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Step 1 (Let's Do This)! > UWorld- Aug '15 > Flashcards

UWorld- Aug '15 Flashcards

1
Q

What is coronary steal syndrome? Which drugs can cause in coronary vesserls?

A

Phenomenon where blood flow to ischemic areas is reduced due to arteriolar vasodilation in nonischemic areas.
Coronary vessel specific dilators can trigger: Adenosine and Dipridamole

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2
Q

If a coronary vessel is blocked, what is compensatory response?

A

Collateral circulation allows flow to mocardium distal to blocked vessel. Coronary artery distal occlusion is DILATED, so blood can reach ischemic site.

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3
Q

Effect of dilation of:

  • systemc veins
  • systemic arteries
  • mixed artery and vein
A
  • veins: ↓ventricle vol, ↓ventricle wall tension→↓O2 demand by myocrdium
  • ateries: ↓afterload, same effect.
  • Dilation of both also same effect
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4
Q

MCC of Sudden Cardiac death? Presentation and demographic

A

V. fib in patient

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5
Q

Sudden cardiac death in elderly MCC?

A

80% coronary atheroschlerosis; CAD (70%).

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6
Q

What is hybernating myocardium?

A
  • Chronic persistent ischemia due to contraction inhibition by NOS and TNF-α
  • Reversible
  • less severe form of Myocardial stunning (brief ischemic episodes
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7
Q

How do you treat Hibernating myocardium?

A

Revascularization w/ CABG or Balloon angioplasty

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8
Q

What is Ischemic Preconditioning?

A

MI resistance due to episodes of non-lethal ischemia

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9
Q

How do you access fetal lung maturity?

A

L/S ≥2 (amniotic fluid), lungs mature. Surfactant assessment.
Lecithin (phosphatidylcholin): Sphingomyelin

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10
Q

How to measure fetal neural tube defect?

A

Alpha-Fetoprotein (AFP) elevated (amniotic fluid)

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11
Q

Suspect Erythroblastosis fetalis. What do you measure?

A

Fetal bilirubin!

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12
Q

Detect fetal adrenal gland dysfunction?

A
  • measure amniotic 17-hydroxyprogesterone levels
  • gene linkage of HLA region for Ch 6
  • Molecular probe for abnormal gene
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13
Q

Neural tissue ischemia presentation for

A

3-6hrs: Nothing seen

12-48 hrs: “red neurons”- eosinophili cyto, pyknotic nuclei, loss of Nissl substance

24-72hrs: Necorosis and Neutrophil infiltration

3-5days: macrophage infiltration

Nothing macro

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14
Q

Which cells make surfactant and when? Describe cells

A

Type II pneumocyte: Cuboidal and clustered. Also a precursor cell to Type I, and more Type II.

SUrfactant mae 26wks, reaching mature levels at 35wks.

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15
Q

How does neural tissue presents after 1 week of ischemia?

A

1-2wk: Reactive gliosis and vascular proliferation around necrotic area. Gross: liquifactive necrosis

> 2wks: Glial scar.

> 1 month: Gross: Cystic area surrounded by gliosis

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16
Q

Common cause of falling of elderly? Give examples

A

Medication can increase risk of falling:
Antipsychotics, Anti-depressents, and Benzo
-Amlodipine and Ibuprofin

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17
Q

What activates NK cells and what is their mechanism?

A

-Target cells w/ reduced or absent MHC I expression-Use -perforin create hole in membrane, and granzymes induce apoptosis
IFN-gamma, IL-12 activate. Enhanced by IFN alpha, beta. and IL-12.

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18
Q

Only lymphocyte part of innate immune system? Other unique qualities as a lymphocyte?

A
  • NK cell
  • Do not require thmus for maturation, present in athymic pts, and have no Ag-specific activities (do not need AG exposure for activity)
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19
Q

Surface marker if NK cells?

