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USMLE > Comp (blood/lymph and cardio) > Flashcards

Comp (blood/lymph and cardio) Flashcards

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USMLE® Step 1 flashcards
1
Q

pt taking primaquine for malaria prophylaxis, African American boy has dark urine and yellowing of his eye. Anemic, shows heinz body. Due to

A

G6PD defeciency

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2
Q

Blood type that can cause hemolytic disease of newborn

A

Mother: O and Father: AB

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3
Q

Transfusion, fatigue and jaundice. What test to do?

A

The direct antiglobulin test (DAT) is used to determine whether red blood cells (RBCs) have been coated in vivo with immunoglobulin, complement, or both. The direct antiglobulin test is sometimes colloquially referred to as the Coombs test.

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4
Q

A 6-month-old boy is brought to the physician because of left knee swelling for 24 hours. Three months ago, he had three large hematomas on his forehead that resolved without treatment. His two sisters and his mother have no history of similar symptoms. His mother’s maternal uncle and her brother died before the age of 30 years of massive cerebral hemorrhages. Physical examination shows deep ecchymosis over the buttocks and severe swelling of the left knee. The most likely explanation for these findings is a deficiency of which of the following?

A

factor 8

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5
Q

girl with down syndrome, nosebleeds, decreased apepitite and fatigue. Low bp, anemicc, high leukocytes, atypical ly,mphyoctes, low plaeltes. Mechnisn of lab findings:

A

infiltration of bone marrow by leukemic blast

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6
Q

test when fetus has fetal hydropis

A

Maternal Rh status with antibody screening

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7
Q

For children with HS who remain transfusion-dependent or severely symptomatic from anemia after one year of age, its suggested to do:

A

spleenectomy

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8
Q

Major causes of __________include blood loss and reduced absorption (eg, due to celiac disease, Helicobacter pylori [H. pylori], gastritis, or bariatric surgery

A

iron def anemia

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9
Q

———– most commonly due to mutations in the HFE gene, is an autosomal recessive disorder in which there is increased intestinal iron absorption. The major clinical manifestations of iron accumulation in advanced HH include liver disease, weakness and lethargy, skin pigmentation, diabetes mellitus, arthropathy, impotence in males, and cardiac enlargement with or without heart failure or conduction defects.

A

Hereditary hemochromatosis (HH)

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10
Q

2 brothers that bruise easisly and have recurrent hemarthrosis. their uncle died of mild head trauma. Have long PTTT. def in

A

factor 8 (hemophilia a)

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11
Q

clotting factor decreased by 50% right after starting waraferin

A

VII (proconvertin

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12
Q

blistering of skin when exposed to sun . defective:

A

heme synthesis Porphyria cutanea tarda and hepatoerythropoietic porphyria

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13
Q

A 53-year-old man, who recently returned from Africa, has fever, headache, and abdominal discomfort. He received appropriate vaccinations prior to the trip. His temperature is 39.4°C (103°F). Physical examination shows no other abnormalities. A Wright-stained peripheral blood smear is shown. Which of the following is the most likely diagnosis?

A

maleria

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14
Q

In ITP, autoantibodies are directed against

A

Glycoprotein 2b/3a complex

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15
Q

child with nosebleeds and wasy brusing. Recent URI. normal hemoglbin and leukocytes. Decreased platelets. What is it?

A

Immune thrombocytopenia (ITP) of childhood is characterized by isolated thrombocytopenia (platelet count <100,000/microL, with normal white blood cell count and hemoglobin). The cause of ITP remains unknown in most cases, but it can be triggered by a preceding viral infection.

