uworld assessment block#1 4.15 Flashcards Preview

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Flashcards in uworld assessment block#1 4.15 Deck (65):
1

definition of ARDS. 1st step & pathogenesis

acute onset lung dysfunction, pulmonary edema, normal left atrial pressure, PaO2/FiO2 noncardiogenic pulmonary edema

CAUSED by injury to ENDOTHELIAL cell lining pulmonary capillaries adjacent to alveoli --> leak fluid into alveoli --> (diffuse alveolar damage) --> hyaline membrane formation --> diffusion barrier, etc.

damage to type II pneumocytes --> fibrosis.

2

conducitivty of AP in heart.

slowest conduction velocity --> AV node. fastest --> purkinje system.

atrial muscle conductivity faster than ventricular

slowest to fastest:

AV node, ventricles, atria, purkinje

3

pathognomonic radiograph sign of avascular necrosis

crescent sign: subchondral collapse

4

radiographic signs of osteosarcoma

destruction of normal trabecular bone pattern, mixed radiodense and radiolucent areas, periosteal new born formation, lifting off cortex, Codman's triangle. adjacent soft tissue --> ossification --> sunburst

5

radiographic signs of osteoarthritis

osteophytes and joint space narrowing

6

4 bony diseases that result from advanced chronic renal failure

(1) hyperparathyroid bone disease (2) osteomalacia (3) mixed uremic osteodystrophy (4) aplastic bone

7

paget's disease is associated w/ what other bone problem

osteosarcoma

8

globus hystericus

globus sensation, or "lump in throat" w/o accompanying physical, endoscopic, or radiologic findings of esophageal obstruction.

common (45% of population)
most -- intermittent, some persistent.

often triggered by emotion (fear, tension, anger, mental anguish)

associated w/ organic & functional disorders: GERD, upper esophageal sphincter abnormalities, achalasia, psychiatric disorder, stress

9

esophageal webs

fragile mucosal folds, cause solid food dysphagia.

10

pseudobulbar paresis

caused by conditions like MS.

dysarthria, dysphagia, dysphonia, and impaired movt of tongue and fascial muscles

11

plummer vinison triad

esophageal webs, atrophic glossitis, iron deficiency anemia

12

zenker diverticulum

false diverticulum. outpouching of pharyngeal mucosa thru acquired defect in muscular wall.

dysphagia, obstruction, halitosis

13

common sites of endometriosis (decreasing frequency)

ovaries, cul-de-sac, posterior broad ligaments, uterosacral ligaments, uterus, fallopian tubes, sigmoid colon, appendix, round ligaments

14

adenomyosis

endometrial tissue and stroma within uterine myometrium

15

pyosalpinx

distension of fallopian tube with purulent discharge

16

what supplement must be avoided in pregnancy

vitamin A! normally found in leafy vegetables, liver, kidney, egg yolk, butter, accumulates in stellate cells of liver.

excessive vitamin A (usu through supplements) is HIGHLY teratogenic. esp in first trimester. cleft calate, microcephaly, cardiac anomalies, early epiphyseal closure, growth retardation, spontaneous abortion

17

oseltamivir

sialic acid analogue, inhibits neuroaminidase.

neuroaminodase needed to cleave terminal sialic acid residues on hemaglutinin (so hemagglutinin can attach to cells and respiratory tract mucins)

block prevents release of viron particles

18

formation of 180 bp fragments of DNA

DNA laddering: sensitive marker of APOPTOSIS. karyorrhexis:

specific endonucleases cleave DNA at internucleosomal linker regions.

helps distinguish from necrotic tissue

19

dicyclomine, hyoscyamine

antispasmodics

20

drugs w/ common anticholinergic effects

(1) antihistamines (2) antipsychotics (3) antispasmodics (4) TCAs

21

methyphenidate, dextroamphetamine, methamphetamine, phentermine

all increase catecholamines at synaptic cleft (block reuptake)

dextroamphetamine also increases release of catecholamines

22

mosaicism

presents of two or more genetically different cell lines within the body. somatic or germ-line (oocyte / spermatocyte) or both.

usu from a MUTATION in first stages of embryonic development.

23

when genetic mutation in multiple children but not in parents / family history?

consider germline mutation

24

important recommendation to diabetic patient

daily foot inspection (infections usu secondary to trauma in setting of preexisting lower extremity vascular and neurologic disease)

25

fish oil supplementation for...

refractory hypertriglyceridemia

26

IL-1 is chiefly produced by

mononuclear phagocytes

27

TNF-alpha is primarily made by..

activated macrophages

28

IFN-alpha chiefly made by

monocytes, macrophages, B cells and NK cells

29

what two intercellular linkages depend on cadherins

desmosomes and adherens junctions. desmosomes = intermediate filaments. adherens junction = actin.

cadherins = calcium-dependent.

intracellular: bind to intermediate proteins (catenin, plakoglobin, desmoplakin, which bind to actin/IF)
extracellular: bind toa adjacent cadherin molecule (Ca2+ dependent)

30

rosacea

first: easy flushing.
later: persistent erythema, telangiectasia, sensitivity to sunlight or insults of chemical/physical nature.

