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UWorld Flashcards

1
Q

Furosimide SFx

A

hypokalemia, hyperuricemia, hypovolemia

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2
Q

Methotrexate SFx

A

hepatotoxicity, pulmonary fibrosis, bone marrow suppression

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3
Q

Metoprolol SFx

A

Selective B1-andrenergic blocker, few SFx

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4
Q

Penicillin SFx

A

hypersensitivity

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5
Q

What else to screen for with Major Depressive Disorder?

A

History of bipolar disorder (rule out unipolar disorder)
MDD = SIG E CAPS
multiple episodes, over last 6-12 mo, 5/9 following
*pt w/fast onset SSRI could be clue of mania

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6
Q

Pharyngeal Arches (and pouch/clefts) -rules

A 
mesoderm forms: muscle, vascular
neuroectoderm: bone, CT
-each arch innervated by own CN
*just think about arch number and associated place on upper body, with DIT rules, should be able to get there
Arch 1 = M and T
Arch 2 = S (stapes)
Arch 3 = pharyngeus everything
Arch 4 and 6 = Cricoid, thyroid, larynx
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7
Q

Antibody structure

A

Light chain = binds the antigen at FAB (fragment ag binding region)
Carboxy end of heavy chain = (farthest from LC is where Frc region) binds the Fc R on phagocytes
LC ag binding signals phagocytosis of ag

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8
Q

Neurophysin

A

Hypothalamus transports for OTC and VPN

Gene MT could lead to Central DI because no VPN/ADH will be released

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9
Q

Rapid glomerulonephritis with crescent formation

A

macrophages and t cells enter bowmans space, dmg capillaries, BM gets gaps, fibrin deposits and fibrosis occurs

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10
Q

Infection and risk of abscess at this muscle for HIV, DM, IV drug users

A

iliopsoas muscle (primary iliopsoas muscle abscess)

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11
Q

Fragile X syndrome

A

mild intellectual disability, CGG repeat, macrocephaly, long narrow face, macroorchidism
FMR1 gene
*small gap near tip of long arm of X chromosome (cytogenetic studies)

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12
Q

Oxygen-Hb Dissociation Curve (R/L Shift)

A 
Right shift (left shift is opposite) = Hb decrease affinity for oxygen
"ACE BATs right"
Increase:
Acid
CO2
Exercise
2,3 - BPG
Altitude
Temperature
If Hb has an increased affinity for oxygen (or decrease in above), less oxygen will be released, leading to errythrocytosis (via EPO release)
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13
Q

Withdrawal Sx for: alcohol, stimulants (cocaine, amphetamines), benzodiazepines, heroin, nicotine

A

alcohol: delirium,agitation, PE: tremor, seizure
stimulants: intense psychomotor agitation with severe depression, no PE
benzodiazipines: agitation, anxiety, tremor, PE: seizure
nicotine: increased appetite, no PE
Heroin: N/V, abd pain, PE: yawning, lacrimation, dilated pupils

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14
Q

Achondroplasia - genetics/heritability

A

Sporadic MT, AD heritable, MT Fibroblast GFR3 (FGFR3),

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15
Q

Krukenberg tumor met to ovaries - describe features of this malignant CA and met statistics

A

Tumor - primary GI tumor that met to the ovaries (#1 met to ovaries is GI CA), Histo: signet ring cells with large amounts of mucin displacing the nucleus. It spread by lymphatics and seeded the peritoneum
Px - weight loss, early satiety (met), epigastric pain

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16
Q

B Cell maturation including VDJ/VJ and Isotype

A

B Cells:
1 - proliferate/mature in bone marrow (go to lymphoid organs)
-VDJ (heavy chain) / VJ (light chain) rearrangement occurs via DNA rearrangement
2 - Ag exposure/activation (some go into blood with IgM specificity ST, some go on as plasma cells, others go to follicle of LN for further maturation)
3 - Follicle: Germinal center, cortex of LN - isotype switching (IgG to.. IgA). Activated B-cell expresses CD40 and connects with CD40L CD4+, CD4+ cytokines mediate isotype switching (IL 2/4/5/6, INF-gamma)
-subsequent Ag encounters by B cell release IgG (IgA for mucin)
*negative selection is T cells in the thymus

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17
Q

Heart pressures RA, RV, PA, LA, LV, Aorta

A

RA <5, RV 25/5, PA 25/10, LA <10, LV 120/10,

Aorta 120/80

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18
Q

Bacterial endocarditis - Aortocavitary fistula - where does blood flow?

A

because Aortic P&raquo_space;»» RV P,

blood with CONTINUOUSLY flow from aorta to the RV with a fistula between them

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19
Q

Where is most water absorbed in the nephron?

