3/6 UWORLD- test #34

Question 1

Q 14. What cephalosporins (2) treat pseudomonas?

Answer 1

Third gen: Ceftazidime

Fourth gene: Cefepime

Question 2

Q 14. What drugs treat pseudomonas? (6 drug classes)

Answer 2

• cephalosporins (ceftazidime, cefepime)
• aminoglycosides
• fluoroquinolone
• monobactem (aztreonam)
• carbapenems (-penem)
• broadspectrum penicilins (piperacilin, ticarcilin)

Question 3

Q 1. suspensory ligament of ovary houses ovarian vessel. what is fancy word for this ligament? This ligament connects what?

Answer 3

infundibulopelvic ligament

connects ovary with lateral pelvic wall

Question 4

Q 2. Which immune cells mediate killing of tumor cells ? Which cytokine mediates this?

Answer 4

NK cells

IL-2

Question 5

Q 2. Which immune cells secrete IL-2? What cells does it stimulate for growth?

Answer 5

primarily from Helper T cells

Stimulates all sorts of T cells (helper, cytotoxic, regulatory) + NK cells

Question 6

Q 3. What is glial fibrilary acidic protein? What cells show immunoactivity for this protein? What CNS tumors (2) will be positive?

Answer 6

• GFAP
• astrocytes
• glioblastoma multiforme & pilocytic astrocytoma

Question 7

Q 3. What is synaptophysin? Which cells (3) will show immunoactivity for this protein?

Answer 7

• transmembrane glycoprotein in presynaptic vesicles

- neuron, neuroendocrine, neuroectoderm

Question 8

Q 4. What determines severity of tetralogy of Fellot?

Answer 8

RVOT (right ventricle outflow tract) obstruction
-> will cause irreversible damage to pulmonary artery

• right ventricular hypertrophy could be reversible

Question 9

Q 5. How AV shunt changes hemodynamics?

Answer 9

Arterioles bypass capillary and directly enters venous

-> thus it will increase venous return & preload

Question 10

Q 6. When does beta thalessemia major become symptomatic? why?

Answer 10

After 6 month of child birth

Before 6 months, gamma globulin chain will be predominant form. So Fetal hemoglobin (HbF, two alpha, two gamma) will be normally functioning.

As Fetal hemoglobulin drops after 6 months, newborn baby cannot produce normal HbA, becoming symptomatic.
This rule applies to other beta globulin disorder (sickle cell disease)

Question 11

Q 7. characteristics/functions of tRNA

• trinucleotide sequence in 3’end?
• D arm (dihydrourine)?
• T arm (ribothymidine, pseudouridine, cytidine)?

Answer 11

• 3’ end CCA
• D arm (dihyrdourine): tRNA recognition by correct aminoacyl-tRNA synthetase
• T arm (ribothymidine, pseudouridine, cytidine): tRNA ribosome binding

Question 12

Q 7. Function of aminoacyl-tRNA synthetase? what part of tRNA ensure integrity of this enzyme’s reaction?

Answer 12

transfer of aminoacid to 3’OH end of tRNA

pairing of right aminoacyl-tRNA is mediated by D arm (dihydrourine)

Question 13

Q 9. MRI finding of loss of grey-white matter with sulcal effacement suggests what?

Answer 13

hypoxic brain injury

possibly due to acute MI

Question 14

Q 9. nuclei for eye: function? location?

• Edinger-westphal nucleus
• pretectal nucleus
• lateral geniculus nucleus

Answer 14

• Edinger-westphal nucleus: ipsilateral efferent CN3, located in upper midbrain
• pretectal nucleus: receives afferent CN2, sends BILATERALLY to Edinger-westphal nucleus, located in upper midbrain
• lateral geniculus nucleus: receives afferent CN2, sends ipsilaterally to calcarine sulcus for vision, located in thalamus

Question 15

Q 9. Draw how CN2/CN3 are interconnected for pupillary light reflex

Answer 15

FA. 487

Question 16

Q 10. Define psychologic term “avoidance”

vs. “schizoid”?

Answer 16

not socialize due to fear of criticism / rejection

Schizoid is voluntary withdrawal from socializing.
In avoidance, affect/repectfulness are intact, while schizoid is not.

Question 17

Difference between antisocial vs. conduct disorder?

Answer 17

Disrespectful, violation of rights of others

• antisocial: > 18 yo
• conduct disorder: <18 yo

Question 18

Q 10. Define 4 characteristics of boarderline disorder

Answer 18

• emotional instability
• suicidality & self-mutilation
  (don’t confuse this with depression)
• emptiness
• impulsivility

Question 19

Q 13. What tissue has maximal blood flow during ventricular diastole & minimal blood flow during ventricular systole? explain physiology. How is this different from all other tissues?

Answer 19

• left ventricular myocardium
• stretch/ compression
  during contraction, muscles compress coronary artery
  also, myocardium stretch coronary vessel, making it thinner => less blood supply
• other tissues are opposite. They receive the most volume during systole!

Question 20

Q 16. compare “somatic symptom disorder” vs. “conversion disorder”

Answer 20

somatic symptom: unexplained, generalized body complaints (fatigue, pain) + excessive anxiety

conversion disorder: unexplained NEUROLOGIC symptoms

• think like this: some pains get CONVERTED to NEUROLOGIC pain.

Question 21

Q 16. compare “somatic symptom disorder” vs. “illness anxiety disorder”

Answer 21

Like somatic symptom disorder, illness anxiety disorder also shows excessive anxiety of having/or acquiring disease.

But, somatic symptoms are MINIMUM

Question 22

Q 17. Where is germinal matrix? what is consequence of germinal matrix hemorrhage?

