3/3 UWORLD test # 31 Flashcards Preview

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Flashcards in 3/3 UWORLD test # 31 Deck (49):

Q 2. What are side effects of TCAs on heart? ECG findings? Pathophysiology? antidote?

arrythmia, enlarged QRS, prolonged QT
Blockade of Na+ channel
can be reversed by NaHCO3


Q 3. What is gross appearance of angiomyolipoma in kidney? Which neurocutaneous disease is associated with it? What others are associated with it? (remember mneomic in FA 495)

- mass containing blood vessel, muscle, fat

- tuberous sclerosis

H- Hamartoma
A- Ash-leaf spot on skin (hypopigmented skin with leaf shape)
M- Mitral regurgitation
A- Angiofibroma
R- Rhabdomyoma
T- Tuberous sclerosis
O- autosomal dOminant
M- Mental retaradation
A- Angiomyolipoma


Neurocutaenous disease: NF1 vs. NF2
- mutated gene/ chromosome number / which protein
- manifestations

- NF1: neurofibromin, negative regulator of RAS on chromosome 17
=> cafe-au-lait spots, pheocytochroma, cutaneous fibromas (think about gross appearance), Lisch noduels (pigmented iris)

- NF2: NF2 gene on chromosome 22
=> bilateral schwannoma, juvenile cataracts, meningioma


von Hippel-Lindau disease
- what gene/ chromosome
- what cancers (4)

-VHL gene on chromosome 3

- bilateral RCC, pheocytochroma, hemangioblastoma (high vascularity with hyperchromic nuceli), angiomatosis


Sturge-Weber syndrome
- what gene
- findings (5)

- activating mutation on GNAQ gene

S-port-wine Stain
T- tram track calcification of opposing gyrion CT
U- unilateral
R- retardation
G- glaucoma/ GNAQ
E- epilepsy


Q 5. Gross appearance of tinea versicolor? which infection? microscopy characteristic?

- hypopigemeted (and/or) pink patches

- Malassezia

- meatball sphaghetti


Q 7. Granulomatous destruction of interlobular bile ducts: what is this disease?

primary biliary cholangitis


Q 7. What hepatic condition is associated with ulcerative colitis?

primary sclerosing cholangitis


Q 7. What are clinical symptoms (5) of PBC (primary biliary colangitis) ?

cholestasis (jaundice, pale stool, dark urine)
hypercholesteroliemia: biliary obstruction limits elimination of cholesterol
pruritus: accumulation of bile salts


Q 8. What is another fancy word for B12?



Q 8. What is another fancy word for B6?



Q 8. What is another fancy word for B2?
Its usage in what TCA cycle rxn?
deficiency symptoms (2)


succinate dehydrogenase: succinate --> fumarate

Cheilosis, corenal vasculization (2 Cs)


Q 8. What kind of heart failure is seen in wet beriberi? describe physical exam findings

high output cardiac failure (thus WET)

displaced apical impulse at PMI
collapsing carotid pulses


Q 8. Clinical presentations of dry beriberi

peripheral neuropathy
symmetrical muscle wasting -> eventually inability to walk

With B1 deficiency, dry beriberi may coexist with wet beriberi


Q 9. Sudden onset of heart failure can be caused most likely by what conditions (2)? Would Aortic stenosis present sudden onset of HF?

- acute atrial fibrilation or acute MI

- In case of aortic stenosis, onset of heart failure is usually gradual. not suddenly


Q 10. Facial drop vs. Facial numbness: what would most likely happen with parotid gland enlargement. why?

Facial drop

trigeminal nerve is deep so it is unlikely compressed by parotid gland, while facial nerve is superficial



Q 11. Diagnostic criteria for cyclothymic disorder

MORE THAN 2 YEARS of alternating episodes of hypomanic and mild depression


Q 11. Define key difference: manic vs. hypomanic

manic: DIG FAST severe enough to interfere with occupational/social life

hypomanic: asl DIG FAST, but not severe enough to cause marked impairment in social/occupational functioning


Q 12. Patient ask physician out for a date. What is the physician's appropriate response?

Tell patient that it is unethical


Q 13. What is protruding in femoral hernia? What is complication of femoral hernia? why is this?

- most commonly bowel protrudes through femoral ring

- Femoral vein/artery serve as lateral landmark! It is NOT femoral vessels that protrude.

- Malabsorption, nausea, vomiting, abdominal pain/distention, fever)
: Because femoral ring is small, femoral hernia can cause incarceration (protruding tissue become trapped and no longer be pushed back) or strangulation (impaired blood flow -> ischemia-> fever)


Q 15. Amiodarone side effects on
- skin
- eye

- blue/green skin deposits with photosensitive dermatitis

- corneal deposits


Q 16. Which cranial nerve mediates tongue movement? Left side defect on this CN results in what?

- hypoglossal

- tongue deviation to left


Q 16. Which CN mediates gag reflex
- motor

- sensory: glossopharnyngeal

- motor: vagus


Q 16. glossopharyngeal nerve
- sensory
- motor
- parasympathetic

sensory: posterior 1/3 tongue, tonsil, carotid sinus/ body

motor: stylopharyngeus muscle only. elevation of pharynx/larynx during swallowing

parasympathetic: salivation


Uvula deviation to right: What cranial nerve defect? which side?

left vagus


Q 17. What is fancy word for vitamin B7?



