NBME 31 Flashcards
Vaginal discharge types
Candida A: Cottage cheese like
Chlamydia T: Watery
N. Gonorrhoeae: Mucopurulent
Trichomonas v: Green, malodorous, frothy
antibodies in Granulomatosis with polyangitis (Wegener granulomatosis) bind to
Neutrophils (c-ANCA = cytoplasmic antineutrophil cytoplasmic antibodies)
Acromegaly resistant to Somatostatine/octreotide tto, treat with
D2 agonist (bromocriptine, cabergolin)
To resect a mass in the sella turcica, one must go through
Sphenoid sinuses
How does one calculate weight loss with caloric deficit?
1 pound of body fat = 3.500 kcal
Caloric deficit per day /3500= number of pounds loss
Anorexia nervosa key feature
Intense fear of gaining weight
BMI usually <17
Dry skin, hypotension
Sulfonylureas mec of action
Close ATP-dep K+ channels -> depol-> Ca+2 influx -> insulin vesicles release
Undescended testes is called
Cryptorchidism
Primary hemostasis steps
- Vasoconstriction via endothelin
- Platelets adhesion via vWF (platelets attach to GpIb the vWF and vWF to collagen)
- Platelet activation release TXA2, ADP -> amplifies response
- Aggregation/ platelet plug via GpIIb/llla
Neonatal respiratory distress syndrome manifests as___ due to___
Atelectasis due to lack of pulm surfactant
Causes of Atelectasis
- Obstructive: something block alveoli expansion from the inside (mucus)
- Compressive: block from the outside (pleural effusion)
- Adhesive: lack of surfactant (NRDS)
- Cicatricial (pulm fibrosis due to toxin inh)
Hair cell leukemia key features
(Hair like)cytoplasmic projections
Acid phosphate positive in presence of Tartrate (TRAP +)
Massive splenomegaly and no lymphadenopathy
B cell tumor
ADPKD (cystic kidney) is autosomal dom, has complete penetrance but
variable expression (different phenotypic presentations)
Decrease penetrance means
Not all subjects with the genotype manifest the disease
Carcinoid tumor/sd features
Secretes Serotonin
Dg with 5-Hydroxyindoleacetic acid (serotonin 1st metabolite)
If metastasis out of gastro track, weight loss, diarrhea and flushing are common
Pancreatic Cancer marker
Ca19.9
Young pt (<30) with HTA and periumbilical bruit, expected angiography ?
Beaded (pearl like) stenosis of renal artery -> Renin on-> HyperALD
Amoebiasis key feature
Colonoscopy showing flask shaped mucosal ulcers
RUQ pain (amoebic abscesses)
Bloody diarrhea
Leukemoid Rx (left shift) outside of hematologic malignancy is the product of ___ that accelerates release of cells from___
An acute stressor (infection/inflam/surgery)
Bone marrow postmitotic reserve pool
Sinusitis usually affects ___ sinus, which drains into ___ where a cannula is usually placed
Maxillary
At the hiatus semilunaris in the middle meatus
Physiologic gynecomastia can present as
tender, unilateral or bilateral mass behind the nipple.
Generally small, rubbery, freely mobile, and well-circumscribed (a mass)
Recent respiratory tract infection + hematuria + igA deposits in mesangium on renal biopsy, think of
IgA nephropathy-> increases IgA synthesis and alt complement pathway activation
Pediatric pt with recent resp tract infection and nephrotic sd, think of
Minimal change disease
Stents tend to have Paclitaxel to prevent
Smooth musc growth (neointima formation) over stent and restenosis
Exudative pleural effusion associates to
Infection
Malignancy
Inflam disease (lupus, RA)
Transudative pleural effusion associates with
Alt hydrostatic pressure (HF, cirrhosis and nephrotic sd)
pleural fluid-to-serum protein ration > 0.5; pleural fluid-to-serum LDH ratio > 0.6; think of ___ effusion
Exudative
Most common type of primary bone cancer___. This commonly originates in ___ or __.
Osteosarcoma
Distal femur (above knee)
Proximal tibia (Below the knee)
Hypoglycemia post OH consumption occurs due to
Increased NADH, not enough NAD left for the TCA
Baby found unresponsive in crib with dicarboxylic acid in urine but no ketones, think of
No fatty acid oxidation due to acyl-CoA DHG def
Basal cell carcinoma features
Most common skin cancer
Pink, pearly papule/nodule with central crusting/ulceration
On sun exposed areas (face and neck) *upper lip
Squamous cell carcinoma (skin) features
2nd most common skin cancer
Ulcerative, non-healing skin lesions
Commonly on face, lower lip, ears, hands
Keratin pearls on biopsy
Multiple Mieloma is caused by neoplastic proliferation of
Plasma cells
Multiple mieloma key features
History of radiation, old people
Excess IgG
M spike
Neoplastic Plasma cells-> Excess cytokine production-> Hypercalcemia, bone lesions.
