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UWorld > 2015.04.01 > Flashcards

2015.04.01 Flashcards

1
Q

Phenycylidine (PCP) abuse

A

Most likely to induce violent behavior

Fatalities associated with trauma

Loss of coordination, nystagmus, acute brain syndrome (disorientation, poor judgment and memory loss)

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2
Q

Cocaine intoxication

A

Myocardial infarction due to sympathomimetic effects that lead to increased myocardial oxygen demand

Ischemic stroke and intracranial hemorrhage

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3
Q

What is the process of administrating antitoxin called?

A

Passive immunization - transfer of pre-existing, neutralizing antibodies

Used for treating Diphtheria

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4
Q

Major flexors of the hip

A

Iliacus and psoas muscles (12th thoracic - 5th lumbar transverse process to the hip joint capusle to insert into the lesser trochanter of the femur)

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5
Q

Psoas sign

A

Inflammation of the psoas muscle causes pain when the hip is extended

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6
Q

Differentiate schizoaffective disorder from major depressive or bipolar disorder with psychotic features

A

Schizoaffective disorder - hallucinations exist even WITHOUT mood symptoms; but mood symptoms are present for most of illness

Bipolar Disorder with psychotic features - psychotic symptoms ONLY present WITH mood symptoms

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7
Q

What does C1 esterase inhibitor inhibit?

A

Kallikrien (which activates conversion of kininogen to bradykinin → angioedema)

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8
Q

Causes of Angioedema

A

Acquired - ACE Inhibitors when low C1 esterase inhibitor levels

Hereditary - autosomal dominant

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9
Q

What is common cause of Paroxysmal supraventricular tachycardia?

A

(common dysrhythmia that frequently occurs in patients with no other heart disease)

Due to re-entrant circuit in AV node

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10
Q

What are treatments for Paroxysmal supraventricular tachycardia?

A

Adenosine

Vagal maneuvers - carotid sinus massage and Valsalva

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11
Q

When do you see basement membrane splitting?

A

Alport syndrome - nephritis; deafness and ocular manifestations

Membranoproliferative glmoerulonephritis (MPGN) type 1 - granular deposits in IF

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12
Q

a3 chain of type IV collagen antibodies

A

Goodpasture syndrome Anti-GBM antibodies

Cause pulmonary hemorrhages and rapidly progressive glomerulonephritis (RPGN)

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13
Q

IgM and C3 deposits on sclerotic areas of glomeruli in IF

A

Focal segmental glomerulosclerosis (GSGS) IF changes

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14
Q

Nephrotic Syndrome

A

Marked proteinuria (>3.5g/day), hypoalbuminemia, hyperlipidemia, lipiduria

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15
Q

Linear deposits of IgG and C3 vs. Granular deposits of IgG and C3 along glomerular basement membrane

A

Goodpasture syndrome vs. Membranous glomerulopathy

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16
Q

Uniform, diffuse capillary wall thickening with granular deposits of IgG and C3 along glomerular basement membrane

A

Membranous Glomerulopathy changes

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17
Q

Recurrent epistaxis, echhymoses, and marked thrombocytopenia with no other symptoms or abnormal lab values

A

Isolated acquired thrombocytopenia - such as immune thrombocytopenic purpura (ITP)

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18
Q

When does gluconeogenesis become principle source of blood glucose?

A

12 to 18 hours of fasting

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19
Q

Pyruvate to oxaloacetate

A

Pyruvate carboxylase

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20
Q

Oxaloacetate to phosphoenolpyruvate

A

Phosphoenolpyruvate carboxykinase (PEPCK)

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21
Q

Initial committed step of gluconeogenesis

A

Conversion of pyruvate to oxaloacetate, and oxaloacetate to phosphoenolpyruvate

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22
Q

Where is Broca’s area?

