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General 8
Q bank: Randomly Generated 8
| Question | Answer |
|---|---|
| What feature is most reassuring when comparing benign intraductal papilloma with ductal carcinoma? | Presence of fibrovascular core and both epithelial and myoepithelial fronds |
| What is the most likely pathologic finding in temporal arteritis: atherosclerotic plaques, leukocytoclastic vasculitis, or focal granulomatous inflammation? | Focal granulomatous inflmation (with giant cells); another name is giant cell arteritis. Symptoms include unilateral headache w/ photophobia, intermittent visual symptoms varying from blurry vision and teary eyes to blind spots. |
| This phosphodiesterase and adenosine receptor inhibitor can precipitate sinus tachycardia and severe tremor. | Theophylline; used to treat asthma |
| Thymoma is strongly associated with what syndrome? | Myasthenia gravis; antibodies that react with muscular nicotinic receptors and interfere with cholinergic neurotransmission |
| Overly rapid correction of severe hyponatremia can severely damage what CNS structure? | Pons; central pontine myelinolysis leading to para or quadriparesis, dysarthria, or dysphagia |
| A patient with abnormally small posterior fosssa, with resultant downward displacement of cerebellar vermis and medulla thorugh the foramen magnum. Diangnosis? | Arnold-Chiari type 2; associated with lumbar meningocele and syringomyelia |
| Downward displacement of cerebellar tonsils through the foramen magnum | Arnold-Chiari type 1 |
| What is the most common cause of bundle branch block (not drugs), and what appearance does it have on ECG? | Coronary artery disease; wide, diphasic QRS complex, as depolarization after the bundle branch block will be delayed in depolarizing |
| Patients with celiac sprue are at increased risk of developing: Colonic adenocarcinoma, Crohn disease, Ulcerative colitis, Intestinal lymphoma? | Intestinal lymphoma (breast cancer is also increased in incidence among patients with celiac sprue) |
| Why is propranolol contraindicated in patients with COPD? | It is a nonselective beta blocker that causes bronchoconstriction |
| Elevated C-reactive protien, serum amyloid A, and serum amyloid B are all signals of what? | Inflammation; most commonly measured acute-phase reactants |
| Patient presents with acute cholecystitis, what would be the best narcotic to treat his pain: Meperidine, morphine, oxycoodone, or propoxyphene? | Meperidine; unlike the others, it does not cause spasm of the sphincter of Oddi |
| What disorders are associated with the following: anti SS-B, anticentromere, p-ANCA, anti-ds DNA, antimicrosomal, anti-smith | Anti SS-B: Sjogren's along with SS-A; Anticentromere: CREST; p-ANCA: microscopic polyangitis; anti-ds DNA and anti-sm: SLE; Antimicrosomal: Hashimoto thyroiditis |
| The median nerve arises from what two cords? | lateral and medial |
| What is the most common type of bias in cohort study? | Cohort study follows different groups over time to see if they have different incidence rates; problem is selection bias, in that those participating in the study may not represent the broader population |
| A 12 year old boy was given aspirin for a fever caused by varicella infection. He progressed to develop severe vomiting, altered sensorium, elevated LFT's, and hypoprothrombinemia and hyperammonemia. What is this syndrome? | Reye syndrome |
| Aspirin inhibits platelet aggregation by decreasing the production of what factor? | Aspirin is a cyclooxygenase inhibitor and inhibits formation of thromboxane A2 |
| When would you expect each of the following forms of necrosis: coagulative, liquefactive, fat, and fibrinoid? | Coagulative: following ischemic tissue damage; Liquefactive: following an infectios process, especially in abscess; Fat: in pancreatitis w/ lipase release; Fibrinoid: following inflammatory process, often arteries |
| TSST-1 causes release of what cytokines from TH1 and macrophages? | TH1: IL-2 and IFN-gamma; Macrophages: IL-1, IL-6, TNF-alpha |
| Chylous pleural effusions appear grossly milky-white, w/ high TG's and low to variable cholesterol compared w/ serum. What are the most common causes of such effusions? | Lymphoma, damage to the thoracic duct, and other carcinomas |
| Mutation of myosin chain genes have what effect on the hearts architecture? | Hypertrophic cardiomyopathy with thickening of interventricular septum (assymetric cardiac hypertrophy) |
| This is the only gastrointestinal hormone that inhibits gastric emptying. | CCK |
| What is the mechanism of the drug used to treat pelvic inflammatory disease? | Binds and inhibits 50S subunit of bacterial ribosomes (Macrolide antibiotic); Azithromycin, treating chlamydia |
| What is the mechanism of the drug used to treat herpesvirus infections? | Acyclovir; inhibits DNA synthesis |
