Uworld_NTK_Wk3 Flashcards
cyclic breasting in which apnea is wolowed by gradually increase then decreasing tidal volumes until the next apneic period. ?
Cheyne-Stokes breathing.
commonly associated with Advanced CHF
What is Cheyne-strokes breathing commonly associated with?
Advanced CHF
biofilms ~w/ what bug?
Staph epidermidis
What is the pathogenesis of alcohol-induced hepatic steatosis?
decrease in free fatty acid oxidation secondary to excess NAHD production by the 2 major alcohol metabolism enzymes, alcohol dehydrogenase and aldehyde dehydrogenase.
triglyceride accumulation within the hepatocellular system == ?
hepatic steatosis
lipids can be stained with oil-red-O or Sudan black.
Sudan black ?
stains for lipids
What is the Serum K+ levels in a pt. w/ DKA?
normal to increased serum K+, despite a total body K+ deficit.
gram-neg rod that does not gram stain?
Legionella
what reconizes stop codons (UAA. UAG, UGA) and terminated protein synthesis?
releasing factors
if you can’t find the appendix via palpation during an appendectomy, how else can you locate it?
follow the teniae col to their origin at the cecal base.
High temp and exercise can cause what in a CF pt?
HYPOnatremia d/t excessive sodium loss through sweat.
Transmission of Hepatitis A?
Oral-fecal.
~overcrowding, poor sanitation, contaminated water or food, raw or steamed shellfish
OYSTERS
double layer of peritoneum that extencs from the liver to the lesser curvatve of the stomach and the beginning of the duodenum.
less omentum; it is divided into the hepatogastric and hepatoduodenal ligaments.
Gastic bands pass through the lesser omentum
That drug therapy is ~w/ fat redistribution?
HAART.
redist. fat from face and extremities to trunk
what is the immediate precursor of dopamine and can cross the BBB?
levodopa;
dopamine cannot cross the BBB
func. of the drug entacapone?
to reduce the peripheral metabolism of levodopa —> increase levodopa bioavailablity to the brain.
_________ is a peripheral DPA decarboxylase inhibitor.
Carbidopa.
Acute bacterial arthritis in sexually active young pt. is caused by?
N. gonorrhoeae
wrist and elbow joint pain.
joint aspirate with high neutrophil count and intracellular organisms.
What are the diseases classified as microangiopathic hemolytic anemia?
- HUS
- thrombotic thrombocytopenia purpura (TTP)
- DIC
- malignant HTN
- mets. carcinoma
What does a low Vol. of Distribution mean? V_d?
drug is trapped in plasma compartment.
means that drugs is:
- high molecular wt.
- high plasma protein binding.
- high charge
- hydrophilic
Benign tumors in peds, that appear in the first weeks of life, grow rapidly and disappear by age 5-8?
strawberry hemangiomas. (capillary hemangiomas)
common in pregos, pt. w/ liver diz, and in pt. taking OCP or estrogen supplements.
spider angiomas;
dilated cutaneous arterioles that present as central papule with radiating blanching capillaries.
small, bright red, cutaneous papules that appear in pt. during adulthood.
MC benign vascular proliferation in adults.
Cherry hemangiomas;
dilated caps and post-capillary venules in papillary dermis and do NOT regress spontaneously.
What is a DNA-dependent RNA polymerase that incorporates short RNA primers into replicating DNA?
Primase
elevated alk-Phos labs of unclear etiology should be followed up with what lab?
gama-glutamyl transpeptidase;
this enzyme is mainly in hepatocytes and biliary epithelia; uses to figure out with high AlkPhos is or HEPATIC or BONY origin.
Which of the “bleeding issues” labs asseses liver function?
PT time?
Vitamin K-dep factors are made in the liver. (
Which of the “bleeding issues” labs assesses liver function?
PT time?
Vitamin K-dep factors are made in the liver. (
DOC for the Tx of treatment-resistant schizophrenia?
Clozapine; 2nd generation anti-psychotic.
Clozapine has affinity for multiple DA and 5HT receptors, but precise MOA is unknown.
