Uworld/combank/comquest flash cards

Question 1

Sexual development

testosterone

leads to devlopment of

Answer 1

internal male genitalia,

spermatogenesis

male sexual differentiation at puberty

Question 2

dihydrotestosterone (DHT)

leads to the development of ?

Answer 2

external male genitalia

growth of prostate

male pattern hair growth

also amplifies effects of testosterone due to high affinity for testosterone receptor

Question 3

estrogen

leads to the development of ?

Answer 3

endometrial proliferation

development of ovarian granulosa cells

breast development

Question 4

pt had a congenital heart condition as a child, that they refused to get fixed. he of exertional dyspnea and fatigability, when boy tires easily when walking and cannot keep up with his peers at the playground. on PE toe cyanosis and clubbing but no finger abnormalities. all extremity pulses are full and equal.

whats the diagnosis?

Answer 4

*patent ductus arteriosus

large PDAs can present in childhood with progressive pulmonary htn and reversal of the shunt to right to left

causing

Eisenmenger syndrome. (cyanosis)

heart failure (shortness of breath, fatigability)

note: cyanosis and clubbing are more pronounced in the lower extremities bc PDA delivers unoxygenated blood distal to the left subclavian artery.

if it was VSD then cyanosis would be equal.

also the characteristic continuous murmur decreases as the pulmonary pressure rises.

Question 5

from point 1 to point 2

hemoglobin is most likely to release?

Answer 5

proton (H) and CO2

(haldane effect)

as inc alveolar pO2 increases this increases binding to hemoglobin and increases release of Co2 and H

Question 6

BRCA 1

BRCA2

Normally are responsble for what process

Answer 6

DNA repair

(dsDNA breeaks)

Question 7

p53

main function is?

Answer 7

protein degradation

it activates p21, blocks G1 –> S phase

Question 8

HER2 / neu (c-erbB2)

has what gene function

Answer 8

receptor tyrosine kinase involved in growth signal transduction

Question 9

what nucleus in the medulla receives info from the area postrema, GI tract via the vagnus n, vestibular system, and cns for vomiting reflex

Answer 9

nucleus tractus solitarius (NTS)

Question 10

what are the 5 major receptors involved in stimulating the vomiting reflex in the area postrema and adjacent vomiting center nuclei

Answer 10

M1 muscarinic

D2 dopaminergic

H1

5-HT3

neurokinin (NK1) receptors

Question 11

neurokinin1 (NK1 receptor) antagonist used for

refractory chemo induce vomiting MOA

Answer 11

inhibit substance P release

Question 12

pt with transitional cell carcinoma (bladder cancer)

classic presentation: painless gross hematuria.

in most cases the neoplastic cells resemsble those of normal bladder epithelium (urothelial transitional cell carcinomas)

****what feature would be the most important prognostic marker in this pt?

Answer 12

involvement of the muscular layer

degree of invasion into the bladder wall and adjacent tissue is the most important

bladder cancer most often grows as a papillary or sessile mass and is easily diagnosed on cystoscopy

Question 13

12 yo boy with Von willebrand disease

hes given desmopression

whats the mechanism

Answer 13

increases in endothelial protein release

(increases release of vWF stored in endothelium)

Question 14

list the organ susceptibility to infarction after occlusion of a feeding artery from greatest to least

Answer 14

CNS> myocardium > kidney > spleen > liver

LIVER is least bc of Dual/ collateral blood supply (hepatic artery and portal vein)

Question 15

HUS caused by E coli 157H7 is caued by eating?

Answer 15

undercooked BEEF

Question 16

list the speed of conduction of the AP from fastest to slowest in relationship to cardiac structures

1 = 0.05 m/sec

2 = 0.3 m/sec

3. = 1.1 ,/sec

4 = 2.2 m/sec

Answer 16

Purkinje (2.2) > atrial muscle > ventricular muscle > AV node

“Park At Venture AVenue”

Question 17

6 mercaptopurine is inactived by?

Answer 17

xanthine oxidase

Question 18

for USMLE

what progressive neurologic disease may be associated with

cystic degeneration of the putamen

Answer 18

wilsons disease

Question 19

pt with maple syrup disease

besides restrictions of branched amino acids

(isoleucine, leucine, valine)

what supplement can help this pt

Answer 19

thiamine

Question 20

which anticonvulsant cant cause agranulocytosis

(aplastic anemia)

Answer 20

carbamazepine

Question 21

macrolides (erythromycin)

increase what GI hormone

Answer 21

motilin

pt presents 5 days after being treated for community acquired pneumonia. now has vomiting and vomiting shortely after eating

Question 22

kid with pyruvate kinase deficiency

what is responsible for splenomegaly in this pt

A. red pulp hyperplasia

B. passive spenic congestion

Question 23

red pulp hyperplasia

bc the reiculoendothelial cells (macrophages) in the splenic red pul are involved in removal of damaged RBCS,

there increased activity causes splenomegaly

wrong answer: passive splenic congestion which is seen in leukemia and lymphoma.

