NBME 26 Flashcards
Fetal Alchohol Syndrome
Microcephaly, facial dysmorphia (Small palpebral fissure, thin vermilion border & smooth philtrum & failure to meet developmental milestones)
Fetal blood circulation = Upon child’s BIRTH = ↑ pulmonary blood flow
Umbilical v. → liver & ductus venosus → IVC → RA → foramen ovale = LA or RV = pulmonary truck → ductus arteriosus = Aorta
Osteoarthritis of Hip: Pain on walking & ROM & resolves w/ rest
Type II collagen: cartilage (hyaline - articular jt.), vitrous body & nucleus pulpous. Degradation of type II = Matrix metalloproteases
VDJ rearrangement
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
C5 & C6 nerve roots
Innervation of deltoid m. & m. of rotator cuff. COMPRESSION = loss of sensation @ deltoid & lateral arm & loss of arm abduction @ shoulder > 15 °
Mycobacterium tuberculosis
Virulence factor = Cord factor (glycolipid surface of cell wall) PROTECTS bacteria phagocytic killing & directly cytotoxic to macrophages
Porphobilinogen deaminase (PBGD) deficiency ≠ synthesis heme
Acute intermediate porphyria: Painful abdomen, Port wine colored Pee, Polyneuropathy, Psychological disturbance, Precipitated by factors: ↑ ALA synthase, CYP450 inducers, Starvation
Proton pump Inhibitors: Esomeprazole
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
Urge Incontinues vs. Overflow Incontinues
Urge Incontinues = Detrussor m. overactive & urge to void vs. Overflow Incontinues: straining urine = urinary retention = ↑ post-void urine. Detrussor m. underactive or outlet obstrcution
Lead poisioning
Inhibits: Ferrochelatase & ALA dehydratase = Lead lines on gingivae, encephalophathy & erythrocyte basophic stippling, abdominal colic + sideroblastic anemia & Drop wrist & foot
Grave dx = Thyroidectomy = accidentally removed PT gland
↓ 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.
Oral morphine in old age
OLD AGE: liver ↓ hepatic blood flow & liver size = ↓ certain Rx(Morphine) metabolism = ↓ first pass effect(takes place @ liver after absorption @ liver
HHV-6/ Roseola
High fever for few days → after fever disapperars → pt. rash truck and spread to face & upper & lower extermities
Infective endocarditis
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
Squamous cell carcinoma: Centrally located
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
Pt. has normal lipase & amylase ≠ problem w/ pancreas but luminal enzyme: Enteropeptidase/enterokinase deficiency
Trypsinogen ≠ converted to trypsin, chymotrypinogen, proelastase = failure to thrive, loss of weight = diarrhea, hypoalbuminemia Normal funx: Enterokinase converts Trypsinogen → trypsin & trypsin activates chymotrysinogen & procarboxypeptidase
Fetal Oxygen supplement
Premature babies = supplement O2 = prevent abnormal vasularization & neovascularization of the retina
Intention to treat ≠ change if pt. don’t follow thru
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
Fragile X syndrome = CGG trinucleotide repeat
Postpubertal macroorchidism(enlarged testes),high arched palate, long face w/ large jaw, large everted ears, hypermobile jts. Mitral valve prolase
Selective IgA deficiency
↓ 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.
Von Willebrand dx
vEF conc deficiency: Mucocutaneous bleeding, epitaxis, gingival bleeding, petichiae & easy bruising, menorrhagia: excess menstrual bleeding ↑ BT, ↓ factor VIII & suppression of ristocetin activity
Inflammation
Erythema, warth, & edema = localized vasodilation = Histamine, PGE2 & bradykinin IL-1: recruitment & migration of neutrophils
Kaposi Sarcoma
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
↓PCo2 of pt. on PEEP: prevents the alveoli from collasing always maintain a + pressure, prevent alveoli removing of all O2
↓PCo2 maintained by: Ventilation & exchange of CO2 btw blood & alveoli. ↑ ventilation = ↓ PCo2 &↑ PEEP = ↑ arterial O2
↓ Tyroxine binding globulin(binds to T4) =Chronic liver dx
↓ Total T4, Normal TSH & Free T4
Ovaries lymph drain
Para-aortic lymph nodes via lymphatic vessels carried in suspensory ligament. Para-aortic: Pair of testes, ovaries, kidneys, fallopian tubes & fundus of the uterus
Uncomplicated grief < 12 mths
≠ meet criteria for Major depressive disorder. Dr. should schedule regular appt to monitor sucidal ideation & psychiatric disorder(depression).
