Missed UWorld Questions Flashcards
Onset of aspiration pneumonia vs chemical pneumonitis
Onset of aspiration pneumonia is more delayed,
more delayed than….
How can you reduce recurrence of HSV?
Daily Valacyclovir, prevents recurrence of….
Most common point of entry for enteroccocus infection?
GU procedures, ex cystoscopy
Most common cause of what infection?
What nerve runs with the superior thyroid artery? What does it innervate?
Superior laryngeal nerve, innervates cricothyroid muscles
What artery does it run with?
Most common cause of death in diabetes?
MI, CAD
Most common cause of death in….
Pre-tibial myxedema is seen in….
Graves disease
Physical findings…
Histologic findings in Medullary Thyroid CA
Nest s of cells, stain with Congo red
Histologic findings in….
What part of bone is affected by hyper-PTH?
Compact bone, causes subperiosteal errosions
Findings in….
What part of bone is affected by osteoporosis?
Trabecular bone
Degraded in…..
What behavioral change has greatest reduction in MI risk?
Smoking
Greatest behavioral change to prevent……
What is the greatest risk for cervical cancer?
Immunosuppression
greatest risk for what cancer?
What drug can improve fertility in PCOS?
Estrogen Receptor Modulator: Clomiphene
Improves fertility in…..
What can improve fertility in Turner Syndrome?
Give Estrogen and Progesterone to grow decidua then do IVF (60%) success rate
Improves fertility in….
What hormone/molecule is required for normal fetal renal function?
Angiotensin II
Important for what part of fetal development?
What vitamins are not in breast milk?
D and K
Are they in breast milk?
How many kcal/gram in protein, carb, fat, and alcohol?
Protein and carb = 4kcal/gram
Fat = 9 kcal/gram
Alcohol = 7 kcal/gram?
Ulcers in mid or distal duodenum. More likely H Pylori or ZE?
Zollinger Ellison syndrome.
More likely to cause ulcers where?
Gallstone ileus is more likely to lodge where?
Terminal ileum, smallest caliber
What could lodge here?
Pneumobilia is suggestive of….
gallstone illeus
Physical exam finding?
Crohn patients have increased risk of gallstones. Why?
Reduced bile acid reabsorption.
Causes gallstones in…..
Gastrin has trophic effects on what cells?
Gastric Parietal cells
Trophic factor includes…..
Epiethelial cell type of true vocal cords
Increases infection by…..
Stratified squamous epithelium
HPV
What structure is this?
Where do herpes viruses get their envelope?
Host cell membrane
Source of envelope for what viruses?
Sorbitol is typically metabolised into……
Fructose
What is the purpose of Neisseria IgA protease?
Increases adherence which increases infection
What bacteria has IgA Protease?
Causes of Polyhydramnios?
Impaired swallowing: GI obstruction, anencephaly
These fetal defects cause…..
Grave’s disease treatment can cause……
Agranulocytosis
What is a Pyrrolidonyl Arylamidase Test?
Replaces bacitracin test for strep pyogenes
What cells does Parvovirus infect for replication?
Erythrocyte precursors
Site of replication for…..
Infertility in CF and Kartagners is caused by…..
CF = absent ductus deferens Kartageners = defective sperm motility
What treatment for pregnant mothers with risk of tetanus?
Vaccinate pregnant mother, don’t give ABs to newborn
Where does SMA cross over duodenum?
3rd portion of duodenum.
Which artery crosses here?
Findings with Meckel Diverticulum?
Painless bleeding, possible intussusception in <2yr old
Findings in…..
What tests show liver injury? Dysfunction?
Injury markers are AST, ALT, GGT, ALP
Dysfunction are PTT, Albumin, Bilirubin
What increases cholesterol solubility in bile?
Bile acids and phosphatidylcholine
Purpose in bile?
Causes of Zenker Diverticulum vs Achalasia
Zenker: Cricopharyngeal motor dysfunction
Achalasia: Myenteric nerve dysfunction
Cancer mutation sequence in Crohn, UC
Early P53, Late APC
Carcinoma sequence in…..
How do fibrates cause gallstones?