Essential mixed cryoglobulinemia key features
nephritic or nephrotic sd + weakness+ purpuric rash/purpura** + arthralgias
Antiglomerular basement membrane disease (Goodpasture sd) features
IgG accumulates in basement mb in lung and kidney
Hemoptisis-Hematuria
Type ll hypersensitivity
Fibrinoid necrosis is associated with
Vasculitis and other autoimmune diseases
Ursodiol is used for___. It acts (mec)___
Cholelithiasis
Decreasing cholesterol secretion into bile via use of ursodeoxycholic acid
Type l hyper IgM sd features
Lack of CD40L on CD4+T cells -> no B cell binding -> No Ig class switching-> High IgM, low IgG, igE and IgA -> infection risk (opportunistic, sinopulm, gastro)
Small lymphoid tissue
When SVC is obstructed, blood from the upper body returns to the heart via
Int mammary and intercostal veins
COPD Tto
Beta-adrenergic agonist (Albuterol) first line
Muscarinic antagonist if sts persist
First degree AV block ECG
PRs equally prolonged
QRS are equal
Second degree AV block, Mobitz l ECG
PRs increasingly prolonged (PR1<PR2<PR3)
QRS are equal
Second degree AV block, Mobitz ll ECG
PRs are equal
Some QRS do not conduct (absent)
Third degree AV block ECG
PP intervals are equal
QRS are dissociated (Look distantly equal)
P waves in between QRSs
Collagen synthesis requires
Prolyl 4- hydroxylase for lysine and proline hydroxylation + Vit C as a cofactor
Pt with painful, pruritic rash on groin and thigh, think of ___, by__
Tinea cruris by Trichophyton rubrum
Polycystic kidney disease is associated with kidney and ___ cysts
Liver
Autosomal recessive PKD vs Autosomal dominant PKD
ARPKD: childhood, renal disease usually req dialysis and/or transplant
ADPKD: adulthood, berry aneurysm and liver cysts
Defective peristalsis and relaxation of esophagus (LES contracted) suggests problem with ___. This causes___
Myenteric plexus/enteric ganglia (in control of LES and Meissner plexus)
Achalasia
Pediatric male pt with history of UTI, abnormally small kidney and Hydronephrosis, think of
Ureteral obstruction
Lynch Sd feature
High Risk for colorectal Ca (other abdo, brain and skin Ca too)
MSH1,2 and 6 mut -> DNA replication errors ->
Suspect if several family members have history of tumor
Which Craneal nerves traverse the cavernous sinus
III, lV, V1,V2, Vl
Acetylcysteine is given for Acetaminophen OD, it helps by increasing
Glutathione-> conjugates NAPQI (hepatotoxic) -> easier excretion
Silicosis pathognomonic pulm lesions are
Silicotic nodules with spiral appearance from layered collagen
Influenza vaccination produces antibodies again which viral protein?
Hemagglutinin
Oseltamivir targets which influenza virus prot?
Neuraminidase
Skin lesion with asymmetry, irregular borders, color variation, a diameter greater than 6 mm, and rapid evolution, think of
Malignant melanoma
Think of ABCDE
EB virus reactivation in immunocompromised is associated with
Lymphoproliferative disease, nasopharyngeal and gastric carcinomas, oral hairy cell leukoplakia, and various lymphomas.
Breast Ca can be sporadic but also a germline mut of BRCA1 or 2, which is autosomal__ . Main RF is___
Dominant
Family history of breast or ovarian Ca before 45 yo.
Poorly controlled HIV pt with supraclavicular mass, think of
Malignant transformation of B cells (lymphoma) by EB virus
Exposure to rat poinsons is associated to__, this will cause ___ and as a result___
Warfarin intox
Vit K inhibition
No carboxylation of glutamate on coagulation factors
Ant wall duodenal ulcers have high risk of __ whereas post wall ulcers have higher risk of___
Perforation
Hemorrhage (traversing gastroduodenal artery is near)
History of antiacids + HyperCa+2 + alkalosis, think of
Milk-alkali sd
Celiac trunk divides into ___ arteries
Common Hepatic
Left gastric
Splenic
Marfan key features
Connective tissue prob (impaired collagen synthesis)
Cardiaovasc: Ao dilation, regurgitation, aneurisms
Ocular: ectopia lentis, retinal detachment
Skeletal: tall, long fingers, chest abnormalities, joint hypermobility
Cimetidine affects other drugs metab due to___
CYP450 inhibition
Sural Nerve is good for nerve biopsy because it is purely ___
Sensory
Acute Tubular Necrosis features
Usually in the context of shock/ischemia or nephrotoxicity
Initial oligiria with subsequent polyuric phase
Muddy brown casts in urine
Acute myelocytic leukemia features
Anemia
Thrombocytopenia
Leukocytosis (majority are immature granulocytes/myeloblasts)
Down and out eye position + ptosis, think of which nerve damage ? This will affect the ipsilat ___ pupillary arc
Oculomotor
Efferent
Inclusion body myositis features
Proximal or distal weakness
Does not respond to corticoids/immunosuppressants
Basophilic-rimmed vacuoles in biopsy
Takayasu arteritis biopsy
Granulomatous inflam and intimal fibrosis
Polyarteritis nodosa (necrotizing vasculitis) histology
Fibrinoid necrosis
Small vessel vasculitis biopsy
Leucocytoclasia ( fragmented neutrophils nuclei)
Fibrinoid necrosis (fibrin deposition)
NB hypoglycemia with DMI mother mec
Placenta-> Human placental lactogen-> insulin resistance in mom-> hyperglycemia in mom and then fetal -> excess insulin continues even after birth.
