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Uworld > #3 > Flashcards

#3 Flashcards

1
Q

stage IV chronic kidney disease
- Cardiac auscultation reveals S4
- Anemia low reticulocyte count
Treatment with recombinant glycoprotein hormone is begun and improvement in hemoglobin level occurs.

MOA?

A

Janus Kinase 2/signal transducers and activators of transcription
- Recombinant EPO agents works by JAK2/STAT

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2
Q

52 yo worsening right leg pain

  • injured while motorized watercraft on the ocean near florida
  • Small laceration on the dorsal of the right foot
  • Leukocyte and serum lactic acid are elevated
  • Yield curved gram-negative rods

Greatest risk factor for this patient’s infection?

A

Condition causing iron overload

- Vibrio vulnificus

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3
Q

HLA DQA0501 - DQB 0201 haplotype is 0.2

However DQA0501 is 0.3 & DQB0201 is 02

What explains the difference ?

A

Linkage disequilibrium

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4
Q

Congenital abnormalities and use of acetaminophen
- Interview mother to determine fetal exposure to acetaminophen

  • Susceptible to which bias?
A

Recall bias

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5
Q

67 yo altered mental status
Unable to follow command
- Most appropriate in decision making ?

A

Ask them both to make a decision based on what they think the patient would have wanted if he was able to make the decision

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6
Q

35 yo frequent urination
- Urine osmolality increased after 4h of dehydration
- Plasma osmolality found to be 298
Vasopressin was administered subcutaneously

Diagnosis?

A

Central diabetes insipidus

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7
Q

2yo boy fever and mouth pain
Swollen gums and vesicular inflamed lesions on his hard palate and lips
Enlarged and tender cervical lymph nodes

Responsible agent?

A

DNA virus, DS, enveloped

Herpes virus

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8
Q

27 yo woman several sexual partners

  • positive for HPV
  • Biopsy reveals low grade dysplasia

Features the distinguishes lesion from cervical malignancy?

A

Reversibility of changes

‘‘low grade dysplasia’’

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9
Q

62 yo man evaluation of Jaundice

  • Presence of edema , elevated transaminases
  • Trichrome staining shows blue deposits

Cell is responsible for the histologic ?

A

Stellate Ito cells - produce collagen in large quantities. ‘’ hepatic fibrosis’’

  • Collagen stains blue with masson trichrome
  • Patient has hepatic cirrhosis
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10
Q

Arterial pressure
75, 110, 80, 90, 75, 110
Median?

A

85mm Hg

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11
Q

28 yo woman pregnant
- Fetus is not her husband child, she ask not to tell him

Appropriate response?

A

I will not tell your husband

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12
Q

38 yo wo

  • It’s almost lunchtime and I still haven’t gotten my breakfast
  • Appropriate response by physician?
A

You must be very hungry, so let me find out what happened to your meal

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13
Q

65 yo male, after stroke

  • presents with left upper and lower extremity weakness
  • Prescribed diazepam to decrease muscle spasticity

Cautioned to avoid?

A

Chlorpheniramine ( 1st generation antihistamine) can cause significant sedation

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14
Q

patient given amiodarone

What should be tested before?

A

Serum TSH

Amiodarone can cause hypo and hypethyroidism

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15
Q

55 yo several months of fatigue
- Significant for hypertension and obesity
Mucosal pallor
MCV 84

Cause of patient anemia?

A

Anemia of chronic disease

- Increased hepcidin

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16
Q

Deletion in PECAM-1 gene, this will affect which neutrophil function?

A

Transmigration

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17
Q

24 yo binge drinking
- Red blood vomit

Distal branch of which blood vessel is likely to be emboli zed during procedure?

A

Left gastric artery branch esophageal artery

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18
Q

62 yo patient can’t feel anything on right side of her body
- Loss of body touch, temperature and vibratory sensation

Muscle is 5/5

Stroke affects ?

A

Left thalamus

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19
Q

Pure sensory stroke, after years patient dies an we find cavities in the deep structures of her brain with clear fluid

What is responsible for this finding?

A

Lipohyalinosis with small vessel occlusion = liquefactive necrosis

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20
Q

42 yo woman with parkinson disease
- Loss of function mutation in a gene that leads to accumulation of misfolded proteins

Process defective?

A

Ubiquitination

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21
Q

Hand hygiene with alcohol based disinfectant is recommend because of pathogens that present?

A

Lipid bilayer envelope like influenza

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22
Q

78 yo man abdominal pain and discomfort
- No bowel movement in 5 days
Polyethylene glycol is administered and movement is produced

Action is most similar to?

A

Lactase deficiency

- Osmotic laxative same as magnesium hydroxide

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23
Q

38 weeks gestation neonate has respiratory distress after delivery
- cyanosis, tachypnea, poor perfusion
- Decreased left sided breath sounds
Chest X-ray shows tube entering left side of chest

Reason for respiratory distress?

