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review / wrong answers > 6/5 UWorlds > Flashcards

6/5 UWorlds Flashcards

1
Q

What is a better test for hypothyroidism, TSH or T3/T4

A

TSH

TSH levels will rise before T4 levels fall below normal

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2
Q

Describe the role that troponin and tropomyosin play in muscle contraction

A

Tropomysin sits in the myosin-binding sites of actin

Troponin molecules are situated alongside tropomyosin

When Ca2+ binds to troponin C, the Troponin-Ca2+ complex pulls tropomyosin away, exposing the myosin-binding site

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3
Q

What disorder is associated with decreased levels of hypocretin

A

Narcolepsy

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4
Q

What bases (A, G, T, U) are present at the 5’ and 3’ splice site of the intron

A

5’ splice site = GU

3’ splice site = AG

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5
Q

What is the single AA mutation in sickle cell vs. hemoglobin C

A

Sickle cell: Glutamic acid to Valine (THINK: G and V are more far apart so more severe)

Hb C: Glutamic acid to Lysine (THNK: G and L are closer together so milder)

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6
Q

What is the presentation of Henoch-Schonlein purpura

A
  • Due to IgA immune complex deposition
    • Follows URI infections
  • Presentation:
    • Palpable purpura on buttocks and legs
    • Arthralgias
    • GI pain and bleeding
    • Hematuria – IgA nephropathy (aka Berger disease)
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7
Q

Describe the origin and insertion of the ACL

A
  • Originates on the lateral femoral condyle
  • Courses anteriorly and medially to insert on the anterior intercondylar area of the tibia
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8
Q
A
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9
Q

Describe the origin and insert of the posterior collateral ligament (PCL)

A
  • Originates on the medial condyle of the femur
  • Courses posteriorly to the posterior head of the tibia
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10
Q

What are the CYP450 substrates

A
  • Always Think When Outdoors:
    • A - Anti-epileptics
    • T - Theophylline
    • W - Warfarin
    • O - OCPs
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11
Q
A
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12
Q
A
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13
Q

What are the CYP450 inducers

A

§ Corona, Guinness, ‘N’ PBRS induce Chronic alcoholism

· C - Carbamazepine

· G - Griseofulvin

· N - Nevirapine

· P - Phenytoin

· B - Barbiturates

· R - Rifampin

· S - St. John’s Wort

· Chronic alcoholism

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14
Q

What are the CYP450 inhibitors

A

§ SICKFACES.COM:

· S - Sodium valproate

· I - Isoniazid

· C - Cimetidine

· K - Ketoconazole

· F - Fluconazole

· A - Acute alcohol abuse

· C - Chloramphenicol

· E - Erythromycin (macrolides)

· S - Sulfonamides

· C - Ciprofloxacin

· O - Omeprazole

· M - Metronidazole

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15
Q

What is the clinical presentation of Legionella

A

Atypical pneumonia

Hyponatremia

Neuro sx (HA and confusion)

Diarrhea

High fever (over 104)

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16
Q

What type of cardiac disease is typically associated with hemochromatosis

A

Dilated cardiomyopathy

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17
Q

What type of individuals are eligible for Medicare

A

Patients > 65 y/o

Patients < 65 with certain disabilities, and those with end-stage renal disease, and ALS

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18
Q

Describe the effects/time frame following an MI

A
  • THINK:
    • Nothing
  • 1 day à Coagulative necrosis
    • Inflammation
  • 1 week
    • Granulation tissue
  • 1 month
    • Scar formation
  • < 4 hours
    • Gross changes:
      • None
    • Microscopic changes:
      • None
    • Complications:
      • Cardiogenic shock (cannot provide blood to organs)
      • Congestive heart failure (decreased ejection fraction)
      • Arrhythmias
  • 4 – 24 hours:
    • Gross changes
      • Dark discoloration
    • Microscopic changes:
      • Coagulative necrosis (nucleus removed from dead cells)
      • Contraction bands (due to reperfusion injury from hypercontraction)
      • Wavy fibers with narrow, elongated myocytes
    • Complications:
      • Arrhythmia
  • 1 – 3 days:
    • Gross changes
      • Hyperemia
    • Microscopic changes:
      • Neutrophils
    • Complications
      • Fibrinous pericarditis (neutrophils attaching the dead heart will leak out into pericardium)
        • Presents as chest pain with friction rub
  • 4 – 7 days:
    • Gross changes:
      • Yellow pallor (due to WBC)
    • Microscopic changes
      • Macrophages
    • Complications
      • Rupture of ventricular free wall can lead to cardiac tamponade
      • Rupture of interventricular septum
      • Rupture of papillary muscle (fed by R coronary artery) leading to mitral insufficiency
  • 1 -3 weeks:
    • Gross changes:
      • Red border emerges as blood vessel from normal tissue grow into necrotic tissue to form granulation tissue
    • Microscopic changes:
      • Granulation tissue with fibroblasts, collage, and blood vessels
    • Complications:
      • Arrhythmias
  • Months:
    • Gross changes
      • White scar
    • Microscopic changes:
      • Fibrosis
    • Complications
      • Aneurysm (scar is not as strong as myocardium)
      • Mural thrombus and embolism (secondary to aneurysm)
      • Dressler syndrome (antibodies against pericardium) occurring 6-8 weeks after infarction
        • Chest pain, pericardial friction, and persistent fever
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19
Q

