Key Associations Flashcards

Question

Preload also called (2)

Answer 1

LVEDV- volume of blood in LV when FILLED LVEDP- pressure in LV when filled

Answer 2

CHRONIC MULTIPLE WORRIES, anxiety, tension

Answer 3

Th1 drives CMI- CD8 and macrophages Macrophages release IL12–> drives Th1 production Th1 secretes IL2- Activates B and NK cells, T cell growth factor IFN gamma- activates Th1 and suppresses Th2, activates more macrophages, express more MHC I and II TH1 CRITICAL FOR INTRACELLULAR PATHOGENS- esp for Tb and Listeria

Answer 4

Beta blockers- metoprolol Thiazides

Answer 5

RBCs with HEINZ BODIES- dark intracellular inclusions that stain with SUPRAVITAL STAIN. Represent Hb that is denatured/precipitated from oxidative stress S/s- intravascular and extravascular hemolysis with anemia, reticulocytes, indirect hyperbilirubinemia, low haptoglobin (dt removal of free Hb-haptoglobin complexes)

Answer 6

Asymptomatic mass in peds Associated with WT1 tumor suppressor on chrom 11 Arises from nephroblasts in kidney Abdominal mass that does not cross midline, HTN, hematuria Assoc with WAGR (Wilms tumor, aniridia, GU malformation, retardation (motor and intellectual)

Answer 7

Serous cystadenoma

Answer 8

Non selective beta blocker With alpha 1 inhibition Reduces AV conduction and inhibits alpha 1 receptors—> smooth muscle relaxation and vasodilation—> decreases SVR —> reduces preload and afterload AE- hypotension

Answer 9

Elevated sweat Cl levels Abnormal transepithelial potential difference

Answer 10

Drug B with no therapeutic action enhances therapeutic effect of drug A Carb idols and levodopa

Answer 11

Excess NaCl increases serum Cl to cause hyperchloremia Cl and bicarbonate are the only anions, increased Cl causes intracellular shunting of bicarbonate to maintain neutrality This “loss of bicarbonate” decreases blood pH Infused NaCl increases ECV, which kidneys respond to by increasing Na excretion—> increased urine Na

Answer 12

NADH and CO2

Answer 13

cAMP beta 2 stimulation —> INCREASED cAMP - peripheral vasodilation - bronchodilation

Answer 14

Rupture of bridging veins | Crescent shaped

Answer 15

Trabeculated part of LA and RA

Answer 16

Promotes Th1 development (cell mediated response) Macrophage secreted

Answer 17

Short acting vasodilator (ARTERIES AND VEINS) - lowers preload and after load Increases cGMP via direct release of NO Can cause cyanide toxicity

Answer 18

IP3 - when stimulated, increased IP3 activity—> peripheral vasoconstriction, urethral construction, pupillary dilation

Answer 19

Outer membrane LIPOPOLYSACCHARIDE- especially LIPID A component, highly toxic, triggers cytokines release

Answer 20

``` FSH LH ACTH TSH CRH hCG ADH V2 MSH PTH CALCITONIN HISTAMINE H2 GLUCAGON GnRH ```

Answer 21

Acetylcholinesterase inhibitor used for myasthenia gravis

Answer 22

Compulsive consumption of non nutritive/ non staple food source Common in pregnancy, often assoc with iron deficiency, nutritional deficiency MC- ice, dirt, raw starch (flour, cornstarch)

Answer 23

Preformed mediators (HISTAMINE) released by mast cells Deeper burns form blisters dt extravasation thru gaps between damaged venue endothelial cells

Answer 24

Transient bluish discoloration of vision Monocular vision loss- afferent pupillary defect, decreased visual acuity, optic disc ischemia

Answer 25

Acquire PIGA gene mutation in hematopoietic stem cells—> high complement mediated intravascular hemolysis (at night) PIGA mutation —> impaired GPI anchor synthesis for DAF/CD55 and CD59/MIRL (protect RBC membrane from complement) Coombs - hemolytic anemia, pancytopenia, thrombosis (BUDD CHIARI) Associated with APLASTIC ANEMIA, acute leukemia, pink/red urine in am CD55/59 - RBCs on flow Tx- ECULIZUMAB (targets terminal complement protein C5)

Answer 26

``` Carbamazepine Phenytoin Phenobarbital Rifampin St John’s Wort ``` Decreases warfarin effect, decrease in efficacy

Answer 27

Idarucizumab Dabigatran is direct inhibitor of thrombin—> oral anticoagulant for stroke and VTE prophylaxis Thrombin catalyzes conversion of fibrinogen to fibrin in final step of coagulation cascade

Answer 28

Asymptomatic mass in peds Associated with WT1 tumor suppressor on chrom 11 Arises from nephroblasts in kidney Abdominal mass that does not cross midline, HTN, hematuria Assoc with WAGR (Wilms tumor, aniridia, GU malformation, retardation (motor and intellectual)

Answer 29

Depression with suicidal ideation, fatigue, hypersomnia, hyperphagia, vivid dreams

Answer 30

Macrophage marker BINDS LPS (in plasma) Once bound—> IL1, IL6,IL8, TNF released

Answer 31

Nonmalignant liver lesion that occurs in YOUNG WOMEN Lesions appear as small, solitary, PALE NODULES composed of cords of normal Appearing hepatocytes and a CENTRAL STELLATE SCAR with fibrous septal that surround abnormally large hepatic arterial branches Usually asymptomatic and incidental finding

Answer 32

Block conversion of angiotensin I to angiotensin II—> results in DECREASED aldosterone release and decreased NaK ATPase and Na channel activity in distal segments - lowers Na - increases K - no effect on phos

Answer 33

S aureus exfoliative toxin—> EXFOLATIN Exfolatin destroys keratinocytes attachments Cleaves DESMOGLEIN 1 complex - Desmosome protein - links keratinocytes together Affects STRATUM GRANULOSUM (intra epidermal)

Answer 34

Genetic cancer syndrome, AD Multiple benign, malignancies VHL tumor suppressor deletion on CHROMOSOME 3 - normally, VHL protein binds HYPOXIA INDUCIBLE FACTOR and tags it for ubiqutination—> post translational modification—> adds ubiquitin to proteins to be degraded in proteasome In VHL, ubiquitination will not occur—> cells will behave as if they are hypoxic—> blood vessel growth MULTIPLE HEMANGIOBLASTOMAS - occurs in cerebellum, spinal cord, retina RENAL CELL CARCINOMAS (bilateral) PHEOCHROMOCYTOMAS VHL needs 2 hits to devo malignancy—> similar to retinoblastoma, Li Fraumeni, FAP

Answer 35

Impaired detrusor contractility, bladder outlet obstruction Incomplete emptying and persistent involuntary dribbling PVR HIGH

Answer 36

I- PKs, PDs, safety profile in small number of people II- drug efficacy in small number of people III- safety and efficacy of new treatment compared to standard IV- adverse effects over time

Answer 37

1. INCREASED LVED pressure- decreased CO 2. INCREASED RA pressure- RAP represents central venous pressure and elevation is indicative of volume overload and possible RHF. RHF MC occurs dt LHF

Answer 38

CD3, CD4, CD25, FOXP3 identification markers Produce anti inflamm- IL10 aND TGFb

Answer 39

Third pharyngeal arch

Answer 40

GPCR—> adenylyl cyclase converts ATP to cAMP—> cAMP activates protein kinase A

Answer 41

Ground glass hepatocytes and central balloon degeneration

Answer 42

DES exposure in utero

Answer 43

SERM DOES NOT INCREASE RISK OF ENDOMETRIAL CANCER Agonist effects on bone Antagonist effects on uterine and breast tissue

Answer 44

Anxiety restricted to social and performance situation FEAR OF SCRUTINY and embarrassment

Answer 45

RCA Inferior infarction can lead to rupture of PM papillary muscle - severe MR - acute HF

Answer 46

Chemo agent Disrupts purine salvage pathway and de novo synthesis Mimics hypoxanthine (IMP) and guanine (GMP) —> added to PRPP creates thioinosinic acid LESS IMP/AMP/GMP CAUTION WITH ALLOPURINOL- may boost 6MP effects and toxicity

Answer 47

Cytotoxic T cells | Kill viral infected cells and tumor cells

Answer 48

Restriction of diastolic filling of the right heart, with engorgement and decreased inspiration collapse of IVC PULSUS PARADOXUS (>10mmHg drop in SBP during inspiration Electrical alternans on EKG Equal diastolic filling pressures in all 4 chambers —> chambers cannot relax Becks triad- hypotension, JVD, distant heart sounds

Answer 49

Transcription factor Burkitt lymphoma

Answer 50

Jaundiced, elevated liver enzymes, elevated HBsAg and anti HBc IgG indicates chronic active hepatitis B infection Histology: dense lymphocytic inflammation, piecemeal (peripheral) necrosis, GROUND GLASS HEPATOCYTES (granular eosinophilic cytoplasm)

Answer 51

Inhibit dihydropteroate synthase —> inhibits folate synthesis Resistance- altered enzyme, decreased uptake, high PABA synthesis VERY HIGH AMOUNT OF HSRs and hemolysis in G6PD

Answer 52

Located between left kidney and spleen Contains tail of pancreas and splenic artery (branch of celiac trunk)

Answer 53

Collections of squamous cell debris that form pearly mass behind tympanic membrane in middle ear Can be congenital or acquired (following infection, trauma, surgery of middle ear) Can cause hearing loss dt erosion into auditory ossicles

Answer 54

Dt mixing of deoxygenated blood with oxygenated blood from pulmonary veins Deoxygenated blood comes from: 1. The bronchial arteries carry blood to the bronchi and bronchioles and, together with the pulmonary artery, form the dual blood supply to the lungs. The bronchial veins return only a portion of this blood to the right heart via azygous/hemi azygous; most of the blood supplied by the bronchial arteries returns to the left heart via pulmonary veins 2. Small cardiac (thebesian) veins that drain into the LA and ventricle contribute to normal anatomic shunting

Answer 55

1. BRAF mutation - proto oncogene - triggers cell proliferation with RAS activation - V600E mutation—> treatable with BRAF inhibitors (VEMURAFENIB, DABRAFENIB)

Answer 56

X LINKED RECESSIVE Same as Hemophilia A

Answer 57

Multiple peripheral sites Non contiguous spread Extranodal involvement- gi (thickened bowel wall), skin WALDEYERS RING- lymphoid tissue in pharynx, enlargement of Waldeyers ring common in non Hodgkin lymphoma, NOT Hodgkin lymphoma

Answer 58

BNP ANP EDRF (NO)

Answer 59

The binding of programmed cell death protein PD1 to one of its ligands PDL1 Dow regulates the immune response by inhibiting cytotoxic T cells Many cancers evade immunodetection by increasing expression of PDL1 on their surface. Mab against PD1 upregulate the T cell response and promote tumor apoptosis PD1 mab- pembrolizumab, nivolumab PDL1 mab- atezolizumab

Answer 60

Ascending tract Senses pressure, vibration, fine touch, PROPRIOCEPTION Decussates at medulla

Answer 61

Multiple blood transfusions or hereditary HFE mutation (can result in HF, bronze diabetes, and high risk HCC)

Answer 62

One set of maternal DNA and 2 sets of paternal DNA—> 69XXY Trophoblastic proliferation is limited Normal uterine size, slight elevation in hCG, PRESENCE OF FETAL TISSUE, partial hydronic degeneration Less likely to transform to choriocarcinoma

Answer 63

DNA repair genes Breast Ovarian Pancreatic cancers

Answer 64

Gentamicin, tobramycin Bind 30S ribosomal subunit and inhibit protein synthesis RISK OF ACUTE KIDNEY INJURY - acute tubular necrosis (focal tubular epithelial necrosis with granular casts that obstruct tubular lumen and lead to rupture of basement membrane) - electrolyte wasting, Franconia syndrome, loss of concentrating capacity with polyuria Mild proteinuria with granular or hyaline casts

Answer 65

[steady state]x(clearance/F)

Answer 66

Calcineurin inhibitor Blocks T cell activation by PREVENTING TRANSCRIPTION OF IL2 AE- NEPHROTOXIC (vasoconstricts afferent and efferent, GINGIVAL HYPERPLASIA, HIRSUTISM Treat secondary HTN with DILTIAZEM

Answer 67

Associated with smoking, grows rapidly, disseminates early Located CENTRALLY, along bronchial airways, GREY TAN WHITE MASS Tumor composed of small round or polygonal cells and associated with MYCL oncogene Small cell lung cancer can mimic lymphoma therefore MUST ensure tumor DOES NOT STAIN FOR LEUKOCYTE COMMON ANTIGEN (LCA) - can exhibit crush cell artifact Tumor derived from bronchial NEUROENDOCRINE CELLS IHC: NSE and CHROMAGRANIN confirm neuroendocrine origin. Cytokeratin confirms epithelial cell differentiation Paraneoplastic syndromes- SIADH, ACTH secretion

Answer 68

Destruction of airspace walls creates enlarged cystic spaces in place of normal lung tissue Functional consequences of tissue loss: - decreased elastic recoil—> increased lung compliance. TLC increases and patients may develop barrel chest - decreased mechanical tethering of airways-> airway collapse and air trapping, which increases RV - airway collapse and obstruction reduces FEV1, FEV1/FVC ratio - decreased alveolar surface area—> decreased gas exchange. Manifests as a reduced lung diffusing capacity for carbon dioxide (DLCO) When emphysema predominates, patients tend to hyperventilate and use accessory muscles, giving a pink complexion (pink puffer)

Answer 69

Bisphosphonates - irritate GI lining - contraindicated in patients with GI motility disorders (achalasia) - other side effects include osteonecrosis of jaw, femur fx, hypocalcemia

Answer 70

Associated with esophageal malignancy abs produces symptoms of solid and liquid dysphagia, regurgitation, chest pain, weight loss Findings on manometry include elevated LES pressure and absence of peristalsis Pseudoachalasia can be differentiated from achalasia by duration and progression of symptoms (pseudoachalasia more rapid than achalasia), asymmetrical esophageal wall thickening, inability to pass endoscope thru LES, presence of enlarged supraclavicular LNs

Answer 71

Hereditary peripheral neuropathy caused by mutations in genes coding for peripheral nerve axonal or myelin proteins Present in adolescence with progressive, symmetric distal muscle atrophy and weakness ANKLE SPRAINS, difficulty with exercise Muscle wasting in distal LE, sensory loss, areflexia, PES CAVUS (high arch), hammer toes

Answer 72

Increase in PaCO2 - stimulates central chemoreceptors and triggers increased ventilation

Answer 73

Lectin pattern recognition receptor binding Host pattern recognition receptors bind to carbohydrates that are produced only by pathogens. Binding generates cleavage of C4 and C2 to C3 without C1

Answer 74

Abundance of follicles on LN bx CD19 and CD20 + t(14;18)—> overexpression of BCL2, blocks apoptosis, uncontrolled B cell growth - germinal center B cells usually lack BCL2–> when overexpressed—> uncontrolled B cell growth Older patients (65yo) Usually indolent course, CAN CONVERT TO DIFFUSE LARGE B CELL LYMPHOMA (DLBCL)—> poor prognosis

Answer 75

Inhibits arabinosyl transferase May cause optic neuropathy

Answer 76

Pulmonary HTN drug Endothelin receptor anatagonist Competitively antagonizes endothelin1 receptors—> lowered pulmonary vascular resistance AE: hepatotoxic

Answer 77

Patches, plaques, tumors Varying size, shape Indolent “Bathing trunk” distribution Dx: skin bx with lymphoid cells, ATYPICAL LYMPHOCYTES WITH CEREBRIFORM NUCLEI AND PAUTRIER MICROABSCESSES (epidermal aggregates)

Answer 78

1. Cat scratch disease - low fever, tender, proximal regional LAD, self limited 2. Bacillary angiomatosis - immunocompromised pts. Red purple papular lesions, can be found in viscera, can be fatal if not treated 3. Culture negative endocarditis

Answer 79

Vasodilator VEINS - reduces PRELOAD Vasodilates by increased NO in vascular smooth muscle—> increase cGMP and smooth muscle relaxation CONTRAINDICATED IN RV MI, HYPERTROPHIC CARDIOMYOPATHY, concurrent PDE5 inhibitor use Give with beta blocker to avoid reflex tachy, associated with Monday disease (tolerance during the week, washout during weekend, HA, tachycardia, dizzy upon re exposure)

Answer 80

Rate hereditary dx Inflammatory disease, recurrent episodes of fever and inflammatory pain Involves NEUTROPHILS Serosal inflammation- abd pain, pericarditis Secondary (AA) amyloidosis MAJOR CAUSE OF DEATH tx w COLCHICINE (inhibits neutrophils)

Answer 81

Reversible alpha blocker Given to pts on MAOi who eat tyramine rich food and for severe cocaine induced HTN AE- orthostatic hypotension, reflex tachycardia

Answer 82

Myeloblast malignancy Adult males S/s- bone marrow suppression - myeloblasts accumulate in marrow, suppress cell growth - anemia, fatigue, weakness, pallor - thrombocytopenia (bleeding gums) Peripheral smear- anemia, thrombocytopenia, BLASTS, MYELOPEROXIDASE (MPO) +, AUER RODS

Answer 83

1. Antisocial- disregard and violation of others rights 2. Borderline- chaotic relationships, abandonment fears, labile, mood, impulsivity, inner emptiness, self harm 3. Histrionic- superficial, theatrical, attention seeking 4. Narcissistic- grandiosity, lack of empathy

Answer 84

Plasma cell disorder characterized by infiltration of bone marrow by neoplastic cells Bone marrow shows abnormal plasma cells containing immunoglobulin rich Russell bodies S/s: bone pain, pathological fractures, anemia, increased infections, hypercalcemia, renal failure Punched out lytic lesions on XR BENCE JONES PROTEINS IN URINE dt kappa or lambda light chain excretion Monoclonal IgG spike typically on protein electrophoresis

Answer 85

Tick borne illness from American dog tick Illness dt Rickettsia rickettsi (weakly GN obligate intracellular organism with affinity for vascular endothelial cells) Patients have non specific symptoms (fever, malaise, myalgia) followed by rash that begins at ankles and spreads to body and PALMS AND SOLES Treat with DOXYCYCLINE

Answer 86

Endothelial damage from external factors- HTN, smoking, advanced fly action of end products which leads to inflammation, adhesiveness, and invasion of SMCs into tunica intima

Answer 87

MC cause of pathological (bloody, serosanguinous, unilateral w or wo palpable masses abs skin changes) Classically presents as unilateral bloody nipple discharge with NO breast masses, skin changes, or axillary LAD Most cases are BENIGN BX: epithelial and myoepithelial cells lining around a fibrovascular core forming papillae within duct or cyst wall Bloody discharge is from twisting of the vascular stalk of papilloma in duct

Answer 88

Adaptive and innate immune systems work together to kill pathogen Antibodies coat pathogen/cell—> pathogen destroyed by immune cells in non phagocytotic process Examples: NK cells and eosinophils Ie. IgG abs coat target pathogen—> NK cell CD16 binds Fc of IgG and NK cell degranulates

Answer 89

Migraine pathogenesis includes genetic predisposition to increased cerebral excitability, allowing wave of cortical spreading depression to propagate across cerebral cortex —> aura and abnormal activation of trigeminal afferents (which extend into meninges and intracranial vasculature) This activation leads to release of CALCITONIN GENE RELATED PEPTIDE (CGRP), a neuropeptide involved in pain transmission CGRP also causes local vasodilation and increases neurogenic inflammation—> further sensitized trigeminal afferents and increases pain Triptans- 5-HT1B/1D receptor agonists that cause: Vasoconstriction of (dilated) cranial and basilar arteries Inhibition of trigeminal nerve nociception Inhibition of vasoactive peptide secretion Most effective if taken at the onset of headache

Answer 90

Process by which cytotoxic lymphocytes and NK cells can recognize NEOPLASTIC cells by expression of tumor antigens or lack of expression of self antigens (MHC I)

Answer 91

Dx by LOW nasal nitric oxide levels

Answer 92

RV outflow obstruction RV obstruction dt central pulmonary valve stenosis and hypoplasia determines severity of cyanosis and intensity of systolic murmur Higher degree of RV outflow obstruction, the more unoxygenated blood bypasses pulmonary circulation and shunts straight thru VSD to LV

Answer 93

Only found in P. Vivax or P. Ovale Appear as multiple brick red dots (punctuate granulations)

Answer 94

Beta 1 (increased cardiac contractility and HR, increased renin release from JG cells) Beta 2 (peripheral vasodilation and bronchodilation)

Answer 95

Block reuptake of NE and epi—> increases levels of neurotransmitters in synaptic space Amitryptiline, nortryptiline, imipramine POSSESS STRONG ANTIMUSCARINIC EFFECTS- dry mouth, tachycardia, urinary retention and sedation Orthostatic hypotension, QT PROLONGATION, TORSADES DE POINTES, AV BLOCK

Answer 96

Slow decline in gonadal testosterone production with lower total and free testosterone levels Compensatory rise in LH Increased hepatic synthesis and higher levels of sex hormone binding globulin

Answer 97

Potent vasoconstrictors Proteins released by endothelial cells near site of endothelial damage Endothelin receptor blockers used in pulmonary HTN to lower pulmonary vasoconstriction.

Answer 98

Tyrosine kinase receptor over expressed in 20% breast cancers Protooncogene Overexpression associated with more aggressive clinical course and worse prognosis Targeted directly by TRASTUZUMAB

Answer 99

14 Luteal phase is time between ovulation and onset of menstruation. Luteal phase is constant 14 days dt life span of corpus luteum Follicular phase (beginning of cycle) is variable

Answer 100

D1 sympathomimetic ``` LOWER BP (vasodilation) Increased HR, CO ``` Used in postop HTN, HTN crisis Vasodilator (coronary, peripheral, RENAL, splanchnic) PROMOTES NATRIURESIS Can cause hypotension and tachycardia

Answer 101

Progressive b/l spastic stiffness, abnormal movements, growth delay, elevated arginine levels Arginase normally produces urea and ornithine from arginine Mild or no hyperammonemia Treatment- arginine free diet, low protein

Answer 102

Mutation in WAS gene, leukocytes and platelets unable to reorganize actin cytoskeleton —> defective antigen presentation X LINKED RECESSIVE Thrombocytopenia Eczema Recurrent (pyrogenic) infections LOW IgG, IgM HIGH IGE AND IGA

Answer 103

Increases GFR- Efferent constriction causes significant increase in glomerular capillary hydrostatic pressure because of reduction in renal blood outflow. This also reduces RPF Increased FF - increased GFR + decreased RPF. Decreased RPF allows slower capillary flow and more time for filtration of plasma across glomerular membrane As efferent arteriolar constriction increases—> GFR will decrease dt flow mediated rise in oncotic pressure in glomerular capillaries

Answer 104

Hypocalcemia dt CKD

Answer 105

Blocks thalamic T type Ca channels First line absence seizures

Answer 106

Ubiquitin ligase, inhibits hypoxia inducible factor 1a Renal cell carcinoma von Hippel Landau syndrome

Answer 107

MC type of breast cancer Affects both genders Histology shows MALIGNANT GLANDS, ABSENT MYOEPITHELIAL CELLS, surrounded by STROMAL DESMOPLASIA

Answer 108

Methotrexate - folic acid antagonist —> inhibits DNA synthesis and cell reproduction—> preferential destruction of actively proliferating cells ie fetal cells and trophoblasts

Answer 109

Transamination (AST, ALT) Decarboxylation reactions Glycogen phosphorylase Synthesis of glutathione, cystathione, heme, niacin, histamine, neurotransmitters Deficiency- sideroblastic anemia, convulsions, hyper irritability, peripheral neuropathy Deficiency inducible by INH and OCP

Answer 110

Trigeminal autonomic cephalagia Behind one eye, excruciating sharp and stead pain (ice pick) Ipsilateral sweating, facial flushing, nasal congestion or rhinorrhea, pupillary changes, lacrimation, ptosis, miosis Tx with triptans and verapamil

Answer 111

Cell wall and membrane (thick peptidoglycan) LIPOTEICHOIC ACID (LTA)

Answer 112

Hepatic inflammation Necrosis with neutrophilic infiltration Pt will have vomiting, confusion, fever

Answer 113

Inhibits bacterial dihydrofolate reductase CAN CAUSE BONE MARROE SUPPRESSION (leucovorin rescue)

Answer 114

Muscle glycogen phosphorylase deficiency (myophosphorylase deficiency) Muscle cramps, weakness with exercise, myoglobinuria, no lactate rise during strenuous exercise

Answer 115

Fatigue, fever, splenomegaly Peripheral smear shows many GRANULOCYTES, varying stages of maturation BCR-ABL gene from t(9;22) translocation —> unregulated tyrosine kinase activity Tx: IMATINIB - tyrosine kinase inhibitor

Answer 116

Condensed cytoskeleton proteins Eosinophilic cytoplasmic inclusions that do not stain with PAS Seen in alcoholic hepatitis

Answer 117

1. Glomeruli 2. Bowmans capsule 3. Proximal tubules 4. Loop of henle 5. DCT

Answer 118

Rare childhood eye malignancy Mutations in RB1 gene—> codes for Rb protein, abnormal Rb—> unregulated cell growth via E2F Rb holds E2F back and controls cell growth Inherited forms- child born with 1 mutated Rb, initially child heterozygous—> loss of heterozygosity—> cancer

Answer 119

Grows Haemophilus influenzae Contains NAD (factor V) and hemin (factor X) Classic scenario- H influenzae will grow on plate with Staph aureus because S aureus is beta hemolytic and will lyse RBCs and release NAD and hemin for H influenzae to grow

Answer 120

Ovarian artery Ovarian vein Lymphatics Nerves Ovarian artery is major blood supply for ovary Therefore suspensory ligament must be located during oophorectomy to prevent bleeding

Answer 121

Head trauma to temporal bone—> ruptures middle meningeal artery Characteristic lucid interval with loss of consciousness and coma and deterioration

Answer 122

Vascular/plasma leakage syndrome - dt increased capillary permeability during infection S/s: high fever (break bone fever), RETRO ORBITAL EYE PAIN, n/v, mucosal bleeding, fluid accumulation

Answer 123

Remove volume Raise HR Pool blood in veins—>MOA of nitrates

Answer 124

AR Tri nucleotide repeat within FRATAXIN gene Assoc with kyphoscoliosis, pes cavus, ataxia, nystagmus, dysarthria, HYPERTROPHIC CARDIOMYOPATHY

Answer 125

Hypercoagability Endothelial damage Blood stasis

Answer 126

Competes with para aminobenzoic acid (PABA) Inhibits dihydropteroate synthetase Disrupts folic acid pathway Used for Pneumocystis jiroveci and Mycobacteria leprae (leprosy) Causes hemolysis in G6PD can cause agranulocytosis

