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UWorld > 6.29.16 > Flashcards

6.29.16 Flashcards

1
Q

hypoCa: ssx

A
  • muscle cramp
  • perioral paresthesia
  • hypotension
  • NM hyperexcitable
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2
Q

cavernous sinus thrombosis: ssx

A
  • HA
  • fever
  • proptosis
  • ipsilat deficits in CN III, IV, VI, V (ophthalmic & maxillary br)
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3
Q

what is: washout period

A

crossover study: period of no tx bw trtmt intervals to limit confounding effects of prior tx

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4
Q

adenine at end of tRNA: fx

A

aa binding site

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5
Q

xanthelasma: assoc dz

A

1ary, 2ndary hyper/dys-lipidemia

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6
Q

clomiphene: MOA

A

estrogen receptor modulator –> decrease neg feedback inh on hypothalamus by circulating estrogen –> increase gonadotropin (FSH & LH) production –> ovulation

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7
Q

LA enlarge –> leads to?

A

compress esophagus –> dysphagia

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8
Q

Dandy Walker malformation: clinical presentation

A

infant:
- dev delay
- progressive skull enlrg
- cerebellar dysfx
- non-communicating hydrocephalus

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9
Q

pulm HTN: comp

A

cor pulmonale (RV fail)

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10
Q

opportunistic infections in HIV –> toxoplasma gondii –> prophylactic? when?

A

TMP/SMX

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11
Q

MVP: #1 cause

A

mitral valve CT protein defect –> predispose to myxomatous degen of mitral leaflets & chordae tendinae

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12
Q

PCOS pt –> desire fertility –> tx?

A

clomiphene

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13
Q

ubiquitin proteasome pathway: fx in immune response

A

degrade foreign intracell proteins –> viral particles –> antigen presentation on MHC class I

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14
Q

pyruvate kinase def: pathophys

A

insuff ATP production –> cannot maintain RBC struct –> hemolytic anemia

splenic parenchyma –> increase work to remv deformed RBCs –> splenic hyperplasia

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15
Q

what is the most common indicator of obesity-related dz? what else might you find?

A

reduced ERV –> reduce FRC

decreased: FEV1, FVC, TLC

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16
Q

release of sarcoplasmic Ca stores following NM Ach stim allows?

A

synchronization of skeletal muscle contraction & glycogen brkdown –> provide energy necess for anaerobic muscle contract

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17
Q

toxic megacolon: what dx studies are CI?

A
  • barium contrast
  • colonoscopy
  • -> risk for perforation
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18
Q

VSD: onset

A

neonatal period after pulm vasc resistance has declined –> enable L-to-R shunting

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19
Q

where is the descending aorta?

A

post to esophagus & LA

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20
Q

what is: case-ctrl study

A

1) select pts w dz (case)
2) no dz (ctrl)
- -> determine previous exposure status

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21
Q

what aa play an important role in transporting N throughout body?

A
  • alanine

- glutamine

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22
Q

toxic megacolon: ssx

A
  • abd pain/ distention
  • bloody diarrhea
  • fever
  • signs of shock
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23
Q

renal cell CA: cell of origin

A

epithelial cells of proximal renal tubules

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24
Q

retinal artery occlusion –> leads to?

A

acute, painless, monocular vision loss

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25
Q

opportunistic infections in HIV –> mycobact avium complex –> prophylactic? when?

A

azithromycin

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26
Q

what is: expiratory reserve vol

A

max vol of air that can be expired after normal tidal expiration

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27
Q

viral bronchiolitis: ssx

A
  • low grade fever
  • cough
  • tachypnea
  • increased work of breathing –> retractions
  • diffuse wheezes, crackles
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28
Q

ophthalmic V injury: ssx

A

impaired venous drainage:

  • proptosis (eye protrusion)
  • chemosis (conjunctival swelling)
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29
Q

what should you do if you suspect a VSD?

A

echocardiography –> confirm size & location

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30
Q

how are proteins marked to go to lysosome?

A

phosphotransferase enzyme –> phosphorylate specific mannose residues –> ensure proper transit thru Golgi apparatus

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31
Q

viral bronchiolitis: most common cause

A

RSV

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32
Q

how is acid primarily excreted in urine?

A

in the form of NH4+ & titratable acids (H2PO4-)

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33
Q

what can lead to a C diff infection?

