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UWorld > 2015.04.03 > Flashcards

2015.04.03 Flashcards

1
Q

IgA Nephropathy (Berger Disease) Clinical presentation

A

Painless hematuria 2-3 days following an upper respiratory tract infection

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2
Q

IgA Nephropathy Diagnosis

A

Detection of IgA deposits in mesangium of glomerui on IF

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3
Q

Henoch-Schonlein disease

A

IgA nephropathy associated with extra-renal symptoms:

1) skin: purpuric lesions on extensor surfaces
2) GI syndrome

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4
Q

Difference between Poststreptococcal Glomerulonephritis and IgA nephropathy

A

Both associated with recent upper respiratory or skin infection.

Timing differenetiates:

IgA - few days after infection

PSGN - few weeks to develop (+ low C3 levels, no mesangial IgA deposition)

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5
Q

Ligamentum teres

A

remnant of umbilical vein in the adult

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6
Q

Fetal Circulation

A

Umbilical vein

Ductus Venosus (bypasses hepatic circulation)

IVC

Heart

1) Pulmonary Circulation
2) Foramen Ovale
3) Ductus arteriosus (bypasses lung)

Umbilical arteries carries back deoxygenated blood

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7
Q

Ligamentum Arteriosum

A

Remnant of ductus arteriosus

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8
Q

Ligamentum venosum

A

Remnant of ductus venosus

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9
Q

Insulin-like growth factor-1 (IGF-1)

A

Produced by liver and binds to cell membrane-associated receptors with tyrosine kinase activity

Anti-apoptotic and anabolic effects

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10
Q

Protein Kinase A

A

Activated by cAMP formed by adenylate cyclase.

Phosphorylates threonine and serine residues.

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11
Q

k-RAS

A

G-protein that participates in cellular signaling.

Mutations are common in pancreatic malignancies

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12
Q

TATA Box

A

Promoter region that binds transcription factors and RNA polymerase II during the initiation of transcription

25 bases upstream from coding region

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13
Q

Shine-Dalgarno

A

Translation stimulatory sequences

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14
Q

Reduction of plaque stability

A

Macrophages secreting metalloproteinases, which degrade collagen.

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15
Q

Procollagen peptidase

A

Cleaves terminal regions of procollagen molecules exocytosed by fibroblasts or SMC, transforming the procollagen into insoluble tropocollagen, which aggregates to form collagen fibrils.

Deficient in Ehlers-Danlos Syndrome

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16
Q

Ehlers-Danlos syndrome

A

disorganized collagen bundles

Stretchable skin, hypermobile joints, short stature

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17
Q

Leptin

A

Protein hormone produced by adipocytes in proportion to quanity of fat stored.

Acts on arcuate nucleus of hypothalamus to:

1) inhibit neuropeptide Y, a potent appetite stimulant
2) stimulates production of POMC which is cleaved into alpha-MSH (increases satiety)

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18
Q

Actue Cardiac Transplant Rjection

A

Occurs weeks follow transplantation and is cell-mediated process.

Sensitized Host T-lymphocyte sensitization against graft MHC antigens.

Dense infiltrate of mononuclear cells (mostly T-lymphocytes)

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19
Q

Hypersensitivity Myocarditis

A

Perivascular infiltrate with abundant eosinophils.

Due to initiation of new drug therapy (body mounts atopic response)

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20
Q

ETEC

A

Traveler’s diarrhea

Heat labile (LT, similar to cholera toxin): activates adenylate cyclase and increases intracellular cAMP

Heat stabile (ST): activates guanylate cyclase and increases cGMP

Water and electrolyte loss and watery diarrhea

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21
Q

Intestinal invasion

A

Salmonella

Shigella

EIEC

Campylobacter jejuni

Entamoeba histolytica

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22
Q

“Stacked-brick” intestinal adhesion

A

Enteroaggregative E. Coli (EAEC)

Adhere to human jejunal, ileal, and colonic mucosa

Persistent diarrhea in infants

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23
Q

Xanthomas

A

Yellow nodules composed of lipid-laden histiocytes in the dermis.

