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Board questions > Uworld > Flashcards

Uworld Flashcards

1
Q

Pt with diphyllobothrim latum is at risk for what?

What kind of organism is D. latum?

How is it ingested?

A

B12 deficiency and megaloblastic anemia

fish tapeworm

larvae in raw fresh water fish

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2
Q
  • large crusting mass in mandible
  • 46 yo homeless man
  • no water source, no etoh, or drug use, occ. smokes
  • lumpy mass, “wooden”
  • yellow colored healing ulcer

Dx?

pathogen?

description of what we would culture?

A

Actinomycosis

actinomyces israelii

forms sinus tracts that heal and recur, fibrosis/wooden, can shed sulfur granules

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3
Q

Stool microscopy in V. cholerae and enterotoxigenic E. coli are unique because…

A

they cause purely toxin mediated watery diarrhea and cells are not damaged - no RBCs or WBCs in stool

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4
Q
  • very narrow zone of beta hemolysis
  • tumbling motility at room temp
  • multiply in fridge/cold enrichment

pathogen?

main process to eliminate?

A

listeria monocytogenes - facultative intracellular gram + rod

cell-mediated immune response needed bc its intracellular - circulating immune factors can’t reach; bacteria protein fragments on surface -> cytotoxic T cells -> lysis and macrophage develop via IFNy

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5
Q

indurated painless ulcer on penis, no erythema, no LAD

Dx?

pathogen?

tx and MOA?

A

primary syphilis

treponema pallidum

penicillinm- binds and inhibits transpeptidase, blocks cell wall formation of binding D-alanine-D-alanine

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6
Q

best steps for prevention of central venous catheter infections are…

A
  1. proper hand hygiene
  2. full barrier precautions during insertion
  3. chlorhexidine skin
  4. avoid femoral insertion site
  5. remove cath when no longer needed
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7
Q

What is the number 1 vector borne disease in the US?

It is most prevalent in what area?

pathogen?

how is this transmitted?

appropriate tx for adult and child?

A

lyme disease

NE states

borrelia burgdorferi

ixodes tick

adult - doxy; child or prego - amoxicillin

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8
Q

pt with dysphagia and dialated esophagus - dx?

pt is from central or S. America so it could be secondary to…

How?

What else could this cause?

A

achalasia

chagas disease

destruction of submucosal (meissner) and myenteric (auerbach) plexi

nonischemic cardiomyopathy and megacolon

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9
Q

intense pruritis in inguinal genital area

prior STDs and no other ssx

excoriations and image of thing clinging to pubic hair

pathogen? transmitted?

how would you dx it?

tx? MOA?

A

Phthirus pubis - human pubic louse

skin to skin

dx with image

tx with topical permethrin

MOA: blocks Na+ ion conduction, leading to paralysis and death

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10
Q

What is Thayer Martin agar made of?

What else can Neisseria grow on?

A
  • vancomycin, colistin, nystatin
  • chocolate agar
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11
Q

How is chocolate agar made and what will grow on it?

A

RBCs heated to 56C to lyse them, releasing factor V and factor X

haemophilus influenza and neisseria

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12
Q

exposure to farm poop, myalgias, fatigue, fever >10d, retro-orbital HA

nl WBC, thrombocytopenic, increased LFTs

Dx?

pathogen?

What is another common ssx?

A

Q fever

Coxiella burnetti

pna with lobar consolidation

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13
Q

Why and how long should one use mefloquine chemoprophylaxis for malaria?

A

if going to endemic region continue for 4 weeks s/p return

ensures elimination of hepatic shizonts because mefloquine only works on replicating parasites

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14
Q

Where is the facial nucleus found?

A

caudal pons near fourth ventricle

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15
Q

An epidural hematoma is MCC by rupture of what artery?

What is this artery a branch of and where does it course?

A

middle meningeal artery

terminal branch of maxillary a. (off ECA)

goes through forament spinosum to enter cranium

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16
Q

What two factors does haemophilus need to grow?

What pathogen facilitates growth via the ‘satellite phenomenon’?

A

X factor - hematin

V factor - NAD+

S. aureus

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17
Q

+ HBsAg

+ HBeAg

+/- Anti-HBcAg (depending on how far along infection is)

dx?

A

acute infection Hep B

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18
Q
  • 35 yo HIV+
  • 80% compliant with tx
  • CD4 ct 190
  • viral load 100k

pt is at risk for what disease?

tx prophylactically?

MOA of rx?

A

CD4 <200 risk pneumocystis pna and toxoplasma gondii

tx prophylactically with TMP-SMX

MOA- works on folate pathway

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19
Q

4 yo M with skin lesions on face x2 days, golden yellow crust

dx? pathogen? sequelae?

A

impetigo

S. aureus or S. pyogenes

post-strep glomerular nephritis (facial edema, dark urine/hematuria, HTN, RBC casts in urine)

acute rheumatic fever (usually s/p GAS pharyngeal infection, rather than skin infection)

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20
Q

several months of pain and itching perirectally on HIV+ pt with occasional rectal bleeding

single hard mass and ulceration in anal canal, no LAD, CD4 ct 280

dx? pathogen to initiate disease process?

A

anal squamous cell carcinoma (often ulcerative)

from HPV 16 and 18

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21
Q

What would be the markers for a chronic state of Hep B infection?

A
    • HBsAg
    • Anti-HBcAg
  • +/- HBeAg or Anti-HBeAg
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22
Q

What are 2 parasites that cause disease in RBCs?

What are their vectors?

A
  • plasmodium - anopheles misquito
  • babesia - ixodes scapularis tick
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23
Q

2 yo with vesicles on palate and lips

dx?

pathogen? describe

A

gingivostomatitis

HSV-1

dsDNA enveloped

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24
Q

fever, cough, rhinorrhea, conjunctivits

maculopapular rash on face and descends, spots in mouth too

dx?

pathognomonic for it?

transmission?

vaccine?

describe pathogen

A

measles/rubeola

koplick spots

airborne/ person to person

MMR - live attenuated

paramyxoviridae - enveloped, negative sense RNA, non segmented virus

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25
Q

describe pseudomonas aeruginosa

A

gram negative rod, non lactose fermenting on Macconkey, oxidase +, motile

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26
Q

lesions in lower lobes with perihilar lymph node involvement form what?

seen in what disease?

