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uWorld 28 Flashcards

1
Q

what happens if you administer naloxone to a patine already in withdrawal

A

more severe withdrawal symptoms and potentially cause SEIZURES

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2
Q

neural tube defects occur due to FAILED FUSION of the neural tube during the 4th week of fetal development; what can be seen in the AMNIONIC FLUID due to leakage of fetal CSF

A

ALPHA-FETOPROTEIN (AFP)- crosses the placenta so can be measured in mothers serum

ACETYLCHOLINESTERASE

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3
Q

duodenal atresia is an example of failure of what

A

apoptosis

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4
Q

Hirschsprung’s disease is an example of failure of what

A

failure of migration

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5
Q

what cofactor is required for ALA synthase and thus a deficiency can cause microcytic hypochromic anemia

A

PYRIDOXINE (B6)

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6
Q

what are the side effects of using dihydropyridine calcium channel blockers (amlodipine, nifedipine) as antihypertensive mediations

A

PERIPHERAL EDEMA- related to preferential dilation of pre capillary vessels (arteriolar dilation), which leads to increased capillary hydrostatic pressure
-ACEI can normalize the increased hydrostatic pressure via post capillary venodilation

dizziness or lightheadedness
flushing

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7
Q

what prevents the SUPERFICIAL and what prevents the HEMATOGENOUS spread of CANDIDA

A

superficial: T LYMPHOCYTES
hematogenous: NEUTROPHILS

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8
Q

disseminated candidiasis (candidaemia, endocarditis) is more likely in what patients

A

those with NEUTROPENIA (since neutrophils protect against hematogenous spread of Candidia)

otherwise immunocompromised (cancer with chemotherapy)

those with inherited IMPAIRMENTS of pHAGOCYTOSIS

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9
Q

a T cell deficiency like AIDS predisposes one to what kind of Candida infection

A

SUPERFICIAL (oral/esophageal candidiasis, cutaneous candidiasis, Candida vulvovaginitis)

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10
Q

what is EFFECT MODIFICATION

A

when the effect of an exposure on an outcome is modified by another variable (not a bias)

EX: smoking status modified the effect of the new estrogen receptor agonist (exposure) on DVT incidence (outcome).

Smokers had a higher risk (RR over 1 and p value less than 0.05) while nonsmokers did not (p-value greater than 0.05)

a natural phenomenon that should be DESCRIBED NOT CORRECTED

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11
Q

what does a RR greater than one and a P less than 0.05 mean

A 
increased risk (RR over 1)
statistical significance (p less than 0.05)
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12
Q

effect modification is easily confused with what

how are they separated

A

easily confused with CONFOUNDING

STRATIFIED ANALYSIS (analyzing the cohort as different subgroups) can help distinguish b/w the two

with effect modification, the different strata will have different measures of association (one p-value less than 0.05 and one above 0.05)

with confounding, stratification usually reveals no significant difference between the strata (both when separated will have p-values less than 0.05)

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13
Q

what is a confounder

A

something that is associated with both exposure and outcome and affects the measure of association b/w the exposure and outcome, such that there initially appears to be a statistically significant association b/w the 2 on crude analysis, but once STRATIFIED by the confounding variable, the association disappears

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14
Q

what are the most common pathogens causing nosocomial bloodstream infections

A

coagulase-negative staph
staph aureus
enterococci
candida species

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15
Q

indwelling central catheters predispose patients to what

A

bacteremia
sepsis
should be monitored regularly for signs and symptoms of infection

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16
Q

what are the 3 most predisposing factors for hypoglycemia in a patient with type 1 diabetes

A

excessive insulin dose
inadequate food intake
physical activity/exercise

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17
Q

why does exercise cause hypoglycemia in T1DM

A

if pt is on EXOGENOUS INSULIN the insulin will continue to be released form the injection site during exercise despite falling glucose levels

normally as glucose goes down in exercise, this stops the release of insulin and counter-regulatory hormones (glucagon) will increase endogenous glucose production via gluconeogenesis and glyogenolysis

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18
Q

what up regulates GLUT-4 in skeletal muscle

A 
INSULINE
MUSCLE CONTRACTION (NO, AMP-activated kinase, Ca-calmodulin-activated protein kinase)
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19
Q

what does “degenerate” mean when referring to genetic code

A

more than 1 codon can code for a particular amino acid

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20
Q

what is the wobble hypothesis s

A

certain tRNA can recognize MULTIPLE DIFFERENT CODONS coding for the SAME ANIMO ACID

first 2 nucleotides require traditional watson crick base pairing, the third “wobble” spot may undergo less stringent (nontraditional) base pairing

