Missed UWorld Questions Flashcards
1
Q
Onset of aspiration pneumonia vs chemical pneumonitis
A
Onset of aspiration pneumonia is more delayed,
more delayed than….
2
Q
How can you reduce recurrence of HSV?
A
Daily Valacyclovir, prevents recurrence of….
3
Q
Most common point of entry for enteroccocus infection?
A
GU procedures, ex cystoscopy
Most common cause of what infection?
4
Q
What nerve runs with the superior thyroid artery? What does it innervate?
A
Superior laryngeal nerve, innervates cricothyroid muscles
What artery does it run with?
5
Q
Most common cause of death in diabetes?
A
MI, CAD
Most common cause of death in….
6
Q
Pre-tibial myxedema is seen in….
A
Graves disease
Physical findings…
7
Q
Histologic findings in Medullary Thyroid CA
A
Nest s of cells, stain with Congo red
Histologic findings in….
8
Q
What part of bone is affected by hyper-PTH?
A
Compact bone, causes subperiosteal errosions
Findings in….
9
Q
What part of bone is affected by osteoporosis?
A
Trabecular bone
Degraded in…..
10
Q
What behavioral change has greatest reduction in MI risk?
A
Smoking
Greatest behavioral change to prevent……
11
Q
What is the greatest risk for cervical cancer?
A
Immunosuppression
greatest risk for what cancer?
12
Q
What drug can improve fertility in PCOS?
A
Estrogen Receptor Modulator: Clomiphene
Improves fertility in…..
13
Q
What can improve fertility in Turner Syndrome?
A
Give Estrogen and Progesterone to grow decidua then do IVF (60%) success rate
Improves fertility in….
14
Q
What hormone/molecule is required for normal fetal renal function?
A
Angiotensin II
Important for what part of fetal development?
15
Q
What vitamins are not in breast milk?
A
D and K
Are they in breast milk?
16
Q
How many kcal/gram in protein, carb, fat, and alcohol?
A
Protein and carb = 4kcal/gram
Fat = 9 kcal/gram
Alcohol = 7 kcal/gram?
17
Q
Ulcers in mid or distal duodenum. More likely H Pylori or ZE?
A
Zollinger Ellison syndrome.
More likely to cause ulcers where?
18
Q
Gallstone ileus is more likely to lodge where?
A
Terminal ileum, smallest caliber
What could lodge here?
19
Q
Pneumobilia is suggestive of….
A
gallstone illeus
Physical exam finding?
20
Q
Crohn patients have increased risk of gallstones. Why?
A
Reduced bile acid reabsorption.
Causes gallstones in…..
21
Q
Gastrin has trophic effects on what cells?
A
Gastric Parietal cells
Trophic factor includes…..
22
Q
Epiethelial cell type of true vocal cords
Increases infection by…..
A
Stratified squamous epithelium
HPV
What structure is this?
23
Q
Where do herpes viruses get their envelope?
A
Host cell membrane
Source of envelope for what viruses?
24
Q
Sorbitol is typically metabolised into……
A
Fructose
25
What is the purpose of Neisseria IgA protease?
Increases adherence which increases infection
| What bacteria has IgA Protease?
26
Causes of Polyhydramnios?
Impaired swallowing: GI obstruction, anencephaly
| These fetal defects cause.....
27
Grave's disease treatment can cause......
Agranulocytosis
28
What is a Pyrrolidonyl Arylamidase Test?
Replaces bacitracin test for strep pyogenes
29
What cells does Parvovirus infect for replication?
Erythrocyte precursors
| Site of replication for.....
30
Infertility in CF and Kartagners is caused by.....
```
CF = absent ductus deferens
Kartageners = defective sperm motility
```
31
What treatment for pregnant mothers with risk of tetanus?
Vaccinate pregnant mother, don't give ABs to newborn
32
Where does SMA cross over duodenum?
3rd portion of duodenum.
| Which artery crosses here?
33
Findings with Meckel Diverticulum?
Painless bleeding, possible intussusception in <2yr old
| Findings in.....
34
What tests show liver injury? Dysfunction?
Injury markers are AST, ALT, GGT, ALP
| Dysfunction are PTT, Albumin, Bilirubin
35
What increases cholesterol solubility in bile?
Bile acids and phosphatidylcholine
| Purpose in bile?
36
Causes of Zenker Diverticulum vs Achalasia
Zenker: Cricopharyngeal motor dysfunction
Achalasia: Myenteric nerve dysfunction
37
Cancer mutation sequence in Crohn, UC
Early P53, Late APC
| Carcinoma sequence in.....
38
How do fibrates cause gallstones?
