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zz - step 3 - uworld > uWorld 3 > Flashcards

uWorld 3 Flashcards

1
Q

most common intra0abdominal organ injured during blunt trauma is

A

SPLEEN (not a foregut derivative but is supplied by an artery of the foregut- splenic artery off the celiac)
intraperitoneal orago derived from the MESODERM of the dorsal mesentery

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2
Q

what is a case-control study

A

designed by selecting patients with a particular disease (cases) and without that disease (controls) and then determining their previous exposure status

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3
Q

what is a cross-sectional study

A

prevalence study
characterized by simultaneous measurement of exposure and outcome
snapshot of study seeing that frequently uses surveys
relatively inexpensive and easy to perform

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4
Q

what is often large and sessile and can have velvety or cauliflower-like projections in the colon

A

Villous Adenoma (long glands with villi-like projections extending from the surface

can SECRETE large amounts of MUCUS leading to SECRETORY DIARRHEA, hypovolemia, and electrolyte abnormalities

most likely adenoma to undergo MALIGNANT TRANSFORMATION

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5
Q

what are tubular adenomas composed of and what do they look like

A

dysplastic colonic mucosal cells that form tube-shaped glands and tend to be smaller and pedunculated

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6
Q

what is a harmatomatous polyp and when are they seen

A

disorganized mucosal glands, smooth muscle, and connective tissue
can cause bleeding and intussusception (not secretory diarrhea)
Pout-Jeghers syndrome
Juvenile polyposis

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7
Q

what is seen histologically in an intestinal carcinoid

A

insular and trabecular assess of monotonous SMALL ROUND CELLS with peripheral palisading, finely granular cytoplasm, small nucleoli, and SALT and PEPPER chromatin

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8
Q

what is a hyperplastic polyp

A

well-differentiated mucosal cells that form glands and crypts
also always asymptomatic

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9
Q

what is projection

A

immature defense mechanism that involves MISATTRIBUTING ONE’S OWN unconscious, undesired thoughts or FEELINGS to ANOTHER person who does not actually have them

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10
Q

erythrocyte glutathione reductase activity may be decreased in patients with what deficiency

A

riboflavin (B2)

FAD is a cofactor used by glutathione reductase to reduce disulfide bonds

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11
Q

pyruvate kinase deficiency presents how

A

AR

congenital hemolytic anemia due to impaired glycolytic ATP generation

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12
Q

erythrocyte transketolase is deficient in what patients

A

B1 (thaimine) deficiency which causes Wernicke-Karsakoff syndrome and beriberi

transketolase is an enzyme of the hexose monophosphate pathway

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13
Q

polyribosylribitol phosphate (PRP) is a major virulence factor of what and what does it do

A

Haemophelus Influenza
capsule which protects bacterium against phagocytosis and complement-mediated lysis by binding FACTOR H ( a circulating complaint control protein that prevents compleknt deposition on host cells)

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14
Q

what is the Hib vaccine

A

PRP conjugated to tetanus toxoid

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15
Q

what is trehalose dimycolate

A

cell wall component and major virulence factor of Mycobacterium tuberculosis
protects M. Tb from being killed by macrophages and simulates granuloma formation

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16
Q

how does toxic shock syndrome toxin (TSST) work

A

SUPERANTIGEN
MACROPHAGES (or another APC) and T CELLS receptor to cause a nonspecific WIDESPREAD activation of T lymphocytes
IL-2 from T cells
IL-1 and TNF from macrophages
capillary leakage, circulatory collapse, hypotension, shock, fever, skin findings, and multi organ failure

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17
Q

what is fetal hemoglobin made up of

A

alpha2gamma2

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18
Q

what is a compilation that can arise form a pudendal nerve block

A

inadvertent injection into internal pudendal artery or inferior gluteal artery (run medial to the PN) can lead to HEMATOMA or ARRHYTHMIA from intravascular infiltration of local anesthetics
landmarks: ISCHIAL SPINES and SACROSPINOUS LIGAMENT

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19
Q

the pudendal nerve is derived from what roots and provides sensory to what and mortar to what

A

S2-S4

sensory: genials and perineum
motor: sphincter urethrae and external anal sphincter

