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review / wrong answers > 5/26 - UWorld > Flashcards

5/26 - UWorld Flashcards

1
Q

What is CREST syndrome

A

· Calcinosis / anti-centromere antibody

· Raynoud

· Esophageal dysmotility

· Sclerodactyly (tightening of skin with loss of wrinkles)

· Telangiectasias

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2
Q

Cause and presentation of Hyper-IgE Syndrome (aka Job)

A

o Deficiency in IFN-y lead to impaired neutrophil recruitment

o Presentation - FATED

§ F – coarse Facies

§ A – Abscesses

§ T – retained primary Teeth

§ E – increased IgE (all other immunoglobulins are normal)

§ D – dermatologic problems (eczema)

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3
Q

Release and function of TNF-a

A

§ Secreted by activated macrophages

§ Mediates septic shock

§ Causes neutrophil and lymphocyte recruitment

§ Responsible for fever, anorexia, corticotrophin releasing hormone, septic shock, and cachexia

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4
Q

Infliximab

A
  • TNF-a inhibitor
    • Recall: TNF-a is an acute phase reactant produced by activated macrophages to mediate inflammation by accelerating neutrophil migration, and facilitate lymphocyte proliferation; TNF-a is responsible for fever, anorexia, corticotropin releasing hormone, septic shot, and cachexia
  • Mechanism of action:
    • Is a monoclonal antibody to TNF-a
  • Uses:
    • Used for autoimmune conditions due to anti-inflammatory effect
    • Rheumatoid arthritis, psoriasis, ankylosing spondylitis
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5
Q

Cyclosporine

A
  • Immunosuppressant
    • Blocks lymphocyte activation and proliferation
  • MOA:
    • Binds cyclophilin (protein within cytosol of T-cells)
    • Inhibits calcineurin (which stimulates IL-2) = prevention of IL-2 transcription
  • Uses:
    • Transplant rejection
    • Psoriasis
    • Rheumatoid arthritis
  • Toxicity
    • Nephrotoxicity
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6
Q

Tacrolimus

A
  • Immunosuppressant
    • Blocks lymphocyte activation and proliferation
  • MOA:
    • Binds FK506 binding protein
    • Inhibits calcineurin à prevention of IL-2 transcription
  • Uses:
    • Transplant rejection prophylaxis
  • Toxicity:
    • Nephrotoxicity
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7
Q

Sirolumus (aka Rapamycin)

A
  • Immunosuppressant
    • Blocks lymphocyte activation and proliferation
  • MOA:
    • Binds FKBp12 = inhibition of mTOR
    • Prevents response to IL-2
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8
Q

Dacluzimab

A
  • Immunosuppressant
    • Blocks lymphocyte activation and proliferation
  • MOA:
    • Binds CD25 (IL-2 receptor) = preventing response to IL-2
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9
Q

Describe Wiskott Aldrich syndrome

A
  • X-linked recessive immunodeficiency
    • Mutation in WASp gene
    • T cells unable to reorganize actin skeleton = defective antigen presentation
  • WATER - Wiskott Aldrich, Thrombocytopenia, Eczema (especially truncal), Recurrent infections
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10
Q

Antibody associated with mixed connective tissue disease

A

Anti-U1 RNP (ribonucleoprotein)

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11
Q

What are the different defects that cause homonymous hemianopia with macular involvment vs homonymous hemianopia with macular sparing

A
  • E: homonymous hemianopia with macular involvement is consistent with involvement of the temporal lobe (e.g. occlusion of the middle cerebral artery)
  • H: homonymous hemianopia with macular sparing is consistent with occlusion of the posterior cerebral
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12
Q

When after fertilization will b-hCG become positive in maternal serum and urine?

A
  • ~8 days after fertilization in maternal serum
  • ~14 days after fertilization in urine
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13
Q

What are the muscles of the rotator cuff?

A

Supraspinatus

Infraspinatus

Teres minor

Subscapularis

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14
Q

What is the supraspinatus test?

