Uworld 8

Question 1

What is seen on duodenal biopsy for celiac disease?

Answer 1

crypt hyperplasia, villous atrophy, and intraepithelial lymphocyte infiltration.

Question 2

What is amyloid precursor protein? (APP) What happens with abnormal APP processing?

Answer 2

APP gene is located on c.21 and encodes a cell-surface protein that can be degraded into beta amylid.

Abnormal APP processing, impaired beta-amyloid clearance, and production of higher levels of APP are associated with the increased formation of the neurotoxin plaques that characterize ALzheimer dementia.

Question 3

MOA of selective serotonin reuptake inhibitors

Answer 3

Inhibition of serotonin reuptake by blocking the serotonin transporter

Question 4

What is the main adverse effects seen with nitrate therapy?

Answer 4

Headache and cutaneous flushing along with lightheadedness and hypotension due to systemic vasodilation

Question 5

The great saphenous vein drains into?

Answer 5

Th femoral vein within the region of the femoral triangle, a few centimeters inferolateral to the pubic tubercle.

The great saphenous vein is a superficial vein of the leg that originates on the medial side of the foot, courses anterior to the medial malleolus, and then travels up the medial aspect of the leg and thigh.

Question 6

Oncogenesis in pancreatic ductal adenocarcinoma is almost always due to?

Answer 6

An early activating mutation in the KRAS oncogene, which produces a constitutively active protein that allows for uncontrolled proliferation of tumor cells.

Question 7

What is obstructive sleep apnea due to?

Answer 7

Due to relaxation of oropharyngeal muscle tone with occlusion of the upper airway.

Sx: daytime sleepiness, headaches, and depression.

Complications: systemic and pulmonary HTN, right heart failure, and an increased risk for cardiac events

Question 8

CMV can cause what in AIDS patients?

Answer 8

CMV is a common cause of colitis in patients with advanced AIDS.

It is the second most common CMV reactivation disease in this population (CMV retinitis is the most common).

Patients with CMV colitis often have abdominal pain, fever, diarrhea, and weight loss.

Colonoscopy usually shows erythema, erosions, and ulcerations; colonic biopsy typically reveals large cells with prominent basophilic intranuclear inclusions.

Question 9

Protease inhibitors block?

Answer 9

viral protease from cleaving gag-pol polyproteins, which results in the formation of immature virions that are noninfectious.

Question 10

Decompensated heart failure is a common cause of which murmur?

Answer 10

Common cause of secondary (functional) mitral valve regurgitation.

Increased left ventricular end-diastolic volume causes dilation of the mitral vale annulus and restricted movement of the chordae tendineae with subsequent regurgitation.

Txt: diuretics and vasodilators can improve heart failure induced MR.

Question 11

What is a common side effect of atropine?

Answer 11

increased intraocular pressure.

It may precipitate acute closed-angle glaucoma in susceptible individuals.

Question 12

Atropine is indicated for the txt of?

Answer 12

Bradycardia as it decreases vagal influence on the SA and AV nodes

Question 13

Hepatic encephalopathy is caused by?

Answer 13

Increased levels of ammonia and other neurotoxins in the circulation that lead to increased inhibitory neurotransmission and impaired excitatory neurotransmitter release.

Frequently precipitated by a stressor (eg, GI bleeding, infx) that increases blood ammonia levels.

Question 14

What response does inactivated (killed or component) viral vaccines primarily generate?

Answer 14

Primarily generate a humoral immune response against extracellular viral antigens, preventing viral entry into the cell.

Question 15

Live attenuated viral vaccines can generate what kind of response?

Answer 15

A strong cell mediated immune response that can kill virally-infected cells, in addition to providing humoral immunity.

Question 16

Pain due to diabetic neuropathy may be difficult to control and require multiple medications. To reduce the risk of adverse effects and improve pain control, medications should work through different mechanisms. One such combination may include?

