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Flashcards in uWorld 43 Deck (51):
1

whats in rat poison

BRADIFACOUM (SUPERWARFARIN) a long acting 4-hydroxycoumarin derivative

depletes vitamin K clotting factors resulting in a coagulopathy similar to WARFARIN tox

use FRESH FROZEN PLASMA if emergency situation or vitamin K (if just the coagulation tests are fucked but no symptoms)

2

what is CRYOPRECIPITATE

obtained from fresh frozen plasma

contains factors VIII, XIIII, vWF, and fibrinogen

3

what accounts for dyspnea in left sided heart failure

DECREASED LUNG COMPLINACE (from fluid accumulation)


left ventricular contractility significantly decreases, reducing left ventricular output

resulting HIGH END-DIASTOLIC PRESSURE imparts diastolic return of blood TRANSUDATION of FLUID from the pulmonary capillaries into the lung interstitial

presence of fluid in the pulmonary intertisitium causes distortion (swelling) of affected tissue increasing resistance of movement (DECREASING LUNG COMPLIANCE)

as a result, the negative pressure generated during normal inspiratory effort is not sufficient to adequately distended the lungs, resulting in poor gas exchange and shortness of breath

4

what are some causes of decreased lung compliance

left sided heart failure

pulmonary fibrosis

insufficient surfactant

5

what enteric bacteria release AB5 toxins that activate electrolyte transport

Campy
Vibrio

6

what mediates cholesterol uptake

ENDOCYTOSIS via LDL receptor

7

GLUT transporters are examples of what

carrier mediated transport (FACILITATED DIFFUSION)

GLUT-4 is INSULIN SENSITIVE for UPTAKE of glucose found in SKELETAL MUSCLE and ADIPOCYTES

GLUT-2 facilitates export of glucose FROM the LIVER, SMALL INTESTINES, KIDNEYS into circulation

8

sickle cell causes what changes in hemoglobin

acidic glutamic acids (glu) residue at 6th position on beta-globing chain is replaced by NONPOLAR (neutral charge) VALINE (val) residue

leads to alteration of the region on the beta-globing SURFACE that interacts with a complementary site on another Hb molecule

the HYDROPHOBIC INTERACTIONS that occur cause aggregation of the Hb molecules (under anoxic conditions)

tertiary structure changed on surface

9

what happens in HbC

glutamic acids replaced by BASIC POLAR (positively charged) LYSINE

presence of lys causes HbC to have decreased mobility on electrophoresis

10

what is Familial Hypocalciuric hypercalcemia (FHH)

AD disorder due to defective CALCIUM SENSING by PARATHYROID and RENAL TUBULES

prevents PTH from being SUPRESSED in response to an INCREASE in CALCIUM

results in HYPERCALCEMIA with NORMAL-to-HIGH serum PTH levels

HYPOCALCIURIA due to impaired renal calcium sensing

11

what is seen in secondary hyperparathyroidism

chronic renal failure or vitamin D deficiency

hypocalcemia and elevated PTH

12

what is seen primary hyperparathyroidism

increased calcium and PTH

13

tetrahydropterin is needed for synthesis of what neurotransmitter

SEROTONIN (tryptophan hydroxylase needs it)

also Dopa, Norepi, and Epi (cuz phenylalanine hydroxylase and tyrosine hydroxylase needs it)

14

tetrahydropterin defieiceny causes what

disrupted neuronal and glial development (high phenylalanine development)

neurologic deterioration (low serotonin and other neurotransmitters)

developmental delay, hypotonia, dystonia, and seizures

low phenylalanine diet and BH4 supplementation

15

how is glutamate made

glutamine from glutaminase

16

how is GABA made

via glutamate decarboxylase

17

what patients are predisposed to priapism

sickle cell
multiple myeloma

18

how does trazodone work

serotonin modulator (antagonizes receptors and and inhibits reuptake)

alpha 1 blocker

H1 blocker

19

what causes mallory weiss tears

increased intraluminal gastric pressure due to retching, vomiting, or other abdominal straining

20

medicare is offered to whom

patients 65 or older who have worked and paid into the system

younger peeps with disabilities, end-stage renal disease, or ALS

21

what are the parts of medicare

part A: inpatient hospital visits

Part B; seller number of outpatient services and medical devices

Part C: optional captivated plan with additional benefits (vision, dental)

Part D: optional prescription drug plan

22

who is covered by medicaid

homeless

undocumented immigrants

PREGNANT WOMEN

LOW-INCOME families

23

what are causes of secondary hyperaldosteronism

renovascualr hypertension
malignant hypertension
renin-secreting tumor
diuretic use

24

what is superior mesenteric artery syndrome

if the angle between the SMA and aorta is less than 20 degrees (its normally 45 degrees), the TRANSVERSE PORTION of the DUODENUM can get trapped b/w the SMA and aorta, leading to symptoms of PARTIAL BOWEL OBSTRUCTION

happens when aorticomesenteric angle critically decreases, secondary to diminished mesenteric fat, pronounced lordosis, or surgical correction of scoliosis

