NBME 19 Topics

Study online at quizlet.com/_3j9qr9

1. 3rd and 4th Thymus and parathyroids (tetany hypocalcemic)

pharyngeal pouch
2. Acetominophen It blocks COX in the CNS. So it is safe to give people who have stomach ulcers. Obviously you would look
for a "coxib" with stomach ulcers but tylenol will do too. It does not have antiinflammatory and does NOT
have anti platelet disorder.
3. Acute Tubular Granular Brown Muddy Cast
Necrosis Caused by ischemic or nephrotoxic injury
Ischemic due to decreased renal blood flow (hypotension, shock, sepsis, hemorrhage). Tubular cells die and
slough off
Nephrotoxic, due to toxic substances like aminogycosides, radiocontrast, lead, cisplatin), crush injury like
myoglobinuria.
The PCT is very susceptible to ATN
4. Adverse Side effects Astronaut shutting eyes w/ IgE missiles on ship: Type 1 IgE mediated hypersensitivity reaction
of penicillin.
Exploding asteroids w/ IgG: drug-induced autoimmune hemolytic anemia (positive direct coombs test)

Kidney shaped nebula: Drug induced interstitial nephritis

5. Antisocial Criminality
Disregard for and violation of others right with lack of remorse
Conduct disorder if they are less than 18
Sometimes you see the classic triad of "setting fires, torture animals and bed wetting"
6. Aspiration Pneumonia Look for a concentrated fluid (white concentrated) at a single area. Aspiration pneumonia are like alcoholics.
7. B-Cell and T Cell They interact with each other to class switch the B cell.
interaction
B-Cell antigen presentation to CD4 helper T cells via MCH II
1. CD40 on B cell binds to CD40R on T cell
2. T cell releases Il-4 and IL-5 (mediates B cell isotype switiching, hypermutation and maturation of plasma
cells.
8. Bronchioles Smooth Muscles line the bronchioles.
9. Candida Albicans Diaper Rash
It is Normal skin flora, and oral flora and gut flora. It gets to be bad when you are immunocompromised.
10. Chorionic Villi Chorionic Villi sampling happens between 10- 12 weeks Gestation
Sampling vs. Amniotic
Fluid Analysis Amniocentesis can be performed 14-18 weeks Gestation.
11. Constriction vs So if the eye does not constrict in a certain eye, then you have "Marcus Gunn Pupil" and that is ipsilateral
Dilation of the eye optic nerve damage. Diagnose this with the swinging flashlight test.
12. Conversion Disorder Pt presents w/ a physiologic disorder (i.e. right arm is paralyzed), but none of the labs/tests confirm that one
really exists. Usually follows some sort of acute stress (i.e. divorce).
13. Cryptoorchidism Means testes are undescended. Obviously if you are not descended then you have an increase risk of germ
cell tumors (primarily seminoma's)
14. Erythema Multiforme Blistering Dermatoses, characterized by target rash and bullae.
Target appearing cuz central epidermal necrosis surrounded by erythema.
Associated with HSV infection, other associations include mycoplasma infection.
If it involves oral mucosa, its Steven Johnsons syndromewith diffuse sloughing off of skin resembling a large
burn (most often due to adverse drug reaction).
15. Ethics Always follow the wishes of the wife if there is no advance directives. Then follow the wishes of the kids.
16. Fecal incontinence Damaged the anal sphincter.
after giving birth
17. Fibrates (Gemfibrozil) PPAR Alpha to upregulate LPL
DECREASE SERUM TRIGLYCERIDES (via increase hydrolyses of VLDL's and chylomicrons)
Decrease serum VLDL
Increase serum HDL
SE: fibrates combined with statins increase MYOPATHY
CAUSE CHOLESTEROL GALLSTONES
18. Grading vs Staging a Grading is assessing how different the tumor is (architectural and nuclear features). Well differentiated vs
Tumor poorly differentiated. Metastases is a big indicator of this

Staging is TNM. Tumor size or depth, N is spread to regional lymph nodes,

and M is mets.
19. Granuloma

Granuloma's appear when you have a suture still stuck in you. You know that they are granulomas because
there are giant cells.
20. Graves Disease Autoantibody against the thyrotropin receptor.
21. HIV Status of Infant born You have to be careful in babies because babies born to moms with HIV initially get a positive ELISA or
to an HIV infected Western Blot test but these tests are positive only because (anti gp120 (envelope protein) crosses the
mother. placenta.

Hence babies status is unsure in the beginning.

22. Langerhans Cell Proliferative disorders of dendritic (langerhans) cells.
Histiocytosis Can present with lytic bone lesions and skin rash or recurrent otitis media with a mass involving the
mastoid bone.
Basically the cells are immatuer and do not stimulate primary Tcells via antigen presentation.
BIRBECK GRANULE ARE CHARACTERISTIC
23. Libido and Nocturnal Note that cerebral infarcts can result in depression in the elderly. This means that the libido will be down,
Erection in the Elderly but as long as there are not any damage to the parasympatheics in the penis, nocturnal erections will still
be fine.
24. Meningioma Benign primary brain tumor. Most often occurs near the surface of the brain and the parasagittal regions.
Could also be called interhemispheric fissure inthe region of the central sulcus.
25. Metoclopromide D2 receptor antagonist
antagonist at Chemoreceptor Trigger Zone (CTZ) in Area postrema.

Also works on the release of PROLACTIN from the adenohypophisis.