A

ghon complex

primary TB

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27
Q

hepatic abscess in first world country - source?

routes of possible infection?

A

bacteria - S. aureus via hematogenous spread

biliary tract inf.

portal vein pyemia

hepatic a.

direct from adjacent

penetrating trauma

(enteric bacteria usually)

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28
Q

fungal hyphae branching at acute angles with septation

pathogen?

A

aspergillus fumigatus

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29
Q

tx of diphtheria?

A

diphtheria antitoxin - that has preformed, neutralizing abs that bind and inactivate circulating toxin

does not work on toxin already in cells

C. diphtheriae doesn’t generally enter blood

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30
Q

developing nation, cyst in liver, no prior ssx until now

dz/pathogen?

tx? rx?

A

echinococcus granulosis parasite

surgical resection of cyst

rx: albendazole

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31
Q

East Africa, small insect bite (4-5cm) indurated erythematous and rubbery swelling

myalgias, arthralgias, and intermittent fevers

blood smear: long slender, flagellated protozoa with kinetoplasts

Dx? pathogen? vector spread? ssx?

A

African trypanosomiasis/African sleeping sickness

Trypanosoma brucei (Tbr and Tbg)

tsetse fly

posterior cervical LAD aka Winterbottom’s sign

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32
Q

P.ovale and P. vivax have dormant hepatic phase called…

What is unique about this?

What would be the tx to prevent this?

A

hypnozoite

can reactivate several months after return from an endemic region

tx with primaquine to prevent reactivation

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33
Q

Why does staphylcoccal scaled skin syndrome occur?

What is Nikolsky’s sign?

A

production of exotoxin exfoliation by staph

widespread epidermal sloughing especially with gentle pressure

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34
Q
  • sore throat x2days
  • now fever, chills, and diffuse erythematous blanching rash on chest and abdomen with 1-2mm papules
  • 12 yo
  • throat and tongue erythematous

dx?

pathogen?

sequelae most dangerous?

A

scarlet fever

S. pyogenes (GAS) - pyrogenic exotoxins

rheumatic fever

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35
Q

What is the exchange of genes between 2 chromosomes via crossing over within homologous regions called?

What kind of genome can do this?

A

recombination

2 dsDNA genomes needed

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36
Q

What is the only glycosylated HIV polyprotein?

product of what gene?

it is then cleaved into…

A

gp 160

env gene

gp120 and gp41

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37
Q

What does a pt with impaired cellular mediated immunity and prego lady in third trimester have in common?

A

Listeria

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38
Q

UMNs for contralateral side of the body and face are located where?

A

precentral gyrus (face most lateral, then UE, then most medial is LE)

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39
Q

In HELLP syndrome, how do you prevent sz?

What are signs of toxicity of this drug?

A

magnesium sulfate drip

loss of DTRs, respiratory paralysis, coma

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40
Q

What is Group D strep?

How does it enter the blood stream?

tx?

A

S. gallolyticus, previously S. bovis

in GI tract normally, so any interruption in mucosa, esp. colon CA

penicillin G for 4 weeks

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41
Q

Chronic Q fever is an infection >6 mo and more likely in what pts?

A

pregnant, I/C, or having an underlying valvular pathology

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42
Q

How does HBV facilitate infection of HDV?

A

HBV creates protein that coats HDV viral particles

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43
Q

pt has cat, probable AIDS, sz, AMS

CT shows ring lesions enhanced with contrast

pathogen?

A

toxoplasma gondii

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44
Q

What are inflammatory anaphylatoxins that trigger histamine release from mast cells, resulting in vasodilation and enhanced vascular permeability?

A

C3a, C4a, and C5a

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45
Q

Besides being anaphylatoxins, what do C3a and C5a do, respectively?

A
  • C3a
    • recruits and activates eosinophils and basophils
  • C5a
    • recruits and activates neutrophils, monocytes, eosinophils, and basophils
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46
Q

What are some significant chemotactic agents?

A

IL-8

n-formylated peptides

leukotriene B4

5-HETE (the leukotriene precursor)

complement component C5a

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47
Q

What pure sensory nerve innervates the posterolateral leg and lateral foot?

A

sural nerve

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48
Q

failure of pt’s neutrophils to turn blue on nitroblue tetrazolium testing is characteristic of what?

this is most often caused by an X linked mutation affecting…

A

chronic granulomatous disease

NADPH oxidase

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49
Q

Neutrophils affected by Chronic granulomatous disease are unable to kill…

this results in…

A

catalase-producing organisms

resulting in recurrent bacterial and fungal infections that frequently involve the lungs, skin, and lymph nodes

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50
Q

coagulase from staph aureus activates prothrombin, resulting in conversion of firbinogen to fibrin

how is this a virulence factor?

A

leads to fibrin coating of the organism and resistance to phagocytosis

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51
Q

What is the major virulence factor produced by Clostridium perfringens?

How does this work?

A

lecithinase (alpha toxin)

has phospholipase C activity, increases platelet aggregation and adherence molecule expression on leukocytes and endothelial cells resulting in vasoocclusion and ischemic necrosis of infected tissues

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52
Q

What are three stop codons?

When ribosome encounters a stop codon, what happens?

A

UAA, UAG, UGA

releasing factor proteins bind to the ribosome and stimulate release of the formed polypeptide chain and dissolution of the ribosome-mRNA complex

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53
Q

What facilitates tRNA binding and the translocation steps of protein synthesis?

A

elongation factors

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54
Q

What is the major cause of morbidity and mortality in pts recovering from SAH?

How will it present?

How can this be prevented?

A

vasospasm

4-12 days s/p initial insult - causes cerebral ischemia, presenting as new-onset confusion and/or focal neurologic deficits

nimodipine - selective Ca2+ channel blocker

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55
Q

Most intracranial schwannomas are found where and attach to what nerve?

What are they called here?

A

cerebellopontine angle

attached to CN VIII

acoustic neuromas

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56
Q

What are common ssx of acoustic neuromas?

bilateral acoustic neuromas occur in what disease?

