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zz - step 3 - uworld > uWorld 38 > Flashcards

uWorld 38 Flashcards

1
Q

glomerular sclerosis and hyalinosis is seen in what

A

diabetic nephropathy

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2
Q

ischemic tubular necrosis in the kidney results from what

A

hemorrhage, low-flow states (such as MI), or systemic vasodilatation (such as sepsis)

symptoms are those of acute renal failure:
oliguria, increased serum BUN and creatine (azotemia), fluid overload, and electrolyte disturbances

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3
Q

what is seen in pulmonary actinomyces

A

ASPIRATION and can be confused with lung abscess, malignancy, or tuberculosis

microscopic findings include FILAMENTOUS, branching, gram-positive bacteria and SULFUR GRANULES

FOUND in DENTAL CARIES and at MARGIN of GUMS in pts w/ poor dentition

tx: penicillin

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4
Q

when do CD4+ and when CD8+ T cells predominate in bronchiolar lavage

A

CD4+ in SARCOIDOSIS

CD8+ in HYPERSENSITIVITY PNEUMONITIS

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5
Q

what is thePI3K/Akt/mTOR pathway

A

intracellular signaling pathway that is important for cellular proliferation
activated when a growth factor binds to its receptor tyrosine kinase, causing autophosphorylation of specific tyrosine residues within the receptor

these phosphotyrosine residues activate PHOSPHOINOSITIDE 3-KINASE (PI3K), which then PHOSPHORYLATES PIP2 found in the plasma membrane to PIP3

this leads to activation of Akt (or PROTEIN KINASE B) a serine/threonine-specific protein kinase

Akt activates mTOR (mammalian target of rapamycin), which translocates to the nucleus to induce genes involved in cell survival, ANTI-APOPTOSIS, and ANGIOGENESIS

HIGHLY ACTIVE IN CANCER CELLS (increased activity of PI3K or Akt or loss of PTEN

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6
Q

what inhibits mTOR activation

A

PTEN (phosphatase and tennis homolog)- a tumor suppressor protein that removes the phosphate group form PIP3

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7
Q

tRNA that is charged with the incorrect amino acid (AND NOT CORRECTED by AMINOACYL-tRNA SYNTHETASE PROOFREADING) will do what

A

incorporate the wrong amino acid into the growing peptide chain

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8
Q

DNA glycosylases are involved in what

A

DNA base excision repair

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9
Q

following water deprivation where URINE most DILUTE

A

DISTAL CONVOLUTED TUBULE (b/c ascending limb of loop is where dilution occurs in the tubule

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10
Q

what is absorbed in the ascending limb of the loop of henle

A

ELECTROLYTES NOT WATER (main place of urine DILUTION though absorption of NaCl straight up w/ no water)

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11
Q

the iliohyogastric nerve arises form what root(s)

A

L1

suprapubic and gluteal regions and motor function to the anterolateral abdominal wall muscles

APPENDECTOMY can damage the nerve and cause decreased sensation and/or burning pain at the suprapubic region

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12
Q

what does the genitofemoral nerve do

A

L1-L2 and provides sensation to the upper anterior thigh and motor function to parts of the genital (cremasteric reflex in men, mons pubis in females)

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13
Q

what the lateral femoral cutaneous nerve

A

L2-L3 provides sensation to lateral thigh

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14
Q

what the femoral nerve do

A

L2-L4

sensation to upper thigh and inner leg

muscles that extend knee and flex at the hip

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15
Q

what is the most common indicator of obesity related lung disease (especially morbid, central obesity)

A

REUDCTION in EXPIRATORY RESERVE VOLUME (ERV) and FUNCTIONAL RESIDUAL CAPACITY (FRC)

FEV1, FVC, and TLC are also usually decreased

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16
Q

FEV1, FVC, and TLC may be increased in whom

A

trained athletes

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17
Q

dietary lipids(TGs, phospholipids, and cholesterol esters) are primarily DIGESTED in the DUODENUM via pancreatic enzymes. what happens next

A

bile salts emulsify lipid breakdown products, forming WATER-SOLUBLE MICELLES that facilitate lipid absorption in the JEJUNUM

most cholecystectomy patients can tolerate fatty foods in the diet because bile is constantly being released into the duodenum