Reducing bile acid synthesis by inhibiting 7alpha-hydroxylase
39
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?
40
Type of inflammation in primary biliary cirrhosis vs biliary cholangitis?
Biliary Cirrhosis: Granulomatous
| Biliary Cholangitis: Autoimmune inflammatory
41
Necrotising Enterocolitis findings and associations
Air in the bowel wall
Associated w/ prematurity and reduced immune function
Disease is......
42
Adenomyosis vs Endometrial Hyperplasia
Adenomyosis: painful, heavy irregular bleeding
Hyperplasia: painless, irregular bleeding
43
What causes dimpling of breast tissue in CA?
Invasion of suspensory ligament
| Causes what physical finding in breast CA?
44
Causes of Down Syndrome?
95% nondisjunction, 2-3% translocation, <2% mosaicism
| Causes of what disease?
45
What vitamin is needed for amino acid transamination or decarboxylation?
B6, Pyridoxime
| Needed for what biochemical reactions?
46
GI bleeding leads to increased what in blood?
Increased ammonia from increased nitrogen absorption
47
Are syphilis gummas painful?
No
48
What viruses can undergo genetic shift?
BOAR segmented viruses
Bunya, Orthomyxo, Arena, Rio
All can undergo what?
49
What bacteria produces H2S?
Salmonella, turns TSI agar black
| What causes this?
50
What makes up cutaneous nodules in NF-1?
Schwann cells, neural crest derived
| Makes up cutaneous nodules in what disease?
51
What do you give to reduce vasospasm after hemorrhage?
CCBs, specifically Nimodipine
| Given to after what event?
52
What causes Narcolepsy?
Low CSF Hypocretin-1
| Seen in.....
53
What causes intraparenchymal hemorrhages in brain?
Hypertension, lenticulostriate vessels
| Can lead to.....
54
What type of incontinence is associated with DM-1?
Neuropathy leads to overflow incontinence
| What disease?
55
What is source of energy in first 12=18 hours of fasting?
Glycogenolysis
| How long does it provide energy in fasting?
56
Recombination vs Phenotypic Mixing
crossing over between coinfected viruses
Swapping genome and capsules w/ co-infection
57
Reye syndrome liver histology/pathology
Microvesicular steatosis of liver
| Seen in what disease?
58
How does Neisseria reach the meninges?
Blood not lymph
59
Where are VLC fatty acids oxidized?
Peroxisomes
| Site of oxidation of which fatty acids?
60
Pathogenesis of Huntington disease, intracellular
Gain of function, histone deacetylation
| Causes what disease?
61
Median nerve enters hand between what muscles?
Flexor digitorum profundus and flexor digitorum superficalis
| What nerve passes between these muscles?
62
Does choriocarcinoma have chorionic villi?
NO
63
What cells can't use ketones for energy?
Erythrocytes
64
When does vertical transmission of HepB typically occur?
During delivery
65
Mother with respiratory arrest after delivery, what does she have?
Amniotic fluid embolism
66
If patient can't have metronidazole, what do you give for Garnerella?
Clindamycin
| Given as second line treatment for what STD.....
67
How do you tell if respiratory compensation is appropriate?
Winters Formula: (1.5 HCO3) + 8 +/- 2
68
BH4 deficiency decreases synthesis of what hormones?
Serotonin (also causes PKU)
69
Essential Tremor, treatment and inheritance
Treat with Alcohol and beta blocker. Autosomal Dominant
| What disease?
70
What are P bodies?
mRNA-ribosome complexes in cytoplasm
71
How do eosinophils kill parasites?
Antibody-mediated release of granules
72
How are osteocytes connected?
Gap junctions
73
What cytokine is important in giant cell arteritis?
IL-6
| important in the pathogenesis of what disorder?
74
What is Neprilysin?
A metalloprotease that cleaves natriuretic peptides
75
How is copper removed from the body?
In bile
76
What artery causes femoral head necrosis?
Medial Circumflex
77
Transthyretin Amyloidosis
Can cause restrictive cardiomyopathy; form of senile anyloidosis
78
Ureters pass anteriorly to what arteries?
Internal Iliac Arteries
| Pass posteriorly to.....
79
Causes of hereditary pulmonary hypertension?
BMPR2 mutation, increases smooth muscle proliferation.
| Causes....
80
AV Shunt
Bypasses arterioles, causes increased preload and decreased afterload
81
Palpable, non-tender gallbladder with associated weightloss and obstructive jaundice
Suggests pancreatic adenocarcinoma at head of pancreas
82
Does Amiodarone or type IA anti-arrythmics have lower risk of torsades?
Amiodarone has lower risk of torsades
83
Increased serine phosphorylation reduces.....