Answer 127

``` Joint pain (migratory polyarthritis) Carditis Nodules (subQ) Erythema marginatum (evanescence rash with ring margin) Sydenham chorea ```

Answer 128

Neutrophils express integrins that bind ICAM on endothelial cells

Answer 129

Vibration Propioception

Answer 130

Myelinates CNS axons Most common glial cell in white matter Destroyed in MS

Answer 131

Follicular thyroid Choriocarcinoma Renal cell carcinoma Hepatocellular carcinoma

Answer 132

Autoimmune Inflammation, FIBROSIS, STRICTURES, in biliary tree—> involves INTRA AND EXTRA HEPATIC BILE DUCTS STRONGLY ASSOC WITH ULCERATIVE COLITIS Cholestasis, ELEVATED IGM, + P ANCA Histology- ONION SKINNING BILE DUCT FINROSIS and strictures alternating with dilations—> “beading” HIGH RISK OF CHOLANGIOCARCINOMA (bile duct cancer)

Answer 133

Flecainide, propafenone ``` Blocks voltage gated Na channels in high use dependence manner - binds Na channel in open/inactivated states —> class IC dissociates SLOWLY from receptor which allows their blocking effects to accumulate over multiple cardiac cycles ``` Greater heart blockade at higher heart rates—> good for terminating tachyarrhythmias Sodium channel binding strength IC>IA>IB

Answer 134

Inflammation (high IL6)—> high HEPCIDIN (released by liver, binds ferroportin on intestinal mucosal cells and macrophages, thus inhibiting iron transport)—> decreased release of iron from macrophages and decreased iron absorption from gut Mild anemia Lack of available iron—> trapped in storage form KEY MEDIATOR IS HEPCIDIN Low iron, low TINC, HIGH ferritin (age trapped in cells)

Answer 135

Vd = amnt injected/[drug] Vd of plasma protein bound drugs can be altered by hypoalbuminemia (kidney/ liver dx)

Answer 136

Deposition of IgA containing complexes LM- mesangial hypercellularity IF- IgA in mesangium

Answer 137

Renal cell carcinoma: associated with VHL and cigarette smoking; paraneoplastic syndromes (EPO, renin, PTHrP, ACTH)

Answer 138

Abdominal aorta > coronary arteries > popliteal artery > carotid arteries

Answer 139

Panhypopituitarisn dt ischemic necrosis of pituitary gland During pregnancy, pituitary enlarges dt estrogen induced hyperplasia of the lactotrophs, but the blood supply does not increase proportionally As a result, enlarged pituitary is vulnerable to ischemia in case of systemic hypotension dt peripartum hemorrhage

Answer 140

Bordatella pertussis- pertussis toxin INACTIVATES Gi—> AC activation—> high cAMP and impaired neutrophil recruitment

Answer 141

Studded with ribosomes Involved in transfer of proteins to cell membrane and extra cellular space Well developed in protein secreting cells

Answer 142

Generates NADPH and ribose 5 phosphate Glucose 6 phosphate dehydrogenase catalyze the initial and rate limiting step—> deficiency of G6PD causes hemolytic anemia dt inability to generate NADPH Transketolase inter concerts ribose 5 phosphate (nucleotide precursor) and glucose 6 phosphate (glycolysis intermediate)

Answer 143

Caused by PINEAL TUMOR compression SUPERIOR COLLICULI and PRETECTAL AREA of DORSAL MIDBRAIN (region containing vertical gaze center)—> vertical palsy - vertical gaze defects - noncommunicating hydrocephalus dt compression of cerebral aqueduct - near light dissociation (large pupils that do not react to light but react to near far accommodation (accommodate but do not react)

Answer 144

Cannot convert glucose 6 phosphate to 6 phosphogluconate G6PD is rate limiting step of PPP

Answer 145

Mania, delusions, hallucination occurring in the absence of major mood episode Life time history of at least 2 weeks of psychotic symptoms in the absence of mood episode

Answer 146

Acidosis in body stimulates renal tubular epithelial cells to metabolize glutamine to glutamate, which generates ammonium that is excreted in urine and bicarbonate that is reabsorbed into blood This process is responsible for majority of renal acid excretion in chronic acidotic states

Answer 147

Benign salivary tumor that has strong association with cigarette smoking Usually bilateral, slow growing Histologically characterized by cystic spaces lined by oncocytic cells abs dense lymphoid stroma with germinal centers

Answer 148

Caused by direct impact to anterior knee Acutely swollen knee Focal patellar tenderness INABILITY TO EXTEND KNEE AGAINST GRAVITY Palpable gap in extensor mechanism

Answer 149

X linked recessive Males affected, females carriers

Answer 150

Paramyxovirus infection of osteoclasts

Answer 151

Anti hypertensive Stimulates central alpha 2 adrenergic receptors —> decreased presynaptic release of NE and decrease in sympathetic outflow Prevents normal baro receptor mediated increase in PVR and HR during standing and causes orthostatic syncope

Answer 152

P. Falciparum

Answer 153

47XXY Dx at puberty 1. Primary testicular failure dt hyalinization and fibrosis of seminiferous tubules—> small firm testes and azoospermia. Leydig cell dysfunction occurs and leads to testosterone deficiency, LH and FSH INCREASED dt gonadal failure 2. Euchanoid body dt no testosterone 3. MR

Answer 154

Accidental excision during thyroidectomy

Answer 155

Neurotoxin that blocks Na channels—> inhibits signaling Found in Japanese puffer fish

Answer 156

anticentromere antibodies ``` Calcinosis cutis Raynaud phenomenon Esophageal dysmotility- from esophageal sclerosis Sclerodactylyl Telangiectasias ```

Answer 157

Topical immunomodulatory drug that treats derm dx associated with abnormal cell proliferation - HPV, basal cell carcinoma, actinic keratosis Works by activation of toll like receptor 7–> upregulates proinflammatory transcription factor NFkB —> increased cytokines production and enhanced immune mediated killing of aberrant cells Also induces apoptosis- via inhibition of bcl2 (increased caspases) - inhibits angiogenesis

Answer 158

Taenia solium (pork tapeworm) ingestion Causes multiple brain lesions - cystic lesions - seizures Tx praziquantel

Answer 159

Antibody- antigen binding C1 complex forms on arc portion of IgM and IgG that’s bound to antigen C1 complex cleaves C4 and C2 into C3 convertase MC cause of complement deficiency is autoantibodies (which activates classical complement system after binding host antigens)—> low C4 and C3 leveler and normal Factor B, CH50 levels will also be low (measures functional activity of classical pathway). This pattern common in SLE.

Answer 160

Helper T cells Produce cytokines Activate other cells DIRECT IMMUNE RESPONSE

Answer 161

mab against HER2 tyrosine kinase receptor Kills cancer cells by ANTIBODY DEPENDENT CELL MEDIATED CYTOXICITY - cell tagged by abs, effector cell (NK cells) binds to Fc portion of abs and releases toxic contents that kill cells—> targeted killing Assoc with cardiotoxicity (NOT dose dependent, reversible when drug stopped), no necrosis on heart bx

Answer 162

Block angiotensin II type 1 receptors, inhibiting effects of angiotensin II Results in arterial vasodilation and decreased aldosterone secretion Resulting fall in blood pressure increases renin, angiotensin I, and angiotensin II levels

Answer 163

1. Polysaccharide capsule- impedes phagocytosis and complement binding 2. IgA protease (inactivates secretory IgA) 3. Adhesins (necessary for adhesion to epithelial cells) 4. Pneumolysin (cytotoxin that causes pores in cell membrane and cell lysis)

Answer 164

Disease via toxins 1. Toxin A- enterotoxin- watery diarrhea 2. Toxin B- cell necrosis/fibrin deposition - both bind GI cells and are internalized - DESTROY CYTOSKELETON OF GI CELLS—> pseudomembrane

Answer 165

GnRH TRH ADH V1 Angiotensin II

Answer 166

1. Neutrophils dominate early (<2 days) | 2. Monocytes/macrophages dominate late (>2 days). Live longer, replicate in tissues

Answer 167

Constitutive activation of FIBROBLAST GROWTH FACTOR RECEPTOR 3 (FGFR3) Sporadic, but once mutation occurs, transmitted AUTOSOMAL DOMINANT - 1 mutant copy of FGFR3 causes disorder - 2 copies are lethal

Answer 168

Atrophy of striatum in basal ganglia —> chorea, athetosis dt loss of GABAnergic neurons

Answer 169

Psychotic symptoms (delusions, hallucinations, disorganized speech and behavior, negative symptoms) lasting more than 1 month and less than 6 mos

Answer 170

``` Furosemide Probenacid HCTZ Acetazolamide Sulfasalazine Sulfonylurea ```

Answer 171

1. Immunocompetent host- mono like symptoms, negative heterophile ab test 2. Reactivation in AIDS- brain abscesses seen as MULTIPLE RING ENHANCING LESIONS ON MRI. - CD4<100 - HA, seizures 3. Congenital toxoplasmosis- chorioretinitis, hydrocephalus, INTRACRANIAL CALCIFICATIONS Transmission- cysts in pork meat, oocysts in cat feces, crosses placenta

Answer 172

B1B2 sympathomimetic Lowers BP (vasodilation) Increase HR Increase CO - isoproteronol causes B2 mediated vasodilation, resulting in LOWERED MAP and INCREASED HR dt B1 reflex activity Used in electrophysiologic evaluation of tachyarrythmias. Can worsen ischemia Negligible alpha effect

Answer 173

Aggressive, high grade B cell lymphoma characterized by t(8;14)—> over activation of transcription factor C MYC (PROTO ONCOGENE) Typically involves jaw, MC in equatorial Africa, usually associated with EBV

Answer 174

G1/S transition inhibitor Inhibits E2F Retinoblastoma Osteosarcoma

Answer 175

Rate limiting step of heme synthesis Stimulated by low levels of heme B6 COFACTOR FOR ALA SYNTHETASE

Answer 176

Deficient glucose-6-phosphatase - liver cannot break down glycogen into glucose - glycogen accumulation causes hepatomegaly, renomegaly, growth retardation, profound fasting hypoglycemia - also lactic acidosis, hypertriglyceridemia, hyperurucemia Features: severe fasting hypoglycemia, lactic acidosis, hepatomegaly, hyperlipidemia, hyperuricemia, short stature, doll like face, protruding abdomen, emancipated extremities Normal glucose structure

Answer 177

Interfere with DNA replication by binding proteins such as DNA gyrase

Answer 178

Systemic BP and ABG PaCO2 most important regulator A DROP IN PaCO2 DUE TO HYPERVENTILATION CAUSES VASOCONSTRICTION - reduction in cerebral blood volume leads to decreased ICP - lowering PaCO2 is a measure employed to REDUCE ICP in ventilated pts with cerebral edema Tachypnea causes hypocapnia and cerebral vasoconstriction —> decrease cerebral blood volume and ICP

Answer 179

Fetal hypothyroidism dt 1. antibody mediated maternal hypothyroidism 2. Thyroid dysgenesis (MC in US) 3. Iodine deficiency 4. Dyshormogenic goiter (mutations in thyroid peroxidase) FINDINGS: 1. Pot bellied 2. Pale 3. Puffy face 4. Protruding unbilicus 5. Protuberant tongue 6. Poor brain development Thyroid hormone ha important interactions with growth hormone to promote bone growth—> if thyroid hormone affected, so is GH—> GH and thyroid hormone both share negative feedback involving somatotropin

Answer 180

Denatured Hb inclusions in RBCs in pts with G6PD deficiency in setting of hemolysis

Answer 181

Defect in phytanic acid oxidase (peroxisomal enzyme reqd for initial step in FA metabolism) Resulting accumulation of BCFA leads to their incorporation into phospholipids, which alters neuronal function and skin permeability Retinitis pigmentosa is common complication- starts with night blindness and can progress to vision loss

Answer 182

Tendency for certain alleles at 2 linked loci to occur together High in alleles that are close

Answer 183

vWF synthesized by endothelial cells and platelets and functions as carrier protein for factor 8 — vWF binds platelets to endothelium and other platelets - absence of vWF leads to impaired platelet function and coagulation pathway abnormalities MC HERITABLE BLEEDING DX, AD (both males and females) Mild, easy bruising, skin bleeding, nose bleed, menorrhagia NO platelet aggregation with RISTOCETIN COFACTOR ASSAY - normally causes platelet aggregation IF vWF present, if no aggregation, vWF is defective PROLONGED BLEEDING TIME- defect in platelet plug formation, low vWF—> defect in platelet to vWF adhesion PROLONGED PTT- intrinsic pathway coag defect, low vWF—> high PTT because vWF carries/protects factor 8) NORMAL PLATELET COUNT, PT TREAT- DESMOPRESSIN (releases vWF stored in endothelium) or aminocaproic acid

Answer 184

Presents in infancy- poor feeding, vomiting, hypotonia, high anion gap metabolic acidosis, hepatomegaly, seizures Deficiency of propionyl coA carboxylase —> high propionyl coA and propionic acid, low methylmalonic acid Organic acid accumulation: 1. Inhibit gluconeogenesis—> low fasting BG, HIGH ketoacidosis—> high anion gap metabolic acidosis 2. Inhibits urea cycle- hyperammonemia Tx: limit VOMIT (all metab into propionyl coA), propionyl coA carboxylase converts propionyl coA to succinylcoA to enter TCA cycle

Answer 185

Fluoroquinolones (ciprofloxacin)

Answer 186

Dt abnormal migration of ventral pancreatic bud—> pancreatic tissue completely surrounds second part of duodenum, causing obstruction (pancreatitis, vomiting) or asymptomatic Ventral bud is foregut derivative that appears by 5th week of gestation and rotates BEHIND duodenum during week 7 Ventral bud gives rise to uncinate process and main pancreatic duct Body and tail derive from dorsal bud

Answer 187

MC type of ovarian germ cell neoplasm Women 10-30 BENIGN Show mature tissues derived from multiple germ layers (frequently include skin, hair, nails)

Answer 188

``` Fatty liver (microvesicular fatty changes) Mitochondrial abnormalities ``` Rare childhood hepatic encephalopathy associated with viral infection (VZV, influenza) that has been treated with aspirin Aspirin metabolites decrease beta oxidation by reversible inhibition of mitochondrial enzymes

Answer 189

REM sleep is stage of sleep cycle where patients experience DREAMS Can occur with DISCONTINUATION of medications or drugs that are known to suppress REM including - alcohol - barbiturates - stimulants - TCAs - SSRIs - lithium - MAOIs When REM sleep depressants stopped, compensatory in increase amount of REM sleep—> REM rebound

Answer 190

Direct spread of ethmoid or frontal sinus Single abscess Usually bacterial (viridans strep, s aureus)

Answer 191

Convert malate and NADP+ to pyruvate, CO2, and NADPH Cytoplasmic enzyme in liver that produces NADPH for FA synthesis This pathway works in G6PD deficiency pts

Answer 192

Ectopic EPO production —> stimulates erythropoiesis—> high Hct, reticulocytes, and total bilirubin 1. HCC 2. RCC 3. Hemangioblastoma 4. Pheochromacytoma

Answer 193

Detrusor hyperactivity Sudden overwhelming urge to urinate Ie MS- as disease progresses the bladder can become atonic and dilated leading to overflow incontinence

Answer 194

Inhibits mycolic acid synthesis AE: - neurotoxicity (give B6) - hepatotoxic

Answer 195

AR GAA trinucleotide repeat dx—> reduces activity of FRATAXIN gene ( Frataxin is essential for mitochondrial function, involved in iron binding and storage —> absent frataxin causes free radical injury to mitochondria—> neuronal degradation Dysarthria, ataxia, impaired position and vibration sense

Answer 196

Diphtheria toxin- AB exotoxin that inhibits protein synthesis by ADP RIBOSYLATION Toxin works locally causing respiratory cell necrosis with formation of fibrinous, coagulative exudates Complications- Suffocation Myocarditis/ heart failure Neurological toxicity

Answer 197

Dubin Johnson syndrome (inability of hepatocytes to secrete conjugated bilirubin into bile)

Answer 198

Transient hyperglycemia without known DM Risk factors: hemorrhage, major trauma, hypoxia, sepsis—> common in ICU Severe metabolic stress associated with increased production of cortisol, catecholamines (NE, epi), glucagon, IL1, IL6, TNFa —> act on liver to increase glycogenolysis and gluconeogensis, stimulating release of glucose from liver IL1, IL6, TNFa associated with increased expression of GLUT1 (CNS, macrophages) and decreased GLUT4 (insulin induced glucose uptake in skeletal muscle and fat)—> facilitates increased glucose by brain and immune cells

Answer 199

Positive sense single strand RNA flavin iris transmitted by female mosquitos during summer months in southern US, Africa, Latin America Fever, HA, rash Neuroinvasive- MC in older patients with hx of malignancy, organ transplant, meningitis, confusion (encephalitis),ASYMMETRIC FLACCID PARALYSIS with concomitant Parkinsonism features (tremor, bradykinesia)

Answer 200

T cell lymphoma affecting entire body Widespread erythema (SKIN BRIGHT RED) LAD Malignant cells in blood (Sezary cells- cerebriform nuclei of T cells)

Answer 201

mab that blocks IL2R

Answer 202

Conversion of prothrombin to thrombin

Answer 203

Antibodies against type IV collagen in GBM LM- glomerular crescents IF- linear staining (IgG) along GBM

Answer 204

Urogenital differentiation Wilms tumor (nephroblastoma)

Answer 205

AR condition dt defects in NUCLEOTIDE EXCISION REPAIR Children with severe sun burning after minimal UV exposure and signs of skin damage (freckling, actinic keratosis, hyperpigmentation, eye lesions) High risk of skin cancer and blindness (dt cataracts or corneal ulcerations) When DNA exposed to UV radiation—> thymidine dimers form—> absence of normal repair increases risk of DNA replication errors —> skin cancer

Answer 206

Inhibits late Na current Reduces calcium overload—> reduce wall tension and O2 demand AE: Qt prolongation, Tdp

Answer 207

hyperCalcemia Renal insufficiency Anemia Bone lesions

Answer 208

Stimulant laxative Enteric nerve stimulation—> colonic contraction AE: MELANOSIS COLI

Answer 209

Inhibits mycobacterial RNA transcription by targeting DNA dependent RNA polymerase

Answer 210

Full mu opioid receptor AGONIST used for withdrawal and maintenance treatment of opioid use disorder LONG HALF LIFE- suppresses cravings and withdrawal symptoms Also blocks euphoric effects of other opioids by maintaining high tolerance levels AE: QT PROLONGATION, respiratory depression

Answer 211

Both produce shiga toxin Both cause bloody diarrhea Shigella- disease from bacterial invasion of mucosa, toxin less important in disease that invasion EHEC- do not invade mucosa, disease from toxin (inflammation), toxin enters circulation and causes HUS

Answer 212

Pyrogenic- phayringitis, cellulitis, impetigo (honey crusted lesions), erysipelas Toxigenic- scarlet fever (rash dt ERYTHROGENIC TOXIN), toxic shock like syndrome, necrotizing fasciitis Immunologic- RF, poststreptococcal GN PYRROLIDONYL ARYLAMIDASE (PYR+) M protein inhibits phagocytosis - abs to M protein enhance host against GAS but can give rise to RF - ASO titter or anti DNase B abs indicate recent GAS infection

Answer 213

Ampulla of Fallopian tube

Answer 214

Risk of ipsilateral blindness dt occlusion of ophthalmic artery; polymyalgia rheumatica

Answer 215

Malignant dx of myeloid progenitor cells—> overproduction of granulocytes - high numbers of neutrophils, basophils, eosinophils - chronic phase: - leukocytosis (100,000 wbc/mL), few blasts HIGH BASOPHILS Mild anemia, normal/increased platelets Can progress to BLAST CRISIS - acute leukemia (>20% blasts in periphery or marrow), usually myeloblasts MUST R/O INFECTION TO DX CML—> LOW leukocyte alkaline phosphatase activity (will be high if infection, low in CML) t(9;22) PHILADELPHIA CHROM IS GENETIC HALLMARK OF CML - Bcr- abl fusion gene—> abnormal tyrosine kinase Tx with IMATINIB

Answer 216

Smooth parts of LV and RV

Answer 217

X LINKED RECESSIVE NADPH necessary to keep glutathione reduced, which detoxifies free radicals and peroxides If no G6PD, cannot reduce glutathione via PPP—> less NADPH in RBCs leads to hemolytic anemia dt poor RBC defense against oxidizing agents (fava beans, sulfonamides, nitrofurantoin, primaquine/chloroquine, INH) Infection can also produce hemolysis- inflammation produces free radicals that diffuse into RBCs and cause oxidative damage BITE CELLS (results from splenic macrophages biting Heinz bodies out of RBCs) and HEINZ BODIES (denatured globin chains precipitate within RBCs dt oxidative stress)

Answer 218

Widened pulse pressure SBP-DBP - SBP increases due to sympathetic mediated increase in cardiac contractility and stroke volume - DBP decreases due to vasodilation caused by tissue hypoxia abs local accumulation of metabolites, CO2, H+ Anemia limits how much O2 blood can carry, forcing dependent tissues to compensate for reduced supply through locally mediated reflex vasodilation. SVR falls, PP widens

Answer 219

Unilateral fluctuations mass of posterolateral vulva caused by obstruction of glands duct Obstruction typically dt sequelae of previous infection

Answer 220

GTP binding protein Cholangiocarcinoma Pancreatic adenocarcinoma

Answer 221

Markedly decreased blood volume—> reduces CVP and CO—> leads to increased SVR (peripheral vasoconstriction) Shock causes reduced organ and tissue perfusion, which leads to lactic acidosis (metabolic acidosis) and compensatory increase in ventilation (ie compensatory respiratory alkalosis)

Answer 222

Numbness and parathesias in stocking and glove distribution Results from nonenzymatic glycosylation of proteins, leading to hyalinization of endometrial arteries and ischemic nerve damage. In addition, accumulation of sorbitol within neurons results in deranged metabolism and increased oxidative stress

Answer 223

Congenital vascular dx of capillaries - capillary malformation - spontaneous mutation, NOT INHERITED - somatic mutation in GNAQ 1. Port wine stain in CN V1/V2 distribution 2. Leptomeningeal angioma- occurs on SAME side as port wine stain, causes SEIZURES 3. Increased ocular pressure (glaucoma)- in infancy/childhood - vision impairment

Answer 224

Contractility After load Preload HR

Answer 225

Psychostimulants- methylphenidate, amphetamines Rapid onset of action Common AES- decreased appetite, weight loss, insomnia Less common- tics, high HR, HTN

Answer 226

Competitively binds estrogen receptors in hypothalamus and pituitary—> causing hypothalamus to perceive low estrogen—> increased GnRH release—> increased FSH AND LH release Ovulation induction agent

Answer 227

Defective type IV collagen EM- lamellated appearance of GBM

Answer 228

``` Agitation Tremulousness Diaphoresis Confusion SNS overactivation- tachycardia, diaphoresis, HTN, seizures Hallucinations (visual and auditory) ```

Answer 229

Gemfibrozil, fenofibrate, clofibrate Lowers TRIGLYCERIDES and INCREASES HDL Fibrates activate PPARalpha and INCREASES expression of lipoprotein lipases AE- fibrates increase cholesterol in bile and therefore increase risk of gallstones. Can cause rhabdomyolysis especially when combined with statins.

Answer 230

Limits perfusion to nonventilated alveoli, shunting blood toward better- ventilated ones, preserving ventilation- perfusion matching to maintain oxygenation. Hypoxic pulmonary vasoconstriction can be impaired by inflammatory vasodilation (pneumonia, sepsis) and restoration of hypoxic pulmonary vasoconstriction optimizes oxygenation despite minimal improvement of ventilation of consolidated alveoli

Answer 231

Genomic stability Most cancers Li Fraumeni syndrome

Answer 232

Anti Scl 70 (anti DNA topoisomerase) Anti-RNA polymerase III- high risk of renal crisis Widespread disease- renal sclerosis, pulmonary fibrosis , heart block, pulmonary HTN ASSOC WITH PRIMARY BILIARY CHOLANGITIS

Answer 233

Myelinates CNS axons Most common glial cell in white matter Destroyed in MS

Answer 234

WARFARIN MOA- inhibits epoxied reductase which interferes with GAMMA CARBOXYLATION of vitamin K clotting factors 2,7,9,10, C and S (Warfarin increases PT, effects EXTRINSIC pathway)

Answer 235

CAH Blocks aldosterone and cortisol synthesis, but pts present with HTN and hypokalemia dt accumulation of 11 deoxycorticosterone, a mineralcorticoid Neonatal virilization occurs dt excess production of androgens

Answer 236

Ascending Pain, temperature, crude touch Decussates at spinal cord, where info enters spinal column

Answer 237

Autoimmune disease caused by abs targeting POST SYNAPTIC ACh receptors Muscular weakness with diurnal variation Worse at end of day Associated with thymoma TYPE II HSR Dx: ERDROPHONIUM TEST (AChE inhibitor improves symptoms by increasing synaptic concentration of ACh at NMJ) Tx: AChE inhibitors (pyridostigmine, neostigmine)

Answer 238

Used in chemo induced N/V - aprepitant, fosfoprepitant NK1 inhibitors block the interaction between substance P and NK 1 in areas of brain stem that mediate vomiting (nucleus tract solitarius, area postrema) Prevents central cause of vomiting/nausea AE- neutropenia

Answer 239

Excess collagen from fibroblasts —> marrow fibrosis Stimulation by MEGAKARYOCYTE growth factors - PDGF - TGFb Marrow failure—> EXTRAMEDULLARY HEMATOPOIESIS - spleen, liver, LNs, CNS, lungs, bladder, skin Older pts Fatigue, night sweats, weight loss—> dt increased metabolism MASSIVE SPLENOMEGALY Smear- leukoerythroblastosis- immature erythrogenic abd granulocytic precursors in blood and TEAR DROP CELLS SEVERE ANEMIA, HYPERURICEMIA (gout)

Answer 240

Inadequate canalization of ureteropelvic junction (connection between kidney and bladder)

Answer 241

Acts as protease that cleaves synaptobrevin, a SNARE protein → prevention of inhibitory neurotransmitters (i.e., GABA and glycine) release from Renshaw cells in the spinal cord → uninhibited activation of alpha motor neurons → muscle spasms, rigidity, and autonomic instability

Answer 242

Quadriplegia and speechlessness (dt interruption of corticospinal and corticobulbar tracts) with preserved consciousness and vertical eye movements, eye opening, sensation Caused by ischemic injury to VENTRAL PONS

Answer 243

Causes ISOLATED systolic HTN in elderly SBP elevated and DBP remains the same Age related calcification and deposition of connective tissue within walls of blood vessels reduces their compliance and limits the ability of the arterial tree to accommodate blood during systole and SBP rises to compensate.

Answer 244

Alcohol with cephalosporins Warmth, flushing, sweating Caused by inhibition of acetaldehyde dehydrogenase—> build up of acetaldehyde

Answer 245

Conjugate vaccine Contains polyribosyl ribitol phosphate (PRP) conjugated to toxoid protein Vaccine gives significant protection against H influenzae meningitis and epiglottits Major virulence factor is POLYSACCHARIDE CAPSULE

Answer 246

Lysosomal storage dx Deficient a galatosidase a Neuropathy, skin lesions, lack of sweat, cardiac hypertrophy

Answer 247

``` HTN hypokalemia Metabolic alkalosis Decreased plasma renin - inappropriately high aldosterone suppresses renin as part of feedback loop ``` Medically treated with aldosterone antagonists - spironolactone - eplerenone (less side effects)

Answer 248

VERY LOW As few as 10 Shigella organisms can cause disease

Answer 249

Facultative intracellular pathogen, slow growing, pale staining, aerobic, GN, requires cysteine for growth Fever, LAD in animal carcass handlers (hunters) Cell mediated immunity involving Th1 cells and macrophages is most important (TYPE IV HSR)

Answer 250

PCNs Sulfonamides Ciprofloxacin Phenytoin, carbamazepine

Answer 251

Pathognomonic for AML Accumulation of MPO CAN CAUSE DIC

Answer 252

Intercostobrachial nerve Results in SENSORY DYSFUNCTION (burning, numbness) to skin of axilla and medial upper arm

Answer 253

MC lung cancer MC in women Found in periphery MC lung cancer in never smokers

Answer 254

Tachycardia Low voltage QRS Electrical alternans- beat to beat variation QRS axis Chest tightness, dyspnea on exertion dt decreased diastolic ventricular filling which leads to decreased SV

Answer 255

Formation of benign collagenous stroma around neoplasms that provide connective tissue and support Common in malignancy and is a reaction to tumor invasion of healthy tissue

Answer 256

Neuroblastoma (malignant)

Answer 257

Positive inotropic agent Increases parasympathetic tone Slows AV conduction Digoxin DIRECTLY inhibits Na K ATPase pump in myocardial cells—> decreased Na efflux (increased intracellular Na). The decreased transmembrane Na gradient reduces forward activity of Na Ca exchanger—> secondary decrease in Ca efflux from the cells. Increased intracellular Ca concentration stimulates the binding of calcium to troponin C and subsequent actin myosin cross bridging—> improved myocyte contractility and LV systolic function

Answer 258

Glycolysis FA synthesis Pentose phosphate pathway (TRANSKETOLASE)

Answer 259

Trinucleotide repeat dx CTG on chrom 19 Abnormal DMPK gene—> codes for myotonic dystrophy protein kinase PROLONGED MUSCLE CONTRACTIONS- inability to release grip, locking of jaw Long narrow face with hollow cheeks Cataracts (at younger age) Toupee- frontal balding Gonad atrophy Arrhythmias

Answer 260

Schistocytes (HELMET CELLS) Burr cells (also seen in pyruvate kinase deficiency) Red blood cell fragments

Answer 261

Haemophilus ducreyi PAINFUL GENITAL LESION Multiple, deep ulcers Base may have grey yellow exudate Organisms clump in long parallel strands (school of fish)

Answer 262

Clonal proliferation of dendritic cells Cells of myeloid origin EXPRESS CD1a, S100, CD207 Contain Birbeck granules on EM (tennis racket shaped granules) MC IN PEDS OFTEN INVOLVES BONE AND SKIN Lytic lesions, skin rash, recurrent otitis media with mass of mastoid bone

Answer 263

Stable population declining birth rates low mortality long life expectancy Developed countries

Answer 264

Inhibits ribonucleoside reductase - enzyme generates deoxyribonueotise triphosphates for DNA synthesis/repair - LACK of deoxyribonueoside triphosphates slows erythrocyte nuclear development—> less RBCs and bigger in size - increases fetal Hb in SCD CAN CAUSE PANCYTOPENIA in high doses

Answer 265

Trinucleotide repeat dx- GAA AR Adolescent with progressive spinal cord and cerebral at degeneration Associated with HYPERTROPHIC CARDIOMYOPATHY Kyphoscoliosis, FOOT ABNORMALITIES

Answer 266

Renal artery stenosis CKD (PCKD, diabetic nephropathy) Hyperaldosteronism

Answer 267

Bernard Soulier syndrome (defect in platelet adhesion to von Willebrand factor

Answer 268

``` Sepsis Ob complications Cancer Burns Trauma Major surgery Acute pancreatitis APL ```

Answer 269

A hormone has no direct effect on a physiological process but allows another hormone to exert its maximal effect on that process. Example: cortisol and catecholamines

Answer 270

Causes galactose buildup and the excess is converted to galactitol, an osmotic agent that causes cataracts Excess galactose spills into urine—> reducing substance in urine Infantile cataracts may be only manifestation.

Answer 271

Carotid and aortic bodies Stimulated by hypoxemia

Answer 272

Initial unchecked M tb replication within alveolar macrophages After few weeks—> APCs in draining lymph system display mycobacterial antigens and release IL12, stimulates naive CD4 T cells to differentiate into Th1 cells that release IFN gamma—> activates more macrophages and causes them to: 1. Form fully acidified phagolysosomes that can destroy intracellular mycobacterium 2. DIFFERNTIATE INTO EPITHELIOD CELLS and multinucleated Langerhans giant cells that surround extracellular M Tb within granulomas - these cells release digestive enzymes and generate ROS, which helps limit M Tb proliferation but also causes CASEOUS NECROSIS and cavitary lung lesions

Answer 273

Abnormal presence of endometrial glands and strong within uterine myometrium Dysmenorrhea and uterine tenderness UNIFORMLY ENLARGED UTERUS regular, heavy menstrual bleeding Common in multiparous women and prior uterine surgery (c section)

Answer 274

IL2 used for renal cell carcinoma and melanoma Thought to work because activates NK cells

Answer 275

Inhibit mycolic acid synthesis Can be neurotoxic

Answer 276

Acts as estrogen antagonist on breast and endometrium receptors and agonist on bone receptors Used for osteoporosis in pts who have contraindications to bisphosphonates or post menopausal F who benefit from breast cancer prophylaxis Increased risk of thromboembolism

Answer 277

Causes galactose buildup and the excess is converted to galactitol, an osmotic agent that causes cataracts Excess galactose spills into urine—> reducing substance in urine Infantile cataracts may be only manifestation.

