UWorld Flashcards
1
Q
Cancer pt experiencing
1. in-patient diarrhea when should obtain
a latex agglutination of viral antigen vs PCR for a bacterial toxin gene
A
latex agglutination of viral antigen = Rotavirus → nonbloody diarrhea + vomiting + fever in less than 48 hours
PCR for a bacterial toxin gene = C. difficile → watery diarrhea + ab pain w/ hospital stay 2+ days
2
Q
alpha-synuclein protein aggregation
A
Lewy Body Dementia = Parkinsons
3
Q
Pts w/ uterine enlargement + heavy menses
A
Adenomyosis
4
Q
impaired myelination in the ascending dorsal columns + spinocerebellar tracts = diminished position/vibration sense + ataxia
Impaired myelination descending lateral corticospinal tracts = muscle weakness + spastic paresis
A
Vitamin B12 (cobalamin) deficiency
Or Vitamin E deficiency
5
Q
Tremor
Dystonia = involuntary (unintended) muscle contractions
Parkinsonism
Ataxia
Chorea which are associated with dysphagia, dysarthria and drooling
A
Wilson Disease
Dx: Slit Lamp (Kayser-Fleischer rings)
6
Q
Startle myoclonus (rapidly progressive)
Dementia (rapidly progressive)
Sharp waves on EEG
Increase 14-3-3 proteins in CSF
A
Creutzfeldt-Jakob disease = Prion misfolding beta-pleated sheets (PrPsc)
7
Q
Pt w/ multiple syncope episodes while wearing a tight (tie, shirt collar)
A
Carotid sinus hypersensitivity via overstimulation of CN9 (glossopharyngeal)
8
Q
Female
Tetracycline
Obesity
Vitamin A excess
Danazol (androgen agonist)
A
Idiopathic Intracranial HTN = pseudotumor cerebri
9
Q
B1 deficiency → issues w/ APT-B
A
- A-ketoglutarate dehydrogenase (TCA-cycle)
- Pyruvate dehydrogenase (glycolysis → TCA)
- Transketolase (HMP shunt) – RBC activity decrease
- Branched-chain ketoacid dehydrogenase
10
Q
Dopamine metabolite
A
Homovanillic acid & when low in CSF → Parkinson disease
11
Q
Leptin = produced primarily by fat cells + long-term adequacy of fat stores → during fasting ______
A
Falls
12
Q
Clara cells =
A
glycosaminoglycans to protect the lining of bronchioles
13
Q
DLCO increases w/
A
asthma
14
Q
DLCO decreases w/
A
COPD
15
Q
R → L shunt =
A
decrease alveolar ventilation
BLOCKAGE present
16
Q
Increased V/Q
A
reduced perfusion (Pulmonary embolism)
17
Q
Decreased V/Q
A
decreased oxygenation of the alveoli (lung pathology)
18
Q
Pulmonary HTN
Right Heart failure
Normal PCWP
A
Cor pulmonale + Eisenmenger syndrome
Etiology: pulmonary fibrosis (CREST syndrome + radiation)
19
Q
Benign paroxysmal positional vertigo (BPPV)
Spinning + no vomiting
Nystagmus beating to 1 side
A
Otolith = Posterior semicircular canal
20
Q
When do you obtain a ECG stress test
A
Arterial insufficiency
If they have BBB then echo
21
Q
Medial malleolus ulcer
Leg color change
A
Chronic venous insufficiency
Dx: duplex US
22
Q
Punched-out ulcer on foot
Intermittent claudication
A
Arterial Insufficiency = Peripheral vascular disease
Dx:
1. Ankle-brachial indices (ABI)
2. Doppler US or arteriography
23
Q
Cold → increased a-1 agonism =
A
myogenic reflex
Central Blood volume increases
ADH decreases
ANP increases
24
Q
CONCENTRIC hypertrophy
________ heart failure is associated with
due to _________ overload
A
Diastolic heart Failure
S4 sound = pressure overload
normal ejection fraction
25
ECCENTRIC hypertrophy
________ heart failure is associated with
due to _________ overload
Systolic heart Failure
S3 sound = volume overload
decrease ejection fraction
26
______ increase right-sided murmurs
______ increases left-sided murmurs
Inspiration = right-sided
Exhalation = left-sided
27
Increased intrathoracic pressure
Valsalva + Exhalation
28
Decreased intrathoracic pressure
Inhalation
29
Blood related conditions (sickle cell + anemia)
Increased HR
Normal BP
Mid-systolic murmur at URSB (upper right sternal border)
Transient functional flow murmurs
29
MVA or fall
Widening mediastinum on CXR
Rupture aorta (thoracic)
GET a arteriography
30
Damage to the ______ → Diabetes Insipidus
hypothalamic nuclei
31
Low _______ → lowers a1 receptors on arterioles → low BP
Cortisol
32
Viral infection
Vertigo
Vestibular neuritis
33
Viral infection
Tinnitus
Vertigo
+/- neurosensory hearing loss
Labyrinthitis
34
Dilute urine + low serum sodium
