Q Banks: Week of 03/20/17 #2 Flashcards
1
Q
Nasal hemianopsia can result from vascular lesions to _____________________.
A
the lateral deviation of the optic nerve branches at the optic chiasm (such as from a berry aneurysm)
2
Q
What cardiopulmonary findings are often seen in hydrops fetalis?
A
Lung hypoplasia from pleural effusions due to CHF
3
Q
Another term for pharmacologic potentiation is ________________.
A
permissiveness
4
Q
Synergistic drug effect refers to when ________________.
A
two drugs have a combined effect that is greater than the sum of their parts
5
Q
Sketchy showed the owl-eye inclusions of HL and CMV with the same symbol. Why is this misleading?
A
The inclusions in HL are double circles and actually look like owl’s eyes, while the inclusions in CMV are single and do not.
6
Q
In those with alkaptonuria, the ________________ pathway is disrupted.
A
tyrosine to fumarate
“Your urine will be as black as the FUMes of a burning TiRe.”
7
Q
What two things should you look for in a histologic specimen of PSGN?
A
- Hypercellular glomerulus (this could be confused with a crescent, so be careful)
- Subepithelial deposits
8
Q
If they give you a slew of urine and serum labs and ask you to calculate FF, what formula should you use?
A
FF = GFR/RBF
- GFR = [(urine creatinine) / (serum creatinine)] x urine production rate
- RBF = [(urine PAH) / (serum PAH)] x urine production rate
9
Q
What does a high arteriovenous concentration gradient for an inhaled anesthetic indicate?
A
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.
10
Q
Manometry of achalasia and systemic sclerosis can be very similar. What is the key difference?
A
The LES pressure will be high in achalasia and low in systemic sclerosis.
11
Q
What are type I errors and type II errors?
A
- 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!)
12
Q
What is the power of a study?
A
1 - beta
Beta is the probability of a type II error (a type Beta error).
13
Q
Cavernous hemangiomas raise risk of intracerebral bleed in the ______________ cavity.
A
supratentorial
14
Q
At what age should most babies have more adult hemoglobin than fetal hemoglobin?
A
Roughly 6 weeks
15
Q
What did Sketchy not mention about HBV?
A
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.
16
Q
Those with factor V Leiden mutations will have what abnormal test?
A
The PTT fails to prolong when factor C is added to solution.
17
Q
What progression is typical of strawberry hemangiomas?
A
First increase then decrease in size
18
Q
What pathology most commonly causes spinal stenosis?
A
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.
19
Q
_______________ is a common dose-limiting of ACE inhibitors.
A
First-dose hypotension
20
Q
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?
A
The duodenum
21
Q
Which are indicators of worse prognosis in liver failure?
•Elevated AST/ALT
• Increased PT and decreased albumin
A
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.
22
Q
True or false: any CK levels are abnormal.
A
False. CK levels up to 100 are normal.
23
Q
Because sarcoidosis is easily confusable with hypersensitivity pneumonitis, the __________ ratio is often used to distinguish the two. A high ratio indicates sarcoidosis.
A
bronchoalveolar lavage CD4/CD8
Hypersensitivity pneumonitis presents with high CD8.
24
Q
True or false: T3 can be converted to reverse T3 if supplies are excessive.
A
False. Reverse T3 comes entirely from T4.
25
What is Lynch syndrome?
Mutations in MSH that lead to HNPCC, endometrial cancer, and ovarian cancer.
26
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.
27
What things can a minor consent for?
* Contraception
* Drug rehabilitation/treatment
* Psychiatric care
* Prenatal care
(So "Sex, Drugs, Rock & stROLLer")
28
The ____________ artery usually goes over the left renal vein and can occlude it in some people.
superior mesenteric
29
Anti-topoisomerase antibodies are found in what disorder?
Systemic sclerosis
30
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.
31
Although most men with CF are infertile, they can _______________.
have kids with procedures that remove sperm from the testis directly
32
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.
33
The first zymogen to be activated is ____________.
trypsinogen ("It's the first to TRiP!")
34
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.
35
Why doesn't FFP help treat heparin overdose?