Answer 278

Hematogenously

Answer 279

Coenzyme A and fatty acid synthase Deficiency- adrenal insufficiency, burning feet, alopecia

Answer 280

Massive persistent activation of coagulation and fibrinolytic systems Associated with DIFFUSE RENAL CORTICAL NECROSIS dt renal vessel thrombosis and ischemia (from diminished renal perfusion)

Answer 281

Conjunctivitis Urethritis (cervicitis in F) Arthritis Inflammatory arthropathy activates NEUTROPHILS Synovial biopsy of joint will show inflammatory cells, neutrophils (similar profile to RA joint aspiration cell wise)

Answer 282

Toxin A- granulocytes attractant Toxin B- cytopathic DOES NOT INVADE BOWEL WALL

Answer 283

ACEi and ARBs Inhibit efferent arterioles constriction, which can lead to decreased GFR and AKI Pts with bilateral RAS are especially susceptible to this effect because the kidneys rely on efferent arteriole constriction to maintain GFR

Answer 284

CNS macrophages Proliferate in response to injury HIV can persist in brain via microglia - chronic HIV encephalitis: nodules of activated microglia

Answer 285

Southwest US, California VALLEY FEVER: 1. Fever, malaise, cough 2. ERYTHEMA NODOSUM (inflammation of subq fat) 3. Joint pain Dx: sputum culture—> SPHERULES FILLED WITH TINY ENDOSPORES Can cause MENINGITIS

Answer 286

Maintenance dose=clearance * (plasma concentration at steady state)/F

Answer 287

Defective nonhomologous end joining Mutation chromosome 11 in ATM gene DNA hypertensive to ionizing radiation CNS, skin, immune system affected

Answer 288

Caused by shiga toxin producing bacteria- toxin injure endothelium of preglomerular arterioles abs glomerular capillaries—> platelet activation and activation, form thrombi - E. coli O157H7 - shigella Clinically: antecedent diarrheal illness (often bloody) Hemolytic anemia with schistocytes THROMBOCYTOPENIA- platelet consumption with no bleeding/petechiae Acute kidney injury

Answer 289

Barbiturates (phenobarbital) potentiates GABA by INCREASING DURATION OF GABA LIGAND GATED CL CHANNEL OPEN - safety issues, used for induction of anesthesia Benzodiazepines (lorazepam, diazepam)potentials GABA by INCREASING FREQUENCY OF GABA CHANNEL OPENING

Answer 290

1. Spent phase (progression to myelofibrosis) 2. Leukemia (usually AML) 3. GOUT (high purine metabolism—> high uric acid. Also seen in CML)

Answer 291

NTD | Carbamazepine is folate inhibitor

Answer 292

Type IV HSR- usually triggered by drugs NECROSIS OF EPIDERMIS, usually triggered by drugs, may involve mucus membranes - prone to infections - lose water - lose protection of epidermis + Nikolsky sign Prodrome - 1-3 days fever, malaise Lesions start on FACE/ CHEST spreads symmetrically, red tender skin, progresses to bullae—> SLOUGHING OF SKIN Toxic epidermal necrolysis- >30% of skin

Answer 293

S aureus E. coli Aspergillus

Answer 294

Rare MATURE B cell malignancy C19, CD20, CD22, CD103–> (sensitive marker) MASSIVE SPLENOMEGALY- red pulp engorged, atrophy/ obliteration of white pulp DRY TAP- hairy cells induce marrow fibrosis TARTRATE RESISTANT ACID PHOSPHATASE (TRAP) + - cellular enzyme, hairy cells have strong positivity for TRAP stain - TRAP + assoc with BRAF mutation Average age of dx 52yo, pts usually present with ABDOMINAL PAIN—> massive spleen, bone marrow suppression Tx w CLADRIBINE- adenosine analog, highly toxic to HCL cells

Answer 295

Coma Convulsions Cardiac arrhythmias Side effects with alpha1 blockade (orthostatic hypotension) and muscarinic blockade (tachycardia, constipation, urinary retention, dry mouth)

Answer 296

Citrate allosterically inhibits PFK1 | Citrate is a positive allosteric regulator of acetyl coA carboxylase- rate limiting and regulated step of FA synthesis

Answer 297

Smooth part of LA

Answer 298

GBS E coli L monocytogenes (infants) S pneumoniae/ N meningiditis (kids/teens)

Answer 299

GI Irritation cause increased mucosal serotonin and activation of 5HT3 receptors on vagal and spinal afferents USE 5HT3 receptor ANTAGONISTS - ondansetron

Answer 300

Caused by defect in protein responsible for carnitine transport across the mitochondrial membrane Without carnitine, fatty acids cannot be transported into mitochondria as acyl carnitine Mitochondria cannot beta oxidize the fatty acids into acetyl coA for TCA—> cardiac and skeletal myocytes cannot generate ATP from FAs—> weakness, cardiomyopathy and liver cannot synthesize ketone bodies (hypoketotic hypoglycemia- cannot make acetoacetate or beta hydroxybutyrate)

Answer 301

Clearance = volume of plasma cleared of drug per unit time CL=(0.7*Vd)/t1/2

Answer 302

Inhibition of bacterial DNA dependent RNA polymerase

Answer 303

B cell lymphoma Express CD19, CD20, CD5 Poor prognosis, cancer of older pts (70yo) t(11;14) —> OVEREXPRESSION OF CYCLIN D1–> promotes cell cycle transition from G1 to S

Answer 304

Caused by defect in protein responsible for carnitine transport across the mitochondrial membrane Without carnitine, fatty acids cannot be transported into mitochondria as acyl carnitine Mitochondria cannot beta oxidize the fatty acids into acetyl coA for TCA—> cardiac and skeletal myocytes cannot generate ATP from FAs—> weakness, cardiomyopathy and liver cannot synthesize ketone bodies (hypoketotic hypoglycemia- cannot make acetoacetate or beta hydroxybutyrate)

Answer 305

Lacks 3’ to 5’ exonuclease activity —> no proofreading ability—> HCV envelope antigenic variation

Answer 306

Recurrent UNEXPECTED panic attacks

Answer 307

Decidualized endometrium- dilated, coiled endometrial glands and vascularized edematous storma These changes occur in LUTEAL PHASE under the influence of progesterone, as the endometrium prepares for implantation

Answer 308

Non inflammatory (exotoxin) No WBCs, no RBCs V cholera and ETEC—> purely toxin mediated watery diarrhea Toxins secreted by these organisms modify electrolyte handling by enterocytes but do not cause cell death. No RBCs or WBCs on stool microscopy

Answer 309

Inhibits ribosomal peptidyl transferase at 50S subunit Interferes with bacterial protein synthesis Causes grey baby syndrome- infants cannot break down high doses of drug which results in cardiovascular collapse and ashen skin color - infants lack glucuronyl transferase - infants have inadequate renal excretion High risk of aplastic anemia

Answer 310

1. Decreased pulmonary vascular resistance (dt oxygenation and ventilation of lungs- pulmonary vasodilation) 2. Increased SVR (dt removal of low resistance placenta) 3. LV responsible for entire CO (RV no longer contributes to systemic flow)

Answer 311

Scalloped edges with abundant cytoplasm Activated, pathogen specific cytotoxic T cells and NK cells that form in response to INTRACELLULAR INFECTIONS - EBV - HIV - CMV Contain PERFORIN (holes in infected cell membrane) and GRANZYMES (enter cytoplasm and trigger cell death)

Answer 312

Ultimate product of beta oxidation of OCFA Metabolized into succinylcoA in vitamin B12 dependent process Elevated propionyl coA in cells can be used by citrate synthase as a substrate to generate methyl citrate (marker of B12 deficiency, or defect in propionyl coA carboxylase or methylmalonyl coA mutase) - B12 def neuropathy can be caused in part by incorporation of methylmalonyl coA into FA synthesis —> FAs incorporated into phospholipids in nervous system—> altered myelin sheath around neurons diminishing neuron function

Answer 313

Used for serious systemic mycoses, forms membrane pores that allow electrolytes to leak out, and binds ergosterol Nephrotoxic- decrease in GFR and toxic to tubular epithelium, RTA type I Hypokalemia and hypomag because of altered renal tubule permeability—> arrhythmias- SUPPLEMENT K AND MG Fever and chills—> shake and bake, phlebitis, nephrogenic DI

Answer 314

<1% PRE RENAL >1% INTRINSIC >4% POST RENAL FENa is % of Na excreted in urine

Answer 315

Single brain abscess usually caused by direct spread of a contiguous infection Temporal lobe abscess usually a result of otitis media that spread to mastoid air cells Usually bacterial (viridans strep, s aureus)

Answer 316

E. coli Lactose fermenters (E coli) appears as colonies with GREEN METALLIC SHEEN or blue-black to brown color Bacteria that do not ferment lactose appear as colorless or transparent

Answer 317

``` Chronic EtOH Carbamazepine Phenobarbital Phenytoin Rifampin Griseofulvin St. John’s wort Modafinil Cyclophosphamide ```

Answer 318

CLL/SLL that transforms to aggressive DIFFUSE LARGE B CELL LYMPHOMA - classic presentation: Pt w known CLL has rapid growth of single LN On bx- diffuse large B cell lymphoma

Answer 319

Between ovulation and menses (days 15-28) Progesterone released by corpus luteum causes uterine glands to coil and secrete glycogen rich mucus in preparation for embryo implantation Endometrial storms is edematous and completely traversed by spiral arteries

Answer 320

Effect modification is present when the effect of the main exposure on the outcome is modified by the presence of another variable

Answer 321

1. Partially dsDNA virus - genome enters hepatocyte—> nucleus—> DNA becomes fully add—> mRNA synthesized—> cytoplasm 2. Reverse transcriptase synthesized - viral mRNA—> viral DNA, packaged in capsid 3. Envelope from ENDOPLASMIC RETICULUM

Answer 322

Sporadic X linked, mostly girls Normal development until 6-18 months then REGRESSION OF SPEECH, loss of purposeful movements, repeated hand movements (clapping, hand wringing) and gait abnormalities MECP2 gene mutated—> ARRESTED BRAIN DEVELOPMENT (impaired dendritic maturation, reduced neuro melanin in substantia nigra)

Answer 323

Inhibits ribonucleotide reductive Blocks formation of deoxynucleotides (RNA intact) Used in polycythemia Vera, essential thrombocytosis, SCD

Answer 324

Diplopia Dysphasia Dysphona Dyspnea

Answer 325

mTOR inhibitor Prevents response to IL2 Kidney transplant rejection prophylaxis AE- pancytopenia

Answer 326

Liver to duodenum Contains PORTAL TRIAD: - hepatic artery proper - portal vein - common bile duct Ventral mesentery PRINGLE MANEUVER—> ligament compressed in omental foramen to control bleeding from hepatic inflow source Borders omental foramen which connects greater and lesser sacs

Answer 327

CD8+ T cells Reactive against EBV infected B cells EBV infection- + heterophile ab test

Answer 328

Gain entrance to dopamine, NE, serotonin nerve terminals and cause RELEASE OF THESE NEUROTRANSMITTERS by reversing the direction of the transporters that usually mediate neurotransmitter uptake from synaptic cleft Dopamine plays important role in reward system of brain and in reinforcing effects of stimulants Nucleus accumbens impt in dopaminergic reward pathway

Answer 329

Caused by abnormal 3 and 4 pharyngeal pouch development and abnormal neural crest cell migration dt chromosome 22 abnormalities 1. Craniofacial malformations (cleft palate, low set ears, micrognathia) 2. Partial or total agenesis of derivatives of pharyngeal pouches 3 and 4 (no parathyroid hormone or thymus tissue, resulting in hypocalcemia and impaired immune system dt T cell deficiency) 3. Cardiac anomalies (persistent truncus arteriosus bc NCC fail to properly form aorticopulmonary septum)

Answer 330

Aka diffuse alveolar damage Acute respiratory failure resulting from diffuse injury to the alveolar/capillary barrier. B/l infiltrates abs opacity seen on CXR Caused by shock, severe trauma, sepsis, ACUTE PANCREATITS, massive transfusion, gastric aspiration NEUTROPHIL DEPENDENT INJURY to alveolar/capillary endothelium - neutrophils accumulate in lung microvasculature. Release chemokines, oxygen radicals, prostaglandins, proteases - vascular injury and capillary permeability cause fluid to leak—> protein rich pulmonary edema and hyaline membrane formation - accumulation of hyaline membranes, increased inflammation cause intrapulmonary pulmonary shunting, hypoxemia, and decreased CO2 excretion PaO2/FiO2 <200 diagnostic for ARDS

Answer 331

Reduce aortic wall shear stress to limit extension of dissection Accomplished by anti impulse therapy to decrease rate of change in aortic BP per time ESMOLOL - decreased LV contractility (reduce SV) to decrease rise in BP with each contraction - decreased HR- subjecting aorta to fewer VL contractions per minute (less BP change)

Answer 332

Pineal gland tumors compress VERTICAL gaze center in tectum of brain Can lead to Parinaud syndrome - eye movement and pupil dysfunction—> vertical gaze palsy and light near dissociation

Answer 333

Thiazides diuretic Potentiates the diuretic effect of loop diuretics, can be helpful in refractory volume overload (decompensated HF) Na excretion caused by loop diuretics is limited by reabsorption of Na in DCT- the Na Cl cotransporter in DCT counteracts loops by reabsorbing much of the Na that was not reabsorbed in the TAL - inhibition of Na Cl cotransporter with METOLAZONE prevents reabsorption of increased Na delivered to DCT, significantly increasing total Na excretion

Answer 334

COPD pts have decreased sensitivity to PaCO2 (dt chronic CO2 retention) AND may have profound hypoxemia (PaO2 <60), therefore PaO2 levels become a significant contributor to respiratory drive Peripheral chemoreceptors in carotid and aortic bodies are primary sites for sensing PaO2 and are stimulated by hypoxemia Supplemental oxygen rapidly increases PaO2 and reduces peripheral chemoreceptor stimulation and decreases the respiratory rate

Answer 335

Identifies INCORRECTLY PLACED bases/nucleotides - occurs when proofreading misses error- no damage to base - repairs DNA slippage and keeps microsatellites stable -OCCURS S/G2 phase - microsatellite INSTABILITY occurs when MMR deficient —> occurs in colon cancer (Lynch syndrome- germline mutation of DNA MMR enzymes - mutations in MLH1 and MLH2)

Answer 336

Attracts neutrophils Macrophage secreted

Answer 337

Anxiety and agitation - more dopamine available to the brain

Answer 338

Serum sickness- days to weeks after exposure, complement activation IgG Circulating abs-ag complexes deposit in tissues and cause diffuse symptoms- fever, urticaria, arthritis

Answer 339

Blocks Na channels Phenytoin decrease Na current in cortical neurons by reducing ability of Na channel to recover from inactivation increases refractory period, inhibits neuronal high frequency firing

Answer 340

Staph aureus Part of peptidoglycan cell wall, inhibits phagocytosis by BINDING Fc PORTION OF IgG antibodies—> prevents opsonization and phagocytosis by macrophages Prevents complement activation

Answer 341

AD Recurrent epistaxis Melena Multiple cutaneous and mucosal vascular lesions Propensity to develop AVMs in brain, lungs, liver. Cerebral AVMs produce seizures Pts may develop high output heart failure dt AVMs May develop secondary polycythemia dt EPO secretion from chronic hypoxia dt right to left shunting via pulmonary AVMs Pts may devo iron deficiency anemia dt bleeding episodes

Answer 342

P450 Reduction Oxidation Hydrolysis (Polar) Water soluble metabolite Geriatrics lose phase I first

Answer 343

Usually children Tdt+ Usually pre B cell malignancy (CD10+, CD19+, CD+20) Treated with chemo-> may need intrathecal chemo, testical chemo dt “sanctuary sites”- testes and CNS have poor penetration of chemo, relapse may occur in these locations Philadelphia chromosome (t9;22) - ALL in adults, not children - POOR PROGNOSIS t(12;21) - fusion of TEL-AML1–> impairs differentiation of blasts - GOOD PROGNOSIS, MC rearrangement in children ASSOC WITH DOWN SYNDROME Smear shows HIGH LYMPHOBLASTS

Answer 344

Mobile genetic element that encodes for penicillin binding proteins (PBP2a) that has LOW affinity for beta lactam abx Must treat MRSA with non beta lactam ie TMP SMX (inhibits 2 steps in folate synthesis), clindamycin (binds 50S subunit), doxycycline (binds 30S subunit), vancomycin (inhibits integration of peptidoglycan subunits) Found in MRSA which can grow in oxacillin because of mecA gene

Answer 345

Proto oncogene Tyrosine kinase receptor—> stimulates growth CD117+ Gain of function mutation in 95% of GI stromal tumors (GISTs) Treat with IMATINIB

Answer 346

Uremia causes platelet aggregation dysfunction | - Prolonged bleeding time with normal platelets, normal PT, normal aPTT

Answer 347

Trisomy 18 Dt meiotic non disjunction Micrognathia, low set ears, prominent occiput, rocker bottom feet, clenched hands, overlapping fingers, horseshoe kidney, VSD/PDA

Answer 348

``` Anti arrhythmic class III - K channel blocker in phase 3 ``` AE: pulmonary fibrosis, hepatotoxic, hypothyroidism OR hyperthyroidism Acts as HAPTEN- corneal deposits, blue/grey skin Neurological effects Constipation Bradycardia, heart block, HF CHECK PFTs, LFTs, TFTs ``` Has class I, II, III, IV effects - lipophilic ```

Answer 349

Contra lateral motor and sensory deficits of LE, behavioral changes, urinary incontinence Anterior cerebral arteries supply medial portions of the 2 hemispheres (frontal and parietal lobes)

Answer 350

CD3, CD4, CD25, FOXP3 identification markers Produce anti inflamm- IL10 aND TGFb

Answer 351

Heart: negative chronotrope and ↓ contractility of atria Functions via Gi NOT FOUND IN BLOOD VESSELS

Answer 352

In SIADH, increased ADH causes excessive water absorption by the kidneys leading to transient sun clinical hypervolemia Mild increase in extracellular fluid volume suppresses the renin aldosterone axis and stimulates the production of natriuretic peptides—> excretion of sodium in urine (natriuresis) As a result, pts with SIADH have clinically normal extracellular fluid volume and low plasma osmolarity (euvolemic hyponatremia) Features of volume overload (edema, crackles, JVP) not seen.

Answer 353

Cross endothelium into tissues Neutrophils bind PECAM 1 between endothelial cells

Answer 354

Cholinesterase inhibitors, used as pesticides Excess muscarinic stimulation (salivation, miosis, bronchospasm, bradycardia) Tx: ATROPINE (competitively inhibit postganglionic muscarinic receptors) However, pts at risk for paralysis dt NICOTINIC over activation—> need to treat with PRALIDOXIME (cholinesterase reactivating agent)

Answer 355

Heme synthesis Urea cycle Gluconeogenesis

Answer 356

TCA used for OCD when SSRIs have failed TCAs inhibit 5HT and NE reuptake

Answer 357

Pyruvate carboxylase is mitochondrial enzyme that catalyzes formation of OAA from pyruvate Deficiency if pyruvate carboxylase leads to accumulation of gluconeogenic precursors alanine, pyruvate, and lactate because cannot perform gluconeogenesis AUTOSOMAL RECESSIVE Hypoglycemia, elevated alanine, pyruvate, lactate, and ketoacids

Answer 358

PD1 is found on cytotoxic T cells and when bound by its ligand, down regulates cytotoxic T cell response. Neoplasticism cells exploit this and over express PD1 ligand—> suppresses T cell ability to induce apoptosis in cancer cells Pembrolizumab (PD1 receptor inhibitor) restores T cell response, which promotes tumor cell apoptosis and allows cytotoxic T cells to invade tumor cells

Answer 359

Congenital displacement of urethral opening dt malformation of urethral groove and canal Can lead to infertility

Answer 360

Ischemia and/or infarcts dt - large vessel atherosclerosis - small vessel disease (arteriosclerosis) - cerebral amyloid angiopathy S/s - early, prominent executive dysfunction - multi infarcts- often stepwise decline - strategic infarct- localizing cortical deficits - subcortical vascular encephalopathy: subcritical deficits (urinary incontinence, gait problems) Imaging- SCATTERED LESIONS IN WHITE MATTER AND SUBCORTICAL GREY MATTER, ESPECIALLY THALAMUS - cortical infarcts - subcortical lacunar infarcts - white matter hyperintensities

Answer 361

PEPTIDES ONLY

Answer 362

Malignant cells that cause HODGKIN LYMPHOMA Large cells with MULTILOBED NUCLEUS, “OWL EYED”, usually B cells CD15 and CD30 POSITIVE - NOT positive for typical B cell markers

Answer 363

M leprae antigens injected into skin distinguish tuberculoid vs lepromatous leprosy Tuberculoid pts will develop hard indurated nodule at inj site—> strong Th1 response Lepromatous pts are nonreactive to test dt no Th1 response

Answer 364

Generates NADPH and RIBOSE 5 PHOSPHATE (nucleotide precursor) Consists of 2 types of rxns oxidative (irreversible) and nonoxidative (reversible) - both can function independently depending on cell requirements NONOXIDATIVE rxns governed by cells need for ribose 5 phosphate - when ribose 5 phosphate produced in excess—> TRANSKETOLASE can produce glycolytic intermediates for ATP generation - when ribose 5 phosphate demand EXCEEDS oxidative pathway—> nonoxidative pathway reverses and TRANSKETOLASE can make ribose 5 phosphate from glycolytic intermediates PPP occurs in: Lactating mammary gland, liver, adrenal cortex, RBCs

Answer 365

X LINKED RECESSIVE Carrier mother’s pass disease to sons

Answer 366

1. Kill human cells infected by viruses and human cells with REDUCED MHCI 2. Produce IFN gamma to activate macrophages

Answer 367

Inhibit oxidative deamination—> increases presynaptic ability of serotonin, NE, epi, and DA

Answer 368

IL4- activates Th2, suppresses Th1, PROMOTES IgE PRODUCTION (parasites) IL5- activates eosinophils (helminths), PROMOTES IgA PRODUCTION (GI bacteria) IL10- inhibits Th1, ANTI INFLAMMATORYl Th2 involved in humoral immunity- drive Ab mediated response

Answer 369

Hypersensitivity to gluten Gliadin triggers immune mediated reaction causing VILLOUS ATROPHY, CRYPT HYPERPLASIA, INTREPITHELIAL LYMPHOCYTE INFILTRATION —> impaired nutrient absorption in duodenum and proximal jejunum Classically presents at age 6-24 months w abd pain, diarrhea, v, weight loss Elevated IgA anti endomysial and anti TTG Dx confirmed with bx. Gluten free diet to tx

Answer 370

p57 negative Complete mole- 46XX or XY- all paternal DNA Trophoblastic proliferation and edematous chorionic villi Bunch of grapes appearance, “snowstorm pattern” on us NO FETAL EMBRYONIC TISSUE

Answer 371

Blast crisis

Answer 372

Mast cell stabilizing agents that inhibit mast cell degranulation independent of the triggering stimulus Less effective than inhaled glucocorticoids 2nd line therapy for asthma

Answer 373

Partial agonist (used alone or with naloxone- opioid antagonist) for opioid use disorder Less likely to cause respiratory depression.

Answer 374

Consequence of GAS pharyngeal infection Infects mitral valve> aortic> tricuspid (high pressure valves affected most) Aschoff bodies and Anitschkow cells High anti streptolysin O (ASO) and high anti DNase B TYPE II HSR- abs to M protein crisis rwact with self antigens in myosin (molecular mimicry) Treat with PCN

Answer 375

Presents as appendicitis: RLQ pain, fever, vomiting, leukocytosis Caused by mesenteric lymphadenitis from complication of Yersinia infection (Y enterolitica contaminated from raw pork)

Answer 376

Cholinergic agonists Used to lower intra ocular pressure in glaucoma - cholinergic associated miosis causes iris to move farther from cornea. This widens the anterior chamber angle and allows for better outflow of aqueous humor

Answer 377

Bind transpeptidases and prevent peptidoglycan cross linking Beta lactamases, but NOT PCNs Resistant to cleavage by most beta lactamases Used for ESBLs, B fragilis, pseudomonas and enterobacter Imipenem-give with cilastatin (inhibits dehydropeptidase I) to decrease nephrotoxicity

Answer 378

Post influenza bacterial PNA with CAVITARY LESIONS and SALMON COLORED SPUTUM Can for lung abscesses S aureus is very destructive to lung tissue p

Answer 379

Site of ribosomal subunit maturation and assembly RNA POL1 functions exclusively in nucleolus to transcribe pre rRNA gene

Answer 380

Antidepressants- SSRI, MAOis, tricyclics Antipsychotics Anticonvulsants- carbamazepine Antineoplastics- cyclophosphamide

Answer 381

Block carbonic anhydrase in PCT, thereby inhibiting Na Cl and bicarbonate reabsorption The resulting osmotic diuresis increases Na Cl delivery to macula densa (located in TAL) Glomerular afferent arteriolar resistance will increase as a result of tubuloglomerular feedback

Answer 382

Follows either GAS pharyngitis or skin infection Dark urine, periorbital edema, HTN, oliguria SUBEPITHELIAL HUMPS ON EM GRANULAR PATTER OF IGG IGM AND C3 ON IF

Answer 383

Selective Estrogen Receptor Modulator (SERM) Antagonistic effects on breast tissue (used for ER + breast ca) Agonist effects on bone and uterine tissue Post menopausal women on tamoxifen have 2-3x risk of endometrial cancer

Answer 384

Sphingomyelinase deficiency —> sphingomyelin accumulation in lysosomes of CNS and reticuloendothelial system Cherry red spot on macula Hepatomegaly Microcephaly, severe MR ZEBRA BODIES IN INCLUSIONS FOAMY MACROPHAGES

Answer 385

Autonomic instability- hyperthermia, HTN, tachycardia AMS- agitation, confusion Neuromuscular hyperactivity- tremor, hyperreflexia, myoclonus Causes: 1 serotonergic meds- SSRI/SNRI, TCA, tramadol 2 drug interactions: serotonergic med + MAOI or LINEZOLID 3 overdose or abuse

Answer 386

Asthma, chronic sinusitis, peripheral neuropathy, subQ nodules Peripheral eosinophilia and glomerulonephritis Pauci immune glomerulonephritis p ANCA positive

Answer 387

Exotoxins that’s inhibit host cell protein synthesis: C. Diptheria- diphtheria toxin P aeroginosa- exotoxins A - inhibits E2F Shigella- shiga toxin EHEC- shiga like toxin - INACTIVATES 60s ribosome

Answer 388

Way for VALINE, ODD CHAIN FAS, METHIONINE, ISOLEUCINE, THREONINE to enter TCA cycle

Answer 389

Produced by acetyl coA to malonyl coA in rate limiting step of Fa synthesis by acetylcoA carboxylase Malonyl coA inhibits carnitine shuttle—> prevents breakdown of FAs

Answer 390

Papillary carcinoma (childhood radiation)

Answer 391

Quinidine Procainamide Disopyramide Na channel blocker, intermediate use dependence

Answer 392

External rotation of arm at shoulder Innervated by suprascapular nerve

Answer 393

Winters formula: | PaCO2 = (1.5*bicarB) + 8 +/- 2

Answer 394

Binds FKBP and inhibits mTOR—> interrupts IL2 signaling and prevents G1 to S phase progression and lymphocyte proliferation

Answer 395

Site of ribosomal subunit maturation and assembly RNA POL1 functions exclusively in nucleolus to transcribe pre rRNA gene

Answer 396

Calcineurin inhibitor, binds FK506 and prevents IL2 transcription No gingival hyperplasia, hirsutism

Answer 397

Wnt signaling Colon, gastric, pancreatic cancer FAP

Answer 398

RER Vitamin c req as cofactor Defective hydroxylation finishes the amount of collagen secreted by fibroblasts and impairs triple helix stability and covalent cross linking

Answer 399

Multiple myeloma Waldenstrom macroglobulinemia Ig light chains —> increased production —> amyloid light chain (AL) deposition Kidney, spleen, liver, heart, peripheral nerves, tongue, skin

Answer 400

Antibodies directed towards PRE SYNAPTIC voltage gated calcium channels Usually in association with SCLC

Answer 401

Produced by acetyl coA to malonyl coA in rate limiting step of Fa synthesis by acetylcoA carboxylase Malonyl coA inhibits carnitine shuttle—> prevents breakdown of FAs

Answer 402

Chemical stress testing | - use vasodilators to induce coronary steal to test for

Answer 403

Greater porin penetration Ticarcillin, pipercillin - usually given with beta lactamase inhibitor DO NOT COVER MRSA Hospitalized patients with sepsis/PNA dt GNs

Answer 404

Stiff/hypertrophic ventricle Aortic stenosis, restrictive cardiomyopathy Chronic HTN causes LVH which may promote S4 Sound results from atrial contraction which forces blood into LV that’s reached its limit of compliance “Presystolic” “late diastolic” Best heard at cardiac apex at PMI in left lateral decubitus position

