Uworld_Cards_Set 2

Front 1

rapid recovery from thiopental is due to

Back 1

redistribution of the drug into other tissues, NOT from metabolism

Front 2

adverse effect of organophosphate poisoning not treated by atropine

Back 2

muscle paralysis
organophosphate poisoning affects both muscarinic and nicotinic junctions
since atropine only works on muscarinic, pts are just in danger of the nicotinic effect which is muscle paralysis
this can be helped by pralidoxime

Front 3

Downs pts have an increased risk of?

Back 3

ALL and AML

Front 4

primidone

Back 4

an antiepileptic that is metabolized into phenobarbital and phenylethymalonamide (PEMA)
this can cause sedation and lethargy

Front 5

MCC of death in DM pts

Back 5

MI
also more than 50% of pts with ESRD die from ishemic heart disease

Front 6

33-32

Back 6

.

Front 7

pain in URQ with opioid use

Back 7

opioids can cause contration of the smooth muscles in the sphincter of Oddi, creating an obstruction and gall bladder distention
this pain is called biliary colic
it is thought meperidine does this less often, for just use NSAIDS like ketorolac

Front 8

why elastin has plasticity and recoil ability

Back 8

unique crossbridging of lysine

Front 9

area of nephron for the action of ADH

Back 9

ADH works to increase water reabsorption in the medullary segments of the collecting ducts

Front 10

gene defect and cause of ataxia telangiectasia

Back 10

ataxia telangiectasia is due to mutated gene, ATM, that is responsible for DNA break repairs
triad of cerebellar ataxia, telangiectasias, and increased pulmonary infections (due to IgA def)

Front 11

why edema is not initally seen in early COPD

Back 11

increased lymphatic drainage can compensate for increased central venous pressure seen in COPD to a small degree, initally preventing edema

Front 12

consequence of left heart failure

Back 12

pulmonary HTN can be from reactive vasoconstriction secondary to pulmonary venous congestion

Front 13

DNA pol that has 5-3' exonuclease activity

Back 13

DNA pol I is the only one with 5-3' exonuclease activity
DNA pol III has the 3-5' exonucleast activity

Front 14

benzos to use in pts with an increased risk of falling

Back 14

long acting benzos increase the "hangover" effect with daytime drowsiness and the risk of falling
these include diazepam, clorazepate, and flurazepam

Front 15

short acting benzos

Back 15

short acting benzos: alprazolam, triazolam, oxazepam
they have less risk of hangover effect, but higher risk of dependence

Front 16

isoniazid effect on TB staining

Back 16

isoniazid inhibits mycolic acid formation, so it cause TB to loss it's acid fast staining quality

Front 17

location on cochlea of high freq sounds

Back 17

high freq sounds are heard by the base close to the oval and round windows
low freq sounds are heard at the apex closest to the helicotrema

Front 18

helicotrema

Back 18

helicotrema is at the apex of the cochlea where the scala vestibuli and scala tympani meet

Front 19

MAO of resistance in chemotherapy

Back 19

chemotherapy reistance is largely due to the human multidrug resistance gene (MDR1) that codes for a P-glycoprotein that is an ATP-dep transmembrane protein that pumps out the drugs

Front 20

ras gene MOA

Back 20

ras gene is a GTP dependent system
mutations are due to inability of ras to split the GTP to inactivate, leading to cancer

Front 21

MCC of mitral stenosis

Back 21

chronic rheumatic heart disease

Front 22

association with imperforate anus

Back 22

imperforate anus is commonly suspected with inability to pass meconium
this is often seen with other malformations of the GU tract

Front 23

NBTE consequence

Back 23

NBTE (non-bacterial thrombotic endocarditis) involves a hypercoag state, similar to that of Trousseau's sign seen in pancreatic carcinoma

Front 24

risk factors for infective endocarditis

Back 24

risk factors in infective endocarditis include prosthetic heart valves, prior valvular inflammation and scarring (often a consequence of rheumatic heart disease)