A

Proximal convoluted tubule (beginning), just like everything else, the rest of nephron is for lesser adjustments (electrolytes, acid/base dumping, water reabsorbing) and concentrating the urine

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20
Q

Mullerian aplasia/vagina agenisis/MRKH syndrome

A

variable uterine development, no upper vagina, primary amenorrhea, normal development of ovaries, regular development of secondary sexual characteristics (breasts, etc.)

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21
Q

Sexual development-Mullerian vs Wolfian

A

Mullerian is default, wolfian ducts will degenerate without anything. Male - testosterone will cause mullerian ducts to degenerate and wolfian ducts to grow

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22
Q

Vaginal adenosis

A

children of mothers who took diethylstilbestrol, causes replacement of the vaginal squamous epithelium with columnar, risk for vaginal clear cell carcinoma

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23
Q

Turner Syndrome

A

45X, premature ovarian failure (=high LH and FSH)(streak ovaries), no breasts or menses. Can also have bicuspid valve or coarctation of aorta

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24
Q

Relative Risk = ?

A 
Coronary event / No Coronary Event
ACEI
No ACEI
RR = (a/(a+b)) / (c/(c+d))
can remove the equalizer that joins both groups (here the Q was patient populations with DM)
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25
Q

Failure in rotation of the midgut

A

omphacele or gastrochisis

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26
Q

Down syndrome has what abdominal abnormality?

A

uncomplicated hernia as a newborn (defect in linea alba)- failure of closure of the umbilical ring. Will likely resolve spontaneously

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27
Q

Failure of physiologic occlusion and subsequent recanalization of the midgut results in:

A

Duodenal atresia

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28
Q

Persistent processus vaginalis

A

Congenital inguinal hernia forms - processus vaginalis, an outpouching of the peritoneum, fails to obliterate, allowing a path for bowel contents to go into the inguinal canal

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29
Q

Delayed Hypersensitivity Reaction: tests, process

A

PPD test, Candida extract skin reaction, contact dermatitis, granulomatous inflamtion
-T-lypmphocyte mediated (Th1). Dendrites in skin bring to T cell –> Th1 call macrophages with INF-y. 48-72hr.

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30
Q

Transplant reactions: hyperacute, acute, chronic

A

hyperacute (min-hr) - preformed Ab in recipient
acute (less than 6 mo) - humoral, cellular response
chronic (mo-yrs) - low grade immune response, thickening and fibrosis

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31
Q

neurocysticercosis

A

T. solium

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32
Q

Gastric cell layers (top->bottom) in gastric body (5)

A

simple columnar epithelial cells - secrete mucus
upper grandular layer - parietal cells
deeper aspect of gastric glands - chief cell (pepsinogen)
muscularis mucosea - lamina from submucosa
submucosa - vascular and CT

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33
Q

Number Needed to Harm - calculation

A 
NNH = 1 / AR
AR = Event rate (tx) - Event rate (placebo)
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34
Q

Huntington Dz impact on other genes - mech of action?

A

AD, CAG repeats -> results in gain of function of the huntington gene -> causes deacetylation of histones, will silence other genes/decrease gene expression

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35
Q

Resolving hematoma - blood breakdown path

A

Heme is broken down by heme oxygenase into:
biliverdin (green), CO, ferrous iron
biliverdin broken down to yellow pigment bilirubin, transported to liver by albumin

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36
Q

cauda equine syndrome

A

S2-S5

pain low back to legs, saddle anesthesia, loss ancutaneous reflex (finger in rectum), bowel/bladder dysfunction

37
Q

Rhuem A - test

A

anti-CCP present

arginine -> citruline in pr vimentin

38
Q

Translocation Down Syndrome

A

46, XX t(14;21)

Robertson translocation - (nrm balanced) DS = unbalanced translocation - lose 2 short arms chrome

39
Q

Non-modifiable risk factors for bone fracture

A 
advanced age
female
white, Hispanic, asian
(African americans protective)
Fhx early bone fractures
40
Q

Appendix identification for appendicitis

A

teniae coli - 3 separate smooth muscle ribbons travel longitudinally outside of the colon and converge at the root of the vermiform appendix

41
Q

If have cavity from TB infection and Aspergillus settles forming an aspergilloma, what is this called?

A

colonization

NOT INVASION!

42
Q

CF - CFTR MT results in what?
sweat test
nasal transepithelial difference test

A

CF transmembrane conductance regulator
normally secretes Cl to hydrate mucus (will dec Na/water absorption by ENaC
*this is opposite in sweat glands (dec Cl secretion)
MT - will flip
Sweat test - (+) Na and Cl will be sweat out w/ Cl
Nasal transepithelial difference test - when Na presented, Na will be absorbed

43
Q

Beer’s criteria

A

what not to give to old people (look up phone pic)

44
Q

Filtration Fraction

A

= GFR/RPF
RPF = renal plasma flow clearance
GFR = use inulin or creatine clearance
RPF = use PAH (all secreted into kidney goes urine)
Clearance =
(urine conc S x urine flow rate) / plasma conc of S
= (Cr Cl / PAH Cl) x 100%

45
Q

Lung elastase - what produces it?

