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MS > MS UWorld 3 > Flashcards

MS UWorld 3 Flashcards

0
Q

Effects of PTH on calcium and phosphate

A

Increases serum calcium by activating osteoclasts (via blasts, RANK) and increasing kidney absorption

Increases URINE phosphate by decreasing kidney absorption

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1
Q

Achondroplasia: mutation and inheritance

A

Autosomal dominant activating mutation of FGF-R3

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2
Q

Drug-induced lupus: what causes it, and how are these things metabolized

A

Drugs are acetylated in liver

Examples include hydralazine, procainamide, isoniazide

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3
Q

Artery at risk in femoral neck fracture

A

Medial circumflex

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4
Q

Drugs that can lower risk of breast cancer and bone fractures

A

Selective estrogen receptor modulators (SERMs) are agonists at bone (limit osteoporosis) and antagonists at mammary tissue

Clomiphene, tamoxifen, raloxifene

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5
Q

Tibeal nerve injury presentation

A

Inability to curl toes, loss of sensation on plantar foot. Foot is everted and dorsiflexed (can’t invert or plantarflex)

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6
Q

Bone density in black and white women

A

Higher in black women

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7
Q

Risk factors for osteoporosis

A

Smoking, menopause, corticosteroids, inactivity, white, low body weight, EtOH

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8
Q

In allergy, what cytokine is responsible for antibody class shift?

A

IL-4, secreted by Th2 cells after initial exposure, cause isotype switching to IgE

IL-5 stimulates IgA production

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9
Q

Alkaptonuria

A

Benign childhood deficiency of homogenistic acid oxidase, important in phenylalanine and tyrosine metabolism. Accumulation of homogenistic acid causes pigmentation prolems, and deposits also cause arthritis later in adulthood.

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10
Q

Trabecular thinning with fewer interconnections

A

osteoporosis

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11
Q

Osteoid matrix accumulation around trebeculae

A

Vitamin C deficiency

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12
Q

Subperiostial resorption with cystic degeneration

A

Hyperparathyroidism

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13
Q

Lamellar bone structure resembling a mosaic

A

Paget’s disease of bone

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14
Q

Avascular necrosis associated with

A

Sickle cell disease, SLE, steroids, EtOH

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15
Q

Osteomyelitis in sickle cell

A

salmonella

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16
Q

Bacillus anthracis capsule, appearance on culture

A

Contains D-Glutamate instead of polysaccharide

Forms non-hemolyzing adherent colonies, described as serpentine or medusa head.

Associate this with working with animals (especially goats), not in the USA.

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17
Q

Bisphosphonates

A

structural analogues of pyrophosphate, end in -dronate (alendronate, risedronate, ibandronate)

Make hydroxyapatite more insoluble and interfere with osteoclasts to decrease bone resorption

Used to treat Pagets, osteoporosis, malignancy-induced hypercalcemia.

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18
Q

Acute dystonia due to antipsychotic use

A

due to blockage of D2 receptors

sudden onset pain and stiffness

An extrapyramidal symptom, Happens abruptly between 4 hours and 4 days

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19
Q

Adverse effects of succinylcholine

A

Malignant hyperthermia in genetically susceptible patients or with halothane

Sever hyperkalemia in pts with burns, myopathies, crush injuries, denervation

Bradycardia from parasympathetic stimulation or tachycardia from symathetic ganglionic effects

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20
Q

How does succinylcholine work

A

Depolarizing neuromuscular blocking agent. Binds to nicotinic ACh receptor but is not degraded by AChE –> continuous stimulation and inactivation of end plate.

Phase I = flaccid paralysis, phase II = desensitization non-depolarizing blockade

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21
Q

Most common rotator cuff injury

A

Supraspinatus tendon, which is an abductor

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22
Q

Pseudogout crystals

A

Calcium pyrophosphate, rhomboid crystals with weakly positive birefringence

Note: knee is more often in pseudogout, Metatarsophalangeal more common in gout

23
Q

Pityriasis versicolor (tinea versicolor)

A

Benign skin condition of hyper or hypo pigmented skin patches or papules. Caused by malassezia furfur. Common in areas with hot or humid climates

24
Q

Serum sicknes

A

Type III HSR, produces fever, urticaria, arthralgias, glomerulonephritis, lymhadenopathy 5-10 days after exposure to antigen. Circulating immune complexes can develop and deposit, activate neutrophil infiltration, fibrinoid necrosis, and complement activation (low serum complement).

common rxn to sulfa drugs

25
Q

Blue sclera and history of multiple fractures suggest

A

osteogenesis imperfecta - deficiency/abnormality in type I collagen –> impaired bone matrix formation

26
Q

Osteoblast activity reflected by what lab value?

A

Alk phos

27
Q

Which part of vitamin D metabolism uses sunlight?

A

First reaction: 7-dehydrocholesterol (provitamin D3) to cholecalciferol

28
Q

Ulnar nerve injury

A

From a fracture or medial epicondyle of humerous or fracture hook of hamate

Loss of sensation of 5th and middle of 4th fingers, palmar and dorsal hand. Flattened hypothenar eminance. Ulnar claw on digit extension.