| Patient presents with back pain and facial pain. PE reveals coarse facial features and kyphosis, elevated alkaline phosphatase, skull thickening. Mosaic pattern of bone spicules with prominent osteoid seams. Diagnosis? | Paget disease of bone; first clue is the elevated alkaline phosphate, not specific but high index of suspicion, "mosaic pattern" of newly formed bone is conclusive |
| What is the maternal contribution to the placenta? | Lacunar network that communicates with maternal spiral arterioles |
| Patient presents with increased energy, irritability, and racing thoughts. Diagnosis? | Manic or hypomanic episode; often elated or euphoric mood and racing thoughts, other symptoms such as hypersexuality, grandiosity, and increased talkativeness |
| What is the difference between an aminopeptidase, carboxypeptidase, and endopeptidase? | Aminopeptidase is an exopeptidase that removes an amino acid from the amino terminus, carboxy is an exopeptidase that removes an amino acid from the carboxy terminus, and endopeptidase cleave amino acid bonds within the molecule |
| Neuropeptide Y has what effect on the body and where is it secreted? | Stimulates feeding; secreted from hypothalamus and gut |
| Patient presents with 1 wk persistance of diarrhea. Stools show numerous granular, spherical, thin-walled cysts. Trichrome stains show up to four nuclei in most of the cysts. What is the organism responsible? | Entamoeba histolytica |
| Well-demarcated areas of demyelination of white matter at autopsy, remitting relapsing course of various neurologic problems. What is the inheritance pattern? | MS; not hereditary, although genteic factors play an important role. Believed to be autoimmune with possible role of infectious agents |
| These are the drugs of choice for hypertension during pregnancy. | Methyldopa (alpha 2 agonist) and hydralazine (nitric oxide donor) |
| 4 yro boy w/out immunization presents w/ sudden onset fever, inspiratory stridor, refusal to drink water. Patient is very ill appearing and is drooling. Diagnosis? | Epiglottitis; HIB infection, first clue is the lack of immunization, think what do we immunize against to narrow your choices and operate on exclusion (doesn't sound like mumps or measles or rubella etc.) "EMOP" mnemonic for HIB and epiglottitis is there |
| What is the most typical histopathologic feature of HIV encephalititis? | Multinucleated giant cells, otherwise may appear similar to PML from JCV so if they say giant cells think HIV encephalitis |
| What two viruses directly infect oligodendrocytes? | JC virus and measles virus |
| Where are the HIV reservoirs in the body? | Follicular dendritic cells in germinal centers of lymph nodes |
| Who has the highest survival rate for adenocarcinoma of the: Prostate, esophagus, pancreas? | Prostate: 50-70% (similar to breast: 60-70%); Pancreatic has one of the worst (3.5%), and esophagus is almost as bad (10%) |
| Well-demarcated mass of the nasopharynx demonstrates plasma cell proliferation. Serum electrophoresis shows monoclonal IgG spike. Bone marrow shows no plasma cell proliferation and no lesion seen on skeletal X-ray. Diagnosis? | Plasmacytoma (solitary myeloma) may involve soft tissues (lungs, nasopharynx, nasal sinuses) and if so has little metastatic potential; if, however, it involves bone it may progress to multiple myeloma in 10-20 years |
| What type of necrosis is associated with hydrolytic enzyme action, what type is associated with protein denaturation? | liquefactive necrosis is related to hydrolytic enzyme action leading to liquified tissue w/out cell outlines; Coagulative necrosis is associated with protein denaturation and often times cell outline is preserved |
| What personality disorder is associated with short term psychotic episodes, self mutilation, unstable interpersonal relationships, and "splitting" into "good/bad" personality extremes? | Borderline personality disorders |
| 3 month old baby presents with nuchal rigidity and bulging fontanells. CSF demonstrates neurtophils and gram-positive cocci chains. What is the organism responsible? | Group B strep; other common causes in the 0-6 months age range are E. Coli (Gram negative rod) and Listeria (Gram positive rod) |
| What two markers are strongly associated with Reed-Sternberg cells? | CD30 and CD15; note RS cells are neither T nor B lymphocytes so they do not express CD20 common to most B-cell leukemias and lymphomas |
| 10 year old child develops colicky flank pain. Urinalysis shows yellow-brown hexagonal crystals. Abdominal x-ray shows radiopaque staghorn calculi of both renal pelvises. Nitroprusside cyanide test on urine is positive. Diagnosis? | Cystinuria (autosomal recessive); nitroprusside cyanide test is confirmatory, as it alkalinizes the urine, yellow-brown, hexagonal structures dissolve. Eventual development of end-stage renal failure is common |
| Glucosuria, phosphaturia, aminoaciduria, and bicarbonate wasting. Diagnosis? | Fanconi syndrome; impaired reabsorption in the proximal tubule |
