Uworld

Front 1

Negative predictive value

Back 1

-probability of being free of a disease if the test result is negative

-NPV varies with the PRE-TEST probability of patient having disease

-patient with a high probability of having a disease will have a low NPV with a negative test, but a patient with a low probability of having a disease will have a high NPV with a negative test

Front 2

DiGeorge syndrome

Back 2

-Due to mal-development of the THIRD AND FOURTH BRANCHIAL (PHARYNGEAL) POUCHES due to deletion on chromosome 22

-clinical associations include absence of thymic shadow on neonatal x-ray, hypocalcemic tetany from absence of parathyroids, cleft palate, mandibular deformity, low-set ears, aortic arch abnormalities

Front 3

Renal angiomyolipoma

Back 3

-renal angiomyolipoma = benign tumor composed of blood vessels, smooth muscle, and fat

-these tumors can be seen with abdominal CT scan, as density of fat is less than that of water

-associated with TUBEROUS SCLEROSIS, an autosomal dominant condition

-tuberous sclerosis is characterized by cortical tubers (region of brain that develops abnormally) and sub-ependymal hamartomas in the brain, with consequent seizures and mental retardation

-cardiac rhabdomyomas, facial angiofibromas, and leaf-shaped patches of skin that lack pigment (ASH-LEAF PATCHES) can also occur

Front 4

C peptide

Back 4

-C peptide is formed from pro-insulin in the pancreatic beta-cell Golgi apparatus

-within Golgi apparatus, converses cleave proinsulin into insulin, C peptide, and two pairs of basic amino acids

-C peptide is packaged along with insulin in the islet cell secretory granules, and secreted in equimolar concentrations with insulin

Front 5

Transference (psych)

Back 5

-unconscious shifting of emotions or desires associated with one person (e.g., sibling , parent, spouse) to another (physician, therapist).

-this can be positive or negative

-transference reactions often arise from childhood parent-child relationships

Front 6

Acting out

Back 6

-immature defense mechanism – unconscious wishes or impulses are expressed through actions (like temper tantrums)

Front 7

Displacement

Back 7

-displacement is shifting feelings or conflicts from one situation or person to another seen as safer and less distressing

-ex: a medical resident belittled by his attending on rounds who later angrily berates a medical student

Front 8

Projection

Back 8

-projection involves attributing one's own unacceptable thoughts and feelings to another person

-ex: patient accuses therapist of having sexual interest in him when, in fact, the patient is attracted to the therapist

Front 9

Mallory-Weiss tear

Back 9

-tear in gastric MUCOSA near the GE junction

-typically result of repetitive forceful vomiting, which can lead to metabolic alkalosis

-may present with vomiting/retching, hematemesis, and epigastric pain

-bleeding from submucosal arterial or venous plexus

Front 10

Boerhaave syndrome

Back 10

-Boehaave syndrome = esophageal TRANSMURAL TEAR

-also caused by forceful coming (increased intragastric pressure)

-ESOPHAGEAL AIR/FLUID LEAKS INTO MEDIASTINUM AND PLEURA

-presents with vomiting/retching, chest and upper abdominal pain

--> fever, dyspnea, and septic shock

-

Front 11

Ethanol intoxication – metabolic effects

Back 11

-ethanol intoxication can cause lactic acidosis, which produces a HIGH ANION GAP metabolic acidosis

Front 12

Normal anion gap metabolic acidosis

Back 12

-normal anion gap metabolic acidosis is usually caused by loss of bicarbonate, which can occur with PROLONGED DIARRHEA

-vs. recurrent vomiting causes metabolic alkalosis, not acidosis

Front 13

Respiratory acidosis

Back 13

-respiratory acidosis usually seen in patients with chronic obstructive pulmonary disease (COPD) or central nervous system depression (e.g., narcotic overdose)

Front 14

Respiratory alkalosis

Back 14

-respiratory alkalosis occurs with hyperventilation

-seen with panic attacks, and pulmonary emboli

Front 15

Congenital adrenal hyperplasia

Back 15

-21-hydroxylase deficiency is the most common form of congenital adrenal hyperplasia

-affected female infants present at birth ambiguous (virilized) genitalia

-vs. male infants have normal genitalia, and present later with SALT-WASTING or precocious puberty

-a high serum level of 17-hydroxyprogesterone is diagnostic

Front 16

Suspensory ligament of ovary

Back 16

-the nerves and vessels supplying the ovary are delivered through the SUSPENSORY LIGAMENT OF THE OVARY

-so in removal of an ovarian mass, a surgeon should ligate the suspensory ligament to avoid excessive bleeding

Front 17

Transverse cervical ligament

Back 17

-transverse cervical ligament, aka cardnial ligament, extends from cervix and lateral fornix of vagina to lateral pelvic walls

-the uterine artery courses though the transverse cervical ligament and must be ligated during radical hysterectomy

Front 18

Meiosis of oocytes

Back 18

-primary oocytes are completely developed in female embryos by fifth month of gestation, at which point they are ARRESTED IN PROPHASE OF MEISOSIS 1

-ovarian cycle hormones stimulate primary oocyte to resume differentiation

-prior to fertilization, secondary oocytes are arrested in METAPHASE of MEIOSIS II

Front 19

Methemoglobinemia

-presentation: nitrite exposure, with anxiety, weakness, dyspnea, headache
-cyanosis not corrected by oxygen supplementation

Back 19

-methemoglobinemia causes dusky discoloration to the skin (similar to cyanosis)

-since methemoglobin can't carry oxygen, a state of functional anemia is induced

-blood partial pressure of O2, however, will be unchanged in this condition because oxygen's partial pressure is a measure of O2 dissolved in the plasma, and is NOT related to hemoglobin function

-nitrites bind hemoglobin and keep iron in its Fe3+ form, so that it cannot carry oxygen

-Hb saturation is also decreased in CO poisoning, as CO competes with O2
--but still, Po2 of blood (dissolved oxygen) would be NORMAL

Front 20

Bilirubin metabolism

Back 20

-liver takes up indirect/unconjugated bilirubin through a passive process – secretes direct/conjugated bilirubin through an ACTIVE process

-unconjugated bilirubin is virtually insoluble in water at physiologic pH – tightly complexed to serum albumin while in the circulation

--so UNCONJUGATED/INDIRECT BILIRUBIN CANNOT BE EXCRETED IN URINE< EVEN WHEN BLOOD LEVELS ARE HIGH

-vs. conjugated bilirubin is water-soluble, non-toxic, and only loosely bound to albumin – thus can be excreted freely in the urine