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UWORLD first pass- week 8 > 3/21 UWORLD test # 58 > Flashcards

3/21 UWORLD test # 58 Flashcards

1
Q

Q 1. left eye pain that is attenuated by ocular movement, episodes of numb and tingling of hands. most likely diagnosis?

A

MS

Of answer choices, if neurologic symptoms shows some random pattern, and regress/relapsing pattern, think MS in a differential

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2
Q

Q 2. two mediums for growth of diptheria

A
  • cystine-tellurite agar

- Loeffler

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3
Q

Q 5. increased EPO in response to hypoxia is mediated by what cells? what organ?

A

peritubular cells in kidney

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4
Q

Q 4. sensorineuronal hearing loss and conductive hearing loss: compare findings of rinne test (mastoid) and weber test (vibrating in middle)

A

Rinne test

  • sensorineural hearing loss: normal, not detectable (AC>BC)
  • conductive hearing loss: abnormal to affected side (BC>AC)

Webertest

  • sensorineuronal hearing loss: lateralize to unaffected side
  • conductive hearing loss: lateralize to affected size
  • Both Rinne and weber need to be done to know whether it is sensorineural or conducvite. Weber alone does not tell whether it is sensorineural or conductive
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5
Q

Q 6. which LSD accumulates alpha-galactosidase A?

A

Fabry

  • Fabry first on FA table, thus alpha (1st)
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6
Q

Q 6. phenotypes of Fabry

  • early
  • late (2)
A
  • early: acroparesthesias- pain in palm and sole
  • late
    1. renal failure
    2. cardiovascular disease
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7
Q

Q 7. What is pulmonary response to DKA? what can happen in severe DKA?

A
  • hyperventilation

- for severe DKA, respiratory failure can happen

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8
Q

Q 8. which antibiotic can cause serotonin syndrome?

A

linezolid

  • sketchy: smile balloons in museum
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9
Q

Q 8. What are side effects of vancomycin?

A
  • nephrotoxicity
  • ototoxicity
  • thrombophlebitis: vein thrombosis
  • redman syndrome: diffuse flushing
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10
Q

Q 8. How redman syndrome with vancomycin can be revesred? (2 ways)

A
  • slow infusion

- infusion with anti-histamine

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11
Q

Q 9. Which nerve pass through obturator canal? what part of leg does it innervate?

A

obturator nerve

medial thigh

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12
Q

Q 11. What is the only cranial nerve that is compressed by herniation syndrome? what herniation can compress this neuron? what brain structure does this herniation involve?

A

CN3

uncal herniation

uncal herniation involves tentorium cerebelli
uncus compress through tentorium cerebelli

  • uncal herniation is also called as transtentorial herniation
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13
Q

Q 11. uncal herniation also can compress which vessel?

A

PCA

-> homonymous hemianopia with macular sparing

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14
Q

Q 12. increased central venous pressure due to pulmonary conjestion, yet no signs of peripheral edema. by what compensatory mechanism?

A

increased lymphatic drainage

more fluid -> more hydrostatic pressure -> more fluid forced into lymphatic drainage.

  • when fluid leaking is so severe and thus lymphatic drainage can not keep up with it, then peripheral edema will occur
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15
Q

Q 13. What is molecular target of cycrosporin or tacrolimus? what does this molecule normally do?

A

calcineurin

calcineurin dephosphorylates NFAT. Dephosphorylated NFAT then migrates into nucleus, binds to IL-2 promoter region and induces transcription

  • remember this was Beck’s project at OHSU?
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16
Q

Q 14. which anatomical structure is the most commonly injured during hysterectomy? what will be symptom?

A
  • ureter: ureter runs right posteriorly to uterine arteries (housed by cardinal ligament)
  • present with flank pain
  • normally no issue with urination as another ureter is intact (bilateral ureter injury is very uncommon)
17
Q

Q 15. What is presentation of dengue fever? What can cause more severe symptoms? what are severe symptoms?

A
  • primary infection is normally not severe and self-limited
  • secondary infection WITH DIFFERENT VIRAL SEROTYPE can lead to severe symptoms, including high fever, muscle pain, elevated liver enzymes, thrombocytopenia/leukocytopenia
18
Q

Q 18. recent history of abortion followed by septic shock symptoms. what is going on?

A

septic abortion

After abortion, remnant products of conception can cause infection

19
Q

Q 18. What are two most common infectious organisms for septic abortion?

