UWorld 9

ruvehici's version from 2016-07-16 02:12


Question Answer
A CHF pt on hydralazine and isosorbide dinitrate. ContraindicationSildenafil
Pt with a history of Rheumatoid Arthritis presents with intermittent sharp pain, which is exacerbated by deep breathing and can be decreased by leaning forwardPericarditis
Pt with high triglycerides and the MOA for the vitamin used for TX isAntagonize VLDL Cholesterol Secretion
Fibrate MOAIncreases catabolism of LDL-cholesterol
Minimal Alveolar concentration of an anesthetic has to do withPotency
Blood Gas partition coefficientSolubility and rate of absorption into CNS
Lower Blood gas partition coefficientFaster onset
Higher Blood gas partition coefficientSlower Onset and need more drugs
Roundworm Ascaris LumbricoidesFeces contaminated soil
Pt with DM 2 presents with erythema of the mid calf, edema, exquisite tenderness of the ankle, after cutting his R foot, along with High Leukocyte count. reaction is due toLeukotriene
Drug X alone has decreased BP but Drug X + Angiotensin II increased the bp slightly meansDrug X is partial agonist at Angiotensin II receptors
Pt with a history of Prostate cancer and had an orchiectomy later presents a few weeks later for a followup and showsProstate with scattered shrunken cells due to lack of testosterone from the Testes
Herpes Simples viral enzyme isDNA polymerase
Despite Chloroquine administration what survives?P.Vivax & P.Ovale because you also NEED Primaquine
PTT prolonged in a pt leads to coagulation factors abnomal and inflammatory factor abnormal isKallikrenin (Also works with brady kinin and plasmin)
Hepatits C liver biopsy shows lymphocytic infiltration and collagen deposition is due toChronic Inflammation (lymphocytes is the primary immune reaction)
Non Selective antagonist blocks a1 & b-adrenoreceptorsLabetalol Dx - Hypertension
Pink rods and blue cocciG- and Outer membrane are characteristic
Pudendal nerve respnsible forEjaculation
Hypogastric NerveEmission
Ilioinguinal NervePhysical contact leads to erection for a short period of time
Pt with severe abdominal pain with nausea, vomiting, which the pain originates in the left flankand radiates to the groin with high blood pressure, with tenderness of the left flank and the let lower quadrant of the abdomenUreteral Calculus
Horseshoe Kidney Pt with aneurysm abdominal complicationAbnormal Origins of multiple renal arteries to each kidney
Ligament of the spineLigamentum Flavum
Damage to what structure is very common during the removal of prostatePelvic Parasympathetic Nerves
25-year-old man with severe pain of his low back that radiates down his left leg. He tried to lift a bar loaded with 91 kg (200 lb) from the ground to over his head. The pain began immediately after this attempt. Most likely cause of this patients pain?Rupture of the inter-vertebral disc
Infrapinatus & teres minorRotate the head of humerus outward/ external/ or lateral rotation
SubscapularisMedial(Internal) Rotation & Adduction
Superior Orbital FissureCN III, IV, V1, VI
Foramen RotundumCN V2 Maxillary Branch
Foramen OvaleCN V3 Mandibular Branch
Internal Auditory MeatusCN VII, XII
Jugular ForamenCN IX,X,XI
Foramen SpinosumMiddle Meningeal Artery
Pt who presents with a history of chronic atrophic gastritis complains of lethargy, dizzines, decreased vibratory senses, and HIGH MCV Diagnosis?B12 deficiency due to Parietal cells missing from chronic atrophic gastritis
Release of Hydrogen ionParietal cell Fried egg appearance
SarcoidosisHigh calcium, Low sodium
Cigarette SmokingMucus secretion & Macrophage function GOES UP, Activity of airrway cilia GOES DOWN
6wk-old boy with homozygosity for hemoglobin S(Sickle cell). Daily Rx with penicillin decreases risk of infx from which organism?Most common Streptococcus pneumoniae
Giardia VS Chagas (DO NOT CONFUSE SPECIMEN)Nifurtimox
Pt present with abdominal pain, bloody diarrhea after kenya trip, stool specimen shows throphozoites dysplaying erythrophagocytosis RBC's in the cytoplasmEntamoeba histolytica
Filamentous g + rodNocardia Species
Pt who is going through chemotherapy for ALL Immnocompromised is having lung infiltrates and they are stained with PAS Stain Fungal. DOC?Amphotericin B
45-year-old fever chills, dysuria and a tender, enlarged prostate. Organism?Escherichia Coli
Pt who is alcoholic is collapsed and coughing on park bench.Halitosis, missing teeth, dental caries Chest exam shows increased fremitus, dullness to percussion, and tubular breath sounds over the right lower lung field Pneumonia Sputum shows purulence, gram-positive cocci in chains, and gram-negative bacilli. CXR shows cavitation of right lower lung lobe. Diagnosis?Aspiration Pneumonia -> Normal oral flora NOT supposed to be in lungs