Answer 16

a tricyclic antidepressant (eg nortriptyline) and an anticonvulsant (eg, gabapentin)

Question 17

Mutations in factor V Leiden predisposes to?

Answer 17

Heterozygote carriers of a mutation in factor V Leiden, which is modified to resist activated protein C, have a hypercoagulable state that predisposes to deep vein thromboses (the source of most pulmonary emboli)

Question 18

Malignant pleural effusions are usually exudative by Light criteria and can occur via several mechanisms, including?

Answer 18

An inflammation-induced increase in vascular permeability (leading to increased inflow) and blockage of pleural fluid reabsorption by parietal pleura lymphatics (leading to decreased outflow)

Question 19

S3, a third heart sound occurs due to?

Answer 19

Sudden limitation of ventricular movement during passive ventricular filling in diastole.

Question 20

An S3 in patients age>40 suggest?

Answer 20

abnormal ventricular cavity enlargemnt such as occurs in chronic severe mitral regurg, chronic aortic regurg, or dilated cardiomyopathy

Question 21

Transudative effusions are characterized by?

Answer 21

Low protein and lactate dehydrogenase content compared to serum values.

Question 22

Heart failure can cause what type of pleural effusion?

Answer 22

Transudative pleural effusion due to an increase in pulmonary capillary hydrostatic pressure

Question 23

Burkitt lymphoma is associated with which translocation?

Answer 23

Translocations of the MYC gene on chromosome 8 to the immuniglobin heavy chain region of c.14 (t8;14), resulting in MYC over expression.

Presents with rapidly growing mass (eg, jaw) and histo: starry sky appearance, with numerous mitotic figures and apoptotic bodies

Question 24

Pregnant women with severe preelampsia can develop?

Answer 24

HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome.

Nausea/vomitting and RUQ pain occur due to liver ischemia and/or hemorrhage (eg subcapsular hematoma).

Also at risk for seizure, renal insufficiency, and disseminated intravascular coagulation due to widespread endothelial dysfunction

Question 25

What is the MOA of class IC antiarrhythmics such as flecainide?

Answer 25

Potent sodium channel blockers that have increased effect at faster heart rates (use-dependence). This makes them more effective at treating tachyarrhythmias, but can also cause prolonged QRS duration (a proarrhythmic effect) at higher heart rates

Question 26

What is asthma characterized by?

Answer 26

Chronic airway inflammation, which leads to airway remodeling, airway hyperresponsiveness, and bronchoconstriction.

Question 27

Treatment for asthma

Answer 27

Corticosterioids reduce airway inflammation and are used for both chronic asthma management (inhaled adminstration) and acute exacerbations (systemic adminstration).

Question 28

What are the most prominent organisms in intraabdominal infections?

Answer 28

Bacteroides fragilis and E. coli

Question 29

Cardiac auscultation in patients with mitral stenosis reveals?

Answer 29

A loud first heart sound, an early diastolic opening snap after the second heart sound, and a low-pitched diastolic rumble best heard at the cardiac apex The opening snap is caused by the sudden opening of the mitral valve leaflets when the left ventricular pressure falls below the left atrial pressure at the beginning of diastole.

Question 30

ACTH regulates which zones in the adrenal?

Answer 30

ACTH is the major trophic hormone of the zona fasciculata and reticularis

Question 31

Zona glomerulosa is regulated by?

Answer 31

angiotensin II

Question 32

Excess production of ACTH causes?

Answer 32

increased cortisol synthesis within the zona fasciculata (Cushing's manifestations) and increased androgen production within the zona reticularis (irregular menstruation, hirsutism in women)

Question 33

A deformation anomaly is caused by?

Answer 33

Abnormal extrinsic forces on a developing fetus. Talipes equinovarus (clubfoot) is an anomaly in which the foot is plantarflexed and pointed inward due to restricted in utero movement.

Question 34

Transudative pleural effusions result from?

