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UWorld mixed > facts from sim test 4.30 > Flashcards

facts from sim test 4.30 Flashcards

1
Q

venous drainage to anal canal above/below the pectinate line

A

above: superior rectal vein -> inferior mesenteric -> portal circulation
below: middle & inferior rectal vein -> internal pudendal -> inferior mesenteric -> internal iliac -> IVC

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2
Q

most likely site for external hemorrhoids

A

posterior canal – poor perfusion

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3
Q

coarctation murmur

A

systolic, best auscultated in interscapular region

due to turbulent flow through narrow lumen

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4
Q

braf v600e mutation in? rx?

A

melanoma!. mutation in BRAF kinase.

rx: vemurafenib: BRAF kinase inhibitor

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5
Q

origin of gut tube lining from esophagus to above pectinate line

A

endoderm

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6
Q

VACTERL syndrome

A

mesodermal origins

vertebral defects
anal atresia
cardiovascular defects
tracheoesophageal fistula
renal defects
limb defects (bone & muscle)
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7
Q

luminal epithelial derivatives: endoderm

A

lung, liver, gallbladder, pancreas, eustachian tube, thymus, parathyroid, thyroid follicular

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8
Q

toxic shock syndrome toxin (TSST-1) vs. toxic shock-like toxin

A

both toxin shock syndrome

TSST-1: staph aureus

Toxic shock-like toxin: S. pyogenes

both superantigens

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9
Q

arthus reaction

A

local subacute antibody mediated HSR Type III reaction.

intradermal injection of antigen induces antibodies, form antigen-antibody complexes in skin.

edema, necrosis, complement activation

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10
Q

Streptococcus mitis

A

alpha-hemolytic strep in mouth

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11
Q

modifications made in golgi (3)

A
  1. add N-olgosaccharides in asparagine
  2. adds O-oligosacch on serine/threonine
  3. mannose-6-phosphate to traffic to lysosomes
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12
Q

endosomes

A

sorting center for material from outside cell or from golgi – send to lysosome for destruction or back to membrane/golgi

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13
Q

I cell disease: defect & presentation

A

inherited.

defective in mannose-6-phosphotransferase –> lysosomal proteins secreted extracellular

presentation:
1. coarse facial features
2. clouded cornea
3. restricted joint movement.

high plasma levels of lysosomal enzymes.

often fatal

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14
Q

COPI vesicle trafficking protein

A

golgi -> golgi (retrograde)

gogi -> ER

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15
Q

COPII vesicle trafficking protein

A

golgi -> golgi anterograde

ER to golgi

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16
Q

clathrin

A

trans-golgi -> lysosomes; plasma membrane -> endosomes

–> receptor mediated endocytosis

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17
Q

peroxisome

A

membrane-enclosed organelle involved in catabolism of

  1. very long chain fatty acids,
  2. branched chain fatty acids, &
  3. amino acids
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18
Q

recurrent fungal and myobacterial infection?

A

IL-12 receptor deficiency
autosomal recessive

reduced Th1 response

reduced IFN-gamma

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19
Q

mnemonic for branchial arches

A 
chew (1), 
then smile (2), 
then swallow stylishly (3), 
or simply swallow (4), & 
then speak (4)
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20
Q

1st branchial arch

A

M

cartilage: meckel cartilage: Mandible, Malleus & incus, spheno-Mandibular ligament
muscles: muscles of Mastication (temporalis, Masseter, lateral & Medial pterygoid), mylohyoid, anterior belly of digastric, tensor tympani, tensor veli palatini

CN: V2 and V3

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21
Q

treacher-collins

A

1st arch neural crest fails to migrate -> mandibular hypoplasia and facial abnormalities

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22
Q

2nd branchial arch

A

S
Reichert cartilage:
Stapes, Styloid process, lesser horn of hyoid, Stylohoid ligament

mucles of facial expression, stapedius, stylohyoid, plastysma, belloy of digastric

