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UWorld mixed > test #24 4.13 > Flashcards

test #24 4.13 Flashcards

1
Q

slow acetylators metabolize which 4 drugs slowly?

A

P450 acetylation of dapsone, hydralazine, procainamide, and isoniazid

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2
Q

methylation is an important drug biotransformation for..

A

azathioprine and 6-mercaptopurine

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3
Q

gilbert syndrome can affect drug metabolism..

A

bc some drugs require gluronidation for biotransformation.

dysfunctional glucoronyl transferase

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4
Q

drug hydrolysis occurs with..

A

esterases and amidases

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5
Q

normal amount of amniotic fluid

A

1000ml.

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6
Q

fetal anomalies associated w/ impaired swallowing (2)? increase urination? (polyhydramnios)

A

impaired swallowing: duodenal, esophageal, or intestinal atresia (GI obstruction) & anencephaly

increased fetal urination: high cardiac output due to (1) anemia or (2) twin-to-twin transfer

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7
Q

posterior urethral valve

A

congenital obstruction to urine flow

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8
Q

rachischisis

A

neural tube defect where vertebral column does not close over spinal cord. (posterior neuropore fails to close).

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9
Q

MI w/ normal coronary artery? think (3)

A

(1) coronary arteritis, (2) hypercoagulability w/ acute thrombosis, (3) coronary vasopasm

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10
Q

describe libman-sacks endocarditis

A

verrucous (wart-like) endocarditis, 25% of patients on EITHER side of valve. sterile, finely granular, fibrinous, eosinophilic. may result from immune complex deposition. can progress to valve fibrosis & regurg or stenosis.

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11
Q

Churgg-Strauss

A

polyarteritis nodosa-associated condition w/ lung vasculitis, severe asthma, and eosinophilia (in atopic patients). have necrotizing granulomas

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12
Q

flexor retinaculum aka

A

transverse carpal ligament.

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13
Q

carpa tunnel is associated with what scenarios?

A

(1) chronic repetitive stress (typing, knitting)
(2) fluid retention (renal failure, hypothyroidism, pregnancy
(3) diabetes mellitus, acromegaly, rheumatoid arthritis

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14
Q

dialysis associated amyloidosis

A

B2-microglobulin. can lead to median nerve compression (often bilateral)

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15
Q

endoneural inflammation infiltration with segmental demyelination seen in..

A

guillain-barre syndrome

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16
Q

endoneural arteriole hyalinization occurs in..

A

diabetic microangiopathy

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17
Q

insulin secretion is stimulation by which 3 systems

A

(1) blood glucose
(2) parasympathetic: secrete

insulin at smell/sight of food
sympathetic can inhibit or stimulate depending on receptor
(1) alpha- INHIBIT insulin release
(2) beta- STIMULATE insulin release

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18
Q

diphenhydramine, dimenhydrinate, chorpheniramine

A

commonly used antihistaminic agent (blocks H1). commonly have (1) anti-muscarinic (2) anti-alpha-adrenergic effects

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19
Q

ephedrine

A

indirect general sympathetic agonist, releases stored catecholamines.

used for nasal decongestion, urinary incontinence, hypotension

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20
Q

alpha receptor agonist on insulin?

A

inhibit insulin release

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21
Q

beta receptor agonist on insulin

A

promote insulin release

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22
Q

loratadine, fexofenadine, cetirizine

A

second generation H1 blockers. less sedating bc less CNS penetration.

still anti-Muscarinic

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23
Q

alpha-2 agonists (2)

A

clonidine & methyl-dopa

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24
Q

clonidine use

A

alpha-2 agonist, does not decrease renal blood flow. hypertensive urgency, ADHD

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25
Q

alpha-methyldopa

A

alpha-2 agonist. hypertension in pregnancy

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26
Q

classic anti-inflammatory effects

A

TGF-beta, IL-10

generally TGF-beta shuts it all down. and IL-10 shuts down cell-mediated and enhances humoral.

TGF-beta: (1) inhibit Th2 lymphocyte differentiation, (2) cytotoxic T cell activities, and (3) B-cell immunoglobulin secretion.

also suppress NK, LAK, and cytotoxicity of mononuclear phagocytes

IL10 (1) inhibits IL-2 and IFN-gamma production by Th1 cells, (2) enhances IL-4 and IL-5 production by Th2 lymphocytes. (3) inhibits TNF-alpha and IL-12 by monocytes and (4) decreases NK cell IFN-gamma production. (5) inhibit monocyte MHC class II and B7 expression (impairing antigen presentation)

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27
Q

TNF-alpha

A

proinflammatory cytokine. made by T cells and monocytes. induces NFKb (important factor in production of inflammatory mediators. IL-1, IL-4, IL-5, IL-12.

