NBME 30 EXAM QUESTIONS WITH 100% CORRECT ANSWERS

NBME 30 EXAM QUESTIONS WITH 100% CORRECT ANSWERS "Nodular glomerulosclerosis - CORRECT ANSWER assoc w/ diabetic nephropathy & amyloidosis" "supraoptic nucleus - CORRECT ANSWER responsible for ADH secretion from pituitary & urine concentration" "anterior hypothalamic nucleus - CORRECT ANSWER thermoregulation (cooling)" "arcuate hypothalamic nucleus - CORRECT ANSWER appetite stimulation" "dorsomedial hypothalamic nucleus - CORRECT ANSWER regulation of feeding & circadian rhythm" "lateral hypothalamic nucleus - CORRECT ANSWER promotes appetite (GHRELIN)" "posterior hypothalamic nucleus - CORRECT ANSWER thermoregulating (heating)" "ventromedial hypothalamic nucleus - CORRECT ANSWER satiety (LEPTIN)" "osteopetrosis - CORRECT ANSWER excessive mineralization of bone & failure of osteoclastic resorption - mutation in macrophage colony stimulating factor" "achondroplasia - CORRECT ANSWER human dwarfism - AD mutation in fibroblast growth factor receptor 3 (FGFR3) gene" "Chronic granulomatous disease - CORRECT ANSWER X-linked mutation affecting NADPH oxidase causing dysfunctioning neutrophils and oxidative burst - recurrent infections with catalase (+) organisms: S. aureus, Aspergillus & Nocardia" "MPO deficiency - CORRECT ANSWER Recurrent candida infections" "Wiskott-Aldrich syndrome - CORRECT ANSWER mutation in WAS gene; abnormal cytoskeleton of B & T cells - Eczema, recurrent respiratory infections, thrombocytopenia" "Chediak-Higashi syndrome - CORRECT ANSWER Mutation in LYST (lysosomal trafficking gene regulator) which causes accumulation of large cytoplasmic granules that cannot fuse with lysosomes - increase of bacterial, viral, and fungal infections - Albinism, photophobia, silver hair" "Coccidioidomycosis - CORRECT ANSWER fungal infection endemic to Southwest US & California - respiratory illness, fever, fatigue, cough, arthralgia" "Pores of Kohn - CORRECT ANSWER small openings in the alveolar walls that allow gases, fluid, macrophages & BACTERIA to travel between the alveoli" "Osgood-Schlatter disease - CORRECT ANSWER inflammation or irritation of the tibia at its point of attachment with the PATELLAR TENDON - common in YOUNG ATHLETES - focal pain & tenderness w/ application of tension to tibial tubercle" "increased risk of liver injury from acetaminophen + alcohol - CORRECT ANSWER alcohol leads to induction of P450 enzymes that convert acetaminophen to NAPQI - NAPQI can cause hepatotoxicity" "childhood perception of death - CORRECT ANSWER - <3 years: no understanding of death - age 3-5: death is temporary & reversible - >5 years: all living things die (irreversible & inevitable)" "Weber syndrome (lower midbrain stroke) - CORRECT ANSWER stroke of paramedic branches of PCA - ipsilateral CN III palsy (diplopia, ptosis, primary gaze palsy, pupillary constriction defects) - contralateral hemiparesis with UMN pattern dysfunction" "gerstmann syndrome - CORRECT ANSWER stroke of angular gyrus - agraphia, acalculia, finger agnosia & left sided disorientation" "Horner syndrome - CORRECT ANSWER lesion of upper spinal cord interrupting sympathetic supply to ipsilateral face - ptosis, mitosis, anhidrosis" "HIV encephalopathy (AIDS dementia) - CORRECT ANSWER memory & language impairment, psychomotor deficits - T2 hyper intensities in subcortical white matter, multinucleate giant cells & microglial nodules" "case control studies - CORRECT ANSWER group patients according to disease outcome status - disease vs. health - analyze exposure to a particular hazard (useful for determining odds ratio)" "case series - CORRECT ANSWER involves a small group of patients with a similar diagnosis (NON ANALYTIC) - kinda like a story (history, possible exposure); do not actually test a hypothesis" "melanin - CORRECT ANSWER pigment made by melanocytes - African Americans have a HIGH # OF MELANOSOMES" "vocal cords while coughing - CORRECT ANSWER - while swallowing: CLOSED - immediately after laryngeal irritation: CLOSED - while coughing: OPEN" "Phases of clinical trials - CORRECT ANSWER 1. assess SAFETY in health volunteers 2. assess EFFICACY in sick volunteers 3. large, randomized trial comparing new intervention to placebo/standard 4. post-marketing surveillance for long term & rare effects (FDA involvement)" "first morphologic