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16
Q

A typical history in a patient with mild to moderate __________ disease includes epistaxis lasting longer than 10 minutes in childhood, lifelong easy bruising, and bleeding with or following dental extractions, other invasive dental procedures, or other forms of surgery. In women, most have excessive bleeding during menstrual periods

A

Von willebrand its autosomal dominant

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17
Q

plasmid loss responsible for decreased _____resistance

A

vancomycin

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18
Q

———- may be distinguished from malaria by the presence of merozoites arranged in tetrads (known as a “Maltese Cross”; this finding is uncommon but pathognomonic for babesiosis)

A

Babesiosis

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19
Q

Pt with babesiosis infection (fever, chills, joint pain) will show what in blood smear

A

small intraerythrocytic rings;

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20
Q

target erythrocytese from splenectomy due to loss of function of:

A

red pulp

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21
Q

burnt almond smell in:

A

cyanide poisoning

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22
Q

metal worker collapses after an exposure to chemical. Smells like burnt almonds. What is treatment?

A

amyl nitrate cyanide poisoning

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23
Q

chemo and radiation for hodgkin and pt later develops AML bc:

A

Therapy for Hodgkin disease causes mutations in hematopoietic stem cells, and one mutant cell progresses to leukemia

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24
Q

Which of the following best explains why deoxygenated blood can carry more carbon dioxide for a given Pco2 than oxygenated blood?

A

Deoxyhemoglobin is a better buffer of hydrogen ions than oxyhemoglobin

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25
Q

Prominent early clinical features of acute ——– poisoning include: tinnitus, vertigo, vomiting and diarrhea; more severe intoxication can cause altered mental status, hyperpyrexia, coma, noncardiac pulmonary edema, and death. ——— can cause thrombocytopenia, capillary fragility, and decreased platelet adhesion.

A

salicylate (aspirin)

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26
Q

abnormal ——- in aspirin poisoning

A

bleeding time

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27
Q

A healthy 25-year-old man lives at 10,000 feet above sea level for 4 weeks. Two weeks after returning to sea level, ventilation has returned to normal, but oxygen delivery to muscles is greater than before acclimatization. An increase in which of the following best explains the oxygen delivery finding in this man?

A

Hematocrit

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28
Q

62yr old man, fatigue, indigetiion, splenomegaly, anemic. Lymphocytes have cytoplasmic projections and positivity for acid phosphatase even in the presence of tartrate. Which of the following is the most likely diagnosis?

A

Hairy cell leukemia

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29
Q

cat scratch organism

A

Bartonella henselae

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30
Q

DIC in sepsis lab finding

A

Decreased plasma fibrinogen concentration

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31
Q

Pregnant woman vomiting, abdominal pain, high BP, RUQ tenderness, anemic, low platelets, elevated liver enzmes, elevated bilirubin. Blood smear will show:

A

Microangiopathic hemolytic anemia with schistocytes on blood smear Has HELLLP syndrome from eclampsia

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32
Q

Carbon monoxide poisoning effect in electron transport pathway:

A

Carbon monoxide blocks complex IV in the electron transport chain. Complex IV is composed of cyt a + cyt a3.

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33
Q

therapy for lymphedema

A

compression sleeve

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34
Q

Failure of intrinsic factor production in

A

vit B12 def

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35
Q

—————— should be suspected in the following situations: the occurrence of unexplained venous or arterial thrombotic events in a young patient (ex: pulmonary embolism), adverse outcomes related to pregnancy (ex: stillborn), unexplained thrombocytopenia or prolongation of a test of blood coagulation (ex: increased partial thromboplastin time)

A

Antiphospholipid antibody syndrome

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36
Q

sickle cell disease on blood smear:

A

Polymerization of hemoglobin with hypoxic conditions due to amino acid substitution in the beta-chain

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37
Q

Waraferin overdose treatment

A

4-factor prothrombin complex concentrate (PCC), if available, or 3-factor PCC and either recombinant factor VIIa or fresh frozen plasma (FFP).

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38
Q

A 38-year-old woman is brought to the emergency department after being found lying on the sidewalk. She is conscious but says she is too weak to stand (fatigues>anemia, metabolic disorder, pulmonary). Physical examination shows a red, swollen, tender tongue; angular stomatitis; and spoon-shaped nails. Hemoglobin and mean corpuscular volume are decreased. (Hypochromic and microcytic) Which of the following is the most likely diagnosis?

