Front Back
Block 1
1 SCFE fat kid with hip injury
2 Keratosis Pilaris
3 Obstructive Sleep Apnea & Hemoglobin OSA is a common cause of increased hemoglobin concentration, termed appropriate absolute polycythemia
4 Goodpasture hemoptysis, hematuria, proteinuria, hypertension; antibodies against type IV collagen
5 Turner - horsheshoe kidney Due to fusion of the inferior poles of the metanephros during ascent
6 Warfarin cyp450 Rifampin induced CYP450 and decreases warfarin effect
7 HIV infection EBV like symptoms with negative heterophile antibody
8 Retinal arteriovenous nicking the phenomenon where the venule is compressed or decreases in its caliber at both sides of an arteriovenous crossing. Recent research suggests that retinal AVN is associated with hypertension and cardiovascular diseases such as stroke.
9 Circle of Willis (left MCA stroke) right-sided weakness, Broca’s aphasia (inability to speak), right lower facial weakness, and dysphagia
10 Barrett esophagus for omeprazole,
antibody need
formation to monitor
against gastricwhat you're
parietal eating
cells, leads to decreased gastric acid and intrinsic factor production.
11 Pernicious Anemia Methionine and Succinyl-Coa synthesis is impaired with buildup of homocysteine and methylmalonyl-coa
12 Cancer metastasis to lungs primary gastrointestinal malignancy most likely traveled through the right-sided mesenteric venules into the superior mesenteric vein and into the portal vein, through the liver (depositing hepatic metastases), and into the inferior vena cava before reaching the lungs
13 Central diabetes insipidus Paraventricular and supraoptic nuclei of the hypothalamus
14 left ventricle hypertrophy? Increased synthesis of contractile filaments
15 Vitamin A deficiency xerosis
95%: CIcutis, xeropthalmia,
of mean = mean ± 1.96bitot ×spots, keratomalacia (from pancreatic insufficiency --> decreased ADEK vitamins)
(SD/√n)
16 Confidence intervals 99% CI of mean = mean ± 2.58 × (SD/√n)
Recruiting an additional 1000 patients to a study will decrease the chance of a Type {{c1::II}} error
17 Emphysema decreased FEV1:FVC
Type I Error = α and isratio
often(<70%),
0.05 orincreased residualofvolume
0.01. So chance Type I(obstruction), and impaired
error is determined diffusionlevel
by significance (decreased
chosen DLCO).
by researcher.
18 Type I vs Type II error Type II Error: Power = 1 - β → β = 1 - Power; ↑ sample size → ↑ power of a study → ↓ β (probability of a Type II error)
19 Decreased epithelial cadherin expression? ??? still don't know this one lol (E-cadherin causes cells to stick to their neighbors. Gastric cancer cells decrease expression to allow for invasion/spread)
20 Weight and insulin Higher fasting insulin and c-reactive protein are associated with higher body mass index (BMI) and all-cause mortality
21 Cardiac function graph decreased output leads to increased retention of blood within the left ventricle, as an increased end-diastolic volume (EDV)
22 Bipolar I Mania: seven or more days of abnormal and persistently elevated, irritable, or expansive mood along with increased goal-directed activity, behavior, or energy
23 Information disclosure Should disclose the most important information first
24 Benign prostatic hyperplasia testosterone to dht
25 Pneumothorax findings Decreasedthyroid
medullary fremitus, hyperresonant
carcinoma, percussion, decreased
pheochromocytoma, breath sounds
hyperparathyroidism, MEN2A, RET (proto-oncogene) mutation
26 MEN2A Compare MEN1 (parathyroid, pituitary, pancreas)
27 Aortic dissection (with carotid) Pressure discrepancies between arms suggests aortic dissection; horner on left suggests carotid dissections
Virchow triad: {{c1::disruption in blood flow (stasis)}}, {{c2::hypercoagulability}}, and {{c3::endothelial cell damage}}
28 Urothelial carcinoma Exposures (alcohol, napthylamine,
Hypercoagulability: tobacco),
factor V leiden / proteinpresentation (painless
C/S deficiency, OCPshematuria
/ SERMs /throughout
Pregnancy,micturition and flank
severe burns, pain)
cancer
29 Pulmonary embolism risk (Factor V leiden) Factor V: causes clotting, normally broken down by protein C/S; factor V does not respond to protein C/S
30 Syringomyelia Ask about trauma history; traumatic inflammatory obstruction of the central canal of the spinal cord, leading to cavitary dilatation and subsequent compression of cord structures, including:
31 Rhabdomyosarcoma most common malignant orbital tumor in children, tumor of primitive skeletal muscle cells, known as rhabdomyoblasts
32 Biliary colic in Sickle Cell Disease unconjugated bilirubin results from heme catabolization and can increase the risk of pigmented calcium bilirubinate gallstone formation
33 Gaussian distribution or a normal distribution of data, mean (average) is the most reliable measure of central tendency
34 Sarcoidosis and hypercalcemia Granuloma causes increased extra-renal production of 1-alpha hydroxylase. This increased enzymatic expression leads to increased conversion of 25-vitD to 1,25-vit D, causing increased gastrointestinal calcium and phosphate absorption, increased renal calcium reabsorption, and increased bone resorption. This is seen as hyperphosphatemia, hypercalcemia, hypervitaminosis D, and suppression of PTH levels.
