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UWorld Review > 4/17/19 > Flashcards

4/17/19 Flashcards

1
Q

Given a positive test result, what is the probability that a patient has the disease?

A

Calculate PPV = a / (a + b)

number of people with disease who test positive among all those who test positive

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2
Q

PPV varies with disease

A

prevalence

if disease prevalence increases, PPV increases

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3
Q

Hereditary angioedema is a rare AD disorder associated with

A

painless episodes of swelling involving face, lips, larynx, extremities

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4
Q

Hereditary angioedema is caused by

A

AD

C1 inhibitor deficiency

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5
Q

Sickle cell disease causes what kinds of hemolysis

A

intra and extravascular hemolysis

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6
Q

Sickle cell disease causes increase in

A

indirect bilirubin
lactate dehydrogenase
decreased haptoglobin

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7
Q

What is haptoglobin

A

Acute phase reactant

  • decreased in sickle cell disease
  • binds circulating hemoglobin
  • reduces renal excretion of free Hgb preventing tubular injury
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8
Q

African american with swelling hands and feet

A

sickle cell disease

dactylitis (hand-foot syndrome) - vasoocclusive symptoms

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9
Q

Transplant patients (esp. lung) at risk for what virus

A

CMV
enveloped dsDNA
Herpesviridae family

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10
Q

Patients at risk for CMV infection

A

transplant
HIV
fetuses (congenital infection)

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11
Q

In HIV, CMV usually causes

A

esophagitis
colitis
retinitis

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12
Q

CMV histology

A
  • enlarged cells with intranuclear and intracytoplasmic inclusions (viral particles)
  • often surrounding halo (owl’s eye)
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13
Q

Ppx for CMV in transplant patients

A

valganciclovir

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14
Q

Influenza virus is an

A

enveloped

ssRNA

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15
Q

P450 inducers

A 
phenytoin
barbituates
rifampin
carbamazepine
griseofulvin
chronic alcohol consumption
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16
Q

P450 inhibitors

A 
isoniazid 
cimetidine
macrocodes
azole antifungals
grapefruit juice
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17
Q

Tight tie causing lightheadedness

A

carotid sinus hypersensitivity (baroreceptors)

dilation of internal carotid artery

severe bradycardia, hypotension, syncope

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18
Q

baroreceptors are found in the

A

carotid sinus

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19
Q

baroreceptors work by

A

arterial wall stretch as an indication of systemic BP

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20
Q

How does the carotid sinus work

A

afferent limb: baroreceptors in carotid sinus –> medullary center via Hering nerve (glossopharyngeal nerve CN IX)

efferent limb: from medulla carries PNS impulses via vagus nerve

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21
Q

Carotid massage or pressure can cause

A
  • stimulation of baroreceptors
  • increase in PNS output/withdrawal of SNS output to heart and peripheral vasculature
  • decreased BP (peripheral vasodilation)
  • decreased CO (decreased contractility/SV/HR)
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22
Q

The vagus nerve controls BP by

A

afferent limb: for nerve fibers of aortic arch baroreceptors

efferent limb: for carotid sinus reflex

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23
Q

What is a low osmolarity in the tubular system

A

100-300

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24
Q

Where is the lowest osmolarity in the tubule system

A

distal convoluted tubule

100 mOsm/L

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25
Q

Where is the highest osmolarity in the tubule system

A

descending limb of loo of Henle (when ADH is high)
collecting duct
1200 mOsm/L

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26
Q

Decerebrate posturing (extending) is from damage to

A

brainstem at/below level of the red nucleus (midbrain tegmentum, pons)

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27
Q

Decorticate (flexor) posturing is from damage to

A

neural structures above the red nucleus (cerebral hemispheres, internal capsule)

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28
Q

Which one is worse, decerebrate or decorticate posturing

A

decerebrate

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29
Q

which Ig can cross the placenta

A

IgG

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30
Q

Hemolytic disease of the newborn is caused by

A

severe autoimmune hemolytic anemia
destruction of fetal RBCs by maternal Ans directed against fetal erythrocyte Ag

