NBME 21 Flashcards
tactile fremitus
increase –> lung fibrosis or inflammation so its denser/thicker
decrease –> air or fluid built up in the lung
pityriasis rosea
“herald patch” followed three days later by other scaly erythematous plaques, often in a christmas tree distribution on the trunk
- multiple pink plaques with collarette scale
- self resolving in 6-8 weeks
how to prevent NSAID induced ulcers
misoprostol
- PGE1 analog (increases production of mucosal barrier and decreases gastric acid production)
- can cause diarrhea and dont give to pregnant women
metoclopramide
- D2 receptor antagonist: increases resting tone, contractility, LES tone, motility, promotes gastric emptying (does not influence colon transport time)
- clinical use: diabetic and postoperative gastroparesis, antiemetic, persistent GERD
-adverse effects: increase parkinsonian effects
how old do kids start puberty and what happens
~8-11.5 years old
pubic hair appears
testicular enlargement
breast bud forms
what builds up when pts start gluconeogenesis
pyruvate gets converted into alanine and lactate before pyruvate so they can then get turned into oxaloacetate then PEP
Alanine Pyruvate lactate
pyruvate -pyruvate carboxylase-> oxaloacetate -PEP carboxykinase-> PEP
whats made in ketogenesis
HMG-CoA —> acetoacetate —> beta-hydroxybutyrate
what will see you in the bones of a pt with osteomalacia/rickets
osteoid matrix accumulation
contralateral hemianopia with macular sparing, alexia without agraphia (dominant hemisphere)
posterior cerebral artery stroke
-lesion –> occipital lobe (visual agnosia: can see but cant recognize)
if a pt has some tumors or extra calcium/gastric acid then asks what else you should look for… where should your mind go
THINK ONE OF THE MEN SYNDROMES
be sure to write out... pit pan para pheo medullary thyroid carcinoma mucosal neuroma/marfanoid
what type of cells proliferate in EBV mononucleosis
lymphocytes
sideroblastic anemia
causes –> genetic (X-linked defect in S-ALA gene), acquired (myelodysplastic syndromes), and reversible (alcohol is most common, lead, vitamin B6 deficiency, copper deficiency, drugs)
- ringed sideroblasts (with iron-laden, prussian blue-stained mitochondria) seen in bone marrow
- peripheral blood smear: basophilic stippling of RBCs
treat with pyridoxine (B6 –> S-ALA)
sideroblastic anemia is essentially anemia due to defective protoporphyrin synthesis so you get iron going into erythroid precursors then getting stuck in mitochondria cause there is no protoporphyrin for it to bind to
- increase ferritin and serum iron and % saturation
- decrease TIBC
values to know in anemia of chronic disease
- increase ferritin and free erythrocyte protoporphyrin
- decrease TIBC, serum iron, and % saturation
how to relieve esophageal bleeding
surgical shunt b/w splenic and left renal veins
vision: pie in the sky vs pie on the floor
pie in the sky = contralateral meyer loop (temporal lobe) lesion
pie on the floor = contralateral dorsal optic radiation (parietal lobe) lesion
actions of super oblique muscle vs inferior oblique muscle
superior oblique –> looks down and in
inferior oblique –> looks up and in
what muscles lie on the orbital floor
inferior oblique
inferior rectus
what causes prolonged apnea in a pt who was administered succinylcholine
pseudocholinesterase deficiency
why/how to oxytocin levels rise during labor
birth canal reflex
apocrine vs cerumen vs eccrine vs sebaceous exocrine glands
apocrine –> your armpits smell like an ape
cerumen –> theres no room in your ears cause they are full of wax
eccrine –> when you exercise your pores are crying
sebaceous –> sebum is seeping out of your pores
what type of cells secrete renin and where are they located in the kidney
juxtaglomerular cells secrete renin and the highest concentration will be in the cortex of the kidney
what are the 4 blood transfusion reactions and explain them
- Allergic/anaphylatic reaction –> pt presents with urticaria, pruritus, fever, wheezing, hypotension, respiratory arrest, shock
- type 1 hypersensitivity against plasma proteins
- ex: IgA deficient people must receive blood products without IgA - Acute hemolytic transfusion reaction –> pt presents with fever, hypotension, tachypnea, tachycardia, flank pain, hemoglobinuria (intravascular hemolysis), jaundice (extravascular)
- type 2 hypersensitivity, ABO incompatibility or host antibody reaction - febrile nonhemolytic transfusion reaction –> pt presents with fever, headache, chills, flushing. reaction prevented by leukoreduction of blood products
- induced by cytokines or associated with type 2 hypersensitivity reaction - transfusion-related acute lung injury –> respiratory distress and noncardiogenic pulmonary edema
- GVHD of blood
gonadotrophs
these are the cells in the anterior pituitary that secrete LH and FSH
mixed venous oxygen tension… what does this phrase mean
how much oxygen is bound to hb thats going back to the right side of the heart
pt presents with recurrent cutaneous urticaria and occasional episodes of laryngospasm over the past year and there are no allergic causes… what do they have
C1 esterase inhibitor deficiency