A

CD16 or CD56

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20
Q

Describe Korsakoff psychosis

A

Anterograde and retrograde amnesia, apathy, confabulation.

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21
Q

What structure most frequently damaged in Wernicke encephalopathy? Result of what deficiency?

A

Mamillary Body

acute deficiency of Thiamine (B1)

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22
Q

Alcoholic w/ B1 deficiency Tx?

A

Alcoholic or malnourished receive IV B1 before IV dextrose, because dextrose w/o thiamine can precipitate Wernicke encephalopathy

23
Q

Clinical presentation of Wernick encephalopathy?

A

Ataxia
Nystagmus
Opthalmoplegia
Anterograde amnesia

24
Q

What increases Statin S/E on muscles? Describe S/E

A

Myopathy: muscle pain w/ serum CK more than 10X the upper limit of normal

It increaes when statin given w/ Fibrates (i.e. Gemfibrozil)

25
Q

Describe shift in fluid compartments w/

1) Infusion of isotonic saline
2) Diarrhea or GI hemorrhage

A

Osmolarity unchanged for both

1) ECF vol↑ → ↓Hct, ↑BP
2) ECF vol↓ → ↑Hct, ↓BP

26
Q

Describe fluid shift w/ excessive Nacl intake

A

Serum Osm↑
Water shifts from ICF→ECF (∴ECF↑,ICF↓)
Protein and Hct↓ due to ECF↑

27
Q

Describe fluid shift w/ sweating in a dessert

A

Sweat is Hypotonic. ∴Serum (ECF) osm↑, ECF vol↓
ICF↓
[Protein]↑
Hct unchanged. H2O shifted out of RBCs)

28
Q

SIADH effect on water movement from compartments

A

Hypotonic volume expansion
Excess H2O: Osmolarity ↓, ECF↑, water shifts to ICF↑
[protein]↓. Hct same.

29
Q

Adrenocortical insufficiecy (NaCl loss) effect of fluid shift

A

Osmolarity drops
ECF↓, ICF↑
Protein and Hct↑

30
Q

Most potent mediator of coronary vascular dilation in large arteries and pre-arteriolar vessels?
How is it made?

A

Nitric Oxide

Made by Arginine and O2 by Endothelial cells.
Causes vasodilation via cGMP.

Adenosine vasodilates small coronary arterioles

31
Q

Physician priority encountering Intimate Partner Violence?

A
  • Ensure patient’s safety w/ referrals and an emergency safety plan.
  • Be nonjudgemental. Ask if patient feels safe.
32
Q

Describe values of statistical significance that can strengthen Relative Risk results

A

Confidence internal must NOT have a nul value. When 95% CI has no null value, means that p-value less than 0.5

33
Q

Describe path of median nerve

A
  • Lateral and medial cords of BPlexus
  • Runs w/ brachial artery between biceps brachii and brachialis
  • Courses between humeral and ulner heads of pronator teres
  • Travels beween flexor digitorum superficialis and flexor digitorum profundus
  • enters wrist w/n Flexor retinaculum and Carpal tunnel
34
Q

Sensory and mechanical innervation of median nerve

A 
Thumb flexion/opposition
Flexion of 2nd, 3rd digits
Wrists flexion/ABduction
Sensory: Thumb, digit 2,3, and; 1/2 4 (palm side). 
posterior of digit 2 and 3
35
Q

Classic sign of Median nerve injury (proximal)?
When is this seen.
What median nerve damage does not present?

A

Preachers hand- weakness of thenar and flexor digitoru muscles of 2nd, 3rd digit. Seen w/ humerus fracture of entrapment between pronator teres.

Pts w/ Carpal tunnel, suicide attempt do not present w/ this, branches responsible for this more proximal.

36
Q

How to osteocytes communicate w/ one another in the bone matrix?

A

Gap junctions via cytoplasmic processes, that lye within canaliculi.

Send signals, exchange nutrients and waste products.

37
Q

Describe Haversian system.