Abs cross the placenta and opsonize fetal erythrocytes causing hemolysis

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31
Q

Erythroblastosis fettles is MCC by

A

Rh incompatibility, D antigen

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32
Q

Hemolytic disease of the newborn can cause what in the baby

A
  • profound anemia - stimulates release of immature nucleated erythrocytes = persistent extra medullary hematopoiesis
  • jaundice (poss kernicterus)
  • generalized edema (hydros fetalis d/t accumulation of interstitial fluid)
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33
Q

Panic disorder is described as

A

recurrent, unexpected panic attacks, concern about future panic attacks

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34
Q

Acute stress disorder is described as

A

exposure to a traumatic event followed by development of characteristic symptoms )re-experiencing, avoidance, arousal) lasting from 3 days to 1 month

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35
Q

Adjustment disorder requires

A

symptoms that develop in response to an identifiable stressor

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36
Q

Generalized anxiety disorder is described as

A

chronic multiple worries, excessive worry for at least 6 months, may or may not precipitate panic attacks

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37
Q

Recent MI
sharp/pleuritic chest pain
exacerbation with swallowing

A
  • peri-infarction pericarditis
  • 2-4 days post transmural MI
  • reaction to necrosis of myocardium near epicardial surface
  • resolves in 1-3 days with aspirin
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38
Q

Peri-infarction pericarditis involves damage to

A

visceral and parietal pericardium localized to areas overlying necrotic myocardial segment

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39
Q

Dressler syndrome

A
  • autoimmune mediated pericarditis
  • provoked by antigens exposed or created by infarction and necrosis of cardiac muscle
  • onset weeks to months after MI
  • pericardium diffusely affected
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40
Q

Nutrients affected by gastric bypass

A 
Iron
B12
Folate
fat soluble vitamins, esp D
calcium
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41
Q

Methacholine MOA

A

inhaled muscarinic cholinergic agonist

induces bronchoconstriction

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42
Q

Patients with asthma react to methocholine by

A
  • hyper-responsitivity

- reduction in FEV1 at lower doses than in those without asthma

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43
Q

Muscle biopsy showing ragged red fibers

A

mitochondrial myopathy

maternal inheritance

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44
Q

myopathy
nervous system dysfunction
lactic acidosis
ragged red fibers on biopsy

A

mitochondrial myopathies

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45
Q

PSGN presents with

A

elevated ASO

low C3 levels

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46
Q

Lumbar puncture is done between levels

A

3rd and 4th lumbar vertebrae

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47
Q

Hyponatremia
lung mass
headache, weakness, altered mental status, seizures

A

SIADH

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48
Q

Small cell lung carcinomas are tumors of what origin

A

neuroendocrine

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49
Q

SIADH leads to

A

euvolemic hyponatremia
decreased plasma osmolality
elevated urine osmolality

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50
Q

SIADH gets euvolemic hyponatremia bc

A
  • excessive water absorption = subclinical hypervolemia
  • increase in ECF suppresses RAAS
  • stimulates production of natriuretic peptides leading to excretion of sodium in urine

= normal ECF volume and low plasma osmolality

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51
Q

SIADH do not have

A

signs of volume overload

  • peripheral edema
  • pulmonary crackles
  • elevated JVP
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52
Q

long term PPIs are associated with

A

osteoporotic fractures

possibly by decreasing calcium absorption

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53
Q

Bilateral wedge-shaped strips of necrosis over cerebral convexity, parallel and few centimeters later to inter hemispheric cerebral fissure

A
  • global cerebral ischemia

- neuron cell death is at areas most vulnerable to hypoxia = watershed zones

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54
Q

Irreversible cell injury is associated with

A

mitochondria vacuolization

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55
Q

Disaggregation of granular and fibrillar elements of the nucleus is associated with

clumping of nuclear chromatin

A

reversible cell injury

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56
Q

inflammation phase of wound healing

A
  • fibrin clot for hemostasis
  • cytokines from activated plt and damaged cells lead to migration of neutrophils (24 hr) and macrophages (2-3 days later)
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57
Q

proliferation phase of wound healing

A
  • 3-5 days after injury
  • fibroblasts and endothelial vascular cells form connective tissue and blood vessels
  • epithelial cells begin to proliferate at dermal edges and secrete BM material
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58
Q

maturation phase of wound healing

A
  • fibrosis/scar formation during 2nd week after injury

- active fibroblasts synthesize collagen, elastin, connective matrix

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59
Q

Hypertrophic/keloid formation is d/t

A

increased TGF-beta activity

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60
Q

Fibrosis of the lung, liver, kidney with chronic inflammation is d/t

A

increased TGF-beta activity

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61
Q

What is capitation

A
  • payment structure underlying HMO’s

- payor pays fixed, predetermined fee to cover all medical services required by a patient

