NBME 20 Flashcards
if they give you a lung cancer question and the person has hypercalcemia what type of cancer do they have
squamous cell carcinoma
- hilar mass arising from bronchus
- cavitation
- cigarrettes
- hypercalcemia (produces PTHrP)
Note: if it were small cell they would give you a ton of paraneoplastic syndromes
pt with pale oval shaped areas on the skin/trunk
ash-leaf spots…. THINK tuberous sclerosis (AD)
- these pts also have…
- hamartomas in CNS/skin
- angiofibromas
- mitral regurgitation
- cardiac rhabdomyoma
- mental retardation
- renal angiomyolipoma
- seizures
- shahgreen patches
- increased incidence of subependymal giant cell astrocytomas and ungual fibromas
BRCA mutations
defects in recombinational double-stranded DNA break repair
female with uterovaginal agenesis with low testosterone likely has normal what..
ovaries and breasts
pt with frontal bossing and no clavicle with decreased ALP levels
Craniocleidodysplasia
- defect in membranous ossification
- decrease in ALP –> osteoblast problem
what is the pregnancy-associated plasma protein of pts with any sort of trisomy
decreased
whatre the serum/in-utero markers of a pt with down syndrome
first trimester ultra sound commonly shows increased nuchal translucency and hypoplastic nasal bone
- increased hCG and inhibin
- decreased estriol and AFP
guaifenesin
expectorant –> promotes secretion of sputum by the air passages (used to treat coughs)
- thins respiratory secretions
- does not suppress cough reflex
loratadine
second generation H1 blocker
viral myocarditis
coxsackie virus (picornavirus)
newborn with CXR showing a gasless abdomen
pure esophageal atresia (atresia or stenosis)
-due to incomplete formation of pleuroperitoneal membrane
propranolol mechanism of action
decreased slope of diastolic depolarization
-prolonged repolarization at AV node
can occur in renal calyces, pelvis, ureters, and bladder
- painless hematuria (no casts)
- associated with phenacetin, smoking, aniline dyes, and cyclophosphamide
transitional cell carcinoma (urothelial carcinoma)
- most common tumor or urinary tract system
- histology –> fibrovascular core in papillary tumor and dysplastic urothelium
what are the lung capacities in restrictive lung disease
all decreased
MELAS syndrome
mitochondrial myopathy
- encephalomyopathy
- lactic acidosis
- stroke-like episodes
- secondary failure in oxidative phosphorylation
- muscle biopsy shows ragged red fibers due to accumulation of diseased mitochondria in subsarcolemma of muscle fiber
- deafness may also occur
leber hereditary optic neuropathy
cell death in optic nerve neurons –> subacute bilateral vision loss in teens/young adults
- usually permanent
- 90% males
- mitochondrial inheritance
what changes in the CV system as a person ages
increased basal systolic blood pressure
-note –> cardiac muscle mass does not increase
what type of environment makes exercise induced asthma worse
cold and dry air
how are cell proteins targeted to be destroyed
ubiquitin ligase // proteasome
pt with DM2 severe constipation and laxatives dont help… what nerves are likely not working well
pelvic splanchnic –> provide parasympathetic innervation to the hindgut
HLA match between siblings
1:4
hemolytic anemia
acanthocytosis
muscle weakness
demyelination of posterior columns (decrease position and vibration sensation) and spinocerebellar tract (ataxia)
vitamin E deficiency
-also pt can have decreased deep tendon reflexes
vitamin B6 deficiency
convulsions, hyperirritability, peripheral neuropathy (deficiency inducible by isoniazid and oral contraceptives), sideroblastic anemia (due to impaired hemoglobin synthesis and iron excess)
pt presents with rheumatoid arthritis and lung problems… whats likely
CAPLAN SYNDROME
-rheumatoid arthritis + penumoconiosis/bonchogenic carcinoma
complement mediator that stimulates histamine release from mast cells
C3a (also C4a and C5a) –> all three of these are involved in anaphylaxis
HIV pt with CD4 count less than 100
-1 ring enhancing lesion vs multiple ring enhancing lesions
only 1 –> EBV, B-cell lymphoma (non-hodgkin lymphoma, CNS lymphoma)
multiple –> toxoplasma gondii, brain abscesses with multiple ring-enhancing lesions on MRI
salivary secretion at low vs high flow
At low flow = High concentration of potassium; low concentrations of sodium, bicarb, & chloride
At high flow = low concentration of potassium; high concentrations of sodium, bicarb, & chloride
*ductal ion reabsorption is more efficient at low flow rates
what is happening in the liver of a pt with a glucagonoma
partial oxidation of fatty acids
new rash (necrolytic migratory erythema) and new diabetes
glucagonoma (tumor of pancreatic alpha cells)
Presents with 5D’s:
- Dermatitis (necrolytic migratory erythema)
- Diabetes (hyperglycemia)
- DVT
- Declining weight
- Depression
hydropic change
one of the early signs of cellular degeneration in response to injury that results in accumulation of water in the cell. Hypoxia/ischemia leads to decease in aerobic respiration in the mitochondria and decreased ATP production due to failure of the Na+/K+ ATPase leading to Na+ and water diffusion into the cell. Individual tubule cells appear swollen and “empty” with almost occluded lumen, glomerulus is hypercellular
thumb opposition
median nerve
bicycle handlebar injury classically damage what
Guyon Canal Syndrome
deep branch of the ulnar nerve at the hook of the hamate bone
-ulnar canal is above transverse carpal ligament and roof is formed by palmar fascia
what happens when a pt takes too many iron/ferrous sulfate tablets
metabolic acidosis with an increased anion gap
Negative nitrogen balance is associated with…