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28
Q

persistent lymphedema (chronic dilatation of lymphatic channels) predisposes to..

A

lymphangiosarcoma.

rare malignant neoplasm of endothelial lining of lymphatic channels.

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29
Q

pyogenic granuloma

A

polypoid form of capillary hemangioma. often grow rapidly, as exophytic red nodules attached by a stalk on gingival or oral mucosa or skin. bleed easily, may be ulcerated. resemble hypertrophic granulation tissue.

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30
Q

port-wine stain

A

birthmark of malformed, dilated blood vessels in superficial dermis. permanent.

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31
Q

kaposi sarcoma (histology)

A

HHV-8. hyperplasia or neoplasm of spindle-like cells w/ markers for (1) smooth muscle (2) vascular endothelium lining

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32
Q

liver hemangiosarcoma. caused by… (3)?

A

MALIGNANT tumor of endothelial origin. associated w/ exposure to..

(1) arsenic - pesticide
(2) vinyl chloride (plastics in industry)
(3) thorotrast - former radioactive contrast

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33
Q

PDA murmur

A

continuous, but will still hear distinct S1 / S2. can hear inspiratory splitting. best heart left infraclavicular. maximal intensity at S2.

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34
Q

Lutembacher syndrome

A

ASD presenting as continuous murmur when there is mitral valve obstruction due an elevated pressure gradient across atria. very uncommon

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35
Q

what travels through the optic canal (3)

A

CNII (optic n), opthalmic artery, central retinal vein.

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36
Q

what travels through superior orbital fissure (6)

A

CN III, IV, V1, VI, opthalmic vein, sympathetic fibers

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37
Q

what travels through foramen rotundum

A

CN V2 (travels in pterygopalatine fossa and then through inferior orbital fissure [[not in orbit]]

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38
Q

what travels through foramen ovale

A

CN V3

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39
Q

what travels through foramen spinosum

A

middle meningeal artery

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40
Q

what travels through internal auditory meatus? (2)

A

CN VII, and VIII

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41
Q

what travels through jugular foramen? (4)

A

CN IX, X, XI, jugular vein

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42
Q

what travels through hypoglossal canal?

A

CN XII

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43
Q

what travels through foramen magnum (3)

A

spinal roots of CN XI, brain stem, vertebral arteries

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44
Q

where do the branches of the trigeminal n leave the skull (3)

A

standing room only.

V1: superior orbital fissure
V2: foramen rotundum
V3: foramen ovale

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45
Q

foramen lacerum

A

occluded by cartilage. internal carotid artery courses just superior to the foramen lacerum in the carotid canal

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46
Q

ways to damage radial n

A

proximal: uses crutches improperly, passing out on chair. midshaft fracture of humerus (travels w/ deep brachial artery)
distal: medial epicondyle fracture.
path: medial to surgical neck of humerous, inferior to teres major within axilla. enters posterior arm between long head of triceps brachii and posterior humerus.

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47
Q

roots and cord of radian n.

A

C5-T1. posterior cord.

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48
Q

suprascapular n.

A

supraspinatus and infraspinatus. abduct and laterally rotate arm

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49
Q

damage to long thoracic nerve. how is it often damaged?

A

damage serratus anterior. winging of scapula (medial border).

damage long thoracic w/ lymph node dissection, radial masectomy

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50
Q

fracture of surgical neck of humerus / anterior dislocation of glenohumeral joint

A

axillary nerve injury. paralysis of deltoid and teres minor.

problems w/ abduction, extension, flexion, lateral rotation of arm at sohulder

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51
Q

spinal accessory innervates

A

trapezius and sternocleidomastoid

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52
Q

what % of small cell carcinoma occur in nonsmokers

A

1%

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53
Q

what extrapulmonary feature is large cell carcinoma of lung associated w.

A

gynecomastia and galactorrhea

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54
Q

what extrapulmonary feature is adenocarcinoma associated with (2)

A

hypertrophic osteoarthropathy and clubbing

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55
Q

most common lung cancer in population (female and nonsmokers)?