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20
Q

what is the course and innervation of the genitofemoral nerve

A

courses along the anterior surface of the psoas muscle
innervates scrotum/labia majora and the medal thigh
injury during ABDOMINAL RETRACTORS during LAPAROTOMY

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21
Q

what does the ilihypogastric nerve innervate and what injury fucks this up

A

suprapubic skin innervation

injury during PFANNENSTIEL skin incisions (CAESAREAN SECTION) can result in turing pain and paresthesias

22
Q

the obturator nerve innervates what and what injury fucks it up

A

L3-L4
motor (adduction) and sensory to the medial thigh
RETROPERITONEAL PELVIC LYMPH NODE DISSECTION can result in loss of medial thigh sensation and ability to adduct the thigh

23
Q

what is the course of the lateral femoral cutaneous nerve and what injury fucks it up

A

courses deep to the inguinal ligament to innervate the anterolateral thigh skin
commonly injured during HYPERFLEXION of the THIGH in the LITHOTOMY POSITION for PELVIC SURGERY or a VAGINAL DELIVERY
anterior and lateral thigh numbness (meralgia parenthetic)

24
Q

what forms the roof of the cubital tunnel and what does compression here cause

A

aponeurosis of the flexor carpe ulnas at the elbow (spans from olecranon to the medial epicondyle)
ulnar nerve runs through here so compression causes sensory symptoms involving the ulnar aspect of the hand

