uWorld 23 Flashcards
what are the features of the third heart sound (S3)
ventricular GALLOP sound (AFTER S2)
heard during RAPID FILLING of ventricles in diastole
turbulent blood flow to the ventricles due to increased volume
when is S3 normal and abnormal
normal: children, YOUNG adults, PREGNANCY
abnormal: over age 40 HF RESTRICTIVE cardiomyopathy HIGH-OUTPUT states (thyrotoxicosis) enlarged ventricular chamber (DILATED CARDIOMYOPATHY)
what are the features of the fourth heart sound (S4)
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
when is S4 normal and abnormal
normal: healthy OLDER adults
abnormal:
younger adults, children
VENTRICULAR HYPERTROPHY
acute MI
when is a left sided S4 heard best
cardiac apex with patient in left lateral decubitus position
intensify during expiration due to increased blood flow from the lungs to the left atrium
what is caudal regression syndrome and when is it seen
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
where is the lowest pH along the nephron (aka the location uric acid stones would precipitate)
DISTAL TUBULES and COLLECTING DUCTs
what are the 3 ways of getting Down Syndrome
MEIOTIC NONDISJUNCTION
Robertsonian translocation (balanced has HIGH RECURRENCE RISK- genetic counseling for parents)
mosaicism
what are the early signs of graft vs host disease (GVHD)
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
what are the valvular lesions seen in rheumatic heart disease
early: mitral REGRUGITIATION
late: mitral STENOSIS
how can rheumatic heart disease be prevented
prompt treatment of strep pharyngitis with PENICILLIN
what is seen in biotin deficiency
role in carboxylation reaction
rash, hair loss, neuropsychiatric defects
what is seen in seen in pyridoxine (B6) deficiency
cheilosis
glossitis
dermatitis
peripheral neuropathy
what is seen in riboflavin (B2) deficiency
angular stomatitis cheilitis glossitis seborrheic dermatitis eye changes (keratitis, corneal neovascularization) Korsakoff psychosis
what is seen in zinc deficiency
acrodematitis enteropathica
growth retardation
infertility
what do spliceosomes remove at the 5’ and 3’
INTRONS continuing GU at the 5’ splice site and AG at the 3’ splice site
late onset asthma is seen in what condition
Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss): MPO-ANCA aka p-ANCA
what is mononeuritis multiplex
asymmetric multifocal neuropathy
particularly common in Churg Strauss due to the VASCULITIS affecting the epieneural vessels (wrist drop due to radial nerve involvement)
what antibodies are highly specific for systemic sclerosis
antitopoisomerase I (Scl-70)
anticentromere
anti-RNA polymerase III
capacity to refuse treatment requires what ability to do what
express choice
understand the relevant medical information
appreciate the consequence s of treatment options
offer a rationale for the decision
what is the most commonly delayed milestone
language
what should be done in a patties with suspected isolated language disorder
HEARING examination
speech and language evaluation
increase in skeletal muscle blood flow, glyocgenolysis, and lipolysis can be done via what receptor
beta 2
classic presentation of legionella infection leading to legionnaire’s disease
ver high fever in a smoker accompanied by
diarrhea
confusion
cough that may initially be only slightly productive
HYPONATREMIA
TX; fluoroquin or macrolide
what is the major function of the paraventricular nuclei in the hypothalamus
secretion of: ADH CRH Oxytocin TRH
what is the job of the supraoptic nuclei of the hypothalamus
ADH and oxytocin secretion
what does the arcuate nuclei of the hypothalamus do
secretion of dopamine (inhibits prolactin)
GHRH
Gn-RH
what is a uterine leiomyoma (fibroid)
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
what are pelvic organ prolapse symptoms
pelvic pressure- “feeling a bulge or that something is falling out of the vagina”
posterior vaginal wall prolapse (rectocele) can cause
constipation
splinting- manual deflection of the obstruction- is common
no uterine enlargement
women at low risk are: premenopausal, non obese, nulliparous
what is the course of the pudendal nerve
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
what is seen in cauda equina syndrome
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
what and when would one get an epidural hematoma after a epidural anesthesia
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
what is lumbosacral plexopathy
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)
what oral diabetic medication can cause can cause HYPOGLYCEMIA
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)
how does acarbose work
alpha-glucosidase inhibitor
decreases intestinal glucose absorption and blunts the postprandial rise in serum glucose
what is sitagliptin
dipeptidyl peptidase 4 (DPP-4) inhibitor
decreases glucose utilization by peripheral cells and increases beta cell insulin release
glucose-dependent effect
headaches (retroorbital) w/ photophobia pneumonia fever (more than 10 days) fatigue myalgia
da fuq is it??
Q FEVER
Coxiella burnetti
also see THROMBOCYTOPENIA and increased liver enzymes
chronic is fatal and presents as infectious endocarditis in people with valvular disease
progressively weakening diaphragmatic contractions during maximal voluntary ventilation with intact phrenic nerve stimulation indicate…
neuromuscular junction pathology (myasthenia gravis)
and/or abnormally rapid diaphragmatic muscle fatigue (restrictive lung or chest wall disease)
what is Ondine’s curse
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
what is the most common cause of alarming bloody or serosanguineous (blood-tinged) nipple discharge
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
what is the most common defect in beta oxidation of fatty acids (in mitochondria)
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
more than half of patients with a subarachnoid hemorrhage develop what
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
diagnosis of primary anxiety disorders requires ruling out what
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
what conditions can cause medical-induced anxiety
hypoglycemia hyperthyroidism pheochromocytoma hypercortisolism cardiac arrhythmias
increase in estrogen activity (pregnancy, oral contraceptive, postmenopausal HRT) does what to thyroid hormone levels
↑ 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
the supraspinatus tendon is prone to impingement where during abduction
b/w humoral head and acromion
extension of the humerus is done by what muscles
latissimus dorsi
posterior deltoid
heres major
adduction of the humerus is done by what msucles
latissimus dorsi pectorals major coaracobrachialis subscapularis teres major and minor
flexion of the humerus at the shoulder is done by what muscles
pectorals major
coracobrachialis
biceps brachii
anterior deltoid
what rotator cuff muscle internal rotates the humerus
subscapularis
what happens to radial traction in emphysema and pulmonary fibrosis
emphysema: ↓
pulmonary fibrosis: ↑
increase in chest wall recoil does what to the expiratory flow rates
decreases expiratory flow rates- respiratory muscles have to work harder during expiration to oppose the increased outward force
what effect does increased thickness of the wall have on expiratory flow rates
decreases expiratory flow rates b/c the radius of conducting airways is smaller
levels of what immunoglobulin is different in patients treated with the two different polio vaccines
duodenal luminal IgA
serum IgA is the same with both vaccines
what part of the spinal cord is destroyed in syringomyelia
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)
epithelial ovarian cancer is strongly associated with increased levels of what
CANCER ANTIGEN 125 (CA-125)
what is gamma hemolytic and PYR positive
Enterococci
also grow in bile and on 6.5 NaCl
negative urinalysis for nitrites (unable to convert nitrates to nitrites)
