uworld assessment block #3 4.15 Flashcards Preview

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Flashcards in uworld assessment block #3 4.15 Deck (123):
1

genetic pulmonary hypertension? demographic?

inactivating mutation in BMPR2. normally inhibits smooth muscle proliferation.

2

uterine leoimyomas presentation? demographic?

some asymptomatic. others: pelvic pressure, pain, menorrhagia, reproductive difficulties.

more common in women in thirties and forties. black women esp.

3

ischemic colitis

mucosal hemorrhage, patchy areas of necrosis.

eventually becomes edematous and bowel wall thickens. then transmural infarction --> bowel perforation.

crampy abdominal pain, tenderness to palpation, bloody stool.

caused by (1) hypoperfusion 2nd to diministed cardiac output (2) occulusion of bowel vascular supply (atheroma, thrombosis, embolism)

common cause of GI hemorrhage in elderly.

4

presentation of whipple's disease

PAS+ foamy macrophages in lamina propria

CANN:
cardiac symptoms (valves), arthalgia (synovial), mesenteric Nodes, and Neurologic symptoms (CNS).

--> fat malabsorption // steatorrhea bc of occlusion of lymphatics

nfxn w/ tropheryma whipplei (gram positive)

5

type 1 collagen important in

bone, fibrous tissue, tendon, ligament, skin, sclerae.

body is 30% collagen by weight

6

mutations in osteogenesis imperfecta

COL1A1 and COL1A2. both combine to form type 1 collagen --> results in qualitative and quantitative type I collagen defects

brittle bone, short stature, scoliosis, blue sclerae (translucent CT over choroidal veins), hearing loss (abnormal ossicles), skin and ligament laxity, easy bruising.

7

blue sclerae seen in..

osteogenesis imperfecta, progeria, menkes syndrome, cutis laxa

8

general beta oxidation & ketone production

sequential removal of two-carbon units (acetyl-CoA) from fatty acids

first step. Acyl CoA dehydrogenase. when a lot of acetyl-CoA is made via beta oxidation, shunt to ketone body production (acetoacetate, 3-hydroxybutyate, acetone)

9

3 forms of acyl CoA dehydrogenase

short, medium, long-chain

10

most common genetic defect in beta oxidation

medium chain acyl CoA dehydrogenase deficiency. symptoms first few years of life w/ prolonged fasting.

see increased dicarboxylic acids [from omega oxidation]. low glucose & ketones. acetyl-CoA low, cannot stimulate pyruvate carboxylase in gluconeogenesis. low acetyl-CoA, low glucose.

[energy from beta oxidation needed for gluconeogenesis!]

11

glycogen phosphorylase

cleave alpha-1,4-glycosidic link between glycogen, liberates glucose-1-phosphate.

results in McArdles, when missing from muscle.

results in Hers disease, when missing from liver.

12

Ras

oncoprotein component of MAP-kinase. inactive-GDP bound. active-GTP bound.

brings signal from receptor of cell surface into nucleus -- promote mitogenesis.

13

c-myc

nuclear phosphoprotein. fxns as a transcription activator controlling cell proliferation, differentiation, and apoptosis.

14

Rb

nuclear phosphoprotein, regulates G1-S checkpoint.

15

velocity of a chemical reaction depends on.. (3)

concentration of enzyme, substrate, and product

16

increasing enzyme concentration

increases Vmax.
Km unchanged.

lower Y intercept on lineweaver-burke plot

17

increased Km on lineweaver burke plot

right on x-intercept (-1/Km)

18

what do chlamydia have INSTEAD of cell wall

cysteine-rick out membrane w/ S-S bridges

19

hyphae are..

multicellular branching filaments

20

fungi genome

diploid (eukaryotes)

21

four rRNA in eukaryotic cells

28S, 18S, 5.8S, 5S.

first: 45S transcript made by rRNA (pre-RNA) and cleaved in nucleolus by ribonucleases to make 28S, 18S, 5.8S rRNA molecules.