Woman with 1-week history of fever and chills. 4.5-kg weight loss, 5-year hx of chronic sinusitis Temp 102.2 F Has markedly diminished nasal septa. Chest x-ray shows multiple pulmonary nodules Serologic studies show presence of antibodies against proteinase 3 Dx?Wegener Granulomatosis
30yr old man develops hemoptysis, dyspnea, weakness, and hematuria Diffuse pulmonary hemorrhages bilaterally. Renal biopsy shows focal glomerular necrosis with crescent formation and linear deposition of IgG and C3 in glomerular capillary loops Pathogenic mechanisms responsible?RPGN -> Goodpasture Syndrome - Autoantibodies against host cell basement membranes
SarcoidosisEpitheloid macrophages produce High Vitamin D(1,25-Dihydroxycholecalciferol) BUT LOW PTH
Neurotransmitter for PainSubstance P
Bringing body temeprature down is dueEvaporation of sweat
45yr old with congestive heart failure. Two 1st degree relatives died in 40s with dilated cardiomyopathy and cirrhosis Genetics Has cardiac enlargement and generalized hyperpigmentation Glucose is 320. Histologic exam of endomyocardial tissue is most likely to show an excess of?Hemochromotosis -> Iron
24-year-old African American M with 3-mo Hx of red bumps on his face and chin, istchy and painful. Hyperpigmented papules over the cheeks, jawline, and neck~ Dx?Pseudofolliculitis Barbae (Razor Rash)
Menopause confirmed byIncreased Follicular Stimulating Hormone
CT angiography shows large embolism occluding blood flow to the right lower lobe. Which describes ventillation-perfusion relationship in right lower lobe?Dead space
27yr f with 3-week hx of episodes of left-sided chest pain and tenderness radiating to the back and exacerbated when reaching over her head or back. No SOB, sweating, or light-headedness Tenderness to palpation 2 cm lateral to the midline and 10 cm below the clavicle on the left CXR and ECG normal. Dx?Costochondritis (Inflammation of the Ribs)
Charcot Leyden Crystals and eosinophilsAsthma -> Pathogenesis involves Leukotriene C4
24yr old M with nasal congestion, discharge, and sneezing. Happen each spring Which drugs is most effective in relieving these sx in the SHORT TERM?Alpha-adrenergic agonist(Phenylphrine, Midodrine, Epinephrine)
2yr old boy with increased thirst, urinary frequency, and failure to thrive, dehydration and decreased muscle tone. Diagnosed with Fanconi syndrome MOA?Proximal tubular reabsorption problem in kidneys - Amino Acids DECREASED; Glucose DECREASED, Phosphate DECREASED, HCO3 DECREASED
Pt is started on PPI. Measurement of which is next step?Serum calcium concentration OR Magnesium
Thyroglossal duct cystMidline neck and will move with swallowing
Female newborn, Pregnancy complicated by untreated maternal Graves disease. Stridor, nasal flaring, intercostal retractions, and an asymmetric neck mass Cause of the stridor?Enlarged Thyroid Gland
18year-old with fever, malaise, blood in urine since she began oral antibiotic therapy for a UTI 5 days ago 3-day hx of rash , petechial rash over the chest, back, and upper and lower extremities. U/A shows: Blood 3+, Protein 1+, WBC 150 (30% eosinophils). Dx?Interstitial nephritis
66yr-old man surgical excision of a brain mass; photomicrograph of excised tissue shown. Smoked 1 pack daily for 50 years. Labs show polycythemia, hypercalcemia, and microscopic hematuria Immunostaining of the tissue is positive for epithelial membrane antigen and negative for carcinoembryonic antigen Site of primary neoplasm?Kidney(Renal Cell carcinoma)
38-year-old woman for checkup, No illness. No meds. Labs show Hb 8.2, HCT 25%, MCV 69 (Microcytic Anemia) WBC 5.9k, Retics 0.8%, platelets 350k. Dx?Iron deficiency anemia NOT B-Thalasemia Minor(Increased HbA2 >3.5%
yr old with diagnosis for pheochromocytoma. Before excising the tumor make sure to give what drugs?Phenoxybenzamine & Propanolol
Non-selective antagonist that blocks alpha-1 and beta Labetalol
69-year-old African American woman has moderate hypertension and type 2 DM. BMI 31. On hydrohlorothiazide. Labs show microalbuminuria (Kidney Remodelling) Most appropriate to add which drugs?1st line ACE, 2nd Line Sartans - eg Irbesartan
Newborn female dx with hypothyroidism 2 days after birth. Ultrasonography of the neck shows absence of any thyroid gland tissue. Physical is normal. Maternal to fetal transfer of which explains normal development?Thyroxine (T4) passes through the utero Mother -> Fetus
Ghrelin GRAWRR Hungry!When you eat Ghrelin levels GO DOWN
Hammer toes Seen inFriedriech Ataxia & Charcot Marie Tooth
Sudden onset headache with 163/90 BP, Non-reactive pupil, Adduction of right eye impaired Nuchal rigidity, blood in subarchanoid space, Which artery had the aneurysm?Posterior Communicating Artery ->CN III Palsy down & out
Pancreatic cancer risk factor(Abdmonial pain raditiating to back, Weightloss,Migratory thrombophlebitis, obstructive jaundice with palpable gallbladder)Tobacco use, Chronic pancreatitis, Age >50, Jewish & African american males
