2/5 UWORLD test # 7

Question 1

Q 1. What are deposits of crescentic glomerulonephritis (2)? vs. FSGN?

Answer 1

1. IgG
2. C3
   These two are opsonins!
3. Fibrin

vs. FSGN: hyaline (not inflammatory)

Question 2

Q 1. Which complement generally deposits in nephritic/nephrotic syndromes? why? Can other complements be deposited?

Answer 2

C3

C3b is the only opsonin in complement. Apart from C1 (which can be seen in FSGN), none of other complements are seen

Question 3

Q 4. What are two GI defects in Down syndrome?

Answer 3

• Duodenal atresia

- Hirschsprung

Question 4

Q 4. What is omphalocele? Due to what specific embryologic defect?

Answer 4

omphaloSEAL.
: GI organs are extruded out belly but sealed by peritoneum

Due to failure in lateral fold closure

Question 5

Q 4. What abnormality can be found on ultrasonography in Down syndrome?

Answer 5

nuchal translucency

Question 6

Q 5. For Down syndrome, what are results of the second- trimester quad screen in pregnant mom?

Answer 6

• increased beta-hCG
• increased inhibin A
• decreased AFP
• decreased estriol

Question 7

Q 7. What are three possible routes of transmission of Campylobacter jejuni infection?

Answer 7

1. poultry
2. pet
3. fecal oral

Question 8

Q 7. What is route of transmission of Shigella?

Answer 8

fecal oral

Question 9

Q 9. What signaling pathway does prolactin stimulate?

Answer 9

JAK-STAT

Question 10

Q 9. What signaling pathway does growth hormone stimulate?

Answer 10

JAK-STAT

Question 11

Q 9. What receptor does Insulin stimulate?

Answer 11

Tyrosine kinase

Question 12

Q 9. What receptor does IGF-1 stimulate?

Answer 12

Tyrosine kinase

Question 13

Q 10. IL-3 stimulates what?

Answer 13

bone marrow stem cell

Question 14

Q 10. IL-4 stimulates what?

Answer 14

IgG and IgE

Question 15

Q 10. IL-5 stimulates what?

Answer 15

IgA and eosinophil

Question 16

Q 10. IL-2 stimulates what?

Answer 16

Differentiation/ growth for CD4/CD8/regulatory T cells, NK cells

Question 17

Q 11. What are derivatives of each aortic arch?

• 1st
• 2nd
• 3rd
• 4th
• 5th
• 6th

Answer 17

• 1st aortic arch: maxillary artery
• 2nd: Stapedial artery (this artery normally regress)
• 3rd: common carotid, proximal part of internal carotid
• 4th: aortic arch, proximal part of right subclavian
• 5th: regress
• 6h: proximal part of pulmonary artery, ductus arteriosus

Question 18

Q 13. Why OCPs are contraindicated in smokers?

Answer 18

OCPs increase risk for DVT and CAD

Question 19

Q 14. What is Midodrine? 
Its effect on
- Cardiac contractility
- HR
- Vascular resistance

Answer 19

alpha 1 agonist

• decreased contractility (reflex)
• decreased HR (reflex)
• increased vascular resistance

Question 20

Q 14. What are two non-selective alpha antagonist?

Indications?

Answer 20

• Phentolamine (reversible): tyramine (cheese/wine) intake while taking MAOI- hypertensive crisis
• Phenoxybenzamine (irreversible): pheochromocytoma

Question 21

Q 14. What is Clonidine? 
Its effect on
-Cardiac contractility
-HR
-Vascular resistance

Answer 21

alpha2 agonist

• decreased contractility
• no change in HR
• decreased vascular resistance

Question 22

Q 14. alpha1 blocker vs, beta1 blocker: which one causes orthostatic hypotension? What is patient’s complain for orthostatic hypotension

Answer 22

alpha blocker
orthostatic hypotension: standing up (increasing peripheral blood circulation) leads to syncope due to cerebral hypopefusion

Question 23

Q 15. What is CSF protein level in viral infection?

Answer 23

increased (so does bacterial)

Question 24

Q 17. What is signaling pathway for insulin

• binds to what receptor?
• metabolic pathway: what signaling molecules?
• growth pathway: what signaling molecules?

