Uworld19 Flashcards
What is the major virulence factor of Strep pyogenes?
M protein, an alpha-helical coiled protein that shares structural homology with tropomyosin and myosin.
It extends from the cell wall and prevents phagocytosis, inhibits complement binding, and mediates bacterial adherence.
Antibodies against M protein form shortly after acute infection and may cross react with epitopes on myosin, leading to rheumatic carditis
Chronic lithium toxicity (eg, confusion, ataxia, neuromuscular excitability) can be precipitated by?
volume depletion and drug interactions with thiazide diuretics, ACE inhibitors, and nonsteroidal anti-inflammatory drugs
What is cyclic neutropenia?
Cyclic neutropenia occurs as a result of a mutation in the gene encoding neutrophil elastase.
This leads to accelerated apoptosis of neutrophil precursors with characteristic bone marrow findings of nuclear fragmentation and membrane blebbing.
Cyclic neutropenia is characterized by episodic (every 3 weeks), severe neutropenia that causes recurrent fever and mucositis
Why does Pseudomonas cause persistent infection in cystic fibrosis?
Patients with cystic fibrosis have thick, viscous mucus that accumulates in the airways and promotes colonization of bacteria, particularly Pseudomonas.
This gram-negative rod can produce biofilms, which act as a protective matrix that allows bacterial macrocolonies to develop, causing persistent infection.
What is the pathogenesis of Mallory-Weiss tears?
Mallory Weiss teats accounts for about 10% of cases of upper GI hemorrhage.
They occur due to increased intraluminal gastric pressure due to retching, vomiting, or other abdominal straining
What is dystonia?
a neurologic movement disorder characterized by sustained, involuntary muscle contractions that often result in abnormal, sometimes painful posturing.
Many patients can have temporary relief with the use of a sensory trick (eg, touching the face)
In the adenoma to carcinoma sequence, which gene mutation develops to malignant transformation?
The adenoma to carcinoma sequence is a series of gene mutations that leads to the development of colon adenocarincoma.
TP53 tumor suppressor gene mutation is part of the final step in the sequence and leads to malignant transformation of preexisting large adenomatous polyps.
Hypocalcemia causes?
Hypocalcemia can cause muscle cramps, perioral paresthesias, hypotension, and neuromuscular hyperexcitability.
Injury to the parathyroid glands during thyroid surgery is a common cause of hypoparathyroidism and acute hypocalcemia
What is anaphylaxis? Treatment?
type 1 (immediate) HSR involving IgE mediated mast cell and basophil degranulation.
Epinephrine is the primary treatment for anaphylaxis because it decreases further mast cell release of inflammatory mediators and counteracts existing systemic inflammatory effects (eg, shock, bronchoconstriction)
What is Ehrlichia chaffeensis?
harbored in white tailed deer and transmitted to humans by tick bite
It replicates in vacuoles within monocytes and forms mulberry-shaped, intraleukocytic inclusions (morale).
Manifestations: nonspecific symptoms (eg, fever, chills, myalgia, maculopapular rash, and significant laboratory abnormalities, particularly lymphopenia
Steady state concentration is reached in how many half lives?
During continous infusion of a drug metabolized by first order kinetics, the steady state concentration is reached in 4 to 5 half lives
Which cytokines is associated with chronic inflammation?
Chronic inflammation is associated with increased circulating pro-inflammatory cytokines (eg, IL-1, IL-6, tumor necrosis fator-alpha), which stimulates the liver to release acute phase reactants (eg, C-reactive protein, fibrinogen)
The presence of acute phase reactants increase the erythrocyte sedimentation rate, a nonspecific marker for inflammation
How are the pneumoconiosis cleared from the lungs?
The pneumoconioses are diseases resulting from the inhalation of fine dust particles that reach the respiratory bronchioles and alveoli.
Particles that lodge in this region are normally cleared by alveolar macrophages.
High particulate burden can cause the excessive release of cytokines from macrophages, resulting in progressive pulmonary fibrosis
What is illness anxiety disorder?
excessive concern about having a serious, undiagnosed disease, despite few or no symptoms and negative medical workup
5-HT3 receptor antagonists are useful for the treatment of?
visceral nausea due to gastrointestinal insults, such as gastroenteritis, chemotherapy, and general anesthesia
Antihistamines and anticholinergics are recommended for what kind of nausea?
vestibular nausea
Dopamine antagonists are useful for what kind of nausea?
nausea associated with migraine
The upper midbrain contains?
the neural structures (eg, optic nerve, pretectal nuclei, Edinger-Westphal nuclei, oculomotor nerve) that mediate the direct and consensual pupillary light reflex
What is pulmonary arterial hypertension?
a vascular complication of systemic sclerosis.
also involves fibroproliferative remodeling of the vessel wall, leading to increased pulmonary vascular resistance and right sided heart failure
Transport of glucose into the cell of most tissues occurs by the means of?
facilitated diffusion.
Glucose moves from areas of high concentration to areas of low concentration with the help of transmembrane glucose transporter proteins (GLUT). These carrier proteins are stereoselective and have preference for D-glucose.
What is reciprocal induction?
a type of signaling that occurs between two tissues that requires both be present to induce normal development.
Reciprocal induction occurs in development of the kidney (ie, between metanephric blastema and ureteric bud) and the eye (ie, between optic vesicle and surface ectoderm)
Patients with a long history of asbestos exposure are at risk for developing?
asbestosis, pleural disease and malignancies such as bronchogenic carcinoma and mesothelioma.
Bronchogenic carcinoma is the most common malignancy in this population, although mesothelioma is more specific for asbestos exposure
What is the treatment for cyanide poisoning?
Cyanide is a potent mitochondrial toxin that binds to the ferric ion in the heme center of cytochrome c oxidase.
This blocks the electron transport chain and uncouples oxidative phorsphorylation.
Hydroxocobalamin, an antidote for cyanide poisoning, rapidly binds to cyanide and forms the nontoxic metabolite cyanocobalamin, which is excreted in the urine
What is accumulation effect?
The concept of accumulation effect can be applied to disease pathogenesis and exposure to risk modifiers.
Cumulative exposure to a risk factor or risk reducer must sometimes occur for prolonged periods before a clinically significant effect is detected