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UWORLD- Incorrects WEEK 1
Terms in this set (106)
What is the function of IgA protease?
It facilitated the mucosal adherence of bacteria
How do Natural Killer cells function?
NK cells recognize decreased MHC 1 on cells
Nifedipine: Type of drug? Use? SE?
Type: Calcium channel blocker
Effects: Vascular specific vasodilation
SE: Reflex tachycardia- USEFUL FOR PATIENTS WITH BRADYCARDIA
Nucleaus basalis of Meynert is associated with what NT?
What is the most abundant AA in collagen?
What is the function of Theca and Granulosa cells?
Theca externa- capsule
Theca interna- convert cholesterol to androgens
Granulosa- convert androgens to estrogen
Name the murmor: Low pitched, holosystolic heard best at left sternal border with accentuation during handgrip
Can be asyx if small
Vs ASD- mid systolic pulmonary ejection murmor
What is the common sequela of impetigo?
PSGN: Face puffiness and dark urine
Note: ARF only occurs after strep pharyngitis
What is a feared SE of ACEI? What is it caused by?
Angioedema caused by increased bradykinin/kinin
Note: Angioedema= face swelling and difficulty breathing caused by vasodilatory effects of bradykinin
What is a neurophysin and what is its function?
Carrier protein for oxytocin and ADH- help shuttle to posterior pituitary
If defect --> Diabetes incipitus (not enough ADH)
When is aortic regurg heard loudest? What does it sound like?
At the beginning of Diastole when the pressure gradient between aorta and LV in maxed
"Diastolic decreshendo murmur"
Heard loudest when patient leans forward
Case presentation: 3 week old, jaundice, dark urine, light colored stool, increase direct bilirubin
Biposy: Intrahepatic cholestasis and proliferation of intrahepatic bile ducts
- Extrahepatic- obstruction of bile ducts
How does Digoxin decrease HR?
Increased parasympathetic tone
(Note: Increased intracellular ca increases cardiac contractility)
What is the immunological effect of Superantigens (ie. TSST)?
Non specific activation of T cells --> increase T cell activation and Macrophage
What are the symptoms of primary ciliary dyskinesia?
Infertility- impaired sperm motility
Sinusitis, Bronchiectasis/dilation, AOM- impaired mucociliary clearence
Clinical presentation: 12 year old with proteinuria, RBC casts and hypercellular glomeruli
Diagnosis? Lab findings?
Post strep GN
IgG, IgM and C3 deposition ( so low serum C3
SE of Chlorpromazine vs. fluphenazine?
Fluphenazine= high potency= neuro/ EPS side effects (dystonia, akathisia, parkinsonism, muscle rigidity)
Other high potency drugs: Trifluorperazine Haloperidol " Tri to fly high"
Chlorpromazine= low potency= Sedation and anticholinergic side effects (also Thioridazine " Cheating theives are low")
What is the definition of Standard error? How does this relate to confidence interval?
SE = SD/ square root of n
95% confident= mean +/- 1.96 x SE
99% confident = mean +/- 2.58 X SE
What is the cofactor for Pyruvate --> OAA
Enzyme: pyruvate carboxylase
What is organism causing food poisening d/t Mayo? MOA?
Preformed toxin- heat stable exotoxin
What are the rapid acting insulins?
" No Lag"
Lispro, Aspart, Glulisine
Post prandial short acting
What is the Hawthrone effect?
the tendency of study subjects to change their behavior as a result of their awareness that they are being studied
What is the pathyophys of Zenker diverticulum?
Diminished relaxation of pharyngeal muscles during swallowing --> Increase intra luminal pressure --> mucosa herniates through wall forming diverticula
What is conversion disorder? What is somatization disorder?
Conversion- unconcious manifestation of neuro symptoms with there is no pathophy explanation (ie woman who just broke up with fiance now has muscle weakness)
Somatization- numerous complains, prior to age 30, significant impact life, multiple different types of symptoms
Lesh Nyhan syndrome
What is defect?
What are syx?
