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Flashcards in uWorld 35 Deck (49):
1

patient who was on a cruise, has pneumonia, watery diarrhea, neurologic symptoms (confusion, headache)

LESIONELLA pneumonia

look for HYPONATREMIA or elected TRANSAMINASES
only neutrophils on sputum stain

can have bradycardia and neurologic symptoms (confusion, headache)

buffered charcoal yeast extract (BYCE) used to see it because its faintly staining gram-negative baccilus that is facultatively INTRACELLULAR

2

who is at higher risk for legionella infection

immunocompromised
elderly
smokers
alcoholics
COPD patients

3

what is seen in diffuse esophageal spasm (DES)

solid/liquid DYSPHAGIA
CHEST PAIN
heartburn
food regurgitation

likely due to IMPAIRED NEUROLOGIC NEUROTRANSMISSION within the esophageal myenteric plexus

"CORKSCREW" ESOPHAGUS on barium esophagram
NON-PERISTALTIC CONTRACTIONS on esophageal manometry

4

what is eosinophilic esophagitis

atopic patients with solid food dysphagia and/or food impaction

5

what arteries supply the greater and lesser curvatures of the stomach

lesser curvature:
-left (proximal) GASTRIC: branch of celiac
-right (distal) GASTIC: branch of proper hepatic ← common hepatic ← celiac

greater curvature:
-left (proximal) GASTROEPIPLOIC: splenic ← celiac
- right (distal) GASTROEPIPLOIC: branch off gatroduodenal ← common hepatic ← celiac
-SHORT GASTRIC (proximal above splenic artery): splenic ← celiac

6

cerebellar ataxia, telangiectasis (numerous superficial blanching tests of distended capillaries on sun-exposed areas of the skin), and increased risk of sinopulmonary infections are characteristic of what

ATAXIA TELANGIECTASIA (AR disorder)

mutation in ATM gene responsible for DNA BREAK REPAIR

patients are hypersensitive to X-ray radiation that causes multiple chromosomal breaks

immunodeficiency primarily manifests as IgA deficiency and predisposes to infection of the upper and lower airways

7

heart problems, edema, hepatomegaly, neurologic problems (decreased light touch, vibration in the feet, w/ decreased knee and ankle reflexes bilaterally)
what nutrient is fucked up

THIAMINE (WET BERIBERI)

8

what is seen in infantile beriberi

2-3 months old
fulminant cardiac syndrome with cardiomegaly, tachycardia, cyanosis, dyspnea, and vomiting

9

what is seen in adult beriber

dry: symmetrical PERIPHERAL NEUROPATHY (sensory and motor impairments)

wet: addiaotin of CARDIAC INVOLVEMENT

10

what regulates bone turnover

RATIO of OPG to RANK-L

OPG (osteoprotegerin) is a decoy receptor that blocks the RANK-RANKL interaction

11

non-glucose monosaccharides enter the glycolytic pathway at different points. which non-glucose monosaccharide allows for faster metabolism and why

FRUCTOSE

it bypasses PHOSPHOFRUCTOKINASE (one of the key enzymes in regulating the rate of glycolysis)

12

how should a physician respond to disclosure of past sexual abuse

empathy and concern
clearly acknowledging the trauma can communicating willingness to discuss it when the patient is ready will help strengthen the physician-patient relationship

13

mild or brief sadness without significant interference in psychosocial function is consistent with what

NORMAL SADNESS

(need functional impairment to be adjustment disorder)

14

polycystic ovary syndrome results from increased activity of what

17alpha-hydroxylase
17,20lyase
3beta-hydroxysteroid dehydrogenase

leads to increased androgen levels (hirsutism and acne)

15

polycystic ovary syndrome puts patients at long term risk for what

ENDOMETRIAL HYPERLASIA and ADENOCARCINOMA b/c they get anovulatory cycles from excess androgen and thus DECREASED PROGESTERONE
imbalance in progesterone-estrogen fucks it up

16

what is vaginal adenosis

persistence of glandular columnar epithelium in the vagina and is a precursor for clear cell adenocarcinoma of the vagina

female offspring exposed to DES are at increased risk and may present wth vaginal discharge or vaginal cysts/fleshy colored lesions

17

course granular deposits of IgG and C3 in a "lumpy bumpy" appearance

PSGN

election dense deposits ("humps") on EPITHELIAL rise of basement membrane

18

what is DIHYDROERGOTAMINE

an ergot alkaloid commonly used to treat acute migrant headache

may induce vasospastic angina (constricts vascular smooth muscle via stimulation of alpha-adrenergic (partial agonist) and serotinergic receptors)

