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Flashcards in uWorld 36 Deck (40):
1

the RER is the site of synthesis of what

SECRETORY, LYSOSOMAL, an integral MEMBRANE proteins

post-translational medication before going to golgi

2

what is made in the SER

STEROID and PHOSPHOLIPID

also detoxifies numerous drugs (especially in hepatocytes)

all-steroid producing cells (cells in ADRENALS, GONADS, and LIVER) contain WELL-DEVELOPED SER

sarcoplasmic reticulum of striated muscle cells is a specialized SER

3

cells that have HIGHLY-DEVELOPED SMOOTH endoplasmic reticulum

STEROID PRODUCING CELLS:
ADRENALS (all cortex made things are cholesterol-derived steroid hormones)
GONADS
LIVER

4

when should one confront a terminally ill patient their denial stage of grief

if it is affecting their medical care (refusing treatment) or significant relationships

if this isn't happening but they are in denial then encourage them to focus on short-term plans to maximize participation in areas that give meaning to their life

5

what cells are CD-19 positive

B cells

6

what does parvovirus B19 use to attach to human erythroid cells

erythrocyte P antigen (globoside)

7

what does EBV use to attach too CD21 (aka CR2)

gp350

(CD21 is the cellular receptor for C3d complement component found on B cells and nasopharyngeal epithelial cells)

8

acute onset dyspnea, hypoxemia, and hypocapnea are consistent with that

alveolar HYPERVENTILATION

9

assuming normal metabolic CO2 production, HYPOCAPNEA implies what

alveolar HYPERVENTILATION

EXAMPLE:
can be due to V/Q mismatch that causes DECREASED O2 and CO2 exchange (PNEUMONIA or PE)
-resultant hypoxemia triggers peripheral chemoreceptors and increases the respiratory drive above normal levels
-leads to excess CO2 excretion by the lungs, resulting in HYPOcapnea
-HYPOXEMIA PERSISTS b/c blood flowing through highly oxygenated lung cannot absorb extra O2 to compensate for the hypoxemic blood returning form the tissues
-TX is O2 and fixing underlying problem

10

upper airway obstruction, reduced ventilatory drive, respiratory muscle fatigue, and decreased chest wall compliance are all possible causes of what

HYPERcapnea and HYPOventilation

11

what acts as the central regulator of iron hemostasis

HEPCIDIN (acute phase reactant form liver)

↑ iron levels and inflammatory conditions → ↑ hepcidin synthesis

hypoxia and erythropoiesis → ↓ hepcidin synthesis

hepcidin interacts with FERROPORTIN (a transmembrane protein responsible for transferring intracellular iron to the circulation)
-upon binding hepcidin, ferroportin is internalized and degraded, ↓ intestinal iron absorption and inhibiting release of iron by macrophages

12

what brain tumors are collectively called gliomas and stain GFAP positive

astrocytomas
oligodendrogliomas
ependymomas

13

transposition of the great arteries is incompatible with life unless what is present

patent foramen ovale, septal defect, PATENT DUCTUS ARTEROSIS to allow for MIXING of the oxygenated blood with systemic blood

pts are tachypneic, cyanotic, and tachycardic

14

BLUNT AORTIC INJURY (traumatic aortic rupture) most commonly due to motor vehicle collisions occurs where

AORTIS ISTHMUS (tethered by the ligamentum arteriosum and is relatively fixed and immobile compared to the rest of aorta)

mechanism of injury involved SUDDEN DECELERATION that results in extreme stretching and torsional forces affecting the heart and aorta

most die before getting to hospital but may see chest pain, back pain, or shortness of breath w/ a WIDENED MEDIASTINUM on CXR

15

what are the symptoms of acute encephalitis and those specifically related to HSV encephalitis

HEADACHE, FEVER, MENTAL STATUS changes (lethargy, disorientation), CN deficits (Bells Palsy), SEIZURES

HSV Encephalitis:
temporal lobe damage- APHASIA and PERSONALITY CHANGES (hyper sexuality, aggression)

16

where is toxoplasma encephalitis usually found

RING-ENHANCING lesions of PARIETAL or FRONTAL loves

17

whats the difference b/w schizoid and avoidant personalities

schizoid ppl are content with being isolated

avoidant have the desire for social acceptance and may fantasize about having relationships

18

how does penicillin stop PBPs and how is this different than vanc

structurally similar to D-ala D-ala structure of peptidoglycan wall which facilitates their BINDING to PBPs

vanc DIRECTLY binds D-ALA D-ALA (this is an EARLIER STAGE of cell wall SYNTHESIS than penicillins)

19

how does PAH get into the blood

both freely filtered at the glomerulus but also SECRETED into the tubular fluid (an ENZYME-CARRIER MEDIATED process that can be SATURATED)

20

can excretion be maximalized?

no because excretion is filtration + secretion - reabsorption

filtration can never be saturated so neither can excretion

21

sharp mid-chest pain that increased with deep inspirations and decreased when sitting up
respiratory illness one week prior
normal bp and high pulse (120/70 and 110bpm)

nothing els tis given at all so what going on?