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21
Q

what is the adherence site for DEXTRAN from strep viridans

A

FIBRIN/PLATELET aggregates (which are deposited at sites of endothelial damage)

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22
Q

what factors are associated with better TREATMENT ADHERENCE in an adolescent

A

CLOSE PEERS WITH COMPLEMENTARY BEHAVIORAL PRACTICES
positive family functioning
physician empathy
immediate benefits of treatment

adolescents are also less able to weight the risks and benefits of their decision b/c prefrontal cortex (center of executive function) is not fully formed until 3rd decade of life

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23
Q

what is the difference between TRACTION and PULSION diverticula (a way of classification)

A

TRACTION: created by inflammation and subsequent scarring of the gut wall, which typically results in pulling and out pouching of ALL gut wall layers (TRUE DIVERTICULA)

PULSION: increased intraluminal pressure created during strained bowel moments (due to chronic constipation or something) causes the MUCOSA and SUBMUCOSA to herniate through areas of focal weakness in the muscularis (FALSE DIVERTICULA)

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24
Q

diverticulosis most commonly affects where

A

SIGMOID COLON and is usually seen in peeps over 60

most peeps asymptomatic but can present with HEATOCHEZIA due to disruption of the arterioles adjacent to the diverticula

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25
what are the symptoms of diverticulosis
LEFT LOWER quadrant pain low-grade fever constipation or diarrhea due to INFLAMMATION
26
where and from what would one see a traction diverticula
mid esophagus | mediastinal lyphadenitiis caused by TB or final infection
27
the graph of serum creatinine and GFR looks like what
not linear (serum creatinine begins to rise sharply at GFR below 60 when GFR is normal, relatively large decreased in GFR result in only small increases in serum creatine when the GFR is significantly decreased, small decrement in GFR produce relatively large changes in serum creatine every time GFR halves, serum creatinine doubles
28
what substances undergo no tubular reabsorption or secretion (filtered amount = excreted amount)
INULIN | mannitol
29
what substances undergo net tubular reabsorption (excreted amount
glucose sodium urea
30
what substances undergo net tubular secretion (excreted amount >> filtered amount)
PAH | creatinine
31
transduction of mechanical sound waves into nerve impulses occurs where
ORGAN of CORTI 1. sound reaches middle ear by vibrating the tympanic membrane 2. the vibration is transferred to the oval window by the ossicles 3. vibration of the oval window causes vibration of the basilar membrane, which in turn causes bending of the hair cell cilia against the tectorial membrane 4. hair bending causes oscillating hyperpolarization and depolarization of the auditory nerve, thereby creating nerve impulses from sound
32
NOISE INDUCED hearing loss results from what
trauma to the STEREOCILIATED HAIR CELLS of the ORGAN of CORTI HIGH-FREQUENCY hearing is lost FIRST (regardless of frequency of sound causing it) bilateral
33
what is the cochlear cupula
apex of the cochlea and is distant form the oval window | the distal cochlea primly registered LOW-FREQUENCY sound
34
where do meningiomas tend to arise
DURAL REFLECTIONs (fall cerebra, tentorium cerebelli) slow-growing (benign) intracranial tumor typically of adult may present with SEIZURE, headache, or focal neurologic deficits depending on size and location
35
what is thoracic outlet syndrome (TOS)
COMPRESSION of the LOWER trunk of the BRACHIAL PLEXUS as it passes through the THORACIC OUTLET presents with: upper extremity numbness, tingling, and weakness upper extremity swelling (compression of SUBCLAVIAN VEIN) exertional arm pain (compression of SUBCLAVIAN ARTERY) most commonly occurs in SCALENE TRIANGLE
36
what is the scalene triangle
formed by the anterior and middle scalene muscles and the first rib the brachial plexus TRUNKS and subclavian ARTERY pass b/w the anterior and middle scenes; the subclavian vein runs anteromedial to the triangle
37
where do the anterior and middle scalene originate and insert
anterior: C3-C6 transverse processes and attaches to the scalene tubercle of the first rib posterior: C2-C7 transverse processes and inserts into the posterior of the first rib
38
what can cause thoracic outlet syndrome (TOS)
anomalous cervical rib (extra one) scalene muscular anomalies injury (repetitive overhead arm movements, trauma)
39
all antidepressants carry a risk of inducing what into susceptible patients
``` MANIA bipolar I (manic episodes) are at greater risk ```
40
