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UWORLD facts > last week!!! > Flashcards

last week!!! Flashcards

1
Q

what biostat is used to represent a studies ability to detect a difference when one exists

A

statistical power = 1-B(beta = type II error)

depends on sample size and the difference in outcome between groups (to detect a difference you want to maximize power)

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2
Q

what is type II error

A

when researchers fail to reject the null hypothesis when it is truly false

beta = the probability of committing a type II error

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3
Q

what is type I error

A

when researches reject the null hypothesis when it is really true

alpha = the maximum probability of making a type I error that a researcher will accept

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4
Q

where is aqueous humor produced

A

epithelial cells of the cilary body

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5
Q

what findings on a fundoscopic exam suggest glaucoma

A

increased cup to disk ratio

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6
Q

what is the MOA for Timolol (and other beta blockers) in the treatment of glaucoma

A

it decreases the secretion of aqueous humor by the ciliary epithelium

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7
Q

which reflexes are mediated by C5-C6 spinal nerves

A

biceps and brachioradialis

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8
Q

what causes maple syrup urine disease

A

an autosomal recessive deficiency in branched-chain a-ketoacid dehydrogenase complex (BCKDC)

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9
Q

what dietary changes should be made in a child with maple syrup urine disease

A

avoid leucine, isoleucine, and valine (branched chain amino acids)

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10
Q

what commonly causes congenital long QT syndrome

A

most commonly genetic mutations in the K+ channel proteins that contribute to the outward potassium current (decreased outward K+ flow)

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11
Q

what does prolonged QT predispose patients too and how can it present

A

predisposes the development of life-threatening ventricular arrhythmias (torsades de pointes) which can present as recurrent palpitations, syncope, seizures or sudden cardiac death

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12
Q

what is the most common location of a nose bleed

A

anterior nosebleeds in the watershed area of the nasal septum (anteriorinferior part) known as the Kiesselbach plexus

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13
Q

what is axonal reaction

A

changes seen in the neuronal body after the axon is severed. cellular edema causes it to become swollen and rounded, with the nucleus displaced to the periphery. Nissl substance becomes fine, granular and dispersed throughout the cytoplasm (central chromatolysis).

axonal reaction becomes visible in 24-48 hours after injury and maximal changes occur 12 days after injury. Changes are due to increased protein synthesis in order to regenerate the severed axon

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14
Q

what are characteristics of atypical depression

A

mood reactivity (main distinguishing characteristic), leaden paralysis, rejection sensitivity, and increased sleep and appetite

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15
Q

where is the SA and AV node located

A

SA - at the junction of the right atrium and superior vena cava

AV- right atrium near the septal cusp of the tricuspid valve

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16
Q

what is dysdiadochokinesia and what is it associated with

A

impaired rapid alternating movements associated with cerebellar hemisphere injury

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17
Q

what are 3 common findings associated with cerebellar hemisphere injury

A

dysdiadochokinesia, limb dysmetria, and intention tremor

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18
Q

what are the 3 types of rapidly progressive glomerulonephritis

A
  1. anti-GBM (Goodpastures)
  2. Immune Complex RPGN (post strep, SLE, IgA nephropathy, or henoch-Schonlein purpura)
  3. Pauci-Immune (ANCA)
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19
Q

what is the MOA of lantanoprost when used for glaucoma

A

increased outflow of aqueous humor, it is a topical prostaglandin (applied as a prodrug and activated by esterase in the cornea)

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20
Q

where are melanocytes derived from embryologically

A

neural crest cells

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21
Q

what is the cause of vitiligo

A

loss of epidermal melanocytes (appears as flat well-circumscribed macules and patches of absent pigment)

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22
Q

what is a holocrine exocrine gland and where are they found

A

a gland that produces lip-rich secretory products that are released by lysis of the cell membrane and release of cytoplasmic contents.

examples = sebaceous glands and meibomian glands of the eyelid

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23
Q

what drug can be used to decrease alcohol cravings and what is its MOA?

A

Naltrexone - it blocks the mu-opioid receptor (blocks the rewarding and reinforcing affects of alcohol and reduces cravings, can be used while the pt is still drinking)

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24
Q

in what 2 patient groups is bupropion contraindicated

A

pts with seizure disorders and current or previous bulimia or anorexia nervosa

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25
Q

is repression or suppression a conscious choice?