change in myocardial ischemia - CORRECT ANSWER swelling of endoplasmic reticulum" "guanosine analogs - CORRECT ANSWER acyclovir, famciclovir, valacyclovir - must be phosphorylated by THYMIDINE KINASE" "hemochromatosis - CORRECT ANSWER BRONZE DIABETES - liver failure, DM, arthritis, gonadal atrophy, heart failure & hyperpigmentation - EXCESS IRON" "Type I hypersensitivity reaction - CORRECT ANSWER - mechanism: antigen/IgE cross linking on mast cells & basophils - ex: allergic reaction, asthma, anaphylaxis - mnemonic: Acid" "Type II hypersensitivity - CORRECT ANSWER - mechanism: cytotoxic IgM/IgG activates complement - ex: GOODPASTURE SYNDROME ("Cmooth"), myasthenia gravis, hemolytic disease of newborn, Grave's disease, AHA - mnemonic: aCid" "type III hypersensitivity - CORRECT ANSWER - mechanism: immune complex formation b/w IgG & antigen (antibody-antigen) - examples: SLE, serum sickness, PSGN ("lumpI bumpI" appearance) - mnemonic: acId" "Type IV hypersensitivity - CORRECT ANSWER delayed hypersensitivity; T-cell mediated (CD8+ TH1 cells directly kill antigen) - ex: Diabetes, Diagnosing TB (granulomas, PPD) & Dermatitis - mnemonic: aciD" "cystocele - CORRECT ANSWER hernia of the urinary bladder; seen as a bulge into anterior vaginal wall on Valsalva maneuver - caused by connective tissue disorders, previous vaginal delivery, menopause, prior pelvic surgery increased abdominal pressure - presents w/ urinary retention/incontinence" "uterine prolapse - CORRECT ANSWER the condition in which the uterus slides from its normal position in the pelvic cavity and sags into the vagina - due to pelvic floor weakness (elevator ani complex) - lowering of cervix → vagina on Valsalva maneuver" "peptic ulcer disease - CORRECT ANSWER epigastric or LUQ pain that worsens (gastric) or improves (duodenal) with meals - causes: H. pylori > NSAIDS > smoking >>> alcohol" "tPA (tissue plasminogen activator) - CORRECT ANSWER Drug that immediately dissolves clots - thrombolytics used during MI/CVA → catalyze formation of PLASMIN to dissolve clot" "Neurofibromatosis type 1 - CORRECT ANSWER autosomal dominant mutation of NF1 gene on chromosome 17 w/ variable expressivity - cutaneous neurofibromas, hyperpigmented lesions (cafe au lait spots), Lisch nodules in iris, optic gliomas (seizures), pheochromocytoma" "cells involved in HIV - CORRECT ANSWER macrophages and CD4+ T cells - both possess CD4 & CCR5 on their cell surface, which HIV binds to" "Granulomatosis with polyangiitis (Wegener) - CORRECT ANSWER c-ANCA necrotizing granulomatous vasculitis of small & medium vessels - sinopulmonary, renal & skin involvement" "Leukocytoclastic vasculitis (LCV) - CORRECT ANSWER Palpable purpura, purpuric wheals, hemorrhagic bullae in dependent areas - burning rash, fever, weight loss, myalgia; more common in woman" "Temporal arteritis - CORRECT ANSWER autoimmune vasculitis that affects large & medium arteries - more common in women; constitutional symptoms, jaw claudication & headache - complication: loss of vision" "Cleidocranial dysostosis - CORRECT ANSWER mutation in CBFA gene - brachycephaly (frontal bossing, facial bone malformations, supernumerary teeth), absent clavicles, wormian bones - abnormal OSTEOBLASTS" "Peutz-Jeghers syndrome - CORRECT ANSWER autosomal dominant - hamartomatous (benign) polyps throughout GI tract → intussception, bowel obstruction, hypo chromic microcytic anemia - mucocutanous hyperpigmentation (freckle-like spots) on lips, oral mucosa, and genital skin" "Cowden syndrome - CORRECT ANSWER presence of hamartomatous polyps in the GI tract associated with the PTEN gene; increased risk of breast/ovarian cancer in females - mucocutanous neuromas, oral papillomas & cutaneous trichilemmomas" "autoantibodies to sperm suggest dysfunction in which cell type? - CORRECT ANSWER Sertoli cells (immune function)" "perforated duodenal ulcer - CORRECT ANSWER - severe retrosternal pain radiating to the epigastrum - pneumoperitoneum, peritonitis, abdominal rigidity, rebound tenderness & guarding - nausea, vomiting, possible septic shock (perforated viscus)" "metaplasia in smokers - CORRECT ANSWER squamous SCC → pulmonary cavitations, central location & hypercalcemia casuel by paraneoplastic PTH-related peptide (PTHrP) production" "Barrett's esophagus - CORRECT ANSWER columnar