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UWORLD Q REVIEWS > Wk 8 block > Flashcards

Wk 8 block Flashcards

1
Q

All ribosomal RNA except rRNA is transcribed in the?

A

nucleolus

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2
Q

Pts with antiphospholipid syndrome will have prolonged PT/PTT?

A

PTT (cardiolipin interferes with PTT test)

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3
Q

A wet mount test is the same thing as a?

A

Saline microscopy

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4
Q

The most likely bacteria to cause infection in a septic abortion is?

A

Staph aureus

Others: E.coli

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5
Q

Long term complication of septic abortion?

A

Adhesions -> secondary amenorrhea and infertility (Asherman Syndrome)

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6
Q

Tumors in the hypophaynx, larynx or base of tongue can cause?

A

Referred otalgia (ear pain) due to sensory contributions from CN 9 & 10

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7
Q

When PD-L1 (programmed death ligand) binds to cytotoxic T cell, what do they do?

A

Inhibits their ability to induce apoptosis

** so many cancer cells upregualte PDL-1 receptors to avoid apoptosis.

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8
Q

A fracture at the pteryion will risk damage to this blood vessel?

A

Middle meningeal artery leads to epidural hematoma

**branch of maxillary artery

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9
Q

This maneuver can be used to abolish paroxysmal supraventricular tachycardia?

A

Valsava maneuver

Others; carotid massage (vagal stimulation)

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10
Q

A patient presenting with sinopulmonary infections, Giardia Lambia gastro, failure to thrive and low immunoglobulins is suggestive of?

A

X-linked agammaglobunemia

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11
Q

A patient presenting with sinopulmonary infections, Giadia Lamblia gastro, failure to thrive and low immunoglobulins is suggestive of?

A

X-linked agammaglobunemia
(failure of pre-B cells to mature)

Increased risk of infection with pyogenic bacteria

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12
Q

N-acetlytransferase results in diminished ability to metabolize drugs such as?

A

Isonaizid & sulfonamides

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13
Q

Erythromycin, in addition to being an antibiotic can also act to?

A

Increase gastrointestinal motility (acts as agonist on motilin receptors in the muscularis externa)

**can be used to tx pts with diabetic gastroparesis

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14
Q

Intracellular receptors that directly act as transcription factors contain zinc finger binding domains and bind the following materials?

A

Steroids, Thyroid hormone and fat soluble vitamins (all pass through the lipid membrane into cytoplasm)

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15
Q

Ligation of these arteries should stop post partum hemorrhage?

A

Internal illiac arteries (stops uterine blood flow)

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16
Q

Treatment for narcolepsy include?

A

Pyschostimulants (modafinil)

2nd line: amphetamines

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17
Q

Holoprosencephaly is an example of a ___ defect?

A

Field defect

**an initial embryonic disturbance (incomplete division of the forebrain) leads to multiple malformations by disrupting the development of adjacent tissues and structures.

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18
Q

Down syndrome is associated with low levels of __ and ___?
&
high levels of__ & ___

A

AFP and estriol

B-hCG & inhibin A

**These 4 are known as the quadriple screen test.

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19
Q

Omphalocele and gastroschisis and Neural tube defect and multiple gestation lead to high levels of?

A

AFP

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20
Q

Infection by this organism can cause serpiginous tracks due to subq migration and pruritic rash?

A

Hookworm (contact from waking outside barefooted)

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21
Q

What molecule stimulates neutrophil migration to sites of inflammation?

A

Leukotriene B4

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22
Q

Thoracic outlet syndrome most often occurs due to compression of brachial plexus within?

A

Scalene triangle (made up to ant. and middle scalene and first rib)

*UE weakness, numbness, tingling with repetitive overhead arm movements.

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23
Q

Ultraviolet rays damage DNA by cross-linking _____?

A

Pyrimidines

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24
Q

Epidural hematoma?

A 
Between bone and dura matter
Often from MVA
Affect middle meningeal artery
Transient loss of consciousness
Ipsilateral dilated pupil due to uncal herniation and CN III compression.
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25
Q

Which lung disease does diffuse cutaneous scleroderma present with?

Limited Cutaneous?

