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uWorld Flashies > uWorld 55 > Flashcards

uWorld 55 Flashcards

1
Q

what do C3a and C5a do

A

both are anaphlatoxins (so is C4a)

C3a: recruits and activates EOSINOPHILS and BASOPHILS

C5a: recruits and activates NEUTROPHILS

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2
Q

what are specific neutrophil chemotactic agents

A

N-FORMYlATED PEPTIDES
leukotrienes B4
5-HETE (the leukotriene precursor)
C5a

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3
Q

what is NEPRILYSIN

A

a metalloproteiase that cleaves and inactivates endogenous peptides including NATRIURETIC PEPTIDES, GLUCAGON, OXYTOCIN, and BRADYKININ

inhibition of neprilysin leads to increased levels of ENDOGENOUS NATRIURETIC PEPTIDES, which promote beneficial effects in heart failure

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4
Q

how do you treat and adrenal crisis

A

hydroxycortisone or dexamethasone

HIGH-FLOW IV FLUIDS

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5
Q

aflatoxins cause what mutation

A

G:C to T:A mutation in codon 249 of the p53 gene leading to hepatocellular carcinoma

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6
Q

what do short non-coding RNA sequence (microRNA and small interfering RNA) do

A

induce post translational gene silencing by base-pairing with complementary sequences within target mRNA molecules

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7
Q

a double stranded RNA molecule that is complementary to a region of mRNA fucks up what

A

mRNA translation (posttranscriptional modification)

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8
Q

what is RNA interference

A

an important mechanism in which short (20-30bp) non-coding RNA sequence induce POSTTRANSCRIPTIONAL GENE SILENCING

types of silencing RNA include SMALL INTERFERING RNA (siRNA) and microRNA (miRNA)

after being transcribed, miRNA undergoes processing in the nucleus to form a DOUBLE-STRANDED precursor that is then exported into the cytoplasm

there, the precursor is clever into a short RNA helix by a ribonuclease protein called DICER

individual strands are then separated and incorporated into RNA-INDUCED SILENCING COMPLEX (RISC)

multi protein complex uses its associated miRNA was a template to bind to complementary sequences found on target mRNAs

exact match results in mRNA degradation, but a partial match also causes translational repression by preventing ribosome and transcription factor binding

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9
Q

whats the difference b/w brown and black pigment stones (gallbladder)

A

BLACK stones: CHRONIC HEMOLYSIS (sickle cell, spherocytosis) or increased ENTEROHEPATIC CYCLING of bilirubin (ILEAL disease)

BROWN stones: BILIARY TRACT INFECTION (E coli, liver fluke) which release of microbial beta-glucronidases

BOTH result in increased UNCONJUGATED BILIRUBIN leading to calcium-bilirubinate precipitation

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10
Q

what do the gluteus medius and minus do

A

stabilize hip

abduct the thigh when limb is extended

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11
Q

whats the obturator internus do

A

fan-shaped muscle originating from the medial surface of the obturator membrane, ischium, and pubic rim

exits pelvis through he lesser sciatic foramen and insets on the greater trochanter of the femur

externally rotate thigh when extended and abduct the thigh when flexed (same as piriformis)

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12
Q

what does the piriformis do

A

originates on anterior aspect of sacrum and occupies most of the space in the greater sciatic foramen

inserts on the greater trochanter of the femur

externally rates the thigh when etude and abduct the thigh when flexed

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13
Q

what structures run above the piriformis and under it in the greater sciatic foramen

A

above: SUPERIOR gluteal vessels and superior gluteal nerve
below: INFERIOR gluteal vessels, internal pudendal vessels, multiple nerves (SCIATIC)

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14
Q

what is piriformis syndrome

A

muscle injury or hypertrophy compression SCIATIC nerve to cause sciatica-lied symptoms (pain, tingling, and numbness in buttocks and along the nerve distribution)

muscle can be tender with deep palpation or on stretching with adduction and internal rotation

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15
Q

conditions that cause GI irritation (infection, chemo, distention) causing EMESIS should be treated how

