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STEP > Classic Presentations > Flashcards

Classic Presentations Flashcards

1
Q

Abdominal pain, diarrhea, leukocytosis, recent antibiotic use

A

Clostridium dificile infection

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2
Q

Achilles tendon xanthoma

A

Familial hypercholesterolemia

decreased LDL receptor signaling

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3
Q

Adrenal hemorrhage, hypotension, DIC

A

Waterhouse-Friderichsen syndrome (meningococcus)

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4
Q

Anaphylaxis following a blood transfusion

A

IgA deficiency

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5
Q

Anterior drawer sign (+)

A

ACL injury

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6
Q

Athlete w/ polycythemia

A

Secondary to EPO injxn

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7
Q

Back pain, fever, night sweats

A

Pott disease

vertebral TB

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8
Q

Bilateral acoustic schwannoma

A

NFT type II

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9
Q

Bilateral hilar lymphadenopathy, uveitis

A

Sarcoidosis

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10
Q

Black eschar on the face of a patient w/ diabetic ketoacidosis

A

Mucor or Rhizopus infxn

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11
Q

Blue sclera

A

Osteogenesis imperfecta

Type I collagen defect

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12
Q

Bluish line on the gingiva

A

Burton line

Lead poisoning

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13
Q

Bone pain, bone enlargement, arthritis

A

Paget disease of the bone

Increased osteoblastic and osteoclastic activity

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14
Q

Bounding pulses, diastolic heart murmur, head bobbing

A

Aortic regurgitation

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15
Q

Butterfly facial rash and Raynaud phenomenon in a young female

A

SLE

Rash
Arthritis
Serositis
Hematologic disorders

Oral ulcers
Raynaud’s Phenomenom/ Renal disease

Photosensitivity
Antinuclear abs
Immunosuppressants
Neurologic disorders (seizures, psychosis)

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16
Q

Cafe-au-lait spots, polyostotic fibrous dysplasia, precocious puberty, multiple endocrine abnormalities

A

McCune-Albright syndrome

mosaic G-protein signaling mutation

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17
Q

Cafe-au-lait spots, Lisch nodules (iris hamartoma), cutaneous neurofibromas, pheochromocytommas, optic gliomas

A

NFT Type I

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18
Q

Cervical Lymphadenopathy, desquamating rash, coronary aneurysms, red conjunctivae, red tongue

A

Kawasaki disease

(Tx. w/ IVIG and aspirin)

CRASH and burn

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19
Q

Calf pseudohypertrophy

A

Muscular dystrophy

most commonly Duchenne, due to X-linked recessive mutation of dystrophin gene

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20
Q

“Cherry-red” spots on the macula

A

Tay-Sachs Disease
(ganglioside accumulation)

Nieman-Pick’s Disease
(sphingomyelin accumulation)

Central retinal artery occlusion

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21
Q

Chest pain on exertion

A

Angina (stable)

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22
Q

Chest pain, pericardial effusion/friction rub, persistent fever following an MI

A

Dressler Syndrome (AI-mediated post-MI fibrinous pericarditis, 2-12 weeks after episode)

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23
Q

Chest pain w/ ST depressions on EKG

A

Unstable angina

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24
Q

Child uses arms to stand up from squat

A

Gower’s Sign

Duchenne’s muscular dystrophy

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25
Q

Child w/ fever later develops red rash on face that spreads to body

A

“Slapped cheeks”

(erythema infectiosum/fifth disease; parvovirus B19

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26
Q

Chorea, dementia, caudate degeneration

A

Huntington’s Disease

AD CAG repeat expansion

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27
Q

Chorioretinitis, hydrocephalus, intracranial calcifications

in newborn

A

Congenital toxoplasmosis

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28
Q

Chronic exercise intolerance w/ myalgia, fatigue, painful cramps, myoglobinuria

A

McArdle’s Disease

(Skeletal muscle glycogen phosphorylase deficiency)

(Type V glycogen storage disease)

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29
Q

Cold intolerance

A

Hypothyroidism

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30
Q

Conjugate horizontal gaze palsy

A

Internuclear ophthalmoplegia

damage to MLF; may be unilateral or bilateral

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31
Q

Continuous “machine-like” heart murmur

A

PDA

Close w/ indomethacin; open or maintain w/ PGE

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32
Q

Cutaneous/dermal edema due to connective tissue deposition

A

Myxedema

(Caused by hypothyroidism, Grave’s Disease)

-Commonly pretibial

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33
Q

Cutaneous flushing, diarrhea, bronchospasms

A

Carcinoid syndromem

Right sided cardiac valvular lesions, increased 5-HIAA

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34
Q

Dark purple skin/mouth nodules in a patient w/ AIDS

A

Kaposi’s Sarcoma

HHV-8

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35
Q

Deep, labored breathing/hyperventilation

A

Kussmaul respirations

Diabetic Ketoacidosis

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36
Q

Dermatitis, dementia, diarrhea

A

Pellagra

Niacin deficiency

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37
Q

Dilated cardiomyopathy, edema, alcoholism or malnutrition

A

Wet beriberi

Thiamine deficiency

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38
Q

Dog or cat bite resulting in infxn

A

Pasteurella multocida

cellulitis at infxn site

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39
Q

Dry eyes, dry mouth, arthritis

A

Sjogren syndrome

AI destruction of salivary glands

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40
Q

Dysphagia (esophageal webs), glossitis, iron deficiency anemia

A

Plummer-Vinson Syndrome

May progress to esophageal SCC

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41
Q

Elastic skin, hypermobility of joints, increased bleeding tendency

A

Ehlers-Danlos syndrome

Type V collagen defect; type III collagen defect seen in vascular subtype of EDS

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42
Q

Enlarged, hard left supraclavicular node

A

Virchow node

Abdominal metastasis

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43
Q

Episodic vertigo, tinnitus, hearing loss

A

Meniere Disease

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44
Q

Erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T-cells

A

Mycosis fungiodes
(cutaneous T-cell lymphoma)

