Uworld 10

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pszurnicki
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144409
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Uworld 10
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2012-04-12 13:04:20
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Uworld 10
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  1. what antihypertensive has dopamine antagonistic effects?
    alpha-methyl dopa
  2. 2 endocrine disorders that can produce depression?
    • hypothyrodism
    • hyperparathyrodism
  3. Ret oncogne is associated with what two thyroid cancers?
    Ras oncogne is associated with what thyroid cancer?
    • Papillary
    • Medullary
    • follicular
  4. What drugs inhibit the following enzymes?
    PRPP synthetase?
    Dihydrofolate reductase
    Ribonucleotide reductase
    Thymidylate Synthetase?
    • 6MP
    • MTX
    • Hydroxyurea
    • 5FU and MTX
  5. Which eukaryotic polymerase replicates leading strand?
    lagging strand?
    repairs DNA?
    replicates mitochondrial polymerase?
    • delta
    • alpha
    • beta, epsilon
    • gamma
  6. What causes Bloom syndrome?
    • DNA repair defect
    • sensitivity to sunlight
    • leukemia, lymphoma
  7. what are structural motifs present in Transcription factors?
    • leucine zipper
    • zinc finger
    • turn loop turn
  8. Marker of osteoblast activity?
    osteoclast activity?
    • alkaline phosphatase
    • tartrate resistant acid phosphatase
  9. Lymph drainage usually follows what?
    blood supply
  10. What vitamin aids in recovery from measles, pneumonia or diarrhea?
    Vitamin A
  11. What is the most common lung tumor in non smokers and women?
    adenocarcinoma
  12. What is the gross morphology of a pilocytic astrocytoma?
    cystic lesions and solid lesions
  13. What are the 2 places where nicotinic receptors are found?
    skeletal muscle and preganglionic synapses
  14. Young woman + HTN?
    OCP
  15. Migraine +aura you should not give what?
    OCP
  16. When do Theca-Lutein Cysts occur?
    when there is high beta HCG as in choriocarcinoma and molar pregnancies, twins or triplet pregnancies
  17. SHiller Duval bodie are seen in what cancer?
    Yolk sac Tumor
  18. Prior C section increases the risk for what?
    • previa
    • accreta
  19. What causes the following breast pathology?
    breast tumor in women under 25?
    Most common breast mass in post menpausal women?
    most common breast mass in premenopausal women?
    most common form of breast cancer?
    small mobiile firm mass with sharp edges?
    histological leaf like projections
    signet ring cells
    loss of e-cadherin cell adhesion gene
    always Estrogen + and Progesterone
    commonly presents with nipple discharge
    eczematous patches on nipple
    multiple bilateral fluid filled lesions with diffuse pain
    firm fibrous mass in a 55 year old man
    • Fibroadenoma
    • invasive ductal
    • fibrocystic change
    • invasive ductal
    • fibroadenoma
    • phyllodies tumor
    • invasive lobular
    • invasive lobular
    • invasive lobular insite
    • ductal papilloma
    • pagets suggestive of invasive ductal
    • fibrocystic change
    • invasive ductal
  20. Aromatase inhibitors?
    • anastrozole
    • exemestane
  21. What are the 2 major side effects of Pioglitazones?
    • LIver dysfunction
    • Congestive heart failure in a susceptible patient
  22. Vitteline duct gives rise to what?
    Urachus(allontois remnant) gives rise to what?
    • Meckel's diverticulum or discharge of feces from umbilicus
    • discharge of urine from umbilicus
  23. What enzyme is responsible for acute necrotizing pancreatitis?
    Trypsin activation
  24. What enzyme needs Riboflavin Vit B2?
    succinate dehydrogenase
  25. Transmural vasculitis with fibrinoid necrosis is characteristic of what vasculitis?
    PAN
  26. PAN never involves what structure?
    LUNG
  27. MOA of Bisphosphonates?
    • pyrophosphate--component of hydroxyapetite
    • pyrophosphate--inhibits osteoclasts
  28. Which inhaled anesthetic has nephrotoxicity?
    methoxyflurane
  29. which IV anesthetic is proconvulsant?
