UWorld_4.6

Question 1

Classes of Dopamine agonists

Answer 1

• ergot compounds
  
  • bromocriptine
  • pergolide
• non-ergot compounds
  
  • pramipexole
  • ropinirole

Question 2

CCl4 toxicity ==>

Answer 2

• CCl4 oxidized by P450 ==> CCl3 = free radical that reacts with lipid membrane components
• ==> fatty change and hepatocyte necrosis

Question 3

Primidone: MOA, use

Answer 3

• first line for benign essential tremor
• breaks down to phenobarbitol <== must track levels to prevent toxicity/AMS

Question 4

Mechanism of sympathetic transmission

Answer 4

• generally: 2 neuron system from spinal cord
  
  • first neuron releases ACh @ nicotinic receptor @ sympathetic ganglion
  • second neuron releases NE @ various organs: heart, smooth m., nerve terminals)
• exceptions:
  
  • adrenal medulla = one neuron releases ACh directly @ medulla ==> systemic epinephrine + NE release
  • sweat glands = second neuron releases ACh onto a muscarinic receptor
  • kidney vasculature = second neuron releases DA

Question 5

t_1/2 =

Answer 5

t_1/2 = (Vd x ln2)/CL

ln2 = ~.7

Question 6

common mechanism of carcinogenesis of chemical in human pody

Answer 6

• many chemicals enter as pro-carcinogens
• **oxidation by CYP450 system ==> carcinogen
  
  • e.g. cyp450 monooxogenase = present @ hepatic microsomes & ER of other cells

Question 7

SGLT2 inhibitors: MOA, use, SE

Answer 7

• e.g. canagliflozin, dapagliflozin
• oral anti-diabetic agents
• work to decrease proximal tubular reabsorption of glucose
• SE
  
  • renal damage
  • UTIs
  • hypotension
  • **monitor Cr

Question 8

E.coli virulence factors

Answer 8

• LPS ==> IL-1, IL-6, TNF-alpha ==> bacteremia and sepsis
• K1 capsular polysacc ==> prevents phago/complement lysis ==> neonatal meningitis
• Vertoxon/Shiga-like ==> 60S inhibition => cell death ==> bloody diarrhea + HUS
• Heat-labile/stable toxins ==> fluid and electrolyte secretion ==> watery diarrhea
• P fimbraie ==> urothelial adherence ==> UTI

Question 9

Amlodipine: MOA, use, SE

Answer 9

• MOA: ca-channel blocker
• use: HTN
• SE: flushing and peripheral edema

Question 10

Enzyme mutation ==> hyperglycemia in pregnancy

Answer 10

glucokinase = glucose sensor in pancreatic beta cells

Question 11

Proton-pump i: e.g. and MOA

Answer 11

• Omeprazole
• Lansoprazole
• MOA: acts on H+/K+ ATPase pump ==> inhibition of final common pathway of acid secretion
  
  • will decrease acid secretion in response to any stimulus

Question 12

Product that accumulates in aging cells

Answer 12

lipofuscin = product of lipid peroxidation

Question 13

HIV tx ==> fat redistribution/hyperglycemia

Answer 13

protease inhibitors (-navirs)

Question 14

Antibiotic tx for lung abcess

Answer 14

clindamycin (for anaerobic coverage)

Question 15

Nerves and vessels that supply ovary contained in…

Answer 15

suspensory ligament

Question 16

Prophylaxis in HIV patients

Answer 16

• TMP/SMX
  
  • PCP pneumo (@ <200 T cells)
  • Toxo (@ <100 T cells)
• Azithromycin
  
  • MAC (@ <50 T cells)
• Itraconazole
  
  • Histoplasma (@ <150 T cells)

Question 17

Structure under 12th rib left side

Answer 17

kidney

Question 18

Digoxin toxicity sx

Answer 18

• GI
  
  • abdominal pain
  • N/V
  • anorexia
• Neuro
  
  • fatigue
  • confusion
  • weakness
  • color vision alterations

Question 19

Rubella virus type

Answer 19

toga virus

Question 20

Estrogen impact on thyroid hormones

Answer 20

estrogen ==> decreased catabolism of TBG ==> increasted total T4 with normal thyroid fxn

Question 21

marker for mast cell activation

Answer 21

histamine

tryptase

Question 22

tryptophan forms…

Answer 22

serotonin

niacin (B3)

Question 23

Fenoldapam: MOA

Answer 23

D1 agonist ==> arteriolar dilation + increased renal perfusion/diuresis

Question 24

Low c1 esterase inhibitor ==>

Answer 24

• elevated bradykinin
• do not use ACE-i in these patients because ==> angioedema

Question 25

Pseudomonas tx

Answer 25

* Pen = Piperacillin; Ticeracillin * Ceph = Cefepime, Ceftazidime * Gentamicin * Cipro/Levofloxacin * Aztreonam * Imipenem

Question 26

Common cause of lacunar infarcts

Answer 26

hypertensive arteriolosclerosis of small, penetrating arterioles