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UWorld Facts 2 Flashcards

1
Q

How to diagnose major depressive disorder?

A

> 2 week period of 5 or more symptoms including either depressed mood or loss of interest/pleasure

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2
Q

Hawthorne effect

A

Observer effect: study subjects change their behavior if know they are being studied

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3
Q

Thoracic Outlet Syndrome

A
  • due to compression of LOWER TRUNK of BRACHIAL PLEXUS in the scalene triangle (anterior and middle scalene and first rib)
  • symptoms: upper extremity numbness, tingling and weakness
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4
Q

What is the most common BENIGN lung tumor?

A

Hamartomas

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5
Q

How to manage acute intermittent porphyria

A

Glucose or hemin - inhibit ALA synthase

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6
Q

Porphyria cutanea tarda

A
  • vesicle and blister formation in sun-exposed areas (photosensitivity)
  • deficiency in uroprophyrinogen dexarboxylase (uroporphyrin accumulates)
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7
Q

Etoposide - MOA

A
  • Targets topoisomerase II: does double strand nicks in DNA to relieve positive and negative supercoiling
  • etoposide prevents topoisomerase II to seal the nicks it creates, leading to accumulation of DNA fragments and ell death
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8
Q

How to treat restless leg syndrome

A

Dopamine agonists

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9
Q

Prepatellar bursitis

A

“Housemaid’s Knee”

  • prepatellar bursa: between anterior skin and patella
  • can be caused by anterior trauma or extensive KNEELING
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10
Q

Baker cyst

A
  • caused by swelling of gastrocnemius or semimebranous bursa
  • often form from extrusion of synovial fluid from knee joint into the bursa in patients with osteoarthritis or inflammatory joint disease
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11
Q

Tibial nerve injury - findings

A
  • Tibial nerve does foot inversion, plantar flexion and toe flexion, supplies sensation to DORSUM of foot
  • injury causes foot eversion, dorsiflexion and loss of sensation to dorsum of foot (opposite of common peroneal injury)
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12
Q

Creutzfeldt-Jacob disease - microscopic findings

A

Multiple vacuoles are seen in gray matter of the brain (spongiform encephalopathy)

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13
Q

Treatment of dermatophytosis

A

Terbinafine - antifungal that inhibits ergosterol synthesis suppressing squalene epoxidase

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14
Q

Terbinafine - MOA, use

A
  • Antifungal that inhibits ergosterol synthesis by suppressing SQUALENE EPOXIDASE
  • used to treat dermatophytosis
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15
Q

Winters Formula

A

PCO2 = (1.5 X HCO3- )+ 8 +/- 2

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16
Q

Aspirin toxicity - acid-base abnormalities

A

Causes respiratory alkalosis with an anion-gap metabolic acidosis later on - MIXED acid-base situation (would not see changes in PaCO2 levels based on compensation alone)

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17
Q

Does the patella assist in knee flexion or extension?

A

Extension

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18
Q

What can induce methemoglobinemia?

A

Nitrites and benzocaine by oxidizing Fe2+ to Fe3+

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19
Q

Role of CALCINEURIN

A

Activates IL-2 through dephosphorlyation of NFAT (NFAT binds to IL-2 promoter in nucleus) to promote GROWTH AND PROLIFERATION of T cells

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20
Q

How to calculate an odds ratio

A

ad/cb

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21
Q

How to calculate relative risk

A

[a/(a+b)]/[c/(c+d)]

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22
Q

What exits through the superior orbital fissure?

