uWorld 42 Flashcards
what is neuropraxia
left vocal cord paresis and hoarseness due to left atrial enlargement impinging the left recurrent laryngeal nerve
what is health promotion
the process of enabling people to increase control over their health and its determinants, and thereby improve their health
typically falls under PRIMARY PREVENTION
what is case finding
an example of SECONDARY PREVENTION
LOOKING for DISEASE that may be PRESENT BUT ASYMPTOMATIC in patients receiving medical care (age- and gender-appropriate screening)
community screening is an analogous intervention at the community level (state fair BP screenings)
what is tertiary prevention
treating an established contains with the goal of minimizing its progression or complications
what is community level intervention to improve the health of the public
taxes on cigarettes or soda or mandating smoke-free establishments implemented at the community level
what is the stages of change model
precontemplation- not thinking about behavior modification
contemplation- thinking about behavior medication
preparation- planning behavior modification
action- putting plan into action
maintenance- maintaining the new behavior
what is health risk assessment
rely on questionnaires that use demographic, medical, lifestyle, and family history information or calculate the patients “risk age”
if your risk age is higher than actual age then you are at a higher risk of death than the average individual of your age
what are laminins
heterotimeric glycoproteins that bind to type IV collagen underlying epithelial cells
they contribute to the organization and function of the basal lamina (basement membrane)
what is DACTYLITIS
PAINFUL swelling of hands and feet
common presentation of SICKLE CELL DISEASE (SCD) in YOUNG CHILDREN- one of many VASOOCCLUSIVE manifestations of SCD
sickling episodes of sickle cell disease results in what
INTRA- and EXTRAVASCULAR HEMOLYISS, which leads to increased bilirubin and lactate dehydrogenase and decreased haptoglobin
what are the vasoocclusive symptoms of sickle cell disease
hypoxic tissue injury and infarction due to obstruciotn of small vessels by sickled cells
microvascular occlusion typically involved the bone marrow, periosteum, and deep muscles
DACTYLITIS (hand-foot syndrome)- small infarcts in the bone of the extremes causing swelling, tenderness, and warmth- YOUNG KIDS
adults: pain crises, ACUTE CHEST SYNDROME, leg ulceration, PRIAPISM, AUTOSPLENECTOMY, STROKE
older person (79) comes in sick and wife is concerned about hearth b/c of multiple hospitalizations and stuff should you make sure is addressed during the rest of the admission process
make sure that there is an ADVANCE DIRECTIVES and the PATENTS wishes for END-of-LIFE care are known
this should IDEALLY be done during OUTPATIENTS VISITS with the PRIMARY CARE PROVIDER but make sure to readdress these decisions during the hospital readmission process to ensure that medical personnel adhere to the patient’s specific wishes
what is an advanced directive
living will (says end-of-life wishes and often includes specifies on intubation, resuscitation, enteral feeding..) and heathy care proxy
what bacteria can undergo transformation (aka pick up naked DNA form environment)
Strep Pneumo (how non encapsulated versions can get a capsule)
H flu
Neisseria spp
what is conjugation
one-way transfer of chromosomal or palms DNA between bacterial cells through direct physical contact
donor cells contain an extra segment of DNA called F FACOTR that codes for a SEX PILUS and other proteins necessary for transfer
bacteria that lack F FACTOR see as recipient cells
what is transduction
transfer of bacterial DNA form one bacterium form another by means of a BACTERIOPHAGE
what is generalized transduction
occurs during LYTIC infections when RANDOM BACTERIAL GENES are accidentally packaged into the viral capsid
what is specialized transduction
occurs in LYSOGENIC infection when a RESTRICTED SET OF BACTERIAL GENES near the viral INSERTION SITE is excised and packaged into the vision
PAINLESS hematuria in an adult should raise suspicion for what
genitourinary malignancy
pharmacologic treatment of a patient with low HDL should focus on what
lowering LDL with HMG-CoA reductase inhibitors (STATINS) which also reduce risk of cardiovascular events
what are cationic exchange resins (in terms of lipid lowering drugs)
bile acid resins (cholestyramine, colesnvelam, colestipol)
what does G6PD do
rate limiting step of the oxidative portion of the HMP Shunt
catalyses Glucose-6-phosphate to 6-phosphogluconate (formation of NADPH occurs)
what does phosphoglucomutatse do
interconverts glucose-6-phosphate and fructose-6-phosphate
“CLASP-KNIFE” SPACISITY is seen with UPPER MOTOR NEURON LESIONS
this in contact with left arm clumsiness, motor weakness of left arm and leg, drooping of left lower face, slurred speech
where is the lesion
INTERNAL CAPSULE
what happens in a internal capsule stroke
