UWorld Questions Flashcards
1
Q
A collagenous scar is mainly composed of which type of collagen? Where is this collagen also seen?
A
Type I; Dermis, bone, tendons, ligaments, blood vessels, scar tissue
2
Q
Type II collagen is found where? Type IV?
A
Cartilage and nucleus pulposes; Basement membrane
3
Q
Granulation tissue is composed of which type of collagen? Where is this collagen also seen?
A
Type III; spleen, lymph nodes, bone marrow
4
Q
In the healing process after an MI, when is granulation tissue seen and when does scar formation occur?
A
Granulation tissue: 1-2 weeks; replaced by collagenous scar 2 weeks- 2 months
5
Q
What murmur is seen in Turner’s Syndrome and where is it heard?
A
Associated with bicuspid valve - aortic ejection sound. Right, second interspace over the aorta.
6
Q
Which cardiac structure makes up most of the anterior surface?
A
Right ventricle
7
Q
The nipple is at which intercostal level?
A
4th intercostal space
8
Q
What 3 skull bones come together to form the pterion, a thin region in the bone? What artery is at risk of being severed? Potential complication?
A
Sphenoid, Frontal and Parietal; Middle meningeal artery; epidural hematoma
9
Q
Middle meningeal artery is a branch off of what artery?
A
Maxillary artery (a branch off the external carotid)
10
Q
Aortic arches and their derivatives (nerves and arteries). 6 in all.
A
1: Trigeminal n. and portion of maxillary artery
2: Facial n.
3: Glossopharyngeal n. and common carotid arteries
4: Superior laryngeal branch of vagus n. and true aortic arch (+ subclavian arteries)
5: Obliterated
6: Recurrent branch of vagus n. and pulmonary arteries + ductus arteriosus
11
Q
A blowing, holosystolic murmur is indicative of what defect?
A
Mitral or tricuspid regurgitation
12
Q
S. bovis is a concern for endocarditis for which patients?
A
Patients with colon cancer
13
Q
Endocarditis in IVDU is caused by what organism? What structure does it affect and what is a complication?
A
Staph aureus, tricuspid valve, septic pulmonary emboli
14
Q
When does acute graft rejection occur and histologically what is seen? What about chronic rejection?
A
1-4 weeks following a transplant. T-cell lymphocytic infiltrate (mononuclear). Chronic is months to years. Scant inflammatory cells and interstitial fibrosis.
15
Q
What are the normal pressures assessed with a catheter through different parts of the heart?
A
SCV = RA = 1-6 mmHg RV = 2 - 25 mmHg (the lowest has to be lower than RA) PA = 10 - 25 mmHg (increase in diastolic with no change in systolic) PCWP = 6-12 mmHg (indicative of LA pressure as well) LV = 10 - 130 mmHg
16
Q
An anterior and inferior aorta is characteristic of what defect? How does it present?
A
Transposition of great arteries; causes cyanosis in newborns.
17
Q
Presentation of congestive heart failure with symmetrical peripheral neuropathy is suggestive of what illness? What is it caused by?
A
Wet Beriberi (cardiac involvement vs dry beriberi). Thiamine deficiency (Vit B1).
18
Q
Catheterization of the femoral artery superior to the inguinal ligament increases risk of hemorrhage into what space?
A
Retroperitoneal space. The artery lies behind the peritoneum.
19
Q
What can be done to reduce infections associated with central venous catheters?
A
Appropriate hand hygiene, appropriate barrier methods (gloves/drapes)
20
Q
What is a 2 sample T test used to evaluate?
A
The means between two populations
21
Q
What structures can be compressed by enlargement of the left atrium?
A
Mid-esophagus (dysphagia); left recurrent laryngeal nerve (hoarseness)
22
Q
Baroreceptors are located in what parts of the arterial blood vessels (2)? What nerves transmit these signals? Carotid massage leads to what in the heart?
A
Carotid sinus (glossopharyngeal) and aortic arch (Vagus). Parasympathetics to heart to inhibit SAnode and slow conduction through AV
23
Q
Dysmorphic features (flat face, protruding tongue, small ears) are characteristic of what disease? What is the cause?
A
Down’s Syndrome; Meiosis Non-Disjunction
24
Q
Isolated systolic hypertension in the elderly is commonly caused by what condition?
A
Increased arterial stiffness
25
Viral syndrome followed by symptoms of heart failure is indicative of what pathology?
Dilated cardiomyopathy
26
What is the embryological cause of Tetrology of Fallot
Failure of neural crest cell migration resulting in deviation of infundibular septum
27
Hemolysis activity of Staph aureus and Coag-negative staph
S. aureus is beta-hemolytic; others are gamma
28
A trans-esophageal probe mid-esophagus faces _____ anteriorly and _____ posteriorly.
Left atrium; descending aorta
29
When are S3 and S4 heart sounds heard and what are the causes?
S3 is heard right after mitral valve opens in early diastole (filling). Associated with increased filling pressures. S4 is right before mitral valve closes during that final atrial contraction due to increased atrial pressure.
30
Opening snap following by rumbling diastolic murmur is indicative of what? Where is is best heard?
Mitral stenosis. It is heard during diastole as mitral valves open. Best heard over apex of the heart.
31
In an abdominal CT, how do you distinguish between the aorta and IVC?
The IVC is larger and runs to the right (of the patient; left on imaging).
32
What level do the common iliac veins merge to become IVC? What level does aorta bifurcate to common iliac arteries?
Veins: L5
Aorta: L4
33
What procedures puts someone at risk for Enterococcus endocarditis?
GI/GU Procedure (cytoscopy etc.) since Enterococcus is normal GI/Urogenital flora
34
Enterococcus are _____ hemolytic, PYR _____ and grow in ____ and ____.
Gamma, positive, NaCl hypertonic saline and bile
35
Differentiate Strep bovis from Enterococcus.
They are both gamma hemolytic. Enterococcus is PYR positive and but S. bovis is PYR negative.
36
Cardiac myocyte viability may still be maintained despite atherosclerotic occlusion because of what process?
Ischemia may induce VEGF which stimulates formation of collateral vessels. This is possible if the plaque is slow growing.
37
What can be said about atherosclerotic plaques in ostial locations?
Ostial is at a dividing point between two arteries. Plaques in this location can occlude more than one artery, thereby limiting blood flow.
38
ANP is released from _____ in response to _____ and does what functions (3)?
Atrial myocytes; atrial stretch; Peripheral vasodilation; inhibits aldosterone secretion; dilates efferent arterioles in the kidneys to promote glomerular filtration and urinary excretion of sodium and water.
39
Myocardial perfusion occurs during (systole/diastole). During exercise, and increase in heart rate shortens what?
Diastole; increased heart rate shortens duration of diastole
40
What is the driving force (pressure) for coronary blood flow?
Diastolic AORTIC pressure.
41
Ischemia in cardiac myocytes results in swelling of cells through what mechanisms?
Ischemia decreases ATP production. ATP is necessary for Na/K pumps and re-sequestering Ca into the SR. Without this, intracellular levels of Na and Ca rise, pulling water into cells.
42
A bicuspid aortic valve puts you at risk for what?
Aortic stenosis and atherosclerosis at an early age (50s)
43
Sudden cardiac death in athletes is caused by? How did patient die? What is an important histological feature?
Hypertrophic cardiomyopathy; V fib; myocyte disarray
44
Endocardial thickening and non-compliant ventricular walls are characteristic of what pathology?
Restrictive cardiomyopathy
45
Calcification of an aging valve most likely occurred through what process? Seen with hypercalcemia?