metaplasia of distal esophagus from GASTRIC CONTENTS (chemical irritation) - increased risk for esophageal adenocarcinoma" "lead poisoning on blood smear - CORRECT ANSWER - basophilic stippling (polka dots) - due to inhibition of ferrochetalase and d-ALA dehydratase → decreased heme synthesis - encephalopathy, cognitive dysfunction, peripheral neuropathy, hearing loss, interstitial nephritis, vomiting, abdominal pain, constipation & anemia" "salt intake effects on renal function - CORRECT ANSWER increased salt intake suppresses aldosterone & vice versa (b/c salt raises BP) - aldosterone increases epithelial Na+ channel transcription & activity - high salt diet → increased epithelial Na+ channel transcription & decreased resorption (b/c BP won't need to be lowered)" "familial hyperchylomicronemia - CORRECT ANSWER LIPOPROTEIN LIPASE & Apo A-II (activates lipoprotein lipase) DEFICIENCY - inability of epithelial cells to catalyze breakdown of triglycerides from circulating CHYLOMICRONS → "milky appearance" & increased amylase - PAIN AFTER FATTY MEALS, eruptive xanthomas & lipemia retinals (cream-colored discoloration of retina), STEATOSIS" "councilman bodies - CORRECT ANSWER seen in hepatitis - signify APOPTOSIS" "Ataxia Telangiectasia - CORRECT ANSWER AR disorder resulting from DNA REPAIR DEFECT - increased risk for Hodgkin lymphoma - cerebellar ataxia, telangiectasias, abnormal eye movements & decreased Ig → recurrent sinopulmonary infections" "degeneracy of the genetic code - CORRECT ANSWER multiple species of tRNA exist for most amino acids - WOBBLE POSITION" "mitral regurgitation - CORRECT ANSWER Reflux of blood from left ventricle into left atrium during systole - HOLOSYSTOLIC MURMUR best heard in midclavicular line → radiates to L axilla - assoc w/ MVP or prior MI" "carcinoid tumor - CORRECT ANSWER neuroendocrine cell tumor, often in small bowel (SMALL INTESTINE) - weight loss, flushing, diarrhea, bronchospasm, RIGHT SIDED HEART DISEASE, abdominal pain - inc serotonin (5-HIAA) - tx: ocreotide (somatostatin analog)" "Pheochromocytoma - CORRECT ANSWER benign tumor of adrenal medulla → increase BP, headaches, paliptations" "anemia during pregnancy - CORRECT ANSWER expansion of intravascular volume → dilution anemia & thrombocytopenia" "senile/actinic purpura - CORRECT ANSWER due to atrophy of dermal collagen w/ age & chronic sun exposure → blood vessel fragility - dorsal hands & forearms" "the PREVALENCE of disease is 3x greater in women than in men, but the INCIDENCE of disease is no different... why? - CORRECT ANSWER duration of disease is shorter in men" "osteitis deformans (Paget disease) - CORRECT ANSWER elderly → increased bone density due to inc. osteoblastic & osteoclastic activity - SCLEROTIC, WOVEN BONE w/ pain in that area - inc alk phos" "avoidant personality - CORRECT ANSWER sensitive to rejection, withdrawn, requires uncritical acceptance - weird, but sensitive (vs. schizoid)" "schizoid personality disorder - CORRECT ANSWER persistent avoidance of social relationships and little expression of emotion - weird, but doesn't care (vs. avoidant)" "antisocial personality disorder - CORRECT ANSWER (usually a man) exhibits a lack of conscience for wrongdoing, even toward friends and family members - may be aggressive and ruthless or a clever con artist; aggressive, impulsive" "Adenosine deaminase deficiency - CORRECT ANSWER SCID → recurrent bacterial & viral infections due to B & T cell deficiency - ROSARY RASH - enzymatic defect in metabolic pathway of ADENOSINE → INOSINE" "neonatal respiratory distress syndrome - CORRECT ANSWER premature neonates w/ insufficient surfactant (type II pneumocytes) - increased risk for alveolar tension & collapse (ATELECTASIA) - PROTEINACEOUS ALVEOLAR DEBRIS" "Normal Pressure Hydrocephalus (NPH) - CORRECT ANSWER Dementia, ataxia, and urinary incontinence EARLY IN DISEASE COURSE (vs. Alzheimers which is progressive)" "steroid hormone binding - CORRECT ANSWER CORTISOL - ex: estrogen, androgen, glucocorticoids" "thyroid hormones bind at receptors on the... - CORRECT ANSWER NUCLEUS - hyperthyroidism: hormones act on nuclear/retinoid X complexes w/ DNA" "insulin & glucagon (peptide hormones) bind at receptors on the... - CORRECT ANSWER CELL MEMBRANE" "Erlichiosis - CORRECT ANSWER doxycycline - binds to 30S