3/21 UWORLD test #57 Flashcards

1
Q

Q 2. Name 5 possible conditions associated with carpal tunnel syndrome. Explain pathophysiology for each

A
  1. pregnancy -> volume overload: median n. compression
  2. rheumatoid arthritis -> inflammation
  3. diabetes-> connective tissue thickening
  4. hypothyroidism-> glycosaminoglycan build up
  5. dialysis -> amyloidosis resulting in compression
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2
Q

Q 3. Why TB test needs to be done before etanercept?

A

TNF-alpha is required to sequester mycobacteria within granuloma

  • It is TNF-alpha that push mycobacteria into and limited in granuloma
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3
Q

Q 4. How does pyruvate kinase deficiency results in hemolysis of RBC? what kind of hemolysis?

A

defective PK -> no ATP -> electrolyte imbalance and loss of water -> cell lysis

  • intravascular hemolysis + extravascular as well (spleen removing damaged RBC)
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4
Q

Q 4. What part of spleen is responsible for removal of damaged RBC? what cells mediate this?

A

reticuloendothelial cells within red pulp

  • Red pulp =Rbc
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5
Q

Q 5. Somatic symptom disorder: what is the best approach?

A

scheduling regular outpatient visit
: not symptomatic driven, but more like regular visits
=> office visits should focus on functional improvement, rather than symptom elimination

  • referring to psychiatrist is not an ideal as it will not help alleviating patient’s symptom well.
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6
Q

Q 7. Primary vs. secondary hyperaldosteronism

  • etiologies
  • lab findings
A
  • Etiology
    primary: adrenal cortex issue
    (* primary: site of aldo production= adrenal cortex)
    secondary: most likely JGA issue
  • Labs
    primary: only aldo up, renin down
    secondary: BOTH renin and aldo up
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7
Q

Q 9. Name three pathways where BH4 is needed

A
  1. phenylalanine -> tyrosine
  2. tyrosine -> DOPA
  3. tryptophan -> serotonin
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8
Q

Apart from BH4, what else is needed for serotonin synthesis from tryptophan?

A

B6

BOTH B6 and BH4 are required for serotonin synthesis

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9
Q

Q 10. Which doparminergic pathway is associated with prolactin? Decrease or increase of this pathway leads to decrease or increase prolactin?

A

tuberoinfundibular pathway

decreased tuberoinfundibular pathway

  • > increased prolactin
  • > subsequent amenorrhea and decreased libido
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10
Q

Q 10. Which doparminergic pathway is associated with positive symptom? decrease or increase?

A

mesocortical

decreased mesocortical
-> negative symptoms

  • easy way to remember:
    mesoCortical= neCative
    (simillar with weCner=C-anca)
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11
Q

Q 10. Which doparminergic pathway is associated with negative symptoms? decrease or increase?

A

Mesolimbic

increased mesolimbic -> positive symtpom

  • Mesolimbic is only pathway that is associated with increased activity that causing disease. All rest is decreased activity.
  • easy way to rembmer: positive symptom, positive means adding more, so increased activity
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12
Q

Q 10. Which doparminergic pathway is associated with parkinsonism?

A

nigrostriatal

decreased nigrostriatal -> parkinsonism

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13
Q

Q 10. Antipsychotic drugs mostly targets which doparminergic pathway?

A

mesolimbic

antipsychotic drugs have limited activity against mesocortical

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14
Q

Q 11. spongiosa filling medullary canals with no mature trabeculae: description of bone for what disease?

A

osteopetrosis

*buzzword: FILLING, NO MATURE

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15
Q

Q 11. subperiosteal thinning with subperiosteal erison: description of bone for what disease?

A

primary hyperparathryoidism

PTH mediated bone absorption -> subperiosteal ( or cortical bone)

  • buzzword: SUBPERIOSTEAL
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16
Q

Q 12. infectious endocarditis vs. rheumatic fever:

how valvular manifestaions are different?

A
  • infectious endocarditis: vegetations

- rheumatic fever: fibrous stenosis

17
Q

Q 14. How to distinguish between: gout vs. pseudogout on bifringe scope picture?

A

shape

  • gout: needle, uric acid
  • pseudogout: rhomboid, calcium pyrophosphate
  • don’t go by color on image it is confusing.
    Question might just ask in text for that case,
  • yellow: uric acid, negative bifringe
  • blue: calcium pyrophosphate, positive bifringe
18
Q

Q 15. What is portal triad? what ligament houses it?

A

hepatoduodenal ligament

hepatic artery, hepatic portal vein, common bile duct

19
Q

Q 18. fungal pneumonia: buzz signs?

  • candida
  • cryptococcus
  • jivroceii
  • aspergilos
A
  • candida: very uncommon
  • cryptococcus: immunocompromised, other clues (pigeon, dimorphic, india ink, latex agglutination)
  • jivroceii: immunocompromised, other clues (diffuse ground glass chest x ray)
  • aspergilos: immunocompromised, hemoptysis (invasive)
20
Q

Q 19. ACE mediates what reaction in RAAS

A

angiotensin 1 –> angiotensin 2

21
Q

Q 19. Pregnant mom with multiple anti-hypertensive drugs. baby born with potter syndrome. why?

A

maternal ACEI use

ACE is important for fetal renal development

22
Q

Q 21. Which two bacteria are most common source for intraabdominal infection?

A
  • Bacterioides fragilis
  • E.Coli
  • in fact, bacteriodes fragilis is more common dominant flora than E.coli in colon
23
Q

Q 26. What is usage of meta- analysis?

A

epidemiologic method to pull data from several studies

*buzzword: SEVERAL STUDIES

24
Q

Q 26. Chai-squiare is used for differences in two or more group for what two values?

A
  • percentage
  • outcome (not mean, which is for ANOVA)
  • thus simple 2x2 table analysis (in which outcomes are listed, again not mean value) is suited for Chai-square test
25
Q

Q 29. anti-HIV drug: Raltegravir- MOA?

A

integrase inhibitor

  • > viral gene cannot be integrated to host genome
  • > inhibited viral mRNA synthesis
  • ralTEGRavir = inTEGRation
  • all other integrase inhibitors also contain TEGR in the middle of the name
26
Q

Q 30. CTFR for cystic fibrosis: how does it work differently in respiratory/intestinal epithelia vs. sweat duct?
How this difference explains
1. findings of sweat test in cystic fibrosis patient
2. ion balances in mucus production at respiratory/intestinal epithelia

A
  • BOTTOM LINE:
    cystic fibrosis
  • HIGH chloride sweat
  • THICK mucus

CTFR
- sweat gland: intracellular Cl- transport
=> high Cl- and Na+ in sweat
=> low Cl- and Na+ in sweat gland epithelial cell

  • repiratory/intestinal : extracellular Cl- transport
    => low Cl- and Na+ in respiratory/intestinal mucous
    => less water => thick mucus
    => high Cl- and Na+ in respiratory/intestinal epithelial cell
27
Q

Q 32. What protein is mutated in hemochromatosis? what chromosome? What does it interact with? what’s its normal function? how mutation messes serum iron level?

A

HFE (High iron, Fe) @ chromosome 6

HFE normally interacts with transferrin and works as iron sensor: limit iron absorption with high iron. With mutation, iron sensing doesn’t work, inducing iron transport via ferroportin

28
Q

Q 36. Orbital fissure fracture may lead to what dysfunctions (2)

A
  • loss of sensation of upper lip, upper cheek, upper gingiva

- vertical gaze impairment due to damage to inferior rectus muscle

29
Q

Q 37. renal cell carcinoma is originated from what segment of nephron?

A

PCT, proximal convoluted tubule