Flashcards in 2/28 UWORLD test # 27 Deck (43):
Q 1. What breast disease is the most common cause of nipple discharge (serous or bloody)? What is histologic finding?
- intraductal papilloma: can be serious and bloody
- projection of papillary cells with fibrovascular core
Q 1. Is fat necrosis associated with bloody nipple discharge? What is commonly associated with it? What is histologic finding?
-fat necrosis is commonly associated with trauma
Q 1. What breast disease is associated with apocrine metaplasia? Is it associated with bloody nipple discharge?
What breast diseases (3) are associated with nipple discharge? characteristics of discharge for each?
- Intraductal papilloma: bloody/serous discharge
- mammary duct ectasia: green-brown discharge
- acute mastitis: purulent discharge
Q 4. ST elevation in leads I and aVL: where is infarct? which coronary artery occlusion?
- lateral side
- left circumflex
Q 4. ST elevation in leads II,III, and aVF: where is infarct?which coronary artery occlusion?
- right coronal artery
Q 4. ST elevation in lead V7-V9: where is infarct? which coronary artery occlusion?
- posteior descending artery
Q 4. ST elevation in lead V1, V2: where is infarct? which coronary artery occlusion?
- proximal left anterior descending artery
Q 4. ST elevation in lead V3, V4: where is infarct? which coronary artery occlusion?
- distal left anterior descending artery
Q 4. ST elevation in lead V5, V6: where is infarct? which coronary artery occlusion?
- left circumflex or left anterior descending
Q 4. ST DEPRESSION in V1-V3 with tall R wave: where is infarct? which coronary artery occlusion?
- posterior descending artery
Q 6. What cell mediates inflammation in sarcoidosis? What lab values (3) can be used?
CD4+ T cell
1.elevated CD4/CD8 ratio
3. elevated ACE
Q 7. diplopia, intact upward gaze, problem with downward gaze (reading). Which CN is impaired?
trochlear (CN 4)
superior oblique is the only muscle that does depression (and intorsion as well)
Q 8. Define borderline disorder
- mood instability, self-injury, marked impulsity
- splitting common for ego self-defence
Q 8. Define disruptive mood dysregulation disorder
persistent irritability with frequent temper outburst
Q 8. What adolescence behaviors are considered to be normal? How can it be differentiated by other psychological disorder?
-transient emotional outburst is considered to be normal
- severity, DURATION, FREQUENCY are keys
Q 9. Where does amino acid binds to tRNA? Explain nature of chemical bond
Q 10. Through what pathway are odd number fatty acids, branched chain amino acids, methionine, and threonine metabolized? what are metabolic intermediates (4)?
Propionyl-CoA-> methylmalonyl-CoA -> Succinyl coA
Q 10. Describe how these are altered in methlymalonic acidemia
- acidosis: accumulation of methylmalonic acid
- hyperammoniemia: acid prevent urea cycle
- high ketone
Q 12. repetitive behavior and lack of social engagement. Diagnosis?
Autism spectrum disorder
Q 14. What is the most common cause of mitral valve stenosis?
prior rheumatic carditis
Q 15. macrophage vs. ciliated cell: both are responsible for clearing of foreign material in respiratory system. what is the main difference?
macrophage: alveolar and distal respiratory bronchiole (as ciliated cuboidal cell becomes squamous)
ciliated cell: from bronchi to proximal respiratory bronchiole
Q 20. Catheter insertion through what vessels are recommended? Which vessel has the highest infection rate?
- subclavian & internal jugular
- femoral vein has the highest infection risk.
( Because groin area is dirty!)
Q 20. Will frequent change of catheter helps reducing infection risk?
Taking out catheter ASAP when no longer needed is much more effective in reducing infection risk
Q 21. What is cancer drug, monoclonal antibody that targets EGFR? Mutation on what gene can cause resistance to anti-EGFR therapy? why?
- KRAS mutation will lead to constitutive activation of EGFR downstream signaling
Q 23. vesicles on lips, hard palate and enlarged/tender lymphadenopathy. Which infection is most likely?
VESICLES is key word
Q 24. Which two cell types express beta-1 receptor?
- JGA (JuxtaGlomerular Appratus)
Q 25. overactivity of which enzyme is associated with increased cancer development upon exposure to carcinogen? why?
- cytochrome P-450 (microsomal monooxygenase)
- most carcinogens enter the system as a pro-carcinogen (inactive form), which then is metabolized by P-450 to become active carcinogen
Q 30. Canagliflozin
- mechanism of action
- side effects
- contraindication, why?
- SGLAT1 inhibitor -> limit glucose reabsorption at PCT
- type 2 DM
- moderate to severe renal dysfunction. With renal dysfunction, it may increase risk of UTI
Q 26. What is landmark for appendectomy?
Q 31. What is Ranibizumab?
Q 31. age-related macular degeneration can be treated with what medication? why?
VEGF inhibitors (Ranibizumab, Bevacizumab)
: Macular degeneration is caused by neovasculization in macular-> newly synthesized vessels become leaky and cause macular hemorrhage
Q 32. Ribavirin
- mechanism of action
- example of drug that acts by same mechanism, but has different indications. what are indications for this drug?
- inhibition of GMP synthsis
- anti-Hepatitis C
- Mycophenolate also inhibits GMP synthesis. Indicated for transplant rejection prophylaxis or lupus nephritis
Q 32. Which anti-viral medication works by impairing uncoating?
- note: it is no longer used. It is now indicated for parkinson (by promoting dopamine release/ inhibiting dopamine reuptake)
Q 34. What cytokine mediates septic shock? how?
it increased vascular permeability, recruits WBC
Q 35. What is clinical significance of CEA (Carcinoembryonic Antigen)?
not diagnostic due to low specificity
But good indicator for recurrence & monitoring after treatment
Q 36. lingual thyroid
- what is it?
- symptoms (3)
- thyroid in lingual region within oral cavity
- abnormal descending of thyroid during development
- dysphagia, dyspnea (airway obstruction), dysphonia
Q 37. High Arteriovenous gradient indicates what property of inhaled analgestics? explain physiology and principle
High arteriovenous gradient => high tissue solubility. Tissue/capillary is taking up more analgestic, meaning that it takes longer to saturate and exerts effect on CNS
=> SLOWER ONSET
MORE SOLUBILITY, takes longer to saturate, thus SLOWER ONSET
Q 39. CA-125 is marker of what cancer?
CA 19-9 is marker of what cancer?
Q 39. Is long-term OCP use beneficial or harming for development of ovarian cancer? why?
OCP (estrogen/progesterone) -> inhibits FSH/LH -> less estrogen stimulation
Q 39. Is long-term use of antioxidant helpful for delaying cancer progression? What is example of anti-oxidant?
- vitamin C works as anti-oxidant