UWORLD I

Benzos and sfx

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ITP

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acute chest syndrome in Sickle cell dz

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Cx of reperfusion injury?

1. oxygen free radical (parenchymal, endothelial, leukocytes), 2. mito damage 3. inflamm (neutrophil recruit) 4. complement

Signs of vertical transmission of HIV from mother to fetus? Prevention?

1st year of life: oral thrush, interstitial pneumonia, severe lymphopenia. Prevention: Zidovudine, AZT (retroviral RT inhibitor) @ 14 wks, and infant 6 weeks postpartum.

Toxins of C diff

A: attaches to cell membrane B: actin depolymerization -->loss of cellular cytoskeleton integrity

Tx for crypto

Amp B, flucytosine

Rx with neg chronotropic effects

B blockers, non DH CCB, cardiac glycosides, amiodarone and sotalol, cholinergic agonists (pilocarpine, rivastigmine).

Histo: Chlamydia and HSV

C: intracyto inclusion bodies HSV: multinucl giant cells % intranuclear inc

Viral cells and binding R

CD4 and HIV gp120; CD21 and EBVgp350; erytrocyte antigen and parvovirus B19

CREST : pathophys

CD4 lymph -->secretions-->fibroblast -->collagen-->tissue fibrosis. LES muscle replaced by fibrous tissue.

EBV mononucl like symptoms caused by:

CMV, HHV-6, toxo

What nerve controls the stapedius muscle? Clinical consequence of damage?

CN VII. sensitivity to sounds

Rx for hairy cell leukemia? properties

Cladribine. Adenosine analog and not degraded by adenosine deaminase.

Causes of Down syndrome? %

DS due to meiotic non dysjxn > robertsonian t14:21 t21:22 (3-4%)

Vaccination for C diptheriae

Dipth toxoid --> induces IgG against toxin B. Prevents AB toxin damage of neuro and cardiac organs.

Cimetidine use and sx

H2 r antagnoist for ulcers. SFX: gynecomastia. also inhib p450.

pol gene mut and HIV

HIV RT inhibitors and HIV protease inhibitors

Diff b/w HSV, syphilis, and Chlam

HSV ulcers -painful, heal in 10 days S: ulcer heals in weeks. Chlam - painless, heal few days.

Tx for fainted diabetic?

IM glucagon (IM glucose not practical)

pathogenesis of cushing ulcers?

INC ICP-> vagus activation-->inc HCl release

Marker seen in MS?

IgG in CSF

Nitrate bioavailability orally? (Nitroglycerin, Isosorbide dinitrate, Isosorbide mononitrate, amyl nitrite)

Isosorbide mononitrite >> others No 1st pass met. Na Nitroprusside (IV) Amyl nitrite (Inhaled)

painless ulcers on genitals

Klebsiella inguinale, trepobema pallidum, Chlamidia trachomatis

Association with MG, LE?

MG: thymoma LE: pre-existing malignancy (ie lugn cancer)

Lesion in optic tract can give contralat homonymous hemianopia and relative aff pupillary defect in contral eye. How?

Marcus Gunn pupil: nasal portion of retina contributes more input to pretectal nucleus than temporal portion of retina.

Allergic bronchopulmonary aspergillosis

May complicate asthma. --> transient recurrent pulm infiltrates and eventually proximal bronchiectasis.

Cold agglutinins infxn and dz

Mycoplama pneumoniae, EBV, hematologic malignancy

Difference of mycoplasma and mycobacteria walls?

Mycoplasma has mycolic acid (long brached chain sat. FA). Mycobacteria has no wall.

cx of green sputum in bacterial infection in lungs?

Myeloperoxidase (neutrophil azurophilic granules).. used to produce HCOL for resp burst.

Adenosine effect on pacemaker cell? Similar rx?

Open K channel (slow I funny), inhibit Ca influx (inc Th). Ach similar.

Opioids and RUQ pain

Opioids act on smooth muscle (contraction) at sphincter of Oddi -->inc pressures in bile duct and gall bladder.