Front 25

mechanism of increased ESR

Back 25

IL-1, IL-6, and TNF-alpha mediate acute phase proteins, like fibrinogen, and are responsible for an increased ESR

Front 26

Class 3 anti-arrythmics

Back 26

Class 3 antiarrythmics reduce K flow and are:
amiodarone, ibutilide, dofetilide, and sotalol

Front 27

major virulence factor of Strep pyogenes

Back 27

protein M of Strep pyogenes is the major virulence factor, inhibiting phagocytosis and compliment activation

Front 28

CT features of constrictive pericarditis

Back 28

calcification can thickening of the pericardium > 4mm are common features of constrictive pericarditis on CT

Front 29

alkaptonuria

Back 29

alkaptonuria is a def of homogentisate oxidase, stopping tyrosine from eventually becoming fumarate

Front 30

35-19

Front 31

SE of direct arteriolar vasodilators

Back 31

direct arteriolar vasodilators like hydralazine and minoxidil work as antiHTN, but cause reflex SANS activation leading to sodium/fluid retention and tachycardia

Front 32

broncioloalveolar carcinoma

Back 32

bronchioloalveolar carcinoma is a subtype of adenocarcinoma arising from the alveolar epithelium and does not have a risk due to smoking
histo shows tall columnar cells linng the alveloar septa without vascular or stroma invasion

Front 33

atopic dermatitis is associated with

Back 33

asthma and allergic rhinitis

Front 34

formula for the confidence interval of 95%

Back 34

mean +/- 1.96*SD/( sqrt of n)

Front 35

result of thiazolidinediones (TZDs)

Back 35

activate PPAR-gamma, a nuclear receptor, decreasing insulin resistance

Front 36

polymyositis

Back 36

symmetric proximal muscle weakness
muscle biopsy shows inflammation and necrosis of muscle fibers
overexpression of MHC I on the sarcolemma leading to CD8 infiltration

Front 37

bosentan

Back 37

competitive antagonist of endothelin receptors blocking the vasoconstriction of endothelin and reducing pulmonary HTN

Front 38

crystals seen in gout

Back 38

monosodium urate

Front 39

decrease CO, like in HF, does what to arteriolar resistance

Back 39

RAR system will increase arterial resistance to increase BP, but this exacerbates problems with the already failing heart

Front 40

Klinefelter's labs

Back 40

small testes and damaged seminiferous tubules lead to decreased testosterone and sperm count
this limits pituitary feedback, so serum LH and FSH are increased

Front 41

what removes the CAP from the binding domain in the lac operon

Back 41

glucose induced decrease in adenylate cyclase leads to low cAMP, which causes poor binding of CAP, reducing expression of the lac operon

Front 42

name the sulfonylureas

Back 42

.

Front 43

function of the 16S rRNA

Back 43

a portion of the 30S ribosomal unit, it is a complementary strand to the mRNA Shine-Dalgarno sequence
this binding is necessary for the initation of translation

Front 44

MOA of niacin

Back 44

inhibits hepatic VLDL production
it also increases HDL (this is the primary reason for prescribing)

Front 45

MOA of statins

Back 45

inhibit cholesterol synthesis, thereby up-regulating LDL receptors

Front 46

protein phosphatase-1

Back 46

increases glycogen synth
decreases glycogenolysis

Front 47

Wilson's disease: S/S, dx

Back 47

advanced disease has Parkinsonian-like tremor, rigidity, ataxia, slurred speech
labs will have increased transaminases, low serum ceruloplasmin, high hepatic copper, and Kayser-Fleischer rings that are best seen with a slit lamp exam

Front 48

HbA2

Back 48

normal hemoglobin is HbA1, in beta-thalassemia minor and intermediate, its production is impaired, so there is elevated production of HbA2

Front 49

what do you do to confirm a malabsorption syndrome?

Back 49

with a hx of diarrhea, steatorrhea, wieght loss, or vit def, suscpect malabsorption, take a stool sample, and stain with Sudan III which will identify fecal fat and conclude a type of malabsorption. Then further investigation is needed

Front 50

what causes tissue distruction in TB infections?

