Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Step 1 Prep > UWorld Practice Questions #6 > Flashcards

UWorld Practice Questions #6 Flashcards

1
Q

Name 3 signs that are concerning for drug seeking behavior.

A

Requesting a medication by name, pain out of proportion to physical exam, and running out of a medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What should you do to distinguish btwn under-controlled pain and drug seeking behavior in the ED?

A

Clarify the pt’s medication hx and see what drugs have been prescribed in the past, by whom, and at what frequency.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What can subluxation of the radial head cause?

A

Can damage the deep branch of the radial nerve as it passage thru the suppinator canal and can lead to finger drop.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How long is the incubation period in neurocystercosis?

A

Prolonged. Can be months to years after ingestion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What metabolite/chemical can have decreased levels in amniotic fluid in the setting of placental abnormalities and fetal growth restriction?

A

Estriol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What do clopidogrel and ticlopidine do?

A

They inhibit ADP mediated platelet aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Rapid electrical impulses originating in the pulmonary veins is the most common trigger of what?

A

Atrial fibrilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A re-entrant circuit that rotates around the tricuspid annulus causes what?

A

Atrial flutter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the clinical manifestations of anti-phospholipid antibody syndrome?

A

Venous or arterial thromboembolic disease (PE, DVT, etc.) and adverse pregnancy outcomes (unexplained embryo or fetal loss, premature birth due to placental insufficiency and pre-eclampsia).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does the Romberg test assess? What does failure to hold the position indicate?

A

Proprioception. Failure to maintain the position indicates sensory ataxia whereas w/ cerebellar ataxia pts can generally maintain the position w/ minimal unsteadiness.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does chronic Li toxicity present and what are some common drugs that can precipitate toxicity?

A

Presents w/ slowly progressive neuro sxs like involuntary movements, ataxia and tremor. Common drugs that can precipitate this include thiazide diuretics (due to causing volume depletion leading to reduced GFR and thus reduced Li filtering at the PCT), ACEIs and NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

True or false, loop diuretics provide survival benefit in HF pts?

A

False!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is mannitol primarily used?

A

To reduce increased ICP and to tx acute glaucoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe adenocarcinoma in situ in the lung?

A

A subtype of adenocarcinoma where there are columnar cells w/ growth along the intact alveolar septa. It is a pre-invasive lesion as there is no stromal or vascular invasion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the pathogenesis of TTP

A

Deficiency (genetic or acquired) of ADAMTS13, a vWF cleaving protease leads to uncleaved vWF. This leads to platelet trapping and activation which produces microthrombi that lead to clinical manifestations?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the clinical sxs of TTP?

A

Hemolytic anemia, thrombocytopenia, and may have renal failure, fever and neuro manifestations.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What enzyme is deficient in porphyria cutanea tarda?

A

Uroporphyinogen decarboxylase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What enzyme is deficient in acute intermittent porphyria?

A

PGB deaminase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the morphology of magnesium ammonium phosphate urinary stones?

A

Rectangular prism (coffin lid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the morphology of calcium oxalate stones?

A

Octahedron (square w/ an X in the middle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which malignancies are associated w/ pure red cell aplasia (PRCA), a severe hypoplasia or marrow erythroid precursors in the setting of normal granulopoeisis and thrombopoeisis?

A

Thymomas and lymphocytic leukemias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Patients w/ T2DM are most likely to die from what disease?

A

coronary artery disease, regardless of presence or absence of other CVD RFs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do hormones in pregnancy promote gallstone formation?

A

Estrogen induces hypersecretion of cholesterol into bile and progesterone promotes gallbladder hypomotility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is medical therapy for restless leg syndrome?

A

Dopamine agonists like pramipexole or ropinirole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Contrast Arnold-Chiari malformations type I and II

A

Type I is less severe and can be benign or discovered in early adulthood. It is where there are low lying cerebellar tonsils that extend below the foramen magnum

Type II is more severe and there is herniation of the cerebellum (tonsils and vermis) and medulla through the foramen canal. Often discovered in neonatal period, and often produces an obstructive hydrocephalus. Can have an associated lumbar myelomeningocele.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What does Bcl-2 do?

A

Inhibits cell apoptosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What does liver histo show in Reye syndrome?

A

Microvesicular steatosis (the presence of small fat vacuoles w/in the cytoplasm of hepatocytes). Note that there is NO necrosis or inflammation of the liver.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What characterizes leukoclastic vasculitis (aka microscopic polyangiitis)?

A

Segmental fibrinoid necrosis of small vessels. Appears histologically similar to PAN, w/ the difference being that PAN affects medium sized arteries and this is a small vessel vasculitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

In which vasculitides is there granulomatous inflammation of the media?