A

Inferior frontal gyrus of dominant hemisphere

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23
Q

Primary motor cortex location

A

precentral gyrus

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24
Q

Primary somatosensory cortex location

A

postcentral gyrus

lesion here would cause sensation loss on contralateral body

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25
Q

Secondary lactase deficiency

A

Due to gastroenteritis - damaged cells (which normally contain concetrated lactase) is sloughed off and replaced by immature cells (low lactase)

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26
Q

Giardia lamblia forms/stages

A

1) trophozoite (pathogenic stage) - pear-shaped, multiple flagella, and 2 nuclei (owl’s eye appearance)
2) cyst (infective stage) - oval, 4 nuclei

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27
Q

Major immune mechanisms against Giardia

A

Secretory IgA production (deficiency impairs adherence and predisposes the patient)

CD4+ T helper cells

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28
Q

Tetrodotoxin

A

Blocks voltage-gated sodium channels in nerve cell membranes

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29
Q

Verapamil

A

Blocks L-type calcium channels, thus inhibits passive transport of calcium ions in cardiomyocytes

30
Q

Lidocaine

A

Local anesthetic and class 1B antiarrhytmic agent

BLocks voltage-gated sodium channels in sensory neurons, Purkinje fibers, and ventricular cells

31
Q

Dofetilide

A

Class III antiarrhytmic drug that blocks passive transport of potassium, specifically the delayed outward rectifier potassium current.

Leads to prolongation of refractory period and QT interval

32
Q

Dubin-Johnson syndrome

A

autosomal recessive with absence of biliary transport protein, MRP2, used in hepatoceulluar excretion of bilirubin glucuroindes into bile canaliculi.

Liver is darkly pigmented, but typically asymptommatic

33
Q

Crigler-Najjar syndrome

A

autosomal recessive disorder of bilirubin metabolism, caused by genetic lack of UGD enzyme needed to catalyze bile glucuronidation

34
Q

Unconjugated hyperbilirubinemia

A

Crigler-Najjar syndrome; can develop kernicterus (neural symptoms due to high unconjugated bile)

35
Q

Amitriptyline

A

Tricyclic antidepressants block muscarinic receptors (mimic atropine toxicity)

36
Q

Carbamazepine

A

Anticonvulsant for seizure disorders, trigeminal neuralgia and bipolar disorder.

Toxic effects: stupor, coma, increased seizure risk

37
Q

Prazosin

A

a1-adrenergic blocker used to treat hypertension and urinary retention due to benign prostatic hypertrophy

38
Q

Adverse effects of nonselective B-adrenergic blockers

A

bronchial constriction, bradyarrhythmias, CNS depression, worsening of Raynaud phenomeon and masked symptoms of hypoglycemia in diabetics

39
Q

How does Huntington disease alter gene expression?

A

CAG trinucleotide repeats in the gene that codes for huntingtin protein causes increased histone deacetylation and silences genes necessary for neuronal survival

(histone acetylation is needed to weaken DNA-histone bond to allow access for TF and RNA polymerases)

40
Q

Flumazenil

A

Benzodiazepine receptor antagonist used in benzodiazepine reversal and intoxication

41
Q

Micturition reflex regulation centers

A

1) Sacral micturition center - S2-S4 level parasympathetic fibers from ventral white matter within pelvic nerves stimulate cholinergic receptors in bladder wall
2) Pontine micturition center - pontine reticular formation; relaxes external urethral sphincter
3) Cerebral cortex - inhibits sacral micturition center

42
Q

Treatment of acute symptoms of thryotoxicosis

A

Beta-adrenergic antagonists relieve symptoms related to sympathetic nervous system (tachycardia, hypertension, tremor); can’t resolve exophtalamos (increased soft tissue mass within bony orbit)

43
Q

Psuedomonas aeruginosa

A

oxidase +, non-lactose fermenting, gram -

44
Q

Escherichia coli

A

lactose-fermenting, gram- rod

45
Q

Increased Citrate concentration

A

helps prevent calculi formation by binding to free (ionized) calcium

46
Q

Viruses with segmented genomes are capable of genetic shifts through reassortment

A

Orthomyxoviruses and rotaviruses

47
Q

Insuline-like growth factor (IGF-1)

A

made from the liver; stimulated by growth hormone from anterior pituitary to promote bone, cartilage, and soft tissue growth

48
Q

Gigantism

A

condition characterized by rapid linear growth due to hypersecretion of GH BEFORE fusion of epiphyseal growth plates

49
Q

Methylxanthines (ie. Theophylline) intoxication

A

Abdominal pain, vomiting, seizures (major cause of mortality); tacharrhythmias (do not cause QT prolongation though)

50
Q

Pilocytic astrocytomas vs. Medulloblastomas vs. Ependymomas

A

All are common childhood brain tumors.