Sezary Syndrome
(mycosis fungiodes+malignant T-cells in blood)

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45
Q

Facial muscle spasm on tapping

A

Chvostek sign

hypocalcemia

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46
Q

Fat, female, forty, fertile

A

Cholelithiasis

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47
Q

Fever, chills, headache, myalgia following antibiotic tx. for syphilis

A

Jaisch-Herxheimer reaction

Rapid lysis of spirochetes resulting in endotoxin release

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48
Q

Fever, cough, conjunctivitis, coryza, diffuse rash

A

Measles

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49
Q

Fever, night sweats, weight loss

A

B-sx. of lymphoma (likely Hodgkin’s)

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50
Q

Fibrous plaques in soft tissue of penis w/ abnormal curvature

A

Peyronie disease

Connective tissue disorder

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51
Q

Golden brown rings around peripheral cornea

A

Kayser-Fleischer rings)

Cu2+ accumulation in Wilson’s disease

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52
Q

Gout, intellectual disability, self-mutilating behavior in a boy

A

Lesch-Nyhan Syndrome

HGPRT deficience, X-linked recessive

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53
Q

Hamartomous GI polpys, hyperpigmentation of mouth/feet/hands/genitalia

A

Peutz-Jeghers syndrome

inherited, benign polyposis can cause bowel obstruction; increased cancer risk, mainly GI but others too

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54
Q

Hepatosplenomegaly, pancytopenia, osteoporosis, aseptic necrosis of femur, bone crises

A

Gaucher’s Disease

glucocerbrosidase deficiency

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55
Q

Abdominal pain, ascites, hepatomegaly

A

Budd-chiari syndrome

posthepatic venous thrombosis

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56
Q

Hereditary nephritis, sensorineural hearing loss, cataracts

A

Alport syndrome

Defective type IV collagen

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57
Q

Hyperphagia, hypersexuality, herporality, hyperdocity

A

Kluver-Bucy Syndrome

Bilateral amygdala lesion

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58
Q

Hyperreflexia, hypertonia, Babinski

A

UMN damage

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59
Q

Hyporeflexia, hypotonia, atrophy, fasciculations

A

LMN damage

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60
Q

Hypoxemia, polycythemia, hypercapnia

A

Blue bloater

Chronic bronchitis; hyperplasia of mucous cells

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61
Q

Indurated, ulcerated genital lesion

A

Nonpainful: chancre (Primary syphilis)

Painful: Chancroid (Haemophils ducreyi)

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62
Q

Infant w/ cherry-red spot on macula, hepatosplenomegaly, neurodegeneration

A

Niemann-Pick Disease

Sphingomyelinase deficiency

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63
Q

Infant w/ cleft lip/palate, microcephaly or holoprosencephaly, polydactyly, cutis aplasia

A

Patau syndrome

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64
Q

Infant w/ hypoglycemia, hepatomegaly

A

Cori disease (debranching enzyme deficiency)

Von Gierke disease (glucose-6-phosphatase deficiency; more severe)

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65
Q

Infant w/ rocker-bottom feet, microcephaly, clenched hands, structural heart defect

A

Edwards syndrome

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66
Q

Jaundice, palpable distended non-tender gallbladder

A

Distal obstruction of biliary tree

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67
Q

Large rash w/ bulls-eye appearance

A

Erythema migrans (Lyme disease from Ixodes TICK bite)

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68
Q

Lucid interval after traumatic brain injury

A

Epidural hematoma

Middle meningeal artery rupture

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69
Q

Male child, recurrent infxns, no mature B-cells

A

Bruton’s Disease (X-linked agammaglobulinemia)

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70
Q

Mucosal bleeding and prolonged bleeding timme

A

Glanzmann thrombasthenia

defect in platelet aggregation due to lack of GPIIb/IIIa

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71
Q

Muffled heart sounds, distended neck veins, hypotension

A

Beck’s triad

Indicates cardiac tamponade

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72
Q

Multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth

A

Gardner Syndrome

Subtype of FAP

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73
Q

Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance

A

Pompe Disease (lysosomal a1,4-glucosidase deficiency)

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74
Q

Neonate w/ arm paralysis following difficult birth

A

Erb-Duchenne palsy (superior trunk injury from C5-C6)

Results in waiter’s tip

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75
Q

No lactation postpartum, absent menstruation, cold intolerance

A

Sheehan syndrome

Pituitary infarct

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76
Q

Nystagmus, intention tremor, scanning speech, bilateral internuclear opthalmoplegia

A

MS

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77
Q

Painful blue fingers/toes, hemolytic anemia

A

Cold agglutinin disease

Mycoplasma pneumonia= anti-I

Mono= anti-i

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78
Q

Painful fingers/toes changing color from white to blue to red with cold or stress

