UWORLD random 3/20a

Question 1

parietal cell epi location

Answer 1

upper glandular layer

below simple columnar epi cells that secrete mucus

Question 2

calcineurin

Answer 2

activates NFAT –> NFAT binds IL-2 promotor in nucleus –> ++ IL-2

IL-2 stimulates growth and differentiation of T cells

Question 3

calcineurin inhibitors

Answer 3

cyclosporine

tacrolimus

Question 4

vit C deficiency sc

Answer 4

easy bruising
mucosal bleeding
periodontal disease
poor wound healing
hyperkaratotic follicles with corkscrew airs

scurvy

Question 5

Vit C deficiency pathophys

Answer 5

impaired hydroxylation of proline and lysine residues during collagen synthesis

Question 6

IL-12

Answer 6

on macrophage

stimulate T-cell differentiation into TH1 subset

Question 7

IL-12 deficiency

Answer 7

no activation of macrophages for intracellular organisms (mycobacteria)

tx IFN-y (bypass IL-12)

Question 8

post strep A complications - preventable with AB?

assoc with skin infxn?

Answer 8

PSGN - not preventable by AB

acute rheumatic fever - preventable
NOT after skin infections

Question 9

multiple myeloma

Answer 9

normocytic, normochromic anemia
infiltration of bone marrow by plasma cells
IL-1, IL-6 activate osteoclasts –> bone resorption, osteopenia
hypercalcemia
hyperimmunoglobulinemia
AL amyloid
renal failure

Question 10

head bobbing with carotid pulsations

Answer 10

large LV stroke volume to head and neck

aortic regurg

Question 11

bounding femoral/carotid pulses

Answer 11

wide pulse pressure

aortic regurg

Question 12

aorti regurg murmur

Answer 12

diastolic decrescendo murmur L sternal border

Question 13

mycoplasma & anemia

Answer 13

complement mediated intravascualr anemia

similar antigens to cell membrane of M pneumo and erythrocytes

Question 14

genetic shift

Answer 14

influenza A
rotavirus

segmented genome

Question 15

normal FEV1/FVC

Answer 15

80%

Question 16

tolerance to opioid side effects does NOT include

Answer 16

constipation

Question 17

Cheyne-Stokes breathing

Answer 17

CHF

cyclic breathing pattern
apnea - gradually increasing and decreasing tidal volumes - apnea

poor prognostic sign

Question 18

location of thoracentesis

Answer 18

b/t 6-8 ribs along midclavicular line
8-10 midaxillary line
10-12 paravertebral line

above = hit lung
below = hit liver/abdominal structures

Question 19

familial dyslipidemias (I-IV)

Answer 19

I chylomicronemia (LPL, ApoCII -- chylomicrons)
II hypercholesterolemia (LDL-r, ApoB100 -- LDL)
III dysbetalipoproteinemia (ApoE -- chylomicron, VLDL remnants)
IV hypertriglyceridemia (ApoA-V - VLDL)

Question 20

familial dyslipidemia complications

Answer 20

I,IV = pancreatitis
I, II, III = xanthomas
II, III = premature CAD

Question 21

transesophageal echo - closest structure

anterior?
posterior?

Answer 21

ant = left atrium

post = desc aorta

Question 22

tx adrenal crisis

Answer 22

hydrocortisone

dexamethasone

Question 23

active Ras

Answer 23

GTP

activate MAPK

Question 24

neprilysin

Answer 24

metalloprotrease that inactivates peptide hormones

bradykinin, glucagon, enkephalins, natriuretic peptids

Question 25

ANP

Answer 25

from atrial cardiomyotyces in response to atrial stretch

lowers BP via peripheral vasodilation, natriuresis, diuresis (kidney, adrenal gland, BV)

Question 26

glyburide

Answer 26

sulfonylurea

Question 27

liver biosynthetic fxn tests

Answer 27

albumin
prothrombin time
serum bilirubin

poor prognosis

Question 28

conduction vs sensorineural hearing loss

Answer 28

bone conduction > air conduction –> conductive hearing loss

middle of forehead =
lateralize to affected ear –> conductive
lateralize to unaffected ear –> sensorineural hearing loss

Question 29

amitriptyline

Answer 29

tricyclic antidepressant with strong anticholinergic properties

ADR = anticholinergic tox
(hot as a hare, dry as a cracker, blind as a bat, mad as a hatter, full as a flask, red as a beet)

Question 30

meds with anticholinergic properties

Answer 30

antihistamines
tricyclic antidepressants
1st gen antipsychotics (chlorpromazine)
2nd gen antipsychotic (clozapine)
antiparkinsonian
belladonna

Question 31

derived from common cardinal veins

Answer 31

superior vena cava

systemic venous circulation

Question 32

develops from truncus arteriosus

Answer 32

ascending aorta

pulm trunk

Question 33

constrictive pericarditis phys exam

Answer 33

JVP
kussmaul sign
pericardial knock (early diastole)

Question 34

kuss maul sign

Answer 34

paradoxical rise in JVP during inspiration

vol restricted RV is unable to accommodate inspiratory increase in venous return

Question 35

holosystolic murmur

Answer 35

mitral regurg (apex)
VSD (LL sternal border)

Question 36

loud P2

Answer 36

pulm hypertension

Question 37

midsystolic click

Answer 37

mitral valve prolapse

Question 38

methylmalonic acidemia

Answer 38

AR
organic acidemia

deficiency of methylmalonyl-CoA

hypoglycemia
+ serum ketones
+ serum ammonia

+ urine methylmalonic acid
+ urine propionic acid

lethargy, vomiting, tachypnea in newborn

Question 39

ARDS

Answer 39

risk facors = sepsis, pulm infxn

fluid filled alveolar spaces

Question 40

sepsis cytokines

Answer 40

TNF
IL-1, 6, 8

activate pulm epithelium, neutrophil chemotaxis

Question 41

estrogen agonist on bone & antagonist on breast, uterus

Answer 41

raloxifene

Question 42

estrogen agonist on bone, uterus, antagonist on breast

Answer 42

tamoxifen

Question 43

concentric LV hypertrophy

Answer 43

pressure overload

chronic hypertension
aortic stenosis

Question 44

eccentric LV hypertrophy

Answer 44

vol overload

aortic/mitral regurg
MI
dilated cardiomyopathy