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uWorld 20 Flashcards

1
Q

where does heme synthesis occur

what are the principle sites of heme synthesis

A

partially in CYTOPLASM and partially in MITOCHONDRIA (first and final three steps)
erythrocyte precursor cells (located in the bone marrow) and hepatocytes (use heme in microsomal CYP450 system)

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2
Q

what happens when erythrocytes lose their mitochondria

A

lose ability to generate heme and therefore hemoglobin

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3
Q

what are PaO2, SaO2, and oxygen continent in cyanide poisoning

A

all are normal

venous oxygen octane raises and the arterial-venous oxygen gradient falls

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4
Q

what are PaO2, SaO2, and oxygen continent at high altitude

A

all are decreased

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5
Q

what are PaO2, SaO2, and oxygen continent in obese patients

A

hypoventilation due to reduced chest wall compliance
increased lower lobe perfusion (V/Q mismatch)
all decrease and CO2 content increases

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6
Q

what are PaO2, SaO2, and oxygen continent in anemia

and what is a common cause of anemia in premenopausal women

A

O2 content decreased but PaO2 and SaO2 are normal

chronic blood loss secondary to menstruation

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7
Q

what are the toxins of C. diff, which is more virulent, and in what way do they both work

A 
toxin A (enterotoxin)
toxin B (cytotoxin)- more virulent
both toxins INACTIVATE Rho-REGULATROY PROTEINS involved in signal transduction and ACTIN CYTOSKELETON STRUCTURE maintenance
as a result, the toxins cause DISRUPTION of INTERCELLULAR TIGHT JUNCTIONS leading to cell rounding/retraction as well as increased (paracellular) intestinal fluid secretion
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8
Q

what happens to RPF and GFR in a hypovolemic state (i.e.. diarrhea and vomiting for 24 hours)

A

reduced ↓↓RPF and ↓GFR and thus reduced FF (FF = GFR/RPF)
leads to compensatory efferent arteriolar vasoconstriction,w which raises the filtration fraction and maintains GFR at near normal (but still decreased) levels. As RPF continues o decline, increasing glomerular oncotic pressure will eventually overwhelm he compensatory increase in hydrostatic pressure, leading to a precipitous drop in GFR

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9
Q

what is polymyositis

A

autoimmune disease that occurs due to CD8+ lymphocyte-mediated skeletal muscle damage and usually presents with symmetric proximal muscle weakness

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10
Q

what is aldosterone escape

A

despite increase in sodium absorption, hypernatremia and pedal edema are rarely observed in hyperaldosteronism

increased intravascular volume causes increased renal blood glow (with resulting pressure natriuresis) and augmented release of atrial natriuretic peptide
this limits net folium retention and prevents the development of overt volume overload and significant hypernatremia

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11
Q

what are the sodium, potassium, and bicarb levels in primer hyperaldosteronism

A

sodium: normal (aldosterone escape)
potassium: low
bicarb: high (metabolic alkalosis)

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12
Q

when would one see hypernaremia, hypokalemia, and metabolic acidosis

A

diarrhea (loss of water, K+, and HCO3- in the stool)

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13
Q

when would one see hypotension, hyperkalemia, hyponatremia, and metabolic acidosis

A

primary adrenal insufficiency (increased sodium loss, reached urinary exertion of K+ and H+ due to low aldosterone activity)

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14
Q

how does hyperaldosteronism work

A

increased Na+ reabsorption form the collecting tubule
creates a negative charge in the lumen, pulling K= and H+ from fibular cells and leading to increased excretion of urinary K+ and H+
aldosterone escape- stops hypernatremia and pedal edema

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15
Q

what DNA pol is the only one with 5’ to 3’ exonuclease activity, what does this allow it to do?

A

DNA POLYMERASE I

used to remove RNA rimer synthesized by RNA primase

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16
Q

all 3 PROKARYOTIC DNA polymerases have the ability to do what

A

3’ to 5’ EXONUCLEASE (“PROOFREADING”) activity

allows them to be capable of REOVING MISMATCHED NUCLEOTIDES

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17
Q

what temporarily cleaves both strands of the DNA double helix and introduces negative supercoils into he circular DNA to relieve tension created during strand unwinding

A

topoisomerase II (DNA grase)

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18
Q

what promotes unwinding and dissociation of parent DNA strands at the replication fork

A

helicase

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19
Q

selective ARTERIOLAR VASODILATORS (hydrazine, minoxidil) lower blood pressure by reducing systemic vascular resistance. this is limited by what

A

reflex SYMPATHETIC ACTIVATION and stimulation of the RENIN-ANGIOTENSIN-ALDOSTERONE axis results in SODIUM and FLUID RETENTION with peripheral edema
and TACHYCARDIA

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20
Q

what does the PCA supply

A

CN III and IV
thalamus, medial temporal lobe, selenium of the corpus callous, parahippocampal gyrus, fusiform gyrus, and occipital lobe