- causes hereditary angioedema due to unregulated activation of kallikrein leading to increased levels of bradykinin
- decreased level of C4
- ACEi are contraindicated cause they increase bradykinin levels also
dorsal vs ventral spinal cord
dorsal –> pressure, vibration, fine touch, proprioception
ascending –> pain and temperature // crude touch and pressure
what is pneumonitis
presence of lung inflammation without evidence of an infection
blistering rash in infancy followed by wart-like skin growths which become swirly brown/gray patches in childhood then become lighter in adulthood
incontinentia pigmenti
X-linked dominant
what levels increase in pregnant women that can make hypothyroidism worse
TBG increases making hypothyroidism worse and the baby can have cretinism (congenital hypothyroidism)
- 6Ps
1. Pot-bellied
2. Pale
3. Puffy-face child
4. Protruding umbilicus
5. Protuberant tongue
6. Poor brain development
what is required to maintain good nutrition
linoleic acid (omega 6 fatty acid)
palmitic acid vs palmitoleic acid
palmitic: saturated fatty acid
palmitoleic: unsaturated fatty acid
how does rhabdovirus get to the brain
retrograde transport through nerves
endogenous ligand for ccr5
chemokine receptor 5 …. so chemokines
flagellin
protein that can increase efficacy of a vaccination specifically used in neisseria
what do you want to give a pt who has kwashikor
kwashikor = protein deficient
odd-chain fatty acids, branched chain amino acids, methionine, and threonine
squamous cell carcinoma of the esophagus
- upper 2/3
- keratin nests or pearls within or between cells with intracellular bridging
- ovoid eosinophilic cytoplasm
how does metronidazole work
forms toxic free radical metabolites in the bacterial cell that damage DNA
bactericidal and antiprotozoal
what type of cancer is associated with hydronephrosis and renal failure
invasive carcinoma of the uterine cervix
-lateral invasion blocks the ureters –> hydronephrosis –> renal failure
hyperacute graft rejection
type II hypersensitivity (antibody) and complement
case control vs cohort study
case control –> compares people with disease vs without disease (odds ratio)
cohort study –> compares group with and without certain exposure (relative risk)
dyslipidemias
1- LPL or C-II deficiency
2- absent or defective LDL receptors or ApoB-100
3- defective apoE
4- hepatic overproduction of VLDL
how to get to the lungs by the….
midclavicular line –>
midaxillary line –>
midscapular –>
midclavicular line –> 6-8
midaxillary line –> 8-10
midscapular –> 10-12
drug you can give for diarrhea that does not have CNS penetration
Loperamide
-mu agonist and slows gut motility
ampulla of vater
aka. heptopancreatic ampulla
- stones get stuck here and can cause increased levels of amylase and lipase
which abused drug has tachycarida, hypertension, nausea, and rhinorrhea during withdrawal
heroin
young boy comes in with aching temples/headaches and has not been himself lately and also develops an ataxic gait
inhaled glue
which antiHIV drug causes pancreatitis
didanosine
biogenic amine neurotransmitters
dopamine, norepinephrine (noradrenaline), and epinephrine (adrenaline)—and histamine and serotonin
what are the 3 ways CO2 gets transported from the tissues to the lungs and which happens more often
- HCO3- transported in the plasma (70%)
- carbaminohemoglobin or HbCO2 (21-25%)
- dissolved CO2 (5-9%)
african american woman with erythema nodosum, parotid enlargement, hepatosplenomegaly, hypercalcemia, and bilateral hilar lymphadenopathy
sarcoidosis
-these pts have an increase in ACE levels as well as 1alpha-hydroxylase
what is bromodeoxyuridine staining used for
detection of proliferating cells in living tissues
pt who just went to cancun and yucatan comes back with fever, headache, excruciating pain of muscles and joints, with mild macular rash
pt got this from an arthropod vector likely causing dengue fever or even chikungunya
-both have rash and extreme pain and come from the ayedes mosquito
collagen hydroxylation defect
due to vitamin C deficiency causing scurvy
problems forming triple helix due to problem with hydrogen and disulfide bonds
osteogenesis imperfecta
hexagonal urine crystals
cystine
rhomboid or rosettes urine crystals
uric acid
coffin lid urine crystals
ammonium magnesium phosphate (struvite)
wedge-shaped prism urine crystals
calcium phosphate
envelope/dumbbell shaped urine crystals
calcum oxalate (hypocitraturia)
pt with shortness of breath 2 weeks after giving birth
- JVD
- edema at lung bases
- mild heptaomegaly
- pitting edema in the lung bases
peripartum cardiomyopathy
- 4 chamber dilation of the heart after giving birth
- dilated cardiomyopathy
after a pt receives high dose chemotherapy… what should you give them as replacement for stuff they lost
granulocyte colony stimulating factor
post penicillamine or NSAIDs with IgG and C3 granular deposits
membranous glomerulonephritis
kid with tuberous sclerosis and heart problem… what is the likely heart problem
rhabdomyoma
what can you give a pt who wants to try natural remedies to lower LDL and triglycerides
niacin (vitamin B3)
-inhibits lypolysis in adipose tissue and reduces hepatic VLDL synthesis