Dystrophic calcification; NOT associated with hypercalcemia (unlike metastatic calcification). It is a hallmark of cell injury and death (preceded by necrosis)
46
What are paradoxical emboli? What causes them (2 causes)? Which is more common?
Venous emboli seen in arterial system because of shunt from RA to LA. Due to ASD (aplasia of septum primum or secundum) or patent foramen ovale (incomplete fusion of septum primum and secundum)
47
How does sustained valsalva maneuver alter cardiac pressures?
Increased pressure in right atrium
48
Venous drainage of arms, head (scalp, face) and neck?
Subclavian drains upper extremities, external jugular drains the scalp and lateral face, internal jugular drains the brain, face and neck. The all come together as the brachiocephalic vein. This comes from both sides and forms the SVC.
49
The S4 heart sound is heard when? And can be caused by what pathology?
Right before S1 (mitral valve closing). Restrictive cardiomyopathy or LV hypertrophy (due to HTN)
50
What heart pathology has an irregularly regular rhythm with patient complaining of palpitations? How does it appear on ECG? What acute activity can cause this to occur? Where do impulses originate?
Atrial fibrillation; absent P waves irregularly spaced QRS complexes; night of excessive drinking; originate in pulmonary veins in LA
51
High QRS voltage in the precordial leads is indicative of what?
Ventricular hypertrophy
52
A prolonged QT is associated with an increased risk for what?
Torsades de pointes
53
Romano Ward Syndrome and Jervell and Lange-Nielsen Syndrome (presentation, genetics and findings)
RWS (purely cardiac-AD) and JLNS (cardiac and sensorineural hearing loss-AR). Associated with prolong QT due to defective potassium channels (delayed repolarization)
54
Chest pain that is reproducible with palpation and with movement is indicative of what?
Costochondritis; chest wall
55
What is the best indicator of severity of mitral stenosis?
Time between S2 (A2) and opening snap. Shorter interval is indicative of increased severity
56
Strep viridans have the ability to produce _____ which allow them to colonize what surfaces? What does the bacteria adhere to?
Dextrans; teeth enamel and heart valves (endocarditis); fibrin
57
The apex of the heart can be found at what anatomical location? What chamber is it composed of?
5th intercostal space at the mid-clavicular line. Left ventricle.
58
How soon after ischemia do myocytes stop contracting? How long after is ischemic injury irreversible?
60 seconds; 30 minutes
59
What happens to ATP under hypoxic conditions in cardiomyocytes?
ATP gets converted to AMP and eventually adenosine which can cause vasodilation of arteries.
60
Atrial myxomas can have what kind of murmur?
Mimic mitral stenosis with low-pitches mid-diastolic rumble
61
Histology of myxomas
Scattered cells in mucopolysaccharide stroma
62
Concentric vs eccentric ventricular hypertrophy (causes, sarcomere additions, appearance)
Concentric: HTN, aortic stenosis; sarcomeres added in parallel. Thick wall with small chamber. Eccentric: volume overload from aortic/mitral regurgitation or dilated cardiomyopathy. Wall is generally thinner, but chamber is larger.
63
how much must an artery be occluded to experience stable angina?
>75%
64
Phase 4 of pacemaker action potential and associated channels.
Spontaneous depolarization with funny current (Na) which with enough depolarization opens the T-type Ca channels and eventually opens L type calcium channels (which continue to Phase 0)
65
Which organ extracts the most oxygen from blood?
Myocardium (heart)
66
What determines the severity of mitral regurgitation?
Presence of audible S3 sound (higher volume of blood will enter ventricle after regurgitation). S3 can be indicative of severe chronic MR
67
Source of thrombus in atrial fibrillation
Left atrial appendage
68
How is fetal lung maturity assessed? Include gestational age what is seen.
Assessed through amniotic lecithin (phosphatidylcholine) and sphingomyelin ratio. These are components of surfactant. At ~30 weeks, they are equal. Lecithin sharply increases afterwards and a ration of 2:1 is considered mature (35 weeks)
69
Most common defect in genetic defect in cystic fibrosis and result
Deletion of Phe508 resulting in abnormal folding of the protein. Re-directed to proteosome and does not make it to cell membrane.
70
Pain that is exacerbated by coughing or deep inspiration is indicative of what condition? This pain can radiate to the neck and back - why?
Pleuritic chest pain due to inflammation of the pleura (often seen in pneumonia). The parietal pleura (the diaphragmatic and mediastinal portions) send pain fibers via the phrenic nerve (C3-C5 distribution).
71
What is the genetic condition that can predispose someone to developing emphysema? How? What lobe is generally affected?
Alpha-1 anti-trypsin deficiency. This is a deficiency in a protease inhibitor. This leads to increased activity of protease (elastase) which breaks down elastin which is supposed to allow alveoli to stretch and recoil. Lowe lobe.
72
What property of elastin allows it to stretch and recoil?
The cross-linking between molecules on lysine residues.
73
Actions of histamine upon degranulation of mast cells (3)
Bronchoconstriction, increases vascular permeability and increased mucous secretion
74
How does the immune system control a mycobacterium tuberculosis infection? What cells are important?
Initially, replication of bacteria in alveolar macrophages. Several weeks later: immune response. APC display antigens on MHCII and release IL12 to cause CD4 to become TH1. TH1 release IFN-gamma to activate macrophages which can form phagolysosomes to destroy bacteria, or form granulomas.
75
Normal A-a gradient
Alveolar to arterial (4-15 mmHg)
76
How does physiologic dead space change during exercise?
This is decreased because during exercise the capillaries in the apex of the lung dilate to allow for increased ventilation
77
Young women with progressive dyspnea and loud S2 with no other significant PMH is concerning for what pathology? What is the cause?
Pulmonary hypertension. Genetics. Inactivating mutation in BMPR2 (AD) causing smooth muscle proliferation.
78
Bronchi with thickened bronchial walls, inflammatory infiltrates (lymphocytes), mucous gland enlargement and patchy squamous metaplasia of bronchial mucosa is concerning for what disease? What is the most common cause?
Chronic bronchitis from smoking
79
A hospitalized patient who suddenly develops chest pain and shortness of breath is concerning for what pathology?
Pulmonary embolism
80
Pulmonary embolism is what type of V/Q mismatch?
Dead-space ventilation. Well ventilated areas are not perfused because of the clot.
81
What is the cause of dyspnea in left-sided heart failure?
Fluid transudates from pulmonary capillaries into lung interstitium. Decreases lung compliance
82
The Haldane effect occurs in the lungs and is caused by _____ binding Hemoglobin. What does it cause?
O2; release of H+ and CO2 from Hemoglobin molecule
83
The Bohr effect takes place in peripheral tissues. _____ and _____ facilitate _____ unloading from Hemoglobin.
H+ and CO2; O2 unloading
84
What is a virulence factor seen in TB and what does it allow?
Cord factor prevents macrophage mediated phagolysosome destruction
85
Location of thoracentesis in three locations: midclavicular line, midaxillary line and paravertebral line. Where do veins, arteries and nerves run? What structure is at risk of injury?
MC: between 6-8 rib
MA: Between 8-10 rib
PV: Between 10 -12 rib
VAN run just below the rib so thoracentesis should be done on the superior border. Abdominal structures at risk
86
Two important functions of Type II pneumocytes
Surfactant production and regeneration of alveolar lining "stem cells"
87
Lung architecture. Name the parts (conducting zone and respiratory zone). Also note what structures are present. Where do cilia end.