Pilocytic has cystic and solid components. Pilocytic astrocytes and Rosenthal fibers are seen. Good prognosis.

Medulloblastomas are always solid. Most common malignant.

Ependymomas obstruct flow of CSF - hydrocephalus; see “rosettes” (tumor cells from gland-like structures)

51
Q

Restless leg syndrome treatment

A

Dopamine agonists (ropinirole, prampipexole)

52
Q

Hexose monophosphate shunt (HMP, PPP) nonoxidative/reversible reactions

A

Carried out by transketolase and transaldolase

53
Q

Benzodiazepine indications

A

hypnotics, anxiolytics, anticonvulsants, general anesthetics

main side effect = daytime drowsiness

54
Q

Short acting Benzodiazepines (<10 hours)

A

Alprazolam

Triazolam

Oxazepam

(Rapid elimination, less side effects; but severe withdrawal)

55
Q

Medium acting Benzodiazepines

A

Estazolam

Lorazepam

Temazepam

56
Q

Long acting Benzodiazepines

A

Chlordiazepoxide

Clorazepate

Diazepam

Flurazepam

(Long action, severe daytime drowsiness; less withdrawl since slower clearance)

57
Q

Inhibitory cytokines

A

TGF-B (suppresses all inflammatory cells)

IL-10 (inhibits Th1 - cell-mediated; enhances Th2 - humoral-mediated immunity)

58
Q

Isolated systolic hypertension (ISH)

A

age-related decrease in compliance (increased stiffness) of the aorta and its proximal branches

59
Q

Difficulty swalling (dysphagia) and disfigured fingernails (spoon nails or koilonychia)

A

Iron deficiency anemia (microcytic, hypochromic)

60
Q

Panic attacks

A

hyperventilation and decreased pCO2; hypocapnia causes cerebral vasoconstriction and decreased cerebral blood flow

61
Q

Cherry hemangiomas

A

small, bright-red, papular lesions - most common benign vascular tumor in adults

do not regress

proliferation of capillaries and post-capillary venules in the papillary dermis

62
Q

Cavernous hemangiomas

A

dilated vascular spaces with thin-walled endothelial cells; soft blue in skin, mucosa, deep tissues and visera

associated with von Hippel-Lindau disease

63
Q

Phenytoin

Carbamazepine

Valproic acid

A

inhibits neuronal high-frequency firing by reducing ability of sodium channels to recover from inactivation

64
Q

Ethosuximide

A

block T-type calcium channels in thalamic neurons, causing hyperpolarization

treatment of absence seizures

65
Q

Valproic Acid

A

Blocks NMDA receptors and affect potassium current; also sodium channels and GABA receptors

66
Q

Celiac disease small intestion biopsy

A

severe atrophy and blunting of the villi; chronic inflammatory infiltrate of the lamina propria

67
Q

Small bowel obstruction

A

Bilious vomiting, abdominal distention, air fluid levels, and small bowel distention

68
Q

Meconium ileus

A

distal small bowel obstruction in a neonate due to abnormally dehydrated meconium; associated with cystic fibrosis

Pneumonias, bronchiectasis, bronchitic obstructive pulmonary disease, associated cor pulmonale lead to eventual death in CF patients

69
Q

First pharyngeal (branchial) arch

A

CN V

Neural crest cells: Maxilla, zygoma, mandible, vomer, palatine, incus, and malleuls

Mesodermal derivatives: muscles of mastication, anterior belly of digastric, mylohyoid, tensor tympani, tensor veli palatini

70
Q

Second pharyngeal (branchial) arch

A

CN VII

Neural crest derivatives: styloid process, lesser horn of the hyoid, stapes

Mesodermal derivatives: muscles of facial expression, stylohyoid, stapedius, posterior belly of digastric

71
Q

Catilaginous structures of the larynx embryological origin

A

Fourth and sixth branchial arch

UWorld (16 decks)

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