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AM- STEP1 > Last Set > Flashcards

Last Set Flashcards

1
Q

ADPKD associated with (4)

A

Berry aneurysms
MVP
Benign hepatic
Diverticulosis

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2
Q

Anaerobes

A

Anaerobes Cant Breath Fresh Air

Clostridium
Bacteroides
Fusobacterium
Actinomyces

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3
Q

Facultative intracellular

A

Some Nasty Bugs May Live FacultativeLY

Salmonella
Neisseria
Brucella
Mycobacterium
Listeria
Francisella
Legionella
Yersinia pestis
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4
Q

Urease positive

A

Pee CHUNKSS

Proteus
Cryptococcus 
H pylori
Ureaplasma
Nocardia
Klebsiella
S epidermidis
S saprophyticus
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5
Q

Catalase positive organisms

A

Cats Need PLACESS to Belch their Hairballs

Catalase

Nocrrdia
Pseudomonas
Listeria
Aspergillus
Candida
E coli
Staphylococci
Serratia
B cepacia
H pylori
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6
Q

Live attenuated vaccine

A

“Attention Teachers” Please Vaccinate Small Beautiful Young Infants with MMR Regularly

Adenovirus
Typhoid
Polio (Oral)
Varicella
Small pox
BCG
Yellow fever
Influena (intranasal)
MMR
Rotavirus
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7
Q

Killed vaccine

A

RIP Always

Rabies
Influenza (injection)
Polio (injectable)
Hepatitis A

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8
Q

Gardner
Dimorphic fungus

Pustule on puncture site

Nodules follow draining lymphatics

Tx

A

Sporothrix schenckii

Tx: Itraconazole (first line)
potassium iodine

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9
Q

Bloody diarrhea
Flask shaped ulcers
RUQ pain

  • type organism
  • transmittered
  • diagnosis
  • tx
A

Entamoeba histolytica

Liver abscesses

Fecal-oral route
- eating food or water contaminated with feces that contain cysts

Trophozoites or cysts in stool

Treatment

  • trophozoites= metronidazole or tinidazole
  • cysts= iodoquinol or paromomycin
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10
Q

Ingest helminths

A

“EAT”

Enterobius vermicularis
Ascaris lumbricoides
Trichinella spiralis

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11
Q

Penetrating helminths

A

“Sand”

Stronglyoides
Ancylostoma
Necator
D

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12
Q

Giant limbs

  • type
  • transmitted
  • tx
A

Wuchereria bancrofti

Helminth, neomatoid
Round worm in GI

Mosquitoes

Migrate to lymphatics

Elephantiasis of limbs
Hydrocele of scrotum

Tx
Diethylcarbamazine

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13
Q

Hydatid cyst lesion in liver
RUQ pain
Well circumscribed circular lesion

  • transmitted
  • can find where in body
  • symptom
  • tx
A

Echinococcus granulosus

dog feces

Egg shell calcifications

Form mature larval cysts in liver and lungs

Anaphylaxis

Surgical removal of cysts

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14
Q

Ixodes deer tick

A

Borrelia burgdorferi
Anaplasma
Babesia

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15
Q

Giemsa Stain

A 
Rickettsia
Chlamydia
Trypanosomes
Plasmodium
Borrelia
Helicobacter pylori (Histoplasma)

Ricky got Chlamydia as he Tried to Please the Bored Hot Geisha

Chinese Painted wHores Bow To Rich

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16
Q

Silver stain

A

Fungi

  • Coccidioides
  • Pneumocytstis jirovecii
  • Legionella
  • H. pylori
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17
Q

Drug binds to cell wall glycoproteins

Drug interferes with DNA replication proteins

Drug binds to ribosomal proteins

Drug binds to transpeptidases

A

Vancomycin

Fluoroquinolones, binds DNA gyrase

Macrolides, tetracyclines

Pencillin, cephalosporins

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18
Q

1st generation cephalosporins

A

Cefazolin
Cephalexin

Gram + cocci

PEcK
Proteus mirabilis
E. coli
Klebsiella

UTIs
URIs

Prophylaxis viridans strep endocarditis

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19
Q

2nd generation cephalosporins

A

Cefoxitin
Cefaclor
Cefuroxime
Cefprozil

HENS PEcK
H. influenza
Enterobacter
Neisseria
Serratia marcescens
Proteus mirabilis
Ecoli
Klebsiella

Not used for gonorrhea

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20
Q

3rd generation cephalosporins

A

Ceftriaxone
Cefotaxime
Ceftazidime
Cefdinir

Serious gram - infections

HENS PEcK
E.coli
Proteus mirabilis
Klebsiella
Enterobacter
Serratia
Citrobacter
Neisseria
H. influenza
Strep pneumoniae **
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21
Q

4th generation cephalosporin

  • use
  • coverage
A

cefepime
broad spectrum
Pseudomonas

Gram + coverage

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22
Q

5th generation cephalosporin

A

Ceftaroline
Broad spectrum

MRSA

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23
Q

Protein synthesis inhibitors

mneumonic

A

Buy AT 30, CCELL at 50

30S inhibitors

  • Aminoglycosides
  • Tetracyclines

50S

  • Chloramphenicol
  • Clindamycin
  • Erythromycin, macrolides
  • Lincomycin
  • Linezolid
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24
Q

TCA

  • MOA
  • coverage
  • avoid with
  • toxicity
A

Binds 30S
Prevents attachment of aminoacyl tRNA

VACUUM THe BedRoom
Vibrio cholerae
Acne
Chlamydia
Ureapolasma urelyticum
Mycoplasma pneumoniae
Tularemia
Helicobacter pylori
Borrelia burgdorferi
Rickettsia

Avoid with
- milk antiacids
Iron, calcium, magnesium
(inhibit absorption in gut)

Discoloration teeth
Inhibit bone growth kids
Photosensitivity
Blue skin (minocycline)

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25
Q

Sulfa drug allergies

A

“Sulfa Pills Frequently Cause Terrible Allergy Symptoms”

Sulfasalazine
Probenecid
Furosemide
Celecoxib
Thaizide (TMP-SMX)
Acetazolamide
Sulfonyureas
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26
Q

Vaccines

1) 1st Given
2) Who gets flu shot
3) 2 months
4) 4 months
5) 6 months

A

1) Hep B- 1st given
2) Yearly from 6 months

2,4,6 (8) who do we appreciate STRIPPERS

“Damn BaBy, ROTate that ass on the POLe”

3) Dtap, HepB, Hib, Rotavirus, Polio (IPV), PCV (pneumococcal)
4) DTaP, Hib, Polio, PCV, Rotavirus
5) DTAP, Hib, PCV, RV

