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Review / Wrong Answers > 6/2 UWorld > Flashcards

6/2 UWorld Flashcards

1
Q

MOA and use of 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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2
Q

MOA and use of Cyclosporine

A
  • Immunosuppressant
    • Blocks lymphocyte activation and proliferation
  • MOA:
    • Binds cyclophilin (protein within cytosol of T-cells)
    • Inhibits calcineurin (which stimulates IL-2) à prevention of IL-2 transcription
  • Uses:
    • Transplant rejection
    • Psoriasis
    • Rheumatoid arthritis
  • Toxicity
    • Nephrotoxicity
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3
Q

MOA and use of Sirolumus

A

Aka Rapamycin

  • Immunosuppressant
    • Blocks lymphocyte activation and proliferation
  • MOA:
    • Binds FKBp12 à inhibition of mTOR
    • Prevents response to IL-2
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4
Q

MOA and use of Etanercept

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:
    • Mimics TNF-a receptor (aka it intercepts TNF-a before it can reach its target)
  • Uses:
    • Used for autoimmune conditions due to anti-inflammatory effect
    • Inflammatory bowel disease, rheumatoid arthritis, ankylosing spondylitis, psoriasis
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5
Q

MOA and use of 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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6
Q

MOA of Dacluzimab

A
  • Immunosuppressant
    • Blocks lymphocyte activation and proliferation
  • MOA:
    • Binds CD25 (IL-2 receptor) à preventing response to IL-2
  • THINK: Da-clu = da claw = claw grabbing on to the receptor
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7
Q

What is the defect and associated triad in Ataxia telangiectasia?

A

Defect in ATM gene - failure to repair DNA double strand breaks

Triad: ataxia, telangiectasia, IgA deficiency

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8
Q

MOA and use of Paclitaxel

A
  • MOA:
    • Hyperstabilization of polymerized microtubules in M phase so that mitotic spindle cannot break down and anaphase cannot occur
  • Uses:
    • Used to treat ovarian and breast carcinoma
    • Also prevents intimal hyperplasia, so can be used as coating in stent placement to prevent stent restenosis
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9
Q

What biochemical process is often defective in patients with accumulation of misfolded proteins (e.g. Parkinson’s and Alzheimers)

A

Ubiquination - misfolded proteins unable to be marked for degradation

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10
Q

What is the embryologic origin of the ureteric bud

A

Mesonephros:

  • Forms temporary kidney during 1st trimester
  • Later contributes to male genital system – Wolffian ducts
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11
Q

What structures are formed by the ureteric bud

A
  • Caudal end of the mesonephros becomes the ureteric bud which gives risk to ureter, pelvises, calyces, collecting ducts
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12
Q

What structures are formed by the metanephros

A
  • Interaction with the ureteric bud (caudal portion of mesonephros) induces differentiation and formation of glomerulus, Bowman’s space, proximal tubule, loop of Henles, and distal convoluted tubule
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13
Q

What is the cause behind higher insulin levels in oral glucose vs. IV glucose

A

Incretins (hormones produced bby gut mucosa) stimulate pancreatic insulin secretion in response to sugar-containing meals

This response occurs independent of blood glucose levels

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14
Q

What is temporomandibular disorder (TMD)

A

o Characterized by constellation of symptoms:

§ Unilateral face pain that worsens with jaw movement

§ Headache

§ Ear discomfort

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15
Q

What nerve may be involved in temporomandibular disorder (TMD)

A
  • Mandibular nerve
    • Largest branch of trigeminal nerve, containing both motor and sensory components
    • Sensory:
      • Sensation to TMJ, mandibular teeth, flood of mouth, inside of cheeks, anterior tongue, skin of lower face
    • Motor:
      • Muscles of mastication (medial and laterl pterygoid, masseter, temporalis)
      • Muscle of floor of mouth (mylohyoid)
      • Tensor veli palatati
      • Tensor tympani of middle ear
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16
Q

Rank these in order from fastest to slowest speed of conduction:

Atria, ventricles, AV node, purkinje fibers

A
  • Purkinje > atria > ventricles > AV node
    • Purkinje fibers must travel fastest to ensure that ventricles contract in a bottom-up fashion (necessary for efficient propulsion of blood into the pulmonary artery and aorta)
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17
Q

Rank the rate of the different pacemakers from fastest to slowest (SA node, Bundle of His, AV node)

A
  • SA > AV > bundle of His/Purkinje/ventricles
18
Q

Describe the function of each of the 4 muscles of the rotator cuff

A
  • (1) Supraspinatus
    • Suprascapular nerve
    • Abducts arm initially (before deltoid kicks in)
    • Most common rotator cuff injury
    • Assessed with “empty can” test
  • (2) Infraspinatus
    • Suprascapular nerve
    • Laterally rotates arm
  • (3) Teres minor
    • Axillary nerve
    • Adducts and laterally rotates arm
  • (4) Subscapularis
    • Upper and lower subscapular nerves
    • Medially rotates and adducts arm
19
Q

What type of drug is Chlordiazapoxide

A

Benzodiazepine

20
Q

What are the complimentary amino acids (G, A, U, C)

