6/8 UWorld Flashcards
1
Q
What is orthopnea
A
SOB while lying flat
2
Q
What is the only cardiac abnormality that INCREASES with valsalva maneuver
A
- Valsalva maneuver
- This increases intrathoracic pressure, thus decreasing preload (opposite of inspiration)
- Decreases all murmurs except increases S4 heard in hypertrophic cardiomyopathy
3
Q
What is pleiotropy
A
When one gene mutations contributes to multiple phenotypic effects, often in different organ systems
4
Q
What is effect modification
A
- When the effect of the main exposure on the outcome is modified by the presence of another variable
- E.g. Experimental drug has a significant effect in non-smokers but insignificant effect in smokers
- Effect modification is not a bias
5
Q
What is relative risk and its equation?
A
- Probability of getting disease in exposed group vs. probability of getting disease in unexposed
- Calculated from cohort studies
- Equation:
- RR = [a/(a+b)] / [c/(c+d)]
6
Q
What is odds ratio and its equation
A
- Odds that group with disease (case) was exposed to a risk factor vs. odds that group without disease (control) was exposed
- Calculated from case-control studies
- Equation:
- OR = [(a/c) / (b/d)] = ad/bc
7
Q
Occlusion of what artery will cause Wernicke’s aphasia?
A
Middle cerebral
8
Q
Occlusion of what artery will cause Broca’s aphasia?
A
Middle cerebral
9
Q
What dietary substance other than fructose should be avoided in aldolase B deficiency?
A
Sucrose (disaccharide that breaks down into fructose)
10
Q
In what 3 steps of the citric acid cycle is ribaflavin (B2) necessary?
A
Pyruvate dehydrogenase (TLCFN)
Alpha-ketoglutarate dehydrogenase (TLCFN)
Succinate dehydrogenase (FAD –> FADH2)
11
Q
What is the sublingual drug given to patients with angina
A
Nitroglycerin
- Venodilation = decreased preload
12
Q
What are the symptoms of Gerstmann Syndrome
A
- Aka defect in dominant parietal lobe
- Symptoms:
- Agraphia (inability to write)
- Acalculia (inability to calculate)
- Finger agnosia (inability to identify individual fingers)
- Left-right disorientation
13
Q
What is the MOA of phenelzine
A
Sketchy = wine funnel
- MOA: Monamine oxidase inhibitor (MAOI)
- Increases serotonin, NE, and DA
14
Q
What is the main characteristic of atypical depression
A
- Mood reactivity - improved mood in response to positive events
- Others:
- Vegetative symptoms (increased sleep and appetite)
- Leaden paralysis
- Sensitivity to rejection
15
Q
What disorders are associated with basophilic stippling
A
- Small dots in the periphery of erythrocytes = visualization of ribosome aggregation in cytoplasm of RBCs
- Seen in:
- Lead poisoning
- Thalassemias
- Myelodysplastic syndrome
16
Q
Describe the function of Dynein and Kinesin
A
- Are both microtubule-associated motor proteins that transport cargo from one end of microtubule to another
- Dynein:
- Transports from (+) to (-) end of microtubule
- Retrograde transport towards the nucleus
- THINK: Negative end Near Nucleus
- Defect in Kartagener syndrome
- Kinesin:
- Transports from (-) to (+) end of microtubule
- Anterograde transport away from nucleus
- THINK: Positive end Points to Periphery
17
Q
MOA of Polyethylene glycol
A
Osmotic laxative
18
Q
MOA of Psyllium
A
-
Bulk-forming laxatives:
- Is an indigestible hydrophilic colloid = will absorb water = distention = peristalsis
19
Q
MOA of Docusate
A
-
Stool surfactant agents (stool softener)
- Facilitate the penetration of stool by water and lipids
20
Q
What is Meniere disease
A
- Increased pressure and volume of endolymph
- Features:
- Recurrent vertigo
- Ear fullness/pain
- Unilateral hearing loss and tinnitus
