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review / wrong answers > 6/15 UWorld > Flashcards

6/15 UWorld Flashcards

1
Q

What is the source and function of ANP and BNP

A
  • Released from atrial (ANP) and ventricular (BNP) myocytes in response to increased blood volume
  • Acts via cGMP
  • Causes vasodilation and decreased Na+ reabsorption at the renal collecting tubule
    • Dilates afferent arteriole and constricts efferent arterial, promoting diuresis
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2
Q

Adverse effects of Digoxin

A
  • Hyperkalemia (recall that dysfunctional Na+/K+ ATPase blocks K+ from entering the cell, so it builds up in the serum instead)
  • Premature ventricular contractions and other arrhythmias
  • Digitalis effect = T-wave changes, QT interval shortening, ST depression
    • = taSTy scoop of ice cream = “scooped”/concave ST depression of EKG
  • Bradycardia due to parasympathetic activity at SA node
    • à SA music “note” (node) on top L of dancefloor
    • à dangling heart watch = bradycardia
  • Heart block due to excess parasympathetic activity of AV node in digoxin toxicity
    • à AV music note
    • à heart shield pendant on girl = heart block
  • Contraindicated in heart block (or other drugs that depress SA or AV nodes e.g. beta-blockers)
    • à sign over door: “remain unblocked”
    • à blocked is spelled with a ‘beta’ B
  • GI symptoms (nausea, vomiting, abd pain)
    • à nauseated kid
  • Neuro sx (confusion and weakness)
  • Alteration in color vision
    • Xanthopsia (objects appear yellow)
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3
Q

Factors that exacerbate Digitalis toxicity

A
  • Hypokalemia (hypokalemia increases Digoxin binding to Na+/K+ ATPase)
    • Can be caused by loop diuretics or diarrhea
  • Renal insufficiency
    • Increased the serum half life of digoxin, increasing susceptibility to toxicity
  • Many antiarrhythmics inhibit renal clearance of digoxin, increasing susceptibility to toxicity
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4
Q

MOA of Milrinone

A
  • Sketchy = “One in a million” sign
  • Phosphodiesterase inhibitor, leading to decreased breakdown of cAMP, leading to a positive inotropic effect
    • = “Don’t phoster disinterest” sign
    • = CAMPaign
    • = big muscles of donkey = positive inotropic effect
  • Also causes arteriolar dilation and decreased afterload
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5
Q

MOA of Nesiritide

A
  • Sketchy = “Turn the tide” elephant
  • Synthetic form of BNP, which increased cGMP in smooth muscles, leading to venous and arteriolar dilation (reducing afterload and preload)
    • = BuMP
    • = dilated red ears and blue legs
  • Also causes natriuresis
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6
Q

Describe the effects of prostaglandins and ATII on GFR

A

Prostaglandins dilate the afferent arteriole = increased GFR

ATII constricts the efferent arteriole = increased GFR

Coadministration of NSAIDs and ACEi will lead to significantly decreased GFR due to contricted afferent and dilated efferent arteriole - can precipitate kidney injury

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7
Q

MOA of Aliskiren

A
  • Sketchy = “High risk” slots
  • Mechanism of action
    • Direct Renin inhibitor
    • Prevents conversion of angiotensinogen to ATI
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8
Q

What drugs improve mortality in chronic CHF patients vs. drugs that treat symptoms?

