UWorld Practice Questions #6 Flashcards
(229 cards)
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
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.
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.
4
Q
How long is the incubation period in neurocystercosis?
A
Prolonged. Can be months to years after ingestion.
5
Q
What metabolite/chemical can have decreased levels in amniotic fluid in the setting of placental abnormalities and fetal growth restriction?
A
Estriol
6
Q
What do clopidogrel and ticlopidine do?
A
They inhibit ADP mediated platelet aggregation
7
Q
Rapid electrical impulses originating in the pulmonary veins is the most common trigger of what?
A
Atrial fibrilation
8
Q
A re-entrant circuit that rotates around the tricuspid annulus causes what?
A
Atrial flutter
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).
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.
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
12
Q
True or false, loop diuretics provide survival benefit in HF pts?
A
False!
13
Q
When is mannitol primarily used?
A
To reduce increased ICP and to tx acute glaucoma
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.
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?
16
Q
What are the clinical sxs of TTP?
A
Hemolytic anemia, thrombocytopenia, and may have renal failure, fever and neuro manifestations.
17
Q
What enzyme is deficient in porphyria cutanea tarda?
A
Uroporphyinogen decarboxylase
18
Q
What enzyme is deficient in acute intermittent porphyria?
A
PGB deaminase
19
Q
What is the morphology of magnesium ammonium phosphate urinary stones?
A
Rectangular prism (coffin lid)
20
Q
What is the morphology of calcium oxalate stones?
A
Octahedron (square w/ an X in the middle)
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
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.
23
Q
How do hormones in pregnancy promote gallstone formation?
A
Estrogen induces hypersecretion of cholesterol into bile and progesterone promotes gallbladder hypomotility.
24
Q
What is medical therapy for restless leg syndrome?
A
Dopamine agonists like pramipexole or ropinirole
25
Contrast Arnold-Chiari malformations type I and II
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.
26
What does Bcl-2 do?
Inhibits cell apoptosis
27
What does liver histo show in Reye syndrome?
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.
28
What characterizes leukoclastic vasculitis (aka microscopic polyangiitis)?
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)
29
In which vasculitides is there granulomatous inflammation of the media?
GCA and Takayasu arteritis
30
Why isn't there peripheral edema in the early stages of R sided HF?
Because moderate increases in capillary fluid transudation can be offset by increasing lymphatic drainage. Clinically apparent edema occurs once this gets overwhelmed.
31
What sequelae of rubella do most adult women get?
Polyarthritis and polyarthralgia
32
What is the time frame for when Dressler syndrome typically occurs?
1 week to multiple months after an MI
33
What are two important opsonins in the human body?
IgG and C3b
34
How does high urinary citrate affect nephrolithiasis?
It - along w/ high fluid intake - prevents calculi formation
35
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?
Pilocytic astrocytoma
36
What are the four major elements that underlie the pathophysiology of acne?
Follicular epidermal hypoproliferation, excessive sebum production, inflammation, and propionibacterium acnes colonization/infection
37
What is NADPH used for?
Cholesterol and fatty acid synthesis, and the glutathione antioxidant mechanism (regenerates glutathione).
38
Cytosolic HMG-CoA synthase is for ______, whereas the mitochondrial HMG-CoA synthase is for______?
Cytosolic --> starting point for cholesterol synthesis
Mitochondrial --> rate limiting step in ketone body synthesis
39
What is another name for the brachiocephalic artery?
Innominate artery
40
Where does the IVC run in the abdomen?
Just anterior to the right half of the vertebral bodies.
41
Why can hypothyroidism lead to elevated prolactin levels?
Because lactotroph cells that secrete PRL have TRH receptors and elevated TRH leads to elevated PRL
42
What is the drug of choice for managing bulimia nervosa?
SSRI w/ fluoxetine having the most evidence
43
What area of the brain demonstrates the greatest degree of atrophy in Alzheimer's disease?
The hippocampus
44
Why is a high sodium intake a RF for nephrolithiasis?
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
45
What is the mechanism thru which cyanide causes toxicity?
Binds Fe3+ of cytochrome C in the ETC and thus inhibits oxidative phosphorylation
46
Over-administration of nitroprusside presents as what sort of toxicity?
Cyanide toxicity
47
What are the treatments of cyanide toxicity and how do they work?
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.
48
Does alveolar hyaline membrane disease cause an obstructive or restrictive pattern?
