Factionless Flashcards
(663 cards)
1
Q
Why is Succinylcholine contraindicated in pts with burns, myopathies, crush injuries or denervating Dz
A
Can cause SIGNIFICANT K+ RELEASE –> VFIB in pts at high risk for Hyperkalemia
2
Q
What is Priapism and which antiPsychotic is associated with it
A
Painful Long-Lasting Erections; Trazodone (TraZaBone)
3
Q
What is Rxn Formation in Psychiatry
A
Reacting to an unacceptable situation by Forming a completely opposite response
covering fears of faling exam by being overly confident
4
Q
Cocaine intoxication stimulates _____ [Miosis vs. Mydriasis]
A
Cocaine intoxication stimulates Mydriasis
Pupils Wide Open on Coke!
5
Q
Pts who’ve had a major depressive episode in the past have to be screened for what before giving Antidepressants
A
Mania (rule out Bipolar DO)
Antidepressants are contraindicated in Bipolar pts since they precipitate mania
6
Q
[ADHD medication] SE (2)
A
- DECREASED appetite
- Insomnia
These Drugs INC NorEpi & Dopamine in PreFrontal Cortex
7
Q
What’s the most effective tx for Specific phobia?
A
CBT (Systematic Exposure)
8
Q
Drug used for Tx-Resistant Schizophrenia
A
Clozapine
9
Q
Tx for [Somatic Symptom DO]
A
Regularly scheduled Med visits (Goal: Improve functionality)
DO = preocupation with unexplained (but proven to be benign) medical sx
10
Q
MOD for Death from TriCyclic Antidepressant OD
A
Blocks Fast Na+ in cardiomyocytes –> Prolonged QT/Arrhythmia
11
Q
Is the EDV in Diastolic HF Elevated, Normal, or DEC?
A
NORMAL
12
Q
Which Vitamins are intestinal bacteria known for producing? (2)
A
Vitamin K and [Folate B9]
13
Q
Describe the histology for [lactase deficiency] pts and how you diagnose it?
A
Normal; STOOL pH less than 7
14
Q
Tx for Hepatic Encephalopathy and their MOA (2)
A
- Lactulose (converts NH3 –> NH4+ in colon - but DOES CAUSE DIARRHEA)
- Rifaximin abx (⬇︎NH3 producing colonic bacteria)
15
Q
Which parts of the GI tract are affected in Hirschsprung Dz? (2)
A
- RECTUM - always
- Sigmoid Colon sometimes
16
Q
What is linkage disequilibrium
A
When a pair of alleles are inherited together in the same [gamete haplotype] more than would be expected by random chance
Can occur even if genes are on different chromosomes
17
Q
What GI structure is used to identify the appendix during an appendectomy?
A
Teniae Coli
Teniae Coli travel outside colon and converge at root of appendix vermiform
18
Q
Where would you find [Branched Tubular Submucosal glands] with alkaline secretions in the GI tract
A
[Brunner Submucosal glands] are found from the Pylorus all the way through [Duodenum 1st segment]
19
Q
What’s the major immune mechanism against Giardia (2)
A
[CD4 Helper T] & IgA
Eosinophils can’t help against Giardia
20
Q
Lymph drainage of [Rectum proximal to dentate] drains into the _____ lymph nodes (2)
A
*Inferior Mesenteric
*[Internal iLiac]
21
Q
Lymph drainage of [Rectum Distal to dentate] drains into the _____ lymph nodes
A
Superficial Inguinal
22
Q
Failure of the [Vitelline Omphalomesenteric Duct] to obliterate leads to what 2 things?
A
- Meckel Diverticula
- Enterocyst
23
Q
Estrogen ____[INC/DEC] the level of TBG in the blood. How does this affect [Free thyroid hormone]? Explain
A
Estrogen INC TBG in blood –> INC binding sites available to carry thyroid hormone –> INC [TOTAL T4 (bound + free)] and [Total T3].
Free thyroid hormone levels are NOT affected
24
Q
Identify sections of the Adrenal Gland
A
1 = Glomerulosa
2= Fasciculata
3= Reticularis
4 = Medulla chromaffin (stimulated by ACh)
25
How does Anorexia cause Amenorrhea?
Anorexia --\> DEC GnRH from hypOthalamus
26
Which drug is used to control, [Graves Dz **Ophthalmopathy**] specifically and how does this help
**Prednisone**; DEC inflammation
27
Which layer of the stomach is Parietal cells found?
B; Upper Glandular Layer
28
Where, in the GI tract, is iron absorbed? (2)
Duodenum & Proximal Jejunum
29
What are the levels of Cholesterol, Phosphatidylcholine and Bile in pts with Gallstones?
INC Cholesterol
## Footnote
**DEC** Bile (since it's saturated w/Cholesterol instead)
DEC Phosphatidylcholine
*Bile & Phosphatidylcholine are protective against Gallstones*
30
SCID MOD
auto recessive deficiency of Adenosine Deaminase (needed to eliminate excess adenosine inside cells)
31
What happens when SCID affects WBC
Adenosine accumulates in Lymphocytes --\> Death --\> Deficiency --\> Multile Pathogen infections
32
NF-kB is most involved in what process
**INFLAMMATION**; allows Cytokine production
33
[Tracheoesophageal fistula w/esophageal atresia] results from what?
Failure of [PleuroPeritoneal membrane] to form completely
34
Describe the location of Femoral Hernias (3)
Inferior to Inguinal ligament
Lateral to Pubic Tubercle
Medial to Femoral Vein
*Keep in mind: Incarceration/Stragulation is common*
35
The Celiac trunk is the ___ main branch of the abd aorta. It provides oxygenated blood to which organs (6)
**1st** main branch of abd aorta = **SPALDS**
1. **S**pleen
2. **P**ancreas
3. **A**bd Esophagus
4. **L**iver (via Hepatic a. daughter branch)
5. **D**uodenum
6. **S**tomach
36
Out of the Retroperitoneal Organs, which is most commonly associated with Retroperitoneal Bleeding?
PANCREAS (body)
## Footnote
**SAD** **P****UCKER**
37
Which Colon CA is the most common GI malignancy?
Colon ADC
38
Compare clinical manifestations between [R Colon ADC] and [L Colon ADC]
[R Colon ADC] = Bleeds / Iron deficiency anemia
vs.
[L Colon ADC] = Obstruction sx (altered bowel habits / NV)
39
Weakening of the ____ in ___ triangle causes Direct Inguinal hernia. They protrude only through the \_\_\_\_\_\_
Weakening of the **Transversalis Fascia** in **Hesselbach's** triangle causes [Direct Inguinal Hernia]. They protrude only thorugh the **EXTERNAL inguinal ring**
40
How can we diagnose Tropheryma Whippelii with stains?
Cell Wall **Glycoprotein** in T.Whippelii stains magenta with PAS
41
Sucralfate MOA
Binds to [Mucosal Ulcer Base] and physically protects it against gastric acid --\> Speeds up healing
## Footnote
*Does NOT inhibit acid secretion*
42
Which lab markers are the best indicators for Poor pgn in Cirrhosis pts? (3)
1. Albumin
2. Bilirubin
3. **P**ro**T**hrombin Time
## Footnote
*These Reflect Liver function in Cirrhotic pts*
43
Function of Betalipoproteins
Component of [Chylomicrons and **V**LDL] that enables LDL small intestinal absorption
## Footnote
*Abetalipoproteinemia = inhertied dz --\> enterocytes accumulated with clear foamy cytoplasm from INC LDL*
44
What are the *most occuring* CA amongst Women from greatest to least
Breast \> Lung \> colon
## Footnote
Breast = Most occuring
45
Why does [Hemolytic Dz of Newborn*(Erythroblastosis Fetalis)* ] occur more in [O**-** Mothers] and less in [A**-** or B**-** Mothers]?
[A**-** or B**-** Mothers] have mostly [anti-Rh Ig**M** antibodies]--Ig**M** does NOT cross placenta
* * *
* [TYPE O **-**MOTHERS] HAVE MOSTLY* [anti-Rh Ig**G** antibodies] --Ig**G** *crosses placenta! --\> HDNEF*
46
Sickle cell anemia is ___(mode of inheritance) and should be diagnosed with what?
auto recessive; [HgB electrophoresis] determines carrier status
## Footnote
*[Gluta**MATE** --\> Valine @ 6th position]*
47
[Wiskoff Aldrich Syndrome] Clinical Manifestation
"My *Recessive-X* *_WAS_* **Bleeding**, [**always sick**] and had **Eczema**!
## Footnote
1. **Bleeding** (thrombocytopenia)
2. **always sick** (recurrent infection)
3. **Eczema**
X-linked recessive
48
[Ataxia Telangiectasia] MOD and clinical presentation
ATM gene defect --\> Faulty DNA repair --\> **ROE**
**R**ecurrent Infection
**O**culocutaneous telangiectasia
**E**arly cerebellar ataxia
49
Where does complement bind on the Immunoglobulin
Heavy chain **near the hinge point**
50
Mode of Inheritance for [Hemophilia A vs. B]
Both are X-linked Recessive
51
What part of the Thymus/lymph node is underdeveloped in DiGeorge Syndrome? How does this affect function?
Paracortex; prevents 1° lymphoid follicles & germinal centers form forming in cortex
52
Identify which Knee this is (L vs. R) and the letters
**RIGHT** Knee
53
What should be monitored in pts with Ankylosing Spondylitis? Why?
Chest Wall Expansion; involvement of thoracic & costovertebral spine can limit chest wall expansion --\> hypOventilation
54
After Clavicle Fracture, which muscle causes SUPERIOR displacement of the midshaft and which causes INFERIOR (2)
SUPERIOR = Sternocleidomastoid
inferior = PEC Major & arm weight
*CLAVICLE = MOST FRACTURED BONE (especially in kids)*
55
What type of Hypersensitivity is Myasthenia Gravis?
Type 2 (Ab-mediated)
## Footnote
*Same as GoodPasture*
56
Preferred Diagnostic tool for Vertebral Osteomyelitis
MRI
57
What 3 markers reflect Osteo**clast** activity
1. Urine DeOxyPyridinoline (most specific)
2. Urine HydroxyProline
3. [Tartrate Resistant Acid Phosphatase]
58
MOD for [Giant Cell temporal Arteritis]
IL6 drives **cell-mediated** immunity against LARGE blood vessels
59
[Mccune Albright] Clinical Presentation (3)
1. Unilateral Cafe Au Lait
2. Endocrine Problems
3. Polyostotic Fibrous Dysplasia
*Lethal if onset b4 fertile but survivable in mosaicism pts*
60
How are Contractures formed and what do they ultimately result in
comes from too much [matrix metalloproteinase activity + myofibroblast accumulation]. Contractures --\> Wound deformitites
61
How does Anabolic Steroid misuse cause Acne?
Androgens stimulate follicular epidermal hyperproliferation and INC sebum --\> Acne (inflammatory nodular eruptions)
62
Clinical Presentation for [Caudal Regression Syndrome] (2). What's the major RF
1. [LumboSacral AGENESIS NTD] --\> [Flaccid LE + Urinary incontinence]
2. Heart defects
**Maternal DM** = RF
63
Allopurinol (a ___ inhibitor) INC the concentration of what 2 drugs as a result?
Allopurinol = **Xanthine Oxidase** inhibitor --\> INC
Azathioprine
6-MP
64
Sarcomere is defined as the distance between _____. [Actin Thin filaments] are bound & structurally supported by the \_\_\_\_\_
Sarcomere = Distance between **Two Z Lines**
[Actin Thin filaments] are bound & structurally supported by the [**Z Lines] in the [I band]**
65
Sarcomere is defined as the distance between _____. [Myosin THICK filaments] are bound & structurally supported by the \_\_\_\_\_
Sarcomere = Distance between **Two Z Lines**
[Myosin THICK filaments] are bound & structurally supported by the [**M** **Lines] in the [A band]**
66
In Lateral Epicondylitis, which tendon is often swollen and what function does it have?
[Extensor Carpi Radialis brevis]; Extends Wrist
67
What's significant about Black women and Bone mass
Black women have **Higher** bone density and DEC risk of fractures
68
Lymph drainage of medial foot drains into the _____ lymph nodes. What part of the reproductive system also drains here?
Superficial Inguinal ; SCROTUM
69
Lymph drainage of Lateral foot drains into the _____ lymph nodes (2)
Superficial Inguinal **AND** Popliteal
70
Clinical Presentation for [Serum Sickness Type 3 Hypersensitivity] (5)
"_Drugs_ can make ur Serum **CAUFF**"
1. [**C**3 & C4 DEC]
2. **A**rthralgia
3. **U**rticaria
4. **F**ibrinoid Vasculitits Necrosis
5. **F**ever
71
What is [Serum Sickness Type 3 Hypersensitivity] mostly caused by?
Drugs acting as Haptens
## Footnote
(such as Infliximab :-) )
72
The Thymus and [inferior parathyroid] comes from the ___ pharyngeal pouch
**3rd**
73
Which pharyngeal arch does the [SUP parathyroid] come from?
**4th**
74
Which DO is characterized as [Endomysial CD8 inflammation + patchy necrosis] and what's the MOD
Polymyositis; Ab against [Histidyl tRNA synthetase]
75
What ions contribute to the resting potential of a cell
[HIGH K+ conductance] **AND** [some Na+ conductance]
76
Tibial n. supplies **sensory** innervation to what part of the foot?
Plantar Foot
77
Falls onto an outstretched hand may **dislocate** the ____ bone, **fracture** the ____ bone --\>which INC risk of developing _____. Fracture of the \_\_\_\_bone is in between which 2 tendons?
dis**L**ocate **L**unate; [fracture Scaphoid--\> Avascular Necrosis] found between extensor longus and brevis (snuff box)
78
Which drug DEC risk of both Breast CA and Bone Fractures in Women
Raloxifene SERM
79
Histology description for Osteoclast and list what 2 factors activate differentiation
multinucleated; [M-CSF and RANKL -both from OsteoBLast]
80
How does Omeprazole affect Skeleton system
long term use of PPI --\> Osteoporosis
## Footnote
***T**hese **C**oAg **C**anners **O**bliterate **S**pongyBoneTrabeculae*
81
Identify the finding
Clubbing (associated with prolonged hypoxia-typically from Lung Dz)
82
Difference between [Muscle Spindle system] and [Golgi Tendon system]
[Muscle Spindle system] = monitors muscle length
vs.
[Golgi Tendon system] monitors muscle **force** (associated with relaxation)
83
Defect in [PECAM1] --\> No Neutrophil \_\_\_\_
Transmigration
84
Hematogenous Osteomyelitis is most common in ____ and usually affects the ____ of bone
Children; **Metaphysis**
85
Buttock injections to what quadrant(s) risk Sciatic n. injury
Superomedial, Inferomedial, InferoLateral
86
Butt injections to what quadrant(s) risk SUP Gluteal n. injury --\> ___ Gait
Superomedial
Will cause **Trendelenburg** gait
87
COX __ is an inducible enzyme (by IL1) usually undetectable except during inflammation
COX**2**
88
Which musculoskeletal condition is associated with having an extra cervical rib?
Thoracic Outlet Syndrome --\> UE paresthesias & weakness
89
Function of [Human Placental Lactogen] (2)
"**HPL** gives Mom **H**igher **P**lasma [**L**ipids & Glucose] for the baby"
[DEC Mom's Fatty acid stores] and INC Mom's Blood Glucose] for the baby
90
What would an US of the uterus in an ectopic pregnancy show?
**Decidualized endometrium** - Dilated, coiled endometrial glands & [vascularized edematous stroma] from progesterone preparation but no implant
91
Pelvic fractures are associated with injury to what Male GU structure?
[**P**osterior Urethra: _Membranous_ segment]
## Footnote
* Cather placement is cx in Urethral injury*
* Prostatic segment is protected by Prostate*
92
Saddle injuries are associated with injury to what Male GU structure?
Anterior Urethra
*Catheter placement is cx in Urethral injury*
93
Between Epispadia and hypOspadia, which is associated with faulty positioning of the genital tubercle?
Epispadia
## Footnote
*You P**E**E in ur **E**ye with **E**pispadia*
94
Difference between [Androgen insensitivity Syndrome] and [Mullerian aplasia]
AIS have [**NO** Fallopian tube and Uterus (even rudimentary)] and [**NO** sexual hair] (2)
95
Saline Microscopy is AKA \_\_\_\_\_
**WET MOUNT**
*think Trichomonas vaginalis*
96
What is Cervical Cytology typically used for?
This is a **PAP Smear** ; HPV
97
Both [Indirect inguinal hernia] and [Communicating Hydroceles] are caused by what?