| One treatment option for psychotic depression is electroconsulve therapy, what is the major concern for this therapy? | Memory loss both before and after treatment, occurs in 1 in 1000 individuals and usually memory returns in several weeks |
| This anti-tuberculosis agent works by inhibiting arabinosyl transferase necessary for mycobacterial cell-wall synthesis. | Ethambutol (remember, INH works by inhibiting mycolic acid synthesis, rifampin inhibits DNA-dependent RNA polymerase) |
| What HLA locus is associated with hemochromatosis and what stain is used to demonstrate iron deposition? | HLA-A3; prussian blue |
| What are the viruses that cannot complete life cycles without their own polymerase? | Negative-sense RNA viruses (Arena, Bunya, Paramyxo, Orthomyxo, Filo, Rhabdo), Reo, Pox, and Retro |
| What types of cancer are associated with myasthenia gravis? | Thymoma or bronchgenic carcinoma |
| What is the mechanism of action of Losartan? | angiotensin II inhibitor at the AT-1 receptor |
| From what structure does the medial umbilical ligament arise vs. the median umbilical ligament? | Medial umbilical ligaments arise from umbilical arteries (off of internal iliac), the Median umbilical ligament is a remnant of the urachus connecting the bladder to the umbilicus |
| What are the four lysogenic (insertion of bacteriophage DNA into bacterial chromosomal of a temperate phage) traits? | O antigen of Salmonella, botulinum exotoxin, erythrogenic exotoxins of S pyogenes, and diphtheria toxin (as an unrelated aside anthrax and tetanus are encoded on plasmids) |
| Lyme disease can cause what type of cardiac abnormality? | AV block |
| 5 weeks post MI, what is the major concern: arrhythmia, ventricular rupture, ventricular aneurysm, or fibrinous pericarditis? | Ventricular aneurysm, fibrous scar tissue has less resistance then myocardium and bulges out to become an aneurysm; arrhythmia is first 2-4 days post MI; ventricular rupture is 4-7 days post MI; fibrinous pericarditis also occurs in the first week |
| Patient presents with bloody diarrhea but the 3rd year med student can't tell if it's caused by salmonella, shigella, or campylobacter jejuni. He knows the organism is gram negative, what else should he be looking for to distinguish these 3? | First off if it is oxidase positive, it is C. jejuni; Second if it is oxidase negative and motile, then it is salmonella (salmon swim); also C. jejuni are comma shaped which should also aid in distinction |
| In Bruton's agammaglobulinemia, what is the defective enzyme resulting in failed B-cell maturation (Low IgM, IgG, and IgA)? | Bruton's tyrosine kinase (btk); also called X-linked agammaglobulinemia |
| Deficiency of CD40 ligand causes what syndrome? | Hyper-IgM syndrome, in which there is inability to switch immunoglobulin isotypes |
| 23 yro woman w no history of psychiatric or substance abuse, presents with sudden onset restlessness, visual and auditory hallucinations, and emotional lability. 2 weeks ago she was treated w/ TMP/SMT: Acute intermittent porphyria, SLE, or Guillain-Barre? | Acute intermittent porphyria |
| 17 yro male develops a painless, firm mass beneath the nipple of left breast. Mass is mobile and no fluid can be expressed from breast: Fibrocystic change, gynecomastia, or intraductal papilloma? | Gynecomastia, it is the most common cause of breast mass in men; Fibrocystic changes reflect physiological responses in the breast to sex hormones and are not observed in men |
| The nerve that supplies the 7th rib lies in what space? | The 7th intercostal nerve lies in the 7th intercostal space |
| What cells are seen in M1, M2, M3, M5, and M7 variants of AML? | M1: myelobalst; M2: promyeloblast; M3: promyelocyte; M5: promonocyte; M7: Megakaryocyte |
| Patients with antitopoisomerase I and no anticentromere antibodies usually die from what complications? | Anticentromere scleroderma usually results in limited systemic sclerosis w/out visceral involvement; Antitopoisomerase I however can result in either CREST syndrome or potentially fatal systemic fibrosis |
| Sickle cell crises can precipitate patchy papillary necrosis, proteinuria, and cortical scarring, but what vascular structure is damaged to cause these problems? | Vasa Recta |
| In order, tell me the disorder: Atrophy of caudate, depigmentation of substantia nigra, diffuse cortical atrophy, selective frontal and temporal lobe atrophy | Huntington's, Parkinson's, Alzheimer's, Pick disease |
| In order to make the diagnosis of sarcoidosis granuloma, what type of cells must be present? | Epitheliod macrophage or histiocyte |
| What is Megestrol acetate? | Hormone w/ antineoplastic properties that can substantially increase appetite to moderate weight loss associated with cancer |
Created by:
rahjohnson
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