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UWorld > 7.4.16 > Flashcards

7.4.16 Flashcards

1
Q

gluconeogenesis: unique enzymes

A
  • pyruvate decarboxylase
  • phosphoenolpyruvate carboxykinase (PEPCK)
  • fructose 1,6 bisphosphatase
  • glucose 6 phosphatase
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2
Q

choriocarcinoma: ssx

A
  • abnormal vag bleed
  • uterine enlrg
  • sig increased B-hCG
  • hematogenous spread –> lung –> dyspnea, hemoptysis
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3
Q

what can increase incidence of statin-induced myopathy?

A

concomitant admin of drug that inh CYP450 –> inh statin metab

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4
Q

heme oxygenase: rxn

A

degrade heme to biliverdin –> green color of bruise

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5
Q

Chiari type I vs II

A

I: relatively benign –> adult –> occipital HA, cerebellar dysfx
- II: more severe –> neonate –> assoc w lumbar myelomeningocele, hydrocephalus

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6
Q

what is: Lambert-Eaten myasthenic synd

A

NM disorder presenting w:

  • proximal muscle weak
  • CN involvement
  • autonomic ssx
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7
Q

abd/pelvic trauma: comp

A

retroperitoneal hematoma

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8
Q

what releases IL-5?

A

TH2

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9
Q

ulnar N: sensory fx

A

mid ring –> pinky

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10
Q

tRNA –> 3’ CCA tail: fx

A
  • recog seq by proteins

- its terminal -OH grp serves as aa binding site

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11
Q

how does chronic kidney dz lead to renal osteodystrophy?

A

hyperphosphate –> hypocalc –> 2ndary PTH

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12
Q

migraine: acute tx

A

triptan –> abortive tx

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13
Q

how is S3 best heard?

A

L lat decubitus at end expiration

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14
Q

ectopic preg: RF

A

scarring:
- PID
- endometriosis

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15
Q

membranous nephropathy: nephritic or nephrotic?

A

nephrotic

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16
Q

subdural hematoma: CT scan

A

crescent-shaped mass

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17
Q

ulnar N injury: location

A
  • medial epicondyle of humerus (funny bone)

- Guyon’s canal: near hook of hamate, pisiform

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18
Q

essential tremor: mode of inheritance

A

AD

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19
Q

when does neurosyphilis occur?

A

any stage of infect

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20
Q

what is: myopia

A

nearsighted: can’t focus on far object –> image focus in front of retina

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21
Q

measles: neuro comp

A
  • w/in days: encephalitis
  • wks: acute disseminated encephalomyelitis
  • yrs: subacute sclerosing panencephalitis
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22
Q

what drug prolongs QT but has low risk of torsades?

A

amiodarone

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23
Q

intercostal V/A/N: location

A

subcostal groove on lower border of rib

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24
Q

SLE w Cushing synd –> died of LCA thrombus –> what increased risk of CAD?

A

cushing synd & lupus both increase risk of CAD

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25
Q

SLE: most common renal dz

A

diffuse prolif GN

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26
Q

amatoxin: MOA

A

poison from mushroom (Amanita phalloides, death cap) –> inh RNA pol II –> halt mRNA syn

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27
Q

what is: Chiari malformation

A

congenital disorder: post fossa underdev –> cerebellum, medulla –> herniate thru foramen magnum

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28
Q

piriformis: passes thru what?

A

greater sciatic foramen

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29
Q

what can cause a subdural hematoma in the young? elder? how does it present?

A
  • young: fall, motor vehicle accident –> gradual onset HA, confuse
  • elder: minor trauma –> variety of neuro ssx
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30
Q

what are the parts of tRNA?

A
  • acceptor stem
  • 3’ CCA tail
  • D loop
  • anticodon loop
  • T loop
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31
Q

ulnar N: motor fx

A
  • finger adduct
  • finger abduct (except thumb)
  • digit 4 & 5: flex
  • wrist: flex, adduct
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32
Q

ectopic preg: classic presentation

A

lower abd pain few weeks after missed period

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33
Q

bipolar disorder –> tx –> why not use antidep?

A

risk of precipitating mania

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34
Q

hepatic encephalopathy: precipitating factors

A
  • drugs
  • hypovol
  • excessive N load
  • infect
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35
Q

hypoxic ischemic encephalopathy: pathophys

A

profound systemic hypotension (cardiac arrest, shock) –> disminish blood supply to entire brain –> global cerebral ischemia:

  • in 5-10 sec –> syncope
  • 4-5min –> permanent brain damage
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36
Q

choriocarcinoma is commonly preceded by?

