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COMLEX > Random 1 (12/16) > Flashcards

Random 1 (12/16) Flashcards

1
Q

Treponema pallidum

A

Single Ulcer with indurate borders
Bilateral, nontender inguinal lympadenopathy

Tx: Penicillin

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2
Q

Haemophilius Ducreyi

A

Large, deep ulcer with well demarcated borders and exudate
Severe and suppurative lymphadenopathy

Tx: Azithromycin or Ceftriaxone

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3
Q

Hereditary fructose intolerance presentation

A

Infant tries fruit, gets hypoglycemia (tiredness, vomitting, diaphoresis)
Autosomal recessive, absense of aldolase B so gets fructose-1-phosphate build up

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4
Q

Papillary carcinoma

A
  • Empty-appearing nuclei with central clearing
    -Psammoma bodies (hollow nuclei and laminar calcified bodies)
    -BRAF mutatuion
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5
Q

Medullary carcinoma

A

-Originates from parafollicular “C cells”
-Calcitonin is a tumor marker
-RET proto-oncogene mutation

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6
Q

Calcium oxalate stones

A

-Can result from ethylene glycol
-X-ray= radioopaque
-Shape: Envelope
Tx: Thaizides and Citrate

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7
Q

Intention Tremor

A

Location: Cerebellar lesion
Gets worse with: Goal directed movement

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8
Q

35 y/o fatigue, pruritis, and RUQ abdominal discomfort

A

Primary biliary cholangitis, characterizzed by T-lymphocyte-mediated autoimmune destruction of intralobular bile ducts
-Abnormal liver function tests, elevated ALP
-Anti-mitochondrial antibodies

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9
Q

Anticentromere Antibodies

A

-Limited cutaneous scleroderma
-CREST (Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia)

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10
Q

Anti-ds DNa antibodies

A

SLE

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11
Q

Anti-histone antibodies

A

Drug induced SLE
Hydralazine+ Procainamide

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12
Q

Anti-microsomal antibodies

A

Hashimoto thyroiditis

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13
Q

Anti-Jo-1 (Histidine-tRNA ligase)

A

Dermatomyositis, polymyositis

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14
Q

Leiomyoma

A

Hx of menorrhagia and recurrent pregnancy loss, CT shows calcified pelvic mass
-Benign, soft tissue mass composed of smooth muscle and fibroblasts

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15
Q

Interactions with tyramine-containing foods, such as wine and aged cheese with an MAO-I (phenelzine) can result in severe HTN

A

Tx: Phenolamine, a reversible nonselective alpha blocker

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16
Q

Type 1 interferons: IFN-a and IFN-b

A

Innate immune cytokines that inhibit viral replication and increase MHC class 1 expression
-Secreted by Th1 helper cells
-Responsbole for phagocytosis by mactophages and granuloma formation

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17
Q

Asherman syndrome

A

Results from intrauterine adhesions that arise secondary to trauma and stratum basalis of the endometruum–> absence of the stratum basalis layer of the endometrium

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18
Q

Brown-Sequard syndrome

A

-Loss of ipsilateral upper motor neuron below lesion (CST)
-Loss of ipsilateral vibration and proprioception (Dorsal Spinal Columns)
-Loss of contralateral pain and temp 2-3 levels below level of lesion (STT)

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19
Q

The umbilical cord and contents

A

2 umbilical arteries arising from the internal iliac arteries (carry deoxygenated blood from fetus to the placenta) and 1 umbilical vein, which carries oxygenated, nutrient rich blood from placenta to the fetus

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20
Q

Lambert-Eaton myasthetic syndrome

A

-presynaptic disorder in which the presynaptic nerve terminals release a reduced amount of AcH–>antibodies against voltage gated calcium channels so you get leg wakeness, pain and stiffness, dry mouth, impotence
-Associated with heavy smoking

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21
Q

Bacterial meningitis findings

A

Opening pressure: Increased
Cell type: Neutrophuls
Protein: Increased
Glucose: Decreased

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22
Q

Viral meningitis/ encephalitis

A

Opening pressure: Normal or increased
Cell type: Lymphocytes
Protein: Normal or increased
Glucose: Normal

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23
Q

Barrets esophagus

A

Metaplastic change of esophageal mucosal lining from normal squamous epithelium to columnar epithelium

