UWorld Test 5/24/2014

Question 1

Reassorment is? happens between?

Answer 1

Mixing of segment genetic material between segmented viruses

Question 2

Recombination?

Answer 2

Gene exchange that involves crossing over between two double stranded DNA molecules.

Question 3

Narcolepsy characterized by? Etiology?

Answer 3

Excessive daytime sleepiness, hypnagogic or hypnapompic hallucinations, nocturnal/narcoleptic sleep episodes, cataplexy loss of all muscle tone in some patients). Due to decreased production of orexin from lateral hyptohalamus

Question 4

Tx for narcoplepsy

Answer 4

Modafinil (non-amphetamine stimulant), amphetamines in the daytime , sodium oxybate for nighttime

Question 5

Classic triad of reactive arthritis?

Answer 5

Non-gonococcal urethritis, anterior uveitis/conjuctivitis, arthritis. Most common cause of asymmetric inflammatory arthritis in young males.

Question 6

Reactive arthritis occurs after? Causes what in 20% of patients

Answer 6

Several weeks after GU (non-gonoccoal urethritis) or GI (bacterial enteritis) infection. Belongs to group of seronegative arthropathies. Sacroilitias.

Question 7

What drugs are effective against pseudonomas

Answer 7

Few specific penicillins (ticarcillin, piperacillin), cephalosporins (ceftazidime, cefepime). Some aminoglycosides (amikacin, gentamicin, tobramycin), fluoroquinolones (ciprofloxacin, levovofloxacin), and carabanepams (impinem, meropenem), monobactams (aztreonam) are also effective.

Question 8

Burkitt lymphoma is what translocation? What does it results in?

Answer 8

t(8;14) - translocation of c-myc (8) to heavy chain (14). Results in overexpression of c-myc - cell growth, differentiation, proliferation

Question 9

Psamomma bodies are found in?

Answer 9

Core of dense calficiation with surrounding collagen bundle fibers. Found in 1) meningiomas (slow growing, well circumscribed benign tumors) 2) thryoid papillary carcinoma 3) serous papillary ovarian adenocarcinoma

Question 10

Patient with signs of renal failure and toe gangrene or livedo reticularis (mottled vascular pattern) following invasive vascular procedure like has what? Light microscopy shows?

Answer 10

Atheroembolic renal disease. Light microscopy shows choleserol emboli (cholesterol crystals) blocking the renal arterioles

Question 11

Synpatophysin stain, GFAP stains?

Answer 11

Synpatophysin - protein found in neurons, neuroectoderm, neuroectodermal tumors. CNS of neuronal origin stain + for synaptophysin. Neoplasms of GLIAL origin stain + for GFAP - astrocytomas, ependymomas, oligodendrogliomas

Question 12

What are the short, mid, long acting benzodiazepines? Which ones have an increased risk for daytime drowsiness/falling?

Answer 12

Short: Alprazolam, triazolam, oxazepam Medium: Estrazolam, lorazepam, temazepam. Long: Chlordiazepoxide, diazepam, flurazepam. Long acting causes more severe daytime drowsiness and high risk of falling

Question 13

Schizoaffective disorder criteria

Answer 13

Psychosis must occur in the ABSENCE of mood symptoms but must have mood symptoms for most of the illness. FA: at least 2 weeks of stable mood with psychotic symptoms plus a major depressive manic or both episode. 2 subtypes: bipolar/depressive

Question 14

Elderly patients are at risk of what after an influenza infection?

Answer 14

Secondary bacterial pneumonia. Most common agents: 1) Strep pneumo 2) Staph aureus 3) H Influenza

Question 15

What is dobutamine

Answer 15

Sympathomimetic. Beta1 receptor > beta2, and alpha receptor. Increases cardiac contractility (increased CO and decreased ventricular filling pressure) , increases HR, cardiac conduction velocity => increased O2 consumption

Question 16

Pulmonary lung abscesses with suppruative destruction of lung parenchyma due to?

Answer 16

Release of lysosomal enzymes by neutrophils and macrophages.

Question 17

What veins join to form the braciocephalic vein

Answer 17

Subclavian and Internal jugular. On the right side, the right thoracic duct drains into the right braciocephalic vein.

Question 18

Obstruction of braciocephalic vein vs superior vena cava

Answer 18

Braciocephalic vein obstruction - uniliateral swelling sx. Superior vena cava - bilateral symptoms

Question 19

What is Leuprolide? Effects on testosterone and DHT?

Answer 19

GnRH analog. Concordant increase and then decrease in testosterone and DHT levels.

Question 20

What is heteroplasmy?

Answer 20

Presence of both normal and mutated mt DNA in an individual cell. Degree of disease depends on the ratio of normal to mutated mtDNA.

Question 21

Caudal regression syndrome is characterized by? Due to?

Answer 21

Uncontrolled maternal diabetes. Sacral agenesis, lower extremity paralysis, and urinary incontinence. Dorslflexed contractures of the feet

Question 22

What are the JG cells, where are they located. What happens to them in chronic renal hypoperfusion

Answer 22

Modified smooth muscle cells of the afferent arterial that synthesize and secrete renin. They undergo hypertrophy and hyperplasia

Question 23

How does increased cAMP cause smooth muscle relaxation?

Answer 23

Usually in smooth muscle contraction, activated myosin light chain kinase phosphrylates Myosin-Action to Myosin-p-Actin=> contraction. Increased cAMP INHIBITS myosin light chain kinase, thereby INHIBITING contraction

Question 24

What is ipratropium

Answer 24

Anti-muscarinic which inhibits bronchoconstriction

Question 25

What is N meningitidis’ virulence factor?

Answer 25

Lipo-oligosaccharide (like gram negative LPS)

Question 26

5-10% of patients who receive IV acyclovir can develop what? Prevent with what?

Answer 26

Nephrotoxicity. When acyclovir concentration in the collecting duct exceeds its solubility, cyrstallization, crystaluria, and renal tubular damage may result. Aggressive hydration

Question 27

What presents in von Hippel Landau disease? What kind of inheritance

Answer 27

Cavernous hemangiomas in skin, organs, mucosa; congenital cysts/neoplasms of kidney, pancreas, liver; (bilateral) renal cell carcinoma, and HEMANGIOBLASTOMAS in retina, cerebellum, brain stem; pheochromocytomas. A/D.

Question 28

What is Osler Weber Rendu Syndrome

Answer 28

Hereditary hemorrhagic telangiectasia - inherited disorder of blood vessels. Telangiectasia, recurrent epistaxis, skin discolorations, AVMs, BI bleeding, hematuria

Question 29

Isosorbide mononitrate has what pharmacokinetic property?

Answer 29

Active metabolite of isosorbide dinatrate. Has 100% bioavailability after PO route, unlike nitroglycerin and isosorbide dinatrate which undergo considerable first pass metabolism

Question 30

Extended consumption of appetite suppressants (what are examples?) leads to what?

Answer 30

Examples: fenfluramine, phentermine is a/w increased pulmonary hypertension, leading to right ventricular hypertrophy

Question 31

Pantothenic acid ‘s active form is what

Answer 31

Coenzyme A