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uWorld Flashies > uWorld 52 > Flashcards

uWorld 52 Flashcards

1
Q

myocardial oxygen extraction exceeds that of any other tissue or organ in the body
due to high degree of oxygen extraction, increases in myocardial oxygen demand (doing exercise) are med by what

A

nearly proportionate increase in coronary blood flow

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2
Q

the greatest difference in O2 content is between the aorta and what vessel in the body

A

coronary sinus (coronary venous blood is draining here)

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3
Q

what distinguishes coronary circulation from the rest of the body

A

heart muscle is PERFUSED during DIASTOLE

myocardial O2 extraction is very high

myocardial oxygen demeaned and coronary blood flow are tightly coupled

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4
Q

where do the PCL and ACL attache

A

PCL: ANTEROlateral surface of MEDIAL FEMORAL CODYLE and POSTERIOR part of intercondylar area of TIBIA

ACL: ANTERIOR portion of intercondylar area of TIBIA and the POSTEROmedial surface of the LATERAL FEMORAL CONDYLE

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5
Q

whats the transverse genicularr ligament do

A

attaches the medial and lateral menisci anteriorly on the proximal articular surface

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6
Q

what you see on fine needle aspiration of HASHIMOTO

A

mononuclear parenchymal infiltration (lymphocytes and plasma cells) with well-developed GERMINAL CENTERS

HURTHLE CELLS- large oxyphilic cells filled with granular cytoplasm- FOLLICULAR EPITHELIAL CELLS that have undergone MALIGNANT CHANGE

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7
Q

what is the “triangle of treatment” for thyrotoxicosis aimed at minimizing

A
  1. thyroid hormone synthesis and release
  2. peripheral conversion of T4 to the more active T3 (inhibits iodothyronine doiodinase)
  3. sympathetic outflow and/or its actions on target tissue
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8
Q

beta-blockers are effective at treating what part of thyrotoxicosis

A

peripheral conversion of T4 to the more active T3

sympathetic outflow and/or its actions on target tissue

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9
Q

what is akathisia

A

subjective restlessness with inability to sit still
days to weeks after starting antipsychotic treatment

inability to sit or stand in one position and may pace frequently or demonstrate other restless behaviors

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10
Q

in most states minors can consent to what

A 
PRENATAL CARE
diagnosis and treatment of STDs
CONTRACEPTION
DRUG or ALCOHOL REHABILITATION
emergency care
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11
Q

what do you use to treat AGITATION and PSYCHOSIS associated with DELIRIUM

A

HALOPERIDOL (and other HIGH POTENCY first generation antipsychotics)
or some second-generation antipsychotics can be used (not clozapine though)

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12
Q

what is doxepin

A

TCA

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13
Q

what is an allosteric activator of the first step of gluconeogenesis

A

ACETYL-CoA (step is done by enzyme PYRUVATE CARBOXYLASE making oxaloacetate- BIOTIN dependent and occurs in mitochondria)

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14
Q

ALKAPTONURIA is characterized by a deficiency in what conversion pathway

A

TYROINE to FUMARATE

dysfunctional HOMOGENTISATE OXIDASE (AR disorder)

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15
Q

thoracodorsal nerve innervates what

A

LATISSIMUS DORSI- should extension, adduction, and internal rotation

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16
Q

P-glycoprotein is what kind of protein

A

TRANSMEMBRANE patient that functions as an ATP-DEPENDANT efflux pump

broad specificity for HYDROPHOBIC compounds

human multi drug resistance (MDR1) gene

can reduce influx of drugs into the cytosol and increase efflux form the cytosol, thereby preventing the action of chemotherapeutic agents

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17
Q

what are the pH, bicarb, and CO2 levels in ASPRIN OVERDOSE (4-5 hours after ingestion)

A

at this point most likely mixed RESPIRATORY ALKALOSIS (direct brain stimulation- happens FIRST) and ANION GAP METABOLIC ACIDOSIS
pH is actually close to normal (7.38) b/c of mixed respiratory alkalosis and metabolic acidosis

PaCO2 is hella LOW (20) b/c respiratory alkalosis

Plasma HCO3- is hella LOW (12) b/c of metabolic acidosis

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18
Q

patients with adult-type coarctation of the aorta commonly die of what?

