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zz - step 3 - uworld > world 45 > Flashcards

world 45 Flashcards

1
Q

what are the two most common causes of right-to-left intracardiac shunts in CRYPTOGENIC STROKE

A

ATRIAL SEPTAL DEFECT (ASD)

PATENT FORAMEN OVALE (PFO)

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2
Q

when does one see a PARADOXICAL EMBOLIS

A

PATENT FORAMEN OVALE (PFO)

conditions that raise the RIGHT ATRIAL PRESSURE above the left atrial pressure (VALSALVA) can produce a transient right-to-left shunt across the PFO that may result in paradoxical embolization

foramen ovale is patent in 25% of adults (compared to0.1% w/ ASD)

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3
Q

what is the best test for hypo/hyperthyroidism

A

TSH

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4
Q

initiation of transcription is governed by the binding of transcription factors to the regulatory region of the gene. Transcription factor II D binds where

A

TATA promotoer sequence located ~25 bases upstream form the coding region of the gene

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5
Q

elongation factors facilitate what in tRNA

A

tRNA binding and the TRANSLOCATION steps of protein synthesis

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6
Q

chicks with anti-phospholipid antibody are at greater risk for what complications

A

VENOUS or ARTERIAL THROMBOEMBOLIC DISEASE

  • DVT
  • PE
  • ischemic stroke/TIA

ADVERSE PREGNACNY OUTCOMES

  • unexplained embryonic or fetal loss
  • premature birth due to placental insufficiency or preeclampsia
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7
Q

chicks with anti-phospholipid antibody have what lab findings

A

LUPUS ANTICOAGULANT EFFECT- paradoxical aTT prolongation NOT REVERSED on plasma mixing studies

ANTICARDIOLIPIN antibody

ANTI-BETA-2-GLYCOPROETIN-1 antibody

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8
Q

attenuated S2 heart sound indicated what

A

PULMONARY HYPERTENSION

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9
Q

what is seen in CREST syndrome

A 
Calcinoshs
Raynauds phenomenon
Esophageal dysmotility
Scleodactyly
Telangiectasias

PULMONARY HTN develop due to damage to pulmonary ARTERIOLES (attenuated heart sounds and cor pulmonale)

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10
Q

what causes limited and systemic sclerosis

A

increased DEPOSITION of COLLAGEN in TISSUES (thought to be triggered by monoclonal T cell in the affected tissues that secret a variety of cytokines (TGF-beta), which increase collagen and ECM proteins by fibroblasts)

earliest damage is seen in SMALL ARTERIOLES and CAPILLARIES

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11
Q

pt with PYRUVATE DEHYDROGENASE DEFICIENCY gets build up of PYRUVATE which gets shunted to lactate via lactate dehydrogenase, resulting in potentially life-threatening lactic acidosis. how is this disease manged

A

KETOGENIC DIET (high fat, low card diet w/ moderate levels of protein) and LYSINE and LEUCINE are the only truly ketogenic

LYSINE and LEUICINE can provide energy for these peeps in the form of ACETYL-CoA without increasing lactate production

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12
Q

how does AML present

A

adults (65)

pancytopenia (fatigue form anemia, bruising/bleeding from thrombocytopenia, infection from possible functional neutropenia despite leukocytosis)

white count around 15,000 at presentation

over 20% blasts

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13
Q

urinary concentration of creatine and inline remain equal to what

A

filtered load of the substance regardless of the serum concentration

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14
Q

what is cystitis c’ path in the glomerulus

A

filtered at glomerulus w/ no active reabsorption

metabolized by renal tubular cells, which results in variable urinary excretion

appears in urine at level low serum concentration

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15
Q

what are PAH concentrations like at differed filtered amounts

A

urinary exertions exceeds total filtered amount always because its actively secreted

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16
Q

what are the possible causes of HYPOXIA with a NORMAL A-a gradient (b/w 5-15)

A

ALVEOLAR HYPOVENTIALTION

INSPIRATION of AIR at HIGH ALTITUDE

the normal A-a gradient indicates that the low PaO2 is due directly to low PAO2

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17
Q

what causes an increased A-a gradient

A

thickening of alveolar capillary membranes (alveolar hyaline membrane disease)

right-to-left shunt

V/Q mismatch (pneumonia, COPD)

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18
Q

L2 nerve rood radiculopathy results in what

A

sensory loss: upper anteromedial thigh

weakness: hip flexion (iliopsoas)

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19
Q

L3 nerve rood radiculopathy results in what

A

sensory loss: lower anteromedial thigh

weakness: hip flexion (iliopsoas), hip adduction, knee extension (quads)

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20
Q

L4 nerve rood radiculopathy results in what

A

sensory loss: lower anteromedial thigh, knee, medial calf and foot

weakness: hip adduction, knee extension (quads), PATELLAR reflex

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21
Q

L5 nerve rood radiculopathy results in what

A

sensory loss: buttocks, poterolateral thigh, anterolateral leg, dorsal foot

weakness: foot dorsiflexion and inversion (tibialis anterior), eversion (peroneus), and toe extension (extensor digitorum braves)

22
Q

S1 nerve rood radiculopathy results in what

A

sensory loss: buttons, posterior thigh and calf, lateral foot

weakness: HIP EXTENSION (gluteus maximus), knee flexion (hamstrings), foot plantar flexion (gastrocnemius), ACHILLES refelx