35 Candida vaginal smear reveals the presence of normal vaginal epithelium and pseudohyphae
36 Brachial plexus injury biceps (C5) and triceps (C7) reflex so probably injury below that, would be T1; thoracic nerves emerge below corresponding vertebra; clavicle is essentially on the same horizontal plane as the articulation of t1/t2; loss of sensation to pinprick can be localized +/- 1 from lesion, so T1 works
37 Familial hypercholesterolemia Elevated LDL,
A: capillary LDL receptor
endothelial cell deficiency, presents with tendinous xanthomas
38 Aortic regurgitation (aortic anulus) B: RBC
Seen in Marfan; 4/6 late diastolic murmur heard at the lower left sternal border
C: Type I pneumocyte (gas exchange)
39 Medial longitiudinal fasciculus Left eye does
D: Type not adduct (surfactant
II pneumocytes past the midline on horizontal
production, gaze when
regeneration the patient looks
by differentiating to the
into type I}} right.
40 Alveolar wall structure E: macrophages
Block 2 Stage 2: initial formation of a breat bud (areolar tissue enlargement), and an increase in areolar diameter
1 Tanner staging Thelarche --> pubarche --> menarche
2 Constipation bloody stool consisting of hard “pebbles” and blood on toilet paper; abdominal distension, hypoactive bowel sounds, and a rectal mucosal prolapse
3 Reverse transcription-PCR
4 Group C nerve fibers?
5 Pertussis treat with azithromycin (macrolide)
6 Allergy desensitization Increased production
Biliary atresia: of IgG
jaundice, antibodies
scleral icterus,that blockstools,
acholic allergndark
binding to hepatomegaly,
urine, mast cells direct hyperbilirubinemia, and mild elevations in AST/ALT.
7 Biliary atresia Physiologic Jaundice: indirect hyperbilirubinemia that presents after the first day of life
8 Atherosclerotic Renal artery stenosis Loss of pain and temperature sensation in diabetic neuropathy (https://thebrain.mcgill.ca/flash/d/d_03/d_03_cl/d_03_cl_dou/d_03_cl_dou.html), (https://www.reddit.com/r/step1/comments/1an64vq/spoiler_free_120_neuro_content_question/)
9 CKD (decreased erythropoietin) normocytic, nonhemolytic anemia in a patient with chronic kidney disease (CKD)
10 UTI risk factors female sex, sexual intercourse, abnormalities of the urinary tract (e.g., BPH, nephrolithiasis, congenital malformations), pregnancy, prior conditions (e.g., diabetes mellitus, immunosuppression), and prolonged indwelling urinary catheter usage (CAUTI).
11 Tinea pedis treat with terbinafine (a squalene epoxidase inhibitor)
12 Viral meningitis in kids Enteroviruses (Enterovirus, Coxsackieviruses, Echovirus, Poliovirus), part of picornaviridae, pos sense RNA
13 Calcium deposit in right shoulder this is where the supraspinatus inserts , used to initiate first 15 degrees of abduction (but maybe fact check lol)
14 Communication "I'm committed to learning as much as I can" - even though patient has some kind of psych disorder
15 Allergic contact dermatitis Mortuary science student has a rash up to his wrists on both hands - probably from using latex gloves
16 Patient wants home birth "Let's set up an appointment next week to discuss your birth plan in detail" - more patient centered
17 ACEi teratogenesis Inhibit fetal renal production: oligohydramnios, impaired cranial ossification, and potential fetal demise
18 Age-consistent memory loss still able to recall objects, follow commands, perform calculations
19 Breast cancer suggested by pleomorphic irregular glands
20 Toxic epidermal necrolysis rapidly spreading bullous rash over her body and mouth that began 10 days after treatment with a sulfonamide antibiotic (TMP-SMX).
