Mixed Blocks Notes 7 Flashcards Preview

Uworld > Mixed Blocks Notes 7 > Flashcards

Flashcards in Mixed Blocks Notes 7 Deck (184):
1

Treatment of Restless Leg Syndrome

(1) Limit alcohol, nicotine, caffeine; (2) Dopamine Agonists (eg pramipexole)

2

Restless Leg is common in those with

Iron Deficiency, CKD, Diabetes

3

Treatment of Cataplexy

Muscarinic Antagonists (narcolepsy)

4

When does the neural tube form

Third week of fetal life

5

When do the neuropores close

Week Four = Anterior on day 25, Posterior on day 27

6

Tensilon Test

Tx of MG pt with Edrophonium (short acting AChEsterase inhibitor); Lack of improvement = cholinergic crisis

7

What mediates rapid decrease in myocardial calcium before relaxation

Na/Ca pump sarcolemmal pump; and Ca-ATPase

8

Major immune mechanism against Giardia

CD4 and IgA

9

RUQ pain after opiate

Biliary colic from contraction of SM cells in sphincter of oddi

10

Mu opioid effects on Histamine, Parietal Cells

Increase histamine (don't use in hypotension); Decr parietal gastric acid secretion

11

Non-caseating granulomas - Crohn's or Ulcerative colitis

Crohn's

12

Unidirectional enzymes in glycolysis

Gluco/Hexokinase, PFK-1, Pyruvate Kinase

13

F-2,6-BP activates what?

PFK1 = Glycolysis

14

Insulin vs Glucagon effects on PFK1

Insulin --> PFK2 --> F-2,6-BP --> PFK-1 = Glycolysis; Glucagon inactivates PFK-2 via phosphorylation

15

What causes myocardial swelling with ischemia?

No ATP to pump Na (Na/K) or Ca (Ca-ATPase) out

16

Mechanism of nitrites in cyanide poisoning

Oxidized iron to Fe3+, which binds and sequesters cyanide, preventing it from binding cytochrome a-a3

17

What is used beside nitrites in cyanide poisoining

Thiosulfate --> Sulfate binds cyanide

18

Most common cause of aPTT prolongation

Lupus anticoagulants

19

Common findings in PCA stroke

(1) Contralateral hemianopia; (2) Contralateral parasthesias and numbness [thalamus]

20

Cranial Nerves supplied by PCA

III and IV

21

Why gallstones in Crohn's

Can't resorb bile acids in terminal ileum

22

Rate limiting step in catecholamine synthesis? What blocks this?

Tyrosine Hydroxylase - Metyrosine

23

What maintains cardiac output in acute/subacute aortic regurgitation

HR temporarily, but mainly increased LV preload

24

Carbamazepine adverse effects

(1) BM suppression; (2) Hepatotoxic; (3) SIADH

25

Drugs that cause SIADH

Carbamazepine, Cyclophosphamide, SSRI's

26

Allergic contact dermatitis is due to

Antigen presentation by Langerhans cell --> CD4 response

27

Acanthosis

Incr in spinosum (think psoriasis)

28

Hypergranulosis

Excessive granulation of s granulosum (think lichen planus)

29

Max and min pressures in RV, Pulmonary Artery

4-25 in RV; 9-25 in PA

30

Treatment of PSGN

Loop diuretics and Vasodilators to relieve edema and hypertension

31

Most important prognostic indicator in PSGN

Age

32

Osteoporosis tends to affect what bone

Trabecular - Vertebral bodies, Neck of femure

33

what is characteristic of hyperparathyroidism

Subperiosteal resorption with cystic degeneration

34

Vit D bone loss is characterized by

Excessive unmineralized osteoid

35

Osteopetrosis is characterized by

Persistance of primary, unmineralized spongiosa in medullary canals

36

Drugs that cause seizures

I BItE my tongue - INH, Buproprion, Imipenem, Enflurane

37

Most common sites of intracranial hemorrhage

Deep brain = Basal ganglia, Cerebellar nuclei, Thalamus, Pons

38

Cerebral amyloid angiopathy tends to occur in what areas

Lobar/cortical parenchyma

39

Findings with Pulmonary Silicosis

Nodular densities and eggshell calcifications

40

Pulmonar berylliosis findings

Resembles sarcoidosis (nodular infiltrates, enlarged lymph nodes, non-caseating granulomas), but is not strongly associated with pleural plaques or effusions

