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Boards First Aid and Kaplan > Practice Test 6 > Flashcards

Practice Test 6 Flashcards

1
Q

What disease is distinguished on light microscopy by “lumpy-bumpy” deposits in the renal basement membrane?

A

Post-infectious glomerulonephritis-deposits of IgG and C3b

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2
Q

What are the immune complex deposits in Berger disease and what do they cause?

A

IgA immune complex deposits -> activate alternative complement pathway

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3
Q

What is FSGS?

A

Glomerular hypertrophy without compensatory growth of podocytes leads to a loss of the filtration barrier and leakage of proteins

  • MCC of nephrotic syndrome in adults
  • Associated with drug use, HIV, HTN, hyperlipidemia, and hematuria
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4
Q

What are the classic symptoms of polycystic kidney disease?

A
  • Flank pain, symptoms exacerbated by cyst rupture, gross hematuria, HTN and chronic UTIs
  • Anemia and inc BUN/Cr
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5
Q

What is acute cholecystitis?

A
  • Inflammation of the gallbladder
  • Commonly caused by a gallstone in the cystic duct
  • Sx-fever, vomiting, palpable GB, and RUQ pain that radiates to the back
  • Labs-inc bili
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6
Q

What is granulomatosis with polyangitis?

A

Nephritic disorder

  • Triad of respiratory symptoms, kidney symptoms, and hematuria
  • C-ANCA and immune complex deposition in renal vessels
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7
Q

Describe the pain sensation associated with appendicitis

A
  • Rebound tenderness, as well as, RLQ pain with pressure on the LLQ
  • Psoas pain with hip extension
  • Pain 1/3 the distance from the ASIS to the umbilicus
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8
Q

What is renal cell carcinoma?

A

Cancer of the renal parenchyma

  • Sx-flank pain, fever, HTN, unexplained weight loss, hematuria, and an abdominal mass
  • Increase in RBC production due to EPO release from the kidney
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9
Q

What is the difference in presentation between the autosomal dominant form of PKD and the autosomal recessive form of PKD?

A

Age of presentation

  • ADPKD presents in adulthood
  • ARPKD presents childhood (usually fatal)
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10
Q

What are the characteristics of epidural hemorrhages?

A
  • Result from rupture of the middle meningeal artery

- Pts present with a lucid interval, severe headache, and pupil abnormalities

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11
Q

What is the change in preload/afterload due to Mueller maneuver?

A

Increases preload

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12
Q

What is the change in preload/afterload due to squatting?

A

Increases preload

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13
Q

What is the change in preload/afterload due to handgrip?

A

Increases afterload

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14
Q

What is the change in preload/afterload due to valsalva maneuver?

A

Decreases preload

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15
Q

What is the change in preload/afterload due to standing?

A

Decreases preload

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18
Q

Important to understand the difference between aortic stenosis and hypertrophic cardiomyopathy and what happens when there is increased blood in each

A

Aortic stenosis-A fixed lesion, when more blood is passing through the stenotic area, there will be a greater intensity in the murmur

Hypertrophic cardiomyopathy-A dynamic lesion, when more blood is passing through the valve pushes open the obstructed portion making a larger space for it to pass through, lowering the intensity of the murmur

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19
Q

What is the murmur associated with aortic regurgitation?

A

High pitched diastolic murmur heard best heard at the left sternal border
-Will increase in intensity with a maneuver that increases afterload (handgrip)

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20
Q

What is the murmur associated with aortic stenosis?

A

Systolic crescendo-decrescendo murmur that radiates into the carotids
-A fixed lesion, when more blood is passing through the stenotic area, there will be a greater intensity in the murmur

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21
Q

What is the murmur associated with mitral regurgitation?

A

Systolic murmur with a high pitched blowing quality heard best at the apex

  • The murmur can radiate to the left axilla
  • Decreases in intensity with standing
  • Increases in intensity with squatting
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22
Q

What is the murmur associated with mitral stenosis?

A
  • Low pitched diastolic rumble
  • Best heard at the apex with patient in the left lateral decubitus patient
  • Decreases in intensity with maneuvers that decrease preload
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23
Q

Intrauterine devices are associated with?

A
  • Reduced risk of pregnancy

- BUT if the patient does become pregnant, there is an increased risk that it will be ectopic

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24
Q

What is the most common cause of nephrotic syndrome in children?

A

Minimal change disease

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25
Q

What is the presentation of nephrotic syndrome?

A
  • Hypoalbuminemia
  • Proteinuria
  • Hyperlipidemia
  • Generalized edema
26
Q

What is the treatment for minimal change disease?

A

Corticosteroids

27
Q

What type of hypersensitivity reaction is post strep glomerulonephritis?

A

Type 3 hypersensitivity

28
Q

What is centrilobular congestion and necrosis of the liver indicative of?

A

Budd-Chiari syndrome-thrombosis of two or more hepatic veins

  • Associated with hypercoagulable states
  • Classic triad-RUQ pain, hepatomegaly, and ascites
29
Q

What is seen on abdominal US in patients with Budd-Chiari syndrome?

A

Collateral vessels in a spider web pattern and decreased hepatic venous blood flow

30
Q

What are the treatments for Budd-Chiari syndrome?

A

Initial medical treatment is thrombolysis followed by anticoagulation
-Treatments that are more definitive include the TIPS (transjugular intrahepatic portosystemic shunt) procedure or liver transplant

31
Q

Diffuse fibrosis of the liver and nodular regeneration is associated with?

A

Cirrhosis
-Signs and sx include hematemesis and melena (d/t esophageal varices and/or peptic ulcers), splenomegaly, caput medusae, ascites, and hemorrhoids

32
Q

What are caput medusae?

