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uw 1 Flashcards

1
Q

Contralateral homonymous hemianopia

A

Optic tract lesion. Tested with the “swinging flashlight” test. Pupils appear to dilate when light is swung from unaffected to affected eye

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2
Q

Decreased bilateral pupillary constriction when light is shone in the affected eye relative to unaffected eye

A

optic nerve damage ( afferent pupillary defect)

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3
Q

Inability to contrict when you shine light into either eye

A

Occulomotor Nerve lesion (CN 3)

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4
Q

Down syndrome screening

A

Quadruple screen at 15-18 weeks. Low maternal AFP and unconjugated estriol levels. Increased B-HC and inhibin A

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5
Q

NK cells

A

NK cells recognize and kill cells with decreased MHC I expression, such as virus infected and tumor cells. They are large lymphoid cells that contain perforin and granzymes in cytoplasmic granules. NK cells kill by inducing apoptosis.

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6
Q

Vitamin D metabolism

A

Absorbed in GI or synthesized from precursors in skin after sunlight exposure. Converted in 24OH-vitD in liver. Converted to 1,25(OH)vit D (calcitriol) in kidney

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7
Q

Excess vitamin D

A

hypercalcemia, hypercalciuria, confusion, polydipsia, anorexia, vomiting, muscle weakness and bone demineralization.

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8
Q

what are patients with sarcoid or other granulomatous diseases prone to developing?

A

Hypercalcemia due to high levels of active vitamin D

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9
Q

what is elevated in rheumatoid arthritis?

A

Rhematoid factor and citrulline containing peptide antibodies

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10
Q

What is decreased in carcinoid syndrome?

A

Decrease levels of niacin

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11
Q

Where does serous fluid accumulate in a hydrocele?

A

Tunica Vaginalis

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12
Q

What is the tunica vaginalis contiguous with?

A

Peritonium. Testis descend through the inguinal canal drawing a diverticulum of peritonium into the scrotum.

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13
Q

External spematic fascia is derived from what layer?

A

aponeurosis of the external oblique (outermost layer)

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14
Q

Internal spermatic fascia is derived form what layer?

A

transversalis fascia

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15
Q

What is the tunica albuginea?

A

Fibrous tissue that overlies the corpus spongiosum and the corpora cavernosa of the penis

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16
Q

What is a common presentation of Charcot-Marie-Tooth?

A

Weakness of foot dorsiflexion ( foot drop) due to involvement of common peroneal nerve. Mutation that causes abnormal myeline synthesis resulting in decreased nerve conduction velocity.

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17
Q

Biopsy shows endomysial inflammatory infilatration.

A

Polymyositis. Causes proximal muscle weakness

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18
Q

Biopsy shows perifasicular inflammation

A

Dermatomyositis. Causes proximal muscle weakness

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19
Q

Biopsy shows endoneural infiltration

A

Guillain Barre. Causes an ascending flaccid paralysis and hyperreflexia

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20
Q

What population does Whipple disease affect?

A

T. whippelii affects middle aged Caucasion males and presents as malabsorption with diarrhea and weight loss. Arthropathy, polyarthritis and psychiatric and cardiac abnormalities may be present. PAS+ ( enlarged fomay macrophages packed with bacilli and diastase-resistant granules)

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21
Q

what is acanthosis

A

increase in thickness of stratum spinosum. Associated with psoriasis

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22
Q

what is spongiosis

A

Intercellular epidermal edema that histologically appwars as increase in the number of spaces between cells. Associaed with spongiotic dermatitis ( eczematous dermatitis)

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23
Q

what is acantholysis?

A

loss of cohesion between kertinocytes in epidermis or adnexal structures. Associated with spongiotic dermatitis ( eczematous dermatitis)

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24
Q

What is dyskeratosis?

A

Abnormal, premature keratinization of individual keratinocytes. Strongly eosinophilic and have small, basophilic nuclear remnant. Can be found in squamous cell carcinoma

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25
Q

What is urticaria?

A

Superficial dermal edema and lymphatic channel dilation.

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26
Q

What does the genitofemorial nerve innervate?

A

Splits into genital and femoral branches. Genital N. innervates scrotum/ labia majora. Femoral N. innervates femoral triangle.

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27
Q

What is blocked in a pudendal nerve block?

A

S2-S4 nerve roots which provides sensory innervation to perineum and genitals and motor innervation to the sphincter urethrae and external anal sphincter.

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28
Q

What does the lateral femoral cutaneous enrve innervate?

