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zz - step 3 - uworld > uWorld 33 > Flashcards

uWorld 33 Flashcards

1
Q

the COLA transporter is fucked in what

A

CYSTINURIA

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2
Q

what is seen in Cystinuria

A

COAL transporter fucked (free cysteine, ornithine, lysine, and arginine can’t be absorbed)

no amino acid deficiencies because absorbed as oligopeptides in gut

high urinary cystine concentration leads to CYSTINE KIDNEY STONES (FLAT, YELLOW, HEXAGONAL “SIX”tine for the 6 sides)

risk facts are LOW URINE pH, the presence o a preexisting CRYSTAL NIDUS, and URINE SUPERSATURATION

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3
Q

what is found to be SODIUM CYANIDE NITROPURRSIDE TEST positive

A

CYSTINURIA

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4
Q

what is SERTRALINE

A

SSRI

causes sexual dysfunction

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5
Q

how do influenza vaccines work

A

introduce NEUTRALIZING ANTIBODIES against he HEMAGGLUTININ ANTIGEN in select viral strains

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6
Q

what kind of vaccines strongly stimulates MCH class I antigen-processing pathway and can great CD8+ T cells that kill infected cells

A

LIVE-ATTENUATED

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7
Q

BOUNDING FEMORAL and CAROTID PULSES (marked by abrupt dissension and quick collapse (“water hammer” pulses) due to wide pressure pulses and HEAD BOBBING with CAROTID PULSATIONS (de MUSSET SIGN) due to momentum of left ventricle stroke volume to the head and neck is seen in what

A

AORTIC REGURGITAION (diastolic decrescendo murmur)

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8
Q

what is the cause of phenylketonuria if both hyperphenylalanemia and elevated prolactin are present, why

A

DIHYDROBIOPTERIN REDUCTASE (produces the cofactor TETRAHJYDROBIOPTERIN (BH4))

BH4 is required for PHENYLALANINE HYDROXYLASE (turns phenylalanine into TYROSINE) and also for TYROSINE HYDROXYLASE (converts tyrosine to DOPA)

without DOPA, dopamine cannot be produced via DOPA decarboxylase

with lower dopamine levels prolactin isn’t inhibited as well as normal

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9
Q

how can you tell von Willebrand and Bernard Soulier appart

A

both have abnormal ristocetin but in Bernard Soulier since vWF levels are normal the addition of normal plasma will not correct the aggregation

in vWD addition of normal plasma corrects the ristocetin test

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10
Q

what does ristocetin do

A

activates Gp1b receptors on platelets and makes them available for vWF binding

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11
Q

what is first line treatment for females with menorrhagia due to von Willebrand Disease

A

combined oral contraceptives

desmopressin may be used too

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12
Q

what is seen in congenital deficiency of factor XII (hangman factor)

A

prolonged PTT without bleeding diathesis

tendency for thromboembolic complications

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13
Q

any suprasellar mass with 3 components (solid, cystic, calcified) is highly suggestive of what

A

craniopharyngioma

present in childhood with visual defects and mass effect (hypopituitarism)

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14
Q

what causes DECEREBRATE (extensor) posture

A

lesion AT or BELOW the RED NUCLEUS (midbrain TEGMENTUM, PONS)

due to loss of descending excitation of the upper limb flexors (via rubrospinal tract) and extensor predominance (due to unopposed vistublospinal tract output)

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15
Q

what causes DECORTICATE (flexor) posturing

A

lesions ABOVE the RED NUCLEUS (cerebral hemisphere)

due to loss of descending inhibition of the red nucleus and subsequent hyperactivity of upper-extremity flexor muscles

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16
Q

damage to the cerebellar vermis does what

A

fucks up balance and coordination of the axial/proximal limb muscles, resulting in gait and truncal ataxia
maybe nystagmus and vertigo

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17
Q

damage to the internal capsule typically results in in what

A

contralateral motor/sensory deficits

cortical signs (aphasia, agnosia, neglect, apraxia, hemianopsia) are classically absent

