UWorld_3.27

Question 1

Characteristics of restrictive lung disease

Answer 1

-decreased lung volumes -increased FEV1 due to increased elastic recoil (decreased compliance) & increased radial traction by fibrotic lung

Question 2

Cells contained in TB granulomas

Answer 2

epithelial macrophages w/pale pink granular cytoplasm CD14 = cell marker

Question 3

Structures @ retroperitoneum

Answer 3

1. vessels: abdominal aorta, IVC + branches 2. solid organs: pancreas (except tail), kidneys, adrenal glands 3. hollow organs: segment 2,3, and part of 4 of duodenum + asc/desc colon + rectum, ureters, bladder 4. vertebrae and pelvic m.

Question 4

Histo description of Burkitt’s

Answer 4

-medium-sized tumor cells (lymphocytes) -basophillic cytoplasm -proliferation fraction (Ki67 fraction) > 99%

Question 5

Cause of warfarin skin necrosis

Answer 5

-Protein C deficiency -Protein C = natural anticoag completely depleted protein C ==> hypercoag state ==> thrombi @ microvasculature ==> skin necrosis

Question 6

Characteristics of Criggler-Najar

Answer 6

-disruption in uncoj. bilirubin metabolism @ liver due to lack of UGT enzyme -UGT normally conjugates bilirubin with glucuronic acid - ==> unconjugated hyperbilirubinemia - unconj. bili bound to albumin ==> unable to be excreted by kidney ==> deposition in tissue - ==> brain deposition = kernicterus ==> severe jaundice, encephalopathy w/m. rigidity, seizures, lethargy ==> death

Question 7

Molecules that increase insulin resistance in overweight individuals

Answer 7

-FFA -serum triglycerides

Question 8

beta hydroxybutyrate =

Answer 8

-marker of insulin deficiency -present in DM1

Question 9

Molecular mechanism of chemical interference with insulin receptor response

Answer 9

-**phosphorylation of serine and threonine residues** ==> decreased activity of insulin receptor ==> insulin resistance -e.g. TNF-a ; glucocorticoids; catecholamines; glucagon; FFA

Question 10

High ethanol intake impact on glucose metabolism

Answer 10

-hypoglycemia + elevated intracell NADH ==> ethanol is being used as NRG source and gluconeo is inhibited -ethanol catabolism ==> production of NADH ==> favor conversion of pyruvate=>lactate and OAA=>malate -since OAA and pyruvate are gluconeogen intermediates; conversion to other molecules inhibits gluconeogen

Question 11

High vs. low potency antipsychotics

Answer 11

high = fluphenazine, haloperidol low = chlorpromazine, thioridazine

Question 12

Class of anti-arrhythmics that show “use-dependence” + example

Answer 12

-class I anti-arrhymics (Na-cahnnel blockers) -IC = strongest association w/Na; slow to leave ==> prolonged QRS, but no effect on overall AP ==> normal QT

Question 13

Carbamazepime: MOA, use, SE

Answer 13

-MOA = blocks VSSC @ neurons -use = partial, partial complex, gen TC seizures + mood stabilizer -SE = bone marrow suppression

Question 14

pleural thickening + calcifications @ lower lobes + small pleural effusion ==> dx?

Answer 14

abestosis

Question 15

coal pneumo problems ==>

Answer 15

multiple discrete nodules @ upper lobes

Question 16

silicon imapct @ pulm ==>

Answer 16

nodular densities + eggshell calcifications @ hilar nodes

Question 17

pulmonary berylliuosus ==>

Answer 17

~sarcoidosis: non-caseating granulomas, enlarged hilar lymph, nodular infiltrates

Question 18

Gq receptor pathway

Answer 18

1. binding ==> phospholipase C converts mem. phospho ==> IP3 & DAG 2. IP3 ==> increased Ca release from SR 3. Ca + DAG activate PKC 4. PKC phosphorylates 2nd mess ==> downstream effects

Question 19

Burr cells and helmet cells indicate…?

Answer 19

mechanical/traumatic hemolysis; e.g. prosthetic valve

Question 20

Ethambutol SE

Answer 20

optic neuritis, color blindness ,etc.

Question 21

Location of absent ganglia in hirschprung

Answer 21

-narrowed rectum/rectosigmoid = lack autonomic -lack submucosa (meissner) and myenteric (auerbach) -ganglia will be absent in submucosal layer

Question 22

Nitrate with highest bioavailability

Answer 22

isosorbide mononitrate

Question 23

Neonatal complications of maternal DM during preg.

Answer 23

1. premature delivery 2. fetal macrosomia 3. congenital malformations: NTDs, CV, caudal regression 4. respiratory distress 5. transient hypoglycemia 6. polycythemia and hyperviscosity

Question 24

Complications of pre-eclampsi

Answer 24

-DIC -acute fatty liver -ATN -HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet count) ==> eclampsia = seizures

Question 25

Location/risks assoc. with BRCA-1/BRCA-2 genes

Answer 25

-both = tumor suppressor genes -BRCA-1 @ chr. 17 ==> increased risk of breast + ovarian -BRCA-2 @ chr. 13 ==> increased risk of breast cancer

Question 26

Structures @ risk in total abdominal hysterectomy

Answer 26

-ureters = contained w/in broad ligament and run just posterior to uterine arteries -==> post-surgical acute renal failure