CN: VII

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23
Q

congenital pharyngocutaneous fistula

A

persistence of cleft & pouch –> fistula between tonsilar area and lateral neck

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24
Q

3rd branchial arch

A

cartilage: greater arch of the hyoid
muscle: stylopharyngeus

CN IX: glossopharyngeal

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25
4th branchial arch
(w/ 6th for cartilage): thyroid, cricoid, arytenoid, cornuculate, cuneiform muscle: most PHARYNGEAL constrictors; laryngeal: CRICOTHYROID, levator veli palatini CN X: superior laryngeal branch (swallow)
26
6th branchial arch
(w/ 4th for cartilage): thyroid, cricoid, arytenoid, cornuculate, cuneiform muscle: all intrinsic muscle of LARYNX, EXCEPT CRICOTHYROID. CN X: recurrent laryngeal branch (speak)
27
which branchial arches make up the posterior 1/3 of tongue
arches 3 & 4
28
mnemonic for branchial pouches
ears, tonsils bottom to top 1. ear (endoderm-lined structures: middle ear cavity, eustachian tube, mastoid air cells) 2. tonsil: epithelial lining of palatine 3. dorsal wings: inferior parathyoid ventral: wings: thymus 4: dorsal wings: superior parathyroids 4th & 5th pouch -- parafollicular cells of medullary thyroid
29
cleft lip follows failed fusion of..
maxillary & medial nasal processes (primary palate)
30
cleft palate follows failed fusion of..
two lateral palatine processes or lateral palatine process w/ nasal septum / medial palatine fossa
31
kinase vs. phosphorylase
kinase: adds phosphate using ATP phosphorylase: adds inorganic phosphate w/o consuming ATP
32
how do epi & glucagon increase glycogenolysis
both increase adenylate cyclase -> cAMP -> PKA -> glycogen phosphorylase kinase -> glycogen phosphorylase -> glucose from glycogen
33
what stimulates glycogen phosphorylase kinase (3)
1. PKA (from glucagon/epi stim) 2. Ca2+/calmodulin complex 3. Ca2+ directly
34
anti-Ro, anti-La or anti-SSA, anti-SSB
Sjorgen syndrome
35
anti-Jo, anti SRP, anti-Mi-2
polymyositis, dermatomyositic
36
anti-Scl-70 or anti-DNA topo I
Scleroderma (diffuse)
37
anti-smooth muscle
autoimmune hepatitis
38
1st generation sulfonylurea (2)
tolbutamide | chlorpropamide
39
2nd generation sulfonylurea (3)
glyburide glimepride glipizide
40
what stimulates Th17 formation
TGF-beta & IL-6
41
what stimulates Treg formation
TGF-beta
42
TGF-beta (3)
1. anti-inflammatory 2. TH17 formation (w/ IL-6) 3. Treg formation
43
regulation of nf-kB
normally inhibited by IkB, released when ikB is phoshparylated. nfKb then goes to nucleus --> transcription factor
44
carbon dioxide transport in RBC
1. HCO3- (90%) 2. carbaminohemoglobin: co2 bound to hb at n-terminus of globin (not heme) --> favors O2 unloading by stabilizing taut form (5%) 3. dissolved CO2 (5%)
45
carboxyhemoglobin, methemoglobin, carbaminohemoglobin
carboxyhemoglobin: CO in place of O2 methemoglobin: Fe3+, does not bind O2 as readily (high affinity for cyanide) carbaminohemoglobin: CO2 bound to Hb at N-terminus of globin (NOT HEME). CO2 binding favors taught form (oxygen unloading)
46
haldane effect
lungs: oxygenation of Gb promotes dissociation of H+ from Hb (shifts equilibrium towards CO2 formation --> release)
47
Bohr effect:
peripheral tissue, H+ from tissue shifts curve to right, unloading O2
48
majority of CO2 carried as
HCO3-
49
SLE presentation
usu: rash, joint pain, fever RASH OR PAIN rash: malar or discoid arthritis soft tissue/serositis hematologic disorder (cytopenia oral-nasopharyngeal ulcer renal disease, raynaud photosensitivity, positive VDRL antinuclear antibodies immunosuppressants neurologic disorder (seizure, psychosis)
50
renal disease in lupus
nephrotic: membranous nephropathy nephritic: diffuse proliferative glomerulunephropathy
51
cause of death in lupus (3)
1. cardiovascular disease 2. immunosuppresion 3. renal disease
52
gingival hyperplasia side effect (4)
phenytoin, verapamil, cyclosporine, nifedipine
53
metoclopramide