A

Derived from L2 and L3. Courses deep to inguinal liagment to innervate skin on anterolateral thigh

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29
Q

What does the iliohypogastric nerve innervate?

A

Derived from T12/ L1 it innervates the skin overlying the iliac crest.

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30
Q

What does the obturator nerve innervate?

A

Derived from L3 and L4, it innervates the adductors of the thigh

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31
Q

What does the inferior gluteal nerve innervate?

A

Derived from L5-S2, it provides motor innervation to gluteus maximus

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32
Q

what will be increased on a CBC after high dose prednisone?

A

Neutrophils. Neutrophil count increase as a result of demargination of leukocytes previosly attached to the vessel wall. Decreased lymphocyte, monocyte, basophil and eosinophil counts.

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33
Q

what labs should you expect from a patient on Lisinopril?

A

Elevated potassium ( hyperkalemia), increased Creatinine (decreased GFR). ACEi decrease ANG II and decrease GFR by preventing constriction of efferent arterioles. Can rarely cause life threatening angioedema.

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34
Q

what are some typical side effects of metoprolol?

A

Beta blocker can cause bradycardia and erectile dysfunction.

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35
Q

What are some side effects of atorvastatin?

A

HMG CoA reductase inhibitor can cause rhabdomyolysis ( esp. with fibrates and cyclosporin) Massive rhabdomyolysis can lead to acute kidney injury ( myalgias, muscle weakness and dark urine)

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36
Q

What are some side effects of HCTZ?

A

Hypokalemia. Can decrease GFR if it results in volume depletion and pre-renal azotemia

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37
Q

What receptor does Prazosin act on?

A

alpha 1 adrenergic antagonist. Used in hypertension

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38
Q

How does interstitial lung disease present?

A

progressive dypsnea, fine crackles, clubbing, diffuse reticular opacities. Pulmonary fibrosis with thickening and stiffenieng of pulmonary interestitium causes increased elastic recoil, which leads to airway widening due to increased outward pulling (radial traction) by surrounding fibrotic tissue. Results in supernormal expiratory flow rates. Spirometry: decrease FEV1 and FVC. But ratio increased because FEV1 decreases less than FVC.

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39
Q

What is lung compliance?

A

Change in lung volume for given change in pressure. Increased compliance means lung tissue stretches and expands more in response to increased pressure.

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40
Q

When does ischemic injury to the heart become irreversible?

A

After 30 minutes. Under hypxic condictions, ATP is degraded to ADP, AMP and adenosine. Adenosine is able to cross cell membrane and function as a vasodilator when coronary blood flow is insufficiency. However persistent ischemia can lead to depletion of adenosine

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41
Q

What is the evolution of an MI?

A

4-12 hours: Early coagulative necrosis, wavy fibers. Dark mottling. 12-24 hours: neutrophil migration. Reperfusion injury may cause contraction bands. 1-3 days: acute inflammation with neutrophils. 3-14 days: Hyperremic border with central yellow brown softening. Macrophages then granulation tissue at margins. 2 weeks to 1month: Gray white scar.

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42
Q

What are the complications post MI?

A

1 day: arrythmia. 1-3 days: fibrinous pericarditis 3-14 days free wall rupture. 2 weeks to month: Dressler syndrome, ventricular aneurysm

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43
Q

What are the functions of VIP?

A

Produced by pancreatic islet cells and neurons in GI mucosa. Causes relaxation of GI smooth muscle, inhibition of gastic H+ secretion and stimulates pancreatic bicarb and Cl- secretion. VIPoma causes WDHA syndrome (watery diarrhea, hypokalemia and achlorhydria). Tx: somatostatin

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44
Q

How does Measles and German measles present?

A

Maculopapular rash that begin at the head and neck and spread down. Postaurical and occipital lymphadenopathy. Develop polyarthritis and polyarthralgia as sequelae. Fetal infection can cause sensorineural deafness, cataracts, cardiac malformations (PDA)

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45
Q

What are typical late manifestations of congenital syphillis?

A

Malformed teeth (Hutchison’s incisors and mulberry molars)

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46
Q

what are some symptoms that suggest mucormycosis?

A

facial pain, headache and nasal eschar in patient with diabetic ketoacidosis

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47
Q

VACTERL

A

Veretebral defects, anal atresia, cardiac anomalies, trachesophageal fistual, esophageal atresia, renal anomalies and Limb anomalies

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48
Q

What is a cricothyrotomy? What layers are incised?

A

Indicated when an emergency airway is required. Layers include: skin, superficial cervical fascia, investing and pretracheal layers of deep cervical fascia and criothryoid membrane.

