NBME-29 Flashcards
What unique physical finding will be found in lung consolidation (pneumonia, pulmonary edema)
Increased tactile fremitus (vibration against the hand) over the consolidated area of the lung.
Edema specific to parts of the body that that are influenced by gravity, such as your legs, feet, or arms
Dependent edema
Intestinal absorption of calcium (and also phosphate) is regulated (increased) by
Vitamin D (active form)
How does active vitamin D increase GI absorption of calcium and phosphate?
via calcium-binding protein “Calbindin”
Describe Vitamin D activation
- 7-Dehydrocholesterol –> Cholecalciferol
- converted by UV light in the skin - Two steps of hydroxylation
- first in the liver by 25-hydroxylase
- second in the kidney by 1a-hydroxylase - Formation of 1,25-dihydroxycholecalciferol (active Vitamin D)
Bile acids are synthesized mainly from
cholesterol
The body’s “primary” source of cholesterol excretion although 90% of it are reabsorbed through the intestine and recycled by the liver
bile acids
Bile acid resins is used to treat hypercholesterolemia through what MOA?
Bile acid resins prevents the reabsorption of bile acids from the intestinal lumen –> decreased intrahepatic cholesterol –> upregulation of hepatic LDL receptors (to restore intrahepatic cholesterol concentration) –> decreased serum level of LDL
Demyelinating polyneuropathy caused by autoimmune antibodies against peripheral nerve myelin
Guillan-Barre syndrome
Guillan-Barre syndrome is often preceded by an infection caused by
Camp. jejuni
Guillan-Barre syndrome presents with what symptoms/signs?
acute symmetrical muscle weakness, hyporeflexia or absent of deep tendon reflexes (LMN dysfunction), autonomic dysfunction (BP fluctuations, cardiac irregularities), and sensory deficits (pain, vibration, etc.)
A condition often following a viral illness and presents with thrombocytopenia, and petechiae/purpura and easy bruising due to autoimmune antibodies attack against Gpllb/IIIa on platelets
Immune Thrombocytopenic purpura (ITP)
Thrombocytopenia in ITP is caused by
peripheral destruction of platelets by macrophages in spleen (phagocytose the platelet-antibody complex)
BM Biopsy of ITP shows
- Increased # of Megakaryocytes
bleeding time bleeding time (BT), PT, and PTT of ITP
BT: prolonged
PT: normal
PTT: normal
- platelet itself is normal so PT and PTT is normal
Tx for ITP
Usually self-limited; steroids/immunosuppressants for chronic ITP
What medication can exacerbate asthma, respiratory symptoms (bronchospasm), and nasal polyps?
Aspirin (NSAIDs)
- The diagnosis: Asprin (or NSAIDs)-exacerbated respiratory disease (AERD)
Describe Arachidonic acid pathways (AA to P, P, T eicosanoids)
- Phospholipids (membrane) –> Arachidonic Acid
- by Phospholipase A2 - AA –> Cyclic endoperoxides
- by COX 1 & 2 - Cyclic endoperoxides –> P, P, T
- Prostacyclin (PGI) by prostacyclin synthetase
- Prostaglandin (PGE) by prostaglandin synthetase
- Thromboxane (TXA) by thromboxane synthetase
Describe Arachidonic acid pathways (AA to L eicosanoid)
- Phospholipids (membrane) –> Arachidonic Acid
- by Phospholipase A2 - AA –> 5-HPETE
- by 5-Lipoxygenase - 5-HPETE –> Leukotrienes
- by leukotrienes synthase
What NSAIDs nonselectively and irreversibly inhibits COX 1 and COX 2?
aspirin
Leukotrienes can increase bronchial tone and cause
bronchospasm
Medications that cause muscular paralysis (diaphragm paralysis) via competitive antagonism at the POSTsynaptic acetylcholine receptor sites in the neuromuscular junction
Nondepolarizing neuromuscular blocker (-curarine, -curonium, -curim)
Muscular paralysis can be treated with _____, as in myasthenia gravis
acetylcholinesterase
- Neostigmine
- Pyridostigmine
Because of its unopposed estrogen stimulation of the endometrium, Tamoxifen or SERMs increases the risk for what cancer?
