3/11 UWORLD -test # 36 Flashcards

1
Q

Q 2. What are two most important metabolites that mediate blood flow autoregulation? explain physiology

A

NO & adenosine

increasing blood pressure -> stretch vessel -> vasodilation by NO/ adenosine to maintain same blood flow.
If vessel doesn’t stretch, blood flow will increase.

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2
Q

Q 14. Autopsy findings (2) of erythroblastosis fetalis?

A
  • multinucleated RBC (immature RBC synthesis/release due to massive RBC destruction)
  • extramedullary hematopoiesis (hepatosplenomegaly)
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3
Q

Q 16. Anatomy: compare limited ROM in injury of deltoid vs. injury of trapezius. (hint: what nerve innervates each?)

A
  • injury of deltoid: innervated by axillary nerve (C5-T1), impaired abduction of arm BELOW horizontal line
    ( C5-T1 is located BELOW compared to spinal accessory nerve)
  • injury of trapezius: innervated by spinal accessory nerve, impaired abduction of arm ABOVE horizontal line
    ( spinal accessory nerve passes through posterior triangle of neck, above C5-T1, thus ABOVE horizontal line)
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4
Q

Q 1. Kid with no vaccination, fever, stridor, epiglottis. What infection is this?

A

H. influenzae

buzzing word: epiglottis and unvaccination

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5
Q

Q 1. What is virulence factor of H.Influenzae?

A

encapsulated bacteria
PRP (Polyribosylribitol phosphate)
PRP capsule protects bacteria from phagocytosis

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6
Q

Q 3. What is Pygmalion effect?

A

practitioner who believes in efficacy of treatment is biased

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7
Q

Q 3. What is Hawthorne effect?

A

study subjects change their behavior as a result of their awareness that they are being studied

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8
Q

Q 3. What is Berkson’s bias?

A

choosing hospitalized patients as control group is biased, they are less healthy

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9
Q

Q 7. What are three phenotypes of VIPoma?

A
  • Watery Diarrhea
  • Hypokalemia
  • Achlorhydria: low gastric acid

VIPoma is also called as WHDA syndrome

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10
Q

Q 7. What does cholecystokinin does in terms of gastric emptying?

A

inhibits gastric emptying to allow more time for gastric digestion

CCK is sort of digestation facillitator

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11
Q

Q 8. Mullerian duct

  • derivative of what type of nephric duct?
  • gives rise to what structure (3)?
  • Mullerian duct aplasia phenotype?
A
  • paramesonephric duct
  • fallopian tubes, uterus, upper 1/3 vagina
  • note: gonad (ovary) is NOT derived from it. Gonad is derived from mesothelial layer of peritoneum
  • rudimentary uterus, primary amonorrhea (no uterus!), short vagina.
  • note: ovary is intact. Thus normal sexual characteristic developments
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12
Q

Q 8. Wolffian duct

  • derivative of what type of nephric duct?
  • gives rise to what structure (4)?
A
  • mesonephric duct
- SEED
Seminal vesicle
Epididymis
Ejaculatory duct
Ductus deferan
* note: gonad (testis) is NOT derived from it. Gonad is derived from mesothelial layer of peritoneum
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13
Q

Q 8. Kallman syndrome

  • what embryological abnormality?
  • phenotypes (2)
A
  • impaired migration of GnRH cells in hypothalamus & formation of olfactory bulb
  • anosmia (impaired smell sensation)
  • low GnRH: no secondary sexual development, infertility
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14
Q

Q 8. What is phenotype of 47XXX?

A
  • tall stature
  • normal sexual development
  • slightly low IQ
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15
Q

Q 9. ethics: what is the best way to deal with patients who have low level of literacy?

A

use alternative resources (video, etc) to convey knowledge. Give a written paper will not work

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16
Q

Q 10. Is senile endocardial amyloidosis associated with valvular calcification? What pathology may amyloidosis cause?

A
  • no association with calcification

- restrictive cardiomyopathy/ HF

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17
Q

Q 10. Dystrophic calcification

  • what process is usually preceded?
  • histologic finding?
  • serum calcium level?
A
  • cell necrosis or injury happens first, then calcification
    : dystropic calcification is secondary to injury or necrosis
  • psomma bodies
  • normal serum calcium level (vs. metastatic calcification, which occurs in hypercalcemia)
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18
Q

Q 10. How does metastatic calcification differ from dystrophic calcification?

A

metastatic calcification is secondary to hypercalcemia. It happens on normal tissue

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19
Q

Q 12. What two cardiac pathology are associated with SLE?

A
  • Libman-Sacks endocarditis (thrombi both sides)

- pericarditis (serositis)

20
Q

Q 13. What is intestinal phase of gastric acid secretion? what mediator is involved? what is mechanism?

A
  • down-regulation of acid secretion as food enters duodenum

- ileum & colon release peptide YY, which inhibits histamine release from ECL cells

21
Q

Q 13. What is cephalic phase of gastric acid secretion?

A

acid secretion by cholinergic and vagal stimulation

stimulated by smell, visual, taste of food

22
Q

Q 13. What is gastric phase of gastric acid secretion?

A

acid secretion by gastrin

23
Q

Q 15. Damage to what nerve causes deltoid flattening? what injury is commonly associated with it?