A

Raynaud’s phenomenon

Vasospasm

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79
Q

Painful, raised red lesions on pads of fingers/toes

A

Osler nodes

Indicates infective endocarditis

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80
Q

Painless erythematous lesions on palms and soles

A

Janeway lesions

Indicates infective endocarditis, septic emboli

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81
Q

Painless jaundice

A

Cancer of the pancreatic head obstructing the bile duct

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82
Q

Palpable purpura on buttocks/legs, joint pain, abdominal pain, hematuria

A

Henoch-Schonlein purura

IgA vasculitis affecting skin and kidneys

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83
Q

Pancreatic, pituitary, parathyroid tumors

A

MEN 1 (AD)

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84
Q

Periorbital and peripheral edema, proteinuria, hypoalbuminemia, hypercholesterolemia

A

Nephrotic syndrome

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85
Q

Pink complexion, dyspnea, hyperventilation

A

Pink puffer

Emphysema

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86
Q

Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic Rickett’s

A

Fanconi syndrome

Multiple combined dysfnxn of the PCT

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87
Q

Pruritic, purple, planar, polygonal papules and plaques

A

Lichen planus

Assoc. w/ HCV

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88
Q

Ptosis, miosis, anhydrosis

A

Horner Syndrome

Sympathetic chain lesion

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89
Q

Pupil accommodates but doesn’t react

A

Argyll-Robertson pupil

Neurosyphilis; “Prostitute’s pupil”

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90
Q

Rapidly progressive limb weakness that ascends following GI/URI

A

Guillain-Barre syndrome

Acute inflammatory demyelinating polyradiculopathy subtype

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91
Q

Rash on palms and soles

A

Coxsackie A, secondary syphilis, Rocky Mountain Spotted Fever

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92
Q

Recurrent cold abscesses, unusual eczema, high serum IgE

A

Hyper IgE syndrome

Neutrophil chemotaxis abnormality

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93
Q

Red “currant jelly” sputum in alcoholic or diabetic pts.

A

Klebsiella pneumoniae pneumonia

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94
Q

Red “currant jelly” stools

A

Acute mesenteric ischemia (adults)

Intussusception (children)

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95
Q

Red, itchy, swollen rash of nipple/areola

A

Paget’s disease of the breast

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96
Q

Red urine in the morning, fragile RBCs

A

Paroxysmal nocturnal hemoglobinuria

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97
Q

Renal cell carcinoma (bilateral), hemangioblastomas, angiomatosis, pheochromocytoma

A

von-Hippel Lindau disease

Dominant TSG mutation

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98
Q

Resting tremor, akinesia, rigidity, postural instability, shuffling gait

A

Parkinson disease

Loss of dopaminergic neurons in the SN pars compacta

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99
Q

Retinal hemorrhages w/ pale centers

A

Roth spots

Indicates bacterial endocarditis

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100
Q

Severe jaundice in neonate

A

Cirgler-Najjar syndrome

Congenital unconjugated hyperbilirubinemia

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101
Q

Severe RLQ pain / palpation of LLQ

A

Rovsing sign

Acute appendicitis indicator

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102
Q

Severe RLQ pain w/ rebound tenderness

A

McBurney sign

Acute appendicitis indicator

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103
Q

Short stature, cafe-au-lait spots, thumb/radial defects, increased incidence of tumors/leukemia, aplastic anemia

A

Fanconi anemia

Genetic loss of DNA crosslink repair; often progresses to AML

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104
Q

Single palmar crease

A

Down syndrome

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105
Q

Situs inversus, chronic sinusitis, bronchiectasis, infertility

A

Kartagener syndrome

Dynein arm defect affecting cilia

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106
Q

Skin hyperpigmentation, hypotension, fatigue

A

Addison’s disease

Increased ACTH and a-MSH production; due to adrenocortical insufficiency

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107
Q

Slow, progressive muscle weakness in boys

A

Becker muscular dystrophy (X-linked missense mutation in dystrophin; less severe than Duchenne’s)

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108
Q

Small, irregular red spots on buccal/lingual mucosa w/ blue-white centers

A

Koplik spots

Measles (rubeola)

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109
Q

Smooth, moist, painless, wart-like lesions on the genitals

A

Condylomata lata

Secondary syphilis

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110
Q

Splinter hemorrhages in fingernails

A

Bacterial endocarditis

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111
Q

“Strawberry tongue”

A

Scarlet Fever
or
Kawasaki disease

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112
Q

Streak ovaries, congenital heart disease, horseshoe kidney, cystic hygroma at birth, short stature, webbed neck, lymphedema

A

Turner Syndrome

45 XO

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113
Q

Sudden swollen/painful big toe joint

A

Gout

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114
Q

Swollen gums, mucosal bleeding, poor wound healing, petechiae

A

Scurvy

Vitamin C deficiency (cant hydroxylate proline/lysine for collagen synthesis)

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115
Q

Swollen, hard, painful finger joints

A

Osteoarthritis

Osteophytes on PIP, DIP

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116
Q

Systolic ejection murmur (crescendo-decrescendo)

A

Aortic stenosis

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117
Q

Telangectasias, recurrent epistaxis, skin discoloration, arteriovenous malformations, GI bleeding, hematuria