Reducing bile acid synthesis by inhibiting 7alpha-hydroxylase
How does Crohn disease increase risk of kidney stones?
Reduced fat absorption causes calcium to bind FAs in gut, calcium cannot bind oxalate in gut so more oxylate is absorbed.
What disease and what risk?
Type of inflammation in primary biliary cirrhosis vs biliary cholangitis?
Biliary Cirrhosis: Granulomatous
Biliary Cholangitis: Autoimmune inflammatory
Necrotising Enterocolitis findings and associations
Air in the bowel wall
Associated w/ prematurity and reduced immune function
Disease is……
Adenomyosis vs Endometrial Hyperplasia
Adenomyosis: painful, heavy irregular bleeding
Hyperplasia: painless, irregular bleeding
What causes dimpling of breast tissue in CA?
Invasion of suspensory ligament
Causes what physical finding in breast CA?
Causes of Down Syndrome?
95% nondisjunction, 2-3% translocation, <2% mosaicism
Causes of what disease?
What vitamin is needed for amino acid transamination or decarboxylation?
B6, Pyridoxime
Needed for what biochemical reactions?
GI bleeding leads to increased what in blood?
Increased ammonia from increased nitrogen absorption
Are syphilis gummas painful?
No
What viruses can undergo genetic shift?
BOAR segmented viruses
Bunya, Orthomyxo, Arena, Rio
All can undergo what?
What bacteria produces H2S?
Salmonella, turns TSI agar black
What causes this?
What makes up cutaneous nodules in NF-1?
Schwann cells, neural crest derived
Makes up cutaneous nodules in what disease?
What do you give to reduce vasospasm after hemorrhage?
CCBs, specifically Nimodipine
Given to after what event?
What causes Narcolepsy?
Low CSF Hypocretin-1
Seen in…..
What causes intraparenchymal hemorrhages in brain?
Hypertension, lenticulostriate vessels
Can lead to…..
What type of incontinence is associated with DM-1?
Neuropathy leads to overflow incontinence
What disease?
What is source of energy in first 12=18 hours of fasting?
Glycogenolysis
How long does it provide energy in fasting?
Recombination vs Phenotypic Mixing
crossing over between coinfected viruses
Swapping genome and capsules w/ co-infection
Reye syndrome liver histology/pathology
Microvesicular steatosis of liver
Seen in what disease?
How does Neisseria reach the meninges?
Blood not lymph
Where are VLC fatty acids oxidized?
Peroxisomes
Site of oxidation of which fatty acids?
Pathogenesis of Huntington disease, intracellular
Gain of function, histone deacetylation
Causes what disease?
Median nerve enters hand between what muscles?
Flexor digitorum profundus and flexor digitorum superficalis
What nerve passes between these muscles?
Does choriocarcinoma have chorionic villi?
NO
What cells can’t use ketones for energy?
Erythrocytes
When does vertical transmission of HepB typically occur?
During delivery
Mother with respiratory arrest after delivery, what does she have?
Amniotic fluid embolism
If patient can’t have metronidazole, what do you give for Garnerella?
Clindamycin
Given as second line treatment for what STD…..
How do you tell if respiratory compensation is appropriate?
Winters Formula: (1.5 HCO3) + 8 +/- 2
BH4 deficiency decreases synthesis of what hormones?
Serotonin (also causes PKU)
Essential Tremor, treatment and inheritance
Treat with Alcohol and beta blocker. Autosomal Dominant
What disease?
What are P bodies?
mRNA-ribosome complexes in cytoplasm
How do eosinophils kill parasites?
Antibody-mediated release of granules
How are osteocytes connected?
Gap junctions
What cytokine is important in giant cell arteritis?
IL-6
important in the pathogenesis of what disorder?
What is Neprilysin?
A metalloprotease that cleaves natriuretic peptides
How is copper removed from the body?
In bile
What artery causes femoral head necrosis?
Medial Circumflex
Transthyretin Amyloidosis
Can cause restrictive cardiomyopathy; form of senile anyloidosis
Ureters pass anteriorly to what arteries?
Internal Iliac Arteries
Pass posteriorly to…..