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49
Q

How is Diabetes insipidus diagnosed?

A

Vasopressin during a water deprivation test. >10% increase in urine osmolality suggests DI. >50% increase suggests complete DI

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50
Q

Function of ApoA

A

LCAT activation (choleterol esterification)

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51
Q

Function of ApoB-48

A

chylomicron assembly and secretion by intestine

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52
Q

Function of ApoB-100

A

LDL particle uptake by extrahepatic cells

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53
Q

Function of ApoC-II

A

LPL activation

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54
Q

Function of ApoE3 and E4

A

VLDL and chylomicron remnant uptake by liver cells

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55
Q

Antibiotics effective against pseudomonas?

A

Ticarcillin, Piperacillin. Ceftazidime, Cefepime. Amikacin, Gentamicin, Tobramycin. Ciprofloxacin, Levofloxacin. Aztreonam. Imipenem, Meropenem.

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56
Q

How does adrenal crisis present?

A

hypotensive, tachycardic, hypoglycemia. Hx of adrenal insufficiency: vomiting, abdominal pain, weightloss and hyperpigmentation. Start corticosteroids.

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57
Q

Side effects of Lithium

A

neuronal excitabiity (irregular tremors, fascicular twitching, rigid motor agitation, ataxia). May also cause nephrogenic DI, hypothyroidism, cardiac conduction defects. Hypothyroidism: weight gain, dry skin, hairloss and constipation (Need to measure TSH)

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58
Q

Methimazole side effects

A

edema, rash, agranulocytosis

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59
Q

Amiodarone side effects

A

thyroid dysfunction, corneal micro-deposits, blue-gray skin discoloration, drug related hepatitis, pulmonary fibrosis

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60
Q

characteristics of squamous cell carcinomas

A

solid nests of neoplastic squamous cells with abundant eosinophilic cytoplasm

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61
Q

when do you refer to ethics committee?

A

no advanced directive and family members disagree

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62
Q

Use dependent joint pain. Morning stiffness lasting 10-15 minutes. Bony swelling at DIP and PIP due to osteophyte formation

A

Osteoarthritis

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63
Q

Joint pain that improves with use. Last for more than 30 minutes. Involves MCP and PIP. Symmetric.

A

Rheumatoid arthritis

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64
Q

Red, swollen and painfail joint. Monoarticular. Affecting first metatarsophalangeal joint.

A

Gouty arthritis

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65
Q

Tracheal deviation towards affected side

A

Lung volume loss (atelectasis)

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66
Q

Tracheal deviation away from affected side

A

Pleural effusion

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67
Q

Pulmonary edema on CXR

A

fluffy infiltrates ( fluid in alveolar spaces)

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68
Q

Pulmonary fibrosis on CXR

A

Interstitial lung disease would cause reticular markings on both lungs

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69
Q

Pneumonthorax on CXR

A

increased lucency on affected side

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70
Q

Sharply demarcated, salmon colored, rounded plaques with a loosely adherent, silvery white scale

A

Psoriasis. Tx: topical vitamin D (calcipotriene) and cyclosporin, Etanercept, methotrexate, ustekinumab

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71
Q

Mechanism of Cyclosporin?

A

Inhibits NFAT ( nuclear factor of activated T cells) from entering nucleus and prevents release of IL-2 and thus inhibits activation of T-cells.

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72
Q

Mechanism of Etanercept?

A

Recombinant TNF receptor that binds TNF-a.

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73
Q

What is nitroblue tetrazolium testing?

A

Adding NBT to neutrophils will cause them to reduce yellow NBT to form a dark blue precipitate if normal. Used to test for chronic granulomatous disease

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74
Q

What is dihydrorhodamine flow cytometry? DHR

A

Measure production of superoxide radicals by measuring conversion of DHR to rhodamine. Cells with deficient NADPH oxidase will show decreased fluorescent green in chronic granulomatous disease.

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75
Q

What is used to estimate GFR?

A

Inulin/ Creatinine. Freely filtered and not absorbed or secreted.

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76
Q

What is used to estimate renal plasma flow?

A

PAH. Filtered and actively secreted in PT.

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77
Q

Which ribs overlie the left kidney?

A

12th

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78
Q

which ribs overlie the spleeen?

A

left 9, 10, 11

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79
Q

which ribs have the greatest risk of damaging the visceral pleura?

A

ribs 1-6

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80
Q

Which nerves go through the superior orbital fissure?

