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1

Histology of GBM

Necrosis, Hemorrhage, Pallisading pattern

2

Histology of Meningioma

Psammoma bodies (also papillary thyroid carcinoma, serous papillary ovarian adenocarcinoma)

3

Histology of Oligodendroglioma

Fried egg appearance

4

PCNSL Histology

Uniform atypical lymphocytes

5

Lingual Thyroid

Thyroid tissue fails to migrate --> Removal cause hypothyroid

6

dx of asthma after Methacholine challenge

Decr in FEV1 of >20%

7

Cutaneous Neurofibromas -->

NF1 --> Autosomal Dominant (Chr 17)

8

Widened QRS converts to narrow during tachyarrhythmia in WPW b/c

accessory pathway no longer pre-excites but instead forms re-entrant circuit

9

EKG Triad for WPW

Shortened PR, Delta wave, Wide QRS

10

Linear deposits of Ig along glomerular basement membrane

Anti-GBM disease (Goodpasture) = Type 1 RPGN = Crescents on LM

11

Basement membrane splitting in kidney bx

Alport and MPGN Type 1

12

Uniform, diffuse wall thickening in kidney bx

Membranous Glomerulopathy

13

B6 is an essential cofactor for

Transamination and Decarboxylation of Aas, Gluconeogenesis

14

OAA + Glutamate -->

Aspartate and a-KG

15

Transamination reactions

AA and a-keto acid --> Amine transferred to a-keto acid, which becomes AA

16

Most common form of Galactosemia

Galactose-1-P uridyl transferase deficiency

17

What to check before initiating metformin therapy?

Serum Creatinine --> Lactic Acid accumulation (also contraindicated in hepatic dysfunction, CHF, alcoholism, sepsis)

18

Bloom syndrome is characterized by

General chromosomal instability

19

Ataxia Telangiectasia is characterized by

DNA hypersensitivity to ionizing radiation

20

Cardiac Output equation

1. SV x HR; 2. (O2 consumption) / (AV O2 difference)

21

TCA cause what heart manifestation

Quinidine-like effect: QRS and QT prolongation by inhibiting fast Na channels

22

Treatment for cardiac TCA overdose

Hypertonic NaHCO3: Corrects QRS prolongation, Reverses hypotension, Treats ventricular dysrhythmias

23

What accounts for awakening from barbiturate anesthesia

Redistribution (not elmination)

24

MOA of Oxybutynin

M3 antagonist --> Decr IP3 --> Decr Ca (urge incontinence)

25

Common causes of myopathy with elevated CK

Hypothyroid, Muscular Dystrophy, Inflammatory Muscle Disease, HMG-CoA Reductase inhibitor

26

Fatiguability, Weight gain, and Myoedema -->

Hypothyroid

27

CK levels in Steroid-induced myopathy

Normal

28

Ciprofloxacin is NOT effective for

Anaerobic infections

29

Ceftriaxone has poor activity against

Anaerobes

30

Azithromycin is used for

Chlamydia, Mycoplasma, H flu, Moraxella

31

Permissive effects of cortisol

Incr vascular and bronchial smooth muscle reactivity to catecholamines

32

Valproate causes what birth defect

Neural Tube defects

33

PYR positive

GAS

34

What molecule is upregulated to mediate Transmigration

PECAM-1

35

Caspofungin is most active against

Candida and Aspergillus (not against Mucor or Rhizopus)

36

Selective Proteinuria

Albumin loss with minimal loss of more bulky proteins (IgG, Macroglobulin)

37

Most selective derminant for size in glomerulus

GBM and slit diaphragm (4nm)

38

Barrier to albumin loss in urine

charge selectivity

39

Tubular proteinuria

Presence of low molecular weight proteins in urine that should have been reabsorbed

40

Overload pronteinuria

Normally reabsorbed, smaller proteins exceed reabsorption capacity

41

Functional proteinuira

change in blood flow through glomerulus

42

Histologic features of Acute Viral Hepatitis

Ballooning degeneration, Mononuclear infiltrates, Councilman bodies

43

Anorexia, nausea, and low grade fever followed by bilirubinuria and R upper quadrant tenderness