A

HYPERTENSION-ASSOCIATED complications:
left ventricular failure
rupture dissecting aortic aneurysm
intracranial hemorrhage

increased risk for ruptured intracranial aneurysm because of the increased incidence of congenital berry aneurysms of the circle of Willis as well as aortic arch hypertension

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19
Q

people with ASD can get what problem

A

CHRONIC PULMONARY HYPERTENSION as a result of left-to-right intracardiac shunt

eisenmenger syndrome is the late-onset reversal of the shunt due to pulmonary vascular sclerosis

closer of the ASD can prevent this

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20
Q

what is the immunochemistry seen with hydatiform moles

A

complete: p57 NEGATIVE
partial: p57 POSITIVE

21
Q

extremely high beta-hCG levels of a complete hydatifiform mole can cause what

A

HYPEREMESIS GRAVIDARUM
PRE-ECLAMPSIA
HYPERTHYROIDISM
THECA-LUTEIN CYSTS

fun facts: BUNCH OF GRAPES macroscopically and dont forget the “SNOWSTORM” appearance on ultrasound

22
Q

what is the ATTRIBUTABLE RISK PERCENT in the EXPOSED (ARPexposed)

A

important measure of the impact of a risk factor

represents the excess risk in an exposed population that can be explained by exposure to a particular risk factor

ARPexposed = 100*[(risk in exposed- risk in unexposed)/risk in exposed]

ARPexposed = 100* [RR-1)/RR]

23
Q

what is a COMPLETE ATRIOVENTRICULAR VANAL sepal defect

A

most common type of cardiac defect in patients with DOWN SYNDROME

failure of endocardial cushion fusion results in an OSTIUM PRIMUM ASD; a VSD; and a single, large COMMON AV VALVE

significant left-to-right shunting and AV valve regurgitation lead to excessive pulmonary blood flow and symptoms of HEART FAILURE

AV valve regard (HOLOCSTOLIC, heard best at APEX)
increased pulmonary venous return (MID-SYSTOLIC RUMBLE)

24
Q

what are the ADRs of nitrates

A

HEADACHES, CUTANEOUS FLUSHING, lightheadedness, HYPOTENSION, and REFLEX TACHYCARDIA

CONTRAINDICATED in hypertrophic cardiomyopathy , RV infraction , PDE inhibitors

25
Q

what is CEFEPIME

A

4th generation CEFALOSPORIN that CAN treat PSEUDOMONAS

26
Q

patients with acute viral hepatitis typically present how

A

FEVER, malaise, ANOREXIA, nausea/vomiting, RUQ pain

choestatic symptoms after a week or so: jaundice, purpuritis, DARK-COLORED URINE and echoic stools (lacks bilirubin pigment)

27
Q

what is a functional heart murmur

A

due to hemodynamic changes, in the absence of any fixed vance lesions

dilation of left ventricle in response to increased preload can result in functional mitral regurgitation, which can be eliminated by preload reduction and reduced by after load reduction

28
Q

what is the UBIQUITIN PROTEASOME PATHWAY (UPP) is essential for what

A

breakdown of intracellular proteins, both native and foreign, and helps recycle them into the amino acid building blocks

ubiquitin functions as a tag that is attached to proteins to mark them for destruction

process performed by UBIQUITIN LIGASES, enzymes that recognize specific protein substrates and catalyze ubiquitin attachment

tagged proteins are then taken up by the proteasome, where they are broken down into their constituent oligopeptides and , eventually, amino acids

29
Q

what is the role of the ubiquitin proteasome pathway (UPP) in immune response

A

related to its ability to DEGRADE FOREIGN INTRACELLULAR PROTEINS, such as viral particles

these proteins are degraded to an appropriate size, coupled to MHC CLASS I protein complex in the endoplasmic reticulum, and then presented on the cell surface for recognition by CYTOTOXIC CD8+ lymphocytes

30
Q

pericarditis 4 days after MI is due to what

A

pericardial inflammation OVERLYING the NECROTIC SEGMENT of MYOCARDIUM

fibrinous or serofibrinous

short lived and usually disappears with 1-3 days of aspiring therapy

(fun fact: dressler syndrome is weeks to months after)