A

III: occulomoto, IV: trochlear, V1: trigeminal (nasociliary branch), VI: abducens ( opthalmic vein and sympathetic fibers)

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81
Q

What goes through the inferior orbital fissure?

A

V2 Trigeminal (Maxillary branch)

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82
Q

what goes through the optic canal?

A

Optic Nerve (II)

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83
Q

What goes through the Foramen rotundum?

A

V2 ( maxillary) which then goes through the inferior orbital fissure to the infraorbial foramen

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84
Q

What goes through the foramen ovale?

A

V3 ( Mandibular branch)

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85
Q

What does an S3 heart sound indicate?

A

Turbulent blood flow to ventricules due to increased volume. Heart in young adults, pregnancy, children.

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86
Q

What does an S4 heart sound indicate?

A

Heard immediately after atria contraction phase as blood is forced into a stiff ventricle in late diastole. Heathly older adults. Ventricular hypertrophy

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87
Q

What amino acid is deficient in Hartnup disease?

A

Neutral amino acids including tryptophan which can lead to B3 (Niacin) deficiency.

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88
Q

Atropine can reverse symptoms of organophosphate poisoning except which symptom? What can reverse this symptom?

A

Muscle paralysis ( nicotinic receptors) Pralidoxime restores cholinesterases and can reverse muscarinic and nicotinic effects

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89
Q

Side effects of carbamazepine

A

Aplastic anemia. Monitor CBC

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90
Q

Side effect of citalopram

A

(Selective serotonin reuptake inhibitor) Sexual dysfunction

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91
Q

Side effect of clozapine

A

(atypical antipsychotic) Causes agranulocytosis and serizure

92
Q

Side effect of Lamotrigine

A

Risk of rash (Steven-Johnson syndrome)

93
Q

Side effect of Risperidone

A

(atypical anti-psychotic): Hyperprolactemia ( galactorrhea and amenorrhea)

94
Q

Side effect of Trazodone

A

Painful ereection, orthostatic hypotension and sedation

95
Q

Bacterial Vaginosis: Exam, Labs, Tx

A

Thin, off-white discharge with fishy odor. pH > 4.5, clue cells, positive whiff test. Tx: Metronidazole

96
Q

Trichomoniasis: Exams, labs, Tx

A

Thin, yellow-green. Malodorous, frothy discharge, vaginal inflammation. pH>4.5 motile trichomonads on smear. Tx: metronidazole. Tx sexual partner

97
Q

Candida vaginitis: Exam, labs, tx

A

Thick, white discharge with cottage cheese appearance. Normal pH, pseudohyphae. Tx: fluconazle

98
Q

Pain and swelling in proximal interphalangeal, metacarpophalangeal and wrist joint. Resolves spontaneously. In children causes fever and a rash. No rheumatoid factor

A

Parvovirus B19 ( Erythema infectiosum)

99
Q

Inulin

A

Filtered not secreted

100
Q

Creatinine

A

Filtered and secreted

101
Q

Urea

A

Filtered and poorly absorbed in the proximal tubule.

102
Q

Loss of ability to abduct and laterally rotate arm

A

Suprascapular nerve (supraspinatus and infraspinatus)

103
Q

Damage cuases paralysis of serratus anterior and winging of scapula

A

Long thoracic n

104
Q

Fracture of surgical neck of humerus and anterior dislocation

A

Axillary nerve. Paralysis of deltoid and teres minor causes weakness of abduction, extension, flexion and lateral rotation of the shoulder

105
Q

injury by improperly fitted crutches or fracture at the midshaft of the humerus

A

Radial nerve (paralysis of the extensor muscles of the forearm and wrist)= wrist drop

106
Q

Holosystolic murmur that increases in intensity during inspiration

A

Tricuspid regurgitation. During inspiration, intrathoracic pressure drops allowing more blood to return to the heart

107
Q

Mid diastolic, low pitch murmur that starts after S2 and ends before S1

A

Mitral stenosis

108
Q

High pitched holosystolic murmur most prominent over cardiac apex. Best heard in left lateral decubitus.

A

Mitral regurgitation

109
Q

Mid systolic ejection click that starts after S1 and ends before S2. Crescendo-decrescendo

A

Aortic stenosis

110
Q

Diastolic murmur that starts with S2 and ends before S1. Decrescendo and may increase in intensity during inspiration. High pitched and blowing sound over 2nd and 3rd intercostal spaces.