41

Findings in coal worker's pneumoconiosis

Multiple discrete nodules most prominent in upper lung zones

42

X ray of hypersensitivity pneumonitis due to inhalation of organic dust

Diffuse nodular interstitial infiltrates

43

Granulomatous destruction of liver bile ducts

Primary biliary cirrhosis

44

Intrahepatic hydatid cysts

Echinococcus

45

Mechanism of gingival hyperplasia with phenytoin

PDGF

46

Phenytoin toxicity mainly effects

Cerebellum and vestibular system --> Ataxia, Nystagmus

47

Systolic ejection murmur that increases with standing? Decreases with standing?

Hypertrophic CM - increases; Valvular aortic stenosis - decreases

48

Wide splitting of S1 accentuated by inspiration

Delayed closure of tricuspid = Complete right bundle branch block or tricuspid stenosis

49

Carboxylation of glutamate residues

Vitamin K

50

Erythropoeisis and peripheral blood smeal in Acute Intermittent Porphyria

Erythropoeisis and peripheral blood smear normal

51

Opiates used for diarrhea

Loperamide, Diphenoxylate

52

Pathogens most responsible for post-flu pneumonia

Pneumococcus, S aureus, H flu

53

Mycobacterium kanasaii symptoms

Pulmonary tuberculosis-like symptoms

54

High intracellular NADH in setting of hypoglycemia

Fuel other than glucose is being metabolized

55

High NADH/NAD+ ratio

Pyruvate to lactate and OAA to malate => Inhibits gluconeogenesis

56

What antibody is rarely seen in drug-induced Lupus

Anti-dsDNA (look for anti-histone)

57

Range for microalbuminuria

30-300 ug/mg creatinine

58

MOA of Adenosine in Supraventricular Tachy

Slows conduction thru AV node by hyperpolarizing the nodal pacemaker and conducting cells

59

All inhalational anesthetics, except what, are respiratory depressants

NO

60

Inhalational anesthetics preferred in pts with asthma

Halothane, Sevofluorane - Bronchodilation properties

61

Inhalational anesthetic effects on hepatic, renal, and cerebral BF

Decr hepatic; Incr cerebral; Decr GFR and RPF

62

Main side effects of bile acid binding resins

HyperTG (incr VLDL and TG synthesis), GI upset, Malabsorption, Gallstones

63

First line treatment of hypertriglyceridemia

Fibrates - decr hepatic synthesis

64

Clinical manifestations of schistosomiasis result from

Th2-mediated granulomatous response directed against eggs (with eos and mac's)

65

Periportal Pipestem Fibrosis

Hepatic schistosomiasis

66

Echinococcus reservoir

Dog

67

Diphyllobothrium latum comes from

Freshwater fish

68

2,3-BPG only binds to

Deoxyhemoglobin

69

Why doesn't HbF bind 2,3-BPG as well

Serine residues instead of histidine

70

HbC

Glutamic acid --> Lysine = Mild, chronic hemolytic anemia

71

Directly responsible for intimal thickening in athersclerosis

Smooth muscle cells (NOT FIBROBLASTS)

72

Treatment with Menotropin and hCG

Menotropin is human menopausal gonadotropin and acts like FSH; hCG acts like LH surge

73

Hepatolenticular degeneration

(GP and Putamen) Wilson's disease --> Wing-beating tremor, Psychosis

74

Burning or stabbing sensation in one half of body

Thalamic syndrome

75

Mechanism of Dermatitis Herpetiformis

Cross reaction of anti-Gliadin ab's with Reticulin in epidermal basement membrane