A

Osler-Weber-Rendau syndrome

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118
Q

Thyroid and parathyroid tumors, pheochromocytoma

A

MEN 2A

AD RET mutation

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119
Q

Thyroid tumors, pheochromocytoma, ganglioneuromatosis, marfoid habitus

A

MEN 2B

AD RET mutation

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120
Q

Toe extension/fanning upon plantar scrape

A

Babinski sign

121
Q

Unilateral facial drooping involving forehead

A

LMN facial nerve palsy; UMN lesions will spare the forehead

122
Q

Urethritis, conjunctivitis, arthritis in male

A

Reactive arthritis assoc. w/ HLA-b27

123
Q

Vascular birthmark (port-wine stain) of the face

A

Nevus flammeus

Assoc. w/ Sturge-Weber syndrome

124
Q

Vomiting blood following gastroesophageal lacerations

A

Mallory-Weiss syndrome

Usually in alcoholic and bullemic patients

125
Q

Weight loss, diarrhea, arthritis, fever, adenopathy

A

Whipple disease

Caused by Tropheryma whipplei

126
Q

“Worst headache of my life”

A

Subarachnoid hemorrhage

127
Q

Delayed separation of the umbilical cord

A

Leukocyte Adhesion Deficiency

-defect in LFA-1 integrin causing poor PMN migration

128
Q

Partial albinism, peripheral neuropathy, recurrent infxns

A

Chediak-Higashi syndrome

129
Q

Ataxia, spider angiomas, IgA deficiency

A

Ataxia-telangectasia

-Asoc w/ increased AFP; cause by defect in ATM gene causing decreased DNA double strand break repair

130
Q

Cheilosis, Corneal vascularization

A

2 C’s of B2 deficiency; decreased capability of some redox reactions

-cheliosis is inflammation and fissure formation at the corners of the mouth

131
Q

Diarrhea

Dermatitis

Dementia

A

3 Ds of D3

Dementia- hallucinations

Dermatitis- rash on sun-exposed areas, especially around the collar

132
Q

Excessive egg white consumption

A

Biotin (B7) deficiency

-Needed for carboxylase enzymes (deficiencies cause decreased FA production, breakdown, and gluconeogenesis)

Clinical: Dermatitis, alopecia, enteritis

133
Q

Upward gaze palsy, absent pupillary light reflex, impaired convergence

A

Parinaud Syndrome

-possibly due to a pinealoma

134
Q

Utricle

A

Contains hair cells that respond to linear acceleration and the force of gravity

135
Q

What later of the meninges is the sclera continuous with?

A

The dura mater

136
Q

Location of the canal of Schlemm

A

The limbus (sclerocorneal jnxn)

Obstruction causes glaucoma

137
Q

Retinitis pigmentosa

A

Inherited degeneration of the rods associated with Abetalipoproteinemia

➡️night blindness, “gun-barrel” vision

Tx: Vitamin A

138
Q

Embryonic Sources of the adult diaphragm

A
  1. Septum Transversum (part of the central tendon of the diaphragm in the adult)
  2. Paired Pleuroperitoneal membranes
  3. Dorsal mesentary of the esophagus
    (Forms the Crura of the diaphragm in an adult)
  4. Body wall
139
Q

hPL

A

Hormone produced by the placenta that induces lipolysis to increase FFA levels in the mother

“Pregnancy growth hormone”

140
Q

APGAR

A 
Appearance
Pulse
Grimace
Activity
Respiratory effort

0-3 = life-threatening situation

3-7 = ventilation support needed

141
Q

Peurperium

A

The 6 weeks it takes for normal uterine fnxn to return after having a baby

May manifest as after pains, some uterine discharge

-If lactating, may take 10 weeks

142
Q

Newborn with digit hypoplasia, Craniofacial defects, mental and growth retardation, and a cleft palate

A

Fetal Hydantoin syndrome

143
Q

HCTZ and pregnancy

A

Causes fetal jaundice and thrombocytopenia

144
Q

Irreversible damage to hepatocytes signified by…

A

Damage to the connective tissue architecture of the liver

145
Q

Integrins

A

Bind intracellular cytoskeletal elements (like actin) to extracellular proteins (like fibronectin)

146
Q

RAS proteins are activated by what type of receptor?

A

Growth factors (usually TKs)

147
Q

CDK1

A

Controls the G2 =» M transition

-Regulated by CDKIs which can be activated by TGF-B

148
Q

Gene knockout therapy is performed on what kind of cells?

A

Embryologic stem cells (represent a totipotent type of stem cell)

149
Q

MAP Kinase

A

Activated by growth factor signals and increase RAS activation and DNA transcription

150
Q

CCR5 and CXCR4 are what type of receptors?