A

Pulmonic regurgitation

111
Q

Effect of Norepinephrine

A

alpha 1: vasoconstriction in skin and viscera leading to increeased systolic and diastolic BP. Beta1: increases contractility and heart rate. NE on the heart is counteracted by baroreceptor mediated reflex bradycardia that occurs following the increase in peripheral resistance. ( HR remains unchanged even after NE administration)

112
Q

small, gland-like structures that contain acidophilic material (suggestive of immature follicles)

A

Call Exner bodies ( Granulosa-theca cell tumor)

113
Q

CA-125

A

Found in malignant ovarian epithelial cells in serous, endometrioid and clear cell carcinoma of the ovary. Not for screening. Used to monitor therapeutic response

114
Q

Tremors, agitation, anxiety, delirium, psychosis, seizure, tachycardia, palpitations

A

Alcohol withdrawal

115
Q

Tremors, anxiety, perceptual disturbances, psychosis, insomnia, seizures, tachycardia, palpitations

A

BZD withdrawal

116
Q

Nausea, vomiting, abdominal cramping, muscle aches, dilated pupils, yawning, piloerection, lacrimation, hyperactive bowel sounds

A

Heroin

117
Q

increased appetite, hypersomnia, intense psychomotor retardation, severe depression

A

Stimulant (amphetamine) withdrawal

118
Q

Dysphoria, irritability, anxiety, increased appetite

A

Nicotine withdrawal

119
Q

Progressive dypsnea and dizziness on exertion

A

Pulmonary hypertention ( R heart cant increase cardiac output against increased pulmonary resistance during exercise) Results in chornic pulmonary hypertension leading to right ventricular hypertrophy and cor pulmonale.

120
Q

progressive fatigue, lower-extremity parathesia, megaloblastic RBC

A

Pernicious anemia caused by auto-antibody destruction of parietal cells. Results in chronic atrophic gatritis ( loss of parietal cells and lymphocytic and plasma cell infiltration)

121
Q

Mid systolic ejection click with late systolic murmur of mitral regurgitation (heart best at mitral area in cardiac apex)

A

Mitral valve prolapse

122
Q

Syncope, Angina, Dyspnea

A

Severe aortic stenosis

123
Q

Expression of what proteins by osteoblsats regulate bone turnover?

A

RANK L and Osteoprotegerin (OPG). RANK L and MSF stimulates development of mature osteoclasts. OPG acts as a decoy receotor

124
Q

loss of upper extremity pain and temperature sensation. Upper extremity weakness and hyporeflexia, ower extremity weakness and hyperreflexia, Kyphoscoliosis

A

Syringomyelia

125
Q

Gait apraxia and urinary incontinence

A

Normal pressure hydrocephalus

126
Q

which type of kidney stone is radiolucent?

A

Uric acid

127
Q

What is Mesna used for?

A

Hemorrhagic cystitis in patients on cylophosphamide. Binds acrolein ( toxic metabolite)

128
Q

What is leucovorin used for?

A

MTX reversal

129
Q

What is filgrastim used for?

A

Granulocyte stimulating facotor analog that is used to stimulate proliferation and differentiation of granulocytes in patients with neutropenia

130
Q

What is Dexrazoxane used for?

A

iron chelating agent that can prevent anthracycline induced cardiotoxicity

131
Q

What is Amifostine used for?

A

Cytoprotective free radical scavenger used to decrease cumulative nephrotoxicity associated with platinum containing and alkylating chemotherapeutic agents

132
Q

Risk of thyroidectomy?

A

Damage to the recurrent laryngeal nerve (ligature of inferior thyroid artery) and external branch of superior paryngeal nerve (sligature of superior thyroid artery)

133
Q

which nerve is at risk of being injured in an anterior shoulder dislocation?

A

Axillary nerve: paralysis of deltoid and teres minor. Sensory loss of upper lateral arm

134
Q

Violent stretch between head and shoulder during delivery or trauma in adult results in damage to which nerves?

A

Upper trunk of brachial plexus (Erb Duchenne): musculocutaneous and suprascapula nerves ( adducted shoulder, protonated arm and extended elbow)

135
Q

what is the route of damage by rabies?

A

Wound to neuron axons to salivary glands

136
Q

what is the route of damage by diptheria toxin?

A

Fibrinous exudate to systemic circulation (bloodstream) to cortical neurons

137
Q

What is the route of damage by Listeria?

A

Food to systemic circulation to meninges

138
Q

What is the route of damage by botulinum toxin?

A

Food to systemic circulation to peripheral nerves

139
Q

What is the route of damage by tetanus toxin?

