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NBME16 Flashcards

1
Q

Describe Fanconi syndrome

A

reabsorptive defect of PCT
cannot reabsorb anything

high excretion:
AAs
glucose
HCO3
PO4

may result in metabolic acidosis (proximal renal tubular acidosis)

can be caused by hereditary, ischemia, drugs, etc

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2
Q

what does Kullikrein do

A

cleaves High-molecular weight Kininogen to Bradykinin to help activate PTT coag cascade.

it’s also chemotactic for neutrophils

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3
Q

where do you see hamartomas, ash-leaf spots, and seizures

A

tuberous sclerosis

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4
Q

what murmur are you going to hear ~3 days after MI

A

you’re at risk for free wall rupture, leading to tamponade, papillary muscle rupture

that will give you mitral regurg

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5
Q

what is the mech of resistance for VRE

A

substitution of d-lactate for d-alanine in peptidoglycan

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6
Q

what PTH finding do you see in Sarcoidosis

A

hypercalcemia
(2/2 1-alpha-hydroxylase mediated vitamin D activation in macrophages)

high 1,25-dihydroxycholecalciferol

low PTH (negative feedback)

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7
Q

what is Charcot Marie Tooth

A

Hereditary Motor and Sensory Neuropathy HMSN

abnormal myelin sheaths

associated with foot deformities (hammer toes), LE weakness, and sensory deficits (steppage gait)

(vs Friedrich Ataxia, w/ Hammer toes and degeneration of oligodendrocytes)

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8
Q

what is the buzzword cell for interstitial nephritis

A

eosinophils.

The forum guy doesn’t think any other kidney problems have eosinophils

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9
Q

what would cause cell convolution

A

decreased function of a channel/membrane protein

reversible change- cell could swell

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10
Q

what structure inferior to ovary is at risk of damage during ovarian removal

A

ureter

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11
Q

what is dysthymic disorder

A

mild depression lasting >2yrs

low mood with at least 2 other depressive symptoms

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12
Q

what is the cause of Reye syndrome

A

cerebral edema; hepatic encephalopathy

not viral encephalopathy

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13
Q

how do you promote blood filtration to get more flow through lymph

A

increase hydrostatic pressure (with 0.9% Saline)

just increasing arterial pressure isn’t effective

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14
Q

what is Graft vs Host disease

A 
onset varies
Grafted immunocompetent (donor) T cells proliferate in the immunocompromised host and reject host cells. 
Leads to severe organ dysfunction
Type 4 hypersensitivity

gives you maculopapular rash, jaundice, diarrhea, HSM, etc.

usually in bone marrow or liver transplant

potentially beneficial in leukemia (graft vs tumor effect)

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15
Q

what is a cross-sectional study

A

“what is currently happening”

so i you wanted to know what was going on at work, you measure some risk factor and “disease” among your employees
(level of noise vs hearing)

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16
Q

what are PCOS lab values with insulin, T, and LH

A

Fasting Insulin: increased (glucose increased)

T: increased

LH: increased (LH:FSH >2)

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17
Q

what is complicated about surgical repair of horseshoe kidney

A

anomalous origins of multiple renal arteries to each kidney

not abnormal origin of SMA

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18
Q

what cytokine will be positive in a positive TB test

A

Interferon-gamma

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19
Q

what’s a common side effect of chemotherapy drugs

A

sensory loss 2/2 microtubule damage for axonal transport

commonly 2/2 Vincristine, which damages tubulin

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20
Q

how does chronic inflammation present

A

“lymphocytic infiltration and collagen deposition”

mononuclear (monocyte, macrophage, lymphocyte, plasma cell) and fibroblast-mediated
persistent destruction and repair (proliferation and fibrosis)
granulomas: made of epithelial macrophages and giant cells

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21
Q

what is abnormal in spherocytosis

A

spectrin protein deficiency

pt may have splenectomy to get rid of destructive cause

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22
Q

which organelle transports to the Golgi

A

RER

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23
Q

what might you see in Small cell lung carcinoma

A

“infiltrating sheets w/o distinct organization”

paraneoplastic syndromes, including SIADH
which would make the pt hyponatremic

can also see cushing syndrome (high ACTH)

