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UWORLD first pass- week 4 > 2/25 UWORLD test # 24 > Flashcards

2/25 UWORLD test # 24 Flashcards

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1
Q

Q 1. biceps reflex is mediated by what nerve root?

A

C5, C6

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2
Q

Q 1. Musculocutaneous nerve is derived from which nerve root? What functions are lost with musculocutaneous n. injury?

A
  • C5, C6

- bicep reflex, forearm flexion, lateral forearm sensation, and supination

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3
Q

Pancreas embryology: Each structure gives rise to what?

  • ventral pancreatic bud
  • dorsal pancreatic bud
A
  • ventral: head and uncinate process of pancreas, main pancreatic duct
  • dorsal: body and tail of pancreas, accessory pancreatic duct
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4
Q

Q2. Annular pancreas

  • Which embryological defect?
  • symptoms
  • clinical finding
A
  • abnormal migration of ventral pancreatic bud
  • abdominal pain, non-villious vomiting, pancreatitis (obstruction of pancreatic duct). Mostly asymptomatic
  • narrowed duodenum
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5
Q

Pancreas divisum

  • Which embryological defect?
  • symptoms
A
  • failure of fusion of ventral pancreatic bud with dorsal pancreatic bud
  • abdominal pain, pancreatitis, mostly asymptomatic
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6
Q

Q 4. polyuria, polydipsia, fruity odor to breath or urine. Diagnosis?

A

DKA

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7
Q

Q 5. Compare: cross-sectional vs. Ecological study

A

They both randomly select samples and evaluate exposure & outcome.

Cross-sectional: individual
Ecological: population

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8
Q

Q 6. T cell development: explain brief picture of what is happening in each structure

  • bone marrow
  • thymus
  • secondary lymphoid tissues (lymph node- paracortex / spleen- PALS)
A
  • bone marrow: T cell production
  • thymus: T cell maturation- CD4+ T cell and CD8+ T cell
  • Secondary lymphoid tissues: T cell activation ( Th becomes Th1, Th2, Th3 & CD8 cell becomes killer T cell)
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9
Q

Q 6. T cell maturation: describe what is happening in thymus

A
  • before thymus: bone marrow - CD4-/CD8- double negative
  • cortex: positive selection, CD4+/CD8+ double positive
    => majority of T cell get killed during positive selection
  • medulla: negative selection, single positive (either CD4+ or CD8+)
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10
Q

Q 7. Inheritance pattern of G6PD deficiency?

A

X-linked recessive

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11
Q

Q 7. Two reactions (oxidative & non-oxidative) of HMP shunt

  • which rxn is reversible? which is irreversible?
  • key enzymes
  • what are reactant and product?
A
  • oxidative: irreversible, first couple of rxns
    non-oxidative: reversible, final couple of rxns
  • oxidative: G6PD
    non-oxidative: transketolase (B1 dependent)
  • oxidative: G6P ->->->5P-ribosulase+ NADPH
  • no-oxidative: 5P- ribosulase Ribose 5-P, F6P, Glyceraldehyde-3P
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12
Q

Q 8. What are three symptoms of Hodgkin lymphoma? How these symptoms are collectively called? (there is fancy word for it) Another medical condition that results in these symptoms?

A

B signs

  1. fever
  2. night sweat
  3. weight loss

These B signs may also be seen in TB

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13
Q

Q 9. Which cells undergo clonal expansion by TSS toxin from S.aureus?

A

T cell

TSST works as supraantigen that leads to polyclonal T cell exapansion

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14
Q

Q 9. Which toxin is made by C.perfringens? What does it do?

A

alpha toxin

disruption of phospholipid membrane

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15
Q

Q 10. Define intellectualization

A

using fact and logic to put emotional distance from situation
- focusing only on survival rate after cancer diagnosis

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16
Q

Q 10. Define passive aggression

A

indirect expression of emotion

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17
Q

Q 10. Define projection

A

attributing unacceptable internal impulse to another person

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18
Q

Q 10 . Define regression

A

INVOLUNTARILY going back to premature state UNDER STRESSFUL SITUATION, commonly seen in kids

  • kids urinating in bed when they are stressed
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19
Q

Q 11. In a non-emergency situation, where should physician contact to report impaired colleagues? What if such a body does not exist?

A

physician health program

state licensing board if physician health program does not exist

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20
Q

Q 13. After period of starving, patient develops hypoketotic hypoglycemia: what is going on? what enzyme is most likely missing?

A

inability to undergo beta-oxidation for ketogenesis

Either cartine acyltransferase or acyl-coA dehydrogenase may be deficient

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21
Q

Q 13. What is role of carnitine in beta- oxidation? what are phenotypes for carnitine deficiency?

A

to shuttle long chain (over 14 carbons) fatty acyl-coA into mitochondria, where further steps in beta oxidation occurs

with carnitine deficiency, hypoketotic hypoglycemia after fasting

22
Q

Q 14. How are PaO2 and PaCO2 during exercise in healthy people?

A

generally well maintained due to adjusted ventilation, V/Q

23
Q

Q 15. Define nature of mutation in factorV laiden.

coagulability state? inheritance pattern?

A

resistance against protein C -> hypercoagulable state

gain of function so autosomal dominant

24
Q

Q 16. How diet should be modified in celiac disease?

A

no grains (wheat, barly, rye)

25
Q

Q 16. How diet should be modified in lactose intolerancE?

