U world 6/13/23

Question 1

key features of autism spectrum disorder include

Patients with milder forms of autism spectrum disorder frequently have normal language and cognitive development. Characteristic features include deficits in social communication and reciprocal social interactions, restricted interests, and behavioral rigidity that become more apparent as social and academic demands increase.

Answer 1

social communication deficits, and social interactions are restricted with repeated interests and sterotyped behavior.

trouble taking turns in coversations, fixated on sameness and interests

Question 2

frameshift mutations

Answer 2

deletion or insertion of any number of nucleotides that are not a multiple of 3- changes the reading from during protein translation

A frameshift mutation occurs with the deletion/addition of a number of bases not divisible by 3 in the coding region of a gene. Frameshift mutations alter the reading frame of the genetic code, dramatically changing the protein structure and often resulting in the formation of a premature stop codon

Question 3

intrabdominal infections/abcessess are most common caused by

Answer 3

polymicrobial and members of the normal colonic flora

Intraabdominal infections are polymicrobial, with B. fragilis and E. coli being the most prominent organisms isolated.

Question 4

what are the organisms that are apart of normal colonic flora

Answer 4

Bacteroides fragillis, Ecoli, Enterococci and Streptococci

Question 5

what gram negative rod expresses surface polysaccarhides that have been shown to favor abscess formation?

Answer 5

bacteroides fragilis

Question 6

what are the 2 phases of type IV delayed hypersensitivity

Answer 6

sensitzation phase: where cutaneous langerhan cells take up the allergen and present them to Cd4- TH1 and Cd8 cells in the lymph nodes. This results in the clonal expansion of allergen sensitive T cells (takes about 12 days)

Elicitation phase: with reexposure to the allergen the APC present the allergen to the sensitized T cells and the T cell mediated damage that causes a puritis erythema, vesicles and bullae this happes 2 days after reexposure.

Question 7

in type 1 hypersensitivty what happens

Answer 7

initally allergen stimulates TH2 induced B cell heavy chain isotype switching and production of IgE which binds to mast cells

CD40 and CD40 L bind together

reexposure: allergen binds to IGE on mast cells and vasopeptides are released leading to uticaria (minutes)

Question 8

bullous pemphigoid has autoantibodies against

epidermal and dermal seperation

Answer 8

hemidesmosomes

Question 9

pemphigus vulgaris has autoantibodies against?

Answer 9

desmosomes

acatholysis

Question 10

immune complex deposition in small cutaenous vessels causes

Answer 10

cutaneous small vessel vasculittis

Question 11

what are the symptoms of cutaneous small vessel vasulitis

Answer 11

non blanchable purpura and petechiea

caused by medications **extravasation of red blood cells due to vessel wall inflammation

Question 12

what gives blood its inital purple bluish color

Answer 12

hemoglobin containg erythrocytes

Question 13

what converts heme into billiverdin

Answer 13

heme oxygenase

Question 14

what does heme oxygenase convert heme into

Answer 14

biliverdin, carbon monoxide, ferrous iron

Question 15

what color is biliverdin

Answer 15

green

Heme oxygenase converts heme to biliverdin, a pigment that causes the greenish color to develop in bruises several days after an injury.

Question 16

billiverdin is converted to billirubin by

Answer 16

billiverdin reductase

Question 17

what color is bilirubin

Answer 17

yellow

Question 18

what is the enzyme necessary for conjugating bilirubin

Answer 18

5’ diphospho-glucuronyl transferase (UGT)

Question 19

uroporphyrinogen dercarboxylase def is see in what disease

Answer 19

prophyria cutanea tarda

Question 20

porhobillinogen deaminase def is seen in what disease

Answer 20

acute intermittent porphyria

Question 21

what is ghrelin

Answer 21

hormone produced in the stomach that responds to facting, it stimulates apetitie and promotes weight gain

Question 22

what is leptin

Answer 22

hormone produced by fat cells in response to short term food intake and long term adequecy fat stores’

it cats on the hypothalamus to decerase appetite

Question 23

what blunts leptin action to decrease appetite

Answer 23

obestity

Question 24

during fasting states leptin levels _

Answer 24

fall

Question 25

what is insulin

Answer 25

a hormone produced by the pancreatic beta cells in response to high blood glucose levels it decreases appetitie as well.