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18
Q

mucicarmine stains what red

A

cryptococcus neoformans

due to POLYSACCHARIDE CAPSULE

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19
Q

what is the inheritance of hypertrophic cardiomyopathy

A

AUTOSOMAL DOMINANT (SARCOMERE GENES: beta-myosin heavy chain and myosin-binding protein C)

asymmetric left ventricular hypertrophy

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20
Q

adjustment disorder is not diagnosed if the patient meet the criteria for what

A

full criteria (sufficient number and severity of symptoms) for a MAJOR DEPRESSIVE EPISODE so then they have major depressive disorder

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21
Q

what are the criteria for major depressive episode

A 
depressed mood
loss of interest
sleep disturbances
appetite disturbances
loss of energy
psychomotor agitation or retardation
impaired concentration
guilt
suicidal thoughts
22
Q

what is premenstrual dysphoric disorder

A

depressive symptoms must remit with the onset of menses and diagnosis must be confirmed by daily prospective rating over several cycles

23
Q

syncope and ECG recordings during the episodes showing POLYMORPHIC QRS COMPLEXES that CHANGE in AMPLITUDE and CYCLE LENGTH. Between the episodes ECG shows QT prolongation

whats he got and whats causing it

A

LONG QT SYNDROME with associated TORSADES de POINTS

electrolyte imbalances (hypokalemia, hypomagnesimia)

CLASS IA and III ANTIARRYTHMICS (quinidine, stall)

macrolides, fluoroquinolone

methadone

antipsychotics (haloperidol)

24
Q

what is SOTALOL

A

a CLASS III ANTIARRYHTMIC

K+ channel blocker used for treatment of AFIB

prolonges action potential duration, resulting in QT interval PROLONGATION

25
Q

tuberoeruptive and palmar xanthomas are sound in what hyperlipoproteinemia

A

Familial DYSBETALIPOPROTEINEMIA (type III)

APO E defect

ChYLOMICRON and VLDL remnants build up

also see PREMATURE CORONARY ARTERY DISEASE and peripheral vascular disease

26
Q

lipoprotein lipase deficiency (or Apo C-II) is seen in what

A

FAMILIAL CHYLOMICRONEMIA SYNDROME (type I)

SEE SUPERNANANT LAYER IN PLASMA

chylomicrons build up

at risk for:
ACUTE PANCREATITIS 
lipemia retinalis
eruptive skin xanthomas
hepatosplenomegaly
27
Q

accelerated coronary artery disease, tendon xanthomas, and xanthelasmas are seen in what

A

familial hypercholesterolemia

defect in LDL receptor or ApoB-100

LDL builds up

can also see corneal arcus

28
Q

klebsiella is a common cause of spontaneous bacterial peritonitis and nosocomial pneumonias as well as UTIs. what kind of organism is it

A

LACTOSE FERMENTING gram-negative rob

29
Q

DERMATOMYOSITIS is a paraneoplastic syndrome of what cancers

A

OVARIAN
LUNG
colorectal
non-hodgkin lymphoma

30
Q

what is seen in dermatomyositis

A

systemic autoimmune disease characterized by proximal muscle weakness resembling polymyositis but with additional inflammatory features of the skin

HELICOTROPE RASH in the peri-orbital area and checks along with GOTTRON’s PAPULE, which are raised erythematous places over the joints and bony prominences of the hands

muscle biopsy: mononuclear PERIMYSIAL INFILTRATES, perifascicular atrophy, and patchy necrosis

31
Q

what is seen in Whipple disease

A

arthritis, diarrhea, fever

hyper pigmentation maybe

32
Q

inflammatory disease of MUSCLES and SKIN and you are completely fucking lost

A

DERMATOMYOSITIS and its probably a paraneoplastic syndrome of:
OVARIAN, LUNG, colorectal, non-hodgkin lymphoma

33
Q

what is a highly sensitive (but not specific) measure than can detect the degree of bronchial hyperactivity in suspected asthma

A

methacholine challenge test

sense its sensitive a negative test will help RULE OUT asthma

34
Q

all patients with major depression should be screened for what

A

PAST HISTORY of MANIC EPISODES to differentiate major depressive direr form BIPOLAR DISORDER

especially in patients with past repaid responses to SSRIs (usually take 2 weeks to take effect)