A

no dairy

26
Q

Q 16. Describe histologic finding of duodenal biopsy in celiac

A

loss of villi
crypt hyperplasia

  • check image FA 358
27
Q

Q 16. Which parts of GI (2) are most susceptible to damage by gliadin mediated inflammation in celiac?

A

distal duodenum and proximal jejunum

28
Q

Q 20. Non-depolarizing neuromuscular blocking drug

  • mechanism of action
  • examples
  • explain physiology of train of four (TOF) stimulation
A
  • Ach receptor antagonist, compete with Ach
  • tubocurarine, atracurium (-cur-)
  • gradual decrease with each stimulation as further decrease in Ach release (it also acts on presynaptic Ach receptor)
29
Q

Q 20. Depolarizing neuromuscular blocking drug

  • mechanism of action
  • example (1)
  • explain physiology of train of four (TOF) stimulation
A
  • Ach receptor agonist, generates weaker response with sustained contraction
  • succinylcholine

deposustained constant but much weaker response followed by gradual decrease due to desensitization

30
Q

Q 21. Mechanism of action of alcohol as antiseptic agent? Can it also kill bacterial spore?

A

disruption of cell membrane -> leakage

alcohols can NOT kill bacterial spore

31
Q

Q 22. What is Tzanck test? What does it look for? What infections are indicated?

A

smear of scrap of ulcered skin

multinuclear giant cells will be seen with infected HSV-1 &2, VZV

32
Q

Q 22. Difference: primary HSV infection vs. reactivation of HSV

A

primary HSV infection shows some systemetic symptoms including fever, malaise,
while reactivation of HSV results in vesicles around lips/eyes

33
Q

Q 23. What additional contact precautions (2) are required for enteric bacteria (C. Diff)?

A
  • NONSTERILE gloves (sterile gloves are only required during surgery)
  • gown
34
Q

Q 24. Major sites (2) for iron absorption?

A

duodenum and proximal jejunum

35
Q

Q 24. What is common complication of gastrojejunostomy?

A

iron deficiency anemia

36
Q

Q 25. Pathophysiology of ataxia in Ataxia-Telangiectasia?

A

cerebellar atrophy

37
Q

Q 26. Describe pathophysiology of low body weight induced secondary amenorrhea

A

low body weight

  • > decreased leptin (leptin is released from adipose tissue)
  • > decreased GnRH -> decreased FSH/LH -> amenorrhea
38
Q

Q 27. What is major difference between testosterone vs. DHT in male genitalia development?

A

testosterone: internal genitalia

DHT: external genitalia

39
Q

Q 29. Dantrolene

  • mechanism of action
  • indications
A
  • block ryanodine receptor in SR

- neuroleptic malignant syndrome, malignant hyperthermia

40
Q

Q 30. List 4 clinical symptoms/ findings in NMS (neuroleptic malignant syndrome)

A
  • DIFFUSE muscle rigidity
  • hyperthermia
  • autonomic instability (tachycardia)
  • rhabdomyolysis (elevated CK, myoglobinuria)
41
Q

Q 30. serotonin syndrome vs. NMS: What is major difference in terms of clinical symptom

A

serotonin syndrome is more like clonus movement of ankle, while NMS is diffuse muscle rigidity

42
Q

Q 30. Why ACEI (or ARB) is used for diabetic nephropathy?

A

ACEI (or ARB if patient is not compliant with massive cough from ACEI) is used to slow progression of chronic renal failure by reducing GFR
: GFR reduction diminishes hyperfiltration induced glomerular injury

43
Q

Q 30. What is mechanism of cough production by ACEI?

A

ACE breaks down bradykinin and substance P

Elevated bradykinin and substance P by ACEI produces cough. Patients non-compatible with cough can use ARB instead

44
Q

Q 31. Explain physiology of GI stress induced vomiting

A

GI stress -> SEROTONIN release -> stimulation of afferent vagus -> vomiting center in medulla

45
Q

Q 32. Jaw deviation to left side

  • what CN is injured?
  • This CN passes exits through what skull structure?
A
  • CN 5-III ( mandibular branch)

- foramen ovale

46
Q

Q 35. What is serum calcium level in patient with calcium kidney stone? why?

A

normocalcemic

vitamin D and PTH are intact to regulate Ca2+

47
Q

Which step in collagen synthesis is impaired with vitamin C deficiency?

A

hydroxylation

48
Q

Which step in collagen synthesis is impaired with Ethlers-Danlos syndrome?

A

cross linking

49
Q

Q 37. Craniopharyngioma

  • adult or kid?
  • origin of tumor
  • gross appearance/ MRI finding
  • symptoms
A
  • kid
  • remnant cells f Rathke’s pouch
  • cystic, calcified tumor
  • visual field defects, headache
50
Q

Q 38. Axonal reaction

  • what is it?
  • microscopic changes (2)?
  • what is fancy word for this?
A
  • axon’s response to damage to increase protein synthesis
  1. dispersed Nissl substance (rough ER) within cytoplasm
  2. peripheral displacement of nucleus within cytoplasm
  • chromatolysis

make sure to check figure in FA220

51
Q

Q 39. What are clinical presentations (3) of superior vena cava syndrome?

A
  • puffy, red face
  • dilated veins in upper chest
  • headache/ confusion due to increased ICP
52
Q

Q 40. What is role of choline acetyltransferase?

A

synthesis of acetylcholine in presynaptic neuron

UWORLD first pass- week 4 (7 decks)

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