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NBME 26 > NBME 26 > Flashcards

NBME 26 Flashcards

1
Q

Fetal Alchohol Syndrome

A

Microcephaly, facial dysmorphia (Small palpebral fissure, thin vermilion border & smooth philtrum & failure to meet developmental milestones)

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2
Q

Fetal blood circulation = Upon child’s BIRTH = ↑ pulmonary blood flow

A

Umbilical v. → liver & ductus venosus → IVC → RA → foramen ovale = LA or RV = pulmonary truck → ductus arteriosus = Aorta

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3
Q

Osteoarthritis of Hip: Pain on walking & ROM & resolves w/ rest

A

Type II collagen: cartilage (hyaline - articular jt.), vitrous body & nucleus pulpous. Degradation of type II = Matrix metalloproteases

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4
Q

VDJ rearrangement

A

T-cell @ thyroid vs. B-cell @ bone marrow = size of J is the same in both, if not the same assume Q shows = T-cell ↑ J size = Unrearranged immunoglulin gene

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5
Q

C5 & C6 nerve roots

A

Innervation of deltoid m. & m. of rotator cuff. COMPRESSION = loss of sensation @ deltoid & lateral arm & loss of arm abduction @ shoulder > 15 °

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6
Q

Mycobacterium tuberculosis

A

Virulence factor = Cord factor (glycolipid surface of cell wall) PROTECTS bacteria phagocytic killing & directly cytotoxic to macrophages

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7
Q

Porphobilinogen deaminase (PBGD) deficiency ≠ synthesis heme

A

Acute intermediate porphyria: Painful abdomen, Port wine colored Pee, Polyneuropathy, Psychological disturbance, Precipitated by factors: ↑ ALA synthase, CYP450 inducers, Starvation

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7
Q

Proton pump Inhibitors: Esomeprazole

A

GERD → mucosal erythema → metaplasia → Barrett esophagus → Esophageal adenocarcinoma. GERD, Peptic Ulcer, Zollinger-Ellison syndrome. Txt: PPI: ↓ gastric acid secretion by parietal cells thru Irreversible Inhibitor of H+/K+ ATPase on the luminal surface = Inhibits hydrogen into the gastric lumen

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8
Q

Urge Incontinues vs. Overflow Incontinues

A

Urge Incontinues = Detrussor m. overactive & urge to void vs. Overflow Incontinues: straining urine = urinary retention = ↑ post-void urine. Detrussor m. underactive or outlet obstrcution

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8
Q

Lead poisioning

A

Inhibits: Ferrochelatase & ALA dehydratase = Lead lines on gingivae, encephalophathy & erythrocyte basophic stippling, abdominal colic + sideroblastic anemia & Drop wrist & foot

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9
Q

Grave dx = Thyroidectomy = accidentally removed PT gland

A

↓ PTH = ↑ vit D or ↓Ca2+ = prolonged QT interval (SA node AP = ↓Ca2+ @ phase 4) & Chvostek sign = tap on facial n. = spasm of the facial m. Trousseau sign: Inflammed BP cuff occluded brachial a. = carpopedal spam.

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10
Q

Oral morphine in old age

A

OLD AGE: liver ↓ hepatic blood flow & liver size = ↓ certain Rx(Morphine) metabolism = ↓ first pass effect(takes place @ liver after absorption @ liver

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11
Q

HHV-6/ Roseola

A

High fever for few days → after fever disapperars → pt. rash truck and spread to face & upper & lower extermities

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12
Q

Infective endocarditis

A

Intravenous drug use = Tricuspid valve. Tricuspid regurgitation = holosystolic murmur heard @ L. lower sternal border = R. sided heart failure = ↑ JVP, hepatomegaly, ascites, peripheral extermity edema. R. ventricle = anterior & inferior part of heart

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13
Q

Squamous cell carcinoma: Centrally located

A

Intravenous drug use = Tricuspid valve. Tricuspid regurgitation = holosystolic murmur heard @ L. lower sternal border = R. sided heart failure = ↑ JVP, hepatomegaly, ascites, peripheral extermity edema. R. ventricle = anterior & inferior part of heart
assiociated w/ ↑ Ca2+ by PTHrP production & smoking. Histo: Keratin pearl & desmosomes = polygonal cells w/ intercellular bridges

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14
Q

Pt. has normal lipase & amylase ≠ problem w/ pancreas but luminal enzyme: Enteropeptidase/enterokinase deficiency

A

Trypsinogen ≠ converted to trypsin, chymotrypinogen, proelastase = failure to thrive, loss of weight = diarrhea, hypoalbuminemia Normal funx: Enterokinase converts Trypsinogen → trypsin & trypsin activates chymotrysinogen & procarboxypeptidase

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15
Q

Fetal Oxygen supplement

A

Premature babies = supplement O2 = prevent abnormal vasularization & neovascularization of the retina