A

Interstitial lung disease

PAH (pulmonary HTN)

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26
Q

Low dose dopamine action?

Increasing doses?

High end of dose

A

Vasodilation via D1 (Incr. Blood flow) in renal and mesenteric vasculature

Stimulate B1 & A1 receptors (incr. CO)

Decr. CO (due to increased afterload)

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27
Q

What medication is first line for tx of aortic dissection?

A

Esmolol (given IV) helps to decrease contraction velocity and HR.

**can give vasodilators after not before (to avoid reflex tachy)

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28
Q

Are monoclonal Antibodies eliminated by hepatic or renal clearance?

A

NONE

**removed by target mediated drug clearance (endocytosis) and non specific clearance by immunoglobulins

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29
Q

Duodenal atresia is caused by?

Jejunum/ileum atresia are caused by?

A

Failure of recanalization (double bubble sign) * asx with Down syndrome

Vascular injury. Apple peel or Christmas tree deformity. Asx with gastrcoschisis

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30
Q

This dz will px with a pruritic rash on flexor surfaces of wrist, finger, and webs?

A

Scabies

Dx: skin scraping.

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31
Q

What is wrong is Alkaptouria?

A

Disorder or tyrosine metabolism. Tyrosine -> Dopa (melanin & catecholamines) or Homogenistic acid (fumarate). In Alkaptouria Tyrosine is unable to be transformed to fumarate. Excess Homogenistic acid -> black pigments around the body.

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32
Q

Simple cuboidal cells are found in the female repro organ?

A

Ovary

helps with repair of ovulatory surface defects from ovulation

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33
Q

Treatment of scabies?

A

Topical permethrin and/or ivermectin.

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34
Q

A retroperitoneal hematoma can also injure this nerve?

A

Femoral n

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35
Q

As patients get older, what happens to their bone marrow?

A

It gets replaced with fat (decreased mass)

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36
Q

Injury to the prostatic plexus or prostatectomy can cause?

A

Erectile dysfunction

** the prostatic plexus is found within the prostatic fascia (can be injured during surgery)

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37
Q

Hemorrhagic cystitis after chemotherapy (esp cyclophosphamide) can be prevented by?

A

Mesna. In addition: aggressive hydration, bladder Irrigation.

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38
Q

Flutamide MOA?

A

Non steroid anti-androgen that acts as competitive inhibitor of testosterone receptors.

**used in tx of prostate cancer

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39
Q

Tumor suppressor genes are involved in the following processes? (4)

A

DNA repair
Cellular differentiation
Checkpoints control of cell cycle
Transcription factor regulation

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40
Q

Patients with tx//castration resistant prostate cancer should be treated with?

A

17 alpha hydroxylase inhibitors (abiraterone). Block generation of androgen -> limit prostate cancer growth.

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41
Q

Bisphophonates is taken to tx this condition.

An adverse effect of this medication is?

A

Osteoporosis

Osteonecrosis of the jaw & medication induced esophagitis

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42
Q

Patients with Giant cell (temporal) arteritis will have elevated?

A

CRP and ESR

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43
Q

The most common causes of DIC in pregnancy is?

A

The release of tissue factor (thromboplastin) from an injured placenta.

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44
Q

Mitochondrial inheritance shows ______ ( genetic inheritance feature)?

A

Heteroplasmy (different mitochondrial genomes within a single cell) the severity of dz is dependent on the proportion of abnormal to normal mitochondria within a patients cell.

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45
Q

SLE can have antibodies against snRNPS (anti-Smith). What are snRNPS?

A

Small nuclear DNA (snRNA) complexed with Specifc proteins to form snRNPs (an essential part of spliceosomes).

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46
Q

Horizontal transection of the rectus abdominis at the level of the arcuate line (cesarean section)could damage this structure?

A

Inferior epigastric artery

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47
Q

Painful enlargement of the thyroid gland is suggestive of?

A

Subacute granulomatous thyroiditis (de Quervain)

**histology will show mixed inflammatory infiltrate with macrophages with multi-nucleated giant cells

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48
Q

Subacute granulomatous thyroiditis usually occurs after?

A

Acute viral illness.

**Incr in acute phase markers (ESR & CRP)

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49
Q

BCL-2 is an antiapototic protein that prevents cancer death in CLL by this MOA?

