UWorld 4

gubavula's version from 2016-08-02 19:54


Question Answer
Ulcer is worse and extends intoSubmucosa only (Gi layers - Mucosa-Musculari mucosa-Submucosa-Muscularis propria-Serosa)
Erosion is better and only extends tillMucosa (Muscularis mucosa) (Gi layers - Mucosa-Musculari mucosa-Submucosa-Muscularis propria-Serosa)
Japanese Puffer fish bindsto voltage gated Na channel(teratodotoxin) inhibting Na influx -> Depolarization
Multiple sclerosis left optic nerve demyelinizationLight reflex defect of the left eye -> right eye no constriction when light shined on the left eye / Right eye light shining would constrict both left and right pupils
75% occlusion without any thrombusStable angina
Rupture atherosclerosis plaque with ruptured thrombosisMyocardial infarction
Ulcerated atherosclerosis plaque with partially obstructed thrombosisUnstable angina
Calcium is needed inTo release vesicles to release there contents into the synaptic cleft
Hyperpigmented macules(cafe- au spots), Soft fleshy cutaneous tumorsNF1 -> Derived from Neural crest -> Autosomal dominant
Galactorrhea pt due to anti-psychotic medication -> Breast engorgement & tendernessDopamine inhibit prolactin secretion and in this pt dopamine is missing from tubuloinfundibular pathway
Small gap near the tip of the long arm of the X chromsome, mild intellectual disabilityFragile X Syndrome -> Macro orchidism, long ears
ADHDInattention or hyperactivity in greater than TWO settings
Normal glucose levels, severe cardiomegaly, macroglossia, hypotonia, glycogen accumulation in lysosomesPompe diseases -> Acid a-glucosidase
Hepatomegaly & steatosis, fasting hypoglycemia, lactic acidosis, hyperuricemia &hyperlipidemiaGlucose 6-phosphatase(Von gierke)
Hepatomegaly, ketotic hypoglycemia, hypotonia, abnormal glycogen with very short outer chainsDebranching enzyme - Cori Disease -> a-1,6-glucosidase OR a-1,4-transferase
Muscle phosphorylsae deficiency, weakness & fatigue with exercise, no rise in blood lactate levels after exerciseMcArdle disease -> Glycogen Phosphorylase
Doxorbicin toxicitydIlated cardiomyopathy -> give dexrazoxane
Restricted cardiomyopathy associated withHemochromotosis, amylodosis, sarcoidosis, and radiation therapy
Squatting in TOFIncreases SVR & decreases right to left shunt
Lady present with right axilla lymph node sweliing, multiple scratches, works as a veterinarianCat scratch disease in health pts -> Bacillary Angiomatosis in immunocompromised & Culture - endocarditis
Frame shift mutationDeletion one or two nucleotide but NEVER 3 -> AU, A
C-jun / C-fosSouthern western blot -> DNA-protein are nuclear transcription factors
Fatigue, Paresthesia, MCV increased, atrophy of gastric body & fundusPernicious anemia(autoimmune disorder) -> Destruction of parietal cells -> Lack of intrinsic factor -> Secreted from Upper glandular layer(2nd)
Irritable, feedspoorly, vomiting, white yellow chorioretinal lesions in both eyes, enlarged ventricles, scattered intracranial calcificationsCongenital toxoplasmosis gondii -> In-utero infection
Nitroblue tetrazolium testing NegativePositive Catalase organisms recurrent infections -> Chronic Granulomatous disease -> NADPH Oxidase deficiency
MAO inhibitors+ SSRIContraindicated due to increase serotonin in the presynaptic -> Serotonin Syndrome-> Give SSRI 2 weeks so MAO A&B can be formed to BREAK DOWN too much serotonin from SSRI
Pt urinates when coughUrethral support & Intrabdominal pressure exceeds urethral sphinctor pressure
Urge incontinance(Constantly wants to pee)Detruser hyperactivity
Commoncold(fever,cough,sore throat,runny nose), Naked viral particlesRhino virus
Retrosternal discomfort, dysphagia, reduced number of inhibitory ganglion cells, decreased amplitude of peristalsis esophagus, increased tone & incomplete relaxation at the LESAchalasia
Silicosis leads to apoptosis of macrophages leading toIncreased risk of tuberculosis
SSRI sxSexual dysfunction
