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step 1 - elise > UWorld Day Three > Flashcards

UWorld Day Three Flashcards

1
Q

Demyelination of a nerve directly decreases ___. Directly increases ___.

A

Decreases the length constant (the distance the impulse can travel).
Increases the time constant.

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2
Q

Fever, tinnitus, tachypnia, and an empty pill bottle - what was ingested and what ABG toxicity?

A

Aspirin toxicity (two steps).

  1. Respiratory alkalosis - salicylates directly stimulate the medullary respiratory center, causing hyperventilation.
  2. Anion gap metabolic acidosis - salicylates increase lipolysis, uncouple oxphos, and inhibit TCA –> accumulation of organic acids in blood (ketoacids, lactate, pyruvate).
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3
Q

What would the ABG (pH, PaCO2, HCO3) be 4-5 hours after aspirin toxicity?

A 
normal range pH
low PaCO2 (respiratory alkalosis and compensation for metabolic acidosis)
low HCO3 (metabolic acidosis)
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4
Q

Name the etiology and MOA:

A person ate sushi and presents with dizziness, weakness, loss of reflexes, paresthesias of face and extremities, N/V/D.

A

Tetrodotoxin from puffer fish binds to VGSC in nerve and cardiac tissue and prevents Na influx and depolarization.

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5
Q

TPR in parallel v. in series for R1, R2, R3, R4

A

In parallel: 1/TPR = 1/R1 + 1/R2 + 1/R3 + 1/R4 —> TPR = 1/(total added)
In series: TPR = R1 + R2 + R3 + R4

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6
Q

Antiepileptics with MOA of:

  1. inhibiting presynaptic VGCaC
  2. disrupting vesicle fusion
  3. blocking VGNaC
A
  1. Gabapentin
  2. Leviteracitam
  3. Phenytoin and carbamazepine
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7
Q

A middle age man with SOB, elevated liver enzymes, and no history of smoking or alcohol.

A

Alpha-1 Antitrypsin. Panacinar emphysema with cirrhosis due to build up of AAT in liver.

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8
Q

Morphine MOA

A

opioid. Morphine binds to mu-receptors, activating K-efflux, which hyperpolarizes and blocks pain conductance.

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9
Q

lanosprazole

A

PPI (same as omeprazole)

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10
Q

sx: PSVT

Admin ___ drug with AE of flushing, burning in chest, hypotension, AV block, SOB

A

adenosine - suppresses Ca influx.

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11
Q

Nitroglycerine (AHF and severe HTN) does what to levels of:
LVEDP
Venous capacitance
Systemic Vascular Resistance

A

decrease
increase
decrease

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12
Q

MOA of sulfonylureas and meglitinides

A

DM - increase insulin release (so increase C-peptide)

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13
Q

What two drugs decrease hepatic glucose production and increase sensitivity to insulin?

A

Metformin and rosiglizazone

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14
Q

Why take nitrates NOT around the clock?

A

because tolerance formation

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15
Q

Drugs involved in anti-histone ab presence

A

SHIPP-E: Sulfa-drugs, Hydralazine, INH, Procainamide, Phenytoin, Etanercept (TNF-alpha inhibitors)

Due to acetylation

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16
Q

Hyperphosphatemia, hypocalcemia, hyperK, hyperuricemia. Give what two drugs to decrease uric acid buildup during chemo-induced cell breakdown

A

hydration, allopurinol and rasburicase

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17
Q

HypoK –> mm weakness and arrhythmias, shake and bake, type 1 RTA. What drug toxicity. (Histo infxn)

A

Amphoterecin B

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18
Q
  1. Two causes of angioedema (1 drug, one genetic) due to bradykinin buildup.
  2. Two causes of angioedema due to mast cell activation.
  3. Sx Difference between mast cell activation and bradykinin.
A

ACE inhibitors, C1 inhibitor deficiency –> NO PRURITIS OR URTICARIA

Type 1 HSR, IgE mediated and direct mast cell activation –> PRURITIS AND URTICARIA

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19
Q

SE of what:
adipose - Lipolysis, altered fat distribution
adrenal cortex - atrophy
bone - osteoporosis
immune - suppression, T cell apoptosis
liver - increased gluconeogenesis and glycogenesis (LARGEST INCREASE IN PROTEIN SYNTHESIS)
skeletal muscle - atrophy
skin - thinning, stria, impaired wound healing

A

glucocorticoids

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20
Q

Difference between competitive and noncompetitive antagonists on graph.

A
  • Competitive cause graph to shift right, meaning higher concentrations of agonist can have same biological effect.
  • Noncompetitive antagonists cause the competitive agonist curve to lower in biological activity because regardless of agonist concentration, its effects are blocked.
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21
Q

__ = amount of drug given (mg) / plasma concentration of drug (mg/L)

A

Volume of distribution (L)

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22
Q

What type of volume of distribution (low or high):

  1. high molecular weight, high plasma protein binding, high charge, hydrophilicity
  2. small molecular weight, uncharged (lipophilic or hydrophobic)
A
  1. Low Vd because drug trapped in plasma compartment

2. High Vd because can cross easily through cell membrane into intracellular compartment

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23
Q

COX-2 selective inhibitor (only inflammation).

AE

A

celcoxib

AE is thrombosis bc TXA2 (causes platelet aggregation) is dependent on COX-1 and thus, not inhibited.

24
Q

Calcium plays what role in vasculature?

So give CCB after what?

A

Causes vasoconstriction

Give CCB after a SAH to prevent cerebral vasospasm.

