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UWorld self assessment #1
Terms in this set (84)
what is the pathophysiology of ARDS?
What is the definition
1. damage to the endothelial cells lining the pulmonary capillaries resulting in leakage of fluid into the alveoli -> exudative stage.
Later: proliferative stage and final fibrotic stage
2. acute onset lung dysfunction, pulmonary edema, normal left atrial pressure
mesangial expansion, glomerular basement membrane thickening and glomerular sclerosis
rank cardiac action potential speed
atrium, ventricle, AV node, purkinge system
Purkinge system > atrium > ventricle > AV node
What malignancy is Paget's disease associated with?
sensation of a lump in the throat without accompanying physical, endoscopic, or radioloic findings of esophageal obstruction
presence of endometrial tissue and stroma within the uterine myometrium
whorled pattern of smooth muscle bundles with intervening connective tissue
most common cause of bronchiolitis in children under 2?
Respiratory Syncytial virus (RSV)
appearance of 180bp fragments to identify apoptotic cells
name some common anticholingergis
antihistamines (hydroxyzine, diphenydramine), antipsychotics (chlorpromazine, olanzapine), antispasmodics (dicyclomine, hyoscyamine), cyclic antidepressant (amitriptyline, desipramine)
acute promyelocytic leukemia
Which cytokine is produced only by T cell and what is its function
stimulate growth and differentiation of T cell, B cells, NK cells, and macrophages
Ca dependent transmembrane proteins that participate in desmosome formation via homologous interaction with cadherins on adjoining cells. Do not participate in hemidesmosome function (mediated by integrns)
extracellular matrix glycoprotein that binds cell surface integrins, faciliate cell bidning to the ECMM
what kind of virus
how is it transmitted in kids and adult
transmitted via direct skin-skin contact in kids (eyelids, face, trunk, axilla)
adult: sexually transmitted
trunk and anoggenittal region
What structure is most commonly injured with anterior and posteiror displacement of the knee?
popliteal artery (rigidly fixed proximal and distal to the kneen joint by the adductor magnus and soleus muscles)
infection of the uterus
usually follows delivery
sighn and symptoms: fever, leukocytosis, utrine ttenderness aand foul smelling discharge
usually causeed by mmixeed floraa witth bacteroids the most commonly isolated organismm
mature defense mechanism in whicha person channels socially unacceptable thoughts or impuleses iinto accepttable acitons
shifting feeling or conflicts associated with one situation or person to another. Ex medical resident who yells at his med student afteer being emmbarrassed by his atteending
defense mechanism where an individual attributes his own unacceptable thoughts and feelings to another person.
Interview technique: reflection
repeat what the patient has said in order to confirm understanding and let the patient know tthat hhe is beingg heard
interrveiw techhnique: facilitation
interviewer encourage the patient to talk more about his or her experience
intervview technique: confrontation
draws the patient's attention to discrepancies in his statement
interview technnique: support and empathy
support: expression of concern for a patient'ss experience and well being which does noot involve vicarious experiencing of a patient's situation
empathy: expression of vicariouss undderstaanding of a patien'ts feelingss and emootions
what happens to GFR 6 weeks after heminnephrectomy?
compensatory hyperfiltration and hypertrophy of the nephrons in the remaiining kidney
increased from 50% post nephrectomy to approx. 80% of the oriinal valuess within several weeks
Where does phosphodiessteraase 5 iinhibitors such as ssildenafil promote erection through?
increased cGMP causes relaxation of venous sinus smooth muscle within the corporra cavvernosa
Acute stress dissorder vs. PTSD
PTSD last for more than 4 weeeks
behavioral symmptoms that deevelop within 3 months of a sttressor and are considered excesssive relative to the exxpectted response. No flashbacks or nightmares likke in actue stress disorder
Brief psychotic episodes vs. schizophreniform disorder, vs. psychosis in schizophrenia
less than 1month, more than 1 month but lesss than 6 months, last longerr than 6 months
Schzotypical personality idsorder
magical thinking, odd beliefs that include telepathy superstition, bizarrer fantasies or preoccupations
lack close friends
on auditory hallucinations in personality disorders
schizoid personality disorder
no desire for close relationships with family, friends or others
flattened effect, no friends
absent psychotic symptoms like hallucinations and delusions
Most common viral encephalitis?
Where does it infect?
seizures, personality changes, psychosis
Which enzyme is deficient in acute intermittent porphyria? What is the typical presentation of this disease?