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27
Q

CCR-5 antagonist

A

Maraviroc

CCR-5 on macrophages and CD4 T cells

Inhibits gp120 conformational change

Only in patients with all R5 virus

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28
Q

HIV drug causes

  1. Bone marrow suppression
  2. Pancreatitis
  3. Hepatic steatosis
  4. Hypersensitivity rxn
  5. Rash
  6. Nightmares, vivid dreams, depression
  7. False-positive to drug test for cannabinoids
  8. Teratogenic
  9. Nephrolithiasis
  10. Increases bilirubin
  11. peripheral neuropathy
A
  1. Zidovudine (NRTI)
  2. Didanosine (NRTI)
    Ritonavir (PI)
  3. Didanosine (NRTI)
  4. Abacovir (NRTI)
  5. NNRTIs
  6. Efavirenz (NNRTI)
  7. Efavirenz (NNRTI)
  8. Efavirenz (NNRTI)
  9. Indinavir, Atazanavir (protease inhibitor)
  10. Atazanavir (protease inhibitor)
  11. Didanosine
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29
Q

Antifungal that

  1. Disrupts membrane
  2. Disrupts microtubules
  3. Blocks precursors to pyrimidines
  4. Blocks Squalene to lanosterol
  5. Blocks lanosterol to ergosterol
A
  1. Nystatin, Amphotericin B
  2. Griseofulvin
  3. Flucytosine
  4. Terbinafine
  5. -azoles
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30
Q

Terbinafine

  • use
  • side effects
A

Inhibits enzyme squalene epoxidase

uses superficial fungal infections

Hepatotoxicity
GI symptoms
Headache
TASTE disturbance

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31
Q

Haemophilus influenzae can be grown

tx

A

Chocoalte agar w/ factor V and X

or w/ S. aureus which provides factor V (NAD) through hemolysis of RBCs

Tx: Amoxicillin +/- clavulanate (mucosal infxn)
Ceftriaxone (meningitis)
Rifampin prophylaxis

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32
Q

S or comma shaped

A

Campylobacter jejuni
- bloody diarrhea

Vibrio cholerae
- water diarrhea

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33
Q 
Constipation
Red spots of abdomen
Abdominal pain
Fever
Followed by diarrhea

Tx

A

Salmonella typhi

Ceftriaxone
Fluroquinolone

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34
Q

Myalgia of calves
Jaundice
Photophobia
Flu like

Tx

A

Leptospira interrogans

Water contaminated with animal urine

Pencillin
Ceftriaxone
Doxycycline

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35
Q

Tongue ulcers

Splenomegaly

A

Histoplasmosis

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36
Q

Severe diarrhea in AIDS

A

Cryptosporidium

Oocytes in water

Oocytes on acid fast

Nitazoxaninde in IC hosts

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37
Q

What viruses uses this receptor

1) Integrins
2) CD21
3) CD4, CXCR4, CCR5
4) P antigen on RBCs
5) Nicotinic AChR
6) ICAM-1

A

1) Integrins= CMV
2) CD21= EBV
3) CD4, CXCR4, CCR5= HIV
4) P antigen on RBCs= ParvoB19
5) Nicotinic AChR= Rabies
6) ICAM-1= Rhinovirus

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38
Q

Rotavirus

  • causes
  • type of virus
  • MOA
A

infantile gastroenteritis

Segmented ds RNA virus (reovirus)

Diarrhea
- day care center

Villous destruction with atrophy leads to decreased absorption of Na and loss K

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39
Q

Paramyxovirus Prophylaxis

A

Palivizumab

paramyxovirus causes RSV, croup, mumps, measles

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40
Q

Strawberry cervix

A

Trichomoniasis

Trichomonas vaginalis

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41
Q

Daptomycin

  • MOA
  • uses
  • adverse effects
A

Lipopeptide that disrupts the cell membrane of gram + cocci by creating transmembrane channels

S aureus skin infections
(MRSA), bacteremia, endocarditis, VRE

Adverse

  • myopathy
  • rhabdomyolysis
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42
Q

S. aureus tissue destruction with MRSA uses what toxin ____ affects what two cell types

A

Panton-Valentine Leukocidin

Neutrophils
Macrophages

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43
Q

Gram positive rods

A

Clostridum (anaerobes)
Corynebacterium
Listeria
Bacillus

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44
Q

Gram negative oxidase positive diplococci

1) sputum from COPD
2) Urethral discharge
3) CSF

A

1) sputum from COPD= Moraxella catarrhalis
2) Urethral discharge= N. gonorrhoeae
3) CSF= N. meningitis

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45
Q

Gram negative cocci

Gram negative coccobacill

A

Cocci

  • N. meningitidis
  • N. gonorrhea
  • Moraxella catarrhalis

Coccobacilli

  • H. influenza
  • Bordatella pertussis
  • Pasteurella
  • Brucella
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46
Q

Gram negative Lactose fermenting rods

Gram negative non lactose fermenting rods

A

Lactose (Fast)

  • Klebsiella
  • E.coli
  • Enterobacter

Lactose (slow)

  • Citrobacter
  • Settaria

Non lactose fermenter

  • Shigella
  • Salmonella
  • Proteus
  • Yersinia
  • Pseudomonas (oxidase +)
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47
Q

Painful enlarged swollen LN in groin

Came into contact with animal

A

Yersinia pestis

Safety pin on staining

Prarie dog

New mexico

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48
Q

[Linezolid, Tetracycline, Aminoglycoside, Macrolides, Chloramphenicol, clindamycin]

1) Ototoxicity
2) Pseudomembranous colitis
3) Prolonged QT
4) Gray baby syndrome
5) PHotosensitivity
6) MRSA/ VRE coverage
7) Anaerobic coverage
8) Discolored teeth
9) Atypical pneumonia coverage

A

1) Aminoglycosides
2) Clindamycin
3) Macrolide
4) Chloramphenicol
5) Tetracycline
6) Linezolid
7) Clindamycin
8) Tetracycline
9) Macrolide

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49
Q

MOA of each drug

1) Sulfamethoxazole
2) Trimethoprim
3) Levofloxacin
4) Nitrofurantoin
5) Metronidazole
6) Polymyxin B

A

1) Sulfamethoxazole
- Inhibit dihydropteroate synthetase

2) Trimethoprim
- inhibit dihydrofolate reductase

3) Levofloxacin
- Inhibit DNA gyrase (topoisomerase II)

4) Nitrofurantoin
- Inhibit bacterial ribosomes

5) Metronidazole
- Forms toxic free radicals that damages DNA

6) Polymyxin B
- Acts like cationic detergent

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50
Q

1) Vomiting and watery diarrhea on cruise

2) Watery diarrhea 12 hrs after eating meat or poultry from cafeteria

A

1) Norovirus

2) Clostridium perfringens

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51
Q

Which RNA virus

1) Hand, foot, and mouth
2) Break bone fever
3) Common COld
4) Fever, jaundice, black vomit
5) Meningitis in summer months
6) Tourniquet test helps diagnose hemorrhagic disease
7) Infects motor neurons of anterior horn