Psychogenic polydipsia
35
Where does Aldosterone work
Cortical collecting ducts
36
Where does ADH work
Medullary Collecting ducts
37
Renal tubular acidosis 1
DCT
– bilateral stones linked to Sjogren syndrome
38
Renal tubular acidosis 2
PCT
- Fanconi (carbonic anhydrase inhibitors + expired tetracyclines)
39
Renal tubular acidosis 4
Collecting ducts
(resembles Addison but has HYPOKALEMIA)
40
Who gets Ca++ oxalate stones
1. Intestinal malabsorptive disorders
Why = increased intrasinstainal binding of fat to Ca++ → less Ca++ to bind to oxalate intraluminally → increased Oxalate absorption
2. Diets w/ low Citrate
Why = Citrate helps prevent Ca++ Oxalate compounds by binding to free Ca++
3. High Na+ diets = decrease Ca++ reabsorption
41
What can cause K+ wasting (increased K+ secretion)
MI w/ LBP
42
C. tetani causes disease by producing a potent ___________ (tetanospasmin)
metalloprotease exotoxin
43
increased serotonin release contributes to the extreme fluid _______ seen in ________
secretion
cholera
44
Type 4 hypersensitivity rxn
MS = t-cell destruction of oligodendrocytes = in demyelination of the cCNS
Hashimoto = t-cell destruction of thyroid tissue
DM1 = t-cell destruction of β cells
Acute rejection = host attacks donor
45
Type 3 hypersensitivity rxn
antibody-antigen immune complex deposition → to complement activation + neutrophil recruitment
Arthus rxn = pre-sensitized individuals receiving a toxoid vax booster → local edema, inflammation, and fibrinoid necrosis
Polyarteritis nodosa (PAN) = vessels
Poststreptococcal glomerulonephritis = post strep infection IgG & C3 deposits on kidney
Fibrinoid necrosis = HTN + vasculitis (Leaking of proteins (fibrin) into vessels → bright pink staining)
46
middle-aged men
Fever + weight loss + abdominal pain
Melena = Dark stools
HTN
renal dysfunction
Biopsy samples = fibrinoid necrosis + renal microaneurysms (a string of pearls)
Polyarteritis nodosa
47
An ______ Coombs test will identify if a woman has Rh antibodies in her serum
indirect
48
Type 2 hypersensitivity rxn
Pemphigus vulgaris = IgG antibodies against desmoglein-1 or desmoglein-3.
49
cytotoxic Type 2 hypersensitivity rxn
Autoimmune hemolytic anemia (AIHA)
50
Type I hypersensitivity rxn → _____ binding to allergens → mast cell degranulation of _______
IgE (Th2 w/ B-cells)
histamine + leukotrienes + tryptase
51
__________ = Th1 cell-mediated response to Ag. Skin: well-demarcated lesions with central hypopigmentation via granulomatous inflammation
Tuberculoid
52
Th2-mediated humoral response to Ag → inhibiting Th1 response Skin: poorly demarcated nodular lesions on cool regions of the body (skin, mucous membranes, genitalia, nerves) → invasion of these structures by the bacilli = Damage
Lepromatous
53
Inability to make new memories (anterograde amnesia)
Global cerebral ischemia
54
Chiari 2 malformation
Herniation of 2 structures = Cerebellum + Medulla
Associated w/ myelomeningocele
Dysphagia + stridor + apnea + limb weakness
55
Tracheal deviation towards dysfunctional side
Atelectasis
56
Albinism is associated w/ the following genetic changes
Epistasis = 1 gene affects the phenotype expression of another gene
Locus heterogeneity = mutation at different loci → same disease
57
Frameshift mutation = deletion/insertion of nucleotide → which disorders
Duchenne muscular dystrophy
Tay-Sachs Disease
58
PLAIN ole Chediak
Progressive neurodegeneration
Lymphohistiocytosis
Albinism
Infections – recurrent pyogenic
Neuropathy – peripheral
Chediak-Higashi Syndrome
59
CRITOE
Capitellum
radial head
internal (medial) epicondyle
Trochlea
Olecranon
external (lateral) epicondyle
Order of ossification
60
Seizures
mild intellectual disability
history of a cardiac rhabdomyoma
hypopigmented macule ("ash leaf" spots)
angiofibroma
tuberous sclerosis = TSC1 or TSC2 genes (AD)
60
______________ → Gagging + Cyanosis w/ Feeding & Normal XR
Tracheoesophageal Fistula
61
Bacillus Anthracis morphology
Spore Forming Gram Positive Rod
62
Hepcidin Inhibits Intestinal Iron Absorption in
Anemia Of Chronic Disease
63
Which of the following correctly describes the passage of light from the environment to the retina?