Answer 22

close proximity to lateral ventricle

germinal matrix hemorrhage can lead to intraventricular hemorrahge

Question 23

Q 19. ACEI vs. ARB: affect on

• aldosterone
• bradykinin

Answer 23

ACEI
- aldosterone: decrease

• bradykinin: increase -> angioedema with c1 esterase inhibitor deficiency

ARB
- aldosterone: decrease (remember AngII binds to AngII receptor on adrenal cortex to stimulate aldo secretion)

• bradykinin: no change (it is ACE that mediates bradykinin breakdown, not AngII)

Question 24

Q 20. What hematoma is associated with skull fracture?

Answer 24

epidural

Question 25

Q 20. epidural hematoma is associated with rupture of what artery? This artery is branch of what artery?

Answer 25

middle meningeal artery | branch of maxillary artery

Question 26

Q 21. Definition of intrapartum?

Answer 26

during labor and delivery

Question 27

Q 22. Draw and explain physiology regarding how breathing frequency & breathing work graph is affected in: - asthma - pulmonary fibrosis

Answer 27

Note p.26

Question 28

Q 23. Pulsus paradoxus & hypotension shortly week after upper respiratory infection. what is diagnosis?

Answer 28

cardiac temponade NOT acute pericarditis: it can also cause pulsus paradoxus, but not hypotension. Also, it would take longer (months) to develop pericarditis after infection

Question 29

Q 23. 4 etiologies of cardiac temponade

Answer 29

- infection - radiation - connective tissue disease (inflammation) - malignancy

Question 30

Q 25. pathophysiology: vitiligo vs. albinism

Answer 30

vitiligo: complete absence of melanocytes albinism: impaired melanin production due to reduced tyrosinase activity (tyrosinase: DOPA -> melanin)

Question 31

Q 27. Hypertriglyceridemia (>1000mg/dL): what disease should I think first?

Answer 31

actue pancreatitis

Question 32

Q 28. MOA for bisphosphonate?

Answer 32

inhibition of osteoclast ACTIVITY bisphosphonate binds to HYDROXYAPATITE on bone surface, inhibiting binding of osteoclast on bone

Question 33

Q 31. spreading pattern of maculopapular rash in rubeola (measles)?

Answer 33

starting from face, spread to trunk and extremities. normally spares hands/feet. DOWNWARD spread

Question 34

What is SSPE (subacute sclerosing panencephalitis)?

Answer 34

severe complication of measles that may present with seizure, myoclonus, personality changes, ataxia, and comma. Normally seen in immigrant kids with no history of MMR vaccination.

Question 35

Q 32. How does bronchial obstruction causes lung collapse? unilateral lung collapse due to bronchial obstruction will show what findings on chest X-ray?

Answer 35

bronchial obstruction -> air trapped -> lung volume loss as air slowly diffuse into blood -> essential aveloar collapse X-ray: hemithorax on affected side deviation of trachea TOWARD affected side *think like this: in normal settings trachea is in the middle with well balanced tension. With lung collapse on one side, the tension on affected side is decreased and structures will deviated TOWARD collapsed (weak) side.

Question 36

Chest x-ray with pneumothorax. what should I find first?

Answer 36

TRACHEA trachea/direction of trachea deviation & side of pneumothorax Once find a direction of trachea deviation, then figure out etiology - trachea deviating TOWARD hemithorax: lung collapae due to alveolar obstruction - trachea deviating AWAY from hemithorax: tension pneumothorax (air within pleural space is accumulating and can't get out -> air pressure builds up, pushing structures toward unaffected side

Question 37

Q 33. What is Trousseau syndrome? What medical condition is associated with it? How does it present clinically?

Answer 37

migratory thrombophlebitis visceral cancer (pancreatic, colon, lung adenocarcinoma) erythematous/tender thrombophlebitis showing migration pattern (extending forearm to elbow, for example)

Question 38

Q 33. What is Trousseau sign? What does it indicate?

Answer 38

- blood pressure cuff- > carpal spasm | - hypocalcemia

Question 39

Q 34. genetics: what is in-frame deletion?

Answer 39

deletion of 3x nucleotides. no frameshift

Question 40

Q 35. elevated orotic acid in urine - what are two possible diseases? - compare these two diseases in terms of 1) missing enzyme 2) clinical presentation

Answer 40

- hereditary orotic aciduira 1) UMP synthase defect 2) megaloblastic anemia, no hyperammonemia - ornithine transcarbamylase deficiency 1) ornitine transcarbamylase in urea cycle 2) encephalopathy due to hyperammonemia, no magaloblastic anemia

Question 41

Q 36. What is HbA2? Under what condition is it increased?

Answer 41

- 2 alpha globulin + 2 delta globulin - increased in both beta thalessemia major/ minor >3.5% on electrophoresis can be diagnostic for beta thalessemia minor, which is usually asymptomatic

Question 42

Q 38. What three medications are used for first line regimen for long-term bipolar management?

Answer 42

- lithium - valporate (or lamotrigene) - quetiapine (atypical antipsychotics)

Question 43

Apart from anti-epileptic usage, in what other two conditions can valporate be used?

Answer 43

- bipolar disorder (long term management) | - prophylaxis for migraine

Question 44

Q 39. cytokeratin - what is it? - For which disease can it be used as marker?

Answer 44

- keratin-containing intermediate filaments that make up cytoskeleton of EPITHELIAL cells - cytokeratin can be used a marker for epithelial cell derived tumor (squamous cell carcinoma)

Question 45

Q 40. HER2 - encodes for what type of receptor/ function - marker for what diseases (2) - prognosis indicator? - which drug target HER2?

Answer 45

- tyrosine kinase receptor for EPIDERMAL growth/proliferation - breast cancer, gastric cancer - HER2 positive breast cancer has worse prognosis than HER2 negative - trastuzumab