UWorld Day Day Two Questions

Question 1

How is chronic rejection in the lung transplant different from other locations (i.e. kidney?

Answer 1

Lung transplant rejection primarily affects the small bronchioles via inflammation and obstruction/destruction causing BRONCHIOLITIS OBLITERANS. Renal rejection primarily involves the renal vasculature.

Question 2

IL-4 = Ig__

Answer 2

IgE

Question 3

IL-1 is produced by what cell to activate Th0 lymphocytes?

the same cell type also produces IL-12 to stimulate development of Th1

Answer 3

macrophages

Question 4

IL-2 is secreted by Th__ cells to stimulate produciton of CD4, CD8 and B cells.

Answer 4

Th1

Question 5

Th1 produces IL-__ to promote bone marrow stem cell differentiation
Th2 produces IL-__ to activate eosinophils and promotes IgA syntehsis

Answer 5

IL-3

Question 6

IL-__ is produced by Th2 cells to inhibit IFN-gamma, leading to decreased Th1

Answer 6

IL-10

Question 7

Why is methadone so powerful as a rehab drug? What are AE?

How is buprenorphine different than methadone?
How is naloxone different?

Answer 7

Full mu-agonist for heroin/opioid addiction with a LONG half life.
AE - QT prolongation and respiratory depression.
Buprenorphine is a partial mu-agonist.
Naloxone is a mu-antagonist.

Question 8

Direction of DNA synthesis and what is present on lagging strand not present in leading strand?

Answer 8

5’ to 3’

okazaki fragments which are short stretches of newly synthesized DNA separated by RNA primers.

Question 9

A patient is started on infliximab and presents a few days later with joint pain and pruritic skin rash. Biopsy shows fibrinoid necrosis and neutrophil infiltration of his small blood vessels. What is this?

Answer 9

Serum sickness - type 3 HSR. Complex deposition and Complement consumption (so decreased C3 serum levels).

Question 10

Name chest, kidney, heart, and ovary findings in Turner Syndrome

Answer 10

Shield chest, horseshoe shaped kidney, coarctation of aorta, bicuspid aortic valve, streaked ovaries/amenorrhea, infertility.

Question 11

Hep virus strain that has a high mortality rate i npregment women.

Answer 11

Hep E - unenveloped ssRNA

Question 12

Chronic demyelinating disease of the CNS white matter.

Answer 12

Multiple Sclerosis

Question 13

Babinkski indicates what lesion

Answer 13

UMN - hyperreflexia, spasticity, muscle paralysis/weakness

Question 14

LMN damage sign

Answer 14

hyporeflexia/decreased DTRs, muscle atrophy, fasciculations

Question 15

Type of eukaryotic polymerase that:

• forms essential ribsosomal subunits
• forms essential component of 60s
• forms small nucleus RNA

What is the round, dense, basophilic (dark staining) body seen in the nucleus?

Answer 15

RNA polymerase 1 (**synthesizes most of the RNA in the nucleus)
RNA polymerase 3
RNA polymerase 2

the nucleolus

Question 16

Aneurysm of what artery can impinge on the optic chiasm laterally, causing ipsilateral nasal hemianopia.

Answer 16

Internal Carotid Body

Question 17

An infant has 3-5 days of high FEVER, followed by an erythematous maculopapular rash on TRUNK

Answer 17

HHV6 - roseola

Question 18

Child has erythematous oropharyneal ulcers and maculopapular or vesicular lesion on palms and soles.

Answer 18

Coxsackievirus A16

Question 19

Child with painful gingivostomatitis, fever, irritability.

What if fever and seizures in newborn?

Answer 19

HSV-1

HSV-2

Question 20

Maculopapular rash on FACE of child that spreads to trunk and extremities.
What is it fi in addition, spots on soft palate.
What if there are koplick spots on oral mucosa?

Answer 20

Rubella (togavirus) - spots on soft palate

Measles - koplick

Question 21

Flulike illness followed by face and truncal reticular rash. May cause apastic crisis if child has sickle cell.

Answer 21

Barvovirus B19

Question 22

Sandpaper rash on skindfolds of a chidl

Answer 22

sclaret fever - strep pyogenes

Question 23

lysyl hydroxylase and procollagen peptidase play a role in what process and deficiency causes ____ disease.