A

“empty can” test

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15
Q

What murmur might radiate to the neck

A

Aortic stenosis

Turbulent blood pushed out of the aorta may still be turbulent when it reaches the carotids

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16
Q

What murmur is associated with an opening snap vs. an ejection click

A

Opening snap = mitral stenosis

Ejection click = Aortic stenosis

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17
Q

Common side effects of Chloramphenicol

A

Pancytopenia: anemia, leukopenia, and/or thrombocytopenia

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18
Q

What are the parasites that can cause disease in red blood cells

A

Plasmodium (malaria) and Babesia

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19
Q

What is the most common location of patients infected with Babesia

A

NE United States (NE on maltese cross on floor)

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20
Q

Presentation of babesiosis

A

Fever and hemolytic anemia (can result in jaundice)

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21
Q
A
22
Q

Blood smear of Babesiosus

A

Ring form or Maltese cross

23
Q

Clinical manifestation of carcinoid syndrome

A

Bronchospasm, Flushing, Diarrhea, R-sided heart disease/murmur

24
Q

Describe the mechanism behind glucose-induced insulin release

A
  • Glucose enter beta cells of pancreas through GLUT-2 transporters
  • Glucose is metabolize by glucokinase to glucose-6-phosphate
  • Glucose-6-phosphate is further metabolized by glycolysis and the Krebs cycle to produce ATP
  • High ATP leads to closure of ATP-sensitive potassium channels
  • Closure of potassium channels leads to depolarization which results in opening of voltage-gated calcium channels (= inflow of calcium)
  • High intracellular calcium causes exocytosis of insulin vesicles
25
Q

Where is the inflammation and with what T-cell (CD4+ or CD8+) is inflammation caused by in Dermatomyositis vs. Polymyositis

A
  • Dermatomyositis
    • Perimysial (THINK: periphery b/c of muscle + skin involvement) inflammation with CD4+ T cells
  • Polymyositis
    • Endomysial inflammation with CD8+ T cells
26
Q

What are Class I vs Class II human leukocyte antigens

A

Class I: HLA-A, HLA-B, and HLA-C

Class II: HLA-DP, HLA-DQ, and HLA-DR

27
Q

What are the seronegative spondyloarthopathies

A

PAIR:

Psoriatic arthritis, ankylosing spondylitis, inflammatory bowel disease, reactive arthritis

28
Q

What human leukocyte antigen is associated with the seronegative spondyloarthropaties

A

HLA-B27

29
Q

What human leukocyte antigen is associated with Rheumatoid arthritis

A

HLA-DR4

30
Q

What is the procedure performed in a vasectomy?

A

Transection of the vas deferens

Viable sperm can remain in the portion of the vas deferens distal to ligation for 3 months and at least 20 ejaculations

31
Q

Occlusion of the L circumflex artery will affect what part of the heart, which corresponds to ST elevations in what leads?

A

L circumflex artery provides to the lateral aspect of L ventricle

Will see ST elevations in leads I and aVL

32
Q

Describe the presentation of the 3 phases of Lyme disease

A
  • o Stage I
    • Erythema Chronic Migrans (“Bulls Eye” rash) = “Stage 1” with bulls eye with spiral arrow (spirochete)
      • Non-painful and non-pruritic
    • Sweating and feverish, flu like illness = Sir Wright is sweating and looking feverish -
  • Stage II
    • Heart block caused by myocarditis = heart shield
    • Bilateral facial nerve palsy = 2 bells for Bell’s Palsy
  • o Stage III
    • Joint pain arthritis of large joints, symptoms may move from joint to joint (migratory polyarthritis) à
      • Arrow in knee = arthritis of large joint
      • Straw man swinging back and forth = migratory polyarthritis
    • Subtle encephalopathy = Memory difficulty, lymphocytic meningitis.
      • Arrow in the head of straw man and Sir Giemsa is confused
33
Q

Treatment of Lyme disease

A

Stage 1 = Doxycycline

Later stages = Ceftriaxone

34
Q

Cause of acute primary adrenal insufficiency

A

Waterhouse-Friederichsen syndrome

Acute primary adrenal insufficiency due to adrenal hemorrhage associated with septicemia (usually Neisseria meningitides), DIC, endotoxic shock

35
Q

Which hormones use the cAMP pathway (Gs and Gi)

A

Most hormones of anterior pituitary

FSH, LH, ACTH, TSH, hCG, MSH, GHRH, CRH, PTH, calcitonin, glucagon, V2 vasopressin receptor

  • THINK: FLAT ChAMP
    • FSH, LH, ACTH, TSH, CRH and calcitonin, hCG, ADH (V2), MSH, PTH
36
Q

Which hormones use IP3 pathway (Gq)

A

Hormones of posterior pituitary minus V2

GnRH, TRH, oxytocin, V1 vasopressin receptor, H1 histamine receptor, angiotensin II, gastrin

