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DIT End of Session Questions Flashcards

1
Q

What developmental structure matches the following description? 1. Fetal placental structure that secretes hCG 2. Maternal component of the placenta

A
  1. Syncitiotrophoblast 2. Decidua Basalis
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2
Q

What are the stages of an embryo between conception and an inner cell mass?

A

Zygote -> Morula -> Blastocyst (includes trophoblast and inner cell mass)

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3
Q

What other findings would you expect to see in a patient with an aganglionic colon and other neural crest derivative deficiencies?

A
  1. Peripheral nervous system abnormalities
  2. Autonomic dysfunction
  3. Conductive hearing loss
  4. Anterior chamber eye problems
  5. Dental abnormalities
  6. Albinism
  7. Heart defects
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4
Q

List as many drugs as you can that are contraindicated in pregnancy

A
  1. Methotrexate 2. Valproic Acid 3. Carbamazepine 4. Phenytoin 5. Tetracycline 6. Aminoglycosides 7. Atorvastatin 8. Vitamin A 9. ACE Inhibitors 10. Fluoroquinolones 11. Sulfonamides 12. Metronidazole 13. Warfarin 14. Clarithromycin 15. Diethylstilbestrol 16. Thalidomide
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5
Q

What is the relationship between the notochord, the neural plate, the neural tube, and the neural crest cells?

A

The mesodermal notochord induces overlying ectoderm to form the neural plate, which becomes the neural tube and neural crest

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6
Q

What is the embryologic origin of the following adult structures? 1. Anterior Pituitary 2. Cornea 3. Lens 4. Retina 5. Olfactory eptihelium 6. Mammary glands 7. Salivary glands 8. Sweat glands

A
  1. Anterior Pituitary = Surface Ectoderm 2. Cornea = Neural Crest 3. Lens = Surface Ectoderm 4. Retina = Neurectoderm 5. Olfactory eptihelium = Surface Ectoderm 6. Mammary glands = Surface Ectoderm 7. Salivary glands = Surface Ectoderm 8. Sweat glands = Surface Ectoderm
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7
Q

What must be present on a protein in order for that protein to gain entry into the nucleus?

A

Nuclear localization signals

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8
Q

Which types of proteins are responsible for fostering the progression through the cell cycle?

A

Cyclins and cyclin dependent kinases

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9
Q

Which cyclin-CDK complexes assist in the progression from G1 to S phase?

A
  1. Cyclin D + CDK4 2. Cyclin E + CDK2
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10
Q

Which cyclin-CDK complexes assist in the progression from G2 to M phase?

A
  1. Cyclin A + CDK2 2. Cyclin B + CDK1
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11
Q

What molecule targets proteins in the endoplasmic reticulum for lysosomes

A

Mannose-6-Phosphate

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12
Q

What are the different methods that a cell uses to break down proteins?

A
  1. Proteosomal degradation (via ubiquitin) 2. Lysosomal degradation 3. Calcium-dependent degradation
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13
Q

Which cell types are rich in smooth ER?

A
  1. Hepatocytes 2. Hormone-producing cells of the adrenal cortex
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14
Q

What drugs act on microtubules?

A
  1. Mebendazole & Thiobendazole (antihelminthic) 2. Vincristine & Vinblastine (Anticancer) 3. Colchicine (Microtubules of phagocytes) 4. Griseofulvin (Antifungal) 5. Paclitaxel (Anticancer -> stabilize MT’s)
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15
Q

What two fundamental substances are required to make most things work inside the cell?

A
  1. ATP 2. Calcium
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16
Q

Which organelle is responsible for the breakdown of very long-chain fatty acids?

A

Peroxisome

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17
Q

What are the intermediate filaments for the following tissue types and cellular structures? 1. Connective tissue 2. Muscle tissue 3. Epithelial tissue 4. Axons

A
  1. Connective tissue = Vimentin 2. Muscle tissue = Desmin 3. Epithelial tissue = Cytokeratin 4. Axons = Neurofilaments
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18
Q

What are the defects seen in Kartagener Syndrome?

A

Immotile cilia causing infertility, bronchiectasis, recurrent sinusitis, and Kartagener syndrome is associated with situs inversus

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19
Q

Which arachidonic acid product causes each of the following effects?

  1. Increased bronchial tone
  2. Decreased bronchial tone
  3. Increased platelet aggregation
  4. Decreased platelet aggregation
  5. Increased uterine tone
  6. Decreased uterine tone
  7. Increased vascular tone
  8. Decreased vascular tone
A
  1. Increased bronchial tone: Thromboxane and Leukotriene
  2. Decreased bronchial tone: PGI2 (Prostacyclin) and prostaglandin
  3. Increased platelet aggregation: Thromboxane
  4. Decreased platelet aggregation: PGI2
  5. Increased uterine tone: Prostaglandin
  6. Decreased uterine tone: PGI2
  7. Increased vascular tone: Thromboxane
  8. Decreased vascular tone: PGI2 and prostaglandin
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20
Q

What are the two most abundant substances in plasma membranes?

A

Cholesterol and phospholipids

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21
Q
  1. What drugs act on the arachidonic acid product pathway? What enzymes do they affect?

FA #404

A
  1. Corticosteroids inhibit phospholipase A2
  2. Zileuton inhibits lipoxygenase
  3. NSAIDS, Acetaminophen, COX-2 inhibitors, and Aspirin inhibit cyclooxygenase
  4. Zafirlukast and Montelukast inhibit leukotriene receptors
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22
Q

What substances do cytotoxic T cells and NK cells use to induce apoptosis in the cells infected with virus?

A

Perforin and Granzyme B

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23
Q

What highly damaging events can cause irreversible cell injury?

A
  1. Ca2+ influx causing caspase activation
  2. Plasma membrane damage
  3. Lysosomal rupture
  4. Increasing mitochondrial permeability
  5. Nuclear pyknosis - irreversible condensation of chromatin
  6. Karyolysis - complete dissolution of chromatin
  7. Karyorrhexis - Fragmentation of nucleus
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24
Q

What cellular enzymes are responsible for handling oxygen free radicals?

