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UWORLD first pass- week 6 > 3/10 UWORLD- test # 35 > Flashcards

3/10 UWORLD- test # 35 Flashcards

1
Q

Q 2. List the frequency of atherosclerosis formation in following sites.

  • popliteal artery
  • coronary artery
  • abdominal aorta
  • carotid artery
A

From most common to least common

abdominal aorta > coronary artery > popliteal artery > carotid artery

abdomen> heart> knee> neck

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2
Q

Q 3. four symptoms of mononucleosis?

A
  • fever
  • fatigue
  • splenomegaly
  • atypical lymphocyte
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3
Q

Q 3. What two viruses will show mononucleosis? How are they differentiated?

A

CMV and EBV

  • EBV: positive monospot test- agglutination with heterophilic RBC(hoarse) as infected B cells (via CD21) releases heterophilic antibody
  • CMV: negative monospot test- no agglutination
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4
Q

Q 4. Farmer with lacrimation, 2mm pupil, bilateral wheezing lung sound, excessive sweating. What is going on? What is treatment?

A

organophsophates ( parathion), usually insecticides, are potent acetylcholine esterase inhibitor. Treated with atropine

bilateral wheezing lung sound- parasympathetic bronchoconstriction

  • key: with bunch of parasympathetic symptoms (BB SLUDGE), look at signs for possible causes.
    OCCUPATION in this case!
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5
Q

Wheezing lung sounds indicate what lung pathology? What two lung diseases may show wheezing breathing sound?

A

obstructive lung disease

- Asthma, chornic bronchitis

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6
Q

pulse indicates HR. what is normal pulse range?

A

60-100 bpm

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7
Q

Q 5. amino acids from muscle as energy source

  • Draw reactions in liver/muscle
  • What is primary amino acid that works as a nitrogen carrier?
  • ALT: Alanine aminotransferase, requires what vitamin as cofactor?
A
  • note p.27: alanine-glucose cycle
    amino acids from muscle breakdown can be used as an energy source (glucose). Alanine exits muscle as nitrogen carrier, becomes pyruvate, while nitrogen is taken by alpha-ketoglutarate to form glutamate. Glutamate enters urea cycle in liver as a way to nitrogen disposal.
  • ALT requires B6
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8
Q

Q 6. What are non-glucose polysacchrides (3)? Which one has the fastest metabolism? why?

A
  • mannose, fructose, galactose
  • fructose has the fastest metabolism because it bypass PFK-1. Fructose can enter directly to glyceraldehyde-3-P in glycolytic pathway
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9
Q

Q 7. Which nerve is in close proximity to inferior thyroid artery? What would be complication of thyroidectomy?

A

recurrent laryngeal nerve

During ligation of inferior thyroid artery in thyroidectomy, damage to recurrent laryngeal nerve can cause hoarseness

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10
Q

Q 8. What is key difference between schizoaffective disorder vs. bipolar disorder with psychotic features?

A

Mania is also considered as mood episode. Thus, mania and psychosis (delusion, hallucination) can happen in schizoaffective disorder just like bipolar disorder with psychotic features.

BUT
In schizoaffective disorder, mood episode happens CONCURRENTLY with psychosis. While in bipolar disorder with psychotic features, mood episode happens EXCLUSIVELY (thus cyclic).

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11
Q

Q 9. Pharyngeal arches are derived from what two cell types?

A
  • mesoderm

- neural crest

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12
Q

Q 9. What is Treacher Collins syndrome?

A

neural crest dysfunction leading to malformation of 1st/2nd pharyngeal arch derivatives: mandibular hypoplasia, facial abnormalities

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13
Q

Three things to think about recurrent laryngeal nerve?

A
  • laterally loops ductus arteriosus (or ligamentum arteriosum)
  • run close proximity to inferior thyroid artery
  • can be compressed (thus hoarseness) by mediastinal mass
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14
Q

Go over branchial apparatus and its derivaties

A

note P. 28

FA p.568- p.570

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15
Q

Q 10. Medicare

  • who is eligible
  • part A covers what?
  • part B ?
  • part C?
  • part D?
A

Eligibility

  • age 65 or older
  • younger people with end-stage renal disease or ALS
  • part A: inpatient
  • part B: outpatient & diagnostic testings
  • part C: private companies
  • part D: drugs
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16
Q

Who is eligible for medicaid?

A

low income
Although income is low, people working full time and getting some insurance coverage by employer are NOT qualified

AIDs low income people with medicAID

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17
Q

Q 11. What is thrombin time? What does prolonged thrombin time mean?

A

time to clot in plasma with anti-coagulant after addition of excess thrombin (factor 2a).
TT is prolonged if anti-coagulant is either directly or indirectly inhibit factor 2a
- direct 2a inhibitor: argotroban, bivalirudin
- indirect 2a inhibitor: heparin (especially unfractionated)

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18
Q

Q 13. ECG: irregular rhythm, no P wave, narrow QRS. diagnosis?

A

A Fib

19
Q

Q 13. Atrial fibrilation

  • How is it initiated?
  • what determines ventricular contraction rate
A

electrical impulse arises from ectopic region in atria
(not SA node, thus no P wave)
-> electrical remodeling
-> shortened refractory period & increased conductivity
-> transmission of ectopic impulse to AV node

Since irregular impulse pass AV node, AV node refractory period determines ventricular contraction rate

20
Q

Q 14. patellar fracture impairs what motion?

A

knee extension

21
Q

Q 15. What disease is associated with “endoneuronal inflammatory infiltrate”? What is pathophysiology of this disease?