26. Morphine Could have an adverse reaction to the drug would would entail, general pruritis and warmth and facial
flushing.
27. Nerves that make you Pudendal nerve innervates the perineum and helps you poop.
Poop vs Pee
Pelvic nerve innervates the bladder and you dick.
Helps you pee and maintain an erection. Pelvic nerve is parasympathetic.
28. Osteoarthritis vs Osteoarthritis:
Rheumatoid Arthritis Mechanical, wear and tear. Age, female, obesity, joint trauma.
Pain at the end of the day, knee cartilage loss begins medially.
Osteophytes (bone spurs).
Involves DIP! (Heberdan Nodes) and PIP (Bouchards Nodes) and 1st CMC.

Rheumatoid Arthritis
Autoimmune, inflammatory CYTOKINES
Cells induce pannus (proliferative granulation tissue) which erodes articular cartilage and bone.
Positive + Rheumatoid factor (Anti IgG antibody in 80%).
Anti-cyclic citrullinated peptide antibody (more specific).
Involves MCP, PIP, wrist NOT DIP OR 1st CMC!!!
29. Osteoporosis Trabacular (spongy) and cortical bone lose mass. Most commonly due to Decrease estrogen and old
age.
Can lead to vertebral compression fractures.
Prophylaxis is vitamin D intake and Calcium intake through diet throughout adulthood.
30. Other Paraneoplastic Squamous cell lung carcinoma
Tumors I should know. PTH
Hyper calcemia

Renal Cell Carcinoma

Erythropoieten
Polycythemia

Thymoma
Antibodies against post synaptic AcH receptors- Myasthenia Gravis

Hemangioblastoma-
Erythropoieten
Polycythemia

Intracranial Neoplasm
ADH
SIADH

Breast Carcinoma
PTH
Hypercalcemia

Luekemia and lymphomas

Excess nucleic acid turnover
Gout
31. Paget's Bone Disease Localized disorder of bone remodeling. Everything is normal except increase ALP.
Cortical thickening with endplates creating "picture frame" vertebrae.
32. Patient does not trust Establish a therueaputic alliance with the patient is the most important thing before treating any chronic
doctor diseases.
33. Prevalence vs. Incidence Prevalence = number of Total Existing cases divided by the total population

Incidence = number of New cases within a certain time period divided by the total number of
susceptible individuals in the population

Usually they go hand in hand (when one goes up the other goes down, but be careful because
sometimes they might try to trick you when they mess with duration)
34. Primaquin Give for hypnozoites in the liver but be careful with G6PD Defeciency, which is an enzyme within erythrocytes.
35. Propranolol Increase total peripheral resistance and decrease cardiac output.
36. Prostate Cancer Giving Flutamide and Leuprolide together. Leuprolide and a strong GnrH agonist. Basically, you give Leuprolide
medications to downregulate things (constant stimulation leads to downregulation) but the initial stimulation is what gets you
(Flutamide and cuz it can be counterproductive to the prostate cancer. Hence, give em flutamide, so that you block the initial
Leuprolide) androgenic action of leuprolide.
37. Prostatic Men over 50.
Adenocarcinoma Posterior lobe (peripheral zone)
Prostatic acid phosphatase (PAP) and PSA are good tumor markers
OSTEOBLASTIC metastasis in BONE !! especially in lower vertebrae.
38. Psychogenic Excessive water drinking, even when water is deprived. Patient says that he does not have excessive thirst.
Polydipsia
39. Renal Cell Originates from PCT cells, polygonal clear cells.
Carcinoma Manifests clinically with hematuria and palpable mass and polycythemia and obviously weight loss.
METS TO LUNG AND BONE!!
Paraneoplastic syndrome, EPO (erythropoiten (polycythemia), ACTH, PTHrP, renin)
RCC= 3 letters=chromosome 3
40. Small cell Location is Central.
carcinoma of the Neoplasm of neuroendocrine cells,
lung Chromogranin A Positive.
Can have paraneoplastic syndrome.
May produce ACTH (Cushing Syndrome)
SIADH (Hyponatremia and euvolemic)
Antibodies against Pre-synaptic Ca channels (Eaton Lambert)
41. STD Situations Haemophilus ducreyi (painful chancroid): painful chancroid with unilateral painful swollen lymph node that
contain pus, often become matted and rupture

Herpes (HSV-1,2): vesicular appearance (unique blister like lesions). This can be misdiagnosed as chancroid after
they ruptured, but Herpes often has systemic symptoms (myalgia, fever) while chancroid often do not.

Chlamydia Trachomatis (lymphogranuloma venereum): painless matted pus containing inguinal lymph node that
develop more slowly than chancroid. Another way to distinguish it from chancroid is that the lymph node
enlargement appear after the skin lesion disappear while skin lesion and enlarged lymph node appear together in
chancroid

Treponema pallidum (syphilis): painless ulcer, bilateral non pus lymph node. OBLITERATIVE ENDARTERITIS WITH
LYMPHOCYTES AND PLASMA CELLS

Granuloma inguinale: painless ulcer that look like syphilis, but inguinal lymph enlargement is often absence in this
disease (present in syphilis)
42. Sun exposed Nuclear excision repair of pyramidine dimers.
damage
43. Transcription Recognize and bind to specific DNA sequences at numerous sites on multiple chromosomes.
Factor
Retinoic Acid Recpetors and HOX Gene products are like this.
44. tRna Process

1. Aminoacyl-tRNA binds to A site (except for initiator methionine)

2. rRNA ("ribozyme") catalyzes peptide bond formation, transfers growing polypeptide to amino acid in A site
3. Ribosome advances 3 nucleotides toward 3 end of mRNA, moving peptidyl tRNA to P
site (translocation)
45. Tubocurine Nondepolarizing Drugs
Muscle Paralysis in Surgery or VENTILATION ( Diaphragm, phrenic nerve)
Can try to reverse with neostigmine
46. Tubular Uses the most amount of ATP. Basically in the kidneys, uses more ATP for re-absorption than any other type of
Reabsorption processes.