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62
Q

What is global payment

A

arrangement where insurer pays provider single payment to cover all expenses associated with an incident of care

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63
Q

Dyspnea/cough
nodular pleural thickening
pleural effusion (hemorrhagic)

A

mesothelioma

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64
Q

Histology of mesothelioma

A

numerous long, slender microvilli, and abundant tonofilaments

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65
Q

immunohistochemical markers for mesothelioma

A

pancytokeratin

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66
Q

HCM is caused by

A

genetic mutations in structural proteins of cardiac sarcomere

  • beta-myosin heavy chain
  • myosin-binding protein C)
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67
Q

histology of HCM

A

cardiomyocyte hypertrophy

haphazard cellular arrangement and interstitial fibrosis

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68
Q

Before surgery, who has to confirm the surgical site

A

the nurse and surgeon verify independently

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69
Q

Hepatic steatosis characterized by

A

TG accumulation within hepatocellular cytoplasm

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70
Q

alcohol-induced hepatic steatosis is d/t

A

decrease in FA oxidation secondary to excess NADH production from

  • alcohol dehydrogenase
  • aldehyde dehydrogenase
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71
Q

Fulminant hepatitis in pregnant women

A

hepatitis E

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72
Q

Hepatitis E is an

A

undeveloped

ssRNA virus

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73
Q

Opioids cause what in the sphincter of oddi

A

contraction and spasm

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74
Q

Tumor lysis syndrome is characterized by

A

hyperphosphatemia
hyperkalemia
hyperuricemia
hypocalcemia

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75
Q

Dobutamine causes

A 
Increased:
cAMP
isotropy 
chronotropy
cardiac output
myocardial oxygen consumption (trigger/exacerbate myocardial ischemia)

Decreased:
LV filling pressures
SVR

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76
Q

Dobutamine is used in

A

cardiogenic shock

refractory HF w/severe LV systolic dysfunction

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77
Q

Do not use dobutamine in

A

decompensated HF

78
Q

Dobutamine MOA

A

beta-1 agonist
weak beta-2 agonist
minimal activity of alpha-1 agonist
Gs receptor

79
Q

Hibernating myocardium

A

state of chronic myocardial ischemia

  • decreased metabolism and function to match concomitant reduction in coronary blood flow
  • new equilibrium prevents myocardial necrosis
  • decreased contractility and LV systolic dysfunction
  • coronary revascularization restores blood flow and improves contractility and LV function
80
Q

Concentric LV hypertrophy is associated with

A
  • decreased LV compliance
  • increased angiotensin II signaling
  • increased cardiac myosin heavy chain-beta expression
81
Q

There is higher Cl in RBC venous blood bc

A

chloride shift

  • carbonic anhydrase forms HCO3 from CO2 and water
  • excess HCO3 transferred out of RBC into plasma via exchange with Cl
82
Q

In COPD, changes are

A

increase in RV and TLC
decrease in FVC
more profound decrease in FEV1
decrease in FEV1/FVC

83
Q

Damage to what nerve with repetitive use of a screwdriver, direct trauma, subluxation of radius

A

Radial nerve during passage through the supinator canal

weakness during finger/thumb extension
no wrist drop or sensory deficits

84
Q

nontreponemal serologic tests

A

RPR
VDRL
mix patients serum with cardiolipin-cholesterol-lecithin antigen
lower sensitivity in early infection

85
Q

treponema diagnostic serology

A

FTA-ABS
TP-EIA
Ab to treponema antigens
greater sensitivity in early disease

86
Q

RF is an Ab that targets

A

Fc portion of IgG

seen in RA and AI

87
Q

Hepatic abscess in US caused by

A
  • S. aureus via hematogenous seeding to liver
  • enteric bacteria (E. coli, Klebsiella, enterococci) by ascending biliary tract, portal vein pyemia, direct invasion from adjacent area
88
Q