Conducting zone: Cartilage found from trachea to bronchi. Goblet cells end in bronchioles. Last portion is terminal bronchioles.
Respiratory zone contains respiratory bronchiole and alveolar sacs. Cilia and club cells continue up to respiratory bronchiole.
Cells change from pseudostratified to cuboidal
88
In Chronic Granulomatous Disease (CGD), how do patients present? What process is disrupted? Describe mechanism.
Recurrent granulomatous infections (skin, liver etc.). Patients have a deficient NADPH oxidase complex and cannot make superoxides for killing bacteria. Micro-organisms produce H2O2 as by-product which accumulates within macrophages and allows for killing. However, catalase positive organisms can destroy their own hydrogen peroxide.
89
What are the catalase positive organisms? What disease makes individuals susceptible to infection by these guys?
Staph aureus, Burkholderia cep, Serratia, Nocardia, Aspergillus
90
How are ventilation and perfusion in the apex compared to the base? What about V/Q ratio?
In upright position, both ventilation and perfusion are decreased apex and increased in base. But it affects perfusion more so perfusion in apex is markedly decreased leading to high V/Q at apex and low V/Q at base.
91
When a patient is supine, where are they likely to aspirate? What about when they are upright?
Right lobe in general. Supine: posterior aspect of upper lobe or superior aspect of lower lobe. Upright: basilar segment of lower lobe.
92
What are causes (2) of hypoxemia in normal A-a gradient?
Obesity hypoventilation syndrome, high altitude
93
FEV1 and FVC in obstructive and restrictive lung diseases.
Both values are decreased in both diseases. FEV1/FVC ration is decreased in obstructive. FEV1/FVC is normal/increased in restrictive.
94
What lung volume(s) increases in obstructive lung disease?
Functional residual capacity due to increase in residual volume (cannot get air out). TLC is also mildly increased.
95
Explain chloride shift. Which has higher chloride content, venous or arterial blood?
Venous blood. There is an increase in tissue CO2 which undergoes rxn w Carbonic anhydrase to make HCO3- and H+. HCO3- diffuses out of the cell and to compensate, Cl- comes in.
96
What produces green-sputum in pneumonia?
Myeloperoxidase released from neutrophil granules.
97
Rusty colored sputum in pneumonia is characteristic of what microorganism? What causes this color?
S. pneumo. Necrosis and extravasation of RBC and hemoglobin into sputum
98
What is a cause of secondary polycythemia?
Chronic hypoxemia from lung disease cause an increase in erythropoietin secretion from kidneys
99
What nerve can be stimulated to improve obstructive sleep apnea? Why?
Hypoglossal nerve because sleep apnea occurs due to neuromuscular weakness of oropharynx
100
What can be administered to pregnant women at risk of premature delivery? What does it help prevent?
Corticosteroids (dexamethasone, betamethasone) to prevent neonatal respiratory distress syndrome.
101
What is a causative agent of "walking pneumonia" and is of concern in people living in close quarters?
Mycoplasma pneumonie
102
Mycoplasma pneumonie needs what to grow?
Cholesterol
103
Legionella pneumophila is spread through contaminated _____. What stain can be used to visualize?
Water sources. Aerosolized water is a risk. Silver stain.
104
Haemophilus influenza requires what for growth? What media can it be grown on?
Factor V (NAD+) and Factpr X (hematin). Found in erythrocytes. Lysed RBC (chocolate agar).
105
Virulence factor of H. influenzae
Capsule. Prevents phagocytosis
106
How do the kidneys respond to a state of chronic metabolic acidosis? What (2) compounds are important for maximizing acid excretion in urine?
Ammoniagenesis. Renal tubular cells use glutamine to release NH3 (twice) to become alpha-ketoglutarate. The NH3 will bind H+ and get excreted in the urine as ammonium (NH4). HPO4 is also an acid buffer in the urine that will bind H+ (H2PO4) and aid in acid excretion.
107
What is seen in chronic allograft rejection, histologically? How does a patient present?
Vascular thickening (intimal fibrosis), parenchymal atrophy, interstitial fibrosis. Scattered mononuclear infiltrate. Worsening hypertension and progressive increase in serum creatinine.
108
What are mononuclear cells?
Typically lymphocytes (T cells or B cells). Also monocytes. Not granulocytes which are multi-lobed.
109
Nodular glomerulosclerosis is characteristic of what disease? What else is seen on histology?
Seen in diabetic glomerulo-nephropathy. Aka Kimmelstiel-Wilson lesions. Non-enzymatic glycation of tissue proteins resulting in mesangial expansion and GBM thickening.
110
Renal amyloidosis would present in what way? And what would be seen on biopsy?
Present as nephrotic syndrome with heavy proteinurua and edema. Biopsy should be visualized with Congo Red Stain and would show Apple-Green birefringence
111
Nephrotic syndrome with diffuse capillary wall thickening. What is the pathology and what do immuno-fluorescence and EM show?
Membranous nephropathy. IC deposition would show granular deposits on IF. EM has dome and spike appearance.
112
Pseudomonas aeruginosa. Gram stain? Does it ferment lactose? Oxidase- _____.
GNR. Non-lactose fermenting. Oxidase-positive
113
The clearance of which substance estimates GFR? Why? Clearance of which substance estimates renal plasma flow? Why?
Inulin. Only filtered and not secreted/absorbed.
| PAH estimates RPF because of all of it gets excreted (filtered and secreted)
114
Bladder outlet obstruction can cause what changes in the kidney? How does it affect GFR and filtration fraction?
Pressure induced parenchymal atrophy. Decreased GFR (due to increased pressure in BS). Decreased FF because GFR decreases and RPF is unchanged. FF=GFR/RPF.
115
What is the blood supple to the proximal ureter? What about distal ureter?
Renal artery. Superior vesicular artery.
116
Functions of angiotensin II (3).
Systemic vasoconstriction. Preferential constriction of efferent arterioles in kidney. Aldosterone secretion.
117
Uric acid precipitates in (high/low) pH causing stones. Which part of nephron does this occur?
Low pH. DCT and CD have lowest pH.
118
Multiple Myeloma causes (lytic/blastic) lesions
Lytic
119
PTH has what function in the kidney?
Increases calcium reabsorption and increases production of active Vit D (1,25 dihydroxyvitamin D)
120
Gene associated with renal cell carcinoma. Chromosome. Function of that gene.
VHL (can be sporadic or genetic). Chromosome 3. Tumor suppressor which inhibits angiogenic factors (VEGF, PDGF). Deletion results in activation of multiple angiogenic factors.
121
Flu-like symptoms, fever and new-onset cardiac murmur are concerning for what illness?
Infective endocarditis
122
Potter's Sequence is caused by what? And how does it present?
Renal agenesis leading to oligohydramnios. Pulmonary hypoplasia (cause of death). Flat face, abnormal limbs.
123
How is the majority of PAH acid excreted?
Some filtered through glomerulus, but a majority is secreted in PCT. It is not resorbed anywhere.
124
Straw-colored discharge from the umbilicus of a neonate is indicative of what? What other pathology can occur?
Patent urachus (remnant of allantois) which embryonically connected the yolk sac to the urogenitul sinus. If the urachus does not obliterate before birth, it connects the umbilus to the bladder and the discharge is urine. If the central portion of the urachus does not obliterate, it becomes a urachal cyst.
125
Acute hemolytic transfusion rxns are what hypersensitivity? What is happening at the cellular level and how does patient present?
Type II. Anti-ABO antibodies attack RBC and complement mediated lysis occurs. Patient presents with fever, chills, back/flank pain and hematuria.
