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Usmle > Block 25 > Flashcards

Block 25 Flashcards

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USMLE® Step 1 flashcards
1
Q

Suppurative parotitis in adults

A

Risk factors:
-decreased salivary flow such as anticholenergic medications, obstruction, dehydration or postsurgical/intubation.
Microbiology:
-s.aureus, or anaerobes
Clinical:
-firm, erythmatous pre/postauricular swelling
-trismus, dysphagia, systemic findings
Diagnosis:
- imaging (ultrasound/ct) shows ductal inflammation, cyst or abscess.
- serum amylase is elevated with no pancreatitis.

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2
Q

Difference in DI and Acute GI hemorrhage effect on ECF and ICF

A

In DI both ECF and ICF decreased in volume and osmolarity increases while in acute GI hemorrhage (hypovolemia), only ECF volume is decreased with normal osmolarity.

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3
Q

Aminoglycosides adverse effect

A
  • Ototoxicity (hearing loss and tinnitus)

- nephrotoxicity

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4
Q

Adverse effect of graves disease treatment

A
  1. Antithyroid drugs: (methimazole,…)
    - agranulocytosis
    - methmazole can cause 1st trimister teratogen, cholestasis
    - propylothuracil : hepatic failure, ANCA associated vasculitis.
  2. Radioiodine ablation:
    - permanent hypothyroidsm.
    - worsening of ophthalmopathy
    - possible radiation sied effects
  3. Surgery :
    - permanent hypothyroidism
    - risk of reccurent laryngeal nerve
    - risk of hypoparathyrodism
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5
Q

Postpartum hemorrhage control

A

Obstetrical emergency and a leading cause of maternal mortality. Postpartum hemorrhage is frequently caused by failure of uterus to contract and compress placental site blodd vessels .

  • bilateral ligation of the internal illiac arteries should stop uterine blood flow and hemorrhage, thereby preventing the need for hysterectomy.
  • the uterus has collateral blood flow from the ovarian arteries which is suffecient to maintain uterine function after internal illiac ligation.
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6
Q

Lymph nodes anatomy

A

Follicle : site of B cell localization
Medulla: consist of medullary cords and medullary sinuses, they contain reticular sites and macrophages.
Paracortex: house of T cells, region between the follicules and medulla.(not well developed in patients with di george syndrome)

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7
Q

Failed lateral fusion of paramesonephric duct leads to

A
  • incomplete lateral fusion of upper segment can result in bicornuate uterus
  • complete lack of fusion lead to uterine didelphys
  • failed involution of the paramesonephric duct can result in longitudinal uterine septum.
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8
Q

Silicosis increase predisposition of lung infections, ? How

A

Silicosis impairs macrophae effector arm of cell mediated immunity which is integral to the immune response against myobacteria. Its thought that macrophae phagolysosomes are disrupted by internalized silica particles causing release of the particle and viable myobcateria.
-this extracllular release o flyzozomal enzymes is thought. To contribute to alveolar and interstitial lung injury in silicosis.

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9
Q

hypocalcemia after blood transfusion ?

A
  • the condition can lead to parasethesia due to hypocalcemia.
  • whole blood transfusion is mixed usually with citrate anticoagulants containing solution.
  • citrate can chelate serum Ca++ causing hypocalcemia
  • this usually occurs after 5-6 liters of blood transfusion occurs.
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10
Q

Isotype switching

A

Occurs in the germinal centers late in the primary response providing activated B-cells the ability to produce antigen specific antibodies of different isotypes.
- this usually occurs in lymphnodes follicules

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11
Q

Anterolateral humoral fracture

Anteromedial humoral fracture

A
  • radial nerve injruy in anterolateral humoral fracture.

- median nerve injury anteromedial humoral fracture.

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12
Q

Signs of atheroembolism following invasive vascular procedure

A
  • blue toe
  • livedo reteculatis with normal peripheral pulses
  • raises the suspicion of atheroembolic disease in which cholesterol containing debris gets dislodged from larger arteries and lodges in small vessels.
  • AKI is the most common presenting symptom of postprocedure atheroembolism and is frequently seen in elderly patietnts with preexisting ATH.
  • cholesterol is dissolved during tissue preperation for microscopic evaluation, leaving needle shaped clefts that partially or completely obstruct the arcuate or intralobular renal arteries.
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13
Q

Symptoms of pyelonephritis

A 
Fever, chills, nausea, vmoiting , flank/abdominal ain and costovertebral angle tenderness develops. 
WBC casts (the most specific sign) and bacteria.
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14
Q

Acute decompensated HF on xray

A 
Pleural effusion
Cardiomegaly 
Peripheral alveolar edema
Cepahlization of pulmonary vessels 
Kerely B lines
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15
Q

Actinomycosis

A

These oorganisms usually colonize the mouth, colon, and vagina and can be found in dental caries as well as the margins of gums in patients with poor dentition.

