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
2
Q
Hawthorne effect
A
Observer effect: study subjects change their behavior if know they are being studied
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
4
Q
What is the most common BENIGN lung tumor?
A
Hamartomas
5
Q
How to manage acute intermittent porphyria
A
Glucose or hemin - inhibit ALA synthase
6
Q
Porphyria cutanea tarda
A
- vesicle and blister formation in sun-exposed areas (photosensitivity)
- deficiency in uroprophyrinogen dexarboxylase (uroporphyrin accumulates)
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
8
Q
How to treat restless leg syndrome
A
Dopamine agonists
9
Q
Prepatellar bursitis
A
“Housemaid’s Knee”
- prepatellar bursa: between anterior skin and patella
- can be caused by anterior trauma or extensive KNEELING
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
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)
12
Q
Creutzfeldt-Jacob disease - microscopic findings
A
Multiple vacuoles are seen in gray matter of the brain (spongiform encephalopathy)
13
Q
Treatment of dermatophytosis
A
Terbinafine - antifungal that inhibits ergosterol synthesis suppressing squalene epoxidase
14
Q
Terbinafine - MOA, use
A
- Antifungal that inhibits ergosterol synthesis by suppressing SQUALENE EPOXIDASE
- used to treat dermatophytosis
15
Q
Winters Formula
A
PCO2 = (1.5 X HCO3- )+ 8 +/- 2
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)
17
Q
Does the patella assist in knee flexion or extension?
A
Extension
18
Q
What can induce methemoglobinemia?
A
Nitrites and benzocaine by oxidizing Fe2+ to Fe3+
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
20
Q
How to calculate an odds ratio
A
ad/cb
21
Q
How to calculate relative risk
A
[a/(a+b)]/[c/(c+d)]
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
23
Q
Dantrolene - MOA
A
Antagonizes RYANODINE receptors —> decrease Ca release from the SR
- used to treat neuroleptic malignant syndrome
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
25
Functions of Prostacyclin
- produced by vascular endothelial cells (synthesized from prostacyclin H2 by prostacylin synthase)
- vasodilation
- inhibits platelet aggregation
- increases vascular permeability
- functions oppose thromboxane A2!
26
Anaplastic Tumors
- 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)
27
Theophylline intoxication
SEIZURES AND TACHYARRHYTHEMIAS
28
Hypercalcemia (Vit D toxicity) - symptoms
mental status changes, weakness, constipation, polyuria, polydypsia, dehydration
29
Cricothyrotomy
- 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
30
Neonatal manifestations of Turner syndrome
- cystic hygromas
- lymphedema
- are due to abnormalities of lymphatic outflow
31
Thionamide-induced agranulocytosis
- 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
32
Retroperitoneal abdominal organs - SAD PUCKER
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)
```
33
Squatting to relieve Tet spells in Tetralogy of Fallot - pathyphys
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
34
Abacavir hypersensitivity reaction
- 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
35
Cervical spine involvement is associated with which type of arthritis?
Rheumatoid arthritis
36
Lumbar spine involvement is associated with which type of arthritis?
Osteoarthritis
37
Milrinone
- 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
38
Familial Retinoblastoma
- mutation in Rb tumor suppressor gene on chrm 13
- often BILATERAL
- increased risk for other cancers: osteosarcomas most common
39
Sporadic retinoblastoma
- Usually UNILATERAL
| - not at increased risk for other cancers
40
How to treat radioactive iodine poisoning
Potassium Iodine —> competes with radioactive iodine for uptake into the thyroid and inhibits it from entering thyroid follicular cells
41
Umbilical hernia
- 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
42
Subacute thyroiditis (De Quervain)
- 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
43
Bisphosphonates - MOA
Pyrophosphate analogs —> bind to hydroxyapatite on bone, preventing osteoclasts from binding —> decrease bone reabsorption
44
Acute serum sickness
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
45
Most common cause of death with TCA
Cardiac arrhythmias and refractory hypotension —> block sodium channels in cardiomyocytes —> slow down conduction
46
Most common injury in hysterectomy
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
47
Choriocarcinoma
- 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
48
Left sided lesions in Frontal lobe
Apathy and depression
49
Right sided lesions in frontal lobe
Disinhibited behavior
50
Tertiary syphilis and heart problems
- causes aortitis due to VASA VASORUM destruction
51
Burkitt lymphoma - translocation
t(8;14) - c-MYC —> transcription activator
52
Sensory innervation to below the dentate line
Inferior rectal —> branch of pudendal nerve
53
Latissimus dorsi
Internal rotation of humerus —> innervated by thoracodorsal nerve (C6-C8)
54
Noise induced hearing loss
- due to trauma to stereo ciliated cells in ORGAN of CORTI
| - loss of high-frequency hearing
55
Conductive hearing loss
- Rhinne test: bone > air
| - Weber: localizes to AFFECTED EAR
56
Sensorineural hearing loss
- Rhinne test: air > bone
| - Weber: localizes to UNAFFECTED ear
57
Blunt aortic injury (traumatic aortic rupture)
- most commonly due to injury of AORTIC ISTHMUS from rapid deceleration in motor vehicle crashes
58
Attributable risk percentage in the exposed - equation
ARP(exp) = 100 X [(RR-1)/RR]
59
Daptomycin
- 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
Spinal accessory nerve injury
- Trapezius weakness: impaired ABduction ABOVE horizontal plane, SHOULDER DROOP on affected side
- sternocleidomastoid muscle: weakness turning head to contralateral side of lesion
61
Treatment of delirium
Low dose antipsychotics (i.e. haloperidol)
62
Treatment of panic attacks
- SSRIs: preferred because less abuse potential and dependence —> good for someone who is not acutely symptomatic with a substance abuse problem
- benzodiazepines
63
Serum tumor marker for hepatocellular carcinoma
alpha-fetoprotein
64
Beta-hCG is a serum marker for which tumors?