A

GCA and Takayasu arteritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Why isn’t there peripheral edema in the early stages of R sided HF?

A

Because moderate increases in capillary fluid transudation can be offset by increasing lymphatic drainage. Clinically apparent edema occurs once this gets overwhelmed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What sequelae of rubella do most adult women get?

A

Polyarthritis and polyarthralgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the time frame for when Dressler syndrome typically occurs?

A

1 week to multiple months after an MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are two important opsonins in the human body?

A

IgG and C3b

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How does high urinary citrate affect nephrolithiasis?

A

It - along w/ high fluid intake - prevents calculi formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

A brain tumor microscopically has spindle cells w/ hair-like glial processes associated w/ microcysts, and these cells are mixed w/ Rosenthal fiber. What brain tumor is this?

A

Pilocytic astrocytoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the four major elements that underlie the pathophysiology of acne?

A

Follicular epidermal hypoproliferation, excessive sebum production, inflammation, and propionibacterium acnes colonization/infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is NADPH used for?

A

Cholesterol and fatty acid synthesis, and the glutathione antioxidant mechanism (regenerates glutathione).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Cytosolic HMG-CoA synthase is for ______, whereas the mitochondrial HMG-CoA synthase is for______?

A

Cytosolic –> starting point for cholesterol synthesis

Mitochondrial –> rate limiting step in ketone body synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is another name for the brachiocephalic artery?

A

Innominate artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Where does the IVC run in the abdomen?

A

Just anterior to the right half of the vertebral bodies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Why can hypothyroidism lead to elevated prolactin levels?

A

Because lactotroph cells that secrete PRL have TRH receptors and elevated TRH leads to elevated PRL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the drug of choice for managing bulimia nervosa?

A

SSRI w/ fluoxetine having the most evidence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What area of the brain demonstrates the greatest degree of atrophy in Alzheimer’s disease?

A

The hippocampus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Why is a high sodium intake a RF for nephrolithiasis?

A

B/c Ca passively follows the reabsorption of Na and H20 at the kidney. If there is high Na then less will be reabsorbed which means less Ca is reabsorbed along w/ it leading to hypercalciuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the mechanism thru which cyanide causes toxicity?

A

Binds Fe3+ of cytochrome C in the ETC and thus inhibits oxidative phosphorylation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Over-administration of nitroprusside presents as what sort of toxicity?

A

Cyanide toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are the treatments of cyanide toxicity and how do they work?

A

Sodium nitrate –> promotes methyhemoglobin formation which combines w/ cyanide to form cyanmethemoglobin

Sodium thiosulfate –> Sulfar donor to promote hepatic rhodanese mediated conversion of cyanide into thiocyanate, which is excreted in the urine

Hydroxycobalmin –> cobalt moiety binds to intracellular cyanide ions and forms cyanocobalmin which is excreted in the urine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Does alveolar hyaline membrane disease cause an obstructive or restrictive pattern?

A

Tends to reduce lung compliance and thus causes a restrictive pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

How do R sided vs. L sided colon cancers present differently?

A

B/c R sided lumen is large caliber there are rarely obstructive sxs and instead pts present w/ features of iron deficiency anemia like fatigue, pallor, etc. Sxs like malaise, anorexia and fatigue can also occur.

Conversely, L sided lesions do tend to present w/ obstructive sxs and you get stuff like change in bowel habits (i.e. constipation), abdominal pain, distention, N/V, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Constipation that alternates w/ diarrhea is classic for what?

A

IBS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is first line tx for acute gouty arthritis? Which drugs should NOT be used during acute flares?

A

NSAIDs! Second line is colchicine.

Note that drugs in the class of allopurinol and probenicid should NOT be used during acute flares as they can exacerbate arthritis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are lung hamartomas made of?

A

Comprised of disorganized cartilage, adipose and fibrous tissue.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

True or false, infection w/ molloscum contagiosum can cause eosinophilic cytoplasmic inclusions?

A

True!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Name 5 cardiac changes that are associated w/ normal aging:

A

Decreased LV cavity size, increased L atria size, sigmoid shaped septum, dilated aortic root, shortened base to apex dimension. Overall myocardial atrophy w/ increased collagen deposition occurs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Which ovarian cell synthesizes the androgens (that later go on to be converted to estrogen)?

A

Theca interna cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is genetic transition vs. transversion?

A

Genetic transition is where a mutation occurs that replaces a purine for a purine or a pyrimidine for a pyrimidine. Transversion is a mutation that swaps a purine for a pyrimidine, or vice versa.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is the motor function of the obturator nerve?

A

Adduction of the thigh

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

How does the superior gluteal nerve exit the pelvis?

A

Through the greater sciatic foramen, above the piriformis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

How does the inferior gluteal nerve exit the pelvis?