Hepatic abscess in third world countries

A

-entamoeba histolytica via food borne exposure and poor sanitation

89
Q

Bacillus anthraces main virulence factors

A
  • encased in antiphagocytic polypeptide capsule composed of D-glutamic acid
  • edema factor, mimics adenylate cyclase
90
Q

intracellular polyphosphate granules are associated with what bacteria

A

diphtheria

loeffler medium and methylene blue staining

91
Q

Prevent migraines with

A
  • anticonvulsants (topiramate, valproate)
  • TCA (amitriptyline)
  • beta blockers (metoprolol, propranolol)
92
Q

abort migraines with

A
  • triptans
  • NSAIDs, acetominophen
  • antiemetics
  • ergotamine
93
Q
  • middle age, insidious onset
  • symmetrical proximal muscle wasting w/mild pain
  • difficulty climbing stairs, getting up from chair, carrying heavy objects
A

polymyositis

94
Q

Polymyositis and dermatomyositis can occur paraneoplasically especially with

A

adenocarcinoma

95
Q

biopsy of polymyositis shows

A

endomysial mononuclear infiltrate

patchy fiber necrosis

96
Q

labs for polymyositis

A
  • elevated muscle enzymes (CK, aldolase)

- ANA, anti-Jo-1

97
Q

Associated complications of polymyositis

A

interstitial lung disease

myocarditis

98
Q

Anti-Jo-1 is a

A

anti-histidyl-tRNA synthetase

specific for polymyositis and dermatmyositis

99
Q

dermatomyositis biopysy shows

A

perifascicular inflammation in segmental pattern without vasculopathy

100
Q

muscle biopsies in MG and LEM are

A

normal

101
Q

Dilated cardiomyopathy leads to

A

increased right atrial pressure

increased LVED pressure

102
Q

Charcot-bouchard aneurysm affects

A

deeper brain structures/intracerebral hemorrhage

  • BG
  • cerebellum
  • thalmus
  • pons

HTN

103
Q

Saccular (berry) aneurysm affects

A

circle of willis
subarachnoid hemorrhage

see in ADPKD, Ehlers-Danlos, HTN

104
Q

Neuroleptic malignant syndrome is caused by

A

dopamine antagonist
1-3 days for onset
hyporeflexia

105
Q

Treatment for neuroleptic malignant syndrome

A

benzos

dantrolene

106
Q

dantrolene MOA

A

postsynaptic muscle relaxant

107
Q

Serotonin syndrome is caused by

A

serotonergic agent
onset less that 1 day
hyperreflexia

108
Q

Hormone sensitive lipase does what

A

in adipose tissue
mobilizes store TG into FFA and glycerol
used during starvation to provide substrates for hepatic gluconeogenesis and ketone formation

109
Q

Hormone sensitive lipase is activated by

A

stress hormones
catecholamines
glucagon
ACTH

110
Q

Hormone sensitive lipase is inhibited by

A

insulin

111
Q

Hormone sensitive lipase MOA

A

stress hormone to Gs protein on adipocytes
increased cAMP
activation of protein kinase A
HSL activated and lipolysis

112
Q

Hyperprolactinemia from prolactinoma suppresses

A

GnRH production = oligomenorrhea/amenorrhea

113
Q

cohort studies test compare

A

disease incidence

114
Q

case control studies compare

A

risk factor frequency between disease and no disease

115
Q

cross sectional studies compare

A

disease prevalence

116
Q

compare disease incidence

A

cohort

117
Q

compare risk factor frequency between disease and no disease

A

case control

118
Q

compare disease prevalence

A

cross sectional

119
Q

complications after SAH

A

arterial vasospasm
rebleeding
hydrocephalus
seizures

120
Q

MC complication after SAH

A
  • arterial vasospasm
  • unopposed vasoconstriction causes delayed cerebral ischemia
  • change in mental status and/or new focal near deficits
  • 3-12 days after SAH
  • no changes seen on new CT
121
Q

