uWorld 51 Flashcards
involuntary head bobbing is a sign of what and seen in what
WIDENED PULSE PRESSURE
seen in AORTIC REGURGITATION (unusually large LV stroke volumes and a heart murmur with the widened pulse pressure)
palpitations usually result from what implying what
result from forceful ventricular contractions ejecting LARGE STROKE VOLUMES (high stroke volume meaning wider pulse pressure)
if HBeAg persists for several months and host anti-HBeAg remain low or undetectable levels, suspect
CHRONIC HEPATITIS B infections with HIGH INFECTIVITY
the recurrent laryngeal muscle innervates what muscles
posterior cricoarytenoid lateral cricoarytenoid obligue arytenoid transverse arytenoid thyroarytenoid
the superior laryngeal nerve (cur at the superior pole of the thyroid lobe due to proximity of superior thyroid artery and vein) innervates what
supraglottic sensation (internal laryngeal branch)
CRICOTHYROID (external laryngeal branch)- TENSES VOCAL CORDS resulting in hoarseness
PE is an example of what kind of shunt
RIGHT-to-LEFT intrapulmonary shunt (often results in HYPOXEMIA)
under normal conditions how do astrocytes regulate neurotransmission
takin up glutamate present in the synapse, preventing excessive neuronal excitation
using glutamine synthetase, glutamate undergoes condensation reaction with AMMONIA to from GLUTAMINE (a non-neuroactive compound)
glutamine is then released by the astrocytes, teen up by neurons, converted back into glutamate to be used as a neurotransmitter
EXCESS AMMONIA in the blood from cirrhosis causes elevation of what in astrocytes
GLUTAMINE
extra glutamine in the astrocytes leads to intracellular osmolarity, causing astrocyte swelling and impaired glutamine release
decreases amount of glutamine available for conversion to glutamate in neurons, resulting in DISRUPTION of EXCITATORY NEUROTRANSMISSION
what happens to levels of alpha-ketoglutarate in hyperammonemia
they are depleted because ammonia is detoxified into glutamate via glutamate dehydrogenase- this causes impaired energy metabolism in the brain
what are the signs of primary carnititne deficiency
muscle weakness
cardiomyopathy
HYPOKETOTIC hypoglycemia
elevated muscle triglycerides
caused by deficit in protein responsible for carinitine transport across the plasma membrane- w/o carnitine, FAs can’t be transported from cytoplasm INTO MITOCHONDRIA as acyl-carnitine
mitochondria therefore cannot beta-oxdize the fact acids into acetyl CoA, the carbon substrate for the TCA cycle
cardiac and skeletal muscle cannot generate ATP from fatty acids and the liver is unable to synthesize KETONE BODIES wen glucose levels are low
what are signs of medium chain acyl CoA dehydrogenase (MCAD) deficiency
hypoglycemia
HYPOKETOTIC hypoglycemia
15 year old girl w/ gait instability, kyphoscoliosis, res caves, bilateral lower extremity ataxia
joint position and vibration sense are impaired
she has an inherited disease what is it and whats she gna die from
FREIDREICH ATAXIA
death by CARDIOMYOPATHY
DORSAL COLUMNS, DRG, LATERAL CORTICOPANIAL, SPINOCEREBELLAR all fucked
what is the inheritance of wilson disease
AR
aka hepatolenticular degeneration
liver failure, movement abnormalities, psychiatric symptoms
localized amyloidosis confined to cardiac atria (isolated atrial amylodiossi)
beta-pleated ANP-derived proteins
incidence increases with age
this form of senile cardiac amyloidosis may INCREASE RISK of ATRIAL FIB
localized amyloid to thyroid gland is due to what
abnormally folded CALCITONIN-derived peptides
localized amyloid to pituitary gland is due to what
abnormally folded PROLACTIN-derived peptides
localized pancreatic amyloidosis is due to what
islet amyloid protein (AMYLIN)
found in the pancreas of more than 90% of patients with TYPE 2 DIABETES
what is the MCC complication of VZV infection
POSTHERPETIC NEURALGIA- persistent local pain
what is COSTOSTERNAL SYNDROME aka COSTOCHONDRITIS aka ANTERIOR CHEST WALL SYNDROME
occurs after repetitive activity and involves the upper costal cartilage at the costochondral or costosternal junctions
pain is typically REPRODUCED WITH PALPATION and WORSENED with MOVEMENT or CHANGES in POSITION (horizontal arm flexion)
typically DO NOT HAVE palpable warmth, swelling or erythema
how is septic abortion treated and what are complciaotns
broad-spectrum antibiotics and promo SURGICAL EVACUATION to remove the nidus of infection and prevent severe complications such as sepsis, multi-organ failure, and death
long term complications include SYNECHIAE (adhesions) int he uterine cavity that can lead to secondary amenorrhea and infertility (ASHERMAN SYNDROME)