What enzye is upregulated
X linked recessive
Defective:HGPRT (failure of purine salvage)
Syx: Increase uric acid because hypoxanthine and guanine are not recycles
"HGPRT"= hyperuricemia, gout, pissed off, retardation, dystonia
Increase: De novo purine synthesis via PRPP
Clinical presentation: Post chemo, high BUN, peakedT waves, decreased urine output
Tumor lysis syndrome
What is most feared side effect of Lamotrigine?
Stevens Johnson syndrome and TEN
Immediately come to dr if skin rash
Which B Blockers are safe to use in asthma and COPD?
What is Budd Chiari syndrome? What are the biopsy findings?
Occlusion of hepatic vein
Liver biopsy shows centrilobular congestion and and fibrosis
What are findings in tuberus sclerosis?
Angiomyolipoma, brain hamartomas and ash leaf skin patches
What is the most important factor in the pathogenesis of Shigella?
Mucosal invasion of M cells that overly peyers patches
Note: shiga toxin plays minor role
Patient in MVC receives transfusion and develops chest and back pain, difficulty breathing, chills
Diagnosis? Pathophys? Type of rxn?
Acute hemolytic transfusion reaction
Occurs minutes to hours
Other syx: hemoglobinuria (red/brown)
Type 2 Hypersensitivity
Most often due to ABO incompatibility
Host IgM anti- ABO ab bind ag on donor erythrocytes --> complement mediated cell lysis
What is the most common cause of aspetic meningitis in 12 year old? What is the mode of transmission?
Fecal Oral transmission
What is the MOA of carbamazepine?
Decrease sodium current in cortical neurons (stabilizes channels in the inactive state)
What is the MOA of oseltamivir?
Inhibit neuramididase --> decrease release of progeny virus
What is the difference in presentation of the different kinds of ALL?
T cell ALL- large anterior mediastinal mass, svc syndrome, dysphagia, dyspnea, stridor
B cell ALL- most commn- bleeding, bone pain, hepatosplenomegaly
What is the signaling pathway for insulin? What is the signaling pathway for growth hormone?
Growth hormone: JAK STAT- (TK associated receptor, no intrinsic enzyme activity) Activate cytosol protein
Insulin: MAP K (receptor autophosphorylates and phosphorylates RAS) INTRINSIC anzyme activity
What is the treatment for a defect in transport of ornithine from cytosol to mitochondria
What is succinylcholines train of four response?
Phase 1: all same height, smaller height
Phase 2: Phade
Non- depolarizingNMJ blockers- rocuronium etc- always faded
What LN does anal canal drain to? What abou sigmoid colon?
Anal canal- superficial inguinal nodes
Sigmid colon- IMA
What are the characteristics of a pilocytic astrocytoma?
Spindle cells with hair like glial processes and associated with microcysts.
Mixed with rosenthal fibers and granular eosinophilic bodies
Often in cerebellum
Partial agonist and weak antagonist at mu receptors
Decrease abuse potential but may precipitate opioid withdrawl in addicted patients
What is treatment for narcalepsy?
What is the pathophys of inherited Pulmonary HTN?
vascular smooth muscle proliferation
What are the markers of Down Syndrome in utero?
Low AFP and estradiol
Increased bHCG and Inhibin A
Organ transplant rejection one week post transplant: What is pathophys/cause? What do you see on histology?
This is ACUTE rejection (weeks)
MOA: Host T cell sensitization against graft MHC antigens
Histology: dense infiltrate of mononuclear cells
M TB loose acid fastness and stop proliferating when exposed to a drug- what drug is it? Whats the MOA?
MOA: Inhibit mycolic acid synthesis- cells cant divide or build in tact cell walls
CAUSE mycobacteria to loose acid fastness (Rifampin wouldnt do this!)
What is MOA of Ethosuximide? What about phenytoin? Carbamazepine? Valproic acid?
