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uWorld 23 Flashcards

1
Q

what are the features of the third heart sound (S3)

A

ventricular GALLOP sound (AFTER S2)
heard during RAPID FILLING of ventricles in diastole
turbulent blood flow to the ventricles due to increased volume

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2
Q

when is S3 normal and abnormal

A

normal: children, YOUNG adults, PREGNANCY

abnormal: 
over age 40
HF
RESTRICTIVE cardiomyopathy
HIGH-OUTPUT states (thyrotoxicosis)
enlarged ventricular chamber (DILATED CARDIOMYOPATHY)
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3
Q

what are the features of the fourth heart sound (S4)

A

LOW FREQUENCY LATE DIASTOLIC SOUND- atrial gallop sound (BEFORE S1)

after onset of P wave on EKG

heard immediately AFTER ATRIAL CONTRACTION PHASE as blood is forced into a stiff ventricle

sign of DIASTOLIC DYSFUNCTION

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4
Q

when is S4 normal and abnormal

A

normal: healthy OLDER adults

abnormal:
younger adults, children
VENTRICULAR HYPERTROPHY
acute MI

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5
Q

when is a left sided S4 heard best

A

cardiac apex with patient in left lateral decubitus position

intensify during expiration due to increased blood flow from the lungs to the left atrium

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6
Q

what is caudal regression syndrome and when is it seen

A

pts born with agenesis of the sacrum and occasionally lumbar spine
FLACCID PARALYSIS of the legs, DORSIFLEXED CONTRACTURES of the FEET, and URINARY INCONTINENCE

related to poorly controlled MATERNAL DIABETES

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7
Q

where is the lowest pH along the nephron (aka the location uric acid stones would precipitate)

A

DISTAL TUBULES and COLLECTING DUCTs

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8
Q

what are the 3 ways of getting Down Syndrome

A

MEIOTIC NONDISJUNCTION
Robertsonian translocation (balanced has HIGH RECURRENCE RISK- genetic counseling for parents)
mosaicism

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9
Q

what are the early signs of graft vs host disease (GVHD)

A

maculopapular rash that has a predilection for the palms and soles and may DESQUAMATE in severe cases
GI tract involvement causes DIARRRHEA, BLEEDING, and PAIN

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10
Q

what are the valvular lesions seen in rheumatic heart disease

A

early: mitral REGRUGITIATION
late: mitral STENOSIS

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11
Q

how can rheumatic heart disease be prevented

A

prompt treatment of strep pharyngitis with PENICILLIN

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12
Q

what is seen in biotin deficiency

A

role in carboxylation reaction

rash, hair loss, neuropsychiatric defects

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13
Q

what is seen in seen in pyridoxine (B6) deficiency

A

cheilosis
glossitis
dermatitis
peripheral neuropathy

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14
Q

what is seen in riboflavin (B2) deficiency

A 
angular stomatitis
cheilitis
glossitis
seborrheic dermatitis
eye changes (keratitis, corneal neovascularization)
Korsakoff psychosis
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15
Q

what is seen in zinc deficiency

A

acrodematitis enteropathica
growth retardation
infertility

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16
Q

what do spliceosomes remove at the 5’ and 3’

A

INTRONS continuing GU at the 5’ splice site and AG at the 3’ splice site

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17
Q

late onset asthma is seen in what condition

A

Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss): MPO-ANCA aka p-ANCA

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18
Q

what is mononeuritis multiplex

A

asymmetric multifocal neuropathy
particularly common in Churg Strauss due to the VASCULITIS affecting the epieneural vessels (wrist drop due to radial nerve involvement)

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19
Q

what antibodies are highly specific for systemic sclerosis

A

antitopoisomerase I (Scl-70)
anticentromere
anti-RNA polymerase III

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20
Q

capacity to refuse treatment requires what ability to do what

A

express choice
understand the relevant medical information
appreciate the consequence s of treatment options
offer a rationale for the decision