A
  1. Glutathione Peroxidase
  2. Superoxide Dismutase
  3. Catalase
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25
Describe the process of leukocyte extravasation
4 steps: 1. Rolling adhesion - mediated by P and E Selectins 2. Tight adhesion - mediated by ICAM (integrin) 3. Diapedesis - PECAM-1 4. Migration - Bacterial products (chemokines)
26
What findings are associated with Ehlers-Danlos syndrome?
1. Hyperflexible and dislocated joints 2. Aneurysms 3. Stretchy skin 4. Eary bruising/bleeding
27
What are the different types of collagen and where can they be found?
Type I: "Strong" - Skin, tendon, bone, late scar tissue Type II: "Slippery" - cartilage, nucleus pulposus, and vitreous body Type III: "Bloody" - Skin, Reticular fibers, fetal tissue, blood vessels, early scar tissue Type IV: Basement membrane
28
Which amino acids are found in large concentrations in collagen? In elastin?
Collagen: Glycine, Proline, and Hydroxyproline Elastin: Glycine and Proline
29
What is the role of vitamin C in collagen production?
Vitamin C is involved in the hydroxylation of lysine and proline
30
What cytokine is particularly important in the formation of granulomas
TNF-alpha
31
What cell type plays a role in inflammation by generating fibrinogen and C-reactive protein?
Hepatocytes
32
What cell is most responsible for the acute phase of inflammation?
Neutrophils (chronic inflammation is primarily macrophages and monocytes)
33
Does the compensatory growth of muscle fibers occur primarily as a result of hyperplasia or hypertrophy?
Hypertrophy
34
Does myometrial growth in pregnancy occur primarily as a result of hyperplasia or hypertrophy?
Hypertrophy
35
What can happen to the cells of the lower esophagus in response to chronic acid reflux?
Metaplasia: Squamous -\> Columnar
36
What is actually occurring at the cellular level during atrophy?
1. Reduction in the number of organelles 2. Decreased protein synthesis 3. Increased protein degradation-ubiquitin-proteosome pathway 4. Autophagy ("self-eating")
37
What is a lipofuscin granule?
Residual body within the cell that contains brown pigment. Results from free radical-induced lipid oxidation
38
What abnormalities are often found with an Arnold-Chiari Malformation?
Herniated cerebellar vermis - Hydrocephalus - Stenosis of the aqueduct Syringomyelia Myelomeningocele
39
What are the classic presenting symptoms of syringomyelia
Spinothalamic tract compression - Bilateral loss of pain and temperature sensation in upper extremity Severe cases affects motor neurons of anterior horn - Weakness/atrophy of the hand muscles
40
What amniotic fluid lab abnormality might point you to a diagnosis of anencephaly?
Alpha Fetoprotein (AFP)
41
Which nervous system cell matches each of the following descriptions? 1. Look like fried eggs under histologic staining 2. Form multinucleated giant cells in the CNS when infected with HIV 3. Myelinates multiple CNS axons 4. Myelinates one PNS axon 5. Damaged in Guillain-Barre syndrome 6. Damaged in Multiple Sclerosis 7. Macrophages of the CNS 8. Cells of the blood brain barrier
1. Look like fried eggs under histologic staining: Oligodendrocytes 2. Form multinucleated giant cells in the CNS: when infected with HIV: Microglia 3. Myelinates multiple CNS axons: Oligodendrocyte 4. Myelinates one PNS axon: Schwann cell 5. Damaged in Guillain-Barre syndrome: Schwann cell 6. Damaged in Multiple Sclerosis: Oligodendrocytes 7. Macrophages of the CNS: Microglia 8. Cells of the blood brain barrier: Astrocyte
42
In which neurological diseases is acetylcholine altered?
Huntingtons Chorea: Ach is decreased Alzheimers Disease: Ach is decreased Parkinsons disease: Ach is increased
43
What is the main inhibitory neurotransmitter of the CNS? In which diseases are levels altered?
GABA (Glycine is the main inhibitory neuron in the spinal cord). GABA is decreased in Huntigtons disease and in anxiety
44
What are the components of the blood-brain barrier?
1. Tight junctions 2. Basement membrane 3. Astrocyte
45
Which nucleus of the hypothalamus fits each of the following descriptions? 1. Considered "master clock" for most of our circadian rhythms 2. Regulates the parasympathetic nervous system 3. Destruction results in hyperthermia 4. Regulates the sympathetic nervous system 5. Produces antidiuretic hormone to regulate water balance 6. Receives input from the retina 7. Savage behavior and obesity result from stimulation 8. Savage behavior and obesity result from destruction 9. Stimulation leads to eating and destruction leads to starvation 10. Regulates the release of gonadotropic hormones 11. Responsible for sweating and cutaneous vasodilation in hot temperatures 12. Responsible for shivering and decreased cutaneous blood flow in the cold 13. Destruction results in neurogenic diabetes insipidus 14. Destruction results in inability to stay warm 15. Releases hormones affecting the anterior pituitary
1. Considered "master clock" for most of our circadian rhythms: Suprachiasmatic nucleus 2. Regulates the parasympathetic nervous system: Anterior nucleus & a little from preoptic nucleus 3. Destruction results in hyperthermia: Anterior nucleus & a little from preoptic nucleus 4. Regulates the sympathetic nervous system: Posterior nucleus & a little from Lateral nucleus 5. Produces antidiuretic hormone to regulate water balance: Supraoptic 6. Receives input from the retina: Suprachiasmatic nucleus 7. Savage behavior and obesity result from stimulation: Dorsomedial nucleus 8. Savage behavior and obesity result from destruction: Ventromedial nucleus 9. Stimulation leads to eating and destruction leads to starvation: Lateral nucleus 10. Regulates the release of gonadotropic hormones: Preoptic nucleus 11. Responsible for sweating and cutaneous vasodilation in hot temperatures: Anterior nucleus 12. Responsible for shivering and decreased cutaneous blood flow in the cold: Posterior nucleus 13. Destruction results in neurogenic diabetes insipidus: Supraoptic nucleus 14. Destruction results in inability to stay warm: Posterior nucleus 15. Releases hormones affecting the anterior pituitary: Arcuate nucleus
46
What EEG waveforms correspond to the different stages of sleep?
Awake: Beta (High frequency, low amplitude) Stage I: Theta Stage II: Sleep spindles and K complexes Stage III/IV: Delta (low frequency, high amplitude) REM: Beta
47
What is the pathway by which retinal information induces the release of melatonin?
Light stimulation of the retina - reduces release of melatonin Dark stimulation of the retina - induces the release of melatonin Darkness -\>Suprachiasmatic nucleus releases NE -\> Pineal gland releases melatonin
48
Which cranial nerves have their nuclei located in the medulla?
CN X, XI, XII and IX
49
Which cranial nerves have their nuclei in the pons?
CN V, VI, VII, VIII
50
Which cranial nerves have their nuclei in the midbrain?
CN III and IV
51
A 19 year-old patient presents with a furuncle on his philtrum, and the cavernous sinus becomes infected. What neurological deficits might you see in this patient?
Varying degrees of opthalmoplegia (CN III, IV, VI)
52
What are the muscles of mastication
1. Temporalis: Closes jaw 2. Masseter: Closes jaw 3. Medial pterygoid: Closes jaw 4. Lateral pterygoid: Opens jaw
53
What nerves innervate the branchial arches? Later, what structures are derived from these arches? 1st Arch 2nd Arch 3rd Arch 4th-6th Arches
1st Arch: CN V2 and V3, muscles of mastication, malleus, incus, mylohyoid muscle, mandible, meckel's cartilage 2nd Arch: CN VII, stapes, muscles of facial expression, stapedius, stylohyoid, styloid process, lesser horn of hyoid, stylohyoid ligament 3rd Arch: CN IX, stylopharyngeus, greater horn of hyoid 4th-6th Arches: CN X, superior laryngeal nerve (swallowing), recurrent laryngeal nerve (speaking), cricothyroid mm, levator veli palatine mm, muscles of the larynx, thyroid cartilage, cricoid cartilage, arytenoids, corniculate cartilage, cuneiform cartilage
54
From which branchial pouch are each of the following structures derived? 1. Middle ear and eustachian tubes 2. Superior parathyroids 3. Inferior parathyroids 4. Epithelial lining of the palatine tonsils 5. Thymus
1. Middle ear and eustachian tubes: 1st 2. Superior parathyroids: 4th 3. Inferior parathyroids: 3rd 4. Epithelial lining of the palatine tonsils: 2nd 5. Thymus: 3rd
55
How does the parasympathetic nervous system affect the following body structures? 1. Heart 2. Eye 3. Salivary glands 4. Bronchiolar smooth muscle 5. Bladder 6. Male GU 7. GI tract
1. Heart: Decreased HR and small decrease in contractility 2. Eye: Contraction of ciliary muscle, miosis 3. Salivary glands: Salivation 4. Bronchiolar smooth muscle: bronchoconstriction 5. Bladder: Contract bladder wall, relax sphincter 6. Male GU: Erection 7. GI tract: Contract intestinal wall, relax sphincter
56
What drug regenerates acetylchoinesterase after organophosphate poisoning?
Pralidoxime
57
What is the antidote for organophosphate poisoning?
Atropine or Pralidoxime
58
Which anticholinesterases are used in the treatment of Alzheimer disease?
1. Donepezil 2. Galantamine 3. Rivastigmine
59
Identify the following drugs as a direct agonist, anticholinesterase, antimuscarinic, or cholinesterase regenerator 1. Pilocarpine 2. Oxybutynin 3. Donepezil 4. Pralidoxime 5. Darifenacin 6. Ipratropium 7. Tropicamide 8. Benztropine 9. Scopalamine 10. Edrophonium 11. Tolterodine 12. Trospium 13. Homatropine 14. Carbachol
1. Pilocarpine: Direct Muscarinic Agonist 2. Oxybutynin: Antimuscarinic 3. Donepezil: Cholinesterase Inhibitor 4. Pralidoxime: Cholinesterase regenerator 5. Darifenacin: Antimuscarinic 6. Ipratropium: Antimuscarinic 7. Tropicamide: Antimuscarinic 8. Benztropine: Antimuscarinic 9. Scopalamine: Antimuscarinic 10. Edrophonium: Cholinesterase Inhibitor 11. Tolterodine: Antimuscarinic 12. Trospium: Antimuscarinic 13. Homatropine: Antimuscarinic 14. Carbachol: Direct Muscarinic & Nicotinic Agonist
60
Which of the muscarinic antagonists could be used to improve FEV-1 in a patient with COPD?
Ipratropium & Tiotropium
61
What substances inhibit the reuptake of norepinephrine?
Tricyclic antidepressants & Cocaine
62
What substances stimulate the release of norepinephrine from neurons?
1. Calcium is the normal trigger for release 2. Amphetamine 3. Ephedrine 4. Tyramine
63
What G protein class does each of the following receptors stimulate? 1. Alpha 1 2. Alpha 2 3. Beta 1 4. Beta 2 5. Muscarinic 1 6. Muscarinic 2 7. Muscarinic 3 8. Dopamine 2
1. Alpha 1: Gq 2. Alpha 2: Gi 3. Beta 1: Gs 4. Beta 2: Gs 5. Muscarinic 1: Gq 6. Muscarinic 2: Gi 7. Muscarinic 3: Gq 8. Dopamine 2: Gi
64
Outline the pathway by which stimulation of a Gs receptor activates Protein Kinase A
Gs -\> Adenylate Cyclase -\> Increased cAMP -\> Protein Kinase A
65
In what part of the cell would you find steroid hormone receptors?
Inside the cell: In the cytoplasm
66
What clinical finding would you expect to find in a man with high sex hormone binding globulin?
Low free testosterone -\> Gynecomastia
67
What clinical finding would you expect to find in a woman with low sex hormone binding globulin?
Increased free testosterone -\> Hirsutism
68
A patient's MRI reveals replacement of tissue in the sella turcica with CSF. What is the most likely clinical presentation?
This is Empty Sella syndrome. Its usually asymptomatic (subclinical) but sometimes symptoms can present according to a deficiency in one or more pituitary hormones
69
Which hormones share a common alpha subunit?
1. TSH 2. LH 3. FSH 4. HcG
70
What is the most common presentation of hyperprolactinemia in a female patient?
Premenopausal: Hypogonadism (infertility: oligomenorrhea or amenorrhea) Postmenopausal: Asymptomatic
71
What are some of the possible clinical features of acromegaly?
1. Large hands and feet 2. Course face (large nose, ears, tongue) 3. Increased spacing of teeth 4. Deep voice 5. Impaired glucose tolerance
72
What are the symptoms of 21 alpha-hydroxylase deficiency?
Blocks the pathways to Aldosterone and Cortisol (these will be absent), shunting production to androgens Hypotension and masculinization result
73
What are the symptoms of 11 beta-hydroxylase deficiency?
Blocks the pathways of Aldosterone and Cortisol production (these will be absent), and shunts production to Androgens. Deoxycorticosterone builds up though (a mineralcorticoid) Hypertension and masculinization result
74
What food substance is an essential starting point in the synthesis of adrenal steroids?
Cholesterol
75
An adult male with elevated serum cortisol levels and signs of Cushing Syndrome undergoes a dexamethasone suppression test. 1mg of dexamethasone does not decrease cortisol levels, but 8mg does. What is the diagnosis?
Cushing Disease
76
What effect does cortisol have on bone formation and immune system functioning?
1. Decreased bone formation 2. Immunosuppression
77
What are the potential side effects of glucocorticoid use?
Cushing Syndrome * Buffalo hump * Moon facies * Muscle wasting * Truncal obesity * Easy bruisability * Insomnia * Psychosis * Glaucoma * Acne * Osteoporosis * Peptic ulcers * Glucose intolerance or diabetes
78
What are the clinical manifestations of Addison Disease? What is the cause of Addison Disease?
Hyperpigmentation Hyperkalemia Hypotension Weakness & Malaise Anorexia & Weight loss Hyponatremia Caused by autoimmune destruction of the adrenals (adrenal atrophy, decreased Aldosterone, decreased Cortisol)
79
What tumor locations are associated with the 3 different types of multiple endocrine neoplasia?
1. MEN1: Parathyroid, Pancreas, Pituitary 2. MEN2a: Medullary thyroid tumor, Pheochromocytoma, parathyroid hyperplasia 3. MEN2b: Medullary thyroid tumor, Pheochromocytoma, Mucosal neuromas
80
What might a lab detect in the urine of a patient with pheochromocytoma?
Catecholamine breakdown products 1. Vanillyl mandelic acid (VMA) 2. Homovanillic acid (HVA) 3. Metanephrine 4. Noremetanephrine
81
Which receptors are stimulated by each of the following sympathomimetics? 1. Clonidine 2. Dopamine 3. Phenylephrine 4. Albuterol 5. Norepinephrine 6. Isoproterenol 7. Epinephrine 8. Dobutamine 9. Terbutaline
1. Clonidine: Alpha2 2. Dopamine: D1 & D2 (low dose), B1 & B2 (medium dose), a1 & a2 (High dose) 3. Phenylephrine: a1\>a2 4. Albuterol: B2\>B1 5. Norepinephrine: a1, a2, B1 6. Isoproterenol: B1 = B2 7. Epinephrine: a1, a2, B1, B2 8. Dobutamine: B1 \> B2 9. Terbutaline: B2 \> B1
82
Which sympathomimetic matches each of the following statements? 1. Given as a nebulizer for asthma 2. Drug of choice for anaphylaxis 3. Most common first line agent for patients in cardiogenic shock 4. Most common first line agent for patients in septic shock 5. Given SubQ for asthma 6. Used by ENT to vasoconstrict nasal vessels
1. Given as a nebulizer for asthma: Albuterol or levalbuterol 2. Drug of choice for anaphylaxis: Epinephrine 3. Most common first line agent for patients in cardiogenic shock: Dobutamine 4. Most common first line agent for patients in septic shock: Norepinephrine 5. Given SubQ for asthma: Terbutaline 6. Used by ENT to vasoconstrict nasal vessels: Cocaine, Phenylephrine
83
How does blood pressure response to phenylephrine administration change if an alpha-blocker is administered before hand? Why is this different than the change seen when epinephrine is used rather than phenylephrin?
Phenylephrine wont have an effect becuase it cannot activate the alpha receptor, whereas epinephrine will cause vasodilation because it will still be able to exert its B2 effects.
84
What are the common side effects of beta-blockers? Which patient populations should use caution when taking beta-blockers?
1. Bronchospasm - use with caution in asthmatics, COPD 2. Raise blood glucose & mask sympathetic symptoms of hypoglycemia 3. Bradycardia and AV block - use with caution in acute CHF 4. Erectile dysfunction
85
What are the various clinical applications of beta-blockers?
1. MI 2. CHF 3. Hypertension 4. Stage fright 5. Supraventricular tachycardia 6. Angina 7. Glaucoma
86
What is the most common location of salivary gland tumors?
Parotid gland
87
What is the most common salivary gland tumor? What is the histological appearance of this tumor?
Pleomorphic adenoma. Histologically, it has both epithelial and mesenchymal differentiation
88
What is the second most common **_benign_** salivary gland tumor?
Warthins tumor
89
What is the most common malignant salivary gland tumor (the second most common tumor overall of the salivary gland)?
Mucoepidermoid Carcinoma
90
What medication is often used in the treatment of allergic rhinitis, nasal polyps, and eustachian tube dysfunction?
Intranasal steroids
91
A 35 year-old woman presents with diffuse goiter and hyperthyroidism. What are the most likely relative values of TSH and thyroid hormones?
1. Decreased TSH 2. Increased Free T3/ T4
92
What would you suspect to be the cause of hyperthyroidism in a patient presenting with symptoms of hyperthyroidism in addition to each of the following findings? 1. Extremely tender thyroid gland 2. Pretibial myxedema 3. Pride in recent weight loss, medical professional 4. Palpation of single thyroid nodule 5. Palpation of multiple thyroid nodules 6. Recent study using IV contrast (iodine) 7. Eye changes (proptosis, edema, injection) 8. History of thyroidectomy or radioablation of thyroid
1. Extremely tender thyroid gland: Subacute (De Quervain) Thyroiditis 2. Pretibial myxedema: Graves disease 3. Pride in recent weight loss, medical professional: Facticious Hyperthyroidism (Thyroid hormone abuse) 4. Palpation of single thyroid nodule: Toxic thyroid adenoma 5. Palpation of multiple thyroid nodules: Toxic multinodular goiter 6. Recent study using IV contrast (iodine): Jod-Basedow Phenomenon (iodine deficient Pt supplied suddenly supplied w/ iodine) 7. Eye changes (proptosis, edema, injection): Graves disease 8. History of thyroidectomy or radioablation of thyroid: Patient taking too much exogenous thyroid hormone
93
What is the most common location for ectopic thyroid tissue?
Tongue
94
How would pregnancy affect serum thyroid hormone levels?
1. Estrogen increases thyroid binding globulin (TBG) 2. Increase in total T4/T3 (increased production of T3/T4 to compensate for unbound TBG) 3. Normal free T4/T3
95
What type of thyroid cancer matches each of the following statements? 1. Most common type of thyroid cancer (70-75%) 2. Second most common type of thyroid cancer (10%) 3. Activation of receptor tyrosine kinases 4. Hashimoto's thyroiditis is a risk factor 5. Cancer arising from parafollicular C cells 6. Commonly associated with either a RAS mutation or a PAX8-PPAR gamma I rearrangement 7. Commonly associated with rearrangements in RET oncogene or NTRKI 8. Most common mutation in the BRAF gene (serine/threonine kinase)
1. Most common type of thyroid cancer (70-75%): Papillary carcinoma of thyroid 2. Second most common type of thyroid cancer (10%): Follicular carcinoma of thyroid 3. Activation of receptor tyrosine kinases: Papillary & Medullary carcinoma of thyroid 4. Hashimoto's thyroiditis is a risk factor: B cell lymphoma 5. Cancer arising from parafollicular C cells: Medullary carcinoma of thyroid 6. Commonly associated with either a RAS mutation or a PAX8-PPAR gamma I rearrangement: Follicular carcinoma of thyroid 7. Commonly associated with rearrangements in RET oncogene or NTRKI: Papillary carcinoma of thyroid (Medullary carcinoma only associated with RET) 8. Most common mutation in the BRAF gene (serine/threonine kinase): Papillary carcinoma
96
To which lymph nodes do the sigmoid colon and the rectum drain?
Sigmoid colon: Drains to colic lymph nodes which drain into inferior mesenteric nodes Rectum (above pectinate line): Drains into internal iliac lymph nodes
97
Where can B and T cells be found in the lymph nodes?
B cells: Follicles of the cortex T cells: Paracortex
98
Which MHC is recognized by T helper cells? Which MHC is recognized by cytotoxic T cells?
1. Helper T cells: MHC II 2. Cytotoxic T cells: MHC I
99
What characteristic finding would you see on electron microscopy of a dendritic cell with Langerhans cell Histiocytosis?
Birbeck granules (Shaped like tennis rackets)
100
What molecules are expressed on the surface of antigen presenting dendritic cells?
1. MHC I & MHC II 2. B7 co-stimulatory signal (CD80 & CD86) 3. CD40
101
What are 3 cell types that are known for presenting antigens to T cells?
1. Dendritic cells 2. Macrophages 3. B cells
102
Which cytokines are produced by Th1 cells? Which cytokines are produced by Th2 cells?
_Th1_ 1. IL-2 (stimulates CD8 T cells) 2. IFN-gamma (stimulates macrophages, inhibits Th2) _Th2_ 1. IL-10 (inhibits Th1) 2. IL-4 & IL-5 (stimulates B cells)
103
Which cytokines inhibit Th1 cells? Which cytokines inhibit Th2 cells?
1. Th1 is inhibited by IL-10 2. Th2 is inhibited by IFN-gamma
104
How do cytotoxic T cells kill virus-infected cells and neoplastic cells?
1. Induce apoptosis by releaseing cytotoxic granules (perforin & granzyme B) 2. Apoptosis can be mediated by the Fas-FAS ligand
105
Which cytokine more than any other should be known as the macrophage-activating cytokine?
IFN-gamma
106
What are the acute phase cytokines that are produced by macrophages?
1. TNF-alpha 2. IL-1 3. IL-6
107
What is the function of macrophages in the spleen?
1. Remove encapsulated bacteria 2. Remove dysfunctional cells
108
What name is given to RBCs partially digested by splenic macrophages?
Bite cells (degmacytes)
109
What amino acid frequently has more coding sequences in the mRNA than are represented in the peptide that is created from that mRNA?
Methionine - The start codon codes for methionine which is often removed later on
110
What is the difference between an intron and an exon?
1. Introns are intervening (noncoding) regions of RNA that get spliced out of the mature mRNA and stay within the nucleus 2. Exons are coding regions of RNA that get spliced together to form mature mRNA which leaves the nucleus
111
How is transcription of the lac operon regulated?
1. Lac repressor: Present in the absence of lactose 2. Lac enhancer (Catabolite activating protein ): Present in the absence of glucose and facilitates RNA polymerase binding and production of beta-galactosidase
112
What enzyme matches amino acids to tRNA?
Aminoacyl-tRNA synthetase
113
What antibiotics are inhibitors of prokaryotic protein synthesis at the 30S ribosome? 50S?
"Buy **_AT_** 30, **_CCELL_** at 50" _30S_ 1. Aminoglycosides 2. Tetracycline _50S_ 1. Chloramphenicol 2. Clindamycin 3. Erythromycin (and other Macrolides) 4. Linezolid 5. Lincomycin 6. *Also Streptogramins*
114
Which immunoglobulin isotypes fit each of the following statements? 1. Associated with allergies because it is bound by mast cells and basophils and causes them to degranulate and release their histamine 2. Comprises 70-75% of the total immunoglobulin pool 3. Present in large quantities on the membrane of many B cells 4. Crosses the placenta and, additionally, confers immunity to neonates in the first few months of life 5. Can occur as a dimer 6. Largely confined to the intravascular pool and is the predominant early antibody frequently seen in the immune response to infectious organsims with complex antigens 7. Distributed evenly between the intravascular and extravascular pools 8. The predominant immunoglobulin in mucoserous secretions, and genitourinary secretions 9. Can be a pentamer
1. Associated with allergies because it is bound by mast cells and basophils and causes them to degranulate and release their histamine: **IgE** 2. Comprises 70-75% of the total immunoglobulin pool: **IgG** 3. Present in large quantities on the membrane of many B cells: **IgD & IgM** 4. Crosses the placenta and, additionally, confers immunity to neonates in the first few months of life: I**gG** 5. Can occur as a dimer: **IgA** 6. Largely confined to the intravascular pool and is the predominant early antibody frequently seen in the immune response to infectious organsims with complex antigens: **IgM** 7. Distributed evenly between the intravascular and extravascular pools: **IgG** 8. The predominant immunoglobulin in mucoserous secretions, and genitourinary secretions: **IgA** 9. Can be a pentamer: **IgM**
115
Which cellular organelles are particularly important to plasma cell function?
Rough endoplasmic reticulum & Golgi apparatus
116
What initiates recombination of V(D)J sequences?
Recombination Activating Gene Complexes (RAG-1 & RAG-2)
117
Which viral vaccines are potentially dangerous to patients with an egg allergy?
Influenza vaccine & Yellow fever vaccine (MMR vaccine made with a tiny amount of egg that is not a concern for egg allergy)
118
What autoimmune disease is associated with anti-dsDNA antibodies?
SLE (especially SLE with renal disease)
119
What stain is used to identify amyloid microscopically, and how is its appearance described?
1. Congo red stain 2. Amyloid has apple green birefringence under polarized light
120
Which immunosuppressant matches each of the following statements? 1. Precursor of 6-mercaptopurine 2. Can cause nephrotoxicity 3. Antibody that binds to CD3 on T cells 4. Antibody that binds IL-2 receptor on activated T cells 5. Inhibits inosine monophosphate (IMP) dehydrogenase
1. Precursor of 6-mercaptopurine: **Azothioprine** 2. Can cause nephrotoxicity: C**yclosporine & Tacrolimus** 3. Antibody that binds to CD3 on T cells: **Muromomab** 4. Antibody that binds IL-2 receptor on activated T cells: **Daclizumab** 5. Inhibits inosine monophosphate (IMP) dehydrogenase: **Mycophenolate Mofetil**
121
Which immunosuppressant matches each of the following statements? 1. Inhibits calcineurin resulting in the loss of IL-2 production and blockage of T cell differentiation and activation 2. Binds FK-binding protein (FKBP) leading to loss of IL-2 production 3. Binds FKBP12 leading to inhibition of mTOR and T cell proliferation 4. Used for lupus nephritis 5. Metabolized by xanthine oxidase, therefore increasing allopurinol toxicity
1. Inhibits calcineurin resulting in the loss of IL-2 production and blockage of T cell differentiation and activation: **Cyclosporine** 2. Binds FK-binding protein (FKBP) leading to loss of IL-2 production: **Tacrolimus** 3. Binds FKBP12 leading to inhibition of mTOR and T cell proliferation: **Sirolimus** 4. Used for lupus nephritis: **Cyclosporine, Azothioprine, Mycophenolate mofetil** 5. Metabolized by xanthine oxidase, therefore increasing allopurinol toxicity: **Azothioprine & 6-Mercaptopurine**
122
What cytokine matches each of the following statements? 1. Promotes B cell growth and differentiation 2. Produced by Th1 cells 3. Produced by Th2 cells 4. Involved in growth and activation of eosinophils 5. Secreted by helper T cells and activates macrophages
1. Promotes B cell growth and differentiation: **IL-4 & IL-5** 2. Produced by Th1 cells: **IL-2 & IFN-gamma** 3. Produced by Th2 cells: **IL-4, IL-5, IL-10** 4. Involved in growth and activation of eosinophils: **IL-5** 5. Secreted by helper T cells and activates macrophages: **IFN-gamma**
123
What cytokine matches each of the following statements? 1. Inhibits macrophage activation 2. Pyrogens secreted by monocytes and macrophages 3. Inhibits production of Th1 cells 4. Inhibits production of Th2 cells 5. Mediate inflammation
1. Inhibits macrophage activation:**IL-10** 2. Pyrogens secreted by monocytes and macrophages: **IL-1, IL-6, TNF-alpha** 3. Inhibits production of Th1 cells: **IL-10** 4. Inhibits production of Th2 cells: **IFN-gamma** 5. Mediate inflammation: **IL-1, IL-6, TNF-alpha**
124
What cytokine matches each of the following statements? 1. Enhances synthesis of IgE and IgG 2. Enhances synthesis of IgA 3. Released by virus-infected cells 4. Supports growth and differentiation of bone marrow stem cells 5. Supports T cell proliferation, differentiation, and activation
1. Enhances synthesis of IgE and IgG: **IL-4** 2. Enhances synthesis of IgA: **IL-5** 3. Released by virus-infected cells: **IFN-alpha & IFN-beta** 4. Supports growth and differentiation of bone marrow stem cells: **IL-3** 5. Supports T cell proliferation, differentiation, and activation: **IL-2**
125
Which type of hypersensitivity is responsible for each of the following clinical problems? 1. Poststreptococcal glomerulonephritis 2. Asthma 3. Rheumatic fever 4. Tuberculosis skin test
1. Poststreptococcal glomerulonephritis: **Type III** 2. Asthma: **Type I** 3. Rheumatic fever: **Type II** 4. Tuberculosis skin test: **Type IV**
126
Which type of hypersensitivity is responsible for each of the following clinical problems? 1. Allergies, anaphylaxis, and hay fever 2. Polyarteritis nodosa 3. Serum sickness 4. ABO blood type incompatibility
1. Allergies, anaphylaxis, and hay fever: **Type I** 2. Polyarteritis nodosa: **Type III** 3. Serum sickness: **Type III** 4. ABO blood type incompatibility: **Type II**
127
Which type of hypersensitivity is responsible for each of the following clinical problems? 1. Poison Ivy 2. Eczema 3. Contact dermatitis 4. Goodpastures syndrome
1. Poison Ivy: **Type IV** 2. Eczema: **Type I** 3. Contact dermatitis: **Type IV** 4. Goodpastures syndrome: **Type II**
128
A patient suffers from recurrent Neisseria infections. What complement proteins are deficient?
Any one of C5-C9
129
Which complement is responsible for neutrophil chemotaxis?
C5a
130
What would you expect to see in a patient with Wiskott-Aldrich Syndrome?
Deficiency of IgM antibodies, and elevated IgA antibodies "WAITER" 1. Wiskott 2. Aldrich 3. Immunodeficiency 4. Thrombocytopenia 5. Eczema 6. Recurrent pyogenic infections
131
1. What is the cause of chronic granulomatous disease? 2. what infections are these individuals susceptible to?
1. Defective NADPH oxidase - phagocytes cant generate oxygen-free radicals 2. Susceptible to infection by staph aureus, E. coli, Klebsiella, Aspergillus, & candida
132
A young child presents with tetany from hypocalcemia, and candidiasis resulting from immunosuppression. What cell type is deficient in this patient?
1. DiGeorge Syndrome characterized by thymic aplasia resulting in a deficiency of T cells and parathyroid dysfunction resulting in hypocalcemia.
133
When should patient with HIV begin prophylactic medication for opportunistic infections?
CD4 \< 200: Pneumocystis Jirovecii prophylaxis with TMP-SMX CD4 \< 100: Toxoplasmosis prophylaxis with TMP-SMX (only in patients with positive IgG titer for PCP) CD4 \< 50: Mycobacterium Avium Complex (MAC) prophylaxis with Azithromycin In endemic regions - CD4 \< 100: Histoplasmosis prophylaxis with Itraconazole
134
What organisms are known to cause infections in the mouth of AIDS patients?
1. Candida Albicans 2. HSV 3. CMV 4. EBV
135
What are the three structural genes that code for HIV proteins?
1. Pol: codes reverse transcriptase 2. Env: gp120 and gp41 3. Gag: p24
136
Categorize the following agents as protease inhibitor, NRTI, or NNRTI: 1. Ritonavir 2. Didanosine 3. Delavirdine 4. Zidovudine 5. Abacavir 6. Lamivudine 7. Nelfinavir 8. Efavirenz
1. Ritonavir: **Protease Inhibitor** 2. Didanosine: **NRTI** 3. Delavirdine: **NNRTI** 4. Zidovudine: **NRTI** 5. Abacavir: **NRTI** 6. Lamivudine: **NRTI** 7. Nelfinavir: **Protease Inhibitor** 8. Efavirenz: **NNRTI**
137
What are the two HIV envelope proteins and the drugs that interfere with them?
gp120: Inhibited from binding CCR5 by the drug Maraviroc (which binds CCR5) gp41: Fusion inhibited by Enfuvirtide
138
Which antiretroviral or antiretroviral class matches each of the following statements? 1. Side Effect - Lactic Acidosis: 2. Side Effect - GI intolerance: 3. Side Effect - Pancreatitis: 4. Side Effect - Peripheral neuropathy: 5. Side Effect - Megaloblastic anemia:
1. Side Effect - Lactic Acidosis: **NRTIs** 2. Side Effect - GI intolerance: **Protease Inhibitors** 3. Side Effect - Pancreatitis: **Didanosine, Ritonavir** 4. Side Effect - Peripheral neuropathy: **_Didanosine_, Stavudine, Zalcitibine** 5. Side Effect - Megaloblastic anemia: **Zidovudine**
139
Which antiretroviral or antiretroviral class matches each of the following statements? 1. Side effect - Rash: 2. Side effect - Hyperglycemia, diabetes mellitus, and lipid abnormalities: 3. Side effect - Bone marrow suppression: 4. Given to pregnant women with HIV: 5. Regime for occupational HIV exposures: 6. A combination of different classes of medication used to attack the HIV at different points in its replication/infection cycle in order to control the infection and avoid resistance
1. Side effect - Rash: **NNRTI** 2. Side effect - Hyperglycemia, diabetes mellitus, and lipid abnormalities: **Protease inhibitors** 3. Side effect - Bone marrow suppression: **Zidovudine** 4. Given to pregnant women with HIV: **Zidovudine** 5. Regime for occupational HIV exposures: **Zidovudine + Lamivudine** 6. A combination of different classes of medication used to attack the HIV at different points in its replication/infection cycle in order to control the infection and avoid resistance: **HAART**
140
A newborn is having trouble feeding. He vomits milk when fed and has a gastric air bubble on X-ray. What kind of fistula is present?
Tracheoesophageal fistula: Most commonly a blind upper pouch of proximal esophagous with a distal esophagous attatched to the trachea
141
What substance is important for relaxing the lower esophageal sphincter?
Nitric oxide
142
What are the names of the diverticula found in the esophagus based on their anatomical locations?
1. Zenker diverticulum: Immediately above the upper esophageal sphincter 2. Traction diverticulum: Near midpoint of the esophagus 3. Epiphrenic diverticulum: Immediately above the lower esophageal sphincter
143
A 60 year-old man with chronic reflux presents with esophageal cancer. What is the most likely diagnosis?
Adenocarcinoma, which is most common in the USA (Squamous carcinoma is most common world wider)
144
1. What is the artery of the foregut? 2. Of the midgut? 3. Of the rectum and distal third of the colon?
1. Celiac artery 2. Superior mesenteric artery 3. Inferior mesenteric artery
145
1. What disorder is characterized by a excess of gastrin? 2. What is the treatment?
1. Zollinger-Ellison Syndrome 2. Proton pump inhibitors +/- Octreotide (an octapeptide that mimics natural somatostatin pharmacologically)
146
What receptors found on gastric parietal cells regulate acid secretion?
1. Histamine (H2) receptors 2. CCKB receptors 3. M3 receptors 4. Prostaglandin receptors 5. Somatostatin receptors
147
What happens to serum pH at the time of gastric acid secretion?
Alkalosis (pH rises)
148
A 60kg man with status asthmaticus is being given an IV infusion of drug X at 60 mg/hr. The clearance of drug X is 2 L/hr, and the volume of distribution is approximately 0.5 L/kg. 48 hours after administration has begun, the asthma attack is under control. At this time, the concentration of drug X in his plasma is 20 mg/L. What is the half-life of drug X in this patient?
Clearance = [rate of elimination]/[plasma drug concentration] Or Clearance = [Volume of distribution]x[elimination constant] The elimination constant = 0.7/[half-life] So Vd = 0.5 L/kg x 60 kg man = 30 L Clearance is given as 2 L/hr Clearance = (Vd x 0.7)/(t1/2) t1/2 = (Vd x 0.7)/[Clearance] = (30 L x 0.7)/(2 L/hr) t1/2 = 10.5 hrs
149
A 60kg man with status asthmaticus is being given an IV infusion of drug X at 60 mg/hr. The clearance of drug X is 2 L/hr, and the volume of distribution is approximately 0.5 L/kg. 48 hours after administration has begun, the asthma attack is under control. At this time, the concentration of drug X in his plasma is 20 mg/L. What loading dose could have been used to reach the target concentration of 20 mg/L?
Loading dose (Ld) = Concentration of steady state (Css) x Volume of distribution (Vd) Vd = 0.5 L/kg x 60 kg man = 30 L Css given as 20 mg/L Ld = 20 mg/L x 30 L = 600 mg
150
A 60kg man with status asthmaticus is being given an IV infusion of drug X at 60 mg/hr. The clearance of drug X is 2 L/hr, and the volume of distribution is approximately 0.5 L/kg. 48 hours after administration has begun, the asthma attack is under control. At this time, the concentration of drug X in his plasma is 20 mg/L. If the patient begins to show signs of toxicity, and the target dose is decreased to 10 mg/L, what would you do to get to this level?