Lab to do before prescribing metformin

A

creatinine level

122
Q

Hemosiderin-laden macrophages (heart failure cells) are signs of

A

chronic lung congestion

macrophages digest RBC that leak from capillaries

123
Q

Sign of acute pulmonary edema

A
  • intraaveolar transudate appears as acellular pink material

- engorged alveolar capillaries

124
Q

Signs of early interstitial lung disease (idiopathic pulmonary fibrosis)

A

mononuclear interstitial pulmonary infiltrates

125
Q

Signs of pulmonary hemorrhage syndromes like Goodpasture and other vasculitides

A

focal necrosis of alveolar wall w/intraalveolar hemorrhage

126
Q

cutaneous neurofibromas from NF-1 are comprised of

A

Schwann cells

127
Q

NF-1 are at increased risk of developing

A

optic gliomas
pilocytic astrocytomas
causing elevated intracranial pressure and HA

128
Q

Cryptococcus is characterized by

A

round/oval yeast surrounded by thick polysaccharide capsule

129
Q

nephrotic syndrome with pitting edema is d/t

A

hypoalbuminemia

decreased oncotic pressure

130
Q

Abnormal vaginal bleeding with significantly increased HCG after normal/abnormal pregnancy

A

gestational choriocarcinoma (malignant)

131
Q

gestational choriocarcinoma arises from

A

trophoblast

132
Q

gestational choriocarcinoma invades the

A

uterine wall via hematogenous spread

133
Q

MC distal site of metastasis for gestational choriocarcinoma

A

lungs (SOB and hemoptysis)

134
Q

histologically, gestational choriocarcinoma looks like

A
  • abnormal proliferation of mononuclear cytotrophyblasts
  • multinuclear syncytiotrophoblasts
  • no villi present
135
Q

What are the two malignant gestational trophoblastic diseases

A

gestational choriocarcinoma

invasive mole

136
Q

Difference in findings of partial and complete mole

A

partial - focally hyperplastic trophoblasts, focally enlarged hydropic villi, present embryonic tissue, triploid

complete - diffusely hyperplastic trophoblasts, diffusely enlarged hydropic villi, absent fetal/embryonic tissue

137
Q

Difference in findings of invasive mole and gestational choriocarcinoma

A

invasive mole - diffusely hyperplastic trophoblasts with myometrial invasion, diffusely enlarged hydropic villi, absent fetal/embyronic tissue

gestational choriocarcinoma - diffusely anapestic/necrotic trophoblasts with vascular invasion, absent villi, present of absent fetal/embryonic tissue

138
Q

Which malignant gestational trophoblastic disease has myometrial invasion

A

invasive mole

139
Q

Which malignant gestational trophoblastic disease has vascular invasion

A

gestational choriocarcinoma

140
Q

which mole has present fetal/embryonic tissue

A

partial mole

triploid

141
Q

efferent renal arteriole constriction causes

A

increase GFR

increase FF

142
Q

which chronic efferent renal arteriole constriction what will happen to GFR

A

decrease
RPF low secondary to severe efferent arteriolar constriction
substantially increased capillary oncotic pressure results in overall decrease in GFR

143
Q

what always increases with renal efferent arteriole constriction

A

FF

144
Q

patients with vesicoureteral reflux are at increased risk for

A

chronic pyelonephritis

renal scarring at upper and lower poles of kidney

145
Q

If vesicoureteral reflux is not corrected it can lead to

A

loss of nephrons

secondary hypertension

146
Q

KIT receptor tyrosine kinase mutation

A

systemic mastocytosis

  • expression of mast cell typtase
  • excessive histamine
  • induces gastric acid secretion = ulcers
  • inactivates pancreatic and intestinal enzymes = diarrhea
147
Q

What comes out the superior orbital fissure

A

CN III, IV, V1, VI, ophthalmic vein, SNS fibers

148
Q

What comes out of the foramen spinosum

A

middle meningeal artery and vein

149
Q

What comes out of the optic canal

A

CN II, ophthalmic artery and central retinal vein

150
Q

What comes out of the internal acoustic meatus

A

CN VII and VIII

151
Q

what comes out of the jugular foramen

A

CN IX, X, XI, jugular vein

152
Q

what comes out hypoglossal canal

A

CN XII

153
Q

what comes out of the foramen magnum

A

spinal roots of CN XI, brain stem, vertebral arteries

154
Q

posterior cranial fossa has which foramen

A

internal acoustic meatus
jugular foramen
hypoglossal canal
foramen magnum

155
Q

noncompetitive or irreversible inhibitors have

A

decreased maximal effect, Vmax

no significant change on Km (affinity)