A
  • oculomotor (CN III)
  • opthalmic nerve branches (CN V1)
  • trochlear nerve (CN IV)
  • abducens (CN VI)
  • superior opthalmic vein
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23
Q

Dantrolene - MOA

A

Antagonizes RYANODINE receptors —> decrease Ca release from the SR
- used to treat neuroleptic malignant syndrome

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24
Q

Hereditary angioedema

A
  • deficiency in C1 ESTERASE INHIBITOR which normally suppresses the activation of C1 in classic complement pathway. Also inhibits kallikrein which converts kininogen to bradykinin
  • get accumulation of bradykinin —> ANGIOEDEMA
  • ACE inhibitors are CONTRAINDICATED
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25
Q

Functions of Prostacyclin

A
  • produced by vascular endothelial cells (synthesized from prostacyclin H2 by prostacylin synthase)
  • vasodilation
  • inhibits platelet aggregation
  • increases vascular permeability
  • functions oppose thromboxane A2!
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26
Q

Anaplastic Tumors

A
  • anaplastic = highly undifferentiated cells that lack the characteristics of that tissue of origin
  • anaplastic tumors have numerous mitoses, GIANT CELLS, and hyper chromatic cells (dark staining nuclei)
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27
Q

Theophylline intoxication

A

SEIZURES AND TACHYARRHYTHEMIAS

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28
Q

Hypercalcemia (Vit D toxicity) - symptoms

A

mental status changes, weakness, constipation, polyuria, polydypsia, dehydration

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29
Q

Cricothyrotomy

A
  • indicated when EMERGENCY airway is needed and other things have failed —> place tube between cricoid cartilage and thyroid cartilage
  • requires incision through: skin, superficial cervical fascia, investing and pre tracheal layers of deep cervical fascia, cricothyroid membrane
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30
Q

Neonatal manifestations of Turner syndrome

A
  • cystic hygromas
  • lymphedema
  • are due to abnormalities of lymphatic outflow
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31
Q

Thionamide-induced agranulocytosis

A
  • thionamides (methimazole, propylthiouracil) inhibit thyroid peroxidase which impairs iodine organification
  • toxicity includes agranulocytosis —> sudden fever, sore throat, ulcers
  • discontinue drug and check white blood cell count with diff to confirm diagnosis
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32
Q

Retroperitoneal abdominal organs - SAD PUCKER

A

S: suprarenal glands
A: aorta and inferior vena cava
D: duodenum (except 1st part)

P: pancreas (head and body)
U: ureters and bladder
C: colon (ascending and descending) 
K: kidneys
E: esophagus
R: rectum (mid-distal)
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33
Q

Squatting to relieve Tet spells in Tetralogy of Fallot - pathyphys

A

Squatting increases SYSTEMIC VASCULAR PRESSURE —> increased SVR:PVR —> forces a higher proportion of right ventricular blood into the pulmonary artery where pressure is lower, less deoxygenated blood goes to aorta

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34
Q

Abacavir hypersensitivity reaction

A
  • Abacavir: NRTI
  • hypersensitivity related to HLA-B*57-01 allele —> drug directly binds to HLA and alters the presentation of self peptides to the immune system —> get TYPE IV delayed hypersensitivity reaction
  • STOP drug for improvement
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35
Q

Cervical spine involvement is associated with which type of arthritis?

A

Rheumatoid arthritis

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36
Q

Lumbar spine involvement is associated with which type of arthritis?

A

Osteoarthritis

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37
Q

Milrinone

A
  • selective PHOSPHODIESTERASE INHIBITOR —> increases cAMP
  • causes increased Ca in cardiomyocytes —> increases contractility (POSITIVE IONOTROPE)
  • also increases cAMP in vascular tissues —> increases arterial and venous dilation
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38
Q

Familial Retinoblastoma

A
  • mutation in Rb tumor suppressor gene on chrm 13
  • often BILATERAL
  • increased risk for other cancers: osteosarcomas most common
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39
Q

Sporadic retinoblastoma

A
  • Usually UNILATERAL

- not at increased risk for other cancers

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40
Q

How to treat radioactive iodine poisoning

A

Potassium Iodine —> competes with radioactive iodine for uptake into the thyroid and inhibits it from entering thyroid follicular cells

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41
Q

Umbilical hernia

A
  • Large reducible midline bulge that increases with increased abdominal pressure
  • caused by incomplete closure of umbilical ring (defect in line alba)
  • associated with Down syndrome, hypothyroidism and Beckwith-Wiedemann syndrome
  • usually asymptomatic and resolves on own
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42
Q