A

Guillain-Barre

autoimmune attack of peripheral myeline by antibodies against infection (campy): molecular mimicry

22
Q

Q 15. What are treatment options for Guillain-Barre

A

plasmapheresis or IVIG

*steroid does NOT work

23
Q

Q 18. gamma-glutamyl transferase

  • location and function?
  • elevated level is associated with what pathology?
A

gamma carboxylation in vitamin K dependent coagulation factors

elevated gamma-glutamyl transferase is associated with hepatic/biliary pathology. also alcohol liver disease

24
Q

Q 18. What findings indicated worse prognosis in terms of liver function?

A

coagulation deficiency (prolonged PT/PTT), hypoalbuminemia, hyperbilirubin

AST, ALT, gamma-glutamyltransferase also indicates hepatic disease, but does NOT provide reserve of liver function. So these are not ideal for prognosis

25
Q

Q 21. what three factors are associated with increased risk of candida vaginalis?

A
  • antibiotics: decreased nutrient competing bacteria in vagina
  • birth control pill
  • diabetes
26
Q

Q 22. biostat: what does standard deviation 1, 2, 3 mean?

Assume average is 220, and standard deviation is 10. What percentage of sample will be >240?

A

SD1: 68%

SD2: 95%

SD3: 99.7%

With average 220, and SD 10, 95% will be within 2SD (200-240).
That means, <200 and >240 comprise rest 5%.
Thus, >240 will be 2.5%

27
Q

Q 23. What is neprilysin? What proteins (4) are target?

A

neprilysin is metalloprotease that cleaves endogenous peptides including ANP, glucagon, oxytocin, and bradykinin

28
Q

Rheumatic fever vs. PSGN

  • difference in preceding GAS infection symptom?
  • difference in mechanism?
A

RF- pharyngitis (sore throat)
PSGN- impetigo (honey crust skin)

RF- type II hypersensitivity, molecular mimicry
PSGN- type III hypersensitivity, immune complex deposition on glomeruli

29
Q

Q 25. autosomal recessive disease that is known to affect 1 in 40,000 of population. Mom is carrier, dad has disease. probability for son having it?

A

mom carrier - 1/2
dad disease, thus gene frequency will be 1/200 of each gene
Thus son: 1/400

30
Q

Q 26. What are two mediators for extrinsic apoptosis?

A
  • TNF-alpha binding to TNF receptor

- FasL binds to Fas (CD95)

31
Q

Q 27. first line for narcolepsy?

A

modafinil- non amphetamine stimulant

32
Q

Q 29. side effects of metformin?

A
  • GI: vomiting, nausea, diarrhea
  • lactic acidosis
  • remember: metformin does NOT cause any nephrotoxicity. It is renaly excreted so contraindicated in pts with renal insufficiency
33
Q

Q 29. What does ACEI do for serum creatinine level? why?

A

Elevation of serum creatinine

ACEI reduces GFR, thus less creatinine is filtered

34
Q

Q 30. Warfarin effect (target INR) is affected by what two major drugs?

A
  • warfarin is hepatic meabolized. Thus CYP450 function. CYP450 inducers (phenytoin, phenobarbitol, rifampin) will metabolize warfarin, reducing its efficiency
  • sulfanamide: displaces albumin bound warfarin, increasing free warfarin. Increases warfarin activity, leading to hemorrhage
35
Q

Q 31. GI discomfort with diarrhea, flushing, dyspnea, and wheezing. Diagnosis?

A

Carcinoid syndrome

36
Q

Q 31. Treatment of carcinoid syndrome?

A

octreotide

37
Q

Q 31. Cabergoline

  • MOA
  • indication
A

Dopamine agonist, D2 agonist (same as bromocriptine)

indicated for prolactinoma

38
Q

Q 31. Leuprolide

  • MOA
  • indications (3)
A

GnRH agonist

  • pulsatile: increase FSH/LH
  • continuous: decrease FSH/LH

indicated for precocious puberty, infertility, endometriosis

39
Q

Q 32. Cliostazol

  • MOA (2)
  • indications (3)
  • side effects (2)
A
  • MOA
    1. vasodilator
    2. inhibit platelet aggregation (by increasing cAMP in platelets)
  • indications
    1. intermittent claudication
    2. angina prophylaxis
    3. prevention of stroke (in combination with aspirin)
  • side effects
    1. hypotension/ headache
    2. flushing
40
Q

Q 34. Is psudomona motile or non-motile?

A

motile
This is not presented in sketchy, but think how people in the sketchy are moving (except monariza who is just lying on water bath)

41
Q

Q 35. Which two surface markers are missing in paroxysmal nocturnal hemoglobinuria? Deficiency of what protein results this? What is function of each?

A

Absence of GPI anchor

  • CD55: decay accelerating factor, inhibition of C3 convertase
    => lack of CD55 -> more C3 convertase
    -> more complement activation
  • CD59: MAC inhibitor
42
Q

Q 36. Postprandial epigastric pain, food aversion/weight loss, hyperlipidemia, no abnormal finding on upper GI endoscopy. Diagnosis?

A

chronic mesenteric ischemia

43
Q

Q 39. Two types of vaccines for strep.pneumo

  • recommended age
  • advantages
A
  • unconjugated polysacchride:
    weaker immune response as polysacchride is not presented to T cells, recommended for young adults

advantage: decreasing replacement of strains

  • toxoid-conjugated polysacchride:
    stronger immune response as conjugated toxoid can be presented to T cells, recommended for kids/ eldery

advantage: stronger immune response ( B cell/ T cell), more immunogenic memory

UWORLD first pass- week 6 (6 decks)

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