23
Q

a postitive straight leg raise test (pain elicited in the supine patient when the left is held straight while raised off the examining table) is a sign of what

A

SCIATIC NERVE ROT (L4-S3) IRRITATION

most sensitive for intervertebral disc herniation causing sciatica

24
Q

whats going on in hemochromatosis

A

AR
excessive intestinal iron absorption and accumulation within parenchymal tissues that result in end organ damage

MISSENSE mutation in HFE gene (C282Y)

enterocytes and hepatocytes sense false low iron levels

  • increased divalent metal transporter 1 internal iron absorption
  • decreased hepsiden synthesis- increasing ferroportin expression and promotes iron secretion into circulation
25
Q

what is depersonalization/derealization disorder

A

persistent or recurrent experiences of 1 or both:

  • depersonalization (feelings of detachment from, or been an outside observer of, one’s self)
  • derealization (experiencing surroundings as surreal)

intact reality testing

26
Q

what is dissociative amnesia

A

inability to recall important personal information, usually of a traumatic or stressful nature
not explained by another disorder (PTSD, substance use)

27
Q

what is dissociative identity disorder

A

marked discontinuity in identity and loss of persona fence with fermentation into 2 or more distinct personality states

associated with severe trauma or abuse

28
Q

what is stress incontinence

A

sphincter dysfunction or weakness when intrabdominal pressure exceeds the urethral sphincter pressure (SNEEZING, COUGHING) causing involuntary urice leakage

29
Q

what is overflow incontinence

A

impaired detrusor contractility or bladder outlet obstruction (tumor obstructing urethra)

involuntary and continuous urinary leakage when the bladder is full and often have incomplete emptying

post-void volume usually high

30
Q

what is urge incontinence

A

detrusor overactivity causing sudden and/or frequent urge to urinate and empty the bladder

fucked up in MS tx with antimsucarinic

31
Q

visceral obesity as measured by weight circumference or waist-to hip ratio is an important predictor of what

A

insulin resistance

32
Q

what is seen in silicosis

A

CALCIFICATIONS of the RIM of HILAR NODES (EGGSHELL calcifications) and BIREFRINGENT SILICA PARTICLES surrounded by fibrous tissue on histology

associated with TB

IMPAIRS MACROPHAGE effector arm of cell-mediated immunity

33
Q

anterolateral humeral fracture fucks what up

A

RADIAL NERVE

-wrist drop and sensory loss to posterior forearm/dorsolateral hand

34
Q

anteromedial humeral fracture fucks what up

A

MEDIAN NERVE and branchial artery (pulseless hand)

35
Q

where is the ulnar nerve found in he elbow

A

posterior to medial epicondyle

damaged in hyper flexion injuries (falling on outstretched elbows)

36
Q

tamoxifen is metabolized by what into what

A

CYP2D into its ACTIVE METABOLITE ENDOXIFEN

37
Q

thiopurine methyltransferase is responsible for the metabolism of what

A

thiopruines like 6-MP and azithriopurine

38
Q

decrease activity of N-acetyltransferase results in dmininsed ability to metabolize what

A

ISONIZAID

sulfonamides

39
Q

over expression of p-glycoprotein causes what

A

multidrug ressitance

40
Q

what nerve MOST LIKELY gets fucked up in thyroid surgery

A

RECURRENT LARYNGEAL (the inferior thyroid artery comes close to the nerve near the thyroid)

  • unitlateral injury: hoarseness
  • bilateral injury:inspiratory stridor and respiratory distress due to complete VOCAL CORD PARALYSIS
41
Q

what other nerve (not recurrent laryngeal) can get fucked in thyroid surgery

A

external branch of superior laryngeal (innverbates cricothyroid muscle)

proximity to superior thyroid artery makes it ligatable in surgery

42
Q

how do FIBRATES cause cholesterol gallstones

A

they inhibit cholesterol-7-alpha-hydroxylase which makes cholesterol into bile slats

this inhibition increases the cholesterol/bile salts ratio leading to formation of cholesterol stones

43
Q

what are the crystals in gout

A

MONOSODIUM URATE

44
Q

patient resists simultaneous extension of the leg and thigh, particularly at the hip. what muscle is fucked up

A

PSOAS major

45
Q

what are the signs of a psoas abscess

A

fever
flank pain
inguinal mass
difficulty walking

risk facts are FM, IV drug use, HIV, immunosuppression

46
Q

what is the most common sign of post procedure atheroemolism

A

ACUTE KIDNEY INJURY

47
Q

what are signs that should make you suspicious of atheroemolic disease following invasive vascular procudre

A

blue toe, livedo reticularis (blue veiny legs) w/ normal peripheral pulses

see CHOLESTEROL CLEFTS in arterial lumen

48
Q

whats the initiation stage of acute tubular necrosis

A

ischemic injury to renal tubules precipitated by hemorrhage, acute MI, sepsis, surgery

49
Q

whats the maintenance stage of acute tubular necrosis

A

decreased urine output, fluid overload, increasing creatinine/BUN, HYPERKALEMIA

50
Q

whats the recovery stage of acute tubular necrosis

A

gradual increase in urine output leading to high volume diuresis

electrolyte abnormalities incude DECREASED: K, Mg, PO4, and Ca due to slowly recovering tubular function

51
Q

ether and other inorganic solvents can inactivate what kind of viruses

zz - step 3 - uworld (62 decks)

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