PURE MOTOR WEAKNESS affecting the CONTRALATERAL arm, leg, and lower face
spasticity or increased tone, hyperreflexia, and a positive babinski are also present
what does the insular cortex (insult) do
integrates body states with emotions (limbic system), autonomic nervous system control, and consul experience of visceral sensations
lesions of the putamen cause what
contralateral rumor, bradykinesia, and rigidity
damage to the globus pallidus does what
external part: decreases motion/movement
internal: excessive motion/movement
what is seen in aortic regurgitation
early diastolic murmur
usually asymptomatic, symptoms occur as the regurgitant volume increases; PALPATIONS or ATYPICAL CHEST PAIN
signs and symptoms of LEFT HEART FAILURE can also occur (exertional dyspnea and fatigue)
CAUSED BY AORTIC ROOT DILATION (murmur best heart at RIGHT sternal border) or a BICUSPID AORTIC VALVE
what doe the duration of aortic regurgitation tell you
severity of murmur
more ADVANCED cases produce a HOLODIASTOLIC murmur and MILD cases lead only to EARLY DIASTOLIC murmur
hypertrophic cardiomyopathy is always associated with what valvular defect
MITRAL REGURGITATION secondary to impaired mitral valve closure (systolic murmur)
(fun fact: papillary muscle dysfunction also causes this)
what is the murmur of MVP
MID-SYSTOLIC CLICK followed by murmur
what is the lung disease caused by cryptococcus
LUNG infection OCCURS FIRST but is usually asymptomatic
can manifest as: cough w/ scant sputum production, dyspnea, or pleuritic chest pain
MOST COMMON PRESENTATION OF CRYPTOCOCCUS IS
MENINGOENCEPHALITIS can see the things in CSF with india ink or in the lungs with mucicarmine staining
what is the most commonly dislocated joint in the body
GLENOHUMERAL JOINT due to the shadow articulation b/w the humeral head and the glenoid fossa of the scapula
can dislocate anteriorly, inferior, or posteriorly but ANTERIOR dissociation is most common
ANTERIOR DISLOCATION of the HUMERUS classically follow what, what is seen
blow to an EXTERNALLY ROTATED and ABDUCTED ARM (THROWING A FOOTBALL)
FLATTENING of the DELTOID prominence, PROTRUSION of the ACROMION, and anterior axillary fullness (due to humeral head’s movement into this locate)
AXILLARY NERVE is classically fucked- innervates DELTOID and TERES MINOR as well as sensory to LATERAL SHOULDER
acromioclavicular joint subluxation typically results form what
downward blow on the tip of the shoulder
produces swelling and UPWARD DISPLACEMENT of the clavicle
not usually associated with specific nerve injuries/deficits
clavicular fractures usually occur when
after direct trauma to the clavicle
most features are in the middle third and produce local welling and tenderness
neurovascular damage is rare
rotator cuff inures ma occur during shoulder dislocation but they do not cause what
NO NERVE INJURY
when would one see a spiral fracture of the MIDSHAFT HUMERUS
TORSION produced during a FALL on OUTSTRETCHED HANDS
swelling, bone crepitus, and ecchymosis on the arm
RADIAL NERVE injured
fattening of deltoid muscle with acromial prominence after a shoulder injury suggests what
anterior humerus dislocation (most commonly from a blow to an externally rotated and abducted arm)
axillary nerve damage is associated with it cause deltoid and teres minor paralysis as well as loss of lateral shoulder sensation
increased nuchal translucency on ultrasound suggests what
DOWN SYNDROME (so does decreased AFP)
gotta CONFIRM with CHORIONIC VILLOUS SAMPLING or AMNIOCENTESIS
at risk for duodenal atresia, imperforate anus, Hirshprung disease , tracheoesophageal fistula, and celiac disease
what are the signs of duodenal atresia
DOUBLE BUBBLE SIGN
bilious emesis
marked elevated AFP is seen with what
open neural tue and VENTRAL WALL DEFECTS (omphalocele, gastrochisis)
myelomeningocele is associated with what trisomy
18
omphalocele is associated with what trisomy
both 13 and 18
what is the MOST IMPORTANT mediator of SEPTIC SHOCK
TNF-alpha
IL-1 and IL-6 also help
what is responsible for the GREEN color of pus and sputum in bacterial infections
MYELOPEROXIDASE (a blue-green heme-based pigmented molecule contained within the azurophilic granules of neutrophils and catalyzes the production of hypochlorus acid from chloride and hydrogen peroxide during phagocytic respiratory burst)
reperfusion injury is thought to occur secondary to what
oxygen free radical generation
mitochondria damage
inflammation
what are the ADRs of cidofovir
nephrotoxicity manifesting as proteinuria or elevated creatinie
what are the ADRs of foscarnet
HYPOCALCEMIA (it can chelate calcium)
HYPOMAGNESEMIA (renal wasting)
both of which promote SEIZURES
also a reduction in PTH release occurs
what is sofosbuvir
inhibits nonstructural protein 5B (NS5B) as RNA-dependent RNA polymerase needed for hepatitis C virus replication
ADRs: fatigue and nausea
what are the clinical manifestations of B6 deficieny
dermatitis, atrophic glossitis, sideroblastic anemia