    enflurane
  30. What vitamin deficiency produces posterior column and spino-cerebellar demyelination?
    Vitamin E
  31. What patients learn to squat to improve pulmonary blood flow and improve oxygenation?
    TOGV
  32. RPGN are of 3 types, what diseases make them up?
    • type I-good pasture
    • type II--immune complex deposition
    • Type III-pauci immune..no complement deposition just crescents
  33. What are the 7 titratabe amino acids with 3 protons?
    a
    l
    h
    a
    g
    t
    c
    • arginine
    • lysine
    • histidine
    • aspartic acid
    • glutamic acid
    • tyrosine
    • cysteine
  34. Arginine gives rise to what 3 important products?
    • creatine
    • nitric oxide
    • urea
  35. What is resposible for erection, emission, ejaculation?
    • erection--para
    • emissio--hypogastric--sympathetic
    • ejaculation--visceral and somatic nerves
  36. RET vs RAS?
    • RET--tyrosine kinase
    • RAS- GTPAse
  37. What kind of fibers are responsible for the following?
    1-pricking sharp pain
    2-Burning or dull pain
    3-Receptor for cold sensation
    4-Receptor for warm sensation
    5-Vibration and pressure
    6-Dynamic/changing light, discriminatory touch
    7-Static/changing light touch
    8-Proprioception--muscle length monitoring
    9-Proprioception-- Muscle tension monitoring
    10-Resembles an onion in cross section
    11- Robust spindle shaped found in soles of feet
    12- Found only in areas of skin without hair
    13-simplest sensory receptor for pain and thermoreception
    14 Touch receptor that looks like melanocytes
    15- Look like fried eggs under histologic staining
    16- Forms multinucleated giant cells in HIV in CNS
    • 1-A-delta
    • 2- C
    • 3-A delta
    • 4- C
    • 5-Pacinian
    • 6-Meissners
    • 7-Merkels
    • 8- muscle spindle
    • 9-golgi tendon
    • 10 Pacinian corpuscle
    • 11- ruffinin endings
    • 12-Meissners
    • 13-free nerve endings
    • 14-Merkel cells
    • 15--Oligodendrocytes
    • 16- Microglia
  38. In the basal ganglia, what does the Direct pathway of Striatum do?
    Indirect?
    Subthalamic?
    Globus pallidus Internal?
    • promotes movement
    • Inhibits movement
    • Inhibits movement
    • Inhibits movement
  39. The following is associated with ?
    presents at birth as floppy baby?
    Lewy Bodies
    Dementia w/ frequent falls and syncope
    dementia + visual hallucinations
    dementia + personality changes or aphasia
    Intranuclear inclusions called cowdry bodies caused by?
    Eosinophilic rodlike inclusions in hippocampus of alzheimers?
    • Wernig-Hoffman--LMN affected
    • Lewy bodies--parkinssons, lewy body dementia, alzeihemer
    • Lewy body
    • Lewy Body
    • Picks
    • HSV and CMV
    • Hirano bodies
  40. 3 drugs for tonic-clonic seizures?
    • phenytoin
    • carbamezapine
    • valproic acid
  41. WHat opiod induces withdrawal with a full opiod agonist?
    Butorphanol
  42. Which anesthetic?
    nephrotoxic
    used in endoscopy
    convulsions/seizure
    hepatotoxic
    rapid anesthesia and short procedures
    rapid anesthesia
    decreases blood flow
    does not induce histamine release like morphine
    high triglyceride content increases risk of pancreatitis
    • methoxyflurane
    • midazolam with fentanyl
    • enflurane
    • halothane
    • propofol
    • NO
    • Thiopental
    • Fentanyl
    • Propofol
  43. What makes up SAM?
    ATP + methionine
  44. What 2 substrates inhibit Glucokinase? Promote
    What 2 substrates inhibit pyruvate kinase? Promote
    WHat 2 substrates inhibit Pyruvate dehydrogenase?