A

Underdevelopment of pulmonary tissue

- Congenital diaphragmatic hernia causing pulmonary hypoplasia

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24
Q

27 yo man dyspnea on exertion
- 3/6 systolic murmur along left sternal border that decreases in intensity when moving from standing to squatting position

Inheritance of this condition?

A

Autosomal dominant - consistent with hypertrophic cardiomyopathy
Affect cardiac myosin binding protein C and cardiac beta myosin heavy chain

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25
Q

70 yo wo progressive dyspnea
- No pain or edema
- S4 is heard
- Left atrial enlargement, concentric left ventricular hypertrophy
Changes seen in: Left ventricular compliance, Angiotensin II signalling, myosin heavy chain beta ?

A

Compliance decrease, the rest increases

26
Q

Ischemic injury to cardiomyocytes, left anterior descending coronary artery is ligated, ATP concentration decreases

At which point in time does myocardium stops contracting?

A

Earliest point in the graph about 1 to 2 minutes

27
Q

72 to man sudden abdominal pain

  • History of coronary artery disease
  • Small intestine is resected and several large-caliber vessels with needle shaped cholesterol clefts are present

Patient at highest risk for?

A

Kidney injury

28
Q

7 yo congestion with facial pain

  • Pain over cheeks
  • Yellow mucus, gram shiny masses
  • Lungs coarse breath sounds
  • Diagnosis?
A

Cystic fibrosis

29
Q

50 yo wo large painful skin lesion
- Started on warfarin not long ago

Cause of skin lesion?

A

Protein C deficiency

30
Q

25 yo wo at 37 week gestation

  • Abdominal pain and sudden vaginal bleeding
  • Fetal heart 105/min

Cause of bleeding?

A

Premature placental separation

  • Vasa previa ( placenta implantation over cervix) bleeding is painless
31
Q

46 yo 4 days of intermittent fever
- 2 days of decreased urine output and skin rash
- Petechial rash and facial puffiness
- Bleeding time is prolonged
- PT & PTT are normal
-Presence of schistocytes and reduced platelets with giant forms
There is proteinuria & Hematuria

Seen on renal biopsy?

A

Platelet rich thrombi in glomeruli and arterioles

- TTP-HUS

32
Q

2 month old, physician advise vaccine and mother doesn’t want to , she has read that it is very harmful to the immune system.

Appropriate response?

A

I understand your concern, and I believe that ensuring your children’s health & safety is our shared goal

33
Q

32 yo wo bloating, intermittent diarrhea
- Diagnosed with irritable bowel syndrome
Patient decide to start a strict vegan diet.
Nutritional supplement should be given?

A

Calcium & vitamin D

Cobalamin deficiency may also occur

34
Q

36 yo man, severe acute knee pain
- Underwent renal transplant 8 weeks ago
- Taking cyclosporine and low-dose prednisone
Fluid from knee shows numerous neutrophils as well as intra and extracellular crystals

Mechanism responsible for symptoms?

A

Decreased urinary excretion of uric acid

Patient has gout, cyclosporine impairs renal excretion of uric acid

35
Q

32 yo cough and malaise

  • Tonsillectomy at age 8
  • Outdoor adventure in the great lakes
  • KOH preparation reveals large yeast cell with a single bud

Infected with?

A

Blastomyces dermatitidis

36
Q

62 yo with cough and dyspnea

  • COPD, smoked for 40 years
  • Right lung reveals bronchial sound and crackles.

Mediastinal contour on CT scan over right is formed by?

A

Right atrium - right middle lobe

37
Q

16 yo boy burning with urination and penile discharge

  • Sexually active
  • gram stain shows gram negative diplococci

Appropriate treatment?

A

Tetracycline and third generation cephalosporin

- Treat for gonorrhoea and Chlamydia at the same time

38
Q

28 yo wo hing dose glucocorticoids improved hepatitis.
- Jaundice
Prednisone is tapered and azathioprine is prescribed.

What should be monitored while patient takes new medication?

A

Complete blood count

- Azathioprine causes pancytopenia

39
Q

62 yo man sudden onset severe headache
BP 180/95, right pupil is larger
- Right basal ganglia hemorrhage with compression of right lateral ventricle and shift of midline structures
- Intravenous bolus of mannitol is administered

Acute effect of medication on serum sodium concentration, renal tubular flow, glomerular filtrate osmolality?

A

Decreased serum sodium concentration, increased the rest

40
Q

Respiratory epithelium changes in composition as airway continue distally from trachea to alveolar ducts

Feature last to disappear?

A

Cilia, it will be present at the respiratory bronchioles

41
Q

Girlfriend found unresponsive

  • History of major depression and anxiety disorder
  • Screen is positive for benzodiazepines

Arterial blood gas present
PaO2 / PaCO2 / Alveolar- arterial O2 gradient?

A

Decrease (55)/ Increase (60) / normal (10)

42
Q

56 yo wo frequent urination, suprapubic pain, hematuria
- Positive for breast cancer and started chemotherapy last month.

What drug could have prevented current condition?