Causes of hereditary pulmonary hypertension?
BMPR2 mutation, increases smooth muscle proliferation.
Causes….
AV Shunt
Bypasses arterioles, causes increased preload and decreased afterload
Palpable, non-tender gallbladder with associated weightloss and obstructive jaundice
Suggests pancreatic adenocarcinoma at head of pancreas
Does Amiodarone or type IA anti-arrythmics have lower risk of torsades?
Amiodarone has lower risk of torsades
Increased serine phosphorylation reduces…..
Tryosine kinase activity
Is reduced by…….
Caudal Regression syndrome, complication of…..
Maternal Diabetes, sacral-lumbar agenesis
What is it?
Stimulation of what nerve can improves obstructive sleep apnea?
Hypoglossal nerve.
Stimulation can improve…..
What type of receptors are calcium-sensing receptors on Parathyroids?
G-protein coupled receptors, defective in familial hypocalciuric hypercalcemia
Histology of acute viral hepatitis
hepatocyte necrosis with cellular swelling
Characteristic of…..
Nitroprusside overdose
Increased cyanide, give sulfur donors and hydroxycobalamin
Treatment for…..
Centriacinar Emphysema causes and histology
Smoking
increased macrophages and PMN proteases
Charcot-Bouchard aneurysm
HTN-associated aneurysm in central gray matter structures
Normal alveolar-arterial gradient
5-15
Role of lactate in anaerobic glycolysis
Replenishes NAD+ to allow for more glycolysis
Glucagonoma physical exam findings
necrolytic migratory erythema; plaques with brown center on face, groin, extremities
Finding suggests…..
Post-abortion septic infections caused by…..
Staph Aureus
What structure is damaged in hemiballismus?
Subthalamic nucleus
What point in spirometry is pulmonary vascular resistance the lowest?
At functional reserve capacity, low point of tidal volume
Chorioretinitis is caused by what infection?
CMV, causes what eye finding in newborns?
Mast cell granules contain…..
Histamine and Tryptase
Contents of…..
2nd most common valve affected by rheumatic heart disease?
Aortic
What part of airway has highest resistance?
Medium bronchi
Scotoma
A small visual field defect secondary to retina or optic nerve damage
Alkaptonuria
Black urine, no tyrosine to fumarate conversion
Homogentisate deficiency
Idiopathic membranous nephropathy typically caused by…..
IgG4 to PLA2R
What cytokine is needed to differentiate TH into cytotoxic TH1s?
IL-12 and IFN-gamma
Needed for what cell differentiation?
H Flu capsule composition and function
Polyribosylribitol Phosphate, binds factor H and prevents phagocytosis
Treatment for Neuropathic Malignant Syndrome?
Danrolene
Opacified CXR with tracheal deviation to same side is caused by…..
Mainstem bronchus block
CXR findings?
What bacteria is indole positive?
E Coli
Indole test?
What signaling increases glycogenolysis in liver and muscle?
Liver = increase cAMP Muscle = increased calcium
Where do you cut for emergency airway?
Cut deep cervcial fascia and cricothyroid membrane
Between cricoid and thyroid cartilage
Hilar adenopathy, increased ACE, Hypercalcemia, Non-caseating granulomas
Sarcoidosis
Findings?
Middle meningeal artery is branch of…..
Maxillary artery
Effects of aging on lung volumes?
- TLC, Low expiratory reserve, low vital capacity, high functional residual capacity, high residual volume
Stomach erosion vs ulcer
Erosions stop in the mucosa and don’t breach muscularis
Ulcers pass muscularis into sub-mucosa
What nerve runs in piriform recess?
Internal superior laryngeal nerve, needed for cough reflex
Where does it run?
Where does Sciatic nerve run? What muscle runs with it?
Through sciatic foramen with piriformis
Effect of arteriovenous shunt
Decreased peripheral resistance (passes arterioles) and increases cardiac output (increased preload)
Meiosis I vs II nondisjunction
Meiosis I results in 2 different extra chromosomes from same parent
Meiosis II results in 2 same extra chromosomes from same parent
Contact Dermatitis is what hypersensitivity?