Stop the infusion for 1 half-life
151
A 60kg man with status asthmaticus is being given an IV infusion of drug X at 60 mg/hr. The clearance of drug X is 2 L/hr, and the volume of distribution is approximately 0.5 L/kg. 48 hours after administration has begun, the asthma attack is under control. At this time, the concentration of drug X in his plasma is 20 mg/L. The patient begins to show signs of toxicity, and the target dose is decreased to 10 mg/L. Assuming 100% bioavailability, what oral dose of drug X would be necessary to maintain the new target level?
Maintainance dose (Md) = Concentration of steady state (Css) x Clearance (CL) Css given a 10 mg/L CL given as 2 L/hr Md = 10 mg/L x 2 L/hr = 20 mg/hr
152
A 60kg man with status asthmaticus is being given an IV infusion of drug X at 60 mg/hr. The clearance of drug X is 2 L/hr, and the volume of distribution is approximately 0.5 L/kg. 48 hours after administration has begun, the asthma attack is under control. At this time, the concentration of drug X in his plasma is 20 mg/L. If the patient has a kidney disease, and the clearance is reduced to 1 L/hr, but the Vd is unchanged, what effect will this have on loading dose and maintainance dose?
Loading dose will be unchanged Maintainance dose will be decreased by half
153
What are the two most common underlying causes of a hospital admission for a bleeding peptic ulcer?
1. H. Pylori 2. NSAIDs
154
Which antacid matches each of the following statements? 1. May cause diarrhea 2. May cause constipation 3. Mayc cause rebound hypercalcemia 4. May cause hypokalemia
1. May cause diarrhea: **Magnesium Hydroxide** 2. May cause constipation: **Aluminum Hydroxide** 3. Mayc cause rebound hypercalcemia: **Calcium Carbonate** 4. May cause hypokalemia: **All 3 of the above antacids**
155
A patient taking NSAIDs for the management of her gout develops anemia, has pain with eating, and is positive on occult blood test. What drug would most directly address the mechanism behind this patient's current problem?
Misoprostol
156
Where is Virchow's node located?
Left supraclavicular lymph node
157
What important secretory products are secreted from each of the following cells of the GI tract? 1. G cells 2. I cells 3. S cells 4. D cells 5. Parietal cells
1. G cells: **Gastrin** 2. I cells: **CCK** 3. S cells: **Secretin** 4. D cells: **Somatostatin** 5. Parietal cells: **Gastric acid & Intrinsic factor**
158
What GI ligament matches each of the following descriptions? 1. Contains the portal triad and may be compressed to control bleeding 2. Attaches the spleen to the posterior abdominal wall 3. Attaches the spleen to the stomach
1. Contains the portal triad and may be compressed to control bleeding: **Hepatoduodenal ligament** 2. Attaches the spleen to the posterior abdominal wall: **Splenorenal ligament** 3. Attaches the spleen to the stomach: **Gastrosplenic ligament**
159
What is the mechanism of action of metoclopramide?
D2 receptor antagonist and serotonin agonist Increases contractility of GI tract (prokinetic)
160
Which hormones stimulate pancreatic secretion?
1. CCK: Pancreas & gall bladder 2. Secretin: Stimulates bicarb secretion 3. Acetylcholine (neurotransmitter not a hormone)
161
What enzyme catalyzes the rate-limiting step in carbohydrate digestion?
Oligosaccharide hydrolases found at the intestinal brush border
162
What are the possible etiologies of acute pancreatitis?
"GET SMASHED" 1. Gall stones 2. Ethanol 3. Trauma 4. Steroids 5. Mumps 6. Autoimmune 7. Scorpion Stings 8. Hypercalcemia/Hypertriglyceridemia 9. Endoscopic Retrograde Cholangiopancreatography (ERCP) 10. Drugs
163
1. What is the typical presentation of a patient with pancreatic insufficiency? 2. What is the treatment for pancreatic insufficiency?
1. Diarrhea, steatorrhea, malabsorption, weight loss, deficiency of fat-soluble vitamins (A, D, E, K) 2. Pancreatic enzyme supplementation, fat soluble vitamin supplementation, limit fat intake
164
How is hemoglobin glycosylated in DM to form HgbA1c?
Nonenzymatic glycosylation
165
Which type of diabetes mellitus fits the following descriptions? 1. Associated with obesity 2. May cause ketoacidosis 3. Strong genetic predisposition 4. Associated with HLA DR3 & DR4
1. Associated with obesity: **Type II** 2. May cause ketoacidosis: **Type I** 3. Strong genetic predisposition: **Type II** 4. Associated with HLA DR3 & DR4: **Type I**
166
In which tissues will you find GLUT-2 receptors?
1. Liver 2. Pancrease (beta cells) 3. Kidney 4. Small intestine
167
Which tissues depend on insulin for glucose uptake?
Skeletal muscle and adipose tissue
168
Which of the oral agents used in the control of type II diabetes has the following characteristic? Lactic acidosis is a rare but worrisome side effect
Biguanide: Metformin
169
Which of the oral agents used in the control of type II diabetes has the following characteristic? Most common side effect is hypoglycemia
Sulfonylureas: Glyburide, Glimepiride, Glipizide
170
Which of the oral agents used in the control of type II diabetes has the following characteristic? Recommended first-line treatment for most patients
Biguanide: Metformin
171
Which of the oral agents used in the control of type II diabetes has the following characteristic? Also helps lower triglycerides and LDL cholesterol levels
Biguanide: Metformin
172
Which of the oral agents used in the control of type II diabetes has the following characteristic? Not safe in settings of hepatic dysfunction or CHF
Primarily Thizolidinediones: Pioglitazone and Rosiglitazone Also could be Biguanide: Metformin
173
Which of the oral agents used in the control of type II diabetes has the following characteristic? Should not be used in patients with elevated serum creatinine
Biguanide: Metformin
174
Which of the oral agents used in the control of type II diabetes has the following characteristic? Should not be used in patients with cirrhosis, elevated serum creatinine, or inflammatory bowel disease
Alpha-Glucosidase Inhibitors: Acarbose & Miglitol
175
Which of the oral agents used in the control of type II diabetes has the following characteristic? Hepatic serum transaminase levels should be carefully monitored when using these agents
Thiazolidinediones: Pioglitazone & Rosiglitazone Biguanide: Metformin
176
Which of the oral agents used in the control of type II diabetes has the following characteristic? Not associated with weight gain, often used in overweight diabetics
Biguanide: Metformin
177
Which of the oral agents used in the control of type II diabetes has the following characteristic? Metabolized by the liver; excellent choice in patients with renal disease
Thiazolidinediones: Pioglitazone & Rosiglitazone
178
Which of the oral agents used in the control of type II diabetes has the following characteristic? Primarily effects prostprandial hyperglycemia
Alpha-Glucosidase Inhibitors: Acarbose & Miglitol
179
Which of the oral agents used in the control of type II diabetes has the following characteristic? MOA: Closes K channel on beta cells -\> Depolarization -\> Ca2+ influx -\> Insulin release
Sulfonylureas: Glyburide, Glimepiride, & Glipizide
180
Which of the oral agents used in the control of type II diabetes has the following characteristic? MOA: Inhibits alpha-glucosidase at intestinal brush border
Alpha-Glucosidase inhibitors: Acarbose & Miglitol
181
Which of the oral agents used in the control of type II diabetes has the following characteristic? MOA: Agonist at PPAR-gamma receptors -\> improved target cell response to insulin
Thiazolidinediones: Pioglitazone & Rosiglitazone
182
A 40 year-old man comes to the emergency room for the treatment of DKA. His type I diabetes is normally well controlled, and he doesnt know why his DKA developed this time. What is the differential diagnosis for the development of his DKA?
1. Infection 2. Dehydration 3. Medication omission or reduction 4. Severe mental illness 5. Glucocorticoids 6. Alcohol/drug abuse
183
Describe the process by which B12 is absorbed
1. Pepsin in the stomach releases B12 from protein-bound form 2. In the stomach, B12 binds to salivary vitamin B12 binding proteins (R-binder) 3. In the duodenum, this complex of R-binders and B12 is broken down by pancreatic proteases 4. In the duodenum, unbound B12 binds to intrinsic factor 5. Intrinsic factor plus B12 binds Intrinsic factor receptors on cells of the terminal ileum 6. B12 crosses the mucosal cell membrane and is picked up by plasma protein trans-cobalamin-2
184
What serum antibodies are associated with celiac sprue?
1. Anti-Tissue Transglutaminase Antibody Anti-Gliadin Antibody
185
What organism is associated with Whipple disease?
Tropheryma Whippeli
186
What specific organs are involved in the absorption of vitamin B12?
1. Salivary glands 2. Stomach 3. Pancreas 4. Duodenum 5. Distal Ileum
187
What pathology of the small intestine is most closely associated with the following statement? Small intestinal mucosa laden with distended macrophages in the lamina propria (that are filled with PAS (+) granules and rod-shaped bacilli seen by electron microscopy)
Whipple disease
188
What pathology of the small intestine is most closely associated with the following statement? Gluten sensitivity
Celiac Disease
189
What pathology of the small intestine is most closely associated with the following statement? Total or subtotal atrophy of the small bowel villi, plasma cells and lymphocyte infiltration into the lamina propria and epithelium, and hyperplasia/elongation of crypts
Celiac disease
190
What intestinal disorder is common in the NICU to premature babies that receive oral feeds too soon?
Necrotizing enterocolitis
191
What are the common causes of small bowel obstruction?
1. Adhesion 2. Hernia 3. Tumor
192
What are the classic symptoms of carcinoid syndrome?
1. Bronchospasm 2. Flushing 3. Diarrhea 4. Right-sided hear disease/murmur
193
What irreversible enzymes are involved in gluconeogenesis?
1. Pyruvate carboxylase 2. PEP carboxylase 3. Fructose-1,6-bisphosphatase 4. Glucose-6-phosphatase
194
What effect do glucagon and insulin have on glycolysis?
1. Insulin -\> decreased cAMP -\> decreased PKA -\> _decreased_ fructose bisphosphatase 2 & _increased_ phosphofructokinase 2 -\> increased stimulation of PFK-1 -\> **increased glycolysis** 2. Glucagon -\> increased cAMP -\> increased PKA -\> _increased_ fructose bisphosphatase 2 & _decreased_ phosphofructokinase 2 -\> decreased stimulation of PFK-1 -\> **decreased glycolysis**
195
What is the clinical consequence of a glycolytic enzyme deficiency?
Hemolytic anemia: RBCs cannot maintain Na/K ATPase -\> RBC swelling/lysis
196
Which enzyme converts glucose to glucose-6-phosphate?
1. Glucokinase: Liver and beta-cells of pancreas 2. Hexokinase: Everywhere else
197
What is the rate-limiting enzyme for the following metabolic pathway? 1. Glycolysis 2. Gluconeogenesis 3. Glycogenesis 4. Glycogenolysis
1. Glycolysis: **Phosphofructokinase 1** 2. Gluconeogenesis: **Fructose-1,6-bisphosphatase** 3. Glycogenesis: **Glycogen Synthase** 4. Glycogenolysis: **Glycogen phosphorylase**
198
Which enzyme converts glucose-6-phosphate to glucose?
Glucose-6-phosphatase
199
Which glycogen storage disease matches each of the following phrases? 1. Glycogen phosphorylase deficiency 2. Glucos-6-phosphatase deficiency 3. Lactic acidosis, hyperlipidemia, hyperuricemia (gout) 4. Alpha-1,6-glucosidase deficiency 5. Alpha-1,4-glucosidase deficiency
1. Glycogen phosphorylase deficiency: **Type V (McArdle disease)** 2. Glucos-6-phosphatase deficiency: **Type I (Von Gierke disease)** 3. Lactic acidosis, hyperlipidemia, hyperuricemia (gout): **Type I (Von Gierke disease)** 4. Alpha-1,6-glucosidase deficiency: **Type III (Cori disease)** 5. Alpha-1,4-glucosidase deficiency: **Type II (Pompe disease)**
200
Which glycogen storage disease matches each of the following phrases? 1. Cardiomegaly 2. Diaphram weakness leading to respiratory failure 3. Increased glycogen in liver; severe fasting hypoglycemia 4. Hepatomegaly, hypoglycemia, hyperlipidemia (normal kidneys, lactate, and uric acid) 5. Painful muscle cramps, myoglobinuria with strenuous exercise 6. Severe hepatosplenomegaly, enlarged kidneys
1. Cardiomegaly: **Type II (Pompe disease - Infantile type)** 2. Diaphram weakness leading to respiratory failure: **Type II (Pompe disease - Adult type)** 3. Increased glycogen in liver; severe fasting hypoglycemia: **Type I (Von Gierke disease)** 4. Hepatomegaly, hypoglycemia, hyperlipidemia (normal kidneys, lactate, and uric acid): **Type III (Cori disease)** 5. Painful muscle cramps, myoglobinuria with strenuous exercise: **Type V (McArdle disease)** 6. Severe hepatosplenomegaly, enlarged kidneys: **Type I (Von Gierke disease)**
201
What are the possible products of pyruvate?
1. Lactate 2. Oxaloacetate 3. Alanine 4. Acetyl CoA
202
What are the two main nitrogen transporters in the blood?
Alanine & Glutamine
203
What are the major regulatory enzymes of citric acid cycle?
1. Citrate Synthase 2. Isocitrate Dehydrogenase 3. Alpha-Ketoglutarate Dehydrogenase
204
What substances are known to inhibit the complexes of the electron transport chain?
1. Amytal 2. Rotenone 3. MPP 4. Antimycin A 5. Cyanide 6. Azide 7. Carbon monoxide (CO) 8. Hydrogen Sulfide (H2S)
205
What substances can increase the permeability of the inner mitochondrial membrane, thereby decreasing ATP synthesis but increasing heat generation?
1. Aspirin 2. Thermogenin 3. 2,4-Dinitrophenol
206
What is the rate-limiting step of the pentose phosphate pathway?
Glucose-6-Phosphate Dehydrogenase (G6PD)
207
Which tissues of the body use the pentose phosphate pathway?
1. Liver 2. Red blood cells 3. Adrenal cortex 4. Mammary glands
208
Expalin why a deficiency of the enzyme that is the rate-limiter for the HMP shunt can result in hemolytic anemia
G6PD generates NADPH -\> NADPH is used to produce reduced glutathione -\> No G6PD = oxidative damage = hemolysis
209
What are the symptoms of classic galactosemia?
1. Failure to thrive 2. Mental retardation 3. Hepatomegaly 4. Jaundice 5. Infantile cataracts
210
What disorder is caused by a deficiency of each of the following enzymes? 1. Galactokinase 2. Aldolase B 3. Lactase 4. Galactose-I-Phosphate Uridyltransferase 5. Fructokinase
1. Galactokinase: **Galactokinase deficiency** - Galactitol accumulates if galactose is present in diet. Relatively mild condition (Symptoms are galactose appearing in blood and urine, infantile cataracts, may initially present as failure to track objects or to develop a social smile) 2. Aldolase B: **Fructose intolerance -** Fructose-1-Phosphate accumulates causing a decrease in available phosphate which results in inhibition of glycogenolysis and gluconeogenesis (symptoms are hypoglycemia, jaundice, cirrhosis, vomiting) 3. Lactase: L**actose intolerance -** Symptoms are bloating, cramps, osmotic diarrhea 4. Galactose-I-Phosphate Uridyltransferase: **Classic Galactosemia -** Damage caused by accumulation of toxic substances including galactitol, which accumulates in the lens of the eye (Symptoms are failure to thrive, jaundice, hepatomegaly, infantile cataracts, and mental retardation) 5. Fructokinase: **Essential Fructosuria** - A benign, asymptomatic condition, since fructose is not trapped in cells (Fructose appears in blood and urine)
211
What is the primary energy source in a patient that has not eaten in two days?
Fatty acids
212
What hormone stimulates the storage of lipids in the fed state?
Insulin
213
What is the rate limiting enzyme in ketone body synthesis?
HMG-CoA Synthase
214
A stressed physician comes home from work, consumes 7 or 8 shots of tequila in rapid succession before dinner, and becomes hypoglycemic. Why did she become hypoglycemic?
Ethanol metabolism generates NADH and drives: * Pyruvate -\> Lactate * Oxaloacetate -\> Malate No longer have pyruvate and oxaloacetate to undergo gluconeogenesis, causing hypoglycemia
215
What are some of the hallmark features of Kwashiorkor?
1. Protein malnutrition 2. Edema and ascites 3. Anemia 4. Malfunction of the liver (fatty change) 5. Skin lesions 6. Skin and hair depigmentation
216
What are the five categories of criteria for the diagnosis of metabolic syndrome?
1. Abdominal Obesity: Waist \>/= 40 inches (Men), 35 inches (Women) 2. Triglycerides \>/= 150 3. BP \>/= 130/85 4. Fasting Glucose \>/= 100 5. HDL = 40 mg/dl (Men), = 50 mg/dl (Women)
217
What liver disease is associated with obesity?
Non-alcoholic Steatohepatitis
218
At what BMI is a patient considered obese?
\>/= 30
219
What enzyme is responsible for the conjugation of bilirubin?
UDP-Glucuronyl Transferase
220
Which hereditary hyperbilirubinemia matche each of the following statements? 1. Mildly decreased UDPGT 2. Completely absent UDPGT 3. Grossly black liver 4. Responds to phenobarbital 5. Treatment includes plasmapheresis and phototherapy 6. Asymptomatic unless under physical stress (Alcohol, infection)
1. Mildly decreased UDPGT: **Gilbert Syndrome or Type II Crigler-Najjar Syndrome** 2. Completely absent UDPGT: **Type I Crigler-Najjar Syndrome** 3. Grossly black liver: **Dubin-Johnson Syndrome** 4. Responds to phenobarbital: **Type II Crigler-Najjar Syndrome or Gilbert Syndrome** 5. Treatment includes plasmapheresis and phototherapy: **Type I Crigler-Najjar Syndrome** 6. Asymptomatic unless under physical stress (Alcohol, infection): **Gilbert Syndrome**
221
What are the signs of portal hypertension?
1. Ascites 2. Esophageal varices (Causing Hematemesis and Melena) 3. Hemorrhoids 4. Splenomegaly 5. Caput Medusae
222
1. What is seen in Budd-Chiari Syndrome? 2. What conditions are associated with Budd-Chiari Syndrome?
1. Occlusion of the Inferior Vena Cava or hepatic veins 2. Hepatocellular carcinoma, Polycythemia vera, Pregnancy
223
What is the mechanism by which aspirin can cause Reye Syndrome?
1. Metabolites of aspirin inhibit mitochondrial enzymes 2. Decreased Beta-oxidation
224
A young man presents with ataxia and tremors. He has brown pigmentation in a ring around the periphery of his cornea. What treatment should he recieve?
This is Wilson Disease and it is treated with Penicillamine
225
1. What is the underlying problem in Wilson disease? 2. What are the characteristics of Wilson disease? 3. What is the treatment for Wilson disease?
1. Impaired copper excretion - body does not put copper into the bile appropriately 2. Decreased Ceruloplasmin, Asterixis, Basal ganglia degeneration, Cirrhosis, Kayser-Fleischer rings, Copper accumulation, Dementia, Dyskinesia, Dysarthria 3. Penicillamine
226
1. What is the classic triad of symptoms in hemochromatosis? 2. What lab tests are used to diagnose hemochromatosis? 3. What is the treatment for hemochromatosis?
1. Diabetes, pigmentation, cirrhosis 2. Increase Ferritin\*, Increased transferrin saturation, increased serum iron, decreased TIBC 3. Phlebotomy and Deferoxamine
227
What are the risk factors for the development of hepatocellular carcinoma?
1. Hepatitis B and C 2. Hemochromatosis 3. Alpha 1-Antitrypsin deficiency 4. Hepatic Adenoma 5. Alcoholic cirrhosis
228
Identify the hepatitis B status of each of the following patients based on their hepatitis B serologic markers 1. HBsAg (-), HBsAb (+), HBcAb (+) 2. HBsAg (-), HBsAb (-), HBcAb (+) 3. HBsAg (+), HBsAb (-), HBcAb (+ IgM) 4. HBsAg (+), HBsAb (-), HBcAb (+ IgG) 5. HBsAg (-), HBsAb (+), HBcAb (-)
1. HBsAg (-), HBsAb (+), HBcAb (+): Past infection (recovered 2. HBsAg (-), HBsAb (-), HBcAb (+): Window period 3. HBsAg (+), HBsAb (-), HBcAb (+ IgM): Acute infection 4. HBsAg (+), HBsAb (-), HBcAb (+ IgG): Chronic infection 5. HBsAg (-), HBsAb (+), HBcAb (-): Vaccine
229
What medications are used in the treatment of chronic hepatitis B and C?
1. Interferon Alpha\* - Chronic hepatitis B and C 2. Ribavirin - Chronic hepatitis C only
230
Which antibodies can be used to help make the diagnosis of autoimmune hepatitis?
1. ANA (+), Anti-Smooth muscle Antibody (+) 2. Anti-liver-kidney microsomal Antibody (+) 3. Anti-mitochondrial (-)
231
What is the fate of bilirubin after it is conjugated and secreted into the GI tract?
1. Bacteria convert it to urobilinogen 2. Most is excreted in the stoll as stercobilin 3. Some is reabsorbed/recycled in bile 4. Tiny amount is excreted in the urine as urobilin
232
What enzyme is functioning suboptimally in newborns with physiologic jaundice?
UDP-Glucuronyl Transferase
233
What are some of the intrahepatic and extrahepatic causes of biliary obstruction?
_Intrahepatic_ 1. Pimary biliary cirrhosis 2. Primary sclerosing Cholangitis 3. Drugs (Chlorpromazine & Arsenic) _Extrahepatic_ 1. Pancreatic neoplasia 2. Choledocolithiasis 3. Pancreatitis 4. Cholangiocarcinoma
234
What is the difference between primary biliary cirrhosis and primary sclerosing cholangitis?
Primary biliary cirrhosis 1. Positive AMA 2. Middle aged females 3. Autoimmune disease (CREST Scleroderma) Primary sclerosing cholangitis 1. Positive cANCA 2. Males over 40 3. Ulcerative colitis & cholangiocarcinoma 4. "Beads on a string" on ERCP
235
What are some of the risk factors for the development of cholesterol gallstones?
"4 F's" 1. Fat 2. Fertile 3. Female 4. \> Forty
236
What deficiency causes familial hypercholesterolemia?
Deficiency of LDL receptors
237
Which apolipoprotein matches each of the following statements? 1. Activates LCAT 2. Mediates chylomicron secretion 3. Mediates VLDL secretion 4. Binds to LDL receptor 5. Cofactor for lipoprotein lipase 6. Mediates uptake of remnant particles
1. Activates LCAT: **A1** 2. Mediates chylomicron secretion: **B48** 3. Mediates VLDL secretion: **B100** 4. Binds to LDL receptor: **B100** 5. Cofactor for lipoprotein lipase: **C2** 6. Mediates uptake of remnant particles: **E**
238
What is the rate-limiting enzyme for each of the following metabolic pathways? 1. Hexose monophosphate pathway 2. Fatty acid synthesis 3. Beta-oxidation of fatty acids 4. Ketone body synthesis 5. Cholesterol synthesis
1. Hexose monophosphate pathway: **Glucose-6-Phosphate dehydrogenase** 2. Fatty acid synthesis: **Acetyl CoA Carboxylase** 3. Beta-oxidation of fatty acids: **Carnitine Acyltransferase** 4. Ketone body synthesis: **HMG-CoA synthase** 5. Cholesterol synthesis: **HMG-CoA reductase**
239
Which group of medications inhibits the rate limiting enzyme of cholesterol synthesis?
Statins
240
Where in the cell would you find each of the following enzymatic processes taking place? 1. Fatty Acid degradation 2. Fatty Acid synthesis 3. Glycolysis 4. TCA cycle 5. Electron transport chain (oxidative phosphorylation) 6. Gluconeogenesis
1. Fatty Acid degradation: **Mitochondria** 2. Fatty Acid synthesis: **Cytoplasm** 3. Glycolysis: **Cytoplasm** 4. TCA cycle: **Mitochondria** 5. Electron transport chain (oxidative phosphorylation): **Mitochondria** 6. Gluconeogenesis: **Mitochondria & Cytoplasm**
241
What are the essential amino acids?
"PVT TIM HALL" 1. Phenylalanine 2. Valine 3. Threonine 4. Tryptophan 5. Isoleucine 6. Methionine 7. Histidine 8. Arginine - Component of nuclear localization signal 9. Leucine 10. Lysine - Helpful in treatment of viral infections, component of nuclear localization signal
242
Amino acid is a precursor to each of the following molecules? 1. Histamine 2. Porphyrin, heme 3. NO 4. GABA (a neurotransmitter) 5. S-adenosyl-methionine(SAM) 6. Creatine
1. Histamine: **Histidine** 2. Porphyrin, heme: **Glycine** 3. NO: **Arginine** 4. GABA (a neurotransmitter): **Glutamate** 5. S-adenosyl-methionine(SAM): **Methionine** 6. Creatine: **Arginine**
243
Compare carbamoyl phosphate synthetase I to carbamoyl phosphate synthetase II
_CPS I_ 1. Urea cycle 2. Mitochondria 3. Gets nitrogen from ammonium _CPS II_ 1. Pyrimidine synthesis 2. Cytosol 3. Gets nitrogen from glutamine
244
What is the mechanism of action of lactulose?
1. Digested by bacteria in the colon 2. Creates an acidic environment 3. NH3 -\> NH4 4. NH4 excreted in the stool
245
A full-term neonate becomes mentally retarded and hyperactive and has a musty odor. What is the diagnosis?
Phenylketonuria (PKU)
246
A patient with PKU should have diet low in phenylalanine. What other dietary modifications should a patient with PKU make?
Increase Tyrosine in the diet Replace tetrahydrobiopterin (if this is the cause of PKU)
247
A middle-aged man has dark spots on his sclera and has noted that his urine turns black when left sitting for a period of time. What is the diagnosis?
Alkaptonuria
248
What is the underlying cause of maple syrup urine disease?
Deficiency of Alpha-ketoacid dehydrogenase
249
1. Which hepatic phase of metabolism is lost first by geriatric patients? 2. Which phase is mediated by cytochrome p450?
1. Phase I 2. Phase I
250
Which medication overdose can be treated with sodium bicarbonate?
Weak acids like Aspirin
251
Which medication overdose can be treated with ammonium chloride?
Weak bases like amphetamines
252
What medication inhibits alcohol dehydrogenase
Fomepizole
253
Which medications inhibit acetaldehyde dehydrogenase?
Disulfuram
254
What coagulation factor is deficient in hemophilia A?
Factor VIII
255
What coagulation factor is deficient in hemophilia B?
Factor IX
256
What is the clinical consequence of a deficiency in either protein C or protein S?
Hypercoagulable state
257
What are the treatments for overdose of Heparin and Warfarin?
Heparin: Protamine Sulfate Warfarin: Vitamin K (Delayed effect) or Fresh frozen Plasma (immediate effect)
258
What is the treatment for heparin induced thrombocytopenia?
Stop heparin Start Anticoagulation with another drug such as a direct thrombin inhibitor (Lepirudin)
259
What allows RBCs to change shape as they pass through vessels?
Spectrin
260
1. Where does fetal erythropoiesis take place? 2. Inwhich adult bones does erythropoiesis take place?
1. "**Y**oung **L**ivers **S**ynthesize **B**lood" * Yolk sac (8 weeks) * Liver * Spleen * Bone (28 weeks) 1. Adult bones * Vertebrae * Ribs * Pelvis * Sternum * Tibia & Femur
261
What is the name given to immature erythrocytes?
Reticulocyte
262
What are some of the different causes of polycythemia?
1. Excessive Erythropoietin * Renal cell carcinoma * Pheochromocytoma * Hepatocellular carcinoma * Hemangioblastoma 2. Chronic hypoxia * COPD * Obstructive sleep apnea * High altitudes 3. Polycythemia vera 4. Trisomy 21
263
What pathologic form of RBC would you see in each of the following diseases? 1. Lead poisoning 2. G6PD deficiency 3. DIC 4. Abetalipoproteinemia 5. Asplenia
1. Lead poisoning: **Basophilic stippling** 2. G6PD deficiency: **Heinz bodies & Bite cells** 3. DIC: **Schistocytes** 4. Abetalipoproteinemia: **Acanthocytes (Spur cells)** 5. Asplenia: **Target cells, Howell-Jolly bodies**
264
1. What is the structure of HbH? 2. What disease results in HbH production? 3. What is the structure of Hb Bart's? 4. What disease results in Hb Bart's production?
1. What is the structure of HbH?: Beta-4 2. What disease results in HbH production?: Alpha-Thalassemia 3. What is the structure of Hb Bart's?: Gamma-4 4. What disease results in Hb Bart's production?: Hydrops Fetalis
265
1. What is the rate limiting-step in purine synthesis? 2. In pyrimidine synthesis?
1. Glutamine PRPP Aminotransferase 2. CPS-II
266
1. What are the sources of carbons in the formation of purines? 2. What are the carbon sources in pyrimidine synthesis?
1. Glycine, CO2, and Tetrahydrofolate (Aspartate & Glutamine are essential to provide nitrogen) 2. Aspartate and CO2 (Glutamine is essential to provide nitrogen)
267
Which medication matches each of the following statements? 1. Inhibits ribonucleotide reductase 2. Inhibits dihydrofolate reductase 3. Inhibits thymidylate synthase 4. Inhibits inosine monophosphate dehydrogenase 5. Inhibits PRPP synthetase
1. Inhibits ribonucleotide reductase: **Hydroxyurea** 2. Inhibits dihydrofolate reductase: **Trimethoprim & Methotrexate** 3. Inhibits thymidylate synthase: **5-Fluorouracil** 4. Inhibits inosine monophosphate dehydrogenase: **Mycophenylate** 5. Inhibits PRPP synthetase: **6-Mercaptopurine**
268
What are the characteristic features of orotic aciduria?
1. Orotic acid in urine 2. Megaloblastic Anemia 3. Failure to Thrive 4. No elevation of ammonia
269
1. What accounts for the positive charge of histones? 2. What accounts for the negative charge of DNA?
1. Lysine & Arginine 2. Phosphate groups
270
How many adenine residues are found in a molecule of DNA if one strand contains A=2000, G=500, C=1500, T=1000
3000
271
What strand of DNA nucleotides opposes this DNA strand: 5'-ATTGCGTA-3'
5'-TACGCAAT-3'
272
How does UV light damage DNA?
UV pairs thymine to thymine on same DNA strand (Thymine dimers)
273
What eukaryotic DNA polymerases matches each of the followin descriptions? 1. Replicated lagging strand, synthesized RNA primer 2. Repairs DNA 3. Replicates mitochondrial DNA 4. Replicates leading strand DNA
1. Replicated lagging strand, synthesized RNA primer: **DNA Pol Alpha** 2. Repairs DNA: **DNA Pol Beta & Epsilon** 3. Replicates mitochondrial DNA: **DNA Pol Gamma** 4. Replicates leading strand DNA: **DNA Pol Delta**
274
What has been the most common clinical scenario of excess iron ingestion in the last 3 decades?
Infant consuming mom's iron-fortified vitamins (Prenatal vitamins, vitamin supplements)
275
What are some of the clinical effects of zinc deficiency?
1. Delayed wound healing 2. Decreased immune response 3. Acrodermatitis Enteropathica 4. Anorexia and diarrhea 5. Growth retardation (children) 6. Depressed mental function 7. Impaired night vision 8. Infertility
276
What are some of the signs of hypocalcemia?
1. Trousseau's sign (a blood pressure cuff is placed around the arm and inflated to a pressure greater than the systolic blood pressure and held in place for 3 minutes. This will occlude the brachial artery. In the absence of blood flow, the patient's hypocalcemia and subsequent neuromuscular irritability will induce spasm of the muscles of the hand and forearm. The wrist and metacarpophalangeal joints flex, the DIP and PIP joints extend, and the fingers adduct) 2. Chvostek's sign (When the facial nerve is tapped at the angle of the jaw (i.e. masseter muscle), the facial muscles on the same side of the face will contract momentarily - typically a twitch of the nose or lips - because of hypocalcemia with resultant hyperexcitability of nerves) 3. Tetany and neuromuscular irritability
277
What organs are primarily affected by an excess of cadmium?
1. Increased risk of lung cancer 2. Kidney damage 3. Calcium loss -\> Osteoporosis/Osteomalacia
278
What organs are primarily affected by an excess of mercury?
Kidney & Brain
279
What test can be used to diagnose beta-thalassemia minor?
Hb electrophoresis to look for increased HbA2
280
What lab findings allow you to distinguish iron deficiency anemia from microcytic, hypochromic anemia resulting from thalassemia?
Iron deficiency anemia 1. Ferritin: Low 2. Serum Fe: Low 3. TIBC: High Thalassemia 1. Ferritin: normal 2. Serum Fe: Normal 3. TIBC: Normal
281
What should you rule out in a man over 50 with new-onset iron deficiency anemia?
Colon cancer
282
A patient is diagnosed with a macrocytic, megaloblastic anemia. What is the danger of giving folate alone?
Might be vitamin B deficient - Folate will correct the anemia but not address the B12 deficiency
283
What is the cause of anemia, given each of the following statements? 1. Microcytic anemia + swallowing difficulty + Glossitis 2. Microcytic anemia + \>3.5% HbA2 3. Megaloblastic anemia not correctable by B12 or folate 4. Megaloblastic anemia along with peripheral neuropathy
1. Microcytic anemia + swallowing difficulty + Glossitis: **Iron deficiency anemia (Plummer-Vinson Syndrome)** 2. Microcytic anemia + \>3.5% HbA2: **Beta-Thalassemia minor** 3. Megaloblastic anemia not correctable by B12 or folate: **Orotic Aciduria** 4. Megaloblastic anemia along with peripheral neuropathy: **B12 deficiency**
284
What is the cause of anemia, given each of the following statements? 1. Microcytic anemia + Basophilic stippling 2. Microcytic anemia reversible with B6 3. HIV-positive patient with macrocytic anemia 4. Normocytic anemia + red urine in the morning 5. Normocytic anemia and elevated creatinine
1. Microcytic anemia + Basophilic stippling: **Lead poisoning** 2. Microcytic anemia reversible with B6: **Sideroblastic anemia** 3. HIV-positive patient with macrocytic anemia: **Drug induced anemia (Zidovudine)** 4. Normocytic anemia + red urine in the morning: **Paroxysmal Nocturnal Hemoglobinuria** 5. Normocytic anemia and elevated creatinine: **Chronic kidney disease**
285
What are the causes of aplastic anemia?
1. Radiation 2. Drugs (Benzene, Chloramphenicol) 3. Alkylating agents 4. Antimetabolites 5. Viruses 6. Fanconi Anemia (a genetic defect in a cluster of proteins responsible for DNA repair. As a result, the majority of FA patients develop cancer, most often acute myelogenous leukemia, and 90% develop bone marrow failure by age 40)
286
A child anemic since birth has now been cured with splenectomy. What is the disease?
Hereditary Spherocytosis
287
What findings are associated with hereditary spherocytosis?
1. Anemia 2. Pigmented gallstones 3. Jaundice 4. Splenomegaly 5. Spherocytes on peripheral smear 6. Positive osmotic fragility test 7. Coombs test negative
288
What is the difference between the hemoglobin S defect and the hemoglobin C defect?
S: Valine substituted for glutamic acid on position 6 of Beta-globin gene C: Lysine substituted for glutamic acid
289
What is the difference between a warm agglutinin and a cold agglutinin?
1. Warm is IgG 2. Cold is IgM
290
What are schistocytes?
Fragmented RBCs
291
What are two protozoal diseases that can cause hemolytic anemia?
1. Malaria 2. Babesiosis
292
In what hematologic disorder would you find each of the following abnormal tests/findings? 1. Ham's test 2. DEB test 3. Heinz bodies 4. Basophilic stippling 5. Osmotic fragility test
1. Ham's test: Paroxysmal nocturnal hemoglobinuria 2. DEB test: Fanconi Anemia (Aplastic anemia) 3. Heinz bodies: G6PD deficiency 4. Basophilic stippling: Lead poisoning (also can be seen in thalassemia) 5. Osmotic fragility test: Hereditary spherocytosis
293
What is the cause of ITP?
Autoimmune reaction to glycoprotein IIb/IIIa on platelets
294
What is the defect in Bernard-Soulier disease?
Glycoprotein Ib deficiency
295
What is the life span of a platelet (Which is also the maximum life of platelets after a transfusion)?
8-10 days
296
What molecule is expressed on the surface of a platelet after it becomes activated?
Glycoprotein IIb/IIIa
297
NSAIDs inhibit the production of which substance important in platelet aggregation?
Thromboxane A2
298
After normal spontaneous vaginal delivery, the new mom bleeds profusely from her vagina and later from her gums. What abnormal lab values would you suspect?
This is DIC * Low Platelets * High PT, PTT, Bleeding time, and D-Dimer
299
What is the mechanism of action of each of the following drugs? 1. Streptokinase 2. Aspirin 3. Clopidogrel 4. Abciximab 5. Tirofiban 6. Ticlopidine 7. Enoxaparin 8. Eptifibatide
1. Streptokinase: **Converts Plasminogen to Plasmin** 2. Aspirin: **Irreversibly inhibits COX-1** 3. Clopidogrel: **Blocks ADP receptors** 4. Abciximab: **Monoclonal Ab - Inhibits GP IIb/IIa** 5. Tirofiban: **Inhibits GP IIb/IIa** 6. Ticlopidine: **Blocks ADP receptors** 7. Enoxaparin: **Xa inhibitor** 8. Eptifibatide: **Inhibits GP IIb/IIa**
300
Compare the age distribution of those affected by Hodgkin Lymphoma to those affected by non-Hodgkin lymphoma
1. Hodgkin lymphoma: Bimodal (20s and around 65) 2. Non-Hodgkin lymphoma: Variable
301
1. What is the most common type of non-Hodgkin lymphoma in adults? 2. In children?
1. Diffuse large B cell lymphoma 2. Acute Lymphoblastic lymphoma
302
A patient with anemia, hypercalcemia, and bone pain receives a bone marrow biopsy which reveals plasma cells. What is the diagnosis, and what may be found on urinalysis?
