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UWORLD first pass- week2 > 2/7 UWORLD test # 9 > Flashcards

2/7 UWORLD test # 9 Flashcards

1
Q

Q 1. Scar tissue is what type of collagen? This collagen type is also associated with what other structures?

A

type 1

bone, tendon, ligament, cornea

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2
Q

Q 1. What is granulation tissue? What type of collagen is in granulation tissue?

A

highly vascularized structure, formed before scar formation. Type 3 collagen.

This type 3 collagen will be replaced by type 1 during scar formation by Zn dependent collagenase

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3
Q

Q 3. What is lead-time bias? How can investigators reduce this bias?

A

early detection of disease makes survival seemed to be improved, although it is simply due to early detection timing, not due to real impact on survival

can be prevented by measuring severity of disease at the point of diagnosis and see how survival is affected

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4
Q

Q 4. During oogenesis, meiosis is arrested at two different phases. What are those phases?

A

Before ovulation: meiosis 1 propase

Before fertilization: meiosis 2 metaphase

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5
Q

Q 5. What is medial, lateral, inferior border for direct inguinal hernia?

A

medial- rectus abdominis
lateral- inferior epigastric vessel
inferior- inguinal ligament

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6
Q

Q 5. What is medial and inferior border for indirect inguinal hernia? (no lateral border for indirect)

A

medial- inferior epigastric vessel

inferior- inguinal ligament

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7
Q

Q 5. What is anatomical landmark that distinguishes direct inguinal hernia from indirect inguinal hernia?

A

inferior epigastric vessel

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8
Q

Q 5. What is superior and lateral border for femoral hernia? Is it more common to men or women?

A

superior- inguinal ligament
lateral: femoral vessel
more common in female

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9
Q

Q 6. Does nitrates act on artery as well?

A

nitrates predominantly work on veins, but also have some effect on artery

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10
Q

Q 8. For what is theophylline is indicated? other effects? (hint: related with cardiac) mechanism of action? side effects?

A
  • theophylline is indicated for mild to severe asthma
  • also inhibits adenosine on cardiac tissue (like caffeine)
  • side effects: tachycardia, CNS effects- seizure, tremor
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11
Q

Q 9. What type of hydrocephalus is normal pressure hydrocephlaus? What are three phenotypes for normal pressure hydrocephalus?

A

communicating

  • urinary incontinence (wet)
  • cognition defect (wacky)
  • magnetic gait - foot stuck to floor (wobbly)
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12
Q

Q 9. treatment for normal pressure hydrocephalus?

A

VP shunt: ventricular peritoneal shunt

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13
Q

Q 10. What disease describes hypoxemia induced hemolysis?

A

sickle cell disease

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14
Q

Q 10. What disease describes oxidant induced hemolysis?

A

G6PD deficiency

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15
Q

Q 10. In sickle cells disease what three conditions can induce sickling?

A
  • hypoxia (hypoventilation, high altitude)
  • hypovolemia (dehydration)
  • acidosis
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16
Q

Q 10. With RBC mutation which results in increased oxygen binding affinity, what is normal physiologic response?

A

erythrocytosis due to less oxygen is available to tissue because of tight binding of O2 to Hb

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17
Q

Q 11. What is equilibrium potential for specific Ion? Explain physiology

A

Equilibrium potential for specific ion indicates specific ion’s contribution on membrane potential (relative potential of cytoplasm compared to extracellular fluid) at resting state.

For example, EK is -80mV, meaning K+ ALONE will give -80mV of membrane potential via efflux
ENa is +60mV, meaning Na+ ALONE will give +60mV of membrane potential via influx

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18
Q

Q 13. Define “generalized anxiety disorder” How is it differentiated with panic disorder?

A

chronic multiple worries, anxiety.
Unlike panic disorder, generalized anxiety disorder does not have recurrent/unexpected episodes. So people with generalized anxiety disorder do not worry about recurrent symptoms. They just worry about other things

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19
Q

Q 13. Diagnosis of panic attack requires what feature following attack?