A

Through the greater sciatic foramen, below the piriformis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What is the pathogenesis of abdominal aortic aneurysm?

A

RF like age >60, smoking, HTN, etc. cause chronic transmural inflammation of the vessel and extracellular matrix degradation w/in the wall of the aorta. This sets pts up for the aneurysm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the major mech w/ which copper is eliminated from the body?

A

Secreted into bile (either as straight copper or as ceruloplasmin which is copper bound to an alpha2-globulin) and then excreted in stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

On PA CXR, what makes up the R side of the cardiac silhouette?

A

The R atrium. As such it can be obscured by a consolidation in the R middle lobe of the lung.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Which factor and from which cell(s) promote smooth muscle migration to the intima (from the media) and smooth muscle proliferation in atheroma pathogenesis?

A

Platelet derived growth factor. It comes from the locally adherent platelets, the dysfunctional endothelial cells and the infiltrating macrophages.

Platelets also release TGF-B which is chemotactic for smooth muscle cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What are the prominent ADRs w/ nitrates?

A

headache, hypotension, cutaneous flushing, light-headedness and reflex tachycardia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

When are anti-centromere antibodies seen?

A

CREST syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Release of cytochrome C is seen in what process?

A

Release of cytochrome C from mitochondrial is a pro-apoptotic signal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

In the intrinsic pathway of apoptosis, what changes of proteins in the mitochondrial membrane and cytoplasm occur?

A

Anti-apoptotic proteins Bcl-2 and Bcl-x are replaced w/ pro-apoptotic proteins such as Bak, Bax and Bim

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What sort of K+ labs are a sign of digoxin toxicity and why?

A

Elevated K+ labs are a sign of toxicity. This is because it inhibits the Na/K ATPase pump and that means there is more K+ extracellularly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What enzyme do trimethoprim, methotrexate, and pyrimethamine all target?

A

Dihydrofolate reductase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What enzyme does sulfamethoxazole inhibit?

A

Competes w/ PABA to inhibit dihydropteroate synthetase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Which second gen sulfonylureas are more likely to cause hypoglycemia? Why?

A

Glyburide and glimepiride b/c they are more long acting. Glipizide is short acting so has a lower risk of hypoglycemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What kind of drug is sitagliptin?

A

DDP4 inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What characterizes fat embolism syndrome (seen in a minority of pts w/ severe skeletal trauma)?

A

Pulm insufficiency, diffuse neuro impairment, anemia and thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Which CN carries the parasympathetic innervation to the lacrimal, sublingual and submandibular salivary glands?

A

CN 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What are the indications for clozapine?

A

Tx resistant schizophrenia or schizophrenia associated w/ suicidality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What histo characterizes osteopetrosis?

A

Presistance of primary spongiosa in the primary cavity (due to impaired osteoclast function)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What are the three layers of abdominal muscle in order from superficial to deep?

A

External oblique –> internal oblique –> transversus abdominus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What EEG findings are indicative of absence seizures?

A

3-Hz spike wave discharges during seizure episodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Describe a Ghon complex. When in TB is it seen?

A

Lower lobe fibrotic focus + hilar lymphadenopathy. It occurs during initial infection w/ TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Where do Benzos bind on the GABA receptor?

A

At a different site than where GABA binds. Thus, Benzo binding in the presence of GABA increases the frequency of Cl- channels opening.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What is the drug target of baclofen?

A

It acts at the GABAb receptor in skeletal muscle. Note that benzos and barbs act at GABAa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Name two drugs that can be used to treat spasticity?

A

Baclofen and tizanidine (an alpha 2 agonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What are common causes of myopathy w/ elevated CK levels?

A

Hypothyroid myopathy, muscular dystrophies, inflammatory muscle disorders, and meds like statins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What is the first line tx for Lyme disease in a pregnant woman?

A

Amoxicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What molecules use the JAK-STAT pathway for signaling?

A

GH, cytokines, erythropoeitin, G-CSF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Which pituitary/hypothalamic hormones signal through the Gs pathway?

A

ACTH, TSH, ADH (V2 receptors).

Note that PTH does too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Which pituitary/hypothalamic hormones signal through the Gq pathway (the one involving DAG and IP3)?

A

GnRH, TRH, ADH (V1 receptor).

Note that AngII does too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What are the microscopic findings consistent w/ PSGN?

A
  • LM –> enlarged and hypercellular glomeruli
  • EM –> humps on the epithelial side of the BM
  • IF –> coarse, granular deposits of IgG and C3
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What is uniform, diffuse thickening of the glomerular capillary walls on LM consistent w/?

A

Membranous glomerulopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What causes the ataxia in ataxia-telangiectasia syndrome?

