nbme 19

Question 1

what type of HIV med causes lipodystrophy

Answer 1

proteases

(teases you into thinking you are losing weight, but it is really just gathering in your gut)

Question 2

pt has heparin during preg and her platelet count drops significantly, why?

Answer 2

ITP

antibodies to platelets

Question 3

Rifampin inhibits

Answer 3

RNA synthesis (via inhibiting DNA dependent RNA synthesis)

Question 4

meningioma

Answer 4

occur near the surface of the brain

is extra-axial (external to brain parenchyma)

Question 5

nerve that detects stretch in bladder

detrussor contraction nerve

internal sphincter relaxation

Answer 5

pelvic

hypogastric

pudendal

Question 6

no tonsils

Answer 6

BRUTON!

bruTON

Question 7

up to 3 days wound healing

Answer 7

inflammatory

platelets, neutrophils, macrophages

clot formation, increased vessel perm, neutrophil migration

(at day 2 macrophages are clearing the debris)

Question 9

wound healing 3 days-weeks

Answer 9

proliferative phase

fibroblasts involved, myofibroblasts, endothelial keratinocytes and macrophages

Depositon of granulation tissue and TYPE 3 COLLAGEN, also angiogenesis, disollution of clot, wound contraction (from myofibroblasts)

Question 10

weeks –> months wound healing

Answer 10

Remodeling phase

fibroblasts ONLY

replace Type 3 collagen –> Type 1 Collagen (to increase tensile strength)

metalloproteases do tissue remodeling

Question 11

what is overexpressed in keloid scar

Answer 11

PDGF

excess collagen depositon by fibroblasts

Question 12

erythyma marginatum

erythema migrans

erythema multiforme

Answer 12

marginatum –> JONES criteria

migrans –> lymes

multiforme –> macules, vacules (nonspecific for multiform rash) can be seen in HSV, mycoplasma)

Question 13

conversion disorder

Answer 13

loss of sensory or motor function (paralysis, blindness, muteness) following an acute stressor

pt is indifferent to sx

Think teenage girl!

Question 14

temperature to kill prion

kill spore

Answer 14

NO temp, not living

121 for 15 min in autoclave (need STEAM, not just high temp)

Question 15

sterile urine cultures with pyuria

Answer 15

chlamydia or neisseria

pyuria =pus

Question 16

bilateral retinoblastoma

Answer 16

this is a germ cell problem where all of your cells already have the first hit. Thus you only need one more hit

(just think, you have something seriously wrong if you are getting bilateral problems…ie congenital)

If you had unilateral, more likely to be two somatic mutations in the retinal cells. This patient would NOT have an increased risk for other cancers

Question 17

abx that cause ototoxicity

Answer 17

aminoglycosides

(a mean guy hit you in the ear)

Question 18

Birbeck granules

Answer 18

langerhan cells

tennis racket looking

Langerhan cell histiocytosis –> lytic lesions plus eczema rash

S100+

Question 19

melanin distribution (asian, black, white)

Answer 19

blacks have free melanin

asian have melanosome above the nucleus

white melanocytes anywhere in the cell

Question 20

histone acetylation

Answer 20

makes DNA active

relaxes DNA coiling and allows for transcription

Acetylation = Activation

Question 21

Which histone is the linker?

Answer 21

H1

all the others are part of the nucleosome

Question 22

fecal incontinence after birth

Answer 22

because of damage to the anal sphincter

Question 23

silver stain in the stomach

Answer 23

looking for H. Pylori –> peptic ulcers

Question 24

most common cause of viral meningitis in the USA

Answer 24

coxsackie B virus

single stranded RNA virus, member of the enterovirus, of the picornovirus family

Question 25

mechanical ventilation sepsis commonly caused by what bug?

Answer 25

pseudamonas aerginosa (also klebsiella, S. Aureus) smell sweet odor is indicative of pseudamonas

Question 26

fever with bradycardia (faget sign) indicative of

Answer 26

yellow fever

ss RNA virus

see elevation in transaminases and direct bilirubin

AST> ALT

see councilman bodies in the liver

Question 27

H. Pylori more likely to be found in?

Answer 27

Duodenal ulcers 90%

Gastric ulcers 70%

3-5x risk of gastric carcinoma with 6-50x risk of MALT lymphoma

Question 28

staph scalded skin syndrome

Answer 28

epidermis separates at the stratum granulosum as a result of binding of epidermolytic toxins A and B to desmoglein 1 in this layer

Think about if skin is sluffing off (+Nikolski) that it must be fairly superficial

DESMOSOMES INVOLVED

Question 29

giardia pathogenesis

Answer 29

infammation and villous atrophy, which reduces absorptive capacity and causes malabsorption

(kinda like celiac)

Question 30

circular RNA viruses

Answer 30

Dhey Are Balls

Deltavirus

Arenavirus

Bunyavirus