3/22 UWORLD test # 60 Flashcards
Q 1. Atrial enlargement, recurrent atrial fibrilation: where is the thrombi located?
atrial appendage
Q 2. Flank pain with ballotable mass after pelvic surgery. What is going on?
hydronephrosis due to uretral obstruction
During pelvic surgery such as hysteroctomy, unintentional ureter ligation can result in uretral obstruction
- buzzword: ballotable mass => movable mass within liquid, suggesting liquidy mass
Q 3. Anastrozole
- MOA
- indication
aromatase inhibitor
ER positive breast cancer treatment
Q 4. Name three reactions of TCA cycles that require NAD (remember mneomic?)
IMaK
- Isocitrate -> alpha ketoglutarate
- Malate -> OAA
- alpha ketoglutarate -> succinyl-coA
Q 4. Alcoholic patient will have the most significant impairment of which TCA cycle? explain
alpha ketoglutarate –> succinyl-coA
this reaction not only requires NAD+, but also B1
- with alcohol, NADH/NAD+ ratio increases AS WELL AS DEPLETION OF B1 (thiamine)
Thus, this reaction is the most susceptible
Q 5. the most common cause of death after lightening thunder storm
cardiac arrythmia
high current thunder messes up electric conductance of heart
Q 9. discrepancy of blood pressure between right arm and left arm: what does this suggest?
dissection.
Intimal dissection leads to hemartoma, which can spread and compresses main brachial arteries.
If dissection happens at ascending aorta, it can compress brachicephalic trunk, which serves as blood supply source for right arm -> relative decrease in right arm BP, compared to left arm
Q 10. JV distention and pulmonary crackles. what cardiac pathology?
Dilated cardiac myopathy
=> in DCM, BOTH right ventricle and left ventricle will be dilated, leading to congestion at BOTH SIDES.
- with signs of congestion in BOTH sides of heart, always keep in mind DCM
Q 11. What is disease progression course for Cruetzeflet-Jakob disease?
long incubation period, but rapid progression once it starts
Q 14. What is Kassamuel sign? What cardiac pathology?
increased JVP even with inspiration
constrictive cardiac pathology- pericarditis, restrictive cardiomyopathies
- Kassamuel sign is kinda similar with pulsus paradoxus
Q 15. When does maternal to child transmission of HepB occurs
during delivery.
Q 17. budding yeast with thick capsule. What is bug?
cryptococcus
- buzzword: THICK CAPSULE
- sketchy: mira is in thick container
Q 17. Cryptococcus cause what in HIV patient? CD4 count?
CD4 < 100
menigitis, encephalitis
(called together as menigioencephalitis)
Q 18. What protein is mutated in hereditary hypertrophic cardiomyopathy
beta myosin heavy chain
Q 20. What is amniotic fluid embolism? What is histologic findings of lung in amniotic fluid embolism? How is it different from ARDS?
Fetal keratin/ mucin debris enter maternal circulation
- > occlusion of maternal pulmonary circulation
- > hypoxia and cardiopulmonary arrest -> death
histologic finding is pulmonary artery branch with swirls of fetal keratin
- amniotic fluid embolism results in death of mom after delivery. amniotic fluid embolism later can result in ARDS though. So if mom did not die instantly, but later complicated to pulmonary symptoms, then it is ARDS
Q 21. MOA for bethamechol? indication?
M3 muscarinic agonist
- indicated for urinary retention
: muscarinic stimulation -> bladder contraction
Q 21. MOA for oxybutynin? indication?
muscarinic antagonist
- indicated for overactive bladder
Q 21. Imipramine is what drug class?
TCA
Q 23. Zolpidem
- MOA
- indication
- important features (4)
- other drugs act similarly
- similar mechanism with BDZ
- hypnotics (for sleep deprivation)
- unlike BDZ, zolpidem has
1. low dependence
2. rapid onset/ clearance
3. no muscle relaxing property
4. no anticonvulsant - Zalplon, eZopiclone
- all Z (ZZZ for sleeping)
Q 25. Is chronic pancreatitis associated with H.pylori?
FUCK NO.
chronic pancreatitis is associated with chronic alcoholism, which will obstruct pancreatic duct, leading to autodigestion
Q 25. What is implication of decreased somatostatin in H.pylori infection?
somatotstatin downregulates gastrin release.
With loss of somatostatin secreting D cells (in GASTRIC MUCOSA) by H.pylori, more gastrin release
-> more acid -> mucosal ulceration
Q 26. How level of haptoglobin is changed in hemolytic anemia?
RBC hemolysis -> release of heme
- > heme scavanger haptoglobin binds to heme and transfer back to spleen for later use
- > decrease in haptoglobin (free haptoglobin, as haptoglobin is used for heme saving)
Q 28. statistics: what is mode?
most frequently observed data point
: highest peak point
Q 30. travel history to central America, pulmonary manifestation. what bugs should I think?
histoplasmosis and blastomycosis
central America : Missisipi and Ohio