Incomplete obliteration of Processus Vaginalis --\> connection between scrotum & Abd cavity
98
Most dangerous SE of Tamoxifen SERM
Although [E2 blocker @ Breast], it's [**E2 agnoist @ Endometrium**] --\> [Endometrioid Endometrial ADC]
99
What does pregnancy analytes show for [Down Syndrome] (4)
1. INC inhibin A
2. INC beta-HCG
3. DEC AFP
4. DEC Es**triol**
100
Bilateral ligation of which vessel resolves Postpartum Hemorrhage
Internal iLiac
101
Describe Septic Abortion and what causes it (2)
Seeding of Uterine cavity from instruments after having abortion --\> Foul discharge + fever + abd pain
**Staph Aureus** & **E.Coli** cause it!
102
[Gestational Placental Choriocarcinoma] is usually preceded by _____ and causes ____ with ____. What happens if this metastasizes?
**some form of pregnancy**; [VERY HIGH bHCG + Vaginal Bleeding] ; Hematogeous spread --\> Lungs--\> Hemoptysis
103
Tx for PCOS (4)
Use a **SOCK** to treat PCOS
1. **S**pironolactone -2ND LINE AND SHOULDN'T BE USED IN FERTILE PTS
2. **O**CP - _1ST LINE_
3. **C**lomiphene
4. **K**etoconazole
104
Ovarian CA is usually diagnosed in _____. What are the CA marker? (2)
Postmenopausal women; [Epithelial = CA-**125**] but [Stromal/Granulosa = Estrogen]
## Footnote
*Granulosa will have Call-Exner rosette & appear yellow from theca lipid*
105
Which drug reduces the **volume** of the prostate in pts with BPH
Finasteride (5a-reductase inhibitors)
106
What's the most common cause of [Blood Nipple Discharge] in women and describe its Histology
Intraductal Papilloma; [Papillary cells w/fibrovascular core] --\> **Unilateral** bloody/serous discharge
1.5-2 risk of CA
107
What is a Cystic Hygroma and what pts have it?
Posterior neck mass made of cystic spaces separated by connective tissue; Turner Syndrome
108
Ovarian Torsion MOD
**[SIPL -** **S**uspensory **I**nfundibulo**P**elvic **L**igament**]** twist due to large adnexal mass --\>arterial Occlusion---\>Ovarian ischemia
109
[Kegel Pelvic floor strengthening] targets what muscle for [Stress Urinary Incontinence] tx
Levator Ani
110
Congenital Torticollis MOD
**Malpositioning of Head in Utero vs. During birth** --\> constant contraction of SCM--\>Lateral Neck swelling
111
Adenomyosis clinical presentation (3)
1. **Uniformly** enlarged Uterus w/normal endometrial
2. Menorrhagia
3. Dysmenorrhea
*MOD= endometrial glands within myometrium*
112
Which thyroid tx contains Iodide and thus acts by competitively blocking
Perchlorate & PerTechnetate
113
Pt taking Hyperthyroid medication with [**sudden** fever & sore throat] should receive what test and why?
WBC w/ diff; Anti-Thyroid meds can --\> Agranulocytosis
## Footnote
*PTU also causes Liver Failure*
114
What is the recommended regimen for Diabetics on Insulin
1 Long Acting (Glaaaaaaarrgine vs. Detmir)
+
1 short acting pre-meal (glulisine vs. aspart vs. lispro)
115
Between Glycogenolysis and Gluconeogenesis, which does EtOH inhibit in liver?
Gluconeogenesis
116
Which Lipid lowering drug actually INC HDL and TAG if used alone?
BABR (Bile Acid binding resin)
## Footnote
*[Cholestyramine & Cole]*
117
Type 2 DM pts mostly die from what?
MI
118
What are the 4 most common causes of Myopathy (elevated CK)
**S**tatins **P**robably **h**urt **M**uscles
1. **S**tatins
2. **P**olymyositis vs. Dermatomyositis (autoimmune)
3. **M**uscular Dystrophy
4. **h**ypOthyroidism
119
Histology for Osteopetrosis (2)
Primary spongiosa in medullary cavity with no mature trabeculae + accumulated woven bone
120
Even though Prolactin INC during pregnancy, why is lactation actually inhibited?
Actual **Lactogenesis** (not Prolactin secretion) is inhibted by HIGH levels of E2 or Progesterone
## Footnote
*Dopamine also bock Prolactin*
121
Genetic causes for Down Syndrome (3)
1. **Meiotic Nondisjunction (most common)**
2. Mosaicism for a trisomy 21 cell line
3. Robertsonian Translocation (14 --\>21)
122
Why are pregnant pts (Fertile) at higher risk for Gallstones?
[E2 --\> Cholesterol Hypersecretion] & [Progesterone--\> Gallbladder hypOmotility]
123
Polyhydraminos (INC amniotic fluid) is caused by what? (2)
1. Impaired fetal swallowing (Anencephaly, GI obstruction/atresia)
2. Excessive amniotic production (high cardiac output, twin transfusion syndrome)
## Footnote
*Renal Agenesis --\> Oligohydraminos (not enough amniotic)*
124
Define Pyknosis
Nuclear Shrinkage
125
Describe the process of EtOH breakdown to Acetic Acid and explain how Metronidazole disrupts this
Metronidazole has Disulfiram-like activity --\> Acetaaldehyde accumulation --\> Flushing/NV/Cramps after drinking
126
Testicular Torsion MOD
Twisting of Testes around spermatic cord which cuts off [testicular vein outflow] but still preserves [gonadal a. inflow (**from Abd aorta**)] --\>Engorgement --\>Hemorrhagic infarct
127
How does Testicular Torsion present? (2)
1. High - riding Testis
2. Absent Cremasteric reflex
128
What is Vaginal Adenosis and what demographic is it seen
Persistence of upper 2/3 [**Glandular columnar**]--\> [Clear cell ADC]; DES daughters
129
[Prader Willi]
MOD (2)
&
Clinical Presentation (3)
[**P**aternal gene deletion] vs. [Maternally imprinted (silenced) gene disomy (receiving both genes from Mom)]
1. [Short & Obese]
2. hypOtonia
3. Retarded
130
Which structures should be ligated during an oophorectomy and why?
[**SIPL** - Suspensory InfundibuloPelvic ligament] contains [ovarian NAVL(Nerve/Artery/Vein/Lymphatics)] ; prevents bleeding
131
What is Ebstein anomaly (3)? What medication is associated with it?
[Tricuspid displacement toward apex] + [DEC RV volume] + [atrialization of RV]
Lithium during pregnancy
132
Although the prostate drains into the ___ lymph nodes, how does osteoblastic metastasis to skeletal system occur?
[Prostate drains --\>Internal iLiac Lymph nodes]
BUT
Bone metastasis from Pelvis spread via [Vertebral venous Plexus] (Prostatic venous plexus)
133
Where is the [Prostatic plexus] located and what does it innervate
[Inside Fascia surrounding Prostate]; innervates [Corpus Cavernosa --\> Penile Erection]
## Footnote
*Can be damaged during prostatectomy*
134
Cystic Fibrosis and Kartagener (SIBS) present VERY similarly! What is the differentiating sign?
**Cystic Fibrosis has [Bilateral Absence of Vas Deferens]**! (This --\> Infertility)
135
Mi**F**epristone MOA
**F** this baby, smh
Progesterone R Blocker
*Used for [1st trimester Abortion]*
136
Misoprostol MOA
Prostaglandin E1 agonist; given with MiFepristone
137
[Sertoli Leydig ovarian tumors] come from ____ and secrete _____. Describe the Histo
[Sex Cord Stroma]; Testosterone; Round Sertoli surrounded by fibrous stroma w/ **Reinke** crystals]
138
What is Rheumatoid factor
IgM Ab that targets [host IgG Fc region]
139
What all conditions are associated with [HLA B27 Seronegative spondyloarthropathies] (4)? Which class of MHC do they belong to?
**PAIR**
**P**soriatic Arthritis
**A**nkylosing Spondylitis
**I**nflammatory bowel Dz arthritis
[**R**eiters Reactive arthritis]
[MHC Class 1 = HLA A, B and C] (all else = MHC Class 2)
140
Latissimus Dorsi
A: Innervation
B: function (3)
C: Attachment (3)
A: Thoracodorsal n.
B: [Humerus: Extension / ADDuction / medial rotation]
C: iLiac crest --\> [Spinous process of T7-12] and inserts at bicipital humerus groove
141
Describe the "Empty-Can" test and which muscle it test for?
[ABduction of arm] + [30°flexion of arm forward] + [thumbs pointed toward floor] --\> Pain = [**Supraspinatus** Rotator cuff injury]
142
What are T-Tubules and what is their job?
[Invaginations of the Sarcolemma] that extend into each fiber; **Coordinates** contraction of myofibrils by transmiting depolarization to BOTH Sarcoplasmic Reticulum between 2 muscle fibers
143
What is Calcitriol
Vitamin D (1-25 Dihydroxycholecalciferol)
144
Where is Calcitonin produced and how does it DEC serum Ca+
[Thyroid parafollicular C-cells]; inhibits Osteoclast
145
Effect of T3 on bone
Activates Osteoclast (INC bone turnover) --\> INC Ca+ and Phosphate
146
What biochemical change is exhibited in Myasthenia gravis on the motor end plate?
REDUCED MOTOR END PLATE POTENTIAL (from inability of ACh to stimulate opening of Na+ influx)
147
Which muscles allow you to sit up from supine position (3)
1. [**iLiopsoas** Hip Flexors (iLiacus/Psoas Major & minor)]
2. Rectus Abdominis
3. External Oblique
148
Clinical Presentation for [**DILE** - **D**rug **I**nduced **L**upus **E**rythematosus] (3). Which drugs cause this (3)?
[**Sudden FAP** - **F**ever/**A**rthralgia/**P**leuritis]; (Drugs linked to Liver Acetylation --\>Procainamide/Hydralazine/INH)
## Footnote
*SLOW ACETYLATORS = INC RISK!*
149
Describe the [Psoas Sign] and what it indicates
Pain when Hip is extended; Psoas m. damage/abscess
## Footnote
*Psoas and iLiopsoas m. are the major hip flexors*
150
Which arteries are associated with the following nerves?
A: Long Thoracic
B: Axillary
C: Radial
D: Median
E: Tibial: Popliteal fossa
F: Tibial: posterior to medial malleolus
A: Long Thoracic = Lateral Thoracic artery
B: Axillary = POST Circumflex a.
C: Radial = **DEEP** Brachial a.
D: Median = Brachial a.
E: Tibial: Popliteal fossa = Popliteal a.
F: Tibial: posterior to medial malleolus = POST Tibial a.
151
Involuntary deviation of the Head to the R with neck muscle pain is an example of \_\_\_
DYSTONIA = abnormal (painful) movements or postures from sustained contraction
## Footnote
*[Spasmodic Torticollis Cervical Dystonia] = most common*
152
Hiccups and [Hypnic jerks seen when falling asleep] are an example of what?
Myoclonus = Sudden brief shock-like muscle contraction
153
A: List the n. roots associated with Obturator n.
B: Associated Injury (2)
C: Sensory deficit
D: Motor Deficit
**Obturator nerve**
A: L2-4
B: Pelvic Surgery vs. ANT Hip Dislocation
C: medial thigh loss
D: No Thigh ADDuction
154
A: List the n. roots associated with Femoral n.
B: Associated Injury (2)
C: **Sensory** deficit
**Femoral nerve**
A: L3-4
B: [Pelvic path involving iLiopsoas m.] vs. [Retroperitoneal path]
C: [(AnteroMedial Thigh) & (Medial leg)]
155
List the n. roots associated with Common Peroneal n.
L4-S2
foot is drop**PED** (**P**eroneal **E**verts & **D**orsiflexes)
156
List the n. roots associated with Tibial n.
L4-S3
can't walk on **TIP**toes (**T**ibial **I**nverts & **P**lantarflexes)
157
A: List the n. roots associated with [SUP Gluteal n.]
B: Associated Injury (2)
C: Sensory deficit
D: Motor Deficit (2)
**[SUP Gluteal nerve]**
A: L4-S1
B: [Superomedial Butt injection] vs. POST Hip dislocation
C: none :-)
D: [Trendelenburg gait] & [No Thigh ABduction]
158
A: List the n. roots associated with [inferior Gluteal n.]
B: Associated Injury (2)
C: Sensory deficit
D: Motor Deficit (2)
**[inferior Gluteal nerve]**
A: L5-S2
B: Butt injection vs. POST Hip dislocation
C: none :-)
D: [No Thigh Extension]
159
What are the 3 drugs used for Acute Gout attack and which are first line?
**GNC**
**G**lucocorticoid/**N**SAIDs/**C**olchicine
Use NSAID 1st \> Colchicine \> Glucocorticoid
160
What is Dystrophin and in what dz is the gene for it deleted?
Protein allowing connection between [Extracell Conennective tissue] and [intramuscle cell contraction apparatus]; Duchenne Muscular Dystrophy (Gower sign)
161
Injury to the Femoral Neck can --\> [Femoral head osteonecrosis] by damaging which artery
[**Medial** Femoral Circumflex] = perfuses Femoral Head & Neck
162
[Lateral Twisted Ankle sprain] is due to _________ and involves the ______ ligament
[Plantar flexed foot that's forcefully inverted]; [ANT TaloFibular ligament]
163
Which drug is used for [rapid sequence intubation] and how does it affect the body longterm?
[Succinylcholine = fast acting **depolarizing** neuromuscular blocker]--\> Phase 1 Neuromuscular blockade; Prolonged admin --\> Phase 2 Neuromuscular blockade
164
Which cytokine plays the biggest role in IBD? What is its role and how does it do this? (3)
IL**10**; ANTI-inflammation;
1. Inhibits TH1 cytokine release
2. [DEC MHC Class 2 expression]
3. [deactivates macrophages/dendritic cells]
165
Function of Enteropeptidase and where is it secreted?
Converts [inactive trypsinogen] --\> [ACTIVE TRYPSIN]; Secreted from Jejunum
166
Which nerve enables visceral umbilicus pain during appendicitis?
What causes pain to shift from umbilicus to McBurney point? (2)
[T10 Afferent Pain fibers]; Irritation of **Parietal peritoneum** & **Abd Wall** shifts pain to McBurney
167
Which diagnostic is best to screen for malabsorption DO?
Sudan 3 Stain (test stool for fat)
168
Which 2 vitamins can Breast milk not provide for newborns?
Vitamin D and K
169
Annular Pancreas MOD
abnormal migration of [Pancreatic **ventral** bud] --\> encircles the [descending 2ndpart duodenum] during 8th week gestation
170
Pancreas Di**v**isum MOD
**v**usion incompletion of Ventral & Dorsal pancreatic buds --\> Asx w/ no obstruction
171
Pancreatitis can cause blood clots in the ____ which affects the stomach how?
Pancreatitis can cause blood clots in the **splenic vein** --\> INC pressure in [short gastric fundal veins] --\> [short gastric fundal varices]
172
Identify
173
Which cytokines do TH1 produce to cause injury in Crohn's IBD (3)
IF-gamma / IL2 / TNFa
## Footnote
*Infliximab targets TNFa*
174
Imaging characteristics of Cholecystitis (4)
1. US Gallbladder wall thickening
2. US Pericholecystic fluid
3. Positive Sonographic Murphy sign
4. Failed gallbaldder visualization on radionuclide scan
175
Describe the Histo (2) and Identify the GI lesion
Villous Adenoma
[Long glands + Villi projections from the surface]
176
Describe the Histo (2) and Identify the GI lesion
[**Disorganized** glands] + [smooth m. & tissue]
Hamartomatous polyps
177
What is Courvoisier sign and what is it associated with?
[Palpable BUT NONTENDER Gallbladder] = Pancreatic CA
## Footnote
* will be accompanied w/obstructive jaundice + CA sx*
* smoking = biggest risk factor for Pancreatic CA*
178
Identify
179
Describe [SUP Mesenteric Artery] Syndrome
Occurs when [Transverse Duodenum] becomes trapped between the SMA and aorta due to [DEC in the aortomesenteric angle] --\> intestinal obstruction
180
What compounds are Absorbed EXCLUSIVELY in Duodenum only (4)
**MIC** + [Vitamin A]
181
What compounds are Absorbed EXCLUSIVELY in Jejunum only (6)
**TEAM W**ater + [Vitamin DEK]
182
Dietary Lipids are Digested in the _____ but absorbed in the _____. How does reabsorption occur?
Lipids = Digested in Duodenum; Absorbed in Jejunum
Bile from Duodenum forms water-soluble micelles around [fatty acids] which are **passively** absorbed into the [**Jejunum** brush border enterocyte].
[Fatty acids] are then reconstructed and combined with apoprotein --\> Chylomicron --\> intestinal lymphatics
183
What compounds are Absorbed EXCLUSIVELY in iLeum only (3)
184
[Lynch HNPCC Hereditary CA] MOD
Which genes are implicated (3)
DNA mismatch repair --\> microsatellite instability --\> CRC
[MSH2 & 6 / MLH1 / PMS2]
185
Name the key differentiating factors for CRC from **Ulcerative Colitis** (vs. Lynch/Sporadic) (3)
CRC from UC are like **MEN**!
