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UWORLD
Overall review 1
| Question | Answer |
|---|---|
| What is the most common organ to be affected by GVHD? | Liver |
| What is the main characteristic of the liver, skin, and GI tract to develop GVHD? | Lymphocyte rich organs |
| What is the main pathogenesis of GVHD? | Donor T cells attack MHC antigens of the recipient |
| What immunologic cells attach to the Fc portion of the heavy immunoglobulin chain? | Neutrophils and macrophages |
| What part of the immunoglobulin is the site for attachment for phagocytic cells? | Fc portion (the tail of the immunoglobulin) |
| What is attached to the Fab portion of the immunoglobulin? | Antigens |
| The "fork" (pointy 2 ends) of the immunoglobulin is the Fab or Fc portion of the immunoglobulin? | Fab |
| What type of cells are attached the carboxy terminal of the Fc portion of on the heavy immunoglobulin chain? | Neutrophils and macrophages |
| Where does the complement attaches in the immunoglobin structure? | Middle section (junction between the tail and the pointy heads) |
| What does the portion connecting the Fab and Fc portions of the immunoglobulin servers as attachment site for? | Complement |
| What is the Phase 1 of clinical trials? | Assess the pharmacokinetics, pharmacodynamics, and safety of new treatment in humans |
| What clinical trial phase is often conducted in a small number of healthy individuals? | Phase 1 |
| What are the main things assess in Phase 1 of clinical trials? | Pharmacokinetics and Pharmacodynamics |
| What are two common Statistical tests? | ANOVA and t-test |
| When is a t-test used? | Use to compare the difference between the means of 2 groups |
| What type of statistical test can be used to compare the difference in the means of 2 groups? | t-test |
| What does ANOVA stand for? | Analysis of Variance |
| What is the functionality or use for ANOVA ? | Comparison the difference between the means of 2 or more groups |
| Which test is indicated in comparing mean difference of 3 age groups, t-test or ANOVA? | ANOVA |
| What is main pathological characteristic of Hypertrophic cardiomyopathy? | Asymmetric ventricular septal hypertrophy and dynamic left ventricular outflow tract obstruction |
| What are common maneuvers that decrease preload? | Abrupt standing and Valsalva strain phase |
| Does abrupt standing increase or decrease preload? | Decrease preload |
| Actions that decrease preload will diminish or accentuate the Hypertrophic cardiomyopathy murmur? | Increase intensity of HCM murmur |
| Conditions that increase or decrease preload and afterload will increase of decrease HCM murmur intensity? | Increase |
| Why does decreasing preload and/or afterload increase intensity to HCM murmur? | Worsens LVOT obstruction |
| Does physical exercise cause a sympathetic or parasympathetic discharge? | Sympathetic |
| What are the the main effects of hemodynamics due to strenuous exercise? | 1. Increase in CO 2. Splanchnic vasoconstriction 3. Decrease in total systemic vascular resistance |
| Does the Splanchnic vasculature experience a vasoconstriction or -dilation due to physical exercise? | Splanchnic vasoconstriction |
| Is Total Systemic vascular resistance increased, decreased, or unchanged by physical exercise? | Decreased |
| What is the main type of collagen in mature scars? | Type 1 collagen |
| What is the most abundant and prevalent type of collagen in the body? | Type 1 collagen |
| What are common parts with high amount of type 1 collagen? | Bones, tendons, ligaments and skin |
| CT findings of Constrictive pericarditis: | Calcification and thickening of pericardium |
| What are the clinical findings associated with Constrictive Pericarditis? | Progressive dyspnea, peripheral edema and ascites |
| Which areas of body are most prone to develop Actinic keratosis? | Sun-exposed body areas |
| What is the description of Actinic keratosis lesions? | Erythematous papules with central scale and a rough "sandpaper-like" texture |
| Is Actinic keratosis premalignant or bening? | Premalignant |
| What type of skin cancer may be due to precedent actinic keratosis lesions? | Squamous cell carcinoma of the skin |
| How is Insulin cleared from body? | Insulin has both, renal and hepatic clearance |
| What is the reason that patients with CKD or DM, may develop hypoglycemia? | Decreased insulin renal clearance |
| Why is insulin levels and administration adjusted in patients with DM or CKD? | Decreased insulin renal clearance |