Acute Hepatitis - most commonly caused by HAV in young adults

44

Pulmonary Vascular Resistance is lowest when

At Functional Residual Capacity (after casual exhalation)

45

Require cholesterol for growth in acellular media

Mycoplasma

46

MacConkey agar contains ___ to inhibit growth of contaminant

Bile

47

Virulence factor of E coli in neonatal meningitis

K1 capsular antigen

48

Virulence factor of E coli in non-bloody gastroenteritis

Heat stable/labile

49

Virulence factor of E coli in UTI's

P (pyelonephritis) Fimbriae

50

Na channel binding strength among Class I Anti-arrhythmics

1C > 1A > 1B (correlates to use dependence)

51

MOA of BNP

Incr cGMP via GC

52

Slow acetylation affects which drugs

INH, Dapsone, Hydralazine, Procainamide

53

MOA of Rifampin

DNA-dependent RNA synthesis inhibition

54

Rifampin vs Isoniazid

Rifampin is not specific for mycobacteria

55

99mmTc-pertechnetate scan detects

presence of gastric mucosa

56

Digestive effects after sub-total pancreatectomy

Deficient in all digestive enzymes normally secreted by pancrease into duodenum

57

D-xylose absorption

Monosaccharide that can be absorbed direct w/out pancreatic enzymes

58

oral administration of fixed dose D-xylose

Differentiate b/t malabsorption of pancreatic vs GI mucosal etiology

59

Langhans Cells

Multinucleated giant cell with role in Granulomatous inflammation

60

Raquet-shaped intracytoplasmic granule

Birbeck granule in Langerhans cells

61

Merkel Cells

Basal layer neuroendocrine cells with role in touch

62

Portal triad runs in

Hepatoduodenal ligament

63

Which part of heart injured in stab wound to left 4th intercostal space

Right Ventricle

64

Two important steps in workup of metabolic alkalosis

Volume Status, Urine Chloride

65

Treatment of Vomiting/NG suction Metabolic Alkalosis

Isotonic saline for volume and Cl repletion

66

What leads to metabolic alkalosis that is saline unresponsive

Hyperaldosteronism or Hypercortisolism

67

Low blood-gas partition coefficient means

Poor solubility --> Blood saturates quickly --> Fast rise in partial pressure --> Faster brain saturation --> Faster onset time

68

High blood-gas partition coefficient means

High solubility --> Blood saturates slowly --> Delayed rise in partial pressure --> Slow brain saturation --> Slow onset time

69

Function of BRCA1/2

Double strand DNA break repair

70

Heritability of BRCA mutations

Autosomal dominant

71

Dysfunction in Alkaptonuria

Homogentisate Oxidase - Tyrosine to Fumarate

72

What in urine in Alkaptonuria imparts black color if oxidized

Homogentisic Acid

73

Ochronosis

Blue-black pigmentation in Alkaptonuria

74

Tx for combined absence and tonic clonic

Valproate

75

Tx for Absence Seizures

Valproate, Ethosuximide

76

Ethosuximide is not effective for

Tonic Clonic

77

Chronic effects of Obstructive Sleep Apnea

Reflexive systemic and pulmonary vasoconstriction and sympathetic cardiac stimulation --> Pulmonary HTN and Right Heart Failure

78

Hepatic Angiosarcoma is associated with

Arsenic, Thorotrast, Polyvinyl Chloride

79

CD31

PECAM1 --> Leukocyte migration thru endothium

80

IF microscopy in PSGN

Granular deposits of IgG, IgM, C3 = Starry Sky

81

EM in PSGN

Subepithelial humps = Antigen-antibody complexes

82

Longer menstrual cycles and irregular bleeding in adolescent

Anovulatory cycles due to immature HP-Ovarian axis

83

Transports ammonia from peripheral tissues to kidneys

Glutamine --> Glutamate + Free Ammonia Ion

84

Function of N-acetylglutatmate

Active Carbamoyl Phosphate Synthetase I in urea cycle

85

Nitrogen atoms in urea cycle are derived from

NH3 and Aspartate

86

Rate limiting enzyme in urea cycle

Carbamoyl Phosphate Synthetase I (activated by N-acetylglutamate)

87

Causes of HIV esophagitis

Candida, HSV1, CMV - Clinically indistinguishable, need endoscope

88

Endoscopic findings in Candidal Esophagitis

Patches of adherent gray-white pseudomembranes

89

Endoscopic findings in HSV-1 Esophagitis

Small vesicles that evolve into typical "punched out" ulcers

90

Endoscopic findings in CMV Esophagitis

Linear ulceration

91

Isospora belli

Profuse, watery diarrhea in HIV patients

92

Fever, Generalized LAD, Facial Edema, and Diffuse Morbilliform skin rash 2-8 weeks after drug exposure

DRESS!!!

