UWorld 5/16/2014 Flashcards
What is a gastrojejunomy
Gastric antrum removed and side to side anastomoses between jejunum and gastric body is made
Where is iron, folate and ADEK absorbed
Iron - duo and prox jejunum, adek - jejunum and ileum although some in duo too, folate - jejunum and ileum
Hep B infection histology?
Eosinophilic cytoplasm with granules/tubules filled with HBsAg. Ground glass appearance
Where is the foramen cecum wrt to the terminal sulcus?
Along the terminal sulcus, in the ANTERIOR 2/3rd of tone
Pain from posterior 1/3rd, anterior 2/3 of tongue is mediated by?
Anterior 2/3 - mandibular div of trigeminal nerve, poster 1/3rd is from glossopharyngeal
What part of the nephron is impermeable to water?
Thick ascending loop. Urine becomes less concentrated.
Where is the third part of the duodenum (wrt to veretbra). What structures is it close to?
Horizontal across L3. Overlies abdominal aorta, IVC. Closely a/w with uncus of pancreas and SMA and SMV.
What is the virulence mechanism of stapholococcus epidermis
Ability to make biofilms. Biofilms help encase bacteria and prevent opsonization, neutrophil migration and T lymphocyte activation
What is conversion disorder?
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
What is somatization disorder?
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)
What is the most common cause of meconium ileus
CF
What kind of diseases account for most of the deaths in CF
Cardiorespiratory complications - pneumonia, bronchiectasis, bronchitic obstructive pulmonary disease
What are the major hip flexors
Psoas and iliacus
What is the psoas sign
Pain when hip is extended
Psoas abscesses occur due to?
Result of hematogenous or lymphatic seeding from adjacent structures like vertebral bodies or a distant site as well.
What drug causes direct vasodilation and inhibition of platelet aggregation?
Cilostazol, dipyridamole
What is the MOA of cilostazol and dipyridamole
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.
What does estrogen do to growing bone
Necessary for fusion of epiphyses
Deficiency of what enzyme causes ambiguous genitalia in a female and maternal virilization
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
Prostate cancer is what hormone dependent?
Testosterone
what is the MOA of Flutamide?
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
What is DDAVP and why is it used in von willenbrand disease
DDAVP is a vasopressin analog. It stimulates release of vWF from endothelial cells and is helpful in controlling bleeding in patients with VW disease
In patients who have had a TIA what drug is used to prevent primary and secondary coronary artery events and ischemic strokes?
Aspriin
Patients with classic 21alpha hydroxylase deficiency present how?
Boys: salt wasting, hypotension, hyperkalemia. Girls: virilization ambiguous genitalia)
What is MEN1
Multiple endocrine neoplasia 1. pituitary, parathyroid and pancreas tumors
In the pathogenesis of atherosclerotic plaques, what stimulates smooth muscle migration?
release of PDGF from macrophages and platelets and endothelial cells promotes smooth muscle cell migration
Brown pigment stones typically arise from?
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
The spleen is derived from? It is supplied by?
Mesodermal dorsal mesentery. Supplied by the splenic artery which is from celiac trunk (primary blood supply of the gut)
How does heme affect ALA and porphobilinogen
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