A

Cerebellar atrophy. Note that these pts have DNA hypersensitivity to ionizing radiation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Pts w/ Fanconi anemia are hypersusceptible to what sort of DNA damage?

A

DNA cross-linking agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Which immune cell is thought to be important to the pathogenesis of granuloma formation?

A

Th1 cells.

Note that overall granuloma formation involves chronic Th1 and macrophage activation in response to difficult to clear antigen.

93
Q

What is the synovial fluid WBC that is highly suggestive of septic arthritis (including absence of crystals too)?

A

WBC > 100,000/mm^3

94
Q

What is the difference btwn a simple focal and complex focal seizure?

A

In a simple one there is no LOC whereas in a complex focal seizure there is LOC and post-ictal state.

95
Q

Which generalized seizure does NOT have a LOC?

A

Myotonic seizure. It is characterized by brief jerking motions. Note that the other generalized seizures (tonic-clonic and absence) do have LOC.

96
Q

What is the language milestone of children who are two years old?

A

Vocab of 50-200 words and should be able to speak using 2 word sentences.

97
Q

What is selective mutism?

A

Failure to speak in some social settings (i.e. school), but not others (i.e. home). It is associated w/ anxiety, especially social phobia.

98
Q

Corprus cavernosa, bilateral or unilateral structure?

A

Bilateral. The spongiosum is unilateral and is what the urethra runs through.

99
Q

How do venodilators affect cardiac preload?

A

They decrease preload

100
Q

What histologic changes are seen on bx of a syphilis chancre?

A

Obliterative endarteritis w/ lymphocytes and plasma cells

101
Q

What are the odds that a sibling inherits the same HLA pattern as another sibling? Why?

A

1/4. This is b/c the HLA genes for class I, II and III are closely linked on chromosome 6.

102
Q

What is HLA-DR3 associated w/?

A

T1DM, SLE, Graves disease, Hashimoto thyroiditis, Addison disease

103
Q

What is HLA-DR4 associated w/?

A

T1DM, RA, Addison disease

104
Q

What is the mechanism of action of drugs like nitroglycerin or isosorbide dinitrate?

A

They increase NO in vascular smooth muscle which will increase cGMP in vascular smooth muscle and lead to relaxation and thus vessel dilation.

105
Q

What is the pathogenesis of hyperacute organ rejection?

A

Pathogenesis is the pre-existence of antibodies in the recipient to donor antigen. Causes ischemia and necrosis of the graft w/in minutes.

106
Q

What is the pathogenesis of acute organ rejection (takes weeks to months)?

A

There are CD8+ recipient cells that attack MHC proteins on the donor cells. This leads to vasculitis of donor vessels and a dense interstitial lymphocytic infiltrate.

Can be a humoral component too that is similar to hyperacute rejection but the antibodies form after the graft is placed.

107
Q

Uniformly thickened glomerular capillary basement membranes and IF studies showing granular deposition of C3 and IgG is consistent w/ what?

A

Membranous nephropathy.

108
Q

In which stage of wound healing do you see granulation tissue and deposition of type III collagen? What stage precedes it and what stage follows it?

A

Proliferative phase (day 3 - weeks after the wound)

Preceded by inflammatory phase (neuts, platelets, etc.) and followed by the remodeling phase (type III collagen replaced by type I collagen)

109
Q

On what cells is the CD34 marker seen?

A

Pluripotent stem cells

110
Q

What cells have CD56?

A

NK cells

111
Q

What are the two primary substances that drive angiogenesis?

A

VEGF and fibroblast growth factor (FGF - works by stimulating angioblast production)

112
Q

Hypoxemia can have a normal (5-15 mmHg) or elevated Arterial-alveolar gradient. What are 2 causes w/ a normal gradient and 3 causes w/ an elevated gradient?

A

Normal A-a gradient –> Hypoventilation (i.e. obesity hypoventilation syndrome or neuromuscular disease), and decreased inspired fraction of O2 (i.e. high altitude).

Elevated A-a gradient –> V/Q mismatch, R to L shunt, and impaired diffusion (i.e. interstitial lung disease).

113
Q

Which part of the pancreas is NOT retroperitoneal?

A

The tail. It is peritoneal.

114
Q

In the setting of a UTI, what are WBC casts pathognomonic for?

A

Pyelonephritis

115
Q

In what settings of bacterial infection can sterile pyuria be seen?

A

Urethritis causes by chlamydia or ureaplasma

116
Q

What can orbital floor injury cause numbness and paresthesia of upper check, upper lip and upper gingiva?

A

Because the infraorbital nerve runs along the orbital surface of the maxilla and exits the skull via the infraorbital foramen. This can be disrupted by this injury.

117
Q

What tumor can have N-Myc amplification?

