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Level 1/Step 1 > NBME 31 > Flashcards

NBME 31 Flashcards

1
Q

Ursodiol
MOA

A

decreases cholesterol content in bile = prevents the formation of cholesterol gallstones

2nd line therapy
1st line colectomy = classic biliary colic

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2
Q

SVC obstructed name collateral pathways

A
  1. Intercostal veins
  2. Internal Mammary veins
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2
Q

Head & neck neoplasms drain into which node

A

Cervical lymph node

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3
Q

Gastric cancers (renal + gonadal + GI) drain into which node

A

Supraclavicular = left side is call Virchow nodes

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4
Q

where do malignancies of the trunk including Lung cancer + Melanoma drain

A

Mediastinal lymph nodes

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5
Q

1 lb of fat = ____ kcals

A

3500

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6
Q

25M or F
macrocytic anemia
why are RBC abnormally enlarge

A

Impaired DNA synthesis = antifolate

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7
Q

pt w/
1. urticaria (red rash)
2. vasodilation
3. tachycardia
4. angioedema

A

Degranulation of mast cells –> the release of histamines

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8
Q

27F
severe ab pain 2 days
audible wheezing
rash (red & diffused across neck + chest)
Pulse = 120/min
BP = 90/65

A

Anaphylactic shock–> skin rxn = urticaria = histamine release = degranulation of mast cells

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9
Q

Focal seizures

A

Temporal lobe = (an aura, motor sx)
motor automatisms = lip-smacking + fidgeting
autonomic dysfunction = confusion

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10
Q

Generalized tonic clonic seizures

A

Frontal lobe = +/-Loss of awareness

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11
Q

Somatosensory seizures

A

Parietal lobe = sensation of numbness + tingling + warmth + pain

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12
Q

16M
painful + pruritic rash on groin & upper thigh
PE: rash w/ red scaling margins
skin scraping = fungal hyphae + arthospores

A

Dermatophyte
Trichophyon rubrun = scalp + trunk + nails + groin + feet

note candidia albicans does not have scaling margins

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13
Q

35M
chronic hep c
rash on his legs
kidney issues
decreased C3/C4
gross hematuria

A

Essential mixed cryoglobulinemia

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14
Q

Osteoporosis tx

A

1st line: Bisphosphonates (bind to hydroxyapatite & stop osteoclasts (no RANLL-RANK) = osteoclasts apoptosis - C/I (history of esophageal cancer or esophageal disorders)

-Selective estrogen receptor modulators (SERMs) - C/I (hot flashes + DVT + PE + Stroke)

-Teriparatide (a recombinant form of parathyroid hormone)

-Denosumab

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14
Q

Celiac trunk supplies

A
  1. liver
  2. stomach
  3. proximal duodenum
  4. pancreas
  5. inferior esophagus
  6. spleen
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15
Q

Descending aorta dissection –> compromise of

A

Celiac trunk
Renal Arteries

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16
Q

2month M
difficulty breathing
vocal cords = multiple slender finger-like excrescences

A

HPV (6 & 11) –> laryngeal papillomatosis

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17
Q

Congenital syphilis

A
  1. rhinitis = mucopurulent nasal discharge
  2. rhagades dental malformations = teeth + irregularly shaped molars
  3. +/- hepatosplenomegaly
  4. lymphadenopathy
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18
Q

40M
cerebellar hemangioblastoma
retinal angiomas
RCC (renal adenocarcinoma)

A

von Hippel-Lindau disease

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19
Q

Tachycardia shortens the duration of

A

diastole & ventricular filling time = reduced preload

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20
Q

Metabolic functions that are SPECIFIC to hepatocytes

A
  1. urea cycle
  2. amino acid deamination + transamination
  3. gluconeogenesis
  4. synthesis of albumin
  5. coagulation factors
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21
Q

Viral infection
Fungal infections
liver abscesses
catalase-positive organisms

A

Chronic granulomatous disease

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22
Q

maxillary sinus can be cannulated via its opening into the

A

nasopharynx at the hiatus semilunaris in the middle meatus

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23
Q

Chronic HTN + hemorrhage

A

Intraparenchymal

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24
Q

Trauma + brain hemorrhage

A

Epidural = LOC + lucid interval +progressive decline in mental status

Subdural = headache + vomiting + meningismus + UMN

Subarachnoid = photophobia + coma + severe headache

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25
Q

Ruptured aneurysmal = what brain hemorrhage

A

Subarachnoid = photophobia + coma + severe headache

1.Anterior communicating artery
2. Middle cerebral artery bifurcation

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26
Q

What innervates the LES

A

enteric ganglia

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27
Q

Albendazole

A

alteration of the cytoskeleton by binding the tubulin

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28
Q

Impaired wound and bone healing, and disordered hair grow as a result of deficiency