1. Multiple Myeloma 2. Nothing will be seen on urinalysis because Bence Jones proteins dont show up on urinalysis. Urine Protein Electrophoresis must be performed
303
What form of leukemia matches the following statement? 1. Most common leukemia in children 2. Most common leukemia in adults in US 3. Characteristic Auer rods 4. Myelodysplastic syndromes have a tendency to progress to what 5. Myeloproliferative disorders may progress to what
1. Most common leukemia in children: **ALL** 2. Most common leukemia in adults in US: **CLL** 3. Characteristic Auer rods: **AML (M2 and M3)** 4. Myelodysplastic syndromes have a tendency to progress to what: **AML** 5. Myeloproliferative disorders may progress to what: **AML**
304
What form of leukemia matches the following statement? 1. More than 20% blasts in marrow 2. Leukemia with more mature cells and \<5% blasts 3. PAS (+) Acute leukemia 4. Commonly presents with bone pain 5. Numerous basophils, splenomegaly, and negative for leukocyte alkaline phosphatase (LAP)
1. More than 20% blasts in marrow: **ALL** 2. Leukemia with more mature cells and \<5% blasts: **CLL** 3. PAS (+) Acute leukemia: **ALL** 4. Commonly presents with bone pain: **ALL** 5. Numerous basophils, splenomegaly, and negative for leukocyte alkaline phosphatase (LAP): **CML**
305
What form of leukemia matches the following statement? 1. Always positive for the Philadelphia chromosome t(9;22) 2. Acute leukemia positive for peroxidase 3. Solid sheets of lymphoblasts in marrow 4. PAS (-) acute leukemia 5. Always associated with BCR-ABL gene
1. Always positive for the Philadelphia chromosome t(9;22): **CML** 2. Acute leukemia positive for peroxidase: **AML (M2 and M3)** 3. Solid sheets of lymphoblasts in marrow: **ALL** 4. PAS (-) acute leukemia: **AML** 5. Always associated with BCR-ABL gene: **CML**
306
What vitamin in excess can cause hypercalcemia?
Primarily Vitamin D but also vitamin A
307
What are the symptoms of Vitamin A toxicity?
1. Increased intracranial pressure 2. Dry and pruritic skin 3. Hepatotoxicity (Enlarged or possibly cirrhotic liver) 4. Arthralgias (Bone/joint pain) 5. Visual impairment 6. Fatigue 7. Ataxia 8. Alopecia 9. Hyperlipidemia **Remember Vitamin A is teratogenic!!!**
308
In which common chronic diseases is vitamin D supplementation particularly essential?
1. Osteoporosis 2. Chronic kidney disease
309
What headache-causing condition can result from an excess of vitamin A?
Pseudotumor cerebri
310
What vitamins have a function similar to reduced glutathione?
Vitamins A, E, and C are all antioxidants
311
What clinical features would lead you to suspect that a patient has scurvy?
1. Loose teeth with sore, spongy gums 2. Fragile blood vessels (Bruising) 3. Poor wound healing 4. Anemia 5. Swollen joints (due to bleeding into the joint spaces)
312
Vitamin C is necessary for the hydroxylation of which amino acids in collagen synthesis?
Proline and lysine
313
What is the other name for Vitamin E?
Alpha-tocopherol
314
A patient presents with convulsions and irritability. What vitamin deficiency is causing these symtpoms in this patient?
Vitamin B6 (Pyridoxine)
315
What type of anemia can be caused by folate or B12 deficiency?
Megaloblastic anemia
316
Where is B12 absorbed into the circulation?
Terminal ileum
317
Which vitamin deficiency matches each of the following descriptions? 1. Increased RBC fragility 2. Peripheral Neuropathy, glossitis 3. Hemorrhagic disease 4. Neural tube defects 5. Dermatitis, diarrhea, dementia
1. Increased RBC fragility: **Vitamin E** 2. Peripheral Neuropathy, glossitis: **Vitamin B12** 3. Hemorrhagic disease: **Vitamin K** 4. Neural tube defects: **Folate (Vitamin B9)** 5. Dermatitis, diarrhea, dementia: **Vitamin B3 (This condition is known as pellagra)**
318
Which vitamin deficiency matches each of the following descriptions? 1. Megaloblastic anemia 2. Pernicious anemia 3. Bitot spots, keratomalacia, xerophthalmia 4. Osteomalacia 5. Rickets
1. Megaloblastic anemia: **B12 or folate (B9)** 2. Pernicious anemia: **B12** 3. Bitot spots, keratomalacia, xerophthalmia: **Vitamin A** 4. Osteomalacia: **Vitamin D** 5. Rickets: **Vitamin D**
319
Which vitamin matches each of the following statements? 1. Can be used to treat acne and psoriasis 2. Used in oxidation/reduction reactions 3. Used in carboxylation reactions 4. Involved in the hydroxylation of prolyl residues 5. Requires intrinsic factor for absorption 6. Deficiency may result from kidney disease
1. Can be used to treat acne and psoriasis: **Vitamin A (Vitamin D can be used to treat psoriasis but not acne)** 2. Used in oxidation/reduction reactions: **Vitamin B2 & B3** 3. Used in carboxylation reactions: **Biotin (Vitamin B7) - "Buy-a-tin of CO2"** 4. Involved in the hydroxylation of prolyl residues: **Vitamin C** 5. Requires intrinsic factor for absorption: **Vitamin B12** 6. Deficiency may result from kidney disease: **Vitamin D**
320
Which vitamin matches each of the following statements? 1. Used by pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase 2. Given prophylactically to newborns 3. Can be used to elevate HDL and lower LDL 4. Deficiency can be caused by isoniazid use 5. Cobalt is found within this vitamin 6. Critial for DNA synthesis
1. Used by pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase: **B1 (**_T_**TP from Thiamine), **_L_**ipoic Acid, B5 (**_C_**oA from pantothenic acid), B2 (**_F_**AD from Ribflavin), B3 (**_N_**AD from Niacin)- "Tender Loving Care For No-one"** 2. Given prophylactically to newborns: **Vitamin K** 3. Can be used to elevate HDL and lower LDL: **Niacin (Vitamin B3)** 4. Deficiency can be caused by isoniazid use: **Vitamin B6 (but also Vitamin B3)** 5. Cobalt is found within this vitamin: **Vitamin B12** 6. Critial for DNA synthesis: **Folate (Vitamin B9) & Vitamin B12**
321
What is the classic presentation of appendicitis?
1. Begins with diffuse periumbilical pain that migrates to Right lower quadrant (McBurney's sign) 2. Nausea 3. Fever
322
A 50 year-old man complains of diarrhea. On exam, his face is plethoric and a heart murmur is detected. What is the diagnosis?
Carcinoid syndrome (location: bronchopulmonary or GI tract with metastasis to the liver)
323
What is the fundamental problem in Hirschsprung disease?
Neural crest cells fail to migrate to the colon. Missing Enteric ganglia/nerve plexuses (Auerbach's plexus and Meissner's plexus)
324
What is the most abundant bacteria in the colon of most individuals?
Bacteriodes Fragilis
325
A 40 year-old woman presents with having to defecate 4 times a day for several months along with a constant low-grade abdominal pain that is somewhat relieved by defecation. Colonoscopy is normal. What is the most likely diagnosis?
Irritable bowel syndrome
326
1. Which pathological lesions of the colon are considered precursors to malignancy? 2. Which colon pathology has the most malignant potential?
1. Adenomatous 2. Villous adenomas
327
What are the risk factors for colon cancer?
1. Obesity 2. Smoking 3. High fat/low fiber diet 4. Adenomatous polyps 5. Inflammatory bowel disease 6. Polyposis syndromes
328
What is the classic presentation for diverticulosis?
Usually asymptomatic If symptoms are present, they may include mild left lower quadrant pain and painless rectal bleeding
329
Which portion of the colon is most commonly affected by volvulus?
1. Sigmoid colon 2. Cecum
330
Where in the distal GI tract does endodermal tissue make an abrupt transition to tissue derived from surface ectoderm?
Pectinate line
331
What problem is most closely associated with each of the following statements? 1. Most common cause of acute right lower quadrant pain 2. Most common cause of acute left lower quadrant pain 3. Most common cause of right upper quadrant pain 4. Colonoscopy reveals very friable (easily crumbled) mucosa extending from the rectum to the distal transverse colon
1. Most common cause of acute right lower quadrant pain: **Appendicitis** 2. Most common cause of acute left lower quadrant pain: **Diverticulitis** 3. Most common cause of right upper quadrant pain: **Cholecystitis** 4. Colonoscopy reveals very friable (easily crumbled) mucosa extending from the rectum to the distal transverse colon: **Ulcerative colitis**
332
Which form of E. Coli causes hemolytic uremic syndrome (HUS)?
Enterohemorrhagic E. Coli (0157:H7)
333
What medications are commonly used to treat C. Diff colitis?
1. Metronidazole (Most of the time) 2. Oral vancomycin
334
What infectious agent most likely corresponds to each of the following statements? 1. Food poisoning as a result of mayonnaise sitting out too long 2. Diarrhea caused by Gram (-) nonmotile organism that does not ferment lactose 3. Rice-water stools 4. Diarrhea caused by an S-shaped organism
1. Food poisoning as a result of mayonnaise sitting out too long: **Staph Aureus** 2. Diarrhea caused by Gram (-) nonmotile organism that does not ferment lactose: **Shigella** 3. Rice-water stools: **Vibrio Cholera (also could be enterotoxigenic E. Coli)** 4. Diarrhea caused by an S-shaped organism: **Campylobacter Jejuni**
335
What infectious agent most likely corresponds to each of the following statements? 1. Diarrhea transmitted from pet feces 2. Food poisoning resulting from reheated rice (Chinese food) 3. Diarrhea caused by Gram (-) motile organism that doesn't ferment lactose 4. Most common cause of "traveler's" diarrhea
1. Diarrhea transmitted from pet feces: **Yersinia Enterocolitica** 2. Food poisoning resulting from reheated rice (Chinese food): **Bacillus Cereus** 3. Diarrhea caused by Gram (-) motile organism that doesn't ferment lactose: **Salmonella** 4. Most common cause of "traveler's" diarrhea: **Enterotoxigenic E. Coli**
336
What infectious agent most likely corresponds to each of the following statements? 1. Diarrhea after a course of antibiotics 2. Diarrhea caused by gram (-) lactose fermenting bacteria, no fever 3. Diarrhea caused by Gram (-) comma-shaped organism, no fever 4. Diarrhea + recent ingestion of water from a stream 5. Food poisoning from undercooked hamburger meat
1. Diarrhea after a course of antibiotics: **Clostridium Difficile** 2. Diarrhea caused by gram (-) lactose fermenting bacteria, no fever: **E. Coli** 3. Diarrhea caused by Gram (-) comma-shaped organism, no fever: **Vibrio Cholera** 4. Diarrhea + recent ingestion of water from a stream: **Giardia (also could be Entamoeba Histolytica)** 5. Food poisoning from undercooked hamburger meat: **0157:H7**
337
What protozoan matches each of the following statements? 1. Cause of malaria 2. Most common protozoal infection in the U.S. 3. Cause of Chagas disease 4. Amoebic dysentery 5. African sleeping sickness
1. Cause of malaria: **Plasmodium species** 2. Most common protozoal infection in the U.S.: **Toxoplasma Gondii** 3. Cause of Chagas disease: **Trypanosoma Cruzii** 4. Amoebic dysentery: **Entamoeba Histolytica** 5. African sleeping sickness: **Trypanosoma Brucei (Rhodesiense or Gambiense)**
338
What protozoan matches each of the following statements? 1. Diarrhea in campers and hikers 2. Transmitted in raw meat or infected cat feces 3. Transmitted by sandflies 4. Causes vaginitis
1. Diarrhea in campers and hikers: Giardia Lamblia 2. Transmitted in raw meat or infected cat feces: Toxoplasma Gondii 3. Transmitted by sandflies: Leishmania Donovani 4. Causes vaginitis: Trichomonas Vaginalis
339
A patien who visited Mexico presents with bloody diarrhea. What infectious form is found in the stool?
Cysts of Entamoeba Histolytica
340
A 32 year-old man went camping in northern California 2 weeks ago, had a 2-day stint of diarrhea, and now presents with symptoms of liver damage and jaundice. What is the infecting organism?
Entamoeba Histolytica
341
What are the names of the following stages in the malaria life-cycle? 1. Looks like a diamond ring 2. Ruptures the cell host 3. Replicating intracellularly 4. Form injected from the Anopheles mosquito 5. Banana-shaped
1. Looks like a diamond ring: **Trophozoite** 2. Ruptures the cell host: **Merozoite** 3. Replicating intracellularly: **Schizont** 4. Form injected from the Anopheles mosquito: **Sporozoite** 5. Banana-shaped: **Gametocyte of plasmodium falciparum**
342
A patient returning from a 2-week vacation in West Africa presents with typical malaria presentation and recurrent fever. What is the mechanism responsible for this patient's recurrent fever?
Hemolysis of RBCs
343
What helminth matches each of the following statements? 1. Most common helminthic infection in the US 2. One-quarter of the world infected with it 3. Snail host, "swimmer's itch" 4. Most common predisposing factor for bladder cancer in 3rd world countries 5. Contracted by eating undercooked fish and causes an inflammation of the biliary tract
1. Most common helminthic infection in the US: **Enterobius Vermicularis** 2. One-quarter of the world infected with it: **Ascaris Lumbricoides** 3. Snail host, "swimmer's itch": **Schistosoma** 4. Most common predisposing factor for bladder cancer in 3rd world countries: **Schistosoma haematobium** 5. Contracted by eating undercooked fish and causes an inflammation of the biliary tract: **Clonorchis Sinensis**
344
What helminth matches each of the following statements? 1. Soil-\>Enters through skin-\>venous blood supply-\>lungs-\>coughed into pharynx-\>swallowed into the intestines where the reside 2. Hookworm 3. Giant roundworm 4. Contracted by eating undercooked crabmeat and causes inflammation of the lung
1. Soil-\>Enters through skin-\>venous blood supply-\>lungs-\>coughed into pharynx-\>swallowed into the intestines where the reside: **Strongyloides stercoralis** 2. Hookworm: **Ancylostoma duodenale & Necator americanus** 3. Giant roundworm: **Ascaris lumbricoides** 4. Contracted by eating undercooked crabmeat and causes inflammation of the lung: **Paragonimus westermani**
345
What helminth matches each of the following statements? 1. Pork tapeworm 2. Responsible for lymphatic filariasis 3. Adult patient from Mexico with new onset seizures and brain calcifications 4. Hematuria in patient from 3rd world country
1. Pork tapeworm: **Taenia solium** 2. Responsible for lymphatic filariasis: **Wuchereria bancrofti** 3. Adult patient from Mexico with new onset seizures and brain calcifications: **Taenia solium (Neurocystercercosis)** 4. Hematuria in patient from 3rd world country: **Schistosoma haematobium**
346
What medication is used to treat each of the following parasitic infections? 1. Giardia, Entamoeba, Trichomonas 2. Most malarias 3. Plasmodium vivax or ovale 4. Resistant malarias
1. Giardia, Entamoeba, Trichomonas: **Metronidazole** 2. Most malarias: **Chloroquine** 3. Plasmodium vivax or ovale: **Chloroquine + Primaquine** 4. Resistant malarias: **Quinine + Doxycyclin, Mefloquine, Atovaquone-Proguanil, Artemether-Lumefautrine**
347
What medication is used to treat each of the following parasitic infections? 1. Most all flukes and tapeworms 2. Hookworm, pinworm, and roundworm 3. Chagas disease 4. Best guess for roundworms 5. Leishmaniasis
1. Most all flukes and tapeworms: **Praziquantel** 2. Hookworm, pinworm, and roundworm: **Benzamidazoles (mebendazole) or Pyrantel Pamoate** 3. Chagas disease: **Nifurtimox** 4. Best guess for roundworms: **Benzamidazoles** 5. Leishmaniasis: **Cutaneous - Sodium Stibogluconate, Visceral - Liposomal Amphotericin B**
348
Which 2 agents are usually used in the treatment of pediculosis capitis and pediculosis pubis?
Permethrin or Pyrethrin
349
Why is lindane not the preferred agent in the treatment of lice?
It is neurotoxic and many lice are resistant
350
What type of cancer is associated with the following tumor suppressor genes? 1. Rb 2. DPC 3. p53 4. APC 5. WT1 6. BRCA1 and BRCA2
1. Rb: **Retinoblastoma and osteosarcoma** 2. DPC: **Pancreatic cancer** 3. p53: **\>50% of cancers** 4. APC: **Familial Adenomatous Polyposis Coli** 5. WT1: **Wilms tumor** 6. BRCA1 and BRCA2: **Breast and ovarian cancer**
351
What cancers are associated with a mutation of the K-RAS oncogene?
Colon, pancreas, and lung cancers (H-RAS is associated with bladder and kidney tumors, N-RAS is associated with melanomas and hematologic malignancies)
352
Among men and among women, compare the most common cancers and the most common cancers causing mortality
_Men_ 1. Most common: Prostate \> Lung \> Colon 2. Cause of death: Lung \> Prostate \> Colon \> Pancreas _Women_ 1. Most common: Breast \> Lung \> Colon \> Uterus 2. Cause of death: Lung \> Breast \> Colon \> Pancreas
353
What neoplasms are associated with each of the following conditions? 1. Hashimoto Thyroiditis 2. Down syndrome 3. Tuberous Sclerosis 4. Ataxia-Telangiectasia 5. Paget Disease of bone
1. Hashimoto Thyroiditis: **Lymphoma** 2. Down syndrome: **AML & ALL** 3. Tuberous Sclerosis: **Cardiac Rhabdomyoma, Astrocytoma, and Angiomyolipoma** 4. Ataxia-Telangiectasia: **Leukemia & Lymphoma** 5. Paget Disease of bone: **Osteosarcoma and Fibrosarcoma**
354
Which neoplasm is associated with each of the following? 1. Nitrosamines 2. Asbestos 3. Naphthalene 4. Arsenic 5. EBV 6. HPV 7. Schistosoma Haematobium
1. Nitrosamines: **Esophageal, stomach, and colon cancer** 2. Asbestos: **Bronchogenic carcinoma, mesothelioma** 3. Naphthalene: **Transitional cell bladder cancer** 4. Arsenic: **Squamous cell skin cancer & Angiosarcoma of the liver** 5. EBV: **Burkitt lymphoma, Hodgkin lymphoma & Nasopharyngeal carcinoma** 6. HPV: **(types 16 & 18) - Cervial, vulvar, penil, and anal cancer** 7. Schistosoma Haematobium: **Squamous cell carcinoma of the bladder**
355
What type of tumor matches each of the following descriptions? 1. Benign tumor of epithelium 2. Malignant tumor of blood vessels 3. Benign tumor of bone 4. Malignant tumor of smooth muscle
1. Benign tumor of epithelium: **Adenoma or Papilloma** 2. Malignant tumor of blood vessels: **Angiosarcoma** 3. Benign tumor of bone: **Osteoma** 4. Malignant tumor of smooth muscle: **Leiomyosarcoma**
356
What unique enzyme is normally absent in somatic cells, but is active in stem cells and cancer cells?
Telomerase
357
Which tumor marker would you use to follow each of the following cancers? 1. Hepatocellular carcinoma (Hep B and C) 2. Ovarian cancer 3. Pancreatic cancer 4. Melanoma 5. Colon cancer 6. Astrocytoma
1. Hepatocellular carcinoma (Hep B and C): **Alpha-fetoprotein (AFP)** 2. Ovarian cancer: **CA-125** 3. Pancreatic cancer: **CEA & CA 19-9** 4. Melanoma: **S-100** 5. Colon cancer: **CEA** 6. Astrocytoma: **S-100**
358
1. What is the most common cause of hypercalcemia? 2. What cancers may cause hypercalcemia?
1. Primary hyperparathyroidism 2. _Cancers_ * Squamous cell lung cancer * Breast cancer * Renal cell carcinoma * Multiple Myeloma * Metastatic disease to the bone * Squamous cancer of the head and neck
359
What neoplasm is most commonly responsible for each of the following paraneoplastic syndromes? 1. ACTH-\>Cushing Syndrome 2. Erythropoietin-\>Polycythemia 3. ADH-\>SIADH
1. ACTH-\>Cushing Syndrome: **Small cell lung cancer** 2. Erythropoietin-\>Polycythemia: **Renal cell carcinoma, hemangioblastoma, hepatocellular carcinoma, pheochromocytoma** 3. ADH-\>SIADH: **Small cell lung cancer or Intracranial neoplasms** *Small cell lung cancer also causes Lambert-Eaton Syndrome (autoimmune disorder that is characterised by muscle weakness of the limbs that gets better with use)*
360
Which cancers metastasize to bone?
"Permanently Relocated Tumors Totally Love Long Bones" 1. Prostate 2. Renal cell carcinoma 3. Thyroid 4. Testes 5. Lung 6. Lymphoma 7. Breast
361
Which cancers metastasize to brain?
"Lots of Bad Stuff Kill Glia" 1. Lung 2. Breast 3. Skin (Melanoma) 4. Kidney (Renal cell carcinoma) 5. GI tract (Colorectal cancer)
362
Which cancers metastasize to liver?
"Cancer Sometimes Penetrates Benign Liver" 1. Colon 2. Stomach 3. Pancreas 4. Breast 5. Lung
363
What is currently the most effective intervention in the prevention of the following cancers? 1. Lung cancer 2. Cervical cancer 3. Renal cell carcinoma 4. Breast cancer 5. Colon cancer
1. Lung cancer: **Stop smoking** 2. Cervical cancer: **PAP smear/HPV vaccine** 3. Renal cell carcinoma: **Stop smoking** 4. Breast cancer: **Screeing mammograms** 5. Colon cancer: **Colonoscopy**
364
What is the only definitive way to prevent ovarian cancer?
Bilateral oopherectomy
365
Which male patients should be screened for prostate cancer with a serum PSA?
Controversial but screeing can beperformed in any male between 50 and 70 who has a 10-year life expectancy
366
What is the primary immune system cell type involved in host tumor immune surveillance?
Cytotoxic T-cells
367
What enzyme present in melanoma generates peptides that are targets for host T cells?
Tyrosinase
368
How can tumor cells evade attack from cytotoxic T cells?
By developing the loss of expression of MHC class I
369
How might tumor cells induce apoptosis of T cells that would antagonized them?
Expressing FasL
370
How does the mechanism of action of methotrexate differ from 5-Fluorouracil?
Both decrease DNA and protein synthesis 1. Methotrexate is a folic acid analog that inhibits Dihydrofolate reductase 2. 5-Fluorouracil is a pyrimidine analog that inhibits thymidilate synthase
371
How does the body metabolize 6-mercaptopurine?
Xanthine oxidase
372
Which anticancer drug is also often used in rheumatoid diseases as well as ectopic pregnancies?
Methotrexate
373
Which anticancer drug fits each of the following descriptions? 1. Forms a complex between topoisomerase II and DNA 2. Alkylates DNA, toxicity -\> pulmonary fibrosis 3. Fragments DNA, toxicity -\> Pulmonary fibrosis 4. Blocks purine synthesis, metabolized by xanthine oxidase 5. Cross-links DNA, nephrotoxic, ototoxic
1. Forms a complex between topoisomerase II and DNA: **Etoposide** 2. Alkylates DNA, toxicity -\> pulmonary fibrosis: **Busulfan** 3. Fragments DNA, toxicity -\> Pulmonary fibrosis: **Bleomycin** 4. Blocks purine synthesis, metabolized by xanthine oxidase: **6-Mercaptopurine** 5. Cross-links DNA, nephrotoxic, ototoxic: **Cisplatin and Carboplatin**
374
Which anticancer drug fits each of the following descriptions? 1. Nitrogen mustard, alkylates DNA (electrophile that binds DNA) 2. Folic acid analog that inhibits dihydrofolate reductase 3. Prevents tubulin disassembly 4. Intercalates DNA, produces oxygen free radicals, cardiotoxic 5. DNA alkylating agents used in brain cancer
1. Nitrogen mustard, alkylates DNA (electrophile that binds DNA): **Cyclophosphamide** 2. Folic acid analog that inhibits dihydrofolate reductase: **Methotrexate** 3. Prevents tubulin disassembly: **Paclitaxel** 4. Intercalates DNA, produces oxygen free radicals, cardiotoxic: **Doxyrubicin & Daunorubicin** 5. DNA alkylating agents used in brain cancer: **Nitrosoureas**
375
1. Applied topically for AKs and basal cell cancers 2. Treatment for childhood tumors (Ewing sarcoma, Wilms tumor, Rhabdomyosarcoma) 3. Inhibits ribonucleotide reductase 4. SE of hemorrhagic cystitis 5. Inhibitor of the mutated tyrosine kinase produced by the philadelphia chromosome
1. Applied topically for AKs and basal cell cancers: **5-Fluorouracil** 2. Treatment for childhood tumors (Ewing sarcoma, Wilms tumor, Rhabdomyosarcoma): **Dactinomycin** 3. Inhibits ribonucleotide reductase: **Hydroxyurea** 4. SE of hemorrhagic cystitis: **Cyclophosphamide** 5. Inhibitor of the mutated tyrosine kinase produced by the philadelphia chromosome: **Imatinib**
376
What are the equations for sensitivity, specificity, positive predictive value, and negative predictive value?
1. Sensitivity = A/(A+C) 2. Specificity = D/(D+B) 3. PPV = A/(A+B) 4. NPV = D/(D+C)
377
A physician is looking for risk factors for pancreatitis. He interviews 100 hospitalized patients with pancreatitis and 100 hospitalized patients without pancreatitis. What type of study is this?
Case-control study
378
A group of smokers and a group of non-smokers are followed over 20 years. Wvery two years, it is determined who develops cancer and who does not. What type of study is this?
Prospective cohort study
379
A certain screening test has a 1% false-negative rate. What is the sensitivity of the test?
99%
380
What are the equations for odds ratio, relative risk, attributable risk, and number needed to treat?
1. OR = (A/B)/(C/D) 2. RR = (A/(A+B))/(C/(C+D)) 3. AR = A/(A+B) - C/(C+D) 4. NNT = 1/ARR
381
The small town of Mickey City (Pop. 8000) is immediately adjacent to factories where asbestos products are produced. During the past year, the prevalence of mesothelioma has been 16 cases. In the town of Donaldville (Pop. 6000) 15 miles upwind of (and theoretically safely distant from) Mickey City, there was a prevalence of 3 cases during the same year: What is the relative risk of mesothelioma for the population of Mickey City?
RR = (A/A+B)/(C/(C+D)) = (16/8000)/(3/6000) = 4
382
A new glucose test arrives and you decide to see how well it works. There is a standard substance provided that has 90 mg/dL of glucose. Your repeated measurements of the substance reveal the following values: 54, 56, 55, 54, 53, 56, 55, and 54. What can you say about the precision and accuracy of your new glucose test?
1. High precision 2. Low accuracy
383
The prevalence of varicella in population A is 2 times the prevalence of varicella in population B. The incidence is the same in populations A and B. What can be assumed about the disease duration in population A versus population B?
Duration of varicella is twice as long in population A as in B
384
Study X show that vitamin C can prevent Coronavirus infections, but 10 other studies show no benefit. What type of error is found in study X?
Type I (alpha)
385
Study Y shows that aspirin administration during an MI offers no improvement in patient morbidity or mortality. What type of error is present?
Type II (beta)
386
What is the difference between the mean, median, and mode?
1. 2. Mean = average 3. Median = Middle value 4. Mode = Most frequent value
387
What does it mean to say that a statistical distribution has a positive skew?
Mean \> Median \> Mode
388
What is the current recommendation on receiving a meningitis vaccine?
All children 11-12 years old Booster at 16 For high-risk children, vaccinate as young as 2 months of age
389
When is it important for a patient with a tetanus prone wound to receive a tetanus vaccine?
1. Minor wound - vaccinate if \>10 years since last booster 2. High risk wound - Vaccinate if \>5 years since last booster 3. If vaccine status is unknown - Vaccinate
390
Which adult populations should receive a pneumococcal vaccine?
Vaccinate after age 65 Vaccinate high risk populations: Residents of long term care facilities, COPD/Asthma, smokers, cardiovascular Dx, diabetes, asplenia, HIV, CSF leaks
391
What are the current indications for the herpes zoster vaccine?
1 dose after age 60
392
At minimum, what four medications should a patient with a prior MI due to atherosclerosis be taking?
1. Aspirin (Clopidogrel if ASA-allergic) 2. Beta-blocker 3. ACE inhibitor 4. Statin
393
What vaginal disorder is common in elderly women?
_Vaginal atrophy_ 1. Thinning of the vaginal mucosa 2. Vaginal dryness causing bleeding with intercourse 3. Urinary incontinence
394
What are the 3 leading causes of death in patients over age 65?
1. Heart disease 2. Cancer 3. Stroke
395
Which patients should be screend for an abdominal aortic aneurysm using an abdominal ultrasound?
Men age 65-75 who have never smoked
396
At what age should every geriatric patinet have had a DEXA bone density scan?
_Women_ 1. All over age 65 2. Younger women whose fracture risk is greater than that of a 65 yo white woman with no additional risk factors _Men_ 1. USPSTF does not recommend screen 2. National Osteoporosis foundation recommends screen to men 50-70 with risk factors and all men over 70
397
A 60 year old business man complains of a lack of succesful sexual contacts with women and a lack of ability to reach full erection. One year ago, he had a heart attack. What might be the cause of his problem?
1. Atherosclerosis 2. Fear of sudden death during intercourse
398
What is the difference between a premium, co-pay, and deductible?
1. Premium = monthly payment to insurance company 2. Co-pay = Amount paid out-of-pocket at time of service 3. Deductible = Amount that must be paid out-of-pocket before insurance starts paying
399
Which usually offers patients a greater variety of physicians to choose from: HMO or PPO?
PPO
400
What is the difference between being paid by capitation and fee-for-service?
1. Capitation is amount paid for a period of time or number of patients 2. Fee-for-service is amount paid according to the specific service provided
401
What must a hospital submit to a third-party payer in order to receive payment for services?
1. ICD-9 diagnosis codes 2. CPT service/procedure codes
402
What department in a hospital oversees the maximization of the quality of care while minimizing the cost of care?
Utilization Management Department (Utilization Review)
403
What structures traverse the diaphragm, and what vertebral levels do they pass through?
"I Ate Ten Eggs At Twelve" 1. T8: IVC 2. T10: Esophagus and vagus nerve 3. T12: Aorta, thoracic duct, and azygous vein
404
What is the difference between a hiatal hernia and an incisional hernia after an abdominal surgery?
1. Hiatal hernia: Peritoneal contents herniate through the diaphragm into the thorax 2. Incisional hernia: Defect in the abdominal wall resulting in abdominal contents bulgin outward
405
What histological change takes place in the trachea of a smoker?
Metaplasia: Ciliated columnar -\> Squamous
406
A patient in the ER is having anaphylaxis. You make an incision beneath thyroid cartilage to establish airway. What structure was cut?
Cricothyroid membrane
407
What cell type proliferates during lung damage?
Type II pneumocytes
408
What amniotic fluid measurement is indicative of fetal lung maturity?
Lecithin:Sphyngomyelin ratio \>2
409
A young woman has infertility, recurrent URIs, and dextrocardia. Which of her proteins is defective?
This is Kartagener syndrome caused by a **Dynein** arm defect
410
The following lung volumes are obtained from an elderly smoker: FRC = 5L, IRV = 1.5L, IC = 2L, VC = 3.5L. What is his total lung capacity?
TLC = FRC + IC = 7L
411
If a lung collapses, what happens to the intrathoracic volume?
It increases
412
What gene mutation can cause primary pulmonary hypertension?
Bone Morphogenetic Protein Receptor 2 (BMPR2) gene
413
What are some of the secondary causes of pulmonary hypertension?
1. COPD 2. Sleep apnea 3. Frequent thrombosis 4. Mitral stenosis 5. Left-to-right shunt
414
What are some of the treatment options available for pulmonary hypertension?
1. Bosentan or Ambrisentan 2. Prostaglandin analogues 3. Sildenafil 4. Dihydropyridine Ca channel blockers (Nifedipine)
415
What is the mechanism of action of bosentan?
Completely antagonize endothelin-1 receptors -\> Decreases pulmonary vascular resistance
416
Which form of hemoglobin A has high affinity for oxygen? Which has a low affinity for oxygen?
1. T form (Taut) - Low affinity for O2 2. R form (Relaxed) - High affinity for O2
417
1. What substances tend to shift the oxygen-hemoglobin dissociation curve to the right? 2. Does this favor oxygen loading or unloading?
1. Increased CO2, temperature, 2,3-DPG, H+, Exercise/activity 2. Favor unloading
418
What is the treatment for methemoglobinemia?
1. Methylene blue 2. Vitamin C
419
1. What is the normal value for the A-a gradient? 2. What might an elevated A-a gradient indicate?
1. 10-15 mmHG 2. _Causes of high A-a gradient include_ * High FiO2 (from supplemental O2) * Shunting of blood * Pulmonary fibrosis (Impaired gas diffusion) * V/Q mismatch * Advanced age
420
A 42 year-old woman with fibroids is chronically tired. What is the most likely diagnosis, and what changes have occured in the oxygen content and saturation?
* She most likely has iron deficiency anemia from excessive uterine bleeding from her fibroids * There is no change in the O2 saturation but a decrease in total O2 content of her blood
421
A patient is shown to have hypoxia, and CXR reveals an enlarged heart. What is the most likely cause of hypoxia?
Heart failure
422
1. What is the V/Q at the apex of the lung? 2. At the base of the lung? 3. During airway obstruction? 4. During blood flow obstruction?
1. Greater than 1 2. Less than 1 3. Approaching zero 4. Approaching infinity
423
How is CO2 transported from the tissues to the lungs?
1. As bicarbonate 2. Bound to the N terminus of globin (5%) 3. Dissolved in the blood
424
How do CO2 levels in circulation change during exercise?
1. Increase in venous CO2 2. No change in arterial CO2
425
How does the body compensate for hypoxia at high altitude?
1. Increased ventilation 2. Increased renal excretion of bicarb 3. Increased mitochondria in the tissues (better utilization of O2) 4. Increased 2,3-BPG 5. Increased erythropoietin
426
How much does the H&H change in a person that has acclimatized to a hypoxic environment for weeks?
1. Hematocrit: 40-45 -\> 60 2. Hemaglobin: 15 g/dl -\> 20 g/dl
427
At what positive G force does a visual "black-out" occur? Why does this occur?
1. 4-6 G 2. Centrifugal force pools blood in the legs and abdomen causing insufficient blood to the brain
428
What physiologically is taking place in decompensation sickness?
Nitrogen precipitates out of the blood, forming bubbles that occlude small blood vessels
429
For what conditions is hyperbaric oxygen therapy particularly helpful?
1. Decompression sickness 2. Arterial gas embolism 3. Carbon monoxide poisoning 4. Gas gangrene (due to anaerobic clostridium) 5. Osteomyelitis
430
By what physiological mechanism does acute mountain sickness cause acute cerebral edema and acute pulmonary edema?
Hypoxia-induced vasodilation
431
A patient suffers a stroke after incurring multiple long bone fractures in a skiing accident. What caused the infarct?
Fat embolus to cerebral artery via patent foramen ovale
432
A patient with a recent tibia fracture and no history of COPD or asthma is shown to have hypoxia. CXR is normal. What is the cause of the hypoxia, and what disease process does it mimic?
1. DVT -\> Pulmonary embolism 2. Mimics MI
433
A patient presents with asthma attack. What immunological reaction is taking place that is responsible for anaphylaxis in this patient?
Antigen cross linking IgE on pre-sensitized mast cells (type I hypersensitivity)
434
What asthma medication fits each of the following statements? 1. Inhaled treatment of choice for chronic asthma 2. Inhaled treatment of choice for acute exaserbations 3. Narrow therapeutic index, drug of last resort 4. Blocks conversion of arachidonic acid to leukotriene
1. Inhaled treatment of choice for chronic asthma: **Inhaled steroid** 2. Inhaled treatment of choice for acute exaserbations: **Albuterol or levalbuterol (Not salmeterol)** 3. Narrow therapeutic index, drug of last resort: **Theophylline** 4. Blocks conversion of arachidonic acid to leukotriene: **Zileuton**
435
What asthma medication fits each of the following statements? 1. Inhibits mast cell release of mediators, used for prophylaxis only 2. Inhaled treatment that blocks muscarinic receptors 3. Inhaled long-acting Beta 2 agonist 4. Blocks leukotriene receptors
1. Inhibits mast cell release of mediators, used for prophylaxis only: **Cromolyn** 2. Inhaled treatment that blocks muscarinic receptors: **Ipratropium and Tiotropium** 3. Inhaled long-acting Beta 2 agonist: **Salmeterol** 4. Blocks leukotriene receptors: **Montelukast & Zafirlukast**
436
A patient has an extended expiratory phase. What is the disease process?
Obstructive lung disease
437
1. What is the hallmark sign of COPD? 2. What is the hallmark sign of a restrictive lung disease?
1. COPD: FEV1/FVC \< 0.8 2. Restrictive lung disease: Decreased total lung capacity but FEV1/FVC \>/= 0.8
438
How does the emphysema caused by smoking differ from the emphysema caused by alpha-1 antitrypsin deficiency?
1. Smoking: Centriacinar emphysema 2. Alpha-1 Antitrypsin deficiency: Panacinar emphysema
439
