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Step 1 > NBME 20 > Flashcards

NBME 20 Flashcards

1
Q

if they give you a lung cancer question and the person has hypercalcemia what type of cancer do they have

A

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

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2
Q

pt with pale oval shaped areas on the skin/trunk

A

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
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3
Q

BRCA mutations

A

defects in recombinational double-stranded DNA break repair

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4
Q

female with uterovaginal agenesis with low testosterone likely has normal what..

A

ovaries and breasts

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5
Q

pt with frontal bossing and no clavicle with decreased ALP levels

A

Craniocleidodysplasia

  • defect in membranous ossification
  • decrease in ALP –> osteoblast problem
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6
Q

what is the pregnancy-associated plasma protein of pts with any sort of trisomy

A

decreased

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7
Q

whatre the serum/in-utero markers of a pt with down syndrome

A

first trimester ultra sound commonly shows increased nuchal translucency and hypoplastic nasal bone

  • increased hCG and inhibin
  • decreased estriol and AFP
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8
Q

guaifenesin

A

expectorant –> promotes secretion of sputum by the air passages (used to treat coughs)

  • thins respiratory secretions
  • does not suppress cough reflex
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9
Q

loratadine

A

second generation H1 blocker

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10
Q

viral myocarditis

A

coxsackie virus (picornavirus)

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11
Q

newborn with CXR showing a gasless abdomen

A

pure esophageal atresia (atresia or stenosis)

-due to incomplete formation of pleuroperitoneal membrane

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12
Q

propranolol mechanism of action

A

decreased slope of diastolic depolarization

-prolonged repolarization at AV node

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13
Q

can occur in renal calyces, pelvis, ureters, and bladder

  • painless hematuria (no casts)
  • associated with phenacetin, smoking, aniline dyes, and cyclophosphamide
A

transitional cell carcinoma (urothelial carcinoma)

  • most common tumor or urinary tract system
  • histology –> fibrovascular core in papillary tumor and dysplastic urothelium
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14
Q

what are the lung capacities in restrictive lung disease

A

all decreased

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15
Q

MELAS syndrome

A

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
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16
Q

leber hereditary optic neuropathy

A

cell death in optic nerve neurons –> subacute bilateral vision loss in teens/young adults

  • usually permanent
  • 90% males
  • mitochondrial inheritance
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17
Q

what changes in the CV system as a person ages

A

increased basal systolic blood pressure

-note –> cardiac muscle mass does not increase

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18
Q

what type of environment makes exercise induced asthma worse

A

cold and dry air

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19
Q

how are cell proteins targeted to be destroyed

A

ubiquitin ligase // proteasome

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20
Q

pt with DM2 severe constipation and laxatives dont help… what nerves are likely not working well

A

pelvic splanchnic –> provide parasympathetic innervation to the hindgut

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21
Q

HLA match between siblings

A

1:4

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22
Q

hemolytic anemia
acanthocytosis
muscle weakness
demyelination of posterior columns (decrease position and vibration sensation) and spinocerebellar tract (ataxia)

A

vitamin E deficiency

-also pt can have decreased deep tendon reflexes

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23
Q

vitamin B6 deficiency

A

convulsions, hyperirritability, peripheral neuropathy (deficiency inducible by isoniazid and oral contraceptives), sideroblastic anemia (due to impaired hemoglobin synthesis and iron excess)

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24
Q

pt presents with rheumatoid arthritis and lung problems… whats likely

A

CAPLAN SYNDROME

-rheumatoid arthritis + penumoconiosis/bonchogenic carcinoma

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25
Q

complement mediator that stimulates histamine release from mast cells

A

C3a (also C4a and C5a) –> all three of these are involved in anaphylaxis

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26
Q

HIV pt with CD4 count less than 100

-1 ring enhancing lesion vs multiple ring enhancing lesions

A

only 1 –> EBV, B-cell lymphoma (non-hodgkin lymphoma, CNS lymphoma)
multiple –> toxoplasma gondii, brain abscesses with multiple ring-enhancing lesions on MRI

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27
Q

salivary secretion at low vs high flow

A

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

28
Q

what is happening in the liver of a pt with a glucagonoma

A

partial oxidation of fatty acids

29
Q

new rash (necrolytic migratory erythema) and new diabetes

A

glucagonoma (tumor of pancreatic alpha cells)

Presents with 5D’s:

  • Dermatitis (necrolytic migratory erythema)
  • Diabetes (hyperglycemia)
  • DVT
  • Declining weight
  • Depression
30
Q

hydropic change

A

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

31
Q

thumb opposition

A

median nerve

32
Q

bicycle handlebar injury classically damage what

A

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

33
Q

what happens when a pt takes too many iron/ferrous sulfate tablets

A

metabolic acidosis with an increased anion gap

34
Q

Negative nitrogen balance is associated with…

A
  • 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
35
Q

Positive nitrogen balance is associated with…

A
  • 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
36
Q

what to give a pt with neuropathic pain

A

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
37
Q

dyspnea, cough, chest tightness, headache

-in pt with a bird

A

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
38
Q

precontemplation vs contemplation

A

precontemplation –> denying problem

contemplation –> acknowledging problem but unwilling to change

39
Q

what antibiotics can be used for acne

A

tetracyclines

40
Q

what does decreasing respiratory rate do to intracranial pressure

A

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

41
Q

lung sounds (percussion and expiratory phase)

A

Percussion

  • resonant sound is normal
  • hyperresonant with overexpansion

Expiratory phase
prolonged expiratory phase -> obstructive conditions

42
Q

pt vomiting blood with legs that have perifollicular hyperkeratosis and hemorrhage

A

vitamin C

-hydroxylation of proline

43
Q

list the opioid antagonists

A

naloxone
naltrexone
methylnaltrexone

44
Q

what does propranolol do to total peripheral resistance

A

increases it

but it decreases cardiac output

45
Q

hypertrophic scar/keloid formation are associated with what defect

A

abnormality in collagen synthesis

46
Q

inheritance pattern of hereditary spherocytosis

A

AD

47
Q

why cant you take tetracycline with milk/antacids

A

formation of complexes with mineral ions

-divalent cations inhibit drugs absorption in the gut

48
Q

natural compensation for post-renal transplant

A

hypertrophy

-increase in glomerular size

49
Q

high cardiac output in pt with infection

A

distributive/septic shock

50
Q

cilostazol and dipyridamole

A

antiplatelet phosphodiesterase inhibitors

  • increase cAMP in platelets
  • inhibit platelet aggregation
  • vasodilation
51
Q

pt presents with coarse facial features, gingival hyperplasia, clouded corneas, restricted joint movements, claw hand deformities, kyphoscoliosis, and high plasma levels of lysosomal enzymes

A

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

52
Q

what are the wrist bones to consider if they say the center of the palm is in pain

A

capitate and lunate

  • Lunate is the only carpal bone that is frequently dislocated
  • Scaphoid and hook of the hamate are frequently fractured
53
Q

what happens to sleep patterns in narcolepsy

A

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

54
Q

what type of pt gets what type of inguinal hernia

A

indirect (most common) –> seen in infants, people lifting heavy objects, and constipated people

direct –> seen in old men

55
Q

placement of indirect inguinal hernias

A

lateral to inferior epigastric vessels

superior to inguinal ligament

56
Q

what cranial nerve is being tested with uvular deviation

A

vagus (CN 10)

-ask the pt to say “ahhh”

57
Q

what uses the IP3 signaling pathway

A

GnRH, Oxytocin, ADH (V1-receptor), TRH, Histamine (H1-receptor), Angiotensin II, Gastrin.

FA mnemonic: “GOAT HAG”

58
Q

spinal tract function

  1. dorsal column
  2. spinothalamic tract
  3. lateral corticospinal tract
A
  1. Dorsal column –> pressure, vibration, fine touch, proprioception
  2. Spinothalamic tract –> lateral: pain, temp // anterior: crude touch, pressure
  3. Lateral corticospinal tract –> voluntary movement of contralateral limbs
59
Q

when is your data insignificant

A

relative risk CI includes 1

mean difference CI includes 0

60
Q

how to determine clonality of neoplasia

A

based on glucose-6-phosphate dehydrogenase

-present on X-chromosome so its based on X-chromosome linked isoenzymes

61
Q

why cant you give itraconazole with a omeprazole

A

itraconazole requires an acidic environment to be activated

62
Q

african american male with painful, itchy, hyperpigmented papules over the cheeks, jawline, and neck

A

pseudofolliculitis barbae (essentially razor bumps)

-foreign body inflammatory facial skin disorder characterized by firm, hyperpigmented papules and pustules that are painful and pruritic

63
Q

if a pt drinks methanol… what is the toxic metabolite you would expect

A

formic acid

-can cause visual disturbances (snowflake white spots in his vision)

64
Q

what amino acid is used in desmosine and elastin that you would always think of

A

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)

65
Q

what type of vitamin D goes to the skin (stratum basalae)

A

D3 = cholecalciferol

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