Subacute thyroiditis (De Quervain)

A
  • transient disease following viral illness
  • hyperthyroid first, then hypothyroid
  • PAINFUL thyroid enlargement
  • decreased iodine uptake, increased ESR
  • see granulomatous inflammation on histology —> macrophages and giant cells
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43
Q

Bisphosphonates - MOA

A

Pyrophosphate analogs —> bind to hydroxyapatite on bone, preventing osteoclasts from binding —> decrease bone reabsorption

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44
Q

Acute serum sickness

A

TYPE III HYPERSENSITIVITY

  • immune complex deposition following exposure to nonhuman proteins: chimeric monoclonal antibodies and nonhuman immunoglobulins
  • get fever, pruritic skin rash and arthralgias 7-14 days after exposure
  • see fibrinoid necrosis and intense neutrophilic infiltration
  • immune complex deposition activates complement —> low C3 and C4 levels
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45
Q

Most common cause of death with TCA

A

Cardiac arrhythmias and refractory hypotension —> block sodium channels in cardiomyocytes —> slow down conduction

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46
Q

Most common injury in hysterectomy

A

URETER!

  • due to close proximity to structures: courses inferior and lateral to uterine artery prior to entering bladder —> “water under the bridge)
  • can get flank pain and fever
  • normal voiding and voiding because second ureter is usually fine
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47
Q

Choriocarcinoma

A
  • malignant tumor of TROPHOBLAST cells that arises following pregnancy
  • clinical: vaginal bleeding, uterine enlargement and very high beta-HCG levels
  • metastasizes to LUNGS quickly through blood
  • gross: bulky mass that is soft, yellow-white with areas of hemorrhage and necrosis
  • histology: composed of anaplastic cytotrophoblasts and syncyciotrophoblasts without villi
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48
Q

Left sided lesions in Frontal lobe

A

Apathy and depression

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49
Q

Right sided lesions in frontal lobe

A

Disinhibited behavior

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50
Q

Tertiary syphilis and heart problems

A
  • causes aortitis due to VASA VASORUM destruction
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51
Q

Burkitt lymphoma - translocation

A

t(8;14) - c-MYC —> transcription activator

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52
Q

Sensory innervation to below the dentate line

A

Inferior rectal —> branch of pudendal nerve

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53
Q

Latissimus dorsi

A

Internal rotation of humerus —> innervated by thoracodorsal nerve (C6-C8)

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54
Q

Noise induced hearing loss

A
  • due to trauma to stereo ciliated cells in ORGAN of CORTI

- loss of high-frequency hearing

55
Q

Conductive hearing loss

A
  • Rhinne test: bone > air

- Weber: localizes to AFFECTED EAR

56
Q

Sensorineural hearing loss

A
  • Rhinne test: air > bone

- Weber: localizes to UNAFFECTED ear

57
Q

Blunt aortic injury (traumatic aortic rupture)

A
  • most commonly due to injury of AORTIC ISTHMUS from rapid deceleration in motor vehicle crashes
58
Q

Attributable risk percentage in the exposed - equation

A

ARP(exp) = 100 X [(RR-1)/RR]

59
Q

Daptomycin

A
  • lipopeptide antibiotic
  • MOA: depolarizes cell membrane by creating transmembrane channels —> causes intracellular ion leakage
  • Bugs: gram + including MRSA!
  • toxicity: MYOPATHY —> increased creatine phosphokinase levels
60
Q

Spinal accessory nerve injury

A
  • Trapezius weakness: impaired ABduction ABOVE horizontal plane, SHOULDER DROOP on affected side
  • sternocleidomastoid muscle: weakness turning head to contralateral side of lesion
61
Q

Treatment of delirium

A

Low dose antipsychotics (i.e. haloperidol)

62
Q

Treatment of panic attacks

A
  • SSRIs: preferred because less abuse potential and dependence —> good for someone who is not acutely symptomatic with a substance abuse problem
  • benzodiazepines
63
Q

Serum tumor marker for hepatocellular carcinoma

A

alpha-fetoprotein

64
Q

Beta-hCG is a serum marker for which tumors?