A

Overexpression of BCL-2 - prevents trigger of the intrinsic apoptotic cascade via release of cytochrome C from the mitochondria and subsequent activation of caspases.

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50
Q

Osgood-schlatter disease is characterized by anterior knee pain and swelling due to chronic avulusion of the?

A

Tibial tubercle.

**quadriceps attach here

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51
Q

Delayed stage (skin induration) of T1 HS rxn is due to?

A

Local tissue damage caused by major basic protein released from eosinophils

**occurs hours after exposure

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52
Q

3 ways that Down syndrom can be inherited?

A

Meiotic nondidjucntion
Unbalanced Robertsonian translocation
3. Mosaicism: some cells have an extra copy of chromosome 21

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53
Q

Why would a pt with Klinefelter syndrome px with gynecomastia?

A

In Klinefelter syndrome -> damaged sertoli cells (lack of inhibin feedback) & damaged leydig cells (low testosterone) -> excess gonadotrophins -> Increase estrogen levels.

**Azoospermia & infertility

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54
Q

Dissection of axillary lymph nodes during a mastectomy can damage this nerve?

A

Long throacic n -> weakness in serratus anterior -> winging of scapula

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55
Q

Most immediate physical symptoms of marijuana use?

A

Tachycardia & conjuctivial injection (red eyes)

Others: increased appetite and dry mouth

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56
Q

Difference between polymyalgia rheumatica & fibromyalgia.

A

PR - older age >50. Inflammatory condition. Inc in acute phase protein - ESR & CRP

Fibro: w/t neuro symptoms and tenderpoints and fatigue

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57
Q

What tests can support the diagnosis of chronic pancreatitis (3)?

A

Low fecal elastase (not degraded) + sudan staining and elevated Hgb A1C

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58
Q

What is the function of a p-glycoprotein?

A

Also known as permeability-protein. Efflux pump found on brain capillary endothelial cells (Part of BBB) -> inhibit a wide range of substrates from entering the brain.

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59
Q

PAS stain helps in staining this products?

A

Glycoporoteins of cell wall.

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60
Q

Why is Bicalutamide is usually administered with GnRH analogs?

A

Prevent initial surge

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61
Q

Patients with IL-12 efficiency are susceptible to?

A

Severe mycobacterial infections (inability to mount strong cell mediated granulomatous immune response) due to lack of IFN-alpha

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62
Q

What is Methynaltrexone?

A

Peripherally acting mu opoid antagonist (can be used to treat constipation w/o inducing withdrawal symptoms)

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63
Q

What type of immunity do TNF-alpha inhibitors impair?

A

Cell mediated immunity (increased susceptibility to TB)

**evaluate for TB first before starting theraphy

64
Q

Valproatic acid leads to neural tube defects by decreasing levels of?

A

Folic acid

65
Q

Peripheral smear in leukomoid reaction will show this in neutrophils?

A

Dohle bodies (basophilic oval granules/inclusions)

66
Q

Irritation of what nerve causes hiccups?

A

Phrenic nerve

**any abdominal process (ruptured spleen, peritonitis, hemoperitoneum) can irritate this n.

67
Q

Peritonitis can cause referred pain to the?

A

Shoulder (kehr sign)

68
Q

Rapid onset of numerous seborrhagic keratosis is typically indicative of?

A

Internal malignancy (leser-trelet sign)

69
Q

Wrinkled tissue paper appearance of macrophage in bone marrow aspirate is associated with?

A

Guacher dz (Lipid laden Macrophages)

70
Q

Guacher dz presents with?

A

Incr levels of B-glucocerebrosidase deficiency. Pancytopenia and hepatomegaly.

71
Q

Cytotoxic (early) edema that begins hours after an ischemic brain injury is due to?

A

Decreased ATP (due to failure of ATP dependent pumps) -> Na accumulate in cells-> water follows -> swelling.

72
Q

When does vasogenic edema occur after an ischemic stroke?

A

24-48 hours later after inflammatory mediators disrupts tight junctions of BBB

73
Q

How does human placental lactogen affect maternal glucose?

A

Causes insulin resistance -> incr glucose -> help provide nutrient for growing fetus.

