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Boards First Aid and Kaplan > Practice Test 4 > Flashcards

Practice Test 4 Flashcards

1
Q

What are the 9 possible criteria for major depressive disorder?

A

Need 5/9 for at least 2 weeks and at least one must be anhedonia or depressed mood

  • Depressed mood most of the day
  • Anhedonia
  • Significant weight loss/gain, diminished appetite
  • Insomnia/hypersomnia
  • Psychomotor agitation/retardation almost everyday
  • Fatigue or loss of energy
  • Feelings of worthlessness, guilt
  • Diminished ability to think or concentrate
  • Recurrent thoughts of death/suicide w/ or w/o a plan
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2
Q

What drug class is typically the first line tx of major depressive disorder?

A

SSRIs-lowest side effect profile

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3
Q

What is the raphe nucleus responsible for?

A
  • Plays a role in the sleep-wake cycle and patient’s level of arousal
  • Primary NT in this area is serotonin
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4
Q

What is venlafaxine?

A

An SNRI - works to increase the levels of serotonin in the raphe nucleus
-Serotonin can be decreased in depression and anxiety

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5
Q

What is the basal nucleus of Meynert?

A

Contains neurons that mostly contain receptors for Ach

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6
Q

What is the locus ceruleus?

A
  • Principal site for the production of norepi

- Closely associated with the SANS

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7
Q

What is the nucleus accumbens?

A
  • Plays a large role in the risk reward system

- Primary NTs in this area are dopamine and GABA

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8
Q

What is the ventral tegmentum?

A
  • Plays a role in cognition, motivation, orgasm, and drug addiction
  • Primary NT is dopamine
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9
Q

What are the signs and symptoms of DiGeorge syndrome and the mnemonic to remember these?
-Digeorge syndrome is AKA?

A 
CATCH-22
-*C*ardiac defects
-*A*bnormal facies
-*T*hymic hypoplasia
-*C*left palate
-*H*ypocalcemia
-deletion on the chromosome 22 (22q11)
Digeorge syndrome is AKA congenital thymic aplasia
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10
Q

Aberrant development of what pouch causes the thymic hypoplasia in Digeorge syndrome?

A

3rd pharyngeal pouch

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11
Q

Aberrant development of which pharyngeal pouch(es) causes the hypoCa?

A

3rd pharyngeal pouch-develops into inferior parathyroids

4th pharyngeal pouch-develops into superior parathyroids

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12
Q

The 1st pharyngeal cleft develops into what structure?

A

External auditory meatus

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13
Q

The 2nd, 3rd, and 4th pharyngeal clefts develop into?

A

Temporary cervical sinuses-normally obliterate but if they persist they can cause cervical cysts

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14
Q

What does the 1st pharyngeal pouch develop into?

A

Middle ear canal

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15
Q

What does the 2nd pharyngeal pouch develop into?

A

Tonsillar fossa crypts

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16
Q

Describe the histology associated with small cell lung cancer

A

Small cell lung cancer AKA oat cell carcinoma

  • Arises from neuroendocrine Kulchitsky cells that line the bronchioles
  • These cells have small, dark blue appearance and are capable of local hormone secretion
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17
Q

Small cell lung cancer can be associated with what paraneoplastic diseases?

A
  • SIADH
  • Lambert-Eaton syndrome
  • Cushing’s syndrome (d/t secretion of ACTH)
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18
Q

What are the symptoms of SIADH?

A

-Hyponatriemia-Sx begin at Na < 120-Nausea, vomiting, watery diarrhea, HTN, oliguria, increased ICP, and potentially seizure and coma

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19
Q

What is the protocol for correcting hypoNa?

A
  • HypoNa must be corrected slowly using hypertonic saline

- Overly rapid increase in serum Na may cause central pontine demyelination

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20
Q

What is Lambert-Eaton syndrome?

A

-AutoAbs to presynaptic Ca channels which prevents Ach release leading to proximal muscle weakness

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21
Q

What is Cushing’s syndrome?

A
  • Excess cortisol as a result of ectopic ACTH production

- Sx-HTN, weight gain, moon facies, truncal obesity, buffalo hump, hyperglycemia, and/or osteoporosis

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22
Q

What is Conn’s syndrome?

A
  • Hyperaldosteronism
  • Primary hyperaldo-aldo secreting tumor
  • Secondary hyperaldo-caused by kidney’s perception of low intravascular volume which causes increased renin
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23
Q

What is Kallmann syndrome?

