UWorld Sim 1 Flashcards
what is the pathogenesis in acute respiratory distress syndrome and what will you see
- Alveolar insult (sepsis, aspiration, pneumonia, trauma, pancreatitis)
- pro-inflammatory cytokines being released
- PMNs and release of toxic mediators
- Capillary endothelial damage and increase in vessel permeability
- leak of protein rich fluid in the alveoli
- formation of intra-alveolar hyaline membranes and pulmonary edema
*note loss of surfactant also contributes to alveolar collapse
Abnormal chest x-ray (bilateral lung opacities)
Respiratory failure within 1 week of alveolar insult
Decreased PaO2/FiO2 (<300, hypoxemia due to increased intrapulmonary shunting and diffusion abnormalities)
Symptoms of respiratory failure are not due to HF/fluid overload
-impaired gas exchange, decreased lung compliance, pulmonary hypertension
globus sensation/hystericus/pharyngeus
common abnormal sensation of foreign body, tightness, or fullness in throat without accompanying findings of esophageal obstruction
- worsens when swallowing spit but better when eating and drinking
- considered a functional disorder of the esophagus
what is the one vitamin you do NOT want in excess when pregnant?
vitamin A
- accumulates in the stellate cells of the liver and is not readily excreted in the urine
- too much in the first trimester (during organogenesis) can result in fetal microcephaly, cardiac anomalies, early epiphyseal closure, growth retardation, and spontaneous abortion
DNA laddering
- appearance of DNA fragments in multiples of 180 base pairs
- sensitive indicator of apoptosis
what are the filaments used in each type of cell connection
tight junction: claudin and occludin
adherens junction: cadherins
desmosome: cadherins with intermediate filaments
gap junction: connexons made up of connexins
hemidesmosome: integrin, fibronectin/laminin, ECM/collagen
what is the primary concern of both anterior and posterior dislocations of the knee join
injury to the popliteal artery
what should you be concerned about in a case with:
penetrating trauma to the popliteal fossa
OR
blunt trauma to the lateral knee
tibial nerve
OR
common peroneal nerve
nummular eczema
pruritic, coin-shaped, erythematous patches
being an angry person then going and playing sports to get the aggression out
sublimation
ligand binding to a tyrosine kinase receptor results in formation of….
receptor dimers and a conformational change that exposes tyrosine kinase active sites
Chiari I vs Chiari II vs Dandy-Walker
Chiari I –> ectopia of cerebellar tonsils inferior to foramen magnum (1 structure), usually asymptomatic in childhood but with cough/headaches in adulthood and cerebellar symptoms
Chiari II –> herniation of cerebellar vermis and tonsils (2 structures) through foramen magnum with aqueductal stenosis, noncommunicating hydrocephalus, usually with lumbosacral myelomeningocele and may present as paralysis/sensory loss at and below the level of the lesion
Dandy-Walker –> agenesis of cerebellar vermis leads to cystic enlargement of 4th ventricle that fills the enlarged posterior fossa, associated with noncommunicating hydrocephalus and spina bifida
female with primary amenorrhea, absent uterus and upper vagina, cryptorchid (undescended testes), minimal to absent pubic hair, yes to breast development
x-linked defect of androgen receptor (complete androgen insensitivity)
premature neonate with impaired BP in premature infants, altered level of consciousness, bulging fontanelle, hypotension, seizures, coma
Neonatal intraventricular hemorrhage
- bleeding into ventricles
- increased risk in premature and low-birth-weight infants
- originates in germinal matrix (highly vascularized layer within the subventricular zone)
- due to reduced glial fiber support and impaired autoregulation of BP in premature infants
cisplatin and carboplatin
cross-links DNA
-used for testicular, bladder, ovary, and lung carcinomas
adverse effects: nephrotoxicity, peripheral neuropathy, and otoxicity (tinnitus and hearing loss by damaging hair cells within the organ of corti of the cochlear membranous labyrinth)
prevent nephrotoxicity with amifostine (free radical scavenger) and chloride (saline) diuresis
which medications can cause interstitial lung diseases
bleomycin, busulfan, amiodarone, methotrexate
how do nitrates affect heart and blood vessels
increase heart rate and decrease end-diastolic left ventricular volume
*just think about it… since it causes venodilation the amount of blood going to the heart will decrease so the heart will have to pump faster to compensate for that
what mutation will you see in achondroplasia
AD mutation of FGFR3 gene
what is the purpose of the N-terminal sequence of mRNA
this is what signals it to go to the RER and if not then it’ll get translated in the cytosolic ribosomes and will accumulate in the cytoplasm
fetal ultrasound with ascites, large bilateral pleural effusions, and small pericardial effusions from a couple who are from southeast asia
hemoglobin barts (4 gene loss: alpha thalassemia) -this means both parents must have 2 gene losses and their phenotype would be a mild microcytic anemia
what cell is messed up if a male pt has fertility troubles, normal serum testosterone, and low gonadal testosterone
Sertoli cells cause they do not release androgen binding protein like they should in order to keep the testosterone concentration high in the testes/seminiferous tubules thats needed for normal sperm production and maturation
what should you expect to see in a pt with exertional dyspnea and right ventricular hypertrophy
this pt has pulmonary arterial hypertension
you will see pulmonary endothelial dysfunction
what should be top on your differential if you have a young woman with VERY heavy menstrual periods (to the point where blood transfusions are needed after menses)
leiomyoma (uterine fibroids)–> benign uterine smooth muscle tumor that can result in endometrial venous ectasia which can lead to heavy menses
note: submucosal/intracavitary fibroids are particularly associated with anemia
distortion of the intrauterine cavity can result in reproductive difficulties
tumor composed of polygonal, eosinophilic cells that stain positive for neuropeptides (chromogranin and synaptophysin)
carcinoid tumor
-typically arise in GI tract or bronchus and can be associated with dramatically elevated levels of vasoactive compounds like serotonin leading to carcinoid syndrome (facial flushing and diarrhea)
most frequently involved site of crohns
terminal ileum
-may also have aphthous ulcers of the mouth and perianal disease (fissures and abscesses)
alpha1 and 2 along with beta1 and 2
what are their second messengers when stimulated
a1 = IP3 (increase) a2 = cAMP (decrease)
beta1 and 2 = cAMP increase
where does the recurrent laryngeal nerve lie and what does it supply
circles around the aortic arch off of the vagus nerve
All the intrinsic muscles of the larynx
- posterior and lateral cricoarytenoid
- oblique and transverse arytenoid
- thyroarytenoid
patient with fatigue and painless goiter
hashimotos
- diffuse lymphocytic infiltration of thyroid gland by B and T cells specific for thyroid antigens (lymphoid germinal centers and destruction of thyroid follicles)
- hurthle cells also seen
inheritance of duchenne muscular dystrophy
x-linked recessive
birds beak on barium swallow and food feeling like its stuck in throat
achalasia
-inflammation and degeneration of neurons in esophageal wall
as sample size increases what value decreases
standard error (less variability in data points)
peutz-jeghers syndrome
AD
- numerous hamartomas throughout GI tract along with hyperpigmented macules on mouth, lips, hands, and genitalia
- associated with increased risk of breast and GI cancer
what can acanthosis nigricans be a sign on
insulin resistance or malignancy
-more likely to be malignancy if it appears suddenly and spreads quickly (usually GI or lung malignancy)
transduction
transfer of genes via bacteriophage
transformation
naked DNA uptake from surrounding areas
conjugation
bacterial sex with pilus
homeobox (HOXA13) gene expression
hand-foot-genital syndrome
-hypoplastic fingers and mullerian fusion abnormalities (uterus didelphys)