Stimulation of osteocytes.

A

Osteocytes located in bone matrix space, Lacuna. Processes from osteocytes extend out w/n canaliculi.
Layers are lamallae, centered on Central (Haversian) canal.

Osteocytes: maintain bone matrix, and short term Ca release.
Plasma [Ca] directly effects, PTH and calcitonin indirectly influence metabolic activity.

38
Q

Layers of epidermis

A

Stratum:

  • Corneum (Keratin)
  • Lucidum
  • Granulosum
  • Spinosum (spines= desmosomes)
  • Basale (stem cell sites)

“Chicagoans Love Giordanos, Sears towers, and daa Bears!”

39
Q

What are epidermal glands?

A

Sebaceous- holocrine. Associated with hair follicle.
Eccrine- secretes sweat. Everywhere on body.
Apocrine- makes milky, viscous fluid. Presents after puberty. Located at axillae, genitals, and areolae. Odor due to bacteria.

40
Q

Fx and structure of Zonula Occludens?

A

Tight junctions
Prevents para cellular movement of solutes
Composed of Claudins and Occludins.
@ apices

41
Q

What epithelial junction promotes metastasis if lost?

Describe location, Fx, structure

A

Zonula adherens
Below tight junctions
Forms belt connecting actin cytoskeletons of neighboring cells w/ Cadherins (Calcium dependent adhesion proteins)

42
Q

What structure maintains basement membrane of epithelium?

A

Integrins. Bind to laminin in BM

43
Q

What is targeted I Pemphigus vulgaris, and how.

Location.

A

Desmosomes (macula adherens) - supports via keratin.
Part of Stratified Sqm Epi.
IgG against desmoglein.

44
Q

What is targeted in bullous pemphigoid?Describe Fx and structure

A

AutoAbs against Hemidesmosomes

Connects keratin in basal cells to underlying BM.

45
Q

Describe structure that allows cardiac myocyte Action potential spread.

A

Gap junctions-protein connexon channels permit electrical and chemical communication between cells.

Also how Osteocytes communicates via their cytoplasmic processes w/n canaliculi.

46
Q

Cause of cat scratch disease?

Associated diseases with same bug

A

Bartonella henselae, gram neg

  • Cat scratch: Lymphadenopathy, low fever
  • Endocarditis
  • Bacillary angiomatosis (immuno-weak): red/purple papular skin or viscera lesions.
47
Q

Stages of membrane action potential (muscle, nerves). Describe ionic flow, and membrane potential (mV)

A 
Resting potential (-70): high permeability to K, efflux via non gated leak channels. 
Depolarization: opening of Na, voltage gated channels, influx. Overshoot, MAX value reached. (+35)
Repolarization: closing of Na channels, opening of K voltage gated-channels
Hyper polarization (-85): after repolarization reached, membrane shortly more negative due to K channels remaining open. Returns to resting after K voltage channels close
48
Q

Label Action potential diagram

A

Depolarization, overshoot, depolarization, hyper polarization, threshold,

Pg. 385

49
Q

Injury of Musculocutaneous nerve presents how (sansory and movement)?

A

Paralysis of elbox flexors (biceps, brachialis, coracobrachialis)
Loss of sensation over lateral forearm

50
Q

Fx and sensaory loss w/ ulnar nerve damage?

A

MSensation loss of medial 1.5 digits
Weakness on wrist flexion/ADduction
Finger ABduction/ADduction
Flexion of 4th, 5th diit

51
Q

Ulnar nerve physical path?

A
  • Between olecranon and medial epicondyle of humerus

- enters forearm. Lies between flexor carpi ulnaris and flexor digitorum profundus

52
Q

Radial nerve path?

A

-through supinator muscle near head of radius

53
Q

Fx and sensory loss of radial nerve damage?

A 
Wrist drop (extensors of wrist at forear)
Sensation loss: posterior arm, forwarm, dorsolateral hand, dorsal thumb

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