Ethosuximide: Blocks Ca channels, decreasing current in thalamic neurons
Phenytoin/Carbamazepine: decrease sodium current in cortical neurons
Skin hyperpigmentation, DM and pigment cirrhosis with hepatomegaly
Hemachromatosis (late stage)
Telangiectasia on skin and mucus membranes of lips, oronasopharynx, resp tract/GI
Also: Epistaxis, GI bleed, hematuria`
Diagnosis? Mode of inheritance?
Osler Weber Rendu= Hereditary hemorrhagic telangiectasia
12 year old with ataxia, episodic erythematous and pruritic skin lesions, loose stools.
Labs: neutral aromatic AA in urine
Diagnosis: Harnup disease
MOA:Ineffective intestinal and renal reabsorption of tryptophan
Tx: High protein diet, Nicotonic acid (Tryptophan is precursor to Niacin)
Which histone protein is located outside of the nucleosome core and helps package into more compact? What proteins are in core?
Core is 2 (2a 2b 3 4)
What medication can you give post SAH to prevent vascular spasm?
Ca Channel blocker- Nimodipine
What is the most feared SE of Doxorubicin?
What organism does not have a cell wall and therefore cannot be treated with PEN?
What is MOA of Raltegravir?
Integrase inhibitor ' Integrave"
Prohibits integration into host cell chromosone --> impair mRNA transciption
MOA? Use? SE?
Carbonic Anhydrase inhibitor
Works in PCT
USE: Acute angle glaucoma- will decrease Bicarb and aqueous humor formation
SE: Urine Alkalinization
You see spherules packed with endospores on histology?
What is difference between Chloroquine and Primaquine?
Chloroquine- eliminates inRBC
Primaquine- P.Vivax and ovale to eradicate the intrahepatic stages of the trophozoites
What property accounts for Elastins platicity and ability recoil?
Interchain cross links involving lysine
" Desmoglein crosslinking"
Enzyme: lysyl hydroxylase
What is HCTZ effect of K?
Hypokalemic metabolic alkalosis
Hyper: glycemia, lipidemia/Cholesterol, uricemia, calcemia
breast biopsy: ducts distended by pleomorphic cells with prominent central necrosis
Breast biopsy: solid sheets of vesicular, pleomorphic, mitotically active cells with lymphoplasmacytic infiltrate
NF 1 type of cell?
Neural crest- tumor of schwann cell
What is HbsAg?
What about HbcAg and HbeAg?
Non infective glycoprotein that forms spheres and tubules 22 nm in diameter
Component of ENVELOPE
Correlates poorly with viral replication
c and e are nucleocapsid- correlate with viral replcation
Name 5 drugs that cause SLE like syx?
How does lithium cause Diabetes Incipitus?
Antagonize effects of ADH in the collecting tubule/ CD
Syx: polyuria, polydipsia, inability to concentrater urine even when restricting water
What is the effect of citrate on urine?
Citrate in high concentration in urine --> binds ionized/free Ca --> prevent precipitation and increase excretion
Prescribe Potassium citrate for recurrent Ca stones
What is the treatment for Enterobius Vermicularis?
What is Kaussmals sign?
Paradoxical rise in JVP during inspiration
What is hypocretin? what does it do? When would it be low?
Orexin produced in lateral hypothalamus
promote wakefulness/inhibit REM
Low in narcalepsy
What reaction is catalyzed by Glucose 6 Phosphate dehydrogenase?
Glucose 6 phosphate --> 6 phosphogluconate
Hexose Monophosphate pathway (generate NADPH to maintain glutathione)
What is biggest risk factor for primary sclerosing Cholangitis?
If EF is low- is it systolic or diastolic disfunction?
Where are the following fingers in the vault hold?
Index: Greater wing of sphenoid
Middle: Zygomatic process of temporal bone
Ring: Mastoid process of temporal bone
Little finger on occiput
External rotation of R temporal bone, chin goes...?
Chin displaced right
mandibular fossa will go posterior, chin towards side of external rotation
Which protozoa/GI is acid fast?
What is SE of Chrones?
What causes endometrial hyperplasia?