A

neutrophils - in alpha granules (A1 antitrypsin inhibs)
macrophages - in lysosomes (Tissue metaloprotinases inhibs-TIMPs)
-make own types, can inhibit each others
-excess elastase –> dmg and emphysema

46
Q

Salmonella Typhi

A 
watery diarrhea -> green -> become bloody (wk3)
Salmon colored spots on abdomen
fever
hepatosplenomegaly
intestinal invasion (wk 3)
47
Q

classic galactosemia

A

AR disorder
most common and severe galactosemic Ds
deficiency enzyme: galactose-1-phosphate uridyl transferase
newborns within days: Px - jaundice, vomiting, hepatomegaly

48
Q

Mycoplasma pneumoniae

A

causes anemia - cold agglutinins (IgM cross-reactivity) resolves with infection cure
(not due to return of cellular iron stores)

49
Q

Chediak-Higashi syndrome

A

immodeficiency (failure phagosomal lysosomes fusing –get abn large lysosomal inclusions), albinism, neural defects (ex: nystagmus)

50
Q

Cori Disease

A

debranching enzyme deficiency
Px: hypoglycemia, hypotonia, hepatomegaly
key feature: cytosolic accumulation of glycogen with abnormally short outer chains

51
Q

Vitelline (omphalmesenteric) duct

-connects what to what and if not obliterated during 7th week embryogenesis, what can it cause?

A

midgut lumen with yolk sac cavity
persistent VD - fistula, meconium out of umbilicus
Meckel diverticulum - #1
vitelline sinus - partially patency at umbilicus
vitelline duct cyst - connected w/ileum and abd wall
*fibrous band attaches to everything, causes issue

52
Q

cure Confounding Bias - how?

A

matching (match patient group to like age, race controls)

53
Q

homeobox / HOX genes - code for what?

A

txn factors – crainal to caudal spinal alignment

54
Q

Adenomyosis = Px?

A

=endometrial glandular tissue into uterine myometrium
pain, heavy bleeding, uniform fullness of uterus
Bx - normal endometrium appearance (secretory endometrium)

55
Q

opioids = #1 cause?

A

Most common cause of OD death (heroin or prescription)

respiratory failure, unresponsive

56
Q

sarcomere

A

electron micro
thin filaments + Z line = clear with black middle (I-band)
thick filaments = dark with M-line (A-band)

57
Q

Persistence of processus vaginalis in male - testicle descent

A

leaves opening between scrotum and the peritoneal cavity via the inguinal cavity
small opening –> hydrocele
large opening –> indirect inguinal hernia w/abd organs

58
Q

Palpable mass anterior to recturn

A

imperforate hyman - obstruction

incomplete degeneration of the fibrous tissue band connecting the walls of the vagina

59
Q

poison ivy = conctact dermatitis -how Px? what HSR?

A

Px -intensely pruritic erythematous papules, vesicles, or bullae in linear pattern (urishiol is the poison)
Type 4 HSR - T lymphocyte mediated (bc poison ivy dermatitis is a contact allergic dermatitis)

60
Q

Lupus Ab - against what?

A

Anti-smith = vs snRNPs, involved in removing introns with spliceosomes

61
Q

bacterial IgA proteases are used to mainly do what? (think N. Meningitides invasion)

A

adherence to the mucosal wall (IgA binds bacterial pili and other prs that help it adhere)
NOT MAINLY vs complement and phagocytosis

62
Q

CF patients - most common gene MT

A

CFTR 3 base pair deletion of phenylalanine at position(deltaF508) - leads to impaired post-translational processing of CFTR –> ER notices, tags for peroxisomal degradation

63
Q

Two sample T test - purpose:

A

to see if the mean of two populations are equal

  • need the 2 means, std deviation variances, and the sample sizes
  • calculate t score, derive p value
  • p value <0.05 = null hypothesis is true and both means are statistically different
64
Q

HIV patients and Candida - what WBCs are more infected? superficial vs disseminated (candidemia)

A

superficial - will occur due to low T-cell count
candidemia - will occur due to low neutrophil cout/neutropenia
*therefore -superficial candida is more common in HIV patients, but candidemia is more common in neutropenic patients

65
Q

SFx of 1st-line antipsychotic D2 blocker

A

-blockade on nigrostriatal pathway

extrapyramidal Sx -dyskinesia reactions, akathisia, parkinsonian

66
Q

Prokaryotes - DNA replication, how many polymerases, what actions?

