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NBMEs Flashcards

1
Q

Diag?

A

Alzheimers

  • widespread cortical atrophy, especially hippocampus —shows as a lot of black space on MRI
  • narrowing of gyri and widening of sulci
  • MRI here is normal
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2
Q
  • 67 yo f
  • Acute onset dyspnea and chest pain, dies within mins
  • stage IV ovarian cancer
  • bed ridden for 2 mo

COD?

A

DVT –> PE

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3
Q

Diag?

A

Parkinsons

  • pic: diminished substantia niagra in midbrain (there is loss of pigmentation)
    • ​Only on the R (the L one is normal)
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4
Q

How to calculate relative risk?

A
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5
Q

Drugs that cause tinnitus

A
  • Aspirin
  • quinidine (IA antiarrhythmic)
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6
Q

What can Arginine be made into?

A
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7
Q
  • 48 yo m
  • long hx alcohol abuse
  • painless hematemesis
  • incr HR, decr BP
  • dies
  • hemorrhage found in lower esoph

Diag?

A

Esophagela varices

  • get from transmission of portal HTN to esophageal Vs
  • alcohol is risk factor for cirrhosis and portal HTN
  • This is usually in lower esoph
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8
Q

Heart sound with pt is left lateral decubitus position

  • sound is in late diastole
  • best heard at apex

Which sound is this?

A

S4

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9
Q
  • 27 yo m
  • solitary thyroid nodule
  • nodules takes up radioactive iondine

diag?

A

Follicular thyroid adenoma (this is toxic type, not nodule) -s\consists of single palpable nodule, benign

-Histology is follicular

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10
Q

Which enzymes destroy H2O2

A

Catalase (in phagolysosome) and glutathione peroxidase (in neutrophil)

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11
Q

Differentiate bw parkinsons w/ dimentia vs lewy body dementia

A
  • both have lewy bodies
  • Lewy body dimentia if cognitive and motor sx onset is < 1 yr apart, otherwise it’s parkinsons w/ dimentia
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12
Q

Pt previously had colon cancer

-how did pt get this?

A

Hematogenous spread of colon cancer through the venous protal system

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13
Q

case fatality rate formula

A

CFR % = (NUMBER of deaths/ NUMBER of cases) x 100

= % of deaths that occur over the disease course

-if 10 ppt get meningitis, and 4 ppl die, CFR = 40%

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14
Q

Pt has PID with a tender RLQ mass found on palpation

-What is the mass?

A

The mass is hydrosalpinx– where fallopian tube gets blocked and fills with fluid. You can see this in PID

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15
Q
  • 62 yo m
  • 6 mo hx strange behavior
  • stopped bathing and combing hair
  • uncharacteristically rude
  • mild memory problems

Diag?

A

Frontotemporal dementia (Pick’s disease)

  • Frontal lobe changes: personality & behavior
  • Temporal lobe changes: aphasia
  • Hyper phosphorylated tau (pick) bodies : like like tangles in alzheimers but these are SPHERICAL/circular
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16
Q

What procedure improves the immunogenicity of vaccines that use capsular polysaccharides as antigens?

A

Protein conjugation

-ex) S. pneumoniae vaccine: polysacchs converted/conjugated to diphtheria-like toxins)

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17
Q

What is this?

A
  • neurofibrillary tangles
    • = intracellular hyperphosphorylate tau protein = insoluble skeletal elements
    • # tangles correlates w/ degree of dementia
    • See in Alzheimerz, and other neurodegenerated diseases
  • Brain bx: amyloid plaques
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18
Q

-pt has AIDs

Which organism caused this?

A

Toxoplasma gondii

  • in non immunocompromised- see mono-like sx w/ (-) heterophila Ab test
  • in IC- see mult ring enlancing lesions on MRI (really brain abscesses)
  • also see mult ring enhancing lesions with primary CNS lymphona (distinguish the 2 by CSF analysis)
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19
Q

Which enzyme responsible for making both ADP and GDP

A

PRPP

  • for ADP: PRPP + ARPT
  • For GDP: PRPP + HGPRT
  • this is in purine salvage pathway
  • defect can lead to hyperuricemia –> gout
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20
Q

What is function of superoxide dismutase

A
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21
Q

Which artery?

A

I think AICA (anterior inferior cerebellar A)

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22
Q

How long does it take post vasectomy to have infertility

A

10 wks

-before that still see viable sperm in the ejaculate

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23
Q

Diag?

A

Huntingtons

  • Loss of neurons (atrophy) of caudate nu –> leads to ventriculomegaly
  • image here is normal for comparassion
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24
Q
  • Pt w/ familial hypercholesterolemia
  • Which drug reduces plasma VLDL and LDL, but causes cutaneous vasodil with that subsides with repeated doses
A

Niacin (B3)

  • Inhs lipolysis (hormone sensitive lipase)
  • Inhs CHolesterol —> VLDL in liver
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25
Q

What H arrow pointing to?

