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NBME17 Flashcards

1
Q

what are the 2nd generation antihitamines

A

Loratadine
Fexofenadine
Desloratadine
Cetirizine

“a fox, cert, and lonely rat”
usually end in -adine

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2
Q

which immunoglobulins are the warm and col

A

Warm: IgG
“warm weather is Great”

Cold: IgM and complement
“Cold weather is Miserable”

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3
Q

small tender blisters on genitals a few days after sex. what are they

A

Herpes simplex virus 2

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4
Q

what is Rosacea?

A

erythematous papule and pustules, no comedones

may be associated with facial flushing in response to external stimuli (alcohol, heat)

Phymatous rosacea can cause rhinopehyma (nose deformity)

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5
Q

what does Malaria vs Leishmania look like on stain

A

Malaria:
tiny little horseshoes with knobs on the end inside of RBCs

Leishmania:
macrophages containing amastigotes- which looks like a polka-dot cell

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6
Q

distinguish between visceral and cutaneous Leishmaniasis

A

Visceral: Kala-azar
AKA black fever
spiking fevers, HSM, pancytopenia

Cutaneous:
skin ulcers
brazilyensis- “flesh eating”

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7
Q

what is Cholera’s MOA

A

works w/ a Gs mechanism- so it activates adenylyl cyclase and cAMP

“GaS can” in “cAMP Cholera”

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8
Q

where would a tumor be if it gave you ataxia, but muscle strength, DTR, sensation, and proprioception are all normal

A

cerebellum

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9
Q

what might a newborn’s serum show if they have congenital CMV

A

IgG and IgM

the mom’s IgG crosses the placenta
the baby makes IgM

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10
Q

when does neural tube develop

A

neural tube forms in week 3 and closes by week 4

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11
Q

where does the femoral nerve come from

A

L2-L4

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12
Q

what are the stages of change

A

pre-contemplation: no acknowledgment of problem

contemplation: acknowledging there’s a problem, but not willing to do anything

preparation/determination: getting ready to change

action/willpower: changing behaviors

maintenance: maintaining the changes
relapse: returning to old behaviors and abandoning new ones

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13
Q

what is the reaction to poison ivy

A

type 4, cell-mediated with T LYMPHOCYTES

(linear vesicles)

antigenic activation of T lymphocytes and macrophages leads to the production of lymphokines, which produce the tissue injury.
this rxn does not require formation of antibodies.

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14
Q

what do the labioscrotal swellings make

A

Scrotum or labia majora

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15
Q

what do the urogenital folds make

A

ventral shaft of penis (penile urethra) or labia minora

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16
Q

what does the urogenital sinus make x 2?

A

1- prostate gland or
urethral and paraurethral glands (of Skene) in female

2- Bulbourehtral glands (of Cowper) or
greater vestibular glands (of Bartholin)

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17
Q

what makes the urinary bladder

A

urogenital sinus + mesonephric ducts

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18
Q

what do the genital tubercles make x 2?

A

glans penis or
glans clitoris

corpus cavernosum and spongiosum or
vestibular bulbs

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19
Q

what would happen if you were in cold water for 20 min

A

peripheral vessels would constrict, so
central blood volume would increase

ADH will be decreased, because
your body thinks it has enough volume right now with it all shifting centrally

ANP would be increased, because
it thinks you’re in a hypervolemic state (the atria is seeing more fluid)

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20
Q

delayed separation of umbilical cord is buzzword for what

A

Leukocyte adhesion deficiency :)

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21
Q

when someone asks about why they’re overweight

A

you can attribute it both to genes and environment

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22
Q

confused, diarrhea, not taking care of himself, stomatitis, and diffuse rash on sun exposed areas… what does he have

A

Pellagra

probably from Niacin deficiency

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23
Q

what does a highly sensitive test or specific

A

sensitivity: rules out the HEALTHY ONES, if this is high and you get a negative test result, then it’s safe to say they don’t have it.