Tryosine kinase activity
| Is reduced by.......
84
Caudal Regression syndrome, complication of.....
Maternal Diabetes, sacral-lumbar agenesis
| What is it?
85
Stimulation of what nerve can improves obstructive sleep apnea?
Hypoglossal nerve.
| Stimulation can improve.....
86
What type of receptors are calcium-sensing receptors on Parathyroids?
G-protein coupled receptors, defective in familial hypocalciuric hypercalcemia
87
Histology of acute viral hepatitis
hepatocyte necrosis with cellular swelling
| Characteristic of.....
88
Nitroprusside overdose
Increased cyanide, give sulfur donors and hydroxycobalamin
| Treatment for.....
89
Centriacinar Emphysema causes and histology
Smoking
| increased macrophages and PMN proteases
90
Charcot-Bouchard aneurysm
HTN-associated aneurysm in central gray matter structures
91
Normal alveolar-arterial gradient
5-15
92
Role of lactate in anaerobic glycolysis
Replenishes NAD+ to allow for more glycolysis
93
Glucagonoma physical exam findings
necrolytic migratory erythema; plaques with brown center on face, groin, extremities
Finding suggests.....
94
Post-abortion septic infections caused by.....
Staph Aureus
95
What structure is damaged in hemiballismus?
Subthalamic nucleus
96
What point in spirometry is pulmonary vascular resistance the lowest?
At functional reserve capacity, low point of tidal volume
97
Chorioretinitis is caused by what infection?
CMV, causes what eye finding in newborns?
98
Mast cell granules contain.....
Histamine and Tryptase
| Contents of.....
99
2nd most common valve affected by rheumatic heart disease?
Aortic
100
What part of airway has highest resistance?
Medium bronchi
101
Scotoma
A small visual field defect secondary to retina or optic nerve damage
102
Alkaptonuria
Black urine, no tyrosine to fumarate conversion
| Homogentisate deficiency
103
Idiopathic membranous nephropathy typically caused by.....
IgG4 to PLA2R
104
What cytokine is needed to differentiate TH into cytotoxic TH1s?
IL-12 and IFN-gamma
| Needed for what cell differentiation?
105
H Flu capsule composition and function
Polyribosylribitol Phosphate, binds factor H and prevents phagocytosis
106
Treatment for Neuropathic Malignant Syndrome?
Danrolene
107
Opacified CXR with tracheal deviation to same side is caused by.....
Mainstem bronchus block
| CXR findings?
108
What bacteria is indole positive?
E Coli
| Indole test?
109
What signaling increases glycogenolysis in liver and muscle?
```
Liver = increase cAMP
Muscle = increased calcium
```
110
Where do you cut for emergency airway?
Cut deep cervcial fascia and cricothyroid membrane
| Between cricoid and thyroid cartilage
111
Hilar adenopathy, increased ACE, Hypercalcemia, Non-caseating granulomas
Sarcoidosis
| Findings?
112
Middle meningeal artery is branch of.....
Maxillary artery
113
Effects of aging on lung volumes?
- TLC, Low expiratory reserve, low vital capacity, high functional residual capacity, high residual volume
114
Stomach erosion vs ulcer
Erosions stop in the mucosa and don't breach muscularis
| Ulcers pass muscularis into sub-mucosa
115
What nerve runs in piriform recess?
Internal superior laryngeal nerve, needed for cough reflex
| Where does it run?
116
Where does Sciatic nerve run? What muscle runs with it?
Through sciatic foramen with piriformis
117
Effect of arteriovenous shunt
Decreased peripheral resistance (passes arterioles) and increases cardiac output (increased preload)
118
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
119
Contact Dermatitis is what hypersensitivity?
Type IV
120
Arsenic and Polyvinyl chloride cause.....
Liver Angiosarcoma
| Caused by.....
121
Migratory Thrombophlebitis is suggestive of.....
Visceral cancer, typically gastric
| Skin finding is......
122
Small cell lung cancer paraneoplastic syndromes (4)
ACTH, ADH, Lambert-Eaton, Anti-neuron ABs
123
Mean, Median, and Mode with Skews
Mean shifts the most, Mode shifts the least
124
What hypertrophies in renal artery stenosis?
JGA and Maculodensa (smooth muscle of afferent arteriole)
| Hypertrophy with......
125
What stimulus is required for osteoclast differentiation and survival?
RANK expression and stimulation
126
What symptoms don't recover in Wernicke-Korsacoff?
Memory and learning (Korsakoff portion)
| Ataxia is slow to recovery but improves
127
What bug grows in highly alkaline media
Cholera
128
Symptoms of VIPoma
WDHA: watery diarreha, hypokalemia, achlorhydia
129
What murmur is not detected at birth?