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21
Q

how does PCP (the drug) work

A

NMDA antagonist that is a hallucinogen
dissociative symptoms (detachment and withdrawn)
violent behavior
nystagmus (horizontal and vertical)

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22
Q

what happens to ventilation, perfusion, and V/Q mismatch form apex to base of lung

A

perfusion and ventilation increase at the base of lungs b/c of gravity
perfusion in crease is greater thus V/Q ratio DECREASED from apex to base

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23
Q

describe the blood flow in the 3 zones of the lung

A

zone 1 (apex): does not occur under physiological conditions (Palv greater then Part greater than Pven)

Zone 2: higher areas of lung where blood flows in a pulsatile fashion (Part greater than Palv greater than Pven)

zone 3: lower areas of lung where blood flows continuously (Part greater than Pven greater than Palv)

in supine lung is ALL ZONE 3 (gravity)

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24
Q

what is the difference b/w mania and hypomania

A

hypomania has lesser degree of severity and functional impairment and the absence of psychosis
ppl who are hypomanic have noticeable behavior charge but are often very productive

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25
Q

what are neurophysins

A

carrier proteins for oxytocin and vasopressin (ADH)
unique neurophysins carrier oxytocin and ADH from site of production in PARAVENTRICULAR and SUPRAOPTIC NUCLEI to the posterior pituitary

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26
Q

point mutations in neurophysin II underlie most cases of what

A

hereditary hypothalamic diabetes insipidus (disorder resulting form insufficiency ADH please into the systemic circulation

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27
Q

pulmonary artery occlusion pressure is measured at the distal tip of the pulmonary artery catheter after an inflated ballon occludes flow through a pulmonary artery branch
this closely corresponds to what

A

left atrial and left ventricular end-diastolic pressure

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28
Q

what are the best methods for diagnosing type I diabetes

A 
FASTING GLUCOSE (over 126 mg/dL)
HEMOGLOBIN A1C (over 6.5%)
random glucose (over 200)
oral glucose tolerance test (expensive and less convenient than other options)
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29
Q

oral glucose test is the preferred screening methods for what

A

gestational diabetes and cystic fibrosis related disease

30
Q

matching is a method generally used in the design stage of case-control studies to control what kind of bias

A

CONFOUNDING

initial step of matching involves selecting variables that could be confounders (age, race, gender, smoking)
cases and controls are then selected based on the matching variables so that both groups have a SIMILAR DISTRIBUTION in accordance with the variables

31
Q

where are parietal cells found in the gastric mucosa

A

UPPER GLANDULAR LAYER

OXYNTIC (pale pink)

32
Q

the deeper aspect of the gastric glands has what

A

preponderance of small, basophilic, granular CHIEF CELLS that synthesize and secrete pepsinogen

33
Q

what are causes of vitamin A deficiency

A 
pancreatic insufficiency (chronic pancreatitis, cystic fibrosis)
cholestatic liver disease/ BILIARY OBSTRUCTION (primary biliary cirrhosis)
intestinal malabsorption (IBD, bariatric surgery)
insufficient dietary intake
34
Q

what is the ocular manifestation of rheumatoid arthritis

A

episcleritis or scleritis

usually presents as ocular discomfort

35
Q

what is the ocular manifestation of sickle cell

A

retinopathy due to micro vesicular occupation, retinal ischemia, and neovascualrization/hemorrhage

vasoocclusive symptoms too usually at this stage (lung disease)

36
Q

what is borezomib

A

inhibits 26S proteasome

can facilitate apoptosis of neoplastic cells by preventing degradation of pro-aporptoci factors in multiple myeloma

37
Q

what is mycophenolate

A

reversibly inhibits a critical step in de novo purine nucleotide synthesis (inosine monophosphate dehydrogenase), which is required for proliferation of activated lymphocytes
selectively targets lymphocytes, reducing B and T cell proliferation and antibody production while promoting T cell apoptosis

38
Q

ssDNA → dsDNA template → ssDNA progeny is the replication cycle of what virus

A

parvovirus

39
Q

dsDNA → dsDNA template → dsDNA progeny is the replication cycle of what virus

A

adenovirus, poxvirus, herpesvirus

40
Q

dsDNA → +RNA template → dsDNA progeny is the replication cycle of what virus

A

hepadnavirus (HBV)

41
Q

ssRNA → -RNA template → ssRNA progeny is the replication cycle of what virus

A

poliovirus

42
Q

ssRNA → dsDNA template → ssRNA progeny is the replication cycle of what virus

A

retroviruses

43
Q

ssRNA → +RNA template → ssRNA progeny is the replication cycle of what virus

A

influenza, measles, rabies

44
Q

what are the common medical conditions with POLYGENIC INHERITANCE

A 
androgenic alopecia
epilepsy
glaucoma
hypertension
ischemic heart disease
schizophrenia
TIIDM
45
Q

what is male pattern baldness

A

androgenic alopecia
most common type of hair loss in both males and females
POLYGENIC INHERITANCE
Ch 20, X, and Y