specificity: rules in the disease
so if this isn’t super high, you still need to do additional testing to confirm dx. just because a test is positive, doesn’t mean they definitely have this

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24
Q

what causes beta thalassemia

A

point mutations in splice sites of introns, causing a retained intron

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25
how could you identify HIV-2
less common, less pathogenic, really only in Africa p24 (capsid) will be positive in HIV-1 and HIV-2 NAT for viral RNA is more specific, so the primers will bind to HIV-1 not HIV-2, so it can differentiate
26
what are the 2 possible cancers after complete molar pregnancies
gestational trophoblastic neoplasia GTN: vaginal bleeding, enlarged uterus, super high beta-hCG material within endometrial cavity w/ no intrauterine pregnancy CT shows necrotic intrauterine mass and metastatic nodules Choriocarcinoma: can develop in mother or baby malignancy of trophoblastic tissue NO CHORIONIC VILLI PRESENT it looks like these might be the same...
27
describe Basal cell carcinoma
locally invasive, but rarely metastasizes Pink, pearly nodules, commonly w/ telangiectasis, rolled borders, central crusting, or ulceration non healing ulcers with infiltrating growth scaling plaque! "palisading" nuclei on histo
28
describe squamous cell carcinoma
locally invasive, may spread to lymph nodes, but rarely metastasizes ulcerative red lesions with frequent scale associated with chronic draining sinuses keratin pearls on histology keratoacanthoma is a variant that grows rapidly then may regress
29
what is actinic keratosis
scaly plaque precursor to squamous cell carcinoma usually from people exposed to UVB
30
what 2 organs release glucose into the blood
liver and KIDNEY
31
what do type 2 pneumocytes look like
little bear claws type 1 pneumocytes are really thin stretches of cells a capillary lumen will have RBCs in it
32
where whats the buzzwords for suprasellar mass
craniopharyngioma Rathke pouch remnants diverticulum of the roof of the embryonic oral cavity ectoderm ORAL ECTODERM
33
which factor recruits PMNs to inflammatory sites by epithelial cells
IL-8
34
what will give you infertility and PID
gonorrhea
35
pt has progressive thirst, drinking lots of water, and urinary frequency over last 3 days. Specific gravity <1.006 most likely dysfunction
posterior pituitary- ADH dilute urine is ADH because it purely affects water/volume Aldosterone retains Na/water, and dumps K/H+
36
if they give you a painful blue thrombus in anus, what is it
inferior rectal vein below pectinate = painful blue = vein
37
6 week old infant w/ vomiting small amount of milk 2-3x/day. normal growth. what's wrong
immature LE sphincter
38
what is buzzword for pyloric stenosis
olive mass palpable | non bilious projective vomiting 2-6 weeks old
39
what should you think with polyhydramnios
esophageal atresia- the baby can't swallow pure TEF = H type (esophagus and trachea are connected) EA with distal TEF = most common (blind ending esophagus; gasless abdomen)
40
widened aortic arch is buzzword for what
dissecting aneurysm diminished pulses somewhere in L upper extremity
41
what's your next step if you suspect a defect in fatty acid oxidation
measure serum acylcarnitine concentration carnitine is what breaks down fatty acids eventually to acetyl CoA to either go to ketone bodies or TCA cycle "carnage" of fatty acids
42
what is 1st degree heart block
prolonged PR interval | benign, asymptomatic
43
what is 2nd degree heart block
Mobitz type 1 and 2 1: progressive PR lengthening that eventually drops a P wave variable RR interval 2: randomly dropped P waves often treated with pacemaker
44
what is 3rd degree heart block
atria and ventricles functioning independently of each other atria rate > ventricular rate treat with transvenous pacemaker can be caused by Lyme disease
45
how does toluene toxicity present