24
Q

what happens to myocytes cells while they’re in a cast

A

polyubiquitination

25
what is Vincristine's intracellular target
Tubulin
26
what is natural transformation
ability for bacteria to take up naked DNA (from cell lysis in the environment) especially seen in SHiN bacteria: S pneumo H influenzae Neisseria adding deoxyribonuclease to environment will degrade the naked DNA and prevent transformation
27
knee-jerk answer for older person with asplenia and meningitis
S pneumo
28
what neuro finding caused decreased muscle mass
degeneration of motor neurons leads to muscle atrophy may present with LMNs, or even UMNs
29
where is the ligamentum flavum, posterior longitudinal ligament, and anterior longitudinal ligament
ligamentum flavum: most posterior; just before spinal cord in LP posterior longitudinal ligament: just anterior to spinal cord anterior longitudinal ligament: anterior to vertebral bodies
30
what's the most important predisposing factor for gout
alcohol
31
what would explain 3 abortions and one poorly formed baby
unbalanced chromosome rearrangement (not gonadal mosaicism) they can give you miscarriage, stillbirth, or chromosomal imbalance like in Robertsonian Down Syndrome or Patau
32
what is the difference between high and low stage
metastasis and LN involvement | invasion through BM doesn't count
33
what kills bacteria (strep pneumo) inside of a neutrophil
lysosomal hydrolases
34
what is a treatment target for RA after prednisone and methotrexate is ineffective
TNF-alpha with Adalimumab, Certolizumab, Infliximab monoclonal Antibodies, that target soluble TNF-alpha
35
what is an embolism defect considered in the lungs
dead space perfusion defect
36
what's the most appropriate action if pt demands opioid refill w/o PE abnormalities
determine which drugs have been prescribed in the past | vs refer to drug addiction program
37
what 2 things point to ZE syndrome
Gastritis + pancreatic mass could also incl sweating, black stools, light-headedness causes high gastrin release
38
what do septal defects and a persistent truncus arteriosus indicate
problem with neural crest migration
39
what provides sensation to penis and allows erection reflex
pudendal nerve responsible for afferent component of penile and clitoral erection
40
what is a leukemiod reaction
reactive neutrophilic leukocytosis distinguished from CML because it has LAP positive with granulocytes no basophils no 9;22 translocation
41
what drug increases fertility in PCOS
clomiphene
42
what can happen with morphine tx
morphine is metabolized to active metabolites that accumulate (morphine 6 glucuronide) that provides the analgesia, but this can lead to toxic accumulation
43
how does intervertebral disc rupture present
nerve associated with the inferior vertebral body is impinged generally herniate posterior-laterally because of thin posterior longitudinal ligament severe pain that radiates down leg starts "almost immediately" after insult, lifting something over your head a sciatic nerve tear will be muscle weakness muscle tear would be local swelling and tenderness
44
what are lamellar bodies
secretory organelles may be low in a neonate with ARDS 2/2 type 2 pneumocytes with low lamellar bodies
45
how can poliovirus translate efficiently in the absence of a 5' methyl cap
it has an internal ribosome entry site that directs the translation of its mRNA
46
what is contraindicated when you give isosorbide dinitrate
sildenafil- life threatening hypotension
47
what do Gi and Gs proteins activate
adenylyl cyclase, which uses ATP to increase cAMP , which increases Protein Kinase A
48
what do Gq proteins activate
Phospholipase C, which works on Lipids/PIP2 to make 2 things: DAG --> Protein Kinase C IP3 --> increase Ca for SM Contraction "Phospholipase C and Protein Kinase C"
49
what is I-cell disease
inherited lysosomal storage disorder defect in N-acetylglucosamine-1-phosphotransferase, causing a failure of the Golgi to phosphorylate mannose residues on glycoproteins proteins are secreted extracellularly rather than delivered to lysosomes causes coarse facial features, clouded corneas, restricted joint movement, high plasma levels of lysosomal enzymes
50
what is neomycin's MOA
"nuclear bomb to bacteria" it kills bacteria in the gut that generate ammonia, which is a useful tx in hepatic encephalopathy
51
how do you treat cyclophosphamide-induced hemorrhagic cystitis
Mesna its thiol group binds the toxic metabolite
52
what is the mechanism of Li-Fraumeni syndrome
impaired regulation of apoptosis Li Fraumeni is associated with p53 mutation, which is a tumor suppressor gene p53 normally inhibits a defective cell from going from G1 to S phase either by inducing apoptosis or activating repair enzymes. Mutation of p53 means the cell won't be stopped at the G1/S checkpoint
53
what is the first location that will show signs of anoxic injury in kidney
proximal tubule ischemia, think tubule
54
how will lungs present after 1 week of cigarette smoke exposure
high mucus production and secretion low activity of airway cilia (carcinogens destroy cilia) low alveolar macrophage function (someone said not required for clearance of smoke irritants...?)
55
what cell plays a role in recognizing and killing the virus-infected tumor cells
Tumor cells are killed by CD8+ T cells and NK cells better answer between the two (if you're unlucky) is CD8+ T cells this would be HPV-16 giving you squamous cell carcinoma of the cervix

Daily Flashcard Quizzes (21 decks)

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