Tends to reduce lung compliance and thus causes a restrictive pattern
49
How do R sided vs. L sided colon cancers present differently?
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.
50
Constipation that alternates w/ diarrhea is classic for what?
IBS
51
What is first line tx for acute gouty arthritis? Which drugs should NOT be used during acute flares?
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.
52
What are lung hamartomas made of?
Comprised of disorganized cartilage, adipose and fibrous tissue.
53
True or false, infection w/ molloscum contagiosum can cause eosinophilic cytoplasmic inclusions?
True!
54
Name 5 cardiac changes that are associated w/ normal aging:
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.
55
Which ovarian cell synthesizes the androgens (that later go on to be converted to estrogen)?
Theca interna cells
56
What is genetic transition vs. transversion?
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.
57
What is the motor function of the obturator nerve?
Adduction of the thigh
58
How does the superior gluteal nerve exit the pelvis?
Through the greater sciatic foramen, above the piriformis
59
How does the inferior gluteal nerve exit the pelvis?
Through the greater sciatic foramen, below the piriformis
60
What is the pathogenesis of abdominal aortic aneurysm?
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.
61
What is the major mech w/ which copper is eliminated from the body?
Secreted into bile (either as straight copper or as ceruloplasmin which is copper bound to an alpha2-globulin) and then excreted in stool
62
On PA CXR, what makes up the R side of the cardiac silhouette?
The R atrium. As such it can be obscured by a consolidation in the R middle lobe of the lung.
63
Which factor and from which cell(s) promote smooth muscle migration to the intima (from the media) and smooth muscle proliferation in atheroma pathogenesis?
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.
64
What are the prominent ADRs w/ nitrates?
headache, hypotension, cutaneous flushing, light-headedness and reflex tachycardia.
65
When are anti-centromere antibodies seen?
CREST syndrome
66
Release of cytochrome C is seen in what process?
Release of cytochrome C from mitochondrial is a pro-apoptotic signal.
67
In the intrinsic pathway of apoptosis, what changes of proteins in the mitochondrial membrane and cytoplasm occur?
Anti-apoptotic proteins Bcl-2 and Bcl-x are replaced w/ pro-apoptotic proteins such as Bak, Bax and Bim
68
What sort of K+ labs are a sign of digoxin toxicity and why?
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.
69
What enzyme do trimethoprim, methotrexate, and pyrimethamine all target?
Dihydrofolate reductase
70
What enzyme does sulfamethoxazole inhibit?
Competes w/ PABA to inhibit dihydropteroate synthetase
71
Which second gen sulfonylureas are more likely to cause hypoglycemia? Why?
Glyburide and glimepiride b/c they are more long acting. Glipizide is short acting so has a lower risk of hypoglycemia.
72
What kind of drug is sitagliptin?
DDP4 inhibitor
73
What characterizes fat embolism syndrome (seen in a minority of pts w/ severe skeletal trauma)?
Pulm insufficiency, diffuse neuro impairment, anemia and thrombocytopenia
74
Which CN carries the parasympathetic innervation to the lacrimal, sublingual and submandibular salivary glands?
CN 7
75
What are the indications for clozapine?
Tx resistant schizophrenia or schizophrenia associated w/ suicidality
76
What histo characterizes osteopetrosis?
Presistance of primary spongiosa in the primary cavity (due to impaired osteoclast function)
77
What are the three layers of abdominal muscle in order from superficial to deep?
External oblique --> internal oblique --> transversus abdominus
78
What EEG findings are indicative of absence seizures?
3-Hz spike wave discharges during seizure episodes
79
Describe a Ghon complex. When in TB is it seen?
Lower lobe fibrotic focus + hilar lymphadenopathy. It occurs during initial infection w/ TB
80
Where do Benzos bind on the GABA receptor?
At a different site than where GABA binds. Thus, Benzo binding in the presence of GABA increases the frequency of Cl- channels opening.
81
What is the drug target of baclofen?
It acts at the GABAb receptor in skeletal muscle. Note that benzos and barbs act at GABAa
82
Name two drugs that can be used to treat spasticity?
Baclofen and tizanidine (an alpha 2 agonist)
83
What are common causes of myopathy w/ elevated CK levels?
Hypothyroid myopathy, muscular dystrophies, inflammatory muscle disorders, and meds like statins
84
What is the first line tx for Lyme disease in a pregnant woman?
