Uworld: 2C

Front 1

Penetrating injury at left sternal border in 4th intercostal space will likely injure __________.

Back 1

RV

Front 2

What comprises the majority of the anterior surface of the heart?

Back 2

RV

Front 3

When would a stab wound likely hit the left ventricle?

Back 3

4th intercostal space, midclavicular line after passing through bulk of lung

Front 4

When would a stab wound likely hit the pulmonary trunk?

Back 4

Second intercostal space, left sternal border

Front 5

When does hypospadias arise?
Ventral or dorsal?

Back 5

Incomplete fusion of urethral (urogenital) folds

Hypospadias is ventral

Front 6

When does epispadias arise?
Ventral or dosral?

Back 6

Faulty positioning of genital tubercle-->epispadias

Dorsal

Front 7

Label

Back 7

1. Right lung
2. RA
3. RV
4. LV
5. Left lung
6. Aorta
(note: space between aorta and LA (south of where 4 points) = esophagus)

Front 8

Label and describe

Back 8

A-Ventral White Commissure; decussation, transmits pain and temp sensation; destruction (syringomyelia) results in loss of temp/pain sensation in arms/hands bilaterally.

B-Ventral horn--motor neurons responsible for voluntary motor activity; can be affected by syringomyelia, result in areflexia, flaccid paralysis, fasciculaitons, atrophy of hand mm.

C- Ventral spinothalamic track--light touch, pressure sensation

D- Contralateral lateral funiculus; damage would cause contralateral loss of pain and temp sensation in one segment below lesion (not bilateral loss)

E- Dorsal horn--receives sensory input

F-Dorsal column--contains gracile and cuneate fasciculi; proprioception, vibration, tactile sensation

Front 9

Syringomyelia affects the __________ of the spine.

Back 9

Ventral white commissure
(pain and temperature sensation of hands/arms)

Cervical region!

Can also destroy MNs of ventral horns-->flaccid paralysis, atrophy of intrinsic mm

Front 10

Fragile X Syndrome:
Mutation
Presentation

Back 10

Inc'd numnber of CGG repeats in Familial Mental Retardation gene (FMR-1) located on X-chromosome long arm

Presents with:
-macrosomia with inc'd head circumference
-Large jaw, large protruding ears, long thin face, prominent forehead

-Macroorchidism (enlarged teses)

-Mild-to-moderate MR, language delay, bhvrl abnlts

Front 11

Male
Tall stature
Gynecomastia
Small testes

Back 11

Klinefelter

Front 12

Absolute risk reduction for drug A vs standard therapy is 4%.

If incidence of pulmonary embolism with standard therapy is 6% and there are 24 pulmonary emboli in drug A group, how many total subjects are there in the drug A group?

Back 12

ARR= Event rate (control) - Event rate (treatment)
4%=6%-Event rate (treatment)
Event rate (treatment) =2%

Event rate (treatment) = Events/total treatment arm subjects
2%=24/total treatment arm subjects
Total treatment arm subjects = 1200

Front 13

DiGeorge Syndrome:
Embryologic pathophys

Back 13

Maldev't of third and fourth BRANCHIAL (PHARYNGEAL) POUCHES

Front 14

Describe schizophrenia, disorganized type.

Back 14

Too disorganized to take care of themselves or perform activities of daily living like showering, dressing, etc.

Front 15

Describe schizophrenia, paranoid type.

Back 15

Prominent delusions and auditory hallucinations. Often persecutory in nature.

Front 16

Describe schizophrenia, catatonic type.

Back 16

Disturbance of motor fn--abnl voluntary mvmts, immobility (waxy flexibility or stupor) excessive motor activity, bizarre posturing

Mutism, echolalia (repetition of word or phrase spoken by another person), echopraxia (repetitive mimicking of another person's mvmts), extreme negativism

Front 17

Describe schizophrenia, residual type.

Back 17

Persistence of syx like emotional blunting, eccentric bhvr, loose assocns b/t episodes of active schizophrenia.