1) Eruptive - yellow papules
2) Tuberous
3) Tendinous (Achilles and extensor tendons of the fingers)
4) Plane (linear lesions in skin folds assoc. with primary biliary cirrhosis)
5) Xanthelasma (soft eyelid or periorbital plaques)

Suggestive of hyperlipidemia

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24
Q

Prolactinomas

A

Most common pituitary tumors.

High levels of prolactin suppress gonadotrophin-releasing hormone (GnRH) from the hypothalamus, resulting in hypogonadism (low estrogen), anovulation, ameorrhea.

Low estrogen caues accelerated bone loss and vaginal dryness.

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25
Q

Furosemide

Torsemide

Bumetanide

Ethacrynic acid

A

Loop Diuretics

Inhibits Na-K-2Cl cotransporter in the thick ascending loop of Henle

Causes:

Hypokalemia

Metabolic alkalosis

Hypocalcemia

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26
Q

Hydrocholorothiazide

Chlorothalidone

Indapamide

Metolazone

A

Thiazide diuretics

Inhibits the Na-Cl cotransporter in early DCT

Results in:

Hyponatremia

Hypercalcemia

Hypokalemia

Metabolic alkalosis

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27
Q

Amiloride

Triamterene

A

Sodium channel blockers (Inhibits the apical ENaC channel in the CCT)

Results in:

Hyperkalemia

Metabolic acidosis

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28
Q

Spironolactone

Eplerenone

A

Mineralcorticoid receptor antagonists

Inhibits apical ENaC channel & basolateral Na/K ATPase pump in CCT

Results in:

Hyperkalemia

Metabolic acidosis

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29
Q

Thiazides vs. Loop Diuretics

A

Cause significant volume depletion, activating the renin-angiotensin-aldosterone system - leads to hypokalemia and metabolic alkalosis.

Thiazides - hyponatremia and hypercalcemia

Loop diuretics - hypocalcemia

(Loop diuretics mess up corticomedullary concentration gradient, and lose both salt and water; Thiazide diuretics are better able to retain free water in response to ADH and develop hyponatremia)

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30
Q

Somatic Symptom Disorder

A

Unexplained medical symptoms and excessive health care use.

Managed by regularly scheduled visits that focus on the goal of functional improvement to decrease stress and improve coping strategies.

31
Q

Contraindications to use of OCPs

A
  1. Prior history of thromboembolic event or stroke
  2. History of an estrogen-dependent tumor
  3. Women over age 35 years who smoke heavily
  4. Hypertriglyceridemia
  5. Decompensated or active liver disease (impair steroid metabolism)
  6. Pregnancy
32
Q

Oral Contraceptive Pills

A

Estrogen - suppress midcycle gonadotropin surge, inhibiting ovulation

Progesterone - counteract increased risk of endometrial cancer (due to unopposed effect of estrogen); also decreases peremeability of cervical mucus to sperm

Side effects: Menstrual bleeding, breast tenderness, weight gain, and cardiovascular events (DVT, PE, IS, MI)

33
Q

Base Excision Repair Pathway

A
  1. Glycosylases remove defective base
  2. Endonuclease cleaves 5’ end of sugar-phosphate
  3. Lyase cleaves 3’ end of sugar-phosphate
  4. DNA polymerase
  5. Ligase
34
Q

Arsenic Poisoning

A

GI symptoms, decreased level of consciousness, hypotension, tachycardia and garlic odor on breath

35
Q

Dimercaprol

A

Chelating agent for arsenic poisoning

Displaces arsenic ions from sulfhydryl groups of enzymes

Side effets: nephrotoxicity and HTN

36
Q

EDTA

A

Chelating agent for treatment of acute lead and mercury poisoning.