A

A form of hypogonadotropic hypogonadism

  • Pathogenesis-Abnormal development of neurons associated with the olfactory bulb in the hypothalamus, which leads to decreased synthesis of GnRH
  • Lack of or delayed puberty, gonad development
  • ANOSMIA/hyposmia
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24
Q

What are the lab findings associated with Kallmann syndrome?

A

-Decreased FSH, LH, testosterone, and sperm count

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25
Q

5 alpha reductase deficiency is characterized by?

A
  • Inability to convert testosterone to DHT
  • DHT is required for the development of male external genitalia, before birth
  • These pts have ambiguous genitalia until puberty
  • Normal LH, FSH, and testosterone levels
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26
Q

What happens at puberty in pts with 5 alpha reductase deficiency?

A

When the patient hits puberty increased levels of 5 alpha reductase in peripheral tissue convert testosterone leading to masculinization

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27
Q

What is androgen insensitivity syndrome?

A

AKA testicular feminization

  • Caused by a defect in the androgen receptor
  • Results in genotypical males to have female phenotypes, except testes are present
  • Levels of testosterone, estrogen, and LH are elevated
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28
Q

What is klinefelter syndrome?

A

-Male with phenotypical female features-gynecomastia and female hair distribution

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29
Q

What would a patient with an XYY phenotype look like?

A

Tall male with severe acne and antisocial behavior

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30
Q

What are the symptoms of zinc deficiency?

A
  • Hypogonadism
  • Anosmia
  • Dysgeusia (taste)
  • Poor wound healing
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31
Q

What paraneoplastic syndrome can be associated with squamous cell carcinoma?

A

Pseudohyperparathyroidism-production of PTHrp (Serum PTH levels would be normal but would have hyperCa and hypophosphatemia)

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32
Q

What would squamous cell carcinoma look like on chest x ray?

A

Hilar mass near the bronchi

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33
Q

How is chronic kidney disease officially diagnosed clinically?

A

Decreased GFR for 6 months

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34
Q

What does a serum BUN:Cr ratio > 20 indicate?

A

Pre renal cause of renal dysfx such as hypotension and renal artery stenosis

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35
Q

What does a serum BUN:Cr ratio of 10-20 indicate?

A

Postrenal cause of renal dysfx (or normal)

-Ureteral obstruction or BPH

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36
Q

What does a serum BUN:Cr ratio of < 10 indicate?

A

Intrarenal cause of renal dysfx-glomerulonephritis or acute tubular necrosis

37
Q

What characteristics promote cast formation?

A
  • Low urine pH
  • Low urine flow rate
  • High urinary salt concentration
38
Q

Where in the renal tubule do casts usually form?

A

Distal convoluted tubule or collecting duct

39
Q

Casts in the urine are usually indicative of a disease of what origin?

A

Intrarenal origin

40
Q

Waxy and broad casts are indicative of?

A

Advanced renal failure

41
Q

Brown and muddy casts are indicative of?

A

Acute tubular necrosis (Casts may be absent in 20-30% of patients)

42
Q

What is the definition of acute kidney injury?

A
  • Abrupt (days-weeks) decline in renal function
  • Manifested by acute elevation in plasma BUN and serum creatinine
  • Usually reversible
43
Q

What is acute tubular necrosis?

A
  • When an acute ischemic or toxic event results in tubular cell damage/death
  • MCC of acute kidney injury in the intrarenal category
  • Follows a well-defined 3 part sequence-initiation, maintenance, and recovery
  • Normal sized kidneys on US
44
Q

What are hyaline casts indicative of?

A
  • Can show up in the urine of healthy people
  • Can also occur in patients with dehydration, low urine flow, acidic patients, or vigorous exercise
  • Very non-specific
45
Q

Red blood cell casts can be indicative of?

A
  • Glomerulonephritis, particularly nephritic syndrome

- SLE, Goodpasture syndrome, post-strep GN

46
Q

What is nephritic syndrome?

A

Characterized by:

  • Urine protein loss of less than 3.5 g/day, rbc casts, hypoproteinemia, edema and hyperlipidemia
  • Typically associated with systemic illnesses
47
Q

What is the classic presentation of Goodpasture syndrome?

A

Pulmonary hemorrhage and glomerulonephritis

48
Q

How would a nephritis causing diseases (Goodpasture’s or SLE) be diagnosed?