- burns, serious tissue injuries, fevers, hyperthyroidism, wasting diseases, and during periods of fasting
- the amount of nitrogen excreted from the body is greater than the amount of nitrogen ingested
Positive nitrogen balance is associated with…
- periods of growth, hypothyroidism, tissue repair, and pregnancy
- the intake of nitrogen into the body is greater than the loss of nitrogen from the body, so there is an increase in the total body pool of protein
what to give a pt with neuropathic pain
TCA’s are known to treat neuropathic pain very well (i.e. diabetes, ART therapy)
- Hydrocodone/Methadone can lead to dependence – avoid in long term use
- NSAIDs you also avoid due to partial ineffectiveness in neuropathic pain as well as ulcer risk
dyspnea, cough, chest tightness, headache
-in pt with a bird
hypersensitivity pneumonitis (restrictive lung disease)
- mixed type III/IV hypersensitivity reaction to environmental antigen (birds/dust)
- often seen in farmers and those exposed to birds
- reversible in early stages if stimulus is avoided
precontemplation vs contemplation
precontemplation –> denying problem
contemplation –> acknowledging problem but unwilling to change
what antibiotics can be used for acne
tetracyclines
what does decreasing respiratory rate do to intracranial pressure
increases it
-because if youre not breathing off enough oxygen your CO2 increases which causes vasodilation of the cerebral vessels causing an increase in intracranial pressure
lung sounds (percussion and expiratory phase)
Percussion
- resonant sound is normal
- hyperresonant with overexpansion
Expiratory phase
prolonged expiratory phase -> obstructive conditions
pt vomiting blood with legs that have perifollicular hyperkeratosis and hemorrhage
vitamin C
-hydroxylation of proline
list the opioid antagonists
naloxone
naltrexone
methylnaltrexone
what does propranolol do to total peripheral resistance
increases it
but it decreases cardiac output
hypertrophic scar/keloid formation are associated with what defect
abnormality in collagen synthesis
inheritance pattern of hereditary spherocytosis
AD
why cant you take tetracycline with milk/antacids
formation of complexes with mineral ions
-divalent cations inhibit drugs absorption in the gut
natural compensation for post-renal transplant
hypertrophy
-increase in glomerular size
high cardiac output in pt with infection
distributive/septic shock
cilostazol and dipyridamole
antiplatelet phosphodiesterase inhibitors
- increase cAMP in platelets
- inhibit platelet aggregation
- vasodilation
pt presents with coarse facial features, gingival hyperplasia, clouded corneas, restricted joint movements, claw hand deformities, kyphoscoliosis, and high plasma levels of lysosomal enzymes
I-cell disease
defect in N-acetylglucosaminyl-1-phosphotransferase —> failure of golgi to phosphorylate mannose residues (decrease in mannose-6-phosphate) on glycoproteins
-proteins are secreted extracellularly rather than delivered to lysosomes
what are the wrist bones to consider if they say the center of the palm is in pain
capitate and lunate
- Lunate is the only carpal bone that is frequently dislocated
- Scaphoid and hook of the hamate are frequently fractured
what happens to sleep patterns in narcolepsy
Narcolepsy –> all the “right kinds” of sleep are happening at all the “wrong times” of day.
During the day, when a power nap would typically throw you immediately into REM, this kid is only entering Stage 1 or 2 (lightest sleep = slightest noises jar him back to reality)
At night, when he should peacefully drift into Stage 1, 2, and so on, he instead completely zonks out
what type of pt gets what type of inguinal hernia
indirect (most common) –> seen in infants, people lifting heavy objects, and constipated people
direct –> seen in old men
placement of indirect inguinal hernias
lateral to inferior epigastric vessels
superior to inguinal ligament
what cranial nerve is being tested with uvular deviation
vagus (CN 10)
-ask the pt to say “ahhh”
what uses the IP3 signaling pathway
GnRH, Oxytocin, ADH (V1-receptor), TRH, Histamine (H1-receptor), Angiotensin II, Gastrin.
FA mnemonic: “GOAT HAG”
spinal tract function
- dorsal column
- spinothalamic tract
- lateral corticospinal tract
- Dorsal column –> pressure, vibration, fine touch, proprioception
- Spinothalamic tract –> lateral: pain, temp // anterior: crude touch, pressure
- Lateral corticospinal tract –> voluntary movement of contralateral limbs
when is your data insignificant
relative risk CI includes 1
mean difference CI includes 0
how to determine clonality of neoplasia
based on glucose-6-phosphate dehydrogenase
-present on X-chromosome so its based on X-chromosome linked isoenzymes
why cant you give itraconazole with a omeprazole
itraconazole requires an acidic environment to be activated
african american male with painful, itchy, hyperpigmented papules over the cheeks, jawline, and neck
pseudofolliculitis barbae (essentially razor bumps)
-foreign body inflammatory facial skin disorder characterized by firm, hyperpigmented papules and pustules that are painful and pruritic
if a pt drinks methanol… what is the toxic metabolite you would expect
formic acid
-can cause visual disturbances (snowflake white spots in his vision)
what amino acid is used in desmosine and elastin that you would always think of
proline, glycine. and lysine are all nonhydroxylated in elastin….
but if you have to pick one for this type of question then always go with lysine (at least when talking about desmosine cause its made up of 4 lysine residues)
what type of vitamin D goes to the skin (stratum basalae)
D3 = cholecalciferol