A

tinnitus, vertigo, hearing loss

Neurofibromatosis (NF) type 2

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57
Q

How does NF type 2 differ from NF-1?

What is the gene mutation a/w each and clinical presentation?

A

NF2 causes fewer cutaneous manifestations and presents with CNS involvement

  • NF-1
    • NF-1 tumor suppressor gene; codes protein neurofibromin
    • chromosome 17
    • cafe-au-lait spots, multiple neurofibromas, lisch nodules
  • NF-2
    • NF-2 tumor suppressor gene; codes protein merlin
    • chromosome 22
    • bilateral acoustic neuromas
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58
Q

Mutation of APC gene (adenomatous polyposis coli) is on what chromosome and what is it a/w?

A

chromosome 5

familial adenomatous polyposis syndromes and colon cancer

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59
Q

What is the MC mutation found in human cancers? What chromosome is it on?

What is it also associated with?

A

p53 tumor suppressor gene on chromosome 17

Li-Fraumeni syndrome, rare familial syndrome characterized by development of breast cancer, sarcomas, brain tumors, leukemia, and adrenocortical tumors at a young age

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60
Q

Where is RB1 tumor suppressor gene found?

Mutations here put someone at risk for what?

A

chromosome 13

increase risk of retinoblastoma and osteosarcoma

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61
Q

What is the mutation in Hippel-Lindau disease?

It is characterized by…

A

mutation of VHL gene on chromosome 3

renal cysts, renal cell carcinomas, and hemangioblastomas of the cerebellum and retina

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62
Q

What is the pathophysiologic mechanism behind altitude sickness?

A

hypobaric hypoxia

decreased pO2 in the air and blood, causes tissue hypoxia resulting in stimulation of peripheral chemoreceptors causing hyperventilation

this decreases pCO2 in blood, raising the pH (respiratory alkalosis)

renal bicarb excretion compensates for the alkalosis, stabilizing the pH toward the normal range within about 48 hours

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63
Q

What nerve provides sensation to the suprapubic adn gluteal regions and motor function to the anterolateral abdominal wall muscles?

A

iliohypogastric nerve

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64
Q

What nerves accompanies the spermatic cord through the superficial inguinal ring and provides sensation to the upper and medial thigh and parts of the external genitalia?

A

ilioinguinal nerve

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65
Q

What nerve provides sensation to the upper anterior thigh and motor function to parts of the genitalia (cremasteric reflex or mons pubis)?

A

genitofemoral nerve

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66
Q

What is the first line tx for status epilepticus?

MOA?

A

IV benzos

enhance GABA-A receptor, increasing influx of Cl- ions, leading to hyperpolarization of the postsynaptic neuron and suppression of AP firing

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67
Q

What is the pathophysiological reason for peripheral neuropathy in diabetic pts?

A

endoneural arteriole hyalinization and accumulation of sorbitol leading to osmotic nerve injury

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68
Q

What are the virulence factors of B. pertussis that allow it to strongly attach to respiratory epithelium?

A

pili, filamentous hemagluttinin, pertactin

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69
Q

What inflammatory exotoxins does B. pertussis have and what do they do?

A
  • tracheal cytotoxin - directly damages and destroys ciliated epithelial cells, leading to a loss of airway protection, subsequent microaspiration, and development of paroxysmal cough
  • pertussis toxin - an AB toxin that enters cells and activates adenylate cyclase leading to alterations in cellular signaling that inhibit phagocyte activity and can cause lymphocytosis
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70
Q

What is first line tx of CMV colitis and retinitis?

MOA?

AE?

A

ganciclovir

inhibits viral synthesis by blocking CMV DNA polymerase

also blocks host DNA polymerase to a lesser degree, causing neutropenia, anemia, and thrombocytopenia

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71
Q

In treating HIV, what drugs are a/w myopathy and rhabdomyolysis?

A

integrase inhibitors like raltegravir and dolutegravir

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72
Q

What is the most abundant amino acid in collagen?

How does its triple helical formation occur?

A

glycine

occurs d/t the repetitive amino acid sequence within each alpha chain, in which glycine occupies every third aa position

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73
Q

How does fomepizole work do combat alcohol poisoning?

A

decreases the conversion rate of the parent alcohols into their toxic metabolites

(competitive inhibitor of alcohol dehydrogenase)

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74
Q

What acid-base abnormalities are characteristic of acute salicylate intoxication?

A

respiratory alkalosis

anion gap metabolic acidosis

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75
Q

What triad is seen in adults with aspirin intoxication?

A

fever, tinnitus, and tachypnea

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76
Q

What is the primary type of collagen in mature scars?

A

collagen type I

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77
Q

bradycardia and dropped P waves are consistent with what?

This is commonly resulting from…

A

sick sinus syndrome

age related degeneration of the SA node

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78
Q

narrow QRS complex preceded by long pause and no P wave

A

junctional escape beat

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79
Q

asymptomatic pt with a harsh, holosystolic murmur best heard at mid to lower left sternal border

What will happen to the murmur with handgrip?

A

small Ventral septal defect

worsens murmur

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80
Q

systolic crescendo-decrescendo murmur best heard at the base of the heart with radiation to the neck

A

aortic stenosis

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81
Q

a wide, fixed-split S2 and a systolic ejection murmur that is best heard at the upper left sternal border due to increased flow across the pulmonic valve

A

atrial septal defect

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82
Q

What statistical analysis test should you use to compare the means of 2 groups of subjects?

A

two-sample t test

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83
Q

What statistical test is best when using categorical data?

