3/2 UWORLD test # 30 Flashcards
Q 1. Which enzyme mediates destruction of elastic fibers in emphysema? What two cells secrete this enzyme?
elastase
synthesized by neutrophil and macrophage
Q 2. Symptoms of acute HepB infection (4)
- pruritic rash
- lymphadenopathy
- significantly elevated ALT/AST (more than 10 times)
- joint pain
Q 3. What is stool microscopy with sudan 3 stain for?
fat
useful primary test for fat malabsorption
Q 4. Bisphosphonates (-dronate)
- mechanism of action
- side effects
- recommendation for drug intake
- pyrophosphate analogs, it binds hydroxyapatite in bone and prevents osteoclast’s binding to bone
- esophagitis, jaw fracture
- take with bunch of water and stay upright for 30 mins (to prevent esophagitis)
Q 6. uncorrected PDA : which irreversible change will occur? through what mechanism?
Uncorrected PDA –> pulmonary HTN & pulmonary artery sclerosis –> right ventricular hypertrophy: Eisenmenger syndrome
Pulmonary artery sclerosis is NOT reversible
right ventricular hypertrophy is not necessarily irreversible. It can be reversible
Q 7. Effects of hypercalcemia on each system
- renal (2)
- muscle
- bone
- GI (2)
- psych
- Renal: kidney stone, polydypsia/polyuria
- muscle: muscle weakness
- bone: bone pain
- GI: constipation, abdominal pain
- psych: altered mental status, anxiety
Q 9. Teres major vs. Teres minor
- attachments
- movement
- Teres major: inferior scapular to medial interturbercular sulcus, arm extension & internal rotation
- Teres minor: lateral border of scapular to greater tubercle, external arm rotation & adduction
Q 9. Rotator cuff muscles attachment to humerus
- teres minor
- suprascapularis
- subscapularis
- infrascapularis
Everything attaches to greater tuberosity
EXCEPT subscapularis, which attaches to lesser tuberosity and mediates internal rotation & adduction
Q 12. NK cells
- markers (2)
- target cells
- mechanism of action
- cytokines (4) responsible for activation
- CD15, CD56
- cells lacking MHC1
- perforin, granzyme -> apoptosis
- INF-alpha, INF-beta, IL2, IL12
Q 13. In each category of volume of distribution: give approximated Vd value, compartment, drug types
- low Vd
- medium Vd
- High Vd
- low Vd: ~4L, mostly plasma, large highly hydrophilic
- medium Vd: ~ 15L, mostly extracellular fluid, small molecule, hydrophilic
- High Vd: ~ 40L, every where including ells, small molecule, lipophilic
Q 14. infant with flaccid lower extremities, absence of ankle reflexes, failure to develop sacrum/lumbar spine
- what is going on?
- what maternal condition predisposes it?
- caudal-regression syndrome
- maternal diabetes
Q 16. Cricothyrotomy
- when is it indicated?
- surgical incision point?
- when emergency airway is necessary, but nasotracheal tubation is unsuccesful or contraindicated (hemorrhage)
- cutting of cricothyroid membrane & cervical fascia
Q 18. HIV + EBV infected. What CNS cancer?
primary CNS lymphoma
Q 19. Main location of norephinephrine synthesis? Where is it located?
- locus ceruleus
- posterior rostral pons near fourth ventricle
Q 20. Roselola (HHV-6)
- affected population
- symptoms (3)
- kids
- 3-4 days of fever and regression of fever, followed by
- maculopapular rash
- seizure
Q 25. Vitamin D deficiency- level & explain why
- serum Ca2+
- serum phosphate
- PTH
- low Ca2+ due to less Ca2+ absorption. In spite of complementary PTH release, serum Ca2+ usually STILL LOW
- Low phosphate due to PTH -> increased phosphate excretion
=> remember that PTH acts oppositely on Ca2+ and Phosphate! - High PTH: to compensate low Ca2+
Q 27. Bloot type A, B, O & Rh-: what antibodies? which immunoglobin?
- A
- B
- O
- Rh-
- A: IgM Anti-B
- B: IgM Anti-A
- O: IgG Anti-A & Anti-B (FA: IgG..)
- Rh- IgG Anti-D
Q 28. Three medications that can treat absence seizure? Which one is first line?
- ethosuximide
- valporic acid
- lamotragine
- First line is ethosuximide
Q 30. What is the single most preventable cause of death/disease in the U.S.?
smoking
Q 31. Air container cavity in chest x-ray
- what is this?
- pathophysiology?
- pulmonary abscess
- necrosis of pulmonary parenchyma due to lysosomal content released by macrophages
Q 33. patient with prosthetic valve developed anemia
- pathophysiology
- what type of RBCs (2) may be seen in blood smear
- mechanical shearing of RBC
- shistocyte, burr cells
Q 35. Describe use of these tumor markers
- alpha-fetoprotein (AFP) (3)
- carcinoembryonic antigen (CEA) (1)
- Alkaline phosphatase (ALP) (2- one is not tumor)
- AFP: hepatocellular carcinoma, hepatoblastoma, yolk sac tumor- recurrence and monitoring
- CEA: colorectal cancer- recurrence, not quite specific
- ALP: pagets disease, seminoma
Q 36. Possible gross skin manifestation in Crohn? explain why
bowel content draining into cutaneous skin
enterocutaneous fistula
Q 38. Two possible metabolic pathway for homocysteine. What vitamin is needed for each pathway?
homocysteine ->methionine: B12
homocysteine -> cystathionine -> cystine: B6
Q 39. 7-alphahydroxylase: enzyme for what reaction?
first step in the synthesis of bile acids
Q 39. Pathophysiology of infection mediated brown pigmented gallstone formation?
infection -> release of beta-glucuronidase -> increased unconjugated bilirubin
Q 40. What would happen if ACEI is given to patient who is taking diuretics?
Diuretics will cause elevated renin activity due to volume depletion.
Patient will rely on renin for BP control. Sudden addition of ACEI can cause severe BP drop, leading to hypotension/ lightheadness