Type IV
Arsenic and Polyvinyl chloride cause…..
Liver Angiosarcoma
Caused by…..
Migratory Thrombophlebitis is suggestive of…..
Visceral cancer, typically gastric
Skin finding is……
Small cell lung cancer paraneoplastic syndromes (4)
ACTH, ADH, Lambert-Eaton, Anti-neuron ABs
Mean, Median, and Mode with Skews
Mean shifts the most, Mode shifts the least
What hypertrophies in renal artery stenosis?
JGA and Maculodensa (smooth muscle of afferent arteriole)
Hypertrophy with……
What stimulus is required for osteoclast differentiation and survival?
RANK expression and stimulation
What symptoms don’t recover in Wernicke-Korsacoff?
Memory and learning (Korsakoff portion)
Ataxia is slow to recovery but improves
What bug grows in highly alkaline media
Cholera
Symptoms of VIPoma
WDHA: watery diarreha, hypokalemia, achlorhydia
What murmur is not detected at birth?
VSD –> pulmonary resistance is still high
Symptoms of primary carnitine deficiency
myopathy, cardiomyopathy, hypoketoic hypoglycemia
Pathogenesis of ARDS
Endothelial damage by neutrophil toxins, protein fluid leakage into alveoli, hyaline membranes in alveoli
Direct Inguinal Hernia
Breaks through weak transversalis fascia through Hesselbach’s triangle, medial to inferior epigastrics
What does high arteriovenous concentration difference mean for anesthetics?
High partitioning into peripheral tissues
2 main opsonins for phagocytosis
IgG and C3b
What vertebrae have lateral horns?
T1-L2
Ehler Danlos vs Marfan
Collagen issue, no eye symptoms
Fibrillin glycoprotein issue, lens issues
Learning disorder
Poor performance in a major academic category, might see restlessness or anixety issues with that subject
What characteristics keep a drug in the plasma compartment? (4L of volume of distribution)
Large, High protein binding, Highly charged (hydrophilic)
3 Effects of high oxygen supplementation in chronic COPD patients
Increased physiologic deadspace (sudden vasodilation)
High pCO2 from rapid CO2 dissociation from hemoglobin (Haldane effect)
Reduced minute ventilation from reduced chemoreceptor stimulation.
What causes these effects?
Which structures should be targeted with deep brain stimulation in parkinson disease?
Constant stimulation of Globus Palidus or Subthalamic nucleus prevent firing
This can be used to treat…..
Morbidity and Mortality in Neisseria Meningititis infections are directly associated with serum concentrations of……
LOS (endotoxin like LPS but w/o repeating O antigen)
Levels are associated w/ mortality and morbidity in….
Multiple change disease is characterized by……
selective albuminuria. Increased selective filtration of albumin due to T-cell release of glomerular permeability factor that fuses podocytes together.
Two causes of hypoxemia with normal A-a gradient
Hypoventilation and High Altitude
Findings in Rett Syndrome
Normal development followed by loss of milestones and gain of hand-wringing movements, deceleration of head growth
more common in girls
What drug should be used in treatment-resistant schizophrenia?
Clozapine
Pathogenesis of neurotoxicity in hyper-ammonemia
Ammonia is taken up by astrocytes and converted to glutamine which causes an osmotic imbalance. This impairs normal glutamine release which is typically converted to glutamate for excitatory signaling
Normal degenerative arthritis of the spine leads to hypertrophy of what ligament? Symptoms improve with…..
Ligamentum flavum hypertrophy. Symptoms improve with bending forward (spinal flexion)
What nerve passes through obturator canal? What muscle function does it innervate?
Obturator nerve. What does it pass through?
It provides adductor muscle innervation
Intestinal Atresia is caused by what intrauterine process?
Vascular occlusion
Causes what deformation in utero?
What is the body’s natural attempt to correct heart failure? (3)
Low cardiac output causes: sympathetic stimulation, RAAS activation, and ADH secretion
All of these are a natural response to what condition?
Most common cause of death in tricyclic overdose?
Arrhythmia caused by sodium channel inactivation and QRS prolongation.
most common cause of death in overdose of what med?