A

adenocarcinoma

56
Q

endometrium days 1-14 (proliferative/follicular phase)

A

estrogen stimulates proliferation of stratum functionale. nonbranching, nonbudding, UNIFORM glands evenly distributed throughout uniform stroma. glands are TUBULAR, NARROW, STRAIGHT, lined w/ pseudostratified elongated mitotically active epithelial cells. spiral artery in deep layers.

gland:stroma ratio < 1:1

begins w/ menses and ends w/ ovulation

57
Q

endometrium days 15-28 (secretory phase)

A

progesterone promotes development of secretory endothelium. glands larger, more COILED, cells lining glands have cytoplasmic vacuoles. glycogen-rich MUCUS released. stroma = EDEMATOUS. prominent spiral arteries extend to endometrial surface.

gland:stroma ratio ~1:1

begins w/ ovulation and ends w/ onset of menses.

58
Q

how does c. tetani cause disease

A

tetanospasmin toxin binds to presynaptic membrane of motor neurons, migrates retrograde axonal transport to cell bodies, into spinal cord & brain stem. block glycine and gaba release from central system.

59
Q

cardiac output with ficks principle

A

co = o2 consumption / arteriovenous O2 difference

how much blood must flow through pulmonary / systemic circulation to account for the difference in oxygen content between arterial and venous circulations

60
Q

respiratory quotient

A

ratio of CO2 to O2 across alveolar membrane. estimates metabolic rate. usu 0.8.

61
Q

ovary findings in turner’s

A

various degrees of ovarian dysgenesis (complete absence to streaked [connective tissue w/ no or minimal follciles]

62
Q

hirsuitism and primary amenorrhea

A

polycystic ovarian syndrome

63
Q

disseminated candida infxn? test?

A

rarely, in very immunosuppressed, any organ. pneumonia, esophagitis, right sided endocarditis, abscesses, candidemia (sepsis)

cold - yeast. heat - mold.

on light microscope: budding yeasts w/ pseudohyphae.

innoculation into serum 37 C (98.6) for 3 hours: form true hyphae (see yeast transforming to mold) on scope

64
Q

adult lead poisioning

A

less common, miners or industrial workers, especially battery manufacturing

65
Q

presentation of lead poisioning

A

weakness, abdominal pain, constipation. severe: neuro. blue “lead lines” at junction of teeth and gingivae. peripheral blood smear: coarse basophillic stippling on background of hypochromic microcytic anemia.

inhibition of ALAD and ferrochelatase

accumulate protoporphyrin and d-ALA

66
Q

mees lines – white lines on finger nails

A

arsenic poisioning

67
Q

purple / blue ilnes on gingiva

A

lead poisioning

68
Q

basophillic stippling in lead poisioning

A

ribosomal aggregates

69
Q

enzyme deficiency in acute intermittent porphyria. symptoms.

A

porphobillinogen deaminase.

build up porphobillinogen, d ALA, and (coporphobillinogen in urine)

symptoms = 5 P’s
painful abdomen, port-wine coloured urine, polyneuropathy, psychological disturbances, ppt by drugs, alcohol, and starvation.

rx: glucose + heme, to stop ALAS (rate-limiting step) reduces production of d-ALA & porphobillinogen

70
Q

porphyria cutanea tarda

A

deficient in uroporphyrinogen decarboxylase

71
Q

first step in heme synthesis requires. blocked in?

A

glycine, succinyl-CoA —-> d-ALA

enzyme: d-ALA synthase
cofactor: B6

defective in x-linked sideroblastic anemia

72
Q

steps in heme synthesis blocked by lead poisioning (2)

A
  1. d-ALA —> porphobillinogen
    via d-ALAD (d-ALA dehydratase)

build up d-ALA

  1. protoporphrin + Fe2+ —> heme
    via ferrochelatase

both steps in mitochondria!

73
Q

defective step in acute intermittent porphyria

A

conversion of porphobillinogen —> hydroxymethylbilane.

via porphobilinogen deaminase

(will have corporbillinogen in urine)

74
Q

defective step in porphyria cutanea tarda

A

uroporphyrinogen III —-> coproporphyrinogen III

via uroporphryrinogen decarboxylase

build up uropohryin (tea coloured urine

75
Q

tea-coloured urine + blistering photosensitivity

A

porphyria cutanea tarda. defective uroporphyrinogen decarboxylase.

76
Q

abdominal pain w/o abdominal tenderness

A

acute intermittent porphyria

77
Q

leukoerythroblastosis

A

immature granulocytes w/ nucleated tear drop-shaped RBCs. results from myelopthisic processes

78
Q

Pica

A

abnormal compulsive consumption of nonfood and/or non-staple food. can occur in any stage of pregnancy. associated w/ iron-deficiency anemia.

can LEAD to anemia bc of decreased nutritional intake.

vs. normal pregnancy craving: overeat normal foods

79
Q

anorexia nervosa

A

excessive DIETING. weight loss of 25% of body weight. or 15% below normal weight for age / height. distorted body image.