74
Q

Postural muscles (e.g paraspinal) are type I or 2 fibers?

A

Type 1 slow twitch with high number of mitochondria.

75
Q

Non disjunction occurs due to failure of homologous chromosome to separate in?

A

Meiosis

** or failure of sister chromatids to separate during meiosis II or mitosis

76
Q

Pts with homocytsinuria respond dramatically to?

A

B6 - pyridoxine supplementation

77
Q

Object lodged in the piriform recess may cause damage to this nerve impairing the cough reflex

A

Internal laryngeal n. (branch of CN 10)

78
Q

Which nerve travels through the guyon canal?

A

The ulnar n (enters between the hook of hamate and pisiform bone)

79
Q

PECAM-1 is responsible for this neutrophil action during inflammation ?

A

Transmigration

80
Q

ICAM is helps neutrophils acheivethis action?

A

Tight adhesion and crawling

81
Q

E -selectin/P selectin on endothelial cells help neutrophils perform this action?

A

Rolling

82
Q

Abnormal bleeding in uremia affects only this value?

A

Prolonged bleeding time (toxins impair platelet aggregation)

83
Q

Adrenalectomy of the zona glomerulosa will lead to these sx?

A

Electrolyte abnormality -> parasthesia and muscle weakness.

84
Q

What is a competitive inhibitor of alcohol dehydrogenase and acts as a treatment for ethylene glycol or methanol poisoning?

A

Fomepizole

**ethylene glycol - kidney injury
Methanol injury - blindness

85
Q

To prevent congenital rubella effects utilize a ____ vaciine?

A

Live attenuated virus vaccine

86
Q

Anal fissure often happen at this location?

A

Posterior mid-line (due to decreased blood flow to this area)

87
Q

Pelvic fracture of ten damage this part if the male GU?

A

Posterior urethra

**px with full bladder sensation, boggy prostate and blood at meatus

**Anterior ureter - saddle injury

88
Q

Genetic abnormality in DiGeorge is due to?

A

Microdeletion

89
Q

Gold test for Di George syndrome?

A

FISH

90
Q

Pathology for Bloom syndrom?

A

Mutation in BLM gene which codes for helicase -> chromosomal instability to breakage -> growth retardation, facial anomalies -> photosensitive rash -> immunodeficiency

91
Q

In which type of carcinoma do you see signet ring cells?

A

Diffuse carcinoma (linitis plastica)

**due to loss of ecadherins

92
Q

2 signs associated with gastric adenocarcinomas incleuse?

A

Sister mary joseph nodule (periumbilical nodes)

Virchows node (supraclavicular node)

93
Q

Paget dz of bone often present with increased amounts of this molecule?

A

Alk phosphatase (increase formation of new bone)

94
Q

Pts with androgen receptor dysfunction (AIS - androgen insensitivity syndrome) in will px with these symtoms?

A

Decreased facial, axillary and pubic hair. Also oligospermia, gynecomastia, undervirilization

95
Q

Necrotizing entercolitis is associated with these 2 thins?

A

Premature & eteral feeding

96
Q

Characteristic neuroimaging findings in Huntington include?

A

Enlargement of the frontal horns of the lateral ventricles.

**Atrophy if caudate nucleus and putamen

97
Q

Serum sickens is a Type ____ HS rxn and is characterized by?

A

Type 3 HS rxn

Characterized by vasculitis that arise from deposition of immune complexes.

**can occur following administration of monoclonal antibodies

98
Q

Red man syndrome is a (mast cell activation) reaction to this _____ antibiotic that is NOT _____ mediated?

A

Vancomysin

Not IgE mediated]

**infuse slower and symptoms will stop

99
Q

This is an essential protein in the activation of Interleukin 2 that promotes the growth and differentiation of T cells?

A

Calcineurin

**tacrolimus and cyclosproine (used in transplant patients) inhibit its activation

100
Q

The recognition sequence in tRNA is?

A

CCA (at 3’ end) - serves as AA binding site

tRNA will have chemically modified bases (pseudouridins, dihydrouridine etc)

101
Q

Epistaxis is commonly caused by the irritation of highly vascular muscosal of ?