Amoxicillin
85
What molecules use the JAK-STAT pathway for signaling?
GH, cytokines, erythropoeitin, G-CSF
86
Which pituitary/hypothalamic hormones signal through the Gs pathway?
ACTH, TSH, ADH (V2 receptors).
Note that PTH does too
87
Which pituitary/hypothalamic hormones signal through the Gq pathway (the one involving DAG and IP3)?
GnRH, TRH, ADH (V1 receptor).
Note that AngII does too
88
What are the microscopic findings consistent w/ PSGN?
- LM --> enlarged and hypercellular glomeruli
- EM --> humps on the epithelial side of the BM
- IF --> coarse, granular deposits of IgG and C3
89
What is uniform, diffuse thickening of the glomerular capillary walls on LM consistent w/?
Membranous glomerulopathy
90
What causes the ataxia in ataxia-telangiectasia syndrome?
Cerebellar atrophy. Note that these pts have DNA hypersensitivity to ionizing radiation.
91
Pts w/ Fanconi anemia are hypersusceptible to what sort of DNA damage?
DNA cross-linking agents
92
Which immune cell is thought to be important to the pathogenesis of granuloma formation?
Th1 cells.
Note that overall granuloma formation involves chronic Th1 and macrophage activation in response to difficult to clear antigen.
93
What is the synovial fluid WBC that is highly suggestive of septic arthritis (including absence of crystals too)?
WBC > 100,000/mm^3
94
What is the difference btwn a simple focal and complex focal seizure?
In a simple one there is no LOC whereas in a complex focal seizure there is LOC and post-ictal state.
95
Which generalized seizure does NOT have a LOC?
Myotonic seizure. It is characterized by brief jerking motions. Note that the other generalized seizures (tonic-clonic and absence) do have LOC.
96
What is the language milestone of children who are two years old?
Vocab of 50-200 words and should be able to speak using 2 word sentences.
97
What is selective mutism?
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
Corprus cavernosa, bilateral or unilateral structure?
Bilateral. The spongiosum is unilateral and is what the urethra runs through.
99
How do venodilators affect cardiac preload?
They decrease preload
100
What histologic changes are seen on bx of a syphilis chancre?
Obliterative endarteritis w/ lymphocytes and plasma cells
101
What are the odds that a sibling inherits the same HLA pattern as another sibling? Why?
1/4. This is b/c the HLA genes for class I, II and III are closely linked on chromosome 6.
102
What is HLA-DR3 associated w/?
T1DM, SLE, Graves disease, Hashimoto thyroiditis, Addison disease
103
What is HLA-DR4 associated w/?
T1DM, RA, Addison disease
104
What is the mechanism of action of drugs like nitroglycerin or isosorbide dinitrate?
They increase NO in vascular smooth muscle which will increase cGMP in vascular smooth muscle and lead to relaxation and thus vessel dilation.
105
What is the pathogenesis of hyperacute organ rejection?
Pathogenesis is the pre-existence of antibodies in the recipient to donor antigen. Causes ischemia and necrosis of the graft w/in minutes.
106
What is the pathogenesis of acute organ rejection (takes weeks to months)?
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
Uniformly thickened glomerular capillary basement membranes and IF studies showing granular deposition of C3 and IgG is consistent w/ what?
Membranous nephropathy.
108
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?
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
On what cells is the CD34 marker seen?
Pluripotent stem cells
110
What cells have CD56?
NK cells
111
What are the two primary substances that drive angiogenesis?
VEGF and fibroblast growth factor (FGF - works by stimulating angioblast production)
112
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?
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
Which part of the pancreas is NOT retroperitoneal?
The tail. It is peritoneal.
114
In the setting of a UTI, what are WBC casts pathognomonic for?
Pyelonephritis
115
In what settings of bacterial infection can sterile pyuria be seen?
Urethritis causes by chlamydia or ureaplasma
116
What can orbital floor injury cause numbness and paresthesia of upper check, upper lip and upper gingiva?
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
What tumor can have N-Myc amplification?
Neuroblastoma. Amplification is associated w/ a poorer prognosis.
118
What is opsoclonus-myoclonus syndrome and what tumor is it associated w/?
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
The well perfused compartment of the body will get initial rapid distribution of inhaled anesthetics. Which organs constitute this compartment?
