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UWORLD
QUESTIONS
Question | Answer |
---|---|
Ureters important landmarks | OVER: Common/External Iliac vessels UNDER: Gonadal Vessels (injury during ligation of Ovarian Vessels) LATERAL: Internal Iliac MEDIAL: Gonadal Vessel as they enter true pelvis |
Structure injured during ligation of uterine vessels in Histerectomy | Ureter |
Chi-Square | Association of 2 CATEGORICAL variables |
t-Test | Means of 2 GROUPS |
ANOVA (ANALYSIS OF VARIANCE) | Means of 3 or more GROUPS |
Meta-analysis | Pools data and integrates results from several similar studies to reach an overall conclusion (LIMITED BY: quality of individual studies or bias in study selection) |
ANTERIOR Drawer sign | ACL (anterior cruciate ligament) injury |
POSTERIOR Drawer sing | PCL (posterior cruciate ligament) injury |
Common injury in contact sports due to lateral force applied to a planted leg. | Damage to ACL, MCL and lateral meniscus |
Determines the dose rate required to maintain a steady state plasma concentration (Css) | Clearance= Vd x Ke= rate elimination/plasma drug concentration |
Maintenance Dose | Cp x CL/F |
Most important steps for prevention of central venous catheter infections | *Proper hand washing * Full barrier precautions durin insertion of a central line *Chlorhexidine for skin disinfection *Avoidance of the femoral insertion site *Removal of catheter(s) when no longer needed |
Gram (+) infects prosthetic devices and intravenous catheters | Staphylococcus epidermidis (Novobiocin sensitive; Biofilms) |
Patient with ATYPICAL depression who has a hypertensive crisis after a wine and chefs party! | MAO inhibitor-tyramine crisis (especially Phenelzine) |
MAO inhibitors MOA | Nonselective Monoamine Oxidase Inhibitors, increase level of amine neurotransmitters (NE, 5-HT, Dopa) |
Most common cardiovascular syndrome associated with SLE | Pericarditis |
Same sex twins | Dichorionic/diamniotic (2 oocytes, 2 sperm, 2 amnios, 2 chorions) |
Acute onset neurologic abnormalities + Hypoxemia + Petechial Rash | Fat Emboli (patient with severe long bone fracture and/or pelvic fracture) |
Types of PE | FAT BAT (Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor) |
Test of choice for a PE | CT Pulmonary Angiography |
Necrotizing Fasciitis | 1) Streptococcus Pyogenes (Group A strep) 2) Staphylococcus aureus 3) Clostridium Perfringens |
Pyrrolidonyl Arylamidase (PYR) positive | Streptococcus Pyogenes (Group A strep)--> Gram (+), catalase (-), beta hemolytic, bacitracin sensitive, forms chains |
Posterior Fossa malformations | Arnold Chiari Dandy- Walker |
Symmetric muscle weakness, endomysial inflammation with CD8+ Tcells, MHC I | Polyomyositis (LAB: increased CK, (+) ANA, (+)anti-Jo-1, (+)anti-SRP) |
Low EF, poor contractility, often 2º to Ischemic Heart disease or DCM | Systolic Dysfunction |
Isolated RHF | Cor Pulmonale |
Most common cardiomyopathy (90% cases) | Dilated Cardiomyopathy (S3, Echo->dilated heart, CRX->balloon appearance of heart) |
Eccentric hypertrophy of heart (sarcomeres added in series) | DCM |
Yeast and pseudohyphae (dimorphic), Positive Germ tube test at 37ºC | Candida albicans |
Four primary features of Neuroleptic Malignant Syndrome | 1. Hyperthermia 2. Extreme generalized rigidity 3. Autonomic Instability 4. Altered mental status Treatment: Dantrolene (D2 agonist) |
MOA of Typical Antipsychotics (Haloperidol + ¨-azines¨) | Block dopamine D2 receptors, increasing cAMP |
2 most common causes of 1º eugonadotropic amenorrhea | 1. Imperforate hymen 2. Mullerian Duct abnormalities |
1º amenorrhea in a female with fully developed 2º sex characteristics and normal levels of estrogens, gonadotropins | Mullerian duct abnormality |
Triad of abnormalities in ECG of Wolf Parkinson White | 1. Delta wave at the start of QRS complex 2. Shortened PR interval 3. Widened QRS |
Most common type of Ventricular Pre-excitation Syndrome | Wolf Parkinson White (abnormal fast accessory conduction pathway from atria to ventricle; bundle of Kent, bypasses AV node) |
BH4 is used as a cofactor for the synthesis of | 1. Tyrosine 2. Dopamine 3. Serotonin 4. Nitric Oxide |