A preterm infant has difficulty breathing. An x-ray reveals diffuse air space and interstitial opacities, with air bronchograms. What is the diagnosis, and what could have prevented this condition?
1. Neonatal respiratory distress syndrome 2. Maternal steroids administered 24-48 hrs prior to delivery
440
What are common causes of ARDS?
1. Trauma 2. Shock 3. Sepsis/infection 4. Gastric aspiration 5. Uremia 6. Acute pancreatitis 7. Amniotic fluid embolism 8. Heroin overdose 9. High concentrations of O2 for extended period of time
441
H&E of lung biopsy from a plumber shows elongated structures with clubbed ends in tissue. What is the diagnosis? What is he at increased risk for?
1. Asbestosis 2. Mesothelioma and Bronchogenic carcinoma
442
What are the manifestations of sarcoidosis?
"GRUELING" 1. Granulomas 2. Rheumatoid Arthritis association 3. Uveitis 4. Erythema Nodosum 5. Lymphadenopathy (bilateral hilar lymphadenopathy) 6. Idiopathic 7. Not TB 8. Gammaglobulinemia And Increased ACE, Vit D, and Ca
443
What do patients with silicosis need to be worried about?
Increased susceptibility to TB
444
A patient devolops bronchogenic lung cancer but has never smoked. He is a coal miner: Exposure to what substance has put him at risk for developing lung cancer?
Radon (Coal dust and silica do not increase the risk of cancer and asbestos isnt located in mines)
445
What complications can arise from lung cancer?
1. SIADH (small cell lung cancer) 2. Cushing Syndrome (small cell lung cancer) 3. Lambert-Eaton Syndrome (small cell lung cancer) 4. PTHrP -\> Hypercalcemia (squamous cell lung cancer) 5. Carcinoid Syndrome (Carcinoid tumor) 6. Horner Syndrome (Pancoast Tumor) 7. Hoarse voice (Pancoast Tumor) 8. Superior vena cava syndrome (direct obstruction of the superior vena cava) 9. Pleural effusions 10. Dysphagia (esophageal invasion) 11. Laryngeal invasion
446
What are the 3 most common locations of lung cancer metastasis?
Bone, Brain, and Liver
447
Examination of a lung autopsy reveals a peripheral lesion with caseous necrosis. What is the diagnosis?
Tuberculosis
448
A 30 year old comatose man on ventilatory support in the ICU develops an infection and dies. Autopsy reveals a pus-filled cavity in his right lung. What is the likely etiology
Aspiration resulting in an abcess
449
What infectious agent is the cause of pneumonia, based on each of the following lab tests? 1. Gram (+) cocci in clusters 2. Gram (+) cocci pairs 3. Gram (-) rods in 80 year-old 4. Gram (+) cocci in neonate 5. Gram (-) rods in neonate
1. Gram (+) cocci in clusters: **Staph Aureus** 2. Gram (+) cocci pairs: **Strep Pneumoniae** 3. Gram (-) rods in 80 year-old: **E. Coli** 4. Gram (+) cocci in neonate: **Group B strep** 5. Gram (-) rods in neonate: **E. Coli**
450
What bacterial structures have the following functions? 1. Mediates adherence of bacteria to the surface of a cell 2. Protects against phagocytosis 3. Provides rigid support to bacterial cell and protects against osmotic pressure differences 4. Space between the inner and outer cellular membranes in Gram (-) bacteria
1. Mediates adherence of bacteria to the surface of a cell: **Fimbria or pili** 2. Protects against phagocytosis: **Capsule** 3. Provides rigid support to bacterial cell and protects against osmotic pressure differences: **Peptidoglycan layer** 4. Space between the inner and outer cellular membranes in Gram (-) bacteria: **Periplasm**
451
What bacterial structures have the following functions? 1. Motility 2. Bacterial form which provides resistance to dehydration, heat, and chemicals 3. Forms attachment between two bacteria during transfer of DNA material (AKA conjugation) 4. Genetic material within bacteria that contains genes for antibiotic resistance
1. Motility: **Flagella** 2. Bacterial form which provides resistance to dehydration, heat, and chemicals: **Spore** 3. Forms attachment between two bacteria during transfer of DNA material (AKA conjugation): **Sex pilus (F pilus)** 4. Genetic material within bacteria that contains genes for antibiotic resistance: **Plasmid**
452
What stain is required to see the following organism (or substance)? 1. Cryptococcus neoformans 2. Pneumocystis Jirovecii 3. Chlamydia
1. Cryptococcus neoformans: India ink 2. Pneumocystis Jirovecii: Legionella 3. Chlamydia: Giemsa
453
Which organisms do not take gram stain?
"These Rascals May Microscopically Lack Color" 1. Treponema (too thin to be detected) 2. Rickettsia (intracellular) 3. Mycobacteria 4. Mycoplasma (no cell wall) 5. Legionella Pneumophila (primarily intracellular) 6. Chlamydia (intracellular and lacks muramic acid in cell wall)
454
Which bacteria are encapsulated?
"Even Some Pretty Nasty Killers Have Shiney Bodies" 1. E. Coli 2. Strep pneumo 3. Pseudomonas aeruginosa 4. Neisseria meningitidis 5. Klebsiella pneumoniae 6. Haemophilus influenzae 7. Salmonella typhi 8. Group B strep *Cryptococcus neoformans is a fungi with a capsule*
455
By what method are plasmids exchanged between bacteria?
Conjugation
456
What exotoxin matches each of the following characteristics? 1. Inhibits Ach release -\> flaccid paralysis 2. Lecithinase that causes gas gangrene 3. Inhibits the inhibitor of adenylate cyclase -\> whooping cough 4. Stimulates adenylate cyclase -\> Cl- and water into gut -\> diarrhea 5. Destroys leukocytes 6. Composed of edema factor, lethal factor, and protective antigen
1. Inhibits Ach release -\> flaccid paralysis: **Botulin toxin** 2. Lecithinase that causes gas gangrene: **Alpha-toxin of Clostridium perfringens** 3. Inhibits the inhibitor of adenylate cyclase -\> whooping cough: **Pertussis toxin** 4. Stimulates adenylate cyclase -\> Cl- and water into gut -\> diarrhea: **Cholera toxin & heat-labile E. Coli toxin** 5. Destroys leukocytes: **Leukocidin of Staph Aureus** 6. Composed of edema factor, lethal factor, and protective antigen: **Cytotoxin of Bacillus Anthracis**
457
What exotoxin matches each of the following characteristics? 1. Enterotoxin causing rice-water diarrhea 2. Causes Scarlet fever 3. Causes toxic shock syndrome 4. Inactivates EF-2 -\> pseudomembranous pharyngitis 5. Blocks the release of the inhibitory neurotransmitter glycine
1. Enterotoxin causing rice-water diarrhea: **Cholera toxin and heat-labile E. Coli toxin** 2. Causes Scarlet fever: **Erythrotoxin and pyrotoxin of strep pyogenes** 3. Causes toxic shock syndrome:**TSST-1 of Staph Aureus** 4. Inactivates EF-2 -\> pseudomembranous pharyngitis: **Diptheria toxin** 5. Blocks the release of the inhibitory neurotransmitter glycine: **Tetanospasmin (tetanus toxin)**
458
What 6 bacteria secrete enterotoxins (exotoxin that causes water and electrolyte imbalances of intestinal epithelium resulting in diarrhea)?
1. Vibrio cholera 2. ETEC 3. Staph Aureus 4. Yersinia 5. Salmonella 6. Shigella
459
What is the function of catalase?
Breakdown hydrogen peroxide to H20 and O2
460
What is the most common aerobic skin flora?
Staph Epidermidis
461
What organisms are most commonly implicated in subacute endocarditis?
1. Viridans Strep 2. Enterococci 3. Staph Epidermidis
462
What infections are most commonly caused by Strep. Pyogenes?
_Proliferative/Pyogenic_ 1. Skin infections 2. Pharyngitis 3. Endocarditis 4. Necrotizing fasciitis 5. Bacteremia _Toxin-mediated_ 1. Toxic shock syndrome 2. Scarlet fever _Autoimmune-antibody mediated but initiated by S. pyogenes_ 1. Rheumatic fever 2. Acute glomerulonephritis
463
Which gram (+) organism matches each of the following statements? 1. Causes scalded skin syndrome 2. White membrane on pharynx 3. Pharyngitis -\> glomerulonephritis 4. Most common cause of meningitis 5. Most common cause of osteomyelitis 6. Serious newborn infections
1. Causes scalded skin syndrome: **Staph Aureus** 2. White membrane on pharynx: **Corynebacterium Diphtheria** 3. Pharyngitis -\> glomerulonephritis: **Strep pyogenes** 4. Most common cause of meningitis: **Strep pneumoniae** 5. Most common cause of osteomyelitis: **Staph Aureus** 6. Serious newborn infections: **Group B strep, Listeria (and the gram (-) E. Coli)**
464
Which gram (+) organism matches each of the following statements? 1. Infant with poor muscle tone 2. Diarrhea after using antibiotics 3. Respiratory distress in a postal worker 4. Otitis media in children 5. Cellulitis
1. Infant with poor muscle tone: Clostridium Botulinum 2. Diarrhea after using antibiotics: Clostridium Difficile 3. Respiratory distress in a postal worker: Bacillus Anthracis 4. Otitis media in children: Strep pneumoniae 5. Cellulitis: Strep pyogenes and Staph aureus
465
One hour after eating potato salad at a picnic, an entire family began to vomit. After 10 hours, they were better. What is the organism?
Staph aureus
466
What patients are susceptible to Listeria monocytogenes?
Neonates and immunocompromised
467
Which bacteria are spore formers?
1. Clostridium 2. Bacillus 3. Coxiella burnetii
468
What organism can be treated with ampicillin or amoxicillin?
_Effective against the "HEELPSS" organisms_ 1. H. influenzae 2. E. Coli 3. Enteroccoci 4. Listeria 5. Proteus 6. Salmonella 7. Shigella _Indications_ 1. URIs: Gram (+) and H. influenzae 2. UTIs and colon infections: E. coli, Proteus, Enteroccoci, Salmonella 3. Neonatal infections: E. coli, Listeria
469
Which of the penicillins can be used to treat pseudomonas infections?
Ticarcillin, piperacillin, carbenicillin
470
What are the two different mechanisms of resistance bacteria use against penicillin agents?
1. Beta-lactamase: Hydrolyzes the beta-lactam ring of penicillins 2. Alteration of Beta-lactam targets - IE the Penicillin Binding Proteins (PBPs)
471
What are the beta-lactamase inhibitors?
1. Clavulanic acid (often combined with Amoxicillin or Ticarcillin) 2. Sulbactam (often combined with Ampicillin) 3. Tazobactam (often combined with Piperacillin)
472
Which generation of cephalosporin would you choose to use for each of the follwoing infections? 1. UTI prevention 2. Serratia UTI 3. N. Meningitidis 4. Pseudomonas 5. Otitis media due to nontypable H. influenzae
1. UTI prevention: **1st or 2nd** 2. Serratia UTI: **2nd** 3. N. Meningitidis: **3rd** 4. Pseudomonas: **4th** 5. Otitis media due to nontypable H. influenzae: **2nd**
473
Which substances can have a side-effect similar to disulfuram with alcohol consumption?
1. Disulfuram 2. Metronidazole 3. Cephalosporins: Cefotetan, Cefamandole, Cefoperazone 4. Procarbazine (antineoplastic chemotherapy drug for the treatment of Hodgkin's lymphoma) 5. 1st Generation Sulfonylureas (Tolbutamide)
474
What side effect would you be concerned about if a patient is receiving both ceftriaxone and gentamicin?
**Nephrotoxicity** can result with concommitant use of a cephalosporin and an aminoglycoside
475
What cell wall inhibitor matches each of the following statements? 1. Can cause "Red Man syndrome" 2. Next step in treatment of otitis media if resistant to amoxicillin 3. Prophylaxis against bacterial endocarditis 4. Increases the nephrotoxicity of aminoglycosides
1. Can cause "Red Man syndrome": **Vancomycin** 2. Next step in treatment of otitis media if resistant to amoxicillin: **[Amoxicillin + Clavulanic acid] or 3rd gen cephalosporin - Cefdinir** 3. Prophylaxis against bacterial endocarditis: **Penicillin V, aminopenicillin (amoxicillin), or cephalexin** 4. Increases the nephrotoxicity of aminoglycosides: **Cephalosporins**
476
What cell wall inhibitor matches each of the following statements? 1. Aminoglycoside pretender 2. Inpatient treatment for MRSA 3. Sufficient for the treatment of syphilis 4. Single dose treatment of gonorrhea
1. Aminoglycoside pretender: **Aztreonam** 2. Inpatient treatment for MRSA: **Vancomycin** 3. Sufficient for the treatment of syphilis: **Penicillin G** 4. Single dose treatment of gonorrhea: **Ceftriaxone**
477
What cell wall inhibitor matches each of the following statements? 1. Hospitalized patient with new Gram (+) cocci clusters in blood 2. Treatment for C. Diff colitis 3. Broad spectrum coverage for appendicitis 4. Cell wall inhibitors effective against Pseudomonas
1. Hospitalized patient with new Gram (+) cocci clusters in blood: **Vancomycin** 2. Treatment for C. Diff colitis: **Oral vancomycin (Tx of choice is Metronidazole but Metronidazole is not a cell wall inhibitor)** 3. Broad spectrum coverage for appendicitis: **Carbapenams such as imipenem/cilastatin or meropenam** 4. Cell wall inhibitors effective against Pseudomonas: **Cefepime (4th gen cephalosporin), carbapenams, Aztreonam, Carboxypenicillins (ticarcillin)**
478
How does an organism develop resistance to vancomycin?
D-ala-D-ala -\> D-ala-D-lac
479
A patient is receiving an IV infusion of an antibiotic and the nurse calls you when his face becomes flushed 15 minutes after the infusion started. What is the treatment for this patient?
Stop the Vancomycin -\> Add an antihistamine such as Diphenhydramine -\> Restart the Vancomycin at a decreased rate of infusion
480
What is the distinction between a Ghon complex and a Ghon focus? Are these seen in primary or secondary tuberculosis?
1. Ghon focus = Calcified lung scar 2. Ghon complex = Calcified lung scar (Ghon focus) + hilar lymphadenopathy 3. They occur in primary TB
481
What does a positive PPD skin test indicate?
1. Previous TB exposure 2. BCG vaccination 3. Current infection
482
What does a negative PPD skin test indicate?
1. No TB exposure/infection 2. Immunosuppressed (HIV) 3. Sarcoidosis 4. Chronic steroid use 5. Malnutrition
483
A patient is attempting to recall for you what medications he is taking, and there is one medication that he is taking to "keep his lungs healthy" that he also says can "hurt his nerves" unless he takes his B vitamin. To what medication is he referring?
Isoniazid
484
What is the classic presenting symptom in a patient with lyme disease?
Erythema Chronicum Migrans *(Also fatigue, fever, and headache)*
485
What pupillary sign might point you to a diagnosis of syphilis?
Argyll Robertson pupils: Not reactive to light but constrict with accomodation
486
What organism is associated with each of the following clues? 1. Lymphadenopathy + a new kitten 2. Dog bite 3. Ixodes tick 4. Rabbit hunter 5. Pet prairie dog
1. Lymphadenopathy + a new kitten: **Bartonella** 2. Dog bite: **Pasteurella multocida** 3. Ixodes tick: **Borrellia burgdorferi** 4. Rabbit hunter: **Francisella tularensis** 5. Pet prairie dog: **Yersinia pestis**
487
What is the Rickettsial triad of symptoms?
Headache, fever, rash
488
A 25 year-old with Mycoplasma atypical pneumonia exhibits anemia due to cryoagglutinins. What type of immunoglobulins are responsible for the anemia?
IgM (cold agglutinins)
489
A homeless, alcoholic patient vomited while intoxicated, and subsequently developed foul-smellin sputum. What organism is most likely causing his infection?
Klebsiella pneumonia or anaerobic pneumonia
490
Which embryologic structure of the heart gives rise to each of the following adult structures? 1. Ascending aorta and pulmonary trunk 2. Coronary sinus 3. SVC 4. Smooth parts of the left and right ventricle 5. Smooth part of the right atrium 6. Trabeculated left and right atrium 7. Trabeculated parts of the left and right ventricle
1. Ascending aorta and pulmonary trunk: **Truncus arteriosus** 2. Coronary sinus: **Left horn of sinus venosus** 3. SVC: **Right common cardinal vein and right anterior cardinal vein** 4. Smooth parts of the left and right ventricle: **Bulbus cordis** 5. Smooth part of the right atrium: **Right horn of sinus venosus** 6. Trabeculated left and right atrium: **Primitive atria** 7. Trabeculated parts of the left and right ventricle: **Primitive ventricle**
491
1. What structure divides the truncus arteriosus into the aortic and pulmonary trunks? 2. What is the cellular origin of this structure?
1. Aorticopulmonary septum 2. Neural crest derivative
492
Which fetal vessel has the highest oxygenation?
Umbilical vein \> Ductus venosus \> Inferior vena cava \> Right atrium
493
What causes the ductus arteriosus to close?
Infant breathing -\> Increased oxygenated blood in aorta -\> Decreased prostaglandins
494
What causes the foramen ovale to close?
Infant breathing -\> Decreased pulmonary resistance -\> Increased left atrial pressure
495
What is the most common congenital cardia anomaly?
Ventricular Septal Defect (VSD)
496
What are the components of the Tetralogy of Fallot?
1. Pulmonary Stenosis 2. Right Ventricular Hypertrophy 3. Ventricular Septal Defect 4. Overriding Aorta
497
Explain how the great vessels are attached in a transposition of the great vessels.
1. Right ventrical is attached to the Aorta 2. Left ventrical is attached to the pulmonary trunk
498
A 45 year-old man presents with a BP of 160/90 on the right arm and 170/92 on the left arm. There are no palpable pulses in the feet/ankle. What problem does this patient most likely have?
Coarctation of the aorta
499
Describe the blood flow through a Patent ductus arteriosus
Left to right shunt from aorta to the pulmonary artery via the patent ductus arteriosus
500
What heart defect is associated with each of the following disorders? 1. Chromosome 22q11 deletions 2. Down syndrome 3. Congenital rubella 4. Turner syndrome 5. Marfan syndrome
1. Chromosome 22q11 deletions: **(This is a DiGeorge variant) Persistent truncus arteriosus, tetralogy of Fallot** 2. Down syndrome: **Endocardial cushion defect** 3. Congenital rubella: **PDA, Pulmonary artery stenosis** 4. Turner syndrome: **Coarctation of the aorta, bicuspid aortic valve** 5. Marfan syndrome: **Aortic insufficiency**
501
What is the pulse pressure in a patient with systolic BP of 150 and a MAP of 90?
MAP = 90 = 2/3 Diastolic + 1/3 Systolic 90 = 2/3 D + 50 Diastolic = 60 Pulse pressure = Systolic - Diastolic PP = 150 - 60 = 90
502
What is the basic equation for cardiac output? What is the Fick principle?
1. CO = SV x HR 2. CO = Rate of oxygen consumption/(arterial O2 content - venous O2 content)
503
How can the myocardial oxygen demand be decreased in circumstances where the heart is ischemic?
1. Decrease contractility 2. Decrease afterload 3. Decrease HR
504
What can make the stroke volume increase for a given preload?
Increased contractility: Sympathetic stimulation, inotropic drugs, increased intracellular Ca, decreased extracellular Na
505
What factors affect stroke volume?
1. Afterload 2. Preload 3. Contractility
506
What is the heart ejection fraction?
EF = SV/EDV
507
What are the signs of right-sided heart failure?
_Peripheral signs/symptoms_ 1. Lower extremity edema 2. Jugular venous distension
508
What are the signs of left-sided heart failure?
_Pulmonary signs/symptoms_ 1. Dyspnea on exertion 2. Orthopnea 3. Paroxysmal nocturnal dyspnea 4. Pulmonary congestion symptoms
509
What medications are used to treat chronic heart failure?
_Improve outcomes_ 1. ACE inhibitors 2. ARBs 3. Aldosterone antagonists (K sparing diuretics like spironolactone) 4. Beta-blockers (Metoprolol and Carvedilol) _Improve symptoms_ 1. Loop diuretics 2. Digoxin 3. Nitrates
510
What medications are used to treat acute heart failure?
"LMNOP" 1. Loop diuretics 2. Morphine 3. Nitrates 4. Oxygen 5. Positioning and pressors
511
What is the mechanism of action of the cardiac glycosides (eg Digoxin)?
Inhibit Na/K counter transporter -\> Increase intracellular Ca
512
How do the following circumstances impact the Starling forces of fluid movement through capillaries? 1. Heart failure 2. Liver failure 3. Renal failure 4. Infections and toxins 5. Nephrotic syndrome
1. Heart failure: **Increase capillary pressure** 2. Liver failure: **Decrease oncotic pressure** 3. Renal failure: **Decrease in plasma proteins -\> Decrease in plasma colloid osmotic pressure** 4. Infections and toxins: **Increased capillary permeability** 5. Nephrotic syndrome: **Decrease plasma protein -\> Decreased plasma colloid osmotic pressure**
513
How do the following circumstances impact the Starling forces of fluid movement through capillaries? 1. Lymphatic blockage 2. Burns 3. Diuretic administration 4. IV infusion of albumin or clotting factors 5. Venous insufficiency
1. Lymphatic blockage: **Increased interstitial osmotic pressure -\> draw fluid out of capillaries into interstitium** 2. Burns: **Increased capillary permeability** 3. Diuretic administration: **Osmotic agent to prevent water reabsorption -\> Decreased Hydrostatic pressure** 4. IV infusion of albumin or clotting factors: **Increased plasma protein -\> Increased plasma colloid osmotic pressure** 5. Venous insufficiency: **Increased capillary pressure**
514
How do the vascular resistance and stroke volume differ in hypovolemic shock compared to septic shock?
1. Hypovolemic shock: Increased vascular resistance, decreased SV 2. Septic shock: Decreased vascular resistance, increased SV
515
What are some of the causes of cardiogenic shock?
1. MI 2. Pulmonary embolism 3. Arrhythemia 4. Cardiac tamponade
516
How is the skin of a patient different in cardiogenic shock compared to septic shock?
1. Cardiogenic shock: Less perfused -\> Cold/clammy/cyanotic 2. Septic shock: More perfused -\> Warm/flushed
517
What other severe problems often coexist with septic shock in ICU patients?
1. DIC 2. Multiorgan failure (Acute pancreatitis, acute renal failure, liver failure, adrenal insufficiency) 3. Acute respiratory distress syndrome 4. Intestinal ileus
518
What serum lab marker is helpful in assessing the appropriate oxygenation of tissues?
Lactic acid
519
When does isovolumetric contraction take place?
After the mitral valve closes but before the aortic valve opens
520
How does an increase in afterload affect the stroke volume of the heart assuming contractility remains the same?
Decreased SV
521
What impact does an increase in contractility have on stroke volume assuming preload and afterload remain constant?
Increased SV
522
1. What heart sound is associated with dilated congestive heart failure? 2. What heart sound is associated with chronic hypertension?
1. S3 2. S4
523
What gives rise to the jugular venous a, c, and v waves?
1. a: Right atrial contraction 2. b: Right ventricular contraction 3. v: Atrial filling
524
Where does the QRS complex fall in relation to valvular dynamics?
Ventricular depolarization -\> Mitral valve closure
525
What defect is associated with the following type of murmur? Crescendo-decrescendo systolic murmur best heard in the 2nd and 3rd interspace close to the sternum
Aortic stenosis
526
What defect is associated with the following type of murmur? Early diastolic decrescendo murmur heard best along the left side of the sternum
Pulmonic regurgitation
527
What defect is associated with the following type of murmur? Late diastolic decrescendo murmur heard best along the left side of the sternum
Tricuspid stenosis
528
What defect is associated with the following type of murmur? Pansystolic (AKA holosystolic or uniform) murmur best heard at the apex and often radiates to the left axilla
Mitral regurgitation
529
What defect is associated with the following type of murmur? Late systolic murmur usually preceded by a mid-systolic click
Mitral prolapse
530
What defect is associated with the following type of murmur? Crescendo-decrescendo systolic murmur best heard in the 2nd-3rd left interspaces close to the sternum
Pulmonary stenosis
531
What defect is associated with the following type of murmur? Pansystolic murmur best heard along the left lower sternal border and generally radiates to the right lower sternal border
VSD or Tricuspid regurgitaion
532
What defect is associated with the following type of murmur? Rumbling late diastolic murmur with an opening snap
Mitral stenosis
533
What defect is associated with the following type of murmur? Continuous machine-like murmur (in systole and diastole)
PDA
534
What defect is associated with the following type of murmur? High-pitched diastolic murmur associated with a widened pulse pressure
Aortic regurgitation
535
What murmurs are heard best in the left lateral decubitus position?
1. Mitral Regurgitation 2. Mitral Stenosis 3. Left sided s3 & s4 heart sounds
536
Describe the flow of ions during a pacemaker action potential
Phase 4: Na in Phase 0: Ca in Phase 3: K out
537
What physiology accounts for the automaticity of the AV and SA nodes?
Phase 4 gradual sodium conductance
538
What is the mechanism of action of each class of antiarrhythmic?
"No Bad Boy Keeps Clean" Class I: Na channel blockers Class II: Beta-blockers Class III: K blockers Class IV: Ca channel blockers
539
Which antiarrhythmic has the side effect of cinchonism?
**Quinidine** Cinchonism = headache + tinnitus Quinidine also causes thrombocytopenia and torsades de pointes
540
What are the potential side effects of amiodarone use?
1. **Pulmonary fibrosis** 2. **Liver toxicity** 3. **Hyper or hypothyroidsm** 4. **Blue-grey skin discoloration** 5. Photodermatitis 6. Bradycardia 7. Heart block 8. Corneal deposits 9. Neurologic Sx 10. Constipation
541
What is the mechanism of action of adenosine as an antiarrhythmic?
1. Increase outward K current 2. Hyperpolarizes cells 3. Decreases intracellular Ca 4. Stops heart
542
To which class of antiarrhythmics does each of the following agents belong? 1. Sotalol 2. Propranolol 3. Bretylium 4. Quinidine
1. Sotalol: **Class III (Beta-blocker but even more of a K channel blocker)** 2. Propranolol: **Class II** 3. Bretylium: Cl**ass III** 4. Quinidine: **Class Ia**
543
To which class of antiarrhythmics does each of the following agents belong? 1. Verapamil 2. Procainamide 3. Lidocaine 4. Diltiazem
1. Verapamil: **Class IV** 2. Procainamide: **Class Ia** 3. Lidocaine: **Class Ib** 4. Diltiazem: **Class IV**
544
How does the cause of a narrow QRS complex differ from the cause of a wide QRS comples?
1. Narrow: Depolarization through AV node and down the purkinje system 2. Wide: Beat originates in the ventricles as a result of a premature ventricular contraction, Ventricular tacchycardia, or bundle branch block
545
What is the ECG axis given the QRS deflections in each of the follwoing scenarios? 1. Positive in lead I, positive in lead II 2. Positive in lead I, Negative in lead III 3. Neagtive in lead I, positive in lead III 4. Positive in lead I, negative in aVR
1. Positive in lead I, positive in lead II: **Normal axis** 2. Positive in lead I, Negative in lead III: **Left axis deviation or normal axis** 3. Neagtive in lead I, positive in lead III: **Right axis deviation** 4. Positive in lead I, negative in aVR: **Normal axis**
546
How does hyperkalemia affect the shape of T waves?
Hyperkalemia: **Tall peaked T waves** Hypokalemia: Flattened T waves
547
What is the initial treatment for ventricular fibrillation?
CPR and shock
548
What is the initial treatment for ventricular tachycardia when there is no pulse?
CPR and shock
549
What is the hallmark of a 3rd degree heart block?
No coordination between P-waves and QRS segments
550
What drugs are known to prolong the QT interval, increasing the likelihood of torsades in those at risk?
1. Anti-infectivess: Macrolides, chloroquine 2. Anti-psychotics: Haloperidol, risperidone 3. Anti-HIV: Protease inhibitors (-navirs) 4. Anti-arrhythmics: Class Ia (quinidine) and Class III (K channel blockers such as sotalol)
551
What are the two different types of second degree AV block? How do they differ?
1. Mobitz I (Wenckebach): Progressively prolonged PR interval followed by a dropped beat 2. Mobitz II: Randomly dropped beats
552
Why is warfarin anticoagulation important in patients with chronic atrial fibrillations?
Blood pools in the atrium during atrial fibrillation, increasing the risk of thrombosis and embolism
553
Outline the mechansim by which the kidneys regulate BP
Juxtoglomerular apparatus senses low BP and synthesizes renin -\> Renin converts angiotensinogen (Created by liver) into angiotensin I -\> ACE (created in lungs) converts angiotensin I into angiotensin II -\> Angiotensin II causes vasoconstriction and also stimulates aldosterone secretion by the adrenal cortex -\> Aldosterone promotes Na and H20 retention in the distal convoluted tubule and proximal collecting duct
554
What substances act on smooth muscle myosin light-chain kinase? How does this affect blood pressure?
**Dihydropyridine Ca channel blockers** inhibit the Calmodulin-Ca complex: The calmodulin-Ca complex normally activates myosin light-chain kinase, resulting in the phosphorylation of myosin and contraction. Thus, Ca channel blockers inhibit contraction and promote relaxation **Epinephrine (beta2 receptors) and prostaglandin E2** receptor binding results in an increase in cAMP: cAMP inhibits myosin light chain kinase. Thus, epinephrine and prostaglandins inhibit contraction and promote relaxation
555
Describe the chain of events in which hypotension causes a reflex tachycardia
Decreased baroreceptor stretch in the carotid sinus (Aortic arch baroreceptors only sense high BP) -\> Less stimulation of CN IX and less afferent signaling to the solitary nucleus -\> More sympathetic activation and less parasympathetic activation -\> Reflex tachycardia
556
1. What BP values mark the diagnosis of hypertension? 2. What values mark prehypertension?
1. Hypertension \>/= 140/90 2. Pre-hypertension \>/= 120/80 *Only systolic or diastolic pressures have to exceed their respective cuttoff in order for the patient to fall in that category*
557
What would you most suspect the cause of hypertension to be in a patient with each of the following clinical clues? 1. Paroxysms of increased sympathetic tone - Anxiety, palpitations, diaphoresis 2. Age of onset between 20 and 50 3. Elevated serum creatinine and an abnormal urinalysis 4. Abdominal bruit 5. BP in arms \> legs
1. Paroxysms of increased sympathetic tone - Anxiety, palpitations, diaphoresis: **Phoechromocytoma** 2. Age of onset between 20 and 50: **Primary Hypertension** 3. Elevated serum creatinine and an abnormal urinalysis: **Renal disease** 4. Abdominal bruit: **Renal artery stenosis** 5. BP in arms \> legs: **Coarctation of the aorta**
558
What would you most suspect the cause of hypertension to be in a patient with each of the following clinical clues? 1. Family history of Hypertension 2. Tachycardia, heat intolerance, diarrhea 3. Hyperkalemia 4. Episodic sweating and tachycardia 5. Abrupt onset in a patient younger than 20 or older than 50, and depressed serum K+ levels
1. Family history of Hypertension: **Essential hypertension** 2. Tachycardia, heat intolerance, diarrhea: **Hyperthyroidism** 3. Hyperkalemia: **Renal failure** 4. Episodic sweating and tachycardia: **Pheochromocytoma** 5. Abrupt onset in a patient younger than 20 or older than 50, and depressed serum K+ levels: **Hyperaldosteronemia**
559
What would you most suspect the cause of hypertension to be in a patient with each of the following clinical clues? 1. Central obesity, moon-shaped face, hirsutism 2. Normal urinalysis and normal serum K+ levels 3. Young individual with acute onset tachycardia 4. Hypokalemia 5. Proteinuria
1. Central obesity, moon-shaped face, hirsutism: **Cushing syndrome** 2. Normal urinalysis and normal serum K+ levels: **Primary hypertension** 3. Young individual with acute onset tachycardia: **Cocaine or amphetamine use** 4. Hypokalemia: **Renal artery stenosis causing hyperaldosteronism** 5. Proteinuria: **Renal disease**
560
What chest x-ray finding is a possible sign for aortic dissection?
Widened mediastinum
561
What category of BP medications is preferred in the treatment of aortic dissection?
Beta-blocker
562
Which antihypertensive class or drug fits each of the following side effects? 1. First dose orthostatic hypotension 2. Ototoxic (especially with aminoglycosides) 3. Hypertrichosis 4. Cyanide toxicity
1. First dose orthostatic hypotension: **Alpha-1 Blockers (Prazosin)** 2. Ototoxic (especially with aminoglycosides): **Loop diuretics** 3. Hypertrichosis: **Minoxidil** 4. Cyanide toxicity: **Sodium Nitroprusside**
563
Which antihypertensive class or drug fits each of the following side effects? 1. Dry mouth, sedation, severe rebound HTN 2. Bradycardia, impotence, asthma exacerbation 3. Reflex tachycardia 4. Cough
1. Dry mouth, sedation, severe rebound HTN: **Alpha-2 agonists (Clonidine)** 2. Bradycardia, impotence, asthma exacerbation: **Beta-blockers** 3. Reflex tachycardia: **Any vasodilator (Nitrates, Hydralazine, Dihydropyridines)** 4. Cough: **ACE inhibitors**
564
Which antihypertensive class or drug fits each of the following side effects? 1. Avoid in patients with a sulfa allergy 2. Possible angioedema 3. Possible development of drug-induced lupus 4. Hypercalcemia, hypokalemia
1. Avoid in patients with a sulfa allergy: **Loop and thiazide diuretics** 2. Possible angioedema: **ACE inhibitors and ARBs** 3. Possible development of drug-induced lupus: **Hydralazine** 4. Hypercalcemia, hypokalemia: **Thiazide diuretics**
565
Which antihypertensives are particularly beneficial to heart failure patients?
1. Beta-blockers 2. ACE inhibitors 3. ARBs 4. Aldosterone antagonists (K sparing diuretics)
566
Which antihypertensives are safe to use in pregnancy?
"Hypertensive Moms Love Nifedipine" 1. Hydralazine 2. Methyldopa 3. Labetalol 4. Nifedipine
567
What are the most common locations for atherosclerosis, and what disorders result from plaques in these locations?
1. Abdominal aorta - Abdominal aortic aneurysm (AAA) 2. Coronary Artery - MI and Angina 3. Popliteal artery - Claudication and peripheral vascular disease 4. Carotid arteries - Transient ischemic attack, strokes, dementia
568
A patient with poorly-managed HTN has acute, sharp substernal pain that radiates to the back and progresses over a few hours. Death occurs in a few hours. Diagnosis?
Aortic dissection
569
What is the most likely cause of chest pain in each of the following scenarios? 1. Acute onset dyspnea, tachycardia, and confusion in the hospitalized patient 2. Rapid onset of sharp pain in the 20-year-old and associated with dyspnea 3. Pain began the day following an intensive new exercise program 4. ST segment elevation only during bried episodes of chest pain 5. Sharp pain lasting hours to days and is somewhat relieved by sitting forward 6. Chest wall tenderness on palpation
1. Acute onset dyspnea, tachycardia, and confusion in the hospitalized patient: **Pulmonary embolus** 2. Rapid onset of sharp pain in the 20-year-old and associated with dyspnea: **Spontaneous pneumothorax** 3. Pain began the day following an intensive new exercise program: **MSK pain** 4. ST segment elevation only during bried episodes of chest pain: **Prinzmetal's angina** 5. Sharp pain lasting hours to days and is somewhat relieved by sitting forward: **Pericarditis** 6. Chest wall tenderness on palpation: **MSK pain**
570
Which lipid lowering agent matches each of the following descriptions? 1. SE: Facial flushing 2. SE: Elevated LFTs, Myositis 3. SE: GI discomfort, bad taste 4. Best effect on HDL 5. Best effect on triglycerides/VLDL 6. Best effect on LDL/cholesterol 7. Binds C. Diff toxin
1. SE: Facial flushing: **Niacin** 2. SE: Elevated LFTs, Myositis: **Statins & Fibrates** 3. SE: GI discomfort, bad taste: **Bile acid binding resins** 4. Best effect on HDL: **Niacin** 5. Best effect on triglycerides/VLDL: **Fibrates (and omega-3 fatty acids but less effective)** 6. Best effect on LDL/cholesterol: **Statins** 7. Binds C. Diff toxin: **Cholestyramine (Bile acid binding resin)**
571
A 50 year-old man starts on lipid-lowering medication. Upon his first dose, he develops a rash, pruritis, and diarrhea. What drug is he taking?
Niacin
572
How can the flushing reaction of niacin be prevented?
1. Aspirin or NSAID 30 minutes before niacin 2. Avoid alcohol/hot beverages 3. Take at bedtime 4. Be persistent
573
Which serum lab markers are commonly used to make the diagnosis of MI?
1. Troponin-I 2. CK-MB
574
Which coronary artery is most commonly occluded in an MI?
Left Anterior Descending (LAD)
575
What would cause each of the following findings after an MI? 1. Cardiac tamponade 2. Severe mitral regurgitation 3. New VSD 4. Stroke
1. Cardiac tamponade: **Ventricular wall rupture** 2. Severe mitral regurgitation: **Papillary rupture** 3. New VSD: **Intraventricular septum rupture** 4. Stroke: **Mural thrombus -\> embolus**
