NBME Qs Flashcards
Large swollen rectal veins seen on Rectal exam. What is most common cause?
Patient has external hemorrhoids. Swollen and inflamed veins in the rectum and anus that cause discomfort and bleeding. The most common cause of external hemorrhoids is repeated straining while having a bowel movement (constipation).
What are you not suppose to take Tetracycline with? WHy?
Do not take tetracyclines with milk (Ca2+), antacids (eg. Ca2+ or Mg2+), or iron-containing preparations b/c divalent cations inhibit drugs’ absorption in the gu
Interfere with absorption
What happens to the capillary hydrostatic, interstital hydrostatic and interstitial oncot Pressure in HF?
Patient’s symptoms began 30 min after mowing lawn (i.e. after doing physical activity). He has severe chest pain and is cool, clammy, diaphoretic. He has increased pulmonary artery pressure and increased left atrial pressure. Taken altogether, this is cardiogenic shock.
Cardiogenic shock is a heart pump problem – the LV isn’t working.
When the LV, isn’t working, it causes a back up in the direction opposite to how blood normally flows. Therefore, blood will back up in the lungs.
This causes increased capillary hydrostatic pressure –> this drives more fluid into the interstitium –> this causes increased interstitial hydrostatic pressure –> there is now more fluid than normal in the interstitium –> this affects the protein ratio within the interstitum –> this causes decreased interstitial oncotic pressure.
4 week old infant, vomitted after every feeding. Forceful, with regurgitation through nostrils. Mild dild distention with visible peristalsis. What is Dx?
Hypertrophic pyloric stenosis
How do you treat a patient with painful spasms, muscle weakness, exaggerated DTRS and muscle cramps?
Baclofen is a GABA-B agaonist specific to the spinal cord. Used to Treat muscle spasticitiy, dystonia, and Multiple sclerosis.
What is the first line treatment for cirrhotic ascites?
Spironolactone + Furosemide
Explain atrophy in the setting of patient cast-immbolization due to fracture?
increased cytoskeleton degradation via ubiquitin-proteasome pathway and autophagy;
-decreased protein synthesis) and/or number of cells (apoptosis).
Causes include disuse, denervation, loss of blood supply, loss of hormonal stimulation, poor nutrition.
What is the difference between schizoid personality disorder and avoidant personality disorder?
Schizoid = voluntary social disorder, limited emotional expression and social isolation.
Avoidant= feels inadaquate, afraid people wont like them/of embaraassment. Want to socialize but cant
Can you explain the changes that go in a solitary kidney? MOA?
Compensatory hypertrophy –> Increase in glomerular size.
NO NEW CELLS, just bigger cells!! (pure hypertrophy)
Patient has Stable Angina and HTN. What is a drug that works by platelet altering platelet function AND providing direct arterial vasodilation?
PDE-inhibitors (cilastazol + Dipyridamole)
Schizophrenia pt with antipsychotic. Serum sodium concentration of 120. Urine Na+ of 8 mEQ. Urine osmo of 80. What is the disorder?
Patient has low serum sodium = hyponatremia.Given that the patient has a LOW URINE OSMOLARITY, it suggests that ADH is NOT active. The only way for someone to have hyponatremia AND a low ADH (in this case) is through psychogenic polydipsia (e.g. if it was SIADH, the urine would be MAXIMALLY concentrated and it is NOT in this case)
(A) would cause central DI – no ADH means one develops hypernatremia as free water is lost in the urine, thus concentrating the serum.
(B) osmotic diuresis could cause hypernatremia due to loss of free water in the urine
(C) degradation of ADH leads to DI which means one develops hypernatremia
(E) resistance to ADH (nephrogenic DI), again, hypernatremia.
What is the chance that an AUtodominant disorder is passed down?
50%
What is the MOA behind sensation of temperature? what is the main NT?
Per UWorld; capsaicin found in chili peppers causes excessive activation of TRPV1 (transmembrane channel), which increases intracellular calcium that results in long-lasting dysfunction of nociceptive nerve fibers (defunctionalization). It also causes release and depletion of Substance P (NT), causing at first burning and erythema but over time causes decreased pain sensation.
WHen is the only time you transfuse a jehovah witness?
When they’are below 18.
What is MOA of I cell disease?
I-cell disease (inclusion cell disease/mucolipidosis type II)—inherited lysosomal storage disorder; defect in N-acetylglucosaminyl-1-phosphotransferase → failure of the Golgi to phosphorylate mannose residues (forming mannose-6-phosphate) on glycoproteins → proteins are secreted extracellularly rather than delivered to lysosomes. Results in coarse facial features, gingival hyperplasia, clouded corneas, restricted joint movements, claw hand deformities, kyphoscoliosis, and high plasma levels of lysosomal enzymes. Often fatal in childhood.
