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NBME 22 Flashcards

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1
Q

Two patients are vastly different and are getting IV treatment. What parameter will be the same in both?

A

Loading dose (is independent of drug clearance)

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2
Q

What is the Cv systems response to cold temperatures (or anything that increases blood volume/preload)?

A

cold temp causes constriciton of the blood vessels to keep organs warm, this increases central blood volume, which increases preload to the right side of the heart. the heartreleases ANP to decrease the volume, and ADH release from the hypothalamus is decreased becasue you dont wanna add more water to the body

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3
Q

What is an open-label clinical trial?

A

Clinical trial - compares therapeutic benefits of 2+ treatments (warfarin vs. dalteparin) Open-label - both the health providers and the pt are aware of the drug being given

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4
Q

what is it called when the doctor projects feelings abour a formative or other important persons onto the patient (example: patient remids you of a younger subling)?

A

countertransference

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5
Q

Wny would someone with protein malnutrition (Kawashkior Disease) present with a negative nitrogen balance?

A

Nitrogen balance is a measurement of protein metabolismin the body. A negative nitrogen balance indicates muscle loss, as increased amounts of amino acids are being metabolized to produce energy. This increases the amount of nitrogen secreted from the body. Because the amount of nitrogen you are taking in is less than the amount of nitrogen you are secreting, you have a negative nitrogen balance.

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6
Q

How do you treat central diabetes insipidus?

A

desmopressin

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7
Q

What happens to someone with renal failure who doesnt get dialysis?

A

Undialyzed renal failure leads to metabolic acidosis, and as a result bicarb gets depleted as it tries to buffer the accumulation of organic acids.

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8
Q

What kind of process occurs in the kidney after multiple UTIs?

A

Urinary tract infections are the most common acquired cause of Vesicouteric Reflux (VR) in children. VR can lead to Reflux Nephropathy, which is characterized by chronic tubulointerstitial inflammation with fibrosis and scarring, leading to renal failure.

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9
Q

How does post-partum thyroiditis present?

A

self-limited thyroiditis after deliver, can present as hyper or hypotyroid.

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10
Q

how does parovirus B19 rash present?

A

slapped cheek apperance, lacy rash in malar area (may include other parts of body, but will def be on cheeks)

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11
Q

What are 2 ways to develop retinoblastoma?

A
  • Sporadic= knock out both genes of RB in the same retinal cell; unilateral
  • inherited= one gene already knocked out, then the other gene gets knocked out; both eyes affected.
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12
Q

Where does prostatic adenocarcinoma metastasize to in men?

A

lumbar spine

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13
Q

What organism can cause diarrhea, abd pain, and cramping and can be found in unpasteurized milk and puppy poop?

A

Yersinia enterocolitica

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14
Q

which anti-lipid drug, when combined with a statin, exacerbates myopathy?

A

Gemfibrozil is a CYP450 inhibitor causing an increase drug concentration of statin which would lead to the adverse side effect of myopathy.

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15
Q

how do you calculate loading dose of a drug?

A

​Contrast with loading dose:

(Css * Vd) / F

Css=drug concentration in plamsa

… where t is elapsed time between doses (not relevant here since it’s continuous infusion) and F is bioavailability (which is 100% or 1.0 here because it’s given IV).

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16
Q

A woman with blurry vision can not adduct her right eye, but can converge. What is the problem?

A

This is internuclear ophthalmoplegia. In INO you would see impaired adduction during horizontal gaze due to a lesion of the ipsilateral MLF. However, since the MLF is not involved in convergence, the affected eye is still able to converge normally.

seen in MS!

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17
Q

Where are pancreatic islet cells derived from embryologically?

A

endodermal cells

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18
Q

What would someone’s urine pH, bicarb, and volume look like after taking a carbonic anhydrase inhibitor?

A

all would be elevated; Since you’re losing all your bicarb into your pee, you would expect the pH to be more alkaline. Also, since there is decreased Na+/H+ antiport, there is less sodium reabsorbed and therefore increased loss of free fluid to the urine.

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19
Q

how do you calculate maintenance dose of a drug?

A

Maintenance dose = (Css * CL * t) / F

… where t is elapsed time between doses (not relevant here since it’s continuous infusion) and F is bioavailability (which is 100% or 1.0 here because it’s given IV).