A

Vit C = affects collagen production via prolyl hydroxylase

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29
Q

ipsilateral fine touch, pressure, vibration, and proprioception

A

lesions of the dorsal funiculus of the spinal cord = sensory fibers of the dorsal column-medial lemniscus spinal tract

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30
Q

ipsilateral weakness and decreased deep tendon reflexes

A

Lesions of the anterolateral funiculus

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31
Q

55M
hematopoietic cell transplant
maculopapular

A

GVHD

Type 4 hypersensitivity

T lymphocytes = initiate Fas-ligand pathway –>
Apoptosis = shrink + eosinophilic cytoplasm + nucleus condenses & fragments + cellular debris removed by macrophages

could also include = hepatoslenomegly + jaundice

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32
Q

Tx of GVHD acts by

A

directly inhibiting production of T
lymphocytes or by suppressing the normal function of these cells

Examples include
1. mycophenolate mofetil (inhibits
the synthesis of nucleotides needed for lymphocyte proliferation)
2. etanercept (tumor necrosis factor (TNF) -a receptor inhibitor)
3. pentostatin (purine analog that inhibits T cell proliferation)
4. sirolimus (inhibits mammalian target of inhibitor rapamycin = mTOR) = (suppress T cells proliferation)
5. anti-thymocyte globulin (directly targets T cells)

33
Q

Body louse

Kissing bug

Mosquito

Sandfly

Tsetse fly

A

Body louse = Rickettsia prowazkii

Kissing bug = Trypanosoma cruzi (lymphadenopathy + splenomegaly + dilated cardiomyopathy + arrhythmia + CHF + megaesophagus)

Mosquito = Plasmodium (chills + blood smear)

Sandfly = Leishmania genus (cutaneous + organomegaly)

Tsetse fly = Trypansoma brucei african sleeping sickness

34
Q

Autophagy

A

lysosomes = formation of isolation membranes

35
Q

Apoptosis

A

Caspases –> proteases + endonucleases
Intrinsic: Bc12 –> cytochrome c
Extrinsic: FAS-L
Cytotoxic CD8+ T cells

36
Q

More intoxicated vs Lower intoxication of alcohol

A

More = decreased alcohol dehydrogenase activity

Lower = indiction of enzymes in the microsomal ethanol-oxidizing system

37
Q

The presence of multiple phenotypic variations of a trait w/n a population

A

Balanced polymorphism

38
Q

Certain disadvantageous recessive
alleles persist in a population b/c the heterozygous phenotype has a survival advantage relative to the dominant and
recessive homozygous phenotypes

A

Heterozygote advantage

39
Q

frequency of 1/20 among AA
frequency of 1/200 among Hispanic
originally produced this stratification of allele

A

Heterogeneity Advantage

40
Q

N-Acetylglucosamine–N-acetylmuramic acid

A

peptidoglycan polymer found
in bacterial cell walls

41
Q

Cellulose

A

Plant cell walls

42
Q

Glucans

A

main components of the fungal cell wall
1. Glucans
2. chitin
3. Glycoproteins

43
Q

Polyglutamic acid

A

Bacillus organisms

expressed in the cell capsule (virulence factor) = immune system evasion

44
Q

Teichoic acid

A

gram-positive bacteria = increased flexibility to the cell wall

45
Q

Occurs secondary to scarring in the setting of sexually transmitted infection,
+ in the setting of cystic fibrosis

A

Obstruction of the ductus deferens

46
Q

27M
infertility = decrease sperm count
B/L soft masses (testes)
US = increased temperature w/n scrotum

A

Varicocele = will NOT transilluminate

Note: hydrocele = processeus vaginalis –> accumulation of fluid around testicles

47
Q

Alcohol pathophysiology

A

EtOH –> increase in EtOH dehydrogenase –> increased Acetaldehyde production + NADH

Acetaldehyde goes to the mitochondria & is converted into Acetate + NADH

Increased NADH:NAH+=
1. ↑Lactic Acid
2. ↑Ketones
3. ↑TG production = lipid accumulation due to decrease FFA oxidation causing a fatty liver

48
Q

31M
right side of face is lower than left
unable to grimace his right cheek or elevate his right eyebrow

CN injured?