1. Comes from [**N**ON-Polyp dysplastic lesions]
2. **M**ultifocal
3. [**E**ARLY p53 but LATE APC] --\> Higher Histological grade
186
Identify the Dz and describe its MOD
List 2 classic findings
Intussuception; Telescoping of proximal bowel into distal usually at iLeocecal junction; [Currant jelly stool + Bulls Eye US]
187
Anal fissures are ___ tears that come from ______. Where do they occur?
longitudinal; hard stools; [Distal to Dentate in the **Posterior** midline]
188
Identify
189
What do the Dorsal and Ventral Pancreatic buds each form?
Ventral = [Major pancreatic Duct of Wirsung], Uncinate, [posterior Head]
Dorsal = Everything Else
190
Which neonatal GI condition are Down syndrome pts most susceptible to? MOD? Name 2 other GI conditions
Umbilical Hernia;
Linea Alba defect --\>incomplete umbilical ring closure --\> [**Reducible** protrusion COVERED BY SKIN] that resolves spontaneously
*Omphalocele = herniation within a thin membranous sac*
Also susceptible to Duodenal Atresia, Hirschprung
191
Identify the key finding. What is this pt at risk of developing?
[Porcelain Gallbladder from Chronic Cholecystitis] --\>Gallbladder ADC
## Footnote
*Dystrophic intramural Ca+ deposition + chronic inflammation*
192
Where is the Ligament of Treitz
193
lithium toxicity (LMNOP) can be precipitated by what? (4)
1. Thiazides
2. ACE inhibitors
3. NSAIDs
4. Volume Depletion
194
Which drugs cause Agranulocytosis? (6)
**G**angs **CCC**rush **M**yeloblast & **P**romyelocytes
## Footnote
**G**anciclovir
**C**lozapine
**C**arbamazepine
**C**olchicine
**M**ethimazole(also Teratogenic--\>Cutis Aplasia)
**P**TU
195
Which 4 conditions is Buproprion contraindicated in?
1. **SEIZURES** hx
2. Anorexia
3. Bulimia
4. Panic DO
196
Out of the anti-convulsants (Carbamazepine, Valproate & Lamotrigine), which is used for Seizure **Px**
Valproate
## Footnote
*These are also used for Bipolar tx*
197
Why is Antidepressant **mono**therapy contraindicated in Bipolar or person who may have Bipolar
Antidepressant monotherapy can INDUCE MANIA in Bipolar vs. [Unrecognized Bipolar DO]
198
Difference between Avoidant DO and Schizoi**D** DO
Avoidant DO = avoidance only due to fears of rejection or criticism (pts don't want or like this)
vs.
SchizoiD DO = avoidance that these pts are perfectly content with
199
How do you differentiate [Bulimia Nervosa] from [Sjogren syndrome] (3)
Bulimia Nervosa will have
1. Abnormal Electrolytes
2. **INCREASED** Amylase and Lipase (Parotid swelling)
3. [Russell Dorsal Hand Calluses]
200
Common characteristics of Cocaine Withdrawal (3)
* SEVERE ACUTE DEPRESSION (CRASH)
* Hyperphagia
* Hypersomnia w/vivid dreams
201
Phencyclidine (AKA \_\_\_) is a __(*MOA*)\_\_\_ and main toxication sign is \_\_\_\_\_
PCP (Hallucinogen = [NMDA Glutamate Blocker])! ; [Vertical Nystagmus]
202
LSD main toxication sign is \_\_\_\_\_
Visual Hallucinations
203
Heroin main toxication sign is _____ (2)
1. Miosis
2. Respiratory Depression
204
What are the signs of Cocaine intoxication? - 3
1. MyDriasis (*Pupils Wide Open on coke!*)
2. Chest Pain
3. Seizures
205
What is the primary SE of [SSRI AND SNRI] and which drug is an appropriate alternative
Sexual dysfunction; replace with Buproprion
206
Describe [Atypical Depression] (3)
Which drug is best for this type of Depression?
1. Mood Reactivity (positive events brightens mood)
2. Leaden Paralysis (extremities feel "heavy")
3. Rejection Sensitivity (super sensitive to criticism)
**MAO inhibitors** = tx resistant and atypical depression
207
Damage to what lobe of the brain results in [Apathy and organization impairment]?
*R handed person*
**LEFT Frontal**
208
Damage to what lobe of the brain results in Disinhibition?
*R handed person*
**RIGHT Frontal**
209
Difference between Tourette and [Chronic Tic DO]
Tourette = [Motor **_AND_** Vocal Tics both] for GOE 1 year
210
Which Benzodiazepines have short half life but can't be used in Liver failure pts? Wh
Alprazolam & Clonazepam = intermediate] and [Triazolam & = short half life]
**CAN NOT USE IN LIVER FAILURE PTS** (they undergo hepatic metabolism) - LOT is preferred in liver failure pts [Lorazepam/Oxazepam/Temazepam]
211
Difference Between [Bulimia Nervosa] and Anorexia
pts with **[Bulimia Nervosa] will NOT show signs of malnutrition** because they still maintain body weight at or above minimal
212
Which function is dysfunctional in Xeroderma Pigmentosum and which enzyme is implicated
[Nucleotide Exicision Repair]; Endonuclease
## Footnote
*These pts have hyperpigmentation in sun exposed areas and INC risk for Skin SQC*
213
Explain how sun exposure causes skin DNA changes and how it's repaired
UVB forms Pyrimidine dimers
Endonuclease nicks the damaged strand on both sides of the Pyrimidine dimer --\> Excises it--\>
Replacement by DNA polymerase
214
Acanthosis Nigricans is mostly associated with ____ but can also be tied to \_\_\_\_\_
mostly Insulin Resistance!; Gastric ADC
215
Terbinafine MOA
[Squalene Epoxidase] inhibitor
216
Accessory Nipples MOD
Failed regression of mammary ridge during utero --\> Asx but sometimes tender (espeically during menses) mass in Teens
217
Which cells are responsible for the Type __ TB Skin Test reponse
Type **4**; [CD4, CD8, macrophages]
## Footnote
*CD4 & macrophages also keep TB in check with granuloma formation*
218
Typically, Type 1 Hypersensitivity involves IgE-mediated mast cell stimulation
Which compounds do NOT need IgE to stimulate [Type 1 Hypersensitivity mast cell degranulation]? (3)
1. Morphine (Opioids)
2. Radiocontrast
3. Vancomycin
219
Name the common causes of Erythema Multiforme (7)
"Only **CHAMPPS** can hit the Target!"
**C**ancer
**H**SV
**A**utoimmune
**M**ycoplasma Pneumoniae
**P**CN
**P**henytoin
**S**ulfa abx
220
What is [Osgood Schlatter Dz]
Repetitive Quadricep contractions --\> overuse injury of [2° ossification apophysis] of Tibial Tuberosity
## Footnote
*Presents as pain at the Tibial Tubercle*
221
The Piriformis muscle passes through the ____ foramen and functions to do what?
[Greater Sciatic Foramen] --\>can compress Sciatic n. if injured; External Hip rotation
222
In psychiatry, what is splitting? Which demographic is commonly seen in
Splitting people into either all good, or all bad; Borderline PD
223
For Bipolar **Mania** dx, you need at least [\_\_ sx +/- \_\_\_] that last for ___ duration. What are the sx? (7)
[3 sx +/- major depression]; 1 week duration;
**BIPOLAR**
**B**uying excessively (INC in pleasurable activity)
**I**nflated self-esteem
**P**sychomotor agitation (pacing)
wide aw**O**ke - won't sleep
**L**ots of Language (talking a lot)
**A**DD-like distractability
**R**acing thoughts & Ideas
224
Cocaine MOA and toxicity signs (4)
[Presynaptic Reuptake inhibitor] of **DNS** [Dopamine/NorEpi/Serotonin]
1. myDriasis responsive to light
2. Tachycardia
3. Agitation
4. Vasoconstriction --\> Myocardial ischemia (cp)
225
In Psychiatry, what is Displacement
Displacing feelings meant (but never given to) one person toward a "safer" person
226
In Psychiatry, what is Transference
Transfering unconscious emotions associated with a person in the past --\> person in present
## Footnote
*Pts abused as kids have difficult time seeking care in the future since they associate it with poor caretaking*
227
In Insomnia tx, what is Stimulus Control
Eliminating stimulating bedroom activities and only getting in bed when sleepy
## Footnote
*pt should leave bedroom if unable to fall asleep within 20 min*
228
Buspirone MOA, indication and primary cons (2)
Buspir**one** = [5HT**1**a agonist]; GAD; [slow onset] and [lacks muscle relaxant/anticonvulsant properties]
229
In Psychiatry, what is Projection
Projecting your unaccetable feelings of something onto someone else (as if they have the feelings) so u don't have to acknowledge ur own feelings
230
What is unique regarding frequency of Pheochromocytoma presentation
Sx may be Paroxysmal or Constant
## Footnote
*Sx can resolve on their own sometimes*
231
Ovarian vein thrombosis can extend to which vessels (L Ovarian vein vs. R Ovarian Vein)
[L Ovarian Vein] --\> [L Renal Vein]
[R Ovarin Vein] --\> IVC
232
List the peak times for
A: Glulisine/Aspart/Lispro
B: Regular insulin
C: NPH
D: Detemir
E: GLargine
233
Cinacalcet MOA
[Mimics Ca+] and allosterically sensitizes [Parathyroid CaSR] --\> DEC PTH
## Footnote
*Used for 1° or 2° HyperParathyroidism*
234
Describe the Histo for [Hashimoto Autoimmune hypOthyroid] (3)
1. [Hurthle Oncocytes] = pink cytoplasm from numerous mitochondria
2. [Mononuclear parenchymal infiltration] +
3. [Germinal centers]
235
[Primary Biliary Cirrhosis] MOD and marker
What other DO has similar findings?
Autoimmune Lymphocytic & **Granulomatous** destruction of intraHepatic AND interlobular Bile ducts
Marker = AntiMitochondrial Ab
*This is all similar to [Graft vs. Host Dz]*
236
What are the HLA associations for Type 1 DM (2)
HLA [DQ] and [DR3 & 4]
237
[INC ACTH + Hyperpigmentation] should make you suspicious for what dz
[Addison's 1° Adrenal Insufficiency]
238
What's the most serious complication of untreated Prolactinoma in women
Bone loss
239
The following histo from an Ovary likely indicates what dx?
Mature Teratoma
240
Describe how a female may end up with an indented uterus fundus
Incomplete lateral fusion of paramesonephric ducts --\> Bicornuate uterus (indented uterus fundus)
## Footnote
*Paramesonephreic ducts --\> Fallopian/Uterus/Cervix/Upper Vagina*
241
How does elevated Free Fatty acid contribute to Insulin resistance (2)
impairs [insulin-dependent] glucose uptake by Liver and INC liver gluconeogenesis
## Footnote
*Sedentary Lifestyle & Obesity can also do this*
242
Describe the Histo; Identify Dz
## Footnote
*sample come from Breast Mass*
[Fibrous myxoid stroma] that encircles [Glandular spaces]; Fibroadenoma
243
Describe the Histo; Identify Dz
## Footnote
*sample come from Breast Mass*
Cell proliferation surrounded by well preserved [Ductal basement membrane]; DCIS (Ductal Carcinoma In Situ)
244
Identify Dz and its MOD
## Footnote
*sample come from Breast Mass*
malignancy spreading from superficial DCIS --\> nipple skin w/out crossing basement membrane --\> Nipple Crust; [Paget Dz of Nipple]
245
What is an Imperforate Hymen and how does it present?
Incomplete degeneration of central fibrous tissue band connecting vaginal walls --\>
Teen with 1°Amenorrhea, **normal secondary sex characterisitcs** but cyclical pelvic pain due to menstrual blood accumulation (hematocolpos)
246
During pregnancy, a mother who experiences [Maternal Virlization] probably has a fetus & placenta with what defective enzyme? Explain
Aromatase! (not 21aH) - the fetus and placenta will both have Aromatase deficeincy
In 21aH, placenta aromatase is still functional --\> NO Maternal virilization during pregnancy
247
A: [Age related Macular Degeneration] MOD
B: Tx (2)
Retinal neovascularization from INC VEGF --\> [Grayish subretinal membrane +/- hemorrhage]
B: [VEGF inhibitors(*RaniBizumab*)] & Smoking cessation
248
A: Glaucoma MOD
B: Tx approaches (3) and how specifically does B-blockers work?
INC intraocular pressure from [INC production vs. DEC outflow of Aqueous humor]
B:B-Blockers --\> DEC Ciliary **Epithelium** Aqueous humor secretion!
*Topical Prostaglandins = latanoprost (open angle glaucoma)*
249
The testicles drain lymph into the ____ lymph nodes. Where do Glans Penis drain?
ParaAortic; Glans Penis--\> [**Deep** inguinal nodes]
250
Identify Dz and its MOD
[CLOSED angle Glaucoma]; INC intraocular pressure from DEC aqueous humor drainage
251
Describe how Granulomas are formed
[CD4+ T] secrete IF-gamma --\> activates macropages --\> macrophages secrete TNFa --\> further matures them and forms granuloma (walled off defense)
252
Common complications of Psoriasis (3)
1. Psoriatic Arthritis (**PAIR**) -[Dactylitis Sausage fingers/Pencil in Cup]
2. Nail pitting
3. Uveitis
253
\_\_\_ is the most common ocular childhood tumor. How does it present and what CA does it predispose them to?
**Retinoblastoma** (2 hit hypothesis); [Leukocoria White pupillary reflex] and may --\> OsteoSarcoma
## Footnote
* Unilateral = sporadic*
* Bilateral = familial (worst pgn)*
254
Dz
[Retinal pale whitening] + [Cherry Red Macula] = [**Central Retinal Artery Occlusion**] --\> Painless monocular blindness
255
Common characteristics of Down Syndrome pts - 7
the **SHEEPPS** of genetics
1. **S**kin excessive at nape of the neck = nuchal skin
2. **H**ypOtonia w/ ⬇︎ Startle Moro reflex
3. **E**picanthal folds
4. **E**ars that are small
5. **P**rotruding tongue w/flat face
6. **P**alpebral fissures are upslanted
7. **S**ingle palmar crease
256
In [Graft versus Host Dz] the transplant __ cells attack the Recipient. What are the manifestations? (4)
Which transplants are associated with GVHD? (2)
[Donor **T**cells] proliferate in immunoCOMPRO recipient;
1. Maculopapular Rash
2. Jaundice
3. Diarrhea
4. Hepatosplenomegaly
Bone Marrow & Liver
*Has similar Histo to Primary Biliary Cirrhosis*
257
How can Testicular CA or [Gestational Trophoblastic Dz] cause Hyperthyroidism
Both of these secrete a lot of HCG, which is structurally similar to TSH --\> INC T3/T4
258
Functions of TNFa (4)
**WECS**
**W**BC recruitment
**E**ndothelium activation --\> vascular leakage
**C**A Cachexia
**S**eptic shock
259
Significant SE of Nitroprusside and reversal tx (3)
Cyanide toxicity --\> seizures, bright red venous blood & lactic acidosis;
Antidote =
1. Hydroxocobalamin (directly binds)
2. Sodium Nitrite (induces methemoglobinemia)
3. Sodium ThioSulfate (Sulfur donor)
260
Which layers of the Throat are passed when doing a Cricothyrotomy? (3)
[Superficial Cervical fascia], [Pretracheal fascia] & [Cricothyroid membrane]
261
Prolonged exposure to loud noises prediposes to damage of what part of the ear
[Organ of Corti: stereociliated hair cells]
262
Classic triad for ASA toxicity ; What acid-base state will these pts be in? (2)
**ASA** --\> [Mixed Respiratory alkalosis + AG metabolic acidosis] (Normal pH/Low PCO2/Low HCO3)
## Footnote
[**A**ir is Fast (Tachypnea)]
[**S**ound ringing (Tinnitus)]
[**A**ir is Hot (Fever]
263
[Meniere TVS] Dz Sx Triad and MOD
[Meniere **TVS**]
INC endolymph volume in vestibular apparatus --\> **RECURRENT**
**T**innitus
**V**ertigo
[**S**ensorineural hearing loss]
264
What is a Cholesteatoma?