Omalizumab?
Anti-IgE antibodies.
DOC fot severe allergic asthma.
What drug are effective to Tx chronic urticarial and allergic Sx, but NOT effective in the Tx of asthma?
H1 receptor antagonist.
What is a proteasome inhibitor used in the Tx of multiple myeloma and Waldenstrom macroglobulinemia?
Bortezomib
In what pt. can ambiguous external genitalia be seen?
(46, XX) w/ congenital adrenal hyperplasia
In what diz do pt. have absent uterus and primary amenorrhea?
Mullerian agenesis
androgen insensitivity syndrome
Fibrotic fallopian tubes are sometimes seen in ?
pelvic inflammatory disease
What is the genetic mech. responsible for the clinical variability of MITOCHONDRIAL diseases called?
Heteroplasmy
What is the best medical Tx of gallstones?
Give hydrophilic bile acids (ursodeoxycholic acid) –> reduces cholesterol secretion and increases biliary bile acid concentration.
How do fibrates increase risk of gallstones?
increase cholesterol content in bile ==> increase gallstone formation
what does estrogen and progesterone do w.r.t. bile?
estrogen increase cholesterol secretion.
progesterone reduces bile acid secretion. –? stasis
think makes the bile supersaturated with cholesterol.
Digoxin is used for ventricular rate control in a-fib b/c it decreases AV nodal conduction by _______________________ tone.
Digoxin increases PNS vagal tone.
Pt. who desires relationships but fear rejection == ?
Avoidant personality disorders
Pt. w unstable relationships, impulsivity, mood lability, and self-harm == ?
Borderline personality disorder
pt. with long-standing pattern of eccentric behavior, odd beliefs, perceptual distortions, and social anxiety despite familiarity == ?
Schizotypal
wound –> motor neuron axons –> spinal cord.
is the infection pathway of ???
C. tetani
wound –> neuron axons –> salivary glands.
infection pathway of ??
Rabies virus
fibrous exudate –> systemic circulation –> cortical neurons.
infection pathway of ??
diphtheria toxin.
fucks with cardiac and cerebral cortical tissues.
food –> systemic circulation –> meninges.
infection pathway of ???
listeria monocytogenes
meningitis in neonates
food –> systemic circulation –> peripheral nerves.
infection pathway of ??
botulinum toxin.
insect bite that leads to encephalitis, meningitis, flaccid paralysis ???
West Nile Virus; pos-sense, single strand flavivirus
What is used to Tx cardiac toxicity that is ~w/ TCA overdose?
Sodium Bicarb.
The Sx of TCA overdose is due to what?
TCA overdose ==> blockade of cardiac fast sodium ch. and inhibition of ACh, H, and alpha-1 receptors.
What are the Sx of TCA overdose?
- delirium
- seizures
- cardiac abn.
- severe HTN
- signs of anti-cholinergic tox
What nerve do you stimulate to help with OSA?
stimulate hypoglossal nerve ==> increase diameter of the oropharyngeal airway and decrease freq. of apneic events.
What func. does cilicosis impair in the lungs?
Macrophages; thus fucks with cell-mediated immunity, increases infection by mycobacteria.
How do you Tx cyanide poisoning and what’s the MOA?
inhaled amyl nitrite.
nitrites are oxidizing agents that induce methemoglobinemia (Fe3+), which has high affinity for cyanide.
where are the neurons that release serotonin loc. in the CNS?
raphe nuclei
substantia nigra contains what type of neurons?
dopaminergic neurons; these are depleted in parkinsons.
Where are the NE-secreting neurons loc. in the CNS?
Locus ceruleus
What tracts are fucked in B12 def.?
- dorsal columns
- lateral corticospinal
- spinothalamic
non-selective beta-blockers exacerbate ____________ and mask’s its adrenergic symptoms mediated by NE and Epi.
hypoglycemia
what enzyme is released by injured hepatocytes and bacteria hydrolyzes bilirubin glucuronides to unconjugated bilirubin?
Beta-glucuronidase
What kind of drug is chlordiazepoxide?
benzo
Disease that is confirmed by excessive amounts of NEUTRAL amino acids in the urine.
