April 21

Question 1

Failure of left and right hemispheres to separate and seen in Patau syndrome and fetal alcohol syndrome?

Answer 1

Holoprosencephaly–may be related to mutations in sonic hedgehog signaling pathway

Question 2

What do MHC I molecules consist of?

Answer 2

Heavy chain and B2-microglobulin

–expressed on all nucleated cells

Question 3

What is the function on enhancer sequence and where can it be found?

Answer 3

Stretch of DNA that alters gene expression y binding transcription factors
–may be located close to, far from, or even within (in an intron) the gene whose expression it regulates

Question 4

Active SLE is characterized by…

Answer 4

Consumption of complement with reduced serum complement levels
–binding of autoantibodies to self-antigens leads to deposition of immune complexes in tissues and consumption of complement

Question 5

What are the classic findings seen with neonatal abstinence syndrome and what is used to treat it?

Answer 5

Tremors–jittery movements and hypertonia
Irritability
Diarrhea
Poor feeding

Caused by opioid withdrawal–tx with methadone or morphine

Question 6

What are the characteristics of schizotypal personality disorder?

Answer 6

Eccentric appearance, odd beliefs or magical thinking, interpersonal awkwardness

SchizoTypal= magical Thinking

Question 7

Malignant cells with polygonal clear cells filled with accumulated lipids and carbohydrates?

Answer 7

Clear cell renal cell carcinoma —originates from PCT cells

Metastasizes to lung and bone

Question 8

What are the high potency antipsychotics?

Answer 8

Trifluoperazine
Fluphenazine
Haloperidol

Try to Fly High–neurologic side effects–EPS

Question 9

What are the low potency antipsychotics?

Answer 9

Chlorpromazine
Thioridazine

Cheating Thieves are low–anticholingeric, antihistamine, and a1-blockade effects

Question 10

Silicosis is associated with increased susceptibility to _____ through what mechanism?

Answer 10

TB
–Macrophages respond to silica and release fibrogenic factors–leading to fibrosis–silica disrupts phagolysosomes and impairs macrophages –increased susceptibility to TB

Question 11

Chlamydia trachomatis L1-L3 causes what and is characterized by…

Answer 11

lymphogranuloma venereum

Characterized by initial PAINLESS ulcer with later progression to painful inguinal lymphadenopathy (buboes) and ulceration

Question 12

What is the cause of thoracic outlet syndrome?

Answer 12

Compression of lower trunk of brachial plexus and subclavian vessels –within scalene triangle–space bordered by anterior and middle scalene muscles and 1st rib

Syms worsen with overhead activity

• Upper extremity numbness
• Tingling
• Weakness
• Edema due to vascular compression

Question 13

What is the MOA of amyl nitrate when given for cyanide poisoning?

Answer 13

Oxidizes Fe2+ —> Fe3+ –metHb which has high affinity for cyanide limiting toxic effects of cyanide

Thiosulfate and hydroxocolbalamin are also given which bind cyanide and eliminate in urine

Question 14

What is the function of DNA polymerase I, found in prokaryotes only?

Answer 14

Excises RNA primer with 5’–>3’ exonuclease—removes RNA primary created by RNA primes and repair damaged DNA sequences

Same function as DNA polymerase III BUT also excesses RNA primer

Question 15

What is the role of TATA and CAAT boxes?

Answer 15

Promoter–site where RNA polymerase II and multiple other transcription factors bind to DNA upstream from gene locus to initiate transcription

Question 16

Atopic dermatitis (eczema) is associated with what?

Answer 16

Often associated with other atopic diseases

• Asthma
• Allergic rhinitis
• Food allergies

Increased serum IgE

Question 17

B-oxidation of fatty acids is inhibited by what?

Answer 17

Malonyl-CoA

• -Acetyl-CoA is converted to Malonyl-CoA outside the mitochondria during De Novo fatty acid synthesis
• -Malonyl-CoA blocks Carnitine shuttle into mitochondrial matrix—blocking B-oxidation of fatty acids (blocks breakdown)

Question 18

Spironolactone and epleronone inhibit aldosterone, which has what effect on the renal collecting tubule?

Answer 18

Blocks reabsorption of Na+
Decreases loss of K+ and H+

Normally aldosterone increases Na+ and H2O reabsorption within the collecting tubule and causes loss of K+ and H+ into the urine

Question 19

High levels of ____ and ____ increase cholesterol solubility and decrease the risk of gallstone production.

Answer 19

Bile salts

Phosphatidylcholine

Question 20

The scrotum drains into what lymph nodes?

Answer 20

Superficial inguinal lymph nodes

Question 21

Histological picture of acute post streptococcal GN?