Endometrial Hyperplasia/cancer
Tamoxifen use can cause hypercoagulability state and increase the risk for
DVT, PE
Tamoxifen use can cause hypercoagulability state and increase the risk for
DVT, PE
Excess serum monosodium urate can precipitate in tissues as
tophi (hard lumps we typically know gout as)
Acute Tx for gout
- NSAIDs
- Steroids
- Colchicine
What acute gout tx works as and anti-inflammatory (impairs neutrophil chemotaxis and degranulation)?
Colchicine
Chronic Tx for gout
- Probenecid
- Allopurinol
What chronic gout tx competitively inhibits xanthine oxidase?
Allopurinol
What chronic gout tx inhibits reabsorption of uric acid in PCT but increases risk of uric acid calculi?
Probenecid
a psychiatric impulse control disorder that presents with repetitive hair pulling resulting in noticeable hair loss and several unsuccessful attempts to stop hair pulling; focal hair loss with broken hairs of different lengths
Trichotillomania
a disorder of diffuse, nonscarring hair loss that results from inciting factors such as medical illness, childbirth, nutritional deficiencies, or emotional stress
Telogen effluvium
a chronic, immune-mediated disorder of hair loss that can present with diffuse or focal hair loss. Areas may have smooth or irregular borders. Hairs are typically narrower proximally than distally and are prone to breaking.
Alopecia areata
The region of the immunoglobulin (Ig) molecule and is exchanged during isotype (class) switching from IgM to another Ig class; identical in all IgM molecules but shared (similar) in all IgG molecules
Constant region
The region of the immunoglobulin (Ig) molecule that is unique region for antigen binding; this region in each individual Ig is specific to an antigen
Variable region (aka. antigen binding region)
The region of the immunoglobulin that is intact during class switching
Variable region (aka. antigen binding region)
A movement disorder in which your muscles contract involuntarily, causing repetitive or twisting movements
Dystonia
A component of cartilage and is a highly polar molecule with many negative charges; strong affinity with water due to it’s polarity
Chondroitin sulfate
What molecule component of cartilage is heavily hydrated, which increases the overall volume of the complex, in contrast to its closer-packed form when it is a dehydrated solid?
Chondroitin sulfate
The ability of what ion to be removed from the cytoplasm is critical to cessation of muscle contraction and preparation to be depolarized again (diatole)?
Ca2+
What pump/channel helps re-establish the low basal calcium concentration in the cytoplasm during myocardial diastole?
Na+–Ca2+ exchanger –> brings Na+ into the cell in exchange for Ca2+ leaving the cell
What is the benefit of continuous positive airway pressure (CPAP) in patients with sleep apnea?
- Decreases the frequency of apneic episodes
2. Decreases blood pressure
Untreated HTN in patients with sleep apnea is associated with
adverse cardiovascular outcomes (stroke)
What treatment of type 2 diabetes mellitus binds to peroxisome proliferator-activated receptors (PPARs), which act as transcription factors to regulate metabolism and promote insulin sensitivity?
Pioglitazone
- HINT: Sketchypharm!
a scale that is used to measure the consciousness of a person; low score = decreased conciousness
Glasgow Coma Score
The predominant cell types found at the site of PPD exposure and in the lungs of patients with pulmonary tuberculosis.
Macrophages and CD4 T Cells (Th1)
Describe how PPD skin testing works in patients previously exposed to Mycobacterium tuberculosis (MTB)
- Mycobacterial antigen (tuberculin) is placed directly under the skin
- Prior exposure to MTB results in the formation of memory Th1 cells against typical mycobacterial antigens
- Tuberculin is processed by dendritic cells and presented to Th1 cells.
