USMLE Rx: Week of 06/20/16 Flashcards
What renal hormone is secreted in response to vigorous exercise?
ADH
Describe Horner syndrome.
A superior lung tumor can press on the sympathetic chain ganglia and lead to ipsilateral ptosis and miosis (drooping of the eye)
What do teardrop cells indicate?
Primary myelofibrosis (the RBCs are crying tears when they get squeezed out of their home)
What renal syndrome can statins cause?
Acute tubular necrosis from rhabdomyolysis
Inspiration increases _________ heart sounds.
right heart sounds (because more blood enters the heart during inspiration)
Having patients stand up or Valsalva will decrease most heart murmurs except __________.
mitral valve prolapse and HOCM, which will increase because venous return is decreased; squatting does the opposite and increases most heart soudns
What peripheral cells are associated with CLL?
Smudge cells (those that lack any nucleus and look crushed; CLL = “crushed little lymphocytes”)
What does verrucous mean?
Wart-like
Those with ALL will often also have _________.
neutropenia
Renally, diabetes can cause ___________ which will lead to vesico-ureteral reflux and thence pyelonephritis.
neurogenic bladder
Those with sickle-cell trait can have episodic _________.
hematuria, because of micro-thrombi with the kidneys
The most common CF mutation causes defective _____________ processing.
ER
What can happen to the spleens of those with sickle cell?
Recurrent infarctions leading to shrunken size
Sickle cell can cause acute episodes of ________ due to clotting.
localized pain
Remember, those with sickle cell are given __________.
hydroxyurea, which induces more fetal hemoglobin
In terms of bone malignancies, ________ are more common.
metastases (as opposed to primary malignancies)
Malignancy should be highly suspect in people with elevated _________ levels and lytic bone lesions.
alkaline phosphatase
Hodgkin’s lymphoma usually presents with what type of node distribution?
Focal (meaning multiple lymph nodes in one area)
In addition to Reed-Sternberg cells, what histologic finding is characteristic of Hodgkin’s lymphoma?
Lacunar cells (with vacant area surrounding them)
Nodular sclerosing Hodgkin’s presents with what histologic pattern?
Thickened pink bands
List the characteristics of the vasculitis that often presents after hepatitis B infection.
Polyarteritis nodosa presents in young adults with transmural inflammation of the small and medium blood vessels, but this pattern spares the pulmonary vessels; fever; abdominal pain
Necrotic granulomas are found in the cardiac tissue of what heart condition?
Rheumatic heart disease; these are called Aschoff bodies which sometimes contain Anitschkow
What barrel-shaped fungus is endemic in the southwestern United States?
Coccidioidomycosis immitis
Aplastic anemia is not just depletion of RBCs, but rather ___________.
depletion of the entire range of hematopoietic cells
What enzyme is inhibited by lead poisoning?
Alpha-aminolevulinic acid dehydratase
Laminated, dystrophic spheres of calcification are called _____________.
psammoma bodies
Describe the causes and presentation of thrombotic thrombocytopenic purpura (TTP)?
Antibodies develop against ADAMTS13 metalloprotease. That enzyme cleaves vWF multimers; thus, without it vWF builds up and leads to microangiopathic hemolytic anemia. The presenting signs are FAT RN (fever, anemia, thrombocytopenia, renal failure, and neurologic disturbances)
What B-cell lymphomas express CD5?
Follicular, small lymphocytic lymphoma (aka CLL), and DLBCL
Importantly, follicular lymphoma and CLL can transform into DLBCL
How can you remember that the allantois becomes the median umbilical ligament?
Both have an N
Homocysteine and methylmalonic acid are both elevated in which anemia?
B12 deficiency (think that “B” deficiency causes Both to be elevated)
Intrinsic factor is needed to absorb which nutrient?
B12 (think of Biff from Back to the Future–he was crazy, just like how B12 deficiency can make you crazy… “B IF”)
Describe osteopetrosis.