25
Q

Always use ___, even if HDL is low.

MOA

Do not administer wtih what type of drugs?

A

Use a statin to lower LDL (not niacin to increase HDL) - because statins decrease risk of CV event.

Stains inhibit HMG-CoA Reductase

Do not administer with drugs that inhibit CYP34A

26
Q

What lipid lowering therapy decreases serum TGs most? Primarily used to prevent pancreatitis in people with high HDL.

MOA?

A

fibrates

MOA - activates transcription factor PPAR to increase lipoprotein lipase activity

27
Q

When do you give ezetimibe?

A

When person cannot take statin due to myopathy or hepatotoxicity.

28
Q

What drug inhibits Na/K ATPase pump, which increases Na intracellularly, promoting Ca influx through Na(out)/Ca(in) and increasing myocardial contractility?

A

Digoxin

29
Q

dobutamine - what type of drug?

A

Beta 1 adrenergic agonist. So Gs, increasing cAMP and increasing cytosolic Ca, increasing myocardial contractility.

30
Q

Biologic agents:

  • mab =
  • cept =
  • nib =
A 
monoclonal ab (i.e. rituximab)
receptor molecule (i.e. etanercept)
kinase inhibitor (ie. imatinib)
31
Q

Open angle glaucoma (Increased IOP) drugs (three classes):
____ diminishes aqueous humor secretion by ciliary epithelium
____ decreases aqueous humor secretion by ciliary epithelium
____ decrease IOP by increasing outflow of aqueous humor

A

NS-Beta blocker (timolol)

CAI (acetazolomide)

PGF2alpha (latanoprost, travoprost) or Cholinomimetics (pilocarpine, carbachol)

32
Q

What molecule binds GP1b?
Deficiency in the above molecule results in what change in blood tests?
Function of ristocetin

A

vWF binds GP1b.

Abnormal ristocetin and decrease F8, so increased PTT.

Ristocetin activates vWF to bind GP1b.

33
Q

How is Bernard-Soulier different from vWF deficiency?

A

Bernard is hereditary deficit in GP1b receptors.
vWF is a deficiency.

Ristocetin will be abnormal for both, but when normal plasma is added, vWF will have a normal ristocetin test while Bernard will not.

34
Q

What is GP2b-3a deficiency? What is ristocetin test - abn or normal?

A

Glanzmann thrombasthenia. Normal ristocetin

35
Q

thrombocytopenia, enlarged platelets, mucocutaneous bleeding

A

Bernard-Soulier

36
Q

What is mosaisism, Robertsonian (unbalanced) translocation, and _____ = ___?

A

meiotic nondisjunction = 3 causes of Down Syndrome

meiotic nondisjunction can also cause Kleinfelter

37
Q

Alk phos measures what cell in bone remodeling?

A

osteoblast - it is released as bone matrix is synthesized

also released from liver, placenta, and intestine. bone alk phos is denatured by heat

38
Q

TRAP, urinary hydroxyproline, and urinary deoxypyridinoline measure acitivity of what cell in bone remodeling?

A

osteoclast

39
Q

give what substance to promote apoptosis/menstrual bleeding?

A

medroxyprogesterone

40
Q

What is a drug used for peripheral artery disease that arterial vasodilates and decreases platelet aggregation?

A

cilastazol - a PDE inhibitor

41
Q

What IL-__ has ANTI inflammatory properities?

A

IL-10 (reduces Th1, MHC2, macrophages, and DC)

42
Q

MC pathogens that infect sickle cell patients

A

HiB and Strep pneumo

43
Q

Why is there pretibila myxedema in gRaves disease (hyper thyroid)

A

bc autoimmune response to TSH receptors causes buildup of glycosaminoglycans

44
Q

foot slap - nerve. cannot evert food, cannot feel sensation on dorsum or lateral shin

A

common fibular

45
Q

Causes pneumonia, brain abcesses, and cutaneous involvement in esp immunocompromised. Gram positive, catalase positive, Acid fast

A

Nocardia

46
Q

mucosal neuromas with marfanoid habitus

A

MEN 2B (pheo, mucosal neuromas, marfanoid habitus, medullary thryoid.

47
Q

Pancreatic tumor (esp gastrinoma), Pituitary (prolactinoma and visual defects), and Primary hyperparathyroid (hypercalcemia)

A

MEN1

48
Q

Medullary thyroid carcinoma (calcitonin), pheochromocytoma, parathyroid hyperplasia

A

MEN2A

49
Q

three Bacteria that use transformation - the direct uptake of naked DNA

A

Strep pneumo, Haemophilus, N gono/meningitidis

50
Q

S3 is best heard in left lateral decibitus position at _____ time. Abn in adults - indicates ___

A

ventricular enlargement, best heard at the end of exhalation

51
Q

Cardiac tamponade, COPD, severe asthma, and constrictive pericarditis all have what in common?

A

pulsus paradoxus (systolic >10mmHg different upon inspiration v expiration

52
Q

Arterial supply to ureters:

A

proximally is renal artery
distally is superior vesicle artery
in between in variable and anastomotic

53
Q

testosterone secreting ovarian tumor

A

sertoli-leydig

54
Q

What does mitochondrial vacuolization signify?

A

irreversible cellular damage

55
Q

“bilateral hilar LAD”

A

sarcodiosis

56
Q

what drug inhibits platelet aggregation by irreversibly blocking ADP receptors, which dows not allow for GP2b3a expression, thus inhibiting fibrinogen binding.

A

clopidogrel

step 1 - elise (30 decks)

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