FFP contains antithrombin and actually enhances the effect of heparin.
36
How does alcohol kill bacteria?
It disrupts cell membranes and denatures proteins.
37
Morphine causes pruritus by what mechanism?
IgE-independent mast cell degranulation
38
What is acantholysis?
Disruption of the bonds between keratinocytes (seen in pemphigus vulgaris)
39
What histologic pattern is seen in hives?
Dermal edema
40
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).
41
Gallbladder hypomobility (such as from prolonged TPN or low CCK) can lead to ____________ in the gallbladder.
sludge
42
The parameter "maternal mortality" only applies to ___________ births.
live
43
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.
44
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
45
The measure "attributable risk" is the decimal version of ______________.
"percent of risk attributable to..."
46
How do you calculate standard error of the mean?
SD/(√n)
47
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.
48
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.
49
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
50
The HR is determined by _____________ in atrial fibrillation.
the AV node refractory period
51
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.
52
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
53
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
54
How should you handle a drug seeker?
Look in state databases for documented history of prescription abuse
55
What is purpura?
Larger petechiae: dot-like hemorrhages from blood extravasated from micro vessels
56
What is the proper name for the sun spots that come with age?
Solar lentigos
57
Venous stasis predisposes people to what three complications?
* Skin ulcerations
* Stasis dermatitis
* Poor wound healing
58
Why is vancomycin give to those with S. epidermidis endocarditis?
Most strains of S. epidermidis are methicillin-resistant.
59
The superficial inguinal nodes drain what area?
The skin from the umbilicus down
The only exceptions are the glans penis and the posterior calf – both of which drain directly to the deep inguinal nodes.
60
How does cGMP produce vasodilation?
It activates proteins that dephosphorylate myosin.
61
_____________ activates AMPK which decreases hepatic gluconeogenesis.
Metformin
62
Lymphoid hyperplasia can look a lot like lymphoma. What is a key feature that lymphoma has that lymphoid hyperplasia doesn't?
Monoclonal expansion
If a lymph node is primarily occupied by B cells with one isotype of a T cell receptor, for instance, then it is likely malignant.
63
What lab can determine if a patient's elevated alkaline phosphatase is of hepatic origin?
Gamma-glutamyl transpeptidase (GGTP)
This enzyme is found exclusively in the liver and bile duct. Thus, if a patient has an elevated alk phos and you're wondering if it's from the bone or liver, GGTP can tell you.
64
True or false: superior vena cava syndrome most often results from superior sulcus tumors.
False. Superior sulcus tumors cause shoulder pain and Horner syndrome. MEDIASTINAL masses cause SVC syndrome.
65
Long-term ______________ use has been shown to lower the risk of colonic adenomas.
aspirin
66
Those with ______________ are more susceptible to Burkholderia and Serratia infections.
CGD
67
Describe chylomicronemia.
* Can result from defects in lipoprotein lipase or C-II (the ligand for lipoprotein lipase)
* Leads to acute pancreatitis from elevated triglycerides
68
Describe dysbetalipoproteinemia.
* Defects in apo-E
* Failed reabsorption of chylomicrons and VLDL
* Elevated triglycerides and LDL
69
Orthopnea can be caused by CHF or ___________.
mitral stenosis
70
Listening at the apex when the patient exhales in the LLD position is useful for which murmurs?
DCM S3 and mitral stenosis
71
What is the difference (histologically) between lipomas and liposarcomas?
Lipomas are mature fat cells, while liposarcomas are immature fat cells that are irregularly shaped and have multiple mitoses.
72
What are keratinocytes?
All the cells of the epidermis (basalis to corneum)
73
What rashes present with immune deposits around dermal blood vessels?
Henoch-Schonlein purpura and porphyria cutanea tarda
74
Neonatal respiratory distress (aka hyaline membrane disease) is more common in premature infants and _____________.
infants born to mothers with diabetes
75
Pancoast tumors are what kind of lung cancer?
Bronchogenic carcinoma
76
You might hear Meckel diverticulum referred to as _______________.