Squamous cell debris that form **pearly** masses behind tympanic membrane of middle ear
265
Which arteries anastomose at the [Kisselbach plexus] of the ANT nasal septum (3)
ANT Ethmoidal
Sphenopalatine
SUP labial
266
Sensation to the ear canal is NOT innervated by Vestibulocochlear n. What does innervate it? (2)
Vagus --\> POST External Auditory canal
[CN5: B3] --\> the rest
267
Which nerve is dangerously close to the inferior thyroid artery
[*RIGHT* **R**ecurrent Laryngeal n.]--\> [**R**aspy Vocal Cord Paralysis(same as L)]
268
**Cleft LIP** mechanism of formation.
**Cleft palate** mechanism of formation?
When does this occur
Cleft lip = [maxillary &
medial nasal processes (formation of 1° palate)] fail to fuse
Cleft palate— [the two lateral palatine shelves] vs. [lateral palatine shelf with median palatine shelf (or nasal septum) (formation of 2°
palate)] fail to fuse
5th-6th Week Embryo
269
MOA of Succinylcholine
ACh receptor agonist tht actually produces sustained depolarization and prevents
muscle contraction.
270
Describe Succinylcholine Phase 1 and its OD antidote
Phase I (prolonged depolarization)—**no antidote.** Block potentiated by cholinesterase inhibitors.
271
Describe Succinylcholine Phase 2 and its OD antidote
Phase 2 (repolarization finally starts but ACh R are still blocked since even tho they're available, they're desensitized)
antidote is cholinesterase inhibitors
272
How might a newborn suffering from Vitamin K deficiency present? (3)
*Impaired clotting factor carboxylation*
1. Intracranial hemorrhage
2. Bulging ANT Fontanelle
3. [Eyes driven downward & unable to track up]
273
Clinical Presentation of Fanconi Anemia (3)
1. Short stature
2. Absent Thumbs
3. INC CA Risk [Myelodysplastic syndrome and AML]
274
What is Fanconi Anemia
[Loss of DNA crosslink repair] --\> Inherited Aplastic Anemia
275
Describe Pancytopenia (3)
*Pan* cytopenia : **TAN**
**T**hrombocytopenia (petechiae, hemorrhage)
**A**nemia (fatigue, pallor)
**N**eutropenia (opportunistic infection)
276
What's the most important Pgn factor for [Bladder Urothelilal Transitional cell carcinoma]
Tumor Penetration into Bladder Wall
277
Chemotherapeutic (and toxic) effect of MTX can be overcome with what drug? Why does this help?
[Leucovorin THFolinic acid]; This is a reduced form of Folic Acid BUT doesn't require DHF reductase like Folic Acid
278
MTX Indications (7)
1. Brain Tumor - HIGH IV DOSES
2. Meningitis (carcinomatous vs. lymphomatous)
3. Leukemia
4. Lymphoma
5. Psoriasis
6. RA
7. Ectopic Pregnancy
279
[Tumor Lysis Syndrome] MOA and Clinical Presentation (4)
Develops during Chemo in CA with rapid turnover
HYPER**KUP** + [low Ca+]
1. HYPER**K**alemia
2. HYPER**U**ricemia (tx: Rasburicase vs. Allopurinol)
3. HYPER**P**hosphatemia
4. hypOcalcemia
280
The MDR1 gene codes for the _____, which is a \_\_\_\_\_
MDR1 gene codes for [**P-GlycoProtein Efflux Pump**], which is an transmembrane ATP-dependent protein that effluxes hydrophobic protein out of the cell --\> ChemoResistance
281
Hydroxyurea Indication (3)
* **Sickle Cell Anemia** (INC HbB Fetal synthesis)
* Rapidly DECREASES High [WBC Blast count] in pts with **AML** and [**Chronic Granulocytic Leukemia w/blast crisis**]
*Inhibits [Ribonucleotide Reductase] --\> inhibits [DNA thymine] synthesis*
282
Multiple Myeloma [Tx and its MOA]
**C**razy **A**ss **BUMP**
[Bortezomib Proteasome inhibitor] = Boronic acid-protein that inhibts breakdown of [Excess Proteins like (Monoclonal IgG)]--\>intracell accumulation --\> Plasma cell apoptosis
*Also tx for Mantle Cell Lymphoma*
283
Etoposide MOA
E*2*oposide: Topoisomerase *2* inhibitor --\> Double stranded DNA breaks
284
Etoposide Indication (3)
1. Testicular CA
2. Lymphoma
3. SOLC
285
Etoposide SE
Leukomogenic (Leukemia Promoter)
286
Function of Ristocetin
Activates [GP1B/2A Platelet R] --\>**INC availability** for vWF adherence
287
Elderly who've received intubation or dehydrated are at risk for [Acute Staph Aureus \_\_\_\_] Dx? (2)
Acute Staph Auerus **Parotitis**; [Amylase & imaging]
288
Difference between Reassortment & Recombination
Reassortment (ex. influenza) = reassortment of [viral genome **segments**] within a host cell infected with 2 viruses
vs.
Recombination = gene exchange via crossing over of 2 double-stranded DNA molecules
289
How does LOE (**L**PS **O**uterMembrane **E**ndotoxin) from [Gram negative bacteria] facilitate Gram negative sepsis
[**LOE** = LPS OuterMembrane Endotoxin]
LOE is _passively_ released from Gram neg bacteria. **LIPID A** is the toxic component of LOE and activates macrophages --\> IL1 and TNFa --\> Sepsis
290
Is Angioedema Hereditary or Acquired? What enzyme deficiency INC the risk of Angioedema and why?
BOTH!; [Low C1 esterase inhibitor] activity --\>INC bradykinin from the start --\> INC risk of acquired Angioedema
## Footnote
**ACEk2 inhibitors are contraindicated in these pts!**
291
Describe the Monospot EBV test
Heterophile Ab that react with [**Horse or Sheep** RBC = EBV +]
292
[C1 esterase inhibitor deficiency] MOD (2) and presentation
293
What is the major virulence factor for [Group A Strep Pyogenes] and what does it do? (3)
**M Protein**
## Footnote
1. Inhibits Phagocytosis
2. Inhibits Complement
3. Mediates Bacterial Adherence
294
Anaphylaxis (IgE) involves widespread mast & ___ degranulation. What is a specific marker for mast cell activation?
mast & **basophil** degranulation; Tryptase
## Footnote
*Histamine & Heparin are also released*
295
What is one of the more severe complications of [Reiters Reactive Arthritis]
SacroiLiitis
## Footnote
*Also: RRA can also cause skin rash on palms & soles!*
296
Formula for Drug Concentration
[Drug Dose (mg) / VD]
## Footnote
VD = Volume of Distribution (L)
297
*Presbyopia and skin wrinkles are [Age related changes] (along with Macular degeneration)*
Describe Presbyopia & how it's related to skin wrinkles
[Denaturated Lens Hardening] --\> DEC Lens elasticity--\>inability to thicken
(In skin: DEC collagen & elastin --\> wrinkles)
298
The following was obtained from a Liver biopsy. What's the Dx, MOD
[Alpha 1 Antitrypsin deficiency];
No [Alpha 1 antitrypsin] --\> INC [(macrophage tryptase)/(neutrophil elastase)] --\> [Panacinar emphysema from alveolar wall destruction]
**AND**
Liver Cirrhosis from accumulation of malfolded [Alpha1AntiTrypsin] (*seen in PAS+ image*)
299
Name MOD and key findings for [Patau Trisomy \_\_] (6)
[**P**atau Trisomy **13**]; Prechordal mesoderm fusion --\> midline defects
## Footnote
1. a**P**lasia cutis
2. holo**P**roscencephaly (incomplete separation of prosencephalon forebrain - cerebral hemispheres)
3. [Cleft **P**alate/Cleft Lip]
4. **P**olydactyly
5. [om**P**halocele umbilical hernia]
6. Rocker bottom feet
300
Describe [Acute Compartment Syndrome] and describe which vessels are impacted by
A: ANT Compartment (2)
B: Lateral (1)
C: Deep Posterior (3)
INC pressure within fascial compartments --\> DEC perfusion
301
Explain the purpose of adding Primaquine to a Chloroquine regimen
Targets the [Plasmodium Vivax & Ovale] [intrahepatic hypnoZoite stage] --\> **DEC Relapses** from these species
302
Difference in MOA between BetaLactams and Vancomycin
BetaLactams = bind to PBP (**SUCH AS TRANSPEPTIDASE**)--\> DEC peptidoglycan cell wall cross-link
vs.
Vancomycin = BINDS DIRECTLY TO [Terminal D-alanine glycoproteins **of cell wall itself**] prevents [PBP Transpeptidases] from ever binding
*Both bind irreversibly*
303
Difference in MOA between [Echinocandin (i.e. Caspofungin)] and Azole antifungals
Azoles inhibit fungal [Ergosterol **membrane** synthesis]
vs.
[Echinocandin (Caspofungin) inhibits fungal [**WALL** synthesis]
304
N. meningitidits, gonorrhea, Strep Pneumo and H.Flu all have **IgA Protease**. What is its function?
Cleaves IgA at hinge region --\> INC ability to bind to mucosal surfaces
305
Tx for [Gardnerella Bacterial Vaginosis] (2)
Metronidazole
Clindamycin
306
What's unique about the Herpes virus membrane envelope?
Although most enveloped viruses get their [lipid bilayer envelope from host plasma membrane], **Herpes family get theirs from host NUCLEAR membrane**
## Footnote
*Image showing HSV Tzanck Smear*
307
Describe how Acyclovir is activated (3)
[Herpesfamily Thymidine Kinase] MUST first monophosphorylate Acyclovir --\> intermediate --(host cell enzymes)--\> [Active Triphosphate form]
## Footnote
*Acyclovir = Guanosine analog*
308
Organisms that are Indole positive means what
Can convert Tryptophan --\> Indole
## Footnote
*(Ex. E.Coli & Pasteurella)*
309
[Cavernous Sinus Thrombosis] MOD and Presentation (3)
Infection of medial face sinuses or teeth spread thru facial venous --\> cavernous sinus
* [CN3 / 4 / CN5B1 and B2 / 6] ipsilateral involvement
* Proptosis
* HA
310
[Facial CN7] exits the ____ foramen and courses through the ____ gland. Tumors of this gland cause what n. manifestation?
Stylomastoid; Parotid; [Ipsilateral Facial Droop]
311
What are the 2 immune defenses for Candida Albican infection
Local = T Cells (*Reason HIV pts have local candida infections*)
vs.
Systemic = neutrophils
312
Describe a Gumma and its Demographic
Cutaneous [Painless indurated granulomatous white-gray rubbery lesions]; [**TERTIARY** syphillis]
313
Name the cases in which [INH **Mono**therapy] can and can not be given
NEVER for ACTIVE TB
but [INH Monotherapy] can be given to pts with [Positive PPD but NEGATIVE CXR (Latent TB)
314
What is the main source of immunity against Influenza
Humoral Ab against **Hemagglutinin** prevents reinfection
315
Name the 2 common organisms that cause [Osteomyelitis in Sickle cell pts]
Salmonella & Staph Aureus
## Footnote
*Sickle Cell = [Gluta**MATE** --\> Valine @ 6th position]*
316
What constitutes as a low Volume of Distribution and what drug characteristics cause this? (4)
low Vd = 3-5 L;
- Too much protein binding
- Too Hydrophilic
- Too Heavy (high molecular wt.)
- Too much charge
317
Describe the process of antigen presentation (starting with Ubiquitin ligases) (3)
Ubiquitin ligase recognize protein substrate and tags it --\> [tagged complex is degraded by proteosome & coupled with MHC1 in ER]--\>presented to CD8
## Footnote
*This process is impaired in Parkinson's & Alzheimer's*
318
Function of Northern, Southern, Western and Southwestern Blots
"**N**o **M**an **S**teals **D**rugs **W**ith **P**ride"
**N**orthern = **m**RNA detection: "Is gene being expressed?"
**S**outhern = **D**NA detection
**W**estern blots = **P**rotein detection
Southwestern = [DNA-bound Protein] detection
*All separated by size & charge on electrophoresis*
319
Nucleosomes are made of ______. How does [H1 Histone] associate with Nucleosomes?
Nucleosomes = DNA wrapped around core of 8 histone proteins (2 each of H2A/H2B/H3/H4).
[H1 histone] is outside nucleosome core & compacts nucleosomes by linking DNA between adjacent nucleosomes
320
During *continuous infusion*, 1st order kinetic drugs reach steady state in how many half lives?
[1st order kinetic drugs] reach steady state in **4** half lives
321
Telomerase Function and [Locations (2)]
[Reverse Transcriptase Ribonucleoprotein] that adds **TTAGGG** to [**3'** telomere region of chromosomes] --\> lengthens Stem cell telomeres; Bone marrow & [Epidermis Stratum Basale]
322
Which molecules recognize stop codons and terminate protein synthesis
Releasing Factors
## Footnote
(these release the polypeptide chain from ribosome & disolve ribosome-mRNA complex)
323
What do Homeobox genes encode for
**Transcription factors** important in segmental organization of embryo along cranio-caudal axis
324
[Ragged Red Fibers on muscle biopsy] indicates what type of DO
**Mitochondrial** DO! (passed by Moms)
325
How are thyroid DO associated with depression
hypOthyroidism ---\> Depression
326
What type of receptors contain Zinc-finger domains
**INTRA**cellular receptors (steroid/thyroid/fat-solbule vitamins)
327
When is [Anti-Rh (D) IgG] given to Rh- Moms
1st: 28 weeks gestation
2nd time: Immediately postpartum
328
Describe [JAK-STAT] and list which ligands use it (6)
[**Cytoplasmic** (*Not Receptor*) Tyrosine Kinase]. STAT enters nucleus --\> tx
**PIGG**L**ET**
**P**rolactin
**I**mmunomodulators (cytokines/IL)
**G**CSF
**G**H
**E**rythropoietin
**T**hrombopoietin
329
What 2nd messenger is used by [GPCR/cAMP pathway] and name the main hormones that use this (12)
PKA;
**FLAT ChAMP C**alls **G**irls **G**luttunous
1. **F**SH
2. **L**H
3. **A**CTH
4. **T**SH
5. **C**RH
6. **h**CG
7. **A**DH
8. **M**SH
9. **P**TH
10. **C**alcitonin
11. **G**HRH
12. **G**lucagon
330
Pts with a hx of _____ are at risk for inaccurate pregnancy dating. Maternal serum quadruple screen is for identifying \_\_\_\_
**Irregular menses**; **Congential Defects**
331
Glucose is typically transported into cells via _____ from high to low concentrations. GLUT transporters prefer what isomer of glucose?
[Facilitated carrier mediated Diffusion]; **D**-Glucose
332
Lab findings for Absent Seizures (2)
1. [3 Hz Spike EEG]
2. Slow wave EEG
333
Gold standard for TIA px and what's the MOA
ASA; COX inhibitor --\> DEC [Thromboxane A2] --\> DEC Platelet **aggregation** and **vasoconstriction**
334
Why is there actually an overall **DECREASE** in Mean Arterial pressure during exercise
Skeletal m. arterial Dilation from local [Adenosine/K+/Co2/lactate] ---\> [**DECREASE** overall systemic vascular resistance]
335
Characteristics for Carcinoid Syndrome (9)
336
How do ACEk2 inhibitors affect Bradykinin?
[ACEk2 inhbiitors] --\> **INCREASE** Bradykinin
## Footnote
*Kininase2 degrades Bradykinin*
337
Difference between Schizo**Affective** and Schizophrenia
Shizo**Affective** = [Psychosis occurs WITHOUT mood DO] but [Mood DO can only occur with Psychosis]
Schizophrenia has NO significant mood sx
338
Pathognomonic presentation for [Large PDA --\> Eisenmenger] (3)
[Clubbing hemipresent] + [Cyanosis hemipresent] + [**NO** BP or pulse discrepancy]
## Footnote
*hemipresent = present in LE but not UE = differential*
339
Hydralazine MOA and [SE (5)]
INC cGMP --\> selective arteriole vasoDilation
Reflex Tachycardia + **HALF**
**H**A
**A**ngina
**L**upus syndrome
**F**luid/Na+ retention
340
Cyanide poisoning MOD
Cyanide inhibits Fe3+ in the [mitochondrial cytochome c oxidase] --\> DEC O2 cell **consumption** --\> No change in Arterial O2 parameters but INC venous O2 content --\> DEC AV O2 gradient
341
Which artery perfuses the **inferior** **heart**
PDA
342
Tx for Carcinoid Syndrome Sx
Octreotide
343
How does Opioid analgesics affect the Biliary system
Opioids can contract [Sphincter of Oddi smooth m.] --\> INC pressure in common bile duct & gallbladder!
344
Explain how cells adere to Extracell Matrix starting with [ECM Collagen]
345
5a-reductase deficiency is ___(*mode of inheritance*)\_\_\_ and presents with what? (3)
auto recessive;
1. Feminized External genitalia (will masculinize @ puberty)
2. small phallus
3. hypOspadia
346
Adenosine [Indications (2)] and [major SE (3)]
Antiarrhythmic used for [PSVT and Chemical stress test] due to rapid 10 second half life
## Footnote
SE:
[Bronchospasm chest burn]
Flushing
High Grade BLOCK
347
Describe the Urease test used for H.Pylori Dx
[Pt Gastric mucosa] is added to [solution with pH indicator & urea].
