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UWORLD Q REVIEWS > WEEK 7 > Flashcards

WEEK 7 Flashcards

1
Q

Inguinal hernias: Population/location/failure of what process
Indirect
Direct
Femoral

A

Indirect: make infants/inguinal canal, follows spermatic cord/ failure of inguinal ring to close

Direct: Older males/medial to femoral vessels/ weakness of transversalis fascia

Femoral: Female/Inferior to inguinal ligament/widening of femoral ring

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2
Q

Lynch syndrome Pathology?

A

AD. Abnormal nucleotide mismatch repair

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3
Q

Leptin ___ satiety? Via these 2 methods?

A

Increases via 2 methods.
Decrease levels of Neuropeptide Y (an appetite stimulant
Increase alpha-MSH (increasing satiety)

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4
Q

What drains into the superficial inguinal nodes?

A

Most of the cutaneous lymph from the umbilicus down including anus below dentate line). EXCEPT - glans penis and posterior calf -> drain to inguinal nodes.

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5
Q

Histology of GERD?

A

Basal cell hyperplasia & papillae elongation and scattered eosinophils

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6
Q

Gastric varices can be seen with splenic vein thrombosis due to ?

A

Chronic pancreatitis, pancreatic cancer and abdominal tumors.

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7
Q

Splenic vein thrombosis can lead to varices in these vessels?

A

Short gastric veins. Will px at gastric varices only in the fundus

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8
Q

What are the types of neoplastic polyps that have malignancy potential?

A

Adenomatous and serrated

Non neoplastic- hyperplastic, inflammatory, juvenile & submucuosal

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9
Q

What is the most indicative feature that correlates with malignancy risk?

A

Increasing polyp size

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10
Q

Ulcers in the lesser curvature often affect these arteries?

A

L. gastric a.

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11
Q

Patients with sclerosis (impaired peristalsis) are at risk for?

What does this lead to?

A

Small intestinal bacterial overgrowth.

Leads to deconjugation of bile acids (less time for fat emulsification), mucosal inflammation and carbohydrate fermentation.

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12
Q

How does H.pylori lead to duodenal ulcers?

A

Increased gastric acid secretion and destruction of somatostatin cells in ANTRUM (H. pylori colonize this location in duodenal ulcers).

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13
Q

How does H. pylori lead to gastric ulcers?

A

H. pylori colonize the gastric body-> destroy parietal cells -> bacterial products directly damage mucuosa + inflammation -> ulcer.

**associated with metaplasia and malignancies.

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14
Q

the spleen is a derivative of?

A

Mesoderm

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15
Q

What 2 features make the liver susceptible to metastasis?

A

The liver is fed by the portal and systemic circulation

Fenestrated hepatic sinusoids that allow tumor cells easily pass from the bloodstream into the lover parenchyma.

**colon cancer is most common

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16
Q

Anti smooth muscle auto antibodies is highly specific for?

A

Autoimmune hepatitis

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17
Q

Recurrent sinopulmonary infections and congenital absence of the vas deferens are consistent with?

A

Cystic fibrosis

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18
Q

R. colon cancer often grow as ___ masses? An px with what features?

A

Exophytic

Iron deficiency anemia (occult bleeding)

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19
Q

Studies have linked increased activity of COX to some forms of _____ cancer.

A

Colon adenocarcinoma

** Regular NSAID use may be protective

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20
Q

How would a glucagonama present?

A

Necrolytic migratory erythema. DB. Erythematous lesions that enlarge and coalesce, GI symptoms.

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21
Q

Calcium sensing proteins are G_ protein couples.

Defect of CaSR is known as?

A

G-Q protein coupled

Familial hypocalciuric hypercalcemia

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22
Q

Damage to the ___ causes transient Diabetes Insipidus.

Damage to the ___ causes permanent Diabetes Insipidus?

A

Pituitary gland

Hypothalamus

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23
Q

A deficiency in lipoprotein lipase will lead to ____ syndrome?

Major risk of developing?

A

Familial chylomicronemia

Acute pancreatitis

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24
Q

Adrenal insufficiency will lead to what acid base disorder?

A

Non anion gap metabolic acidosis.

Decr Na -> Increase K & H -> low HCO3 -> compensatory Inc in Cl

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25
Q

What hormones utilize the Gs messenger system?

A

TSH, glucagon and PTH

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26
Q

Destruction of B-cells in T1D is due to which type of immunity? Cellular or humoral?

A

Cell mediated response

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27
Q

Pathology of Hartnup disease?