A

1) Hand, foot, and mouth= coxsackievirus
2) Break bone fever= dengue
3) Common COld= rhinovirus, coronavirus
4) Fever, jaundice, black vomit= yellow fever
5) Meningitis in summer months= Echovirus, coxsackievirus, other enteroviruses
6) Tourniquet test helps diagnose hemorrhagic disease= dengue
7) Infects motor neurons of anterior horn= poliovirus, west nile virus

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52
Q

Which antiviral

1) Prophylaxis for influenza A
2) used to tx for chronic hep C
3) First line for herpes simplex virus or VZV

A

1) Prophylaxis for influenza A= zonamivir, oseltamivir
2) used to tx for chronic hep C= ribavirin + IFN-alpha
3) First line for herpes simplex virus or VZV = acyclovir, valacyclovir, famiciclovir

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53
Q

Bilateral interstitial infiltrates

Silver stain

Tx

A

Pneumocystis jirovecii

circular ring with clear center

TMP-SMX

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54
Q

Flu vaccine against what part

A

Humoral response to hemaglutinin

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55
Q

Organisms that cause granulomatous disease

  • Bacteria
  • Fungal
  • Parasitic
A

Bacteria

  • Mycobacteria (tuberculosis, leprosy)
  • Bartonella henselae (cat scratch)
  • Listeria monocytogenes
  • Treponema pallidum (tertiary syphilis)

Fungal
- Histoplasmosis

Parasitic
- Schistosomiasis

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56
Q

Zoonotic bacteria

1) Cat scratch
2) Rodents to Tick
3) Cattle fluids
4) Birds and pigs
5) Birds
6) Infected placenta or contaminated fluid of newborn farm animals
7) Lone star tick
8) Rabbit or squirrel
9) Infected animal urine
10) Nine-banded armadillo
11) dog bit
12) Lice
13) Fleas
14) Tick, rash on palms
15) Fleas, prairie dogs

A

1) Cat scratch= Bartonella henselae
2) Rodent to tick= Borrelia burgdorferi
3) Cattle fluids= Brucellosis
4) Birds and pigs= Campylobacter
5) Birds= Chlamydophila psittaci
6) Infected placenta or contaminated fluid of newborn farm animal= Coxiella burneii
7) Lone star tick= Ehrlichia chaffeensis
8) Rabbit or squirrel= Francisella tularensis
9) Infected animal urine= Leptospira
10) Nine-banded armadillo= Mycobacterium leprae
11) Dog bite= Pasteurella multocida
12) Lice= Rickettsia prowazekii
13) Fleas= Rickettsia typhi
14) Tick, rash on palm= Rickettsia rickettsii (rocky mountain spotted fever)
15) Fleas, prairie dogs= Yersinia pestis

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57
Q

Obligate anaerobes (3)

Tx

A

Clostridium species
Actinomyces (Gram +)
Bacteroides (Gram -)

Tx metronidazole
Clindamycin

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58
Q

Headache
Fever
Rash on wrist and ankles moves to palms soles and trunk

A

Ricketta ricksttsii

Rocky mountain spotted fever

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59
Q

Pseudoappendicitis

A

Yersinia enterocolitica

Heat stable toxin

Increase cGMP

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60
Q

Common infectious organism of tonsils and adenoids

Common infectious organism of salivary gland

A

S. pyogenes

S. aureus, viridans group streptococci

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61
Q

Bacteria vaccine

  • toxin
  • capsular polysaccharides
  • killed bacteria
  • live attenuated bacteria
A

Toxin
- Tetanus toxoid

Capsular polysaccharides

  • S. pneumoniae
  • H. influenzae

Killed bacteria
- Vibrio cholerae

Live attenuated bacteria

  • Typhoid vaccine
  • BCG vaccine
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62
Q

Lactose non-fermenters
Urease producing

-Creates what

A

Proteus spp

Alkaline urine 
Struvite stones (Staghorn calculi)
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63
Q

What is the unique features of gram negative bacteria cell wall

A

Outer membrane

  • endotoxin (LPS)
  • induce IL-1, TNF alpha
Periplasmic space (between membranes) 
- beta lactamase
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64
Q

Spore forming bacteria

A

Bacillus anthracis
Bacillus cereus

Clostridum spp
(perfringens, tetani, botulinum, difficle)

Coxiella burnetti

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65
Q 
Weight loss 
Lymphadenopathy 
Hyperpigmentation 
Cardiac symptoms 
Arthralgias 
Neurlogic symptoms 
PAS+ Foamy macrophages in lamina propria
A 
Whippe disease
Tropheryma whipplei (Gram +)

Penicillin
Ampicillin
Tetracycline

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66
Q

Nef

tat

A

HIV regulatory genes

Nef: downregulates teh expression of class I major histocompatibility complex proteins on teh surface of infected cells, limits immune recognition by cytotoxic T cells

tat: is a transcriptional activator that promotes viral gene expression

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67
Q

5 y.o difficulty breathing
dysphagia
drooling fever
Swollen and cherry red epiglottis

sign

A

H. influenzae type B

thumb sign

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68
Q 
Headache
Fever 
Malaise 
Cough 
Nodular infiltrates 
Clumping once room temp
A

Mycoplasma pneumoniae

Walking pneumoniae
Cross reactive IgM
Activate complement –> erythrocyte lysis

Cold agglutinins

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69
Q

1) Parasite eggs in stool
2) Perianal egg deposition
3) Proglottids in the stool
4) Rhabdoitiform larvae in the stool
5) Trophozoites and cysts in the stool

A

1) Schistosoma mansoni or S. japonicum
2) Enterobius vermicularis (pinworms)
3) Intestinal tape worms (Taenia solium, T saginata, Diphyllobothrium latum)
4) Strongyloides stercoralis
5) Protozoal infections (Giardia lamblia, entamoeba histolyticsa)

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70
Q

Four obligate aerobic bacteria

A

Nagging Pest Must Breathe

Nocardia
Pseudomonas aeruginosa
Mycobacterium tuberculosis
Bacillus

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71
Q 
Fever 
Headache 
Nuchal rigidity 
Normal glucose 
elevated protein
A

Aseptic meningitis

Enteroviruses

  • coxsackievirus
  • echovirus
  • poliovirus
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72
Q

Pig farmer

A

Loeffler syndrome
Ascaris infection

Eosinophilic invasion due to parasitic infection

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73
Q

Goes with?