    • ATP/citrate- F-2,6 Bisphophate
    • ATP/alanine- F 1,6 Bisphosphate
    • ATP/NADH/Acetyl coA
  45. What are the 4 ways of getting biliary stones?
    • too much cholesterol--estrogen
    • FIbrates via 7 alpha hydroxylase
    • Bile acid binding resins
    • too much bilirubin--hemolysis
    • infection with bacteria producing beta glucuronidase which breaks down conjugated bilirubin to unconjugated
  46. In relation to ovarian and internal illiac vessels, where are the ureters?
    • Medial to the ovarian
    • Lateral to the internal illiac
  47. Chronic alcoholics have a deficiency of what vitamin?
    Folate
  48. Ornithine transcarbamoylase is inherited how?
    x-linked
  49. Precursor to 6-MP?
    May prevent nephrotoxicity with mannitol diuresis
    Antibody that binds to CD3 on T cells
    Antibody that binds IL-2 on activated T cells
    Inhibits Inosine Monophosphate dehydrogenase
    Inhibits calcineurin --loss of IL-2
    binds Fk protein --no IL-2
    Binds FKBP-12---inhibition of mTOR
    used for Lupus nephritis
    metabolized by xanthine oxidase and allopurinol increases its toxicity
    • Azathioprine
    • Cyclosporine
    • Muronomab
    • dacluzimab
    • mycophenolate
    • cyclosporine
    • tacrolimus
    • sarolimus
    • mycophenolate
    • 6MP and Azathioprine
  50. Most common complication of cholelithasis?
    cholecystitis
  51. Cholecystitis in the setting of cholelithiasis is caused by what?
    outflow obstruction caused by the stones
  52. Which of the hereditary hyperbilirubinemias are fatal in the 1st few years?
    Crigler Naijar Type I--due to gluconoryl transferase
  53. Which hereditary Hyperbilirubinemia causes a black liver?
    What is the defect there?
    • Dubin-Johnson
    • no transporter molecule for bilirubin
  54. Alpha toxin of C. Perfringens is a what type of an enzyme?
    lecithinase
  55. What ratio is increased in COPD?
    RV/TLC
  56. What is the side effect of chronic topical corticosteroid use?
    atrophy of connective tissue and muscle
  57. 2 Short acting insulins for Post-prandial Hyperglycemia?
    • Lispro
    • Aspart
  58. What are the changes seen in ischemia to the brain parenchyma at
    1 day?
    2 days?
    5 days?
    10 days?
    2 weeks?
    • 1st day--red neurons
    • 2 days-- neutrophils
    • 5 days--macrophages
    • 10 days--granulation tissue and neovascularization
    • 12 weeks--collagen-glial scar--gliosis with astrocytes
  59. Parts of the brain most susceptible to ischemia?
    • hippocampus
    • neocortex
    • cerebellum
  60. Short acting insulin?
    Long acting insulin?
    • Lispro
    • Aspart

    Long acting--glargine
  61. Reversible cell injury manifests itself how in the following organelles?
    Plasma membrane
    ER
    mitochondria
    Nucleus
    • PM--blebbing, loss of microvilli, blunting
    • ER--dilation, detachment of polysomes, myelin figures present
    • Mitochondria--swelling, not vacuolization
    • Nucleus--disaggregation of elemetns
  62. WHat g Proteins sitmulate acid secretion in the stomach?
    • Gq
    • Gs
  63. Sucralfate requires what kind of environment to work?
    acidic to polymerize
  64. Biopsy of pt with esophagitis shows large pink intranuclear inclusions with host cell chromatin pushed to the edge of the nucleus?
    HSV
  65. Stomach biopsy shows neutrophils above the basement memebrane, loss of surface epithelium an fibrin containing purulent exudate?
    gastritis
  66. Biopsy of parotid gland shows double layer of columnar epithelial cells resting on a dense lymphoid stroma?
    warthin tumor
  67. Small intestine biopsy shows small lymphocytes with irregular nuclear contours and proliferation of them into the mucosa and epithelial glands?
    MALTOMA
  68. Basal cell hyperplasia, eosinophilia and elongation of lamina propria see in the esophagus?
    Chronic GERd
  69. Goblet cells in the distal esophagus
    Barret
  70. Stomach biopsy shows lymphoid aggreagates in the lamina propria, columnar absorptive cells and atrophy of glandular structures?
    chronic gastritis
  71. Biopsy of esophagus shows enlarged cells and intranuclear cell inclusions?
    CMV
  72. Diffuse thickenin of gastric folds, high gastrin levels, biopsy shows glandular hyperplasia without foveolar hyperplasia?
