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NBME 30 Flashcards

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1
Q

Specificity is calculated using which formula

A

True negative/ true neg + false positives

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2
Q

Biceps muscle is in charge of __ and __ the arm.
It is innervated by __

A

Flexing the elbow and supinating the forearm
Musculocutaneous

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3
Q

ATBs are indicated in food poisoning by Salmonella enterica only if

A

Severe, immunocompromised or extreme age

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4
Q

Using ATBs in salmonella infections can cause ___ but that doesn’t mean one must continue further ATB use

A

Asymptomatic shedding of salmonella in the stool for a short time

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5
Q

Amyloidosis proteins that can accumulate in the heart

A

Lambda light chains
Transthyretin (hereditary)

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6
Q

In statistics a Type I error and alpha mean

A

Type I error = false positive = rejects H0 = Accepta H1 (there is a difference between groups)
Alpha value = significance = probability of making a type l error

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7
Q

Power refers to __ in statistics

A

1 - beta = chance of detecting true difference between groups

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8
Q

What’s actinic or senile purpura

A

Atrophy of dermal collagen from age and actinic (sun-related) damage -> dermal vessels become fragile and easily broken. Common on dorsal hands and arms

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9
Q

S1 and S2 lesion will manifest as

A

Sensory deficit on lat foot
Weakness in plantarflexion
Achilles tendon hyporeflexia

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10
Q

Child or teen with persistent rash around nose and mouths (for months) + conjunctival injection + anorexia + unusual breath odor + other possible multi-organ system, consider

A

Inhalant abuse (glue, spray, shoe polish, etc)

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11
Q

Which beta blocker is the most rapid-acting and has short half-life

A

Esmolol

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12
Q

Increased cryoglobunins (inmunoGb) associates with___ and can manifest as___

A

-Chronic viral infections, Chronic inflamm conditions, Lymphoproliferative disease
-purpura (leukocytoclastic vasculitis)

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13
Q

Mixed cryoglobulinemia sts

A

*Weakness
*Arthralgias
*Palpable purpura
Hepatosplenomegaly
Hematuria
Peripheral neuropathy

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14
Q

Migraines are treated with ___ which are ___ that help___

A

Triptans
Serotonin agonists
Inhibiting descending pain pathways and vasoconstricting

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15
Q

Proteosome inhibitors mec

A

Impaire the capacity of proteosome to chop up intracell proteins -> load them up on MHC l -> be recognized by CD8 cells

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16
Q

MHC I vs MHC ll

A

I: on All nucleated cells, Presents Endogenous antigens (e.g. viruses, tumor proteins) Recognized by CD8+. Allows CD8+ to recognize and kill infected or abnormal cells

II: on APCs (e.g. dendritic cells, macrophages, B cells) Presents Exogenous antigens (e.g. bacteria, extracellular pathogens) Recognized by: CD4+ (release cytokines and help other immune cells)

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17
Q

Which ACh receptors are found in the NMJ ?

A

Nicotinic
*affected in Myasthenia Gravis
*Remember Muscarinic ones are in the PSNS

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18
Q

Succinylcholine (neuromusc blocker) is adm for intubation. Prolongation of its paralyzing effects can be due to a genetic abnormality of

A

Pseudocholinesterase

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19
Q

Heparin exerts its effects by binding to

A

Anti-thrombin lll

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20
Q

Sulfunureas names

A

• 1st gen: Chlorpropamide, Tolbutamide
• 2nd gen (more common): Glyburide, Glipizide, Glimepiride

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21
Q

What’s external validity ?

A

determines whether an experiment can be generalized, and its conclusions applied to other groups

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22
Q

Cryptosporodiosis vs cryptococosis vs coccidioidomycosis sts HIV

A
  1. Chronic watery diarrhea
    2.meningitis
  2. Lung cavities / meningitis
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23
Q

Suppression vs repression vs denial

A

S: conscious decision to ignore something
R: unconscious response to deny something internal
D: unconscious response to deny something external

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24
Q

Zollinger-Ellison Sd

A

Pancreatic or duodenal secreting tumor -> recurrent duo/jejunum ulcers, malabsorption,hematochezia, etc

