uWorld 41 Flashcards
what are the signs of digoeroge (22q11.2 micro deletion)
hypocalcemia (tetany, carpopedal spasms, or seizures)
loss of thymic shadow (no thymus due to 3rd pouch fucked)
recurrent viral, fungal, protozoan infections
conotruncal anomalies (interrupted aortic arch, truncus arteriosus)
what are the Ckvostek and Trousseau signs
due to HYPOCALCEMIA
Chvostek sign: twitching of the nose and lips when tapping on the facial nerve
Trousseau sign: inflation of BP cuff leads to CARPASL SPASM
what needs to be known in order to perform the amplification part of PCR
the nucleotide sequence of the regions flanking the target exon
these are used to make the PRIMERS necessary to start PCR
thermostable DNA pol, deoxynucleotide tirphosphates, and a source DNA template strand are also necessary
what is the best initial approach to someone who has drug seeking behaviors (clearly asking for specific drug and getting frustrated when you suggest otherwise)
clarify the patients medication history to determine which drugs have been prescribed, by whom, and at what frequency
state-based, online prescriptions, clarify prescription patterns, and identify patients who obtain prescriptions from multiple providers
by identifying potential opioid misuse, providers can make more informed decisions regarding pain prescriptions
hematogenous osteomyelitis is predominantly a disease of children that most frequently affects the long bones. what are the most common causes
- Staph Aureus
2. Strep pyogenes
in what phases do oocytes arrest
childhood-puberty: meiosis I arrested in PROPHASE
-chromosome pairs arranged in tetrad and in close proximity allowing for RECOMBINATION
monthly, from puberty to menopause: meiosis II arrested in METAPHASE until fertilization
when during the membrane potential is the membrane most permeable to POTASSIUM, what about sodium
potassium: during the depolarization phase (halfway down, before the undershoot)
sodium: at the peak of the membrane potential the sodium permeance is the greatest
during aerobic exercise what increased in terms of blood gas values
skeletal muscle CO2 production increased PCO2 of mixed venous blood but homeostatic mechanisms maintain arterial blood gas levels and arterial pH near the resting values
most common lung cancer in female nonsmoker
adenocarcinoma
CLUBBING and HYPERTROPHIC OSTEOARTHROPATHY
BRADYCARDIA with regular rhythm and NARROW QRS complexes but complete DESYNCHRONIZATION b/w P waves and QRS
where the beat coming from
AV NODAL CELLS (become pacemakers when conduction b/w SA and AV node gets fucked)
can occur in complete (THIRD-DEGREE) AV block: impulses from SA node cause ATRIAL contraction while AV node causes VENTRICULAR contractions
pace is about 45-55bpm
boy with left sternal murmur that accentuates with the handgrip exercise (most likely diagnosis)
VSD (often asymptomatic and detected incidentally during routine cardiac auscultation)
proly gna have a sound clip with a low pitch holosystolic murmur
they systolic ejection murmur of hypertrophic cardiomyopathy decreases when
maneuvers that INCREASE AFTERLOAD and PRELOAD (b/c increasing these attenuate the left ventricular outflow tract obstruction, and associated mitral regurgitation, by increasing left ventricular volume)
handgrip increases after load thus decreased this murmur
straining phase of the VALSALVA (decreases preload) will INCREASE IT
when would one see POPLITEAL and INGUINAL lymph node enlargement from the same thing
LATERAL lesions of the foot (drain via lateral superficial lymphatic system)
medial lesions follow the medial superficial lymphmatic system which go straight to superficial inguinal lymph nodes with no connection to the popliteal lymph nodes
where does the glans penis lymph drain
DEEP INGUINAL NODES
different from the rest of the skin of the penis and scrotum which go to the superficial inguinal nodes
what cytokines cause bacteremia and shock
IL-1, IL-6 and TNF-alpha
facial pain, headache, and nasal eschar in a patient with likely diabetic ketoacidosis
what the fuck they got
MUCORMYCOSIS
