uWorld 39 Flashcards
abnormally slow RELAXATION of MUSCLES is what
MYOTONIA
what are the classic symptoms of myotonic dystrophy
difficulty LOOSENING one’s GRIP after a HANDSHAKE or inability to RELEASE it from a DOORKNOB
CATARACTS
frontal balding
GONADAL ATROPHY
ATROPHY of MUSCLE FIBERS especially TYPE I
AUTOSOMAL DOMINANT
CTG expansion coding for myotonia-protein kinase
increased severity with generation (anticipation)
what is seen in ion channel myopathies
MYOTONIA and episodes of HYPOTONIC PARALYSIS (often associated with EXERCISE)
Pas-Positive intracytoplasmic vacuoles found in these conditions
impaired renal tubular bicarbonate reabsorption is seen in what
type 2 (proximal) renal tubular acidosis
poor bicarb resorption can occur in a variety of inherited or acquired conditions, like multiple myeloma and drug toxicity (acetazolamide)
pt with history of dementia and stroke and lung problems (air-fluid opacities), what they got
ASPRIATION PNUMONIA
dysphagia due to neurologic deficits (stroke, neurodegenerative disease)
what are predisposing conditions to aspiration pneumonia
altered state of consciousness imparting cough reflex/glottic closure (dementia, drug into)
dysphagia due to neurologic deficits (storke, neurodegenerative disease)
upper GI tract disorders (GERD)
mechanical compromise of aspirations defenses (nasogastric and endotracheal tubes)
protracted vomiting
large-volume tube needing in recumbent position
what i beta thalassemia TRAIT
beta thalassemia MINOR (they are the same shit)
only TWO BETA THAL genes on chromosome 11 thus loss of one gene is the trait but also called minor
see increased HbA2 (alpha2delta2)
what is cathepsin D protease
PROTEOLYTIC ENZYME used by tumor cells with others like metalloproteases to invade the basement membrane
whats the difference b/w basophilic stippling and ring sideroblast
basophilic stippling is the PERIPHERAL BLOOD smear and is due to rRNA building up
ringed sideroblast is seen in BONE MARROW and is due to IRON build up in the MITOCHONDRIA (due to defect in heme synthesis)
what is atypical depression and what treats it
characterized by:
MOOD REACTIVITY (feeling better in response to positive events)
LEADEN PARALYSIS (pts arms and legs feel extremely heavy)
REJECTION SENSITIVITY
reversed vegetative signs of INCREASED SLEEP and APPETITE
TX: MOAI can be used (especially if previously treatment resistant pt)
what cells in the bone have PTH receptors
osteoBLASTS- causes them to increase production of RANK-L and M-CSF (both of which stimulate osteoclastic precursors to differentiate into bone-resorbing mature osteoclasts)
also decreases osteoprotegrin production
what does the pulmonary function test look like in alveolar hyaline membranes, atelectasis due to extrinsic pulmonary compression, diffuse intraalveolar hemorrhage
RESTRICTIVE for all of them
diffuse intraalveolar hemorrhage would tend to decrease surfactant, leading to alveolar surface tension and promoting alveolar atelectasis
what is danazol
synthetic androgen that acts as a partial agonist at androgen receptors
use: endometriosis, hereditary angioedema
what in the body is unable to use ketones for energy
ERYTHROCYTES- no mitochondria
LIVER- no succinyl-CoA-acetoacetate CoA transferase (thiophorase) which is required to convert acetoacetate to acetoacyl CoA
when a patient has difficulty conceiving or RECURRENT PREGNANCY LOSS how can one screen for structural uterine anomalies
HYSTEROSALPINGOGRAM (HSG) which involves contrast injection through the cerviz into the uterus with a concurrent pelvic x-ray
if HYSTEROSALPINGOGRAM (HSG) shows 2 UNFuSED UTERINE HORNS with a central filling defect, which can reprint a BICORNUATE UTERUS or a LONGITUDINAL UTERINE SEPTUM, how can one tell them apart
MRI will distinguish the two as a SEPTATE UTERUS has a NORMAL OUTER UTERINE CONTOUR
what causes a SEPTATE UTERUS (LONGITUDINAL UTERINE SEPTUM)
failure of INVOLUTION of the PARAMESONEPHRIC DUCTS
what is seen in DENGUE FEVER
recent travel to BRAZIL
RETRO-ORBITAL PAIN
acute febrile illness, headache, JOINT and MUSCLE PAIN
can be hemorrhagic (petechia, purpura, epistaxis, melon), thrombocytopenia, leukopenia, and hemoconcentration
AEDES MOSQUITO is vector
what is seen in CHIKUNGUNYA
febrile illness with flulike symptoms, prominent POLYARTHALGIA/ARTHRITIS (hands, wrists, ankles), and diffuse maculopaular rash
AEDES MOSQUITO is the vector (same as dengue)
what are the most common causes of bacterial meningitis in adults
adults: STREP PNEUMO and NEISSERIA
neonates: GROUP B STREP
what is seen in allergic bronchopulmonary aspergillosis
in pts with asthma
WEEZING and MIGRATORY LUNG INFILTRATE
TX: CORTICOSTEROIDS
what is seen in invasive aspergillosis
develops in IMMUNOCOMPROMISED pts
prolonged neutropenia with leukemia/lypmphoma tx is a strong risk factor for invasive aspergillosis
usually affects lungs causing granulomas with fever, pleuritic chest pain, hemoptysis
