UWorld Test Review 6 Flashcards
7yo M w/ sudden onset of facial swelling 2 hours ago w/o itching or pain other than a sore throat over last 2 days, for which he was given acetaminophen. Pt has had similar episodes before which resolved spontaneously. PE shows non-pitting edema of cheeks, lips, and tongue w/o erythema or tenderness. Dx?
hereditary angioedema: deficiency of C1 inhibitor —> elevated bradykinin (causes vasodilation + increased permeability)
labs show low C4 because C1 cleaves C4
which infectious causes of GI illness do the following pathological findings represent?
a. blunting of villi in duodenum and proximal jejunum
b. extensive colonic mucosal injury with yellow-white adherent layer
c. flask-shaped ulcerations in the cecum and ascending colon
d. foamy macrophages in the small intestinal lamina propria
e. inflammatory infiltrate and necrosis of the Peyer patches
a. blunting of villi in duodenum and proximal jejunum = rotavirus
b. extensive colonic mucosal injury with yellow-white adherent layer = C. diff
c. flask-shaped ulcerations in the cecum and ascending colon = Entamoeba histolytica
d. foamy macrophages in the small intestinal lamina propria = Tropheryma whipplei (Whipple disease)
e. inflammatory infiltrate and necrosis of the Peyer patches = Salmonella typhi
failure of which of the following describes the cause of spina bifida occulta?
a. anterior neural tube closure
b. myelencephalon division
c. neural crest cell migration
d. notochord separation from endoderm
e. vertebral arch fusion
e. vertebral arch fusion
how can you differentiate PCP (phencyclidine) vs methamphetamine intoxication?
PCP (hallucinogen): violent behavior, hallucinations, ataxia, nystagmus (horizontal or vertical)
methamphetamine (stimulant): violent behavior, psychosis, tachycardia/HTN, choreiform movements, can last up to 20 hours (much longer)
the intercostal vein, artery, and nerve lie along the [upper/lower] border of the rib
the intercostal vein, artery, and nerve lie along the LOWER border of the rib (just below each rib)
—> thoracentesis is performed along upper board of rib (just above it)
which drug class may cause angioedema due to excess bradykinin?
ACE inhibitors
[ACE is responsible for bradykinin breakdown]
explain the mechanism of insulin release from beta cells (4 steps)
- glucose enters via GLUT-2
- glycolysis produces ATP
- ATP binds K+ channel, causing them to close —> membrane depolarization
- voltage-gated Ca2+ channels open —> inducing insulin release
describe the steps of the Gq pathway (3)
- Gq activates phospholipase C (PLC)
- PLC breaks PIP2 into IP3 + DAG
- DAG stimulates protein kinase C (PKC), while IP3 increases intracellular Ca2+ (also activating PKC)
where in the nephron are uric acid crystals most likely to precipitate and why?
uric acid has pKa of 5.4 - soluble at physiologic pH, but precipitates in acidic environment
distal tubules/collecting duct is most acidic part of the nephron
Vitamin A supplementation can be beneficial in the treatment of _____ infection by reducing comorbidities (ocular, keratitis, diarrhea, pneumonia)
Vitamin A supplementation can be beneficial in the treatment of MEASLES infection by reducing comorbidities (ocular, keratitis, diarrhea, pneumonia)
measles (paramyxovirus) - exanthema rash (blanching, erythematous) starts on face and spreads to trunk/ extremities while sparing palms/soles
cause of epispadias vs hypospadias
epispadias: abnormal opening on DORSAL penis due to faulty positioning of genital tubercle
hypospadias: abnormal opening on VENTRAL penis due to incomplete fusion of the urethral (urogenital) folds
55yo F presents w/ post-menopausal bleeding for the last 6 months. Denies pelvic pain. PMH includes DM2, BMI is 38. Uterus is small and nontender, and there are no palpable adnexal masses. Which of the following is the most likely explanation?
a. autonomous pituitary secretion of prolactin
b. ectopic implantation of endometrial glands and stroma
c. elevated sex-hormone binding globulin levels
d. increased peripheral aromatization of androgens
e. suppression of hypothalamic GnRH secretion
d. increased peripheral aromatization of androgens
dx = endometrial hyperplasia or cancer - most common risk factor is chronic unopposed estrogen and associated with obesity
after menopause, some androgens are still produced, and in obese women, peripheral aromatase (adipose tissue) produces a lot of estrogen
a. autonomous pituitary secretion of prolactin - can cause neg. feedback on hypothalamic GnRH, but would see either galactorrhea or mass effect
b. ectopic implantation of endometrial glands and stroma - painful and requires a very high estrogen (pre-menopausal)
c. elevated sex-hormone binding globulin levels - DECREASE after menopause
e. suppression of hypothalamic GnRH secretion - occurs with caloric restriction (not obese) and does not cause bleeding
most common cause of mitral stenosis
rheumatic fever (99%!!!) - often latency of 10-20 years (4th/5th decade)
14yo F presents w/ primary amenorrhea. Tanner stage 1, blind vaginal pouch. Imaging reveals absence of uterus and fallopian tubes. Epididymis, vasa deferentia, and testes are present bilaterally. Karyotype is 46,XY. What is the most likely mechanism?
a. absent conversion of testosterone to dihydrotestosterone
b. aplasia of fetal Leydig cells
c. complete defect in androgen receptor function
d. inability to convert 17-hydroxyprogesterone to 11-deoxycortisol
e. loss of sex-determining region of the Y chromosome
dx: 5-alpha reductase: a. absent conversion of testosterone to dihydrotestosterone (needed for male external genitalia)
b. aplasia of fetal Leydig cells - Leydig cells secrete testosterone, required for internal male genitalia
c. complete defect in androgen receptor function - internal male genitalia would be absent
d. inability to convert 17-hydroxyprogesterone to 11-deoxycortisol - would have normal male external genitalia
e. loss of sex-determining region of the Y chromosome - would have female internal/external genitalia
what is the function of endothelin 1?
stimulated by angiotensin II, increases Na+ and water reabsorption and SVR to maintain BP
how does insulin (specifically) stimulate glycolysis?
insulin increases production of fructose 2,6-bisphosphate via phosphofructokinase-2 (PFK2)
fructose 2,6-bisphosphate is the most potent stimulator of phosphofructokinase-1 (PFK1) - the rate-limiting step in glycolysis
how is number needed to harm (NNH) calculated?
- find absolute risk increase (ARI) by finding difference in rate (risk) of adverse effects between treatment group and control group (placebo)
- the NNH is the inverse (1/ARI)
rapid onset of _______ lesions is an indicator of internal malignancy (Leser-Trelat sign), especially [type of cancer]
rapid onset of seborrheic keratosis lesions is an indicator of internal malignancy (Leser-Trelat sign), especially gastric adenocarcinoma
what are the leading pathogens causing secondary bacterial pneumonia (for example, following influenza virus) in healthy patients? (3)
- Streptococcus pneumoniae
- Staphylococcus aureus - esp. younger patients
- Haemophilus influenzae
loss of sensation in perineal area (saddle anesthesia) indicates…
cauda equina syndrome: commonly due to epidural cord compression from malignancy
causes urinary and fecal incontinence late in disease course
lower extremity purpura (buttocks + legs) + colicky abdominal pain + hematuria (renal disease) + joint pain =
Henoch-Schonlein purpura: IgA-mediated vasculitis, often follows URI
Industrial worker presents w/ rapid-onset SOB, dizziness, palpitations, and flushed skin. Pt is tachypneic and has reddish skin without cyanosis. Pt is treated with hydroxocobalamin. What were they exposed to, and what is the purpose of this treatment?
cyanide poisoning - blocks ETC because CN- binds ferric ion (Fe3+) in cytochrome c oxidase with high affinity
tx:
1. sodium thiosulfate: forms thiocyanate for excretion
2. hydroxocobalamin: forms cyanocobalamin for excretion
3. sodium nitrite: nitrites promote formation of methemoglobin, which binds CN- with greater affinity than cytochrome c oxidase
what is the tx (2) for congenital toxoplasmosis? how do these drugs work?
sulfadiazine + pyrimethamine
work synergistically to inhibit protozoal DNA synthesis by blocking subsequent steps in formation of tetrahydrofolate (THF) - cofactor required for purine synthesis
[sulfadiazine inhibits dihydropteroate synthase; pyrimethamine inhibits dihydrofolate reductase]
name 2 complications of incomplete obliteration of the processes vaginalis
- communicating hydrocele
- indirect inguinal hernia
Pt presents with pain in shoulders, hips, and proximal extremities. Labs show elevated erythrocyte sedimentation rate, but x-rays are normal. Dx?
polymyalgia rheumatica
what do labs show in Paget disease of bone?
Paget disease of bone: excessive and disordered bone formation commonly affecting the skull, long bones, vertebral column —> spinal stenosis, nerve compression, compression fracture
Labs show elevated serum alkaline phosphatase, but normal serum calcium and phosphorus levels due to changes occurring slowly
Radiographs show lytic or mixed lytic – sclerotic lesions, thickening of cortical and trabecular bone, bony deformities
Which three UTI bacteria produce nitrites?
- E. coli
- Klebsiella
- Proteus
produce nitrate reductase - reduces normal urinary nitrate (NO3-) to nitrite (NO2-)
what do Abs to the following antigens represent?
a. centromeres
b. dsDNA
c. Fc portion of IgG
d. mitochondrial components
e. nuclear basic proteins
f. phospholipid-binding proteins
g. sheep erythrocytes
a. centromeres - CREST
b. dsDNA - SLE
c. Fc portion of IgG = rheumatoid factor (IgM)
d. mitochondrial components - primary biliary cholangitis
e. nuclear basic proteins (antinuclear) - nonspecific finding in many connective tissue disorders
f. phospholipid-binding proteins (beta2 glycoprotein I) - SLE and antiphospholipid syndrome
g. sheep erythrocytes (heterophile Abs) - EBV infection (Monospot test)
what is the function of the nigrostriatal pathway?
projects from substantia nigra to the caudate nucleus and putamen and primarily regulates the coordination of voluntary movements
D2 receptor blockade in this pathway results in extra-pyramidal effects (dystonia, akathisia, tardive dyskinesia) and drug-induced parkinsonism
Which two cytokines might tumor cells increase production of two evade immune response?
- IL-10
- TGF-beta
both are immunoinhibitory
which 3 bacteria should come to mind for patients with cystic fibrosis?
- Haemophilus influenzae
- Staphylococcus aureus
- Pseudomonas aeruginosa - adults
which cell types are heavily involved in the pathology of centriacinar emphysema?
centriacinar emphysema: associated with chronic/heavy smoking, caused by release of proteases (esp. elastase) from infiltrating neutrophils + alveolar macrophages
contrast the 2 disorders of phenylalanine metabolism
phenylketonuria (PKU): deficiency of phenylalanine hydroxylase (converts phenylalanine —> tyrosine) —> neuro abnormalities + hypopigmentation + musty odor; tx = restrict phenylalanine + give tyrosine
BH4 deficiency: deficiency of dihydropteridine reductase (regenerates BH4, needed for rxns involving phenylalanine, tyrosine, tryptophan) —> elevated phenylalanine (same symptoms as above) + low dopamine/epinephrine/serotonin; tx = restrict phenylalanine + give BH4
Gram neg. non-lactose-fermenting, nonmotile, rod-shaped =
Shigella
name 2 low potency and 2 high potency first-gen. antipsychotics
low potency (non-neurological): chlorpromazine, thioridazine
[side effects due to histaminergic/cholinergic/alpha1 blockade]
high potency (neurological): haloperidol, fluphenazine
[side effects due to extrapyramidal symptoms]
how do sulfonylureas work?
inhibit ATP-sensitive K+ channel on pancreatic beta cell membrane —> induce depolarization and Ca2+ influx, followed by insulin release independent of blood glucose concentration
therefore, sulfonylureas can cause hypoglycemia because they stimulate insulin secretion even when blood glucose is normal
which muscles does the mandibular nerve (CN V3) supply?
- muscles of mastication - medial and lateral pterygoid, masseter, temporalis
- tensor veli palatini
- tensor tympani (middle ear, dampens loud sounds by tensing tympanic membrane)
which 3 metabolic pathways occur in the cytosol, and which 3 occur in the mitochondria?
cytosol: glycolysis + fatty acid synthesis + PPP
mitochondria: beta-oxidation + TCA + gluconeogenesis
describe the pathogenesis and associations with hypertrophic osteoarthropathy?
painful bone/ soft tissue enlargement in distal extremities —> clubbing, joint pain, periostosis (tender thickening of periosteum)
disruption of normal pulmonary circulation leads to AV shunting —> megakaryocytes bypass lungs into systemic circulation and lodge in peripheral tissues —> release PDGF/VEGF —> fibrovascular hyperplasia and abnormal bone formation
associated w/ lung adenocarcinoma, cystic fibrosis, bronchiectasis, lung abscess, cyanotic heart disease
which of the following may present with regular, heavy menses? (2)
a. adenomyosis
b. chronic endometritis
c. complete hydatidiform mole
d. endometriosis
e. uterine leiomyoma
f. uterine sarcoma
a. adenomyosis and e. uterine leiomyoma
b. chronic endometritis - irregular bleeding
c. complete hydatidiform mole - amenorrhea or irregular first-trimester bleeding
d. endometriosis - no heavy menses (extra-uterine implants)
f. uterine sarcoma - irregular, postmenopausal bleeding
differential cyanosis (cyanosis affecting only lower body) suggests…
… right to left shunting across patent ductus arteriosus (PDA)
which cytokine is an important driver of the severity of giant cell arteritis?
IL-6 - promotes vessel damage and remodeling (intimal hyperplasia)
can target w/ tocilizumab