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UWorld > 7.6.16 > Flashcards

7.6.16 Flashcards

1
Q

radial N: motor fx

A
  • extend: arm, wrist, fingers
  • supination
  • thumb abduct
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2
Q

radial N: sensory fx

A

post arm, forearm, hand

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3
Q

what passes thru the supinator canal?

A

radial N

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4
Q

radial N injury at supinator canal: cause?

A
  • repetitive pronation/supination
  • direct trauma
  • subluxation of radius
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5
Q

radial N injury at supinator canal: ssx

A
  • weak finger/thumb extend (finger drop)
  • no wrist drop
  • no sensory deficits
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6
Q

renal papillary necrosis: commonly seen in?

A
  • sickle cell dz/trait
  • analgesic nephropathy (NSAID)
  • DM
  • severe obstructive pyelonephritis
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7
Q

renal papillary necrosis: classic presentation

A
  • gross hematuria
  • acute flank pain
  • passage of tissue fragments in urine
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8
Q

McArdle dz: pathophys? ssx?

A

glycogen storage dz: deficient myophosphorylase –> isoenzyme of glycogen phosphorylase present in muscle tissue

decreased brkdown of glycogen during exercise:

  • poor exercise tolerance
  • muscle cramp
  • rhabdomyolysis –> myoglobinuria
  • no rise in blood lactate after exercise
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9
Q

Pompe dz: def? main features?

A

acid a-glucosidase –> lysosome can’t brkdown glucose

  • normal glucose
  • severe cardiomegaly
  • glycogen accum in lysosomes
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10
Q

Cori dz: def? main features?

A

debranching enzyme

  • hepatomegaly
  • ketotic hypoglycemia
  • hypotonia, weak
  • abnormal glycogen w very short outer chains
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11
Q

von Gierke dz: def? main features?

A

glucose 6-phosphatase

  • hepatomegaly
  • steatosis
  • fasting hypoglycemia
  • lactic acidosis
  • hyperuricemia
  • hyperlipid
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12
Q

what is the purpose of blinding in clinical trials?

A

prevent observer bias: prevent pt/researcher expectancy from interfering w outcome

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13
Q

what gives elastin its rubber-like properties?

A

lysyl oxidase –> extensive crosslinking bw elastin monomers (desmosine crosslinks)

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14
Q

how does a1 antitrypsin def lead to early onset emphysema?

A

excessive alveolar elastin degradation

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15
Q

bronchial tree –> particle clearance?

A

mucociliary clearance: proximal transport of mucus by ciliated epithelial cells

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16
Q

distal to terminal bronchioles –> particle clearance?

A

alveolar macrophage

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17
Q

what is: HbF

A

a2gamma2

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18
Q

what is: HbA2

A

a2delta2

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19
Q

thalassemia: what does B-null indicate?

A

absent B-globin

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20
Q

thalassemia: what does B+ indicate?

A

diminished B-globin

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21
Q

B-thalassemia: who?

A
  • african

- mediterranean

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22
Q

B-thalassemia minor: genotype

A

B/B+

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23
Q

B-thalassemia minor: ssx

A

usu asymptomatic w increased RBC count

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24
Q

B-thalassemia minor: histology? Hb electrophoresis?

A
  • microcytic, hypochromic RBC
  • target cells

Hb electrophoresis:

  • slight decrease HbA
  • increase HbA2
  • increase HbF
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25
Q

B-thalassemia major: genotype

A

Bnull/Bnull

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26
Q

B-thalassemia major: onset

A

few months after birth –> severe anemia

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27
Q

vancomycin: MOA

A

direct bind D-ala-D-ala in cell wall –> prevent peptidoglycan formation

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28
Q

hepatitis E: what kind of virus? transmission?

A

unenveloped ssRNA –> fecal-oral

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29
Q

hepatitis E: #1 concerning feature

A

high mortality rate in infected preg F

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30
Q

dystrophic calcifcation –> indicatess?

A

hallmark of cell injury & death –> occurs in damaged, necrotic tissue

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31
Q

what is: metastatic calcification

A

hyperCa –> calcification of normal tissue

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32
Q

why would you see dystrophic calcifcation on the aortic valve? how does it manifest?

A

chronic hemodynamic stress –> endothelial, fibroblast death

aortic sclerosis –> usu benign –> over time –> calcific aortic stenosis

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33
Q

isoproterenol: what is? effect?

