UWorld 5/16/2014

Question 1

What is a gastrojejunomy

Answer 1

Gastric antrum removed and side to side anastomoses between jejunum and gastric body is made

Question 2

Where is iron, folate and ADEK absorbed

Answer 2

Iron - duo and prox jejunum, adek - jejunum and ileum although some in duo too, folate - jejunum and ileum

Question 3

Hep B infection histology?

Answer 3

Eosinophilic cytoplasm with granules/tubules filled with HBsAg. Ground glass appearance

Question 4

Where is the foramen cecum wrt to the terminal sulcus?

Answer 4

Along the terminal sulcus, in the ANTERIOR 2/3rd of tone

Question 5

Pain from posterior 1/3rd, anterior 2/3 of tongue is mediated by?

Answer 5

Anterior 2/3 - mandibular div of trigeminal nerve, poster 1/3rd is from glossopharyngeal

Question 6

What part of the nephron is impermeable to water?

Answer 6

Thick ascending loop. Urine becomes less concentrated.

Question 7

Where is the third part of the duodenum (wrt to veretbra). What structures is it close to?

Answer 7

Horizontal across L3. Overlies abdominal aorta, IVC. Closely a/w with uncus of pancreas and SMA and SMV.

Question 8

What is the virulence mechanism of stapholococcus epidermis

Answer 8

Ability to make biofilms. Biofilms help encase bacteria and prevent opsonization, neutrophil migration and T lymphocyte activation

Question 9

What is conversion disorder?

Answer 9

Type of somatoform disorder in which there is complaint/manifestation of neurological symptoms when pathophysiological reasons for the sx cannot be found. Happens more typically in women and after life stresor

Question 10

What is somatization disorder?

Answer 10

Patients with numerous physical complaints over years for which no physical explanation can be found. Sx must’ve started before ago 30 and significantly impact social or occupational function. Need a lot of bodily sx for diagonosis (different organ systems)

Question 11

What is the most common cause of meconium ileus

Answer 11

CF

Question 12

What kind of diseases account for most of the deaths in CF

Answer 12

Cardiorespiratory complications - pneumonia, bronchiectasis, bronchitic obstructive pulmonary disease

Question 13

What are the major hip flexors

Answer 13

Psoas and iliacus

Question 14

What is the psoas sign

Answer 14

Pain when hip is extended

Question 15

Psoas abscesses occur due to?

Answer 15

Result of hematogenous or lymphatic seeding from adjacent structures like vertebral bodies or a distant site as well.

Question 16

What drug causes direct vasodilation and inhibition of platelet aggregation?

Answer 16

Cilostazol, dipyridamole

Question 17

What is the MOA of cilostazol and dipyridamole

Answer 17

Inhibits phoshodiesterase III thereby maintains elevated cAMP levels. Elevated cAMP levels inhibit ADP release from dense grandules. ADP is needed for platelet aggregation…therefore this drug inhibitis plately aggregation. Also vasodilates directly.

Question 18

What does estrogen do to growing bone

Answer 18

Necessary for fusion of epiphyses

Question 19

Deficiency of what enzyme causes ambiguous genitalia in a female and maternal virilization

Answer 19

Aromatase, which converts testosterone to estriol andrenestenedione to estrone. Androgens cross placenta during pregnancy causing maternal virilization. Females with aromatase deficiency have primary amenorrhea and tall stature. Males are tall with osteoporosis with no genital abnormalities

Question 20

Prostate cancer is what hormone dependent?

Answer 20

Testosterone

Question 21

what is the MOA of Flutamide?

Answer 21

Flutamide competes with testsoterone and DHT at their receptors and therefore blocks the needed testosterone in cancer growth. Flutamide monotherapy does lead to increased testosterone levels because of feedback but this can be reduced with simultaneous GNRH agonist administration

Question 22

What is DDAVP and why is it used in von willenbrand disease

Answer 22

DDAVP is a vasopressin analog. It stimulates release of vWF from endothelial cells and is helpful in controlling bleeding in patients with VW disease

Question 23

In patients who have had a TIA what drug is used to prevent primary and secondary coronary artery events and ischemic strokes?

Answer 23

Aspriin

Question 24

Patients with classic 21alpha hydroxylase deficiency present how?

Answer 24

Boys: salt wasting, hypotension, hyperkalemia. Girls: virilization ambiguous genitalia)

Question 25

What is MEN1

Answer 25

Multiple endocrine neoplasia 1. pituitary, parathyroid and pancreas tumors

Question 26

In the pathogenesis of atherosclerotic plaques, what stimulates smooth muscle migration?

Answer 26

release of PDGF from macrophages and platelets and endothelial cells promotes smooth muscle cell migration

Question 27

Brown pigment stones typically arise from?

Answer 27

Secondary to infection of the biliary tract which results in release of beta glucuronidase by injured hepatocytes and bacteria. This contibutes to hydrolysis of bliribuin glucuronides and increases amount of unconjugated biliriubin => brown

Question 28

The spleen is derived from? It is supplied by?

Answer 28

Mesodermal dorsal mesentery. Supplied by the splenic artery which is from celiac trunk (primary blood supply of the gut)

Question 29

How does heme affect ALA and porphobilinogen

Answer 29

Heme normally decreases ALA synthase activity/regulates it. Without it, there will be increaes ALA and prophobilnogen levels, leading to acute attacks of intermittent hepatic porphyria