156
Q

phenoxybenzamine is a

A

irreversible alpha 1 and 2 rec antagonist

157
Q

reversible competitive inhibitor have

A

increased affinity, Km

158
Q

almost all volatile anesthetics increase

A

cerebral blood flow

increased ICP

159
Q

inhalation anesthetics can cause which AE

A

myocardial depression
hypotension
respiratory depression
decreased renal function

160
Q

mitochondrial diseases are characterized by

A

exclusively maternal inheritance

heteroplasty - different presentations due to different distribution of affected mitochondria

161
Q

variable expressivity refers to

A

differences in severity of AD disorders

does not apply to mitochondrial diseases

162
Q

genetic imprinting is

A

selective inactivation of paternal or maternal alleles

163
Q

transforming unacceptable feelings/impulses into the opposite

A

reaction formation

164
Q

expressing unacceptable feelings through actions

A

acting out

165
Q

reverting to earlier developmental stage

A

regression

166
Q

channeling impulses into a socially acceptable behavior

A

sublimation

167
Q

putting unwanted feelings aside to cope with reality

A

suppression

168
Q

Dihydrofolate reductase and DNA polymerase are used in

A

DNA synthesis

S phase of cell cycle

169
Q

What is a regulator of transition from G1 to S phase

A

Rb protein

170
Q

Serotonin is derived from

A

tryptophan

171
Q

Tyrosine is a precursor for

A 
thyroxine
DA
Epi
NE
melanin
172
Q

Methionine is a precursor for

A

cytosine, carnitine, taurine, lecithin

173
Q

Treatment for serotonin syndrome

A

airway and temperature maintenance
hydration
cryoheptadine

174
Q

What is cryoheptadine

A

serotonin antagonist

1st gen antihistamine w/nonspecific 5-HT1 and 5-HT2 rec antagonism

175
Q

Flumazenil is the antidote for

A

benzodiazepine OD

176
Q

What should be avoided in serotonin syndrome

A

long half life antihypertensives like propranolol

risk of hypotension and shock

177
Q

how to treat HTN in serotonin syndrome

A

short acting meds
esmolol
nitroprusside

178
Q

corticosteroid use causes increase of what WBC

A

neutrophils

179
Q

GFR increases with

A

higher glomerular hydrostatic pressure

180
Q

GFR decreases with

A

increasing Bowman’s capsule hydrostatic pressure

higher glomerular capillary oncotic pressure

181
Q

Ureteral obstruction causes

A

increase in hydrostatic pressure proximal to constriction –> Bowman’s space
decreased GFR

182
Q

Which bacteria are assoc with struvite stones

A

urease producing
klebsiella
proteus

increased pH

183
Q

Major adaptive immune mechanism that prevent reinfection with influenza

A

anti-hemagglutinin abs

184
Q

Guillain-Barre Syndrome histology

A
  • inflammatory infiltrate within the endoneurium
  • lymphocytes and macrophages extend from small vessels to associated nerve axon
  • lipid laden macrophages
185
Q

The alpha helical regions of G protein are for

A

anchoring to cell membrane

186
Q

Those with giant cell arteritis, about half will also have

A

polymyalgia reumatica

187
Q

Giant cell arteritis biopsy

A

focal granulomatous inflammation of the media with intimal thickening, elastic lamina fragmentation, giant cell formation (without granulomas)

188
Q

Giant cell arteritis is histologically identical to

A

Takayasu arteritis that’s usually in aortic arch and affects younger patients

189
Q

Truncating mutations in TTN gene affecting sarcomere protein titin with sudden death

A

DCM

190
Q

Acute hemolytic transfusion reaction

A

Type II hypersensitivity
C3a and C5a cause vasodilation/shock
C5b-9 causes complement mediated cell lysis

191
Q

Muscle that goes through greater sciatic foramen

A

Piriformis

192
Q

Muscle that goes through lesser sciatic foramen

A

obturator internus

UWorld Review (35 decks)

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