Question 24

which cell type containing telomerase (ribonucleoprotein) that addes TTAGGG repeats to the 3’ end of chromosomes

will have higher number proteins in comparison to other cell types in adults

Answer 24

stem cells (epidermal basal cells)

bc stem cells have long telomerases

somatic cells have shorter telomerases and dont proliferate indefinitely (myocardial, neurons, pancreatic B cells)

Question 25

pt with downs trisomy 21

which meiosis event did nondisjunction occur?

Answer 25

maternal meiosis 1

Question 27

55 yo man comes to office due to malaise and cough over the past 2 months

he describes yellow sputum produciton w/ occasional streaks of blood

smookes pack cigs daily and hx of alcohol abuse.

normal temp.

exam shows poor dentition w/ dental caries, gingivitis, and enlarged submandibular lymph nodes

ronchi heard in right lung, with lung consoidative process w/ air bronchograms

diagnosis?

Answer 27

actinomycosis (actinomyces israelii)

gram + anaerobic bacteria. typically colonizes mouth, colon, vag. found in dental caries, and margins of gums in pts with poor dentition

pulmonary actinomycosis mc occurs by aspriation.

diagnosis: made by identifying bacteria w/ unqiue filamentous, branching pattern and the characteristic sulfur granules (red arrow) formed by calcified mycelial fragments

question 10993

Question 28

describe the histo for actinomyces

Answer 28

branched filamentous pattern

Question 29

65 yo

disease of MI

congo red staining of brain samples obtained from cerebral aterioles reveals patchy red deposits that urn yellow green under polarized light.

diagnosis

Answer 29

alzhemers disease

Question 30

pt has infrarenal AAA, during the repair the inferior mesenteric artery is ligated. collateral circulation from which vessels is responsible for preventing ischemia of the descending colon?

Answer 30

superior mesenteric artery

the SMA and IMA form an anastomeses: the marginal artery of drummond, (the principal anastomosis) and the inconsistently present arc of Riolan (mesenteric meandering artery)

Question 31

what is responsible for the change in the quality of pain (from umbilicus to mcburneys) seen in a pt with appendicitis

Answer 31

inflammation of the parietal peritoneum

as the appendix becomes more inflammed, it irritates the parietal peritoneum and abdominal wall adn causes a more severe somatic pain that shifts from umbilical region to mcburney point

incorrect answer: involvement of the psoas major muscle

Question 32

14 yo girl. presents for eval of bump on chest just below the right breast.

the bump has been there for as long as she can remember.however it has become a little larger 2-3 years ago.

the bump becomes tender just before menses.

its soft raised hyperpigmented, 0.5 cm nontender lesion inferior to the right breast.

what is the cause of this pts presentation

A. failed involution of the mammary ridges

B. fat cells in a fibrous capsule

C. pedunculated growth of normal skin

Answer 32

failed involution of the mammary ridges

she has an accessor nipple (polythelia, supernumerary nipple)

usually asymptomatic and become tender and swollen similiar to normal breast.

Question 33

a pt with membranous nephropathy,

flank pain

hematuria

and left varicocele

likely has?

as a result of nephrotic syndrome

* urinary loss of what substances most likely prediposed this pt to his acute condition?

A. albumin

B. antithrombin III

Answer 33

developed renal vein thrombosis

due to the increased glomerular capillary wall permeability in nephrotic syndrome leads to loss of substances in urine

loss of antithrombin III

leading to hypercoagulable state,

Question 34

pt was given a intramuscle deep muscle injection

now presents with trendelenbur sign in right leg

where was the shot given

A. inferomedial quadrant of left butt

B. superomedial quad of the left butt

Question 35

autopsy finding in a 65 yo male. who suffered myocardial infarction, extensive carotid atherosclerosis and intermittent claudication are shown

wotf produced the lesion seen on slide

A. lysosomal digestion of the tissue

B. granulomatous rxn in the area of necrosis

C. hemorrhage into the necrotic area

Answer 35

lysosomal digestion of the tissue

(liquefactive necrosis is characterized by complete digestion and removal of necrotic tissue w/ formation of cystic cavity.∫

hypoxic CNS injury is often followed by liquefactiv necrosis.

abscess formation due to bacterial or fungal infection is another example of necrosis

Question 36

what condition is an infant at highest risk of developing from exposure to second hand cigarette smoke.