A

Neuroblastoma. Amplification is associated w/ a poorer prognosis.

118
Q

What is opsoclonus-myoclonus syndrome and what tumor is it associated w/?

A

It is nonrhythmic conjugate eye movements and involuntary jerky movements of the trunk and limbs. It is part of the clinical presentation of neuroblastoma.

119
Q

The well perfused compartment of the body will get initial rapid distribution of inhaled anesthetics. Which organs constitute this compartment?

A

Brain, heart, liver, kidneys, lungs

120
Q

Where is edema seen in uticaria?

A

In the superficial dermis

121
Q

What is acantholysis and when is it seen?

A

It is loss of the cohesion btwn keratinocytes in the epidermis. It is a characteristic finding in pemphigus vulgaris.

122
Q

What is acanthosis and in what conditions is it seen?

A

It is diffuse thickening of the stratum spinosum layer and is commonly seen in psoriasis, seborrhic dermatitis, and acanthosis nigricans.

123
Q

What are lab findings that can be seen in Q fever?

A

Thrombocytopenia and elevated liver transaminases

124
Q

What is calcipotriene and how does it tx psoriasis?

A

It is a vitamin D analog that is used topically. It binds to Vit D receptor, a nuclear TF, and causes inhibition of keratinocyte proliferation and stim of keratinocyte differentiation.

125
Q

What is the mechanism of ustekinumab?

A

It targets IL12 and IL23 and is used to tx psoriasis.

126
Q

What does absence of CD55 and CD59 demonstrate on flow cytometry? What is the characteristic presentation of said disorder?

A

Paroxsymal nocturnal hemoglobinura. Classically presents w/ complement mediated hemolysis (as CD55 and CD59 are important inhibitors of complement activation), hypercoagulability, and pancytopenia.

127
Q

True or false, listeria is susceptible to cephalosporins?

A

False! This is due to altered PBPs. It is however susceptible to ampicillin.

128
Q

What innervates the detrusor?

A

Sacral micturition center, containing parasympathetic fibers that travel in the pelvic nerve and come from the L2-L4 level.

129
Q

What does the pontine micturition center do?

A

Coordinates relaxation of the external urethral sphincter w/ bladder contraction during voiding.

130
Q

What is the pathogenesis of incontinence in normal pressure hydrocephalus?

A

Expanded ventricles place traction on cortical afferent and efferent fibers, including those that are responsible for inhibiting the sacral micturition center. This leads to incontinence.

131
Q

What is the sudan III stool stain used for?

A

It is a test for fat malabsorption and is the most sensitive test for screening for malabsorption disorders. It identifies unabsorbed fat.

132
Q

Why is evaluation for monoclonality important when lymphoma is suspected?

A

B/c this would be a sign that there is indeed malignancy.

133
Q

Is there immune complex deposition as evidence by IF in Wegner’s form of crescentic glomerulonephritis?

A

Nope! Note that this is distinct from the other causes (i.e. anti-GBM disease) of crescentic glomerulonephritis.

134
Q

What sort of ventricular heart remodeling of the LV does mitral regurg lead to?

A

Eccentric hypertrophy and dilation of the LV cavity. Note this is different from the concentric hypertrophy seen in long-standing HTN.

135
Q

What are the four stages of lobar pneumonia? Describe each one macroscopically and microscopically.

A

1 = congestion (first 24 hours). Affected lobe is red, heavy and boggy. Microscopically there is vascular dilation and alveolar exudate w/ mainly bacteria.

2 = red hepatization (days 2-3). Lobe is red, firm and has liver-like consistency. Microscopically the alveolar exudate contains erythrocytes, neuts, and fibrin.

3 = grey hepatization (days 4-6). Grey-brown firm lobe. Micro RBCs disintegrate and alveolar exudate contains neuts and fibrin.

4 = resolution. Restoration of normal architecture and micro shows enzymatic digestion of the exudate.

136
Q

What is the finding of air in the bowel wall as demonstrated by curvilinear areas of lucency that parallel the bowel wall, in the setting of abd distension and bloody stools, diagnostic for?

A

Necrotizing enterocolitis.

137
Q

What CD markers demonstrate immature T cells in T-ALL?

A

TdT+ as well as CD1, CD4 and CD5 +

138
Q

What CD markers demonstrate immature B cells in B-ALL?

A

Postive for TdT, CD10 and CD19 (usually).

139
Q

What produces the lipofuscin pigment?

A

Free radical injury and lipid peroxidation.

140
Q

What do ranibizumab and bevacizumab do?

A

They are VEGF inhibitors

141
Q

How does advanced macular degeneration (AMD) present?

A

Dry –> gradual vision loss in one or both eyes leading to difficulty reading and driving. See drusen deposits on fundoscopic exam.