"heterotopic mucosa"
77
Split S2 can be caused by ASD, pulmonary hypertension, or ________________.
right bundle branch block (that leads to delayed right ventricular emptying)
78
What CBC and immunoglobulin patterns will you see in CVID?
Normal lymphocyte count with low levels of all Ig types
79
What is the formula for accuracy?
(TP + TN) / (all observations)
80
What histologic pattern will the renal damage from cyclosporine and tacrolimus produce?
Obliterative vasculopathy with vacuolization of the tubules
81
Prior to testing the lecithin:sphingomyelin ratio, the _______________ test was used to assess levels of surfactant.
foam stability test
In this test, various dilutions of amniotic fluid are mixed with ethanol. High enough levels of surfactant will make a stable ring of foam when shaken.
82
What is the "female athlete triad"?
* Amenorrhea
* Estrogen deficiency (with subsequent osteopenia, vaginal dryness, breast atrophy, and infertility)
* Disordered eating
83
On abdominal CTs, the pancreas can be as far the the right as ________________.
the kidney (anterior to the IVC)
84
True or false: its capsule is the main virulence factor allowing N. gonorrhoeae to survive in the uterus.
False!
Recall that N. meningitidis has a capsule but N. gonorrhoeae does not (the Sketchy scene has the mom breaking a wine glass to illustrate the lack of a capsule). The antigenic pili are the main virulence factor for N. gonorrhoeae.
85
Describe the pathogenesis of exophthalmos.
TSH-stimulating antibody attaches to TSH receptors in the back of the eye and induces a lymphocyte infiltrate. The Lymphocytes secrete cytokines that stimulate fibroblasts to produce glycosaminoglycans. Those GAGs attract water which adds to the bulk behind the eye.
Note: the GAG secretion is why surgery is needed to repair exophthalmos. If it were only lymphocyte infiltrate, excision of the thyroid would cure exophthalmos.
86
Why do pinealomas cause upward gaze palsy?
The mass presses on the superior colliculus.
87
The muscularis mucosa is _____________ to the submucosa.
superficial/above (closer to the lumen)
88
Small intestinal stem cells reside in the _________________.
crypts of Lieberkuhn
89
What is the key difference between a case-control study and a cross-sectional study?
* Case-control: the outcome is discovered first and then the exposure is looked at retrospectively
* Cross-sectional: exposure and outcome are discovered at the same time
90
Analyzing based on intention to treat preserves the benefits of _________________.
randomization
91
In a positively skewed plot, the mean is ___________ than the median.
greater
92
What cells make up the nodules and septae in cirrhosis?
* Nodules: regenerating hepatocytes
| * Septae: fibrosis
93
Macrolides, linezolid, and _____________ all bind to the 23S subunit of the 50S ribosome.
clindamycin
| Cleaning woman on a train
94
Lactose intolerance acquired in adulthood most often results from which kind of genetic defect?
Downregulation of healthy gene expression
95
Which epithelial cancers are most likely following radiation therapy?
Thyroid cancers
This is commonly seen in those who've survived a nuclear accident or toxic exposure.
96
Acute back pain is an extremely common complaint. What are some indications that a person needs to have additional testing (e.g., MRIs) done?
* Neurologic deficits
* Pain for more than 4 weeks
* Constitutional symptoms (e.g., fever, weight loss)
* History of cancer
In the absence of all these – if all the patient has is acute lower back pain – then NSAIDs with follow-up for persistence or worsening of symptoms is the correct response.
97
Calcineurin normally activates what molecule to stimulate IL-2 production in T cells?
NF-AT
98
Describe the pathogenesis of tardive dyskinesia?
With long-term D2 antagonism, the brain upregulates D2 receptors. This causes the direct pathway of the basal ganglia to be extra sensitive to dopamine. Discontinuation of D2 antagonists sometimes reverses the symptoms of tardive dyskinesia, but many times the upregulation is permanent.
99
Those with impairments in sympathetic activation – such as orthostatic hypotension, ejaculation difficulties, boggy nasal mucosa, hypothermia, and ptosis – might have a defect in what enzyme?
