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
how does leptin decrease food intake
decrease production of neuropeptide Y (potent appetite stimulant) in the arcuate nucleus of hypothalamus
stimulates production of POMC in arcuate nucleus- alpha-MSH made and inhibits food intake
what is th most common cause of spontaneous LOBAR HEMORRHAGE (particularly in patient over 60)
AMYLOID ANGIOPATHY- a consequence of beta-amyloid deposition in the walls of small- to medium-sized cerebral arteries, resulting in weakening and predisposition to rupture
hemorrhage tends to be RECURRENT and involve the OCCIPITAL (homonyms hemianopsia) and PARIETAL (contralateral hemisensory loss) LOBES
what is seen in hypertensive encephalopathy
PROGRESSIVE headache and nausea/vomititing followed by nonloaclaizing neurlogoic symptoms (confusion)
what is seen in Eulerian aplasia (aka vaginal agenesis or Mayer-Rokitansky-Kuster-Hauser (MRKH) Syndrome)
VARIABLE UTERINE DEVELOPMENT and NO UPPER VAGINA (aka short vagina)
patient cannot menstruate (PRIMARY AMENORRHEA) w/ no uterus
NORAML OVARIES which secrete estrogen normally so they have NORMAL SECONDARY SEXUAL CHARACTERISTICS
what is kallman syndrome
decreased synthesis of GnRH in the hypothalamus (hypothalamic hypogonadism)
females: primary amenorrhea, no secondary sexual characteristics, OLFACTORY SENSORY deficit
males; OLFACTORY SENSORY DEFICIT, small phallus and testicles, no pubic hair
what is required for haemophilus to grow
X FACTOR (HEMATIN)
V FACOR (NAD+)
“SATELLITE” PHENOMENON: H flu will grow around the streaks of beta-hemolytic Staph Aureus because the staph secreted V FACOTR (NAD+) and facilitates realize of X FACTOR (HEMATIN) form beta-hemolysis-induced erythrocyte lysis
coronary dominance is determined how and what artery most commonly arises from the dominant coronary artery
deterred by the coronary artery that supplies the POSTERIOR DESCENDING ARTERY (PDA or posterior interventricular artery)
right coronary in about 70%
left circumflex in about 10%
codominant in about 20%
the AV NODAL artery most often ARISES from DOMINANT coronary artery
where does the AV nodal artery come from
dominant coronary artery
flushing, burning in the chest and shortness of breath after treating sudden onset of palpations with IV injection
what drug was it
ADENOSINE (slows AV node conditions via hyperpolarization)
DOC for paroxysmal supraventricualr tachycardia
ADRs: flushing, chest burning due to bronchospasm, hypotension, high grade AV block
DRUG USED FOR CHEMICAL STRESS TESTS
Graft-vs-Host disease occurs in immunocompromised following allogenic bone or lymphocytic-rich tissue (liver, non irradiated blood). what does liver involvement look liek
rise in ALP and lymphocytic infiltration and destruction of small intrahepatic bile ducts (similar to the findings seen primary biliary cirrhosis)
what is seen in primary biliary cholangitis (cirrhosis)
autoimmune liver disease characterized by DESTRUCTION of SMALL and MID-SIDEX INTRAHEPAIC BILE DUCTS with resulting CHOLESTASIS
FATIGUE, ITCHING, HEPATOMEGALLY
lymphocytic inflammation with destruction of intrahepatic bile ducts and necrosis and micro nodular regeneration of periportal tissues
common in middle ages women with other autoimmune disorders
ANTI-MITOCHONDRIAL antibodies, and increased ALP
atropine used to treat bradycardia in someone with MI can cause EYE PAIN WHY
precipitate ANGLE-CLOSURE GALUCOMA (unilateral eye pain with visual disturbances (halos))
what is CAPITATION
arrangement in which a payor (individual, employer, or government entity) pays a FIXED
what is GLOBAL PAYMENT
arrangement in which an insurer pays a provider a single payment to cover all the expenses associated with AN INCIDENT OF CARE
most commonly done of selective surgeries, in which the global payment covers the surgery as well as any pre- and post-op visits needed
what is a point of service plan
requires patines to have a primary care provider and obtain referrals for special consultations