Glucose transport across adipocytesCarrier mediated transport(L-glucose & D-glucose transport)
Little girl had a few days ago, colicky abdominal pain, vomiting, and loose blood stools later few days has low urine output, conjunctival pallor, low platelets & hemoglobinHUS -> Microthrombi in small blood vessels
Ganciclovir + Trimethoprim-sulfamethoxazole SXNeutropenia due to bone marrow suppression
Foscarnet SxHYPOcalcemia, HYPOkalemia, HYPOmagnesemia, HYPOphosphatemia
Amiodarone SxThyroiditis, Hyperthyroidism, Hypothyroidism
Amphotericn SxRenal toxicity(renal vaso constriction & low gfr), Severe hypokalemia & hypomagnesemia(increased tubular membrane permeability, Low epo production
Malignancy MOST LIKELY to develop in an Asbestosis ptBronchogenic carcinoma
Bright red tongue, rash in the abdomen & chest that blanches with pressure, sore throat with gray white tonsillar exudates(BACTERIAL), mouth circumoral pallorS.Pyogenes -> Untreated complication is Rheumatic fever(DO NOT CONFUSE WITH KAWASAKI DISEASE)
AcetazolamideDiuretic to treat glaucoma(works at the proximal convoluted tubule)
Transcription (DNA-> mRNA)Northern blot
Translation(mRNA -> protein)Western blot
Fast twitchType II -> Anaerobic glycogenolysis (Biceps, Latismus Dorssi, Deltoid, Pectoralis major)
Slow twitchType I -> Myoglobin rich, glycogen poor fibers, mitochondria (Soleus, paraspinal)
Lymph nodesGerminal centers -> B cells -> Cd 40 ligand for isotope switching
Normal phenylalanine levels, neurological abnormalities, microcephaly, elevated prolactin(low dopamine)Cofactor enzyme- Dihydropteridine reductase / Enzyme Deficiency DOPA -> Dopamine- Dopa decarboxylase / Enzyme deficiency Phenylalanine -> Tyrosine- Phenylalanine hydroxylase
Intracellular hemosiderin accumulationCommon in hemolytic pts OR frequent transfusion pts
Dystrophic calcification of elderly aging healthy normal pt valves in setting of normal calcium levelsDue to cell necrosis(injury or death) -> Psammoma bodies
AV node supplied byAV nodal artery -> Posterior descending artery -> left circumflex artery(Left dominant) 10%
AV node supplied byAV nodal artery -> Posterior descending artery -> Right coronary artery(right dominant)70%
Infection-> High fever -> High body temperature -> Seizures txAcetamenophen
Hot temperature -> High body temperature txRapid external cooling
Tender with deep palpation or on stretching with adduction or internal rotation of the legPiriformis syndrome -> Due to hypertrophy or muscle injury can compress sciatic nerve -> Pain, tingling, or numbness of buttocks
G6PD biochemical pathwayNAPH made is required for -> Cholestrol synthesis / Glutathione antioxidant mechanism
Twins -> Male & female (Non - identical)Dichorionic/diamnionic
Twins identicalMonochorionic/Monoamnionic
Difficulty walking, muscle cramps after walking one block, resolves with rest, decreased sexual performanceDue to lipid filled initimal plaques
DNA-mRNA-Protein -> Translation - TranscriptionS-N o -W -> DRoP
Incomplete fusion of uretheral folds(vagina in female)In male causes Hypospadias
Abnormal opening of urethera on the dorsal surface due to faulty positioning of the genital tubercle in the fifth week of gestationEpispadias
Cheidak Higashi(Japanese)Oculocutaneous Albinism, Peripheral neuropathy -> Dysfunction of phagocytes, phagosome-Lysosome fusion
TBTHINK of Macrophages and Cd 4 T-lymphocyte -> Granulation
Young female pt has bone fracture from falling from chair height(osteoporosis- low estrogen), Diagnosed with hyper prolactanioma a few yrs ago(hypogonadism -> Low estrogen), pathophysiology for bone fracture can also causeVaginal dryness(Estrogen) DO NOT CONFUSE WITH MEN 1
Isoproterenol Dose dependent increase in contractile &↓in vascular resistance
Gastric acid -> Thoughts, taste, smell -> Increase gastric acid secretionCephalic phase(1)
Histamine secretion -> Gastric acid secretion -> Distention of the stomach -> Increase gastric acid secretionGastric phase(2)
