3/5 UWORLD test #33 Flashcards Preview

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Flashcards in 3/5 UWORLD test #33 Deck (57):
1

Q 1. How does inflammatory acne form?

overproduction of keratin & sebum
-> blocks follicles (forming comedones)
-> propionibacterium acnes infection
-> bacteria produces lipase that breaks down TG in sebum
-> acne

2

Q 1. Definition and example of each
- apocrine
- merocrine
- holocrine

- aporcine: vesicle mediated release
ex) mammary gland (remember apocrine metaplasia that does not progress to cancer?)

- merocrine: exocytosis mediated release
ex) eccrine/apocrine sweat gland, salivary gland

- holocrine: lysis and release of cytoplasmic contents
ex) sebaccus gland (thus acne is example of holocrine)

* all of these are exocrine system: release via duct

3

Q 2. common infection source of osteomyleitis
- children
- sickle cell (2)
- pott disease

- children: S. aureus

- sickle cell: S.aureus, Salmonella

- pott disease: Mycobacteria

4

Q 2. Moraxella catarrhalis: associated disease? (3)
* This bug is not covered in sketchy/FA

otitis media
sinusitis
exacerbation of COPD

5

Q 3. How to calculate median?

sum two middle values/2
data set should be in even number

ex: 1,2,3,4,5,6
-> median: (3+4)/2=3.5

6

Q 4. Which viral encoded protein is the major determinant for viral tropism on specific host tissue?

surface glycoprotein

viral surface glycoprotein attaches to corresponding receptors on host cell membrane: the very initial step.

This makes sense as orthomyxovirus major antigenic variation is on hemagluttin (surface gylcoprotein)- shift/drift

7

Q 6. epigenetics: histone acetylation vs. histone deacetylation? What each does for txn?

- acetylation: txn activation

- deacetylation: txn deactivation

8

Q 6. Huntington disease
- which gene is mutated? what chromosome? how?
- nature of mutation: gain of function or loss of function?

- huntingtin protein, chromosome 4, multiple CAG repeats

- gain of function, mutated hungtingtin protein promotes histone deacetylation, causing transcriptional repression of many other genes

9

Q 7. histologic finding in glioblastoma multiforme? what about macroscopic finding?

- mcroscopic finding: butterfly lesion that crosses corpus callosum

- histologic finding: pseudopallisading necrosis ( cells lining up around necrosis) & angiogensis

10

Q 7. glioblastoma multiforme is tumor of what neuronal cell origin? what is kid's brain tumor that has equivalent cell origin? What stain can be used for this cell origin?

- astrocyte

- kids: pilocytic astrocytoma

- both are GFAP positive

11

Q 7. What is prognosis for glioblastoma multiforme?

very bad. it progresses rapidly. Pt usually die within 2 years after diagnosis

12

Q 8. Tetanus vaccine
- what is it?
- what immune response is triggered?

- tetanus toxoid: formaldehyde inactivated tetanus toxin

- humoral response: antibody

13

Q 9. Lactase degrades lactose to what two sugars?

- glucose
- galactose

14

Q 9. galactose metabolism disorder: galactose kinase deficiency vs. classic galactosemia
- compare phenotypes

Galactose kinase deficiency
- cataracts
- failure to track objects/ social smile

Classic Galactosemia
- hepatomegaly
- jaundice
- intellectual instability
- also cataracts

*LIVER manifestations are only for CLASSIC GALATOSEMIA

15

Q 10. Ethics: What are four exceptions for protecting patient's confidentiality?

- harming oneself/ another that may happen in the future again

- child or elder abuse

- knife or gunshot wounds

- reportable communicable disease ( transmittable infectious disease such as ebola)

16

Q 12. Describe the location of AV node. Radiofrequency ablation of AV node is indicated in what heart condition?

- endocardial surface near atrial septum & coronary sinus

- Atrial fib

17

Q 12. Describe the location of SA node.

- upper anterior atrium near opening of SVC

18

Q 12. Radiofrequency ablation of which part of heart is indicated for atrial flutter?

- isthmus between IVC & tricuspid annulus

19

Q 13. What is the most effective approach to enhance adherence to medication for adolescent patient?

Finding support and role models within PEER group

20

Q 14. What determines coronary dominance? What is the most common dominance type?

- Blood that supplies PDA (posterior descending artery)

- Right dominance is about 85%

21

Q 14. SA node and AV node are supplied by what coronary artery?

