Uworld: 5 - 7

Front 1

What reaction requires S-Adenosylmethionine?

Back 1

SAM is required by PNMT for NE-->E

Front 2

Dobutamine:
MOA
Use
Effects

Back 2

Dobutamine: Selective beta-1 agonist

Increases HR, contractility, conduction velocity, and myocardial oxygen consumption

Front 3

Back 3

CMV Inclusion Body

Front 4

CMV:
RNA/DNA
Single/Double Stranded

Back 4

Double-stranded DNA virus

Front 5

1st vs 2nd vs 3rd part of duodenum:
Nearby structures that tumor may spread to

Back 5

1st part: none

2nd part: ampulla of Vater, common bile duct

3rd part: SMA/SMV

Front 6

Th1 vs Th2 cells:
Cytokine secretions

Back 6

Th1 (cell-mediated immunity):
IL-2, IFN-gamma

Th2 (class switching, antibody production; humoral immunity):
IL-4,5,10

Front 7

What is sublimation?

Back 7

Similar to displacement in that unacceptable drives or emotions are redirected, but in sublimation they're redirected toward acceptable targets.

Ex: Directing anger toward a hard workout at the gym or directing aggressive impulses into a career in the military

Front 8

What vessels supply the femoral head and neck?

Which makes the greatest contribution?

Back 8

Superior & inferior gluteal arteries
Medial & lateral femoral CIRCUMFLEX arteries

Medial femoral circumflex makes largest contribution

Front 9

Back 9

Nondisplaced left subcapital femoral neck fracture.

Note femoral neck is markedly shortened compared to right side.

Dashed line = intertrochanteric line; red dots label fracture plane.

Front 10

Label structures and VASCULATURE.

Back 10

A) Descending aorta
B) Esophagus
C) Trachea
D) Azygos Vein
E) Left Pulmonary Artery

Front 11

What role does sunlight play in vitamin D metabolism?

Back 11

Catalyzes:
7-dehydrocholesterol-->Cholecalciferol

Front 12

1-alpha-hydroxylase:
Function

Back 12

Transforms 25-OH D to 1,26-di-OH D

Front 13

DKA
Normal PaCO2

Back 13

Respiratory failure.

Should respond with Kussmaul respirations, but instead PaCO2 is normal (needs to be low in setting of !)

Note: Kussmaul is a form of hyperventilation

Front 14

What is the effect of ADH on kidneys?

Back 14

Increases permeability of CD to water.

Without ADH, CD is impermeable to H2O.

Front 15

In the absence of ADH, which regions of the nephron are permeable to water?

Back 15

PCT
Descending LOH

Front 16

Label:
-Osmolality
-Regions permeable to water
-Regions permeable to solute
-Macula Densa

Back 16

macula densa = E--CONTROLS JGA

CD only permeable to H2O with ADH

Front 17

Sunscreen that protects against UVB only.

Back 17

PABA (para-aminobenzoic acid)

Front 18

Sunscreen that protects against UVAI and UVAII.

Back 18

Avobenzone

Front 19

Sunscreen that protects against UVB, UVAI, UVAII.

Back 19

Zinc oxide

Front 20

Which form of UV radiation is the major cause of sunburn, histologic skin damage, and carcinogenesis?

Back 20

UVB

Front 21

Tzanck smear

Back 21

HSV

Front 22

Which form of herpes causes genital warts?

Back 22

HSV-2

Front 23

DNA-binding proteins:
Examples
Procedure to identify them on gel electrophoresis

Back 23

Jun (binds to DNA for transcriptional control)
Transcription factors
Nucleases
Histones

Southwestern Blot

Front 24

Which histones comprise the nucleosome core?

Which comprise the outside core?

Back 24

Front 25

Which cells are susceptible to pernicious anemia?

Where in the gastric gland are they located?

Back 25

Parietal cells; located in superficial region of gastric gland

Front 26

Label location of relevant glands.

Back 26

Front 27

What are iron levels like in patients with beta-thalassemia?
Histologic sign?
Treatment?

Back 27

Iron levels are elevated because can't transport iron on RBCs

Will see hemosiderin-laden macrophages

Treatment = iron chelation (don't want to bleed someone who's anemic)

Front 28

Rosenthal fibers
Granular eosinophilic bodies

Back 28

Pilocytic astrocytoma (runs in kids)

Front 29

Well-differentiated spindle cells with hair-like glial processes
Microcysts

Back 29

Pilocytic astrocytoma (runs in kids)

Front 30

Necrosis
Poorly-differentiated, pleomorphic astrocytic cells
Symmetrical lesion across cerebral hemispheres

Back 30

Glioblastoma multiforme

Front 31

Homer-Wright rosettes

Back 31

Medulloblastoma

Front 32

Ependymal pseudorosettes with glial fibrillary acidic protein (GFAP)

Back 32

Ependymoma (children)

Front 33

Neuropil processes
Elevated HVA, VMA

Back 33

Neuroblastoma

Front 34

MYCN (N-MYC)

Back 34

Neuroblastoma

Front 35

Why is the phospholipid content of the amniotic fluid measured during amniocentesis?

Back 35

To monitor fetal lung maturity

Front 36

When are fetal lungs considered mature (provide a lab value)?

Back 36

Lecithin:Sphingomyelin ≥ 2

Note lecithin AKA phosphatidylcholine, which is a phospholipid!!

Front 37

Primary amenorrhea
Fully developed sexual characteristics

Diagnosis

Back 37

Imperforate hymen or Müllerian agenesis

Front 38

What structures does the Mullerian duct give rise to?