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21
Q

what is the most commonly delayed milestone

A

language

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22
Q

what should be done in a patties with suspected isolated language disorder

A

HEARING examination

speech and language evaluation

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23
Q

increase in skeletal muscle blood flow, glyocgenolysis, and lipolysis can be done via what receptor

A

beta 2

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24
Q

classic presentation of legionella infection leading to legionnaire’s disease

A

ver high fever in a smoker accompanied by
diarrhea
confusion
cough that may initially be only slightly productive

HYPONATREMIA

TX; fluoroquin or macrolide

25
Q

what is the major function of the paraventricular nuclei in the hypothalamus

A 
secretion of:
ADH
CRH
Oxytocin
TRH
26
Q

what is the job of the supraoptic nuclei of the hypothalamus

A

ADH and oxytocin secretion

27
Q

what does the arcuate nuclei of the hypothalamus do

A

secretion of dopamine (inhibits prolactin)
GHRH
Gn-RH

28
Q

what is a uterine leiomyoma (fibroid)

A

monoclonal tumor (each one is derived from a distinct progenitor cell)

can be located on serial surface of uterus (subserosal), within the uterine wall (intramural) and below the endometrium (submucosal)

irregular UTERINE ENLARGEMENT from fibroids can put pressure on adjacent organs causing BULT-RELATED SYMPTOMS

POSTERIOR FIBROIDS- constipation that can be relieved by “splinting” to defecate- manual deflection of the obstruction

29
Q

what are pelvic organ prolapse symptoms

A

pelvic pressure- “feeling a bulge or that something is falling out of the vagina”

30
Q

posterior vaginal wall prolapse (rectocele) can cause

A

constipation
splinting- manual deflection of the obstruction- is common
no uterine enlargement

women at low risk are: premenopausal, non obese, nulliparous

31
Q

what is the course of the pudendal nerve

A

passes b/w the PIRIFORMIS and COCCYGEUS muscles as it exits the pelvis through the GREATER SCIATIC foramen
reenters the pelvis near the ISCHIAL SPINE through the LESSER SCIATIC foramen prior to dividing into its terminal branches

32
Q

what is seen in cauda equina syndrome

A

neurosurgical emergency resulting from compression of spinal cord nerve roots below the conus medullaris

severe bilateral radicular pain, saddle anesthesia, and hyporeflexia

bowel and bladder incontinence are late manifestations

33
Q

what and when would one get an epidural hematoma after a epidural anesthesia

A

presents within 5 hours to days following procedure

sudden onset of back pain or radicular pain with progression to complete or partial paralysis of the lower extremities

34
Q

what is lumbosacral plexopathy

A

occurs during fetal descent as a result of direct compression of the lumbosacral trunk

foot drop and numbness of the lateral aspect of the leg and the dorms of the food

typically transient (most resolve w/in a year)

35
Q

what oral diabetic medication can cause can cause HYPOGLYCEMIA

A

SULFONYLUREAS (increase insulin secretion by beta-islet cells independent of glucose concentration)

HIGH incidence with GLYBURIDE and GLIMEPIRIDE (long-acting)

ask increases with exercise, missed meals, chronic malnourishment, or organ dysfunction, or after hospital admission\

LOW incidence with GLIPIZIDE (short acting)

36
Q

how does acarbose work

A

alpha-glucosidase inhibitor

decreases intestinal glucose absorption and blunts the postprandial rise in serum glucose

37
Q

what is sitagliptin

A

dipeptidyl peptidase 4 (DPP-4) inhibitor
decreases glucose utilization by peripheral cells and increases beta cell insulin release
glucose-dependent effect

38
Q 
headaches (retroorbital) w/ photophobia 
pneumonia
fever (more than 10 days)
fatigue
myalgia

da fuq is it??

