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BOARD PREP > From USMLE Practice Test 1 > Flashcards

From USMLE Practice Test 1 Flashcards

1
Q

what is the term for:

  1. disruption in organ morphogenesis that occurs after embryogenic period?
  2. an error in organ morphogenesis that arises from the breakdown of an organ or body region that was developmentaly normal
  3. intrinsic disruption in organ development
A
  1. deformation
  2. disruption
  3. malformation
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2
Q

How does a change in afterload or inotropy change a Frank-Starling curve?

A

increased afterload - shift down (for a given preload, there is a reduced cardiac output relative to normal)

decreased afterload - shift up

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3
Q

How does AV malformation affect cardiac output?

A

increases venous return

leading to increased preload and therefore increased CO

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4
Q

What is the affect on arterioles of severe, chronic hypertension?

A

hyperplastic arteriosclerosis (hyperplastic arteriolitis)

concentric thickening of the vessels with a laminar appearance caused by the proliferation of smooth muscles cells

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5
Q

What ist he affect of sodium nitroprusside on the PV mechanics of the heart?

A

preferentially affects arterioles, so decreases afterload without really affectign preload

you have a shorter PV loop

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6
Q

Central diabetes insipidus can result from a tumor involved what areas of the hypothalamus?

A

paraventricular & supraoptic nuclei

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7
Q

Identify the functions of the following hypothalamic nuclei:

  1. anterior hypothalamic nucleus
  2. arcuate hypothalamic nucleus
  3. dorsomedial hypothalamic nucleus
  4. lateral hypothalamic nucleus
  5. posterior hypothalamic nucleus
  6. ventromedial hypothalamic nucleus
A
  1. thermoregulation - specifically cooling
  2. complex regulatory functions important in appetite stimulation
  3. feeding & circadian rhythm
  4. stimulating appetite under stimulation of ghrelin
  5. thermoregulatino - specifically heating
  6. stimulating satiety under stimulation of leptin
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8
Q

What are the genetic mutations that can cause osteopetrosis?

A

channelopathies (CLCN7)

RANKL

RANK receptor

carbonic anhydrase deficiency (CA2)

net effect of all is impaired resorption by osteoclasts

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9
Q

Osteoclasts differentiate from what precursor?

Osteoblasts?

A

osteoclast : monocyte/macrophage lineage

osteoblast : mesenchymal stem cells

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10
Q

What is the mutation in porphyeria cutanea tarda?

A

decreased activity of uroporphyrinogen decarboxylase (used in the production of heme)

catalyzes the conversion of uroporphyrinogen III to copropophyrinogen III

so, this deficiency causes uroporphyrinogen III to accumulate in the skin

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11
Q

What are the initial substrates for heme synthesis?

A

glycine

succinyl CoA

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12
Q

What is the disorder that causes people to consciously produce symptoms for primary gain (to be cared for)?

A

factitious disorder

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13
Q

Why are tyrosine supplements necessary in patients with PKU?

A

catecholamine production

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14
Q

What is the effect on LH, FSH & testosterone of taking leuprolide in a non-pulsatile fashion?

A

b/c leuprolide is a GnRH analog, when taken non-pulsatile it acts as a GnRH receptor antagonist

decrease in LH, FSH which then causes a decerase in testosterone

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15
Q

Definition of brief psychotic disorder?

A

acute onset of one or more psychotic symptom lasting less than one month

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16
Q

What structures are responsible for producing progesterone throughout a pregnancy?

A

immediately following ovulation, corpus luteum form & produces progesterone that maintains the endometrial lining

if pregnacy occurs, the placeta develops from the embryo & makes human chorionic gonadotropin which maintains the corpus luteum & its secretion of progesterone

around 7-10 weeks, the placenta become primarily responsible for producing progesterone

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17
Q

A nitroblue tetrazolium test screens for what condition?

A

chronic granulomatous disease (do not demonstrate color change)

NADPH odixase deficiency (can’t kill catalase positive organisms)

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18
Q

What is the problem in Lambert Eaton Syndrome?

A

have antibodies to presynaptic voltage-gated calcium channels - this decreases calcium influx and therefore ACh release

presynaptic release of ACh

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19
Q

OCP are contraindicated in what demographics?

A

patients with a history of DVT, PE, stroke, or MI

patients 35 or older who smoke 15+ cigarettes/day

patients diagnosed with hypertension, migraine with aura, severe cirrhosis, breast cancer

20
Q

What are the pores of Kohn?

A

form connections between alveoli & are present in normal lung tissue

aid in normal oxygenation & prevention of atelectasis

21
Q

Why is the PO2 in the renal vein relatively high compared to venous PO2 from other organs?

A

blood flow per gram of tissue is greater in the kidney than other organs

(receibes 1/2 to 1/5 of total cardial output)

22
Q

What is the general location of distribution for the following types of molecules:

large molecules or protein bound molecules

small hydrophilic molecules

small lipophilic molecules

A
  • large molecules or protein bound molecules
    • vasculature
  • small hydrophilic molecules
    • interstitial space
  • small lipophilic molecules
    • adipocytes
23
Q

What cells secrete GIP? Where?

What is its function?

Its release is stimulated by what?