No hallucinations, delusions, disorganized speech, or catatonia.

"Burned out" schizophrenics.

Front 18

Propionic acid:
How is it made?
Describe its metabolism.

Back 18

Isoleucine, valine, threonine, methionine, cholesterol., odd-chain FAs-->Propionic Acid

Propionic Acid-->methylmalonic acid via BIOTIN-DEPENDENT carboxylation

Isomerization of methylmalonyl CoA-->succinyl CoA-->TCA

Front 19

Describe the metabolism of phenylalanine.

Back 19

Phenylalanine-->Tyrosine-->Fumarate-->TCA

Front 20

Cold agglutinins:
When are they produced?
Diagnostic utility?

Back 20

Produced in response to mycoplasma pneumoniae infection

Directed against antigens that are also present on surface of human RBCs

Responsible for transient anemia documented in pts w/M. pneumoniae infection

Also assocd w/EBV and hematologic malignancies

If place test tube of pts blood in ice (with anti-coagulant), will clump!

Front 21

Rapidly progressive dementia
Myoclonic jerks
Multiple vacuoles in gray matter

Back 21

Creutzfeld-Jakob Dz

Front 22

Creutzfeld-Jakob Disease;
Pathophys
Presentation

Back 22

Prion dz:
-Prior protein present in host neurons
-Long incubation period, and rapidly progressive after onset of syx
-Spongiform encephalopathy--vacuoles form in cytoplasm of nphils and neurons, transform into cysts
-No treatment :(

Presentation: rapidly progressive dementia, myoclonic jerks, multiple vacuoles in gray matter of brain (spongiform encephalopathy)

Front 23

70-year old man
Bone pain
Elevates serum alkaline phosphatase
Haphazard cement lines of lamellar bone

Back 23

Paget's Dz:
Begins as inc'd oclast activity, followed by increase in oblast activity.
Net result: inc'd bone resorption and formation of abnl bone

Front 24

Levodopa:
AEs alone
AEs with carbidopa

Back 24

Alone:
CNS f/x: Anxiety, agitation because of DA
Peripheral f/x: n/v (DA activates emetic center in brainstem--outside of BBB), tachyarrhythmias--extrasystoles, a fib, postural hypotn (due to peripheral conversion of levodopa to DA)

With carbidopa, peripheral conversion is inhibited ; only syx seen are agitation/anxiety (which can actually be worsened bc so much of L-dopa is being converted centrally)

Front 25

Label attachments/structures (knee)

Back 25

A--attachment of ACL
B--attachment of lateral meniscus
C--Covered by lateral meniscus
D--Attachment of PCL
E--Covered by medial meniscus

Front 26

Diniminished first heart sound
Apical holosytolic murmur
Bibasilar lung crackles
No JVD

Back 26

Holosytolic murmu-->Mitral Regurgitation

Lung crackles-->LHF

Front 27

In a patient with mitral regurgitation, what would decrease the amount of blood flowing back into the LA?

How can this be achieved?

Back 27

Lower LV afterload would decrease pressure gradient driving regurgitant flow into LA. (would also increase forward stroke volume).

Achieve by arterial vasodilation

Front 28

What drug would block gastric acid secretion normally stimulated by acetylcholine, histamine, and gastrin?

Back 28

Proton pump inhibitor!!

-prazole

Front 29

This drug blocks gastric parietal cell acetylcholine receptors.

Back 29

Atropine

Front 30

This drug blocks parietal cell H2 receptors.

Back 30

Cimetidine (ranitidine, etc.)

Front 31

Draw cardiac PV curve to show a change in afterload.

Back 31

Front 32

Draw a cardiac PV curve to show systolic dysfunction.

Back 32

Front 33

Infant
Loss of motor skills
HSM
Hypotonia
Cherry-red macular spot

Diagnosis
Pathophys

Back 33

Niemann-Pick Disease

Differs from Tay-Sachs bc HSM is present; Tay-Sachs doesn't have HSM.
Niemann-Pick = lipid storage disorder where lipids accumulate in spleen, liver, lung, BM, brain.

