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UWORLD first pass- week 5 > 3/2 UWORLD test # 30 > Flashcards

3/2 UWORLD test # 30 Flashcards

1
Q

Q 1. Which enzyme mediates destruction of elastic fibers in emphysema? What two cells secrete this enzyme?

A

elastase

synthesized by neutrophil and macrophage

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2
Q

Q 2. Symptoms of acute HepB infection (4)

A
  • pruritic rash
  • lymphadenopathy
  • significantly elevated ALT/AST (more than 10 times)
  • joint pain
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3
Q

Q 3. What is stool microscopy with sudan 3 stain for?

A

fat

useful primary test for fat malabsorption

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4
Q

Q 4. Bisphosphonates (-dronate)

  • mechanism of action
  • side effects
  • recommendation for drug intake
A
  • 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)
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5
Q

Q 6. uncorrected PDA : which irreversible change will occur? through what mechanism?

A

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

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6
Q

Q 7. Effects of hypercalcemia on each system

  • renal (2)
  • muscle
  • bone
  • GI (2)
  • psych
A
  • Renal: kidney stone, polydypsia/polyuria
  • muscle: muscle weakness
  • bone: bone pain
  • GI: constipation, abdominal pain
  • psych: altered mental status, anxiety
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7
Q

Q 9. Teres major vs. Teres minor

  • attachments
  • movement
A
  • 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
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8
Q

Q 9. Rotator cuff muscles attachment to humerus

  • teres minor
  • suprascapularis
  • subscapularis
  • infrascapularis
A

Everything attaches to greater tuberosity

EXCEPT subscapularis, which attaches to lesser tuberosity and mediates internal rotation & adduction

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9
Q

Q 12. NK cells

  • markers (2)
  • target cells
  • mechanism of action
  • cytokines (4) responsible for activation
A
  • CD15, CD56
  • cells lacking MHC1
  • perforin, granzyme -> apoptosis
  • INF-alpha, INF-beta, IL2, IL12
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10
Q

Q 13. In each category of volume of distribution: give approximated Vd value, compartment, drug types

  • low Vd
  • medium Vd
  • High Vd
A
  • 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
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11
Q

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?
A
  • caudal-regression syndrome

- maternal diabetes

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12
Q

Q 16. Cricothyrotomy

  • when is it indicated?
  • surgical incision point?
A
  • when emergency airway is necessary, but nasotracheal tubation is unsuccesful or contraindicated (hemorrhage)
  • cutting of cricothyroid membrane & cervical fascia
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13
Q

Q 18. HIV + EBV infected. What CNS cancer?

A

primary CNS lymphoma

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14
Q

Q 19. Main location of norephinephrine synthesis? Where is it located?

A
  • locus ceruleus

- posterior rostral pons near fourth ventricle

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15
Q

Q 20. Roselola (HHV-6)

  • affected population
  • symptoms (3)
A
  • kids
  • 3-4 days of fever and regression of fever, followed by
  • maculopapular rash
  • seizure
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16
Q

Q 25. Vitamin D deficiency- level & explain why

  • serum Ca2+
  • serum phosphate
  • PTH
A
  • 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+
17
Q

Q 27. Bloot type A, B, O & Rh-: what antibodies? which immunoglobin?

  • A
  • B
  • O
  • Rh-
A
  • A: IgM Anti-B
  • B: IgM Anti-A
  • O: IgG Anti-A & Anti-B (FA: IgG..)
  • Rh- IgG Anti-D
18
Q

Q 28. Three medications that can treat absence seizure? Which one is first line?

A
  • ethosuximide
  • valporic acid
  • lamotragine
  • First line is ethosuximide
19
Q

Q 30. What is the single most preventable cause of death/disease in the U.S.?

A

smoking

20
Q

Q 31. Air container cavity in chest x-ray

  • what is this?
  • pathophysiology?
A
  • pulmonary abscess

- necrosis of pulmonary parenchyma due to lysosomal content released by macrophages

21
Q

Q 33. patient with prosthetic valve developed anemia

  • pathophysiology
  • what type of RBCs (2) may be seen in blood smear
A
  • mechanical shearing of RBC

- shistocyte, burr cells

22
Q

Q 35. Describe use of these tumor markers

  • alpha-fetoprotein (AFP) (3)
  • carcinoembryonic antigen (CEA) (1)
  • Alkaline phosphatase (ALP) (2- one is not tumor)
A
  • AFP: hepatocellular carcinoma, hepatoblastoma, yolk sac tumor- recurrence and monitoring
  • CEA: colorectal cancer- recurrence, not quite specific
  • ALP: pagets disease, seminoma
23
Q

Q 36. Possible gross skin manifestation in Crohn? explain why

A

bowel content draining into cutaneous skin

enterocutaneous fistula

24
Q

Q 38. Two possible metabolic pathway for homocysteine. What vitamin is needed for each pathway?

A

homocysteine ->methionine: B12

homocysteine -> cystathionine -> cystine: B6

25
Q

Q 39. 7-alphahydroxylase: enzyme for what reaction?

A

first step in the synthesis of bile acids

26
Q

Q 39. Pathophysiology of infection mediated brown pigmented gallstone formation?

A

infection -> release of beta-glucuronidase -> increased unconjugated bilirubin

27
Q

Q 40. What would happen if ACEI is given to patient who is taking diuretics?

A

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

UWORLD first pass- week 5 (8 decks)

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