allow patients to see out of network providers
what are the 1,2,3 most common brain tumors in children (second most common tumor in children after leukemias)
- PILOCYTIC ASTROCYTOMA
- medulloblastoma
- ependymoma
what is a pleocytic astrocytoma
low-grade neoplasm from astrocytes
CEREBELLUM is most common location (can be seen in the hemispheres)
cystic with a tumor nodule protruding form the wall (nodule is part of active tumor0
madd with both SOLID and CYSTIC components seen on T1 image
ROSENTHAL (EOSINOPHILIC CORKSCREW) FIBERS seen microscopically
benign
what is seen in a medulloblastoma in a child
most common MALIGNANT childhood brain tumor
located ONLY in CEREBELLUM mc in the VERMIS
SOLID sheets of blue cells with heyperchromatic nuclei and scant cytoplasm
high malignant
headaches and cerebellar dysfunction
what is seen in an ependymoma
arise form ependymal lining of canticle and can obstruct CSF flow
presents with HYDROCEPHALUS
tumor cels form GLAND-LIKE STRUCTURES called “ROSETTES”
saddle nose and oliguria are most characteristic of what
GRNAULOMATOSIS with POLYANGITIS (WEGENER’S)
c-ANCA positive
what are the actions of c diff’s toxins
CYTOTOXIN A; watery diarrhea
CYTOTOXIN B: colonic epithelial cell necrosis and FIBRIN deposition (COLITIS)
tumor made of fat, smooth muscle, and blood vessels in the kidney (bilateral and multiple)
RENAL ANGIOMYOLIPOMA (can be diagnosed via CT as a density b/c radio density of FAT is less than water)
associated with TUBEROUS SCLEROSIS (AD disorder)
bilateral renal angiomyolipomas have an 80-90% incidence of tuberous sclerosis
what is seen in tuberous sclerosis
SUBEPENDYMAL HAMARTOMAS and thus has SEIZURES and cognitive liability
renal ANGIOMYOLIPOMA
cardiac RHABDOMYOMA
facial ANGIOFIBROMAS
leaf-shaped patches of skin lacking pigment (ASH-LEAF PATCHES)
mitral REGURGITIATION
HAMARTOMAS: Hamatomas in CNS and skin; Angiofibromas; Mitral regurg; Ash-leaf spots; cardiac Rhabdomyoma; (Tuberous sclerosis); autosomal dOminant; Mental retardation; renal Angiomyolipoma; Seizure; Shagreen patches
↑ incidence of SUBEPENDYMAL ASTROCYTOMAS and usual fibromas
what is seen in Sturge-Webber
congenital, non-inherited (SOMATIC), developmental anomaly of NEURAL CREST derivatives due to ACTIVATING mutation of GNAQ gene
affects small (capillary-sized) blood vessels → PORT WINE STAIN on face (nevus flammeus CN V1/V2 distribution)
ipsilateral leptomeningeal angioma → SEIZURES/EPILEPSY
intellectual disability
episcleral hemangiona → ↑ IOP → early onset GLAUCOMA
STURGE: Stain; Tram track calcifiaciotns (opposing gyri); Unilateral; Retardation (intellectual disability); Glaucoma: GNAQ gene; Epilepsy
what is seen in hereditary hemorrhagic telangiectasia
telangiectasis of the skin and mucosa
recurrent EPISTAXIS and GI BLEEDING (MELENA)
AV malformations
what gives mycobacterium its “serpentine” appearance
presence of CORD FACTOR a VIRULENCE factor- inhibits neutrophils, damaging mitochondria, and induces relate of TNF
cord factor is a myocside (composed of mycotic acids bound to the disaccharide trehalose)
what are the additional complications seen in psoriasis
psoriatic arthritis
nail changes: YELLOW-BROWN discoloration, PITTING, thickening, or crumbling
inflammatory disorders of the eye: conjunctivitis, blepharitis, or UVEITIS
where are anal fissures typically found
POSTERIOR MIDLINE of the anal verge
SHARP pain and BRIGHT RED rectal bleeding on defecation
due to stretching of the mucosa and are characterized by longitudinal tears in the anal canal detail to dentate line
C1 inhibitor deficiency leads to elevated levels BRADYKININ which can cause what and how is it managed
facial swelling (no itching), life-threatening laryngeal edema, GI probe (nausea/vomiting, colicky pain, diarrhea)
management of acute attacks involves supportive care and adminitrationof C1INH concentrate and KALLIKREIN INHIBITOR
what causes OUTBREAKS of fulminant hepatitis in PREGNANT WOMEN
HEPATITIS E VIRUS (naked RNA virus, spread fecal oral)
INDEEEEEEA (its found in india a lot)
