Random Missed Uworld - Week 1 Flashcards
What artery mainly supplies the pelvic organs?
Internal illiac artery
AKA: hypogastric artery
Other arteries branch off:
uterine arteries –> uterus
[note: ovarian a. branches from abdominal aorta]
What artery would supply the perinuem?
internal pudenal branch of the internal illiac artery
Acute promyeocytic leukemia (APL):
What is the chromosomal abnormality?
What does this lead to?
What is a viable treatment?
APL type M3 of AML, results from a t(15;17) –> PMR/RAR fusion gene, which is unable to signal for proper cellular differentiation, unlike normal retinoic acid receptor.
This could present as DIC
TX: all-trans-retinoic-acid (ATRA), which is a vitamin A derivative
Polymyositis
Clinical presentation
Biopsy findings
Lab findings
Related ddx
Clinical Presentation: progressive symmetric proximal muscle weakness
Biopsy Findings: endomysial inflammation with CD8+ T cells
Lab findings: anti-ANA, anti-Jo-1 (anti-histidyl-tRNA-synthetase), anti-Mi-2
Related ddx: dermatomyositis (like poly but with skin presentations as well - malar rash/similar to SLE)
SCID
severe combined immunodeficiency disorder
Etiology
Inheritance
Clinical Features
Tx:
DDX:
Characterized by defective T-cell development and B cell dysfunction
A genetic defect leads to failure of proper T cell development –> absence of T-cells leads to B cell dysfuction.
Inheritance could either be X-linked recessive or autosomal recessive
Recurrent infections - viral, fungal, bacterial and opportunistic! [sinusitis, otitis media, j. joveii infection…]
Failure to thrive
chronic diarrhea
tx: stem cell transpant ONLY (must be done ASAP)
DDX: congenital HIV [failure to thrive + recurrent infections - need to differentiate]
What is the candidal antigen skin test used for?
What are they key cells involved?
To determine the presence of cellular or T-cell mediated immunity through the detection of delayed-type hypersensitivity reaction (type IV)
key cells: macrophages, cytotoxic CD8+ T cells, and CD4+ helper T cells
SCID pt – anergy – no reaction
What are some tumors that can present psammoma bodies histologically? (5)
Meningioma
papillary thyroid carcinoma
mesothelioma
papillary serous CA of the ovary
papillary serous CA of the endometrium
Explain how the clearance of lithium could lead to its side effects seen?
What are some drug interactions?
Mgmt:
Acutely, lithium side effects include: GI upset (V/D) and later neurological findings (excitability, delirium) as it penetrates the CNS
Chronic toxicity, could be due to the way lithium is cleared. Lithium is mostly renally excreted thus anything that decreases glomerular filtration could lead to an increase in reabsorption at the proximal tubule (volume depletion/hyponatremia, CHF, cirrhosis)
These AEs: ataxia, fasiculations, confusion and agitaiton
Drug interactions with: thiazide diuretics, NSAIDS (not aspirin), ACE inhibitors
Mgmt: hemodyalisis for severe cases
Deficiency of what enzyme could lead to propionic acedemia, which presents with poor feeding, vomiting, hypotonia, lethargy, dehydration and anion gap acidosis?
Metabolism of what amino acids (4), would worsen this condition?
Deficiency of propionyl CoA carboxylase prevents the conversion of propionyl CoA to methylmalonyl CoA, which hten leads to propionic acedemia as it accumulates
Metabolism of valine, isoleucine, threonin, methionine results in the initial production of propionyl CoA
VOMIT = valine, odd chain FA, methionine, isoleucine, threonine.
What is isolated systemic hypertension and what are some causes…
Increased systolic BP with normal (<90) diastolic BP
This is mostly seen in the aging population due to increased arterial stiffness –> dec compliance of aorta and major peripheral arteries
Other causes: severe aortic regurg, anemia, hyperthyroidism
Meckel diverticulum is known as the dz of 2’s why? (5)
what is the cause?
Meckel’s diverticulum is a TRUE diverticulum (includes all layers not just mucosa), due to the presistence of the vitelline duct before week 9 –> vitelline cyst/omphalomesenteric duct
It is the most common congenital GI tract anomaly
Can cause: melena, RLQ pain, intussusception, volvulus, obstruction near terminal ileum
Rule of 2’s:
2 in long
2 feet from ileocecal valve
2% of population
commonly presents in the first 2 years of life
May have 2 types of epithelial (gastric / pancreatic)
-called ectopy NOT metaplasia-
What nerve innervates the skin of the pubic region?
iliohypogastric (branches off the L1 never root)
- this nerve also innervates the anteriorlateral abdominal wall muscles and the gluteal region*
(recall: the iliohypogastric artery supplies most of the pelvic organs)
Microorganisms invovled in:
Cat bites (2)
Dog bites (3)
Human bites (3)
Cat bites:
Pasturella multocida (mouse-like odor)
Bartonella Henselae (immunocomp host)
Dog bites:
Pasturella multocida
Strep
Staph A.
