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Flashcards in USMLE World 2 Deck (204):
1

pericarditis

complication of AMI (10-20%); sharp pleuritic chest pain irradiated to the neck (phrenic nerves), low fever, friction rub, fibrinous exudate, autoimmune reaction 6-8 weeks after AMI

2

Libman-Sacks endocarditis

present in 25% os SLE; sterile valve vegetations, fibrosis; AMI can develop due to hypercoagulable antiphospholipid antibody syndrome present in 12-30% of SLE

3

heart changes in hypertension

concentric ventricular hypertrophy without dilation and aortic insuficiency

4

heart changes in AMI

dilated cardiomyopathy

5

congenital QT prolongation syndrome

syncope in healthy young patients due to mutations in iK potassium channels + sensorineural deafness

6

localized amyloidosis

cardiac atria --> ANP; thyroid --> calcitonin; brain --> beta amyloids; pituitary --> prolactin

7

RCA thrombosis ECG

ST elevation in DI, DII and aVF plus sinus bradycardia

8

transmural ischemia of septum ECG

ST elevation in V1, V2 and 3rd degree heart block

9

ischemia of left anterior ventricle ECG

ST elevation in V3, V4

10

occlusion of proximal LAD artery ECG

ST elevation in V1-V4

11

ischemia of lateral wall of left ventricle on ECG

ST elevation in V5 and V6

12

post MI causes of death

cardiogenic shock MCC; free ventricular wall rupture 2nd MCC

13

hypertrophic cardiomyopathy

myofiber disarray + interstitial fibrosis due to mutations in genes encoding cardiac sarcomere proteins; 25% systolic anterior motion of the anterior leaflet of mitral valve which bulges into outflow tract ---> systolic murmur

14

diagnosis and Rx of Prinzmetal angina

Dx: ergonovine; Rx nitrates and CCBs

15

normal aging heart changes

decreased left ventricular chamber, sigmoid shaped ventricular septum, myocyte atrophy with interstitial fibrosis, brownish lipofuscin pigment

16

heart findings in hemochromatosis

dilated cardiomyopathy + hemosiderin granules in myocytes

17

aortic stenosis

systolic pressure gradient between LV and aorta; "SAD" syncope, angina, dyspnea; MCC is senile calcification

18

Kusmaul sign

paradoxical increase in jugular venous pressure with inspiration; diferential diagnosis: cardiac tamponade, restrictive cardiomyopathy, right failure, tricuspid stenosis, constrictive pericarditis

19

Down syndrome heart findings

ostium primum ASD + mitral/tricuspid insuficiency

20

suceptibility to infarction of different organs

CNS, myocardium, kidney, spleen, liver; spleen and liver have double blood supply

21

pulsus paradoxus

exageration of the normal decrease in blood pressure on inspiration; radial pulse disappears in inspiration; cardiac tamponade

22

cor pulmonale

dyspnea on exertion, right ventricular hypertrophy, sudden death

23

pulmonary embolus

acute chest pain, dyspnea tachychardia, tachypnea, hypotension; MCC is DVT; perfusion defect without ventilation defect; lung collapse --> perfusion and ventilation defect

24

Osler-Weber-Rendu

hereditary hemorrhagic telangiectasias, rupture causes epistaxis, GI bleeds, hematuria

25

dissecting aorta aneurysm

hematoma may compress branches of aortic arch --> hypertension in one limb, hypotension in the other

26

hemangioma types

cherry --> adults; strawberry --> kids; cavernous --> associated with VHL

27

migratory thrombophlebitis

pancreatic cancer

28

cystic hygroma

cavernous lymphangioma without luminal blood vessels in the neck or axila; Turner

29

Churge-Straus syndrome

adult onset asthma, eosinophilia, polyneuropathy, p-anca vasculitis

30

bronchiolitis obliterans

due to chronic transplant rejection; affects small airways; dyspnea, wheezing

31

acute rejection

perivascular infiltration of blood vessels with lymphocytes, macrophages and plasma cells

32

causes of pulmonary hypertension

COPD-induced hypoxic vasocronstriction; volume overload in CHF; idiopathic vasoconstriction

33

sarcoidosis associations

associated with high levels of vitamin D/hypercalcemia produced by macrophages

34

asbestosis

localized pleural thickening with calcifications of the lower lobes

35

silicosis

nodular densities and calcifications of the hilar nodes plus birefringent silica particles

36

pneumoconiosis

multiple discrete nodules prominent in upper lobes

37

ARDS

decreased lung compliance, increased work of breathing, V/Q mistmatch, normal pulmonary wedge pressure