A

B1 & B2 agonist:

  • increase myocardial contractility
  • decrease SVR
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34
Q

hepatocell damage: indicators

A

increased: ALT, AST

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35
Q

biliary injury: indicators

A

increased: alk phos, gamma-glutamyl transpeptidase

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36
Q

liver fx: indicators

A

impaired biosyn capacity:

  • elevated prothrombin time
  • hypoalbumin

impaired transport, metab capacity:
- elevated bilirubin

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37
Q

aromatase: rxn

A

testosterone –> estradiol

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38
Q

aromatase inh: drugs

A
  • anastrozole
  • letrozole
  • exemestane
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39
Q

aromatase inh: MOA

A

decrease estrogen syn from androgen –> suppress estrogen level –> slow progression of ER+ breast cancer

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40
Q

what are the parts of an advance directive?

A

1) living will: end of life wishes, other specific directives
2) health care proxy

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41
Q

when should you do advance care planning?

A
  • ideally in outpt w PCP

- essential when admitted to hosp

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42
Q

humerus –> midshaft fracture –> may injure?

A
  • deep brachial A

- radial N

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43
Q

what A runs with radial N at post aspect of humerus?

A

deep brachial A

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44
Q

what is: diffuse esophageal spasm

A

esophageal myenteric plexus –> impaired inh innervation –> periodic, simult, non-peristaltic contractions

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45
Q

diffuse esophageal spasm: ssx

A
  • liq/solid dysphagia

- chest pain

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46
Q

what is: reverse T3

A

inactive form of T3 generated from peripheral conversion of T4

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47
Q

how do you dx celiac dz?

A
  • screening test: elevated tissue transglutaminase IgA

- confirmatory test: duodenal bx –> villous flattening, intraepi lymphocyte infiltration

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48
Q

hereditary nonpolyposis colon cancer (HNPCC): aka

A

Lynch synd

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49
Q

what is: HNPCC

A

AD genetic predisposition to colon CA

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50
Q

HNPCC: mutation

A

DNA mismatch repair genes –> MSH2, MLH1, MSH6, PMS2

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51
Q

HNPCC: presentation

A

colonic adenoCA at young age (

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52
Q

Lynch synd: assoc neoplasms

A
  • colorectal
  • endom
  • ovarian
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53
Q

APC mutation –> leads to

A

familial adenomatous polyposis

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54
Q

familial adenomatous polyposis: mutation? assoc neoplasm?

A

APC

  • colorectal
  • desmoid & osteoma
  • brain tumor
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55
Q

von Hippel-Lindau synd: mutation? assoc neoplasm?

A

VHL

  • hemangioblastoma
  • clear cell renal CA
  • pheochromocytoma
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56
Q

Li-Fraumeni synd: mutation? assoc neoplasm?

A

TP53

  • sarcoma
  • breast cancer
  • brain tumor
  • adrenocortical CA
  • leukemia
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57
Q

what hereditary cancer synd is caused by an activating mutation?

A

MEN2 –> RET

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58
Q

lab test –> lower cutoff point –> what happens to:

  • TP
  • FP
  • FN
  • sensitivity
  • PPV
A
  • TP: increase
  • FP: increase increase
  • FN: decrease
  • sensitivity: increase
  • PPV: decrease
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59
Q

enteric bact produce what vit?

A
  • vitK

- folate

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60
Q

small intestinal bact overgrowth (SIBO): charact

A
  • overproduction of vitK, folate
  • nausea
  • bloat
  • abd discomfort
  • malabsorption: deficiency of most vit (B12, A, D, E, iron)
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61
Q

small intestinal bact overgrowth (SIBO) is seen in?

A

gastric bypass surg: excessive bact prolif in blind-ended gastroduodenal segment

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62
Q

transketolase: fx

A

pentose phosphate pathway –> nonoxidative (reversible) br –> ribose-5-phosphate for nucleotide syn

interconversion of ribose-5-phosphate (nucleotide precursor) & fructose 6 phosphate (glycolytic interm)

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63
Q

what is the NADPH generated from the pentose phosphate pathway used for?

A
  • chol & fa syn

- glutathione antioxidant mechanism

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64
Q

succinylcholine –> who is at high risk for hyperK?

A
  • burn
  • myopathy
  • crush injury
  • denervating injury, dz
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65
Q

succinylcholine: MOA

A

depolarizing NM-blocking agent: attach to nAChR –> depolarize end plate:

  • phase 1 block: end plate depolarized –> flaccid paralysis
  • phase II block: nAChR become desensitized to succinylcholine –> gradual repolarization –> non-depolarizing blockade
66
Q

succinylcholine: AE

A
  • malig hyperthermia
  • severe hyperK
  • bradycardia/tachycardia
67
Q

hyperK –> leads to?

