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uWorld Flashies > uWorld 18 > Flashcards

uWorld 18 Flashcards

1
Q

the vertebral venous plexus communicates with many things what connections allow for spread of prostate, breast, and lung cancers to the thoracic spine

A

prostate- prostatic venous plexus

lung and breast- Azygous Vein

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2
Q

what are lumacaftor and ivacaftor

A

CFTR-modulating medications that can potentially help pts with CF by restoring CFTR proteins to the membrane and also by enhancing protein function (chloride transport) at the membrane, respectively

has been shown to improve predicted FEV and decrease rates of pulmonary exacerbations

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3
Q

what parts of the pleura does the phrenic nerve innervate

A

DIAPHRAGMATIC and MEDIASTINAL PELURA

costal and cervical are innervated by intercostal nerves and are felt more locally

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4
Q

as the airways move distally what is the last thing to disappear as the epithelium changes along the respiratory tube

A

cilia (not found in alveolar ducts or alveoli themselves but everywhere else)

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5
Q

what part of the G-protein coupled receptor has 20 amino acids consisting mainly of valine, alanine, and isoleusine

A 
TRANSMEMBRANE DOMAIN (anchors to the cell membrane)
has many non polar, hydrophobic amino acids (Ala, Val, Leu, Ile, Phe, Trp, Met, Pro, Gly
arranged in ALPHA HELIX and project hydrophobic R groups outward, ANCHORING the transmembrane region of the protein to the hydrophobic core of the PHOSPHOLIPID BILAYER
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6
Q

hormone sensitive lipase is activated and inhibited by what

A

activated by stress hormones (catecholamines, glucagon, ACTH) via Gs receptors on adipocytes inc cAMP and PLA and PKA phosphorylating and activating HSL- stimulating lipolysis
inhibited by INSULIN

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7
Q

what does hormone sensitive lipase do

A

enzyme found in adipose tissue that catalyzes the mobilization of stood TBs into FREE FATTY ACIDS (FFAs) and GLYCEROL

the FFAs can be oxidized by the liver to acetyl-coA, which can be further metabolized into KETONE BODIES or shunted into TCA to generate energy for gluconeoenesis

glycerol used primarily as carbon source for GLUCONEOGENESIS

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8
Q

what does glycogen phosphorylase do

A

rate-limiting step of GLYCOGENOLYSIS- process that frees glucose-1-phosphate from stored glycogen chains

increases blood glucose levels during first several hours of fasting (no effect on FA oxidation)

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9
Q

what does mitochondria HMG-CoA Synthase do

A

plays a role in keynote production

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10
Q

what does testosterone influence the development of

A

internal male genetalia
spermatogenesis
male sexual differentiation at poverty (muscle mass, libido)

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11
Q

what does DHT influence the development of

A

external male genitalia
growth of prostate
male-pattern hair growth
amplifies the effects of testosterone due to high affinity for testosterone receptor

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12
Q

prenatal cocaine abuse increases the risk of what

A

preeclampsia
spontaneous abortion
fetal demise
placental abruption

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13
Q

what is gestation diabetes associated with

A 
mascrosomia
caudal regression syndrome
hypoglycemia
hypocalcemia
hypertrophic cardiomyopathy
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14
Q

what happens if leydig cells are functional but Sertoli cells are not in a fetus that is 46XY w/ testes

A

both female and male internal genitalia
male external genitalia

w/o MIF from sertoli cells the mullerian ducts will form female internal genitalia (fallopian tubes, uterus)

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15
Q

what is testes determining factor (TDF) and where is it found

A

responsible for gonadal differentiation into testes

found on STY gene no the Y chromosome

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16
Q

what tumor has characteristic waxing and waning of lymph nodes

A

FOLLICULAR t(14,18) blc-2overexpression

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17
Q

ALL is the most common leukemia in children, how does it present

A 
lymphadenopathy
hepatosplenomegaly
fever
bleeding
bone pain
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18
Q

who does diffuse b-cell lymphoma typically present

A

rapidly enlarging nodal (neck, abdomen, mediastinum) or extranodal symptomatic mass
Waldeyer’s ring (oropharyngeal lymphoid tissue) and GI tract are often involved
B-symtposm (fever, weight loss, drenching night sweats) can also be seen