A

Iron def

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39
Q

what enzyme is defecient in Acute intermittent porphyria?

A

biosynthetic enzyme porphobilinogen deaminase (PBGD)

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40
Q

pt with 1-day history of irrational behavior and severe abdominal pain. He began treatment with trimethoprim-sulfamethoxazole for a urinary tract infection 3 days ago. His urine turned a light burgundy color during a similar episode 1 year ago. His mother and his maternal grandfather have had similar symptoms. He appears anxious and restless. His pulse is 96/min. Physical examination shows diaphoresis. Serum studies show increased concentrations of 5-aminolevulinic acid (δ-ALA) and porphobilinogen. Diagnosis?

A

Acute intermittent porphyria

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41
Q

A 20-year-old competitive cyclist taking recombinant human erythropoietin has polycythemia. Which of the following is the most likely cause?

A

Proliferation of erythroid precursors

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42
Q

treatment for a man with longstanding diabetes, chronic kidney disease, decreased hemoglobin and mean corpuscular volume, suggesting microcytic anemia.

A

The primary therapeutic options for the anemia of CKD include iron, erythropoiesis-stimulating agents (erythropoietin), and, rarely, red blood cell (RBC) transfusions. The treatment depends on severity of anemia and iron deficiency.

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43
Q

Which of the following is most likely to be associated with acute myelogenous leukemia?

A

PML-RARα oncogene

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44
Q

Reason for hypertension and cardiac dysfunction like wide QRS in cocaine intake

A

Potentiation of norepinephrine and blocking of its presynaptic uptake cocaine can slow Na+ current in cardiac myocytesslow Na+ current in cardiac myocytes

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45
Q

cocaine induced inhibition of _______ respsonbile for sudden cardiac arrest

A

Norepinephrine reuptake

46
Q

Pt with CHF, pitting edema. Function of the product secreted by atrial mycotes

A

ANP inhibits renin release

47
Q

Pindolol is a

A

partial agonism indolol and acebutolol have the potential advantage of causing less depression of cardiac function (less depression of pulse rate).

48
Q

_____hypertrophy in cyclist

A

Eccentric hypertrophy sarcomeres are added in series and individual cardiomyocytes grow longer.

49
Q

MOA of carotid massage in afib

A

Increased cardiac parasympathetic activity Carotid sinus massage increases vagal tone. In the heart, parasympathetic (vagal) stimulation causes local release of acetylcholine, which results in slowing of sinus node impulse formation and slowed conduction with lengthening of the refractory period in the atrioventricular (AV) node.

50
Q

During which phase of the ventricular action potential does norepinephrine influence the influx of calcium ions?

A

phase 2

51
Q

HR increasing before person even starts to exercise due to an increase in which transmitter acting at the indicated receptor

A

Norepinephrine beta 1

52
Q

location of AV node:

A

Wall of the right atrium along the orifice of the interior vena cava

53
Q

Cause of blowing holosystolic murmur heard best over the lower left sternal border in a healthy 2 month old

A

VSD

54
Q

Men with blood clot given herparin but then develops stroke. He has:

A

Fixed, wide splitting of S2 that does not change with inspiration Patent foramen ovale

55
Q

2 month old girl, tachy, low BP, 3/6, systolic murmur that is best heard in the interscapular region. Femoral pulses are decreased bilaterally. Cause:

A

coartication of aorta

56
Q

The classic findings of _________ are systolic hypertension in the upper extremities, diminished or delayed femoral pulses (brachial-femoral delay), and low or unobtainable arterial blood pressure in the lower extremities.

A

coarctation of the aorta

57
Q

An 18-month-old male presents to the pediatric cardiologist for a follow-up examination. His was diagnosed with a continuous, grade 3/6, rumbling, machine-like murmur that is heard best over the mid to upper left sternal border. Which of the following is the most likely diagnosis?