A

life threatening arrhythmia

68
Q

what is: placenta accreta

A

placenta adhered to myometrium

69
Q

what is the most common cause of postpartum hemorrhage?

A

uterine atony: fail of uterus to contract adeq after delivery

70
Q

how can placenta accreta occur?

A

prior surg (C-section) –> scar tissue –> malformed or absent decidual layer bw placenta & myometrium –> villous tissue direct attach to myometrium

71
Q

which has higher distending pressure: small or lrg sphere? why?

A

small

Laplace’s law: distending pressure (pressure required to keep sphere distended):

  • directly proportional to surface tension
  • inversely proportional to radius
72
Q

which will collapse first: small or lrg sphere? why?

what would counteract this?

A

small –> higher distending pressure

surfactant: decrease surface tension as alveolar radius decrease –> counteract alveolar collapse

73
Q

cyclosporine: MOA

A

inh nuclear factor of activated T cells (NFAT) from enter nucleus –> modulate transcription activity –> impair IL2 production & release –> inh IL2-induced activation of resting T cells

74
Q

what is: etanercept

A

recombinant form of TNF receptor –> bind TNFa

75
Q

topical vitD analog: drugs

A
  • calcipotriene
  • calcitriol
  • tacalcitol
76
Q

topical vitD analog: MOA? use?

A

bind vitD receptor:

  • inh keratinocyte prolif
  • stim keratinocyte differentiation

psoriasis

77
Q

subthalamic nucleus: fx

A

modulation of basal ganglia output

78
Q

damage to subthalamic nucleus –> leads to?

A

decrease excitation to globus pallidus internus –> reduce inh of thalamus –> contralat hemiballism –> wild, involuntary, lrg amplitude, flinging mvmts of proximal limbs (arm and/or leg)

79
Q

damage to subthalamic nucleus: #1 cause

A

lacunar stroke (conseq of longstanding HTN, DM)

80
Q

what makes up most of the heart’s ant surface?

A

RV

81
Q

penetrating injury to L sternal border at 4th intercostal space would puncture?

A

RV

82
Q

CSF: viral pattern

A
  • elevated protein
  • normal glucose
  • lymphocytic predominance
83
Q

CSF: bact pattern

A
  • elevated protein
  • low glucose
  • neutrophilic predominance
84
Q

what is a L shift on Hb-O2 dissociation curve? cause?

A

increased Hb-O2 affinity –> O2 less avail to tissues

  • increased pH
  • decrease 2,3 bisphosphoglycerate
  • decrease temp
85
Q

neurofibromatosis type 1: cause? ssx?

A

AD –> NF1 gene

  • cafe au lait spots
  • mult neurofibroma
  • Lisch nodules
  • pseudoarthrosis
86
Q

what is: Lisch nodules

A

pigmented asymptomatic hamartoma of iris

87
Q

severe combined immune def (SCID): pathophys? ssx?

A

combined T & B cell dysfx –> present in infancy:

  • severe bact & viral infect
  • mucocut candidiasis
  • persistent diarrhea
  • fail to thrive
88
Q

SCID: lab findings

A
  • absent T cells
  • hypoIg
  • no thymic shadow (d/t severe T cell def)
89
Q

what is: CFRT protein

A

transmembrane ATP-gated Cl- channel

90
Q

leukemoid rxn: cause

A
  • severe infect
  • severe hemorrhage
  • malig (ie leukemia)
  • acute hemolysis
91
Q

leukemoid rxn: histology

A
  • increased bands
  • early mature neutrophil precursors (myelocytes)
  • basophilic granules (Dohle bodies) in neutrophils
92
Q

lung abscess: tx? why?

A

clindamycin –> covers anaerobic oral flora + aerobic bact

93
Q

what is depersonalization/derealization disorder? how is it diff from psychotic disorders?

A

dissociative disorder involving recurrent episodes of feeling detached from one’s body and/or feelings of unreality

intact reality testing

94
Q

what is: depersonalitzation

A

sense of being outside observer of self

95
Q

what is: derealization

A

sense of detachment or unreality regarding surroundings

96
Q

vesicoureteral reflux: what is most susceptible to reflux-induced damage? how does this present?

