Qbank - 6/13/2012

Front 1

24 yo male w/headache & visual changes, intracranial calcified mass on MRI, gross inspection shows cystic spaces w/thick brownish fluid rich in cholesterol?

Back 1

cranyiopharyngioma = calcified mass, young ppl, usually yellow viscous fluid filled (cholesterol crystals)

Front 2

local secretory antibody synthesis is best promoted when?

Back 2

specific mucosal surfaces are directly stimulated by antigen

Front 3

5 yo male w/persistent food seeking behavior, obsese, sometimes aggressive/bizzarre behaviors - what part of brain is lesioned?

Back 3

Ventromedial thalamic nucleus, where satiety centers reside

Front 4

is the portal vein intraperitoneal or retroperitoneal?

Back 4

it is retroperitoneal

Front 5

what structure is at high risk from invasion of tumor of 3rd part of duodenum?

Back 5

superior mesenteric artery, uncinate process of pancrease

Front 6

Campylobacter is showing increased worldwide resistance to what antibiotic? New antibiotic of choice?

Back 6

resistant to fluoroquinolones
use erithromycin

Front 7

why does penicillin tx of group A strep prevent RF but not APSGN?

Back 7

rheumatic fever (antigen mimicry)
NOT post-strept glomerulonephritis (immune complex deposition)

Front 8

what lab test should follow a moderately elivated alk phosph of unclear etiology?

Back 8

gamma-glutamyl transpeptidase
it's present in liver but NOT bones, helpful in distinguishing

Front 9

alveolar cells w/golden cytoplasmic granules turning dark blue w/prussian blude staining?

Back 9

"heart failure cells"
hemosiderin containing alveolar macrophages

Front 10

golden yellow or brownish cytoplasmic granules - what might they contain? What stain to differentiate?

Back 10

either lipofuscin or hemosiderin
Prussian blue stain detects intracellular iron (stain will turn dark blue)

Front 11

variation in what process of isoniazid elimation results in 2 sets of populations w/different elimation speeds?

Back 11

acetylation
slow acetylators at increased risk of adverse side effects

Front 12

what is the main source of resistance in the vascular system?

Back 12

capillary beds

Front 13

what is best tx for cardiac abnlities associated w/TCA?

Back 13

sodium bicarbonate

Front 14

what indications might make phenelzine a reasonable 1st line tx choice?

Back 14

it's an MAOIs, can be 1st line for atypical depression (mood reactivity, leaden fatigue (arms & legs feel heavy) rejection sensitivity, reversed vegetative signs - increased sleep & appetite)
not nl first line b/c of tyramine crisis, interactions (SSRI), etc

Front 15

where are lipids/lipid-soluble vitamins absorbed?

Back 15

Jejunum, after digestion in the duodenum

Front 16

53 yo male w/dyspnea on exertion
CXR densities in both lung fields most prominent apically
calcified hilar lymph nodes, on biopsy are negatively birefringent surrounded by collagen fibers - what's going on?

Back 16

Silica exposure
distinguished from other pneumoconioses by eggshell calcification & birefringent silica particles surrounded by fibrous tissue

Front 17

MCC ventricular fibrillation in ppl < 30 yo?

Back 17

Hypertrophic cardiomyopathy

Front 18

what is the MC cardiomyopathy?

Back 18

dilated cardiomyopathy, ~90%
account for ~10-15% cases sudden cardiac death

Front 19

42 yo female w/bouts of spinning sensation w/nausea & ringing in left ear, diminished hearing
"feels fine" between episodes - what condition? Pathophys?

Back 19

Meniere's dz, increased volume of endolphym from defective resporption
triad - tinnitus, vertigo, sensorineural hearing loss

Front 20

1st line tx for general anxiety disorder? How long is response delayed?

Back 20

Buspirone (selective agonist of 5HT-1a)
clinical response can be delayed up to 2 weeks of regular use

Front 21

what class of meds reduces all cause mortality in CHF? Which one in particular?

Back 21

beta blockers
carvedilol

Front 22

strawberry vs cherry hemangioma?

Back 22

strawberry occur during 1st few weeks of life, grow rapidly then regress by 5-8 yo
cherry hemangiomas appear in 30-40's, do not regress & increase w/age (aka senile hemangiomas) - ALWAYS cutaneous, histologically are sharply circumscribed areas of congested capillaries & post-capillary venules in the papillary dermis

Front 23

when initiating therapy w/ACE inhibitors what adverse effect is of concern (on INITIATION)? What other common drugs might predisopose to this?

Back 23

First-dose HTN
diueretics could predispose via hypovolemia
also hyponatremia, low BP, high renin/aldo, and heart failure

Front 24

what is the Bezold-Jarisch refelx seen with ACE inhibitors?

Back 24

a decrease in angiotensin II levels, causing vagally mediated hypotension & bradycardia

Front 25

what kind of T-cell & cytokine profile is seen w/immune reaction in Sarcoidosis?

Back 25

granulomas --> cell mediated
Th1 type CD4+ w/IL-2 & IFN-gamma (IL-2 stim prolife of Th1
IFN-gamma activating macrophages promoting granuloma formation)

Front 26

amino acids w/3 titratable protons?

Back 26

histidine, arginine, lysine, cysteine, tyrosine, aspartic acid, glutamic acid

Front 27

total sensory loss on one side of the body & face with no motor involvement indicates lesion where?

Back 27

thalamus

Front 28

lesion of internal capsule can result in what isolated deficits?

Back 28

motor

Front 29

patient w/hx of sensory stroke affecting 1 side of the body w/no motor involvement dies of unrelated cause years later
brain shows two 5-6 mm cavities in deep structures of the brain - what are these? What pathophys explains them?