A

Chemokine receptors; utilized by HIV for entry into macros and CD4 cells

151
Q

MCC tumors assoc. w/ HIV

A

B-cell non Hodgkin’s lymphoma and Kaposi’s sarcoma

152
Q

Juvenile Rheumatoid Arthritis

A

Child presenting w/ arthritis involving the large joints of the lower extremities

  • RF will be ABSENT
  • Most cases spontaneously resolve w/ no long term consequences
153
Q

Hereditary Angioedema

A

Pts. present w/ recurrent episodes of edema throughout their life; possible dyspnea accompanying episodes but no increase in IgE, eos, or other HSN markers

-ACEIs are CI’d

154
Q

IL-17

A

Made by Th17 cells; play a role in Type IV HSN

155
Q

Protein that allows tumor cells to attach to new BMs

A

Laminins

156
Q

HNPCC mutations

A

DNA mismatch repair genes PMS1, PMS2, MLH1

157
Q

TNM

A

Tumor size (>distant metastases)

158
Q

Unilateral orbital swelling, travel to SA, megacolon/megaesophagus, dilated cardiomyopathy with apical atrophy

A

Trypanosoma cruzi

Tx: Nifurtimox/benznidazole

159
Q

Fever and sporadic hemolytic anemia, Maltese cross on Blood smear

A

Babesia

Tx: Atovaquone and Azithromycin

160
Q

Botulism EPPs

A

EPP is the only thing that goes down; actual Ach response remains the same

161
Q

Internal Validity

A

Reflects the amount of bias in a study; inversely related

162
Q

Immunohistochemistry

A

Fluorescent antibodies used to identify proteins including CDs

163
Q

Drug used to control postpartum bleeds

A

Oxytocin; has vasoconstrictive properties

164
Q

RF for stomach ulcers

A

Smoking; increased gastric blood flow needed to drain excess acid and prevent exacerbation of ulcer

165
Q

Common causes of prematurity

A

Smoking

Cocaine

166
Q

Cephalosporins

A

ARE NOT B-lactam DRUGS; they do bind to PBPs to fnxn tho

167
Q

VDJ recombination

A

Occurs in T-cells

168
Q

Diabetic neuropathy presentation

A

Can present as burning pain as well as loss of sensation

169
Q

Kid w/ a new puppy and diarrhea

A

Campylobactter

170
Q

Sucrose

A

Glucose + Fructose

-Avoid this in aldolase B deficiency!

171
Q

Proximal Lesser curvature of the stomach artery

A

Left gastric artery

Origin: Celiac

172
Q

Artery of the distal lesser curvature of the stomamch

A

Right gastric artery

Origin: Proper hepatic

173
Q

Artery of the proximal greater curvature of the stomach

A

Left gastroepiploic artery

Origin: splenic

174
Q

Artery of the distal greater curvature of the stomach

A

Right gastroepiploic artery

Origin: gastroduodenal

175
Q

Proximal greater curvature of the stomach arterial supply

A

Short gastric arteries

Origin: splenic

176
Q

Ventricular free wall rupture

A

Occurs 5-14 days post-MI; will see coagulative necrosis w/ PMN and macro infiltrate

Clinical: Pericardial tamponade 
              Distant heart sounds 
             JVD 
             Profound hypotension 
             Cardiogenic shock
177
Q

Thromboangitis obliterans inflammation pattern

A

Transmural, segmental

-Extends into the nerves and veins producing pain and ulceration/gangrene respectively

178
Q

Nerve that looks like 2 nerves leaving the brainstem

A

CN VII

179
Q

Mitochondrial appearance on EM

A

Wavy, crystal looking circles

180
Q

Constitutive heterochromatin

A

Always condensed heterochromatin that contains repetitive DNA near the centromere

181
Q

Positively charged AAs

A

Lysine and arginine

-Make up histones so they can bind DNA

182
Q

Bloom Syndrome

A

Mutation in DNA repair enzymes

Clinical: Long, narrow face
Erythema/teleangectiasia in butterfly distribution
Protuberant ears
Patches of hyper/hypopigmentation
Immunodeficiency (decreased IgG, IgM, IgA)

183
Q

G2 phase specific anticancer drug

A

Bleomycin

184
Q

ATM kinase

A

Responds to dsDNA breaks; activates p53

p53 =» increased p21 which inhibits Cdk2-cyclin E from forming

-Also increased p16 which inhibits Cdk4/6-cyclin D

***Ultimately, all of this inhibits the phosphorylation of Rb

185
Q

CD1 marker

A

Positive in histiocytosis

186
Q

Adrenoleukodystrophy

A

x-linked defect in ATP-binding cassette transporter which Fnxns to transport long FA-chains into peroxisomes

Clinical: Adrenocortical failure
Inflammatory demyelination causing dementia

187
Q

Increased startle response

A

Tay-Sachs

188
Q

Aprepitabt, Fosaprepitant

A

Prevent substance P release to area postrema

-Use if odansetron fails

189
Q

Eosinophilic casts

A

Tamm-Horsfall protein which leads to increase free light chains (BJ) in the urine as well

-Cause tubular destruction, Mesangial deposition, and epithelial injury

190
Q

Piriform recess

A

Lie on either side of the pharyngeal orifice

  • Internal laryngeal nerve travels beneath it carrying sensory innervation
  • Damage =» loss of cough reflex
191
Q

VA teratogen risk

A

Neural tube defects

192
Q

Combined absence and tonic-clonic seizure tx

A

Valproate

193
Q

Pulmonary fibrosis

A

Gradual onset of dyspnea w/ end-inspiratory crackles

CXR: Bilateral, diffuse reticulonodular opacities
-most pronounced in lower lobes

-Possible sequelae of RA, IBD, or cancer tx.