31

posterior dislocation of tibia most commonly will injury

popliteal artery

(common peroneal and tibial n also at risk, but less susceptible)

common peroneal: lateral knee injury
tibial n: penetrating trauma to popliteal fossa

32

endometritis caused by

often mixed aerobic and anerobic, but BACTEROIDES commonly isolated.

usu post-partum vaginal or cessarian

33

nummular eczema

pruitic, coin-shaped erythematous patches.

often occurs in setting of xerosis. exacerbated by use of harsh soaps, environmental toxins.

34

hormones using RTKs

insulin, EGF, PDGF, VEGF

35

interviewing techniques: facilitation? reflection?

facilitation: encourage patient to talk more about experience "tell me more"

reflection: repeat what was told. tells patient you listen, allows for clarification.

36

headache, chronic nasal discharge, atrophic nasal mucosa, thinning of nasal septum, septum perforation, oropharyngeal ulcers, osteolytic sinusitis

long-term intranasal cocaine abusers

37

allergic rhinitis vs. hay fever vs. vasomotor rhinitis

allergic rhinitis: sneezing, rhinorrhea, nasal congestion, post-nasal drip, pruitis of eyes, nose, palate.

hay fever -- seasonal form of allergic rhinitis, provoked by pollen

vasomotor rhinitis -- chronic nasal congestion, worsens w/ abrupt changes in temperature or humidity, or exposure w/ odors or alcohol

38

GFR immediately after nephrectomy? 6 wks later?

immediately after: 50% GFR.
6-wks later: 80%
(hemodynamic & structural adaptations: single nephron GFR rises)

hyperfiltration and hypertrophy of nephron

never 100% again.

39

sildenafil

promotes erection via relaxation of venous sinus smooth muscle within corpora cavernosa. allows for vascular congestion --> engorgment

40

amaurosis fugax

symptom of carotid disease, transient monocular blindness

41

monocular blindness (2)

amaurosis fugax or temporal arteritis

42

3 places the optic tract terminates

LGN, pretectal nucleus, superior colliculus

43

damage to long thoracic n caused by? prevents?

caused by axillary lymph node dissection.

C5-7, serratus anterior. unable to raise arm over head and protrustion (winging) of medial border of scapula when outstretched arm is pushed forward agiainst resistance

44

pec minor articulation

anterior surface of 3-5 ribs, attaches to coracoid process of scapula. medial pectoral n.

45

bicarbonate rich secretions come from which 2 tissues

(1) exocrine pancreas (2) epithelial cells of billary tract

both stimulated by secretin (S cells in duodenal mucosa)

HCO3 and Cl are inverse. K is stable.

46

salivary secretion composition

Na, Cl reabsorbed.
K and HCO3 secreted.

high flow rate: more like plasma

47

sweat composition

hypotonic NaCl. very little HCO3-

48

acute stress disorder vs. PTSD

SAME symptoms. PTSD > 4 wks

acute stress disorder: following a life-threatening traumatic event. re-experiencing, disturbed sleep, poor conventration, irritable, hypervigilance, restless. distress and impairment.

does NOT last more than 4 wks

49

schizophrenia & schizophreniform diagnosis

2 or more of: delusion, hallucination, disorganized speech/behavior, negative symptoms.

schizophreniform = 1-6 months
schizophrenia = >6 months

50

false positive formula

1-specificity x no. w/o disease

1- (of people w/o disease, number that test negative)

51

number need to treat

1/ARR (absolute risk reduction)

52

acanthomeba infection

immunosuppressed. fatal. accumulates into space-occupying lesions

53

enzyme deficiency in acute intermittent porphyria (several names for it!)

- porphobillinogen deaminase
- hydroxymethylbilane synthase (HMB synthase)
- uroporphyrinogen I synthetase

54

congenital erythropoietic porphyria

URO III synthase deficiency (cannot convert HMB to URO III).

severely mutilating: photosensitivity in infancy, erythrodontia, hemolytic anemia

55

porphyria cutanea tarda

uro decarboxylase deficiency. most common form.

cannot convert URO III --> copro III

tea-coloured urine; blistering cutaneous photosensitivity

56

hereditary coprophoryria

deficient copro oxidase III. systemic symptoms of AIP with skin findings of PCT

57

variegate porphyria

deficiency protophry oxidase. HCT with more cutaneous symptoms

58

erythropoetic protophryia

cutaneous photosensitivity in childhood

59

pedigree anticipation, difficulty swallowing w/ tongue fasiculations

X-linked bulbospinal muscular atrophy (kennedy disease)

60

genetic heterogeneity

mutations of different genes cause similar phenotype

61

reading graphs

read X axis, look at corresponding Y value!!!

62

osmotic fragility of sickle cells

decreased!

63

hereditary spherocytosis can cause..

splenomegaly, jaundice, billirubin gallstones (bc of extravascular hemolysis in spleen, increased bilirubin)

splenectomy: improves anemia, decreases hemolysis and jaundice, and reduced incidence of bilirubin gallstones.

64

3rd heart sound

rapid ventricular filling in mid diastole. sudden deceleration of blood as the elastic limits of ventricular chamber are reached.

normal in children, adults --> ventricular failure.

65

4th heart sound

forceful contraction of atria pushing blood into overfilled / stiffened ventricle