| What is the common treatment for Bacteroides? | Piperacillin-Tazobactam |
| What is the structure of Bacteroides? | Gram-negative anaerobic rods |
| What important enzyme is secreted by Bacteroides? | B-lactamase |
| Why treating Bacteroides with antibiotics is best is done with Tazobactam? | It inhibits B-lactamase, which is secreted by Bacteroides |
| What is a common risk factor of Candidemia? | Indwelling central (or peripheral) catheter |
| What is the morphology of C. albicans? | Branching pseudohyphae with blastoconidia |
| Which organisms seen with a branching pseudohyphae with blastoconidia morphology? | Candida albicans |
| What nerve is associated with development of Bell's palsy? | CN VII |
| What are the type of CN VII lesion leads to Bell's palsy? | Peripheral nerve lesion (distal lesion) |
| A stroke (proximal) affecting CN VII is most likely to cause peripheral or CNS lesions? | CNS lesions |
| What are the clinical signs of proximal stroke of CN VII leading to CNS lesion? | 1. Unilateral lower facial weakness (contralateral) 2. Spares the forehead |
| Is forehead movement spared or lost, in Bell's palsy? | Lost movement of forehead |
| If the forehead movement is unaffected by a lesion to CN VII, it is most likely to be CNS or Peripheral nerve lesion? | CNS lesion |
| What are the minor clinical signs of Bell's palsy? | Decreased tear production, hyperacusis and decreased taste sensation |
| What type of head hematoma is due to rupture of the MMA? | Epidural hematoma |
| Which foramen is used by MMA to enter the skull? | Foramen spinosum |
| What is a clinical important branch of Maxillary artery? | Middle Meningeal artery |
| What is the shape of an Epidural hematoma? | Lentiform |
| What type of hematoma is seen with bleeding between the Dura and meninges? | Epidural hematoma |
| The bleed in epidural hematoma is between with two structures? | Dura and Meninges |
| What nerve innervates the cheek? | CN V2 |
| What foramen is used by CN V2? | Foramen Rotundum |
| What is the path follow by the CN V2? | Foramen rotundum --> Infraorbital foramen |
| If a person needs to have CNV2 nerve blocked, it is done at what point? | Infraorbital foramen |
| What is a common anesthetic that causes Methemoglobinemia? | Benzocaine |
| What condition is seen with having Fe2+ -----> Fe3+? | Methemoglobinemia |
| What is the shift seen in Methemoglobinemia? | Left shift of the Oxygen-Hb dissociation curve |
| What common Iron-oxygen affinity condition is associated with a left-shift in the oxygen-hemoglobin dissociation curve? | Methemoglobinemia |
| A patient with evident cyanosis due to Methemoglobinemia, will or will not see positive results with treatment of supplemental oxygen? | No improvement |
| What does "NAGMA" stand for? | Non-anion gap metabolic acidosis |
| What is the general causative definition for non-anion gap metabolic acidosis? | Loss of bicarbonate (HCO3-) anions, leading to a relative increase in H+ (cations) (protons) |
| What are the most common causes of NAGMA? | RTA and severe diarrhea |
| What is another term or way to refer to Non-anion gap metabolic acidosis or "NAGMA"? | Hyperchloremic acidosis |
| What is NAGMA often referred as hyperchloremic acidosis? | Decrease In serum HCO3- is compensated by increasing serum Cl- to maintain the electronegative balance |
| How is the electronegative balance maintained in NAGMA? | Increment of Cl- in the serum, due to the loss of HCO3- |
| What artery irrigates the proximal part of the ureter? | Renal artery |
| What artery irrigates the distal part of the ureter? | Superior vesical artery |
| Is the part of the ureter close to bladder the distal or promial portion of ureter? | Distal |
| Ureter and kidney junction area is referred as the distal or proximal part of the ureter? | Proximal |
| Which part of the ureter is affected, distal or proximal, if there is accidental dissection of the Renal artery? | Proximal |
| Which part of ureter is affected the Superior Vesical artery is occluded? | Distal |
| Common and often cause of Pericardial effusions? | Malignancy |
| What are the findings (histological) of Pericardiocentesis of a pericardial effusion? | Atypical cells (malignant) |
| What are the ECG findings of Pericardial effusion? | Decreased QRS voltage and +/- electrical alternans |
| What organs or tissues are affected in Whipple disease? | Small intestine, joints, and CNS |