Lecithinase

M protein

Protein A

Trehalose dimycolate

Polyribosylribitol phosphate (PRP)

A

Lecithinase: toxin A, clostridium perfringens
- results in cell lysis and gas gangrene

M protein: strep. pyogenes
-Binds factor H to prevent opsonization and destruction by alternative complement pathway

Protein A: staph aureus
- prevent opsonization by binding Fc region of immunoglobulins

Trehalose dimycolate: cellw all component , mycobacterium tuberculosis
- protects from being killed by macrophages and stimulates granuloma formation

Polyribosylribitol phosphate: Haemophilus influenzae type b
- capsule protects against phagocytosis and complement mediated lysis by binding factor H (prevents complement C3b deposition on host cells

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74
Q

1) Budding yeast with thick capsule
2) Macropahges with intracellular small yeast
3) Round spherules iwth multiple endospores
4) Septate hyphae with dichotomous branching
5) Yeasts with pseudohyphae and blastoconidia

A

1) Cryptococcus neoformans
- bird droppings
- immunocompromised
- meningoencephalitis

2) Histoplasma capsulatum
- Missouri caves
- fever nonproductive cough

3) Coccidioides immitis
- pulmonary disease

4) Aspergilus fumigatus
- V shaped branching
- AIDS

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75
Q

Multiple ulcers
Mucosal erosions
Large cells iwth basophili cintranuclear and intracytoplasmic inclusions`

A

CMV

herpesvirus

76
Q

Rash followed by desquamation of hands and feet (sloughing of skin)
Snuffles (blood tinged nasal secretions)
Skeletal abnromalities
Hepatomegaly

A

Early manifestations Congenital syphilis (during first 2 years)

77
Q

Identify

1) Multiple painful ulcers
2) Painful single ulcer
3) Painless ulcer, raised indurated edges
4) School of fish
5) Granulomatous lesions on skin ( large areas of dying flesh)

A

1) Herpes simplex
2) Haemophilus ducreyi
3) Syphilis
4) Haemophilus ducreyi

5) Tertiary syphilis
- Gummatous syphilis

78
Q

Severe fetal anemia
Ascites
Pleural effusions

A

Hydrops fetalis

Parvovirus B19

79
Q

Clostridium perfringens toxins

A

Alpha toxin (phospholipase)

  • Gas gangrene
  • Myonecrosis

Enterotoxin

  • Food poisoning
  • Food left out too long once cooked
80
Q

Bacteria w/ capsule pneumonic

A

Even Some Pretty Nasty Killers have Shiny Bodies

E coli 
Strep pneumonia 
Pseudomonas 
Neisseria meningitidis 
Klebsiella 
Haemophilius influenza type B 
Salmonella 
Group B strep

Cryptococcus neoformans
- encapsulated yeast

81
Q

Bilateral facial nerve palsy

Tx

A

Borrelia burgdorferi

Ixodes tick

Tx Doxycycline (early stage)
Amoxicilin (children <8)
Doxycycline or Ceftriaxone (late)

82
Q

Rash involving palms and soles

Maculopapular

A

Kawasaki disease
Coxsackie A virus
Rocky mountain spotted fever
Syphillis

Meningococcemia

You drive Kawaski CARS with your hands and feet

83
Q

What three bacteria are obligate intracellular bacteria

A

Rickettsia
Coxiella
Chlamydia

84
Q

Replicative process

1) DS dna –> DS dna template –> ds DNA progeny
2) DS dna -> +RNA template -> partially ds-DNA
3) ssDNA –> ds DNA template –> ss DNA progeny
4) ss +RNA –> ds DNA template –> ss +RNA progeny
5) ss +RNA –> - RNA template –> ss + RNA progeny
6) ss -RNA –> +RNA template –> ss -RNA progeny

A

1) Adenovius, herpesvirus, poxvirus
2) Hepatitis virus
3) Parvovirus B19
4) Retroviruses (HIV)
5) poliovirus
6) Influenza virua, measles virus, rabies virus

85
Q

Facial infection of jaw/mandible

Sinus tracts draining pus

A

Actinomyces israelii

86
Q

Shiga toxin

A

Cleaves host rRNA at adenine base in 60S ribosomal subunit

Inhibition of protein synthesis

Shigella

87
Q

Repetitive unilateral shooting/ shock like pain in face. Triggered by chewing, talking touching certain parts of face. Lasts seconds to minutes. Increase in intensity and frequency over time

Tx

A

Trigeminal neuralgia

Carbamazepine
- Blocks Na channels

88
Q

Appendectomy, Anesthesia by mask to quickly anesthetize would have what characteristic

A. High blood solubility
B. High cerebrospinal fluid solubility
C. High lipid solubility
D. Low blood solubility
E. Low lipid solubility
A

D. Low Blood solubility

CNS drugs must be lipid soluble (cross the bbb)

Drugs with low solubility in blood= rapidly induction and recovery time

Increase solubility in lipids= increased potency

89
Q

A) Antibodies directed against the glycoprotein (Gp) IIb/IIIa complex
c) Decreased concentration of the GpIb/IX complex
D) Decreased concentration of the GpIIb/IIIa complex
F) Deficient binding of von Willebrand factor to the GpIb/IX complex

A

A) ITP

C) Bernard-Soulier

D) Glanzman thromboasthenia

F) Von Willebrand def

90
Q

Blistering lesions in sun exposed areas. Recurrent hx of these lesions.

Increased Total porphyrin
Increase Urine uroporphyrin III

Precursor to uroporphyrin?

A

Dx: Porphyria

Precursor= Succinyl-CoA

Defective uroporphyrinogen decarboxylase= porphyria cutanea tardia.

Succinyl-CoA combines with glycine to form ALA start of heme synthesis

91
Q 
Enlarged tongue
Progressive weakness
Hypotonia
Cardiomegaly
Increased glycogen

Impairment of what enzyme?

A. Branching enzyme
B. Glucose-6-phosphatase
C. alpha-1,4-glucosidase
D. Glycogen synthase
E. Phosphoglucomutase
A

C. Alpha-1,4- glucosidase

Pompe disease

92
Q

Heart transplant
One year later, increase BP and creatinine. Which immunosuppressive drug would cause this?

A) Azathioprine
B) Corticosteroid
C) Cyclophosphamide
D) Cyclosporine
E) Muromonab CD3
A

D) Cyclosporine

  • Nephrotoxicity
  • HTN
  • Gingival hyperplasia
  • Hirsutism

Azathioprine
- Pancytopenia

Cyclophosphamade

  • Hemorrhagic ycstitis
  • SIADH
93
Q

Bulimia values

K
HCO3
Anion Gap
pH

A

Increase pH
Increase HCO3
Decrease K
Normal Anion gap

94
Q

Blood dots on tongue and lips
Progressive SOB
Nosebleeds
CLubbing nails

Disease?
What is causing SOB

A

Hereditary hemorrhagic telangiectasia (osler-weber-rondu)

Arteriovenous malformations (AVMS)
- atrial septal defect
95
Q

Hematocrit

A

Volume of RBC compared to total volume

96
Q

Major manifestations

Familial chylomicronemia assoc with

Familial hypercholesterolemia assoc with

Familial dysbetalipoproteinemia assoc with

Familial hypertriglyceridemia

A 
Familial chylomicronemia 
- Acute pancreatitis
- Hepatomegaly
- Eruptive skin xanthomas 
(Tendon xanthomas)