(ensures equal amounts are made)

5S rRNA made separately by RNA pol III

note additive, based on molecule size and how they move during centrifugation in a viscous medium.

22

how do thiazolidinediones increase insulin sensitivity

PPar gamma.

increase GLUT4 expression, increases number of insulin-responsible adipocytes.

23

glyburide

second generation sulfonyurea. closes K+ channel of pancreatic B cell, induces depolarization and L-type Ca2+ opening; stimulating insulin release.

24

repaglinide

meglitinide dervative: short-acting insulinotropic agent. adjunct to diet & exercise in DM-2. mechanism similar to sulfonyureas.

unlike sulfonyureas, repaglinide does NOT stimulate insulin release when extracellular glucose levels are lw

25

first generation sulfonyureas

tolbutamide, chlorpropamide

26

second generation sulfonyureas

glyburide, glimepiride, glipizide

27

amylin analogs

pramlintide; reduce gastrin emptying, reduce glucagon

28

GLP-1 analogs

exenatide, liraglutide.

increase insulin release, reduce glucagon release

like DDP-4 inhibitors

(side effect: pancreatitis

29

DDP-4 inhibitors

linagliptin, saxagliptin, sitagliptin

increase insulin, reduce glucagon (like GLP-1 analogs).

side effect: urinary or upper respiratory infection

30

metformin (biguanide)

can be used in absence of B cell function. decrease gluconeogenesis and increases glycolysis in cells

31

Crohn's disease extrainstestinal signs

perineal abscess, kidney stones, sacroilitis, strictures/fistula

(ankylosing spondylitis, uveitis, apthous ulcers, pyoderma gangrenosum, erythema nodosum)

32

Ulcerative colitis extraintestinal signs

primary sclerosing cholangitis

(pyoderma gangrenosum, erythema nodosum, ankylosing spondylitis, apthous ulcers uveitis)

33

crohn's disease vs ulcerative colitis on barium swallow

crohn's = string sign (bowel wall thickening)

ulcerative colitis = loss of haustra (lead pipe sign)

34

common area involved in crohn's disease? second?

1st: terminal ileum
2nd: colon

35

common area involved in ulcerative colitis

always rectal involvement. only colon (no small bowel)

36

normal half life of warfarin

40 hours (steady state 4 hours later -- 6.7 days)

therefore, P450 inducers/inhibitors take a few days to alter levels

37

warfarin in pregnancy

crosses placenta! teratogenic

38

why does warfarin cause skin / tissue necrosis

early --> prothrombotic bc kills off protein C before factors 2, 7, 9, 10 (due to protein C half life)

39

rx for hepatic encephalopathy

remove ammonia, acidify intestinal contents (i.e. lactulose --> lactic acid), to increase NH4+

40

lactulose rx for hepatic encephalopathy

nonabsorbable dissacharide, degraded by colonic bacteria --> lactic & acetic acid. acidify GI content -- convert NH3 -> NH4+ --> osmotic effect, results in luminal distention, promote peristalsis --> levels of ammonia in circulation gradually declines

41

how does B2 agonist cause bronchodilation

increase cAMP INHIBITS myosin light chain kinase

vasodilation, bronchodilation

42

bony callus

after trauma: firm but flexible hyaline cartilage, gradually strengthened by Ca2+ deposition and a surrounding meshwork of woven bone.

43

physical signs of peripheral artery disease (i.e. DM)

thinning of skin, calf claudication (w/ rest pain), prolonged venous filling time, shiny coloured skin, hair loss, nail changes.