glue sniffing in a teenager ``` daily headaches, bilateral temple aches confused, forgetful ataxia, frequent falls broad-based ataxic gait slow to answer questions ```
46
which nerve may cause constipation
a parasympathetic nerve injury, like pelvic splanchnic
47
what might affect an azole/drug's efficacy if it's not a CYP 450 question
look for something that changes acid/base, like a PPI omeprazole
48
which hormone will stimulate Hormone-sensitive lipase in adipocytes to accumulate insulin
epinephrine, | I think because it's GH's back-up to clearing insulin from the blood
49
when a pt sees your face and knows you have bad news, what do you do
say "yes it is bad news" my guess is address it right then, and don't try to change the subject or sugar coat it? don't ask how they're feeling, don't say you want to talk positive's first
50
mechanism of renal failure in a pt with bilateral hydronephrosis and dilated ureter
increased hydrostatic pressure in Bowman's space
51
what will congenital ureteral obstruction cause
hydronephrosis proximal to the block | recurrent bacterial infections and minimal function on that side
52
what organism is non-hemolytic, catalase-neg, gram-pos cocci in pairs and chain
Enterococcus faecalis
53
how does osteomyelitis commonly present
sickle cell pt with fever, pain in bones, stable Hct, elevated WBC, predominance of neutrophils
54
what's the first sign of female puberty
breast bud development
55
what exposure risks are associated with asbestos
shipbuilding, roofing, plumbing
56
what does asbestos look like on histo
"ferruginous" bodies golden brown fusiform rods resembling dumbbells found in septum sputum sample visualize w/ Prussian blue stain
57
which structure in lungs initiate fibrosis
alveolar macrophages
58
which type of renal stone causes stag horn calculi
struvite AKA Ammonium magnesium phosphate
59
how does endometrial hyperplasia present
abnormal endometrial proliferation, usually 2/2 excess estrogen without progesterone to oppose it presents as more bleeding than normal- postmenopausal bleeding; or premenopausal F bleeding between cycles or irregularly curettage shows "abundant tissue"
60
what cells are most likely to have deficient function in TB lung lesions
macrophages
61
when does cellular degradation with p53 via E6 in HPV start
degradation begins when p53 protein is target to ubiquitin ligase enzyme
62
joint pain not responsive to aspirin | bilateral swelling of PIPs and MCPs, and wrists with small nodules
Rheumatoid arthritis
63
``` pain in weight-bearing joints asymmetric involvement no systemic symptoms no inflammation involves DIP and PIP, but NOT MCP ```
osteoarthritis
64
what is alondronate's MOA
inhibition of osteoclast-mediated bone resorption
65
what causes an NG tube to be in left hemithorax, with mediastinum displacement to the right, absence of bowel gas in abdomen?
incomplete formation of pleuroperitoneal membrane | diaphragmatic hernia
66
lichen sclerosis- describe
vulvar itching atrophy of labia minora THIN, PARCHMENT-LIKE SKIN over vulva and anus
67
where is the SA node
junction of SVC and RA it's in the name "SA" node "superior" and "atrium"
68
what drug is used for DVT treatment
Heparin
69
what is Heparin's MOA
activates Antithrombin 3, which decreases Factor 2a (thrombin) decreases Factor 10a
70
what vessel should you ligate postpartum to control heavy bleeding
internal iliac branch
71
what substance is released with muscle tenderness
myoglobin
72
what determines where leprosy infects people
temperature sensitivity- it likes cool temperatures, | so it infects skin and superficial nerves in stocking/glove distribution
73
what causes hypercalcemia in sarcoidosis
1,25-dihydroxycholecalciferol
74
what is amyloidosis
abnormal aggregated proteins of BETA PLEATED SHEETS CONGO RED STAIN
75
what causes edema
increased capillary hydrostatic pressure
76
what does prednisone suppress
T lymphocytes
77
prolonged PTT, hemarthrosis, and positive FHx?
Hemophilia
78
what does Vit E deficiency look like
malabsorption story hemolytic anemia muscle weakness neurologic symptoms that mimic B12, but NO megaloblastic anemia or high methylmalonic acid