21 Telephone interpreter service use would not be appropriate to delay care or communications with the patient and their family to wait for the hospital interpreter, so using a telephone interpreter service is most appropriate
22 Correlation correlation of 0.6 means that the two variables, serum LDL and serum hs-CRP, have a positive linear relationship, meaning that high values of serum LDL will be associated with high values of hs-CRP. Importantly, two variables being associated does not imply that one causes the other.
23 GERD most commonly due to transient loss of lower esophageal tone and reflux of gastric contents into the distal esophagus.
24 Polycythemia vera a proliferation of {{c1::hematopoietic stem cells}} due to {{c1::JAK2}} mutation
25 Folate deficiency megaloblastic
otherwise healthyanemia in alcoholic
XX newborn guy to have a penile-appearing structure with hypospadias located above the vaginal introitus. Maternal androgen exposure (C) is correct because this promotes virilization.
is found
26 Maternal androgen exposure Other options: a) no bc that --> HTN not virilization (11 & 21 deficiencies are virilization; remember the "hack" if it starts w/ a 1 it --> HTN if it ends in a 1 --> virilization, b) MIH from sertoli inhibits female internal genitalia would not promote growth of phallus, d) karyotype is XX, there's no Y gene/ no SRY, also that makes testes not a phallus, e) no bc formation of phallus signifies response to androgen, whereas 5a deficiency would be decreased conversion from testosterone to DHT
27 Elder abuse important to assess her relationship with her family to ensure she is receiving adequate care and help while also ruling out forms of elderly abuse
28 Mendelian genetics (color blindness) 50% chance kid will be a boy, mom has father with color blindness (which means she has to have his messed up x chromosome), so 50% chance that the boy will get mom's carrier chromosome
29 Primary dysmenorrhea Diagnosis is {{c1::Primary dysmenorrhea}} due to which is caused by {{c1::increased prostaglandin production by the endometrium}}. Treat with NSAIDs, OCPs
30 Ureter obstruction --> hydronephrosis T2-weighted MRI shows a proximal obstruction at the level of the ureteropelvic junction—site where the ureter leaves the renal collecting pelvis.
31 Absolute risk reduction ARR = Procedure B – Procedure A = (18/1000) – (12/1000).
32 Portal hypertension Every other option drains to the portal vein; relieve pressure by shunting to inferior vena cava
33 Motivational interviewing
34 Bulimia Pilocarpine to reduce parotid enlargement, likly secondary to bullemic sialadenosis/parotid hypertrophy. She has physical exam findings indicative of induced purging. Also treat with SSRI
35 Fatal fetal prognosis "I'm very sorry, but the baby will not survive"
36 Leishmania donovani transmitted by sandfly
37 Hypokalemic periodic paralysis full-body weakness which usually happen after playing football and eating "a lot of pasta and salty foods."
38 Baby with galactorrhea from maternal prolactin exposure
39 Aortic valve See image (similar question on NBME 30 - something about drawing lines from the carina to the apex or some shit. I don't really get it tbh.)
40 Necrotizing fasciitis Caused by {{c1::Staphylococcus aureus, Clostridium perfringens, or Strep pyogenes::3 species}}
Block 3
1 Osteoclast proliferation increase in osteoclast lifespan and activation due to corticosteroid mediated upregulation of RANKL expression.
2 Jarisch-Herxheimer reaction due to rapid lysis of spirochetes
3 21-hydroxylase deficiency Treatment involves glucocorticoid and mineralocorticoid replacement.
4 Acute interstitial nephritis WBC casts and eosinophilia; remember 5 ps (Pee, pain-free (NSAIDs), Penicillions (also cephalosporins, TMP-SMX), Ppis, Rifampin
5 Alcohol withdrawal Benzodiazepines are the first-line agents in the management of alcohol withdrawal. Longer acting agents (e.g., chlordiazepoxide, diazepam) are classically preferred in most patients, but shorter acting agents (e.g., lorazepam, temazepam) are preferred in patients with altered drug metabolism (e.g., liver disease, elderly).