93

Common drugs associated with DRESS

Anticonvulsants, Allopurinol, Sulfonamides

94

Drug-induced Anti-neutrophil cytoplasmic antibodies

Hyperthyroidism meds, Hydralazine

95

Mixed cryoglobulinemia is typically associated with

Chronic inflammatory states (SLE, HepC)

96

Purpose of squatting in Tetralogy of Fallot

Incr SVR/PVR ratio to prevent bypass of lungs

97

Synthesize dextrans from sucrose? Purpose?

Strep viridans --> Adherence to fibrin

98

Why does Strep viridans only bind to damaged endothelium

Adheres to fibrin, which is only deposited at sites of damage

99

Colistin kills

Gram negatives other than Neisseria

100

Reducing media

Used to culture organisms that reduce iron or sulfur

101

Result of incr in Hb saturation at lower oxygen mmHg

Erythrocytosis

102

Activated macrophages are necessary for

Delayed hypersensitivity reactions, Cytotoxicity against intracellular organisms

103

IL-12 receptor deficiency

Severe mycobacterial infections with inability to mount strong cell-mediated granulomatous immune response --> Tx with IFN-g

104

Infused citrate in packed RBCs can cause

Hypocalcemia (occurs with 5-6 liters of blood given over 24 hours)

105

6-MP and 6-TG are converted to active metabolites by

HGPRT

106

Degradation of activated 6-MP and 6-TG is done by

Xanthine Oxidase, Thiopurine Methyltransferase

107

Why give Allopurinol with 6-MP

Prevents inactivation by Xanthine Oxidase and greatly reduces needed dose

108

First line treatment for gestational diabetes

Diet then Insulin

109

Korsakoff syndrome is associated with damage to

Anterior and Dorsomedial Thalamic Nuclei --> Memory loss and Confabulation

110

Role of microglia in post-infarct repair

Move into area 3-5 days after onset of ischemia and phagocytize fragments of neurons, myelin, and necrotic debris

111

How does leptin regulate appetite, metabolism

Decr NPY in arcuate nucleus; Stimulates POMC/a-MSH in arcuate nucleus

112

EML4-ALK is seen in ___? Targeted therapy?

Non-Small Cell Lung Carcinoma (often nonsmokers with adenocarcinoma) --> Crizotinib

113

Sensorineural hearing loss, Tinnitus, Paralysis of facial muscles, Loss of corneal reflex -->

Vestibular Schwannoma affectiing V, VII, VIII --> Cerebellopontine angle

114

Specific symptoms of iron-deficiency anemia

Dysphagia, Koilonychia

115

Most common cause of Hydatid Cysts in humans

Echinococcus granulosus

116

beta adrenergic activity in coronaries

vasodilation

117

Oxygen content in Pulmonary Artery vs Coronary Sinus

Lower in coronary sinus because much more O2 used in myocardium than systemically

118

Prior strep infections are evidenced by

Anti-Streptolysin, Anti-DNaseB, Anti-Hyaluronidase

119

PYR Positive vs negative

GAS, Enterococci are PYR+; GBS, Bovis are PYR-

120

Etiologic agent of scrofula

Mycobacterium scrofulaceum

121

MOA of Nacetylcysteine

Glutathione substitute, Provides sulfhydryl groups to enhance non-toxic sulfation elimination of acetaminophen

122

Effect of glucocorticoids on liver protein synthesis

Incr Gluconeogenic and Glycolytic enzyme synthesis

123

Used to stimulate peristalsis in post-op ileus

Bethanechol, also to treat non-obstructive urinary retention

124

Effect of cholinergic agonist on glaucoma

Miosis causes iris to move further from cornea --> Widens anterior chamber and allows for better outflow of acqueous humor