ribosomal subunit and inhibits protein synthesis" "p value 5% (0.05 or less) - CORRECT ANSWER probability that a type I error has been committed & null hypothesis has been rejected - statistically significant" "Type II error - CORRECT ANSWER failing to reject a false null hypothesis >20% p value" "majority of thyroid hormone & radioactive iodine uptake - CORRECT ANSWER T4 bound to T4-binding globule (thyroxin + thyroglobulin)" "valve replacement - CORRECT ANSWER - aortic & mitral are most commonly replaced - when looking at a LATERAL xray, draw a diagonal line from carina → cardiac apex (aortic is superior, mitral is inferior) - when looking at POSTERIOR-ANTERIOR, draw a line from widest point of left & right (aortic is superior, mitral is inferior)" "paraneoplastic syndrome assoc w/ small cell lung carcinoma - CORRECT ANSWER Cushing syndrome, SIADH, Lambert Eaton myasthenia syndrome, paraneoplastic myelitis, encephalitis & subacute cerebellar degeneration - composed of neuroendocrine cells - DOES NOT RESPOND TO DEXAMETHASONE" "adrenal carcinoma - CORRECT ANSWER responds to dexamethasone (decreases ACTH)" "calcium oxalate kidney stones - CORRECT ANSWER increased Ca2+ resorption in distal tubule → Ca2+ in urine → octahedral radiopacities - tx: low sodium diet, THIAZIDES (act on DCT), oral citric acid" "pathophysiology of diabetic peripheral neuropathy - CORRECT ANSWER persistent activated of voltage gated Na+ channels in the nociceptor - tx: TCAs & carbamazepine → block Na+ channels" "Methemoglobinemia - CORRECT ANSWER impaired binding of O2 to hemoglobin - cyanosis, tachypnea, tachycardia & subcostal/intercostal retractions - DARK BROWN BLOOD - tx: supplemental O2 & methylene blue → reduces Fe3+ to Fe2+ allowing O2 to bind to Hb" "tx Diabetic Ketoacidosis (DKA) - CORRECT ANSWER Fluids, insulin, and electrolyte repletion (eg, K+) - insulin up regulates GLUCOKINASE → phosphorylation of glucose to G6P → hepatic glycolysis - insulin administration may result in refractory HYPERglycemia due to activation of hepatic ADENYLYL CYCLASE in attempts to restore glucose homeostasis" "the kidney is derived from ... - CORRECT ANSWER Metanephros (mesoderm)" "Leber hereditary optic neuropathy - CORRECT ANSWER Mitochondrial disorder creates a defective enzyme responsible for converting oxygen, fats, and simple sugars to energy - VISION LOSS - IMPAIRED COMPLEX I: decrease ability to oxidize NADH, normal FADH2" "cytokines involved in rheumatoid arthritis - CORRECT ANSWER TNFa & IL1 - tx w/ adalimumab (targets TNFa)" "ITP - CORRECT ANSWER autoimmune destruction of platelets → severe thrombocytopenia, mucosal bleeding (nose bleedings), petechiae, purpura" "TTP - CORRECT ANSWER fever, microangiopathic hemolytic anemia, thrombocytopenia, renal dysfunction, neurologic abnormalities" "heroin withdrawal - CORRECT ANSWER hypertension, tremors, nausea & vomiting - LACRIMATION, RHINORRHEA, PILOERECTION & YAWNING" "testicular cancer - CORRECT ANSWER firm, painless nodule in young man - metastasizes via PARA-AORTIC (LUMBAR) LYMPH NODES - para-aortic lymph nodes drain both testes & ovaries" "internal iliac nodes - CORRECT ANSWER prostate, cervix, corpus cavernous of penis, proximal vagina" "external iliac nodes - CORRECT ANSWER uterus & superior bladder" "periumbilical lymph nodes - CORRECT ANSWER GI system" "superficial inguinal lymph nodes - CORRECT ANSWER distal vagina, vulva, scrotum & distal anus" "restriction of valine, isoleucine & leucine in the diet is effective in tx of patients with... - CORRECT ANSWER MSUD - branched chain amino acid deficiency" "incidence - CORRECT ANSWER The number or rate of new cases of a particular condition during a specific time - original # of people who already have a condition are taken out of the equation - ex: 250/1250 have depression, the following year 100 more people develop depression so incidence = 100/1000 = 10%" "both polio virus vaccines (live attenuated & killed) share this feature: - CORRECT ANSWER neutralizing antibodies in the circulation" "differentiating b/w IBD & IBS - CORRECT ANSWER IBD: occult blood/melena, nighttime awakening from pain/diarrhea, worsening abdominal pain, family hx of IBD/colon cancer, weight loss" "Reflux Esophagitis (GERD) - CORRECT ANSWER inflammation of tissue at the lower end of the esophagus - burning