576
Which ECG leads will show evidence of ischemia in an anterior wall MI?
V1-V5
577
What medications would you think to prescribe in an ER patient diagnosed with MI?
_"MONA"_ 1. **Morphine** 2. **Oxygen** 3. **Nitroglycerin** 4. **Aspirin** _Also_ **Beta-blockers**: Decrease O2 demand, decrease infarct size, decrease mortality (They increase risk of acute cardiogenic shock if there is significant Left ventrical dysfunction) **ACE inhibitor of ARB**: Decrease afterload, decrease O2 demand, decrease cardiac remodelling, and decrease risk of heart failure and death **Statins**: Stabilize atherosclerotic plaques, may decrease inflammation , decrease LDL **MG \> 2, K \> 4**: Reduce the risk of arrhythmia
578
What are the differences between acute and subacute bacterial endocarditis?
_Acute_ 1. Usually caused by Staph Aureus 2. Onset is very rapid 3. Normal valves can be affected _Subacute_ 1. Usually caused by Viridans strep 2. affects already damaged valves 3. Insidious onset
579
An IV drug user presents with chest pain, dyspnea, tachycardia, and tachypnea. What is the most likely cause?
Bacterial endocarditis with bacterial embolism to the pulmonary arteries
580
A patient in a motor vehicle accident presents with chest pain, dyspnea, tachycardia, and tachypnea. What is the most likely cause?
Tension pneumothorax
581
A post-op patient presents with chest pain, dyspnea, tachycardia, and tachypnea. What is the most likely cause?
Pulmonary embolism from a DVT
582
A young girl with congenital valve disease is given penicillin prophylactically. In the ER, bacterial endocarditis is diagnosed. What is the next step in her management?
IV Vancomycin until the blood culture comes back. Once the culture results come back, you can switch to an antibiotic regimen specific for the bacteria's susceptibilities
583
Under what circumstances might you see pulsus paradoxus?
1. Cardiac tamponade (mainly) 2. Asthma 3. Croup 4. Obstructive sleep apnea 5. COPD
584
What are the Jones criteria for the diagnosis of acute rheumatic fever?
1. Joints 2. Pancarditis 3. Nodules 4. Erythema marginatum 5. Syndenham's chorea
585
What heart pathology fits each of the following statments? 1. Diffuse myocardial inflammation with necrosis and mononuclear cells 2. Focal myocardial inflammation with multinucleate giant cells 3. Fever + IV drug abuser + new heart murmur 4. Chest pain and course rubbing heart sounds in patient with creatinine of 5.0 5. Tree-barking of the aorta
1. Diffuse myocardial inflammation with necrosis and mononuclear cells: **Myocarditis** 2. Focal myocardial inflammation with multinucleate giant cells: **Aschoff bodies of Rheumatic heart disease** 3. Fever + IV drug abuser + new heart murmur: **Infective endocarditis** 4. Chest pain and course rubbing heart sounds in patient with creatinine of 5.0: **Uremic pericarditis** 5. Tree-barking of the aorta: **Syphilis heart disease**
586
What heart pathology fits each of the following statments? 1. Child with fever, joint pain, cutaneous nodules 4 weeks after throat infection 2. ST elevation in all ECG leads 3. Disordered growth of myocytes 4. ECG shows electrical alterans
1. Child with fever, joint pain, cutaneous nodules 4 weeks after throat infection: **Rheumatic fever** 2. ST elevation in all ECG leads: **Pericarditis** 3. Disordered growth of myocytes: **Hypertrophic cardiomyopathy** 4. ECG shows electrical alterans: **Cardiac Tamponade**
587
Which disorders are commonly discovered in patients with Raynaud phenomenon?
1. Lupus 2. Buerger's Dx 3. CREST Scleroderma 4. Mixed Connective Tissue Disease
588
What are the characteristic features of Kawasaki disease?
1. Vasculitis of small and medium vessels in an asian child 2. Coronary aneurysms 3. High fever 4. Conjunctivitis 5. Desquamating rash on palms and soles 6. Bright red inflammation of lips/oral mucosa 7. Strawberry tongue 8. Lymphadenopathy
589
Which type of vasculitis fits each of the following high-yield characteristics? 1. Weak pulses in upper extremities 2. Necrotizing granulomas of lung and necrotizing glomerulonephritis 3. Necrotizing immune complex inflammation of visceral/renal vessels 4. Young male smokers
1. Weak pulses in upper extremities: **Takayasu's arteritis** 2. Necrotizing granulomas of lung and necrotizing glomerulonephritis: **Wegener's Granulomatosis (Granulomatosis with polyangiitis)** 3. Necrotizing immune complex inflammation of visceral/renal vessels: **Polyarteritis Nodosa** 4. Young male smokers: **Buerger's disease**
590
Which type of vasculitis fits each of the following high-yield characteristics? 1. Young asian women 2. Young asthmatics 3. Infants and young children; involved coronary arteries 4. Most common vasculitis
1. Young asian women: **Takayasu's arteritis** 2. Young asthmatics: **Churg-Strauss Syndrome** 3. Infants and young children; involved coronary arteries: **Kawasaki disease** 4. Most common vasculitis: **Temporal (Giant Cell) arteritis**
591
Which type of vasculitis fits each of the following high-yield characteristics? 1. Associated with hepatitis B infection 2. Occlusion of opthalmic artery can lead to blindness 3. Perforation of nasal septum 4. Unilateral headache, jaw claudication
1. Associated with hepatitis B infection: **Polyarteritis Nodosa** 2. Occlusion of opthalmic artery can lead to blindness: **Temporal (Giant Cell) arteritis** 3. Perforation of nasal septum: **Wegeners granulomatosis (Granulomatosis with polyangiitis)** 4. Unilateral headache, jaw claudication: **Temporal (Giant Cell) arteritis**
592
Which vascular tumor fits each of the following descriptions? 1. Benign, raised, red lesion about the size of a mole in older patients 2. Raised, red area present at birth, increases in size initially then regresses over months to years 3. Lesion caused by lymphoangiogenic growth factors in an infected HIV patient
1. Benign, raised, red lesion about the size of a mole in older patients: **Cherry hemangioma** 2. Raised, red area present at birth, increases in size initially then regresses over months to years: **Strawberry hemangioma** 3. Lesion caused by lymphoangiogenic growth factors in an infected HIV patient: **Kaposi Sarcoma**
593
Which vascular tumor fits each of the following descriptions? 1. Polypoid red lesion found in pregnancy or after trauma 2. Benign, painful, red-blue tumor under fingernails 3. Cavernous lymphangioma associated with Turner Syndrome 4. Skin papule in AIDS patient caused by Bartonella
1. Polypoid red lesion found in pregnancy or after trauma: **Pyogenic Granuloma** 2. Benign, painful, red-blue tumor under fingernails: **Glomus tumor** 3. Cavernous lymphangioma associated with Turner Syndrome: **Cystic hygroma** 4. Skin papule in AIDS patient caused by Bartonella: **Bacillary angiomatosis**
594
A lesion to which area of the brain is responsible for each of the following clinical scenarios? 1. Hemispatial neglect syndrome 2. Poor repetition 3. Poor comprehension 4. Poor vocal expression
1. Hemispatial neglect syndrome: **Non-dominant parietal lobe** 2. Poor repetition: **Arcuate Fasciculus (Conduction aphasia)** 3. Poor comprehension: **Wernicke's area** 4. Poor vocal expression: **Brocas area**
595
A lesion to which area of the brain is responsible for each of the following clinical scenarios? 1. Personality changes 2. Dysarthria 3. Agraphia and acalculia 4. Hyperorality, hypersexuality, disinhibited behavior
1. Personality changes: **Frontal lobe** 2. Dysarthria: **Cerebellar Vermis** 3. Agraphia and acalculia: **Dominant parietal lobe** 4. Hyperorality, hypersexuality, disinhibited behavior: **Bilateral Amygdala (Called Kluver-Bucy Syndrome)**
596
What typically is the cause of a lesion to the mamillary bodies?
Vitamin B1 deficiency
597
What is the most feared consequence of carotid artery stenosis?
Rupture of atherosclerotic carotid plaque -\> Plaque embolus to the brain -\> Ischemic embolic stroke
598
What artery is damaged with each of the following presentations? 1. Broca or Wernicke aphasia 2. Unilateral lower extremity sensory and/or motor loss 3. Unilateral facial and arm sensory and/or motor loss
1. Broca or Wernicke aphasia: **Middle cerebral artery** 2. Unilateral lower extremity sensory and/or motor loss: **Anterior cerebral artery** 3. Unilateral facial and arm sensory and/or motor loss: **Middle cerebral artery**
599
What artery supplies the medial lemniscus and medullary pyramid of the medulla?
Anterior spinal artery
600
1. Where does the corticospinal tract decussate in the brainstem? 2. Where does the dorsal column-medial leminiscal pathway decussate?
1. Caudal Medulla prior to medullary pyramids 2. Medulla then ascends as medial lemniscus
601
What artery supplies the following medullary structures: Spinothalamic tract, inferior cerebellar peduncle, nucleus ambiguus, and lateral spinothalamic tract?
Posterior Inferior Cerebella Artery (PICA)
602
How do the symptoms of a lesion to the cortical motor region of the face differ from a lesion of the facial nerve or nucleus?
1. Lesion in cortical motor face region: **Paralysis of contralateral lower face** 2. Lesion of facial nerve or nucleus: **Paralysis of ipsilateral full face**
603
A patient has a leftward deviation of the tongue on protrusion, and has a right-sided spastic paralysis. Where is the lesion?
Left medulla
604
What are the signs of Weber syndrome?
PCA infarction 1. Contalateral spastic paralysis 2. CN III palsy (eye looks down and out) 3. Ptosis
605
What are the signs of Wallenberg syndrome?
PICA infarction 1. Contalateral loss of pain and temperature sensation of body 2. Ipsilateral loss of pain and temperature sensation of face 3. Hoarse voice, difficulty swallowing, loss of gag reflex 4. Ipsilateral Horner syndrome 5. Vertigo, nystagmus, nausea/vomiting 6. Ispsilateral cerebella deficits
606
A patient cannot abduct her left eye on lateral gaze and convergence is normal. She is also having difficulty smiling. In what part of the CNS is there a lesion?
Pontine lesion
607
A lesion of what artery can cause a locked-in syndrome?
Basilar artery
608
1. What is the most common site of a berry aneurysm? 2. What diseases are often associated with berry aneurysms?
1. Anterior communicating artery 2. Autosomal dominant polycystic kidney disease & Ehlers-Danlos syndrome
609
An 85 year-old man with Alzheimer disease falls at home and presents 3 days later with severe headache and vomiting. What is the most likely diagnosis and what structures were damaged?
1. Subdural hematoma 2. Bridging veins
610
1. Where is CSF generated? 2. Where is CSF reabsorbed?
1. Choroid plexus of the ventricles 2. Arachnoid granulations in the superior sagittal sinus
611
What is the difference between communicating and noncommunicating hydrocephalus?
1. Communicating: Decreased absorption of CSF at the arachnoid villi 2. Non-communicating: Physical, mechanical obstruction of ventricles
612
What clinical features characterize normal pressure hydrocephalus?
1. Wet: Urinary incontinence 2. Wobbly: Ataxia 3. Wacky: Dementia
613
What are the differences between the 1a afferent motor pathway and the 1b afferent motor pathway?
1a: Intrafusal fibers within muscle spindle that stimulate alpha motor neurons -\> contraction 1b: Sensory from the golgi tendon organ that inhibits alpha motor neurons -\> inhibits contraction
614
What portion of the thalamus relays the following types of information? 1. Somatosensory from body (via medial lemniscus and spinothalamic) 2. Cerebellum (Dentate nucleus) and basal ganglia -\> motor cortex 3. Trigeminothalamic and taste pathways to somatosensory cortex
1. Somatosensory from body (via medial lemniscus and spinothalamic): **Ventral Posterolateral Nucleus (VPL)** 2. Cerebellum (Dentate nucleus) and basal ganglia -\> motor cortex: **Ventrolateral Nucleus (VL)** 3. Trigeminothalamic and taste pathways to somatosensory cortex: **Ventroposteromedial Nucleus (VPM)**
615
What portion of the thalamus relays the following types of information? 1. Retina -\> occipital lobe 2. Basal ganglia -\> prefrontal, premotor; and orbital cortices 3. (Auditory info) brachium of inferior colliculus -\> Primary auditory cortex
1. Retina -\> occipital lobe: **Lateral Geniculate Nucleus (LGN)** 2. Basal ganglia -\> prefrontal, premotor; and orbital cortices: **Ventral Anterior Nucleus (VA)** 3. (Auditory info) brachium of inferior colliculus -\> Primary auditory cortex: **Medial Geniculate Nucleus (MGN)**
616
1. What are classic signs of an upper motor neuron lesion? 2. Of a lower motor neuron lesion?
_Upper motor neuron lesion_ 1. Spastic paralysis 2. Hyperreflexia 3. Positive babinski sign _Lower motor neuron lesion_ 1. Flaccid paralysis 2. Fasciculations 3. Atrophy
617
What is the difference between essential tremor; resting tremor; and intention tremor
_Essential tremor_ * Occurs with a family history * Present with or without movement _Resting tremor_ * Disappears with voluntary movement _Intention tremor_ * Appears with voluntary movement
618
What are the cardinal features of Parkinson disease?
1. Resting tremor, pill rolling tremor 2. Rigidity 3. Hypokinesia 4. Cogwheel rigidity 5. Mask-like facies 6. Festinating gate
619
28 year-old chemist presents with MPTP exposure. What neurotransmitter is depleted?
Dopamine
620
How do each of the following structures normally impact movement? 1. Globus pallidus internal segment 2. Subthalamic nucleus 3. Substantia nigra pars compacta
1. Globus pallidus internal segment: **Inhibits movement** 2. Subthalamic nucleus: **Inhibits movement** 3. Substantia nigra pars compacta: **Promotes movement**
621
A male paitent presents with involuntary flailing of one arm. Where is the lesion?
Subthalamic nucleus on the contralateral side *This is Hemibalism*
622
What neurotransmitters are altered in Huntington disease?
1. Decreased Ach 2. Decreased GABA 3. Increased Dopamine
623
Which spinal tract conveys the following types of information? 1. Touch, vibration, and pressure sensation 2. Voluntary motor command from motor cortex to body 3. Voluntary motor command from motor cortex to head/neck 4. Alternate routes for the mediation of voluntary movement
1. Touch, vibration, and pressure sensation: **Dorsal column** 2. Voluntary motor command from motor cortex to body: **Lateral and Ventral Corticospinal tract** 3. Voluntary motor command from motor cortex to head/neck: **Corticobulbar tract** 4. Alternate routes for the mediation of voluntary movement: **Reticulospinal and Rubrospinal tracts**
624
Which spinal tract conveys the following types of information? 1. Pain and temperature sensation 2. Important for postural adjustments and head movements 3. Proprioceptive information for the cerebellum
1. Pain and temperature sensation: **Lateral Spinothalamic tract** 2. Important for postural adjustments and head movements: **Vestibulospinal tract** 3. Proprioceptive information for the cerebellum: **Dorsal and Ventral Spinocerebellar tract**
625
What are the findings of Brown-Sequard syndrome?
1. Ipsilateral UMN signs below lesion 2. Ipsilateral dorsal column loss of information below lesion 3. Contralateral pain and temperature loss at 2-3 segments below lesion 4. Ipsilateral pain an temperature loss at level of the lesion 5. LMN signs at level of lesion
626
What clinical presentation would lead you to suspect amyotrophic lateral sclerosis as a diagnosis?
Combined UMN and LMN motor loss without sensation loss
627
What are some of the more classic presenting scenarios for multiple sclerosis?
1. _Charcot' Triad_ * Scanning speech * Intention tremor * Nystagmus 2. Bowel or bladder incontinence 3. Internuclear opthalmoplegia 4. Optic neuritis
628
What are the symptoms of a lesion to the C5 and C6 nerve roots?
_Erb-Duchenne Palsy_ 1. Paralysis of upper extremity (Arm hangs at side) 2. Medial rotation of arm with forearm pronation (Waiters tip hand)
629
What are the symptoms of a lesion to the inferior trunk of the brachial plexus?
_Klumpke's Palsy_ 1. Sensory deficits of the forearm and hand on the medial side 2. Atrophy of the thenar, hypothenar, and interosseous muscles
630
What nerve is damaged when a patient presents with the following symptom (upper extremity)? 1. Claw hand 2. Ape hand 3. Wrist drop 4. Scapular winging 5. Unable to wipe bottom
1. Claw hand: **Ulnar or median nerve** 2. Ape hand: **Median nerve** 3. Wrist drop: **Radial nerve** 4. Scapular winging: **Long Thoracic nerve** 5. Unable to wipe bottom: **Thoracodorsal nerve**
631
What nerve is damaged when a patient presents with the following symptom (upper extremity)? 1. Loss of forearm pronation 2. Cannot abduct or adduct fingers 3. Loss of shoulder abduction 4. Weak external rotation of arm 5. Loss of elbow flexion and forearm supination
1. Loss of forearm pronation: **Median nerve** 2. Cannot abduct or adduct fingers: **Ulnar nerve** 3. Loss of shoulder abduction: **Axillary nerve** 4. Weak external rotation of arm: **Suprascapular and Axillary nerves** 5. Loss of elbow flexion and forearm supination: **Musculocutaneous nerve**
632
What nerve is damaged when a patient presents with the following symptom (upper extremity)? 1. Loss of wrist extension 2. Trouble initiating shoulder abduction 3. Unable to abduct arm beyond 10 degrees 4. Unable to raise arm above horizontal
1. Loss of wrist extension: **Radial nerve** 2. Trouble initiating shoulder abduction: **Suprascapular nerve** 3. Unable to abduct arm beyond 10 degrees: **Axillary nerve** 4. Unable to raise arm above horizontal: **Long thoracic and spinal accessory nerves**
633
What nerve is most at risk of injury with the following types of fractures/injury? 1. Fracture of the shaft of the humerus 2. Fracture of the surgical neck of the humerus 3. Supracondylar humerus fracture
1. Fracture of the shaft of the humerus: **Radial nerve** 2. Fracture of the surgical neck of the humerus: **Axillary nerve** 3. Supracondylar humerus fracture: **Median nerve**
634
What nerve is most at risk of injury with the following types of fractures/injury? 1. Fracture of the medial epicondyle 2. Anterior shoulder dislocation 3. Injury to the carpal tunnel
1. Fracture of the medial epicondyle: **Ulnar nerve** 2. Anterior shoulder dislocation: **Axillary nerve** 3. Injury to the carpal tunnel: **Median nerve**
635
A patient falls off a motorcycle and lands on his right shoulder. On physical exam you notice his shoulder has an abnormal configuration. X-rays indicate an anterior dislocation of his shoulder. What artery and nerve are most at risk of being damaged?
Axillary nerve and Posterior Circumflex artery
636
1. A highschool athlete falls on his arm during practice. In the ER, a radiograph shows a midshaft break of the humerus. Which nerve and which artery have the highest risk of being damaged? 2. What muscular actions are affected?
1. Radial nerve and Deep Brachial artery 2. Wrist drop and loss of brachioradialis reflex
637
A patient presents with decreased pain and temperature sensation over the lateral aspects of both arms. Where is the lesion?
Central canal of cervical spinal cord *This is Syringomyelia*
638
Exam of a patient reveals decreased prick sensation on the lateral aspect of her foot and leg. What muscular defect would you also expect to be present?
Injury to the common peroneal nerve: **Problem with dorsiflexion (causing foot drop) and eversion of the foot**
639
A patient fractures her fibula neck. What nerve is most at risk of being damaged?
Deep peroneal nerve
640
Which two muscle receptors are responsible for opening the sarcoplasmic reticulum in response to depolarization?
1. Dihydropyridine receptors 2. Ryanodine receptors
641
What drug prevents the release of calium from the sarcoplasmic reticulum of skeletal muscle?
Dantrolene
642
For what conditions is the drug Dantrolene useful?
1. Malignant hyperthermia 2. Neuroleptic malignant syndrome
643
Which type of muscle would usually be dominant in the gastrocnemius muscle?
Type II muscle fibers (Fast twitch, white muscle)
644
Where does new bone formation take place in growing long bones?
Epiphyseal plate
645
What cell types are most similar to osteoclasts?
Monocytes/macrophages
646
Which bony disease fits each of the following descriptions? 1. Reversible when vitamin D is replaced 2. Excess osteoclastic activity results in disorganized bony architecture 3. Bone is replaced by fibroblasts, collagen, and irregular bony trabeculae
1. Reversible when vitamin D is replaced: **Osteomalacia/Rickets** 2. Excess osteoclastic activity results in disorganized bony architecture: **Paget disease of bone** 3. Bone is replaced by fibroblasts, collagen, and irregular bony trabeculae: **Polystotic fibrous dysplasia**
647
Which bony disease fits each of the following descriptions? 1. Soft bones due to defective mineralization of osteoid 2. Failure of bone resorption -\> Thickened and dense bones 3. Genetic deficiency of carbonic anhydrase II
1. Soft bones due to defective mineralization of osteoid: **Osteomalacia/Rickets** 2. Failure of bone resorption -\> Thickened and dense bones: **Osteopetrosis** 3. Genetic deficiency of carbonic anhydrase II: **Osteopetrosis**
648
What measures can be taken to prevent osteoporosis?
1. Weight bearing exercise 2. Calcium intake 3. Vitamin D intake 4. Stop smoking 5. Avoid steroid use 6. Avoid chronic use of heparin
649
How would the following lab values be affected in Paget Disease of the bone? 1. Serum Ca 2. Serum Phos 3. Alk Phos 4. PTH
1. Serum Ca: **No change** 2. Serum Phos: **No change** 3. Alk Phos: **Increase** 4. PTH: **No change**
650
How would the following lab values be affected in Osteomalacia/Rickets? 1. Serum Ca 2. Serum Phos 3. Alk Phos 4. PTH
1. Serum Ca: **Decrease** 2. Serum Phos: **Decrease** 3. Alk Phos: **Increase** 4. PTH: **Increase**
651
How would the following lab values be affected in Osteitis fibrosa cystica? 1. Serum Ca 2. Serum Phos 3. Alk Phos 4. PTH
1. Serum Ca: **Increase** 2. Serum Phos: **Decrease** 3. Alk Phos: **Increase** 4. PTH: **Increase**
652
1. How would the following lab values be affected in Osteopetrosis? 2. Serum Ca 3. Serum Phos 4. Alk Phos 5. PTH
2. Serum Ca: **No change** 3. Serum Phos: **No change** 4. Alk Phos: **No change** 5. PTH: **No change**
653
Which primary bone tumor fits each of the following descriptions? 1. Most common malignant primary bone tumor of children 2. Most common malignant primary bone tumor in adults 3. Most common benign bone tumor
1. Most common malignant primary bone tumor of children: **Osteosarcoma** 2. Most common malignant primary bone tumor in adults: **Multiple myeloma** 3. Most common benign bone tumor: **Osteochondroma**
654
Which primary bone tumor fits each of the following descriptions? 1. 11;22 translocation 2. Soap-bubble appearance on x-ray 3. Onion-skin appearance of bone
1. 11;22 translocation: **Ewing sarcoma** 2. Soap-bubble appearance on x-ray: **Giant cell tumor** 3. Onion-skin appearance of bone: **Ewing sarcoma**
655
Which primary bone tumor fits each of the following descriptions? 1. May actually be a hamartoma 2. Codman's triangle on x-ray 3. Associated with Gardner syndrome
1. May actually be a hamartoma: **Osteochondroma** 2. Codman's triangle on x-ray: **Osteosarcoma** 3. Associated with Gardner syndrome: **Osteoma**
656
What are the 3 functions of vitamin D?
1. Increase dietary absorption of Ca 2. Increase dietary absorption of phosphate 3. Increase bone absorption of both Ca and phosphate
657
1. How does PTH affect calcium? 2. How does PTH affect phosphate
1. Increases calcium by increasing bone resorption of Ca and increasing renal reabsorption of Ca 2. Decreases phosphate by taking phosphate in bone and excreting it in the urine
658
1. What cell type produces PTH? 2. What cell type produces calcitonin?
1. PTH is secreted by the chief cells of the parathyroid 2. Calcitonin is secreted by the parafollicular "C cells" of the thyroid
659
What are two signs of hypocalcemia?
1. Chvostek's sign: Tap cheek = contraction of facial muscles 2. Trousseau's sign: Tighten BP cuff = carpopedal spasm
660
What are the two most common causes of primary hyperparathyroidism?
1. Parathyroid adenoma (90-95%) 2. Parathyroid hyperplasia (5%)
661
What are some possible causes of hypocalcemia?
1. Hypoparathyroidism * Accidental parathyroidectomy * Autoimmune destruction of the parathyroid * DiGeorge syndrome 2. Vitamin D deficiency 3. Low calcium in diet 4. Acute pancreatitis
662
What ligaments are typically injured during an ankle sprain?
_Lateral ligaments_ 1. Anterior talofibular ligament 2. Calcaneofibular ligament 3. Posterior talofibular ligament
663
What is the leading cause of knee pain in patients younger than 45?
Patellofemoral syndrome
664
What is the other name for housemaid's knee?
Prepatellar bursitis
665
Which muscles of the rotator cuff are responsible for each of the following actions? 1. Initial 15 degrees of arm abduction 2. Lateral rotation of arm 3. Medial rotation of arm
1. Initial 15 degrees of arm abduction: **Supraspinatus** 2. Lateral rotation of arm: **Infraspinatus & Teres minor** 3. Medial rotation of arm: **Subscapularis**
666
Which antibiotic class is known to increase the risk of tendon rupture in adults?
Fluoroquinolones
667
By what mechanism do NSAIDS cause renal disease?
NSAIDS prevent prostaglandin synthesis -\> Prostaglandins normally optimize renal blood flow -\> Less prostaglandins causes contriction of renal vessels and decreased renal perfusion
668
What medications are used in the treatment of an acute gout exacerbation?
1. NSAIDS (Indomethacin) 2. Colchicine (2nd line) 3. Steroids (real world application but prob not an answer for step 1)
669
What drugs can be used in the treatment of chronic gout?
1. Allopurinol (more common) 2. Probenecid
670
What are the classic symptoms of Sjogren syndrome?
Xerophthalmia (dry eyes) Xerostomia (Dry mouth) Arthritis
671
What organism causes painless white patches on the tongue that cannot be scraped off?
Hairy Leukoplakia (Caused by EBV)
672
Which skin disorder matches each of the following statements? 1. Pruritic, purple, polygonal papules 2. Life threatening rash with bullae 3. Pruritis associated with asthma 4. Pruritic vesicles associated with celiac disease 5. Allergy to nickle
1. Pruritic, purple, polygonal papules: **Lichen Planus** 2. Life threatening rash with bullae: **Stevens Johnson Syndrom/Toxic Epidermal Necrolysis** 3. Pruritis associated with asthma: **Atopic dermatitis** 4. Pruritic vesicles associated with celiac disease: **Dermatitis Herpetiformis** 5. Allergy to nickel: **Contact dermatitis**
673
Which skin disorder matches each of the following statements? 1. Thickened scar especially around face/chest 2. Antibodies against epidermal basement membrane 3. Antibodies against cell-cell adhesions 4. Parakeratotic scaling 5. Keratin-filled cysts
1. Thickened scar especially around face/chest: **Keloid** 2. Antibodies against epidermal basement membrane: **Bullous Pemphigoid** 3. Antibodies against cell-cell adhesions: **Pemphigus Vulgaris** 4. Parakeratotic scaling: **Psoriasis** 5. Keratin-filled cysts: **Seborrheic Keratosis**
674
Which skin disorder matches each of the following statements? 1. Sand-paper; predisposition to squamous cell cancer 2. Skin rash and proximal muscle weakness 3. Honey-crusting lesions common about the nose and lips 4. Hyperkeratosis and koilocytosis 5. Histology shows palisading nuclei
1. Sand-paper; predisposition to squamous cell cancer: **Actinic keratosis** 2. Skin rash and proximal muscle weakness: **Dermatomyositis** 3. Honey-crusting lesions common about the nose and lips: **Impetigo** 4. Hyperkeratosis and koilocytosis: **Verrucae** 5. Histology shows palisading nuclei: **Basal cell carcinoma**
675
Which fungus matches each of the following statements? 1. Found in SW U.S including west Texas and California 2. Found in Mississippi and Ohio River basins 3. Causses San Joaquin Valley fever 4. Found in rural Latin America 5. Associated with plant thorns and cutaneous injury
1. Found in SW U.S including west Texas and California: **Coccidioides immitis** 2. Found in Mississippi and Ohio River basins: **Histoplasma capsulatum** 3. Causses San Joaquin Valley fever: **Coccidioides immitis** 4. Found in rural Latin America: **Paracoccidioides brasiliensis** 5. Associated with plant thorns and cutaneous injury: **Sporothrix Schenckii**
676
Which fungus matches each of the following statements? 1. Found in states east of the Mississippi River 2. Found in bird and bat droppings 3. Mold form contains barrel-shaped arthroconidia 4. Associated with dust storms 5. Broad-based budding of yeast 6. Multiple budding of yeast form
1. Found in states east of the Mississippi River: **Blastomyces dermatitidis** 2. Found in bird and bat droppings: **Histoplasma capsulatum** 3. Mold form contains barrel-shaped arthroconidia: **Coccidioides immitis** 4. Associated with dust storms: **Coccidioides immitis** 5. Broad-based budding of yeast: **Blastomyces dermatitidis** 6. Multiple budding of yeast form: **Paracoccidioides brasiliensis**
677
Which fungus matches each of the following statements? 1. Causes diaper rash 2. Opportunistic mold with septate hyphae that branch at a 45 degree angle 3. Opportunisitic mold with irregular nonseptate hyphae that branch at wide angles (\>90 degrees) 4. Causes thrush in immunocompromised patients and vulvovaginitis in women 5. Known for causing pneumonia in AIDS patients -\> start Bactrim prophylaxis when CD4 \< 200 6. Yeast known for causing meningitis in AIDS patients
1. Causes diaper rash: **Candida albicans** 2. Opportunistic mold with septate hyphae that branch at a 45 degree angle: **Aspergillus fumigatus** 3. Opportunisitic mold with irregular nonseptate hyphae that branch at wide angles (\>90 degrees): **Mucor or Rhizopus** 4. Causes thrush in immunocompromised patients and vulvovaginitis in women: **Candida albicans** 5. Known for causing pneumonia in AIDS patients -\> start Bactrim prophylaxis when CD4 \< 200: **Pneumocystis jirovecii** 6. Yeast known for causing meningitis in AIDS patients: **Cryptococcus neoformans**
678
What infections are associated with birds?
1. Histoplasma 2. Cryptococcus 3. Chlamydophila psitacci 4. West Nile Virus 5. H5N1 influenza
679
An HIV (+) patient with CSF showing 75/mm^3 lymphocytes suddenly dies. Yeast is identified in the CSF. What is the most likely diagnosis?
Cryptococcal meningitis
680
Which antifungal fits each of the following statements? 1. Interferes with microtubule function 2. "Swish and swallow" for oral candidiasis (thrush) 3. Cell wall synthesis inhibitor used in invasive aspergillosis 4. Binds ergosterol -\> membrane pores 5. Inhibits ergosterol synthesis
1. Interferes with microtubule function: **Griseofulvin** 2. "Swish and swallow" for oral candidiasis (thrush): **Nystatin** 3. Cell wall synthesis inhibitor used in invasive aspergillosis: **Caspofungin** 4. Binds ergosterol -\> membrane pores: **Nystatin and Amphotericin B** 5. Inhibits ergosterol synthesis: **Azoles and Terbinafine**
681
Which antifungal fits each of the following statements? 1. Most common treatment for onychomycosis 2. SE: arrythmias and nephrotoxicity 3. Deposits in heratin-containing tissues 4. Inhibits hormone synthesis and cytochrome P450 5. SE: Liver dysfunction
1. Most common treatment for onychomycosis: **Terbinafine, Itraconazole, Fluconazole** 2. SE: arrythmias and nephrotoxicity: **Amphotericin B** 3. Deposits in keratin-containing tissues: **Griseofulvin** 4. Inhibits hormone synthesis and cytochrome P450: **Azoles (particularly Ketoconazole)** 5. SE: Liver dysfunction: **Azoles and Griseofulvin**
682
Which antifungal fits each of the following statements? 1. SE: teratogenic, carcinogenic 2. Used for cryptococcal meningitis in AIDS 3. Converted to fluorouracil, inhibits DNA synthesis 4. Drug of choice for sporotrichosis
1. SE: teratogenic, carcinogenic: **Griseofulvin** 2. Used for cryptococcal meningitis in AIDS: **IV Amphotericin B + Flucytosine** 3. Converted to fluorouracil, inhibits DNA synthesis: **Flucytosine** 4. Drug of choice for sporotrichosis: **Itraconazole**
683
Which antifungal can be used intrathecally for fungal meningitis?
Amphotericin B
684
What is the clinical use and side effects of Griseofulvin?
1. _Used for superficial fungal infections_ * Dermatophytes (Ring worm and athletes foot) * Tinea capitis * Tinea unguium 2. _Side effects_ * Teratogenic and carcinogenic effects * Confusion/headache * Cytochrome P450 inducer * Hepatotoxicity
685
What 5 drug classes are used in the treatment of glaucoma?
1. Beta blockers 2. Alpha agonists 3. Prostaglandins 4. Diuretics (acetazolamide and Mannitol) 5. Direct or indirect cholinomimetics
686
How does the optic disc appearance differ in glaucoma when compared to hydrocephalus?
1. Glaucoma: Cupping of the optic disk 2. Hydrocephalus: Papilledema
687
Light stimulus in patient's right eye produces bilateral pupillary constriction. When the light is shown in the left eye, there is a paradoxical bilateral pupillary dilatation. What is the defect?
Afferent pupillary defect
688
What is the treatment for dry age-related macular degeneration?
1. Cessation of smoking 2. Daily supplementation with antioxidant vitamins
689
A patient with vertigo, tinnitus, and hearing loss. What is the diagnosis?
Meniere disease (Endolymphatic hydrops)
690
Which organisms are most commonly responsible for acute otits media?
1. Strep pneumo 2. Haemophilus influenza (non-typeable) 3. Moraxella catarrhalis
691
What organism is most commonly responsible for otitis externa?
Pseudomonas aeruginosa
692
Chronic otitis media can sometimes result in a cystic lesion that is lined by keratinizing squamous epithelium which can be metaplastic, that is filled with amorphous debris. What is the name of this condition?
Cholesteatoma
693
What structure of the brain is responsible for mental alertness?
Reticular activating system
694
What psychosocial crisis are most 25 year-old working through?
Intamacy vs isolation
695
What is the order of human needs as described by Maslow?
1. Physiological needs 2. Safety needs 3. Love and belonging 4. Esteem 5. Self-actualization
696
Which portion of the brain is responsible for delayed gratification?
Prefrontal cortex
697
Which portion of the brain is responsible for memory?
Hippocampus
698
What term applies to the growth of new neurons?
Neurogenesis
699
What name is given to chronic compulsive hair pulling common in young girls?
Trichotillomania
700
What stimulant medications are commonly used in the treatment of ADHD?
1. Methylphenidate 2. Dextroamphetamine
701
Which childhood psychiatric disorder matches each of the following statements? 1. Females only, loss of previously acquired purposeful hand skills between 6-30 months 2. Impairments in social interactions, communications, play, repetitive behaviors 3. Impairment insocial interaction (but not avoidance), no language delay
1. Females only, loss of previously acquired purposeful hand skills between 6-30 months: **Rett disorder** 2. Impairments in social interactions, communications, play, repetitive behaviors: **Autism** 3. Impairment insocial interaction (but not avoidance), no language delay: **Aspergers**
702
Which childhood psychiatric disorder matches each of the following statements? 1. Stereotyped hand movements 2. Ignoring the basic rights of others 3. Characterized by hostility, annoyance, vindictiveness, disobedience, and resentfulness
1. Stereotyped hand movements: **Rett disorder** 2. Ignoring the basic rights of others: **Conduct disorder** 3. Characterized by hostility, annoyance, vindictiveness, disobedience, and resentfulness: **Oppositional Defiant disorder**
703
Which childhood psychiatric disorder matches each of the following statements? 1. Multiple motor and vocal tics 2. Impulsive and inattentive 3. 7-year-old that avoids going to school to stay home with parent
1. Multiple motor and vocal tics: **Tourettes syndrome** 2. Impulsive and inattentive: **ADHD** 3. 7-year-old that avoids going to school to stay home with parent: **Separation anxiety**