Increase levels of circulating estrogen
African immigrant- day tme sleepiness, night time insomnia, irritable, fever comes and goes, swollen posterior cervical lymph nodes, 2 cm painless chancre
Trypanosomiasis- sleeping sickness
Patient is on a lipid lowering drug and is having lots of GI side effects. What is the name of drug? what are the names?
Bile acid sequestrants (cholestyramine, colesvelam, colestipol)
What does sensory innervation between eye and upper lip? How is this nerve injured?
Infraorbital N- branch off of maxillary nerve
Injured via orbital floor frature
Child with Down syndrome- when did nondisjunction occur?
What is the most likely head bleed in elderly person after trauma? What does it look like on CT?
SDH- from bridging V ( Brain atrophy makes bridging veins more likely to rupture)
What are the long acting BZD? What is the SE we are worried about
"Dont fall colleen"
Increase drowsiness, decrease dependence
What is first line treatment is acute gouty arthritis?
What is transketolase and what reaction does it take part in? Where is it located in the cell?
Pentose phosphate pathway- uses B1/thiamine
What is first line treatment of hirsutism due to PCOS?
What is the treatment of acute diptheria?
1. Antitoxin= PASSIVE IMMUNIZATION- you are administering ab to patient
3. DPT vaccine (prevent future infxn
What is responsible for clearing irritants from lungs?
Up to terminal bronchioles- ciliated cells
Distal to terminal bronchioles- macrophages
Patient on HIV treatment regimen- develops hypocalcemia and hypomag- what is drug?
" Ca and Mg are slipping through net"
Remember that it can chelate Ca, also does NOT require activation by viral kinase
Case presentation:kyphoscoliosi, high plantar arch, brother had neuro disorder and died of heart failure at 25- what is neur0 problem?
Friedrichs ataxia- degeneration of multiple spinal cord tracts (spinocerebellar tracts)
This degeneration leads to gait ATAXIA
Patient has anitbodies to PLA2R- what is diagnosis?
This protein is in podocytes
Mechanism of injury: Sudden upward jerking of arm (ie hanging from a tree by brach)
What is most likely injured?
Lower portion of brachial plexus --> hand clumsiness
How do you determine the percentage of a disease that can be attributed to a certain risk factor?
Attributable risk percent= (RR-1)/RR
Patient with ADPKD has head bleed- what kind is it? What does this look like on CT?
Star of death
"Worst headache of life"
What step of the TCA cucle is ribogflavin used?
Succinate dehydrogenase: Succinate --> fumarate
What is the morophology of a signet ring gastric carcinoma?
Infiltrative growth within the stomach wall
Diffuse carcinoma - "Linitus plastica"
5 year old with fever, irritability, refusal to eat, painful ginigival ulcers, swollen gums and cervical lympahdenopathy
Diagnosis? What do you see on smear?
Primary HSV infection
What are the effects of isoproternol on contraction force and vascular resistance
Increase contraction force (B1)
Decrease vascular resistance (B2)
What reaction is pantothienic acid ncessary?
Acetyl CoA to citrate
What is the marker for ovarian malignancy? What about pancreatic malignancy?
Ovary- CA 125
Pancreatic malignancy CA 19-9
Neuronal injury 1 week old- see lipids stained on histology- why? What is it?
3-5 days after injury, microglia move to site and phagocytose neurons- including lipid rich myelin
What is the function of GTO?
GTP are located at the junction of muscle and tendon and are sensitive to muscle tension
If muscle exerts too much force, GTO inhibit contraction of the muscle causing sudden muscle relaxation
Patient is started on Phenytoin, 4 weeks later develops fever, LAD, facial edema, skin rash
What is diagnosis? What do you see on labs?
DRESS Syndrome- Drug reaction with eosinophilia and systemic symptoms
EOSINOPHILIA on labs
What is mechanism of Sheehans syndrome?
During pregnancy you get growth of pituitary --> enlarge --> more vascular
If get hypotension/post partum hemmorage --> ischemic necrosis of pituitary
(NOTE Apoplexy occurs into existing pituitary adenoma)
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