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24
Q

Acetazolamide

A

Acts on the PCT of the nephron and results in sodium bicarbonate diuresis that can lead to metabolic acidosis

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25
Q

Carcinoid syndrome

A

caused by a neuroendocrine tumor that secretes vasoactive substances, such as serotonin. Typical symptoms include episodic upper body flushing, telangiectasis, diarrhea, and broncospasm

Tx: Octeotide

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26
Q

Primary Sclerosing cholangitis

A

biliary tract disease associate with ulcerative colitis; idopathic disorder characterized by inflammation fibrosis, and trictures of medium and large ducts in the intrahepatic andf extrahepatic ducts–>beads on a string

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27
Q

Anti-topoisomerase

A

Associated with systemic sclerosis–> thickening and hardened skin and raynaud phenomon

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28
Q

Paraneoplastic syndrome from squamous cell carcinoma causing hypercalcemia

A

Pts findings of pulmonary mass and symptoms of hypercalcemia (constipation, abd pain, polyuria, and mentation changes)—> releases parathyroid hormone-related peptide acts like PTH but serum PTH levels would be supressed

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29
Q

Myxomas

A

90% occur in the left atrium and are prone to embolization can can lead to complications such as embolic stroke
-Syncopal episodes happen and there is a diastolic murmur that changes in frequency with movement

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30
Q

Schistosomiasis

A

Pt with history of swimming in an african river and examination findings of eosinophilia, hematuria, and lower abd pain
-Tx: Praziquantel

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31
Q

Monckeberg arteriosclerosis characterized by calcification of the internal elastic lamina and the tunica media of arteries

A

no symptoms just something to be aware of

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32
Q

Tetralogy of Fallot

A

-Boot shaped heart
-Left upper sternal border harsh systolic murmur
-cyanotic episodes
-Right ventricular hypertrophy

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33
Q

Acute intermittent porphyria

A

Affected enzyme: Porphobilinogen deaminase
Accumlated: Porphobilinogen and ALA
Clinical presentation: ABD pain, polyneuropathy, port wine colored urine, EtOH and smoking make worse

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34
Q

Cardiogenic Shock

A

Preload: Increases
SVR: Increases
CO: Decreases

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35
Q

Hypovolemic Shock

A

Preload: Decreases
CO: Decreases
SVR: Increases

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36
Q

Distributive Shock

A

Preload: No change/ Decreases
CO: Increases
SVR: Decreases

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37
Q

Obstructive Shock

A

Preload: Decreases
CO: Decreases
SVR: Increases

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38
Q

Eosinophililic Granulomatosis with Polyangitis

A

p-ANCA small and medium vessel vasculitis; characterized by significant eosinophilia and chronic rhinosinutis and asthma

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39
Q

Granulomatosis with Polyangiitis (Wegner)

A

c-ANCA presents with sinus, lung, and kidney involvement associated with saddle nose deformity, hemoptysis, and renal failure
Tx: Cyclophosphamide

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40
Q

DiGeorge Syndrome

A

Autosomal Dominat condition caused by a 22q11.2 microdeletion resulting in cardiac defects, abnormal facies, thymic hypoplasia, cleft palate, and hypocalcemia

3rd and 4th pouches

Decreased T cells; recurrent viral and fungal infections

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41
Q

Zollinger-Ellison Syndrome

A

Caused by a gastrin-secreting tumor; suspected when patients have refractory epigastric pain and ulcers throughout the duodenum; Gastrin is normally produced by G cells in the PYLORIC ANTRUM and then stimulates the parietal cells to produce gastric acid in the fundus of stomach

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42
Q

Wallenberg Syndrome

A

Infarction of the lateral medulla of the brainstem due to occlusion of the PICA, associated with acute onset of vertigo
PE shoes nystagmus, ipsilateral Horner syndrome (ptosis,miosis,and anhidrosis), ipsilateral limb ataxia adn sensory loss of pain and temp sensation on ipsilateral face (spinal trigeminal nucleus) and contralateral trunk(spinothalamic tract)