| What are the histological findings of Whipple disease biopsy? | Small intestine mucosa containing enlarged, foamy macrophages packed with both rod-shaped bacilli and PAS-positive, diastase-resistant granules |
| What are the contents packing the enlarged and foamy macrophages in Whipple disease? | 1. Rod-shaped bacilli 2. PAS-(+), diastase-resistant granules |
| What is the treatment for Whipple therapy? | Antibiotic therapy |
| What disease is caused by Tropheryma whipplei infection? | Whipple disease |
| What is the change (fraction) that a female sibling of an affected brother with an XR disease, and normal genotypic husband, to have an affected son? | 1/8 |
| What happens to the spleen function of Sickle cell patients? | Become functional asplenics due to repeated microinfarction of the splenic vascular beds |
| What is the result of microinfarctions of the spleen vasculature in Sickle cell patients? | Functional asplenia |
| What type of organisms are most likely to infect a person with functional asplenia? | Encapsulated bacteria |
| What common encapsulated bacteria causes infection in Sickle cell patients? | S. pneumoniae |
| What is a common bone-related condition associated with asplenics? | Salmonella osteomyelitis |
| Aspergillus fumigatus is a fungus, bacteria, or virus? | Fungus |
| What is the morphology of Aspergillus? | Thin, septate hyphae with acute V-shaped branching |
| What is the specific and unique shpate of branching seen in Aspergillus? | V-shaped |
| What are common conditions seen in AIDS patients infected with Aspergillus fumigatus? | Aspergillomas, Aspergillosis, and Allergic pulmonary aspergillosis |
| What part of the brain anatomy if damaged causes tremor? | Cerebellum |
| What is Cerebellar tremor? | Low frequency (<5Hz) and high amplitude, and increases as an action approaches the target |
| A person with cerebellar tremor has a accentuated tremor while reaching a target or while at rest? | Reaching the target |
| What are the clinical manifestations of cerebellar tremor? | Target-approaching tremor, ataxia, dysmetria, and impaired rapidly alternating movements |
| What artery is block in Wallenberg syndrome? | PICA |
| What syndrome or condition is due to PICA occlusion? | Wallenberg syndrome |
| What is a more specific way to refer to Wallenberg syndrome due to PICA occlusion? | Lateral Medullary syndrome |
| What are the main (list) of deficits seen with Lateral Medullary (Wallenberg) syndrome? | 1. Vertigo and Nystagmus 2. Ipsilateral cerebellar signs 3. Loss of pain and temperature in ipsilateral face and contralateral body 4. Bulabal weakness 5. Ipsilateral Horner syndrome |
| What are the main ipsilateral clinical manifestation of Wallenberg syndrome? | Cerebellar signs, loss of pain/temperature sensation in face, and Horner syndrome |
| What is the contralateral sign or physical manifestation of Wallenberg syndrome? | Loss of pain and temperature in the contralateral body |
| Where would a Femoral nerve blocked be applied? | Below the Inguinal ligament |
| A physician applies numbing (anesthetic) injection just below the inguinal ligament. What nerve block is performed? | Femoral nerve block |
| What is an important anatomical landmark for a femoral nerve block just below the inguinal ligament? | Inguinal crease |
| What are organs or tissues are exception to the 2-neuron signal transmission of the SNS? | Eccrine sweat glands and the adrenal medullae |
| Is the SNS or PNS associated with 2-signal transmission path? | SNS |
| What are the 2 signal associated with signal transmission of the SNS? | - Cholinergic preganglionic neurons - Adrenergic postganglionic neurons |
| Are cholinergic neurons in SNS signal transmission associated with pre-or post-ganglionic neuron transmission? | Preganglionic |
| What type of neurons are used in SNS (1-neuron) signal transmission in Eccrine sweat glands and Adrenal medulla? | Cholinergic neurons |
| What kind of effusion is expected to be seen in cirrhotic patient? | Transudative effusion |
| What causes or develops the pleural effusion in a cirrhotic patient with abdominal ascites? | Passage of intraabdominal fluid into the chest cavity thoru small fenestration in the diaphragm |
| Which muscle is affected by fenestrations in cirrhotic patients leading to abdominal fluid into the chest cavity? | Diaphragm |
| What is the histology of the Bronchi? | Ciliated pseudostratified columnar epithelium with mucin-secreting Goblet cells and submucosal numerous glands |
| What are the mucin-secreting cells in the Bronchi? | Goblet cells |
