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UWorld mixed > #5 3/9 > Flashcards

#5 3/9 Flashcards

1
Q

Histology of (1) zona glomerulosa (2) zona fasiculata (3) zona retiularis (4) adrenal medulla

A

(1) rounded/arched cluster (2) foamy-appearing cells in columns (3) basophilic cells in anastomosing cords (4) basophilic cytoplam

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2
Q

Adrenal medulla releases…

A

80% Epi, 20% Norepi

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3
Q

Aldosterone secretion from zona glomerulosa regulated by… (2 things)

A

(1) Angiotensin II (2) extracellular K+ levels

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4
Q

TNF-alpha inhibitors treat…

A 
Rheumatoid arthritis (STUDY MORE)
etanercept, inflixamab & adalimumab
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5
Q

First-line drug for established rheumatoid arthritis

A

methotrexate

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6
Q

NSAID side effects (3)

A

GI ulcer and bleeding, fluid retention (block prostaglandin-mediated vasodilation of afferent arteriole)

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7
Q

Kallmann’s syndrome

A

Failure of GnRH-secreting neurons to migrate from olfactory lobes to hypothalamus (migration problem)

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8
Q

Thyroid development

A

(1) lower end of pharynx (2) migration along thyroglossal duct, from foramen cecum on dorsal surface of tongue to superior border of thyroid isthmus (can become sublingual if impaired

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9
Q

Parafollicular C-cells originate from

A

ultimobranchial bodies

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10
Q

Clinical presentation of hypothyroidism in children

A

lethargy, feeding problems, constipation, macroglossia, umbilical hernia, large fontanels, dry skin, hypothermia, prolonged jaundice

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11
Q

How does an enzyme speed up the reaction rate?

A

reduce the energy of the transition state (activation energy); cannot alter Gibbs free energy

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12
Q

deltaG describes..

A

direction of a chemical rxn & concentrations of reactants and products at equilibrium

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13
Q

deltaG0 describes..

A

change in free energy that accompanies formation of 1 mol of products from substrate under standard condition
exothermic = -deltaGo (spontaneous)
endothermic = +deltaGo

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14
Q

Differentiate mucor/rhizopus from aspergillus on microscopy & affected population

A

irregular BROAD non-septate hyphae branching at WIDE angles (vs. septate hyphae that branch at 45 degrees).

Aspergillus: chronic granulomatous disease & immunocompromised
Mucor/Rhizopus: diabetic ketoacidotic & leukemic

Both can cause sinusitis in immunosuppressed

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15
Q

Dimorphic Fungi

A

Body Heat Changes Shape: blastomycoses, histoplasma, coccidiomycoses, sporothrix

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16
Q

Thyrotoxicosis on serum calcium

A

hypercalcemia due to increased bone resorption

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17
Q

Familial hypocalciuric hypercalcemia (inheritance and defect)

A

autosomal dominant, defective calcium-sensing receptor on parathyroid cells & kidney

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18
Q

Hydrochlorothiazide electrolyte abnormalities:

A

elevated: glucose, lipid, uric acid, calcium
decreased: potassium, magnesium, sodium

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19
Q

Hypothyroid effect on skeletal muscle

A

myopathy: pale muscle fibers, decreased striation, deposition of mucinous material. atrophy or type II muscle fibers (increase in creatine kinase)

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20
Q

Elevated creatinine kinase isoform localize: CK-MB, CK-BB, CK-MM

A

CK-MB: cardiac muscle
CK-BB: nervous system
CK-MM: skeletal muscle

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21
Q

Common causes of elevated creatine kinase (4)

A

hypothyroidism, HMG-CoA reductase (statins), autoimmune disease (polymyositis, dermatomyositis), muscular dystrophy (Duchenne)

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22
Q

evolution of EPS side effects & Rx

A

4 hr: acute dystonia (muscle spasm, stiff, oculogyric crisis) rx: diphenhydramine
4 day: akathisia rx: propanolol
4 wk: bradykinesia rx: benztropine
4 mo: tardive dyskinesia rx: discontinue

