3/10 UWORLD- test # 35 Flashcards
Q 2. List the frequency of atherosclerosis formation in following sites.
- popliteal artery
- coronary artery
- abdominal aorta
- carotid artery
From most common to least common
abdominal aorta > coronary artery > popliteal artery > carotid artery
abdomen> heart> knee> neck
Q 3. four symptoms of mononucleosis?
- fever
- fatigue
- splenomegaly
- atypical lymphocyte
Q 3. What two viruses will show mononucleosis? How are they differentiated?
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
Q 4. Farmer with lacrimation, 2mm pupil, bilateral wheezing lung sound, excessive sweating. What is going on? What is treatment?
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!
Wheezing lung sounds indicate what lung pathology? What two lung diseases may show wheezing breathing sound?
obstructive lung disease
- Asthma, chornic bronchitis
pulse indicates HR. what is normal pulse range?
60-100 bpm
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?
- 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
Q 6. What are non-glucose polysacchrides (3)? Which one has the fastest metabolism? why?
- mannose, fructose, galactose
- fructose has the fastest metabolism because it bypass PFK-1. Fructose can enter directly to glyceraldehyde-3-P in glycolytic pathway
Q 7. Which nerve is in close proximity to inferior thyroid artery? What would be complication of thyroidectomy?
recurrent laryngeal nerve
During ligation of inferior thyroid artery in thyroidectomy, damage to recurrent laryngeal nerve can cause hoarseness
Q 8. What is key difference between schizoaffective disorder vs. bipolar disorder with psychotic features?
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).
Q 9. Pharyngeal arches are derived from what two cell types?
- mesoderm
- neural crest
Q 9. What is Treacher Collins syndrome?
neural crest dysfunction leading to malformation of 1st/2nd pharyngeal arch derivatives: mandibular hypoplasia, facial abnormalities
Three things to think about recurrent laryngeal nerve?
- laterally loops ductus arteriosus (or ligamentum arteriosum)
- run close proximity to inferior thyroid artery
- can be compressed (thus hoarseness) by mediastinal mass
Go over branchial apparatus and its derivaties
note P. 28
FA p.568- p.570
Q 10. Medicare
- who is eligible
- part A covers what?
- part B ?
- part C?
- part D?
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
Who is eligible for medicaid?
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
Q 11. What is thrombin time? What does prolonged thrombin time mean?
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)
Q 13. ECG: irregular rhythm, no P wave, narrow QRS. diagnosis?
A Fib
Q 13. Atrial fibrilation
- How is it initiated?
- what determines ventricular contraction rate
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
Q 14. patellar fracture impairs what motion?
knee extension
Q 15. What disease is associated with “endoneuronal inflammatory infiltrate”? What is pathophysiology of this disease?
Guillain-Barre
autoimmune attack of peripheral myeline by antibodies against infection (campy): molecular mimicry
Q 15. What are treatment options for Guillain-Barre
plasmapheresis or IVIG
*steroid does NOT work
Q 18. gamma-glutamyl transferase
- location and function?
- elevated level is associated with what pathology?
gamma carboxylation in vitamin K dependent coagulation factors
elevated gamma-glutamyl transferase is associated with hepatic/biliary pathology. also alcohol liver disease
Q 18. What findings indicated worse prognosis in terms of liver function?
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