Human:
Anarobes
Strep
Eikenella Corrodens
What is ID50 (infectious dose) stand for?
The minimum number of organisms required to cause disease in 50% of the individuals
What is the most common form of male and female baldness?
How is it transmitted?
What is the clinical presentation?
Androgenetic aloplecia is the most common form of battern baldness in both males and females [reason why one of the treatments is 5-alpha reductase as it blocks the conversion to DHT]
It will present with increasing baldness, especially starting in the temporal and vertex, but the pattern and severity will depend on both circulating HORMONES and GENETICS
This condition is POLYGENIC inheritance with VARIABLE EXPRESSIVITY
Other dz that are polygenic:
androgenic aloplecia
schizophrenia
DM II
Epilepsy
HTN
glaucoma
Ischemic heart disease
How is cystic fibrosis diagnosed in a newborn?
What symptomatic electrolyte imbalance can this lead to?
What is a recommended supplementation?
It is screened for, but positive results should be confirmed with a sweat test - it will be ISOTONIC to ECF
Normally, as the sweat travels through the duct, Cl- will be absorbed, followed by Na+ and H20 –> hypotonic sweat; CF patients are not able to do this, thus their sweat would be high in sodium and chloride
–> hyponatremia (excessive loss)
RF: high temperatures, exercise
Salt supplemenation is recommended
What effect do alpha-adrenergic agonist have on systemic blood pressure and heart rate?
On visera?
alpha-adrenergic agonist increase systemic BP by stimulating adrenergic 1 receptors of the vascular walls, which –> vasoconstriction
This, effectively, will stimulate baroreceptors located in the carotid sinus and aortic arch –> reflexive vagal stimulation that will inhibit SA node, slow conudction of AV and overall DEC myocardial contractility / HR
INC cardiac afterload, INC pul cap pressure, INC LVEDP
ON visceral organs: vasoconstriction of renal and splanchnic arteries –> DEC perfusion to kidney and other visceral organs
What anti-hypertensive medication is recommended for heart failure patients due to their additional, independent protective factor in the prevention of deleterious cardiac remodeling? (2 categories)
ACE inhibitors
Angiotension II Receptor Blockers
[others: diuretics for symptomatic relief, but no long-term benefits; beta-blockers for compensated HF - contraindicated for cardiogenic shock and should be used with caution in decompensated HF]
What is phenytoin used for?
What is a common side effect?
What are common AEs?
anti-convulsive, used for grand-mal seizures, status epilepticus and partial seizures
Common side effect: gingival hyperplasia (also seen in calcium channel blockers), others include coarsing facial features and hirtuism
AEs: inteferes with folic acid, and can cause megaloblastic anemia;
contraindicated in preg, CNS manifestations such as ataxia and nystagmus,
Lateral epicondyle serves as the primary attachment for what muscle?
What is the function of this muscle?
What injury is frequently seen here?
Extensor Carpi Radialis Brevis and Extensor Digitorum
involved in wrist extension
overuse –> microtrauma –> angiofibroblastic tendonitis@ its insertion point –> lateral epicondyilitis = tennis elbow
What are the three major types of vaginitis:
For each - major examination findings, lab dx, tx
1. Bacterial Vaginosis (Gardnerella vag)
off-white, fishy order with no inflammation; clue cells, positive whiff test with KOH, >pH; tx with metronidazole or clindamycin
2. Trichomoniasis (trichomonas vaginalis)
thin yellow-green, malodorous frothy discharge w/inflammation; motile trichomonadas, >pH; tx with metronidazole and treat partner
3. Candida vaginitis (candidia albicans)
thick, cottage-cheese discharge, vag inflmmation; pseduhyphae with nl pH (3.8-4.5); tx with fluconazole
The method of “matching” is used in what type of studies most frequently to control what type of bias?
In case-control studies, matching is used to try to pair similar patients in the case group with the population of the control group. This tries to address the issue of confounding factors.
The matching factors should try to address potential confounding factors such as age, race, socioeconomic, smoking status, environmental…
an example) colorectal CA patients are the cases, and their neighbors are selected for the control, trying to match age, race, socioeconomic factors, environment; controls are choosen to match the variables of the case patients.
