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Application key pearls Flashcards

1
Q

3F

rumbling murmur auscultated in the neck that goes away when child is supine and the neck rotated

Dx?

A

venous hum
benign peds murmur that will go away as child grows

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2
Q

Neonate with supravalvular aortic stenosis

A

Williams syndrome
Chromosome 7 – AD

increases vit D sensitivity

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3
Q

Location of SA node?

A

junction of SVC and RA

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4
Q

Location of AV node

A

inferior to the opening of the coronary sinus = posteroinferior interatrial septum near the coronary sinus

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5
Q

Location of coronary sinus?

A

between the opening of the IVC and the tricuspid valve

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6
Q

2-year-old boy has cardiac myxoma
-peri-oral melanosis = hyperpigmentation around the mouth/lips)
-hyperthyroidism
Dx?

A

Carney complex –> bilateral pigmented zona fasciculata hyperplasia = Cushing syndrome, but can be hyperthyroidism or growth hormone

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7
Q

What kind of pulse is seen in AS?

A

a slow-rising pulse = pulsus parvus et tardus

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8
Q

Heyde syndrome is

A

the combo of AS + angiodysplasia = painless rectal
bleeding in elderly due to superficial tortuous vessels on the bowel wall

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9
Q

AR

A

which causes bounding pulses with head-bobbing = pulse has brisk upstroke with precipitous downstroke

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10
Q

What’s the structural change in the heart with HOCM?

A

asymmetric septal hypertrophy –>
the anterior mitral valve leaflet to block off the LV outflow tract under states of lesser preload

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11
Q

Marfans syndrome AR

A

causes increase in LV cavity size

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12
Q

Marfans syndrome MVP

A

result of myxomatous degeneration

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13
Q

Who gets MS

A

previous rheumatic fever which is a type 2 hypersensitivity

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14
Q

33F
pregnant at 20 weeks
new-onset dyspnea
crackles in both lung fields
diastolic rumbling murmur

A

MS b/c of increases plasma vol

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15
Q

Who gets PS

A

Tetralogy of Fallot - DiGeorge Syndrome
Noonan syndrome

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16
Q

Who gets TR

A

Carcinoid syndrome
note gets louder w/ inspiration

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17
Q

Orlistat

A

pancreatic lipase inhibitor

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18
Q

Evolocumab
Alirocumab

A

PCSK9 inhibitors = prevents the breakdown of LDL receptors

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19
Q

Ivabradine

A

inhibits myocardial funny Na channels

causes luminous phenomenon = brightness in an areas of the visual field

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20
Q

Sacubitril

A

neprolysin inhibitor = breaks down ANP & BNP

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21
Q

Polyarteritis nodosa

A

HepB +
Beads on a string

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22
Q

When is rapidly progressive glomerulonephritis (RPGN) the answer?

A

acute deterioration in renal function (high Cr, high BUN, oliguria) in someone who has a vasculitis

  1. granulomatosis with polyangiitis = formerly Wegener
  2. eosinophilic granulomatosis with polyangiitis = formerly Churg-Stauss
  3. microscopic polyangiitis
  4. Goodpasture syndrome
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23
Q

Biopsy shows what in RPGN?

A

fibrin crescents =
1. parietal cell hyperplasia
2. leukocytic infiltrate

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24
Q

c-ANCA =

A

anti-proteinase 3 (anti-PR3)

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25
Q

p-ANCA =

A

anti-myeloperoxidase (anti-MPO)

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26
Q

Sulfa drug
kidney issue
no blood in urine
Dx?

A

membranous glomerulonephropathy (MG)

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27
Q

Biopsy finding in MG?

A

subepithelial deposits
“spike and dome”

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28
Q
  • HepB or C
    nephrotic syndrome
    Dx?
A

MG = membranous glomerulonephropathy

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29
Q

Autoantibodies in membranous glomerulonephropathy?

A

positive for anti-phospholipase A2 receptor antibodies

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30
Q

Late finding seen histologically in diabetic nephropathy is Kimmelstiel-Wilson nodules which are composed of

A

hyaline

DN = mesangial matrix expansion

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31
Q

Beckwith-Wiedemann syndrome?

