DIT- Things to know COPY

Question 1

Loss of pain and temp on C/L body
Loss of pain and temp on ipsl face
Hoarseness
Difficulty swallowing
Loss of gag reflex
Vertigo
Nystagmus
N/V

Answer 1

Lateral Medullary syndrome (Wallenberg)

Question 2

Lateral Medullary syndrome (Wallenberg) (6)

Answer 2

Spinothalamic tract damage
- Loss of pain and temp sensation over c/l body

Spinal Trigeminal nucleus damage
- Loss of pain and temp sensation over ipsl face

CN IX and X damage
- Hoarseness, difficulty swallow, loss of gag reflex

Descending sympathetic tract
- Ipsilateral Horner syndrome

Vestibular nuclei damage
- Vertigo, nystagmus, N/V

Inferior cerebellar peduncle damage
- Ipsilateral cerebellar deficits
(ataxia, past pointing)

Question 3

Vessel occluded in stroke of lateral medulla

Answer 3

PICA

Question 4

Internuclear opthalmoplegia

Answer 4

Medial longitudinal fasciculus

Eyes dont track together

Medial rectus palsy (right)
Left eye: horizontal nystagmus

Abducting eye: nystagmus
Adducting eye: unable to adduct

Question 5

Locked in syndrome

Answer 5

Can only move eyes

basilar A. stroke affects both sides of superior pons

Question 6

Dysphagia
Dysphonia
Dysarthria
C/L spastic hemiparesis
Ipsl ptosis
Pupillary dilation
Lateral strabismus (down and out)

Answer 6

Weber syndrome

Anterior midbrain infarction resulting from occlusion of paramedian branches of the posterior cerebral artery

Oculomotor nerve
Cerebral peduncle lesion

Question 7

Lumbar puncture layers (9)

Answer 7

1. Skin/ superficial fascia
2. Supraspinous lig
3. Interspinous lig
4. Ligamentum Flavum
5. Epidural space
6. Dura mater
7. Subdural space
8. Arachnoid membrane
9. Subarachnoid space

Question 8

Last place blood from brain travels before exiting cranium through jugular foramen

-becomes

Answer 8

Sigmoid sinus

Internal jugular vein

Question 9

Carotid sheath contains (3)

Answer 9

Internal jugular v.
Common carotid A.
Vagus n.

Question 10

Clinical features of normal pressure hydrocephalus

Answer 10

Wet wacky wobbly

Urinary incontinence
Dementia
Gait disturbances

Question 11

Magnetic gait

Answer 11

Normal pressure hydrocephalus

Wet wacky wobbly

Urinary incontinence
Dementia
Gait disturbances

Question 12

Fetal component that secretes hCG

Answer 12

Synctiotrophoblast

Question 13

Maternal component of the placenta

Answer 13

Decidua basalis

Question 14

Migraines are made worse by foods that contain

Answer 14

Tyramine

Question 15

Jaw muscle pain when chewing

Answer 15

Giant cell arteritis

Temporal arteritis

Question 16

Pt using topical retinoic acid for acne

Answer 16

Vit A toxicity –>

Idiopathic intracranial HTN

Question 17

Elevated ESR headache

Answer 17

Giant cell arteritis

Question 18

Headache + Extraocular muscular palsies

Answer 18

Cavernous sinus thrombosis

Question 19

Scintillating scotomata prior to HA

Answer 19

Migraine

Question 20

Stages that an embryo goes through between conception and development of inner cell mass

Answer 20

Zygote –> Morula –> blastocyst

Question 21

Adult brain tumor pneumonic

Answer 21

MGM studios

Metastasis
Glioblastoma
Meningioma
Schwannoma

Question 22

Pediatric brain tumor pneumonic

Answer 22

Animal kingdom
Magic kingdom
EpCot

Prepubescent minds eaten with cancer

Pilocytic astrocytoma
Medulloblastoma
Ependymoma
Craniopharyngioma

Question 23

Rapidly progressive primary brain tumor
Irregular necrotic center
Surrounded by edema
GFAP stain
Pseudopalasating pattern "snake like"

Answer 23

Glioblastoma

Question 24

Slow growing primary brain tumor
“Whorled”
Surface of brain
Psammoma bodies

• originates
• risk

Answer 24

Meningioma

Arachnoid cells

Risk

• Radiation
• Neurofibromatous type 2

Question 25

Benign brain tumor S-100 Tennitus, hearing loss Vertigo, unsteady gait -assoc with

Answer 25

Schwannoma Bilateral assoc w/ NF2

Question 26

Fried egg brain tumor

Answer 26

Oligodendroglioma

Question 27

Slow growing brain tumor Frontal lobe Perinuclear cytoplasmic clearing

Answer 27

Oligodendroglioma

Question 28

Hypogonadism or acromegaly | Bitemporal hemianopia

Answer 28

Pituitary adenoma

Question 29

Things that have fried egg appearance

Answer 29

Oligodendroglioma HPV Seminoma

Question 30

Two brain tumors associated with NF-2

Answer 30

Meningioma | Schwannoma

Question 31

Posterior fossa brain tumor GFAP Rosenthal fibers

Answer 31

Pilocytic astrocytoma Rosenthal fibers: eosinophilic corkscrew fibers

Question 32

Rathke's pouch Compresses optic chiasm Supratentorial tumor of childhood

Answer 32

Craniopharyngioma

Question 33

Malignant brain tumor Cerebellar Compress 4th ventricle Homer-wright rosettes

Answer 33

Medulloblastoma Cells circle around tangle of fibers

Question 34

Compress 4th ventricle | Peri-vascular pseudo-rosettes

Answer 34

Ependymona Circular arrangement of cell around vessel

Question 35

Eosinophilic corkscrew fibers

Answer 35

Rosenthal fibers Pilocytic astrocytoma

Question 36

Which cranial nerve relays the following information 1) Hypoxia measure by carotid body 2) Motor information on swallowing 3) BP from aortic arch 4) Salivation from the sublingual glands 5) Salivation from the parotid gland 6) BP from carotid body

Answer 36

1) CN IX 2) IX, X 3) X 4) VII 5) IX 6) IX

Question 37

Which type of collagen abnormal in alport syndrome Alport syndrome

Answer 37

Type IV collagen BM Nephritis and kidney failure Hearing loss Eye problems (cataracts) Can see, cant pee, cant hear high C

Question 38

Which type of collagen abnormal in Classic Ehler Danlos syn Which type in Vascular EDS

Answer 38

Type V and I (Type 1: bone) Type III Type (III: stretchy, blood vessles, uterus)

Question 39

Collagen synthesis 3*

Answer 39

Preprocollagen alpha chains synthesized in rough ER of fibroblast ( glycine-proline- X) or (glycine-x-hydroproline) Hydroxylation of lysine and proline (requires Vit C) Glycosylation of the hydroxylated lysin --> procollagen Exocytosis Cleave terminal regions of procollagen --> Tropocollagen (proteolysis) Crosslink tropocollagen to make collagen fibrils (covalent bond)

Question 40

What is seen in early onset Alz dis vs late onset

Answer 40

Early onset - Presenilin 1 - presenilin 2 - amyloid precursor protein (APP) chr 21 Late onset - Apo E4

Question 41

Dementia w/ Lewy body inclusion

Answer 41

Pinkish eosinophilic cytoplasmic inclusions, made up of protein called alpha-synuclein

Question 42

Inclusions of Tau proteins Atrophy of frontal and temporal lobe Dementia and behavioral changes Dementia and progressive aphagia (inability to understand)

Answer 42

Pick's dis Frontotemporal dementia

Question 43

``` Rapidly progressive dementia Personality changes Muscle spasm Myoclonus Weeks to months ```

Answer 43

Creutzfeldt-Jakob disease Prions aka spongiform encephalopathy

Question 44

Dementia plus 1) Visual hallucinations 2) Progressive aphasia 3) Ataxia & loss pupillary light reflex 4) Megaloblastic anemia and peripheral neuropathy 5) Resting tremor and bradykinesia 6) Uninhibited social behavior 7) Urinary incontinence and magnetic gait 8) Syncopal episodes 9) Dysarthria and liver dis 10) Myoclonus

Answer 44

1) Lewy body dis 2) FTD (Pick) 3) Tertiary syphilis 4) B12 5) LBD or Parkinsons dis 6) FTD (Pick) 7) Normal pressure hydrocephalus 8) Lewy body dis 9) Wilson dis (copper build up) 10) Creutzfeltd-Jakob dis

Question 45

Identify pigment inclusion 1) Herpes simplex 2) Rabies 3) Parkinson dis 4) Assoc w/ aging 5) Dark pigment in substantia nigra and locus coeruleus, not seen in parkinson dis 6) Eosinophilic, rod like seen in hippocampus of Alz pts 7) Diagnostic of Alz dis 8) Filamentous inclusion that stain w/ silver, do not survival neuronal death 9) Filamentous inclusion that stain w/ PAS and ubiquitin

Answer 45

1. Cowdry Type A 2. Negri bodies 3. Lewy body 4. Lipofuscin granules 5. Melanin 6. Hirano bodies 7. Neurofibrillary plaques and tangles 8. Pick bodies 9. Lewy body

Question 46

Dementia work up (5)

Answer 46

``` RPR- syphilis HIV B12 TSH MRI ```

Question 47

Dominant parietal lobe lesion (4) Non-dominant parietal lobe lesion

Answer 47

Gerstman syndrome - agraphia - acalculial - Finger agnosia (inability to distinguish fingers) - L to R disorientation Hemispatial neglet (Ignore c/l side of body)

Question 48

Cholinergic excess pneumonic

Answer 48

DUMBBELSS ``` Diarrhea Urination Miosis Bronchospasm Bradycardia Excitation of skeletal m./ CNS Lacrimination Salivation Sweating ```

Question 49

Ptosis Diplopia Worsens as day goes on

Answer 49

Myasthenia gravis Ab to acetycholine receptor Thymus pathology

Question 50

Nicotinic receptor and Muscarinic receptor are what type of receptor

Answer 50

Nicotonic: Ligand gated Na/K channels Muscarinic: G protein coupled

Question 51

Anxiety is assoc with altered levels of neurotransmitters

Answer 51

Decrease GABA Decrease Serotonin Increase NE

Question 52

Uvela deviates to right, damage to what 2 things

Answer 52

Left vagus n. | Left nucleus ambiguus

Question 53

What beside alpha feto protein is abnormal in fetus with neural tube defect

Answer 53

Increase acetylcholinesterase (amniotic)

Question 54

Patient can not adduct left eye on lateral gaze, convergence is normal What is damaged

Answer 54

Intranuclear opthalmoplegia Medial longitudinal fasciculus

Question 55

Pharyngeal pouches from

Answer 55

Endoderm

Question 56

Sympathetic receptor on vasculature of skeletal m. on heart on lungs

Answer 56

vasculature of skeletal m.: Alpha 1 Beta2 (more) Heart: Beta 1 Lungs: Beta 2

Question 57

alpha 1 alpha 2 Beta 1 Beta 2

Answer 57

Alpha 1: vascular smooth m. contraction - increase resistance and BP - bladder sphincter contraction Alpha 2: Inhibit NE release Beta 1: Heart - Tachycardia - increase contractility - release renin Beta 2: Lungs - Vasodilation - bronchodilation - insulin release - decrease uterine tone

Question 58

Pharyngeal pouches structures

Answer 58

1st pouch: mastoid air cells, middle ear cavity, eustacian tubes 2nd pouch: lining of palatine tonsils 3rd pouch: thymus, inferior parathyroid glands 4th pouch: superior parathyroid glands

Question 59

Structures in cavernous sinus

Answer 59

``` Oculomotor Trochlear n. Abducens Opthalmic div V1 Maxillary div V2 ``` Internal carotid A.

Question 60

Catecholamine synthesis

Answer 60

Phenylalanine (BH4 -> BH2) --> Tyrosine [Phenylalanine hydroxylase] Tyrosine (BH4--> BH2) --> DOPA [Tyrosine hydroxylase) DOPA (Vit B6) --> Dopamine [DOPA decarboxylase] Dopamine (Vit C) --> NE [Dopamine beta-hydroxylase] NE --> EPI [PNMT] (+) Cortisol

Question 61

Cofactors in metabolism of NE

Answer 61

Catechol-o-methyltransferase (COMT) - methylates NE ``` Monoamine oxidase (MAO) - oxidized NE ```

Question 62

Damage to which artery would produce each 1) Bilateral loss of lateral visual fields 2) Broca or wernicke aphasia 3) Unilateral lower extremity sensory and/or motor loss 4) Unilateral facial and upper extremity sensory and motor loss

Answer 62

1) Anterior communicating A. 2) Middle cerebral A. 3) Anterior cerebral A. 4) Middle cerebral A.

Question 63

Diuretic used for idiopathic intracranial HTN

Answer 63

Acetazolamide

Question 64

When does implantation of blastocyst take place

Answer 64

6 days after fertilization

Question 65

Therapeutic index (TI)

Answer 65

LD50/ED50 Lethal dose/ effictive dose Higher the TI safer the drug

Question 66

Low therapeutic index drugs

Answer 66

Some Drugs With Low Therapeutic index ``` Seizure drugs Digoxin Warfarin Lithium Theophylline ```

Question 67

Which regions of the brain compose the limbic system

Answer 67

``` Amygdala Septal nucleus Mamillary bodies Fornix Hippocampus ```

Question 68

What structure grows to close the opening/ canal between the atrial chamber and ventricular chamber into two smaller openings

Answer 68

Superior endocardial cushion Inferior endocardial cushion

Question 69

Aortic arches

Answer 69

Most likely to be test on 3rd and 4th 1st - Part of maxillary A. 2nd - stapedial A. - hyoid A. 3rd - common carotid a. - proximal part of internal carotid A. 4th - Left: arch of adult aorta - Right: Proxiaml part of right subclavian a. 6th - proximal part of pulmonary A. - Ductus arteriosus

Question 70

R to L shunts

Answer 70

1. Persistant Truncus arteriosus 2. Transposition of the great vessels (2 vessels) 3. Tricuspid atresia 4. Tetralogy of Fallot 5. Total anamalous pulmonary venous return

Question 71

Ebstein anomaly

Answer 71

Tricupsid leaflets are displaced into right ventricle Hypoplastic right ventricle Lithium use Widely split S2

Question 72

Tetralogy of Fallot

Answer 72

IHOP Interventriculat septal defect (USD) Hypertrophy of RV Overriding aorta Pulmonic stenosis

Question 73

Boot shaped heart in infant

Answer 73

Tetralogy of fallot

Question 74

Maternal alcohol use can lead to heart defects

Answer 74

Tetralogy of fallot VSD ASD

Question 75

Pregestational diabetes possible heart defect

Answer 75

Transposition of great vessels

Question 76

Congenital Rubella possible heart defect

Answer 76

PDA | Pulmonary artery stenosis

Question 77

DiGeorge syndrome possibe heart defect

Answer 77

Tetralogy of fallot | Truncus arteriosus

Question 78

Turner syndrome possible heart defect

Answer 78

Coarctation of the aorta | Bicuspid aortic valve

Question 79

Trisomy 21 possible heart defect

Answer 79

ASD or VSD

Question 80

Most common congenital cardiac anomaly

Answer 80

VSD

Question 81

Most common congenital cause of early cyanosis

Answer 81

Tetralogy of Fallot

Question 82

Rib notching heart defect

Answer 82

Coarctation of aorta

Question 83

Enzymes involved in catabolism of NE

Answer 83

``` Catechol-o-methyltransferase (COMT) Monoamine oxidase (MAO) ```

Question 84

Cardiac output is equal to

Answer 84

Stroke vol (SV) x HR

Question 85

Stroke vol is equal to

Answer 85

End-diastolic vol minus end-systolic vol

Question 86

Fick Principle

Answer 86

CO= Rate of O2 consumption/ arterial O2 content- venous O2 content

Question 87

Mean arterial pressure (P) =

Answer 87

MAP = Cardiac output (Q) x Peripheral resistance (R) P= QxR MAP= 2/3 diastolic pressure + 1/3 systolic pressure

Question 88

Pulse pressure =

Answer 88

systolic pressure - diastolic pressure The higher the stroke volume the higher the pulse pressure

Question 89

Digoxin does what

Answer 89

Increase contractility

Question 90

Ejection fraction (EF) =

Answer 90

SV/ EDV

Question 91

CHF does what to capillary hydrostatic pressure (Pc)

Answer 91

Increases it

Question 92

Liver disease does what to starling forces

Answer 92

Decreases plasma colloid osmotic pressure

Question 93

What increased interstitial colloid osmotic pressure

Answer 93

Lymphatic obstruction

Question 94

Affect on starling forces 1. HF 2. Liver failure 3. Oliguric renal failure 4. Infections 5. Nephrotic syndrome 6. Lymphatic blockage 7. Burns 8. Diuretic administration 9. IV infusion of albumin 10. Venous insufficiency

Answer 94

1. HF= Increase Pc 2. Liver failure= Decrease TTc 3. Oliguric renal failure= Increase Pc 4. Infections= Increase Kf 5. Nephrotic syndrome= Decrease TTc 6. Lymphatic blockage= Increase TTi 7. Burns= Increase Kf 8. Diuretic administration= Decrease Pc 9. IV infusion of albumin= Increase TTc 10. Venous insufficiency= Increase Pc

Question 95

Drug causes eye dilation

Answer 95

Anticholinergic | Atropine

Question 96

Wide splitting of S2

Answer 96

Wider on inspiration Pulmonic stenosis RBBB

Question 97

Fixed splitting of S2

Answer 97

Split on both inspiration and expiration equally atrial septal defect

Question 98

Paradoxical splitting of S2

Answer 98

Split on expiration Aortic stenosis LBBB

Question 99

Which heart sound is associated with dilated congestive heart failure

Answer 99

S3 Mitral regurg L To R shunt

Question 100

Which heart sound is associated with chronic HTN

Answer 100

S4 Hypertrophic cardiomyopathy Aortic stenosis LV hypertrophy Post MI

Question 101

Inspiration makes what murmur louder

Answer 101

Tricuspid

Question 102

What murmur is louder with expiration

Answer 102

Mitral

Question 103

Hang Grip makes what murmur louder

Answer 103

Most quieter except Hypertrophic cardiomyopathy

Question 104

Bounding pulses, head bobbing, diastolic murmur

Answer 104

Aortic regurg

Question 105

Underlying mechanism of organophosphate poisoning

Answer 105

Inhibit acetylcholinesterase

Question 106

MOA of N-acetylcysteine for acetaminophen overdose

Answer 106

Regenerates glutathione

Question 107

Equation for 1/2 life

Answer 107

T1/2= (0.7 x VD)/ CL

Question 108

What two antibodies most useful in diagnosing rheumatoid arthritis

Answer 108

Rheumatoid factor | Anti-citrullinated protein Ab

Question 109

How do NSAIDS cause renal disease

Answer 109

Block prostaglandin Syn | Constrict renal vessels

Question 110

Epidermis pneumonic

Answer 110

Come Lets Get Sun Burnt ``` Corneum Lucideum Granulosum Spinosum (only palms and soles) Basale ```

Question 111

Components of Zona Occludens

Answer 111

TIght junction Claudins Occludin

Question 112

Components of Zona adherens

Answer 112

Bridge to skeleton | E-cadherin actin

Question 113

Components of Macula adherens

Answer 113

Desmosomes, resist shearing forces Simple/ stratified squamous epithelium Desmoglein

Question 114

Components of Gap junctions

Answer 114

Cardiac cells Connexon

Question 115

Components of Hemidesmosomes

Answer 115

Connect to BM Integrins

Question 116

Auer rods

Answer 116

AML 15;17

Question 117

15;17

Answer 117

AML

Question 118

8;14

Answer 118

Burkitt lymphoma Starry sky Basophilic cytopasms containing prominenet lipid vacuoles

Question 119

9;22

Answer 119

CML Blood smear shows leukocytosis with many immature myeloid cells (horseshoe nucleus)

Question 120

12;21

Answer 120

B cell- ALL Anemia Thrombocytopenia Lymphoblasts

Question 121

14;18

Answer 121

Follicular lymphoma

Question 122

Firm flesh color papules on face with umbilicated center is

Answer 122

Molluscum contagiosum from Pox virus See Molluscum bodies: eosinophilic cytoplasmic inclusions

Question 123

Ballooning multinucleated giant cells

Answer 123

Herpes simplex Enlarged cells w/ intranuclear inclusions, cell fusion produc giant cells

Question 124

Basaloid cells with peripheral palisading nuclei

Answer 124

Basal cell carcinoma Slow growing papules, ulceration or rolled border

Question 125

Cells with enlarged nuclei and perinuclear halos

Answer 125

Veruca vulgaris due to HPV

Question 126

Encapsulated round yeast forms

Answer 126

Cryptococcus neoformans cerebrospinal fluid shows budding encapsulated yeast

Question 127

What is at risk with an anterior/ posterior knee displaccement

Answer 127

Popliteal artery

Question 128

What is commonly damaged by blunt trauma of lateral knee, vessel

Answer 128

Common peroneal nerve

Question 129

Concentrations of fluids within - Ileum - Pancreas - Salivary gland - Sweat gland

Answer 129

Ileum - Alkaline - bicarb > Cl - increase K Pancreas - bicarb and chloride change with flow rate - high flow: high bicarb low Cl - low flow: low bicarb high Cl - fixed Na and K concentration Salivary gland - isotonic solution - Lower [Na] [Cl] - Higher [K] Eccrine glands - hypotonic - composed of sodium chloride, some potassium - minimal bicarb

Question 130

Acute stress disorder become PTSD

Answer 130

> 1 month

Question 131

Cerebellar degeneration vs cobalamin deficiency

Answer 131

Cerebellar degeneration - tremors - gait impairment Cobalamin deficiency - Decreased vibration sensation - Gait impairment - Positive Babinski - Hyperactive/ hypo reflexes

Question 132

Difficulty chewing Double vision Ptosis Associated with

Answer 132

Myasthenia gravis Associated with thymic hyperplasia

Question 133

Loss of heterozygosity

Answer 133

Inherits one mutation and must develop the second one for tumor to form

Question 134

Defective DNA repair

Answer 134

Xeroderma pigmentosum

Question 135

Parental imprinting

Answer 135

Prader-Willi | Angelmann syndromes

Question 136

Blue green image

Answer 136

potassium hydroxide (KOH) mount Fungi

Question 137

Low CD3 | Normal B cells

Answer 137

Di George

Question 138

Allelic heterogeneity

Answer 138

Multiple genes same phenotype

Question 139

Hereditary hemochromatosis

Answer 139

AR Excessive absorption of iron ``` Hyperpigmentation (bronze diabetes) Arthalgia, arthropathy Hepatomegaly DM Progressive weakening Dry mouth Hypogonadism (small testes) ```

Question 140

COL1A1 mutation

Answer 140

Osteogenesis imperfecta Type I collagen Short stature Blue sclerae

Question 141

Infant suffering from recurrent infections, abnormal gene for cytoplasmic tyrosine kinase

Answer 141

Bruton aggammaglobulinemia Bruton's tyrosine kinase (BTK) X linked

Question 142

Genetic mutations chromosome 7

Answer 142

Cystic fibrosis Ehlers Danlos Osteogenesis imperfecta

Question 143

Genetic mutations chromosome 16

Answer 143

Polycystic kidney disease | Tuberous sclerosis

Question 144

Increase in branched chain alpha-keto acid What can also be deficent

Answer 144

Maple syrup urine disease Alpha ketoacid dehydrogenase require thaimine pyrophosphate (Vit B1) as coenzyme

Question 145

Pyridoxine order to go with

Answer 145

Isoniazid

Question 146

Previous MI Crampy abdominal pain Blood in stool Elderly

Answer 146

Ischemic colitis Mucosal hemorrhage and patchy areas of necrosis

Question 147

Not eating for days Low ketones Vomiting and lethargy

Answer 147

Medium-chain acyl-CoA dehydrogenase deficiency Hypoketotic hypoglycemia

Question 148

Glucose 6 phosphatase deficiency

Answer 148

Von Gierke disease

Question 149

Glycogen phosphorylase deficiency

Answer 149

McArdle

Question 150

Warfarin with CYP 450 inducer leads to what Vmax and KM

Answer 150

Warfarin metabolism increased | Increased V max

Question 151

Chromogranin

Answer 151

Carcinoid tumor Secretes serotonin

Question 152

Diabetes medications 1. Acarbose 2. Canagliflozin 3. Glyburide 4. Pioglitazone 5. Repaglinide

Answer 152

Acarbose -intestinal brush border alpha glucosidase inhibitor decreases postprandial hyperglycemia by reducing GI absorption of glucose Canagliflozin - sodium glucose cotransporter 2 inhibitors, act on kidney to decrease reabsorption of filtered glucose Glyburide (sulfonylureas) and Meglitinides (repaglinide) - bind to and close ATP sensitive K channels in pancreatic beta membrane - depolarize and open L type Ca channel - Increase Ca influx, insulin release Pioglitazone (Thiazolidinediones) peroxisome proliferator-activated receptor gamma (PPAR-y) - decrease insulin resistance - expression glut 4 - adiponectin

Question 153

Celiac disease location

Answer 153

Distal duodenum | Proximal jejunum

Question 154

Chronic diarrhea Drainage of abscess Erythema near perineum

Answer 154

Crohns terminal ileum

Question 155

Abnormal formation of lamellar bone is seen in

Answer 155

Paget disease of bone

Question 156

Autosomal dominant cancer mutations disease

Answer 156

``` Lynch syndrome Familial adenomatous polyposis VHL Li-Fraumeni MEN1/2 ```

Question 157

Laryngeal nerves | -Internal laryngeal supplies

Answer 157

Internal laryngeal: Supraglottic External laryngeal: cricothyroid L. recurrent laryngeal: posterior cricoarytenoid, lateral cricoarythenoid, oblique arytenoid, transverse arytenoid, thyroarytenoid

Question 158

DNA virus

Answer 158

Papillomaviruses | Poxviruses (replicates in cytosol)

Question 159

Acute onset anemia Evidence of hemolysis (icterus, elevated reticulocyte count) Tx w/ TMP-SMX

Answer 159

G6pD deficiency Erythrocyte enzyme deficiency

Question 160

Unmyelinated nerve fibers

Answer 160

Post ganglionic autonomic nervous system axons

Question 161

Positive sense ssRNA virus 1) Meningitis 2) common cold

Answer 161

Picornavirus Coronoavirus- cold

Question 162

negative sense ssRNA virus

Answer 162

Arenavirus- hemorrhagic fever

Question 163

Prader Willi syndrome

Answer 163

Loss of paternally inherited allele ``` Tantrums Excessive food seeking Obesity Small hands Short stature Hypogonadism Intellectual disability ```

Question 164

Tantrums Excessive food seeking behavior Obesity Small hands

Answer 164

Prader Willi syndrome Loss of paternally inherited allele

Question 165

Angelmann syndrome

Answer 165

Loss of maternal allele Epilepsy/ seizures Ataxic gait Innappropraite laughter/ smiling

Question 166

Cobblestone mucosa

Answer 166

Crohns disease

Question 167

Aggressive biting fingers, tongue and lips

Answer 167

Hypoxanthine-guanine phosphoribosyltransferase deficiency (HGPRT) Lesch-Nyhan syndrome X linked recessive

Question 168

Stroke blindness

Answer 168

Homonymous hemianopsia

Question 169

acanthosis nigrcans associated iwth

Answer 169

velvety hyper pigmented plaques on the skin in axillae and neck insulin resistance GI malignancy

Question 170

Cystic fibrosis type of mutation

Answer 170

Frame shift

Question 171

Hyperflexible joints | Stretchy skin

Answer 171

Ehlers danlos Collagen defect

Question 172

Drug A. Absolute risk reduction for drug A versus standard therapy 4%. The incidence of recurrent PE in standard therapy group was 6%. There were 24 pts who developed recurrent PE in drug A group. How many total subjects in drug A group?

Answer 172

ARR= ER control- ER treatment (Event rate) 0.4= 0.6- x ER treatment= 0.2 ER treatment= Number of events/ number of subjects 0.2= 24/ number of subjects =1200

Question 173

IFN-y fxn

Answer 173

activates macrophages | promotes TH1 differentiation

Question 174

IL-4

Answer 174

produced by TH2 | activates B cells

Question 175

Stimulates neutrophil migration to sites of inflammation

Answer 175

Leukotriene B4

Question 176

Acute pancreatitis is due to activation of waht

Answer 176

Trypsin

Question 177

Elastin composition

Answer 177

Nonpolar aminoacids Not hydroxylated Lysyl oxidase copper-dep enzyme oxidatively deaminates lysine residues of tropoelastin, facilitating desmosine cross links [Collagen synthesis - Disulfide bridges - post translational hydroxylation - triple helix assembly]

Question 178

Reverse T3 (rT3)

Answer 178

inactive form of T3 generated by entirely from the peripheral conversion of T4

Question 179

Diphtheria toxin and Exotoxin A (pseudomonas)

Answer 179

Inactivates EF-2 vis ribosylation, thus inhibiting host cell rpotein synthesis

Question 180

Tc-pertechnetate scan

Answer 180

Meckel diverticulum Failed obliterationo fthe vitelline duct

Question 181

Promotor regions -disrupted

Answer 181

CAAT TATA - Prevent initiation of transcription

Question 182

Palpitations Tachycardia Irregularly irregular rhythm

Answer 182

Atrial fibrillation No P waves

Question 183

Neutralizes reactive oxygen species

Answer 183

Superoxide dismutase

Question 184

Kidney biopsy | Green straight lines

Answer 184

Anti-glomerular basement membrane disease (Goodpasture dis) Collagen IV Seen glomerular crescents

Question 185

Origin of melanoma

Answer 185

Neural crest

Question 186

Receptor of T cells to identify tumor cells and induce apoptosis

Answer 186

Programmed death ligand 1 (PD-1)

Question 187

Yellow nodules on palmar creases. Father has MI at 56. Accumulation of lipid laden macrophages Lack of ApoE3 and ApoE4. What is impaired?

Answer 187

Familial dysbetalipoproteinemia AR -defect in ApoE Impaired chylomicron remnant uptake by liver cells Accumulation cholestesrol and triglyceride levels

Question 188

Hyperlipoproteinemias types

Answer 188

Type I (AR) - Familial chylomicroenemia - Defect: Lipoprotein lipase - Defect: ApoC-2 production - Elevated chylomicrons - Acute pancreatitits*, Lipemia retinalis, eruptive xanthomas ``` Type IIA - Familial hypercholesterolemia - Defect: LDL receptor - Defect: ApoB-100 - Elevated LDL* (Impaired LDL particle uptake by hepatocytes) -Premature atherosclerosis* - Tendon xanthomas, xanthelasmas (yellow deposit around eyes) ``` Type III - Familial dysbetalipoproteinemia - Defect ApoE - Elevated: chylomicron & VLDL remnants - Premature atherosclerosis* - Tuboeruptive and palmar xanthomas Type IV - Familial hypertriglyceridemia - Defect Polygenic - Elevated VLDL - Associated with coronary disease, pancreatitis and diabets

Question 189

Defect in Fibrillin-1

Answer 189

Marfan ``` Microfibrils Blood vessels (aorta) Long thin extremities long fingers Aortic root dilation ```

Question 190

Vit D overdose similar to what condition

Answer 190

Sarcoidosis, Tb Have PTH independent conversion due to expression of 1-alpha-hydroxylse in activated macrophages

Question 191

Oculomotor (CN III) palsy secondary to a compressive aneurysm located where

Answer 191

Posterior communicating artery

Question 192

Bronchiolitis

Answer 192

Rhinorrhea and congestion Followed by cough, low grade fever and increased work of breathing

Question 193

Repetitive vomiting leads to what acid-base disturbance

Answer 193

Metabolic alkalosis

Question 194

Conjunctival injection

Answer 194

Red eyes

Question 195

Glucagon mediator responsible for decrease glycogen stores adn glucose

Answer 195

Gs Adenylate cyclase Protein kinase A

Question 196

Insulin resistance leads to increase in waht

Answer 196

Free fatty acid level

Question 197

How to measure mean arterial pressure

Answer 197

placing an arterial catheter directly in central arterial circulation (common femoral or radial artery) and reflects the average aortic pressure

Question 198

Measuring pressure in pulmonary artery is also measuring pressure where?

Answer 198

Left atrial pressure

Question 199

Ammonium and bicarbonate generated from AA Urea and ornithine produced from pyruvate produced from AA oxaloacetate produced from AA

Answer 199

glutamine arginine Alanine aspartate

Question 200

Lymphatic drainage Testis glans penis Upper 2/3 vagina, uterus, cervix, prostate Lower 1/2 vagina, vulva, scrotum

Answer 200

Testis: para-aortic Glans penis: deep inguinal nodes Upper 2/3 vagina, uterus, cervix, prostate: External iliac nodes, internal iliac nodes Lower 1/2 vagina, vulva, Scrotom: superficial inguinal nodes

Question 201

Broad, nonseptate hyphae that branch at wide 90 angles

Answer 201

Mucor Rhizopus Absidia

Question 202

Immediate hypersensitivity txn

Answer 202

Type 1 Cell surface bound antibody bridging by antigen

Question 203

Three primary ketones

Answer 203

Acetoacetate Beta-hydroxybutyrate (BHB) Beta-hydroxybutyric acid

Question 204

Septic aborption organisms

Answer 204

Staph aureus Ecoli Group B strep

Question 205

Intellectual disability Hx of seizures Abnormal pallor of substantia nigra, locus ceruleus and vagal nucleus dorsalia

Answer 205

Phenylalanine hydroxylase deficiency PKU Cant convert phenylalaine to tyrosine

Question 206

Tennis racquet granules

Answer 206

Langerhan cells

Question 207

9 month old 2 minute general seizures Fever 3 days later afebrile Maculopapular rash on trunk

Answer 207

Human herpesvirus 6

Question 208

Exertional dyspnea Easy fatigue Gait unstable when eyes closed Impaired vibratory sensation of lower extremiteis Marked pallor of conjunctivae, nail beds and palms

Answer 208

Vit B 12 deficency Co factor for methylmalonyl-CoA Elevated Serum methylmalonic acid and homocysteine

Question 209

Increased intracranial pressure in infant

Answer 209

Intracranial hemorrhage due to vit K deficiency Impaired clotting factor carboxylation

Question 210

Acute compartment syndrome (ACS) affects what in the leg

Answer 210

Foot extensors Anterior tibial A. Deep peroneal (Fibular) nerve

Question 211

Pleiotrophy

Answer 211

One mutation multiple things wrong w/ person

Question 212

Power of the study?

