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UWORLD first pass- week 5 > 3/2 UWORLD test #29 > Flashcards

3/2 UWORLD test #29 Flashcards

1
Q

Q 1. How splenic laceration causes shoulder pain?

A

abdominal irritation -> phrenic nerve innervating diaphragm -> C3-C5 root -> referral pain in shoulder

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2
Q

Q 2. Cavernous sinus houses which nerves (6)? What are symptoms associated with each nerve?

A
  • 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

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3
Q

Describe how sympathetic nerve in face runs

: origin, first synapse, second synapse, targets

A

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
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4
Q

Q 4. patient with TB, treated with drug, and develops anemia. What is going on?

A

INH -> B6 depletion -> impaired ALA synthase -> sideroblastic anemia

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5
Q

Heme synthesis: discuss all steps that need vitamins as a cofactor

A
  • Methylmalonic-coA -> succinyl-coA : B12

- SuccinylcoA- > ALA : B6

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6
Q

Lead poisoning impairs which 2 enzymes in heme synthesis?

A

ALAD

Ferrochelatase

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7
Q

Q 5. cellulitis -> antibIotic tx -> severely hypotensive, diffuse erythematous skin rash: what is going on?

A

drug induced anaphylaxis

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8
Q

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?

A
  • tryptase
  • heparin
  • histamine
  • leukotrienes

elevated tryptase can be used as a confirmation for anaphlyaxis

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9
Q

Q 5. What is 5-hydroxyindoleacetic acid? In what disease it can be elevated?

A

5-HIAA, breakdown product of serotonin

carcinoid

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10
Q

Q 5. In what disease can calcitonin elevated?

A

medullary thyroid cancer

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11
Q

Q 5. In what circumstance can myeloperoxidase elevated?

A

MPO is in neutrophil (this enzyme is used during respiratory burst). Thus infection or inflammation

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12
Q

Q 6. Describe how degranulation of mast cell occurs

A

antigen bound IgE attached on mast cell surface

-> antigen-IgE AGGREGATES, grouped together and cross-links

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13
Q

Q 7. Naloxone has antagonistic effect on which opioid receptor?

A

u (mu),

this receptor is the target for majority of opioid

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14
Q

Q 7. Describe effect of opioid binding in each receptor

  • u
  • k
  • delta:
A
  • u (mu): CNS, respiratory depression, constipation
  • k (kappa): miosis
  • d (delta): anti-depressent effect
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15
Q

Q 8. Three stop codon sequences?

A

우아, 우악, 우가

UAA, UAC, UGA

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16
Q

Q 8. What is nature of mutation in Duchenne? Which gene? What kind of mutation? What about Becker?

A
  • Duchenne: frameshift or nonsense mutation on dystrophin -> truncated
  • Becker: non-frameshifting insertion on dystrophin -> partial function impairment
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17
Q

Q 8. non-sense mutation vs. missense mutation

A
  • non-sense: STOP codon

- missense: different amino acid

18
Q

Q 11. What is narcolepsy? What is molecular marker for narcolepsy? how its level changed in CSF analysis? where is it produced?

A
  • excessive drowsiness during day, suddenly falling into sleep
  • Hypocretin-1
  • lateral hypothalamus
19
Q

Q 11. What molecular marker can be used for diagnosis of Creutzfeldt-Jakob disease?

A

14-3-3 protein in CSF

20
Q

Q 14. Function of ANP (atrial natriuretic peptide) in

  • renal vasculature
  • systemic vasculature
  • adrenal gland
A
  • renal vasculature: afferent arteriole dilation-> increase GFR
  • systemic vasculature: vasodilation
  • adrenal gland: inhibit aldo synthesis
21
Q

Q 15. Where is enteropeptidase located? what is its function?

A
  • intestinal brush border

convert chymotrypsin -> trypsin
Trypsin then cuts other zymogens

22
Q

Q 16. Eye opening vs. Eye closing

  • which muscle?
  • what cranial nerve?
A
  • eye opening
    : CN3, levator palpebrae

-eye closing
: CN7, orbicularis oculi

23
Q

Q 16. Inward deviation of eye is due to defect in what cranial nerve?

A

CN6 (abducens)

lateral rectus is impaired

24
Q

Q 16. List four phenotypes of CN3 palsy. mechanism of each abnormality?

A
  • ptosis (eye drooping): levator palpebrae
  • down-out eye: ocular muscles except SO, LR
  • impaired accomodation: parasympathetic- ciliary muscle
  • mydriasis: parasympathetic- sphincter
25
Q

Q 17. Describe failure in what embryological stage leads to cleft lip

A

failure of fusion of medial nasal process (which will become intermaxillary segment) with maxillary process

26
Q

Q 18. What is foam cells in development of artherosclerosis? What is gross appearance?

A

lipid laiden macrophages

raised yellow spots within artery wall

27
Q

Q 20. What is the most common case for sudden cardiac death from MI?

A

V fib

28
Q

Q 21. Anatomy: which arteries supply ureter

  • proximal ureter (1)
  • distal ureter (3)
A
  • proximal: renal artery

- distal: external iliac, internal iliac, vescial artery

29
Q

Q 22. Which bacteria synthesizes dextrans from sucrose? How is this related to pathogenesis?

A

Strep virdians

Dextrans attach to fibrin-platelet aggregate, housing on valve and cause valvular disease

30
Q

Q 23. Antifungal agents: azoles vs. echinocandins

  • target?
  • location of target?
A

azole: cell membrane (ergosterol)
echinocandins: cell wall (polysacchiride)

31
Q

Q 24. What amyloid deposits in myocardium, causing infiltrative restrictive cardiomyopathy?

A

transthyretin

32
Q

Q 27. Restless leg syndrome

  • presentations
  • medication for tx
A
  • abnormal sensation of legs (may be hard to describe), urge to move legs (especially during sleep) & rapid relief with movement
  • dopamine agonist
33
Q

Q 31. Cryoprecipitate vs. Frozen Fresh Plasma (FFP)

  • contents
  • indications
A
  • 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
34
Q

Q 32. What 3 biosynthesis can NADPH be used?

A
  • fatty acid synthesis
  • cholesterol
  • steroid
35
Q

Q 34. What is Reid index? (how do you calculate it?) It can be used for diagnosis of what disease?

A
  • thickness gland mucosal layer/ thickness between epithelium & cartilage (cartilage NOT involved)
  • Reid index higher than 50% is diagnostic criteria for chronic bronchitis
36
Q

Q 36. Dihydroegortamine

  • indication
  • side effect
A
  • acute miagraine

- vasospasm -> prinzmetal (variable) angina

37
Q

Q 37. What are two good diagnostic tools for vertebral osteomyelitis?

A
  • MRI

- blood culrture

38
Q

Q 37. serum protein electrophoresis is diagnostic tool for what disease?

A

gammaglobulin pathy- ex: multiple myeloma

39
Q

Q 37. CT myelogram

  • diagnostic tool for what disease?
  • indcation
A
  • also vertebral pathology ( vertebral osteomyelitis, spine stenosis)
  • more invasive than MRI, usually reserved for pts who can not do MRI (pacemaker, metallic implant)
40
Q

Q 38. What can exacerbate Wernike encephalopahty? why?

A

glucose infusion

excess glucose will deplete B1, which is required in glycolysis/ TCA as TPP

41
Q

Q 39. What two prior infections predispose to PID (Pelvic Inflammatory disease?

A
  • chlamydia

- N. gonorrhea

UWORLD first pass- week 5 (8 decks)

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