A

PDA

58
Q

Exercise intolerance, LV dilation and dysfunction, wide systemic pulse pressure and signs of left ventricular volume overload, such as a displaced left ventricular apex found in

A

moderate PDA

59
Q

_______ is a vasodilator that promotes ductal patency

A

Prostaglandin E2 (PGE2)

60
Q

_________ inhibitors, like ibuprofen and indomethacin, are effective in the pharmacologic closing of PDA in preterm infants

A

cyclooxygenase (COX)

61
Q

________________ is a ventriculoarterial discordant lesion in which the aorta arises from the right ventricle and the pulmonary artery from the left ventricle.

A

Transposition of the great vessels - Transposition of the great arteries (TGA)

62
Q

Signs of TGA:

A

tachypnea but comfortable, systolic ejection murmur along upper left sternal border, cyanosis Echocardiography reveals that the aorta is positioned anterior and to the right of the pulmonary artery.

63
Q

A 5-day-old newborn has been cyanotic since birth and has a soft systolic murmur. An x-ray of the chest shows decreased pulmonary vascular markings indicating a decrease in pulmonary blood flow. Which of the following is the most likely diagnosis?

A

Transposition of the great vessels

64
Q

Cell type absent during early fetal cardiac development in patient with Truncas Arteriosus

A

ectoderm neural crest cells

65
Q

Chromosomal abnormality in DiGeorge syndrome

A

22q deletion Ex) 46, XY, del (22)(q11)

66
Q

What syndrome is this? Pt has small mouth, narrow nose, and upward slant of the eyes. (Micrognathia (small chin) and low-set ears), cleft palate, immunodeficiency (thymic hypoplasia), developmental delays and adult-onset psychiatric illnesses (e.g., schizophrenia and anxiety disorders).

A

DiGeorge syndrome

67
Q

loud, harsh, high-pitched holosystolic murmur that radiates over the precordium and a palpable thrill at the left sternal border What defect is this?

A

VSD

68
Q

Diagnosis? Pt with constant substernal chest pain for 12 hours that is exacerbated by coughing and inspiration. The pain is relieved with sitting up and leaning forward. There is no family history of heart disease. His temperature is 38°C (100.4°F), pulse is 120/min, and blood pressure is 110/60 mm Hg. The lungs are clear to auscultation. Cardiac examination shows distant heart sounds. An ECG shows diffuse ST-segment elevation in all leads. An x-ray of the chest shows normal findings

A

pericarditis

69
Q

A 37-year-old male dies suddenly. He had a history of fatigue, dyspnea, dependent edema, and decreased ejection fraction. At autopsy, the structure of the valves is normal, but all four chambers of the heart are enlarged. A mural thrombus is attached to the wall of the left atrium. Histologic examination of the heart show hypertrophied and atrophied muscle cells. Which of the following is the most likely diagnosis?

A

Amyloidosis

70
Q

ACE inhibitors produce systemic vasodilation by:

A

Decreased bradykinin degradation

71
Q

A 67-year-old male with severe congestive heart failure and edema has gained 9.1 kg. Which of the following is most likely to contribute to renal sodium retention?

A

Increased renal sympathetic nerve activity

72
Q

A 51-year-old female presents with a 2-month history of a persistent cough and worsening dyspnea. She denies chest pain or other illnesses. Her blood pressure is 114/72 mm Hg, and pulse is 120/min. Chest auscultation reveals diffuse basilar crackles bilaterally, an S3 gallop, and no detectable murmur. ECG shows is consistent with tachycardia and nonspecific ST-T wave changes. Echocardiography show a dilated left ventricle and a diffusely hypokinetic heart. Which of the following represents the most likely diagnosis?

