UWorldTests 5/29/2014

Question 1

What is ARDS? What is the pathophys? What does chest xray/histo look like?

Answer 1

ARDS can be caused by trauma, sepsis, shock, acute pancreatitis, or amnionitic fluid embolism. Diffuse alveolar damage, pulmonary edema, NORMAL left atrial pressure (PCWP) and PaO2/FiO2 leakage of fluid rich exudate into alveoli that gets filled => respiratory distress. Xray - near complete opacification of the lungs. Histo: thickened hyaline membranes. => proliferative stage => somtimes, final fibrotic stage

Question 2

What is globus hystericus?

Answer 2

Sensation of “lump in throat” common. Emotions commonly trigger globus hystericus. No physical, endscopic, barium swallow findings.

Question 3

What is anaplasia?

Answer 3

Loss of structural function and differentiion of cells. Often equated with undifferentiated malignant neoplasms. IRREVERSIBLE process.

Question 4

What is DNA laddering?

Answer 4

Process that occurs in apoptosis. Sensitive indicator of apoptosis. Basically DNA endonucleases cleave DNA at nucleosomal linker regions leading to 180kb base pair fragments. Equal separation on gel gives ladder appearance.

Question 5

Germline mosaicism should be considered when?

Answer 5

genetic mutation is identified in offspring but not in parents. Germline mosaicism - presence of 2 or more genetically different cell lines. Can be somatic or gametes or both.

Question 6

Diabetes patients should do what on a daily basis?

Answer 6

Daily foot inspection

Question 7

What is the primary concern in anterior and posterior dislocations of the knee joint?

Answer 7

Popliteal artery (above tibial nerve). Present deep into the popliteal fossa and fixed rigidly both distally and proximally to the knee joint by the soleus nand adductor magnus.

Question 8

What is endometritis? When does it commonly occur? Sx. Tx?

Answer 8

Inflammation fo the endometrium due to retained products of conception following delivery/vaginal birth/ C section/ IUD. Foul smelling discharge, fever uterine tenderness, leukocytosis. Retained material gets inflected from intestinal and vaginal flora. bacteroides is most commonly isolated: Tx: gentamicin + clindamycin with or without ampicillin

Question 9

What happens to GFR values immediately after heminephrectomy and 6 week after surgery?

Answer 9

Immediately after: 50%, Within weeks, remaining kidney undergoes hemodynamic and structural adaptations to increase overall GFR to around 80%.

Question 10

What is a craniopharyngioma? What does it cause – leads to confusion about dx? Where does it commonly occur? Derived from? Also commonly occurs when?

Answer 10

Benign childhood tummor. Derived from remnants of Rathke’s pouch (which gives rise to adenohypophysis). Most common supratentorial tumor. Often causes hemianopsia – leading to confusion about it being a pituitary adenoma. Calcification is common (tooth enamel like?). Also comonly prsents 2nd/3rd decaide of life with headahces, visual problems

Question 11

Acute stress disorder vs PTSD?

Answer 11

PTSD more than 4 weeks. Acute stress disorder less than. Causes same symptoms

Question 12

Dx for schizophrenia vs schizoprheniform?

Answer 12

Have 2 or more of the following 1) delusions 2) hallucinations 3) disorganized speech 4) disorganized behavior 5) negative symptoms like flat affect, social withdrawal, lack of motivation, lack of speech or thought. Schizophrenia>6 months schizophreniform 1-6 months

Question 13

What is the most common viral encephalitis? Has predliction for? Sx?

Answer 13

Herpes. Predliection for temporal lobes. Typical encephalitis sx like fever, headache , seizures, altered level of consciousness/coma. But also more specific to herpes: personality changes, olfactory hallucinations, anosmia, delirium, aphasia, hemiparesis

Question 14

Acute intermittent porphryia is due to?

Answer 14

AD defect in hydroxymethylbilane synthesis which converts porphobilinogen to hydroxymethlbilane. Deficiency causes elevated levels of porphobilinogen and ALA. Causes abdominal pain, urine turns dark on standing

Question 15

Porphyria cutanea tarda caused by?

Answer 15

Defect in uro decarboxylate that converts uroporphyrinogen to coproporhyrinogen III

Question 16

Exudation vs transudation occurs normally in? Lab findings?

Answer 16

Exudation = in setting of infection, malignancy, or others. Transudation = from CHF. Exudate protein effusion /protein serium > 0.5, exudate LDH/serum LDH > 0.5 transudate lackes these features

Question 17

What is the primary site for hemolysis in patients with hereditary spherocytosis? Tx improves what

Answer 17

Spleen. Splenectomy => improves anemia (because no longer undering hemolysis), reduces gallstone incidence, reduces jaundice

Question 18

What are the two tissues that secrete biarcarbonate rich fluid in response to stimulation?

Answer 18

Pancreas and biliary epithelia in response to secretin.

Question 19

Describe bicarb and chloride levels in pancreatic secretion

Answer 19

Increased bicarb secreted, Chloride taken in

Question 20

Classic anticholinergic syndrome?

Answer 20

Hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter

Question 21

Common anticholinergics?

Answer 21

Atropine, TCAs, Antipsychotics, antihistamines

Question 22

Myelodysplastic syndrome vs. myelofibrosis?

Answer 22

myelodisplastic syndrome = ineffective hematopoiesis due to stem cell disorder => defects in cell maturation of all non-lymhphoid cell lines. Caused by de novo mutations or environemtnal exposure. In myelofibrosis - fibrotic replacement of bone marrow => atypical megakaryocytes and massive splenomegaly due to extramedullary hematopoeisis.

Question 23

What kind of hematologic disorders do you find in Lupus

Answer 23

Can have pancytopenia due to antibodies against RBCs (warm IgGs). Can also get neutropenia and decreased platelets. Type 2 hypersensitivity reaction

Question 24

Translocation for follicular lymphoma

Answer 24

Adults. T(14;18) - translocation of heavy chain 14 (14) to bcl-2. “waxing and waning” ppt. overexpression anti-apoptotic Bcl2

Question 25

What is the most common benign liver tumor? What does it look like microscopically?

Answer 25

Cavernous hemangioma. Lots of cavernous blood filled vascular spaces of different sizes lined with a SINGLE layer of epithelium. Biopsy not advisable due to possible fatal hemorrhage

Question 26

What catalyzes the rate limiting step of bile synthesis

Answer 26

Cholesterol 7 alpha hydroxylase

Question 27

How is estrogen related to cholesterol levels. How are fibrates related to gallstones?

Answer 27

Increased estrogen => increased cholesterol synthesis by upregulation of HmG-CoA reductase. Fibrates suppress cholesteral alpha hydroxylase which is the final step of bile acid synthesis. Increased levels of cholesterol promotes gallstone formation

Question 28

What is PT, pTT, bleeding time and platelet count in patients with uremia (ppt as ESRD on dialysis)

Answer 28

Everything normal besides bleeding time which is elevated.

Question 29

Brown pigment stones usually due to?

Answer 29

Infection to biliary tract which results in release of beta-glucuronidase from injured hepatocytes. These break down bilirubin glucuronides into unconjugated bilirubin in the bile