A

fear that attack may occur again

: patient may restrict other social activities due to this concern

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20
Q

Q 14. Which parameter best correlates with potency of inhaled anesthetics?

A

MAC: minimal alveolar concentration

potency= 1/MAC

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21
Q

Q 15. Define paranoid personality disorder

A

No trust on people

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22
Q

Q 15. Define schizoid personality disorder

A

Voluntary withdrawal from social activity

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23
Q

Q 15. Define schizotypal personality disorder

A

weird/freak: odd beliefs, magical thinking, eccentric appearance

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24
Q

Q 16. How amino acids are handled in renal tubule? What is an example of another molecule that has similar pattern?

A

All filtered amino acids are reabsorbed with Na+ through Na+/aa channel in PCT
Glucose follows same pattern.

25
Q

Q 16. How PAH is handled in renal tubule? PAH clearance is best predictor of what?

A

All PAH entered through renal artery is excreted. It does not get filtered all at first, but ALL remnants in afferent arteriole are further secreted

PAH clearance is best predictor of renal blood flow

26
Q

Q 16. How inulin is handled in renal tubule? Inulin clearance is best predictor of what?

A

Inulin is filtered and excreted with no reabsorption or secretion.

Inulin clearance is best predictor of GFR

27
Q

Q 18. What are cytologic findings for B cell non-hodgkin lymphomas? (3) which genes get over expressed? what is consequence for that?

A
  • Follicular: t(14;18), Ig heavy chain with Bcl-2-> Bcl-2 over-expression -> inhibition of apoptosis
  • Mantle: t(14:11), over-expression of cyclin D1-> increased G1/S phase transition thus more cell division
  • Marginal: no cytology, MALToma: H.pylori, Sjogren
  • Burkitt: t(14;8), over-expression of c-myc -> cell proliferation
28
Q

Q 18. Which cancer is associated with mutation in p53? What is role of p53? What disease can be caused by p53 mutation?

A

Li-Fraumeni syndrome

p53: tumor suppressor gene, it induces p21, which inhibits CDK (G1->S transition)

29
Q

Q 19. Anterior Cerebral Artery supplies what surface of brain? Symptoms of ACA stroke?

A

anterior/ medial

low extremities: contralateral paralysis

30
Q

Q 19. Middle Cerebral Artery supplies what surface of brain? Symptoms of MCA stroke?

A

lateral

upper extremities/ face/ language

31
Q

Q 19. Posterior Cerebral Artery supplies what surface of brain? Symptoms of PCA stroke?

A

posterior- visual occipital

contralateral hemianopia with macular sparing

32
Q

Q 19. Aphasia is sign of what artery stroke? (among ACA, MCA, PCA)

A

MCA

Wernicke, Broca area lies on the lateral surface of parietal lobe

33
Q

Q 21. What would be a negative effect of treating angina patient with B-blockers + Non-Dihydropidine

A

hypotensive crisis & significant bradycardia due to extreme negative chronotropic effect.

Both B-blockers and Non-Dihydrodipine decreases HR

34
Q

Q 24. Agitated saline forming bubbles in echocardiogram. What does this suggest?

A

heart septal defect- Right to left shunt (Agitated saline is injected in vein)

35
Q

Q 24. Describe embryology of atrial septation

A

septum primum -> septum secundum -> foramen ovale formation -> closure of foramen ovale and fusion of septum secundum and septum primum

36
Q

Q 24. How does patent foramen ovale form?

A

failed closure of foramen ovale

Closure normally happens as LA pressure becomes higher than RA pressure

37
Q

Q 24. What is paradoxical brain embolism?

A

emboli from vein travels to LA through patent ovale foramen and travel up to brain

Normally venous emboli causes pulmonary embolism.

38
Q

Q 25. Describe gross appearance/ microscopic finding/ possible complications post MI: 4 different time lines (First aid p.288)

A
  • first 24 hrs: coagulative necrosis, arrythmia, reperfusion injury
  • 1-3 days: neutrophil, fibrous pericarditis
  • 5 days -2 wks: macrophage, valvular rupture, ventricular rupture followed by cardiac temponade or pseudoaneurysm
  • 2 wks- months: scarring, fibrous tissue, Dressler syndrome
39
Q

Q 25. What is Dressler syndrome?