44

signs & symptoms of DVT

leg pain, tenderness, edema, fever, Homan's sign, venous distension

45

diabetic patient w/ foot infxn

think peripheral artery disease

46

RET in MEN2

single allele ACTIVATING mutation, predisposes to malignancy

47

DDx for hoarseness

laryngitis (most common), vocal cord paralysis, vocal cord nodules, laryngeal cancer, GERD, thyroid masses, overuse

48

path of right and left recurrent laryngeal n

RIGHT: loops below right SUBCLAVIAN (junction between brachiocephalic artery)

LEFT: loops below AORTIC ARCH

49

fxn of recurrent laryngeal

intrinsic muscles of larynx except CRICOTHYROID (external laryngeal)

50

most DNA virus replicate where? except one DNA to replicate in cytosol completely? partially?

most in nucleus

completely cytosol: pox virus (largest DNA virus, carries own DNA-dependent RNA polymerase)

partially: hepadnavirus

51

membrane of Herpesvirus?

from nuclear membrane

52

circular DNA viruses (3)

polyoma, papilloma, hepadna

53

RNA viruses mostly replicate in? except?

mostly: cytosol.

except: retrovirus and influenza virus

54

naked DNA viruses

PAPP:
parvovirus, adenovirus, polyoma virus, papilloma virus

55

naked RNA virus

CPR-Hepe

calicivirus, picornavirus, reovirus, hepevirus

56

capsid of all DNA viruses

icosahedral (except pox, complex)

57

all arboviruses cause.. name classes (3)

encephalitis & fever.
flaviviridae, togaviridae, bunyviridae

58

papoviridae include

papillomavirus and polyomavirus

59

infection w/ coccidiodes immitis

spherules w/ endospores that propogate. usually mild pneumonia w/ pleural effusion, can have thin-walled cavities (fever, hemoptysis)

also skin

SOUTHWEST.

60

currant jelly hemopytsis

klebsiella! lobar, alcoholic

61

PCP

less than 200ml. weakness and dyspnea, ground glass on x-ray

62

mycoplasma

walking pneumonia. fever, malaise, nonproductive cough

63

which cells are affected in hashimoto thyroiditis?

auto-immune mediated apoptosis of epithelial cells in thyroid gland.

see intense, diffuse (B & T) cell lymphocytic infiltration, germinal center formation.

high levels of serum thyroid autoantibodies (anti-TG & TPO)

64

histology of graves disease

thyroid gland follicular epithelium TALL & crowded, forming pseudopapillae into follicular lumen

65

colloid goiter

diffuse, nontoxic goiter. can occur sporadically. flattening of crowded columnar epithlium in follicles. gland becomes enlarged and colloid rich.

66

follicular adenoma presentation

presents as unilateral neck mass. intact capsule separate normal thyroid tissue from numerous large, well-differentiated, colloid-containing follicles

67

follicular carcinoma

single nodule in older woman. relatively uniform cells forming small follicles, nests, or sheets. colloid may be in follicles. capsular invasion with areas of hemorrhage or vascular invasion are common,

68

VSD murmur

holosystolic murmur over left sternal border

69

PDA on oxygenation of blood

allows oxygenated blood to flow from AORTA to pulmonary artery (spike in PO2)

70

by when does Duchenne's present?

age 3-5 progressive weakness, gower's.

by age 12: loose ability to walk

71

supression vs. repression

suppression: mature, conscious, TEMPORARY withhold unpleasant information from one's awareness to postpone dealing with it.

repression: immature, unpleasant feelings pushed away, not to be dealt with.

72

two key features of achalasia

hypertensive LES. absence of esophageal peristalsis in distal esophagus

due to less inhibitory ganglion cells in esophageal wall (imbalance favoring activity of excitatory ganglion cells)

73

Glanzmann thrombasthenia

reduced GpIIb/IIIa. labs: no platelet clumping on smear (less platelet-platelet interaction)

like ITP / abciximab

74

Bernard Soulier syndrome

reduced GpIb (less platelet-vWF interaction)

75

what motor abnormality often accompanies broca's aphasia?

located inferior frontal gyrus.

head and upper limb (near primary motor cortex

76

damage to frontal eye field (frontal lobe)

IPSILATERAL eye deviation

(normally points eye in opposite direction)

77

astereognosis

inability to identify objects based on touch

78

agraphesthesia

inability to identify characters drawn on skin by touch alone

79

hemihypesthesia

loss of sensation on one side of body

80

on axial MRI, prostate is located

posterior to the pubic symphysis

81

RBF =

RPF/ (1-Hct)

82

RPF =

can be related to MAP and total vascular resistance in afferent and efferent arterioles

RPF = MAP / TVR

TVR = resistant in afferent + efferent

83

postganglionic autonomic nervous system axons are..