A
  • Improved survival:
    • ACEI
    • ARBs
    • Aldosterone antagonists
    • B-blockers
  • Symptomatic relief:
    • Diuretics
    • Digoxin
    • Vasodilators
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9
Q

Cause, CO, SVR, and Rx of Septic/Anaphylactic shock

A
  • Sepsis/anaphylaxis
    • Sepsis and anaphylaxis cause vasodilation and leaky capillaries
      • Skin will be warm and flushed to do vasodilation
    • SVR = Decreased (this is part of the cause of septic shock)
    • CO = Increased (compensatory tachycardia)
    • Rx = Antibiotics, IV fluids, vasopressors (norepinephrine)
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10
Q

Cause, CO, SVR, and Rx of Neurogenic shock

A

Brain is not communicating properly with the heart – e.g. brain injury, spinal cord injury

CO = Decreased

SVR = Decreased

Rx = IV fluids

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11
Q

On a pressure-volume loop of the LV, describe where on the graph the mitral valve and aortic valve close and open

Volume on the X-axis and pressure on the Y-axis

A
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12
Q

Adverse effects of Milrinone

A

Hypotension

Due to arteriolar dilation

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13
Q

In the cardiac cycle graph, show were mitral and aortic valve opening and closing occur

A
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14
Q

Label the jugular venous tracing graph

A

A wave = atrial contraction

C wave = ventricular contraction

V wave = atrial filling against closed tricuspid valve

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15
Q

Describe what normal heart sound splitting is

A

Inspiration = decreased intrathoracic pressure = increased venous return = increased RV filling = increased RV stroke volume = increased RV ejections time = delayed closure of pulmonic valve

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16
Q

When do you see wide splitting vs. fixed splitting

A
  • Wide splitting:
    • Splitting occurs both in inspiration and expiration
    • Due to conditions that delay RV emptying (e.g. Pulmonic stenosis, R bundle branch block)
  • Fixed splitting:
    • Occurs during right heart overload (e.g. atrial septal defect)
    • ASD –> L-to-R shunt –> increased RA and RV volumes –> increased flow through pulmonic valve such that, regardless of breath, pulmonic closure is delayed
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17
Q

Describe paradoxical splitting

A
  • Due to conditions that delay aortic valve closure (e.g aortic stenosis, left bundle branch block)
  • Normal order of valve closure is reversed so that P2 occurs before delayed A2
  • On inspiration, P2 closes later and moves closer to A2, thereby “paradoxically” eliminated the split
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18
Q

What maneuver enhances mitral regurg vs. tricuspid regurg

A

Mitral regurg enhanced by increased afterload (e.g. hand grop or squatting)

Tricuspid regurg enhanced by increased preload (e.g. inspiration)

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19
Q

Causes of aortic regurgitation

A

Aortic root dilation (e.g. syphilis or Marfan)

Bicuspid aortic valve

Endocarditis

Rheumatic fever

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20
Q

What murmurs are increased by inspiration vs. hand grip vs. valsalva

A
  • Inspiration:
    • This decreases intrathoracic pressure, thus increased venous return to the heart
    • Increased intensity of R heart sounds (e.g. Tricuspid murmur)
  • Hand grip:
    • This increases SVR, this increasing afterload
    • Increased intensity of mitral regurgitation, aortic regurgitation, and VSD
  • Valsalva maneuver
    • This increases intrathoracic pressure, thus decreasing preload (opposite of inspiration)
    • Decreases the intensity of most murmurs EXCEPT increases intensity of hypertrophic cardiomyopathy
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21
Q

Complications/presentation of aortic stenosis

A

SAD:

Syncope, angina, dyspnea

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22
Q

Describe electrolytes responsible for each phase in cardiac myocyte fast action potential (Phase 4, 0, 1, 2, 3)

A
  • Stage 4 (baseline negative state)
    • Only “leaky” potassium channels open (K+ leaking out of cell - inward rectifier current)
  • Stage 0
    • Voltage gated Na+ channels open (after threshold -70 is reached by Na+ and Ca+ leaking through gap junctions)
    • Na enters very quickly à fast depolarization
  • Stage 1
    • Initial repolarization – Na+ channels close and voltage gated K+ channels open (K+ leaves cell), causing repolarization
  • Stage 2
    • Plateau – Ca2+ channels open (Ca enters cells) – L-type channels
    • Ca2+ and K+ channels pull voltage in opposite directions, so reach sort of plateau
    • This is the phase that causes myocyte contraction (due to Ca2+ triggering more Ca2+ release from sarcoplasmic reticulum)
  • Stage 3
    • Rapid repolarization – Ca2+ channels close, so only K+ channels open
    • But eventually the voltage gated K+ channels will close, leaving only open the “leaky” potassium channels, so there is membrane stabilization
23
Q