38

fat embolism

acute onset of neurologic abnormalities, petechial rash and hypoxemia in traumatized patient; fat exits bone marrow to pulmonary microvessels; via capillary shunts to CNS and adhere to platelets causing thrombocytopenia

39

dermatomyositis

proximal muscle weakness, heliotrope rash, violaceous eruption on the knuckles; muscle lymphocytic infiltrate

40

hamartoma

benign and composed of fibrous and adipose tissue

41

Reid index

thickness of mucous gland layer / wall thickness > 0.4 --> chronic bronchitis

42

stages of pneumonia

red congestion (24 hours); red hepatization (3 days); gray hepatization

43

retrolental fibroplasia

retinal neovascularization due to O2 treatment in ARDS of newborn

44

pneumonia complication

absess due to lysosomal enzymes from neutrophils and macrophages

45

pneumothrorax

unilateral chest pain, hyperresonance and absent breath sounds; due to blebs, emphysema, trauma

46

causes of lung absess

MCC is aspiration of fusobacteria, peptostrep and bacteroides associated with seizures, alcoholism, anesthesia; bacterial pneumonia and sepsis

47

green discoloration of pus/sputum

due to heme-containing myeloperoxidase

48

NSAID-induced nephropathy

seen in chronic arthritis treated patients; reversible renal failure, papillary necrosis, chronic interstitial nephritis

49

multiple myeloma

easy fatigability due to anemia; constipation due to hypercalcemia; back pain due to osteoclast activating factor; azotemia; eosinophilic casts with bence-jones proteins

50

complication of nephrotic syndrome

loss of antithrombin III --> renal vein thrombosis --> varicocele

51

renal cell CA

arises from proximal tubule cells; MC is urothelial cancer --> painless hematuria, proximal tubule cells filled with glycogen and lipids

52

ethylene glycol intoxication (antifreeze)

acute renal failure, anion gap metabolic acidosis and calcium oxalate crystals in urine

53

glomerular membrane histology

fenestrated endothelium is selective for size; GBM has negative charge

54

acute tubular necrosis

oliguric stage --> volume retention, oliguria, anion gap metabolic acidosis, hyponatremia, hyperkalemia; recovery phase --> polyuria, hypernatremia, hypokalemia

55

microalbuminuria

30-300mg of albumin in 24-hour urine; first sign of diabetic nephropathy

56

crescents

glomerular parietal cells, monocytes, macrophages, abundant fibrin

57

muddy brown casts

pathognomonic for acute tubular necrosis

58

minimal change disease

loss of GBM negative charge; selective proteinuria consists of albumin and no IgG or alpha-2-macroglobulin

59

diabetic nephropathy

increased mesangial matrix, thickening of GBM and nodular glomerulosclerosis, hyaline arteriosclerosis

60

nephrotic syndrome

increased glomerular permeability --> proteinuria --> edema --> decreased effective blood volume --> increased ADH and aldosterone plus increased liver synthesis of proteins including lipoproteins

61

T cell ALL

mediastinal mass causes superior vena cava syndrome, dysphagia, dyspnea and throat pain

62

high EPO

obstructive sleep apnea, COPD, right-left shunts, high altitude

63

factor VIII

synthesized in the liver, stored in endothelial cells; desmopressin stimulates release

64

SLE pancytopenia

due to IgGs against RBCs

65

Factor V leiden

leads to less deactivation by protein C --> hypercoagulable state --> DVT/pulmonary thromboembolism

66

spherocytosis

increased MHCH is diagnostic

67

G6PDH deficiency inheritance

X-linked recessive

68

spherocytosis inheritance

autosomal dominant

69

vonWillenbrand inheritance

autosomal dominant with variable penetrance

70

pure red cell aplasia

normo anemia plus decreased reticulocytes; associated with thymoma and parvoB19

71

vonWillenbrand disease

vW factor is carrier for factor VIII --> increased BT and PTT

72

Reed-Sternberg cells

abundant cytoplasm bilobed or double nucleus surrounded by halo, inclusion-like eosinophilic nucleoli

73

sodium metobisulfate

induces sickling in sickle cell trait

74

lipoprotein lipase

synthesized by adipocytes, cardiac and skeletal muscle cells; deficiency leads to hypertriglyceridemia and acute pancreatitis

75

acute pancreatitis lab findings

hypocalcemia, macrocytosis, increased serum lipase and amylase

76

colon adenoma to carcinoma sequence

polyp (mutation of APC gene) --> large polyp (mutation of k-ras) --> malignant polyp (mutation of p53)