Dopamine beta-hydroxylase
This enzyme normally synthesizes norepinephrine from dopamine.
(Think Dopamine Beta-Hydroxylase = Don't Be Hypertensive)
100
How does pulmonary embolism affect central venous pressure?
PE increases CVP, because the output of the right heart decreases.
101
By what chromosomal abnormality can some women express symptoms of an XLR recessive when they are only carriers?
Skewed X inactivation
Most women have 50:50 inactivation of X chromosomes. If a woman was a carrier of a faulty X gene, then you would expect her to have 25% functional levels of that gene (because 50%/2). Skewed X inactivation can lead to up to a 70:30 ratio of inactivation, which would lead to a 15% functional level if more of the good X gene were inactivated.
102
Contractures of what muscle are suggestive of rabies?
Pharyngeal contractures
103
Decreased renal blood flow ultimately ___________ filtration fraction.
increases
104
Retinoids are used for acne and what other dermatologic condition?
Psoriasis (specifically acitretin)
105
Why do you get the spike and dome appearance in membranous glomerulonephritis?
There are immune deposits in the basement membrane in those with membranous glomerulonephritis. When you do a methenamine silver stain, the membrane will come between the immune deposits leading to the classic spike and dome appearance.
106
How can you differentiate stasis dermatitis from xerosis?
Stasis dermatitis will present with varicosities and red/bronze discoloration of the skin. Xerosis is a dryness of the skin that is especially common in the elderly during the winter months.
Stasis dermatitis is treatable with compression stockings and xerosis is treatable with moisturizers after bathing.
107
Explain the regulation accomplished by fructose-2,6-bisphosphate.
Fructose-2,6-bisphosphate stimulates glycolysis and inhibits gluconeogenesis. It regulates phosphofructokinase.
(Think of it this way: you get roughly 30 molecules of ATP from the TCA, and 26 is close to 30.)
The same molecule makes F26BP and F6P. It is called PFK-2/fructose-2,6-bisphosphatase. Insulin stimulates the PFK-2 portion, leading to glycolysis, and glucagon stimulates the bisphosphatase portion, leading to gluconeogenesis.
108
The alpha-helical domains of many transmembrane proteins (like GPCRs) contain _____________.
lots of alanine
109
The _______________ is unique because it receives blood from the brain and from the face.
cavernous sinus
110
A young man with decreased libido following an episode of orchitis would be a candidate for ______________ treatment.
testosterone
Note: because the testosterone would be low due to destruction of Leydig cells, agents such as bHCG and LH would not raise testosterone levels.
111
Explain the mechanism of probenecid.
It can do two things:
• Prevent excretion of drugs from renal capillaries to the PCT. This is useful if you don't want the drugs to be excreted (like penicillin or cidofovir).
• Prevent substances from being resorbed in the PT. This is useful in enhancing excretion of uric acid in in those with gout.
Remember: ProbeneCid works in the PCt.
112
Girls with 17-alpha hydroxylase deficiency may be asymptomatic (with the exception of hypertension) until _____________________.
puberty, at which time they will not develop secondary sexual characteristics due to the deficient androgens
113
What does 17-OH deficiency cause in males?
Hypovirilization due to lack of androgens
114
Patients with COPD can often have syncope with coughing episodes due to what?
Increased intrathoracic pressure with decreased venous return
115
Which kind of lymphoma presents with waxing and waning lymphadenopathy?
Follicular lymphoma
| Think of the Fases of the moon.
116
Histologically, neurofibromas are composed of what cell type?
Schwann cells
117
Other than optic gliomas, von Recklinghausen syndrome raises risk of which intracranial mass?
Pilocytic astrocytoma
118
True or false: endometriosis raises risk of endometrial cancer.
False. It raises risk of ovarian epithelial carcinoma.
119
True or false: menopause is caused by quiescence of the oocytes.
False. Quiescence refers to the state of a cell in which it is not dividing. In menopause (as in premature ovarian failure), the main cellular process is apoptosis of oocytes.
120
Paclitaxel is coated on stents to prevent what?