What disease typically presents with anemia, renal insufficiency, back pain, and hypercalcemia

A

Multiple myeloma:

  • Malignant proliferation of monoclonal plasma cell within the marrow
    • Recall: Plasma cells = mature B-cells that produce immunoglobulin
    • M spike
  • Classic presentation:
    • Anemia – plasma cells packed in bone marrow inhibit production of other cells (Rouleauz formation)
    • Renal insufficiency – excessive antibodies plug up kidney and form casts
    • Back pain – plasma cells activate osteoclasts
    • Hypercalcemia – plasma cells stimulate osteoclasts
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20
Q

What are the 2 types of gastric cancer

A

Intestinal and diffuse

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21
Q

Which gastric cancer is associated with H. Pylori and chronic gastritis

A

Intestinal type

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22
Q

What is a characteristic carcinogen associated with i_ntestinal type_ gastric cancer

A

Nitrosamines (smoked foods)

This is why intestinal gastric cancer is so prevalent in Japan

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23
Q

Describe histology of diffuse gastric cancer

A
  • Signet ring cells (mucin-filled cells with peripheral nuclei)
  • Stomach wall grossly thickened and leathery (linitis plastica)
24
Q

What cancer is associated with HTLV-1

A

Adult T-cell leukemia/lymphoma

25
Q

What disease is cyclin D1 associated with?

A

Mantle cell lymphoma t(11;14)

  • THINK: You dine (D1) at a table with a double candle holder (11) on the mantle
26
Q

Describe the mechanism by which Cyclin D1 is an oncogene

A

Cyclin D activates CDK4

The cyclinD/CDK4 kinase comples phosphorylates Rb protein, allowing progression from G1 to S phase

27
Q

Is p53 an oncogene or a tumor suppressor

A
  • Tumor suppressor
28
Q

What condition is seen with one mutated p53 (only needs one more to express disease)

A

Li Fraumeni syndrome

29
Q

Describe how unmutated p53 normally prevents uncontrolled cell growht

A
  • Blocks transition from G1 to S phase
  • In response to DNA damage, p53:
    • Slows cell cycle and upregulates repair enzymes
    • If DNA repair is not possible, p53 induces apoptosis
      • P53 urpegulates BAX, which disrupts Bcl2 (which usually stabilizes the mitochondrial membrane to that cytochrome C doesn’t lead out and activate apoptosis)
30
Q

Is a Rb an oncogene or a tumor suppressor?

A

tumor suppressor

31
Q

Describe how unmutated Rb usually prevents uncontrolled cell growth

A
  • Blocks transition from G1 to S phase
    • Rb “holds” the E2F transcription factor, which is necessary for transition to S phase
    • E2F is release when Rb is phosphorylated by CylinD/CDK4 complex
    • Rb mutation results in constitutively free E2F, allowing for uncontrolled progression through the cell cycle and uncontrolled growth of cells
32
Q

Is Bcl-2 an oncogene or a tumor suppressor?

A

Oncogene

33
Q

Describe the function of unmutated Bcl-2

A

Bcl2 inhibit apoptosis

Bcl2 stabilizes the mitochondrial membrane, blocking the release of cytochrome C

Disruption of Bcl2 allows cytochrome c to leave the mitochondria and activate apoptosis

34
Q

What disease is associated with Bcl-2 mutation?

A

Follicular lymphoma

t(14;18)

  • THNK: 18 y/o is when you can buy a gun and start killing people (apoptosis)
    • Apoptosis occurs in the follicle
35
Q

What inflammatory cells are increased in COPD?

A
  • Inflammatory cells that are increased: neutrophils, macrophages, CD8+ cells
  • They secrete enzymes and proteases that cause and perpetuate both alveolar destruction of emphysema and mucus hypersecretion found in chronic bronchitis
36
Q

What is the enzyme deficiency and presentation of acute intermittent porphyria

A
  • Deficiency of Porphobilinogen (PBG) deaminase
    • THINK: Acute intermittent = guys hollering “damn” (deam-inase) intermittently at A CUTE pretty big girl (PBG) walking by
  • Symptoms – 5 P’s
    • Painful abdomen, Port wine colored urine (due to increase PGB), Polyneuropathy, Psychological disturbances, Precipitated by drugs (CYP450 inducers), alcohol, and starvation
  • Treatment
    • Glucose + heme à inhibition of ALA synthase
37
Q