79
what blood cells do you see in HELLP syndrome
schistocytes
80
what is gout a risk factor
kidney stones
81
what helps infection resolutions happen
maintenance of basement membrane integrity
82
what will happen if a hypothyroid pt takes a lot of triiodothyronine
low TSH (neg feedback) low free T4 (neg feedback) high free T3 (your drug)
83
what will alcoholic liver biopsy show
Mallory Hyaline
84
what will your HCO3 be in a COPD pt
high blood HCO3 (CO₂ retention, therefore H+ retention, making you acidotic, so your body holds on to more HCO3 to help neutralize the acid)
85
what do NSAIDS cause in renal artery stenosis
in bilateral renal artery stenosis, using NSAIDs will increase the Creatine drastically because the NSAIDs will inhibit the vasodilating prostaglandins at the afferent arteriole.
86
how will early septic shock present in elderly
``` bedriden, confused tachy, hypotensive! BP doesn't change after 1L fluid afebrile (elderly!!) high CO low PCWP low SVR ```
87
what could cause high beta-HCG in male
testicular carcinoma beta-hCG is binding to testicle and producing estradiol, which could cause gynecomastia in a male beta-hCG is similar to LH, FSH, and TSH
88
what CN are you testing with the uvula
Vagus
89
what's methylphenidate's MOA
increased Dopamine and NE release/retention in synaptic cleft used in ADHD
90
what is cyclosporine's MOA
suppress the early response of T lymphocytes to activation (decreasing likelihood of rejection in transplant)
91
what's first line ED pharm MOA
inhibit phosphodiesterase
92
which skin disease is associated with desmosomes
pemphigus vulgaris- superficial, flaccid blisters in the epidermis
93
what causes menopause symptoms
failure of ovaries to secrete 17-beta-estradiol
94
which drug inhibits transport of cholesterol through the intestinal wall
Ezetimibe
95
what gives you string of beads sign on artery
fibromuscular dysplasia
96
what causes fibroblast migration/proliferation, increased collagen and fibronectin, and decreased metalloproteinases?
TGF-beta | transforming growth factor-beta
97
what does leak of H+ inward across inner mitochondrial membrane cause
causes increased ratio of oxygen consumption to ATP generation (brown adipose tissue?)
98
what converts Dopamine to NE?
Dopamine-beta-hydroxylase
99
what does T10 innervate
area around the belly "but-ten" think appendicitis
100
whats common cause of LVH
this is concentric hypertrophy caused by Aortic stenosis
101
what is a lab value you see with DIC
low fibrinogen
102
what is cyclophosphamide's MOA
targets DNA replication via alkylating and forming cross-links
103
what can you use for a thyroid tumor marker
calcitonin
104
which nuclei is damaged with sudden uncontrollable irregular movements of L side of body
Right sub thalamic nucleus
105
what causes the release of Troponin I and CK-MB in an MI
membrane lipid peroxidation
106
young girl with round, shiny bumps on areas with eczema. similar bumps on friend at pool party. smooth, umbilicate papule 2-4mm in clusters. what virus is this?
poxvirus- molluscum contagiosum
107
where is MLF on brain slice
two backside medial bilateral nubs in the pons correspond with MS- the affected will be on the IPSILATERAL side of the brain lesion
108
what is the pathology of familial hypercholesterolemia
absence of functional LDL receptors on hepatocytes
109
what is the pathology of familial hypercholesterolemia
absence of functional LDL receptors on hepatocytes
110
what is a hypervascular mass on pole of kidney with flank pain, gross hematuria, and
renal cell adenocarcinoma
111
what are IBD treatments
antibodies directed at TNF-alpha
112
what are IBD treatments
antibodies directed at TNF-alpha
113
what lab value is likely to be abnormal in a pt with recurrent systemic neisseria meningitidis infections
total hemolytic complement concentration
114
what causes a friction rub 3 days after MI
fibrinous pericarditis

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