  • actinomyces infection most frequently leads to the formation of cervicofacial abscesses, but systemic infection can develop anywhere in the body when the mucosa is disrupted.
  • diagnosis is made by identifying the bacteria with unique filamentous, branching patters and the characteristic sulfur granules which are formed by calcified mycelial fragments.
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16
Q

Features of constrictive pericarditis

A 
Etiology ; 
-idiopathic or viral 
- cariac surgery or radiation therapy 
-TB
Pathogenesis: 
- thickned, rigid pericardium forms a noncompliant casing surrounding the heart, limiting ventricular expansion during diastolic filling.
Hemodynamic signs: 
-increased jugular venous pressure 
-kussmaul sign
-pulsus paradoxus
- pericardial knock.
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17
Q

Kussmaul sign

A

Seen on constrivtive pericarditis , normally JVP drops in normal respiration however in kussmaul sign there is paradoxical rise in JVP

18
Q

Di george syndrome is due to

A

Chromosomal micro-deletion

19
Q

Polymerization defect in RBC occurs in

A

Polymerization of hemoglobin occurs in sickle cell anemia. A missense mutation in the beta globin chain leads to the production of hemoglobin S.

20
Q

Imbalance between alpha and beta globins is seen in

A

Thalasemia

Target cells

21
Q

Fibromyalgia

A

Is a chronic disorder that is charactrized by widespread musculoskeletal pain in association with fatighe, and neuropsychiatric disturbances.
Its most common in women age 20-55, examination shows tenderness at characterestic locations in the soft tissues and at bony prominence.
- the diagnosis can be made in patients with chronic pain and fatigue for >3 months in the absence of physical or laboratory findings suggestive for inflammatory etiology.
-gradual incremental aerobic exercise is proven to reduce pain and improve function.
-TCA and serotonin-NE reuptake inhibitors modify processing of pain signals and can also be considered in patients with more severe or refractory symptoms

22
Q

Third heart sound

A

The S3 can be normal in young individuals and pregnant patients, its presence in those age >40 s typically a sign of LV failure/overload.

  • in early diastole, the ventricles relax and the AV valves open, allowing blood to rush in and fill the ventricles.
  • S3 develops with forecful rapid passive filling that exceeds the expansion capacity of the LV —> sudden deceleration of the entering blood column and reverberation of ventricular walls.
  • as a result, S3 is often heard in pathologic settings causing high ventricular filling pressure or volume overload, particulary aortic or mitral regurgitation and dilated CM.
23
Q

Etanercept

A

TNF-a inhibitor added to methotrexate to treat moderate to severe RA in patients who have failed methotrexate alone. Its a fusion protein linking a soluble TNF-a receptor to the Fc component of human IgG1.
-etanercept is : —“ not monoclonal antibody”, it reduces the biological activity of TNF-a by acting as a decoy receptor.

24
Q

Deletion of dystrophin gene causes ?

A
  • Duchene muscle dystrophy. The condition is X-linked recessive and therefore affects primarily boys.
  • dystrophin is a structural protein of muscle fibers, and its absence causes muscle fiber destruction (myocnecrosis).
  • variation in muscle fibers shape and size, regenerating fibers, and increased amounts of connective tissue are seen on light microscopy.
  • disease onset is age 2-5. Muscle of the proximal lower extremities, back and pelvic and shoulder girdles are affected first.
25
Q

Duchene muscle dystrophy

A

Symptoms of DMD include the following:

  1. Ambulation difficulties: clumsy, slow ,waddling gait, cant keep up with peers.
  2. Gower sign: progressive weakness in proximal musculature,resulting in use of the hands to support weight on standing
  3. Calf pseudohypertrophy: calf muscle hypertrophy initially in response to proximal muscle weakness and are later replaced by fat and connective tissue.
  4. Asymmetric weakening of the paraspinal muscle, leading to kyphoscoliosis.
    - most patients with DMD are wheelchair bound by age 12. Scoliosis progresses rapidly due to muscle imbalance and body positional changes.
    - worsening scoliosis is complicated by restrictive pulmonary function.
26
Q

structual differences between regular insulin and analogue insulin

A

Insulin analogues have altered amino acids: alteration of aminoacid structure at the C terminal of the insulin B chain can prevent polymerization and allow rapid absorption from the injection site. This leads to lower risk of hypoglycemia and faster onset of action.