Answer 212

1- beta beta= type II error, probability to conducting there is no difference

Question 213

MHC to CD8 composed of

Answer 213

``` MHC class I beta microglobulin ```

Question 214

MCH to CD4 composed of

Answer 214

MHC class II alpha and beta chains

Question 215

Hepatitis B C D vs A E

Answer 215

BCD transmitter parenterally (IV, blood) AE: fecal oral

Question 216

Hepatitis pregnant women

Answer 216

Hep E unenveloped ssRNA

Question 217

Takes place in cytosol vs mitochondria

Answer 217

Cytosol - Glycolysis - FA synthesis - Pentose phosphate pathway Mitochondria - beta oxidation of fatty acids - citric acid cycle carboxylation of pyruvate (gluconeogenesis)

Question 218

Interferon alpha and beta do what

Answer 218

halt protein synthesis Only works on dsDNA

Question 219

Sorbitol conversion

Answer 219

Sorbitol -- sorbitol dehydrogenease --> fructose

Question 220

Start codon

Answer 220

AUG

Question 221

Stop codon

Answer 221

UAA UAG UGA

Question 222

OCD tx

Answer 222

SSRI

Question 223

``` Fever myalgia Profound fatigue Swollen LN in neck and behind ears Lymphocytosis Splenomegaly ```

Answer 223

EBV transferred vis kissing

Question 224

Splenomegaly South asia Anemia thrombocytopenia

Answer 224

Malaria

Question 225

Splenomegaly South asia Progressive splenic enlargement WL over months

Answer 225

Leishmaniasis

Question 226

scabes tx

Answer 226

topical permethrin

Question 227

Tx for staph aureus cellulitis

Answer 227

Topical mupirocin

Question 228

Anemia Hypercoagulability Pancytopenia

Answer 228

Paroxysmal nocturnal hemoglobinuria (PNH) Mutation PIGA Deficiency: glycosylphosphatidylinositol (GPI) anchor Deficiency: CD55 CD59

Question 229

Positive VDRL w/ vulvar lesion

Answer 229

Tertiarty syphilis Gumma

Question 230

Tx Manic depression

Answer 230

Valproic acid Lithium Carbamazepine

Question 231

Tx w/ antibiotic Proteinuria Hematuria

Answer 231

Acute poststreptococcal glomerulonephritis

Question 232

HTN Hematuria Proteinuria

Answer 232

Nephritic syndrome

Question 233

Breast dimpling signals involvement of

Answer 233

Suspensory ligaments

Question 234

HTN HA Adrenal mass

Answer 234

Pheochromocytomas From Neural crest

Question 235

Narcolepsy caused by

Answer 235

hypocretin-1 | hypocretin-2

Question 236

Elevated 14-3-3 protein CSF

Answer 236

Creutz-jakob Prions

Question 237

Temporal lobe encephalitis

Answer 237

Herpes simplex virus Tx acyclovir - effects viral DNA polymerase

Question 238

Meningitis w/ increased protein and normal glucose

Answer 238

Viral

Question 239

Meningitis w/ low glucose and elevated protein

Answer 239

Bacterial

Question 240

CHF leads to increase in what force

Answer 240

Capillary hydrostatic pressure (Pc)

Question 241

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

Answer 241

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

Question 242

Metastatic bone pneumonic

Answer 242

Permanently Relocated Tumors That Like Bones ``` Prostate Renal cell cancer Testes Thyroid Lung Breast ```

Question 243

Osteopetrosis due to deficient

Answer 243

Carbonic anhydrase II

Question 244

Polyostotic Fibrous dysplasia associated with

Answer 244

Bone replaced by collagen and fibroblast Assoc with McCune Albright syn - Precocious puberty - Cafe au lait - Fibrous dysplasia bone

Question 245

Precocious puberty Cafe au lait spots Fibrous dysplasia bone

Answer 245

McCune albright syndrome

Question 246

unhappy Triad

Answer 246

Anterior cruciate lig Medial cruciate lig Lateral/ medial meniscus

Question 247

Ankle sprain (3)

Answer 247

Anterior talofibular lig Calcaneofibular lig Posterior talofibular lig

Question 248

What structures damaged in anterior shoulder dislocation

Answer 248

Axillary n. Posterior circumflex artery Supraspinatus tendon Anterior glenohumoral ligaments

Question 249

What is damaged with posterior dislocation of the hip

Answer 249

Medial and lateral circumflex femoral a. Femoral v Sciatic nerve Head of femur

Question 250

Polymyositis

Answer 250

Inflammatory muscle disease Proximal muscle weakness CD8 t cells induced injury to muscle fibers Increase Ck and aldolase

Question 251

Fibromyalgia

Answer 251

Excess tenderness at 11 of 18 sites Fatigue Tx. Pregabalin, milnacipran

Question 252

Duchenne muscular dystrophy

Answer 252

X linked frame shift mutation Absent Dystrophin gene INcreased creatine kinase

Question 253

Becker muscular dystrophy

Answer 253

Inframe shift mutation Mutated dystrophin gene

Question 254

Polymyalgia rheumatica

Answer 254

Joint pain Stiffness in proximal joints Malaise, fever, WL No weakness Tx prednisone

Question 255

S-100 tumor marker

Answer 255

Melanoma

Question 256

Melanoma histologically

Answer 256

Nests of melanocytes that fill dermis and obsecure epithelial dermal junction

Question 257

Albinism due to

Answer 257

Lack of melanin pigment due to lack of tyrosinase enzyme

Question 258

Vitillago due to

Answer 258

Decreased number of melanocytes

Question 259

Melasma

Answer 259

Dark discoloration common in pregnant women those take OCPs or hormone replacement Patchy cheeks or lip Due to stimulation of melanocytes by estrogen and progesterone

Question 260

Cellulitis organisms looks like

Answer 260

Staph. aureus Strep pyogenes Painful and tender to touch rapidly spreads

Question 261

cellulitis tx - MRSA - non-MRSA

Answer 261

Non-MRSA( no abscess) - oral dicloxacillin, cephalexin MRSA: - oral trimethoprim/sulfamethoxazole - clindamycin

Question 262

Necrotizing fasciitis organism Tx

Answer 262

Strep. pyogenes Anaerobic bacteria Tx: Debridement IV carbapenem clindamycin

Question 263

Painful flaccid blister biopsy shows Ab against test unique feature

Answer 263

Pemphigus vulgaris acantholysis Ab desmosomes Positive Nikolsky sign oral lesions

Question 264

Tight raised blister

Answer 264

Bullous pemphigoid Ab to hemidesmosomes Eosinophils within blister Negative nikolsky no oral lesion

Question 265

Blister IgA in tips of dermal papillae

Answer 265

Dermatitis herpetiformis assoc w/ celiac

Question 266

Erythema multiforme

Answer 266

Deposition of immune complexes Following infection or drug exposure Target lesions

Question 267

Pruritic, purple, polygonal papules and plaques - microscopically see - assoc with

Answer 267

Lichen planus Sawtooth pattern at dermal-epidermal junction Hepatitis C

Question 268

Acanthosis nigricans - hyperplasia of - assoc w/

Answer 268

velvety hyperpigmentation of skin Stratum spinosum Hyperinsulinemia and visceral malignancies

Question 269

Erythema nodosum assoc with

Answer 269

Sarcoidosis, histoplasmosis, Tb, leprsy

Question 270

Pruritic vesicles associated with celiac disease

Answer 270

Dermatitis herpetiformis

Question 271

Ligaments of ovaries/ uterus w/ vessels

Answer 271

Cardinal ligament - uterine vessels Cervix to pelvic sidewall Infundibulopelvic ligament (suspensory lig of ovary) - ovarian vessels - ovary to pelvic side wal Broad ligament - uterus, fallopian tubes, and ovaries to pelvic wall - contain ovarian lig, round lig, and suspensory lig of ovary

Question 272

Ligaments of ovaries/ uterus with no vessels

Answer 272

Round ligament of uterus - gubernaculum - uterus thorugh inguinal canal to labia majorum Ovarian ligament - ovary to uterus - gubernaculum

Question 273

Nerves damaged w/ prostatectomy --> erectile dysfunction Release Leads to

Answer 273

Cavernous n. release NO (vasodilation) Increase cGMP Decrease Ca

Question 274

Nervous system components of male sexual response

Answer 274

Erection (point) - parasym Emission & ejaculation (shoot) - sympathetic

Question 275

R ovarian/ testis vein drain to

Answer 275

R gonadal v to IVC

Question 276

L ovarian/ testis vein drin to

Answer 276

L gonadal v. to L. renal vein --> IVC

Question 277

Indirect inguinal hernia Direct inguinal hernia

Answer 277

Indirect inguinal hernia - Most common - Congenital due to failure of closure of processus vaginalis - Protrude through deep inguinal ring, lateral to inferior epigastric vessels and pass through inguinal canal Direct inguinal hernia - Weakening of abdominal wall in Hesselbach's triangle - Increase pressure heavy lifting - Directly through abdominal wall medial to inferior epigastric vessel, exit out superficial inguinal ring

Question 278

Hesselbach's triangle

Answer 278

Inguinal lig Inferior epigastric vessel Lateral border of rectus abdominis

Question 279

Mitral regurg vs Aortic regurg

Answer 279

Mitral regurg - Left lateral decubitis best heard - Enhanced w/ squatting - Expiration - Holosystolic Aortic regurg - Widening of pulse pressure - Diastolic - Decrescendo

Question 280

Epispadias associated with

Answer 280

opening of penis on dorsal surface (top) Exstrophy of bladder - exposure of bladder interior to the outside world

Question 281

Male reproductive development process

Answer 281

Mesonephric duct SRY gene on Y chromosome Produce testis-determining factor -Induces gonad differentaition - Develop of two cells types Sertoli - Produce Mullerian inhibitor factor - Paramesonephric duct degenerates Leydig cells - Produce testosterone - Mesonephric duct --> internal male (but not prostate)

Question 282

What induces urogenital sinus and genital tubercle to become male external genitalia

Answer 282

DHT

Question 283

Paramesonephric duct forms

Answer 283

Fallopian tube, uterus and upper portion of vagina

Question 284

What forms the lower portion of the vagina

Answer 284

Urogenital sinus --> sinovaginal bulbs --> lower vagina

Question 285

Genital homologs 1) Glans penis 2) Corpus spongiosum and corpus cavernosum 3) Bulbourethral (Cowper) glas 4) Prostate gland 5) Ventral shaft of penis 6) Scrotum

Answer 285

1) Glans penis= glans clitoris 2) Corpus spongiosum and corpus cavernosum= vestibular bulbs 3) Bulbourethral (Cowper) glands= Greater vestibular (Bartholin) glands 4) Prostate gland= Urethral and paraurethral (skene) glands 5) Ventral shaft of penis= Labia minora 6) Scrotum= Labia majora

Question 286

Genital homologs 1) Glans clitoris 2) Vestibular bulbs 3) Greater vestibular (Bartholin) glands 4) Urethral and paraurethral (skene) glands 5) Labia minora 6) Labia majora

Answer 286

1) Glans penis= glans clitoris 2) Corpus spongiosum and corpus cavernosum= vestibular bulbs 3) Bulbourethral (Cowper) glands= Greater vestibular (Bartholin) glands 4) Prostate gland= Urethral and paraurethral (skene) glands 5) Ventral shaft of penis= Labia minora 6) Scrotum= Labia majora

Question 287

Gubernaculum and Processus vaginalis in males and females

Answer 287

Males - Gubernaculum: anchors testes to scrotum - Processus vaginalis: forms tunica vaginalis Females - Gubernaculum: becomes ovarian ligament and round ligament of uterus (anchors uterus to labia majora) - Processus vaginalia: obliterated

Question 288

Sertoli cells stimulated by | secrete (3)

Answer 288

Anti-mullerian hormone Inhibin (FSH feedback) Androgen binding protein - maintain levels testosterone - helps mature spermatocytes

Question 289

Leydig cells - located - stimulated by - secretes

Answer 289

Interstitium LH Secretes testosterone

Question 290

Amenorrhea | Loss of smell

Answer 290

Kallman syndrome Defect of X linked KAL chain Decrease GnRH --> Low LH and FSH

Question 291

Redness swelling and tenderness of scrotom relieved by support of the testes - Organisms - Tx

Answer 291

Epididymitis GC/Chlamydia Anal: E coli GC/Chlamydia: Ceftrixone (IM) then doxycycline Ecoli: Fluoroquinolone

Question 292

Lesions on penis Gray, solitary, crusty plaque on the penile shaft or scrotum Red, velvety plaque involving the glans of the penis Multiple papular lesions, not invasive

Answer 292

Bowen disease - progress to invasive SCC Erythroplasia of Queyrat - the tip of the penis Bowenoid papulosis -affects younger individuals

Question 293

95% of penile cancers

Answer 293

SCC assoc w/ HPV

Question 294

Peyronie disease

Answer 294

Angulation of penis Leading to painful erections Inflammation of tunica albuginea

Question 295

Priapism Lead to assoc w/

Answer 295

Persistent penile erection Ischemia and clotting of blood retained in penis Assoc w/ sickle cell disease and spinal cord injuries

Question 296

Balanitis - organism - more common

Answer 296

Inflammation of glans penis Candida Uncircumcised Diabetes

Question 297

Prostatitis - Organism - Tx

Answer 297

<35: Gonorrhea, Chlamydia >35: E coli, klebsiella, serratia, enterobacter, proteus Tx: Fluoroquinolone (levofloxacin), TMP-SMX

Question 298

Estradiol Estrone Estriol

Answer 298

Estradiol - Most potent estrogen - Produced ovaries - need both granulosa and theca cells to produce Estrone - aromatase conversion - adipose tissue Estriol - produced by placenta - weakest

Question 299

hCG - fxn - alpha and beta subunit

Answer 299

Prevents degradation of corpus luteum Shares alpha subunit with LH, FSH, and TSH Beta subunit specific for hCG - detectable in blood 1 wk - detectable in urine 2 wk

Question 300

Prolactin vs oxytocin

Answer 300

Prolactin - milk production Oxytocin - milk ejection (letdown)

Question 301

Menopause - definition - labs

Answer 301

12 months of amenorrhea Decrease estradiol Decrease Inhibin Increase GnRH, LH, FSH Estrone is predominant, aromatase still working

Question 302

Byproducts of MAO and COMT enzymatic activity of dopamine, NE, Epinephrine

Answer 302

Dopamine --> homovanillic acid (HVA) NE --> Vanillylmandelic acid (VMA) Epi --> Metanephrine

Question 303

Smooth white plaques on vulva Parchment paper Fusion of labia majora and minora - due to - tx - risk of

Answer 303

Lichen sclerosus Thinning of epidermis Corticosteroids SCC of vulva

Question 304

Koilocytosis

Answer 304

Enlarged nuclei and perinuclear halo Fried egg Seminoma Dysgerminioma HPV

Question 305

Vaginal tumors (3)

Answer 305

SCC ``` Clear cell adenocarcinoma - DES exposure - T shaped uterus - Vaginal adenosis (patches of columnar epithelium on ectocervix and vagina) ``` Sarcoma botryoides (Embryonal rhabdomyosarcoma) - infants, <5 y.o - bunch of grapes out of vagina

Question 306

HPV 16 and 18 MOA

Answer 306

E6 binds p53 --> degradation | E7 binds Rb and inactivates

Question 307

Post coidal bleeding | Pelvic or low back pain

Answer 307

Cervical cancer Lesion on surface of cervix

Question 308

Bunch of grapes growing out of vagina

Answer 308

Sarcoma botryoides Embryonal rhabdomyosarcoma

Question 309

T shaped uterus | Patches of columnar epithelium on ectocervix and vagina

Answer 309

(Vaginal adenosis) Clear cell adenocarcinoma due to DES exposure

Question 310

Cervical cancer presentation

Answer 310

abnormal vaginal bleeding - post coidal Vaginal discharge Pelvic or low back pain Bowel or bladder symptoms Ureteral obstruction - Pyelonephritis - uremia

Question 311

Endometrium layers | Which are shed

Answer 311

Stratum compactum Stratum spongiosum Stratum basalis Basalis only one not shed Stratum functionalis - Stratum compactum - Stratum basalis

Question 312

Endometritis - what cells do you see in endometirum - tx

Answer 312

Plasma cells Broad spectrum Ab Post partum - Gentamicin + clindamycin

Question 313

Adenomyosis

Answer 313

Endometrial tissue extends into myometrium enlarged globular uterus tender to palpation

Question 314

Whorled pattern

Answer 314

Leiomyomas

Question 315

Nontender enlarged uterus | Infertility

Answer 315

Leiomyomas

Question 316

Rapidly enlarging uterus -from

Answer 316

Leiomyosarcoma Rare malignant Denovo from myometrium

Question 317

Dermoid cyst aka

Answer 317

Benign cystic teratoma

Question 318

String of pearls

Answer 318

PCOS

Question 319

PCOS symptoms - also see (3)

Answer 319

Need 2 of 3 Anovulation/ Oligoovulation - menstrual irregular - infertility Hyperandrogenism - acne - hirsuitism (hair on face) Polycystic ovarian on US ALso see - Obesity - insulin resistance - increased risk endometrial hyperplasia

Question 320

Midcycle pelvic pain associated with ovulation

Answer 320

Mittelschmerz

Question 321

Ascites in otherwise healthy female think

Answer 321

ovarian carcinoma

Question 322

Ovarian tumor | Psamomma bodies

Answer 322

Serous tumor

Question 323

Abundant mucinous ascites

Answer 323

appendical cancer

Question 324

Brenner tumor

Answer 324

Benign ovarian tumor | Urinary tract like epithelium

Question 325

Struma ovarii

Answer 325

Teratoma contains functional thyroid tissue --> hyperthyroidism

Question 326

Rosettes of tumor cells surrounding eosinophilic spaces

Answer 326

Call- Exner body Granulosa cell tumors yellow produce estrogen

Question 327

Meigs syndrome

Answer 327

Ovarian tumor Ascites Pleural effusion

Question 328

SIgnet ring cells

Answer 328

FIlled w/ mucin Pushes nucleus to periphery Metastatic gastric adenocarcinoma to bilateral ovaries Krukenberg tumor

Question 329

Swollen hydropic villi | Snow strom appearance

Answer 329

Hydatidiform mole

Question 330

Hydatidiform mole hallmarks

Answer 330

Swollen hydropic villi Look like grape clusters US: Snowstorm appearance

Question 331

Bloody brown vaginal discharge - arises from - metastasizes to

Answer 331

Choriocarcinoma Complete mole, miscarriage, normal pregnancy, ectopic pregnancy Lung

Question 332

Triple or quadruple screen in pregnancy

Answer 332

AFP Estriol hCG Inhibin

Question 333

Trisomy 18 lab values

Answer 333

Decrease AFP Decrease estriol Decrease hCG

Question 334

Trisomy 21 lab values

Answer 334

Decrease AFP Decrease estriol Increase hCG Increase inhibin

Question 335

Partial mole vs complete mole

Answer 335

Partial mole - 69 XXX, XXY, XYY - Fetal parts - Normal size uterus - increase hCG - No risk choriocarcinoma Complete mole - 46, XX or YY - No fetal parts - Large uterus - BIG increase hCG - Risk of choriocarcinoma

Question 336

Type of ovarian cyst associated with molar pregnancies

Answer 336

Increase hCG Theca-lutein cyst

Question 337

Cause of placental abruption

Answer 337

``` Hx prior placental abruption HTN Trauma Smoking Cocaine use** ```

Question 338

HTN Proteinuria or end organ dysfunction

Answer 338

Preeclampsia ``` Thrombocytopenia Renal insufficiency Increased LFT Pulmonary edema Cerebral or visual symptoms - HA, visual disturbances, seizure ```

Question 339

Hemolysis Elevated liver enzymes Low platelets

Answer 339

HELLP syndrome

Question 340

Patients who have migraines with aura are at an increased risk for what other neurologic condition?

Answer 340

Stroke

Question 341

Trisomy 21 what happens w/ chromosomes | - gene effect seen

Answer 341

Maternal nondisjunction of homologous chromosomes during anaphase of meiosis I Mosaicism

Question 342

Rocker bottom feet Micrognathia Intellectual disability

Answer 342

Trisomy 18

Question 343

``` Rocker bottom feet Intellectual disability Microcephaly Cleft lip and palate Holoprosencephaly Polydactyly ``` labs? US?

Answer 343

Trisomy 13 Patau Decrease hCG, PAPP-A US: increase nuchal translucency

Question 344

Kleinfelter labs

Answer 344

Testicular atrophy Decrease testosterone Decrease inhibin Increase FSH

Question 345

Commonly seen w/ Double Y males

Answer 345

Tall Severe achne Antisocial behavior

Question 346

High-pitched crying and newing also seen (4) Mutation

Answer 346

Cri-du-chat syndrome Microcephaly Severe intellectual disability Epicanthal folds Cardiac abnormalities 5p deletion

Question 347

William syndrome - characteristics (5) - mutation

Answer 347

``` Elfin facies Intellectual disability Hypercalcemia (hypersensitivity to Vit D) Good verbal skills Friendly w/ strangers ``` Microdeletion of long arm of chr 7

Question 348

What should be suspected as a cause of HA in a patient using topical retinoic acid for tx of acne

Answer 348

Idiopathic intracranial hypertension (IIH)

Question 349

What is associated iwth berry aneurysms mutation?

Answer 349

Autosomal dominant polycystic kidney dis APKD1 mutation on chr 16

Question 350

AD disease6

Answer 350

1) Achondroplasia 2) Autosomal dominant polycystic kidney dis 3) Familial adenomatous polypopsis 4) Gardner syndrome 5) Familial hypercholesterolemia 6) Hereditary hemorrhagic telangiectasis 7) Hereditary spheocytosis 8) Huntington dis 9) Li-Fraumeni syndrome 10) Marfan syndrome 11) MEN 12) NF1 13) NF2 14) Tuberous sclerosis 15) VHL

Question 351

Trinucleotide repeat disorders

Answer 351

Huntington Myotonic dystrophy Fragile X syndrome Friedreich ataxia

Question 352

Bilateral acoustic neuroma Hearing loss Tinnitus mutation

Answer 352

NF2 Chr 22 AD

Question 353

Cafe au lait spots Neural tumor Lisch nodules (pigment hamartoma in eye) Scoliosis mutation

Answer 353

NF I AD mutation chr 17

Question 354

Huntington mutation

Answer 354

Chr 4 | CAG repeats

Question 355

Hereditary spherocytosis defect in

Answer 355

Spectrin or ankyrin

Question 356

MEN syndrome

Answer 356

MEN1: MEN 1 gene - PPP - Parathyroid adenomas - Pituitary adenomas - Pancreatic tumor MEN2A: RET gene - PPM - Parathyroid adenomas - Pheochromocytoma - Medually thyroid cancer MEN2B: RET gene - PMM - Pheochromocytoma - Medullary thyroid cancer - Mucosal neuromas

Question 357

``` Facial lesions Hypopigmented ash leaf spots Cortical and retinal hamartomas seizures intellectual diability ```

Answer 357

Tuberous sclerosis Mutation of hamartin or tuberin gene

Question 358

Hemangioblastomas of retina, cerebellum, medulla | Phenochromocytomas

Answer 358

von Hippel lindau disease Deletion of VHL Expression of HIF

Question 359

Fragile X syndrome

Answer 359

X linked trinucleotide repeat Mutation for FMR1 gene which codes for FMRP cytoplasmic protein Involved in mRNA translation of axons and dendrites CGG repeat ``` Macro-orchidism Long face Large jaw Everted ears Mitral valve prolapse Intellectual disability ```

Question 360

``` Macro-orchidism Long face Large jaw Everted ears Mitral valve prolapse Intellectual disability ```

Answer 360

Fragile X syndrome

Question 361

``` AR trinucleotide repeat disorder Staggering gait Falling Nystagmus Pes cavus Kyphoscoliosis ```

Answer 361

Friedreicha ataxia GAA Mutation for gene that codes for frataxin (mitochondrial protein that is involved in iron detoxifying and storage)

Question 362

AD disease fits 1) Associated with mitral valve prolapse, liver disease, berry aneurysms 2) Neural tumors and pigmented iris hamartomas 3) Very strong association with colon cancer 4) MI before age 20 5) Hemangioblastomas of retina/ cerebellum/ medulla 6) Increased MCHC, hemolytic anemia 7) Bilateral acoustic neuromas 8) Facial lesions, seizure disorder, cancer risk 9) Caudate atrophy, dementia 10) Cystic medial necrosis of aorta 11) Defect of FGF receptor 3 12) Assoc w/ floppy mitral valve, dissecting aortic aneurysm

Answer 362

1) ADPKD 2) NF1 3) Familal adenomatous polyposis 4) Familial hypercholestrolemia 5) VHL 6) Hereditary spherocytosis 7) NF2 8) Tuberous sclerosis 9) Huntington's dis 10) Marfan syn 11) Achondroplasia 12) Marfan syndrome

Question 363

X linked recessive pneumonic

Answer 363

Oblivious Females will Give Her Boys Her (x)Linked Disorders ``` Ocualr albinism Fabry dis Wiskott aldrich G6PD defiency Hunter syndrome Bruton agammaglobulinemia Hemophilia A/B Lesch-Nyhan syn Duchenne muscular dystrophy ```

Question 364

Lysosomal storage disease

Answer 364

``` Fabry dis (X linked recessive) Gaucher dis Krabbe Metachromatic leukodystrophy Niemann Pick Tay-sach ``` ``` Hurler syndrome Hunter syndrome (X linked recessive) ```

Question 365

Painless papules on lower abdomen peripheral neuropathy glomerulopathy (renal failure)

Answer 365

Fabry disease Deficient: alpha- galactosidase Accumulation: ceramide trihexoside; globotriaosylceramide

Question 366

``` Hepatosplenomegaly Cherry red spot Painful bony lesions Anemia Fatigue thrombocytopenia ``` -Microscopically

Answer 366

Gaucher disease Deficient: glucocerebrosidase Accumulation: Glucocerebroside Prominent blue cytoplasmic fibrils (crumpled tissue paper)

Question 367

``` Hepatosplenomegaly Cherry red spot Thrombocytopenia Ataxia Dysarthria Dysphagia Gradual worsening of intellectual fxn ``` - Mircoscopically

Answer 367

Niemann-Pick disease Deficient: Sphingomyelinase Accumulation: sphingomyein Foam cells

Question 368

Irritability Regression of motor skills Macrocepahly Cherry red spot

Answer 368

Tay-Sachs Deficient: hexosaminidase A Accumulation: GM2 ganglioside

Question 369

``` Peripheral neuropathy Seizures Optic atrophy Developmental delay Weakness ```

Answer 369

Krabbe disease Deficient: galactocerebrosidase Accumulation: galactocerebroside

Question 370

Muscle wasting Weakness Progressive vision loss Dementia

Answer 370

Metachromatic leukodystrophy Deficient: arylsulfatase Accumulation: cerebroside sufate

Question 371

``` Progressive deterioration Coarse facial features Hepatosplenomegaly Intellectual disability Poor growth (dwarfism) Corneal clouding ```

Answer 371

Hurler syndrome Deficient: alpha-L-iduronidase Accumulation: heparan sulfate and dermatan sulfate

Question 372

``` 2 y.o Progressive deterioration Coarse facial features Hepatosplenomegaly Intellectual disability Poor growth (dwarfism) Aggressive behavior ```

Answer 372

Hunter syndrome Deficient: iduronate sulfatase Accumulation: heparan sulfate and dermatan sulfate

Question 373

Hepatomegaly Hypoglycemia Seizure Lactic acidosis

Answer 373

Von Gierke Glycogen storage disease

Question 374

Cardiomegaly | Severe hypotonia

Answer 374

Pompe disease Lysosomal alpha-1,4, glucosidase deficiency

Question 375

What type lysosomal storage diseases have myelin sheath pathology leading to peripheral neuropathy

Answer 375

Krabbe disease Metachromatic leukocystrophy

Question 376

Signet ring cells | ER and PR positive

Answer 376

LCIS

Question 377

Large bulky breast tumor | Leaf like projections on histology

Answer 377

Phyllodes tumor

Question 378

Bloody nipple discharge

Answer 378

intraductal papilloma

Question 379

What is a feature of gram positive bacteria cell wall

Answer 379

Lipoteichoic acids Induce cytokine production IL-1, TNF-alpha

Question 380

What is the unique featuers of gram negative bacteria cellw all

Answer 380

Outer membrane - endotoxin (LPS) - induce IL-1, TNF alpha ``` Periplasmic space (between membranes) - beta lactamase ```

Question 381

Quellung reaction

Answer 381

Anti-capsular serum added to bacteria Capsule appears swollen under microscope

Question 382

Bacteria w/ capsule pneumonic

Answer 382

Even Some Pretty Nasty Killers have Shiny Bodies ``` E coli Strep pneumonia Pseudomonas Neisseria meningitidis Klebsiella Haemophilius influenza type B Salmonella Group B strep ``` Cryptococcus neoformans - encapsulated yeast

Question 383

Mycoplasma vs mycobacteria

Answer 383

Mycoplasma - sterols for plasmsa membrane - No cell wall Mycobacteria - Mycolic acid cell wall - Rich in lipids, resistant to staining

Question 384

Bacteria that dont stain well

Answer 384

Mycoplasma Mycobacteria Treponema - due to corkscrew and small - dark field microscopy Legionella pneumophilia - stain poorly due to unusual branch chain fatty acid in wall

Question 385

Giemsa stain

Answer 385

Giemsa Chinese Painted wHore Bows To Rich ``` Chylamydia Plasmodium Histoplasma Borrelia Trypanosomes Rickettsiae ```

Question 386

PAS stain for

Answer 386

Tropheryma whipplei Whipple disease

Question 387

Ziehl neelsen stain

Answer 387

Acid fast organism

Question 388

India ink

Answer 388

Fungus Crytococcus neoformans

Question 389

Silver stain

Answer 389

Fungi -Pneumocystis jirovecii Legionella

Question 390

Neurotoxins

Answer 390

Interfere with neural transmission Botulinum toxin Tetanus toxin

Question 391

Enterotoxins

Answer 391

Affect intestines Shigella Vibero cholera

Question 392

Superantigens

Answer 392

Exotoxins that simulatenously bind MHC II receptor and T cell receptor Polyclonal expansion of T cells Large amounts of cytokines Staph Aureus Strep Pyogenes

Question 393

Diphtheria toxin

Answer 393

Inactivates EF-2 Inhibits protein synthesis Corynebacterium diphtheriae

Question 394

Inactivates EF-2

Answer 394

Exotoxin A - pseudomonas Diphtheria toxin

Question 395

Shiga toxin

Answer 395

Cleaves host rRNA at adenine base in 60S ribosomal subunit Inhibition of protein synthesis Shigella

Question 396

Ecoli toxin

Answer 396

Verocytotoxin (Shiga toxin) - Bloody diarrhea - HUS ``` Heat labile toxin - stimulates adenylyl cyclase - Increase cAMP Heat stabile toxin -stimulate guanylyl cyclase - increase cGMP ETEC ```

Question 397

Heat stable toxin

Answer 397

ETEC | Yersinia enterocolitica

Question 398

Pseudoappendicitis

Answer 398

Yersinia enterocolitica Heat stable toxin Increase cGMP

Question 399

Anthrax toxin

Answer 399

Edema factor (adenylyl yclase) Lethal factor Protective antigen Bacillus anthracis

Question 400

Vibrio cholerae

Answer 400

Cholera toxin stimulates adenylyl cyclase increase cAMP chloride and water cross lumen rice water stools

Question 401

Bordetella pertussis

Answer 401

Pertussis toxin binds and inactivates inhibitory G proteins --> increase cAMP

Question 402

Clostridium tetani

Answer 402

Tetanospasmin blocks release of inhibitory NT gaba and glycine

Question 403

Botulinum toxin

Answer 403

Exotoxins A->G inhibit release of ACh at NMJ CLostridium botulinum Spoiled canned goods Honey

Question 404

Clostridium perfringens toxins

Answer 404

Alpha toxin (phospholipase) - Gas gangrene - Myonecrosis Enterotoxin - Food poisoning - Food left out too long once cooked

Question 405

Endotoxin triggers (3)

Answer 405

1. Macrophages - IL-1 IL-6= fever - TNF= cell death - NO= hypotension, development septic shock 2. Complement - C3a= release histamine, hypotension, edema - C5a= neutrophil chemotaxis 3. Tissue factor - coagulation cascade --> DIC

Question 406

Toxic associated with Staph aureus - hemolysis - tissue destruction w/ mRSA affects both neutrophils and macrophages - food poisoning - release of cytokines, high fever, hypotension, diffuse rash - Scalded skin syndrome in newborns

Answer 406

Hemolysis - alpha-toxin (alpha hemolysin) - sphingomyelinase C (beta) - leukocidin (gamma) - delta-toxin Panton-Valentine leukocidin Enterotoxin (superantigen) Toxic shock syndrome toxin 1 (superantigen) Exfoliative toxin

Question 407

Toxins secreted by Strep pyogenes

Answer 407

Streptolysin O - hemolysis (oxygen labile) Streptolysin S - hemolysis (oxygen stable) Streptococcal pyrogenic exotoxins Type A, B, C/ erythrogenic toxins - red rash (erythro-) and fever (pyro-) of scarlet fever (superantigen)

Question 408

Degrades H202 into H20 and O2

Answer 408

Catalase

Question 409

Increases bidning to host tissues, induce coagulation or blood clotting

Answer 409

Coagulase

Question 410

S. epidermidis vs s. saprophyticus

Answer 410

S. epidermidis - Novobiocin sensitive - heart valves S. saprophyticus - Novobiocin resistant - UTI

Question 411

Gram positive diplococci

Answer 411

Strep. pneumoniae

Question 412

Viridans streptococci

Answer 412

Colonizer of the oral cavity Cause infective endocarditis No capsule Partial hemolysis

Question 413

Chronic granulomatous disease

Answer 413

NADPH oxidase deficiency H2O2 easily broken down by catalase (+) organisms Susceptible in infections by staph

Question 414

Contaminated deli meat

Answer 414

Listeria

Question 415

meningitis in very young and old

Answer 415

Listeria

Question 416

Potato salad

Answer 416

Staphyloccus aureus Rapid vomiting

Question 417

Fried rice Reheated rice

Answer 417

Bacillus cereus

Question 418

Pigment producing bacteria (4)

Answer 418

Staph aureus - Large golden colonies Actinomyces israelii - yellow (sulfur) granules - yellow sand Pseudomonas aeruginosa - blue green pigment ``` Serratia marcescens (MARsecens) - red pigment ```

Question 419

What ovarian tumor matches each of hte following 1) Estrogen secreting leading to precocious puberty 2) Produces AFP 3) Psammoma bodies 4) Testosterone secreting leading to virilization

Answer 419

1) Granulosa theca cell tumor 2) Yolk sac tumor 3) serous cystadenocarcinoma 4) Sertoli-leydig cell tumor

Question 420

Gram (+) cocci Catalase negative Dental plaque

Answer 420

S. mutans (most) S. sanguinis - preexisting heart flow problems

Question 421

Common disease caused by Group A strep (pyogenes)

Answer 421

Acute pharyngitis Cellulitis Invasive infection Acute post-streptococcal glomerulonephritis Rheumatic fever Toxic shock syndrome

Question 422

Impetigo caused by

Answer 422

Staph aureus | Strep pyogenes

Question 423

Otitis media and sinusitis Sudden onset chills Lobular consolidation Rust colored sputum

Answer 423

Streptococcus pneumoniae

Question 424

Group A Strep immunologic complications

Answer 424

Body immune response to bacteria ``` Jones Joints Pancarditis (endo/myo/pericarditis) Nodules (SQ) Erthema marginatum Sydenham chorea ```

Question 425

Neonatal sepsis

Answer 425

Group B strep Listeria Ecoli

Question 426

Gram positive bacteria associated iwth colon cancer

Answer 426

Streptococcus bovis Group D strep Endocarditis Found in gut

Question 427

Bacteria cause subscute endocarditis

Answer 427

``` Coagulase neg Staph Viridans group streptococci Strep bovis Enterococci HACEK organisms ``` ``` HACEK - not gram (+) Haemophilus aphrophilus Aggregatibacter spp Cardiobacterium hominis Eilcenella corrodens Kingella kingae ```

Question 428

Spore forming

Answer 428

Clostridium spp Bacillus anthracis Coxiella burnetti

Question 429

Clostiridum difficile - toxins - diagnosis - tx

Answer 429

Toxin A (enterotoxin) - binds brush border - secretion and inflammation ``` Toxin B (cytotoxin) - disruption actin cytoskeleton ``` Pseudomembrnaous colitis Stool toxin assay (PCR or ELISA) Tx - Metronidazole - Oral vancomycin - Fidxomicin (recurrent)

Question 430

Mediastinal widening on CXR

Answer 430

``` Bacillus anthracis Aortic dissection Ruptured esophagus Lymphoma Aortic aneurysm due to syphillus ```

Question 431

Large painless ulcer w/ central necrosis (eschar)

Answer 431

Cutaneous anthrax | Wound

Question 432

Obligate anaerobes (3) Tx

Answer 432

Clostridium species Actinomyces (Gram +) Bacteroides (Gram -) Tx metronidazole Clindamycin

Question 433

Facial infection of jaw/mandible | Sinus tracts draining yellow pus

Answer 433

Actinomyces israelii

Question 434

Decaying vegetation | Infection in immunocompromised

Answer 434

Nocardia

Question 435

Whitish patch on posterior oropharynx, makes greyish membrane, will bleed if scrap off Tx

Answer 435

Corynebacterium diphtheriae Erythromycin or penicillin Antitoxin Vaccinate

Question 436

Chocolate agar | - requires

Answer 436

Haemophilus influenza Factor V and X

Question 437

Epiglottitis

Answer 437

Haemophilus influenza

Question 438

Buffered charcoal yeast extract agar - requires - transmission - tx

Answer 438

Legionella pneumophila Iron Cysteine Aerosols from water sources macrolides Fluoroquinole

Question 439

Spiral shaped rod urease positive causes tx

Answer 439

Helicobacter pylori Gastric adenocarcioma ``` Tx: Triple therapy - PPI - Clarithromycin - Amoxicillin or metronidazole ``` Quadruple therapy - PPI - Bismuth - Metronidazole - Tetracycline

Question 440

Lactose non-fermenters Urease producing -Creates what

Answer 440

Proteus spp ``` Alkaline urine Struvite stones (Staghorn calculi) ```

Question 441

Associated w/ reactive arthrits

Answer 441

``` Shigella Salmonella Campylobacter jejuni Yersinia Chlamydia ```

Question 442

Question marked shaped Rodent urine Phase 1 Phase 2

Answer 442

Leptospira interrogans Phase 1 Fever chills Body ache HA Phase 2 Hyponatremia Renal failure Liver damage w/ jaundice

Question 443

``` Bulls eye Fever HA Body ache Fatigue ``` Tx

Answer 443

Borrelia burgdorferi Ixodes tick Tx Doxycycline (early stage) Amoxicilin (children <8) Doxycycline or Ceftriaxone (late)

Question 444

Bilateral facial nerve palsy Tx

Answer 444

Borrelia burgdorferi Ixodes tick Tx Doxycycline (early stage) Amoxicilin (children <8) Doxycycline or Ceftriaxone (late)

Question 445

Argyll robertson pupil

Answer 445

Pupil constricts with accomodation but doesnt react w/ direct light Neurosyphilis

Question 446

Rash involving palms and soles | Maculopapular

Answer 446

Kawasaki disease Coxsackie A virus Rocky mountain spotted fever Syphillis Meningococcemia You drive Kawaski CARS with your hands and feet

Question 447

Sensory ataxia Lancinating pain: sudden stabs of pain in body Loss of proprioception and vibratory sense

Answer 447

Tabes dorsalis Posterior dorsal columns of SC and dorsal root Neurosyphilis

Question 448

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

Answer 448

1) Bartonella henselae 2) Borrelia burgdorferi 3) Brucellosis 4) Campylobacter 5) Chlamydophila psittaci 6) Coxiella burneii 7) Ehrlichia chaffeensis 8) Francisella tularensis 9) Leptospira 10) Mycobacterium leprae 11) Pasteurella multocida 12) Rickettsia prowazekii 13) Rickettsia typhi 14) Rickettsia rickettsii (rocky mountain spotted fever) 15) Yersinia pestis