“goodness of fit”

A

chi square test

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84
Q

B1

primary function

syndromes of deficiency

A

thiamine

decarboxylation of alpha-keto acids (carb metabolism)

beriberi (peripheral neuropathy and HF) and Wernicke-Korsakoff syndrome

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85
Q

B2

primary function

syndromes of deficiencies

A

riboflavin

mitochondrial electron carrier (FMN, FAD)

angular cheilosis, stomatitis, and glossitis; normocytic anemia

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86
Q

B3

primary function

syndrome of deficiency

A

niacin

Electron transfer reactions (NAD/NADP)

Pellagra (dermatitis, dementia, diarrhea); peripheral neuropathy

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87
Q

B6

primary function

deficiency

A

pyridoxine

transamination of amino acids (amino acid synthesis)

cheilosis, stomatitis, glossitis

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88
Q

B9

primary function

deficiency

A

folate, folic acid

hydroxymethyl/formyl carrier (purine and thymine synthesis)

megaloblastic anemia; neural tube defects (fetus)

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89
Q

B12

primary function

deficiency

A

cobalamin

isomerase and methyltransferase cofactor (DNA and methionine synthesis)

megaloblastic anemia; neurologic deficits

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90
Q

Vitamin C

primary function

deficiency syndromes

A

ascorbic acid

hydroxylation fo proline and lysine (collagen synthesis)

scurvy

91
Q

absent P waves, irregularly irregular RR intervals, narrow QRS complexes

A

atrial fibrillation

92
Q

polymorphic ventricular tachycardia that occurs in the setting of a congenital or acquired prolonged QT interval

A

torsades de pointes

93
Q

What are some medications that prolong the QT interval, predisposing a pt to torsades?

A

antiarrhythmatics - sotalol, quinidine

antipsychotics - haloperidol

abx - macrolides and fluoroquinolones

94
Q

autosomal dominant mutations in the TTN gene, which encodes for the sarcomere protein titin are the MCC of…

A

familial dilated cardiomyopathy

95
Q

What could occur 5-14 days s/p MI and presents with sudden onset of chest pain, profound shock, and rapid progression until death?

Morphologically, what does this look like?

A

Left ventricular free wall rupture

ruptures appear as a slit like tear in the infarcted myocardium with a preference for the L ventricle due to higher systolic pressures

96
Q

How does digoxin work?

A

slows the ventricular rate during A fib by increasing the parasympathetic tone, leading to inhibition of AV node conduction

also used in HF by inhibiting the Na-K-ATPase pump, having an inotropic effect

97
Q

What histopathology is most consistent with acute graft rejection?

when would this acute rejection be most likely to occur?

how is this process mediated?

A

dense infiltrate of mononuclear cells usually composed of mostly T lymphocytes

1-4 weeks s/p transplant

cell mediated - host T cells sensitization against graft (foreign) MHC antigens

98
Q

acute cessation of blod flow through an organ immediately after anastomosis of recipient vessels to donor vessels is characteristic of…

why does this occur?

A

hyperacute graft rejection

occurs due to preformed abs in the recipient directed against donor antigens

99
Q

concentric coronary atherosclerosis found on angiography s/p heart transplant means…

A

donor heart had preexisting atherosclerosis prior to the organ being harvested

100
Q

perivascular infiltrate with abundant eosinophils is a histopathologic presentation consistent with…

this is often due to…

A

hypersensitivity myocarditis

initiation of a new drug therapy, against which the body mounts and atopic response

101
Q

scant inflammatory cells and interstitial fibrosis is most characteristic of what s/p transplant?

how is this process mediated?

when does it occur?

A

chronic rejection

mediated by host T cell and B cells as well as abs and classically occurs months to years following solid organ transplant

102
Q

young pt presents with dyspnea, LE edema, JVD, and pulomnary crackles - consistent with what?

if pt has had a symptomatic viral prodrome, what should I be suspecting as the dx?

A

decompensated heart failure

dilated cardiomyopathy due to viral myocarditis

103
Q

top 3 viruses implicated in causing DCM?

A

coxsackie, adneovirus, influenza virus

104
Q

direct damage to cardiomyocytes, leading to myocardial contraction dysfunction (systolic dysfunction), volume overload, and ventricular dilation

A

dilated cardiomyopathy

105
Q

systolic anterior motion of the mitral valve; exercise induced syncope; sudden cardiac death in young athletes

A

hypertrophic cardiomyopathy

106
Q

what heart disease occurs due to long standing uncontrolled HTN?

A

concentric LV hypertrophy

107
Q

a crescendo-decrescendo murmur with LV hypertrophy probably has what valve issue?

A

aortic stenosis

108
Q

pt with rheumatic heart disease might develop what that would cause palpitations and exertional dyspnea?

A

mitral stenosis/regurg leading to L atrial enlargement and extrinsic compression of the esophagus

109
Q

What can L atrial enlargement end up compressing?

A

esophagus and sometimes the L recurrent laryngeal nerve (hoarse voice and chronic cough)

110
Q

Where is the AV node located?

Why would you ablate this area?

A

in endocardium of RA, near septal leaflet of the tricuspid valve and the orifice of the coronary sinus

tx pharmocologic resistant arrhythmias, possibly Afib

111
Q

What area would you perform an ablation on in order to treat A flutter?

A

isthmus between the IVC and tricuspid annulus

112
Q

What is the MC cardiac malformation in pts with Turner Syndrome?

What will be the audible presentation of this?

A

bicuspid aortic valve

early systolic, high frequency click (in nonstenotic bicuspid) heard over the right second interspace

113
Q

What are the MC cardiac anomalies in Down Syndrome?

What sounds are heard with these?

A
  • complete atrioventricular canal
  • ASD (fixed splitting of second heart sound)
  • VSD (holosystolic murmur at the left lower sternal border)
114
Q

mid-systolic click, often with late systolic murmur, is hallmark of ….?

It is more common in what kind of disorders?

A

Mitral valve prolapse

MC in CT disorders like Marfan’s and Ehler’s Danlos

115
Q

elevated levels of homocysteine are an independent risk factor for…

A

thrombotic events (venous thromboses, coronary artery disease, and ischemic stroke

116
Q

How is homocysteine metabolized?

A
  • to methionine via remethylation
    • occurs with the donation of methyl from methyl-THF via methionine synthase
      • has Vit B12 (cobalamin) as cofactor
  • to cystathione via transsulfuration
    • via cystathionine-beta-synthase
    • subsequently to cysteine via cystathionase, with B6 as cofactor
117
Q

Once a methyl group is donated from methyl-THF to homocysteine, how is it regenerated?

A

enzyme MTHFR (methylene tetrahydrofolate reductase) using FAD as cofactor

118
Q

What is the MC genetic cause of hyperhomocysteinemia?

