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UWORLD first pass- week 5 > 3/3 UWORLD test # 31 > Flashcards

3/3 UWORLD test # 31 Flashcards

1
Q

Q 2. What are side effects of TCAs on heart? ECG findings? Pathophysiology? antidote?

A

arrythmia, enlarged QRS, prolonged QT
Blockade of Na+ channel
can be reversed by NaHCO3

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2
Q

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)

A
  • 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
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3
Q

Neurocutaenous disease: NF1 vs. NF2

  • mutated gene/ chromosome number / which protein
  • manifestations
A
  • 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
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4
Q

von Hippel-Lindau disease
- what gene/ chromosome
- what cancers (4)
-

A
  • VHL gene on chromosome 3

- bilateral RCC, pheocytochroma, hemangioblastoma (high vascularity with hyperchromic nuceli), angiomatosis

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5
Q

Sturge-Weber syndrome

  • what gene
  • findings (5)
A
  • 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
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6
Q

Q 5. Gross appearance of tinea versicolor? which infection? microscopy characteristic?

A
  • hypopigemeted (and/or) pink patches
  • Malassezia
  • meatball sphaghetti
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7
Q

Q 7. Granulomatous destruction of interlobular bile ducts: what is this disease?

A

primary biliary cholangitis

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8
Q

Q 7. What hepatic condition is associated with ulcerative colitis?

A

primary sclerosing cholangitis

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9
Q

Q 7. What are clinical symptoms (5) of PBC (primary biliary colangitis) ?

A

cholestasis (jaundice, pale stool, dark urine)
hypercholesteroliemia: biliary obstruction limits elimination of cholesterol
hepatosplenomegally
fatigue
pruritus: accumulation of bile salts

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10
Q

Q 8. What is another fancy word for B12?

A

cobalamin

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11
Q

Q 8. What is another fancy word for B6?

A

pyridoxine

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12
Q

Q 8. What is another fancy word for B2?
Its usage in what TCA cycle rxn?
deficiency symptoms (2)

A

riboflavin

succinate dehydrogenase: succinate –> fumarate

Cheilosis, corenal vasculization (2 Cs)

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13
Q

Q 8. What kind of heart failure is seen in wet beriberi? describe physical exam findings

A

high output cardiac failure (thus WET)

displaced apical impulse at PMI
collapsing carotid pulses
S3

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14
Q

Q 8. Clinical presentations of dry beriberi

A

peripheral neuropathy
symmetrical muscle wasting -> eventually inability to walk

With B1 deficiency, dry beriberi may coexist with wet beriberi

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15
Q

Q 9. Sudden onset of heart failure can be caused most likely by what conditions (2)? Would Aortic stenosis present sudden onset of HF?

A
  • acute atrial fibrilation or acute MI

- In case of aortic stenosis, onset of heart failure is usually gradual. not suddenly

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16
Q

Q 10. Facial drop vs. Facial numbness: what would most likely happen with parotid gland enlargement. why?

A

Facial drop

trigeminal nerve is deep so it is unlikely compressed by parotid gland, while facial nerve is superficial

FACIAL=superFICIAL

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17
Q

Q 11. Diagnostic criteria for cyclothymic disorder

A

MORE THAN 2 YEARS of alternating episodes of hypomanic and mild depression

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18
Q

Q 11. Define key difference: manic vs. hypomanic

A

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

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19
Q

Q 12. Patient ask physician out for a date. What is the physician’s appropriate response?

A

Tell patient that it is unethical

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20
Q

Q 13. What is protruding in femoral hernia? What is complication of femoral hernia? why is this?

A
  • 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)
21
Q

Q 15. Amiodarone side effects on

  • skin
  • eye
A
  • blue/green skin deposits with photosensitive dermatitis

- corneal deposits

22
Q

Q 16. Which cranial nerve mediates tongue movement? Left side defect on this CN results in what?

A
  • hypoglossal

- tongue deviation to left

23
Q

Q 16. Which CN mediates gag reflex

  • sensory
  • motor
A
  • sensory: glossopharnyngeal

- motor: vagus

24
Q

Q 16. glossopharyngeal nerve

  • sensory
  • motor
  • parasympathetic
A

sensory: posterior 1/3 tongue, tonsil, carotid sinus/ body
motor: stylopharyngeus muscle only. elevation of pharynx/larynx during swallowing
parasympathetic: salivation

25
Q

Uvula deviation to right: What cranial nerve defect? which side?

A

left vagus

26
Q

Q 17. What is fancy word for vitamin B7?