Question 449

What is the classic presenting symptoms in a patient with Lyme disease

Answer 449

Erythema migrans (bulls eye)

Question 450

Leprosy Hansen disease two types

Answer 450

Lepromatous disease - weak immune system - disfuguring Tuberculoid disease - strong immuen response - fewer skin lesions

Question 451

Clue cell - organism - characteristic (2) - change - tx (2)

Answer 451

Vaginale pithelial cell covered in coccobacilli Gardnerella vaginalia - gray vaginal discharge - fishy smell - elevated pH >4.5 Oral metronidazole Metronidazole cream

Question 452

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

Answer 452

Ricketta ricksttsii Rocky mountain spotted fever

Question 453

HA | Fever, Rash centrally spreads to extremities

Answer 453

Rickettsia prowazekii -Lice Rickettsia typhi - Fleas

Question 454

Febrile Non specific Morulae within monocytes or granulocytes Vector Tx

Answer 454

Ehrlichia chaffeensis -Lone star tick Anaplasma phagocytophilum - Ixodes scapularis Tx: Doxycycline

Question 455

Acute flu like illness w/ pneumoniae Works on farm - chronic assoc w/

Answer 455

Coxiella burnetii - Q fever - Spore forming - chronic assoc w/ endocarditis

Question 456

Chlamydia Types 1) A-C 2) D-K 3) L1-L3 Tx

Answer 456

A-C - Acute eye infection - Can lead to scarring and blindness D-K - Urethritis, cervicitis, PID - Neonatal pneumonia and conjunctivitis L1-L3 - Lymphogranuloma venereum - Genital ulcer - Unilateral lymphadenopathy - Groove sign - Proctitis Tx: Azithromycin

Question 457

Atypical pneumonia

Answer 457

Legionella pneumophila Chlamydophila pneumoniae Mycoplasma pneumoniae

Question 458

``` Malaise, HA Low grade fever Nonproductive cough Diffuse interstitial infiltrates Coughing for weeks ``` CXR: patchy reticulonodular infiltrate Tx Diagnosis

Answer 458

Mycoplasma pneumonia College kids- dorms Military recruits Macrolide (azithromycin) Doxycycline (empiric) Fluroquinoles (empiric) Cold agglutinins - Nonspecific IgM Ab to erythrocytes

Question 459

Lymphatic drainage 1) Arm lateral breast 2) Posterior calf, dorsolateral foot 3) Thigh 4) Stomach, upper duodenum 5) Lower duodenum, jejunum, ileum, proximal 2/3 of colon 6) Distal 1/3 of colon, upper rectum 7) Lower rectum (above pectinate line) 8) Anal canal (below pectinate line) 9) Test, ovaries, uterus kidneys 10) Scrotum, vulva 11) Right arm and right side of face 12) Rest of body

Answer 459

1) Arm lateral breast = Axillary LN 2) Posterior calf, dorsolateral foot = Popliteal LN 3) Thigh = Superficial inguinal LN 4) Stomach, upper duodenum = Celiac LN 5) Lower duodenum, jejunum, ileum, proximal 2/3 of colon = Superior mesenteric 6) Distal 1/3 of colon, upper rectum = Inferior mesenteric 7) Lower rectum (above pectinate line) = Internal iliac 8) Anal canal (below pectinate line) = superficial inguinal 9) Testes, ovaries, uterus kidneys = para-aortic 10) Scrotum, vulva = superficial inguinal 11) Right lymphatic duct 12) Thoracic duct --> L subclavian

Question 460

Peyers patches are located

Answer 460

Lamina propria and submucosa of ileum

Question 461

Which muscles and nerves are derived from the first brachial arch?

Answer 461

M & T Muscles of mastication - Masseter - Medial pterygoid - Lateral pterygoid - Temporalis Mylohyoid Tensor tympani Tensor veli palatini Anterior 2/3 of tongue Mandibular and maxillary division of Trigeminal n.

Question 462

What is the cell type in peyer's patches

Answer 462

M (microfold) cells Take up Ag from lumen of gut and transcytose to other side of cell

Question 463

Dendritic cell surface markers

Answer 463

MHC I MHC II B7 protein (CD80 or 86) CD40

Question 464

HLA-B27 HLA-DR3, HLA-DR4

Answer 464

Seronegative spondoloarthropathies "PAIR" Psoriatic arthritis, ankylosing spondylitis, inflammatory bowel disease, reactive arthritis Type 1 diabetes mellitus

Question 465

S-100 CD1a Tennis rackets

Answer 465

Langerhans cell histiocytosis Excessive proliferation of langerhan cells but are poor at presenting Ag

Question 466

Positive selection | - occurs where

Answer 466

Selecting for T cells that can bind to MHC Loss CD4 or CD8 Cortex of thymus

Question 467

Negative selection | - occurs where

Answer 467

Selectingout T cells w/ receptor for self antigen Corticomedullary junction

Question 468

Induces Th1 differentiation Th1 produces Functions of those produced

Answer 468

IL-12 --> Th1 Th1 --> IL-2, INF-gamma IL-2: proliferation of T cells induce more Th1 IFN-gamma: activate macrophages, suppress Th2

Question 469

Induces TH2 differentiation Th2 produces Functions of those produced

Answer 469

IL-4 --> Th2 Th2 --> IL-4, IL-5, IL-10 IL-4, IL-5= proliferation of B cells, induce production of Th2 cells Il-10= inhibit production Th1, inhibits macrophages

Question 470

T cell activation

Answer 470

2 signals TCR and CD4/CD8 binds to MHC II/I B7 protein (CD80/86) on APC binds to CD28 of T cell

Question 471

Transcription factor the helps control the development of Treg cells

Answer 471

FOXP3 Forkhead Box Protein P3 Found on X chromosome Mutation: suppress immune system - condition called IPEX ``` Immune dysregulation Polyendocrinopathy - Type I diabetes - Thyroiditis Enteropathy - Severe diarrhea - Failure to thrive X linked ```

Question 472

Male infant Severe chronic diarrhea Neonatal diabetes or thyroiditis Eczema

Answer 472

IPEX Mutation of FOXP3

Question 473

B cell activation

Answer 473

1) Th cell activated 2) B cell endocytoses Ag and present to Th cell 3) B cell has CD40 and binds to CD40L on T cell 4) Th2 produce IL-4, IL-5 induce B cell proliferation and class switching

Question 474

NK cells activity induced by

Answer 474

IL-12 IL-2 IFN-alpha IFN-beta

Question 475

IFN-alpha and IFN-beta fxn

Answer 475

Induce NK cells Induce near by cells to inhibit viral protein synthesis

Question 476

CD16 - does what - found on - function

Answer 476

Binds to Ab (on constant region Ab) ``` Found on: NK cells Macrophages Monocytes Neutrophils Eosinopohils ``` Antibody dependent cell mediated cytotoxicity (ADCC) - Enemy cell get coated with IgG antibody, NK cells and other cells w/ CD16 surface marker are able to recognize Ab coated cells and kill them

Question 477

VDJ recombination begins with Initated by

Answer 477

Breaks in dsDNA at Recombination Signal sequences RSSs Initiated by RAG-1 and RAG-2

Question 478

Surface markers B cells T cells T cytotoxic T helper NK cells Macrophages Dendritic

Answer 478

1) B cells - CD19, 20, 21 - IgG, IgM - B7 - CD40 - MHC II 2) T cells - CD3 - TCR - CD28 3) T cytotoxic - CD3 - TCR - CD28 - CD8 4) T helper - CD3 - TCR - CD28 - CD4 - CD40 ligand 5) NK cells - CD16 - CD56 6) Macrophages - CD14 - MHC II - B7 - CD40 7) Dendritic - MHC II - B7 - CD 40

Question 479

IgG (5) IgA (5) IgE (4) IgM (4) IgD (1)

Answer 479

1) IgG - Delayed immune response - Fixes complement - Crosses placenta ** - Opsonizes bacteria ** - Neutralize viruses and bacterial toxins 2) IgA - Secreted by MALT - Mucous membranes and GI - Monomor in circulation - Dimer in secretion (Mucus, tears, saliva, breast milk) 3) IgE - Immunity to parasites - Activates eosinophils - Mast cells and basophils - Type I hypersensitivity 4) IgM - Surface of B cells (monomer) - Circulation (pentamer) - Primary immune response - Does NOT cross placenta 5) IgD - surface of B cells

Question 480

Live Virus vaccinations pneumonic

Answer 480

Attention! Please Vaccinate Young Infants with MMR Regularly Attenuated virus vaccines ``` Polio (sabin, oral) Varicella Yellow fever Intranasal influenza MMR Rotavirus ```

Question 481

Egg based vaccines

Answer 481

Influenza Yellow fever (MMR) tiny amount

Question 482

Bacteria vaccine - toxin - capsular polysaccharides - killed bacteria - live attenuated bacteria

Answer 482

Toxin - Tetanus toxoid Capsular polysaccharides - S. pneumoniae - H. influenzae Killed bacteria - Vibrio cholerae Live attenuated bacteria - Typhoid vaccine - BCG vaccine

Question 483

Amyloidosis types (6)

Answer 483

1) Immunologic (primary) - Ig light chain - AL fibril 2) Secondary - SAA (serum amyloid associated protein) - AA fibril 3) Type 2 diabetes - Amylin (secreted by pancreas) - AIAPP 4) Medullary thyroid CA - Calcitonin - A-CAL 5) Alzheimer - beta-amyloid - APP (amyloid precursor protein) 6) Dialysis associated - beta2- microglobulin - Abeta2M

Question 484

Opsonization

Answer 484

C3b | IgG

Question 485

Stimulates mast cells and basophils (complement)

Answer 485

C3a

Question 486

C5a does what

Answer 486

Neutrophil chemotaxis

Question 487

Deficiency of C1 esterase inhibitor Deficiency of C3 Deficiency of MAC Deficiency of DAF

Answer 487

1) Def C1 esterase inhibitor - Hereditary angioedema - Elevated bradykinin - Never take ACE inhibitor, also increase bradykinin levels 2) Def C3 - Recurrent pyogenic sinus infections and resp tract infections - encapsulated organisms - Strep pneu, Haemophilus influ - Increased sensitivity to type II infections 3) Neisseria bactermia susceptible 4) Def in DAF (CD55) - Protect self form spontaneous complement activation through alternative pathway - Paroxysmal noctural hemogobinuria (PNH)

Question 488

Paroxysmal nocturnal hemoglobinuria (PNH) deficient in what clinical (3) Tx (3)

Answer 488

TBC deficient in two surface molecules that protect against MAC 1) Glycosylphosphotidylinositol (GPI) which anchors Decay accelerating factor (CD55) to plasma membrane 2) MAC inhibitory protein (CD59) Clinical - break down RBC intravascular - hemosiderinura (red urine) - thrombosis (platelets destroyed) Transfusion Warfarin Eculizumab

Question 489

Which organisms cannot be stained w/ gram stain

Answer 489

``` Treponema Rickettsia Chlamydia Legionella Mycoplasma Mycobacteria ```

Question 490

Macrophages secrete

Answer 490

IL-1, IL-6, TNF-alpha (acute phase) | IL-12

Question 491

Neutrophils chemotactic agents

Answer 491

IL-8 C5a Leukotriene B 4

Question 492

Cytokines functions pneumonic

Answer 492

Hot T bone stEAk ``` IL-1: fever IL-2: stimulates T cells IL-3 stimualtes bone marrow IL-4: IgE adn IgG IL-5: IgA and eosinophils ```

Question 493

Differential diagnosis Eosinophilia pneuonic

Answer 493

CANADA P Collagen vascular disease (PAN, dermatomyositis) Atopic disease (allergies, asthma) Neoplasm Adrenal insufficiency (addison dis) Drugs (NSAIDS, penicillins, cephalosporins) Acute interstitial nephritis Parasites (stronglyloides, ascaris) HIV Hyper igE coccidioidomycosis

Question 494

Chvostek sign | Trousseau sign

Answer 494

Chovstek: tap on cheek, causes facial spasm Troussseau: blood pressure cuff, leads to spasm of arm Hypocalemia

Question 495

6 month old boy Recurrent bacterial infections Low immunoglobulins - defect - inheritence

Answer 495

Bruton agammaglobulinemia Defective tyrosine kinase X linked

Question 496

Recurrent candida infections and respiratory infections Diarrhea Failure to thrive No thymus seen on imaging - deficiency - decrease in

Answer 496

Severe combined immunodeficiency (SCID) Decrease B and T cells Adenosine deaminase deficiency

Question 497

Cant follow object Talangiectasias of face Recurrent infections clinical (2) sensitive (2) risk (2) elevated

Answer 497

Ataxia-telangiectasia IgA deficiency T cell deficiency ``` Cerebellar ataxia Telangiectasias after 5 y.o Radiation sensitivity (avoid x ray) Increased risk: lymphoma leukemia -Elevated AFP (8 months) ```

Question 498

Ataxia-telangiectasia mneumonic "ATAXIA"

Answer 498

``` "ATAXIA" Ataxia Telangiectasia, tracking eye difficulties Acute leukemia and lymphoma Xray sensitivity IgA deficiency AFP ```

Question 499

Wiskott-Aldrich syndrome mneumonic

Answer 499

``` WAITER Wiskott Aldrich Immunodeficiency Thrombocytopenia and purpura Eczema Recurrent pyogenic infections ``` X linked Low IgM, high IgA

Question 500

1) Defect tyrosine kinase 2) Elevated AFP 3) Adenosine deaminase deficiency 4) Low IgM, high IgA 5) Lack NADPH oxidase 6) Defect LYST gene 7) STAT3 mutation 8) Abnormal integrins 9) Two rows of teeth 10) Delayed separation umbilical cord

Answer 500

1) Bruton agammaglobulinemai 2) Ataxia-telangiectasia 3) SCID 4) Wiskott-Aldrich sydrnome 5) Chronic granulomatous disease (CGD) 6) Chediak-Higashi sydnrome 7) Hyper IgE syndrome (Job syn) 8) Leukocyte adhesion deficiency 9) Hyper IgE syndrome (Job syn) 10) Leukocyte adhesion deficiency

Question 501

Chronic granulomatous disease (CGD)

Answer 501

X linked Lack of NADPH oxidase Cant destroy catalase + Staph aureus, aspergillus TMP-SMX Itraconazole

Question 502

Giant cytoplasmic granules in PMN Partial albinism Recurrent respiratory tract and skin infections Neurologic disorders

Answer 502

Chediak- Higashi syndrome LYST gene defect (lysosomal transport) Defective phagocyte lysosomes

Question 503

``` High level IgE and eosinophils Eczema Recurrent cold S. aureus abscesses Coarse facial features Two rows teeth ```

Answer 503

Hyper IgE syndrome STAT3 signaling protein mutation Impaired differentiation of TH12 Impaired recruitment of neutrophils

Question 504

X linked immunodeficiencies

Answer 504

Bruton agammaglobulinemia Chronic granulomatous disease Wiskott aldrich syndrome SCID

Question 505

Eczema Recurrent cold abscesses high serum IgE

Answer 505

Hyper IgE syndrome

Question 506

Large phagosomal vesicles with neutrophils

Answer 506

Chediak=Higashi disease

Question 507

Tuberous sclerosis mutations | - what is the gene for

Answer 507

TSC1 or TSC2 ``` TSC1= hamartin protein TSC2= tuberin protein ```

Question 508

Seizures Intellectual disability Angiofibromas (tiny bumps/ tumors on nose and cheeks) - also seen

Answer 508

Tuberous sclerosis ``` Hypomelanotic macules (white spots) Retinal hamartomas (white circumscribed tumor of eye) Cortical tuber (white mass in brain benign) ```

Question 509

``` Flaccid paralysis Hyporeflexia weakness Faciculations Fever, HA, malaise Lymphocytic pleocystois (increase lymphocytes in CSF) Slightly elevated protein Normal glucose ```

Answer 509

Polio

Question 510

Infantile flaccid paralysis

Answer 510

Most infants die before 1 year AR Werdnig-hoffman Death of neuron in the anterior horn of Spinal cord

Question 511

``` Rapidly progessive weakness Muscle atrophy Fascicultations Spasticity Difficulty speaking and swallowing ``` - Defect - Tx

Answer 511

ALS Superoxide dismutase 1 Riluzole - lengthens survival - decrease glutamate release

Question 512

Tabes dorsalis - assoc w/ - affects - test

Answer 512

Tertiary syphilis Obliterates dorsal columns Light tough and proproceptive cant get to CNS Romberg sign

Question 513

Bilateral loss of pain and temperature sensation in upper extremities (cape like) Hand muscle weakness and atrophy

Answer 513

Syringomyelia

Question 514

``` Ipsl UMN sign Ipsl loss tactile vibrtaion and proprioception C/L pain and temp below lesion LMN at level of lesion At lesion ipsl pain /temp ```

Answer 514

Brown sequard syndrome complete hemisection spinal cord

Question 515

Brown sequard syndrome

Answer 515

``` Ipsl UMN sign Ipsl loss tactile vibrtaion and proprioception C/L pain and temp below lesion LMN at level of lesion At lesion ipsl pain /temp ```

Question 516

Deep nuclei of cerebellum from medial to lateral

Answer 516

Fast Gerbals Exercise Daily Fastigial nucleus Globose nucleus Emboliform nucleus Dentate nucleus

Question 517

Involuntary flailing of one arm

Answer 517

Hemiballismus Subthalamic nucleus

Question 518

which portions of the hypothalamus are inhibited by leptin ? which are stimulated

Answer 518

Inhibits the lateral nucleus Stimulates teh ventromedial nucleus

Question 519

Dopamineric signals from the ______ to _______ induce movement

Answer 519

Substantia nigra to neostriatum

Question 520

Parkinson - signs - seen in brain - loss of

Answer 520

``` Hypokinesia Festinating gait Pill rolling tremor Cogwheel rigidity Mask like facies ``` Depigmentation of substantia nigra Loss of dopamine

Question 521

Also has parkinsonian features

Answer 521

Synthesizing meperidine Creates MPTP -- MAO--> MPP

Question 522

Athetosis

Answer 522

Slow writhing snke like movements in hands and fingers

Question 523

Akathisia

Answer 523

Compulsion to move

Question 524

Huntingtons Disease

Answer 524

Huntington chorea C's ``` CAG trinucleotide repeat Chromosome cuatro (4) Cuarenta (age 40) Chorea Cognitive decline Caudate atrophy ``` Excessive excitation by glutamate --> death of neurons Increase dopamine Decrease GABA Decrease ACh

Question 525

Fracture to shaft of humerus Fracture of surgical neck of humerus

Answer 525

Radial n. - Wrist drop Axillary n. Posterior circumflex A.

Question 526

Poststreptococcal glomerulonephritis deposits

Answer 526

IgG IgM C3 Immune complex deposition

Question 527

Enteropeptidase activity

Answer 527

Trypsin

Question 528

Gram neg rod Green metallic sheen on eosin methylene blue agar Hemolysis on blood agar

Answer 528

Ecoli

Question 529

Green metallic sheen on eosin methylene blue agar

Answer 529

Ferments lactose

Question 530

Pyruvate kinase deficiency

Answer 530

Pyruvate kinase needed to convert phosphoenolpyruvate to pyruvate, resulting in generation of ATP Deficiency means less ATP, less gradient Disruption of RBC membrane Splenic red pulp hyperplasia to remove RBCs Splenomegaly

Question 531

RAS is usually active when bound to

Answer 531

GTP MAP kinase pathway

Question 532

``` Fever chills, fatigue, dyspnea Temp Ring shaped and Maltese cross Splenectomy Intraerythrocytic inclusions ```

Answer 532

Babesiosis Tick borne infection Babesia microti

Question 533

Heteroplasmy

Answer 533

condition of having different mitochondrial genomes

Question 534

Frothy foamy urine caused by Starling forces?

Answer 534

Proteinuria or bile salts in urine Low plasma oncotic pressure

Question 535

Absence of CD18

Answer 535

Leukocyte adhesion deficiency CD18 needed for formation of integrins Persistent leukocytosis

Question 536

Average total body water is extracellular fluid Plasma volume

Answer 536

41 liters 14 L 3 L (within extracellular)

Question 537

Posterior duodenal wall ulcer erodes into

Answer 537

Gastroduodenal artery

Question 538

Mass in right temporal love vision problems

Answer 538

Affects meyer's loop Left homonymous superior quadrantanopia Left top quadrant of both eyes

Question 539

Hepatoduodenal ligament contains

Answer 539

Common bile duct Hepatic artery Portal vein

Question 540

Amnio acids modified in golgi

Answer 540

Tyrosine Serine Threonine Aspargine

Question 541

Failure of what process results in I cell disease

Answer 541

Addition of mannose-6- receptor marker to lysosome enzymes

Question 542

What develops week 4 Week 8 Week 10

Answer 542

Week 4: 4 chamber heart, 4 limb buds Week 8: fetal movement 8 and "Gait" Week 10: sex specific genitalia ("ten"italia")

Question 543

Neural crest derivitives

Answer 543

Magic Cops ``` Melanocytes Aorticopulmonary septum Ganglia (autonomic, dorsal root, enteric) Iris stroma Chromaffin cells Cranial nervs Odontoblasts/ ossicles Parafollicular C cells Sclerae ```

Question 544

Emybryonic origin of each 1) Anterior pituitary 2) Posterior pituitary 3) Parotid glands 4) Sublingual glands 5) Sclera 6) Lens 7) Retina 8) Mammary glands 9) Sweat glands

Answer 544

1) Anterior pituitary= surface ectoderm 2) Posterior pituitary= neural tube 3) Parotid glands= surface ectoderm 4) Sublingual glands= endoderm 5) Sclera= neural crest 6) Lens= surface ectoderm 7) Retina= Neural tube 8) Mammary glands= surface ectoderm 9) Sweat glands= surface ectoderm

Question 545

G1 --> S

Answer 545

cyclin D binds/ activates CDK4 --> phosphorylation of Rb protein Rb protein released from E2F E2F left free to transcribe/ synthesize components needed for progression through S (cyclin E, DNA polymerase, thymidine kinase) Cyclin E binds/ activates CDK2 --> the cell is allowed into S pahse

Question 546

G2 --> M

Answer 546

Cyclin A - CDK2 complex --> mitotic prophase Cyclin B- CDK1 complex is activated by cdc25 --> breakdown of nuclear lamins and initiation of mitosis

Question 547

Trafficking proteins (3)

Answer 547

1) COP-11 - antrograde trafficking - protein from ER to golgi 2) COP-1 - retrograde from golgi to ER 3) Clathrin - farside of golgi - helps golgi to form vesicles to transport enzymes called hydrolases to lysosomes

Question 548

Post translational modifications of proteins and proteoglycans in golgi apparatus

Answer 548

1) GLycosylation of core proteins to form proteoglycans 2) Sulfation of proteoglycans and selected tyrosine residues 3) Add O-oligosaccharides to serine and threonine residues 4) Adds mannose-6-phosphate to asparagine residues located on lysosomal enzymes

Question 549

I cell disease

Answer 549

Deficiency of mannose phosphorylation No mannose-6-phosphate to target lysosomal proteins Secreted out of cell instead of into lysosomes Corneal clouding, coarse facies, hepatosplenomegaly, skeletal abnormalities, restricted joint movement

Question 550

Corneal clouding, coarse facies, hepatosplenomegaly, skeletal abnormalities, restricted joint movement

Answer 550

I cell disease

Question 551

Beta oxidation of very long chain fatty acids and branched chain fatty acids - synthesis of

Answer 551

Peroxisomes Synthesis of plasmalogens (phospholipids in myelin)

Question 552

Retrograde movement on axon

Answer 552

Dynein

Question 553

Antrograd movement on axon

Answer 553

Kinesin

Question 554

Situs inversus Chronic sinusitis Bronchiectasis Infertility

Answer 554

Kartagner syndrome Dynein doesnt work Immotile cilia

Question 555

what intermediate filaments are found in each of the following? ``` Connective tissue Muscle tissue Epithelial tissue Axons Nuclear envelope and DNA Schwann cells ```

Answer 555

CT= Vimentin Muscle tissue= desmin Epithelial tissue= cytokeratin Axons= neurofilaments Nuclear envelop and DNA= Nuclear lamins Schwann cells= Glial fibrillary acid proteins

Question 556

Kartagener syndrome

Answer 556

Situs inversus Bronchiectasis Chronic sinsitis

Question 557

Which arachidonic acid product causes each of the following effects 1) Increased bronchial tone 2) Increased platelet aggregation 3) Decreased platelet aggregation 4) Increased uterine tone 5) Decreased uterine tone 6) Increased vascular tone 7) Decreased vascular tone

Answer 557

1) LTD4, LTE4, LTC4 2) TXA A2 3) PGL2 4) PGE2, PGF2alpha 5) PGI2 6) TXA A2 7) PGI2, PGE1

Question 558

Needed for Granuloma formation

Answer 558

IFN-gamma: forms granuloma TNF-alpha: maintains granuloma

Question 559

Blue sclerae Hearing loss Multiple fractures -inheritence

Answer 559

``` Osteogenesis imperfecta (OI) - Autosomal dominant ```

Question 560

Cant see Cant pee Cant hear high C

Answer 560

Alport syndrome Type IV collagen Nephritis and kidney failure Hearing loss Eye problems (Cataracts)

Question 561

Role of Vit C in collagen production

Answer 561

Hydroxylation of lysine and proline

Question 562

Damaged in Guillain-Barre syndrome CSF changes Classic manifestations

Answer 562

Schwann cell Normal cell count Increase protein Symmetric ascending muscle weakness Bilateral facial paralysis (palsy) Preceded by infection No sensory loss

Question 563

Holoproencephaly - conditions - mutation

Answer 563

Trisomy 13 patau Fetal alcohol SHH mutation

Question 564

Chiari Malformation

Answer 564

Herniation of cerebellar tonsils

Question 565

Enlarged posterior fossa Cerebellar vermis fails to develop Dilation of 4th ventricle

Answer 565

Dandy Walker

Question 566

Brocas

Answer 566

Language production Understand Cant talk

Question 567

Wernicke's area

Answer 567

Comprehension of language Can talk in sentences Doesnt make sense

Question 568

Lesion to which area of brain is responsible for each of the following 1) Hemispatial neglet syndrome 2) Poor repetition 3) Poor comprehension 4) Poor verbral expression 5) Personality changes and disinhibition 6) Agraphia and acalculia

Answer 568

1) Nondominant angular gyrus, parietal 2) Arcuate fasciculus 3) Wernicke 4) Broca 5) Frontal lobe 6) Dominant angular gyrus, parietal

Question 569

What regulates the progression of the cell cycle from the G1 phase to S phase

Answer 569

p53 | Rb

Question 570

Which arachidonic acid product has actions that oppose that of prostacyclin

Answer 570

Thromboxane A2

Question 571

Disease which has abnormal breakdown of elastin

Answer 571

Alpha 1 anti-trypsin deficiency

Question 572

Associated with berry aneurysms

Answer 572

ADPKD | Ehler Danlos

Question 573

Fearless Curious Puts things in mouth Hypersexual

Answer 573

Bilateral lesion in amygdala Kluver-Bucy syndrome

Question 574

Nystagmus Ataxia Encephalopathy Amnesia

Answer 574

Wernicke-Korsakoff syndrome ``` Thiamine deficiency (Vit B) - alcoholics ``` Mamillary body lesion

Question 575

Located in anterior hypothalamus - damage to this neuron causes dilute urine - secretes antidiuretic hormone

Answer 575

Supraoptic nucleus

Question 576

Stimulation increases appetite Damage causes anorexia adn WL Leptin inhibits this nucleus

Answer 576

Lateral nucleus

Question 577

Regulates teh secretion of TSH Regulates teh secretion of ACTH Secretes oxytocin

Answer 577

Paraventricular nucleus

Question 578

Receives input from retina Controls circadian rhythms Master clock

Answer 578

Suprachiasmatic nucleus

Question 579

Damage leads to savage behavior Damage leads to obesity Stimulated by leptin

Answer 579

Ventromedial nucleus

Question 580

Thermoregulation (cooling) | Damage causes hyperthermia

Answer 580

Anterior nucleus

Question 581

Involved in memory | Damage causes wernicke korsakoff

Answer 581

Mamillary nucleus

Question 582

Regulates appetite Pulsatile secretion of FnRH Secretes dopamine Secretes GHRH

Answer 582

Arcuate nucleus

Question 583

Regulates hunger | Damage leads to obesity and a savage behavior

Answer 583

Dorsomedial nucleus

Question 584

``` Does thermoregulation (warming) Damage causes hypothermia ```

Answer 584

Posterior nucleus

Question 585

Secretes GnRH | nucleus?

Answer 585

Preoptic area nucleus

Question 586

Which amino acids are found in nuclear localization signals

Answer 586

PAL Proline Arginine Lysine

Question 587

Cavernous sinus becomes infected. What neurological deficits

Answer 587

Ophthalmoplegia - CN III: down and out - CN VI: unable to abduct Diplopia Pain/ numbness in upper face ``` Oculomotor n. Trochlear n. Abducens n. Opthalmic div of CN V1 Maxillary div of CN V2 ```

Question 588

Nerve for 1) dorsal foot 2) lower leg 3) Sole of foot 4) lateral lower leg

Answer 588

1) Common fibular nerve 2) Sciatic n. 3) Tibial n. 4) common fibular n.

Question 589

Merkel corpuscle - adaption - sensation - location

Answer 589

Slow Static pressure Superficial

Question 590

Meissner corpuscle - adaption - sensation - location

Answer 590

Rapid Light tough Superficial

Question 591

Ruffini - adaption - sensation - location - shape

Answer 591

Slow Pressure, position sense Deep Spindle shaped

Question 592

Pacinian - adaption - sensation - location - shape

Answer 592

Rapid Vibration Deep Onion-shaped

Question 593

Previous infection In the last week -Muscle weakness in legs -Muscles weakness spread to hands and trunk - can also see

Answer 593

Guillain-Barre syndrome Bilateral facial paralysis no sensory loss

Question 594

Slowly adapting vs fast adapting

Answer 594

Slowly adapting - sends a continuous electric signal thoughout stimulus - Merkel, Ruffini Fast adapting - sends a electrical signal only at the beginning and end of continuous stimulus - Meissner, Pacinian

Question 595

Bilateral facial muscle paralysis or weakness

Answer 595

Guillain-Barre | Lyme disease with Bells palsy

Question 596

``` Abrupt onset of pain HA at the eyebrow Colored halos Rainbows of light Red teary eye, hazy cornea, fixed Mid dilated pupil (not reactive to light) Firm to palpation ```

Answer 596

Acute angle-closure glaucoma Lens against iris

Question 597

Patients complains of glare with vision | Eye sight has improved, was near sighted

Answer 597

Cataract

Question 598

White or bluish ring on periphery of cornea Elderly -due to

Answer 598

Arcus senilis Accumulation of cholesterol

Question 599

Clouding of cornea

Answer 599

Mucopolysaccharidosis (hurler syndrome) Deficient: alpha-L-iduronidase Accumulation: heparan sulfate and dermatan sulfate

Question 600

Enlarged optic disc > 50% of optic cup

Answer 600

Glaucoma

Question 601

Auditory pathway (10)

Answer 601

1) Tympanic membrane 2) Middle ear ossicles (malleus --> incus --> stapes 3) Hair cells 4) Spiral (cochlear ganglion) 5) Cochlear nuclei 6) C/L superior olivary nucleus 7) Lateral lemniscus 8) Inferior colliculus 9) Medial geniculate nucleus 10) Primary auditory cortex

Question 602

Intermittent vertigo Tinnitus Hearing loss

Answer 602

Meniere disease Imbalance of fluid and electrolyte composition of the endolymph

Question 603

Acute otitis externa organisms

Answer 603

S. aureus | Pseudomonas aeruginosa

Question 604

Acute otitis media organisms

Answer 604

S. pneumonia Nontypable Haemophilius influenzae M. Catrrhalis

Question 605

Facial angiofibromas Ash-leaf spots of depigmentation Hx of seizures Intellectual disability What neoplasms is this patient at an increased risk of developing

Answer 605

Tuberous sclerosis Cardiac rhabdomyoma Astrocytomas Angiomyolipoma

Question 606

Awake (open) Awake (closed) Non-REM stages REM stages

Answer 606

Awake (open): beta waves Awake (closed): alpha Stage N1: Theta waves Stage N2: Sleep spindles and K complexes - Bruxism (teeth grinding) Stage N3: Delta waves - Sleepwalking, night terror, bedwetting (enuresis) REM: Beta waves

Question 607

Upper motor neuron lesion classic signs LMN classic signs

Answer 607

UMN - Spastic paralysis - Hyperreflexia LMN - Flaccid paralysis - Hyporeflexia - Atrophy - Fasciculations

Question 608

What can be damaged with parotid gland surgery

Answer 608

Facial n. | Runs through parotid gland

Question 609

Common infectious organism of tonsils and adenoids Common infectious organism of salivary gland

Answer 609

S. pyogenes S. aureus, viridans group streptococci

Question 610

Tumor of parotid gland

Answer 610

Pleomorphic adenomas | benign

Question 611

Child Recurrent staphylococcus abscesses Neutrophils fail to respond because chemotactic stimuli are deficient

Answer 611

Leukocyte adhesion deficiency Hyperimmunoglobulin E syndrome

Question 612

What upper GI problem associated with findings 1) Biopsy of pt with esophagitis reveals large pink intranuclear inclusions and host cells chromatin that is pushed to the nucleus

Answer 612

HSV esophagitis

Question 613

What upper GI problem associated with findings Biopsy of a patient with esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo

Answer 613

CMV esophagitis

Question 614

An esophageal biopsy reveals a lack of ganglion cells between the inner and outer muscular layers

Answer 614

Achalasia

Question 615

Protrusion of the mucosa in the upper esophagus

Answer 615

Plummer-vinson syndrome

Question 616

Outpouching of the esophagus found just above the LES

Answer 616

Epiphrenic diverticulum

Question 617

Goblet cells seen in the distal esophagus

Answer 617

Barrett esophagus

Question 618

A PAS stain on a biopsy obtained from a patient with esophagitis reveals hyphate orgnaisms

Answer 618

Candida esophagitis

Question 619

Esophageal pouch found in the upper esophagus

Answer 619

Zenker diverticulum

Question 620

Dark urine Clay stools Jaundice - due to

Answer 620

Extrahepatic biliary atresia Incomplete recanalization of the bile duct during development of the bile duct

Question 621

Non-bilious vomiting Shortly after birth Constricting ring around duodenum -due to

Answer 621

Annual pancreas Failure of ventral pancreatic bud to rotate properly

Question 622

Mega-esophagus | Cardiomegaly

Answer 622

Chagas disease | Trypanosoma cruzi infection

Question 623

Dysphagia Glossitis And ____

Answer 623

Plummer-vinson Iron deficiency anemia

Question 624

Directly inhibits parietal cells from generating acid

Answer 624

Somatostatin

Question 625

Gastrin secreted by Secretion stimulated by

Answer 625

G cells of antrum Phenylalanine Tryptophan Calcium

Question 626

Stomach biopsy reveals neutrophils above the basement membrane, loss of surface epithelium and fibrin-containing purulent exudate

Answer 626

Acute gastritis

Question 627

What is seen in chronic gastritis

Answer 627

Stomach biopsy reveals lymphoid aggregates in the lamina propria, columnar absorptive cells and atrophy of the glandular structures

Question 628

Spiral shaped bacteria

Answer 628

H. pylori

Question 629

A 54 y.o male presents with abdominal pain, diarrhea, bilateral lower extremity edema and 5 lb weight loss over last 3 months. An esophagogastroduodenoscopy is performed and cerebriform rugae are observed throughout the body of the stomach. A biopsy of the region shows an abundance of mucous cells forming glands in the shape of corkscrews, but very few parietal and chief cells. most likely diagnosis is - increased risk of

Answer 629

Menetrier disease Gastric adenocarcinoma

Question 630

Menetrier disease 5 things

Answer 630

1. Hypertrophy of mucous producing cells, rugae of stomach hypertrophy look like gyri 2. Atrophy of parietal cells 3. Decrease gastric acid production 4. Enteric protein loss --> hypoalbuminemia --> edema 5. Increase risk of gastric adenocarcinoma

Question 631

Signet ring cell in ovary

Answer 631

Krukenberg tumor gastric cancer metasisi to ovary

Question 632

Non bilious projectile vomiting | Palpable oliver mass in epigastric

Answer 632

Pyloric stenosis - pylorus is hypertrophied - narrowing of gastric outlet

Question 633

What enzymes do obligate anaerobes lack

Answer 633

Catalse | Superoxide dismutase

Question 634

WHich mycobacterium species fits each 1) Causes leprosy 2) Causes pulmonary TB-like symptoms in COPD patients 3) Causes cervical lymphadenitis in children 4) Cuases a disseminated disease in AIDS patients 5) Associated iwth hand infection in aquarium handlers

Answer 634

1) Myco. leprae 2) Myco. kansasii 3) Myco. scrofulaceum 4) Myco. avium intracellulure (MAI) Myco. avium complex (MAC) 5) Myco. Marinum

Question 635

Stimulates gallbladder contraction Faciliates pancreatic HCO3 secretion Increase insulin release Inhibits secretion of all GI hormones Relaxes smooth muscle and sphincter through out GI Produces peristaltic waves

Answer 635

Cholecystokinin (CKK) - I cells - Gall bladder contraction, decrease gastric emptying, increase pancreatic secretion Secretin - S cells - Neutralize gastric acid - Decrease gastric acid production Gastric inhibitory peptide (GIP) - K cells - Decrease gastric acid production - Increase insulin release Somatostatin - D cells in GI tract - delta cells in pancreas Vasoactive intestinal peptide (VIP) - Relaxes smooth m and sphincter - Increase secretion of electrolytes and water - Copious watery diarrhea Motillin

Question 636

Hepatoduodenal ligament contains

Answer 636

Portal triad - Hepatic artery - portal vein - common bile duct

Question 637

Retroperitoneal

Answer 637

``` SAD PUCKER Suprarenal (adrenal) glands Aorta Duodenum (2nd-->4th part) Pancreas (not tail) Ureters Colon (ascending and descending) Kidney Esophagus (lower 2/3) Rectum ```

Question 638

Four obligate aerobic bacteria

Answer 638

Nagging Pest Must Breathe Nocardia Pseudomonas aeruginosa Mycobacterium tuberculosis Bacillus

Question 639

Carbohydrate breakdown and transport

Answer 639

Carbs - immediately: salivary amylase in mouth Carbs --> disaccharides (pancreatic amylase) Disaccharides --> monosaccharides (intestinal brush border) Sodium dependent transport - GLucose - Galactose ``` Faciliate diffusion (GLUT5) - Fructose ```

Question 640

Protein breakdown and transport

Answer 640

Protein --> Amino acids & dipeptides, tripeptides (pancreatic proteases) Sodium dependent transport - Amino acids Hydrogen gradient - dipeptides, tripeptides

Question 641

Lipid breakdown and transport

Answer 641

Lipids --> triacylglycerol ( salivary lipase, stomach) Triacylglycerol --> Fatty acids, 2-monoacylglycerol ( Pancreatic lipase) Bile acids emulsify hydrolyzed product Forms micelles --> Triglycerides, cholesterol Gets balled up into chylomicrons, transported to liver

Question 642

Location of absorption Iron Folate Vit B12

Answer 642

Duodenum Duodenum and jejunum Terminal ileum

Question 643

Bite cell

Answer 643

G6PD deficiency Due to removal of Heinz bodies by macrophages in the spleen

Question 644

``` Deficiency ApoB-48, ApoB-100 Malabsorptive Steatorrhea Failure to thrive Ataxia acanthocyes "spur cell" on microscope Lipid-laden enterocytes ``` - inheritence - mutation - missing - later manifestations - tx

Answer 644

Abetalipoproteinemia AR Mutation in gene that encodes for microsomal transfer protein (MTP) Chylomicrons, VLDL and LDL absent Retinitis pigmentosa progressive ataxia acanthocytosis Restriction of long chain fatty acids Large doses oral Vit E

Question 645

``` Defective ApoB-100 Increased LDL, cholesterol, VLDL Premature atherosclerosis Tendon xanthomas Xanthelasmas ```

Answer 645

Familial hypercholesterolemia - AD - Absent LDL receptors Defective LDL particle uptake by hepatocytes

Question 646

``` Deficiency ApoC-2 Increased chylomicrons Acute pancreatitis Lipemia retinalis Eruptive xanthomas ```

Answer 646

Familial chylomicronemia AR Creamy white retinal blood vessels Localized lipid deposits in skin, red bumps

Question 647

Deficiency ApoE Premature atherosclerosis Lipid droplets in palms of hand Lipid laden macrophages What is impaired

Answer 647

Familial dysbetalipoprotenemia Chylomicron remnant uptake by liver cells Increase chylomicron and VLDL remnants

Question 648

Celiac disease Ab to

Answer 648

Gliadin | Tissue transglutaminase

Question 649

``` Weight loss Lymphadenopathy Hyperpigmentation Cardiac symptoms Arthralgias Neurlogic symptoms PAS+ Foamy macrophages in lamina propria ```

Answer 649

``` Whippe disease Tropheryma whipplei (Gram +) ``` Penicillin Ampicillin Tetracycline

Question 650

Small intestinal mucosa laden with distended macrophages in the lamina propria

Answer 650

Whipple disease

Question 651

Horrible abdominal pain Mild tenderness to palpation Dilated loops of bowel Bowel wall thickening

Answer 651

Intestinal ischemia

Question 652

Blood supply proximal to pectinate line Blood supply distal to pectinate line

Answer 652

Superior rectal artery from inferior mesenteric artery Inferior rectal artery (br. of pudendal a.)