Wet –> progressive ECM deposition eventually results in retinal hypoxia and you get subretinal vascularization from VEGF, forming leaky vessels. Presents w/ acute vision loss (days to weeks). Fundoscopy shows a greyish-green retinal discoloration w/ surrounding edema/hemorrhage.

142
Q

How does inhaled amyl nitrate tx cyanide poisoning?

A

Oxidizes Fe in Hgb so it has more affinity for cyanide. This will sequester cyanide and prevent it from having its toxic effects.

143
Q

Name 2 lead chelators

A

Dimercaprol and EDTA

144
Q

Where is a cricothyrotomy preformed relative to the laryngeal prominence and thyroid?

A

Inferior to laryngeal prominence and superior to thyroid gland, between the cricoid and thyroid cartilage.

145
Q

Is pseudomonas motile?

A

Yes

146
Q

What is Uhthoff phenomenon?

A

It is seen in MS pts and is where sxs worsen w/ increased body temp (post-exercise, hot shower, etc.)

147
Q

What are neuro manifestations of polycythemia vera?

A

Pts can get transient visual disturbances and focal neuro deficits due to increased blood viscosity.

148
Q

What is the mechanism of varencicline and what are its effects?

A

It is a partial agonist at nicotinic receptors (specifically the a4B2 one believed to be involved in reward pathway) and thus it reduces nicotine withdrawal and attenuates the pleasurable/rewarding effects of nicotine. Can be used to help w/ smoking cessation.

149
Q

When are anti-smooth muscle antibodies seen?

A

In autoimmune hepatitis

150
Q

How does mechanical sound cause nerve impulses?

A

Sound reaches tempanic membrane and causes it to vibrate –> this vibration is transmitted to the oval window by ossicles –> vibration at oval window causes vibration of the basolateral membrane, which in turn causes bending of the hair cell cilia against the tectorial membrane –> hair cell bending causes oscilating depolarization and repolarization, which leads to nerve impulses in the auditory nerve.

151
Q

What causes noise-induced noise trauma hearing loss?

A

Damage to the stereocilia cells in the organ of Corti. Characteristically high freq hearing is lost first.

152
Q

What causes DIC in the setting of placental injury (i.e. placenta abruption) during pregnancy?

A

Release of tissue factor from placenta into maternal circulation.

153
Q

What sort of tumor can a sub-ungual bluish lesion indicate?

A

subungual melanoma or glomus tumor (note that the glomus body is a structure found in the dermis of the nail bed, toe and finger pads, and ears, and functions in thermoregulation).

154
Q

What is the single most important measure to reduce the transmission of organisms btwn patients?

A

hand hygiene by healthcare providers.

155
Q

What do HFE mutations cause?

A

Hereditary hemochromatosis

156
Q

What is the major cause of morbidity and mortality in theophyline intoxication?

A

Seizures. Note that tachyarrhythmias can occur too but do so less commonly.

157
Q

What dermatological condition is strongly associated w/ pseudomonas bacteremia? What does it look like?

A

Ecthyma gangrenosum. Presents w/ dark skin patches of necrosis and w/ occasional ulcerations.

158
Q

Where do microglia in the CNS come from?

A

Monocytes in the bone marrow

159
Q

What does the ventral posterolateral thalamus do?

A

Mediates somatic sensation of the body

160
Q

What does the ventral posteromedial thalamus do?

A

Mediates facial sensation and taste

161
Q

What are the adverse effects of calcineurin inhibitors at the kidney?

A

They demonstrate a dose dependent renal vasoconstriction and tubular cell damage. This can percipitate acute renal failure.

162
Q

What is Jervell and Lange-Nielsen syndrome?

A

The congenital long QT syndrome (due to K+ channel defect) that also has sensorineural deafness.

163
Q

What is the primary mech of B cell destruction in T1DM?

A

Cellular auto-immunity. It is thought that the auto-antibodies that are seen are largely permissive.

164
Q

What do mutations that render trypsin resistant to inactivation result in? Why?

A

Hereditary pancreatitis. This is b/c invariably there is always a little bit that gets activated prematurely and if the inhibitory mechanisms are lost (i.e. these premature stuff can’t be degraded), that will lead to pancreatitis.

165
Q

Damage above the red nucleus causes ______ posturing while damage at or below it causes ______ posturing?

A

Above –> decorticate (flexor)

At or below –> decebrate (extensor) posturing

166
Q

Mycobacteria that lack cord factor are not able to cause disease as cord factor corresponds to virulence. What is the growth pattern of mycobacteria that possess cord factor?

A

Growth of thick, ropelike cords of organisms in a serpentine pattern.

167
Q

What vasculitis is often known for extending into continuous veins and nerves?

