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Flashcards in uWorld 54 Deck (38):
1

symmetrical proximal muscle weakness
increasing difficulty climbing stairs, getting up from chain, carrying heavy objects, combing hair
INCREASED MHC CLASS I expression on the sarcolemma and CD8+ cells

POLYMYOSITIS

EVELVATED MSUCLE ENZYMES (CK, aldolase)
anti- ANA, Jo-1(aka anti-histidyl-tRNA)

ENDOMYSIAL mononucelar infiltrate, patchy necrosis, and regeneration and fibrosis of the muscle fibers

associated with: INTERSTITIAL LUNG DISEASE, MYOCARDITIS

2

in multiple myeloma what causes the BONE RESORPTION

section of IL-1 (osteoclast activating factor) and IL-6 by neoplastic cells- activates osteoclasts

bone pain, pathologic fractures, "punched out" lytic lesions on X-ray

HYPERCALCEIMIA from bone destruction- CONSTIPATION, CONFUSION, FATIGUE

3

what is higher in pulmonary vein than artery from the RAAS

ANGIOTENSIN II- potent vasoconstrictor of the systemic circulation and causes a rise in blood pressure (increased after load) that worsens cardiac output

4

difference in minute vent and alveolar vent is what

dead space (tidal volume times Paco, Peco, Paco)

5

what causes hereditary pulmonary HTN

INACTIVATION mutation in BMPR2, which is transmitted AD

predisposition for dysfunctional endothelial and SMOOTH MUSCLE CELL PROLIFERATION

second insult (infection, drugs, ion channel defects) is then thought to activate the disease process, which involves increased ENDOTHELIN (vasoconstrictor) and decreased NO (vasodilator) and prostacyclin (vasodilator and platelet inhibitor)- TWO HIT HYPOTHESIS

vasoconstriction with vascular smooth muscle proliferation

6

increased pulmonary artery pressure can cause what

dyspnea, fatigue, and can be heard as an ACCENTUATION of the PULMONARY component of the SECOND HEART SOUND (P2)

can lead to cor pulmonale (angina, DJP, hepatic congestion, and peripheral edema)

7

how is relative risk calculated

(a/(a+b))/(c/(c+d))

used in cohort

8

how is odds ratio calculated

OR: ad/bc
used in case-control

9

perforating stab wound right above clavicle, what is pierced

LUNG APICES and CERVICAL PLEURA extend above CLAVICLE and FIRST RIB

stab wounds immediately above the clavicle and lateral to the manubrium can puncture the pleura and acute pneumothorax, tension pneumothorax, or hemothroax

10

how do beta blockers lower BP

reducing myocardial contractility and heart rate
decreasing renin release by the kidney

11

what are the areas in the colon most susceptible to non-occlusive ischemia (like due to diabetes or atherosclerotic arterial disease)

2 WATERSHED ZONES
splenic flexture (SMA and IMA)
RECTOSIGMOID JUNCTION (sigmoid and superior rectal arteries)

complications: acidosis, sepsis, gangrene, perforation

pale mucosa and petechial hemorrhages

12

myxomatous changes of large arteries are found in what

CYSTIC MEDIAL DEGENERATION

characterized by fragmentation of elastic tissue ("basket weave" pattern) and separation of the elastic and fibromusclar components of the tunica media by small, cleft-like spaces that become filled with amorphous extracellular matrix

MARFAN SYNDROME- AORTIC ANEURYSMS and DISSECTIONS

13

what is beta-aminopropionitrile (a chemical found in certain kinds of sweat peas)

causes inhibition of lysyl oxidase, an enzyme responsible for cross-linking elastin fibers and collagen fibers

ingestion can cause change in elasticity of the aorta that mimics myxomatous degeneration

14

a PALPABLE but NONTENDER GALLBLADDER (courvoisier sign), weight loss, and obstructive jaundice (pruritic, dark urine, dark stool) are indicative of what

ADENOCARCINOMA of the HEAD of the PANCREAS compressing the biel duct

associated with SMOKING, age, DM, chronic pancreatitis, genetic predisposition (hereditary pancreatitis, MEN 1, HNPCC, FAP)

15

a low-fiber diet is associated with what kind of cancer

colon adenocarcinoma

16

what is released from HEMOGLOBIN in the lungs

HYDROGEN ION (the BOHR-HALDANE effect)

in the peripheral tissues relate of O2 from hemoglobin is enhanced by increased pCO2 and the resultant decrease in pH (BOHR effect)- bicarb is sent out of RBC for Cl- and H+ ions remain in the erythrocytes (buffered by HISTIDINE RESIDUES in hemoglobin)

when deoxygenated blood enters the alveolar capillaries of the lung- the rise in pO2 increased the binding of oxygen to hemoglobin and causes release of HYDROGEN IONS and CO2 from hemoglobin (HALDANE EFFECT)

