Q Banks: Week of 03/27/17 Flashcards
A question describes a young girl with aplastic anemia. How could you decide whether the etiology is idiopathic or related to a previous Parvovirus infection?
Parvovirus infection only causes aplastic anemia in those with underlying hematologic issues such as sickle cell (remember the USSR sickle on the plane bombing the bone in the Sketchy scene!). Thus, if the girl has no known hematologic problems, then the cause is likely idiopathic.
Genetic absence of ____________ leads to inability to digest proteins or fats.
enteropeptidase
This enzyme cleaves trypsin and initiates the enzymatic cascade. Thus, without it none of the pancreatic enzymes would be activated.
Hydatid cysts present with what kind of capsule?
“Eggshell” calcifications (like the egg award in the Sketchy scene)
The locus ceruleus secretes _____________ to maintain alertness.
norepinephrine
The red nucleus is a go-between for the _________________.
cerebellum and cortex; it helps to coordinate movement
The nucleus of Meynert is involved in which disease?
Alzheimer’s
Just think that your MEmorY will be iNERT if you don’t have acetylcholine from your MEYNERT nucleus.
Which nuclei do SSRIs target?
The nuclei of Raphe in the brainstem
Remember that RAPHaEl was the most depressed TNMT, so of course you’d want a drug to target the nucleus of Raphe.
In a CT at the level of the heart, what structure is immediately posterior to the SVC?
The arch of the azygos vein
If a male has an exceptionally full bladder, you may see the bladder on a CT in which location?
Anterior to the prostate!
Why do PPIs cause osteoporosis?
Calcium absorption requires an acid environment in the stomach
Why do antiepileptics cause fractures?
Phenytoin and carbamazepine upregulate CYP450 which degrades vitamin D.
Where are pudendal nerve blocks supposed to be injected?
Medial to the sacrospinous ligament (near the sacral ganglia)
In those with CF, more ___________ is absorbed by the respiratory epithelium.
sodium
Without being able to secrete chloride, the transmembrane potential is much more negative. Thus, sodium in the mucus is pulled in. This makes the mucus even thicker.
When does multicystic dysplastic kidney present?
At birth
List three types of non-neoplastic polyps.
- Hyperplastic
- Lymphoid (bulges caused by underlying lymph proliferation)
- Hamartomatous
Important: hyperplastic polyps DO NOT carry risk of malignant transformation!
Measles and rubella have similar presentations. How can you distinguish the two?
•Rubella:
- The rash does not coalesce. It remains as a lacy network.
- Auricular lymphadenopathy particularly common.
- Rash spreads fast
•Measles:
- Rash often coalesces to become solid (red dress in Sketchy scene).
- The C’s: conjunctivitis, coryza, cough, Koplik’s spots.
True or false: the MYC genes are tumor suppressors.
False. They are oncogenes. Remember how Burkitt lymphoma presents with amplification of MYC.
NK cells express CD16 and CD____.
56
Penicillin is structurally similar to what bacterial component?
D-ala-D-ala
This is tricky: Vancomycin binds directly to D-ala-D-ala and prevents elongation. Penicillin binds to the transpeptidase protein in the spot that would bind D-ala-D-ala and crosslink the strands.
What is uterine atony?
The most common cause of postpartum hemorrhage, uterine atony is the failure of the uterus to contract after labor. Most often it can be treated with uterine massage or agents that stimulate uterine contraction.
How is chylomicronemia different from dysbetalipoproteinemia?
- Chylomicronemia presents with elevated chylomicrons only. It results from defects in lipoprotein lipase or C-II.
- Dysbetalipoproteinemia presents with elevated chylomicrons and VLDL. It results from defective apoE.
Why, again, does C1 esterase deficiency cause edema?
Kallikrein converts kininogen to bradykinin. C1 esterase normally degrades kallikrein. Without C1 esterase, excess levels of kininogen build up.
SSPE can present with what neurologic signs?
