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
