Bocock Uworld Week 4.4

Front 1

Steps of primary hemostasis?

Back 1

(1) vasoconstriction
(2) platelet adhesion
(3) platelet degranulation
(4) platelet platelet aggregation

Front 2

Derivative of cyclooxygenase in plts that promotes platelet aggregation?

Back 2

TXA2

Front 3

Clinical sxs of a patient with a primary hemostasis DO...a platelet problem?

Back 3

mucosal bleeding, skin bleeding, and easy bruising

Front 4

MCC of thromboctytopenia in children and adults?

Back 4

Immune thrombocytopenic purpura

Front 5

How do you get thombocytopenia in ITP?

Back 5

(1) splenic plasma cells make ab against plts
(2) splenic macs eat ab bound platelets

Front 6

Microangiopathic hemolytic anemia is seen in what two DOs?

Back 6

(1) Thrombotic thrombocytopenic purpura (TTP)
(2) Hemolytic uremic syndrome (HUS)

Front 7

What enzyme is decreased in TTP?

Back 7

ADAMTS13

Front 8

Classic pt with TTP is an adult that makes autoantibodies against this molecule?

Back 8

ADAMTS13

Front 9

What does ADAMTS13 do?

Back 9

cleaves multimers of VWF

Front 10

How do you get thrombocytopenia with MAHA?

Back 10

platelets are being used up in microthrombi

Front 11

Key mechanism of HUS?

Back 11

Ecoli o157:H7 verotoxin damages endothelial cells

Front 12

HUS is commonly seen in children who get Ecoli O157:H7 from eating what?

Back 12

undercooked beef

Front 13

Predominant problem seen in TTP?

Back 13

CNS abnormalities

Front 14

Predominant problem seen in HUS?

Back 14

renal insufficiency

Front 15

What are the PT and PTT findings in HUS and TTP?

Back 15

normal PT and PTT

Front 16

On blood smear, what do you see in Bernard Soulier syndrome?

Back 16

enlarged platelets..immature....BIG SUCKERS

Front 17

Molecule made from plt cyclooxygenase that calls in other platelets to aggregate?

Back 17

TXA2

Front 18

IRREVERSIBLY inactivates cyclooxygenase

Back 18

ASA

Front 19

Sxs in a pt with a secondary hemostasis DO...a coagulation problem?

Back 19

deep tissue bleeding....and post surgical bleeding

Front 20

What is present if a mixing study does not correct the PTT?

Back 20

coag factor inhibitor...usually against factor 8

Front 21

What is the reason PTT is increased in von willebrand disease?

Back 21

VWF stabilizes factor 8....and here it is missing

Front 22

Mucosal skin bleeding w/ an increase in PTT and an abnormal ristocetin test?

Back 22

von willibrands disease

Front 23

Vit K is activated by what enzyme in the liver?

Back 23

eposide reductase

Front 24

How does heparin cause HIT?

Back 24

hep forms a complex with platelet factor 4...IGs are made against the complex...plts are taken out by the spleen

Front 25

Best screening test for DIC?

Back 25

elevated fibrin split products (D Dimers)

Front 26

What is the enzyme that inactivates plasmin?

Back 26

alpha 2 antiplasmin

Front 27

These are present in a thrombis and help to distinguish it from a post mortem clot?

Back 27

lines of zahn and attachment to the vessel wall

Front 28

Protein C and S deficiency + warfarin leads to...?

Back 28

warfarin skin necrosis

Front 29

MCC of a pt having a hypercoagulable state?

Back 29

factor V leiden

Front 30

How does heparin prevent coagulation?

Back 30

activates antithrombin III

Front 31

How do oral contraceptives cause thrombosis?

Back 31

estrogen causes increased production of coag factors

Front 32

This protein is associated with creutzfeldt jakob disease?

Back 32

prion protein PrP

Front 33

Mechanism of prion disease?

Back 33

the PrP is resistant to proteases as it takes on a Beta pleated sheet config

Front 34

Histologic change seen with prion disease?

Back 34

spongioform transformation of the cortex

Front 35

What would an indian ink stain of CSF show for cryptococcus?