Dominant artery. Either by RCA (for right dominance) or LCA (for left dominance)

22

Q 15. Nitroprusside
- MOA
- indication
- side effect

- increase cGMP by direct release of NO => balanced vasodilation of BOTH artery and vein. Very SHORT acting

- hypertensive crisis

- cyanide toxicity (also releases cyanide)

23

Q 17. pancreatic head is derived from what pancreatic bud?

- inferior/posterior head: ventral pancreatic bud

- rest of head: dorsal pancreatic bud

* Remember: ventral pancreatic bud does give rise to uncinate process, but NOT all parts of head

24

Q 17. main pancreatic duct vs. accessory pancreatic duct each is derived from what pancreatic bud?

- main pancreatic duct: ventral pancreadic bud

- accessory pancreatic duct: dorsal pancreatic bud

25

Q 19. What urine pH condition will precipitate kidney stones
- Ca oxalate
- Ca phosphate
- MAP (what is this?)
- Uric acid
- Cystine

- Ca oxalate: - (neutral)
- Ca phosphate: basic
- MAP (magnesium ammonium phosphate): basic
- uric acid: acidic
- cystine: acidic

26

Q 19. Pathophysiology of cystine kidney stone? What other amino acids will be accumulated

- mutation on transporter-> impaired reabsorption in kidney and reabsorption at gut as well

- COLA
C- cysteine
O- ornithine
L- Lysine
A- Arginine

These all share same transporter

27

Q 20. What mutation on what gene is implicated in melanoma? What does this mutation do?

BRAF V600E
increase signaling pathway in melanocyte proliferation/metastasis/survival

28

Q 22. What is co-infection mechanism of HDV? (Why HepD virus needs HepB virus to infect hepatocyte? )

HepD virus (delta virus) must be COATED by HepB surface antigen to infect hepatocytes

29

Q 21. Diazepam
- What class of drug is this?
- MOA
- indications (6)
- side effects (3)
- should be avoided with what drugs?

- BDZ

- increase frequency (vs. phenobabitol- duration) of GABA-A

- status epilepticus (1st line), alcohol withdrawal, insomnia, anxiety, analgesia, muscle relaxant ( to stop spasticity in stroke)

- sedation, mental status change-confusion/disorientation (elderly), dependence/tolerance

- Any drugs that cause same side effects
ex: Anti-histamines (first generation, sedation is less significant in second gen.)

30

Q 21. Chlorpheniramine: what class of drug is this? What other drugs (2) are in this class?

first generation anti-histamine

- Diphenhydramine, dimenhydrinate

31

Q 21. Loratadine: what class of drug is this? What other drugs (3) are in this class?

second generation anti-histamine

- fexofenadine, cetirizine, desloratadine

32

Q 22. Ranitidine
- MOA
- indication
- side effect (1)

- H2 receptor blocker -> less gastric acid secretion

- peptic ulcer disease, GERD, gastritis

- decrease renal excretion of creatinine

33

Cimetidine
- MOA
- indication
- side effects (3)

- H2 receptor blocker -> less gastric acid secretion

- peptic ulcer disease, GERD, gastiritis

- side effects
1. potent CYP450 inhibitor (DDI)
2. decrease renal excretion of creatinine (so does ranitidine)
3. anti-androgen effects (gynecomastia, impotence, decreased libido, prolactinemia)

34

Q 23. Cheyne- stroke breathing
- Describe breathing pattern?

- explain physiology

- under what medical conditions? explain physiology

- apnea followed by gradual increase then decrease tidal volume

- apnea induced hypercapnea -> hyperventilation to compensate and then hypoventilation to reduce hypocapnea

-CHF, brain trauma, stroke

w/ CHF: lack of effective ventilation (due to pulmonary conjestion) -> unbalanced hyper/hypo ventilation

w/ brain trauma/stroke: delayed pCO2 sensation in central chemoreceptor-> unbalanced hyper/hypo ventilation

35

Q 24. What are diagnostic criteria for diabetes
- Hb1AC
- fasting glucose level
- 2hr glucose tolerance

- Hb1AC >6.5

- fasting glucose >126

- 2hr glucose tolerance >200

36

Q 24. elevated free serum fatty acid vs. elevated C-peptide: which one contributes to progress of T2DM?

elevated free serum acid

Elevated free serum acid -> less need of insulin dependent glucose uptake -> insulin resistance

- elevated C-peptide is also seen in T2DM, but it is byproduct of insulin resistance (increased insulin synthesis in insulin resistance), not causation of insulin resistance

37

Q 25. What is eplerenone?

aldosterone antagonist

just like spironolactone

38

Q 27. What ECG finding is seen after beta-blocker?