Back 50

a type IV delayed hypersens rxn
this creates the caseous necrosis

Front 51

possible consequence of axillary LN dissection following breast cancer

Back 51

chronic lymphedema of the ipsilateral arm that can predispose to angiosarcoma

Front 52

proto-oncogenes (where an activating mutation leads to cancer)

Back 52

Ras, n-myc, ERB/B1, sis, abl

Front 53

tumor suppressors (where an inactivating mutation leads to cancer)

Back 53

BRCA1/2, NF-1, APC, DCC, p53, RB, WT-1

Front 54

consequence of hypokalemia

Back 54

muscle weakness, paresthesias, arrythmias

Front 55

Cushing's ulcers are caused by

Back 55

increased ICP

Front 56

what should be monitored in pts with chronic back pain/stiffness and are HLA-B27 positive

Back 56

chest expansion, which can decrease in the setting of ankylosing spondylitis

Front 57

gastric erosion vs ulcer

Back 57

gastric erosion are mucosal defects that do NOT penetrate the muscularis mucosa, if they do then it is termed an ulcer

Front 58

what do homeobox genes code for?

Back 58

DNA binding transciption factors important in morphogenesis

Front 59

the first commited steps in gluconeogenesis

Back 59

conversion of pyruvate to oxaloacetate via biotin dependent pyruvate carboxylase, then to PEP via PEPCK (phosphoenopyruvate carboxykinase)

Front 60

Langhans cells in TB caseating granulomas are formed by what cells?

Back 60

CD4 Th1 cells

Front 61

what stimulates proliferation in athersclerotic plaques?

Back 61

while the process is started with exposed endothelial cells, proliferation is induced by PDGF from platelets

Front 62

gene mutation found in medullary thyroid cancer

Back 62

ret gene, as also seen in MEN2 syndromes

Front 63

what happens to renal clearance of urea after vasopression injection

Back 63

it decreases, as more water is reabsoped, more urea will be reabsorbed as well

Front 64

ticlopidine

Back 64

like clopidogrel, but rarely used due to SE, which include mouth ulcers, fever, and neutropenia, so CBC monitoring is needed

Front 65

unique adverse effect of bile acid binding resins

Back 65

they increase blood triglyceride lvls

Front 66

MCC of sudden cardiac death in young atheletes

Back 66

hypertrophic cardiomyopathy

Front 67

unique property of amiodarone compared to other Class II antiarrhythmics

Back 67

while it prolongs the QT interval like all the other Class III's (and Class 1As), it does NOT predispose to torsade de pointes like they do

Front 68

severe adverse effect of amphotericin B

Back 68

renal toxicity leading to hypokalemia and hypomagnesemia
this renal toxicity can also decrease epo leading to normo/normo anemia

Front 69

MOA of scurvy

Back 69

vit C def that decreased collagen production due to the inability to hydoxylate proline and lysine

Front 70

medullary sponge kidney (MSK)

Back 70

common and generally benign congenital disorder with cystic dilations of the medullary collecting ducts
most common complication is kidney stones

Front 71

secretin stimulates what

Back 71

secretiin is released in response to increased duodenal H+ and stimulates the pancreas to secrete bicarb

Front 72

taste of the tongue

Back 72

.

Front 73

general sensation of the tongue

Back 73

.

Front 74

motor of the tongue

Back 74

.

Front 75

the only clinically sig non-enveloped ssDNA virus

Back 75

parvo B19

Front 76

cilostazol

Back 76

a phosphodiesterase inhibitor used in PAD to treat intermittent claudication
it inhibits platelet aggregation and is a direct arterial vasodilator

Front 77

muscles of mastication are innervated by what nerve passing through what foramina?

Back 77

V3 of CN V passing through the foramen ovale

Front 78

what is the fasted metabolized monosaccharide?

