3/16 UWORLD test # 46 Flashcards
Q 2. Empiric use of penicillin for bacterial pharyngitis in developing country: may also reduce what?
cardiac disease
- remember Group A strep
pharyngitis -> rheumatic fever
vitiligo -> PSGN - also another buzz word: DEVELOPING COUNTRY
Acute rheumatic fever is prevalent in developing country
Q 2. Two good medications for group A strep?
penicilin
clindamycin: for severe infection
Q 2. Can empiric use of penicillin reduce PSGN occurrence?
NO.
penicillin is proven for reducing rheumatic fever, but not PSGN
Q 4. Three possible mechanisms for trisomy in Down syndrome?
- meiotic non-disjunction: either meiosis 1 or 2
- translocation: t(14;21)- long arm of 21 (functional 21) is translocated to 14
- mosaicism
Q 4. Define uniparental disomy.
Which step of meiosis has error in
- heterozygous
- homozygous
receiving two chromosomes from one parent only
- heterozygous: meiosis 1 error
- homozygous: meiosis 2 error
Q 6. Can psoriatic arthritis cause deformity?
YES.
pencil-in-cup deformity is classic
It can present very similarly as rheumatoid arthritis
Q 6. Is psoriasis associated with pulmonary fibrosis?
NOPE
In fact, pulmonary fibrosis is NOT associated with any of seronegative spondyloarthritis
What rheumatologic diseases are associated with pulmonary fibrosis (3)?
- sarcoidosis: pulmonary manifestation (ILD, pulmonary HTN) is the most common cause of death in sarcoidosis
- scleroderma
- RA
- no SLE, no seronegative spondylitis
Q 7. low grade fever, RUQ pain upon palpation, dark urine. Patient came back from traveling to Mexico. What is going on?
Acute Hepatitis A
mild acute presentation
- HepA is the most common cause of acute viral hepatitis in young adults who just returned from endemic region
- buzz word: MEXICO- endemic region of HepA
Q 7. Describe histologic findings (3) of liver biopsy of HepA
- hepatocyte swelling: ballooning degeneration with cytoplasmic emptying
- monocyte infiltration
- eosinophilia (Councilman bodies)
check image of test #46-Q7
Describe histologic finding of liver biopsy of HepB.
This change is mediated by what cell?
eosinophilic groundglass appearance
mediated by cytotoxic T cells
Q 8. Describe morphology of plasma cell in blood smear.
wagon wheel, giant nuclei.
cell looks similar to blast, but nuceli is huge
- check image of test #46-Q8
Q 9. Kid, fever, conjunctival injection, bright red tongue, non-pitting edema on hands/foots. Diagnosis?
Kawasaki
- buzz words
- bright red tongue: strawberry tongue
- non-pitting edema on hands/foots: abnormal hand/foot. Erythema is also common
Q 9. Serious complication of Kawasaki disease?
coronary artery aneurysm
Q 10. 5 symptoms of cocaine withdrawal
- hyperphagia: binge eating
- hypersomina
- vivid dreams
- depression
- fatigue
4 symptoms of Marijuana withdrawal
- decrease appetite
- insomnia
Above two are main difference with cocaine withdrawal - irritability
- anxiety
- withdrawal
- cocain: you can’t sleep, eat like crazy
- marijuana: so sleepy, not interested in eating. I will just sleep
Q 12. Is PTH associated with renal calcium handling? If so, how?
YES
PTH works not only on phosphate clearance, but it also stimulates Ca2+ reabsorption from urine via Ca2+/Na+ channel on apical side at DCT
Q 14. PML (progressive multifocal leukoencephalopathy ): infection to what virus? what viral family? DNA?RNA? envelope?
JC virus
(Junky Cerebrum)
polyomavirus
dsDNA, not enveloped
Q 14. Apart from infulenza virus, what another virus family also encodes hemagglutinin. what is its function?
paramyxovirus
(infuenza virus is orthomyxovirus, so MYXOVIRUS expresses hemagglutinin)
- hemagglutinin mediates viral attachment to membrane
Q 14. CNS complication of measles virus? symptoms?
subacute sclerosing panencephalitis (SSPE)
Q 15. Urea reabsorption at kidney is mediated by what hormone? at which segment of nephron?
ADH
medullary collecting duct: important for maintaining high medullary concentration gradient
- This makes sense, it only water is being reabsorbed, concentration gradient will not be maintained. It needs solute. and that solute is urea
Q 16. thalamic nucleus: what information relays through it?
- VPL
- VPM
- Lateral geniculate
- Medial geniculate
- VL
- VPL: primary somatosensory
- VPM: primary sensory for trigeminal (Masking=face)
- LG: visual (Light)
- MG: auditory (Music)
- VL: primary motor
Q 17. What does brain cavity with clear fluid suggest?
liquefactive necrosis
brain: fatty -> liquefactive necrosis mostly due to brain infarcts
Q 17. lacunar infarct
- definition
- common site
- most common etiology
- infarct in small vessel
- deep brain structure
- lipohyalinosis -> vasocclusion
Q 19. Menstural cycle in PCOS? why?
irregular mestural cycle
High LH -> androgen from theca interna -> estrone -> decreased FSH -> less follicle stimulation ->anovulation
Q 20. Clomiphene
- MOA
- indication
- side effects (2)
- selective estrogen receptor antagonist (SERM)
at hypothalamus
-> inhibition of negative feedback from estrogen -> more LH/FSH - PCOS, infertility due to anovulation
- side effects: hot flashes (estrogen), ovarian enlargement
Q 23. Vancomycin resistance on bacterial cell wall?
D-ala-D-ala –> D-ala-D-lac
Q 27. Three complications of enterococci infection
- endocarditis
- UTI
- biliary tract infection (bile resistant)
Q 29. what class of drug is oxycodone?
opioid
Q 30. Kid, sore throat, restless/involuntary jerking. what is going on?
Rheumatic fever
restless/involuntary jerking: Sydenham chorea
Q 30. Early dementia: associated with what disease?
Down syndrome
amyloid-Beta is in chromosome 21
Q 32. etiology of diffuse esophageal spasm?
impaired inhibitory innervation on esophageal myenteric plexus
Q 34. Why drug free interval is necessary when taking nitrate? (1 in morning, 1 in afternooon, and no in night)
to avoid tolerance development
Q 35. Inheritance pattern of G6PD deficiency
X- linked recessive
only men eat bites of Fava bean with Heinz ketchup!
Q 36. DRESS syndrome
- definition
- drugs (5) that can cause it
- clinical presentations (4)
- lab finding
- Drug Reaction with Eosinophilia and Systemic Symptoms
- phenytoin, carbamazepine, vancomycin, sulfasalazine, allopurinol
- fever, diffuse/mobile rash, facial swelling, lymphadenopathy
- eosinophilia
Q 37. How long should depressive symptoms last to meet major depressive disorder diagnosis criteria? how many for SIGECAPS
> 2 weeks
> 5 or more SIGECAPS symptoms
Q 37. SIGECAPS for major depressive disorder?
S- sleep disturbance I- loss of Interest G- guilt E- energy loss C- concentrate A- appetite P- psychomotor retardation or agitation S- suicidal ideation
Q 38. pathophysiology of pancreatic insufficiency in cystic fibrosis?
production of thick mucus -> obstruction & inflammation of pancreatic duct
Q 39. What is normal Aa gradient?
10-15mmHg