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18
Q

damage to the dorsal midbrain (tectum) usually results in what

A

vertical gaze palsy (inability to look up) due to its proximity to the superior colliculus

may also cause light-near dissociation (pupils constrict for accommodation but not light)

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19
Q

bilateral damage to the thalamus can result in what

A

coma

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20
Q

what drug is a motilin receptor agonist used for gastroparesis

A

ERYTHROMYCIN

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21
Q

what 5 receptors regulate vomiting reflex

A 
M1 muscarinic
D2 dopamine
H1 histamine
5-HT3 serotonin- good for chemo
neurokinin 1 (NK1)- good for chemo
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22
Q

what is a CHOLESTEATOMA

A

collections of SQUAMOUS CELL DEBRIS that form a round, PEARLY MASS behind the tympanic membrane in the middle ear

cause painless OTORRHEA

primary- a result of chronic negative pressure in the middle ear causing retraction pockets int he tympanic membrane that become cystic

secondary- occur after squamous epithelium migrates to or is implanted in the middle ear (“skin in the wrong place”)

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23
Q

a chromosome 16 inversion is observed in what

A

M4Eo (eosinophilic) subtype of AML

24
Q

what is used to treat RECURRENT C. DIFF infection in someone who is allergic to penicillin

A

FIDAXOMICIN (a macrolicyclic antibiotic-related to macrolides- that inhibits sigma subunit of RNA polymerase

bactericidal

oral vanc works for recurrent but not in allergic patient

25
Q

dilated pupils are seen with what drugs

A

cocaine intox

opioid withdrawal

26
Q

cortical watershed infarcts typically appear how

A

BILATERAL WEDGESHAPED strips of necrosis over the cerebral convexity, parallel and adjacent to the longitudinal fissure

severe carotid stenosis may develop unilateral

27
Q

charcot-bouchard infants typically involve what structures

A

basal ganglia, cerebellar nuclei, thalamus, pons

28
Q

cerebral amyloid antipathy results in what type of hemorrhage

A

lobar (occipital, parietal)

particularly in elderly

29
Q

where do lacunar infantry occur

A

basal ganglia
internal capsule
pons
thalamus

30
Q

what is the most common cause of viral gastroenteritis in developed countries

(especially in schools, hospitals, cruise ships, nursing homes)

A

NOROVIRUS- incubation period of 2 DAYS, fecal-oral spread, watery non bloody diarrhea

while you may think ROTAVIRUS in developed countries due to VACCINATION it is not most common cause. it is however in underdeveloped countries

31
Q

what is the most common way that humans are infected with Bacillus anthracis

A

contact with infected animals or animal products or through use of biochemical weapon

32
Q

phenylephrine, xylometazoline, and oxymetazoline are alpha adrenergic agonists that have prominent vasoconstriction in the nasal mucosa, making them effective decongestants. what is a draw back to their use

A

TACHYPHYLAXIS- rapidly declining effect after a few days of use

decreased production of endogenous norepi from the nerve terminals due to a negative feedback mechanism, resulting in relative vasodilation and subsequent EDEMA and CONGESTION

leads to EXACERBATION of nasal congestions symptoms

33
Q

what is rebound rhinorrhea (rhinitis medicamentosa)

A

nasal congestion without cough, seeing, or postnasal drip (may or may nor have rhinorrhea)

associated with topical decongestants for MROE THAN 3 DAYS

STOP THE ADRENERGIC AGONIST DECONGESTANT

34
Q

if patient has nonspecific symptoms but clearly has MALABSORPTION what test should be done to work up the condition

A

STOOL test with SUDAN III STAIN which test for FAT MALABSORPTION

this is done before further workup of celiac or anything in a case that is nonspecific and doesn’t point towards another problem to at least confirm the presence of malabsorption before further testing

35
Q

if person is on warfarin and PT is increased but INR is below reference range what is going on

A

warfarin is NOT WORKING properly and a CYP INDUCER is being used with it

PT is up but in patient with clotting deficiency its not supposed to be normal so its actually low in this patient who is supposed to have a PT 2-3x normal which is represented by an INR of 2-3