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16
Q

Intention to treat ≠ change if pt. don’t follow thru

A

grp pt. randomized regardless of the pt. follow thru or not = this dilute the true effects of the intervention Pt. GERD: two grp one go will go thru surgery and other medical txt. few pt. in the surgery grp doesn’t get surgery & few pt. in medical grp get a surgery

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17
Q

Fragile X syndrome = CGG trinucleotide repeat

A

Postpubertal macroorchidism(enlarged testes),high arched palate, long face w/ large jaw, large everted ears, hypermobile jts. Mitral valve prolase

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18
Q

Selective IgA deficiency

A

↓ IgA(structure dimer) w/ normal = IgG & IgM: Recurrent respiratory(sinus) infection & diarrhea (Giardia). Immediate Anaphylaxis to blood transfusion: pt. ≠ have IgA so donors IgA ag is presented to mast cell. False - lab for pt. have celiac dx.

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19
Q

Von Willebrand dx

A

vEF conc deficiency: Mucocutaneous bleeding, epitaxis, gingival bleeding, petichiae & easy bruising, menorrhagia: excess menstrual bleeding ↑ BT, ↓ factor VIII & suppression of ristocetin activity

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20
Q

Inflammation

A

Erythema, warth, & edema = localized vasodilation = Histamine, PGE2 & bradykinin IL-1: recruitment & migration of neutrophils

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21
Q

Kaposi Sarcoma

A

Immunocompromised & HIV pt. Caused by Human herpesvirus 8(HHV-8) = Reddish purple & nonblanching plaques @ lower extermities, face & oral mucosa & genitalia, lungs & GI tract . Histo: Proliferating spindle cells forming slit-like spaces filled w/ blood

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22
Q

↓PCo2 of pt. on PEEP: prevents the alveoli from collasing always maintain a + pressure, prevent alveoli removing of all O2

A

↓PCo2 maintained by: Ventilation & exchange of CO2 btw blood & alveoli. ↑ ventilation = ↓ PCo2 &↑ PEEP = ↑ arterial O2

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23
Q

↓ Tyroxine binding globulin(binds to T4) =Chronic liver dx

A

↓ Total T4, Normal TSH & Free T4

24
Q

Ovaries lymph drain

A

Para-aortic lymph nodes via lymphatic vessels carried in suspensory ligament. Para-aortic: Pair of testes, ovaries, kidneys, fallopian tubes & fundus of the uterus

25
Q

Uncomplicated grief < 12 mths

A

≠ meet criteria for Major depressive disorder. Dr. should schedule regular appt to monitor sucidal ideation & psychiatric disorder(depression).

26
Q

If the mean & median are the same. Mean is greather R. skewed distrubution

A
26
Q

Zidovudine & Lamivudine

A

Inhibits reverse transcription (RNA → DNA)

27
Q

Brain-type natriuretic peptic (BNP)

A

Produced by ventricles = INHIBITs = RAAS = ↓ Na+ & blood volume = ↑ cGMP = dilates afferent arteriole & ↓ Renin & ↑ GFR

28
Q

Myasthenia Gravis

A

Assiociated w/ thymomas or thymic hyperplasia = Ab’s block or destroy nicotinic acetylcholine receptors. Txt: Acetylcholinesterase inhibitors or thymectomy

29
Q

Rheumatic arthritis

A

Pt. + Rhematoid factor & anti-cyclic citrullinated peptide Ab’s. ↑ Neutrophils, IL-1(promotes bone reabsorption & cartilage destruction) & TNF & ↓ C3

30
Q

Genital herpes & haemophilus ducreyi

A

Painful vesicles due to Unprotected sexual intercourse

31
Q

Cryptosporidium

A

Cause: Contaminated H20, Infect pt. w/ AIDS/HIV & Immunocompromised = fever, watery diarrhea & crampy abdominal pain. LM shows: stool : Intra-luminal oocysts on acid fast stain

32
Q

Acute tubular necrosis = ↓ BP = ISCHEMIA

A

Muddy brown cast, ↑ creatinine

33
Q

Estrogen therapy = Menopausal symptoms or prevention of Osteoporosis. Obese women in post-menopausal

A

Vaginal bleeding in post-menopausal women = uterine OR cervical endometrial carcinoma. Obese women in post-menopausal = androgen converts to estrogen

34
Q

Goodpasture Syndrome

A

Type 2 Hypersensitivity. Upper respiratory infection → Ab’s target type IV collagen = kidney & pulmonary capillaries = hemoptosis, hematuria & HTN

35
Q

Sensitivity

A

All pt. test + dispite whether they have the dx or not.

36
Q

Graft vs. Host Dx = Type IV Hypersensitivity dx

A

Bone marrow transplant. Donor T cell → Cell mediated response → Host tissue damage. Maculopapular rash & GI systoms Allografts = transplants of tissue taken from a nonidentical individual of the same species as the host.

