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zz - step 3 - uworld > uWorld 42 > Flashcards

uWorld 42 Flashcards

1
Q

what is neuropraxia

A

left vocal cord paresis and hoarseness due to left atrial enlargement impinging the left recurrent laryngeal nerve

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2
Q

what is health promotion

A

the process of enabling people to increase control over their health and its determinants, and thereby improve their health

typically falls under PRIMARY PREVENTION

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3
Q

what is case finding

A

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)

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4
Q

what is tertiary prevention

A

treating an established contains with the goal of minimizing its progression or complications

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5
Q

what is community level intervention to improve the health of the public

A

taxes on cigarettes or soda or mandating smoke-free establishments implemented at the community level

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6
Q

what is the stages of change model

A

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

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7
Q

what is health risk assessment

A

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

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8
Q

what are laminins

A

heterotimeric glycoproteins that bind to type IV collagen underlying epithelial cells

they contribute to the organization and function of the basal lamina (basement membrane)

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9
Q

what is DACTYLITIS

A

PAINFUL swelling of hands and feet

common presentation of SICKLE CELL DISEASE (SCD) in YOUNG CHILDREN- one of many VASOOCCLUSIVE manifestations of SCD

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10
Q

sickling episodes of sickle cell disease results in what

A

INTRA- and EXTRAVASCULAR HEMOLYISS, which leads to increased bilirubin and lactate dehydrogenase and decreased haptoglobin

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11
Q

what are the vasoocclusive symptoms of sickle cell disease

A

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

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12
Q

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

A

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

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13
Q

what is an advanced directive

A

living will (says end-of-life wishes and often includes specifies on intubation, resuscitation, enteral feeding..) and heathy care proxy

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14
Q

what bacteria can undergo transformation (aka pick up naked DNA form environment)

A

Strep Pneumo (how non encapsulated versions can get a capsule)
H flu
Neisseria spp

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15
Q

what is conjugation

A

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

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16
Q

what is transduction

A

transfer of bacterial DNA form one bacterium form another by means of a BACTERIOPHAGE

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17
Q

what is generalized transduction

A

occurs during LYTIC infections when RANDOM BACTERIAL GENES are accidentally packaged into the viral capsid

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18
Q

what is specialized transduction

A

occurs in LYSOGENIC infection when a RESTRICTED SET OF BACTERIAL GENES near the viral INSERTION SITE is excised and packaged into the vision

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19
Q

PAINLESS hematuria in an adult should raise suspicion for what

A

genitourinary malignancy

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20
Q

pharmacologic treatment of a patient with low HDL should focus on what

A

lowering LDL with HMG-CoA reductase inhibitors (STATINS) which also reduce risk of cardiovascular events

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21
Q

what are cationic exchange resins (in terms of lipid lowering drugs)

A

bile acid resins (cholestyramine, colesnvelam, colestipol)

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22
Q

what does G6PD do

A

rate limiting step of the oxidative portion of the HMP Shunt

catalyses Glucose-6-phosphate to 6-phosphogluconate (formation of NADPH occurs)

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23
Q

what does phosphoglucomutatse do

A

interconverts glucose-6-phosphate and fructose-6-phosphate

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24
Q

“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

A

INTERNAL CAPSULE

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25
Q

what happens in a internal capsule stroke

A

PURE MOTOR WEAKNESS affecting the CONTRALATERAL arm, leg, and lower face

spasticity or increased tone, hyperreflexia, and a positive babinski are also present

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26
Q

what does the insular cortex (insult) do

A

integrates body states with emotions (limbic system), autonomic nervous system control, and consul experience of visceral sensations

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27
Q

lesions of the putamen cause what

A

contralateral rumor, bradykinesia, and rigidity

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28
Q

damage to the globus pallidus does what

A

external part: decreases motion/movement

internal: excessive motion/movement

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29
Q

what is seen in aortic regurgitation

A

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

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30
Q

what doe the duration of aortic regurgitation tell you

A

severity of murmur

more ADVANCED cases produce a HOLODIASTOLIC murmur and MILD cases lead only to EARLY DIASTOLIC murmur

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31
Q

hypertrophic cardiomyopathy is always associated with what valvular defect

A

MITRAL REGURGITATION secondary to impaired mitral valve closure (systolic murmur)

(fun fact: papillary muscle dysfunction also causes this)

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32
Q

what is the murmur of MVP

A

MID-SYSTOLIC CLICK followed by murmur

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33
Q

what is the lung disease caused by cryptococcus

A

LUNG infection OCCURS FIRST but is usually asymptomatic

can manifest as: cough w/ scant sputum production, dyspnea, or pleuritic chest pain

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34
Q

MOST COMMON PRESENTATION OF CRYPTOCOCCUS IS

A

MENINGOENCEPHALITIS can see the things in CSF with india ink or in the lungs with mucicarmine staining

35
Q

what is the most commonly dislocated joint in the body

A

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

36
Q

ANTERIOR DISLOCATION of the HUMERUS classically follow what, what is seen

A

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

37
Q

acromioclavicular joint subluxation typically results form what

A

downward blow on the tip of the shoulder

produces swelling and UPWARD DISPLACEMENT of the clavicle

not usually associated with specific nerve injuries/deficits

38
Q

clavicular fractures usually occur when

A

after direct trauma to the clavicle

most features are in the middle third and produce local welling and tenderness

neurovascular damage is rare

39
Q

rotator cuff inures ma occur during shoulder dislocation but they do not cause what