Intimal hyperplasia
121
Why shouldn't you abduct your arm if you have a broken clavicle?
On the anterior side of the body, the deltoid inserts on the inferolateral aspect of the clavicle. If you abduct your arm, then you are pulling the distal fragment of the clavicle in the inferolateral position – preventing its fusion with the medial segment.
122
Which nerve carries the sensory innervation of the dorsal foot?
The superficial peroneal nerve
Not the deep!!! The deep peroneal does not provide sensory innervation to the leg.
123
Carbamoyl phosphate synthase deficiency looks a lot like ornithine transcarbamylase deficiency, but there is one key lab difference: ________________.
orotic acid is only high in OTC deficiency
In CPS deficiency, ornithine gets shuttled into the mitochondria and stays there.
124
Proline hydroxylation is needed for _____________________ formation.
triple helix
125
Huntington's disease results in a ______________ mutation.
gain-of-function
126
What disorder results from expanded glutamine repeats?
Huntington's
| Think: GUThrIE got a disorder with GlUTamInE repeats.
127
Some people have MHC haplotypes that cause defective IgG response. What process is usually inhibited in this defect?
Antigen presentation
128
```
VHL syndrome presents with the following constellation of symptoms:
• RCC
• Hemangioblastomas in the cerebellum
• __________________
• __________________
• __________________
```
* Pheochromocytoma
* Pancreatic and renal cysts
* Polycythemia vera from EPO production
129
Where in the eye does copper deposit in those with Wilson's disease?
The cornea
It looks like the iris, but it is not.
130
What is the best way to distinguish between fibroadenomas and fat necrosis?
* Fibroadenomas are estrogen-sensitive and so will enlarge with pregnancy or ovulation.
* Fat necrosis is irregular.
* Fibroadenomas are well-demarcated.
131
Describe dysplastic nevus syndromes.
* Caused by a mutation in cyclin-dependent kinase on 9p21 (think of the show 90210 being about a bunch of 90s high schoolers with moles)
* Raises risk of melanoma
132
What happens to end-diastolic volume in intense exercise?
It increases because of increased preload.
Note: end-systolic volume decreases because of increased contractility.
133
List the embryologic structures that give rise to the brain.
• Prosencephalon (aka forebrain):
- Telencephalon: cerebrum
- Diencephalon: thalamus and eyes
* Mesencephalon (aka midbrain): midbrain
* Rhombencephalon (aka hindbrain):
- Metencephalon: pons and cerebellum
- Myelencephalon: medulla
134
Describe the structure of leucine zippers.
Leucine zippers make up a type of transcription factor. Leucine residues repeat every seventh amino acid and interact to stabilize the two helices. The DNA-binding region contains many lysine and arginine (positively charged) residues that interact with phosphate.
135
Synthesis of nucleic acids takes place in the ______________.
cytoplasm
Recall that PRPP amidotransferase (for purines) and carbamoyl phosphate synthase (for pyrimidines) reside in the cytosol.
136
______________ is not required for a diagnosis of anti-basment membrane IgG syndrome.
Hemoptysis/lung involvement
137
How do retinoids help treat comedonal acne?
Retinoids promote increased turnover of keratinocytes which prevents blocking of pores.
138
What passes through the esophageal hiatus with the esophagus?
The vagus nerves!
Remember it like this: the vagus nerve provides PNS input to the GI tract, so it makes sense that it would pass through the esophageal hiatus.
139
True or false: the liver and pancreas utilize glucokinase.
True!
gLuCokinase is in the Liver and panCrease.
HExokinase is HEverywhere else.
140
Giving glucose to someone with Von Gierke disease leads to ________________.
lactic acidosis
The glucose (or fructose) cannot be converted to glycogen and the TCA cycle is backed up from excess intracellular glucose, so the new glucose leaves the cell as lactic acid!
141
CNS tumors can produce _____________ edema.
vasogenic
They secrete cytokines that destroy the BBB and allow blood to increase pressure in the intracranial cavity.
142
Which two cell types are evident in a pap test?
* Columnar epithelium from the endocervix
| * Stratified squamous epithelium from the ectocervix