What allows for elastin’s elastic properties, especially during inspiration?
What dz impairs this property of elastin?
extensive cross-linking between elastin monomers, which is facilitated by lysyl oxidase
alpha-1-antitrypsin –> excessive alveolar elastin dedegration due to a protease inhibitor deficiency, thus can lead to early-onset of lower-lobe predominent emphysema
- leads to PANACINAR emphysema
What makes ribosomal RNA?
Where does synthesis occur (describe this location).
What is one clinical significant of being able to visualize a nucleolus?
Ribosomal RNA is made by RNA POL I
Synthesis, assembly and maturation of ribosomal subunit occurs in the NUCLEOLUS
Usually, increasingly differentiated cells have a smaller nucleolus since less ribosomes are needed for protein production BUT in MALIGNANT CELLS, high metabolic activity usually have a large number of active rRNA genes and a PROMINENT NUCELOUS (basophili/dark!)
Obstructive lung disease is characterized by …(lung volumes)
What are causes of obstructive lung disease (2):
complications..
Obstruction of air flow –> air trapping in the lungs/airways close prematurely at high lung volumes =
INC RV
DEC FVC
PFTs: DEC FEV1, DEC FVC – DEC FEV1/FVC ratio, V/Q mismatch
Examples:
- anatomical obstruction, such as chronic bronchitis, where hyperplasia of mucus-secreting glands in bronchi, anatomically decrease the amt of air that is able to leave the lungs
- blue bloater*
- DEC in lung wall elasticity, such as in emphysema, due to destruction of interalveolar wall –> compression during expiration, and unable to breath air out
- barrel-shaped chest, pink puffer*
Sarcoidoisis:
What are hallmark clinical presentation
What can be seen in imaging
what can be seen in labratory
Hallmark for sarcoidosis: young, African-american female, presenting with SOB, cough, chest pain, UVEITIS, skin lesions, lofgren syndrome (acute presentation: bilateral hilar adenopathy, erythema nodosum, polyathralgia/polyarthritis)
Imaging: bilateral hilar adenopathy, pulmonary reticular infiltrates
Labs: INC ACE, INC Ca2+
non-caseating granulomas (high presence of T-lymphocytes CD4+)
What is Kartagener Syndrome?
What are the consolation of clinical pres?
What is its caused by?
it is a form of PRIMARY CILLIARY DYSKINESIA [dynein arm defect affecting cilia function]
Clinical pres: Sinus Invertus, chronic sinusitus, bronchiectasis [due to impaired mucociliary clearance], infertility
Occurs due to mutations that impairs the structure or function of cilia
Inheritance is auto recessive via wide variety of mutations
What effect would hypOventilation have on PCO2?
less breathing = holding PCO2 in = INCREASED levels of PC02
more breathing = more expelling = DEC CO2 levels (ie- panic attack)
If it is acute process (such as heroin overdose), then there will be uncompensated respiratory acidosis:
HI PCO2, low pH (nl: 7.35-7.45), nl to mildly elevated bicarb (renal compensation requires at least 24 hours of persistent respiratory acidosis)
What microtubules are associted with the establishment and recurrence of hereps infection?
Dynein, responsible for retrograde travel (+ –> -) helps ESTABLISH infection (goes towards cell body)
Kinesin, responsible for antegrade travel (- –> +) helps infection REOCCUR, taking the virus back to the skin surface
What can the sensitivity and specificity of a test help you determine?
Sensitivity = how likely a person WITH a disease will test positive [less chance of false negative, correctly identifies those with a disease]
Specificity = how likely a person WITHOUT a disease will test negative [less chance of false positives, correctly identifies ppl without dz]
Remember: SNOUT and SPIN
SeNsitiivty helps you rule OUT a dz
SPecificity helps you rule IN a dz
What is the filtration fraction equation of the kidney?
FF = GFR / RPF
Renal plasma flow could be determined from the renal blood flow via, RPF = (renal blood flow)* (1-hematocrit)
Expression cloning is similar to southerwestern blot; how does expression cloning function, and what types of molecules can it detect?
Both are used to detect DNA-binding proteins
examples include: transcription factors, steroids, thyroid proteins, vitamin D receptor, retinoic acid R, DNA transcription and replication proteins, etc…
expression cloning is a type of DNA cloning, where the signal for translation and transcription are included in the clone portion; allows for the use of bacteria in the process as a mRNA is able to be made into a cDNA which then can be inserted in a plasmid, made and then identified using a DNA probe.
What is the equation of odds ratio?
In a standard table, it is equal to
= AD/BC
(attach image)
Only odds ratio should be used in case-control studies