If H.Pylori present, [bacterial urease] converts [Urea --\> CO2 + NH3] --\> INC pH --\> COLOR CHANGe
348
[VPL thalamus] receives input from ____(2).
[VPM thalamus] receives input from \_\_\_\_\_
Damage to these result in ____(*ipsilateral/contralateral*) sensory loss
[Dorsal column & Spinothalamic] --\> VPL
Trige**M**inal ---\> VP**M**
Damage --\> CONTRALATERAL sensory loss ( pure sensory stroke - Lacunar syndrome)
349
[**MAC** Mycobacterium Avium Complex] occurs in HIV+ pts with CD4 less than ___ and requires ____ px. List key characteristics (4)
50; Azithromycin
1. Hepatosplenomegaly
2. INC [ALP and lactate dehydrogenase]
3. Can grow at HIGH temperatures (i.e. 41 C )
4. [Fever/Wt loss / Diarrhea]
*MAC is Acid Fast*
350
Define Venous Capacitance
the **AMOUNT** of blood that can be held in the Veins
351
Ca+ sensing receptors are what type of receptors?
GPCR
352
Dynein is a microtubular motor protein used in ___ transport. Explain this directionality?
**RETRO**grade transport;
TOWARDS THE NUCLEUS! = Retrograde
353
Which Five **Catalase +** organisms are pts with [Chronic Granulomatous Dz] at risk for? (9)
"These cats [**N**eed **B**ig **PLACESS**] to kill"
1. **N**ocardia
2. **B**urkholderia
3. **P**seudomonas
4. **L**isteria
5. **A**spergillus
6. **C**andida
7. **E**.Coli
8. **S**erratia
9. **S**taph
354
What causes bruises to turn green several days after injury
Heme oxygenase converts heme --\> Bili**Verdin** (green color) --- (*BiliVerdin Reductase*) ---\> UnConjugated Bilirubin --\> Out into Blood
355
Terbutaline MOA and indication
B2 agonist that relaxes uterus and DEC contraction freq. during labor
356
What are the common areas of infection for HPV (3)
Cervix , Anus, [True Vocal Cords]
## Footnote
*HPV likes Stratified Squamous epithelium*
357
Why is Desmopressin used to treat [Von Willebrand Dz]
Desmopression stimulates endothelial release of vWF
358
Why do pts with Chronic hemolytic anemia (such as Sickle cell pts) develop folic acid deficiency?
Rapid INC RBC turnover --\> depletes folic acid --\> Macrocytic changes
359
Anesthetic [Blood Gas partition coefficient] is AKA \_\_\_\_
Anesthetic **Solubility**
## Footnote
*Image: Drug A has HIGHER Solubility (reason it takes longer)*
360
Name the factors that INC(2) and DEC(2) **TPR** on the [Cardiac & Vasulcar function Curve]
[Sympathetics / Vasopressors = INC TPR
vs.
Exercise /AV Shunt = DEC TPR
*REMEMBER THAT MEAN SYSTEMIC PRESSURE DOESN'T CHANGE*
361
Anaphylaxis would change what parameter of the [caridac output curve]
DEC **Venous Return** curve only
362
Name the factors that INC and DEC(3) **Venous Return** on the [Cardiac & Venous Return Curve]
[Fluid infusion = INC TPR]
vs.
[Spine anesthesia / Acute hemorrhage / Anaphylaxis] = DEC TPR
*REMEMBER THAT MEAN SYSTEMIC PRESSURE DOESN'T CHANGE*
363
[Drug-induced parkinsonism] is an EPS component caused by ____ blockers. ; What's the antidote for it?-4
D2 blockers;
1. Benztropine
2. Trihexyphenidyl
3. Propranolol
4. Lorazepam
364
Why would damage to the POST Pit only produce TRANSIENT DI
ADH & Oxytocin are **MADE** in the hypothalamic nuclei and just secreted from POST Pit. Axonal regeneration would rebuild POST Pit
## Footnote
*Only hypothalamic (paraventricular & supraoptic) n. damage --\> permanent DI*
365
Tx for [Maple Syrup Urine Dz] (2)
1. Lifelong restriction of "**I** **L**ove **V**ermont" = **I**soleucine/**L**eucine/**V**aline
2. Thiamine B1 *(a-ketoacid dehydrogenase needs Thiamine B1)*
366
How do macrophages play a role in atherosclerotic plaque stability?
inflammatory intraplaque macrophages secrete **Metalloproteinases** --\> Degrade [ECM collagen] --\> Plaque rupture
367
Which growth factors promote CA angiogenesis (4)
1. VEGF
2. [Fibroblast GF]
3. [IL1 and IL-gamma --\> INC VEGF]
368
Function of [2,3 BPG]
DECREASES Hgb O2 affinity (for unloading) by stabilizing the [Taut DeOxyHgB]
369
What is the major Cause of Death in **Acute** Rheumatic Fever
PANcarditis
## Footnote
*Mitral Stenosis develops later down the line*
370
What component of N.meningiditis actually causes the toxic effects
**LOE**
[**L**ipoOligoSaccharide **O**uterMembrane **E**ndotoxin]
371
Cirrhosis MOD for Asterixis neuro changes
Liver can't metabolize nitrogenous waste and cant convert to Urea --\>
## Footnote
1. NH3 crosses Blood Brain Barrier --\> [Astrocyte **Glutamine** & **GABA** Accumulation] --\> Disrupts neurotransmission
2. DEC BUN (since there's no Urea conversion)
372
How does the sympathetic NS respond to HF
INC Afterload from vasoconstriction --\> cardiac remodeling :-(
## Footnote
*Renin pathway will also be activated*
373
How does BNP respond to HF (2)
it helps!
BNP vasoDilates, stimulates diuresis --\> DEC BP
374
Describe Streak Ovaries and what demographic they're seen
Ovaries made of connective tissue with no follicles; Turner Syndrome
375
What is the difference between [Superior Vena Cava] and [Brachiocephalic vein] syndrome
Both have [Facial Edema] & [SubQ Vein engorgement]
**BUT [SUPERIOR VENA CAVA] SYNDROME WILL BE BILATERAL**
376
Homocystinuria MOD, Clinical presentation (3) and tx
[Cystathionine synthase] deficiency --\> Thromboembolism
1. Marfanoid habitus (elongated limbs, arachnodactyly, scoliosis)
2. Ectopia Lentis
3. Retarded
tx = [Pyridoxine B6]
377
What type of pulmonary manifestations are seen in pts with [Diffuse or CREST Scleroderma]
[Pulmonary arteriole intimal thickening] --\>Pulm HTN --\> Cor Pulmonale
## Footnote
*small arterioles & capillaries are affected first in this DO*
378
Explain why [R Testicular Varicoceles] typically indicate ____ or ____ dx
[Renal Vein Thrombosis with spread to IVC] vs. Renal CA; [R Testicular vein] dumps **directly** into IVC. If IVC is occluded --\> R Varicocele
## Footnote
* L Testicular Vein dumps into L renal vein*
* Renal Vein Thrombosis is a known complication of nephrOtic syndrome!*
379
SE for ACEk2 inhibitors (4)
1. DEC GFR
2. Hyperkalemia
3. Cough
4. Angioedema (rare)
380
How is [PRPP amidotransferase] related to Lesch Nyhan syndrome
Absence of HGPRT to ReConvert [**hypOxanthine**--\> inosine monophosphate] and [**Guanine** --\> Guanosine monophosphate] means INC degradation of these 2..-\> INC de novo purine synthesis involving [PRPP synthetase & amidotransferase]
381
What does this lymph node biopsy indicate?
Follicular Lyphoma (t18 \<----\>14 BCL2)
## Footnote
*[Anti-Apoptosis BCL2] overexpression*
382
Where does isotype switching occur
[2°Follicle Germinal Center]
## Footnote
*isotype switching = IgM --\> IgG*
383
Where does [VDJ/VJ Recombination] occur (2)
**Bone marrow** during B-cell maturation and then affinity maturation occurs in [2° follicle **germinal centers**]
384
Where does Negative selection/Tolerance occur?
Fetal Thymus: Medulla
## Footnote
*Positive occurs in [Fetal Thymus: Cortex]*
385
How does Acidemia affect the kidneys?
Tubular cells convert Glutamine --\> GlutamATE --\> [NH3(excreted) + HCO3(ReAbsorbed)]. This helps acidemia
386
Describe Delirum (4) and its tx
**Acute** confusion w/ agitation & possible psychosis
## Footnote
Tx = Haloperidol
387
Describe how Glucose stimulates Insulin release in Beta cells
388
Ammonia is made in the ___ from ____ and ____. How does GI Bleeds affect this?
Ammonia is made in the **GI tract** from [**Glutamine Catabolism**] and [**Bacterial** **Protein** **Catabolism**]. GI Bleeds allow more HgB to reach GI Tract --\> INC Ammonia Absorption into blood --\> Asterixis
389
How are Monosacchardies processed in the GI tract and role does the [D-xylose test] play in this?
Monosacchardies are absorbed directly w/ no need for amylases.
D-xylose = Differentiates between **pancreatic** insufficiency & physical malabsorption problem
390
Identify the Dz and describe the histo
**Candida**
Budding yeast w/[pseudohyphae germ tubes] (Germ Tube test @ 37 °C)
*MOST COMMON OPPORTUNISTIC FUNGI*
391
Amniocentesis showing [**INC** AChE & AFP] indicates \_\_\_\_
Neural Tube Defects
(Failure of Neural tube to fuse during 4th week gestation)
392
Identify and Note which part is involved in MVC
Rapid Deceleration while restrained/seatbelted (occurs in MVC) causes **Aortic Isthmus** to tear ---\> Aortic Rupture
393
[**Cromolyn** and **Nedocromil**] MOA
[**Mast Cell** Stabilizing agents] --\> Inhibit Mast cell degranulation indepedent of stimuli.
## Footnote
*BLOCKS **D** in image*
394
Chronic Granulomatous Dz MOD and Dx (2)
[NADHPH oxidase (normally reduces O2 --\> Superoxide ROS)] is deficient --\> [Cat +infection]
Dx:
1. [Nitroblue Tetrazolium] = absent dark blue precipitate
or
2. [DHR flow cytometry] = absent green fluorescence
395
What are the main factors that **INCREASE** HgB Affinity for O2 (4)
"**LAF** & [DEC **H2**]**O**"
1. DEC **H**+ and **H**igh Altitude
2. DEC **2**,3 BPG (2,3BPG **increases** at high altitude--\>DEC affinity)
3. c**O**ld temp (DEC temp)
**L**eftward shift/**A**ffinity INC/**F**etal HgB
396
What would [Chronic high-altitude adaptation] do to HgB O2 affinity
"**LAF** & [DEC **H2**]**O**"
[Chronic high altitude adaptation] --\> INC 2,3BPG --\> **DECREASES O2 HgB Affinity**
*Severe Anemia ALSO DEC O2 HgB Affinity*
397
[Pericardial fluid accumulation with late diastolic collapse of the R atrium] describes ____ and occurs why?
Cardiac Tamponade; when ventricles relax they displace pericardial fluid --\> collapses R atrium during diastole
398
Clinical findings for [Middle Cerebral Artery] occlusion
CTL [**Face (no forehead)**] & **UE** paralysis
## Footnote
+ [aphasia(if dominant hemisphere)] or [spatial Neglect (if Non-dominant hemisphere)]
399
Clinical findings for [Anterior Cerebral Artery] occlusion (unilateral vs. bilateral)
CTL **LE** paralysis
or
[Behavioral/Primitive Reflex/Urinary incontinence - if bilateral]
400
Severe Chronic Hemolytic Anemia (i.e. B-thalassemia) ---\> ______ hematopoiesis in the __ and ___. Seeing ____ precursors in these organs is a good sign.
Why does this happen?
Extramedullary Hematopoiesis in **Liver** & **Spleen**. [Clumps of Erythryoid Precursors in Liver & Spleen] is a good sign
EPO stimulates marrow cells to invade extramedullary organs if bone marrow isn't sufficient --\> Hepatosplenomegaly
401
2 most common bacterial isolates in intraabdominal infection
(B.Fragilis) & (E.Coli)
402
We all know Statins cause Muscle toxicity. What is another big SE?
**LIVER** toxicity
403
[Diffuse Esophageal Spasm] MOD
Loss of [MAP (Myenteric Auerbach Plexus) Inhbition] --\> Periodic, simultaneous and Non-peristaltic LARGE contractions
404
Hepatitis E
A: Enveloped? Double vs. Single strand?
B: Transmission
C: Virulence
A: **Naked** single-RNA
B: Fecal Oral
C: Fulminant Hepatits in Pregnant Women
405
406
Etiology for Gallstones made of **Calcium** (2)
Which enzyme plays the biggest role & how?
[Liver fluke Clonorchis Sinensis] vs. bacteria infect biliary tract --\> [**CUPS** (**C**a+: **U**nConjugated bilirubin **P**igment **S**tones]
[**Beta Glucuronidase** from injured hepatocytes] & Bacteria both hydrolyze bilirubin glucuronide --\> INC UnConjugated bilirubin --\> [**CUPS** (**C**a+: **U**nconjugated bilirubin **P**igment **S**tones]
407
What is Secondary Lactase deficiency
[Celiac inflammation] vs. [**Infection**] damage [small intestinal microvilli brush border] that carries lactase --\> Lactose intolerance
## Footnote
*1° Lactase deficiency occurs with age*
408
Genetic Cause of Neurofibromatosis Type 1
[chromo 17 mutation]--\> [NeurofibroMin loss]. NeurofibroMin tumor suppresses (RAS GTPase activating protein
409
Characteristics of Neurofibromatosis **Type 1** (6)
**CLAP** **ON** type 1!"
1. **N**eurofibroma PLEXIFORM
2. **A**coustic Schwannoma-Unilateral (HA/Tinnitus/Vertigo)
3. [**O**ptic n. Glioma]
4. **L**isch nodules
5. [**C**afe Au Lait Spots]
6. **P**heochromocytoma
410
Neurofibromatosis **Type 2** Genetic Cause
[chromo 22 tumor suppresor gene mutation--\> (Merlin cytoskeletal protein)]
411
In [Neurofibromatosis Type 1], Fleshy cutaneous neurofibromas are made of ______ which embryologically come from _____. These pts may also have hyperpigmented spots known as \_\_\_\_
In NF1, Fleshy cutaneous neurofibromas are made of **Schwann cells**, which are embryologically from **Neural _Crest_**. May also have [**Cafe Au Lait Spots** (*image*)]
## Footnote
*Image: Cutaneous Neurofibromas & Cafe Au Lait Spots*
412
Dz
**Constrictive Pericarditis** (Pericardial Calcification)
413
A: Explain how Wallerian Degeneration works in the PNS.
B: Why doesn't this work in the CNS?
C: What role do Astrocytes play
A: After axon damage, Schwann degrade myelin **distal** to injury and recruit macrophages to clear myelin debris --\> allows axon regeneration
B: IN CNS: macrophages are recuirted slowly due to BBB AND Oligodendrocytes undergo apoptosis --\> inhibits axon growth & allows persistent myelin debris to accumulate
C: Astrocytes proliferate weeks-months post injury and form glial scar --\> also blocks axon regeneration
414
Why are ESRD Renal Failure pts at risk for bleeding? What type of coagulopathy will they have? Labs?
**UREMIA** in ESRD --\> **_Qualitative_** Platelet dysfunction --\> **PRIMARY** Hemostasis DO --\> [ONLY INC BLEEDING TIME] (all other labs are normal)
415
Arsenic Poisoning Presentation(3), MOD and Tx
1. Garlic breath!
2. Prolonged QT
3. Watery Diarrhea
Arsenic inhibits pyruvate dehydrogenase --\> DEC Cellular respiration
Tx = Dimercaprol
416
B**L**ack Gallstone etiology (2)
1. Hemo**L**ysis Chronically--\> INC UnConjugated bilirubin --\> Ca+ bilirubinate precipitation--\> B**L**ACK [**CUPS**: **C**a+ **U**nConjugated bilirubin **P**igment **S**tones]
vs.
2. Can also come from iLeal Dz that --\> INC recycling of Bilirubin
417
Clinical signs for HyperCalcemia (3)
" **P**robably **M**ucho **C**a+! "
1. **M**uscle Weakness
2. **C**onstipation
3. **P**olyUria --\> Polydipsia
418
Which n. is associated with Piriform Recess damage and what is it responsible for?
**Internal** Laryngeal n.(CN10) = Cough Reflex
419
Describe the life cycle of Hepatitis **B** starting with entry
420
OLDER Pt with severe braydcardia is treated with Atropine but develops Severe Eye Pain. What happened?