A

5-HT3 receptor antagonists (ondansetron)

the GI irritation results in increased mucosal SEROTONIN relate and activation of 5-HT3 receptor on vagal and spinal afferent nerves

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16
Q

what is pharyngoconjucntival fever

A

ACUTE onset FEVER, COUGH, CONGESTION, PHARYNGITIS, and OCNJUCTIVITIS

ADENOVIRUS

dsDNA virus (NAKED)

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17
Q

localized back pain, low-grade fever, recent staph bacteremia suggests what

A

VERTEBRAL OSTEOMYLITIS

hematogenous spread (skin or soft tissues, IV cath), direct invasions form trauma or local spinal procedures, or direct spread from adjacent soft tissue infection

BLOOD CULTURES and MRI of SPINE

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18
Q

what causes digital clubbing

A

prolonged hypoxia

lung cancer, TB, cystic fibrosis, suppurative lung disease (emphysema, bronchiectasis, and chronic lung abscesses)

cyanotic congenital heart disease (5Ts- especially tetralogy of fallot) and bacterial endocarditis

IBD, hyperthyroidism, and malabsorption

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19
Q

what does an S3 heart sound in an adult suggest

A

suggests VENTRICULAR ENLARGEMENT

chronic severe mitral regurg, chronic aortic regurg, heart failure associated with dilated or ischemic cardiomyopathy

heard during DIASTOLE, shortly after S2
heard with bell at APEX while patient is in the left lateral ducbitous position at END EXPIRATION

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20
Q

what does amyl nitrite inhalation do

A

causes VASODILATION, decrease in venous return and blood pressure

decreases intensity of S3 (so does furosemide and valsalva)

21
Q

lower extremity cyanosis and clubbing in a 10 year old WITHOUT pulse difference in extremities suggests what

A

PATENT DUCTUS ARTERIOSUS complicated by Eisenmenger syndrome

(coarctation has pulse differences in upper and lower body)

22
Q

what kind of hypersensitivities are seen in SLE

A

Type II: antibodies against blood cells (PANCYTOPENIA)

Type III: LUPUS NEPHRITIS- immune complex deposition causing PROTEINURIA and RBC CASTS

23
Q

what does primaquine do in malaria treatment

A

kills HYPNOZOITES (the LATENT HEPATIC infection) that are caused by P VIVAX and OVALE

24
Q

what is the most serious long term effect of chloroquine use

A

RETINOPATHY

25
Q

how do you manage someone with somatic symptoms disorder

A

schedule REGULAR VISITS with SAME PROVIDER

LIMIT UNNECESSARY WORKUPS and REFERRALS to specialists

reassure that serious illness has been ruled out

legitimize symptoms but make functional improvement to treatment goal

  • decrease stress
  • improve coping strategies

mental health referral only once physician-patient relationship is well established

26
Q

patients with sickle cell (or other hemolytic anemias) are predisposed to what kind of anemia

A

FOLIC ACID DEFICIENCY b/c of large TURNOVER of ERYTHROCYTES

27
Q

how can one tell if microcytic anemia in sickle cell (or another hemolytic anemia) is due to extra medullary hematopoiesis or folic acid deficiency

A

check the RETICULOCYTE INDEX

LOW reticulocyte index suggests erythropoiesis is NOT the main factor contributing to the microcytic anemia

elevated RI relents adequate marrow response and would suggest erythropoiesis

28
Q

non-pupil sparing 3rd nerve palsy is due to compression where

A

POSTERIOR CEREBRAL ARTERY (ISPSILATERALLY)

nerve passes between PCA and superior cerebellar artery(found right below the PCA on imaging)- either one can compress it

chronic smoking or poorly controlled HTN are risk factors for aneurysmal anywhere intracranially

29
Q

infant with delated motor development and flaccid paralysis (hypotonia, decreased deep tendon reflexes)- can’t life up head or roll over at 6 months- likely has what

A

SPINAL MUSCLAR ATROPHY

surveil motor neuron (SMN1) gene mutation that encodes for snRNPs in lower motor neurons- impaired SPLICEOSOME FUNCTION and DEGENERATION of ANTERIOR HRONS CELLS