A

Inability to reabsorb neutral AA from Proximal tubule -> deficiency of tryptophan -> deficiency of Niacin -> pellagra.

Confirmed through neutral AA in urine.

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28
Q

Deficiency of Acyl-Coa is called?

A

MCAD deficiency aka hypoketototic hypoglycemia (unable to perform B-oxidation) in times of fasting.

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29
Q

In maple syrup disease which AA are absent?

What cofactors are needed for branched chain alpha-ketoacid dehydrogenase to function?

A

Branched AA - Isoleucine, Leucine and Valine

Tender loving care for Nancy; Thiamine, Lipoate, Coenzyme A, FAD, NAD.

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30
Q

Glycogenolysios is the main source of glucose in the first __ hours of fasting?

A

12-18 hours

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31
Q

Infection with HSV leads to lifelong latent infection of the ____ ganglion and leads to symptoms that _____ over time?

A

Sensory ganglion

Flare and resolve over time.

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32
Q

Pheochromocytoma is a tumor arising from ____ cells. It stains positive for?

A

Synpatophysin, chromogranin and neuron specific enolase.

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33
Q

What is the monoclonal antibody used in the tx of post menopausal osteoporosis that works in a manner similar to OPG?

A

Denosumab

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34
Q

Impairment of this process in Parkinson & Alzheimers (degenerative diseases) can lead to their symptoms?

A

Ubiquitination

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35
Q

3 stages of bordetella pertussis?

A

Catarrhal, Paroxysmal (cough) & coalescent stage

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36
Q

Lymph drainage from testes?

Scrotum?

A

Paraaortic LN

Superficial inguinal LN

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37
Q

Next best step (most sensitive) for assessing for impaired nutrient absorption in patients?

A

Stool microscopy with Sudan III stain (check for fat malabsorption)

Fat is usually the most severely affected nutrient in generalized malabsorption.

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38
Q

VHL is caused by ____ mutation.

A

Loss of function (is a tumor suppressor)

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39
Q

How does brown fat create more heat?

A

Uncouple the ETC and Phosphorylation. Proton pumped out by ETC returns to matrix via thermogenin -> heat, not ATP is produced.

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40
Q

Hereditary hemachromotosis is most commonly caused by a _____ mutation

A

Missense

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41
Q

Toxic megacolon is a life threatening complication of this IBD?

A

Ulcerative colitis

pts will px with abd/distension, bloody diarrhea, fever and signs of shock.

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42
Q

Diabetic gastroparesis is a complication of diabetes caused by?

A

Destruction of enteric neurons and loss of cells of cajal (uncoordinated peristalsis).

*will px with delayed gastric emptying (post prandal fullness, regurgitation of undigested food, N/V)

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43
Q

Organisms with IgA protease include?

A

N. meningitis & gonorrhea, S. pneumo & H. influenza.

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44
Q

Organisms with IgA protease infect via this means?

A

Destroy secretory IgA which Inhibit the action of pilli and other surface antigens that mediate adherence.

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45
Q

In a cricothyrotomy, incision passes through there layers?

A

Superficial cervical fascia, pretracheal fascia and cricoid membrane.

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46
Q

What structures cross under the piriformis muscle?

A

Inferior gluteal vessels, internal pudendal vessels and sciatic nerve.

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47
Q

This is the presence of endometrial glandular tissue within the myometrium?

A

Adenomyosis.

Px: with uniform enlargement of the uterus, painful and heavy bleeding.

48
Q

Hyperimmunoglobin M syndrome results from?

A

Defective immunoglobulin class switching due to a defect in CD40L -CD40 interaction.

49
Q

What method can be used to determine the carrier status of a prospective patient with sickle cell?

A

Hemoglobin electrophoresis

50
Q

Rota virus causes diarrhea by?

A

Villous blunting, proliferation of secretory crypts (secretory diarrhea) & loss of brush border enzymes

51
Q

Defective ApoE leads to what condition?

A

Dysbeta-lipoprotenemia

- Defect in clearance of chylomicrons.

52
Q

The most common ligament damaged in ankle sprain damages is?

A

Anterior talofibular ligament

53
Q

Toxic megacolon is a life threatening complication of this IBD?

A

Ulcerative colitis

54
Q

Diabetic gastro paresis is a complication of diabetes caused by?

A

Destruction of enteric neurons.

55
Q

Organisms with IgA protease include?

A

N. meningitidis & gonorrhea, S. pneumo & H. influenza.

56
Q

Organisms with IgA protease infect via this means?

A

Destroy secretory IgA which Inhibit the action of pilli and other surface antigens that mediate adherance.