Answer 405

CNS macrophages Proliferate in response to injury HIV can persist in brain via microglia - chronic HIV encephalitis: nodules of activated microglia

Answer 406

Right upper limb Right side of head Drains into right subclavian

Answer 407

Nematode that’s acquired by ingestion of ova in fecally contaminated soil Cylindrical, very long Ingest eggs—> larvae hatch and migrate to lungs (cough, dyspnea)—> mature in GIT (abdominal pain, diarrhea) Tx with albendazole or mebendazole

Answer 408

RER Vitamin c req as cofactor Defective hydroxylation finishes the amount of collagen secreted by fibroblasts and impairs triple helix stability and covalent cross linking

Answer 409

Abduction of arm 0 to 15 Suprascapular nerve MC injury to rotator cuff

Answer 410

Mostly conveyed to nontoxic metabolites by sulfation and glucuronidation, small amount metab by cytochrome P450 into TOXIC metabolite NAPQI Tylenol overdose depletes glutathione —> high NAPQI and liver toxicity ACUTE EtOH ingestion can reduce Tylenol hepatotoxicity—> acute EtOH competitively inhibits cytochrome P450 and decrease metab of Tylenol to NAPQI Chronic EtOH increases NAPQI by INDUCTION of P450 and risk of liver toxicity if Tylenol overdose mixed with chronic alcoholism

Answer 411

ESRD Dialysis >5 years Beta2 microglobulin—> decreased clearance —> amyloid beta2-m (Abeta2-m) deposition Ligaments, carpal tunnel syndrome, shoulder joints, bone

Answer 412

Catalyzes initial and RATE LIMITING step of PPP Deficiency results in hemolytic anemia dt inability to generate NADPH in oxidative portion of pathway. However, nonoxidative reactions are responsible for conversion of fructose 6 phosphate to ribose 5 phosphate (via TRANSKETOLASE)

Answer 413

ANTIBODY DEPENDENT CELLULAR CYTOTOXICITY - natural or monoclonal IgG binds to complementary surface antigen on host or foreign cell - patrolling NATURAL KILLER CELL binds Fc portion of attached IgG via CD16 - binding triggers NK cell to release its granules (PERFORIN, granzymes (proteases) that induce apoptosis/osmotic lysis of ab bound cell

Answer 414

Vasculitis of medium sized arteries Conjunctivitis Mucositis Rash- often perineal area Distal extremity changes - erythema, edema, DESQUAMATION OF HANDS AND FEET Cervical LAD Prolonged HIGH FEVER that does not break with anti pyretics Strawberry tongue Feared complication- coronary artery aneurysms

Answer 415

Modulates GABA and glutamate release Binds SV2A to modulate release of GABA and glutamate

Answer 416

Add volume Slow HR—> more filling—> more volume Constrict veins—> veins force blood into heart, veins hold LARGE blood volume, helps maintain CO in setting of blood loss

Answer 417

Infection of medial face, sinuses (ethmoidal or sphenoidal) or teeth may spread thru valveless facial venous system into cavernous sinus causes a thrombosis Pts present with HA, fever, proptosis, I psi lateral deficits in CNs III, IV, VI, V (ophthalmic and maxillary branches)

Answer 418

PTH ACTH TSH ADH V2

Answer 419

Beta>alpha INCREASE BP (HIGH DOSES) INCREASE HR INCREASE CO Used in ANAPHYLAXIS, asthma, open angle glaucoma Alpha effects predominate at HIGH DOSES Stronger B2 effects than NE

Answer 420

Insulin DEPENDENT Fat and skeletal muscle

Answer 421

Small intracellular yeasts in MACROPHAGES Grow in culture as small (2 to 5micron) yeasts with NO CAPSULE Mississippi Ohio river valley ``` SLOW ONSET PNA HILAR LAD, CAVITARY PULMONARY LUNG DX, CALCIFIED LN ENLARGED SPLEEN MOUTH ULCERS PANCYTOPENIA ``` Dx by urine/serum antigen test

Answer 422

Alpha1>alpha2>beta1 INCREASE BP INCREASE HR No/increase CO Used in HYPOTENSION, SHOCK NE increases systolic and diastolic pressure as a result of alpha1 vasoconstriction —> increase MAP—> reflex BRADYCARDIA

Answer 423

Malignant tumor that arises from trophoblasts MC preceded by normal pregnancy Abnormal vaginal bleeding, uterine enlargement, very high bhCG Composed of anaplastic cytotrophoblasts and syncytiotrophoblasts with no vili Presents with dyspnea/hemoptysis dt pulmonary mets from hematogenous spread

Answer 424

0.7x (Vd/t1/2)

Answer 425

IL17 and IL23 Psoriasis - extensor surfaces, silvery plaques

Answer 426

Binds ergosterol (cell membrane) and leads to pore formation and cell lysis

Answer 427

aPTT Heparin binds antithrombinIII which INACTIVATES thrombin and IX, X, XI, XII, and plasmin Prevents progression of existing clots by inhibiting further clotting abs lysis of existing clots relies of endogenous thrombolytics aPTT measure INTRINSIC and common PATHWAYS

Answer 428

STIs Cervical cancer Bladder cancer Prostate cancer

Answer 429

Mouth anaerobes enter lungs Peptostreptococcus, Fusobacterium, Prevotella Tx with Clindamycin

Answer 430

Highly lipophilic GABA AGONIST used for long term sedation in ICU, RAPID ANESTHESIA INDUCTION AE- vasodilation that can result in hypotension, INCREASED SERUM TRIGLYCERIDES AND LIPASE Respiratory depression

Answer 431

C tetanus - tetanospasm, prevents release of inhibitory GABA (lockjaw, spastic paralysis) C botulinum- botulinum toxin, prevents release of stimulatory ACh (flaccid paralysis) Both inhibit SNARE proteins- neuron can’t release NTs

Answer 432

AD CAG trinucleotide repeats on HTT chromosome 4 Degeneration of striatum in basal ganglia (composed of caudate nucleus and putamen)—> chorea and athetosis Motor cortex provides excitatory input to striatum which regulates voluntary movement based on cortical input

Answer 433

1. Amount of Cl- secreted = amount of water in GI tract. Secretion of Cl- regulated by CFTR 2. To increase Cl- secretion, active Gs or AC. CFTR regulated by Gs—> when activated stimulates AC—> increases amount of cAMP inside cell—> activates CFTR to secrete more Cl-. Exotoxins will increase Cl- secretion and therefore the amount of water

Answer 434

Prostate/breast>kidney, thyroid, lung

Answer 435

Defective heme synthesis that leads to accumulation of heme precursors PORPHOBILINOGEN DEAMINASE DEFICIENCY AD, late onset Accumulation of PORPHOBILINOGEN and ALA - porphobilinogen and d ALA NEUROTOXIC —> must test levels during acute attack! - acute intermittent attacks, only when porphobilinogen high 5 Ps - Painful abdomen - Port wine colored pee - Polyneuropathy - Psychological disturbances - Precipitated by P450 inducers, alcohol, starvation, smoking Treat- HEMIN and GLUCOSE- both blunt heme production—> inhibit d ALA synthase *30-40yo recurrent unexplained abdominal pain with abnormal urine color and confusion/neuropathy

Answer 436

AR organic acidemia resulting in deficiency of methylmalonyl coA mutase Results in: - buildup of METHYLMALONIC ACID and PROPRIONIC ACID—> metabolic acidosis - HYPOGLYCEMIA dt increased metabolic rate, increased glucose utilization, direct toxic inhibition of gluconeogenesis by organic acids - hypoglycemia causes increased FFA metabolism—> KETONES in urine - HYPERAMMONEMIA dt organic acids directly inhibiting urea cycle Anion gap acidosis, hypoglycemia, ketosis, hyperammonemia - hypotonia, lethargy, vomiting, respiratory distress DIAGNOSIS- ELEVATED URINE METHYLMALONIC ACID and PROPIONIC ACID **normally- catabolism of VOMIT leads to formation of propionyl coA, which is converted to methylmalonyl coA by biotin dept carboxylation—> isomerization via B12 to succinyl coA—> enters TCA cycle

Answer 437

Enriched selective media for Neisseria Supplemented chocolate agar with: VANCOMYCIN (kills GP) COLISTIN (polymyxin) kills GN NYSTATIN (kills fungi)

Answer 438

``` Low compliance (distensibility) - HTN and elderly ```

Answer 439

Rhabdomyoma, often seen in tuberous sclerosis

Answer 440

T cell mediated Skin - EBV pharyngitis - maculopapular rash - SJS- dermal/epidermal breakdown, fever, necrosis, vesicles - TEN Nephritis - drug acts as hapten - fever, oliguria, increased BUN/Cr, eosinophils in urine, WBCs, WBC CASTS (sterile pyruvate)

Answer 441

After ligand binds GPCR that activates phospholipase C, membrane phospholipids broken down to DAG and IP3. Protein kinase C activated by DAG and calcium. Calcium released from ER under IP3 influence

Answer 442

Vitamin D - phenytoin induces CYP24, which converts 25 hydroxyvitamin D to inactive form - result: less 25 hydroxyvitamin D available for conversion to 1,25 di hydroxy vitamin D—> deficiency leads to less intestinal absorption of calcium and compensatory increase in PTH causes release of Ca from bones—> loss of BMD

Answer 443

Lipid synthesis Carbohydrate metabolism Detoxification

Answer 444

Binds to terminal D alanine residues of cell wall glycoproteins and prevents transpeptidases from forming cross links

Answer 445

Alpha ketoglutarate dehydrogenase complex | - thiamine dependent

Answer 446

Benign AUTOSOMAL DOMINANT disorder caused by defective Calcium sensing Receptors (CaSRs) in PARATHYROID GLAND and KIDNEYS In FHH, higher serum calcium levels are required to suppress PTH—> raises set point of calcium induced regulation of PTH secretion FHH pts have mild asymptomatic hypercalcemia, reduced urinary excretion of calcium, high/normal PTH **CaSRs are transmembrane GqPCRs that regulate secretion of PTH in response to circulating calcium levels Binding of calcium to CaSRs leads to inhibition of PTH release, whereas low calcium levels allow increased PTH release

Answer 447

Multiple malformations that occur secondary to embryonic disturbance in adjoining groups of cells Holoprosencephaly- spectrum of fetal anomalies dt incomplete division of forebrain

Answer 448

Antiviral medication that inhibits viral DNA polymerase by binding pyrophosphate binding sites DOES NOT NEED TO BE ACTIVATED BY VURAL KINASE AE: seizures, HYPOCALCEMIA, nephrotoxic, leukopenia, electrolyte abnormalities

Answer 449

Sympathomimetic B1>B2,alpha INCREASE HR, CO Used in HF, cardiogenic shock (inotropic (contractility)>chronotropic(HR)) Cardiac stress testing

Answer 450

SERCA removes Ca2+ from sarcoplasm and sequesters Ca in sarcoplasmic reticulum. Allows myocyte to relax. SERCA is inhibited by PHOSPHOLAMBAN In exercise—> Beta adrenergic stimulation by SNS phosphorylase phospholamban, allows SERCA to take up Ca more vigorously —> more rapid and vigorous relaxation (higher lusitropy)—> more preload

Answer 451

Excess formation of ORGANIZED extracellular matrix Protrude above surface of the skin but are confined to the original wound margins

Answer 452

Krukenberg tumor (mucin secreting signet ring cells)

Answer 453

``` Dopamine antagonists (metoclopromide, prochlorpermazine) - treat cent nausea and reduce migraine HA pain ``` AE- sedation, extrapyramidal symptoms

Answer 454

Hypoxic vasoconstriction is a physiologic mechanism unique to lung tissue that helps minimize ventilation perfusion mismatch and increases overall gas exchange efficiency However, chronic and diffuse pulmonary vasoconstriction, which occurs in advanced hypoxic lung disease can lead to pulmonary HTN (ie increased RV afterload) Dyspnea, fatigue, left parasternal shift (from RVH) and loud S2 dt high pulmonary artery pressure. Overtime, RV may be unable to pump against resistance from lunch’s—> RHF and edema, JVD

Answer 455

Self limited dx OFTEN FOLLOWING FLU LIKE ILLNESS (viral infection) Maybe hyperthyroid early followed by hypothyroid Histology: granulomatous inflammation Findings: HIGH ESR, JAW PAIN, VERY TENDER THYROID

Answer 456

Can cause vascular leak, septic shock Cachectin- inhibits lipoprotein lipase in fat tissue—> reduces utilization of FAs—> cachexia Increases synthesis of endothelial adhesion molecules—> allows neutrophils to enter inflamed tissue Can cause DIC- coagulation and thrombosis in vasculature of tumor Macrophage secreted

Answer 457

Altered gut biome/defective mucosal barrier INCREASED IL17, TNF alpha, PROSTAGLANDINS Increased risk with HLAB27 Inflammatory back and buttock pain, reduced chest expansion and spinal motility,

Answer 458

DECARBOXYLASE RXNS Branched chain ketoacid dehydrogenase Alpha ketoglutarate dehydrogenase (TCA) Pyruvate dehydrogenase (links glycolysis with TCA) Transketolase (HMP shunt)

Answer 459

High ammonia, hyperammonemia Increased blood glutamine BUN decreased NO OROTIC ACIDURIA AR CEREBRAL EDEMA, lethargy, coma, death

Answer 460

Complete failure of obliteration of the urachus (connection between bladder and umbilicus) Straw colored urine discharge from umbilicus, gets worse with crying, proning, straining Local skin irritation

Answer 461

Small cell carcinoma of lung

Answer 462

Gives rise to Collecting system of kidney - collecting tubules and ducts - major and minor calyces - renal pelvis - ureters

Answer 463

Promoter region Located directly upstream from a gene

Answer 464

Neural structures (optic nerve, pretectal nuclei, and Edinger Westphal nuclei, oculomotor nerve) that mediate direct and consensual pupillary light reflex

Answer 465

21 hydroxylase deficiency - it’s cannot convert 17- hydroxyprogesterone to 11 deoxycortisol - therefore reduced cortisol and aldosterone synthesis and elevated 17 hydroxyprogesterone - corticosteroid precursors accumulate and diverted to excess adrenal androgen production - low cortisol leads to high ACTH Girls at birth have ambiguous genitalia (virilization) dt excess androgens. Boys have normal genitalia and are identified at 1-2 weeks with vomiting, hypotension, hyponatremia, hyperkalemia dt lack of mineralcorticoids Cortisol deficiency causes hypoglycemia and impairs ability to maintain BP

Answer 466

Bacteroides fragilis (anaerobe) Treat with Metronidazole

Answer 467

Gives rise to ``` GLOMERULI BOWMANS CAPSULE PCT LOOP OF HENLE DCT ```

Answer 468

Dimorphism fungi that can cause pulmonary infections in IMMUNE COMPETENT PEOPLE Exists in mold in soil, organic matter, animals Transmitted respiratory route, inhaled and transforms to yeast BROAD BASED BUDDING May be asymptomatic or mimic PNA GRANULOMAS FORMATION Extrapulmonary disease in immunopromised

Answer 469

Occurs dt hemodynamicat significant stenosis of

Answer 470

Follicular lymphoma (BCL2 activation, anti apoptotic oncogene)

Answer 471

PCN binds bacterial transpeptidases Mimics d ala- d ala—> INACTIVATES ENZYMES Wall breakdown>wall creation—> autolysis

Answer 472

Flattening of deltoid muscle with acromion prominence after shoulder injury Axillary nerve injury—> deltoid paralysis and loss of sensation over lateral shoulder MC occurs to externally rotated, abducted arm (throwing football)

Answer 473

Uterine fibroids Benign myometrial smooth muscle cell tumors Heavy menses Uterus is NONTENDER and IRREGULARLY SHAPED

Answer 474

``` Insulin Growth hormone Cytokines (interferon) Hematopoietic growth factors (EPO, GCSF) MAP kinase ```

Answer 475

Decreased diastolic BP Increased LVEDP Aortic regurgitation can be a complication of Transcatheter Aortic Valve Implantation (TAVI) from improper sealing of prosthetic valve to native annulus—> paravalvular leak TAVI also risks stroke, MI

Answer 476

HPV 6 and 11 Predilection for stratified squamous epithelium—> anal canal, vagina, cervix, and TRUE VOCAL CORDS - infants can acquire respiratory papillomatosis via passage through infected birth canal - warty growths on true vocal cords—> weak cry, hoarseness, stridor

Answer 477

Cerebellar atrophy Spider angiomas IgA deficiency Mutation in ATM gene- mutation in NHEJ and serine/threonine kinase involved in V(D)J Recombination - major mechanism for ab and lymphocyte diversity Pts also have high AFP

Answer 478

Develops dt aspiration Can be confused with lung abscess, malignancy, Tb Microscopy shows filamentpus, branching, gram + bacteria and SULFUR GRANULES (turn purple on H&E) Actinomyces colonizers mouth, colon, vagina and can be found in cavities and margins of gums with poor dentition Actinomyces infection MC leads to cervicofacial abscesses, can have lung involvement Alcoholics at risk. Tx with PCN G

Answer 479

Alkaline phosphatase, collagenase, lysozyme, lactoferrin Fuse with phagosome to kill pathogens AND can be released into extra cellular space Specific/secondary

Answer 480

Skin disorder of malignant T cells Variable expression of CD markers PRESENTS WITH SKIN LESIONS - localized dx: Mycosis fungoides - diffuse systemic dx: Sezary syndrome

Answer 481

Ability to convert tryptophan to indole—> distinguishes E coli from Enterobacter cloaca, both common pathogens for UTIs in women

Answer 482

Supra Adrenals Aorta and IVC Duodenum (2nd- 4th parts) ``` Pancreas (head and tail) Ureters Colon (descending and ascending) Kidneys Esophagus (thoracic portion) Rectum (partial) ```

Answer 483

GABA AGONIST Rapid induction of anesthesia, short acting HEMODYNAMICALLY NEUTRAL- does not change HR, CO, BP Inhibits cortisol synthesis—> reversible adrenocortical suppression AVOID IN PTS WITH SEPTIC SHOCK

Answer 484

Acute IgE mediated Anaphylaxis

Answer 485

Repairs UV damage—> repairs bulky pyrimidine dimers Defective in XERODERMA PIGMENTOSA - defective nucleotide excision repair in skin cells - extreme sensitivity to UV light - s/s appears in infancy/childhood - easy sunburning, dry skin, HIGH RISK FOR SKIN CANCER

Answer 486

``` Left upper extremity Left side of head Neck Chest Body below diaphragm ``` Drains into left subclavian vein

Answer 487

LARGE PULSE PRESSURE Loss of aortic dicrotic notch Steep diastolic decline of aortic pressure Murmur best heard with patient leaning forward and right after aortic valve closes (pressure gradient between aorta and LV greatest)

Answer 488

AUTOSOMAL DOMINANT mutations in TTN gene (titin- sarcomere protein)

Answer 489

Gilbert syndrome (benign congenital unconjugated hyperbilirubinemia)

Answer 490

Bind 50s ribosome at P site at 23S rRNA—> block translocation Inhibit protein synthesis Azithromycin, Clarithromycin, Erythromycin Used for intracellular infections- atypical PNA, chlamydia, B pertussis, GP infection in PCN allergic pts ``` AE: Motility issues (GI) Arrhythmias (QT PROLONGATION) Cholestatic hepatitis Rash Eosinophilia ``` INCREASES THEOPHYLLINE AND WARFARIN LEVELS - clarithromycin and erythromycin INHIBIT P450

Answer 491

Blocked degradation of BRANCHED CHAIN AMINO ACIDS (ISOLEUCINE, LEUCINE, VALINE) dt decreased branched chain alpha keto acid dehydrogenase —> causes high alpha keto acids in blood, ESPECIALLY LEUCINE AUTOSOMAL RECESSIVE Leucine is neurotoxic—> SEVERE CNS DEFECTS, MR, death. Urine smells like burnt sugar Tx: dietary restriction of ISOLEUCINE, LYSINE, LEUCINE

Answer 492

Normal oral, reproductive, GI flora Causes oral/facial abscesses that drain thru sinus tract Can cause PID from IUD

Answer 493

Weeks/months low dose MTX therapy Usually hypersensitivity reaction—> eosinophils and lymphocytes Can progress to pulmonary fibrosis if MTX not discontinued

Answer 494

Smooth part of RA

Answer 495

Heparin induces conformational change in platelet factor 4–> formation of neoantigen IgG abs form against heparin-platelet factor 4—> abs aggregation on platelet surface 5-10 days after heparin start Thrombocytopenia is hallmark feature dt clearance of antibody coated platelets by splenic macrophages Antibody aggregation on platelets cause platelet aggregation—> worsens thrombocytopenia and increases risk of DVT TREATMENT- stop heparin and start argatroban/bivalrudin

Answer 496

Classic finding in alcoholic liver disease Intracytoplasmic eosinophilic inclusions of damaged keratin filaments Ok bx: swollen and necrotic hepatocytes with neutrophilic inflammation and Mallory bodies

Answer 497

WBC casts Can also be seen with acute interstitial nephritis (fever, AKI symptoms, no urinary symptoms)

Answer 498

IL2 used for renal cell carcinoma and melanoma Thought to work because activates NK cells

Answer 499

Disordered proliferation Mild dysplasia may resolve Usually occurs in epithelial cells Usually preceded by hyperplasia, metaplasia

Answer 500

Helper T cells Produce cytokines Activate other cells DIRECT IMMUNE RESPONSE

Answer 501

Mesonephros regresses and becomes vestigial Gardner’s ducts

Answer 502

Receptor tyrosine kinase Lung adenocarcinoma

Answer 503

Second generation sulfonylurea that undergoes hepatic clearance and is safer to use in patients with RENAL DYSFUNCTION and heart failure than metformin MOA- insulin secretogogue that blocks K channels in pancreatic beta cells—> cell depolarization and Ca influx—> INSULIN RELEASE Metabolized by LIVER and safer to use in HF and RENAL FAILURE METFORMIN SHOULD NOT BE USED IN RENAL INSUFFICIENCY, HF, CONDITIONS THAT PREDISPOSE PTS TO HYPOXEMIA OR LACTIC ACIDOSIS

Answer 504

Thrombocytopenia Eczema Immunodeficiency Defective protein WASp- participates in reorganization of hematopoietic cell cytoskeleton in response to stimuli —> WAS pts cells cannot migrate in response to normal stimuli ELEVATED IGA AND IGE, no IgM X linked recessive, young boys - hepatosplenomegaly - thrombocytopenia - recurrent infections - eczema High risk of lymphoid malignancies

Answer 505

C5-T1 Sensory innervation to skin of posterior arm, forearm, dorsolateral hand Motor innervation to ALL EXTENSOR MUSCLES OF UPPER LIMB BELOW SHOULDER Axilla or midshaft humerus injury—> wrist drop

Answer 506

Alpha1>alpha2 ``` Increase BP (vasoconstriction) LOWER HR ``` Used in HYPOTENSION (vasoconstrictor) Mydriatic ocular procedures Rhinitis (decongestant) Ischemic priapism

Answer 507

22q11 deletion Triad- loss of thymus (recurrent infections, no T cells), loss of parathyroid glands (hypocalcemia, tetany), congenital heart defects (upper part of heart—>contonotruncal= abnormal aortic arch, truncus arteriosus, TOF, ASD/VSD) Failure of third and fourth pharyngeal pouches Viral, fungal, protozoal infections, intracellular bacterial infections Absent of thymic shadow on CXR Cleft palate and mandible problems also common

Answer 508

Inhibits sigma unit of RNA polymerase—> inhibits C diff protein synthesis Oral Macrocyclic abx (related to macrolides)

Answer 509

Caused by Anaplasma phagocytophilum Intracellular bacteria transmitted by Ixodes tick (which also transmits Lyme (Borrelia burgdorfei) and Babesia microti Presents with influenza like symptoms and no rash PATHOGNOMONIC FEATURE: morulae (berry like clusters of organisms) inside pts granulocytes Tx with DOXYCYCLINE

Answer 510

Demyelinating disease in young women

Answer 511

Common aging process Results from AGE RELATED STIFFENING (replacement of elastin with collagen) and REDUCED COMPLIANCE OF AORTA/ large arteries CV changes in elderly- 1. Aortic stiffening- elastin replaced with collagen, high pulse pressure (isolated SBP HTN) 2. Mild concentric LVH- higher after load, lower CO 3. Conduction cell degeneration - lower resting HR and maximal HR 4. Reduced baroreceptor sensitivity and adrenergic responsiveness (orthostasis, lowered HR and contractility)

Answer 512

Deficiency of lysosomal hexosaminidase A Accumulation of ganglioside GM2 (sphingolipid) in lysosomes of CNS and retina - cherry red spot on macula - dilated neurons with lipid filled vacuoles in CNS - normal at birth, progressive loss of motor, vision, hearing - intellectual ability - EXAGGERATED STARTLE REFLEX AUTOSOMAL RECESSIVE NO HEPATOMEGALY NO SPLENOMEGAL

Answer 513

PEPTIDES ONLY

Answer 514

TYPE II HSR Aschoff bodies- cardiac modules with inflammatory cell (granulomas) Anitschkow cells- macrophage with owl eye appearance ELEVATED ASO TITERS ``` Joint pain (polyarthralgia) Carditis Nodules (subQ) Erythema marginatum Sydenham chorea - sore throat or URI with joint pain, new murmur - 2 types cardiac involvement: 1. Acute RF: severe valve disease, HF 2. Later: mitral stenosis (rare aortic or tricuspid) ```

Answer 515

Malignant cell: REED STERNBERG CELL - minority of cells in enlarged LNs - release cytokines—> generate REACTIVE CELLS Majority are REACTIVE CELLS - majority of cells in LN - B symptoms common (MC than in non Hodgkin lymphoma) - can lead to HYPERCALCEMIA - macrophages get activated—> contain 1alpha hydroxylase —> excess vitamin D—> hypercalcemia

Answer 516

1. Right gastric supplies distal lesser curve | 2. Left gastric supplies proximal lesser curve

Answer 517

[steady state]x(Vd/F)

Answer 518

CD4 T cell malignancy Occurs with HTLV1 infection (RNA virus, infects CD4 T cells) Key diagnostic test- anti HTLV1 abs Pts from JAPAN, Caribbean, West Africa (endemic regions): - LAD - LYMPHOCYTOSIS - SKIN LESIONS ``` SKIN LESIONS (ulcers, nodules, papular rash) Rapidly progressive ``` LYTIC BONE LESIONS w HIGH CALCIUM

Answer 519

Caused by meiotic non disjunction resulting in 47XXY, 46XY/47XXY mosaicism, or 48XXXY—> more Xs, more severe manifestations Diagnosed at puberty when characteristic signs develop 1. Primary testicular failure dt hyalinization and fibrosis of seminiferous tubules. SMALL FIRM TESTES AND AZOOSPERMIA (infertility) Leydig cell dysfunction also occurs abs leads to testosterone deficiency. LH and FSH are increased secondarily to gonadal failure 2. Testosterone deficiency results in development of euchanoid body habitus. Tall stature, gynecomastia. Facial and body hair is sparse/absent and low muscle mass 3. Mild MR

Answer 520

Partial agonists Acebutolol (b1>b2) Pindolol (b1=b2) Intrinsic sympathomimetic activity - beta AGONIST when SNS activity low - beta BLOCKER when SNS activity high Can cause ANGINA dt b1 activation

Answer 521

Erosion SHALLOWER than ulcer Ulcers involve damage to gastric mucosa beyond muscularis mucosa and into the submucosa

Answer 522

Immunosuppressed (low CD4) pts with fungal meningitis BUDDING ENCAPSULATED YEAST ACQUIRED FROM PIGEON DROPPINGS AND UREASE POSITIVE Not dimorphism, hematogenous spread to meninges Dx via latex agglutination of CSF or India ink (halo), mucicarmine stain ELEVATED OPENING PRESSURE WITH LP Amphotericin b + flycytosine followed by fluconazole

Answer 523

Modulates pain transmission by INHIBITING VG NA CHANNELS in sensory nerves, blocks NMDA (excitatory) receptors in spinal cord and alter NE signaling in brain

Answer 524

Increased production of FOLIC ACID and VITAMIN K Deficiency of B12, A, D, E, and IRON

Answer 525

Palpable purpura, abdominal pain, arthralgia, renal involvement Leukocytoclastic vasculitis- damage to SMALL blood vessels with fibrinoid necrosis, peri vascular neutrophilic inflammation IF shows IgA and C3 deposition

Answer 526

Key enzyme in estrogen synthesis Aromatase converts androstenedione to estrone and testosterone to estradiol Aromatase deficiency is AR characterized by high androgen and low estrogen. Newborn girls with aromatase deficiency have normal internal genitalia but AMBIGUOUS EXTERNAL GENITALIA. Mother’s can develop virilization from excess androgens spilling from fetus to mother through placenta

Answer 527

Stimulates cells from G1 to S Binds tyrosine kinase PDGF released at atherosclerotic lesions by platelets, macrophages and stimulates proliferation and migration of smooth muscle cells in tunica intima in response to endothelial injury Mediates differentiation of fibroblasts into myofibroblasts- necessary for fibrous cap formation

Answer 528

Cardiac output = SV x HR Cardiac output= rate of O2 consumption/ arteriovenous O2 content difference

Answer 529

Acid phosphatase, myeloperoxidase Fuse with phagosome ONLY Primary or azurophillic

Answer 530

Associated with cervical cancer Expresses HPV oncogene E6–> leads to synthesis of E6 protein E6 protein binds p53–> p53 degradation Degradation via ubiquitination—> p53 binds to ubiquitous—> targets protein for degradation in proteosomes