Answer 34

Increased intracapillary pressure (eg, heart failure)

Question 35

Exudative effusions develop from?

Answer 35

Inflammatory disruption of the vascular membrane

Question 36

What are the labs for transudative pleural effusions?

Answer 36

Transudative pleural effusions have low fluid/serum ratios of total protein and lactate dehydrogenase and low absolute levels of lactate dehydrogenase compared to exudative effusions

Question 37

Methanol and ethylene glycol have relatively little direct toxicity (similar to ethanol) but are metabolized into highly toxic compounds by alcohol and aldehyde dehydrogenase. Treatment involves?

Answer 37

Adminstration of fomepizole, a competitive inhibitor of alcohol dehydrogenase (increases Km without reducing Vmax)

Question 38

Parkinson disease is caused by?

Answer 38

bradykinesia, resting tremor, and rigidity are features of Parkinson disease, which is caused by dopaminergic neurodegeneration. Traumatic brain injuries can accelerate neurodegeneration, leading to a higher incidence and earlier onset of Parkinson disease

Question 39

Acute cardiac transplant rejection usually occurs weeks to months following transplantation and is primarily a cell-mediated process. In acute cellular rejection, endomyocardial biopsy shows?

Answer 39

An interstitial lymphocytic infiltrate with myocyte damage.

Question 40

What is renal ammoniagenesis?

Answer 40

Acidosis stimulates renal ammoniagenesis, a process by which renal tubular epithelial cells metabolize glutamine to glutamate, generating ammonium that is excreted in the urine and bicarbonate that is absorbed into the blood. This process is responsible for the vast majority of renal acid excretion in chronic acidotic states.

Question 41

Septic arthritis in a young, sexually active adult should raise suspicion for?

Answer 41

Disseminated Neisseria gonorrhoeae infection. Patients may also have the triad of polyarthritis, a vesiculopustular skin rask, and tenosynovitis. N gonorrhoeae is G- diplococci that is usually identified by microscopy, culture, or nucleic acid amplification.

Question 42

Norepinephrine-releasing agents (eg, phentermine) are sympathomimetic weight loss drugs indicated for short term treatment of obesity. MOA?

Answer 42

They stimulate the release and inhibit the reuptake of norepinephrine. Subjective effects: increased sensation of satiety, leading to reduced caloric intake. Weight regain after cessation is common with these drugs.

Question 43

What is responsible for converting nonpathogenic Corynebacterium into toxigenic Corynebacterium?

Answer 43

Lysogenic bacterophages are responsible. Toxigenic strains elaborate the diphtheria exotoxin, which causes pseudomembreanous pharyngitis and potentially life threatening systemic effects (eg, myocarditis, neuritis)

Question 44

How does erythrocytes bypass the ATP generating step of glycolysis?

Answer 44

2,3-BPG decreases hemoglobin's affinity for oxygen. Therefore, in the presence of lower blood oxygen concentrations, higher 2,3-BPG levels within erythrocytes enable increased oxygen delivery in the peripheral tissues. 2,3-BPG is produced from 1,3-BPG by the enzyme bisphosphoglycerate mutase. This reaction bypasses an ATP-generating step of glycolysis, causing no net gain in ATP.

Question 45

What are signs of cocaine intoxication?

Answer 45

Cocaine intoxication can produce psychotic symptoms (eg, paranoid delusions), euphoria, and agitation. Physical signs indicating sympathetic stimulations (eg, tachycardia, diaphoresis, mydriasis) can assist in differentiating cocaine intoxication from primary psychiatric disorders

Question 46

Why is the pO2 in the left atrium and ventricle lower than in the pulmonary capillaries?

Answer 46

Due to mixing of oxygenated blood from the pulmonary veins with deoxygenated blood from the bronchial circulation and thebesian veins

Question 47

What is the mechanism of diphtheria toxin?