epigastric/chest pain in assoc w/ large meal or trigger food - mucosal erythema, hyperplasia, eosinophilic infiltrate & erosions" "thyroid hormone changes in pregnancy (euthyroid) - CORRECT ANSWER estrogen increases b/c of production by placenta → T4 (thyroxine) increased, TSH normal" "hurler syndrome - CORRECT ANSWER Mucopolysaccharides accumulate due to lysosomal storage deficiency - COARSE FACIAL FEATURES (HIRSUTISM), CORNEAL CLOUDING, hepatosplenomegaly, skeletal abnormalities (dysostosis multiplex), intellectual disability & developmental delay - heart failure, hydrocephalus, hearing loss" "intraperitoneal hemorrhage posterior to liver after trauma - CORRECT ANSWER avulsion of hepatic veins from IVC" "Benzodiazepines MOA - CORRECT ANSWER Positive allosteric modulators at GABA receptors - potentiates the actions of GABA promoting hyperpolarization - BINDS AT A DIFFERENT SITE THAN GABA" "papillary transitional cell carcinoma - CORRECT ANSWER bladder cancer → painless gross hematuria - cigarette smoking, NAPTHYLAMINE (rubber), aniline dyes" "vinyl chloride - CORRECT ANSWER Angiosarcoma of liver - occupational exposure; used to make polyvinyl chloride (PVC) for use in pipes" "myasthenia gravis - CORRECT ANSWER autoantibody to NICOTINIC ACh receptor - tx: pyridostigmine (acetylcholinesterase inhibitor)" "Organs in left upper quadrant - CORRECT ANSWER stomach, spleen (posterior), portion of colon" "ACE inhibitors (-pril) - CORRECT ANSWER targets RAAS and increases bradykinin, slowing down HR (vasodilatory effect) - ADE: PERSISTENT COUGH" "Reflux nephropathy - CORRECT ANSWER Renal scarring & blunted calyces due to pyelonephritis from vesicoureteral reflux" "EBV - CORRECT ANSWER affects B cells through CD21 - CD8+ T cells react to the virus → lymphocytic leukocytosis (abundant Lacey cytoplasm on blood smear)" "what measure is most predictive of a clonal lymphoid proliferation? - CORRECT ANSWER surface kappa:lambda ratio - normally equal; predominance of kappa or lambs light chains suggests CLL" "NMDA receptor antagonist - CORRECT ANSWER Memantine (Namenda) - protects against excitotoxicity by decreasing Ca2+ entry into neurons" "Zidovudine (AZT, Retrovir) - CORRECT ANSWER Nucleoside reverse transcriptase inhibitor (NRTI) - inhibit RNA-DEPENDENT DNA polymerase" "protease inhibitors (-navir) - CORRECT ANSWER "Navir tease a protease" MOA: stops cleavage of HIV polypeptide into functional parts, thus preventing maturation of new viruses Clinical use: HIV Toxicity: hyperglycemia, GI intolerance, lipodystrophy (buffalo hump); nephropathy, hematuria (indinavir) -Ritonavir inhibits P450 enzymes" "bacterial mechanism of fluoroquinolone resistance i.e. ciprofloxacin - CORRECT ANSWER mutation in DNA GYRASE (topoisomerase)" "abuse of laxatives vs diuretics - CORRECT ANSWER - laxatives: hypokalemia, HCO3- rich stool, non anion gap metabolic acidosis - diuretics: hypokalemia, metabolic acidosis, FINE HAIR & DRY SKIN" "secondary polycythemia - CORRECT ANSWER from dehydration, COPD, heart disease, sleep apnea (hypoxia), high altitude, or physical conditioning - increased EPO production" "musculocutaneous nerve - CORRECT ANSWER anterior upper arm - biceps brachia and brachial muscle (C5-C7)" "radial nerve - CORRECT ANSWER Nerve that runs along the thumb side of the arm and posterior arm/hands C5-T1" "pulmonary edema, pleural effusions, ascites & peripheral edema occur as a result of cirrhosis due to... - CORRECT ANSWER loss of plasma colloid osmotic pressure - secondary to HYPOALBUMINEMIA" "rapid acting beta blocker - CORRECT ANSWER ESMOLOL used for tachyarrhythmia" "varicocele - CORRECT ANSWER enlarged, dilated veins near the testicle (pampniform plexus) - oligospermia & infertility may occur - left testicle appears smaller than right, enlarged spermatic cord w/ Valsalva" "VIPoma (WDHA) - CORRECT ANSWER assoc w/ MEN - chronic & watery diarrhea, hypokalemia, hypercalcemia, achlorhydria, alkalosis, flushing & vasodilation - tx: OCREOTIDE" "Niacin deficiency (vit B3) - CORRECT ANSWER pellagra: dermatitis, diarrhea, dementia, death" "Vitamin E deficiency - CORRECT ANSWER Hemolytic anemia, posterior and spincocerebellar tract demyelination - IMPAIRED INTESTINAL FAT ABSORPTION" "large uptake of radioactive iodine is due to... - CORRECT ANSWER ectopic (retrosternal) thyroid