Protein contain food enters the duodenum -> Decreases gastric acid secretionIntestinal Phase(3)
Lambert eatonImpotence and mouth dryness, difficulty climbing stairs or getting up from chair, Irregular round mass in the upper lobe of his right lung
Common fibular nerve injurySensory loss of the dorsum of the foot, Cant dorsiflex(deep peroneal nerve) and Evert(Superficial peronial nerve)
Tibial nerve injury Sensory loss of the soleus of the foot
3rd part of the duodenum artery foundSuperior Mesenteric artery
Ist part of the duodenum artery foundGastroduodenal artery / Common bile duct
UTI most commonE.Coli, Klebsiela Pneumonia(Lactose fermenting)
UTI oppurtunisticPsuedomonas(Oxidase + Non lactose Fermenting)
Chi square test2 categorical variables (Gender & smoking status)
ANOVA VS t-testMean of groups 2 or more vs Means of two groups(1 group moderate smokers, 1 group non smokers, 1 group light smoker, 1 group heavy smoker)
Young pt with gait disturbances, frontal balding, cataracts, gonadal atrophy, difficulty loosing grip after handshake or door knob release, atrophy of muscleMyotonic Dystrophy(CTG) -> Trinucleptide repeats
PostMenopause women, vaginal bleeding, thickened endometerium, solid left adnexal mass, abnormal endometrial biopsy, cuboidal cells in sheets with gland like structures containing acidophillic material, microfollicular pattern pink eosinophilic center(coffee bean)Granulosa cell tumor(Secretes estrogen)
Acute goutNSAIDS
Chronic GoutXanthine Oxidase Inhibitors(Allopurinol), Uricosuric agents(Probenicd contraindicated in Kidney stones pts)
Diabetes Mellitus Type II CAUSESAbdominal fat distribution(Insulin resistance), Excessive body weight [Resistance +Lack of Insulin] -> Islet Amlyoid deposition
Diabetes Mellitus Type I CAUSESDKA, Excessive thirst, Polyuria, Urine + for glucose & ketones, confusion, fatigue -> Islet leukocytic infiltration
Xeroderma pigmentosaThymine dimers later Endonuclease activity recognize the area and remove with new one
Prescribing medication for friends"I would like to help but I dont feel comfortable prescribing to for someone I am not treating"
Greatest risk factor for suicide isPrevious suicide attempts
Innervated by thoracodorsal nerve/ Internal rotation of shoulderLatissmus dorsi
Young pt with skin rash(Angio keratomasdark red, non-blanching macules -buttocks groin umblicus), burning sensation during exercise,stress or fatigue(Neuropathic pain), rarely sweats(Hypohidrosis), low levels of a-galactosidase A(Fabrys Disease)Increased globotriaosylceramide & Telangiectasis, Cerebrovascular(TIA,Stroke) & cardiac diseases(LVH), Renal failure(due to build of GT3)
Holosystolic murmur at the left sternal borderVentricular Septal defect
decreased femoral to brachial blood pressure ratioCoarctation of the aorta
Fixed wide splitting of S2Atrial septal defects
Bifid carotid pulse with brisk upstroke(spike & dome)Hypertrophic cardiomyopathy
Expect an hypertension pt on Thaizide diuritics to have labs ofLow serum Na & PTH & High Calcium(Due to the fact Hydrochlorothiazide excretes Na and reabsorbs Ca hence why good drug to use for osteoporosis pt)
A 10 yr old with excessive height and sweatingGigantism-> Due to increase Growth hormone stimulating IGF-1 release by the liver Sx - Sweating, Oily Skin, weight gain, prognathism
Gigantism VS AcromegalyTeenagers(Tall stature) VS Adults(Epiphyseal growth plates fused-> Sideways)
Cystic FibrosisAbnormal postranslational processing of transmembrane protein(CFTR)
History of fever, abdominal pain and diarrhea. Pt has a puupy who had a diarrheaCamplobacter Jejuni ->Corckscrew fashion-> fecal-oral-> initially water later bloody diarrhea -> mimic appendicitis -> Guillain barre syndrome related
Allopurinol & Azathioprine Clinical Significance?Allopurinol CONTRAINDICATED WITH Azathioprine-> Bone Marrow suppression due to active metabolite 6mercaptonurine is metabolized by Xanthine Oxidase.