Mononucleosis Monospot (-) | CMV |
(+) Monospot-heterophile antibodies detected by sheep agglutination RBCs | EBV |
Confirm Menopause | INCREASED FSH (loss of negative feedback on FSH due to low estrogen) |
Menopause before age 40 | premature ovarian failure |
Hormonal changes in Menopause | Increased: FSH, LH, GnRH Decreased: Estrogen |
Should be removed from a patients diet suffering from Aldose B deficiency (Fructose Intolerance) | decreased intake BOTH: fructose+sucrose |
Phosphodiesterase Inhibitors (Cilostazol,Dipyridamole) cause | Increase cAMP= VASODILATION |
Oxaloacetate forms aspartate while reacting with glutamate, whats the essential cofactor for this reaction | Pyridoxine (vit B6) |
ALL current cases | Prevalence |
New cases | Incidence |
Incidence rate | # NEW cases specified time period/Population at risk during SAME time period |
Prevalence | Prevalence= Incidence x Time |
Prevalence > Incidence | Chronic diseases |
Fever, urticaria, arthralgias, proteinuria, lymphadenopathy, decreased serum C3 levels following drug use | Serum sickness (Immune complex disease, type III Hypersensitivy) |
Most serum sickness is now caused by drugs (not serum) acting as | Haptens |
NORMAL urinary excretion in Pancreatic insufficiency, DECREASED with Intestinal mucosa defects or bacterial overgrowth | D-xylose absorption test |
DIAGNOSE Pancreatic Insufficiency | 1. Normal D-xylose absorption test 2. Increased neutral fat in stool |
MOST gastric ulcers occur in? | Lesser Curvature (Transitional zone) |
Enzyme activated responsible for pathogenesis of Acute Pancreatitis | Trypsinogen (converted to trypsin by enterokinase enteropeptidase, a brush border enzyme on the duodenal and jejunal mucosa) |
Pupillary light reflex | Illumination on 1 eye= bilateral pupillary constriction |
Decreased bilateral pupillary constriction when light is shone in AFFECTED eye relative to UNAFFECTED eye | Marcus Gunn Pupil (Afferent pupillary defect- due to optic nerve damage or severe retinal injury) |
Degranulation of MAST CELLS | IgE-Fc receptor aggregation on the cell surface |
Digoxin (Cardiac Glycoside); MOA | Direct inhibition of Na+/K+ ATPase leads to indirect inhibition of Na+/Ca2+ exchanger/antiport. INCREASING [Ca2+]i---> positive inotropy. Stimulates vagus nerve---> decreasing HR. |
Digoxin (Cardiac Glycoside); CLINICAL USE | 1. CHF (increases contractility) 2.Atrial fibrillation (decreases conduction at AV node and depression of SA node) |
1º line treatment for Atrial Fibrillation with Rapid Ventricular Response | 1. Ca2+ channel blockers (class IV, Antiarrhythmics): Diltiazem 2. Cardioselective beta blocker |
2º line treatment for Atrial Fibrillation with Rapid Ventricular Response | Digoxin |
Treatment for Rheumatoid Arthritis | TNF-alpha inhibitors |
lnfliximab, Adalimumab (TNF-alpha inhibitor) | 1. Crohn's disease 2. Rheumatoid arthritis 3. Psoriatic arthritis, 4. Ankylosing spondylitis 5. Inflammatory bowel disease (IBD) |
All TNF-alpha inhibitors predispose to | INFECTION including reactivation of latent TB. TNF blockade prevents activation of macrophages and destruction of phagocytosed microbes. |
What test should be performed before starting treatment with a TNF-alpha inhibitor | PPD skin test |
TNF-alpha inhibitors | 1. Etarnecept 2. Infliximab, adalimumab |
Anti-TNF-alpha monoclonal antibody | Infliximab, adalimumab |
Hypertension, hypokalemia, metabolic alkalosis and LOW plasma renin | Conn Syndrome (1º Hyperaldosteronism) |
Conn Syndrome (1º Hyperaldosteronism) is caused by | 1. Adrenal hyperplasia 2. Aldosterone-secreting adrenal adenoma |
Treatment for Conn Syndrome (1º Hyperaldosteronism) | 1. Surgery 2. Spironolactone (K+ sparing diretic, aldosterone antagonist) |
Single MOST important risk factor associated with Aortic Disecction | Hypertension |
CT shows intraluminal tear forming a ¨flap¨ separating true and false lumen | Aortic Disecction |
Aortic Disecction associated with | 1. Hypertension 2. Bicuspid aortic valve 3. Connective tissue disorders (Marfan syndrome) |
