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Review / Wrong Answers > 5/18 UWorld > Flashcards

5/18 UWorld Flashcards

1
Q

What is the presentation of multiple sclerosis

A
  • Charcot triad of symptoms - SIN:
    • Scanning speech
    • Intention tremor, Incontinence, Internuclear ophthalmoplegia
    • Nystagmus
  • Hemiparesis, hemisensory symptoms
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2
Q

MRI findings in multiple sclerosis

A

Periventricular plaques (areas of oligodendrocyte loss and reactive gliosis)

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3
Q

Describe the mechanism behind glucagon as a treatment for beta blocker toxicity

A

Glucagon acts on G-protein coupled receptors, increasing intracellular cAMP, and thus increasing release of intracellular calcium during muscle contraction

This increases heart rate and cardiac contractility

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4
Q

What are the 2 types of epithelium in Meckel diverticulum

A

Gastric and pancreatic

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5
Q

What are the branches of the celiac trunk

A
  • Common hepatic artery
    • Gastroduodenal artery
      • R gastroepiploic - greater curvature of stomach (anastomoses with L gastroepiploic)
      • Anterior superior pancreaticoduodenal à head of pancreas, proximal duodenum
    • Right gastric artery - lesser curvature of stomach (anastomoses with L gastric a.)
    • Proper hepatic artery
  • Splenic artery - spleen
    • Left gastroepiploic artery - greater curvature of stomach
  • Left gastric artery - lesser curvature of stomach
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6
Q

What are the actions of angiotensin II

A
  • (1) Acts on the zona glomerulosa cells of the adrenal cortex to stimulate synthesis of aldosterone
    • Aldosterone acts on principal cells of renal distal tubule and collecting duct to increase Na+ reabsorption and increase K+ and H+ excretion
  • (2) Stimulates Na+/H+ exchange in the renal proximal tubule
    • Leading to increased reabsorption of Na+ and HCO3-
  • (3) Acts on the hypothalamus
    • Increases thirst and water intake
    • Increases release of ADH
  • (4) Acts directly on arterioles to cause vasoconstriction
    • Leads to an increase in TPR à increased BP
  • (5) Constricts efferent arteriole of the glomerulus
    • Increases filtration fraction to preserve renal function (GFR) in low volume states
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7
Q

How does Hepatitis D use Hepatitis B in order to cause infection

A
  • Hepatitis D antigen must be coated with Hepatitis B surface antigen (HBsAg) in order to penetrate the hepatocyte to cause infection and multiply
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8
Q

Cause of gastric varices within the fundus

A

Portal HTN

Splenic vein thrombosis (often due to pancreatitis, pancreatic cancer, or abdominal tumors - splenic vein runs posterior to pancreas)

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9
Q

Describe the relationship between Creatinine and GFR

A
  • When GFR is normal, relatively large decreases in GFR result in only small increases in serum creatinine
    • A person’s serum Cr can be essentially normal even after 50% loss of kidney function
  • Cr levels begin to rise significantly as the GFR declines to <60%
    • As the GFR continues to decline, the slope of the Cr curve steepens
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10
Q

What is the formula for filtration fraction?

A

FF = RPF/GFR

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11
Q

Describe the adenoma-to-carcinoma sequence of colorectal cancer

A
  • Normal colon
    • APC (adenomatous polyposis coli) gene mutation
  • Colon at risk for polyps
    • KRAS mutation
  • Development of polyps/adenoma
    • p53 mutation (loss of tumor suppressor) + increased expression of COX
  • Progression to carcinoma
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12
Q

Describe Displacement vs. Projection

A
  • Displacement
    • Transferring avoided feeling or ideas to a neutral person
    • E.g. Father yells at child because his boss yelled at him
  • Projection
    • Attributing unacceptable internal impulses to an external source
    • E.g. Accusing wife of cheating because of your desire to cheat
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13
Q

Describe Isolation (psych)

A
  • Separating feelings from ideas and events
  • E.g. Describing murder in detail without an emotional response
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14
Q

What is reaction formation

A
  • Unconsciously replacing warded-off feelings by emphasis on its opposite
  • E.g. Really sexual person become a monk
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15
Q

Describe sublimation (psych)

A
  • Consciously replacing an unacceptable wish with a similar but acceptable course of action
  • E.g. Redirection of aggression towards father into sports
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16
Q

What drugs can be used for nocturnal enuresis?