126
Loop diuretics stimulate _____ release which have vasodilatory effects. Taking ____ with loop diuretics can result in decreased diuretic response.
prostaglandin; NSAIDS.
| PDA (Prostaglandins Dilate Afferent arterioles). Increase GFR
127
In addition to aquaporins, ADH puts in channels to reabsorb _____ in _____ (location in nephron).
Urea in collecting duct
128
Why can't horseshoe kidney ascend from pelvis to abdomen?
Gets stuck under inferior mesenteric artery
129
In PSGN, glomeruli are _____. Immunofluorescence reveals _____ deposits on ____ (side).
Hyper-cellular; granular deposits epithelial side
130
Post-prandial pain with weightloss and risk factors of atherosclerosis is suggestive of _____
Mesenteric (intestinal) ischemia
131
Marked unilateral kidney atrophy is suggestive of ____. It occurs in elderly individuals due to ____.
Renal artery stenosis; atherosclerosis
132
Treatment for DKA involves _____ and _____. Providing one of the treatments affects K+ levels. How?
Insulin and saline. Insulin causes K+ shift intracellularly which can lead to hypokalemia.
133
Renal artery stenosis is most commonly caused by ____ in elderly males and ____ in young females.
Atherosclerosis; fibromuscular dysplasia
134
_____ is a developmental defect of the blood vessel wall resulting in irregular thickening, aneurysmal dilation, loss of internal elastic lamina. String of beads. Leads to renal artery stenosis.
Fibromuscular dysplasia
135
The ureteric bud gives rise to what structures in the kidney? What about the metanephric mesoderm?
Ureteric bud: Collecting system (Collecting ducts, calyces, renal pelvis and ureters); MM: Glomeruli, BS all the way to DCT
136
What is similar between the systemic and pulmonary circuit?
Blood flow rate
137
Inferior surface of the heart is supplied by _____ artery, a derivative of _____
Posterior Descending Artery. Right Coronary artery
138
Palpable trill over left upper sternal border and continuous murmur on auscultation are concerning for what?
Patent Ductus Arteriosus
139
Triad of Kartagner's syndrome
Situs inversus, chronic sinusitis, bronchiectasis
140
If there is renal artery stenosis to one kidney, what is seen in that kidney? What about the other kidney?
Atrophic tubules, crowded glomeruli, smaller size; other kidney would have arteriolosclerosis due to increased blood pressure
141
Acute Tubular Necrosis can be caused by ____ or ____, which is the _____ stage. The maintenance stage follows in which urine output _____. Creatinine/BUN levels _____ and there is concern for metabolic _____. In the recovery phase, glomerular filtration improves and urine output _____. Major electrolyte imbalance concern is _____
ischemia, nephrotoxic agent; decreases; rise, acidosis. increases, hypokalemia
Hypokalemia because filtration improved but resorptive capacity hasn't been fully restored yet.
142
What causes edema in nephrotic syndrome? How does urine appear?
Loss of protein (albumin) in the urine. Leading to low plasma osmolality. Foamy or frothy due to proteins.
143
Renal biopsy showing epithelial necrosis and intra-tubular casts is concerning for what pathology?
Acute Tubular Necrosis
144
Angiotensin converting enzyme is found in the small vessels of _____
Lungs
145
Aldosterone levels in nephrotic syndrome
Typically increased because intravascular fluid is decreased (leaking out and causing edema)
146
_____ is characterized by a cough lasting >2 weeks associated with post-tussive emesis. It is caused by _____
Pertussis (whooping cough); Bordatella pertussis (GNR)
147
Immune-fluorescence in PSGN shows what substances (3)
IgG, IgM and C3
148
Waxy casts are seen in ____. At this point there is concern for (hypo/hyper)kalemia and metabolic _____
Advanced Renal Disease/Chronic renal failure. Hyperkalemia and Metabolic acidosis
149
Large, rounded/polygonal cells with clear cytoplasm are concerning for _____ carcinoma of what organ? Common site of mets?
clear cell; renal; lung
150
How does a patient with DKA present?
Abdominal pain, n/v, fruity odor, polyuria and polydypsia
151
_____ cancer is associated with paraneoplastic syndromes which include what?
Renal; PEAR (PTHrP, Ectopic EPO, ACTH, Renin)
152
TH___ cells contribute to Type I HS rxns (asthma). These cells secrete ____ to cause class switching to ___.
2; IL-4, IgE
153
IL-5 promotes class switching to ____ and recruits ___
IgA, eosinophils
154
Gradual-onset progressive dyspnea with non-productive cough and fatigue is characteristic of what lung pathology?
Pulmonary fibrosis
155
Patients with RA can develop what lung pathology? Why?
Pulmonary fibrosis either through the disease process or due to the medications
156
Most common types of kidney stones are _____.
Calcium oxalate and Calcium phosphate
157
In Calcium kidney stones urine calcium levels are _____, and serum calcium levels are _____
increased; normal. Tends to be idiopathic hypercalcuria.
158
Infection with _____ (microorganism) can cause cold-agglutination due to antibodies binding _____. What antigen does the microorganism have that is also found in our body?
Mycoplasma pnumoniae. Erythrocytes. I-antigen found on RBC
159
What are the holosystolic murmurs (3)? Which one increases with respiration (inspiration or expiration)?
MR, TR, VSD. TR increases in intensity with inspiration.
160
Nodular densities in the lung that reveal bire-fringent particles surrounded by dense collagen fibers is characteristic of what disease? What is the exposure? What lobes?
Silicosis (Pneumoconiosis); mining and sand-blasting; upper lobes
161
What dimorphic fungi presents as macrophages with intracellular round yeast?
Histoplasma capsulatum
162
Oxygen therapy for neonatal respiratory distress syndrome can result in what pathology?
Retinopathy due to abnormal vascularization
163
A triphasic, scratchy sound heard on chest auscultation is indicative of what? What causes it? What is seen on ECG?
Fibrinous pericarditis due to fibrin deposition in the pericardial space. Diffuse ST elevation.
Can be caused by autoimmune disorders (Lupus/RA), idiopathic, Uremia (Renal failure) and Post MI
164
Autosomal recessive polycystic kidney disease is caused by a mutation in ____.
PKHD1
165
Where is AV node located anatomically? SA Node?
RA on the septal wall near the opening of the coronary sinus. Upper anterior RA near SVC opening.
166
What are Aschoff bodies and Anitshkow cells? What are they seen in?
Interstitial myocardial granulomas. Anitschkow cells are plump macrophages with linear nuclei. Seen in Acute Rheumatic Fever.
167
Infarct of RCA is associated with (right/left) ventricular dysfunction. How is cardiac output? PCWP? Central venous pressure?
Right. Decreased, decreased (less blood going to LA), increased (build-up in the veins).
168
Vaccines for S. pneumo (2)
Polysaccharide (T-cell independent response) and Polysaccharide conjugated with inactivated diptheria toxin (protein component) - T-cell dependent, better response
169
The (right/left) ventricular myocardium has constant blood flow through cardiac cycle. The (right/left) ventricular myocardium receives a majority of blood during diastole.
Right - constant. Left - diastole
170
In the lungs, tissue hypoxia causes (vasoconstriction/vasodilation)
Vasoconstriction (different from other organs)
171
Osler-Weber-Rendu Syndrome
Inherited (AD) disorder of blood vessels causing telangiectasia on skin and mucous membranes and recurrent epistaxis. Rupture can cause GI bleeding or hematuria
172
Diffusing capacity for carbon monoxide in emphysema, vs COPD
Decreased in emphysema; can be normal in COPD
173
Fick's principle
CO= rate of O2 consumption / arteriovenous O2 content different
174
What is pulsus paradoxus and what is the cause? When does it occur?
