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UWORLD
Overall review 6
| Question | Answer |
|---|---|
| What is Photoaging? | A product of excess exposure to UV-A wavelengths and characterized by epidermal atrophy with flattening of rete ridges |
| Which UV exposure aging process involves decreased collagen fibril production? | Photoaging |
| In addition to less collagen fibril production, photoaging also produces: | Increased degradation of collagen and elastin in the dermis |
| How is Hypothyroid myopathy clinically presented? | Myalgias, proximal muscle weakness, elevated CK levels, and delayed relaxation of deep tendon reflexes |
| Is CK level elevated or decreased in hypothyroid myopathy? | Elevated |
| How is Hypothyroid myopathy diagnosis confirmed? | Elevated TSH level |
| Which are some myopathies that cause elevation in CK level? | Inflammatory myopathies, muscular dystrophies, and HMG-CoA reductase inhibitors |
| Which interaction is ESSENTIAL for the formation and differentiation of Osteoclasts? | RANK---RANK-L |
| What is the nuclear factor kappa B associated with Osteoclast differentiation? | RANK |
| What is Osteoprotegerin mode of action? | Block the binding ro RANK-L to RANK and reduces formation of mature osteoclasts, leading to a decreased bone resorption |
| Osteoprotegerin use increases or decreased bone resorption? | Decreases bone resorption |
| What is a common monoclonal antibody used to treat osteoporosis in postmenopausal women? | Denosumab |
| Which monoclonal antibody works similar to Osteoprotegerin? | Denosumab |
| What compensatory mechanism are triggered by Hypovolemia? | 1. Activation of RAAS 2. Increased Vasopressin release 3. Increased sympathetic tone |
| What is the effect of aldosterone and Endothelin upon stimulation of RAAS? | Increased aldosterone and Endothelin levels |
| When does a Small Bowel obstruction occurs? | In setting when a mechanic or functional obstruction disrupts the normal flow of intestinal intraluminal contents |
| What is a common cause for Small bowel obstruction? | Herniated bowel loop as in a Inguinal hernia |
| What is a severe complication of herniated bowel loop obstruction by an inguinal hernia? | Incarceration of the hernia |
| What is the most common relation of Hypoxic-ischemic neuronal dalmage? | Formation of Reactive Oxygen Species (ROS) |
| What is a way to prevent ROS formation in brain, thus preventing or delaying neurological hypoxic damage? | Therapeutic hypothermia, as it decreases ROS formation by decreasing cellular metabolism and slowing reperfusion |
| What type of hypersensitivity is Serum Sickness? | Type III Hypersensitivity |
| What is Serum Sickness? | Type III hypersensitivity reaction to NON-human proteins characterized by vasculitis resulting from tissue deposition of circulating immune complexes |
| What are some clinical findings of Serum Sickness? | Fever, pruritic skin rash, arthralgias, and low serum C3 and C4 complement levels |
| How are both, C3 and C4 serum levels in Serum Sickness? | Both are low in the blood |
| Which type III hypersensitivity reaction is characterized by low serum levels of C3 and C4? | Serum Sickness |
| What is the most likely diagnosis of a painless, solid scrotal mass that does not transilluminate? | Testicular cancer |
| What are some of the findings of testicular findings in physical exam? | Solid, firm, or fixed nodule in the tunica albuginea that is ovoid in shape and painless to palpation |
| Is testicular painful or painless to touch? | Painless to touch |
| What is Leukemoid reaction? | Significant leukocytosis that occurs in response to an underlying conditions, commonly a severe infection |
| What are common histologic findings in PBS of a Leukemoid reaction? | Neutrophilia with reactive features ( Dohle bodies), as well as neutrophil precursors (bands, metamyelocytes, and myelocytes) |
| What are some common neutrophils precursors? | Neutrophilic bands, metamyelocytes, and myelocytes |
| How are the levels of LAP in Leukemoid reaction? | Normal or increased |
| Is LAP expected to rise or fall in a Leukemoid reaction? | Rise |
| What glomerular disorder is associated with malignancy, viral hepatitis, and SLE? | Membranous glomerulonephritis |
| What causes the thickening of the glomerular basement in Membranous glomerulonephritis? | Immune-complex deposition in the subepithelial portion of the glomerular capillary walls |
| What is the description given to the immune-complex deposits in the subepithelial portion of the glomerular capillary walls in Membranous glomerulonephritis? | "Spike and dome" appearance when stained with silver stains |
| Silver stain of a glomerular wall sample shows a "spike and dome" appearance. Dx? | Membranous glomerulonephritis |
| Membranous glomerulonephritis. Nephrotic or Nephritic syndrome? | Nephrotic syndrome |
| Which two viral hepatitis types are the ones most likely to cause HCC? | HBV and HCV |
| How does HBV infection increase likelihood to develop Hepatocellular carcinoma (HCC)? | 1. Chronic inflammation and cell turnover 2. Carcinogenic due to production of oncogenic proteins and the insertion of HBV genome into host chromosomes |
| What is a unique form by which HBV causes HCC? | Carcinogenicity; due to production of oncogenic proteins and the ability to insert the HBV genome into host chromosomes |
| What IBD is often associated with Short Bowel syndrome? | Crohn disease |
| When is Short bowel syndrome most likely to occur? | In patients with massive small bowel resection and/or Crohn disease due to loss of intestinal absorptive surface area and decreased intestinal transient time |