46
Q

what is the dandy walker malformation

A

HYPOPLASIA/ABSENCE of CEREBELLAR VERMIS and CYSTIC DILATION of the FOURTH VENTRICLE with posterior fossa enlargement
non-communicating HYDROCEPHALUS may occur due to areas of the formina of Luschka and Magendie (nausea vomiting)
agenesis of corpus callous and malformation of faces, heart, limbs

DEVELOPMENTAL DELAY and PROGRESSIVE SKULL ENLARGEMENT

47
Q

what is Arnold-Chiari malformation (Chiari II malformation)

A

downward displacement of the cerebellar vermis and tonsils below the foramen magnum
spinal myelomeningocele usually present

48
Q

how is a brain arteriovenous malformation present

A

age 10-30

intracranial hemorrhage, seizure, headache, or focal neurologic hemorrhage

49
Q

what is hypoxic-ischemic brain injury

A

may occur with complicated deliveries (emergency cesarean section)
typically presents with ALTERED CONSCIOUSNESS and decreased spontaneous MOVEMENTS during the neonatal period
watershed necrosis of the gray matter b/w perfusions zones of major cerebral arteries

50
Q

high potency (neurological) 1st generation antipsychotics (Haloperidol and fluphenazine) side effects

A

extrapyramidal signs (acute dystonia, akathisia, parkinsonism)

51
Q

low potency (non-neurological) 1st generation antipsychotics (chlorpromazine, thioridazine) side effects

A

sedation (histamine)
anticholinergic
orthostatic hypotension (alpha-1 blocker)

52
Q

what drug is used to treat male pattern baldness

A

finasteride- can minimize progression if used early on

DHT is strongly correlated with follicular hair growth

53
Q

what is used to treat ALOPECIA AREATA

A

autoimmune disorder that causes rapid-onset patch or diffuse hair loss

54
Q

what does B anthraces look like on standard culture

A

forms long chains that are described as being “serpentine” or “medusa head”
nonhemolyzing adherence colonies

55
Q

intracellular polyphosphate granules are characteristic of what bacteria and can be seen on what type of agar

A

Corynebacterium diphtheriae

can be visualized on microscopy after growth on LOEFFLER MEDIUM and staining with methylene blue

56
Q

what are peritrichous flagella

A

flagella distributed uniformity over the entire surface of a bacterial cell and are characteristic of highly motile organisms like PROTEUS MIRABILIS

57
Q

how are the oligodendrocytes in MS destroyed

A

Helper T cells abnormally react to antigens in the myelin, causing relate of inflammatory cytokine (IFN-gamma) that promote the infiltration of destructive macrophages/migroglia and leukocytes
slowed nerve conduction due to loss of myelin

58
Q

what contributes to the blood-brain barrier

A

astrocytes (glial cells- non neural cells)

potassium buffering, neurotransmitter metabolism, and glial scar formation

59
Q

what are microglia

A

resident macrophages in CNS

60
Q

at what level do the renal arteries originate from the aorta

A

L1

61
Q

where and from what is the IVC formed

A

L4-L5
right and left common iliac veins

drains to right atrium t T8

62
Q

what is a test of a patients concentration

A

reciting months of the year backwards

63
Q

what is a test of patients comprehension

A

following multistep commands

64
Q

what is a test of short-term memory

A

recalling 3 unrelated words after 5 minutes

65
Q

what is a test of executive function

A

drawing a clock oriented to the time requested

66
Q

in order to make a diagnosis of DEMENTIA the patient must demonstrate

A

IMPAIRMENT ACROSS SEVERAL COGNITIVE DOMAINS during testing as well as FUNCTIONAL IMPAIRMENT in ACTIVITIES of DAILY LIVING

67
Q

what are the most common causes of drug-induced tubular necrosis

A 
aminoglycosides
radiocontrast media
cisplatin
amphoteriin B
foscarnet
68
Q

ACE inhibitors can precipitate acute renal failure, causing what to happen to filtration fraction

A

decreases

see an increase of creatine of more than 30% (block the angiotensin mediated vasoconstriction of the efferent arteriole)

69
Q

what findings at autopsy are characteristic of CARCINOID HEART DISEASE

A

endocardial thickening
fibrosis of tricuspid and pulmonary valves

PATHOGNUMONIC plaque-like DEPOSITS OF FIBROUS TISSUE occur most commonly on the ENDOCARDIUm leading to TRICUSPID REGURGITATION, pulmonic valvulopathy, and right-sided heart failure

70
Q

what is the most common outcome of HBV

A

acute hepatitis with mild or subclinical symptoms that eventually completely resolve

uWorld Flashies (62 decks)

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