Hydatidiform moles, choriocarinomas, TESTICULAR tumors, mixed germ cell tumors
65
Increased ACh in amniotic fluid suggests which abnormality?
Neural tube defects: CSF leaks out which contains ACh and alpha-fetoprotein
66
Causes of mitral valve prolapse
Defects in CONNECTIVE TISSUE of mitral valve proteins
67
Maneuvers that increase preload:
- squatting
- sustained hand grip
- passive leg raise
68
Maneuvers that decrease preload:
- standing
- Valsalva maneuver
- nitroglycerin
69
Composition of 3' end of tRNA:
CAA
- used as recognition sequence by proteins
- served as AMINO ACID BINDING SITE
70
Calcitriol
Active Vit D
| vs. calcidiol which is inactive Vit D
71
Which type of brain tumor has Psammoma bodies?
Meningioma
72
Which muscles ABduct the arm ABOVE the horizontal plane?
Trapezius muscle and Serratus anterior muscle
73
Axillary lymph node dissection can cause what injury?
Injury to LONG THORACIC NERVE
- innervates serratus anterior
- get winging of the scapula and impaired abduction of arm over horizontal plane
74
Down syndrome - lab findings on quadruple screen
- low alpha-fetoprotein and unconjugated estriol
| - high beta-hCG and inhibin A
75
Which enzyme metabolizes toxins and pro-carcinogens?
CYP450 MONOOXYGENASE
- found in hepatic microsomes and endoplasmic reticula of various tissues
- activity of these enzymes are genetically determined
76
Homocystinuria
- 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
Cancers caused by EBV
- Burkitt lymphoma
- Hodgkin lymphoma
- Nasopharyngeal carcinoma
- primary CNS lymphoma
78
Theca externa cells vs theca interna cells:
Externa: provides connective tissue structural support
Interna: produces androgens
79
Hereditary pancreatitis
- 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
Relative risk - equation
RR= [a/(a+b)] / [c/(c+d)]
81
Odds ratio - equation
OR = ad/bc
82
Disulfiram reaction - pathphys
Medications (ie: metronidazole) can inhibit ALDEHYDE DEHYDROGENASE in ethanol metabolism and act like disulfiram (antabuse) —> get accumulation of acetylaldehyde
83
Main cell type in peripheral blood smear of patient with infectious mono due to EBV
- Cytotoxic CD8+ lymphocytes —> proliferate to kill virally infected cells
- CD21+ B cells are present but less than T cells (EBV infect B cells)
84
What to use for treatment-resistant schizophrenia?
Clozapine: 2nd gen antipsychotic
- treats positive and negative symptoms of schizophrenia
- toxicity: agranulocytosis —> monitor neutrophil count!
85
Estrogen and progesterone effects on gallstone formation
- estrogen: increases cholesterol secretion —> upregulates HMG-CoA reductase activity
- progesterone: reduces bile acid secretion and causes gallbladder hypomotility
86
Treatment of bipolar disease
- 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
Mitochondrial Myopathies
- "RAGGED RED MUSCLE FIBERS" —> abnormal mitochondria accumulate under the sarcolema
- stains with Gomori trichome stain
- inherited through mitochondrial DNA
88
Polyarteritis nodosa
- MEDIUM VESSEL VASCULITIS
89
Mediators of vomitting:
- Serotonin
- Histamine 1
- dopamine 2
- muscarinic 1
- neurokinin 1
90
Amphotericin B - toxicity
RENAL TOXICITY
- causes vasoconstriction and decreased GFR
- toxin that can damage kidney structures —> acute tubular necrosis, renal tubular acidosis
- hypokalemia and hypomagnesia
91
Beers criteria: drugs to avoid in elderly
- TCADS
- first gen antihistamines
- sulfonylureas
- muscle relaxants
- alpha blockers
92
Pneumatosis intestinalis is related to which disease?