A

Hydatidiform moles, choriocarinomas, TESTICULAR tumors, mixed germ cell tumors

65
Q

Increased ACh in amniotic fluid suggests which abnormality?

A

Neural tube defects: CSF leaks out which contains ACh and alpha-fetoprotein

66
Q

Causes of mitral valve prolapse

A

Defects in CONNECTIVE TISSUE of mitral valve proteins

67
Q

Maneuvers that increase preload:

A
  • squatting
  • sustained hand grip
  • passive leg raise
68
Q

Maneuvers that decrease preload:

A
  • standing
  • Valsalva maneuver
  • nitroglycerin
69
Q

Composition of 3’ end of tRNA:

A

CAA

  • used as recognition sequence by proteins
  • served as AMINO ACID BINDING SITE
70
Q

Calcitriol

A

Active Vit D

vs. calcidiol which is inactive Vit D

71
Q

Which type of brain tumor has Psammoma bodies?

A

Meningioma

72
Q

Which muscles ABduct the arm ABOVE the horizontal plane?

A

Trapezius muscle and Serratus anterior muscle

73
Q

Axillary lymph node dissection can cause what injury?

A

Injury to LONG THORACIC NERVE

  • innervates serratus anterior
  • get winging of the scapula and impaired abduction of arm over horizontal plane
74
Q

Down syndrome - lab findings on quadruple screen

A
  • low alpha-fetoprotein and unconjugated estriol

- high beta-hCG and inhibin A

75
Q

Which enzyme metabolizes toxins and pro-carcinogens?

A

CYP450 MONOOXYGENASE

  • found in hepatic microsomes and endoplasmic reticula of various tissues
  • activity of these enzymes are genetically determined
76
Q

Homocystinuria

A
  • deficiency in CYSTATHIONINE SYNTHASE (methionine —> cysteine)
  • AR
  • clinical: ectopia lentis, marfanoid habitus, die from THROMBOEMBOLISM
  • treatment: give B6 which is a cofactor for disease or limit methionine in diet
77
Q

Cancers caused by EBV

A
  • Burkitt lymphoma
  • Hodgkin lymphoma
  • Nasopharyngeal carcinoma
  • primary CNS lymphoma
78
Q

Theca externa cells vs theca interna cells:

A

Externa: provides connective tissue structural support
Interna: produces androgens

79
Q

Hereditary pancreatitis

A
  • mutation that renders trypsin insensitive to cleavage by itself, so cannot be inactivated
  • can also have mutation in SPINK1 that prevents trypsin from cleaving and activating other proteases
  • have recurrent attacks of acute pancreatitis
80
Q

Relative risk - equation

A

RR= [a/(a+b)] / [c/(c+d)]

81
Q

Odds ratio - equation

A

OR = ad/bc

82
Q

Disulfiram reaction - pathphys

A

Medications (ie: metronidazole) can inhibit ALDEHYDE DEHYDROGENASE in ethanol metabolism and act like disulfiram (antabuse) —> get accumulation of acetylaldehyde

83
Q

Main cell type in peripheral blood smear of patient with infectious mono due to EBV

A
  • Cytotoxic CD8+ lymphocytes —> proliferate to kill virally infected cells
  • CD21+ B cells are present but less than T cells (EBV infect B cells)
84
Q

What to use for treatment-resistant schizophrenia?