A

Mesna

Patient has hemorrhagic cystitis caused by cyclophosphamide

43
Q

25 yo man persisten diarrea

  • History of HIV
  • Diarrhea has become bloody ‘‘shigella’’
  • There has been transfer of nonchromosmal DNA between adjacent bacteria via a small hair like appendage

Process responsible for bacteria resistance?

A

Conjugation ‘’ cell to cell contact’’ creates antibiotic resistance. Via pilus ( hair like appendage)

44
Q

2yo boy sits in a corner playing with favourite truck, he forms no words
- When pulling truck away he begins screaming and pulls it back

Diagnosis?

A

Autism spectrum disorder

45
Q 
84 yo wo sent to nursing home
- urinary tract infection history
- 3 days of fever and abdominal pain
Patient started on ceftriaxone
- Urine shows extended spectrum beta lactamase producing Escherichia coli

Features found in this organism?

A

Plasmid with drug resistance gene

This will rend cephalosporins and beta lactic antibiotics inactive

46
Q

24 yo wo with partial bowel resection for crohn disease
- Since surgery had difficulty eating and has inserted a central venous catheter.
Blood cultures show positive for yeast

Organism responsible for infection?

A

Pseudohyphae with blastoconidia

- Candida in catheter

47
Q

62 yo wo end stage kidney disease due to diabetic nephropathy
- She is given medication that prevent rejection by inhibiting the conversion of inosine monophosphate to guanosine monophosphate

What medication was used?

A

Mycophenolate
Inhibits de novo purine synthesis
Can cause lymphopenia and diarrhea

48
Q

46 yo recurrent nosebleeds

  • alcohol use disorder
  • Swollen gums, scattered ecchymoses and hyperkeratosis
  • Chronic ulcer in lower extremity

What mechanism accounts for finding?

A

Abnormal proline hydroxylation

- vitamin C deficiency ‘’ necessary for collagen synthesis’’

49
Q

Cell in which glycolysis of single glucose molecule always yields pyruvate but sometimes generates no net ATP?

A

Erythrocytes

Convert 1,3 BPG to 2,3 BPG this produces no ATP. In order to increased oxygen delivery

50
Q

13 yo boy difficulty with breathing, hoarseness and dysphagia
- Oropharyngeal examination reveals a large red lingual mass.

Failure of which embryologic process is responsible for this?

A

Migration

- Remaining of thyroglossal duct causes a lingual thyroid

51
Q

55 yo man watery diarrhea for last 2 weeks

  • Kidney transplantation 5 years ago
  • He is in immunosuppressive medication
  • Ziehl-Neelsen staining shows multiple acid-fast organism

Cause of condition?

A

Cryptosporidium parvum

- Focal orally transmitted, oocyst identified by acid fast

52
Q

Patient says to doctor ‘’ you know noting, you are not even a real doctor’’
Resident is reminded of her father, she replied you can’t leave and Im ordering haloperidol to calm you down

What process explains the resident’s response?

A

Countertransference

53
Q

mRNA sequences composed of CUC & CUU are incubated with ribosomes and amino acids. After hours it is found both chains contain leucine repeats

  • Observed finding is due to ?
A

Wobble

- Multiple codons code for same amino acid

54
Q

45 yo man enlarging neck mass and hoarseness

  • Biopsy + for papillary thyroid cancer
  • After thyroidectomy patient develops tingling around mouth and muscle cramps in lower extremities

Increase in which of the following best explain current symptoms?

A

Increase in urinary calcium excretion

- Hypocalcemia caused by unwanted removal of PTH

55
Q

32 yo reveals enlarged cervical, axillary and lymph nodes, diffuse skin rash
- serum added to cadiolipin, cholesterol and lecithin leads to clumping

Antibodies directed agains what?

A

Treponema pallidum

- VDRL test secondary syphilis

56
Q

32 yo wo stuck in elevator
- dizziness, blurred vision and weakness

Cause of symptoms?

A

Decreased arterial partial pressure of CO2

  • Hyperventilation leads to decreased cerebral perfusion
57
Q

68 yo woman right femoral neck fracture

  • Weakness in dorsiflexion, plantar flexion and knee flexion
  • Hip & Knee extension are normal
  • Sensation is decreased to touch on dorsal of right foot, ankle reflex is absent on the right

Cause of findings?

A

Sciatic nerve injury (L4-S3)

  • L5 radiculopathy (disc herniation) will have back pain with normal ankle reflex
58
Q

23 yo stab injury
- laterally directed anterior chest wall stab wound at the 5th intercostal space along the midclavicular line

Structure injured?

A

Left lung

59
Q

64 yo hypertension history

  • Unable to sleep in flat position
  • BP 192/102
  • Started on nitroglycerin infusion

Physiologic changes most likely to occur in left ventricular end-diastolic pressure / peripheral venous capacitance / systemic vascular resistance?

A

Decrease ventricular end-diastolic pressure
Increase venous capacitance
Decrease vascular resistance

60
Q

although eukaryotic genome is larger and more complex than of the prokaryote, eukaryotic DNA replication still occurs in a timely manner

Why?

A

Multiple origins of replication

Uworld (11 decks)

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