Answer 531

Competitive antagonist at androgen receptors Non steroidal anti androgen Used to treat prostate cancer Decreased endogenous androgen activity —> inhibits tumor growth and may contribute to tumor regression

Answer 532

Direct ARTERIOLAR VASODILATOR - reduces afterload Increased cGMP—> smooth muscle relaxation Admin with beta blocker to prevent reflex tachycardia

Answer 533

Holosystolic murmur that increases in intensity with INSPIRATION Loudest at left sternal border at second or third intercostal space

Answer 534

Common malignancy in chemistry under 5 Arises from NCC that populate adrenal medulla and sympathetic chain Mutation in tumor suppressor, MYCN - poor prognosis ASYMPTOMATIC ABDOMINAL MASS CROSSING MIDLINE Histo- small blue cells forming Homer Wright peudorosettes (rings of tumor cells that surround tumor nerve fibers)

Answer 535

INNATE IS Key receptors on macrophages, dendritic cells, mast cells Recognize PAMPs (LPS, flagellin, nucleic acids) and DAMPs. Leads to activation of NfKB

Answer 536

AR lysosomal storage dx Caused by deficiency of sphingomyelinase—> breaks down sphingomyelin (phospholipid) to ceramide Excess sphingomyelin results in lipid laden foam cells that accumulate in LIVER, SPLEEN, CNS—> hepatosplenomegaly and hypotonia and neurodegeneration AND retinal opacification (cherry red spot on macula)

Answer 537

Acquired via inhalation with hematogenous spread to MENINGES Highlighted with INDIA INK, MUCOCARMINE (red inner capsule), LATEX AGGLUTINATION detects polysaccharide antigen Causes cryptococcosis, cryptococcal meningitis, cryptococcal encephalitis (soap bubble lesions in brain) IN IMMUNOCOMPROMISED PEOPLE tx: amphotericin b + flucytosine followed by fluconazole for meningitis

Answer 538

Nerve roots L2 to L4 Injury dt pelvic fracture, mass involving iliopsoas/iliacus muscles (hematoma, abscess), injury during surgery or childbirth Impaired flexion of thigh and extension of leg Findings: 1. quadriceps weakness(difficulty with stairs, knee buckling) 2. Decreased patellar reflex 3. Sensory loss over anterior and middle thigh/leg

Answer 539

Alpha1 ``` INCREASE BP (vasoconstriction) Lowers HR, lowered CO ``` Used for AUTONOMIC INSUFFICIENCY and POSTURAL HYPOTENSION May exacerbate supine HTN

Answer 540

Asymptomatic plasma cell disorder Abnormal SPEP (presence of M protein) No end organ damage Can progress to multiple myeloma No CRAB findings

Answer 541

Rate varies with drug concentration % change with time is constant (half life) Most drugs FLOW DEPT ELIMINATION

Answer 542

Arises from PARAFOLLICULAR C CELLS (which produce calcitonin) Calcitonins precursor proteins can precipitate and form amyloid deposits that appear as AMORPHOUS PROTEINACEOUS material on FNA

Answer 543

Stains Pneumocystis jirovecii- atypical, extracellular monomorphic (yeast like) Saucer shaped cysts on microscopy P. jirovecii causes DIFFUSE B/L INTERSTITIAL PNA AND SEVERE HYPOXIA AIDS defining illness Tx/prophylaxis: TMP SMX, PENTAMIDINE, dapsone, atovaquone Start prophylaxis when CD4 count <200

Answer 544

Astrocytomas- cerebellum of children (GFAP +) JC virus infects astrocytes and oligodendrocytes - causes PML in HIV pts

Answer 545

Chronic infection Chronic inflammation Serum amyloid A—> increased production—> amyloid A (AA) deposition Kidney, liver, spleen, heart, peripheral nerves, tongue, skin

Answer 546

5HT1b/1d AGONIST indicates for treatment of acute migraine attacks HYPERTENSIVE CRISIS AND MI are potential side effects of sumatriptan Contraindicated in pts with poorly controlled HTN or MI

Answer 547

Newborn disease, seen in adults with renal insufficiency Colonization of skin with S AUREUS Diffuse exfoliative toxin Fever, diffuse erythema, sloughing of upper layer of epidermis HEALS COMPLETELY WITH NO SCAR + Nikolsky sign, treat w abx

Answer 548

X LINKED RECESSIVE Lysosomal storage disease resulting from hereditary deficiency of ALPHA GALACTOSIDASE A—> intracellular accumulation of GLOBOTRIAOSYLCERAMIDE Kidneys, heart, nervous system, eyes commonly affected - URINARY FAT BODIES from ceramide in urine Triad- episodic peripheral neuropathy, angiokeratomas, hypohydrosis Later in life- renal failure, CV disease

Answer 549

Anemia decreases the oxygen content of arterial blood because the vast majority of oxygen is transported in blood bound to Hb—> anemia reduces Hb content of blood and thereby REDUCES OXYGEN CARRYING CAPACITY - this limits how much oxygen can be delivered to tissues, so while arterial blood entering a vascular bed will have a normal O2 saturation —> blood exiting vascular bed will have a reduced O2 saturation compared to Normal AND the venous PO2 will also be lower OXYGEN CARRYING CAPACITY OF BLOOD IS PROPORTIONAL TO RBC NUMBERS (Hct) and Hb

Answer 550

“Hyperchloremic acidosis” - inverse relationship between bicarbonate and Cl ``` Hyperalimentation Addisons RTA Diarrhea Acetazolamide Spironolactone Saline infusion ```

Answer 551

Upper left quadrant Deep to ribs 9,10,11

Answer 552

ANGIOTENSIN II

Answer 553

Increase GABAa action Bind GABA receptors a d all increased Cl current thru ion channel. Hyperpolarizes cell membrane, which increases threshold of excitability of post synaptic neuron

Answer 554

CMV EBV- heterophile +

Answer 555

Inhibit NE and 5HT reuptake MAJOR SIDE EFFECTS: 1. Anti muscarinic effects- dry eyes, dry mouth, tachycardia, urinary retention, sedation, constipation 2. Alpha adrenergic block- orthostatic hypotension 3. QT prolongation, Tdp, AV block - TCAs have broad receptor effects

Answer 556

Large EXTRACELLULAR MATRIX PROTEIN

Answer 557

Block translocation of NFAT (nuclear factor of activated T cells)—> reduced IL2 transcription

Answer 558

Subtype of non Hodgkin’s lymphoma B cell malignancy OVER EXPRESSION OF BCL2–> mitochondrial pores will not open, caspases cannot activate—> cell will not undergo apoptosis—> uncontrolled cell growth t(14;18)

Answer 559

Widened pulse pressure SBP-DBP - SBP increases due to sympathetic mediated increase in cardiac contractility and stroke volume - DBP decreases due to vasodilation caused by tissue hypoxia abs local accumulation of metabolites, CO2, H+ Anemia limits how much O2 blood can carry, forcing dependent tissues to compensate for reduced supply through locally mediated reflex vasodilation. SVR falls, PP widens

Answer 560

Lead affects AMINOLEVULINATE (ALA) DEHYDRATASE and FERROCHELATASE in heme pathway—> low heme synthesis and high RBC protoporphyrin —> microcytic hypochromic anemia Also inhibits rRNA degradation—> RBCs retain aggregates of rRNA (basophilic stippling) S/s: - lead lines on gingivae, metaphysis of long bones - encephalopathy and erythrocyte basophilic stippling - abdominal colic and sideroblastic anemia - wrist drop and foot drop, demyelination Iron studies can be low/normal Tx- DIMERCAPROL and EDTA, use SUCCIMER for chelation in kids

Answer 561

Irreversibly bind to penicillin binding proteins (transpeptidases)

Answer 562

Subset of CD4 Produce IL17 Important for mucosal immunity in GIT Loss of Th17 cells shows GI bacteria in blood stream Recruit neutrophils and macrophages

Answer 563

Genetic condition resulting in progressive dystrophy of retinal pigmented epithelium and photoreceptors Progressive night blindness, loss of peripheral vision dt early loss of rods (very metabolically active) Exam shows dark pigments deposited in bone spicule pattern and retinal vessel attenuation and optic disc pallor

Answer 564

Lesions composed of tissue types that are native to the organ of involvement but show abnormal disorganized arrangement Benign neoplastic lesions

Answer 565

NON DHP CCB Inhibits L type calcium channels in the heart NEGATIVE INOTROPIC EFFECT—> reduced contractility, can exacerbate symptoms of HF

Answer 566

Site of ribosomal subunit maturation and assembly RNA POL I functions exclusively within nucleolus to transcribe rRNA

Answer 567

HEMOLYTIC ANEMIA (vitamin E protects RBCs membranes from free radical damage) MUSCLE WEAKNESS DEMYELINATION OF POSTERIOR COLUMNS (Decreased position and vibration sensation) and SPINOCEREBELLAR TRACT (ataxia) HEMOLYTIC ANEMIA and MUSCLE WEAKNESS , DIPLOPIA Neuro presentation may appear solitary to B12 deficiency but NO megaloblastic anemia, hypersegmented or high MMA

Answer 568

Infection causes hyperreactivity of respiratory apparatus Produces PERTUSSIS TOXIN (A and B)—> ADP ribosylates Gi—> inhibits negative regulator of adenylate cyclase—> increaseS cAMP S/s: - increased insulin production—> HYPOGLYCEMIA - lymphocytosis - blockade of immune effector cells - increased histamine sensitivity Grown on Bordet Gengou agar Fluorescent abs verifies dx

Answer 569

Disorder of naive lymphocytes CD5+, CD20+, CD23+ B CELLS MC adult leukemia (60yo) Asymptomatic, LAD, splenomegaly, hepatomegaly Observed without treatment SMUDGE CELLS- peripheral lymphocytes are fragile, membranes crushed during prep B cell disruption—> HYPOGAMMAGLOBULINEMIA- low Igs therefore HIGH INFECTION SUSCEPTIBILITY Autoimmune hemolytic anemia typically develops

Answer 570

Diffuse activation of clotting factors - consumption coagulopathy ``` Prolonged PT/PTT Thrombocytopenia Vascular occlusion - microangiopathic hemolytic anemia - ischemic tissue damage ``` Can present as bleeding

Answer 571

``` GnRH OXYTOCIN ADH V1 TRH HISTAMINE H1 ANGIOTENSIN II GASTRIN ```

Answer 572

Expressed by GAS Surface molecules on bacteria M protein prevents phagocytosis by binding factor H and breaks down C3 convertase —> prevents formation of C3b (prevents opsonization) Shares properties with myosin—> may be basis for rheumatic heart disease And post strep complications - rheumatic heart disease - glomerulonephritis Different M protein subtypes associated with each complication.

Answer 573

CD16- binds Fc of IgG—> enhanced activity of NK cells, antibody dependent cell mediated cytotoxicity CD56- marker for NK cells

Answer 574

EtOH metabolized by alcohol dehydrogenase and aldehyde dehydrogenase—> reduces NAD+ to NADH—> increases NADH/NAD+ ratio This inhibits all other pathways requiring NAD+, including gluconeogenesis - lactate cannot be converted to pyruvate, which forces pyruvate to lactate Excess NADH inhibits conversion of malate to OAA Both pyruvate and OAA are intermediates in gluconeogenesis; therefore conversion of these molecules to lactate and malate inhibits gluconeogenesis Hypoglycemia once hepatic glycogen stores depleted

Answer 575

Decreased urethral sphincter tone, urethral hyper mobility Leakage with coughing, sneezing, lifting

Answer 576

Fomepizole Inhibits alcohol dehydrogenase and prevents formation of toxic metabolites EtOH competitive inhibitor of alcohol dehydrogenase and can also be used in toxicity

Answer 577

Nephritic syndrome 2-3 weeks after GAS infection Nephritogenic strains- bacteria with certain M protein subtypes cause nephritis

Answer 578

Astrocytomas- cerebellum of children (GFAP +) JC virus infects astrocytes and oligodendrocytes - causes PML in HIV pts

Answer 579

Flattened facies Limb deformities Pulmonary hyposplasia Caused by oligohydramnios High mortality

Answer 580

Increased appetite and sleep Leaden paralysis Rejection sensitivity Mood reactivity MAOIs used in patients with treatment resistant MDD with atypical features (phenelzine, tranylcypromine)

Answer 581

Wilson’s disease

Answer 582

Produced by Sertoli cells and is the physiologic inhibitor of FSH Sertoli cells present in seminiferous tubules of testes

Answer 583

Diphenhydramine Promethamine Chlorpheniramine Hydroxyzine Cause significant sedation, especially when used with benzodiazepines (ie diazepam- long acting benzo) Easily penetrate CNS and accumulate

Answer 584

``` High muscle mass High resting oxygen extraction Coronary perfusion DIASTOLE ONLY Less developed collateral circulation Low ischemic pre conditioning ```

Answer 585

Diazoxide is a potassium channel activator that opens potassium channels → potassium efflux from insulin-producing β cells → hyperpolarization of the cell membrane → negative membrane potential that inactivates and closes voltage-gated calcium channels → decreased influx of calcium into pancreatic cells → drop in intracellular calcium concentration → decreased exocytosis of insulin granules (side effects include sodium retention, edema, hirsutism, and hyperkalemia) Also used in hypertensive emergency—> K channel activation relaxes arteriolar smooth muscles cells and causes vasodilation

Answer 586

MC cardiac tumor in adults - mucoid, gelatinous hypo cellular Generate in LEFT ATRIUM Benign, mesenchymal origin Cause syncope dt mitral valve outflow obstruction and thromboembolic events

Answer 587

1. Increased arteriolar diameter (reflex vasodilation) which results in decreased SVR - arteriolar diameter increases reflexively in pts with tissue hypoxia. Vasodilation in response to decrease PO2 is homeostatic mechanism facilitate increased increased blood flow to hypoxic areas 2. Decreased tissue oxygen tension (anemic hypoxia) 3. Decreased blood viscosity 4. Decreased splanchnic flow

Answer 588

S pneumoniae

Answer 589

1. Modified PBPs - genetic mutations 2. Reduced bacterial cell penetration. 3. Beta lactamases - in periplasm of GN, GP secrete into extracellular space

Answer 590

Large area of cells within a field (upper aerodigestive tract) that are “primed” to develop cancer because of widespread exposure to mutagens (tobacco) Even with adequate treatment of malignancy, these areas affected by field cancerization remain at higher risk of developing multiple primary malignancies

Answer 591

AFFERENT ARTERIOLAR CONSTRICTION Auto regulation is a property of all vascular beds. In kidney, 2 mechanisms: 1. Myogenic response - vascular smooth muscle cells contract reflexively in response to rising wall tension caused by increasing perfusion pressure. Contraction decreases RBF. Rapid and accounts for 40-55% of auto regulation 2. Tubuloomerular feedback. - when SBP arises, GFR rises which increases NaCl delivery to macular densa. They respond by releasing adenosine and ATP to stimulate contraction of afferent arteriole Efferent arteriole does not contribute to auto regulation of RBF, but it’s constriction helps maintain stable GFR at low perfusion

Answer 592

Inferior parathyroid gland and thymus

Answer 593

Phenelzine Trancyclomine Isocarboxazid - GI and hepatic MAO inhibited by MAOIs and allow large quantities of tyramine to reach systemic circulation Tyramine enters synaptic terminals and displaces massive amounts of NE from the —> sympathetic crisis and HTN emergency

Answer 594

CYPROHEPTADINE | - anti histamine and non specific serotonin antagonist

Answer 595

Attenuate immune response

Answer 596

Inflammatory condition that begins in infancy/childhood and flares with low humidity (winter months) or excessive heat FAMILY HX OF ATOPIC DX- asthma, allergies, allergic rhinitis HIGH IgE Genetically mediated epidermal barrier dysfunction - loss of FILAGGRIN - loss of epidermal water content - increased permeability to environmental allergens/irritants - skin inflammation - IL4 and IL13 mediated (IL4 produces IgE) - Th2 predominate immune response (IL4/13 Th2 cytokines) Itchy, dry, erythematous papules/vesicles Infants- face, adults- flexor surfaces Histology- T cell, mast cell, eosinophil infiltration Flexor surfaces Chronic lesions show epidermal thickening dt repetitive scratching

Answer 597

Distractingly Impulsive Grandiosity Flight of ideas Activity is high Sleep not needed Talkative, pressured speech

Answer 598

Amiodarone Ibutilide Sotalol Dofetilide Block K channels and inhibit outward K currents in phase 3 of cardiac action potential —> prolongs depolarization and total action potential duration, increased QT interval

Answer 599

Caused by Mycobacterium leprae (infects skin and superficial nerves- glove and stocking loss of sensation), cannot be grown in vitro Lepromatous is diffusely over skin with LEONINE (lion like facies) COMMUNICABLE, HIGH BACTERIAL LOAD, LOW CELL MEDIATED IMMUNITY, no granulomas Largely Th2 (humoral response) Severe neuropathy

Answer 600

CENTRAL VENOUS PRESSURE

Answer 601

Enterobius vermicularis

Answer 602

Deficiency of homogentisate oxidase, the enzyme that converts homogentisate to MALEYLACETOACETATE Dark urine dt oxidation of homogentisate Homogentisate deposits in tissues lead to connective tissue discoloration and organ damage Tx- low tyrosine and phenylalanine diet

Answer 603

High JVP with inspiration - ventricle cannot accept high venous return Seen in: Constrictive pericarditis Restrictive cardiomyopathy RV MI NOT SEEN IN TAMPONADE

Answer 604

``` Infliximab Adalimumab Golimumab Certolizumab Etanercept (decoy receptor) ``` Neutralizing abs can form if patient on long term therapy and disease worsens

Answer 605

Pyrogen Stimulated liver to synthesis acute reactive proteins Secreted by macrophages

Answer 606

Presents in young obese F with daily HA (worsens with Valsalva), bilateral papilledema, transient visual disturbances Increased intracranial pressure compresses the optic nerves, resulting in impaired axoplasmic flow and optic disc edema Increased intracranial pressure transmitted through CSF in subarachnoid space, which is continuous with optic nerve sheath

Answer 607

LMN and UMN damage 50 year old M, slow progressive course, arm weakness, dysphasia to solids/liquids, some flaccid muscles, some spasticity, NO SENSORY SYMPTOMS Familial cases- zinc copper superoxide dismitase deficiency

Answer 608

Depolarizing neuromuscular agent used to induce skeletal muscle relaxation during surgery and intubation Acts as a COMPETITIVE AGONIST of NICOTINIC ACETYLCHOLINE RECEPTORS of motor end plate, where it induces persistent depolarization —> desensitization and skeletal muscle paralysis Succinylcholine is rapidly HYDROLYZED BY PLASMA PSEUDOCHOLINESTERASE- allows for 10% of drug administered to reach NMJ—> duration of <10 mins Pts with pseudocholinesterase deficiency are unable to metabolize succinylcholine, so a large amount of drug reaches NMJ. Heterozygotes maybe have longer paralysis and homozygotes can have persistent paralysis for several hours

Answer 609

Non receptor tyrosine kinase Chronic myelogenous leukemia

Answer 610

Colon, stomach, pancreas

Answer 611

Gap junctions - exchange nutrients and waste products

Answer 612

Intracoronary ergonovine - acts on smooth muscle serotonergic (5HT2) receptors - admin during angiography—> induces vasospasm Intracoronary ACh - acts on endothelial muscarinic receptors - in healthy endothelium—> ACh triggers NO release and vasodilation - in endothelial dysfunction—> ACh induces spasm AVOID PROPRANOLOL DT UNOPPOSED ALPHA STIMULATION

Answer 613

ETOH in adults | Cystic fibrosis in peds

Answer 614

Sensory nerves up to cortex Pain and temp

Answer 615

AMYLOID PRECURSOR PROTEIN (APP) located on chrom 21–> extra copy—> accelerates amyloid accumulation and leads to early onset AD Alzheimer’s dx before age 65 Characteristic changes include - INTRACELLULAR NEUROFIBRILLARY TANGLES (hyperphosphorylated tau) - AMYLOID BETA PLAQUES (amyloid beta is abnormal fragment of AMYLOID PRECURSOR PROTEIN, normally involved in synaptic repair, in AD, protein not properly cleared—> harden into plaques and accumulate in brain/vessel tissue)

Answer 616

RPR- nonspecific screening test for syphilis that detects anticardiolopin abs False positives- infectious mono, HAV, malaria, pregnancy, antiphospholipid syndrome (abs against cardiolipin)

Answer 617

DM1 RA Addison disease

Answer 618

P. Vivax and p. Ovale capable of causing relapses after recovery from primary infection. Both organisms leave dormant hypnzoites in liver

Answer 619

MATCHED UNRELATED DONOR Donor cells will be HLA matched but will not have genomic mutation causing disease

Answer 620

Known seizure disorder Parkinson’s Bowel obstruction MOA- D2 receptor antagonist—> increases resting tone, contractility, LES tone, MOTILITY (used for motility in gastroparesis) Anti emetic, persistent GERD AE- Parkinsonian effects, drug interaction with digoxin, TARDIVE DYSKINESIA (irreversible)

Answer 621

AE of dopamine blocking receptors in the brain by antipsychotics Diffuse muscle rigidity, high fever, autonomic instability (HTN, tachycardia), AMS Elevated creatine kinase dt rhabdomyolysis which can result in acute renal failure Tx: fluids, DANTROLENE- antagonizes ryanodine receptors and inhibits Ca release from sarcoplasmic reticulum Can also use BROMOCRIPTINE (DA agonist)

Answer 622

Less common COMMON ADOLESCENT BOYS (teens to 20s) - parents as mass (LAD, MEDIASTINAL MASS, anterior with pleural effusions) Tumor compression may occur - SVC syndrome - tracheal obstruction Pathology- blasts—> CD7+, CD2, 3, 4, 5, 8+ NOT CD10+

Answer 623

Type II HSR where IgG or IgM binds to antigens expressed on cell surface Antibodies recognized by Fc receptors on immune cells, triggering release of perforins and granzymes that lead to cell lysis

Answer 624

Middle cerebral artery

Answer 625

``` Mebendazole (antihelminthic) Griseofulvin (anti fungal) Colchine (anti gout) Vincristine/vinblastine (anti cancer) Paclitaxel (anti cancer) ```

Answer 626

Mab targets CD52 positive cells (T, B, NK, monocytes) Used for refractory MS and CLL

Answer 627

Atherosclerosis | Smokies is major risk factor

Answer 628

Diarrhea RTA - loss of bicarb from kidneys/GIT and serum Cl increased to maintain electro neutrality EXCESS NORMAL SALINE INFUSION - excess NaCl increases Cl and causes hyperchloremia, this causes bicarbonate to shift into cells to maintain electronegative balance This “loss of bicarb” decreases pH Infusion of increased volume increases intravascular volume—> kidneys respond by increasing Na excretion—> increased Na in urine

Answer 629

Endometrial cancer Ovarian cancer Testicular cancer Mets

Answer 630

Exaggerated drop (>10mmHg) in systolic blood pressure during inspiration Detected by inflating BP cuff and gradually deflating it The difference between systolic pressure at which Kortokoff sounds frost become audible during expiration and the pressure at which they are heard throughout all phases of respiration quantifies pulsus paradoxus *inspiration causes increased systemic return, resulting in increased R heart volumes. Normally, this results in expansion of the RV into pericardial space with little effect on L heart. In conditions that impair expansion into the pericardial space (I.e tamponade), the increased RV volume occurring with inspiration leads to bowing of interventricular septum towards the LV. This leads to decrease in LV end diastolic volume and stroke volume with a resultant decrease in systolic pressure during inspiration

Answer 631

Melatonin agonist Binds with high affinity to melatonin receptors in suprachiasmatic nucleus Lowest side effect burden in elderly

Answer 632

p57 positive 69XXX, XXY- maternal and paternal DNA Enlarged villi with focal trophoblastic proliferation Fetal/embryonic tissue present

Answer 633

Iron stored intracellularly as ferritin Stored in macrophages of liver and bone

Answer 634

Inhibits IMP dehydrogenase Blocks conversion of IMP to GMP Inhibits synthesis of guanine nucleotides (purines) so less G for virus to use to replicate its genome

Answer 635

Wernicke encephalopathy (thiamine deficiency causing ataxia, opthalmoplegia, confusion)

Answer 636

Host cell NUCLEAR MEMBRANES

Answer 637

Very low birth rates Low mortality rates Long life expectancy Shrinking population Very advanced countries

Answer 638

Competitive antagonist at androgen receptors Non steroidal anti androgen Used to treat prostate cancer Decreased endogenous androgen activity —> inhibits tumor growth and may contribute to tumor regression

Answer 639

Inactivation eliminates oversight of cell cycle Loss of function mutation, both alleles must be mutated for loss of function

Answer 640

Posterior cord C5-T1 Proximal radial nerve injury can occur at nerves superficial location in axilla - repetitive pressure/trauma of crutches - sleeping with arm over chair (Saturday night palsy) S/s: weakness/paralysis of forearm, hand, finger extensor muscles (wrist drop, absent tricep reflex) and sensory loss in posterior arm abs forearm, dorsolateral hand and thumb

Answer 641

IgE class switching Induces Th2 differentiation

Answer 642

Rash after GAS pharyngitis Skin rxn dt ERYTHROGENIC TOXIN- transferred by lysogenic bacteriophage sandpaper skin, strawberry tongue, desquamates

Answer 643

Insulin INDEPENDENT Neurons and placenta

Answer 644

CCB- nimodipine Delayed cerebral ischemia dt cerebral vasospasm presents 3-12 days after initial SAH- change in mental status, neuro deficits Nimodipine, selective CCB improves outcomes in patients with cerebral vasospasm by inducing cerebral vasodilation and decreasing calcium dependent excitotoxicity.