21
Q
Describe presentation of Vestibular neuritis
A
- Vestibular neuritis (labyrinthitis):
- Inflammation of vestibular nerve
- Features:
- Single episode that can last days
- Severe vertigo but no hearing loss
22
Q
Is HLA-DR3 and HLA-DR4 associated with Type I or Type II DM
A
Type I DM
23
Q
MRI findings in multiple sclerosis
A
Periventricular plaques (areas of oligodendrocyte loss and reactive gliosis)
24
Q
Describe the MOA of glucagon as a treatment for beta blocker toxiciy
A
\
- Glucagon acts on G-protein coupled receptors, increasing intracellular cAMP, and thus increasing release of intracellular calcium during muscle contraction
- This increases heart rate and cardiac contractility
25
How does hepatitis D use Hep B to cause infection
* Hepatitis D antigen must be coated with Hepatitis B surface antigen (HBsAg) in order to penetrate the hepatocyte to cause infection and multiply
26
Where are the different parts of the stomach (fundus, cardia, antrum, body)
27
Cause of gastric varices within the fundus
Portal HTN
Splenic vein thrombosis (often due to pancreatitis, pancreatic cancer, or abdominal tumors - splenic vein runs posterior to pancreas)
28
Describe isolation (psych)
* Separating feelings from ideas and events
* E.g. Describing murder in detail without an emotional response
29
Describe sublimation (psych)
* _Consciously_ replacing an unacceptable wish with a similar but acceptable course of action
* E.g. Redirection of aggression towards father into sports
* Vs. Reaction formation -
* _Unconsciously_ replacing warded-off feelings by emphasis on its opposite
30
What drugs can be used for nocturnal enuresis
* Imipramine:
* TCA
* Decreases Non-REM N3
* Short-term treatment
* Desmopressin
* Decreases urination
* Indomethacin:
* Decreases renal blood flow, thus decreasing urine formation
31
What structures are contained in the cavernous sinus
Describe the presentation of cavernous sinus syndrome
* Collection of venous sinuses on either side of pituitary
* Contains CNs III, IV, V1, VI, and occasionally V2, + internal carotid
* Cavernous sinus syndrome:
* Can be due to pituitary tumor, infection
* Presentation:
* Ophthalmoplegia (CN II, IV, VI)
* Decreased corneal sensation (CN V1)
* Horner syndrome
* Decreased maxillary sensation (CN V)
32
Describe each stage of the sleep cycle
* To remember EEG waves THINK: _BATS_ **_D_**ream **_B_**ig
* Awake (eyes open)
* Beta waves
* Awake (eyes closed)
* Alpha waves
* Meditating
* Non-REM N1
* Theta waves
* Light sleep
* Non-REM N2
* Sleep spindles and K complexes
* Bruxism (teeth grinding)
* Non-REM N3
* Delta waves (lowest frequency)
* Deepest sleep
* Sleep-walking, night terrors, bed wetting
* REM sleep
* Beta waves
* Loss of motor tone
* Dreaming
33
Describ embryology of brain formation
* Prosencephalon à forebrain
* Telencephalon
* Walls à cerebral hemisphere
* Cavities à lateral ventricles
* Diencephalon
* Walls à thalamus, hypothalamus
* Cavities à third ventricle
* Mesencephalon à midbrain
* Mesencephalon
* Walls à midbrain
* Cavity à aqueduct
* Rhombencephalon à hindbrain
* Metencephalon
* Walls à pons, cerebellum
* Cavity à upper 4th ventricle
* Myelencephalon
* Walls à medulla
* Cavity à lower 4th ventricle
34
Supraoptic nucleus of the hypothalamus
* Produces ADH to be stored in posterior pituitary
* THINK: Eyeball cup filled with water
35
Paraventricular nucleus of the hypothalamus
* Produces oxytocin to be stored in posterior pituitary
* THINK: near valleys filled with love and happiness
36
Pre-optic area of the hypothalamus
* Secretes GnRH à stimulates release of LH and FSH