57
Q

In a cricothyrotomy, incision passes through these layers?

A

Superficial cervical fascia, pretracheal fascia and cricoid membrane.

58
Q

Which areas are considered watershed areas of the colon?

A

Splenic flexure and rectosigmoid junction

59
Q

PCOS is a risk factor for which type of diabetes?

A

T2DM

60
Q

Menotropin - drug that helps in an-ovulation by mimicking?

A

FSH

61
Q

hCg is structurally similar to ___ and can mimic its action

A

LH

62
Q

Pierre Robin is a sequence disorder characterized by?

A

Primary defect (mandibular hypoplasia) leads to cascade of further malformations (micrognathia, post. displaced tongue and u shaped cleft palate)

63
Q

Diabetes during pregnancy leads to this neonatal complication?

A

Transient hypoglycemia

64
Q

Latissimus dorsi is innervated by the ___ nerve?

A

Thoracodorsal N.

65
Q

What role does vitamin C play in the prduction of collagen?

A

Hydroxylation of proline and lysine residues in procollagen

66
Q

Activating mutations involving PRPP (phosphoribosyl pyrophosphate synthethase) leads to?

A

Gout (due to increased production and degradation of purines)

67
Q

These muscles aid in depressing (opening) the mandible?

A

The lateral pterygoids

68
Q

A communicating hydrocele occurs when fluid accumulates in the ___?

A

Tunica vaginalis, often due to a patent processus vaginalis.

69
Q

A communicating hydrocele results when ___ accumulates within the tunical vaginalis and present as?

A

Serous fluid

Painless swelling that illuminates on exam

70
Q

The most cocmmn cause f rotator cuff syndrome?

A

Supraspinatus tendinopathy (gets compressed between the acromion and head of the humerus)

71
Q

Rotator cuff muscles?

A

SITS (supra spinatus, Infraspinatus, teres minor, and subscapularis)

72
Q

PCP is a ____ antagonist?

A

NMDA

**px withe psychosis, severe agitation -> violent. Ataxia and vertical nystagmus, memory loss.

73
Q

Enterocytes respond to low iron levels by?

A

Increasing apical expression of divalent metal transporter (DMT 1) -> increases absorption

74
Q

Hepatocytes respond to low iron levels by?

A

Decreasing hepcidin synthesis -> increased feroportin -> increased iron secretion into circulation

75
Q

Classic triad of increased Iron levels?

A

Micronodular cirrhosis, DB and pigmentation.

Can lead to HCC, CHF and testicular atrophy

76
Q

Loss of epidermal melanocytes leads to ___?

A

Vitiligo

77
Q

How does low estrogen affect bone?

A

Decreased estrogen -> decreased OPG, Increased RANK-L expression and increased RANK expression in osteoclast precursors.

78
Q

Abnormal spams or diminished relaxation of cricopharyngeal m during swallowing leads to?

A

Zenkers diverticulum

79
Q

Pneumococcal conjugate vaccines are strongly immunogenic in infancy due to?

A

Both B and T cell recruitment

**polysaccharide vaccines are poorly immunogenic in infants due to their underdeveloped humoral Ab response.

80
Q

Neoplastic plasma cells are susceptible to proteasome inhibitors because?

A

They produce large amounts of protein (immunoglobulins) and these inhibitors are unable to let the cells break down toxic products -> accumulation -> eventual apoptosis.

**also leads to increase in proapoptic proteins

81
Q

CEA (carcinoembryonic antigen) can be elevated in a number of conditions, what are they?

A

Colon cancer, Pancreatic cancer, COPD, cirrhosis.

**also higher in smokers vs non smokers

82
Q

Vitamin K does this to clotting factors?

A

CARBOXYLATION

**usually produced by colonic bacteria, but can be given prophylactically to newborns to prevent bleeding.

83
Q

Germinal matrix fragility is responsible for intraventricular hemorrhages in?

A

Newborns.

84
Q

Intussuception is most common in children of ____ age and in this region____?

A

<2 yo

Ileocecal valve

**px with currant jelly stools and palpable mass

85
Q

Some medications can trigger IgE independent mast cell degranulation. What are they?

A

Opiods
Radicontrast agents
Some antibiotics (vancomysin)

86
Q

The presence of this in schistosomiasis is an important diagnostic clue?

A

Eosinophilia.

**Chronic exposure can lead to periportal fibrosis and bladder cancer complications.

87
Q

Progesterone during pregnancy leads to these symptoms?