A

biotin

27
Q

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)
A
  • carboxylation
  1. pyruvate carboxylase: pyruvate -> oxaloacetate
    ( for gluconeogenesis)
  2. propionyl-coA carboxylas: propionyl-coA-> methylmalonic-coA
    ( for odd chain fatty acids / amino acid metabolism)
  3. 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
28
Q

Q 19. midgut malrotation during development: what can happen? explain pathophysiology

A

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

29
Q

Q 20. Hepatitis A

  • infection route
  • possible infection causes (2)
  • prognosis, hepatocellular carcinoma risk? hepatitis? cirrhosis?
A
  • oral/fecal
  • raw/cooked shellfish, contaminated water
  • good prognosis, no risk for HCC, hepatitis, cirrhosis
30
Q

Q 21. What is classic triads of meningitis? One more symptom in addition to this triads?

A
  • classic triads: headache, altered mental status, nuchal rigidity
  • photophobia may also present
31
Q

Q 22. Histologic findings: cardiogenic acute pulmonary edema vs. cardiogenic chronic pulmonary edema

A
  • 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)
32
Q

Q 23. Silicosis

  • occupations (3)
  • increased risk for what? pathophysiology
  • which lobe is affected
A
  • 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)
33
Q

Asbestosis

  • occupations (3)
  • increased risk for what (2)?
  • characteristic CT finding
  • which lobe is affected
A
  • roof, shipbuilding, plumbing
  • bronchogenic carcinoma > mesothelioma
  • calcified pleural plaques
  • lower lobe (opposite to roof)
34
Q

Q 26. Describe how celecoxib is different from other NSAIDs

  • primary target (not cox2, downstream products)
  • advantage over other NSAIDs
  • side effects (2)
A
  • prostacyclin
  • no mucosal bleeding (PGE intact), no bleeding (TXA2 intact)
  • side effects:
    1. thrombosis -> cardiovascular disease (inhibition of prostacyclin, which inhibits platelet aggregation)
  1. sulfa alleargy
35
Q

Q 28. How OCP affects each level of thyroid hormone: explain physiology

  • total T3/T4
  • free T3/T4
  • TSH
A
  • 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)
36
Q

Q 31. Nitrate vs. Nitrite: these two are totally different! explain each for

  • mechanism of action
  • indication
A
  • 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
37
Q

Q 31. What exactly is PaO2 (partial pressure of oxygen) ?

A

amount of oxygen dissolved in plasma

not related to hemoglobin

38
Q

Q 31. What is oxygen content in the blood?

A

O2 carried by hemoglobin + O2 dissolved in plasma

= 1.34 * Hb* SaO2 + 0.003* PaO2

39
Q

Q 32. What are three functions of osteocytes?

A
  • structural support of bone
  • short term Ca2+ storage/ Ca2+ release
  • stress sensor-> modulate osteoblast activity in response to mechanical stress
40
Q

Q 32. through what connection do osteocytes communicate each other?

A

gap junction

41
Q

Describe how estrogen helps osteoporosis (FA. 314)

A

estrogen -> synthesis of OPG (osteoprotegerin): RANK-L decoy receptor -> inhibits osteoclast activation by RANK-L

42
Q

Q 33. Gas analgestics: what does partial pressure change in a given time tell about

  • solubility
  • potency
  • onset
A

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
43
Q

Q 34. parotitis: what enzyme is expected to be elevated? what infections are possible?

A
  • amylase

- staph aureus, mumps virus

44
Q

Q 35. Which two tests are used for diagnosis for chronic granulomatous disease? what are positive results?

A
  • nitroblue tetrazolium testing: no blue inclusion

- dihydrorhodamine (DHR): decreased green fluorescence

45
Q

Q 36. spirometry: what would be the hall mark for restrictive physiology

A

significant decrease in FVC

due to small lung size

46
Q

spirometry: obstructive vs. restrictive
- FEV1
- FVC
- FEV1/FVC
- RV
- TLC

A

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

47
Q

Q 38. Which type of knee injury happens from following activities

  • kneeling
  • running
A
  • kneeling: prepatella bursitis

- running: suprapatella bursitis

48
Q

Q 39. location of headaches

  • migraine
  • cluster
  • tension
A
  • migraine: unilateral
  • cluster: periorbital
  • tension: bilateral, band squeezing head
49
Q

Q 40. pathophysiology of analgestic nephropathy

A

analgestic -> accumulation in renal medulla -> using up glutathione depletion -> lipid peroxidation -> chronic interstitial nephritis -> ischemic papillary necrosis

UWORLD first pass- week 5 (8 decks)

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