Sore throat, High fever, cervical or auricular lymphadenopathy, petechie, splenomegaly, teenager, AgglutinatesEBV -> Nasopharyngeal carcinoma(Asian) & Burkitt Lymphoma(Black)
Child with PSGN, renal biopsy of electronmicroscopy showsImmune complex Deposits -> IgG IgM C3
RPGN electron microscopy showsFibrin Deposition
DIC SxPt bleeds, Coagulation elevated, PT & PTT prolonged, Low fibrinogen & Increased FDP(Fibrin degradation product)
TTP HUS SxUsually do not bleed, Platelets Activated, Coagulation NORMAL, Fibrinogen NORMAL
Pseudomonas & C. DiptheriaExotoxin A & Diptheria ToxiN -> Inactivating Elongation Factor 2 -> Inhibit Protein Synthesis
Goodpasture Syndrome & Mysthania GravisType II hypersensivity
NmycIs a transcription factor that has DNA binding ability -> Can be detected by DNA probes
After birth testing all babies for a disease is an exampleSensitivity -> Screening Test(Correctlyidentify people with disease)
Statins VS Bile acidsSimvastatin Decreases and Bile acid Increases Hepatic Cholesterol Synthesis
Apolipoprotein E-4 VS Apolipoprotein B-100Alzheimers Disease VS Familial Hypercholestrolemia
Right arm numbness, fluctuating tingling numbness right shoulder, arm, hand -> Swelling(Subclavian vein) or Pain(Subclavian artery)Thoracic outlet syndrome -> Compression of lower brachial plexus & scalene muscles
Partial pressure of oxygen alveoli-71mmhg(Normal 104), Partial Pressure of oxygen arterial blood-60mmhg(Normal 100), AlcoholicDx Hypoventilation with Normal A-agradient(71-60->11mmhg(Normal 5-15))
Partial pressure of oxygen alveoli-71mmhg(Normal 104), Partial Pressure of oxygen arterial blood-60mmhg(Normal 100), AthleticDx High Altitude Normal A-agradient(71-60->11mmhg(Normal 5-15))
Diffusion Impairment causes increaseA-agradient(5-15)
Right to left shunting increaseA-a gradient(5-15) -> Congenital cyanotic conditions
V/Q(Ventiliation/Perfusion) Mismatch increasesA-a gradient -> Airway obstruction, Pneumonia
Pseudohyphae & blastocondiaCandida
Septae Hyphae with dochotomous branchingASpergillous
Ondanestron DOC for nausea and vomiting5-HTreceptor antagonist
Pt during or after pregnancy leads to cardiogenic shock, Respiratory failure, DIC, seizures OR comaAmniotic Fluid embolism -> Pulmonary Artery branch with swirls of fetal squamous cells
Central US, cave exploration, oviod cells within macrophagesHistoplasmosis Capsulatum
DKAInitially Metabolic acidosis but later turnsinto respiratory alkalosis by hyperventialating->Respiratory Failure
Pt who had MI is started on fibrinolytic drugs to break down clot and then later went into comatose, asymmetric pupils& irregular breathing Intracerebellar bleedingAlteplase, Tenecteplase SX Hemmorrhage