3/23 UWORLD test #61 Flashcards
Q 1. African kid, severe swelling in hands and feet. What should I suspect?
sickle cell disease
- dactylitis: vasocclusive phenotype
Q 2. What anti-HIV drugs needed to be screened for hypersensitivity? What needs to be screened? What type of hypersensitivity
Abacavir
- sketchy: abracadabra wizard, where he is reading book titled as HLA-B*5701
Q 3. Two watershed area that is susceptible for ischemic colitis?
- splenic flexure
- rectosigmoid colon
Q 4. Describe reactions of respiratory burst. What is enzyme for each reaction
O2 –> O2 radical : NADPH oxidase
O2 radical –> H2O2: superoxide dismutase
*O2 radical here is also called reactive oxygen species
H2O2 –> HClO radical: myeloperoxidase
Q 5. Alkaptouria
- defective gene, inheritance pattern, accumulated product
- phenotypes (3)
- homogenestic acid dioxygenase -> accumulation of homogenestic acid
autosomal recessive - phenotypes
1. blue-black spots on sclerae and connective tissue
2. arthralgia
3. urine turns dark after air exposure (homogenestic acid)
Q 6. abdominal pain, reddish urine. what disease is this?
acute intermittent porphyria
Q 8. What two electrolyte imbalance can amphorecin B cause?
hypokalemia
hypomagnesemia
Q 9. What is eczema?
atopic dermatitis
: type 1 hypersensitivity rxn, IgE dependent
Q 9. What is dyskeratosis? example?
abnormal (dys-) keratinization
-> squamous cell carcinoma
Q 9. What is Acanthosis? examples (2)?
epidermal hyperplasia due to increased startum spinosum (spinosoum - desmosome, which connects keratinocytes)
-> psoriasis (hyperplastic epidermis pilling off), acanthosis nigrans
Q 9. What is spongiosis? example?
epidermal accumulation of fluid
-> atopic dermatitis (eczema)
Q 10. sensitivity vs. specificity: what is used for screening? another one is used for what?
SCREENING: rule out disease, so sensitivity
CONFIRMATION of disease with positive from screening: rule in, so specificity
Q 11. key phenotypic difference between antipsychotic drugs induced parkinsonism vs. neuroleptic malignant syndrome
parkinsonism: no fever, no autonomic instability (tachy, hypertension)
- NES: high fever, autonomic instability
* muscle rigidity/stiffness can be shown in both cases, so it is not a good phenotype to differentiate between two
Q 11. First line treatment for antipsychotic induced parkinsonism?
benztropine
Q 11. Can Levodopa be for antipsychotic induced parkinsonism? why or why not?
NO
Levodopa can induce psychosis
- sketchy: van goh picture
Q 12. DLCO in emphysema?
decreased
- Although it seems like alveoli surface area is increased, it is floppy useless alveoli. Discussed this with Andy
Q 14. Reticulocyte
- size compared to mature RBC
- Wright-Giemsa stain: appearance? what is stained?
- immature RBC, bigger than mature RBC
- blue color, ribosomal RNA is stained by Wright-Giemsa stain
Q 20. Turner syndrome: will develop secondary sexual characeristics?
no
streak ovary- very low estrogen
Q 20. Imperforate hymen
- what is it
- phenotypes (2)
- development of secondary sexual characeristics
- incomplete degeneration of fibrous tissue bands that surround walls of vagina: imperforable, nothing discharges from uterus to vagina
- amenorrhea (no exit, blood trapped within uterus)
- cyclic abdominal pain/distention
- ovary and all internal sexual organ is intact. It is that fibrous tissue blocking way from uterus to vagina. So normal secondary sexual characteristics
Q 21. hypotension when supine, BP resolves with standing up.
- what is diagnosis?
- Most commonly seen in what pt group? explain physiology
- supine hypotensive syndrome
- preganant women >20wks gestation
: enlarged uterus compress IVC, decreasing venous return. When supine or lateral decubitus position, uterus compression effect is much less.
Q 22. What antibiotic is used to treat S.epidermis?
vancomycin
- most S.epidermis is methicilin resistant. needs to be treated like MRSA
Q 23. molecular target of ceftriaxone?
same as
transpeptidase
- Don’t get confused with cell wall glycoprotein. It it D-ala D-ala analogue that binds to transpeptidase in cell wall. NOT CELL WALL GLYCOPROTEIN
Q 26. What is general rule of thumb in terms of side of neuronal defect with cerebellar lesion?
IPSILATERAL side defect
Name of 4 nuclei in cerebellum (from lateral to medial, remember mnenomic?)
Dont Eat Greasy Food
D- Dendate
E- Emboliform
G- Globose
F- Fastigius
Q 26. Define intention tremor. Associated with lesion at where?
same as dysmetria, tremor during movement toward a target (INTENTIONALLY moving toward TARGET)
cerebellum lesion
Q 26. Define dysdiadochokinesia
disorganized movement during rapid alternating movement (PE- hand flipping)
Q 28. When it comes to talk about hereditary colorectal cancer, what should I find a first to distinguish between two big categories?
polyps? or no polyps?
polyps- FAP, Gardner, Turcot, Putez-Jeghers, Juvenile polyposis
no polyps- Lynch
- In question stem, if they explicitly mentioned “no polyps”, then go with Lynch syndrome for sure
Q 29. Most common primary cardiac tumor? where is the most prevalent location of tumor? Gross appearance?Describe histologic finding of this tumor? heart sound finding?
- myxoma
- left atrium, pedunculated mass
- scattered cells within mucopolysaccharide STROMA
- early diastolic tumor plop sound (during diastolic phase, pudenculated tumor flops and makes sound)
Q 30. What two lung cancers can present paraneoplastic syndrome? What types of hormones are secreted from each?
- small cell lung cancer
1. ACTH
2. SIADH - squamous cell cancer
: PTHrP -> hypercalcemia
Q 31. Aplastic anemia vs Myelodysplastic syndrome
- similarity
- difference
- similarity
: Both show pancytopenia (decreased level of every kind of blood cell) - note: aplastic anemia is dismonomer, it causes not only anemia, but also thrombocytopenia, leukopenia as well.
Difference
- Aplastic anemia: dry bone marrow tap
- myelodysplastic syndrome: hypercellular bone marrow (yet immature cells)
Name three hematologic disorders that yield dry tap bone marrow
- aplastic anemia
- hairy cell leukemia
- myelofibrosis
Q 34. Quadriceps muscle is innervated by what nerve? what is the best site for analgestic injection to knock down this nerve?
femoral nerve
inguinal crease (lateral border of femoral artery)
Q 38. Patient come in with joint pain. Kid was seen by physician for facial rash and fever before. what is going on?
possible Parvovirus B19 infection
- adult mainfestation: arthritis (RA like)
- kid manifestation: erythema infectiosum (slapped cheeks rash, which migrates down)
Q 38. What is treatment for parvovirus induced arthritis in adult?
NSAID for pain relief
usually arthritis itself is self-resolving
Q 39. Budd-chiari vs. hepatic portal vein embolism: differences (2)?
Budd-chiari
- embolism at hepatic vein
- liver cirrhosis
Hepatic vein embolism
- embolism at HPV
- varicies (ex-esophageal varicies), no liver cirrhosis (liver biopsy should be normal)
Q 40. what is meconium ileus? which disease is associated with it?
ileum obstruction by meconium (first stool in infant), causing bowel distention and emesis
cystic fibrosis
Q 40. What is fatal cause of death in cystic fibrosis?
pneumonia