125

Kidney histology in chronic transplant rejection

Vascular wall thickening, Luminal narrowing, Interstitial fibrosis, Parenchymal atrophy

126

What causes activation of RAS

GTP binding

127

NADPH is required as cofactor for

FA, Cholesterol, Steroid synthesis

128

MOA of Anastrozole

Aromatase inhibitor (+ Letrozole, Exemestane)

129

Bones associated with First Pharyngeal Arch

Maxilla, Zygoma, Mandible, Vomer, Palatine, Incus, Malleus

130

Bones associated with Second Pharyngeal Arch

Styloid, Lesser Horn of Hyoid, Stapes

131

Muscles associated with Second Pharyngeal Arch

Facial Expression, Stylohyoid, Stapedius, Posterior Digastric

132

Neonatal manifestations of Erythroblastosis Fetalis

Anemia, Jaundice, Edema, Nucleated RBCs, Extramedullary Hematopoiesis

133

Who gets oral thrush

Dentures, DM, Immunosuppressed, HIV

134

What causes problem with Fragile X expansion

Hypermethylation (not breakage)

135

What is unique to the duodenum

Brunner's Glands - Located in SUBMUCOSA and secreted bicarb

136

3rd Aortic Arch Derivatives

Common Carotid, Prox internal carotid

137

4th Aortic Arch Derivatives

True Aortic Arch, Subclavian Arteries

138

6th Aortic Arch Derivatives

Pulmonary arteries, Ductus arteriosus

139

Effect of DKA on K

Incr excretion, Decr total stores, But increased extracellular

140

Homeless man with increased fatiguability and exertional dypnea, LE edema, decr sensation in periphery + cardiac dilation and incr CO

B1 deficiency (Beriberi)

141

Laryngeal edema and difficulty breathing after ACEi is due to

Kinin accumulation

142

Long acting benzodiazepines

Chlordiazepoxide, Chlorazepate, Diazepam, Flurazepam (Carefully Choose Due to Falls)

143

What are the dimorphic fungi?

Blasto, Histo, Paracoccidiodies, Coccidiodes, Sporothrix - Body Heat Purportedly Changes Shape

144

Removal of apical ectodermal ridge from newly formed limb bud

Shortened length, Abnormal ventral dorsal

145

Which aortic arch becomes Ductus Arteriosus

Sixth

146

Refsum's disease

Myelin synthesis due to FA oxidation/synthesis disorder

147

Findings in Sarcoidosis

GRAIN - Globulinemia, RA, elevated ACE, Interstitial fibrosis, Noncaseating granulomas

148

pregnant woman hypotensive when supine

IVC compression --> lay on left side at night

149

Especially effective CT agent for Hodgkin

Vincristine

150

Location of the CTZ

Area postrema of the medulla

151

CV manifestations of Turner's

Bicuspid Aortic Valve, Preductal Coarction of Aorta

152

Where is stratified squamous epithelium found in respiratory tract?

Oropharynx, Laryngopharynx, Anterior epiglottis, Upper half of posterior epiglottis, True vocal cords

153

MOA of Alpha-Glucosidase inhibitors

Prevent disaccharide breakdown in intestine, thus absorption

154

Role of adiponectin in T2DM

Low, increased by TZDs

155

Annular pancrease is caused by

Abnormal migration (not apoptosis) of ventral pancreatic bud

156

Bilateral lens subluxation, Massive stroke, Old renal infarcts

Homocysteinuria

157

Most patients with Homocysteinuria respond dramatically to

B6 supplementation

158

Fluoxetine overdose

Tachycardia, Drowsiness, Tremor, Vomitting, Nausea

159

Physical exam finding in AV fistula

Pulsative mass with thrill on palpation, Auscultation reveals bruit over site

160

SST decreases

Secretin, CCK, Glucagon, Insulin, Gastrin

161

AA's that are metabolized to Propionyl CoA

Isoleucine, Valine, Threonine, Methionine

162

L-asparaginase

Antineoplastic by lowering circulating asparagine levels (leukemic cells collect asparagine from serum)