A
  • Imipramine:
    • TCA
    • Decreases Non-REM N3
    • Short-term treatment
  • Desmopressin
    • Decreases urination
  • Indomethacin:
    • Decreases renal blood flow, thus decreasing urine formation
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17
Q

What is the cavernous sinus and what does it contain?

A
  • Collection of venous sinuses on either side of pituitary
  • Contains CNs III, IV, V1, VI, and occasionally V2, + internal carotid
  • Cavernous sinus syndrome:
    • Can be due to pituitary tumor, infection
    • Presentation:
      • Ophthalmoplegia (CN II, IV, VI)
      • Decreased corneal sensation (CN V1)
      • Horner syndrome
      • Decreased maxillary sensation (CN V)
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18
Q

Describe each stage of the sleep cycle

A
  • Sleep stages:
    • To remember EEG waves THINK: BATS Dream Big
  • Awake (eyes open)
    • Beta waves
  • Awake (eyes closed)
    • Alpha waves
    • Meditating
  • Non-REM N1
    • Theta waves
    • Light sleep
  • Non-REM N2
    • Sleep spindles and K complexes
    • Bruxism (teeth grinding)
  • Non-REM N3
    • Delta waves (lowest frequency)
    • Deepest sleep
    • Sleep-walking, night terrors, bed wetting
  • REM sleep
    • Beta waves
    • Loss of motor tone
    • Dreaming
19
Q

Describe embryology of brain formation

A
  • (1) Prosencephalon
    • Telencephalon
      • Cerebral hemisphere
      • Lateral ventricles
    • Diencephalon
      • Thalamus, hypothalamu
      • 3rd ventricle
  • (2) Mesencephalon
    • Midbrain
      • Aqueduct
  • (3) Rhombencephalon
    • Metencephalon
      • Pons, cerebellum
      • Upper 4th ventricle
    • Myelencephalon
      • Medulla
      • Lower 4th ventricle
20
Q

Supraoptic nucleus of the hypothalamus

A

Produces ADH to be stored in posterior pituitary

THINK: Eyeball cup filled with water

21
Q

Paraventricular nucleus of the hypothalamus

A

Produces oxytocin to be stored in posterior pituitary

THINK: near valleys filled with love and happiness

22
Q

Pre-optic area of hypothalamus

A
  • Secretes GnRH -> stimulates release of LH and FSH
  • THINK: Before you even see (pre-optic), the person for who they really are you start secreting sex hormones
23
Q

Dorsomedial nucleus of the hypothalamus

A
  • Stimulates GI
  • Stimulation = savage behavior and obesity
  • THINK: green monster on your back making you angry and eating out of jealousy
24
Q

Arcuate nucleus of the hypothalamus

A
  • Releases dopamine and GHRH
  • Regulates hunger and satiety
  • THINK: a smile is an arc so the arcuate nucleus gives you a dopey smile
25
Q

What are the 3 vagal nuclei and their functions?

A
  • Nucleus Solitarius
    • Visceral sensory information à taste, baroreceptors, gut distension
  • Nucleus Ambiguous
    • Motor innervation of pharynx, larynx, upper esophagus (e.g. swallowing, palate elevation)
  • Dorsal motor nucleus
    • Sends autonomic fibers to heart, lungs, upper GI
26
Q
A
27
Q
A
28
Q

What tumors show Rosenthal fibers?

A

Pilocytic astrocytoma

  • Rosenthal fibers – eosinophilic corkscrew fibers
  • THINK: Children’s Christmas tree star is on top of a spiral thing with tall Chris Rossman (Rosenthal) putting up the star
29
Q

What tumors show Homer Wright rosettes?