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19
Q

how does hairy cell leukemia present

A

splenomegaly and pancytopenia in older men

tartrate-resistant acid phosphatase (TRAP) positive cells with hairlike cytoplasmic projections

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20
Q

how does mycosis fungicides present

A

cutaneous T-cel lyphonoma
proliferating CD4+ infiltrate dermis and epidermis, forming POUTRIER MICROABCESSES
manifests with PLAQUES (often on trunk or buttocks)
that may be confused with eczema or psoriasis
granulized erythema and scaling of the skin (erythroderma) may result

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21
Q

what nerve is found in the lateral compartment of the leg

A

superficial peroneal nere

blood drained by peroneal veins

ACS can produce- loss of sensation in the lower leg and dorsal of the food as well as foot drop

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22
Q

what nerve is found in the deep posterior compartment of the leg

A

tibial nerve
posterior tibial nerve and veins
peritoneal artery and veins

ACS of this compartment- decreased sensation of plantar surface, decreased toe flexion, and pain with passive toe expression

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23
Q

what nerve is found in the anterior compartment of the leg

A 
deep peroneal (fibular) nerve
anterior tibial artery and veins

most common site of compartment syndrome- foot extensors fucked (foot drop, decreased sensation b/w 1st and 2nd toes)

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24
Q

what is the course of the great (long) saphenous vein

A

dorsum of food and runs along medial leg and anterior thigh b4 merging with he common femoral vein in the femoral triangle

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25
Q

what are two complications of hereditary spherocytosis (AD)

A 
PIGMENTED GALLSTONES (any hemolytic anemia has this)
aplastic crisis from parvovirus B19 infection
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26
Q

pigmented gallstones are a complication of any what

A

hemolytic anemia

increased bilirubin from lysed RBCs precipitates as calcium bilirubinate, forming pigmented stones in the gallbladder

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27
Q

femoral avascular necrosis is seen in what RBC issue

A

SICKLE CELL

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28
Q

in a patient with both tonic-clonic seizure and absence seizures, what medication is the drug of choice

A

VALPROATE (treats both absence seizures and generalized tonic-clonic)

ethosuximide only treats absence seizures but will not be effective against generalized tonic-clonic

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29
Q

carbamazepine is the drug of choice for what type of seizures

A

complex (loss of consciousness) partial seizures but is also effective in generalized tonic-clonic

feared ADR of agranulocytosis or aplastic anemia

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30
Q

what are the classic 3D’s of C botulism

A

DIPLOPIA
DYSPHAGIA
DYSTONIA
develop within 12-36 hours of consumption

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31
Q

what is the toxin found in pufferfish and what does it do

A 
tetrodotoxin
leads to inhibition of sodium influx into nerve endings
manifests as:
weakness
paresthesias (face, extremities)
loss f reflexes
sometimes severe hypotension
patients commonly remain conscious although paralyzed
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32
Q

what is seen on peripheral blood smear of P falciparum

A

multiple small rings- TROPHOZOITES

banns-shaped gametocytes

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33
Q

what is necessary to kill the dormant liver forms (hypnozoites) of P vivid and ovale

A

PRIMAQUINE must be added to their therapy

34
Q

what is pentamidine used for

A

prophylaxis tx in pneumocystis jirovecii pneumonia in pts with HIV
treats African sleeping sickness
treats leishmaniasis

35
Q

if relative risk equals 1 what does that mean

A

null value, there is no association b/w the exposure and the disease

36
Q

if relative risk if greater than 1 what does that indicate

A

exposure is associated with increased risk of the disease

37
Q

if relative risk is less than 1 what does that indicate

A

the exposure is associated with decreased risk of disease

38
Q

when 95% confidence interval does NOT include the null value (1), this gives a corresponding what

A

P-VALUE LESS THAN 0.5 and an association b/w exposure and outcome is considered statistically significant

39
Q

what lab values are elevated in polycystic ovary syndrome

A

Lh is increased
insulin usually increased (insulin resistance)
androgen production increased
estrogen increased (inc androgens)- endometrial hyperplasia

40
Q

what is used to treat polycystic ovary syndrome

A

weight loss
dural estrogen-progestron oral contraceptives- to minimize endometrial proliferation, reduce androgenic symptoms and prevent unwanted pregnancy