Css=drug concentration in plamsa

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20
Q

Which renal arteriole does prostaglandins dilate?

A

afferent

(blocked by NSAIDs, which constrict afferent arteriole, decreasing RBF)

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21
Q

how would 17-hydroxylase deficiency present?

A

hypertension and some sort of ambiguous sexual presentation (males) or lack of secondary sexual development (females)

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22
Q

an HIV positive mane has zidovudine resistance. This mutation is most likely in which of the following viral genes?

A

reverse transcriptase

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23
Q

How does the body alter the thermostatic setpoint?

A

Alteration of the thermostatic set point is a hypothalamic process mediated by prostaglandins and is independent of the sympathetic nervous system.

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24
Q

What type of hypersensitivity reaction is lupus?

A

type III: immune complex mediated hypersensitivity

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25
What are the stages of hypovolemic shock?
peripheral vasoconstriction (increased angiotensin II) and central vasodilation--\>stasis in the capillary beds--\>decreased capillary hydrostatic pressure
26
what is the treatment for schistosoma?
praziquantel
27
how does hyperventilation affect cerebral blood flow?
**decreases cerebral blood flow:** Hyperventilation decrease PaCO2. Central chemoreceptors respond to low PaCO2 by **vasoconstricting cerebral blood vessels**.
28
a stroke that presents with hoarseness, decreased sensation to ipsilateral face and contralateral body would occur where and in what artery?
Wallernberg syndrome: lateral medulla, PICA know the rules of 4 and go over that stroke diagram
29
which antitussive could you give to an old person with a bad cough, that wont cause constipation?
dextromethorphan; it is an NMDA glutamate receptor antagonist
30
what type of reaction is an acute hemolytic transfusion reaction?
Type II hypersensitivity reaction. Intravascular hemolysis (ABO blood group incompatibility) or extravascular hemolysis (host antibody reaction against foreign antigen on donor RBCs). **antibody, complement C5-9 involved**
31
When someone is on hospice and taking a narcotic for pain control, what is your main concern?
ensure that the pain is controlled; medication dosages should be titrated promptly to achieve effective pain control
32
why do you give glucose and sodium to someone whos is dehydrated?
glucose is co-transported into enterocytes of the small intestine via sodium
33
What are some signs of tuberous sclerosis?
seizures, hypopigmentation(ash leaf spots), hamartomas, astrocytomas and tumors in the ventricles
34
Which nerve innervates the interosseous muscles of the hand (abduct and adduct the fingers?)
Ulnar
35
Autosomal Dominant polycystic kidney disase is a defect in what?
The most common and severe form of autosomal dominant polycystic kidney disease (ADPKD) results from **mutations in PKD1**, encoding **polycystin-1 (PC1)**..
36
What causes a cleft lip?
failure of fusion of the **maxillary and medial nasal prominences**
37
Which abdominal organs are retroperitoneal?
**SADPUCKER** ## Footnote **Suprearenal glands (adrenal glands)** **Aorta and IVC** **Duodenum (2md-4th parts)** **Pancreas (except tail)** **Ureters** **Colon (descending and ascending)** **Kidneys** **Esophagus (thoracic portion)** **Rectum (partially)**
38
young woman who just gave birtch comes in with heart failure signs. What does she have?
dilated cardiomyopathy (can be related to pregnancy)
39
A person has an MI with elevated troponin and cardiac enzymes. What will the levels of intracellular sodium, potassium, and calcium be after the event?
troponin = irreversible injury and membrane damage -\> high extracellular concentration of Na+ and Ca++ causes both to move into cell through damaged membrane (INCREASED INTRACELLULAR NA AND CA) and high intracellular K+ leaves the cell (low intracellular K)
40
What is the best way to vaccinate against a microbe that infects the gut?
orally/enterally; needs to make IgA antibodies
41
Which sex hormone can increase hemoglobin?
**Testosterone** ; ...and other androgens have an erythropoietic stimulating effect that can cause polycythemia, which manifests as an **increase in hemoglobin, hematocrit, or red blood cell count**. ... Clearly, if hematocrit is elevated before starting testosterone, the cause should be determined prior to starting androgen therapy
42