A

Tortuous paraumbilical collateral veins

33
Q

Granuloma formation within the portal triad is seen in what dz?

A

Primary biliary cirrhosis

  • An AI rxn associated with serum mitochondrial Abs
  • Results in damage to the mitochondrial proteins in the bile duct epithelium with lymphocytic infiltration and granuloma formation
34
Q

What are the presenting symptoms of primary biliary cirrhosis?

A

Pruritis, jaundice, dark urine, pale stools, and hepatomegaly

35
Q

What diseases can cause microvascular changes within the liver?

A
  • Acute fatty liver of pregnancy
  • Medications including tetracyclines and salicylates
  • Reye’s syndrome
  • Ethanol use
36
Q

What are the symptoms of acute fatty liver of pregnancy?

A
  • RUQ pain, nausea, vomiting, and jaundice
  • Microvascular changes within the liver
  • No ascites or signs of portal HTN
37
Q

If ascites and portal HTN are present they are indicative of?

A

Thrombosis of the portal system

38
Q

What is Reye’s syndrome?

A
  • Caused by aspirin use in young children

- Presents with hypoglycemia, encephalopathy, and microvesicular fatty liver

39
Q

What are swollen hepatocytes with neutrophilic inflammation indicative of?

A

Hepatitis (inflammation of the liver)

  • Acute hepatitis-MC causes are viruses (HAV, HBV, HCV, HDV, HEV) and drugs
  • Chronic hepatitis-chronic viral infx, alcohol, AI hepatitis, and metabolic syndromes (Wilson’s, hemochromatosis, and A1AT deficiency)
40
Q

What drugs are capable of causing acute hepatitis?

A

Acetaminophen, INH, and methyldopa

41
Q

What is the presentation of acute hepatitis?

A
  • Malaise, nausea vomiting, followed by jaundice and RUQ pain
  • Dramatic increase in liver enzymes
42
Q

What is complex regional pain syndrome?

A
  • Chronic progressive disease
  • Type 1 CRPS-No evidence of nerve damage, characterized by severe burning pain at the site of injury. Muscle spasm, joint spasm, restricted mobility, rapid hair/nail growth, vasospasm, edema, and skin changes can also occur
  • Type 2 CRPS-Same symptoms as type 1, the difference is the presence of a defined nerve injury
43
Q

Occlusion of the inferior division of the middle cerebral artery is associated with what defect?

A
  • Wernicke’s aphasia (difficulty understanding spoken language, speech is preserved but language content is not correct)
  • Can also include contralateral homonymous hemianopia and apraxia
44
Q

Occlusion of the superior division of the middle cerebral artery is associated with what defect?

A

Broca’s aphasia (Non-fluent speech, language comprehension is intact)

45
Q

Describe the protocol for the initial diagnosis and treatment of a stroke

A
  • Initial test-non-contrast CT imaging
  • If imaging shows a normal or hypodense area consistent with acute ischemic stroke, consider aspirin to decrease the incidence of a second event and IV thrombolytics
46
Q

What are charcot-bouchard aneurysms?

A

Microinfarction of the branches of the lenticulostriate vessels that develop into aneurysms

  • Have the propensity to rupture -> hematomas w/in brain tissue
  • Most common sites of hemorrhage are the basal ganglia, thalamus, pons, and cerebellar hemispheres
47
Q

Explain the effects of teratogens during the different stages of fetal development

A

Exposure to teratogens during:

  • Early embryogenesis (first 2 weeks after conception)-usually causes spontaneous abortion or no adverse effect (known as the all or none period)
  • Embryonic period-weeks 3-8-organogenesis begins, extremely sensitive to teratogens
  • After week 8-teratogens can cause minor morphological abnormalities
48
Q

When is the heart most susceptible to teratogens (i.e when does it undergo major development)?

A

During the 3rd/4th weeks of gestation

49
Q

When is the external genitalia most susceptible to teratogens (i.e when does it undergo major development)?

A

During the 8th/9th weeks of gestation

50
Q

What is gastrulation and when does it occur?

A

Development of the 3 layers (ectoderm, mesoderm, and endoderm) occurs in week 3
-The primitive streak, notochord, and neural plate also begin to form

51
Q

What does an elevated DHEA-S level indicate?

A

Androgen secreting tumor

52
Q

What is normal pressure hydrocephalus?

A

A condition where the ventricles are enlarged but normal opening pressures on lumbar puncture

53
Q

What is the triad of symptoms consistent with normal pressure hydrocephalus?

A

Gait disturbance, dementia, and urinary incontinence (“Wet, wacky, and wobbly”)

54
Q

What is the MCC of acute infective endocarditis in IV drug users?

A

Staph aureus followed by pseudomonas aeruginosa

55
Q

Which heart valve is most often involved in acute infective endocarditis in IV drug users?

A

Tricuspid valve

56
Q

What are viridans streptococci (specifically strep mutans) a common cause of?

A

Subacute endocarditis

57
Q

Patients with pre-existing heart conditions, such as valvular defects are at higher risk for infections caused by?

A

Viridans strep, staph epidermidis, and HACEK organisms

61
Q

Describe the murmur associated with hypertrophic cardiomyopathy

A
  • Systolic murmur typically in a crescendo-decresendo fashion
  • Best heard between the apex and left sternal border
  • Radiates to the suprasternal notch (not to carotid arteries or neck)
  • Murmur and gradient are inverse to preload and afterload (intraventricular septum is enlarged and gets in the way of blood flow)
62
Q

What is the treatment for hypertrophic cardiomyopathy?

A

Increase the preload/afterload (try to push the septum out of the way)
-Can do this with beta blocker or verapamil

Boards First Aid and Kaplan (19 decks)

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