Answer 47

Irreverisibly inhibits host protein synthesis due to ADP-ribosylation of elongation factor-2. Local effects include pseudomembranous pharyngitis; systemic effects include potentially life threatening myocarditis and neuritis Immunization with diphteria toxoid generates protective circulating IgG against the exotoxin B subunit

Question 48

ACE inhibitors (eg, lisinopril) MOA

Answer 48

ACE inhibitors block the conversion of angiotensin I to angiotensin II, thereby reducing vasoconstriction and aldosterone secretion. Decreased aldosterone leads to potassium retention, which can cause hyperkalemia, especially in patients with renal insufficiency and those taking other medications that raise potassium levels (eg, angiotensin II receptor blockers, mineralocorticoid receptor blockers)

Question 49

MOA of flutamide

Answer 49

Flutamide is a nonsteroid anti-androgen that acts as a competitive inhibitor of testosterone receptors It is used in combo with long acting gonadotropin-releasing hormone agonists for the treatment of prostate cancer

Question 50

What is multiple myeloma associated with?

Answer 50

Elevated circulating paraproteins (monoclonal immunoglobins), which causes erthrocytes to stack like coins (rouleaux formation). Patients classically have normocytic anemia, hypercalcemia, bone pain, and renal insufficiency

Question 51

Function of kinesin

Answer 51

Kinesin is a microtubule-associated motor protein that functions in the anterograde transport of materials and organelles within cells Reactivation of latent herpes simplex virus requires anterograde transport of viral particles from neuronal cell bodies in the sensory ganglia to the skin and oral mucosa

Question 52

Immunization against hepatitis B virus uses what antibodies?

Answer 52

Uses recombinant HBsAg to generate anti-HBs antibodies. These antibodies prevent infection by binding to the envelope of circulating virus and inhibiting viral entry.

Question 53

What is hypersensitivity pneumonitis?

Answer 53

Hypersensitivity pneumonitis involves an exaggerated immunologic response to an inhaled antigen and can have an acute or chronic presentation. Chronic disease presents with gradually progressive cough, dyspnea, fatigue, and weight loss, and lung biopsy reveals lymphocytic infiltrate, poorly formed noncaseating granulomas, and septal fibrosis

Question 54

What can suggest chronic pancreatitis?

Answer 54

Diarrhea, weight loss, and epigastric calcifications in a patient with chronic alcohol use suggest chronic pancreatitis with resulting pancreatic exocrine insufficiency and malabsorption

Question 55

TSH from the anterior pituitary stimulates the thyriod to produce?

Answer 55

thyroxine (T4) and a small amount of triiodothyronine (T3). T4 is converted in peripheral tissues to T3 (active form) and reverse T3 (inactive form). TSH secretion is under negative feedback by thyroid hormone on the hypothalamus and pituitary

Question 56

What is a frameshift mutation?

Answer 56

A frameshift mutation occurs with the deletion/addition of a number of bases not divisible by 3 in the coding region of a gene. Frameshift mutations alter the reading frame of the genetic code, dramatically changing the protein structure and often resulting in the formation of a premature stop codon.

Question 57

Rapid correction of chronic hyponatremia may lead to?

Answer 57

Osmotic demyelination syndrome (also known as central pontine myelinolysis). It typically manifests 2-6 days after the osmotic insult with spastic quadriplegia, pseudobulbar palsy, and locked in syndrome

Question 58

Left sided heart failure leads to chronically elevated pulmonary venous and capillary pressures, with resulting?

Answer 58

Pulmonary edema and extravasation of red blood cells into the alveolar parenchyma. The iron from red blood cells is taken up by alveolar macrophages and stored as hemosiderin, appearing as brown pigment on microscopy.

Question 59

Where do most gastric ulcers arise?

Answer 59

Most gastric ulcers arise along the lesser curvature of the stomach, usually at the transitional zone between the gastric corpus (body) and the antrum.

Question 60

What arteries run along the lesser curvature of the stomach?