Question 26

weight los is associated with _ insulin sensitivity and _ insulin levels

Answer 26

greater lower

Question 27

caloric restriction and falling fat stores leads to what changes in weight gain hormones grhelin insulin leptin

Answer 27

with a decrease in fat stores you would see a decrease in leptin with caloric restriction aka fasting you would see an increase in ghrelin with weight loss you will see a decrease in insulin ## Footnote Ghrelin stimulates appetite and promotes weight gain. Leptin and insulin act in the CNS to decrease appetite. Caloric restriction leads to increased ghrelin levels along with decreased insulin and leptin levels, causing an increase in appetite that can make it difficult to maintain weight loss.

Question 28

lithium adverse effects

Answer 28

diabetes insipidus hypothyroidism tremor ebstein anomaly

Question 29

valproate adverse effects

Answer 29

hepatotoxicity NTD

Question 30

carbamazepine adverse effects

Answer 30

aplastic anemia, SIADH, NTD

Question 31

lamotrigene adverse effects

Answer 31

benign rash stevens johnson syndrome

Question 32

folate derivates are crucial in the synthesis of? (3)

Answer 32

nucleic acids, converting homocysteine to methionine, and generation of 1 carbon carriers

Question 33

in order for folate to be effective what form should it be in

Answer 33

reduced tetrahydrofolate form of the vitamin

Question 34

what is the RLE of folate metabolism

Answer 34

dihydrofolate reductase

Question 35

what happens if there is a thymidylate synthase def

Answer 35

dump cant be converted into dTMP so uracil is incorporated into DNA and this leads to DNA breaks and apoptosis if you supplement thymidine this will decrease the folate metabolic demand to create thymidine and prevent apoptosis of folate deficent cells (takes 5,10 metheletetrahydrofolate to dihydrofolate) ## Footnote Folate deficiency inhibits the synthesis of nucleic acids, particularly the formation of thymidine. This leads to defective DNA synthesis and increased apoptosis affecting hemopoietic cells (megaloblastic anemia). Thymidine supplementation bypasses the enzyme thymidylate synthase and can reduce erythroid cell apoptosis

Question 36

patient who is thin with brusises, gingival bleeding with normal platelets and coagulation factors have a _ def

Answer 36

vitamin C deficiency (scurvy)- insufficent intake

Question 37

is vitamin C a water soluble vitamin

Answer 37

yes it aids in collagen synthesis

Question 38

what are the symptoms of vitamin C def

Answer 38

perifollicular hyperkeratosis coiled hair poor wound healing fragility of vasculature ( gingival bleeding, ecchymoses, petichiae

Question 39

what is the most commmon cause of hyponatremia following a subarachnoid hemorrhage

Answer 39

syndrome of inapproporiate antidiuretic hormone ## Footnote hypothalamic damage after a SAH can trigger excessive secretion of ADH can cause retention of water and high concentrated urine

Question 40

ADH is normally released when and from where

Answer 40

from the hypothalamus and posterior pituitary in response to elevated serum osmolality (SALT) or decreased blood volume

Question 41

in primary polydipsia _ can lead to excessive water intake and hyponatremia with normal levels of ADH

Answer 41

defective central thirst regulation (usually a psych condition)

Question 42

in an expansive population pyramid what is going on

Answer 42

it is broad at the bottom and narrow at the top there are high birth rates and high mortality rates meaning there is a short life expectancy and the population is young and growing ( common in developing countries)

Question 43

in a stationary population pyramid what is going on

Answer 43

the graph is somewhat rectangular indicating a stable population that has declining birthrates, low mortality rates, and long life extectancies