rhino cerebral infection from some spore inhalation
broad ribbon-like nonseptate hyphae with right-angle branching
tissue invasion i seen along blood vessels; vascular thrombosis and tissue necrosis can occur
to visualize do a MUCOSAL BIOPSY as this shit won’t grow in a blood culture
C5-C6 spinal nerves innervate what
biceps and brachioradialis reflexes
via musculocutanous nerve
high serum levels of what is diagnostic for 21-hydroxylase deficiency
17-HYDROXYPROGESTERONE
all patients with 17-hydroxylase deficiency appear how
phenotypically female
what is cheyne-stokes breathing and when is it seen
commonly seen in patients with advanced CONGESTIVE HEART FAILURE (CHF)
cyclic breathing pattern in which APNEA is followed by GRADUALLY INCREASING THEN DECREASING TIDAL volumes UNTIL the NEXT APNEIC period
what causes KUSSMAUL BREATHING
deep and labored breathing pattern often associated with severe metabolic acidosis
KUSSMAUL: Ketones Uremia Sepsis Salicylates Methanol Aldehydes U Lactic acidosis
what is seen in obstructive sleep apnea
reductions or cessation of airflow during sleep due to upper respiratory obstruction despite ADEQUATE RESPIRATORY EFFORT
ventilation remains nearly constant during the non-apneic periods with minimal cyclical variation in tidal volume
what are the types of neoplastic colonic polyps
serrated
adenomatous (tubular, villous and tubulovillous)
what are the non-neoplasic colonic polyps
hyperplastic
submucosal
inflammatory
mucosal
what is an inflammatory intestinal polyp
non-neoplastic
seen in Ulcerative colitis and Crohn disease
composed of regenerating intestinal mucosa
what is a submucosal polyp
non-neoplastic submucosal structures (LIPOMA, LYMPHOID AGGREGATES) that bulge up into the mucosa
what are mucosal polyps
non-neoplastic
colonic mucosa that resemble polyps but ar made of normal mucosa
what are the criteria that determine the malignant potential of a adenomatous polyp
1/ degree of dysplasia
- histological pattern: VILLOUS adenomas are MORE LIKELY to undergo malignant transformation than tubular adenomas
- size: risk of malignancy increases with size, especially over 4cm
what is the single most important measure to reduce the risk of transmission of microorganisms between patients (and thus hospital acquired infections)
HAND HYGIENE
when must one use contact precautions (wearing NONSTERILE gloves for all patient contact and gowns during substantial contact with infective material)with a patient
specific MULTIDRUG RESISTANT BACTERIA (MRSA) or with PARASITIC or VIRAL pathogens
when are isolation precautions indicated
infectious airborne disease (TB) and involve private airport infection isolation room with negative pressure, closed doors, and the use of specialized particulate respirator masks
what is mifepristone
PROGESTERONE antagonist
glucocorticoid antagonist
used for abortions with misoprostol (PGE1 analog)
causes APOPTOSIS and NECROSIS of the UTERINE DECIDUA and prevents further development of a first trimester pregnancy (has higher affinity for progesterone receptor than natural hormone)
nifedipine and indomethacin are tocolytic drugs used to stop what
PRETERM LABOR
decreased intracellular calcium form nifedipine blocks myosin kinase phosphorylation, which in turn leads to myometrial relaxation
indomethacin stops PG synthesis, which decreases uterine contractility
how does methotrexate terminate pregnancy
inhibits trophoblast division, therefore decreasing trophoblastic survival, hindering implantation, and encouraging explosion
used to tx ectopic pregnancy and used with misoprostol for abrotion with mifepristone not around
what is the inheritance of von WIllebrand disease
Autosomal DOMINANT
how does desmopressin work in von willebrand disease
stimulates secretion of vWF (and factor VIII) from ENDOTHELIAL CELLS
what si the difference between a complete mole and an invasive mole
complete mole is benign
invasive mole is malignant and has invaded the myometrial tissue
how can one tell a choriocarcinoma apart from all the moles
choriocarcinoma has NO VILLI all the moles got at east some
what is the major function of the hippocampus
