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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
What hormones utilize the Gs messenger system?
TSH, glucagon and PTH
26
Destruction of B-cells in T1D is due to which type of immunity? Cellular or humoral?
Cell mediated response
27
Pathology of Hartnup disease?
Inability to reabsorb neutral AA from Proximal tubule -> deficiency of tryptophan -> deficiency of Niacin -> pellagra. Confirmed through neutral AA in urine.
28
Deficiency of Acyl-Coa is called?
MCAD deficiency aka hypoketototic hypoglycemia (unable to perform B-oxidation) in times of fasting.
29
In maple syrup disease which AA are absent? What cofactors are needed for branched chain alpha-ketoacid dehydrogenase to function?
Branched AA - Isoleucine, Leucine and Valine Tender loving care for Nancy; Thiamine, Lipoate, Coenzyme A, FAD, NAD.
30
Glycogenolysios is the main source of glucose in the first __ hours of fasting?
12-18 hours
31
Infection with HSV leads to lifelong latent infection of the ____ ganglion and leads to symptoms that _____ over time?
Sensory ganglion Flare and resolve over time.
32
Pheochromocytoma is a tumor arising from ____ cells. It stains positive for?
Synpatophysin, chromogranin and neuron specific enolase.
33
What is the monoclonal antibody used in the tx of post menopausal osteoporosis that works in a manner similar to OPG?
Denosumab
34
Impairment of this process in Parkinson & Alzheimers (degenerative diseases) can lead to their symptoms?
Ubiquitination
35
3 stages of bordetella pertussis?
Catarrhal, Paroxysmal (cough) & coalescent stage
36
Lymph drainage from testes? Scrotum?
Paraaortic LN Superficial inguinal LN
37
Next best step (most sensitive) for assessing for impaired nutrient absorption in patients?
Stool microscopy with Sudan III stain (check for fat malabsorption) Fat is usually the most severely affected nutrient in generalized malabsorption.
38
VHL is caused by ____ mutation.
Loss of function (is a tumor suppressor)
39
How does brown fat create more heat?
Uncouple the ETC and Phosphorylation. Proton pumped out by ETC returns to matrix via thermogenin -> heat, not ATP is produced.
40
Hereditary hemachromotosis is most commonly caused by a _____ mutation
Missense
41
Toxic megacolon is a life threatening complication of this IBD?
Ulcerative colitis pts will px with abd/distension, bloody diarrhea, fever and signs of shock.
42
Diabetic gastroparesis is a complication of diabetes caused by?
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)
43
Organisms with IgA protease include?
N. meningitis & gonorrhea, S. pneumo & H. influenza.
44
Organisms with IgA protease infect via this means?
Destroy secretory IgA which Inhibit the action of pilli and other surface antigens that mediate adherence.
45
In a cricothyrotomy, incision passes through there layers?
Superficial cervical fascia, pretracheal fascia and cricoid membrane.
46
What structures cross under the piriformis muscle?
Inferior gluteal vessels, internal pudendal vessels and sciatic nerve.
47
This is the presence of endometrial glandular tissue within the myometrium?
Adenomyosis. Px: with uniform enlargement of the uterus, painful and heavy bleeding.
48
Hyperimmunoglobin M syndrome results from?
Defective immunoglobulin class switching due to a defect in CD40L -CD40 interaction.
49
What method can be used to determine the carrier status of a prospective patient with sickle cell?
Hemoglobin electrophoresis
50
Rota virus causes diarrhea by?
Villous blunting, proliferation of secretory crypts (secretory diarrhea) & loss of brush border enzymes
51
Defective ApoE leads to what condition?
Dysbeta-lipoprotenemia | - Defect in clearance of chylomicrons.
52
The most common ligament damaged in ankle sprain damages is?
Anterior talofibular ligament
53
Toxic megacolon is a life threatening complication of this IBD?
Ulcerative colitis
54
Diabetic gastro paresis is a complication of diabetes caused by?
Destruction of enteric neurons.
55
Organisms with IgA protease include?