Question 44

what is going on in a constrictive population graph

Answer 44

narrow bottom this population is shrinking and has a very low birthwat and mortality rates with long life expectancies (advanced countries)

Question 45

warfarin MOA

Answer 45

anticoagulant that inhibits the activation (carboxylation) of K dependent clotting factors (vitamin K antagonist) especially favtor VII which will then prolong PT time. (extrinsic pathway ) ## Footnote can look at INR too

Question 46

side effect of warfarin

Answer 46

bleeding (reversal with FFP or vitamin K) skin necrosis (transiet hypercoaguable state) teratogenic ## Footnote usually just bridges heparin treatment

Question 47

aPTT is used to monitor

Answer 47

heparin (intrinsic pathway_

Question 48

bleeding tume is used for the assessment of

Answer 48

platelet function

Question 49

the combination of decreased fibrinogen levels and fibrin split products like d-dimer is characteristic of

Answer 49

disseminated intravascular coagulation (DIC)

Question 50

tracheoesophageal fistula with esophageal atreas results from

Answer 50

failure or the primitive foregut to appropriately divide into seperate tracheal and esophageal structures

Question 51

symptoms of a TEF/EA in a newborn

Answer 51

polyhydraminos on ultrasound (cant swallow amniotic fluid) drooling, choking, coughing and cyanosis with feeds

Question 52

choanal atresia

Answer 52

congenital obstruction of posterior nasal passages upper airway obstruction and cyanosis with feeding cannot pass nasal gastric tube through the nares

Question 53

standard precautions

Answer 53

all patients require standard precaustions handwashing before and after patient proper disposal of instruments

Question 54

C diff infection requires what precaustions

Answer 54

contact precautions wash with soap and water gown, and non sterile gloves, private room

Question 55

what are the measures for contact precautions and what organisms call for contact precautions

Answer 55

hand hygeine nonsterile gloves gown private room MDR organsim, enteric organisms- C. diff, and scabies

Question 56

what are airborne precautions and when should you employ them

Answer 56

insolated room with negative pressure ventilation and respirator mask to avoid aerosolized particles less than 5 microns - tuberculosis, varicella

Question 57

sterile gloves and gowns are used for

Answer 57

minor procedures or surgeries

Question 58

what are the labs associated with pagets disease of bone

Answer 58

elevated alkaline phospatase normal calcium and phosphorus ## Footnote thickening of cortical and trabecular bone Paget disease of bone is characterized by excessive and disordered bone formation. It commonly affects the skull, long bones, and vertebral column. The increased formation of new bone is associated with an elevated serum alkaline phosphatase level. Radiographs shows lytic or mixed lytic-sclerotic lesions, thickening of cortical and trabecular bone, and bony deformitie

Question 59

trigeminal neuralgia

Answer 59

compression of the trigeminal nerve root as it enters the pons leading to demyelination and atrophy of the nerve - compression due to an abnormal vascular loop of the superior cerebellar artery symptoms: paroxysmal attacks of neuropathic shock like pain, unilateral, brushing teeth is a trigger, no other neurologic deficits

Question 60

dermatomyositis is a systemic autoimmune disease with proximal muscle weakness and skin features (helitrope rash, grotton papules) and perifasciular inflammation. It can occur alone or as a _

Answer 60

paraneoplastic syndrome with underlying adenocarcinoma

Question 61

outer cortex of the lymph node consits of?