A

normal preg but can occur following any preg (molar, ectopic, aborted)

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37
Q

Lambert-Eaten myasthenic synd: pathophys

A

Ab against presynaptic Ca channel of NMJ –> can’t release ACh

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38
Q

what is: Crigler-Najjar synd

A

AR –> no UGT –> no bile glucuronidation –> unconjugated hyperbilirubin –> kernicterus –> death

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39
Q

what is: RPGN

A

nephritic synd that progress to renal fail in wks-mos

40
Q

what is: skin rhytides

A

skin wrinkle

41
Q

RPGN: what disorders?

A
  • Goodpasture synd
  • PSGN
  • diffuse prolif GN
  • Wegener granulomatosis
  • microscopic polyangiitis
  • Churg-Strauss synd
42
Q

enterobius vermicularis: tx

A

1st line: albendazole

preg: pyrantel pamoate

43
Q

where should you perform thoracentesis?

A

bw parietal & visceral pleura:

  • midclavicular line: bw rib 6-8
  • midaxillary: 8-10
  • paravertebral: 10-12
44
Q

idiopathic membranous nephropathy: possible pathophys

A

IgG4 Ab to phospholipase A2 receptor found in high conc in glomerular podocytes –> immune deposition in glomerulus

45
Q

what is: attrition bias

A

form of selection bias: disproportionate loss to FU bs exposed & unexposed grps

46
Q

membranous nephropathy: assoc dz

A
  • HBV
  • HCV
  • solid tumor
  • SLE
  • drugs –> NSAID, penicillamine
47
Q

piriformis: fx

A

hip: ext rot

48
Q

mucormycosis: classic clinical picture

A

paranasal sinus involvement in diabetic or immunosupp pt

49
Q

A-fib: EKG

A
  • irreg irreg rhythm
  • no organized P waves
  • varying R-R intervals
  • f (fibrillatory) waves bw QRS complexes –> irreg, low amp –> rep chaotic atrial activation
50
Q

Lambert-Eaten myasthenic synd: assoc dz

A

malig –> classically small cell lung CA

51
Q

S3: indicates

A
  • healthy YA: normal

- >40yo: V enlargement

52
Q

when should you suspect inherited causes of hypercoag?

A
53
Q

androgenetic alopecia: pathophys

A

polygenic –> but dihydrotestosterone is 1ary pathogenic factor

54
Q

membranous nephropathy: prognosis

A

poor response to steroids –> progress to chronic renal fail

55
Q

muscles: 2 fiber types? fx?

A

1) slow twitch (Type 1): axns requiring low level sustained force –> postural maintenance
2) fast twitch (Type II): rapid forceful pulses of mvmt

56
Q

T cell maturation –> neg selection: what is? where?

A

thymus –> medulla –> eliminate T cells that bind to self MHC or self Ag with overly high affinity

57
Q

essential tremor: ssx

A
  • slowly progressive symm postural/kinetic tremor –> usu UE
  • improve w alcohol
58
Q

nephritic synd: charact

A

immune complex –> inflamm –> bleed:

  • oliguria/azotemia
  • salt retention –> periorbital edema, HTN
  • RBC casts
59
Q

what is: choriocarcinoma

A

malig gestational trophoblastic dz –> anaplastic cytotrophoblasts & syncytiotrophoblasts –> no villi

60
Q

what is the best test to dx 1ary hypothyroid?

A

serum TSH –> most sensitive screening test

61
Q

retroperitoneal organs

A

SAD PUCKER:

  • suprarenal glands
  • aorta, IVC
  • duodenum (1st part)
  • pancreas (head & body)
  • ureter, bladder
  • colon (ascending & descending)
  • kidney
  • esophagus
  • rectum (mid-distal)
62
Q

what is the most common inherited cause of intell disability?

A

fragile X synd

63
Q

Type I & II muscle fibers –> where do they get their ATP?

A

I: aerobic –> high myoglobin (O2 storage), mito
IIa (fast twitch): aerobic metab
IIb: anaerobic glycogenolysis –> glycolysis

64
Q

what is: piriformis synd

A

piriformis muscle –> injury, hypertrophy –> compress sciatic N in greater sciatic foramen –> sciatica like ssx –> pain, tingle, numb –> buttocks, N distribution

65
Q

what is the most common mvmt disorder?