N. meningitidis & gonorrhea, S. pneumo & H. influenza.
56
Organisms with IgA protease infect via this means?
Destroy secretory IgA which Inhibit the action of pilli and other surface antigens that mediate adherance.
57
In a cricothyrotomy, incision passes through these layers?
Superficial cervical fascia, pretracheal fascia and cricoid membrane.
58
Which areas are considered watershed areas of the colon?
Splenic flexure and rectosigmoid junction
59
PCOS is a risk factor for which type of diabetes?
T2DM
60
Menotropin - drug that helps in an-ovulation by mimicking?
FSH
61
hCg is structurally similar to ___ and can mimic its action
LH
62
Pierre Robin is a sequence disorder characterized by?
Primary defect (mandibular hypoplasia) leads to cascade of further malformations (micrognathia, post. displaced tongue and u shaped cleft palate)
63
Diabetes during pregnancy leads to this neonatal complication?
Transient hypoglycemia
64
Latissimus dorsi is innervated by the ___ nerve?
Thoracodorsal N.
65
What role does vitamin C play in the prduction of collagen?
Hydroxylation of proline and lysine residues in procollagen
66
Activating mutations involving PRPP (phosphoribosyl pyrophosphate synthethase) leads to?
Gout (due to increased production and degradation of purines)
67
These muscles aid in depressing (opening) the mandible?
The lateral pterygoids
68
A communicating hydrocele occurs when fluid accumulates in the ___?
Tunica vaginalis, often due to a patent processus vaginalis.
69
A communicating hydrocele results when ___ accumulates within the tunical vaginalis and present as?
Serous fluid | Painless swelling that illuminates on exam
70
The most cocmmn cause f rotator cuff syndrome?
Supraspinatus tendinopathy (gets compressed between the acromion and head of the humerus)
71
Rotator cuff muscles?
SITS (supra spinatus, Infraspinatus, teres minor, and subscapularis)
72
PCP is a ____ antagonist?
NMDA **px withe psychosis, severe agitation -> violent. Ataxia and vertical nystagmus, memory loss.
73
Enterocytes respond to low iron levels by?
Increasing apical expression of divalent metal transporter (DMT 1) -> increases absorption
74
Hepatocytes respond to low iron levels by?
Decreasing hepcidin synthesis -> increased feroportin -> increased iron secretion into circulation
75
Classic triad of increased Iron levels?
Micronodular cirrhosis, DB and pigmentation. Can lead to HCC, CHF and testicular atrophy
76
Loss of epidermal melanocytes leads to ___?
Vitiligo
77
How does low estrogen affect bone?
Decreased estrogen -> decreased OPG, Increased RANK-L expression and increased RANK expression in osteoclast precursors.
78
Abnormal spams or diminished relaxation of cricopharyngeal m during swallowing leads to?
Zenkers diverticulum
79
Pneumococcal conjugate vaccines are strongly immunogenic in infancy due to?
Both B and T cell recruitment **polysaccharide vaccines are poorly immunogenic in infants due to their underdeveloped humoral Ab response.
80
Neoplastic plasma cells are susceptible to proteasome inhibitors because?
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
CEA (carcinoembryonic antigen) can be elevated in a number of conditions, what are they?
Colon cancer, Pancreatic cancer, COPD, cirrhosis. **also higher in smokers vs non smokers
82
Vitamin K does this to clotting factors?
CARBOXYLATION **usually produced by colonic bacteria, but can be given prophylactically to newborns to prevent bleeding.
83
Germinal matrix fragility is responsible for intraventricular hemorrhages in?
Newborns.
84
Intussuception is most common in children of ____ age and in this region____?
<2 yo Ileocecal valve **px with currant jelly stools and palpable mass
85
Some medications can trigger IgE independent mast cell degranulation. What are they?
Opiods Radicontrast agents Some antibiotics (vancomysin)
86
The presence of this in schistosomiasis is an important diagnostic clue?
Eosinophilia. **Chronic exposure can lead to periportal fibrosis and bladder cancer complications.
87
Progesterone during pregnancy leads to these symptoms?
