USMLE Rx: Week of 06/20/16

Question 1

What renal hormone is secreted in response to vigorous exercise?

Answer 1

ADH

Question 2

Describe Horner syndrome.

Answer 2

A superior lung tumor can press on the sympathetic chain ganglia and lead to ipsilateral ptosis and miosis (drooping of the eye)

Question 3

What do teardrop cells indicate?

Answer 3

Primary myelofibrosis (the RBCs are crying tears when they get squeezed out of their home)

Question 4

What renal syndrome can statins cause?

Answer 4

Acute tubular necrosis from rhabdomyolysis

Question 5

Inspiration increases _________ heart sounds.

Answer 5

right heart sounds (because more blood enters the heart during inspiration)

Question 6

Having patients stand up or Valsalva will decrease most heart murmurs except __________.

Answer 6

mitral valve prolapse and HOCM, which will increase because venous return is decreased; squatting does the opposite and increases most heart soudns

Question 7

What peripheral cells are associated with CLL?

Answer 7

Smudge cells (those that lack any nucleus and look crushed; CLL = “crushed little lymphocytes”)

Question 8

What does verrucous mean?

Answer 8

Wart-like

Question 9

Those with ALL will often also have _________.

Answer 9

neutropenia

Question 10

Renally, diabetes can cause ___________ which will lead to vesico-ureteral reflux and thence pyelonephritis.

Answer 10

neurogenic bladder

Question 11

Those with sickle-cell trait can have episodic _________.

Answer 11

hematuria, because of micro-thrombi with the kidneys

Question 12

The most common CF mutation causes defective _____________ processing.

Answer 12

ER

Question 13

What can happen to the spleens of those with sickle cell?

Answer 13

Recurrent infarctions leading to shrunken size

Question 14

Sickle cell can cause acute episodes of ________ due to clotting.

Answer 14

localized pain

Question 15

Remember, those with sickle cell are given __________.

Answer 15

hydroxyurea, which induces more fetal hemoglobin

Question 16

In terms of bone malignancies, ________ are more common.

Answer 16

metastases (as opposed to primary malignancies)

Question 17

Malignancy should be highly suspect in people with elevated _________ levels and lytic bone lesions.

Answer 17

alkaline phosphatase

Question 18

Hodgkin’s lymphoma usually presents with what type of node distribution?

Answer 18

Focal (meaning multiple lymph nodes in one area)

Question 19

In addition to Reed-Sternberg cells, what histologic finding is characteristic of Hodgkin’s lymphoma?

Answer 19

Lacunar cells (with vacant area surrounding them)

Question 20

Nodular sclerosing Hodgkin’s presents with what histologic pattern?

Answer 20

Thickened pink bands

Question 21

List the characteristics of the vasculitis that often presents after hepatitis B infection.

Answer 21

Polyarteritis nodosa presents in young adults with transmural inflammation of the small and medium blood vessels, but this pattern spares the pulmonary vessels; fever; abdominal pain

Question 22

Necrotic granulomas are found in the cardiac tissue of what heart condition?

Answer 22

Rheumatic heart disease; these are called Aschoff bodies which sometimes contain Anitschkow

Question 23

What barrel-shaped fungus is endemic in the southwestern United States?

Answer 23

Coccidioidomycosis immitis

Question 24

Aplastic anemia is not just depletion of RBCs, but rather ___________.

Answer 24

depletion of the entire range of hematopoietic cells

Question 25

What enzyme is inhibited by lead poisoning?

Answer 25

Alpha-aminolevulinic acid dehydratase

Question 26

Laminated, dystrophic spheres of calcification are called _____________.

Answer 26

psammoma bodies

Question 27

Describe the causes and presentation of thrombotic thrombocytopenic purpura (TTP)?

Answer 27

Antibodies develop against ADAMTS13 metalloprotease. That enzyme cleaves vWF multimers; thus, without it vWF builds up and leads to microangiopathic hemolytic anemia. The presenting signs are FAT RN (fever, anemia, thrombocytopenia, renal failure, and neurologic disturbances)

Question 28

What B-cell lymphomas express CD5?

Answer 28

Follicular, small lymphocytic lymphoma (aka CLL), and DLBCL

Importantly, follicular lymphoma and CLL can transform into DLBCL

Question 29

How can you remember that the allantois becomes the median umbilical ligament?

Answer 29

Both have an N

Question 30

Homocysteine and methylmalonic acid are both elevated in which anemia?

Answer 30

B12 deficiency (think that “B” deficiency causes Both to be elevated)

Question 31

Intrinsic factor is needed to absorb which nutrient?

Answer 31

B12 (think of Biff from Back to the Future–he was crazy, just like how B12 deficiency can make you crazy… “B IF”)

Question 32

Describe osteopetrosis.