Answer 21

LM–glomeruli enlarged and hyper cellular
IF–“starry sky”–granular appearance (“lumpy-bumpy”) due to IgG, IgM and C3 deposition along GBM and mesangium
EM–subepithelial immune complex humps

Question 22

What is the mechanism of action of Ipatropium?

Answer 22

Competitively blocks muscarinic receptors, preventing bronchoconstriction

Question 23

NSAID use can cause what 2 renal diseases?

Answer 23

Acute interstitial nephritis

Renal papillary necrosis

Question 24

Isolated atrial amyloidosis is due to what?

Answer 24

ANP-derived protein deposition

–common in normal aging

Question 25

Bloody fluid obtain on thoracentesis. Pleural biopsy shows shows proliferation of epitheliod-type cells that are joined by desmosomes, contain abundant tonofilaments, and are stubbed with very long, slender microvilli. Dx?

Answer 25

Mesothelioma

Question 26

What is the function of cord factor seen with TB?

Answer 26

Creates a serpentine cord appearance in virulent M. tuberculosis strains--inhibits macrophage maturation and induces release of TNF-a

Question 27

Alanine can be converted to glucose, but first its amino acid is transferred to_____.

Answer 27

a-ketoglutarate Alanine is responsible for transferring nitrogen to the liver for disposal --converted to glutamate through a-ketoglutarate where it turns into NH3 and enters the urea cycle

Question 28

Multiple PAINFUL superficial vesicles or ulcerations with erythematous base on genitals in sexually active pt is suggestive of what?

Answer 28

HSV-2 Dx by PCR or tzanck stain

Question 29

Pt with muscle wasting, cataracts, testicular atrophy, frontal balding, arrhythmia?

Answer 29

Myotonic dystrophy --My tania, my testicles, my toupee, my ticker AD--CTG trinucleotide repeat expansion in the DMPK gene--abnormal expression of myotonic protein kinase--> myotonia

Question 30

What artery supplies most of the femoral head and neck and if damaged can cause osteonecrosis of the femoral head?

Answer 30

Medial femoral circumflex

Question 31

Pt who underwent appendectomy has decreased suprapubic sensation, what nerve was most likely damaged?

Answer 31

iliohypogastric nerve--anterior branch

Question 32

What white blood cell is increased with corticosteroid therapy?

Answer 32

Neutrophils --results from demmargination of neutrophils previously attached to the vessel wall

Question 33

What are the functions of vWF?

Answer 33

Promotor of platelet adhesion at sites of vascular injury by binding platelet glycoproteins to sub endothelial collagen on injured blood vessels Acts to protect carrier protein for circulating factor VIII

Question 34

What is the most common cause of hypertrophic cardiomyopathy?

Answer 34

AD--mutation of the B-myosin heavy-chain

Question 35

Low FSH = low _____ and Low LH = low _____.

Answer 35

Inhibin B--because its stimulated to release by FSH and causes negative feedback to stop FSH testosterone

Question 36

Chronic lymphedema, usually caused by lymph node dissection with breast cancer, put pt at increased risk of?

Answer 36

Angiosarcoma --rare blood vessel malignancy

Question 37

Most common cause of death from friedreich ataxia, which is caused by trinucleotide repeat disorder--GAA on Ch 09 and leads to degeneration of multiple spinal cord tracts--> muscle weakness and loss of DTRs, vibratory sense, proprioception?

Answer 37

Hypertrophic cardiomyopathy ``` Staggering gait Frequent falling Nystagmus Dysarthria Pes cavus Hammer toes DM ``` Presents in childhood with kyphoscoliosis

Question 38

Syndrome characterized by low plasma sodium and osmolarity, inappropriately concentrated urine, and clinically normal body fluid volume...

Answer 38

SIADH--seen with small cell carcinoma of the lung

Question 39

What is a cell wall component and major virulence factor of H. influenzae?

Answer 39

PRP--polyribosylribitol phosphate | --part of type B---put in the vaccine which is conjugated to diphtheria toxoid

Question 40

Risk factors for cervical cancer...

Answer 40

Infection with high risk HPV--16, 18, 31, 33 Hx of STD Early onset sexual activity Multiple or high risk partners Immunosuppression History of vaginal or vulvar cancer Low socioeconomic status Tobacco use

Question 41

Urge incontinence (overactive bladder) is tx with?

Answer 41

Anti-muscarinic drug--targeting M3 receptors - -Oxybutynin - -Solifenacin - -Tolterodine

Question 42

What childhood brain tumor shows cystic spaces filled with thick, brown-yellow fluid rich in cholesterol?

Answer 42

Craniopharyngioma ---tumor of the anterior pituitary arise from remnants of Rathke's pouch (embryonic precursor of anterior pituitary) Intracranial calcified mass on imaging