80
Q

bulimia

A

episodic & secretive BINGE eating followed by self-induced vomiting / fasting / laxatives.

81
Q

olfactory craving

A

common appetite disturbance of pregnancy. craving certain smells. often, dangerous items like gasoline, automobile exhaust, liquid

82
Q

what kind of polymerase is telomerase

A

reverse transcriptase (RNA-dependent DNA pol) TTAGGG to 3’ end.

consists of TERT reverse transcriptase and built in TERC RNA template (read repeatedly)

83
Q

bloom syndrome

A

premature aging. associated w/ shortened telomeres

84
Q

what cofactor is needed for oxaloacetate —> PEP (via PEP carboxykinase

A

GTP (made from succinyl-CoA to succinate in TCA)

85
Q

metabolites made in TCA! 5

A
  1. isocitrate –> a-KG makes NADH
  2. a-KG –> succinyl-CoA makes NADH
  3. succinyl-CoA –> succinate makes GTP
  4. succinate –> fumarate makes FADH2
    (fumarate –> malate makes nothing)
  5. malate –> oxaloacetate makes NADH

(malate can leave mitochondria to become oxaloacetate –> PEP consuming GTP

86
Q

how can oxaloacetate get from mitochondria to cytoplasm for gluconeogenesis?

A

(1) PEP carboxykinase in mitochondria can convert oxaloacetate —> PEP
(2) oxaloacetate transamination to aspartate
(3) oxaloacetate reduction to malate

PEP, aspartate, and malate can all leave mitochondria. oxaloacetate cannot.

87
Q

medications that can cause seizures

A

bupropion, clozapine, isoniazid, ciprofloxacin, imipenem

88
Q

rare but important side effect of ticlopidine

A

neutropenia, presents w/ fever and mouth ulcers!

must monitor CBC biweekly for first 3 months!

89
Q

fever and mouth ulcers in patient treated w/ meds post-stroke

A

ticlopidine

90
Q

nipple inversion in breast cancer suggests

A

tumor invades central region of breast

91
Q

skin retraction “focal dimpling”

A

cancer infiltrates suspensor Cooper ligaments

92
Q

peu de orange – lympedema and putting and thickening of skin

A

dermal lymphatic invasion/obstruction, seen w/ invasive breast carcinoma. often inflammatory type. 50% survival in 5 years.

93
Q

diphenoxylate & meperidine

A

mu-optiate agonist. anti-diarrheal. SLOWS gastric motility.

since high doses –> euphoria. add atropine in med to discourage abuse

94
Q

sulfasalazine

A

combination of (1) sulfapyridine (antibacterial) and (2) 5-aminosalicylic acid (anti-inflammatory.

activated by colonic bacteria.

used for crohn’s and ulcerative colitis.

95
Q

kaolin-pectin & attapulgite

A

make stool less watery, symptomatic relief

96
Q

rx for secretory diarrhea

A

can be due to many things. rx: octreotide, bismuth salicylate, probiotics help

97
Q

psychogenic polydipsia

A

(1) serum Na+ low
(2) urine concentrates w/ water deprivation (after dehydration)
(3) <10% increase in urine concentration after ADH

98
Q

DHT binds to..

A

testosterone receptor; has higher affinity than testosterone

99
Q

which drug decreases leydig cell synthesis of testosterone

A

ketoconazole (block 17,20 desmolase) & spironolactone (17-alpha-hydroxlase)

100
Q

ketoconazole’s endocrine effects

A

weak anti-adrenergic. blocks leydig production of testosterone and adrenal production of steroid hormones.

blocks 17,20 desmolase

101
Q

anastrozole

A

aromatase inhibitor

102
Q

flutamide & cyproterone acetate, and spironolactone

A

block testosterone intxn w/ receptor

103
Q

treat metastatic prostate cancer

A

flutamide

104
Q

spironolactone’s endocrine effects

A

(1) blocks testosterone receptor (2) blocks 17,20 desmolase (steroid synthesis)
(3) blocks 17-alpha-hydroxylase

105
Q

adenoma to carcinoma sequence

A

AK-53 & DCC
normal mucosa –> cancer
APC –> K-ras –> p53

APC –> makes adenomatous polyp.
K-Ras –> increase polyp size
p53 + DCC –> malignant transformation

106
Q

mutation in WT-1

A

Wilms tumor

107
Q

normal fxn of BRCA

A

suppresses cell cycle

108
Q

role of APC

A

implicated in sporadic colon cancer (normal mucosa –> polyp –> cancer) & FAP (autosomal dominant inheritance of mutated APC gene.

needed to maintain low levels of beta-catenin (oncogenic) & maintain intercellular adhesion

109
Q

fall from free & catch tree trunk as falling

A

damage lower trunk C8-T1: klumpke’s palsy

110
Q

musculocutaneous n injured when…

A

w/ upper trunk lesions, like head and shoulder are violently stretched apart

111
Q

long thoracic n injury

A

axially node dissection w/ radical masectomy

112
Q

common side effect of all nitrates

A

headaches & cutaneous flushing

113
Q

causes of secondary hyperaldosteronism

A

high aldosterone due to high renin.