Question 653

Peutz-Jeghers syndrome

Answer 653

AD Multiple benign hamartomas in GI tract Hyperpigmented areas on lips, mouth, hands genitalia Increase risk of malignancy

Question 654

Colon cancer APC pathway

Answer 654

``` Loss of APC gene K-RAS mutation Loss of tumor suppressor genes -p53 - DCC (chr 18q) ```

Question 655

colon cancer microsatellite pathway

Answer 655

Loss common HNPCC (lynch) Dysfunction of DNA mismatch repair enzymes

Question 656

LOTs of polyps

Answer 656

Familial adenomatous polyposis | AD mutation of the APC gene

Question 657

Gardner syndrome (4)

Answer 657

Familial adenomatous polyposis Bone and soft tissue tumors Lipomas Retinal hyperplasia

Question 658

Lynch syndrome

Answer 658

HNPCC Nonpolyposis colorectal cancer AD Proximal colon cancer

Question 659

Patient with urinary tract infection caused by Proteus vulgaris is at risk for what type of renal stone

Answer 659

Ammoniummagnesium phosphate stones (Staghorn calculi)

Question 660

Chlamydophila psittaci Chlamydophila pneumoniae Chlamydia trachomatis - A, B, C - D-K - L1 L2 L3

Answer 660

Chlamydophila psittaci - bird exposure - pneumonia Chlamydophila pneumoniae - interstitial pneumoniae - walking pneumonia Chlamydia trachomatis - A, B, C (trachoma eye infxn) - D-K (PID, urethritis, conjunctivitis) - L1 L2 L3 (lymphogranuloma venerum, primary ulcer and LAD)

Question 661

Ventral pancreatic bud --> Dorsal pancreatic bud -->

Answer 661

Ventral --> uncinate process, part of head of pancreas, proximal portion of main pancreatic duct Dorsal --> Body and tail, most of head (superior aspect) , small accessory pancreatic duct

Question 662

What tells the pancreas to start secreting

Answer 662

CCK Vagus n. Secretin

Question 663

Pancreatitis causes

Answer 663

``` "Pancreatitis" hyperParathyroidism** Alcohol** Neoplasm Choleithiasis** Rx (drugs)** ERCP** Abdominal surgery hyperTriglyceridemia ** Infection Trauma Idiopathic Scorpion sting ```

Question 664

Sit wont sit down Severe pain radiates to back What will be elevated

Answer 664

Acute pancreatitis Increased serum lipase

Question 665

Painless jaundice -markers

Answer 665

Pancreatic adenocarcinoma CD19-9 CEA

Question 666

Trousseua syndrome

Answer 666

Hypercoagulability Venous thrombosis Migratory thrombophlebitis Associated with pancreatic cancer

Question 667

A 59-year-old man with no prior medical history presents to the physician with marked hyperglycemia, diarrhea, and weight loss. A CT scan of the abdomen reveals a pancreatic mass. A trial period on an oral hypoglycemic agent has not helped reduce his glucose levels. His physical examination is signifi cant for the rash shown in the image. Which of the following is the most likely diagnosis?

Answer 667

Glucagonoma Tx Octreotide

Question 668

Pancreatic mass Increased insulin Hypoglycemia Elevated C- peptide

Answer 668

Insulinoma

Question 669

``` Pancreatic mass Hyperglycemia Steatorrhea Gallstones Decrease hydrocholic acid (achlorhydria) ```

Answer 669

Somatostatinoma

Question 670

Young child has recurrent lung infections and granulomatous lesions. This is most likely due to what underlyign defect in neutrophils

Answer 670

Chronic granulomatous disease Deficiency of NADPH oxidase

Question 671

Spore forming bacteria

Answer 671

Bacillus anthracis Bacillus cereus Clostridum spp (perfringens, tetani, botulinum, difficle) Coxiella burnetti

Question 672

6 month old gets flaccid paralysis after eating honey. Organism? MOA?

Answer 672

Clostridum botulinum Inhibits release of acetylcholine

Question 673

``` Jaundice male neonate Lethargic Icterus of skin and sclerae Muscle tone decreased Liver no enlarged Total bilirubin high Normal direct bilirubin ``` Phenobarbital does not lower bilirubin levels

Answer 673

Unconjugated hyperbilirubinemia Crigler-najjar Syn (type I)

Question 674

hCG stimulates corpus luteum to produce progesterone until placenta takes over at

Answer 674

8 weeks

Question 675

Adult vs fetal hemoglobin

Answer 675

Adult - Two alpha - two beta Fetal - two alpha - two gamma

Question 676

What allows bilirubin to be taken out of blood

Answer 676

UDP-glucuronyl transferase

Question 677

A healthy 25 y.o man comes in to routine examination. His lab tests show a serum bilirubin level of 4 mg/dL and a direct bilirubin of 0.3 mg/dL. Liver fxn tests are nromal. Which of hte following explains the serum and indirect bilirubin levels

Answer 677

B. Glucuronosyltransferase deficiency Gilbert

Question 678

Phenobarbital in Crigler Najjar

Answer 678

Phenobarbital Type II have decrease in bilirubin Type I no change

Question 679

New born presents with kernicterus, jaundice adn elevation of serum unconjugated bilirubin. Patient dies after 1st birthday. Most likely had a deficiency of?

Answer 679

Uridine diphosphate-glucuronsltransferase Crigler-Najjar tyep I

Question 680

Autopsy of patient has black liver

Answer 680

Dubin Johnson Increase direct bilirubin

Question 681

Increased direct bilirubin | no black liver

Answer 681

Rotor syndrome

Question 682

Encapsulated bacteria? Test for encapsulated bacteria

Answer 682

Even Some Pretty Nasty Killers Have Shiny Bodies ``` E.coli Strep pneu. Pseudomonas Neisseria meningitis Klebsiella H. influenza Salmonella B Group B strep ``` Quellung rxn

Question 683

A 39-year-old white woman who suffers from polycythemia vera presents to the clinic complaining of severe and constant right upper quadrant pain over the past 2 days. Physical examination reveals an enlarged liver. What other finding would most likely be seen at presentation? (A) Ascites (B) Asterixis (C) Esophageal varices (D) Hyperpigmented skin (E) Spider angiomata

Answer 683

A. Ascites Budd-chiari

Question 684

A 34-year-old woman who is at 26 weeks of gestation and who has a history of multiple spontaneous abortions presents with severe abdominal pain, jaundice, ascites, and mental status change. Ultrasonography reveals an obscure hepatic venous connection to the inferior vena cava and absence of any waveform in the hepatic veins. She has a positive serum antiphospholipid antibody titer. Which of the following is the most likely diagnosis? (A) Budd-Chiari syndrome (B) Congestive heart failure (C) Polymyalgia rheumatica (D) Portal vein thrombosis (E) Veno-occlusive disease

Answer 684

A. Budd-chiari syndrome Complete obstruction to blood flow by acute clot in hepatic veins or inferior vena cava Hepatomegaly Pain Ascites Jaundice

Question 685

A 57-year-old white man presents to his primary care physician with dyspnea. He says that he likes to maintain his yard and garden, but that he has recently had trouble doing the work, and becomes short of breath even walking up the one fl ight of stairs in his house. On further questioning, he says that sometimes he wakes up short of breath in the middle of the night. Physical examination demonstrates pitting ankle edema. Which of the following fi ndings would also be expected in this patient? (A) Decreased sympathetic outfl ow (B) Decreased venous pressure (C) Increased aldosterone secretion (D) Increased effective arterial blood volume (E) Increased glomerular fi ltration rate

Answer 685

C. increased aldosterone secretion CHF

Question 686

A 26-year-old man presents to the clinic with bradykinesia, rigidity, and resting tremor. Serum aminotransferase levels are mildly elevated. A liver biopsy is shown in the image. What is the chance that this patient’s sister will have the same condition?

Answer 686

B. 25% Wilsons disease

Question 687

A 19-year-old woman is bothered by a tremor at rest, which becomes progressively worse over the next 6 months. She exhibits paranoid ideation with auditory hallucinations and is diagnosed with an acute psychosis. On physical examination, she has scleral icterus. A slit lamp examination shows corneal Kayser-Fleischer rings. Laboratory findings include total serum protein, 5.9 g/dL; albumin, 3.1 g/dL; total bilirubin, 4.9 mg/dL; direct bilirubin, 3.1 mg/dL; AST, 128 U/L; ALT, 157 U/L; and alkaline phosphatase, 56 U/L. Which of the following additional serologic test findings is most likely to be reported in this patient? A Decreased α1-antitrypsin level B Decreased ceruloplasmin level C Increased α-fetoprotein level D Increased ferritin level E Positive antimitochondrial antibody F Positive HbsAg

Answer 687

B. Decreased ceruloplasmin level Wilson disease

Question 688

``` Cirrhosis Diabetes Hyperpigmentation CHF Testicular atrophy ```

Answer 688

"Bronze diabetes" Hemochromatosis INcreased risk of HCC AR disease - HFE gene --> makes hepcidin Increased ferritin

Question 689

Lung and liver disease

Answer 689

Alpha 1 antitrypsin disease AD Impaired ability to protect organs for elastase

Question 690

What three bacteria are obligate intracellular bacteria

Answer 690

Rickettsia Coxiella Chlamydia

Question 691

Hepatitis A - type - genus - family - transmission - infection type - signs

Answer 691

ssRNA virus non-enveloped Hepatovirus Picronavirus Fecal/oral, poor sanitation Acute Fever, vomiting, jaundice, RUQ pain

Question 692

Hepatitis E - type - genus - family - transmission - infection type - More likely to cause fulminant hepatic failure in

Answer 692

ssRNA Hepevirdae Orthohepevirus Fecal/oral route, contaminated water Acute Pregnant women

Question 693

Hepatitis B - type - genus - family - transmission - infection type - Tx

Answer 693

ds DNA Orthohepadnavirus Hepadnaviridae Perinatally, sexual contact, blood Chronic Tenofovir

Question 694

Hepatitis D - type - genus - family - transmission - infection type - feature - Tx

Answer 694

ssRNA deltavirdae Blood, sexual contact Infects w/ hepatitis B Chronic Pegylated IFN-alpha

Question 695

Hepatitis C - type - genus - family - transmission - infection type - Tx

Answer 695

ssRNA hepacivirus Flavivirdae Blood, sexual contact Chronic Ledipasvir-sofosbuvir Ombitasvir-paritaprevir-ritonavir + dasabuvir

Question 696

ANA | anti-smooth muscle Ab

Answer 696

Autoimmune hepatitis | Type 1

Question 697

Anti-liver-kidney microsomal Ab | Anti-liver cytosol antibody

Answer 697

Autoimmune hepatitis | Type 2

Question 698

Coarse facial features Abscesses Eczema

Answer 698

Hyper IgE syndrome T cell

Question 699

Thrombocytopenia Purpura Infections Eczema

Answer 699

Wiskott aldrich B cell disorder

Question 700

Delayed separation of umbilicus

Answer 700

Leukocyte adhesion deficiency

Question 701

Neurologic defects, partial albinism | recurrent infections

Answer 701

Chediak-Higashi syndrome

Question 702

P450 enzymes in the liver are found in what zone of hepatic lobule

Answer 702

Zone 3

Question 703

Beads on a string + pANCA - due to - tx

Answer 703

Primary sclerosing cholangitis (PSC) COncentric fibrosis of bile ducts liver transplant

Question 704

A 43-year-old man with a 20-year history of ulcerative colitis presents to the physician with complaints of worsening bloody diarrhea, progressive fatigue, pruritus, visual disturbances, and arthralgias. On physical examination, he is found to have icteric sclera, fi nger clubbing, and several small ulcerations with necrotic edges on both legs. Endoscopic retrograde cholangiopancreatography (ERCP) shows alternating strictures and dilations of the bile ducts. Which of the following conditions is consistent with these ERCP fi ndings? (A) Cholelithiasis (B) Pancreatic carcinoma (C) Primary biliary cirrhosis (D) Primary hemochromatosis (E) Primary sclerosing cholangitis

Answer 704

(E) Primary sclerosing cholangitis

Question 705

25. A 46-year-old white woman with rheumatoid arthritis presents with severe pruritus. She denies any history of alcohol or drug use. On physical examination, she is found to have icteric sclera, palpebral xanthomas, and hepatomegaly. She tests positive for antimitochondrial antibody and increased alkaline phosphatase activity. Which of the following is most likely responsible for this patient’s presentation? (A) Destruction of intrahepatic bile ducts (B) Hepatic parenchymal destruction (C) Obstruction of extrahepatic bile ducts (D) Portal vein thrombosis (E) Stenosis of extrahepatic and intrahepatic bile ducts

Answer 705

(A) Destruction of intrahepatic bile ducts The triad of jaundice (icteric sclera), hypercholesterolemia (palpebral xanthomas), and pruritus with positive antimitochondrial antibody titers and elevated alkaline phosphatase activity is classic for primary biliary cirrhosis. Primary biliary cirrhosis is a cholestatic disease with chronic, progressive, and often fatal liver injury characterized by the destruction of medium-sized intrahepatic bile ducts with eventual liver failure. Liver transplantation is the defi nitive treatment.

Question 706

25. A 46-year-old white woman with rheumatoid arthritis presents with severe pruritus. She denies any history of alcohol or drug use. On physical examination, she is found to have icteric sclera, palpebral xanthomas, and hepatomegaly. She tests positive for antimitochondrial antibody and increased alkaline phosphatase activity. Which of the following is most likely responsible for this patient’s presentation? (A) Destruction of intrahepatic bile ducts (B) Hepatic parenchymal destruction (C) Obstruction of extrahepatic bile ducts (D) Portal vein thrombosis (E) Stenosis of extrahepatic and intrahepatic bile ducts

Answer 706

(A) Destruction of intrahepatic bile ducts The triad of jaundice (icteric sclera), hypercholesterolemia (palpebral xanthomas), and pruritus with positive antimitochondrial antibody titers and elevated alkaline phosphatase activity is classic for primary biliary cirrhosis. Primary biliary cirrhosis is a cholestatic disease with chronic, progressive, and often fatal liver injury characterized by the destruction of medium-sized intrahepatic bile ducts with eventual liver failure. Liver transplantation is the defi nitive treatment.

Question 707

A 42-year-old woman comes to the physician with severe itching for the past 4 days. Her physical examination is signifi cant for hepatomegaly and three xanthomas on her right lower extremity. Laboratory studies reveal a normal total bilirubin level and elevated serum cholesterol and alkaline phosphatase levels. A liver biopsy shows granulomatous destruction of medium- sized intrahepatic bile ducts. Which of the following autoantibodies is most likely to be signifi cantly elevated in this patient? (A) Anticentromere antibodies (B) Antihistone antibodies (C) Antimitochondrial antibodies (D) Antinuclear antibodies (E) Rheumatoid factor

Answer 707

C. anti mitochondrial ab primary biliary cholangitis (cirrhosis)

Question 708

Granulomas Cirrhosis Middle age female Anti-mitochondrial antibody - due to - tx

Answer 708

Piarmy biliary cholangitis (PBC) Autoimmune T cells attack bile ductules within teh liver parenchyma Ursodiol (ursodeoxycholic acid) - bile acid that decreases the synthesis of cholesterol in the liver Liver transplant

Question 709

Lysosomal storage disease - accumulation of CM2 ganglioside - associated with renal failure

Answer 709

Tay-Sach Fabry disease

Question 710

Inhaled coin goes where

Answer 710

Right mainstem bronchus

Question 711

Physiologic dead space equation

Answer 711

Vd= Vt x (PaCO2- PeCO2)/ PaCO2 ``` Vd= dead space Vt= tidal volume PaCO2= Pco2 arterial PeCO2= Pco2 expired air ```

Question 712

Pulmonary vascular resistance equations P= R=

Answer 712

P= Q x R Q= perfusion ``` R= 8 nl/ #R^4 n= viscosity l= length of vessel r= radius #= pie ```

Question 713

Beta 2 stimulation

Answer 713

INcrease radius | Decrease resistance

Question 714

Moves oxygen hemoglobin dissociation curve right (5)

Answer 714

``` Co2 Acidosis Increase 2,3 DPG Increase exercise Increase temp ```

Question 715

Form of hemoglobin that has low affinity for oxygen - what favors this form

Answer 715

Taut (T form) Favors tissues, give up oxygen readily Favor the T form - Co2 - H - Increased temp - 2,3 DPG

Question 716

Hemoglobin with high affinity for oxygen

Answer 716

R form (relaxed)

Question 717

Methemoglobin - form - affinity - causes - caused by - tx

Answer 717

Ferric form (3+) of iron Decreased affinity for oxygen Increased affinity for cyanide --> Tissue hypoxia ``` Nitrates and nitrites Antimalarial drugs (Chloroquine, primaquine) Dapsone Sulfonamide Local anesthetics (lidocaine) Metoclopramide ``` Tx - Methylene blue - Vit C - Cimetidine (gradually lowers)

Question 718

Which immunodeficiency matches 1) Neutrophils fail to respond to chemotactic stimuli 2) Adenosine deaminase deficiency 3) Failure of endodermal development 4) Defective tyrosine kinase gene 5) Associated wth high levels of IgE and eosinophils

Answer 718

1) Leukocyte adhesion deficiency 2) Hyper IGE syndrome 3) SCID 4) Bruton agammaglobulienmia 5) Hyper IgE syndrome

Question 719

What occurs in COPD with oxygen levels

Answer 719

Decrease arterial PO2 Physiologic shunt Decrease O2 extraction ration Decreases blood O2 content

Question 720

Alveolar gas equation

Answer 720

PAo2= PIo2- PaCo2/ R PAo2= 150 - PaCO2/0.8

Question 721

CAG - cause - inheritence - signs CGG - cause - inheritence - signs CTG - cause - inheritence - signs GAA - cause - ineritence - signs

Answer 721

Huntington disease - AD - - Fragile X syndrome - gene hypermethylation - X linked dominant - Protruding chin, giant gonads Myotonic dystrophy - AD - Cataracts, Toupee (early balding) , gonadal atrophy Friedreich ataxia - AR - Ataxic gait

Question 722

Defects in DNA mismatch repair

Answer 722

Lynch syndrome increased risk of hereditary non-polyposis colorectal cancer (HNPCC)

Question 723

``` Headache fever inattentiveness Chemotherapy Increased opening pressure Increased protein, low glucose Image: Cds ``` Tx.

Answer 723

Cryptococal meningoencephalitis Initial: Amphotericin B Flucytosine Long term maintenance therapy: Fluconazole

Question 724

Left ventricular myocardial blood supply occurs when

Answer 724

During diastole Ventricle is relaxed

Question 725

Intrapleural pressure when airway pressure is zero

Answer 725

-5 --> -7.5 with inspiration

Question 726

Manic vs hypomanic

Answer 726

Manic - severe - 1 week - May have psychotic features Hypomanic - >= 4 consecutive days

Question 727

Bipolar I Bipolar II Cyclothymic disorder

Answer 727

Bipolar 1 - Manic episode - Depressive episode common Bipolar 2 - Hypomanic - >1 major depressive episode Cyclothymic - >2 years fluctuating, mild hypomanic, depressive symptoms

Question 728

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

Answer 728

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

Question 729

``` Conjunctiva pallor SOB Constipation Decreased concentration Microcytic anemia - Decreased MCV ``` What do you see on peripheral smear?

Answer 729

Lead poisoning Basophilic stippling

Question 730

1) Heinz bodies 2) Howell-Jolly bodies 3) RIng sideroblasts 4) Schistocytes 5) Basophilic stippling

Answer 730

1) Inclusions of denatured hemoglobin after Oxidant stress in pts w/ G6PD deficiency 2) DNA remnant incusion in peripheral RBC taht are normal removed by spleen, indicates decreased or absent splenic function 3) Formed from precipitation of iron granules in developing erythrocytes due to defect in heme synthesis pathway (See in bone marrow no peripheral smear) 4) Are fragments of RBC formed from mechanical hemolysis, hemolytic uremic syndrome, thrombocytopenic purpura, and disseminated intravascular coagulation

Question 731

Lactose deficiency see what in intestine

Answer 731

Normal

Question 732

Tennis elbow | - muscle

Answer 732

Lateral epicondylitis Wrist extension Extensor carpi radialis brevis

Question 733

Prophylactic medication Jaundice Dark urine RBC w/ dark inclusions -inheritence pattern?

Answer 733

G6PD deficiency Heinz bodies X recessive

Question 734

Relative erythrocytosis

Answer 734

aka Relative Polycythemia Normal RBC mass Decrease in plasma volume

Question 735

``` Fever Headache Nuchal rigidity Normal glucose elevated protein ```

Answer 735

Aseptic meningitis Enteroviruses - coxsackievirus - echovirus - poliovirus

Question 736

Ovarian cancer risk factors

Answer 736

Repeat ovulation | - nulliparity

Question 737

Failure to thrive Developmental delay Cant lift head Orotic acid crystals Supplementation of what is needed?

Answer 737

Hereditary orotic aciduria - AR - disorder of pyrimidine synthesis - defect in uridine 5- monophosphate (UMP) synthase Supplement Uridine

Question 738

Ascorbic acid

Answer 738

Vit C

Question 739

Posterior left 12th rib fracture injury Anterior right rib 8-11 fracture Anterior left ribs 8-11 fracture Fracture ribs 1-6

Answer 739

L kidney R liver Spleen visceral pleural of lungs

Question 740

Changes what gene expression 1) 14;18 2) 9;22 3) 8;14 4) Breast cancer

Answer 740

1) Follicular lymphoma - Bcl-2 overexpression 2) CML - Bcr-abl 3) Burkitt lymphoma - C-myc overexpression 4) Erb-B2 overexpression, HER2

Question 741

Increased hemoglobin=

Answer 741

Erythrocytosis Excess erythropoietin porduction

Question 742

1) Linear IgG and C3 deposits on IF microscopy 2) Glomerular basement membrane splitting 3) Glomerular basement fibrin deposition 4) Subepithelial humps on electron microscopy 5) Diffuse capillary wall thickening on light microscopy 6) Glomerular crescents on LM 7) C3 granular straining along GBM

Answer 742

1) Anti-GBM disease 2) Membranoproliferative glomerulonephritis (MPGN) and Alport syndrome 3) Rapidly progressive glomerulonephritis (anti-gbm) 4) Poststreptococcal glomerulonephritis 5) Membranous glomerulopathy 6) Rapidly progressive glomerulonephritis, Anti- GBM disease 7) Poststreptococcal glomerulonephritis

Question 743

Metabolic vs respiratory compensation

Answer 743

Metabolic acidosis - Decrease pH - Decrease PCo2 - Decrease HCO2 Respiratory acidosis - Decrease pH - Increase PCO2 - Increase HCo2 PCO2= 1.5 [HCO3] + 8 (+-2)

Question 744

Rapid onset sepsis Altered consciousness Organ failure Petechial/ ecchymotic rash virulence factor

Answer 744

N. meningitidis Lipo-oligosaccharide (LOS)

Question 745

Reaction rate in skeletal muscles is dependent on ____ which is activated by

Answer 745

Phosphorylase kinase (PK) Ca

Question 746

Skeletal pain Deformity (bowing of legs) Focal warmth

Answer 746

Paget disease

Question 747

How HIV attaches

Answer 747

Attaches to host cells using the viral surface glycoprotein gp120 This glycoprotein bins to teh CD4 as the primary receptor and teh chemokine receptor CC45 as the coreceptor Conformation change in gp120 exposes teh underlying transmembrane glycoprotien gp41 which mediates viral fusion

Question 748

Nef | tat

Answer 748

HIV regulatory genes Nef: downregulates teh expression of class I major histocompatibility complex proteins on teh surface of infected cells, limits immune recognition by cytotoxic T cells tat: is a transcriptional activator that promotes viral gene expression

Question 749

(+) for synaptophysin Chromogranin neuron-specific enolase

Answer 749

Small cell carcinoma of the lung | Carcinoid tumor

Question 750

Temporal hemorrhage affects what nerve

Answer 750

Herniation CN III

Question 751

Missouri caves

Answer 751

Histoplasma capsulatum Macropahges iwth intracellular small yeasts

Question 752

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

Answer 752

1) Cryptococcus neoformans - bird droppings - immunocompromised - meningoencephalitis 2) Histoplasma capsulatum - Missouri caves - fever nonproductive cough 3) Coccidioides immitis - pulmonary disease 4) Aspergilus fumigatus - V shaped branching - AIDS 5) Candida species - immunocompromised

Question 753

Pig farmer

Answer 753

Loeffler syndrome Ascaris infection Eosinophilic invasion due to parasitic infection

Question 754

Most common cause of viral conjunctivitis

Answer 754

Adenovirus Ds non enveloped linear DNA virus

Question 755

Listeria is acquired how

Answer 755

Contaminated food Unpasteurized milk Uncooked meats

Question 756

Decrease in RPF causes what in GFR and FF

Answer 756

Decrease in GFR | Increase FF

Question 757

Anti cholinergic effects

Answer 757

``` Hot as a hare Dry as a bone Red as a beet Blind as a bat Mad as a hatter Full as a flask Fast as a fiddle ```

Question 758

Alpha 1 agonist effects

Answer 758

increase smooth muscle tone of iris dilator (mydriasis) Blood vessel constriction Vasoconstriction reduce nasal congestion

Question 759

DNA binding protein

Answer 759

c-Jun c-Fos

Question 760

Chalky white lesions in mesentery, fat cell destruction and calcium depositions Abdominal pain

Answer 760

Acute pancreatitis

Question 761

Infection from puppy

Answer 761

Campylobacteri jejuni

Question 762

Exertional shortness of breath Progressive dyspnea Lightheadness during exertion Tricuspid regurg

Answer 762

Pulmonary hypertension

Question 763

Glucagon MOA

Answer 763

Increases hepatic glucose production via glycogenlysis and gluconeogenesis

Question 764

What can you suffer from if to quick nitroprusside infusion tx

Answer 764

cyanide toxicity tx sulfur

Question 765

Nissl substance

Answer 765

Normal axonal injury reaction

Question 766

VSD sign

Answer 766

holosystolic murmur over left sternal border

Question 767

Fundal varices

Answer 767

splenic vein thrombosis

Question 768

COPD exacerbation due to

Answer 768

virus: rhinovirus, influenza virus, parainfluenza (most common) bacterial: h. influenza, moraxella catarrhalis, strep. pneumoniae

Question 769

Hyperventilation results in

Answer 769

Decrease in arterial partial pressure of CO2

Question 770

Wrinkles due to

Answer 770

Decrased collagen fibril production

Question 771

Increase RBC | Intense itching after showering

Answer 771

Polycythemia vera Mutation Jak2 Hematopoietic cells more sensitive to growth factors Decrease EPO

Question 772

Projection

Answer 772

Think wife is cheating cause they are

Question 773

Displacement

Answer 773

Mad at boss yells at wife

Question 774

Transference

Answer 774

See psychiatrist as parent

Question 775

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

Answer 775

H. influenzae type B thumb sign

Question 776

Child sticking nose in air

Answer 776

Esophagitis | H. infuenzae type B

Question 777

Cyst in brain Not IC Seizures

Answer 777

Taenia solium Pork tapeworm Feces contaminated food

Question 778

Mutations in pol gene in HIV patient

Answer 778

Inconsistent use of antiretroviral--> antiretroviral resistance

Question 779

Patient in shocks gets IV fluids causes

Answer 779

increase in preload Stretches myocardium Increases the end-diastolic sarcomere length

Question 780

Levothyroxine supplement TSH <0.01 Risk

Answer 780

Too high supplement Atrial fibrillation

Question 781

Copper is eliminated

Answer 781

hepatic excretion into bile

Question 782

Corynebacterium diphtheriae is virulent how

Answer 782

phage conversion permitting exotoxin production

Question 783

Permissive effect

Answer 783

One hormone allows another to exert it s maximal effect

Question 784

``` Lethary confusion Persistent atrial fibrillation CHF Nauseas and decreased appetitie, vomiting Vision difficulties ``` Hyperkalemic

Answer 784

Digoxin toxicity

Question 785

Nitrates MOA

Answer 785

Venodilators (large veins) Increase peripehral venous capacitance --> reducing cardiac preload and left ventricular end-diastolic pressure adn volumne

Question 786

Release of NE from peripheral autonomic nerve terminals will effect

Answer 786

sympathetic output to the detrusor muscle Most organs Smooth muscle glands

Question 787

``` Fever Lethargy urinalysis: positive for proteinuria and hematuria Decreased hemoglobin Elevated reticulocyte count Decreased platelet GI illness scattered petechial rash ``` renal biopsy

Answer 787

Thrombocytopenic thrombotic purpura-hemolytic uremic syndrome Platelet rich thrombi in glomeruli and arterioles

Question 788

Crescent- shaped mass of cellular proliferation and leukocytes

Answer 788

RPGN macroscopic hematuria HTN Progressive renal failure Good pasture

Question 789

Diffuse proliferation and subepithelial immunoglobulin deposits

Answer 789

Post streptococal glomerulonephritis

Question 790

Mesangial IgA deposition and proliferation

Answer 790

Henoch-Schonlein purpura Palpable purpura arthritis

Question 791

Patchy necrosis of tubular epithelium and loss of basement membrane

Answer 791

Acute tubular necrosis Rising creatinine Muddy brown granular casts on urinarlysis

Question 792

RB mutation BRAF HER2 KRAS RET

Answer 792

RB: Retinoblastoma, osteosarcoma BRAF: Hairy cell luekemia, melanoma HER2: breast cancer KRAS: colorectal cancer, non-small cell lung cancer RET: MEN2

Question 793

Calculate False positives Study enrolled 300 patients, 100 have a UTI by urinalysis. New dipstick test 70% sensitive and 90% specific

Answer 793

``` 0.9= D/ 200 TN= 180 ``` False positive= 200-180= 20

Question 794

Diarrhea HIV patient Hemorrhagic nodules or polypoid masses Spindle cells

Answer 794

Kapsoi sarcoma | -HHV8

Question 795

What can not be metabolized to pyruvate and cause more lactic acid if pyruvate dehydrogenase deficiency

Answer 795

Lysine Leucine Ketogenic AA

Question 796

Myeloid cells

Answer 796

``` Myeloblast Metamyelocyte Band Neutrophils Basophils Eosinophils ```

Question 797

UV damage

Answer 797

formation of abnromal covalent bonds between adjacent thymine or cytosine rediues (pyrimidien dimers)

Question 798

Hemosiderin laden macrographes

Answer 798

Chronic passive lung congestion in setting of heart failure (left ventricular systolic dysfunction

Question 799

Collagen synthesis occurs when

Answer 799

RER proline and lysine residues are hydroxyalted Vit C cofactor here

Question 800

Internal hemorrhoid above pectinate line drain into External hemorrhoids drain

Answer 800

Superior rectal vein from inferior mesenteric vein External drain via inferior rectal vein into internal pudendal vein which communicates with internal iliac veins

Question 801

Branches of deep external pudendal artery supply the External iilac vein receives drainage from Left colic artery branches off, supplies The superior vesical artery supplies

Answer 801

Supply the scrotum and labia majora External iliac vein receives drainage from the inferior epigastric and deep circumflex iliac veins, serve the anterior abdominal wall and iliac crest respectively Branches of inferior mesenteric a. to supply the transverse and descending colon portions of the urinary bladder and ductus deferens

Question 802

Complications of herpes zoster

Answer 802

long term residual pain postherpetic neuralgia

Question 803

Beta 1 receptor found

Answer 803

Cardiac tissue Renal JC cells Not vascular smooth muscle Nonselective beta blocker who affect all three

Question 804

Vit B12 deficiency Type 1 DM Hashimoto thyroiditis

Answer 804

Pernicious anemia CD4 mediated immune response against parietal cells Loss of parietal cells mass - decrease in intrinsic factor - decreased secretion of hydrochloric acid Elevated pH that stimulates gastrin secretion

Question 805

Tx for alcohol wanting to quit with help

Answer 805

Naltrexone

Question 806

Apolipoprotein E4 allele

Answer 806

At risk Alz disease

Question 807

Oval budding yeast forms germ tubes at 37 C

Answer 807

``` Candida albicans (true hyphae at 37) ``` Normal commensal of skin and GI

Question 808

Small ovoid yeast in lungs

Answer 808

Histoplasma capsulatum - dimorphic - inhaled as microconidia - pneumonia

Question 809

Noncardiogenic pulmonary edema can be distinguished from cardiogenic pulmonary edema by a

Answer 809

normal pulmonary capillary wedge pressure

Question 810

Pancreatitis SOB adn hypoxemia New bilateral opacities

Answer 810

Acute respiratory distress syndrome Indirect pulmonary insults cause excessive cytokine release leading to endothelial activation, neutrophilic migration to the lungs, degranulation with release of toxic mediators Increase capilalry permeability Formation of hyalien membrane

Question 811

Exercise effect on PaO2, PaCO2, CO and HR

Answer 811

Increase HR and CO No change PaO2, PaCO2

Question 812

Crescent formation 3 types

Answer 812

Rapidly progressive glomerulonephritis (RPGN) 1) Antiglomerular basement membrane 2) Immune complex RPGN - post-streptococcal glomerulonephritis, SLE, IGA, henoch schonlein purupra - decrease C3 C4 3) Pauci-immune RPGN - no immunoglobulin or complement deposits - elevated antineurtrophil cytoplasmic antibodies (ANCA)

Question 813