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23
Q

localize thyroid hormone receptor

A

inside nucleus (also, retinoids, peroxisomal proliferating activated receptors, and fatty acids)

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24
Q

resistance to rifampin

A

genetic mutation in DNA-dependent RNA polymerase (RAPID when monotherapy)

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25
Q

use of rifampin (3)

A

(1) prophylactic monotherapy for H. flu and N. meningitidis; combo: (2) mycobacterium TB (3) leprosy

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26
Q

Rx: MAC

A

macrolide (clarithromycin or azithromycin)
rifampin
ethambutol

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27
Q

Rx: penicillin-resistant pneumococcus

A

ceftriaxone & vancomycin combination

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28
Q

Rx: staphylococcal endocarditis

A

IV penicillin & rifampin or aminoglycoside (synergistic)

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29
Q

Use of colchine & mechanism of action

A

rx: for acute gout & prophylaxis
binds & stabilizes tubulin, inhibiting leukocyte chemotaxis and degranulation
also reduces LTB4

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30
Q
  • 1st line Rx: acute gout

- preferred Rx in elderly/renal failure

A
  • NSAID (anti-inflammatory, analgesic, anti-pyretic)

- intra-articular glucocorticoids

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31
Q

Side effect of colchine

A

GI

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32
Q

Use of leukotriene modulators (zileuton, montelukast, zafirlukast)

A

preventing recurrent of asthma & allergic rhinitis

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33
Q

ADH signal transduction

A

V2 receptor on principal cells in collecting duct -> increased cAMP -> fusion of endosomes with aquaporin 2 to luminal side -> increased water reabsorption

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34
Q
  • highest & lowest tubular fluid osmolarity location (in presence of ADH? in absence?)
  • osmolarity in PCT
A

highest: bottom of loop of henle (1200mOsm when ADH is high)
lowest: DCT (100mOsm)
PCT equivalent to serum (300mOsm)

in absence of ADH, most dilute in collecting ducts (as low as 50mOsm)

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35
Q

Cause of focal brain lesions in HIV+patients

& other causes in any pt

A

toxoplasma, CNS lymphoma (B cell; related to latent EBV infxn)
& primary brain tumor (globlastoma multiforme), metastatic carcinoma, abcesses (cryptococcus, TB)

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36
Q

Irreversible neuronal damage (neuronal shrinkage, eosinophilic cytoplasm) leads to

A

glial hyperplasia; reactive gliosis (NOT fibroblast)

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37
Q

Vertebral level: bifurcation of abdominal aorta

& common iliac vein merge to IVC

A

L4

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38
Q

vertebral level: renal vein entering IVC

A

L1-2

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39
Q

interomediolateral nucleus (lateral horn) levels

A

T1-L2

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40
Q

appetite suppressants (fenfluramine, phentermine, dexfenfluramine) for >3 months causes..

A

pulmonary HTN -> cor pulmonale -> sudden death from arrhythmia

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41
Q

cerebral berry aneurysm associated with which genetic disorders?

A

ADPKD and Eherlos-Danlos

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42
Q

medial calcinosis (affected vessels and prognosis)

A

calcific deposits in muscular artery >50y/o. affects femoral, tibial, radial, ulnar. and arteries to genital tract. do not narrow lumen, so asymptomatic

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43
Q

prominent finding in neonate/fetus with Turner (45X,O) along with others (think: lymph, cardiac, kidney)

A
  • lymphedema of hands and feet
  • abnormal nuchal lymphogenesis (subcutanoue nuchal edema and cystic hydroma)
  • webbed neck/low posterior hairline
  • cardiac abnormalities: coarctation of aorta, bicuspid aortic valve
  • horseshoe kidney
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44
Q

adult presentation of Turner syndrome

A

(45 X,O) short stature, broad shield-like chest, webbed neck, primary ovarian failure – streaked)