76

Cerebral amyloid angiopathy vs hypertensive hemorrhage

Lower mortality rate, More benign clinical course than hypertensive hemorrhage

77

Hematuria and proteinuria in subacute BE

Immune complex deposition

78

Bacteriostatic antibiotic that inhibits binding of aminoacyl-tRNA to 30S subunit

Tetracyclines

79

What is upregulated after statins lower total serum cholesterol

LDL receptor

80

LCAT vs CETP

LCAT catalyzes esterification of cholesterol (nascent HDL to mature HDL); CETP transfers cholesterol to other lipoprotein particles

81

Endocrine hormones that increase cAMP

FLAT ChAMP CGC - FSH, LH, ACTH, TSH, CRH, hCG, ADH (V2), MSH, PTH, Calcitonin, GHRH, Glucagon

82

Hormones that increase cGMP

ANP, BNP, NO (EDRF)

83

Endocrine Hormones that increase IP3

GOAT HAG - GnRH, Oxytocin, ADH (V1), TRH, H1, AgII, Gastrin

84

Intrinstic tyrosine kinase receptors

Insulin, IGF-1, FGF, PDGF, EGF

85

Receptor-associated tyrosin kinase

PIGGLET - Prolactin, Immunomodulators (Cytokines, IFN), GH, G-CSF, EPO, Thrombopoetin - Acidophils and Cytokins

86

Resistant to Ampicillin but sensitive to Ceftriaxone

Beta-Lactamase production

87

Meniere's disease

Triad of vertigo, sensorineural hearing loss, tinnitus --> Incr production and/or decr excretion of endolymph

88

Blastomycosis on chest x ray

Mimics TB --> Granulomatous nodules

89

Systolic ejectin in aortic stenosis

Decr, because it takes longer for valve to open

90

Most common cause of pyridoxine deficiency

INH

91

First line for malignant otitis externa

Fluoroquinolone

92

Renal and lungs masses --> Improvement after removing renal mass

RCC --> Tx with IL_2

93

Central Venous Pressure and what tend to correlated

Pulmonary capillary wedge (at least in septic shock?)

94

Normal CVP and PCWP

CVP 2-8; PCWP 2-15

95

Effects of Ia, b, and c on AP conduction conduction velocity

Ia slows, Ib no effect, Ic slows

96

Effects of Ia, b, and c on AP duration

Ia prolongs, Ib shortens, Ic minimal effect

97

Predominant actions of Class II antiarrhythmics

Slow sinus node discharge rate, Slow AV node conduction and prolong refractoriness

98

Predominant effects of Class III antiarrhythmics

Prolong AP duration; No effect on conduction velocity

99

Predominant effects of Class IV antiarrhythmics

Slow sinus node discharge rate; Slow AV node conduction and prolong refractoriness

100

MOA of Adenosine

A1 receptors --> Activates K channels --> incr K conductance --> transient conduction delay thru AV node

101

Digoxin effects on AP duration and QT interval

Decr APD, Shorten QT interval

102

C3a stimulates

Histamine release --> Permeability, Dilation

103

Platelet Activating Factor causes

Platelet agg, Vasoconstriction, Bronchoconstriction, Incr leukocyte adhesion to endothelium