6 Precocious puberty high LH suggests central cause
7 Uric acid calculus altered purine metabolism
8 Spironolactone Causes hyperkalemia, acts on late DCT and collecting duct, added to ACEi (usually triameterene or amiloride are added cuz they don't cause this effect)
9 Pancreatic insufficiency CREON® (pancrelipase) is a prescription medicine used to treat people who cannot digest food normally because their pancreas does not make enough enzymes due to cystic fibrosis, swelling of the pancreas that lasts a long time (chronic pancreatitis), removal of some or all of the pancreas (pancreatectomy), or other
10 Cardiac myxoma commonly found in the left atrium.
11 Exogenous insulin --> hypoglycemia adjustment most likely led to overcompensation of this child’s carbohydrate intake, causing a brief period of symptomatic hypoglycemia
12 Osteoarthritis The image of her hand reveals Heberden and Bouchard nodes (especially of the 3rd PIP).
13 Parkinson treatment monoamine oxidase type B inhibitor, such as selegiline or rasagiline, prevents the central conversion of dopamine into DOPAC (3,4-dihydroxyphenylacetic acid), prolonging the effect of the neurotransmitter.
14 Fetal alcohol syndrome developmental delay, microcephaly, smooth hypoplastic philthrum, down-slanting short palpebral fissures, epicanthal folds, heart defects (e.g., VSD), and many others.
15 Klinefelter (XXY)
16 Osteoarthritis Smoking, alcohol, and sedentary lifestyle are modifiable risk factors.
17 Epstein-Barr Virus Atypical lymphocytes and cervical lymphadenopathy
18 Poorly controlled diabetes barriers this patient is experiencing when it comes to diet adherence (e.g., financial ability, time requirement, food macronutrient knowledge).
19 Phenylephrine Alpha1 agonist, increases BP but not pulse
20 SCID No T or B cells; RAG1 and RAG2 deficiency prevent V(D)J recombination
21 Postpartum thyroiditis a subtype of subacute lymphocytic thyroiditis. This is due to follicular cell damage with lymphocytic infiltration, leading to the release of preformed thyroid hormone
22 Rheumatoid arthritis associated with anti-citrullinated peptide antibodies ( > 90% specificity), rheumatoid factor (less specific, elevated in infectious disease, other autoimmune diseases, some healthy individuals), and antinuclear antibodies. RA is also associated with a genetic disposition with HLA-DR4 an HLA-DR1 proteins.
23 Colon blood supply If the SMA is blocked beyond the middle colic artery, the proximal jejunum is most likely to appear normal
24 Cystic fibrosis unable to secrete bicarbonate adequately, leading to organ specific manifestations (e.g., pancreatic insufficiency, dental caries, impaired gastrointestinal mucous secretion, cervical mucous thickening, impaired fertility), distinguish between pancreatic exocrine and endocrine secretions. CF mo
25 Parietal lobe lesion Contralateral lower quadrantanopia, contralateral tactile stimuli sensation loss, tripping when walking, signs of hemoneglect syndrome-damage to non dominant parietal lobe
26 Glanzmann Thrombocytopenia Normal platelet count, PT, PTT, and ristocetin with increased bleeding time; defect in Glycoprotein IIb-IIIa
27 Pulmonary hypertension causes decreased pulmonary compliance, resulting in RVH, thus decreased right diastolic function
28 Hemolytic uremic syndrome Triad
Cells of thrombocytopenia,
from the {{c1::proximalAKI, hemolytic anemia
tubule::nephron region}} are the most sensitive to hypoxemia
29 Acute tubular necrosis Damage to this region will cause {{c1::Acute tubular necrosis and RTA2::2}}
30 Mumps bilateral parotid gland swelling, fever, malaise, and decreased appetite.
31 Pyridostigmine overdose can lead to multiple cholinergic side effects, including bradycardia, hypotension, nausea, abdominal pain, diarrhea, hypoventilation, lethargy, weakness, paralysis, bronchospasm
32 Paracentric chromosomal inversion Associated with early spontaneous abortions but not aneuploidy
33 Amphetamine use Amphetamines cause these symptoms via the increased synaptic release and inhibited reuptake of biogenic amines (epinephrine, norepinephrine, serotonin, and dopamine).
34 MERRF MERRF = myoclonic epilepsy with ragged red fibers (ragged red fibers seen on skeletal muscle biopsy stained with gomori trichome)
35 Pernicious Anemia Affects parietal cells in glandular layer €
36 Amiodarone causes delayed repolarization (class III antiarhythmic)
37 Neutropenic fever common oncologic emergency
38 Methotrexate toxicity bypassed by folinic acid. This bypasses the requirement for normal healthy cells to activate folic acid via dihydrofolate reductase—the enzymatic target of methotrexate.