194
Q

Greatest mortality reduction for MI and diabetes

A

Smoking cessation

195
Q

Legionnaire’s Disease

A

Infxn following exposure to contaminated H2O sources (cruises, spas, hospitals)

Clinical: High fever 
             Radiological evidence of pneumonia 
             Bradycardia
             Diarrhea, nausea 
             Increased liver enzymes 
             ***Hyponatremia
196
Q

ADH

A

Fnxns to increase H2O AND UREA reabsorption in the medullary collecting duct

197
Q

Obesity-related restrictive lung disease

A

Due to decreased lung compliance

-Most lung testing show decreases except RV

198
Q

Nonbacterial thrombotic endocarditis

A

Common w/ advance malignancy (esp. mucinous adenocarcinomas) and other chronic inflammatory states

-May be momentarily asymptomatic but can dislodge and embolize

199
Q

Deep Q waves and inverted t waves

A

Recent MI

200
Q

Location and fnxn of Brunner’s glands

A

1st part of the duodenum; secretes HCO3

201
Q

Tx for drug induced Parkinsonism

A

Benztropine, trihexyphenidyl

202
Q

ARPKD

A

Mutation in PKHD1 gene => decreased fibrocystin

  • Baby will present w/ POTTER sequence
  • Later will have HTN and hepatomegaly
203
Q

Invasive Pulmonary Aspergillosis

A

Fever, chest pain, cough, hemoptysis

CXR: consolidated cavitary lesions

RFs: Prolonged febrile neutropenia (like pts. on chemo)

204
Q

Placental abruption

A

Leads to increased Factor III release (tissue factor) =» DIC

-Also vaginal bleeding, uterine tenderness, retroplacental hematoma

205
Q

Damage to the posterior triangle of the neck

A

Damaged CN XI

  • Loss of trapezius (elevation of scapula; shoulder stabilization)
  • Possible loss of SCM
206
Q

Aldosterone escape

A

Potential finding in hyperaldosteronism due to increased ANP

-Decreased Na+ retention but hypokalemia and increased HCO3 still present

207
Q

Immediate Tx for hemophilia

A

Thrombin

208
Q

Left-sided colon cancer

A

Obstruction; narrows the lumen of the rectosigmoid colon

209
Q

Southwestern Blot

A

Stains proteins that bind to DNA

210
Q

c-Jun; c-Fos

A

Leucine zipper proteins

nuclear transcription proteins

211
Q

Buspirone

A

Partial 5-HTa agonist used to tx. GAD

-Only prob is it takes a LONG time to take effect

212
Q

Supplement needed for breastfed babies

A

Vitamin D

213
Q

Thick, yellow green, frothy discharge

A

Trichomonas

214
Q

Women w/ irregular menses and decreased AFP on US

A

Probably just inaccurate dating of the fetus

215
Q

Acute Salicylate Poisoning

A

1st =» Respiratory alkalosis

2nd =» Anion gap metabolic acidosis (3hrs later)

*Normal pH at this point

216
Q

Infant w/ hypertension, recurrent pyelonephritis, enlarged upper and lower poles of kidney

A

Vesicoureteral reflux

-Due to ureters entering the bladder at a perpendicular angle causing decreased flap fnxn

217
Q

Nasal polyp associations

A

CF

Aspirin-intolerant asthma

218
Q

Bacteria causing COPD superinfxn

A

H. Influenzae

219
Q

Bronchial hamartoma

A

Bending mass of lung tissue and cartilage that can be mistaken for Cancer

220
Q

Best lung cancer prognosis

A

Bronchioloalveolar carcinoma

221
Q

S rule of lung cancers

A

S= central, smoking, syndromes

222
Q

MC metastatic site of lung cancer

A

Adrenal glands

223
Q

Potential obstructive sleep apnea Tx.

A

Electrical stimulation of CN XII; moves the tongue forward to remove some obstruction of the pharynx

224
Q

Decreased UMP synthase

A

Hereditary oroditc aciduria

Orotic acid needed to produce IMP and GMP

Clinical: MR
MEGALOBLASTIC anemia
Orotic aciduria

Tx: Uridine

225
Q

Propionyl CoA carboxylase

A

Product of branched AA catabolism along with threonine and methionine

*Requires what cofactor???

Deficiencies cause hypotonia, poor feeding, vomiting, anion gap acidosis, and decreased methlmalonyl CoA

226
Q

Methlmalonyl CoA isomerase

A

Converts methylmalonyl made from propionyl CoA to a-ketoglutarate

-Requires B12

227
Q

Chromosome 22q11.2 deletion

A

DiGeorge Syndrome

Cardiac trunk (TOF, truncus arteriosus)

Abnormal face (low set ears)

Thymic aplasia

Craniofacial abnormalities (cleft palate)

Hypocalcemia

228
Q

Dihydropterine reductase reactions

A

Forms tyrosine and DOPA

Also converts tryptophan =» serotonin

-If deficient in BH4 or dihydropterine reductase, will likely see increased Phe and Trp

229
Q

Hypertensive Arteriolar Sclerosis

A

Chronic HTN causing an occlusion leading to an ischemic stroke

CT scan initially looks ok but weeks later will see a small infarct

*Usually affects the internal capsule or pons

230
Q

Drug used to decrease alcohol CRAVINGS

A

Naltrexone

-Disulfarim can be used in people who have lost cravings

231
Q

Porto-caval anastamoses (3)