D2 receptor antagonist INCREASE resting tone, contractility, LES tone, motility does not influence colon transport time. use: diabetic / postsurgery gastroparesis, antiemetic toxicity: antiparkinson. interact w/ digoxin and diabetic meds.
54
irradiated blood? washed?
irradiate: destroys DNA (WBC) prevents graft vs. host washed: remove all plasma, less often done
55
autosomal dominant polycystic kidney disease vs. hydronephrosis
hydronephrosis: smooth surface ADPKD: rough and bumpy surface
56
tanner stages
1: childhood (prepubertal) 2: pubic hair (pubarche) and breast bud (thelarche) 3: pubic hair darkens & curly, penis size/length increase, breast enlarge (adrenarche) 4: penis width increasese, darken scrotal skin, development of glans, raised areolae 5: adult: areola are no longer raised
57
HTN, bradycardia, and respiratory depression
cushing reaction 1. increased cranial pressure constricts arterioles --> cerebral ischemia --> reflex sympathetic increase in perfusion pressure -- HTN 2. HTN increases stretch --> reflex baroreceptor induced bradycardia
58
baroreceptor innervation (aortic arch & carotid)
carotid sinus: glossopharyngeal (both high & low) aortic arch: just high both go to solitary nucleus
59
describe hypotension detection at carotid sinus
hypotension -> less stretch -> decreased glossopharyngeal firing in solitary nucleus of medulla 1. relieves tonic inhibition on sympathetic 2. decreases firing of parasympathetic --> vasoconstriction, increase HR, contracility, BP
60
describe hypertension detection at carotid sinus:
hypertension -> increased stretch -> increased afferent glossopharyngeal firing in solitary nucleus 1. tonic inhibition of sympathetic 2. stimulation of parasympathetic decrease HR (increased AV node refractory) (aortic arch & vagus will also respond)
61
what stimulates carotid & aortic chemoreceptor (peripheral)
1. PO2 < 60mmHg 2. increased PCO2 3. low blood pH
62
what stimulates central chemoreceptors?
1. pH 2. PCO2 (not directly to O2
63
CREST
calcinosis, raynaud phenomenon, esophageal dysmotility, scerlodactylyl, telangiectasia anti-centromere
64
side effects of niacin (3)
1. hyperuricemia 2. hyperglycemia 3. facial flushing
65
sorbitol dehydrogenase in tissues. lens? schwann cells, retina, & kidney?
usu glucose -> sorbitol (w/ aldolase reductase &NADPH) sorbitol -> fructose w/ sorbitol dehydrogenase & NAD+ most tissues have sufficient sorbitol dehydrogenase lens: less active, can be overwhelmed schwann cells, retina, kidney: much less active, but exists!
66
arteries coming off of celiac trunk
1. common hepatic 2. splenic 3. left gastric (near lesser curvature). anastomose w/ right gastric (from common hepatic) & gives off esophageal branch
67
common hepatic splits into (3)
1. gastroduodenal -> anterior superior & posterior superior pancreaticoduodenal artery & right gastricepiploic (around greater curvature) 2. hepatic artery proper 3. right gastric artery -> less curvature, anastomose w/ left gastric
68
inferior epigastric artery comes off of
external iliac artery
69
ulcer on posterior wall of duodenum can cause bleeding from..
gastroduodenal artery (from common hepatic, from celiac trunk
70
ruptured ulcer on lesser curvature of stomach results in bleeding from
left gastric (from celiac)
71
what does the ventral pancreatic bud contribute? dorsal bud?
main pancreatic duct & pancreatic head (uncinate process specf) everything else: body, tail, isthmus, accessory pancreatic duct --> dorsal bud
72
special embryology of spleen
supplied by foregut (celiac artery) but arises from mesentary of stomach --> MESODERM (pancreas, liver, gallbladder, etc --> endoderm
73
histology of abetalipoproteinemia
decrease synthesis of apolipoprotein B-48, can't make chylomicrons. decreased secretion of cholesterol, VLDL into blood stream --> fat accumulation in enterocytes failure to thrive, acanthocytosis, ataxia, night blindness
74
Wernicke's area specifically located
posterior section of superior temporal gyrus
75
diabetic neuropathic pain is often..
BURNING

UWorld mixed (60 decks)

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