Back 29

Lacunar infarcts
occlusion of small penetrating arteries caused by small vessel lipohyalinosis & atherosclerosis
2ndary to HTN or diabetes

Front 30

septate hyphae 45 degree angle?

Back 30

aspergillus fumigatus

Front 31

what is colonizing aspergillosis?

Back 31

occurs in old lung cavities (TB, emphysema, sarcoidosis), grows as "fungus ball"
CONTRAST to invasive aspergillosis (immunosuppressed) or hypersensitivity reactions to aspergillus (asthma - allergic bronchopulmonary aspergillosis ABPA)

Front 32

medicallyy important dimorphic fungi?

Back 32

form molds (w/hyphae) in ambient temp (25-30) & yeasts (single cells) at body temp (37) - Sporotrhix schenckii
Coccidioides Immitis
Histoplasma Capsulatum
Blastomycoses dermatitidis
Paracoccidioidees brasiliensis

Front 33

biopsy reveals round or cigar shaped budding yeasts?

Back 33

sporothrix schenckii
dimorphic
think gardeners smoking

Front 34

culture at 25 - hyphae w/doubly reflective walls, at 37 - thick walled spherules w/endospores?

Back 34

Coccidioides

Front 35

biopsy reveals oval yeast cells within macrophages?

Back 35

Histoplasma capsulatum

Front 36

round bud vs broad based bud?

Back 36

round bud - sporthrix (also cigar shaped bud)
broad bud - blastomycoces)

Front 37

fungus found in southwest / deserts?

Back 37

Coccidioides

Front 38

fungus found in Ohio & Mississippi River valleys?

Back 38

Histoplasma & Blastomycoces

Front 39

fungus found in soil, bird droppings, bat droppings (chicken coops, caves)?

Back 39

Histoplasma

Front 40

fungus found in Great Lakes region?

Back 40

Blastomycoses (NOT Histo - according to Uworld)

Front 41

fungus found in soil?

Back 41

Coccidioides (mold form), Histoplasma, Blastomycoses

Front 42

fungus found in central & south america?

Back 42

paracoccidioides brasiliensis
mucocutaneous

Front 43

vasculitis in child showing IgA & C3 deposition?

Back 43

Henoch-Schonlein purpura
-recent infection, -palpable skin lesions, -with/or without abdominal pain & arthralgias
self-limiting but glomerulonephritis & even ESRD are possible complications

Front 44

vasculitis w/nasal mucosal ulcerations, "saddle nose" & oliguria?

Back 44

Wegeners, c-ANCA (serum anti-neutrophil)

Front 45

vasculitis w/weak upper extremity pulses?

Back 45

Takayasu arteritis
-large vessels (aorta & prox branches)

Front 46

vasculitis w/headache & blurred vision?

Back 46

Giant Cell Arteritis

Front 47

significant QT prolongation following antiarrhythmic med, also notable for mild bradycardia - which med class? Example?

Back 47

QT prolong = ventricular repolarization
mediated by K+ efflux so look for class III (K+ channel blockers)
Sotalol is an example (tho it is a beta blocker, this explains the bradycardia)
others: amiodarone, ibutilide, dofetilide

Front 48

hemochromatosis causes what kind of cardiomyopathy?

Back 48

dilated, pts present w/signs & sx of CHF

Front 49

concentric vs eccentric cardiac hypertrophy?

Back 49

concentric hypertrophy results from increased afterload (sarcomes added in parallel)
eccentric hypertrophy is more associated with volume/dilation (sarcomeres added in series)

Front 50

pathologic fx secondary to prolactinoma caused by what change? What is another common association?

Back 50

suppression of GnRH leading to estrogen deficiency
vaginal dryness

Front 51

difference between TB & sarcoid granulomas?

Back 51

TB - caseating
sarcoid - non-caseating

Front 52

43 yo african american male w/weeks of malaise, 10 lb weight loss, nocturnal fevers, & cough, CXR w/hilar prominence
former prisoner
palpable node in supraclavicular bed - noncaseating granuloma?

Back 52

sarcoidosis - non-caseating granuloma (so not TB), african american man w/hilar adenopathy & constitutional symptoms

Front 53

does sarcoidosis present with weight loss, nocturnal fevers, and cough, or is that more likely to be TB?

Back 53

could be either

Front 54

what is caseating?

Back 54

caseous necrosis - form of cell death
tissue maintains "cheese-like" appearance
dead tissue appears soft & white protenaceous dead cell mass

Front 55

what neurologic condition are mementine & vitamin E helpful for?

Back 55

Alzheimers
memantine is NMDA receptor antagonist
vitamine E is an antioxidant

Front 56

how do methylxanthines cause vasodilation? (asthma tx)

Back 56

decreasing phosphodiesterase activity (increasing cAMP)

Front 57

what does ipratropium do?

Back 57

anti-muscarinics
mAChR antagonists

Front 58

how does listening at end expiration accentuate a diastolic murmur (S3)?

Back 58

brings apex closer to chest wall

Front 59

what is pramipexole (context: Parkinson's tx)? Others like it?

Back 59

it is a non-ergot dopamine agonist - pramipexole & ropinerole
ergot compounds - bromocriptine and pergolide

Front 60

what symptoms of Grave's dz are not corrected by beta blockers?

Back 60

Exophthalmosis
this is a result of anti-thyroid antibodies
ocular manifestations may respond to corticosteroid therapy

Front 61

what colitis has non-caseating granulomas on light microscopy?

Back 61

Chron's
resemble sarcoid granules- also see linear ulcerations, cobblestone appearance of mucosa, transmural inflammatory infiltrate