Answer 645

Pain and parathesia in distribution of the inferior roots of the brachial plexus (lower trunk C8 to T1)

Answer 646

GPCR—> activated phospholipase C—> phospholipase C hydrolyzes PIP2–> IP3 and DAG—> IP3 mobilizes calcium from ER and DAG directly activate protein kinase C

Answer 647

Ascending aorta and pulmonary trunk

Answer 648

Remnant of umbilical vein

Answer 649

Ovulation induction agent Inhibits aromatase (prevents androgen to estrogen conversion) and suppresses ovarian estradiol production In response to LOW ESTROGEN—> pituitary releases more FSH and LH—> stimulates ovulation

Answer 650

AD mutation Loss of heterozygosity in p53 tumor suppressor - pts inherit one abnormal copy and develop cancer when second allele somatically mutated Multiple malignancies at early age- sarcoma, BREAST, leukemia, adrenocortical carcinoma

Answer 651

Low grade astrocytoma in peds and young adults Usually in posterior fossa, in cerebellum hemispheres Cystic lesion, presents with obstructive hydrocephalus dt external compression of 4th ventricle - ataxia, clumsiness, s/s high intracranial presssure (n/v, AMS) ASSOC WITH NF1 “Cyst with mural nodule” Histology- astrocyte origin, GFAP+, ROSENTHAL FIBERS- eosinophilic, corkscrew fibers with astrocytic processes BENIGN, good prognosis

Answer 652

IP3 M3 stimulation—> INCREASE IP3 - bronchoconstriction - increased insulin release and GI motility - bladder contraction - pupillary constriction - peripheral vasodilation (via NO)

Answer 653

Only muscles of mastication that OPEN THE JAW Spasm of the lateral pyerygoids prevents spontaneous reduction of an anterior dislocation of the TMJ

Answer 654

Sympathomimetic D1D2>B2>alpha INCREASE BP (AT HIGH DOSES) INCREASE HR INCREASE CO Used in unstable bradycardia, HF, shock Inotropic and cheonotropic at lower doses dt B effects Vasoconstriction at high doses dt alpha effects

Answer 655

cAMP Beta 1 stimulation—> INCREASED cAMP - INCREASED contractility and HR - INCREASED renin release by JG cells of kidney

Answer 656

Identifies fat in stool Identifies malabsorption of fat

Answer 657

In addition to anti inflammatory effect—> steroids upregulate beta 2 receptors on bronchial smooth muscle to increase cellular responsiveness to adrenergic stimuli and potentiate the bronchodilator response to inhaled beta2 agonists

Answer 658

Philadelphia chromosome, CML (BCR-ABL oncogene, tyrosine kinase activation) Rare association with ALL

Answer 659

Pseudomonas aeroginosa Streptococcus pneumoniae Haemophilus influenzae type b Neisseria meningiditis E. coli Salmonella Klebsiella pneumoniae group B Streptoccus Capsules are antiphagocytic, opsonized and cleared by spleen Capsular polysaccharide + protein conjugate serves as antigen in vaccines

Answer 660

Thyroid replaced by fibrous tissue and inflammatory infiltrate FIBROSIS MAY EXTEND TO LOCAL STRUCTURES (trachea, esophagus, mimics anaplastic carcinoma) Considered manifestation of IgG4 related systemic dx (autoimmune pancreatits, retroperitoneal fibrosis, non infectious aortits) FIXED HARD (rock like) PAINLESS GOITER

Answer 661

Motile, curved, GN rod that is leading cause of gastroenteritis Pathogen lives in gut of warm blooded animals and is transmitted via ingestion of contaminated food (poultry) and direct contact with domesticated animals Manifestations include fever, cramping abd pain, watery diarrhea that may be bloody. Assoc with Guillain Barre syndrome

Answer 662

Purine analog, mimics adenosine Drug of choice for HAIRY CELL LEUKEMIA

Answer 663

AUTOSOMAL RECESSIVE Absence of galactose 1 phosphate uridyltransferase (GALT)—> prevents metabolism of galactose (derived from lactose) Damage caused by accumulation of toxic substances (GALACTITOL) accumulates in LENS OF EYE (opacification) Clinically- INFANTS with CATARACTS, LIVER DISEASE (hepatomegaly, jaundice), AMINOACIDURIA, MR, growth failure Can predispose to E. coli sepsis in neonates Treat- strict dietary lactose restriction

Answer 664

``` Gentamicin Neomycin Amikacin Tobramycin Streptomycin ``` REQ O2 for uptake Bind 30S ribosome, inhibit bacterial protein synthesis NEPHROTOXIC, OTOTOXIC, NEUROMUSCULAR BLOCK TERATOGENIC

Answer 665

Endogenous pyrogen—> acts on hypothalamus and increases set point of temperature in body Increases synthesis of endothelial adhesion molecules—> allow neutrophils to enter inflamed tissue Macrophage secreted

Answer 666

mab against CD20 - found in most B cell neoplasms - non Hodgkin’s lymphoma, CLL, ITP, RA, TTP, AIHA RISK OF OPPORTUNISTIC INFECTIONS: - PML (JC virus) - HEPATITS B REACTIVATION

Answer 667

Attenuate immune response

Answer 668

Most common urea cycle disorder Excess carbomoyl phosphate converted to orotic acid—> orotic acid accumulates and spills into urine Vomiting, tachypnea, coma HYPERAMMONEMIA AND ELEVATED OROTIC ACID IN URINE

Answer 669

Lower TG levels by activating peroxisome proliferator activator receptor alpha (PPAR)—> decreased hepatic VLDL production and increased lipoprotein lipase activity

Answer 670

``` DM1 SLE Graves’ disease Hashimoto’s thyroiditis (also HLADR5) Addison disease ```

Answer 671

Result of small vessel occlusion from lipohyalinosis and microatheroma formation in the penetrating vessels (LENTICULOSTRIATE ARTERIES)supplying the deep brain Uncontrolled HTN and DM are major risk factors Cavitary infarcts located in basal ganglia, posterior limb of internal capsule, pons, cerebellum

Answer 672

Non viable pregnancy contains two sets of paternal DNA, no maternal DNA No fetal parts, snowstorm appearance on u/s 46XX or 46XY Causes grape like masses of dilated abnormal chorionic villi with secretion of very high hCG and uterine enlargement Rapid trophoblastic proliferation herighyens potential for malignant transformation to choriocarcinoma S/s: vaginal bleeding and hyperemesis gravidarum

Answer 673

Medulla structure Responds to changes in BP Both aortic arch and carotid sinus send afferents to nucleus solitarius

Answer 674

Lidocaine Mexiletine Block voltage gated sodium channels. Have weakest binding compared to other class I anti arrhythmics Rapidly dissociate from Na receptor, little use dependence Selective for ischemic myocardium and are used for ISCHEMIA INDUCED VENTRICULAR ARRHYTHMIAS

Answer 675

B cell malignancy CD19, CD20 Very aggressive Key distinctions: 1. Starry sky morphology 2. EBV 3. C myc translocation (t(8;14)) Endemic form- children, Africa/New Guinea, MANDIBLE mass, assoc with EBV, EBV infects B cells with CD21 Sporadic form- occurs in children, ABDOMINAL MASS (ileocecum or peritoneum)

Answer 676

Amyotrophic lateral sclerosis

Answer 677

Severing the glossopharyngeal nerve sends the medulla a false signal that there is a sudden decrease in BP—> elicits baroreflex that results in increase in sympathetic outflow, leading to HTN and tachycardia

Answer 678

Clomiphene (inhibits hypothalamic estrogen receptors → disruption of normal negative feedback effect of estrogen → ↑ pulsatile secretion of GnRH → ↑ FSH and LH → stimulation of ovulation

Answer 679

AB toxin that ribosylates and inactivates elongation factor 2 This inhibits protein synthesis and leads to cell death

Answer 680

Absent vas deferns (Azoospermia)

Answer 681

ETEC: 1. heat labile toxin- overactivates AC—> cAMP 2. Heat stabile toxin —> overactivates GC—> cGMP, less NaCl reabsorption in gut B anthracis - anthrax toxin, mimics AC, likely responsible for edematous boarders of cutaneous anthrax V cholera- cholera toxin, overactivates AC by increasing cAMP by permanently activating Gs—> high Cl secretion into gut and water efflux - VOLUMINOUS RICE WATER DIARRHEA - death: profound dehydration, electrolyte losses, shock

Answer 682

Located in eosinophils CRYSTALLINE, ROD SHAPED on EM Functions in destruction of parasites and contributes to epithelial damage in asthma.

Answer 683

Urine antigen test Mississippi and Ohio river valley Bat/bird droppings, CAVES Enlarged liver spleen, mouth ulcers, pancytopenia, hilar LAD, slow onset PNA MACROPHAGES FILLED WITH YEAST CELLS CELL MEDIATED IMMUNITY Amphotericin B for systemic infection, fluconazole/itraconazole for local infection

Answer 684

M. Tb growth Need to treat pt before culture comes back Bc grows slow Always stain with Ziehl Neelsen or Auramine rhodamine

Answer 685

Cuktures Mycoplasma pneumoniae - requires CHOLESTEROL to grow Culturing rarely used- usually diagnose via serology (abs), PCR (bacterial DNA), cold agglutinins

Answer 686

Inhibits microtuble formation, which prevents leukocyte migration and phagocytosis, leading to a reduction in inflammation AE- severe diarrhea, abdominal cramping, leukopenia, myelosuppression, hepatotoxic

Answer 687

Lysogenic bacteriophage

Answer 688

Decreased sensitivity of hypothalamic- pituitary- peripheral tissue axis to thyroid hormones dt defect in thyroid hormone receptor (thyroid hormone receptor beta) Levels of T4, T3, TSH INCREASED Pts typically have goiter and develop ADHD

Answer 689

Selectin ligand on neutrophils (Sialyl Lewis X) binds to Selectins on endothelial cells—> neutrophils slow down and roll

Answer 690

1.5xbicarb + 8 +/- 2

Answer 691

1. Paranoid: suspicious, distrustful, hypervigilant 2. Schizoid: prefers to be a loner, detached, unemotional 3. Schizotypal: unusual thoughts, perceptions, behaviors

Answer 692

Subset of CD4 Produce IL17 Important for mucosal immunity in GIT Loss of Th17 cells shows GI bacteria in blood stream Recruit neutrophils and macrophages

Answer 693

Deposition of IgA immune complexes within DERMAL PAPILLA Prurutic papulovesicles on extensor extremities, scalp, back, buttocks

Answer 694

Fibroid Irregular uterine enlargement Can cause pelvic pressure, especially on bladder and colon—> leading to constipation

Answer 695

Composed of magnesium ammonium phosphate Occur after infection by urease producing bacteria (Proteus, Klebsiella) Urine becomes alkaline, resulting in precipitation of magnesium ammonium phosphate salts—> may form large stones (staghorn calculi) MC IN WOMEN AND PTS WITH INDWELLING CATHETERS (paraplegia)

Answer 696

``` Low muscle mass Low resting oxygen extraction Coronary perfusion in BOTH SYSTOLE AND DIASTOLE More developed collateral circulation High ischemic preconditioning ```

Answer 697

From parafollicular cells (C cells)- produces calcitonin Sheets of polygonal cells in amyloid stroma Stains with CONGO RED Associated with MEN2A and 2B RET mutations

Answer 698

Non stimulant treatment for ADHD - less insomnia, loss of appetite Selective norepi reuptake inhibitor NO DIRECT EFFECTS ON DOPAMINE SYSTEMS IN BRAIN - dopamine effects may cause euphoria (abuse potential)

Answer 699

Ascending Pain and temp

Answer 700

Most common urea cycle disorder Excess carbomoyl phosphate converted to orotic acid—> orotic acid accumulates and spills into urine Vomiting, tachypnea, coma HYPERAMMONEMIA AND ELEVATED OROTIC ACID IN URINE

Answer 701

BMI <18.5 Intense fear of weight gain Distorted views of body weight and shape

Answer 702

RBC with dark center, surrounding halo of pallor and dark peripheral ring Form dt excessive surface area to volume ratio Occurs in Thalassemia, iron deficiency or structural mutations to Hb Excessive membrane dt greater cholesterol to phospholipid ratios (liver disease, splenectomy) - splenectomy pts usually devo target cells because spleen is primary organ that prunes excessive red cell membranes

Answer 703

VSMCs - atherosclerosis initiated by endothelial injury—> increased expression of VCAMs—> migration and adherence of monocytes and T lymphs into intima—> infiltrating WBCs release cytokines and growth factors (PDGF, FGF, IL1)—> PROMOTES MIGRATION AND PROLIFERATION OF VASCULAR SMOOTH MUSCLE CELLS (VSMCs) in intima VSMCs stimulated to synthesize extracellular matrix (collagen, elastin, proteoglycan) that form fibrous cap of atheroma

Answer 704

S aureus, B cereus

Answer 705

Competitively inhibit ACh at muscarinic receptor. Need to increase ACh in synaptic cleft Hot as a hare- high body temp, decreased sweat, decreased heat dissipation Dry as a bone- decreased secretions Red as a beet- flushed skin Blind as a bat- paralysis of ciliary muscles and iris sphincter Mad as a hatter- AMS, permeates BBB and affects CNS pathways Full as a flask- decreased smooth muscle contractions Fast as a fiddle- tachycardia, decreased vagal tone to SA node Treat with PHYSOSTIGMINE (cholinesterase inhibitor, increase ACh levels by preventing degradation by cholinesterase)

Answer 706

Oral ulcerations and vesicular extremity rash and herpangina (oral ulcers, high fever) Caused by ENTEROVIRUS- coxsackie A Complications include myocarditis, CNS disease Infants, children Summer season Fecal oral

Answer 707

Blocks GLUCAN synthesis Suppresses fungal wall synthesis Candida, Aspergillus

Answer 708

5th gen cephalosporin Binds PBP2a—> MRSA SPECIFIC Covers MRSA and VRSA, NOT PSEUDOMONAS

Answer 709

Heart, kidneys Increase HR, stimulate renin release b1 block- low CO, low ECV—> low BP

Answer 710

Genetic (X linked defect in ALA synthase gene), acquired (myelodysplastic syndrome), and reversible (alcohol, lead poisoning, B6 deficiency, copper deficiency, INH, linezolid) Iron laden macrophages, RINGED SIDEROBLASTS in marrow—> Prussian blue stained mitochondria Tx B6

Answer 711

Continuous daily valacyclovir, acyclovir, famciclovir

Answer 712

Histamine blocker POTENT 450 INHIBITOR ANTI ANDROGEN - gynecomastia, impotence, prolactin release Crosses BBB and placenta REDUCES CREATININE EXCRETION

Answer 713

Loefflers- selective for C. diptheria Terllurite- C diptheria produces gray black colored colonies

Answer 714

Increases Km Vmax UNCHANGED

Answer 715

Produced by adipocytes on response to short term food intake and long term adequacy of fat stores Acts on hypothalamus to decrease appetite (obesity blunts this action) During fasting states, leptin levels fall

Answer 716

Coronary sinus

Answer 717

``` Idiopathic Heritable Left heart disease (HF) Lung disease (COPD) Hypoxemic vasoconstriction (ie OSA) Thromboembolic (ie PE) ```

Answer 718

Volume expansion Widespread vasodilation Greater basement membrane permeability and decreased tubular reabsorption of filtered protein (trace protein normal in urine) Increased cardiac output Increased RPF Increased GFR —> leads to increased creatinine clearance

Answer 719

IL4- activates Th2, suppresses Th1, PROMOTES IgE PRODUCTION (parasites) IL5- activates eosinophils (helminths), PROMOTES IgA PRODUCTION (GI bacteria) IL10- inhibits Th1, ANTI INFLAMMATORYl Th2 involved in humoral immunity- drive Ab mediated response

Answer 720

Severe asthma COPD Constrictive pericarditis Tamponade

Answer 721

Ehrlichia chaffeensis is harbored by white tailed deer in SW, SE, mid Atlantic US Transmitted by tick bite and spreads to tissues rich in MONONUCLEAR CELLS (bone marrow, LN, liver, spleen) Leads to nonspecific symptoms (fever, chills, myalgia, HA), maculapapular rash and lymphopenia, thrombocytopenia, elevated aminotransferases REPLICATES in membrane bound vacuoles in cytoplasm and appears as MULBERRY SHAPED INTRALEUKOCYTIC INCLUSIONS (morulae) Treat with doxycycline (MEGA= mulberry shaped in monocytes in Ehrlichia, granulocytes in anaplasma)

Answer 722

LAD and LCX

Answer 723

Product of PPP Needed for cholesterol and fatty acid synthesis and glutathione antioxidant mechanism

Answer 724

Caused by tertiary syphilis Results from degen/demyelination of DCML and loss of dorsal roots Patient with other STDs, difficulty walking, 5/5 strength in legs and arms, POSITIVE ROMBERG (loss of proprioception), wide based gait, fleeting, recurrent shooting pains, loss of ankle/knee reflexes, ARGYLL ROBINSON PUPILS

Answer 725

``` TMP SMX, Metronidazole, macrolides Azole antifungals Amiodarone Cimetidine Grapefruit juice ``` INCREASE WARFARIN EFFECT, INCREASE BLEEDING RISK

Answer 726

Double vision, eye lid droop, LATERAL AND INFERIOR eye deviation at rest, dilated pupil that does not react to light Caused by posterior communicating artery aneurysm (compresses CNIII)—> causes injury to outer parasympathetic layer of CNIII (pupillary response) and injury to deeper somatic fibers (extraocular muscles)—> pupil not reactive to light, dilated AND ptosis and down and out gaze

Answer 727

Carbonic anhydrase inhibitor that inhibits HCO3- reabsorption and H+ secretion in PCT Secreted H+ is normally buffeted by NH3 and excreted as NH4+, so by reducing H+ secretion, acetazolamide also reduces NH4+ excretion Can cause metabolic acidosis with decreased plasma bicarb and low pH Used for acute angle closure glaucoma

Answer 728

Diffusion limitation is a mechanism of hypoxia that occurs in diseases that disrupt the alveolar- capillary membrane (emphysema, pulmonary fibrosis). Fibrotic thickening of interstitial space (between air and blood) increases distance O2 must cross, limiting o2 diffusion During exercise- increase in pulmonary blood flow accelerates transit time thru pulmonary capillaries, reducing the time for oxygen extraction. In patients with diffusion limitation, increased blood flow during exercise can result in exertional hypoxemia, even if oxygenation normal at rest

Answer 729

Paired PIGMENTED brainstem nucleus in POSTERIOR ROSTRAL PONS NEAR FLOOR OF 4th VENTRICLE Principle site of NOREPINEPHRINE synthesis Pts with b/l pontine hemorrhage typically present with coma dt disruption of RETICULAR ACTIVATING SYSTEM - total paralysis with extensor posturing dt corticospinal and corticobulbar tract injury and pinpoint pupils dt descending sympathetic tract damage

Answer 730

Binds Hb and lowers it’s O2 affinity, thereby enhancing the release of bound O2 2,3 BPG is generated via glycolytic substrate 1,3 BPG—> accumulates in pyruvate kinase deficiency

Answer 731

RNA picornavirus Fecal oral route dt CONTAMINATED WATER OR FOOD WITH RAW OR STEAMED SHELLFISH Self limited disease

Answer 732

``` S aureus Pseudomonas Serratia Nocardia Aspergillus ```

Answer 733

EBV PHARYNGITIS

Answer 734

High ammonia, hyperammonemia Increased blood glutamate BUN decreased OROTIC ACID IN URINE NO CITRULLINE X LINKED RECESSIVE Cerebral edema, coma, lethargy, convulsions, death

Answer 735

Triad of: 1. Cutaneous hemorrhages (blueberry muffin) 2. Sensorineural deafness 3. Periventricular calcifications In adults- CMV infection causes influenza like syndrome with mild fever and LAD (referred to as heterophile negative mononucleosis)

Answer 736

Progressive low back pain B/l LE weakness Bowel/bladder dysfunction Impaired perineal sensation Dt disruption of nerve roots to the sciatic nerve (LE weakness, radical at low back pain), pudendal nerve (saddle anesthesia), and pelvic splanchnics Pelvic splanchnics S2-S4 provide parasympathetic innervation to hindgut, bladder, urinary sphincters that promote peristalsis, bladder emptying, pelvic floor relaxation to defecate—> CONSTIPATION, DIFF URINATING prominent symptoms of cauda equina dt loss of PNS input to bladder and bowel

Answer 737

cAMP M2 stimulation—> DECREASE cAMP - DECREASED cardiac contractility and HR

Answer 738

Humans only Water/food contamination Developing countries Invades enterocytes—> blunted neutrophil response dt CAPSULAR ANTIGEN Vi—> extensive intracellular replication in macrophages—> spreads thru lymphatics and RES Causes TYPHOID FEVER- progressive fever (pulse temperature dissociation) - ROSE SPOTS, abd pain - hepatosplenomegaly, GIB, perforation

Answer 739

Iatrogenic (exogenous corticosteroids) Adrenocortical adenoma (secretes excess cortisol) ACTH secreting pituitary adenoma (Cushing disease) Paraneoplastic syndrome (ACTH secretion by tumors)

Answer 740

Viridans streptococci produce dextrans that aid in colonizing history surfaces (dental cavities, heart valves) Viridans strept cause subacute endocarditis in pts with preexisting cardiac valvular effects after dental manipulation

Answer 741

Lysosomal a1,4 glycosidase deficiency Inability to degrade lysosomal glycogen Cardiomegaly, muscle weakness, death by 2 Glycogen like material in inclusion bodies

Answer 742

Tryptophan

Answer 743

Rupture of saccular (berry) aneurysm Berry aneurysms occur in autosomal dominant poly cystic disease

Answer 744

Suspensory ligaments of the breast - malignant infiltration of these ligaments causes fibrosis and shortening—> traction on skin with distortion of breast contour

Answer 745

Neurofibrillary tangles of hyperphosphorylated tau protein Extracellular senile plaques consisting of ABeta amyloid Granulovacuolar degeneration and Hirano bodies

Answer 746

MC type of hair loss in men and women Hair loss driven by genetics and hormones (circulating androgens) Occurs at temporal areas and vertex, progresses throughout life Polygenic inheritance with variable expressivity —> severity of hair loss depends on hormonal and genetic factors and vary between males and females

Answer 747

Floor of fourth ventricle houses area postrema—> contains CTZ Vomiting reflex can be triggered by vagal stimulation caused by intense visceral pain Metoclopromide is dopamine antagonist that acts at area postrema to prevent n/v

Answer 748

1. Mono—> positive heterophile antibodies 2. Lymphomas (endemic Burkitt) 3. Nasopharyngeal carcinoma (Asians) 4. Lymphoproliferative dx in transplant pts 5. Aplastic anemia—> rare, HYPOCELLULAR MARROW WITH DIFFUSE FATTY INFILTRATE EBV INFECTS B CELLS VIA CD21

Answer 749

Signal 1. Th cell activation via PEPTIDE or we ration by APC - need CD3 on T cell Signal 2. Co stimulation on T cell via B7 on APC and CD28 naive T cell NEED CD40 receptor on B cell and CD40L on Th cell for class switching Th cells secrete cytokines that determine Ig switching of B cells In vaccines that DO NOT have peptide antigen, WEAKER immune response, NO ab class switching—> will only make IgM abs

Answer 750

Increases Km Vmax UNCHANGED

Answer 751

Inhibit ergosterol (cell membrane) synthesis

Answer 752

Bordatella pertussis Prepared from Potatoes

Answer 753

``` Tb Leprosy Fungal PNA (histo, blasto, coccidio) Bartonella (cat scratch dx) Brucellosis Listeria in infants (granulomatosis infanseptica) Schistosomiasis (worm) Syphilis (gummas) ```

Answer 754

Psychotic symptoms (paranoid delusions) Euphoria Agitation S/s: sympathetic stimulation (tachycardia, diaphoresis, mydriasis)

Answer 755

Ovulation High estrogen from ovaries (stimulated by FSH) have positive feedback on LH and cause LH surge—> rupture of dominant follicle and ovulation Menotropin (human menopausal gonadotropin) mimics FSH and triggers development of dominant ovarian follicle —> exogenous bhCG administered (similar structure to LH, therefore mimics LH surge and induces ovulation. Exogenous bHCG mimics LH surge

Answer 756

DILTIAZEM- impairs metabolism of cyclosporine/ tacro and treats HTN so can use lower dose of cyclosporine

Answer 757

Autoimmune dx caused by auto antibodies directed against NICOTINIC ACETYLCHOLINE RECEPTORS on POST SYNAPTIC MEMBRANE of NMJ Antibody binding leads to receptor degradation and complement mediated damage of postsynaptic membrane, prevent action potentials to be triggered Pts commonly have FLUCTUATING WEAKNESS that worsens throughout the day and most often includes EXTRAOCULAR (ptosis, diplopia) and bulbar (dysphagia, fatiguable chewing) muscles Most patients have thymus abnormalities (thymoma, thymus hyperplasia) that appear as ANTERIOR MEDIASTINAL MASS

Answer 758

``` Tertiary syphilis (syphilitic aortitis) Vasa vasorum destruction ```

Answer 759

1. Opsonization 2. Neutralization 3. Complement fixation

Answer 760

Hypoxemia - COPD pts have blunted response to PaCO2 dt chronic CO2 retaining. Peripheral chemoreceptors primarily sense arterial pressure of oxygen and can be suppressed (decreased respirations) with supplemental oxygen

Answer 761

Rupture middle meningeal artery | Lentiform shaped

Answer 762

Tonic contraction of peripheral vasculature - limits heat transfer to skin Reduced sweat gland density- limits ability to dissipate heat via evaporation Reduced effective epidermal area available for heat transfer- loss of rete pegs and dermal capillaries

Answer 763

Superior parathyroid

Answer 764

Produced primarily in stomach in gastric pits in response to fasting - levels surge leading up to meals and fall after eating - stimulates appetite and promotes weight gain - caloric restrictions and falling fat stores lead to increased ghrelin (along with decreased leptin and insulin levels) which limits weight loss from dietary restriction alone Bariatric surgeries can lose significant number of ghrelin secreting cells—> lower ghrelin, less appetite stimulation in response to fasting, promoting weight loss

Answer 765

Tetrahydrobiopterin (BH4) deficiency caused by dihydropterin reductase BH4 is cofactor for conversion of Phe to Tyr and Tyr to DOPA DOPA is precursor of melanin and catecholamines—> deficiency of BH4–> low dopamine—> hyperprolactinemia MUST SUPPLEMENT BH4 and Tyr in malignant PKU Presentation is classic PKU patient that does not improve with Phe restricted diet

Answer 766

``` Lung cancer Esophageal cancer Hodgkin lymphoma Mets Granulomatous pulmonary diseases ```

Answer 767

Teeth discoloration

Answer 768

Wolffian duct and forms ductus deferents and epididymis

Answer 769

1. Cysteine 2. Carnitine 3. Taurine 4. Lecithin

Answer 770

Monoclonal ab used to prevent organ transplant rejection Binds CD3 receptors on T cells—> triggers apoptosis, reduced T cells and IL2 activity

Answer 771

Enzyme in adipose tissue that catalyze the mobilization of stored triglycerides into FREE FATTY ACIDS and GLYCEROL HSL activated in response to stress hormones: Catecholamines, glucagon, ACTH and is inhibited by insulin - stress hormones activate Gs on adipocytes —> leads to increased cAMP production a d activation of protein kinase A. PKA phosphorylates and activates HSL, stimulating lipolysis FFA and glycerol taken up by liver for gluconeogenesis Liver oxidizes FFAs to acetyl coA—> metabolized to ketones (acetoacetate, beta hydroxybuterate) or shunted into TCA cycle In BRAIN- FFAs do not cross BBB, so only ketone bodies/glucose can be used and RBCs can only use glucose (no mitochondria)

Answer 772

Effect of substance A and B together is equal to the sun of their individual effects Aspirin and acetaminophen

Answer 773

GIT and kidneys In both locations- glucose transported against its concentration Coupled with abs going down it’s concentration gradient

Answer 774

IL12 triggers differentiation of T cells to Th1 Activates Th1 produce IFN gamma Important for response to intracellular infections Children born with deficient receptors have weak Th1 response and low levels of IFN gamma Increased susceptibility to 1. Disseminated salmonella 2. Disseminated nontuberculous mycobacterial 3. Disseminated BCG after vaccine Treatment- IFN gamma

Answer 775

Shigellosis Acute infection of bowel caused by Shigella species Bloody diarrhea, fever, vomiting, abd pain Spread FECAL ORAL DAY CARE SETTING LOW INFECTIOUS DOSE

Answer 776

AD Defects in gene encoding LDL RECEPTOR FH inherited with gene domain effect in which homozygotes are more adversely affected that heterozygotes Offspring of a homozygote and genetically normal individual will be affected heterozygotes-> elevated plasma LDL cholesterol levels

Answer 777

Hallmark: ACANTHOLYSIS- loss of connections between keratinocytes Autoantibodies (IgG) against DESMOGLEIN 1 and 3 - component of desmosomes - TYPE II HSR - reticular pattern on IF Disrupts connections in stratum spinosum + Nikolsky sign Occurs adults 30-60 LARGE FLACCID BULLAE (loose and floppy) Often presents with ORAL BULLAE AND ULCERATIONS

Answer 778

2 or 3 line for asthma treatment Inhibits phosphodiesterase—> increases cAMP in airway smooth muscle and leads to bronchodilation Also antagonizes adenosine receptors to prevent bronchoconstriction Narrow therapeutic window—> toxicity results in TACHYCARDIA, PALPITATIONS, SEIZURES, TREMORS, AGITATION

Answer 779

Monobactam (beta lactamases ring sits alone) Binds PENICILLIN BINDING PROTEIN3 (PBP3)- only in GN ONLY ACTIVE AGAINST GN, active against pseudomonas NO CROSS REACTIVITY WITH PCN- can give to PCN allergic pts SYNERGISITC WITH AMINOGLYCOSIDES

Answer 780

Refractive error caused by INCREASED ANTERIOR POSTERIOR DIAMETER of eye Image falls anterior to the retina—> pts have problems seeing objects at a distance

Answer 781

Associated with CELIAC DISEASE Extensor surfaces, itchy IgA deposition in dermal papillae - abs triggered by gluten cross react with skin Bx- microabscesses with neutrophils, on IF: IgA deposition at tips of dermal papillae

Answer 782

Transports iron in blood INCREASES when iron stores are low Lab value- Total Iron Binding Capacity

Answer 783

Right to left shunt cyanotic congenital heart disease Central cyanosis- normal CO, not enough O2 - blue lips, nails, warm extremities FAILURE OF AORTICOPULMONARY SEPTUM TO SPIRAL - ANTERIORLY positioned aorta connected to RV and posteriorly positioned pulmonary artery connected to LV - pulmonary and systemic circulations separate absexist

Answer 784

Sensorineural hearing loss | Damages CNVIII

Answer 785

Keratin like coat- impermeable Cortex/core wall- peptidoglycan, innermost layer, mainly structural Dipicolonic acid- heat resistance Bacillus and clostridium species

Answer 786

Pulmonary vasodilation and REDUCED pulmonary vascular resistance Increases SVR dt umbilical cord clamping —> decreased pulmonary pressure and increased SVR reverse right to left blood flow across PDA to LEFT TO RIGHT SHUNTING PDA closes 24-48 hours after birth

Answer 787

2nd MC skin cancer Arises from squamous cells in epidermis Occurs in sun exposed areas, actinic keratosis is a precursor to SCC - face, lips, ears, hands - DNA damage by UV light Occurs in older pts (>75yo), rarely metastasize RED SCALING PLAQUES WITH SHARP BORDERS, ULCERATE, CRUST/ BLEED Bx: KERATIN PEARLS Risk factors: - sun exposure - IMMUNOSUPPRESSION (organ tx, HIV, steroids) - chronic skin inflammation (chronic ulcers, burns) - ARSENIC EXPOSURE (contaminated drinking water)

Answer 788

Eyes, testes Certain anatomic sites have inherent immune privilege, in which inflammation is inhibited by multiple mechanisms (physical barriers, lack of lymphatic, low expression of MHC I); this helps limit potential organ damage from a robust inflammatory response Self antigens located in immune privileged sites can be recognized by T cells that escape negative selection in thymus. If self antigens released into lymphatic as a result of trauma, T cells may recognize self antigens as foreign and mount a response in both injured organ and non injured organ. Bacterial introduction and exposure during trauma may upregulate inflammation, increasing chances that auto reactive T cells will develop ** trauma to the eye, an organ that has inherent immune privilege, can lead to release of previously sequestered antigens that T cells recognize as foreign—> can lead to subsequent inflammation and blindness in both injured and uninjured eye

Answer 789

Limb malformation

Answer 790

More than 1 delusion for more than 1 month in absence of other psychiatric symptoms Behavior is not obviously bizarre and functioning is not significantly impaired

Answer 791

Infection of deep tissues dt GAS PYROGENIC EXOTOXIN RELEASE Requires emergent surgical debridement Type 2: GAS, sometimes by staph, occurs in HEALTHY PEOPLE AFTER MONOR SKIN TRAUMA Classic case: minor trauma, redness/warmth, PAIN OUT OF PROPORTION TO EXAM, fever, hypotension

Answer 792

Stains nucleic acids ``` Rickettsia Chlamydia Trypanosomes- causes Chagas dx Plasmodium Borrelia H pylori ```

Answer 793

Carrier proteins for OXYTOCIN and ADH Oxytocin and ADH are carried by neurophysins from their site of production in cell bodies of paraventricular and supraoptic nuclei to their site of release in the axon terminals of posterior pituitary POINT MUTATIONS in neurophysin II cause HEREDITARY HYPOTHALAMIC DIABETES INSIPIDUS—> disorder resulting from insufficient ADH release into circulation

Answer 794

Facultative intracellular GP rod that causes febrile gastroenteritis Evades host immunity by: - LISTERIOLYSIN O (generates pores in phagosome membranes, allows phagocytosed Listeria to escape into cytoplasm of monocytes and avoid lysosomal destruction - actin based trans cellular spread (hijacks actin based motility mechanism of host cells, which allows it to spread cell to cell without re entering extracellular space. Reduces exposure to abs and phagocytic cells Infections controlled primarily by cytotoxic t cells Pregnant women in 3 trimester are at greatest risk

Answer 795

- endotoxin - similar to LPS - found on non enteric GNs - N meningidits more important example

Answer 796

AD bleeding disorder caused by either a deficiency or qualitative defect in vWF (multimeric protein that is required for platelet adhesion by binding platelet Gp1b) vEF normally produced by endothelial cells and megakaryocytes Abnormal vWF causes defect in INITIAL adhesion of normal platelets to damaged vessel vWF also carries factor VIII, so those levels will also be low—> prolonged PTT Spontaneous bleeding, prolonged bleeding time, menorrhagia Normal platelet count Prolonged bleeding time (indicates platelet pathology) Prolonged PTT (intrinsic pathway defect) ABNORMAL PLATELET AGGREGATION ON RISTOCETIN dt abnl vWF Tx- desmopressin, which releases vWF from Weibel Palade bodies of endothelial cells

Answer 797

1. Communicating hydrocele 2. INDIRECT inguinal hernia - common in children, pass thru deep inguinal ring and covered by internal spermatic fascia, lateral to inferior epigastric vessels - persistent communication between scrotum and abdominal cavity - both present as asymptotic scrotal mass that increases in size with Valsalva

Answer 798

Amoeba that causes colitis (bloody, mucusy diarrhea) and liver abscesses characterized by ulcers with undermining edges (flask shaped) that contain cysts and trophozoites Anchovy paste exudate in liver abscess Trophozoites can invade colonic wall abs disseminate through blood Transmitted fecal- oral, ingesting contaminated water, developing nations (travel/residence)

Answer 799

In thoracic section of spinal cord Autonomic nerves

Answer 800

RCA | - infarct may cause nodal dysfunction (bradycardia, heart block)

Answer 801

Plasma cell malignancy—> excess production of immunoglobulins DEPENDENT ON IL6 Disorder of older patients SPEP: M spike CRAB: hyperCalcemia- osteoclast mediated bone resorption, caused by cytokines from myeloma cells, “PUNCHED OUT lesions” on XR, esp vertebral column, elevated CALCIUM Renal failure- light chains and hypercalcemia, excess light chains cannot be reabsorbed and reach distal tubule—> form obstructing casts—> light chains in urine= BENCE JONES PROTEINS Anemia Back pain and bacterial infections- decreased production of normal igs, depressed humoral immunity—> s PNA, S aureus, E. coli ROULEAUX FORMATION

Answer 802

HIGH serum alkaline phosphatase, normal calcium and phosphate Caused by abnormal osteoclasts that accelerate bone remodeling, resulting in bone pain, bitemporal skull enlargement, hearing loss, abnormal bone architecture with increased bone density, cortical thickening, and bowing Feared outcome: osteosarcoma

Answer 803

Cancer of bile duct epithelial cells Symptoms from bile obstruction Key risk factors: - CHRONIC BILIARY INFLAMMATION - primary sclerosing cholangitis (UC) - CLONORCHIS SINESIS

Answer 804

Inhibits bacterial RNA polymerase

Answer 805

Protease that kills leukocytes and causes necrosis Expressed by certain staph aureus strains Causes necrotizing PNA, skin/soft tissue abscesses

Answer 806

Gallstones, ETOH

Answer 807

Preload (LVEDV/P) After load (MAP) Contractility (ejection fraction) HR Hearts starved for O2–> reduce O2 demand Low output—> need to increase work

Answer 808

AR disorder of tyrosine metabolism Deficiency of homogentisic acid dioxygenase blocks homogentisic acid metabolism, preventing conversion of tyrosine to fumarate Homogentisic acid accumulates in body and is excreted in urine—> turns black Deposits in cartilage, connective tissue—> ochronotic arthropathy and ochronosis

Answer 809

High aldosterone, low renin Treatment resistant HTN HTN Hypokalemia Metabolic alkalosis Does not directly cause edema dt aldosterone escape mechanism

Answer 810

Caused by oxidation of ferrous ions (Fe2+) in heme to ferric (Fe3+) which is unable to bind oxygen Nitrites can induce it—> results in tissue hypoxia Treat with METHYLENE BLUE - converts Fe3+ to Fe2+—> restores blood O2 carrying capacity and tissue O2 availability

Answer 811

Alpha 2 (CNS sympatholytic, decreased insulin release) Muscarinic 2 (lower cardiac contractility and HR)

Answer 812

Decreased bone strength resulting from low bone mass abs microarchitectural deterioration of bone tissue - increased susceptibility to fragility fractures (minimal or no trauma fx) NORMAL CALCIUM NORMAL PTH NORMAL PHOSPHORUS ``` Risk factors: Caucasian Female Postmenopausal Old age Sedentary Low body weight Poor Ca and D intake Alcohol and tobacco use Premature menopause Steroid use ```

Answer 813