Brain, heart, liver, kidneys, lungs
120
Where is edema seen in uticaria?
In the superficial dermis
121
What is acantholysis and when is it seen?
It is loss of the cohesion btwn keratinocytes in the epidermis. It is a characteristic finding in pemphigus vulgaris.
122
What is acanthosis and in what conditions is it seen?
It is diffuse thickening of the stratum spinosum layer and is commonly seen in psoriasis, seborrhic dermatitis, and acanthosis nigricans.
123
What are lab findings that can be seen in Q fever?
Thrombocytopenia and elevated liver transaminases
124
What is calcipotriene and how does it tx psoriasis?
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
What is the mechanism of ustekinumab?
It targets IL12 and IL23 and is used to tx psoriasis.
126
What does absence of CD55 and CD59 demonstrate on flow cytometry? What is the characteristic presentation of said disorder?
Paroxsymal nocturnal hemoglobinura. Classically presents w/ complement mediated hemolysis (as CD55 and CD59 are important inhibitors of complement activation), hypercoagulability, and pancytopenia.
127
True or false, listeria is susceptible to cephalosporins?
False! This is due to altered PBPs. It is however susceptible to ampicillin.
128
What innervates the detrusor?
Sacral micturition center, containing parasympathetic fibers that travel in the pelvic nerve and come from the L2-L4 level.
129
What does the pontine micturition center do?
Coordinates relaxation of the external urethral sphincter w/ bladder contraction during voiding.
130
What is the pathogenesis of incontinence in normal pressure hydrocephalus?
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
What is the sudan III stool stain used for?
It is a test for fat malabsorption and is the most sensitive test for screening for malabsorption disorders. It identifies unabsorbed fat.
132
Why is evaluation for monoclonality important when lymphoma is suspected?
B/c this would be a sign that there is indeed malignancy.
133
Is there immune complex deposition as evidence by IF in Wegner's form of crescentic glomerulonephritis?
Nope! Note that this is distinct from the other causes (i.e. anti-GBM disease) of crescentic glomerulonephritis.
134
What sort of ventricular heart remodeling of the LV does mitral regurg lead to?
Eccentric hypertrophy and dilation of the LV cavity. Note this is different from the concentric hypertrophy seen in long-standing HTN.
135
What are the four stages of lobar pneumonia? Describe each one macroscopically and microscopically.
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
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?
Necrotizing enterocolitis.
137
What CD markers demonstrate immature T cells in T-ALL?
TdT+ as well as CD1, CD4 and CD5 +
138
What CD markers demonstrate immature B cells in B-ALL?
Postive for TdT, CD10 and CD19 (usually).
139
What produces the lipofuscin pigment?
Free radical injury and lipid peroxidation.
140
What do ranibizumab and bevacizumab do?
They are VEGF inhibitors
141
How does advanced macular degeneration (AMD) present?
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
How does inhaled amyl nitrate tx cyanide poisoning?
Oxidizes Fe in Hgb so it has more affinity for cyanide. This will sequester cyanide and prevent it from having its toxic effects.
143
Name 2 lead chelators
Dimercaprol and EDTA
144
Where is a cricothyrotomy preformed relative to the laryngeal prominence and thyroid?
Inferior to laryngeal prominence and superior to thyroid gland, between the cricoid and thyroid cartilage.
145
Is pseudomonas motile?
Yes
146
What is Uhthoff phenomenon?
It is seen in MS pts and is where sxs worsen w/ increased body temp (post-exercise, hot shower, etc.)
147
What are neuro manifestations of polycythemia vera?
Pts can get transient visual disturbances and focal neuro deficits due to increased blood viscosity.
148
What is the mechanism of varencicline and what are its effects?
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
When are anti-smooth muscle antibodies seen?
In autoimmune hepatitis
150
How does mechanical sound cause nerve impulses?
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
What causes noise-induced noise trauma hearing loss?
Damage to the stereocilia cells in the organ of Corti. Characteristically high freq hearing is lost first.
152
What causes DIC in the setting of placental injury (i.e. placenta abruption) during pregnancy?
Release of tissue factor from placenta into maternal circulation.
153
What sort of tumor can a sub-ungual bluish lesion indicate?
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
What is the single most important measure to reduce the transmission of organisms btwn patients?
hand hygiene by healthcare providers.
155
What do HFE mutations cause?