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43
Q

Septal

A

Artery: Left anterior descending–> V1/V2

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44
Q

Anterior

A

Artery: Left anterior descending–>V3/V4

45
Q

Lateral

A

Artery: Left Circumflex–> I, aVL, V5 and V6

46
Q

Inferior

A

Artery: Right Coronary–> II,III, and aVF

47
Q

Posterior

A

Artery: Posterior descending–> V1-V3 and posteior leads V7-V9

48
Q

Placenta accreta

A

Placental villi attach to the surface of the myometrium

49
Q

Placenta increta

A

Chorionic villi penetrate into the myometrum

50
Q

Placenta Percreta

A

Chorionic villi penetrate through the myometrium to the uterine serosa

51
Q

Young pt with paresthesias, weakness, urinary incontinence, intermittent vision loss

A

Multiple sclerosis, MRI shows periventricular plaques

52
Q

Severe combined immunodeficiency

A

Deficiency in adenosine deaminase, pts present with recurrent viral, bacterial, fungal, protozoal infections, along with diarrhea and failure to thrive

-No thymic shadow

Reduced levels of B and T lymphocytes and natrual killer cells

53
Q

Chronic granulomatous disease

A

-Lack of nicotinamide adenine dinucleotide phosphate oxidase
-Decreases ROS leading to recurrent infections with catalase-positive organisms (Staph aureus, pseudomonas, klebsiella)

54
Q

Phenylalanine hydroxylase deficiency

A

Converts Phe to Tyrosisne and deficiency results in condition known as classic PKU
-pts have hypopigmentation of skin due to lack of tyrosine but is associated with peculiar body odor

55
Q

Erythema infectiosum (Fifth Disease)

A

Begins with fever, headache, and coryza, and erythematous malar rash with circumoral pallor 2-5 days later
-Results in fetal anemia–>hydrops fetalis
-Parvovirus B19

56
Q

Duodenal atresia

A

Failure to recanalize the distal duodenum, and affected infants present with bilious emesis and abd distention–> abd imaging reveals collections of air in stomach and proximal duodenum (double bubble sign)

57
Q

Cholecystoenteric fistula

A

Gallstones enter the intestine and pts may develop a mechanical SBO within the ileum or ileocecal valve

58
Q

Roseola Infantum

A

-Causative Agent: Herpesvirus Type 6 (Enveloped, linear dsDNA virus)
-Presents with high fever followed by a macular rash over the body
-The fever lasts for 3-5 days then rash appears (Starts on trunk then spreads outward)
-cervical lyphadenopathy

59
Q

Measles (Rubeola)

A

Agent- Enveloped, linear ssRNA virus
-Prodrome of cough, coryza, conjunctivitis along with Koplik spots
-Rash starts on head then moves downward

60
Q

Overproduction of Gastrin

A

Gastrinomas in MEN-1 causes increased acid secretion by G cells, leading to peptic ulcers

61
Q

Uncal Herniations

A

Medial aspect of the temporal lobe herniates across the tentorium cerebelli; initially results in ptosis, mydriasis, lateral strabismus, and contralateral hemiparesis of extremities

62
Q

Fusion inhibitors

A

Maraviroc–> Binds CCR5 (Inhibits interaction with gp120 preventing viral binding)
Enfuviritide–> Binds gp41–>inhibits viral entru into host cell

63
Q

Type I dyslipidemia

A

-Elevated chyomicrons and TGs
-Caused by reduction of lipoprotein lipase

64
Q

Type IIa and IIb

A

IIa- high total cholesterol, high LDL, NORMAL TGS
IIb- high total cholesterol, high LDL/VLDL, and high TGS

65
Q

Disruption of trochlear nerve

A

Pts will complain of diplopia when they try to look downard
Superior oblique is controlled by CN4 which is the trochlear

66
Q

MEN 1

A

3 P’s: Pituatary adenoma, Parathyroid hyperplasia, and Pancreatic involvement
Prolactinomas are most common and cause bitemporal hemianopsia, the Gastrinomas are most common pancreatic tumor

67
Q

Subacute Granulomatous Thyroiditis

A

Caused by a release of pre-formed thyroid hormone from an inflamed thyroid gland; follows flu-like illness

ONLY ONE THAT PRESENTS WITH PAINFUL,ENLARGED, THYROID GLAD

Tx: NSAIDs+Beta vlockers

68
Q

MEN 2A

A

Mutation: RET
-Medullary thyroid cancer (Inc calcitonin)
-Pheochromocytoma
-Primary hyperparathyroid

