3/16 UWORLD test #47 Flashcards
Q 1. Two factors that predispose testicular torsion?
trauma
bell clapper deformity (congenitally horizontal positioning of testis)
Q 1. complication of hydrocele?
indirect hernia
- why indirect?
indirect hernia is only hernia that can pass through deep inguinal ring. Organs may pass through deep inguinal ring, migrate down to spermatic cord and to scrotum
(If patent processus vaginalis is big enough, organs)
Q 1. How Valsalva maneuver does change size of hydrocele? why?
valsalva maneuver -> decreased venous return
-> more blood hanging out in the vein (including spematic veins) -> enlargement of hydrocele
Q 3. Define viral recombination
Exchange of partial genomes via recombination between viral strains. Progenies will maintain altered genome information.
- buzz word: If drug resistance is acquired by recombination, subsequent progeny also maintain the resistance as genome is changed
Q 3. Define viral phenotype mixing. How does it differ from viral recombination?
While MAINTAINIG genome, one viral strain obtain envelop or nucelocapsid proteins from another viral strain when mixed together.
Progenies will essentially lose these new protein as genome is unchanged
vs. recombination, where genome is changed and maintained in subsequent progenies
Q 5. What compound inhibits carnitine acyl transferase (CAT) in beta oxidation?
malonyl-coA
Q 6. Diagnosis
- hemoglovin: 8.5 (man: 13.5-17.5)
- serum creatinine: 2.2 (0.6-1.2)
- Serum Ca2+: 10.6 (8.4-10.2)
anemia, renal disease, slight hypercalcemia
-> multiple myeloma
anemia- plasma cells infiltrate bone marrow
renal disease- amlyoidosis (immunoglobin light chain)
hypercalcemia- osteoclast activating factors released by tumor cells
Q 6. Bortezomib
- composition
- MOA
- indication
- boronic acid containing dipeptide
- proteosome inhibitor
- multiple myeloma:
impaired proteosomal degradation of irregular immunoglobulins -> apoptosis
Q 8. Danzaol
- MOA
- indication
- side effect
- synthetic androgen receptor agonist
- endometriosis: suppression of estrogen via negative feedback against gonadotropin
- androgenic effect: hirshitism, virlization
Q 10. How PAH is renally handled? What if PAH concentration is high? PAH clearance is good estimation for what?
- 100% excretion
: filtration + secretion (carrier enzyme mediated process)
=> because secretion requires carrier enzyme, which can be saturated, at hight level of PAH, it can get saturated and PAH will not be 100% excreted
- renal plasma flow
Q 12. femoral neck & head is supplied by what artery?
medial femoral circumflex
check FA p.427
Q 13. Acute phase reactant production is mediated by what interleukin?
IL-6
Q 13. What molecule is associated with severity of Giant cell arthritis
IL-6!
Q 14. cresendo-decresendo systolic murmur at apex that increases while standing up. What heart condition is this? What medications (2) needed to be avoided
APEX/ attenuated murmur with decreased venous return
-> HCM
Drugs that decrease venous return should be avoided
- nitrates
- diuretics
Q 15. Flaccid bullae vs. bullous
flaccid means: hanging loosely
Thus flaccid bullae: bullae hainging loosely so that it can easily get ruptured (positive Nikolsky sign)
-> pemphigus vulgaris
bullous: negative Nikolsky sign -> Bullous pemphigoid
Q 16. Two possible medications for panic attack? Which one is more preferred? why?
BDZ, SSRI
SSRI is more preferred due to abuse potential of BDZ. patient with prior drug abuse history especially should be avoided for BDZ
Q 18. Shoulder injury, deltoid flattened. Injury to what nerve?
axillary nerve
Q 19. PaO2 vs. PaCO2: which one is direct indicator for ventilation status?
PaCO2
Q 19. Can PaO2 become low during hyperventilation? expalin
YES.
hyperventilation may be caused by V/Q mismatch.
If V/Q mismatch is the reason, high alveolar O2 is not perfused to artery. leading to low PaO2
*PaO2 can be either high or low in hyperventilation. So PaO2 is NOT a good indicator for ventilation status
Q 20. Hypercellular glomeruli on light microscopy, RBC cast, proteinuria, hematouria. Diagnosis?
PSGN
What is caput medusae? what disease is commonly associated with it?
distorted and engorged superficial epigastric veins in periumbilical area
portal HTN, liver cirrhosis
Q 23. What is mesalamine? indication? another similar drug?
- 5-aminosalicylic prepareation (anti-inflammatory)
- used for treatment of ulcerative colitis
- similar mechanism of sulfasalazine
(5-aminosalicylic preparation+ sulfapyridine, anti-biotic)
Absence of what GI parts result in B12 deficiency? (2)
- stomach (parietal cells)
- terminal ileum (where B12 is absorbed)
Q 24. bug in plasma- aggultination on cold tempeature, but rapidly uncoagulates when exposed to warm temperature. What bug is this?
Mycoplasma
only bug that can do cold agglutination
- remember sketchy: RBC is surrounded by snow flake
Q 25. explain dimorphic feature of candida
cold- budding yeast & pseudohyphae
warm- germ tube (true hyphae)
Q 27. Alcoholics with poor oral hygiene has increased risk for what?
aspiration pneumonia
respiratory depression-> foods in mouth can go to lung with oral bacteria
Q 27. Which antibiotic has good coverage for aspiration pneumonia?
clindamycin
- clindamycin above diaphragm, metronidazole below diaphragm
Q 28. Medulloblastoma vs. pilocytic astrocytoma
- simliarities (2)
- differences - origin & prognosis(2)
similarities
- kid brain tumor
- both arise from cerebella
differences
- medulloblastoma: neuroectoderm origin
pilocytic astrocytoma: astrocyte origin
- medulloblastoma: high grade, pleomorphic/giant nuceli
pilocytic astrocytoma: releatively low grade, good prognosis
Q 29. Gram negative, bean shaped diplococci: what bug is this?
N. meningitis
Q 29. What virulence factor of N.meningitis is associated with mortality & morbidity of meningitis?
outer membrane lipooligosaccharide
: can cause septic shock
- equivalent to LPS of gram negative enteric bacteria
- polysaccharide capsule is also important virulence factor of N. meningitis for antiphagocytic effect. But it is not associated with mortality/morbidity of disease
Q 30. How nephrotic syndrome may cause varicocele?
proteinuria
- > loss of anticoagulation factors (antithrombin, for example)
- > hypercoagulable state -> renal vein thrombosis (RVT)
Q 31. Other than skin & renal manifestations, what other two manifestations can Henoch-Shonlein purpura?
- joint: arthralgia
- GI: abdominal pain, abdominal edema, intussusception
Q 33. Acute leukemia: how does level of below. change? why?
- Hb
- platelet
- leukocytes
ALL may (but NOT NECCESARRILY) low
- anemia
- bleeding
- infection
blasts crowd out bone marrow, impairing normal hematopoeisis
Q 36. How level of urinary citrate affects calcium oxalate kidney stone formation?
citrate in urine prevents calcium kidney stone formation by binding to calcium
: less urinary citrate -> more calcium oxalate stone
- In fact, one treatment option for calcium oxalate kidney stone is citrate
Q 37. Calcipotriene (not in FA)
- MOA
- indication
- binds/ activates vitamin D receptor, a nuclear transcription factor that causes inhibition of keratinocyte proliferation & stimulation of keratinocyte differentiatoin
- psoirasis
Q 37. Ustekinumab (not in FA)
- MOA
- indication
- target IL-12 & IL-23
- psoriasis
