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Uworld > #2 > Flashcards

#2 Flashcards

1
Q

22 yo man, knife wound to his neck

  • Right sided hemiplegia
  • Loss of proprioception and vibration sensation below C8
  • On left side loss of pain and temperature below T2

Spine will reveal?

A

Right sided hemisection of the spinal cord

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2
Q

53 yo man weight loss, fatigue, anorexia
- Gastric cancer followed by total gastrectomy
Must receive lifelong administration of?

A

Water soluble vitamin

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3
Q

23 yo wo anxious, symptoms appear for no reason

  • Panic disorder
  • Received medication and feels better within an hour

MOA of drug?

A

Bonds allosterically to the GABA receptor ‘‘benzodiazepines’’ increased frequency of chloride ion channel opening

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4
Q

34 yo man history of HIV and drug use
- India ink staining of cerebrospinal fluid demonstrate spherical yeast forms with thick capsules

Site of primary infection in patient?

A

Lungs ‘‘cryptococcus neoformans’’

- Inhalation with polysaccharide antigen.

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5
Q

8 month old vomiting and watery diarrhea for past 3 days
- Dry membranes and decreased skin turgor
Sets of laboratory finding compared with pre-illness : Hematocrit - Serum albumin concentration - Serum Uric acid concentration?

A

Everything will be increased because of hypovolemia with consequent decreased in plasma volume

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6
Q

26 yo recurrent nausea and vomiting

  • Feels full after eating
  • Emesis contains particles of food
  • Upper GI endoscopy is unremarkable
  • 15 y history of Diabetes type 1

Mechanism responsible for current symptoms?

A

Dysfunction of gastric enteric neurons
‘‘Diabetic gastroparesis is an autonomic neuropathy’’
- Chronic hyperglycaemia leads to destruction of enteric neurons

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7
Q

17 yo girl irregular menses

  • increase hair growth in chest and face
  • Testosterone is high, 17-hydroxyprogesterone is high too

Enzyme reaction step is disrupted?

A

Progesterone conversion to 11-deoxycorticosterone

- 21-hydroxylase deficiency

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8
Q

6h boy feeding difficulties
- several bouts of coughing and perioral cyanosis
- Oxygen saturation 85%
Cause ?

A

Failure of primitive foregut to separate from airway

- Tracheoesophageal fistula with esophageal atresia

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9
Q

25 yo man penile lesions
- Soft, flesh colored, papillary lesions
- Topical agent acts as a toll-like receptor agonist to increase antiviral cytokine production
Medication prescribed?

A

Imiquimod, patient has HPV

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10
Q

16 yo boy focus on endurance training

- Increase in what group of large skeletal muscle components?

A

Mitochondrial content, develop type I fibers, they use oxidative phosphorylation

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11
Q 
44 yo man hypercholesterolemia
- Father died of MI at age 56
- BP is 160/100
Started on enalapril 
GFR decreases a little bit
What is affected by enalapril?
A

Efferent arterioles constriction

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12
Q

43 yo man chemo for Acute myeloid leukaemia

  • Neutrophil count of 100
  • Dense infiltrate involving the right upper lung lobe
  • Bronchoscopy grow mold

Organism responsible?

A

Aspergillus fumigatus

Invasive pulmonary aspergillosis ‘’ septet narrow hype’’ branch at 45 angle

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13
Q

56 yo man with type 2 diabetes mellitus
- Treatment with empagliflozin is initiated
Effects of treatment?

A

Reduction in glomerular hyperfiltration ‘‘SGLT2 inhibitors’’

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14
Q

42 yo man with enlarging mole
- local anesthesia is administered lidocaine mixed with epinephrine
Impact of mixing?

A

Prolonged duration of action of anesthetic agent

‘‘Epinephrine causes vasoconstriction’’

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15
Q

Patients with atrial fibrillation are compared after giving drugs at rest and with 10 minutes of moderate exercise
What drug will have an effect at rest but not during exercise?