HMB synthase (hydroxymethylblane) synthase
Intermittent episodes of abdominal pain with neurological manifestations after exposure to an offending medication. Urine turns dark upon standing in sunlight (during attacks only)
skin photosensitivity is characteristically absent
What does the 3rd heart sound indicate?
sudden deceleration of blood as the elastic limits of the ventricular chambers are reached during rapid ventricular filling
normal in children but in adults typically indicates ventricular failure due to increased end systolic volumes and pressure.
(cardiac failure either systolic or diastolic failure)
How to differentiate between transudate and exudate?
1. Pleural proteins/serum protein >0.5 (high protein content)
2. Pleural LDH/serum LDH >0.6 or a pleural fluid LDH more than two thirds the upper limit of normal serum LDH (high LDH)
Transudate would lack these features
What is the osmotic fragility test used for? What is the blood smear finding in this disease?
osmotic fragility is increased in hereditary spherocytosis
peripheral blood smear shows dense spherocytes without central pallor
What is the Rx for hereditary spherocytosis? When to do this and why? What is the benefit of this treatment?
splenectomy b/c spleen is the primary site for hemolysis
Do this only after 4 years of age and only after pneumococcal and H influenzae vaccines (asplenic patients are at increase risk of infection by encapsulated organisms)
splenectomy would result in increased hemoglobin, decreased hemolysis, decreased jaundice and reduced incidence of bilirubin gallstones
Myasthenia gravis is associated?
What about Eaten-Lambert?
Myasthenia gravis: thymoma
Eaten-Lambert: small cell lung cancer
Also MG gets worse in the end of the day while Eaten Lambert get better with repetitive use
RB1 mutation associated with that?
Retinoblastoma and osteosarcoma
Common cause of infectious arthritis in adults?
Neisseria gonorrhoeae and staph aureus
What is the developmental defect in DiGeorge syndrome?
failed 3rd and 4th pharyngeal POUCHES
What are the metabolic derangements associated with DKA? (list 5)
hyperkalemia (due to H+/K+ exchange)
hyponatremia (due to increased glucose in the blood and more water flows out into the serum to dilute Na concentration)
Complete androgen insensitivity findings
male genotype, female phenotype with normal external female genitali and a vagina ending in blind pouch.
High serum testosterone level (eventually converted to estradiol peripherally) with normal FSH level
Phenoxybenzamine half life?
non competitive, irreversible alpha receptor blocker with a half life of ~24hr, single dose last 3-4 days
Premature infant with intraventricular hemorrhage. Cause?
germinal matrix bleeding
Etoposide, toniposide mech of action, side effects?
inhibits topo II
myelosuppression, GI, alopecia
methotrexate mech of action, side effect
how can the side effect be prevented?
folic acid analog that inhibits dihydrofolate reductase
side effect: myelosuppression, macrovascular fatty change, mucositis, tetratogenic
leucovorin (folinic acid) can reverse the myelosuppression
Chemotherapy agent that causes acoustic nerve damage?
What is another toxicity caused by these agent? how to prevent?
Mech of action?
nephrotoxicity, can be prevented by amifostine (free radical scavenger) and chloride diuresis
cross link DNA
Which antiarrhythmic drug can cause interstitial pneumonitis? Which one causes a pleuritis?
amiodarone: associated with delayed onset interstitial pneumonitis
procainamide: causes a delayed onset pleuritis associated with drug induced lupus
Which prostaglandin stimulate gastric epithelial cell mucus production and decrease parietal cell acid secretion? What drug is an analog of it?
what kind of cancer is the most common in head and neck? What are some common sites of origin?
squamous cell carcinoma
usually associated with use of tobacco, alcohol
oral cavity, ventral tongue, floor of the mouth, lower lip, soft palate, gingiva
how can a G protein coupled receptor increased hydrophobicity?
by palmitolylation: anchoring receptor carboxy tails to the plasma membrane (usually through cysteine residues)
How does nitroglycerin work to relieve angina pectoris?
produce net systemic venodilation
decreased myocardial oxygen consumption by reduction in ventricular volume (decreased preload)
which overcome the associated reflexive increase in heart rate
different mutations in the same genetic locus cause similar phenotypes.
montelukast mech of action
antagonize the leukotriene receptor thus decrease leukotriene D4 activity in asthma (synthesized by esosinophils and mast cells )
physical findings in hemachromatosis?