30
Q

what muscles abudct the hip

A

gluteus medius

gluteus minimus

31
Q

what muscles extend the hip

A

gluteus maximus
semitendinosuss
semimembranososi
biceps femoris-long head (originates from ischial tuberosity and inserts onto lateral head of the fibula)- also flexes let

32
Q

what muscles flex the hip

A

iliopsoas
rectus femoris
tensor facia lata

33
Q

what does obturator externus do

A

lateral rotator of thigh

arises form anteriolmeidal surface of the obrutaor foramen and inserts near the greater trochanter of the femur

34
Q

what is the vests medialis

A

KNEE EXTENSOR

part of quadriceps femurs

raises form proximal femur and inserts into tibial tuberosity via PATELLA

35
Q

corticosteroids are immunosuppressants- what immune cells are elevated from chronic corticosteroid use

A

NEUTROPHILS- they fuck up the sticking of the marginal pool thus increasing the numbers but they are not functional

(increase risk of infection)

36
Q

what are the CNS and respiratory side effects of corticosteroids

A

CNS: HYPOMANIA, PSYCHOSIS, sleep disturbances

respiratory: INCREASE SURFACTANT production

37
Q

what are the endocrine and GI side effects of corticosteroids

A

endocrine: HPA axis suppression, HYPERGLYCEMIA, HYPOGONADISM, OSTEOPOROSIS (decrease bone formation and calcium and phosphate absorption)

GI: peptic ulcer, GI bleed (decreased prostaglandins)

38
Q

what are the skin side effects of coticosteorid

A

central obesity, buffalo hump

skin ATROPHY, bruisability (decreased collagen and fibroblasts)

proximal muscle weakness

39
Q

whats the order of most common vessels for atherosclerosis

A
  1. Abdominal Aorta
  2. coronary arteiras
  3. popliteal
  4. internal carotid
  5. circle of willis
40
Q

what is characterized by low lying cerebellar tonsils that extend below the foramen magnum into the vertebral colum

A

CHIARI TYPE I malformation (most common and benign)

presents during adolescence/adulthood with PAROXYSMAL OCCIPITAL HEADACHES (due to meningeal irritation) or CEREBELLAR DYSFUNCTION (dizziness, ataxia) due to compression of cerebellar tonsils

41
Q

what is seen in CHIARI TYPE II malformation

A

evident in neonatal period

downward displacement of cerebellum (vermis, tonsils) and medulla through foramen magnum

non-communicating hydrocephalus almost always occurs due to AQUEDUCTAL STENOSIS

compression of medulla may cause dysphasia, stridor, apnea

associated LUMBAR MYELOMENINGOCELE- can cause lower limb paralyisis

42
Q

what is BLEPHAROSPASM

A

2nd most common FOCAL DYSTONIA

involuntary forcible closure of the eyelids

initial symptom is uncontorllbzlby blinking

43
Q

the hiccups are an example of what

A

MYOCLONUS (sudden brief, sometimes severe (shock-like) muscle contraction

44
Q

pathological myoclonus is seen in what

A

epilepsy

CRUTZFIELD-JAKOB

45
Q

what causes characteristic brawny discoloration of varicose veins and what does resulting tissue ischemia cause

A

extraversion of RBCs into the tissues leading to IRON deposition

resulting tissue ischemia causes VENOSU STASIS DERMATITIS- associated with POOR WOUND HEALING

46
Q

what is seen in lymphedema

A

soft and pitting edema first

eventually becomes firm and non pitting due to progressive fibrosis and thickening of overlying skin

47
Q

what is beau d’orange

A

erythematous, ITCHY breast rash with SKIN TEXTURE CHANGES analogous to an orange peel

key dermatologic presentation of INFLAMMATORY BREAST CANCER and is caused by cancerous cells OBSTRUCTING LYMPHATIC DRAINAGE due to spread to the dermal lymphatic spaces

48
Q

what are the key feature os invasive beast cancers

A

ductal: most common type, nest and chords of cells
lobular: small cells in single file, mammary stoma invasions
inflammatory: peau d’ orange, dermal lymphatic invasion

uWorld Flashies (62 decks)

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