Ataxia and myoclonus
The ototoxicity of furosemide can present as tinnitus or _____________.
hearing loss
Long-term use of NSAIDs can cause what renal complication?
NSAIDs accumulate in the renal medulla if taken chronically. They uncouple oxidative phosphorylation and cause lipid peroxidization. This leads to chronic interstitial nephritis with subsequent nephropathy and shrinking of the kidneys.
What urinalysis signs will be seen in chronic interstitial nephritis?
Nephropathy with no cells
What most often causes torticollis?
Malposition of the head in utero
Torticollis will present with a firm mass in the neck that doesn’t move with swallowing. The infant may also have plagiocephaly.
What clinical symptom might suggest that a child has T-cell ALL as opposed to B-cell ALL?
Dysphagia
In a young child, the thymus is high enough that it can impinge on the trachea and esophagus.
Describe Kussmaul sign.
Kussmaul sign is a symptom of constrictive pericarditis.
Normally, the JVP should decrease with inspiration because of increased right-ventricular filling. In constrictive pericarditis, the right ventricle cannot expand and thus JVP either doesn’t decrease or can even increase.
Patients with high levels of microsomal monooxygenase are at higher risk of _____________.
cancer from toxins
Many toxins require activation by hepatic phase I metabolism. Thus, those with high levels of microsomal monooxygenase (a CYP enzyme) will produce more toxins from polyaromatic hydrocarbons.
Describe eclampsia andpreeclampsia.
•Preeclampsia:
- new-onset hypertension after 20 weeks’ gestation
- proteinuria
•Eclampsia:
- preeclampsia
- seizures
What are risk factors for preeclampsia?
- Obesity
- Chronic hypertension
- Personal history of preeclampsia
True or false: fibrinous pericarditis five days after an MI is an autoimmune disorder.
False.
There are two kinds of fibrinous pericarditis:
- Within one week of an MI, the pericardium can react to the transmural necrosis of the myocardium and secrete fibrin. This is a normal immune response to necrotic tissue.
- One week to a few months after an MI, immune cells can react to necrotic myocardium and cause pericardial effusion and diffuse inflammation of the pericardium
Note: one clinical symptom that suggests the first situation is localized pain. For example, pain in the neck with inspiration suggests inferior MI fibrinous pericarditis.
Expanding abscesses within bone can cause __________ disruption.
periosteal
Sorbitol is converted to ____________.
fructose by sorbitol dehydrogenase
Which enzyme makes sorbitol?
Aldose reductase
This is another method by which hyperglycemia damages tissues. Saturation of glucose leads to overactivity of aldose reductase. Aldose reductase uses NADPH and thus makes the cell more vulnerable to oxidative injury.
Which type of hydatidiform mole is more hyperplastic?
Complete mole
They are COMPLETELY hyperplastic.
Mycobacteria that do not have _____________ are not virulent.
cord factor (which makes them appear serpiginous)
Cord factor is also called trehalose.
How soon do myocytes stop contracting after an MI?
Within 60 seconds
Note: irreversible cell injury occurs within about 30 minutes.
Regardless of hydration status, the ______________ part of the nephron absorbs the most water.
PCT
What pH disturbance can cause uric acid kidney stones?
Contraction alkalosis
In this disturbance, the kidneys excrete more H+. As such, the collecting duct becomes acidic. This promotes the protonation of uric acid which removes the charge and makes stones more likely to form.
What is the proper course of action in a situation where a parent wants to take their child home when not receiving care could be fatal for the child?
Obtain a court order to hospitalize the child against the parent’s will.
Lactobacilli are Gram-_______________.
positive
Which alpha-hemolytic is bile-insoluble?
S. viridans (the boots mean insoluble in the Sketchy scene)
This conversely means the S. pneumoniae is bile-soluble.
A woman with sickle cell trait presents with abrupt hematuria. What likely caused this?
Renal papillary necrosis
People with sickle cell disease or trait can have infarction of the distal two-thirds of the renal pyramids. This produces hematuria in the absence of flank pain.