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45
Q

fetus with Down Syndrome

A

trisomy 21; flat face, abnormal ears, slanted palpebral fissures, redundant skin at nape of neck, hypotonia, pelvic dysplasia, single transverse palmar crease

46
Q

Edwards syndrome

A

trisomy 18; edwards: prominent occiput, micrognathia, small mouth, low-set and malformed ears, rocker-bottom feet. CHARACTERESTIC: clenched hands with index overriding the middle finger, 5th overriding 4th

47
Q

1st most common autosomal trisomy in liveborn infants? 2nd? 3rd?

A

trisomy 21, downs
trisomy 18, edwards
trisomy 13, patau (most severe)

48
Q

Patau syndrome

A

trisomy 13; patau: holoprosencephaly, microcephaly, polydatyl, rocker-bottom feet. mult facial abnormalities (hypotelorism, micropthalmia, cleft lip, cleft palate, absent or malformed nose)

49
Q

47 XXX

A

clinically silent, decreased IQ, no increase risk of stillbirth

50
Q

Klinefelter syndrome

A

47 XXY; mild mental retardation or normal intelligence. tall male with gynecomastia, small testes, and infertility. no increase risk of stillbirth

51
Q

glucose-6-phosphate dehydrogenase catalyzes what rxn?

A

glucose-6-phosphate –> 6-phosphogluconate (with NADP+ –> NADPH. rate limiting step in HMP shunt

52
Q

glucose through hexose monophosphate (HMP) shunt creates…

A

(1) oxidative: NADPH as a reducing equivalent
- requires glucose-6-phosphate
(2) reductive: ribose 5-phosphate for nucleotide synthesis & intermediates for glycolysis
- requires transketolase (thiamine-dependent)

53
Q

How do RBCs protect against oxidative injury?

A

HMP shunt, generates NADPH to maintain glutathione in a reduced state (via gluathione reductase)

54
Q

G6PD histology & precipitants

A

X-linked; Heinz bodies (denatured hemoglobin from oxidative damage), destroyed in spleen
PAINS: primaquine, aspirin, isoniazid nifuratoin, sulfonamides

55
Q

Ascorbic acid

A

vitamin C; hydroxylation of proline and lysine residues in collagen: CT maintenance and wound-healing

56
Q

Clinical presentation of orotic aciduria and Rx

A

impaired de novo pyrimadine synthesis: hypochromic megaloblastic anemia, neurologic abnormalities, growth retardation, excretion of orotic acid in urine; uridine supplementation, inhibit carbamoyl phosphate synthetase II

57
Q

Resting potential of skeletal myocytes? cardiac myocytes?

A
  • 75mV for skeletal

- 90mV for cardiac (reduced risk of arrhythmia)

58
Q

Plataeu phase of cardiac myocyte action potential

A

phase 2: opening of L-type DHP-sensitive Ca++ channels and closure of some K+ channels

59
Q

Orchiectomy vs. Orchipexy

A

removal of abdominal testes vs. surgery that allows descent

60
Q

Effect of having one testicle on (1) androgen levels (2) inhibin B levels

A

(1) androgen not effected (compensation)

2) inhibin decrease (FSH increase

61
Q

High levels of cortisol on GnRH secretion

A

hypogonadotropic hypogonadism (suppressed GnRH hormone)

62
Q

Lipofuscin pigment

A

‘wear and tear’ pigment; finely granular yellow brown pigment granules composed of lipid containing residues of lysosomal degradation (part of normal aging: heart, liver, kidney…)

63
Q

Pathologic ventricular hypertrophy is characterized by… (2)

A

(1) morphologic changes (increased sarcomere content & volume of myocyte) and (2) gene transcription changes, i.e: ANP

64
Q

ANP vs. BNP (who secretes it, in response to what)