A

Dilated cardiomyopathy

73
Q

Cause of edema in left sided heart failure

A

Increased cap hydrostatic pressure

74
Q

Untreated Obstructive sleep apnea can cause:

A

Right ventricular hypertrophy increased risk for a broad range of cardiovascular morbidities, including systemic hypertension, pulmonary arterial hypertension, coronary artery disease, cardiac arrhythmias, heart failure, and stroke.

75
Q

A 62-year-old man develops a pericardial friction rub 3 days after an acute myocardial infarction. Which of the following is the most likely cause of the friction rub?

A

Fibrinous pericarditis

76
Q

Statins are competitive inhibitors of _________, which represents the rate-limiting step in cholesterol biosynthesis

A

hydroxymethylglutaryl (HMG) CoA reductase

77
Q

What is upregulated as a result of a statin?

A

LDL receptor

78
Q

Treatment for 3rd degree AV block

A

Insertion of transvenous pacemaker

79
Q

Risk of _______when given Ibutilide for afib

A

Prolongation of the QT interval provides the substrate for torsades de pointes (TdP), a polymorphic ventricular tachycardia. Ibutilide, a class III antiarrhythmic drug, blocks IKr, the rapid component of the cardiac delayed rectifier potassium current. This results in prolonged repolarization, increased action potential duration, and lengthening of the refractory period.

80
Q

Reason for low BP in SVT (high hr)

A

inadeuqate ventricle filling

81
Q

Long QT syndrome has defect in

A

Outward (delayed) rectifying potassium channel

82
Q

Mechanism of agina

A

Increased sympathetic stimulation

83
Q

What is Post cardiac injury syndrome

A

autoimmune related. Acute pericarditis and/or pericardial effusion

84
Q

35 yr old woman with 3month SOB on exertion, increased resp, JV distention, loud S2, S4 gallop. Diagnosis: Increased pulmonic expression of what?

A

Pulmonary arterial hypertension Increased expression of endothlin1

85
Q

All patients with ST-elevation myocardial infarction should be treated with _______ therapy

A
86
Q

A 56-year-old male with extensive coronary atherosclerosis presents with coronary vasoconstriction and myocardial ischemia. The most likely cause of the vasoconstriction is failure of the endothelial cell layer of the diseased coronary arteries to produce a substance with which of the following actions?

A

stimulation of cGMP

(dont by NO)

87
Q

Nitroglycerin decreases

A

preload

88
Q

The diagnosis of ______can be strongly suspected when hypotension, raised jugular venous pressure, and clear lung fields are present in a patient whose 12-lead electrocardiogram has findings of an inferior wall infarction as well as ST-elevation in lead V4R.

A

RVMI

89
Q

———— are the most common primary cardiac neoplasm, and are composed of scattered cells within a mucopolysaccharide stroma (scattered mesenchymal cells in an abundant extracellular matrix).——— are most often located in the left atrium and pedunculated, with a surface that is smooth, villous, or friable. About 35% are friable or villous, and these can present with emboli (can obstruct arteries in the lower extremities)

A

Myxomas

90
Q

Which of the following pairs of aortic arches develops into the common carotid arteries?

A

Third

91
Q

to reach the AV node, catherter must be passed through:

A

Left coronary, circumflex, posterior descending

92
Q

In cardiac cath, As the pig-tail catheter is advanced into the apex of the left ventricle, which of the following valves will be crossed?

A

aortic

93
Q

Calcium channel blockers are effective antiarrhythmic agents because they inhibit calcium influx into which of the following structures?

A

AV node

94
Q

Ejection fracture formula

A

Stroke volume/End-diastolic volume

stroke volume is end dilastic volume - systolic

95
Q

The largest proportional increase in left ventricular afterload and myocardial oxygen consumption is most likely to occur following a 20% increase in which of the following?

A

aortic pressure

96
Q

A 17-year-old female comes to the physician because of shortness of breath. A systolic murmur is heard best in the left fifth intercostal space in the midclavicular line. Which of the following valvular abnormalities is the most likely cause of the murmur?