Q 17. Vitamin B7
- General function in metabolic pathway?
- what specific metabolism rxns (3)
- symptoms for B7 deficiency (3)
- possible causes of B7 deficiency (2)

- carboxylation

1. pyruvate carboxylase: pyruvate -> oxaloacetate
( for gluconeogenesis)

2. propionyl-coA carboxylas: propionyl-coA-> methylmalonic-coA
( for odd chain fatty acids / amino acid metabolism)

3. Acetyl-coA carboxylase: acetyl-coA -> malonyl-coA
(for fatty acid synthesis)

- dermatitis, alopecia, enteritis

- deficiency caused by antibiotic use or excessive ingestion of raw white egg


Q 19. midgut malrotation during development: what can happen? explain pathophysiology

fibrous band (Ladd's band) attached colon/cecum to retroperitoneum. This band passes over second part of duodnum

-> duodenal obstruction -> volvulus, obstruction & ischemic necrosis of duodenum


Q 20. Hepatitis A
- infection route
- possible infection causes (2)
- prognosis, hepatocellular carcinoma risk? hepatitis? cirrhosis?

- oral/fecal

- raw/cooked shellfish, contaminated water

- good prognosis, no risk for HCC, hepatitis, cirrhosis


Q 21. What is classic triads of meningitis? One more symptom in addition to this triads?

- classic triads: headache, altered mental status, nuchal rigidity

- photophobia may also present


Q 22. Histologic findings: cardiogenic acute pulmonary edema vs. cardiogenic chronic pulmonary edema

- cardiogenic acute pulmonary edema: blood backing up -> transduate infiltration into alveoli due to increased hydrostatic pressure

- cardiogenic chronic pulmonary edema: hemosiderin laiden macrophage (heart failure cells)


Q 23. Silicosis
- occupations (3)
- increased risk for what? pathophysiology
- which lobe is affected

- mine, sandblasting, foundries

- TB, silica disrupts macrophage's lysosome -> engulfed TB can escape from macrophage ->TB infection

- upper (every other occupational lung disease affects upper lobe, except abestosis)


- occupations (3)
- increased risk for what (2)?
- characteristic CT finding
- which lobe is affected

- roof, shipbuilding, plumbing

- bronchogenic carcinoma > mesothelioma

- calcified pleural plaques

- lower lobe (opposite to roof)


Q 26. Describe how celecoxib is different from other NSAIDs
- primary target (not cox2, downstream products)
- advantage over other NSAIDs
- side effects (2)

- prostacyclin

- no mucosal bleeding (PGE intact), no bleeding (TXA2 intact)

- side effects:
1. thrombosis -> cardiovascular disease (inhibition of prostacyclin, which inhibits platelet aggregation)

2. sulfa alleargy


Q 28. How OCP affects each level of thyroid hormone: explain physiology

- total T3/T4
- free T3/T4

- total T3/T4: increased as estrogen induces TBG (thyroxine binding globulin) synthesis

- free T3/T4: stay same= EUTHYROID
(T3/T4 synthesis actually increased in response to increased TBG, but they become saturated to TBG, so free T3/T4 level stay same)

- TSH: stay same (as free T3/T4 is not changed)


Q 31. Nitrate vs. Nitrite: these two are totally different! explain each for
- mechanism of action
- indication

- nitrate: venous dilation, angina & HF

- nitrite: methamoglobin synthesis by oxidizing ferrous (Fe2+) to Ferric (Fe3+)
oxidized hemoglobin has stronger affinity to cyanide. Thus nitrite can be used to treat cyanide poisoning by sequestering tissue deposited cyanide to methamoglobin


Q 31. What exactly is PaO2 (partial pressure of oxygen) ?

amount of oxygen dissolved in plasma
not related to hemoglobin


Q 31. What is oxygen content in the blood?

O2 carried by hemoglobin + O2 dissolved in plasma
= 1.34 * Hb* SaO2 + 0.003* PaO2


Q 32. What are three functions of osteocytes?

- structural support of bone

- short term Ca2+ storage/ Ca2+ release

- stress sensor-> modulate osteoblast activity in response to mechanical stress


Q 32. through what connection do osteocytes communicate each other?

gap junction


Describe how estrogen helps osteoporosis (FA. 314)

estrogen -> synthesis of OPG (osteoprotegerin): RANK-L decoy receptor -> inhibits osteoclast activation by RANK-L


Q 33. Gas analgestics: what does partial pressure change in a given time tell about
- solubility
- potency
- onset

The faster partial pressure of gas increases with a given time, the faster gas becomes saturated. meaning

- less solubility: dissolved gas will not give partial pressure!
- faster onset
- nothing about potency: potency is only inversely depend on MAC (minimum alveolar concentration), which is dependent on lipophilicity


Q 34. parotitis: what enzyme is expected to be elevated? what infections are possible?

- amylase

- staph aureus, mumps virus


Q 35. Which two tests are used for diagnosis for chronic granulomatous disease? what are positive results?

- nitroblue tetrazolium testing: no blue inclusion

- dihydrorhodamine (DHR): decreased green fluorescence


Q 36. spirometry: what would be the hall mark for restrictive physiology

significant decrease in FVC
( due to small lung size)


spirometry: obstructive vs. restrictive
- FEV1
- RV

-FEV1: significant decrease
-FVC: decrease
-FEV1/FVC: decrease (<80)
-RV: increase
-TLC: increase

- FEV1: decrease (less inhaled gas)
- FVC: significant decrease
- FEV1/FVC: normal
- RV: decrease
- TLC: decrease

FEV1 & FVC: decrease in BOTH


Q 38. Which type of knee injury happens from following activities
- kneeling
- running

- kneeling: prepatella bursitis

- running: suprapatella bursitis


Q 39. location of headaches
- migraine
- cluster
- tension

- migraine: unilateral

- cluster: periorbital

- tension: bilateral, band squeezing head


Q 40. pathophysiology of analgestic nephropathy

analgestic -> accumulation in renal medulla -> using up glutathione depletion -> lipid peroxidation -> chronic interstitial nephritis -> ischemic papillary necrosis