``` Anterior pituitary (Rathke pouch) Lens and cornea Inner ear, olfactory epithelium Nasal and oral linings, salivary glands Epidermis, sweat, mammary glands ```

Answer 814

Marfan syndrome (idiopathic cystic medial degeneration)

Answer 815

Ie apixaban Directly block Xa active site—> reduced conversion of PROTHROMBIN TO THROMBIN Oral, no drug level monitoring needed

Answer 816

Auto activated C3b continually forms in intravascular space and is rapidly inactivated by healthy cells In presence of microbes or damaged cells—> C3b production amplified, engages with factor B and factor D to generate C3 convertase

Answer 817

Superantigen that binds to MHCII complex of APCs without processing and no specifically activate T cells—> dramatic release of inflammatory cytokines—> hypotension, high fever, organ failure, rash

Answer 818

GALT deficiency AUTOSOMAL RECESSIVE Accumulation of galactose 1 phosphate—> TOXIC METABOLITE that causes renal and liver dysfunction Vomiting, lethargy, failure to thrive Can predispose neonates to E. coli sepsis

Answer 819

Cholinergic agonist Stimulates peristalsis in post op ileus and non obstructive urinary retention (atonic bladder)

Answer 820

NADH and CO2

Answer 821

Lymphocyte and plasma cell infiltration of portal and peripheral regions of liver MC in women + anti smooth muscle antibody Hypergammaglobulinemia

Answer 822

Maculopapular rash with head to toe progression JOINT PAIN Postauricular LAD Transplacental transmission to fetus causes CONGENITAL RUBELLA SYNDROME - sensorineural deafness - cataracts - PDA - microcephaly - growth restriction

Answer 823

Cofactor in CARBOXYLATION RXNS (add 1 C) 1 pyruvate carboxylase- gluconeogenesis 2 acetyl co A carboxylase- FA synthesis 3 propionyl co A carboxylase- odd chain FA

Answer 824

Th1 drives CMI- CD8 and macrophages Macrophages release IL12–> drives Th1 production Th1 secretes IL2- Activates B and NK cells, T cell growth factor IFN gamma- activates Th1 and suppresses Th2, activates more macrophages, express more MHC I and II

Answer 825

1. Myogenic response- AFFERENT glomerular arterioles reflexively constrict when they sense greater stretch forces (HIGH BP) 2. Tubuloglomerular feedback- high arterial pressure causes hyperfiltration (high GFR), increasing Na and Cl delivery to macular densa, which secreted vasoactive mediators (adenosine) to constrict AFFERENT ARTERIOLES - protects organs from persistent high BP - in patients with long standing HTN, there is baseline afferent arteriolar constriction, causing renal auto regulation to right shift: HTNsive patients kidneys receive less blood flow at any given BP therefore quickly lowering the BP to normal—> causes steep drop in blood flow, leading to relative ischemia (bump in act, granular casts in urine, AKI)

Answer 826

Heat resistant spores Prevents ACh release at NMJ (no muscle contraction)—> floppy paralysis Dx caused by spore INGESTION Many variants of toxin produced—> carried by BACTERIOPHAGES NOT IN DNA OF BACTERIA

Answer 827

MOST COMMON NH LYMPHOMA B cell malignancy- CD19 and CD20+ Most cells express Ig Occurs in older adults OCCURS IN HIV PTS with low CD4 count - AIDS defining illness TREAT WITH RITUXIMAB- mab CD20 ab. Used in CD20+ B cell lymphomas (diffuse large B cell, follicular)

Answer 828

Anti arrhythmia III - blocks K channels in phase 3 Risk of TORSADES DE POINTES, EXCESSIVE BETA BLOCKADE

Answer 829

High birth rates High mortality rates Short life expectancy Growing population Developing countries

Answer 830

Motor nerves

Answer 831

Opacification of LENS

Answer 832

Unvaccinated child, febrile illness, neuro symptoms 4-5 days later Weakness (legs>arms) Flaccid muscle tone Polio causes destruction of cells in anterior horn

Answer 833

Blueberry muffin baby Seizures Hepatosplenomegaly Newborn deafness

Answer 834

Radiation damage primarily affects alveolar capillary barrier —> inflammatory response with cytokine cascade (IL1, TNF a) and growth factors (PDGF, TGFb) Acutely- hyaline membrane formation, exudative alveolitis Cough and dyspnea

Answer 835

POOR TISSUE OXYGEN USE 3 major mechanisms: 1. Bacterial components and acute phase cytokines trigger production of free radical that damage mitochondria and interfere with ETC—> mitochondrial dysfunction causes decreased oxidative phosphorylation with loss of ATP and shift toward glycolysis which causes lactic acidosis 2. Microcirculatory failure with vasodilation —> blood shunts rapidly thru organs, decreasing opportunity for O2 extraction 3. Increased capillary permeability causes tissue edema—> increases diffusion distance for oxygen to reach mitochondria of target cells

Answer 836

NMDA ANTAGONIST Rapid induction anesthesia, short acting PRESERVES RESPIRATORY DRIVE and PROVIDES ANALGESIC EFFECT Ketamine stimulates release of catecholamines (ie sympathomimetic) which causes BRONCHODILATION, but will increase HR, myocardial contractility, and cerebral blood flow—> puts pts at risk for CV events or INCREASED INTRACRANIAL PRESSURE

Answer 837

Recurrent binge eating episodes and INAPPROPRIATE COMPENSATORY MECHANISMS (fasting, excessive work out) Pts are NORMAL or overweight

Answer 838

``` Cranial bones Adrenal medulla Leptomeninges— Pia and arachnoid Melanocytes Enterochromaffin cells Tracheal cartilage ``` ``` PNS ganglia (Schwann cells) Odontoblasts Spiral membrane— aorticopulmonary septum Endocardial cushions ``` Cranial nerves 3-12

Answer 839

Common malignancy in chemistry under 5 Arises from NCC that populate adrenal medulla and sympathetic chain Mutation in tumor suppressor, MYCN - poor prognosis ASYMPTOMATIC ABDOMINAL MASS CROSSING MIDLINE Histo- small blue cells forming Homer Wright peudorosettes (rings of tumor cells that surround tumor nerve fibers)

Answer 840

MC porphyria, defective heme synthesis that leads to accumulation of heme precursors Usually ACQUIRED DEFICIENCY OF UROPORPHYRINOGEN DECARBOXYLASE - familial - HCV Accumulation of UROPORPHYRIN —> tea colored urine PHOTOSENSITIVITY- blisters, shearing of skin in sun exposed areas, and hyperpigmentation EXACERBATED BY ALCOHOL, HIV, HCV Treat- PHLEBOTOMY, AVOID SUN, ANTI MALARIALS (hydroxychloroquine)

Answer 841

1. Avoidant- avoidance due to fears of criticism and rejection 2. Dependent- submissive, clingy, needs to be taken care of 3. Obsessive- compulsive- rigid, controlling, perfectionist

Answer 842

Contains mesoderm Arch 3- aortic arch, common carotids, and internal carotids Arch 4- aortic arch and subclavian artery

Answer 843

Defect in CD40L on CD4 T cells. —> prevents B cells from class switching Clinically- recurrent sinopulmonary, GI (Giardia), minimal lymphoid tissue, and opportunistic infections High IgM, low/absent IgG/IgA/IgE

Answer 844

Hemolysis - PCNs bind to surface of RBCs—> abs against PCN bound to RBCs - direct Coombs test + IgG mediated

Answer 845

1. Thyroxine 2. Dopamine 3. Epinephrine 4. NE 5. Melanin

Answer 846

P. Vivax and ovale Dormant hepatic stage and can cause recurrent parasetemia Tx with chloroquine (erythrocyte phase) and primaquine (dormant hepatic stage)

Answer 847

DiGeorge syndrome: - cardiac abnormalities - hypoplastic/absent thymus - hypocalcemia Velocardiofacial syndrome - cleft palate - cardiac anomalies - dystrophin facies

Answer 848

Midline mass that moves superiorly with protrusion of tongue and swallowing

Answer 849

Sulci of brain and gyri of cerebral cortex absent/decreased Caused by FAILURE OF NEURONAL CELL MIGRATION from germinal matrix of cerebral ventricles Congenital Zika can cause microcephaly, lissencephaly, seizures, facial/ocular abnormalities, hearing loss S/s feeding issues, psychomotor retardation, devo delay, seizures, failure to thrive

Answer 850

Anti IgE antibody - inhibits IgE binding to mast cells, preventing mast cell degranulation Used in patiens with severe, persistent asthma to lower IgE levels and reduce allergen induced bronchial constriction

Answer 851

Caused by outa toon in hematologist stern cells that eliminates production of anchoring protein that attaches surface molecules to cell membrane Loss of membrane anchor prevents RBCs from expressing COMPLEMENT INACTIVATING SURFACE PROTEINS CD55/59 - without these proteins, auto activated compounds of ALTERNATIVE COMPLEMENT PATHWAY cannot be disabled - this leads to complement amplification and generation of MEMBRANE ATTACK COMPLEXES on RBC membrane and subsequent complement mediated hemolysis Treatment with ECULIZUMAB targets C5 (first complement protein to contribute to MAC) can drastically reduce hemolysis and improve symptoms HOWEVER- MAC is crucial for defense against encapsulated bacteria (NEISSERIA) Pts on anti C5 therapy require vaccination against encapsulated bacteria and abx prophylaxis (PCN) to prevent fulminant infection

Answer 852

Recurrent episodes of binge eating No inappropriate compensatory behaviors Lack of control during eating

Answer 853

Syndrome of multiple malignancies at early age (Sarcoma, breast, leukemia, adrenal gland- SBLA cancer syndrome) Mutation in tumor suppressor gene TP53- codes for p53 Mutation: cell cycle not arrested to allow for DNA repair and CELLS FAIL TO UNDERGO APOPTOSIS Accumulation of damage—> malignancy

Answer 854

Tetanospasmin blocks release of GABA and glycine from Renshaw cells in spinal cord Spastic paralysis Tx w metronidazole, tetanus Ig, benzodiazepines, tetanus toxoid vaccine

Answer 855

Evasion of the Na retaining effects of inappropriately elevated aldosterone levels in conditions such as primary hyperaldosteronism or congestive heart failure Mechanism: sodium and water retention → volume expansion → secretion of atrial natriuretic peptide (ANP) and pressure natriuresis → compensatory diuresis → “escape” from edema formation and hypernatremia

Answer 856

Enzymes thy cleave and INACTIVATES IgA Protease allows for colonization of mucosal surfaces Streptococcus pneumonia Haemophilus influenzae type b Neisseria sp

Answer 857

Ras signal transduction Hairy cell leukemia Melanoma

Answer 858

1. Increased physiological dead space (lung elastin degrades, resembles emphysema) 2. Microatelectasis dt remodeling of muscles of inspiration (lower peak force for coughing, deep inspiration)—> intrapulmonary shunting 3. Greater V/Q mismatch—> increased alveolar- arterial (Aa gradient) 4. PaO2 falls dt high Aa gradient PaCO2 not significantly changed

Answer 859

TMP SMX crosses BBB and displaces bilirubin from its albumin binding site—> accumulation of unconjugated bilirubin—> jaundice, kernicterus

Answer 860

GALT deficiency AUTOSOMAL RECESSIVE Accumulation of galactose 1 phosphate—> TOXIC METABOLITE that causes renal and liver dysfunction Vomiting, lethargy, failure to thrive Can predispose neonates to E. coli sepsis

Answer 861

Hypokalemia contributes to digoxin toxicity by allowing digoxin to inhibit Na K ATPase more effectively Loop diuretics cause hypokalemia and hypomagnesemia Phenytoin induces P450s abs leads to DECREASED digoxin levels

Answer 862

1. Reduces hepatic gluconeogenesis and release of glucose into serum and reduces glucose uptake from intestines 2. Increased insulin dependent peripheral glucose uptake and utilization 3. Reduces circulating lipid levels Circulating insulin is unchanged

Answer 863

Blood supply- SUPERIOR RECTAL ARTERY (IMA branch) Venous- superior rectal vein—> inferior mesentery vein—> PORTAL SYSTEM Lymph drainage- INTERNAL ILIAC NODES Visceral innervation (no pain) - internal hemorrhoids - ADENOCARCINOMA

Answer 864

Trabeculated part of LV and RV

Answer 865

Bacillus anthracis Capsule is D GLUTAMATE Limits/ prevents phagocytosis

Answer 866

Cholelithiasis: fibrates inhibit cholesterol 7α hydroxylase → decreased bile acid synthesis → supersaturation of bile with cholesterol (↑ cholesterol:bile acid ratio)

Answer 867

Enhanced parasympathetic tone —> bradycardia and AV block, reduced CO and syncope

Answer 868

AR- males and females equally affected, consanguinity increases incidence of autosomal recessive condition Deficient pyruvate kinase—> RBCs unable to produce sufficient ATP to maintain normal plasma membrane NaK ATPase activity—> RBCs swell and lyse Echinocytes on smear Fatigue, pallor, scleral icterus, jaundice, splenomegaly (extravascular hemolysis)

Answer 869

Tissue deposition of circulating immune complexes (TYPE III HSR) Fever, rash, arthralgia 7-14 days after antigen exposure Bx shows: 1. Fibrinoid necrosis of small vessels with neutrophil infiltration 2. Hypocomplementemia (decreased C3/C4)—> deposition of IgG/IgM complement fixing abs causing complement consumption Can occur after administration of chimeric monoclonal antibody (infliximab), non human immunoglobulins (venom anti toxins), certain non protein drugs—> PCN, cefaclor, TMPSMX

Answer 870

Uric acid is soluble at physiologic pH, but precipitates in ACIDIC environment The lowest pH in nephron is in DCT and CD—> these segments can become obstructed by uric acid crystals Obstructive utopia they and acute renal failure follow

Answer 871

Antigen binding fragments Contain variable domain and first constant region of heavy and light chain DO NOT CONTAIN Fc region, therefore DO NOT ACTIVATE complement of trigger phagocytosis via Fc receptor on macrophages Fab fragments used in immunotherapy have greater tissue penetration and pharmacokinetics because they are smaller fragments

Answer 872

Derived from septum transversum Only exists between esophagus, STOMACH, upper duodenum In adult: - connection between liver and anterior abdominal wall—> Falciform ligament - connection between liver and stomach—> lesser omentum

Answer 873

``` Tb Sarcoidosis Crohns Leprosy Cat scratch disease (Bartonella henslae) Schistosomiasis Syphilis Temperal arteritis CGD Listeria monocytogenes ```

Answer 874

Associated with p53 mutations Cells produce inactive p53–> uncontrolled cell growth

Answer 875

Causes free radical injury CCl4 oxidized by P450 system—> free radicals that reacts with structural components of lipid membrane —> lipid degradation and hydrogen peroxide formation (LIPID PEROXIDATION) CCl4 cell injury is rapid and leads to swelling of endoplasmic reticulum, mitochondria destruction, increased cell membrane permeability —> culminates in hepatic necrosis

Answer 876

``` Amiodarone Cimetidine Flurorquinolones Clarithromycin Azole antifungals Grapefruit juice INH Ritonavir (protease inhibitors) ```

Answer 877

Leads to increase in parasympathetic tone causing temporary inhibition of SA node activity, slowing conduction through AV node and prolongation of AV node refractory period Useful to terminate paroxysmal supraventricular tachycardia

Answer 878

An ionotopic receptor that depolarizes the neuron when activated by glutamate (and glycine less frequently). Critical for controlling synaptic plasticity and memory function. Overactivation can cause excitotoxicity and cell death.

Answer 879

Insulin INDEPENDENT glucose transporter - uptake when glucose high BRAIN RBC

Answer 880

INCREASED AFP Normal bHCG, inhibin A,unconjugated estriol Connection between spinal canal and amniotic cavity dt failure of anterior and posterior neuro pores NTD also associated with HIGH ACETYLCHOLINESTERASE in amniotic fluid- results from fetal CSF leakage

Answer 881

Hyperthermia Muscular rigidity AMS autonomic dysfunction (tachy, diaphoresis, labile BP) Caused by dysregulation of dopamine - antipsychotics block dopamine (dopamine antagonists)

Answer 882

Precursor to SCC

Answer 883

Seminoma (malignant, radiosensitive) | High placental ALP

Answer 884

Inhibit dihydrofolate reductase—> decreased thymidine in humans, bacteria, protozoa

Answer 885

More dangerous, risk of toxicity ``` Cyclosporine INH erythromycin cimetidine Azoles grapefruit juice Ritonavir ```

Answer 886

STIs | Mets

Answer 887

Chemotactic for neutrophils

Answer 888

Produces CAMP factor- enhances beta hemolysis when streaked with S aureus Hippurate test + Screen 35-37 week pregnant women for GBS- if positive give PCN Can cause sepsis, meningitis, PNA in newborns

Answer 889

Effect of substance A and B together is greater than sun of their individual effects Clopidogrel with aspirin

Answer 890

``` AMS (disorientation) Autonomic hyperactivity (hyperthermia, tachycardia, diaphoresis) Neuromuscular excitation (hyperreflexia, clonus, tremor) ``` Caused by excessive serotonin activity, MC dt SSRI + another serotonergic agent

Answer 891

Pearly, waxy nodule with nonhealing central ulceration, telangiectasias Malignant cells derive from STRATUM BASALE (deepest layer of epidermis. Undergoes most cell division) Malignant cells form dermal nests with peripheral nuclear palisading Sun exposed areas of head, neck, upper trunk, rarely metastasizes

Answer 892

Enzyme in presynaptic nerve terminals that breaks down monoamine neurotransmitters (serotonin, NE, dopamine) MAOIs: irreversibly bind and inhibit MAO—> increased presynaptic availability of monoamine neutransmitters and increase their release into synaptic cleft - need washout period before starting SSRI to reduce risk of Serotonin Syndrome PHENELZINE TRANYLCYPROMINE SELEGILINE

Answer 893

AD inheritance/age related deposition Transthyretin (prealbumin)—> mutation/aging —> amyloid transthyretin (mutated) ATTRm in hereditary OR amyloid transthyretin (wild type) ATTRwt in senile Heart, peripheral nerves, ligaments (carpal tunnel)

Answer 894

Removes pyramidine dimers caused by UV damage Specific endonuclease complex detects abnormality —> nicks damaged strand on both sides of pyrimidine dimer and defective region is excised Mutations in nucleotide excision cause XERODERMA PIGMENTOSUM (severe photo sensitivity and skin cancer at young age)

Answer 895

Alprostadil (PGE1 )

Answer 896

Ehrlichia, vector is tick MONOCYTES WITH MORULAE (mulberry like inclusions in cytoplasm) Non specific symptoms: - fever, chills, myalgia, macularpapular rash, LYMPHOPENIA - elevated liver enzymes

Answer 897

Cytotoxic T cells | Kill viral infected cells and tumor cells

Answer 898

PTH production and secretion PTH normally maintains calcium homeostasis via PTH mediated increases in bone resorption, renal calcium absorption, and phosphate excretion

Answer 899

Exposure to actual or threatened trauma Intrusive memories, nightmares, flashbacks with intense psychological/physiological reactions Amnesia for event, detachment, avoidance of reminders Negative mood, dissociative symptoms Arousal with sleep disturbance, irritability, hypervigilance, exaggerated startle, impaired concentration LASTS MORE THAN THREE DAYS AND LESS THAN 1 MONTH

Answer 900

Displacement of humeral head anterior and inferior Causes axillary nerve injury - impaired shoulder abduction - loss of sensation over lateral arm Axillary nerve provides MOTOR innervation to deltoid and teres minor and SENSORY to skin overlying deltoid

Answer 901

Seen in conditions that delay RV emptying - pulmonic stenosis - RBBB Causes delayed pulmonic sound (on inspiration)

Answer 902

cAMP - alpha 2 stimulation—> DECREASED cAMP - CNS sympatholytic - decreased insulin release, decreased intestinal motility

Answer 903

Non depolarizing skeletal muscle relaxant that competitively blocks NICOTINIC ACETYLCHOLINE RECEPTOR Effect is reversed with AChE inhibitor such as neostigmine because increased ACh will compete with vencuronium at receptor

Answer 904

Deletion of Phe508 on chromosome 7

Answer 905

Smoking associated Tumor is located CENTRALLY ALONG BRONCHIAL TRACT May cause cavitary lesion with central necrosis If tumor arises in upper lung lobe, can extend peripherally to apex, erode adjacent structures, and cause signs of Pancoast tumors (assoc with Horner syndrome, pain in ULNAR NERVE distribution dt brachial plexus compression, superior vena cava syndrome, and erosion into vertebral structures)

Answer 906

IL1, TNF a | IL6, IL 8, IL12

Answer 907

Caused by auto antibody-mediated T cell dependent attack on ACh RECEPTORS OF POST SYNAPTIC NEUROMUSCULAR JUNCTION - ab mediated blockade of active site of AChRS prevents ACh from binding and triggers endocytosis of AChRs (receptor internalization) and complement mediated post synaptic membrane damage —> REDUCED NUMBER OF AChRs and impaired neuromuscular blockade Acquired autoimmune disorder characterized by fatigue, fluctuating weakness of skeletal muscle MC affected muscle are OCULAR, BULBAR (dysarthria, fatigue when chewing), facial (loss of smile), proximal (neck/shoulder) weakness RESPIRATORY FAILURE CAN OCCUR DT DIAPHRAGM WEAKNESS Tx: PYRIDOSTIGMINE: Inhibit AchE → ↓ breakdown of ACh → ↑ ACh levels

Answer 908

Transformation- bacterial cell takes up naked, exogenous out DNA and incorporates into genome Transduction- bacteriophage (virus) transfers DNA from one bacterial cell to another. How bacteria acquire virulence and abx resistance

Answer 909

Immunosuppressant Inhibits IMP dehydrogenase - less guanine nucleotides for T and B cell replication

Answer 910

Methylation Glucuronidation Acetylation- slow acetylators have high side effects Bc if low rate of metabolism (INH, sulfasalazine, procainamide, hydralazine) Sulfation Polar metabolites

Answer 911

MC primary cerebral neoplasm in adults Derives from ASTROCYTES, GFAP + Located in CEREBRAL HEMISPHERES, can cross corpus callosum- “butterfly glioma” Soft, poorly defined margins with areas of NECROSIS and HEMORRHAGE Highly malignant. Less than 1 year survival. Ring enhancing on MRI

Answer 912

Thiazolidinedione Activates transcription regulator PPARgamma, decreased insulin resistance AE- fluid retention/heart failure, WEIGHT GAIN

Answer 913

Biliary cirrhosis without extra hepatic obstruction INTRAHEPATIC DUCTS AUTOIMMUNE DX - T CELL ATTACK ON intralobular bile ducts - GRANULOMATOUS INFLAMMATION ABSENCE OF BILIARY OBSTRUCTION MC in FEMALES - FATIGUE AND ITCHING (obstructed bile ducts—> impaired bile acid excretion—> bile acids deposit in skin and cause ITCHING Pruritis often precedes development of jaundice + ANTI MITOCHONDRIAL ABS, MARKEDLY ELEVATED ALK PHOS

Answer 914

Fungus, PNA in immunocompromised AIDS defining illness Dx BAL with SILVER STAIN Tx with TMPSMX, pentamidine, dapsone PROPHYLACTIC TMP SMX when CD4 count <200

Answer 915

Blocks Na channels and INCREASES GABA levels

Answer 916

Benign salivary tumor that has strong association with cigarette smoking Usually bilateral, slow growing Histologically characterized by cystic spaces lined by oncocytic cells abs dense lymphoid stroma with germinal centers

Answer 917

HIGHEST RESISTANCE TO FLOW Pressure change will always be greatest across arterioles Major determinant of TPR - vasoconstriction - high TPR - vasodilation - low TPR

Answer 918

t(14;18) BCL2 overexpression—> apoptosis evasion Non Hodgkin’s lymphoma derived from germinal center B cells Painless, slow growing, waxing and waning LAD IN MIDDLE AGED/ELDERLY

Answer 919

Primitive, tense bullae, NO MUCOSAL INVOLVEMENT SUBEPIDERMAL CLEAVAGE DEPOSITION OF IGG AND COMPLEMENT AT DERMAL EPIDERMAL JUNCTION autoantibodies against hemidesmosomes Negative Nikolsky

Answer 920

Inhibits arabinosyl transferase AE- optic neuropathy

Answer 921

Receptor tyrosine kinase Breast and gastric carcinoma

Answer 922

Opportunistic FUNGAL infection Meningitis in HIV/AIDS In soil and pigeon droppings Heavily encapsulated—> halo with India ink Can be cx on Sabourad agar Stains with mucicarmine (red inner capsule) Latex agglutination test—> detects polysaccharide capsular antigen CAUSES HIGH ICP AND RISK OF BRAIN HERNIATION WITH LUMBAR PUNCTURE Sometimes need intrathecal tx

Answer 923

Lung, breast, melanoma/colon/kidney

Answer 924

Recurrent inflammation/thrombosis of small/medium vessels in extremities

Answer 925

Serous cystadenocarcinoma

Answer 926

Aniline dye that stains RNA blue High affinity for polyribosomes in cytoplasm and on RER Ribosomal RNA are basophilic

Answer 927

Fructose transporter via Facilitated diffusion.