HYDROGEN ions are ON HEMOGLOBIN
CHLORIDE is IN RBC

17

levels of what decrease in lactase deficiency

pH- the bacterial fermentation of lactose produces short-chain fatty acids (acetate, butyrate, and propionate) which LOWER STOOL pH (less than 6) and HYDROGEN GAS, which cases flatulence

also get INCREASED HYDROGEN in the breath (hydrogen breath test)

elevated stool osmotic gat (over 125mOsm) causing OSMOTIC DAIRRHEA

18

a non bicuspid aorta may present how (seen in turner syndrome)

early SYSTOLIC, high-frequency CLICK over the right second interspace

these valves at risk for stenosis, insufficiency, and infection

19

is HPV enveloped

NO

20

the conversion of alpha-helices to beta sheets requires what

breaking and reforming HYDROGEN BONDS

(these are SECONDARY STRUCTURES- hydrogen bonds are primary stabilizing force)

21

what forces stabilize tertiary protein structure

ionic bonds
hydrophobic interaction
hydrogen bonds
DISULFIDE BONDS (strong covalent bonds b/w 2 cysteine residues within the same polypeptide chain that enhance a proteins ability to WITHSTAND DENATURATION)

22

how do triptans work

5-HTB/D agonists

inhibit release of vasoactive peptides, promote vascoconstricon, blocking pain pathways in brainstem

23

post-synaptic norepi blockade is used for what in migranes

beta-blockers for prophylaxis

24

how does bupropion work

dopamine and norepi reuptake inhibitor used for depression and smoking cession

25

restrictive lung pattern with fibrosis and cystic spaces

IDIOPATHIC PULMONARY FIBROSIS

aka usual interstitial pneumonia- dense fibrosis and fibroblastic foci

alveolar wall collapse leads to formation of cystic spaces (HONEYCOMBING) lined by hyperplastic type II pneumocytes or bronchiolar epithelium

SUBPLEURAL and PARASEPTAL CYSTS

26

magnesium citrate and polyethylene glycol are examples of what

osmotic laxatives

similar mechanism to LACTASE DEFICIENCY

27

what are the main immune mechanism against GIARDIA

CD4+ T helper cells
SECRETORY IgA PRODUCTION- binds to trophozoites and impaired their adherence to the upper small-bowel mucosa

kids with IgA deficiceny, X-linked agammaglobulinemia, and CVID have a predisposition to giardiasis

28

abdominal discomfort, greasy stool, weight loss and multiple PAS-+ macrophages

WHIPPLE DISEASE

athropathy, polyarthritis, and psychiatric and cardiac abnormalities may be seen

antibiotics usually take care of this guy

29

avoidance of what will improve asthma

ANIMAL DANDER- or other allergens you dumb fuck

cold air only for sports induced which is much less common than allergic asthma

30

multisystem involvment and TRANSMUTAL inflammation of the arterial wall with FIBRINOID NECROSIS is seen in what

PAN
look for HEP B

kidney, heart, GI, and liver involvement common (NO LUNG)

31

what is the most common vasculitis associated with antibiotic use

MICROSCOPIC POLYANGITIS

32

how do you treat Diphtheriae

in order of importance:
1. diphtheria ANTITOXIN (passive immunization)
2. penicillin or erythromycin
3. DPT vaccine

33

what is the MCC of death from DIPHTHERIAE

CARDIOMYOPATHY

34

Small cell lung cancer and any other neuroendocrine cancer will stain for what markers

neuroendocrine markers:
NEURAL CELL ADHESION MOLECULE (NCAM or CD56)
neuron-specific ENOLASE
CHROMOGRANIN
SYNAPTOPHYSIN

some small cell can express neurofilaments

35

vimentin is found in what kind of cells and cancers

MESENCHYMAL origin

SARCOMAS

36

where is PPAR-gamma located

nucleus thus THIAZOLIDINEDIONES work by causing PPAR-gamma to form a heterodimer complex with retinoid-X receptor

37

persistent lyphedmea (with cornice dilation of lymphatic channels) predisposes to what

LYMPHANGIOSARCOMA (10 years after radical mastectomy)

38

patients with MEDICALLY INTRACTABLE symptoms of PARKINSON disease may benefit from high-frewuencty stimulation of what

GLOBUS PALLIDUS INTERNUS or SUBTHALMIC NUCLEUS

this removes the negative pathway and allows for improved mobility