Hartnup Disease;
impaired transport of neutral amino acids in the small intestine and PCT.
Pellgra-like Sx and cerebellar ataxia, d/t niacin def.
ADRs:
decreased GFR (increase in creatinine), hypokalemia, cough,
ACE inhibitors
MC predisposing condition for native valve infective endocarditis in DEVELOPED nations?
mitral vale prolapse with regurg.
for developing nations, it is RHEUMATIC HEART DISEASE.
What is the most Px indicator of malignant melanoma?
depth of invasion (Breslow Thickness)
What is the confirmatory test for celiac’s disease?
Duodenal biopsy
- capillary hemangioblastoma in retina/cerebellum.
- congenital cysts/neoplasms in kidney, liver, pancreas.
- increased risk for renal cell carcinoma.
=== ???
VHL
Von Recklinghausen’s disease =
aka: NF1
bilateral CN8 schwannomas and multiple meningomas = ?
NF2
presence of cutaneous facial angiomas and leptomeningeal angiomas == ???
Sturge-weber synd.
skin involvement overlies V!1 and V2 nerve.
skull x-ray shows “tram-track” calcifications.
Osler-weber-Rendu ?
aka: hereditary hemorrhagic telangiectasia.
NO Cysts!!!
What is the most important virulence factor that Uropathogenic E. coli expresses?
P. fimbraie; needed to bind to uroepithelial cells to infect UTI.
without it, the E. coli would just wash away
What does HYPO-ventilation do to pCO2 and pH?
increase atrial pCO2 and decreases serum pH. [Resp. Acidosis]
how do you get different proteins from the same DNA seq.?
alternative RNA slicing.
What is the screening and confirmatory test for T. pallidum?
screening: RPR or VDRL.
Rapid Plasma Reagin (RPR) serum is mixed with solution of cardiolipin, cholesterol and lecithin.
Aggregation, or “flocculation” is a (+) test.
confirmatory: FTA-ABS.
where does lymph from the umbilicus down, including the anus below the dentate line, drain to?
Superficial inguinal lymph nodes.
pancreatic inflammation can cuase a blood clot within what vessel?
Splenic vein.
This can increase pressure in the short gastric veins and lead to gastric varices only in the FUNDUS
Suppression of which hormones is responsible for billiary stone?
CCK;
b/c CCK normally increases gallbladder contraction.
PPV and NPV depend on what statistic? .
prevalence
Conc. of what increases as fluid runs along the proximal tubule?
- PAH
- creatinine
- inulin
- urea
Conc. of what DECREASE as fluid moves along that PCT?
- bicarb
- glucose
- amino acid
i.e. glucose and amino acids are readily reaborbed by the PCT.
What subs. are reabsorbed in concentration approx. equal with water in the PCT?
Na+ and K+
A pt. with oligomenorrhea, hirsutism, and is obese is at risk for what disease?
high risk of endometrial hyperplasia/carcinoma.
pt. has PCOS
What drug is best for visceral nausea d/t to GI insults, chemoTx, general anesthesia?
5-HT3 antag. Odensetron
DOC for vestibular nausea?
Anti-histamines and anticholinergics
DOC for Nausea d/t to migraine?
DA antagonist.
What mu-opioid receptor functions as an anti-motility agent?
Loperamide
S/Sx of stimulant intoxication?
- tachycardia
- hypertension
- hyperthermia
- diaphoresis
- mydriasis
what disease can both finasteride (5-alpha reductase inhibitor) and tamsulosin (alpha-1-blocker) be used to Tx?
BPH
ADRs of tricyclics?
STRONG anti-cholinergic!
- confusion
- constipation
- urinary retention
What lab can be used to monitor colon cancer recurrance, but CANNOT be used to dX colon cancer?
CarcinoEmbryonic Antigen (CEA)
Pt. has S/Sx of hypoglycemia and elevated C-peptide, what does this indicate?
insulin secreatgogue like a sulfonylaurea.
or an insulin-secreting tumor.