Familial hypercholesterolemia

  • Premature MI
  • Tendon xanthomas
  • Corneal arcus

Familial dysbetalipoproteinemia

  • Premature MI
  • Palmar xanthomas

Familial hypertriglyceridemia

  • Pancreatitis risk
  • Obesity
  • Insulin resistance
97
Q

Nest of polygonal cells with congo red positive deposits

A

Medullary thyroid cancer

Polygonal shaped cells with extramedullary amyloid deposits

Polygonal or spindle shaped cells with extrameduallary amyloid deposits

98
Q

Branching structures with interspersed calcified bodies

A

Papillary thyroid cancer

Psammoma bodies

99
Q

Pleomorphic giant cell nests with occasional multinucleated cells

A

Anaplastic thyroid cancer, aggressive

Often irregular giant cells and biphasic spindle cells

100
Q

Fabry disease most at risk for developing

A

Renal failure

Neuropathic pain
Angiokeratomas
Telangiectasias
glomerular disease (proteinuria)
Cerebrovascular disease (stroke)
Cardiac disease (left ventricular hypertrophy)
101
Q

13 yo girl. Blood pressure 152/91. Lack of secondary sexual characteristics and pelvic examination shows a blind vagina. Lab studies show hypokalemia and low testosterone and estradiol levels. Cytogenetic analysis shows 46, XY karyotype. What is deficient

A. 21-hydroxylase
B. 17a- hydroxylase
C. 11b-hydroxylase
D. Side chain cleavage enzyme
E. 5a-reductase
A

B. 17a- hydroxylase

102
Q

Spliceosomes remove introns at

A

GU at 5’ splice site

AG at 3’ splice site

103
Q

Progressive back pain
Intermittent fever
Vertebral boen destruction with fluid collection

A

Mycobacterium tuberculosis spondylitis (potts disease)

104
Q

Pruritic skin rash
Pink papules symmetrically over anterior surface of shins and ankles
Hyperkeratosis with a thickened granular layer
Rete ridges with sawtooth appearance
Scattered colloid bodies

A

Lichen Planus

105
Q

Acute dystonic reaction

  • is what
  • due to
A

Spasmodic torticollis

Antipsychotic medication

D2 antagonism of nigrostriatal pathway

106
Q

Name

1) Bile soluble
2) Bacitracin sensitive
3) Complete hemolysis
4) Optochin sensitive
5) Growth in hypertonic saline
6) Optochin resistance
7) Bile insoluble

A

1) Bile soluble= S. pneu
2) Bacitracin sensitive= Streptococcus pyogenes

3) Complete hemolysis= Group A Strep (s. pyogenes)
Group B Strep ( S. agalactiae)

4) Optochin sensitive= S. pneu

5) Growth in hypertonic saline= gamma- hemolytic ( No hemolysis )
Enterococci
S. bovis

6) Optochin resistance= Viridans group streptococci
7) Bile insoluble= VIridans group streptococci

107
Q

More chloride in RBC

Enzyme responsible

A

Excess HCO3 transferred out of RBC in exchange for Cl

Carbonic anhydrase

108
Q

Thickening of pleural membranes around whole lung

Disease
Due to
Histology

A

Mesothelioma
- Asbestos exposure

Spindle cell positive for cytokeratin

109
Q

Central areas of whorled collagen fibers in lungs

A

SIlicosis
- inhaled silica

Nodules of whorled collagen fibers and dust-laden macrophages

110
Q

Riboflavin deficiency

WHat enzyme impaired?
A. Fumarase
B. G6PD
C. HMG-COA reductase
D. Isocitrate dehydrogenase
E. Malate dehydrogenase
F. Succinate dehydrogenase
G. Succinate thiokinase
A

F. Succinate dehydrogenase

111
Q

Cytotoxic exotoxin organisms

A

Clostridium botulinum
Clostridium tetani
Corynebacterium diphtheriae

Promote host cell death

112
Q 
Dysphagia
Dry mouth 
Blurred vision
Mydriasis
Poorly reactive pupils

Suggests

A

Clostridium botulinum toxin
- neurotoxin

Inhibit ACh release

Canned foods

113
Q

Nephrotic syndromes

  • proteinuria
  • albumin
  • feature

Does not have

Examples

A

Heavy proteinuria

Low albumin

Edema

No hematuria or red blood cell casts

Diabetic nephropathy
Membranous nephropathy
Minimal change disease

114
Q

Nephritic syndrome

  • proteinuria
  • albumin
  • features
A

<3.5 proteinuria

Hematuria
Red blood cell casts

Azotemia
HTN

PSGN
Membranoproliferative
Lupus nephritis
IgA nephropathy

115
Q

Nephritic syndrome associated iwth normal complement levels

A

IgA neprhopathy

116
Q

Oliguria
High serum creatinine level
Intranasal ulcer that wont heal

Ab against?

A. Glomerular basement membrane
B. Smooth m. cells
C. Neutrophils
D. Erythrocytes
E. Platelets
F. Mitochondria
A

C. Neutrophils

Granulomatosis with polyangiitis (wegners)

Nasal mucosal ulcerations and glomerulonephritis

+ c-ANCA
( cytoplasmic staining anti-neutrophil cytoplasmic antibodies)

117
Q

Excessive bleeding in patient with renal dysfunction due to

A

Accumulation of uremic toxins

Impair platelet aggregation and adhesion

Prolonged bleeding
Normal platelet count
Normal PT and PTT

118
Q

Sore throat and fever
Mild tonsillar erythema and exudates

Clumped gram positive bacteria with polar granules that stain deeply with analine dyes

Pathogenesis?

A

Diphtheria

AB Exotoxin

  • B binds heparin-binding epidermal growth factor
  • A inhibits host cell protein synthesis by catalyzing the ADP-ribosylation of protein elongation factor EF-2

Impairment of protein synthesis

119
Q

Jejunum removal requires what supplementation after

A

Decrease in gastric acidity as diminishes iron absorption

Iron absorption duodenum and proximal jejunum

120
Q

Ascorbic acid absorbed where

Pyridoxine absorbed where

Biotin absorbed where

Panthothenic acid absorbed where

A

Vit C: distal small bowel

Pyridoxine (B6) jejunum and ileum

Biotin (B7) small and large intestine

Panthothenic aicd (B5) small and large intestine

121
Q

Large cells iwth intranuclear eosinophilic inclusions, intracytoplasmic basophilic inclusions

  • Presentation
  • Tx
A

CMV

Fever, fatigue, abdominal pain, diarrhea

Ganciclovir
- interferes with viral replication by competitvely inhibiting the incorporation of guanosine triphosphate into CMV stands by CMV DNA polymerase

122
Q

Right gaze

  • right eye: right
  • left eye: forward

Neutral normal

Left gaze
- both look left

Convergence: normal

A

Left internuclear ophthalmoplegia

Damage to medial longitudinal fasciculus

Lesion at left dorsal pons

123
Q 
Fever 
Body aches
Generalized weakness
Rash on legs
Abdominal pain and weight loss
Decreased sensation in leftfoot
Edema
Biopsy: necrotizing vasculitis without IgA deposition
c-ANCA and p-ANCA negative
Image: red dots all over legs

What is most likely associated with the vasculitis?