Hereditary hemochromatosis
156
What is the major cause of morbidity and mortality in theophyline intoxication?
Seizures. Note that tachyarrhythmias can occur too but do so less commonly.
157
What dermatological condition is strongly associated w/ pseudomonas bacteremia? What does it look like?
Ecthyma gangrenosum. Presents w/ dark skin patches of necrosis and w/ occasional ulcerations.
158
Where do microglia in the CNS come from?
Monocytes in the bone marrow
159
What does the ventral posterolateral thalamus do?
Mediates somatic sensation of the body
160
What does the ventral posteromedial thalamus do?
Mediates facial sensation and taste
161
What are the adverse effects of calcineurin inhibitors at the kidney?
They demonstrate a dose dependent renal vasoconstriction and tubular cell damage. This can percipitate acute renal failure.
162
What is Jervell and Lange-Nielsen syndrome?
The congenital long QT syndrome (due to K+ channel defect) that also has sensorineural deafness.
163
What is the primary mech of B cell destruction in T1DM?
Cellular auto-immunity. It is thought that the auto-antibodies that are seen are largely permissive.
164
What do mutations that render trypsin resistant to inactivation result in? Why?
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
Damage above the red nucleus causes ______ posturing while damage at or below it causes ______ posturing?
Above --> decorticate (flexor)
At or below --> decebrate (extensor) posturing
166
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?
Growth of thick, ropelike cords of organisms in a serpentine pattern.
167
What vasculitis is often known for extending into continuous veins and nerves?
Berger's disease (it is unique in this way as others rarely do this).
168
What is the term for compulsive consumption of a non-food or non stable food for at least a month?
Pica. THis is most commonly seen in kids and pregnant women.
169
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?
IgG
170
What is a dandy-walker malformation?
Hypoplasia/absence of the cerebellar vermis, and cystic dilation of the 4th ventricle w/ posterior enlagement.
171
What is an encephalocele?
Rare NTD characterized by protrusion of the brain and meninges through an abnormal opening in the skull.
172
What metabolic pathway does transketolase participate in?
Pentose phosphate pathway
173
What are common lab findings in sarcoidosis?
Hypercalcemia/hypercalciuria (due to production of active form of Vit D) and elevated ACE
174
What is the term for generalized brain atrophy seen in AZ's for example?
Hydrocephalus ex-vacuo
175
What is meant by the term permissiveness?
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
What is the most common location of urethral damage when it occurs in the setting of pelvic trauma (i.e. open pelvic fracture)?
At the bulbomembranous junction (basically at the membranous urethra)
177
Excess of unmineralized bone matrix and epiphyseal cartilage in a child is characteristic for what?
Rickets due to Vit D deficiency
178
What histology is characteristic of acute transplant rejection?
Dense interstitial lymphocytic infiltrate
179
What does NF-kB do?
It is a pro-inflammatory transcription factor that induces cytokine production.
180
Distinguish type I and type II muscle fibers
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
How is plasma renin activity measured?
It is the amount of angI generated per unit time.
182
What is onion-like concentric thickening of arteriolar walls characteristic of?
Hyperplastic arteriolosclerosis. --> not this condition can result from super severe HTN
183
What does cGMP promote in smooth muscle cells?
Myosin light chain dephosphorylation
184
What is bortezomib and what can it be used for?
It is a proteasome inhibitor and can be used to tx multiple myeloma (b/c these cells have really high proteasome activity).
185
What does the lepromin skin test do?
Distinguish btwn tuberculoid and lepromatous leprosy.
Pts w/ tuberculoid get a positive test result and develop an indurated nodule at the injection site.
186
What is the mechanism of action of entanercept
Decoy receptor for TNF-alpha
187
What do the following suffixes mean?
Mab
Cept
Nib
Mab --> monoclonal antibody
Cept --> receptor molecule
Nib --> kinase inhibitor
188
What is Leser-Trélat sign? What does it indicate?
It is rapid appearance of a bunch of seborrhic keratoses and may indicate underlying internal malignancy.
189
What percent of the coronary artery lumen must fixed atherosclerotic plaques obstruct to cause stable angina?
At least 75% of the lumen
190
What is the mechanism by which hep B infection allows hep D infection?
Hepatitis D must be coated by hepatitis B surface antigen in order to be able to penetrate the hepatocyte.
191
What is the other tx for bacterial vaginosis that is NOT metronidazole?