69
Q

MEN 2B

A

Mutation: RET
-Medullary thyroid cancer
-Pheochromocytoma
-Mucosal Neuromas
-Marfanoid body habitus

70
Q

Henoch-Schonlein Purpura

A

Occurs in children following viral infection, there is a purpuric rash, arthritis, GI pain

RENAL BIOPSY shows IgA deposits in the mesangium in the glomeruli producing hematuria

71
Q

Membranoproliferative glomerulonephritis(MPGN)

A

accompanied by significant proteinuria–> dense deposit of C3 in the center of the basement membrane

72
Q

Poststreptococcal glomerulonephritis

A

Hypercellular glomeruli with neutrophils and large, coarse (lumpy-bumpy) subepithelial feposits

73
Q

Membranous glomerulopathy

A

Imaging: spike and dome IgG deposits in the basement membrane
-idiopathic but can be seen in hepatitis B and C, and SLE

74
Q

Polyarteritis nodosa

A

-Medium sized vasculitis
-spares the lings but displays palpable purpura
-associated with hepatis B

75
Q

Mallory-Weiss Tear

A

Focal submucosal lesion of the distal esophagus

76
Q

Tuberous Sclerosis

A

-Autosomal dominant defect in the tumor supressor gene due to a TSC1 mutation (chromosome 9) or TSC2 (chromosome 16)
Clinical: hamartomas in CNS, angiofibromas, ash leaf spots, cardiac rhabdomyoma, renal angiomyolipomas, seizures
-Cardiac rhabdomyoma most common cardiac tumor in children

77
Q

Pemphigus vulgaris

A

-Caused by IgG antibodies against desmosomes located on the surface of kerantinocytes, resulting in flaccid bullae and erosions on the skin/oral mucosa
-Nikolsky sign in which gentle pressure causes epidermis to sep off

78
Q

Bullous pemphigoid

A

linear dermal distribution, antibodies against hemidesmosomes–>tense bullae

79
Q

Eisenmenger syndrome

A

-dyspnea,cyanosis, and pulmonary htn–>caused by reversal of blood flow through ASD
-fixed split S2, indicitive of ASD (most common cause of ASD is failure of closure of the ostium secundum)

80
Q

21 hyroxylase deficiency

A

-Characterized by hypotension, hyperkalemia, and increased renin activity, ambigious genitalia
-decreased conversion of progesterone to deoxycortisone= decreased aldosterone
-decreased conversion of 17-hydroxyprogesterone to 11-deoxycortsol which leads to absent cortisol production

81
Q

McCune-Albright syndrome

A

-Mutation in GNAS gene–>Increase production of pituitary hormones
-Clinical features: precocious puberty, cafe au lait maculrs, and history of long bone fractures secondary to fibrous dysplasia

82
Q

Airway/Resistance

A

Radial traction, airway resistance decreases as lung volume increases, therefore airway resistance is the least at the point of MAXIMAL inspiration

83
Q

Primary brain vesicles

A

Prosencephalon (forebrain)
Mesencephalon (midbrain)
Rhombencephalon (hindbrain)

84
Q

Secondary Brain Vesicles

A

Diencephalon (thalamus and hypothalamus)
Mesencephalon (midbrain)
Metencephalon (pons and cerebellum)
Myelencephalon (medulla)

85
Q

Epidural hematoma

A

-Lucid interval, middle meningiel artery, biconvex lens shaped hematoma
-pterion: frontal,parietal, temporal, sphenoid (origin of middle meningeal artery)

86
Q

Dialated cardiomyopathy

A

-common with alcohol use disorder
-S3 heart sound, show pronounced left ventricular dilation, increased LV mass, and systolic impairment

87
Q

Focal segmental glomerulosclerosis (FSGS)

A

HIV patient with nephrotic range proteinuria, peripheral edema, and hypoalbuminemia
-Sclerosis of podocytes–>disruption of the glomerular charge barrier
-effacement of podocyte foot processes

88
Q

Arnold-Chiari Malformation

A

Congential disorder characterized by a structural abnormailty at the spinomedullary junction, resulting in downward displacement of cerebellar tonsils through the foramen magnum–>causes compression of neural structures and obstruction of normal CSF flow

89
Q

Serotonin syndrome

A

Triad of cognitive impairment, autonomic instability,
-hyperreflexia, disorientation, vomitting, and autonomic instability (HTN and dever)
Tx: cyproheptadine which antagonizes serotonin and can be used in toxicity