A

Clozapine: 2nd gen antipsychotic

  • treats positive and negative symptoms of schizophrenia
  • toxicity: agranulocytosis —> monitor neutrophil count!
85
Q

Estrogen and progesterone effects on gallstone formation

A
  • estrogen: increases cholesterol secretion —> upregulates HMG-CoA reductase activity
  • progesterone: reduces bile acid secretion and causes gallbladder hypomotility
86
Q

Treatment of bipolar disease

A
  • Lithium
  • Valproic acid (can stabilize mood and treat seizures)
  • Carbamazepine
  • atypical antipsychotics
  • Cannot give antidepressants as mono therapy b/c can PRECIPITATE MANIC EPISODES
87
Q

Mitochondrial Myopathies

A
  • “RAGGED RED MUSCLE FIBERS” —> abnormal mitochondria accumulate under the sarcolema
  • stains with Gomori trichome stain
  • inherited through mitochondrial DNA
88
Q

Polyarteritis nodosa

A
  • MEDIUM VESSEL VASCULITIS
89
Q

Mediators of vomitting:

A
  • Serotonin
  • Histamine 1
  • dopamine 2
  • muscarinic 1
  • neurokinin 1
90
Q

Amphotericin B - toxicity

A

RENAL TOXICITY

  • causes vasoconstriction and decreased GFR
  • toxin that can damage kidney structures —> acute tubular necrosis, renal tubular acidosis
  • hypokalemia and hypomagnesia
91
Q

Beers criteria: drugs to avoid in elderly

A
  • TCADS
  • first gen antihistamines
  • sulfonylureas
  • muscle relaxants
  • alpha blockers
92
Q

Pneumatosis intestinalis is related to which disease?

A

Necrotizing enterocolitis

  • most common GI emergency in newborn
  • seen in premature, infant fed babies with immature immune system
  • CURVILINEAR AREAS OF LUCENCY THAT PARALLEL THE BOWEL LUMEN
93
Q

Areas of brain most vulnerable to global cerebral ischemia

A
  • HIPPOCAMPUS: first area to be damaged
  • neocortex
  • Purkinjie cells of cerebellum
  • watershed areas
94
Q

Number needed to harm - formula

A

NNH = 1/attributable risk = 1/(Event rate treatment - Event rate placebo)

95
Q

Complications of subarachnoid hemorrhage

A
  • VASOSPASM: 4-12 days after, NOT seen on CT scan, treat with NIMODIPINE (selective Ca channel blocker)
  • REBLEED: most common, CAN SEE on CT scan
96
Q

Treatment for TCA overdose

A

Sodium bicarbonate - to prevent arrhythmias

97
Q

Osteomyelitis in children affects portion of the bone

A

METAPHYSIS of long bone

98
Q

Congenital hydrocephalus

A
  • due to Dandy walker, chiari malformation, infection
  • symptoms: macrocephaly, bulging fontanelle, poor feeding, developmental delay, HYPERtonicity and HYPERreflexia (UMN lesion)
  • treatment: cerebral shunting
99
Q

Plasma decay of thiopental is due to . . .

A 
TISSUE REABSORPTION (not metabolism) 
thiopental is a barbiturate
100
Q

Cell that protects against SUPERFICIAL candida infection

A

T-lymphocytes —> seen in HIV

101
Q

Cell that protects against HEMATOGENOUS candida infection

A

Neutrophils —> seen with neutropenias and immunocompromised (chemo but not really with HIV)

102
Q

Strongest risk factor for suicide

A

Previous suicide attempt

103
Q

Treatment of OCD

A

CBT, SSRI, clomipramine (TCAD)

104
Q

Cancers in Lynch Syndrome

A

Ovarian, endometrial and colorectal

- due to mutation in mismatch repair genes

105
Q

Foam stability test

A

Evaluates surfactant functionality (lung maturity): mixtures of ethanol and amniotic fluid are shaken and then examined to find the highest value that contains a stable foam ring

106
Q

Regenerative nodules in cirrhosis are made up of which cell?

A

proliferating HEPATOCYTES

107
Q

Cystic hygroma

A
  • lymphangioma of neck
  • presents as soft, compressible mass that transilluminates
  • common in TURNER and trisomies (13, 18, 21)
108
Q

Mechanism of lactose intolerance

A

Decreased GENE EXPRESSION

109
Q

Tardive dyskinesia

A
  • involuntary movements of FACE, TONGUE, LIPS (can also have choreiform movements)
  • induced by DRUGS: antipsychotics, metoclopramide —> prolonged blockade of dopamine receptors —> up regulation and super sensitivity of dopamine receptors
110
Q

Eosinophilic cytoplasmic inclusions in neurons is pathognomonic for?