Classic: Lack sphingomyelinase (degrades sphingomyelin--component of cell membrane)

Front 34

Niemann-Pick Disease:
Pathophys
Presentation

Back 34

Autosomal RECESSIVE disorder char'd by deficiency of sphingomyelinase enzymes

Results in accumuln of sphingomyelin

Patients present in infancy w/loss of motor skills, HSM, hypotonia, cherry red macular spot.

Foamy histiocytes (accumulated sphingomyelin)

Death before age 3

Front 35

What drugs are associated with drug-induced lupus?

Back 35

It's not HIP to have Lupus:
Hydralazine
Isoniazid
Procainamide

Front 36

What is cinchonism?
Side effect of what drug?

Back 36

Tinnitus, dizziness, fainting

Seen in Quinidine

Front 37

Amiodarone:
AEs

Back 37

Thyroid dz
Lung fibrosis
Liver tox
Blue/gray skin

Front 38

Acute acalculous cholecystitis:
What is it?
Pathophys
Treatment

Back 38

Acute inflammn of gallbladder in absence of gallstones

Caused by gallbladder stasis and ischemia, which cause inflammn of and injury to gallbladder wall (such as in hospitalized pts with hypotn, poor blood flow)

Tx: IV broad-spectrum abx and cholecystectomy with drainage of abscess

Front 39

What is porcelain gallbladder?
Risk?

Back 39

Abdominal x-ray showing rim of Ca2+ deposits that outline the bladder

Assocd w/gallbladder carinoma

Front 40

Shrunken, fibrosed gallbladder:
Pathophys

Back 40

Chronic cholecystitis resulting form repeated mild attacks of acute cholecystitis (leads to thickening of gallbladder wall)

Front 41

Intimal streak vs Intimal tear:
Role in aneurysm

Back 41

Major cause of aneursym (AAA specifically) is atherosclerosis

Intimal (fatty) streaks are the earliest lesion of atherosclerosis and are composed of intimal lipid-filled foam cells, which are derived from macs that have engulfed lipoproteins. These then collect in the intima through an injured, leaky endothelium.

Intimal tear initiates formation of a dissecting aortic aneursym.

Front 42

rER vs sER:
Functions

Back 42

Rough ER: (ribosomes attached) snthesizes secretory, lysosomal, and integral membrane proteins

Smooth ER: steroid and phospholipid synthesis. All steroid producing cells (cells in adrenals, gonads, liver) contain well-developed SER. ACTH stimulates the cells in adrenal cortex to produce mineralocorticoids, glucocorticoids an dandrogens, all chol-derived steroid hormones.

SER also involved in detox of drugs, esp in hepatocytes.

Front 43

Identify murmur.

Back 43

Machine-like; PDA

Front 44

Infective endocarditis after diagnosis with colon cancer:

Cause

Back 44

Bacteremia with Strep bovis (part of normal flora of colon) is assocd w/colonic cancer in ~25% of pts.

Front 45

34-year old woman with mitral stenosis
Low-grade fevers
Negative blood cultures

Back 45

Likely has suffered from acute rheumatic fever in past (which is cause of mitral stenosis), she is probably experiencing another episode of rheumatic fever

Front 46

29 year-old male with persistent fever
Tricuspid vegetations
Tricuspid regurgitation

Back 46

Right-sided endocarditis caused by S. aureus, typical of IV drug users.

Front 47

Formula for relative risk.

Back 47

(Dz in group A/Total group A)/(Dz in control group/Total control group)

Front 48

Formula for odds ratio.

Back 48

ad/bc (in 2 x 2 table)

label table as:
a, b
c, d

Front 49

2 year-old male
Fever
Decreased oral intake
Swollen gums with ulcers
Enlarged, tender LAD
Oral lesion demonstrates cells with intranuclear inclusions

Back 49

Herpes virus 1 infection

Front 50

Koplik spots

Back 50

Bluish-gray spots on buccal mucosa-->measles

Front 51

What kind of virus is HSV?