A

Digoxin

  • Increased parasympathetic tone
  • Poorly controls ventricular rate during exercise
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16
Q

55 yo wo breast cancer undergoes mastectomy

  • ER/PR + but HER-2 negative
  • Patient started on tamoxifen, she experiences flashes that come and go

What condition is likely to experience?

A

Endometrial hyperplasia

- selective estrogen receptor modulators

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17
Q

Newborn, low set of ears, small mandible and prominent occiput

  • Clenched hands with second and fifth digits on top of the third
  • IV/VI holosystolic murmur

Chromosomal abnormality?

A

47 XX + 18

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18
Q

32 yo wo sudden left flank pain and nausea
- Pain radiates to groin

Recommendation?

A

Drink plenty of water daily ‘’ patient has nephrolithiasis’’

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19
Q

27 yo daily headaches for 3 months
- Constant Dull pressure
- History of seasonal allergies and sister has migraine headaches
Diagnosis?

A

Tension headache

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20
Q

Epidermis reveals stellar cells that contain granules with the shape of tennis racquet

Cells are referred as?

A

Langerhans cells ‘’ dendritic cells are professional antigen presenting ‘’ brubeck granules

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21
Q

5 month old boy, right sided scrotal enlargement

  • Increase when he cries or strains to pass bowel movement
  • Doesn’t feel pain
  • Fluid collection around testis

Defect can also lead to ?

A

Indirect inguinal hernia

- Failure of obliteration of the processus vaginalis - communicating hydrocele develops from fluid leakage

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22
Q 
25 yo man azoospermia
- History of recurrent pneumonia
- Digital clubbing
- Absence of vas deferens
Tests would confirm the diagnosis?
A

Chloride level in the sweat

Patient has cystic fibrosis

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23
Q

Signal transduction in type 2 diabetes mellitus
- TNF-a results in decreased insulin-mediated glucose uptake
This effect is mediated through up regulation of ?

A

Serine residue phosphorylation

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24
Q

What portion of ECG will be affected by esmolol?

A

PR interval

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25
Q

4 yo boy had seizure, upper respiratory illness for the last 2 days

  • Temperature is 40 C
  • Clear nasal discharge and mild erythema but is alert and cooperative

Cause of seizure?

A

Hyperthermia induced diffuse neuronal dysfunction

26
Q

45 yo man with focal epilepsy
- Given drug that blocks voltage gated calcium channels

This affects which steps in neurotransmission?

A

Fusion and release of neurotransmitter vesicles

Gabapentin

27
Q

37 yo wo dry cough and shortness of breath
- Pulmonary infiltrates and hilar adenopathy
- Presence of non-caseating granulomas
Set of immune cells responsible for development?

A

Patient has sarcoidosis

- Th1. IL-2, interferon y

28
Q

54 yo woman right upper limb weakness and fatigue

  • No sensory loss , but difficulty abducting her arm past the horizontal position.
  • medial border of right scapula lifts off the thoracic wall when press against wall

Patient was hospitalized for which condition?

A

Mastectomy with axillary lymph node removal

- Paralysis of serratus anterio, due to long thoracic nerve injury

29
Q

20 yo woman with painful swelling of right axilla
- Lymph node shows necrotizing granulomas and stellate microabscesses containing pleomorphic gram negative coccobacilli

Route of transmission?

A

Scratch from and infected cat

- Bartonela henselae

30
Q

24 yo man drinks a lot
- he says it helps him unwind and relax after a long workday, I can’t see quitting

Appropriate statement?

A

I can understand your reasons for using alcohol. What are the downsides to drinking from your perspective

31
Q

8 yo boy he never listens, rarely sits, always interrupts, forgets to do his chores

What would be helpful in establishing the diagnosis?

A

Teacher evaluations

32
Q

18 month old
hospitalized for pneumonia 2 times since age 3 months
- Pleural effusion once contained numerous neutrophils and a large number of intact gram-positive cocci
Organism responsible for patients recurrent infections produce what virulence factors?