    Z/E
  73. Protrusion of mucosa in the upper esophagus?
    esophageal web
  74. biopsy of parotid gland shows both epithelial and mesenchymal differentiation?
    pleiomorphic
  75. Biopsy of a parotid gland shows carcinoma composed mostly of mucus secreting cells and also some squamous cells and intermediate hybrids of both?
    mucoepidermoid
  76. pas stain showing hyphenated organisms in the esophagus wall?
    candida albicans
  77. Downs syndrome increases risk for what GI pathologies?
    • Annular pancreas
    • duodenal atresia
    • hirshsprungs
    • celiac disease
  78. Drugs which lower seizure threshold?
    • Bupropion
    • cIlastatin
    • Tramadol
    • Enflurane
  79. What vitamin is alpha- tocopherol?
    vitamin E
  80. What vitamin decreases symptoms of Hypercholesterolemia Type IIb?
    niacin--decreases VLDL and so there is less LDL
  81. IgE antibody?
    Omalizumab
  82. When a factor alters the study outcome but is itself not a bias it is called?
    Effect Modification
  83. Insulin secretion is under the control of what adrenergic receptor?
    Inhibited by what?
    • beta 2
    • alpha 2
  84. Which enterococci can grow in 6.5% NaCl and bile and which ones can only grow in NaCl?
    • enterococci facieum can grow in both
    • s. bovis can only grow in NaCl
  85. Infection with which hepatitis virus produces a serum-sickness like reaction?
    Hepatitis B
  86. the Myc's code for what?
    transcription factor
  87. the ret, abl and erb code for what?
    tyrosine kinase
  88. c-kit codes for what?
    cytokine receptor
  89. Chronic rejection differs how in the lung from the kidney?
    • lung---fibrosis of the airways--small called bronchiole obliterans
    • kidney--fibrosis and occlusion of the vasculature
  90. Whats responsible for the following proteinurias?
    Tubular
    overload
    functional
    selective
    orthostatic
    Isolated
    • tubular--tubulointerstitial nephritis
    • overload--MM
    • functional-change in blood flow due to physical stress
    • selective--Minimal change disease
  91. What HIV drug can cause seizure bc it chelates calcium and increases magnesium secretion?
    Foscarnet
  92. Hypertension causes what kind of pathology in the brain?
    interparenchymal hemorrhages
  93. Difference in the presentation of an ischemic stroke vs a hemorrhagic stroke?
    • ischemic stroke takes several hours to present
    • hemorrhagic stroke is instantaneous
  94. WHat malignant hypertension drug decreases TPR and increases blood flow to kidney?
    Fenoldopam
  95. How do you measure variability, heterogeneity?
    using Standard deviation
  96. WHat causes Mitral valve prolapse?
    myxomatous degeneration--glycosaminoglycans
  97. What drugs increase the serum levels of Lithium?
    • Thiazides
    • NSAIDS
    • ACE Inhibitors
  98. Kallman syndrome presents how?
    • anosomia
    • lack of secondary sexual characteristics due to low GnRH
  99. Heteroplasmy presents with what kind of inherited disorders?
    • mitochondrial inherited disorder--Leiber Optic neuropathy
    • Mitochondrial disorder with rugged red muscle fibers
  100. What causes coronary sinus dilation?
    right atrial enlargement due to high pressures
  101. SIde effect of acyclovir, gancyclovir and fosarnet?
    nephrotocixity
  102. acute intermittent porphyria is caused by what enzyme deficiency?
    porphobilinogen deaminase
  103. Porphyria cutanea tarda is caused by what enzyme deficiency?
    uroporphobilinogen decarboxylase
  104. Proteins secondary structure i.e alpha helices or beta pleated sheet is formed by what bonds?
    hydrogen bonds
  105. What virulence factor of e.coli promotes meningitis?
    diarrha/uti?
    • meningitis--- K1 capsular
    • UTI--pili/fimbraie
  106. What is a verotoxin?
    Shiga-like toxin
  107. Most common cause of death in a person with DM?
    coronary artery disease
  108. WHich of the pneumoconiosis affects only the lowe lobes of the lungs?
    Asbestosis
  109. What is the oxygen content?
    hemoglobin + saturation of it + p02 of it
  110. What is the most common child brain tumor?
    Pilocystic astrocytoma
  111. what is the 2nd most common brain tumor?