A

mitral insuficciency

97
Q

A 64-year-old female has a two-year history of progressive shortness of breath. Blood pressure is 174/74 mm Hg with rapid collapse of the peripheral pulse. She has a high-pitched, blowing, diastolic decrescendo murmur heard best at the second right intercostal space. Which of the following is the most likely diagnosis?

A

aortic regurge

98
Q

A 55-year-old male develops shortness of breath. Examination shows a harsh systolic ejection murmur at the base that radiates to the neck. ECG shows evidence of prominent left ventricular hypertrophy. Which of the following cardiac abnormalities is most likely?

A

bicuspid aortic valve

99
Q

A 51-year-old male has a holosystolic murmur that is loudest over the apical impulse and radiates to the axillae. Which of the following is the most likely diagnosis?

A

mitral insuff

100
Q

A 38-year-old man comes to the physician because of a 1-week history of shortness of breath with exertion. His respirations are 12/min. Light palpation of the carotid artery shows the upstroke to be abnormally brisk and the downstroke to fall precipitously. Cause?

A

aortic regurge

101
Q

A 62-year-old man dies suddenly while playing tennis. He had no known cardiac risk factors and no history of coronary artery disease. At autopsy, examination shows a cardiac valve defect and concentric left ventricular hypertrophy. Which of the following valve abnormalities is most likely involved in his sudden death?

A

aortic stenosis

102
Q

A 13-year-old girl has a grade 2/6, holosystolic murmur that is heard best over the left fifth intercostal space adjacent to the sternum; it increases with inspiration. This murmur is most consistent with an abnormality of which of the following valves?

A

tricuspud

103
Q

The most common abnormality seen in aortic dissection is

A

widening of the aortic silhouette (arch)

104
Q

drop in systolic blood pressure upon inspiration?

A

Pulsus paradoxus

105
Q

BP lower in fulll term pregnant woman while laying down due to:

A

Compression of the vena cava

106
Q

A 68-year-old man is brought to the emergency department because of a 3-day history of increasingly severe deep chest pain. He also has had shortness of breath, stridor, hoarseness, difficulty swallowing, and a nonproductive cough. He has a long-standing history of hypertension. He has smoked 2 packs of cigarettes daily for 45 years. His temperature is 37.2°C (99° F), pulse is 80/min, respirations are 15/min, and blood pressure is 160/94 mm Hg. The lungs are clear to auscultation. Physical examination shows a visible pulsation above the manubrium of the sternum and displacement of the trachea to the right. A murmur is heard in the second right intercostal space. Which of the following is the most likely diagnosis?

A

Aortic aneurysm

107
Q

systolic heart murmur that is best heard in the second interspace at the right sternal border and is transmitted to the carotid arteries. The murmur begins immediately after S1, rises in crescendo before falling in pitch, and ceases before S2. Which of the following is the most likely cause of the murmur?

A

Aortic stenosis

108
Q

Cardiac examination shows a grade 2/6, holosystolic murmur that is best heard at the left axillary line. Which of the following is the most likely cause of this finding?

A

Many patients with mitral regurgitation are initially asymptomatic (patient has not felt ill/feels well). When symptoms develop, they include exertional dyspnea, fatigue, and paroxysmal or persistant atrial fibrillation. The murmur is heard best over the apex and when the MR jet is directed posterolaterally, the murmur radiates to the axilla and when very loud, may radiate to the posterior left thorax.

109
Q

A 25-year-old woman comes to the physician because of fatigue for 3 weeks. She also has had intermittent fever during the past 7 days. She had her teeth cleaned 1 month ago, but she did not receive prophylactic antibiotics. She had rheumatic fever as a child and had an episode of endocarditis 4 years ago. A grade 2/6 murmur is heard on auscultation. Ultrasonography shows an abnormal mitral valve. The causal organism will most likely demonstrate which of the following?

A

green on blood agar

alpha hemlyisis, strep

110
Q
A
111
Q
A

USMLE (14 decks)

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