A

Wilms tumor
neonatal hypoglycemia
macrosomia /macroglossia
hemihypertrophy
+/- omphalocele
caused by WT2 gene mutation

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32
Q

45F
confirmed Dx of early-stage small cell lung cancer
wobbly gait

A

autoimmune = paraneoplastic anti-Hu anti-Yo

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33
Q

12-hour-old newborn
becomes blue when breastfeeding
becomes pink again when crying
Dx?

A

atresia of the choanae (CHARGE syndrome)
1. Coloboma of the eye
2. Heart defects
3. Atresia of the choanae
4. Retardation
5. Genitourinary abnormalities
6. Ear abnormalities/deafness

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34
Q

medial longitudinal fasciculus (MLF) syndrome

A

The side that cannot adduct is the side that is messed up
the normal sides will have the nystagmus

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35
Q

32M
waxing and waning tinnitus & hearing loss
difficulty hearing conversations at dinner and in groups
has family Hx of similar Sx
Dx?

A

Meniere disease = defective endolymphatic drainage

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36
Q

30F
MDD
Easily angered
Clumsy + shaky
history findings?

A

AD triplet expansion in HTT gene
Exhibits anticipation = succeeding generation earlier onset or increased severity

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37
Q

19M
headache + neck pain
Fever
Pt is oriented to person only
Unchallenged ridigity
Defense mechanism of the brain

A

Microglial - essential role in bacterial meningitis

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38
Q

46M
ED w/ stone refractory to acetaminophen
1st line analgesia

A

Ketorolac = NSAID favored for managing renal colic
Nonopioids are tried 1st

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39
Q

Tramadol

A

Metabolized into opioid
ADRs constipation + Respiratory depression (w/ toxicity)

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40
Q

71F
sudden difficulty walking
Horners sx
Palate sags + gag reflex
Loss of facial pinprick sensation

A

PICA = Pick a horse that can swallow
Lateral medullary syndrome

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41
Q

Loss of pinprick sensation to face

A

Ipsilateral spinal trigeminal tract

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42
Q

55F
1 hr history of worst headache ever
Pupils 4 mm bilaterally
Pupils briskly reactive to light
Hyperintensities in the ambient & superior cisterns

A

Middle cerebral artery ruptured
SAH = subarachnoid space
Superior cisterns = subarachnoid

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43
Q

55F
Headache
Hyperdensity w/n basal ganglion or internal capsule

A

Ruptured Lenticulostriate arteries = intraparenchymal hemorrhage

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44
Q

Middle meninges artery rupture

A

Epidural hematoma

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45
Q

68M
Floaters + flashes of light in his eye
History = DM 2 HTN
Detachment of the retina
MOA

A

Dissection of neuronal + pigment epithelial layers of retina
Blood supply to photoreceptors cells is lost

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46
Q

Capillary damage w/ blood leakage into retina
dx

A

Diabetic retinopathy

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47
Q

45F
ED w/ suddenly onset of worst headache
Alter + oriented x3
Sluggish to answer questions
Non-contrast CT scan= no abnormalities
next steps

A

SAH next steps = Lumbar puncture
After 12 hrs CT is not as sensitive —> LP providing evidence of xanthochromia ( yellow CSF) b/c bilirubin

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48
Q

28F
Tx with escitalpram
What caused sx

A

Raphe nuclei = produces Serotonin
Drug targets metabotropic + ligand-gated 5-hydroxytryptamine receptors in nervous system

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49
Q

40M
Hypotension
Increases serum CRT/BUN
Found on urinalysis

A

Brown granular casts = ATN

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50
Q

61M
ED back pain
Osteomyelitis confirmed & Abx for 2 wks
Which Abx can causes brown granular casts

A

Aminoglycosides = GNATS-mycin

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51
Q

61M
ED back pain
Osteomyelitis confirmed & Abx for 2 wks
Which Abx can causes brown granular casts + leukocytes (eosinophils)

A

Cephalosporins + penicillins

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52
Q

63F
Flaccid paralysis post Epsom salt enema for constipation
Prolong PR interval
Widened QRS complexes
Which electrolyte abnormality is present

A

Hypermagnesemia
This blocks neuromuscular junction

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53
Q

35W 25 weeks pregnant
Headache + blurred vision + SOB
Flaccid paralysis + hypotension + Brady after IV to
ECG = prolonged PR & QRS
Best initial tx