| How is the epithelium found in the Bronchi? | Ciliated pseudostratified columnar epithelium |
| At what point of the airway do the columnar epithelium changes into cuboidal epithelium? | Terminal bronchioles |
| What histological features are absent and/or gradually lost in the bronchioles? | Glands and cartilage, and a number of Goblet cells |
| Up to which point of the airway does ciliated epithelium persits? | Respiratory bronchioles |
| What is the vascular effect of ACE-inhibitors in the renal arterioles? | Dilation of the Efferent renal arterioles |
| What is the result on GFR and renal FF due to ACE-inhibitors? | Decrease GFR and renal FF |
| What is the function on the renal arterioles of ACE II? | Mediated vasoconstriction of renal efferent arteriole |
| Common Carbonic anhydrase diuretic: | Acetazolamide |
| What is the MOA of Acetazolamide? | Carbonic anhydrase diuretic, that works on the PCT, responsible for catalyzing reactions necessary for NaHCO3 reabsorption |
| Total body chloride depletion is often associated with which acid-base electrolyte imbalance? | Metabolic alkalosis |
| What urine lab or measurement is important for diagnosis of Metabolic alkalosis due to vomiting? | Urine chloride |
| Which bone if injured leads to Common Peroneal nerve damage? | Fracture to the neck of the Fibula |
| What are the complication or clinical features of Common Peroneal nerve injury? | 1. Weakness on dorsiflexion (Deep peroneal nerve) 2. Weakness on Eversion (Superficial peroneal nerve) 3. Loss sensation over the dorsum of the foot |
| What nerve if injured often results in weakness on dorsiflexion? | Deep peroneal nerve |
| What is the result of Superficial peroneal nerve injury? | Weakness on eversion |
| If a patient is unable to properly evert the foot, which nerve is likely injured? | Superficial peroneal nerve |
| Which part of the foot losses sensation due to Common peroneal nerve injury? | Dorsum of foot |
| What immunoglobulin response or secretion is stronger in live vaccination than killed (inactivated) vaccination? | Stronger mucosal secretory IgA immune response |
| Suspect killed or live vaccination if the immune response is charged by a strong IgA response? | Live (active) vaccine |
| What is the effect of a stronger mucosal secretory IgA immune response? | Increase protection of the site of viral entry by inhibiting attachment to intestinal epithelial cells |
| Which has a stronger IgA immune response, Sabin poliovirus vaccine or Salk poliovirus vaccine? | Sabin poliovirus vaccine |
| Which is the killed (inactive) vaccine for poliovirus? | Salk poliovirus vaccine |
| What is an important hemodynamic and/or cardiac feature seen with Persistent Pulmonary Hypertension of the Newborn (PPHN)? | Right-to-Left shunting across the PDA |
| What are important clinical signs and features of Persistent Pulmonary HTN of the Newborn? | 1. Underlying pulmonary disorder with respiratory distress 2. Strong femoral pulses |
| What heart rate characteristic is unique of PPHN? | Strong Femoral pulses |
| What is an important rash associated with P. aeruginosa bacteriemia? | Ecthyma grangenosum |
| What is Ecthyma gangrenosum? | Skin necrotic diseases with strong association with Pseudomonas aeruginosa bacteremia |
| What gram negative bacterium infection is often seen in Neutropenic, especially those with indwelling catheters? | Pseudomonas aeruginosa |
| What is the inheritance pattern of von Willebrand disease? | Autosomal dominant |
| What are the important labs associated with vW disease? | 1. Normal platelets and PT 2. Normal or slightly increase PTT |
| Why is PTT somatic prolonged in vW disease? | Low level of factor 8 |
| What is a consequence in hematologic times of Factor 8 deficiency? | Prolonged PTT |
| What is C. septicum? | A spore-forming, exotoxin-producing, gram positive, that is common cause of Spontaneous Gas gangrene |
| What is a common risk or factor associated with Spontaneous gas gangrene, due to C. Septicum? | Colonic malignancy |
| Common causative organism of Clostridial myonecrosis | C. septicum |
| What virus causes Condylomata accuminata? | HPV 6 & 11 |
| How is Condylomata accuminata presented? | Pink-or-skin colored plaques, papules, and verrucous lesions on the genitalia, perineum, or perianal skin |
| A person with Condylomata accuminata is ata greater risk for which other viral infection? | HIV infection, and HIV testing is recommended |
| What test is often performed in a person with a positive HPV 6 infection? | HIV testing |