41
Q

what is used in patients with POLYCYSTIC OVARY SYNDROME who WISH to GET PREGNANT

A

CLOMIPHENE- selective estrogen receptor modulator that prevents negative feedback inhibition on the hypothalamus and pituitary by circulating estrogen, resulting in increased gonadotropin production (FSH and LH) and OVULATION

42
Q

what are the two major processes that maintain plasma glucose between meals, what order to they work in

A

glycogenolyisis- primary source first 12-18hours of fasting
gluconeogenesis- once liver runs out of glycogen stores this is major process using lactate, glycerol, and gluconeogenic amino acids

43
Q

what enzymes are bypassed in gluconeogensiss

A

hexokinase
phosphofructokinase and pyruvate kinase
(all unidirectional)

44
Q

what is the first committed step of fluconeogenesis

A

biotin-dependent carboxylation of pyruvate to oxaloacetate by mitochondrial PYRUVATE CARBOXYLASE

45
Q

what is the malate shuttle

A

part of gluconeogenesis
oxaloacetate made in mitochondria is converted to malate there by malate dehydrogenase
malate can leave the mitochondria where it is converted back into oxaloacetate by malate dehydrogenase in the cytosol

46
Q

what does phosphoneolyruvate carboxykinase (PEPCK) do

A

converts oxaloacetate to phosphoenolpyruvate

47
Q

what two enzymes of gluconeogesesis work together to bypass pyruvate kinase

A

pyruvate carboxylase

and PEPCK

48
Q

what gluconeosnesis enzyme bypasses phosphofructokinase

A

FRUCTOSE-1,6-BISPHOSPHATASE

49
Q

what gluconeogenesis enzyme bypasses hexokinase

A

GLUCOSE-6-PHOSPHATASE

50
Q

what is palmitic acid

A

first fatty acid produced from acetyl CoA during lipogenesis in the fed state

51
Q

conversion of acetoacetyl-CoA to 3-hydroxy-3-methylglutaryl-CoA occurs during the synthesis of what

A

cholesterol and keynote bones

52
Q

if rotator cuff is fucked but you can abduct you just can externally rotate, what is fucked up

A

infraspinatus (only function is to externally rotate)

supra scapular nerve

53
Q

what is the origin, insertion, action, and innervation of supraspinatus (rotator cuff)

A

O: supraspinatous fossa
I: greater tuberosity
A: abduction
N: supra scapular nerve

MOST COMMON ROTATOR CUFF INJRUY

54
Q

what is the origin, insertion, action, and innervation of infraspiantous (rotator cuff)

A

O: infraspinatous fossa
I: greater tuberosity
A: external (lateral) rotation
N: suprascapular nerve

PITCHING INJURY (or football quarterback)

55
Q

what is the origin, insertion, action, and innervation of Teres Minor (rotator cuff)

A

O: lateral border
I: greater tuberosity
A: adduction and external (lateral) rotation
N: axillary nerve

56
Q

what is the origin, insertion, action, and innervation of subscapularis

A

O: sub scapular fossa
I: lesser tuberosity
A: adduction and internal (medial) rotation
N: upper and lower sub scapular nerve

57
Q

what opioids treat diarrhea

A

loperamide

diphenoxylate

58
Q

what can be used breast beta-lactamase producing bacterodies

A

piperacillin-tazobactam

59
Q

what is the cephalic phase of acid section within the stomach

A

mediated by cholinergic and vagal mechanisms

triggered b the thought, sight, smell, and taste of food

60
Q

what is the gastric phase of acid section within the stomach

A

mediated by the presence of gastrin (which stimulates histamine secretion and therefore, indirectly, acid secretion), and is triggered by the CHEMICAL STIMULUS of FOOD and the DISTENTION of the stomach

61
Q

what is the intestinal phase of acid secretion within the stomach

A

initiated when protein-containing food enters the duodenum, but this phase plays only a minor role in stimulating acid secretion

62
Q

what is effective in down-regulating gastric acid secretion after a meal

A

INTESTINAL INFLUENCES
ileum and colon release peptide YY, which binds to receptors on the endocrine, histamine-containing cells described as enterochromaffin-like cells
this counteracts the cephalic and gastric phases of acid secretion by inhibiting gastrin-stimulated histamine relate from ECLs
somatostatin and prostaglandins also inhibit acid secretion

63
Q

what is receptive relaxation

A

the reflex that allows the gastric fundus to dilate in anticipation of food passing though the pharynx and esophagus

