2/28 UWORLD test # 27 Flashcards Preview

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Flashcards in 2/28 UWORLD test # 27 Deck (43):
1

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

2

Q 1. Is fat necrosis associated with bloody nipple discharge? What is commonly associated with it? What is histologic finding?

HELL NO.

-fat necrosis is commonly associated with trauma

-calcification (saponification)

3

Q 1. What breast disease is associated with apocrine metaplasia? Is it associated with bloody nipple discharge?

fibrocystic changes

NO DISCHARGE

4

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

5

Q 4. ST elevation in leads I and aVL: where is infarct? which coronary artery occlusion?

- lateral side
- left circumflex

6

Q 4. ST elevation in leads II,III, and aVF: where is infarct?which coronary artery occlusion?

- inferior
- right coronal artery

7

Q 4. ST elevation in lead V7-V9: where is infarct? which coronary artery occlusion?

-posterior
- posteior descending artery

8

Q 4. ST elevation in lead V1, V2: where is infarct? which coronary artery occlusion?

- anteroseptal
- proximal left anterior descending artery

9

Q 4. ST elevation in lead V3, V4: where is infarct? which coronary artery occlusion?

- anteroapical
- distal left anterior descending artery

10

Q 4. ST elevation in lead V5, V6: where is infarct? which coronary artery occlusion?

- anterolateral
- left circumflex or left anterior descending

11

Q 4. ST DEPRESSION in V1-V3 with tall R wave: where is infarct? which coronary artery occlusion?

-posterior
- posterior descending artery

12

Q 6. What cell mediates inflammation in sarcoidosis? What lab values (3) can be used?

CD4+ T cell
1.elevated CD4/CD8 ratio
2. hypercalcemia
3. elevated ACE

13

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)

14

Q 8. Define borderline disorder

- mood instability, self-injury, marked impulsity
- splitting common for ego self-defence

15

Q 8. Define disruptive mood dysregulation disorder

persistent irritability with frequent temper outburst

16

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

17

Q 9. Where does amino acid binds to tRNA? Explain nature of chemical bond

3-OH
Ester bond

18

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

19

Q 10. Describe how these are altered in methlymalonic acidemia
- glucose
- ketone
- ammonia

- acidosis: accumulation of methylmalonic acid
- hyperammoniemia: acid prevent urea cycle
- hypoglycemia
- high ketone

20

Q 12. repetitive behavior and lack of social engagement. Diagnosis?

Autism spectrum disorder

21

Q 14. What is the most common cause of mitral valve stenosis?

prior rheumatic carditis

22

Q 15. macrophage vs. ciliated cell: both are responsible for clearing of foreign material in respiratory system. what is the main difference?

LOCATION

macrophage: alveolar and distal respiratory bronchiole (as ciliated cuboidal cell becomes squamous)

ciliated cell: from bronchi to proximal respiratory bronchiole

23

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!)

24

Q 20. Will frequent change of catheter helps reducing infection risk?

NO

Taking out catheter ASAP when no longer needed is much more effective in reducing infection risk

25

Q 21. What is cancer drug, monoclonal antibody that targets EGFR? Mutation on what gene can cause resistance to anti-EGFR therapy? why?

-cetuximab

- KRAS mutation will lead to constitutive activation of EGFR downstream signaling

26

Q 23. vesicles on lips, hard palate and enlarged/tender lymphadenopathy. Which infection is most likely?

HSV-1

VESICLES is key word

27

Q 24. Which two cell types express beta-1 receptor?

- JGA (JuxtaGlomerular Appratus)

- cardiomyocyte

28

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

29

Q 30. Canagliflozin
- mechanism of action
- indication
- side effects
- contraindication, why?

- SGLAT1 inhibitor -> limit glucose reabsorption at PCT

- type 2 DM

- UTI

- moderate to severe renal dysfunction. With renal dysfunction, it may increase risk of UTI

30

Q 26. What is landmark for appendectomy?

Teniae coli

31

Q 31. What is Ranibizumab?

VEGF inhibitor

32

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

33

Q 32. Ribavirin
- mechanism of action
- indication
- 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

34

Q 32. Which anti-viral medication works by impairing uncoating?

Amentadine

- note: it is no longer used. It is now indicated for parkinson (by promoting dopamine release/ inhibiting dopamine reuptake)

35

Q 34. What cytokine mediates septic shock? how?

TNF-alpha
it increased vascular permeability, recruits WBC

36

Q 35. What is clinical significance of CEA (Carcinoembryonic Antigen)?

not diagnostic due to low specificity
But good indicator for recurrence & monitoring after treatment

37

Q 36. lingual thyroid
- what is it?
- pathophysiology
- symptoms (3)

- thyroid in lingual region within oral cavity

- abnormal descending of thyroid during development

- dysphagia, dyspnea (airway obstruction), dysphonia

38

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

39

Q 39. CA-125 is marker of what cancer?

ovarian cancer

40

CA 19-9 is marker of what cancer?

pancreatic adenocarcinoma

41

Q 39. Is long-term OCP use beneficial or harming for development of ovarian cancer? why?

beneficial

OCP (estrogen/progesterone) -> inhibits FSH/LH -> less estrogen stimulation

42

Q 39. Is long-term use of antioxidant helpful for delaying cancer progression? What is example of anti-oxidant?

NOPE

- vitamin C works as anti-oxidant

43

Q 40. Findaxomicin
- mechanism of action
- indication

- inhibition of sigma subunit of RNA polymerase

- recurrent C. Difficle