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Step 1 Complete > USMLE World 2 > Flashcards

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

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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

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3
Q

heart changes in hypertension

A

concentric ventricular hypertrophy without dilation and aortic insuficiency

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4
Q

heart changes in AMI

A

dilated cardiomyopathy

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5
Q

congenital QT prolongation syndrome

A

syncope in healthy young patients due to mutations in iK potassium channels + sensorineural deafness

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6
Q

localized amyloidosis

A

cardiac atria –> ANP; thyroid –> calcitonin; brain –> beta amyloids; pituitary –> prolactin

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7
Q

RCA thrombosis ECG

A

ST elevation in DI, DII and aVF plus sinus bradycardia

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8
Q

transmural ischemia of septum ECG

A

ST elevation in V1, V2 and 3rd degree heart block

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9
Q

ischemia of left anterior ventricle ECG

A

ST elevation in V3, V4

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10
Q

occlusion of proximal LAD artery ECG

A

ST elevation in V1-V4

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11
Q

ischemia of lateral wall of left ventricle on ECG

A

ST elevation in V5 and V6

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12
Q

post MI causes of death

A

cardiogenic shock MCC; free ventricular wall rupture 2nd MCC

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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

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14
Q

diagnosis and Rx of Prinzmetal angina

A

Dx: ergonovine; Rx nitrates and CCBs

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15
Q

normal aging heart changes

A

decreased left ventricular chamber, sigmoid shaped ventricular septum, myocyte atrophy with interstitial fibrosis, brownish lipofuscin pigment

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16
Q

heart findings in hemochromatosis

A

dilated cardiomyopathy + hemosiderin granules in myocytes

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17
Q

aortic stenosis

A

systolic pressure gradient between LV and aorta; “SAD” syncope, angina, dyspnea; MCC is senile calcification

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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

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19
Q

Down syndrome heart findings

A

ostium primum ASD + mitral/tricuspid insuficiency

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20
Q

suceptibility to infarction of different organs

A

CNS, myocardium, kidney, spleen, liver; spleen and liver have double blood supply

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21
Q

pulsus paradoxus

A

exageration of the normal decrease in blood pressure on inspiration; radial pulse disappears in inspiration; cardiac tamponade

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22
Q

cor pulmonale

A

dyspnea on exertion, right ventricular hypertrophy, sudden death

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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

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24
Q

Osler-Weber-Rendu

A

hereditary hemorrhagic telangiectasias, rupture causes epistaxis, GI bleeds, hematuria

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25
Q

dissecting aorta aneurysm

A

hematoma may compress branches of aortic arch –> hypertension in one limb, hypotension in the other

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26
Q

hemangioma types

A

cherry –> adults; strawberry –> kids; cavernous –> associated with VHL

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27
Q

migratory thrombophlebitis

A

pancreatic cancer

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28
Q

cystic hygroma

A

cavernous lymphangioma without luminal blood vessels in the neck or axila; Turner

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29
Q

Churge-Straus syndrome

A

adult onset asthma, eosinophilia, polyneuropathy, p-anca vasculitis

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30
Q

bronchiolitis obliterans

A

due to chronic transplant rejection; affects small airways; dyspnea, wheezing

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31
Q

acute rejection

A

perivascular infiltration of blood vessels with lymphocytes, macrophages and plasma cells

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32
Q

causes of pulmonary hypertension

A

COPD-induced hypoxic vasocronstriction; volume overload in CHF; idiopathic vasoconstriction

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33
Q

sarcoidosis associations

A

associated with high levels of vitamin D/hypercalcemia produced by macrophages

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34
Q

asbestosis

A

localized pleural thickening with calcifications of the lower lobes

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35
Q

silicosis

A

nodular densities and calcifications of the hilar nodes plus birefringent silica particles

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36
Q

pneumoconiosis

A

multiple discrete nodules prominent in upper lobes

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37
Q

ARDS

A

decreased lung compliance, increased work of breathing, V/Q mistmatch, normal pulmonary wedge pressure