39 False positive rate calculation 80 people actually have breast cancer and 99920 do not. False positive is 10% hence 9992 would be correct
40 Age-related changes to heart No murmur heard on PE; symptoms most likely due to calcific aortic sclerosis (calcification and fibrosis if aortic valve leaflets) due to age-related valvular damage
Block 1
1 SCFE fat kid with hip injury
2 Keratosis Pilaris
3 Obstructive Sleep Apnea & Hemoglobin OSA is a common cause of increased hemoglobin concentration, termed appropriate absolute polycythemia
4 Goodpasture hemoptysis, hematuria, proteinuria, hypertension; antibodies against type IV collagen
5 Turner - horsheshoe kidney Due to fusion of the inferior poles of the metanephros during ascent
6 Warfarin cyp450 Rifampin induced CYP450 and decreases warfarin effect
7 HIV infection EBV like symptoms with negative heterophile antibody
8 Retinal arteriovenous nicking the phenomenon where the venule is compressed or decreases in its caliber at both sides of an arteriovenous crossing. Recent research suggests that retinal AVN is associated with hypertension and cardiovascular diseases such as stroke.
9 Circle of Willis (left MCA stroke) right-sided weakness, Broca’s aphasia (inability to speak), right lower facial weakness, and dysphagia
10 Barrett esophagus for omeprazole,
antibody need
formation to monitor
against gastricwhat you're
parietal eating
cells, leads to decreased gastric acid and intrinsic factor production.
11 Pernicious Anemia Methionine and Succinyl-Coa synthesis is impaired with buildup of homocysteine and methylmalonyl-coa
12 Cancer metastasis to lungs primary gastrointestinal malignancy most likely traveled through the right-sided mesenteric venules into the superior mesenteric vein and into the portal vein, through the liver (depositing hepatic metastases), and into the inferior vena cava before reaching the lungs
13 Central diabetes insipidus Paraventricular and supraoptic nuclei of the hypothalamus
14 left ventricle hypertrophy? Increased synthesis of contractile filaments
15 Vitamin A deficiency xerosis
95%: CIcutis, xeropthalmia,
of mean = mean ± 1.96bitot ×spots, keratomalacia (from pancreatic insufficiency --> decreased ADEK vitamins)
(SD/√n)
16 Confidence intervals 99% CI of mean = mean ± 2.58 × (SD/√n)
Recruiting an additional 1000 patients to a study will decrease the chance of a Type {{c1::II}} error
17 Emphysema decreased FEV1:FVC
Type I Error = α and isratio
often(<70%),
0.05 orincreased residualofvolume
0.01. So chance Type I(obstruction), and impaired
error is determined diffusionlevel
by significance (decreased
chosen DLCO).
by researcher.
18 Type I vs Type II error Type II Error: Power = 1 - β → β = 1 - Power; ↑ sample size → ↑ power of a study → ↓ β (probability of a Type II error)
19 Decreased epithelial cadherin expression? ??? still don't know this one lol (E-cadherin causes cells to stick to their neighbors. Gastric cancer cells decrease expression to allow for invasion/spread)
20 Weight and insulin Higher fasting insulin and c-reactive protein are associated with higher body mass index (BMI) and all-cause mortality
21 Cardiac function graph decreased output leads to increased retention of blood within the left ventricle, as an increased end-diastolic volume (EDV)
22 Bipolar I Mania: seven or more days of abnormal and persistently elevated, irritable, or expansive mood along with increased goal-directed activity, behavior, or energy
23 Information disclosure Should disclose the most important information first
24 Benign prostatic hyperplasia testosterone to dht
25 Pneumothorax findings Decreasedthyroid
medullary fremitus, hyperresonant
carcinoma, percussion, decreased
pheochromocytoma, breath sounds
hyperparathyroidism, MEN2A, RET (proto-oncogene) mutation
26 MEN2A Compare MEN1 (parathyroid, pituitary, pancreas)
27 Aortic dissection (with carotid) Pressure discrepancies between arms suggests aortic dissection; horner on left suggests carotid dissections
Virchow triad: {{c1::disruption in blood flow (stasis)}}, {{c2::hypercoagulability}}, and {{c3::endothelial cell damage}}
28 Urothelial carcinoma Exposures (alcohol, napthylamine,
Hypercoagulability: tobacco),
factor V leiden / proteinpresentation (painless
C/S deficiency, OCPshematuria
/ SERMs /throughout
Pregnancy,micturition and flank
severe burns, pain)
cancer
29 Pulmonary embolism risk (Factor V leiden) Factor V: causes clotting, normally broken down by protein C/S; factor V does not respond to protein C/S
30 Syringomyelia Ask about trauma history; traumatic inflammatory obstruction of the central canal of the spinal cord, leading to cavitary dilatation and subsequent compression of cord structures, including:
31 Rhabdomyosarcoma most common malignant orbital tumor in children, tumor of primitive skeletal muscle cells, known as rhabdomyoblasts
32 Biliary colic in Sickle Cell Disease unconjugated bilirubin results from heme catabolization and can increase the risk of pigmented calcium bilirubinate gallstone formation
33 Gaussian distribution or a normal distribution of data, mean (average) is the most reliable measure of central tendency
34 Sarcoidosis and hypercalcemia Granuloma causes increased extra-renal production of 1-alpha hydroxylase. This increased enzymatic expression leads to increased conversion of 25-vitD to 1,25-vit D, causing increased gastrointestinal calcium and phosphate absorption, increased renal calcium reabsorption, and increased bone resorption. This is seen as hyperphosphatemia, hypercalcemia, hypervitaminosis D, and suppression of PTH levels.