| What condition is often due to a decrease in intestinal absorptive surface area in increased transient time? | Short bowel syndrome |
| How is Short Bowel syndrome most likely presented? | Postprandial voluminous diarrhea and weight loss due to malabsorption |
| Which important vitamin deficiency may be due to loss of function of the distal ileum? | Vitamin B12 deficiency |
| What is a possible and high risk complication of Axillary lymph node dissection? | Ipsilateral chronic lymphedema |
| What is a common complication of chronic lymphedema? | Angiosarcoma |
| What is a syndrome due to chronic lymphedema leading to Angiosarcoma? | Stewart-Treves syndrome |
| What is Stewart-Treves syndrome? | Rare angiosarcoma that develops in people with long-standing lymphedema |
| Which people or patients are at higher risk of developing Stewart-Treves syndrome? | Breast cancer patients treated with radical lymphadenectomy |
| What are the clinical signs of Psoriasis? | 1. Psoriatic arthritis 2. Nail changes 3. Uveitis |
| What are significant features fo Ankylosing Spondylitis? | Inflammatory spondyloarthropathy characterized by simultaneous erosion of bone and new bone formation |
| Which bone areas are most likely to develop erosion of bone in Ankylosing spondylitis? | Vertebral bodies |
| Where is most of the new bone formation in Ankylosing spondylitis? | At the junction of periosteal margin and adjacent cartilage, leading to bridging syndesmophytes and ankylosis |
| What is the result of new bone formation at the junction of perostea margin and adjacent cartilage in Ankylosing Spondylitis? | Bridging of syndesmophytes and ankylosis |
| What are the clinical (symptoms) manifestations of the bridging syndesmophytes and ankylosis seen in Ankylosing Spondylitis? | Spinal rigidity, postural alterations, and increased risk of fracture |
| What virus is strongly associated with Burkitt lymphoma? | EBV |
| Which virus is associated with almost all primary CNS lymphomas occurring in HIV (immunocompromised) patients? | EBV |
| What feature (lab measurement) is typically indicative of Burkitt lymphoma? | High mitotic index |
| High mitotic index + submandibular mass + EBV genome. Dx? | Burkitt lymphoma |
| What causes Amyloid cardiomyopathy? | Accumulation of misfolded amyloid fibrils, appears as pink, amorphous extracellular material on LM |
| What are the structural changes of LV cavity? | Normal and slightly decreased |
| What occurs to the ventricular walls of Amyloid cardiomyopathy? | Ventricular wall become stiff and uniformly thickened, leading to impaired diastolic relaxation, and a dilated left atrial cavity, and progressive left-&-right sided heart failure |
| How is Fibromyalgia most likely presented? | Most commonly in women age 20-55, and presented with diffuse musculoskeletal pain, fatigue, and neuropsychiatric disturbances |
| Which condition is characterized by abnormal central processing of painful stimuli? | Fibromyalgia |
| What has proved to improve pain and function in patients with Fibromyalgia? | Aerobic exercise |
| What is the role of the CFTR protein? | Reduces Cl- secretion and increases sodium reabsorption by the respiratory epithelial, ,resulting in dehydrated mucus |
| Which condition is due to defective CFTR protein? | Cystic Fibrosis |
| What is the result of administering saline to a patient with Cystic fibrosis? | Increased sodium absorption in patients with CF causes a more negative transepithelial potential differences |
| How si Retinal Artery Occlusion presented clinically? | Sudden, painless and permanent monocular blindness |
| What are some funduscopic findings of Retinal Artery occlusion? | Pale retina and "cherry-red" macula |
| What are the arteries irrigation bodies of the lungs? | Supplied by dual circulation from the Pulmonary and Bronchial arteries |
| What is the reason behind the dual (collateral) blood circulation to the lungs? | Protects against lung infarction due to pulmonary artery occlusion, as the bronchial circulation can continue to provide blood to the lung parenchyma |
| What is Creatinine (Cr)? | Waste product generated by the breakdown of Cr in the muscles, and is used to estimate GFR |
| What is the formation of Creatine dependent on? | Muscle mass and meat intake |
| What is often a factor of age that promotes development of primary hypertension? | Progressive decrease in AORTIC COMPLIANCE |
| What some hemodynamic changes due a decrease in Aortic compliance? | 1. Increase in pulse pressure 2. Slight decrease in diastolic pressure |
| What population is often associated with Isolated Systolic hypertension? | Elderly |
| Why do DM1 patients on exogenous insulin have a higher risk of hypoglycemia? | Insulin will continue to be absorbed from the injection site despite falling glucose levels |
| How is glucagon associated with long-standing DM1? | Develops decreased glucagon secretion and therefore, added to exogenous insulin administration, have a greater risk for rapid hypoglycemia |
| What are the effects on Preload and SVR in PDA? | 1. Increased left ventricular preload 2. Decreased SVR |
| What leads to increased LV preload in PDA? | Increased pulmonary venous return to the left atrium |
| What causes the decrease in SVR in patient with PDA? | Continuous Left to Right shunt |
| What does the combination of higher LV preload and lower SVR in PDA patient result in? | Early increase in Left Ventricular Cardiac Output |
| What is the reason for the early increase in LV CO in PDA? | Increased LV preload + Decreased SVR |
Created by:
rakomi
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