3/19 UWORLD test # 53

Question 1

Q 1. pancreatitis- > what pulm complication? explain pathophysiology

Answer 1

ARDS

pancreatitis -> release of cytokines & inflammatory mediators into circulation
-> infiltration into pulmonary interstitium and alveolar

Question 2

Q 2. What tissue is being degenerated in mitral valve prolapse?

Answer 2

MVP is considered as myxomatous degeneration (connective tissue degeneration)

• think valve leaflet and chordate tendineae as connective tissue

Question 3

Q 3. Define tertiary prevention

Answer 3

treating established condition with a goal of minimizing its progression or complications

Question 4

Define primary prevention. what about secondary prevention?

Answer 4

primary prevention: prevent before disease occur- vaccination

secondary prevention: screen early for and manage existing but asymptomatic disease (ex: pap smear for cervical cancer)

Question 5

Q4. which colonic polyp is neoplastic? What is two types of this polyp? which type is more aggressive

Answer 5

adenomatous polyp is malignant polyp
serrated polyp is pre-malignant

Villous adenomatous polyp is more aggressive than tubular form

Question 6

Q 5. Kid infected with Diptheriae with no previous vaccination? what is the best treatment? antibiotics? or passive immunity?

Answer 6

passive immunity (injecting anti-toxin antibody) is much more effective than antibiotics.

Question 7

Q 6. What are four primary strains of HPV that are associated with cervical cancer? What is primarily infection route of it?

Answer 7

HPV 16, 18, 31, 33

sexual route

Question 8

Q 6. What is vaginal douching? This will increase risk for what?

Answer 8

cleaning showering vagina after mens or intercourse
bacterial vaginosis ( gardenella will grow out)

Question 9

Q 7. What are two acid buffers in urine? How DKA will change these concentration

Answer 9

NH3 + H+ ==> NH4+
HPO4-+ H+ ==> H2PO4

DKA -> more acid in urin -> increased NH4+ and H2PO4

Question 10

Q 8. which cell mediates immune response against polysaccharide-toxoid conjugated vaccine?

Answer 10

T cell

Question 11

Q 10. Coxiella burnetii

• gram?
• symptom: what is fancy word for this? what is classic triad?
• transmission route
• lab findings (2)

Answer 11

• gram negative
• Q fever
  1. headache (retrorbital)
  2. fever
  3. pneumonia: lobular condensation on chest X ray
• aerosols, farm animals (sheep)
• hepatotoxcity (elevated liver enzymes) , thrombocytopenia

Question 12

Q 11. What is fontanel?

Answer 12

space between baby skull bones

baby’s skull bone is still growing to fill this empty space

Question 13

Q 11. Vitamin K deficiency in infants

• why is baby’s susceptible to vitamin K deficiency?
• clinical manifestations (3)

Answer 13

• gut flora (vitamin K synthesizer) is not well established
  + breast milk has very low vitamin K in it.
• intracranial hemorrhage -> altered mental status, large head circumference, bulging fontanel
• should not have trauma: different from abusive trauma that also can lead to increased ICP

Question 14

Q 14. two cardiac manifestations of Turner?

Answer 14

• bicuspid aortic valve

- coractation of aorta

Question 15

Q 15. Where does ductal carcinoma in-situ arise from?

Answer 15

arise WITHIN ductal LUMEN.

For invasive carcinoma, cancer cell outgrowth, penetrating basement membrane

Question 16

Q 16. What electrical disturbance is primarily responsible for symptoms of dehydration?

Answer 16

hyponatremia

with CTFR mutation, Cl- is not able to INTRACELLUARLY transported and so does sodium.
=> excess wasting of chloride and sodium

*hypochloermia is also noticed with CF, but it is usually asymptomatic. it is SODIUM that causes sign of dehydration

Question 17

Q 18. history of DVT, cerebral infarct: what heart defect may exist?

Answer 17

paradoxical embolism: somehow emboli from DVT bypass pulmonary circulation and enters to systemic. how?
=> ASD & foramen ovale!!

Question 18

Q 19. Patient with ST elevation ECG, died suddenly. what is most likely going on?

Answer 18

severe hypotension due to cardiac wall rupture

Question 19

Q 19. true ventricular aneurysm vs. pseudo ventricular aneurysm. what is difference? Which one can cause ventricular rupture?

Answer 19

true ventricular aneurysm: happens after extensive fibrosis.

pseudo ventricular aneurysm: happens during 3-14 days, all layers are sticking out -> easily get ruptured

Question 20

Q 22. Cidofovir

• MOA
• indication
• side effect

Answer 20

• inhibits viral DNA polymerase. does not require phosphorylation by viral kinase
• CMV retinitis, gancyclovir resistance HSV, VZV
• nephrotoxicity

Question 21

Q 24. buzzword for multiple sclerosis brain MRI?

Answer 21

periventricular plaques

Question 22

Q 26. What is pathogenesis of paraneoplastic cerebellar degeneration?

Answer 22

autoimmune antibody attacking cerebellar nerve fibers

Question 23

Q 27. where is piriform recess located? what nerve runs behind it? what reflex does this nerve mediate?

Answer 23

side of laryngeal orfice

internal laryngeal nerve (branch of vagus) runs behind it

internal laryngeal nerve mediates cough reflex (cough when upper respiratory tract is irritated)

Question 24

Q 28. End stage renal disease: what hematologic disorder may be seen? why?

Answer 24

end stage renal disease -> uremic toxin

uremic toxin prevents platelet aggregation
-> primary homeostasis defect

• it is called uremic bleeding

Question 25

Q 29. What is primary risk factor for mesothelioma?

Answer 25

Abstesosis

Question 26

What two markers can be used for diagnosis of mesothelioma?

Answer 26

• cytokeratin

- calretinin

Question 27

Q 30. Can syringomyelia cause loss of motor & vibrational/ proprioception?

Answer 27

yes.

at later stage of syringomyelia, it can expand to involve dorsal column, as well as lateral spinal tract

Question 28

Q 33. What is akathisia?

Answer 28

restlessness
inability to sit or stand in one position

• note that this is different from parkinsonism, which is more like cogwheel rigidity, pill rolling hand tremor, shuffling gait

Question 29

Q 36. absent ankle reflex, which nerve root is damaged?

Answer 29

S1

Question 30

Q 37. MI initially, then pain is exacerbated while swallowing. What does this suggests?

Answer 30

pericardial involvement

MI results in postinfarction fibrinous pericarditis
=> pain exacerbation with swallowing suggest involvement of posterior pericaditis

Question 31

Q 39. ATP citrate lyase mediates what reaction?

Answer 31

citrate -> acetyl-coA

during fatty acid synthesis

Question 32

Q 39. glycerol kinase mediates what reaction?

Answer 32

glycerol -> DHAP —> glucose

glycerol kinase also mediates gluconeogensis from glycerol, fatty acid break down product

fatty acid -> glycerol + TG (fatty acids)