A

IV Ca++ w/ loop diuretics
Preeclampsia tx = Mg which leads to the ECG readings peaked T waves + Prolong PR & QRS

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54
Q

70M
Syncopal episodes
Orthostatic hypotension
High serum Na+ levels
Tx

A

Isotonic (.9) then hypotonic (.45%) saline w/ 5% dextrose

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55
Q

65F
paresthesia
mean corpuscular high

A

Pernicious anemia

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56
Q

Pernicious anemia MOA

A

Parietal cells destruction in the upper glandular layer of stomach

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57
Q

1F
green-yellow vomit post feeding

A

bilious emesis most likely due to intestinal atresia which causes an obstruction

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58
Q

Duodenal atresia

A

recanalization issue seen in 21
Gastric + Proximal duodenal dilations = double bubble

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59
Q

Jejunal/Ileal atresia

A

vascular occlusion (SMA) seen in gastroschisis + volvulus
Dilated loops in small intestine + air/fluid levels

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60
Q

Failure of neural crest cell migration to distal colon (rectum)–> aganglionic colon segments = functional obstruction

A

Hirschsprung disease

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61
Q

Hirschsprung diseases biopsys show

A

absence of submucosal + myenteric plexi
xray = transition zone (narrow-caliber)

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62
Q

334F
known Hep B carrier
IV drug user
Sx of liver issues
Labs + for HBsAg and Hep D RNA
Life cycle?

A

Coating of viral particles
Hep B surface antigen is required to coat Hep D antigen before it can infect + multiply

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63
Q

Jak-STAT pathway used for

A
  1. cytokines = interferon
  2. hematopoietic growth factors = EPO + G-CSF
  3. hormones that bind to cell surface (i.e. GH)
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64
Q

cAMP- PKA pathway used for

A

PTH
ACTH
TSH
ADH

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65
Q

DAG-PKC & IP3-Ca++/calmodulin pathways used for

A

GnRH
TRH
ADH

Releasing in hypothalamus

66
Q

35M
gynecomastia

A

increased estrogen > androgens
this occurs if
1. increases aromatase activity
2. decreased Leydig activity (testosterone production)

67
Q

3wkG
blood-streaked stool
mom = premature rupture of membranes
X-ray = Lucency (gas pockets) that run along the bowel wall

A

Pneumatosis intestinalis = Necrotizing enterocolitis

preterm infant + GI issues

68
Q

Kehr sign

A

seen in splenic laceration = shoulder pain due to peritoneal irritation (stimulates phrenic nerve)

69
Q

4dayM
increased indirect bilirubin
Jaundice

A

increased Bilirubin production (infant RBCs have shorter lifespan)
Increased enterohepatic bilirubin circulation (infant have sterile guts = decreased urobilinogen (reduction))

70
Q

54M
Hepatoslenomegaly
eosinophils
bleeding esophageal varices

A

Schistosomiasis

note S. haematobium = urinary

71
Q

Chronic iron-deficiency anemia + eosinophilia

72
Q

Return from Africia
hepatosplenomegaly
anemia
acute = fever chills malaise

A

malaria
Giema stain

73
Q

27F
RLQ pain
inflamed terminal ileum or sigmoid colon

A

Crohn Disease
noncaseating granulomas
skip lesions
mouth & anus spread
Rectum SPARED
Fistulae

74
Q

42M
painless blood in stool
digital rectal exam = mucosal lesions ABOVE dentate line

A

Internal hemorrhoids

MOA: prolonged distension of anal AV plexus = anal canal is now inflamed + thrombose + prolapse

Have no pain b/c no somatic sensory innervation

75
Q

42M
painful blood in stool
digital rectal exam = mucosal lesions BELOW dentate line

A

External hemorrhoids

76
Q

Where do Internal hemorrhoids drain

A

Superior rectal vein which communicates w/ inferior mesenteric vein

77
Q

Where do external hemorrhoids drain

A

Inferior rectal vein which communicates w/ internal pudendal vein

78
Q

Anastrozole

A

Decreases androgen aromatizations

Used to tx slow the progression of ER+ tumors

Decrease estrogen production

79
Q

54M
Hep C history
Several episodes of vomiting BRIGHT red blood
ab distention + gynecomastia
Altered mental status

