3/23 UWORLD test #61

Question 1

Q 1. African kid, severe swelling in hands and feet. What should I suspect?

Answer 1

sickle cell disease

• dactylitis: vasocclusive phenotype

Question 2

Q 2. What anti-HIV drugs needed to be screened for hypersensitivity? What needs to be screened? What type of hypersensitivity

Answer 2

Abacavir

• sketchy: abracadabra wizard, where he is reading book titled as HLA-B*5701

Question 3

Q 3. Two watershed area that is susceptible for ischemic colitis?

Answer 3

• splenic flexure

- rectosigmoid colon

Question 4

Q 4. Describe reactions of respiratory burst. What is enzyme for each reaction

Answer 4

O2 –> O2 radical : NADPH oxidase

O2 radical –> H2O2: superoxide dismutase
*O2 radical here is also called reactive oxygen species

H2O2 –> HClO radical: myeloperoxidase

Question 5

Q 5. Alkaptouria

• defective gene, inheritance pattern, accumulated product
• phenotypes (3)

Answer 5

• 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)

Question 6

Q 6. abdominal pain, reddish urine. what disease is this?

Answer 6

acute intermittent porphyria

Question 7

Q 8. What two electrolyte imbalance can amphorecin B cause?

Answer 7

hypokalemia

hypomagnesemia

Question 8

Q 9. What is eczema?

Answer 8

atopic dermatitis

: type 1 hypersensitivity rxn, IgE dependent

Question 9

Q 9. What is dyskeratosis? example?

Answer 9

abnormal (dys-) keratinization

-> squamous cell carcinoma

Question 10

Q 9. What is Acanthosis? examples (2)?

Answer 10

epidermal hyperplasia due to increased startum spinosum (spinosoum - desmosome, which connects keratinocytes)

-> psoriasis (hyperplastic epidermis pilling off), acanthosis nigrans

Question 11

Q 9. What is spongiosis? example?

Answer 11

epidermal accumulation of fluid

-> atopic dermatitis (eczema)

Question 12

Q 10. sensitivity vs. specificity: what is used for screening? another one is used for what?

Answer 12

SCREENING: rule out disease, so sensitivity

CONFIRMATION of disease with positive from screening: rule in, so specificity

Question 13

Q 11. key phenotypic difference between antipsychotic drugs induced parkinsonism vs. neuroleptic malignant syndrome

Answer 13

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

Question 14

Q 11. First line treatment for antipsychotic induced parkinsonism?

Answer 14

benztropine

Question 15

Q 11. Can Levodopa be for antipsychotic induced parkinsonism? why or why not?

Answer 15

NO

Levodopa can induce psychosis

• sketchy: van goh picture

Question 16

Q 12. DLCO in emphysema?

Answer 16

decreased

• Although it seems like alveoli surface area is increased, it is floppy useless alveoli. Discussed this with Andy

Question 17

Q 14. Reticulocyte

• size compared to mature RBC
• Wright-Giemsa stain: appearance? what is stained?

Answer 17

• immature RBC, bigger than mature RBC

- blue color, ribosomal RNA is stained by Wright-Giemsa stain

Question 18

Q 20. Turner syndrome: will develop secondary sexual characeristics?

Answer 18

no

streak ovary- very low estrogen

Question 19

Q 20. Imperforate hymen

• what is it
• phenotypes (2)
• development of secondary sexual characeristics

Answer 19

• incomplete degeneration of fibrous tissue bands that surround walls of vagina: imperforable, nothing discharges from uterus to vagina

1. amenorrhea (no exit, blood trapped within uterus)
2. 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

Question 20

Q 21. hypotension when supine, BP resolves with standing up.

• what is diagnosis?
• Most commonly seen in what pt group? explain physiology

Answer 20

• 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.

Question 21

Q 22. What antibiotic is used to treat S.epidermis?

Answer 21

vancomycin

• most S.epidermis is methicilin resistant. needs to be treated like MRSA

Question 22

Q 23. molecular target of ceftriaxone?

Answer 22

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

Question 23

Q 26. What is general rule of thumb in terms of side of neuronal defect with cerebellar lesion?

Answer 23

IPSILATERAL side defect

Question 24

Name of 4 nuclei in cerebellum (from lateral to medial, remember mnenomic?)

Answer 24

Dont Eat Greasy Food

D- Dendate
E- Emboliform
G- Globose
F- Fastigius

Question 25

Q 26. Define intention tremor. Associated with lesion at where?

Answer 25

same as dysmetria, tremor during movement toward a target (INTENTIONALLY moving toward TARGET) cerebellum lesion

Question 26

Q 26. Define dysdiadochokinesia

Answer 26

disorganized movement during rapid alternating movement (PE- hand flipping)

Question 27

Q 28. When it comes to talk about hereditary colorectal cancer, what should I find a first to distinguish between two big categories?

Answer 27

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

Question 28

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?

Answer 28

- myxoma - left atrium, pedunculated mass - scattered cells within mucopolysaccharide STROMA - early diastolic tumor plop sound (during diastolic phase, pudenculated tumor flops and makes sound)

Question 29

Q 30. What two lung cancers can present paraneoplastic syndrome? What types of hormones are secreted from each?

Answer 29

- small cell lung cancer 1. ACTH 2. SIADH - squamous cell cancer : PTHrP -> hypercalcemia

Question 30

Q 31. Aplastic anemia vs Myelodysplastic syndrome - similarity - difference

Answer 30

- 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)

Question 31

Name three hematologic disorders that yield dry tap bone marrow

Answer 31

- aplastic anemia - hairy cell leukemia - myelofibrosis

Question 32

Q 34. Quadriceps muscle is innervated by what nerve? what is the best site for analgestic injection to knock down this nerve?

Answer 32

femoral nerve inguinal crease (lateral border of femoral artery)

Question 33

Q 38. Patient come in with joint pain. Kid was seen by physician for facial rash and fever before. what is going on?

Answer 33

possible Parvovirus B19 infection - adult mainfestation: arthritis (RA like) - kid manifestation: erythema infectiosum (slapped cheeks rash, which migrates down)

Question 34

Q 38. What is treatment for parvovirus induced arthritis in adult?

Answer 34

NSAID for pain relief | usually arthritis itself is self-resolving

Question 35

Q 39. Budd-chiari vs. hepatic portal vein embolism: differences (2)?

Answer 35

Budd-chiari 1. embolism at hepatic vein 2. liver cirrhosis Hepatic vein embolism 1. embolism at HPV 2. varicies (ex-esophageal varicies), no liver cirrhosis (liver biopsy should be normal)

Question 36

Q 40. what is meconium ileus? which disease is associated with it?

Answer 36

ileum obstruction by meconium (first stool in infant), causing bowel distention and emesis cystic fibrosis

Question 37

Q 40. What is fatal cause of death in cystic fibrosis?

Answer 37

pneumonia