Back 51

Enveloped dsDNAvirus

Front 52

Developing nation
Fulminant hepatitis in pregnant women
High mortality rate

Back 52

Hep E

Front 53

What kind of virus is hepatitis E?

Back 53

Unenveloped single-stranded RNA virus

Front 54

Hepatitis E:
Mechanism of spread
Presentation

Back 54

Fecal-oral

Occurs in young/middle-aged adults living in developed nations. Typically self-limiting without chronic or carrier states. High mortality rate in pregnant women.

Front 55

Mucor vs Aspergillus

Back 55

Mucor and Rhizopus: broad, NON-septate angles
Aspergillia: septate, V-angles

Front 56

This organism is likely to form fungus balls.

Where?

Back 56

Aspergillus forms fungus balls in old lung cavities (as in those caused by Tb or bronchiectasis).

Front 57

Back 57

Mucor

Front 58

Back 58

Aspergillus

Front 59

Hyponatremia
Hyperkalemia
Hypoglycemia
Fever
Vomiting
Nuchal rigidity
Petechial rash

Back 59

Adrenal crisis + meningitis = Waterhouse-Friedrichsen Syndrome

Front 60

Waterhouse-Friedrichsen Syndrome:
What is it?

Back 60

Adrenal hemorrhage (and thus insufficiency) + meningitis

Front 61

Mental retardation
Eczema
Mousy, musty body odor

Back 61

Phenylketonuria

Front 62

Phenylketonuria:
Presentation
Pathophys

Back 62

AUTOSOMAL RECESSIVE
Caused by mutation of gene encoding phenylalanine hydroxylase

Front 63

Pioglitazone:
Drug Class

Back 63

TZD

Front 64

Thiazolidinedione:
Suffix
MOA
Use

Back 64

Used in DM

Improve insulin resistance by binding PPAR-gamma (involved in glucose and lipid metabolism)

Causes increase in adiponectin (this is low in DMII)

Front 65

Glimepiride:
Drug Class

Back 65

Sulfonylurea

Front 66

Sulfonylureas:
Prefix
MOA
Use

Back 66

Used in DM
Begin in gli- (glip, glim)

Bind K-ATP chnnel on beta cells, closes them, and allows for Ca2+ channels to open

Front 67

This anti-diabetic drug binds PPAR-gamma.

Back 67

TZDs (glitazones)

Front 68

This anti-diabetic drug binds K-ATP channels.

Back 68

Sulfonylureas (gli--)

Front 69

This anti-diabetic drug binds surface tyrosine kinase-coupled receptors.

Back 69

Insulin

Front 70

This anti-diabetic drug binds surface adenylate cyclase-coupled receptors.

Back 70

Glucagon like polypeptide 1 (GLP-1)

Front 71

Glucagon like polypeptide 1 (GLP-1):
Secreted by
MOA

Back 71

Secreted by intestinal L cells in response to food intake

MOA: acts through cell surface receptors coupled with adenyl cyclase G protein to induce satiety, decrease gastric emptying, and increase insulin release from beta cells (all of this decreases blood glucose)

Front 72

Volatile (inhaled) anesthetics:
Side effects

Back 72

Almost ALL increase cerebral blood flow (undesirable bc it increases intracranial pressure)

Myocardial depression
Hypotension
Respiratory depression
Dec'd renal fn

Front 73

What is the most common cause of death in patients with TCA overdose? Why?

Back 73

Refractory hypotension
Cardiac arrhythmias

via Inhibition of Fast Sodium Channels in cardiac myocytes

Front 74

TCA anti-depressants:
MOA
AEs

Back 74

MOA: Inhibit reuptake of NE and 5HT

AE:
-Inhibit muscarinic receptors-->tach, mydriasis, flushing, diaphoresis, hypertherm, urinary retention

-inhibit alpha-1 receptors->peripheral vasodilation--orthostatic hypotn

-INHIBIT CARDIAC FAST SODIUM CHANNELS-->conduction defects, arrhythmias, hypotn

-inhibit H1 receptors-->sedation

Front 75

This anti-diabetic drug requires LFTs.

