UWorld Day Five

Question 1

dysphonia, dysphagia, diploplia - etiology

Answer 1

canned foods - Clostridium botilinum

Question 2

MC lab value indication of kidney function

Answer 2

creatinine - the higher the creatinine, the lower the kidney function (GFR)

Question 3

DKA urine:
pH

HCO3-

H2PO4- (from HPO4) and NH4 (from NH3)

Answer 3

(metabolic acidosis)
pH decreased - especially increased secretion in the distal tubules

HCO3 decreased - more is reabsorbed (as CO2 and H20 from H2CO3)

H2PO4 and NH4 are increased because it acts as a buffer to trap H+ in the urine so that it can be secreted

Question 4

Why is brown fat brown and what is its function?

Answer 4

Color due to increased mitochondria and intracytoplasmic fat droplets. Function as heat generators in newborns by uncoupling oxphos with the protein thermogenin.

Question 5

To test for hypothyroidism, do you test T3 and T4 or TSH?

Answer 5

TSH - the most sensitive marker

Question 6

Describe the three steps of nucleotide excision repair, like after sunburn induced T-C pyrimidine dimers.

Answer 6

1. Endonuclease nicking - removes damaged/crosslinked strand.
2. DNA polymerase replaces removed bases.
3. DNA ligase seals the gaps.

Question 7

difference between synergistic effect and permissiveness of two hormones.

Answer 7

Synergy (additive effect) - coadmin results in sum of both max effects
Permissiveness is when one hormone allows the other to have its max effect

Question 8

ACTH levels are suppressed (v. normal or elevated). What three potential causes?

Answer 8

1. Adrenal adenoma (–> negative feedback on pituitary with increased adrenal output)
2. Adrenal malignancy
3. Exogenous GC malignancy

Question 9

What does ACTH and cortisol suppression with high dose dexamethasone mean?

Answer 9

High dose dexamethasone suppression that DECREASES ACTH and CORTISOL indicates a pituitary adenoma (Cushing DISEASE - ACTH overproduction)

Question 10

Two drugs that selectively cause coronary vasodilation should not be given under

Answer 10

adenosine and dypiramidole - exacerbate coronary steal

Question 11

GFR = inulin = ___ in this transporter is blocked in the proximal tubule.

What is greater than filtered load (freely filtered and secreted into urine)

Answer 11

glucose (freely filtered, so if it can’t be taken back, then it is = to GFR)

PAH

Question 12

MC type of kidney stone (also Crohn)

Answer 12

calcium oxalate (hypocitrauria) - “x” in middle

Question 13

Kidney stone with urease + bug

Answer 13

ammonium magnesium phosphate (staghorn) - coffin lid

Question 14

rhomboid kidney stone

Answer 14

urea

Question 15

hexagon stone

Answer 15

Cysteine - “six”eine - hereditary with cysteine transporter (reabsorbing) in proximal tubule is defective

Question 16

a person presents with a tremor that gets better with alcohol. Treat tremor with?

Answer 16

this is an essential tremor. MC movemnt disorder. hereditary

treat with propanolol

Question 17

Nitroprusside toxicity is due to what? Treat?

Answer 17

cyanide (affects cytochrome c oxidase in ETC). treat with sulfer -

Question 18

Difference between low dose and high dose epinerpherine (HR, systolic, diastolic BP)

Block low dose change in ___ how?

Answer 18

both: increase HR, increase systolic BP
low dose: decreases diastolic BP (beta 2) –> Block with B2 blocker
high dose: increases diastolic BP (alpha 1)

Question 19

treat insomnia in elderly with what?

Answer 19

melatonin agonist - ramelteon (not benzo, antihistamine, or sedating antidepressant)

Question 20

drug toxicity associated with hyperkalemia and vision chagnes

Answer 20

digoxin (inhibits Na/K/ATPase

Question 21

doxazosin, prazosin, terazosin

Answer 21

alpha1 blockers