A

absence of normal intestinal microbial flora

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34
Q

lobar pneumonia –> resolution: key features

A

microscopic: enzymatic digestion of exudate
gross: restoration of normal architecture

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35
Q

hairy cell leukemia: how dx?

A
  • BM bx

- flow cytometry (has replaced tartrate-resistant acid phosphatase (TRAP) activity testing)

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36
Q

what are the 2 categories of ssx of hypoglycemia?

A
  • neurogenic (autonomic)

- neuroglycopenic

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37
Q

what is: xanthelasma

A

type of xanthoma –> yellowish macule/papule on medial eyelid –> dermal accumulation of macrophages containing chol & TG

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38
Q

renal cell CA: gross appearance

A

golden yellow mass d/t high lipid content in cells –> “clear cell”

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39
Q

esophagus is in closest proximity to what part of the heart?

A

LA

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40
Q

free ammonia: fx

A

excreted into urine by kidney for acid-base reg

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41
Q

1ary biliary cirrhosis –> can lead to?

A

hyperchol

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42
Q

lobar pneumonia –> red hepatization: key features

A

day 2-3

microscopic: alveolar exudate –> RBC, neutrophil, fibrin
gross: red, firm –> liver-like consistency

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43
Q

Lyme dx: tx? use?

A
  • doxycycline –> erythema chronicum migrans

- PCN-type abx –> ceftriaxone –> prevent progress to late Lyme dz

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44
Q

what part of the spleen undergoes hyperplasia in pyruvate kinase def?

A

red pulp –> reticuloendothelial cells in red pulp involved in remval of damaged RBCs

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45
Q

hairy cell leukemia –> BM fail –> pathophys?

A

infiltrate BM –> cytokine –> fibrosis –> BM fail –> pancytopenia

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46
Q

C diff infect: #1 RF?

A

abx tx

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47
Q

thyroid surg –> can injure what N? why?

A

recurrent laryngeal N

close proximity to inf thyroid A

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48
Q

opportunistic infections in HIV –> histoplasma capsulatum –> prophylactic? when?

A

itraconazole

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49
Q

hypoglycemia: neurogenic (autonomic) ssx

A

sympathoadrenal activation:

  • NE/Epi: tremulous, palpitation, anxiety/arousal
  • ACh: sweat, hunger, paresthesia
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50
Q

VSD: clinical presentation

A

depend on size of defect:

  • small –> asympt holosystolic murmur
  • lrg –> HF
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51
Q

viral bronchiolitis: onset

A
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52
Q

what is: crossover study

A

subject randomly allocated to seq of 2 or more tx given consecutively

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53
Q

increased cGMP –> leads to?

A

decrease intracell Ca –> decrease myosin light chain kinase activity –> myosin light chain dephosphorylate –> vasc SM relax

54
Q

adult –> painless hematuria –> suspect?

A

GU malig

55
Q

CN III palsy: ssx

A
  • ptosis

- mydriasis

56
Q

what is: Kartagener synd

A

triad:
- situs inversus
- chronic sinusitis
- bronchiectasis

57
Q

PCOS: clinical features

A
  • obesity
  • menstrual irreg
  • hirsutism
  • enlarged ovary
  • increase risk of DM, endometrial hyperplasia
58
Q

CN III, iV, VI injury: ssx

A

ocular muscle paralysis

59
Q

ubiquitin ligase: fx

A

recog specific protein substrate –> attach ubiquitin tag –> ubiquitin proteasome pathway

60
Q

colchicine: AE? why?

A

disrupt microtubule –> impair GI mucosal fx –> diarrhea, N/V, abd pain

61
Q

transesophageal echocardiography best visualizes what struct?

A
  • LA

- descending aorta

62
Q

what forms the majority of the post surface of the heart?

A

LA

63
Q

what is: functional residual capacity

A

RV + ERV

64
Q

what part of the body extracts the most O2?

A

myocardium

65
Q

what is the most common indolent non-Hodgkin lymphoma in adults?

A

follicular lymphoma

66
Q

Lyme dz –> late: ssx

A
  • chronic asymm lrg jt arthritis

- encephalopathy

67
Q

MVP: murmur

A

midsystolic click & mid-late systolic murmur of mitral regurg

68
Q

hairy cell leukemia: charact

A
  • BM fail
  • infiltration into reticuloendothelial system –> massive splenomegaly
  • dry tap
  • lymphocytes w cytoplasmic projections
69
Q

Lyme dz –> early: ssx

A
  • flu-like ssx

- erythema chronicum migrans

70
Q

how is phosphorylase kinase (PK) activated in liver?