35 Candida vaginal smear reveals the presence of normal vaginal epithelium and pseudohyphae
36 Brachial plexus injury biceps (C5) and triceps (C7) reflex so probably injury below that, would be T1; thoracic nerves emerge below corresponding vertebra; clavicle is essentially on the same horizontal plane as the articulation of t1/t2; loss of sensation to pinprick can be localized +/- 1 from lesion, so T1 works
37 Familial hypercholesterolemia Elevated LDL,
A: capillary LDL receptor
endothelial cell deficiency, presents with tendinous xanthomas
38 Aortic regurgitation (aortic anulus) B: RBC
Seen in Marfan; 4/6 late diastolic murmur heard at the lower left sternal border
C: Type I pneumocyte (gas exchange)
39 Medial longitiudinal fasciculus Left eye does
D: Type not adduct (surfactant
II pneumocytes past the midline on horizontal
production, gaze when
regeneration the patient looks
by differentiating to the
into type I}} right.
40 Alveolar wall structure E: macrophages
Block 2 Stage 2: initial formation of a breat bud (areolar tissue enlargement), and an increase in areolar diameter
1 Tanner staging Thelarche --> pubarche --> menarche
2 Constipation bloody stool consisting of hard “pebbles” and blood on toilet paper; abdominal distension, hypoactive bowel sounds, and a rectal mucosal prolapse
3 Reverse transcription-PCR
4 Group C nerve fibers?
5 Pertussis treat with azithromycin (macrolide)
6 Allergy desensitization Increased production
Biliary atresia: of IgG
jaundice, antibodies
scleral icterus,that blockstools,
acholic allergndark
binding to hepatomegaly,
urine, mast cells direct hyperbilirubinemia, and mild elevations in AST/ALT.
7 Biliary atresia Physiologic Jaundice: indirect hyperbilirubinemia that presents after the first day of life
8 Atherosclerotic Renal artery stenosis Loss of pain and temperature sensation in diabetic neuropathy (https://thebrain.mcgill.ca/flash/d/d_03/d_03_cl/d_03_cl_dou/d_03_cl_dou.html), (https://www.reddit.com/r/step1/comments/1an64vq/spoiler_free_120_neuro_content_question/)
9 CKD (decreased erythropoietin) normocytic, nonhemolytic anemia in a patient with chronic kidney disease (CKD)
10 UTI risk factors female sex, sexual intercourse, abnormalities of the urinary tract (e.g., BPH, nephrolithiasis, congenital malformations), pregnancy, prior conditions (e.g., diabetes mellitus, immunosuppression), and prolonged indwelling urinary catheter usage (CAUTI).
11 Tinea pedis treat with terbinafine (a squalene epoxidase inhibitor)
12 Viral meningitis in kids Enteroviruses (Enterovirus, Coxsackieviruses, Echovirus, Poliovirus), part of picornaviridae, pos sense RNA
13 Calcium deposit in right shoulder this is where the supraspinatus inserts , used to initiate first 15 degrees of abduction (but maybe fact check lol)
14 Communication "I'm committed to learning as much as I can" - even though patient has some kind of psych disorder
15 Allergic contact dermatitis Mortuary science student has a rash up to his wrists on both hands - probably from using latex gloves
16 Patient wants home birth "Let's set up an appointment next week to discuss your birth plan in detail" - more patient centered
17 ACEi teratogenesis Inhibit fetal renal production: oligohydramnios, impaired cranial ossification, and potential fetal demise
18 Age-consistent memory loss still able to recall objects, follow commands, perform calculations
19 Breast cancer suggested by pleomorphic irregular glands
20 Toxic epidermal necrolysis rapidly spreading bullous rash over her body and mouth that began 10 days after treatment with a sulfonamide antibiotic (TMP-SMX).