Hyperacusis (increased sensitivity to everyday sounds) is caused by damage to what cranial nerve?
Facial nerve, stapedius branch
Paralysis of this muscle can cause?
Neutralizing antibodies to influenza recognize what epitope?
Hemagluttinin
This is the epitope recognized by neutralizing antibodies to what bug?
What role do sertoli cells play in sexual differentiation?
Secrete AMF to regress mullerian ducts
What is a Kussmal sign on physical exam?
Suggests constrictive pericarditis; right ventricle can’t take increased venous return on inspiration so JVD increases
What amino acid is required for nitric oxide synthesis in endothelial cells?
Arginine
Used to produce what in endothelial cells following ACh stimulation?
Zinc motif in a receptor, what does it do?
See Zinc, think Zinc finger and DNA binding. Probably an intracellular hormone receptor that moves to nucleus
What are the 2 history findings in anti-phospholipid syndrome?
Recurrent miscarriages and increased clotting (DVT, PE, ect)
These are signs of……..
What are the lab findings in anti-phospholipid?
VDRL positive, elevated PTT
Half life equation
thalf = (0.7 * Vd) / Cl
Left vs Right frontal lobe lesion symptoms
Left = apathy
Right = disinhibition
Lesions to which part of brain?
Intra-Scalene anesthetic administration can also paralyze what nerve?
Phrenic C3-C5
Can be accidentally paralyzed in what anesthetic administration?
Which test is most specific for diagnosing gallbladder obstruction?
Nucleotide scan is more specific than ultrasound
For determining obstruction in what condition?
Pseudopalasading necrosis is seen in what brain tumor?
Glioblastoma Multiforme
Major histologic finding?
What mutation can cause polycythemia vera?
Jak-Stat mutation
This can cause what disease?
What type of signal transducer is Jak-Stat?
Cytoplasmic Tyrosine Kinase
What signal transducer is this?
Aspiration pneumonia lobes upright and supine
Upright aspiration: basilar segments of lower right lobes
Supine: posterior segment of right upper or superior segment of right lower
What is a genetic risk factor for reactive arthritis?
HLA-B7
In addition to ank spond and psoriatic arthritis, what else does this put you at risk for?
Main lab results seen in primary hyperaldosteronism?
Na, K, Bicarb
Normal Na (aldosterone escape)
Hypo K
High Bicarb
What is the treatment for pyruvate dehydrogenase deficiency?
Ketogenic diet, Leucine and Lysine
Treatment for?
Patients with severe aortic stenosis are reliant on what to keep good systolic function?
Heavily reliant on atrial contraction for ventricle filling due to low ventricle compliance. A loss in atrial function (ex Afib) can causes severe hypotension and possible pulmonary edema
Wilson Disease: where does copper accumulate?
Copper accumulates in Liver (hepatotoxic), cornea, and basal ganglia (neurologic symptoms)
What disease?
What drug is given to severely immunocompromised patients (CD4 <50) for Mycobacterium prophylaxis?
Azithromycin
Used as prophylaxis for what disease in what patients?
What can lead to isolated loss of erythocyte precursors with normal myeloid precursors? (3)
Pure Red Cell Aplasia
Parvovirus B19
Autoantibodies (Lymphocytic leukemia)
Cytotoxic T Cells (thymoma)
These can cause…..
What is the single greatest risk factor for aortic dissection?
Hypertension
Pneumonic for shifts in hemoglobin oxygen curves
ACE BATs right handed Acid CO2 Exercise 2,3-BPG Temperature
Effect of acute mitral regurgitation on preload, afterload, and ejection fraction
Increased Preload, Decreased Afterload, and Increased ejection fraction. However, less blood is moving forward, causing hypotension
Landmark for lumbar puncture?
Iliac crests
Landmark for?
What does Romberg test assess?
Proprioception
Reduced blood pressure by 10mmHg only during inspiration is suggestive of?
Pulsus Paridoxus, suggestive of pericardial disease (ex cardiac tamponade)
Treatment for acute COPD exacerbation?
Beta Blocker
First line treatment of gout?
