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Flashcards in NBME 22 Deck (96)
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Two patients are vastly different and are getting IV treatment. What parameter will be the same in both?

Loading dose (is independent of drug clearance)


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

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


What is an open-label clinical trial?

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


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)? 



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

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.


How do you treat central diabetes insipidus?



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

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


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

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.


How does post-partum thyroiditis present?

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


how does parovirus B19 rash present?

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


What are 2 ways to develop retinoblastoma?

  • 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. 


Where does prostatic adenocarcinoma metastasize to in men?

lumbar spine


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

Yersinia enterocolitica


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

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


how do you calculate loading dose of a drug?

​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).


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

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!


Where are pancreatic islet cells derived from embryologically?

endodermal cells


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

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.


how do you calculate maintenance dose of a drug?

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


Which renal arteriole does prostaglandins dilate?


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


how would 17-hydroxylase deficiency present?

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


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

reverse transcriptase


How does the body alter the thermostatic setpoint?

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


What type of hypersensitivity reaction is lupus?

type III: immune complex mediated hypersensitivity


What are the stages of hypovolemic shock?

peripheral vasoconstriction (increased angiotensin II) and central vasodilation-->stasis in the capillary beds-->decreased capillary hydrostatic pressure


what is the treatment for schistosoma?



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.


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


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


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