predilection for blood vessels and can spread heamtggenously, causing infection and infects involving the skin, paxrasinal, sinuses, kidneys, endocardium, brain
DIAGNOSIS made by LIGHT MICROSCOPY showing V-SHAPED, narrow, SEPTATE HYPHAE invading the tissue
TX: AMPHOTERICIN B
decreased levels of what are seen in fetal growth restrictions
estriol
alcohol can cause fetal growth restrictions
what is found within the fascia of the prostate and can be fucked up in resection of the prostate due to cancer
PROSTATIC PLEXUS which originates form the inferior hypogastric plexus (which itself is a continuation of the hypogastric nerve with additional input from the pelvic and sacral splanchnic nerves)
lesser and greater CAVERNOUS NERVES arise from the PROSTATIC PLEXUS and pass beneath the public arch to innervate eat corpora cavernous of the penis and urethra
cavernous nerves carry post-ganglionic PARA-SYMPATHETICS
what innervates external urethral sphincter and external anal sphincter
branches of pudendal
pudendal nerve injury can result in what
fecal incontenance
decreased penile sensation
external urethral sphincter paralysis
a penetrating injury at the left sternal border in the fourth intercostal space (level of nipple) will pass through the following layers (in order):
- skin and subcutis
- pectoralis major muscle
- external intercostal membrane
- internal intercostal muscle
- internal thoracic artery and veins
- transversus thoracis muscle
- parietal pleura
- pericardium
- RIGHT VENTRICULAR MYOCARDIUM
a penetrating wound to the back to the immediate RIGHT of the vertebral body could hit what
IVC
a stab would to the 4th intercostal space in the left midclavicular line can hit what
LEFT LUNG but then LEFT VENTRICLE if it makes it through the lung
penetrating wound to the SECOND intercostal space at the LEFT sternal border would fuck what up
pulmonary trunk
what are the cardiovascular effects of inhales anesthetics
myocardial depression leading to decreased CO and increased atrial and ventricular pressures
hypotension is result of decreased CO
what are the respiratory effects of inhaled anesthetics
all but NO are resp DEPRESSANTS
decreased TIDAL VOLUME and MINUTE VENTILATION causing HYPERCAPNIA
suppression of MUCOCILLIARY CLEARANCE (can predispose to post op atelectasis)
what inhaled anesthetics are preferred with asthmatics
halothane and sevoflurane (have bornchodilatory effects)
what are the brain effects of inhaled anesthetics
decreased vascular resistance leading to INCREASED CEREBRAL BLOOD FLOW
(undesirable effect leading to increased ICP)
what are the kidney effects of inhaled anesthetics
decreased glomerular filtration rate, increased renal vascular resistance and decreased renal plasma flow
lipid accumulation within the muscle fibers is seen when
lipid myopathies like carnititne palmitoyltransferase deficiency
when blood flow cannot meet myocardial demands, cardiac myocytes transition from aerobic to anaerobic metabolism. However, anaerobic metabolism cannot maintain proper intracellular ATP thus ADP, AMP, and adenosine all accumulate. Without ATp, the membrane Na/k ATPase and sarcoplasmic reticulum Ca-ATPases cannot work, what happens
intracellular Na+ and Ca2+ INCREASE as well as intramitochondrial Ca2+
these increased concentrations ATTRACT FREE WATER, causing cellular and mitochondrial swelling
failure of sarcoplasmic reticulum to resequester Ca2+ leads to cessation of contraction within ischemic zones of myocardium
postprandial epigastric pain and food aversion/weight loss in the setting of generalized atherosclerosis is consistent with what
CHRONIC MESENTERIC ISCHEMIA
bowel can suffer from diminished blood supply and the intestinal hypo perfusion can be very painful, and especially PRONOUNCED WITHIN an HOUR AFTER MEALS when more blood is needed for the digestion/absorption of nutrients (“INTESTINAL ANGINA”)
tarry stools (aka melena) are associated with what chemo agent
any that affects rapidly-dividing cells
most classically associated with ALKYLATING AGENTS
what ADRs are seen with mercaptopurine
abdominal pain and jaundice due to choestatis and hepatitis
heartburn that is resistant to over-the-counter antacids
telangiectasis on the face, several ulcers at the tips of the filters, and small calcium deposits in the soft tissues of the hands and elbows
the fuck she got
CREST SYNDROME
Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerdactyly, Telangiectasias
a limited variant of systemic sclerosis with the skin disease that primarily effects the FACE, FOREARMS, and FINGERS
FINGER TIP ULCERS from chronic ischemic tissue damage
esophageal motility results in symptoms of GERD from ATROPHY and FIBROUS replacement of MUSCULARIS in the lower esophagus
myocardial cells with prominent intracytoplasmic granules that are tinged YELLOWISH-BROWN what the fuck are they
LIPOFUSCIN which is a sign of “wear and tear” or AGING
pigment is the product of FREE RADICAL INJURY and LIPID PEROXIDATION
commonly seen in heart of liver of aging or cachectic, malnourished patients
