Uworld 12

Front 1

Turner syndrome manifestations

Back 1

-primary amenorrhea, high arched palate, and widely spaced nipples are characteristic manifestations of Turner syndrome

-an additional characteristic finding is OVARIAN DYSGENESIS, which manifests as "streak gonads"

Front 2

Bartonella henselae

Back 2

-Bartonella henselae causes cat-scratch disease --> fever/lymphadenopathy (self-limited)

-organism resides in oral cavity of cats – transmitted to humans by cat scratches and bites

-Bartonella henselae can also cause bacillary angiomatosis (BA) in immunocompromised patients, with red-purple papular skin lesions.

--these vascular proliferations may also be found within the viscera

--bacillary angiomatosis can be fatal if left untreated

-Lastly, Bartonella henselae can cause culture-negative endocarditis

Front 3

Toxic shock syndrome

Back 3

-toxic shock syndrome (TSS) is caused by Staphylococcus aureus

-patients present with fever, vomiting diarrhea, desquamation, and hypotension

Front 4

Hemolytic uremic syndrome

Back 4

-hemolytic uremic syndrome is triad of microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency CAUSED BY E.COLI O157:H7

Front 5

Malignant otitis externa

Back 5

-pseudomonas aeruginosa can cause malignant otitis externa in individuals using contaminated pools and hot tubs

Front 6

Reactive arthritis

Back 6

-reactive arthritis is a type of HLA-B27-positive reactive arthritis classically accompanied by urethritis and conjunctivitis

-reactive arthritis is associated with Chlamydia, Shigella, Salmonella, Yersinia, and Campylobacter infections

Front 7

Condylomata acuminata

Back 7

-condylomata acuminata = genital warts

--caused by human papillomavirus (HPV), type 6 and 11

--condylomata acuminata presents as soft, tan, cauliflower-like masses on penis, vulva, and peri-anal areas

Front 8

Femoral neck fracture

Back 8

-a femoral neck fracture can damage the blood supply to the femoral head and neck

--most common with displaced fractures

--the MEDIAL FEMORAL CIRCUMFLEX ARTERY provides majority of blood supply to femoral head and neck

--injury to this vessel can cause avascular necrosis of the femoral head

Front 9

Chediak-Higashi syndrome

Back 9

-AR disorder of neutrophil phagosome-lysosome fusion

-results in neurologic abnormalities, PARTIAL ALBINISM, and an immunodeficiency caused by defective neutrophil function

-Ched – head problems (neurologic)
-Hi-gosh you're white (albinism)

Front 10

GI embryo

Back 10

-abnormal rotation and fixation of midgut early during fetal life results in intestinal malrotation

-two main manifestations of this condition are intestinal obstruction (due to compression by the adhesive bands) and midgut volvulus (intestinal ischemia due to twisting of vessels).

Front 11

Eosinophils

Back 11

-late phase of an atopic asthma attack involves mucosal infiltration by eosinophils, basophils, and neutrophils

-eosinphils have biloped nuclei, and are backed with large eosinophilic (pink) granules of relatively uniform size

-eosinophils also release MAJOR BASIC PROTEIN, a potent ANTI-HELMINTHIC toxin capable of damaging human epithelial and endothelial cells.

-vs. neutrophils tend to have multilobed (more than 3) nuclei and stain relatively pale

-vs. basophils contain granules that stain dark blue, are irregularly sized, and usually obscure the nucleus.

Front 12

Blood transfusion and calcium chelation

Back 12

-normal serum calcium level is 8.4-10.2 mg/dL

-patients who receive equivalent of more than one body blood volume (5-6 liters) of whole blood transfusions or packed red cells over period of 24 hours may develop elevated plasma levels of CITRATE (a substance added to stored blood).

-citrate chelates calcium and magnesium, and may reduce their plasma levels, causing paresthesias

Front 13

Normal sorbitol metabolism

Back 13

-aldose reductase converts glucose into sorbitol, which is further metabolized into FRUCTOSE by sorbitol dehydrogenase

-this pathway is most active in the seminal vesicles, because sperm use fructose as their primary energy source

-other tissues that have sorbitol dehydrogenase activity include retina, renal papilla, and Schwann cells, but these have much less sorbitol dehydrogenase activity

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Front 14

Sorbitol dehydrogenase in the lens

Back 14

-human lens has significant levels of sorbitol dehydrogenase, which allows for production of fructose

-however, this enzyme has much lower Vmax in sorbitol-to-fructose direction than in reverse direction

-when glucose levels are low, the limited forward activity of this enzyme is sufficient to convert enough sorbitorl into fructose to prevent sorbitol accumulation

--but long-standing hyperglycemia can lead to production of excessive amounts of sorbitol that is trapped in cells

--this leads to increased osmotic pressure, facilitating influx of water into lens cells, causing lens degeneration

--> lens opacification and cataract formation

Front 15

Lipoic acid

Back 15

-lipoic acid is a cofactor for several mitochondrial enzymes

--pyruvate dehydrogenase (PDH –deficiency results in lactic acidosis)
--PDH converts pyruvate to acetyl CoA, which can enter the Krebs cycle and be made into citrate by citrate synthase (first step)

--branched chain ketoacid dehydrogenase (deficiency results in maple syrup urine disease)

--alpha ketoglutarate dehydrogenase

Front 16

Positive and negative predictive values

Back 16

-these depend on disease prevalence in population

-vs. sensitivity and specificity of a test do not depend on prevalence of disease in population