Exacerbation of Closed angle Glaucoma!
## Footnote
**ATROPINE IS CX IN GLAUCOMA PTS**
421
Dz
[RSO-Reed Sternberg OwlEye] cells in **Hodgkin Lymphoma**
422
Describe [Bronchioalveolar ADC in situ]
Lung ADC subtype = [**dysplastic columnar** cells] which line alveolar septa and secrete **mucus** without invasion
423
Identify & Describe composition(2)
Benign Hamartoma (coin lesion on CXR!); [**Disorganized** Hyaline Cartilage + Fat]
424
A: Clinical Manifestations of **DiGeorge Syndrome** (5)
B: Genetic Cause
C: Embryologic cause
"**CATCh 22** & **P**a**3**"
## Footnote
**C**ardiac (*Tetralogy of Fallot +* *Aortic Arch abnormalitites*)
**A**bnormal face (Bifid Uvula/low set ears)
**T**hymus Aplasia (Thymic shadow in image) --\> Virus/Fungal infection
**C**left Palate
[**h**ypOcalcemia from PTH deficiency] *may*--\> *Carpopedal Spasms*
**22**q.11.2 deletion
**P**haryngeal arch - **3**rd/4th both fail to develop
425
Describe the DDx for [Polycythemia Erythrocytosis]
426
IF-\_\_\_ is important for mycobacterial infections. Explain how it helps to kill them
IF-**GAMMA**
427
Describe how Iron is Absorbed and stored
428
Which drug is used in Acute MI management but can also precipitate SOB in pts with COPD/asthma
[General B-blockers]
429
RA management centers around ____, which take ____ to onset. Name them (5)
***DMARDS** take **weeks** to onset*
1. MTX
2. Hydroxychloroquine
3. Sulfasalazine
4. Minocycline
5. TNFa inhibitors
430
In which cell does low O2 stimulate Glucose --\> pyruvate but maybe no ATP, and why?
**RBC**; 2-3BPG INC when O2 is low but the ATP generating step is bypassed in order to make 2,3BPG
431
Isolated Systolic HTN (Sys\>140 & Diastolic\<90)
Age-Related Stiffness of aorta & arteries
432
*Anatomically, During _Thorancentesis_ how would you access:*
A: [**Lungs & Visceral Pleura**] (3)
B: Which visceral structures are you attempting to *Avoid* by using these positions?? (2)
*image*
B:
1. **Abdominal** Structures
2. [***Sub*costal** **Neurovascular bundle**]
* Paravertebral = [POST Scapular]*
433
Describe [Acidophilic Councilman bodies] and when you'd see them
Hepatocytes that have shrunk, undergone nc.fragmentation and become eosinophilic. ; Indicates **Apoptosis**
434
Kidney Embryo: What does the [Metanephric mesoderm blastema] give rise to? [Ureteric Bud]?
[Metanephric Mesoderm blastema] --\> Internal Kidney structures
vs.
[Ureteric bud] --\> Collecting system (CD, Calyces, Pelvis, Ureters)
435
Which joints are involved in RA (5)
1. MCP & PIP
2. Wrist
3. Elbows
4. Knees
5. **Cervical** spine subluxation vs. cord compression
436
Sciatica MOD and Clinical Manifestation (3)
"Having Sciatica is like breaking **LAWS**"
* [**L**ower Back pain w/radiation down POST thigh --\> lateral foot]
* **A**nkle jerk reflex ABSENT - (*S1-S2 involvement*)
* **W**eak Hip Extension-(*S1-S2 involvement*)
* [**S**1 n. posterolateral compression between L4-S3]
437
Which artery perfuses the Broca and Wernicke area?
MCA
438
A completely opacified hemithorax with tracheal deviation toward the opacification suggest _____. Explain
**Mainstem Bronchus obstruction**; Obstruction allows air distal to it to remain there and once pulm blood absorbs all of it, everything squishes together (opacification) and trachea moves toward the vacuum
439
Steps for converting Tyrosine --\> Epinephrine (4)
440
Liver Dz Portacaval _Venous_ Anastomses used during:
## Footnote
**Esophageal Varices**
[L Gastric] with [Esophageal]
441
Liver Dz Portacaval _Venous_ Anastomses used during:
## Footnote
**Rectal Hemorrhoids**
[SUP Rectal] with [Mid & inf. rectal]
442
Liver Dz Portacaval _Venous_ Anastomses used during:
## Footnote
**Caput Medusae**
Paraumbilical with [Superficial & inf. epigastric]
443
[T or F] DIC (elevated D-Dimer and low Fibrinogen) is associated with HUS-HAT
**FALSE**
*only Unconjugated bilirubin & LDH will be INC*
444
Lung Biopsy
[**Sulfur Granules** - **Actinomyces** **Israelii**]
445
Cystic Fibrosis MOD
446
Describe [Ladd's Fibrous Bands]. What's their MOD
Bands connecting RLQ to Retroperitoneum --\> bilious emesis from duodenal compression;
**Incomplete counterclockwise rotation --\>midgut malrotation around SMA** --\> Volvulus and/or [Ladd's Fibrous Bands]
447
448
What is the most common cause of DIC in **Pregnant Women**
**Injured Placenta** can release [Tissue factor Thromboplastin] in mom --\> DEC platelet count from hyperactivation --\> DIC
449
Which Fungus
Candida (oval yeast w/**narrow** base budding)
450
Which Fungus
Histoplasma Capsulatum
451
A pt taking Clindamycin (abx) who suddenly develops Intractable Watery Diarrhea + Leukocytosis probably has what? MOD?
C.Diff; Toxin A (and B) both disrupt actin cytoskeletal structure & intracell signal in GI tract
## Footnote
*Contact Precautions = **G**erms **N**' **H**ospitals! = [**G**own/**N**onSterileGloves/**H**andWashing]*
452
Which DO is associated with [**KIT** Receptor Tyrosine Kinase] mutation? Describe its presentation
Mastocytosis; Mast cell proliferation --\> Excess Histamine release --\> [INC gastric acid] & [pruritus post hot shower]
453
What are the 2 watershed areas of the colon
[Splenic Flexure] and [Rectosigmoid Junction]
454
Which _mucous membranes_ are affected by [**OWR** - Osler Weber Rendu syndrome](4)
What's the worst complication?
Telangiectasias on...
1. Mucocutaneous (Lips, Skin)
2. GI
3. Respiratory
4. Urinary
**May rupture --\> Bleeds**
455
Clinical Presentation for [Type 1 Hypersensitivity IgE Mast cell response] (3)
**PUB**
**P**ruritus
**U**rticaria
**B**ronchospasm
456
Desrcribe the intracellular change AND clinical effect for each receptor
a1, a2, B1, B2
457
[Ehlers Danlos] MOD
Heritable Abnormal Collagen formation from [Procollagen Peptidase deficiency (impaired cleavage of N-terminal propeptides)] --\>abnormal collagen
458
[Mar**F**an Syndrome MOD].
Where is this protein found normally (3)
[**F**ibrillin1 defect (an extracellular scaffold for elastin)]
1. Lens
2. Periosteum
3. Aortic Media --\> Aortic Root Dilation --\> Dissection
459
DDx breakdown for Gram **negative** bacteria
460
SE for HCTZ and Chlorthalidone (6)
* Hyper**GLUC** (Glucose/Lipids/Uric/Ca+)
* [hypOkalemic metabolic alkalosis] (*Aldosterone mediated*)
* hypOnatremia
461
Describe the following
[Multinucleated Giant Cell] with epithelioid macrophages
This makes up a Granuloma
462
Sciatica MOD and Clinical Manifestation (3)
"Having Sciatica is like breaking **LAWS**"
* [**L**ower Back pain w/radiation down POST thigh --\> lateral foot]
* **A**nkle jerk reflex ABSENT - (*S1-S2 involvement*)
* **W**eak Hip Extension-(*S1-S2 involvement*)
* [**S**1 n. posterolateral compression between L4-S3]
463
What are Contact Precautions (3)?
When should you use them(4)?
**G**erms **N** **H**ospitals!
**G**own / **N**onSterileGloves / **H**andWashing
1. MRSA
2. C.Diff
3. VRE
4. Scabies
464
[Alcohol Hepatic Steatosis] MOD
[EtOH dehydrogenase] & [Acetealdehyde dehydrogenase] produces EXCESS NADH --\> [DEC Free Fatty Acid oxidation] --\> Fatty acummulation
465
Fill in the Blanks; Which is associated with [E.Coli Sepsis]
**GALT** deficiency --\> E.Coli Sepsis
466
Hepatic biopsy showing [**Spotty Necrosis** + Ballooning Degeneration] indicates \_\_\_\_\_
Acute Viral Hepatitis
467
What type of Hypersensitivity is [Seronegative Spondyloarthropathy *PAIR* HLA-B27]
Type 3 (Immune Complex deposition)
468
What causes AAA (3)
1. Transmural Aortic wall Inflammation
2. Abnormal collage remodeling
3. DEC Smooth m. & Elastin
All together --\> Wall weakening
469
Renal failure Azotemia with [Large Eosinophilic Cast] in an elderly with fatigue likely indicates \_\_\_\_\_
[Bence Jones Proteinuria] in **Multiple Myeloma**
470
Why do VSD sometimes present after a neonate has already been discharged?
Neonatal VSD (most common congenital heart defect) presents **AFTER** [pulm vascular resistance] has DEC
471
472
Why do pts with Sepsis have [INC Anion Gap] (2)
Tissue hypOperfusion DEC Oxidative phosphorylation --\> Forces Pyruvate to shunt into Lactate instead
+
Hepatic hypOperfusion --\> Lactic Acid accumulation since Liver normally clears lactate
473
What are the most common aspiration sites when Supine (2)
*Dense air space opacities*
474
What are the most common aspiration sites when Upright
*Dense air space opacities*
475
Pts with hypersensitivity to [intradermal tobacco injections] probably have ____. Describe Histo
[Buerger's Thromboangiitis Obliterans]; **Thrombosing Segmental Vasculitis** extending into contiguous veins & nerves
476
Neonate with Olive sized mass on deep palpation to RUQ indicates \_\_\_\_
Pyloric Stenosis from **muscularis mucosae hypertrophy**
477
CA **Activating** mutation of ____ can --\> constant EGFR pathway stimulation ---\> Resistance to Anti-EGFR drugs
KRAS
478
[Creutzfeldt Jakob Dz] MOD
PrP (prion protein), normally in neurons as [a-helical structure] converts--\> [**INFECTIOUS** **Beta pleated sheets**] --\> Protease resistance --\>
Vacuoles in [**Gray** Matter Neurons & Neutrophils] develop --\> Cyst = [**Spongiform** Gray Matter]
479
What is Transthyretin
(Heriditary vs. Senile) [Primary A**L** Amyloidosis] deposition
480
[Familial hypOcalciuric Hypercalcemia]
Defective Parathyroid CaSR (*Ca+ Sensing Receptors*) --\> **INC** PTH
481
[Thiamine B1] deficiency causes ____ and **BeriBeri**.
Describe BeriBeri (2)
What biochem rxn is [Thiamine B1] needed for?
[Wernicke Korsakoff Syndrome] and [BeriBeri]
**BeriBeri** (Wet vs. Dry vs. BOTH) is associated with...
1. Heart involvement = ***WET***
2. Symmetrical Peripheral Neuropathy = ***DRY***
[Thiamine B1] = Decarboxylation of a-ketoacids (carb metabolism)
482
What biochem rxn is [Ribo**F**lavin B2] needed for(2)? What sx are present with deficiency(3)?
*No Ribo**F**lavin--\>Problems with **F**lavor*
**F**MN & **F**AD; [Glossitis/ Angular Stomatitis / Normocytic Anemia]
483
What biochem rxn is [Niacin B3] used in
Hydrogen acceptor (NAD / NADH)
484
Which DNA Polymerase has exonuclease activity and what is the exonuclease function (2)
[DNA Pol **3**] = [3 ---\> 5 exonuclease activity] + [5--\>3 Polymerase]
&
[DNA Pol **1**]= [3 **\<\<---\>\>** 5 exonuclease acvitiy] + [5 ---\>3 Polymerase]
Exonuclease removes RNA primer and repairs DNA sequences
485
A: List the n. roots associated with Femoral n.
B: Associated Injury (2)
C: **Motor** Deficit (3)
**Femoral nerve**
A: L2-4
B: [Pelvic path involving iLiopsoas m.] vs. [Retroperitoneal path]
C:
1) [No Thigh Flexion]
2) [No Leg extension]
3) [Patellar Reflex loss]
486
In Pudendal n. blocks during labor, anesthesia is injected ____ medial to the _____ through the _____ ---\> ____ anesthesia
Anesthesia is injected **intravaginally** medial to **Ischial Spine** through the **Sarcospinous Ligament** = perineum anesthesia
487
Classic Presentation for [**R**enal **C**ell **C**arcinoma] (4)
RCC looks like **HAWF**!
[**H**ematuria PAINLESS (most common)] / [**A**bd Yellow Mass] / [**W**t loss] / [**F**lank Pain]
*L RCC in image*
488
Fibrates MOA (2)
What other drug has similar MOA
Activates **PPARa** --\> [INC LPL(TAG clearance)] AND [DEC Hepatic VLDL synthesis]
[Omega 3 Fish Oil] ALSO [DEC Hepatic VLDL synthesis] + [DEC apo B]
489
Glucagonoma Manifestation (4)
[**D**ermatitis (*necrolytic migratory erythema*)]
## Footnote
**D**epression
**D**VT
**D**M
*comes from pancreatic alpha cells*
490
Which CA cause [Osteo**Blastic Sclerotic**] Bone Metastasis (3)?Aggressive or indolent?
indolent
491
Which CA cause [Mixed] Bone Metastasis (2)?
492
Which CA cause [Osteo**Lytic Lucent**] Bone Metastasis (5)?Aggressive or indolent?
AGGRESSIVE
493
Multiple Myeloma Presentation (10)
**C**razy **A**ss **BUMP**
## Footnote
**CR**2**AB** - [Hyper**C**alcemia/(**R**enal damage from Bence Jones prOteinuria) & (**R**ouleaux RBC stacking)/**A**nemia/(**B**one Dark lytic lesions from IL6)]
**A**L amyloidosis
**B**ack pain
**U**rine IgG
[**M**ott cell histo-full of Russel bodies - *image*]
[**P**rotein M serum spike from monoclonal IgG]
494
Glioblastoma Histological Findings (5)
**CRE**E**PY**
- **C**ystic Change
- **R**eddish brown hemorrhage
- **E**ndothelial Cell Hyperplasia on *Histo*
- **P**seudopalisading Necrosis on *Histo - image*
- **Y**ellow necrosis
495
496
In [Wolff Parkinson White] an accessory AV conduction path can --\> ______. What is the sx triad
PSVT
497
Recall the [**PAm**: **P**I3K **A**KT **m**TOR] pathway starting with Growth factor receptor binding
498
Describe [Hairy Cell Leukemia] (6)
"*Hairy* **M**en **M**ake **D**icks **P**enis **T**otally **F**reakin **h**ard!"
1. **M**id Aged Men
2. **M**assive Splenomegaly
3. [**D**ry Tap from fibrosis 2° to (_B-lymphocyte_) infiltration & cytokines]
4. [**P**entostatin / 2CDA / Cladribine tx]
5. **T**RAP dx - replaced with... **F**low cytometry
6. **h**ypOcellular bone marrow (pancytopenia)
499
What is Chlordiazepoxide
Chlor**DIAZE**poxide (like **DIAZE**pam)
Benzo *(GABA - A allosteric modulator)*
500
POMC is a polypeptide precursor cleaved into what 3 substances?
1. ACTH
2. MSH
3. B-Endorphin
501
Explain difference between tumor **Stage** vs. **Grade**? Which is more important for Pgn?
**S**tage = **S**pread/expansion of Tumor = MOST IMPORTANT PGN FACTOR!
## Footnote
vs.
**G**rade = differentiation (anaplastic vs. well-differentiated)
502
Why are Nitrates contraindicated in HOCM pts (2)
HOCM pts have LV outflow obstruction so if you **DEC venous return** or **DEC total peripheral resistance** you will worsen amount of blood getting through
503
504
[Thin curvilinear areas of lucency that parallel bowel lumen] indicates ______, often seen in _______. Causes(2)?
