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review / wrong answers > 6/21 UWorld > Flashcards

6/21 UWorld Flashcards

1
Q

What is the name and cause of damage to the superior trunk of the brachial plexus

A
  • Erb-Duchenne Palsy (“waiter’s tip”)
    • Injury to superior trunk (C5-C6)
    • Causes:
      • Lateral neck traction during delivery of babies
      • Trauma in adults
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2
Q

Muscle/functions innervated by superior gluteal m/

A
  • Innervates:
    • Hip abduction and medial rotation of thigh = tensor fasciae lata, gluteus minimus, gluteus medius
  • Lesion:
    • Posterior hip dislocation, polio
    • Leads to Trendelenburg sign:
      • Contralateral hip drops when you are standing on leg ipsilateral to lesion
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3
Q

Muscle/function innervated by inferior gluteal

A
  • Innervates:
    • Hip extension and lateral rotation of thigh à gluteus maximus
  • Lesion:
    • Posterior hip dislocation
    • Hard time getting up from sitting position
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4
Q

Damage to what nerve caused Trendelenberg gait

A

Superior gluteal (respsonsible for gluteus medius and minimus, which do hip abduction)

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5
Q

What nerve gets damaged with knee injury

A

Tibial (is located posterior to knee)

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6
Q

What nerve gets damaged with fibula neck fracture

A

Deep or superficial peroneal

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7
Q

What nerves are involved in each of the following reflexes?

  • Achilles
  • Patellar
  • Biceps/brachioradialis
  • Triceps
  • Cremasteric
  • Anal wink
A

Clinical reflexes:

  • Achilles reflex = S1, S2 (“buckle my shoe”)
  • Patellar reflex = L3, L4 (“kick the door”)
  • Biceps and brachioradialis reflexes = C5, C6 (“pick up sticks”)
  • Triceps reflex = C7, C8 (“lay them straight”)
  • Cremasteric reflex = L1, L2 (“testicles move”)
  • Anal wink reflex = S3, S4 (“winks galore”)
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8
Q

Innervation of teres minor

A

Axillary nerve

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9
Q

Defect and presentation of Atazia telangectasia

A
  • Immunodeficiency = decreased T-cells and IgA
  • Defect in ATM gene = failure to repair DNA double strand breaks = cell cycle arrest
    • THINK: the “T” in aTaxia and Telangiectasia is a dsDNA
  • Triad:
  • · Cerebellar defects – ataxia
  • · Spider angiomas – telangiectasia
  • · IgA deficiency
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10
Q

Structures formed by meso- and metanephros

A
  • Mesonephros
    • Forms temporary kidney during 1st trimester
    • Later contributes to male genital system – Wolffian ducts
    • Caudal end becomes the ureteric bud which gives risk to ureter, pelvises, calyces, collecting ducts
  • Metanephros
    • Interaction with the ureteric bud (caudal portion of mesonephros) induces differentiation and formation of glomerulus, Bowman’s space, proximal tubule, loop of Henles, and distal convoluted tubule
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11
Q

What type of drug is Chlordiazopoxide

A

Benzo

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12
Q

Histology of granulosa-theca cell tumor

A

Call-Exner bodies

Granulosa cells arranged haphazardly around collections of eosinophilic fluid, resembling primordial follicles

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13
Q

Histology of Sertoli-Leydig cell tumor

A

Reinke crystals

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14
Q

What does HELLP syndrome stand for and what is the reasoning behind the symptoms

A
  • Stands for:
    • H - Hemolysis (anemia)
    • EL - Elevated Liver enzymes (RUQ pain, jaundice)
    • LP - Low Platelets (bruising bleeding)
  • Preeclampsia + thrombotic microangiopathy
    • Hemolysis = thrombi causing schistocytes
    • Liver enzymes = lack of RBCs leads to infarction of liver tissue
    • Platelets = all used up in thrombi
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15
Q

What is Meigs syndrome

A

Triad of: ovarian fibroma, ascites, pleural effusion

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16
Q

Mutation and presentation of Williams syndrome

A

Microdeletion of long arm of chromosome 7 (deletion includes elastin gene)