A

Berger’s disease (it is unique in this way as others rarely do this).

168
Q

What is the term for compulsive consumption of a non-food or non stable food for at least a month?

A

Pica. THis is most commonly seen in kids and pregnant women.

169
Q

What isotype of immunoglobulin are the anti-Rh(D) antibodies that are adminstered to Rh- mothers at 28 weeks gestation and at the immediate postpartum period?

A

IgG

170
Q

What is a dandy-walker malformation?

A

Hypoplasia/absence of the cerebellar vermis, and cystic dilation of the 4th ventricle w/ posterior enlagement.

171
Q

What is an encephalocele?

A

Rare NTD characterized by protrusion of the brain and meninges through an abnormal opening in the skull.

172
Q

What metabolic pathway does transketolase participate in?

A

Pentose phosphate pathway

173
Q

What are common lab findings in sarcoidosis?

A

Hypercalcemia/hypercalciuria (due to production of active form of Vit D) and elevated ACE

174
Q

What is the term for generalized brain atrophy seen in AZ’s for example?

A

Hydrocephalus ex-vacuo

175
Q

What is meant by the term permissiveness?

A

Where the presence of one hormone allows another to have its maximal effect. Cortisol and norepi at vascular responsiveness is an example of this.

Different from synergism where effects are additive.

176
Q

What is the most common location of urethral damage when it occurs in the setting of pelvic trauma (i.e. open pelvic fracture)?

A

At the bulbomembranous junction (basically at the membranous urethra)

177
Q

Excess of unmineralized bone matrix and epiphyseal cartilage in a child is characteristic for what?

A

Rickets due to Vit D deficiency

178
Q

What histology is characteristic of acute transplant rejection?

A

Dense interstitial lymphocytic infiltrate

179
Q

What does NF-kB do?

A

It is a pro-inflammatory transcription factor that induces cytokine production.

180
Q

Distinguish type I and type II muscle fibers

A

Type I are slow twitch and are good for sustained contraction (i.e. paraspinal muscles). They have high mito and high myoglobin content. They get ATP from oxidative metabolism.

Type II are fast twitch, specialized for generating rapid forceful movement. Have more glycogen stores I believe.

181
Q

How is plasma renin activity measured?

A

It is the amount of angI generated per unit time.

182
Q

What is onion-like concentric thickening of arteriolar walls characteristic of?

A

Hyperplastic arteriolosclerosis. –> not this condition can result from super severe HTN

183
Q

What does cGMP promote in smooth muscle cells?

A

Myosin light chain dephosphorylation

184
Q

What is bortezomib and what can it be used for?

A

It is a proteasome inhibitor and can be used to tx multiple myeloma (b/c these cells have really high proteasome activity).

185
Q

What does the lepromin skin test do?

A

Distinguish btwn tuberculoid and lepromatous leprosy.

Pts w/ tuberculoid get a positive test result and develop an indurated nodule at the injection site.

186
Q

What is the mechanism of action of entanercept

A

Decoy receptor for TNF-alpha

187
Q

What do the following suffixes mean?

Mab
Cept
Nib

A

Mab –> monoclonal antibody

Cept –> receptor molecule

Nib –> kinase inhibitor

188
Q

What is Leser-Trélat sign? What does it indicate?

A

It is rapid appearance of a bunch of seborrhic keratoses and may indicate underlying internal malignancy.

189
Q

What percent of the coronary artery lumen must fixed atherosclerotic plaques obstruct to cause stable angina?

A

At least 75% of the lumen

190
Q

What is the mechanism by which hep B infection allows hep D infection?

A

Hepatitis D must be coated by hepatitis B surface antigen in order to be able to penetrate the hepatocyte.

191
Q

What is the other tx for bacterial vaginosis that is NOT metronidazole?

A

Clindamycin

192
Q

What region of long bones is most commonly affected by hematogenous osteomyelitis in kids?

A

Metaphysis. Note that this condition is more likely to occur in kids than adults

In adults most common location is vertebral body.

193
Q

Which cytokine signals for eosinophil infiltration of the bronchial wall (leading to eos and Charcot-Leyden crystals in sputum) in chronic eosinophilic bronchitis (as part of extrinsic allergic asthma)

A

IL-5

194
Q

What chromosomes are BRCA1 and BRCA2 located on?

A

BRCA1 –> 17

BRCA2 –> 13

195
Q

What do prostaglandins do at the kidney?

A

Dilate the afferent arteriole. This is why NSAIDs can be harmful.

196
Q

Which vascular beds are most susceptible to atherosclerosis?

A

Lower abdominal aorta and coronary arteries

197
Q

Where are “ground-glass” hepatocytes seen?

A

Hep B. They have a finely granular, eosinophilic cytoplasm.

