2015-05-08 General UWorld

jdlevenson's version from 2015-05-09 03:16


Question Answer
Muscarinic receptors agonists, GI sphincter relaxation or contractionRelaxation. Contraction of smooth muscles -> Secretion and Motility. Vs antimuscarinic -> GI muscle relaxation and contraction. Decreased motility.
Endothelial surface have what kind of receptorsMuscarinic.
Cholinomimetics receptors -> NO -> ?EDRF, NO-> GC -> cGMP -> activates Ca pump and causes Ca efflux from the cell. Decrease in Ca = vascular wall smooth muscle relaxation.
ANS and Renin?Alpha 1 decrease and Beta 1 increase.
Detrusor/ bladder wall smooth muscle CONTRACTIONCholinomimetics. URINATION.
Detrusor/ bladder wall smooth muscle relaxationAnticholinergics.
When BP increased, barreceptorsFIRE.
When BP decreased, baroreceptorsAre SILENT.
MEAN BP is2/3 DBP and 1/3 SBP.
Cardiac muscle has sympathetic and parasympathetic innervation but importantly differs in thatSA and AV node have both M1 (PS) and B1 (S) but cardiac muscle only has B1 (S)
Ciliary muscle affects lens/ focusing. It is only innervated byMuscarinics, not adrenergics. So, M agonists cause accommodation and M antagonists prevent accommodation/ cyclopegia.
Any drug that affects accommodation/ causes blurry vision must beMuscarinic acting, agonist or antagonist.
GC has what effect on CaDECREASES Ca. Vasodilation. Smooth muscle relaxation.


Question Answer
Thesbian veinscardiac vessels that drain into LA and LV.
Mixing of deoxygenated bloodSlight difference in pulmonary capillaries oxygenation relative to systemic arterial blood in LA due to contribution of bronchial veins and pulmonary veins.
Bronchial veins return bloodTo right heart AND directly to left heart.
Perfusion limited gas exchangeNormal physiologic resting state. Equilibration of blood with alveolar air is complete by time blood traverses 1/3 of pulmonary capillary length.
Diffusion limited gas exchange due toPulmonary fibrosis, ARDS, emphysema, hyaline membrane disease of the infant.
Diffusion limited gas exchangeBlood p02 does not equilibrate with alveolar p02 by end of its traversal through alveolar capillaries.


Question Answer
Propionyl-coA (-> methylmalonyl-CoA) can be made from what amino acidsValine, Isoleucine via oxidative decarboxylation via branched chain alpha ketoacid dehydrogenase. Threonine and Methionine too.
Arginine to Ornithine via Arginase is what type of reactionHydrolysis.
Methylmalonyl coA to Succinyl coA is what type of reactionIsomerization. Also requires B12 for Methylmalonyl coA Mutase.
Hydroxylation thinkProline and Lysnine residues of collagen hydroxylated post translationally by prolyl and lysyl residues.
Transamination requiresB6.
TransaminationAmino group from one AA to an alpha Keto Acid.


Question Answer
What ribs overlie spleen9, 10, 11
Floating ribs11, 12
Rib 12 fractureFloating and so can be displaced into retroperitoneum when fractured lacerating left kidney.
Left kidney is immediately deep to12th rib on left.
Rib 12 overliesParietal pleura medially and kidney laterall.
Trauma to where causes pancreatic damage Abdomen.
Pancreas overliesL2, second lumbar vertebra.
Overlying posterior surface of liverRibs 8, 9, 10, 11
Lungs relative to ribsLung lie rib 1 to 10, midscapular but can expanded to 12th rib with inspiration. Damage to ribs 1-6 -> greatest risk to lung


Question Answer
Posterior pituitary/ hypophysisStores ADH and Oxytocin
DI can be permanent or transient from injury. It usually occursIn hypothalamus (where ADH is made, SON and PVT) and not posterior pituitary because neuronal cell bodies are not located there and if can hypertrophy and regenerate in response to injury.
Permanent DI result whenDamage to HT causes a sufficient number of vasopressinergic neurons to be destroyed.


Question Answer
TSS a/wTampons. Nasal packing.
TSS clinicalFever, vomiting, muscle pain, erythroderma and desquamation of palms and soles, usually 1-2 weeks after onset of illness.
TSS causesUsually Staph Aureus; sometimes Group B Strep Pyogenes and its Exotoxin
Superantigen definitionunlike usual antigen which activates only a few Thelper, super antigen activates a large number of T cells -> non specific widespread activation of T lymphocytes -> IL-2 release, IL-1 and TNFa from Macrophages.


