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