UNMYELINATED

84

important unmyelinated axons

(1) postganglionic autonomic axons
(2) afferent neurons that conduct heat sensation & from slow-onset dull, burning or visceral pain.
(3) first order bipolar sensory neurons of OLFACTION

unmyelinated referred to: group C fibers

85

preganglionic autonomic nervous system fibers are..

MYELINATED.

both sympathetic and parasympathetic.

86

grey vs. white rami communicans

white: preganglionic (myelinated) fibers from spinal cord to sympathetic chain.

grey: post-ganglonic (unmyelinated) fibers from sympathetic chain to spinal nerve.

87

shared psychotic disorder

development of delusion in a person who is in a close relationship w/ a delusional person

(when not better explained by another psychotic disorder, medication, drug of abuse)

88

magical thinking in schizotypial

odd beliefs (telepathy, superstitions, bizarre fantasies, preoccupations)

eccentric behavior, odd thinking, & ideas of reference

often lack close relationship

89

delusional disorder

non-bizarre delusions present for at least one month.

non-bizzare: situations that, while unlikely, are possible. being followed, cheated, poisoned.

also: preserved occupational/social functioning, failure to meet diagnostic criteria for schizophrenia.

90

formula for standard error

standard deviation / square root of n (same size)

SE decreases when sample size is increased

larger sample size, smaller standard error

91

aseptic meningitis often caused by

picornaviridae

(usu enteroviruses: poliovirus, coxsackie A & B, echorvirus)

enterovirus that doesn't cause asceptic meningitis: hepatitis A)

picornavirus that is not an enterovirus: rhinovirus

92

two important arenaviruses

-ssRNA:

- LCV (lymphocytic choriomeningitis virus): aseptic meningitis

- lassa virus: hemorrhagic fever virus, passed to humans when dirt / dust contaminated by rodent urine inhaled.

93

- ss RNA

always bring polymerase or fail replication

must bring own RNA-dependent RNA polymerase

arenavirus, bunyviridae, paramyxovirus, orthomyxovirus, filovirus, rhabdovirus

note: FILO (not flavi) and RHABDO (not reo or retro)

filo - ebola, marbug, crazy.
rhabdo - rabies, crazy

94

what's included in paramyxoviridae

mumps, measles, RSV, parainfuenza

mumps & measles can cause encephalitis

95

most common cause of infant pneumonia? croup?

infant pneumonia & bronchiolitis: RSV
croup: parainfuenza

96

MHC II coded by

HLA-DR, DP, DQ

97

MHC I coded by..

HLA-A, B, C

98

composition of MHC class I? class II

MHC I: alpha chain & b2 macroglobulin

(proteosomal fragments load peptides (via TAPs) into ER, assemble w/ b2 macroglobulin and alpha chain)

TAP = transporter associated w/ antigen processing

MHCII: alpha & beta chain

(invariant chain in ER) -- invariant chain degraded in endosome

99

possible presentation of iron deficiency anemia

(typical anemia: weakness, fatigue, headache, irritability)

& glossal pain, dry mouth, atrophy of tongue papillae, alopecia, pagophagia (eating ice)

100

pagophagia

craving for ice, specific for iron deficiency

101

presentation of folate deficiency

megaloblastic anemia w/..

sore tongue, pain on swallowing, angular stomatitis, GI upset, hyperpigmentation

102

inheritance of sideroblastic anemia

associated w/ MDS

x-linked recessive defect in d-ala synthase

(can't turn glycine + succinyl CoA ---> d-ALA)

103

acquired sideroblastic anemia causes

most common: alcohol. also, lead, B6 deficiency, Cu deficiency, isoniazid

104

histology of sideroblastic anemia

ringed sideroblasts w/ iron-laden mitochondria.

