USMLE World 2 Flashcards
1
Q
pericarditis
A
complication of AMI (10-20%); sharp pleuritic chest pain irradiated to the neck (phrenic nerves), low fever, friction rub, fibrinous exudate, autoimmune reaction 6-8 weeks after AMI
2
Q
Libman-Sacks endocarditis
A
present in 25% os SLE; sterile valve vegetations, fibrosis; AMI can develop due to hypercoagulable antiphospholipid antibody syndrome present in 12-30% of SLE
3
Q
heart changes in hypertension
A
concentric ventricular hypertrophy without dilation and aortic insuficiency
4
Q
heart changes in AMI
A
dilated cardiomyopathy
5
Q
congenital QT prolongation syndrome
A
syncope in healthy young patients due to mutations in iK potassium channels + sensorineural deafness
6
Q
localized amyloidosis
A
cardiac atria –> ANP; thyroid –> calcitonin; brain –> beta amyloids; pituitary –> prolactin
7
Q
RCA thrombosis ECG
A
ST elevation in DI, DII and aVF plus sinus bradycardia
8
Q
transmural ischemia of septum ECG
A
ST elevation in V1, V2 and 3rd degree heart block
9
Q
ischemia of left anterior ventricle ECG
A
ST elevation in V3, V4
10
Q
occlusion of proximal LAD artery ECG
A
ST elevation in V1-V4
11
Q
ischemia of lateral wall of left ventricle on ECG
A
ST elevation in V5 and V6
12
Q
post MI causes of death
A
cardiogenic shock MCC; free ventricular wall rupture 2nd MCC
13
Q
hypertrophic cardiomyopathy
A
myofiber disarray + interstitial fibrosis due to mutations in genes encoding cardiac sarcomere proteins; 25% systolic anterior motion of the anterior leaflet of mitral valve which bulges into outflow tract —> systolic murmur
14
Q
diagnosis and Rx of Prinzmetal angina
A
Dx: ergonovine; Rx nitrates and CCBs
15
Q
normal aging heart changes
A
decreased left ventricular chamber, sigmoid shaped ventricular septum, myocyte atrophy with interstitial fibrosis, brownish lipofuscin pigment
16
Q
heart findings in hemochromatosis
A
dilated cardiomyopathy + hemosiderin granules in myocytes
17
Q
aortic stenosis
A
systolic pressure gradient between LV and aorta; “SAD” syncope, angina, dyspnea; MCC is senile calcification
18
Q
Kusmaul sign
A
paradoxical increase in jugular venous pressure with inspiration; diferential diagnosis: cardiac tamponade, restrictive cardiomyopathy, right failure, tricuspid stenosis, constrictive pericarditis
19
Q
Down syndrome heart findings
A
ostium primum ASD + mitral/tricuspid insuficiency
20
Q
suceptibility to infarction of different organs
A
CNS, myocardium, kidney, spleen, liver; spleen and liver have double blood supply
21
Q
pulsus paradoxus
A
exageration of the normal decrease in blood pressure on inspiration; radial pulse disappears in inspiration; cardiac tamponade
22
Q
cor pulmonale
A
dyspnea on exertion, right ventricular hypertrophy, sudden death
23
Q
pulmonary embolus
A
acute chest pain, dyspnea tachychardia, tachypnea, hypotension; MCC is DVT; perfusion defect without ventilation defect; lung collapse –> perfusion and ventilation defect
24
Q
Osler-Weber-Rendu
A
hereditary hemorrhagic telangiectasias, rupture causes epistaxis, GI bleeds, hematuria
25
dissecting aorta aneurysm
hematoma may compress branches of aortic arch --> hypertension in one limb, hypotension in the other
26
hemangioma types
cherry --> adults; strawberry --> kids; cavernous --> associated with VHL
27
migratory thrombophlebitis
pancreatic cancer
28
cystic hygroma
cavernous lymphangioma without luminal blood vessels in the neck or axila; Turner
29
Churge-Straus syndrome
adult onset asthma, eosinophilia, polyneuropathy, p-anca vasculitis
30
bronchiolitis obliterans
due to chronic transplant rejection; affects small airways; dyspnea, wheezing
31
acute rejection
perivascular infiltration of blood vessels with lymphocytes, macrophages and plasma cells
32
causes of pulmonary hypertension
COPD-induced hypoxic vasocronstriction; volume overload in CHF; idiopathic vasoconstriction
33
sarcoidosis associations
associated with high levels of vitamin D/hypercalcemia produced by macrophages
34
asbestosis
localized pleural thickening with calcifications of the lower lobes
35
silicosis
nodular densities and calcifications of the hilar nodes plus birefringent silica particles
36
pneumoconiosis
multiple discrete nodules prominent in upper lobes
37
ARDS
decreased lung compliance, increased work of breathing, V/Q mistmatch, normal pulmonary wedge pressure