“Elfin” facies, intellectual disability, hypercalcemia, well-developed verbal skills, extreme friendliess with strangers

THINK: Will Ferrel in the movie elf

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17
Q

Describe presentation of Tuberous sclerosis

A
  • Due to mutated hamartin (or tuberin) gene
    • TSC1/TSC2 mutation on chromosome 16
  • Triad:
    • Angiofibromas, mental retardation, seizures
      • Vs. VHL which is angiomatosis
  • Other symptoms: Ash-leaf spots, hamartomas of CNS and skin, angiomyolipoma
  • Incomplete penetrance and variable presentation
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18
Q

What is the equation for incidence

A
  • Incidence = number of new cases during a specific time period
    • (# of new cases) / (# of people at risk)
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19
Q

Equation for number needed to treat

A

1/ARR

NOT 1 - ARR!!

20
Q

Differentiate between case-control study and cohort study

A

Case control = compare a group with disease to group without disease and look for prior exposures/risk factors (is retrospective)

Cohort study = compare a group with risk factor to a group without risk factor and look for likelihood of disease (can be prosepective or retrospective)

21
Q

Describe difference between T-test, ANOVA, and chi-square

A
  • T-test:
    • Tests for differences between means of 2 groups with continuous variables
    • THINK: Tea is meant for 2
  • ANOVA:
    • Tests for differences between means of 3 or more groups with continuous variables
    • THINK: 3 words in “Analysis Of Variance”
  • Chi-square:
    • Checks differences between 2 or more percentages or proportions of categorical outcomes (not mean values)
    • THINK: Chi-tegorical
22
Q

Medicare vs. Medicaid

A

Medicare = elderly + those with certain conditions and end-stage disease

Medicaid = low income

23
Q

What is a Cushing ulcer

A

Gastric ulcer due to brain injury

Brain injury = increased vagal stimulation = increased ACh = increased H+ production

24
Q

What is Menetrier disease

A
  • Menetrier disease:
    • Gastric hyperplasia of mucosa cells of the stomach
      • Leads to hypertrophied rugae which look like brain gyri
    • Atrophy of parietal cells à decreased gastric acid production
    • Increased risk of gastric carcinoma
25
Q

Where is VIP produced and what is its function

A
  • Produced by smooth muscle cells in gut and parasympathetic ganglia
  • Relaxes smooth muscle and sphincters throughout the GI tract
    • Causes copious diarrhea
26
Q

Presentation of tropical sprue

A
  • Unknown cause – probably infectious
    • Looks like celiac but:
      • Affects the entire small bowel
        • Vs. Celiac which mainly affects distal duodenum and proximal jejunum
      • Responds to antibiotics
27
Q

Presentation of Whipple disease

A
  • Infection with Tropheryma whipplei
  • Symptoms:
    • Weight loss, lymphadenopathy, hyperpigmentation, cardiac symptoms, arthralgias, neurologic symptoms
  • Histology:
    • PAS (+) foamy macrophages in intestinal lamina propria
28
Q

What is boerhaave syndrome

A

Transmural, usually distal esophageal rupture

Due to violent retching

Surgical emergency

29
Q

What is the enzyme that converts glucose to sorbitol?

Sorbitol to fructose?

A

Glucose –> (aldose reductase) –> Sorbitol

Sorbitol –> (sorbitol dehydrogenase) –> Fructose

30
Q

What bug stains with aniline dye

A

Diptheria

Metachromatic granules will stain red and the rest of the cell will stain blue

31
Q

What are the possible karyotypes of a partial mole

A

69, XXX (1 X from egg and 2 X from sperm)

69, XXY (1 X from egg, 1 X from sperm, 1 Y from sperm)

69, XYY (1 X from egg, 2 Y from sperm)

32
Q

What are the possible karyotypes of a complete mole?

