UWorld Test 5/21/2014

Question 1

What is the role of MMP in wound healing? XS MMP can lead to?

Answer 1

They encourage myofibroblast accumulation at the wound edges and scar tissue remodeling. Excess MMP activity can cause wound contracture. Deformities of the wound and the surrounding tissues. Most often on palms, soles, anterior thorax or at serious burn sites.

Question 2

What is wound dehiscence

Answer 2

Rupture of previously closed wound. Can result from insufficient granulation/scar tissue.

Question 3

Presentation of patient with SCID

Answer 3

Recurrent infections by bacteria, fungi, viruses and opportunitistc infections. Failure to thrive. Chronic diarrhea within first year of life.

Question 4

How do leukotrienes play a role in asthma? What pharm tx addresses this?

Answer 4

LTC4, D4, and E4 causes bronchial constriction, increased mucus secretion, worsening asthma. Leukotriene receptors such as Zafirlukast and Montelukast help block leukotriene action

Question 5

Do you know glyocgen metabolism?

Answer 5

Know it!!!

Question 6

What is akathisia

Answer 6

Restlessness that occurs 4 days after anti-psychotic meds

Question 7

What is the evolution/timeline of EPS side effects with antipsychotics?

Answer 7

4 hours - acute dystonia (muscle spasm, stiffness, oculogyric crisis), 4 days - akathisia, 4 weeks - bradykinesia (parkinsonism), 4 months - tardive dyskinesia (sterotypical oral facial movements - potentially irreversbile - involuntary movements like lip smacking, choreoatheoid movements, biting, cheweing)

Question 8

What is a serious toxicity of antipsychotics? Tx?

Answer 8

Neuroleptic malignant syndrome - ridigity, myoglobinuira, autonomic instability, hyperpyrexia. Tx: dantrolene, D2 receptor agonists (bromocriptine)

Question 9

What are the side effects of antipsychotics?

Answer 9

EPS symptoms (Tx. Benztropine or diphenhydramine), endocrine symptoms (dopamine receptor antagonism -> hyperprolactinemia => galactorrhea), muscarinic block effects like dry mouth, constipation, hypotnesion (alpha 1), sedation (histamine receptors)

Question 10

Liver uptake of unconjugated bilirubin and secretion of conjugated bilirubin is through what processes?

Answer 10

Uptake is passive, secretion is via active anion transporter mechanism. Side note - unconjugated is tightly bound to albumin and highly insoluble/unable to excrete it. Conjugated biliribuin is high soluble and loosely bound to albumin. Can be excreted in urine.

Question 11

What is Fragile X syndrome? Defect? PPt?

Answer 11

Trinucleotide disorder = CGGn. X-linked defect affecting methylation and expression of FMR1 gene. 2nd most common cause of intellectual disability after Down syndrome. Findings: large testes, long face with long jaw, large everted ears, autism, mitral valve prolapse, short height, joint laxity, scoliosis

Question 12

Lack of ApoE3 and ApoE4 results in impairment of?

Answer 12

Chylomicrom remnant uptake by liver cells and resulting increase in cholesterol and triglyceride levels in the serum.

Question 13

What kind of receptors are nicotinic receptors and what is the immediate result?

Answer 13

Ionotropic receptors (ion channels that open directly upon ligand binding). Results in immediate influx of Na+, Ca2+ into the cell and outflux of K+ from the cell

Question 14

excess prolactin from prolacin secreting pituitary adenoma can cause?

Answer 14

Visual changes due to compression of the adenoma on the optic chiasm, galactorrhea and amenorrhea (prolactin inhibits GnRH secretion)

Question 15

What kind of vaccine is the rabies vaccine?

Answer 15

Consists of various rhabdovirus strains grown in tissue cell culture

Question 16

What is the clinical ppt of rabies infection?

Answer 16

non-specific flu-like prodrome (n/v/headache/fever/malaise) followed by acute neurological symptoms - agitation, restlessness, dysphagia, variable consciousness. Generalized flaccid paralysis and and coma ensue.

Question 17

Cytokertin is an immunohistochemical marker for what kind of cell?

Answer 17

Epithelial cell

Question 18

Administration of alpha 1 adrenergic agonists results in?

Answer 18

Increase in both diastolic and systolic blood pressure via vasoconstriction, resulting in reflexive increase in vagal influence of the heart. Resulting inhibition of SA node’s pacemaker activity and slowed conduction through AV node leads to decreased heart rate, contractility and conductance.

Question 19

What effect does Vitamin B6 have on levodopa

Answer 19

Increases peripheral metabolism of levodopa, which means less available to go to CNS, which means non-improving Parkinson symptoms.

Question 20

Where does the third cranial nerve run (between which blood vessels?)

Answer 20

Courses between the posterior cerebral artery and superior cerebellary artery as it leaves the midbrain and is susceptible to injury from an expanding aneurysm. The parasympatehtic GVE fibers run outside and the GSE run inside. GVE more susceptible to compression and GSE to injury from ischemia.

Question 21

What microorganisms requires cholesterol to grow on artificial media

Answer 21

Mycoplasma

Question 22

Superior, middle and inferior rectal veins drain?

Answer 22

Superior -inferior mesenteric ( portal circulation), middle and inferior to internal iliac and internal pudendal => systemic

Question 23

What is isopreterenol

Answer 23

Beta 1=Beta 2 agonist. Causes both increased contractility and vasodilation (Decreased peripheral resistance)