A

Catalase, patient has CGD, impaired NADPH oxidase

33
Q

18 month old, neurologic regression

  • Inability to sit with with support ‘‘regression’’
  • Enlarged liver, spleen
  • Diminshed deep tendon reflexes in all limbs and hypotonia
  • Cherry red macular spot

Accumulation of?

A

Sphigomyelin - Niemman pick disease

34
Q

Serum insulin level is higher when given oral glucose vs IV

Why?

A

Glucagon like peptide 1

‘‘Incretin’’ functions by stimulating release following oral consumption of glucose.

35
Q 
76 yo wo found unresponsive
- Ate less dinner than usual
- Blood glucose is 34
- Rapidly improve after bolus of dextrose
Confuse again several hours later

Medication cause of this?

A

Glyburide ‘‘sulfonylurea ‘’ persistent hypoglycaemia

36
Q

4 week infant episodes of hypoglycaemia

  • elevated insulin levels during periods of fasting
  • Mutation involving potassium channels

Which substance binds and regulates ion channel responsible for hypoglycaemia?

A

ATP- sensitive potassium channel

37
Q

46 yo woman hiatal hernia and GERD
- Gastric fundus is mobilized and wrapped around the lower esophagus

Structure traversing esophageal hiatus of diaphragm was injured

Potential effect of injury?

A

Delayed gastric emptying, damage to vagal trunks

38
Q

68 yo woman abdominal pain an dvomiting

  • Episode of acute calculous cholecystitis
  • Exam shows tympanic abdomen with high-pitched bowel
  • Air in gallbladder and biliary tree

Gallstone lodged in?

A

Ileum

39
Q

32 yo wo
worsening headaches and double vision
- Nasal discharge for several days
- Weakness of lateral rectus muscle

What nerve is involved?

A

Abducens nerve

40
Q

68 yo wo
- Confusion and lower extremity weakness
- She is visiting family in texas for the summer
- Flaccid paralysis of lower extremity
- CSF shows lymphocytic pleocytosis and elevated protein
Viral RNA

Mode of transmission of agent infecting ?

A

Insect bite ‘’ west nile virus’’

41
Q

Summer camp, 4 children with cough congestion, sore throat and red eyes

Cause of outbreak?

A

Adenovirus

42
Q

2day old boy mother has beta thalassemia trait and father is normal
- Hemoglobin composition of infant?

A

A2y2 will be there for the first 6 months

43
Q

Present Absent

Test + 45 30
Test - 5 120

Likelihood that patient with negative test does not have disease?

A

120/125 = 0.96

44
Q

23 yo woman with sickle cell disease
- Is given hydroxyurea

MOA of drug?

A

Increased fetal hemoglobin synthesis

45
Q

2 month old girl restricted movements of upper and lower extremities

  • Mother had inconsistent prenatal care
  • Mild pallor, generalized lymphadenopathy, hepatosplenomegaly
  • Knee joints reveal metaphysical erosions with periosteal reaction

Cause?

A

Transplancental transmission of a spirochete ‘’ T palladium’’
Congenital syphilis

46
Q

17 yo girl right wrist mass

  • Swelling on top of wrist, rounded mass on dorsal that transilluminates with penlight
  • Painless

Underlying ethology?

A

Degeneration of periarticular tissue

‘’ ganglion cyst’’

47
Q

Case control SLE 1040 , nonSLE 1260.
- Among SLE 240 have endometriosis, nonSLE 210

Odds ratio of endometriosis in women of SLE compared to non SLE?

A

SLE + SLE -

Endometriosis + 240 210
Endometriosis - 800 1050

Odds ratio 240/800 = 0.3 exposure
Odds ratio 210 / 1050= 0.2 controls

0.3/0.2 = 1.5

48
Q

32 yo woman after delivery of placenta patient losses large amount of vaginal bleeding
- Postpartum hemorrhage
Dose of tranexamic acid is administered, MOA?

