Q Banks: Week of 03/20/17 #2 Flashcards
Nasal hemianopsia can result from vascular lesions to _____________________.
the lateral deviation of the optic nerve branches at the optic chiasm (such as from a berry aneurysm)
What cardiopulmonary findings are often seen in hydrops fetalis?
Lung hypoplasia from pleural effusions due to CHF
Another term for pharmacologic potentiation is ________________.
permissiveness
Synergistic drug effect refers to when ________________.
two drugs have a combined effect that is greater than the sum of their parts
Sketchy showed the owl-eye inclusions of HL and CMV with the same symbol. Why is this misleading?
The inclusions in HL are double circles and actually look like owl’s eyes, while the inclusions in CMV are single and do not.
In those with alkaptonuria, the ________________ pathway is disrupted.
tyrosine to fumarate
“Your urine will be as black as the FUMes of a burning TiRe.”
What two things should you look for in a histologic specimen of PSGN?
- Hypercellular glomerulus (this could be confused with a crescent, so be careful)
- Subepithelial deposits
If they give you a slew of urine and serum labs and ask you to calculate FF, what formula should you use?
FF = GFR/RBF
- GFR = [(urine creatinine) / (serum creatinine)] x urine production rate
- RBF = [(urine PAH) / (serum PAH)] x urine production rate
What does a high arteriovenous concentration gradient for an inhaled anesthetic indicate?
A large difference between the concentration of a gas in the arteries and the veins indicates that the gas was taken up by peripheral tissues. This means two things: (1) the gas has high peripheral tissue solubility; and (2) the gas will take a long time to induce anesthesia because you will need to administer a large continuous dose of it to saturate the blood before saturating the brain.
Manometry of achalasia and systemic sclerosis can be very similar. What is the key difference?
The LES pressure will be high in achalasia and low in systemic sclerosis.
What are type I errors and type II errors?
- Type I: saying that a difference exists when there isn’t one
- Type II: saying that a difference doesn’t exist when one does
(Think of it like this: In type I errors, you’re SINGLING out ONE of the groups as special. In type II errors, you’re saying that the two groups are exactly the same –like the two lines II –when one is actually different!)
What is the power of a study?
1 - beta
Beta is the probability of a type II error (a type Beta error).
Cavernous hemangiomas raise risk of intracerebral bleed in the ______________ cavity.
supratentorial
At what age should most babies have more adult hemoglobin than fetal hemoglobin?
Roughly 6 weeks
What did Sketchy not mention about HBV?
It can still cause HCC even after antibodies to HBsAg are developed because pieces of the HBV genome can be incorporated into the host genome, resulting in the production of HBx which inhibits p53.
Those with factor V Leiden mutations will have what abnormal test?
The PTT fails to prolong when factor C is added to solution.
What progression is typical of strawberry hemangiomas?
First increase then decrease in size
What pathology most commonly causes spinal stenosis?
Decreased vertebral height puts more stress on the discs that then push the spine back. This leads to increased inflammation of the ligamentum flavum on the roof of the vertebral canal with subsequent thickening.
_______________ is a common dose-limiting of ACE inhibitors.
First-dose hypotension
While looking at a CT scan of the renal slice of the body, you notice what looks like a second IVC to the patient’s right of the IVC. What is that?
The duodenum
Which are indicators of worse prognosis in liver failure?
•Elevated AST/ALT
• Increased PT and decreased albumin
PT and albumin
AST/ALT elevations indicate hepatocyte rupture. This might be temporary or only affect a part of the liver. Decreased synthetic function (indicated by PT and albumin analogies) is a stronger indicator of liver-wide failure.
True or false: any CK levels are abnormal.
False. CK levels up to 100 are normal.
Because sarcoidosis is easily confusable with hypersensitivity pneumonitis, the __________ ratio is often used to distinguish the two. A high ratio indicates sarcoidosis.
bronchoalveolar lavage CD4/CD8
Hypersensitivity pneumonitis presents with high CD8.
True or false: T3 can be converted to reverse T3 if supplies are excessive.
False. Reverse T3 comes entirely from T4.
What is Lynch syndrome?
Mutations in MSH that lead to HNPCC, endometrial cancer, and ovarian cancer.
True or false: in most states, parental consent is not required for a minor to have an abortion.
False. There are some states in which it is not required, but most states require parental consent.
What things can a minor consent for?
- Contraception
- Drug rehabilitation/treatment
- Psychiatric care
- Prenatal care
(So “Sex, Drugs, Rock & stROLLer”)
The ____________ artery usually goes over the left renal vein and can occlude it in some people.
superior mesenteric
Anti-topoisomerase antibodies are found in what disorder?