37
Q

Capsaicin cream

A

Depletion of Substance P = gradual pain relief

38
Q

Lateral corticospinal tract: from cortex (E&F)

A

@medullarly pyramid = lession = UMN pattern weakness of contralateral upper & lower extermities

39
Q

Pancreatic cancer = risk factor

A

Smoking, Obesity & type 2 diabetes mellitus. Symtoms: Wt. loss, type 1 diabetes & gall stone

39
Q

Non-selective B-blockers

A

Propranolol = Inhibit cAMP = ↓ Intracellular Ca2+ = prolonage phase 0 & 4 (SA node) = ↑ PR interval = ↓ HR = ↓ slope of diastolic deplorization

40
Q

Renal cell carcinoma

A

Older male smokers. Paraneoplastic syndrome:↑ PTHrP, EPO, ACTH & Renin = Polycythemia, hypercalcemia, Hematuria, flank pain, palpable mass ↑ metastasis to Lungs. Polygonal clear cell w/ ↑ carb & lipid

41
Q

VIt E

A

Protetects RBC & cells from free radical damage. Deficiency = hemolytic anemia & generalize m. weakness. Smilar presentation as Vit B12 deficiency: posterior colunm & spinocerebellar tract demyelination = gait ataxia, bilateral weakness & ↓ deep tendon reflexes

42
Q

Pt. not happy w/ care provided w/ a heatlthcare worker, comes to you. Encourage the pt. to directly dissuss his issues w/ Healthcare worker = discussion will improve interpersonal communication btw the pt. & team member = ↑ chance pt. specific needs being met.

A
43
Q

Immune thrombocytopenia (ITP) = Platelet destruction

A

mucocutaneous bleeding = thrombocytopenia. Ab’s destroys platelets (bind GpIIb/IIIa) & bone marrow biopsy = ↑ # megakaryocytes

44
Q

Glypizide

A

↑ release of Insulin by INHIBITING = K+ out of the cell = depolarization = opening of voltage gated Ca2+ channels. Second-generation Sulfonylurea = Side effect: Hypoglycemia & wt. gain

45
Q

Incidence rate

A

(number of new cases) / (total population at risk(total pop subtract ppl affected)

46
Q

C1connected w/ skull & C1 connected to C2 too & C2 connected to C3. If C2-3 fussed then C1-2 will be also affected = Altantoaxial Jt. Vertebral a. travels thru transverse foramina C6 thru C1. Fracture of transverse foramina = Injury of Vertebral a’s.

A
47
Q

Hypoglycemia = Liver & kidney response

A

Activates Sympathethic NS (tremors, sweating, confused & tachycardia) = ↑ Epi & Nor-Epi from adrenal medulla → ↑ glucogon = ↑protein kinase A = glycogenolysis

48
Q

Immunogenicity

A

foreign Ag(HPV) = ↑ Ab production vs. self Ag(breast or prostate cancer)

49
Q

Smoking, Male & Hx of HTN = ↑ risk of Abdominal aortic aneurysms = Pulsatile abdominal mass

A

Risk factors: hypercholestrolemia, HTN or trauma, + family hx

50
Q

Hypoglycemia = Liver & kidney response

A

Activates Sympathethic NS (tremors, sweating, confused & tachycardia) = ↑ Epi & Nor-Epi from adrenal medulla → ↑ glucogon = ↑protein kinase A = glycogenolysis

51
Q

Yersinia Pestis = Bubonic plague

A

Gram - bacillus, trasmited by rat fleas & prairie dogs, direct handling, consumption or aerosolized droplet from infected animal(cats) or affected humans = leads to range of dx’s: sepsis, meningitis, & pneumonia = Bacteria migrates to lymph nodes.

52
Q

Opiod overdose

A

Respiratory depression ↑ CO2(hypocapnia) = cerebral vasodilation = ↑ cerebral blood flow

53
Q

Cellulits

A

Cutaneous(red rash) erythema, warmth, tender & induration(thickening and hardening of the skin) = causes S. aureus gram + no chain ONLY cocci vs. S. pyogenes = gram +, chain of cocci, B-hemolytic & bacitracin sensitive

54
Q

Familial Hypercholestrolemia (types IIa/b)

A

Absent/defective LDL receptor (able to bind BUT can’t internalize = Cytoplasmic domain of LDL receptor mutated) or apoB 100 → ↑LDL & cholestrol = Pt. Xanthomas(Achilles tendon), Xanthelasmas(fat deposit above eyes) & early artherosclerosis (MI) & corneal arcus

55
Q

Zollinger Ellison syndrome or Duedonum mass

A

Gastrin secreting tumor @ duodenum or pancreas = ↑ ulcers @ duodenum & jeujunum, malabsorption & abdominal pain. Assiociated w/ MEN1

56
Q

Proliferative glomerulonephritis/ Post Streptococcal Glomerulonephritis

A

Type 3 HS rxn, occurs 2-4 wks of infection(S. pyogenes) ↓ C3 complement, ASO titer + & IF: lump3 & bump3 = lumpy & bumpy subepithelial hump @ glomerulus.

57
Q
A

NBME 26 (1 decks)

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