36
Q

what common antibiotics inhibit warfarin metaboism

A

METRONIDAZOLE

BACTRIM

37
Q

in cystic fibrosis what causes the mucus in the lungs to be thick

A

increased sodium absorption

CFTR normally inhibits the apical epithelial sodium channel but can’t what its fucked up

REMEMBER THIS IS THE OPPOSITE IN THE SWEAT- the CFTR channel removes chloride from sweat and acts to resorb luminal chloride and activate ENaC to resorb sodium too making sweat hypotonic- but this is fucked in CF and sweat is then hypertonic

38
Q

what is seen in the intestinal type adenocarcinoma

A

resembles colonc cancers
well-formed glands that consist of columnar or cuboidal cells

grow as nodular, polypoid, and well-demarcated asses that RAPIDLY EXPAND within the gastric lumen

often ulcerate/bleed and must be differentiated from peptic gastric ulcers by biopsy

39
Q

rural thickening with acid hyper secretion is characteristic finding in the stomach of a patient with what

A

Zollinger-Ellison

40
Q

what is Ménétrier disease

A

gastric hyperplasia of mucosa leading to HYERPTROPHIED RUGAE (looking like BRAIN GYRI

excess MUCUS PRODUCTION with resultant protein loss and PARIETAL CELL ATROPHY with DECREASED ACID PRODUCTION

Precancerous

41
Q

H. pylori is found in highest concentrations where

A

gastric antrum (pre-pyloric area)

42
Q

what is cinacalcet

A

calcimimetic that allosterically activates the calcium sensing receptor in the parathyroid gland decreasing PTH release

used for secondary hyperparathyroidism in dialysis patients

43
Q

what is sevelamer

A

non-absorbable phosphate-binding polymer that decreases absorption of phosphate in the GI tract

used to treat hyperphosphatemia in dialysis patients

44
Q

what is AGE-REALTED MACULAR DEGENERATION (AMD)

A

dry AMD : GRADUAL vision loss in one or both eyes and can cause difficulty with driving/reading
-likely due to chronic oxidative damage of the retinal pigment epithelium and chroiocapillaries, leading to subretianl inflammation with abnormal extracellular matrix formation (DRUSEN DEPOSITS)

wet AMD: ACUTE vision loss (days to weeks) with METAMORPHOSIS (distortion of straight line)
-GRAYISH-GREEEN sub retinal discoloration with adjacent fluid/hemorhage

TX: SMOKING cessation,
VEGF inhibits (ranibizumab, bevacizumab) for WET AMB
45
Q

epidermal growth factors (eroltinib, gefitinib) are used to treat what

A

non-small cell lung cancer

46
Q

what is a P body

A

distinct foci found within eukaryotic cells the tare involved in mRNA regulation and turnover

occurs ONLY IN CYTOPLASM

function as a from of mRNA storage (some mRNA can be incorporated into P bodies only to be later release and utilized for protein translocation

47
Q

what processing steps have to occur before mRNA can leave nucelus

A

5’-capping
poly A tail addition
intron splicing (snRNPs)

48
Q

hypo chromic, microcytic anemia

A

always think iron deficiency and OCCULT BLOOD LOSS from GI Tract (EVEN IF PATIENT doesnt have dark stools or menorrhagia

49
Q

the medial forearm sensory is from what

A

branch of medial cord off brachial plexus (medial cutaneous branch of the forearm)

50
Q

how is minimal change disease treated

A

corticosteroids

51
Q

what is the function of the posterior limb of the internal capsule

A

separate the globes pallid us and putamen form the thalamus and carries corticospainal motor and somatosensory fibers as well as visual and auditory fibers

52
Q

what is the gene (“knee”) of the internal capsule

A

b.w anterior and posterior branches and carries corticobulbar fibers

53
Q

what is the anterior limb of the internal capsule

A

separates the caudate from the globes pallid us and putamen

carries portion of the thamocortical fibers

54
Q

berry aneurysms are associated with what two congenital disorders

A

Ehlers danlos

ADPKD

55
Q

what is the main purpose of blinding in a clinical trial

A

prevent patient or researcher expectancy form interfering with the determination of the outcome

zz - step 3 - uworld (62 decks)

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