25

narrowing of the aortomesenteric angle can occur with what

any condition that causes DIMINISHED MESENTERIC FAT, including low body weight, recent weight loss, severe burns or other inducers of catabolism, and prolonged bed rest

can also occur with prolonged lordosis or after surgical correction of scoliosis, as this procedure lengthens the spine resulting in decreased mobility of SMA

26

where do the gonadal arteries arise

abdominal aorta slightly below the renal arteries

right goes over IVC and below ileum

left goes behind left colic and sigmoid arteries and iliac colon

27

fever cough malaise
feeling sick since trip to great lakes
KOH of large yeast with SINGEL BUD that when incubated at 24C a multicellular structure with branching, tubular cells grows

fucking BLASTO
"DIMORPHIC"

SINGLE "BROAD-BASED" BUD

yeast has a DOUBLE REFRACTILE WALL

28

what is paracoccidioides

central and south america

CAPTAINS WHEEL on biopsy

multipel BLASTOCONIDIA on culture

mucocutaneous chronic mucocutaneous or cutaneous ulcers, can progress to lymph nodes and lungs

29

what looks like spaghetti and meat balls on KOH

malathesiza furfur

30

epidermal growth factor is implied in what cancer

HER2/neu

31

what is the clinical manifestation of AML

anemia
thrombocytopenia (petechiae, hemorrhages)
neutropenia (fever, opportunistic infection)

SIC

32

food- systemic circulation- meninges is seen in what infection

LSITERIA
gram + food born pathogen causing meningitis in neonates and pregnant

33

what happens to potassium in DKA

total body potassium DEFICIT but extracellular potassium is normal or increased

lack of insulin causes extracellular shifting of potassium as insulin normally promotes cellular uptake of potassium

make sure when giving insulin to give potassium too!

34

what the fuck is an ecological study

unit of analysis of a study is in POPULATIONS not individuals

frequency of a given characteristic (vitamin D intake) and a given outcome (multiple sclerosis) are studied using POPULATION DATA

useful to generate hypothesis but should not be used to make conclusion regarding individuals within these population (ECOLOGICAL FALLACY)

35

cross-sectional study is about what

PREVALENCE

collects data from a group of people to assess frequency of disease (and related risk factors) at a PARTICULAR POINT OF TIME

"What is happening"

36

what is the moa of digoxin

increased vagal tone (slows conduction through the av node)

Na/K ATPase inhbition- increased intracellular sodium and calcium (increases cardiac contractility)

37

what is seen digitoxin tox

cardiac arrhythmia and nonspecific GI (nausea, vomtiing), neurological (confusion, weakness) and visual symptoms

elevated potassium

38

atherosclerosis is initiated by what

repetitive endothelial cell injury

leading to chronic inflammatory state of underlying intima

39

how is severe hypoglycemia with loss of consciousness treated

IM GLUCAGON in a NONMETAL SETTING

IV DEXTROSE in a medical setting

40

what is used to treat mild hypoglycemia in a conscious patient

oral glucose

41

what are holocrine gland

SEBACEOUS (acne) and MEIBOMIAN glands

cells release ENTIRE contents of the cytoplasm and cell membrane

42

what are mercerize glands

SALIVARY, ECCRINE SWEAT, APOCRINE SWEAT

cells secrete via EXOCYTOSIS

43

what are apocrine glands

MAMMARY glands

cells secrete via MEMBRANE-BOUND VESICLES

44

what injectable insulin form of insulin that has no noticeable peak at all and lasts about 24 hours

GLARGINE (long acting that has pH of 4 and forms micropreipitate in the subcutaneous tissues after injection, resulting in a very slow release)

detemir doesn't last quite as long as peak at 3-9 hours (starts in 2 hours)

45

when does regular insulin peak after injection

2-4 hours
starts after 30
lasts 5-8 hours

46

how is essential tremor treated

propanolol

AD familial tremor

improve with alcohol consumption

classically worsens while minting a particular posture (holding an object)

most common movement disorder

slowly progressive, symmetric postural and/or kinetic tremor that most commonly affects upper extremities

47

how do you prevent GBS meningitis in a neonate

intrapartum penicillin (ampicillin is an acceptable alternative)

vaginal/anal screening is done at 35-37 week gestation

48

what is the most common organism causing bacteria in sickle cell patients

STREP PNEUMONIAE

H flu (second most common)

recommended that all splenic patients receive penicillin prophylaxis and pneumococcal vaccination

49

how does pituitary apoplexy (hemorrhage) present

severe HEADACHE and visual disturbances

signs of meningeal irritation can also be seen (micmic subarachnoid hemorrhage)

can develop CARDIOVASCULAR COLLAPSE due to ATCH deficiency and subsequent

MEDICAL EMERGENCY that requires urgent neurosurgical consultation and treatment with GLUCOCORTICOIDS

50

what are the clinical manifestations of ALL

fever, fatigue, pallor, petechiae, and bleeding

lymphadenopathy, hepatosplenomegaly, and bone pain

most common malignancy of childhood

51

what is the AML M7 type

primitive megakaryoblasts
t(1;22) and Down syndrome associations