(1) renal artery stenosis, associated w/ fibromuscular dysplasia, or atheroscerlosis.
(2) malignant hypertension (leading to microvascular damage and renal ischemia).
(3) renin-secreting tumors (juxtaglomerular cells)

114
Q

cancers associated with Rb

A

retinoblastoma and osteosarcoma

115
Q

cancers associated w/ BRCA

A

breast and ovarian

116
Q

cancer associated w/ APC

A

colon cancer (FAP and sporadic), and melanoma

keep beta-catenin low & maintain intercellular adhesion

117
Q

most common cancers in li-fraumeni

A

inherited autosomal dominant. p53 (tumor suppressor). need to have sporadic mutation in second.

breast, brain, adrenal cortex.

118
Q

bile soluble means..

A

it will die in bile! like s. pneumoniae

119
Q

differentiate s. bovis & enterococci

A

both survive in bile. s. bovis DIES in NaCl

120
Q

hypertrophic cardiomyopathy (HCM) associated w/ mutations in..

A

sarcomere proteins

myosin heavy chain, myosin binding protein, cardiac troponin T, tropomyosin

121
Q

inherited dilated cardiomyopathy

A

1/3rd are inherited. majority due to autosomal dominant defect in cytoskeletal protein (like distrophin) or mitochondrial enzymes

122
Q

where is ADH / vassopressin made

A

supraoptic / paraventricular nuclei of hypothalamus

123
Q

transient central diabetes insipidus

A

damage to posterior pituitary. magnocellular neurons in hypothalamus hypertrophy and undergo axonal regeneration –> allows for release of fxnal ADH eventually.

124
Q

permanent central diabetes insipidus

A

damage to hypothalamus or supraoptic-hypophysial tract. not enough magnocellular neurons to make enough ADH

125
Q

main feature of G1, S, and G2 phase

A

G1: synthesis of RNA, protein, lipid and carbohydrate
S: DNA replication
G2: ATP synthesis

126
Q

active Rb

A

hypophosphorylated ‘unleashed’. prevents G1—>S transition

127
Q

evidence of frontal lobe damage

A

inappropriate behavior, impaired judgement, poor executive fxn. incontinence and gait disturbances

128
Q

damage to inferior parietal lobe of DOMINANT hemisphere? non-dominant?

A

dominant (usu left): Gerstmann’s syndrome: right/left confusion, dysgraphia, dyslexia, dyscalculia.

nondominant: apraxia, contralateral neglect

129
Q

marantic endocarditis

A

non-bacterial thrombotic endocarditis associated w/ underlying visceral malignancy. often: mucinous adenocarcinomas of pancreas & adenocarcinoma of lung (relate to procoagulant effects of circulating mucin)

(bc cancer-related wasting of body “marasmus”)

tumor-associated release of procoagulants also thought to be responsible for migratory thrombophlebitis (Trousseau syndrome)

130
Q

Trousseau syndrome

A

migratory thrombophlebitis sometimes seen w/ underlying malignancy (GI).

like marantic endocarditis: mucin-related GI malignancy –> hypercoagulable state –> NBTE

131
Q

achalasia

A

failure of LES to relax. absence of myenteric (auerbach’s plexus) –> high LES opening pressure and uncoordinated peristalisis. progressive dysphagia to solids and liquids. “bird beak” on barium swallow

132
Q

which pharyngeal muscle is important to initiate wave of peristalisis

A

cricopharnyngeus muscle, push bolus down.

133
Q

cricopharyngeal dysfunction

A

failure of cricopharyngeal muscle to relax during swallowing. causes choking or food sticking sensation and pain with swallowing

134
Q

brain metastasis

A

multiple well-circumscribed masses and junction of gray and white matter.

135
Q

gross oligodendrogliomas

A

well circumscribed gray messes. areas of necrosis and hemorrhage not common

136
Q

gross glioblastoma

A

frequently cross midline, in white matter. foci of necrosis and hemorrhage common

UWorld mixed (60 decks)

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