``` SOB Cough Exacerbated when lay down MI Bilateral crackles at lung base S3 ```

Answer 813

Left sided heart failure --> elevation of end-diastolic pressure --> decrease lung compliance

Question 814

zollinger-Ellison syndrome associated with also at risk for

Answer 814

MEN 1 ``` primary hyperparathyroidism ( hypercalcemia, constipation, kidney stones) Recurrent nephrolithiasis ``` Pituitary adenomas

Question 815

Calcifications in epigastric area abdominal pain Chronic diarrhea Consumes alcohol

Answer 815

Chronic pancreatitis Digestive enzyme deficiency --> diarrhea

Question 816

Vomiting/ nausea due to

Answer 816

``` GI irritation (infections chemotherapy, distention) - increase serotonin release and activation of 5HT ``` ``` Central nausea (migraines) - use dopamine receptor antagonist to stop ``` Vestibular nausea - dopamine receptor stimulation and H1 stimulation - promethazine tx both

Question 817

Seen in hashimoto on biopsy

Answer 817

Intense lymphoplasmacytic infiltrate with active germinal centers Hurthle cells

Question 818

Thyroid biopsy 1) Branching papillae with cells containing empty -appearing nuclei 2) Dense fibrous tissue extending beyond the thyroid capsule 3) Follicular hyperplasia with tall cells projecting into the follicular lumen 4) Intense lymphoplasmacytic infiltrate with active germinal centers 5) widespread inflammatory infiltrates, giant cellls, and disrupted follicles

Answer 818

1) Papillary thyroid cancer - orphan annie eye 2) Reidel thyroiditis 3) Graves disease 4) Hashimoto 5) Subacute granulomatous (de Quervain) thyroiditis

Question 819

Ureters anterior to

Answer 819

Internal iliac artery

Question 820

Drugs with pt fever, joint pains, rash of face and trunk, Positve anti-nuclear ab

Answer 820

Drug induced lupus ``` SHIPP Sulfonamides Hydralazine Isoniazid Phenytoin Procainamide ```

Question 821

Pencillin binding proteins

Answer 821

Transpeptidases

Question 822

Smokers have 5x the risk of esopahgeal carcinoma compared to non smokers (relative risk = 5.0, 95% CI 2.9-7.1) What percentage of SCC of the esophagus in smokers can be attributed to smoking?

Answer 822

Attributable risk percentage in exposed (ARP) ARP exposed= 100 x (risk in exposed - risk in unexposed)/ risk in exposed ARP= 100 x [(RR-1)/ RR] ARP= 100 x [(5-1)/5]= 80%

Question 823

Ionizing radiaton tx for cancer does what

Answer 823

DNA ds breaks free radical formation

Question 824

What is released as O2 saturation curve moves up

Answer 824

protons CO2

Question 825

Anal fissures occur where

Answer 825

Posterior midline distal to dentate line

Question 826

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

Answer 826

CMV | herpesvirus

Question 827

Patent foramen ovale

Answer 827

wide and fixed splitting | no change with respiration

Question 828

``` Headache Fever Malaise Cough Nodular infiltrates Clumping once room temp ```

Answer 828

Mycoplasma pneumoniae Walking pneumoniae Cross reactive IgM Activate complement --> erythrocyte lysis Cold agglutinins

Question 829

``` Action potential conduction velocity Point 1- 0.05 Point 2 - 0.3 Point 3- 1.1 Point 4- 2.2 ``` Points correspond to what location

Answer 829

AV node Ventricular muscle Atrial muscle Purkinje system

Question 830

Insulin effect

Answer 830

decrease glucagon secretion increase glycogen synthesis Increase glucose uptake

Question 831

Cirrhosis Agitated and confused. Jerky irregular flexion-extension tremor in hands What is elevated in astrocytes

Answer 831

Hepatic encephalopathy Increased nitrogen, ammonia Ammonia + glutamate --> glutamine (non-neuroactive compond)

Question 832

Demyeliantion of pons

Answer 832

overly rapid correction of electrolyte abnromalities

Question 833

Neurodegenerative disease presents at birth as "floppy baby"

Answer 833

Werdnig Hoffman disease

Question 834

Perfusion is greatest where in the lung -V/Q ratio Exercise effect of V/Q

Answer 834

Bases - V/Q <1 Exercise - V/Q moves down toward 1 - Vasodilation in apex - perfusion increases

Question 835

V/Q --> zero V/Q --> infinity

Answer 835

V/Q --> zero - low ventilation, high perfusion - air way obstruction - pneumonia, pulmonary edema, lung cancer - supplemental O2 ineffective V/Q --> infinity - high ventilation, low perfusion - blood flow obstruction - supplemental O2 effective

Question 836

Responses to exercise - O2 - Co2 - ventilation rate - V/Q in apex vs base - Pulmonary blood flow - pH - arterial PO2 - arterial pCO2 - Venous CO2 content

Answer 836

Increase O2 consumption Increase CO2 production Increase ventilation rate V/Q more uniform Increase pulmonary blood flow due to increase CO Decrease pH No change in arterial PO2 and PCO2 Increase venous CO2 content

Question 837

Normal A-a gradient Causes of elevated A-a gradient

Answer 837

10-15 mmHg ``` High FiO2 Shunting o f blood Diffusion limitation (pulmonary fibrosis) V/Q mismatch Advanced age ``` Pressure alveolar oxygen to pressure arterial oxygen

Question 838

Name the exotoxin 1) Causes scarlet fever 2) Inactivates EF-2 3) Blocks release of the inhibitory neurotransmitter glycine

Answer 838

``` 1) Erythogenic toxin Pyogenic toxins (s. pyogenes) ``` ``` 2) Diphtheria toxin Exotonin A (pseudomonas) ``` 3) Tetanospasmin (c. tetani)

Question 839

Underlying cause of achalasia? How is it diagnosed?

Answer 839

Failure of LES to relax due to loss of myenteric (Auerbach) plexus due to loss of postganglionic inhibitory neurons ( which contain NO and VIP) Dysphagia solids and liquids ``` Diagnosis - Manometry (Uncoordinated or absent peristalsis) - Barium swallow (dilated esophagus with an area of distal stenosis ) (birds beak) ```

Question 840

Clinical derangements that come about in a patient with acute mountain sickness

Answer 840

Headache Fatigue Extreme cases - Acute cerebral edema due to hypoxia induced vasodilation - acute pulmonary edema

Question 841

Partial pressure of oxygen difference at sea level vs 20,000

Answer 841

Sea level= 760 mmHg 20,000= 349 mm Hg Partial pressure of oxygen is 21% of barometric pressure Partial pressure is higher at sea level

Question 842

Response to high altitude (6)

Answer 842

Increase ventilation - have to breathe more - blow off more CO2 Increased erythropoietin - HCT 40% --> 64% - Hgb 15 --> 20 g/dL Increase 2,3 BPG - unloads oxygen to tissue better Increase mitochondria Increase efficiency of O2 utilization Increase renal excretion of bicarb

Question 843

pH = Breathing more causes what pH change

Answer 843

HCO3/ pCO2 Respiratory alkalosis Decreases pCO2 --> raises pH

Question 844

Physiologic changes that occur in chronic mountain sickness (6)

Answer 844

Increase RBC mass and hematocrit Increased blood viscosity and decrease tissue blood flow Elevated pulmonary artery pressure (pulmonary artery constricts in response to hypoxia) Right sided heart enlargement ( due to increase pulmonary artery pressure) Peripheral artery pressure falls Congestive heart failure

Question 845

Positive G-force in which visual black out occurs Due to G force in space lift off

Answer 845

4-6 G Insufficient blood return to heart Insufficient pumping of blood to brain 8-9 G

Question 846

Nitrogen narcosis

Answer 846

Nitrogen dissolves into neuronal membrane, which causes reduced neuronal excitability Diver becomes jovial/ careless Loss strength and coordination

Question 847

Symptoms of decompression sickness

Answer 847

aka "Bends" Nitrogen bubbles undissolving from blood, make bubbles in blood vessels can occlude Joint/ muscle pains in arms and legs Neurologic problems (dizziness, paralysis, syncope) "The chokes (Bubbles occlude the lung capillaries --> SOB, pulmonary edema, death) ``` "BENDS" Breathign problems Extremity pain Neurologic changes Death ```

Question 848

VIrchow triad for

Answer 848

DVT "SHE" Stasis - severely ill, paralyzed, long trips, cast Hypercoagulability - sickle cell, polycythemia, estrogen excess, cancer, pregnancy, OCPs, smoking Endothelial damage - vessel trauma, fracture, froeign body, bacterial infection

Question 849

Homan's sign

Answer 849

Pain with ankle dorsiflexion DVT

Question 850

``` Tall thin young male Smoker Uneven chest expansion Unilateral Chest pain Hyperresonance Dimished breath sounds ``` Due to

Answer 850

Primary spontaneous Pneumothorax Due to rupture of apical subpleural blebs or cysts

Question 851

Location for needle for tension pneumothorax

Answer 851

Above 2nd rib

Question 852

``` Pleuritic chest pain SOB Cough Tachypnea Tachycardia Low grade fever ``` Elevated D dimer Normal CXR Large A-a gradient ECG?

Answer 852

Pulmonary embolism (PE) ECG S1Q3T3 - deep S in lead I - large Q and inverted T in lead III

Question 853

Elevated D-dimer

Answer 853

DVT | PE

Question 854

The C's of huntington disease

Answer 854

``` Chorea Cuarenta (40) CAG repeats Chr Cuatro 4 Cognitive decline Caudate atrophy ```

Question 855

FEV1/ FVC normal Obstructive restrictive

Answer 855

80% <80% obstructive > 80% restrictive

Question 856

Hexagonal, double pointed, needle like crystals in bronchial secretions

Answer 856

Charcot-Leygen crystals - eosinophilic granules Asthma

Question 857

Spiral shaped mucus plugs

Answer 857

Curschmann spirals Desquamated epithelium Asthma Obstructive lung disease

Question 858

Pulsus paradoxus

Answer 858

Abnormal drop of 10 mm/Hg in systolic pressure during inspiration Decreased intrathoracic pressure --> increased right ventricle blood return Right ventricle push into left ventricle --> poor cardiac output and drop in systolic pressure Decreased capacity of LV ``` Cardiac tamponade Asthmatics Severe pulmonary embolism COPD Croup ```

Question 859

Hyperplasia of both goblet cells and submucosa glands

Answer 859

Chronic bronchitis

Question 860

Emphysema increased what

Answer 860

Compliance (loss of elastic fibers)

Question 861

Right main stem bronchi same size Productive cough Increased sputum production FEV1/FVC <80% Causes (4)

Answer 861

Bronchiectasis Allergic bronchopulmonary aspergillosis Kartagener syndrome - sinus inversus Cystic fibrosis (most common) Primary ciliary dyskinesia

Question 862

Hallmark of obstructive lung disease

Answer 862

FEV1/FVC= < 80% Difficulty getting air out Increased lung volumes

Question 863

Hallmark of restrictive lung disease

Answer 863

FEV1/FVC= >80% Decreased lung volume Can not get air in

Question 864

Reid index

Answer 864

Thickness/ glands/ thickness of wall Chronic bronchitis 50% composed of mucus glands elevated reid index= normal

Question 865

What disease is associated with the Ab 1) Anti- mitochondrial 2) Anti- neutrophil cytoplasmic 3) Antiplatelet Ab

Answer 865

1) anti-mitochondrial Primary biliary cholangitis 2) Anti-neutrophil cytoplasmic cANCA - granulomatosis w/ polyangiitis pANCA - Eosinophilic granulomatosis with pollyangiitis (churg-strauss) - Microscopic polyangiitis - Pauci-immune crescentric glomerulonephritis - primary sclerosing cholangitis - ulcerative collitis 3) Immune thrombocytopenic purpura (ITP)

Question 866

Female homolog? 1) Corpus spongiosum 2) Bulbourethral glands 3) Ventral shaft of penis

Answer 866

1) Corpus spongiosum - Vestibular bulb 2) Bulbourethral glands - Vestibular (Bartholin) glands 3) Labia minora

Question 867

Most common salivary gland tumor

Answer 867

Pleomorphic adenoma

Question 868

ARDS pathway

Answer 868

Shock, infection, toxic gas inhalation, aspiration, pancreatitis, heroin OD, sepsis, trauma, uremia, amniotic fluid embolism --> Inflammatory cells/ mediators and oxygen free radicals --> Damage to endothelial or alveolar epithelial (type I) cells --> Diffuse alveolar damage (DAD)

Question 869

Sarcoidosis mneumonic tx

Answer 869

A GRUELING Disease ``` ACE enzyme increase Gammaglobulinemia Rheumatoid factor Uveitis Erythema nodosum Lmphadnopathy (bilateral, hilar) Idiopathic Noncaseating Granulomas Vit D increase (hypercalcemia or hypercalcinuria) ``` Glucocorticoids

Question 870

Honeycomb lung on CT Patchy interstitial fibrosis - mutations - risk factors - survival - also seen

Answer 870

Idiopathic pulmonary fibrosis (cryptogenic fibrosing alveolitis) Mutations: telomerase, mucin MUC5B 3 year survival Usual interstitial pneumonia

Question 871

A 68-year-old man has had worsening dyspnea with a nonproductive cough for the past 9 months. On physical examination, he is afebrile and normotensive. On auscultation of the chest, diffuse dry crackles are heard in all lung fields. A chest radiograph shows irregular opacifications throughout both lungs. A transbronchial biopsy is obtained and the microscopic findings with trichrome stain are shown in the figure. Laboratory studies include negative serologic tests for ANA, anti–DNA topoisomerase I, ANCA, and anticentromere antibody. Despite glucocorticoid therapy, his condition does not improve, and he dies 2 years later. What is the most likely diagnosis? A Goodpasture syndrome B Hypersensitivity pneumonitis C Idiopathic pulmonary fibrosis D Sarcoidosis E Systemic sclerosis

Answer 871

C. idiopathic pulmonary fibrosis

Question 872

A 50-year-old man has increasing dyspnea with idiopathic pulmonary fibrosis, which was diagnosed 18 months ago. Physical examination shows elevated jugular venous pressure and pedal edema. Laboratory studies show serum AST of 221 U/L, ALT of 234 U/L, alkaline phosphatase of 48 U/L, lactate dehydrogenase of 710 U/L, total bilirubin of 1.2 mg/dL, albumin of 3.5 g/dL, and total protein of 5.4 g/dL. The figure shows the microscopic appearance of a liver biopsy specimen. Which of the following terms best describes these findings? A Apoptosis B Centrilobular congestion C Cholestasis D Hemosiderin deposition E Macrovesicular steatosis F Mallory-Denk bodies G Portal fibrosis

Answer 872

B. Centrilobular congestion

Question 873

What is low in restrictive lung disease

Answer 873

TLC FVC Both FEV1 and FVC decreased FEV1/FVC = > 80%

Question 874

Innumerable calcified nodules Eggshell calcification in hilar nodes - increased susceptibility to - increased risk of

Answer 874

Silicosis Susceptibility to TB Increased risk of cancer

Question 875

Sandblasting Mining Demolition Cement/concrete

Answer 875

Silicosis

Question 876

Shipbuilding Roofing Pipe fitting plumbing

Answer 876

Asbestosis

Question 877

``` Fibers in lung bases Dumbbells on stain (prusian blue) Pleural plaques Pleural effusions interstitial fibrosis ``` - seen w/ cells - cancer

Answer 877

Asbestosis Macrophages release inflammatory mediators and free radicals Cancer - Bronchogenic carcinoma - mesothelioma

Question 878

Tennis racket shaped cytoplasmic organelles | Young adult smoker

Answer 878

Pulmonary Langerhans Cell histiocytosis Focal collections of langerhans often accompanied by eosinophils Burbbeck granules Quit smoking

Question 879

Lung disease + glomerulonephritis think

Answer 879

Goodpasture syndrome Granulomatosis with polyangiitis (Wegener's granulomatosis)

Question 880

Necrotizing granulomas vasculitis most prominent in lungs and upper airways Focal necrotizing glomerulonephritis

Answer 880

Granulomatosis with polyangiitis

Question 881

Bilateral hilar adenopathy | uveitis

Answer 881

Sarcoidosis

Question 882

CD surface marker fits each of the following 1) Found on all NK cells and binds the constant region of IgG 2) Inhibits complement C9 binding 3) Endotoxin receptor found on macrophages

Answer 882

1) CD16 2) CD55/59 3) CD14

Question 883

Lung cancer 1) in peripheral lung 2) in central lung 3) most common in non smokers 4) hypercalcemia 5) giant cells 6) ACTH, ADH 7) Ab to presynaptic Ca channels leading to? 8) Mutations in Adenocarcinoma 9) Mutations in TP53, Rb

Answer 883

1) adenocarcinoma, large cell carcinoma 2) SCC, small cell carcinoma 3) Adenocarcinoma 4) SCC 5) Large cell carcinoma 6) Small cell carcinoma 7) Small cell carcinoma Lambert Eaton syndrome 8) "MARKER" MET, ALK, RET, KRAS, EGFR, ROS 9) Small cell carcinoma

Question 884

Lambert Eaton syndrome

Answer 884

Muscle weakness that improves iwth use Ab against Ca channels Small cell carcinoma

Question 885

Tumor in apex of lung - symptoms

Answer 885

Pancoast tumor ``` Hoarseness (compress recurrent laryngeal n.) Horner syndrome - ptosis - miosis -anhidrosis (affect cervical sympathetic plexus) ```

Question 886

Lung cancer metastasize to Receive metastases from

Answer 886

``` To: Brain Bone Liver Adrenal glands ``` ``` Receive from: Breast Colon Prostate Bladder ```

Question 887

Which lysosomal storage disease 1) Accumulation of dermatan sulfate 2) Deficiency in hexosaminidase

Answer 887

1) Hurler dis, hunter syn, scheic syn | 2) Tay-sach disease

Question 888

Which infectious agent fits 1) Common cause of pneumonia in immunocompromised patients 2) Most common cause atypical pneumonia 3) Agent for penumonia in alcoholics 4) Can cause an interstitial pneumonia in bird handlers 5) Pneumonia in pts w/ hx of exposure to bats and bat droppings 6) Pneumonia in pt who visited south california, new mexico, or west texas 7) Pneumonia associated iwth currant jelly sputum 8) Q fever 9) Assocaited with pneumonia acquired from air conditioners 10) Most common cause of pneumonia in children 1 year old or younger 11) Pneumonia in neonate 12) Pneumonia in children and young adults (college, militrary, prison inmates) 13) Viral pneumonia 14) Causes wool-sorter's disease (life-threatening pneumonia) 15) Common pneumonia in ventilator patients and those with CF 16) Pontiac fever

Answer 888

1) Pneumocystis jirovecii 2) Mycoplasma pneumoniae 3) Klebsiella pneumoniae 4) Chlamydophila psittaci 5) Histoplasma 6) Coccidioides immitis 7) Klebsiella pneumoniae 8) Coxiella burnetii 9) Legionella pneumophilia 10) RSV 11) Group B strep, E coli 12) Mycoplasma pneumoniae 13) RSV 14) Bacillus anthracis 15) Pseudomonas, MRSA 16) Legionella pneumophila

Question 889

Lung abscess bacteria Tx Complication of

Answer 889

Anaerobes ``` Peptostreptococcus Prevotella Bacteroids Fusobacterium S. aureus Klebsiella pneumoniae Gram negative bacteria ``` First line for anaerobe - Clindamycin Aspiration pneumonia - alcoholics - drug abusers - general anesthesia

Question 890

Test for sleep apnea

Answer 890

Polysomnography

Question 891

GI problem associated 1) 50 y.o woman, pruritus w.o jaundice, positive AMA 2) GI bleeding, buccal pigmentation 3) 60 y.o female, RA, no alcohol hx, fatigue, and right abdominal pain, elevated ANA adn ASMA, elevated serum IgG lvel, no viral serologic markers 4) 23 y.o woman no alcohol hx; elevated levels of LKM-1 ab, no viral serologic markers, liver biopsy with infiltration of the portal and periportal area with lymphocytes 5) Fatal disease of unconjugated bilirubin resulting from a complete lack of UDPGT activity

Answer 891

1) Primary biliary cirrhosis 2) Peutz-jegher syndrome 3) Autoimmune hepatitis 4) Autoimmune hepatitis 5) Crigler- Najjar type I

Question 892

What substances act on smooth muscle myosin light chain kinase? How does this affect blood pressure

Answer 892

Dihydropyridine Ca channel blockers Epinephrine (acting at beta2 receptor) Prostaglandin E2 Relaxation of vascular smooth m -> vasodilation --> decrease BP

Question 893

Watery diarrhea Dyspnea and wheezing Flushed and red Mass in right liver lobe and ileum What is it? Treatment?

Answer 893

Carcinoid syndrome - secrete serotonin Hepatic metastasis Octreotide for symptomatic patients

Question 894

``` Developmental delay Difficulty seeing board Tall, thin habitus Elongated limbs Lens subluxation Thrombus and infarct ``` Supplement?

Answer 894

Homocystinuria Error of methionine metabolism AR deficiency cystathionine beta-synthase that requires pyridoxine (Vit B6) as cofactor

Question 895

A 6-year-old girl is found to be nearsighted during a vision screening at school, and the school nurse tells the parents the child should be fi tted for corrective lenses. Her mother is upset because her daughter is already much taller than her classmates, has an awkward gait, and was recently diagnosed with scoliosis. She is afraid that the glasses will only add to her daughter’s problems at school, where her classmates frequently tease her. When the ophthalmologist observes that the patient’s right lens is dislocated, he suspects that her symptoms are in fact related to an enzyme defi ciency. As a result of this defi ciency, which of the following amino acids is essential in this patient’s diet? (A) Cysteine (B) Lysine (C) Methionine (D) Tryptophan (E) Tyrosine

Answer 895

The correct answer is A. Homocystinuria is an inborn error of metabolism caused by a defect in cystathionine synthase, the enzyme that converts homocysteine to cystathionine. Cystathionine is later converted to cysteine, so patients with this enzyme defi ciency are required to supplement their diets with exogenous cysteine. In addition to marfanlike features and subluxation of the lens, these patients are at increased risk of a variety of cardiovascular derangements, includin

Question 896

Arteries off splenic artery

Answer 896

Short gastric Left gastroepiploic

Question 897

CXR reveals a round density with an air fluid level in right lung Copious sputum - What is it - Key player in formation

Answer 897

Lung abscess Neutrophils that release cytotoxic granules (lysosomes) containing myeloperoxidase Copious sputum (foul smelling)

Question 898

intermittent claudication (pain comes and goes) due to Chest pain relieved by rest Cause?

Answer 898

Atherosclerosis Lipid filled arterial intimal plaques

Question 899

Onion-like concentric thickening of arteriolar walls Homogenous acellular thickening of the arteriolar wall

Answer 899

Hyperplastic arteriosclerosis Hyaline arteriolosclerosis - homogenous deposition of hyaline material in the intima and medial of small arteries and arterioles

Question 900

``` Man to ER Found unconscious Temp White patches on mucosa Bilateral crackles in lungs Bilateral interstitial infiltrates ``` Silver stain

Answer 900

Pneumocystisi pneumonia atypical fungal infection Opportunistic infection

Question 901

Silver stain

Answer 901

Fungi - coccidoides - pneumocystis jirovecci Legionella Helicobacter pylori

Question 902

Hernia that originates medial to the inferior epigastric vessels Defect in

Answer 902

Direct hernia MDs dont LIe - medial to inferior epigastric = direct - lateral = indirect Weakness of transversalis fascia

Question 903

Cause of indirect hernia Location

Answer 903

Lateral to inferior epigastric vessels Due to patent processus vaginalis

Question 904

Cause of femoral hernia Location

Answer 904

Emerges inferiro to inguinal ligament Widening of the femoral ring is defect

Question 905

Epistasis

Answer 905

Phenomenon in which the allele of one gene affects the expression of alleles in another gene

Question 906

Imprinting

Answer 906

Phenomenon in which an offspring's genes are expressed in a parent specific manner. Caused by DNA methylation

Question 907

Person is exercising what value will increase What will decrease

Answer 907

Venous blood mean CO2 content will increase pH decreases - Lactic acid produced Decrease physiologic dead space - due to decrease in pulmonary vascular resistance Mean O2 content of venous blood remains the same or decreases

Question 908

S. bovis risk of

Answer 908

Streptococcus gallolyticus Causes subacute bacterial endocarditis Part of normal flora of colon Associated with colon cancer

Question 909

Still get Haemophilus influenzae even though had vaccine how?

Answer 909

The strain responsible for the patients disease does not produce a capsule H. influenzae nontypeable Vaccine only against more invasive type b strain

Question 910

Diuretic that causes hypercalcemia

Answer 910

Thiazide diuretic

Question 911

Nerve associated with cremasteric reflex

Answer 911

Genitofemoral n.

Question 912

Nerve that passes through spermatic cord through superficial inguinal ring

Answer 912

Ilioinguinal nerve.

Question 913

Nerve damaged in appendectomy causes decreased sensation to suprapubic region

Answer 913

Iliohypogastric n.

Question 914

``` Fever Malaise sore throat VERY tired Palatal petechiae cervical LAD Splenomegaly ``` -Assoc with

Answer 914

Mono | - EBV

Question 915

EBV associated with

Answer 915

Burkitt lymphoma Nasopharyngeal carcinomas Mononucleosis

Question 916

Severe HTN emergency >180/120 Manifests as (2)

Answer 916

Fibrinoid necrosis Hyperplastic arteriolosclerosis - onion skin

Question 917

Glutamate --> alpha ketoglutarate for TCA cycle requires Oxaloacetate --> aspartate

Answer 917

Transamination Vit B 6 Pyridoxine

Question 918

Biotin is cofactor for

Answer 918

Vit B7 ``` carboxylase enzymes - pyruvate carboxylase Acetyl-COA carboxylase Propionyl--CoA carboxylase 3-methylcrotonyl-CoA- carboxylase ```

Question 919

Vessel with lowest oxygen content

Answer 919

Coronary sinus

Question 920

Emysema causes what to lung compliance Asthma on lung compliance What shifts the graph right and down? decrease compliance

Answer 920

Increase Shift left and up No change Pulmonary fibrosis

Question 921

What hormone increases bicarb secretion? Cell type?

Answer 921

Secretin | - Duodenal S cells

Question 922

Skin lesion on eyelid ma Lipid laden macrophages Assoc with

Answer 922

Xanthelasma Associated iwth primary or secondary hyperlipidemias - Primary biliary cirrhosis

Question 923

Most common cause of overdose death

Answer 923

Opioids

Question 924

Aortric regurgitation Mediastinal widening + fluorescent treponemal ab Suggest? - Due to - Begins with

Answer 924

Aortic aneurysm Syphilis Vasa vasorum endarteritis adn obliteration

Question 925

H. influenzae type b virulence factor

Answer 925

Polysaccaride capsule composed of polyribosylribitol phosphate (PRP)

Question 926

Goes with? Lecithinase M protein Protein A Trehalose dimycolate Polyribosylribitol phosphate (PRP)

Answer 926

Lecithinase: toxin A, clostridium perfringens - results in cell lysis and gas gangrene M protein: strep. pyogenes -Binds factor H to prevent opsonization and destruction by alternative complement pathway Protein A: staph aureus - prevent opsonization by binding Fc region of immunoglobulins Trehalose dimycolate: cellw all component , mycobacterium tuberculosis - protects from being killed by macrophages and stimulates granuloma formation Polyribosylribitol phosphate: Haemophilus influenzae type b - capsule protects against phagocytosis and complement mediated lysis by binding factor H (prevents complement C3b deposition on host cells

Question 927

Rebound anxiety, tremor, insomnia, palpitations, diaphoresis | Seizure

Answer 927

Benzodiazepine withdrawal Lorazepam

Question 928

Itching after hot showers Fatigue Rash worse with rubbing Flushing Clusters of mast cells

Answer 928

Systemic mastocytosis Excessive histamine

Question 929

Excessive histamine causes

Answer 929

Mastocytosis Gastric hypersecretion

Question 930

Hyperestrogenic states can cause

Answer 930

Gynecomastia Spider angiomata - estrogen effect on arteriolar dilation

Question 931

Continous IV infusion with first order kinetics takes __ half lives to reach 95%

Answer 931

4-5

Question 932

High urinary excretion of ketones suggests

Answer 932

absolute insulin deficiency | Diabetes type I

Question 933

Huntingtons neuroimaging

Answer 933

Caudate atrophy with enlargement of the lateral ventricles Enlargement of frontal horns of the lateral ventricles

Question 934

Seen with? 1) Diffuse ventriculomegaly without sulcal widening 2) Enlargement of frontal horns of the lateral ventricles 3) Hypoplastic vermis with a dilated fourth ventricle 4) Pronouced atrophy of bilateral hippocampi 5) Regional atrophy of frontal and temporal lobes

Answer 934

1) Normal pressure hydrocephalus 2) Huntington's dis 3) Dandy-walker malformation 4) Early onset alzheimer dis 5) Frontotemoral dementia

Question 935

Winging scapula can occur due to what nerve and what event

Answer 935

Long thoracic nerve to serratus anterior Axillary LN dissection

Question 936

Histopathologic evaluation of syphilis lesion

Answer 936

Intense plasma cell rich infiltrate with proliferative endarteritis

Question 937

What is this? 1) Acantholysis with superficial dermal lymphocytic infiltrate 2) Dysplastic spndle cells iwht viral genome that form vascular channels 3) Intense plasma cell-rich infiltrate with proliferative endarteritis 4) Panniculitis and sepal inflammation with multinucleated giant cells 5) Papillomatous epidermal hyperplasia with cytoplasmic vacuolization

Answer 937

1) Pemphigus vulgaris 2) Kaposi sarcoma 3) Syphilis 4) Erythema nodosum 5) Anogenital warts, HPV-6

Question 938

``` Headaches Dizziness Facial plethora (reddish) Splenomegaly Peptic ulcer disease Increased erythrocytes ``` - Mutation

Answer 938

Polycythemia vera - uncontrolled erythrocyte production Abnormal transduction of erythropoietin growth signals Mutation in JAK2 Erythropoietin receptor has no intrinsic kinase activity and must interact with JAK2 a cytoplasmic tyrosine kinase

Question 939

Mutation of 1) Growth stimulating transcription factor 2) Tumor suppressor protein

Answer 939

1) c-myc - burkitt lymphoma 2) p53 - Li-fraumeni syndrome

Question 940

Protein 4.5 g antinuclear ab glomerular capillary wall thickening Irregular spikes protruding from glomerular basement membrane

Answer 940

Membranous glomerulopathy

Question 941

HIV process involving glycosylation

Answer 941

Only glycosylated HIV polyprotein is gp160 - product of the env gene gp160 is extensively glycosylated in the rough ER and golgi cleaved into envelope proteins gp120 and gp41 gp120: mediates viral attachment gp41: mediates viral fusion

Question 942

HIV pol gene encodes for

Answer 942

reverse transcriptase integrase protease RT: ssRNA --> ds DNA Integrase: integrate into host genome Protease: cleave HIV polyproteins into individual proteins after trasncription in rough ER

Question 943

Acondroplasia inheritence

Answer 943

AD

Question 944

``` Anorexia Nausea Dark-colored urine Trip to mexico Fever Right upper quadrant pain ``` liver biopsy?

Answer 944

Acute viral hepatitis HAV Hepatic swelling

Question 945

Seen with? 1) Fibrinoid necrosis of liver 2) Liquefactive necrosis 3) Hepatocyte swelling 4) Regenerative nodules

Answer 945

1) Fibrinoid necrosis= immune vasculitis or malignant hypertension 2) Liquefactive necrosis= severe viral hepatitisor entamoeba histolytica infection 3) Hep A acute infection 4) Regenerative nodules= cirrhosis form chronic hepatitis

Question 946

For viral particle to be coupled to MHC class I it first has to be involved with what

Answer 946

Ubiquitin ligase

Question 947

Increase in fructose 2,6 bisphosphate causes a decrease in

Answer 947

Inhibits gluconeogenesis Decrease Alanine --> glucose

Question 948

Thiamine deficiency Get thiamine infusion What neurologic finding will persist despite treatment?

Answer 948

Memory loss Korsakoff syndrome

Question 949

Airway resistance from trachea --> medium sized bronchi --> bronchioles --> terminal bronchioles

Answer 949

Airway resistance increases from trachea to medium sized bronchi Decreases after that due to lower respiratory tract are arranged in parallel

Question 950

N gonorrhoeae infection and repeat infections

Answer 950

High variability of gonococcal surface antigens (porins, opa proteins and lipooligosaccharide) limits effectiveness of antibody response Previous infections results in almost no protective immunity against future infections

Question 951

Decrease in PAH level would be due to

Answer 951

Carrier transport saturation

Question 952

Vaginal discharge Grayish white Fishy smelling What is seen on microscopy?

Answer 952

Epithelial cells covered with gram-variable rods

Question 953

Identify 1) Epithelial cells covered with gram-variable rods 2) Epithelial cells with rare leukocytes 3) Gram-negative intracellular diplococci 4) leukocytes and pear-shaped organisms 5) Pseudohyphae with leukocytes

Answer 953

1) Gardnerella 2) normal vaginal discharge 3) Gonorrhea 4) trichomonas vaginitis 5) Candida vaginitis

Question 954

Back pain that is better when leaning on stroller Thickening of what?

Answer 954

Ligamentum flavum Spinal stenosis

Question 955

Paroxysmal atrial fibrillation can be caused by aberrant electrical foci in the

Answer 955

Aberrrant electrical foci in the pulmonary veins

Question 956

Alpha 1 effects Examples

Answer 956

Increase blood pressure Contraction of internal urethral sphincter Mydriasis (eye dilation) - contraction of pupillary dilator muscle Epinephrine NE Phenylephrine Methoxamine

Question 957

Beta 1 effects examples

Answer 957

Heart - Increase HR, contractility and conductance Epinephrine Dopamine Dobutamine Isoproterenol

Question 958

Beta 2 effects examples

Answer 958

Vasodilation Decrease diastolic BP Bronchodilation Relaxation (uterus) Isoproterenol Terbutaline Ritodrine

Question 959

What releases growth factors in formation of atheroma

Answer 959

platelets

Question 960

``` Rapid onset Headache Fever Altered mental status Nuchal rigidity Pruritic rash ``` Type of vaccine?

Answer 960

Meningococcal meningitis Capsular polysaccharide Ag

Question 961

Vaccine with inactivated (killed organisms)

Answer 961

RIP Always Rabies Influenza (injection) Polio (oral) Hep A

Question 962

Vaccine with live attenuated organisms

Answer 962

"Attention Teachers! Please vaccinate SMALL, Beautiful Young INFants with MMR Regularly!" ``` Adenovirus Typhoid Polio Varicella Small pox BCG Yellow fever Influenza (intranasal) MMR Rotavirus ```

Question 963

Vaccine with virus-like particles Subunit type

Answer 963

Induces only the Ag that stimulate the immune system Hep B HPV

Question 964

Hypercalcemia | Lung mass

Answer 964

Hypercalcemia of malignancy Parathyroid hormone-related peptide (PTHrP)

Question 965

Multiple polyps found in colon due to mutation of

Answer 965

Familial adenomatous polyposis APC mutation

Question 966

What mutation 1) Lung adenocarcinoma 2) CML, ALL 3) Follicular lymphoma 4) non-hodgkin lymphoma 5) Neuroblastoma 6) Melanoma 7) MEN 2A and 2B 8) Colorectal cancer assoc w/ FAP 9) Hairy cell leukemia 10) Osteosarcoma 11) Li-Fraumeni 12) Tuberous sclerosis 13) Burkitt lymphoma 14) Colon cancer 15) Diffuse large B cell lymphoma

Answer 966

1) ALK 2) BCR-ABL 3) BCL-2 4) BRAF 5) n-myc 6) BRAF, CDKN2A 7) RET 8) APC 9) BRAF 10) Rb 11) TP53 12) TSC1/2 13) c-MYC 14) KRAS 15) BCL-2

Question 967

``` Exertional dyspnea Dry cough Bilateral hilar adenopathy Reticular pulmonary infiltrates ACE and Ca elevated ``` Predominant cell type?

Answer 967

Sarcoidosis CD4 lymphocytes

Question 968

Painless lymph node enlargement Translocation?

Answer 968

Follicular lymphoma t(14;18)

Question 969

Most common cause of bilateral fetal hydronephrosis in boys

Answer 969

Posterior urethral valves

Question 970

Heart murmur Best heard when patient sits up and leans forward Peak intensity?