A

G - C

A - U

21
Q

What are the stop codons

A

UGA, UAG, UAA

22
Q

What type of HSR is acute hemolytic transfusion reaction

A

Type II HSR

Anti-ABO antibodies in the recipient will bind to donor erythrocytes, leading to complement activation

23
Q

What type of HSR is hemolytic disease of the newborn

A

Type II

24
Q

What type of HSR are each of the following (also include time frames):

  • Hyperacute transplant rejection
  • Acute transplant rejection
  • Chronic transplant rejection
  • Graft-vs-host disease
A
  • Hyperacute
    • Within minutes
    • Type II HSR (pre-existing antibodies)
  • Acute
    • Weeks-months
    • Type IV HSR
    • Cellular and humoral:
      • Cellular – CD8+ T-cells against donor MHCs
      • Humoral – antibodies develop after transplant
  • Chronic
    • Months-years
    • Type II and IV HSR
    • Cellular and humoral
      • Cellular – CD4+ T-cells respond to recipient APCs presenting donor peptides
  • Graft-vs-host disease
    • Timing varies
    • Donor (foreign) bone marrow is transplanted into the patient, and then the donor cells begin to attack the host
25
Q

What is Kussmaul sign, and what disorder is it found in

A

Kussmaul sign = JVD with inspiration (instead of normal decreased JVD)

Occurs in chronic constrictive pericarditis

26
Q

What is pulsus paradoxus and what disorder is it found in?

A
  • Decrease in amplitude of systolic BP by > 10 mm Hg during inspiration
    • Usually when you inspire this decreases intrathoracic pressure and causes the ventricular septum to deviate to the L, causing a smaller LV and a normal but slight decrease in BP
    • In pulsus paradoxus, there will be an exaggerated decrease in BP
  • Seen in cardiac tamponade, asthma, obstructive sleep apnea, pericarditis, croup
    • Occurs in cardiac tamponade > constrictive pericarditis (vs. Kussmaul sign)
27
Q

What is struma ovarii

A

teratoma comprised of thyroid tissue, which can present with hyperthyroidism

28
Q

Describe the timeframe of twinning

A
  • 0-4 days – dichorionic/diamniotic
  • 4-8 days – monochorionic/diamniotic
  • 8-12 days – monochorionic/monoamniotic
  • >13 days – conjoined twins
29
Q

With what type of twins can twin-twin transfusion syndrome occur?

A

Occurs in monochorionic/diamniotic twins

Arterio-venous anastamosis leads to shunting of blood

Donor – anemic, pale, growth restricted

Recipient – polycythemic, plethoric, overloaded, heart failure

30
Q

What presents with “snowstorm” appearance on US

A

Hydatidiform mole

31
Q

What is another term for endodermal sinus tumor, and what serum marker will be elevated

A

Yolk sac tumor

Elevated AFP

32
Q

Presentation of placenta abruption

A
  • Premature separation of placenta from uterine wall before delivery
  • Presentation:
    • Abrupt, painful bleeding in the 3rd trimester (vs. placenta previa which is painless)
    • Possible DIC, maternal shock, fetal distress
    • Life threatening for mother and fetus
33
Q

Differentiate between placenta accreta/increta/percreta and describe general presentation

A
  • Defective decidual later – placenta improperly implants into the myometrium
  • Presentation:
    • No separation of placenta after delivery
    • Postpartum bleeding
  • Types:
    • Placenta accreta – placenta attaches to myometrium without penetration
    • Placenta increta – placenta penetrates into myometrium
    • Placenta percreta – placent penetrates and perforates through the myometrium
      • Can attach to rectum or bladder
34
Q

Presentation of placenta previa

A
  • Attachment of placenta to lower uterus over internal cervical os
  • Presentation:
    • Painless third trimester bleeding (vs. placenta abrupta which is painful)
  • Often requires C-section
35
Q

Diagnostic criteria of preeclampsia

A

HTN: BP > 140/90 after 20th week of gestation

Proteinuria

Edema

36
Q

Histology of granulosa-theca cell tumor

A
  • Call-Exner bodies
  • Granulosa cells arranged haphazardly around collections of eosinophilic fluid, resembling primordial follicles
37
Q

Histology of Sertoli-Leydig cell tumor

A

Reinke crystals

38
Q

What does HELLP syndrome stand for and what is the reasoning behind the symptoms

A
  • Stands for:
    • H - Hemolysis (anemia)
    • EL - Elevated Liver enzymes (RUQ pain, jaundice)
    • LP - Low Platelets (bruising bleeding)
  • Preeclampsia + thrombotic microangiopathy
    • Hemolysis = thrombi causing schistocytes
    • Liver enzymes = lack of RBCs leads to infarction of liver tissue
    • Platelets = all used up in thrombi
39
Q

What is Meigs syndrome

A

Triad of: ovarian fibroma, ascites, pleural effusion

40
Q

Quad screen values in trisomy 21 (AFP, bhCG, estriol, inhibin A)

A
  • Decreased alpha-fetoprotein
  • Increased b-hCG
  • Decreased estriol
  • Increased Inhibin A

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