascular permeability and 3) vasodiation. It is secreted by vascular endothelial cells.

40
Q

Propionic acidemia is a result of what congenital deficiency?

A

Deficiency of propionly coA carboxylase which converts propionyl CoA to methylmalonyl CoA.

41
Q

Propionyl CoA is derived from?

A

Isoleucine, threonine, methionine, valine, odd no FA and cholesterol side chains.

42
Q

Where is the IVC relative to the AA

A

IVC is RIGHT of the AA. On the right side of the vertebral bodies.

43
Q

At what level do the renal veins join the iVC, and what level do the comon iliac veins merge to join the IVC?

A

L1/L2, level 4

44
Q

Anti dsDNA antibodies are specific for>

A

SLE

45
Q

What serum antibodies are specific for RA

A

anti citrullinated peptide (anti CCP)

46
Q

What causes scarlet fever?

A

Strains of Group A streptococcus that produces pyrogenic exotoxins.

47
Q

Scarlet fever is characterized by?

A

Fever, pharyngitis (swollen, erythematous, covered with gray-white exudates), inflamed strawberry tongue with red papillae, rash appears on neck, armpit and groin that generalizes to rest of body (sandpaper like rash), circumoral pallor (flushed cheek with pale mouth in comparison)

48
Q

Most lethal complication of Scarlet fever?

A

acute rhemuatic fever

49
Q

What is Cheynes Stokes respiration?

A

Cyclic breathing in which apnea is followed by gradually increasing tidal volumes and then gradually decreasing tidal volumes until the next apneic period. Commonly seen in advanced heart failure.

50
Q

What are the digitoxin toxicities? What is the most lethal complication of digitoxicn?

A

Nausea, vomiting, diarrhea,abdominal pain, confusion, delirium BLURRY VISION/COLOR CHANGE/DISTURBED COLOR PERCEPTION. Ventricular tachyarrythmias. AV block

51
Q

What characteristic should a drug have if hepatic metabolism and clearance is desired?

A

High lipophilicty (means greater Vd, also greater CNS penetration). Highly lipophilic drugs tend to be poorly eliminated by the kidney as these agents tend to rapidly cross tubular cell membranes

52
Q

Multiple ring enhancing lesions in HIV patient (oral thrush, lympadenopathy) is a sign of?

A

Toxoplasmosis

53
Q

What side effect is most likely to persist in a Parkinson patient taking Levodopa when carbidopa is added?

A

Anxiety and agitation are adverse central effects of dopamine. When carbidopa is added, more dopamine is available for CNS and these adverse effects can/will persist.

54
Q

What is the clinical presentation of organophosphate poisoning.

A

Organophosphate poisoning = inhibits AchE therefore XS ACH in both muscarinic and nitocinic clefts. DUMBBELSS. Diarrhea, urination, miosis, bronchoconstriction, bradycardia, excitation of skeletal muscles, lacrimation, sweating and salivation.

55
Q

What is the antidote to organophosphate poisoning

A

Atropine - blocks MSUCARINIC EFFECTS ONLY. Therefore nicotinic effects like sleketal muscle contraction/paralysis will continue. PRALIDOXINE - if given early will reverse both effects because it restores AchE.

56
Q

What is rubeola

A

Infection with the Measles virus which is a member of the paramyxovirus family. Enveloped, nonsegmented negative sense RNA virus.

57
Q

What is measles also called?

A

Rubeola

58
Q

What are the 3Cs of Rubeola. What is rubeola rash like?

A

Coryza, conjunctiva, Koplik spots and cough (like a prodrome). Develops cranial to caudal. Begins 1-2 days after Koplik spot tiny white or blue-gray lesions on buccal mucosa

59
Q

Exacerbation of myasthenia gravis in a patient treated with achE inhibitors is due to

A

1) myasthenia crisis - this is when not enough AchE inhibitors are given so there is not enough ach to compete against the autoimmune antibodies 2) cholinergic crisis - this is when there is too much achE inhibitor and this results in exessive skeletal muscle stimulation and paralysis

60
Q

How do you differentiate between myasthenic crisis and cholinergic crisis?

A

Infusion of short acting cholinesterase inhibitor like Tensilon test. It increases nmj transmission and provides SX improvement. If this happens, it is MYASTHENIC crisis. In cholinergic crisis, no improvement

61
Q

What is the normal lab value for K+

A

3.5-5.0mEq/L

62
Q

Hyperkalemia secondary to ACEinhibitor (lisinopril) is most common in patients with?

A

Renal insufficiency or patients taking K+ sparing diuretics like AMILORIDE, TRIAMTERENE AND SPIRONOLACTONE

63
Q

What medication should be used with caution in a patient that has BPH?

A

Amitryptiline (TCAs) should be used with caution because they have significant anti-cholinergic effects and can exacerbate urinary retention.

64
Q

Increased alpha fetoprotein levels are a/w?

A

Neural tube defects, dating error, anterior abdominal wall defects (omphalocele, gastrosschisis), multiple gestation. Down syndrome is associated with DECREASED

65
Q

Triple test tests for what?

A

Alpha fetoprotein, estriol, and beta-hcg - tested between weeks 16 and 18

66
Q

E Coli strains that cause neontal meningtis have what?

A

K-1 capsule

Esther's Step 1 UWorld Tests (20 decks)

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