    Medulloblastoma
  112. Which brain vessels rupture in a hypertensive stroke/.
    lenticulae striae arteries supplying basal ganglia and internal capsule
  113. What are 2 causes of cholecystitis?
    • cholelithiasis
    • hypotension
  114. What lesions have hyperkeratosis and parakeratosis?
    actinic keratosis
  115. Anions and cations of drugs are secreted where in the kidney?
    anions are secreted using what?
    cations?
    • proximal tubule
    • anions--alpha keto-glutarate
    • cations
  116. What 2 opiods produce withdrawal?
    • Butorphanol
    • Pentazocine
  117. What is hibernating myocardium?
    myocardium that is not active due to ischemia but is reversible if blood flow is restored
  118. Among Verapamil, Diltiazem and nifedipine which one has the most effect on the heart?
    heart--verapamil>diltiazem>nifedipine
  119. Side effect of DIgoxin?
    Cholinergic-----nausea, voming, diarrhea, blurry vision, bradycardia
  120. Drug for herpes infection that does not require viral phosphorylation?
    cidofovir
  121. WHat is the triad of Wernicke's encephalopathy?
    Korsakoff?
    • ataxia
    • anterograde amnesia
    • opthalmoplegia
    • nystagmus
    • KORSAKOFF---
    • retro and antero amnesia
    • confabulation
    • apathy
  122. Appearance of an abundant amoutn of seborheic keratosis is indicative of what?
    GI lymphoma
  123. Based on the location, how are Glioblastoma Multiforme, Meningioma and shwannoma different?
    • Glioblastoma Multiforme--in the cerebral hemisphere-necrosis and hemorrhage
    • Meningioma--surface of brain, continuous with dura
    • Shwannoma--cerebello-pontine angle
  124. Adhesion molecules bind what?
    Fibronectin
  125. Where is epo made?
    endothelial cells of peri-tubular capillaries
  126. How does Addisons disease produce eosinophilia?
    cortisol normally suppresses eosinophils but in absence of cortisol you get eosinophilia
  127. What hormones produce neutrophilia?
    • corticosteroids
    • epinephrine
  128. What protein kills parasites?
    Major basic protein
  129. Role of eosinophils in Hypersensitivity type I?
    down regulat the reaction via histaminase and arylsulfatase which breaks down leukotrienes
  130. What is the purpose of fever?
    fever is high temp--which shift the oxygen dissociation curve to right..giving up oxygen which is used for the respiratory burst
  131. What protein is important in granulation tissue?
    Fibronectin
  132. Decreased hydroxylation does what to collagen?
    weak triple helix bc you can't cross bridge
  133. 3 Miochondrial diseases?
    • MELAS---encephalopathy with lactic acidosis and stroke
    • Myoclonic epilepsy with ragged red fiber
    • Lebiers hereditary neuropathy
  134. What is most outcome of Hep C infection?
    Hep B?
    • Stable chronic hepatitis
    • complete resolution
  135. During embryological development there is 3 sets of veins, umbilical, vitelline, and cardinal..what becomes of them?
    • umbilical--degenerate
    • vitelline--portal veins
    • cardinal--all systemic veins
  136. Hemorrhagic stroke in the basal ganglia is due to what?
    Hemorrhagic stroke in the lobar hemispheres is due to what?
    • HTN
    • amyloid angiopathy
  137. The following conditions result in what encephalopathy?
    Carotid atherosclerosis/cardiac embolism
    Hypoxic encephalopathy
    HTN encephalopathy
    Cereberal amyloid angiopathy
    AVM
    Saccular aneurysm
    Charcot Bouchard Aneurysm
    • ischemic stroke
    • watershed areas
    • basal ganglia
    • lobar hemorrhagic strokes
    • avm--arachnoid hemorrhage
    • savvular aneurysm--hemorrhagic stroke
    • charcot bouchard aneurysms--basal ganglia, thalamus, internal capsule
  138. Erosion vs ulcer?
    • erosion doesn't involve the muscularis mucosa
    • ulcer involves the muscularis mucosa and submucosa

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