163

Symptoms, Signs of congenital hypothyroidism

Poor feeding, Prolongued jaundice, Constipation, Hypotonia, Hoarse Cry, Macroglossia, Myxedema, Umblical hernia

164

Which diuretic is used to decrease urine calcium

Thiazides

165

Most common cause of SVC syndrome

Bronchogenic Carcinomas

166

Most important HLA association with RA

HLA-DR4

167

HLA associated with SLE

HLA-DR2/3

168

HLA-A3 associated with

Primary Hemochromatosis

169

Lambert Eaton vs MG

LE doesn not improve with AChEi's, Strength improves with repeated testing, Enhanced neurotransmission with repetitive stimulation

170

Limited vs Systemic Sclerosis Ab's

Limited associated with Anti-centromere; Systemic with Anti-Topo 1

171

Kernicterus is most likely to affect which parts of CNS

Basal ganglia, Thalamus, Cerebellum, Cerebral gray matter, Spinal cord

172

Which hepatitis type is associated with PAN

Hep B (Hep C associated with Mixed Cryoglobulinemia)

173

Symptoms of Acute Intermittent Porphyria

Abdominal pain, N/V, Peripheral neuropathy, Paralysis, Psychiatric

174

Anti-mitochondrial Ab is a marker for

Primary Biliary Cirrhosis

175

Treatment of Lithium-induced DI

Amiloride - Blocks channel that lithium uses to enter principal cell

176

SLE on prednisone long term - what vitamin to supplement?

VITAMIN D

177

Toxicity of Nitrosureas

Carmustine --> pulmonary fibrosis

178

Accumulated intermediate in Acute Intermittent Porphyria vs Prophyria Cutanea Tarda

AIP = Porphobilinogen, PCT = Uroporphyrinogen

179

MOA of Bacitracin

Inhibits transfer of mucopeptides to growing cell wall

180

When do Red Neurons appear after cerebral ischemia?

12-24 hours

181

When does liquefactive necrosis appear after cerebral ischemia?

1-2 weeks

182

What can minors consent to when pregnant?

Prenatal care, Dx and Tx of STD's, Drug and Alcohol Rehab; NOT abortions (or elective non-emergency procedures)

183

Acute transplant rejection is mediated by

T cell response against HLA/MHC antigens

184

Symptoms of Systemic Mastocytosis are induced by

Histamine releas

185

What is pulsus paradoxis

Decr systemic blood pressure during inspiration (incr venous return deviates IV septum toward left and blocks outflow)

186

When does Pulsus Paradoxis occur

Acute cardiac tamponade, Constrictive pericarditis, Severe obstructive lung dz, Restrictive CM

187

Most significant factor in Shigellosis

Mucosal invasion, not toxin

188

Confusion, Fever, Nausea, Elevated LFT's four days after anesthesia

Massive hepatic necrosis from Halothane

189

Hepatic Granulomatosis is associated with

Methyldopa, Hydralazine, Quinidine

190

MOA and use of Primidone

First line for benign essential tremor; MOA unknown but metabolizes to phenobarbital

191

Activation of Intrinsic vs Extrinsic pathway

Intrinsic by damaged vessel (XII), Extrinsice by tissue damage (TF, VII)

192

Defect and major manifestations of Type 1 Dyslipidemia

LPL, ApoC --> Chylomicrons --> Acute pancreatitis, Xanthomas, HSM

193

Defect and major manifestations of Type 2a Dyslipidemia

LDL, ApoB-100 --> LDL --> CAD, Corneal Arcus, Tendon Xanthomas

194

Defect and major manifestations of Type 3 Dyslipidemia

ApoE --> Chylomicron, VLDL remnants --> CAD, PVD, Xanthomas

195

Defect and major manifestations of Type 4 Dyslipidemia

ApoA-V --> VLDL --> Pancreatitis, Obesity, Insulin resistance

196

Purine Antimetabolites

6-MP, 6-GP, Fludarabine, Cladribine

197

Use of Cladribine

Hairy Cell Leukemia - Resistant to Adenosine Deaminase

198

Bupropion is contraindicated with

Anything that can lower seizure threshold (eg electrolyte disorders from bulemia)

199

Good samaritan law

Standard of care must be met (meant to protect people, including off duty medical professionals, who help in accidents/emergencies)