UWORLD 14

should thoracentesis be performed above or below the border of the rib? why

above the upper border of the rib bc the INTERCOSTAL VEIN ARTERY AND NERVE lie in the subcostal groove along the LOWER BORDER OF THE RIB

true diverticulum

all 3 gut wall layers outpouch ( mucosa ,submucosa, and muscular layers)

once calcium binds to troponin complex, what happens?

conformational change causing tropomyosin to move out the way exposing myosin binding sites

Myelin reduces charge dissipation thereby increasing the length constant. so in MS, would length constant decrease or increase

decrease

mylenation increases or decreases the time constant ?

decreases

MOA of pertussis toxin

disinhibits AC through Gi ADP-ribosylation; increasing cAMP levels; causes edema & phagocyte dysfunction b/c Gi is ribosylated this allows Gs to take over basically and increase cAMP

colonic and Zenker diverticula or true or false diverticulum

false

metro or vancomycin are good drugs of choice for c. diff. if a patient is having multiple recurring infections what drug would be good to give?

fidaxoicin

multiple myeloma urine electrophoresis will show what protein?

lambda light chains

what organ is at risk during thoracentesis at the 10th rib

liver injury

cAMP (camp fire) stimulates

protein kinase A (pick axes)

drug used to treat breast cancer that can cause DVT?

raloxifene (rolex)

once calcium is released from the SR, what does it bind to?

troponin

what kind of dihhareha does c diff cause?

watery

C. diff (diffuser) toxins

- Toxin A (hay) enterotoxin: fluid accumulation in bowel by disrupting tight junctions in intestinal epithelal cells - Toxin B (bee) cytotoxin: disrupts microfilament system (trellis falling off hay) by actin depolymerization

second line tx for acute gouty arthritis? first line?

-colchicine - NSAIDs ( naproxen, indomethacin)

protein kinase A (pick axes) phosphorylates what? it also has what other effect on calcium?

1.MLCK ( molative cocktail) aka myosin light chain kinase 2. increases calcium

zinc-dependent protease that inhibits mitogen activated protein kinase signaling, causing apoptosis name the toxin and organism

Bacillus anthracis: Lethal factor

What types of cells does HPV infect

HPV has a predilection for infecting stratified squamous epithelium found in 1. anal canal 2. vagina 3. cervix 4. True vocal cords (Note: infants can acquire respiratory papillomatosis via passage through the birth canal of mothers infected with the virus.)

Vertebral subluxation

Complication of chronic rheumatoid arthritis that affects CERVICAL SPINE at the ATLANTOAXIAL joint causing a misaligned vertebra. This can lead to spinal cord compression and areflexic paralysis.

*Gout occurs with increased frequency in patients with activating mutations involving which enzyme due to increased production and degradation of purines?

PRPP synthetase

Meckel's diverticulum- Pathogenesis

Pathogenesis → Meckel's diverticulum results from the incomplete obliteration of the vitelline duct (=omphalomesenteric duct = Dottergang) → The incomplete obliteration leads to the formation of a true diverticulum of the small intestines

Meckel's diverticulum- Pathogenesis of GI bleeding

Pathogenesis of GI bleeding → Meckel's diverticula that contain ectopic gastric mucosa are generally associated with bleeding → The ectopic gastic mucosa secrets acid thereby leading to ulceration of the sourrounding small bowel mucosa → The site of ulceration is adjacent to or just downstream from the diverticulum not from the mucosa or ectopic tissue within the diverticulum

73 year old man, blood in urine, bright red blood at the end of micturition , no freq or pain with urination. smoked for 30 years, hematuria, urine cytology is positive for maligant cells.What feature is worst for progrosis?

Tumor invasion into muscularis propria layer of bladder

damages erythrocyte membranes, causes beta-hemolysis in strep pyogens. name the toxin

Streptolysin O&S

thoracentesis is performed where along the a. midclavicular line b. midaxillary line c. paravertebral line

a. between the 6th and 8th ribs midclavicular b. between the 8th and 10th ribs midaxillary c. between the 10th and 12th ribs paravertebrally