A rare genetic disorder that leads to impaired osteoclasts; without normal resorption of bone, bone marrow gets excessively calcified with “woven bone”
Phrenic nerve damage leads to elevated diaphragm on the __________ side.
ipsilateral
What is the formula for dead space that uses tidal volume, expired CO2, and arterial CO2?
V(d) = V(t) x ([paCO2 - expCO2]/paCO2)
The axillary nerve branches off of the _______ nerve.
radial
Human T-cell lymphotrophic virus (HTLV) causes adult T-lymphocyte leukemia and what other illness?
A myelinopathy characterized by lower-extremity weakness and urinary incontinence
Recall that ATLL can present with ____________.
rashes, bone lesions, and hypercalcemia
Of HIV, HCV, and HBV, what is the order of infectability?
HBV, HCV, then HIV (from most to least infectious)
What is a renal complication of DIC?
Diffuse cortical necrosis (which can also be caused by sepsis and vasospasm)
What type of coronary syndrome can Kawasaki’s cause?
Aneurysms
What is the mechanism of heparin-induced thrombocytopenia?
The antibodies to PF-4 (the combination of heparin and its platelet receptor) activates platelets, exhausting their supply and leading to thrombocytopenia.
What is the main component of surfactant?
Phosphatidylcholine (think of CHOking without surfactant)
Which PFTs are decreased in COPD?
FVC
FEV
VC
** Remember, FEV is decreased more than FVC
What sounds will ASDs and VSDs produce?
ASD: loud S1 and fixed split S2
VSD: holosystolic murmur heard best over the tricuspid area
In what population is giant cell arteritis most common?
Elderly females
Those with giant cell arteritis often also have __________.
polymyalgia rheumatica
List some characteristics of polymyalgia rheumatica.
Aching joints
Increased inflammatory markers (ESR and CRP)
Rapid response to steroids
Describe the metabolic state that excessive diuretic use and cystic fibrosis can cause.
Both of these syndromes can cause contraction alkalosis, a condition in which volume is lost but bicarb is not. In the case of diuretics, Na and Cl are lost alongside fluid, but bicarb is not. In the case of CF, patients sweat excessively and cannot retain Cl, thus leading to a similar low-volume, high-bicarb state.
What are the relative speeds of conduction in the heart, as categorized by tissue?
His-Purkinje fibers are faster than sinoatrial node is faster than atrioventricular node
Transferrin will be high in ___________ states.
low-iron
If a patient has OSA, what metabolic consequence is likely?
Periods of respiratory acidosis leading to increased HCO3 retention in the kidneys
E. coli only produce lactose-digesting enzymes when they cannot metabolize glucose. Describe the mechanism by which this change occurs.
Allolactose binds to the inhibitor upstream of the lac operon, inhibiting it. Low glucose levels lead to increased cAMP levels (because glucose inhibits adenylate cyclase), and the increased cAMP levels activate the transcription promoters for the lac operon.
What pregnancy category is aspirin?
Safe (not sure what letter…)
Recall that ANCAs target ____________.
neutrophils
What disorder will have low fluorescence of dihydrorhodamine on assay?
Chronic granulomatous disorder
_________ syndrome will not lead to fat in the stool (also called steatorrhea).
Kartagener
What enzyme is defective in Pompe disease?
Alpha-1,4-glucosidase
What three labs are elevated in tumor lysis syndrome?
Phosphate, potassium, and urate
What drug is used to treat tumor lysis syndrome?
Allopurinol
What is cinchonism?
Headache and tinnitus
What is the most feared adverse effect of class I anti-arrhymthics?
Torsades de pointes
What step of meiosis is most often the cause of Down syndrome?
Anaphase I
What do antibodies target in pemphigus vulgaris and bullous pemphigoid?
Desmosomes and hemidesmosomes, respectively (bullous = bullow the epidermis)