25
what is the interosseous membrane and what does disruption here cuase
thick connective tissue sheet that runs between the radius and ulna serves as a muscular attachment point and contributes to stability of the forearm disruption can lead to instability of the forearm
26
how does one access the great saphenous vein
inferolateral to the pub tubercle longest vein in body- superiorly from medial foot, anterior to the medial malleolus, and up the medial aspect of the leg and thigh
27
where is the ulnar collateral ligament and what does it do, what fucks it up
medial side of the elbow joint and strengthens and ulnohumeral joint injuries occur most commonly in throwers (baseball pitchers) due to intense values dress at the elbow treatment requires reconstruction surgery "Tommy John" surgery
28
what is radial head subluxation (nursemaids elbow)
sudden ration on the outstretched and pronated arm of a child
29
where does the deoxygenated blood that mixes with newly oxygenated blood come from
``` the BRONCHIAL BLOOD (via pulmonary veins) small cardiac (THEBESIAN) veins that drain into the left atrium and ventricle also contribute to normal anatomic shunting ```
30
diffusion limited hypoxia occurs frequently due to what
``` pulmonary fibrosis acute respiratory distress syndrome emphysema hyaline membrane disease of the infant (gas exchange does not equilibrate by the end of its traversal through the alveolar capillaries) ```
31
what is Candida intertrigo
erythematous plaques and erosions with satellite papule or pustules that can occur in the axillae, genital areas, web spaces of fingers/toes, skin folds
32
what congenital adrenal hyperplasia do all patients present phenotypically female
17 alpha hydroxylase
33
what are proprotein convertase subtilisin kexin 9 (PCSK9) inhibitors
monoclonal antibodies that reduce LDL receptor degradation in the liver
34
what is expression cloning
type of DNA cloning where the signals produce large amounts of a protein of interest 1st mRNA is used as a template by reverse transcriptase to produce cDNA w/ promoter sequences (Pribnow box or -35 sequence in prokaryotes) and translation stimulatory sequences (Shine-Dalgarno) gene is incorporated into a plasmid and subsequently transcribed and translated into protein in order to then be radiolabeded by a DNA probe, the PROTEIN MUST BE ABLE TO BIND DNA Ex: transcription factors, steroids, thyroid proteins, vitamin D receptors, retinoid acid receptors, DNA transcription and replication proteins
35
what are some examples of proteins that are able to bind DNA
``` transcription factors steroids thyroid proteins vitamin D receptors retinoid acid receptors DNA transcription (C-myc, N-nyc) and replication proteins ```
36
how does protein kinase A work
activated by cAMP formed by adenylate cyclase | regulates activity of target proteins by phosphorylating threonine and serine residues
37
what cells mediate Type IV Hypersensitivity (delayed type hypersensitive)and what are some examples of it
``` Th1 lymphocytes presented antigen by dendritic cells via MHC-II which release interferon-g to cause recruitment and stimulation of macrophages contact dermatitis granulomatous inflammation tuberculin skin test Candida extract skin reaction ```
38
what drugs should be avoided in old peeps
1st generation antihistamines (diphenhydramine) anticholinergic drugs (hallucinations, confusion, dry mouth, constipation) alpha blockers (orthostatic hypotension) TCAs (sedation) sufonylureas (hypoglycemia) muscle relaxants (sedation)
39
carbon tetrachloride causes what kind of injury to the liver
free radical injury- culminating in hepatocyte necrosis (and fatty change) it is oxidized by CYP 450 oxidase system in liver resulting in formation of free radicals that react with the lipids of cell membranes (LIPID PEROXIDATION) swelling of ER, destruction of mitochondria, increased permeability of cell membranes
40
what step of the citric acid cycle produces GTP (cycle is done in mitochondria)
``` succinate thiokinase (succinyl-CoA synthetase) succinyl-CoA → succinate ```
41
what steps of the Citric acidy cycle produce NADH (cycle done in mitochondria)
``` isocitrate dyhdrogenase (isoctrate → α-ketoglutarate) α-ketoglutarate dehydrogenase complex (α-ketoglutarate → succinyl-CoA) malate dehydrogenase (malate ↔ oxaloacetate) ```
42
what step of the citric acid cycle produces FADH2 (cycle done in mitochondria)
succinate dehydrogenase (succinate → fumarate)
43
what is an example of a GTP-hydrolyzing enzyme that converts oxalocacetate to phophoenolpyruvate during glujconeogeneis
phosphoenolpyruvate carboxykinase
44
total resistance in parallel is calculated how
1/TPR=(1/R1)+(1/R2)+(1/R3)....
45
patient with end stage renal disease who develops bleeding around the catheter exit site that is difficult to control who has NOT been on any anticoagulants probably has what problem and what lab values are changed (PT, PTT, platelet, BT)
uremic platelet dysfunction- excessive bleeding is common in patients with significant renal dysfunction in part due to accumulation of UREMIC TOXINS in the circulation impair platelet aggregation and adhesion, resulting in QUALITATIVE PLATELET DISORDER characterized by PROLONGED BLEEDING TIME all other lab values are normal can be improved by DAILYSIS to remove the toxins and partially reverse bleeding abnormality
46
what kind of protein is human epidermal growth factor receptor 2 (HER2 aka ERBB2)
transmembrane glycoprotein with TYROSINE KINASE activity | treat w/ trastuzumab an anti-HER2 monoclonal antibody
47
what chromosome is N-myc found on
2
48
the what is the sis porto-oncogene and when is it overexpressed
encodes platelet-derived growth factor astrocytomas osteosarcomas
49
a patient with a painful rash involving her groin an perineum that has been worsening for 2 weeks has diabetes for 6 months normocytic anemia 1 month coalescing erythematous lesions w/ crusting and scaling at the borders w/ central areas of bronze-colored induration (superficial necroylsis in the lesion on biopsy) what she got?
GLUCAGONOMA (high glucagon levels in serum) rare tumor of ALPHA-Cells of pancreatic islets of Langerhans necrolytic migratory erythema (elevated painful and pruritic rash of face, groin, extremities that coalesce and form large lesions w/ central clearing of bronze-colored induration) rash also commonly affects mucous membranes leading to glossitis, cheilitis, and blepharitis hyperglycemia leading to diabetes also happens
50
what are the level of amino acids like in glucagonoma and what is that thought to cause
low | necrolytic migratory erythema
51
excess somatostatin secretion from a somatostatinoma typically presents with what
``` abdominal pain gallbladder stones constipation hyperglycemia steatorrhea due to inhibition of insulin, glucagon, gastrin, secretin, CCK, and GI motility ```
52
how does zinc deficiency present
``` erythematous skin lesions occurring mainly around body orficies that are predominantly vesicular and pustular without a central clearing hypogonadism azoospermia hair loss impaired taste night blindness impaired wound healing ```

zz - step 3 - uworld (62 decks)

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