Child, fever, painful gingival ulcers, swollen gums, cervical lymphadenopathy. Oral ulcer base scraping---> interpretation.

Oral ulcer base scraping--Tzanck test (look for multinucleated giant cells). HSV, VZV: present w/ fever, vesiculoulcerative (herpatic) gingivostomatitis, cervical lymph for PRIMARY INFXN. Reactivation: limited perioral blister.

Tx of N. meningiditis. Prof?*

Penicillin. Prof: rifampin or ceftriaxone (only ones that can eliminate from nasal).

Opioid drug that causes withdrawl sx?

Pentacozin ***

NE IV causing blanching and induration. Prevention?

Phentolamine (alpha 1 blocker).

Warfirin induced lesion?

Protein C or S def.

ACE I can cause dec renal filtration fraction in what pts?

Pts with renal artery stenosis (CAD).

Adrenal crisis presentations. Treatment?

Px: hypotensive, tachycard, hypoglycemic, hx (vomiting, abdominal pain, weight loss, hyperpig). Tx: corticosteroids

Tx for CNS toxo?

Pyrimethamine, and sulfadiazine

GAS: RF and acute post-strep GN..

RF follows strep throat only. APSGN can follows impetigo or pharyngitis.

MCC of pneumonia in adults?

S penumoniae, followed by N .meningetitis.

Secondary infections following influenza infxn? In elderly?

S. pneumo, S. aureus, H influenza

drug to reduce tobacco withdrawal cravings and attentuate reward efects of nicotine

Varenicline : partial agonists of nicotine Ach R.

Tachyphylaxis and examples

Vasoctxn by a-adrenergic agonists (Phenylephrine, xylometazoline, oxymetazoline) use >3 days causes dec NE synth. Nitroglycerine also dec release of NO (need drug free interval of 8-10h)

Patients with recurring giardia infxns?

a gammaglobulinemia, other immune def : no IgA which fights giardia.

Diphenoxylate: use, moa, sfx

anti-diarrheal opiate (related to meperidine), binds mu to slow motility. Euphoric at high dose

shaken baby syndrome

bilat retinal hemorrhages, subdural hematoma.

craniopharyngioma (histo, origin,

calcified cyst, w/ squamous epithelium, kertain pearls, viscious fluid rich in xol. Derived from Rathke's pouch

Presentations of intestinal malrotation embryology?

cecum in RUQ. Ladd's bands. midgut fixed to SMA. compl: intestinal obxtn, midgut volvulus.

Virion and cellular receptor: CMV, EBV, HIV, Rabies, Rhinovirus

cellular integrins, CR2, CD4&CXCR4/CCR5, nAch, ICAM1 (CD54)

Transmission of vibrio parahemolytics

contaminated shellfish

Methenamine silver

crypto

NF-kB is associated with production of:

cytokines. Overexpression in crohn's.

Lipohyalinosis and microatheromas

destructive vessel lesion characterized by loss of nml aterial architecture, mural foam cells; accum of lipid-laden MO w/ in itimal layer of vessel . Assoc with lacunar infarct.

Role of p450 monooxygenasae

detox but also activate pro-carcinogens

Colchicine sfx

diarrhea, N/V MOA: inhibit tubulin polymerization

campylobacter transmission

domestic animals or contaminated food.

MC aseptic meningitis infections?

enteroviruses: coxsackie, echo, entero, polio

Use of chloroquine? other drug added, why?

eradicates plasmodia from blood stream but not latent hepatic infections (P vivax, P ovale) Primaquine to prevent relapse.

Aseptic meningitis presentations

fever, ha, photophobia, painful extraocular movements. -->myalgias, asymmeteric paralysis.

PAS stains

glycoprotein in cell walls of G+ actinomycete Tropheryma whippellii

Painful ulcers on genetilas

haemophilus ducrey, HSV 1,2

Influenza virus antibodies against:

hemagglutinin - IgA and IgG

Tx of DVT in pregnancy?

heparin. Warfarin (main tx is CI)

bacterial casues of anterior uveitis

herpes, syphillis, lyme dz

Diff b/w myocardial hibernation, stunning, remodeling..?

hibernation: reversed by reperfusion adn more serious than stunning (ischmeia-induced reversibel loss of contractile fxn). Ischemia preconditioning: resistance to infarction due to repetitive non-letha isch. Ventricle remodeling: change in mass, vol, shape, myocyte comp of heart.