64
Q

hyperparathyroidism (evidence by renal stones fixed by neck surgery) and starts getting bitemporal visual field defects, what should you suspect

A 
MEN type 1
hyperparathyroidism (hypercalcemia)
pituitary tumors (prolactin, casual defects)
PACNREATIC TUMORS (especially gastrinomas)
65
Q

what is infliximab

A

chimeric IgG1 monoclonal antibody to TNF-alpha

used in rheumatoid arthritis, ankylosing spondylitis, and fistulizing Crohn’s disease

66
Q

interleukin-2 is FDA-apprived for treatment of what

A

renal cell carcinoma
melanoma

regulates the activation and differentiation of T-cells to aid in tumor cell destruction

67
Q

what is abciximab

A

chimeric mouse-human monoclonal antibody against platelet GpIIb/IIIa receptor
works by blocking the final step in platelet aggregation
often administered during angioplasty in pts with acute coronary syndrome

68
Q

what is an anaplastic tumor

A

neoplastic cells that demonstrate complete lack of differentiation

69
Q

what are the typical features of anaplastic tumors

A
  • loss of cell polarity with complete disruption of normal tissue architecture; cells coalesce into sheets os islands in a disorganized, infiltrative fashion
  • significant variation in the shape and size of cells (cellular pleomorphism) and nuclei (nuclear pleomorphism)
  • disproportionately large nuclei (high N/C ratio) that are often deep-staining (hyperchromatic) with abundant, coarse-clumped chromatin an large nucleoli
  • numerous, often abnormal, mitotic figures
  • giant, multinucleated tumor cells
70
Q

acute pancreatitis in an alcoholic, what other findings would one expect to see due to cause of pancreatitis

A 
pancreatitis is causes by alcohol a lot
folate deficiency (megaloblastic anemia)
71
Q

how does ethanol cause panreatitis

A

ethanol stimulates pancreatic secretions with high protein concentration and low fluid content
these viscous secretions are prone to precipitate and form plugs that can obstruct the lumina of the pancreatic ductules
alcohol can cause spasms of the sphincter of odds and has a direct toxic effect not he acinar cells

72
Q

what is URUSHIOL

A

product of poison ivy, poison oak, and poison sumac

a small allergenic substance the causes an immune response when attached to proteins (i.e., hapten)

73
Q

abdominal aortic aneurysms are characterized by what

A

TRANSMURAL INFLAMMATION of the aortic wall

chronic inflammation leads to degradation of elastin and collagen by proteases, resulting in LOSS OF ELASTIN and smooth muscle cells and ABNORMAL COLLAGEN remodeling and cross-linking
these changes lead to weakening and progressive expansion of the aortic wall, resulting in ANEURYSM FORMATION

74
Q

an intimal tear in the aortic wall is the primary even involved in the pathophysiology of what

A

aortic dissection

75
Q

what is a mycotic aneurysm

A

caused by septic embody

present with painful, pulsatile masses and systemic signs such s fever and malaise

76
Q

what is inflammatory AAA

A

perivascular fibrosis with an extensive lymphocytic infiltrate and thickening of the adventitia
rate cause of AAA
typically associated with systemic symbols- fever, fatigue

77
Q

what happens in the first week after TB exposure

A

intracellular bacterial proliferation

SULFATIDE virulence factors allow for proliferation after phagocytosis

78
Q

wha are posterior urethral valves

A

result from malformation of the Wolffian duct, and therefor only occur in MALES
can present with BILATERAL HYDRONEPHROSIS and CALCYCEAL DILATION due to obstruction of urine flow in the urethra

79
Q

when does one see renal scaring most commonly at the upper and lower poles of the kidney in which compound papillae are found

A

chronic pyelonephritis due to vesicoureteral reflux (VUR)
seen in kids

compound papillae are alway open (unlike simple papillae in the mid kidney) and therefore much more susceptible to dilation and subsequent injury

80
Q

is uncorrected vesicoureteral reflux (VUR) can lead to what

A

loss of nephrons and SECONDARY HYPERTENSION

81
Q

what is multicystic dysplastic kidney (MCDK)

A

nonhereditary renal malformation characterized by multiple noncommunicating cysts with intervening dysplastic tissue
unilateral MCDK may be clinically silent, but bilateral MCDK presents with early, severe real insufficiency due to absence of functional renal tissue

uWorld Flashies (62 decks)

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