104

Hyperplastic polyps are composed of

Well-differentiated mucosal cells that form glands and crypts

105

Hamartomatous polyps are composed of

Mucosal glands, Smooth muscle, CT

106

Inflammatory polyps are seen in

UC, Crohn's --> Regenerating intsetinal mucosa

107

Lymphoid polyps are found in

children

108

4 Non-neoplastic polys

Hyperplastic, Hamartomatous, Inflammatory, Lymphoid

109

Symptoms of Diffuse Esophageal Spasm

Dysphagia and Chest pain

110

Phosphoglucomutase

Glucose 1 6 phosphate

111

Carnitine deficiency

Impairs FA transport into mitochondria, restricting ketone body formation

112

Skeletal Muscle Carnitine def symptoms

Myoglobinemia, Weakness after exercise, Elevated muscle TG's, Hypoketonemia

113

Medium Chain Acyl-CoA DH deficiency

Hypglycemia, Hypoketonemia

114

Tryptophan is a precursor for

Nicotinic Acid, Serotonin, Melatonin

115

Clinical manifestations of Hartnup disease are primarily due to

Tryptophan malabsorption --> Niacin deficiency

116

Symptoms of Hartnup

Most children asymptomatic --> Can have pellagra-like rashes, photosensitivity, ataxia

117

Urinary excretion of what AA's is normal in Hartnup

Proline, Hydroxyproline, Arginine

118

Thiamine use by the body is maximal in states of

Accelerated carb metabolism

119

Pyridoxine def results in

Anemia, Peripheral neuropathy, Dermatitis

120

Tocopherol deficiency

Vitamin E = Myelopathy and neuro

121

How do Listeria and Shigella survive intracellularly

Escape from phagosome into cytosol

122

How does MTB survive intracellularly

Blocks fusion of phagosome with lysosome, Inhibits phagolysosome acidification

123

Immune response to Listeria

IFNg, TNFb, IL-12 --> Cell mediated response --> macrophage killing

124

Gram negative rod that grows at 4 degrees

Listeria

125

Uricosuric drugs

Probenecid, Sulfinpyrazone

126

Xanthine oxidase inhibitor safer than allopurinol

Febuxostat

127

Most common manifestation of CMV in HIV

Retinitis

128

Epispadias results from

Faulty positioning of genital tubercle in fifth week of gestation

129

Virus that aquires lipid envelope form nucleus

Herpes family

130

Blockade of what receptor inhibits gluconeogenesis, glycogenolysis, and lipolysis

B2

131

Main effect of nitrates in treating angina

Reduce preload --> reduce LV volume

132

Herniation causing CN III neuropathy

Uncal

133

Most common cause of Abetalipoproteinemia

LOF mutation in Microsomal TG Transfer Protein (MTP) --> Normally folds apoB and transfers lipids into chylomicros or VLDL

134

Polyol pathway impairment occurs in tissues that

Do not rely on insulin for glucose transport (lens, peripheral nerves, kidney, blood vessels)

135

Elevated galactitol

Galactosemia --> Cataracts

136

Cross linking of proteins by glycosylation products in vessels facilitates

Inflammatory cell invasion, Deposition of LDL --> Atheroscerlosis

137

Skeletal findings in hyperparathyroidism

Cortical (compact) bone in appedicular skeletal --> Subperiosteal erosions, Salt-and-pepper skull, Osteolytic cysts (osteitis fibrosa cystica)

138

Disorganized lamellar bone structure in mosaic pattern

Paget's

139

Osteoid matrix accumulation around trabeculae

Vit D deficiency - Excessive unmineralized osteoid with widened osteoid seams

140

Persistence of primary spongiosa in medullary cavity with no mature trabeculae

Osteopetrosis --> Accumulation of woven bone, diffuse skeletal thickening

141

Trabecular thinning with fewer interconnections

Osteoporosis

142

How do erythrocytes utilize NADPH

Maintain Glutathione in reduced state by glutathione reductase

143

What is a Heinz body

Denatured Hb from oxidative stress

144

As opposed to serotonin syndrome, NMS is characterized by

Absence of myoclonus and presence of rigidity

145

Keratoderma blennorhagicum commonly associated with

Reactive Arthritis

146

Mechanism of Pertussis toxin

Disinhibits AC via Gi ADP ribosylation --> incr cAMP --> Incr histamine sensitivity and phagocyte dysfunction