A

Cirrhosis (Hep c ab distention + gynecomastia) + recent GI bleed = Hepatic encephalopathy

80
Q

Hepatic encephalopathy

A

increases nitrogen delivery to gut (from GI bleed) can be converted into ammonia which can be absorbed into the bloodstream

accumulation of ammonia can increase inhibitory NT

81
Q

Metyrapone stimulation test

A

tests the HPA axis function

it inhibits 11-b-hydroxylase = decrease cortisol

decrease cortisol = increase ACTH

82
Q

2F
BM with blood
telescoped duodenal
biopsy shows glands

A

Meckel diverticulum incomplete obliteration of vitelline duct
ectopic tissue = gastric mucosa + thyroid etc

83
Q

73M
epigastric pain 30-40 after meals
HTN + hyperlipid + CABG
normal endoscopy

A

Chronic mesenteric ischemia
linked to stable angina

84
Q

Penicillamine

A

increases urinary excretion of copper
copper chelation agent

85
Q

16F
sx of hyperthyroidism
Small thyroid gland
decrease TSH
undetectable thyroglobulin levels
elevated free T4 (thyroxine)

A

Exogenous hyperthyroidism
causes atrophy of the thyroid follicles w/ decreased colloid

86
Q

MOST common cause of hepatic metastases =

A

Colorectal cancer and it spreads via the portal venous circulation

86
Q

MOST common cause of hepatic metastases =

A

Colorectal cancer and it spreads via the portal venous circulation

87
Q

True diverticulum has

A

mucosa
submucosa
muscularis

88
Q

30M
bilious emesis
Bulging pouch connected to ileum

A

Meckel diverticulum

88
Q

Herniated muscular layers

A

Colonic & Zenker (upper esophageal) diverticula = false diverticula
mucosa + submucosa layers

89
Q

23M
hepatomegaly
unprotected sex
never been vax for Hep

90
Q

Hep C vs Hep B

A

Hep C = generally asymptomatic spread = IV drugs

Hep B = Sex + IV drugs + vertical transmission

91
Q

76F
hypoglycemia w/ skipping a meal

A

Sulfonylureas = gly or gli

Meglitinides = glide

92
Q

52F
post-menopausal is given tx
how will the pts condition change the thyroids affects on the body

or 25F
prego

A

Increase TBG & Total T4 & T3

Estrogen –> increases thyroxine-binding globin
TBG lowers free T4 and T3 –> increase TSH transiently

Increases TSH = increased Total T4 (TGB + free T4) & T3

93
Q

Newborn
High TSH
low T4 (thyroxine)

A

Primary hypothyroidism
Thyroid dysgenesis
TSH resistance

94
Q

Newborn w/
Increases TSH & T4

A

Thyroid hormone resistance

95
Q

46M
HIV
oropharyngeal = poor dentition
Endoscopic: Esophageal hyperemia + linear ulceration
Microscopic: cytoplasmic inclusions

96
Q

46M
HIV
oropharyngeal = poor dentition
Endoscopic: punched-out ulcer
Microscopic: multinuclear squamous cells + eosinophilic

97
Q

46M
HIV
oropharyngeal = poor dentition
Endoscopic: gray/white erythematous mucosa
Microscopic: yeast

A

Candida albicans = most common

98
Q

46M
HIV
oropharyngeal = poor dentition
Endoscopic: gray/white erythematous mucosa
Microscopic: yeast

A

Candida albicans = most common

99
Q

Who has GLUT 4 receptors

A

Skeletal Muscles + Adipocytes

100
Q

70F
Blacked colored stool
endoscopy = gastric antrum irregular borders + ulcer
Biopsy of ulcer = glandular structures containing intestinal-like columnar cells

A

Gastric adenocarcinoma

predisposes pt =
1. excessive salt-preserved foods
2. H. pylori infection
3. n-nitroso-containing compounds
4. autoimmune atrophic gastritis

101
Q

63M
- Immunosuppression meds
- 2cm ulcerated mass from the anal verge into the rectum
- Biopsy =
1. eosinophilic squamous epithelial cells
2. hyper-chromatic
3. irregular nuclei
4. scant cytoplasm
5. keratinization