tissue" "hypoxic injury in the brain - CORRECT ANSWER cytotoxic edema → neuronal enlargement in susceptible areas i.e. hippocampus, cerebellum, watershed area" "Calcineurin inhibitors - CORRECT ANSWER Cyclosporine Tacrolimus - inhibit T cell proliferation, preventing transcription of IL2" "Aspergilloma (fungus ball) - CORRECT ANSWER colonization of lung cavities (TB, emphysema, sarcoidosis) - bloody, persistent cough usually in immunosuppressed pt - cell wall consists of 1, 3,B-D gluten" "uterine atony - CORRECT ANSWER The most common cause of postpartum hemorrhage (boggy uterus) - tx with uterine massage & oxytocin (Gq protein coupled receptor) → increased Ca2+ to increase uterine myometrium contraction" “difference b/w Kwashiorkor & Marasmus - CORRECT ANSWER - kwashiorkor (edematous malnutrition): marasmus PLUS EDEMA - marasmus (WASTING SYNDROME): skin lesions, fatty liver, acute protein-energy malnutrition with decreased arm circumference, weight per length or BMI" "deformation - CORRECT ANSWER disruption in organ morphogenesis occurring AFTER embryonic period; extrinsic force limits normal organ development" "vascular changes in chronic HTN - CORRECT ANSWER - hyaline arteriolosclerosis: protein deposition in vessel walls - hyperplastic arteriosclerosis (arteriolitis): concentric thickening of vessel wall w/ laminar appearance caused by proliferation of smooth muscle cells - commonly affects renal arterioles" "porphyria cutanea tarda - CORRECT ANSWER severe cutaneous photosensitivity with blistering & hyperpigmentation after exposure to sunlight - decreased activity of uroporphyringoen decarboxylase enzyme in the production of HEME" "CD8+ T lymphocytes - CORRECT ANSWER responsible for CLEARING a virus - class I MHC receptors present a virus to CD8+ T cell on an APC - CD8+ T cell has a specific TCR for the virus; responds by secreting inflammatory mediators (to attract other cells) perforin/granzyme or interacting with Fas/FasL to trigger apoptosis" "Class II MHC - CORRECT ANSWER are on the surface of antigen-presenting cells (APCs), including B cells - trigger CD4+ T cells, which recruit CD8+ cytotoxic T cells" "PKU - CORRECT ANSWER deficiency of phenylalanine hydroxylase - supplementation of TYROSINE is required for synthesis of catecholamines (norepinephrine, epinephrine & dopamine)" "leuprolide - CORRECT ANSWER GnRH agonist used for the treatment of prostate cancer - decreased LH & testosterone release" "production of progesterone during pregnancy - CORRECT ANSWER - first 7-10 weeks: CORPUS LUTEUM (stimulating by hCG from placenta) >10 weeks: placenta" "Lambert-Eaton Myasthenic Syndrome (LEMS) - CORRECT ANSWER Auto-Immune; antibodies formed against voltage gated Ca2+ channels at NMJ; IMPAIRED PRESYNAPTIC ACH RELEASE - Sx: skeletal muscle weakness in limbs (improves w/ activity) - paraneoplastic syndrome assoc w/ small cell lung carcinoma" "round ligament - CORRECT ANSWER binds uterus to labia majora - commonly leads to pain during pregnancy" "mesothelioma - CORRECT ANSWER pleural effusion & scalloped pleural density; thick, firm, white pleural tumor - interstitial fibrosis - ASBESTOSIS: working in a shipyard, roofing & plumbing" "biggest risk factor for complications w/ use of OCPs - CORRECT ANSWER tobacco smoking in patients >35 years - contraindications: history of DVT, PE, stroke, MI, HTN, migraine w/ aura, cirrhosis & current breast cancer" "Waardenburg Syndrome - CORRECT ANSWER autosomal dominant disorder of abnormal neural crest development → abnormal melanoblasts - white forelock, PATCHY depigmentation iridic heterochromia & deafness - eyes may be laterally displaced" "failure of internalization of melanin granules by keratinocytes - CORRECT ANSWER NONPATCHY albinism, no hearing loss (vs. Waardenburg)" "maintenance of constant GFR in the setting of renal artery constriction - CORRECT ANSWER increased EFFERENT arteriole resistance → activation of RAAS" "rapid plasma reagent (RPR) false positive - CORRECT ANSWER SLE → antiphospholipid antibodies will yield false (+) RPR/VDRL are used to detect antibodies against syphilis" "cold agglutinins - CORRECT ANSWER Mycoplasma pneumoniae, EBV - marker of HEMOLYSIS" "heterophiles antibodies - CORRECT ANSWER Infectious mononucleosis (EBV)" "p24 antigen - CORRECT ANSWER