147

Direct tissue effects of GH

(1) Insulin resistance; (2) Fat utilization; (3) Protein synthesis

148

Indirect tissue effects of GH

IGF-1 by liver --> Growth of bone, cartilage, soft tissue

149

GH vs IGF-1 receptor

GH is JAK-STAT; IGF-1 is specific receptor TK

150

Main sites of digestion and absorption of dietary lipids

Duodenum --> Jejunum

151

How does diet affect calcium stones

Low calcium diet actually increases risk; High protein and Na diet increases risk

152

What is recommended for patients with calcium stones who have hyperoxaluria

Pyridoxine --> Decreases endogenous oxalate production

153

Vitelline vs Cardinal veins

Vitelline form portal; Cardinal form caval

154

PG's that mediate protection of gastric mucosa

PGI2 and PGE2

155

Salicylism

Vertigo, Tinnitus, Hearing loss

156

Classic Legionnaires presentation

Very high fever in smoker + diarrhea, confusion, cough

157

Coccidiomycosis in immunocompetent

Usually asymptomatic

158

Conversion of NE to Epi occurs where? Stimulated by?

Adrenal medulla by PNMT - Stimulated by Cortisol (incr PMNT gene expression)

159

COMT converts epi and NE to

Metanephrine and Normetanephrine

160

SGLT2 inhibitors

Canagliflozin, Dapaglifozin

161

AE's of SGLT2 inhibitors

Urinary tract and Genital mycotic infections; Symptomatic hypotension

162

What should be assessed before starting SGLT2 inhibitors

Renal function

163

Which anti-diabetic requires LFT's

Thiaxolidinediones

164

Soft, breathy voice =

Vocal cord dysfunction

165

Acid-base abnormality in ATN

Retention of H and anions --> high anion gap metabolic acidosis

166

Recovery phase of ATN

Profuse diuresis, HypoK/Mg/PO4/Ca

167

Triptan MOA

5-HT 1b/d agonists --> Inhibit vasoactive peptides, promote vasoconstriction, block pain pathways

168

Bupropion MOA

DA, NE reuptake inhibitor

169

Migraine prophylaxis

TCAs, SNRI's, BB's, Valproate, Topiramate

170

What cholesterol meds increase bile acid synthesis

Binding resins; Fibrates

171

First and second line treatment of AF with RVR

CCBs/BB's, then Digoxin

172

Delayed afterdepolarizations

Occur in states of hyperexcitability (eg high intracellular Ca or high catecholamine states) - How digoxin can lead to Vtach

173

Signs of Uncal (transtentorial) herniation

CNIII, Contralateral or ipsilateral hemiparesis (crus cerebri), Contralateral homonymous hemianopsia with macular sparing (PCA)

174

Subfalcine herniation sign

ACA compression

175

Duret hemorrhage

Caudal displacement of brainstem --> Rupture of paramedian basilar artery branches --> Duret

176

Ingestion of what can cause myxomatous degeneration

Sweet peas --> Angiolathyrism

177

Incr murmur in HOCM

Decrease preload or afterload --> Decr LVEDV and increase outflow obstruction

178

Bile salt deconjugation

Colonic bacteria in small intestine --> Steatorrhea due to failure of miscelle formation

179

Final product of FA oxidation that enters CAC

Succinyl CoA (from methlymalonyl CoA)

180

Lab findings in SLE

Hemolytic anemia, Thrombocytopenia, Leukopenia, Hypocomplementemia

181

Cause of anemia and thrombocytopenia in SLE

Type II hypersensitivity

182

Fibrous intimal thickening with endocardial plaques limited to right heart

Carcinoid heart disease --> Pulmonic stenosis, Restrictive cardiomyopathy

183

How to grow H flu in sheeps blood agar

S aureus --> X factor released by hemolysis, V factor secreted by s aureus

184

Fat embolism syndrome is characterized by

pulmonary insufficiency, diffuse neuro impairment, thrombocytopenia, anemia