Cornea → aqueous humor → pupil → lens → vitreous body → retina
64
Nephrotic syndrome sx
Phospholipase A2 receptor Ab (linked to clots)
Membranous nephropathy
65
p-ANCA Ab
Anti-myeloperoxidase (anti-MPO)
66
c-ANCA Ab
Anti-proteinase 3 (anti-PR3)
67
Signs of Nephritic syndrome
Fibrin crescents + C3b + Leukocytic infiltrates
ANAC +
Rapidly progressive glomerulonephritis (RPGN)
68
Capillary looping
Joint pain
Blood in urine
Diffuse proliferative glomerulonephritis
69
lesions on butt or thighs
Arthralgias = joint pain
Ab pain
Red urine
HSP → IgA deposits
70
Sore throat
Blood in urine weeks laters
PSGN
71
Sore throat or viral infection or GI infection
Blood in urine 1-3 days laters
IgA nephropathy
72
Nephritic syndrome findings =
Hematuria
Oliguria
Azotemia = high nitrogen compounds in the blood (BUN)
HTN
73
If on biopsy subendothelial deposits are discovered
Pt has either
Membranoproliferative
Diffuse proliferative
74
Dilated renal pelvis
Dilated collecting system = calyces + collecting ducts
Ureters NOT dilated
Incomplete recanalization of proximal ureter
75
Which ligament is folded peritoneum enclosing FT
Broad ligament
75
Past viral infection
Multiple bruises + Petechiae + Bleeding gums
anti-GpIIb/IIIa Ab (type II hypersensitivity rxn)
Increased megakaryocytes - BM biopsy
Decrease Platelet count
Idiopathic thrombocytopenic purpura
76
AD syndrome associated with a variety of tumors:
1. hemangioblastoma (cerebellum and spine)
2. retinal angiomas
3. clear-cell RCC (adenocarcinoma)
4. Pheochromocytoma
5. serous cystadenomas
6. neuroendocrine tumors of the pancreas
7. papillary cystadenomas of epididymis + broad ligament
Polycystic kidney disease = Von Hippel-Lindau syndrome (VHL)
77
Low levels of hypocretin-1 in CSF
shortened REM sleep
Narcolepsy
78
Mitral stenosis → ______ LA pressure + ______ pulmonary artery pressure (_________)
Increased pressures
Pulmonary edema
79
Amyloid deposition in cortical blood vessels
Congo red staining plaques in hippocampus
Alzheimer dementia = slow progressive memory loss
80
64M
Vertebral artery = retrograde flow
dx
Subclavian steal syndrome
81
TIBC low means
iron is bound = abnormal iron utilization
82
55M
watery diarrhea
Stool Ziehl-Neelsen stain = acid-fact organism
Cryptosporidium parvum
83
Ziehl-Neelsen stain
Carbol fuchsin = Acid fast bacteria
Mycobacteria = mycolic acid in cell wall in disseminated infection
Nocardia = mycolic acid in cell wall
Cryptosporidium = protozoa oocytes (stool)
84
Infant w/ edema + Turners syndrome
lymphedema due to lymphatic network dysgenesis
85
Tetrahydrobiopterin BH4 =
cofactor = Dopamine + Serotonin
Phenylalanine hydroxylase deficiency = hypopigmented
Tyrosine hydroxylase = mood + appetite + sleep + muscle contraction changes
86
Bevacizumab
binds to vascular endothelial growth factor (VEGF)
87
26F prego
PE
LMWH therapy
renal vein thrombosis
HITT = Ab against platelet factor 4 (IgG)
88
14monthM
difficulty sitting unsupported
megaloblastic anemia
Orotic acid crystals in urine
Tx
Hereditary orotic aciduria (AR) = UMP synthase deficient
tx = Uridine supplementation
89
Mifespristone
partial progesterone agonist = placental separation + uterine contractions
90
Misopreostol
Prostaglandin E1 agonist = uterine contractions
91
Intracellular pathogens are eliminated by
cell-mediated immune responses
92
Some
Nasty
Bugs
May
Live
FacultativeLY
Some = Salmonella
Nasty = Neisseria
Bugs = Brucella
May = Mycobacterium
Live = Listeria
FacultativeLY = Francisella +Legionella + Yersinia
93