Answer 32

A rare genetic disorder that leads to impaired osteoclasts; without normal resorption of bone, bone marrow gets excessively calcified with “woven bone”

Question 33

Phrenic nerve damage leads to elevated diaphragm on the __________ side.

Answer 33

ipsilateral

Question 34

What is the formula for dead space that uses tidal volume, expired CO2, and arterial CO2?

Answer 34

V(d) = V(t) x ([paCO2 - expCO2]/paCO2)

Question 35

The axillary nerve branches off of the _______ nerve.

Answer 35

radial

Question 36

Human T-cell lymphotrophic virus (HTLV) causes adult T-lymphocyte leukemia and what other illness?

Answer 36

A myelinopathy characterized by lower-extremity weakness and urinary incontinence

Question 37

Recall that ATLL can present with ____________.

Answer 37

rashes, bone lesions, and hypercalcemia

Question 38

Of HIV, HCV, and HBV, what is the order of infectability?

Answer 38

HBV, HCV, then HIV (from most to least infectious)

Question 39

What is a renal complication of DIC?

Answer 39

Diffuse cortical necrosis (which can also be caused by sepsis and vasospasm)

Question 40

What type of coronary syndrome can Kawasaki’s cause?

Answer 40

Aneurysms

Question 41

What is the mechanism of heparin-induced thrombocytopenia?

Answer 41

The antibodies to PF-4 (the combination of heparin and its platelet receptor) activates platelets, exhausting their supply and leading to thrombocytopenia.

Question 42

What is the main component of surfactant?

Answer 42

Phosphatidylcholine (think of CHOking without surfactant)

Question 43

Which PFTs are decreased in COPD?

Answer 43

FVC
FEV
VC

** Remember, FEV is decreased more than FVC

Question 44

What sounds will ASDs and VSDs produce?

Answer 44

ASD: loud S1 and fixed split S2
VSD: holosystolic murmur heard best over the tricuspid area

Question 45

In what population is giant cell arteritis most common?

Answer 45

Elderly females

Question 46

Those with giant cell arteritis often also have __________.

Answer 46

polymyalgia rheumatica

Question 47

List some characteristics of polymyalgia rheumatica.

Answer 47

Aching joints
Increased inflammatory markers (ESR and CRP)
Rapid response to steroids

Question 48

Describe the metabolic state that excessive diuretic use and cystic fibrosis can cause.

Answer 48

Both of these syndromes can cause contraction alkalosis, a condition in which volume is lost but bicarb is not. In the case of diuretics, Na and Cl are lost alongside fluid, but bicarb is not. In the case of CF, patients sweat excessively and cannot retain Cl, thus leading to a similar low-volume, high-bicarb state.

Question 49

What are the relative speeds of conduction in the heart, as categorized by tissue?

Answer 49

His-Purkinje fibers are faster than sinoatrial node is faster than atrioventricular node

Question 50

Transferrin will be high in ___________ states.

Answer 50

low-iron

Question 51

If a patient has OSA, what metabolic consequence is likely?

Answer 51

Periods of respiratory acidosis leading to increased HCO3 retention in the kidneys

Question 52

E. coli only produce lactose-digesting enzymes when they cannot metabolize glucose. Describe the mechanism by which this change occurs.

Answer 52

Allolactose binds to the inhibitor upstream of the lac operon, inhibiting it. Low glucose levels lead to increased cAMP levels (because glucose inhibits adenylate cyclase), and the increased cAMP levels activate the transcription promoters for the lac operon.

Question 53

What pregnancy category is aspirin?

Answer 53

Safe (not sure what letter…)

Question 54

Recall that ANCAs target ____________.

Answer 54

neutrophils

Question 55

What disorder will have low fluorescence of dihydrorhodamine on assay?

Answer 55

Chronic granulomatous disorder

Question 56

_________ syndrome will not lead to fat in the stool (also called steatorrhea).

Answer 56

Kartagener

Question 57

What enzyme is defective in Pompe disease?

Answer 57

Alpha-1,4-glucosidase

Question 58

What three labs are elevated in tumor lysis syndrome?

Answer 58

Phosphate, potassium, and urate

Question 59

What drug is used to treat tumor lysis syndrome?

Answer 59

Allopurinol

Question 60

What is cinchonism?

Answer 60

Headache and tinnitus

Question 61

What is the most feared adverse effect of class I anti-arrhymthics?

Answer 61

Torsades de pointes

Question 62

What step of meiosis is most often the cause of Down syndrome?

Answer 62

Anaphase I

Question 63

What do antibodies target in pemphigus vulgaris and bullous pemphigoid?

Answer 63

Desmosomes and hemidesmosomes, respectively (bullous = bullow the epidermis)