A

Kidney biopsy and histologic examination of the glomerulus

49
Q

What are white blood cell casts indicative of?

A

Acute pyelonephritis or acute tubulointerstitial nephritis

-Direct inflammation and infection of the kidney

50
Q

What is the presentation of pyelonephritis?

A

-Dysuria, flank pain, fever, nausea and vomiting

51
Q

What is tubulointerstitial nephritis?

A

-Tubulointerstitial=broad term used to refer to kidney diseases that involve structures in the kidney outside of the glomerulus

52
Q

What is acute interstitial nephritis?

A
  • Tubular damage caused by drugs or infx -> renal tubular dysfx with or without renal failure
  • Damage is generally reversible
53
Q

What is the principal mechanism that causes acute tubulointerstitial nephritis?

A
  • Hypersensitivity reaction to drugs such as penicillins, NSAIDs, and sulfa drugs
  • Can also be caused by infx-viral or bacterial-often associated with obstruction or reflux
54
Q

What is the anterior interosseous nerve?

A
  • Branch of the median n
  • Found in the interosseous membrane with the interosseous a.
  • Provides only motor innervation to the deep muscles of the hand (FPL, lateral half of FDP, and pronator quadratus)
55
Q

What type of fracture can lead to compression or inflammation of the anterior interosseous n?

A

-Significant distal forearm injury (such as a Galeazzi fracture)

56
Q

What would be the deficits of a patient with a lesion of the median nerve?

A

Motor and sensory deficits
-Sensory changes over the lateral 3.5 digits on the palmar side and distal 1/3 of the dorsum of the thumb, 2nd and 3rd digit

57
Q

What is the musculocutaneous nerve?

A

Part of the brachial plexus-innervates part of the upper extremity

  • Arises from the lateral cord from levels of C5, C6, and C7
  • Innervates the biceps, coracobrachialis, and upper aspect of the brachialis
  • Also provides sensation to the lateral aspect of the forearm
58
Q

What nerves are most often involved in Erb’s palsy?

A

AKA waiter’s tip

Upper trunk C5-C6-suprascapular, musculocutaneous, and axillary

59
Q

Isolated injury of the musculocutaneous nerve presents as?

A

Weakness of elbow flexion and forearm supination

60
Q

What is the radial nerve?

A

-Provides sensation to the posterior aspect of the forearm and dorsal aspect of the lateral hand and medial 2/3 of the thumb

61
Q

Radial nerve injury presents as?

A

Saturday night palsy/using crutches incorrectly

  • Loss of finger extension and wrist (wrist drop)
  • Motor weakness with elbow extension (triceps innervation) and extensor muscles of the forearm
  • Sensory changes across the posterior forearm and lateral 3.5 digits
62
Q

What is the ulnar nerve?

A
  • Provides sensation to part of the 4th digit and whole 5th digit
  • Provides motor innervation for the flexion, abduction, and opposition of the 5th digit
63
Q

Ulnar nerve injury presents as?

A

Inability to adduct and abduct their fingers -> claw hand deformity

64
Q

What are the symptoms of a tension headache?

A
  • Ascending headache with hypertonicity of the head and neck
  • Diffuse pain
  • Absence of neurologic sx or photosensitivity
  • Bilateral
65
Q

What is the acute treatment for a tension headache?

A

Acetaminophen and NSAIDs

66
Q

What is the prophylactic headache for tension headache?

A
  • Patient education regarding posture and lifestyle medications
  • TCAs (amitriptyline)
  • Behavioral modification including biofeedback, relaxation, and CBT for stress management
67
Q

What is a cluster headache?

A
  • Unilateral and periorbital with rapid onset
  • Commonly assoc with nasal stuffiness and watery eyes
  • Often have a “cluster” of headaches w/in a short time frame
  • More common in males
68
Q

What are migraine headaches?

A

-May be accompanied by the sensation of an aura, photosensitivity, nausea, vomiting, unilateral pain, and possibly temporary neuro symptoms

69
Q

Migraines without aura (non-classic) are described as?

A
  • Lasting 4-72 hours
  • With at least 2 of the following: unilateral location, pulsating feeling, moderate/severe intensity, aggravation by physical activity
  • And at least 1 of the following: nausea, vomiting, photophobia, phonophobia
  • And at least 5 attacks
70
Q

What are cerebral aneurysms?