31
Q

what is seen in Dressler Syndrome

A

1 week to months after MI

fever, pleuritis, leukocytosisi, pericardial friction rub, and chest radiograph evidence of new pericardial or pleural effusions

autoimmune polyserositis provoked by antigens exposed or created by infarction of the cardiac muscle

pericardium is usually DIFFUSELY INFLAMED

other serial surfaces including the lung pleura may be involved

generally responds to aspirin, NSAIDS, and/or glucocorticoids

32
Q

the infusion of glucose without thiamine in a patient with chronic thiamine deficiceny precipitates what

A

ENCEPHALOPATHY
confusion, ataxia, and ophthalmoplegia from the triad of Wernicke encephalopathy

hemorrhage into the maxillary bodies is characteristic

33
Q

what is an acer rod

A

AZUROPHILIC GRANULES found in cytoplasm of myeloblasts

stain positively for MYELOPEROXIDASE

34
Q

what is seen in FANCONI ANEMIA

A

inherited cause of aplastic anemia

present with SHORT STATURE and ABSENT THUMBS and is associated with an increased risk of malignancy (myelodysplastic syndrome, acute myeloid leukemia)

35
Q

what is myelodysplastic syndrome

A

caused by defect in stem cell maturation leading to ineffective differentiation of cell lines and, therefore, pancytopenia

bone marrow biopsy will be hyper cellular with abnormally differentiated cells (misshapen nuclei)

primarily occurs in patients over 65

36
Q

what is AXONAL REACTION

A

changes seen in neuronal body after the axon is severed

cell body shows sings of CELLULAR EDEMA

SWOLLEN and ROUNDED, with the NUCLEUS displaces to the PERIPHERY

NISSL substance becomes FINE, GRANULAR and DISPERSED throughout the cytoplasm (central chromolysis)

becomes visible 24-48 hours after the injury

maximal changes in the neuronal body occurs approximately 12 days after the injury

these changes reflect increased synthesis of protein by the cells in order to regenerate the severed axon

37
Q

what is Wallerian degeneration

A

occurs in the segment of axon that has lost connection with the cell body

represents the degeneration of axon an dymelin distal to a point of injury

fist: swelling and irregularity are noted in the distal segment of the axon

within a week the axon is destroyed and its fragments are digested by Schwann cells and macrophages

degeneration of the proximal segment extend to the closest node of Ranvier

38
Q

benzene causes what

A

aplastic anemia

39
Q

what is retinopathy of prematurity

A

use of concentrated oxygen therapy for neonatal respiratory distress syndrome may be complicated by abnormal RETINAL NEOVASCULARIZATION and is a major cause of blindness in developed nations

thought to be VEGF reuptake mediated from return to regular air after temporary local hyperoxia in the retina

40
Q

what is terbutaline

A

a beta-mimetic tocolytic drug used to delay labor and delivery by suppressing uterine contractions

use has been linked to an increased risk of neonatal intraventricalr hemorrhage, hypoglycemia, hypocalcemia, and ileus

41
Q

what are the complications of surfactant treatment

A

transient hypoxia and hypotension, blockage of an endotracheal tube, and pulmonary hemorrhage

42
Q

where do charcot-bouchard aneurysms occur

A

basal ganglia
cerebellum
thalamus
pons

intracerebral hemorrhage

progressive neurologic deficits, headaches may follow

43
Q

what is the most common cause of lobar/cortical parenchymal hemorrhage

A

cerebral amyloid angiopathy

44
Q

what is hypertensive encephalopathy

A

PROGRESSIVE headache and nausea/vomitting followed by non localizing neurologic symptoms (confusion)

patients deep intracranial hemorrhage makes hypertensive vasculopathy more likely

45
Q

what is hypoxic encephalopathy

A

caused by decrease oxygenation of the blood (due to cardiac arrest)

often present with decreased consciousness (coma or vegetative state)

46
Q

what does squatting do in mitral valve prolapse

A

makes the murmur disappear

(mid systolic click followed by late systolic murmur is MVP w/ mitral regurgitation- click is from sudden tensing of chord tendinae as they are pulled tight by leaflets)

47
Q

what is seen in the myxomatous lesions of MVP

A

proliferation of spongiosa of valve leaflets, fragmentation of elastin fibers with increase in mucopolysaccharide and type III collagen deposits

48
Q

what happens to murmur in hypertrophic cardiomyopathy when squatting

A

decreases in intensity (due to increase left ventricular volume and decreased outflow tract obstruction)

systolic murmur at cardiac apex

uWorld Flashies (62 decks)

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