A

suppression - this is a mature defense while repression is subconscious

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26
Q

what is the mechanism that morphine can cause diffuse itching

A

IgE independent mast cell degranulation - morphine can induce degranulation by activation of protein kinase A and PI3 kinase resulting in the release of many mediators including histamine, bradykinin, heparin, and others

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27
Q

what is needed for a diagnosis of Tourettes

A

at least one motor and one vocal tick (one or more of either type is chronic tic disorder)

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28
Q

what are characteristics of Neuroleptic malignant syndrome

A

hyperthermia, muscle rigidity and confusion/altered mental status, autonomic instability

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29
Q

what is a main difference in symptoms of NMS and serotonin syndrome

A

both have mental status changes, hyperthermia and autonomic instability but serotonin syndrome has neuromuscular hyperactivity (shivering, clonus, hyperreflexia) as opposed to the diffuse rigidity and brady reflexia seen in NMS

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30
Q

drug intoxication by what agent presents with violent behavior, hallucinations, nystagmus and ataxia

A

Phencyclidine (PCP)

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31
Q

what drugs can be used to treat narcolepsy

A

first line is modafinil - non-amphetamine stimulant

2nd line - amphetamines (increased side effects)

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32
Q

what are symptoms of a CN IX lesion

A

loss of the gag reflex, loss of general sensation in the upper pharynx, posterior tongue, tonsils, and middle ear cavity and loss of taste sensation on the posterior third of the tongue

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33
Q

in Maple Syrup urine disease dietary supplementation of what can be of benefit

A

thiamine (in addition to avoidance of branch amino acids)

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34
Q

what are labratory findings in polymyositis

A

elevated serum creatine kinase, aldolase and autoantibodies ANA and anti-hystidyl-tRNA synthase (Anti-Jo-1)

biopsy shows endomysial mononuclear inflammatory infiltrate and patchy muscle fiber necrosis

35
Q

what are signs of superior vena cava syndrome

A

dyspnea, cough, swelling of the face and neck, and upper extremities. Headaches, dizziness and confusion due to cerebral edema. Dilated collateral veins in the upper torso

caused by a mediastinal mass either lung cancer or non-hodgkin lymphoma are the most common

36
Q

what structures must be cut through during a cricothyrotomy

A
  1. skin
  2. superficial cervical facial (includes subcutaneous fat and platysma muscle)
  3. investing and pretracheal layers of the deep cervical fascia
  4. Cricothyroid membrane
37
Q

how does significant renal dysfunction affect bleeding?

A

uremic toxins impair platelet aggregation and adhesion resulting in a qualitative platelet disorder (PT, PTT, and platelet counts are all normal while bleeding time is increased)

38
Q

describe the murmor of a VSD

A

low pitch holosystolic murmur heard best at the left sternal border and increases with the hand grip exercise (increased afterload)

39
Q

what structures must a chest tube placed for drainage of a pleural effusion pass through?

A

usually placed at the 4th or 5th intercostal space in the mid axillary line- it passes through the serratus anterior muscle, intercostal muscles and parietal pleura

40
Q

at the level of the thyroid what nerve runs near the inferior thyroid artery

A

recurrent laryngeal nerve (injury would result in vocal cord paralysis)

41
Q

which organs are hindgut derivatives

A

distal 1/3 of the transverse colon, descending colon, sigmoid colon, and rectum

all receive blood supply from the IMA and are drained by the IMV (which goes to the splenic and then portal vein)

42
Q

if the femoral artery is punctured above the inguinal ligament what is there a risk of?

A

retroperitoneal bleeding (cannot be controlled by manual compression and can cause significant hemorrhage)

43
Q

what are the 2 location for ulnar nerve injury

A

medial epicondyle and hook of the hamate

44
Q

what are symptoms of an anterior dislocation of the shoulder

A

flattening of the deltoid muscle

if the axillary nerve is damage then there will be paralysis of the deltoid and loss of sensation over the lateral shoulder

45
Q

where is a central line typically placed?

A

the superior vena cava (derived from the common cardinal veins)

46
Q

what are risk factors for a psoas abscess?

A

HIV, IV drug use, diabetes

47
Q

a child (

A

annular ligament has become trapped between the radial head and humerous = radial head subluxation ( most common elbow injury in children)

48
Q

a pts with lung cancer presents with right-sided face and arm swelling and engoragement of the subcutaneous veins on the side of the neck, which vein is obstructed

A

the brachiocephalic vein (it forms from the right subclavian and internal jugular vein, it also drains the right lymphatic duct)

49
Q

stimulation of what part of the ear can cause vasovagal syncope? and how?

A

the posterior part of the external auditory canal – it is innervated by the vagus nerve which when stimulated increases parasympathetic outflow slowing the heart and decreasing BP

50
Q

injury to what nerve may cause fecal incontinence

A

pudendal nerve

51
Q

what disease and symptoms can be caused by repetitive quadriceps use (jumping) in a young athlete

A

Osgood-Schatter disease

focal pain and swelling at the tibial tuberosity

52
Q

hypertrophy of what muscle may compress the sciatic nerve where it passes through the greater sciatic foramen

A

the piriformis muscle

53
Q

what is a common cause of intracerebral hemorrhage extending into a ventricle in a premature infant

A

germinal matrix

54
Q

what ligament is most often injured in an ankle sprain

A

anterior talofibular ligament (lateral ligaments) presents with pain and ecchymosis at the anterolateral aspect of the ankle (usually do to inversion)