A

ANP: secreted by atria & sometimes hypertrophic
BNP: predominately ventricles
both in response to volume overload –> natriuesis & diuresis

65
Q

Laplace’s law

A

distending pressure (pressure required to keep a sphere open) proportional to surface tension and inversely proportional to radius

P= 2T/r

as the radius of a sphere with constant ST decreases, pressure increases

66
Q

Surfactant (2 effects)

A

prevent smaller airways from collapsing during expiration & regulates alveolar expansion (all at similar rates)

67
Q

Chlamydia trachomatis cell wall

A

Lacks peptidoglycan in cell wall (muramic acid) and has cysteine residues instead (does have a cell wall, but can’t be treated with penicillin/cephalosporins)

68
Q

(2) organisms that lack a cell wall

A

Ureaplasma urealyticum & mycoplasma (increased cholesterol)

69
Q

causes of urethritis

A

gonococcal & (NGU) chlamydia trachomatic, ureaplasma urealyticum, mycoplasma, trichomonas. Rx: NGU: azithromycin

70
Q

chlamydia anomaly

A

chlamydia has PBPs and genes for peptidoglycan synthesis, but does not have peptidoglycan on cell wall

71
Q

MRSA survives penicillin by..

A

modification of PBPs

72
Q

Class IA antiarrhythmics (procainamide) are good for what type of arrhythmia

A

arising from centers of normal automaticity (rather than areas demonstrating abnormal automaticity)

73
Q

Class IV antiarrhythmics (verapamil) are good for…

A

atrial tachycardia (i.e. supraventricular tachycardia, bc slows conduction through AV node)

BAD for ventricular tachycardia; exacerbates

74
Q

use of adenosine

A

paroxysmal supraventricular tachycardia

75
Q

digoxin as an antiarrythmic

A

slow conduction through AV node

76
Q

Labetolol mechanism & use

A

blocks alpha and beta adrenergics (decreased PVR, HR, contractility, slow AV conduction). used for refractory HTN, hypertensive urgency / emergency, and patients with pheo

77
Q

Rx: ventricular tachycardia

A

amiodarone (class III) (used to be lidocarine class IB)

78
Q

Niacin/nicotinic acid/B3 side effects…

A

acute flare of gouty arthritis (hyperuricemia),
facial flushing (cutaneous vasodilation Rx: aspirin)
hyperglycemia (acanthosis nigricans)
heptatitis

79
Q

Mechanism of Niacin/nicotinic acid/B3

A

decrease hepatic synthesis of TGs and VLDL, increasing HDL

80
Q

Drugs that increase risk of gouty attacks

A

HCTZ, cyclosporine, pyrazinamide, Niacin

81
Q

Statin side effects

A

hepatitis, myopathy

82
Q

First-line Rx: hypertriglyceridemia & side effects

A

fibrates; gallstones & myopathy (worse w/ statins)

83
Q

Ezetimibe effect

A

inhibit intestinal absorption of cholesterol

84
Q

Bile acid-binding resins (cholestyramine) side effects

A

GI upset
Hypertriglyceridemia
malabsorption

85
Q

Acute monoarticular arthritis in septic arthritis vs. gout / pseudogout

A

septic arthritis (gonococcus) has high WBC (100,000) while gout / pseudogout has <20,000

86
Q

MDD diagnosis vs. Dysthymic

A

5 symptoms of SIG-E-CAPS for at least 2 wks w/ depressed mood or anhedonia

vs. dysthmic disorder: depressed mood for >2yrs w/ 2 symptoms

both respond to antidepressants

87
Q

Borderline personality disorder

A

instability in relationships and marked impulsivity
splitting: swing from scorning to idealizing
suicidal / self-mutilating

88
Q

Manifestation of transplant rejection

  • hyperacute
  • acute
  • chronic
A
  • vascular fibrinoid necrosis; neutrophil infiltrate; thrombosis; infarction
  • dense interstitial T-cell infiltrate (cell-mediated) OR vasculitis (Ab: in between hyperacute/chronic)
  • obliterative intimal smooth muscle hypertrophy and fibrosis
89
Q

