3/15 UWORLD test # 44 Flashcards
Q 1. most common intra-abdominal organ that is susceptible to get injured by trauma?
spleen
Q 1. Spleen is derived from what embryological structure?
mesoderm
Q 2. Turner syndrome
- ovary?
- palate?
- kidney?
- chest?
- ovarian dysgenesis: streak ovary -> primary amenorrhea
- palate: high arched palate
- kidney: horseshoe
- shield chest: broadened & widely apart nipples
Q 3. Which organ is the most susceptible for embolic infarction? why?
kidneys
high perfusion rate to maintain GFR
Q 3. most common cause of
- systemic embolism
- pulmonary embolism
- systemic embolism: left side of heart, so atrial fibrillation (stasis -> emboli formation). systemic embolism also can be caused by endocarditis or MI
- PE: embolus entering right side heart, so DVT is the most common cause
Q 4. Primary spontaneous pneumothorax
- definition
- describe how it happens
- commonly affected group
- spontaneous formation of pneumothorax without underlying lung disease
- sudden increase in pressure -> break in visceral pleura
- > apical alveoli forms bleb -> bleb spontaneous ruptures through viscera
- thin, tall male. smokers
Q 5. Niemann-Pick disease
- what is big category of this disease
- missing enzyme
- accumulated substrate
- phenotypes (3)
- histologic finding
- lysosomal storage disease (LSD)
- sphingomyelinase
- sphingomyelin
- neurodegenration
- hepatomegaly
- cherry-red spot on macula
- foam cells (lipid laiden macrophage)
Q 6. Sudden onset of erectile dysfunction, followed by persistent erectile dysfunction. what is the most likely cause?
emotional stress
- buzz word: sudden onset. happens suddenly at one night
Q 7. Pulsus paradoxus: ECG finding
beat to beat variation QRS amplitude
Q 10. Repaglinide
- MOA
- name of another drug that works with same mechanism?
- blocks ATP dependent potassium channel in pancreatic beta cell membrane-> deplorization-> insulin release
: binding site is different from sulfonylurea - Nateglinide
Q 11. How ischemic damage occurs in subarachnoid hemorrhage?
- vasospasm-> vasoconstriction-> ischemic infarct
Q 11. What medication is proven for decreasing morbidity and mortality by reducing post subarachnoid hemorrhage vasospasm?
nimodipine (CCB)
Q 12. Compare symptoms of rupture: saccular aneurysm vs. Charcot-Bouchard aneurysm
- Saccular aneurysm: sudden onset of headache
- Charcot-Bouchard aneurysm: progressive neural deficit, headache may follow
Q 13. Effect of phenylephrine on
- vascular resistance
- Systolic pressure
- pulse pressure
- HR
phenylephrine: alpha agonist
- increased vascular resistance: vasoconstriction
- increased systolic pressure: increased afterload
- decreased pulse pressure: less stroke volume due to reflex
- decreased HR: reflex bradycardia
Q 15. Stool finding of vibrio cholrae infection? why?
sloughed epithelial cells & flecks of mucus
cholera is not inflammatory
Q 15. Stool finding of shigella? why?
lots of leukocytes-PMN, with (or w/o) red blood cells,
Dysentery
Q 15. Stool finding of salmonella typhi vs. salmonella spices?
salmonella typhi: leukocytes- PMN
salmonella spp.: leukocytes- mononuclear leukocytes.
Q 16. What is adenomyosis?
extension of endometrium into myometrium
Q 16. fibroid (reproductive)
- what is another fancy word
- what is it
- estrogen sensitive?
- histologic finding
- leiomyoma
- as leiomyoma suggests, it is benign smooth muscle tumor
- estrogen sensitive: may grow in size during pregnancy
- whorled pattern of smooth muscle bundles with well demarcated border
Q 17. Anatomy: where is iliacus? where is psoas major?
-
Q 18. Pancoast tumor
- most common location
- sensorimotor defects? (3) why?
- apex of lung
- weakness upper limb, ipsilateral shoulder pain, areflex of upper limb
Q 20. Following gastrotecomy, which nutrition should be given?
B12
water soluble vitamin
Q 21. Explain mechanism regarding rapid onset of propofol
propofol initially distributes to highly vascularized structure- brain
Q 21. Explain mechanism regarding rapid recovery from anesthetic action of propofol
site of anesthetic action of propofol is brain
As time goes by, propofol becomes redistributed to peripheral tissue/organ (less vascularized)
–> propofol is reduced in brain -> recovery
Q 22. intellectual disability- homocystinuria or Marfan? or both? or neither?
intellectual disability is only in homocysteinuira
Q 22. Cardiac manifestations of Marfan syndrome (2)
medial necrosis of aorta
:aortic incompetence/ dissecting aortic aneurysm
floppy mitral valve
Q 23. How hemosiderin looks like in microscope (not Prussian blue stained)
yellowish brown pigment
Q 25. Which pneumoconioses is visible on polarized microscopy?
silica
bifringement particle surrounded by fibrous collagen
*buzzword: FIBROUS & BIFRINGEMENT
Q 26. Which two carcinogens can cause hepatic angiosarcoma?
- arsenic
- vinyl chloride
Q 26. molecular marker of hepatic angiosarcoma?
CD 31 (PECAM)
Q 27. What muscular irregularity may be seen in narcolepsy? what is it called?
cataplexy
(cata-: destructing)
sudden loss of muscle tone precipitated by strong emotion (laughter)
Q 28. In patient who is currently on long term opioid therapy, what does buprenorphine do in terms of withdrawal effect?
buprenorphine works as partial agonist with strong affinity.
Thus with presence of other opioid agonists, buprenorphine will bind and trigger weaker response (partial agonist), PRECIPITATING withdrawal effect
Q 28. For patient who was taking opioid, but not taking currently, what does buprenorphine do in terms of withdrawal effect?
buprenorphine can be useful for relieving withdrawal effect
Q 28. Either buprenorphine or methadone can be used to treat opioid withdrawal symptoms. What is difference?
buprenorphine: long acting partial agonist
methadone: long acting FULL agonist.
Thus methdone will NOT precipitate withdrawal symtoms when given with other opioids
Q 29. Describe histologic feature of carcinoid tumor cells
From what cell is carcinoid tumor cells derive from?
uniform, oval/round shaped big nuclei
(check image from test # 44- Q29)
- neuroendocrine cells
Q 30. True vs. false diverticulum
true: all layers including MUSCULARIS
false: only mucosa & submucosa
Q 30. What is key term that describes pathogenesis of false diverticulum. what does this term mean?
pulsion
increased intraluminal pressure pushing (rePULSION) mucosa and submucosa outward
Q 31. What does “white microcytes” on blood smear mean?
hypochromic microcytic RBC
Q 31. What can cause iron deficiency anemia in postmenopausal, well nourished woman?
occult bleeding
- occult means hidden, so no apparent visual bleeding., still can’t rule out occult GI internal bleeding even though stool doesn’t seem to contain blood
Q 33. Mechanism of hepatocyte damage by HepB
Cytotoxic T cell killing HepB virus on hepatocyte cell surface can also damage hepatocyte cell surface.
HepB does NOT have virulence factor that DIRECTLY DAMAGES hepatocyte
Q 34. Effect of opioid on blood pressure? explain physiology
hypotension
opioid promotes histamine release
Q 35. What is Cushing’s ulcer?
acute gastritis caused after brain injury
brain injury -> increased ICP -> direct vagal stimulation
-> increased HCl release
Q 37. two bugs found on dental carries?
- Strep. virdian
- actinomycoses