A

Nasal septum (has kiesselbach plexus - anastamoses)

102
Q

Which type of Cushing Syndrome (ACTH dependent or ACTH independent causes hyperpigmentation?

A

ACTH dependent

melanin is a product of POMC - ACTH precursor

103
Q

Which neuro effect is associated with Chediak-Higashi syndrome?

A

Nystagmus and progressive peripheral neuropathies.

104
Q

What is the most powerful stimulator of Phosphorylase Kinase (activate glycogen phosphorylase to start breakdown of glycogen) in muscle cells?

A

Calcium release

105
Q

C1 inhibitor deficiency will px as?

A

Angioedema

  • C1 inhibitor also inhibits kininogen -> bradykinin (a potent vasodilator) so in its absence -> excess bradykinin -> angioedema
106
Q

Releasing factors recognize ___ codons?

A

stop codons

**UAA, UAG,UGA

107
Q

In contact dermatitis which T cells are primary effector cells?

A

CD8 cells

108
Q

The only histone protein not a part of the histone -DNA (nucleosome) core complex is?

A

Histone H1 (helps package nucleosome in t more compact structures by linking adjacent DNA

**made up of 8 (2 each of 2A, 2B, 3, 4)

109
Q

Antibody-drug conjugates help improve drug efficacy in chemotherapy?

A

allowing conventional agents to selectively target and kill cancer cells (while sparing healthy cells) Targeted delivery

(eg EGFR + csispalstin)

110
Q

ALS can affect this organ that is important for breathing?

A

Diaphragm

**can result in dyspnea and respiratory failure

111
Q

Rate limiting step in heme synthesis is?

An important cofactor for this step is?

A

ALA synthase

B6 (pyrodixine)

112
Q

Which structure contains the ovarian artery, vein, lymphatic and nerves?

A

Suspensory ligament

113
Q

Head lice is known as?

A

Pediculus humanus capitis

114
Q

How are C- peptide removed from the cell

A

Stored in granules until secretion from the cell via exocytosis

115
Q

Prolonged exposure to loud noises causes hearing loss due to damage to?

A

stereociliated hair cells of the organ of corti

High frequency hearing gloss is lost first regardless of frequency of sound causing damage

116
Q

Flattening of deltoid m with acromial prominence after shoulder injury is indicative of?

A

Anterior humerus dislocation (blow to abducted and externally rotated arm)

*loss of axillary n -> deltoid paralysis and loss of sensation over lateral shoulder

117
Q

What is the most common GI complication of Downs Syndrom?

A

Duodenal atresia

Others: imperforate anus, Hirsprung, tracheoesophageal fistula and celiac dz

118
Q

The superficial and deep inguinal rings are physiologic opening s of ?

A

The external abdominal oblique muscles and transversus abdomins muscle

119
Q

Reducing sugar tests used in the testing of essential fructosuria contain this material?

A

Cooper (is a copper reduction test)

120
Q

A painless solid mass should be considered to be ____ until proven otherwise?

A

Testicular cancer

121
Q

Hypothyroid myopathy presents with these sx?

A

Myalgia, proximal m. weakness, elevated CK levels, DELAYED RELAXATION of deep tendon reflexes.

122
Q

What cells release IFN- gamma?

A

T lymphocytes

123
Q

What type of cells do NK cells recognise?

A

Cells with decreased MHC class i antigen expression ( e.g virus infected cells ad tumor cells)

124
Q

Icthyosis is characterized by dermal dryness and scaling and drying that primarily affect the trunk and extensor surface of extremities is caused by?

A

Mutation in filaggri gene -> epidermal hyperplasia -> defect desquamation -> loss if normal barrier function

125
Q

Why does the hepatititis C virus have many sub-types and is genetically unstable?

A

lacks proofreading 3’-5’ exonuclease activity in its RNA polymerase.

126
Q

Which enzyme is unregulated during inflammation by IL-1 and TNF-alpha?

A

COX-2

127
Q

Most aggressive form of breast cancer?

A

HER2

**responds to anti-HER mab - trastuzumab. Is tyrosine kinase active -> increase cell proliferation

128
Q

Which DNA polymerase has both 5’-3’ exonuclease activity in addition to 5’-3’ polymerase and 3-5’ exonuclease actitivities?

