nbme recopilation flashcards

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1/2500 incidence. What is the carrier freq for CF

AR = 1/2500 (square root it) = 1/50 (multiply by 2) = 1/25

1 wk hx confusion, disorientation, talking to himself, delusional ideas about his landlord and incontinence, diag?

delirium

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1 wk hx of dizzy, warm water in left ear = nystagmus to left, in rt ear = nothing. Where is the damage?

vestibular = rt side.

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1 yr old, multiple infection, partial albinism, neutropenia, giant granules in neutrophils. Diag and def?

chediak higashi. Def in phagolysosome function

1yr old, v, copious D, dec urinary freq, similar illness at schools. Resistant to ether, contains double stranded segmented RNA genome. Organism?

rotavirus

2cm^2 cross section aneurysm and 20cm/sec blood flow rate. What is the flow rate in L/min through the aneurysm?

20x2 = 40 ml/sec. (40x60)/1000 = 2.4 L/min

2 day hx of low urine. Surg 2 wks ago and gentamicin. Diag and damage to nephron location?

acute tub necrosis proximal tubule

3 boy, pain in legs, specially at night. Cannot keep up with peers. Gluteal muscle weakness bilaterally. Diag and inc marker

DMD. Serum creatine kinase activity

3 day old, fever, stiff neck, gram neg rods, neutrophils. Diag?

e. coli

3hr hx difficulty breathing, midl lt shoulder paiin, htn, smoker, Po2-58. diag?

pul edema

3 month, virus, lower rti. Multinucleated cells in tissue. Rx?

RSV = ribavirin

3 wks post MI, accumulation of free fluid in peritoneal space. Cause

inc capillary hydrostatic pressure

3 year old boy, CF, inc PT, PTT, pt improves with cofactor for?

carboxylation of prothrombin - Vit K.

3 year old boy, only able to speak 20 words. Correct response?

further eval for cause of language delay

4 boy, macrocephaly, large ears, prominent chin, 3 word vocab. Fragile x. 12 year old daughter - next best step

wait and let her decide if she wants to be tested of her carrier status

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4 boy, two bacterial UTI, marked dilation of left ureter and renal pelvis, minimal lt sided renal function. Diag?

congenital ureteral obstruction

4m boy, AR skeletal dysplasia or dilated RER = can not endochondral bones. Null mutation go from RER to Golgi in genes that control the traffic of = achondroplasia cesicles into the golgi. EM will show? 4th ventricles originate from

metencephalon

5 boy, flulike sxs treated by aspirin. Diag? why is pt in coma?

reyes syndrome. Cerebral edema. Inc ammonia, lactate, PT, transaminase activity.

5 boy, pharyngitis. Beta hemolytic gram + coccus in chains. Wht gives it its shape?

peptidoglycan

6 boy, two weeks after URI, periorbital edema, peripheral edema, normal labs, ASO is normal

minimal change

6m hx of hrt burn, difficult swallowing, no n or v, swelling of wrists and hands, no meds, no wrincles on face and neck. Diag and esophageal persistalsis and LES tone.

CREST synd. Peristalsis dec, LES tone dec

6 month boy, sluggish, edematous, coarse immature facies, poor muscle tone

congenital hypothyroidism

7 mm red scaly plaque on the helical rim of left ear. Diag?

actinic keratosis = know histo

8 boy, gen edema for 2 months, 4+ protein, oval fat bodies. Diag? involves what part of kidney?

minimal change. Glomerilar capillary loops

8 m hx of burning chest pain, bitter taste in mouth, sxs at night when pt lies down. No pain radiation. No sob. Dx? What is assocated with it?

barretts esophagus metaplasia of esophageal epithelium

8 wks after recovering from pneumococcal pneumonia. Normal x ray. Why?

maintenance of basement membrane integrity = normal BM so nothing was messed up = norma x ray

8 yr hx of htn, tires easily, no family hx of liver ds, inc AST and ALT. what caised inc of serum liver enzymes?

nonalcoholic steatohepatitis

10 boy, chronic iron def anemai, improves with H2 antagonist.

meckel diverticulum

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10 day hx, yellow skin, abd discomfort, fatigue, AST-320, ALT340. damaged to hepatocytes are mediated by?

cytotoxic T lymphocytes

10 month old. abd mass, 10cm mass in upper pole. Diag?

nephroblastoma wilms tumor

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11 boy, extreme thirst, passing large ketones = B amounts of urine, wt loss. Lethargic hydroxybutyric acid and drowsy. What does the brain use other than glucose for energy

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12 boy, 6m hx of difficulty walking and leg pain. Hammer toes, high stepping gain. Diag? nerve biopsy would show?

charcot marie tooth. Abnormal myelin sheath

14 girl, palpitations, irregular pulse, mig polyarthritis, low fever. Prophylactic antistrep for?

mitral valve stenosis

15 boy, colors seemes bright, sounds louder, desks appear to move. Diag?

hallucinogen use

15 boy, gynacomastia. Cause?

normal for puberty boys - resolve with time

15 girl, redness day after sunbathing. No welts, used sunblock every few hours. Diag?

first degree burn

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16 female, never had period. Short stature, little sexual development. Ovaries would show?

atrophy

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24 black, red bumps on face and chin, itchy, painful, hyperpigmented papules. Diag?

psudofolliculitits barbae = razor burns.

24 female, intermittenet fevers, chest x ray show diffuse interstitial nodular densitites. Biopsy show, accumulation of chronic inflammatory cells in interstitium and noncaseating loosely formed granulomas. Diag?

hypersensitivity pneumonitis

24 female, v, fatigue, dizziness, Hb-6, hematocrit 18%. What is most likely to be decreased in artery?

arterial O2 carrying capacity

24 male, hx eczema, recurrent infections, dec platelets, low IgM. Diag?

wiskott aldrich syndrome

25 female, inc facial hair and chest hair, irregular menses. Inc 17hydroxy. Bp - 116/62. def of ?