A. Hepatitis B seropositivity
B. History of heavy smoking
C. Jaw claudication
D. Recent upper respiratory infection
E. Weak pulses in upper extremities
A

A. Hepatitis B seropositivity

Patient has polyarteritis nodosa (PAN)

Vasculitis of medium vessels
Spares lungs
Palpable purpura
Assoc w/ Hep B
Necrotizing inflammatory lesions
HTN
Asymmetric polyneuropathy
Skin lesions
GI
124
Q

+ p-ANCA
Lungs
Kidneys
Nasophagyngeal

A

Microscopic polyangitis

125
Q

5 y.o low grade fever and rash
Bright red erythemaous rash on face prominent on cheeks
Blanching reticulated rash on arms and trunk. Up to date on vaccinations. Facial rash erupted 3 days ago and body rash this morning. Reticulocytopenia

A. Coxsackievirus A
B. Human herpesvirus 6
C. Measles
D. Parvovirus B19
E. Streptococcus pyogenes
A

D. Parvovirus B19

Fifth’s disease
Erythema infectiosum

Slapped cheek

  • respiratory droplets
  • bone marrow suppression
126
Q

Sand paper rash

A

Strep pyogenes

Scarlet fever

Delayed type skin reactivity to pyrogenic exotoxins

127
Q

Bone tumor

1) Anaplastic stromal cells make a tumor osteoid bone matrix
2) Epitheloid clusters with vesicular nuclei and abundant vacuolated soap bubble like cytoplasm
3) Sheets of oval/spindle cell with interspersed large multinuclearted ostoclast like giant cells
4) Small round cells some of which are binucleated with abundant cartilage like matrix

A

1) Osteosarcoma
2) Chordomas
3) Giant cell tumor
4) Chondrosarcoma

128
Q

Cardiogenic shock

A. High cardiac output
B. Hyperkalemic hyponatremic metabolic acidosis
C. Inadequate ventricular function
D. Low cardiac filling pressures
E. Low pulmonary wedge pressure
A

C. Inadequate ventricular function

Shock

  • Low blood pressure
  • Hypoperfusion
  • Adequate blood volume

Inability of heart to generate flow thorughout the body due to myocardial infarction

Unable to maintain oxygenation of its tissues

A. High cardiac output
- Septic shock early presentation

B. Hyperkalemic hyponatremic metabolic acidosis
- adrenal shock secondary to addisonian crisis

D. Low cardiac filling pressure
- opposite in shock, have high cardiac filling pressures due to failure of cardiac output to match venous return

E. Wedge pressure= left atrial pressure is elevated in shock

129
Q

Describes what

1) 2 micron spherical micro-organism in the brush border
2) 4-6 micron single cell organisms in the lumen near teh absorptive surface
3) Macrophages in the lamina propria bearing PAS positive bacteria
4) Superficial penertrating ulcers with a mixed inflammatory infiltrate perhaps containing non-caseating granulomas

A

1) Cryptosporidia
- malabsorption in immunocompromised

2) Giardiasis
- prevent absorption of nutrients
- nausea
- purple burps
- belching sulfurous taste
Ghost face on stain (ghost balloon)

3) whipple disease
4) crohns disease

130
Q

CTG trinucleotide in a serine-threonine kinase
- caused by

Instability during both maternal and paternal meiosis

Instability during paternal meiosis

A

Myotonic dystrophy type I (DM1)
-Instability during maternal meiosis

Friedreich ataxia

  • AR
  • GAA repeat
  • Limb and gait ataxia
  • Cardiomyopathy
  • DM

Huntington disease
CAG repeat

131
Q

Uncontrollable facial and chest flushing
Diarrhea
Wheezing
Elevated 5-HIAA

Tx
Can led to
Additonal finding

A

Carcinoid syndrome
- secretion of serotonin

Octreotide

Niacin deficiency

Tricuspid regurgitation

132
Q

H2S enterobacteriaceae

A

Salmonella

133
Q

1) Microcytic hypochromic RBC with coarse basophilic stippling
2) Microcytic hypochromic RBC with elongation

A

1) Beta-thalassemia

2) Iron deficiency anemia

134
Q

Hypertensive crisis

A 
Severe HTN
End organ symptoms
Tachycardia
Cardia arrthymias
Stroke

Too much monoamine oxidase inhibitors
or taken with drugs that potentiate catecholamine activity or tyramine (wine cheese)

135
Q

Neuroleptic malignant syndrome

A

Adverse drug rxn to antipsychotic

Increased dopamine blockade throughout body

Autonomic instability
Muscle rigidity
high fever
Decreased reflexes

"FEVER"
Fever
Encephalopathy
Vital signs unstable
Elevated creatine phosphokinase
Rigidity of muscle
136
Q

What would increase MVP murmur

A

Valsalva maneuver

Decrease volume of left ventricle, causes the prolapse to occur sooner

137
Q

Increase preload maneuver

A

Squatting
Isometric handgrip

Aortic regurg louder

138
Q

Inspiration on heart murmur

A

increase right heart sounds

139
Q

Hand grip

A

Increase afterload

Increase intensity MR, AR, VSD
Decrease hypertrophic cardiomyopathy and AS murmurs

140
Q

Valsalva

A

Decrease preload

Decrease intensity of most murmurs

Increase hypertrophic cardiomyopathy

MVP earlier onset

141
Q

Rapid squatting

A

Increase venous return
Increase preload
Incerase afterload

Decrease intensity of hypertrophy cardiomyopathy

Increase MR, AR, and VSD murmur

MVP later onset

142
Q

VHL syndrome

  • inheritence
  • 3 features
A

AD

Multiple tumors including hemangioblastomas, RCC, pheochromocytomas

143
Q

Enlarged bilateral cystic ovaries in obese infertile female

due to
lab values
associated with

A

Polycystic ovarian syndrome

Increased LH production and slightly decreased FSH

Abnormal fxn of HPO axis
Deranged steroid synthesis by theca cells

Increased LH
Decreased FSH
Increased testosterone
Increased androgens
Increased estrogen

Insulin resistance type 2 DM

144
Q

Slowest and highest amplitude waves on EEG

A

Delta brain waves

non-REM stage 3

145
Q

Used to tx? STI

1) 5-flurouracil
2) Acyclovir
3) Metronidazole
4) Penicillin

A

1) HPV
2) HSV
3) Gardnerella vaginalis
4) Syphilis (trepponema pallidum)

146
Q 
Turkish Mediterranean descent
Mouth and genital ulcers
No sexual history
Uveitis
Erythema nodosum

What is it
Associated with

A

Behcet syndrome

Immune complex vasculitis

Associated iwth HLA-B51

147
Q

Alcoholic with swelling in extremities. Shifting dullness to percussion. Periumbilical vessels. Tender nodules at 5th intercostal space. Mechanism of edema?