Virus that is ~w/ pharynconjunctivitis and coryza (runny, nose, nasal congestion)
Adenovirus
MCC viral gastroenteritis?
norovirus.
~ outbreaks, schools, ships.
~ vomiting and watery diarrhea.
~ peds and adults
Rotavirus causes similar S/Sx and in outbreaks, but less common in developed and vaccinated populations.
Chronic lymphedema increases risk of dev of what?
angiosarcoma (Stewart-Treves syndrome)
DOC vs. Pseudomondas aeruginosa?
cefepime or ceftazidme.
Trimethoprim-Sulfamethoxazole does NOT have activity here.
Polygenic inheritance: ?
some key genetic influence are inherited in x-linked manner,
others are in autosomal dom.
Common conditions with polygenetic inheritance: (7)
- androgenetic aplopecia
- epilepsy
- glaucoma
- hypertension
- ischemic heart disease
- schizophrenia
- DM2
What bacterial infection is ~w/ bacillary angiomatosis?
Bartonella henselae; Cat-scratch disease.
G-neg endocarditis.
what causes accessory nipple?
failure of regression of the mammary ridge in utero.
aSx, but can be tender along with regular breast tissue d/t hormonal fluctuation.
Raised and can be hyperpigmented. d/t clonal proliferation of benign melantocytes in utero.
congenital melanocitic nevi.
What is the defect in Ehlers-Danlos syndrome?
defective collagen synthesis.
def. in procollagen peptidase; enzyme that cleaves terminal propeptides from procollagen in the ECM space.
S/Sx: hyperextensible skin, fragile tissue w/ easy bruising, and poor wound healing.
How do you Dx tentanus?
Clinical hX and P. exam.
What diz is X-linked recessive and presents with intramuscular hemorrhage, hemarthroses and increased aPTT?
Hemophilia
Gi diz w/:
transmural inflammation, stricture, fistulas ==> ?
Crohns
in elderly, triad of
- ataxic gait
- urinary incontinence
- dementia
==>
Normal pressure hydrocephalus ==> leads to distortion of periventricular white matter.
lost of coritical inhibition on teh sacral micturition center causes the develop of urge incontinence.
What can cause acture pancreatitis if its serum levels are very high!?
triglycerides > 1000mg/dL
What is a major complication that can arise 4 - 12 days after a subarachnoid hemorrhage?
Servere vasospasm, leading to weakness in the extermities. (major cause of death)
Tx with Nimodipine, selective CCB.
Beta-Thal increases what Hb?
HbA2; increased to compensate for beta globin underproduction.
==> microcytic RBC that are prone to hemolysis!
INCREASED red cell turnover = FALSELY low HbA1c levels
What is the biggest regulator of the removal of cholesterol-containing IDL and LDL particles from circulation>?
LDL receptor on the liver!
Symmetrical enlargement of the venticals in the brain ==> ?
communiting hydrocephallus.
dysfunc. w/ arachnoid granulations
_____1_____ tumors are composed of islands or sheets of uniformed cells with eosinophillic cytoplasm and oval-to-round stippled nuclei. they are derived from ______2_____ cells in the GI tract.
- carcinoid
2. nueroendocrine cells
Ghon complex ~ ? (lower lung lesion)
primary infection by M. tuberculosis
factor V leiden increases risk of what?
DVT,
b/c factor V leiden ==> HYPER-coag state.
What diz id neuroimaging best for?
excluding causes of movement disorders;
- tumors,
- infarction,
- demyelinating diseases
IgE-med degranulation of mast cells increase permeability –> edema of superficial dermis ==> ?
Urticaria
High peak in the gamma-globulin region = ?
M-protein
M-protein ~ ?
overproduced monocloncal Igs == Multiple Myeloma (Plasma cell neoplasm)
_____________ –> hematoma –> extend prox. & distally –> compression of major arteries and impair blood flow (STUPID HIGH BP)
Intimal tearing.
This is a Aortic Dissection.
bridging veins ~
Subdural hem.
Func. of NF-kB protein?
pro-Inflammatory Transcription factor.