19

REST and NIGHTTIME angina associated with TRANSIENT ST ELEVATION

vasospastic or varient (PRINZMETAL) angina

20

how does leptin decrease food intake

decrease production of neuropeptide Y (potent appetite stimulant) in the arcuate nucleus of hypothalamus

stimulates production of POMC in arcuate nucleus- alpha-MSH made and inhibits food intake

21

what is th most common cause of spontaneous LOBAR HEMORRHAGE (particularly in patient over 60)

AMYLOID ANGIOPATHY- a consequence of beta-amyloid deposition in the walls of small- to medium-sized cerebral arteries, resulting in weakening and predisposition to rupture

hemorrhage tends to be RECURRENT and involve the OCCIPITAL (homonyms hemianopsia) and PARIETAL (contralateral hemisensory loss) LOBES

22

what is seen in hypertensive encephalopathy

PROGRESSIVE headache and nausea/vomititing followed by nonloaclaizing neurlogoic symptoms (confusion)

23

what is seen in Eulerian aplasia (aka vaginal agenesis or Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome)

VARIABLE UTERINE DEVELOPMENT and NO UPPER VAGINA (aka short vagina)

patient cannot menstruate (PRIMARY AMENORRHEA) w/ no uterus

NORAML OVARIES which secrete estrogen normally so they have NORMAL SECONDARY SEXUAL CHARACTERISTICS

24

what is kallman syndrome

decreased synthesis of GnRH in the hypothalamus (hypothalamic hypogonadism)

females: primary amenorrhea, no secondary sexual characteristics, OLFACTORY SENSORY deficit

males; OLFACTORY SENSORY DEFICIT, small phallus and testicles, no pubic hair

25

what is required for haemophilus to grow

X FACTOR (HEMATIN)

V FACOR (NAD+)

"SATELLITE" PHENOMENON: H flu will grow around the streaks of beta-hemolytic Staph Aureus because the staph secreted V FACOTR (NAD+) and facilitates realize of X FACTOR (HEMATIN) form beta-hemolysis-induced erythrocyte lysis

26

coronary dominance is determined how and what artery most commonly arises from the dominant coronary artery

deterred by the coronary artery that supplies the POSTERIOR DESCENDING ARTERY (PDA or posterior interventricular artery)
right coronary in about 70%
left circumflex in about 10%
codominant in about 20%

the AV NODAL artery most often ARISES from DOMINANT coronary artery

27

where does the AV nodal artery come from

dominant coronary artery

28

flushing, burning in the chest and shortness of breath after treating sudden onset of palpations with IV injection
what drug was it

ADENOSINE (slows AV node conditions via hyperpolarization)

DOC for paroxysmal supraventricualr tachycardia

ADRs: flushing, chest burning due to bronchospasm, hypotension, high grade AV block

DRUG USED FOR CHEMICAL STRESS TESTS

29

Graft-vs-Host disease occurs in immunocompromised following allogenic bone or lymphocytic-rich tissue (liver, non irradiated blood). what does liver involvement look liek

rise in ALP and lymphocytic infiltration and destruction of small intrahepatic bile ducts (similar to the findings seen primary biliary cirrhosis)

30

what is seen in primary biliary cholangitis (cirrhosis)

autoimmune liver disease characterized by DESTRUCTION of SMALL and MID-SIDEX INTRAHEPAIC BILE DUCTS with resulting CHOLESTASIS

FATIGUE, ITCHING, HEPATOMEGALLY

lymphocytic inflammation with destruction of intrahepatic bile ducts and necrosis and micro nodular regeneration of periportal tissues

common in middle ages women with other autoimmune disorders

ANTI-MITOCHONDRIAL antibodies, and increased ALP

31

atropine used to treat bradycardia in someone with MI can cause EYE PAIN WHY

precipitate ANGLE-CLOSURE GALUCOMA (unilateral eye pain with visual disturbances (halos))

32

what is CAPITATION

arrangement in which a payor (individual, employer, or government entity) pays a FIXED

33

what is GLOBAL PAYMENT

arrangement in which an insurer pays a provider a single payment to cover all the expenses associated with AN INCIDENT OF CARE

most commonly done of selective surgeries, in which the global payment covers the surgery as well as any pre- and post-op visits needed

34

what is a point of service plan

requires patines to have a primary care provider and obtain referrals for special consultations

allow patients to see out of network providers

35

what are the 1,2,3 most common brain tumors in children (second most common tumor in children after leukemias)