Answer 970

Aortic regurgitation Just after aortic valve closure

Question 971

What causes the green color of sputum

Answer 971

Neutrophil myeloperoxidase

Question 972

Pathologic finding of varicella zoster

Answer 972

Multinucleated cells with intranuclear inclusions

Question 973

Identify 1) Acantholysis and intrercellular IgG deposits 2) Eosinophilic cytoplasmic inclusions 3) Microabscesses at the tips of dermal papillae 4) Multinucleated cells with intranuclear inclusions 5) Koilocytosis of the superfical epidermal layers

Answer 973

1) Pemphigus vulgaris 2) Molluscum contagiosum (poxvirus) 3) Dermatitis herpetiformis 4) Varicella zoster 5) HPV of skin w/ warts

Question 974

Serotonin syndrome

Answer 974

``` Mental status changes Hyperthermia Sympathetic hyperactivity Clonus Hyperreflexia ```

Question 975

Neuroleptic malignant syndrome Tx

Answer 975

``` Mental status changes Hyperthermia Sympathetic hyperactivity Diffuse rigidity (lead pipe) Hyporeflexia ``` Dantrolene Dopaminergic drugs - Bromocriptine (DA agonist) - Amantadine (Increase DA release)

Question 976

Meningitis --> bleeding from venous puncture sites Results in what cells

Answer 976

Disseminated intravascular coagulopathy (DIC) Schistocytes

Question 977

Bite cells

Answer 977

Oxidant induced damage G6PD deficiency

Question 978

Surgery --> Fever, lethary, N/V Scleral icterus RUQ tenderness Elevated AST, ALT and bilirubin What drug used during surgery

Answer 978

Acute hepatitis Inhaled halogenated --> hepatocellular damage -flurane

Question 979

High fever Nasal discharge Bilateral conjunctival injection Several small white spots with an erythematous base on buccal mucosa No vaccines What else is seen

Answer 979

Measles Maculopapular rash

Question 980

Measles vaccine is

Answer 980

Live attenuated

Question 981

Vesicular rash

Answer 981

Chicken pox

Question 982

``` Myalgia Fatigue HA Chills Fever ``` Sick and recovered Mild jaundice Hepatosplenomegaly Elevated indirect bilirubin Ringed inclusions

Answer 982

Malaria Trophozoites (ringed inclusions) on Giemsa Dormant hepatic phase

Question 983

Virus that infects by CD21 Virus that infects by glycoprotein gp120 Virus that infects via the blood group P antigen (globoside)

Answer 983

1) EBV 2) HIV 3) Parvovrus B19

Question 984

Damage seen due to megaloblastic anemia

Answer 984

Vit B12 deficiency Damage to dorsal column of spinal cord Axonal degeneration of the peripheral nerves Loss of poition and vibration sense Gait problems

Question 985

Pear shaped organism Watery diarrhea Small bowel shows? Immune mechanism?

Answer 985

Giardia lamblia (parasite) Villus atrophy and crypt hyperplasia CD4 T cells and secretory IgA production

Question 986

Lesion to cerebellar vermis leads to

Answer 986

truncal ataxia | Gait ataxia

Question 987

Pain in both knees Pain in multiple joints Blue-black spots on sclerae Diffuse darkening of the auricular helices Deficiency?

Answer 987

Alkaptouria AR Deficiency of homogentisic acid dioxygenase Accumulated homogentisic acid

Question 988

Decreased ceruloplasmin

Answer 988

Wilson disease (copper buildup)

Question 989

Proteinuria Hematuria lactate dehdyrogenase elevated

Answer 989

Renal infarction Renal vein thrombosis due to antithrombin III loss

Question 990

HTN is defined as

Answer 990

>= 140/90 3 different occasions

Question 991

Tearing chest pain that radiates to the back See on CXR? TX?

Answer 991

Aortic dissection Widening of the mediastinum Large aorta, double circle Lower BP - Beta blocker

Question 992

Substances that act on smooth muscle mysoin light chains kinase How does this affect blood pressure

Answer 992

Dihydropyridine Ca channel blockers Epinephrine (acting at beta 2 receptor) Prostaglandin E2 Relaxation of vascular smooth m. Vasodilation Decrease BP

Question 993

Loss of forearm pronation nerve

Answer 993

Median

Question 994

Guillain- Barre syndrome preceded by what infection

Answer 994

Symmetric ascending muscle weakness Campylobacter jejuni (CMV, HIV, EBV, mycoplasma pneuonae)

Question 995

Where do neurons of the lateral corticospinal tract synapse prior to exiting the spinal cord

Answer 995

At the cell body of the anterior horn

Question 996

Endogenous hormones that stimulate gastric acid secretion Endogenous hormone that inhibit gastric acid secretion Drugs that regulate secretion

Answer 996

Stimulate - Histamine - Acetyl choline - Gastrin Inhibit - Prostaglandins - Somatostatin - Secretin - GIP Drugs that regulate - PPIs - H2 blockers - Antimuscarinic drugs (atropine)

Question 997

What type of lipoproteins accumulates first in atherosclerosis What cell adheres next Steps

Answer 997

LDL Macrophages and foam cells 1) Endothelial dysfunction 2) Accumulation of lipoprotein 3) Monocytes adhesion 4) Migration into intima transformation --> macrophages and foam cells 5) Factor release (platelets, macrophages) 6) Smooth muscle proliferation, deposition extracellular matrix elastin and collagen 7) Lipid accumulation

Question 998

Onion skin appearance of vessels

Answer 998

Arteriolosclerosis (Not atherosclerosis) Hyperplasia of vascular smooth muscle cells Hyaline thickening of arterioles

Question 999

Most common MI

Answer 999

Anterior wall MI | LAD

Question 1000

Inferior wall MI artery Lateral wall MI artery

Answer 1000

Inferior: Posterior descending A (RCA most common) Lateral: circumflex

Question 1001

Chest pain in younger adult Occurs at rest - Due to - ECG changes - Tx

Answer 1001

``` Prinzmetal angina (variatn angina) ``` Coronary artery spasm ST segment elevation Dihydropyridine Ca channel blockers (Nifedipine)

Question 1002

Classic presentation of congenital pyloric stenosis (5)

Answer 1002

2-6 weeks age Nonbillous projectile vomiting Palpable "olive" RUQ Hypochloremic metabolic alkalosis Hypokalemia

Question 1003

Relays what type of information from thalamus 1) Ventral posterior lateral 2) Lateral geniculate 3) Ventral posterior medial 4) Ventral anterior

Answer 1003

1) Somatosensory info from body 2) Visual retinal to occipital lobe 3) Somatosensory from face 4) Motor basal ganglia to cortex

Question 1004

Changes seen on EKG after MI Hours 1-2 days Weeks

Answer 1004

Hours - ST elevation - R wave decreases - Q wave appears 1-2 days - T wave inverts - Q wave deepens Weeks - ST normal - T wave normal - Q wave persists

Question 1005

Dressler syndrome

Answer 1005

Post MI pericarditis Chest pain Pericardial freiction rub Persistent fever occuring several weeks after MI

Question 1006

Type of hyperbilirubinemia that responds to phenobarbital

Answer 1006

Crigler Najjar type II | Gilbert

Question 1007

ECG leads the correspond 1) Left anterior descending 2) Left circumflex 3) Right coronary 4) Right coronary (posterior descending )

Answer 1007

1) Anterior wall V1-V4, V5 2) Lateral wall aVL, V5, V6, lead I 3) Inferior wall II, III, aVF 4) Posterior wall - R precordial ECG, V4

Question 1008

MI Sudden onset mitral regurgitation New holosystolic murmur Cardiac tamponade

Answer 1008

Papillary muscle rupture Intraventricular septal rupture (VSD) Ventricular wall rupture - bleeding into pericardium

Question 1009

Cardiac tamponade

Answer 1009

Compression of heart by fluid Decrase Cardiac output Equilibration of diastolic pressures in all 4 heart chambers ``` Hypotension Distended neck veins Distant heart sounds Increased HR Pulsus paradoxus ``` Electrical alternans

Question 1010

Kartagener syndrome

Answer 1010

Situs inversus Bronchiectasis Recurrent sinusitis Dynein arm defect

Question 1011

A 2-year-old boy presents to the pediatrician with fever, facial tenderness, and a green, foulsmelling nasal discharge. The patient is diagnosed with sinusitis, and the physician notes that he has a history of recurrent episodes of sinusitis. X-ray of the chest is ordered because of the fever; it reveals some dilated bronchi and shows the heart situated on the right side of his body. A congenital disorder is diagnosed. Which other finding would this patient be most likely to have? (A) Defective chloride transport (B) Elevated blood sugar (C) Infertility (D) Reactive airway disease (E) Tetralogy of Fallot

Answer 1011

C. infertility Kartagener's syndrome

Question 1012

Bronchiectasis

Answer 1012

Abnromal bronchial dilation caused by chronic infection Purulent sputum

Question 1013

A 19-year-old man has a history of recurrent mucoid rhinorrhea with chronic sinusitis and otitis media since childhood. He has experienced multiple bouts of pneumonia. His temperature is 37.7° C. On examination of his chest, there is tactile fremitus, rhonchi, and rales in lower lung fields. Nasal polyps are noted. A chest radiograph shows bronchial dilation with bronchial wall thickening, focal atelectasis, and areas of hyperinflation; his heart shadow appears mainly on the right. Which of the following abnormalities is he most likely to have? A α1-Antitrypsin deficiency B Atopy C Chloride ion channel dysfunction D Ciliary dyskinesia E HIV infection

Answer 1013

D. Ciliary dyskinesia

Question 1014

Carcinoid syndrome

Answer 1014

B FDR Bronchospasm and wheezing Flushing Diarrhea Right sided heart lesions

Question 1015

Painful red nodules on finger and toe pads Erythematous maculoes on palms and soles Splinter hemorrhages in fingernails Fever Organisms? Acute vs subacute

Answer 1015

Endocarditis - inflammation of valves S. Aureus Viridans streptococci Enterococcus Coagulase neg staph Acute - s. aureus - days - normal valves Subacute - Viridans streptococci - wks --> months - previously damaged valves

Question 1016

Systolic murmer louder with valsalva - due to Softer with squatting - due to Tx

Answer 1016

Hypertrophic cardiomyopathy - Hypertrophy of interventricular septum - outflow tract obstruction Reduces preload Increases afterload Beta blocker Verapamil

Question 1017

Endocarditis with streptococcus bovis also check

Answer 1017

Colon cancer

Question 1018

Endocarditis with negative blood cultures

Answer 1018

HACEK - Haemophilus - Actinobacillus - Cardiobacterium - Eikenella - Kingella Coxiella burnetii (Q fever) Bartonella Brucella

Question 1019

Endocarditis mneumonic Treatment

Answer 1019

``` Bacteria FROM JANE Fever Roth spots (eye) Osler nodes (tender fingertip) Murmur Janeway lesions (painless) Anemia Nail bed hemorrhage Emboli ``` Prophylactic Penicillin Empiric IV vancomycin (covers staph and strep)

Question 1020

Retinal hemorrhages with pale centers

Answer 1020

Roth spots Infective endoarditis

Question 1021

Valve affected in infective endocarditis Valve affected in IV drug user infective endocarditis

Answer 1021

Mitral valve Tricuspid valve

Question 1022

Kussmaul's sign

Answer 1022

JVD during inspiration Right sided heart problem Decreased capacity of RV Constrictive pericarditis (>>tamponade)

Question 1023

Aschoff bodies | Anitschkow cells

Answer 1023

Aschoff bodies - granuloma with giant cells - area of fibrinoid necrosis infiltrated by lymphocytes and giant cells Anitschkow cells - activated histocytes with owl eye appearance

Question 1024

EKG change with pericarditis

Answer 1024

Diffuse ST elevation

Question 1025

Most common primary cardiac tumor in adults

Answer 1025

Myxomas Left atrial myxoma Ball valve obstructs mitral valve --> syncopal episodes Plop sound

Question 1026

Tuberous sclerosis is associated iwth what three tumors

Answer 1026

Rhabdomyoma Astrocytoma Angiomylipoma

Question 1027

What heart pathology 1) Focal myocardial inflammation with multinucleate giant cells 2) Chest pain and coarse rubbing heart sounds in patient with Cr of 5.0 3) Tree barking of the aorta 4) ST elevation in all ECG leads 5) ECG shows electrical alternans 6) Child with fever, joint pain, cutaneous nodules, four weeks after throat infection

Answer 1027

1) Aschoff bodies - Rheumatic heart disease 2) Uremic pericarditis 3) Tertiary syphilis 4) Pericarditis 5) Cardiac tamponade 6) Acute rheumatic fever

Question 1028

Primary biliary cholangitis vs primary sclerosing cholangitis

Answer 1028

PBC - Autoimmune - (+) AMA - Middle aged female ``` PSC - (+) p-ANCA - Males > 40 - Assoc: UC and cholangiocarcinoma ERCP: alternating beading stricturing ```

Question 1029

``` Fever Jaundice RUQ pain Hypotension Altered mental status ```

Answer 1029

Reynold's pentad for cholangitis

Question 1030

Pulseless disease Poor pulses in extremities Young asain female - Histology - Elevated

Answer 1030

Takayasu arteritis Granulomatous inflammation of arteries of teh arotic arch Elevated ESR

Question 1031

Unilateral headache Jaw claudication Vision loss - Histology - Elevated - Assoc with - Tx

Answer 1031

Giant cell arteritis aka temporal arteritis Inflammation of branches of external carotid artery - temporal arteries Vision loss (occlusion of opthalamic artery) Elevated ESR Polymyalgia rheumatic - pain and joint stiffness High dose steroids for several months

Question 1032

``` Child Fever 5 days Conjunctivitis Rash on trunk Cervical lymph nodes swollen Red tongue Erythema on hands and feet ``` Potential for? Tx?

Answer 1032

Kawasaki disease (Mucocutaneous lymph node syndrome) Potential for coronary aneurysms - rupture - thormbosis --> MI Tx - VI immunoglobulin - Hig dose aspirin

Question 1033

Only child you give asprin to?

Answer 1033

Kawaski disease

Question 1034

Gangrene of fingers Smoker Male in 40s

Answer 1034

THromboangititis obliterans Buerger disease Small medium peripheral arteries adn veins Cold sensitivity Stop smoking

Question 1035

Hep B Vasculitis (-) anca involves spares assoc with Tx

Answer 1035

Polyarteritis nodosa (PAN) Involves kidneys, skin, GI, heart spares lungs Associated iwth hep B adn C Corticosteroids

Question 1036

Recent upper respiratory infection Palpable purpura on butt and legs Abdominal pain Protein and blood in urine - also have what disease - Tx

Answer 1036

Henoch-Schonlein purpura (IgA vasculitis) Renal dease - IgA nephropathy (berger's disease) Nephritis andhematuria Self limiting

Question 1037

``` Patient with asthma Sinusitis Multinucleated giant cells and eosinophils + p-ANCA Increased IgE ```

Answer 1037

Eosinophilic granulomatosis with polyangiitis | Churg-Strauss syndrome

Question 1038

A 53-year-old man with a long-standing history of allergic rhinitis and asthma presents with uveitis, mild hearing loss, numbness and tingling in his right hand, and diffuse joint pain for the past 10 days. Physical examination shows weak to absent left knee patellar reflexes (right knee reflex strong and intact). Laboratory studies show a markedly elevated eosinophil count. A diagnosis is made, and the patient is treated with cyclophosphamide. Further laboratory studies show elevated serum levels of the most common autoantibody associated with this condition. What structure is primarily targeted by the autoantibodies that are most likely elevated in this patient’s serum? (A) Acetylcholine receptors (B) Neutrophils (C) Oligodendrocytes (D) RBCs (E) TSH receptors

Answer 1038

B

Question 1039

p-ANCA - Ag - Ab c-ANCA - Ag - Ab

Answer 1039

p-ANCA - Myeloperoxidase (MPO) - MPO-ANCA c-ANCA - Proteinase 3 (PR3) - PR3-ANCA

Question 1040

Affects both kidneys and lungs

Answer 1040

Granulomatosis with polyangiitis (GPA) | Goodpasture

Question 1041

``` Dyspnea Hemoptysis Heamturia Saddle nose +c-ANCA Necrotizing granulomas ``` Tx

Answer 1041

Granulomatosis with polyangiitis (GPA) Wegners Focal necrotizing vasculitis

Question 1042

A 46-year-old man comes to the clinic with a cough that is occasionally productive of blood, diffuse muscle and joint pain in the upper extremities, and blood in his urine for the past several days. On further questioning, the patient reveals that he has had chronic sinusitis for the past several years. The patient has a low grade fever and nasal ulcerations. Laboratory studies show a markedly elevated erythrocyte sedimentation rate, and staining for antibodies to cytoplasmic antigens of neutrophils is positive.Biopsy of a nasal ulceration reveals vasculitis and necrotizing granulomas. Which of the following is the most likely diagnosis? (A) Alport’s syndrome (B) Giant cell (temporal) arteritis (C) Goodpasture’s syndrome (D) Takayasu’s arteritis (E) Wegener’s granulomatosis

Answer 1042

E. wegeners

Question 1043

(+) p-ANCA

Answer 1043

Eosinophilic granulomatosis with polyangiitis Microscopic polyangiitis

Question 1044

(+) c-ANCA

Answer 1044

Granulomatosis with polyangiitis (GPA)

Question 1045

Necrotizing vasculitis of lungs kidneys skin Crescentic GN Palpable purpura + p-ANCA Doesnt have

Answer 1045

Microscopic polyangiitis No naropharyngeal involvement

Question 1046

``` Recurrent nose bleeds Gi bleeding Hematuria Telangiectasias Skin discolorations Microcytic anemia ``` - inheritence

Answer 1046

Hereditary Hemorrhagic Telangiectasia aka osler-weber rondu syndrome AD Due to vascular malformations in mucosa --> prone to bleeding

Question 1047

Microcytic anemia

Answer 1047

Iron deficiency Thalassemias Lead poisoning

Question 1048

Normocytic Hemolytic anemia

Answer 1048

``` Sickle cell HbC disease Pyruvate kinase deficiency G6PD deficiency Paroxysmal nocturnal hemoglobunuria Hereditary spherocytosis ```

Question 1049

Megaloblastic macrocytic anemia

Answer 1049

Folate def Vit B12 def orotic aciduria Fanconi anemia

Question 1050

Can cause perforation of nasal septum | Vasculitis

Answer 1050

Granulomatosis with polyangiitis (wegener's granulomatosis)

Question 1051

Anti smooth muscle Ab Antimitochondrial Ab

Answer 1051

Autoimmune hepatitis Primary biliary cholangitis

Question 1052

Chronic granulomatous disease suspectable to

Answer 1052

Lack NADPH oxidase activity Catalase positive s. aureus aspergillus

Question 1053

``` Port wine stain Intellectual disability Hemiplegia Calcification of outer boarder of brain Also see ```

Answer 1053

Sturge-Weber disease - affects capillaries Seizures Early onset glaucoma Hemiplegia (paralysis one side body) Leptomeningeal angioma

Question 1054

Red polyp on skin Can ulcerate and bleed Assoc w/ trauma and pregnancy

Answer 1054

Pyogenic granuloma

Question 1055

Red prominent bumps smooth dots

Answer 1055

Baronella henselae Bacillary angiomatosis

Question 1056

Large dark brown spots on legs

Answer 1056

Kaposi sarcoma (KS) Herpes virus 8

Question 1057

Raynaud phenomenon associ with

Answer 1057

Blue fingers in cold SLE CREST scleroderma Thromboangiitis obliterans (Buerger dis) Mixed CT disease

Question 1058

What cell type secretes histamine that stimulates the histamine receptor on parietal cells

Answer 1058

Enterochromaffin -like cells (ECL cells)

Question 1059

Cohort study gives

Answer 1059

Relative risk | A/A+B) / (C/ C+D

Question 1060

Cross sectional gives

Answer 1060

Prevalence

Question 1061

Plummer vinson

Answer 1061

Dysphagia (esophageal webs) Glossitis Iron deficiency

Question 1062

what changes depending on disease prevalence?

Answer 1062

PPV increases with increasing prevalence NPV decreases with increase prevalence

Question 1063

Sensitivity equation (2)

Answer 1063

A/ A+C 1- false negative rate

Question 1064

What is seen in distal duodenum of patients with celiac sprue

Answer 1064

Blunting of villi Hyperplastic crypts Lymphocytes in lamina propria

Question 1065

Attributable risk (AR) equation

Answer 1065

AR= incidence disease (exposed) - incidence of disease (unexposed) AR= (A/ A+B) - (C/C+D)

Question 1066

Odds ratio

Answer 1066

(A/B)/ (C/D)

Question 1067

Relative risk

Answer 1067

Probability to getting disease in exposed group compared to unexposed group (A/A+B) / (C/C+D)

Question 1068

Absolute risk reduction (ARR)

Answer 1068

(C/C+D) - (A/A+B)

Question 1069

Number needed to harm

Answer 1069

1/ AR AR= (A/ A+B) - (C/C+D)

Question 1070

Number needed to treat (NNT)

Answer 1070

NNT= 1/ ARR ARR= (C/C+D) - (A/A+B)

Question 1071

``` NNT? 100 acute stroke patients given tPA 40 have complete recovery 400 acute not give tPA 80 have complete recovery ```

Answer 1071

60 40 320 80 (320/ 400) - (60/100)= 0.2 NNT= 1 / 0.2= 5

Question 1072

Most common benign salivary gland neoplasm Most common malignant slaivary gland neoplasma Most common location for salivary gland neoplasm

Answer 1072

Pleomorphic adenoma Mucoepidermoid carcinoma Parotid gland

Question 1073

Positive skew

Answer 1073

Tail toward positive direction (to right) Mean > Median > Mode

Question 1074

Negative Skew

Answer 1074

Tail on left | Mean < Median < Mode

Question 1075

Small p value

Answer 1075

indicates that the study values didnt occurred on chance alone Reject null Statistically significant

Question 1076

Type I error

Answer 1076

alpha Stating there is an effect when there isnt one Accusing an innocent man False positive

Question 1077

Type II error

Answer 1077

beta Stating there is no effect when there is one You blindly let the guilty man go free False negative

Question 1078

Power=

Answer 1078

Probability that a test will correctly reject the null hypothesis Increases with increased number of study participants 1-beta

Question 1079

Confidence interval =

Answer 1079

CI= mean +- Z (SEM) 90% CI; Z= 1.5 95% CI; Z= 2 99% CI; Z= 2.5 SEM= standard dev/ squr root ( sample size)

Question 1080

One standard deviation away from zero percentage 2 standard deviation away 3 standard deviation away

Answer 1080

68% 95% 99.7%

Question 1081

Male vs female Diseased vs not diseased Comparing percentages of members Test?

Answer 1081

Chi-squared

Question 1082

Correlation coefficient (r)

Answer 1082

Measure of relationship of two variables ``` r= - 0.8 straight negative line r= - 0.4 spread out up negative line r=0 no relationship r= 0.4 spread out positive line r= 0.8 straight positive line ```

Question 1083

Blood pressure between men and woemn test

Answer 1083

T test

Question 1084

What hormones stimulate pancreatic secretion

Answer 1084

Acetylcholine CCK Secretin

Question 1085

IPV vaccine

Answer 1085

Poliomyelitis

Question 1086

Meningococcal vaccine recommendation

Answer 1086

11 or 12 yo | Boooster at 16

Question 1087

What diarrheal illnesses should be reported

Answer 1087

Salmonella | Shigella

Question 1088

E/M ICD-10 CPT

Answer 1088

E/M= evaluation and management codes ICD-10= international classification of diseases (diagnosis) CPT= current procedure terminology (produre done)

Question 1089

Capitation

Answer 1089

Fixed payment for a period of time or number of patients (ER shift, concierge practice)

Question 1090

Which department in a hospital oversees the maximization of the quality of care while minimizing the cost of care?

Answer 1090

Utilization management department

Question 1091

In patient with elevated alkaline phosphatase, elevation in which other serum lab markers would point toward a diagnosis of liver disease?

Answer 1091

AST ALT GGT

Question 1092

Ethical duty to act in the patients best interest

Answer 1092

Beneficience

Question 1093

Physicians must strive to treat people fairly

Answer 1093

Justice

Question 1094

Dont need informed consent from parents or guardians for (7)

Answer 1094

``` Emancipated minors STDS Pregnancy Drug addiction Child of a minor Minor serving a sentence of confinement Emergency situation ```

Question 1095

Right sided heart failure signs

Answer 1095

Peripheral signs Lower extremity edema Jugular venous distention Hepatosplenomegaly

Question 1096

What areas of the hypothalamus regulate the autonomic nervous system

Answer 1096

Anterior hypothalamus: parasympathetic Posterior: sympathetic

Question 1097

Pneumonia in neonates (Birth to 28 days Pneumonia in children Pneumonia in adults

Answer 1097

Neonates - Group B streptococcus - E coli - Chlamydia trachomatis - HSV Children - Viruses (RSV) - Streptococcus pneumoniae - Mycoplasma pneumoniae - Chlamydophila pneumoniae Adults - Streptococcus pneumoniae - H. influenza - Mycoplasma pneumoniae - Chlamydophila pneumoniae - Influenza virus Elderly - Streptococcus pneumoniae - H. influenza - Influenza virus - S. aureus - Gram negative rods (klebsiella )

Question 1098

Organism taht causes pneumonia in each of these patients 1) Alcoholic patient 2) Patient with decrased level of consciousness 3) Pt w/ cystic fibrosis 4) Pt w/ HIV and CD4<200 5) Post-influenza 6) Acquired from patio-cooling water mister 7) Travel to southwestern U.S. 8) Exposure to bird/ bat droppings in ohio missiissippi river 9) Patient with pet parrot

Answer 1098

1) Klebsiella 2) Anaerobes 3) Pseudomonas 4) Pneumocystis jirovecii 5) Staphylococcus aureus 6) Legionella pneumophilia 7) Coccidioides immitis 8) Histoplasma capsulatum 9) chlamydophila psittaci

Question 1099

Meningitis by age Neonates Infants/children Adults Elderly adults

Answer 1099

Neonates - Group B strep - E.coli - Listeria monocytogenes Infants/ children - Streptococcus pneumoniae - Neisseria meningitides - H. influenza type B - viruses (enteroviruses) Adults - strep pneumoniae - Neisseria meningitidis - enteroviruses Elderly - Streptococcus pneumoniae - Listeria - Gram negative rods (ecoli)

Question 1100

Meningitis gram positive diplococci

Answer 1100

Streptococcus pneumoniae

Question 1101

Meningitis gram negative coccobacilli

Answer 1101

H. influenzae

Question 1102

Meningitis gram positive rod

Answer 1102

LIsteria monocytogenes

Question 1103

Variola virus

Answer 1103

Pox virus Small pox Respiratory droplets Contaminated objects Rash around mouth --> spread to face --> trunk extremities

Question 1104

What type of meningitis? 1) Unvaccinated child 2) Outbreak in dorm 3) Meningitis with petechial rash 4) Patient with HIV 5) RBCs in CSF + temporal lobe involvement on MRI

Answer 1104

1) H. influenza type B 2) N. meningitis 3) N. meningitides 4) Cryptococcus neoformans 5) HSV encephalitis

Question 1105

CSF findings bacterial meningitis ``` Opening pressure WBC count Cell type Protein Glucose Gram stain ```

Answer 1105

Increased pressure Increased WBC Neutrophils HIGH protein Decreased glucose Gram stain positive

Question 1106

CSF findins TB/ fungal meningitis ``` Opening pressure WBC count Cell type Protein Glucose Gram stain ```

Answer 1106

Increased pressure INcreased WBC Lymphocytes Increased protein Decreased glucose No stain

Question 1107

CSF findings in viral meningitis ``` Opening pressure WBC count Cell type Protein Glucose Gram stain ```

Answer 1107

Normal or increased opening pressure WBC increased Lymphocytes Normal or increased protein Normal glucose No stain

Question 1108

Meningitis Slightly increased protein Normal glucose Incrased opening pressure

Answer 1108

Viral meningitis

Question 1109

1) Newborn with chronic diarrhea, Failure to thrive Chronic candidiasis 2) Child with eczema, coarse facial features and cold abscesses 3) Child with partial albinism, pepripheral neuropathy, and recurrent infections

Answer 1109

1) Severe combined immunodeficiency (SCID) 2) Hyper IgE syndrome 3) Chediak- Higashi disease

Question 1110

Frothy yellow green Fishy odor pH > 4.5 Pear shaped Tx

Answer 1110

Trichomonas vaginalis Metronidazole

Question 1111

Thick white cottage cheese like 4-4.5 pH Tx

Answer 1111

Candida spp Azoles Nystatin

Question 1112

Thin gray-white fishy odor >4.5 pH Clue cells Tx

Answer 1112

Gardnerella vaginalis Part of normal flora Metronidazole Clindamycin

Question 1113

Budding yeast and peudohyphae

Answer 1113

Candidiasis

Question 1114

Strawberry cervix

Answer 1114

Trichomoniasis

Question 1115

Perinuclear cytoplasmic clearing

Answer 1115

Koilocytes HPV

Question 1116

What can have painful inguinal lymphadenopathy

Answer 1116

Bubo Lymphogranuloma venereum Chlamydia trachomatis

Question 1117

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

Answer 1117

1) Herpes simplex 2) Haemophilus ducreyi 3) Syphilis 4) Haemophilus ducreyi 5) Tertiary syphilis - Gummatous syphilis

Question 1118

Adhesion to liver | Violin strings

Answer 1118

FItz-Hugh Curtis Extension of PID

Question 1119

WBC cast

Answer 1119

Formed in tubules of kidney Pyelonephritis

Question 1120

Gram negative rod Swarming motility Urease positive Forms what

Answer 1120

Proteus mirabilis Hydrolyzes urea to ammonia Urine more alkaline Struvite stones Magnesium ammonium phosphate stones Staghorn calculus

Question 1121

Staghorn calcus

Answer 1121

Urease producing bacteria Proteus mirabilis Kelbsiella

Question 1122

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

Answer 1122

Early manifestations Congenital syphilis (during first 2 years)

Question 1123

``` Frontal bossing Interstitial keratitis Hutchinson teeth Saddle nose Perforation of hard palate Sabershins ```

Answer 1123

Late mnaifestation of congenital syphilis

Question 1124

Infects transfered through placenta or during birth

Answer 1124

TORCHeS ``` Toxopolasmosis Other (parvovirus B19) Rubella CMV HIV/HSV Syphilis ```

Question 1125

Pregnant lady and cat feces or undercooked meat - What happens

Answer 1125

Toxoplasmosis Chorioretinitis Hydrocephalus Intarcranial calcifications

Question 1126

Child | Red rash on cheek spread to chest and shoulder

Answer 1126

Parvovirus B19

Question 1127

Severe fetal anemia Ascites Pleural effusions

Answer 1127

Hydrops fetalis Parvovirus B19

Question 1128

``` Newborn Cataracts Harsh machine like murmur Deafness Blueberry muffin rash ```

Answer 1128

Rubella

Question 1129

Newborn Jaundice Hepatosplenomegaly Sensorineural hearing loss

Answer 1129

CMV

Question 1130

Nosocomial infection 1) Catheter assoc UTI 2) Ventilator assoc pneumonia 3) Central lines infxn 4) Surgical wounds/ decubitus ulcers 5) Parenteral nutrition

Answer 1130

1) E. coli Gram neg rods Pseudomonas Candida 2) Pseudomonas Staph aureus 3) Staph epidermdiis 4) Staph aureus 5) Candida

Question 1131

Osteomelitis | Gangrene organism

Answer 1131

Clostridium perfringens Alpha toxin

Question 1132

Wolff parkinson White syndrome

Answer 1132

D wave (curving of slope between P and R wave Ventricular pre-excitation syndrome Abnormal fast accessory conduction pathway from atria to ventricle (bypass AV) Ventricles begin to partially depolarize earlier --> SVT

Question 1133

Infantile cataracts

Answer 1133

Galactokinase deficiency Classic galactosemia Rubella

Question 1134

Vit B12 used for

Answer 1134

Methionine synthase

Question 1135

Herpes virus

Answer 1135

dsDNA

Question 1136

Calcium stone due to diuretic

Answer 1136

Thiazide diuretic

Question 1137

Cataracts and deafness

Answer 1137

Rubella

Question 1138

Migraine NT

Answer 1138

Excessive glutamate

Question 1139

Liver abscess

Answer 1139

E histolytic Protozoan Amebic dysentery

Question 1140

Bloody dirarrhea | Eosinophils

Answer 1140

E. histolytica

Question 1141

Saccular aneurysm

Answer 1141

aka berry aneurysm ACA

Question 1142

Empysema

Answer 1142

Increase compliance | Increases alveolar dead space

Question 1143

Hesselbach triangle?

Answer 1143

Inguinal ligament Inf. epigastric Lateral border rectus abdominis

Question 1144

Carbamoyl phosphate synthetase (1 and 2)

Answer 1144

CPS-1 - urea cycle - mitochondria - source of nitrogen: ammonia CPS-2 - pyrimidine synthesis - cytosol - source of nitrogen: glutamine

Question 1145

Rate limiting step in pyrimidine synthesis

Answer 1145

Carboamoyl phosphate synthetase 2

Question 1146

Rate limiting step in purine synthesis Inhibited by

Answer 1146

Glutamine PRPP amidotransferase 6-mercaptopurine

Question 1147

Sources of carbon in sythesis of purines? In pyrimidine synthesis?