**Pneumatosis Intestinalis**(air in bowel wall); **Necrotizing Enterocolitis**
Caused by Prematurity vs. [Enteral feeding initiation]
505
Starting with [Day 0 Fertilization], describe the process of Implantation (9 steps)
506
507
In which parts of the TCA cycle do you get ___(x)\_\_\_ and how many ATP do they give
A: NADH
B: GTP
C: FADH2
*Can I Keep Selling Sex For Money, Officer?*
## Footnote
A: NADH = 2.5 ATP each = (I-Keep) (Keep-Selling) (Money-Officer)
B: GTP = 1 ATP = (Selling - Sex) - **used in Gluconeogenesis by PEP Carboxykinase to convert Oxaloacetate--\>PEP**
C: FADH2 = 1.5 ATP each = (Sex - For)
508
[Maturity onset Diabetes of the Young] MOD
Glucokinase mutation in the beta cells
509
Which nerve is classically affected by [L Atrial Enlargement] and how does it manifest
[*LEFT* **R**ecurrent Laryngeal n.]--\> [**R**aspy Vocal Cord Paralysis(same as R)]
510
Which 2 bedside maneuvers **INC** **Intensity** of the HOCM mumur?
"***Val*** [***Stood Up**]* to Hulk HOCM, the MVP, which _INC_ anxiety"
Valsalva
[Standing Up]
(both DEC Preload **AND** Afterload)
511
Genetic cause for [Fragile X]
[CGG repeat] --\>[FMR1 gene Methylation] on [X Chromo long arm] --\>small gap near tip of [X Chromo long arm]
512
Huntington's Dz MOD
[AUTO DOM [Chromo 4 CAG repeats]] ---\> Degeneration of (Caudate nc. inside the ((**I**)ndirect Striatum) --\> [**DEC GABA**]
## Footnote
*"Hunting **4** food is way too aggressive & dancey"*
513
Huntington's Dz Clinical Presentation (2)
*"Hunting 4 food is way too **aggressive** & **dancey**"*
## Footnote
1st: **Aggressive** Dementia w/ strange behavior
2nd: **D****ance**-like Chorea mvmnts
514
Anatomically, what is the diff. between ulcers from [H.Pylori] and [Zollinger Ellison]?
[H.Pylori] = Antrum & **Proximal** Duodenum
vs.
Zollinger Ellison = **DISTAL** Duodenum
515
Vomiting is a reflex regulated by which receptors? (5)
**5** **D**ays of **H**aving **N**auseating **M**oomoo :-(
1. **5**HT3 (ondansentron tx) \*\*\*\*
2. **D**2
3. **H**1 Histamine
4. [**N**K1 Neurokinin 1] \*\*\*
5. **M**1 muscarinic
516
[Bruton X-linked aGammaglobulinemia] MOD.
What pathogens are these pts most susceptible to (2)?
[**B**ruton tyrosine kinase gene mutation] --\> failure of [CD**19** & **20** B cells] to mature --\> **NO B CELLS OR ANTIBODIES**
* Giardia Lamblia
* [Encapsulated Pyogenic bacteria - sinopulmonary]
517
In a pt with an elevated ALP, how can you determine whether or not it's bone origin and why?
Check **GGT**; GGT is found in Liver(just like ALP).. BUT NOT BONE, so if GGT also elevated --\> indicates Liver pathology
518
How long does it take kidneys to INC HCO3 during respiratory acidosis? How is Heroin related to this?
Kidneys need 24 hours to activate [HCO3 compensation] during respiratory pH changes; Heroin --\> cardiorespiratory depression --\>might present as [**Respiratory Acidosis w/normal HCO3**] if \<24 hours
519
Describe the process of Ca+ movement within the Sarcolemma starting with T-tubule
520
GI biopsy shows image. Identify cells and explain its association with appendicitis
**Neuroendocrine cells**(islands of uniform eosinophilic cells w/round nuclei) are in CARCINOID TUMORS
Appendiceal carcinoids may cause Appendcitis
521
CD15 is a marker for ____ and \_\_\_\_\_
Granulocytes & [Hodgkin RSO cells]
522
523
Label; Which rxn is associated with [Thiamine B1 deficiency]
RBC **Transketolase** requires [Thiamine B1]
524
Which step in the TCA cycle is [Thiamine B1] dependent and thus most affected by EtOH intoxication
*Can I Keep Selling Sex For Money, Officer?*
[**Keep - Selling**] (a-Ketogluarate --\>SuccinylCoA)
525
Amatoxins are in ____ and inhibit _____. This stops ____ synthesis
[**Death Cap** **mushrooms**]; RNA Pol2 --\> no mRNA synthesis
526
How is [Apolipoprotein E] related to Alzheimers
Apo E --\> impaired synthesis and clearance of AB-amyloid ---\> INC risk for **LATE** onset Alzheimers
527
What are the n. roots for Bicep/Brachioradialis Reflex? What motor functions are involved(2)?
528
What are the n. roots for Tricep Reflex? What motor functions are involved(2)?
529
What are the n. roots for Finber ABduction?
530
Which part of the EKG is affected by [Phase 0 Fast Na+ influx]
**QRS** (will be widened)
531
An anti-arrhtymic that extends [Phase 3 K+ efflux] will change what on EKG
**T Wave**
532
Name the Psoriasis drugs that are Topical Vitamin D analogs and why they help (3)
Calcipotriene / Calcitriol / Tacalcitol
## Footnote
*These bind to intranuclear Vitamin D R --\> Inhibits Keritinocyte proliferation & differentiation*
533
A: Common manifestations of **Sarcoidosis** (10)
B: Which demographic is most commonly affected
*CD4 TH1 mediated*
## Footnote
A: **LAR** **CUBED**
[**L**iver with scattered noncaseating granulomas around portal triad] + [**L**ymphadenopathy-*Bilateral Hilar*]
**A**CE elevation & [Asteroid vs. Schumann bodies]
**R**estrictive cardiomyopathy (RAMILIES)
**C**alcemia INC (hyperCalcemia)
**U**veitis
**B**ell's Palsy (Facial CN7)
**E**rythema Nodosum (*SubQ Fat lesions*)
**D**iffuse Intersitial Fibrosis (INC FEV1/FVC ratio)
B: AA Females
534
This Liver Biopsy indicates \_\_\_\_\_
Describe the MOD and it contraindications
**Cavernous Hemangioma**; MOST COMMON BENIGN LIVER TUMOR, made of cavernous blood filled vascular spaces
NO BIOPSY SINCE BIOPSY --\> FATAL HEMORRHAGE
*In Brain --\> Intracerebral Hemorrhage + Seizures*
535
List main functions of each hypOthalmic nuclei:
A: VentroMedial
B: ANT
C: POST
D: Lateral
A: VentroMedial = Satiety-Satisfied (full)
B: ANT = Lets Heat Go
C: [**P**OST = Keeps you **P**yogenic/warm]
D: [**L**ateral = **L**ots of food eating (INC Hunger)]
536
List main functions of each hypOthalmic nuclei:
A: Arcuate (3)
B: PVN (4)
C: SON (Supraoptic) (2)
D: SCN (Suprachiasmatic)
E: POA
A: Arcuate = GHRH & Dopamine(inhibits Prolactin) & GnRH
B: PVN = [AVP accessory], CRH, TRH, [AVP **Main**]
C: SON = [AVP **Main**] & Oxytocin
D: SCN = Circadian Rhythm
E: POA = [GnRH **Main**]
537
538
539
Describe the Difference between Gastric **Ulcer** and **Erosion**
Where are Gastric pits and glands in relation to this?
**U**lcers make a deep **U** all the way into Muscularis Propria
## Footnote
vs.
erosions are mucosa only (Pits are invaginations of mucosa that articulate glands in the laminal propria of mucosa)
540
[Carpal Tunnel Syndrome] MOD
BILATERAL Median n. Compression from the [Flexor Retinacular Transverse carpal ligament] --\> Peripheral **mono**neuropathy
## Footnote
*[Flexor Retinacular Transverse Carpal ligament] can be surgically incised for relief*
541
Purpose of the Smooth ER (2)
Where is it mostly found (3)
Steroid Synthesis & Drug Detox
Liver / Adrenal Cortex / Gonads
542
Mesothelioma Histology (3)
Cells with
[long slender microvilli]
[abundant tonofilaments]
[Pleural thickening]
543
Name the 3 mutations sites associated with **EARLY** Alzheimer
1. Trisomy 21
2. [Chromo 14 Presenilin 1]
3. [Chromo 1 Presenilin 2]
544
Name the MAOIs (4)
MAO **T**akes **P**ride **I**n **S**hanghai
**T**ranylcypromine
**P**henelzine
**I**socarboxazid
**S**elegiline (MAOB inhibitor)
545
Why does Iron supplementation --\> Enlarged RBC with **blue** cytoplasm
INC bone marrow erythropoiesis initially --\> accelerated release of [immature reticulocytes] which have blue cytoplasm from residual **ribosomal RNA**
546
What should make you suspect spinal metastasis? (4)
1. [Back Pain **WORST AT NIGHT** - not relieved with rest]
2. Older pt
3. Systemic Sx
4. [Hx of Infection or IV Drug use]
## Footnote
*lead kettle (PB KTL) - Prostate/Breast/Kidney/Thyroid/Lung = most common*
547
BRCA1 is responsible for _____ and most involved in what 2 CA?
DNA repair; Breast & Ovarian
548
A: Name the **COX 1** inhibitors (2)
B: What do they inhibit
C: Function of what they inhibit (3)
C: **SAR** [**S**tomach protection/**A**ggregating Platelets/**R**enal Perfusion INC]
549
A: Name the **COX 2** inhibitors (3)
B: What do they inhibit
C: Function of what they inhibit (5)
C: **VIPR** [**V**asoDilation/**I**nflammation-**P**ain/**R**enal Perfusion INC]
550
551
Describe the process by which Eosinophils attack parasites
[Ig**E** dependent cell mediated cytotoxicity]
552
Intestinal Atresia MOD
**SMA obstruction** during utero --\> [BlindEnd Proximal Jejunum], ABSENT BOWEL, and [terminal iLeum spiraled around iLeocolic vessel]
553
Most serious SE of Loop Diuretics (i.e.furosemide)
Ototoxicity
## Footnote
(especially in renal dz/rapid IV admin/other ototox agents/high doses)
554
What is [Brown Adipose tissue]
[Brown Adipocytes (1 cell with many fat vacuoles & many mitochondria)] = **produces heat** via [uncoupling oxidative phosphorylation] with thermogenin - in newborns/hibernating mammals
## Footnote
*White Adipoctyes only have 1 intracytoplasmic fat droplet*
555
Liver Angiosarcoma is associated with exposure to __(3)\_\_\_. What's the tumor marker?
[Vinyl Chloride / Arsenic / Thorotrast]
CD**31**
556
Milrinone MOA
Phosphodiester**A**se inhibitor --\> INC c**A**MP --\> [INC contracility AND Arteriole Dilation] in HF pts
557
[Nesiritide BNP] MOA (3)
BNP analog that INC cGMP --\>
1. Natriuresis
2. Arteriole Dilation (*DEC Afterload*)
3. Venous Dilation (*DEC preload*)
558
Oligohydraminos --\> ______. Describe this Sequence and Name the 3 most common causes of Oligohydraminos
Oligohydraminos --\> **POTTER** Sequence
**P**ulm hypOplasia
**O**ligohydraminos(cause)
[**T**wisted Face & Extremities]
**T**wisted Skin
**E**ars set low
**R**enal Failure
559
What is the main MOA for pregnancy prevention in OCP
Progestins negatively feeds back on ANT Pit --\> DEC FSH & LH
560
[Radial Head Subluxation Nursemaid's Elbow] MOD and Demographic
[Sudden Traction/Hand pull] on [outstretched and pronated arm] --\> **Annular Ligament** tear & subsequent displacement
Little kids
561
[Nucleotide Excision Repair] involves a *damaged* base
vs.
[Base Excision repair] which involves an *Altered(deaminated/alkylated/oxidated)*
**Describe [Base Excision Repair]**
562
*Identify*
563
*Identify*
*Remember:*
* *[R middle Lung lobe] is adjacent to [R **Atrium**]*
* *R side of Heart of CXR is [R **Atrium**]*
564
Glycolysis, Fatty Acid Synthesis and Pentose phosphate all occur in what part of the cell?
Cytosol
565
B-oxidation, TCA and Pyruvate Decarboxylation all occur in what part of the cell?
Mitochondria
566
[Toxic Shock Syndrome] MOD
[Staph TSS exotoxin] activates BOTH T-cells *(leading to IL2 release)* and [APC MHC2](*leading to Macrophage TNFa release*)
567
Pts with [Nausea from **Acute Migraines**] should have which nausea receptor blocked?
**5** **D**ays of **H**aving **N**auseating **M**oomoo :-(
D2 (central nausea)
568
Pts with [Nausea from **GI irritation (gastroenteritis/chemo/anesthesia)**] should have which nausea receptor blocked?
**5** **D**ays of **H**aving **N**auseating **M**oomoo :-(
5HT3
569
Pts with [Nausea from **Vestibular****/Motion Sickness**] should have which nausea receptor blocked?
**5** **D**ays of **H**aving **N**auseating **M**oomoo :-(
H1 vs. M1
570
Difference between [Rheumatic Fever] and [Infective Endocarditis]
R**F** = [**_F_**_ibrosis_ & **F**usion of valves(mitral\>aortic) and endocardium - Type 2 Hypersensitivity]
vs.
[Infective Endocarditis] = _Vegetations_ on valve cusps --\> destruction
571
HER2 is a ____ receptor
Tyrosine Kinase
572
[Allergic Atopic Asthma] is the most common and is treated with what 2 agents for acute relief?
1. Leukotriene blockers *( -lukast )*
2. M3 blockers ( *Ipratropium* )
573
The Red dot represents ____ which indicates what for lung volume? What is the intrapleural pressure at this point?
**FRC**; resting state where airway pressure = zero;
[At FRC, intrapleural pressure = -5]
574
*Vitamins A and D are both involved in epithelial regulation.* What's the difference?
Deficiency of which is liked to [Keratinizing squamous metaplasia]?
Vitamin A regulates [**SPECIALIZED** Columnar epithelia] and deficieny --\> [Keratinizing Squamous metaplasia] of...
1. Conjuntiva
2. Respiratory tract
3. Urinary Tract
4. Pancreatic ducts
575
Explain the uniqueness of second infection with Dengue fever
*Dengue has 4 serotypes*
1st time infected w/1 serotype = asx vs. self-limited
2nd time infected w/diff. serotype = **SEVERE** pancytopenia + Elevated Liver Enzymes
576
**Familial Chylomicronemia Syndrome**
Sx (5)
**H****HALX**
1. Acute Pancreatitis - *recurrent*
2. HyperTriGlyceridemia (especially Chylomicrons)--\>**creamy supernatant**
3. [Lipdemia Retinalis]= *milky retinal vasculature*
4. [**SKIN** Xanthomas- *eruptive= yellow erythematous papules on extensor surfaces*]
5. HepatoSplenomegaly
Familial HyperCholesterolemia would produce [*Tendon* Xanthomas and Xanthelasmas]
577
How are [PD1 and CTLA4 receptors] associated with CA
578
Somatomedin C is AKA \_\_\_\_
IGF1
579
Identify and describe the histology
[Contact Dermatitis Type 4 Hypersensitivity]; [Spongiosis (edema in the intercellular spaes of epidermis)
## Footnote
*CD = Weeping, Erythematous, papulovesicular*
580
Describe [Lipid PerOxidation]
Lipid degradation and H2O2 formation 2° to **Free Radical** damage --\> [Fatty change and necrosis] ; Carbon Tetrachloride
581
Name the Vitamins and Enzymes inhibited by Excess EtOH (2)
1. [Thiamine B1]
2. [Folate B9]
582
In [Acute Calculous Cholecystitis], describe how Gallstone obstruction **INITIATES** the dz (3)
[Cystic Duct Obstruction] --\>
1. INC hydrolysis of lecithins into LysoLecithins--\>
2. DEC mucus layer --\>allows Bile salt to irritate wall and cause Inflammation --\>
3. invasion by [**KE3 -** **K**leb/**E**.Coli / **E**nterococcus / **E**nterobacter]---\> Necrotic Gall bladder
583
Macrophage cell Marker
CD14
584
585
586
Describe [RNA Polymerase 1] (3)
587
Describe [RNA Polymerase 2] (3)
588
Describe [RNA Polymerase 3]
589
Name the mainstay Drugs for Staph Aureus (8)
i **L**ove **C**razy **C**razy **D**eranged **B**oys **N**' **TV**
1. **L**inezolid
2. **C**lindamycin
3. [**C**efTaroline 5° generation]
4. **D**aptomycin
5. [**B**actrim - *Skin Infection*]
6. [**N**afcillin - MSSA only]
7. **T**igecylcine
8. **V**ancomycin
590
What is the [Colon Adenoma --\> Carcinoma] Sequence (6)
**A**MC**K** - (DCC) - **53**
591
Describe Chiari Malformation **Type 2**
Type 2 is *TOO* BAD:
Congenital Underdevelopment of [POST fossa] --\> Cerebellum & Medulla herniation thru Foramen Magnum
Type **2** = SEVERE NEONATAL ONSET --\> [MEDULLA COMPRESSION--\>apnea] + [NON-COMMUNICATING HYDROCEPHALUS] + [LUMBAR MYELOMENINGOCELE]
592
Describe Friedreich Ataxia (8)
Fri**E**dreich is **Fratastic**! He's your fav., **twisted** **frat iHouse** brother, always **studdering** and **falling**, but has a **sweet**, **big heart**
Fri**E**dreich = [Vitamin **E** Deficiency] mimics it
**Fratastic** has 9 letters = [Chromo 9 Auto Recessive]
**twisted** = Kyphoscoliosis @ childhood
**frat** = [**frataxin** (**iron binding protein**) defect]
**iHouse** = [(iron binding protein) defect]
**studdering** = Dysarthria
**falling** = [Falls + Gait Ataxia + (Pes Cavus High Foot Arch)]
**sweet** = DM
**big heart** = Hypertrophic Cardiomyopathy
*Involves Degeneration of [Dorsal, Lateral CST & Spinocerebellar]*
593
Describe T-cell differentiation for TH1 and TH2
594
List the **Arterial** and **Venous**(3) supply for [ABOVE Pectinate Anus]
**Arterial**: [IMA: Sup Rectal]
**Venous**: [SUP Rectal] --\> [inf. mesenteric] --\> Portal
595
List the **Arterial**, **Venous**(5) and **Nerve** supply for [BELOW Pectinate Anus]
**Arterial**: [Internal Pudendal: inf rectal]
**Venous**: [inf rectal] --\> [Internal Pudendal] --\> [Internal iLiac] --\> [Common iLiac] --\> IVC
Nerve = [Pudendal: inf rectal]
596
MOD for [HFE mutation 1° Hemochromatosis]
HFE mutation --\> Liver & Enterocytes **falsely** detecting low iron --\> [1 and 2] --\> [Liver Cirrhosis & HCC] AND **BRONZED SKIN**
1. Liver DEC Hepcidin release ---\> [INC Ferroportin on Enterocytes basolaterally]--\>INC iron absorption
2. Enterocytes [INC Apical DMT1] --\> ALSO INC iron absorption
597
Why does Diastolic HF --\> Pulm HTN
598
[**ST Elevations**] or [**Q waves**] in these leads indicate **INFARCT** in which areas?