90
Q

Clozapine

A

Used to treat schizophrenia, but can cause AGRANULOCYTOSIS, Wt gain, and Neuroplectic malignant syndrome
-MOA is both antagonism of serotonin 2A and dopamine receptors

91
Q

Iron deficiency anemia

A

Koilinychia, fatigue, and malaise, dyspnea, and tachy, glosittis
Iron panel shows: Elevated transferrin, elevated TIBC, low iron, and low ferritin

92
Q

TIBC

A

measures bloods capacity to bind iron with transferrin correlates with transferrin leveles

93
Q

Transferrin

A

Major transporter of iron trafficing through plasma and hepatic synthesis of transferrin is increased in iron deficient state

94
Q

Ferritin

A

cellular storage protein for iron

95
Q

Rib Dysfunctions/Muscles

A

Rib 1: Anterior and Middle Scalene
Rib 2: Posterior Scalene
Rib 3-5: Pec Minor
Rib 6-9: Serratus anterior
Rib 10-11: Latissimus Dorsi
Rib 12: Quadratus Lumborum

96
Q

Alveolar-Arterial Gradient

A

A-a gradient: PAO2- PaO2 (A=partial presence of oxygen, a=partial pressure of o2 in arterial blood)
Normal is: 4-15

Causes of hypoxemia with normal A-a gradient: Alveolar hypoventilation (opios, obesity) and Low FiO2 (high altititude)

Causes of hypox with increased A-a gradient: Dead space vent (PE), Diffusion limitiation (pulm fibrosis), Intrapulm shunt (pneumonia/edema)

97
Q

Marcus Gunn Pupil

A

Alternating constriction and dilation of both pupils with swinging flashlight test is characteristic of relative afferent pupillary defect with damage to optic nerve

-When penlight is directed into the eye on affected eye, pupils appear to dilate

98
Q

Hereditary Spherocytosis

A

Autosomal dominatn results in abnormalities in cytoskeleton of RBC–> pt presents with hemolytic anemia, jaundice, and splenomegaly (spherocytes on blood smear and positive osmotic fragility test)

99
Q

Elhers-Danlos Syndrome

A

-Type V collagen or Type 3 collegen
-Hyperextensible joints/ easy bruising
-Complications: Berry aneurysms–>SAH, MVP, hernias, Uterine rupture, retinal detachment

100
Q

Diabetic nephropathy

A

The basement membrane in glomeruli thickens and becomes more permeable to protein, Kimmelstein-wilson nodules–> mesangial expansion

101
Q

Dermatis herpetiformis

A

Papulovesicular,pruritic skin rash on elbows and knees; associated with celiac disease and involves development of IgA antibodies that react against gliadin and cause micro abscess formation at the dermal papillae tips

102
Q

Drug of choice to treat myasthenia gravis

A

-Pyridostigmine (AcH inhibitor) adverse effects of AcH inhibitors include increased salvation, lacrimation, miosis, diarrhea, urination, bradycardia, and bronchoconstriction

103
Q

Rotor Syndrome

A

Chronic conjugated and unconjugated hyperbilirubinemia
-altered ability to transport bilirubin glucuronides into bile canaliculi
-total urinary coproporphyrin excertion is increased

104
Q

Squamous cell lung carcinoma

A

Long smoking history, radiating flank pain, wt loss, and circular hilar mass on chest radigraph (central location)–> can lead to release of parathyroid hormone related protein leading to kidney stones

Histo shows Keratin pearls and intercellular bridges

105
Q

Acute HIV

A

Presents with fever, body rash, generalized lymphadenopathy, pharyngitis, and diarrhea

-HIV is an enveloped virus comprised of 2 molecules of ssRNA
-The reverse transcriptase enzyme an RNA dependent DNA poly is packaged in the virus particle, and upon entry into a CD4 T+ cell or macrophage is responsible for copying ssRNA into proviral dsDNA

106
Q

Nocardia

A

-Gram positive, weakly acid fast with a filamentous appearance—>cause pulm infections in immunocompromised pts and are treated with TMP-SMX

107
Q

Basal nucleus of meynert

A

Releases Ach which is invilved in learning, memory, and muscle movement

108
Q

Locus ceruleus

A

Norepinephrine

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