Effects of insulin excess in NB not only causes hypoglycemia but___ due to___
New born RDS
Insulin inhibition of surfactant production
Borderline personality disorder features
Fear of abandonment
Impulsivity
Self-harm
Splitting (people are good or bad)
Infections with Staph A, Aspergillus and Burkholderia cepacia are associated with ____ disease because they are ___
Chronic granulomatous
Catalase (+)
Sputum culture of M. Tubérculo takes how long?
2-5 weeks
Murphy sign
Increase pain and inspiratory arrest
Renal papillary necrosis is associated with
Sickle cell disease
Acute pyelonephritis
Analgesics (NSAIDs)
DM
Acute tubulointerstitial nephritis features
Drug related (diuretics, sulfa drugs,NSAIDs, ATB, PPIs, rifampin)
*eosinophils and WBC casts without infection in urine
Fever, rash, hematuria
Duchenne dystrophy features
X-linked recessive
Frameshift or nonsense mut
Absent dystrophin in cytoplasm-> no actin-plasma mb anchoring-> musc fatigue and later myonecrosis -> high CK and aldolase
Pt in early childhood with hip girldle weakness that progressed superiorly, calf pseudohypertrophy, think of
Duchenne
B12 vs B9 deficiency
B12 deficiency has neuro sts and high methylmalonate
Vit to give if there is Methylmalonic acidemia
B12
Pt coming back from developing country (Brazil) with severe anemia, think of which organism
Ancylostoma or Necator americanus
Which opioids can be used to replace opioids that cause addiction and their mec
Methadone (long acting agonist)
Buprenorphine (partial agonist)
Naloxone (short acting antagonist)
Gastrointestinal stromal tumor (GISTs) are usually a result from a mut of
KIT** or PDGFRA
Which lobe is mostly associated to partial/focal seizures?
Temporal
Temporal vs frontal focal seizures
Temporal usually have motor automatisms (lip smacking or fidgeting)
Myasthenia Gravis vs Lambert-Eaton (myasthenic sd)
MG: post-synaptic prob, antibodies compete with ACh for cholinergic receptors (Blockade of motor nerve conduction)
LE: pre-synaptic prob, antibodies attack Ca+2 channels -> no ACh release
** L before M
Lambert Eaton / myasthenic sd presents as
Anticholinergic sts (constipation, dry mouth, impotence)
Proximal musc weakness
Paraneoplasic (lung Ca)
Myasthenia Gravis presents as
Ptosis
Diplopia
Dyspnea
Dysphagia
Main cell type response in abscess containing pyogenic bacteria
Neutrophils!
Main cell type response in granulomas from Tuberculosis and fungal infections
Macrophages
Clear cell renal carcinoma features
Most common primary renal tumor
Golden-yellow tumor
Well circumscribed, can distort kidney contour
Entero hemorrhagic E. coli (EHEC) features
The H stands for Hamburgers (undercooked food) hemorrhage (thrombocitopenia) and Hemolytic uremic sd.
Shiga toxin
Schistocytes
AKI due to platelet-fibrin clots in renal vessels
BCL2 suppresses___. Which means its overexpression lead to
Apoptosis!
Tumor formation
Where exactly is the neurovasc package on the elbow?
Supracondylar region of humerus
Which organism is known for having Glucans in its cell wall?
Histoplasma c.
AKI due to hyperacute kidney rejection occurs due to
Fibrin thrombosis
Laryngeal neoplasm metastasize initially to
Cervical lymph nodes
*in general head and neck neoplasias
HIV infection steps
Binding (gp120 and 41 to CD4 mb)
Fusion
Reverse transcription (RNA to DNA)
Integration (to CD4 genome)
Replication
Assembly
Budding (infection to other cells)
Cleavage (by HIV protrase-> virus matures)
HIV resistance is more common in which steps? Inhibition of which step is best for controlling it?
Retrotranscription and Cleavage
Fusion (blocking glycoproteins) *Enfuvirtide
Prior to separation and cell division in mitosis, cell must
Attach to spindles
Paclitaxel used for cancer, impairs
Spindle formation via microtubule breakdown inhibition
Which is the best drug for prostate cancer and why?
GnRH agonists (leuprolide)
Constant adm desensitizes GnRH receptor -> less testo-> less DHT -> less proliferation
Clomiphene is used for fertility problems because
It inh estrogen receptor in pituitary-> increases FSH and LH -> helps with ovulation and implantation
