3/18 UWORLD test # 51

Question 1

Q 1. methylphenidate

• what class of drug is this
• indication
• side effects (3)

Answer 1

• CNS stimulants (like amphetamine)
• ADHD
• side effects
  1. insomnia
  2. loss of appetite
  3. weight loss

Question 2

Q 2. What is the most severe complication of second hand smoke exposure to infant?

Answer 2

sudden infant death syndrome

baby unexpectedly die during sleep

Question 3

Q 4. Terbinafine

• MOA
• indication
• side effects (2)

Answer 3

• inhibition of squalene epoxidase
• dermatophytes, especially onychomycosis (nail)
• side effects
  1. GI, diarrhea
  2. hepatotoxicity

Question 4

Q 6. Type 1 muscle

• mitochondira rich or not? color appearance?
• what kind of general motion
• example

Answer 4

• mitochondria rich, red color
• slow twitch with oxidative phosphorylation
• paraspinal muscles (not forceful twitch)

ONE SLOW RED OX
type 1, slow twitch, red color, oxidation (mitochondria rich)

Question 5

Q 9. Vitamin A dependent hydroxlation during collagen synthesis happens in what cellular compartment?

Answer 5

rough ER

Question 6

compare rough ER vs. smooth ER

Answer 6

rough ER: continuous to nucleus, ribosome attached.
synthesis of secretory protein

smooth ER: lacks surface ribosome.
synthesis of steroid and detoxification of drugs

Question 7

What is Nissl body?

Answer 7

rough ER in neuronal cell.

dispersion of Nissl body throughout cytoplasm may be seen in chromatolysis (neuronal cell injury)

Question 8

Q 10. Where is Kiesselbach plexus (highly vascularized vessels within nasal cavity) located?

Answer 8

nasal septum

Question 9

Q 11. superior gluteal nerve

• mediates what muscle
• left superior gluteal nerve injury will lead to what abnormality in what position?
• Iatrogenic injury to sup.gluteal nerve can be caused by intramuscular injection in what gluteal region?

Answer 9

• gluteus medius/minimus
• left sup. gluteal injury
  => left gluteus medius/minimus dysfunction
  => impaired contraction of it when standing with left foot while right foot is lifted
  => hip tilted down toward right side
• injection to superior medial gluteal region can touch superior gluteal nerve, leading to injury

Question 10

Q 13. rapid onset insulin

• name 3 of them
• peak at when
• given when
• molecular basis for rapid onset

Answer 10

• LAG
  L- lispro
  A- aspaart
  G- glulisine
• peak at 45-75min
• given with meal for postprandial glucose control
• alteration of amino acids in B chain at C terminus
  => prevent polymerization -> rapid absorption

Question 11

Q 15. Why vaccine is not effective against N.gonorrhea?

Answer 11

antigenic variation of pilus proteins

=> they produce recombination each other to produce new antigenic types of phili

Question 12

Q 16. progressive weight loss, jaundice, palpable but non-tender gall bladder. What is going on?

Answer 12

adenocarcinoma at head of pancreas compressing common bile duct

• buzz word:
  1. progressive weight loss => should always think about possibility of cancer
  2. palpable, non tender gall bladder => must not be gall stone or cholesytitis. Something must be compressing structure around it to make it disintended

Question 13

Q 19. Sheehan syndrome

• what is this
• most commonly affected to whom?
• clinical findings (3)

Answer 13

• ischemic infarct of pituitary gland -> panhypopituitarism
• women who delivered baby, postpartum bleeding causes ischemic infarct
• anemia, low serum Na+ (low ACTH), low TSH

Question 14

Q 22. What type of urinary incontinence occurs in multiple sclerosis. Explain why

Answer 14

urge incontinence

multiple sclerosis -> demyelination

• > loss of inhibitory neuron on controlling bladder tone
• > hyperactive bladder tone

Question 15

Q27. Indole positive bug

• what does indole positive mean
• example

Answer 15

• indole positivity: ability to convert tryptophan into indole
• E.coli is indole positive.

Question 16

Q 28. What kind of anemia can alcohol cause?

Answer 16

macrocytic anemia

Question 17

Q 28. Most common cause of acute pancreatitis?

Answer 17

gall stone

Question 18

Q 28. causes of acute pancreatitis?

(hint: remember pneumonic?)

Answer 18

I GET SMASHED
I- idiopathic
G- gall stone
E- ethanol
T- trauma
S- steroid
M- mumps
A- autoimmune 
S- scorpion (interesting..)
H- hypertriglycemia, hypercalcemia
E- ERCP
D- drugs

Question 19

Q 29. congenital QT prolonged syndrome

• name two of them
• inheritance pattern
• other features to note?

Answer 19

-Romano-Ward syndrome
AD
no deafness

-Jervell and lange-Nelson
AR
sensorineural hearing deafeness

Question 20

Q 30. What kind of anemia will show increased LDH?

Answer 20

hemolytic anemia

Question 21

Q 30. Assuming otherwise body is functioning normally, what would be expected to be increased in anemia in general?

Answer 21

EPO

Question 22

Q 34. S-100 is marker for what tumors (2)? what cell origin?

Answer 22

melanoma
schwannoma

-Both of them are neural crest origin

Question 23

Q 36. nitroprusside

• MOA
• indication
• toxicity

Answer 23

• direct release of NO, increased cGMP -> vasodilation
• hypertensive crisis
• cyanide toxicity (nitroprusside can release cyanide directly)

Question 24

Q 36. antidote regimen for cyanide toxicity treatment. How does cyanide get metabolized?

Answer 24

nitrite followed by thiosulfate

nitrite: inductino of methemoglobin (high affinity to cyanide)
thiosulfate: SULFUR group donor -> detoxification

Question 25

Q 38. compare neurological manifestations of vitamin B1 deficiency vs. vitamin E deficiency

Answer 25

vitamin B1 deficiency
: polyneuritis, ataxia

vitamin E deficiency
: similar to B12 deficiency
- ataxia, loss of vibration/proprioception,

Question 26

What is physiologic role of vitamin E

Answer 26

anti-oxidant: prevents neuron and RBC against oxidative stress

Question 27

Q 39. Heart sound: what pathologic condition gives S4?

Answer 27

kicking against stiff ventricular wall

left ventricular hypertrophy