Clinical LAB features of Legionella pneumophila | -High fever (>39ºC) -Headache and confusion -Watery diarrhea -Hyponatremia -Sputum gram stain showing many neutrophils, but few or NO organisms -CXR: unilobar infiltrate that progresses to consolidation |
Sputum gram stain showing many neutrophils, but few or NO organisms | Legionella pneumophila (gram-negative, facultative intracellular) |
stain used for Legionella pneumophila | Silver stain |
Legionella pneumophila grows on | Charcoal yeast extract culture with iron and cysteine |
Legionella pneumophila detected clinically by | Antigen in urine. |
Associate Legionella pneumophila | Smokers and patients with Chronic Lung disease. Aerosol transmission from environmental water source (air conditioning systems, hot water tanks,etc) |
X-linked defect affecting the methylation and expression of the FMRI gene. | Fragile X; Trinucleotide repeat disorder (CGG) |
2nd most common cause of genetic mental retardation (after Down syndrome) | Fragile X |
Macroorchidism, long face with a large jaw, large everted ears, autism, mitral valve prolapse. | Fragile X (X-linked; FMRI gene;Trinucleotide repeat disorder (CGG)) |
Trinucleotide repeat disorder (CGG) | Fragile X (X-linked defect affecting the methylation and expression of the FMRI gene) |
ACE inhibitors | INCREASE: renin, AT I, bradykinin DECREASE: AT II, aldosterone |
Acute hemolytic cystitis (dysuria+hematuria) in children | Adenovirus (naked, dsDNA, linear) |
Thrombocytopenic purpura, recurrent Infections, Eczema | Wiskott-Aldrich syndrome |
Wiskott-Aldrich syndrome treatment | HLA-matched bone marrow transplantation |
mutation in WAS gene (X-linked recessive); T cells unable to reorganize actin cytoskeleton. | Wiskott-Aldrich syndrome |
Findings in Wiskott-Aldrich syndrome | 1. Decreased to normal: IgG, IgM 2. Increased: IgE, IgA 3. FEWER and SMALLER PLATELETS |
Aminoacids with 3 titratable protons | Histidine Arginine Lysine Aspartic acid Glutamic acid Cysteine Tyrosine |
Can be injured during axillary node dissection after mastectomy | Long thoracic nerve (C5-C7) |
Inability to anchor scapula to thoracic cage--> cannot abduct arm above horizontal position | Mucle deficit: Serratus anterior Injury: Long thoracic nerve (C5-C7) |
¨winged scapula¨ | Long thoracic nerve (C5-C7) injury |
Wide pulse pressure, bounding pulses and head bobbing | Aortic regurgitation |
Female>65yoa with unilateral headache, jaw claudication, pelvic girdle pain and morning stiffness | Temporal (giant cell) arteritis |
Temporal (giant cell) arteritis is associated with | Polymyalgia rheumatica. |
Lab finding in Temporal (giant cell) arteritis | INCREASED ESR. LM: granulomas in the media of the arteries, consisting of mononuclear infiltrates and multinucleate giant cells |
Temporal (giant cell) arteritis should be treated with high-close corticosteroids prior to biopsy to PREVENT | Vision Loss |
Temporal (giant cell) arteritis most commonly affects | Branches of Carotid Artery |
Most common cause of Acute Gastroenteritis in children and adults in INDUSTRIALIZED COUNTRIES | Campylobacter (Comma or S-shaped, oxidase positive, grows at 42°C) |
Campylobacter transmission | Fecal-oral through foods such as poultry, meat, unpasteurized milk. |
Major cause of bloody diarrhea, especially in children. | Campylobacter (Comma or S-shaped, oxidase positive, grows at 42°C) |
Common antecedent to Guillain-Barre syndrome and reactive arthritis. | Campylobacter (Comma or S-shaped, oxidase positive, grows at 42°C) |
Histone that ties nucleosome beads together in a string. | H1 Histone |
ONLY histone that is NOT in the nucleosome core | H1 Histone |
Single amino acid replacement in beta globin chain; substitution of Glutamic acid for Valine at position 6 | Missense mutation; Sickle Cell anemia |
Metalloproteinases | secreted by inflammatory macrophages in the intima and may reduce plaque stability by degrading collagen |
Bilateral metastases to ovaries. Abundant mucus, signet ring cells. | Krukenberg's tumor (Stomach Cancer) |
Vaccine contains type B capsular polysaccharide (polyribosylribitol phosphate) conjugated to diphtheria toxoid | H. influenzae Hib conjugated vaccine: increased IMMUNOGENICITY |