what is the most important factor in determining prognosis of bladder cancer
TUMOR STAGE and depends on the DEGREE of INVASION into the bladder wall and adjacent tissues
41
malformed teeth (Hutchinsons incisors and mulberry molars) are typical late manifestations of what congenital bug
SYPHILIS
42
what is seen histologically in an amnionic fluid embolism (AFE) and what are signs of it
FETAL SQUAMOUS CELLS and MUCIN in the MATERNAL PULMONARY ARTERIES hypoxia hypotensive shock DIC
43
what drugs would exacerbate myopathy caused by statins (hint: think about metabolism)
statins are metabolized by CYP450 so CYP450 inhibitors would decrease statin metabolism thus increasing the serum concentration and thus increased risk for myopathy ketoconazole, erythromycin, HIV protease inhibitors, grapefruit juice, cyclosporine, INH
44
the immune reaction of TB is mediated by what
Th1 cells caveating granuloma made up of: T lymphocytes epithelioid activated macrophages Longhand giant cells (with horseshoe shaped arrangement of nuclei) proliferating fibroblasts (synthesize collagen)
45
in a patient successfully being treated for eczema with corticosteroid cream, what is seen at the site of application of the cream
dermal atrophy/thinning associated with the loss of dermal collagen, drying, cracking, and/or tightening of the skin, telangiectasis, and ecchymosis
46
what are the histologic findings of eczema
intraepidermal vesicles superficial epidermal hyperkeratosis producing scales epidermal hyperplasia (acanthosis) chronic inflammatory infiltrate within the dermis
47
what does entcapone do
stops the peripheral breakdown of levodopa to 3-OMD by blocking COMT- increases levodopa bioavailability to the brian Tolcapone works both peripherally and centrally used in Parkinson's pts who experience end-of-dose "wearing off" periods with levodopa/carbidopa therapy
48
what parkinson drug likely enhances the endogenous effects of dopamine
AMANTADINE- increases dopamine synthesis/release and inhibiting the reuptake of dopamine
49
acute joint pain, swelling, and erythema with restricted range of motion is consistent with what
SYNOVITIS ``` potential causes: septic arthritis (gonococcal, nongonococcal) crystal arthropathy (gout) hemarthrosis rheumatic disease ```
50
acute synovitis is best evaluated how
DIAGNOSTIC ARTHROCENTESIS and SYNOVIAL FLUID analysis fluid should be sent for: crystal analysis, cell count, Gram stain, and culture
51
what happens to a strawberry-type capillary hemangioma (juvenile hemangioma)
they FIRST GROW then they typically spontaneously REGRESS at or before puberty (usually start to fate between 1-3 years, and regress by 7 in 95% of cases) lesion consists of unencapsulated aggregates of closely packed, thin-walled capillaries can occur in liver, spleen, and kidneys
52
what would a uterine specimen show if a patient has an ectopic pregnancy
DECIDUALIZED ENDOMETRIUM- DIALTED, COILED endometrial glands and VASCUALRIZED EDEMATOUS STROMA occur int he luteal phase of the menstrual cycle, under the influence of PROGESTERONE, as the endometrium prepares for implantation embryonic trophoblastic tissue will be absent
53
tubal ligation (permanent sterilization) is a risk factor for what
ECTOPIC PREGNANCY
54
methotrexate can cause both lung and liver toxicity, what is recommended for baseline
baseline chest x-ray and liver function tests are recommended
55
classic galactosemia is caused by what
galactose-1-phosphate metabolism galactose-1-phosphate uridyl transferase (GALT) is deficiency (no production of UDP-galactose and glucose-1-phosphate)
56
untreated galactosemia can cause what and why
irreversible eye and liver damage | build up of galacticol in cells
57
hematogenous osteomyelitis usually affects what part of the bone
METAPHYSIS of long bones (of young boys usually)
58
what is chronic suppurative osteomyelitis
a condition in which necrotic bone (sequestrum) serves a reseviro for infection and becomes covered by a poorly constructed shell of new bone called an INVOLUCRUM one or more sinus tracts develop to drain the purulent material into the soft tissue or out to the skin TX: antibiotics and debridement of necrotic bone
59
who is melanoma characterized on gross inspection (ABCDE)
``` Asymmetric shape irregular or jagged Border variability of Color Diameter (greater than 0.5-1cm) Evolution in size and appearance over time ```
60
histologically what does melanoma look like
melanoma cells congregate in poorly formed nests and are large with irregular nuclei, clumped chromatin, and prominent nucleoli
61
what is the most important prognostic factor in malignant melanoma
BRESLOW Depth
62
multinucleate giant melanocytes are a characteristic finding in what
lentigomeligna melanoma

uWorld Flashies (62 decks)

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