>10mmHg decrease in systolic pulse pressure during inspiration. Usually due to cardiac tamponade or something constricting the heart (pericardial disease). During inpiration, RV flles with fluid, but there is not enough room to expand so the septum deviates, decreasing room in the left ventricle. Consequently, less blood in left ventricle and less pressure. aka drop in pulse amplitude
175
Acute obstructive pulmonary exacerbations are treated with _____ which _____ (function)
B-adrenergic. Gs - increase cAMP and relax smooth muscle.
176
Carcinoids are _____ tumors commonly originating in _____ with propensity for metastasis to _____. These tumors secrete _____. Manifestations of carcinoid syndrome (Heart, GI, Lungs). What metabolite should be measured for diagnosis?
Neuroendocrine; bowel; liver. serotonin.
Heart: deposits of fibrous tissue in right heart (lung inactivates serotonin so no left heart probs)
GI: diarrhea cramping
Lungs: bronchospasm
Urinary 5-hydroxyindoleacetic acid (metabolite of serotonin)
177
MHC class I and class II structure
MHC CI: Heavy chain + B2 microglobulin
| MHC CII: Alpha chain and Beta chain
178
The course of ureters in relation to gonadal arteries, common iliac artery and at the site of bladder.
Ureters pass posterior to gonadal arteries (ovaries and testes) in the retroperitoneum in the abdomen. In the pelvis, they pass anterior internal iliac and are medial to gonadal arteries. At their junction with the bladder. the uterine artery (females) and vas deferens (males) passes anterior to them
179
CREST Syndrome - and what is it associated with?
Systemic sclerosis. Calcinosis (deposition of calcium in tissues), Raynaud's phenomenon, Esophageal dismotility, Sclerodactyly (skin thickening and tightening due to collagen deposition), Telangiactasia. Pulmonary hypertension.
180
Struvite (Magnesium-Ammonium-Phosphate) kidney stones are seen with _____ producing organisms such as ____. The leads to production of _____, which (decreases/increases) urine pH.
Urease; Klebsiella/Proteus. Ammonia, increases (alkalinization).
181
Small cell carcinoma of the lung is of _____ origin. What markers does it have?
Neuroendocrine. Neural cell adhesion molecule, neuron specific enolase, chromogranin.
182
Sudden, involuntary muscle contraction after beginning anti-psychotic medication is known as _____ and is caused by (agonist/antagonism) on what receptor? What causes it?
Acute Dystonia (Extra-pyramidal symptom). Antagonism of D2. Leads to elevated cholinergic activity (M1) leading to contraction.
183
Kinesin is a _____ that functions in _____ in what cells
motor protein (ATP powered and microtubule associated). Anterograde transport (from nucleus to nerve terminals) in neurons.
184
What can be screened in amniotic fluid to assess for neural tube defects?
alpha-feto protein and acetylcholine esterase
185
Failure of fusion of the rostral neuropore results in _____. Caudal neuropore _____
Anencephaly; spina bifida
186
What organism secretes Protein A virulence factor? How does that function?
Staph aureus. Binds the Fc Portion of IgG and prevents opsonzation, phagocytosis and opsonization
187
Bacterial product from what organism can be give to treat acute dystonia? What is the MOA?
Clostridium botulinum. Produces toxin which cleaves SNARE proteins and inhibits release of acetylcholine from synaptic vesicles - inhibiting muscle contraction
188
Huntington's Disease is ___ trinucleotide repeat resulting in (gain/loss) of function mutation
CAG; gain
189
Transcriptions repression (silencing) can occur due to DNA (hypo/hyper) methylation or Histone (de)-acetylation.
Hypermethylation - cannot transcribe.
| Histone deacetylation - Histones bind more tightly to DNA and cannot transcribe.
190
In patients with HIV, seizures and multiple-ring enhancing lesions on MRI are suggest what microorganism infection?
Toxoplasmic encephalitis
191
If someone has oral thrush, think ____
HIV
192
What neural structure is affected in Wernicke encephalopathy? What is the cause?
Mammillary bodies (part of limbic system) and periaquaductal gray matter. Chronic thiamine deficiency (V-B1)
193
V-B1 is a co-factor for which enzymes (4)?
pyruvate dehydrogenase, alpha-ketoglutarate dehydrogenase, transketolase
194
Pre-treatment of ____ bacterial meningitis with _____ (non-antibiotic medication) helps by what mechanism?
Strep. pneumo; dexamethasone; decreased inflammatory response
195
What compound acts on mu/delta receptors?
Endorphins (endogenous opioids)
196
B-endorphins are derived from _____ (compound) which also gives rise to (2)
POMC; ACTH and MSH (melanocyte stimulating hormone)
197
Using crutches inappropriately can damage ____ nerve which presents as weakness of ____ muscles and absent _____ reflex.
Radial; extensor muscles; triceps
198
_____ protein aids in retrograde axonal transport
Dynein
199
Inspiration is due to _____ (muscle) contraction/relaxation and results in more (positive/negative) intrapleural pressure. Expiration is due to (contraction/relaxation) of _____ (muscle)
diaphragmatic contraction; negative; relaxation of respiratory muscles.
200
Weakening diaphragmatic contractions with intact phrenic nerve stimulation indicates _____ pathology.
Neuromuscular junction
201
Stimulation of GABA-A receptor causes ____ (ion) to move (into/out of) cell, changing the membrane potential from the normal -70 to _____.
Cl; into; -75 (hyperpolarized)
202
Threshold firing for action potention (mV) is _____.
-55 mV
203
Elevated levels of arginine in the blood, accompanied by muscle weakness suggest a deficiency in _____ which is found (metabolic pathway). The enzyme produces (2) products.
arginase; urea cycle; urea and ornithine
204
Treacher Collins affects development of what? What do these structures give rise to?
1st and 2nd pharyngeal arches. 1st: Trigeminal nerve; maxilla, mandible, malleus and incus; muscles of mastication (temporalis, masseter, pterygoid)
2nd: Facial nerve; stapes, lesser horn hyoid; muscles of facial expression.
205
The 4th and 6th pharyngeal arches (together) give rise to what?
Pharyngeal and laryngeal muscles; cricoid and thyroid cartilage
206
Early onset Alzheimer's is associated with what 3 gene mutations? Which chromosome is one of these found on? What about late-onset (1)?
Early: Amyloid precursor protein (21- trisomy 21 inc risk), Presenilin 1 and Presenilin 2;
Late: Apolipoprotein E4
207
What bacteria should be considered in elderly or immuno-compromised presenting with bacterial meningitis? Staining? How is it transmitted? Treatment?
Listeria monocytogenes; GPR; contaminated food; ampicillin
208
_____ bacteria has a tumbling motility and can multiple in (cold/hot) temps.
Listeria monocytogenes; cold temps
209
Lumbar puncture should be performed at what vertebral levels? What is a bony anatomical landmark?
L3/L4 or L4/L5. Iliac crest (L4 Vertebral body)
210
The VPL of the thalamus received input from _____ and the VPM from ____. Damage results in _____ (ipsi/contra) lateral _____ loss.
Spinothalamic and dorsal columns (body sensory); trigeminal (face sensory); contralateral sensory loss.