Answer 24

Insulin
- tyrosine kinase -> autophoshorylation

• metabolic pathway: P13K -> protein phospohtase (dephosphorylation)
• growth pathway: MAPK/RAS

Question 25

Q 18. In what lung volume does total pulmonary vessel resistance is the lowest? What about alveolar vessel resistance? Explain physiology

Answer 25

- total pulmonary vessel resistance is lowest at FRC - alveolar vessel resistance is lowest at RV ``` - physiology: At RV (residual volume), where lung is maximally shrinked due to forced exhalation, alveolar vessel resistance is lowest due to alveolar shrinkage effect. However, extra-avelolar blood vessel resistance will be increased due to loss of blood volume to alveolar vessel ``` At FRC (Functional residual capacity), balance between alveolar vessel resistance and extra-alveolar vessel resistance is the lowest. So total pulmonary vessel resistance is lowest

Question 26

Q 18. What happens to resistance of extra-alveolar vessel in pulmonary circulation as lung volume increases? Explain physiology

Answer 26

extra-alveolar vessel resistance decreases as lung volume (opposite with alveolar vessel resistance) increases due to alveolar stretch effect. As alveolar is stretched, less blood will be in alveolar vessel, resulting in more blood volume in extra-alveolar vessel -> dilation of extra-alveolar vessel -> decreased resistance

Question 27

Q 20. What information does inferior colliculus carry?

Answer 27

auditory

Question 28

Q 21. What is the most common microbial that causes meningitis in adult? What is the second most common cause?

Answer 28

most common: strep. pneumoniae (MOPS) | second most common: Nisseria meningiditis

Question 29

Q 23. What are general (non-specific) symptoms of anal squamous cell carcinoma? What is the most common infection associated with it?

Answer 29

bleeding (might mimic hemorrhoids) Ulcer (more indicative than bleeding) HPV (16, 18, 31, 33)

Question 30

Q 25. With increased risk for gallstone formation, what are levels of below: - cholesterol - bile salt - phosphatidylcholine

Answer 30

- High cholesterol - low bile salt - low phosphatidylcholine Bile salts and phosphatidylcholine BOTH increase solubility of cholesterol, decreasing gall stone

Question 31

Q 27. What enzyme is responsible for initiation of autodigestion in actue pancreatitis

Answer 31

tripsinogen (zymogen) -> tripsin

Question 32

Q 29. What are three As in terms of symptoms of serotonin syndrome? What are examples for each category?

Answer 32

- Agitation - Autonomic: diaphoresis, hyperthemia, hypertension - Activity: ankle clonus, hyperreflexia, seizure

Question 33

Q 29. What is antidote for serotonin syndrome?

Answer 33

Cyproheptadine

Question 34

Q 32. What organ is surrounded by 12th rib?

Answer 34

kidney

Question 35

Q 33. Which two vitamins are not included in breastmilk?

Answer 35

Vitamine D and K

Question 36

Q 34. What is mechanism of action for piogilatazone? side effects?

Answer 36

PPAR- gamma, which binds to transcriptional factor to up-regulates adiponectin, which will increase insulin sensitivity side effects: hepatotoxicity, weight gain, HF

Question 37

Q 35. Hepatitis serologic test for person who was vaccinated against HepB?

Answer 37

Anti-Hbs positive | Anti-Hbe & Anti-HBc negative: key difference from recovery)

Question 38

Q 35. Hepatitis serologic test for chronic infection with high infectivity HepB?

Answer 38

HBsAg positive HbeAg positive Anti-HBc IgG (chronic)

Question 39

Q 35. Hepatitis serologic test for chronic infection with low infectivity HepB?

Answer 39

HbsAg positive HbeAg negative Anti-Hbe postivie Anti-HBc IgG

Question 40

Q 35. Hepatitis serologic test for acute hepatitis B infection?

Answer 40

HBsAg positive HbeAg positive Anti-HBc IgM (acute- key difference from chronic infection with high infectivity)

Question 41

Q 35. Hepatitis serologic test for person who is recovering from previous hepatitisB infection?

Answer 41

Anti-Hbs positive Anti-Hbe positive Still Anti-HBc IgM

Question 42

Q 35. Hepatitis serologic test for a person who is in window period of Hep B infection

Answer 42

Anti-HbC IgM Anti-Hbe postivie Window period is short time after infection (basically very initial period of recovery). During this period, HBsAg/HBeAg str negative, while Anti-HBs is also negative (not enough time to build antibodies in significant amount) Only Anti-HBe is positive, meaning there is no actively replicating virus (not high infectivity), but it still has a potential to infect others. It is still considered to be an acute phase (Anti-HBc IgM)

Question 43

Q 37. What is myocardial hibernation?

Answer 43

Heart muscles adjust to decreased cardiac perfusion (CAD) so that they decrease contractility to avoid ischemic injury due to maintenance of cardiac workload. After coronary artery bypassing surgery, heart retain some contractility.

Question 44

Q 40. What is physiology of skin wrinkles?

Answer 44

Skin wrinkles are due to age processing. Aging of skin (multiple exposure to UV) leads to decreased synthesis of collagen fibrils, resulting in wrinkles