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Flashcards in uWorld 12 Deck (44):
1

what is considered sleep hygiene for treatment of insomnia

maintain regular sleep schedule, avoid naps
avoid caffeine after lunch
avoid alcohol, smoking, large meals near bedtime
adjust bedroom environment to be quiet, dark and cool
exercise regularly, but not soon before bedtime

2

what is considered stimulus control treatment of insomnia

use bed only for sleep and sex (no reading, tv, eating)
go to bed when sleepy
leave bed when unable to sleep and go to another room
fixed wake-up time, including weekends

3

what is the goal of stimulus control therapy for treating insomnia

to dissociate the bedroom from any stimulating activities that do not involve sleep (reading, tv, eating) and the fear of not sleeping

4

what is seen with a galactose-1-phosphate uridyl transferase (GALT) deficiency

most severe and most common form of galatosemia
symptoms first few days of life after initiation of breast feeding or formula
vomiting, jaundice, hepatomegaly, lethargy
cataracts (galactic build up in lens)

5

high levels of fructose-2,6-bisphosphate activates what enzyme and facilitates what

activates phosphofructosekinase-1 (PFK-1) thus facilitating conversion of:
fructose-6-phosphate → fructose-1,6-bisphosphate
this leads to progression of glycolysis

6

high levels of fructose-2,6-bisphosphate inhibits what enzyme and process

inhibits fructose-1,6-bisphosphatase thus stopping conversions of:
fructose-1,6-bisphosphate → fructose-6-phosphate and thus stopping gluconeogenesis (conversion of alanine and other gluconeogeneic substrates to glucose)

7

what enzyme increases levels of fructose-2,6-bisphosphate and how

PHOSPHOFRUCTOKINASE-2 (PFK-2)
INSULIN (↓ cAMP) activates PFK-2 leading to increased conversions of:
fructose-6-phosphate → fructose-2,6-bisphosphate

8

what enzyme decreases levels of fructose-2,6-bisphosphate

FRUCTOSE-2,6-BISPHOSPHATASE
GLUCAGON (↑ cAMP) activates fructose-2,6-bisphosphatease facilitating the conversion of:
fructose-2,6-bisphosphate → fructose-6-phosphate

9

glycogen formation is stimulated by increased levels of what

insulin and glucose-6-phosphate

10

alanine is the major amino acid responsible for transferring nitrogen to the liver for disposal. during the catabolism of proteins, amino groups are transferred to what forming what

transferred to alpha-ketoglutarate to form glutamate
glutamate is then processed in the liver to form urea, the primary disposal form of nitrogen in humans

11

what information is needed to calculate cardiac output

cardiac output = stroke volume x heart rate
using a pulmonary artery (Swan-Ganz) catheter via the FICK principle:
cardiac output = rate of O2 consumption / arteriovenous O2 content difference

12

what is the respiratory quotient

ratio of CO2 to O2 across the alveolar membrane
used to estimate the metabolic rate
normal value is typically 0.8

13

what is one of the most modifiable risk factors for falls

medication use
psychotropic drugs like antipsychotics, antidepressants, and benzos are most commonly associated with falls

canes and walkers assist in mobility but no evidence they help in falls

14

neonate with bp 70/30, pulse 128, resp 40/min
orbital hypertelorism, submucous cleft palate, bifid uvula
right ventricular hypertrophy, pulmonary stenosis w/ VSD, overriding aorta
diagnosed by fluorescent in situ hybridization
what is it?

DiGeorge syndrome
chromosome microdeletion 22q11.2
failure of NEURAL CREST MIGRATION into derivatives of THIRD and FOURTH pharyngeal POUCHES
gold standard test: FLOURESCENSE IN SITU HYBRIZATION

15

what are the signs and symptoms of DiGeorge

CATCH:
Conotruncal cardiac defects: tetralogy of Fallot, trucks arteriosus, interrupted aortic arch
Abnormal facies
Thymic hypoplasia/aplasia (T-cell deficiency)
Craniofacial deformities (cleft palate)
Hypocalcemia/Hypoparathyroidism

16

myocardial perfusion occurs mainly when
what happens to myocardial perfusion if heart rate is increased

during DIASTOLE

increased heart rate shortens time of ventricular relaxation (duration of diastole) and therefore time for maximal coronary blood flow decreased and consequently becomes the major limiting factor for coronary blood supply to the myocardium

17

what vitamin(s) are not present in enough amounts in breast milk

VITAMINS D AND K

18

if patient has progressive right hand weakness
uses screwdriver a lot at work
on exam sensation is intact on upper limbs but there is weakness on extension of the fingers and thumb in the right hand
strength is otherwise intact throughout
what nerve is fucked and where is it fucked

RADIAL NERVE (deep branch)
fucked at the SUPINATOR CANAL (b/w superficial and deep parts of supinator muscle)

19

the radial nerve provides motor innervation to what

deep branch provides motor innervation superficial does sensory
extension at all arm, wrist, and finger joints below the shoulder
forearm supination
thumb abduction in plane of palm