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
Areas of brain most vulnerable to global cerebral ischemia
- HIPPOCAMPUS: first area to be damaged
- neocortex
- Purkinjie cells of cerebellum
- watershed areas
94
Number needed to harm - formula
NNH = 1/attributable risk = 1/(Event rate treatment - Event rate placebo)
95
Complications of subarachnoid hemorrhage
- 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
Treatment for TCA overdose
Sodium bicarbonate - to prevent arrhythmias
97
Osteomyelitis in children affects portion of the bone
METAPHYSIS of long bone
98
Congenital hydrocephalus
- due to Dandy walker, chiari malformation, infection
- symptoms: macrocephaly, bulging fontanelle, poor feeding, developmental delay, HYPERtonicity and HYPERreflexia (UMN lesion)
- treatment: cerebral shunting
99
Plasma decay of thiopental is due to . . .
```
TISSUE REABSORPTION (not metabolism)
thiopental is a barbiturate
```
100
Cell that protects against SUPERFICIAL candida infection
T-lymphocytes —> seen in HIV
101
Cell that protects against HEMATOGENOUS candida infection
Neutrophils —> seen with neutropenias and immunocompromised (chemo but not really with HIV)
102
Strongest risk factor for suicide
Previous suicide attempt
103
Treatment of OCD
CBT, SSRI, clomipramine (TCAD)
104
Cancers in Lynch Syndrome
Ovarian, endometrial and colorectal
| - due to mutation in mismatch repair genes
105
Foam stability test
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
Regenerative nodules in cirrhosis are made up of which cell?
proliferating HEPATOCYTES
107
Cystic hygroma
- lymphangioma of neck
- presents as soft, compressible mass that transilluminates
- common in TURNER and trisomies (13, 18, 21)
108
Mechanism of lactose intolerance
Decreased GENE EXPRESSION
109
Tardive dyskinesia
- 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
Eosinophilic cytoplasmic inclusions in neurons is pathognomonic for?
Rabies - NEGRI BODIES
111
Acitretin - class, use
- RETINOID: Vit A derivative
- used for PSORIASIS
- TERATOGENIC
112
Which cell makes ApoB-100?
Hepatocytes
113
Which cell makes ApoB-48?
Intestinal cells
114
Probenicid
Blocks organic anion transporters in kidney
- inhibits reabsorption of uric acid in PCT
- inhibits secretion of PENICILLIN
115
Dysplastic nevus syndrome
- 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
Aortic dissection: chest x-ray findings
- widening of mediastinum
| - abnormal aortic contour
117
Carbamoyl phosphate synthetase I
- UREA cycle
| - MITOCHONDRIA
118
Carbamoyl phosphate synthetase II
- De novo pyrimidine synthesis
| - CYTOSOL
119
Iliopsoas test
Patient flexes hip against resistance
- if pain, POSITIVE TEST
- sign of psoas abscess or appendicitis
120
Retinoids (Vitamin A) - MOA in acne
- 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
Pontine hemorrhage
pinpoint pupils, loss of horizontal gaze, quadriparesis, decerebrate posturing, and rapidly evolving coma
122
Cervix and transformation zone
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
Hypercalcemia as cause of nephrogenic DI - pathophys
Hypercalcemia downregulates expression of aquaporins in collecting tubule —> impedes water reabsorption and causes resistance to vasopressin
124
Skin dimpling in beast cancer indicates involvement of which structure?
SUSPENSORY LIGAMENTS (COOPER LIGAMENT) of breast
125
Enzyme deficient in ALKAPTONURIA
Homogentisate oxidase
126
Enzyme deficient in ALBINISM
Tyrosinase
127
Glomus tumor
- 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
Liver finding on histology for Reye syndrome
Microvascular fatty changes —> small fat vacuoles in cytoplasm of hepatocytes
lab findings: increased AST, ALT, ammonia and bilirubin, prolonged PT and PTT
129
Which step of TCA cycle produces GTP?
Succinyl-CoA to Succinate step (via succinyl-CoA synthetase)
130
What promotes sickling in sickle cell anemia?
- low oxygen
- dehydration
- LOW pH
- high altitude
131
Cachexia
- 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
Affects of desmopressin in bleeding
Increases endothelial release of vWF and Factor VIII (made in endothelial cells)
133
Side effects of erythopoeisis-stimulating factors
- HYPERtension
| - thromboembolic events