Describe electrolytes responsible for each phase of pacemaker slow action potential

A
  • Stage 4
    • Na+ channels (If – funny current) are open (Na+ enters cells) and allow depolarization (voltage gated K+ channels are closed)
    • The rate of stage 4 depolarization is what sets the heart rate
  • Stage 0
    • Threshold reached where voltage gated Ca2+ channels open causing more rapid depolarization at threshold (-40)
    • Ca2+ enters pretty quickly, but not as quickly as Na+ in stage 0 of myocytes à slow action potential
  • Stage 3
    • At threshold +10, voltage gated Ca2+ channels close and voltage gated K+ channels open (potassium leaves cell), causing repolarization (at -60, the voltage-gated K+ channels will close and Na+ channels will reopen)
    • At certain threshold, K+ channels close, so Na+ is only channel open and cycle restarts
24
Q

What is Addison disease

A

Autoimmune destruction of the adrenal gland

Decreased aldosterone and cortisol

25
Q

What is Conn syndrome

A

Primary hyperaldosteronism due to adrenal adenoma

26
Q

What disease is associated with nephritis, hearing loss, and cataracts

A

Alport syndrome - defect in collagen type IV

“Cant see, cant pee, cant hear high C”

27
Q

Immunochemistry staining that can differentiate complete mole from partial mole

A
  • Complete mole will be p57 negative (p57 protein is a product of paternally imprinted by maternally expressed gene)
    • Can use this to differentiate from a partial mole which will be p57 positive
28
Q

Tumor marker of choriocarcinoma

A

b-hCG

29
Q

What does tumor marker CEA indicate

A

§ Colon cancer

§ Pancreatic cancer

30
Q

What does tumor marker CA 19-9 indicate

A

§ Pancreatic cancer

31
Q

What form of Vitamin D is calcitriol, and what is it stimulated by

A

Active form fo VD (1, 25-dihydroxyvitamin D)

Stimulated by PTH, which increases the enzyme in the kidney that does the final step of VD activation

32
Q

What does an elevated alk phos level suggest?

A

Hepatobiliary disease

Bone problems

33
Q

In the setting of elevated alk phos, what other lab value can indicate if cause is hepatobiliary or bone?

A

gamma-glutamyl transpeptidase (GGTP)

Found predominanlty in hepatocytes and biliary epithelium, so if elevated, suggests hepatic origin over bone origin

34
Q

What is the timeframe difference between mania and hypomania

A
  • Mania = last at least 1 week
  • Hypomania = last at least 4 consecutive days
    • Not severe enough to cause marked impairment in social or occupational function
35
Q

Differentiate Bipolar I vs. Bipolar II vs. Cyclothymic disorder

A
  • Bipolar I
    • 1 manic episode +/- a hypomanic or depressive episode
    • Depression not necessary for diagnosis
  • Bipolar II
    • Hypomanic episode + major depressive episode
  • Cyclothymic Disorder (milder)
    • Mild hypomanic symptoms + mild depressive symptoms
    • Lasts > 2 years
36
Q

What part of tRNA do amino acids bind to during “loading”

A

3’ terminal hydroxyl group of the CCA tail on the acceptor stem

Aminoacyl tRNA synthetase is responsible for “loading”

37
Q

Diagnostic criteria for Tourretes

A
  • Both multiple motor and >/= 1 vocal tic for > 1 year
    • Motor = facial grimacing, blinking, head/neck jerking, shoulder shrugging, tongue protrusion, sniffing
    • Vocal = grunts, snorts, throat clearing, barking, yelling, coprolalia (obscenities)
38
Q