Potency =

higher affinity for receptor

Properties of cancer resistant cell membrane protein?

human multidrug resistance (MDR1) gene codes -->P-glycoprotein (ATP-dependent efflux pump). specificity for hydrophobic compounds.

Fxn of Vit C Epid of def?

hydroxylation of proline and lysin residues in pro-colagen. (prolyl, lysyl hydroxylases) homeless, alcoholic, drug user. Px: perifollicular hemorrhages, easy bruising, gum dz

C diph culture Sx?

in cysteine-tellurite agar. septiciemia, UTI, erythrasma, endocarditis in IC. gray pharyngeal exudate in not vacc.

B6 effects on levidopa, carbidopa

increase metabolism and dec effectiveness.

cx of delirium

infection, electrolyte disbalance.

avitaminosis E

infertility, dec serum phospholipids

Mx of Fondopiranoux

inhibit Xa --> inc Pt, PTT. no effect on TT

flutamide

inhibit testosterone and DHT binding

akathesia

inner restlessness due to anti-psychotic tx

Tx to prevent GBS in child? Consequences of not treating?

intrapartum antibiotic prophylaxis. GBS -->sepsis, pneumonia, meningitis.

Hypervariability of HCV is due to what cellular component ?

lacks 3-5 proofreading exonuclease in RNA polymerase.

Immunocom (HIV) patients at risk for developing reactivation of what infections? leads to waht?

latent EBV-->NH diffuse B cell lymphoma

where are PDA heard best

left sternal border, loudest at S2

Neuron changes in MS:

length constant (signal travels a shorter distance due to dec myelination)

Hereditary pancreatitis cx/

mutation in trypsinogen resulting in no trypsin

mitochondrial dz

myoclonic epilepsy w/ ragged red fibers leber optic neuropathy mitochondrial encephalopathy with stroke-like episodes and lactic acidosis

APC mutations progression:

nml epi-(APC)->early adenoma -(KRAS)->late adenoma-(p53)->adenoCA

wall of mycoplasma org?

no PDG

Mycoplasma pneumoniae pathophys

no cell wall, but has cell membrane. Antigenic similarity b/w cell walls of host and bacteria-->cold aglutinin destruction of host rbc-->anemia. tx w/ erythro or tetra corrects infxn and anemia resolves. C can also cause stevens-johnson

Congenital torticollis

noted by 2-4wks of age. hold head tilted to one side. Cx: malposition of head in utero or birth trauma. Tx: conservative therapy and stretching exercises.

major determinant for bladder cell carcinoma?

penetration of bladder wall.

Succhynil choline phase I and II and how to reverse it?

phase I: depol and paralyze train on four equal. Phase II: depol and dec train en four reverse with neostigmine in phase II. Augments in phase I.

Px of peau d'orange

pitting edema in subcut breast tissue, w/ skin thickening around exagg hair follicles. Neoplastic cells plug dermal lymphatic channels.

Inferior thyroid artery travels close to __ nerve

recurrent laryngeal.

Presentations of pulmonary HTN?

second heart sound, signs of RHF.

Theophylline intox

seizures, tachycardia

bacteria that can cause infection with low counts?

shigella, campylobacter (500), Entamoeba histolytica (1), giardia (1)

Isoniazid effects on vitamins and px

similar to B6. inc excretion of pyridoxine. and competes for binding sites -->defective synth of GABA. need suppl. Px: sensory ataxia, dec pain sensation

Px of platelet sequestration

splenomegaly and platelets low but above 30,000. abnl bleeeding not found

avitaminosis A

squamous metaplasia can keratinize

Isolated systolic hypertension

stiffening of aorta (age related) ie 180/90

MC bacterial cx of acute otitis media, sinusistis, conjunctivitis?

strep pneumo, nontyp H influ, moraxella.