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.