VSD --> pulmonary resistance is still high
130
Symptoms of primary carnitine deficiency
myopathy, cardiomyopathy, hypoketoic hypoglycemia
131
Pathogenesis of ARDS
Endothelial damage by neutrophil toxins, protein fluid leakage into alveoli, hyaline membranes in alveoli
132
Direct Inguinal Hernia
Breaks through weak transversalis fascia through Hesselbach's triangle, medial to inferior epigastrics
133
What does high arteriovenous concentration difference mean for anesthetics?
High partitioning into peripheral tissues
134
2 main opsonins for phagocytosis
IgG and C3b
135
What vertebrae have lateral horns?
T1-L2
136
Ehler Danlos vs Marfan
Collagen issue, no eye symptoms
Fibrillin glycoprotein issue, lens issues
137
Learning disorder
Poor performance in a major academic category, might see restlessness or anixety issues with that subject
138
What characteristics keep a drug in the plasma compartment? (4L of volume of distribution)
Large, High protein binding, Highly charged (hydrophilic)
139
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?
140
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.....
141
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....
142
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.
143
Two causes of hypoxemia with normal A-a gradient
Hypoventilation and High Altitude
144
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
145
What drug should be used in treatment-resistant schizophrenia?
Clozapine
146
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
147
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)
148
What nerve passes through obturator canal? What muscle function does it innervate?
Obturator nerve. What does it pass through?
| It provides adductor muscle innervation
149
Intestinal Atresia is caused by what intrauterine process?
Vascular occlusion
| Causes what deformation in utero?
150
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?
151
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?
152
Hyperacusis (increased sensitivity to everyday sounds) is caused by damage to what cranial nerve?
Facial nerve, stapedius branch
| Paralysis of this muscle can cause?
153
Neutralizing antibodies to influenza recognize what epitope?
Hemagluttinin
| This is the epitope recognized by neutralizing antibodies to what bug?
154
What role do sertoli cells play in sexual differentiation?
Secrete AMF to regress mullerian ducts
155
What is a Kussmal sign on physical exam?
Suggests constrictive pericarditis; right ventricle can't take increased venous return on inspiration so JVD increases
156
What amino acid is required for nitric oxide synthesis in endothelial cells?
Arginine
| Used to produce what in endothelial cells following ACh stimulation?
157
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
158
What are the 2 history findings in anti-phospholipid syndrome?
Recurrent miscarriages and increased clotting (DVT, PE, ect)
| These are signs of........
159
What are the lab findings in anti-phospholipid?
VDRL positive, elevated PTT
160
Half life equation
thalf = (0.7 * Vd) / Cl
161
Left vs Right frontal lobe lesion symptoms
Left = apathy
Right = disinhibition
Lesions to which part of brain?
162
Intra-Scalene anesthetic administration can also paralyze what nerve?
Phrenic C3-C5
| Can be accidentally paralyzed in what anesthetic administration?
163
Which test is most specific for diagnosing gallbladder obstruction?
Nucleotide scan is more specific than ultrasound
| For determining obstruction in what condition?
164
Pseudopalasading necrosis is seen in what brain tumor?
Glioblastoma Multiforme
| Major histologic finding?
165
What mutation can cause polycythemia vera?
Jak-Stat mutation
| This can cause what disease?
166
What type of signal transducer is Jak-Stat?
Cytoplasmic Tyrosine Kinase
| What signal transducer is this?
167
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
168
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?
169
Main lab results seen in primary hyperaldosteronism?
| Na, K, Bicarb
Normal Na (aldosterone escape)
Hypo K
High Bicarb
170
What is the treatment for pyruvate dehydrogenase deficiency?
Ketogenic diet, Leucine and Lysine
| Treatment for?
171
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
172
Wilson Disease: where does copper accumulate?
Copper accumulates in Liver (hepatotoxic), cornea, and basal ganglia (neurologic symptoms)
What disease?
173
What drug is given to severely immunocompromised patients (CD4 <50) for Mycobacterium prophylaxis?
Azithromycin
| Used as prophylaxis for what disease in what patients?
174
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.....
175
What is the single greatest risk factor for aortic dissection?
Hypertension
176
Pneumonic for shifts in hemoglobin oxygen curves
```
ACE BATs right handed
Acid
CO2
Exercise
2,3-BPG
Temperature
```
177
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
178
Landmark for lumbar puncture?
Iliac crests
| Landmark for?
179
What does Romberg test assess?
Proprioception
180
Reduced blood pressure by 10mmHg only during inspiration is suggestive of?