A

Rabies - NEGRI BODIES

111
Q

Acitretin - class, use

A
  • RETINOID: Vit A derivative
  • used for PSORIASIS
  • TERATOGENIC
112
Q

Which cell makes ApoB-100?

A

Hepatocytes

113
Q

Which cell makes ApoB-48?

A

Intestinal cells

114
Q

Probenicid

A

Blocks organic anion transporters in kidney

  • inhibits reabsorption of uric acid in PCT
  • inhibits secretion of PENICILLIN
115
Q

Dysplastic nevus syndrome

A
  • numerous dysplastic nevi in young person who has a family history of melanoma in more than 3 first degree relatives —> 75% chance of developing melanoma in their lifetime
  • associated with mutations in the CDKN2A gene on chrm 9p21
116
Q

Aortic dissection: chest x-ray findings

A
  • widening of mediastinum

- abnormal aortic contour

117
Q

Carbamoyl phosphate synthetase I

A
  • UREA cycle

- MITOCHONDRIA

118
Q

Carbamoyl phosphate synthetase II

A
  • De novo pyrimidine synthesis

- CYTOSOL

119
Q

Iliopsoas test

A

Patient flexes hip against resistance

  • if pain, POSITIVE TEST
  • sign of psoas abscess or appendicitis
120
Q

Retinoids (Vitamin A) - MOA in acne

A
  • bind nuclear receptors —> function as transcription factors —> DECREASE SEBUM production and increase cellular turnover and shedding of cells from stratum corneum —> reduces hyperkeratinization, OPENS BLOCKED PORES, prevents formation of microcomedones
121
Q

Pontine hemorrhage

A

pinpoint pupils, loss of horizontal gaze, quadriparesis, decerebrate posturing, and rapidly evolving coma

122
Q

Cervix and transformation zone

A

Two types of epithelium in cervix:
- stratified non-keratinzed squamous epithelium —> outside part
- simple columnar epithelium —> in cervical canal
TZ
- has both of these epithelium
- is most common site of cervical cancer

123
Q

Hypercalcemia as cause of nephrogenic DI - pathophys

A

Hypercalcemia downregulates expression of aquaporins in collecting tubule —> impedes water reabsorption and causes resistance to vasopressin

124
Q

Skin dimpling in beast cancer indicates involvement of which structure?

A

SUSPENSORY LIGAMENTS (COOPER LIGAMENT) of breast

125
Q

Enzyme deficient in ALKAPTONURIA

A

Homogentisate oxidase

126
Q

Enzyme deficient in ALBINISM

A

Tyrosinase

127
Q

Glomus tumor

A
  • benign, painful, RED-BLUE tumor underneath fingernail
  • arises from modified smooth muscle cells of GLUMOS body (involved with themoregulation by bringing blood to and away from skin)
128
Q

Liver finding on histology for Reye syndrome

A

Microvascular fatty changes —> small fat vacuoles in cytoplasm of hepatocytes
lab findings: increased AST, ALT, ammonia and bilirubin, prolonged PT and PTT

129
Q

Which step of TCA cycle produces GTP?

A

Succinyl-CoA to Succinate step (via succinyl-CoA synthetase)

130
Q

What promotes sickling in sickle cell anemia?

A
  • low oxygen
  • dehydration
  • LOW pH
  • high altitude
131
Q

Cachexia

A
  • weight loss, muscle atrophy, and fatigue in chronic disease —> cancer, HIV, heart failure, TB
  • mediated by TNF-alpha, IFN-gamma, IL-1 and IL-6
132
Q

Affects of desmopressin in bleeding

A

Increases endothelial release of vWF and Factor VIII (made in endothelial cells)

133
Q

Side effects of erythopoeisis-stimulating factors

A
  • HYPERtension

- thromboembolic events

UWorld Facts (12 decks)

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