Answer 61

primary and secondary lymphoid follicles and CD4+ cells (T and B cell interaction)

Question 62

paracortical zone of the lymph node contains what

Answer 62

T lymphocytes and dendritic cells

Question 63

absence of B cells leads to what structures not being formed

Answer 63

germinal centers and primary lymphoid follicles

Question 64

proximal and distal attachment of posterior cruciate ligament

Answer 64

medial femoral condyle posterior intercondylar tibia posterior drawer test*

Question 65

proximal and distal attachment of anterior cruciate ligament

Answer 65

lateral femoral condyle anterior intercodylar area of the tibia (anterior drawer test)

Question 66

proximal and distal attachement of lateral collateral ligament

Answer 66

lateral epidcondyle of the femur fibular head (resists varus force)

Question 67

proximal and distal attachment of the medial collateral ligament

Answer 67

medial epicondyle of the femur medial condyle of the tibia (resists valgus force)

Question 68

what is a common manifestation of a posterior cerebral artery stroke regarding vision

Answer 68

homonymous hemianopia ( same half of the visiual field is affected in both eyes) with macular sparing ## Footnote homonymous hemianopia ( optic radiations) The most common finding with posterior cerebral artery stroke is contralateral homonymous hemianopia. The macula is often spared because there is collateral circulation from the middle cerebral artery to the occipital pole, the area that processes central vision.

Question 69

the posterior cerebral artery supplies the

Answer 69

occipital lobe which contains the primary visual cortex

Question 70

occlusion of the central retinal artery symptoms

Answer 70

sudden painless complete loss of vision in 1 eye

Question 71

PICA injury causes lateral medullary syndrome what is this

Answer 71

pain and temperature loss in the contralteral body and ipsilateral face, ipsilateral bulbar weakness, vertigo, ataxia, and horner syndrome

Question 72

afferent pupillary defect symptoms (demylination of the optic nerve)

Answer 72

absent bilateral pupillary constriction when shining light into affected eye normal pupillary constiction of both eyes with light in the affected eye ## Footnote The optic nerve carries the afferent limb of the pupillary light reflex pathway, which activates the efferent limb bilaterally and causes both direct and consensual pupillary constriction. Unilateral optic nerve lesions (eg, demyelination due to optic neuritis) can result in impaired pupillary constriction bilaterally when light enters the eye ipsilateral to the lesion. When light enters the contralateral eye, pupillary constriction occurs normally in both eyes.

Question 73

defect in the efferent portion of the pupillary light reflec pathway carried by CN III causes

Answer 73

pupillary constriction in the eye ipsilateral to the lesion is impaired when light is shone in either eye pupillary constriction in the contralateral eye occurs normally (preserved afferent input)

Question 74

side effects of lopp diuretics (furosemide)

Answer 74

otocivity (hearing impairement, deafness, tinnitus), hypokalemia, hypomagnesiuma, and hypocalcemia

Question 75

in a leukamoid reaction due to infection there is signifigant leukocytosis: what do the neutrophils look like and what are the leukocyte alkaline phosphate levels

Answer 75

they can be mature with basophilic oval inclusions known as dohle bodies, they can be bands, and precursors keukocyte alkaline phosphate will be increased or normal (in CML they will be decreased)

Question 76

what is basophilic stippling

Answer 76

ribosomal precipatiates (blue granules) in the cytoplasm of red blood cells that are seen in lead positioning, thalassemias or alcohol use disorder

Question 77

what is a necrotic infection of the pulmonary parenchyma that has copious sputum production and caviation with air fluid level

Answer 77

lung abcess

Question 78

what are the key players in formation of a lung abcess

Answer 78

neutrophils they release cytotoxic granules from lyosomes containing myeloperoxidase to destroy the bacteria and this can cause a lung abcess to occur or liquefying necrosis

Question 79

what are the physiological changes to high altitude peripheral chemoreceptors: lungs: sympathetics: brain:

Answer 79

peripheral chemoreceptors: stimulate hyperventilation and cause respiratory alkalosis ( shift left) lungs: vasocontriction of the pulmonary vasculature which increases resistance sympathetics: increased heart rate and cardiac output brain: cerebral vasodilation to increase cerebral blood flow ## Footnote An array of physiologic responses takes place to maintain adequate O2 delivery to the tissues in the hypoxic environment at high altitude. These include hypoxic pulmonary vasoconstriction (increased pulmonary vascular resistance), increased sympathetic activity to increase cardiac output, and aldosterone suppression to reduce plasma volume.