38
fat embolism
acute onset of neurologic abnormalities, petechial rash and hypoxemia in traumatized patient; fat exits bone marrow to pulmonary microvessels; via capillary shunts to CNS and adhere to platelets causing thrombocytopenia
39
dermatomyositis
proximal muscle weakness, heliotrope rash, violaceous eruption on the knuckles; muscle lymphocytic infiltrate
40
hamartoma
benign and composed of fibrous and adipose tissue
41
Reid index
thickness of mucous gland layer / wall thickness > 0.4 --> chronic bronchitis
42
stages of pneumonia
red congestion (24 hours); red hepatization (3 days); gray hepatization
43
retrolental fibroplasia
retinal neovascularization due to O2 treatment in ARDS of newborn
44
pneumonia complication
absess due to lysosomal enzymes from neutrophils and macrophages
45
pneumothrorax
unilateral chest pain, hyperresonance and absent breath sounds; due to blebs, emphysema, trauma
46
causes of lung absess
MCC is aspiration of fusobacteria, peptostrep and bacteroides associated with seizures, alcoholism, anesthesia; bacterial pneumonia and sepsis
47
green discoloration of pus/sputum
due to heme-containing myeloperoxidase
48
NSAID-induced nephropathy
seen in chronic arthritis treated patients; reversible renal failure, papillary necrosis, chronic interstitial nephritis
49
multiple myeloma
easy fatigability due to anemia; constipation due to hypercalcemia; back pain due to osteoclast activating factor; azotemia; eosinophilic casts with bence-jones proteins
50
complication of nephrotic syndrome
loss of antithrombin III --> renal vein thrombosis --> varicocele
51
renal cell CA
arises from proximal tubule cells; MC is urothelial cancer --> painless hematuria, proximal tubule cells filled with glycogen and lipids
52
ethylene glycol intoxication (antifreeze)
acute renal failure, anion gap metabolic acidosis and calcium oxalate crystals in urine
53
glomerular membrane histology
fenestrated endothelium is selective for size; GBM has negative charge
54
acute tubular necrosis
oliguric stage --> volume retention, oliguria, anion gap metabolic acidosis, hyponatremia, hyperkalemia; recovery phase --> polyuria, hypernatremia, hypokalemia
55
microalbuminuria
30-300mg of albumin in 24-hour urine; first sign of diabetic nephropathy
56
crescents
glomerular parietal cells, monocytes, macrophages, abundant fibrin
57
muddy brown casts
pathognomonic for acute tubular necrosis
58
minimal change disease
loss of GBM negative charge; selective proteinuria consists of albumin and no IgG or alpha-2-macroglobulin
59
diabetic nephropathy
increased mesangial matrix, thickening of GBM and nodular glomerulosclerosis, hyaline arteriosclerosis
60
nephrotic syndrome
increased glomerular permeability --> proteinuria --> edema --> decreased effective blood volume --> increased ADH and aldosterone plus increased liver synthesis of proteins including lipoproteins
61
T cell ALL
mediastinal mass causes superior vena cava syndrome, dysphagia, dyspnea and throat pain
62
high EPO
obstructive sleep apnea, COPD, right-left shunts, high altitude
63
factor VIII
synthesized in the liver, stored in endothelial cells; desmopressin stimulates release
64
SLE pancytopenia
due to IgGs against RBCs
65
Factor V leiden
leads to less deactivation by protein C --> hypercoagulable state --> DVT/pulmonary thromboembolism
66
spherocytosis
increased MHCH is diagnostic
67
G6PDH deficiency inheritance
X-linked recessive
68
spherocytosis inheritance
autosomal dominant
69
vonWillenbrand inheritance
autosomal dominant with variable penetrance
70
pure red cell aplasia
normo anemia plus decreased reticulocytes; associated with thymoma and parvoB19
71
vonWillenbrand disease
vW factor is carrier for factor VIII --> increased BT and PTT
72
Reed-Sternberg cells
abundant cytoplasm bilobed or double nucleus surrounded by halo, inclusion-like eosinophilic nucleoli
73
sodium metobisulfate
induces sickling in sickle cell trait
74
lipoprotein lipase
synthesized by adipocytes, cardiac and skeletal muscle cells; deficiency leads to hypertriglyceridemia and acute pancreatitis
75
acute pancreatitis lab findings
hypocalcemia, macrocytosis, increased serum lipase and amylase
76
colon adenoma to carcinoma sequence
polyp (mutation of APC gene) --> large polyp (mutation of k-ras) --> malignant polyp (mutation of p53)
77
acute pancreatitis risk factors
gallstones, alcohol, ERCP, hypertriglyceridemia, hypercalcemia
78
complication of Crohn's disease
gallstones due to loss of enterohepatic circulation and increased cholesterol/bile acid ratio; also oxalate stones due to increased absorption of dietary oxalate because calcium is flushed with lipids and doesn’t bind oxalate
79
zollinger ellison
ulcers at distal duodenum, diarrhea due to inactivation of lipases by gastric acid
80
Whipple disease
PAS+ macrophages with rods
81
PAS stain
stains carbon-carbon bonds bright pink
82
colon cancer marker
CEA to detect recurrence after resection
83
MC site of colon adenocarcinoma
ascending colon; rectosigmoid is 2nd MC site
84
duodenal Vs. gastric ulcer pain characteristics
duodenal --> pain 2-4 hours after food or before eating relieved by food and antacids; gastric ulcer --> pain inmediately after eating not relieved by antacids
85
pseudocyst Vs. cyst
pseudocyst is complication of acute pancreatitis; wall is composed of granulation tissue and fibrosis (not epithelium like true cyst)
86
causes of malabsorption
cystic fibrosis, chronic pancreatitis, celiac sprue, whipple, Crohns, diverticulosis, diabetic neuropathy
87
screening test for malabsorption
sudan stain stains fat in stools
88
consequences of malabsorption
ADEK deficiency; petechiae (vit K), bone pain and tetany (vit D), muscle wasting and edema (protein waste), hyperkeratosis (vit A)
89
false Vs. true diverticula
false --> mucosa and submucosa only, acquired, pulsion; true --> also muscular layer, congenital, traction
90
Reye syndrome
viral infection + aspirin --> vomiting, hepatomegaly, increased AST, ALT, hyperamonemia with encephalopathy, liver microvesicular steatosis without necrosis
91
acalculous cholecystitis
inflamation of gallbladder without stones due to sepsis, immunosupression, trauma, diabetes
92
formation of cholesterol gallstones
cholesterol precipitation --> stones; phosphatidylcholine and bile salts --> solubility
93
HBV damage to liver
no cytopathic effect; HBsAg and HBcAg stimulate CD8 cytotoxicity
94
halothane hepatotoxicity
fulminant, liver shrinks, increased AST, ALT and PT, eosinophilia; histologically the same as hepatitis
95
ceruloplasmin
globulin that accounts for 95% of circulating copper; copper is eliminated in bile
96
echinococcus cysts
mass in the liver; aspiration can cause anaphylaxis
97
cavernous hemangioma
MC benign liver tumor; Rx with resection, no biopsy
98
MCC of liver malignancy
metastasis is MCC > HCC
99
gallbladder hypomotility
due to pregnancy, weight loss, parenteral nutrition, octeotride --> billiary sludge --> stones/cholecystitis
100
types of gallstones
yellow --> cholesterol; brown --> billiary infection; black --> hemolysis
101
porcelain gallbladder
calcifications associated with carcinoma
102
outcome of hepatitis B infection
complete resolution (95%); chronic hepatitis/cirrhosis/HCC (4-5%); fulminant hepatitis (<1%)
103
gallbladder changes in pregnancy
estrogen-induced cholesterol hypersecretion and progesterone-induced hypomotility --> gallstones
104
ulcer erosions
penetrate submucosa, inner and outer muscular but not muscularis mucosa
105
abetalipoproteinemia
no apoB for chylomicrons --> lipid accumulation makes epithelium look foamy --> no lipids in blood, acanthocytes, ataxia and retinitis pigmentosa
106
polyps with adenocarcinoma potential
adenomatous polyps and specially villous adenomatous
107
squamous cell CA of esophagus
keratin pearls look like fibrosis
108
adenomatous polyps
villous adenomas --> large, sessile, dysplastic --> bleeding, secretory diarrhea and partial obstruction
109
anal fissures
90% are found in posterior midline distal to dentate line; due to low fiber diet and constipation
110
effect of atherosclerosis on stomach
can affect gastric branches of celiac trunk --> epigastric pain 30 minutes after eating
111
ischemic colitis
affects splenic angle because it lies between SMA and IMA areas of perfusion
112
HAV infection
low grade fever, anorexia, nausea, coluria, RUQ tenderness, hepatocyte swelling, mononuclear infiltrate, councilman apoptotic bodies
113
ascending cholangitis Vs. hepatic absess
enteric bacteria (ascending) or staph (hematogenous)
114
HBV Vs. HCV histology
HBV --> granular cytoplasmic inclusions; HCV --> lymphoid aggregates and steatosis
115
billiary atresia
congenital obstruction of bile ducts --> clay stools, coluria, hepatomegaly, conjugated hyperbilirubinemia
116
primary billiary cirrhosis
pruritus, increased liver alkaline phosphatase
117
aflatoxins
HCC due to mutation of p53
118
gallstone ileus
large stone passes through fistula into ileum and allows air to pass into billiary tree
119
Wernicke encephalopathy
confusion, ataxia, ocular abnormalities; Rx thiamine
120
Korsakoff confabulation psychosis
damage to medial dorsal nucleus and/or mamillary bodies of thalamus
121
Alzheimer's biochemistry
decreased ACh in basal nucleus of Meynert and hippocampus
122
alcohol changes in brain
upregulation of GABAa receptors and NMDA receptors; increased DA, 5HT and NE
123
complications of subarrachnoid hemorrhage
vasospasm (treat with nimodipine) and rebleeding
124
transtentorial herniation
uncus of temporal lobe herniated through tentorium --> compression of CN III, PCA and corticospinal tract
125
MC extracranial childhood cancer
neuroblastoma associated with N-myc; retroperitoneal mass, episodic hypertension, neuroblast is malignant cell
126
SSPE
complication of measles; anti-measles antibodies in CSF, no anti-M protein antibodies
127
meningioma histology
psamoma bodies in brain tumor --> meningioma
128
Schwanoma marker
S100
129
Pick's disease
pronounced atrophy of frontal lobes, progressive dementia, behavioral dishinibition, dysarthria, aphasia, primitive reflexes
130
Charcot-Bouchard aneurysms
associated with hypertension; found in small arteries of basal ganglia; rupture --> intraparenchymal hemorrhage and focal deficits
131
berry aneurysms
associated with APCKD, Marfan, ED; anterior cerebral arteries most affected; leads to subarachnoid hemorrhage
132
hypoxic encephalopathy
wedge-shaped areas of necrosis on the surface of cerebral convexities and lateral to interhemispheric fissure; due to cardiogenic shock or shock; affects hyppocampus first
133
pontine myelinolysis
too fast correction of hypernatremia; spastic quadriplegia and pseudobulbar palsy
134
stroke scar
cystic cavity surrounded by wall of astrocytes
135
Creutzfeld-Jakob
rapidly progressive dementia and myoclonus; vacuoles in gray matter looks like sponge; due to prion
136
normal pressure hydrocephalus
urinary incontinence, ataxia and progressive dementia
137
Friederich ataxia
triple repeat mutation; spinocerebellar tract degeneration (ataxia), degeneration of dorsal columns, kyphoscoliosis, hypertrophic cardiomyopathy, diabetes
138
lacunar infarcts
small ischemic infarcts involving basal ganglia, pons, internal capsule; due to hypertensive arteriosclerosis of small penetrating arterioles
139
ischemic stroke changes
red neurons (48 hours); neutrophils (72 hours); macrophages (5 days); gliosis/angiogenesis (2 weeks); glial scar (>2 weeks)
140
Arnold-Chiari malformation
small posterior fossa results in herniation of medulla and cerebellum through foramen magnum
141
multiple sclerosis
demyelination, decreased oligodendrocytes, lipid-ladden macrophages, astrocytosis, lymphocytic inflamation
142
CN III diabetic neuropathy
only affects somatic fibers sparing parasympathetic due to different blood supply
143
cerebellar masses
mostly in children; astrocytoma or meduloblastoma
144
tumor associated with myasthenia gravis
thymoma
145
tumor associated with Lambert-Eaton
lung cancer
146
vitamin E deficiency
affects dorsal column and spinocerebeallar tracts; mimics Friederich ataxia
147
temporal lobe encephalitis
aphasia, olfactory abnormalities, personality changes; due to HSV-1
148
myotonic dystrophy
triple repeat mutation, sustained muscle contraction (myotonia) with muscular weakness and atrophy; cataracts, baldness, gonadal atrophy
149
cerebral amyloid angiopathy
recurrent hemorrhagic strokes
150
Duchene
x-linked recessive; fibrofatty muscle replacement
151
diabetic neuropathy
due to osmotic damage to axons and Schwann cells and microangiopathy of endoneural arterioles
152
lead poisoning tratment
dimecarpol, EDTA; heavy metal chelators
153
cystic tumors in cerebellum
pilocytic astrocytoma mostly in kids
154
Meniere
tinitus, vertigo, hearing loss; too much endolymph
155
pretibial myxedema
non-pitting myxedema and thickening of skin around tibia in Graves disease
156
craniopharyngioma
remnant of Rathke's pouch bulges into 3rd ventricle; cystic solid mass with calcifications; headaches, visual deficits and hypopituitarism