What is the enzyme deficiency and presentation of porphyria cutanea tarda

A
  • Deficiency of Uroporphyrinogen decarboxylase
  • Symptoms
    • · Blistering cutaneous photosensitivity
    • · Hyperpigmentation
    • · Hypertrichosis (extra hair)
    • · Tea colored urine
    • · Exacerbated with alcohol consumption
    • · Associated with Hepatitis C
  • (THINK of a stereotypical homeless man)
    • Alcoholic, face blistered and dark from sun, facial hair, liver disease
38
Q

What is the presentation of ALA synthase deficiency

A

Sideroblastic anemia

39
Q

What enzymes are deficient in lead poisoning

A

ALA dehydratase

Ferrochelatase

40
Q

What personality disorder is characterized by hypersensitvity to rejection and socially timid

A

Avoidant

41
Q

What personality disorder is characterized by disregard for and violation of rights of others; impulsive

A

Antisocial

42
Q

Is pulomanary hypoplasia a consequence of poly- or oligohydramnios

A

Oligohydramnios

43
Q

What is the MOA of viral integrase inhibitors

A

Precents viral dsDNA (already transcribed from viral RNA via reverse transciptase) from inserting itself into host cell DNA

44
Q

What is the MOA of Rifaximin in hepatic encephalopathy

A
  • Is a poorly absorbed antibiotic that will remain in the GI lumen and can eradicate ammonia producing intestinal bacteria
  • Used to treat hepatic encephalopathy
45
Q

What is the treatment for febrile seizures

A

Supportive care

Can also give antipyretics (acetaminophen or ibuprofen) to decrease fever and improve patient comfort, although this will not reduce risk of further seizures

46
Q

Is Zollinger-Ellison syndrome more likely to cause gastric ulcers or duodenal ulcers

A

Duodenal - ZE is a tumor of pancreas or duodenum

47
Q

What is the effect of administering secretin to a patient with a gastrinoma?

A

Secretin paradoxically stimulates gastrin release from gastrinomas

48
Q

What is the function of eosinophils, both in parasitic defense and in type I HSR

A
  • Parasitic defense
    • § Stimulated by IL-5 produced by Th2 cells and mast cells
    • § Eosinophils contain Fc receptors that can be bound to IgE or IgE
    • § These antibodies will bind to parasites, triggering eosinophil degranulation and release of cytotoxic proteins and reactive oxygen intermediates to destroy the parasits
      • This is antibody-dependent cell-mediated cytotoxicity (ADCC)
  • Type I HSR
    • § Eosinophils synthesize prostaglandins, leukotrienes, and cytokines that contribute to the inflammation seen in late-phase type 1 HSR and chronic allergic reactions
49
Q

Do prostaglandins keep ductus arteriosus opened or closed?

And thus, are NSAIDs (e.g. Indomethacin) used to maintain patency or close the ductus?

A
  • PDA normally relies on PGE2 to remain open, which declines at birth, allowing DA to close
  • NSAIDs (e.g. Indomethacin) can be used if you need to promote CLOSURE of the DA
50
Q

An interscalane nerve block, targeting the brachial plexus and used to anesthetize the shoulder and upper arm, may also cause paralysis to what structure?

A

Diaphragm

Causes transient ipsilateral diaphragmatic paralysis in nearly all patients by anesthetizing the roots of the phrenic nerve as they pass through the interscalene sheath

This nerve block should be avoided in patients with chronic lung disease or contralateral phrenic nerve dysfunction

51
Q

Which of the acetylcholine esterase inhibitors acts both peripherally and centrally (crosses BBB)?

A

Physostigmine

So can be used to treat atropine overdose

52
Q

Intoxication with what drug causes these sx:

Violent behavior, dissociation, hallucinations, amnesia, nystagmus, ataxia

A

o PCP (phencyclidine)

§ Hallucinogen

53
Q

Intoxication with what drug causes these sx:

Visual hallucinations, euphoria, dysphoria/panic, tachycardia/HTN

A

o LSD

§ Hallucinogen

54
Q

Intoxication with what drug causes these sx:

Euphoria, agitation/psychosis, chest pain, seizures, tachycardia/HTN, mydriasis

A

o Cocaine

§ Stimulant

55
Q

· Intoxication with what drug causes these sx:

· Violent behavior, psychosis, diaphoresis, tachycardia/HTN, choreiform movements, tooth decay

A

o Methamphetamine

§ Stimulant

56
Q

· Intoxication with what drug causes these sx:·

Increased appetite, euphoria, dysphoria/panic, slow reflexes, impaired time perception, dry mouth, conjunctival injection

A

o Marijuana

§ Psychoactive

57
Q

Intoxication with what drug causes these sx:Euphoria, depressed mental status, miosis, respiratory depression, constipation

A

o Heroin

§ Opioid

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