A

Mostly inhibitory effects Decreases LES tone
Reduces gallbladder motility
Decreases colonic smooth muscle activity (constipation)
Decreases the production of motilin

88
Q

What type pf mucosa is most often found in a smptomatic Meckels diverticulum?

A

Gastric ectopic tissue

**other include pancreatic tissue, colonic, jejunal etc

89
Q

Hyper mmonemia can lead to excess ____ (AA) to accumulate within astrocytes?

A

Glutamine

** Accumulation in astrocytes -> leads to decreased glutamine for neurons -> disrupt excitatory neurosignals.

90
Q

Polyethylene glycol acts like a ____?

A

osomotic laxative

**other magnesium sulfate

91
Q

Porcelain gallbladder is associated with increased risk of?

A

Gallbladder adenocarcinoma

92
Q

The microsatellite instability pathway is characterized by mutations in _____ and leads to development of ___?

A

DNA mismatch repair genes

HNPCC (lynch syndrom)

93
Q

A moderately elevated alkaline phos of unclear etiology should be followed by?

A

GGTP (specific to liver and GB)

**Alk phos can be elevated in liver or bone etiologies.

94
Q

ALT and AST are indicators of liver ___?

A

Liver injury

95
Q

**Prolonged PTT, decreased albumin, increased bilirubin are indicators of liver ____?

A

indicators of liver function

**greatest prognostic feature of liver cirrhosis.

96
Q

When a single mRNA codes fro more than 1 protein it is known as?

A

polycistronic mRNA.

**common in prokaryotes not eukaryotes

97
Q

What are cowdry bodies?

Found in which disease?

A

Intracellular eosinophilic inclusions.

Herpes Simplex

98
Q

Esophagitis in an immunocompromised patient is often due to ?

A

Candida, HSV and CMV

99
Q

What biopsy is confirmatory for Celiac disease?

A

Duodenal bipsy

**will see villios blunting & intraepithelial lymphocyte infiltration.

100
Q

What biopsy is performed to dx Crohns Disease?

A

Terminal ileum

101
Q

Patienta with Crohns disease affecting the terminal ileum are prone to?

A

Developing gallstones (reduced absorption of bile acids)

102
Q

Diarrhea, weight loss and epigastric pain in pt with alcoholism is indicative of??

A

Acute pancreatitis.

Other asx: calcification and alcoholism.

**leads to insufficiency and malabsorption

103
Q

What enzyme activate trypsin?

What enzyme inhibits trypsin?

A

Duodenal enterokinase

SPINK 1 - serine peptidase inhibitor Kazal type 1

104
Q

Ghrelin stimulates?

A

Appetite (levels surge leading up to meals and fall afterward)

**Levels increase in fasting

105
Q

Diarrhea px acutely (within hours) of food ingestion is often due to ?

A

S. Aureus (ingestion of preformed toxin)

Other possible cause: baccilus cereus.

106
Q

On histology how do carcinoid tumors appear?

A

Islands with cells of uniform shape and size with eosinophilic cytoplasm.

**can be found in appediceal tissues.

107
Q

Right arising colon cancers often px with these symptoms?

Left arising tumors?

A

Iron deficieny anemia, fatigue

Obstructive sx (constipation, distention, N/V)

108
Q

Rifaximin is used to treat hyperammonia (especially encephalopathy). MOA?

A

Decreases intraluminal ammonia production by altering GI flora

109
Q

Lactulose is used in treatment of hyper ammonia\ (especially encephalopathy). MOA?

A

increases conversion of ammonia to ammonium (by decreasing pH)

110
Q

Unlike true cysts which are lined by epithelium, the walls of a pancreatic pseudocyst consist of?

A

Granulation tissue and fibrosis

**pseudocyts is a common complication of acute pancreatitis.

111
Q

The lac operon is activated by 2 means:

A
  1. Negatively binding repressor protein to the operator locus
  2. Positively by cAMP-CAP binding upstream from promoter region.
112
Q

Increase of conjugated bili often presents with?

A

Jaundice, dark urine and acholic stools

113
Q

Gastric adenocarcinoma are often due to these RF?

A

H. pylori, high Salt ingestion, N-nitroso containing compounds (tobacco, processed meats) and autoimmune gastritis, obesity.

Adenoma carcinoma - ulcerated mass with irregular folded or heaped up edges.

114
Q

Are Zollinger-Ellison syndrome & NSAIDs risk factors for adenocarcinoma formation?

A

NO

115
Q

In cirrhosis, what happens to the splanchnic vessels?

A

Dilate to decrease splanchnic vascular resistance -> lowers effective arterial blood volume (blood pooling)

UWORLD Q REVIEWS (13 decks)

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