27
Q

BNP and ANP

A

Polypeptides hormone that excert their effect by binding ANP receptors —> these are linked to guanylyl cylase that converts guanosine 5’-triphosphate to cyclic guanosine 3’,5’ monophosphate. ( cGMP).
-cGMP then activates downstream cGMP dependent protein kinase, leading to relaxation of vascular smooth muscle and subsequent vasodilation.
Nitric oxide activates the same cGMP second messenger system by binding a cytosolic gunaylyl cyclase.
-penile erection is initiated by a release of Ach and NO from parasympatetic fibers.
-leading to release in intracellular cGMP and vasodilation of the arteries supplying the corpus cavernosum.

28
Q

Estrogen synthesis in women

A

Estradiol, the predominant estrogen in human body is primarily derived from androgens, androgens and progesterone are synthesized from cholesterol in the theca interna cells under the infleuence of LH
-FSH found on granulosa cells —> converts androgens to —> E2. (FSH stimulates aromatase)

29
Q

Lung malignancies paraneoplastic syndromes

A 
Small cell lung carcinoma: 
-siadh
-cushing 
-lambert eaton mysthenic syndrome
-cerbellar ataxia
Squamous cells: 
-hypercalcemia (PTHrP)
Adenocarcinoma :
-hypertrophic osteoarthropathy
-dermatomyositis
-migratory thrombophlebitis
30
Q

Gynecomastia drugs

A

-spironolactone, can be unilateral or bilateral
-neuroleptics
-acute alcohol intake
-ketoconazole
-steroids
-RErspiridone
-cimitidine
-

31
Q

Fragile X syndrome

A 
Pathogensis:
-x-linked disorder caused by loss of function mutation in the fragile X mental retardation gene on the long arm of chromose X.
Clinical:
-neurobehavioral problems
-prominent forehead
-large ears
-long narrow face
-prominent chin
-macroorchidism
32
Q

Chronic messenteric ischemia

A
  • postprandial epigastric pain and associated food aversion/weight lloss in the setting of generailzed atherosclerosis (coronary or carotid disease)
  • intestinal hypoperfusion —> very painful especially within one hour of eating, due to the O2 demands that required to supply intestine (similar to pathophysiology of angina)
33
Q

Aspergillus can cause

A
  1. Invasive aspergillosis develops in immunosuppressed patients. (CML, lymphoma or other treatment ). Usually affects the lung causing granuloma with fever and pleuritic chest pain and hemoptysis. But it can also spread to skin,kidney,paranasal sinuses, endocardium and brain.septate hyphae is seen
  2. Aspergillioma are fungus balls usually present at old lung cavities , thery are limited to preexisting cavity;
  3. Allergic bronchopulmonary aspergillosis, occurs in patients with asthma and presents with wheezing and migratory pulmonary infiltrates. Increased IgE and increased titers of antibodies against aspergillus.
34
Q

Aspergilus biopsy

A
  • fungal hyphae, branching at acute angle
  • sometimes with septation.
  • monomorphic exist only in. Mold form (hyphae)
35
Q

Contraindication for fibrinolysis

A
  • hemorrhagic storke
  • ischemic stroke
  • BP more than 180/110
  • suspected dissecting aneurysm
36
Q

Hartnup disease pathogenesis

A

Autosomal recessive metabolic disorder caused by inactivating mutation affecting the neutral amino acid transporter. This result in impaired transport of neutral amino acid, particularly tryptophan, in the small intestine and PCT of kidney.
-its essential amino acid and a precursor for niacin, serotonin and melatonin, conversion of tryptophan to niacin is responsible for generation of up to half of the NAD required for redox reaction

37
Q

Hartnup clinical:

A

Pellagra like skin eruption (red, rough rash following sun exposure)
Cerberllar ataxia that becomes less severe at adulthood.
-
Diagnosis is confirmed by detecting excessive amounts of neutral amino acids in the urine (neutral aminoaciduria).

38
Q

Xanthelasma

A

Type of xanthoma usually found on the medial eyelids.

  • hyperlipidemia and/or dyslipidemia can result in xanthomas.
  • xanthelasma are dermal accumulation of benign appearing macrophages with abundant foamy cytoplasm containing cholesterol, phospholipids and TAG.
39
Q

Bilateral wedge shaped strips of necrosis over the cerebral convexity, parallel and adjacent to the longitudinal cerebral fissure.

A
  • hypoxic ischemic encephalopathy especially in water shed areas.
  • profound hypotension due to cardiac arrest for example —> diminshed blood supply to the brain —> global cerberal ischemia
  • if ischemia is profound necrosis if the areas supplied by the distal most branches of the cerberal arteries, termed watershed infracts can occur.
40
Q

What are the most valunrable parts in brain secondary to ischemic injury

A
  • hippocampus pyramidal cells

- purkinji fibers of the cerebellum

Usmle (45 decks)

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