21 Telephone interpreter service use would not be appropriate to delay care or communications with the patient and their family to wait for the hospital interpreter, so using a telephone interpreter service is most appropriate
22 Correlation correlation of 0.6 means that the two variables, serum LDL and serum hs-CRP, have a positive linear relationship, meaning that high values of serum LDL will be associated with high values of hs-CRP. Importantly, two variables being associated does not imply that one causes the other.
23 GERD most commonly due to transient loss of lower esophageal tone and reflux of gastric contents into the distal esophagus.
24 Polycythemia vera a proliferation of {{c1::hematopoietic stem cells}} due to {{c1::JAK2}} mutation
25 Folate deficiency megaloblastic
otherwise healthyanemia in alcoholic
XX newborn guy to have a penile-appearing structure with hypospadias located above the vaginal introitus. Maternal androgen exposure (C) is correct because this promotes virilization.
is found
26 Maternal androgen exposure Other options: a) no bc that --> HTN not virilization (11 & 21 deficiencies are virilization; remember the "hack" if it starts w/ a 1 it --> HTN if it ends in a 1 --> virilization, b) MIH from sertoli inhibits female internal genitalia would not promote growth of phallus, d) karyotype is XX, there's no Y gene/ no SRY, also that makes testes not a phallus, e) no bc formation of phallus signifies response to androgen, whereas 5a deficiency would be decreased conversion from testosterone to DHT
27 Elder abuse important to assess her relationship with her family to ensure she is receiving adequate care and help while also ruling out forms of elderly abuse
28 Mendelian genetics (color blindness) 50% chance kid will be a boy, mom has father with color blindness (which means she has to have his messed up x chromosome), so 50% chance that the boy will get mom's carrier chromosome
29 Primary dysmenorrhea Diagnosis is {{c1::Primary dysmenorrhea}} due to which is caused by {{c1::increased prostaglandin production by the endometrium}}. Treat with NSAIDs, OCPs
30 Ureter obstruction --> hydronephrosis T2-weighted MRI shows a proximal obstruction at the level of the ureteropelvic junction—site where the ureter leaves the renal collecting pelvis.
31 Absolute risk reduction ARR = Procedure B – Procedure A = (18/1000) – (12/1000).
32 Portal hypertension Every other option drains to the portal vein; relieve pressure by shunting to inferior vena cava
33 Motivational interviewing
34 Bulimia Pilocarpine to reduce parotid enlargement, likly secondary to bullemic sialadenosis/parotid hypertrophy. She has physical exam findings indicative of induced purging. Also treat with SSRI
35 Fatal fetal prognosis "I'm very sorry, but the baby will not survive"
36 Leishmania donovani transmitted by sandfly
37 Hypokalemic periodic paralysis full-body weakness which usually happen after playing football and eating "a lot of pasta and salty foods."
38 Baby with galactorrhea from maternal prolactin exposure
39 Aortic valve See image (similar question on NBME 30 - something about drawing lines from the carina to the apex or some shit. I don't really get it tbh.)
40 Necrotizing fasciitis Caused by {{c1::Staphylococcus aureus, Clostridium perfringens, or Strep pyogenes::3 species}}
Block 3
1 Osteoclast proliferation increase in osteoclast lifespan and activation due to corticosteroid mediated upregulation of RANKL expression.
2 Jarisch-Herxheimer reaction due to rapid lysis of spirochetes
3 21-hydroxylase deficiency Treatment involves glucocorticoid and mineralocorticoid replacement.
4 Acute interstitial nephritis WBC casts and eosinophilia; remember 5 ps (Pee, pain-free (NSAIDs), Penicillions (also cephalosporins, TMP-SMX), Ppis, Rifampin
5 Alcohol withdrawal Benzodiazepines are the first-line agents in the management of alcohol withdrawal. Longer acting agents (e.g., chlordiazepoxide, diazepam) are classically preferred in most patients, but shorter acting agents (e.g., lorazepam, temazepam) are preferred in patients with altered drug metabolism (e.g., liver disease, elderly).