Systemic sclerosis
Aging of the skin predominantly occurs by what two cellular effects?
- Decreased fibril production
- Increased metalloprotease expression
Note: collagen actually increases in crosslinking with age, which adds to the inflexibility of skin.
Although most men with CF are infertile, they can _______________.
have kids with procedures that remove sperm from the testis directly
Other than CMV, what virus can cause esophageal ulcerations in someone with HIV?
HSV
HSV ulcers have the punched-out look, unlike the linear ulcerations of CMV.
The first zymogen to be activated is ____________.
trypsinogen (“It’s the first to TRiP!”)
True or false: troponin moves out of the actin binding sites and allows myosin to bind.
False. Tropomyosin is in the actin groove. Troponin binds calcium and pushes tropomyosin out of the way.
Why doesn’t FFP help treat heparin overdose?
FFP contains antithrombin and actually enhances the effect of heparin.
How does alcohol kill bacteria?
It disrupts cell membranes and denatures proteins.
Morphine causes pruritus by what mechanism?
IgE-independent mast cell degranulation
What is acantholysis?
Disruption of the bonds between keratinocytes (seen in pemphigus vulgaris)
What histologic pattern is seen in hives?
Dermal edema
What two things stimulate glycogen phosphorylase?
Glycogen phosphorylase (which depolymerizes glycogen) is activated by phosphorylation. Remember that all glucagon-mediated proteins are activated by phosphorylation.
Phosphorylase kinase (which activates glycogen phosphorylase) is activated by calcium and cAMP (the signalling molecule for glucagon).
Gallbladder hypomobility (such as from prolonged TPN or low CCK) can lead to ____________ in the gallbladder.
sludge
The parameter “maternal mortality” only applies to ___________ births.
live
If you’re given a correlation coefficient, how can you calculate what percent the variability of the dependent variable is due to the independent variable?
The variability is explained by the correlation coefficient squared: a correlation coefficient of 0.8 explains 64% of the variability of the dependent variable.
Describe tuberous sclerosis.
- Hamartomas in CNS and skin
- Angiofibromas
- Mitral regurgitation
- Ash-leaf spots
- Rhabdomyomas in the left atrium
- Tuberous sclerosis
- autosomal dOminant disorder of hamartin gene (aka TSC) on chromosome 16
- Mental retardation
- Angiomyolipoma
- Seizures
(Get it?)
Also increased risk of astrocytomas and ungual fibromas
The measure “attributable risk” is the decimal version of ______________.
“percent of risk attributable to…”
How do you calculate standard error of the mean?
SD/(√n)
Positive likelihood ratio is given by __________________.
sensitivity / (1-specificity)
Think about it: with positive likelihood, you’re ruling something in. As such, you need a high specificity. In this formula, high specificity makes the denominator low and the overall value high.
Describe how receiver operations curves are used.
- Sensitivity is on the Y axis
- (1-specificity) is on the X axis
- The area under the curve represents the overall accuracy. The more rectangular it is, the more accurate the test is.
- Higher on the Y axis means the test is more sensitive. More left on the X axis means it is more specific.
Describe the presentation of lactate dehydrogenase deficiency.
- AR disorder of missing LDH
- Exercise intolerance and stiffness following exercise
- Decreased levels of NAD+ (from glycolysis without LDH regenerating NAD+) leads to inhibition of glycolysis
The HR is determined by _____________ in atrial fibrillation.
the AV node refractory period
What molecule causes symptoms in those with C1-esterase deficiency?
Bradykinin
C1-esterase also blocks kallikrein converting kininogen to bradykinin, so without it there will be excess bradykinin. This is also why ACE inhibitors are contraindicated in those with C1 esterase deficiency.
Bradykinins also mediate the angioedema seen in ACE inhibitors reactions.
Again, trace the timeline development of pathologic signs of MI.
- 0 - 4 hours: nothing
- 4 - 12 hours: edema and hemorrhage
- 12 - 24 hours: coagulative necrosis
- 1 - 5 days: neutrophil infiltrate and coagulative necrosis
- 5 - 10 days: macrophage infiltrate
- 10 days to 14 days: granulation tissue
- 2 weeks to 2 months: collagen scar
What are signs of drug seeking?
- Requesting a specific drug by name (“Nothing works for my back pain except OxyContin, doc.”)
- Running out of medications early
- Pain out of proportion to physical exam
How should you handle a drug seeker?
Look in state databases for documented history of prescription abuse
What is purpura?
Larger petechiae: dot-like hemorrhages from blood extravasated from micro vessels
What is the proper name for the sun spots that come with age?
Solar lentigos