A

Inhibits plasminogen cleavage and prevents fibrin degradation

49
Q

Kidneys response to hypoperfusion apply a clip to a pig’s right renal artery
- After 6 months which cells would undergo hyperplasia as a result of clip?

A

Modified smooth muscle cells of afferent arteriole (JG cells)

50
Q

26 yo woman gives birth

  • Baby has protruding tongue, excessive skin at the nape of the neck, upsetting palpebral fissure
  • Harsh III/VI systolic murmur heard over left sternal border ( ventricular septal defect)

Karyotypes likely to be found?

A

46xx t(14:21) down syndrome

51
Q

25 yo wo low mood because landlord won’t allow pets in building
- Her mood would improve if she could get a letter saying the dog needs to live with her.

Statement by physician?

A

I can see you miss your dog very much, let’s start by talking about the mood symptoms you’ve been experiencing

52
Q

58 yo man progressive fatigue , dyspnea and orthopnea

  • BP is 160/95 , bilateral lung crackles and lower extremity edema
  • Maximal impulse is displaced toward axilla. Potassium is 4.2

Long term use of which medication will reduce mortality?

A

Lisinopril ‘‘reduced cardiac remodelling’’

- Patient has heart failure with reduced ejection fraction

53
Q

76 yo Diastolic murmur

  • Cultures grow Enterococcus ‘’ mitral valve vegetations’’ endocarditis
  • Antibiotic develops tinnitus and hearing loss

Antibiotic moa?

A

mRNA genetic code reading

- Aminoglycoside

54
Q

32 yo man with crohn disease

  • high dose glucocorticoids
  • Azathiprine is maintenance therapy

Expected effects of this medication on Lymphocyte count, immunoglobulin level and IL-2 activity?

A

Everything will decrease

Azathiprine disrupts DNA and RNA replication

55
Q

47 yo woman progressive joint pain and swelling of hands

  • Morning activities are difficult
  • Autoantibodies against what component are most specific?
A

Citrullinated peptides

- Rheumatoid arthritis

56
Q

22 yo woman give birth
- Boy external genitalia are ambiguous
- Mobile masses are palpable bilaterally
Karyotype shows 46 XY

Deficiency in which of the following enzymes?

A

5a reductase
- Converts testosterone to DHT
‘‘external male genitalia’’

57
Q

42 yo man fever, diarrhea

  • colonoscopy reveal areas of erosions and ulceration
  • Cells with viral intranuclear and intracytoplasmic inclusions

Patient given an agent that does not require intracellular activation and binds to DNA polymerase
What is the agent?

A

Foscarnet

Patient is suffering from cytomegalovirus

58
Q

46 yo left sided flank pain radiating to the groin
left ureteral calculus
- Left lower lobe lung nodule and foci of calcification in the spleen
- Small calcified nodules in both lungs and mediastinal lymph node
- Farmer who live in Ohio
Tuberculosis test is negative

Most likely cause?

A

Fungal infection

-Suspicion of granulomatous infection, most likely cause is Histoplasma capsulatum

59
Q

38 yo dies suddenly at his work place

  • He was overweight
  • Maternal uncle reportedly dies of heart attack at age 50
  • Myocardial findings show neutrophil invasion

Diagnosis?

A

Acute myocarditis caused by Viral infection
- Myocarditis shows myocyte necrosis or degeneration accompanied by an inflammatory mononuclear cell infiltrate

  • Ventricular arrhythmias leading to sudden cardiac death
60
Q

12yo boy intermittent substernal chest pain occurs with heavy activity

  • Troponin is elevated and ECG reveals ST segment elevations
  • Increased serum methionine level

Which amino acid is essential?

A

Cysteine
Patient has homocystinuria - cystathione synthase deficiency, condition leads to hyper coagulability and thromboembolic occlusion. Results in hypermethioninemia
‘‘Ectopia lentis and intellectual disability’’

Uworld (11 decks)

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