uWorld 6 Flashcards
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
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
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
what is the structure involved “housemaids knee”
PREPATELLAR BURSA
due to repetitive ANTERIOR knee trauma from kneeling
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
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
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
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
what is deposited in dialysis-associated amylodisis
beta2-microglobulin (can deposit in the carpal tunnel causing CTS)
endoneural inflammatory infiltration with multifocal demyelination i seen in what disease state
Guillain-Barre syndrome
a demyelinating peripheral neuropathy
endomysial inflammatory infiltration is found on muscle biopsy of what condition
polymyositis- a myopathy that usually presents with proximal muscle weakness
what step of the citric acid cycle produces FADH2
succinate dehydrogenase (succinate to fumarate) succinate dehydrogenase is COMPLEX II in the electron transport chain
what causes bacterial toxin-mediated axonal damage occurs in what
infections secondary to Corynebacterium diptheriae
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)
what is the second most common brain tumor in children and it causes gait and ataxia and is located in cerebellum
medulloblastoma
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