A
  • Occur in one of the narrow arteries of the circle of willis
  • When an aneurysm ruptures patients typically complain of an acute onset thunder clap headache “Worst headache of my life”
  • Assoc with subarachnoid hemorrhage
71
Q

What is pseudotumor cerebri?

A

AKA idiopathic intracranial HTN

  • increase in ICP in the absence of any distinct pathological entity or mass
  • Sx include headache, nausea, vomiting, diplopia
  • Fundoscopic exam shows papilledema
  • Most common in young obese women
72
Q

What is the protocol for oral contraceptive administration in postpartum patients?

A

OCPs can be detrimental to milk production during the first 3 weeks postpartum
-When lactation is better established past 6 weeks, combined OCPs are a reasonable option

73
Q

What is Ehlers-Danlos syndrome?

A
  • Autosomal dominant
  • CT disorder that involves a defect in the gene encoding for types 3 and 4 collagen (fibrillar type)
  • Hypermobile joints and hyperextensible skin and bruising
  • Aortic aneurysms
  • Dental crowding
  • Mitral valve prolapse
74
Q

What is osteogenesis imperfecta?

A
  • Autosomal dominant
  • Type 1 collagen defect (caused by glycine deficiency)
  • Blue-gray discoloration of the sclera
  • Frequent fractures (due to minor trauma)
75
Q

What is Stickler syndrome?

A
  • Autosomal dominant
  • Affects collagen synthesis
  • Characterized by craniofacial abnormalities (flat face), hearing loss, ocular problems (nearsighted, eye pain d/t inc IOP, and joint problems
76
Q

What is Marfan syndrome?

A
  • Autosomal dominant
  • Defect in the gene FBN1 (encodes fibrillin-1)
  • Most serious complications are heart valve defects and aortic involvement
  • May also affect the lungs, eyes (subluxation of the crystalline lens), and the dural sac surrounding the spinal cord (dural ectasia)
77
Q

What is pseudoxanthoma elasticum?

A
  • Autosomal recessive
  • Causes fragmentation and mineralization of the elastic fibers in certain tissues
  • Mainly involves the skin, Bruch’s membrane of the eye, and vascular tissues in the form of premature atherosclerosis
  • Small yellowish papules develop on the neck, axillae, and groin
78
Q

What is haemophilus influenzae?

A

Gram negative (red) coccobacillus

79
Q

What is the appearance of klebsiella pneumoniae on gram stain and who is commonly infected by this pathogen?

A
  • Causes community acquired pneumonia in chronic alcoholics

- Gram negative rod

80
Q

What is the appearance of moraxella catarrhalis on gram stain?

A

Gram negative diplococci

81
Q

What is the appearance of staph aureus on gram stain?

A

Gram positive cocci in clusters

82
Q

Staph aureus most often causes community acquired pneumonia in whom?

A

Patients with the flu (seasonal flu or H1N1 (swine) flu)

83
Q

What is the histologic diagnosis of squamous cell carcinoma based on?

A

The presence of keratin production by tumor cells and/or intercellular desmosomes (bridges)

84
Q

What is the histologic appearance of carcinoid tumors?

A
  • Cytologically bland cells that are round/oval shaped
  • Finely dispersed chromatin
  • Inconspicuous small nucleoli
85
Q

Bronchial carcinoid tumors are thought to arise from?

A

Specialized bronchial cell (Kulchitsky cell)

  • Belong to the diffuse system of neuroendocrine cells, including enterochromaffin cells of the GI tract (the origin of GI carcinoids)
  • These tumors have the ability to modify amine precursors like L-dopa of 5-hydroxytryptophan -> secrete biologically active neuroamines
86
Q

What is carcinoid syndrome?

A
  • Caused by systemic release of vasoactive substances such as serotonin
  • Acute sx-cutaneous flushing, diarrhea, and bronchospasm
  • Long term sequelae-venous telangiectasias, right sided valvular heart dz, and fibrosis in the retroperitoneum
87
Q

What is large cell carcinoma?

A
  • Malignant epithelial neoplasm lacking gladular or squamous differentiation by light microscopy and lacking cytologic features of small cell carcinoma
  • Sheets of round/polygonal cells with prominent nucleoli and abundant pale cytoplasm
  • Dx of exclusion
88
Q

What is histologic appearance of adenocarcinoma of the lung?

A
  • MC type of lung cancer

- Histologic diagnosis requires either neoplastic gland formation or intracytoplasmic mucin

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