Back 35

encapsulated narrow based budding yeasts

Front 36

Nonseptate hyphae that branch at wide angles?

Back 36

mucromycosis

note: infection of paranasal sinuses

Front 37

Reason F1P is metabolized quicker than other sugars?

Back 37

it bypasses the RL step as it feeds into glycolysis

Front 38

What type of markers can be used to identify small cell carcinoma of the lung?

Back 38

neurofilaments

note: SCC of lung is a neoplasm of neuroendocrine

Front 39

Bilateral loss of pain and temperature sensation in the upper extremities....a "capelike" distribution...with touch intact

Back 39

syringomyelia

Front 40

Niacin can be synthesized from what AA?

Back 40

tryptophan

Front 41

What are the sxs of pellegra..caused by a niacin deficiency?

Back 41

dermatitis, diarrhea, and dementia

Front 42

The MCC of osteomyelitis in pts with sickle cell?

Back 42

salmonella

Front 43

notorious for causing aspiration pneumonia?

Back 43

klebsiella

Front 44

Presents with dyspnea, upper body petechial rash, with multiple bone fractures?

Back 44

fat embolism

Front 45

Type II HSR w/ Abs to GBM and alveolar BM...causes hemoptysis and hematuria?

Back 45

goodpasture syndrome

Front 46

Non-bizaree delusions for atleast 1 month w/ functioning not impaired?

Back 46

delusional disorder

Front 47

Two ketogenic AAs that can be given to pts w/ pyruvate dh complex deficiency?

Back 47

lysine and leucine

note: these cannot be turned into glucose

Front 48

Produce reduced lung volumes and increased FEV1/FVC > 80%?

Back 48

restrictive lung diseases

Front 49

Diffuse effacement of foot processes on podocytes found on EM...will see normal glomeruli on LM?

Back 49

minimal change disease

Front 50

How does waterhouse friderichsen syndrome present?

Back 50

neisseria meningitis with adrenal hemorrhage

Front 51

Associated with increased activity of NFKB protein which increases cytokine production?

Back 51

chron's disease

Front 52

maternal manifestations of rubella infection?

Back 52

rash, lymphadenopathy, and arthritis

Front 53

Classic congenitall rubella manifestations?

Back 53

PDA, cataracts, and deafness

Front 54

Drug which is an ab directed against CD 20 on B cells?

Back 54

rituximab

Front 55

Contains acid secreting ectopic gastric tissue and/or pancreatic tissue

Back 55

meckels diverticula

Front 56

What embryonic process fails in meckels diverticula?

Back 56

failure of the omphalomesenteric duct to obliterate

Front 57

Common SE of TZDs like rosiglitazone?

Back 57

fluid retention...w/ wt gain and edema

Front 58

Rare effect seen with the sulfonylureas

Back 58

agranulocytosis

Front 59

Can increase cardiac contractility and decrease AV nodal conduction by increasing parasympathetic tone?

Back 59

digoxin

Front 60

What can happen w/ ACE I's as they block Ang II from constricting the efferent arteriole....causing serum serum creatine to rise?

Back 60

decreases RFF=GFR/RPF

Front 61

DOC for acute management of thromboembolism?

Back 61

heparin

note: warfarin is long term therapy

Front 62

Becomes an essential AA in homocystinuria...where there is a defect in cystathionine synthetase?

Back 62

cysteine

Front 63

Pts w/ Barrets esophagus have an increase risk of developing what type of CA?

Back 63

adenocarcinoma

Front 64

Associated with lymphogranuloma venerum?

Back 64

chlamydia trachomatis

Front 65

What stain is used to evaluate the small bowel for whipple's disease caused by tropheryma whippelii?

Back 65

periodic acid schiff PAS stain

Front 66

PAS is good for staining what molecules?

Back 66

polysacharrides

Front 67

Damage of this nerve at the head of the radius causes weakness of wrist extension?

Back 67

radial nerve

Front 68

presents w/ skin rash, abdominal pain, joint pain, and igA complexes in children?

Back 68

henoch schonlein purpura

Front 69

Toxicity of this drug can cause color vision change and most seriously...ventricular tachyarrythmias?

Back 69

digoxin