A
  • E.coli

- Staph.aureus

20
Q

Q 19. pyruvate carboxylase: enzyme for which reaction? what cellular compartment does it occur?

A

pyruvate –> OAA: first step of gluconeogenesis

occurs in mitochondria!
once OAA becomes malate and malate leaves mitochondria, then rest of gluconeogenesis reaction is in cytosol

21
Q

Q 19. HMP shunt pathway happens in what cellular compartment? oxidative and non-oxidative?

A

BOTH at cytosol

22
Q

Q 19. What three main metabolic pathways occur in cytoplasm?

A
  • glycolysis
  • HMP shunt
  • fatty acid synthesis
  • gluconeogenesis, beta-oxidation are kinda mixed
23
Q

Q 22. filtration at glomeruli: filtration at each part is based on what? albumin is filtered by what compartment?

  • basement membrane (what molecule specifically mediates this barrier)
  • endothelium
A
  • GBM: charge based, heparan sulfate (negatively charged)
  • endothelium: size based, fenestrated

albumin is filtered by negatively charged GBM
* albumin is small enough to pass through fenestrated endothelium

24
Q

Q 21. Describe two different lymphatic drainage pathway in lower extermities

A
  • lateral pathway: lateral side -> popliteal -> ingunial

- medial pathway: bypass popliteal, directly drain into inguinal

25
Q

Q 24. methotrexate side effect in oral mucosa? what about skin?

A
  • mucositis, oral ulceration
  • psoriasis
  • sketchy: guy poking his mouth with stick with beefball (mucositis) and couples with psoriatic skin kneeling on the ground
26
Q

Q 25. Klinefelter syndrome: level of below hormones

  • LH
  • FSH
  • testosterone
  • estrogen
A
  • LH: high (due to lack of leydig cell -> to compensate nonfunctional leydig, pituitary secrets LH)
  • FSHL high ( seminiferous tubule is messed up -> loss of inhibin)
  • testosterone: low (messed up leydig)
  • estrogen: high -> gynecomastia
  • BOTTOM LINE: Klinefelter is messed up with testes and seminiferous tubule!
27
Q

Q 26. How is pressure associated with surface tension and radius

A

P=T/r

with same surface tension (say lack of surfactant), small alveoli will have higher INWARD pressure. This is why lack of surfactant makes it hard to open up tiny alveoli

28
Q

Q 27. Discrepancy in size between two kidneys is associated with what pathology? explain

A

unilateral renal artery stenosis

kidney supplied with renal artery with stenosis
-> inadequate blood supply -> kidney shrinkage

29
Q

Q 28. CNS: what type of necrosis? pancreas: what type of necrosis?

A

CNS- liquefactive necrosis
brain has alot of fat, but remember this is NOT FAT necrosis. fat necrosis refers to lipase mediated necrosis

pancreas- fat necrosis
pancreas releases lipase

30
Q

Q 30. difference between PNS vs. CNS in terms of clearing process after neuronal injury

A

PNS: fast and efficient. Even schwann cells aid clearing process by demeylinating and secreting cytokines that recruit macrophage

CNS: slow and inefficient. Oligodendrocytes do not aid clearing. Also slow recruitment of microglial due to BBB.
=> myelin debris can persist for years

31
Q

Q 32. myotonia type 1

  • what genetic abnormality? inheritance pattern? what gene?
  • phenotypes (4)
  • vs. Duchenne: in terms of muscle degeneration pattern
A
  • CTG repeat on DMPK. autosomal dominant
  1. myotonia: abnormally slow muscle relaxation
  2. frontal balding
  3. cataracts
  4. testicular atrophy
  • In Duchenne, fibrofatty replacement of muscle is common. This does NOT happen in myotonia type 1
32
Q

Q 34. Is serotonin syndrome common in SSRI? What is the most common side effect of SSRI?

A

no. unless taking multiple high dose of SSRI, serotonin syndrome is not that very common

most common side effect of SSRI is sexual dysfunction (decreased libido)

33
Q

Q 38. What kind of damage will long term BPH affect to kidney?

A

hydronephrosis

: parenchymal pressure atrophy

34
Q

Q 36. Female, never smoked. what lung cancer is this?

A

Adenocarcinoma

35
Q

Q 39. Flutamide

  • MOA
  • indication
A
  • competitive inhibitor of androgen receptors at target site

- prostate cancer

UWORLD first pass- week 8 (11 decks)

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