uWorld 35 Flashcards
patient who was on a cruise, has pneumonia, watery diarrhea, neurologic symptoms (confusion, headache)
LESIONELLA pneumonia
look for HYPONATREMIA or elected TRANSAMINASES
only neutrophils on sputum stain
can have bradycardia and neurologic symptoms (confusion, headache)
buffered charcoal yeast extract (BYCE) used to see it because its faintly staining gram-negative baccilus that is facultatively INTRACELLULAR
who is at higher risk for legionella infection
immunocompromised elderly smokers alcoholics COPD patients
what is seen in diffuse esophageal spasm (DES)
solid/liquid DYSPHAGIA
CHEST PAIN
heartburn
food regurgitation
likely due to IMPAIRED NEUROLOGIC NEUROTRANSMISSION within the esophageal myenteric plexus
“CORKSCREW” ESOPHAGUS on barium esophagram
NON-PERISTALTIC CONTRACTIONS on esophageal manometry
what is eosinophilic esophagitis
atopic patients with solid food dysphagia and/or food impaction
what arteries supply the greater and lesser curvatures of the stomach
lesser curvature:
- left (proximal) GASTRIC: branch of celiac
- right (distal) GASTIC: branch of proper hepatic ← common hepatic ← celiac
greater curvature:
- left (proximal) GASTROEPIPLOIC: splenic ← celiac
- right (distal) GASTROEPIPLOIC: branch off gatroduodenal ← common hepatic ← celiac
- SHORT GASTRIC (proximal above splenic artery): splenic ← celiac
cerebellar ataxia, telangiectasis (numerous superficial blanching tests of distended capillaries on sun-exposed areas of the skin), and increased risk of sinopulmonary infections are characteristic of what
ATAXIA TELANGIECTASIA (AR disorder)
mutation in ATM gene responsible for DNA BREAK REPAIR
patients are hypersensitive to X-ray radiation that causes multiple chromosomal breaks
immunodeficiency primarily manifests as IgA deficiency and predisposes to infection of the upper and lower airways
heart problems, edema, hepatomegaly, neurologic problems (decreased light touch, vibration in the feet, w/ decreased knee and ankle reflexes bilaterally)
what nutrient is fucked up
THIAMINE (WET BERIBERI)
what is seen in infantile beriberi
2-3 months old
fulminant cardiac syndrome with cardiomegaly, tachycardia, cyanosis, dyspnea, and vomiting
what is seen in adult beriber
dry: symmetrical PERIPHERAL NEUROPATHY (sensory and motor impairments)
wet: addiaotin of CARDIAC INVOLVEMENT
what regulates bone turnover
RATIO of OPG to RANK-L
OPG (osteoprotegerin) is a decoy receptor that blocks the RANK-RANKL interaction
non-glucose monosaccharides enter the glycolytic pathway at different points. which non-glucose monosaccharide allows for faster metabolism and why
FRUCTOSE
it bypasses PHOSPHOFRUCTOKINASE (one of the key enzymes in regulating the rate of glycolysis)
how should a physician respond to disclosure of past sexual abuse
empathy and concern
clearly acknowledging the trauma can communicating willingness to discuss it when the patient is ready will help strengthen the physician-patient relationship
mild or brief sadness without significant interference in psychosocial function is consistent with what
NORMAL SADNESS
need functional impairment to be adjustment disorder
polycystic ovary syndrome results from increased activity of what
17alpha-hydroxylase
17,20lyase
3beta-hydroxysteroid dehydrogenase
leads to increased androgen levels (hirsutism and acne)
polycystic ovary syndrome puts patients at long term risk for what
ENDOMETRIAL HYPERLASIA and ADENOCARCINOMA b/c they get anovulatory cycles from excess androgen and thus DECREASED PROGESTERONE
imbalance in progesterone-estrogen fucks it up
what is vaginal adenosis
persistence of glandular columnar epithelium in the vagina and is a precursor for clear cell adenocarcinoma of the vagina
female offspring exposed to DES are at increased risk and may present wth vaginal discharge or vaginal cysts/fleshy colored lesions
course granular deposits of IgG and C3 in a “lumpy bumpy” appearance
PSGN
election dense deposits (“humps”) on EPITHELIAL rise of basement membrane
what is DIHYDROERGOTAMINE
an ergot alkaloid commonly used to treat acute migrant headache
may induce vasospastic angina (constricts vascular smooth muscle via stimulation of alpha-adrenergic (partial agonist) and serotinergic receptors)
REST and NIGHTTIME angina associated with TRANSIENT ST ELEVATION
vasospastic or varient (PRINZMETAL) angina