A

Wound to motor neurons to spinal cord. (retrograde transport)

140
Q

hydatid cysts

A

Dog tapeworm Echinococcus. Ingestion of food contaminated with dog feces

141
Q

B12 deficiency and megaloblastic anemia after ingestion of raw freshwater fish

A

Diphyllobothrium (human tapeworm)

142
Q

Consumption of undercooked pork

A

Taenia solium. Cysticercosis caused by larval stage after ingestion of eggs in excretement of carriers

143
Q

Dysuria and blood in urine after bathing in lakes. Bladder wall thickening

A

Schistosoma from snails that contain larvae

144
Q

ST elevations in V1-V4

A

LAD supplies interventricular septum and anterior wall of left ventricle. ST V1, V2= septum. ST V3-4: anterior left wall

145
Q

ST elevations in V5 V6

A

Left circumflex supplies lateral wall of left ventricle (possibly also I and avL)

146
Q

ST elevations in II, III, AVF

A

Right coronary artery occlusion

147
Q

Intermittent severe abdominal pain, mesangial proliferation and crecent formation, palpable purpura on buttocks, self limited migratory arthralgies and arthritis

A

Henoch Schonlein purpura

148
Q

Swollen lymph nodes, red eyes, high fevers, strawberry tongue, periorbital erythema, periungual desquamation

A

Kawasaki

149
Q

Why should you avoid TCAs in pts with BPH?

A

Anticholinergic side effects causes urinary retention that can be exacerbated

150
Q

Why do you see sedation with TCA use?

A

anti-histamine actions

151
Q

Why do you see orthostatic hypotension with TCA?

A

alpha adrenegic receptor antagonist (Imipramine)

152
Q

What is amiodarone used for?

A

supraventricular (atrial, nodal and junctional) and ventricular tachycardia

153
Q

What type of arrhythmia is lidocane indicated for?

A

Ventricular tachycardia

154
Q

What is adenosine used for?

A

Convert people out out PSVT

155
Q

Exertional calf pain and painful foot ulcers with hypersensitivity to tabacco extract.

A

Thromboangiitis obliterans (Buerger’s disease) Thrombosis of aterial walls with recanalization. Tibial and radial arteries. Seen in heavy tobacco smokers. Can lead to ulcerations and gangrene of toes, feet fingers

156
Q

Granulomatous inflammation of media

A

Temporal (giant cell) arteritis. Usually medium branches of carotid artery (temporal artery)

157
Q

Transmural inflammation of arterial wall with fibrinoid necrosis

A

Polyarteritis nodosa

158
Q

Stains positive for enolase, chromogranin and synaptophysin, neurofilaments

A

Small cell lung cancer

159
Q

poorly developed lumbar spine resulting in floppy baby. Flaccid paralysis of legs, contractures of feet and urinary incontinence

A

Caual regression syndrome related to poorly controlled maternal diabetes

160
Q

cocaine in pregnancy

A

vasocostriciton cau cause insufficient blood flow leading to spontaneous abortion, intrauterine growth retardation and placental abruption

161
Q

vitamin A overdose in pregnancy

A

craniofacial abnormalities, posterior fossa defects, abnormalities of great vessels

162
Q

Labs for hemophilia

A

Normal PT, Platelet, bleeding time. Increase PTT

163
Q

Labs for vWF

A

Normal PT, PTT, platelets. Increase bleeding time

164
Q

Labs for DIC

A

Increase PT, PTT and bleeding time. Decrease platelets

165
Q

Labs for uremic platelet dysfunction

A

Normal PT, PTT, Platelets. Increase bleeding time

166
Q

Labs after Heparin

A

Normal PT and bleeding time. Increased PTT

167
Q

Labs with warfarin use

A

increase PT (PTT), normal platelets, normal bleeding time

168
Q

Labs in ITP

A

Normal PT, PRR. Derease platelets. Increase bleeding time

169
Q

Contralateral loss of pain and temperature, ipsilateral deficients of CN 5, 8, 9, 10, 11. Horner’s syndrome

A

PICA infarct (lateral Medullary (wallenberg) syndrome)

170
Q

Which nerve can be damaged during pelvic surgery, especially in lymph node surgery?