A

MTHFR deficiency

119
Q

What is elevated in both folate and Vit B12 deficiencies?

What is only elevated in Vit B12 deficiency?

A

homocysteine is elevated in both

methylmalonyl-CoA is only elevated in the one

120
Q

What do the 6 embryological pharyngeal/aortic arches give rise to and what are the cranial nerves associated with each?

A
  1. maxillary artery (portion) and trigeminal nerve
  2. stapedial artery (regresses) and facial nerve
  3. common carotid artery, proximal internal artery and glossopharyngeal nerve
  4. true aortic arch, subclavian arteries and superior laryngeal branch of Vagus nerve
  5. obliterated
  6. pulmonary arteries, ductus arteriosus and recurrent laryngeal branch of Vagus
121
Q

finding in cardiac tamponade referring to an exaggerated drop in systolic blood pressure (>10mmHg) during inspiration

what else can this be found in?

A

pulsus paradoxus

severe asthma, COPD, hypovolemic shock, and constrictive pericarditis

122
Q

How do patients with chronic aortic regurgitation (possibly as sequelae of infective endocarditis) remain asymptomatic for long periods of time?

A
  • aortic regurg causes volume overload in LV, distending it, triggering eccentric hypertrophy
  • this causes an increase in stroke volume in order to maintain cardiac output
123
Q

A CVA in the setting of known venous thromboembolic disease is suspiscious for…

what is this?

what sound might be associated?

A

paradoxical embolism

  • thrombus from the venous system crosses into the arterial circulation via an abnormal conenction between the R and L cardiac chambers
    • probably happens during periods of transient shunt reversal (straining or coughing)

Atrial L to R shunts cause wide and fixed splitting of S2

124
Q

CCBs work by …

A

block calcium channels to slow spontaneous depolarization

125
Q

this drug reduces platelet activation by inhibiting platelet phosphodiesterase (which breaks down cAMP) and is also a direct arterial vasodilator

what will administration of this drug ultimately cause?

A

cilostazol

decrease in claudication symptomes and an increase in pain-free walking distances in patients with peripheral arterial disease

126
Q

monoclonal ab that inhibits platelet aggregation by targeting the platelet IIb/IIIa receptor

A

abciximab

127
Q

anticoagulant that potentiates antithrombin III, resulting in the inactivation of thrombin and other factors

A

heparin

128
Q

direct thrombin inhibitor primarily used in teh treatment of heparin-induced thrombocytopenia

A

argatroban

129
Q

oral anticoagulant that is a competitive inhibitor of vit K epoxide reductase and reduces production of vit K dependent coagulation factors (II, VII, IX, X, protein C and protein S)

A

warfarin

130
Q

second line tx for A fib with RVR and more useful in pt with underlying systolic cardiac dysfunction

what are this drug’s major effects?

A
  • digoxin
  • increased vagal tone
    • slowing of conduction through the AV node (rate control)
  • Na-K-ATPase inhibition
    • increased intracellular Na and Ca (increases cardiac contractility)
131
Q

Overuse of what vitamin can cause intracranial hypertension, skin changes, and hepatosplenomegaly?

A

vitamin A

132
Q

What vitamin deficiency is characterized by cheilosis, stomatitis, glossitis, dermatitis, corneal vascularization, and ariboflavinosis?

A

Vit B2 (riboflavin)

133
Q

what is associated with higher mortality rates due to hemorrahagic stroke in adults and higher rates of necrotizing enterocolitis in infants?

A

large doses of Vit E

134
Q

What is the MC pineal gland tumor and how do they present?

If this tumor is located elsewhere in the brain, where would it be and what would it cause?

A

Germinomas

present with obstructive hydrocephalus and dorsal midbrain (Parinaud syndrome)

can also be in the suprasellar region and cause endocrinopathies due to pituitary/hypothalamic dysfunction

135
Q

What causing and what does Parinaud syndrome consist of?

A
  • direct compression of the pretectal region of the midbrain
  • limitation of upward gaze with downward gaze preference,
  • bilateral eyelid retraction (Collier sign, sclera visible above the superior corneal limbus),
  • and light-near dissociation (Argyl-robertson)
136
Q

What kind of cells do germinomas arise from?>

A

embryonic germ cells

137
Q

MC cerebellar tumor in children?

presentation?

A

medulloblastoma

gait and limb ataxia, intention tremor, nystagmus

138
Q

What is the pathway of the median nerve in the forearm?

A

medial aspect of antecubital fossa betweent he humeral and ulnar heads of the pronator teres > goes distal b/t FDS and
FDP > into hand within flexor retinaculum

139
Q

How would you diagnose cryptococcus neoformamns meningoencephalitis?

A

LP - detect polysaccharide capsule in CSF using latex agglutination test

india ink staining can also reval round or oval budding yeast

140
Q

What is the anterior pituitary derived from?

A

Rathke pouch, evagination of surface ectoderm that lines the fetal oral cavity

141
Q

What are derivatives of surface ectoderm?

A
  • anterior pituitary (Rathke pouch)
  • lens and cornea
  • inner ear sensory organs, olfactory epithelium
  • nasal and oral epithelial linings, salivary glands
  • epidermis, sweat and mammary glands
142
Q

What are derivitives of the neural tube?

A
  • brain and spinal cord
  • posterior pituitary, pineal gland
  • retina
143
Q

What are derivitives of neural crest cells?

A
  • neural ganglia, adrenal medulla
  • Schwann cells; pia and arachnoid mater
  • aorticopulmonary septum and endocardial cushions
  • branchial arches (bone and cartilage)
  • skull bones
  • melanocytes
144
Q

MOA of anticonvulsant drug lamotrigine?

AEs?

What other anticonvulsants are associated with this severe AE?

A

blocks voltage gated Na channels

10% get rash, 1% get SJS-TEN (esp children)

carbamazepine, phenobarbital, and phenytoin

145
Q

presence of endometrial glandular tissue within the myometrium

dx?

ssx?

who?

A

adenomyosis

menorrhagia and dysmenorrhea, uniformly enlarged uterus with normal appearing endometrial tissue on biopsy

common in middle aged parous females

146
Q

What causes Henoch-Schonlein Purpura?

