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UWORLD first pass- week 5 > 3/1 UWORLD test # 28 > Flashcards

3/1 UWORLD test # 28 Flashcards

1
Q

Q 1. In mitral regurgitation murmur, what auscultation finding correlates with severity?

A

severity of MR = amount of blood flowing back to atrium

The more blood flowing back to the atrium, the more likely S3 sounds will present in subsequent diastole phase.

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2
Q

Q 1. Why INTENSITY of murmur does not correlate with severity?

A

larger regurgitant orifice leads to higher intensity sound.

This doesn’t necessarily correlates with amount of volume flowing back to atrium, thus doesn’t tell that much about severity

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3
Q

Q 1. What is S3 gallop? Its presence is normal for what patient group?

A

Rapid entrance of blood into ventricle during diastole

It correlates with amount of blood hanging out in atrium.
Severe MR/ HF can cause this.

  • may be heard in children and young adults
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4
Q

Q 2. What is withdrawal symptoms of drug? How does it correlate with drug action

A

withdrawal symptom is the opposite action of drug

This makes sense: drug is acting on suppressing something, and as drug is removed, body’s compensation against that action will be intensified

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5
Q

Q 2. Withdrawal symptoms (5) of opioid (heroin)

A
  • yawning
  • lacrimation
  • dilated pupil (remember opioid causes miosis)
  • GI cramping/ diarrhea (remember opioid causes constipation)
  • sweating
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6
Q

Q 2. Withdrawal symptoms (4) of alcohol? What is treatment?

A
  • tremor
  • sezuire
  • delirium
  • anxiety
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7
Q

Q 2. Withdrawal symptoms (3) of BDZ?

A

pretty similar as alcohol withdrwal

  • insomnia
  • tremor
  • anxiety
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8
Q

Q 2. Withdrawal symptoms (4) of nicotine?

A
  • irritability
  • hypersomnia (excessive drowsiness)
  • depression
  • increased appetite
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9
Q

Q 3. Define linkage disequilibrium. example?

A

due to close proximity of two genes, allele frequency of two genes together is higher or lower than expected

  • HLA-DQA1 and HLA-DQB1
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10
Q

Define incomplete penetrance. example?

A

not all individuals with mutant genotype develops phenotype

  • BRCA1: not all mutants will develop breast cancer
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11
Q

Define pleiotropy. example?

A

mutation can cause multiple phenotypes

  • PKU: musty body odor, intellectual disability, light skin
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12
Q

Define loss of heterozygosity. example?

A

with mutation of one allele, loss of complementary allele must be done to express phenotype

  • retinoblastoma, and two hit hypothesis for lynch syndrome
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13
Q

Define dominant negative mutation. example?

A

mutation in one allele prevents normal gene function

  • mutation of transcription factor in allosteric site. mutant can still bind to DNA, preventing wild-type transcription factor
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14
Q

Define locus heterogeneity. example?

A

mutation on different loci can cause similar phenotype

  • albinism
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15
Q

Define allelic heterogeneity. example?

A

different mutations on same loci can produce same phenotype

  • beta thalassemia
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16
Q

Define heteroplasmy. example?

A

presence of normal and mutated MITOCHONDRIAL DNA

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17
Q

Q 6. What does “anicteric infection” mean?

A

subclinical: infection with clinically insignificant symptoms

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18
Q

Q 7. What are three clinical features of nocardia?

A
  • pneumonia (immunocompromised)
  • brain abcess
  • cutaneous symptom: cutaneous inflammation
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19
Q

Q 7. What may be seen in brain MRI with nocardia infection?

A

ring enhancing focal region

do NOT pick toxoplasmosis just because of this.
Toxo is protozoan. Question will give additional info

20
Q

Q 8. Disaggregation of nuclear granules: is this reversible injury? or irreversible injury?

A

Reversible injury

do NOT confuse with nuclear fragmentation (karyorrhexis) or condensation (pyknosis)

21
Q

Q 9. When does fetal hemoglobin is rapidly being replaced by adult hemoglobin? This explains delayed presentation of what diseases

A
  • after 6 months

- gamma subunit in HbF is replaced by beta subunit in HbA. Thus, any defect with beta (beta-thalessmia or sickle cell)

22
Q

Q 10. What is gross appearance of menigocele/mengiomyelocele?

A

cystic lesion in lower spine with hairy patch

23
Q

Q 10. What intervention in mother can prevent neural tube defects?

A

folate supplementation

24
Q

Q 13. What is motor endplate action potential? How does myasthenia gravis change it?

A

motor end-plate potential is the electric potential (NOT ACTION POTENTIAL) at the end of muscular junction.

In myasthenia gravis, motor end-plate potential is reduced due to less availability of functional ACh receptors. Thus, action potential is NOT generated

Action potential is generated as motor end-plate potential reaches threshold. Once it reaches threshold, same amplitude of action potential is generated, REGARDLESS of magnitude of motor end-plate potential

25
Q

Q 13. What is excitation-contraction coupling?