  • THINK: GOAT HAG
    • GnRH, Oxytocin, ADH (V1), TRH, Histamine (H1), Angiotensin II, Gastrin
37
Q

Which hormones use cGMP pathway

A

Vasodilators:

Nitric oxide (NO), Atrial natriuretic peptide (ANP)

38
Q

Which hormones use steroid receptors

A

Estrogens, progesterone, testosterone, glucocorticoids, aldosterone, thyroid hormone (T3/T4), vitamin D

  • THINK: VETTT CAP
    • Vitamin D, Estrogen, Testosterone, T3, T4, Cortisol, Aldosterone, Progesterone
39
Q

Which hormones use tyrosine kinase receptors

A

Insulin, insulin-like growth factor (IGF-1), platelet derived growth factor (PDGF), fibroblast growth factor (FGF)

40
Q

Which hormones use nonreceptor tyrosine kinase (e.g. JAK/STAT)

A

Prolactin, cytokines (IL-2, IL-6, IFN), GH, G-CSF, Erythropoietin, Thrombopoeitin

  • THINK: PIGGLET
    • Prolactin, Immunomodulators (cytokines, IL-2, IFN), Growth hormone, Granulocyte colony stimulating factor, (No L), EPO, Thrombopoietin
41
Q

MOA of Psyllium

A
  • Bulk-forming laxative
  • Is an indigestible hydrophilic colloid = will absorb water = distention = peristalsis
  • Used for treatment of constipation
  • May lead to increased bloating and flatulence
42
Q

MOA of Docusate

A
  • Stool softener
  • Facilitates the penetration of stool by water and lipids
43
Q

MOA of Senna

A
  • Stimulant laxative
  • Directly stimulate the enteric nervous system and colonic secretions
  • Chronic use causes melanosis coli (brown pigmentation of the colon)
44
Q

MOA of Bismuth

A

MOA:
Binds to ulcer base, providing physical protection and allowing HCO3- secretion to reestablish pH gradient in the mucus layer

USES:
Increased ulcer healing
Traveler’s diarrhea

45
Q

What are the rapid-acting, intermediate-acting, and long-acting insulins

A
  • Rapid acting = Girls and Lads
    • Glulisine, Aspart, Lispro
  • Intermediate acting = Rest Now
    • Regular insulin, NPH
  • Long acting = Don’t Go
    • Detemir, Glargine
46
Q
A
47
Q

What type of drug are Tolbutamide and Chlorpropramide?

A

1st generatino sulfonylureas (“-amide” = goose in maid outfit)

Treat T2DM

48
Q

MOA of Exanatide and Liraglutide

A

“-tide” = GLP-1 agonists

  • These drugs activate GLP-1 receptor (glucagon-like peptide receptor) – opposite of glucagon
    • Increases insulin release and satiety
    • Decreases glucagon release and gastric emptying
49
Q

MOA of Sitagliptin and Linagliptin

A

“-gliptin” = DDP-4 inhibitors

  • DPP-4 (dipeptidyl peptidase) is the enzyme that breaks down endogenous GLP-1
    • If you inhibit DPP-4, you will have more endogenous GLP
      • Increased insulin and decreased glucagon
      • Increased satiety and delayed gastric emptying
50
Q

MOA of Pramlintide

A
  • Amylin analog
  • Amylin is a peptide normally present in insulin secretory granules and secreted along with insulin
    • At pharmacologic doses, it reduces glucagon secretion, gastric emptying, and appetite
  • Used to control postprandial glucose spike in both Type I and Type II DM
51
Q

MOA of alpha-glucosidase inhibitors (Acarbose and Miglitol)

A

Sketchy: A-carb wigglers

MOA:
Inhibition of a-glucosidase on the intestinal brush border decreases the conversion of disaccharides to absorbable monosaccharides –> delayed carbohydrate absorption

USES:
Type 2 DM

ADVERSE EFFECTS:
Diarrhea, flatulence (due to fermentation of undigested carbs)

52
Q

MOA of SGLT2 inhibitors (“-flozin”)

A

Sketchy: Flossing teacher and Salty Glucose Co. bag

MOA:
Inhibition of the sodium-glucose cotransporter in the proximal tubule

USES:
Type 2 DM

ADVERSE EFFECTS:
UTI
Vaginal candidiasis
Dehydration

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