A

essential tremor

66
Q

age related change can lead to what eye condition? pathophys?

A

presbyopia

lens –> struct proteins denature –> lose elasticity

67
Q

what is a pulm lab finding specific for PE?

A

vent-perfusion scan: sig mismatched defect

68
Q

membranous nephropathy: who?

A

white adult

69
Q

what is: bupropion

A

1st line antidep w amphetamine-like properties

70
Q

membranous nephropathy: histology

A
  • thick BM
  • granular IF
  • subepi deposit –> spike & dome
71
Q

how can GI bleed lead to hepatic encephalopathy?

A

1) bleed –> more N (Hb) in gut
2) enterocyte –> convert to ammonia
3) into blood –> liver
4) liver cannot degrade to urea –> ammonia buildup

72
Q

rhabdomyolysis: comp

A

acute renal fail

73
Q

what is the most common cause of inherited hypercoag state?

A

factor V leiden

74
Q

migraine: prophylactic tx

A
  • BB
  • antidep: amitriptyline, venlafaxine
  • anticonv: valproate, topiramate
75
Q

gluconeogenesis: initial 2 steps

A

1) pyruvate decarboxylase: pyruvate –> oxaloacetate

2) phosphoenolpyruvate carboxykinase (PEPCK): oxaloacetate –> PEP

76
Q

PE –> leads to? how?

A
  • hypoxemia
  • resp alk

vent (air) but no perfusion (blood flow) –> hypoxemia –> stim resp drive –> hypervent –> hypocapnia –> resp alk

77
Q

MI –> 12 days after –> sudden cardiac death –> most likely cause?

A

V arrhythmia

78
Q

membranous nephropathy: cause

A

usu idiopathic

79
Q

hepatic encephalopathy: clinical presentation

A
  • confuse, disorientation
  • lethargy
  • asterixis
  • stigmata of chronic liver dz: jaundice, edema/ascites, palmar erythema, telangiectasia, caput medusae
80
Q

what muscle passes thru the greater sciatic foramen

A

piriformis

81
Q

factor V leiden: pathophys

A

mutated factor V –> can’t be deactivated by protein C/S –> excess factor V activity

82
Q

cerebral watershed infarct: gross appearance

A

bilat wedge of necrosis over cerebral convexity, parallel & adj to longitudinal cerebral fissure

83
Q

S3: cause

A

sudden limitation of V mvmt during rapid passive V filling

84
Q

what is: presbyopia

A

can’t focus on near objects –> image focuses behind retina

85
Q

fragile X synd: cytogenetic abnormality

A

X chrom –> long arm –> fragile X mental retardation 1 (FMR1) gene –> oocyte meiosis –> CGG trinucleotide repeats expand –> >200 repeats –> hypermethylation –> FMR1 inactivation

86
Q

subdural hematoma: results from?

A

rupture of cortical bridging vein

87
Q

what is: gumma

A

3ary syphilis: necrotizing granuloma –> skin, mucosa, subQ tissue, bone, other organs

88
Q

S3, S4: diastolic or systolic?

A

S3: diastolic
S4: systolic

89
Q

nephrotic synd: charact

A

proteinuria (>3.5g/day):

  • hypoalbumin –> pitting edema
  • hypoIg –> infect
  • hypercoag
  • hyperlipid/chol –> fatty cast
90
Q

hepatic encephalopathy: pathophys

A

chronic liver fail –> impaired detoxification ability –> ammonia, other neurotoxins accum –> cross BBB:

  • increase inh neurotransmission
  • impair excitatory NT release
91
Q

how can hyperTB lead to acute pancreatitis?

A

pancreas –> lipase –> metab TG to ffa –> toxic & inflamm effects on pancreas

92
Q

who could develop a unilat cerebral watershed infarct?

A

severe carotid A stenosis

93
Q

essential tremor: tx

A

propranolol (nonspec B-adrenergic ant)

94
Q

MLF: location

A

pons –> dorsal –> paramedian

95
Q

hydrops fetalis: ssx

A
  • severe anemia
  • HF
  • pleural effusion
  • pericardial effusion
  • ascites
96
Q

how do macrophage reduce plaque stability?

A

secrete metalloproteinase –> degrade extracell matrix proteins (collagen)

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