Diagnostic criteria for Chronic tic disorder

A
  • Either motor or verbal tics (but not both) for > 1 year
39
Q

Differentiate delusional disorder from schizophrenia

A
  • Diagnosis of schizophrenia – requires at least 2 of the following, with at least one from 1-3:
    • Delusions
    • Hallucinations
    • Disorganized speech
    • Disorganized or catatonic behavior
    • Negative symptoms (affective flattening, avolition, anhedonia, asociality, alogia)
  • Delusional disorder:
    • >/= 1 delusions for >/= 1 month
    • Other psychotic symptoms absent or not prominent
    • Ability to function apart from delusion; behavior not obviously bizarre or odd
40
Q

What is schizofreniform disorder vs. shizoaffective disorder

A
  • Schizophreniform disorder
    • Schizo sx > 1 month and < 6 months
    • > 6 months becomes schizophrenia
  • Schizoaffective disorder:
    • Mood episodes and active symptoms of schizophrenia occurring at the same time + at least 2 week lifetime history of delusions or hallucinations in the absence of prominent mood symptoms
    • Aka normal schizo sometimes and schizo + mood at other times
41
Q

What is brief psychotic disorder

A

Schizo sx > 1 day and < 1 month

> 1 month = schizophreniform disorder

> 6 months = schizophrenia

42
Q

What is the target vessel in a central line

A

SVC

Usually inserted into internal jugual vein

43
Q

What is the stool microscopy test used to identify unabsorbed fat in stool

A

Sudan III stain

44
Q

What type of patients are at a higher risk for developing drug-induced lupus

A

Slow acetylators

Higher levels of drugs that cause DILE

45
Q

What antibody is indicative of drug-induced lupus

A

anti-histone

46
Q

MOA of Bosentan

A
  • Sketchy = Boss man stan
  • Block endothelin (which usually is a potent vasoconstrictor) leading to vasodilation and decreased pulmonary pressure
  • Used to treat pulmonary HTN
47
Q

What is the reasoning behind adding Primaquine on top of Chloroquine for malarial treatment

A

Chlorquine eradicates chloroquine-sensitive plasmodia from the bloodstream, but has no activity against latent hepatic infection established by P vivax and P ovale

Primaquine must be added to eradicate hypnozoites

Skethchy = Primal queen needed when Color Queen is hypnotized by Vivax and Ovale

48
Q

What is the reason behind starting patients on ASA when they are at risk for cardiac events

A

Inhibition of COX-1 in platelets prevents synthesis of TXA2, a stimulator of platelet aggregation and vasoconstriction

49
Q

Label the nerves exiting the brainstem

A
50
Q

Most common causes of bacterial meningitis in neonates and adults

A
  • Neonates:
    • Group B strep
    • Gram negative bacilli (E. coli)
    • Listeria
  • Adults:
    • Strep pneumoniae
    • Neisseria meningitides
    • H. flu type B
51
Q

What are the layers of the epidermis

A
  • Stratum corneum lucidum, granulosum, spinosum, basale
    • THINK: Californians Like Girls in String Bikinis
52
Q

Describe histology of psoriasis

A
  • Acanthosis (epidermal hyperplasia)
    • Increase in stratum spinosum and decrease in stratum granulosum
  • Parakeratosis (hyperkeratosis with retention of keratinocyte nuclei in the stratum corneum)
  • Munro microabscesses (neutrophils within the stratum corneum)
  • Auspitz sign (pinpoint bleeding due to thinning of epidermis above elongated dermal papilla)
53
Q

What is an ecological study

A

Looks for associations between a given characteristic and a given outcome using population data

Can be used to generate hypothesis by should not be used to make conclusions about individuals within these populations

54
Q

What type of colon cancer has “cauliflower-like” appearance

A

Villous adenoma

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