PR prolongation

39

Q 28. Varicose vein
- What is gross appearance ?
- etiologies (4)?
- what is complication?

- dilated & tourtuous vein

- long standing, >50 age, multiple pregnancy, obesity

- ischemic necrosis and skin ulceration

40

Q 30. What agent decreased radioactive I uptake treatment for Graves disease? why?

Pertechneate or Perchlorate

These two agents also undergo uptake by Na+/I- cotransporter. Thus, it will reduce radioactive Iodine uptake

41

Q 30. What is additional function of propylthiouracil that methimazole doesn't have? What is the function that these two commonly have?

5'-deiodinase inhibitor

Both propylthiouracil and methimazole can block TPO (thyroid peroxidase- iodine oxidation/ organification/ coupling)

42

Q 31. What is the best therapy for febrile seizure?

supportive care only

43

Q 31. Is active cooling recommended for febrile seizure? what about antipyretics?

- active cooling is not recommended. It can precipitate seizure by inducing shivering

- antipyretics do not show efficacy in reuding seizure

44

Q 32. What do leukotrines (LTC4, LTD4, LTE4) do? Which medications target leukotrines for asthma?

-bronchoconstriction

- Monteleukast/ Zafirleukast: leukotrine receptor inhibitor

- Ziluton: Direct LOX inhibitor

45

Q 33. hemoptysis, elevated DLCO, proteinuria, hematuria. what is diagnosis?

Goodpasture

Elevated DLCO is due to accumulation of blood within alveoli. Blood will uptake CO (hemoglobin has great affinity to it)

46

Q 34. Which vitamin is precursor for NAD?

Niacin

47

Q 35. peripheral chemoreceptor vs. central chemoreceptor

- location
- senses what?

peripheral chemoreceptor
: carotid body
=> senses pO2

central chemoreceptor
: ventral surface of medulla
=> senses pCO2, pH

48

Carotid body vs. Carotid sinus
- difference
- similarity

- difference: body is chemoreceptor, sinus is pressure receptor

- similarity: they both fires glossopharyngeal nerve to solitary nucleus of medulla

49

Q 37. Blue toes, livedo reticularis after surgery. What is happening?

Thromboembolism

After surgery, cholesterol gets dislodged from big size arteries, and lodged to small size arteries.

50

Q 37. Histologic finding of hyperplastic arteriolor changes in kidney. What is diagnosis?

renal hypertension

51

Q 38. Screening marker in urinalysis for early stage diabetic nephropathy? explain pathophysiology

albumin
In diabetes, upregulation of heparanse will result in loss of negative charge barrier in GBM

52

Q 38. What is earliest morphological change in diabetic nephropathy?

GBM thickening & mesangial matrix expansion due to non-enzymatic glycosylation

53

Q 38. Which molecule in GBM is responsible for barrier for protein filtration?

heparan sulfate
: it is negatively charge. so it creates charge barrier (most protein is negatively charged)

54

Q 38. What medication slows progression of diabetic nephropathy? explain mechanism

ACEI

dilation of efferent arteriole to reduce hyperfiltration damage of glomeruli

55

Q 39. lepromatous leprosy vs. tuberculoid leprosy
- symptoms
- immune response

lepromatous
- severe presentation- diffuse/leonine face (lion face)
- mediated by Th2

tuberculoid
- less severe presentation- limited, skin plaques
- mediated by Th1

* think like this: lepromatous is more nasty one. so you need to stimulate Th2 -> antibody to handle this nasty shit

56

Q 39. What is lepromin skin test? which form of leprosy is more sensitive? why?

- injection of M leprae antigen (like PPD): positive result will show indurated nodule

- lepromin skin test is more sensitive to tuberculoid as it has stronger Th1 response.

57

Q 40. Cavernous hemangioma
- what morphological change?
- affected organs (2)
- complication?

- vascular malformation causing dilated blood vessel

- liver and brain

- blood vessel malformation leads to hemorrhage (intrehepatic, intracranial), stroke, and even seizure (due to mass effect)