A
  • Empty ovum fertilized by sperm – 46 chromosomes(90% of cases)
  • Can be fertilized by one sperm which then duplicates
    • 46, XX
      • 46, YY zygote would not survive
  • Can be fertilized by two sperm
    • 46, XX or 46, XY
33
Q

What is the drug Baclofen used fo

A

GABA-B receptor agonist

Treats spasticity secondary to both brain and spinal cord disease, including multiple sclerosis

34
Q

What is the pathogenesis of thrombotic thrombocytopenic purpura (TTP)

A

Platelets used up in pathologic formation of microthrombi in small vessels

Due to decreased ADAMTS13, enzyme that normally cleaves vWF for degradation

No vWF degradation = abnormal platelet adhesion = microthrombi

35
Q

What is the pathogenesis behind immune thrombocytopenia (ITP)

A

IgG autoantibodies to GP2b3a

Antibodies produced by plasma cells of spleen and antibody-bound platelets consumed by macrophages of spleen

36
Q

What is the defect in Bernard-Soulier syndrome

A

Defect of glycoprotein 1b

Platelet can’t bind to vWF on collagen = defect of platelet plug formation

Platelet count is only slightly low – moderate thrombocytopenia

Large platelets

37
Q

What is the defect in Glanzmann thrombasthenia

A

Genetic GP2b3a deficiency

Defect in platelet aggregation

Platelet count is normal (they aren’t being destroyed, just can’t aggregate)

38
Q

Describe drainage in pancreas divisum

A
  • Ventral and dorsal parts fail to fuse
  • Dominant dorsal duct opens into the duodenum via the major papilla and is responsible for draining the majority of the pancreas
  • Smaller ventral duct opens into the major papilla and drains the inferior/posterior head and uncinated process
39
Q

Describe the role that troponin and tropomyosin play in muscle contraction

A

Tropomysin sits in the myosin-binding sites of actin

Troponin molecules are situated alongside tropomyosin

When Ca2+ binds to troponin C, the Troponin-Ca2+ complex pulls tropomyosin away, exposing the myosin-binding site

40
Q

What bases (A, G, T, U) are present at the 5’ and 3’ splice site of the intron

A

5’ splice site = GU

3’ splice site = AG

41
Q

What disorder is asociated with decreased levels of hypocretin

A

Narcolepsy

  • Diagnostic criteria
    • Recurrent lapses into sleep or naps
      • Minimum 3x per week for 3 months
    • At least 1 of the following:
      • Cataplexy: Brief loss of muscle tone precipitated by strong emotion (e.g. laughter excitement)
      • Low CSF levels of hypocretin
      • Shortened REM sleep latency
42
Q

What is the defect and presentation of multiple myeloma

A
  • Malignant proliferation of monoclonal plasma cell within the marrow
    • Recall: Plasma cells = mature B-cells that produce immunoglobulin
  • Classic presentation:
    • Anemia – plasma cells packed in bone marrow inhibit production of other cells
    • Renal insufficiency – excessive antibodies plug up kidney and form casts
    • Back pain – plasma cells stimulate osteoclasts
    • Hypercalcemia – plasma cells stimulate osteoclasts
43
Q
A
44
Q

What disease is associated with Bcl-2 mutation?

A

Follicular lymphoma

t(14;18)

THNK: 18 y/o is when you can buy a gun and start killing people (apoptosis)

Apoptosis occurs in the follicle

45
Q

What is the MOA of Rifaximin in hepatic encephalopathy

A

Is a poorly absorbed antibiotic that will remain in the GI lumen and can eradicate ammonia producing intestinal bacteria

Used to treat hepatic encephalopathy

46
Q

An interscalane nerve block, targeting the brachial plexus and used to anesthetize the shoulder and upper arm, may also cause paralysis to what structure?

A

Diaphragm

Causes transient ipsilateral diaphragmatic paralysis in nearly all patients by anesthetizing the roots of the phrenic nerve as they pass through the interscalene sheath

This nerve block should be avoided in patients with chronic lung disease or contralateral phrenic nerve dysfunction

47
Q

Is Zollinger-Ellison syndrome more likely to cause gastric ulcers or duodenal ulcers

A

Duodenal - ZE is a tumor of pancreas or duodenum

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