Answer 928

Constant rate of elimination per time No dependence/variation with concentration of drug No constant half life PEA- phenytoin, ethanol, aspirin CAPACITY LIMITED ELIMINATION

Answer 929

Colon cancer | IBD

Answer 930

Intracellular receptors that can bind peptidoglycan and will cause cytokines release Innate IS

Answer 931

1. CD14- LPS 2. Fc receptor- Fc on abs 3. C3b receptor- C3b complement 4. MHCII- binds CD4 on T cell 5. B7- binds CD28 on T cell 6. CD40- CD40 ligand on T cell

Answer 932

Dyspnea, hypoxemia, patchy alveolar infiltrates several days after arrival at high altitude Pathophys- driven by reduced partial pressure of oxygen—> hypoxia pulmonary vasoconstriction and INCREASED subsequent pulmonary arterial pressure —> alveolar capillary membrane disruption causing patchy, bilateral pulmonary edema

Answer 933

0.7x (Vd/t1/2)

Answer 934

Methyldopa abd PCN Mycoplasma PNA can also cause autoimmune hemolytic anemia

Answer 935

C perfringens- alpha toxin- phospholipase (lecithinase) that degrades cell membranes and tissues —> myonecrosis (gas gangrene) and double zone of hemolysis S pyogenes- streptolysin O- protein that degrades cell membrane- lyse RBCs, contributes to beta hemolysis, HOST ABS against toxin (ASO) used to dx rheumatic fever

Answer 936

Staph aureus- TSST1, scalded skin (exfoliative toxin), toxic shock, food poisoning (heat stable enterotoxin) Streptococcus pyogenes- erythrogenic exotoxin A—> scarlet fever, rash, fever, shock ``` Both cross link beta region of TCR to MHCII on APCs outside of ag binding site—> OVERWHELMING RELEASE OF IL1 IL2 TNF a IFN —> cause SHOCK ```

Answer 937

1. Regeneration of alveolar lining following injury | 2. Surfactant production

Answer 938

Anti Tb agent Inhibits mycobacterial arabinosyl transferase- necessary for mycobacterial cell wall AE: blindness, optic neuritis, vision changes

Answer 939

Contains hepatoduodenal ligament of its free edge - contains: 1. Hepatic artery proper 2. CBD 3. Portal vein

Answer 940

Glycogen debranching enzyme deficiency —> alpha 1,6 glucosidase deficiency Hepatosplenomegaly, hypoglycemia, failure to thrive, recurrrent infections in childhood Short outer branches, single glucose residue at outer branch—> LIMIT DEXTRIN LIKE STRUCTURES ACCUMULATE IN CYTOSOL

Answer 941

Innervates intrinsic and extrinsic tongue muscles Lesion to CNXII causes hemipralysis of tongue—> protrusion causes the tongue to point to weak (lesion) side because of unopposed action of opposite genioglossus

Answer 942

Acute immune mediated condition affecting skin and mucus membranes TYPE IV HSR- cytotoxic CD8 cells attack basal epithelial cells —> vesicles and erosions in skin and mucosa (macules, vesicles, bullae, and papules) Most characteristic- TARGERTOID LESIONS (central necrosis surrounded by erythema) on hands and soles ASSOCIATED WITH PRECEDING MYCOPLASMA OR HERPES SIMPLEX VIRUS - characteristic hemorrhagic crusting of vermilion borders of lips

Answer 943

Caused by androgen receptor defect Patients have normal male genotype (46XY), normal F phenotype, abdominal testes, short vagina, absent ovaries/uterus SPARSE PUBIC HAIR

Answer 944

Poultry/eggs, exotic pets Primarily FOODBORNE Industrialized countries Invades enterocytes—> NEUTROPHIL MEDIATED INFLAMMATORY RESPONSE IN LAMINATE PROPRIA/ PEYERS PATCHES—> controls infection Gastroenteritis- self limited watery diarrhea, risk of OSTEOMYELITIS, MYCOTIC ANEURYSM, ENDOCARDITIS

Answer 945

Collecting system of kidney - collecting tubules, ducts - major and minor calyces - renal pelvis - ureters

Answer 946

Removes primer via 5’ to 3’ exonuclease activity and replaces them with DNA via 5’ to 3F’ polymerase activity DNA pol I is only polymerase to possess 5’ to 3F’ exonuclease activity

Answer 947

Least risk of seizures Carbapenems have risk of seizures

Answer 948

Descending Motor

Answer 949

Personality changes, disinhibition, irritability secondary to impairment of behavioral and emotional modulators systems

Answer 950

1. Extension at elbow, wrist, fingers 2. Forearm supination - injury of radial nerve at supination causes finger and thumb extension weakness 3. Thumb abduction

Answer 951

1. Reduce inflammation by inhibiting inflammatory genes 2. Potentiate the bronchodilatory effects of b2 adrenergic agonists (albuterol) - steroids upregulate b2 receptors on bronchial smooth muscle

Answer 952

PGE2 analog given to promote cervical ripening Increases proteoglycan content and changes collagen properties in cervix, can cause uterine contractility

Answer 953

Liver, muscle, bronchioles Dilate vessels, bronchodilator b2 block does not lower BP

Answer 954

Eastern central US, Great Lakes BROAD BASED BUDDING Disseminates to BONE (OSTEOMYELITIS), SKIN LESIONS, slow onset PNA Amphotericin B for systemic, local fluconazole/itraconazole

Answer 955

Caused by Mycobacterium leprae. Likes cool temperatures—> infects skin and superficial nerves (stocking and glove loss of sensation). Cannot be grown in vitro Tuberculoid leprosy- LIMITED to few hypoesthetic hairless skin plaques, HIGH CELL MEDIATED IMMUNITY with Th1 response and LOW BACTERIAL LOAD Granulomas dt strong Th1 CMI response

Answer 956

Common renal malignancy in peds Painless, palpable abdominal mass that DOES NOT cross midline Causes HTN (dt renin secretion) and hematuria ``` Associated with WAGR syndrome: Wilms tumor Aniridia GU malformation Retardation ``` Deletion of WT1 gene - transcription factor for normal GU development Tx: vincristine/vinblastine (AE neuropathy)

Answer 957

In follicular stage, estrogen suppresses FSH and LH through negative feedback inhibition of hypothalamus- pituitary- ovarian axis. Once plasma levels of estrogen reach critical threshold, the negative feedback loop switches to positive feedback loop and LH and FSH surge occurs. This occurs at the end of the follicular phase. LH surge causes ovulation

Answer 958

Noncaseating granulomas with EPITHELOID HISTIOCYTES Multinucleated giant cells of Langerhans Asteroid bodies Schaumann bodies

Answer 959

Adduction and external rotation Axillary nerve

Answer 960

Adduction and internal rotation Upper and lower subscapular nerve

Answer 961

TKI of bcr- abl t(9;22) in CML And c-kit in gi stromal tumors AE- fluid retention

Answer 962

B cell malignancy **marginal zone of LN forms and expands in chronic inflammation** Often extranodal LYMPHOMA IN CHRONIC INFLAMMATORY DX - SJOGRENS - HASHIMOTOS - MALToma

Answer 963

Aka lymphoplasmacytic lymphoma B CELL LYMPHOMA- tumor cells differentiate into plasma cells—> PRODUCE IGM ABS—> hyperviscosity symptoms No osteolytic lesions SPEP- M spoke is IgM S/s: HYPERVISCOSITY SYNDROME - sluggish blood flow, sludging - CNS impairment- HA, dizziness, coma - VISUAL IMPAIRMENT, RETINAL HEMORRHAGE - Raynauds Medical emergency- emergent plasmapheresis Complications- THROMBOSIS

Answer 964

A pattern of chronic inflammation Can be induced by persistent T cell response to infections (Tb) Immune mediated diseases FOREIGN BODIES Wall off resistant stimulus without completely eradicating or degrading it—> persistent inflammation Center of EPITHELOID CELLS (activated macrophages with abundant pink cytoplasm) surrounded by lymphocytes and multinucleated giant cells (formed via fusion of several activated macrophages) T cell mediated HSR—> type IV, CMI processs APCs present to CD4 Th cells and secrete IL12–> CD4 differentiates into Th1 cells Th1 cells secret IFN gamma—> macrophage activation Macrophages secrete TNFa—> donation of epithelioid macrophages and giant cells

Answer 965

Blueberry muffin baby Cataracts Congenital heart disease - PDA Mother acquires infection via respiratory droplets - rash, fever, LAD

Answer 966

Plasma protein that binds free Hb Haptoglobin- hb complex cleared by liver Low serum haptoglobin with intravascular hemolysis

Answer 967

Blood supply- INFERIOR RECTAL ARTERY (branch off pudendal artery (off iliac)) Venous- inferior rectal—> internal pudendal—> internal iliac—> IVC lymph- superficial iliac nodes Somatic innervation - painful - external hemorrhoids SQUAMOUS CELL CARCINOMAS (more common Anal ca)

Answer 968

Hindgut and ectoderm need to meet to firm anus—> if fails to happen—> absence of anal opening—> imperforate anus Commonly associated with GU malformations - renal agenesis - bladder exstrophy S/s - failure to pass meconium - meconium from urethra/ vagina (fistula)

Answer 969

Forms within psoas major muscle from posterior divisions of anterior rami L2-L4 Femoral nerve lies in the groove between psoas major and iliacus Femoral nerve innervates all of the muscles of the anterior compartment of thigh—> hip flexors abs knee extenders

Answer 970

Stimulation of cellular proliferation Gain of function mutation Requires damage to one allele

Answer 971

Burkitt lymphoma (c myc fusion, transcription factor oncogene)

Answer 972

Stains nucleic acids—> gets inside cells ``` Rickettsia Chlamydia TRYPANOSOMES Plasmodium Borrelia H pylori ```

Answer 973

Sympathomimetic: b1> b2, a INCREASE HR, INCREASE CO, no change/lower bp Used in HF, cardiogenic shock (+inotrope), cardiac stress testing

Answer 974

5-HT1B/1D receptor agonists that cause: Vasoconstriction of (dilated) cranial and basilar arteries Inhibition of trigeminal nerve nociception Inhibition of vasoactive peptide secretion Most effective if taken at the onset of headache DECREASE NEUROGENIC INFLAMMATION DECREASE CGRP RELEASE VASOCONSTRICTION

Answer 975

Heparin - LMWHs: dalteparin, enoxaparin Heparins DO NOT cross placenta

Answer 976

M Tb virulence factor Prevents phagolysosome fusion and acidification —> allows M Tb to replicate in uncheck fashion within phagosome of alveolar macrophage

Answer 977

CDH1 gene, component of adherens junctions Mutated in gastric adenocarcinoma and infiltrating lobular carcinoma of breast

Answer 978

Humerus fracture can lacerate RADIAL NERVE Causes loss of function to the muscles that extend the wrist and digits and sensory loss on posterior forearm and hand Patients have difficulty stabilizing wrist when attempting to make a fist

Answer 979

High ventricular filling pressure (mitral regurgitation, HF)- sudden deceleration of blood from LA to LV Common in dilated ventricles- LHF

Answer 980

Psoriatic arthritis Ankylosing spondylitis IBD associated arthritis Reactive arthritis

Answer 981

Lupus nephropathy

Answer 982

Degeneration of dorsal columns

Answer 983

Hyperproliferation of fibroblasts which results in DISORGANIZED overproduction of hyalinized collagen types I and III

Answer 984

Rifampin MOA: inhibits bacterial DNA-dependent RNA-polymerase → prevention of transcription (mRNA synthesis) → inhibition of bacterial protein synthesis → cell death (bactericidal effect)

Answer 985

Antibodies against streptococcal antigens that deposit in GBM IF C3 granular staining EM subepithelial humps nephritic syndrome

Answer 986

[steady state]x(Vd/F)

Answer 987

INNATE IS Key receptors on macrophages, dendritic cells, mast cells Recognize PAMPs (LPS, flagellin, nucleic acids) and DAMPs. Leads to activation of NfKB

Answer 988

Parasitic blood fluke infection Common in sub Saharan Africa Intial infection asymptomatic, patients later develop chronic hepatosplenic (portal HTN, hepatosplenomegaly, esophageal varies) or urinary (bladder cancer) complications years/decades later Eosinophilia important diagnostic clue

Answer 989

AR disorder caused by defective transportation of Cystine, Ornithine, Lysine, Arginine (COLA) across the intestinal and renal epithelium Excess cystine in urine leads to recurrent precipitation of pathognomonic HEXAGONAL CYSTINE STONES Tx- alkalinize urine (acetazolamide, potassium citrate) and cheating agents (penicillimine) Urinary cyanide nitroprusside test diagnostic Methionine free diet Urinalysis shows pathognomonic hexagonal cystine crystal

Answer 990

Invasive - bloody diarrhea Campylobacter, salmonella, shigella, y. Enterolitica, EIEC, entamoeba histolytica, EHEC

Answer 991

Cefotetan, cefazolin- hypoprothrombinemia (low clotting factor levels) Inhibit epoxide reductase (similar to warfarin) Decrease hepatic synthesis of clotting factors - may prolong PT/INR - reversible with vitamin K

Answer 992

Hyperkalemia - TMP blocks epithelial sodium channel in DCT and CD—> impairs Na/K exchange —> reduced K excretion and hyperkalemia Folate deficiency with prolonged use

Answer 993

Preload After load Heart rate Contractility

Answer 994

Multiple, well circumscribed masses At junction of grey- white matter MC mets from lung, breast, kidney, melanoma, colon

Answer 995

Class switching to IgA Growth and differentiation of EOSINOPHILS

Answer 996

MC CAH Hallmarks are SALT WASTING AND VIRILIZATION Salt wasting dt inability to synthesize mineralcorticoids- hyponatremia, hyperkalemia, patient becomes dehydrated dt lack of Na

Answer 997

Both seen in advanced AIDS pts. Both present with night sweats, weight loss, fevers, violaceous vascular skin nodules Bacillary angiomatosis- caused by Bartonellla henslae - Bx: NEUTROPHILIC INFILTRATION AND GRANULOMATOUS CHANGES Kaposi sarcoma- caused by HHV8, lesions present more on legs/face/genitals - on bx: SPINDLE CELLS AND LYMPHOCYTIC INFILTRATE

Answer 998

Increase GI tract smooth muscle tone to produce nausea, vomiting, abd cramps, and diarrhea Decrease HR, cardiac conduction and contractility, may result in bradycardia, heart block, hypotension Cholinergic associated peripheral vasodilation decreases BP dt stimulation of endothelial nitric oxide synthesis Increase secretion, leading to excessive sweating, salivation, lacrimation Can cause dyspnea via bronchoconstriction (increased smooth muscle tone in trachebronchial tree) and increased bronchial secretion

Answer 999

PE leads to increased dead space ventilation with a consequence ventilation/perfusion (V/Q) mismatch that causes HYPOXEMIA. The acute hypoxemia along with pulmonary parenchymal inflammation triggers an increase in respiratory drive and HYPERVENTILATION Rate of CO2 removal is closely tied to ventilation rate, alveolar hyperventilation leads to increased expiration of CO2 with resulting hypocapnia (low PaCO2) and respiratory alkalosis In contrast, rate of O2 absorption becomes capped once hemoglobin is saturated, which occurs at relatively low PaO2 (ie Hb 85% saturated at PaO2 50mmHg). Therefore, blood in highly ventilated lung areas cannot absorb extra O2 to compensate for poorly ventilated regions and hyperventilation does not significantly increase PaO2 Pts with acute V/Q mismatch (PE, PNA) typically have hypocapnia with respiratory alkalosis and persistent hypoxemia

Answer 1000

Inactivated X chromosome - small perinuclear dark staining dot in somatic cells with two or more X chromosomes - found in normal females 46XX and 47XXY (Klinefelter syndrome)

Answer 1001

Cervical LAD with B symptoms Spreads predictably —> limited dx highly curable STAGE IS STRONGEST PREDICTOR OF PROGNOSIS Bimodal age distribution (20 and 60) Risk factors: 1. Prior EBV infection 2. IMMUNOSUPPRESSION (HIV, transplants) - autoimmune dx- RA, lupus

Answer 1002

Calcium releases from sarcoplasmic reticulum binds troponin C—> conformational change in troponin complex, causing it to displace tropomyosin and expose myosin binding sites on actin filaments

Answer 1003

Disorder of impaired horizontal gaze caused by a lesion in MEDIAL LONGITUDINAL FASCICULUS (MLF) Affected eye (same side as lesion) unable to adduct while other eye abducts Convergence and pupil light reflex preserved

Answer 1004

Triad of arthritis urethritis (dysuria, urethral discharge, urgency) conjunctivitis ``` Autoimmune reaction to previous infection with: Shigella salmonella yersinia campylobacter chlamydia ``` HLAB27 associated

Answer 1005

Occurs in M and F | Inherited thru F only

Answer 1006

Benign proliferation’s of melanocytes that involve BOTH dermis and epidermis Lesions are slightly raised papules with uniform pigmentations and symmetrical sharp borders Uniform brown to tan pigmentation

Answer 1007

Excessive and disordered bone formation caused by high osteoclastic activity followed by high osteoclastic activity activity that forms poor quality bone NORMAL Ca, phosphorus, PTH HIGH ALK PHOS Mosaic pattern of woven and lamellar bone - long bone chalk stick fx - hearing loss dt auditory foramen narrowing - high output heart failure (from high blood flow thru AV shunts) - HIGH RISK OF OSTEOSARCOMA (periosteal new bone with lifting of periosteum)

Answer 1008

Purkinje (fastest) Atrial myocytes Ventricular myocytes AV node (slowest)

Answer 1009

Fragments of 180bp multiples Sensitive indicator of apoptosis Laddering arises from the actions of specific endonucleases during karyorrhexis—> cleave DNA IN 180 bp intervals

Answer 1010

Process of cell death that occurs when REGULATING SUBSTANCES (interleukins) withdrawn from proliferating cells Malignant lymphoid cells evade apoptosis by over expressing BCL2 —> anti apoptotic protein

Answer 1011

Excessive and disordered bone formation caused by high osteoclastic activity followed by high osteoclastic activity activity that forms poor quality bone NORMAL Ca, phosphorus, PTH HIGH ALK PHOS Mosaic pattern of woven and lamellar bone - long bone chalk stick fx - hearing loss dt auditory foramen narrowing - high output heart failure (from high blood flow thru AV shunts) - HIGH RISK OF OSTEOSARCOMA (periosteal new bone with lifting of periosteum)

Answer 1012

Purkinje (fastest) Atrial myocytes Ventricular myocytes AV node (slowest)

Answer 1013

Fragments of 180bp multiples Sensitive indicator of apoptosis Laddering arises from the actions of specific endonucleases during karyorrhexis—> cleave DNA IN 180 bp intervals

Answer 1014

Process of cell death that occurs when REGULATING SUBSTANCES (interleukins) withdrawn from proliferating cells Malignant lymphoid cells evade apoptosis by over expressing BCL2 —> anti apoptotic protein

Answer 1015

Involves only oocytes or spermatocytes SHOULD BE CONSIDERED WHEN GENETIC MUTATION IDENTIFIED IN OFFSPRING AND NOT PARENTS

Answer 1016

Low bicarbonate | Higher chloride

Answer 1017

High bicarbonate | Low chloride

Answer 1018

Higher K | Lower Na and Cl

Answer 1019

Isotonic to plasma

Answer 1020

GsPCR AC/cAMP

Answer 1021

GsPCR AC/cAMP

Answer 1022

Receptor tyrosine kinase IP3 pathway

Answer 1023

Normocytic anemia, unconjugated hyperbilirubinemia, reticulocytosis (large blue RBCs), spherocytosis (caused by phagocytosis of IgG ab and component of RBC membrane creates sphere shaped RBCs on smear) Chronic anemia in which IgG causes RBC agglutination CLL- malignant cells produce autoantibodies SLE METHYLDOPA

Answer 1024

B CELL NEOPLASM CD20 CD23 CD5 Smudge cells on smear AUTOIMMUNE HEMOLYTIC ANEMIA!!!!! Richter transformation- CLL/SLL transformation into aggressive lymphoma —> diffuse large B cell

Answer 1025

Self limiting infection that presents with nausea, vomiting, abdominal pain, icterus, hepatomegaly, RUQ tenderness that evolves OVER SEVERAL WEEKS AFTER INGESTION OF POORLY COOKED, IMPROPERLY HANDLED, RAW FOOD- INCLUDING SHELL FISH HAV diagnosed by serologic detection of anti HAV IgM abs

Answer 1026

V/Q mismatch Shunt Diffusion limitation

Answer 1027

Hypoventilation - hypoxemia - respiratory acidosis (dt CO2 retention) - NORMAL Aa gradient of 10

Answer 1028

Ulnar nerve innervates INTRINSIC MUSCLES OF HAND Roots are C8 to T1 Injury causes weakness of abduction and addiction of index, middle, ring, small fingers, loss of wrist flexion, ulnar claw on digit extension - medial epicondyle fx - fractured hook of hamate from FOOSH - Can be injured with traction on brachial plexus

Answer 1029

C5 to T1 Innvervates EXTENSORS of digits, wrist, ABDUCTION OF THUMB Compression of axilla Midshaft humerus fx Repetitive pronation/supination (screw driver) - “finger drop” Wrist drop- loss of elbow, wrist, finger extension Decreased grip strength Loss of sensation over posterior forearm and dorsal hand

Answer 1030

Rapidly and irreversibly causes platelet aggregation thru it’s action on P2Y1 and P2Y2

Answer 1031

Paramyxovirus Prodrome of fever, cough, coryza, conjunctivitis, rash, Koplik spots on buccal mucosa F fusion protein (virulence factor, aids in viral fusion to host cells) Can have formation of giant cells Severe sequelae: - SUBACUTE SCLEROSING PANENCEPHALITIS (SSPE) Personality changes, seizures, dementia, motor deterioration, death - encephalitis - GIANT CELL PNA (seen in immunosuppressed, inclusion bodies and multinucleated giant cells in respiratory epithelium)

Answer 1032

Megaloblastic anemia Hypersegmented neutrophils Erythrocyte macrocytosis INCREASED HOMCYSTEINE normal methylmalonic acid

Answer 1033

Exposure to lead- eating lead paint, inhalation from industrial work Lead inhibits heme synthesis via 2 enzymes in RBCs - ferrochelatase - ALA dehydratase Decreased heme synthesis—> microcytic, hypochromic anemia - normal or low iron studies - buildup of d ALA and protoporphyrin Smear: basophilic stippling - lead inhibits rRNA degradation—> rRNA aggregates in RBCs Abdominal pain, LEAD LINES, nephropathy, WRIST/ FOOT DROP, neurological effects (Devo delay, behavioral issues ``` REMOVE SOURCE OF LEAD Can give chealtors: - DIMERCAPROL - EDTA - SUCCIMER ```

Answer 1034

Ringed sideroblasts- iron loaded mitochondria seen with Prussian blue stain, peri nuclear ring of blue granules Usually microcytic, ringed sideroblasts in bone marrow Caused by FAILURE TO MAKE PROTOPORPHYRIN (no protoporphyrin for iron to bind and make heme therefore get iron accumulation in mitochondria) Usually secondary to toxin - alcohol (mitochondrial poison) - vitamin B6 deficiency (INH) - lead poisoning X LINKED - inherited deficiency of ALA synthase - responds to B6 Microcytic, hypochromic anemia IRON OVERLOAD (high serum iron, high ferritin) Low erythrocyte protoporphyrin levels

Answer 1035

Some problem producing hemoglobin LOW IRON - iron deficiency - anemia of chronic disease (high ferritin) LOW GLOBIN - alpha thalassemia - beta thalassemia LOW HEME - lead poisoning - sideroblastic

Answer 1036

Onset of action: 1. Blood:gas partition coefficient (high= slower onset) 2. Solubility in blood (higher = slower onset) - want less blood solubility for faster onset Potency 1. Oil/gas partition coefficient (higher = more potent) - higher this coefficient, less of the gas needed 2. MAC (lower= more potent)

Answer 1037

Hepatotoxic - massive liver necrosis, increased AST/ALT Malignant hyperthermia - fever, muscle rigidity - tachycardia, HTN - muscle damage (high K and CK) - cause: ryanodine receptos in sarcoplasmic reticulum - tx with dantrolene (muscle relaxant)

Answer 1038

Myocardial depression- lowers CO Respiratory depression N/V Increased cerebral blood flow - cerebral vasodilation - blood flow goes up - ICP goes up Decreased GFR

Answer 1039

Lowers seizure threshold

Answer 1040

Nephrotoxic | - renal toxic metabolite

Answer 1041

Diffusely rapidly into air spaces CANNOT USE IN PNEUMOTHORAX, ABDOMINAL DISTENSION

Answer 1042

Morphine, fentanyl, hydromorphone Mu receptors G protein linked, second messenger not known Increase K efflux from cells—> hyperpolarizes cells—> less pain transmission

Answer 1043

PCP derivative (people on PCP can hallucinate, become very violent) Antagonist of NMDA receptor (activated by glutamate in CNS) Dissociative drug - trance like state - analgesia and amnesia - FEW CV/ RESPIRATORY EFFECTS CAN CAUSE HTN, tachycardia If ketamine used alone as sedative—> EMERGENCE REACTIONS - pts are disoriented, dreams, hallucinations, can be scary for pts - administer with MIDAZOLAM to avoid

Answer 1044

Modulates GABA receptors - blocks neuroexcitation Fast onset of anesthesia, no analgesia Hemodynamically neutral (good for hypotensive pts) BLOCKS CORTISOL SYNTHESIS Used in rapid sequence intubation

Answer 1045

Paralytic- fast onset and offset DEPOLARIZING neuromuscular blocker Strong nicotinic ACh agonist Not metabolized but AChE Sustained depolarization—> prevent muscle contraction 2 phases: 1. Depolarizing phase—> fasciculations can occur - Na open and close, become inactivated 2. Desensitizing phase—> depolarization has occurred, muscle no longer reacts to ACh NO REVERSAL AE- HIGH K (caution in BURN and DIALYSIS Pts), MALIGNANT HTN

Answer 1046

Competitive antagonists - compete with ACh for nicotinic receptors and produce paralysis May cause marked HISTAMINE RELEASE - hypotension and reflex tachycardia Can be reversed by flooding synapse with ACh - done by inhibiting AChE ``` AChE Inhibitors: Physostigmine Neostigmine Pyridostigmine Edrophonium ```

Answer 1047

HIV 2 molecules of RNA 3 structural genes coded for: 1. ENV- formed from cleavage of gp160, - gp120 binds CD4 and either CCR5 (macrophages, early infection) or CXCR4 (T cells, late infection) - gp41 fusion and entry 2. GAG (p24 and p17)- capsid and matrix proteins 3. POL - reverse transcriptase, INTEGRASE, PROTEASE

Answer 1048

Absence, myoclonic, grand max Common in kids Absence seizures first, then myoclonic seizures later, grand mail after HALLMARK: MYOCLONIC JERKS ON AWAKENING FROM SLEEP, shock like irregular movements in both arms

Answer 1049

Pseudo palisading tumor cells border focal necrosis Astrocyte origin, GFAP+ Older age, worse prognosis Can cross corpus callosum

Answer 1050

Common, benign MC in Females, tumor expresses ESTROGEN RECEPTORS Occurs near surface of brain - extra axial (external to brain parenchyma), may have dural attachment Parasagittal meningioma- compresses leg area similar to ACA stroke, classic presentation PSAMOMMA BODIES- laminated calcifications

Answer 1051

Benign growth of pituitary Most secrete prolactin—> galactorrhea, amenorrhea, impotence, low bone mass dt estrogen suppression Headaches and BITEMPORAL HEMIANOPSIA (loss of peripheral vision dt pressure on optic chiasm)

Answer 1052

Derived from Rathkes pouch - invagination of ECTODERM - protrudes from roof of mouth and forms anterior pituitary Often calcified, cystic, CHOLESTEROL CRYSTALS FOUND IN MOTOR OIL LIKE FLUID IN TUMOR Contains epithelial cells—> appearances similar to developing teeth CAN CAUSE BITEMPORAL HEMIANOPSIA Bc compresses optic chiasm

Answer 1053

Rare germ cell tumor Compress pre tectal area of midbrain Cause PARINAUD SYNDROME - PARALYSIS OF UPWARD GAZE - pseudo Argyll Robinson pupils Can compress cerebral aqueduct—> hydrocephalus, papillaedema

Answer 1054

Literal pons Facial droop Hearing loss

Answer 1055

Lateral medulla Dysphagia Hoarseness

Answer 1056

Medial medulla- contralateral motor, tongue deviation Anterior spine- b/l motor, pain, temp, SPARES VIBRATION AND PROPIOCEPTION

Answer 1057

Flow reversal in vertebral artery Caused by stenosis of subclavian artery BP discrepancy of >15mmHg Exercise induced LEFT arm ischemia- pain, fatigue, numbness

Key Associations Flashcards

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