* THINK: Before you even see (pre-optic), the person for who they really are you start secreting sex hormones
37
Dorsomedial nucleus of the hypothalamus
* Stimulates GI
* Stimulation = savage behavior and obesity
* THINK: green monster on your back making you angry and eating out of jealousy
38
Arcuate nucleus of the hypothalamus
* Releases dopamine and GHRH
* Regulates hunger and satiety
* THINK: a smile is an arc so the arcuate nucleus gives you the dopey smile you get when you see delicious dessert
39
What tumors show rosenthal fibers
* Pilocytic astrocytoma
* Rosenthal fibers – eosinophilic corkscrew fibers
* THINK: Chris Rossman (Rosenthal) putting the star (astrocytes) on the top of a child's (tumor of children) christmas tree, so it has a swirly base (corkscrew fibers)
40
What tumor shows perivascular pseudorosettes
* Ependymoma
* Perivascular pseudorosettes (tumor cells surrounding vessel)
* THINK: Ependymoma = tumor surrounding ventricles; ventricles are open spaces containing body fluids; pseudorosettes is surrounding a vessel which contains body fluids
41
What tumor shows pseudopalisading (surrounding area of central necrosis)
* Glioblastoma multiforme
* THINK:
* Pseudopallisading looks like a star = astrocyte
* Central area is necrotic/dead so this must be an old people tumor – astocyte tumor of adults = glioblastoma multiforme
42
What enzyme catalyzes the formation of ribose sugars in the HMP shunt pathway
Transketolase
43
Treatment of pyruvate dehydrogenase deficiency
§ Ketogenic diet (high fat, low carb diet with moderate levels of protein)
§ This forces the production of ketone bodies to fuel the body in place of glucose, so less pyruvate is generated via glycolysis
§ Lysine and leucine are exclusively ketogenic amino acids and cannot be metabolized to pyruvate
44
Compare and contrast conduction aphasia vs. global aphasia
* Conduction aphasia
* Damage to arcuate fasciculus (connection between Broca’s and Wernicke’s area)
* Broca and Wernicke’s area are intact = fluent speech with intact comprehension
* No connection between what you hear and what you say = impaired repetition
* Global aphasia:
* Both Broca and Wernicke area affected
* Influent speech and impaired comprehension
45
What are the 3 C's to remember about toxicity of TCA's?
Cardiac, coma (anti-H1), convulsions (anti-GABA)
46
Compare Parkinson's to Lewy body dementia
* Lewy body:Early onset dementia + Lewy bodies
* Vs. Parkinson’s which has late onset dementia + Lewy bodies
* Lewy bodies within the cortex (aggregates of a-synuclein)
* Vs. Parkinson’s which affects the substantia nigra
* Characterized by dementia and visual hallucinations, followed by Parkinsonian features
47
Presentation of Creutzfeldt-Jakob disease
* Rapidly progressive dementia + ataxia + startle myoclonus
48
Cause and presentation of homocystinuria
* Causes:
* o Cystathionine synthase deficiency
* o Decreased affinity of cystathionine synthase for B6
* o Methionine synthase deficiency
* Presentation:
* o Homocysteine in urine
* o Marfanoid habitus
* o Ocular changes (downward and inward lens subluxation – vs. Marfan which is upward)
* o CV effects
* Homocysteine is _prothrombotic_, which may lead to premature acute coronary syndrome
* o Kyphosis
* o Intellectual disability
49
Cause and presentation of phenylketonuria
* Due to:
* Deficiency in phenylalanine hydroxylase, or
* Deficiency in tetrahydrobiopterin cofactor (BH4)
* Tyrosine becomes an essential amino acid
* Presentation:
* o Intellectual disability
* o Growth retardation
* o Seizures
* o Fair skin = inability to make melanin
* o Eczema
* o Must body odor