Answer 1147

Pyrimidine: aspartate, CO2 Purine= CO2, glycine, tetrahydrofolate

Question 1148

What medication inhibits each 1) Ribonucleotide reductase 2) Dihydrofolate reductase 3) Thymidylate synthase 4) Inosine monophosphate dehydrogenase 5) PRPP amidotransferase`1)

Answer 1148

1) Hydroxyurea 2) Trimethoprim Methotrexate 3) 5-fluorouracil 4) Mycophenolate 5) 6-mercaptopurine

Question 1149

How many adenine residues are found in a molecule of DNA if one strand contains A= 2000 G= 500, C= 1500 T=1000

Answer 1149

2000 + 1000= 3000

Question 1150

Self-mutilating behavior intellectual disability Gout - Deficency - inheritence - tx

Answer 1150

Lesch-Nyhan syndrome Deficency HGPRT X linked Allopurinol Febuxostate

Question 1151

Orotic acid in urine + elevated serum ammonia - inheritence - causes

Answer 1151

Ornithine transcarbamylace deficiency X linked recessive Excess carbamoyl phosphate --> orotic acid Hyperammonemia Decreased BUN No megaloblastic anemia

Question 1152

Orotic acid in urine + normal serum ammonia - deficency - inheritence - feature seen - tx

Answer 1152

Orotic aciduria Deficiency of UMP synthase AR Megaloblastic anemia Tx: Uridine supplementation

Question 1153

Megaloblastic anemia that does not improve with B12 and folate

Answer 1153

Orotic aciduria

Question 1154

Histones consist of what amino acids

Answer 1154

Lysine and arginine

Question 1155

Pyrimidine synthesis requires what four things

Answer 1155

Aspartate Co2 Glutamine ATP

Question 1156

Purine synthesis requires what 5 things

Answer 1156

Cats PURRR until they GAG and Cough on Fur balls Purine synthesis GAG= glycine, aspartate, glutamine Cough= CO2 Fur balls= folic acid or tetrahydrofolate

Question 1157

SCID due to

Answer 1157

Adenosine deaminase deficiency

Question 1158

DNA Polymerase I: DNA polymerase III:

Answer 1158

I: Breaks down RNA primer fills in gap w/ DNA III: leading strand 5 --> direction Lagging stand, short discontinous segments

Question 1159

DNA enzyme that can go in 3--> 5 direction and 5--> 3 direction

Answer 1159

DNA polymerase I 3--> 5 remove 1 nucleotide at a time 5--> 3 remove 1-10 nucleotides

Question 1160

DNA polymerase alpha DNA polymerase beta DNA polymerase delta DNA polymerase episilon DNA polymerase gamma

Answer 1160

Alpha - makes own primer - replicates first 20 nucleotides Beta - DNA repair Delta - Build okazaki fragments on lagging strand Episilon: Elongates teh leading strand Gamma: Replicates mitochodnrial DNA

Question 1161

Base excision repair (5)

Answer 1161

Glycosylase - recognized damaged bases and removes them Lyase - cuts 3' end of back bone Endonuclease - cuts the 5- end and removes backbone DNA polymerase beta - Fills gaps Ligase -seals

Question 1162

Mismatch repair

Answer 1162

Nick daughter strand upstream and remove a whole bunch of bases Redo replication and fill gap

Question 1163

DNA repair that repairs both strands

Answer 1163

Nonhomologous end joining

Question 1164

Hereditary nonpolyposis colorectal cancer DNA defect | -risk of

Answer 1164

Defect mismatch repair Increased risk of colon cancer

Question 1165

Xeroderma pigmentosum DNA repair defect - inheritence - cant do - increased risk

Answer 1165

AR Defective nucleotide excision repair Sensitive to sunlight Cant remove pyrimidine dimers from UV radiation Increased risk of skin cancer, melanoma, SCC, basal cell

Question 1166

Bloom syndrome - DNA defect - Sensitive to - increased risk

Answer 1166

Mutation of helicase - DNA replication - DNA repair Hypersensitive to sunlight Increased risk of leukemia and lymphoma

Question 1167

Ataxia-telangiectasia defect - syndrome - elevated - sensitive to

Answer 1167

Defect repair of dsDNA breaks IgA deficiency Cerebellar ataxia Smooth persuit with eye Elevated alpha fetoprotein after 8 months Sensitive to ionizing radiation

Question 1168

BRCA1 and BRCA 2 DNA repair defect

Answer 1168

dsDNA breaks

Question 1169

What strand of DNA nucelotide opposes this DNA strand? 5' - ATTGCGTA-3'

Answer 1169

5'- TACGCAAT- 3'

Question 1170

Which eukaryotic DNA polymerase performs this function 1) Replicates lagging strand 2) Synthesizes RNA primer 3) Repairs DNA 4) Replicates mitochondrial DNA 5) Replicates leading strand DNA

Answer 1170

1) DNA polymerase delta (first 20 alpha) 2) Alpha 3) Beta 4) Gamma 5) Epsilon (alpha first 20)

Question 1171

What gets compressed in pregnant female to decrease blood pressure when supine

Answer 1171

Inferior vena cava

Question 1172

DNA promoter regions

Answer 1172

- 25 Hogness/ TATA box - 75 CCAAT box - 10 Pribnow/ TATAAT box

Question 1173

Operator region of transcription

Answer 1173

Binds repressor or inducer Located between promoter region and start site

Question 1174

Response elements of trascription

Answer 1174

Enhancer region and repressor region Increase or decrease the rate of transcription Location: close to, far from or within the promotor region

Question 1175

mRNA tRNA rRNA

Answer 1175

mRNA - messenger RNA - coupled to DNA template - transcribed into proteins - largest type - made in nucleoplasm tRNA - transfer RNA - matches to mRNA and brings AA, transfers mRNA to polypeptide chain - Smallest type - made in nucleoplasm rRNA - Part of ribosome - binds AA together - Most abundant - made in nucleus

Question 1176

Start codon

Answer 1176

AUG Methionine

Question 1177

Stop Codons

Answer 1177

UGA UAA UAG

Question 1178

What breaks down lactose into two particles

Answer 1178

beta-galactosidase Into glucose and galactose

Question 1179

What do you need for transcription of beta-galactosidase. When is it present

Answer 1179

CAP (catabolite activating protein) -Present when glucose absent Allolactose - lactose metabolite binds to lac repressor protein and changes shape - Present with abundant lactose

Question 1180

5- cap - what is it - provided by

Answer 1180

1- methyl-guanosine cap Provided by s-adenosyl-methionine (SAM)

Question 1181

specific signal to start polyadenylate tail

Answer 1181

AAUAAA

Question 1182

Substances that inhibit reuptake of NE

Answer 1182

``` Cocaine TCAs SNRIs - venlafaxine - duloxetine Methylphenidate Bupropion ```

Question 1183

When enzyme matches amino acids to tRNA

Answer 1183

Aminoacyl tRNA synthetase

Question 1184

Tendon xanthomas Cafe au alit spot Boot shaped heart

Answer 1184

Familial hypercholesterolemia NF1, McCune albright syndrome RVH --> tetralogy of fallot

Question 1185

Triad of tuberous sclerossi

Answer 1185

Seizures Intellectual disability Angiofibromas (reddish borwn bumps on nose/ cheeks)

Question 1186

Autosomal dominant inheritence Disease?

Answer 1186

Both male and female Every generation affected 50% in any generation ``` Von Hippel Lindau Von Willebrand Dis ALS Retinoblastoma MEN Tuberous sclerosis Hereditary spherocytosis Huntington's disease Marfan Ehler's danlos syndrome Neurofibromatosis Familial adenomatous polyposis Osler-weder-Rondu Achondroplasia Family hypercholesterolmia ADPKD ```

Question 1187

X linked dominant disease

Answer 1187

Fragile X

Question 1188

Autosomal recessive | Type

Answer 1188

25% offspring ONly 1 generation ``` Alpha 1 AT Beta-thalassemia PKU Hemochromatosis Wilson's dis Bernard-Soulier Hartnup syndrome Glanzman thrombasthenia Fanconi Cystic fibrosis Pompe dis Sphingoolipidoses Mucopolysaccharidoses Sickle cell disease Cori disease McArdle Albinism Von Gierke ```

Question 1189

X linked recessive

Answer 1189

50% sons affected ``` Hunter Lesch-Nyhan Fabry disease Meinke's disease Wiskott Aldrich syndrome G6PDH Bruton's agammaglobulinemia Duchenne's muscular dystrophy Hemophilia A Hemophilia B Diabetes insipidus ```

Question 1190

Single gene has more than one effect Mutations oat different loci have same phenotype

Answer 1190

Pleiotrophy Locus heterogeneity

Question 1191

Prader-Willi

Answer 1191

POP Prader willi Overeating Obesity Paternal gene

Question 1192

Angelmann

Answer 1192

``` MAMA Maternal gene Angelmann Mood- happy laughter Ataxia ```

Question 1193

Southern blot Northern Blot Western blot Southwestern blot

Answer 1193

Southern - DNA sample, DNA probe Northern - RNA sample, DNA probe Western - Protein sample, Ab probe Southwestern - Transcription factors, DNA binding proteins - DNA binding proteins sample, Oligonucltide probe

Question 1194

Direct ELISA test for

Answer 1194

Antigens

Question 1195

Indirect ELISA test for

Answer 1195

Antibodies

Question 1196

Hallmark of COPD on pulmonary function testing

Answer 1196

Decreased FEV1/ FVC

Question 1197

Schizophrenic brain

Answer 1197

Smaller Enlarged ventricles Thin cortex Increase dopamine in mesolimbic Decrease dopamine in mesocortical

Question 1198

RNA made from different polymerase RNA polymerase I RNA polymerase II RNA polymerase III

Answer 1198

I= rRNA II= mRNA III= tRNA

Question 1199

Hallmark of restrictive lung disease

Answer 1199

Decrease in total lung capacity | Normal FEV1/ FVC ratio

Question 1200

Dystonia

Answer 1200

sustained muscle contraction

Question 1201

Adjustment disorder

Answer 1201

Identifiable psychosocial stressor <6 months after stressor gone

Question 1202

Virchow node

Answer 1202

Left supraclavicular LN Gastric cancer metastasis

Question 1203

Pattern of behaviors that violate social norms and rights of others

Answer 1203

Conduct disorder Theft Violence Fire Cruelty to animals < 18 conduct > 18 antisocial personality disorder

Question 1204

Trichotillomania Tx

Answer 1204

Hair pulling disorder Education Cognitive behavioral Fluoxetine (SSRI) Clomipramine (TCA)

Question 1205

Redirection of emotions or impulses to a neutral person or object

Answer 1205

Displacement

Question 1206

Partially remaining at a more childish level of development Surgeon throws tantrum in operating room because last case ran late

Answer 1206

Fixation

Question 1207

Separating feelings from ideas and events Describing murder with not emotional response

Answer 1207

Isolation

Question 1208

Replacing a warded-off idea or feeling with an (unconsciously derived) emphasis on its opposite Lustful thoughts so go to church

Answer 1208

Reaction formation

Question 1209

Alleviatin negative feelings via unsolicited generosity, which provides gratification mafia boss makes large donation of charity

Answer 1209

Altruism

Question 1210

Replacing an unacceptable with with a course of action that is similar to the wish but socially acceptable Teenagers aggression towards parents because of high expectations is channeled into excelling in sports

Answer 1210

Sublimations

Question 1211

30 year old says you are the best doctor shes ever had, nurses are the worst. Threatens to change doctors when you wont do a particular lab test Personality disorder?

Answer 1211

Borderline personality disorder Splitting Fear of abandonment Self mutilation

Question 1212

Women comes into office wearing all black, and excessive lipstick. Talks to everyone in waiting room. Wearing feather boa Also?

Answer 1212

Histrionic personality disorder Sexually provocative

Question 1213

A patient with IL-12 receptor deficiency is at particualr risk for what type of infection?

Answer 1213

Mycobacterial

Question 1214

Alcohol has affects on what receptors

Answer 1214

GABA

Question 1215

``` Alcohol in hospital for 2-3 days Sudden confusion Nightmares Agitation Disorientation Hallucinations Fever HTN Seizures ``` Tx

Answer 1215

Delirium Tremens Benzo Alcohol

Question 1216

Wernicke-Korsakoff damages what

Answer 1216

Medial thalamus and mamillary bodies of posterior hypothalamus

Question 1217

What embryologic structure of the heart gives rise to each of the following adult structures? 1) Smooth parts of the left and right ventricles 2) Smooth part of the right atrium 3) Trabeculated left and right atria 4) Trabeculated parts of the left and right ventricles

Answer 1217

1) Smooth parts of the left and right ventricles = Bulbus cordis 2) Smooth part of the right atrium = Right horn of sinus venosus 3) Trabeculated left and right atria = primitive atria 4) Trabeculated parts of the left and right ventricles = primitive ventricle

Question 1218

Mesonephros - does what - becomes

Answer 1218

Fetal kidney (1st trimester) Becomes male genital system

Question 1219

Potter sequence due to

Answer 1219

Failure of ureteric bud to develop No collecting system Nothing to induce metanephros to develop into nephron Bilateral renal agenesis

Question 1220

Horseshoes kidney gets stuck on Associated iwth

Answer 1220

Inferior mesenteric artery Turners syndrome

Question 1221

What remains in capillaries after filtration

Answer 1221

Blood cells Platelets Large proteins Exits through efferent arterioles

Question 1222

Juxtaglomerular apparatus composed of

Answer 1222

Juxtaglomerular cells - secrete renin Macula densa - specialized sensory cells - senses if Na in lumen of distal nephron is too low

Question 1223

Three things that cause JG cells to secrete renin

Answer 1223

Beta adrenergic stimulation Low Na in DCT Low pressure in afferent arteriole

Question 1224

Effect of GFR, RPF, FF 1) Increase serum protein 2) Ureter stone obstruction 3) ACE inhibitors 4) NSAIDS

Answer 1224

1) Osmotic load keeps fluid in GFR: Decrease RPF: No change FF: Decrease 2) High hydrostatic pressure in Bowman capsule, favors blood staying in capillaries GFR: decrease RPF: No change FF: decrease 3) Dilate efferent GFR: Decrease RPF: Increase FF: Decrease 4) Afferent constriction GFR: decrease RPF: decrease FF: no change

Question 1225

How much of body is water? Extracellular fluid Interstitial fluid Plasma volume Intracellular fluid

Answer 1225

60% total 40% Intracellular 20% Extracellular - 75% Interstitial fluid - 25% Plasma

Question 1226

Renal clearance=

Answer 1226

UV/P Urine concentration of substance x urine flow rate / plasma concentration substance

Question 1227

Substance that gives GFR Normal GFR

Answer 1227

Inulin Creatinine 90-135 (think 100)

Question 1228

Substance that gives Renal plasma flow

Answer 1228

PAH

Question 1229

Filtration fraction=

Answer 1229

GFR/ RPF Normally 20%

Question 1230

Prostaglandin effect of GFR, RPF, FF

Answer 1230

Vasodilators | Dilate afferent arterioles

Question 1231

Angiotensin II on GFR, RPF, FF

Answer 1231

Constrict efferent arterioles

Question 1232

Filtered load= Reabsorbed amount= Secretion=

Answer 1232

FL= GFR x P (plasma) Reabsorbed= filtered - excreted Secretion= excreted - filtered

Question 1233

A 55-year-old woman has had worsening problems with memory and the ability to carry out tasks of daily living over the past year. She has had watery diarrhea for the past 3 months. Physical examination shows red, scaling skin in sun-exposed areas. Deep tendon reflexes are normal, and sensation is intact. Which of the following diseases is she most likely to have? A Beriberi B Cheilosis C Hypothyroidism D Marasmus E Pellagra

Answer 1233

Pellagra 3D's Hartnup disease Deficient transporter for neutral amino acids (tryptophan) Inability to make niacin (Vit B3)

Question 1234

What is HUS

Answer 1234

Hemolytic uremic syndrome Associated w/ E.coli 0157:H7 Hemolytic anemia (red blood cells being destroyed) Thrombocytopenia Acute kidney injury

Question 1235

What is absorbed in PCT first half

Answer 1235

All glucose All amino acids 2/3 fluid 2/3 electrolytes Reabsorbs primarily - Bicarb - Na

Question 1236

Na transporter - PCT (early) - PCT (late) - Thick ascending - Early distal tubule

Answer 1236

PCT (early) - Na/ X (glucose, AA, lactate) into cell PCT (late) - Na reabsorption is with chloride Thick ascending - Na/K/ 2CL transporter Early distal tubule - Na/ Cl-

Question 1237

Relative concentrations of ultrafiltrate along proximal tubule (graph)

Answer 1237

"Plasma Concentrations Increase Unless Cleared by Kidneys" ``` PAH Creatinine Inulin Urea Chloride Potassium ``` Sodium Water HCO3 Aminoacids Glucose

Question 1238

What do you need to get an anion from interstitium to lumen What do you need to get an cation from interstitium to lumen

Answer 1238

alpha-ketoglutarate ``` Cation - Na/K ATPase (2 Na/ 3 K) - electrochemical gradient - Cation move down gradient in to cell Cation/H exchange into lumen ```

Question 1239

Responsible for water reabsorption | Impermeable to Na

Answer 1239

Thin descending limb Water follows osmotic gradient into hypertonic medulla Concentrates lumen

Question 1240

Thick ascending limb - fxn - what also gets in - what doesnt - Result

Answer 1240

Actively absorbing Na, Cl, and K (passive in PCT) Ca and Mg sneak inbetween cells Impermeable to water Dilutes urines

Question 1241

PTH acts on

Answer 1241

Ca in early distal convoluted tubule

Question 1242

ADH works on

Answer 1242

V2 vasopressin receptors on principal cells in collecting tubule Tells cells to insert aquaporins into lumen surface of cells Allows water to be resorbed Lithium - Enters through Na channel - Blocks aquaporin

Question 1243

Potassium-sparing diuretics (2 types)

Answer 1243

"SEAT" Aldosterone antagonists - Spironolactone - Eplerenone Inhibit epithelial Na channel - Amiloride - Triamterene

Question 1244

What class of drug inhibits Na/2Cl/K symporter in thick ascending limb

Answer 1244

Loop diuretics Cause isotonic water excretion

Question 1245

Two cells in collecting duct and function

Answer 1245

Principal cells - reabsorb water and Na - secrete K Intercalated cells - Secrete H or HCO3 - reabsorb K

Question 1246

Two types of intercalated cells

Answer 1246

``` Alpha cells (A cells) - Secrete H ``` ``` Beta cells (B cells) Secrete HCO3 ```

Question 1247

What diuretic directly affects principal cells

Answer 1247

Potassium sparing diuretics

Question 1248

What effect does aldosterone have on the principal cells and intercalated cells of the collecting duct?

Answer 1248

Principal= reabsorptionof Na and secretion of K Intercalated cells: stimulates secretion of H

Question 1249

What bacteria secrete enterotoxins?

Answer 1249

``` Vibrio cholerae Enterotoxigenic E.coli Staph aureua Shigella Yersinia Clostridium spp. ```

Question 1250

Charcot's neurological triad

Answer 1250

Associated iwth MS Scanning speech Intention tremor nystagmus

Question 1251

Damage to which part of substantia nigra causes hypokinesia

Answer 1251

Substantia nigra pars compacta

Question 1252

What shifts potassium out of cells --> hyperkalemia

Answer 1252

``` Low insulin Beta blockers Acidosis Digoxin Cell lysis ```

Question 1253

What shifts potassium into cells --> hypokalemia

Answer 1253

Insulin beta agonist Alkalosis Cell creation

Question 1254

You have a patient with an EKG with tall peaked T waves Tx?

Answer 1254

Hyperkalemia 1st: IV calcium - to prevent arrhythmias - wont correct hyperkalemia To correct hyperkalemia: Beta agonist (albuterol) IV bicarb IV insulin + dextrose

Question 1255

Atrial natriuretic peptide - Released from - Due to - MOA - Effect

Answer 1255

Release by atria of heart due to increased atrial volume and atrial pressure ANP on kidneys --> constrict efferent arterioles and dilates afferent arterioles Increase GFR, diuresis

Question 1256

SIADH caused by

Answer 1256

Too much ADH ``` Small cell lung cancer COPD, pneumonia Head trauma Stroke CNS infection Drugs: cyclophosphamide ```

Question 1257

Locked in syndrome

Answer 1257

Central pontine myelinolysis Correct hyponatremia too quickly Causes lysis of myelin and pons

Question 1258

Diabetes insipidus

Answer 1258

Too little ADH Cant concentrate urine Central - Abnormal ADH production by hypothalamus Nephrogenic - Kidneys unresponsive to ADH - Lithium, hypercalcemia, mutation

Question 1259

Patient with excessive thirst and polyuria What to do?

Answer 1259

1) First think DM - check urine and serum glucose 2) Check urine and serum osmolality - Low urine osmolality - High serum osmolality 3) Water deprivation test - Healthy: dehydrate --> secrete ADH --> concentrate urine - DI: urine osm stays low 4) Desmopressin challenge - ADH analog - Central: increase osm - Nephrogenic: no change

Question 1260

Polymyositis vs polymyalgia rheumatica

Answer 1260

Polymyositis - muscle weakness - increased CK and aldolase - Increased ANA - Positive Anti-Jo Polymyalgia rheumatica - Joint pain - No muscle pain - No weakness - Normal Ck and aldolase

Question 1261

MPTP exposure causes depletion of waht

Answer 1261

Dopamine

Question 1262

pH pCO2 HCO3

Answer 1262

``` pH= 7.35-7.45 pCO2= 35-45 HCO3= 22-28 ```

Question 1263

Anion gap

Answer 1263

[Na]- [Cl] - [HCO3] 10-12 normal

Question 1264

Adding acids to blood does what to anion gap

Answer 1264

Add acid, buffered by bicarb Lowers bicarb amount Increases anion gap --> High anion gap

Question 1265

High anion gap acidosis

Answer 1265

"MUDPILES" ``` Methanol Uremia (renal failure) Diabetic ketoacidosis Propylene glycol Iron tablets/ Isoniazid Lactic acid (shock or coding) Ethylene glycol Salicylastes (aspirin) ```

Question 1266

Normal anion gap acidosis

Answer 1266

DIarrhea Renal tubular acidosis Spironolactone Acetazolamide

Question 1267

Normal anion gap metabolic acidosis | Urine pH > 5.5

Answer 1267

Renal tubular acidosis Type I Alpha intercalated cells in collecting tubule unable to secrete H Hypokalemia

Question 1268

Normal anion gap metabolic acidosis Urine pH < 5.5 Hyperkalemia

Answer 1268

Renal tubular acidosis Type 4 Often due to hypoaldosteronism If low not putting potassium into urine Hyperkalemia Prevents PCT from generating NH4

Question 1269

Normal anion gap metabolic acidosis Urine pH < 5.5 Hypokalemia

Answer 1269

Renal tubular acidosis Type 2 Proximal tubule defect of HCO3 reabsorption Hypokalemia hypophosphatemia

Question 1270

Renal tubular acidosis three types

Answer 1270

Type 1 - Impaired hydrogen (H) excretion 1 letter Type 4 - impaired ammonium (NH4) excretion - Type 4= NH4 = aldo Type 2 - impaired BIcarb reabsorption

Question 1271

pH equation

Answer 1271

HCO3/ pCO2

Question 1272

Nephritis vs Nephrosis

Answer 1272

NephrOsis - Proteinuria > 3.5 g day - Hyperlipidemia - Hypoalbuminemia Nephritis - Proteinuria < 3.5g - HTN - Hematuria - Hardly any urine (oliguria) I= eye= symptom you can see

Question 1273

Poststreptococcal glomerulonephritis

Answer 1273

PSG= 3 letters Lump3- Bump3 C3 3 wks poststrep Type 3 rxn Subepithelial humps Coca-cola urine Decrease C3 Increase anti-streptolysin O Decrease anti-DNase B

Question 1274

Rapidly progressive glomerulonephritis

Answer 1274

"Crescentic" Rapidly crescentic glomerulonephritis Crescentic shaped Made up of fibrin and complement and cellular debris

Question 1275

Diffuse proliferative glomerulonephritis

Answer 1275

Dilupus Wire loops= wire lupus SLE

Question 1276

Thin distinct membrane

Answer 1276

Wire loop SLE Anti ds DNA Lupus Diffuse proliferative glomerulonephritis

Question 1277

Vision problems Deafness Protein in urine Coughing up blood

Answer 1277

Cant see Cant pee Cant hear high C Alport syndrome Splitting of basement membrane Defect in Type IV collagen Al-4 Type IV 4 things Lung, kidney, ear and eyes

Question 1278

Goodpasture syndrome

Answer 1278

Goodpasture= 2-pasture Type II hypersensitivity 2 organs (lung + kidneys) Ab vs Type IV collagen

Question 1279

Wegeners Gramulomatosis

Answer 1279

Granulomatosis w/ polyangiitis ``` We-C-ners C over stick figure - nasopharynx - lungs - kidney ``` C-anca

Question 1280

``` Palpable purpura on butt and legs Abdominal pain Increased IgA RBC casts Hematuria ```

Answer 1280

IgA Nephropathy Henoch-Schonlein purpura

Question 1281

What nerve most likely damaged in fibula neck fracture

Answer 1281

Common peroneal n.

Question 1282

Defining features of nephrotic syndrome

Answer 1282

Proteinuria > 3.5 g/day Hypoalbuminemia Peripheral edemia Hyperlipidemia

Question 1283

Flattening or effacement of podocyte foot process Child Post URI Tx

Answer 1283

Minimal change disease Corticosteriods Minimal - kids= minimal age - foot= minimal body part

Question 1284

HIV patient | Proteinuria

Answer 1284

Focal segmentla glomerulosclerosis (FSGS)

Question 1285

Spike and Dome

Answer 1285

Membranous Glomerulonephropathy Thickening of basement membrane Hep B and Hep C Subepithelial immune deposits

Question 1286

Membranous glomerulonephropathy

Answer 1286

" suck some dick to become a MEMBER of the club" Blow job= Dome Who sucks dick= Hepatitis

Question 1287

Membranoproliferative glomerulonephritis

Answer 1287

Prolife "Train Track" Hep B and C Subendothelial humps

Question 1288

Focal segmental Glomerulosclerosis (FSG)

Answer 1288

FSG HIV Half glomerulus affected

Question 1289

Round acellular nodules

Answer 1289

Kimmelstiel wilson nodule Diabetic nephropathy

Question 1290

Congo red stain | Apple green birefringence

Answer 1290

Amyloidosis

Question 1291

Glomerular histology reveals multiple mesangial nodules. THis lesion is indicative of what disease

Answer 1291

Diabetic nephropathy

Question 1292

Prerenal azotemia vs intrinsic renal disease

Answer 1292

Prerenal - Urine Na < 20 mEq/L - FE(Na) < 1% - BUN:CR >20:1 Intrinsic - urine Na > 40 FE (Na) > 2% BUN:Cr 10-15:1

Question 1293

Urinary Casts made up of Secreted by

Answer 1293

Tamm-Horsfall mucoprotein Secreted by tubule epithelial cells

Question 1294

Muddy Brown Casts Drugs that cause

Answer 1294

Acute tubular necrosis Most common cause of acute kidney injury Acute necrosis or death of epithelial cells Aminoglycosides Cisplatin

Question 1295

Azotemia

Answer 1295

Nitrogen in blood High urea High creatinine

Question 1296

Fever Eosinophilia Azotemia Maculopapular rash

Answer 1296

Acute interstitial nephritis (AIN)

Question 1297

Gross hematuria Flank pain Azotemia HTN

Answer 1297

Renal papillary necrosis

Question 1298

1) Hyaline casts 2) RBC casts 3) WBC casts 4) Epithelial cell casts 5) Granular casts 6) Fatty casts 7) Waxy casts

Answer 1298

1) Hyaline casts= Normal patient with concentrated urine 2) RBC casts = Glomerular bleeding (glomerulonephritis, vasculitis) Yellow brown 3) WBC casts= Tubular interstitial disease, acute pyelonephritis, proliferative glomerulonephritis 4) Epithelial cell casts= Acute tubular necrosis, acute interstitial nephritis, glomerulonephritis 5) Granular casts= Acute tubular necrosis, muddy brown 6) Fatty casts= nephrotic syndrome, contain cholesterol (maltese cross) 7) Waxy casts= end stage renal disease

Question 1299

Basic metabolic panel for patient with renal failure

Answer 1299

``` INcreased BUN adn Cr Increased K Decrease Calcium Decrased bicard (metabolic acidosis) ```

Question 1300

WBC casts

Answer 1300

Pyelonephritis

Question 1301

What is associated iwth AD polycystic kidney disease

Answer 1301

Hepatic cysts Intracrnail aneurysms Mitral valve prolapse

Question 1302

ADPKD vs ARPKD

Answer 1302

ADPKD - mutation: PKD1 (chr 16) , PKD2 (chr 4) ARPKD - mutation PKHD1 (chr 6) - infancy oliguria --> potter

Question 1303

Small shrunken kidneys and fiborsis

Answer 1303

Autosomal dominant tubulointerstitial kidney disease aka medullary cystic kidney disease Progressive renal failure

Question 1304

Stone 1) Envelope (square) 2) rectangle (coffin lid) 3) hexagon 4) rhombus or rosette

Answer 1304

1) Calcium oxalate 2) struvite 3) cystine 4) uric acid

Question 1305

Renal cell carcinoma - arises from - deletion --> - triad - secretion - pathology

Answer 1305

PCT in the cortex Deletion on Chr 3 (Von Hippel Lindau dis) Flank pain, hematuria palpable abdominal mass Polycythemia - erythrocytosis due to excess erythropoeitin production Solid tumor wit "clear cells" full of lipids and carbohydrates

Question 1306

Intellectual disability Absence of iris renal tumor Child Also see

Answer 1306

Wlims tumor (nephroblastoma) | Also see genitourinary malformations Cryptorcidism, bicornuate uterus

Question 1307

Painless hematuria Major risk

Answer 1307

Transitional cell carcinoma (urinary tract) Smoking Aniline dyes Naphthylamine dyes Cyclophosphamide

Question 1308

WAGR complex

Answer 1308

Wilms tumor Aniridia (no iris) Genitourinary malformation Mental retardation

Question 1309

Organism that causes bladder cancer

Answer 1309

Squamous cell bladder cancer schistosoma haematobium Middle east Urinary blood fluke Trematode

Question 1310

Developmental milestones 3 m 6 m 9 m 12 mo

Answer 1310

3 mo 3= before everything else - roll - hands together - laugh and squeal - smile 6 mo "Six= S's" - Sit up - Switch objects between hands - Shmooze - Self feed - Stranger danger 9 mo "9= P's (9 in penis) - Pull itself (crawl) - Pincer grasp - Papa - play - permance (object) 12mo "TWELVE= T's" - Two legs (stand, walk) - Track ( object tracking), block in a cup - 2 words - 2 of use (separation anxiety) - drink from cup

Question 1311

Apgar score

Answer 1311

1 and 5 minutes after delivery 0-10 Appearance 0= cyanotic 1= blue extremities 2= pink Pulse 0= absent 1= < 100 2= > 100 Grimace 0= no response 2= cries and pulls away from stimulus Activity 0= limp and floppy baby 2= flexed arms and legs, resist extension Respiration 0= absent effort 1= slow irregular or labored 2= crying and vigorous breathing

Question 1312

What zoonotic bacterium causes each 1) Cat scratch fever 2) Lyme disease 3) Recurrent fever from variable surface antigens 4) Bloody diarrhea 5) Q fever 6) Tularemia 7) Leptospirosis 8) Cellulitis and osteomyelitis from cat or dog bites

Answer 1312

1) Cat scratch fever - Bartonella 2) Lyme disease - Borrelia burgdorferi 3) Recurrent fever from variable surface antigens - Borrelia recurrentis 4) Bloody diarrhea - Campylobacter (puppies, livestock, fecal oral, sexual) 5) Q fever - Coxiella burnetti (spores from tic feces, cattle placenta) 6) Tularemia - Francisella tularesis 7) Leptospirosis - Leptospira spp (animal urine) 8) Cellulitis and osteomyelitis from cat or dog bites - Pasteurella multocida

Question 1313

First step in glucose utilization

Answer 1313

Phosphorylate it to trap in muscle Hexokinase Glucokinase - liver and beta cells

Question 1314

Main enzymes in glycolysis pathway

Answer 1314

1. Hexokinase/ glucokinase 2. Phosphofructokinase-1 3. Pyruvate kinase

Question 1315

Muscle biopsy on patient reveals elevated glycogen levels, elevated fructose-6- phosphate, and decreased pyruvate. What enzyme is deficient?

Answer 1315

Phosphofructokinase-1 deficiency

Question 1316

Insulin on glycolysis pathway Glucagon on pathway

Answer 1316

Doesn't directly stimulate glycolysis Stimulates Phosphofructokinase-2 (fed) --> Forms fructose-2,6 BP Glycogen formation stimulated by insulin GLucagon - stimulates FBPase-2 (fasting) - -> Fructose-6-P

Question 1317

Increase in fructose-2,6 BP leads to

Answer 1317

Decrease conversion of alanine --> glucose

Question 1318

To get ATP need Which requires That is from What is needed for that That comes from Get that from This occurs where TCA and oxidative phosphorylation occur where

Answer 1318

ATP from Oxidative phosphorylation NADH needed for oxidative phosphorylation is from TCA cycle Need acetyl-CoA for TCA cycle Acetyl-CoA from decarboxylation of pyruvate Pyruvate is from glycolysis of glucose Glycolysis in cytosol TCA and oxidative phosphorylation are in mitochondria

Question 1319

Aerobic metabolism two different types of shuttle

Answer 1319

Malate-aspartate shuttle - Heart liver and kidneys - 32 ATP Glycerol-3-phosphate shuttle - brain adn skeletal muscles - 30 ATP

Question 1320

GLUT Transports GLUT 1 GLUT 2 GLUT 3 GLUT 4 GLUT5

Answer 1320

GLUT1 - RBC - Endothelium of BBB - mediates basal glucose uptake (low level) - Takes up glucose regardless of insulin GLUT2 - Found on cells that regulate glucose - Hepatocytes, pancreatic beta cells GUT3 - Neurons - Placenta GLUT4 - Skeletal muscle - Adipose tissue - INSULIN dependent GLUT5 - Fructose uptake in GI tract

Question 1321

Gluconeogenesis steps

Answer 1321

Pyruvate --> Oxaloacetate (pyruvate carboxylase w/ biotin) (+) acetyl-CoA Oxaloacetated -->Phosphoenol pyruvate (PEP carboxykinase ) ... Fructose-1,6-BP --> Fructose6P (Fructose-1,6-bisphosphatase) RL (+) ATP (-) AMP, Fructose 2,6 BP Glucose 6 phosphate --> Glucose (Glucose-6-phosphatase)

Question 1322

Rate limiting enzymes 1) De novo pyrimidine synthesis 2) De novo purine synthesis 3) Glycolysis 4) Gluconeogenesis 5) Glycogen synthesis 6) Glycogenolysis 7) TCA cycle 8) Hexose monophosphate shunt

Answer 1322

1) carbamoyl phosphate synthetase-2 2) glutamine PRPP amidotransferase 3) Phosphofructokinase -1 4) Fructose-1,6- bisphosphatase 5) Glycogen synthase 6) Glycogen phosphorylase 7) isocitrate dehydrogenase 8) glucose-6-phosphate dehydrogenase

Question 1323

What irreversible enzymes are involved in gluconeogenesis

Answer 1323

Pyruvate carboxylase w/ biotin PEP carboxykinase Fructose-1,6- bisphosphatase Glucose-6- phosphatase

Question 1324

RL step of gluconeogenesis

Answer 1324

Fructose-1,6- bisphosphatase

Question 1325

Order molecules based on energy the contain ``` Pyruvate Adenosine monphosphate Glucose Adenosine Adenosine triphsphate ```

Answer 1325

Glucose > pyruvate > ATP > AMP > adenosine

Question 1326

Flow of aqueous humor

Answer 1326

Formed in capillary bed of ciliary body - -> posterior chamber - -> flows between angle formed by lens and iris diaphragm - -> anterior chamber --> reabsorbed in canal of schlemm

Question 1327

Glucose -6- phosphate --> glucose

Answer 1327

Glucose-6- phosphate Last step in glycogenolysis and gluconeogenesis Deficency= Von Gierke

Question 1328

Glycogenolysis To break alpha-1,4 glycosidic linkage need To break alpha- 1,6 glycosidic linkage need

Answer 1328

alpha-1,4= glycogen phosphorylase (RL) alpha-1,6= alpha 1,6 glucosidase (aka debraching enzyme) - two functions - take 3 of last 4 glucose and move to end of other branch (transferase) - remove last glucose (alpha 1,6 glucosidase)

Question 1329

Epinephrine effect of glycogen regulation

Answer 1329

Beta adrenergic receptor stimulate adenylyl cyclase --> Glycogen phosphorylase --> Glycogenolysis

Question 1330

Glycogen synthase - pathway - regulated by

Answer 1330

Glucose 1 phospahte --> glycogen Glycogen synthesis (+) insulin

Question 1331

Glycogen phosphorylase - pathway - regulated by

Answer 1331

Glycogenolysis Glycogen --> Glucose -1- phosphate (+) glucagon (+) Epinephrine (+) cAMP

Question 1332

Von Gierke

Answer 1332

Lack of glucose-6-phosphatase Accumulation of Glucose-6-phosphate in liver Hepatomegaly, Hypoglycemia Hyperlipidemia, Hyperuricemia (fat/protein catabolism) - cant get free glucose have to get energy from fats and proteins Von GEEK disease - Fat - No Muscle (hyperuricemia) - Fatty liver

Question 1333

Cori Disease

Answer 1333

Defect in Debranching enzyme (alpha-1,6- glycosidic linkage) Same symptoms as Von Gierke Only different is abnormal glycogen structure Milder hypoglycemia Hepatomegaly No elevation in lactate levels No elevation in uric acid Cori disease= coral reef

Question 1334

McArdle disease

Answer 1334

Deficiency in glycogen phosphorylase Deficiency in Muscle McArdle= Muscle Muscle cramps on exertion Myoglobinuria Hypoglycemia on exertion Osmotic pressure from glycogen draws water into cells Cell lyses --> myoglobin into serum Rhabdomyolysis - -> Myoglobin in blood to kidney - -> Myoglobinuria - -> Renal failure

Question 1335

Pompe disease

Answer 1335

Deficiency of alpha-1,4, glucosidase in LYSOSOMES Infantile form (severe) - severe muscle weakness - CARDIOMEGALY and heart failure - Only live 1 year Adult form - No cardiac involvement - Gradual onset of skeletal muscle weakness - Diaphragm weakness - Respiratory failure POMPE volcano= build up in volcano, cardiomegaly, explodes

Question 1336

A 2-year-old child with failure to thrive since infancy now exhibits a seizure. Physical examination shows hepatomegaly and ecchymoses of the skin. Laboratory studies show a blood glucose level of 31 mg/dL. A liver biopsy specimen shows cells filled with clear vacuoles that stain positive for glycogen. Which of the following conditions is most likely to produce these findings? A Hurler syndrome B McArdle disease C Pompe disease D Tay-Sachs disease E Von Gierke disease

Answer 1336

E. Von Gierke Def glucose-6-phosphatase

Question 1337

A 25-year-old woman stops going to her aerobic exercise class because of severe muscle cramps that have occurred during every session for the past 2 months. Four hours after each session, she notices that her urine is a brown color. On physical examination, she has normal muscle development and strength. An inherited defect in which of the following substances is most likely to explain her findings? A Dystrophin B Fibrillin C Glucose-6-phosphatase D Lysosomal glucosidase E Muscle phosphorylase F Spectrin

Answer 1337

E. Muscle phosphorylase McArdle

Question 1338

A 6-month-old male infant has failure to thrive and abdominal enlargement. His parents are concerned that he has shown minimal movement since birth. On physical examination, the infant has marked muscle weakness and hepatosplenomegaly. A chest radiograph shows marked cardiomegaly. He dies of congestive heart failure at age 19 months. The microscopic appearance of myocardial fibers at autopsy is shown in the figure. A deficiency of which of the following enzymes is most likely to be present in this infant? A Glucocerebrosidase B Glucose-6-phosphatase C Hexosaminidase A D Homogentisic acid oxidase E Lysosomal glucosidase F Sphingomyelinase

Answer 1338

E. Lysosomal glucosidase Pompe

Question 1339

An 8-month-old boy is brought to the pediatrician by his parents because he has recently lost the ability to crawl or hold his toys. On examination the patient is tachypneic and breathing with considerable effort; the liver is palpable fi ve fi ngerwidths below the right costal margin. X-ray of the chest reveals cardiomegaly. He has a diffi cult time sitting upright and cannot squeeze the physician’s fi ngers or the ring of his pacifi er with any noticeable force. Despite a number of interventions, the child’s symptoms continue to worsen until his death 2 weeks later. On autopsy, it is likely that this patient’s cells will contain an accumulation of which of the following substances? (A) Glucose (B) Glycogen (C) Oxaloacetate (D) Pyruvate (E) Urea

Answer 1339

B. Glycogen Pompe disease

Question 1340

A 14-year-old high school freshman presents to her family doctor for a sports physical. She has not played organized sports in the past but is in good physical shape. She mentions that she experienced severe leg cramps after trying out for the soccer team last week. The night after the tryouts, she noticed that her urine had a reddish tinge. She has no other medical complaints. Her physician orders an ischemic forearm exercise test, which reveals no increase in venous lactate. Which of the following enzymes is most likely defi cient in this patient? (A) Cystathionine synthase (B) Glucose-6-phosphatase (C) α-1,6-Glucosidase (D) Glycogen phosphorylase (E) Lysosomal α−1,4-glucosidase

Answer 1340

D. Glycogen phosphorylase McArdle's disease

Question 1341

What glycogen storage disease matches 1) Glycogen phosphorylase deficiency 2) Glucose-6-phosphatase deficiency 3) Lactic acidosis, hyperlipidemia, hyperuricemia (gout) 4) Alpha -1,6- glucosidase deficiency 5) alpha-1,4- glucosidase deficiency 6) Cardiomegaly 7) Diaphragm weakness leading to respiratory failure 8) Increased glycogen in liver, severe fasting hypoglycemia 9) Hepatomegaly, hypoglycemia, hyperlipidemia (normal kidneys, lactate, and uric acid) 10) Painful muscle cramps, myoglobinuria with strenuous exercise 11) Severe hepatosplenomegaly, enlarged kidneys

Answer 1341

1) McArdle 2) Von Gierke 3) Von Gierke 4) Cori disease 5) Pompe 6) Pompe 7) Pompe 8) Von Gierke 9) Cori 10) McArdle 11) Von Gierke

Question 1342

What is the landmark for a pudendal nerve lbock

Answer 1342

Palpate for ischial spine

Question 1343

Which enzyme catalyzes the RL step in carbohydrate digestion

Answer 1343

Oligosaccharide hydrolases (at intestinal brush border)

Question 1344

What vitamin deficiency results from Hartnup disease?

Answer 1344

Deficiency tryptophan --> Niacin deficiency (vit B3) Pellagra

Question 1345

Electron transport chain steps Energy required steps inhibited by

Answer 1345

1) NADH reductase (NADH --> NAD) (Needs 2.5 ATP) (-) Amytal (-) Rotenone (-) MPP 2) Succinate dehydrogenase w/ Coenzyme Q (Succinate --> fumarate) (Needs FADH2, 1.5 ATP) 3) Cytochrome b + c1 (-) antimycin A 4) Cytochrome a +a3 (1/2 O2 +2H --> H2O) (-) CN (-) N3 - (-) CO (-) H2S 5) ATPase (ADP + Pi --> ATP) (-) Oligomycin A

Question 1346

Cofactors for Pyruvate Dehydrogenase

Answer 1346

Pyruvate --> acetyl-CoA ``` "TLC For Nobody" Thiamine pyrophosphate (vit B1) Lipoid acid Coenzyme A (vit B5) FAD- Vit B2 Nad- Vit B3 ```

Question 1347

Garlic breath Vomiting Rice water stool

Answer 1347

Arsenic exposure Inhibits lipoic acid No acetyl-CoA for TCA cycle

Question 1348

Pyruvate dehydrogenase deficiency

Answer 1348

Cant make acetyl CoA Back up of pyruvate - -> Lactate (Lactic acidosis) - -> Alanine (neurologic defects) X linked Arsenic exposure B vitamin deficiency

Question 1349

TCA cycle main points

Answer 1349

Acetyl-CoA --> citrate (Citrate synthase) Isocitrate --> alpha ketoglutarate (isocitrate dehydrogenase) (NADH + CO2) RL a-ketoglutarate --> succinyl-CoA (a-ketoglutarate dehydrogenase) (NADH + Co2) Highly regulated, needs all cofactors as pyruvate dehydrognase ``` "TLC For Nobody" Thiamine pyrophosphate (vit B1) Lipoid acid Coenzyme A (vit B5) FAD- Vit B2 Nad- Vit B3 ```

Question 1350

Uncoupling agents on Electron transport chain

Answer 1350

Uncouples the electron transport chain from ATPase, so it increases the permeability of inner mitochondria membrane to hydrogen ions, hydrogen ions can leak back in (wasted as heat) Thermogenin (brown fat, hybernation) High dose aspirin 2,4-dinitrophenol (2,4-DNP)

Question 1351

What four end products can be made from pyruvate

Answer 1351

Oxaloacetate (Pyruvate carboxylase) Acetyl-CoA (pyruvate dehydrogenase) Lactate ( Lactae dehydrogenase) Alanine (Alanine Transaminase)

Question 1352

What four B vitamins are needed to make cofactors for pyruvate dehydrogenase

Answer 1352

B1 (thiamine) B2 (riboflavin) B3 (niacin) B5 (pantothenic acid) plus lipoic acid

Question 1353

Which TCA cycle enzyme requires the same cofactors as pyruvate dehydrogenase

Answer 1353

alpha ketoglutarate dehydrogenase

Question 1354

What cofactor is required by all transaminases

Answer 1354

Pyridoxal phospahte (derivative of vitamin B6)

Question 1355

Two main nitrogen transporters in blood

Answer 1355

Alanine | Glutamine

Question 1356

Oxidative burst pathway

Answer 1356

O2 --> O2 (-) superoxide ion (NADPH oxidase) O2 (-) --> H2O2 hydrogen peroxide (Superoxide dismutase) H2O2 --> (+ Cl) --> HOCl hypochlorous acid (Myeloperoxidase)

Question 1357

Steps to neutralize H2O2

Answer 1357

1) React w/ reduced glutathione (antioxidant) --> glutathione disulfide + H2O [Glutathione peroxidase] 2) Glutathione disulfide --> GSH (Need NADPH) --> GSH + NADP+ [Glutathione peroxidase] 3) NADP+ --> NADPH (Need G6P) --> NADPH + 6PG [ Glucose-6-phosphate dehydrogenase]

Question 1358

Deficiency in G6PD --> What substances can cause

Answer 1358

Decrease in NADPH Decrease in GSH Cant neutralize H2O2 ``` "Spleen Purges Nasty Inclusions From Damaged Cells" Sulfonamides Primaquine Nitrofurantoin Isoniazid Fava beans Dapsone Chloroquine ```

Question 1359

Hemolytic anemia | Bit cells

Answer 1359

G6PD deficiency X linked

Question 1360

Build up of fructose in urine | Asymptomatic

Answer 1360

Essential fructosuria Deficency of fructokinase

Question 1361