A.Eczema

B. Sudden infant death syndrome

Answer 36

*Suddent infant death syndrome

risks of second hand smoke exposure

A. prematurity, low birth wt

B. sudden infant death syndrome

C middle ear disease (otitis media)

asthma

Respiratory tract infections (bronchitis, pneumonia)

Question 37

22 yo with severe headache, and vomiting, soon after slips into coma and dies

autopsy shows a ruptured cerebral aneurysm w/ extensive intracranial hemorrhage.

this pts condition is most likely associated w/

Answer 37

coarctation of the aorta.

most common causes of spontaneous intracranial hemorrhage in young adutls is AV malformations, ruptured cerebral aneurysm, or abuse of sympathomimetic drugs (cocaine)

coarctation causes htn in branches of the proximal aorta above the coarct

Question 38

56 yo women, presents with several days of progressive dyspnea, productive cough, and fever.

today her son found her SOB, and obtunded,

hx of RA, htn, type 2 diabetes.

exam: bilateral pneumonia and severe respiratory distress.

this pt is lethargic without focal neurologic deficit.

urgent endotracheal intubation is performed and the pt is started on broad spectrum abs.

2 hours laters shes areflexic, falccid paralysis of all extremites.

what caused the neurologic deficits

Answer 38

vertebral subluxation

bc pt with RA undrewent urgent endotracheal intubation.

wrong anser is guillain barre syndrome and cerebral septic emboli

Question 39

26 yo is in ER after man was assaulting customers in restaurant.

he is experiencing acute mania (hes trying to cure world hunger, up all night for 7 days, he hears voice tellign him he is gods real son and will need to sacrafice himself. fam hx: mom postpartum psychosis. he has no psychiatric or med hx. he doesnt use drugs. on mental exam he is disheveled and paces continuously. his mood is very irritable and his speech is loud, rapid, difficult to interrupts.

diagnosis?

A. bipolar 1 disorder with psychotic features

B. bipolar II disorder

C. brief psychotic disorder

Answer 39

bipolar I disorder w/ psychotic features

pts with one or more lifetime manic episodes are diagnosed w/ bipolar 1 disorder

manic episodes can occur with or without psychotic features (delusions, hallucinations)

depressive episodes are not required for diagnosis of Bipolar 1 disorder

Question 40

what cell secretes a substance that controls iron storage and release by other cells involved in iron homeostasis

Answer 40

hepatic parenchymal cells

secretes hepcidin which interacts with ferroportin which is a transmembrane proteins rewsponsible for transferring intracellular iron to circulation

Question 41

2 hours after patients Mi

light microscopy of the affected myocardium would most likely demonstrate?

Answer 41

normal myocardium (0-4 hours)

4-12 hrs (early coagulation necrosis, edema, hemorrhage, wavy fibers)

12-24 hours coagulation necrosis and marginal contraction band necrosis

Question 42

48 yo admitted to hospital w/ severe epigastric abd pain and vomting after an episode of binge drinking

4 weks later hes found to have a palpable upper abdominal mass and a cystic lesion is visualied on CT.

the inner walls of the lesion are mostl likely lined with

Answer 42

fibrous and glandulation tissue

pt has a pseudocyst from acute pancreatitis

Question 43

Cavernous hemangioma

have an increased risk for?

Answer 43

**intracerebral hemorrhage** and seizures

Question 44

pt has appendectomy.

3 weeks later presents with decreased sensation at the right suprapubic region and burning pain at the surgical scar radiating to the suprapubic region.

what nerve was effected

Answer 44

iliohypogastric

its anterior branch emerges above superficial inguinal ring innervating the skin above the pubic region

wrong answer is ilioinguinal nerve which accompanies the spermatic cord through the superificial ring. providing sensation to the upper and medial thigh and parts of external genitalia.

Question 45

21 yo man, w/ impaired balance, tremor, and difficulty speaking.

symptoms have developed slowly over the last several months.

pts has elevated transaminases. but neg hepatits serology.

he doesnt use tobacco, alcohol, or illicit drugs.

his sibling who was diagnosied at a young age with a progressive neurologic disease.

what diagnositic test would be most helpful?

Answer 45

Slit lamp examination.

pt has wilsons disease

autosomal Recessive mut of ATP7B –> hepatic copper accumulation –> leak from damaged hepatocytes –> deposits in tissue (basal gangliam, cornea)

Question 46

characteristic *mouse like odor (indole-postiive species)

infection typically occurs within 24 hours of inoculation

what organism.