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25
Causes of male infertility
Blood testis barrier damage due to testicular trauma Klinefelter sd Increased testicular temperature GbRH deficiency
26
Which cell may be compromised in male infertility and why
Sertoli cells -> line seminiferous tubules and create blood testis barrier (immune protection)
27
Cystocele vs uterine prolapse
C: Bladder protrudes towards *ant vaginal wall* with valsalva (bulge) Wall weakness U: uterus protrudes into vaginal *canal* Ligament weakness
28
Blistering and hyperpigmentation after exposure to sunlight, think of __ caused by ___
Porphyria cutanea tarda Decreased activity of uroporphyrinogen decarboxylase (heme producer enzyme)
29
Pt with fever, chest pain and cough from central California (southwest US), mild eosinophilia and patchy bronchoneumonia. Think of
Coccidioidomycosis
30
Hypertrophic obstructive Cardiomyopathy TTO
Beta blockers or ND Ca+ channel blockers (reduce HR-> more time for ventricular filling (diastole) -> more coronary irrigation)
31
If after thyroidectomy, radioIodine ablation is done and radioIodine accumulation is found somewhere else, think of
Ectopic thyroid tissue
32
Which vitamines absorption is affected in CF?
Vit A, D, E, K (fat-soluble)
33
Which fat soluble Vit deficiency can cause neuro sts?
Vit E *Similar to B12 deficiency but Vit B is not fat soluble
34
Weber vs Horner
•Weber sd is a *motor* stroke of the ventral midbrain causing ipsilateral oculomotor palsy plus contralateral hemiparesis. •Horner sd is an autonomic block of *sympathetic* fibers to the eye causing ptosis, miosis, and anhidrosis without motor weakness.
35
Coarse Facial feature +hirsutism + hepatomegaly + skeletal abnormality. Think of
Mucopolysaccharidoses
36
Hurler vs Hunter sd (Mucopolysaccharidoses)
Hurler = Hereditary (AR). Hunter = X‑linked → think “H” in Hunter = “Hunts” in boys. • Corneal clouding: Present in Hurler, absent in Hunter. • Enzyme names Hurler: α‑L‑idUronidase Hunter: idUrOnate‑2‑sulfatase Hunter has milder sts
37
Colonic adenocarcinoma mutations
APC -> KRAS -> p53
38
Tight junctions (zonulae occludentes) are particularly affected by
Inflammatory diseases
39
Herpes virus infection is treated with __ which are ___. These must be activated by
-ciclovir Guanosine analogs (inhibit viral DNA polymerase) Thymine kinase
40
Which anatomic lung structure could allow the spread or an organism between alveoli compromising an entire lobe ?
Pores of Kohn *also allow passage of air, fluid and phagocytes in the setting of pneumonia
41
Two reason why a translocation may result in failure to transcribe RNA and produce disease
1. Break point affects section of an exon 2. Break point affects *regulatory sequence* (promoter, enhancer or silencer)
42
Mec of attack by CD8+
Fas-FasL interaction Granzyme and performing release
43
Viral clearance (phagocytosis) depends on
MHC class l complex *after viral fragments are presented to MHC l complex, CD8+ recognizes it and makes the cell go into apoptosis but *it does not phagocyte it*
44
Viral vs bacterial clearance
Virus: APCs->MHC I -> CD8+ Barrería: Macrophages/neutrophils -> APCs -> MHC -> CD4+ -> activate macrophages (phagocyte and *kill*) and B cells (which produce antibodies that also help)
45
Antibodies, produced by activated B cells, mec of action is
-neutralize bacteria (block their toxins or ability to infect cells). -opsonize bacteria (mark them for phagocytosis). -trigger the complement system (punches holes in bacterial membranes)
46
BZD bind to same or different site than GABA which enhances its activity increasing influx of __
Different Cl- *It’s an allosteric drug
47
Most common pediatric injury due to arm grabbing/pulling (specially to keep children from running)
Radial head subluxation/dislocation (Nursemaid elbow)
48
First dg to consider when shown a brain mass
Meningioma
49
Waardenburg sd produces patchy depigmentation of skin, hair irises (heterochromia) and hearing loss. It is due to ___
Abnormal crest development (cells don’t differentiate into melanoblasts or these do not migrate to the right place)
50
Dg information in Pts with dementia and low mini mental test must
Be first given to them even if they lack decisional capacity and then to caretaker
51
In which sleep stage is blood flow increased the most ?
REM *just as while being awake
52