HIV1/2" "glucose-independent insulinotrophic peptide (GIP) - CORRECT ANSWER secreted by K cells in the duodenum & jejunum - decrease gastric acid production & stimulate insulin release from pancreas - secreted in response to glucose/fatty acids to lower blood sugar" "ureteral constriction - CORRECT ANSWER hydronephrosis - vesicoureteral junction, crossing point over COMMON ILIAC ARTERY or ureteropelvic junction ^ renal calculi tend to lodge at these 3 locations" "most common artery to obstruct the ureter - CORRECT ANSWER COMMON ILIAC" "21-hydroxylase deficiency - CORRECT ANSWER excessive androgens, low aldosterone & cortisol - female: hypoaldosteronism & virilization during infancy (develops male characteristics) - male: precocious puberty in childhood" "5a-reductase deficiency - CORRECT ANSWER Inability to convert testosterone into DHT - Male internal genitalia, ambiguous external genitalia until puberty" "Androgen Insensitivity Syndrome (AIS) - CORRECT ANSWER - XY fetus → blind vagina - internal testes/ambiguous genitalia, increased LH, testosterone & estrogen" "acromegaly - CORRECT ANSWER excessive GH & IGF1 (insulin-like growth factor 1) - increased rates of DM & hypertriglyceridemia - increased adipolysis & hepatic gluconeogenesis → since IGF1, body thinks it's always in a hypoglycemic state, so you produce more glucose - decreased muscle glucose uptake" "wound healing - CORRECT ANSWER 1. platelet aggregation & homeostasis 2. neutrophils & macrophages infiltrate area & stimulate fibroblast production & migration via FIBRONECTIN 3. granulation tissue, collagen & neovascularization 4. epidermal cells migrate along collagen to form new skin 5. scar formation & remodeling via MMP collagen breakdown" "Proteasome inhibitors - Bortezomib (Velcade) - Carfilzomib (Kyprolis) - CORRECT ANSWER prevent antigen processing and presentation to CD8+ (cytotoxic) T cells - while these are effective for tx of multiple myeloma, they lead to immunosuppression" "Virchow's triad - CORRECT ANSWER - stasis: bed ridden, long plane ride - endothelial damage: smoking, HTN - hyper coagulability: OCP use * DVT may bypass pulmonary circulation & cause STROKE in patients with PATENT FORAMEN OVALE" "Twin-to-Twin Transfusion Syndrome (TTTS) - CORRECT ANSWER complication of blood supply w/ 1 twin receiving a low amount (the donor) & the other receiving too much (the recipient) - caused by ARTERY-TO-ARTERY CHORIONIC SURFACE ANASTOMOSES" "funisitis - CORRECT ANSWER inflammation/infection of the umbilical cord" "alcohol withdrawal - CORRECT ANSWER sympathetic overdrive (HTN, tachycardia, tremors anxiety, diaphoresis) → seizures & delirium tremens" "testicular atrophy due to anabolic steroid use - CORRECT ANSWER decreased testosterone due to negative feedback on gonadotropin secretion - low GnRH, low LH, low testosterone" "subacute (de Quervain) thyroiditis - CORRECT ANSWER self-limited hyperthyroidism often following viral infection - granulomatous inflammation & absence of iodine uptake on radionuclide scan 1. ↑ ESR 2. jaw pain 3. early inflammation 4. Very TENDER, PAINFUL thyroid" "diffuse toxic goiter (Graves disease) - CORRECT ANSWER most common cause of hyperthyroid; antibody activates TSH receptors - hyperthyroid symptoms, pretrial myxedema, exophthalmos - thyroid is nonpainful" "Euthyroid sick syndrome - CORRECT ANSWER occurs in the setting of acute systemic illness - decreased thyroid hormone" "Autoimmune (Hashimoto) thyroiditis - CORRECT ANSWER - antithyroid peroxidase & antithyroglobulin antibodies - HYPOthyroid symptoms: fatigue, cold intolerance, weight gain, myxedema, dry & cool skin, hyporeflexia - non painful thyroid" "Autoimmune Hemolytic Anemia (AIHA) - CORRECT ANSWER autoantibody against RBC surface antigen - positive direct antibody test (DAT, Coombs), unconjugated hyperbilirubinemia & reticulocytes on peripheral smear" "Secondary hyperparathyroidism - CORRECT ANSWER CHRONIC RENAL FAILURE - decreased Ca2+ & vitamin D - increased PTH & phosphate - increased bony turnover in attempt to increase Ca2+ (renal osteodystrophy)" "dislocation/subluxation of radial head (NURSEMAIDS ELBOW) - CORRECT ANSWER common pediatric injury when parent grabs child's arm to prevent them from running, playing etc. - displacement of radial head from ligamentum annulus - arm is held in a