Death from cardiac cause within 1 hour of onset of symptoms | Sudden Death |
sudden cardiac death most commonly due to | lethal arrhythmia (e.g., ventricular fibrillation) |
Lippid-lowerin agent that can EXACERBATE Gout | Niacin (Vitamin B3) |
Niacin (Vitamin B3) side effects | 1. Red, flushed face 2. Hyperglycemia (acanthosis nigricans) 3. Hyperuricemia (exacerbates gout) |
Contralateral hemianopia with macular sparing | PCA |
Post-traumatic stress disorder | Disturbance lasts > I month, with onset of symptoms beginning anytime after event |
Persistent reexperiencing previous traumatic event. Nightmares, flashbacks, intense fear, helplessness, or horror. Leads to avoidance of stimuli associated with the trauma and persistent arousal. | Post-traumatic stress disorder |
Post-traumatic stress disorder, Treatment | psychotherapy, SSRis. |
Acute stress disorder | 3 days- 1 month |
Most common childhood systemic vasculitis. Often follows URI | Henoch-Schonlein purpura |
Henoch-Schonlein purpura, Classic triad: | Classic triad: • Skin: palpable purpura on buttocks/legs • Arthralgia • GI : abdominal pain, melena, multiple lesions of same age |
Henoch-Schonlein purpura associated with | IgA nephropathy |
Vasculitis 2º to IgA + C3 complex deposition | Henoch-Schonlein purpura |
Virchow's triad | • Stasis • Hypercoagulability (e.g., defect in coagulation cascade proteins, most commonly factor V Leiden) • Endothelial damage (exposed collagen triggers clotting cascade) |
Gestational Diabetes | •Increased INSULIN-->Islet cell hyperplasia= HYPOglycemia in neonate |
The pancreas is derived from | Duodenal portion of the Foregut |
GI embriology | Foregut-pharynx to duodenum. Midgut-duodenum to proximal 2/3 transverse colon. Hindgut-distal 1/3 transverse colon to anal canal above pectinate line |
The ventral pancreatic bud becomes | 1. Uncinate process 2. Pancreatic head 3. Main pancreatic duct |
The dorsal pancreatic bud becomes | Everything else! 1.Tail 2.Body 3.Isthmus 4. Accessory pancreatic duct |
Airway an GI infections, Autoimmune disease, Atopy, Anaphylaxis to IgA containing products | Selective IgA deficiency (Most common 1º immunodeficiency) |
Most common 1º immunodeficiency | Selective IgA deficiency |
The consistency and reproducibility of a test (reliability). Absence of random variation. | Precision |
Reduces precision in a test. | Random error |
Increases precision in a test. | Decrease in standard deviation. |
Deficiency of surfactant | Patchy alveolar atelectasis (collapse) |
Causes hepatocellular cytoplasm to take finely granular, eosinophilic appearance ¨ground glass¨-like | HBV |
Infection with N. gonorrhea does NOT result in lasting immunity due to | Its ability to modify its outer membrane protein, ANTIGENIC VARIATION |
1º cause of urinary tract obstruction in elderly male patient | BPH (Benign Prostatic Hyperplasia) |
Distension/dilation of renal pelvis and calyces | Hydronephrosis |
Most common site of obstruction (hydronephrosis) in fetus. | Ureteropelvic junction |
Causes of Hydronephrosis | -Urinary tract obstruction (e.g, renal stones, BPH, cervical cancer, injury to ureter) -Retroperitoneal fibrosis -Vesicoureteral reflux |
Systolic heart sounds | 1. Aortic/Pulmonic stenosis 2. Mitral/Tricuspid regurgitation 3. Ventricular septal defect |
Diastolic heart sounds | 1. Aortic/Pulmonic regurgitation 2. Mitral/Tricuspid stenosis |
Most common congenital cardiac defect | VSD (L-to-R shunt) |
L-to-R shunts; frequency | VSD>ASD>PDA |
L-to-R shunts; LATE cyanosis ¨blue KIDS¨ | 1.VSD 2.ASD 3.PDA 4.Eisenmenger syndrome |
Holosystolic, harsh-sounding murmur. Loudest at tricuspid area, accentuated with hand grip maneuver due to increased afterload. | Ventricular septal defect |
R-to-L shunts; EARLY cyanosis ¨blue BABIES¨; 5 T´s | 1) Truncus arteriosus (1 vessel) 2) Transposition of great vessels (2 switched vessels) 3) Tricuspid atresia (3=tri) 4) Tetralogy of Fallot (4=tetra) 5) TAPVR (5 letters in the name); Total anomalous pulmonary venous return |