How to tell Wilson’s disease from hemochromatosis?
Younger pts (<35) Affects *brain* (parkinsonism, ataxia, tremors, dystonia, dementia, personality changes) Affects cornea Does not affect skin
53
Neuropathic pain aa a result of peripheral nerve microvasc damage (eg.DM) is due to
Persistent activation of voltage-gated Na channels
54
Abnormal curvature of the penis (shortening), progressively painful erections and subcutaneous fibrotic plaque. Think of
Peyronie disease *hooklike-penis
55
Medication used to stop postpartum uterine bleeding after no response to ext uterine massage is___ which acts vía
Oxytocin Gq prot-coupled receptors -> IP3/DAG -> more influx of Ca+2 -> uterus contracts
56
Severe bleeding postpartum must be treated with ___ which works by activation of ___ receptors
Oxytocin Gq protein-coupled
57
Olygohydramnios will cause malformation or deformation?
Deformation (*external* mom organs will compress)
58
Streptokinase mec of action
Tissue plasminogen activator -> plasmin (cleaves fibrins clots)
59
Heparin mec of action
Increases antithrombin lll affinity for thrombin-> fibrinogen can’t convert to fibrin -> can’t form clots *same for lepirudin and bivalirudin
60
Small cell lung carcinoma vs squamous cell carcinoma
Small: centrally located, TBQ related, paraneoplastic sds (Lambert-eaton myasthenia,SIADH, Cushing sd) Squamous: centrally located. More common, **keratin pearls** and intercell bridges
61
Most common type of lung Ca among non-smokers is__. Key feature
Adenocarcinoma Peripheral location
62
Quinolone resistance mec is due to
DNA *gyrase* *DNA polymerase for acyclovir and similar
63
On X-ray Ao vs Mitral valve are located on
Ao: above line from Carina to Apex
64
Alloimmune hemolytic disease of the NB key feature
Mom is Rh (+) Baby is Rh (-) *mother previously sensitized by previous baby or transfusion
65
1-2 months old baby with anemia but no hemolysis signs + normal WBC but <9% neutros. Think of
Congenital neutropenia *<9% means is <1500. Severe if <3% or <500
66
Pleural effusion + scallop-shaped pleural density (calcified pleural plaque). Think of
Malignant mesothelioma
67
Decreased 5 alpha reductase vs androgen insensitivity
Both have ambiguous genitalia and lack of femenine int organs (AMH ok) but in 5 alpha reductase def DHT is low (no conversion from testosterone) and in androgen insensitivity all is high
68
Corticospinal tracks are ant / lat or post in spinal cord ?
Lat *spinothalmic is ant
69
Vocal cords state when swallowing, after laryngeal irritation and while coughing
Swallowing: closed After laryngeal irritation: closed Coughing: opened (allows air to clear foreign particles)
70
Delayed type hypersensitivity is
Type lV hypersensitivity Rx (Ex. TBC or contact dermatitis)
71
Poliovirus vaccine immune response
Neutralization of antibodies in circulation
72
Young athlete with ep of syncope while playing, previous dyspnea and systolic murmur on left lower sternal border that *increases with less VR* (chest pain or sudden cardiac death). Think of
Idiopathic hypertrophic obstructive *cardiomyopathy*
73
In Grave’s disease, sts are caused by hormones acting on
Nuclear/retinoid receptors with DNA-binding domains
74
G prot binding receptors signaling pathway is via __ and __. Typically seen with
cAMP (FSH, LH, ACTH, TSH, PTH; CRH, GHRH, ADH (v2), MSH, Calcitonin, H2, Glucagon, hCG) IP3 GnRH, Oxytocin, ADH (V1), TRH, H1
75
Cytokine receptors signaling pathway is via __ which is used by
JAK/STAT GH, Prolactine, EPO, Thrombopoietin, G-CSF
76
Tyrosine kinase receptors are used by
Insulin, IGF-1, FGF, PDGF, EGF
77
How to solve a Hardy-Weinberg equilibrium exercise to find Heterozygous probability of disease
1. Remember p^2 (dom prob) + 2pq (hetero prob) + q^2 (recev prob) 2. Find q -> q^2 -> q = √(q²) 3. Use rule p+q = 1 to find p -> p = 1 - q 4. Calculate 2qp
78
Delayed type hypersensitivity is type
IV
79
frontal bossing, facial bone malformations, supernumerary teeth, and absent or diminutive clavicles. Think of
Impaired *osteoblast* differentiation (Cleidocranial dysplasia)
80
Insulin acts on the enzyme that promotes first step hepatic glycolysis which is
Glucokinase
81
Pancytopenia in young man + gingival hypertrophy, think of
Acute myelogenous leukemia
82
Young pt with chronic disease (FEV1 and diffusing cap reduced) + hepatomegaly. Think of
a1-antitrypsin

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