Uworld17 Flashcards
What is pulsus paradoxus?
an exaggerated drop (>10mmHg) in systolic blood pressure during inspiration.
It is most commonly seen in patients with cardiac tamponade but can also occur in severe asthma, chronic obstructive pulmonary disease, or constrictive pericarditits
What is the most common cause of urinary tract infection?
E coli, a nitrate reductase producing bacterium.
Dipstick analysis should be significant for leukocyte esterase, nitrites, and a mildly acidic pH
Concentric left ventricular hypertrophy is a common complication of chronic hypertension, characterized by?
uniformly thickened ventricular walls and enlarged cardiomyocytes and nuclei.
The vasoconstrictors angiotensin II and endothelin likely have a prominent role in the development of concentric LVH independent of their effects on blood pressure.
Angiotensin II receptor blockers are more effective than other antihypertensive agents in reducing LVH.
MOA of patiromer
Patiromer is a nonabsorbable cation exchange resin used to treat hyperkalemia.
It binds colonic potassium in exchange for calcium, trapping potassium within the resin where it is then excreted in the feces.
AE: diarrhea, hypokalemia, hypercalcemia, and hypomagnesemia
Lesions of the glossopharyngeal nerve results in?
loss of the gag reflex (afferent limb), loss of sensation in the upper pharynx, posterior tongue, tonsils, and middle ear cavity, and loss of taste sensation on the posterior third of the tongue.
MOA of colchicine
Colchicine is a second line agent for treating acute gouty arthritis.
It inhibits tubulin polymerization and microtubule formation in leukocytes, reducing neutrophil chemotaxis and emigration to sites inflamed by tissue deposition of monosodium urate crystals.
Gastrointestinal mucosal function is also impaired by microtubules disruption, leading to diarrhea and less commonly nausea, vomitting, and abdominal pain
Morphine generates 2 major metabolites that are metabolically active and renally cleared. These metabolites can?
accumulate in the bloodstream of patients with renal dysfunction and lead to opioid toxicity, evidenced by miosis, respiratory depression, and CNS depression.
Which heart chamber composes most of the heart’s anterior surface?
right ventricle.
A deep, penetrating injury at the left sternal border in the 4th ICS would puncture the right ventricle
Infants who do not receive adeqate iron supplementation are at risk for developing iron deficiency, which progresses in stages as total body iron is depleted. The earliest stage involves?
loss of iron in storage (decreased serum ferritin), followed by iron-limited erythropoiesis with decreased serum iron and transferrin saturation.
Frank iron def anemia, involving the classic findings of low hemoglobin, microcytic/hypochromic erythrocytes, and a low reticulocyte, is a late finding.
What is pica?
Pica is the compulsive consumption of a nonfood substance.
It is often associated with iron def anemia, which is common during pregnancy, and other forms of nutritional def (eg zinc)
What is the relationship of nonselective beta blockers and hypoglycemia?
Nonselective beta blockers exacerbate hypoglycemia and mask hypoglycemic symptoms mediated by norepinephrine/epinephrine
What is neurofibromas?
benign nerve sheath tumors composed of cells normally found in peripheral nerves, including neoplastic Schwann cells, as well as non-neoplastic fibroblasts, perineural cells, and mast cells.
Cutaneous neurofibromas often arise from small nerves in the dermis.
What is leptospirosis?
a zoonotic infection caused by the motile spirochete Leptospira.
Transmission primarily occurs when humans come into contact with water contaminated with animal urine during outdoor recreational or occupational activities.
Patients classically have a mild, self limited flulike illness but may develop more serious complications such as renal or hepatic failure
What is anaphylaxis?
an IgE mediated response to an allergen that results in the release of histamine by mast cells and basophils.
Histamine causes widespread physiologic effects, including vasodilation and increased vascular permeability (eg, hypotension), increased catecholamine secretion (eg, tachycardia), and bronchoconstriction (eg wheezing)
What is pseudocholinesterase deficiency?
Succinylcholine is a depolarizing neuromuscular blocking agent used to induce skeletal muscle relaxation; it typically has a very short duration of action due to metabolism by plasma pseudocholinesterase.
Pseudocholinesterase deficiency is an AR disorder that results in the inability to metabolize succinylcholine, leading to prolonged neuromuscular paralysis after drug adminstration.
MOA of DPP-4 inhibitors (eg, sitagliptin)
Glucagon-like peptide 1 (GLP-1),degraded by dipeptidyl peptidase-4 (DPP-4), helps regulate blood glucose by slowing gastric emptying, suppressing glucagon secretion, and increasing glucose-dependent insulin release.
DPP-4 inhibitors (eg, sitagliptin) increase the effects of GLP-1 and improve glycemic control.
Because the effect on insulin is glucose dependent, there is minimal risk of hypoglycemia.
What is familial hypocalciuric hypercalcemia?
a benign autosomal dominant disorder caused by defective calcium sensing receptors in the parathyroid gland and kidneys
What are calcium sensing receptors?
G protein coupled receptors that regulate the secretion of parathyroid hormone in response to changes in circulating calcium levels
What is seen on blood smear for lead poisoning?
Coarse basophilic stippling (dark blue purple granules throughout red blood cells) and hypochromic, microcytic anemia are common peripheral blood smear findings in lead poisoning.
high risk groups: young children ingesting paint chips and industrial workers inhaling particulate lead
How does ascites develop in cirrhosis?
Ascites in cirrhosis develops from hemodynamic changes related to portal hypertension. Splanchnic vasodilation decreases the splanchnic vascular resistance and lowers the effective arterial blood volume, which causes activation of the renin-angiotensin-aldosterone system and promotes sodium and water retention.
Additionally, low oncotic pressure (ie, hypoalbuminemia due to impaired hepatic function) reduces fluid resorption from the interstitium.
Chronic valvular inflammation and scarring associated with rheumatic heart disease predispose to?
an increased risk of infective endocarditis: valvular vegetations with destruction of the underlying cardiac tissue
What are vegetations on the heart caused by?
Vegetations are caused by bacterial colonization and growth on a sterile fibrin platelet nidus that forms on the damaged/disrupted endothelial surface of the valvular apparatus.
What is ectopic pregnancy?
Ectopic pregnancy may present with unilateral lower abdominal pain, adnexal tenderness, and vaginal bleeding.
Patients with a ruptured ectopic pregnancy have severe intraabdominal bleeding, which causes diffuse abdominal pain with rebound/guarding and hemodynamic instability.
What is the definitive diagnosis of chronic myelogenous leukemia?
Chronic myelogenous leukemia and leukemoid reaction can have presentatons similar to leukocytosis; however, leukocyte (neutrophil) alkaline phosphatase level is normal or elevated in a leukemoid reaction but decreased in CML.
The definitive diagnosis of CML requires demonstration of the Philadelphia chromosome t(9;22) or BCR-ABL fusion gene or mRNA.