- Recognition by these Th1 cells leads to release of interferon-γ, which attracts macrophages to the site of injection
What hypersensitivity type is PPD skin test?
type 4 (delayed)
The most common subtype of melanoma in individuals with darker skin; occurs on the distal extremities (ie, acral sites)
Acral lentiginous melanoma
Distal aspects of the head (ears, nose) and the extremities (hands, fingers, feet, toes)
acral site
(T/F)
Acral lentiginous melanoma is associated with UV radiation
False
- that is why it’s most common in darker skinned patients
SLE, serum sickness reaction, polyarteritis nodosa, and poststreptococcal glomerulonephritis are all examples of type hypersensitivity
III (3)
An aerobic, gram-positive rod that is catalase-positive, β-hemolytic, and shows characteristic tumbling motility under light microscopy.
Listeria monocytogenes
Common sources of Listeria monocytogenes
Unpasteurized dairy or deli meats
Tx for Common sources of
Penicillin
Ectopic ACTH is produced by what neuroendocrine neoplasm?
Small cell carcinoma of the lung
How do you distinguish b/w Cushing disease (ACTH-secreting pituitary adenoma) vs. ectopic tumor production of ACTH?
Cushing disease responds (therefore ACTH decreases) to HIGH-dose dexamethasone
provides blood flow to the right ventricle, right atrium, SA node, and AV node, and in a right-dominant circulation
RCA
provides a majority of the blood supply to the inferior heart through the
posterior descending artery (PDA)
- branch of RCA in 85% of patients
Sores that are caused by prolonged pressure on a single point such as the buttocks, heels, occipital scalp, or elbows; common in patients with limited mobility;
Decubitus ulcers (aka. pressure sores)
The primary method of prevention of decubitus ulcers
Frequent turning or use of an offloading mattress
Type of short stature that is associated with short stature in both parents, a normal gain of height velocity, and a bone age that corresponds with chronological age
Familial short stature
Type of short stature that is independent of parental stature, has a decreased growth velocity, and a bone age younger than the patient’s chronological age
constitutional growth delay
*delayed puberty compared to their peers of similar age
Type of short stature associated with eventual reach of a normal adult height, with more rapid increases in height gain velocity after they reach puberty
constitutional growth delay
Cortisol and glucocorticoids increase production of ____ to inhibit phospholipase A2, therefore decreasing the production of inflammatory eicosanoids (prostaglandins and leukotrienes)
annexin (A1)
annexin (A1) is aka.
lipocortin
In cases of perforated viscus (perforated diverticulitis), pathogenic bacteria are able to enter the normally sterile peritoneal cavity causing deposition of what material to trap/inhibit and spread of infection?
Fibrin
The most common pediatric brain tumor and are usually pilocytic astrocytomas (benign) that occurs infratentorial (in the cerebellum or brain stem)
Gliomas
Type of malnutrition that presents with weight loss, muscle wasting, hypoalbuminemia, and signs of vitamin deficiencies
Protein-calorie malnutrition
Lateral (external) rotation of the thigh is controlled by what muscle?
Piriformis
Inhibin is released by what cells?
granulosa cells of the ovary and Sertoli cells of the testis
*primarily acts to inhibit the production and release of FSH
a noncaseating granulomatous disease that often involves the hilar lymph nodes and/or lungs
Sarcoidosis
Sarcoidosis risk factors include
African-American ethnicity (strongest predisposing risk factor) and being female
characterized by delayed ventricular depolarization and repolarization with an increased risk for ventricular arrhythmias; mutations or defect in voltage-gated potassium channels
LQTS
Expressed on the surface of endothelial cells in response to local infection to bind specific receptors on the surface of leukocytes
E and P selectins
a displacement of the femoral epiphysis (fracture of growth plate) relative to the femoral neck; most commonly occurs in “overweight” children; treatment requires surgical fixation of the femoral epiphysis to prevent complications
Slipped capital femoral epiphysis (SCFE)
Complications of Slipped capital femoral epiphysis (SCFE)
avascular necrosis of the femoral head, gait impairment, and premature osteoarthritis
a rheumatologic inflammatory condition involving the vertebrae that presents with subacute to chronic back pain and limited range of motion that is improved with exercise. It often presents in men between the ages of 20 and 30 years and may be associated with uveitis
Ankylosing spondylitis
osteochondrosis or traction apophysitis of the tibial tubercle that typically occurs in adolescent, athletic children. It presents with pain along the anterior aspect of the proximal tibia and knee that is exacerbated by kneeling or extending the knee. Physical examination typically discloses tenderness over an enlarged tibial tubercle.