go over brachial plexus
43
What are the characteristics of *enterococcus faecalis?*
* Gram + cocci * nonhemolytic * catalase - * causes UTI, biliary tract infections, and subacute endocarditis * Vancomycin resistant enterococci are an important cause of nosocomial infection *
44
What are characteristicsa of Bruton agammaglobulinemia?
x-linked recessive; no B cell maturation, recurrent bacterial infections after 6 months (decreased maternal IgG), absent B cells in peripheral blood, decreased Ig in all classes, **absent/scanty lymph nodes and tonsils,** live vaccines contraindicated
45
What is I-cell disease and what occurs to the lysosomal enzymes in patients who have it?
I-cell disease (inclusion cell disease/mucolipidosis type II)—inherited lysosomal storage disorder; defect in N-acetylglucosaminyl-1-phosphotransferase ; failure of the Golgi to phosphorylate ; mannose residues (mannose-6-phosphate) on glycoproteins --\> **proteins are secreted extracellularly rather than delivered to lysosomes.** Results in coarse facial features, gingival hyperplasia, clouded corneas, restricted joint movements, claw hand deformities, kyphoscoliosis, and high plasma levels of lysosomal enzymes. Often fatal in childhood.
46
someone who smokes comes in and says thery arent ready to quit. WYD?
have them identify the pros and cons of smoking cessaiton
47
What is the mechanism of action of loperamide?
agonist at mu opioid receptors; reverse overdose with naloxone
48
what will you find in a dude who cant get an erection due to vascular disease or nerve damage?
normal libido, decreased nocturnal erections
49
What are some signs and sx of lupus?
Inflammation of joints, kidneys, serosal surfaces, anterior chamber of the eye, and choroid plexus.
50
What will you find in a dude who cant get an erection due to psychological issues?
decreased libido, normal nocturnal erections
51
how would 11-hydroxylase deficiency present?
HTN, virilization in females, NP SALT WASTING, no hyperkalemia
52
MI of right ventricle can cause what?
increased central venous pressure; can lead to hepatomegaly and increased free fluid in the peritoneal space
53
how does 21 hydroxylase deficiency present?
HYPONATREMIA (**SALT WASTING),** virilization in females, increased K+, decreased BP and cortisol
54
Where do prostaglandins cause vasodilation in the kidney?
at the afferent arteriole; NSAIDs inhibit this
55
Which muscles are involved in eversion of the foot?
fibularis/peroneous longus and brevis
56
What hormones will be elevated in PCOS?
* increased fasting insulin, testosterone, and LH PCOS is associated with elevated levels of LH from the pituitary, which stimulates ovaries to produce increased amounts of sex steroids (including androgens --\> hirsutisim). Androstenedione is converted to estrone in adipocytes, which results in still further increased release of LH. Obesity and insulin resistance is associated with PCOS.
57
If an adult patient is being abused, what do you do?
contact adult protective services
58
what is the most common breast mass in postmenopausal women?
carcinoma of the breast
59
In what disease is the MLF of the brainstem affected?
Internuclear Opthalmoplegia C and D=MLF
60
Cystic fibrosis is a defect in _____ in the respiratory epithelium
**protein structure**
61
What are some things that cause **increased** respiratory compliance (lungs easier to fill)?
emphysema, normal aging
62
What causes a cleft palate?
faliure of fusion of the **2 lateral palatine shelves** or **failure of lateral palatine shelves with the nasal septum and/or median palatine shelf**
63
What is phase 1 of clinical trial?
small # of healthy volunteers or patients with disease of interest. testing "Is it safe?)
64
What are the pulmonary function test findings of restrictive lung diseases (idiopathic pulmonary fibrosis, penumoconiosis, sarcoidosis)?
normal or slightly decerased FEV1 very decreased FVC and increased FEV1:FVC ratio
65
What is the mechainsm of action of Niacin as a lipid-lowering agent?
``` inhibits lipolysis (hormone synsitive lipase 0 in adipose tissue; reduces hepatic VLDL synthesis ```
66
What is respiratory system compliance and how is it measured?
the change in lung volume for a change in pressure Compliance=change in volume/change in pressure (volume=tidal volume; change in pressure=end-inspiratory pressure(-)end-expiratory pressure)
67
a baby develops bilious vomiting and ligament of treits is on the right (should be on the left) and there is duodenal obstruction. What aretery is at risk of being occluded?