Back 78

fructose because it can bypass PFK-1

Front 79

what defect can cause gout due to increased purine production?

Back 79

activating mutation of PRPP synthase
this will increase purine production and result in hyperuricemia

Front 80

adhesion of cells to the basement membrane and the extracellular matrix involves what integrins

Back 80

fibronectin, collagen, and laminin

Front 81

cystic tumor in the cerebellum of a child

Back 81

most likely a pilocystic astrocytoma
histo shows spindle cells, hair-like glial processes, Rosenthal fibers, and granular eosinophilic bodies

Front 82

statins when given with p450 inhibits cause

Back 82

myopathy and rhabdomyolysis that can then lead to acute renal failure
classic example is a person on a statin is given a macrolide for an infection

Front 83

atypical depression includes

Back 83

hyperphagia and hypersomnia
MAO inhibitors are particularly useful in these pts, like phenelzine

Front 84

CF pts with malabsorption can be treated with what?

Back 84

pancreatic enzyme supplementation, like pancreatic lipase

Front 85

monitoring to be done with thiazolidinediones

Back 85

LFTs, because when 1st introduced, they were hepatotoxic

Front 86

glucocorticoids action in liver vs other tissues

Back 86

glucocorticoids are mostly catabolic, causing muscle weakness, thin skin, impaired wound-healing, osteoporosis, and immunosuppression
but in liver, it increases protein synth, especially in enzymes involved in gluconeogenesis and glycogenesis

Front 87

acute acalculous cholecystitis

Back 87

acute inflammation of the gallbladder in the absence of gallstones, most commonly seen in the hospitalized and severely ill
thought to occur due to gallbladder statis and ischemia

Front 88

function of bcl-2

Back 88

inhibits apoptosis and promotes cell survival
when mutated, as in 14:18 trans, it leads to follicular lymphoma

Front 89

consequence of Wegner's

Back 89

progressive crescentic glomerulonephritis (RPGN)
also has c-ANCA positive staining

Front 90

vit C used for hydroxylation in collagen synth is performed in what organelle?

Back 90

RER

Front 91

location to perform thoracocentesis along the mid-axillary line

Back 91

between the 7th and 9th ribs
going lower you will hit the liver

Front 92

cause of post-streptococcal glomerulonephritis

Back 92

Strep pyogenes
note that it is bactitracin sens

Front 93

blood supply of the diaphragmatic surface of the heart

Back 93

inferior wall of left vent forms most of the surface and in 90% of people is supplied by the RCA

Front 94

widespread mast cell degranulation release what?

Back 94

histamine that is the major effector

tryptase is also release and used a a marker for mast cell activation

Front 95

what causes the degranualtion of mast cells

Back 95

crosslinking of multiple membrane bound IgE antibodies by a specific antigen, resulting in IgE-Fc receptor aggregation on the cell surface

Front 96

one manifestation of arthritis in reactive arthritis

Back 96

sacroilitis

Front 97

location of highest incidence on the bones of osteomyelitis

Back 97

lone bone metaphysis

Front 98

interpretation of vasopressin admin during water deprevation test

Back 98

less than 10% increase in urine osm means nephrogenic
if between 10% and 50% increase it is partial central DI
over 50% means complete central DI

Front 99

marfans often presents with what, and what is MCC of death

Back 99

skeletal abn (like scoliosis/kyphosis, long extremities), subluxation of lens, and cardiovasc lesions
MCC is aortic dissection secondary to cystic medial degeneration

Front 100

benzo with the shortest 1/2 life

Back 100

alprazolam

Front 101

39-26

Back 101

porphyrin synth

Front 102

cystic hygroma

Back 102

mass of cystic spaces separated by connective tissue rich in lymphoid aggregates
Turner's syndrome often manifests with cystic hydromas and lymphedema

Front 103

metabolic acidosis does what do the urine

Back 103

pH decreases, excretion of HCO3 decreases, excretion of titratable acids, like NH4 and H2PO4 are increased to compensate