A

axillary nerve damage

anterior dislocation of humerus (remember axillary nerve runs posteriorly and comes back anteriorly around humeral head)

24
Q

Q 17. Describe lung abscess in chest X-ray

A

cavitary lesion with air-fluid levels

25
Q

Q 17. Describe chest x-ray of TB

A

cavitary lesion, but NOT air-fluid levels

26
Q

Q 17. symptoms (5) of lung abscess?

A
  • copious production of foul smelling sputum (also green color)
  • fever
  • malaise
  • weight loss
  • cyanosis
27
Q

Q 17. Compare pathophysiology: pneumonia vs. penumonitis

A

pneumonia: aspiration of bacteria
pneumonitis: aspiration of gastric acid

28
Q

Q 18. phosphoribosyl pyrophosphate amidotransferase facilitates what rxn?

  • what metabolites regulate its function?
  • What disease causes increased level of PRPP amidotransferase?
A
  • synthesis of IMP
  • IMP, AMP, GMP down-regulates PRPP amidotransferase level: this makes sense because these are end products of purine salvage pathway
  • Lesch-Nyhan syndrome: lack HGPRT -> less GMP/AMP
  • > increased PRPP amidotransferase
29
Q

Q 18. 5 symptoms of Lesch-Nyhan syndrome?

A
H- Hyperuricemia
G- Gout
P- Pissed off (self-mutilation, agitated)
R- mental Retardation
T- dysTonia
30
Q

Q 19. Cefuroxime is what class of drug?

A

2nd generation cephalosporin

  • sketchy: FURious second guy. ceFURoxime
31
Q

Q 19. Chloramphenicol

  • MOA
  • indications (2)
  • side effects
A
  • ribosome 50S subunit inhibitor
  • meningitis, rocky mountain spotted fever
    : not commonly used in U.S. but used in developing countries due to low cost
  • grey baby syndrome (hypothermia, flaccidity), aplastic anemia
32
Q

Q 20. What is the most common complication of shingles?

A

Post Herpetic Neuralgia (PHN)

: pain persists for several months even after rash (dermatome distribution) is gone

33
Q

Q 22. What are two major characteristics of menigioma

A
  • cells arranged in whorled pattern (spiral wave)

- psammoma bodies

34
Q

Q 24. Subarachnoid hemorrhage

  • most common pathophysiology?
  • most common complication?
  • method to detect complication?
  • medication to prevention?
A
  • saccular aneurysm
  • vasospasm (vessels surrounding ruptured artery)
  • CT will not catch vasospasm, transcranial color doppler is required
  • nimodipine (dihydropyridine CCB)
35
Q

Q 25. Tamoxifen vs. Raloxifene

  • indications
  • side effects
A

Tamoxifen

  • indication: breast cancer
  • side effects: DVT/PE, hot flashes, endometrial cancer

Raloxifene

  • indication: postmenopausal osteoporosis
  • side effects: DVT/PE
36
Q

Q 26. What is Dandy-Walker malformation?

A
  • CYSTIC dilation of FOURTH ventricle
  • absence/hypoplasia of cerebellar vermis

non-communicating hydrocephalus

37
Q

Q 28. Erythropoietin as medication

  • indication
  • side effects (2)
A
  • anemia ( in CKD)
  • thrombosis (hyperviscosity)
  • hypertension (stimulation of EPO receptor in endothelium: exact mechanism unknown)
38
Q

Q 30. Which drug is indicated for anaphylaxis (or anaphylactic shock)?

A

epinephrine
non-specific alpha/beta agonist
alpha- vasoconstriction
beta- cardiac output increase -> reduce hypotension

39
Q

Q 30. What norephinephrine is not indicated for anaphylaxis?

A

compared to epinephrine, NE is alpha1 specific. It can reduce vasodilation effect of anaphylaxis, but may not ultimately enhance hypotension due to limited cardiac output (increased afterload)

40
Q

Q 33. What is key requirement for diagnosis of tetanus?

A

history and physical examination

  • bacterial toxin assay/ antibody test are not available
  • blood culture is not feasible due to poor bacterial growth on culture. It is toxin that causes disease
41
Q

Q 35. Hospital action for reduction of MRSA vs. MSSA (methicillin sensitive Staph. aureus)?

A

MRSA- contact precaution required

MSSA- contact precaution is not required. Hand hygiene is enough

42
Q

Q 38. What lung cancer is associated with ectopic ACTH (thus cushing)?

A

small cell lung cancer

43
Q

Q 39. In hypovolemic state, describe level change/ physiology of

  • RPF
  • GFR
  • FF
A

low blood pressure

  • > renal blood flow is limited
  • > decrease in GFR -> increase in AngII
  • > maintenance of GFR (but GFR is still reduced due to severe reduction in renal blood flow)
  • > increase in FF (GFR decrease is less significant compared to RPF)
44
Q

Q 37. Which two rxns of phenylalanine metabolism require tetrahydrobiopterin as a cofactor?

A
  • phenylalanine -> tyrosine (phenylalanine hydroxylase)
  • tyrosine -> DOPA (tyrosine hydroxylase)

These two rxns need BH4: hydroxylation

45
Q

Q 37. Deficiency of which enzyme results in reduction of BH4? what are three phenotypes?

A
  • Dihydrobiopterin reductase (BH2 -> BH4)

- hyperphenylalaniema, hyperprolactinemia (less dopamine), hypotonia (less muscular stimulation by NE, epinephrine)