A

compound papilla in upper & lower poles of kidney –> dilated calyces w overlying renal cortical scarring

97
Q

vesicoureteral reflux –> can lead to?

A

loss of nephrons –> 2ndary HTN

98
Q

nasal mucosal ulceration + glomerulonephritis –> indicates?

A

granulomatosis w polyangiitis (Wegener’s)

99
Q

granulomatosis w polyangiitis (Wegener’s): what Ab will you find? where?

A

C-ANCA (cytoplasmic-staining antineutrophil cytoplasmic Ab)

neutrophil

100
Q

cardiac tissue conduction velocity: fastest–>slowest

A

“Park At Venture Ave”:

  • Purkinje
  • Atrial muscle
  • Ventricular muscle
  • AV node
101
Q

Zollinger-Ellison synd –> leads to?

A
  • peptic ulcer dz

- parietal cell hyperplasia –> gastric fold enlargement

102
Q

sulfonylurea: MOA

A

increase insulin secretion by pancreatic B cells indep of blood glucose []

103
Q

sulfonylurea: drug

A
  • glyburide

- glimepiride

104
Q

sulfonylurea: AE

A

hypoglyemia –> esp elderly

105
Q

chloramphenicol: AE

A
  • dose-dep (reversible) cytopenia: anemia, leukopenia, and/or thrombocytopenia
  • dose-indep (irrev) aplastic anemia
106
Q

septic abortion: presentation

A

after preg termination:

  • fever
  • abd pain
  • uterine tenderness
  • foul smelling discharge
107
Q

septic abortion: cause

A

bact seeding of uterine cavity during instrumentation –> usu Staph aureus, E.coli

108
Q

septic abortion: tx

A
  • broad spectrum abx

- prompt surgical evacuation –> remv nidus of infection

109
Q

what is: septic abortion

A

any type of abortion resulting in infected retained products of conception

110
Q

septic abortion: comp

A

adhesions in uterine cavity –> Asherman synd (2ndary amenorrhea, infertile)

111
Q

what cytokines induce the systemic inflamm response?

A
  • IL1
  • IL6
  • TNFa
112
Q

TNFa –> high concentration –> can lead to?

A

ssx of septic shock & cachexia

113
Q

IFNgamma: fx? produced by?

A

activated T cell

  • recruit leukocytes
  • activate phagocytosis
114
Q

IL3: fx? produced by?

A

activated T cell

stimulate growth & differentiation of stem cells in BM

115
Q

IL4: fx? produced by?

A

TH2

  • stim growth of B cells
  • increase # of TH2 cells at site of inflamm
116
Q

IL10: fx? produced by?

A

macrophage, TH2

anti-inflamm –> limit production of pro-inflamm cytokines (IFNgamma, IL2, IL3, TNFa)

117
Q

glomangioma: what is? origin?

A

benign glomus tumor –> very tender, small, red-blue lesion under nailbed

originates from modified smooth muscle cells that ctrl thermoreg fx of dermal glomus bodies

118
Q

what is: bursa

A

fluid-filled synovial sac that serves to alleviate pressure from bony prominences and reduce friction bw muscles & tendons

119
Q

repetitive, prolonged kneeling –> leads to?

A

prepatellar bursitis –> ant knee pain

120
Q

CD18 def –> indicates?

A

leukocyte adhesion def

121
Q

leukocyte adhesion def: pathophys

A

absence of CD18 antigens necess for formation of integrins –> fail of leukocyte chemotaxis

122
Q

leukocyte adhesion def: ssx

A
  • recurrent skin, mucosal infect –> no purulence
  • delayed sep of umbilical cord
  • persistent leukocytosis
123
Q

delirium: tx

A

low dose antipsych (haloperidol) –> acute tx of agitation & psychosis assoc w delirium

124
Q

what is: delirium

A

acute onset “confusional state” charact primarily by waxing/waning mental status change and impaired attention

125
Q

what is the most common hemolytic anemia?

A

hereditary spherocytosis

126
Q

chronic hemolysis –> can lead to what in gallbladder?

A

pigmented gallstones

RBC lyse –> high bilirubin

127
Q

hereditary spherocytosis: comp

A
  • pigmented gallstone

- aplastic crisis from parvovirus B19

128
Q

primaquine: use

A

eradicate hypnozoites in P vivax & ovale infections

129
Q

hospital discharge –> what is the most effective strategy for decreasing adverse outcomes and preventing avoidable readmissions?