Answer 46

pasteurella multocida

Question 47

question 1099

pt with gram negative motile enteric rod

pt in honduras

watery diarrhea, with abdominal cramping, nausea and vomiting. resolves in 2 days.

these symptoms are most associated with?

A. cholera ike toxin

B stacked brick intestinal adhesions

Answer 47

cholera like toxin.

(ETEC: travelers diarhea)

the LT enterotoxin, similiar to cholera toxin in structure and mode of action, increases intracellular cAMP (not the heat stable enterotoxin - cGMP) in gut mucosal cells by activating Gs membrane G protein, –> activating adenylate cyclase

B - stacked brick intestinal adhesions (enteroaggregative ecoli)

Question 48

stacked brick intestinal adhesions

Answer 48

enteroaggregative E coli (EAEC)

organism adhere to human jejunal, ieal, colonic mucosa in an aggregative or stacked brick pattern and do not invade

persistent diarrhea in infants in developing countres

Question 50

74 yo hospitalized for Acute urinary retention complicated by urosepsis. pt requires endotracheal intubation

hes on vent for 24 hours then extubated. on 3rd day develops fever and right jaw pain

firm swelling of the preauricular area extending to angle of mandible.

what serum markers is most helpful for confirming diagnosis

Answer 50

amylase

bc patietn has suppurative parotitis

risk factors: decreased salivary flow: meds (anticholinergics) obstruction (calculi), dehydration, intubation

microbe most common: staph a.

clinical pres: firm erthematous pre/post auricular sweling, trismus, dysphagia, fever chiils

daignosis. ductal inflammation/obstruction, frank abscess, image(US or CT)

labs amylase

Question 51

know that visible ulcerative mass (anal cancer are ulcerative in > 50% of cases)

pt with HIV likely has anal squamous cell carcinoma. given the duration of pain, itching, and rectal bleeding

whats the cause

Answer 51

human papillomavirus

Question 52

48 yo with intermittent ear discharge over last 2 years.

conduction hearing loss in that ear

otoscopy: small perforation in tympanic membrane (doesnt have to be ruptured) and a pearly mass behind the membrane

whats the casue of this patients aural mass?

Answer 52

squamous cell debris

(desquamated keratin debris)

wrong answer was cholesterol and lipid accumulation

(this is cholesterol granulomas: which can develop after hemorrhage and are rare)

Question 53

you suspect a pt has allergic dermatitis

the most appropriate diagnostic test is?

A. patch test

B. percutaneous allergy testing

Answer 53

patch test

Question 54

cholestasis

causes

intrahepatic - drug induced (erythromycin, contraceptives), primary billiary cholangitis, cholestasis of pregnancy, primary sclerosing cholangitis (can also be extrahepatic)

extrahepatic: choleocholithiasis, malignancy (pancreatic, gallbladder)

if left untreated what can pt develop

Answer 54

fat soluble deficiency

know this presentation

both obstructive and nonobstructive cholestasis are characterized by the deposition of bile pigment within the hepatic parenchma, often with green brown plugs in the dilated bile canaliculi.

when its prolonged, the reduction in bile flow –> intestinal malabsorption of fasts and fat soluble vitamins, which require bile salts for digestion.

Question 55

MVA accident, rigid abdomen associated with left shoulder pain, hypotension, tachycardia suggests a possible?

Answer 55

splenic laceration and hemoperitoneum

not hemopericardium (blood accumulation in the pericadrial sac : presents iwth SOB, tachycardia, JVD and possible Hypotension.

Question 56

hiccups are due to

Answer 56

phrenic nerve irritation –> hiccups due to spasmodic diaphragmatic contraction pulling air against a closed larynx

Question 57

what is the most likely initial clinical presentation in pt with

acute viral hepatitis

A. fever, anorexia, and dark colored urine

B. prolonged pruritus and fatigue

Answer 57

A.

first prodromal: fever, malaise and anorexia, N/V, RUQ pain. (for 1day -1 week)

then signs of cholestasis arise.

jaundice, pruritus , dark colored urine (due to inc conjugated bilirubin levels, and acholic stool (lack bilirubin pigment)

Question 58

an individual w/ a point mutation affecting the gene responsible for neurphysin synthesis is most likley to suffer from?

Answer 58

diabetes insipidus

neurophysins are carrier proteins for oxytocin and vasopressin (ADH)

Question 59

what contributes to blood vessel development (angiogenesis)

besides VEGF

A. EGF

B. Fibroblast growth factor

Answer 59

fibroblast growth factor