102
Q

Preproinsulin made in

A

RER in B-cells (pancreatic)

103
Q

Proinsulin is made in

A

stored in secretory granules = cytoplasm

104
Q

3 dayM
Poor feeding + emesis + lethargy
Laparotomy - fibrous bands from cecum + right colon to retro-peritoneum = extrinsic compression of duodenum

A

Intestinal malrotation = midgut rotation + intestinal fixation

105
Q

72F
large amount of BRIGHT red blood w/ stool
Colonoscopy = multiple outpouching

A

Colonic diverticulosis

106
Q

Colonic diverticulosis MOA

A

disruption of vasa recta (terminal vessels derived from SMA & IMA) penetrate through the smooth muscular layer of colon = intraluminal colon wall lacks structural integrity (absence of muscularis propria)

107
Q

Colonic diverticulosis tx

A

resuscitation IV + colonoscopy

persistent bleeding = angiography + surgery

108
Q

Terminal ileum vs Proximal Duodenum

A

Terminal ileum = villi + colonic crypts epithelial cells secrete Bicarb

Proximal Duodenum = submucosal glands (Brunner) secrete bicarb

109
Q

2F
karyotype 46XX
evaluation of ambiguous genitalia is the result of

A

11b-hydroxylase deficiency

Causes excess androgen –> virilization

if an infant = aromatase deficiency

110
Q

2M
karyotype 46XY
evaluation of ambiguous genitalia is the result of

A

5-a reductase deficiency

111
Q

15M
Pancreatitis
hypo-reflexia + decreased proprioception
mild hemolytic anemia

112
Q

BPH tx

A

5-a reductase inhibitor
finasteride
decreases conversion of testosterone to DHT

113
Q

finasteride ADR

A

decreased libido
erectile dysfunction
decreased ejaculate vol

5-a reductase inhibitor

114
Q

8month
poor feeding
Enterovirus in brain biopsy

A

X-linked agammaglobulinemia = BTK gene mutation
low circulating B-lymphocyte count

115
Q

19F
O-neg packed RBCs given
facial swelling
generalized hives = urticaria
SOB = wheezing

A

Selective IgA deficiency

sinopulmonary + GI infections
linked to blood products –> anaphylaxis

116
Q

7M
acetaminophen
facial swelling = cheeks + lips + tongue

A

C1 inhibitor deficiency = low C4
increased C1 + bradykinin

117
Q

Decreased in ______ leads to reduced efficacy in Ig by a single plasma cells

A

number of Ag epitopes recognized

118
Q

Sequestered Ag post trauma =

A

Immune privilege = inherent response

119
Q

widespread capillary occlusion during graft procedure

A

Hyperacute rejection

120
Q

Hypersensitivity of hyperacute rejection =

A

2
Ab rxn to donor Ag

121
Q

Dense interstitial lymphocytic infiltrates = which hypersensitivity rxn

A

4 = seen in Acute rejection
recipient CD8+ T cells attacking donor MHC molecules

122
Q

Difference between Graft vs Host disease & Chronic transplant rejection

A

GVHD = Grafted T cells proliferate in immunocompromised hosts & reject host cells = seeing them as “foreign” proteins

Chronic = CD4+ cells secrete inflammatory cytokines to cause smooth muscle proliferation, parenchymal atrophy, and interstitial fibrosis

123
Q

DHR assay converts DHR to rhodamine (green)
this is abnormal in pts with

A

Chronic granulomatous disease (defective NADPH)

124
Q

Young F
irregular heavy menses since the start
PE normal
Labs + pap + US normal
MOA?

A

anovulatory cycles as a result of metrorrhagia (dysfunctional uterine bleeding in young women)
unopposed estrogen (no progestrone)

125
Q

Infant that is breastfeed
increased indirect bulirubin is the result of

A

glucuronyl transferase deficiency

126
Q

40M
Irish-English
fatigue
diminished libido
erectile dysfunction
hyperpigmentation on skin
dx?