A

Obturator nerve (innervates adductors)

171
Q

Abduction at the thigh

A

Tensor fascia lata (superior gluteal) and Sartorius (femoral). Both are in the anterior compartment

172
Q

Flexion of the thigh

A

Psoas (lumbar plexus), iliacus (femoral n), TFL and sartorius

173
Q

Extension of the thigh

A

Gluteus maximus (inferior gluteal nerve which exists through the greater sciatic foramem)

174
Q

Extention of the leg

A

Quadriceps ( femoral nerve)

175
Q

Diastolic murmurs

A

mitral stenosis, aortic regurgitation

176
Q

Systolic murmurs

A

Aortic stenosis, mitral/ tricuspid regurgitation, VSD, mitral valve prolapse

177
Q

chronic diarrhea, failure to thrive, low blood T lymphocyte and decreased Ig levels

A

SCID due to adenosine deaminase deficiency. Adenosine accumulation is toxic to lymphocytes and results in cellular and humoral immunodeficiency. Tx: retroviral vectors have been attempted. Usually with BM transplant

178
Q

Function of xanthine oxidase

A

forms uric acid from hypoxanthine and xanthine (purine degradation)

179
Q

reddish urine that darkens on exposure to light and air

A

AIP due to deficiency of PBG deaminase. oxidation of PBG due to inhibition of ALAS in heme synthesis. Upregulated by CYPE450 induces and downregulated by heme and glucose

180
Q

Syncope, shortness of breath when sitting and improves when laying down. Low pitched, mid-diastolic rumble at cardiac apex

A

Myxoma in left atrium

181
Q

Increase in systolic and diastolic BP and decrease in HR

A

selective a1 adrenergic agonist ( phenylephrine). Increase BP causes increase vagal influence to decrease HR and conduction

182
Q

First enzyme in beta oxidation

A

Acyl-CoA dehydrogenase

183
Q

Glucose 6 phosphatase

A

gluconeogenesis, glycogenolysis (Von Gierke)

184
Q

Acetyl coA carboxylase

A

Fatty acid synthesis

185
Q

Glycogen phosphorylase

A

glycogenolysis (McArdle)

186
Q

Acid maltase

A

Glycogen is broken down by alpha 1,4, glucosidase (acid maltase) Deficiency leads to Pompe disease

187
Q

amatoxins (amanita phalloides)

A

Death cap mushroom. Toxin concentrates in liver cells and bind to DNA dependant RNA polymerase type II and halt mRNA synthesis. Urine test for alpha-amanitin

188
Q

Stroke like episodes, muscle weakness, increase lactate post-exercise

A

MELAS. Mitochondrial disease that displays heteroplasmy

189
Q

Difficulty swallowing, dysphonia, stridor, apnea. Leg paralysis

A

Arnold Chiari type II causes symptoms of compression of the medulla. Lumbar myelomeingocere leads to leg paralysis. Abnormally formed cerebellum andmedulla. Cerebellar vermis and medulla extend downward through the foramen magnum

190
Q

What is phenotypic mixing in viruses?

A

acquisition of new viral surface proteins that is necessary for virus to infect a new type of host cell. Virus A genome obtains some surface components from virus B while both are present on same cell. ( Co-infection with 2 strains). No genetic material is exchanged so progeny are pehnotypically mixed. Next generation will have only type A surface proteins

191
Q

What is reassortment in viruses?

A

changes in genomic composition that occur when host cells are co-infected with 2 segmented viruses that ecchange whole genome segments. Can cause suddent alterations in surface antigens of viral progeny. Genomic changes will be present in second generation

192
Q

What is recombination in viruses?

A

exchange of genes between 2 chromosomes by crossing over in homologous regions. Genomic change will be present in second generation

193
Q

What is transformation in viruses?

A

Incorporation of viral DNA into a host cell chromosome. Alters genetic composition of host cell but no change in progeny virus.

194
Q

What is interference in viruses?

A

inhibition by one virus of the replication and or release of a second virus infecting the same cell. Simple interference would not result in a new progeny phenotype

195
Q

What are the situations in which patient information can be disclosed?

A

Suspected child or elder abuse. Gunshot or stabbing injuries. Communicable disease. Patients threatening to physically harm themselves or others (or have reasonable ability to carry out threat in future)

196
Q

Transplant rejection: hyperacute

A

Minutes to hours. Preformed antibodies against graft in recipient circulation. Grossy mottling and cyanosis. Arterial fibrinoid necrosis and capillary thrombotic occlusion

197
Q

Transplant rejection: acute

A

Less than 6 months. Exposure to donor antigen induces humoral or cellular activation of na¥ve immune cells Humoral (C4d deposition, neutrophilic infiltrate, necrotizing vasculitis) Cellular (lymphocytic interstitial infiltrate and endotheliitis)

198
Q

Tranplant rejection: chronic

A

Months to years. Chronic, low grade immune response refractory to immunosuppresants. Vascular wall thickening and luminal narrowing. Interstitial fibrosis and parenchyma atrophy

199
Q

Type II hypersensitivity

A

Antibody mediated reaction caused by preformed IgG antibodies. Hyperacute transplant rejection. Anti-ABO antibodies and anti-HLA antibodies.