Answer 60

The left and right gastric arteries run along the lesser curvature and are likely to be penetrated by ulcers, causing gastric bleeding

Question 61

How does staph aureus cause hepatic abscesses?

Answer 61

Staph aureus can cause hepatic abscesses via hematogenous seeding of the liver

Question 62

How does enteric bacteria (e. coli, klebsiella, and enterococci) cause hepatic abscesses?

Answer 62

By ascending the biliary tract (ie, ascending cholangitis), portal vein pyemia, or direct invasion from an adjacent area (eg, cholecystitis)

Question 63

Penicillins and cephalosporins are common triggers for drug-induced hemolytic anemia because?

Answer 63

They can bind to the erythrocyte surface and act as haptens for IgG attachment. Subsequent clearance of IgG-coated erythrocytes by splenic macrophages leads to hemolytic anemia. Withdrawal of the offending drug usually leads to complete resolution of symptoms.

Question 64

Subclavian steal syndrome occurs due to?

Answer 64

Severe stenosis of the proximal subclavian artery, which leads to reversal in blood flow from the contralateral vertebral artery to the ipsilateral vertebral artery. Patients may have symptoms related to arm ischemia in the affected extremity (eg, exercise-induced fatigue, pain, paresthesias) or vertebrobasilar insufficiency (eg, dizziness, vertigo)

Question 65

What is the relation of plasma cells and multiple myeloma?

Answer 65

Multiple myeloma is associated with the clonal proliferation of plasma cells in the bone marrow. This prevents normal B cell lymphogenesis and increases the risk of bacterial infection due to decreased production of normal immunoglobulins

Question 66

What is seen in patients with mullerian agenesis (ie, Mayer-rokitansky-kuster-hauser syndrome)?

Answer 66

Patients have variable uterine development and no upper vagina (eg, shortened vagina). These patients are 46,XX females with normal ovaries and secondary sex characteristics.

Question 67

Upper motor neuron lesions (ie, internal capsule stroke) cause what?

Answer 67

Contralateral weakness with clasp-knife spastic rigidity, hyperreflexia, and a positive Babinski sign. These lesions damage the pyramidal motor system (eg, corticospinal tracts), which runs from the precentral gyrus (primary motor cortex) through the internal capsule to the brainstem and spinal cord

Question 68

What is nonexertional heat stroke? What meds can cause it?

Answer 68

Nonexertional heat stroke is a life threatening disorder characterized by hyperthermia (typically >104F) associated with CNS dysfunction (eg, encephalopathy, syncope). Anticholinergic meds (amitrptyline, scopolamine) promote heat stroke by impairing diaphoresis. Other meds: sympathomimetics, dopamine antagonists, diuretics, and beta blockers

Question 69

What is hereditary hemochromatosis?

Answer 69

Characterized by increased intestinal iron absorption with deposition of excess iron in parenchymal tissues. Men typically develop manifesations in their 30s/40s. However, premenopausal women have ongoing blood and iron losses due to menstruation, which partially offsets the excess iron absorption and delays the onset of symptoms

Question 70

What meds should not be used in patients with hereditary angioedema?

Answer 70

ACE inhibitors (-prils)

Question 71

What is Duchenne muscular dystrophy caused by?

Answer 71

Caused by frameshift mutations (most common) or nonsense mutations in the dystrophin gene that lead to the formation of a truncated, defective protein. Duchenne musclar dystrophy presents with progressive proximal muscle weakness in young boys due to increased muscle fiber degeneration. Nonsense mutations introduce premature stop codons (UAA, UAG, UGA) in the coding sequence of mRNA.

Question 72

What is seen in 17-alpha hydroxylase def?

Answer 72

A rare form of congenital adrenal hyperplasia characterized by impaired synthesis of androgens, estrogens, and cortisol with excess production of mineralocorticoids, Genetic males with this may have phenotypically female external genitalia and present with hypertension and hypokalemia around the expected time of puberty.

Question 73

What is seen in Niemann-Pick disease?