A

Esophageal Varices:
Left gastric vein Esophageal veins

Hemorrhoids:
Superior rectal veins Middle and inferior rectal veins

Caput Medusae:
Paraumbilical veins Superior and inferior epigastric veins

232
Q

Question that mentions retroperitoneal or unknown source of bleeding

A

Think retroperitoneal organs

Spleen 
Aorta and IVC 
Duodenum 
Pancreas 
Ureters
Colon
Kidneys
Esophagus
Rectum
233
Q

Rate limiting enzyme in bile salt synthesis

A

Cholesterol 7a-hydroxylase

***Inhibited by fibrates =» cholesterol stones

234
Q

Most important prognostic factor for colon cancer

A

Invasion into the muscularis propria

235
Q

Tx. Of refractory depression

A

Lithium

236
Q

Medicare coverage

A

Lifetime taxpayers over 65

ALS

ESRD

Young people w/ disabilities

237
Q

Craniopharyngioma components

A
  1. Cystic: filled w/ “motor oil” liquid
  2. Solid: composed of the actual tumor cells
  3. Calcifications
    - As always, this is a remnant of Rathke’s pouch
238
Q

Synaptophysin

A

Transmembrane glycoprotein found in neurons

-Stains positive in CNS tumors composed of NEURONS

239
Q

Giant Cell Arteritis Inflammation

A

Segmental, granulomatous lesions

-Same as Takayasu arteritis

240
Q

Constriction of the efferent arteriole

A

Decreases RPF

241
Q

Hypothyroid myopathy

A

Muscle pain and weakness of the proximal muscles due to decreased Ca2+ reabsorption in the SR

Clinical: Increased CK
Delayed reflexes
Myoedema
Other signs of hypothyroidism

242
Q

Mallet Finger

A

Jamming of the finger rips the extensor digitorum tendon as it goes over the DIP

=»Inability to extend the finger

243
Q

Arterial anastamoses around the scapula

A

Blockages in the subclavian or axillary artery is bypassed via the subscapular or thyrocervical trunk vessels

244
Q

Cubital fossa contents

A

Lateral =» Medial
Biceps brachii tendon =» Brachial artery =» Median nerve

-Site of venipuncture= Median cubital vein

245
Q

Propofol

A

Short-acting anesthetic used to induce anesthesis via GABA-A induction

-Causes profound vasodilation tho

246
Q

MAC

A

Essentially the ED50 of inhaled anesthetics; inversely proportional to the potency

247
Q

Fracture of the femoral neck tx.

A

Hip replacement; do this to prevent osteonecrosis due to disrupted blood supply

-Common in osteoporotic women

248
Q

Good schizophrenic prognostic factors

A

Late onset

Obvious precipitating factor

Acute onset

Presence of mood disorder sx.

Family history

Good support system

Presence of positive sx.

249
Q

What causes dimpling in breast cancer?

A

Growth of the tumor to involve the suspensory ligaments

250
Q

Phrenic nerve

A

Innervates the fibrous pericardium, the mediastinal and diaphragmatic pleura, and the muscular diaphragm

251
Q

Cardiac shadow on CXR

A

Right side: SVC and Right atrium

Left side: Aortic arch, pulmonary trunk, left auricle, and left ventricle

252
Q

Nodal branch

A

Arises from the RCA and supplies the SA and AV nodes

253
Q

Blood supply to the apex of the heart

A

The LAD; also supplies the anterior 2/3 of the IVS, the anterior heart wall, and the Bundle of His

254
Q

Defective part of a VSD

A

The membranous part of the ventricular septum

255
Q

Keratoderma blenorrhagica

A

Hyper pigmented plaques and nodules on soles and palms that are assoc. With reactive arthritis

256
Q

Excessive egg white consumption

A

B7 deficiency; egg whites prevent adequate absorption of biotin

257
Q

Velocity of blood flow equation

A

v=Q/A

258
Q

Valsalva maneuver

A

Expiring against a closed glottis ➡️ ⬇️ VR ➡️ ⬇️ CO ➡️ ⬆️ Sympathetic outflow to the heart

⭐️ Used to test the integrity of the Baroreceptor reflex

259
Q

Angiotensin II Fnxns (4)

A
  1. Increases aldosterone synthesis
  2. Increases Na-H exchange in the PCT
  3. Stimulates thirst
  4. Causes vasoconstriction of the Arterioles
260
Q

Auscultation of inferior lobes

A

Performed on the posterior chest wall

261
Q

Auscultation of the middle lobe

A

In b/w the 4th and 6th rib

262
Q

Location of abdominal nerves

A

Deep to the internal oblique muscles and superficial to the transversalis fascia

263
Q

Rectouterine pouch

A

Possible location of pelvic abscess

264
Q

Abnormal migration of the ventral pancreatic bud

A

Annular pancreas

265
Q

Incomplete fusion of the dorsal and ventral pancreatic buds

A

Pancreatic divisum

-Common and typically asymptomatic

266
Q

HbS sickling

A

Valine is a nonpolar AA; this causes the nonpolar, hydrophobic residues of Hb to clump together