Forms complexes with mono-, di-, and trivalent ions

37
Q

Amyl nitrate

A

Treatment of cyanide poisoning by forming methemoglobin that binds cyanide ions, forming the no-toxic compound cyanomethemoglobin. (Prevents cyanide from binding to mitochondrial enzymes in the tissues)

38
Q

Deferoxamine

A

Chelating agent to treat iron poisoning; binds iron in bloodstream and facilitates its urinary excretion

39
Q

Methylene blue

A

Treatment of methemoglobinemia. Reducing agent that converts iron in heme from the Fe3+ to Fe2+ state.

40
Q

Folate Deficiency

A

Needed for the reaction catalyzed by thymidylate synthetase (5,10-MethylTHF + dUMP -> dihydrofolate + dTMP)

This is only de novo pathway for dTMP production.

Leads to megalobastosis and erythoid precursor cell apoptosis.

Thymidine supplementation uses salvage pathway with thymidine kinase to increase dTMP levels.

41
Q

Staphylococcal Scalded Skin Syndrome (SSSS)

A

Exfoliatin exotoxin - acts as protease and cleaves desmoglein in desmosomes.

Nikolsky’s sign: skin slipping off with gentle pressure, epidermal necrolysis, fever and pain.

Also causes Bullous impetico - local form of SSS

42
Q

Boiled eggs insufficiently cooked

A

Salmonella

43
Q

Somatic Sensory of the tongue

A

LIngual nerve (branch of mandibular division of trigeminal - V3) supplies anterior 2/3 of tongue.

V3-also sensory info to skin of phase.

Glossopharyngeal (CN IX) provides posterior 1/3.

44
Q

Hypoglossal nerve muscle innervation

A

CN XII

All intrinsic muscles of tongue except palatoglossus muscle (CN X innervation)

45
Q

Vagus Nerve

A

CN X

Innervates palatoglossus muscle

Carries taste signals from the pharynx and epiglottis (not from tongue)

46
Q

Adrenal Crisis

A

Hypotensive, tachycardic, hypoglycemic (shock-like states)

Usually history of adrenal insufficiency (vomiting, abdominal pain, weight loss, and hyperpigmentation)

Treatment: Glucocorticoids immediately - needed for vasoconstriction

47
Q

Epinephrine Indications

A

Treatment of anaphylaxis, severe asthma, and cardiac arrest.

Stimulates both alpha- and beta-adrengic receptors (promote vasoconstriction and vasodilation); not potent vasoconstrictor.

48
Q

Cystinuria

A

autosomal recessive

Defective transporter of dibasic amino acids (ornithine, arginine, lysine, and cystine) on jejunal cells and proximal tubular cells

Risk for cystine (only) precipitation esp when low urine pH and urine supersaturation.

Kidney stones recurrent. Urinalysis - hexagonal cystine crystals.

49
Q

Osteogenesis imperfecta

A

blue sclerae

history of fractures after minimal trauma

Due to deficiency/abnormality in Type I Collagen.

autosomal dominant

50
Q

Type I Collagen

A

Predominant collagen in bones; also teeth, ligaments, skin, sclera.

Gives flexibility to bone.

51
Q

Bone Matrix

A

Inorganic (hydroxyapatite crystals) and organic (type 1 collagen) components.

52
Q

Defective mineralization of bone matrix

A

vitamin D deficiency

53
Q

Endochondral ossification

A

makes long bones

Mesenchymal cells differentiate into chondroblasts, which secrete cartilage matrix, forming a cartilage template.

Cartilage becomes calcified and ivaded by osteoblasts, osteoclasts, and blood vessels from periosteum.

Deposition of osteoid matrix over the septa of calcified cartilage matrix (woven bone) which undergoes remodeling into compact bone.

54
Q

Intramembranous ossification

A

makes flat bones (eg, skull bones)

Mesenchymal cells differentiate directly into osteoblasts and secrete osteoid matrix secretion without the formation of cartilaginous bones.

