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
what are the important steps in the workup of metabolic alkalosis
ascertaining the patient’s VOLUME STATUS and checking the URINE CHLORIDE
serum sodium and serum osmolality DO NOT necessarily provide information on a patients volume status and CANNOT BE USED to reliably differentiate hypovolemia from hypervolemia
what are the most common causes of metabolic alkalosis
vomiting or nasogastric suctioning (loss of Cl ions in vomit, low Cl ions in urine- SALINE RESPONSIVE)
thiazide or loop diuretics (loss of Cl ions, current use = high Cl ions in urine, prior use = low Cl ions in urine- SALINE RESPONSIVE)
mineralocorticoid excess state (SALINE-UNRESPONSIVE alkalosis- cannot correct with isotonic saline)
what features are worrisome for spinal mets
advanced age
pain tha tis WORSE at NIGHT
persistent and progressive pain that is not relieved with position changes or analgesics
SYSTEMIC SYMPTOMS- fever, weight loss, night whats
known HISTORY OF MALIGNANCY is a strong predictor
thrombin time is prolonged in medications that..
directly or indirectly inhibit thrombin
not by factor Xa inhibitors (they prolong PT and PTT but not thrombin time)
what are the common precipitating factors for G6PD
infections
drugs- DAPSONE, antimalarials, SULFONAMIDE antibiotics
diabetic KETOACIDOSIS
favism (ingestion of fava beans)
scant inflammatory cells and interstitial fibrosis is seen in what type of rejection
chronic rejection
what is the adult derivative of the first aortic arch
part of maxillary artery
what is adult derivative of second aortic arch
hyoid artery
stapedial artery
what is the adult derivative of the 3rd aortic arch
common carotid artery
proximal internal carotid artery
what is the adult derivative of the 4th aortic arch
on left- aortic arch
on right- proximal right subclavian artery
what is the adult derivative go the 6th aortic arch
proximal pulmonary arteries
on left- DUCTUS ARTERIOSUS
what is more common the setting of myeloproliferative disorders: gout or pseudogout
GOUT
what are some causes of gout via increased urate production
idiopathic (primary gout)
myeloproliferative/lymphoproliferative disorders
tumor lysis snydrome
HGPRT deficiency
what is the best indicator of security in mitral valve regurgitation (holosystolic murmur heard best at the apex that RADIATES TO AXILLA)
left ventricular S3 gallop
reflects an increased rate of left ventricular filling use to a large volume of regurgitant flow re-entering the ventricle during mid diastole
what drugs should be avoided in patines with hypertrophic cardiomyopathy
the LV outflow tract obstruction worsens with decreased LV volume, which can be caused by reduction in cardiac preload and/or afterload
VASODILATORs: dhp calcium blockers, nitroglycerine, ACEI- decrease systemic vascular resistance, leading to decreased aftwrload and lower LV volumes
DIRUECTICS- decreased LV venous filling (preload) and also result in greater outflow obstruction
where is the SA node located
upper anterior right atrium at the opening of the superior vena cava along the crista terminalis
where is the AV node located
endocardial surface of the right atrium, near the insertion of the septal leanly of the tricuspid calve and the orifice of the coronary sinus
nitrates improves angina via what hemodynamic change
decreased in left ventricular volume (decreased preload)
what is non-typable H flue
H flu without a capsule
90% of H flu strains isolate from middle ear aspirated of children with acute otitis media are non-typable
what does indole positive mean and what bugs is it used to differentiate
abilriy to convert tryptophan to indole
seen in E COLI and differentiates it from ENTEROBACTER CLOACAE, another lactose fermenting gram-negative rod