77

acute pancreatitis risk factors

gallstones, alcohol, ERCP, hypertriglyceridemia, hypercalcemia

78

complication of Crohn's disease

gallstones due to loss of enterohepatic circulation and increased cholesterol/bile acid ratio; also oxalate stones due to increased absorption of dietary oxalate because calcium is flushed with lipids and doesn’t bind oxalate

79

zollinger ellison

ulcers at distal duodenum, diarrhea due to inactivation of lipases by gastric acid

80

Whipple disease

PAS+ macrophages with rods

81

PAS stain

stains carbon-carbon bonds bright pink

82

colon cancer marker

CEA to detect recurrence after resection

83

MC site of colon adenocarcinoma

ascending colon; rectosigmoid is 2nd MC site

84

duodenal Vs. gastric ulcer pain characteristics

duodenal --> pain 2-4 hours after food or before eating relieved by food and antacids; gastric ulcer --> pain inmediately after eating not relieved by antacids

85

pseudocyst Vs. cyst

pseudocyst is complication of acute pancreatitis; wall is composed of granulation tissue and fibrosis (not epithelium like true cyst)

86

causes of malabsorption

cystic fibrosis, chronic pancreatitis, celiac sprue, whipple, Crohns, diverticulosis, diabetic neuropathy

87

screening test for malabsorption

sudan stain stains fat in stools

88

consequences of malabsorption

ADEK deficiency; petechiae (vit K), bone pain and tetany (vit D), muscle wasting and edema (protein waste), hyperkeratosis (vit A)

89

false Vs. true diverticula

false --> mucosa and submucosa only, acquired, pulsion; true --> also muscular layer, congenital, traction

90

Reye syndrome

viral infection + aspirin --> vomiting, hepatomegaly, increased AST, ALT, hyperamonemia with encephalopathy, liver microvesicular steatosis without necrosis

91

acalculous cholecystitis

inflamation of gallbladder without stones due to sepsis, immunosupression, trauma, diabetes

92

formation of cholesterol gallstones

cholesterol precipitation --> stones; phosphatidylcholine and bile salts --> solubility

93

HBV damage to liver

no cytopathic effect; HBsAg and HBcAg stimulate CD8 cytotoxicity

94

halothane hepatotoxicity

fulminant, liver shrinks, increased AST, ALT and PT, eosinophilia; histologically the same as hepatitis

95

ceruloplasmin

globulin that accounts for 95% of circulating copper; copper is eliminated in bile

96

echinococcus cysts

mass in the liver; aspiration can cause anaphylaxis

97

cavernous hemangioma

MC benign liver tumor; Rx with resection, no biopsy

98

MCC of liver malignancy

metastasis is MCC > HCC

99

gallbladder hypomotility

due to pregnancy, weight loss, parenteral nutrition, octeotride --> billiary sludge --> stones/cholecystitis

100

types of gallstones

yellow --> cholesterol; brown --> billiary infection; black --> hemolysis

101

porcelain gallbladder

calcifications associated with carcinoma

102

outcome of hepatitis B infection

complete resolution (95%); chronic hepatitis/cirrhosis/HCC (4-5%); fulminant hepatitis (<1%)

103

gallbladder changes in pregnancy

estrogen-induced cholesterol hypersecretion and progesterone-induced hypomotility --> gallstones

104

ulcer erosions

penetrate submucosa, inner and outer muscular but not muscularis mucosa

105

abetalipoproteinemia

no apoB for chylomicrons --> lipid accumulation makes epithelium look foamy --> no lipids in blood, acanthocytes, ataxia and retinitis pigmentosa

106

polyps with adenocarcinoma potential

adenomatous polyps and specially villous adenomatous

107

squamous cell CA of esophagus

keratin pearls look like fibrosis

108

adenomatous polyps

villous adenomas --> large, sessile, dysplastic --> bleeding, secretory diarrhea and partial obstruction

109

anal fissures

90% are found in posterior midline distal to dentate line; due to low fiber diet and constipation

110

effect of atherosclerosis on stomach

can affect gastric branches of celiac trunk --> epigastric pain 30 minutes after eating

111

ischemic colitis

affects splenic angle because it lies between SMA and IMA areas of perfusion

112

HAV infection

low grade fever, anorexia, nausea, coluria, RUQ tenderness, hepatocyte swelling, mononuclear infiltrate, councilman apoptotic bodies

113

ascending cholangitis Vs. hepatic absess

enteric bacteria (ascending) or staph (hematogenous)

114

HBV Vs. HCV histology

HBV --> granular cytoplasmic inclusions; HCV --> lymphoid aggregates and steatosis