Back 38

Fallopian tubes
Uterus
Cervix
Upper vagina

Note: Ovaries aren't listed here. So when there's Mullerian agenesis and ovaries develop anyway, you'll end up with developed secondary sex characteristics but no menses.

Front 39

Primary vs Secondary vs Tertiary Protein Structure:
Definition
Bonds Required

Back 39

Primary:
Amino acid sequence
Peptide bonds

Secondary:
alpha-helix, beta-sheet
Hydrogen bonds

Tertiary:
Shape of single polypeptide chain following secondary structure
Hydrophobic interactions
H bonds
Disulfide bonds (between 2 cysteine residues; allow polypeptide chain to withstand denaturation)

Front 40

Nitrate:
Effect
Side Effects
How can side effects be prevented?

Back 40

Effect:
Vasodilation-->decrease in blood pressure

AE: REFLEX tachycardia-->inc'd myocardial oxygen demand

Can prevent reflex tach by administering beta-blocker (ex: metoprolol)

Front 41

Folinic acid:
MOA
Use

Back 41

Reverses toxicity of MTX in non-cancerous cells

Folinic acid is a derivated of tetrahydrofolic acid (THF) and doesn't require action of dihydrofolate reductase (which is inhibited by MTX) for its conversion to tetrahydrofolate.

Front 42

Methotrexate:
MOA

Back 42

DHF = dihydrofolate
THF = tetrahydrofolate
Bottom line: prevent purine synthesis

Front 43

Drug-induced lupus:
Specific drugs
Patients at risk

Back 43

Hydralazine, Procainamide

Patients that are slow acetylators (phase II metabolism)

Front 44

Niacin:
Use
Side effects
How can side effects be limited?

Back 44

Used to treat HLD

Side effect = cutaneous flushing mediated by prostaglandins

Can offset flushing by taking aspirin to inhibit PG synthesis

Front 45

Capsaicin:
Use
MOA

Back 45

Pain relief by decreasing Substance P (which is thought to regulate mood, ANX, stress behavior)

Front 46

Penicillinase-stable penicillins:
Examples

Back 46

Nafcillin
Methicillin
Oxacillin

Front 47

Why is MRSA nafcillin-resistance?

Back 47

MRSA has altered penicillin-binding protein (the protein involved in cell wall synthesis) which reduces its affinity for all beta-lactam antimicrobial agents (including cephalosporins and carbapenems).

Front 48

Draw ventricular pressure-volume loop. Explain events.

Back 48

Front 49

Draw ventricular pressure-volume loop with changes in preload.

Back 49

Front 50

Draw ventricular pressure-loop diagram with changes in afterload.

Back 50

Front 51

What is the effect of nitroprusside on preload/afterload?

Why?

How would this affect the pressure-volume loop?

Back 51

Nitroprusside equally dilates veins and arteries, thus decreases ventricular preload (LV) and afterload, allowing adequate cardiac output to be delivered at lower LV end diastolic pressure.

Pressure-volume loop would be shifted to left and down. Stroke volume (horizontal width) would remain unchanged bc dec in afterload = dec in preload

Front 52

How could pyelonephritis result in acute respiratory distress syndrome?

Back 52

Could enter septic shock
Endotoxin-induced release of injurious products from leukocytes/cytokines could damage pulmonary capillary endothelium-->leaky!

Results in pulmonary interstitial and intra-alveolar edema.

Front 53

Kinesin:
Function

Back 53

Microtubule associated motor protein involved in ANTEROGRADE transport of intracellular vesicles.

Front 54

How does acyclovir work?

Back 54

Acyclovir is taken up into infected cells

Since it's a nucleoside analog, it's converted into acyclovir monophosphate via a virus-endcoded protein.

Cell enzymes convert the monophosphate into acyclovir triphosphate.

When viral DNA polymerase incorporates acyclovir triphosphate into NEWLY REPLICATED VIRAL DNA chain, viral DNA synthesis is terminated.

Side note: Up-regulating IFN release from cells won't work. Leukotrienes are already doing this!

Front 55

Ethosuximide:
Use
MOA

Back 55

Absence seizures

Blocks T-type Ca2+ channels in thalamus (which trigger and sustain rhythmical burst discharges); induces hyperpol

Front 56

Which anti-seizure drugs decrease sodium current?

Where is the current decreased?

Back 56

Phenytoin
Carbamazepine
Valproate

All decrease neuronal high-frequency firing by reducing Na+ channels ability to recover from inactivation.

This occurs in CORTICAL neurons.

Front 57

Cell expressing MHC II
IL-2 receptor

Back 57

CD4+ TH cell

Front 58

CD3:
Role in normal physiology
Utility in pharmacotherapy

Back 58

CD3 = antigen required for proper function of T-cell receptors

Anti-CD3 antibodies bind to and inhibit T lymphocytes (muromonab-CD3)--can be used to reduce acute rejection in transplant pts.

Front 59

Glucagonoma:
General
Presentation
What is the function of glucagon?

Back 59

Rare pancreatic tumor

Necrolytic erythema
Elevated erythematous rash (usually on groin)
Hyperglycemia

Glucagon = hormone secreted by alpha-cells of pancreatic islets of Langerhans. Causes liver to convert glycogen to glucose when blood glucose is low.

Front 60

Alcoholic
Recurrent nosebleeds
Swollen Gums
Ecchymoses
Non-healing ulcers

Diagnosis
Pathophys

Back 60

Vitamin C deficiency (scurvy)

Leads to reduced hydroxylation of proline and lysine residues of pro-collagen

Thus results in dec'd connective tissue strength

(In children, bony deformities and subperiosteal/joint hematomas are characteristic)

Also seen in homeless, drug users.