6 Precocious puberty high LH suggests central cause
7 Uric acid calculus altered purine metabolism
8 Spironolactone Causes hyperkalemia, acts on late DCT and collecting duct, added to ACEi (usually triameterene or amiloride are added cuz they don't cause this effect)
9 Pancreatic insufficiency CREON® (pancrelipase) is a prescription medicine used to treat people who cannot digest food normally because their pancreas does not make enough enzymes due to cystic fibrosis, swelling of the pancreas that lasts a long time (chronic pancreatitis), removal of some or all of the pancreas (pancreatectomy), or other
10 Cardiac myxoma commonly found in the left atrium.
11 Exogenous insulin --> hypoglycemia adjustment most likely led to overcompensation of this child’s carbohydrate intake, causing a brief period of symptomatic hypoglycemia
12 Osteoarthritis The image of her hand reveals Heberden and Bouchard nodes (especially of the 3rd PIP).
13 Parkinson treatment monoamine oxidase type B inhibitor, such as selegiline or rasagiline, prevents the central conversion of dopamine into DOPAC (3,4-dihydroxyphenylacetic acid), prolonging the effect of the neurotransmitter.
14 Fetal alcohol syndrome developmental delay, microcephaly, smooth hypoplastic philthrum, down-slanting short palpebral fissures, epicanthal folds, heart defects (e.g., VSD), and many others.
15 Klinefelter (XXY)
16 Osteoarthritis Smoking, alcohol, and sedentary lifestyle are modifiable risk factors.
17 Epstein-Barr Virus Atypical lymphocytes and cervical lymphadenopathy
18 Poorly controlled diabetes barriers this patient is experiencing when it comes to diet adherence (e.g., financial ability, time requirement, food macronutrient knowledge).
19 Phenylephrine Alpha1 agonist, increases BP but not pulse
20 SCID No T or B cells; RAG1 and RAG2 deficiency prevent V(D)J recombination
21 Postpartum thyroiditis a subtype of subacute lymphocytic thyroiditis. This is due to follicular cell damage with lymphocytic infiltration, leading to the release of preformed thyroid hormone
22 Rheumatoid arthritis associated with anti-citrullinated peptide antibodies ( > 90% specificity), rheumatoid factor (less specific, elevated in infectious disease, other autoimmune diseases, some healthy individuals), and antinuclear antibodies. RA is also associated with a genetic disposition with HLA-DR4 an HLA-DR1 proteins.
23 Colon blood supply If the SMA is blocked beyond the middle colic artery, the proximal jejunum is most likely to appear normal
24 Cystic fibrosis unable to secrete bicarbonate adequately, leading to organ specific manifestations (e.g., pancreatic insufficiency, dental caries, impaired gastrointestinal mucous secretion, cervical mucous thickening, impaired fertility), distinguish between pancreatic exocrine and endocrine secretions. CF mo
25 Parietal lobe lesion Contralateral lower quadrantanopia, contralateral tactile stimuli sensation loss, tripping when walking, signs of hemoneglect syndrome-damage to non dominant parietal lobe
26 Glanzmann Thrombocytopenia Normal platelet count, PT, PTT, and ristocetin with increased bleeding time; defect in Glycoprotein IIb-IIIa
27 Pulmonary hypertension causes decreased pulmonary compliance, resulting in RVH, thus decreased right diastolic function
28 Hemolytic uremic syndrome Triad
Cells of thrombocytopenia,
from the {{c1::proximalAKI, hemolytic anemia
tubule::nephron region}} are the most sensitive to hypoxemia
29 Acute tubular necrosis Damage to this region will cause {{c1::Acute tubular necrosis and RTA2::2}}
30 Mumps bilateral parotid gland swelling, fever, malaise, and decreased appetite.
31 Pyridostigmine overdose can lead to multiple cholinergic side effects, including bradycardia, hypotension, nausea, abdominal pain, diarrhea, hypoventilation, lethargy, weakness, paralysis, bronchospasm
32 Paracentric chromosomal inversion Associated with early spontaneous abortions but not aneuploidy
33 Amphetamine use Amphetamines cause these symptoms via the increased synaptic release and inhibited reuptake of biogenic amines (epinephrine, norepinephrine, serotonin, and dopamine).
34 MERRF MERRF = myoclonic epilepsy with ragged red fibers (ragged red fibers seen on skeletal muscle biopsy stained with gomori trichome)
35 Pernicious Anemia Affects parietal cells in glandular layer €
36 Amiodarone causes delayed repolarization (class III antiarhythmic)
37 Neutropenic fever common oncologic emergency
38 Methotrexate toxicity bypassed by folinic acid. This bypasses the requirement for normal healthy cells to activate folic acid via dihydrofolate reductase—the enzymatic target of methotrexate.
39 False positive rate calculation 80 people actually have breast cancer and 99920 do not. False positive is 10% hence 9992 would be correct
40 Age-related changes to heart No murmur heard on PE; symptoms most likely due to calcific aortic sclerosis (calcification and fibrosis if aortic valve leaflets) due to age-related valvular damage