A

liver –> Epi, glucagon –> bind Gs –> increase cAMP –> PKA –> phosphorylate PK

71
Q

glucose-alanine cycle: fx

A

help remv excess N

72
Q

protein catabolism: major steps

A

1) protein –> alanine
2) amino grp –> transfer to a-ketoglutarate –> form glutamate
3) liver –> process glutamate –> urea

73
Q

what codon initiates protein syn?

A

AUG

74
Q

acute gouty arthritis: 2nd line tx? MOA?

A

colchicine

leukocyte: inh tubulin polymerization –> inh microtubule formation –> reduce neutrophil chemotaxis & migration to sites inflamed by monosodium urate xl deposition

75
Q

recurrent laryngeal N injury: ssx

A

vocal cord paralysis

76
Q

follicular lymphoma: ssx

A

painless waxing & waning LAD

77
Q

Dx: muscle cramp, perioral paresthesia, hypotension, NM hyperexcitable

A

hypoCa

78
Q

ant wall MI: comp? when?

A

5-14 day after –> LV free wall rupture –> hemopericardium, cardiac tamponade –> profound hypotension, shock –> rapid progress to pulseless electrical activity –> death

79
Q

what is: hibernating myocardium

A
  • reduced coronary blood flow at rest –> chronic myocardial ischemia –> LV systolic dysfx –> decrease contractility
  • partially, completely reversible by coronary revascularization
80
Q

PCOS: charact

A
  • elevated LH
  • excess androgen production
  • insulin resistance
81
Q

what is used to degrade proteins for antigen presentation?

A

ubiquitin proteasome pathway

82
Q

vitK def –> can lead to?

A

life-threatening bleeding diathesis:

  • intracranial hemorrhage
  • profuse bleeding from GI, umbilicus, surg sites
83
Q

what are signs of NM hyperexcitability?

A
  • Chvostek sign

- Trousseau sign

84
Q

pyruvate kinase: rxn

A

glycolysis: PEP –> pyruvate + ATP

85
Q

ulcerative colitis: comp

A
  • toxic megacolon

- carcinoma

86
Q

PCOS: tx? effect?

A
  • wt loss –> reverse insulin resistance, restore normal ovulatory fx
  • OCP (not want to become preg) –> minimize endometrial prolif, reduce androgenic ssx, prevent unwanted preg
87
Q

xanthelasma: #1 cause

A

LDL receptor abnormality

88
Q

C diff overgrowth –> leads to?

A
  • transient diarrhea

- pseudomembranous colitis

89
Q

what are the 4 stages of lobar pneumonia?

A

1) congestion
2) red hepatization
3) gray hepatization
4) resolution

90
Q

retinal artery occlusion: cause

A

atherosclerosis –> thromboembolism –> travel from internal carotid A –> ophthalmic A –> retinal A

91
Q

phosphorylase kinase (PK): fx

A

phosphorylate glycogen phosphorylase –> activate

92
Q

opportunistic infections in HIV –> pneumocystis jirovecii –> prophylactic? when?

A

TMP/SMX

93
Q

pyruvate kinase def: ssx

A
  • hemolytic anemia

- splenic hyperplasia

94
Q

tRNA –> what serves as the aa binding site?

A

adenine residue at 1 end of the mole

95
Q

phosphoprotein phosphatase: fx

A

dephosphorylate glycogen phosphorylase –> inactivate

96
Q

Epi: fx in glucose metab

A
  • limit glucose use by insulin-sens tissues

- stim hepatic glycogenolysis, gluconeogenesis

97
Q

what is: hairy cell leukemia

A

middle age M –> indolent B cell neoplasm

98
Q

location: degraded protein coupled to MHC class I

A

ER

99
Q

neonatal vitK def: RF

A
  • parental refusal of vitK prophylaxis at birth

- exclusive breastfeeding

100
Q

acidotic state: what happens to bicarb?

A

completely resorbed from tubular fluid

101
Q

what are the opportunistic infections in HIV?

