UWorld_4.1

Question 1

Pulmonary consequences of LHF

Answer 1

• ==> fluid accumulation in lungs ==> decreased compliance

Question 2

Serum marker of malignant ovarian tumors

Answer 2

• CA-125

Question 3

b-hCG is elevated in …

Answer 3

• hydatiform mole
• choriocarcinoma
• gestational trophoblastic tumors

Question 4

Primary polydipsia vs. DI

Answer 4

• @ water deprivation
  
  • DI ==> 300-500 urine osm
    
    • neurogenic ==> >50% increase w/DDVAP
    • nephrogenic ==> <50% increase w/DDVAP
  • primary polydipsia ==> >500 urine osm
    
    • <10% increase w/DDVAP

Question 5

Tx of idiopathic pulmonary HTN

Answer 5

Bosentan = endothelin antagonist ==> vasodilation @ pulm. artery

Question 6

Gut ulcer location that is least likely to be assoc. with cancer

Answer 6

duodenal

Question 7

Cells & cytokines involved in granuloma formation (e.g. @ TB)

Answer 7

• macrophages ==> IL-12 & TNF-alpha
• IL-12 ==> T_H1 formation ==> INF-gamma

Question 8

Sotalol: MOA, SE

Answer 8

• MOA
  
  • K+ channel blocker
  • • mild B-blocker effects
  • Class 3 anti-arrhythmic
    
    • amiodarone
    • ibutilide
    • dofetilide
• SE
  
  • mild bradychardia
  • prolonged QT interval

Question 9

Gout crystal composition/description

Answer 9

• monosodium urate crystals
• needle shaped/long
• negatively birefringent under polarized light

Question 10

Pseudogout crystals

Answer 10

• calcium pyrophasphate

Question 11

First-line drug for benign essential tremor + SE

Answer 11

• Primidone ==> active metabolites = phenobarbitol (+ phenylethylmalonimide) ==> anticonvulsant effects
• must monitor levels ==> AMS, sedations

Question 12

Ezyme decreased & Enzyme elevated in L-N syndrome

Answer 12

• X-linked deficiency in HGPRT = part of purine salvage pathway
• ==> increased de novo purine synth ==> increased PRPP amidotransferase

Question 13

CFTR channel type

Answer 13

ATP-activate chloride channel

Question 14

Fructose metabolism in essential fructosuria

Answer 14

• AR; generally asymptomatic; deficiency in fructokinase
  
  • ==> elevated fructose in urine
• Fructose can enter glycolysis by fructose ==> fructose-1-P conversion by hexokinase

Question 15

Lactose characteristics and normal breakdown

Answer 15

• Lactose = disacc = galatactose + glucose
• broken down by lactase (=type of B-galactosidase enzyme) @ brush border epithelial cells ==> galactose & glucose

Question 16

Characteristics of secondary lactase deficiency

Answer 16

• deficiency in lactase (B-galactosidase) due to recent gastroenteritis ==> destruction of epthelial cells
• ==> GI distention, flatulence, diarrhea with lactose consumption

Question 17

Swelling of one arm and one side of face ==> dx?

Answer 17

• obstruction of brachiocephalic vein = drainage of lymph and subclavian
• like SVC blockage, except unilateral

Question 18

Most common cause of hypothyroid + histo appearance

Answer 18

• Hashimoto’s thyroiditis
• mononuclear parencymal infilatrate w/well-developed germinal centers

Question 19

Hyperthyroid sx that does not improve w/beta blockers

Answer 19

exopthalmos = due to fibroblast proliferation and ground substance production

Question 20

Drug that ==> vasodilation + blocks platelet agg. used in PAD

Answer 20

Cilosotazol

Question 21

Signs of reversible injury in cardiac myocytes

Answer 21

• myofibril relaxation
• disaggregation of polysomes (rRNA from mRNA)
• dissaggregation of fibrillar and granular elements of nucleus
  
  • & chromatin clumping
• glycogen loss

Question 22

Signs of irreversible cell injury in cardiac myocytes

Answer 22

• mitchondrial vacuolization (mitochondrial membrane damage)
• plasma membrane damage
• lysosomal membrane damage
• nuclear condensation, fragmentation

Question 23

Common markers of chronic alcohol consumption

Answer 23

• macrocytosis (elevated MCV)
• AST: ALT > 2
• elevated gamma-glutamyl transferase (GGT)

Question 24

Drug to prevent vertical transmission of HIV

Answer 24

• zidovudine = reverse transcriptase inhibitor (AZT)

Question 25

Isoniazid: MOA, resistance

Answer 25

• inhibits mycolic acid formation
• must be processed by mycobacterial catalse-peroxidase to become active
• resistance:
  
  • change mycolic acid structure/isoniazid binding site
  • decreased activity of catalase-peroxidase

Question 26

Congenital Toxoplasmosis infection presentation

Answer 26

• hydrocephalus
• intracranial calcifications
• chorioretinitis