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38
Q

fat embolism

A

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

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39
Q

dermatomyositis

A

proximal muscle weakness, heliotrope rash, violaceous eruption on the knuckles; muscle lymphocytic infiltrate

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40
Q

hamartoma

A

benign and composed of fibrous and adipose tissue

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41
Q

Reid index

A

thickness of mucous gland layer / wall thickness > 0.4 –> chronic bronchitis

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42
Q

stages of pneumonia

A

red congestion (24 hours); red hepatization (3 days); gray hepatization

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43
Q

retrolental fibroplasia

A

retinal neovascularization due to O2 treatment in ARDS of newborn

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44
Q

pneumonia complication

A

absess due to lysosomal enzymes from neutrophils and macrophages

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45
Q

pneumothrorax

A

unilateral chest pain, hyperresonance and absent breath sounds; due to blebs, emphysema, trauma

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46
Q

causes of lung absess

A

MCC is aspiration of fusobacteria, peptostrep and bacteroides associated with seizures, alcoholism, anesthesia; bacterial pneumonia and sepsis

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47
Q

green discoloration of pus/sputum

A

due to heme-containing myeloperoxidase

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48
Q

NSAID-induced nephropathy

A

seen in chronic arthritis treated patients; reversible renal failure, papillary necrosis, chronic interstitial nephritis

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49
Q

multiple myeloma

A

easy fatigability due to anemia; constipation due to hypercalcemia; back pain due to osteoclast activating factor; azotemia; eosinophilic casts with bence-jones proteins

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50
Q

complication of nephrotic syndrome

A

loss of antithrombin III –> renal vein thrombosis –> varicocele

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51
Q

renal cell CA

A

arises from proximal tubule cells; MC is urothelial cancer –> painless hematuria, proximal tubule cells filled with glycogen and lipids

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52
Q

ethylene glycol intoxication (antifreeze)

A

acute renal failure, anion gap metabolic acidosis and calcium oxalate crystals in urine

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53
Q

glomerular membrane histology

A

fenestrated endothelium is selective for size; GBM has negative charge

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54
Q

acute tubular necrosis

A

oliguric stage –> volume retention, oliguria, anion gap metabolic acidosis, hyponatremia, hyperkalemia; recovery phase –> polyuria, hypernatremia, hypokalemia

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55
Q

microalbuminuria

A

30-300mg of albumin in 24-hour urine; first sign of diabetic nephropathy

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56
Q

crescents

A

glomerular parietal cells, monocytes, macrophages, abundant fibrin

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57
Q

muddy brown casts

A

pathognomonic for acute tubular necrosis

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58
Q

minimal change disease

A

loss of GBM negative charge; selective proteinuria consists of albumin and no IgG or alpha-2-macroglobulin

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59
Q

diabetic nephropathy

A

increased mesangial matrix, thickening of GBM and nodular glomerulosclerosis, hyaline arteriosclerosis

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60
Q

nephrotic syndrome

A

increased glomerular permeability –> proteinuria –> edema –> decreased effective blood volume –> increased ADH and aldosterone plus increased liver synthesis of proteins including lipoproteins

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61
Q

T cell ALL

A

mediastinal mass causes superior vena cava syndrome, dysphagia, dyspnea and throat pain

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62
Q

high EPO

A

obstructive sleep apnea, COPD, right-left shunts, high altitude

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63
Q

factor VIII

A

synthesized in the liver, stored in endothelial cells; desmopressin stimulates release

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64
Q

SLE pancytopenia

A

due to IgGs against RBCs

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65
Q

Factor V leiden

A

leads to less deactivation by protein C –> hypercoagulable state –> DVT/pulmonary thromboembolism