A

NO NERVE INJURY

40
Q

when would one see a spiral fracture of the MIDSHAFT HUMERUS

A

TORSION produced during a FALL on OUTSTRETCHED HANDS

swelling, bone crepitus, and ecchymosis on the arm

RADIAL NERVE injured

41
Q

fattening of deltoid muscle with acromial prominence after a shoulder injury suggests what

A

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

42
Q

increased nuchal translucency on ultrasound suggests what

A

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

43
Q

what are the signs of duodenal atresia

A

DOUBLE BUBBLE SIGN

bilious emesis

44
Q

marked elevated AFP is seen with what

A

open neural tue and VENTRAL WALL DEFECTS (omphalocele, gastrochisis)

45
Q

myelomeningocele is associated with what trisomy

A

18

46
Q

omphalocele is associated with what trisomy

A

both 13 and 18

47
Q

what is the MOST IMPORTANT mediator of SEPTIC SHOCK

A

TNF-alpha

IL-1 and IL-6 also help

48
Q

what is responsible for the GREEN color of pus and sputum in bacterial infections

A

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)

49
Q

reperfusion injury is thought to occur secondary to what

A

oxygen free radical generation
mitochondria damage
inflammation

50
Q

what are the ADRs of cidofovir

A

nephrotoxicity manifesting as proteinuria or elevated creatinie

51
Q

what are the ADRs of foscarnet

A

HYPOCALCEMIA (it can chelate calcium)
HYPOMAGNESEMIA (renal wasting)
both of which promote SEIZURES

also a reduction in PTH release occurs

52
Q

what is sofosbuvir

A

inhibits nonstructural protein 5B (NS5B) as RNA-dependent RNA polymerase needed for hepatitis C virus replication

ADRs: fatigue and nausea

53
Q

what are the clinical manifestations of B6 deficieny

A

dermatitis, atrophic glossitis, sideroblastic anemia

peripheral neuropathy

54
Q

phenytoin can cause what vitamin deficiency

A

folate (B9)

55
Q

what opioid receptor causes MIOSIS

A

KAPPA

also causes: dysphoria, dedication and analgesia (PNS, some opioids)

56
Q

what does the mu opioid receptor do

A 
physical dependence
euphoria
RESPIRATORY and CARDIAC DEPRESSION
REDUCED GI MOTILITY
sedation
analgesia (CNS, most opioids)
57
Q

what doe the delta opioid receptor do

A

antidepressant effects

analgesia (PNS, some opioids)

58
Q

what is hexamethonium

A

a potent nicotinic receptor antagonist

59
Q

naloxone binds what receptors

A

MU, kappa, and delta

binds MU with the HIGHEST AFFINITY

60
Q

what is the effect of beta blockers not the RAAS

A

beta 1 blockage directly INHIBITS RENIN
thus renin, angiotensin I, angiotensin II, and aldosterone will ALL BE DECREASED

no change in BRADYKININ levels

61
Q

what antibiotic can cause serotonin syndrome (obviously when combined with the right shit)

A

LINEZOLID- has MAOI activity

62
Q

left 12th rib fracture is gna fuck what up

A

left kidney

63
Q

what are true ribs

A

first 7 rib pairs

b/c their costal cartilage attaches directly to the sternum

64
Q

what ar the floating ribs

A

fibs 11 and 12

not bound to anterior rib cage by any cartilage

65
Q

what ribs overlie the spleen

A

9, 10, and 11

66
Q

what ribs overlie the posterior surface of the liver

A

8-11

67
Q

fracture of what ribs has greatest chance of fuckign up visceral pleura

A

1-6

68
Q

likelihood of plaque rupture is based on what

A

STABILITY (or rather instability) not its size or the degree of luminal narrowing

stability largely deepens n mechanical strength of the fiver cap

69
Q

peripheral blood smear with ISOLATED THROMBOCYTOPENIA and no other platelet abnormalities would help confirm what

A

IMMUNE THROMBOCYTOPENIC PURPURA (ITP)

fun fact: MEGAKARYOCYTES can be seen sometimes on peripheral blood smear

70
Q

how is immune thombocytopenic purpura treated

A

corticosteroids

fun fact: can be associated with HI or Hpe C

71
Q

what viruses cause aplasia anemia

A

parvovirus

EBV

72
Q

what should be suspected in a patient with echmymosses, petechia, mucosal bleeding, and not other obvious causes of thrombocytopenia

A

immune thrombocytopenia purpura- autoimmune platelet destruction

73
Q

what causes straw-colored discharge from the umbilicus

A

persistence of allantois remnant

74
Q

what is a URACHAL SINUS

A

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

75
Q

what is another name for the omphalomesenteric duct

A

VITELLINE DUCT (seen in Meckles Diverticulum)

76
Q

what regulates the micturition reflex

A

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)

77
Q

what is the mechanism of normal pressure hydrocephalus causing urinary incontinence

A

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

78
Q

what are paneth cells

A

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)

79
Q

when does one test stool for fecal leukocytes (PMNs)

A

when it is unclear if the cause of diarrhea is inflammatory or not

80
Q

what is polymyalgia rheumatica

A

neck, torso, shoulder, and pelvic girdle pain and morning stiffness

fatigue, fever, and weight loss may also occur

seen in TEMPORAL (GIANT CELL) ARTERITIS

81
Q

what does IgA protease do in NEISSERIA

A

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

82
Q

what nerve senses information form the carotid body chemoreceptors and carotid sinus baroreceptors

A

GLOSSOPHARYNGEAL

83
Q

what nerve senses information form the aortic arch baroreceptors and aortic arch chemoreceptors

A

VAGUS NERVE

84
Q

what is HIV-associated dementia

A

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

zz - step 3 - uworld (62 decks)

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