211
Lacunar infarcts cause _____ necrosis in what brain structures (3)? They are most commonly due to (2) diseases.
liquefactive; basal ganglia, pons, cerebellum, posterior limb of internal capsule. Hypertension and diabetes.
**Note: microemboli released from atherosclerotic lesions commonly cause cortical infarcts. Not the small vessel occlusions of deep brain structures.
212
The BBB is formed by _____ junctions between non-fenestrated endothelial cells. These junctions are composed of ____ proteins (2).
Tight; claudins and occludins
213
Neurofibromatosis 1 disease (von-Recklinghausen) is characterized by (skin findings) / (CNS findings); chromosome + genetics
Cafe-au-lait spots; cutaneous neurofibromas(A BUNCH) - neoplasms of Schwann cells; CNS neoplasms (can present with headache); Chromosome 17 AD
**Note: PNS (schwann cells, nerves etc.) is derived from neural crest cells
214
Long face with prominent forehead, large testes, intellectual disabilities/delays and hyperlaxity (bendy) is indicative of what diagnosis? What is the cause?
Fragile X Syndrome; CGG trinucleotide expansion on Chromosome X - leading to hypermethylation
215
Injury in the posterior triangle of the neck that later affects the ability of an individual to abduct the arm past the horizontal position is indicative of injury to what nerve? And what muscle does it innervate?
Spinal accessory nerve (CN-XI); trapezius.
| Presents with shoulder droop.
216
The deltoid muscle is innervated by the ____ nerve. Injury would inhibit ____
Axillary; abduction below the horizontal position
217
In Lesch-Nyhan Syndrome, there is a deficiency in HGPRT which normally converts ___(2) to ___ (2) with PRPP. This leads to increase activity of enzyme ___ because of increased ___. Findings include:
Guanine and Hypoxanthine to GMP and IMP. PRPP, de novo purine synthesis. He's Got Purine Recovery Troubles.
Hyperuricemia, Gout, Retardation, Aggression, Dystonia
218
Childhood brain tumors that affect the cerebellum (2). How can they be differentiated on histology? Better prognosis?
Pilocytic astrocytoma: Rosenthal fibers and pilocytic astrocytes; Medulloblastoma: sheets of small cells with mitotic figures, worse prognosis
219
Hemiballism (characterized by wide, flailing movements of proximal limb) is due to damage to what cortical structure? Why does damage present like this?
Subthalamic nucleus. STN normally activates the globus pallidus internus which will INHIBIT the thalamus. With damage, there is decreased inhibition of the thalamus., leading to activation and movement
220
Leading cause of meningitis in all ages (not neonates) _____.
2nd most common cause in adults _____. When should this be suspected?
3 most most common cause in neonates _____.
Strep. pneumo;
Neisseria meningitidis (teens living in close quarters)
GBS, E. coli, Listeria
221
Patient presenting w diplopia (down and out) but normal pupillary reflex is indicative of what pathology? Why does it present this way?
Diabetic mononeuropathy of CN III. Results from ischemia of centrally running nerve fibers (somatic responsible for motor function), but blood supply to the peripherally running parasympathetics is spared (making the pupillary reflex possible).
222
Cerebellar lesions present with (ipsi/contra)lateral deficits which include:
Dysdiadochokinesia, intention tremor, dysmetria
223
A positive Babinksi is (plantar/dorsi) flexion of the foot in response to stroking. In adults, it is indicative of _____ lesion characterized by _____.
Dorsiflexion; UMN lesion; hyperreflexia and spasticity
224
A positive straight leg raise test is indicative of ____
Sciatic nerve damage (pain elicited when lifting leg high while lying down). Possible disc herniation.
225
Actions of muscarinic receptors on vascular smooth muscle
Relaxation via increasing NO. Whereas in other locations, it causes SM constriction.
226
With a lesion at the optic chaism, the visual field defect is a ______ which means _____
Bitemporal hemianopia - loss of peripheral vision
227
The rabies virus binds to _____. What is its course after that?
Nicotinic acetycholine receptors. Repicates in muscle tissue and ascends in retrograde fashion through the peripheral nerve to the CNS.
228
Presentation of rabies and progression
Pro-drome of flu-like symptoms; confusion, parasthesia from wound site, pharyngeal spasms and hypersalivation
229
Polycystic Kidney Disease in adults presents with what brain pathology?
Intracranial berry aneurysms - rupture leads to subarachinoid hemorrhage (worst headache of life)
230
Most common types of dystonias (3)
Cervical (neck- spasmodic torticollis), blepharospasm (blinking of eyes) and writer's cramps
231
Cogwheel rigidity is seen in ____ and presents ____
Parkinsons; intermittent resistance on passive extension/flexion
232
Tetrahydrobiopterin is co-factor used in the synthesis of what componnds? Deficiency leads to accumulation of?
Serotonin, tyrosine, dopamine; phenylalanine
233
The anterior pituitary is derived from ___ and the posterior pituitary from ___
Both ectodermal; AP is surface ectoderm and PP is neural tube
234
Classic triad for congenital toxo and presentation. When was the infection acquired?
Chorioretinitis (yellow lesions in eyes), hydrocephalous (CNS inflammation) and intracranial calcifications
235
Clostridium tetani pathophysiology
Infects humans through wound, secrete exotoxin (tetanospasmin) - retrograde transport to CNS. Inhibit release of inhibitory neurotransmitters GABA and glycine. Results in increased muscle rigidity and muscle spasms
236
Intracranial calcified mass found in children that shows cystic spaces rich in cholesterol - this is what tumor? What is it derived from and what does it give rise to?
Cranipharyngeoma (derived from Rathke's pouch) which gives rise to AP. Child presents with visual disturbances.
237
Intraventricular hemorrhage in a neonate is caused by bleeding from _____.
Occurs in premies. From germinal matrix - a site sub-ventricular that is highly vascularized and where neurons and glial cells migrate from.
238
An aneurysm that compresses CNIII is most likely found at what location?
Posterior communicating artery, where it communicates with internal carotid.
239
What is seen on MRI of multiple sclerosis? What is seen on CSF?
Deymeylinating plaques; Oligoclonal IgG antibodies
240
In a young woman with optic neuritis, sensory deficits and worsening symptoms with heat - what should be suspected? Pathogenesis?
Multiple Sclerosis; autoimmune attack against oligodendrocytes
241
Pain and tingling in the first 3 digits of both hands with diminished sensation over first three fingers and radial portion of ring finger is concerning for what? What is it caused by? What motor weakness is seen?
Carpal Tunnel Syndrome; compression of median nerve; thenar atrophy (thumb adduction and opposition)
242
Speed of conduction down axon depends on what two constants? How does myelination or demyelination change that?
Velocity - length/time
Myelination increases length (can travel further along the axon without requiring regeneration).
Time is the time it takes for membrane potential to respond to this change. Myelination decreases time constant. So demylenation would decrease length and increase time: slower velocity
243
E. coli strains that cause neonatal meningitis possess what virulence factor that allow it to survive? What virulence factor allows it to cause urinary tract infections?
K1 capsular antigen; P fimbrae (attach to uroepithelium)
244
What artery supplies Broca's and Wernicke's area?
Middle cerebral artery
245
Loss of upper extremity pain and temp, upper extremity weakness and kyphoscoliosis is concerning for what pathology? What structures are affected?
Syringomyelia; typically anterior white commissure (decussion of spinothalamic tract) and anterior horns
246
What nerve aside from CN8 is involved in hearing? How does it work? Injury presents how?