neutral, extended PRONATED position" "mitral stenosis - CORRECT ANSWER fibrosis and calcification - opening snap & diastolic rumble loudest over cardiac apex - long term complication of rheumatic heart disease (GROUP A STREP)" "rheumatic fever - CORRECT ANSWER Streptococcus pyogenes (group A) - diastolic murmur radiating to axilla, joint pain, inflammatory nodules, erythema marginatum, Syndenham chorea" "Zellweger syndrome - CORRECT ANSWER Peroxisomal disease - lab studies: increased VLCFA's (very long chain fatty acids), hepatic transaminases & direct bilirubin - intellectual disability, hypotonia, hepatomegaly, kidney disease, cataracts, hearing loss, seizures & craniofacial abnormalities" "external validity - CORRECT ANSWER determines whether an experiment can be generalized & its conclusions applied to groups beyond those considered in study group" "reliability - CORRECT ANSWER the extent to which a test yields consistent results - precise result each time" "face validity (content validity) - CORRECT ANSWER refers to simply whether the test looks as though its measuring what its supposed to" "precision - CORRECT ANSWER reproducibility of a measurement" "migraine - CORRECT ANSWER unilateral, pulsating headache assoc w/ photophobia, nausea & phonophobia - visual & sensory aura may be present - acute migraine tx: TRIPTANS (SEROTONIN AGONISTS)" "positive end-expiratory pressure (PEEP) - CORRECT ANSWER Mechanical maintenance of pressure in the airway at the end of expiration to increase the volume of gas remaining in the lungs - PREVENTS ALVEOLAR COLLAPSE & ATELECTASIAS IN MECHANICAL RESPIRATION" "Unambiguity of the genetic code - CORRECT ANSWER the amino acid sequence derived from a given mRNA can vary" "mutations in APC, KRAS & P53 tumor suppressor genes promote cell growth in... - CORRECT ANSWER colorectal adenocarcinoma" "oncogenes assoc w/ Burkitt lymphoma - CORRECT ANSWER mature B-cell neoplasm due to dysregulation of CMYC gene due to t(8;14)" "oncogene assoc w/ melanoma - CORRECT ANSWER BRAF V600E mutation (valine → glutamic acid)" "oncogene assoc w/ small cell undifferentiated carcinoma - CORRECT ANSWER mutation of MYCL1 → neoplasm of neuroendocrine cells" "hypertrophic obstructive cardiomyopathy - CORRECT ANSWER murmur increases when straining, DECREASES WHEN SUPINE w/ LEGS ELEVATED (decrease preload/afterload) - young patient → sudden cardiac death in athlete, dyspnea, syncope (+) family history" "aortic regurgitation - CORRECT ANSWER early diastolic murmur best heard at right 2nd intercostal space - endocarditis, acute rheumatic fever & aortic root dilation" "prolonged apnea after succinylcholine administration during surgery is observed in what enzyme deficiency? - CORRECT ANSWER PSEUDOCHOLINESTERASE" "malignant hyperthermia - CORRECT ANSWER ryanodine receptor defect → overstimulation by succinylcholine (muscle contraction and hyperthermia) - tx: dantrolene" "cardiac changes when going from standing → supine - CORRECT ANSWER - pulse decreases - stroke volume & LVEDV (preload) increase b/c blood from the lower body is rushing back to upper body" "metabolic changes in hemorrhagic shock & hypotension - CORRECT ANSWER - INCREASED arteriovenous PO2 difference, plasma lactic acid & plasma ADH (vasopressin) - REABSORPTION of systemic capillary fluid (b/c you're losing blood and are dehydrated) - plasma lactic acid increases b/c anaerobic metabolism - ADH increases in attempt to restore BP" "Malessezia furfur - CORRECT ANSWER TINEA VERSICOLOR - "spaghetti & meatballs" on KOH prep - hyperpigmentation & hypopigmentation on chest/back (patchy) i.e. GIANA'S CHEST - tx: ketoconazole (topical)" "dermatophytes - CORRECT ANSWER - Epidermophyton - Microsporum - Trichophyton cause superficial fungal infection on trunk (tinea corporis), groin (tinea cutis), foot (tinea pedis), scalp (tinea capitis) & nail (tinea unguium)" "amyloidosis - CORRECT ANSWER Proteinaceous substance deposited intra- and extracellularly in various tissues and organs of the body - derived from LAMBA LIGHT CHAINS - commonly assoc w/ hematological malignancy" "serum amyloid-associated protein (SAA) - CORRECT ANSWER reactive amyloidosis is derived from this, produced by the liver during chronic inflammation (autoimmune disease) - commonly cause nephrotic syndrome due to kidney deposition"