115

billiary atresia

congenital obstruction of bile ducts --> clay stools, coluria, hepatomegaly, conjugated hyperbilirubinemia

116

primary billiary cirrhosis

pruritus, increased liver alkaline phosphatase

117

aflatoxins

HCC due to mutation of p53

118

gallstone ileus

large stone passes through fistula into ileum and allows air to pass into billiary tree

119

Wernicke encephalopathy

confusion, ataxia, ocular abnormalities; Rx thiamine

120

Korsakoff confabulation psychosis

damage to medial dorsal nucleus and/or mamillary bodies of thalamus

121

Alzheimer's biochemistry

decreased ACh in basal nucleus of Meynert and hippocampus

122

alcohol changes in brain

upregulation of GABAa receptors and NMDA receptors; increased DA, 5HT and NE

123

complications of subarrachnoid hemorrhage

vasospasm (treat with nimodipine) and rebleeding

124

transtentorial herniation

uncus of temporal lobe herniated through tentorium --> compression of CN III, PCA and corticospinal tract

125

MC extracranial childhood cancer

neuroblastoma associated with N-myc; retroperitoneal mass, episodic hypertension, neuroblast is malignant cell

126

SSPE

complication of measles; anti-measles antibodies in CSF, no anti-M protein antibodies

127

meningioma histology

psamoma bodies in brain tumor --> meningioma

128

Schwanoma marker

S100

129

Pick's disease

pronounced atrophy of frontal lobes, progressive dementia, behavioral dishinibition, dysarthria, aphasia, primitive reflexes

130

Charcot-Bouchard aneurysms

associated with hypertension; found in small arteries of basal ganglia; rupture --> intraparenchymal hemorrhage and focal deficits

131

berry aneurysms

associated with APCKD, Marfan, ED; anterior cerebral arteries most affected; leads to subarachnoid hemorrhage

132

hypoxic encephalopathy

wedge-shaped areas of necrosis on the surface of cerebral convexities and lateral to interhemispheric fissure; due to cardiogenic shock or shock; affects hyppocampus first

133

pontine myelinolysis

too fast correction of hypernatremia; spastic quadriplegia and pseudobulbar palsy

134

stroke scar

cystic cavity surrounded by wall of astrocytes

135

Creutzfeld-Jakob

rapidly progressive dementia and myoclonus; vacuoles in gray matter looks like sponge; due to prion

136

normal pressure hydrocephalus

urinary incontinence, ataxia and progressive dementia

137

Friederich ataxia

triple repeat mutation; spinocerebellar tract degeneration (ataxia), degeneration of dorsal columns, kyphoscoliosis, hypertrophic cardiomyopathy, diabetes

138

lacunar infarcts

small ischemic infarcts involving basal ganglia, pons, internal capsule; due to hypertensive arteriosclerosis of small penetrating arterioles

139

ischemic stroke changes

red neurons (48 hours); neutrophils (72 hours); macrophages (5 days); gliosis/angiogenesis (2 weeks); glial scar (>2 weeks)

140

Arnold-Chiari malformation

small posterior fossa results in herniation of medulla and cerebellum through foramen magnum

141

multiple sclerosis

demyelination, decreased oligodendrocytes, lipid-ladden macrophages, astrocytosis, lymphocytic inflamation

142

CN III diabetic neuropathy

only affects somatic fibers sparing parasympathetic due to different blood supply

143

cerebellar masses

mostly in children; astrocytoma or meduloblastoma

144

tumor associated with myasthenia gravis

thymoma

145

tumor associated with Lambert-Eaton

lung cancer

146

vitamin E deficiency

affects dorsal column and spinocerebeallar tracts; mimics Friederich ataxia

147

temporal lobe encephalitis

aphasia, olfactory abnormalities, personality changes; due to HSV-1

148

myotonic dystrophy

triple repeat mutation, sustained muscle contraction (myotonia) with muscular weakness and atrophy; cataracts, baldness, gonadal atrophy

149

cerebral amyloid angiopathy

recurrent hemorrhagic strokes

150

Duchene

x-linked recessive; fibrofatty muscle replacement

151

diabetic neuropathy

due to osmotic damage to axons and Schwann cells and microangiopathy of endoneural arterioles

152

lead poisoning tratment

dimecarpol, EDTA; heavy metal chelators

153

cystic tumors in cerebellum

pilocytic astrocytoma mostly in kids

154

Meniere

tinitus, vertigo, hearing loss; too much endolymph

155

pretibial myxedema

non-pitting myxedema and thickening of skin around tibia in Graves disease

156

craniopharyngioma

remnant of Rathke's pouch bulges into 3rd ventricle; cystic solid mass with calcifications; headaches, visual deficits and hypopituitarism