32yo F G4P0A3 delivers female with dysmorphic features and numerous organ anomalies Mother has had spontaneous abortions, and this is her first liveborn child. Explanation of the abnormalities?Unbalanced Chromosome rearrangement -> Meiotic Nondisjunction of homologous chromosomes
Sheep blood agarB-hemolytic -> S.Aureus, S.Pyogenes, S.Agalactiae, L.Monocytogenes
24-year-old woman stung on her right thumb by a bee. Six hour later, area has become indurated and firm. Explanation of the induration?Influx of macrophages producing interleukin-1 (IL-1), IL-6, and tumor necrosis factor-alpha
64 yr old alcoholic man with 1 day of confusion. Disoriented, disheveled. Dehydrated, jaundiced. and has spider angiomata over face and chest Has flapping up and down of the hands when his arms are outstretched. Abdominal distention and bulging flanks. He is administered oral neomycin Question asks which of the following primary mechanisms of action is most likely to occur in this patient as a result of the drug treatmentKilling of bacteria in the gut that generate ammonia
27yr old M with Hodgkin lymphoma receives BMT from first cousin. 2 weeks later, develops generalized erythematous maculopapular rash, diarrhea, and elevated concentrations of liver enzymes and bilirubin (GVH-Disease) Cause?Donor T lymphocytes reacting against host cells
50yr old M with fever and SOB for 3 days. Gram stain shows numerous neutrophils, gram-positive diplococci. Which enzymes initiate intracellular killing of the diplococciCatalase
62yr M with pain in the left hip foe 3 weeks X-ray of the hip shows 4.5-cm osteoblastic lesion with fracture in the proximal femur and two separate similar smaller lesions in pelvis. Biopsy shows metastatic carcinoma. Most likely primary?Prostate
20yr F with BP 140/100. BUN 50, glucose 90. U/A shows numerous WBCs and WBC casts protein excretion is 3000 mg/24h. GFR is 20% of normal. Ultrasonography shows small asymmetric kidneys with broad scars and blunted calyces, with vesicoureteral reflux Dx?Bilateral hydronephrosis
PCOS LABHIGH Insulin, Testosterone & LH, Estrogen LOW fsh
26yr M undergoes colonscopy for tenesmus and bloody diarrhea . Affected area from rectum to Mid ascending colon Biopsy shows microabscesses within the crypts and depletion of mucus from goblet cells.Terminal Ileum NORMAL Dx?Ulcerative colitis
55yo M with constipation since starting OTC medication 2 weeks ago for a chronic, persistent cough and sinus congestion. Which ingredients is causing new symptom?Dextromethorphan
Cells from which of the following areas of the kidney first show signs of anoxic injury?PCT, Thick ascending limb
Menstrual Cycle - High estradiol and low progesteroneDay 12
Menstrual cycle - High progesterona and low FSHDay 21
Menstrual cycle - High FSH, LH, ESTRADIOLDay 14
Machine like murmur, cyanotic baby, aorta lying anterior, inferior, and to the right of the pulmonary artery, Failure of what?Spiraling -> Transposition of The great Arteries
Pt with pulmonary infiltrates had blood coagulate in cold and un-coagulate in warm weatherMycoplasma pneumonia
A-adernargic agonists(brimonidine)Inhibit production of aqueous humor due to vasoconstriction in the ciliary body
Beta blockers glaucomaDecrease production of aqueous humor
Prostaglandins glaucomaIncrease outflow of aqueous humor
Drug the blocks the rewarding and reinforcing effects/ craving of alcohol through MU receptorsNaltrexone aka antidote for morphine Opiod antagonist
Direct frontal trauma of orbital floor affectsInfraorbital nerve of the maxilla -> Paresthesia of upper cheek, upper lip, upper gingiva & affects inferior rectus muscle(vertical gaze)
Insulin resistance measured byViseral obesity Wait-hip ratio
Growth Hormone pathwayJACK-STAT Pathway
Headache and vomiting, papilledema, dry skin, hepatosplenomegaly in a pt with crazy dieting (Intracranial Hypertension)Vitamin A overuse
>2 symptoms(Delusions, hallucinations, disorganized speech) for 1 month with signs of disturbance or other symptoms for more than 6months dx?Schizophrenia
Throught out the year pt had depressive sx, socially isolated, lack of interest, BUT FOR past 1 month disconnected from the world and drinks his urine and says he lives " in the holy buffet of diplomacy"Schizophrenia
25 yr old women, pan cytopenia(low rbc, leukocytes, platelets), proteinuria & rbc casts(SLE nephritis), arthralgias in handsSLE
MOST likely TZD sx?Weight gain & edema
: GI
Question Answer
Eosinophil Infiltration of lamina propria & mucosaCrohns Disease
Granulomas in bowel wall and serosaUlcerative colitis
Loss of vili & increased number of epithelial lymphocytesCeliac disease
Macrophages containing periodic acid-schiff positive bacilli in lamina propriaWhipple Disease(Arthralgia, cardiac, and neurologic)
Normal villi with epithelial cells vacuolated with fatLactase Deficiency