A

Hereditary hemochromatosis

Celtic descent

127
Q

60M
CHF
Normal renal function
which drug increases survival

A

ACEi = slows the abnormal ventricular remodeling to improve survival

128
Q

Percussion of facial nerve – twitching =

A

hypocalcemia

129
Q

Ethmoid = CNs
Sphenoid = CNs
Temporal = CNs
Occipital = CNs

A

Ethmoid = CN1 (Olfactory)

Sphenoid = CN2-6

Temporal = CN7-11

Occipital = CN9-12

130
Q

Norepinephrine increases

A
  1. systolic & diastolic pressures
  2. α1-mediated = vasoconstriction
  3. mean arterial pressure
131
Q

NE causes

A

Reflex bradycardia

132
Q
  1. Unconscious proprioception
  2. Fine touch + vibration + proprioception
  3. Pain & Temperature B/L
A

Unconscious proprioception = spinocerebellar tract

Fine touch + vibration + proprioception = DCML

Pain & Temperature B/L = Syringomelia

133
Q

The fibers of the ________ tract decussate at the spinal level which they innervate

A

anterior corticospinal

134
Q

Extrapyramidal tracts are upper motor neuron pathways that contribute to the

A

autonomic innervation of body tissues

  1. reticulospinal tract
  2. rubrospinal tract
  3. tectospinal tract
  4. vestibulospinal tract
135
Q

Pyramidal tracts are upper motor neuron pathways that contribute to the

A

innervation of skeletal muscle

  1. corticospinal tract
  2. corticobulbar tract
136
Q

Muscles in the lower quadrant innervated by

A

CN VII (facial) = only contralateral innervation

137
Q

Muscles in the superior quadrant receive

A

B/L upper motor innervation via the corticobulbar tract

138
Q

Ventral midbrain degeneration = dx

A

Parkinson’s

Ventral midbrain = substantial nigra

139
Q

Xray = egg on a string

A

Transposition of the great vessels

140
Q

Scrotum drains to

A

Superficial inguinal nodes

141
Q

Testes drain into

A

Para-aortic (lumbar) node

142
Q

Prostate + corpus cavernous drain

A

Internal inguinal node

143
Q

Decrease progesterone causes spiral arteries to

A

Vasospasm = bleeding + menstruation

144
Q

Progesterone allows

A

For spiral arteries to proliferate

Endometrial thickening

Tortious endometrial glands

145
Q

CKD
normal platelet count
normal coagulation studies
excessive bleeding

A

Platelet dysfunction = unregulated NO = decreased adhesion + activation + aggregation

146
Q

Decreased slope of venous return

A

seen in systolic heart failure
increases atrial pressure
causes peripheral edema

147
Q

proximal to distal, the parts of the urethra are

A

prostatic
membranous
bulbar
penile

148
Q

______ poisoning inhibits enzymes that normally prevent the production of reactive oxidative species (ROS), resulting in increased oxidative damage

149
Q

55M
Bone pain
hearing loss
elevated ALP

A

Paget = Osteitis deformans

150
Q

Ramsay Hunt syndrome vs Bell’s Palsy

A

Ramsay Hunt syndrome = latent varicella-ZOSTER virus reactivates in the geniculate ganglion (involving CN VII and CN VIII)

Bell’s palsy = HSV CN 7

151
Q

DiGeorge w/ harsh systolic murmur LLSB

A

Persistent truncus arteriosus

152
Q

increase in urine pH can increase the risk of,

A

nephrolithiasis

Acetazolamide (carbonic anhydrase inhibitor) decreases bicarbonate reabsorption and alkalinizes the urine

153
Q

urinary incontinence
bladder exstrophy

A

Epispadias = Dorsal + Upper side

abnormal genital tubercle

154
Q

Urinary incontinence
inguinal hernias
cryptorchidism

A

Hypospadias = Ventral + Lower side

failure of urethral folds to close

155
Q

Sclerotic phase of Paget disease of bone is defined by predominant

A

osteoblastic activity

156
Q

Congenital adrenal hyperplasia

A

Decreased aldosterone
Decrease BP
Increase K+

157
Q

Oral Scabies tx

A

Ivermectin = parasite paralysis through distinct mechanisms:

  1. stimulation of nerve and muscle cell glutamate-dependent chloride channels = influx of chloride, hyperpolarization
  2. GABA-mediated
158
Q

Smoking cessation

A

Varenicline = partial nicotinic receptor agonist

Bupropin = NE & dopamine antagonist
lowers seizure threshold in pts w/ bulimia

Level 1/Step 1 (15 decks)

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