Answer 73

AR disorder; Ashkenazi Jews It is characterized by sphingomyelinase def and sphingomyelin (phospholipid) accumulation, which cause neurologic regression, hepatosplenomegaly, and retinal opacification (ie, cherry red macula)

Question 74

What is first seen microscopically for an ischemic stroke?

Answer 74

12-24 hours after irreversible ischemic injury = intense eosinophilic staining of the neuronal cytoplasm (red neurons) and nuclear fragmentation.

Question 75

Neuronal damage after hypoxic-ischemic injury is often related to the formation of?

Answer 75

Reactive oxygen species, which mediate widespread cellular damage. Therapeutic hypothermia decreases the formation of reactive oxygen species by decreasing cellular metabolism and slowing reperfusion.

Question 76

Adverse effects of amphotericin B

Answer 76

nephrotoxicity, hypokalemia, and hypomagnesemia

Question 77

MOA of amphotericin B

Answer 77

binds the ergosterol of fungal cell membranes to exert its antifungal effects. However, it also binds cholesterol to some degree, causing toxicity to human tissues.

Question 78

What is Wilson disease?

Answer 78

AR; excessive copper deposition into tissues (liver, basal ganglia, cornea). Presents in young adults with liver disease, neuropsychiatric symptoms (eg, gait disturbance, dysarthria, depression, personality changes) and Kayser-Fleischer rings on slit lamp exam.

Question 79

What is pernicious anemia>

Answer 79

Autoimmune disorder caused by the cell-mediated destruction of parietal cells in the superficial upper glandular layer of the gastric body and fundus. Parietal cells are responsible for the secretion of hydrochloric acid and intrinsic factor, a glycoprotein involved in the absorption of B12. Def leads to megaloblastic anemia and neurologic dysfunction.

Question 80

What is horseshoe kidney?

Answer 80

A congential anomaly in which fusion of the metanephros (specifically, metanephric blastema) results in fused renal parenchyma along the inferior poles. Most patients are asymptomatic, but some may develop recurrent urinary tract infections or nephrolithiasis due to abnormal urine flow through the malpositioned kidney and ureters.

Question 81

Mutations affecting the Kozak consensus will effect?

Answer 81

The Kozak consensus sequence occurs on eukaryotic mRNA and helps initiate protein translation by identifying the proper methionine start codon AUG

Question 82

B thalassemia results in what type of anemia?

Answer 82

Hypochromic, microcytic anemia due to decreased B globin chain synthesis. Unpaired alpha chains precipitate within red cells and cause membrane damage, leading to ineffective erythropoiesis and hemolysis

Question 83

Hypertrophic cardiomyopathy is a common cause of sudden cardiac death in young adults. Histologic features include?

Answer 83

Cardiomyocyte hypertrophy and myofiber disarray with increased interstitial fibrosis. The structural disarray creates a substrate for ventricular arrhythmia (eg, ventricular tachycardia, ventricular fibrillation) that can lead to SCD.

Question 84

Gout occurs with increased frequency in patients with what mutations?

Answer 84

Activating mutations involving phosphoribosyl pyrophosphate synthetase due to increased production and degradation of purines

Question 85

What is first line therapy for acute gouty arthritis?

Answer 85

NSAIDS. They inhibit cyclooxygenase and exert a broad anti-inflammatory effect that includes inhibition of neutrophils. When NSAIDS are contraindicated (eg, peptic ulcer disease, renal impairment), colchicine is useful in the acute management of gout as it inhibits neutrophil chemotaxis and phagocytosis by preventing microtubule formation

Question 86

How does potassium pass through the nephron?

Answer 86

K+ is freely filtered by the glomeruli and is mostly reabsorbed in the proximal tubule and loop of henle. As such, the late distal and cortical collecting tubules are the primary sites for regulation of K+ excretion in the urine. K+ depletion stimulates alpha-intercalated cells to reabsorb extra K; principal cells secrete K under conditions of increased K+ load.

