uWorld 4 Flashcards
what lab values need to be obtained before starting statin therapy
liver function tests (LFTs)- transaminases
inappropriate apoptosis is responsible for what endocrine disease
T1DM
lingual thyroid is dur to failure of what
migration (thyroid can reside anywhere alone the thyroglossal duct’s path)
usually leads to OBSTRUCTIVE SYMPTOMS (dysphagia, dysphonia, dyspnea) typically at times of heightened thyroid stimulation (puberty, pregnancy)
old patient in hospital for many days with catheter in for 8 days gets UTI what is the most effective strategy for preventing this
prompt removal of catheter when nom longer indicated
catheter-associated UTI is a frequent complication in hospitalized patients what is the most significant risk factor for this UTI and what are preventative measures
DURATION OF CATHETERIZATION IS MOST SIGNIFICANT RISK FACTOR FOR UTI
avoid unnecessary catheterization
use sterile technique when inserting catheter
remove catheter promptly when no longer needed
the bioavailability of a drug is equal to what in terms of the areas of the curve of IV vs oral dose curve
area under oral curve/ area under the IV curve
on a graph of plasma concentration vs time what does the area under the oral curve represent
total amount of drug that was absorbed by the body and made available in the systemic circulation form the time of administration to the time of complete elimination
what is released from mast cell and basophil degranulation in anaphylaxis
histamine and TRYPTASE (an enzyme that is relatively specific to mast cells)
5 month old boy w. poor weight gain since birth w/ bulky greasy stools.
jejunal biopsy will be shown and will show normal intestinal mucosal architecture but enterocytes contain clear or foamy cytoplasm which is more prominent at the tips of the villi
abetalipoproteinemia
histological findings are due to accumulation of lipids in the absorptive cels of the intestinal epithelium and are typical of abetalipoproteinemia
what is the most common cause of abetalipoproteinemia
AR loss-of-function mutation in MTP GENE manifesting in first year of life with malabsorption, low TGs and cholesterol levels, and chylomicrons, VLDL, and apoB are completely absent ACANTHOCYTES seen on blood smear from deficiency of fat soluble vitamins and essential fatty acids NEURLOGIC ABNORMALTIES (progressive ataxia, retinitis pigmentosa)
what is seen on light microscopy of crohns
chronic infmallation of all layers of the intestinal wall and noncaseating granulomas
what is seen on LM of whipple disease
distended macrophages in lamina propria of small intestine
PAS(+) and diastase-resistant granules and rod shaped Tropheryma whippelii bacilli
what is seen on LM of celiac disease
atrophy and blunting of bills
chronic inflammatory infiltrate of lamina propria
passive congestion of the spleen with blood occurs when
portal hypertension, splenic vein thrombosis, congestive heart failure
resultant splenic sinusoid dilation can lead to splenomegaly
what cases the splenomegaly in pyruvate kinase deficiency
red pulp hyperplasia from the reticuloendothelial cells removing damaged RBCs that are hemolysized
if restriction fragment length polymorphism (RFLP) analysis shows that the child has 3 bands (indicating 3 different versions of the chromosome) where did the problem occur
meiosis 1
b/c he received two different bands form one one parent and thus to inherit both homologous chromosomes the error must have occurred in meiosis 1 when homologous chromosomes are separated
if restriction fragment length polymorphism (RFLP) analysis shows shows child with two bands but one band is darker and thicker (but the child has trisomy) when did the problem occur
meiosis 2
inheritance of two sister chromatids
defects in what would cause fasting hypothermia
gluconeogeneiss or glycogenolysis (primarily occurring in the liver)
the use go qualified sign language interpreters in deaf individuals leads to what
fewer clinical errors
higher patient satisfaction
better clinical outcomes
if face to face interpreters are not available video remote interpreting services should be offered
what should be done in a suspected urethral injury
retrograde urethrogram to assess urethral integrity (not foley catheter as this could make it worse)
injury to the bulbous urethral segment is susceptible to what kind of injuries
crushing injuries when the perineum is stuck forcefully (straddle injury like falling on crossbar of bike or top of a fence)
when would on suspect a penile urethra injury
penetrating trauma or instrumentation
pelvic fractures are associated with injury to what part of the urethra