Superior mesenteric this is midgut malrotation since the Ligament of Treitz is supposed to be on the right
68
a man has difficulty urinating and frequent urination (BPH). What drug do you use to treat?
alpha 1 blocker
69
why would someone who recovered from PNA have a normal CXR 8 weeks later?
Maintenance of basement membrane integrity
70
What is conversion disorder?
inability to walk that cannot be explained by medical evaluation
71
how do you treat nephrogenic diabetes insipidus?
**hydrocholorothiazide** is DOC for Nephrogenic Diabetes insipidus because it paradoxically causes an increase in BP by increasing sodium absorption and thus water absorption
72
What is seen on histology in post-partum thyroiditis?
**lymphocytic infiltrate** with occasional germinal center formation
73
What structures are in the inguinal canal?
spermatic cord, round ligament of the uterus, ilioinguinal nerve (sensory to genitalia), genital branch of the genitofemoral nerve (supplies the cremaster muscle and anterior scrotal skin in males, and the skin of the mons pubis and labia majora in females)
74
what type of nerve cell blocks reinnervation of muscles after a peripheral nerve injury?
schwan cells
75
What would be seen on a kidney biopsy of a woman with left renal artery fibromuscular dysplasia?
tubular atrophy; fibromuscular dysplasia of the left renal artery causes low flow, resulting in low GFR. Chronic low GFR causes tubular atrophy.
76
what are some things that can cause dilated cardiomyopathy? 10 things
alcohol abuse, wet beriberi, coxsackie B virus, chronic cocaine use, chagas disease, doxorubicin, hemochromatosis, sarcoidosis, thyrotoxicosis, pregnancy
77
What are some characteristics of scabies infection?
rash with itching that is most intense at night, spread from person to person, burrows in skin
78
What are the characteristics of a meningioma?
* most common **benign** CNS tumor in adults. * composed of arachnoid cells * more common in **women** (has estrogen receptor) * may present with **seizures** * **round** mass **attached to dura** (NBME question stem said "2cm round ring enhancing lesion **within the interhemispheric fissure in the central sulcus"** AKA ATTACHED TO DURA) * histo=whorled pattern and psommoma bodies
79
What does a high specificty tell you about the disease the test detects?
it means that a positive result is very likely to bea true positive
80
Which type of lymphocyte undergoes VDJ recombination in multiple myeloma?
B cell; lots of antibodies are being made, so the B cell has to keep recombinging. The T cells arent affected, so they =unrearranged immunoglobulin gene
81
Name the acute-phase reactants upregulated during systemic manifestations
More **FFiSH** in the **C** * **F**erritin * **Fi**brinogen * **S**erum Amyloid A * **H**epcidin * **C**-reactive protein
82
WHere are the gonadal arteries in relation to the renal arteries?
gonadal arteries are below the renal arteries
83
What is another name for lung surfacant ?
**dipalmitoyl lecithin** babies are deficient in RDS
84
What is sensory finding in someone who is having a temporal lobe seizure?
smelling a foul odor that no one else can detect
85
you want to ask a teenager about her sexual activity, but her mother is with her. What do you do?
Ask the mother to leave the room before asking the patient any questions
86
in a CHF patient, what could cause hyponatremia?
dilution of serum sodium via ADH secretion
87
C=subthalamic nucleus D=Substantia nigra E=hippocamppus
88
a person comes in with lower extremity numbness, decreased reflexes, and + romberg. what is the problem?
sensory neuropathy, damage to dorsal column Tabes dorsalis, b12 deficiency
89
GHRH works by which intracellular signaling mechanism?
Adenylyl cyclase--\>cAMP
90
leard acid base shit FA pg 576
91
how does parvovirus B19 cause anemia?
infects erythroid precursors and interrupts erythrocyte production
92
review type I and II error
93
What binds to the TATA box at the promoter region of genes?
RNA polymerase
94
What are some things that cause **decrease** in respiratory compliance (lung harder to fill)?
pulmonary fibrosis, pneumonia, NRDS, pulmonary edema
95
What tissue would differentiate a partial hydatidiform mole from a complete mole?
partial mole: 69 XXY (any triploid phenotype) and presence of fetal tissue (hematopoeitic stem cells)
96
A pregnant woman in Rh- and her baby in her belly is anemic. What RBCs do you give the baby?
O, Rh- is the universal donor

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