29
Q

Antibodies in RA

A

anti-cyclic citrullinated peptide (anti-CCP)

30
Q

Skeletal muscle contraction: Calcium binds to:

A

Troponin C on thin filaments, which shifts tropomyosin to expose myosin binding sites on actin filament

31
Q

Rash and muscle weakness

A

dermatomyositis

32
Q

What does the rash in dermatomyositis look like?

A

Grotton papules: red flat-topped papules with a light scale that appear over bony prominences such as MCP, PIP, DIP

Heliotrope rash: erythematous or violaceous eruption on upper eyelids and periorbital skin

33
Q

Winged scapula shoulder injury: cannot abduct arm past horizontal, when pt presses anteriorly on wall the scapula isn’t anchored to thoracic cage

A

Injury of serratus anterior, due to lesion of the long thoracic nerve. Occurs in axillary node dissection after mastectomy

34
Q

What drug promotes osteoporosis?

A

Chronic corticosteroids, like prednisone.

35
Q

Side effects of prednisone

A

Cushing like symptoms (weight gain, central obesity, muscle breakdown), cataracts, acne, osteoporosis, htn, peptic ulcers, hyperglycemia, psychosis

36
Q

Septic arthritis findings and treatment

A

High synovial WBCs, no crystals. With no other info, assume it is gonococcus and treat with ceftriaxone

37
Q

Marfan’s is a defect in

A

fibrillin, which is a component of microfibrils that form sheath around elastin fibers

38
Q

Bacteria associated with wool

A

bacillus anthracis

39
Q

What toxins are associated with b. anthracis?

A

The anthrax exotoxin has several components

  • Edema factor acts as adenylate cyclase, causing edema and phagocyte dysfunction
  • Lethal factor is a protease, inhibits MAPK signaling, causes apoptosis and multisystem physiologic disruption
40
Q

Homeless alcoholic M with recurrent nosebleeds, swollen gums, ecchymoses, hyperkeratosis, poor healing

A

Malnutrition –> scurvy, vitamin C deficiency

41
Q

Symptoms of vitamin C deficiency

A

Collagen synthesis defect. VC is necessary for hydroxylation of proline and lysine in collagen synthesis. Capillary walls are fragile, prone to bruising and bleeding. Swollen gums, poor wound healing, “corkscrew” hair. Bony deformities, subperiosteal hemorrhages. Weakened immune response.

42
Q

Radial head subluxation

A

Most common elbow injury in kids. Happens from sudden traction on outstretched and pronated arm. Torn annular ligament, which is what hold the radius to the ulna. Child is not in pain if not moving. Holds arm close to body, pronated and extended.

43
Q

Fall on outstretched hand, persistent wrist pain and snuff box tenderness: dx and complication

A

Scaphoid fracture. The dorsal carpal branch of the radial artery goes over the scaphoid, and fracture can cause avascular necrosis.

44
Q

Pain and numbness in dorsum of foot, cannot dorsiflex ankle. What nerve is injured and how did it happen?

A

Injury to the common peroneal nerve. Trauma or compression of lateral leg, or fibular neck fracture.

45
Q

Fever, flank pain, difficulty walking, inguinal mass. Pain when hip is extended.

A

Potentially a psoas abscess. Risk factors are DM, IVDU, HIV, immunosuppression.

46
Q

Nerve that passes through Obturator foramen

A

Obturator nerve. Supplies medial compartment of thigh. Injured during pelvic surgery and causes decreased adduction

47
Q

Nerve associated with foot drop

A

Common peroneal

48
Q

Most commonly dislocated joint in the body

A

Glenohumeral joint, aka shoulder. Most common is anterior dislocation, from forceful external rotation and abduction of arm at shoulder. Injures axillary nerve. Deltoid is flattened, protrusion of acromium, loss of sensation over deltoid and lateral arm, loss of arm abduction, sense of axillary fullness.

49
Q

Dactylitis (sickle cell hand foot disease)

A

Painful swelling of hands and feet. Common presentation of sickle cell in young kids, due to decreased haptoglobin (which has bound to free hemoglobin from hemolysis)

50
Q

Winged scapula: nerve, muscle, cause

A

Long thoracic, serratus anterior, axillary node dissection (mastectomy) or stab wound

51
Q

Prepatellar bursitis

A

Due to prolonged kneeling. Common in roofers, carpenters, plumbers. Knee pain, erythema, swelling, inability to kneel

52
Q

Most common rotator cuff injury

A

Supraspinatus muscle (suprascapular nerve)

53
Q

Test for supraspinatus pathology

A

“Empty can test”, Abduct arms to 90 degrees, then flex 30 degrees with thumbs pointing to floor. Doctor pushes down on arms

54
Q

Bones of hand likely to be injured on fall on outstretched hand

A

Lunar and schapoid

55
Q

Injury grabbing a tree branch on a fall, or infant getting upward force on arm in delivery

A

Klumpke palsy, tear of lower trunk (C8-T1). Causes claw hand

MS (3 decks)

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