3/2 UWORLD test #29 Flashcards
Q 1. How splenic laceration causes shoulder pain?
abdominal irritation -> phrenic nerve innervating diaphragm -> C3-C5 root -> referral pain in shoulder
Q 2. Cavernous sinus houses which nerves (6)? What are symptoms associated with each nerve?
- post ganglionic sympathetic nerve chain -> Horner
- CN 3-> opthalmolegia
- CN 4-> opthalmoplegia
- CN 5-V1 -> decreased corneal sensation
- CN 5- V2 -> decreased maxillary sensation
- CN 6 -> opthalmoplegia
Foramen Rotundum & Foramen ovale + sympathetic
Describe how sympathetic nerve in face runs
: origin, first synapse, second synapse, targets
Hypothalamus
- > first synapse at spinal cord T1 lateral horn
- > run through sympathetic chain , second synapse at superior cervical ganglion
- > run along through internal carotid, cavernous sinus -> sweat gland/ eyelids
Q 4. patient with TB, treated with drug, and develops anemia. What is going on?
INH -> B6 depletion -> impaired ALA synthase -> sideroblastic anemia
Heme synthesis: discuss all steps that need vitamins as a cofactor
- Methylmalonic-coA -> succinyl-coA : B12
- SuccinylcoA- > ALA : B6
Lead poisoning impairs which 2 enzymes in heme synthesis?
ALAD
Ferrochelatase
Q 5. cellulitis -> antibIotic tx -> severely hypotensive, diffuse erythematous skin rash: what is going on?
drug induced anaphylaxis
Q 5. Name four compounds that mast cell release after its granulation?
Which one is relatively specific to mast cell so that its level can be used to confirm mast cell mediated anaphylaxis?
- tryptase
- heparin
- histamine
- leukotrienes
elevated tryptase can be used as a confirmation for anaphlyaxis
Q 5. What is 5-hydroxyindoleacetic acid? In what disease it can be elevated?
5-HIAA, breakdown product of serotonin
carcinoid
Q 5. In what disease can calcitonin elevated?
medullary thyroid cancer
Q 5. In what circumstance can myeloperoxidase elevated?
MPO is in neutrophil (this enzyme is used during respiratory burst). Thus infection or inflammation
Q 6. Describe how degranulation of mast cell occurs
antigen bound IgE attached on mast cell surface
-> antigen-IgE AGGREGATES, grouped together and cross-links
Q 7. Naloxone has antagonistic effect on which opioid receptor?
u (mu),
this receptor is the target for majority of opioid
Q 7. Describe effect of opioid binding in each receptor
- u
- k
- delta:
- u (mu): CNS, respiratory depression, constipation
- k (kappa): miosis
- d (delta): anti-depressent effect
Q 8. Three stop codon sequences?
우아, 우악, 우가
UAA, UAC, UGA
Q 8. What is nature of mutation in Duchenne? Which gene? What kind of mutation? What about Becker?
- Duchenne: frameshift or nonsense mutation on dystrophin -> truncated
- Becker: non-frameshifting insertion on dystrophin -> partial function impairment
Q 8. non-sense mutation vs. missense mutation
- non-sense: STOP codon
- missense: different amino acid
Q 11. What is narcolepsy? What is molecular marker for narcolepsy? how its level changed in CSF analysis? where is it produced?
- excessive drowsiness during day, suddenly falling into sleep
- Hypocretin-1
- lateral hypothalamus
Q 11. What molecular marker can be used for diagnosis of Creutzfeldt-Jakob disease?
14-3-3 protein in CSF
Q 14. Function of ANP (atrial natriuretic peptide) in
- renal vasculature
- systemic vasculature
- adrenal gland
- renal vasculature: afferent arteriole dilation-> increase GFR
- systemic vasculature: vasodilation
- adrenal gland: inhibit aldo synthesis
Q 15. Where is enteropeptidase located? what is its function?
- intestinal brush border
convert chymotrypsin -> trypsin
Trypsin then cuts other zymogens
Q 16. Eye opening vs. Eye closing
- which muscle?
- what cranial nerve?
- eye opening
: CN3, levator palpebrae
-eye closing
: CN7, orbicularis oculi
Q 16. Inward deviation of eye is due to defect in what cranial nerve?
CN6 (abducens)
lateral rectus is impaired
Q 16. List four phenotypes of CN3 palsy. mechanism of each abnormality?
- ptosis (eye drooping): levator palpebrae
- down-out eye: ocular muscles except SO, LR
- impaired accomodation: parasympathetic- ciliary muscle
- mydriasis: parasympathetic- sphincter
Q 17. Describe failure in what embryological stage leads to cleft lip
failure of fusion of medial nasal process (which will become intermaxillary segment) with maxillary process
Q 18. What is foam cells in development of artherosclerosis? What is gross appearance?
lipid laiden macrophages
raised yellow spots within artery wall
Q 20. What is the most common case for sudden cardiac death from MI?
V fib
Q 21. Anatomy: which arteries supply ureter
- proximal ureter (1)
- distal ureter (3)
- proximal: renal artery
- distal: external iliac, internal iliac, vescial artery
Q 22. Which bacteria synthesizes dextrans from sucrose? How is this related to pathogenesis?
Strep virdians
Dextrans attach to fibrin-platelet aggregate, housing on valve and cause valvular disease
Q 23. Antifungal agents: azoles vs. echinocandins
- target?
- location of target?
azole: cell membrane (ergosterol)
echinocandins: cell wall (polysacchiride)
Q 24. What amyloid deposits in myocardium, causing infiltrative restrictive cardiomyopathy?
transthyretin
Q 27. Restless leg syndrome
- presentations
- medication for tx
- abnormal sensation of legs (may be hard to describe), urge to move legs (especially during sleep) & rapid relief with movement
- dopamine agonist
Q 31. Cryoprecipitate vs. Frozen Fresh Plasma (FFP)
- contents
- indications
- cryoprecipitate
: only cold soluble factors (factor 8, factor 13, fibrinogen, vWF) => coagulation factor deficiencies involving factor 8 & 13 - FFP
: all coagulation factors => rapid reversal of warfarin, DIC
Q 32. What 3 biosynthesis can NADPH be used?
- fatty acid synthesis
- cholesterol
- steroid
Q 34. What is Reid index? (how do you calculate it?) It can be used for diagnosis of what disease?
- thickness gland mucosal layer/ thickness between epithelium & cartilage (cartilage NOT involved)
- Reid index higher than 50% is diagnostic criteria for chronic bronchitis
Q 36. Dihydroegortamine
- indication
- side effect
- acute miagraine
- vasospasm -> prinzmetal (variable) angina
Q 37. What are two good diagnostic tools for vertebral osteomyelitis?
- MRI
- blood culrture
Q 37. serum protein electrophoresis is diagnostic tool for what disease?
gammaglobulin pathy- ex: multiple myeloma
Q 37. CT myelogram
- diagnostic tool for what disease?
- indcation
- also vertebral pathology ( vertebral osteomyelitis, spine stenosis)
- more invasive than MRI, usually reserved for pts who can not do MRI (pacemaker, metallic implant)
Q 38. What can exacerbate Wernike encephalopahty? why?
glucose infusion
excess glucose will deplete B1, which is required in glycolysis/ TCA as TPP
Q 39. What two prior infections predispose to PID (Pelvic Inflammatory disease?
- chlamydia
- N. gonorrhea