Osgood-Schlatter disease
bacterial infection of the synovial joint space, most commonly by Staphylococcus aureus. Examination of the affected joint discloses tenderness, swelling, and erythema, and patients generally present with fever. Arthrocentesis is indicated for the evaluation of monoarticular erythema and swelling to evaluate for septic arthritis, which characteristically shows purulent synovial fluid with greater than 50,000 leukocytes/mm3.
Septic arthritis
Metabolically inactive muscle experiences disuse atrophy through the loss of trophic signals from stretch, reflex, and load bearing. Sarcomeres are catabolized, and vascular arbor diminishes, reflected histologically as decreased
capillarity
a neurotransmitter that acts on G protein-coupled receptors and increases gastrointestinal motility. It stimulates contraction of the gastric antrum and fundus to accelerate gastric emptying as well as peristalsis in the small bowel.
Motilin
Antiplatelet therapy that inhibits platelet aggregation by decreasing the expression of glycoprotein IIb/IIIa on the platelet surface.
ADP receptor blockers (aka. P2Y12 receptor blockers )
- Clopidogrel and ticagrelor
Inhibits gamma-carboxylation of coagulation factors
vitamin K antagonists such as warfarin
the main enzyme responsible for adenosine degradation, and deficiency of it is associated with lymphocyte dysfunction in severe combined immunodeficiency.
Adenosine deaminase
Multiple myeloma can present with severe back pain and hypercalcemia caused by increased osteoclastic activity stimulated by
Local interleukin-1 (IL-1) and tumor necrosis factor
free immunoglobulin “light-chain” proteins not present in kidneys unless your body makes too many Igs as in Multiple myeloma
Bence Jones proteins
the mechanism of hypercalcemia seen in most malignancies other than multiple myeloma.
Excessive parathyroid hormone-related protein production (PTHrP)
the only cranial nerves that are part of the CNS and therefore cannot regenerate due to Oligodendrocytes (CNS myelin) that release inhibitory factors that prevent neural regeneration
optic and olfactory nerves
___-adrenergic receptor utilizes phospholipase C as a second messenger, whose activity leads to increased intracellular calcium and protein kinase C activity, in turn causing smooth muscle contraction and arteriolar vasoconstriction.
alpha
What vascular smooth muscle change of the nasal mucosa arterioles decreases nasal secretions, assisting in the treatment of allergic rhinitis and nasal congestion?
Vasoconstriction
- almost counterintuitive!
the primary component of intermediate filaments in muscle tissue.
Desmin
The compounds that is most likely to induce increased titers of these antibodies when conjugated to the polysaccharides
protein (ex. flagellin)
The second most common type of primary lung cancer after adenocarcinoma, which more often presents as a peripheral lesion and can cause obstruction of bronchi
Squamous cell carcinoma of the lung
Educational Objective: Centrally located primary lung cancers include
- squamous cell carcinoma or
2. small cell carcinoma of the lung
Obstruction of the airways can lead to
postobstructive pneumonia.
Protein processing is targeted by protease inhibitors such as
ritonavir/lopinavir
Thinned trabeculae are characteristic of
osteoporosis
Common in elderly women of European descent and also in patients with chronic steroid use and limited physical activity; fragility fractures are a common presentation
osteoporosis