A
  • pneumocystis jirovecii
  • toxoplasma gondii
  • mycobact avium complex
  • histoplasma capsulatum
102
Q

1ary ciliary dyskinesia: pathophys

A

AR –> proteins resp for normal flagellar & ciliary struct/fx (dynein, assembly proteins)

103
Q

1ary ciliary dyskinesia: clinical manifestation

A
  • situs inversus
  • chronic sinusitis
  • bronchiectasis
  • infertility
104
Q

what toxins does C diff produce?

A
  • enterotoxin (toxin A)

- cytotoxin (toxin B)

105
Q

H2PO4-: fx in acid-base balance

A

titratable acid: metab acidosis –> excreted in urine

106
Q

glycogen phosphorylase: fx? how is it regulated?

A

brkdown glycogen

phosphorylated –> active state
dephos –> inactive state

107
Q

toxic megacolon: what imaging?

A

plain abd XR –> reveal colonic dilation

108
Q

what is: inclusion cell (I-cell) dz

A

AR lysosomal storage disorder –> defect in protein targeting

109
Q

what happens to urine pH in metab acid? why?

A

decrease

increase excrete free H+, NH4+, H2PO4-

110
Q

CD4 tx? for what?

A

prophylactic azithromycin for mycobact avium complex (MAC)

111
Q

what drugs should be used with caution in DM? why? what should be used instead?

A

nonselective BB:

  • exacerbate hypoglycemia
  • mask its adrenergic ssx mediated by NE, Epi

if BB is necess –> selective B1 ant

112
Q

how is N disposed from the body?

A
  • urea

- free ammonia

113
Q

lobar pneumonia –> congestion: key features

A

24hr

microscopic:
- vasc dilation
- alveolar exudate –> mostly bact

gross: red, heavy, boggy

114
Q

what distinguishes heart circ from systemic circ?

A
  • heart muscle is perfused during diastole
  • myocardial O2 extraction is very high
  • myocardial O2 demand & coronary blood flow are tightly coupled
115
Q

what is: Dandy Walker malformation

A

dev analomy –> cerebellar vermis –> hypoplasia/absence –> cystic dilation of 4th ventricle w post fossa enlrgmt

116
Q

what can lead to a cavernous sinus thrombosis?

A

medial face, sinus (ethmoidal, sphenoidal), teeth –> infect –> spread to valveless facial venous system –> cavernous sinus –> thrombosis

117
Q

follicular lymphoma: what is the cell of origin?

A

B cell

118
Q

Lyme dz –> 2nd stage: ssx

A
  • AV block

- facial palsy

119
Q

renal cell CA: ssx

A

asympt til relatively advanced:

  • hematuria
  • abd mass
  • flank pain
  • wt loss
  • polycythemia
120
Q

lobar pneumonia –> gray hepatization: key features

A

day 4-6

microscopic:
- RBC disintegrate
- alveolar exudate –> neutrophil, fibrin

gross: gray-brown firm lobe

121
Q

increased pulm A pressure –> on auscultation?

A

accentuation of pulm compt of S2 (P2)

122
Q

what are the stop codons?

A
  • UAG
  • UAA
  • UGA
123
Q

CN V –> ophthalmic & maxillary br –> injury –> ssx?

A

lose:
- upper facial sensation
- aff limb of corneal reflex

124
Q

how is phosphorylase kinase (PK) activated in muscle?

A
  • Epi
  • intracell Ca

no glucagon receptors on skeletal muscle

125
Q

follicular lymphoma: cytogenetic change

A

t(14; 18) –> bcl-2 overexpression

126
Q

Dx: central obesity, resp ssx

A

obesity-related restrictive lung dz

127
Q

mutated BMPR2 –> leads to?

A

1ary pulm art HTN

128
Q

hereditary pulm art HTN: pathophys

A

2-hit hypothesis:

1) inactivating mutation in BMPR2 –> predispose to excessive endothelial & SM cell prolif
2) 2nd insult –> activate dz process –> vasc remodeling, elevated pulm vasc resistance, progressive pulm HTN

129
Q

what is: coronary sinus

A

large vessel that collects blood from the heart muscle –> drain most coronary venous blood –> RA

130
Q

hypoglycemia: neuroglycopenic ssx

A
  • beh change
  • confuse
  • visual disturb
  • stupor
  • sz
131
Q

follicular lymphoma: histology

A

mixture of cleaved & noncleaved follicle center cells in a nodular pattern

132
Q

what is responsible for synchronization of glycogen degradation w skeletal muscle contraction?

A

release of sarcoplasmic Ca following NM stim

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