A

Adrenal gland

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26
Q

GERD is d/t?

A

inappropriate relax of LES

  • RF: fat rich diet, alcohol, smoke, obesity, hiatal hernia
  • Sx: heartburn (mimic cardiac chest pain), asthma
  • Compl: barret esoph
27
Q
  • 60 yo m w/ cirrhosis
  • had mult bl transfusions d/t trauma years ago
  • no hx jaundice or hepatitis

Which type of hepatitis does he have?

A
  • *Hep C**
  • Transmitted by blood
  • hx blood transfusion
  • can progress to cirrhosis or carcinoma
28
Q

Which purine/pyr pathway enzyme responsible for making thymidine

A

DHFR

  • dUMP –> dTMP
    • Req: thymidylate synthase, and THF
      • DHF –> THF . requires DHFR
29
Q
  • doesn’t want to go out with friends
  • prefers indiv activities like hiking
  • doesn’t show emotion or understand feelings

Which personality disorder?

A

Schizoid

  • voluntar social withdrawal
  • limited emotional expression
  • content w/ social isolation (vs avoidant)

Part of cluster A personality disorders (“Weird”)-odd/eccentric, can’t develop meaningful social relationships, no psychosis, genetic assoc w/ schizophrenia

30
Q
  • 45 yo m c/o 6 mo hx burning epigastric pain that ascends to chest
  • worse after large meals and at night
  • PE: inflamm distal 3cm esoph

Diag?

A

GERD

  • heartburn (mimicks cardiac chest pain)
  • fat rich diet is RF
  • d/t reduced LES done
31
Q

Fludrocortisone MOA

A

Fludrocortisone = aldosterone analog

  • aldosterone causes incr Na reab and therefor H20 (acts on alpha intercalated, and principal cells in collecting duct)
  • incr aldosterone –> decr renin bc with incr aldosterone have incr bl vol and bp…JG cells stim to produce renin only when low bl vol or low bp
32
Q
  • 18 yo f, sexually active
  • Fever, purulent vaginal discharge, lower abdominal pain
  • Tender mass palpated in RLQ

Diag?

A

PID

  • adnexal tenderness
  • purulence cervical discharge
  • can see hydrosalpinx = fallopian tube gets blocked and filled with fluid –> RLQ mass
  • Can also see salpingitis (inflamm fallopian tube)
33
Q
  • 55 yo m
  • sudden severe chest pain radiating to the back
  • pulses different in both upper extremities
  • crackles in both lungs
  • blowing early diastolic murmur in L sternal border

Diag?

A

Aortic dissection

  • so saw aortig regurg: erbs point diastolic murmur, blowing
  • can progress to LHF
34
Q

Difference bw schizoid and avoidant

A
  • Schizoid is content with social isolation
  • Avoidant desires relationships with others, hypersensitive to rejection, feelings of inadequacy
35
Q
  • pt having procedure to separate uterus from all surrounding pelvic structures
  • which structure that attaches to the cervical region and extends posteriorly would you want to cut in this pt?
A

Uterosacral lig

36
Q

Round lig of the uterus attaches to what?

A
37
Q
  • 27 yo f
  • 2 yr hx sporadic diplopia & 1 yr hx intermittent numbness/thingling
  • during past yr had 4 episodes of urinary incontinence
  • PE: mild dysarthria
  • MRI: few, small, scattered, non-specific white matter plaques

Diag?

A

Multiple sclerosis

  • demyelination oligodendrocytes
  • Sx intermittent, they come and go
  • Diplopia, ataxia, scanning speech = dysarthria (mimicks alcohol intox), intention tremor, internuclear ophthalmoplegia, sensory sx, neurogenic bladder.
  • More common in ppl living far from equator
  • Oligoclonal bands diag
  • MRI shows white matter plaques
38
Q
  • 54 yo f c/o severe back pain
  • Labs: incr Ca2+
  • Urinalysis: Bence-jones proteins

Diag?

A

Multiple Myeloma

39
Q
  • pt vag bleeding immed after vaginal delivery of newborn at term
  • Uterus exam: fragments of placenta adherent to uterine wall
  • Absence of decidua basalis

diag?