A. Decreased plasma colloid oncotic pressure
B. Increased capillary hydrostatic pressure
C. Increased interstitial colloid oncotic pressure
D. Increased interstitial glycosaminoglycans accumulation
E. Increased permeability of the capillary walls

A

A. Decreased plasma colloid oncotic pressure

Cirrhosis of liver

Decreased production of albumin

148
Q 
Alcoholic in ER
Weakness, dizzinuess
Numbness in both lower extremities
Malnourished
Homeless
Bilateral rotatry nystagmus
Angular cheilitis

Microcytic hypochromic red cells with coarse basophilic granules

A

Vitamin B6 deficiency

Sideroblastic anemia
Numbness of extremities
Glossitis
Cheilosis

149
Q

Organism?

1) Cleaving SNARE protein required for neurotransmitter release
2) Inactivation of the 60S ribosome by cleaving rRNA
3) Inactivation of mitogen-activated protein kinase kinases

A

1) Clostridium tetani

2) Shigella species
- dysentery due to shiga toxin
- shiga toxin works by inactivating 60S ribosome through cleaving rRNA

3) Bacillus anthracis
- black eschar
- Protective factor and lethal factor combine on surface they form lethal toxin
- Lethal toxin is a Zn-dependent endoprotease that clips off the N-terminus of mitogen-activated protein kinase kinases (MAPKK)

150
Q

Diarrhea

1) Motile trophozoites on microscopy
2) Genome identified by reverse transcriptase PCR
3) growth at 42 C (107.6 F)
4) Growth on thiosulphase citrate bile salt sucrose agar
5) Lactose fermentation on MacConkey agar

A

1) Giardia lamblia
2) Norovirus
3) Campylobacter jejuni
4) Vibrio cholerae
5) E. Coli

151
Q

Patient with MS and spasticity tx

A

Baclofen
(Agonist at the GABA-B receptor)

Tizanidine
(alpha 2 agonist)

152
Q

Tumor penetration of basement membrane uses which substances

A

Collagenases and hydrolases (Metalloproteinase)

153
Q

Myelofibrosis

  • type of malignancy
  • clonal expansion of
  • secretion of
A

Hematopoietic stem cell malignancy

Megakaryocytes

TGF-beta secretion
- stimualtes fibroblasts to fill medullary space with collagen.

154
Q

Solid left adnexal mass
Ovarian mass is yellow and firm
Small cuboidal cells in sheet with glandular structures containing acidophilic material

Cells are arranged in microfollicular pattern around a pink eosinophilic center

A

Granulosa cell tumor
- secreting estrogen

Call-Exner bodies

155
Q

Duchenne muscular dystrophy mRNA change

A

Nonsense mutation

UCA –> [ UAA, UAG, UGA]

156
Q

Rituximab

Infliximab

Imatinib

Abciximab

A

Rituximab= Monoclonal Ab for CD20

Infliximab= TNF-alpha monoclonal Ab

BCR/ ABL (CML)

Monoclonal Ab againts platelet GP IIb/IIIa receptor

157
Q

Neurologic regression
Hepatosplenomegaly
Diminished reflexes
Cherry red spot

A

Niemann Pick

- Spingomyelin

158
Q

Total gastrectomy need to supplement

A

A water soluble vitamin

B12

159
Q

Lysing of blood cells when incubated in hypotonic saline with glycerol

A

Hereditary spherocytosis (HS)

160
Q

Progressive weakness and fatigue over last year. Loss of expression of mutation that codes for a protein found on basolateral surface of hepatocytes and enterocytes. Protein is known to interact with transferrin receptor

Greatest risk of developing?

A

Primary hemochromatosis
- mutation of HFE protein

Detects falsely low iron levels

Get iron accumulation

Enterocytes: increase apical expression of DMT1, increasing iron absorption

Hepatocytes: decreasing hepcidin synthsis, increased feroportin expression –> increased iron secretion

Iron excess –> bronze diabetes

At risk for hepatocellular carcinoma

161
Q

Type 2 DM
Confusion lethargy
Hypoglycemia
Elevated C-protein

What drug was used

A

Medication that stimulates pancreatic insulin secretion independent of blood glucose levels

Sulfonylureas (glyburide)

  • glyburide
  • glimepiride
  • glipizide
162
Q

Painless Testicular tumor
Elevated lactate dehydrogenase
Elevated alpha fetoprotein

A

Nonseminomatous germ cell tumor

  • embryonal carcinoma
  • yolk sac tumor
  • choriocarcinoma

hCG
AFP

163
Q

Flutamide MOA

Leuprolide MOA

Anastrozole MOA

Finasteride MOA

A

Flutamide: Impaired androgen receptor interaction
Competitive testosterone receptor inhibitor

Leuprolide: Long acting GnRH agonist
- decrease testicular leydig cell stimualtion

Anastrozole: Aromatase inhibitors
-Decrease peripheral conversion of androgens to estrogen

Finasteride: Decreases peripheral conversion of testosterone to DHT by binding 5alpha reductase

164
Q

Shigella infects via what cell

A

microfold (M) cells at base of mucosal villi within a Peyers patch

165
Q

Intranuclear inclusions in oligodendrocytes

A

Progressive multifocal leukocencephalopathy due to JC virus

166
Q

Bone pain
Hearing impairment

Multinucleated cells with over 100 nuclei

-Factor essential for differentiation of cells

A

Paget’s disease of bone

RANK-L
Receptor activator of nuclear factor kappa-B ligand

167
Q

Mitral regurgitation

  • Afterload
  • Preload
  • Ejection fraction
A

Afterload: decrease
(regurg so low resistance)

Preload: increase
(LV end-diastolic volume)

EF: Increase
(decreased afterload –> increase EF)

168
Q

Polyp formation mutation steps

A

1) Normal mucosa –> small adenomatous polyp (adenoma)
= APC mutation

2) Increase size of adenoma
= KRAS mutation

3) Malignant transformation, adenoma to carcinoma
= TP53 mutation

169
Q

5 y.o, bites on inbetween toes. Stool shows smooth thin walled eggs.

Infection?
Complication

A

Hookworm

  • Necator americanus
  • Ancylostoma duodenale

Egg-containing human feces in soil
- skin direct contact with soil

Larvae to lungs, rupture, coughed up and swallowed. In small intestine, mature into adults and attach to GI mucosa and feed on uman blood by lacerating capillaries

Iron- deficiency anemia
Microcytic anemia

170
Q

Fever HA confusion
Allergic to penicillin

Antibiotic started
Low Erythrocytes
Low Platelets
Low Leukocytes

which antibiotic?