21-hydroxylase = think normal vs hyper. Is normal bp then 21, if htn then 11b def.

25 female, inc LH and FSH. 6 m amenorrhea. Diag?

primary ovarian faliure

25 metformin pills. Se?

lactic acidosis

26 female, acute fever, chest pain, sob, hypokinesis, virus related to heart ds.

coxsackievirus

26, flank pain, palpitations, sweating, recurrent headaches. Diag and where in the adrenal anatomy?

pheochromocytoma. Adrenal medulla catecholamines. Very bottom layer layer with chromaffin cells

27 female, f, malaise, abd pain, vag discharge, bilat lower quad tenderness with rebound and guarding. Ink leukocytes. Diag?

PID = mc is gonorrhea

28 black female, lesions on eyes, nose, hilar lymphadenopathy, diag and histo finding?

sarcoidosis, granulomas with foregin body giant cells, inc ace levels

29 pregnant, wt gain, anxiety, poor concentration, palpitations, loose bowel movements. What to check next?

thyroid glands

17 girl, ha, fading vision in both papilledema eyes, react to light and accomidate, pic. Diag? 18 female, mild retard, dec vision in dark, chronic D, dec muscle control of arms and legs. Diag and def?

abetaliproproteinemia. Apo B

18m old boy, lethargy for 3 hrs. hypoglycemia and D for 10m. Medium chain triglycerides are adiministered daily for 6m. Def of?

LCAD = long chain acyl coa dehydrogenase

18 year old football and wrestler. Gynacomastia. Next step?

ask if using steroids

19 boy, collapses at party, agitated, disoriented, fever, hot flushed skin, pupils dilated, responsive to light. What rx?

ecstacy

19, schizophrenia, txt

olanzapine

20 female, weakness of legs, abd pain, persistent v, port wine colored urine, hx of 3 similar episodes. What will be seen in urine

porphobilinogen = acute intermittent porphyria txt glucose and heme to inh ALA synthase

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22, anxiety and depressed for 6wks. amitriptyline Orthostatic hypotension. What rx?

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30 female, 7wk hx of palpitations and exogenouse use of sob with exertion. Hr 16. tsh -0.01, T4 - levothyroxine 2.6, low iodine uptake, low thyroglobulin, low thyroglobulin antibodies. Caused by? 30 female, jogging what happens to exp minute vent, cardiac output, arterial PO2

inc, inc, unchanged

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30 female, ptosis, double vision, weakness, deep tendon reflex normal, neostigmine improves sxs. Dec num of receptors on what?

plasma membrane

30 female, rt knee pain, gram stain shows organisms in the cells

N. gonorrhoeae

30yr hx of DMt2, fasting endogenous serum insulin concentration would be?

low - below normal around 1uU/mL

31 female, retrosternal chest pain while at rest for 6m. Few mins of ST seg elevation. What caused this in large epicardial artery?

endothelial cell dysfunction

34 wk gestation, pul htn txt with what drug while watching for methemoglobinemia

nitric oxide

35 female, visual dist, weak radial and rt carotid pulse, rt retinal hemorrhage. Narrowing of the brachiocephalic, rt carotid, subclavian arteries. Diag>

takayasu arteritis

35lb wt gain despite diet, 156/96, round ruddy face, hirsutism, enlarged adrenal glands. Histo changes?

cortical hyperplasia

35 male, 4d hx, high fever, muscle aches, malaise, loss of appetite, nonproductive cough. Similar for wife and 2 kids. Replicates in cell's nucleus. Diag?

influenza virus = ss RNA E (-) could also be retrovirus = HIV, HTLV = E ss linear (+)

36 hours post MI would show?

coagulation necrosis and neutrophilic inflammation

37 female, 3year hx progressive dementia and writhing movements in all four limbs. Structure involved?

neurons of striatum

38 female, 10wk hx epigastric pain and freq stools. Hx renal calculi, multiple superficial lipomas. Inc serum gastrin. Next step in management?

serum calcium concentration = MEN 1 - associated with zollinger = kidney stones and stomach ulcers

38 male, 9m hx dyspnea, chronic interstitial inflammatory infiltrates with hyperplasia of type 2 pneumocytes and irreular areas of collagen deposits. Diag?

idiopathic pul fibrosis (collegen - fibrosis restrictive)

40 female, 30 min afer sustaining severe chest inj, 25 yr hx of seizures. What caused seizures?

vascular malformation

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40 female, mole on back, black tan pigment, ill defined margins, peomorphic, hyperchromatic cells within clear islands present on all levels of dermis and extension into papillary dermis. Diag?

melanoma = papillary dermis

40 male, gravel pit worker, x ray show multiple calcified nodule on upper lobes. Ppd negative

silicosis

40 male, sensitive to sunlight. Blisters form right after sun exposure. Very painful. Diag? what pathway is defective?

acute intermitten porphyria. Heme synthesis

42 american, foul smelling stool, wt loss, abd pain, diag?

alcoholic

45 female, 3m hx dec energy, impaired concentration, tingling in both hands, constipation, wt gain. Diag?

hypothyroidism

45 male, drinking 12+ beers for 10 days. Jaundice. Inc total bilirubin, inc AST, inc GGT. Liver biopsy would show?

Mallory haline.

45 male, intermitten bloody D, abd pain, sigmoidoscopy and rectal biopsy show IBD. MAB being used. Diag? ab directed against?

UC. Think anti inf = TNF

45 male, n, v, abd pain, tachycardia, absent bowel sound, involuntay guading. Cause?

peritonitis

45% on A with 2200pts, 49% on B with 1900pts. P