Front 104

different stains of the CNS

Back 104

GFAP for glia derived cells, like astrocytes, oligodendrocytes, and ependymal cells

synaptophysin for neurons, neuroendocrine, and neuroectodermal cells

Front 105

39-40

Back 105

P-bodies

Front 106

reistance to streptomycin

Back 106

altered structure of bacterial ribosomal proteins, because it is an aminoglycoside attacking the 30S ribo

Front 107

polyhydramnios associations include

Back 107

GI obstr, intestinal atresia, anencephaly

Front 108

40-11

Back 108

unfract heparin vs LMWH

Front 109

treatment for the prevention of GBS neonatal meningitis and pneumonia

Back 109

intrapartum PCN or ampicillin

Front 110

high output congestive heart failure with neuro symptoms is strongly suggestive of what?

Back 110

wet beriberi due to thiamine def

Front 111

lead inactivates what enzymes

Back 111

delta-aminolevulinate dehydratase that converts aminolevulinic acid (ALA) into prophobilinogen (PBG)
and ferrocheletase that converts protoporphyrin IX into heme
the leads to a buildup of delta-ALA and protoporohyrin IX

Front 112

why you wait 2 weeks after stopping phenelzine before you start taking sertraline

Back 112

phenelzine is MAOI and sertraline is an SSRI
if they overlap there is a risk of serotonin syndrome

Front 113

the ataxia in Ataxia-telangiectasia is due to what?

Back 113

cerebellar atrophy

Front 114

the advantage of celcoxib

Back 114

inhibits COX2, so you have the anti-inflamatory effects without the side effects of bleeding and GI ulceration

Front 115

what is thought to increase insulin resistance in overweight individuals

Back 115

free fatty acids and serum triglycerides

Front 116

ERB-B2 association

Back 116

invasice ductal carcinoma??

Front 117

vonWillebrand factor binds what?

Back 117

it is a protective carrier for factor VIII

it also binds platelet glycoproteins to collagen on injured blood vessel walls

Front 118

arteritis's that contain granulomatous inflammation

Back 118

Takayasu arteritis and temporal arteritis

Front 119

possible S/E verapamil

Back 119

constipation and AV blocks

Front 120

levels of what enzyme are increased in lead poisoning

Back 120

pyridoxal phosphate, the cofactor needed to produce delta-ALA

Front 121

what virus that causes hepatocellular carcinoma and integrates into the host genome

Back 121

HBV

Front 122

FTA-ABS tests for what

Back 122

syphilis

Front 123

common side effects of ACE inhibitors

Back 123

decreased GFR, hyperkalemia, cough, angioedema
the decrease GFR is from the efferent arteriole not being able to constrict as much as the afferent

Front 124

in healthy people, diff in bone density can be explained by

Back 124

genetic differences

Front 125

angiotensin II preferentially constricts what arteriole

Back 125

the efferent, to maintain GFR
this is why ACE inhibitors can reduce GFR

Front 126

41-20

Back 126

.

Front 127

ecthyma gangrenosum

Back 127

cutaneous necrotic disease with strong association with pseudomonas septicemia

Front 128

cause of wet age related macular degen

Back 128

increase in VEGF
S/S are acute vision loss over days to weeks
treat with anti-VEGF

Front 129

antilipid drugs that can increase gallstone formation

Back 129

cholestyramine and gemfibrozil

Front 130

schizophrenia with amenorrhea

Back 130

antipsychotics can inhibit DA and can lead to hyperprolactinemia that can then lead to amenorrhea

Front 131

gram pos bact that has polar granules that stains deeply with aniline dyes

Back 131

Corynebact diphtheriae can resemble Chinese letters
interfers with host protein synth

Front 132

histology of hepatotropic viruses

Back 132

hepatocyte ballooning degen (hepatocyte swelling) and apoptosis and Councilman bodies (eosinophilic apoptotic heptaocytes)
seen in HAV