55
Q

Thiazide diuretics “HYPER” side effects

A
  1. Hyperuricemia - acute gouty arthritis
  2. Hypercalcemia - useful for treating nephrolithiasis secondary to hypercalciuria
  3. Hyperglycemia - bad for diabics
  4. Hyperlipidemia - increase cholesterol and LDL levels
56
Q

Thiazide diuretics “HYPO” problems

A
  1. Hypokalemia - common effect of all diuretics, except K-sparing agents
  2. Hypotension - primary function of thiazides is to reduce blood pressure
57
Q

Niacin and Gemfibrozil

A

Increase HDL

58
Q

Heparin-induced thrombocytopenia (HIT)

A

Occurrence with Heparin, especially Unfractionated Heparin compared to LMWH.

Causes paradoxical thromb​osis rather than bleeding.

Antibodies to Heparin and platelet factor IV.

Treatment: Direct thrombin inhibitors

59
Q

Hirudin

Lepirudin

Argatroban

A

Direct thrombin inhibitors

Do not require anti-thrombin-III for their actions.

DOC for HIT

60
Q

Ticlopidine

Clopidogrel

A

Inhibit ADP mediated platelet aggregation.

Treatment of: unstable angina, non-Q wave MI

61
Q

Dipyridamole

Cilostazol

A

Inhibit platelet aggregation by inhibition phosphodiesterase activity and increasing cAMP

62
Q

Abciximab

Eptifibatide

Tirofiban

A

Glycoprotein IIb/IIIa inhibitors that inhibiti binding of platelet glycoprotein IIb/IIIa with fibrinogen and fibronectin.

63
Q

Kartagener Syndrome

A

primary ciliary dyskinesia - failure of dynein arms to develop normally

Situs inversus, Chronic sinusitis, Bronchietasis

64
Q

Deficiency of C1 complement component

A

Encapsulated bacteria:

  1. Streptococcus pneumoniae
  2. Haemophilus influenzae
  3. Neisseria meningitidis

Also predisposed to develop SLE

65
Q

Subarachnoid Hemorrhage Complication

A

1) Secondary arterial vasopsasm - cerebral ischemia, which presents as new-onset confusion and/or focal neurological deficit 4-12 days later

Prophylaxis: Nimodipine (selective Ca channel blocker) to prevent vaspospasm

2) Rebleeding - only 30%. CT would show newly-extravasated blood.
3) Hydrocephalus - due to irritation of arachnoid villi; confusion, headahce, incontinence, gait instability, cognitive deterioration. CT would show increased CSF pressure and ventricular dilation.

66
Q

Mature defense mechanisms

A

Altruism

Sublimination

Suppression

Humor

67
Q

Sarcoidosis

A

Erythema nodosum

Arthralgias

Hilar lymphadenopathy

Elevated serum ACE levels

Biopsy: scattered noncaseating granulomas

68
Q

Periportal hepatic fibrosis

A

Chronic viral hepatitis

69
Q

Drug-induced Lupus

A

happens with drugs like with hydralazine and procainamide

both agents are metabolized via phase II N-acetylation in the liver.

Slow acetylators develop lupus more often

anti-histone antibodies

70
Q

Abnornal bleeding into joint spaces (hemarthrosis)

A

Generally due to caogulopathy.

Hemophilia A is the most common inherited coagulopathy.

X-linked inheritance.

Increased PTT

71
Q

Statins Side Effects

A

Hepatotoxicity

Myopathy - myositis causes elevations of creatinine kinase and usually occurs with higher doses of statins (used for patients who had MI); risk is increased with use of fibrates and/or niacin.

Fibrates, niacin, hydroxychloroquine, glucocorticoids, colchicine, IFN-a and penicillamine also assoc. with myopathy.

72
Q

All-trans-retinoic acid (ATRA)

A

Treatment for acute promyelocytic leukemia by stimulating differentiation of myeloblasts into mature granulocytes.

73
Q

Chronic lymphocytic leukemia

A
74
Q

Xanthomas vs. Xanthelasmas

A

Xanthomas have finely vacuolated, “foamy” cytoplasm with high levels of lipids. Lipid laden macrophages are enclosed by inflammatory cells and fibrotic stroma.

Xanthelasmas have small aggregates of dermal foam cells without any surrounding inflammation or fibrosis

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