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66
Q

spherocytosis

A

increased MHCH is diagnostic

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67
Q

G6PDH deficiency inheritance

A

X-linked recessive

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68
Q

spherocytosis inheritance

A

autosomal dominant

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69
Q

vonWillenbrand inheritance

A

autosomal dominant with variable penetrance

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70
Q

pure red cell aplasia

A

normo anemia plus decreased reticulocytes; associated with thymoma and parvoB19

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71
Q

vonWillenbrand disease

A

vW factor is carrier for factor VIII –> increased BT and PTT

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72
Q

Reed-Sternberg cells

A

abundant cytoplasm bilobed or double nucleus surrounded by halo, inclusion-like eosinophilic nucleoli

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73
Q

sodium metobisulfate

A

induces sickling in sickle cell trait

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74
Q

lipoprotein lipase

A

synthesized by adipocytes, cardiac and skeletal muscle cells; deficiency leads to hypertriglyceridemia and acute pancreatitis

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75
Q

acute pancreatitis lab findings

A

hypocalcemia, macrocytosis, increased serum lipase and amylase

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76
Q

colon adenoma to carcinoma sequence

A

polyp (mutation of APC gene) –> large polyp (mutation of k-ras) –> malignant polyp (mutation of p53)

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77
Q

acute pancreatitis risk factors

A

gallstones, alcohol, ERCP, hypertriglyceridemia, hypercalcemia

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78
Q

complication of Crohn’s disease

A

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

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79
Q

zollinger ellison

A

ulcers at distal duodenum, diarrhea due to inactivation of lipases by gastric acid

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80
Q

Whipple disease

A

PAS+ macrophages with rods

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81
Q

PAS stain

A

stains carbon-carbon bonds bright pink

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82
Q

colon cancer marker

A

CEA to detect recurrence after resection

83
Q

MC site of colon adenocarcinoma

A

ascending colon; rectosigmoid is 2nd MC site

84
Q

duodenal Vs. gastric ulcer pain characteristics

A

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
Q

pseudocyst Vs. cyst

A

pseudocyst is complication of acute pancreatitis; wall is composed of granulation tissue and fibrosis (not epithelium like true cyst)

86
Q

causes of malabsorption

A

cystic fibrosis, chronic pancreatitis, celiac sprue, whipple, Crohns, diverticulosis, diabetic neuropathy

87
Q

screening test for malabsorption

A

sudan stain stains fat in stools

88
Q

consequences of malabsorption

A

ADEK deficiency; petechiae (vit K), bone pain and tetany (vit D), muscle wasting and edema (protein waste), hyperkeratosis (vit A)

89
Q

false Vs. true diverticula

A

false –> mucosa and submucosa only, acquired, pulsion; true –> also muscular layer, congenital, traction

90
Q

Reye syndrome

A

viral infection + aspirin –> vomiting, hepatomegaly, increased AST, ALT, hyperamonemia with encephalopathy, liver microvesicular steatosis without necrosis

91
Q

acalculous cholecystitis

A

inflamation of gallbladder without stones due to sepsis, immunosupression, trauma, diabetes

92
Q

formation of cholesterol gallstones

A

cholesterol precipitation –> stones; phosphatidylcholine and bile salts –> solubility

93
Q

HBV damage to liver

A

no cytopathic effect; HBsAg and HBcAg stimulate CD8 cytotoxicity

94
Q

halothane hepatotoxicity

A

fulminant, liver shrinks, increased AST, ALT and PT, eosinophilia; histologically the same as hepatitis

95
Q

ceruloplasmin

A

globulin that accounts for 95% of circulating copper; copper is eliminated in bile

96
Q

echinococcus cysts

A

mass in the liver; aspiration can cause anaphylaxis

97
Q

cavernous hemangioma

A

MC benign liver tumor; Rx with resection, no biopsy

98
Q

MCC of liver malignancy

A

metastasis is MCC > HCC

99
Q

gallbladder hypomotility

A

due to pregnancy, weight loss, parenteral nutrition, octeotride –> billiary sludge –> stones/cholecystitis

100
Q

types of gallstones

A

yellow –> cholesterol; brown –> billiary infection; black –> hemolysis

101
Q

porcelain gallbladder

A

calcifications associated with carcinoma

102
Q

outcome of hepatitis B infection

A

complete resolution (95%); chronic hepatitis/cirrhosis/HCC (4-5%); fulminant hepatitis (<1%)

103
Q

gallbladder changes in pregnancy

A

estrogen-induced cholesterol hypersecretion and progesterone-induced hypomotility –> gallstones

104
Q

ulcer erosions

A

penetrate submucosa, inner and outer muscular but not muscularis mucosa

105
Q

abetalipoproteinemia

A

no apoB for chylomicrons –> lipid accumulation makes epithelium look foamy –> no lipids in blood, acanthocytes, ataxia and retinitis pigmentosa

106
Q

polyps with adenocarcinoma potential

A

adenomatous polyps and specially villous adenomatous

107
Q

squamous cell CA of esophagus

A

keratin pearls look like fibrosis

108
Q

adenomatous polyps

A

villous adenomas –> large, sessile, dysplastic –> bleeding, secretory diarrhea and partial obstruction

109
Q

anal fissures

A

90% are found in posterior midline distal to dentate line; due to low fiber diet and constipation

110
Q

effect of atherosclerosis on stomach

A

can affect gastric branches of celiac trunk –> epigastric pain 30 minutes after eating

111
Q

ischemic colitis

A

affects splenic angle because it lies between SMA and IMA areas of perfusion

112
Q

HAV infection

A

low grade fever, anorexia, nausea, coluria, RUQ tenderness, hepatocyte swelling, mononuclear infiltrate, councilman apoptotic bodies

113
Q

ascending cholangitis Vs. hepatic absess

A

enteric bacteria (ascending) or staph (hematogenous)

114
Q

HBV Vs. HCV histology

A

HBV –> granular cytoplasmic inclusions; HCV –> lymphoid aggregates and steatosis

115
Q

billiary atresia

A

congenital obstruction of bile ducts –> clay stools, coluria, hepatomegaly, conjugated hyperbilirubinemia

116
Q

primary billiary cirrhosis

A

pruritus, increased liver alkaline phosphatase

117
Q

aflatoxins

A

HCC due to mutation of p53

118
Q

gallstone ileus

A

large stone passes through fistula into ileum and allows air to pass into billiary tree

119
Q

Wernicke encephalopathy

A

confusion, ataxia, ocular abnormalities; Rx thiamine

120
Q

Korsakoff confabulation psychosis

A

damage to medial dorsal nucleus and/or mamillary bodies of thalamus

121
Q

Alzheimer’s biochemistry

A

decreased ACh in basal nucleus of Meynert and hippocampus

122
Q

alcohol changes in brain

A

upregulation of GABAa receptors and NMDA receptors; increased DA, 5HT and NE

123
Q

complications of subarrachnoid hemorrhage

A

vasospasm (treat with nimodipine) and rebleeding

124
Q

transtentorial herniation

A

uncus of temporal lobe herniated through tentorium –> compression of CN III, PCA and corticospinal tract

125
Q

MC extracranial childhood cancer

A

neuroblastoma associated with N-myc; retroperitoneal mass, episodic hypertension, neuroblast is malignant cell

126
Q

SSPE

A

complication of measles; anti-measles antibodies in CSF, no anti-M protein antibodies

127
Q

meningioma histology

A

psamoma bodies in brain tumor –> meningioma

128
Q

Schwanoma marker

A

S100

129
Q

Pick’s disease

A

pronounced atrophy of frontal lobes, progressive dementia, behavioral dishinibition, dysarthria, aphasia, primitive reflexes

130
Q

Charcot-Bouchard aneurysms

A

associated with hypertension; found in small arteries of basal ganglia; rupture –> intraparenchymal hemorrhage and focal deficits

131
Q

berry aneurysms

A

associated with APCKD, Marfan, ED; anterior cerebral arteries most affected; leads to subarachnoid hemorrhage

132
Q

hypoxic encephalopathy

A

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
Q

pontine myelinolysis

A

too fast correction of hypernatremia; spastic quadriplegia and pseudobulbar palsy

134
Q

stroke scar

A

cystic cavity surrounded by wall of astrocytes

135
Q

Creutzfeld-Jakob

A

rapidly progressive dementia and myoclonus; vacuoles in gray matter looks like sponge; due to prion

136
Q

normal pressure hydrocephalus

A

urinary incontinence, ataxia and progressive dementia

137
Q

Friederich ataxia

A

triple repeat mutation; spinocerebellar tract degeneration (ataxia), degeneration of dorsal columns, kyphoscoliosis, hypertrophic cardiomyopathy, diabetes

138
Q

lacunar infarcts

A

small ischemic infarcts involving basal ganglia, pons, internal capsule; due to hypertensive arteriosclerosis of small penetrating arterioles

139
Q

ischemic stroke changes

A

red neurons (48 hours); neutrophils (72 hours); macrophages (5 days); gliosis/angiogenesis (2 weeks); glial scar (>2 weeks)

140
Q

Arnold-Chiari malformation

A

small posterior fossa results in herniation of medulla and cerebellum through foramen magnum

141
Q

multiple sclerosis

A

demyelination, decreased oligodendrocytes, lipid-ladden macrophages, astrocytosis, lymphocytic inflamation

142
Q

CN III diabetic neuropathy

A

only affects somatic fibers sparing parasympathetic due to different blood supply

143
Q

cerebellar masses

A

mostly in children; astrocytoma or meduloblastoma

144
Q

tumor associated with myasthenia gravis

A

thymoma

145
Q

tumor associated with Lambert-Eaton

A

lung cancer

146
Q

vitamin E deficiency

A

affects dorsal column and spinocerebeallar tracts; mimics Friederich ataxia

147
Q

temporal lobe encephalitis

A

aphasia, olfactory abnormalities, personality changes; due to HSV-1

148
Q

myotonic dystrophy

A

triple repeat mutation, sustained muscle contraction (myotonia) with muscular weakness and atrophy; cataracts, baldness, gonadal atrophy

149
Q

cerebral amyloid angiopathy

A

recurrent hemorrhagic strokes

150
Q

Duchene

A

x-linked recessive; fibrofatty muscle replacement

151
Q

diabetic neuropathy

A

due to osmotic damage to axons and Schwann cells and microangiopathy of endoneural arterioles

152
Q

lead poisoning tratment

A

dimecarpol, EDTA; heavy metal chelators

153
Q

cystic tumors in cerebellum

A

pilocytic astrocytoma mostly in kids

154
Q

Meniere

A

tinitus, vertigo, hearing loss; too much endolymph

155
Q

pretibial myxedema

A

non-pitting myxedema and thickening of skin around tibia in Graves disease

156
Q

craniopharyngioma

A

remnant of Rathke’s pouch bulges into 3rd ventricle; cystic solid mass with calcifications; headaches, visual deficits and hypopituitarism

157
Q

hypoglycemia in neonate of diabetic mother

A

mother’s hyperglycemia induces islet hyperplasia with increased insulin production

158
Q

mechanism of amenorrhea in anorexia

A

low body fat fails to induce pulsatile secretion of GnRH; also seen in cachexia and athletes

159
Q

psamoma bodies

A

concentric calcified structures; pathognomonic for papillary thyroid CA and meningioma

160
Q

pituitary apoplexy

A

acute bleeding into a preexisting pituitary adenoma; bitemporal hemianopia, sudden headache; complication is cardiovascular collapse due to adrenocortical insuficiency

161
Q

type II diabetes associations

A

amyloid deposition in beta cells

162
Q

seminoma

A

increases hCG which is similar to TSH and can cause hyperthyroidism

163
Q

MCC of death in diabetics

A

AMI

164
Q

primary hyperaldosteronism

A

hypokalemic metabolic alkalosis with hypertension and normal [Na] because of compensatory natriuresis

165
Q

medullary thyroid carcinoma histology

A

polygonal or spindle-shaped cells with extracellular amyloid deposits seen with congo red

166
Q

glucagonoma

A

necrolytic migratory erythema rash and hyperglycemia

167
Q

MEN III

A

medullary thyroid carcinoma, pheochromocytoma, mucosal neuromas and marfanoid habitus

168
Q

ret gene

A

MEN

169
Q

fibromyalgia

A

stiffness, pain, poor sleep, emotional disturbance; pain and stiffness gets worst with exercise; tender spots over multiple joints

170
Q

osteoporosis histology

A

thin trabecula

171
Q

osteopetrosis histology

A

unmineralized spongiosa

172
Q

Paget’s histology

A

focal formation of bone

173
Q

vitamin D deficiency histology

A

unmineralized osteoid

174
Q

hyperPTH histology

A

cystic degeneration of bones

175
Q

pseudogout

A

weakly birefringent rhomboid-shaped calcium pyrophosphate crystals

176
Q

wound contracture

A

myofibroblasts + metalloproteinases in excess

177
Q

parvovirus B19 associations

A

slapped cheek rash and can cause self-limiting arthritis-like disease, pure red cell aplasia; aplastic anemia in sickle cell patients

178
Q

digital clubbing

A

associated with prolonged hypoxia in COPD patients

179
Q

gout

A

deposition of monosodium urate crystals that are negativley birefringent

180
Q

presbyiopia

A

sclerosis of the lens

181
Q

cause of skin wrinckles

A

decreased collagen and increased elastases and collagenases

182
Q

actinic keratosis

A

erythematous papules with central scale and sandpaper texture with acanthosis, parakeratosis and hyperkeratosis

183
Q

acanthosis

A

thick epidermis

184
Q

parakeratosis

A

nuclei in stratum corneum

185
Q

hyperkeratosis

A

thick corneum

186
Q

acanthosis nigricans

A

associated with insulin resistant states (DM, acromegaly, obesity) as well as GI cancer

187
Q

avascular necrosis of femoral head

A

associated with sickle cell, lupus and high-dose steroid therapy

188
Q

atopic dermatitis

A

also called eczema; pruritus, erythematous papules; associated with allergens, asthma and rhinitis

189
Q

hypercalcemia in sarcoidosis

A

due to increased 1,25vitD by macrophages

190
Q

shaken baby syndrome

A

retinal hemorrhages + subdural hematoma; report child abuse

191
Q

rheumatoid arthritis

A

does not involve DIP joints; stiffness lasts more than 30 minutes

192
Q

osteoarthritis

A

can have morning stiffness < 30 minutes and subcutaneous nodules; can involve DIP joints

193
Q

dermatomyositis

A

heliotrope rash and papules in the MCP, PIP and DIP joints

194
Q

osteomyelitis

A

affects long bone metaphysis

195
Q

retinoblastoma

A

associated with osteosarcoma

196
Q

contact dermatitis

A

spongiosis

197
Q

psoriasis

A

reduced stratum granulosum, parakeratosis, acanthosis and dividing cells in epidermis

198
Q

seborrheic keratosis

A

benign epidermal tumor, tan , flat, round, greasy, coin-like stuck on appearance

199
Q

acute interstitial nephritis

A

due to drug allergy; fever, acute renal failure, maculopapular rash and eosinophiluria

200
Q

cysteine stone crystals

A

hexagonal crystals, acid urine, recurrent stones at young age, positive cyanide-nitroprusside test

201
Q

papillary necrosis

A

sickle cell patients or carriers; acute colic pain, gross hematuria, passage of tissue fragments in urine

202
Q

hydronephrosis

A

due to prolonged urinary obstruction in nephrolithiasis, tumor, anatomic defects, neurogenic bladder, BPH; atrophy of cortex with scarring and interstitial fibrosis with inflamation

203
Q

most important mediator of sepsis

A

TNF alpha

204
Q

cryptorchidia

A

decreases inhibin with increased FSH and normal LH/testosterone; remove testis to prevent malignancy

Step 1 Complete (29 decks)

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