NSAIDs
Fibrates mechanism of action
Induce PPAR which reduces VLDL from liver and increases LPL in periphery
Hemosiderin-laden macrophages in alveoli are indicative of….
Heart Failure cells
Where do you see these? How do you visualize them?
What drug do you give for muscle spasms?
Baclofen
What artery changes are seen in claudication?
Atherosclerosis, lipid plaque
What is most common predisposing condition to Strep Viridans mitral valve endocarditis in developed countries?
Mitral valve prolapse in developed
Rheumatic heart disease in developing
These predispose to….
Histological development of AAA?
Transmural inflammation, inflammatory cells releasing metaloproteases and elastases. Weakens AAA wall and leads to aneurysm formation
What nerve innervates the lattisimus dorsi? What are its actions?
Thoracodorsal (C6-8)
Internal rotation, adduction, and extension of shoulder
What is the pathogenesis of fatty liver disease?
Reduced free fatty acid oxidation
This causes…..
Decompensated heart failure after viral infection, what does heart look like?
Dilated ventricles
Acutely occurs due to heart failure caused by….
What else does ADH reabsorb other than water?
Urea, helps to concentrate renal medulla
Absorption from urine is stimulated by….
Alpha Helix vs Beta Sheet is determined by what sort of bonds?
Hydrogen bonds
What part of ear does noise-induced hearing loss effect?
What about presbycusis?
Organ of Corti Damage, damage to stereociliated cells.
Loss of hair cells at cochlear base, high frequency sound
Damaged in what pathologies?
Pain in external hemorrhoids is sensed by what nerve?
Pudendal nerve
3 kinds of osteoblastic bone mets
2 kinds of mixed bone mets
Rest are lytic bone mets
3 blastic = prostate, small cell lung, Hodgkin Lymphoma
2 mixed = breast and GI
Rest are lytic tumors
What chemical is a competitive inhibitor of the sodium-iodine symporter in the thyroid gland?
Potassium Perchlorate and Pertechnitate
Competitive inhibitors of…..
What is CD55?
What does deficiency cause?
Decay Accelerating Factor (complement)
Causes paroxsymal nocturnal hemoglobinuria
What CD marking?
Dilated Cardiomyopathy = Systolic Dysfunction
(Ischemia and DCM)
Hypertrophic Cardiomyopathy = Diastolic Dysfunction
(HTN and HCM)
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Terminal Ileum damage in Crohn Disease can lead to what deficiency?
Loss of bile acid reabsorption = fat malabsorption = vitamin K deficiency = bleeding disorder
Can be caused by what disease?
What is coronary steal? What 3 drugs cause it?
Selective vasodilation of cardiac vessels worsens ischemia by disrupting the arterial pressure gradients created to deliver collateral blood supply to ischemic tissue.
Caused by adenosine, cilostosol, dipyridamole
3 most common brain tumors in kids
Pilocytic Astrocytoma (cerebellar or hemisphere, cystic and solid on imaging)
Medulloblastoma (cerebellar, solid only)
Ependymoma (4th ventricle)
Accumulation of uremic toxins in severe renal disease can lead to what changes in hemodynamics?
Prolonged bleeding (platelet dysfunction) with everything else normal (PT, PTT, Platelet Count)
Oxalate Crystals in renal tubules is suggestive of what cause of AKI?
Toxic from ethylene glycol. What would the kidney look like?
Physical symptoms of Alkaptonuria
Usually benign but what can it cause?
Black urine
Black-Blue spots on sclera
Darkening of auricular cartilage
Can cause severe myalgias from cartilage toxicity.
What disease?
Water Hammer pulse; head bobbing; bounding femoral and carotid pulses with left sternal murmur. Suggestive of?
Aortic Regurgitation.
What would you see on exam? Why?
Which muscle is needed to abduct the shoulder past 90 degrees and to stabilize the scapula? What innervates it? When is it typically injured?
Serratus anterior, innervated by long thoracic, injured during mastectomy with axillary lymph node removal.
Symptoms?
Cholestatic diseases can cause what serum and dermatologic findings?
Hyperlipidemia and Xanthomas
What form of GI diseases can cause these findings?