A: [V1 - V2]
B: [V3 - V4]
C: [V5 - V6]
D: [Lead 1 / aVL]
E: [Lead 2 / 3 / avF]
A: [(V1 - V2) = Anteroseptal - LAD]
B: [(V3 - V4) = Anteroapical - *distal* LAD]
C: [(V5 - V6) = AnteroLateral - LAD vs. LCX]
D: [Lead 1 / aVL] = [Lateral - LCX]
E: [Lead 2 / 3 / av**F**] = [In**F**erior - RCA] = R Vt
599
600
What is the [Cord Factor] in mycobacteria (3)
INC mycobacteria **Virulence** by enabling growth as [*Serpentine* Cords] --\>
## Footnote
1. inhibits neutrophils
2. destroys MITOchondria
3. releases TNFa
601
Classic Presentation for [Acute Viral Hepatitis (4)] and accompanying histo
1. RUQ TTP
2. Dark Urine
3. Fever
4. [Serum Sickness "like"(*CAUFF*) - Hep B]
Histo = Spotty Necrosis + Ballooning Degeneration
602
\_\_\_(3)\_\_\_ activate Guanylyl cyclase --\> what? What other drug has a similar end-goal?
Sildenafil has similar end-goal
603
What [**mini mental state exam**] do you use to test for:
1. Orientation
2. Comprehension
3. Concentration
4. Short term memory
5. Long Term memory
6. Language
7. Visual-Spatial
8. Executive Function
604
What are the 2 biggest RF for Esophageal **Squamous** carcinoma?
Alcohol and Cigarettes
## Footnote
*Fat / Barretts / GERD = Esophageal ADC*
605
List and Describe the 5 causes of CRC
606
Describe the [pH / HCO3 / O2 / CO2] during PE **\< 24 hours**
INC pH
Normal HCO3
low EE
607
Histology for [**Acute Neuronal Injury**] (AKA ___ \_\_\_\_\_) (4)
[**Acute Neuronal Injury** (AKA **RED NEURON**)]
* Cell Body Shrinks
* Nuclei Pyknosis
* Loss of Nissl substance
* Eosinophilic Cytoplasm
*THIS IS **IRREVERSIBLE** INJURY that eventually --\> Neuronal Degeneration!*
608
Histology for [Chromatolysis Axonal Rxn (Loss of Axon)] (4)
[Chromatolysis Axonal Rxn (Loss of Axon)]
* Cell Body ENLARGES
* Nucleolus ENLARGES
* Eccentric nucleus
* Dispersion of Nissl substance
609
What are the Neuroendocrine markers (3)
1. Chromogranin
2. Neuron-specific enolase
3. Synaptophysin
610
In [**R**enal **C**ell **C**arcinoma], what accumulation makes the cytoplasm clear? (2)
RCC looks like **HAWF**!
intracell Glycogen & Lipids
*L RCC in image*
611
What are the 7 P's of [Congenital hypOthyroidism Cretinism]
1. Poor Brain
2. Protruding Fontanelle
3. Puffy Face
4. Protuberant Tongue
5. Pot Belly
6. Protruding Umbilicus
7. [Can't **P**lank = hypOtonia]
## Footnote
*Usually Asx*
612
[Eczema Atopic Dermatitis] MOD and its associations (2)
**Type 1 Hypersensitivity** --\> skin inflammation triggered by environmental AND food antigens
associated with [allergic rhinitis] and asthma
613
Dz AND Describe the composition
[Signet Ring Gastric ADC]; **NON**-gland cells that ironically contain abundant Mucin & undergo [Stomach wall infiltration] --\> [Leathery Linitis plastica]
614
[Burkitt Lymphoma - EBV] is associated with ___ translocation and overexpression of ____. Describe the Histo (3)
[8 14]; c-MYC overexpression *(EBV INC B- cell proliferation--\>INC translocation risk)*
Histo = [Diffuse mid-sized lymphocytes with basophilic cytoplasm and high [Ki-67 fraction-proliferation index]
615
616
617
Which organisms cause [Liver Abscess via Biliary Tract ascension (4)]? Which cause [Liver Abscess via Hematogenous Seeding]?
[Biliary Tract ascension] = [**KE3** - **K**leb/**E**.Coli / **E**nterococcus /][**E**ntamoeba: **Colon--\>Portal Vein**]
Hematogenous = Staph A
618
What are the 2 best diagnositc labs for determining cause of [Metabolic ALKalosis]
[**Urine** Cl] and Volume Status
619
7 common causes of **Dilated Cardiomyopathy**
"the **PIG PAID** for Dilated Cardiomyopathy"
1. **P**ost Myocarditis from [Coxsackie B Enterovirus]
2. **A**lcoholic Cardiomyopathy from long term EtOH usage (direct toxicity vs. nutritional deficiency)
3. [**D**oxorubicin and Daunarubicin Chemotherapy]= dose-dependent
4. **P**eripartum - (late in pregnancy vs. 5 mo. post partum)
5. **G**enetic= affects cytoskeleton
6. **I**ron Overload: [Hereditary Hemochromatosis] or [Multiple Blood Transfusion Hemosiderosis] = Iron accumulates and interferes with metal-dependent enzyme system in myocytes
7. **I**diopathic
* MOST COMMON CARDIOMYOPATHY*
620
List the common causes of **Restrictive Cardiomyopathy** (8)
**RAMILIES**
1. **R**adiation Fibrosis
2. **A**myloidosis (heterogenous misfolded proteins)
3. **S**arcoidosis= [Noncaseating granuloma formation] in multiple organs 2º to [CD4 Helper T] attack on unidentified antigen
4. **M**etastatic Tumor
5. **I**nborn metabolism errors
6. **E**ndomyocardial fibrosis= Common in [African/Tropic children]
7. [**L**oeffler Endomyocardial fibrosis] = (Has [Peripheral blood eosinophilia and infiltrate])
8. **I**ron overload
621
[Fish oil Omega 3 FA] MOA (3)
1. [DEC **TAG** by DEC VLDL and apoB]
2. INC Gallbladder motility
3. INC Bile Acid synthesis --\> DEC Cholesterol saturation
622
Ribavirin MOA (4)
RIBA = **RIMA**
1. **R**NA polymerase inhbitor
2. **I**MPDH inhibitor --\> GTP depletion
3. **M**ethylation of RNA
4. **A**ctivates Immune system
623
Histo Description for VZV (2)
Multinucleated Giant Cells w/ Keratinocyte Intranuclear inclusions
624
Dermatitis Herpetiformis Histo
SubEpidermal blister with neutrophils in dermal papilla
625
Alzheimer's Dz etx (3)
Alzheimers MOD = **CHA**
\*\***C**leavage, **H**emorrhage, **A**Ch \*\*
1. **C**leavage of [transmembrane amyloid precursor glycoprotein] --\> Beta-**amyloid** which accumulates--\> [Neuritic Senile plaques] in temporal lobe early on.
2. **H**emorrhages Spontaneously occur in **Occipital/Parietal** lobes (*image*) from Beta-**amyloid** starting to deposit in cerebral vessels
3. **A**Ch ⬇︎ in the [Basal nc. of Meynert] & Hippocampus 2/2 B-amyloid accumulation causing defective [Choline Acetyltransferase] in those areas --\> Alzheimer Sx
626
How do we acquire Schistosomiasis
Freshwater **SNAILS** infected with larvae
627
Why do Myocardial cells swell during transient ischemia (2)
Na+ accumulation (DEC Na/K ATP pump)
and
Ca+ accumulation (DEC [Sarcoplasmic Reticulum Ca+ ATPase])
628
What vessels are found within the [HepatoDuodenal Ligament] and how is this associated with RUQ Bleeding?
Portal Triad; If Pringle maneuver does NOT stop RUQ Bleeding, then source of bleeding = IVC vs. Hepatic veins
629
ESR is a non-specific marker for ____. What specifically causes INC ESR
Inflammation; [IL1 / 6 / TNFa] --\> [Hepatic A*K*ute phase proteins]--\> INC **Fibrinogen** --\> INC ESR
630
Diveritculosis MOD
INC [Pulsion Pressure] from strained BM--\> [**Mucosa** & **SubMucosa**] herniation thru weak Muscularis = *FALSE* Diverticula
## Footnote
*This is similar to Zenker*
631
How are Blood transfusion related to hypOcalcemia?
[Giving GOE 6 L whole blood] can--\> [INC SERUM **CITRATE**(typically added to stored blood)]--\> Chelates Ca+ and Mg+ --\> hypOcalcemia --\> Paresthesia
632
Which 5 Drugs groups cause Osteoporosis?
**T**hese **C**oAg **C**anners **O**bliterate **S**pongyBoneTrabeculae
**T**hyroid meds
anti-**C**oagulants
anti-**C**onvulsants(Phenytoin)
\*\*\*\***O**meprazole\*\*\*\*
**S**teroids - exogenous
633
Patellar fractures inhibit ____ (*Flexion / Extension*) of the Knee against gravity
**EXTENSION**
634
\_\_\_\_\_ is the most common cause of both kid and Adult Acute Gastroenteritis. Transmission (2)?
Campylobacter Jejuni;
1. [Food: Contamined Poultry vs. Unpasteurized milk]
2. [Domestic Animals: Dog / Cow / Chicken / Sheep]
635
Formula for Bioavailability
636
A: Dystrophic calcifcation is the Hallmark of _____ (3)
B: What is Plasma Ca+ in this DO?
A: [**Dystrophic** calcification] is the HALLMARK OF
- CELL INJURY
- CELL DEATH and
- Necrosis
B: Plasma Ca+ will be _normal_
*This occurs naturally from aging*
637
Main SE for Nitrates (3)
1. HA
2. Flushing
3. hypOtension
638
Name the 2 opiate antidiarrheals
Loperamide & DiPhenOxylate
639
[Pure RBC Aplasia MOD] and dz's its associated with (3)
Failure of marrow to produce **only** [RBC precursor elements];
Parvo B19
Lymphocytic Leukemia
Thymoma
640
The Trapezius muscle is innervated by the _____, found in the _______. Manifestation of injury to this? (3)
**Spinal Accessory**; **POST Triangle**
1. Impaired ABduction past 90°
2. Shoulder Droop
3. Winged Scapula *(also caused by Serratus ANT)*
641
Clinical Manifestations for [Bells Palsy] (4)
Bells Palsy = Facial CN7 paralysis
Loss of **F** --\> Unilateral Paralysis
Loss of **A** --\> Hyperacusis
Loss of **C**--\> DEC Eye lacrimation (tearing)
Loss of **E** --\> Loss of **ANT 2/3 Tongue** Taste
**FACE**
1. **F**acial Muscles
2. **A**fferents(Somatic) from [Ear Pinna (Pain/Temp)] & [External Auditory Canal (stapedius m.)]
3. **C**ry: Parasympathetics to [Lacrimal/Salivary/Sublingual/Submandibular/]
4. **E**at: Taste from ANT 2/3 Tongue
642
Describe [Intestinal Angina]
Postprandial **epigastric** pain from [Chronic Mesenteric ischemia 2° to Atherosclerosis]
643
A: Histology for [**PNET - P**rimitive **N**euro**E**ctodermal **T**umors] (MeDulloblastoma)
B: Pgn
A: Sheets of [small, primitive blue cells] + [abundant mitotic figures]
B: POOR! (PNET tumors are undifferentiated and aggressive)
644
A: Histology for [Pilocytic Astrocytoma] (3)
B: Pgn
A:
Pilocytic Astrocytes (spindle cells with hair-like glial processes)
+
Rosenthal Fibers
+
[Cerebellar Vermis Cyst]
B: (Better than MeDulloblastoma since it is well-differentiated)
645
646
Identify
**LAD**
647
[Leukocyte Adhesion Deficiency Type 1] MOD
Absence of [CD18 integrin] --\> [No WBC Chemotaxis: *Tight Binding w/**ICAM1***] but with persistent leukocytosis --\> Mucocutaneous infections & [delayed umbilical cord separation]
648
What endothelial cell defect --\> No Neutrophil **Rolling**
[**L** vs. (E / P)] **Selectin** defect
## Footnote
*These can be upregulated by Cytokines and [Sia**L**yl selectin] is on the neutrophils*
649
What target organ does the M3 Receptor work in (6)
"[M1s need Brain], [M2s need Heart], [M3s BEGs for Private Lounges"
"M3's **BEGS** for **P**rivate **L**ounges"
**B**ladder(contraction) / **E**yes / **G**I / **S**kin / [**P**eripheral Vasculature] / **L**ungs
650
A: *Describe Histology* (3)
B: Dz
C: What's the primary leukocyte in the skin
A: image
-Solar Elastosis=Grayish-bluish color of the Dermis from sun damage
B: [Actinic Keratosis-*PreMalignant*]
C: Lymphocyte
651
A: *Describe Histology* (3)
B: Dz
A: image
B: Basal Cell Carcinoma
652
Identify
Malaria
653
Common causes of DIC (7)
**STOP** **M**aking **N**ew **T**hrombi
**S**epsis (gram-negative)
* *T**rauma
* *O**bstetric path
* *P**ancreatitis-Acute
* *M**alignancy
* *N**ephrOtic syndrome
* *T**ransfusion
654
What Pharyngeal functions are [Vagus CN10] responsible for? (4)
1. Uvula *(moves **away** from lesion in CN10 damage)*
2. _Epiglottic_ Taste
3. Swallowing
4. Soft palate elevation
655
Which direction does the jaw point in [Trigeminal CN5] damage?
jaw points **TOWARD** lesion (*since force from opposite pterygoid will be weak*)
656
Loop Diuretics SE (6)
**OH DANG**
## Footnote
**O**totoxicity
**h**ypOkalemia
**D**ehydration
**A**llergy
**N**ephritis (intersitial)
**G**out
657
What is the First sign of puberty in Males vs. Females
Males = Pubic Hair
Females = Breast Buds
658
**Sensitivity**
Formula(2) & meaning
659
**SPecificity**
Formula(2) & meaning
660
Recall the [2 x 2 Test vs. Disease] diagram
661
How many ATP are yielded in Aerobic vs. AnAerobic metabolism?
Aerobic = **32**
AnAerobic = [2 + Lactate]
662
Define [p-value] and its relation to Null hypothesis
[p-value] = Chance that study results happened randomly
[p-value] \< 0.05 means you can Reject Null hypothesis since it means there's lil chance the results happened randomly
663
Difference between [Type 1 alpha] and [Type 2 Beta] error
[Type 1 alpha] = u s**A**w a difference that doesn't exist (accepted **A**lternative hypothesis when you shouldn't have)
vs.
[Type 2 **B**eta] = **B**lind to the Truth (accepted Null hypothesis when in actuality there was an effect)