FRICTION RUB

chest pain of ACUTE PERICARDITIS is sharp and pleuritic in nature and characteristically decrease when patients SITS UP and LEANS FORWARD (decreasing pressure on the parietal pericardium)

22

during glycolysis ATP is generated when 1,3-BPG is converted to 3-phosphoglycerate by the enzyme phosphoglycerate kinase. what cells can bypass this step

ERYTHROCYTES can bypass this using BISPHOSPHOGLYCERATE MUTASE, an enzyme that converts 1,3-BPG to 2,3-BPG in a step that produces NO ATP

this is because 2,3-BPG is an important regulator of OXYGEN)HEMOGLOBIN BINDING
-conversion to 2,3-BPG is ↑ in states of HYPOXIA or chronic ANEMIA
-2,3-BPG allosterically decreases hemoglobins affinity for oxygen

23

what is an interscalene nerve block

regional anesthesia technique used for procedures involving the shoulder and upper arm

anesthetic is administered in the SCALENE TRIANGLE (b/w middle and anterior scalene muscles in the posterior neck) and affects the BRACHIAL PLEXUS TURNK and ROOTS

transient ipsilateral DIAPHRAGMATIC PARALYSIS in nearly all pts by anesthetizing the roots of the PHRENIC NERVE (C3-C5)

24

what its the omohyoid msucle

originates form upper scapular border and travels along the front of the neck to insert into the hyoid bone

innervated by cervial plexus (ansa cervicalis) originating form C1-C3

25

the risk of cardiovascular events with oral contraceptive pills in increased in whom

SMOKERS OVER 35

26

APC, BRCA1, KRAS, RB, TP53
which ones are tumor suppressors which ones are oncogenes

oncogenes: KRAS

tumor suppressors: APC, BRCA1, RB, TP53

27

name all the proto-oncogenes and their cancers in uWorld

ABL: CML, ALL

BRAF: melanoma

HER1: squamous cell lung cancer

HER2 breast/ovarian cancer

RAS: lung, colon, pancreatic (KRAS), renal cell, bladder (HRAS)

SIS: astrocytoma, osteosarcoma

TGFA: astrocytoma, hepatocellular carcinoma

28

name all the tumor suppressors and their cancers in uWorld chart

APC/beta-catenin: stomach, colon, pancreatic, FAP

BRCA1/BRCA2: breast/ovarian

DCC: colon cancer

NF1: neuroblastoma, NF1, sarcoma

RB: retinoblastoma, osteosarcoma, other cancers

TP53: most cancer, Li-Fraumeni

VHL: VHL, renal cell

WT1: wilms tumor

29

a patient with pain/distention, bloody diarrhea, fever, and signs of shock in the setting of untreated ulcerative colitis probably has what

TOXIC MEGACOLON

get a PLAIN ABDOMINAL X-RAY
barium enema and colonoscopy are contraindicated as it may cause perforation

(fun fact: toxic megacolon is also associated with c.diff)

30

AQUAGENIC PRURITUS, FACIAL PLETHORA and SPLENOMEGALY w/ elevated hemoglobin, hematocrit, and leukocytes suggests what

POLYCYTHEMIA VERA

JAK2 (CYTOPLASMIC TYROSINE KINASE) mutation causing constitutive activation of the kinase domain

31

what conditions are associated with polycythemia vera

peptic ulcer disease (altered mucosal blood flow due to increased viscosity)

gouty arthritis (higher red cell turnover)

32

what binds to receptor tyrosine kinases

insulin
insulin-like growth factor
epidermal growth factor

33

what causes decreased hemoglobin and haptoglobin levels as well as increases serum lactate dehydrogenase and unconjugated bilirubin

HEMOLYTIC ANEMIA

34

chronic hemolysis can lead to what in the kidney

breakdown of iron-containing erythrocytes that leas to IRON DEPOSITION in the kidney (HEMOSIDEROSIS) which can interfere with proximal tubule function and can cause interstitial scaring and cortical infarcts

hemosiderosis colinde with microvascular thrombosis an increase risk of chronic kidney disease

35

interstitial nephritis is common with what

drugs (analgesics, antibiotics)
recent infection
systemic condito (sarcoidosis)

36

membranous glomerulonephropathy is associated with what

SLE
drugs (NSAIDs)
hep B and C
solid tumor malignancies (lung, prostate, GI)

37

cast nephropathy is usually see with what

multiple myeloma

38

how does polymyxin work

binds to, disrupts, and interferes with permeability of the cytoplasmic membrane

39

how is resistance to aminoglycosides obtained

amino glycoside modifying enzymes
largely plasmid encoded and sere to phosphorylate, adenylate, or acetylate the antibiotic molecules and thus lead to decreased binding ability to ribosomal units

pseudomonas can also decrease antibiotic entry into the bacterium

40

what is the germ tube test and what is it for

CANDIDA

blood cultures inoculated for 3 hours at 37C shows formation of TRUE HYPHAE form of yeast called "GERM TUBES"