uWorld 12 Flashcards
what is considered sleep hygiene for treatment of insomnia
maintain regular sleep schedule, avoid naps
avoid caffeine after lunch
avoid alcohol, smoking, large meals near bedtime
adjust bedroom environment to be quiet, dark and cool
exercise regularly, but not soon before bedtime
what is considered stimulus control treatment of insomnia
use bed only for sleep and sex (no reading, tv, eating)
go to bed when sleepy
leave bed when unable to sleep and go to another room
fixed wake-up time, including weekends
what is the goal of stimulus control therapy for treating insomnia
to dissociate the bedroom from any stimulating activities that do not involve sleep (reading, tv, eating) and the fear of not sleeping
what is seen with a galactose-1-phosphate uridyl transferase (GALT) deficiency
most severe and most common form of galatosemia
symptoms first few days of life after initiation of breast feeding or formula
vomiting, jaundice, hepatomegaly, lethargy
cataracts (galactic build up in lens)
high levels of fructose-2,6-bisphosphate activates what enzyme and facilitates what
activates phosphofructosekinase-1 (PFK-1) thus facilitating conversion of:
fructose-6-phosphate → fructose-1,6-bisphosphate
this leads to progression of glycolysis
high levels of fructose-2,6-bisphosphate inhibits what enzyme and process
inhibits fructose-1,6-bisphosphatase thus stopping conversions of:
fructose-1,6-bisphosphate → fructose-6-phosphate and thus stopping gluconeogenesis (conversion of alanine and other gluconeogeneic substrates to glucose)
what enzyme increases levels of fructose-2,6-bisphosphate and how
PHOSPHOFRUCTOKINASE-2 (PFK-2)
INSULIN (↓ cAMP) activates PFK-2 leading to increased conversions of:
fructose-6-phosphate → fructose-2,6-bisphosphate
what enzyme decreases levels of fructose-2,6-bisphosphate
FRUCTOSE-2,6-BISPHOSPHATASE
GLUCAGON (↑ cAMP) activates fructose-2,6-bisphosphatease facilitating the conversion of:
fructose-2,6-bisphosphate → fructose-6-phosphate
glycogen formation is stimulated by increased levels of what
insulin and glucose-6-phosphate
alanine is the major amino acid responsible for transferring nitrogen to the liver for disposal. during the catabolism of proteins, amino groups are transferred to what forming what
transferred to alpha-ketoglutarate to form glutamate
glutamate is then processed in the liver to form urea, the primary disposal form of nitrogen in humans
what information is needed to calculate cardiac output
cardiac output = stroke volume x heart rate
using a pulmonary artery (Swan-Ganz) catheter via the FICK principle:
cardiac output = rate of O2 consumption / arteriovenous O2 content difference
what is the respiratory quotient
ratio of CO2 to O2 across the alveolar membrane
used to estimate the metabolic rate
normal value is typically 0.8
what is one of the most modifiable risk factors for falls
medication use
psychotropic drugs like antipsychotics, antidepressants, and benzos are most commonly associated with falls
canes and walkers assist in mobility but no evidence they help in falls
neonate with bp 70/30, pulse 128, resp 40/min
orbital hypertelorism, submucous cleft palate, bifid uvula
right ventricular hypertrophy, pulmonary stenosis w/ VSD, overriding aorta
diagnosed by fluorescent in situ hybridization
what is it?
DiGeorge syndrome
chromosome microdeletion 22q11.2
failure of NEURAL CREST MIGRATION into derivatives of THIRD and FOURTH pharyngeal POUCHES
gold standard test: FLOURESCENSE IN SITU HYBRIZATION
what are the signs and symptoms of DiGeorge
CATCH:
Conotruncal cardiac defects: tetralogy of Fallot, trucks arteriosus, interrupted aortic arch
Abnormal facies
Thymic hypoplasia/aplasia (T-cell deficiency)
Craniofacial deformities (cleft palate)
Hypocalcemia/Hypoparathyroidism
myocardial perfusion occurs mainly when
what happens to myocardial perfusion if heart rate is increased
during DIASTOLE
increased heart rate shortens time of ventricular relaxation (duration of diastole) and therefore time for maximal coronary blood flow decreased and consequently becomes the major limiting factor for coronary blood supply to the myocardium
what vitamin(s) are not present in enough amounts in breast milk
VITAMINS D AND K
if patient has progressive right hand weakness
uses screwdriver a lot at work
on exam sensation is intact on upper limbs but there is weakness on extension of the fingers and thumb in the right hand
strength is otherwise intact throughout
what nerve is fucked and where is it fucked
RADIAL NERVE (deep branch) fucked at the SUPINATOR CANAL (b/w superficial and deep parts of supinator muscle)
the radial nerve provides motor innervation to what
deep branch provides motor innervation superficial does sensory
extension at all arm, wrist, and finger joints below the shoulder
forearm supination
thumb abduction in plane of palm
patients with damage to radial nerve during its passage through the supinator canal may be due to REPETITIVE PRONATION/SUPINATION of the forearm (using a screwdriver at work), direct trauma, or dislocation of radius
how do they present
weakness on finger and thumb extension (“FINGER DROP”)
triceps brachii aan extensor capri radialis longus are typically not affected as these branches come off proximal to supinator canal
cutaneous sensory branches also preserved
what is Guyon’s Canal and what passes through it, what does injury here cause
passage of the ULNAR NERVE b/w the hook of hamate and the pisiform bone in the fibroosseous tunnel (Guyon;s Canal)
weakness on finger abduction/adduction and clawing of the 4th and 5th digits
fracture of the surgical neck of the humerus is associated with injury of what never and what is seen
AXILLARY NERVE injury
weakness of DELTOID and TERES MINOR as well as loss of sensation in the lateral upper arm
what causes postpartum hemorrhage and what are some risk factors
failure of the uterus to contract and compress the placental site blood vessels
risk factors: prolonged labor and twin gestation
conditions lead to UTERINE ATONY characterized by a BOGGY UTERUS that cannot contract effectively after placental delivery
surgery is indicated the medical management (uterine massage, uterotonic medications) can’t control bleeding
surgery: ligation of INTERNAL ILIAC ARTERIES (collateral blood supply keeps everything alive)
what drug is used to improve ocular symptoms in graves disease
GLUCOCORTICOIDS can decreased peripheral conversions of T4 to T3 but it is their ANTI-INFLAMMATORY EFFECTS THAT IMPROVE THE OPTHALMOPATHY
antithyroid drugs do not have a direct effect on opthalmopathy