1. PILOCYTIC ASTROCYTOMA
2. medulloblastoma
3. ependymoma

36

what is a pleocytic astrocytoma

low-grade neoplasm from astrocytes

CEREBELLUM is most common location (can be seen in the hemispheres)

cystic with a tumor nodule protruding form the wall (nodule is part of active tumor0

madd with both SOLID and CYSTIC components seen on T1 image

ROSENTHAL (EOSINOPHILIC CORKSCREW) FIBERS seen microscopically

benign

37

what is seen in a medulloblastoma in a child

most common MALIGNANT childhood brain tumor

located ONLY in CEREBELLUM mc in the VERMIS

SOLID sheets of blue cells with heyperchromatic nuclei and scant cytoplasm

high malignant

headaches and cerebellar dysfunction

38

what is seen in an ependymoma

arise form ependymal lining of canticle and can obstruct CSF flow

presents with HYDROCEPHALUS

tumor cels form GLAND-LIKE STRUCTURES called "ROSETTES"

39

saddle nose and oliguria are most characteristic of what

GRNAULOMATOSIS with POLYANGITIS (WEGENER'S)
c-ANCA positive

40

what are the actions of c diff's toxins

CYTOTOXIN A; watery diarrhea
CYTOTOXIN B: colonic epithelial cell necrosis and FIBRIN deposition (COLITIS)

41

tumor made of fat, smooth muscle, and blood vessels in the kidney (bilateral and multiple)

RENAL ANGIOMYOLIPOMA (can be diagnosed via CT as a density b/c radio density of FAT is less than water)

associated with TUBEROUS SCLEROSIS (AD disorder)

bilateral renal angiomyolipomas have an 80-90% incidence of tuberous sclerosis

42

what is seen in tuberous sclerosis

SUBEPENDYMAL HAMARTOMAS and thus has SEIZURES and cognitive liability

renal ANGIOMYOLIPOMA

cardiac RHABDOMYOMA

facial ANGIOFIBROMAS

leaf-shaped patches of skin lacking pigment (ASH-LEAF PATCHES)

mitral REGURGITIATION

HAMARTOMAS: Hamatomas in CNS and skin; Angiofibromas; Mitral regurg; Ash-leaf spots; cardiac Rhabdomyoma; (Tuberous sclerosis); autosomal dOminant; Mental retardation; renal Angiomyolipoma; Seizure; Shagreen patches

↑ incidence of SUBEPENDYMAL ASTROCYTOMAS and usual fibromas

43

what is seen in Sturge-Webber

congenital, non-inherited (SOMATIC), developmental anomaly of NEURAL CREST derivatives due to ACTIVATING mutation of GNAQ gene

affects small (capillary-sized) blood vessels → PORT WINE STAIN on face (nevus flammeus CN V1/V2 distribution)

ipsilateral leptomeningeal angioma → SEIZURES/EPILEPSY

intellectual disability

episcleral hemangiona → ↑ IOP → early onset GLAUCOMA

STURGE: Stain; Tram track calcifiaciotns (opposing gyri); Unilateral; Retardation (intellectual disability); Glaucoma: GNAQ gene; Epilepsy

44

what is seen in hereditary hemorrhagic telangiectasia

telangiectasis of the skin and mucosa

recurrent EPISTAXIS and GI BLEEDING (MELENA)

AV malformations

45

what gives mycobacterium its "serpentine" appearance

presence of CORD FACTOR a VIRULENCE factor- inhibits neutrophils, damaging mitochondria, and induces relate of TNF

cord factor is a myocside (composed of mycotic acids bound to the disaccharide trehalose)

46

what are the additional complications seen in psoriasis

psoriatic arthritis

nail changes: YELLOW-BROWN discoloration, PITTING, thickening, or crumbling

inflammatory disorders of the eye: conjunctivitis, blepharitis, or UVEITIS

47

where are anal fissures typically found

POSTERIOR MIDLINE of the anal verge

SHARP pain and BRIGHT RED rectal bleeding on defecation

due to stretching of the mucosa and are characterized by longitudinal tears in the anal canal detail to dentate line

48

C1 inhibitor deficiency leads to elevated levels BRADYKININ which can cause what and how is it managed

facial swelling (no itching), life-threatening laryngeal edema, GI probe (nausea/vomiting, colicky pain, diarrhea)

management of acute attacks involves supportive care and adminitrationof C1INH concentrate and KALLIKREIN INHIBITOR

49

what causes OUTBREAKS of fulminant hepatitis in PREGNANT WOMEN

HEPATITIS E VIRUS (naked RNA virus, spread fecal oral)

INDEEEEEEA (its found in india a lot)