A

Placenta accreta (type of morbidly adherent placenta)

  • In accreta see placenta attaches to myometrium w/o penetration it, most common type
  • In general, in morbidly adherent placenta= defective decidual layer –> abnormal attachment and separation after delivery. See post-partum bleeding
40
Q

What is the difference bw abruptio placentae and morbidly adherent placenta (placenta accreta, increta, percreta)

A

abruptio = premature placental separation from uterine wall before delivery

accreta/increta/percreta =separation after delivery

41
Q
  • histo: RBCs with spiny projections
  • low cholesterol
  • hx B/L retinitis pigmentosa, ataxia

Diag?

A

Abetalipoproteinemia

-spiky projections = acanthocytes (“Spur cells”)– d/t to lipoprotein buildup on cell wall –> spikes

42
Q
  • 22 yo f
  • pulm embolism 1 yr ago
  • delivered stillborn 2 yrs ago
  • Labs: increased PTT

Diag?

A

Antiphospholipid syndrome

  • incr PTT
  • pts have hx clotting, DVT –> pulm embolsim
43
Q

X-linked (Brutons) agammaglobinemia

A
44
Q

Where does genital herpes remain latent

A

sacral root ganglion

genital herpes = HSV-2

45
Q
  • 22 yo f
  • unable to conveive
  • irregular menses
  • hirtsutism, acne, obese
  • no abnormalities of external genitalia

diag?

A

Polycystic ovarian disease (PCOD)

  • d/t generation of follicles
  • incr LH:FSH > 2
  • Incr LH –> incr androgen production –> hirtsutism, amenorrhea
  • Androgen can be converted to estrone in periph adipose
  • classic presentation: obese, young f, infertile, amenorrhea, hirsutism, insulin resistance so may have type II DM
  • no ovulation bc there is const incr LH (women need LH SURGE to ovulate)
46
Q

-fungins MIA

A

inh fungal cell wall synth

47
Q

Cardiac tamponade

A
  • = compression of the heart by fluids ( ex bl, effusions in pericardiac space) –> decr CO
  • Findings
    • Becks triad:
        1. Hypotension
        1. distended neck veins
        1. distance heart sounds
    • Pulsus parodoxus (decr ampl of systolic bp by >10 mm during inspiration)
    • ECG: low-voltage QRS & electrical alternans
  • Can be caused by:
    • Ventricular free wall rupture (compl MI 5-14 days)
  • Complications:
    • Obstructive shock
48
Q

What causes pulses paradoxus

A

= decr ampl of systolic bp by < 10 mmHG

  • Seen in
    • cardiac tamponade
    • asthma
    • obstructive sleep apnea
    • pericarditis
    • croup
49
Q

31 yo f

  • 1 yr hx infertility
  • IMG below

The cause of these findings is malformation of which embryonic tissue?

A

Paramesonephric (Mullerian) duct

50
Q
  • 51 yo
  • hemoptysis, weight loss, lung CA, smoker, wheezing, HTN, clubbing
  • Labs: urine Osm > serum Osm, low Na+

diag?

A

SCLC –> SIADH (paraneoplastic)

SIADH –> excessive free water retention (urine osm > serum osm), low sodium

51
Q

ADH vs aldosterone

A
52
Q

SIADH vs DI

A
53
Q

2 ways to get increased ADH

A
54
Q

What do you give for warfarin overdose?

A

Fresh frozen plasma

  • this increases all the clotting factors. Use for immed anticoag reversal
  • Warfarin inh epoxide reductase –> so can’t activate 2,7,9,10,C,S
55
Q

-acute fever, N/V, muscle aches

Shows gram stain

Which organism?

A

Listeria monocytogenes

-gram +, intracellular rod

56
Q
  • headache, slurred speech
  • difficulty understanding and answering questions
  • L sided numbness and paralysis in face and upper extremity

Which artery is involved?

A

Middle cerebral A

-supplies lat cortex

57
Q

Where do you inject needle for thoracocentesis

A

Above the 9th rib, midscapular line

58
Q

E.coli virulence factor in UTI

A

fimbriae – allows adhesion

59
Q

What is equation of loading dose

-given Vd, know it’s IV bolus, peak plasma conc given

A

Loading dose = (Cp x Vd) / F

60
Q
  • Was at incr altitude for 4 wks
  • 2 wks after returning to sea level, ventilation returned to normal, but O2 deliver to muscles is greater.

An incr in what describes the O2 delivery finding?

A

Hematocrit

61
Q
  • 25 yo m
  • get temp of 101.5 after running first 10k

his temp returned to normal later bc of which mechanism?

A

evaporation of sweat

62
Q

Alcoholic vomits and has lung cavitations.

Which organisms do you see on culture?

A

this is aspiration pneumonia

-organisms are klebsiella or it’s normal oral flora

63
Q

If a pt has volume contraction , does it mean they have increased or decreased volume of body fluid?

A

Decreased body fluid (hypovolemia)

-get from loop diuretics

Rx (5 decks)

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