Follows opening snap. Delayed rumbling late diastolic murmur. Enhanced by maneuvers that increase LA return (e.g., expiration). | Mitral Stenosis |
Opening snap | Mitral Stenosis |
Chronic Mitral Stenosis results in | LA dilation |
3 points of insertion of Sternocleidomastoid Muscle | 1. ¨Sterno¨: manubrium of Sternum 2. ¨Cleido¨: medial part of Clavicle 3. ¨Mastoid¨: Mastoid process of the skull |
Sternocleidomastoid Muscle function and innervation | -CN XI -Function: turn head in the opposite direction |
Loss of high-frequency hearing 1st; sudden extremely loud noises can produce hearing loss due to tympanic membrane rupture. | Damage to stereocilliated cells in organ of Corti |
Damage to stereocilliated cells in organ of Corti | Noise-induced hearing loss |
Beta1-selective antagonists (Beta1 > Beta2) | 1. Acebutolol (partial agonist), 2. Betaxolol, 3. Esmolol (short acting), 4. Atenolol, 5. Metoprolol |
Beta 1 receptors are found in | -Cardiac tissue -JGA cells |
Law of Laplace | Collapsing pressure (P)= 2 (surface tension)/radius |
2º Hyperaldosteronism | -Renal artery stenosis, -Chronic renal failure, -CHF, -Cirrhosis, -Nephrotic syndrome -Malignant HTN -REnin-secreting tumor (reninoma) |
Renal perception of low intravascular volume results in an overactive renin-angiotensin system. Associated with HIGH plasma RENIN. | 2º Hyperaldosteronism |
Hypertension, HIGH= plasma RENIN, HIGH= plasma ALDOSTERONE | 2º Hyperaldosteronism |
Treatment of 2º Hyperaldosteronism | Spironolactone |
Acute salicylate toxicity | Respiratory alkalosis |
Chronic salicylate toxicity | Metabolic acidosis with compensation (hyperventilation), Increased anion gap |
NADPH is required for | -Reductive reactions, e.g., glutathione reduction inside RBCs, Fatty acid and Cholesterol biosynthesis. -Ribose for nucleotide synthesis and glycolytic intermediates. |
2 distinct phases of HMP shunt (oxidative and nonoxidative), occur in | CYTOPLASM |
HMP shunt sites | Sites: lactating mammary glands, liver, adrenal cortex (sites of fatty acid or steroid synthesis), RBCs. |
Interferes with Gamma-carboxylation of glutamic acid residues | Warfarin |
Vitamin K deficiency | Decreased synthesis of factors II, VII, IX, X, protein C, protein S. vWF carries/protects VIII. |
Warfarin inhibits | Epoxide reductase |
Warfarin; CLINICAL USE | Chronic anticoagulation (after STEMI, venous thromboembolism prophylaxis, and prevention of stroke in atrial fibrillation). |
Follow Warfarin administration with | PT/ INR values |
Thyroid hormones alter gene transcription by binding to receptor situated inside | NUCLEUS |
Diagnosis of Strongyloides stercoralis | Rhabtidiform (non-infectious form) in stool |
Route of transmission; Strongyloides stercoralis | Filariform larvae (infectious form) in soil penetrates the skin |
UMN lesion signs | 1. Hyperreflexia 2. Hypertonia 3. Babinski (+) 4. Spastic paralysis 5. Clasp knife spasticity |
LMN lesion signs | 1. Weakness 2. Atrophy 3. Fasciculations 4. Hypotonia 5. Hyporeflexic 6. Flaccid paralysis |
Major virulence factor of S. pyogenes (Group A streptococci) | M protein |
deficiency causes Cheilosis, Angular Stomatitis, Corneal vascularization. | Riboflavin (Vitamin B2) |
Component of flavins FAD and FMN, used as cofactors in redox reactions,e.g, the succinate dehydrogenase reaction in the TCA cycle | Riboflavin (Vitamin B2) |
Screen pregnant women at 35-37 weeks. Patients with positive culture receive intrapartum penicillin prophylaxis. | Streptococcus agalactiae (group B streptococci) |
Intrapartum penicillin prophylaxis. | Streptococcus agalactiae (group B streptococci) |
Streptococcus agalactiae (group B streptococci) | -Bacitracin resistant, -Beta-hemolytic, -Produces CAMP factor, -Hippurate test positive. Colonizes vagina; causes pneumonia, meningitis, and sepsis, mainly in babies. |
1º line treatment for Essential Tremor | Propranolol (non-specific beta-adrenergic antagonist) |
Action tremor; exacerbated by holding posture/limb position | Essential Tremor |
Autosomal dominant. Patients often self-medicated with EtOH, which decreases tremor amplitude. | Essential Tremor |