3/14 UWORLD- test # 41 Flashcards
Q2. PrP structural conversion from alpha helix to beta pleated sheet
- what disease is this?
- histological change?
Creutzfeldt-Jakob disease (mad cow disease)
spongiform transformation of grey matter
Q 1. Ecocardiogram: aorta lying anterior, inferior, and to right of pulmonary artery.
- what is going on?
- which embryological step is messed up?
- transposition of great vessels
- failure of aorticopulmonary septum spiraling
transposition of great vessels occur as aorticopulmonary septum develops in parallel (without spiraling)
Q 3. What protein does RAS encode? This protein is in active form when bound to what molecule?
G-protein that mediates RAS-MAPK signaling pathway
GTP bound form is active form
Q 6. What is null hypothesis? What is alternative hypothesis?
null hypothesis: hypothesis claiming no difference
alternative hypothesis: hypothesis claiming there is difference
Q 6. What is type 1 error? (alpha)
rejecting null hypothesis even though there is no difference in reality
Q 6. What is type 2 error? (beta)
accepting null hypothesis even though there is difference in reality
REJECTING NULL FIRST, ACCEPT NULL SECOND
rejecting null hypothesis- type 1 error
accepting null hypothesis- type 2 error
Q 6. What is statical power?
1-beta. related to probability of making type 2 error. The greater the statistical power is, the less chance for making type 2 error
Q 8. Psychological term “operant conditioning”
- definition
- what are two types? define/example for each
- behavior is produced as it produces punishment or award
- punishment: decrease behavior
- positive: giving decrease behavior
- negative: removal of award decrease behavior - reinforcement: increase behavior
- positive: giving award increases behavior
- negative: removal of punishment increases behavior
*POSITIVE or NEGATIVE = GIVING or REMOVAL
Q 9. What does metyrapone do? what is metyrapone stimulation test look for?
- metyrapone blocks 11-beta-hydroxylase, preventing cortisol synthesis
- metyrapone stimulation test detects whether hypothalamus-pituitary axis is intact. with normal HPA response, blockade of 11-beta-hydroxylase should stimulate further release of ACTH
Q 10. bad news. patient does not want to know it possibly due to cultural values. Should physician inform the bad news?
no.
patients have their right to refuse to receive medical information
Q 11. CGD- increased risk of infection to what bugs?
catalase positive
N- Norcadia P- Pseudomona L- Listeria A- Aspergilios C- Candida E- E coli S- Staph S-Serratia B- B cepacia H-H.pylori
Q 14. Strep pneumo: cocci? or diplococci?
diplococci
Q 15. Fever, vomiting, diarrhea, muscle plains, diffuse macular rash resembling sun burn. What is going on?
toxic shock syndrome (TSS)
Q 15. TSS (toxic shock syndrome) is mediated by what two cells?
T cells and macrophage
macrophage as antigen presenting cell -> clonal expansion of T cells
Q 16. Is etanercept monoclonoal antiboy? what is it?
soluble receptor decoy protein (TNF-alpha receptor)
Etanercept is NOT monoclonal antibody
Q 19. With continuous infusion of drug that follows fist-order kinetics, when does drug reach to steady-state level?
about 4-5 half life
Q 20. What is macrosomia? what is the common cause of it?
big fetus
maternal diabetes with poor glycemic control
Q 20. macrosomic baby due to maternal diabetes. Will baby have transient or persistent hypoglycemia? why?
transient hypoglycemia
insulin synthesized by baby due to glucose transferred from mom will degenerate in several days.
Q 21. What is cardiac manifestation of carcinoid syndrome? which side?
valvular fibrous plaques Right side (before entering pulmonary system)
Q 22. For what is D-xylose absorption test used for? what disease? Is it pancreatic enzyme dependent?
D-xylose is monosacchride that does not need to be broken down by pancreatic enzyme. Pancreatic enzyme independent.
D-xylose absorption test is used for brush boarder integrity. Can be used for celiac disease diagnosis
Q 24. What is calcitriol?
active vitamin D: (1,25)- OH
Q 25. What is leucovorin? what is it used for
folinic acid
to reverse methotrexate induced myelosuppression
Q 24. polycystic kidney disease. Changes in - phosphate - PTH - calcitriol explain physiology
- phosphate: increased, due to reduced phosphate excretion
- PTH: increased, to get rid of phosphate
- calcitriol: decreased, hyperphosphatemia induces
FGF-23 expression (Fibroblast Growth Factor-23), which blocks phosphate reabsorption. FGF-23 also inhibits calcitriol synthesis. - it is PHOSPHATE that triggers everything
Q 27. Ciprofloxacin: interaction with CYP-450?
CYP-450 inhibitor
Q 29. indication of clozapine?
(other) treatment resistant schizophrenia
- think like this: clozapine can cause nasty side effects (agranulocytosis, cardiac myopathy), you only use it for treatment resistant schiz.
In fact, clozapine is the only drug known for superior efficacy for treatment resistant schiz
Q 31. lysed strain A bacteria (that has virulence factor) + live strain B bacteria (that does not have virulence factor)
=> gained infectivity. What mechanism is this?
transformation
DNA released from lysed bacteria is intracellulary transformed to live bacteria, and incorporated into genome => infectivity
Q 32. neutrophil findings in megloblastic anemia? why?
hypersegmented neutrophil
megaloblastic anemia is caused by impaired DNA synthesis, making cells divide less.
Less cell division leads to hypersegmentation in neutrophils
Q 33. What is parakeratosis? example?
retention of nuclei in corneum startum
ex: psorasis
Q 33. Actinic keratosis has increased risk for developing what skin disorder? What predicts its likely to happen?
squamous cell carcinoma
degree of epithelial dysplasia is proportional to risk of squamous cell carcinoma development
Q 34. What is pulmonary septic emboli
septic infection may cause tricuspid valve endocarditis (most likely to IV drug users), causing emboli formation
Q 35. Suggestion to reduce recurrent kidney stone?
copious water drinking
hydration can dissolve stones
Q 37. How does selective arteriole dilator causes increased sodium and fluid retention?
selective arteriole dilator -> baroreceptor sensor due to lowered BP -> increased sympathetic tone -> b1 receptor on JGA -> more renin
Q 38. How may multiple sclerosis affect bladder?
bladder hypertonia
-> urinary incontinence
Q 39. What part of female reproductive system shows cuboidal epithelial on histology?
ovary
Q 40. Which part of aorta is the most common site of rupture due to trauma?
aortic isthmus (near the point where ligamentum arteriosum is attached)