Question Answer
SLOPE of VR and COTPR. Steeper is less slope.
Height of COCO
Height of VRTPR
Increased slope of CO vs RAPDecreased TPR
Increased slope of Venous returnDecreased TPR
Rightward shift of venous return curve along X-AxisIncreased mean systemic pressure.
Acute AV fistulaDecrease in TPR, increased CO, increased VR
Chronic AV fistulaDecrease in TPR, increased CO and increased Mean Systemic Pressure (rightward shift on venous return curve)
PhenylephrineAlpha 1 Agonist. Some Alpha 2 as well. Used in hypotension, congestion and ocular procedures (mydriasis)


Question Answer
Gonococcal urethritisAsymptomatic until PID or peritonitis.
PID from Chlamydia differs when from Gonorrhoeae in thatC -> subacute, undiagnosed and much more common vs G -> acute.
PID can lead toEndometritis, salpingitis tubo-ovarian abscess and pelvic peritonitis -> infertility.
***Mucopurulent cervicitisPID.
PID risk for infertility15-20% for women with single episode and 50-80% for multiple episodes.
Hydatiform mole presentationEarly in pregnancy with vaginal bleeding and fundal size greater than dates.


Question Answer
Traveler, inflammatoryInflammatory traveler’s diarrhea -> Cipro or another Fluoroquinolone.
Traveler, hiker, smelly and watery diarrheaGiardia.
Giardia most common where and transmitted byUS and Canada and transmitted by contaminated water.
Giardia treatmentMetronidazole.


Question Answer
Beck triadHypotension, distended neck veins and distant heart sounds -> Cardiac tamponade. Indicate that normal compensatory mechanisms to raise BP are not working hence JVD.
Acute CVP elevation, hypotension, tachycardia point toCardiac Tamponade or Tension pneumothorax.
Beck’s triad + tachy ->Tamponade.
Pleuritic chest pain and pericardial friction rub following URIAcute fibrinous pericarditis
Pulsus paradoxusDecrease in amplitude of systolic BP >10 during inspiration.
Pulsus paradoxus seen inCardiac tamponade, pericarditis, asthma, obstructive sleep apnea, croup. Not MI really.
Warm shockLowered SVR and increased CO; initial stages of septic chock.
Constrictive pericarditisTakes months to years.
Cardiac tamponade, 5 thingsBeck’s triad. Tachy. Pulsus paradoxus.
Pulse becomes undetectable to palpitation during inspirationPulsus Paradoxus.
Loeffler syndromeendomyocardial fibrosis with eosinophilic infiltrate and eosinophilia.


Question Answer
Hemoglobin S and C both result fromMissense mutations
Hemoglobin S results from what mutationValine, nonpolar AA, replaces Glutamate, negatively charged. Affects speed across electrophoresis.
Hemoglobin C results from what mutationLysine, positively charged AA, replaces Glutamate, negatively charged. Affects speed across gel electrophoresis. Slowest.


Question Answer
Charcot bouchard ->HTN; Basal Ganglia, Cerebellum, Thalamus, Pons; <1mm; Intracerebral hemorrhage; Progressive neurologic deficits; headache may follow
Saccular/Berry ->ADPKD, EDanlos, AVM, HTN; Subarachnoid/ Circle of Willis; Variable size (2-25 mm); Subarachnoid; Sudden severe headache and focal neurologic deficits are uncommon
Charcot-Bouchard Aneurysms pathProgressive arteriolar hyalinization and fibrinoid necrosis leading to weakning of vessel wall
Acute bleeding on CTBRIGHT/ Hyperattenuated
Charcot-BouchardDeep brain structures
Ischemic stroke most common causesCartoid artery atherosclerosis and cardiac embolism
Cerebral amyloid angiopathyLobar/ cortical parenchymal hemorrhage.
Hypertensive EncephalopathyProgressive headache, N/V, nonlocalizing neurologic symptoms
Hypoxic encephalopathyDecreased econsciousness/ coma/ vegetative state
Cerebral AVMmost common cause of hemorrhage in children