If the mean & median are the same. Mean is greather R. skewed distrubution
Zidovudine & Lamivudine
Inhibits reverse transcription (RNA → DNA)
Brain-type natriuretic peptic (BNP)
Produced by ventricles = INHIBITs = RAAS = ↓ Na+ & blood volume = ↑ cGMP = dilates afferent arteriole & ↓ Renin & ↑ GFR
Myasthenia Gravis
Assiociated w/ thymomas or thymic hyperplasia = Ab’s block or destroy nicotinic acetylcholine receptors. Txt: Acetylcholinesterase inhibitors or thymectomy
Rheumatic arthritis
Pt. + Rhematoid factor & anti-cyclic citrullinated peptide Ab’s. ↑ Neutrophils, IL-1(promotes bone reabsorption & cartilage destruction) & TNF & ↓ C3
Genital herpes & haemophilus ducreyi
Painful vesicles due to Unprotected sexual intercourse
Cryptosporidium
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
Acute tubular necrosis = ↓ BP = ISCHEMIA
Muddy brown cast, ↑ creatinine
Estrogen therapy = Menopausal symptoms or prevention of Osteoporosis. Obese women in post-menopausal
Vaginal bleeding in post-menopausal women = uterine OR cervical endometrial carcinoma. Obese women in post-menopausal = androgen converts to estrogen
Goodpasture Syndrome
Type 2 Hypersensitivity. Upper respiratory infection → Ab’s target type IV collagen = kidney & pulmonary capillaries = hemoptosis, hematuria & HTN
Sensitivity
All pt. test + dispite whether they have the dx or not.
Graft vs. Host Dx = Type IV Hypersensitivity dx
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.
Capsaicin cream
Depletion of Substance P = gradual pain relief
Lateral corticospinal tract: from cortex (E&F)
@medullarly pyramid = lession = UMN pattern weakness of contralateral upper & lower extermities
Pancreatic cancer = risk factor
Smoking, Obesity & type 2 diabetes mellitus. Symtoms: Wt. loss, type 1 diabetes & gall stone
Non-selective B-blockers
Propranolol = Inhibit cAMP = ↓ Intracellular Ca2+ = prolonage phase 0 & 4 (SA node) = ↑ PR interval = ↓ HR = ↓ slope of diastolic deplorization
Renal cell carcinoma
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
VIt E
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
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.
Immune thrombocytopenia (ITP) = Platelet destruction
mucocutaneous bleeding = thrombocytopenia. Ab’s destroys platelets (bind GpIIb/IIIa) & bone marrow biopsy = ↑ # megakaryocytes
Glypizide
↑ 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
Incidence rate
(number of new cases) / (total population at risk(total pop subtract ppl affected)
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.
Hypoglycemia = Liver & kidney response
Activates Sympathethic NS (tremors, sweating, confused & tachycardia) = ↑ Epi & Nor-Epi from adrenal medulla → ↑ glucogon = ↑protein kinase A = glycogenolysis
Immunogenicity
foreign Ag(HPV) = ↑ Ab production vs. self Ag(breast or prostate cancer)
Smoking, Male & Hx of HTN = ↑ risk of Abdominal aortic aneurysms = Pulsatile abdominal mass
Risk factors: hypercholestrolemia, HTN or trauma, + family hx
Hypoglycemia = Liver & kidney response
Activates Sympathethic NS (tremors, sweating, confused & tachycardia) = ↑ Epi & Nor-Epi from adrenal medulla → ↑ glucogon = ↑protein kinase A = glycogenolysis
Yersinia Pestis = Bubonic plague
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.
Opiod overdose
Respiratory depression ↑ CO2(hypocapnia) = cerebral vasodilation = ↑ cerebral blood flow
Cellulits
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
Familial Hypercholestrolemia (types IIa/b)
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
Zollinger Ellison syndrome or Duedonum mass
Gastrin secreting tumor @ duodenum or pancreas = ↑ ulcers @ duodenum & jeujunum, malabsorption & abdominal pain. Assiociated w/ MEN1
Proliferative glomerulonephritis/ Post Streptococcal Glomerulonephritis
Type 3 HS rxn, occurs 2-4 wks of infection(S. pyogenes) ↓ C3 complement, ASO titer + & IF: lump3 & bump3 = lumpy & bumpy subepithelial hump @ glomerulus.