Question 87

A stroke impacting the thalamus can lead to?

Answer 87

Sensory loss affecting all tactile modalities (eg, touch, pain/temp, vibration/proprioception) in the contralateral face, arm and leg

Question 88

Lacunar infarctions are the result of?

Answer 88

Small vessel occlusion (due to lipohyalinosis and microatheroma formation) in the penetrating vessels supplying the deep brain structures. uncontrolled hypertension and diabetes are major risk factors.

Question 89

Where does clear cell carcinoma (renal cell subtype) like to metastasis?

Answer 89

Clear cell carcinoma is the most common subtype of renal cell carcinoma and is composed of large,rounded, or polygonal cells with clear cytoplasm. These tumors are often detected incidentally at an advanced stage; the lung is the most common site for metastasis, followed by osteolytic bone and liver

Question 90

What is postpartum thyroiditis?

Answer 90

Postpartum thyroiditis occurs within 12 months of pregnancy and is characterized by autoimmune destruction of thyroid follicles. It typically begins with a hyperthyroid phase due to the release of preformed thyroid hormone, following by a hypothyroid phase due to depletion of thyroid hormone and an eventual return to a euthyroid state.

Question 91

What is seen on histo for postpartum thyroiditis?

Answer 91

lymphocytic infiltration with the formation of germinal centers, which is similar to chronic lymphocytic (Hashimoto) thyroiditis

Question 92

What is monoamine oxidase?

Answer 92

Monoamine oxidase is a mitochondrial enzyme that breaks down monoamine neurotransmitters (eg, dopamine, norepi, serotonin). Tyramine-induced hypertensive crisis can occur in patient taking MAO inhibitors who consume foods containing high amounts of tyramine (eg aged cheeses, cured meats, draft beers)

Question 93

In silicosis, internalized silica particles impair?

Answer 93

Impair macrophage function by disrupting phagocytosis and promoting apoptosis. This increases the risk of mycobacteria infection (particulary M tuberculosis)

Question 94

What is cholangiocarcinoma? Imaging shows?

Answer 94

A malignancy of the bile duct epithelium that eventually obstructs biliary drainage, resulting in cholestasis (elevated alkaline phosphatase, hyperbilirubinemia) with jaundice, weight loss, pain the RUQ, and hepatomegaly. Imaging: dilated bile ducts in the absence of an obstructive gallstone, and biopsy reveals adenocarcinoma with columnar cells, mucin production, and a significant desmoplastic reaction.

Question 95

What can be injured during pelvic surgery>

Answer 95

The ureter can be injured during pelvic surgery due to its proximity to major pelvic ligaments and vessels such as the uterine artery within the cardinal ligament. Unintentional suturing of the ureter can present postoperatively with unilateral back pain (ie hydronephrosis) due to ureteral obstruction

Question 96

Cleavage of proinsulin in pancreatic beta cell secretory granules yields?

Answer 96

insulin and C-peptide, which are stored in the granules until they are secreted in equimolar amounts

Question 97

How does T1DM typically present?

Answer 97

Typically presents sub acutely with polyuria and polydipsia accompanied by fatigue and weight loss. Dx can be confirmed with a fasting blood glucose or hemoglobin A1c measurement.

Question 98

What is efficacy?

Answer 98

A measure of the maximum pharmacodynamic effect achievable with a drug

Question 99

What is potency?

Answer 99

Refers to the dose of drug that is required to produce a given effect Drugs that bind their receptors with a higher affinity or are better able to gain access to their target tissues will have greater potency (lower ED50).

Question 100

What is referred otalgia?

Answer 100

Referred otalgia is common in head and neck pathology because many cranial nerves innervate the ear (eg, CN V, VII, IX, X). In particular, tumors in the hypopharynx, larynx, or base of tongue cause referred otalgia due to sensory contributions from the glossopharyngeal and vagus nerves.