uWorld 6 Flashcards by Lucas Bracero

if an incapacitated patient doest to have an advanced directive designating a proxy what should be done (say for intubation for someone when a friend says they wouldn’t want to be put on life support)

attempt to contact patient’s FAMILY MEMBER who can act as the SURROGATE DECISION MAKER
if the patient has NO FAMILY, then a PERSON who CARES ABOUT THEM AND KNOWS the patient’s wishes can act as a substitute

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what is a Dohle body and when is it seen

light blue (BASOPHILIC) peripheral granules in neutrophils- likely due to ribosomes round with RER
commonly seen in toxic systemic illness but can also occur with burns or myelodysplasia

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pain in multiple joints , 5yr history of lumbar pain and 2yr bilateral knee pain
blue-black spots on sclerae and diffuse darkening of the auricular helices

Alkaptonuria (AR)
homogentisic acid dioxygenasse deficiency
relatively benign in childhood but marked by severe ARTHRITIS in adult life
urine turns black upon exposure to air (due to oxidization of homogentisic acid

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what is the structure involved “housemaids knee”

PREPATELLAR BURSA

due to repetitive ANTERIOR knee trauma from kneeling

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what is anserine bursitis

pain along the medial knee and well-defined tenderness approximately 4cm distal to the anterolateral joint margin of the knee
frequently results from obesity or overuse in athletes

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what is Popliteal (Baker) cyst

swelling of GASTROCNEMIUS or SEMIMEMBRANOUS BURSA
often due to extrusion of synovial fluid from the knee joint into the bursa in patients with OSTEOARTHRITIS or INFLAMMATORY JOINT DISEASE

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what is WDHA syndrome

VIPoma aka pancreatic cholera
Watery Diarrhea Hypokalemia Achlorhydria (WDHA) Snydrome

VIP stimulates pancreatic bicarbonate and chloride secretion and its binding to intestinal epithelial cells less to adenylate cyclase activation and increased cAMP production causing sodium, chloride, and water section into the bowel

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what is the Phalen sign and what is the Tinel sign

Phalen sign- flexion at the wrist reproduces symptoms of carpal tunnel
Tinel sign- tapping over the flexor surface of the wrist reproduces symptoms

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what is deposited in dialysis-associated amylodisis

beta2-microglobulin (can deposit in the carpal tunnel causing CTS)

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endoneural inflammatory infiltration with multifocal demyelination i seen in what disease state

Guillain-Barre syndrome

a demyelinating peripheral neuropathy

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endomysial inflammatory infiltration is found on muscle biopsy of what condition

polymyositis- a myopathy that usually presents with proximal muscle weakness

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what step of the citric acid cycle produces FADH2

succinate dehydrogenase (succinate to fumarate)
succinate dehydrogenase is COMPLEX II in the electron transport chain

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what causes bacterial toxin-mediated axonal damage occurs in what

infections secondary to Corynebacterium diptheriae

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what is opsoclonus-myoclonus syndrome and what is it associated with

non-rhythmic conjugate eye movements associated with myoclonus
neuroblastoma in young children (most common extra cranial childhood cancer)

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what is the second most common brain tumor in children and it causes gait and ataxia and is located in cerebellum

medulloblastoma

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Mutation of the TRR gene results in what

misfolding and extracellular tissue deposition of transthyrein protein (pre albumin)
cause familial amyloid polyneuropathy or familial amyloid cardiomyopathy

how can one pick out the lunate on x-ray

more medial of two bones that articulate with the radius

of the what bone of the wrist articulates with eh first metacarpal

trapezium

“the thumb swings on the trapezium”

what is the most commonly injured leg nerve and what injury can do it

common peroneal nerve

trauma to the lateral aspect of the leg, fibular neck fractures, external pressure due to prolonged immobility

what is a pure sensory nerve that innervates the psoterolateral leg and lateral foot

sural nerve

the rond ligament of the uterus starts and end where and what is in it

originates a uterine fundus, anteroinferior to the fallopian tubes, coursing through the inguinal coal out the labia major
contain artery of Sampson
(clamped in hysterectomy)

what is the transverse cervical ligament (aka cardinal ligament)

extends from cervix and lateral fornix of vagina to lateral pelvic walls
uterine artery courses in its superior portion
(division and ligation during hysterectomy)

what is used to calculate renal plasma flow (RPF)

para-aminohippuric acid clearance:

(PAH urine * urine flow)/PAH serum

what is the generic equation for clearance

Cs= ([urine concentration of S]*[urine flow rate])/(plasma concentration of S)

how is filtration fraction calculated

FF= GFR/RPF and is usually equal to 20% in healthy individuals

absent CD18 | staph aureus on culture but NO PURULENCE

LEUKOCYTE ADHESION DEFICIENCY PERSISTENT LEUKOCYTOSIS (neutrophils mainly) absent pus at sites of infection poor wound healing recurrent skin and mucosal bacterial infections periodontitis, often necrotizing culture with staph a and gram negative bacilli LATE SEPARATION OF UMBILICAL CORD (more than 21 days)

colchicine affect what part of the arachidonic acid/leukotriene/ prostaglandin pathway

stops the inflammation following leukocyte attraction caused by LTB4 MOA is micro tubular polymerization- disrupting CHEMOTAXIS, PHAGOCYTOSIS, DEGRANULATION

what is the metyrapone stimulation test

sensitive indicator of the hypothalamic-pituatiary-adrenal axis integrity blocks synthesis of 11-beta-hydroxylase which converts 11-deoxycortisol to cortisol in the zona fasciculata no negative feedback on ACTH secretion and thus pituitary ACTH secretion increases ;eating to increase in 11-deoxycortisol which is converted in the liver to 17-HYDROXYCORTICOSTEROIDS that get excreted in urine failure of 11-deoxycortisol and 17-hydroxycorticosteroids to increase implies primary or secondary adrenal insufficiency (distinguished from each other based on plasma ACTH levels)

what diagnostic test result is most SPECIFIC for acute cholescysitsis

failed gallbladder visualization on radio nucleotide biliary scan ultrasounds is PREFERRED initial imaging test for diagnosis of acute cholecystitis but hepatobiliary scanning can be alternative means when ultrasound is INCONCLUSIVE

what is seen in obstructive sleep apnea

HYPERCAPNIA HYPOXIA reflexive systemic and pulmonary vasoconstriction endothelial dysfunction abnormal venous return and cardiac output SYMPATHETIC cardiac stimulation untreated OSA can lead to PULMONARY HTN and right heart failure most pts get SYSTEMIC HTN due to chromic sympathetic stimulation and elevated plasma NE levels

prolonged ACTH stimulation causes what in the adrenals

HYPERPLASIA of fasciulata and reticularis

what happens to plasma renin levels in diuretic induced hypovolemia vs drugs that black sympathetic stimulation (beta blocker and clonidine)

diuretics increase renin | drugs that black sympathetic stimulation decrease renin

what does the time constant represent

time it takes for a change in membrane potential to achieve 63% of the new value lower time consents allow quicker changes in membrane potential, thus increasing axonal conduction speed myelination decreased membrane capacitance, which reduces the time constant demyelination would increase the time constant and lead to slower impulse conduction

the length constant is a measure of what

how far along the axon an electrical impulse can propagate low length consent reduces distances an impulse can travel myelination increases length constant and decreases time constant, both of which improve axonal conduction speed

a carotid sinus massage leads to what

stimulation of baroreceptors and increases the firing rate form the carotid sinus, leading to INCREASES PARASYMPATHETIC OUTPUT and withdrawn of sympathetic output to the heart and peripheral vasculature leads to SLOWING of heart RATE and AV CONDUCTION PROLONGS the AV node REFRACTORY PERIOD with decreased SVR useful for terminating paroxysmal super ventricular tachycardia (usually do to reentrant impulse traveling circularly b/w the slow and rapidly conducting segments of the AV node)

what is the preferred treatment of an elderly person with acer, pruritic rash and history of environmental allergies (typical presentation of utricaia)

antihistamine but MAKE SURE ITS SECOND GENERATION (LORATADINE or CETIRIZINE) avoid 1st generation because of blockage of cholinergic, serotonergic, and alpha-adrenergic pathways

what is seen with chronic rejection in the lungs

bronchiolitis olbiterans syndrome

the QT interval reflects what and is determined in part by what currents

cardiac myocyte action potential which is determined in part by POTASSIUM channels

what are the two important congenital syndromes that cute QT prolongation

Jervell and Lange-Neilsen syndrome (AR w. neurosensory deafness) Romano-Ward Syndrome (AD, no deafness) both may predispose to tornadoes de points at a young age, causing syncopal episodes and possible sudden cardiac death