A

CN 7 = Bell palsy
secondary to the reactivation of HSV
ipsilateral facial weakness

Damage can lead to hyperacusis = loud sounds

49
Q

Lysosomal dysfunction disorders

A
  1. Gaucher disease
  2. Mucopolysaccharidosis 1 & 2
  3. Niemann-Pick disease
  4. Tay-Sachs disease
50
Q

Mitochondria dysfunction disorders

A

Neurologic diseases + Muscular diseases =
1. Leber hereditary optic
2. Myoclonic epilepsy w/ ragged red fibers neuropathy
3. Maternally inherited diabetes & deafness
4. MELAS syndrome

51
Q

Nuclear membrane dysfunction disorders

A

Neural issues
1. Emery-Dreifuss muscular dystrophy
2. AD limb-girdle muscular dystrophy
3. dilated cardiomyopathy w/ conduction system disease
4. Charcot-Marie-Tooth disease

52
Q

Peroxisome dysfunction disorders

A

Fat issue
1. Zellweger syndrome (Elevated phytanic acid)
2. infantile + adult Refsum disease
3. Neonatal Leukodystrophy (CNS issues)

53
Q

Smooth ER dysfunction disorders

A

Glycogen storage disease type 1 = Von Gierke ddisease

54
Q

3M
sway back when standing
girdle weakness
Creatine kinase concentration increased

Dx

A

Duchenne muscular dystrophy

pelvic girdle muscles + progresse superiorly
pseudo-hypertrophy of calf muscle = fibrofatty replacement

DMD = dystrophin gene accumulates in cytoplasm - role = anchoring muscle actin filaments to the plasma membrane

55
Q

3month
hypotonia = floppy baby
hearing issues
renal cyst

Syndrome?

A

Zellweger syndrome spectrum = peroxisome issues

56
Q

56M
behavioral changes
difficulty understanding spoken language
adrenal issues

Dx

A

Adrenal + CNS = X-Linked Adrenoleukodystrophy

peroxisomal issue

57
Q

Locations
SA node

A

SA node = SVC + RA junction

58
Q

Locations
AV node

A

AV node = Posteroinferior interatrial septum (above coronary sinus)

59
Q

Locations
Coronary sinus

A

Coronary sinus = IVC & Tricuspid

60
Q

Tetrahydrobiopterin (BH4) is needed to make

A

Dopamine & serotonin

Deficiency seen in pts w/ PKU (elevated phenylalanine)

61
Q

Flaccid limb weakness
Dysarthria
Dysphagia
Tongue atrophy
Respiratory failure

A

Amyotrophic lateral sclerosis (ALS)

62
Q

The SMA is able to compress

A

the Left renal vein

63
Q

Most common site for acute diverticulitis

A

Sigmoid colon

64
Q

Tx for metastatic prostate cancer

A
  1. -relin or Leuprolide = GnRH agonist
  2. -taxel + vinca alkaloids = microtubule function inhibition
65
Q

Gastrointestinal stromal tumors (GISTs) arise from a mutation in

A

KIT or PDGFRA

66
Q

Hereditary diffuse gastric cancer syndrome = Mutation of

A

CDH1 (E-cadherin) protein

AD

67
Q

Myotome

A

muscles w/ deep abscesses

68
Q

Neurotome

A

neural tube that help establish the embryonic brain during development

69
Q

Sclerotome

A

developing embryo giving rise to bones + MSK tissue

70
Q

Syndetome

A

somite comprising tendon progenitor cells

71
Q

Dermatome

A

nerves + blood vessels + CT + sweat glands + hair follicles
boils (carbuncles)

72
Q

Atherosis of decidual vessels seen in prego =

A

increase odds of preeclampsia

73
Q

Confidence intervals are affected by

A

increased in sample size = decrease confidence intervals

74
Q

________ permits the
digestion of lactose in a glucose-poor environment

A

lac operon

75
Q

transposons

A

Insertion sequences

76
Q

act by cutting and splicing DNA to
adjust coil structure

A

Topoisomerases

77
Q

Alu repeat sequences

A

nuclear elements
frequent cytosine and guanine elements, and are often the sites of epigenetic
regulation (eg, methylation)

78
Q

Asthma
eosinophilia
hematuria

A

Churg-Strauss

79
Q

Hemoptysis
Hematuria

A

Goodpasture

80
Q

Hemoptysis
Hematuria
Head-itis = nasal septal perforation + mastoiditis + otitis + sinusitis
Necrosis

A

Wegener

81
Q

CASE = Catalase+ Microorganisms

A

C= Candida
A = Asperigillus
S = Staph
E = Enterobacteriaceae

Level 1/Step 1 (15 decks)

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