formation of new memories
what nucleus is said to place a central role in panic attacks and pacing disorder
locus ceruleus (NOREPI)
found in the caudal pontine central gray matter
acetazolamide can treat what glaucoma
open angle and acute-angle closure
ADRs: somnolence, paresthesias, urine alkalization, metabolic acidosis, dehydration, HYPOKALEMIA, and HYPONATREMIA
how are ACUTE INTERMITTENT PORPHYRIA attacks managed
infusion of HEMIN or GLUCOSE, which DOWNREGULATES hepatic AMINOLEVULINATE (ALA) SYNTHETASE which is the RATE LIMITING step in hepatic pathway of HEME SYNTHESIS
what is seen in acute intermittent prophyria
acue abdominal pain and neurological symptoms due to accumulation of ALA and PBG resulting form a combo of:
PBG deaminase deficiency
ALA SYNTHASE INDUCTION, typically precipitated by certain medications (phenobarbital, griseofulvin, phenytoin), alcohol use, smoking, progesterone, or LOW-CALORIE DIET
what is seen in WEST NILE VIRUS
FEBRILE illness with a RASH and NEUROLOGICAL SYMPTOMS including ENCEPHALITIS (CONFUSION) associated with FLACCID PARALYSIS syndrome, also causes MENINGITIS
(+)RNA Flavivirus transmitted by MOSQUITOES in the SUMMER
fever, progressive weakness, and dyspnea (due to valvular regurgitation noted by previous diagnosis of a “heart disease”) along with presence of VEGETATIONS on the MITRAL VALVE is consistent with what
INFECTIVE ENDOCARDITIS (IE)
predisposing factors for IE are VALVULAR ANOMALIES (rheumatic heart disease, MVP, prosthetic valves, congenial heart disease) and conditions that promote BACTERMEIA/FUNGEMIA (IV drug use, dental procedures)
in rheumatic heart disease what causes the underlying degeneration of the valve predisposing it to infectious endocarditis
chronic INFLAMMATION and SCARRING
what is the initial process involved in pathogenies of infective endocarditis
DISRUPTION OF NORMAL ENDOCARDIAL SURFACE, most commonly at areas of maximal turbulence to blood flow in preexisting valvular lesions, typically the atrial surface of incompetent AV valves or ventricular surface of incompetence semilunar valves
this is followed by focal adherence of FIBRIN and PLATELETS, forming a STERILE FIBRIN-PLATELET NIDUS
during bacteremia the organisms can colonize the sterile nidus
Staph doesn’t need a nidus it can infect normal healthy valves
what are Janeway lesions
Infective endocarditis
contender, macular, and erythematous lesions typically located not he palms and loses
result of SEPTIC EMBOLIZATION form valvular vegetations and are composed of bacteria, neutrophils (microabscesses), necrotic material, and subcutaneous hemorrhage
what are osler nodes
seen in infective endocarditis
tender, violacious nodules typically located in the pulp of fingers and toes
pathogenesis is IMMUNE-COMPLEX
what is the clincal presentation of medulloblastoma
gait instability and limb ataxia (cerebellar involvement), increased ICP (morning headaches, vomiting, lethargy)
sheets of primitive cells with many mitotic figures (primitive neuroectodermal tumor- PNETs_- composed of small blue cells w/ deeply eosinophil nuclei and scant cytoplasm
undifferentiated aggressive tumor
2nd most common brain tumor of kids
what is seen in pilocytic astrocytoma
cerebellum is invalid
pilocyic astrocytes
ROSENTHAL FIBERS (eosinophilis things)
low-grade tumor
most common brian tumor of kids
why is seen in an ependymoma
3rd most common brain tumor of kids
in the walls of the ventricles and can hamper CSF flow and cause hydrocephalus
form gland-like structures called ROSETTES
what is the order of sodium channel binding strength for class 1 antiarrythmics
1C is the strongest (slow dissociation- USE DEPENDENCE MORE PRONOUNCED)
1A is intermediate (intermediate dissociation)
1B is the weakest (FAST DISSOCIATION)
whats the difference in PSGN in kids and adults
adults have POORER PROGNOSIS (age is the most important poor prognosis factor for PSGN)
more likely to develop chronic hypertension, recurrent proteinuria, chronic renal insufficiency, or rapidly progressive GN
preexisting kidney disease is another poor prognostic facotr