Clindamycin
192
What region of long bones is most commonly affected by hematogenous osteomyelitis in kids?
Metaphysis. Note that this condition is more likely to occur in kids than adults
In adults most common location is vertebral body.
193
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)
IL-5
194
What chromosomes are BRCA1 and BRCA2 located on?
BRCA1 --> 17
| BRCA2 --> 13
195
What do prostaglandins do at the kidney?
Dilate the afferent arteriole. This is why NSAIDs can be harmful.
196
Which vascular beds are most susceptible to atherosclerosis?
Lower abdominal aorta and coronary arteries
197
Where are "ground-glass" hepatocytes seen?
Hep B. They have a finely granular, eosinophilic cytoplasm.
198
What do type 1 interferons (alpha and beta) do when they signal cells?
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
What does interferon gamma (type II interferon) do?
Promotes expression of MHC II and macrophage intracellular killing of infected cells.
200
Drugs w/ instrinsic hepatic clearance tend to have what pharmacokinetic properties?
High Vd and high lipophilicity
201
What pattern of lung disease shows increased radial traction?
Restrictive
202
What antidepressant is associated w/ priapism?
Trazodone (it's a rare side effect)
203
How do schwannomas appear histologically?
Biphasic w/ areas of high cellularity intermixed w/ areas of a more myxoid component.
204
What does S-100 staining positively indicate?
Neural crest origin
205
How does Abetalipoproteinemia present?
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
What is the drug of choice for non-surgical tx of unruptured ectopic pregnancy?
Methotrexate
207
What is fenoldopam?
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
How can you distinguish CML from a leukemoid rxn?
In CML the leukocyte alk phos is decreased whereas in a leukemoid rxn it is normal or increased
209
What is the more specific antibody for dermatomyositis?
Anti-Jo1
210
What does lichen sclerosis cause?
Patchy, whitish thinning of the skin
211
Clearance of what substances can be used to estimate GFR and RPF?
GFR --> creatinine clearance
RPF --> PAH clearance
212
What are the cell body neuron signs of Wallerian degeneration?
Cell body becomes swollen and rounded w/ the nucleus to the periphery. Nissl substance becomes fine and granular and dispersed throughout the cytoplasm.
213
How does irreversible neuronal cell damage manifest?
Shrinkage of neuronal body, deep eosinophilia of the cytoplasm, pyknosis of the nucleus and loss of Nissl substance
214
What is seen in chronic viral hepatitis?
Periportal heptic fibrosis
215
What 4 types of drugs improve long term survival in systolic HF?
B-blockers, ACEIs, ARBs and aldosterone receptor antagonists
216
What causes Nursemaid's elbow (most common elbow injury in little kids)?
Too much traction on the elbow joint that causes subluxation of the radial head and damage/displacement of the annular ligament.
217
What are the most common causes of congenital torticolis?
Birth trauma (i.e. breech birth) or malpositioning during utero.
218
What can vitamin A overdose produce?
Intracranial HTN, skin changes (dry skin, alopecia, etc.) and hepatic damage leading to hepatomegaly.
219
What is actually physically causing the obstruction in HOCM?
Mitral valve leaflet and the interventricular septum
220
What usually causes complete collapse of a lung? Hint: can be due to some sort of mass effect in chronic smokers
Complete obstruction of a mainstem bronchus
221
In a collapsed lung w/ hemothorax the trachea deviates _____ the affected side whereas in tension pneumothorax it deviates ______ the affected side?
Collapsed lung --> toward
Tension pneumo --> away from
222
What forms the R brachiocephalic vein?
Union of R IJ and R subclavian veins
223
Where is the damage in tabes dorsalis?
Dorsal columns and dorsal roots
224
Which asbestos associated malignancy is most common?
Bronchiogenic carcinoma. Note that malignant mesothelioma is pretty rare.
225
What is wound dihesisance?
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
What allele is abacavir hypersensitivty rxn strongly associated w/?
HLAB*57:01
227
Bilateral wedged shaped areas of necrosis in the brain are characteristic for what?
Hypoxic-ischemic encephalopathy
228
What nerve courses w/in the mucosa of the piriform recess of the larynx?
The internal branch of the superior laryngeal nerve - it's important for the cough reflex.
229
Which malignancy does achalasia increase the risk of?
Squamous cell carcinoma of the esophagus
