3/3 UWORLD test # 31 Flashcards
Q 2. What are side effects of TCAs on heart? ECG findings? Pathophysiology? antidote?
arrythmia, enlarged QRS, prolonged QT
Blockade of Na+ channel
can be reversed by NaHCO3
Q 3. What is gross appearance of angiomyolipoma in kidney? Which neurocutaneous disease is associated with it? What others are associated with it? (remember mneomic in FA 495)
- mass containing blood vessel, muscle, fat
- tuberous sclerosis
H- Hamartoma A- Ash-leaf spot on skin (hypopigmented skin with leaf shape) M- Mitral regurgitation A- Angiofibroma R- Rhabdomyoma T- Tuberous sclerosis O- autosomal dOminant M- Mental retaradation A- Angiomyolipoma
Neurocutaenous disease: NF1 vs. NF2
- mutated gene/ chromosome number / which protein
- manifestations
- NF1: neurofibromin, negative regulator of RAS on chromosome 17
=> cafe-au-lait spots, pheocytochroma, cutaneous fibromas (think about gross appearance), Lisch noduels (pigmented iris) - NF2: NF2 gene on chromosome 22
=> bilateral schwannoma, juvenile cataracts, meningioma
von Hippel-Lindau disease
- what gene/ chromosome
- what cancers (4)
-
- VHL gene on chromosome 3
- bilateral RCC, pheocytochroma, hemangioblastoma (high vascularity with hyperchromic nuceli), angiomatosis
Sturge-Weber syndrome
- what gene
- findings (5)
- activating mutation on GNAQ gene
S-port-wine Stain T- tram track calcification of opposing gyrion CT U- unilateral R- retardation G- glaucoma/ GNAQ E- epilepsy
Q 5. Gross appearance of tinea versicolor? which infection? microscopy characteristic?
- hypopigemeted (and/or) pink patches
- Malassezia
- meatball sphaghetti
Q 7. Granulomatous destruction of interlobular bile ducts: what is this disease?
primary biliary cholangitis
Q 7. What hepatic condition is associated with ulcerative colitis?
primary sclerosing cholangitis
Q 7. What are clinical symptoms (5) of PBC (primary biliary colangitis) ?
cholestasis (jaundice, pale stool, dark urine)
hypercholesteroliemia: biliary obstruction limits elimination of cholesterol
hepatosplenomegally
fatigue
pruritus: accumulation of bile salts
Q 8. What is another fancy word for B12?
cobalamin
Q 8. What is another fancy word for B6?
pyridoxine
Q 8. What is another fancy word for B2?
Its usage in what TCA cycle rxn?
deficiency symptoms (2)
riboflavin
succinate dehydrogenase: succinate –> fumarate
Cheilosis, corenal vasculization (2 Cs)
Q 8. What kind of heart failure is seen in wet beriberi? describe physical exam findings
high output cardiac failure (thus WET)
displaced apical impulse at PMI
collapsing carotid pulses
S3
Q 8. Clinical presentations of dry beriberi
peripheral neuropathy
symmetrical muscle wasting -> eventually inability to walk
With B1 deficiency, dry beriberi may coexist with wet beriberi
Q 9. Sudden onset of heart failure can be caused most likely by what conditions (2)? Would Aortic stenosis present sudden onset of HF?
- acute atrial fibrilation or acute MI
- In case of aortic stenosis, onset of heart failure is usually gradual. not suddenly
Q 10. Facial drop vs. Facial numbness: what would most likely happen with parotid gland enlargement. why?
Facial drop
trigeminal nerve is deep so it is unlikely compressed by parotid gland, while facial nerve is superficial
FACIAL=superFICIAL
Q 11. Diagnostic criteria for cyclothymic disorder
MORE THAN 2 YEARS of alternating episodes of hypomanic and mild depression
Q 11. Define key difference: manic vs. hypomanic
manic: DIG FAST severe enough to interfere with occupational/social life
hypomanic: asl DIG FAST, but not severe enough to cause marked impairment in social/occupational functioning
Q 12. Patient ask physician out for a date. What is the physician’s appropriate response?
Tell patient that it is unethical
Q 13. What is protruding in femoral hernia? What is complication of femoral hernia? why is this?
- most commonly bowel protrudes through femoral ring
- Femoral vein/artery serve as lateral landmark! It is NOT femoral vessels that protrude.
- Malabsorption, nausea, vomiting, abdominal pain/distention, fever)
: Because femoral ring is small, femoral hernia can cause incarceration (protruding tissue become trapped and no longer be pushed back) or strangulation (impaired blood flow -> ischemia-> fever)
Q 15. Amiodarone side effects on
- skin
- eye
- blue/green skin deposits with photosensitive dermatitis
- corneal deposits
Q 16. Which cranial nerve mediates tongue movement? Left side defect on this CN results in what?
- hypoglossal
- tongue deviation to left
Q 16. Which CN mediates gag reflex
- sensory
- motor
- sensory: glossopharnyngeal
- motor: vagus
Q 16. glossopharyngeal nerve
- sensory
- motor
- parasympathetic
sensory: posterior 1/3 tongue, tonsil, carotid sinus/ body
motor: stylopharyngeus muscle only. elevation of pharynx/larynx during swallowing
parasympathetic: salivation
Uvula deviation to right: What cranial nerve defect? which side?
left vagus
Q 17. What is fancy word for vitamin B7?
biotin
Q 17. Vitamin B7
- General function in metabolic pathway?
- what specific metabolism rxns (3)
- symptoms for B7 deficiency (3)
- possible causes of B7 deficiency (2)
- carboxylation
- pyruvate carboxylase: pyruvate -> oxaloacetate
( for gluconeogenesis) - propionyl-coA carboxylas: propionyl-coA-> methylmalonic-coA
( for odd chain fatty acids / amino acid metabolism) - Acetyl-coA carboxylase: acetyl-coA -> malonyl-coA
(for fatty acid synthesis)
- dermatitis, alopecia, enteritis
- deficiency caused by antibiotic use or excessive ingestion of raw white egg
Q 19. midgut malrotation during development: what can happen? explain pathophysiology
fibrous band (Ladd’s band) attached colon/cecum to retroperitoneum. This band passes over second part of duodnum
-> duodenal obstruction -> volvulus, obstruction & ischemic necrosis of duodenum
Q 20. Hepatitis A
- infection route
- possible infection causes (2)
- prognosis, hepatocellular carcinoma risk? hepatitis? cirrhosis?
- oral/fecal
- raw/cooked shellfish, contaminated water
- good prognosis, no risk for HCC, hepatitis, cirrhosis
Q 21. What is classic triads of meningitis? One more symptom in addition to this triads?
- classic triads: headache, altered mental status, nuchal rigidity
- photophobia may also present
Q 22. Histologic findings: cardiogenic acute pulmonary edema vs. cardiogenic chronic pulmonary edema
- cardiogenic acute pulmonary edema: blood backing up -> transduate infiltration into alveoli due to increased hydrostatic pressure
- cardiogenic chronic pulmonary edema: hemosiderin laiden macrophage (heart failure cells)
Q 23. Silicosis
- occupations (3)
- increased risk for what? pathophysiology
- which lobe is affected
- mine, sandblasting, foundries
- TB, silica disrupts macrophage’s lysosome -> engulfed TB can escape from macrophage ->TB infection
- upper (every other occupational lung disease affects upper lobe, except abestosis)
Asbestosis
- occupations (3)
- increased risk for what (2)?
- characteristic CT finding
- which lobe is affected
- roof, shipbuilding, plumbing
- bronchogenic carcinoma > mesothelioma
- calcified pleural plaques
- lower lobe (opposite to roof)
Q 26. Describe how celecoxib is different from other NSAIDs
- primary target (not cox2, downstream products)
- advantage over other NSAIDs
- side effects (2)
- prostacyclin
- no mucosal bleeding (PGE intact), no bleeding (TXA2 intact)
- side effects:
1. thrombosis -> cardiovascular disease (inhibition of prostacyclin, which inhibits platelet aggregation)
- sulfa alleargy
Q 28. How OCP affects each level of thyroid hormone: explain physiology
- total T3/T4
- free T3/T4
- TSH
- total T3/T4: increased as estrogen induces TBG (thyroxine binding globulin) synthesis
- free T3/T4: stay same= EUTHYROID
(T3/T4 synthesis actually increased in response to increased TBG, but they become saturated to TBG, so free T3/T4 level stay same) - TSH: stay same (as free T3/T4 is not changed)
Q 31. Nitrate vs. Nitrite: these two are totally different! explain each for
- mechanism of action
- indication
- nitrate: venous dilation, angina & HF
- nitrite: methamoglobin synthesis by oxidizing ferrous (Fe2+) to Ferric (Fe3+)
oxidized hemoglobin has stronger affinity to cyanide. Thus nitrite can be used to treat cyanide poisoning by sequestering tissue deposited cyanide to methamoglobin
Q 31. What exactly is PaO2 (partial pressure of oxygen) ?
amount of oxygen dissolved in plasma
not related to hemoglobin
Q 31. What is oxygen content in the blood?
O2 carried by hemoglobin + O2 dissolved in plasma
= 1.34 * Hb* SaO2 + 0.003* PaO2
Q 32. What are three functions of osteocytes?
- structural support of bone
- short term Ca2+ storage/ Ca2+ release
- stress sensor-> modulate osteoblast activity in response to mechanical stress
Q 32. through what connection do osteocytes communicate each other?
gap junction
Describe how estrogen helps osteoporosis (FA. 314)
estrogen -> synthesis of OPG (osteoprotegerin): RANK-L decoy receptor -> inhibits osteoclast activation by RANK-L
Q 33. Gas analgestics: what does partial pressure change in a given time tell about
- solubility
- potency
- onset
The faster partial pressure of gas increases with a given time, the faster gas becomes saturated. meaning
- less solubility: dissolved gas will not give partial pressure!
- faster onset
- nothing about potency: potency is only inversely depend on MAC (minimum alveolar concentration), which is dependent on lipophilicity
Q 34. parotitis: what enzyme is expected to be elevated? what infections are possible?
- amylase
- staph aureus, mumps virus
Q 35. Which two tests are used for diagnosis for chronic granulomatous disease? what are positive results?
- nitroblue tetrazolium testing: no blue inclusion
- dihydrorhodamine (DHR): decreased green fluorescence
Q 36. spirometry: what would be the hall mark for restrictive physiology
significant decrease in FVC
due to small lung size
spirometry: obstructive vs. restrictive
- FEV1
- FVC
- FEV1/FVC
- RV
- TLC
Obstructive
- FEV1: significant decrease
- FVC: decrease
- FEV1/FVC: decrease (<80)
- RV: increase
- TLC: increase
Restrictive
- FEV1: decrease (less inhaled gas)
- FVC: significant decrease
- FEV1/FVC: normal
- RV: decrease
- TLC: decrease
FEV1 & FVC: decrease in BOTH
Q 38. Which type of knee injury happens from following activities
- kneeling
- running
- kneeling: prepatella bursitis
- running: suprapatella bursitis
Q 39. location of headaches
- migraine
- cluster
- tension
- migraine: unilateral
- cluster: periorbital
- tension: bilateral, band squeezing head
Q 40. pathophysiology of analgestic nephropathy
analgestic -> accumulation in renal medulla -> using up glutathione depletion -> lipid peroxidation -> chronic interstitial nephritis -> ischemic papillary necrosis