A

Generation of action potential is linked to muscle contraction

excitation: action potential, contraction: muscle contraction

AP -> Ca2+ entry -> muscle contraction

26
Q

Q 14. Scopolamine

  • mechanism of action
  • indication
A
  • Ach receptor selective anti-muscarinic

- motion sickness

27
Q

Q 15. Describe the molecular mechanism of insulin release in pancreatic beta-islet cells

A

glucose entry into pancreatic beta cell through GLUT2 (insulin-independent)

  • > ATP generation via glycolysis within the cell
  • > closure of ATP-SENSITIVE potassium channel
  • > depolarization
  • > voltage gated Ca2+ channel opening & Ca2+ entry
  • > exocytosis of insulin granules (with C peptide)
28
Q

Q 16. Schwannoma

  • usually arises from which cranial nerve?
  • intracranial mass occupies what location?
  • due to this location, what other cranial nerves can be compressed?
  • clinical presentations
A
  • CN8
  • cerebellopontine angle: between lateral pons and cerebellum
  • mass may also compress CN7 and CN5
  • UNILATERAL hearing loss: CN8
  • asymmetric smile: CN7
  • facial numbness: CN5
  • lack of corneal reflex: CN5 & 7
29
Q

Q 16. What neural disorder may present with BILATERAL hearing loss?

A

NF2 (neurofibromatosis type 2)

30
Q

Q 19. Compare symptoms: radial nerve injury vs. low trunk branchial plexus injury

A
  • radial nerve: wrist drop

- low trunk of branchial plexus: claw hands (interossi innervated by ulnar)

31
Q

Q 20. Thrombosis induced ischemic injury in brain results in what type of necrosis? What is the mechanism of this type of necrosis?

A

Thrombosis -> ischemic injury -> release of lysozyme
-> liquefactive necrosis

CNS = fat rich = liquefactive necrosis

32
Q

Q 20. Under what circumstance does hemorrhagic CNS infarct happen?

A

reperfusion injury

: introduce of oxygen radical

33
Q

Q 20. Hemorrahgic infarct is common in what organ?

A

organs with dual supply: lung ( pulmonary artery + bronchial artery)

hemorrhagic infarct happens in brain during reperfusion. Most thrombotic infarct in CNS results in liquefactive necrosis

34
Q

Q 22. Cholestyramine vs. ezetimibe

  1. mechanism of action
  2. changes in level of lipids
  3. side effects
A
  1. MOA
    - cholestyramine: inhibit bile reuptake into liver
    - ezetimibe: inhibit INTESTINAL cholesterol absorption
  2. lipid changes
    - cholestyramine: decreased LDL, increased in HDL & TG
    => cholestyramine is the ONLY drug that elevates TG
    - ezetimibe: decreased LDL
  3. side effects
    - cholestryramine: GI upset
    - ezetimibe: diarrhea, increased LFT
35
Q

Q 23. Describe progression of cherry hemangioma

A

Grows rapidly and spontaneously regress by 5-8 yo

36
Q

Q 25. What immune response causes autoimmune destruction of parietal cells in pernicious anemia?

A

CD4+ T cell

37
Q

Q 26. Skin manifestation in Nisseria menigitis? what is the mechanism?

A

petechial rash due to thrombocytopenia

  • sketchy: guy lying down the ground on pants with red dots
38
Q

Q 28. What drugs (4) are proven to increase mortality in HF?

A
  • ACEI
  • ARB
  • B blocker
  • Spironlactone
39
Q

Q 28. What is triamterene?

A

eNac blocker, same as amerolide

40
Q

Q 29. staph allows co-growth of what bug? how?

A

H.influenzae

hemolysis by staph releases NAD+

41
Q

Q 32. Latissimus dorsi

  • innervated by what nerve
  • which arm motion
A
  • thoracodorsal nerve

- internal rotation: latissimus dorsi is attached to frontal side of humerus

42
Q

Q 33. cervical adenopathy, gray pharyngeal exudate, myocarditis: what bug is this?

A

Diptheria

43
Q

Q 34. What is energy metabolism in erythrocyte?

A

only glycolysis

there is no mitochondria in erythrocytes

44
Q

Q 35. What would be a strategy for prevention of hepatocellular carcinoma in developing countries? why?

A

vaccination against HepB virus

There is high incidence in HepB infection in countries with hepatocellular carcinoma

45
Q

Q 37. What neuroendocrine markers (3) may be seen in small cell lung carcinoma?

A
  • neural cell adhesion molecule (NCAM, CD56)
  • chromagranin A
  • enolase
46
Q

Q 38. Cromoyln

  • mechanism of action
  • indication
A
  • stabilize mast cell and prevents degranulation

- prophlyaxis for seasonal symptoms, aspirin induced asthma, exercise induced asthma

UWORLD first pass- week 5 (8 decks)

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