55
Q

what nerve innervates the latissimus dorsi

A

the thoracodorsal nerve

56
Q

what artery does the vertebral arteries arise from

A

left - subclavian

right- brachiocephalic

57
Q

what is the path of blood from the internal carotid artery to the retina

A

internal carotid to ophthalmic to retinal artery

58
Q

a pt cannot move his eye in any direction but visual acuity is not affected. What is the likely problem

A

cavernous sinus thrombosis (usually due to contiguous spread of an infection from the face, sinuses, or teeth) would affect CN III, IV, VI, V1, V2

59
Q

where is the AV node located

A

in the right atrium near the insertion of the septal leaflet of the tricuspid valve and the orifice of the coronary sinus

60
Q

what are the manifestations of a pineal gland mass

A

obstructive hydrocephalus (from aqueductal stenosis- causing headache, papilledema, and vomiting) and dorsal midbrain (parinaud ) syndrome due to compression of the pretectal region (downward gaze preferency, bilateral eyelid retraction, and light-near dissociation)

61
Q

what is a cholesteatoma

A

collection of squamous cell debris that forms a pearly white mass behind the tympanic membrane. may cause hearing loss

62
Q

what type of disorder is ornithine deficiency and how is it treated

A

urea cycle disorder

reduce protein intake to limit ammonia production

63
Q

what initial testing should be done when GCA is suspected

A

ESR and C-reactive protein - if elevated start steroids and do a biopsy to confirm

64
Q

what other disease is seen in 50% of patients with GCA

A

polymyalgia rheumatica (achy pain in the shoulders and hips)

65
Q

which cells of the kidney do most renal cell carcinomas develop from?

A

the epithelium of the proximal renal tubules

66
Q

what are complications of wilson’s disease

A

hepatic damage
corneal deposits
basal ganglia atrophy

67
Q

what 2 organisms can be seen inside RBCs

A

plasmodium and babesiosis

68
Q

describe the steps of neutrophil accumulation in inflamed tissue and important receptors

A
  1. margination
  2. Rolling (sialylated carbohydrate groups ie sialyl lewis X or PSGL-1, and then selectins (E-selectin)
  3. activation - cytokines and integrins
  4. tight adhesion and crawling (binding CD 18 beta 2 integrins (Mac-1 and LFA-1) to intracellular adhesion molecules (ICAM-1) on endothelial cells
  5. Transmigration (PECAM-1 platelet endothelial cell adhesion molecule 1)
69
Q

what is the name of the integrase inhibitor used to treat HIV

A

Raltegravir

70
Q

what is Omalizumab’s MOA and when is it used

A

it is an anti-IgE antibody and can be used in moderate to severe persistant asthma that is refractory to oral steroids

71
Q

what is the first step in converting pyruvate to glucose

A

pyruvate carboxylase converts pyruvate to oxaloacetate in the mitochondria (the activity is allosterically increased by acetyl CoA

72
Q

what is the relationship between renal blood flow (RBF) and renal plasma fllow (RPF)

A

RPF= RBF(1-hct)

73
Q

what is the filtration fraction in the kidney

A

GFR/RPF (PLASMA)

74
Q

explain the set up for a case control study

A

2 groups are obtained one with the disease of interest and one without THEN the exposure status is determined and frequencies are compaired

75
Q

if impaired abduction of the arm over head, winging of the scapula and shoulder droop are present which muscle and nerve is affected

A

the trapezius muscle due to CN XI injury likely in the posterior triangle of the neck

76
Q

what is damaged in hearing loss due to load noise exposure

A

damage to the stereociliated hair cells of the organ of Corti (always begins with high frequency loss)

77
Q

what maneuver can you test the supraspinatus muscle

A

“empty can” test - raise the arm 90 degrees then flex 30 degrees and point the thumbs at the floor. When downward force is applied pain and weakness indicated injury to the supraspinatus tendon

78
Q

during a prostactomy which nerves within the fascia are at risk of injury and what would be the consequence of injury

A

prostatic plexus lies within the fascia of the plexus and contains the cavernous nerves which provide parasympathetic input to the penis allowing for erection

79
Q

which artery is within the spermatic cord and where does it origionate from

A

the gonadal artery from the abdominal aorta

80
Q

what are the characteristics of tumor lysis syndrome

A

hyperphosphatemia, hypocalcemia, hyperkalemia, hyperuriciemia

81
Q

what 3 things can cause a S3

A
  1. forceful, rapid filling of a ventricle with normal or elevated complience
  2. normal filling rate when ventricular complience is low
  3. blood flowing into an overfilled ventricle with high end-systolic volume

associated with LV heart failure in older adults

82
Q

which renal tumor is associated with tuberous sclerosis? and what are some of the other classic findings

A

Renal angiomyolipoma

cortical tubers and subependymal hamartomas in the brain, cardiac rhabdomyomas, facial angiofibromas and ash leaf spots

83
Q

what does proximal tubular cell ballooning and vacuolar degeneration in the presence of acute tubular injury indicate

A

acute tubular necrosis (often from a toxic injury or hypotension)

UWORLD facts (7 decks)

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