105

presentation of pernicious anemia

usu older women of northern european descent.

1. lemon-yellow colouring
2. smooth shiny tongue (atrophic glossitis)
3. shuffling broad-based gait

106

high baseline plasma insulin w/ normoglycemia?

EARLY insulin resistance

(even when glucose levels are normal, and respond to oral glucose just fine)

eventually, amyloid deposition in pancreas w all this glucose secretion will make it fail

107

early insulin resistance vs. insulinoma

both have chronically elevated insulin levels.

normal serum glucose w/ EARLY insulin resistance.

insulinoma: fasting HYPOGLYCEMIA (i.e. after exercising)

108

marfan syndrome (fibrillin gene mutation) and homocystinuria (cystathione beta-synthase deficiency) both result in..

genetic heterogeneity. mutations of diff genes --> same phenotype.

marfanoid body habitus, tall, thin stature, elongated extremities, arachnodacty, ectopia lentis.

109

how many ATP made in glycoylsis? anerobic. (aka RBC; no mitochondria, no oxidative phosphorylation)

2 ATP per glucose (+ 2 NADH, which are used to convert pyruvate to lactate)

110

how many ATP made with aerobic metabolism of 1 glucose

38 per glucose

111

1 cycle of TCA (w/ 1 acetyl-CoA) makes

consume acetyl-CoA --> 3 NADH, 1 FADH2, 1 GTP

112

how many ATP per NADH? FADH? GTP

NADH = 3 ATP
FADH2 = 2 ATP
1 GTP = 1 ATP

113

net aerobic metabolism of glucose via malate/aspartate shuttle (heart and liver)? via glycerol-3-phosphate shuttle (muscle)

net glucose via malate/aspartate: 32

net glucose via glycerol-3-phosphate: 30

114

enzyme inhibited by -azoles

prevent ergosterol synthesis.

block 14-alpha-sterol-demethylase

build up lanosterol

115

flutacytosine fxn

antifungal, disrupts nucleic acid synthesis, inhibits thymidylate synthetase

116

V max depends on...

concentration of enzyme.

117

Km depends on..

affinity of drug for enzyme, inverse

118

enzyme inhibited by -binafine's

prevent formation of lanosterol.

block squalene epoxide

build up squalene

119

lichen sclerosus et atrophocis

inflammatory condition. thought to have underlying autoimmune pathophysiology. autoantibodies against ECM1 protein.

both genders, any part of body. females --> genital and perineal region usu.

pruitis, dysuria, pain w/ defecation and dyspareunia.

lesions: white, atrophic macules w/ a "cigarette paper" quality. coalesce into plaques as condition progresses.

long term sequelae: squamous cell carcinoma, genital disfigurement.

rx: ultra high potency topical corticosteroids

120

leukoplakia

mucosal surfaces of mouth / genital (labia majora not considered mucosal).

white thickening of mucosal surface.

many diff causes. often EBV w/ immunosuppression

121

vaginal candidiasis presentation? cutaneous?

vaginal: white, curd-like malodorus discharge.

cutaneous: skin folds. erythema and satellite pustules.

122

lichen planus

6 P's: pruitic, purple, polygonal, planar papules & plaques.

mucosal presentation: wickham striae (reticular white lines)

histology: sawtooth infiltrate of lymphocytes at dermal-epidermal junction

123

extrinsic causes of ATN?

intrinsic causes?

aminoglycosides, amphotericin B, radiographic contrast dye, heavy metals.

myoglobinuria, hyperuricemia, bence-jones protein in multiple myeloma