A

secreted by K cells in the duodenum & jejunum

decreases acid production & stimulates insulin secretion by the pancreas

release stimulated by presence of fatty acids, amino acids, & intestinal glucose in the

24
Q

How does acromegaly effects glucose homeostasis?

A

increasing peripheral insulin resistance, impairing muscle and adipose uptake of glucose, increasing adipose lipolysis, increasing hepatic gluconeogenesis

25
Q

What is the classic triad of HIV encephalopathy?

A

movement disorders, psychomotor impairment, memory deficits

26
Q

What factor provides the migration pathway for fibroblasts durign migration in the process of wound healing?

A

fibronectin

27
Q

What immunologic process is primarily affected by the proteosome inhibitor bortezomib?

A

presentation of antigens to CD8+ T lymphocytes

(by altering antigen presenation on the surface of MHC I molecules)

28
Q

What heart defect is most likely to be seen in a patient presenting with a DVT?

A

patent foramen ovale, allowing a thromboembolism to bypass the pulmonary circulation & cause a thromboembolic cerebrovascular accident or stroke

29
Q

What is the cause of twin-twin transfusion syndrome (TTTS) & twin anemia polycythemia sequence (TAPS)?

A

arteriovenous (less comonly artery-artery) anastamosis in the chorion of the placenta that allows blood to pass from one fetus to another

30
Q

Downregulation of what hormone leads to testicular atrophy in the setting of exogenous steroid use?

A

results in increased negative feedback on gonadotropin releasing hormone (GnRH)

this subesquently decreased the amount of LH (leads to decreased testicular stimulation of testosterone & therefore leads to testicular atrophy) & decreased FSH

31
Q

What are the laboratory findings you would expect to see in a patient with autoimmune hemolytic anemia?

A

normo- or microcytic anemia

incrased reticulocyte count (b/c increased hematopoiesis)

unconjugated hyperbilirubinemia

positive DAT

32
Q

Rheumatic heart disease classically causes what type of stenosis?

Sound upon cardiac auscultation?

It can result in what furher complications?

A

mitral stenosis

diastolic murmur radiating to the axilla

atrial enlargement, cardiogenic pulmonary edema, arrhythmias (afib/flutter)

33
Q

What is the first morphologic change that would occur at the cellular level after coronary artery ischemia?

A

swelling of the endoplasmic reticulum (and other organelles)

d/t the cessation of the Na/K-ATPase which impairs the osmotic gradient of the cell and leads to swelling

34
Q

Herpetic infections are treated with drugs that inhibit what enzyme? MOA?

A

guanine analogs - ie. acyclovir, valacyclovir, famiciclovir

first need to be polymerized by thymidine kinase

inhibit viral DNA polymerase

35
Q

What type of hypersensitivity is seen in patients with tuberculosis?

A

type IV, delayed hypersensitivity reaction

36
Q

How do fibrinolytics work?

A

catalyzing the formation of plasmin from plaminogen

plasmin is a serine protease that cleaves fibrin clots

37
Q

Renal papillary necrosis can be precipitated by what incidents?

A

infections, diabetes mellitus, sickle cell disease, NSAID

38
Q

What is Zellweger syndrome?

Symptoms?

A

genetic mutation that leads to absence of peroxisomes (synthesize cholesterol, bile acids, and membrane substrates)

seizures, intellectual disability, hypotonia, hepatomegaly, jaundice, kidney disease, cataracts, hearing loss, craniofacial abnormalities

39
Q

What is the purpose of positive end-expiratory pressure for patients on a mechanical ventilator?

This is implemented in the case of acute lung injury to prevent what complication?

A

prevent pressure in the alveoli from dropping to zero or becoming negative during the respiratory cycle

keeps alveoli stented open & therefore able to participate in gas echange

w/ acute lung injury, the patient has impaired gas exchange caused by fluid filling the alveoli, which can result in absorptive atelectasis

40
Q

What signalling is decreased in alzheimer’s dementia?

Treatment?

A

decreased cholinergic signaling in the cerebral cortex & basal forebrain

donezepil / other cholineresterase inhibitors (slow rate of cognitive decline, but not curative)

41
Q

What is Cleidocranial Dysplasia? Mutation?

Symptoms/presentation?

A

mutation of CBFA1 gene - impaired osteoblast differentiation

dimunition or absence of the clavicle (abnormal movement of shoulders anteriorly), impaired skull development, wormian (intrasutural) bones, supernumery teeth, hypoplasia of the maxilla, frontal bossing, hypertelorism, delayed ossification of the pubic symphysis

life expectancy & neurologic development are normal

42
Q

what are the cells responsible for maintaing the barrier between the blood and the seminiferous tubule?

A

sertoli cells

43
Q

What is the most likely diagnosis of a man with pancytopenia, gingival hypertrophy, and 42% blasts on peripheral smear?

A

acute myelogenous leukemia

44
Q

What peripheral blood smear findings are characteristic of lead poisoning? Marrow?

Lead inhibits what enzyme?

A

basophilic stippling

ringed sideroblasts w/in the bone marrow

inhibits ferrochelatase & delta-ALA dehydratase

45
Q

Cause of familial hyperchylomicronemia?

A

lipoprotein lipase deficiency

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