posterior (bulbomembranous junction)
what bug causes bronchiectasis in glucocorticoid-dependant asthmatics
Aspegillus Fumigates causing allergic bronchopulmonary aspergillosis (ABPA)
high IgE and EOSINOPHILIA (dont think its stronglyoides)
what is an early diastolic DECRESCENDO MURMUR and what happens to it when inhaled amyl nitrates are used
aortic REGURG
amyl nitrates produces marked vasodilation, reducing systemic arterial pressure and regurgitant flow (LESSENING THE MURMUR)
what is a systolic ejection murmur the increases in intensity with standing
hypertrophic cardiomyopathy (due to decrease in left ventricular outflow tract size)
what causes a pre systolic murmur that disappears with atrial fibrillation
mitral or tricuspid valve STENOSIS
pre systolic attenuation due to atrial contraction
when would one hear wide splitting of S1 the tis accentuated by inspiration and what is this a sign of
sign of delayed closure of tricuspid valve
complete right bundle branch block or tricuspid stenosis
what is seen in the achalasia
reduced numbers of inhibitory ganglion cells in the esophageal wall
normal contraction of upper sphincter
DECREASED AMPLITUDE OF PERISTALSIS in mid esophagus
INCREASED TONE and INCOMPLETE RELAXATION of LES
dysphagia, regurgitation, and retrosternal chest pain
how is scleroderma different form achalasia on manometry
scleroderma has decreased tone of LES while achalasia has increased tone of LES
what is seen in cricopharyngeal dysfunction
failure of cricopharynxgeus to relax during swallowing and causes choking or “food-sticking” sensation on swallowing
manometry are variable and can show decreased pharyngeal tone or incomplete relaxation of user esophageal sphincter
what is tenesmus and what is it characteristic of
ineffectual/painful stringing on defecation
along with small caliber stool are characteristic of RECTAL adenocarcinoma
what are the side effects of erythropoiesis-stimulating agents (ESAs) (erythropoietin, darbepoetin alpha)
thromboembolic events (increased blood viscosity) hypertension (activation of erythropoiesis receptors on vascular endothelial and smooth muscle cells
what is the cause of fragile X?
CGG trinucleotide repeats the result in GENE METHYLATION of FMR1 thus inactivating FMR1 and preventing transection an production of fragile X mental retardation protein
southern blot is used to measure the degree of methylation and number of CGG repeats
defects in DNA mismatch repair are seen in what
Lynch syndrome (neredary non-polyposis cancer)
what are the ADRs of amph B
NEPHROTOXICITY
HYPOKALEMIA- weakness and arrhythmias
hypomagnesemia
what is the supraspinatous test
“empty can” test
abduction of humerus in parallel to the axis of the scapula (30degrees forward flexion) while in full internal rotation (thumbs pointed to floor)
most commonly affected rotator cuff injury- vulnerable to chronic impingement b/w head of humerus and acromion during abduction
when does one see a uniformly enlarged uterus and dysmenorrhea
adenomyosis (endometrial glandular tissue within the myometrium)
heavy menstrual bleeding is seen
what is the end product of sorbitol metabolism in healthy individuals (what happens if its fucked up)
fructose (sorbitol dehydrogenase)
human lens does not have a lot of sorbitol dehydrogenase and thus sorbitol accumulates and cataract formation happens
what is the polyol pathway and where is it most active, where is it not very active
aldose reductase converts glucose to sorbitol
sorbitol dehydrogenase converts sorbitol to fructose
used in seminal vesicles as sperm use fructose as primary energy source
retina, renal papilla, schwann ells dont have much sorbitol dehydrogenase
sorbitol can’t leave cell gets stuck if not converted to fructose
what causes the erythrocyte sedimentation rate (ESR) a nonspecific marker of inflammation to occur
aggregation of erythrocytes to form stacks (rouleaux) that sediment at a faster rate than do individual erythrocytes
due to TNF-alpha, IL-1, IL-6 causing production of acute phase reactants that bind to microbes and fix complement
renal metabolism of what amino acid is most important for maximizing acid excretion in a patient with acute ischemic colitis
GLUTAMINE
ischemic colon undergoes anaerobic metabolism- acidosis in the kidney stimulates renal ammoniagenesis
renal epithelial cells metabolize glutamine to glutamate, generating ammonium and bicarbonate
ammonium ions are transported into the tubular fluid and excreted in the urine while bicarb absorbed by peritubular cells- BUFFERS ACIDS IN THE BLOOD
what is responsible for increase in renal acid excretion seen with chronic acidosis
increased ammonium production