Front 133

equation that relates fluid flow to cross sectional area

Back 133

Total Flow = velocity x cross sectional area

so for 2 ends of a pipe
V1xA1 = V2xA2

Front 134

root cause of centriacinar emphysema

Back 134

heavy smoking involves damage to the bronchioles with activation of macrophages that inlist neutophils

it is the neutrophils release of proteases, especailly elastase that overwhelm the alpha-1-antitripsin and destroy the lung tissue

Front 135

S/S of acute opioid withdrawl

Back 135

pupillary dilation, rhinorrhea, sneezing, nasal stuffiness, diarrhea, N/V

if suspected in a newborn of drug users, the withdrawl can be mediated with a tincture of opium

Front 136

most common presentation of HAV

Back 136

silent or subclinical anicteric is the most common presentation

Front 137

area where aqueous humor is produced

Back 137

ciliary epithelium produces aqueous humor and is inhibited by beta blockers like timolol

Front 138

drugs that can induce lupus are normally metabolized how?

Back 138

N-acetylation in the liver

Front 139

how biliary obstruction can cause night blindness

Back 139

biliary obstruction leads to chronic cholestasis decreasing fat soluble vitamin absorp
decrease in Vit can lead to night blindness and dry skin/puritis

Front 140

compensatory mech that is seen on labs in aplastic anemia

Back 140

increased epo

Front 141

dofetilide

Back 141

a class III antiarrythmic, slowing K+ efflux from the cardiac myocyte

Front 142

indolent NHL that presents with painless waxing and waning lymphadenopathy

Back 142

follicular lymphoma
usually t(14:18) wutg overexpression of bcl-2

Front 143

2 ominous potential complications of hemochromatosis

Back 143

liver cirrhosis and hepatocellular carcioma

Front 144

hypercellular glomerulus with hematuria, proteinuria, and RBC casts, suspect what?

Back 144

post-strep glomerulonephritis (PSGN)
labs will show anti-streptolysin O (OSA titer) and low C3 conc

Front 145

MVA aortic rupture commonly occurs where along the aorta?

Back 145

at the aortic isthmus, where the ascending and descending meet, just distal to the branch of the left subclavian

Front 146

Zenker diverticulum in elderly can be caused by what?

Back 146

cricopharyngeal muscle dysfunction
pts present with dysphagia, coughing, choking, and recurrent aspiration

Front 147

muscarinic agonist cause vasodilation via what mech?

Back 147

promots release of NO (aka endothelium-derived relaxing factor, EDRF) that stimulates cGMP, effluxing Ca and relaxing cells

Front 148

oxaloacetate and glutamate form what in the urea cycle

Back 148

aspartate and alpha-kepglutarate via transamination
note that B6 is required for this!!!

Front 149

43-20

Back 149

.

Front 150

common side effect of thiazolidinediones

Back 150

weight gain and edema from fluid retention

Front 151

prevention of tetanus in kids

Back 151

vaccination of the mother
this is often not done in developing countries

Front 152

dystonia

Back 152

prolonged, repetitive muscle contractions
most common focal dystonias are cervical dystonia (spasmodic torticollis), blepharospasm, and writer's cramp

Front 153

lung effects from MI vs CHF

Back 153

MI will cause acute pulmonary edema with transudate accumulating in the alveolar lumen

CHF will lead to hemostiderin laden macrophages (heart failure cells)

Front 154

lymph node enlargement

Back 154

antigenic stimulation that is benign LN grow is usually polyclonal proliferation

monoclonial lyphocytic proliferation is strong evidence of malignancy

Front 155

biliary cirrhosis and xanthelasma

Back 155

primary biliary cirrhosis can lead to cholestasis that can lead to hypercholestrolemia and xanthelasma

Front 156

liver compensation in nephrotic syndrome

Back 156

the liver increases lipoprotein synth in response to decreased plasma albumin conc

Front 157

function of what organ is monitored in amiodarone therapy

Back 157

TSH function
as it contains iodine and can lead to thyroid dysfunction

Front 158

apoptosis uses what as effectors

Back 158

caspases