Lung mass w/ hyponatremia =

A

SIADH, EUVOLEMIC

transient subclinical hypervolemia –> production of natriuretic peptides –> excretion of sodium

90
Q

Hyponatremia urine osmolarity DDx (2)

A
  • inappropriately concentrated >100mOsm = SIADH

- maximally dilute <100mOsm = polydypsia (appropriately low ADH)

91
Q

Course of adult polycystic kidney disease

A

asymptomatic; progressively worsening uremia. has renal, pancreatic, and hepatic cysts

92
Q

Risk during pelvic surgery (esp hysterectomy)

A

ligation of ureter, which runs posterior to uterine artery (ligated during hysterectomy for invasive cervical cancer)

93
Q

Vesicoureteral reflex can occur after what surgeries (2)

A

prostatectomy or bladder surgery

94
Q

Differentiate (3) Lambert-Eaton from Myasthenia Gravis

A

LEMS has…

(1) hyporeflexia or areflexia
(2) autonomic symptoms (dry mouth, impotence)
(3) better with stimulation / at the end of the day

95
Q

Myasthenia gravis is associated with what endocrine abnormality, and how does MG happen?

A

thymoma / thymic hyperplasia

MG is NOT inherited acquired autoimmune disease

96
Q

Polymyositis (3 characterizations)

A

idiopathic inflammatory myopathy characterized by (1) bilateral proximal muscle weakness (2) elevated creatinine kinase (3) electromyographic abnormalities

97
Q

Polymyalgia rheumatica (PMR) (2 characterestics)

A

sudden onset of stiffness, pain, and tenderness of musculature (esp shoulders, hips, neck, torso)
- classically elevated ESR

98
Q

Amyotrophic lateral sclerosis

A

(1) upper motor neuron disease – hyperreflexia, spasticity

(2) lower motor neuron disease – atrophy, fasiculation

99
Q

Guillain-Barre syndrome; onset and progression

A

acute post-infectious polyneuropathy (often after Campylobacter jejuni). progressive ascending paralysis

100
Q

Half of all LEMs have…

A

malignancy (small cell carcinoma usu)

101
Q

Localized amyloidosis in cardiac atria (isolated atrial amyloidosis; form of senile cardiac amyloidosis)

A

Natiuretic peptide
IAA risk increases w/ age ( >90% by 90)
senile cardiac amyloidosis: transthyretin, also in brain

102
Q

primary systemic amyloidosis deposits

A

immune globulin light chains (primarily lambda); in mesodermal tissue (heart, muscle, tongue)

103
Q

BRCA-1 gene location and action

A

AD, chr. 17, tumor supressor; control cell cycle & role in gene repair & transcription

104
Q

APC gene mutation associated w/..

A

decreased expression of D-cadherin adhesion molecule

105
Q

genome recombination

A

two defective virus co-infect same host cell yielding cytopathic wild-type genome. exchange of genes between two chromosomes via crossing over within homologous regions

106
Q

viral reassortment

A

exchange of whole genome sequences

107
Q

transformation

A

uptake of naked DNA by prokaryotic cell

108
Q

phenotypic mixing

A

co-infection of a host cell by two viral trains, resulting in a virion w/ nucleocapsid proteins from one strain and genome of other strain (alters infectivity)

109
Q

viral interference

A

one virus inhibits the replication/release of a second virus infecting the same cell

110
Q

sign of NE extravasation & antidote

A

cold, hard, pale IV site –> intense alpha-1 vasoconstriction –> local tissue necrosis. infuse phentolamine (reversible alpha-1 blocker)

111
Q

lidocaine is less effective in…

A

acidic, ischemic tissue (becomes charged)

UWorld mixed (60 decks)

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