A

circulating IgA-antigen immune complexes (type III HS reaction)

deposition in walls of small vessesla dn renal mesangium leads to recruitment of neutrophils and lymphocytes as well as activation of complement via the alternate/lectin pathways

147
Q

What is the first and second MCC of hematogenous osteomyelitis?

A
  1. Staph aureus
  2. Strep pyogenes
148
Q

What is the MC associated arrythmia with WPW syndrome?

what is this and how does it manifest?

A

atrioventricular reentrant tachycardia

a type of paroxysmal supraventricular tachycardia that occurs due to reentry of electrical impulses through the accessory conduction pathway

intermittent palpitations, sensation of racing heart, lightheadedness or syncope

149
Q

what is released from eosinophils in the late stage of a type I HS reaction and causes localized tissue damage?

A

major basic protein

150
Q

what is a secondary inflammatory mediator that must be synthesized from phospholipid prior to being released from activated mast cells and basophils?

what does it do once released?

A

platelet-activating factor

stimulates bronchospasm and increased vascular permeability

151
Q

What is the major stimulator of respiration in healthy individuals?

A change in this will stimulate what?

What happens in COPD?

A

arterial partial pressure of CO2

slight increase stimulates central chemoreceptors and triggers increased ventilation

response to PaCO2 is blunted and hypoxemia can contribute to respiratory drive

152
Q

presence of multiple, genetically different cell lines within the body

types?

A

mosaicism

  • somatic mosaicism
    • affects cells forming the body, causing disease manifestations to develop in affected individuals
    • MC - 45,X/46,XX (mild form of Turner syndrome or asymptomatic)
  • germline mosaicism
    • affects cells giving rise to gametes, allowing the affected genes to pass to the offspring
    • chance of a child being affected depends on the proportion of gametes that carry the mutation
    • the affected parent does not have clinical manifestations
153
Q

describe dizygotic v monozygotic twins in utero

A
  • dizygotic twins
    • can be different sexes
    • from fertilization of 2 oocytes, by 2 different sperm
    • always have 2 amnions and 2 chorions
    • chorions and placentas may be fused depending on proximity of implantation
  • monozygotic twins
    • from fertilization of single oocyte and develop from 1 zygote
    • same sex, genetically identical and are similar in appearance
    • can occur at different stages of embryonic development
154
Q

How do fibrate medications (fenofibrate and gemfibrozil) cause the formation of cholesterol gallstones?

A

inhibit cholesterol 7alpha-hydroxylase, which catalyzes the rate-limiting step in the synthesis of bile acids

reduced bile acid production results in decreased cholesterol solubility in bile and will favor the formation of cholesterol gallstones

155
Q

What is the physiology behind myometrial smooth muscle cells communication prior to delivery?

What do gap junctions consist of?

A
  • estrogen stimulates upregulation of gap junctions between individual myometrial smooth muscle cells
  • increase in gap junction density at delivery heightens myometrial excitability
  • estrogen also increases espression of uterotonic (eg, oxytocin) receptors, which mediate calcium transport through ligand-activated calcium channels
  • gap junctions consist of aggregated connexin proteins (eg, connexin-43) that allow passage of ions between myometrial cells
156
Q

what does the combination of an increase in gap junction density and uterotonic receptors (both upregulated by estrogen) result in?

A

coordinated, synchronous labor contractions

157
Q

autoantibodies to hemidesmosomes

ddx?

what are hemidesmosomes?

A
  • bullous pemphigoid, pemphigoid gestationis

link cells to basement membrane via integrins, the transmembrane anchor proteins

158
Q

What are tight junctions comprised of? What enterotoxin can compromise the efficacy of tight junctions?

A
  • claudins and occludin, serving as paracellular barriers to water and solutes
  • enterotoxin from Clostridium perfringens binds claudin and interferes with tight junctions in the intestinal barrier
    • water loss from the tissue to the intestinal lumen results in watery diarrhea
159
Q

highly sensitive cytogenic test that can identify the presence of chromosomal duplications and large deletions and translocations

How does this test work?

A

Fluorescence in situ hybridization (FISH)

FISH probes are ssDNA segments that are a few hundred kilobases in length; they are added to the cell of interest and anneal to complementary regions of teh cell chromsome, which allows the area of interest to be identified visually

160
Q

used to quantify antibodies or antigens in a fluid

A

ELISA - enzyme-linked immunosorbent assay

161
Q

flow cytometry is often used in the diagnosis of…

how?

A

leukemia

laser-based test elevated surface markers (CD5) on individual cells, not chromosomal duplications

162
Q

technique that size-fractionates proteins in a gel and then targets a specific mRNA sequence of interest; can determine the quantity and size of a particular mRNA section

A

Northern blotting

163
Q

technique that size-fractionates proteins in a gel and then targets a specific protein using an antibody with a radiotracer/enzyme; often used to confirm positive ELISA test in the setting of HIV or Lyme disease

A

Western blotting

164
Q

persistent pattern of violating major societal norms or the rights of others; behaviors include aggression toward people and animals, deceitfulness or theft, destruction of property, and serious violation of rules

how long must this go on?

A

conduct disorder

>12 mo

165
Q

>18 yo pt, pattern of violation of basic societal rules and the rights of others and requires a history of some symptoms of conduct disorder before age 15

A

antisocial personality disorder

166
Q

involves a pattern of angry/irritable mood and argumentative/defiant behavior toward authority figures;

NO physical aggression, stealing, or destruction of property

A

oppositional defiant disorder

167
Q

What all does IL-2 do? Where do they come frome?

A

produced by helper T cells,

  • stimulate growth of CD4 and CD8 T and B cells
  • activates natural killer cells and monocytes
168
Q

What increases expression of MHC class I and II, improving antigen presentation in all cells?

A

IFN-y

169
Q

In a pt with hypothyroidism, why would they be having nipple discharge?

A
  • hypothyroid (decrease T3 and T4)
    • increase TRH
      • TRH stimulates prolactin secretion
170
Q

What is the most important virulence factor allowing E. coli to be a major cause of neonatal meningitis?

how?

could the baby get this again?