What is the pathophysiology underlying the skin finding?
liver disease (hepatomegaly), skin hyperpigmentation (esp in sun exposed area), diabetes mellitus due to pancreatic islet destruction, impotence, arthropathy, cardiac dysfunction & enlargement
What are steps of the ELISA test?
1. add known antigen
2. add patient serum (antibody against the antigen)
3. add anti human immunoglobulin linked with an enzyme
4. Add chromogen which would be modified by the enzyme linked to anti human immunoglobulin if present and elicit a detectable signal (ex. color change)
honey crust on face
S aureus or group A strep
What kind of resistance mechanism do bacteria use to decrease intracellular antibiotic concentration?
(most antibiotics freely cross the bacterial membrane thus getting in is not a problem)
the pump usually used a proton gradient (low proton outside of the cell), sodium gradient or ATP expenditure
fibroblast growth factor 3 (FGF-3) overactivity -> inhibition of cartilage proliferation -> shortened proximal extremities and enlarged head with frontal bossing
fused digit association?
extra digit association?
missense substitution mutation of FGFR-2
extra digit (polydactyly)
bone tumor in pediatric population
Bruton's tyrosine kinase is defective -> no B cells mature or escape the bone marrow
cyctic fibrosis, ehlers danlos, OI
polycyctic kidney disease
What enzyme is deficient in maple syrup urine disease
what coenzyme does it use?
which amino acids are not able to be degraded
branched chain alpha keto acid dehydrogenase
leucine, valine, and isoleucine
What are the enzymes that require B1 as a cofactor? (4)
alpha ketoglutarate dehydrogenase
branched chain amino acid dehydrogenase
What are the use of B6?
transamination, decarboxylation, glycogen phosphorylase
synthesis of cystathionine, heme, niacin, histamine, neurotransmitters (serotonin, epinephrine, norepinephrine, GABA)
male with normal blood testosterone level but low testosterone concentration in seminiferous tubules and epididymis. What's wrong?
what's the normal mechanism?
Sertoli cell synthesize androgen binding protein (ABP) which is secreted into the seminiferous tubule lumen to maintain the high local concentration of testosterone necessary for normal sperm production and maturation. ABP also makes testosterone less lipophilic and can be retained in the lumen.
glucagon downstream signaling pathway?
stimulate adenylate cyclase
raises intraceullar cAMP level
What are the receptors that use Gq?
alpha 1 and V1 receptors
excessive sweating in axillae can be treated by what kind of surgery?
sympathectomy targeting the T2 sympathetic ganglion
What does red safranin O stain?
cartilage, mast cell granules, mucin
-> stain red
Which ligament of the uterus pass through the inguinal canal?
What is the embryo origin?
round ligament of the uterus
project from the uterus through the inguinal canal into the labia majora
What reaction is it from DOPA to dopamine? Which coenzyme is needed?
What reaction is it from dopamine to NE?
Which coenzyme is needed?
addition of an -OH group
What reaction is it from NE to epinephrine? which coenzyme is needed? what enzyme does this? what is the regulatory molecule?
addition of -CH3 grou
phenylethanolamine N methytransferase
cortisol increases the enzyme activity
PE blood gas finding? (pH, PaCO2, PaO2)
respiratory alkalosis, low PaCO2, low PaO2
What is the pathway involved in platelet activation. Which factor is the mediator? What are the effects?
Gq pathway: IP3 mediated release of calcium from ER -> platelet activation
Platelet Activating Factor
platele aggregation, constriciton of smooth muscle in the bronchi, blood vessels, and upper digestive tract
Main reason to treat duodenal ulcer with antibiotics? does it increase the risk of malignancy?
duodenal ulcer does NOT increase the risk of malignancy
H pylori is associated with MALT and gastric adenocarcinoma
Neurofibromatosis 1 findings
cafe au lait spots, intertriginous freckling, optic nerve glioma, bony lesions, irish Lisch nodules,
autosomal dominant on ch. 17
What is "red man syndrome" how can it be prevented?
rapid infusion of vancomycin -> widespread release of histamine from mast cells
NOT an IgE mediated allergic reaction
can be prevented by using a slower rate of infusion
THIS SET IS OFTEN IN FOLDERS WITH...
UWorld Self Assessment 1
UWorld Self-Assessment 2
Uworld self assessment 1 and 2
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