Findings in acute fulminant hepatitis (ex halothane toxicity)
Elevated Aminotransferases and Prolonged PT
NO change in serum albumin (half life is too long)
These symptoms are seen in….
Wheals are formed by edema to what part of skin? What about eczematous dermatitis?
What is the deepest form of edema called?
Wheals are due to edema in the superficial dermis
Eczematous dermatitis has edema in epidermis (spongiosis)
Deep dermal edema is termed angioedema
Signs of occlusion after an invasive vascular procedure (ex PCI) is suggestive of…….
What is most common presenting symptom?
Atheroembolism; cholesterol-containing clots breaking off and lodging in small vessels
Most commonly presents with acute kidney injury
When is this seen?
Which symptoms do you see in SIADH: pulmonary congestion, peripheral edema, high JVP….
None of these, SIADH is apparent euvolemia (high volume with natriuresis = euvolemic hyponatremia)
Silicosis creates an increased risk for what? Why?
Increased risk for TB. It impairs macrophage function.
What disease?
What is Anastrazole? (think Anastasia, Aromatase)
Chemotherpeutic in hormone positive breast cancer that prevents aromatase from making more estrogen
What is first line treatment for Nacrolepsy? Why?
What is second line treatment?
First line treatment is Modafinil, daytime psychostimulant
Second line are amphetamines
What disease?
Bone/Calcium markers in Multiple Myeloma (PTH, VitD, Urinary Ca, Serum Ca, PHrP)
Low PTH (calcium sensing)
Low vitamin D (renal damage, low 1-alpha-hydroxylase)
High urinary Ca (low PTH)
High serum Ca (bone resorption)
What disease?
C1 esterase inhibitor deficiency, symptoms
Angioedema from lots of kallikrein-bradykinin conversion
Will see low C4
What disease?
Carotid massage reflex: afferent and efferent are?
Afferent is Glossopharyngeal
Efferent is Vagus
What reflex is this?
Why is calcium elevated in Sarcoidosis?
Macrophages express 1-alpha-hydroxylase and cause PTH-independent increases in vitamin D
What disease? What finding?
Findings in Patau Syndrome
Micrcephaly, Cleft Lip/Palate, Omphalocele, Polydactyly, Renal Issues, Cutis Aplasia (Incomplete skull closure on top), Rocker bottom feet
Nicotine in Pregnancy
Placenta issues (previa and abrupta) and prematurity
Appendicitis Pain: Why does it change?
Lumen distention activates general visceral autonomic fibers (superior mesenteric plexus, T10). Further infection causes inflammation of the parietal paritoneum which is more localized.
What vascular syndrome is associated with polymyalgia rheumatica?
Giant cell arterities
What rheumotologic disease is this associated with?
Examples of true diverticula? of Pseudodiverticula?
True = Appendix, Meckel's Pseudo = Zenker
Aortic Aneurysm development vs Aortic Dissection
Aortic Aneurysm is caused by long term HTN weakening and possibly autoimmune proceses.
Dissection is due to HTN plus shear stress
How does the adrenal cortex impact Epinephrine synthesis?
Cortisol increases the activity of phenylethanolamine-N-methyltransferase which converts NE to Epi
What murmur is heard best when sitting up and leaning forward?
Aortic Regurgitation
When is this murmur heard best?
What lab findings are seen in SLE?
Anti-nuclear ABs, Anti-ds-DNA ABs, Anti-SNR ABs
Low complement levels (C3 and C4)
What disease has Anti-Jo ABs? What is an anti-Jo AB?
Polymyositis; AB to histidyl-tRNA synthetase
What is another name for this AB?
What causes of Cushing Syndrome produce elevated ACTH? Which can be suppressed with dexamethasone?
High ACTH Cushing syndrome is caused by pituitary adenomas and paraneoplastic ectopic ACTH (squamous lung CA)
Only pituitary adenomas can be suppressed; with high levels dexamethasone
Temporal lobe masses can cause what visual symptoms?
Contralateral upper quadrant loss of vision (myers loop runs in temporal lobe but dorsal optic radiation does not)
Lesions in myers loop causes……