A

DNA polymerase 1

129
Q

Spliceosomes remove introns containing ___ at the 5’ site and __ at the 3’ site?

A

GU

AG

130
Q

In Lower extremities, the medial track runs up to the ____ LN by passing the ___LN.

A

superficial inguinal LN

popliteal

**the lateral tracks go through both the popliteal and inguinal areas

131
Q

Loperamide an opoid agoinist doesnt cross the BBBand inhibits ___ release?

A

aceytocholine

132
Q

Give this medication for severe agitation and psychotic manifestations of delirium?

A

Haldol

133
Q

Difference between chain composition of MHC I & MHC II?

A

MHC 1: 1 heavy chain and a B2 microglobulin

MHC II - 1 alpha and 1 beta chain

134
Q

Severe diabetic acidosis ca leas to eventual?

A

Respiartory failure (inability to compensate)

135
Q

Incretins work in the gut by stimulating insulin release through production of 2 secretions in the absence of glucose?

A

GLP - Glucaon like peptide and GIP

136
Q

Difference between MHC I and MHC II?

A

MHC 1- on all cells, activates CD8 -> apoptosis

MHC II - on APC cells, activates CD4 -> activates cell and humoral immunity

137
Q

Osteoporosis affects this part of the bone first?

A

Trabecular (thinning and perforation with loss of interconnecting bridges)

138
Q

Duchenne Muscular dystrophy is caused by ___ mutation?

A

Frameshift -> truncated dystrophine gene

** Or nonsense mutation

139
Q

A fall on outstretched hand can lead to dislocation of the ___ bone that can compress the median n?

A

Lunate

140
Q

What are the acute phase proteins?

A

CRP & Fibrinogen

Acute phase protein increase ESR (non specific marker for inflammation)

141
Q

Effects of growth hormone are mediated by?

A

Insulin like growth factor

**growth and development of bone, cartilage and soft tissue

142
Q

Entanercept MOA?

A

Acts as decoy receptor of TNF-alpha -> reduces biological activity

143
Q

Androgenic alopecia MOA?

A

Greater DHT effect (increased local coversion of Testosterone -> DHT) -> progressive hair loss.

144
Q

Tt of androgenic hair loss?

A

%alpha reductase inhibitor -> decrease conversion of testosterone -> DHT

145
Q

These antioxidant convert ROS to oxygen and water, neutralizing their capacity fro cellular damage?

A

Superoxide dismutase, gluthathione peroxidase and catalase.

146
Q

In chronic granulomatous disease, what chemical is deficient?

A

NADPH oxidase (those affected are unable to destroy catalase positive organisms)

147
Q

Use of these meds (2) in pregnancy termination?

MOA?

A

Mifepristone - progesterone antagonist -> causes necrosis of decidua

Misoprostol - prostaglandin E1 analog -> cervical softening and uterine contractions

148
Q

Serotonin releasing neurons in the CNS are found here?

A

Raphe nuclei

149
Q

Pts with narcolepsy with cataplexy have undetectable amounts of this in their CSF?

A

Hypocretin -1 2 (orexin A&B)

150
Q

IFN Alpha & Beta are produced by human cells in response to?

A

Viral infections (helps suppress viral replication by halting g protein synthesis and promoting apoptosis)

151
Q

mRNA interact with these in the cytoplasm?

A

P-bodies - they help store mRNA to be later released and utilized for protein translation.

152
Q

Injection in this part of the buttock has a high risk of injuring this nerve?

A

Superior gluteal n -> trendelenburg gait.

153
Q

Excessive matrix metalloprotease activity and myofibroblast accumulation in the wound margin can result in ?

A

contracture

154
Q

Rheumatoid arthritis often affects this part of the spine?

A

Cervical spine involvement (subluxation and cord compression)

155
Q

Decongestants work by affecting ___ smooth muscles?

A

Thee act like Alpha-adrenergic agonists

156
Q

Overuse of decongestants can lead to this?

A

Tachyphylaxis: overuse -> -ve feedback -> decr NE -> relative vasodilation and subsequent edema and congestion -> exacerbation of nasal congestion symptoms.

UWORLD Q REVIEWS (13 decks)

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