A

3 polymerases, all with 3’-5’ proofreading activity
however, DNA polymerase I can also excise RNA primer with 5’->3’ exonuclease. used to repair damaged DNA.
ex: E. Coli

67
Q

What neurons produce these?

DA, dynorphin, E, His, NE, orexin, OTC, ADH/VPN

A

DA - VTA of substantia niagra pars compacta - midbrain
dynorphin - opioid peptide - PAG, medulla, ant horn SC
E - locus ceruleus (post rostral pons, floor 4th ventricle), arousal/RAS system
NE - E->NE conversion in adrenal medulla
His/orexin - posterior hypothal
OTC/ADH - anterior hypothalamus

68
Q

Major sites of metabolism in the cell (2) - what goes on there?

A

Mito - B oxidation FA, (TCA cycle) citric acid cycle, carboxylation of pyruvate (gluconeogenesis)
Cystol - glycolysis, FA synthesis, pentose phosphate pathway
Mixed - heme synthesis, urea cycle, gluconeogensis

69
Q

Major Depressive Ds Criteria - also ask self what question when ruling out psych Ds?

A 
great than or equal to 2 weeks
5/9 sx: SIG E CAPS
Depressed mood
Sleep disturbance
Loss of Interest (anhedonia)
Guilt with feelings of worthlessness
Energy loss and fatigue
Concentration problems
Appetite/weight changes
Psychomotor retardation or agitation
Suicidal ideation
Ask self - do they meet criteria? if they do, then they have it
70
Q

Maternal serum alpha-feto pr levels: high vs low

A

High: open neural tube defects (anencephaly, open spina bifida), ventral wall defects (gastroschisis, omephacele), multiple gestation
Low: aneuploidies (18, 21)

71
Q

Golgi tendon organ

A

Sits at jcn between muscle and tendon, sense contraction against resistance (not muscle lengthening).
If force is too great - will communicate with SC via interneurons and tell the muscle to be paralyzed to save skeletal structure

72
Q

start and stop codons

A

start : AUG

stop: UGA, UAA, UAG

73
Q

Male internal and external sex differentiation

A

Male bone XY
SRY gene will allow testicle development
From testicles get Sertoli and Leydig Cells
Sertoli secrete AMH, F regression insues
Leydig Cells produce testosterone = wolfian ducts go male, testosterone also made in (peripherally converted) DHT -> external development

74
Q

Late Alzheimer’s Disease MT

A

APO E4 (apolipoprotein) - believed to form senile plaques

75
Q

MVC head injury - cause diabetes insipidis -> how px?

A

hyperosmotic blood

  • loss of free water
  • decrease in intracellular/extracellular fluid
76
Q

Wilson Dz - which brain degeneration part?

A

putamen (lateral to globus pallidus)

77
Q

Most important factors for auto-regulation of coronary blood flow: (2)

A

NO is #1 (from arginine and oxygen - works via guanylate-cyclase)
adenosine (works small arteries)
(auto regulation by local control mostly?)
nervous system (NE via sympathetic nerves) has low input for coronary blood flow autoregulation

78
Q

Diffusion speed across a semipermeable membrane (dialysis) - how to increase or decrease?

A

increase diffusion speed: higher molecular concentrations of gradients, large membrane surface area, increased solubility of diffusing substance
decrease: increase membrane thickness, small pore size, high molecular weight, low temperatures

79
Q

Congenital association(abnormalities)- connected without known cause - mnemonic and name them

A 
VACTERL
vertebral defects
anal atresia
cardiac defects
TE fistula
renal anomalies
limb abnormalities
**
80
Q

von Hippel-Lindau syndrome - 3 Px Sx and major gene deletion

A

Px - renal cell carcinoma, hemangioblastomas, pheochromocytoma

Major gene deletion = chromosome 3 gene deletion

81
Q

Whats made in Basal nucleus of Meynert

A

Acetylcholine

82
Q

whats made in ventral tegmentum, SNpc

A

DA

83
Q

whats made in nucleus accumbens

A

GABA

84
Q

whats made in locus ceruleus

A

NE

85
Q

whats made in raphe nucleus

A

SER

86
Q

Blotting -mnemonic

A

SNoW DRoP
Southern = DNA
Northern = RNA
Western = Protein

87
Q

Read and understand the answer choices…

A

foramen ovale is in the atria… why did you pick some ventricle…

88
Q

anti-Jo-1 =?

A

anti-Jo-1 = anti-histidyl-tRNA synthase

seen in polymyositis and dermatomyositis (with rash)

89
Q 
Gential lesions - painful, not painful?
Haemophilus Ducreyi
HSV1/2
Klebsiella granulomatis
Treponema pallidum
Chlamydia trachomatis
A 
Haem d - yes
HSV1/2 - yes
Kleb - no
Treponema - no
Chlamydia trach - no

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