157

hypoglycemia in neonate of diabetic mother

mother's hyperglycemia induces islet hyperplasia with increased insulin production

158

mechanism of amenorrhea in anorexia

low body fat fails to induce pulsatile secretion of GnRH; also seen in cachexia and athletes

159

psamoma bodies

concentric calcified structures; pathognomonic for papillary thyroid CA and meningioma

160

pituitary apoplexy

acute bleeding into a preexisting pituitary adenoma; bitemporal hemianopia, sudden headache; complication is cardiovascular collapse due to adrenocortical insuficiency

161

type II diabetes associations

amyloid deposition in beta cells

162

seminoma

increases hCG which is similar to TSH and can cause hyperthyroidism

163

MCC of death in diabetics

AMI

164

primary hyperaldosteronism

hypokalemic metabolic alkalosis with hypertension and normal [Na] because of compensatory natriuresis

165

medullary thyroid carcinoma histology

polygonal or spindle-shaped cells with extracellular amyloid deposits seen with congo red

166

glucagonoma

necrolytic migratory erythema rash and hyperglycemia

167

MEN III

medullary thyroid carcinoma, pheochromocytoma, mucosal neuromas and marfanoid habitus

168

ret gene

MEN

169

fibromyalgia

stiffness, pain, poor sleep, emotional disturbance; pain and stiffness gets worst with exercise; tender spots over multiple joints

170

osteoporosis histology

thin trabecula

171

osteopetrosis histology

unmineralized spongiosa

172

Paget's histology

focal formation of bone

173

vitamin D deficiency histology

unmineralized osteoid

174

hyperPTH histology

cystic degeneration of bones

175

pseudogout

weakly birefringent rhomboid-shaped calcium pyrophosphate crystals

176

wound contracture

myofibroblasts + metalloproteinases in excess

177

parvovirus B19 associations

slapped cheek rash and can cause self-limiting arthritis-like disease, pure red cell aplasia; aplastic anemia in sickle cell patients

178

digital clubbing

associated with prolonged hypoxia in COPD patients

179

gout

deposition of monosodium urate crystals that are negativley birefringent

180

presbyiopia

sclerosis of the lens

181

cause of skin wrinckles

decreased collagen and increased elastases and collagenases

182

actinic keratosis

erythematous papules with central scale and sandpaper texture with acanthosis, parakeratosis and hyperkeratosis

183

acanthosis

thick epidermis

184

parakeratosis

nuclei in stratum corneum

185

hyperkeratosis

thick corneum

186

acanthosis nigricans

associated with insulin resistant states (DM, acromegaly, obesity) as well as GI cancer

187

avascular necrosis of femoral head

associated with sickle cell, lupus and high-dose steroid therapy

188

atopic dermatitis

also called eczema; pruritus, erythematous papules; associated with allergens, asthma and rhinitis

189

hypercalcemia in sarcoidosis

due to increased 1,25vitD by macrophages

190

shaken baby syndrome

retinal hemorrhages + subdural hematoma; report child abuse

191

rheumatoid arthritis

does not involve DIP joints; stiffness lasts more than 30 minutes

192

osteoarthritis

can have morning stiffness < 30 minutes and subcutaneous nodules; can involve DIP joints

193

dermatomyositis

heliotrope rash and papules in the MCP, PIP and DIP joints

194

osteomyelitis

affects long bone metaphysis

195

retinoblastoma

associated with osteosarcoma

196

contact dermatitis

spongiosis

197

psoriasis

reduced stratum granulosum, parakeratosis, acanthosis and dividing cells in epidermis

198

seborrheic keratosis

benign epidermal tumor, tan , flat, round, greasy, coin-like stuck on appearance

199

acute interstitial nephritis

due to drug allergy; fever, acute renal failure, maculopapular rash and eosinophiluria

200

cysteine stone crystals

hexagonal crystals, acid urine, recurrent stones at young age, positive cyanide-nitroprusside test

201

papillary necrosis

sickle cell patients or carriers; acute colic pain, gross hematuria, passage of tissue fragments in urine

202

hydronephrosis

due to prolonged urinary obstruction in nephrolithiasis, tumor, anatomic defects, neurogenic bladder, BPH; atrophy of cortex with scarring and interstitial fibrosis with inflamation

203

most important mediator of sepsis

TNF alpha

204

cryptorchidia

decreases inhibin with increased FSH and normal LH/testosterone; remove testis to prevent malignancy