Pulsus Paridoxus, suggestive of pericardial disease (ex cardiac tamponade)
181
Treatment for acute COPD exacerbation?
Beta Blocker
182
First line treatment of gout?
NSAIDs
183
Fibrates mechanism of action
Induce PPAR which reduces VLDL from liver and increases LPL in periphery
184
Hemosiderin-laden macrophages in alveoli are indicative of....
Heart Failure cells
| Where do you see these? How do you visualize them?
185
What drug do you give for muscle spasms?
Baclofen
186
What artery changes are seen in claudication?
Atherosclerosis, lipid plaque
187
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....
188
Histological development of AAA?
Transmural inflammation, inflammatory cells releasing metaloproteases and elastases. Weakens AAA wall and leads to aneurysm formation
189
What nerve innervates the lattisimus dorsi? What are its actions?
Thoracodorsal (C6-8)
| Internal rotation, adduction, and extension of shoulder
190
What is the pathogenesis of fatty liver disease?
Reduced free fatty acid oxidation
| This causes.....
191
Decompensated heart failure after viral infection, what does heart look like?
Dilated ventricles
| Acutely occurs due to heart failure caused by....
192
What else does ADH reabsorb other than water?
Urea, helps to concentrate renal medulla
| Absorption from urine is stimulated by....
193
Alpha Helix vs Beta Sheet is determined by what sort of bonds?
Hydrogen bonds
194
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?
195
Pain in external hemorrhoids is sensed by what nerve?
Pudendal nerve
196
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
197
What chemical is a competitive inhibitor of the sodium-iodine symporter in the thyroid gland?
Potassium Perchlorate and Pertechnitate
| Competitive inhibitors of.....
198
What is CD55?
| What does deficiency cause?
Decay Accelerating Factor (complement)
Causes paroxsymal nocturnal hemoglobinuria
What CD marking?
199
Dilated Cardiomyopathy = Systolic Dysfunction
(Ischemia and DCM)
Hypertrophic Cardiomyopathy = Diastolic Dysfunction
(HTN and HCM)
Copyright (c) UWorld, Please do not save, print, cut, copy or paste anything while a test is active.
200
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?
201
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
202
3 most common brain tumors in kids
Pilocytic Astrocytoma (cerebellar or hemisphere, cystic and solid on imaging)
Medulloblastoma (cerebellar, solid only)
Ependymoma (4th ventricle)
203
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)
204
Oxalate Crystals in renal tubules is suggestive of what cause of AKI?
Toxic from ethylene glycol. What would the kidney look like?
205
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?
206
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?
207
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?
208
Cholestatic diseases can cause what serum and dermatologic findings?
Hyperlipidemia and Xanthomas
| What form of GI diseases can cause these findings?
209
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....
210
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
211
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?
212
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)
213
Silicosis creates an increased risk for what? Why?
Increased risk for TB. It impairs macrophage function.
| What disease?
214
What is Anastrazole? (think Anastasia, Aromatase)
Chemotherpeutic in hormone positive breast cancer that prevents aromatase from making more estrogen
215
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?
216
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?
217
C1 esterase inhibitor deficiency, symptoms
Angioedema from lots of kallikrein-bradykinin conversion
Will see low C4
What disease?
218
Carotid massage reflex: afferent and efferent are?
Afferent is Glossopharyngeal
Efferent is Vagus
What reflex is this?
219
Why is calcium elevated in Sarcoidosis?
Macrophages express 1-alpha-hydroxylase and cause PTH-independent increases in vitamin D
What disease? What finding?
220
Findings in Patau Syndrome
Micrcephaly, Cleft Lip/Palate, Omphalocele, Polydactyly, Renal Issues, Cutis Aplasia (Incomplete skull closure on top), Rocker bottom feet
221
Nicotine in Pregnancy
Placenta issues (previa and abrupta) and prematurity
222
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.
223
What vascular syndrome is associated with polymyalgia rheumatica?
Giant cell arterities
| What rheumotologic disease is this associated with?
224
Examples of true diverticula? of Pseudodiverticula?
```
True = Appendix, Meckel's
Pseudo = Zenker
```
225
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
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How does the adrenal cortex impact Epinephrine synthesis?
Cortisol increases the activity of phenylethanolamine-N-methyltransferase which converts NE to Epi
227
What murmur is heard best when sitting up and leaning forward?
Aortic Regurgitation
| When is this murmur heard best?
228
What lab findings are seen in SLE?
Anti-nuclear ABs, Anti-ds-DNA ABs, Anti-SNR ABs
| Low complement levels (C3 and C4)
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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?
230
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
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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......