20

patients with damage to radial nerve during its passage through the supinator canal may be due to REPETITIVE PRONATION/SUPINATION of the forearm (using a screwdriver at work), direct trauma, or dislocation of radius
how do they present

weakness on finger and thumb extension ("FINGER DROP")
triceps brachii aan extensor capri radialis longus are typically not affected as these branches come off proximal to supinator canal
cutaneous sensory branches also preserved

21

what is Guyon's Canal and what passes through it, what does injury here cause

passage of the ULNAR NERVE b/w the hook of hamate and the pisiform bone in the fibroosseous tunnel (Guyon;s Canal)
weakness on finger abduction/adduction and clawing of the 4th and 5th digits

22

fracture of the surgical neck of the humerus is associated with injury of what never and what is seen

AXILLARY NERVE injury
weakness of DELTOID and TERES MINOR as well as loss of sensation in the lateral upper arm

23

what causes postpartum hemorrhage and what are some risk factors

failure of the uterus to contract and compress the placental site blood vessels
risk factors: prolonged labor and twin gestation
conditions lead to UTERINE ATONY characterized by a BOGGY UTERUS that cannot contract effectively after placental delivery

surgery is indicated the medical management (uterine massage, uterotonic medications) can't control bleeding
surgery: ligation of INTERNAL ILIAC ARTERIES (collateral blood supply keeps everything alive)

24

what drug is used to improve ocular symptoms in graves disease

GLUCOCORTICOIDS can decreased peripheral conversions of T4 to T3 but it is their ANTI-INFLAMMATORY EFFECTS THAT IMPROVE THE OPTHALMOPATHY

antithyroid drugs do not have a direct effect on opthalmopathy

25

what are the important steps in the workup of metabolic alkalosis

ascertaining the patient's VOLUME STATUS and checking the URINE CHLORIDE

serum sodium and serum osmolality DO NOT necessarily provide information on a patients volume status and CANNOT BE USED to reliably differentiate hypovolemia from hypervolemia

26

what are the most common causes of metabolic alkalosis

vomiting or nasogastric suctioning (loss of Cl ions in vomit, low Cl ions in urine- SALINE RESPONSIVE)
thiazide or loop diuretics (loss of Cl ions, current use = high Cl ions in urine, prior use = low Cl ions in urine- SALINE RESPONSIVE)
mineralocorticoid excess state (SALINE-UNRESPONSIVE alkalosis- cannot correct with isotonic saline)

27

what features are worrisome for spinal mets

advanced age
pain tha tis WORSE at NIGHT
persistent and progressive pain that is not relieved with position changes or analgesics
SYSTEMIC SYMPTOMS- fever, weight loss, night whats
known HISTORY OF MALIGNANCY is a strong predictor

28

thrombin time is prolonged in medications that..

directly or indirectly inhibit thrombin
not by factor Xa inhibitors (they prolong PT and PTT but not thrombin time)

29

what are the common precipitating factors for G6PD

infections
drugs- DAPSONE, antimalarials, SULFONAMIDE antibiotics
diabetic KETOACIDOSIS
favism (ingestion of fava beans)

30

scant inflammatory cells and interstitial fibrosis is seen in what type of rejection

chronic rejection

31

what is the adult derivative of the first aortic arch

part of maxillary artery

32

what is adult derivative of second aortic arch

hyoid artery
stapedial artery

33

what is the adult derivative of the 3rd aortic arch

common carotid artery
proximal internal carotid artery

34

what is the adult derivative of the 4th aortic arch

on left- aortic arch
on right- proximal right subclavian artery

35

what is the adult derivative go the 6th aortic arch

proximal pulmonary arteries
on left- DUCTUS ARTERIOSUS

36

what is more common the setting of myeloproliferative disorders: gout or pseudogout

GOUT

37

what are some causes of gout via increased urate production

idiopathic (primary gout)
myeloproliferative/lymphoproliferative disorders
tumor lysis snydrome
HGPRT deficiency

38

what is the best indicator of security in mitral valve regurgitation (holosystolic murmur heard best at the apex that RADIATES TO AXILLA)

left ventricular S3 gallop
reflects an increased rate of left ventricular filling use to a large volume of regurgitant flow re-entering the ventricle during mid diastole

39

what drugs should be avoided in patines with hypertrophic cardiomyopathy

the LV outflow tract obstruction worsens with decreased LV volume, which can be caused by reduction in cardiac preload and/or afterload

VASODILATORs: dhp calcium blockers, nitroglycerine, ACEI- decrease systemic vascular resistance, leading to decreased aftwrload and lower LV volumes
DIRUECTICS- decreased LV venous filling (preload) and also result in greater outflow obstruction

40

where is the SA node located

upper anterior right atrium at the opening of the superior vena cava along the crista terminalis

41

where is the AV node located

endocardial surface of the right atrium, near the insertion of the septal leanly of the tricuspid calve and the orifice of the coronary sinus

42

nitrates improves angina via what hemodynamic change

decreased in left ventricular volume (decreased preload)

43

what is non-typable H flue

H flu without a capsule
90% of H flu strains isolate from middle ear aspirated of children with acute otitis media are non-typable

44

what does indole positive mean and what bugs is it used to differentiate

abilriy to convert tryptophan to indole
seen in E COLI and differentiates it from ENTEROBACTER CLOACAE, another lactose fermenting gram-negative rod