Facial Nerve (CNVII); it gives motor innervation to the stapedius muscle. Injury results in increased oscillation of stapes, resulting in hyperacusis
247
What 3 processes prevent axonal regeneration in the CNS
Persistent myelin debris, secretion of neuronal inhibitory factors and dense glial scarring
248
Blotchy red appearance of muscle fibers suggests what?
A mitochondrial myopathy - mitochondrial disease so only maternal inheritance
249
What Vitamin imbalance presents with dry skin, hepatic problems (hepatosplenomegaly) and visual disturbances (pappilledema)?
Vitamin A excess
250
A mentally slow woman presenting with jaundice and anemia, smooth shiny tongue and shuffling gait is concerning for what?
Vit B12 deficiency
251
Tay-Sach's is a deficiency in ___ and results in accumulation of ___. Key featers are ___ and ___
B-hexosaminidase; GM1 ganglioside; neurodegneration and cheery-red macular spot.
252
Differentiating Niemann-Pick Disease from Tay-Sach's since they both have cherry-red macula?
NP has hepatosplenomegaly.
253
A diffuse petechial rash with DIC and multi-organ failure is concerning for what microorganism? What virulence factor?
Neisseria meningitis; Lipo-oligosaccharide (endotoxin) causing inflammatory release
254
Muscle weakness after eating fish is concerning for a toxin ____ that does what?
Tetrodotoxin; binds Na+ channels and inhibits influx
255
Cryptococcus neoformans diagnosis? What is the site of primary infection? Where does it come from?
Latex agglutination test positive for soluble polysaccharide antigen; light microscopy shows budding yeast; lungs; bird droppings in soil
256
Muscle weakness and tingling in the feet, with lower extremity bilateral weakness and absent DTR was most likely preceded by what? What caused it?
Diarrhea; campylobacter jejuni (Patient has Guillan Barre)
257
Triad of Ataxia Telengiectasia (also gene and function)
Cerebellar ataxia, sinupulmonary infections (less IgA) and telangiectasia; ATM gene involved in fixing DNA breaks.
258
Lambor-Eaton is caused by ____. How does muscle response change with stimulation? How does it change throughout the day? What should be of concern?
antibodies to presynaptic calcium channels (can't release NT); incremental response (increases); weakness improves; concern for lung cancer.
259
How does a patient with injury to the right medial longitudinal fasciculus present?
Looking left is a problem. Left eye can look left but cannot coordinate the right eye - so the right eye cannot adduct.
260
Chronic hypertension can lead to the formation of ____ aneurysms which can rupture and bleed into what structures (commonly)
Charcot-Bouchard; basal ganglia, cerebellum, pons
261
Arteries that supply the basal ganglia are _____. If there is hemorrhage into these area, what other structure can be affected?
lenticulostriate; internal capsule (resulting in contralateral hemiplagia)
262
Damage to the orbital floor (eye) results in injury to what nerve? What is the presentation?
Infraorbital nerve (the continuation of V2 Maxillary). Loss of sensation in upper cheek and lip
263
When administering an interscalene nerve block to anesthetize the brachial plexus, what other nerve has the potential to be anesthetized?
Phrenic nerve (C3-C5)
264
Cavernous hemangiomas are characterized by _____ that have a tendency to ____ due to _____. They occur in deep tissues of the body.
dilated blood vessels; bleed; think adventitia (connective tissue)
265
A tumor affecting the right parietal lobe will cause what in a patient?
Contralateral sensory deficits and hemineglect
266
If after birth a woman experiences fecal incontinence due to lack of anal sphincter tone, what is injured?
Pudendal nerve
267
Normopressure hydrocephalus is seen in _____ and is due to ____. Classic triad ___. What is seen on imaging?
elderly; inability of arachnoid granulations to reabsorb CSF; wet (urinary incontinence), wobbly (gait abnormalities); wild (cognitive dysfunction). ventricular enlargement
268
Spontaneous, recurrent lobar hemorrhages in the brain of elderly is most commonly caused by what pathology? What causes it?
Cerebral amyloid angiopathy; caused by B amyloid deposition in arteries resulting in wall weakening and predisposition to rupture.
269
The _____ is a dopaminergic pathway that causes tonic inhibition of prolactin secretion from the hypothalamus. The _____ and ____ are dapominergic pathways altered in schizophrenia - which one is hyperactive and which one is hypo?
Tuberoinfundibular; mesocortical (hypoactive negative symptoms) and mesolimbic (hyperactive - positive symptoms)
270
_______ is a violation of social norms or rights of others in people less than 18. What is it when they're older than 18? What is defiance of authoritative figures - how long must it persist for dx?
Conduct disorder; Anti-social disorder; Oppositional defiant disorder (6 months)
271
_____ occurs after chronic anti-psychotic use (D2 antagonists) and is characterized by?
Tardive dyskinesia; lip-smacking, facial grimacing, tongue protrusions, rhythmic involuntary movements
272
First line therapy for anxiety disorders and panic disorder is ____, but ____ can also be given initially if patient is experiencing increased anxiety. What is given in an acute distress setting?
SSRI; benzodiazepines; benzodiazepines
273
Which benzos would be best for helping with anxiety without causing excessive daytime fatigue?
Short-acting or Intermediate acting; ATOM + Lorazepam
274
Bipolar I consists of ____ and depressive symptoms are required/not required for diagnosis. Bipolar II consists of _____ and depressive symptoms are required/not required for diagnosis.
manic; not required but common
| hypomania; at least 1 major depressive episode required
275
Difference between mania and hypomania (duration, functioning, psychotic features)
Mania: greater than 1 week, impairment in functioning, psychotic features
Hypomania: greater than 4 days, change (but not impairment in functioning) no psychotic features.
276
What is panic disorder characterized by?
UNEXPECTED attacks and WORRY about future attacks which can limit daily activity. They are worried about have these in the future, not about a certain thing (like socializing)
277
Normal sadness vs adjustment disorder with depressed mood
Normal sadness is what is expected. AD is when it is out of proportion or impairs functioning. Most psychiatric diagnosis have impaired social or occupational functioning
278
Treatment for post-partum blues is _____ which typically has an onset at ____ and resolves _____.
Reassurance (it's normal); 2-3 days; 2 weeks
279
2 y/o that doesn't respond to name, grunts (instead of talking), avoids eye contact and engages in repetitive behavior is concerning for?
Autism Spectrum Disorder - usually diagnosed around age 2. Higher functioning may be diagnosed later.
280
All patients presenting with major depressive episode should be evaluated for _____
History of mania (for bipolar dx vs unipolar depression)
281
Loss of sensory or motor function following an acute stressor with unremarkable labs and physical exam findings is consistent for _____
Conversion disorder
282
When the provider reacts towards a patient in a certain way because they see in them past personal relationships, that is an example of _____
Countertransference
283
______ should be considered in school-aged children with behavioral, academic or social difficulties at school.
Learning disorder
284
First-line therapy for specific phobia
Cognitive-Behavioral therapy with exposure
285
Methadone acts as full/partial agonist on what receptor? What about bupernorphine? Is methadone long or short acting?
Full mu-opioid receptor agonist; vs bup is a partial agonist. Methadone is long acting
286
A women who has resentment towards her step-son talks about how much she loves him and prepares elaborate celebrations for him...what defense mechanisms?
Reaction formation - taking your bad feelings and putting it into opposite extreme. (immature)
287
Violent behavior with hallucinations and dissociative symptoms and nystagmus are what drug?
PCP (phencyclidine)
288
Normal development in a child followed by regression of motor and language skills, and deceleration of head growth is classic for what? What is the pathogenesis?