how does a septic abortion oresent
fever, abdominal pain, uterine tenderness, FOUL-SMELLING discharge AFTER PREGNANCY TERMINATION
STAPH AUREUS, E. COLI, GBS are common causes
retinoblastoma is on what chromosome
13q14
active when hypophosphorylated
stroke to where would cause bilateral homonymous hemianopsia WITH MACULAR involvement
MCA
would also have contralateral UPPER LIMB loss of sensory and moroni
PICA occultation results in what
lateral medullary syndrome (Wallenberg)
CONTRALATERAL loss of PAIN AND TEMP
IPSILATERAL CN V, VIII, IX, X, XI deficits
HORNER’s snydrome
te maximum intensity of the murmur in aortic stenosis is directly related to what
magnitude of the left ventricle to aorta pressure gradient
find the spot on the graph (if given one) where the two pressures are the furthest apart during systole
what is a choledochal cyst
congenital dilatation of the common bile duct that typically present during childhood (less than 10) with recurrent abdominal pain and jaundice
what is acute ACALCULOUS cholecystitis
acute inflammatory disorder of the gallbladder in the ABSENCE of GALLSTONES
critically ill patients (sepsis, severe, burns, trauma, immunosupresse) due to gallbladder stats and ischemia
fever, RUQ pain, leukocytosis
a highly soluble gas anesthetic (HIGH BLOOD/GAS partition coefficient) has what properties
blood SATURATES SLOWLY, leading to a delayed rise in partial pressure
decreased pressure slowly brain saturation, increasing onset time
(HALOTHANE)
need a lot to saturate the blood, slow rise in partial pressure in the blood, slow equilibrium in the brain, slow onset of action
a poorly soluble gas anesthetic (LOW BLOOD/GAS partition coefficient) has what properties
blood SATURATES QUICKLY, leading to a fast rise in partial pressure
increased pressure speeds brain saturation, decrying onset time
(NITROUS OXIDE)
need little to saturate the blood, rapid rise in partial pressure in the blood, rapid equilibrium in the brain, rapid onset of action
acyclovir can cause what ADR that makes creatinine go up
CRYSTALLINE NEPHOPATHY (nephrotoxicity)
treat with ADEQUATE HYDRATION, slow rate of infusion, dosage adjustment
better yet PREVENT IT with HYDRATION then when you give them IV acyclovir to avoid this shit
CFTR is what kind of channel
ATP-binding cassette transmembrane ion transporter that pumps chloride ions out of epithelial cells
Chromosome 7
cGMP-gates sodium channels play a role in what
vision
what kind of receptor does VITAMIN D bind to
nuclear one
what the fuck is an ACORCHORDON
SKIN TAG
pedunculated outgrowth of normal skin the tare person on regions affected by acanthosis nigricans
type 1 collagen takes part in what for bone formation
bone matrix formation
osteogenesis imperfecta is transmitted how
AD for most patients
whats cool about hodgkin lymphoma
BIMODAL distribution of age 20s and 60s
B SYMPTOMS (fevers, night sweats, weight loss)
nontender lymphadenopathy
REED-STERNBERG cells seen on biopsy
what is VEMURAFENIB
potenti inbhitior of mutated bFRAG
significant anti-tumor effects with improved survival and long-term outcomes in advanced stage V600E-positive MELANOMA
what does the BRAF mutation V600E (valine to glutamic acid) do
greatly increased ACTIVATION of the signaling pathways for melanocyte growth, survival, and metastasis
if a patient has LOW SODIUM and urine osmolarity INCREASED DURING WATER DEPRIVATION but then does not further increase when ADH is added after 7 hours of water deprivation what do they have
PRIMARY POLYURIA
treat with WATER RESTRICTION
what is the arcuate line
horizontal line located below the umbilicus that demarcates the lower limit of the posterior rectus sheath
above arcuate line the rectus abdomens is surround b anterior and posterior sheaths
below arcuate line the muscle is covered only by the anterior sheath
if RECTUS ABDOMINIS is TRANSECTED HORIZONTALLY what most be identified and ligated bilaterally to prevent bleeding complicaitons
INFERIOR EPIGASTRIC ARTERY b/c there is no SUPPORTING POSTERIOR SHEATH blow the arcuate line- can result in significant hemorrhage if cut
what does the lateral femoral cutaneous nerve do
travels UNDER the INGUINAL LIGAMENT and provides sensory innervation to the anterolateral thigh
entrapment (MERALGIA PARESTHETICA) most commonly occurs in obese or pregnant peeps or those who were mad might clothes around hips
the PPAR family plays a significant role in what
METABOLCI SNYDROMES (obesity, HTN, dyslipidemia, and insulin resistance)
thiazolidinediones exert their glucose-lowering effect how
decreasing insulin resistance through PPAR-gamma