Mostly inhibitory effects Decreases LES tone Reduces gallbladder motility Decreases colonic smooth muscle activity (constipation) Decreases the production of motilin
88
What type pf mucosa is most often found in a smptomatic Meckels diverticulum?
Gastric ectopic tissue **other include pancreatic tissue, colonic, jejunal etc
89
Hyper mmonemia can lead to excess ____ (AA) to accumulate within astrocytes?
Glutamine ** Accumulation in astrocytes -> leads to decreased glutamine for neurons -> disrupt excitatory neurosignals.
90
Polyethylene glycol acts like a ____?
osomotic laxative **other magnesium sulfate
91
Porcelain gallbladder is associated with increased risk of?
Gallbladder adenocarcinoma
92
The microsatellite instability pathway is characterized by mutations in _____ and leads to development of ___?
DNA mismatch repair genes HNPCC (lynch syndrom)
93
A moderately elevated alkaline phos of unclear etiology should be followed by?
GGTP (specific to liver and GB) **Alk phos can be elevated in liver or bone etiologies.
94
ALT and AST are indicators of liver ___?
Liver injury
95
**Prolonged PTT, decreased albumin, increased bilirubin are indicators of liver ____?
indicators of liver function **greatest prognostic feature of liver cirrhosis.
96
When a single mRNA codes fro more than 1 protein it is known as?
polycistronic mRNA. **common in prokaryotes not eukaryotes
97
What are cowdry bodies? Found in which disease?
Intracellular eosinophilic inclusions. Herpes Simplex
98
Esophagitis in an immunocompromised patient is often due to ?
Candida, HSV and CMV
99
What biopsy is confirmatory for Celiac disease?
Duodenal bipsy **will see villios blunting & intraepithelial lymphocyte infiltration.
100
What biopsy is performed to dx Crohns Disease?
Terminal ileum
101
Patienta with Crohns disease affecting the terminal ileum are prone to?
Developing gallstones (reduced absorption of bile acids)
102
Diarrhea, weight loss and epigastric pain in pt with alcoholism is indicative of??
Acute pancreatitis. Other asx: calcification and alcoholism. **leads to insufficiency and malabsorption
103
What enzyme activate trypsin? What enzyme inhibits trypsin?
Duodenal enterokinase SPINK 1 - serine peptidase inhibitor Kazal type 1
104
Ghrelin stimulates?
Appetite (levels surge leading up to meals and fall afterward) **Levels increase in fasting
105
Diarrhea px acutely (within hours) of food ingestion is often due to ?
S. Aureus (ingestion of preformed toxin) Other possible cause: baccilus cereus.
106
On histology how do carcinoid tumors appear?
Islands with cells of uniform shape and size with eosinophilic cytoplasm. **can be found in appediceal tissues.
107
Right arising colon cancers often px with these symptoms? Left arising tumors?
Iron deficieny anemia, fatigue Obstructive sx (constipation, distention, N/V)
108
Rifaximin is used to treat hyperammonia (especially encephalopathy). MOA?
Decreases intraluminal ammonia production by altering GI flora
109
Lactulose is used in treatment of hyper ammonia\ (especially encephalopathy). MOA?
increases conversion of ammonia to ammonium (by decreasing pH)
110
Unlike true cysts which are lined by epithelium, the walls of a pancreatic pseudocyst consist of?
Granulation tissue and fibrosis **pseudocyts is a common complication of acute pancreatitis.
111
The lac operon is activated by 2 means:
1. Negatively binding repressor protein to the operator locus 2. Positively by cAMP-CAP binding upstream from promoter region.
112
Increase of conjugated bili often presents with?
Jaundice, dark urine and acholic stools
113
Gastric adenocarcinoma are often due to these RF?
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
Are Zollinger-Ellison syndrome & NSAIDs risk factors for adenocarcinoma formation?
NO
115
In cirrhosis, what happens to the splanchnic vessels?
Dilate to decrease splanchnic vascular resistance -> lowers effective arterial blood volume (blood pooling)

UWORLD Q REVIEWS (13 decks)

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