Back 75

TZD's--glitazones

HEPATOTOXICITY

Front 76

This anti-diabetic drug is contraindicated in renal failure.

Back 76

Metformin

Front 77

This anti-diabetic drug can aggravate CHF. How?

Back 77

TZDs--glitazones

Cause fluid retention

Front 78

32 year-old female presents with malignant breast mass
History of osteosarcoma
Family history of brain tumor, rhabdomyosarcoma

Back 78

Li-Fraumeni syndrome

Front 79

Li-Fraumeni Syndrome:
Presentation
Pathophys

Back 79

Autosomal DOMINANT predisposition to variety of cancers; sarcomas and tumors of breast, brain, and adrenal cortex are most common.

Assocd w/p53 gene mutation

Front 80

Rb gene:
Role
Associated disease

Back 80

Regulates G1-S checkpoint of cell cycle

Mutation predisposes to retinoblastomas and osteosarcomas

Front 81

BRCA-1 gene mutations can result in _______.

Back 81

Breast and ovarian cancers

Front 82

APC gene mutations can result in ________.

Back 82

Familial polyposis syndromes (responsible for maintaining low levels of beta-catenin, which is oncogenic, and for intracellular adhesion)

Front 83

Progressive lower back pain not relieved by rest or position change
Urinary urgency
Nocturia
Frequency
Hesitancy

Back 83

Prostate cancer with metastases to bone

Front 84

NF-kappa B:
Role
Disease association

Back 84

Responsible for cytokine production (NOT ANTIBODY PRODUCTION)

WHen appropriate immune response to intracellular microbes is blunted, microbes persist and induce chronic inflammation within GI tract (Crohn's)

Front 85

NOD2 Gene:
Role
Disease Association

Back 85

Acts as intracellular microbial receptor that triggers NF-kappa B pathway

Front 86

Infant with increased head circumference
Enlarged ventricles
Irritability
Poor feeding

Back 86

Hydrocephalus

Front 87

Hydrocephalus:
Pathophys
Presentation

Back 87

Impaired CSF outflow due to congenital abnlts

PResents with irritability, poor feeding, muscle HYPERTONICITY and HYPERREFLEXIA from upper MN damage caused by stretching of periventricular pyramidal tracts.

Front 88

QT interval:
What is it?
Anti-arrhythmics that prolong it

Back 88

Remember: QT-interval = ventricular repol as ventricles prepare for next bear.

Repolarization mediated by K+ EFFLUX so class 3 antiarrhythmics (K+ blockers will prolong QT):

Sotalol
Amiodarone
Ibutilide
Dofetilide

Front 89

Back 89

Front 90

Difficulty chewing
Persistent headaches of recent onset
Tenderness over temples

Back 90

Giant cell (temporal) arteritis

Front 91

Giant cell arteritis:
Presentation
Histologic features

Back 91

Jaw claudication (lameness)
HA, facial pain, vision loss

Histology demonstrates granulomatous inflammation of the media

Front 92

This condition bears histologic resemblance to giant cell arteritis.

How does it differ from giant cell arteritis?

Back 92

Takayasu arteritis--may present with medial granulomas, but typically affects aortic arch. Affects women under 40.

Front 93

Positive monospot test

Back 93

EBV--sheep serum agglutination

Front 94

How would HIPAA differ for a physician working with an NCAA Division I collegiate football team.

Back 94

Trainer or team physician is allowed to communicate with coaches and protect player from further injury based on best medical judgment.

Front 95

What processing steps must occur before mRNA can enter the cytoplasm?

Back 95

pre-mRNA (aka hnRNA) must undergo:
-5'-capping (protects mRNA from degradation by exonucleases)

-Poly A tail addition to 3' end (in cytosol, polyA tail is gradually shortened, leading to mRNA degradation)

-Intron splicing

Front 96

P bodies:
Location
Role

Back 96

Cytoplasm

Regulate mRNA decay