A

Release of cardiac antigen from ischemic damage -> autoimmune endocarditis.
Chronic presentation of MI as it takes time to build up autoantibodies

40
Q

Q 26. Which aortic arch derivative gives rise to ductus arteriosus?

A

6th aortic arch

41
Q

Q 26. What does Bulbus Cordis (embryologic feature) give rise to?

A

outflow tract of left and right ventricles

42
Q

Q 27. What are three derivaties of POMC (proopiomelanocortin)?

A
  • ACTH
  • MSH (melanocyte stimulating hormone, why hyperpigmentation is seen in primary adrenal insufficiency)
  • beta-endorphin (endogenous opioid peptide)
43
Q

Q 27. What is somatomedin C?

A

Insulin like growth factor

structurally similar to insulin, it is released upon growth hormone stimulation and promotes growth

44
Q

Q 28. What are three inflammatory mediators that are associated with pathogenesis of COPD?

A

Things that can cause alveolar damage

  • neutrophil
  • macrophage
  • CD8 T cell
45
Q

Q 31. What organ is primarily responsible for complement production?

A

Liver

46
Q

Q 31. What complication of abdominal trauma (or during laparatomy, surgical incision in abdominal area) can worsen severity of infection?

A

spleen rupture -> impaired lymphocyte activation by antigen presentation

spleen is secondary lymphoid tissue
primary: bone marrow

47
Q

Q 31. What organ is primarily responsible for removal of encapsulated bacteria?

A

spleen

Asplenic patient (ex: sickle cell) has higher risk of infection to encapsulated bacteria (ex: Strep. pneumoniae, H.Infulenzae)

48
Q

Q 32. What is autoantibody for drug induced SLE?

A

anti-histone

49
Q

Q 32. Which drugs (4) can induce SLE? How are they metabolized in body?

A
  • procainamide
  • hydralazine
  • INH
  • phenytoin
50
Q

Q 34. Describe how pain develops in appendicitis

A

starts in periumbilical area -> irritation of peritoneum by inflammation then localizes to McBurney point

51
Q

Q 35. What is first line medication for syphilis? What is mechanism of action of this drug?

A

penicillin

binds and blocks transpeptidase (PBP) due to structural similarity between penicillin and D-ala-D-ala

52
Q

Q 37. What is Diphenhydramine?

A

first gen. anti-histamine

53
Q

Q 38. Explain pathophysiology of intracranial hemorrhage in neonates with cystic fibrosis

A

Cystic fibrosis -> pancreatic insufficiency -> fat malabsorption -> limited vitamin K absorption -> impaired vitamin K dependent coagulation factors -> intracranial hemorrhage

54
Q

Q 38. How exactly vitamin K is involved with coagulation factor synthesis? What is specific mechanism? What about warfarin?

A
  • vitamin K: gamma carboxylation to activate coagulation factors
  • Warfarin: blocks epoxide reductase, which is required to reduce vitamin K (activated form)
55
Q

Q 40. Key difference between cardiac embolism and hypoxic-ischemic encephalopathy?

A

cardiac embolism: multiple infarcts as emboli can spread and stuck on multiple sites

Hypoxic-ischemic encephalopathy: one major infarct site, wedge-shaped infarct

56
Q

Q 40. Berry Aneurysm: most common site? associated risk factors? (3)

A

between ACA and Anterior Communicating artery

Risk factors:

  1. HTN
  2. Ethlers-Danlos
  3. ADPKD
57
Q

Q 40. What is Charcot-Bouchard aneurysm? What brain structures (2) are most commonly affected?

A

small artery aneurysm: most commonly lenticulostriate artery, branch of MCA

usually involves deep brain structure: basal ganglia, thalamus

58
Q

Q 40. Wedge shaped necrosis suggest what type of ischemia?

A

embolism

UWORLD first pass- week2 (6 decks)

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