157
hypoglycemia in neonate of diabetic mother
mother's hyperglycemia induces islet hyperplasia with increased insulin production
158
mechanism of amenorrhea in anorexia
low body fat fails to induce pulsatile secretion of GnRH; also seen in cachexia and athletes
159
psamoma bodies
concentric calcified structures; pathognomonic for papillary thyroid CA and meningioma
160
pituitary apoplexy
acute bleeding into a preexisting pituitary adenoma; bitemporal hemianopia, sudden headache; complication is cardiovascular collapse due to adrenocortical insuficiency
161
type II diabetes associations
amyloid deposition in beta cells
162
seminoma
increases hCG which is similar to TSH and can cause hyperthyroidism
163
MCC of death in diabetics
AMI
164
primary hyperaldosteronism
hypokalemic metabolic alkalosis with hypertension and normal [Na] because of compensatory natriuresis
165
medullary thyroid carcinoma histology
polygonal or spindle-shaped cells with extracellular amyloid deposits seen with congo red
166
glucagonoma
necrolytic migratory erythema rash and hyperglycemia
167
MEN III
medullary thyroid carcinoma, pheochromocytoma, mucosal neuromas and marfanoid habitus
168
ret gene
MEN
169
fibromyalgia
stiffness, pain, poor sleep, emotional disturbance; pain and stiffness gets worst with exercise; tender spots over multiple joints
170
osteoporosis histology
thin trabecula
171
osteopetrosis histology
unmineralized spongiosa
172
Paget's histology
focal formation of bone
173
vitamin D deficiency histology
unmineralized osteoid
174
hyperPTH histology
cystic degeneration of bones
175
pseudogout
weakly birefringent rhomboid-shaped calcium pyrophosphate crystals
176
wound contracture
myofibroblasts + metalloproteinases in excess
177
parvovirus B19 associations
slapped cheek rash and can cause self-limiting arthritis-like disease, pure red cell aplasia; aplastic anemia in sickle cell patients
178
digital clubbing
associated with prolonged hypoxia in COPD patients
179
gout
deposition of monosodium urate crystals that are negativley birefringent
180
presbyiopia
sclerosis of the lens
181
cause of skin wrinckles
decreased collagen and increased elastases and collagenases
182
actinic keratosis
erythematous papules with central scale and sandpaper texture with acanthosis, parakeratosis and hyperkeratosis
183
acanthosis
thick epidermis
184
parakeratosis
nuclei in stratum corneum
185
hyperkeratosis
thick corneum
186
acanthosis nigricans
associated with insulin resistant states (DM, acromegaly, obesity) as well as GI cancer
187
avascular necrosis of femoral head
associated with sickle cell, lupus and high-dose steroid therapy
188
atopic dermatitis
also called eczema; pruritus, erythematous papules; associated with allergens, asthma and rhinitis
189
hypercalcemia in sarcoidosis
due to increased 1,25vitD by macrophages
190
shaken baby syndrome
retinal hemorrhages + subdural hematoma; report child abuse
191
rheumatoid arthritis
does not involve DIP joints; stiffness lasts more than 30 minutes
192
osteoarthritis
can have morning stiffness < 30 minutes and subcutaneous nodules; can involve DIP joints
193
dermatomyositis
heliotrope rash and papules in the MCP, PIP and DIP joints
194
osteomyelitis
affects long bone metaphysis
195
retinoblastoma
associated with osteosarcoma
196
contact dermatitis
spongiosis
197
psoriasis
reduced stratum granulosum, parakeratosis, acanthosis and dividing cells in epidermis
198
seborrheic keratosis
benign epidermal tumor, tan , flat, round, greasy, coin-like stuck on appearance
199
acute interstitial nephritis
due to drug allergy; fever, acute renal failure, maculopapular rash and eosinophiluria
200
cysteine stone crystals
hexagonal crystals, acid urine, recurrent stones at young age, positive cyanide-nitroprusside test
201
papillary necrosis
sickle cell patients or carriers; acute colic pain, gross hematuria, passage of tissue fragments in urine
202
hydronephrosis
due to prolonged urinary obstruction in nephrolithiasis, tumor, anatomic defects, neurogenic bladder, BPH; atrophy of cortex with scarring and interstitial fibrosis with inflamation
203
most important mediator of sepsis
TNF alpha
204
cryptorchidia
decreases inhibin with increased FSH and normal LH/testosterone; remove testis to prevent malignancy