A

Medulloblastoma

  • Homer Wright rosettes (small blue cells wrap around pink areas of neuritic processes)
  • THINK: Homer Simpson has the brain of a child with an actual problem of brain cells (child tumor of neurons)
30
Q

What tumors show perivascular pseudorosettes

A

Ependymoma

31
Q

What tumor shows pseudopalisading (bordering central area of necrosis)

A
  • Glioblastoma multiforme
    • Pseudopalisading – tumor surrounding central necrosis
    • THINK: looks like a firework (central area of nothing with surrounding); firework = star (astrocyte tumor of adults)
32
Q

What is the enzyme that catalyzes the formation of ribose sugars in the HMP shunt

A

Transketolase

33
Q

What is the predominant inflammatory cell in gout

A

Neutrophils

34
Q

Treatment for pyruvate dehydrogenase deficiency

A

Ketogenic diet (high fat, low carb diet with moderate levels of protein)

This forces the production of ketone bodies to fuel the body in place of glucose, so less pyruvate is generated via glycolysis

Lysine and leucine are exclusively ketogenic aminao acids and cannot be metabolized to pyruvate

35
Q

Describe the defect and effect of conduction aphasia

A

Conduction aphasia - damage to arcuate fasciculus (connection between Broca’s and Wernicke’s area)

Broca’s and Wernicke’s are intact (speech and comprehension are intact), but no connection between what you hear and what you say (repitition is impaired)

36
Q

Describe the defect and effect of global aphasia

A

Global aphasia - Broca and Wernicke area affected

Influent speech and impaired comprehension

37
Q

Lesion to what part of the brain gives you expressive dysprosody?

A

Non-dominant Broca’s area

38
Q

Effect of lesion to the dominant parietal cortex

A

Gerstmann syndrome

agraphia (inability to write), acalculia (inability to calculate), finger agnosia (inability to distinguish fingers), left-right disorientation

39
Q

What are the 3 C’s to remember about toxicity of TCA’s?

A

Cardiac, coma (anti-H1), convulsions (anti-GABA)

40
Q

Describe the mental/psychological changes in delirium vs. dementia

A

Delirium - Disorganized thoughts, delusions, hallucinations, sleep disturbance

Dementia - Cognitive decline, with minimal psychotic symptoms

41
Q

Compare Parkinson’s to Lewy body dementia

A
  • Lewy body:Early onset dementia + Lewy bodies
    • Vs. Parkinson’s which has late onset dementia + Lewy bodies
  • Lewy bodies within the cortex (aggregates of a-synuclein)
    • Vs. Parkinson’s which affects the substantia nigra
  • Characterized by dementia and visual hallucinations, followed by Parkinsonian features
42
Q

Presentation of Creutzfeldt Jacob disease

A

Rapidly progressive dementia + ataxia + startle myoclonus

43
Q

Cause of and presentation of homocystinuria

A
  • Causes:
    • o Cystathionine synthase deficiency
    • o Decreased affinity of cystathionine synthase for B6
    • o Methionine synthase deficiency
  • Presentation:
    • o Homocysteine in urine
    • o Marfanoid habitus
    • o Ocular changes (downward and inward lens subluxation – vs. Marfan which is upward)
    • o CV effects
      • Homocysteine is prothrombotic, which may lead to premature acute coronary syndrome
    • o Kyphosis
    • o Intellectual disability
44
Q

Deficiency and presentation of Phenylketonuria

A
  • Due to:
    • Deficiency in phenylalanine hydroxylase, or
    • Deficiency in tetrahydrobiopterin cofactor (BH4)
      • BH4 is also a cofactor used for serotonin synthesis
  • Tyrosine becomes an essential amino acid
  • Presentation:
    • Intellectual disability
    • Growth retardation
    • Seizures
    • Fair skin - inability to make melanin
    • Eczema
    • Must body odo

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