peripheral neuropathy
phenytoin can cause what vitamin deficiency
folate (B9)
what opioid receptor causes MIOSIS
KAPPA
also causes: dysphoria, dedication and analgesia (PNS, some opioids)
what does the mu opioid receptor do
physical dependence euphoria RESPIRATORY and CARDIAC DEPRESSION REDUCED GI MOTILITY sedation analgesia (CNS, most opioids)
what doe the delta opioid receptor do
antidepressant effects
analgesia (PNS, some opioids)
what is hexamethonium
a potent nicotinic receptor antagonist
naloxone binds what receptors
MU, kappa, and delta
binds MU with the HIGHEST AFFINITY
what is the effect of beta blockers not the RAAS
beta 1 blockage directly INHIBITS RENIN
thus renin, angiotensin I, angiotensin II, and aldosterone will ALL BE DECREASED
no change in BRADYKININ levels
what antibiotic can cause serotonin syndrome (obviously when combined with the right shit)
LINEZOLID- has MAOI activity
left 12th rib fracture is gna fuck what up
left kidney
what are true ribs
first 7 rib pairs
b/c their costal cartilage attaches directly to the sternum
what ar the floating ribs
fibs 11 and 12
not bound to anterior rib cage by any cartilage
what ribs overlie the spleen
9, 10, and 11
what ribs overlie the posterior surface of the liver
8-11
fracture of what ribs has greatest chance of fuckign up visceral pleura
1-6
likelihood of plaque rupture is based on what
STABILITY (or rather instability) not its size or the degree of luminal narrowing
stability largely deepens n mechanical strength of the fiver cap
peripheral blood smear with ISOLATED THROMBOCYTOPENIA and no other platelet abnormalities would help confirm what
IMMUNE THROMBOCYTOPENIC PURPURA (ITP)
fun fact: MEGAKARYOCYTES can be seen sometimes on peripheral blood smear
how is immune thombocytopenic purpura treated
corticosteroids
fun fact: can be associated with HI or Hpe C
what viruses cause aplasia anemia
parvovirus
EBV
what should be suspected in a patient with echmymosses, petechia, mucosal bleeding, and not other obvious causes of thrombocytopenia
immune thrombocytopenia purpura- autoimmune platelet destruction
what causes straw-colored discharge from the umbilicus
persistence of allantois remnant
what is a URACHAL SINUS
failure to close the detail part of the urachus (adjacent to the umbilicus)
presents with periumbilical tenderness and PURULENT UMBILICAL DISCHARGE due to persistence and recurrent infections
what is another name for the omphalomesenteric duct
VITELLINE DUCT (seen in Meckles Diverticulum)
what regulates the micturition reflex
sacral micturition center (S2-S4 level and responsible of bladder contraction)
pontine micturition center (pontine reticular formation and coordinates realization of external urethral sphincter with bladder contraction during voiding)
cerebral cortex (inhibits sacral micturition center)
what is the mechanism of normal pressure hydrocephalus causing urinary incontinence
expanded ventricle place traction on cortical efferent and afferent fibers (corona radiata)
this traction disrupts the periventricular pathways that transmit impulses form the cortex to the sacral micturition center
later on in disease lack of inhibition form cerebral cortex leads to frequent and uncontrolled micturition, or urge incontinence
bladder fills with urine and empties reflexively when full but patient has no sensation of fullness and no control over bladder function
voluntary relaxation of the urethral sphincter remains intact
what are paneth cells
found at base of intestinal crypts
phagocytic and secretory
provide first-line immune defense against microorganisms
secret lysozyme (decreases cell walls of any bacteria) and defensins (polypeptides with antimicrobial properties)
when does one test stool for fecal leukocytes (PMNs)
when it is unclear if the cause of diarrhea is inflammatory or not
what is polymyalgia rheumatica
neck, torso, shoulder, and pelvic girdle pain and morning stiffness
fatigue, fever, and weight loss may also occur
seen in TEMPORAL (GIANT CELL) ARTERITIS
what does IgA protease do in NEISSERIA
cleave IgA at its hing region causing Fc and Fab portions and decreasing the effectiveness of the IgA
this allows the BACTERIA to ADHERE to the MUCOSA
what nerve senses information form the carotid body chemoreceptors and carotid sinus baroreceptors
GLOSSOPHARYNGEAL
what nerve senses information form the aortic arch baroreceptors and aortic arch chemoreceptors
VAGUS NERVE
what is HIV-associated dementia
features of SUBCORTICAL DEMENTIA (attention/working memory problems, executive dysfunction, slow information processing) as HIV affects primarily the subcortical/deep gray matter structures
pathogenesis: INFLAMMATORY ACTIVATION OF MICROGLIAL CELLS which form groups of MICROGLIAL NODULES around small areas of necrosis and may fuse to form multinucleate giant cells
neuronal damage is believed to be due to cytokine relate by macrophages/microglial cells and the direct toxic effect of HIV-derived proteins