| What is the path or process of replication of Hepatitis B virus? | Double-stranded DNA --> (+) RNA template --> partially double-stranded DNA progeny |
| What is the main cause for Syncope? | Transient loss of cerebral perfusion and numerous mediators |
| What is a common type of CNS drugs or meds that are associated with syncope? | Acetylcholinesterase inhibitors |
| What are two common syncope-causing acetylcholinesterase inhibitors? | Donepezil and Rivastigmine |
| How do Donepezil and Rivastigmine cause syncope ? | Enhancement of PNS tone which leads to bradycardia and AV block with decrease cardiac output |
| What is the morphological or structural shape of the Rabies virus? | Bullet-shaped envelope with knob-like glycoproteins that bid to nicotinic acetylcholine receptors |
| To which type of adrenergic receptors does the Rbeies virus bind to? | Nicotinic ACh receptors |
| CMV binds to what type of receptors or structure? | Cellular integrins |
| EBV binds to which type of cell receptor in order to infect host? | CD 21 receptor |
| What is the receptor to which the rhinovirus binds to in ofer to cause infection? | ICAM-1 |
| What is the CD associated with ICAM-1? | CD54 |
| What is the path that the Trigeminal nerve follows to exit the Brainstem? | Exists brainstem at the lateral aspect of the mid-pons at the level of the middle cerebellar peduncles |
| At which level of the cerebellar peduncles does the Trigeminal neve leaves the mid-pons? | Middle cerebellar peduncles |
| What is a very common tumor suppressor gene? | p53 |
| p53: Tumor suppressor gene or Oncogene? | Tumor suppressor gene |
| What is the role of p53 gene? | Controls cell division and apoptosis |
| What is the result in a decrease of activity of a tumor suppressor gene? | Predisposition and/or development of neoplasms |
| A person is detected with a mutated p53 gene. This finding indicates what action at level of neoplasm development? | A decrease in activity in p53, as it is a tumor suppressor gene, would indicate development of neoplastic processes |
| Why do sustained-release drug preparations have a reduced and delayed peak, when compared to immediate release drug preparations? | Due to slower absorption in the GI tract |
| What is the result of a drug that has a slower GI tract absorption, compare to one with a immediate level of absorption? | Reduced and ledaled peak levels of drug action |
| What is the benefit of "dampening" the peak level of a drug and prolong its GI absorption? | Help maintain effective drug levels while minimizing drug toxicity |
| Which metabolically important process is inhibited by Cyanide poisoning? | Cellular respiration |
| Which commonly tested poisoning impaired cellular respiration? | Cyanide poisoning |
| What is the distinctive breath odor of a person with Cyanide poisoning? | Garlic odor |
| A patient arrives to ED with strong garlic odor in breath. What is a possible cause for such feature? | Cyanide poisoning |
| What are common sources of Cyanide poisoning? | Insecticide and contaminated water |
| A insect exterminator is at greatest risk of what type of posing? | Cyanide poisoning |
| What is the treatment of choice for Cyanide poisoning? | Dimercaprol |
| What common poisoning is treated with Dimercaprol? | Cyanide poisoning |
| What is seen a a neonate of a uncontrolled diabetic (DM2) mother? | Excessive fetal insulin proecutinand islet hyperplasia, leein to transient hypoglycemia |
| Is a neonate of a uncoltelled diabetic mother while pregnant, seen with transient hypoglycemia or hyperglycemia? | Transient hypoglycemia |
| What is the mode of action of stimulant used to treat ADHD? | Increase availability of norepinephrine (NE) and dopamine in the prefrontal cortex |
| What part of the brain experiences an increase in NE and Dopamine available with the use of stimulant meds in treating ADHD? | Prefrontal cortex |
| What condition is associated with: Large PERFUSION defect without ventilation defect? | Pulmonary embolism |
| A Pulmonary embolism is seen with a Perfusion or Ventilation defect? | Perfusion defect |
| Pneumonia and Pulmonary edema are due to Perfusion or Ventilation defects? | Ventilation defect |
| What is the result of ventilation defect without perfusion defect? | Acute alveolar filling |
| Acute alveolar filling describes the main pathogenesis of a perfusion or ventilation defect of the lungs? | Ventilation defect |
Created by:
rakomi
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