704
What is the difference between binge eating disorder and compulsive eating disorder?
_Binge eating disorder_ 1. Negative feelings towards food 2. Binges are and expression of a deeper problem _Compulsive eating disorder_ 1. Patient is obsessed with food
705
What are the stages of behavioral change?
1. Precontemplation 2. Contemplation 3. Preparation 4. Action 5. Maintainance 6. +/- Relapse
706
What is the mechanism of action of the drug disulfuram?
Inhibit Acetaldehyde Dehydrogenase
707
What other drugs have a disulfuram-like reaction?
1. Metronidazole 2. Cephalosporins 3. 1st generation Sulfonylureas 4. Procarbazine
708
What drug intoxication or withdrawal is causing the following symptoms in each of the following patients? 1. Post-op constipations and/or respiratory depression 2. Severe depression, headache, fatigue, insomnia/hypersomnia, hunger 3. Pinpoint pupils, N/V, seizures
1. Post-op constipations and/or respiratory depression: **Opioid use** 2. Severe depression, headache, fatigue, insomnia/hypersomnia, hunger: **Amphetamine or cocaine withdrawal** 3. Pinpoint pupils, N/V, seizures: **Opiod overdose**
709
What drug intoxication or withdrawal is causing the following symptoms in each of the following patients? 1. Belligerence, impulsiveness, nystagmus, homicidal ideations, psychosis 2. Headache, anxiety/depression, weight gain 3. Anxiety/depression, delusions, hallucinations, flashbacks
1. Belligerence, impulsiveness, nystagmus, homicidal ideations, psychosis: **PCP overdose** 2. Headache, anxiety/depression, weight gain: **Smoking or caffiene withdrawal** 3. Anxiety/depression, delusions, hallucinations, flashbacks: **LSD intoxication**
710
What drug intoxication or withdrawal is causing the following symptoms in each of the following patients? 1. Euphoria, social withdrawal, impaired judgement, hallucinations 2. Rebound anxiety, tremors, seizures, life-threatening 3. Anxiety, piloerection, yawning, fever, rhinorrhea, nausea, diarrhea
1. Euphoria, social withdrawal, impaired judgement, hallucinations: **Marijuana intoxication** 2. Rebound anxiety, tremors, seizures, life-threatening: **Alcohol, benzodiazepine, or barbituate withdrawals** 3. Anxiety, piloerection, yawning, fever, rhinorrhea, nausea, diarrhea: **Opioid withdrawal**
711
What weak opioid agonist is commonly used in chronic pain control prior to prescribing stronger opioids?
Tramadol
712
What is the treatment for a patient that is overly intoxicated with each of the following substances? 1. Alcohol 2. Benzodiazepines 3. PCP 4. Opioids
1. Alcohol: **Fluids, respiratory and blood alcohol monitoring, time** 2. Benzodiazepines: **Flumazenil** 3. PCP: **Benzodiazepines or Haloperidol** 4. Opioids: **Naltrexone or Naloxone**
713
What are the usual components of a "dementia work-up"?
1. Mini-mental-status exam 2. Syphilis and HIV screen 3. Head MRI/CT 4. Serum TSH 5. Serum vitamin B12
714
Why is Alzheimer disease more common in patients with Down syndrome?
3 copies of the APP gene on chromosome 21
715
What is the mechanism of action of the drugs used in the treatment of Alzheimer disease?
1. Cholinesterase inhibitors: Prolong the action of Ach 2. Memantine: Antagonist at the NMDA glutamate receptor
716
A 72 year-old patient of yours is not able to recall 3 objects on a mini-mental status exam. When asked what he would do if he smelled smoke in a movie theater, he replies that he would yell "fire." When asked what a table and chair have in common he replies that they both have 4 legs and are made of wood. The family reports that for the past year someone has had to stay with him at all times for his own safety and that he stays awake all day and sleeps well at night. What is the most likely diagnosis in this patient?
Dementia
717
A 72 year old patient of yours is brought into the clinic by his family because of strange behaviors over the past week. She has been very agitated recently, takes many naps during the day, occasionally urinates on herself, and has had a poor appetite. It is difficult for you to administer th MMSE because she is unable to focus her attention on the questions. What is the most likely diagnosis?
Delirium
718
What features allow you to distinguish a migraine from a cluster headache or tension headache?
_Migraine_ 1. Might have an aura 2. Nausea/vomiting 3. Photophobia/phonophobia 4. Unilateral 5. Throbbing 6. Time frame: 24-48 hours _Cluster_ 1. Might have tearing/rhinorrhea 2. Occur daily at certain clusters of time 3. Timeframe: 30 min - 3 hrs _Tension_ 1. Frontal/occipital pain 2. Time frame: Long period of time
719
What is the mechanism of action of Sumatriptan?
Serotonin receptor (1B & 1D) agonist
720
What are the contraindications to sumatriptan use?
1. CAD 2. Prinzmetal's angina 3. Pregnancy
721
What is the usual treatment for migraine headaches in pregnancy?
Opioids
722
What would you suspect as a cause of headache in a patient using topical retinoic acid for acne?
Vitamin A toxicity causing Pseudotumor cerebri (a neurological disorder that is characterized by increased intracranial pressure in the absence of a tumor or other diseases)
723
A 20 year-old woman that has migraine headaches each proceeded by an aura should never be prescribed which medication?
OCP *This does not apply to migraines without aura*
724
What are the 3 most common primary brain tumors in adults? What are the 3 most common in children?
_Adult_ 1. Glioblastoma 2. Meningioma 3. Schwanoma _Child_ 1. Pilocytic astrocytoma 2. Medulloblastoma 3. Ependymoma
725
Which primary brain tumor fits each of the following descriptions? 1. Pseudopalisading necrosis 2. Polycythemia 3. Neruofibromatosis II 4. Associated with von-Hippel-Lindau syndrome
1. Pseudopalisading necrosis: **Glioblastoma multiforme** 2. Polycythemia: **Hemangioblastoma** 3. Neruofibromatosis II: **Schwannoma** 4. Associated with von-Hippel-Lindau syndrome: **Hemangioblastoma**
726
Which primary brain tumor fits each of the following descriptions? 1. Foamy cells, high vascularity 2. Hyperprolactinemia -\> galactorrhea, amenorrhea, anovulation 3. Psammoma bodies
1. Foamy cells, high vascularity: **Hemangioblastoma** 2. Hyperprolactinemia -\> galactorrhea, amenorrhea, anovulation: **Pituitary adenoma** 3. Psammoma bodies: **Meningioma**
727
Which primary brain tumor fits each of the following descriptions? 1. Fried-egg appearance 2. Perivascular pseudorosettes 3. Bitemporal hemianopia
1. Fried-egg appearance: **Oligodendroglioma** 2. Perivascular pseudorosettes: **Ependymoma** 3. Bitemporal hemianopia: **Pituitary adenoma or Craniopharyngioma**
728
Which primary brain tumor fits each of the following descriptions? 1. Worst prognosis of any primary brain tumor 2. Child with hydrocephalus 3. Homer-Wright pseudorosettes
1. Worst prognosis of any primary brain tumor: **Glioblastoma multiforme** 2. Child with hydrocephalus: **Medulloblastoma or Ependymoma** 3. Homer-Wright pseudorosettes: **Medulloblastoma**
729
Which anesthetic fits each of the following descriptions? 1. IV, associated with hallucinations and bad dreams 2. IV, most common drug used for conscious sedation 3. Inhaled, side-effect of hepatotoxicity
1. IV, associated with hallucinations and bad dreams: **Ketamine** 2. IV, most common drug used for conscious sedation: **Midazolam + Fentanyl** 3. Inhaled, side-effect of hepatotoxicity: **Halothane**
730
Which anesthetic fits each of the following descriptions? 1. IV, used for rapid anesthesia induction and short duration of action 2. IV, decreased cerebral blood flow (important in brain surgery)
1. IV, used for rapid anesthesia induction and short duration of action: **Propofol** 2. IV, decreased cerebral blood flow (important in brain surgery): **Barbituates (Thiopental)**
731
Which anesthetic fits each of the following descriptions? 1. Opioid that does not induce histamine release 2. High triglyceride content increase the risk of pancreatitis with long-term use
1. Opioid that does not induce histamine release: **Fentanyl** 2. High triglyceride content increase the risk of pancreatitis with long-term use: **Propofol**
732
What is the mechanism of action of Dantrolene?
Prevents release of Ca from sarcoplasmic reticulum of skeletal muscle
733
1. What is the mechanism of action of local anesthetics? 2. Which nerve fibers are blocked first with local anethesia?
1. Block Na channels 2. _Order of blockade_ 1. Small myelinated fibers 2. Small unmyelinated fibers 3. Large myelinated fibers 4. Large unmyelinated fibers
734
What drugs can be used to reverse neuromuscular blockade?
Acetylcholinesterase inhibitors (neostigmine)
735
In regards to seizures, what do the terms partial, simple, complex, and generalized mean?
1. Partial: **Localized to a specific area of the brain (IE temporal lobe)** 2. Simple: **No alteration in consciousness** 3. Complex: **Alteration in consciousness** 4. Generalized: **Over the entire brain**
736
What are the most common causes of seizures in children?
1. Genetic/congenital 2. Infection 3. Trauma 4. Metabolic disturbances
737
a 10 year-old child "spaces-out" in class (stops talking midsentence and then continues as if nothing had happened). During the spells, there is slight quivering of lips. What is the diagnosis?
Petite mal (absence seizure)
738
What drugs are known for causing Stevens-Johnson syndrome?
1. Seizure drugs: Phenytoin, Carbamazepine, Phenobarbital, Lamotrigine, Ethosuximide 2. Sulfonamides 3. Penicillins 4. Allopurinol
739
1. How is barbiturate overdose managed? 2. How is benzodiazepine overdose managed?
1. Supportive/symptomatically (no antidote) 2. Flumazenil
740
What side effects are common to most all of the anti-epileptics?
1. Sedation 2. Diplopia 3. Ataxia 4. Stevens-Johnson Syndrome
741
What are the toxic side effects of phenytoin?
1. "More gums": Gingival hyperplasia 2. "More hair": Hirsutism 3. "More messed up babies": Fetal Hydantoin syndrome (Cleft lip/palate, congenital heart defects, mental retardation, developmental delays) 4. Induces P450 5. Can cause Stevens-Johnson Syndrome 6. Can cause drug induced lupus
742
What are some of the positive symptoms of schizophrenia? What are some of the negative symptoms?
_Positive symptoms_ 1. Delusions 2. Hallucinations (especially auditory) 3. Disorganized speech 4. Disorganized/catatonic behavior _Negative symptoms_ 1. Flat affect 2. Social withdrawal 3. Lack of motivation 4. Lack of speech (alogia) 5. Thought blocking 6. Poor grooming
743
Categorize the following antipsychotics in the appropriate category as neurleptics (low or high potency) or atypical antipsychotics: 1. Olanzapine 2. Thioridazine 3. Quetiapine
1. Olanzapine: **Atypical antipsychotic** 2. Thioridazine: **Low potency neuroleptic** 3. Quetiapine: **Atypical antipsychotic**
744
Categorize the following antipsychotics in the appropriate category as neurleptics (low or high potency) or atypical antipsychotics: 1. Chlorpromazine 2. Haloperidol 3. Fluphenazine
1. Chlorpromazine: **Low potency neuroleptic** 2. Haloperidol: **High potency neuroleptic** 3. Fluphenazine: **High potency neuroleptic**
745
Categorize the following antipsychotics in the appropriate category as neurleptics (low or high potency) or atypical antipsychotics: 1. Loxapine 2. Risperidone 3. Thiothixene
1. Loxapine: **High potency neuroleptic** 2. Risperidone: **Atypical antipsychotic** 3. Thiothixene: **High potency neuroleptic**
746
Categorize the following antipsychotics in the appropriate category as neurleptics (low or high potency) or atypical antipsychotics: 1. Trifluoperazine 2. Clozapine 3. Aripiprazole
1. Trifluoperazine: **High potency neuroleptic** 2. Clozapine: **Atypical antipsychotic** 3. Aripiprazole: **Atypical antipsychotic**
747
What are the clinical features of neuroleptic malignant syndrome? How is it treated?
_Symptoms_ 1. Delirium and mental status changes 2. Autonomic instability 3. Muscle rigidity 4. Myoglobinuria 5. Hyperpyrexia _Treatment_ 1. Bromocriptine: Restore Dopamine transmission 2. Dantrolene: Stop muscle contraction
748
What are the criteria for the diagnosis of mania?
"DIG FAST" 1. Distractibility 2. Irresponsibility 3. Grandiosity 4. Flight of ideas 5. Activity/agitation 6. Sleep (decreased need) 7. Talkativeness
749
What mood stabilizers are used in the treatment of bipolar disorder?
1. Lithium 2. Seizure medications: Valproic acid, Carbamazepine, and Lamotrigine 3. Atypical antipsychotics: Risperidone, Aripiprazole, and Olanzapine
750
What are the potential side effects of lithium?
1. Teratogenic (Ebstein Anomaly) 2. Polyuria, possible diabetes insipidus 3. Arrhythmias 4. Hypothyroidism 5. Tremor 6. Sedation 7. Lethargy 8. Dizziness
751
What are the criteria for the diagnosis of a major depressive episode?
"SIG E CAPS" 1. Sleep 2. _Interest (anhydonia)_ 3. Guilt/worthlessness 4. Energy 5. Concentration 6. Appetite 7. Psychomotor agitation/retardation 8. Suicidal ideation 9. _Depressed mood_ 10. Must have 5/9 including depressed mood or anhydonia for a perior of 2 weeks
752
What is atypical depression?
1. Hypersomnia 2. Hyperphagia (weight gain) 3. Mood reactivity 4. Rejection hypersensitivity
753
A patient mentions that he has had thoughts of suicide. What question should you ask to help determine how high-risk he is?
"SAD PERSONS" 1. Sex (male?) 2. AGE (Teenager or elderly?) 3. Depression 4. Previous attempts 5. Ethanol/drug use 6. Rational thought +/- 7. Sickness (medical illness) 8. Organized plan 9. Social/spousal support +/- 10. Stated future intent
754
A patient tries to commit suicide by slitting her wrists. After she is appropriately managed in the ER, what question would you ask the patient in order to determine her level of commitment of trying to take her own life?
"What did you do after the suicide attempt" Trying to assess how serious the attempt was or if it was more of a cry for help than an actual attempt
755
A 28 year-old woman has symptoms of mild depression for 6 years. What is the diagnosis?
Dysthymia
756
What is the mechanism of action of each of the following medication classes? 1. SSRI 2. SNRI 3. TCA 4. MAOI
1. SSRI: **Inhibits the reuptake of serotonin** 2. SNRI: **Inhibits the reuptake of serotonin and norepinephrine** 3. TCA: **Inhibits the reuptake of serotonin and norepinephrine** 4. MAOI: **Inhibits the enzyme (MAO) that metabolizes and inactivates norepinephrine (also Serotonin and Dopamine)**
757
Name the 5 SSRIs
"FLashbacks PARalyze SEnior CITizens" 1. Fluoxetine 2. Paroxetine 3. Sertaline 4. Citalopram also Fluvoxamine
758
Name the 3 SNRIs
1. Venlafaxine 2. Duloxetine 3. Milnacipran
759
Name the 7 TCAs
1. Nortiptyline (less anticholinergic side effects) 2. Clomipramine 3. Imipramine 4. Amytriptyline 5. Desipramine (less sedating and higher seizure threshold) 6. Doxepin 7. Amoxapine
760
Name the 4 MAOIs
"MAO Takes Pride In Shanghi" 1. Tranylcypromine 2. Phenelzine 3. Isocarboxazid 4. Selegiline
761
Name the NDRI (NE and DA reuptake inhibitor)
Bupropion
762
Name the 2 tetracyclic antidepressants
1. Trazodone 2. Mirtazapine
763
Which antidepressant matches each of the following statements? 1. SE: Priapism 2. Lowers the seizure threshold 3. Works well with SSRIs and increases REM sleep
1. SE: Priapism: **Trazodone** 2. Lowers the seizure threshold: **Bupropion & TCAs** 3. Works well with SSRIs and increases REM sleep: **Trazodone**
764
Which antidepressant matches each of the following statements? 1. Appetite stimulant that is likely to result in weight gain 2. Can be used for smoking cessation 3. Can be used for bedwetting in children
1. Appetite stimulant that is likely to result in weight gain: **Mirtazapine** 2. Can be used for smoking cessation: **Bupropion** 3. Can be used for bedwetting in children: **Imipramine**
765
What are the symptoms of TCA overdose?
1. Convulsions (causing hyperpyrexia) 2. Coma 3. Cardiotoxicity 4. Respiratory depression
766
What are the symptoms of serotonin syndrome?
1. Muscle rigidity 2. Hyperthermia 3. Cardiovascular collapse
767
What happens if you ingest tyramine while on MAOIs?
1. Hypertensive crisis 2. Hemorrhagic stroke 3. Cardiac arrhythmias
768
A patient on whom you wish to obtain an MRI tells you that he cannot go through with it because of claustrophobia. What can you do to help this patient?
Give him a benzodiazepine
769
A young woman that is anxious about receiving her first pap smear is told to relax and to imagine foing through the steps of the exam. What does this process exemplify?
Systematic desensitization
770
A woman has flashbacks about her boyfriend's death one month ago following a hit-and-run accident. She often cries and wishes for the death of the culprit. What is the diagnosis?
Normal bereavement but bordering on post-traumatic stress disorder
771
A nurse has episodes of hypoglycemia. Blood analysis reals no elevation in C-peptide. What is her diagnosis?
Insulin-induced hypoglycemia due to poorly controlled diabetes, Factitious disorder, or Malingering
772
What somatoform disorder matches each of the following descriptions? 1. Unexplained pain 2. Patient with normal anatomy is convinced a part of their anatomy is abnormal 3. Unexplained loss of sensory or motor function (tests and PE are negative)
1. Unexplained pain: **Pain disorder** 2. Patient with normal anatomy is convinced a part of their anatomy is abnormal: **Body dysmorphic disorder** 3. Unexplained loss of sensory or motor function (tests and PE are negative): **Conversion disorder**
773
What somatoform disorder matches each of the following descriptions? 1. Unwavering belief by the patient that she has a specific disease (despite medical reassurance) 2. Unexplained complaints in multiple organ systems 3. False belief of being pregnant
1. Unwavering belief by the patient that she has a specific disease (despite medical reassurance): **Hypochondriasis** 2. Unexplained complaints in multiple organ systems: **Somatization disorder** 3. False belief of being pregnant: **Pseudocyesis**
774
What defense mechanism fits each of the following statements? 1. Voluntarily choosing not to think about a piece of bad news 2. Not acknowledging a piece of bad news, as though it was never said 3. Involuntary withholding of a feeling from conscience awareness
1. Voluntarily choosing not to think about a piece of bad news: **Suppression** 2. Not acknowledging a piece of bad news, as though it was never said: **Denial** 3. Involuntary withholding of a feeling from conscience awareness: **Repression**
775
What defense mechanism fits each of the following statements? 1. A veteran that can describe horrific war details without any emotion 2. A child abuser was himself abused as a child 3. Man yells at his family when he has a bad day at work
1. A veteran that can describe horrific war details without any emotion: **Isolation** 2. A child abuser was himself abused as a child: **Identification** 3. Man yells at his family when he has a bad day at work: **Displacement**
776
A 65 year-old asks her husband to stay in the hospital overnight with her because she is afraid to be alone. What defense mechanism is she exhibiting?
Regression
777
Which defense mechanism underlies all other defense mechanisms?
Repression
778
A 60 year-old man, admitted for chest pain, jumps out of bed and does 50 push-ups to show the nurses he has not had a heart attack. What defense mechanism is he using?
Denial
779
A 40 year-old woman tells you during one of her office visits that she is in love with you. You refer her to someone else, and she attempts suicide. What type of personality disorder does this patient have?
Borderline personality disorder
780
A 30 year-old woman tells you during one of her office visits that you are the best doctor she's ever had but that your nurse is very disrespectful. On a subsequent visit, she threatens to change doctors because you do not feel a particular lab test is necessary. Additionally, you notice several symmetrical cuts on her left forearm which she attributes to cat scratches. What type of personality disorder does this person have?
Borderline personality disorder *She is also exhibiting splitting (defense mechanism)*
781
A 55 year-old woman comes to your office wearing all black including a black miniskirt and black feather boa. She also is wearing an excessive amount of lipstick, and you notice her having conversations with many of the other patients in the waiting room. What type of personality disorder do you suspect in this patient?
Histrionic personality disorder
782
A person demands only the best and most famous doctor in town. What personality disorder does this person have?
Narcissistic personality disorder
783
What are the cluster A personality disorders?
"Weird" 1. Paranoid 2. Schizoid 3. Schizotypal
784
What are the Cluster B personality disorders?
"Wild" 1. Antisocial 2. Borderline 3. Histrionic 4. Narcissistic
785
What are the Cluster C personality disorders?
"Worried" 1. Avoidant 2. Obsessive-Compulsive 3. Dependent
786
What artery prevents a horseshoe kidney from ascending in the abdomen?
Inferior mesenteric artery
787
A 40 year-old patient of yours weighs 100Kg. What is her estimated plasma volume?
60% of body weight is water 2/3s of that is intracellular 1/3 of 60% of 100kg = 20 kg = 20L 25% of that 20L of extracellular fluid is plasma (the rest is interstitial fluid) 25% of 20L = **5L**
788
What fundamental problem creates Potter syndrome?
Oligohydramnios Usually from bilateral renal agenesis
789
What cell type releases renin?
Juxtoglomerular cells
790
What effect will a renal stone that obstructs the ureter have on GFR and FF?
1. Decreased GFR 2. Decreased Filtration fraction
791
What is the maximal serum glucose concentration at which glucose can be absorbed in the tubules?
350 mg/dl
792
What vitamin deficiency results from Hartnup disease?
Deficiency of tryptophan, leading to Niacin (B3) deficiency (Pellagra)
793
1. What substances can be used to estimate GFR? 2. What substances can be used to estimate renal plasma flow?
1. Creatinine, Inulin 2. Para-aminohippurate (PAH)
794
What is the equation for the renal clearance of any substance?
**Clearance = UV/P** 1. U = urine concentration of substance 2. V = Urine flow rate 3. P = Plasma concentration of substance
795
What segment of the renal tubule matches the following statements? 1. Rebsorbs 67% of the fluid and electrolytes filtered by the glomerulus 2. Segment responsible for concentrating urine 3. Site of secretion of organic anions and cations 4. Always impermeable to water 5. Permeable to water only in the presence of ADH
1. Rebsorbs 67% of the fluid and electrolytes filtered by the glomerulus: **PCT** 2. Segment responsible for concentrating urine: **Collecting duct** 3. Site of secretion of organic anions and cations: **PCT** 4. Always impermeable to water: **Thick ascending limb** 5. Permeable to water only in the presence of ADH: **Late DCT and collecting duct**
796
What segment of the renal tubule matches the following statements? 1. Site of the Na/2Cl/K co-transporter 2. Site of isotonic fluid reabsorption 3. Site responsible for diluting urine 4. Only site where glucose and amino acids are reabsorbed 5. Water reabsorption in the loop of Henle
1. Site of the Na/2Cl/K co-transporter: **Thick ascending limb** 2. Site of isotonic fluid reabsorption: **PCT** 3. Site responsible for diluting urine: **Thick ascending loop** 4. Only site where glucose and amino acids are reabsorbed: **PCT** 5. Water reabsorption in the loop of Henle: **Thin descending limb**
797
What are the two main cell types of the collecting duct?
1. Principle cells 2. Intercalated cells
798
What affect does aldosterone have on the intercalated cells and principle cells of the collecting duct?
1. Intercalated cells: Increases H+ (acid) secretion 2. Principal cells: Increases Na reabsorption (water follows sodium) and K secretion
799
What class of drugs inhibits the Na/2Cl/K symporter in the nephron?
Loop diuretics
800
What type of diuretic is each of the following drugs? 1. Triamterene 2. Acetazolamide 3. Hydrochlorothiazide 4. Bumetanide 5. Spironolactone
1. Triamterene: **K sparing** 2. Acetazolamide: **Carbonic anhydrase inhibitor** 3. Hydrochlorothiazide: **Thiazide** 4. Bumetanide: **Loop** 5. Spironolactone: **K sparing**
801
What type of diuretic is each of the following drugs? 1. Chlorthiazide 2. Ethacrynic acid 3. Mannitol 4. Metolazone
1. Chlorthiazide: **Thiazide** 2. Ethacrynic acid: **Loop** 3. Mannitol: **Osmotic** 4. Metolazone: **Thiazide**
802
What type of diuretic is each of the following drugs? 1. Chlorthalidone 2. Furosemide 3. Amiloride 4. Torsemide
1. Chlorthalidone: **Thiazide** 2. Furosemide: **Loop** 3. Amiloride: **K sparing** 4. Torsemide: **Loop**
803
What diuretic or class of diuretics would be most useful in each of the following situations? 1. Acute pulmonary edema 2. Idiopathic hypercalciuria (-\> calcium stones) 3. Glaucoma 4. Mild to moderate CHF with expanded ECV
1. Acute pulmonary edema: **Loop** 2. Idiopathic hypercalciuria (-\> calcium stones): **Thiazide** 3. Glaucoma: **Acetazolamide or Mannitol** 4. Mild to moderate CHF with expanded ECV: **Loop (or thiazide since its mild CHF)**
804
What diuretic or class of diuretics would be most useful in each of the following situations? 1. In conjunction with loop or thiazide diuretics to retain K 2. Edema associated with nephrotic syndrome 3. Increased intracranial pressure 4. Mild to moderate hypertension
1. In conjunction with loop or thiazide diuretics to retain K: **K sparing** 2. Edema associated with nephrotic syndrome: **Loop** 3. Increased intracranial pressure: **Mannitol** 4. Mild to moderate hypertension: **Thiazide**
805
What diuretic or class of diuretics would be most useful in each of the following situations? 1. Hypercalcemia 2. Altitude sickness 3. Hyperaldosteronism
1. Hypercalcemia: **Loop** 2. Altitude sickness: **Acetazolamide** 3. Hyperaldosteronism: **K sparing direct aldosterone inhibitors (Spironolactone, Eplerenone) **
806
What is the site of action of Mannitol?
PCT
807
What is the site of action of thiazides?
Early DCT
808
A patient with heart failure exacerbation needs medial diuresis but has a sulfa allergy. What diuretic can be used?
Ethacrynic acid
809
What factors/substances cause hyperkalemia?
1. Acidosis 2. Insulin deficiency 3. Beta-blockers 4. Digoxin 5. Cellular lysis 6. Potassium sparing diuretics 7. ACE inhibitors
810
What factors/substances cause hypokalemia?
1. Loops and thiazides 2. Insulin 3. Beta agonists 4. Alkalosis 5. Cell proliferation
811
What are the actions of angiotensin II?
1. Vasoconstriction 2. Stim aldosterone secretion
812
Which electrolyte disturbance fits each of the following presentations? 1. Correcting too rapidly may result in central pontine myelinosis 2. Peaked T waves 3. Tetany
1. Correcting too rapidly may result in central pontine myelinosis: **Hyponatremia** 2. Peaked T waves: **Hyperkalemia** 3. Tetany: **Hypocalcemia**
813
Which electrolyte disturbance fits each of the following presentations? 1. Arrhythmias 2. Decreased deep tendon reflexxes 3. Flattened T waves, U waves on EKG
1. Arrhythmias: **Hyper/Hypo-kalemia, Hypomagnesia** 2. Decreased deep tendon reflexes: **Hypermagnesia** 3. Flattened T waves, U waves on EKG: **Hypokalemia**
814
What are the causes of acidosis with an elevated anion gap?
"MUDPILES" 1. Methanol 2. Uremia 3. DKA 4. Propylene glycol 5. Iron tablets or Isoniazid 6. Lactic acidosis 7. Ethylene glycol 8. Salicylates
815
What are the diagnostic features of diabetes insipidus?
1. Polyuria: Urine has low specific gravity and low urine osmolarity 2. Water deprivation test: Urine osmolality does not rise
816
What are the defining features of nephrotic syndrome?
1. Proteinuria \> 3.5 g/day 2. Hyperlipidemia 3. Edema (Due to hypoalbuminemia)
817
Why is it important to treat Strep throat in children or in those that could transmit Strep pyogenes to a child?
To avoid rheumatic fever *You cant really prevent post streptococcal glomerulonephritis*
818
Which glomerular disease would you suspect most in a patient with the following findings? 1. Granular pattern of immune complex deposition; LM: Hypercellular glomeruli 2. Linear pattern of immune complex deposition 3. Deposition of IgG, IgM, IgA, and C3 in the mesangium 4. Anti-GBM antibodies, hematuria, hemoptysis
1. Granular pattern of immune complex deposition; LM: Hypercellular glomeruli: **Acute poststreptococcal Glomerulonephritis** 2. Linear pattern of immune complex deposition: **Goodpastures syndrome** 3. Deposition of IgG, IgM, IgA, and C3 in the mesangium: **IgA nephropathy (Berger's disease)** 4. Anti-GBM antibodies, hematuria, hemoptysis: **Goodpastures syndrome**
819
Which glomerular disease would you suspect most in a patient with the following findings? 1. Nephritis, deafness, cataracts 2. Crescent formation in the glomeruli 3. Wire-loop appearance 4. Most common nephrotic syndrome in children
1. Nephritis, deafness, cataracts: **Alport syndrome** 2. Crescent formation in the glomeruli: **Rapidly progressive (Crescentic) glomerulonephritis** 3. Wire-loop appearance: **SLE (Diffuse proliferative glomerulonephritis)** 4. Most common nephrotic syndrome in children: **Minimal Change disease**
820
Which glomerular disease would you suspect most in a patient with the following findings? 1. IF: granular pattern of immune complex depostion; LM: Diffuse capillary thickening 2. Kimmelstiel-Wilson lesions (Nodular glomerulosclerosis) 3. Most common nephrotic syndrome in adults 4. EM: loss of epithelial foot processes
1. IF: granular pattern of immune complex depostion; LM: Diffuse capillary thickening: **Membranous glomerulonephritis** 2. Kimmelstiel-Wilson lesions (Nodular glomerulosclerosis): **Diabetic glomerulonephropathy** 3. Most common nephrotic syndrome in adults: **Focal segmental glomerulosclerosis** 4. EM: loss of epithelial foot processes: **Membranoproliferative glomerulonephritis**
821
Which glomerular disease would you suspect most in a patient with the following findings? 1. Nephrotic syndrome associated with hepatitis B 2. Nephrotic syndrome associated with HIV 3. EM: Subendothelial humps and tram-track appearance 4. LM: Segmental sclerosis and hyalinosis
1. Nephrotic syndrome associated with hepatitis B: **Membranoproliferative glomerulonephritis** 2. Nephrotic syndrome associated with HIV: **Focal segmental glomerulosclerosis** 3. EM: Subendothelial humps and tram-track appearance: **Membranoproliferative glomerulonephritis** 4. LM: Segmental sclerosis and hyalinosis: **Focal segmental glomerulosclerosis**
822
Which glomerular disease would you suspect most in a patient with the following findings? 1. Purpura on back of arms and legs, abdominal pain, IgA nephropathy 2. Apple-green birefringence with Congo-red stain under polarized light 3. EM: Spiking of the GBM due to electron dense subepithelial deposits
1. Purpura on back of arms and legs, abdominal pain, IgA nephropathy: **Henoch-schonlein purpura** 2. Apple-green birefringence with Congo-red stain under polarized light: **Renal Amyloidosis** 3. EM: Spiking of the GBM due to electron dense subepithelial deposits: **Membranous glomerulonephritis**
823
Glomerular histology reveals multiple mesangial nodules. This lesion is indicative of what disease?
Kimmelstiel-Wilson lesions indicative of diabetic glomerulonephropathy
824
A teenager presents with nephrotic syndrome and hearing loss. What is the disease?
Alport syndrome
825
What is the WAGR complex?
1. Wilm's Tumor 2. Aniridia (no iris) 3. Genitourinary malformation 4. Retardation
826
What are the risk factors for transitional cell carcinoma?
1. Smoking (Main risk factor) 2. Phenacetin 3. Aniline dyes 4. Cyclophosphamide
827
What are the classic features of drug-induced acute interstitial nephritis?
1. Fever 2. Rash 3. Eosinophilia 4. Azotemia
828
What changes will be seen in a basic metabolic panel in a patient with renal failure?
1. Increased serum Creatinine 2. Increased serum BUN 3. Increased serum Potassium 4. Increased serum Phosphate 5. Decreased Serum Calcium
829
What urinary pathology fits each of the following descriptions? 1. Most common tumor of the urinary tract 2. Most common renal malignancy of early childhood (ages 2-4) 3. Fever + rash + hematuria + eosinophilia 4. Cancer associated with Schistosoma haematobium
1. Most common tumor of the urinary tract: **Transitional cell carcinoma** 2. Most common renal malignancy of early childhood (ages 2-4): **Wilm's tumor** 3. Fever + rash + hematuria + eosinophilia: **Acute interstitial nephritis** 4. Cancer associated with Schistosoma haematobium: **Squamous cell bladder cancer**
830
What infections is Klebsiella pneumoniae known for causing?
1. UTI (particularly nosocomial) 2. Aspiration pneumonia and lung abscess
831
What organisms are the most common causes of UTI?
1. E. Coli 2. Staph saprophyticus 3. Klebsiella 4. Proteus
832
What is the function of the enzyme urease?
Splits urea into 2 molecules of NH3 and 1 molecule of CO2 *Proteus mirabilis does this*
833
A culture reveals Gram negative, oxidase-positive diplococci. What is the likely organism?
N. Meningitidis or N. Gonorrhoeae
834
A 22 year-old medical student has a burning feeling in his gut after meals. An EGD is performed and biopsy of the gastric mucosa shows spiral-shaped Gram (-) bacteria. What is the organism?
H. Pylori
835
A 50 year-old male smoker presents with a new cough and flu-like symptoms. Grams stain of the sputum shows no organisms but silver stain shows rods. What is the diagnosis?
Legionella pneumophila *Does not gram stain as it is intracellular*
836
What Gram (-) organism matches each of the following descriptions? 1. Osteomyelitis in a patient with diabetes mellitus 2. Sepsis, DIC, adrenal hemorrhage 3. 5 year-old with pharyngitis, drooling, and X-ray reveals thumb sign 4. Osteomyelitis in a patient with sickle cell 5. Alcoholic with aspiration pneumonia
1. Osteomyelitis in a patient with diabetes mellitus: **Pseudomonas** 2. Sepsis, DIC, adrenal hemorrhage: **N. Meningitidis** 3. 5 year-old with pharyngitis, drooling, and X-ray reveals thumb sign: **H. influenzae type B (Epiglotitis)** 4. Osteomyelitis in a patient with sickle cell: **Salmonella** 5. Alcoholic with aspiration pneumonia: **Klebsiella**
837
What Gram (-) organism matches each of the following descriptions? 1. Child with a new puppy develops severe abdominal pain 2. Burn wound infection 3. Motile organism that causes UTI 4. Most common form of traveler's diarrhea
1. Child with a new puppy develops severe abdominal pain: **Yersinia enterocolitica** 2. Burn wound infection: **Pseudomonas** 3. Motile organism that causes UTI: **Proteus mirabilis** 4. Most common form of traveler's diarrhea: **ETEC**
838
What Gram (-) organism matches each of the following descriptions? 1. Life-threatening meningitis + purpura 2. Common cause of both UTI and pneumonia 3. Corneal infections in contact lens wearers 4. Septic arthritis in young, sexually active patients
1. Life-threatening meningitis + purpura: **N. Meningitidis** 2. Common cause of both UTI and pneumonia: **Klebsiella** 3. Corneal infections in contact lens wearers: **Pseudomonas** 4. Septic arthritis in young, sexually active patients: **N. Gonorrhoeae**
839
What are the side effects of the aminoglycosides?
"NOT" 1. Nephrotoxicity 2. Ototoxicity 3. Teratogenicity
840
What drugs have photosensitivity reactions?
"SAT for a Photo" 1. Sulfonamides 2. Amiodarone 3. Tetracyclines
841
1. What causes Gray baby syndrome? 2. Gray man syndrome? 3. Red man syndrome?
1. Gray baby syndrome: **Chloramphenicol** 2. Gray man syndrome: **Amiodarone** 3. Red man syndrome: **Vancomycin**
842
What are the clinical uses for macrolides?
"PUS" 1. Pneumonia (Atypical) 2. URIs 3. STDs 4. Also for Gram (+) infections in penicillin-resistant patients *Azithromycin, Arithromycin, and Clarithromycin*
843
What agent is used for porphylaxis for each of the following infections? 1. Gonorrhea 2. Syphilis 3. Recurrent UTIs
1. Gonorrhea: **Ceftriaxone** 2. Syphilis: **Penicillin G** 3. Recurrent UTIs: **TMP-SMX**