200
Q

Type IV hypersensitivity

A

Cell mediated HSR. Acute or chronic solid organ transplant rejection. TB skin test. Contact dermatitis

201
Q

Graft vs host disease

A

competent donor T cells are transplanted into immunocompromised patient that attacks the recipient organs

202
Q

Immediate hypersensitivity

A

Type I hypersensitivity reactions occur in sensitized individuals following an exposure to an antigen that binds preexisting igE on mast cells. Mast cell activation causes release of histamine and leukotrienes that cause vasodilation, vascular leakage

203
Q

Type III hypersensitivity

A

deposition of antigen-antibody complexes in small vessels. Complexes lead to complement activiation and release of chemotactic mediates that lead to inflammation and tissue damage (SLE, PSGN and serum sickness)

204
Q

Hypercoagulability, premature atherosclerosis. Elevated methionine

A

Homocystinuria is a defect in cystathionine beta synthase which converts homocystine to cystathionine. Requires cysteine and B6

205
Q

Blow to the anterior proximal tibia

A

PCL

206
Q

Acute sharp pain is carried by which type of fibers

A

A delta fibers (thin myelinated). Constitute reflex arc.

207
Q

Muscle spindles are innervated by?

A

Group Ia and group II sensory axons and sensitive to changes in muscle length. Mediat the stretch reflex. When muscle is stretched, there is monosynaptic reflex activation of alpha motor neuron causes contract that resists stretch

208
Q

Pacinian corpuscles vs Ruffian

A

Pacinian corpuscles are rapidly adapting mechanoreceptors and Ruffini’s end organs are slowly adapting. Both mediate touch, proprioception and vibratocy sensation and innervated by myelinated A-Beta fibers

209
Q

Tall with disproportionally short upper and lower extremities, large head and prominent forehead

A

Achondroplasia: inherited autosomal dominant mutation in FGF3

210
Q

Triad of findings on EKG for WPW

A

shortened PR, delta wave at QRS and widened QRS

211
Q

selective beta blockers

A

Metoprolol, atenolol, esmolol, acebutolol

212
Q

Hypokalemia with muscle weakness, paresthesias

A

Hyperaldosteronism leading to hypokalemia

213
Q

wide fixed splitting of S2

A

ASD (left to right shunt)

214
Q

Which enzymes require thiamine, lipoic acid, CoA, FAD, NAD

A

pyruvate dehydrogenase, alpha kg dehydrogenase, Transketolase

215
Q

Primary oocytes are arrested in?

A

prophase of meiosis I

216
Q

secondary oocytes are arrested in?

A

Metaphase in meiosis II

217
Q

which toxins activate adenylate cyclase?

A

Pertussis, Edema factor (B.anthracis), heat labile toxin (ETEC), Campylobacter (enterotoxin), Heat labile toxin (B. cereus), V. cholera

218
Q

Which toxins activate guanylate cyclase?

A

ETEC (heat stable toxin), Yersinia (watery diarrhea)

219
Q

Which toxins inactivate elongation factor 2?

A

Diptheria, Pseudomonas (Exotoxin A) by causing ADP ribosylation

220
Q

Which toxins disrupt cytoskeleton?

A

C. diff (toxin B) Depolymerizing actin leads to cell death

221
Q

Easily fatigability, constipation, bone pain, renal failure, obstructing eosinophilic casts

A

Multiple myeloma

222
Q

Drug of choice for status epilepticus?

A

IV lorazepam (administered with phenytoin or fosphenytoin)

223
Q

Side effects of cholinergic agonist?

A

Smooth muscle contractions of GI causes nausea, vomiting, cramps and diarrhea. Decrease HR, cardiac conduction and contractility. Hypotension. Increased secretions leads to excessive sweating, salivation and lacrimation. Bronconstriction and bronchial secretions

224
Q

Bethanechol

A

stimulates peristalsis in postoperative ileus and atonic bladder

225
Q

Carbachol and pilocarpine

A

lower intraocular pressure in (miosis causes iris to move further from cornea to widen the anterior chamber angle and allow outflow of aquesou humor)

226
Q

Intense perianal itching

A

Enterobiasis (pinworm)

227
Q

Hyponatremia, hyperkalemia, hypoglycemia with shock.

A

Adrenal crisis

Uworld (18 decks)

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