Answer 23

Collagen synthesis

Ehlers Danlos

Question 24

Atropine reverses ____ poisoning. but what side effect of the posioning is still at risk?

Answer 24

Reverses organophosphate (DUMBBELLS) poisoning.

Still at risk of muscle paralysis becuase atropine only effects mACHR. Need to administer pralidoxime to resotre AChEsterase to decrease ACh to both muscarinic AND nicotinic.

Question 25

DoC for HTn, HF, Renal failure. Prevents efferent arteriole from constricting more than afferent arteriole, dcreased GFR (so expect GFR to decrease and Cr to increase initially)

Answer 25

ACE inhibitors -prils

Question 26

Sx: HTN, hypoK, metabolic lakalosis, and decreaed renin, adrenal mass.
Dx.
Tx

Answer 26

Dx: hyperaldosteronism (Conn)
Tx: aldosterone antagonist - spironolactone or eplerenone

Question 27

• normal BT, normal PT, prolonged PTT

- normal BT, prolonged PT, normal PTT

Answer 27

Factor 8 - hemophilia A

extrinsic pathway deficiency (i.e. Factor 7)

Question 28

asbestos –> ___ cancer

Answer 28

bronchogenic carcinoma (malignant mesothelioma is rare)

Question 29

Which organ releases EPO into blood stream when hypoxia (ie. due to OSA) is sensed?

Answer 29

kidney’s renal cortical cells

Question 30

NSAIDs and Renal Failure - what type of RF?

Answer 30

chronic intersitital nephritis and papillary necrosis (and calcification)

Question 31

What hormone is derived from POMC, therefore is similar to beta-endorphin (an endogenous opioid peptide).

Answer 31

ACTH and MSH

Question 32

Fibrinoid necrosis seen in…
Coagulative necrosis seen in…
Liquefactive necrosis is seen in…

Answer 32

blood vessels
all locations except CNS
bacterial infections and CNS infarcts

Question 33

Gram positive cocci that synthesize dextrans from sucrose

Answer 33

Viridans strep (dental carries) - strep mutans and strep sanguis

Question 34

Sx: fatigue and pruritis (possible jaundice, pale stool, dark urine) in a 45 year old female
Liver biopsy: lymphocyte infiltration and granulomatous destruction of intralobular bile ducts

Answer 34

Primary biliary Cirrhosis

Question 35

Sx: fatigue in a male with a predisposing condition
Liver biopsy: diffuse inflammation/fibrosis of large intra and extrahepatic bile ducts with periductal concentric fibrosis (onion skin) and obstruction of small ducts.
Lab: high alk phos

Wat is this and what is the associatinve condition?

Answer 35

Primary Sclerosing cholangitis

associated with Ulcerative Colitis

Question 36

Type of stone:

• rectangular, “coffin lid”
• octahedron (square with “X” in center)
• yellow or red brown, diamond or rhombus
• flat, yellow, hexagonal

Answer 36

• Mg ammonium phosphate (struvite)
• calcium oXalate (“X” in center)
• uric acid
• cysteine –> COLA (cysteine, ornithene lysine, arginine)

Question 37

___ = (0.7 x Vd) / CL

what are first order kinetics v. zero order?

Answer 37

half life

for first order kinetics, steady RATE of clearance per unit of time. Zero order is a stead AMOUNT of drug cleared per unit of time.

Question 38

drug for treatment resistant schizophrenia OR schizophrenia associated with suicidality

Answer 38

clozapine (**agranulocytosis)

Question 39

lecithinase aka alpha-toxin aka phospholipase C is the toxin for what gram positive rod? MOA?

Answer 39

Clostridium perfringens - catalyzes phospholipid molecule splitting

Question 40

A person has afib and stops anticoagulation meds. What is the most common site of thromboembolis?

Answer 40

Left atrial appendage.

Question 41

High lipophilicity and high volume of distribution (bc it is lipophilic; including CNS) means the drug is most likely cleared via what mechanism?

Answer 41

hepatically through bile (enters heaptocytes easily)

Question 42

Haptoglobin decreases, LDH and BR increase when ___.

Answer 42

When large amounts of RBCs are released into the blood stream (i.e. intravascualr hemolysis after a valve replacement).