``` Hypoglycemic Vomiting Hepatomegaly Jaundice Elevated Fructose-1-P ```

Answer 1361

Fructose intolerance Deficiency of aldolase B

Question 1362

Infantile cataracts galactosuria galactosemia

Answer 1362

Galactokinse deficiency Deficiency of galactokinase Accumulation of galactitol

Question 1363

A 3-month-old infant presents with failure to thrive, poor feeding, and lethargy. A physical examination reveals an enlarged liver and jaundice. Laboratory analysis reveals an elevated blood galactitol level and increased urinary reducing substance. Which of the following could correctly describe the levels of intermediates of galactose metabolism in this patient? (A) Decreased galactose (B) Decreased uridine diphosphoglucose (C) Elevated glucose-1-phosphate (D) Increased galactose-1-phosphate (E) Increased glycogen

Answer 1363

D. Increased galactose-1-phosphate

Question 1364

``` Infantile cataracts Failure ot thrive Jaundice Hepatomegaly Intellectual disability ```

Answer 1364

Classic galactosemia Deficiency of galactose-1-phosphate uridyltransferase Excess Galactose-1- phosphate Excess Galactose Excess Galactitol

Question 1365

RL step of pentose phosphate pathway

Answer 1365

Glucose 60 phosphate dehydrgenase G6PD

Question 1366

Pentose phosphate pathway what is it used for pathway what tissues use it

Answer 1366

aka HMP shunt Provides a source of NADPH from G6P G6P -->2 NADPH, Ribulose 5P [ G6PD] RBCs Liver Adrenal cortex mammary glands (during lactation)

Question 1367

What disorder is caused by a deficiency of each enzyme 1) Galactokinase 2) Aldolase B 3) Lactase 4) Galactose-1- phosphate uridyltransferase 5) Fructokinase

Answer 1367

1) Galactokinse deficiency 2) Fructose intolerance 3) Lactose intolerance 4) Galactosemia 5) Essential fructosuria

Question 1368

Ketogenesis RL enzyme

Answer 1368

HMG-CoA synthase

Question 1369

Child super skinny arms and legs, proturbarant belly

Answer 1369

Kwashiorkor Protein malnutrition - Fatty liver disease (cant make ApoB 100) Edema Anemia Skin lesions Depigmentation ``` "Flames" Fatty Liver Anemia Malnutrition Edema Skin lesions ```

Question 1370

Child stick and bones

Answer 1370

Marasmus Total energy malnutritoon (protein, fat, carbohydrates) Muscle wasting Subcutaneous fat loss

Question 1371

Lipid transport pathway

Answer 1371

1) Dietary fat broken down [ Pancreatic lipase] 2) Fat particles absorbed by enterocytes an dpacked into chylomicrons 3) Chylomicrons released with help of Apo-B-48 - W/O = abetalipoprotinemia 4) Chylomicrons pass cells that draw free fatty acids off [ Lipoprotein Lipase] 5) End up w/ chylomicron remnant --> Liver 6) Liver synthesizes VLDL from remnant 7) VLDL secreted into circulation with help of Apo-B- 100 8) Free fatty acids pulled off VLDL, VLDL becomes IDL 9a) IDL reabsorbed by liver 9b) IDL hydrolyzed further to become LDL [ Hepatic lipase] 10) LDL reabsorbed by liver or other cells, absorbed by endocytosis by LDL receptor

Question 1372

Apo Proteins 1) Apo-B-48 2) Apo-B-100 3) ApoE 4) ApoA-I 5) ApoC-II

Answer 1372

1) Helps release of chylomicrons from enterocytes - Without you get abetalipoprotinemia 2) Helps VLDL secretion into circulation from liver 3) Mediates extra remnant uptake 4) Activates LCAT, found on HDL 5) Cofactor for lipoprotein lipase

Question 1373

HDL pathway

Answer 1373

1) HDL produced by liver contains Apo-A-I 2) Has increased protein low TG = Nacent HDL 3) Takes up cholesterol [Lecithin-cholesterol acyltransferase (LCT)] 4) Now HDL-2 Exchanges cholesterol esters for TG with other lipoproteins [Cholesterol ester transfer protein (CETP)] 5) HDL full a. Hydrolyzed by Hepatic lipase b. Travels back to liver, Scavenger receptor B1 (SRB1) pulls of cholesterol esters

Question 1374

Fatty acid metabolism - precursor molecule - location - RL enzymes

Answer 1374

Precursor: acetyl-CoA Laction: cytoplasm of hepatocytes RL: Acetyl-CoA carboxylase

Question 1375

Fatty acid degradation - Location - RL - Two outcomes

Answer 1375

Mitochondria Carnitine acyltransferase 1 (carnitine palmitoyltransferase 1) Build up of ketones or Move into TCA cycle

Question 1376

Weakness Hypotonia Hypoketotic hypogycemia

Answer 1376

Deficiency of carnitine acyltransferase 1 Accumulation of LCFA into cytopasm - cant transfer to mitochondria

Question 1377

Abetalipoproteinemia - ineritence - deficency - mutation - lipoproteins - signs - intestinal biopsy - peripheral smear

Answer 1377

AR Decrease ApoB-48 and ApoB-100 Mutation MTP gene Decrease chylomicron adn VLDL synthesis and secretion Steatorrhea Ataxia Night blindness Enterocytes swollen with TGs Acanthocytosis of RBC - Misshaped and spiky

Question 1378

Type I hyperchylomicroenemia - inheritence - deficiency - lipoproteins - signs - extra

Answer 1378

AR Lipoprotein lipase deficiency or defective ApoC-11 Increase chylomicrons, TG and cholesterol Pancreatitis Hepatosplenomegaly Pruritic xanthomas No risk of atherosclerosis

Question 1379

Type IIa familial hypercholesterolemia - inheritence - defect - lipoproteins - signs

Answer 1379

AD Absent of LDL receptor Elevated LDL in blood Tendinous xanthomas (achilles tendon) Corneal arcus Accelerated atherosclerosis MI in 20s

Question 1380

Type IV hypertriglyceridemia - inheritence - defect - lipoproteins - signs

Answer 1380

AD Overproduction of VLDL High level of TG Pancreatitis

Question 1381

A 30-year-old man is diagnosed with type I familial dyslipidemia. He has had recent laboratory studies showing elevated triglycerides and normal cholesterol levels. Which of the following explains the pathophysiology of this disease? (A) Apolipoprotein E defi ciency (B) LDL cholesterol receptor defi ciency (C) Lipoprotein lipase defi ciency (D) VLDL cholesterol clearance defi ciency (E) VLDL cholesterol overproduction

Answer 1381

C. Lipoprotein lipase deficiency Type I dyslipidemia

Question 1382

Which apolipoprotein 1) Activates LCAT 2) Mediates chylomicron secretion 3) Mediates VLDL secretion 4) Cofactor for lipoprotein lipase 5) Mediates uptaek of remnant particles

Answer 1382

1) ApoA-1 2) ApoB-48 3) ApoB-100 4) ApoC-11 5) ApoE

Question 1383

What is the rate limiting enzyme for each pathway 1) Fatty acid synthesis B) Beta oxidation of FA 3) ketone body synthesis 4) Cholesterol synthesis

Answer 1383

1) Acetyl-CoA carboxylase 2) Carnithine acyltransferase I 3) HMG CoA synthase 3) HMG CoA reductase

Question 1384

Essential amino acids

Answer 1384

``` "Private (PVT) TIM HaLL" Phenylalanine Valine Threonine Tryptophan Isoleucine Methionine Histidine Leucine Lysine ```

Question 1385

Basic charged amino acids

Answer 1385

Lysine Argine Histidine (no charge)

Question 1386

Acidic amino acids

Answer 1386

Aspartate and glutamate | negatively charged

Question 1387

Phenylalanine breakdown

Answer 1387

1) Phenylalanine --> Tyrosine (BH4) [Phenylalanine hydroxylase ] (-) def --> PKU 2) Tyrosine --> DOPA (BH4) [Tyrosine hydroxylase] (-) def --> parkinson, albinism 3)DOPA --> Dopamine (Vit B6) [Dopa decarboxylase (-) inhibited by carbadopa to tx parkinsons 4) Dopamine --> NE (Vit C) [DOPA beta-hydroxylase] 5) NE --> Epi (SAM) (+) cortisol

Question 1388

PKU

Answer 1388

Deficiency of phenylalanine hydroxylase Deficiency BH4 Musty odor Intellectual disability Light skin Seizure

Question 1389

An 18-month-old, light-skinned African American child has a developmental delay characterized by mental retardation and inability to walk. The child’s urine has a distinctly “mousy” odor. On physical examination, there is no lymphadenopathy or hepatosplenomegaly. Laboratory studies show hemoglobin, 14 g/dL; platelet count, 302,700/mm3; WBC count, 7550/mm3; glucose, 80 mg/dL; total protein, 7.1 g/dL; albumin, 5 g/dL; and creatinine, 0.5 mg/dL. A mutation involving a gene that encodes which of the following enzymes is most likely to be present in this child? A Adenosine deaminase B α1-Antitrypsin C Galactose-1-phosphate uridyltransferase D Glucose-6-phosphatase E Lysosomal acid maltase F Phenylalanine hydroxylase G Sphingomyelinase

Answer 1389

F. PKU

Question 1390

``` A woman gives birth to a full term baby. Upon delivery, the baby is small and has a musty odor. Upon questioning the woman says that she did not smoke or drink alcohol during the pregnancy, and she only drinks diet soda and water. Which of the following amino acids is most likely to be deficient in the newborn? (A) Alanine (B) Cysteine (C) Glutamine (D) Phenylalanine (E) Proline (F) Serine (G) Tyrosine ```

Answer 1390

G. Tyrosine PKU

Question 1391

Deficency of DOPA beta hydroxylase

Answer 1391

``` Excess dopamine Deficiency NE and Epi Nasal congestion Ptosis Orthostatic hypotension ```

Question 1392

Precursor for 1) Arginine 2) Tryptophan 3) Histidine 4) Glutamate 5) Glycine

Answer 1392

1) Arginine --> Creatine Urea Nitric oxide 2) Tryptophan Niacin --> NAD/NADP (req B6) Serotonin --> Melatonin 3) Histidine --> Histamine (req B6) 4) Glutamate --> GABA (Req B6) Glutathione 5) Glycine --> Porphyrin (Req B6) --> Heme

Question 1393

Deficency of Vit B6 -->

Answer 1393

Lack of inhibition | --> seizures

Question 1394

RL enzyme of urea cycle

Answer 1394

Carbamoyl phosphate 1 (CPS-1) Mitochondria

Question 1395

Urea cycle

Answer 1395

CPS-1 in mitochondria RL step Ornithine transcarbamylase - carbamoyl phosphate --> citrulline

Question 1396

Ornithine Transcarbamylase deficiency

Answer 1396

Most common urea cycle disorder X linked Cant undergo urea cycle - build up nitrogen and ammonia Excess carbamoyl phosphate --> orotic acid Orotic acid in blood and urine Decreased VUN Hyperammonemia ``` Child Slurring speech Vomiting Cerebral edema Blurring vision Hepatoencephalopathy ```

Question 1397

A 9-month-old boy is brought to the emergency department after his mother is unable to rouse him. His past medical history is signifi cant for the onset of seizures at the age of 4 months and for a delay in reaching developmental milestones. On examination, the patient is found to have poor muscle tone and an enlarged liver. Laboratory studies show a blood urea nitrogen level of 3.2 mg/dL, a creatinine level of 0.4 mg/ dL, and a serum ammonia level of 300 mg/dL. A plasma amino acid analysis fails to detect citrulline, while his urinary orotic acid level is increased. This patient suffers from a defi ciency of which of the following enzymes? (A) Argininosuccinate lyase (B) Carbamoyl phosphate synthetase II (C) Glutamate dehydrogenase (D) Ornithine transcarbamoylase

Answer 1397

D. Ornithine trasncarbamoylase

Question 1398

What does each cell secrete 1) G cells 2) I cells 3) S cells 4) D cells 5) Parietal cells

Answer 1398

1) G cells - Gastrin 2) I cells - CCK 3) S cells - secretin 4) D cells - Somatostatin 5) Parietal cells - Gastric acid & intrinsic factor

Question 1399

A 35-year-old man presents to the physician with arthritic pain in both knees along with back pain. He states that the pain has been present for months. In an effort to obtain relief, he has taken only aspirin, but this has been of little benefit. The patient is afebrile, and his slightly swollen knee joints are neither hot nor tender to palpation; however, the pain does restrict his motion. The cartilage of his ears appears slightly darker than normal. No tophi are present. A urine specimen is taken for analysis of uric acid content and turns black in the laboratory while standing. A defect in which of the following is the most likely underlying cause of the patient’s condition? (A) Galactokinase (B) Homogentisic acid oxidase (C) α-Ketoacid dehydrogenase (D) Orotate phosphoribosyltransferase (E) Phenylalanine hydroxylase

Answer 1399

B. Homogentisate Oxidase Alkaptonuria - Deficiency of homogentisate oxidase AR Build up homoentic acid in urine Darkens CT and urine Arthralgias

Question 1400

A 6-year-old girl is found to be nearsighted during a vision screening at school, and the school nurse tells the parents the child should be fitted for corrective lenses. Her mother is upset because her daughter is already much taller than her classmates, has an awkward gait, and was recently diagnosed with scoliosis. She is afraid that the glasses will only add to her daughter’s problems at school, where her classmates frequently tease her. When the ophthalmologist observes that the patient’s right lens is dislocated, he suspects that her symptoms are in fact related to an enzyme deficiency. As a result of this deficiency, which of the following amino acids is essential in this patient’s diet? (A) Cysteine (B) Lysine (C) Methionine (D) Tryptophan

Answer 1400

A. Cysteine Homocystinuria Homocysteine --> cystathionine - Deficency of cystathionine synthase - decreased affinity of cystathionine synthase for Bit B6 Homocysteine --> Methionine - Deficiency of homocysteine methyltransferase - Deficiency of Vit B12

Question 1401

``` Intellectual disability Tall stature Osteoporosis Kyphosis Atherosclerosis Subluxation of lens (down ward) ```

Answer 1401

Homocystinuria

Question 1402

The mother of a 16-month-old girl is concerned because she noticed that her daughter became lethargic and irritable 2 days after an ear infection. The mother recalls periodically noticing sweet-smelling urine in her child’s diaper but that otherwise her development has been normal. An inability to metabolize which of the following would explain these symptoms? (A) Glucosylceramide (B) Histidine (C) Phenylalanine (D) Sphingomyelin (E) Tyrosine (F) Valine

Answer 1402

F. Valine Maple syrup urine disease Urine smells like maple syrup (sweet) Deficiency of branched chain alpha-ketoacid dehydrogenase complex - build up of branched chain amino acids "I LoVe Maple Syrup" - Isoleucine - Leucine - Vaine Intellectual deficiencies Severe CNS defects High mortality

Question 1403

39-year-old woman presents to the physician with complaints of itchy skin and diarrhea. On examination, the patient appears slightly confused and is having trouble remembering what she did earlier in the day. A physical examination shows that the patient has a large, deeply pigmented tongue with thickened papillae. On further questioning, it is discovered that the patient has been taking isoniazid for suspected tuberculosis infection. Which of the following supplements should this patient take? (A) Ascorbic acid (B) Biotin (C) Folic acid (D) Niacin (E) Ribofl avin (F) Thiamine (G) Vitamin D

Answer 1403

D. Niacin Patient has Pellagra

Question 1404

Patient presents to office with itchy skin and diarrhea. She is confused to the day. Examination shows an large deeply pigmented tongue. Genetic cause

Answer 1404

Hartnup disease AR Defective neutral aminoacid transporter Tryptophan not absorbed No Niacin Pellagra

Question 1405

What goes with there 1) homogentisic acid oxidase deficency 2) Alpha ketoacid dehydrogenase def 3) Tyrosine def 4) Decreased tryptophan 5) Phenylalanine hydroxylase def 6) Cystathionine synthase def 7) B6 def 8) COLA def 9) Tetrahydrobiopterin def 10) Decreased Niacin 11) Sweet smelling urine 12) Musty smell 13) Dark urine 14) Increased skin cancer 15) Lens dislocation 16) Cystine stones

Answer 1405

1) Alkaptonuria 2) Maple syrup urine 3) Albinism 4) Hartnup 5) PKU 6) Homocystinuria 7) Homocystinuria 8) Cystinuria 9) PKU 10) Hartnup 11) Maple syrup urine 12) pKU 13) Alkaptonuria 14) Albinism 15) Homocystinuria 16) Cystinuria

Question 1406

Ferritin

Answer 1406

Storage form of iron Acute phase reactant - Alot of inflammation release ferritin to bind up iron so bacteria cant use it

Question 1407

Transferrin

Answer 1407

Transport ferric molecules Increased in iron deficiency

Question 1408

Zinc - use - deficency

Answer 1408

Healing Imune system Carbonic anhydrase - CO2 --> bicarb ``` Delayed wound healing Decrase body and facial hair Hypogonadism Decreased ability to smell Decreased taste Rash around eyes, mouth, nose, anus Impaired night vision Infertility ```

Question 1409

Lead poisoning

Answer 1409

``` Decreased IQ Hearing problems Growth impairment Wrist/ foot drop Lead lines Anemia ``` Basophilic stippling Tx: Chelating agent - succimer or EDTA Pediatric - dimercaprol + succimer

Question 1410

Basophilic stippling | Ringed sideroblasts

Answer 1410

Lead poisoning

Question 1411

Mecury poisoning affects Key feature

Answer 1411

Kidneys and brain Acrodynia: peeling of fingertips

Question 1412

Acrodynia

Answer 1412

Peeling of fingertips Kawaski disease Mercury posoning

Question 1413

Fat soluble vitamins Absrobed in

Answer 1413

Vit AdEK ileum

Question 1414

Sarcoidosis and vit D

Answer 1414

Increases coversion of 25-OH Vit D --> 1,25 (OH2) Vit D Hypercalcemia

Question 1415

Vit K does post-translational modification of what clotting factors

Answer 1415

"diSCo started in 1972" Protein S Protein C Clotting factor 10, 9, 7 and 2

Question 1416

Vit E - fxn - deficency

Answer 1416

Antioxidant Prevents free radials on RBCs ``` Deficiency - hemolytic anemia - Spinocerebellar degeneration (ataxia) - peripheral neuropathy - proximal muscle weakness ```

Question 1417

Vit C - fxn - deficiency

Answer 1417

Hydroxyaltion of prolyl and lysyl residues of collagen Required for dopamine --> NE [Dopamine beta hydroxylase] Antioxidant Iron absorption in gut Deficiency - cant make collagen - scurvy

Question 1418

Differential diagnosis for eosinophilia

Answer 1418

CANADA-P ``` Collagen vascular disease Atopic disease Neoplasma Adison disease Drugs Acute interstitial nephritis Parasites ```

Question 1419

Vit B1

Answer 1419

Thiamine Deficiency - Wernicke-Korsakoff - Beriberi

Question 1420

A 9-month-old infant has failure to thrive following a premature birth with low birth weight. The infant has chronic cholestatic hepatobiliary disease. The infant is now at the 40th percentile for height and the 25th percentile for weight creased vibration and pain sensation, muscle weakness, and abnormalities of eye movement. Laboratory studies show hemoglobin, 9.2 g/dL; hematocrit, 27.6%; MCV, 86 μm3; platelet count, 208,000/mm3; WBC count, 6080/mm3; total protein, 6.4 g/dL; albumin, 3.4 g/dL; glucose, 70 mg/dL; and creatinine, 0.3 mg/dL. A deficiency of which of the following vitamins is most likely to contribute to these findings? A Vitamin A B Vitamin B1 C Vitamin B3 D Vitamin B12 E Vitamin C F Vitamin E G Vitamin K

Answer 1420

F. Vitamin E

Question 1421

The symptoms of thiamine defi ciency were fi rst described over 4,000 years ago. In adults, these symptoms commonly include polyneuropathy of the distal extremities, resulting in paresthesias and motor dysfunction. In addition to neuropathy, how else can isolated thiamine defi ciency present in adults? (A) Chronic infection (B) Convulsions, hyperirritability, and jaundice (C) Excessive diarrhea, dermatitis, and dementia (D) Kidney failure (E) Peripheral edema and congestive heart failure

Answer 1421

(E) Peripheral edema and congestive heart failure BeriBeri

Question 1422

Beriberi Dry vs wet

Answer 1422

Thiamine deficiency ``` Dry Beriberi - peripheral neuropathy (toe drop, wrist drop, foot drop) - Muscle weakness - Hyporeflexia or areflexia ``` Wet Beriberi - Peripheral vasodilation - High output heart failure - peripheral edema - cardiomegaly

Question 1423

Vit B2

Answer 1423

Riboflavin FMN and FAD Cofactors for redox reactions Deficiency - Dermatitis - Cheilosis - Glossitis

Question 1424

Vit B3

Answer 1424

Niacin NAD and NADP Redox reactions Derived from Tryptophan Deficiency - pellagra

Question 1425

Vit B5

Answer 1425

Pantothenate Component of coenzyma A Fxn in transfer of acyl groups Deficiency -dermatitis Enteritis -alopecia-adrenal insufficiency

Question 1426

Vit B6

Answer 1426

pyridoxine coenzyme for transaminations and deaminations Conversion of AA precursors ``` Deficiency - cheilosis -glossitis - convulsions ** (B6 essential for GABA) -Peripheral neuropathy ```

Question 1427

Vit B7

Answer 1427

Biotin Apoenzyme for caboxylation rxns

Question 1428

Vit B9

Answer 1428

Folic acid Synthesis and repair of DNA Rapid cell division and growth Tetrahydrofolate Deficiency - Meds (phenytonin, sulfonamides, TMP, MTX) Neural tube defect Megaloblastic anemia Glossitis Diarrhea Depression Confusion

Question 1429

Megaloblastic anemia

Answer 1429

RBC large Macrocytic anemia Hypersegmented neutrophils Folate and B12

Question 1430

Vit B12

Answer 1430

Cobalamin Need Intrinsic factor to be absorbed in duodenum Cofactor w/ homocysteine methyltransferase --> THF ``` Deficiency - Anemia Ataxia Paresthesias Memory loss Dementia ``` Vegetarians Pernicious anemia

Question 1431

A patient presents with convulsions and irritability, what vitamin deficiency

Answer 1431

Vitamin B6

Question 1432

Which vitamin deficiency 1) Peripheral neuropathy, glossitis 2) Neural tube defects 3) Dermatitis, diarrhea, dementia 4) Megaloblastic anemia 5) Pernicious anemia

Answer 1432

1) B12, B6 2) Folic acid (B9) 3) B3 4) B12 or folic acid (B9) 5) B12

Question 1433

Tumor markers for pancreatic cancer

Answer 1433

CA 19-9 | CEA (also elevated in gastric and colon cancer)

Question 1434

Uses cAMP and protein kinase A as secondary messengers

Answer 1434

``` FSH LH ACTH TSH hCG MSH GHRH, CRH PTH, Calcitonin Glucagon V2 Vasopressin receptor ```

Question 1435

Uses IP3 as second messenger

Answer 1435

GnRH TRH Oxytocin V1 vasopressin receptor

Question 1436

Uses tyrosine kinase receptor as second messenger

Answer 1436

``` Growth hormone Prolactin Inulin insulin-like growth factor Platelet derived growth factor Fibroblast growth factor Cytokines ```

Question 1437

Uses cGMP as secondary messenger

Answer 1437

Nitric oxide | Atrial natriuetic peptide

Question 1438

Uses steroid receptors as second messenger

Answer 1438

``` Estrogen, progesterone, testosterone Glucocorticoids Aldosterone Thyroid hormone Vitamin D ```

Question 1439

What are the two nervous tissue bundles that run through the GI tract and where re they located

Answer 1439

Meissner plexus: submucosa Auerbach's plexus: between layers of the muscularis propria

Question 1440

What disesases specifically damage tehn aterior horn?

Answer 1440

Polio West nile virus ALS Werdnig-Hoffman dis (spinal muscular atrophy)

Question 1441

ACTH is synthesized as part of

Answer 1441

Large precursor called POMC

Question 1442

POMC contains

Answer 1442

Lipotropin MSH beta-endorphin

Question 1443

Somatostatin fxn

Answer 1443

Reduces splanchnic blood flow Reduces GI motility adn GB contraction Inhibits secretion of most GI hormones

Question 1444

Sheehan syndrome

Answer 1444

Postpartum hemorrhage leading to underperfusion of the pituitary Pituitary necrosis and hypopituitarism Agalactorrhea Amonorrhea after delivery Hypothyroidism

Question 1445

Pituitary Anterior lobe forms from - type of cells Posterior lobe - forms from - type of cells

Answer 1445

Anterior lobe - forms from rathke's pouch - ectodermal diverticulum Posterior lobe - forms from invagination of the hypothalamus - neuroectoderm

Question 1446

What increases ADH What decreases ADH

Answer 1446

Increase ADH - Nicotine - Opiates Decrease ADH - Ethanol Atrial natriuretic factor - decreased serum osmolarity

Question 1447

What hormones share a common alpha subunit

Answer 1447

FSH LH TSH hCG

Question 1448

what do type II pneumocytes need to mature

Answer 1448

Cortisol

Question 1449

Adrenal cortex from Adrenal medull afrom

Answer 1449

Cortex= mesoderm Medulla= ectoderm

Question 1450

Tumor in adrenal medulla of kids Causes?

Answer 1450

Adrenal neuroblastoma Sustained HTN

Question 1451

Deficiency in 21 alpha hydroxylase

Answer 1451

Masculization Hypotension Cant make aldosterone or cortisol Hypotension Hyponatremia HYPERkalemia High 1-OH progesterone Cortisol deficiency --> increase ACTH, hyperplasia of adrenal glands Most common

Question 1452

Deficiency in 11b- hydroxylase

Answer 1452

Masculization Hypertension Build up of 11-deoxycorticosterione Still have mineralocorticoid properties Cortisol deficiency --> increase ACTH, hyperplasia of adrenal glands

Question 1453

Deficiency of 17a- hydroxylase

Answer 1453

HTN Ambiguous genitalia Can only make mineralocorticoids Salt and H20 retention Hypokalemia Cortisol deficiency --> increase ACTH, hyperplasia of adrenal glands

Question 1454

3beta-hydroxysteroid dehydrogenase deficiency

Answer 1454

``` Inability to produce - Glucocorticoids Mineralocorticoids Androgens Estrogens ``` Excessive sodium Early death Ambigous genitalia

Question 1455

Adrenal steroids are made from

Answer 1455

Cholesterol

Question 1456

Dexamethasone suppression test, high dose works on

Answer 1456

ACTH-producing pituitary tumor

Question 1457

Cortisol effect on bones and immune system

Answer 1457

Reduces bone formation --> osteoporosis Suppress immune system

Question 1458

Waterhouse-Friderichsen syndrome

Answer 1458

Acute primary adrenal insufficiency due to adrenal hemorrhage - Severe meningococcal sepsis - DIC Petechial rash Coagulopathy

Question 1459

Primary adrenal insufficiency deficient in Tx

Answer 1459

Cortisol and aldosterone Tx: glucocorticoid

Question 1460

Conn syndrome

Answer 1460

Aldosterone-secreting adrenal tumor Hyperaldosteronism HTN Hypokalemia Metabolic alkalosis Decrease in Renin levels

Question 1461

``` Hypotension Hyponatremia Hyperkalemia Fatigue Anorexia Weight loss Hyperpigmentation ```

Answer 1461

Primary adrenal insufficiency (addison disease)

Question 1462

A 42-year-old woman has had increasing weakness, nausea, vomiting, watery diarrhea, and a 5-kg weight loss over the past 7 months. She has generalized muscle weakness, muscle wasting, and increased skin pigmentation on physical examination. After an upper respiratory tract infection lasting 1 week, she develops abdominal pain and faintness and lapses into a coma. Her temperature is 36.9° C, pulse is 83/min, respirations are 17/min and shallow, and blood pressure is 80/40 mm Hg. Laboratory findings show Na+, 129 mmol/L; K+, 3.5 mmol/L; Cl−, 95 mmol/L; CO2, 23 mmol/L; glucose, 48 mg/ dL; and creatinine, 0.6 mg/dL. Atrophy of which of the following tissues is most likely to be present? A Adrenal cortex B Hypothalamus C Islets of Langerhans D Parafollicular C cells in thyroid E Pineal gland F Thyroid epithelium

Answer 1462

A. Adrenal cortex

Question 1463

A 55-year-old man has experienced increasing lethargy for the past 7 months. Physical examination shows hyperpigmentation of the skin. Vital signs include temperature of 36.9° C, pulse of 70/min, respirations of 14/min, and blood pressure of 95/65 mm Hg. Laboratory studies include a serum cortisol level of 3 μg/mL at 8:00 AM with a serum corticotropin level of 65 pg/mL. Which of the following diseases most often occurs in patients with this disorder? A Type 2 diabetes mellitus B Classic polyarteritis nodosa C Hashimoto thyroiditis D Systemic lupus erythematosus E Ulcerative colitis

Answer 1463

C. Hashimoto thyroiditis Addison disease

Question 1464

A 44-year-old woman has become increasingly listless and weak and has had chronic diarrhea and a 5-kg weight loss over the past 7 months. She also notices that her skin seems darker, although she rarely goes outside because she is too tired for outdoor activities. On physical examination, she is afebrile, and her blood pressure is 85/50 mm Hg. A chest radiograph shows no abnormal findings. Laboratory findings include serum Na+, 120 mmol/L; K+, 5.1 mmol/L; glucose, 58 mg/dL; urea nitrogen, 18 mg/dL; and creatinine, 0.8 mg/ dL. The serum corticotropin level is 82 pg/mL. Which of the following is most likely to account for these findings? A Adenohypophyseal adenoma B Autoimmune destruction of the adrenals C Pancreatic neuroendocrine tumor D Metastatic carcinoma with lung primary E Neisseria meningitidis infection of the adrenals F Sarcoidosis of the lung and adrenals

Answer 1464

B Autoimmune destruction of the adrenals

Question 1465

30 y.o man undergoing an evaluation for hypertension. Has a history of multiple episodes of hypokalemia. Lab shows a potassium of 3.0 despite replacement and metabolic alkalosis. What is the cause of HTN?

Answer 1465

Primary hyperaldosteronism

Question 1466

Which causes of vaginal discharge/ vaginitis are associated iwth a high vaginal pH? Wjocj are associated iwth a low vaginal pH?

Answer 1466

Low vaginal pH - physiologic dischrage Candida High vaginal pH - gardnerella Trichomonas

Question 1467

Erythropoietin=secreting tumors

Answer 1467

Pheochromocytoma Renal cell carcinoma Hemangioblastoma (vascular tumor of CNS) Hepatocellular carcinoma

Question 1468

Neuroblastoma - tumor of - type of cells - see in - causes - associated with - histology - tumor marker

Answer 1468

Home Wright rosettesTumor of the adrenals Tumor of sympathetic ganglion cells Most common tumor of adrenal medulla in children Mild HTN N-myc oncogene Homer Wright rosettes Bombesin tumor marker

Question 1469

Homer Wright rosettes

Answer 1469

Adrenal neuroblastoma

Question 1470

N-myc oncogene

Answer 1470

Adrenal neuroblastoma