Rett Syndrome; classically in girls; mutation in X-linked MECP2 gene
289
Brief psychotic disorder is symptoms for ____ long, schizophreniform is symptoms for ___ long and schizophrenia is symptoms for ____
<1 1 month, 1-6 months; > 6 months
290
A young adult who stops socializing, starts spending time alone and has delusional beliefs is concerning for what?
Schizophrenia
291
Withdrawal from ____ results in onset of acute severe depression, hyperphagia, vivid dreams.
Cocaine
292
Appropriate therapy for patient who presents with episodes of binge eating, concerns with body, normal/increased body weight and signs of induced vomiting? What is contraindicated - why?
Fluoxetine (SSRI) with CBT and nutritional rehab; buproprion for increased seizure risk
293
Treatment for anorexia?
CBT and nutritional rehab; if that doesn't work, olanzipine
294
Damage to ____ (part of brain) results disinhibition and impulsivity; ____ part is involved in executive functioning which includes motivation, organization and planned behavior
Oribitofrontal cortex
295
Delusional disorder vs paranoid personality disorder
Delusion is specific delusion(s) ~false beliefs~ for more than a month. Functioning not very impaired. Paranoid personality is more broad and would suggest general mistrust of lots of people - not specific delusions.
296
Characteristic features of marijuana intoxication:
Conjunctival injection, increased appetite, tachycardia, dry mouth (inappropriate laughter also seen)
297
Eccentric behavior with odd beliefs and magical thinking is ____ . Also have social anxiety.
Schizotypal personality disorder (Class A)
298
When taking second generation anti-psychotics, what should be monitored?
Lipid and glucose - dyslipidemia
299
5 stages of change (and what is involved)
```
Precontemplation: Denial of problem
Contemplation: Accepting there is a problem
Preparation: Planning a change
Action: Put plan into action
Maintenance: Maintain new behavior
```
300
In a patient presenting with delirium, in addition to treating underlying condition, what should be given? What should be avoided?
High-potency first gen antipsychotics and some second gen; avoid benzodiazepines (can worsen confusional states)
301
Treatment for PTSD; what about specifically for nightmares? What is it called if it lasts less than a month?
CBT; SSRIs or SNRIs and Prazosin for nightmares; Acute stress disorder
302
Patients with selective IgA deficiency can have what symptoms? What can occur during a transfusion?
Sinupulmonary, GI, autoimmune symptoms. Patients may have anti-IgA IgE antibodies which can react with IgA in transfusion and cause anaphylactic reaction (IgE mediated)
303
Thiazide diuretics increase what serum compounds; and decrease
HyperGLUC (glucose, lipids, uric acid, calcium); hyponatremia, hypokalemia
304
In alcoholics presenting with pulmonary symptoms and foul-smelling sputum, what should be suspected? Treatment?
Aspiration leading to lung abscess - aspiration of oral flora (anaerobes). Clindamycin
305
Which immune cells (3 types) are increased in COPD and contribute to pathogenesis? How?
Neutrophils - release neutrophil elastase (emphysema); CD8 T cells and Macrophages.
306
In chronic heart failure, what process offsets the factors favoring edema?
Increased lymphatic drainage
307
Aldosterone levels in heart failure
Increased (due to increased RAAS) from decreased blood flow to kidney
308
ABG in someone with pulmonary embolism
Hypoxemia leading to increase in respiratory drive. Affects CO2 more than O2, leading to loss of CO2 and respiratory alkalosis (dec CO2). Metabolic compensation takes time so HCO3 will be normal - maybe slight decrease.
309
What is the concern when initiating ACE-I? Patients with what conditions is this problematic?
First-dose hypotension; patients with volume depletion wither from diuretics are heart failure suddenly lose vascoconstrictive capabilities. Results in hypotension.
310
In a smoker with high fever, confusion, watery diarrhea and pulmonary symptoms, what should be considered?
Legionnaire's disease - severe pneumonia caused by legionella
311
What immune cells are bilobed with granules?
Eosinophils
312
What do eosinophils secrete that acts as a potent toxin against helminths
Major Basic Protein
313
What mechanism can prevent lung necrosis during during PE?
Collateral circulation provided by bronchial artery (supplies nutrients etc to lung)
314
M. Tb grows in parallel chains on media due to what?
Cord factor - virulence factor - survival inside macrophage
315
Traumatic aortic rupture due to MVC crash most commonly occurs where?
Aortic isthmus, right after the arch where it is tethered to pulmonary trunk via ligamentum arteriosum
316
Henoch-Schonlein Purpura cause and symptoms
IgA vasculitis that manifests in skin and renals (Berger/IgA nephropathy). IC deposition that occurs typically after URI (make more IgA). Presents with abdominal pain, palpable purpura on leg/butt, arthralgias and hematuria
317
With what deficiencies are bleeding time, aPTT and PT individually increased?
Bleeding time: platelet defects; aPTT intrinsic pathway and PT extrinsic pathway (VII).
318
What type of bleeding is seen with coagulopathies vs palelet defects?
Coagulopathies have deep tissue bleeding (joints/muscle) vs platelets defects are mucocutaneous bleeds (epistaxis and petechiae)
319
What is suspected in African American man with swollen extremities, low serum albumin, hypercholesterolemia and urinalysis with heavy proteinurua and fatty casts?
Nephrotic syndrome (remember high cholesterol leading to fatty casts!). Possible focal segmental glomerulosclerosis (suspect in hispanics and AA; or drug users etc)
320
Enzyme glycosyltransferase in bacteria
Important for cell wall synthesis. Organisms that lack cell wall will be resistant to antibiotics that target that enzyme
321
What is the cause when restored blood flow to ischemic tissue results in damage?
Re-perfusion injury caused by free radical generation, inflammation or mitochondrial damage
322
Why is there a decreased O2 partial pressure in aorta than in pulmonary veins?
The bronchial veins drain the parenchyma of the lung and combine with the pulmonary veins.
323
Corbolfuchsin stain binds _____
Mycolic acid
324
Heteroplasmy
Important in mitochondrial disorders. Refers to how some cells contain more mitochondria with affected DNA than other cells due to in-equal distribution of mictochondria during mitosis
325
A defect in the urea cycle means what dietary change should be implemented?
Protein restriction
326
Malignant hyperthermia is usually caused by _____ exposure and can result in (presentation). Treatment (MOA)
inhaled anesthesia or succinylcholine; sustained muscle contraction, fever and myocyte breakdown; Dantrolene; Ryanodine receptor anatogonist
327
Long standing RA can involve what bones?
Cervical spine leading to vertebral subluxation
328
____ nerve exits the brain stem at mid-pons at level of middle cerebellar peduncles
CNV - Trigeminal
329
Why decrease PaCO2 in patients with a TBI and cerebral edema? What is the effect?
Increased cerebral vascular resistance through vasoconstriction. Low CO2 levels decrease cerebral perfusion through constriction of arteries.
330
Glossopharyngeal nerve (motor- and what gland secretion)
elevates larynx during swallowing; parotid gland secretion
331
____ channels are important for generation and propagation of action potentials; ____ allow for fusion and release of NT
Voltage gated sodium; voltage gated Calcium
332
Wilson disease (gene + inheritance); Inc/Dec levels of ____. Pathogenesis. Blood and urine work. Treatment.
AR ATP7B protein mutation - needed to excrete copper in bile and put on transporter. Cu build up in hepatocytes - damage - leak into body and deposit in other tissues (basal ganglia and cornea). Low serum ceruloplasmin and inc urinary copper excretion. Treat D-penicillamine (copper chelator)