It’s possible to have an ASD that is _____________.
asymptomatic for years
List the cytokines and cell types involved in the development of granulomas.
- Th1: secretes IL-2 to activate more Th1 cells and IFN-gamma to activate macrophages
- Macrophages: forms granuloma
In a pressure-volume loop, arteriovenous fistulas will present with _______________.
increased end-diastolic volume with subsequent increase in stroke volume; also, systolic opening pressure may be less due to the loss of arteriolar resistance
Which two vasculitis disorders can have GI involvement?
Polyarteritis nodosa and Henoch-Scholein purpura
“Poopyarteritis nodosa and Henoch-Shitlein purpura”
True or false: ANCA will be positive in those with polyarteritis nodosa.
False.
Which kind of lymphoma has a waxing/waning presentation?
Follicular (again, like the Fases of the moon)
Think of the Renaissance-fighting pirates on a ship that’s under a waning moon.
Histologic examination of follicular lymphoma will present with what signs?
Splitting/cleavage of the nuclei
Most anal fissures present on the _______________ side of the rectum.
posterior
Anal fissures typically happen in the context of constipation. With repetitive straining, the rectal arteries have less perfusion. The posterior rectum is a watershed area and is more likely to weaken from poor perfusion.
Anti-snRNA antibodies, which are highly specific to lupus, are also called ________________.
anti-Smith antibodies
Describe lichen planus.
The five P’s:
- polygonal
- pruritic
- purple
- planar
- plaques
Associated with hepatitis C and often seen on the wrist.
True or false: seborrheic keratoses are always yellow.
False. They can be yellow, but they can also be brown or tan.
Key features are well-demarcated border, stuck-on appearance, and often velvety look.
What is the Leser-Trelat sign?
Sudden appearance of seborrheic keratoses can portend underlying cancer.
Not describing the actual moves, what increases the sound of HOCM murmurs?
Decreased preload (think about it: Valsalva, standing, NO)
The sustained hand grip maneuver does what?
Increases afterload
Describe Wallerian degeneration.
Severing the axon leads to cell swelling, nucleus being pushed to the periphery, and Nissl degeneration.
Explain the mechanism of ivabradine.
Ivabradine is an I(funny) channel inhibitor that leads to the selective slowing of the heart rate. It only affects the phase 4 outward current and not contractility.
(Think IVabradINe = I(vunny) INhibitor)
Describe the appearance of atypical lymphocytes.
Large lymphocytes with pale cytoplasm and a basophilic rim
List two side effects associated with raloxifene.
- DVT
* Hot flashes
These features are all common in fragile X syndrome: •Macroorchidism •Long face •Prominent ears •Prominent mandible •Neuropsychiatric disturbance •\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Hyperlaxity of the finger and thumb joints
Describe these possible outcomes of GERD:
•Ulceration
•Stricture
- Ulceration: sudden onset odynophagia; dysphagia to solids
* Stricture: dysphagia to solids; less painful
How can vertical transmission of HIV be prevented?
- Standard HAART for pregnant women –regardless of CD4 count
- Zidovudine for neonates
True or false: opiates can cause hypertension.
False. They cause hypotension (and bradycardia)>
Describe the stomach cancer that presents with signet rings.
- Diffuse-type adenocarcinoma (as opposed to the intestinal type)
- Typically does not form glands
- Often spread out into the stomach wall and make the “leather-bottle stomach” sign (medically called linitis plastica)
- Do not project into the lumen (adenocarcinoma does this)
- IS NOT GIST
- When it invades the ovaries, diffuse adenocarcinoma is called Krukenberg tumor
Final point: intestinal adenocarcinoma often ulcerates and causes bleeding, whereas diffuse-type does not.
Rugal thickening is a characteristic of which gastric malady?
Zollinger-Ellison syndrome
Remember that ACTH-secreting adenomas cause hyper-_____________ of the adrenal cortex.
plasia