A. Chloramphenicol
B. Clindamycin
C. Gentamicin
D. Metronidazole
E. Vancomycin
A

A. Chloramphenicol

Aplastic anemia

  • Carbamazepine
  • Chloramphenicol
  • Sulfonamides
171
Q

Brain natriuretic effect on kidney

A

Increases sodium excretion

Increase GFR

172
Q

Unilateral painless testicular enlargement. Bilateral gynecomastia. Elevated serum beta human chorionic gonadotropin level.

A. Choriocarcinoma
B. Diffuse large B cell lymphoma
C. Leydig cell tumor
D. Sertoli cell tumor
E. Yolk sac tumor
A

A. Choriocarcinoma

hCG has an analogue similar to LH –> precocious puberty, gynecomastia, impotence or loss of libido

Leydig

  • increased testosterone
  • Virulization and gynecomastia

Sertoli

  • androgens or estrogens
  • not enough to cause endocrinologic changes

Yolk Sac tumor

  • infants and children
  • painless bulky testicular mass
  • Alpha-fetoprotein
173
Q

Leydig cell tumor

  • secretion
  • causes
  • description
  • feature associated with
  • Marker
  • histology

Sertoli cell tumor

  • secretion
  • causes
  • description
  • histology
  • feature associated with
  • marker

Yolk Sac tumor

  • affects who
  • description
  • pattern
  • histology
  • feature associated with and description of
  • marker
A

Leydig

  • increased testosterone
  • Virulization and gynecomastia
  • yellow tan color
  • solid lobulated
  • Reinke crystals
  • Inhibin A
  • round nuclei, single prominent nucleoli and abundant eosinophilic cytoplasm or clear cytoplasm

Sertoli

  • androgens or estrogens
  • not enough to cause endocrinologic changes
  • well circumscribed, pale yellow to whitish gray
  • tall polyhedral cells arranged in nests, sheets and cords resembling spermatic tubules
  • perinuclear aggregates of intermediate filaments
  • Inhibin A marker
Yolk Sac tumor
- infants and children
- painless bulky testicular mass
-honey comb pattern
- reticular network is formed by vacuolated cytoplasm of tumor cells
-Schiller-Duvall bodies
(Central vessel rimmed by fibrous tissue and surrounded by malignant epithelial cells in a cystic space
- Alpha-fetoprotein
174
Q

First line A-fib

First line tx SVT

A

1) Afib
- Dofetilide (Class III antiarrhythmic)
- Blocks K channels

2) SVT
- Adenosine

175
Q

Spiking fevers
hepatosplenomegaly
Pancrytopenia

  • Disease
  • organism
  • transmitted
  • tx
A

Kala-azar
aka visceral leishmaniasis

Caused by parasite Leishmania donovani

Sand fly
India

Sodium stibogluconate

176
Q

MRI of child’s brain reveals enamel-like calcifications and tumor that is located supratentorially

A. Containing foamy cells that are highly vascular
B. A remnant of Rathke’s pouch
C. Containing solid rosettes of small blue cells
D. Composed of Rosenthal fibers
E. Having a “Fried egg” appearance on histology

A

B. A remnant of Rathke’s pouch

Craniopharyngioma

Ectoderm

Supra cellar calcifications

177
Q

Brain tumor

1) Highly vascular foamy cells
2) Containing solid rosettes of small blue cells
3) Composed of Rosenthal fibers
4) Having a “fried egg” appearance on histology

A

1) Von Hippel-Lindau disease
2) Neuroblastoma

3) Rosenthal fibers are corkscrew-shaped intracytoplasmic inclusions that are seen in optic gliomas of neurofibromatosis 1 and pilocystic astrocytomas
- AD
- Cafe au lait
- visual disturbances

4) Oligodendrogliomas

178
Q

Tumor in proximal colon
Signet ring cells
Father and grandfather same presentation

A. Alternative splicing
B. Base excision repair
C. Mismatch repair
D. Nucleotide excision repair
E. Purine salvage
A

Lynch syndrome
- Hereditary nonpolyposis colorectal cancer

C. Mismatch repair

179
Q 
21 month old
Sick all the time
Oral thrush
RSV and influenza
Impetigo and exudative tonsillitis
A

Severe combined immunodeficiency

180
Q

50 y.o man. Fatigue, fevers, joint and muscle pain and weight loss. Cough and dyspnea and occasional hemoptysis. Denies upper respiratory involvement. Peripheral sensory loss. Palpable purpura on skin and elevated erythrocyte sedimentary rate. Hematuria and mild proteinuira. Biopsy: vasculitis with an absence of granuloma formation.

Diagnosis
Marker
Tx

A

Microscopic polyangiitis (MPA)

Males 50 y.o

[Dont have chronic sinusitis seen in granulomatosis w/ polyangiitis]

Necrotizing vasculitis involving kidneys, lungs and skin with pauci-immune glomerulonephritis and palpable purpura

p-ANCA +
(anti-myeloperoxidase)

Tx Cyclophosphamide

181
Q 
Nausea, vomiting
Vertigo
Numbness on right side of face
Dysarthria and dysphagia
Uvula deviation to left
Hemianalgesia on right side of face and left side of body
Ataxia

Artery involved

A

Lateral medullary syndrome

RIght PICA

182
Q

Loss of pain and temp on face and body
Ipsl facial hemiparesis
Ipsilateral deafness
C/L body analgesia

A

Lateral pontine syndrome

AICA

183
Q 
Fever that rises and falls through day
Night sweats
Joint pain
Heart murmur
Mexico
Goat cheese and unpasteurized milk
A

Brucellosis

184
Q

Recurrent pyogenic infections
Oculocutaneous albinism
Progressive neurologic abnormalities
Coagulation defects

A

Chediak-Higashi syndrome
- AR

Abnormal lysosomal trafficking protein that results in defective phagolysosome formation

185
Q

Nephritic vs Nephrotic types

A 
Nephritic
[ HTN, Inc BUN/CR, Oliguria, RBC casts]
1) Post streptococcal glomerul
2) Rapidly progressive glomer
3) IgA nephropathy (berger)
4) Alport
5) Membranoproliferative glome
Nephrotic
[Proteinuria, edema]
1) Focal segmental glomeruloscl
2) Minimal change
3) Membranous nephropathy
4) Amyloidosis
5) Diabetic glomerulonephri

Nephritic/Nephrotic

  • Diffuse proliferative glomerulonephrtis
  • Membranoproliferative glomerulonephritis
186
Q

Temporal vs parietal radiation visual defect

A

Temporal
-upper right quadrant

Parietal
- Lower left quadrant

187
Q 
Fever Rash
Dysuria
Urinary urgency
Hematuria, mild proteinuria
WBC (eosinophils) in urine
Azotemia
Costovertebral angle tenderness

Diagnosis
Caused by

A

Acute interstitial nephritis

Drug induced

5 P's
Pee (diuretics)
Pain-free (NSAIDs)
Penicillins and cephalosporins
Proton pump inhibitors
RifamPin

AM- STEP1 (20 decks)

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