Question Answer
Tension pneumothoraxTrachea pushed to opposite site
PneumothoraxTrachea shifts to side of collapse
Pneumothorax on xrayWhite visceral pleural line and no vessels visible beyond that
ARDS vs Cardiogenic Pulmonary EdemaARDS will not have JVD and Cardiomegaly.
ARDS triggersSepsis, aspiration, pneumonia, trauma
Crackles and wheezingPulmonary edema/ CHF
Kerley B linesCHF, short horizontal lines situated perpendicularly to the pleural surface that represent edema of the interlobular septa.
Batwing perihilum cxrCardiogenic pulmonary edema


Question Answer
Gallbladder diseaseFat Female Forty Fertile
Bile made ofCholesterol, Bilirubin, Bile Salts; Bile Salt, Bilirubin, Fats (Cholesterol, FA, Lecithin)
Lecithin/ phosphatidylchline thinkSurfactant. Levels increase as surfactant decrease. Ratio <2 = NRDS.
Surfacntat production begins at28 weeks.
CCK functionIncrease pancreatic secretion; increase gallbladder contraction; increase sphincter of Oddi relaxation and decrease gastric emptying
Cholecystitis and CCKFA -> CCK -> GB contraction -> stone -> Pain.
CCK stimulationFA, AA
Gallstones caused fromIncreased cholesterol and or bilirubin; Decreased Bile Salts; Gallbladder stasis
A1AT neutralizes proteases fromNeutrophils and Macrophages in the lungs.
Bile secreted intoDuodenum


Question Answer
Oligohydramnios thinkBilateral renal agenesis. Lack of fetal urine. Pulmonary hypoplasia.
POTTER sequence associated withPulmonary hypoplasia Oligohydramnios (trigger) Twisted face Twisted skin Extremity defects Renal failure (in utero)
Maternal hyperglycemiaGestational diabetes
Maternal hyperglycemiaStillbirth, macrosomia, postnatal hypoglycemia.
Placental previa presentationPainless third trimester bleeding.
Placental previaAttachment of placenta to lower uterine segment over internal cervical os.
Placenta abruption presentation Abrupt painful bleeding in third trimester +/- DIC, maternal shock, fetal distress. Life threatening.
Placenta incretaPlacenta penetrates INTO myometrium.
Placenta accretaPlacenta attaches to myometrium without penetrating. Most common.
Placenta percretaPlacenta penetrates through myometrium and into uterine serosa and can result in placental attachment to rectum or bladder.
Placenta percreta presentationNo separation pf placenta after delivery, can cause postpartum bleeding.
HELLPHemolysis, Elevated Liver enzymes, Low Platelets,. Severe pre-eclampsia (HTN with proteinuria or end organ dsfunction after 20th week). Schistocytes*.
Folate deficiency during first trimester of pregnancFetal neural tube defects.


Question Answer
ARR= Control rate – Treatment Rate
NNT= I / ARR (Control rate – Treatment rate)
Relative risk= Treatment rate/ Control rate
Relative risk reduction ARR / Control Rate.
Higher NNTLess beneficial treatment


Question Answer
DNA topoisomeraseGyrase. Single or double stranded break in helix to add or remove supercoils. Relieve unwinding tension.
Leading strand is which direction of replicaton forkTOWARDS
DNA polymerase IOnly bacterial DNA polymerase with 5’ to 3’ exonuclease activity. Excision repair enzyme and removes RNA primers.
Xeroderma pigmentosum has defectiveExcision endonuclease.
Alpha-amanitin in death cap mushroomsInhibits RNAP2 (which makes mRNA, largest RNA). Causes severe hepatotoxicity.
NucleolosrRNA synthesis by RNAPol1.
Rifampin inhibitsRNAP in prok (recall, Prok only have one RNA poly to make all 3 kinds of RNA).
Actinomcin D inhibitsRNAP in both Pro and Euk. Not used except in lab.


Question Answer
Mousy musty odor + eczema + mental retardationPKU
PKU occurs when what enzyme lostPhenylalanine Hydroxylase
PKU is autosomalRecessive.


Question Answer
ApocrineOdorless when secreted but become malodorous secondary to skin commensal bacteria.
Apocrine locationAxilla, subcutaneous fat of breast areolae, genital regions, dermis. Secrete sweat into hair follicles rather than directly to skin.
ApocrineADRENERGIC; not functional until puberty
Eccrine/ merocrineCHOLINERGIC
Eccrine/ merocrine glandsOn skin; secrete watery fluid rich in Na and Cl