198
Q

What do type 1 interferons (alpha and beta) do when they signal cells?

A

They cause production of antiviral proteins that can halt protein synthesis. –> active in presence of dsRNA so only killing virally infected cells.

Also stimulate MHC I expression

199
Q

What does interferon gamma (type II interferon) do?

A

Promotes expression of MHC II and macrophage intracellular killing of infected cells.

200
Q

Drugs w/ instrinsic hepatic clearance tend to have what pharmacokinetic properties?

A

High Vd and high lipophilicity

201
Q

What pattern of lung disease shows increased radial traction?

A

Restrictive

202
Q

What antidepressant is associated w/ priapism?

A

Trazodone (it’s a rare side effect)

203
Q

How do schwannomas appear histologically?

A

Biphasic w/ areas of high cellularity intermixed w/ areas of a more myxoid component.

204
Q

What does S-100 staining positively indicate?

A

Neural crest origin

205
Q

How does Abetalipoproteinemia present?

A

Malabsorption w/in first year of life. Get acanthocytes and neuro impairment too. On histo see enterocytes w/ clear, foamy cytoplasm. It’s b/c you lack ability to make VLDL and chylomicrons.

206
Q

What is the drug of choice for non-surgical tx of unruptured ectopic pregnancy?

A

Methotrexate

207
Q

What is fenoldopam?

A

It is a short-acting D1 agonist that will cause arteriolar vasodilation, increase renal perfusion, and lead to natriuresis. As such, it can be used for hypertensive crisis.

208
Q

How can you distinguish CML from a leukemoid rxn?

A

In CML the leukocyte alk phos is decreased whereas in a leukemoid rxn it is normal or increased

209
Q

What is the more specific antibody for dermatomyositis?

A

Anti-Jo1

210
Q

What does lichen sclerosis cause?

A

Patchy, whitish thinning of the skin

211
Q

Clearance of what substances can be used to estimate GFR and RPF?

A

GFR –> creatinine clearance

RPF –> PAH clearance

212
Q

What are the cell body neuron signs of Wallerian degeneration?

A

Cell body becomes swollen and rounded w/ the nucleus to the periphery. Nissl substance becomes fine and granular and dispersed throughout the cytoplasm.

213
Q

How does irreversible neuronal cell damage manifest?

A

Shrinkage of neuronal body, deep eosinophilia of the cytoplasm, pyknosis of the nucleus and loss of Nissl substance

214
Q

What is seen in chronic viral hepatitis?

A

Periportal heptic fibrosis

215
Q

What 4 types of drugs improve long term survival in systolic HF?

A

B-blockers, ACEIs, ARBs and aldosterone receptor antagonists

216
Q

What causes Nursemaid’s elbow (most common elbow injury in little kids)?

A

Too much traction on the elbow joint that causes subluxation of the radial head and damage/displacement of the annular ligament.

217
Q

What are the most common causes of congenital torticolis?

A

Birth trauma (i.e. breech birth) or malpositioning during utero.

218
Q

What can vitamin A overdose produce?

A

Intracranial HTN, skin changes (dry skin, alopecia, etc.) and hepatic damage leading to hepatomegaly.

219
Q

What is actually physically causing the obstruction in HOCM?

A

Mitral valve leaflet and the interventricular septum

220
Q

What usually causes complete collapse of a lung? Hint: can be due to some sort of mass effect in chronic smokers

A

Complete obstruction of a mainstem bronchus

221
Q

In a collapsed lung w/ hemothorax the trachea deviates _____ the affected side whereas in tension pneumothorax it deviates ______ the affected side?

A

Collapsed lung –> toward

Tension pneumo –> away from

222
Q

What forms the R brachiocephalic vein?

A

Union of R IJ and R subclavian veins

223
Q

Where is the damage in tabes dorsalis?

A

Dorsal columns and dorsal roots

224
Q

Which asbestos associated malignancy is most common?

A

Bronchiogenic carcinoma. Note that malignant mesothelioma is pretty rare.

225
Q

What is wound dihesisance?

A

It is rupturing of a previously closed wound. Can result from insufficient granulation tissue and scar formation, inadequate wound contraction, or excessive mechanical stress.

226
Q

What allele is abacavir hypersensitivty rxn strongly associated w/?

A

HLAB*57:01

227
Q

Bilateral wedged shaped areas of necrosis in the brain are characteristic for what?

A

Hypoxic-ischemic encephalopathy

228
Q

What nerve courses w/in the mucosa of the piriform recess of the larynx?

A

The internal branch of the superior laryngeal nerve - it’s important for the cough reflex.

229
Q

Which malignancy does achalasia increase the risk of?

A

Squamous cell carcinoma of the esophagus

Step 1 Prep (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions