UWorld Tests 6/2/2014 Flashcards
What is a rare neurologic complication of measles?
Subacute sclerosing encephalitis. Thought to be a strain of measles that does not that the antigen M protein, therefore antibodies doesn’t effectively clear it. Antibodies to the M protein in titers are missing. There are high titers of antibodies to measles and oligoclonal bands of immunoglobulins
What is the most common tumor of the urinary tract system? PPT?
Transitional cell carcinoma. Peak incidence in 7th/8th decade of life with increased incidence in men over women. PAINLESS hematuria with no casts.
RFs for transition cell carcinoma
These can affect your P SAC- Phenacetin use, smoking, aniline dyes, cyclophosphamide. Increased risk with exposure to RUBBER??
What can lead to bilateral wedge shaped bands of necrosis over the cerebral convexity?
Cerebral hypoperfusion - for example, after an MI - leads to infarcts in the watershed areas.
Kidney embryology - short sequence
Urogenital ridge formed by the mesoderm => neprhogenic cord. Proneprhos - completely regresses by weak 4; mesonephros - interim kidney in 1st semester - gives rise to wolffian duct; true kidnecy coems from metanephros. Ureteric bud sprouts off caudal mesonephric duct => penetrates intermediate mesoderm and incudes it to form metanephric mesoderm. Ureteric bud => collecting system i.e., ureters, calyxes, pelvis, collecting duct, Metanephric blaster => glomeruli through DCT.
Friedrich’s ataxia affects NS how?
Causes spinocerebellar tract degeneration causing ataxia, also degeneration of dorsal columns and dorsal root ganglia causing loss of position and vibration sense.
Most dangerous side effect for Amphotericin B. What can ensue?
Nephrotoxicity. Anemia and electroylte imbalances. Hypokalemia=> weakness and arrythmias, T wave flattening, ST segment depression, prominent U waves, premature atrial and ventricular contractions. Profound hypokalemia => v tach/ a fib
Hyperaldosteronism can cause (primary conn) can cause what?
Causes hypkalemia and metabolic alklaosis, causing muscle weakness and paresthesias.
How do you calculate attributable risk
AR = event rate in treatment group - event rate in placebo group. (ATP)
Transmural inflammation of the arteries + fibrinoid necrosis..think what?
Polyarteritis nodosa
How does polyarteritis nodosa present? What kind of infection is it a/w?
Fever, weight loss, malaise headache, GI symptoms like melena, abdominal pain
PCL and ACL attachments?
PCL posterior tibia to anterior MEDIAL epicondyle of femur. ACL - anterior tibia to anterior LATERAL epicondyle of femur.
Dark color in urine after refusing blood transfusion, think?
Acute hemolytic reaction. Dark color from the hemoglobin
KNOW THE DIFFERENCE BETWEEN GP41 AND GP120
Gp120 is the big flower type looking thing compared to the skinny stalk. 120 = bigger number = big flower thing
MOA of enfuvirtide and maraviroc?
Enfuvirtide => binds gp41 inhibiting viral fusion and entry. Maraviroc = binds CCR5 on T cells/monocytes, inhibiting interaction with gp120/attachment.
What is maple syrup urine disease?
Defect in the breakdown of branched chain amino acids due to defect in alpha ketoacid dehydrogenase. Normally gets broken down to acetyl coA but can’t and tissue and serum levels of alpha-ketoacids begin to rise which leads to neurotoxicity
What are the branched chain amino acids?
Leucine, isoleucine and valine
What bacteria lacks peptidoglycan in its cell wall?
Chlamydia. Ureaplasma urealyticum lacks a cell wall entirely
Causes of aortic stenosis
Calficiation, congenital bicuspid valve with calcification, rheumatic heart disease
Aortic stenosis causes what kind of murmur
Harsh crescendo decrescendo systolic murmur heard between the 2nd intercostal space on right, with radiation to the carotids
Treatment for DKA is?
Insulin and normal saline
What does insulin and saline infusion do for DKA?
Insulin => allows glucose to be utilized more => less keton production => less acid production and consequent rise in bicarbonate levels. Insulin also causes K+ to go into cells => drives potassium into cells
Carotid sinus baroreceptors and aortic arch baroreceptors send signals via which nerves
1) glossopharyngeal 2) vagus
In patients with aortic stenosis and concentric LVH, what contributes significantly to ventricular filling?
Atrial contraction. Sudden decrease in pre-load due to afib or something => severe hyopotension
Loss of myocyte contractility occurs how fast? When does ischemic injury become reversible?
Occurs within 60 seconds after the onset of total ischemia. When ischemia lasts less than 30 minutes, reperfusion => restoration of blood flow leads to reversible contractile dysfunction with contractility gradually returning to normal over next several hours/days
Bounding femoral pulses accompanied by head bobbing is characteristic of?
Aortic regurgitation
S3 sound can be accentuated by what position / action?
Lying in left lateral decubitus position and upon exhale. At end of exhale => lung volume smaller, heart is closer to chest wall.
Aortic regurgitation does what to pulse pressure?
Widens pulse pressure
BNP and ANP are elevated in what kind of cardiac disease?
Heart failure. Systolic dysfunction => increaesd volumes => increased ventricle and atria stretch => release of ANP and BNP
What embryological structure gives rise to the superior vena cava
Common cardinal veins
Cardiac tissue conduction velocity, fastest to slowest?
Park at ventricular avenue => purkinje, atrial muscle, ventricles, av node
What are the identifying tests/characteristics for enterococcus?
Gram +, catalase -, gamma hemolytic, able to grown in 6.5% nacl and bile.
2 most common cardiac diseases in Marfan’s?
Mitral valve proloase and cystic medial generation of the aorta
Know the jugular venous pressure curve. Order of events?
Atrial contraction, closure of tricupsid valve, atrial relaxation (as ventricle is contracting), increased venous blood flow, filling ventricle (atria to ventricle) passively
What are the common features of constrictive pericarditis on CT?
Calficiation and thickening of the pericarditis to greater than 4mm
What are the side effects of all nitrates (both short and long acting)
Headaches and cutaneous flushing due to vasodilation
What is the codon that signals initiation of protein synthesis?
AUG
Coffee ground emesis suggests what?
Brisk upper GI bleed = Presecent of blood in the vomit that has been exposed to gastric acid
Which antiarrythmics cause QT prolongation?
IA, and III. Amiodarone is unique in that it is not a/w increased risk for Torsades de Point as the rest are.