=» sickling

267
Q

Suspected elder abuse

A

Interview elder alone; even if they are slightly impaired

-If severe cognitive impairment, notify protective services

268
Q

VonRecklinghausen’s Disease

A

NF1

-Pheochromocytomas, Lisch nodules,

269
Q

Cave exploration in the Ohio River Valley/ Mississippi River Valley

A

Histoplasma infxn

-Can present as an acute pulmonary disease

270
Q

Estrogen effects on TSH

A

Transient increase; will normalize tho

-Increased estrogen increases TBG synthesis leading to increased synthesis of T4 and T3 to return free levels to normal

271
Q

Schizoaffective Disorder

A

Major depressive OR MANIC episodes concurrent w/ schizophrenia

272
Q

Crohn’s Disease complications

A

GI: Fistulas, strictures, increased risk of adenocarcinoma

Skin: Erythema nodosa

Malabsorption: Gallstones, *Kidney oxalate stones (due to decreased calcium absorption) b12 and folate deficiency

-Also arthritis and uveitis

273
Q

Pts. at risk for B12 deficiency

A

Usually in people who have been strict vegetarians for at least 5 years

274
Q

Sulfonylurea w/ decreased likelihood for hypoglycemia

A

Glipizide

-2nd generation are shorter acting

275
Q

POMC derivatives

A
  1. ACTH
  2. MSH
  3. Endorphins, enkephalins
276
Q

MCCo hypothyroidism

A

Hashimoto’s

Assoc. With HLA-DR5; pts. At an increased risk for non-Hodgkin’s lymphoma

Histo shows Germinal centers hurthule cells

277
Q

Locally invasive thyroid tumor

A

Anaplastic carcinoma

-Produces dysphagia and respiratory compromise

278
Q

Stones, bones, groans, and psychiatric overtones

A

Hyperparathyroidism

  • Hypercalciuria (Nephronopthisis)
  • Osteitis fibrosa cystica
  • constipation and weakness
  • depression
279
Q

Venous waves

A

ATRIAL SYSTOLE

A - atrial contraction

C- triCuspid closure

VENTRICULAR SYSTOLE

X descent - emptying

V- Maximum atrial filling pressure

y-descent

280
Q

Eccentric Cardiac Hypertrophy

A

Heart increases in size by adding new sarcomeres in series w/ existing sarcomeres

=»Lengthening (not thickening) of fibers; allows the heart to receive a greater volume of blood

-Results from volume overload (heavy aerobic exercise)

281
Q

Dilated Cardiomyopathy causes

A

Alcohol

Beriberi

Coxsackie B

Cocaine

Chagas

Doxorubicin

-Presents as HF, S3, balloon appearance on CXR

Tx: Na+ restriction; digoxin; ACEIs and BBs

282
Q

X-ray artifact

A

Abnormal x-ray finding due to user error or hardware failure

283
Q

Hartnup’s Disease

A

Deficiency of neutral AA transporters in the kidney and gut

=» Increased excretion and decreased absorption

***Tryptophan deficiency =» Niacin deficiency =» PELLAGRA

Tx: High protein diet; nicotinic acid

284
Q

Urokinase

A

Activates plasmin

⭐️Excess release after radical prostatectomy

➡️Bleeding

Tx: Aminocaproic acid (blocks activation)

285
Q

a-2 anti plasmin

A

Inactivates plasmin

-Liver cirrhosis ➡️⬇️ levels ➡️ ️Bleeding

286
Q

Thrombomodulin

A

Activates protein C

➡️ inhibition of factors V and VIII

287
Q

Palmar xanthoma

A

Familial Dysbetalipoproteinemia

288
Q

Cilostazol

A

PDE inhibitor

-Go to for Buerger disease

289
Q

Macular degeneration

A

Can be identified as Drusen deposits on the retina; pts. will progress to a central scotoma

290
Q

Possible exacerbating factor for MS

A

Heat, stress, exercise

291
Q

Gastric erosions

A

DO NOT EXTEND INTO MUSCULARIS MUCOSA

  • ONLY STAY IN THE MUCOSA LAYER
  • Once in the submucosa, they become ULCERS
292
Q

PAS stains

A

Stains glycoproteins, polysaccharides, mucopolysaccharides, glycogen

Gets C-C bonds, not lipids

293
Q

Neuroblastoma (adrenal)

A

Abdominal mass that goes past the midline and usually assoc. w/ n-MYC mutation

Clinical: HTN, weight loss

Paraneoplastic associations = Opsoclonus, myoclonus, pancytopenia, hepatomegaly, SC compression

-Even those are weird, if you see an abdominal mass w/ HTN and weight loss, you think horseys

294
Q

MC predisposing factor for infective endocarditis in developed world

A

Mitral valve prolapse

295
Q

Neurocysticercosis infxn

A

Accidental ingestion of cysts from contaminated feces

-Symptoms take a while to develop; is why the people are usually MIGRANTS

296
Q

Most important prognostic factor for urothelial carcinoma

A

Depth of invasion

-Involvement of muscular layer= T2

297
Q

Antiarrhythmics

A

Class IA: Quinidine, Procainimide, Disopyramide
-Affects both Na+ influx and AP length

Class IB: Lidocaine, Mexilitine
-DECREASES AP LENGTH

Class IC: Fleicanide, Propafenone
-STRONG INCREASE IN NA+ LENGTH WITH NO CHANGE IN AP LENGTH

298
Q

Eggshell calcifications, birefringent particles, fibrous tissue

A

Silicosis

-Findings otherwise similar to sarcoidosis

STEP (11 decks)

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