Coxiella's
Really
Chilling
inside
Coxiella's = Coxiella
Really = Rickettsia
Chilling = Chlamydia
Inside = Obligate intracellular
94
PPRP synthetase gene caues
increases in purines = joints being affected
95
NSAIDs given to acute gouty arthritis
directly inhibits neutrophils
95
p-glycoprotein efflux pump
ATP-dependent transportor
96
Recurrent epistaxis
Cutaneous telangiectasias
S2 ULSB
dx
Hereditary hemorrhagic telangiectasia = Rendu-Osler-Weber syndrome
AD = TGF-b mutation
causes HF + pulmonary htn + paradoxic embolism + iron deficiency anemia
97
62M
Focal UE weakness
Sx resolve spontaneously
Smoking history
140/84
dx
tx
TIA = transient ischemia attack = resembles a stoke
tx: Statin = helps reduce artherosclerotic plaque formation
98
Pt w/ GCA are at an increase risk of blindness b/c
ischemic optic neuropathy = GCA affects medium + small vessels --> ischemia
99
TATA box
promoter resion = RNA poly 2 knows where to start transcription
100
Hospice care is an option for pt w/
a prognosis of less than 6 months
101
Organisms resistant to PBP thus resistant to Cephalosporins
Listeria
MRSA
Enterococci
102
Chlorpheniramine
1st generation antihistamine = easily penetrates the CNS
103
-trozole
aromatase inhibitors = suppressions ovarian estradiol production
104
Cilostazol
Phosphodiesterase inhibitor
inhibits platelet aggregation + direct arterial vasodilation
105
Argatroban
tx = heparin-induced thrombocytopenia
direct thrombin inhibitor
106
28M
anesthesia
muscle rigidity
130/min
Tachycardia
dx
tx
Malignant hyperthermia
Tx: inhibit sarcoplasmic Ca++ release in skeletal muscles (Dantrolene)
107
Phenoxybenzamine
irreversible a1 & a2 receptors
stop NE
108
DRESS = rash + swelling caused by
Anticonvulsants
Sulfonamides
Abx
Allopurinol
109
Phentolamine
a blockers = vasodilation
110
65M = new-onset confusion + lack of urine output
BPH
HTN
Hyperlipidemia
DM2
Insomnia
which med could cause sx
TCA = insomnia + adjunctive pain management
111
Rx reduces
1. Uterine contractions + serum K+ levels
B2 agonist
Beta agonist = pushes K+ into the cell
B2 = found on smooth muscles --> relaxation
112
Milrinone
PDE3 inhibitor = increased cAMP = positive inotropy = vasodilation (reduces preload + afterload)
112
Isoproterenol
B1 & B2 agonist
decrease TPR & positive inotropy
113
Labetalol
nonselective beta blocker = vasodilation affecting heart
alpha1 blocker = decrease TPR
114
Metolazone
Thiazide
115
Etomidate
GABA agonist = sedation + amnesia
adrenocortical suppressive by inhibiting cortisol production
116
Propofol
GABA agonist = lipophilic
increases TG + lipase & vasodilation
117
Rapid onset of action + short duration anesthesia
Propofol = GABA agonist
Etomidate = GABA agonist
Ketamine = NMDA antagonist
118
Ketamine
NMDA antagonist -->
stimulation of catecholamines (SANS) =
1. bronchodilation
2. tachy
3. Positive inotrophy
3. Cerebral blood flow
119
IgM agglutinin in the cold & has low affinity IgM Ab in 37C
Mycoplasma pneumoniae
120
ST elevation + PR segment depression
children + viral infection
Chest pain worsens in recumbent position
Pericardial inflammation
121
Deficiency in factor 8 = Hemophilia A --> bleeding following minor trauma or _______
1. bleeding into joint
2. bleeding in CNS
3. bleeding in retroperitoneal = retroperitoneal hematoma
122
Bile acid sequestrant -->
diverting additional cholesterol = Cholesterol to cholate
123
Tachycardia =
decrease time for filling =
1. low EDV
2. decrease length in diastole
3. low SV
4. low CO
124
Blocking Na+ channel blockade =