35
Q

acute retinal hemorrhage is most likely due to what

A

severe HYPERTENSION

can cause pre capillary arterioles to have endothelial disruption, leakage from plasma into the arteriolar wall, and fibrinous necrosis

necrotic vessels can then bleed into the nerve fiber layer, which can be seen on examination as DOT- or FLAME-shaped hemorrhages

36
Q

what is seen in central retinal artery occlusion

A

most commonly due to atherosclerosis, cardioemoblic disease, or vasculitis

acute MONOCULAR VISION LOSS

CHERRY RED SPOT at the MCULA due to diffuse retinal ISCHEMIA

37
Q

how does vanc work

A

binds terminal D-ala resides of CELL WALL GLYCOPROTEINS and prevents transpeptidases from forming cross-links

38
Q

describe the work of breathing for patients with stiff lungs (increased elastic resistance)

A

minimized when the respiratory rate is high and the tidal volume is low (rapid shallow breaths are favored in disease that increase elastic resistance (pulmonary fibrosis, pulmonary edema, acute respiratory distress syndrome

graph looks like a normal patient but shifted up and to the left

39
Q

synchronization of glycogen degradation with skeletal muscle contraction occurs due to what

A

release of sarcoplasmic calcium following neuromuscular stimulation

increased intracellular calcium causes activation of phosphylase kinase, stimulating glycogen phosphorylase to increase glycogenolysis

40
Q

what is the lungs response to chronic irritation (like smoking)

A

squamous metaplasia

same concept seen in Barretts esophagus

41
Q

what is linkage disequilibrium

A

pair of alleles from two loci are inherited together in the same gamete (calotype) more or less often than would be expected by random chance alone given their corresponding allele frequency

42
Q

to estimate the probability of two allele appearing tother, multiple their occurrence rates others, why isnt it 2pq like hardy weinberg

A

Hardy-Weinberg is not applicable when comparing frequencies of two distinct loci

43
Q

what is peiotropy

A

occurrence of multiple phenotypic manifestations, often in different organ systems, which result from a different gene

44
Q

what is the law of segregations

A

describes the phenomenon in which gametogenesis results in the separation of paired chromosomes so that the offspring inherit only half of each parents genetic compassion

45
Q

what should you emphasis to a parkinson patient experiencing “on-off”

A

that the drug response in unpredictable

46
Q

whats going on in the “on-off” phenomenon

A

good mobility during “on” periods
and increased bradykinesia/rigidity during “off”periods

oftentimes fluctuations appear to correlate with serum drug levels (like reduced mobility 4 hr after last dose)

as parkinson progresses the therapeutic window for levodopa narrow, possibly due to natural or levodopa-induced NIGROSTRIATAL DEGENERATION

in advanced parkinson the motor fluctuations can occur INDEPENDENTLY of medication dosing and may become unpredictable

47
Q

congestive heart failure with a normal thickness ventricle (1cm) and dilated ventricle is due to what

A

SYSTOLIC DYSFUNCTION (dilated cardiomyopathy or ischemic heard disease)

DECREASED VENTRICULAR CONTRACTION FORCE

48
Q

high levels of 17-HYDROXYPROGESTRONE and ANDROGENS are seen in what

A

all forms of 21-HYDOROXYLASE DEFICIENCY

49
Q

what is the classic, salt-wasting form of 21-hydroxylase deficiency

A

severe form of 21-hydroxylase deficiency (AR)

girls: ambiguous genitalia at birth
males: failure to thrive, dehydration, hyperkalemia, and hyponatremia after 1-2 weeks

50
Q

what is the classic, NON-salt-wasting form of 21-hydroxylase deficiency

A

moderate form of 21-hydroxylase deficiency (AR)

girls: ambiguous genitalia at birth
males: signs of EARLY VIRILIZATION at 2-4 years old, accelerated linear growth due to shunting or corticosteroid precursors toward androgens

51
Q

what is the non-classic, delayed form of 21-hydroxylase deficiency

A

mild form of 21-hydroxylase deficiency (AR)

premature pubarche or sexual precocity in school-age children

young women can preens with acne, hirsutism, and menstrual irregularities

52
Q

how are all congenital adrenal hyperplasias treated

A

exogenous corticosteroids to decrease the excessive ACTH stimulation

zz - step 3 - uworld (62 decks)

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