NBME 16 Block 1 and 2 (Answered) Verified Solution

NBME 16 Block 1 and 2 (Answered) Verified Solution Lab values in Sarcoidosis 1.Elevated ACE levels- from granuloma 2.Elevated CD4/CD8 counts in BAL. 3.High Calcium 4.HIGH 1,25 DIHYDROXYCHOLICALCIFEROL (Due to increased production of 1 alpha hydroxylase that converts Vit D to its active form -nbme) 5. Low PTH Histology of Sarcoidosis : 1.Epithelioid granuloma - Granuloma with foreign body giant cells (means Giant cells with disorganized nuclei) Type 4 HSN. 2.Asteroid body - Star shaped giant cell cytoplasmic inclusion - collection of Lipid 3. Schwmann bodies - Calcificatins - collections of Calcium and protein. Causes of erythema nodosum NODOSUM NO- No cause Idipathic 60% cases D - Drugs Sulfa, Iodide O -OCP S -Sarcoidosis U - UC/CHRONS M- Microbiota - TB,Leprosy, Streptococcus, Yersinia, Histoplasma. Erythema nodosum abd sarcoidosis Most common non specific manifestation in sarcoidosis. Painful, Bilateral. MC organism causing Acute Prostatitis in OLD E.Coli. IN Young - Chlamydia, Gono. Causes of raised CK 1. Hypothyroid myopathy 2. Inflammatory myositis 3. Statin induced Normal CK 1.Polymyalgia Rheumatica 2. Steroid induced Myopathy 3. vit D deficiency Myopathy Polymyositis / Dermato lab values Raised CK, Rasied Aldolase, +ANA +Anti Jo-1 PCOS serum hormonal values Increased LH , Icreased Angrogens , Increased fasting Insulin 20 yr woman with high BP, high Urea, Low glucose, urinalysis numerous WBC and WBC casts with proteinuria >3gm/24hr. USG : Asymmetric Kidneys with broad scars and blunted calyces and voiding cystogram shows Vesico ureteral reflux. Chronic Pyelonephritis. Causes of renal papillary necrosis SAAD papa S - Sickel Cell disease A -Acute pyeloneohritis A - Analgesics (NSAIDS) D - DM Cx of Acute pyelonephritis Chronic Pyelo Renal Papillary nex Perinephric abscess Urosepsis MCC of Acute pyelo Ecoli (ascending UTI) Hematogenous Urine of Chronic and Acute pyelo WBC/WBC CASTS Cause of chronic pyeloneph Predisposed VUR Multiple Acute pyelo Chronically obstructing kidney stones. Biopsy of Chronic Pyelonephritis 1 Cortico med Scarring 2 BLUNTED CALYCES 3 THYROIDINIZATION of kidneys (tubules with eosinophilic casts) Biopsy of Hydronephrosis 1.DISTENSION AND DILATION OF PELVIS AND CALYCES 2.Atrophy of cortex and Medulla Causes of Hydronephrosis 1. Obsturction via STONES, BPH, Cervical Ca, Ureter injury. 2. B/L VUR 3. Retroperitoneal fibrosis. 4. Aortic Aneurysms Hydronephrosis induced renal failure Lab : Inc BUN and Creatinine provide evidence of Secondary Renal Failure. Causes of Hematuria I PEE RBCS Infection PKD Exercise External trauma Renal glomerular disease BPH Cancer - RCC, Bladder Stones. Immunotherapies for RCC ALDESLEUKIN SORAFENIB SUNITINIB Cx of prostatectomy Incontinence or Erectile dysfunction due to injury to pelvic PARASYMPATHETIC NERVES. Schizoaffective vs Brief psychotic disorder Schizoaff - > 2 weeks of pure psychotic features (halluci/delusion) in a patient with previously known major mood disorder (bipolar or mj dep) Brief psychotic - Lasts LESS THAN ONE MONTH <1 month. Usually STRESS RELATED with full RETURN to function. Mode of inheritance of FRAGILE X - XL dominant ACHONDROPLASIA - SPORADIC Herid Spherocytosis ADD Infant PKD ARD OTC deficiency XL Recessive Ducheene and Becker XL Recessive G6PD DEF and LESH-NYHAN XL Recessive Myotonic dystrophy ADD (my tonia,ticker,testicles,toupee) CTG-CATARACT, TOUPEE, GONADAL ATROPHY Marfans syndrome ADD WISKOTT ALDRICH XLR MEN 1 and MEN2 ADD SICKEL CELL DISEASE ARD Bruton agamma globulinemia XLR PKU , GLYCOGEN STORAGE ARD WILSONS Autosomal recessive Mechanism of action of FISH OIL Mechanism of action of NIACIN for dyslipidemia? Inhibits HSL in adipose tissues, hence inhibits lipolysis. Inhibits hepatic VLDL and Cholesterol secretion. Mechanism of fish oil for dyslipidemia Also decreases hepatic VLDL synthesis and reduces serum TG. M/A of Alirocumab and Evolocumab Inhibits hepatic LDL receptor degradation -- more uptake of LDL from circulation. Lowers LDL. aka - PCSK9 INHIBITORS. Post prandial diffuse abd pain, aversion to food, weight loss--- Occlusion of SMA. SMA has the highest velocity and most acute angel branching. Occlusion can be acute or chronic depending upon cause -athero/emboli. Predisposing factors to SMA ischemia 1. Hypercoag states - APL syndrome, hyperchol, H/O bypass graft, malignancy --- OCCLUSION 2. Atrial fibrillation - EMBOLI. 3. ASD - paradoxical thrombus 4. Hypoperfusion ALSO SMALL BOWEL IS MORE COMMONLY AFFEXTED DUE TO LESS COLLATERAL BLOOD FLOW. Symtpoms of colonic ischemia Crampy abd pain followed by Hematochezia. MC site- splenic flexure and distal colon are 2 watershed zones. Distal colon artery supply Inferior mesentric artery and Hypogastric arteries Glyceraldehyde 3 P dehydrogenase Inhibited by Metformin Also inhibited by High Glucose concentration. If Q asks which enz is ingibited by high glucose -- choose the enzyme involved in Gluconeogenesis.