A

K1 capsular antigen

facilitate survival in the blood by preventing recognition of bacterial antigens, complement deposition, and subsequent phagocytosis

K1 capsule is immunogenic and anti-capsular antibodies are protective against repeat infections

171
Q

After acquiring schistosomiasis via contact with freshwater sources that contain snails infected with Schistosoma larvae, how can you tell what species is infecting?

What are clinical manifestations?

what is pathognomonic for hepatic shistosomiasis?

A
  • S. japonicum and S. mansoni
    • intestinal and hepatic shistosomiasis
  • S. haematobium
    • urinary shistosomiasis

from TH2 mediated granulomatous response directed against the eggs that is composed of infiltrating TH2 cells, eosinophils, and M2 macrophages

leads to the development of marked fibrosis and ulceration and scarring of the bowel or bladder/ureters (depending on the species)

eggs that settle into the presinusoidal radicals of the portal vein can cause periportal “pipestem” fibrosis (pathognomonic for hepatic shistosomiasis)

172
Q

What is the primary site of ribosomal RNA (rRNA) transcription?

What enzyme functions exclusively to transcribe the 45S pre-rRNA gene into a single template?

What is this single template subsequently processed into?

A

nucleolus

RNA-polymerase I

18S, 5.8S, and 28S rRNAs

173
Q

What is the type of RNA produced from RNA polymerase II and what is their function?

A
  • messanger RNA
    • translated by ribosomes to form specific proteins
  • small nuclear RNA
    • involved in mRNA splicing and transcription regulation
  • microRNA
    • cause gene silencing via translation arrest or mRNA degradation
174
Q

What type of RNA does RNA polymerase III produce and what is their function?

A

by transcribing DNA to form small RNA molecules like

  • transfer RNA
    • adaptor molecule linking codons with specific amino acids
  • 5S ribosomal RNA
    • essential component of 60S ribosomal subunit

(genes located outside the nucleus)

175
Q

What screen is used in the second trimester to identify pregnancies at high risk for congenital defects?

How does this do so?

A
  • maternal serum quadruple screen
    • AFP
    • estriol
    • b-hCG
    • inhibin A

looked at in the context of gestational age to calculate risk of congenital defects in fetuses

176
Q

tobacco use during pregnancy increases the risk of fetal growth restriction (FGR) and placental insufficiency - what would be decreased in the maternal serum?

A

decreased estriol levels are associated with placental abnormalities and FGR

177
Q

What happens to concentrations of substances as fluid runs along the proximal tubule?

A
  • increase in concentration
    • PAH
    • creatinine
    • inulin
    • urea
  • decrease in concentration
    • bicarb
    • glucose
    • amino acids
178
Q

What neural tract mediates coordinated horizontal eye movements?

A

medial longitudinal fasciculus

179
Q

internuclear ophthalmoplegia is a disorder of conjugate horizontal gaze in which…

what is preserved?

what is usually damaged that causes this?

A

the affected eye (ipsilateral to the lesion) is unable to adduct and the contralateral eye abducts with nystagmus

convergence and pupillary light reflex are presevered

MLF

180
Q

Compare the rashes of rubella and rubeola/measles?

A
  • rubella spreads faster and does not darken or coalesce
    • will have postauricular and occipital LAD
  • both are maculopapular and will spread descendingly
181
Q

What parasite does a black fly transmit?

dz?

What rx tx?

A
  • onchocerca volvulus
  • Onchocerciasis
    • second leading infectious cause of blindness
    • “river blindness”
  • tx: ivermectin
182
Q

Who is more susceptible to vibrio cholerae infection and why?

A

pt with achlorhydria (decreased gastric acid production)

V. cholerae is very acid sensitive so a high burden is usually required in a healthy pt for infection/ssx to present

183
Q

What do gp120 and gp41 do?

Why must they be glycosylated?

A
  • gp 120 - viral attachment
  • gp41 - viral fusion with host
  • immune evasion - acts as shield for conserved regions
  • host cell binding
  • proper protein folding
184
Q

What rx tx sporothrix?

A

itraconazole

185
Q

acute febrile illness with HA, retro-orbital pain, and joint and muscle pain; hemorrhage and thrombocytopenia, leukopenia, hemoconcentrated

dx?

transmission?

other dz with same vector?

A

dengue fever

Aedes aegypti misquito

Chikungunya (febrile, flu-like, polyarthralgias, diffuse macular rash)

186
Q

What two major(ish) illnesses do S. mutans and S. sanguinis cause?

How do these Viridans Strep adhere to structures to cause these issues?

A

dental carries, endocarditis

  • production of insoluble extracellular polysaccharides (dextrans) using sucrose as a substrate
    • allows adherence to enamel
    • and fibrin-platelet aggregates on damaged heart valves
187
Q

pyrrolidonyl arylamidase + bacteria

A

PYR+ = S. pyogenes, Enterococcus

188
Q

homogenous, thin, white discharge in vagina, no erythema

dx?

what happens to pH?

micro?

tx?

test for via..

A
  • bacterial vaginosis
  • pH is going up >4.5
  • clue cells - bacteria adherent to vaginal epithelial cells
  • oral or vaginal metronidazole (against anaerobes)
  • Whiff-test - fishy odor worse with 10% KOH
189
Q

Tx of enterococcus endocarditis?

MOA of Rx?

A

aminoglycoside (gentamicin)

bind 30S subunit causes genetic code misreading, inhibiting protein synthesis

190
Q

recurrent infections of S. aureus coming up in abscesses is due to…

A

colonization of the anterior nares

191
Q

HIV risk for infection when <x>
</x>

A
  • <200
    • Pneumocystis jiroveci
    • Toxoplasma gondii
    • tx- TMP-SMX
  • <100
    • Histoplasma capsulatum
  • <50
    • MAC - fluoroquinolones
    • CMV - ganciclovir
    • Cryptococcus neoformans
192
Q

C. difficile has two toxins that act to create the pathogenesis of diseae. What are they?

How do they work?

A
  • enterotoxin A and cytotoxin B (more virulent)
  • bind R on intestinal mucosal cell and get internalized
  • inactivates Rho-regulatory proteins (signal transduction) and actin cytoskeletal structure maintenance
  • disrupts intercellular tight junctions
193
Q

Rhabditiform larvae in the stool - pathogen?