A

hospital discharge checklist

130
Q

spinal stenosis: location

A

lumbar

131
Q

spinal stenosis: ssx

A
  • posture-dep LE pain: worse w lumbar extension, better w flexion
  • numb, paresthesia
  • weak
132
Q

spinal stenosis: #1 cause

A

degen arthritis of spine:

  • intervertebral disc herniation
  • ligamentum flavum hypertrophy
  • osteophyte formation affecting facet jts

==> narrow spinal canal

133
Q

aedes aegypti mosquito transmits?

A
  • dengue fever

- chikungunya

134
Q

dengue fever: presentation

A

acute febrile illness w HA, retro-orbital pain, jt & muscle pain

135
Q

chikungunya: presentation

A

febrile illness w flu-like ssx, prominent polyarthralgias, diffuse macular rash

136
Q

bony pain in an older man w osteoblastic lesions –> indicates?

A

prostate cancer

137
Q

what cancers that metastasis to bone make osteoblastic lesions?

A
  • prostate cancer
  • small cell lung CA
  • Hodgkin lymphoma
138
Q

elevated PTH-related peptide –> indicates?

A

non-small cell lung cancer

139
Q

sickle cell dz –> what happens to spleen?

A

vasoocclusive events –> repeated splenic infarcts –> fibrosis & atrophy –> asplenia

140
Q

chronic hemolytic anemia –> can lead to what vit def?

A

folic acid def d/t increased RBC turnover

141
Q

C1 inh (C1INH) def: pathophys

A

low C1 inh:

  • increase cleavage of C2 & C4 –> inapprop activation of complement cascade
  • can’t block kallikrein-induced conversion of kininogen to bradykinin –> increased bradykinin
142
Q

what is: Jervell and Lange-Nielsen synd

A

congenital long-QT synd –> AR:

  • QT prolong: syncope, sudden cardiac death from torsades
  • neurosensory deaf
143
Q

what is: Pringle maneuver

A

occlude portal triad to disting source of RUQ bleed –> if bleed not stop –> injury to IVC, hepatic V

144
Q

portal triad –> runs thru?

A

hepatoduodenal lig

145
Q

portal triad: composed of?

A
  • hepatic A
  • portal V
  • common bile duct
146
Q

secretory phase of menstrual cycle: when?

A

day 15-28

147
Q

prolif phase of menstrual cycle: when?

A

day 1-14

148
Q

secretory phase of menstrual cycle: histology

A
  • coiled uterine glands –> secrete glycogen-rich mucus
  • edematous stroma
  • tortuous spiral A –> extend from deeper layers to uterine lumen
149
Q

prolif phase of menstrual cycle: histology

A
  • straight narrow glands –> no secretions
  • compact, non-edematous stroma
  • spiral A only at deeper layers
150
Q

humoral hyperCa of malig: cause

A

malig –> secrete PTHrP

151
Q

fibrate: MOA

A

activate peroxisome prolif-activated receptor alpha:

  • increase LPL activity
  • decrease hepatic VLDL production

==> lower TG levels

152
Q

omega 3 fa: MOA

A

decrease production of VLDL, apoB –> lower TG

153
Q

what is most similar bw systemic & pulm circ?

A

blood flow per min

154
Q

accessory nipple: pathophy

A

failed regression of mammary ridge in utero

155
Q

what is: progestin

A

synthetic equivalent to progresterone –> responsible for preg prevention in all hormonal contraceptives

156
Q

combined hormonal contraceptive: MOA

A

suppress GnRH in hypo –> decrease FSH, LH syn –> no LH spike –> inh ovulation

157
Q

how do you differentiate precursor B-ALL vs T-ALL?

A

immunophenotyping:
- precursor B-ALL: TdT+, CD10+, CD19+
- precursor T-ALL: TdT, CD1, CD2, CD5

158
Q

Down synd: assoc w what quadruple screen results?

A
  • maternal serum a-fetoprotein: low
  • estriol: low
  • B-hCG: high
  • inhibin A: high
159
Q

low maternal serum a-fetoprotein (MSAFP) –> indicates?

A

aneuploidy –> trisomy 18, 21

160
Q

high maternal serum a-fetoprotein (MSAFP) –> indicates?

A
  • open neural tube defect
  • mult gestation
  • abd wall defect
161
Q

chronic lymphocytic (Hashimoto) thyroiditis: histology

A
  • intense lymphocytic infiltrate
  • germinal center
  • Hurthle cells: lrg oxyphilic cells filled w granular cyto

UWorld (28 decks)

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