844
What agent is used for porphylaxis for each of the following infections? 1. Pneumocystis jirovecii pneumonia 2. Exposure to meningococcal or H. influenzae type B meningitis 3. Endocarditis prevention in patient with turbulent flow heart disease
1. Pneumocystis jirovecii pneumonia: **TMP-SMX** 2. Exposure to meningococcal or H. influenzae type B meningitis: **Rifampin** 3. Endocarditis prevention in patient with turbulent flow heart disease: **Amoxicillin/Ampicillin or Clindamycin**
845
What antibiotics should expecially be avoided in pregnancy?
"Countless SAFe Moms Take Really Good Care" 1. Clarithromycin - Embryotoxic 2. Sulfonamides - Kernicterus 3. Aminoglycosides - Ototoxic 4. **Fluoroquinolones - Cartilage damage** 5. **Metronidazole - Mutagenesis** 6. **Tetracyclines - Discolored teeth, bone growth inhibition** 7. Ribavirin - Teratogenic 8. Griseofulvin - Teratogenic 9. **Chloramphenicol - Gray baby**
846
What type of vaccine uses a live virus that has lost its virulence? What are some examples of live virus vaccines?
Live attenuated virus 1. Small Pox vaccine 2. Yellow fever vaccine 3. Varicella Zoster vaccine 4. MMP vaccine 5. Sabin (Oral) Polio 6. Intranasal Influenza vaccine 7. Rotavirus vaccine
847
What is the DNA structure of most all of the DNA viruses and what are the exceptions? What else is common to most DNA viruses and what are the exceptions?
1. Double-stranded: Except Parvovirus 2. Linear genome: Except Papilloma virus, Polyoma virus, & Hepadnavirus 3. Icosahedral shape: Except Poxvirus 4. Replicate in the nucleus: Except Poxvirus
848
When should live vaccines be considered in HIV positive patients?
1. MMR & Varicella Zoster vaccines when CD4 count is \>200 2. No recommendation for or against Shingles vaccine when CD4 count \>200
849
Where does herpesvirus acquire its envelope?
Nuclear membrane *Most get envelope from host cell plasma membrane*
850
Which viral families do not have an envelope?
_Non-enveloped RNA viruses_ 1. Calicivirus 2. Picornavirus 3. Reovirus 4. Hepevirus _Non-enveloped DNA_ 1. Parvovirus 2. Adenovirus 3. Papillomavirus 4. Polyomavirus
851
What is the treatment for the different herpes viruses?
1. HSV-1, HSV-2, VZV, and EBV (only a little): Aciclovir, Valacyclovir, and Famciclovir (Tx of choice for VZV) 2. CMV: Ganciclovir or Foscarnet (if resistant to Ganciclovir)
852
What group of patients is prone to esophagitis caused by CMV?
HIV patients with CD4
853
Where is latent herpes infection found in the body?
1. HSV-1: Trigeminal ganglia 2. HSV-2: Sacral ganglia 3. VZV: Dorsal root ganglia or Trigeminal ganglia 4. CMV: Mononuclear cells 5. EBV: B cells
854
What are Downey cells?
1. Activated T cells responding to an EBV infection as in Mononucleosis 2. Cytoplasm has foamy appearance
855
Which DNA virus is associated with each of the following statements? 1. Erythema infectiosum (AKA Fifth disease) 2. Heterophile-positive mononucleosis 3. Can cause conjunctivitis or diarrhea 4. Enlarged cell with owl's eye inclusions
1. Erythema infectiosum (AKA Fifth disease): **Parvovirus B19** 2. Heterophile-positive mononucleosis: **EBV** 3. Can cause conjunctivitis or diarrhea: **Adenovirus** 4. Enlarged cell with owl's eye inclusions: **CMV**
856
Which DNA virus is associated with each of the following statements? 1. Identified with a pap smear 2. Milkmaid's blisters 3. Burkitt lymphoma and nasopharyngeal carcinoma 4. Gingivostomatitis
1. Identified with a pap smear: **Papillomavirus** 2. Milkmaid's blisters: **Cowpox (Poxvirus)** 3. Burkitt lymphoma and nasopharyngeal carcinoma: **EBV** 4. Gingivostomatitis: **HSV-1**
857
Which DNA virus is associated with each of the following statements? 1. Hides in sensory ganglia of S2 and S3 2. Hides in trigeminal ganglia 3. Hides in dorsal root ganglia 4. Viral family of JC virus
1. Hides in sensory ganglia of S2 and S3: **HSV-2** 2. Hides in trigeminal ganglia: **HSV-1 (Could be VZV)** 3. Hides in dorsal root ganglia: **VZV** 4. Viral family of JC virus: **Polyomavirus**
858
Which DNA virus is associated with each of the following statements? 1. Downey cells 2. Human progressive multifocal leukoencephalopathy 3. Oral hairy leukoplakia 4. Multinucleate giant cells on Tzanck test
1. Downey cells: **EBV** 2. Human progressive multifocal leukoencephalopathy: **Polyomavirus (JC virus)** 3. Oral hairy leukoplakia: **EBV** 4. Multinucleate giant cells on Tzanck test: **HSV-1 & HSV-2**
859
Which DNA virus is associated with each of the following statements? 1. Only DNA virus that is not double-stranded 2. Roseola 3. Heterophile-negative mononucleosis
1. Only DNA virus that is not double-stranded: **Parvovirus** 2. Roseola: **HHV-6 (Sixth disease)** 3. Heterophile-negative mononucleosis: **CMV**
860
A 45 year-old man with squamous cell carcinoma of the penis had exposure to what virus?
HPV 16 or HPV 18
861
A 20 year-old college student presents with lymphadenopathy, fever, and hepatosplenomegaly. His serum agglutinates sheep red blood cells. What cell type is infected?
His B Cells are infected with EBV
862
What is the #1 cause of fatal infantile gastroenteritis?
Rotavirus of the Reovirus family
863
What virus is commonly associated with outbreaks of gastroenteritis on cruise ships?
Norovirus of the Calicivirus family
864
Which RNA virus matches each of the following statements? 1. Hand, foot, and mouth disease 2. "Break bone fever" 3. "Common cold"
1. Hand, foot, and mouth disease: **Coxsackievirus (Picornavirus)** 2. "Break bone fever": **Dengue (Flavivirus)** 3. "Common cold": **Rhinovirus (Picornavirus) and Coronavirus**
865
Which RNA virus matches each of the following statements? 1. Fever, jaundice, black vomit 2. Meningitis in summer months 3. Tourniquet test helps diagnose hemorrhagic disease 4. Infects motor neurons of the anterior horn
1. Fever, jaundice, black vomit: **Yellow Fever (Flavivirus)** 2. Meningitis in summer months: **Echovirus (Picornavirus), Coxsackievirus (Picornavirus)** 3. Tourniquet test helps diagnose hemorrhagic disease: **Dengue (Flavivirus)** 4. Infects motor neurons of the anterior horn: **Poliovirus (Picornavirus), West Nile Virus (Flavivirus)**
866
Which antivirals match each of the following statements? 1. Prophylaxis for influenza A 2. Used in treatment for chronic hepatitis C 3. First-line for HSV or EBV 4. Inhibits viral DNA polymerase when phosphorylated by viral thymidine kinase
1. Prophylaxis for influenza A: **Zanamivir, Oseltemivir** 2. Used in treatment for chronic hepatitis C: **Ribavirin and IFN-alpha** 3. First-line for HSV or EBV: **Acyclovir, Valacyclovir, Famciclovir** 4. Inhibits viral DNA polymerase when phosphorylated by viral thymidine kinase: **Acyclovir, Valacyclovir, Famciclovir**
867
Which RNA virus matches each of the following statements? 1. Characteristic barking seal cough 2. Childhood diarrhea in winter months 3. Asthma-sounding infection in infants (Esp. preemies)
1. Characteristic barking seal cough: **Croup caused by Parainfluenza virus (Paramyxovirus)** 2. Childhood diarrhea in winter months: **Rotavirus** 3. Asthma-sounding infection in infants (Esp. preemies): **RSV**
868
What virus (RNA or DNA) fits the following statement? 1. Can cause conjunctivitis or diarrhea 2. Fever + jaundice + black vomit 3. Enlarged cell with owl's eye inclusions
1. Can cause conjunctivitis or diarrhea: **Adenovirus** 2. Fever + jaundice + black vomit: **Yellow Fever (Flavivirus)** 3. Enlarged cell with owl's eye inclusions: **CMV**
869
What virus (RNA or DNA) fits the following statement? 1. Identified with a Pap smear 2. Barking Seal cough 3. Brassy cough
1. Identified with a Pap smear: **Papillomavirus** 2. Barking Seal cough: **Croup caused by Parainfluenza virus (Paramyxovirus)** 3. Brassy cough: **RSV (Paramyxovirus)**
870
What virus (RNA or DNA) fits the following statement? 1. Negri bodies 2. Hides in trigeminal ganglia 3. Diarrhea in children during the winter months
1. Negri bodies: **Rabies virus (Rhabdovirus)** 2. Hides in trigeminal ganglia: **HSV-1 (Also could be HSV-2 and VZV but these more commonly lay dormant in the sacral ganglia and dorsal root ganglia respectively)** 3. Diarrhea in children during the winter months:** Rotavirus (Reovirus)**
871
What virus (RNA or DNA) fits the following statement? 1. 2 most common causes of common cold 2. Downey cells 3. Aseptic meningitis
1. 2 most common causes of common cold: **Rhinovirus (Picornavirus), Coronavirus** 2. Downey cells: **EBV (these are the activated T-cells of Mononucleosis)** 3. Aseptic meningitis: **Echovirus, Coxackievirus and Enterovirus (All Picornaviruses)**
872
An adolescent presents with cough and rust-colored sputum. What does the gram stain of the sputum show?
Gram (+) diplococci (Strep pneumo)
873
An older male patient has blood in his urine and renal stones. What organism is most likely responsible for the patient's stones?
Proteus
874
What organism would you suspect as the cause of a septic arthritis in a 20 year-old man?
N. Gonorrhoeae
875
What are the most common causes of pneumonia for each of the following patient populations? 1. 6w-18y 2. 18y-40y 3. 40y-65y 4. Elderly
1. 6w-18y: **RSV, Strep pneumoniae, Chlamydia pneumoniae, Mycoplasma** 2. 18y-40y: **Strep pneumoniae, Mycoplasma, Chlamydia pneumoniae** 3. 40y-65y: **Strep pneumo, H. influenzae, anaerobes, viruses** 4. Elderly: **Strep pneumoniae, viruses, G (-) rods**
876
What findings would help you distinguish bacterial meningitis from fungal and viral meningitis?
_Bacterial_ 1. Glucose: **Down** 2. Protein: **Up** 3. CSF pressure: **Up** 4. WBCs: **Neutrophils** _Fungal/TB_ 1. Glucose: **Down** 2. Protein: **Up** 3. CSF pressure: **Up** 4. WBCs: **Lymphocytes** _Viral_ 1. Glucose: **Normal** 2. Protein: **Normal** 3. CSF pressure: **Normal** 4. WBCs: **Lymphocytes**
877
What CSF findings would you see in a patient with TB meningitis?
1. Glucose: **Down** 2. Protein: **Up** 3. CSF pressure: **Up** 4. WBCs: **Lymphocytes**
878
What are the TORCH infections?
"TORCHHeS" 1. Toxoplasma (Chorioretinitis, Hydrocephalus, Intracranial calcifications) 2. Other (Parvovirus B19) 3. Rubella (PDA, Cataracts, Deafness) 4. CMV (Unilateral hearing loss) 5. HIV 6. HSV (Temporal lobe encephalitis) 7. Syphillis
879
A 50 year-old patient recovered from abdominal surgery performed 2 days ago and has had an internal catheter in place since that time. He now has a fever of 100 degrees F. What is the most likely cause of fever?
UTI
880
Which STD matches the following statement? 1. Clue cells 2. Painless genital ulcer 3. Flagellated cells 4. Strawberry cervix
1. Clue cells: **Bacterial vaginosis** 2. Painless genital ulcer: **Syphillis** 3. Flagellated cells: **Trichomonas** 4. Strawberry cervix: **Trichomonas**
881
What medication causes cardiotoxicity and bone marrow suppression?
Doxorubicin and Daunorubicin *Doxorubicin cardiotoxicity is characterized by a dose-dependent decline in mitochondrial oxidative phosphorylation. Reactive oxygen species, generated by the interaction of doxorubicin with iron, can then damage the myocytes (heart cells), causing myofibrillar loss and cytoplasmic vacuolization*
882
A patient tries to commit suicide by overdosing on digitalis. What is the most important step in the management of this patient?
1. Stop digitalis 2. Administer anti digitalis antibody fragments 3. Address K and Mg levels
883
An African-American male that goes to Africa develops anemia after taking prophylactic medicine for primary disease prevention. What enzyme is this patient deficient in?
G6PD
884
Which drugs cause gynecomastia?
"Some Drugs Create Awesome Knockers" 1. Spironolactone 2. Digitalis 3. Cimetidine 4. Amantidine 5. Ketoconazole
885
A patient presents with tinnitus, dizziness, headaches, and GI distress. What drug is causing these symptoms?
This is Cinchonism caused by Quinine (2nd line antimalarial) or Quinidine (1a antiarrhythmic)
886
What medications are known for causing drug-induced lupus?
"SHIPP" 1. Sulfonamides 2. Hydralazine 3. Isoniazid 4. Procainamide 5. Phenytoin
887
What cell type lines the uterus?
Columnar epithelium with some tubular glands
888
What ligament of the female pelvis matches each of the following descriptions? 1. Connects the cervix to the pelvic side wall 2. Connects the ovaries to the lateral pelvic wall 3. Connects the uterus, fallopian tubes and ovaries to the pelvic side wall 4. Contains the uterine vessels 5. Contains the ovarian vessels
1. Connects the cervix to the pelvic side wall: **Cardinal ligament** 2. Connects the ovaries to the lateral pelvic wall: **Suspensory ligament of the ovary** 3. Connects the uterus, fallopian tubes and ovaries to the pelvic side wall: **Broad ligament** 4. Contains the uterine vessels: **Cardinal ligament** 5. Contains the ovarian vessels: **Suspensory ligament of the ovary**
889
What is the landmark used for the pudendal nerve block?
Ischial spine
890
To where does testicular cancer first metastasize?
Para-aortic lymph nodes
891
What structures develop from the mesonephric duct system?
1. Seminal vesicles 2. Epididymis 3. Ejaculatory duct 4. Vas deferens
892
What is the male homologue to each of the following female structures? 1. Vestibular bulbs 2. Labia minora 3. Bartholin glands 4. Urethral and paraurethral glands (ofSkene)
1. Vestibular bulbs: **Corpus spongiosum** 2. Labia minora: **Ventral shaft** 3. Bartholin glands: **Bulbourethral glands** 4. Urethral and paraurethral glands (ofSkene): **Prostate**
893
What gene product comes from the SRY gene that underlies male genital development?
Testes-determining factor
894
What structure anchors the testes to the scrotum?
Gubernaculum
895
How many carbon molecules are found on testosterone and on androstenedione?
19 carbons
896
What is the difference between androgen insensitivity and 5-alpha-reductase?
_Androgen insensitivity_ 1. Testicular feminization 2. Defect in Dihydrotestosterone receptor 3. Phenotypically normal female 4. Increased testosterone, LH, and estrogen _5-alpha-reductase deficiency_ 1. Testosterone cannot be converted to dihydrotestosterone 2. Early defect is ambiguous genitalia 3. Increased testosterone at puberty causes normal male genitalia 4. Normal testosterone, estrogen, and LH
897
What is the role of Sertoli cells and Leydig cells in spermatogenesis?
_Sertoli cells_ 1. Stimulated by FSH 2. Produce inhibin 3. Produce androgen binding protein that maintains high level of concentration of testosteron in seminiferous tubules _Leydig cells_ 1. Stimulated by LH 2. Produce testosterone
898
A 23 year-old patient presents with one testicle. For what is this patient at risk?
This is likely cryptochordism which is associated with increased risk of germ cell testicular cancer
899
What testicular tumor is described by each of the following statements? 1. Composed of cytotrophoblasts and syncytiotrophoblasts 2. May present initially with gynecomastia 3. Elevated AFP 4. Elevated beta-hCG
1. Composed of cytotrophoblasts and syncytiotrophoblasts: **Choriocarcinoma** 2. May present initially with gynecomastia: **Leydig cell tumor (and possibly Sertoli cell tumor)** 3. Elevated AFP: **Yolk-sac tumor and Embryonal carcinoma** 4. Elevated beta-hCG: **Choriocarcinoma and Embryonal carcinoma**
900
What testicular tumor is described by each of the following statements? 1. Most common testicular tumor 2. Most common testicular tumor in infants and children up to 3 years of age 3. Most common testicular tumor in men over age 60
1. Most common testicular tumor: **Seminoma** 2. Most common testicular tumor in infants and children up to 3 years of age: **Yolk-sac tumor** 3. Most common testicular tumor in men over age 60: **Testicular lymphoma**
901
What testicular tumor is described by each of the following statements? 1. Histologic appearance similar to koilocytes (cytoplasmic clearing) 2. Histologically may have alveolar or tubular appearance sometimes with papillary convolutions 3. Composed of multiple tissue types
1. Histologic appearance similar to koilocytes (cytoplasmic clearing): **Seminoma** 2. Histologically may have alveolar or tubular appearance sometimes with papillary convolutions: **Embryonal carcinoma** 3. Composed of multiple tissue types: **Teratoma**
902
What testicular tumor is described by each of the following statements? 1. Histologic endodermal sinus structures (Schiller-Duval bodies) 2. 25% have cytoplasmic rod-shaped crystalloids of Reinke 3. Androgen producing and associated with precocious puberty
1. Histologic endodermal sinus structures (Schiller-Duval bodies): **Yolk-Sac tumor** 2. 25% have cytoplasmic rod-shaped crystalloids of Reinke: **Leydig cell tumor** 3. Androgen producing and associated with precocious puberty: **Leydig cell tumor (and possibly Sertoli cell tumor)**
903
What is the mechanism of action of Sildenafil?
It inhibits cGMP-Phosphodiesterase -\> Increase in cGMP -\> Decrease in smooth muscle contraction
904
What are the side effects of Sildenafil?
1. Flushing 2. Headache 3. Dyspepsia 4. Impaired blue-green color vision 5. Life-threatening hypotension (With nirtrates)
905
What organism is commonly implicated in balantitis?
Candida albicans (Common in diabetes)
906
How does flutamide differ from finasteride in relation to mechanism of action and clinical use?
_Finasteride_ 1. 5alpha-reductase inhibitor 2. Prevents Testosterone conversion fto DHT 3. Used in BPH and Male-pattern-baldness _Flutamide_ 1. Inhibits testosterone receptors 2. Used in prostate adenocarcinoma
907
A 55 year-old man undergoing treatment for BPH has increased testosterone and decreased DHT as well as gynecomastia and edema. What medication is he being treated with?
5alpha-reductase inhibitors
908
What are the diagnositic symptoms of BPH?
1. Nocturia 2. Hesitancy 3. Difficulty stopping and starting urine stream 4. Frequency 5. Dysuria
909
What is the two-cell theory of estradiol production?
Theca cells produce androstenediones from cholesterol -\> Granulosa cells convert the androstenediones into Estrogens (mostly Estradiol)
910
What are the target cells of LH? What cells respond to FSH?
_LH stimulates_ 1. Theca cells (females) 2. Leydig cells (males) _FSH stimulates_ 1. Granulosa cells (females) 2. Sertoli cells (males)
911
State whether each of the following statements describes estrogen or progesterone 1. Production of thick mucus that inhibits entry of sperm into the uterus 2. Induces LH surge 3. Uterine smooth muscle relaxation 4. Follicle growth
1. Production of thick mucus that inhibits entry of sperm into the uterus: **Progesterone** 2. Induces LH surge: **Estrogen** 3. Uterine smooth muscle relaxation: **Progesterone** 4. Follicle growth: **Estrogen**
912
State whether each of the following statements describes estrogen or progesterone 1. Maintainance of pregnancy 2. Hepatic synthesis of transport proteins 3. Withdrawal leads to menstruation
1. Maintainance of pregnancy: **Progesterone** 2. Hepatic synthesis of transport proteins: **Estrogen** 3. Withdrawal leads to menstruation: **Progesterone**
913
When does beta-hCG appear in the urine during pregnancy?
2 weeks after conception
914
What are the pros and cons of oral contraceptive pill use?
_Pros_ 1. Reliable, low-failure rate 2. Decreased risk of ovarian cancer 3. Decreased risk of endometrial cancer 4. Decreased risk of ectopic pregnancy 5. Regulate menses 6. Decrease dysmenorrhea 7. Improve acne _Cons_ 1. Daily dosing 2. No STD protection 3. Possible elevation of Triglycerides 4. Possible nausea 5. Hypertension 6. Induce hypercoagulable state
915
Why is progesterone used in combination with estrogen during estrogen replacement?
Prevent unopposed estrogen which would otherwise cause endometrial hyperplasia and increase the risk of endometrial cancer
916
What is the best option for birth control in a mentally retarded patient?
IM Medroxyprogesterone
917
What hormonal changes are seen during menopause?
1. Decreased estrogen 2. Increased GnRH 3. Increased FSH and LH
918
A 23 year-old woman is on Rifampin for TB prophylaxis and on birth control (estrogen) gets pregnant. Why?
Rifampin induces P450 -\> Increasing the metabolism of birth control pill
919
What are the risk factors for cervical cancer?
1. STDs 2. Multiple sex partners 3. HIV/AIDS 4. No HPV vaccine 5. Smoking
920
What is the classic histological appearance of a vaginal epithelial cell infected with HPV?
Koilocyte: Dysplastic cervical cells with enlarged dark nuclei and perinuclear clearing
921
Who is at risk of clear cell adenocarcinoma?
Individuals who had exposure to diethylstilbestrol in utero
922
What are the risk factors for endometrial carcinoma?
1. Obesity 2. Diabetes 3. Hypertension 4. Exposure to unopposed estrogen 5. Nulliparity 6. Late menopause
923
What uterine pathology matches each of the following descriptions? 1. Excess unopposed estrogen is the main risk factor 2. Menorrhagia with an enlarged uterus and no pelvic pain 3. Pelvic pain that presents only during menstruation 4. Diagnosed by endometrial biopsy in clinic
1. Excess unopposed estrogen is the main risk factor: **Endometrial hyperplasia/carcinoma** 2. Menorrhagia with an enlarged uterus and no pelvic pain: **Leiomyoma** 3. Pelvic pain that presents only during menstruation: **Endometriosis** 4. Diagnosed by endometrial biopsy in clinic: **Endometrial hyperplasia/carcinoma**
924
What uterine pathology matches each of the following descriptions? 1. Definitive diagnosis and treatment is by laparoscopy 2. Menstruating tissue within the myometrium 3. Malignant tumor of the uterine smooth muscle
1. Definitive diagnosis and treatment is by laparoscopy: **Endometriosis** 2. Menstruating tissue within the myometrium: **Adenomyosis** 3. Malignant tumor of the uterine smooth muscle: **Leiomyosarcoma**
925
How does the dosing of leuprolide affect its physiological impact?
1. Constant dosing: GnRH antagonist 2. Pulstile dosing: GnRH agonist
926
What is the underlying cause of PCOS? What are the clinical manifestations? What is the treatment?
_What is the underlying cause of PCOS?_ 1. Increased LH _What are the clinical manifestations?_ 1. Amenorrhea 2. Infertility 3. Obesity 4. Hirsutism 5. Impaired glucose tolerance _What is the treatment?_ 1. Weight loss 2. Metformin (Tx diabetes and induce ovulation) 3. Clomiphene (Induce ovulation) 4. Pulsitile Leuprolide 5. Spironolactone (Tx Hirsutism)
927
A patient with PCOS is most at risk for developing which type of cancer?
Endometrial carcinoma
928
Under what circumstances would you expect to see an elevated LH?
1. PCOS 2. Normal surge before pregnancy 3. Menopause 4. Androgen insensitivity syndrome
929
What drug would you give to inhibit prolactin secretion?
Dopamine analog (Bromocriptine)
930
What ovarian tumor matches each of the following statements? 1. Produces AFP 2. Estrogen-secreting, leading to precocious puberty 3. Intraperitoneal accumulation of mucinous material 4. Testosterone-secreting, leading to virilization
1. Produces AFP: **Yolk-sac tumor** 2. Estrogen-secreting, leading to precocious puberty: **Granulosa-Theca cell tumor** 3. Intraperitoneal accumulation of mucinous material: **Mucinous cystadenocarcinoma** 4. Testosterone-secreting, leading to virilization: **Sertoli-Leydig tumor**
931
What ovarian tumor matches each of the following statements? 1. Call-Exner bodies 2. Resembles bladder epithelium 3. Elevated Beta-hCG
1. Call-Exner bodies: **Granulosa-Theca cell tumor** 2. Resembles bladder epithelium: **Brenner cell tumor** 3. Elevated Beta-hCG: **Choriocarcinoma (Also Dysgerminoma)**
932
What are the risk factors for ovarian cancer?
_Increased number of cycles_ 1. Not being pregnant early in life 2. Late menopause 3. Early menarch
933
An obese woman presents with amenorrhea and increased levels of serum testosterone. What is the most likely diagnosis?
PCOS
934
1. A pregnant woman at 16 weeks of gestation presents with an atypically large abdomen and hypertension. 2. What abnormality might be seen on blood test, and what is the disorder?
1. Increased Beta-hCG on blood test 2. Complete Hydatidiform mole
935
A 15-year-old female patient of yours that normally comes with her parents presents alone this time. She states that she is sexually active but that she knows she is not pregnant because she has never menstruated. What would be the appropriate next step in managing this patient?
1. Check a pregnancy test 2. Work-up for delayed puberty 3. Inform patient about STDs and contraception
936
Monozygotic twins are delivered. One is pale and has a hematocrit of 15%, and the other is flushed with a hematocrit of 55%. What is the cause of these features?
Twin-twin transfusion (They share a placenta and one recieved more blood than the other)
937
What is the difference between placenta previa, abruptio, and accreta?
_Placenta previa_ 1. Placenta overlies the cervical os 2. **Painless** vaginal bleeding 3. Requires a C-section _Placenta abruptio_ 1. **Painful** 2. Placenta separates from the uterus 3. Bleeding inside the uterus 4. Life-threatening to the fetus _Placent accreta_ 1. Placenta is attached to the myometrium 2. Does not separate from myometrium at birth
938
A pregnant woman with previous c-section is at increased risk for which placental abnormalities?
1. Placenta accreta 2. Placenta previa
939
What are some of the conditions that can result in polyhydramnios?
Esophageal or duodenal atresia
940
What is the mechanism of action of mifeprostone?
1. Competitively binds to progesterone receptors 2. Blocks the effects of progesterone
941
What agents are commonly used as tocolytics (Labor suppressants)?
1. Magnesium sulfate 2. Terbutaline 3. Ritodrine 4. Nifedipine 5. Indomethacin
942
What prenatal ultrasound finding is a clue that the fetus may have Down Syndrome?
Nuchal translucency
943
1. What is the most common event that causes Down syndrome? 2. Second most common? 3. Third most common?
1. Meiotic nondisjunction (95%) 2. Robertsonian translocation (4%) 3. Mosaicism (1%)
944
What gene is affected in Fragile-X syndrome?
FMR1 gene
945
What are the clinical features of Fragile-X syndrome?
1. Autism (Mental retardation) 2. Macro-orchidism 3. Long face and large jaw 4. Large everted ears 5. Mitral valve prolapse
946
What are the clinical features of Williams syndrome?
This is a microdeletion of chromosome 7 (deleted region includes elastin gene) 1. Elfin facies 2. Mental retardation 3. Well developed verbal skills 4. Extreme friendliness with strangers 5. Cardiovascular problems (Valvular defects)
947
What are the possible defects in cases of chromosome 22q11 deletion?
1. Absent Thymus (DiGeorge syndrome) 2. Hypocalcemia 3. Abnormal facies 4. Cleft palate 5. Cardiac defects
948
What are the distinguishing characteristics of Klinefelter syndrome compared to Turner syndrome?
_Klinefelter Syndrome_ 1. 47 XXY Male 2. Tall with long extremities 3. Testicular atrophy 4. Gynecomastia _Turner syndrome_ 1. 45 XO 2. Webbing of the neck 3. Shield chest 4. Primary amenorrhea 5. Short stature
949
What genetic defect is responsible for achondroplasia?
Cell signaling defect of FGF receptor (FGFR-3 gene)
950
A genetic defect in which proteins results in hereditary spherocytosis?
Spectrin or Ankyrin
951
What autosomal dominant disease fits each of the following statements? 1. Associated with floppy mitral valve, dissecting aortic aneurysm, berry aneurysm 2. Associated with mitral valve prolapse, liver disease, berry aneurysms 3. Neural tumors and pigmented iris hamartomas
1. Associated with floppy mitral valve, dissecting aortic aneurysm, berry aneurysm: **Marfan syndrome** 2. Associated with mitral valve prolapse, liver disease, berry aneurysms: **Autosomal dominant polycystic kidney disease** 3. Neural tumors and pigmented iris hamartomas: **Neurofibromatosis type I**
952
What autosomal dominant disease fits each of the following statements? 1. Very strong association with colon cancer 2. MI before age 20 3. Hemangioblastomas of retina/cerebellum/medulla
1. Very strong association with colon cancer: **Familial adenomatous polyposis (FAP)** 2. MI before age 20: **Familial Hypercholesterolemia** 3. Hemangioblastomas of retina/cerebellum/medulla: **Von Hippel-Lindau disease**
953
What autosomal dominant disease fits each of the following statements? 1. Increased MCHC, Hemolytic anemia 2. Bilateral acoustic neuromas 3. Facial lesions, seizure disorder, cancer risk
1. Increased MCHC, Hemolytic anemia: **Hereditary Spherocytosis** 2. Bilateral acoustic neuromas: **Neurofibromatosis type II** 3. Facial lesions, seizure disorder, cancer risk: **Tuberous Sclerosis**
954
What autosomal dominant disease fits each of the following statements? 1. Caudate atrophy, dementia 2. Cystic medial necrosis of the aorta 3. Defect of fibroblast growth factor (FGF) receptor 3
1. Caudate atrophy, dementia: **Huntingtons disease** 2. Cystic medial necrosis of the aorta: **Marfan syndrome** 3. Defect of fibroblast growth factor (FGF) receptor 3: **Achondroplasia**
955
What are some of the disorders resulting from trinucleotide repeats?
1. Friedrich Ataxia: GAA 2. Huntingtons disease: CAG 3. Fragile-X syndrome: CGG 4. Myotonic Dystrophy: CTG
956
What is the name of the genetic disease that fits each of the following descriptions? 1. Macro-orchidism and autism 2. Endocardial cushion defects are common 3. Recurrent pulmonary infections, steatorrhea
1. Macro-orchidism and autism: **Fragile-X syndrome** 2. Endocardial cushion defects are common: **Trisomy 21 (Downs syndrome)** 3. Recurrent pulmonary infections, steatorrhea: **Cystic fibrosis**
957
What is the name of the genetic disease that fits each of the following descriptions? 1. Multiple fractures, easily confused with child abuse 2. Associated with Alzheimer disease after age 35 3. Excess fibro-fatty tissue deposits amongst muscle
1. Multiple fractures, easily confused with child abuse: **Osteogenesis imperfecta** 2. Associated with Alzheimer disease after age 35: **Down sydrome (Trisomy 21)** 3. Excess fibro-fatty tissue deposits amongst muscle: **Duchenne muscular dystrophy**
958
What gene is defective in Cystic fibrosis?
CFTR gene on chromosome 7
959
What is the traditional test used to diagnose cystic fibrosis?
Sweat Chloride test \> 60 meq/L
960
What is the difference between Southern blot, Northern blot, and Western blot?
1. Southern blot: Detect DNA with a DNA probe 2. Northern blot: Detect RNA with a DNA probe 3. Western blot: Detect protein with an antibody probe
961
What type of test uses a known antigen to discern the presence of an antibody?
Indirect ELISA
962
What type of test is performed in order to diagnose chromosomal imbalances?
Karyotyping
963
A male infant is born to a woman that is heterozygous for an X-linked disease. The father is normal. What is the probability that the son will be affected?
50%
964
A female infant is born to a woman that is heterozygous for an X-linked disease. The father is normal. What is the probablity that the daughter is a carrier?
50%
965
What is the probablity that a female carrier of an X-linked disease will have a child with that disease assuming she mates with a normal male?
25%
966
If aa symbolizes a recessive disease, what is the likelihood that parents Aa and Aa will have a phenotypically normal child?
75%
967
Cystic fibrosis is an autosomal recessive disorder. Two parents that are heterozygous for cystic fibrosis have a normal, non-affected child. What is the probability that the child is homozygous normal?
33%
968
Upon examination of a pedigree, you note that both males and females are affected with a disease in every generation. What type of genetic disease is this?
Autosomal dominant
969
What is the frequency of the Aa genotype and the AA genotype if the frequency of allele A is .95?
1. AA = 90.25% 2. Aa = 9.5%
970
If 49% of a particular population is homozygous for a curly hair gene that is dominant to a straight hair gene, what percentage of the population has curly hair?
91%
971
Two patients have the smae mutation on chromosome 15 but have different phenotypic expressions. One patient recieved the mutation form the father while the other recieved the mutation from the mother. What is this an example of? Differentiate Angelman syndrome from Prader-Willi syndrome
Imprinting "MAMA and POP" _MAMA_ 1. Maternal gene 2. Angelman syndrome 3. Mood: Happy with inappropriate laughter 4. Ataxia _POP_ 1. Prader-Willi 2. Overeating/Obesity 3. Paternal gene deletion
972
What are some of the causes of gynecomastia?
_Conditions_ 1. Klinefelter syndrome 2. Hyperestrogen state 3. Old age 4. Cirrhosis 5. Testicular tumors _Drugs_ "Some Drugs Create Awesome Knockers" 1. Spironolactone 2. Digoxin 3. Cimetidine 4. Alcohol 5. Ketoconazole
973
What organism is most commonly responsible for acute mastitis?
Staph aureus
974
What is the classic presenting complaint in a patient with intraductal papilloma?
1. "Straw-colored" (yellowish) nipple discharge 2. +/- bloody discharge
975
What breast pathology fits each of the following descriptions? 1. Most common breast tumor in women under 25 2. Most common breast mass in postmenopausal women 3. Most common breast mass in premenopausal women 4. Most common form of breast cancer
1. Most common breast tumor in women under 25: **Fibroadenoma** 2. Most common breast mass in postmenopausal women: **Invasive ductal carcinoma** 3. Most common breast mass in premenopausal women: **Fibrocystic change of the breast** 4. Most common form of breast cancer: **Invasive ductal carcinoma**
976
What breast pathology fits each of the following descriptions? 1. Small, mobile, firm mass with sharp edges in 24 year-old woman 2. Histological "leaf-like projections" 3. Signet ring cells
1. Small, mobile, firm mass with sharp edges in 24 year-old woman: **Fibroadenoma** 2. Histological "leaf-like projections": **Phyllodes tumor** 3. Signet ring cells: **Lobular carcinoma in situ, Invasive lobular carcinoma**
977
What breast pathology fits each of the following descriptions? 1. Loss of e-cadherin cell adhesion gene on chromosome 16 2. Always ER(+) and PR(+) 3. Commonly presents with nipple discharge
1. Loss of e-cadherin cell adhesion gene on chromosome 16: **Invasive lobular carcinoma** 2. Always ER(+) and PR(+): **Lobular carcinoma in situ, Invasive lobular carcinoma** 3. Commonly presents with nipple discharge: **Intraductal papilloma**
978
What breast pathology fits each of the following descriptions? 1. Eczematous patches on nipple 2. Multiple bilateral fluid-filled lesions with diffuse breast pain 3. Firm, fibrous mass in a 55 year-old woman
1. Eczematous patches on nipple: **Paget disease of the breast** 2. Multiple bilateral fluid-filled lesions with diffuse breast pain: **Fibrocystic change of the breast** 3. Firm, fibrous mass in a 55 year-old woman: **Invasive ductal carcinoma**
979
A 58 year-old postmenopausal woman is on tamoxifen. What is she at increased risk of acquiring?
Endometrial cancer
980
What factors are taken into consideration when giving a newborn an Apgar score?
"APGAR" 1. Appearance 2. Pulse 3. Grimace 4. Activity 5. Respiration
981
What is the definition of low birth weight? What complications are associated with low birth weights?
1. \< 2500g at birth 2. _Complications_ * Infections * Respiratory distress syndrome * Necrotizing enterocolitis * Persistent fetal circulation * Intraventricular hemorrhage
982
Based on the following milestones, how old are each of the following children? 1. Jumps up, 6 cube tower, eats with spoon, 2-3 word sentences 2. Regards face, responds to sound, not yet able to roll over 3. Stands with support, 1-3 words, stranger anxiety, drinks from a cup 4. Rides tricycle, understandable sentences, plays board-games
1. Jumps up, 6 cube tower, eats with spoon, 2-3 word sentences: **2 years** 2. Regards face, responds to sound, not yet able to roll over: **\< 3 months (Probably 2-4 weeks old)** 3. Stands with support, 1-3 words, stranger anxiety, drinks from a cup: **1 year old** 4. Rides tricycle, understandable sentences, plays board-games: **3 year old**

High Yield (34 decks)

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