A

Q FEVER

Coxiella burnetti

also see THROMBOCYTOPENIA and increased liver enzymes

chronic is fatal and presents as infectious endocarditis in people with valvular disease

39
Q

progressively weakening diaphragmatic contractions during maximal voluntary ventilation with intact phrenic nerve stimulation indicate…

A

neuromuscular junction pathology (myasthenia gravis)

and/or abnormally rapid diaphragmatic muscle fatigue (restrictive lung or chest wall disease)

40
Q

what is Ondine’s curse

A

impatient of the respiratory control centers in the brainstem can result in decreased frequency and.or amplitude of involuntary respirations

voluntary breathing would be unaffected

41
Q

what is the most common cause of alarming bloody or serosanguineous (blood-tinged) nipple discharge

A

INTRADUCTAL PAPILLOMA

no associated breast mass or skin changes

proliferation of papillary cells in a duct or cyst wall with a fibrovascualr core and may contain foci of atypia or ductal carcinoma in situ

bloody discharge results from twisting of the vascular stalk of the papilloma in the duct

42
Q

what is the most common defect in beta oxidation of fatty acids (in mitochondria)

A

acyl-CoA dehydrogenase deficiency

HYPOKETOTIC HYPOGLYCEMIA after a period of fasting

Tx: avoid prolonged fasting as well as promptly supplying glucose during periods of illness

carnitine (transports fatty acids into mitochondria) deficiency is very similar

43
Q

more than half of patients with a subarachnoid hemorrhage develop what

A

secondary arterial VASOSPASM

presents with new-onset neurological deficit or confusion 4-12 days after initial insult

impaired brain auto regulation

color doppler needed to see it

44
Q

diagnosis of primary anxiety disorders requires ruling out what

A

substance induced etiologies
medical-induced etiologies: symptoms are the physiological consequences of an underlying medical condition (i.e. hyperthyroidism)

new onset with no prior psychiatric history and prominent findings on physical exam

45
Q

what conditions can cause medical-induced anxiety

A 
hypoglycemia
hyperthyroidism
pheochromocytoma
hypercortisolism
cardiac arrhythmias
46
Q

increase in estrogen activity (pregnancy, oral contraceptive, postmenopausal HRT) does what to thyroid hormone levels

A

↑ TBG levels
in pts with normal hypothalamic pituitary thyroid axis, a transient ↑ in TSH will lead to ↑ THYROID HORMONE PRODUCTION to saturate the increased TBG and RESTORATION OF HOMEOSTASIS

levels of free thyroid hormone stays normal but total is ↑ b/c more is bound

47
Q

the supraspinatus tendon is prone to impingement where during abduction

A

b/w humoral head and acromion

48
Q

extension of the humerus is done by what muscles

A

latissimus dorsi
posterior deltoid
heres major

49
Q

adduction of the humerus is done by what msucles

A 
latissimus dorsi
pectorals major
coaracobrachialis
subscapularis
teres major and minor
50
Q

flexion of the humerus at the shoulder is done by what muscles

A

pectorals major
coracobrachialis
biceps brachii
anterior deltoid

51
Q

what rotator cuff muscle internal rotates the humerus

A

subscapularis

52
Q

what happens to radial traction in emphysema and pulmonary fibrosis

A

emphysema: ↓

pulmonary fibrosis: ↑

53
Q

increase in chest wall recoil does what to the expiratory flow rates

A

decreases expiratory flow rates- respiratory muscles have to work harder during expiration to oppose the increased outward force

54
Q

what effect does increased thickness of the wall have on expiratory flow rates

A

decreases expiratory flow rates b/c the radius of conducting airways is smaller

55
Q

levels of what immunoglobulin is different in patients treated with the two different polio vaccines

A

duodenal luminal IgA

serum IgA is the same with both vaccines

56
Q

what part of the spinal cord is destroyed in syringomyelia

A

central portion (a cyst there)

bilateral loss of pain an temp (lateral spinothalamics)

maybe flaccid paralysis and atrophy of the intrinsic muscles of hand (anterior horn)

57
Q

epithelial ovarian cancer is strongly associated with increased levels of what

A

CANCER ANTIGEN 125 (CA-125)

58
Q

what is gamma hemolytic and PYR positive

A

Enterococci

also grow in bile and on 6.5 NaCl

negative urinalysis for nitrites (unable to convert nitrates to nitrites)

uWorld Flashies (62 decks)

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