What is their infectious form?

tx?

A

Strongyloides stercoralis

filariform larvae

ivermectin

194
Q

burn pt, likely infectious pathogens?

A

g+ S. aureus and enterococcus

g- Pseudomonas, E. coli, Klebsiella, and Acinetobacter

195
Q
  1. broad based budding yeast?
  2. dimorphic fungi, SW US, I/C pt?
  3. India ink stain, meningitis in I/C?
  4. R angle branching hyphae, does not grow on blood cultures?
A
  1. blastomyces
  2. coccidioides
  3. cryptococcus
  4. mucorales or rhizopus
196
Q

How is resistance of mycobacterium to isoniazid established?

A

non-expression of catalase peroxidase enzyme or genetic modification of INH binding site on mycolic acid synthesis enzyme

197
Q

What location is Plasmodium found where it is very resistant to chloroquine?

What drug should you rx?

Primaquine is required to tx what 2 strains?

A

Africa

rx atovaquone-proguanil

P. vivax and P. ovale (kill liver hypnozoites)

198
Q

dengue virus description

What is a secondary infection due to and how may it present?

A

ssRNA (4 serotypes)

secondary infection d/t infection with different viral serotype and usually causes more severe illness (eg Dengue hemorrhagic fever)

199
Q

Your pt is diagnosed with primary syphilis and you decide to tx with benzathine Pen G. A few hours later, acute febrile ssx develop.

Dx?

mechanism of illness?

A

Jarisch-Herxheimer reaction

Mech: abx for spirochete infection - causes rapid lysis of spirochetes, spilling bacterial lipoproteins into blood and triggering strong innate immune response

mostly self-limited

200
Q

Where is HIV-2 endemic?

HIV-2, compared to HIV-1, has…

Dx of HIV-2 is suspected when…

A

West Africa

  • lower viral loads
  • less risk of transmission
  • slower progression to AIDS

HIV tests are incongruent

201
Q

What are the HIV genome structural genes?

What do they code for?

Then what happens?

A

gag, pol, env

code for polyproteins, then are cleaved by host or viral proteases into individual proteins of HIV virus

202
Q

What could possibly occur if fetus is infected with rubella during the first trimester?

A

sensorineural deafness

cataracts

cardiac malformations (PDA)

203
Q

3 antiviral drugs to treat HSV-2?

MOA?

A

acyclovir, valaciclovir, famciclovir (nucleoside analogs)

incorporated into newly replicating viral DNA and ultimately terminate viral DNA chain synthesis

204
Q

splenic red pulp is important for what two things?

A
  1. destroy abnormal or old RBCs while holding good cells in storage
  2. clearance of circulating bacteria that becomes lodged in the cords
205
Q

What about N. gonorrhoae lends itself to reinfection?

A

high antigenic variability of its surface molecules (eg porins, Opa proteins, LOS endotoxin), preventing formation of protective immunity allowing for reinfection

206
Q

What is the tx of CMV?

MOA?

A

ganciclovir

competitively inhibit incorporation of dGTP by viral DNA polymerase

207
Q

What is Caspofungin most active against?

It has limited or no activity against what?

A
  • best: Candida and aspergillus
  • none: cryptococcus
  • limited: mucor and rhizopus
208
Q

farmer with penetrating injury leading to gas in infected site, crepitus

pathogen?

other illness it can cause?

A
  • clostridium perfringens
  • late onset food poisoning s/p spore ingestion causing watery diarrhea
  • gas gangrene = clostridium myonecrosis
209
Q

high grade fever, HA, retro-orbital pain, bleeding from nose or purpura, macular rash, muscle and joint pain, ‘break bone fever’; leukopenia, cytopenia, thrombopenia, increased LFTs

A

dengue hemorrhagic fever

210
Q

pt receiving parenteral nutrition through central venous catheter have increased risk for…

which has what morphology?

A

candidemia

pseudohyphae with blastoconidia

211
Q

MOA of caspofungin and other echinocandin antifungals

What is the major polysaccahharide component here?

A

suppress fungal wall cell synthesis by inhibiting glucan synthesis

1,3-beta-D-glucan

212
Q

fungus in spherules?

where is it located?

sequelae of infection?

A

coccidiomycosis

SW US

meningitis and pna

213
Q

UTI with Proteus will probably have..

why?

A

magnesium, ammonium, phosphate crystals in urine;

protease secreates urease, promoting alkalinization causing ppt of phosphate + carbonate and magnesium

leading to production of struvite kidney stome

214
Q

an injury to a patient due to failure to follow evidence based best practice guidelines

A

preventable adverse event

215
Q

unexpected occurrence involving death or serious physical or psychological injury

A

sentinel event

216
Q

a medical error that is recognized before any harm is done to the patient

A

near miss

217
Q

what cytokine is secreted by both Th1 and Th2 cells and promotes the growth and differentiation of bone marrow stem cells

A

IL-3

218
Q

normal RBC mass and decrease in plasma volume will cause a …

what could this be from?

A

relative erythrocytosis

aggressive diuretic therapy for heart failure exacerbation

219
Q

marked erythrocytosis and more modest increase in granulocytes and platelets; low epo level along with increased RBC mass

A

Polycythemia vera

220
Q

What is the apparent threshold for development of secondary erythrocytosis?

A

Sa <92% / PaO2<65

hypoxic erythrocytosis

221
Q

How and where does the hormone leptin work in the brain?

A

acts on the arcuate nucleus of the hypothalamus to inhibit production of neuropeptide Y (decreasing appetite) and stimulate production of alpha-MSH (increasing satiety)

222
Q

What does sunlight exposure catalyze in Vitamin D synthesis?

A

conversion of 7-dehycrocholesterol to cholecalciferol (vit D3) in the skin

223
Q

What is the gene mutation in achondroplasia? What does this cuase?

A

FGFR3 usually limits chondrocyte proliferation during endochondral ossification

in this disease, FGFR3 becomes constitutively activated, causing exaggerated inhibition of chondrocyte proliferation that results in the characteristic bone shortening and craniofacial abnormalities

224
Q
A

Board questions (24 decks)

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